Homework Completion,Patient Characteristics,and Symptom Change in Cognitive Processing Therapy for PTSD

We evaluated the impact of homework completion on change in PTSD symptoms in the context of two randomized controlled trials of Cognitive Processing Therapy for PTSD (CPT). Female participants (n = 140) diagnosed with PTSD attended at least one CPT session and were assigned homework at each session. The frequency of homework completion was assessed at the beginning of each session and PTSD symptoms were assessed every other session. Piecewise growth models were used to examine the relationship between homework completion and symptom change. CPT version (with vs without the written trauma account) did not moderate associations between homework engagement and outcomes. Greater pretreatment PTSD symptoms predicted more Session 1 homework completion, but PTSD symptoms did not predict homework completion at other timepoints. More homework completion after Sessions 2 and 3 was associated with less change in PTSD from Session 2 to Session 4, but larger pre-to-post treatment changes in PTSD. Homework completion after Sessions 2 and 3 was associated with greater symptom change among patients who had fewer years of education. More homework completion after Sessions 8 and 9 was associated with larger subsequent decreases in PTSD. Average homework completion was not associated with client characteristics. In the second half of treatment, homework engagement was associated with less dropout. The results suggest that efforts to increase engagement in homework may facilitate symptom change.     

Temperament and play interaction behavior across infancy

Temporal stability and convergent validity of infant temperament ratings and play interaction behaviors were examined across early to late infancy. Stability was noted for the temperament dimensions activity, rhythmicity, intensity, mood, and persistence. Stability also was noted for the infant play interaction behaviors looking, smiling, and vocalizing. In addition, convergent validity was noted for attentive-affective behaviors and comparable temperament ratings; for example, gaze aversion and nondistractability, and distress brow behavior and negative mood. Generally easier temperament infants were noted to vocalize more and to cry less frequently during their play interactions.     

Teenage parenting in different cultures,family constellations,and caregiving environments: Effects on infant development

Teenage parenting was investigated in different ethnic groups (Cuban and American Black), family constellations (single-parent, nuclear, and extended families), and primary caregiving arrangements (mother versus other). One hundred sixty-four infants born to a representative sample of teenage mothers were observed during interactions with their mothers and were given developmental assessments when they were 12, 18, and 24 months of age. Being a Cuban mother, living in a nuclear family, and being a secondary caregiver were each associated independently with stronger social support systems and more positive child-rearing attitudes and mother-infant play interactions. Despite these early advantages, maternal stimulation and infant performance decreased over the second year of life irrespective of ethnic group, family constellation, and caregiving arrangements.     

Caregivers Dependent upon Drivers with Dementia

This paper reports findings of a preliminary study of caregivers dependent upon drivers with dementia. Fifteen caregivers who perceived themselves as dependent upon their partner for transportation and 15 who perceived themselves as independent were surveyed. Dependent caregivers were significantly more likely to rely on the cognitively impaired driver for routine daily activities such as shopping, medical appointments, and visiting family and friends. Only 20% of the dependent caregivers believed that the driver with dementia should decrease or discontinue driving. Dependent caregivers were less likely than independent caregivers to take an active approach in encouraging driving cessation. Compared to the independent caregivers, the dependent caregivers believed that if the patient with dementia could no longer drive, it would significantly affect their quality of life. The authors discuss the issues and problems uniquely associated with the dependent caregiver.     

Reinstatement versus reactivation effects on active memory in infants

Reinstatement and reactivation are procedurally different reminder paradigms used with infants and children, but most developmental psychologists do not distinguish between them. In 4 experiments with 102 three-month-olds, we asked if they differ functionally as well. Independent groups of infants received either a reactivation or a reinstatement reminder 3 days after training, when the memory is active, but its specific details have been forgotten. In Experiment 1, we measured retention after increasing delays until infants forgot altogether. A single reinstatement protracted retention twice as long after training as a single reactivation. In Experiments 2-4, whether the reminder was the original training stimulus or a novel one differentially affected the duration and specificity of memory in the 2 procedures as well. These data demonstrate that the distinction between reinstatement and reactivation is not artificial. In addition to differing procedurally, reinstatement and reactivation differ functionally, with different memory-preserving effects.     

Aloneness and borderline psychopathology: the possible relevance of child development issues.

The experience of intense painful aloneness is a common event in the lives of borderline patients, especially those closer to the psychotic spectrum. This experience is defined as an intrinsic aspect of the borderline personality defect and consists of a relative or total inability to remember positive images or fantasies of sustaining people in the patient's present or past life, or being overwhelmed by negative memories and images of these people. The development of borderline aloneness is related to a possible developmental failure, defined by Piaget, Fraiberg, and A.-M. Sandler. These workers describe the child's development of object permanence and evocative memory capacity (Piaget's sensori-motor stage VI). We postulate that a major borderline vulnerability is the tenuous achievement of the capacity for affective object permanence and its regressive loss to recognition memory or earlier when under specific stresses. We relate our hypotheses to possible empathic parental failures during the substages of separation-individuation, especially the rapprochement sub-phase. The treatment implications of our formulations are discussed, with an emphasis on the clarification of the need for the therapist's availability and the use of transitional objects during times of the patient's loss of his affective cognitive capacities. These regressive experiences often emerge as a core transference manifestation during psychoanalytic therapy with borderline patients, and often become the basis of significant therapeutic work.