Exposure Therapy Beliefs and Utilization for Treatment of PTSD: A Survey of Licensed Mental Health Providers

Exposure-based therapies for posttraumatic stress disorder (PTSD) and anxiety disorders remain underutilized, despite their effectiveness and widescale dissemination efforts. This study surveyed a broad range of licensed providers (N = 155) to examine rates at which prolonged exposure (PE) and other interventions are used to treat PTSD and to investigate provider characteristics linked to exposure beliefs and utilization. While 92.3% of clinicians reported understanding of or training in exposure, only 55.5% of providers reported use of PE to treat PTSD. Clinicians with current cognitive behavioral therapy (CBT) orientation, CBT training orientation, a doctoral degree, and training in PE endorsed greater likelihood of exposure utilization for PTSD (ps < .001, ds = 0.82–1.98) and less negative beliefs about exposure (ps < .01, ds = 0.55–2.00). Exposure beliefs also differed based on healthcare setting (p < .001). Among providers trained in exposure (n = 106), master’s degree and non-CBT current theoretical orientation were associated with high utilization yet also negative beliefs. Results suggest exposure training, accurate beliefs, and utilization still lag among some groups of providers. Additionally, negative beliefs and misunderstanding of the exposure rationale may persist even among providers who are trained and report high utilization.     

Which Emotion Regulation Strategies are Most Associated with Trait Emotion Dysregulation? A Transdiagnostic Examination

Journal of Psychopathology and Behavioral Assessment - Although definitions of emotion dysregulation infer difficulties in selecting and implementing emotion regulation (ER) strategies,...     

A classical way forward for the regularity and normalization problems

Synthese - Bayesian epistemology has struggled with the problem of regularity: how to deal with events that in classical probability have zero probability. While the cases most discussed in the...     

Are Gender Differences in Vocational Interests Universal?: Moderating Effects of Cultural Dimensions

Are men and women more similar or different in their interests in careers? This question has propelled decades of research into the association between gender and vocational interests. However, our understanding of this question in an international context remains limited. In this study, we examined gender differences in vocational interests across national and cultural contexts by exploring whether national cultural dimensions would be associated with gender differences in the structure and mean levels of vocational interests in people/things, ideas/data, and prestige. Our findings support similarity in the structure of vocational interests for men and women across 42 countries based on two major models on interests. General trends of gender differences in interests emerge such that in comparison to men, women tend to report a large preference for working with people (versus things; d = 1.04), and smaller preferences for working with ideas (versus data; d = 0.29) and with prestige (d = 0.18). National cultural dimensions appear to moderate gender differences in interests beyond the influences of national gender inequality. Specifically, gender differences in interests in people (versus things) tend to be larger in countries of higher uncertainty avoidance and higher indulgence whereas gender differences in ideas (versus data) tend to be larger in countries of higher indulgence, uncertainty avoidance, and lower power distance. This study highlights how a better conceptualization of the influences of culture can inform vocational psychologists, gender studies researchers, and career counselors’ work with men and women in understanding their vocational interests.

     

From the left to the right: How the brain compensates progressive loss of language function

In normal right-handed subjects language production usually is a function oft the left brain hemisphere. Patients with aphasia following brain damage to the left hemisphere have a considerable potential to compensate for the loss of this function. Sometimes, but not always, areas of the right hemisphere which are homologous to language areas of the left hemisphere in normal subjects are successfully employed for compensation but this integration process may need time to develop. We investigated right-handed patients with left hemisphere brain tumors as a model of continuously progressive brain damage to left hemisphere language areas using functional neuroimaging and transcranial magnetic stimulation (TMS) to identify factors which determine successful compensation of lost language function. Only patients with slowly progressing brain lesions recovered right-sided language function as detected by TMS. In patients with rapidly progressive lesions no right-sided language function was found and language performance was linearly correlated with the lateralization of language related brain activation to the left hemisphere. It can thus be concluded that time is the factor which determines successful integration of the right hemisphere into the language network for compensation of lost left hemisphere language function.     

Was Spinoza a Naturalist?

In this article I dispute the claim, made by several contemporary scholars, that Spinoza was a naturalist. ‘Naturalism’ here refers to two distinct but related positions in contemporary philosophy. The first, ontological naturalism, is the view that everything that exists possesses a certain character (variously defined) permitting it to be defined as natural and prohibiting it from being defined as supernatural. I argue that the only definition of ontological naturalism that could be legitimately applied to Spinoza's philosophy is so unrestrictive as to tell us nothing about the content of his ideas. The second, methodological naturalism, is the view that the natural sciences are the best means of finding out substantial truths about the concrete world. I present some historical research showing that Spinoza's way of positioning himself with respect to other philosophers in the Dutch Republic casts very serious doubt on the claim that he was a methodological naturalist. This adds further weight to arguments that have already been made against the naturalist reading of Spinoza.     

Dyadically expanded states of consciousness and the process of therapeutic change

This paper addresses an intersubjective issue that arises out of our model of therapeutic change: Why do humans so strongly seek states of emotional connectedness and intersubjectivity and why does the failure to achieve connectedness have such a damaging effect on the mental health of the infant? A hypothesis is offered—the Dyadic Expansion of Consciousness Hypothesis—as an attempt to explain these phenomena. This hypothesis is based on the Mutual Regulation Model (MRM) of infant–adult interaction. The MRM describes the microregulatory social-emotional process of communication that generates (or fails to generate) dyadic intersubjective states of shared consciousness. In particular, the Dyadic Consciousness hypothesis argues that each individual, in one case the infant and mother or in another the patient and the therapist, is a self-organizing system that creates his or her own states of consciousness (states of brain organization), which can be expanded into more coherent and complex states in collaboration with another self-organizing system. Critically understanding how the mutual regulation of affect functions to create dyadic states of consciousness also can help us understand what produces change in the therapeutic process. © 1998 Michigan Association for Infant Mental Health     

Moving along to things left undone

This paper expands on three areas of clinical theory that are introduced and discussed in the lead paper and the others in this symposium. The first issue addressed is the concept of the real relationship as used in the moment of meeting model of psychotherapeutic change. Particular focus has been placed on the past, the present, and the hierarchy of goals in the treatment relationship. Second, the paper explores the concept of implicit relational knowledge with attention to the concepts of transference, countertransference, interpretation, and insight in the change process. Finally, the paper attends to the nature of the “now moment” in the moment of meeting model. Specifically explicated are ways this concept relates to changes in brain organization and also ways the moment of meeting model relates to other psychotherapy models, such as the relational schools and self-psychology. © 1998 Michigan Association for Infant Mental Health