Implementation of Cognitive Therapy for PTSD in routine clinical care: Effectiveness and moderators of outcome in a consecutive sample

ObjectiveTrauma-focused psychological treatments are recommended as first-line treatments for Posttraumatic Stress Disorder (PTSD), but clinicians may be concerned that the good outcomes observed in randomized controlled trials (RCTs) may not generalize to the wide range of traumas and presentations seen in clinical practice. This study investigated whether Cognitive Therapy for PTSD (CT-PTSD) can be effectively implemented into a UK National Health Service Outpatient Clinic serving a defined ethnically mixed urban catchment area.MethodA consecutive sample of 330 patients with PTSD (age 17–83) following a wide range of traumas were treated by 34 therapists, who received training and supervision in CT-PTSD. Pre and post treatment data (PTSD symptoms, anxiety, depression) were collected for all patients, including dropouts. Hierarchical linear modeling investigated candidate moderators of outcome and therapist effects.ResultsCT-PTSD was well tolerated and led to very large improvement in PTSD symptoms, depression and anxiety. The majority of patients showed reliable improvement/clinically significant change: intent-to-treat: 78.8%/57.3%; completer: 84.5%/65.1%. Dropouts and unreliable attenders had worse outcome. Statistically reliable symptom exacerbation with treatment was observed in only 1.2% of patients. Treatment gains were maintained during follow-up (M = 280 days, n = 220). Few of the selection criteria used in some RCTs, demographic, diagnostic and trauma characteristics moderated treatment outcome, and only social problems and needing treatment for multiple traumas showed unique moderation effects. There were no random effects of therapist on symptom improvement, but therapists who were inexperienced in CT-PTSD had more dropouts than those with greater experience.ConclusionsThe results support the effectiveness of CT-PTSD and suggest that trauma-focused cognitive behavior therapy can be successfully implemented in routine clinical services treating patients with a wide range of traumas.     

Understanding the Behavioral Determinants of Mental Health Service Use by Urban, Under-Resourced Black Youth: Adolescent and Caregiver Perspectives

Black adolescents with mental health problems are less likely than non-Black adolescents with mental health problems to receive treatment, primarily for non-financial reasons including negative perceptions of services and providers, and self-stigma associated with experiencing mental health problems. To better understand these obstacles, 16 adolescents and 11 caregivers, recruited from two K-8th grade elementary-middle schools, participated in four focus groups guided by the unified theory of behavior to explore mental health help-seeking behaviors and perceptions of mental health services. In the focus groups, caregivers acknowledged more positive attitudes about seeking mental health services than adolescents, but both expected the experience of actually doing so to be negative. Adolescents and caregivers also acknowledged social norms that inhibit their mental health help-seeking. Therefore, we conclude that interventions targeting expectancies and social norms might increase the connection of urban, under-resourced Black adolescents and their families to mental health services, and be particularly important given the long-term consequences of untreated mental health problems for this group.     

Semantic Fluency Performance of Patients with Cortical and Subcortical Neurodegenerative Diseases

Previous studies using the Animals Fluency Test have shown that dementia patients with Alzheimer's disease (AD), Huntington's disease (HD), or Parkinson's disease (PD) produce fewer correct words and have smaller semantic cluster sizes than controls or PD patients without dementia (PDND). Although the number of correct words generated by the patients with AD was positively correlated with mental status, cluster size, surprisingly, was not. To increase word output and increase the reliability of estimates of cluster size, semantic fluency was reexamined using the Supermarket Fluency Task. Overall, patients with HD or PD with dementia (PDD) exhibited reduced cluster sizes compared to older controls or PDND patients, but cluster sizes were only marginally reduced for patients with AD. These effects were evident only for female participants, because the cluster sizes for elderly control men were substantially smaller than those of elderly women. For the female patients with AD, cluster size was correlated with mental status, but the relationship was nonlinear. Cluster size was normal for mildly demented patients with AD, but much reduced for moderately or severely demented participants. In contrast to a previous report, in the present study the proportion of category labels generated was increased for patients with HD with dementia but not for patients with AD. This finding questions one line of evidence that semantic memory stores undergo “bottom-up” degradation in AD. Together with previous results, these findings indicate that semantic cluster size reflects efficiency of access to semantic knowledge which is similarly compromised in subcortical and cortical diseases.     

The Appropriation Process of the Belief in a Just World

Research on the belief in a just world (BJW) has been developing since the mid 60s. However, studies have been mainly developed from an individual differences perspective. As a consequence there are no studies that analyze the cognitive processes implied in the appropriation of the BJW during the socialization processes that occur in infancy and onwards. The main purpose of this paper is therefore to analyze this psychological process from childhood to adolescence. The study was carried out with a convenience sample of children and adolescents (N?=?216) from Buenos Aires, between 6 and 17 years old, who participated in an interview guided by the piagetian clinical method. Results indicate that during the appropriation process of the BJW participants reconstruct this belief to make it coherent with hypothetical deductive thinking. This is expressed in three different justifications that the individuals give to justify their BJW: immanent justice, social reciprocity and personal merit. Yet, the appropriation process is incomplete. In the majority of the adolescents a magical thinking remains, constituting a state of cognitive polyphasia expressed in oscillating answers. In conclusion, the BJW is not a previous social condition transmitted from one generation to another. Its appropriation goes beyond the mere reproduction of social beliefs and involves a conceptual reconstruction.     

Effects of chronic administration with high doses of testosterone propionate on behavioral and physiological parameters in mice with differing basal aggressiveness

The effects of testosterone propionate, an anabolic‐androgenic steroid, on the behavior displayed during a social encounter by gonadally intact male mice were investigated. Animals were distributed into three groups according to their attack latency in a pre‐screening test (high‐, moderate‐, and low‐ attacking mice) and each group received weekly injections of 60 or 120 mg/kg of testosterone or sesame oil for 10 weeks. Behavioral tests were then carried out. Afterwards, organs were weighed and blood samples collected in order to obtain hormonal data. Treatment had a differential impact on attack in the three groups of animals. Only the high‐attacking testosterone‐treated mice showed lower total duration of attack than their controls. Those that received 60 mg/kg spent more time exhibiting exploratory behaviors. As an index of the anabolic activity of the drug, all testosterone‐treated mice had heavier kidneys and, as an index of the androgenic activity of testosterone propionate, they had heavier seminal vesicles, lighter testes, and showed higher testosterone levels in a dose‐dependent way than their controls. Hence, the effect of treatment on peripheral physiological parameters was similar in all three groups whereas behavioral effects differed depending on basal aggressiveness, considered a characteristic of coping style. Aggr. Behav. 29:173–189, 2003. © 2003 Wiley‐Liss, Inc.     

A proposal for handling missing data

A method for dealing with the problem of missing observations in multivariate data is developed and evaluated. The method uses a transformation of the principal components of the data to estimate missing entries. The properties of this method and four alternative methods are investigated by means of a Monte Carlo study of 42 computer-generated data matrices. The methods are compared with respect to their ability to predict correlation matrices as well as missing entries. The results indicate that whenever there exists modest intercorrelations among the variables (i.e., average off diagonal correlation above .2) the proposed method is at least as good as the best alternative (a regression method) while being considerably faster and simpler computationally. Models for determining the best alternative based upon easily calculated characteristics of the matrix are given. The generality of these models is demonstrated using the previously published results of Timm.     

Is Age Just a Number? Cognitive Reserve as a Predictor of Divergent Thinking in Late Adulthood

The purpose of the study was to test a model of causal relationships among cognitive reserve (CR), personality variables such as Neuroticism and Openness to experience, and divergent thinking (DT), independently evaluating performance in different domains (verbal and graphic). It was hypothesized that CR, Openness, and Neuroticism would each directly influence verbal and graphic DT. A total of 135 subjects between 55 and 84 years old participated in the study and were interviewed in individual sessions. For a correct fit Neuroticism was eliminated from the measurement model. The goodness-of-fit indexes of the measurement model, the adequate composite reliability index and the discriminant validity supported the viability of the structural equation model (SEM). The goodness-of-fit indexes confirmed the existence of a significant effect of CR and Openness to experience in predicting both verbal and graphic DT. The three CR indicators had high loadings in their theoretical factor, with the observed variables study-work and WAIS vocabulary showing the highest loads. In summary, subjects with CR and Openness to experience were more flexible and original when solving verbal problems, and to a lesser degree, graphic problems.     

Differences in false recollection according to the cognitive reserve of healthy older people

We present an associative recognition experiment comparing three samples of healthy people (young people, older people with high cognitive reserve [HCR], and older people with low cognitive reserve [LCR], with each sample consisting of 40 people), manipulating stimuli repetition during the study phase. The results show significant differences among the three samples in their overall performance. However, these differences are not due to a different use of familiarity, but rather due to a different way of using recollection: although there are no differences in the hit rates between the HRC and LRC samples, the LCR group makes significantly more recollective false alarms than the HCR group. Moreover, repetition provokes an increase in the recollective false alarms in the LCR group, but this does not occur in the group of young people or in the HCR group. These findings are explained in terms of recollection-based monitoring errors and seem to provide support for the cognitive reserve hypothesis.