Clinical research on behavioral activation as treatment for post‐traumatic stress disorder: A brief review and meta‐analysis

Behavioral activation (BA), an effective treatment for depression, has recently been receiving attention as a possible intervention for PTSD. BA interventions could be particularly useful in treating underserved populations (i.e., individuals with lower socioeconomic status). A literature search was conducted, which identified seven outcome studies that examined the effectiveness of stand‐alone BA treatment for individuals with PTSD. All studies identified for this brief review demonstrated clinically significant reductions in PTSD symptoms using BA as an intervention. A meta‐analysis of these few studies revealed a nonsignificant effect (Cohen's d = 0.713, p = .512) despite reporting an average symptom reduction of 25.8%. Other studies utilizing BA treatment for PTSD do so in tandem with other interventions and were excluded from analysis. This brief review summarizes the literature on the use of BA as a stand‐alone treatment for PTSD and suggests that future research seek to confirm the usefulness of BA as a potential treatment modality for mental health‐care providers treating individuals with PTSD.     

Benchmarking Treatment Effectiveness of Community‐Delivered Trauma‐Focused Cognitive Behavioral Therapy

It is critical for urban youth with post‐traumatic stress disorder (PTSD) living in poverty to have access to evidence‐based interventions for their traumatic stress. However, there is limited research on the effectiveness of these interventions when provided in urban, community settings. The objectives of the current study are to (a) evaluate the effectiveness of trauma‐focused cognitive behavioral therapy delivered from 2013 to 2016 in 15 behavioral health agencies on youth (N = 114) PTSD as well as  general mental health symptoms and  functioning, and (b) benchmark these clinical outcomes against other published efficacy and effectiveness trials. Effectiveness data are from the Philadelphia County Community Behavioral Health System, a system that has invested significantly in the training and ongoing support of clinicians providing high‐quality trauma services to youth since 2012. From baseline to last assessment, youth PTSD symptom severity (d = 0.34), PTSD functional impairment (d = 0.38), and overall mental health problem severity (d = 0.29) improved. The effect sizes of  improvements were smaller than effect sizes observed in efficacy and effectiveness studies. This study is the first benchmarking study of TF‐CBT and provides preliminary findings with regard to the effectiveness, and transportability, of TF‐CBT to urban community settings that serve youth in poverty.     

Recovery from post‐traumatic stress disorder in children following road traffic accidents: the role of talking and feeling understood

Forty children were assessed 6 weeks and 8 months after involvement in a road traffic accident (RTA). Ten of the 21 children suffering post‐traumatic stress disorder (PTSD) at 6 weeks continued to fulfil diagnostic criteria at 8 months. There was no evidence of delayed onset of PTSD in children who had not developed this condition at 6 weeks. Talking about the accident and feeling understood were associated with recovery. Providing children with opportunities to talk about their accident may be helpful in preventing or reducing psychological distress. Copyright © 2001 John Wiley & Sons, Ltd.     

The Emphasis on Cognitive‐Behavioural Therapy within Clinical Psychology Training at Australian and New Zealand Universities: A Survey of Program Directors

Surveys of clinical psychologists' self‐reports of professional practice exist in Australia and New Zealand, but comparatively little data exist on the training available in universities. The present study was designed to gather data on the training and assessment of cognitive–behavioural therapy (CBT). A semi‐structured phone interview was designed for use with clinical psychology training directors, or equivalent, in Australia and New Zealand. Out of a total of 48 universities in the region, 40 clinical directors were successfully contacted: One declined involvement, and 39 agreed to participate, yielding a response rate of 81% (six in New Zealand and 33 in Australia). The data showed that it is common for clinical training programmes in our region to provide clinical trainees with foundational knowledge in CBT (i.e., 29 of the 39 surveyed). However, CBT is mainly incorporated into the auspices of clinical training programmes, there is a wide range of assessment methods to evaluate competence in providing therapy, and relatively few academic units exist that focus exclusively on CBT.     

A pilot study of a family‐focused intervention for children and families affected by maternal depression

A non‐experimental pilot study examined child, mother and family outcomes of a 10‐session multi‐family group intervention designed to reduce risk and promote resilience for mothers with depression and their families. Positive changes following the Keeping Families Strong intervention included mother‐reported decreases in child behaviour and emotional problems, improvements in the quality of family interactions and routines and improvements in their own well‐being and support from others. Children (9–16 years) reported decreased internalizing symptoms, improved coping, increased maternal warmth and acceptance and decreased stressful family events. Attendance and mother‐reported satisfaction were high, indicating the perceived value of the intervention.     

A thematic analysis of practitioners' understanding of domestic abuse in terms of post‐traumatic stress disorder (PTSD) and complex‐PTSD (C‐PTSD)

There is a growing body of evidence suggesting that domestic abuse (DA) should be conceptualised within the complex post‐traumatic stress disorder (C‐PTSD) model. Recently, in the draft of the International Classification of Diseases, Eleventh Revision, produced by the World Health Organization (WHO), C‐PTSD was included as a separate criterion in which DA is incorporated (ICD‐11, WHO, 2018). In this study, a thematic analysis was used to explore to what extent practitioners working with DA survivors are familiar with PTSD and C‐PTSD. Research into such a prevalent and detrimental problem as DA is important to understand whether the development of theoretical knowledge about DA and C‐PTSD is addressed in practice. In a Women's Centre in South London, six semi‐structured interviews with middle‐aged female practitioners were conducted to investigate each counsellor's experiences, knowledge and reflections. Six final themes were constructed to summarise the main results. The findings demonstrate limited practitioner understanding of DA in terms of C‐PTSD, which seems to impact not only the effectiveness of treatment plans with DA survivors, but also counsellors’ own psychological and physical states. It is also indicated that DA can be conceptualised within the C‐PTSD model that corresponds with previous literature indicating the complex nature of DA. The overall results of the current research acknowledge that DA sectors should not be neglected and better funding and effective psychoeducation in this field are needed.     

Stress and depression of facing death: Investigation of psychological symptoms in patients with mesothelioma

Cancer often results in psychological impairment, and lung cancer has been associated with greater morbidity and higher levels of psychological distress than any other form. Chronic exposure to asbestos is a significant risk factor for development of lung cancer, called mesothelioma. Few have studied the psychological consequences of chronic asbestos exposure and mesothelioma. This study investigated stress and depression symptoms in 49 men (M = 51.1 years, SD = 6.0) diagnosed with mesothelioma. Participants completed traumatic stress, depression and general psychological health questionnaires. All participants reported significant levels of traumatic stress symptoms, which was associated with increased symptoms of depression, anxiety, somatic complaints and social dysfunction. The results provide important suggestions for clinicians treating such terminally ill patients.     

Adolescent motherhood: a Q‐methodological re‐evaluation of psychological and social outcomes

Traditionally, adolescent motherhood has been associated with numerous negative social, psychological and societal outcomes. However, in recent years there has been a gradual acceptance that there are many positive features to adolescent motherhood, but methodological issues have been identified within the field. This study aimed to examine adolescent motherhood from the mothers' own perspectives, exploring their attitudes towards the issues that they described as being important in their lives, by using Q‐methodology in an attempt to counter some of these methodological limitations. The mothers within the study appeared to be coping positively in their role in that levels of symptomatology, as determined from questionnaire assessment, appeared to be relatively low and they indicated through Q‐sort analysis that motherhood had been beneficial to their lives. Three independent factors (clusters of attitudes) were identified within the sample (N = 23) which differed over the dimensions of: employment, social support, coping, partner co‐habitation, financial support, maternal role satisfaction, aspirations for the future, as well as the nature of the relationship with their child(ren)'s father and their satisfaction with the fathers' role. The significance of these findings with regard to educational and social services is discussed. Copyright © 2007 John Wiley & Sons, Ltd.     

Post–traumatic stress disorder in patients with coronary artery disease: A review and evaluation of the risk

Psychosocial factors are known to impact on the prognosis of patients with coronary artery disease independently of disease severity. However, few studies have looked at whether these patients are at risk of developing post-traumatic stress disorder, and the potential implications for morbidity and mortality. Through a review of the empirical literature, the objectives were to investigate whether patients with coronary artery disease are at risk of developing this disorder, to look at relations between post-traumatic stress disorder and heart disease, and to stimulate further research. The review indicated that some patients with coronary artery disease are at risk of developing post-traumatic stress disorder, although the prevalence varied considerably. Methodological issues together with recommendations for future research are discussed. Although only some cardiac patients may develop post-traumatic stress, this disorder should not be overlooked due to its potential role in reinfarctions and mortality.     

Reductions of intimate partner violence resulting from supplementing children with omega‐3 fatty acids: A randomized,double‐blind,placebo‐controlled,stratified, parallel‐group trial

Omega‐3 supplementation has been found to reduce externalizing behavior in children. Reciprocal models of parent‐child behavior suggest that improving child behavior could lead to improvements in parent behavior, however no study has examined whether omega‐3 supplementation in children could reduce intimate partner violence or child maltreatment by their adult caregivers. In this randomized, double‐blind, placebo‐controlled, stratified, parallel group trial, a community sample of children were randomized to receive either a fruit drink containing 1 gm of omega‐3 fats (Smartfish Recharge; Omega‐3 group, n = 100) or the same fruit drink without omega‐3's (Placebo group, n = 100). Child participants, adult caregivers, and research staff were blinded to group assignment. Adult caregivers reported inter‐partner and child‐directed physical assault and psychological aggression at baseline, 6 months (end of treatment) and 12 months (6 months post‐treatment) using the Conflicts Tactics Scale. Caregivers of children in the omega‐3 group reported long‐term reductions in psychological aggression in a group × time interaction. Improvements in adult psychological aggression were correlated with improvements in child externalizing behavior scores. No differences were reported for child maltreatment. This study is the first to show that omega‐3 supplementation in children can reduce inter‐partner psychological aggression among adult caregivers not receiving supplements. Findings suggest that improving child behavior through omega‐3 supplementation could have long‐term benefits to the family system as a whole.

     

A group‐randomized evaluation of a theatre‐based sexual abuse prevention programme for primary school children in Germany

The study reports a group‐randomized trial of a theatre‐based intervention to prevent sexual abuse targeting first and second grade primary school children in Germany. A sample of 148 first and second graders saw a live performance of a play designed to promote skills in dealing with abuse‐prone interactions with adults, watched a recording of the play on DVD or were assigned to a no intervention control group. Both the live performance and the DVD groups showed significant increases in the target variables (distinguishing good/bad touch and secrets, getting help, rejecting unwanted touch) from baseline to post‐intervention and a follow‐up after 2 weeks, while the control group did not show changes. The live performance and DVD groups participated in a further follow‐up 30 weeks post‐intervention, which showed sustained effects of the intervention. The findings indicate that with appropriately culture‐sensitive measures, sexual abuse prevention programmes can have sustainable effects with young primary school children. Copyright © 2009 John Wiley & Sons, Ltd.     

Theory to social action: A university‐based strategy targeting prejudice against Aboriginal Australians

The level of racism in Australia against Aboriginal Australians is well documented. This has an extremely detrimental effect on the health and wellbeing of Aboriginal Australians. One part of the solution may be anti‐prejudice strategies, but to date few strategies that include a pre‐test and a post‐test assessment have been conducted in Australia. The present study describes the interventional qualities of a cultural psychology unit at an Australian university. Results indicated that after a 6‐week period, students reported a significant reduction in prejudice, acceptance of false beliefs about Aboriginal Australians, and the perception that Aboriginal Australians unfairly receive preferential or special treatment. The article concludes that cultural psychology units have the potential to be an effective way of developing acceptance of cross‐cultural differences.     

How individuals with self‐reported anxiety and depression experienced a combination of individual counselling with an adventurous outdoor experience: A qualitative evaluation

Background: Adventure therapy is a short‐term experiential psychotherapeutic approach that utilises adventurous activities and being in natural environments in order to facilitate therapeutic change in clients. The present paper examines how students with self‐reported anxiety and depression experienced participating in an innovative intervention that combined individual therapy with an adventurous outdoor experience. Clients participating in the Adventure Therapy Project received between 10–15 one‐to‐one counselling sessions prior to the outdoor experience, as well as ongoing counselling following it. Method: Interpretative Phenomenological Analysis was used in order to record and analyse the experiences of three male and three female students who presented at a major UK university student counselling service with self‐reported depression and anxiety. Findings: Twelve themes emerged which were categorised into four major domains: enhancing intrapersonal relationships; improving interpersonal relationships; providing an experiential outdoor venue for achieving therapeutic change; offering a secure, personal place for achieving inner healing. The intervention was perceived to improve the ways in which interviewees related towards themselves and other people. Interviewees perceived the counselling sessions as offering a safe therapeutic space within which they could unveil their anxieties and achieve inner healing. Conclusions: Outdoor experiences offer an experiential venue for achieving personal change and, it appears enhance the therapeutic process. Prior and subsequent individual therapy increases the benefits of such experiences.