Mind the gap: Improving the dissemination of CBT

Empirically supported psychological treatments have been developed for a range of psychiatric disorders but there is evidence that patients are not receiving them in routine clinical care. Furthermore, even when patients do receive these treatments there is evidence that they are often not well delivered. The aim of this paper is to identify the barriers to the dissemination of evidence-based psychological treatments and then propose ways of overcoming them, hence potentially bridging the gap between research findings and clinical practice.     

Peer behavior toward socially anxious adolescents: classroom observations

This study focused on the relation between adolescents' social anxiety and the way they are treated by classmates. The link between class behavior during oral presentations and the social anxiety of the speakers was investigated. Social anxiety was measured both as a trait variable and as manifest in two state anxiety characteristics. A group of 55 students from Grades 8 and 9 were selected to participate in the study. Class behavior during their presentations was rated by the students themselves, their teacher, and an independent observer. Results showed that negative class behavior was related to social anxiety, particularly when behavior was rated by the independent observer. The data suggested that this negative social outcome is related to longer lasting social interactions in the classroom and not to specific state anxiety characteristics.     

Enhanced perceptual priming for neutral stimuli occurring in a traumatic context: two experimental investigations

Intrusive memories in posttraumatic stress disorder are often triggered by stimuli that are perceptually similar to those present shortly before or during the trauma. The present study aims to examine the possible role of perceptual priming in this phenomenon. It further investigates whether the degree of perceptual priming is associated with dissociation and whether both perceptual priming and intrusive memories can be reduced through elaboration. Two experiments measured perceptual priming for neutral stimuli that immediately preceded a "traumatic" event. Volunteers (N=46, 92) watched a series of "traumatic" and neutral picture stories, and completed a blurred object identification (perceptual priming) memory task, and a recognition memory task. Participants in Experiment 1 were selected to score either high or low on the Trait Dissociation Questionnaire [Murray, Ehlers, & Mayou (2002). Dissociation and posttraumatic stress disorder: Two prospective studies of motor vehicle accident survivors. British Journal of Psychiatry, 180, 363-368]. They also completed a state dissociation measure in the session. Experiment 2 randomly allocated participants to an experimental condition designed to increase elaboration or to a control condition. This experiment also included a measure of intrusive memories. Both experiments found enhanced perceptual priming for the stimuli that immediately preceded the "traumatic" stories compared to those preceding neutral stories. Participants with high trait dissociation showed relatively stronger perceptual perceptual priming. The degree of perceptual priming for stimuli from the "traumatic" stories also correlated with state dissociation (Experiment 1). Experimental manipulation of the elaboration of the stories showed that elaboration reduced the enhanced perceptual priming effect and the relative probability of reexperiencing symptoms (Experiment 2). The results support the role of perceptual priming in intrusions after traumatic events.     

Socially anxious adolescents' perception of treatment by classmates

This study addressed the question if socially anxious adolescents have a negatively biased perception of the way they are treated by their peers. A total of 998 high school students from Grades 8-10 were categorized as socially low, middle, or high anxious on the basis of their SAS-A score. The perceived behavior of classmates was measured using three lists that described class behaviors during oral presentations of students, one list was concerned with the behaviors directed towards the student him/herself and the other two with behaviors directed towards a hypothetical high and low socially anxious peer, respectively. The results indicated that high socially anxious students felt negatively treated by their peers and that the other students too perceived that socially anxious classmates were treated more negatively. This suggests that the perception of the high socially anxious students is not distorted but based on the actual treatment they receive from their classmates.     

Regional brain electrical activity in posttraumatic stress disorder after motor vehicle accident

This study examined whether patients with posttraumatic stress disorder (PTSD) related to motor vehicle accidents (MVAs) would show an abnormal pattern of electroencephalographic (EEG) alpha asymmetries, which has been proposed for particular types of anxiety. Patients with PTSD (n = 22) or subsyndromal PTSD (n = 21), traumatized controls without PTSD (non-PTSD with MVA; n = 21), and healthy controls without MVA (n = 23) underwent measurement of EEG activity during baseline and exposure to a neutral, a positive, a negative, and an accident-related picture. Differences in brain asymmetry between groups were observed only during exposure to trauma-related material. PTSD and subsyndromal PTSD patients showed a pattern of enhanced right anterior and posterior activation, whereas non-PTSD with MVA participants showed the opposite pattern. Furthermore, posterior asymmetry in nontraumatized healthy controls varied with gender, with female participants showing a pattern of higher right posterior activation. The results support the hypothesis that symptomatic MVA survivors are characterized by a pattern of right hemisphere activation that is associated with anxious arousal and symptoms of PTSD during processing of trauma-specific information.     

Enhanced perceptual priming for neutral stimuli in a traumatic context: A pathway to intrusive memories?

Clinical observations suggest that re-experiencing symptoms are triggered by stimuli that are perceptually similar to those present shortly before the trauma or its worst moments. Two experiments investigated the possible role of perceptual priming in this phenomenon. Volunteers (N = 28, N = 62) watched a series of "traumatic" and neutral picture stories, and completed blurred object identification (priming) and recognition memory tasks. Neutral objects that immediately preceded the "traumatic" stories were more strongly primed, but not better recognised, than objects from neutral stories. Enhanced priming predicted subsequent re-experiencing symptoms. The results support the role of perceptual priming in re-experiencing.     

Utility of the impact of event scale in screening for posttraumatic stress disorder

This study assesses the optimal cut-off point for the Impact of Event Scale and compares its screening properties with those of the Self-rating Inventory for Posttraumatic Stress Disorder among war-related trauma victims. 74 patients with war-related trauma were administered the Impact of Event Scale and the Self-rating Inventory for Posttraumatic Stress Disorder, followed 1 wk. later by the Clinician-administered PTSD Scale. Receiver operating characteristic analysis indicated for the Impact of Event Scale a sensitivity of .77 and a specificity of .51 at a cut-off value of 36. For the Self-rating Inventory for Posttraumatic Stress Disorder a sensitivity of .86 and a specificity of .69 were found at a cut-off value of 52. The authors conclude that careful use of the Impact of Event Scale as a screening measure for Posttraumatic Stress Disorder is warranted.     

Dysfunctional meaning of posttraumatic intrusions in chronic PTSD

The paper suggests that the negative idiosyncratic meaning of posttraumatic intrusions (e.g., 'I am going crazy') and cognitive strategies intended to control the intrusions play a major role in maintaining posttraumatic stress disorder. Two studies of 159 and 138 motor vehicle accidents survivors showed that the dysfunctional meaning of intrusions explained a proportion of the variance of the intrusion-related distress, strategies used to end the intrusions, and PTSD severity that was not explained by intrusion frequency, accident severity, or by general catastrophic thoughts when anxious. Rumination, thought suppression, and distraction when having intrusions showed substantial correlations with PTSD severity, as did avoidance of reminders of the accident. The results have implications for the treatment of chronic PTSD.     

Heartbeat perception in panic disorder: a reanalysis

This article describes a reanalysis of seven studies on heart beat perception (HBP) in panic disorder. The pooled sample had 709 participants from eight diagnostic categories. Accurate HBP was uncommon, but more prevalent among panic disorder patients than among healthy controls, depressed patients, patients with palpitations and individuals with infrequent panic attacks. No differences were found between panic disorder patients and patients with other anxiety disorders. Accurate perceivers had higher anxiety sensitivity scores than inaccurate perceivers. The data remain inconclusive as to whether perceived heart rate is correlated with anxiety in inaccurate perceivers. Physical exercise, distraction, variations in instructions and treatment each influenced HBP. However, the influence was different than previously thought. Finally, it is suggested that HBP may be understood in terms of schema-guided information processing.     

A cognitive model of posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) is a common reaction to traumatic events. Many people recover in the ensuing months, but in a significant subgroup the symptoms persist, often for years. A cognitive model of persistence of PTSD is proposed. It is suggested that PTSD becomes persistent when individuals process the trauma in a way that leads to a sense of serious, current threat. The sense of threat arises as a consequence of: (1) excessively negative appraisals of the trauma and/or its sequelae and (2) a disturbance of autobiographical memory characterised by poor elaboration and contextualization, strong associative memory and strong perceptual priming. Change in the negative appraisals and the trauma memory are prevented by a series of problematic behavioural and cognitive strategies. The model is consistent with the main clinical features of PTSD, helps explain several apparently puzzling phenomena and provides a framework for treatment by identifying three key targets for change. Recent studies have provided preliminary support for several aspects of the model.