Treating PTSD in active duty service members using cognitive processing therapy or prolonged exposure therapy: Examining everyday practice at a military outpatient clinic

The Institute of Medicine has stressed the need for evaluations of evidence-based treatments (EBTs) for posttraumatic stress disorder (PTSD) among active duty service members (AD) using a variety of evaluation approaches (Institute of Medicine, 2012). The current study examined the clinical files of 134 service members who completed treatment for PTSD using either prolonged exposure (PE) or cognitive processing therapy at an outpatient clinic. At the completion of each session, therapists made a clinical rating as to whether or not the session was protocol adherent. The total number of treatment sessions and the proportion of sessions rated as being protocol adherent were calculated. Multi-level models estimated the change in patient PTSD and other psychological symptoms over time as a function of clinician-rated protocol adherence and total number of sessions. Approximately 65% of clinic encounters were rated by therapists as being protocol adherent. Significant reductions in PTSD and psychological symptoms were associated with protocol adherence, and this was particularly true for patients who began treatment above clinical thresholds for both PTSD and other psychological symptoms. However, as the number of sessions increased, the impact of protocol adherence was attenuated. Patient characteristics, including gender, ethnicity, and co-morbidity for other psychiatric disorders were not related to symptom change trajectories over time. These findings suggest that protocol adherence and efficiency in delivery of EBTs for the treatment of PTSD with AD is critical.     

Bottled memories: On how alcohol affects eyewitness recall

This study investigated how different doses of alcohol affected eyewitness recall. Participants (N = 126) were randomly assigned to three groups with different blood alcohol concentration (BAC), either a control group (mean BAC 0.00%, N = 42), a lower alcohol dose group (mean BAC 0.04%, N = 40), or a higher alcohol dose group (mean BAC 0.06%, N = 44). After consumption, participants witnessed a movie of a mock crime and were interviewed one week later. The main results showed that witnesses with the higher intoxication level recalled fewer details compared to witnesses with the lower intoxication level. The amount of alcohol consumed did not have an impact on the accuracy rate. No sex differences were found. The results are discussed in the light of past research. We conclude that more studies are needed before recommendations can be made to an applied setting.     

Some thoughts about thought disturbance in adolescence

One of the principal aims of adolescence is the development of the capacity to think for oneself. The authors explore the difficulties caused by disturbances of thinking in borderline adolescents, pointing out the role that the analyst can take in promoting better functioning of their patients' mental processes. Two cases are explored, one through a supervision and the other through direct clinical experience. Both illustrate the efforts of the analyst to carry out 'management in the area of thinking' with those borderline patients who have not received help from their parents to think, and still need to be shown how mentation takes place. The authors propose some changes in technique in order to implement this improvement, including sharing with the patient the way in which the analyst thinks about him. Thinking itself can be an important integrating factor for these patients.

Une des tâches principales de l'adolescence est de développer la capacité à penser par soi-même. Les auteurs explorent les difficultés occasionnées par des troubles de la pensée chez des adolescents borderline et soulignent le rôle que peut jouer l'analyste pour favoriser un meilleur fonctionnement des processus psychiques chez ces patients. Deux cas sont étudiés dans cet article ; dans l'un, le matériel est extrait de séances de supervision, dans l'autre, il est tiré directement de la situation thérapeutique. Ces cas mettent en évidence les efforts de l'analyste pour aider le patient à mieux fonder ses processus de pensée ; dans les états limites, le patient bien souvent n'a jamais pu bénéficier de l'aide de ses parents dans ce domaine et devra encore apprendre comment mettre en ?uvre l'idéation. Les auteurs proposent quelques modifications techniques afin de faciliter l'activité mentale chez ce type de patient, visant notamment à lui faire part de la manière dont son analyste pense à lui. La pensée en elle-même peut être un facteur important qui favorise l'intégration psychique chez ces patients.

Uno degli scopi principali dell'adolescenza e' lo sviluppo della capacita' di pensare per se stessi. Le autrici esplorano le difficolta' causate dai disturbi del pensiero in adolescenti borderline, sottolineando il ruolo che l'analista puo' avere nel promuovere un miglior funzionamento dei processi mentali dei loro pazienti. Vengono riportati due casi, uno attraverso l'esperienza di supervisione e l'altro attraverso l'esperienza diretta del lavoro clinico. In entrambi i casi viene illustrato lo sforzo dell'analista di portare avanti il 'management nell'area del pensare' con quei pazienti bordeline che non sono stati aiutati dai loro genitori a pensare, e che ancora hanno bisogno di capire come prende luogo il processo del pensare. Le autrici propongono dei cambiamenti nella tecnica per poter implementare tale miglioramento, compreso il condividere con il paziente il modo in cui l'analista pensa a lui. Il pensare puo' essere di per se' un importante fattore di integrazione per questi pazienti.

Eines der Hauptziele der Adoleszenz ist die Entwicklung der Fähigkeit, für sich selber zu denken. Die Autorinnen betrachten die Schwierigkeiten, die durch Denkstörungen bei Borderline- Jugendlichen verursacht werden, und stellen die Rolle heraus, die Analytiker einnehmen können, um ein besseres Funktionieren der mentalen Prozesse ihrer Patienten zu fördern. Es werden zwei Fälle betrachtet, einer durch Supervision und der andere durch direkte klinische Erfahrung. Beide illustrieren die Bemühungen der Analytikerin, 'Management im Bereich des Denkens' auszuführen mit diesen Borderline-Patienten, die von ihren Eltern keine Unterstützung zu denken erlangt hatten, und denen noch gezeigt werden muss, wie Denkprozesse stattfinden. Die Autorinnen schlagen einige Veränderungen in der Technik vor, um diese Verbesserung zu implementieren, einschliesslich dem, dass man dem Patienten mitteilt, wie die Analytikerin über ihn denkt. Denken selbst kann ein wichtiger integrierender Faktor für diese Patienten sein.     

Examining the Validity of Cyclothymic Disorder in a Youth Sample: Replication and Extension

DSM-IV-TR defines four subtypes of bipolar disorder (BP): bipolar I, bipolar II, cyclothymic disorder and bipolar not otherwise specified (NOS). However, cyclothymic disorder in children is rarely researched, or often subsumed in an “NOS” category. The present study tests the replicability of findings from an earlier study, and expands on the criterion validity of cyclothymic disorder in youth. Using the Robins and Guze (1970) framework we examined the validity of cyclothymic disorder as a subtype of BP. Using a youth (ages 5–17) outpatient clinical sample (N?=?894), participants with cyclothymic disorder (n?=?53) were compared to participants with other BP spectrum disorders (n?=?399) and to participants with non-bipolar disorders (n?=?442). Analyses tested differences in youth with cyclothymic disorder and bipolar disorder not otherwise specified who do, and those who do not, have a parent with BP. Compared to youth with non-bipolar disorders, youth with cyclothymic disorder had higher irritability (p?<?0.001), more comorbidity (p?<?0.001), greater sleep disturbance (p?<?0.005), and were more likely to have a family history of BP (p?<?0.001). Cyclothymic disorder was associated with a younger age of onset compared to depression (p?<?0.001) and bipolar II (p?=?0.05). Parental BP status was not significantly associated with any variables. Results support that cyclothymic disorder belongs on the bipolar spectrum. Epidemiological studies indicate that cyclothymic disorder is not uncommon and involves significant impairment. Failing to differentiate between cyclothymic disorder and bipolar NOS limits our knowledge about a significant proportion of cases of bipolarity.     

Positive Correlation Between Serum Interleukin‐1β and State Anger in Rugby Athletes

Recently, several studies reported a relationship between immune system activation and anger expression. Consequently, the aim of this study was to explore immunitary molecular mechanisms that potentially underlie anger expression. To this end, we applied the Frustration—Aggression Theory in a contact sport model, utilizing the nearing of sporting events to trigger anger feelings. In parallel, we evaluated the activation of immune system at mRNA levels. We enrolled 20 amateur rugby players (age ± SD, 27.2 ± 4.5) who underwent psychological assessment to evaluate anger, with the State‐Trait Anger Expression Inventory‐2 (STAXI‐2), before rugby matches; at the same time blood samples were taken to analyze the variations of gene expression by microarray. During the 2 hr before each game, a significant increase was verified in the Rage State (RS) score compared to the score ascertained 72 hr before. At the same time, we found modulation in expression profile, in particular increased expression of gene that encodes interleukin l‐β (IL‐1β). In a regression analysis, RS score was related to IL‐1β, and the potential risk factors age, body mass index, smoking, and drinking. The levels of cytokine were positively and independently related to RS score. Our results suggest that the nearing of sporting event can trigger anger state feelings and activate immune system in rugby players. We propose the IL‐1β as a potential biological marker of anger. However, further research is necessary to clarify the correlation between cytokine and anger. Aggr. Behav. 39 :141‐148, 2013. © 2012 Wiley Periodicals, Inc.     

Reliability and plasticity of response inhibition and interference control

This study investigated the internal reliability, temporal stability and plasticity of commonly used measures of inhibition-related functions. Stop-signal, go/no-go, antisaccade, Simon, Eriksen flanker, Stroop and Continuous Performance tasks were administered twice to 23 healthy participants over a period of approximately 11 weeks in order to assess test–retest correlations, internal consistency (Cronbach’s alpha), and systematic between as well as within session performance changes. Most of the inhibition-related measures showed good test–retest reliabilities and internal consistencies, with the exception of the stop-signal reaction time measure, which showed poor reliability. Generally no systematic performance changes were observed across the two assessments with the exception of four variables of the Eriksen flanker, Simon and Stroop task which showed reduced variability of reaction time and an improvement in the response time for incongruent trials at second assessment. Predominantly stable performance within one test session was shown for most measures. Overall, these results are informative for studies with designs requiring temporally stable parameters e.g. genetic or longitudinal treatment studies.     

Task set flexibility and feature specificity modulate the limits of temporal attention

The consequences of maintaining a task set in the context of the (speeded) attentional blink were investigated in a series of experiments. Observers were asked to either attend or ignore the first of two target stimuli (T1 and T2). The results showed that when T1 and T2 shared a task relevant feature that was unique to T2, but not to T1, a shallow attentional blink was observed, as well as a lack of Lag 1 sparing. In comparison, when the targets shared a feature that was uniquely task relevant to both targets, the blink could not be avoided. Conversely, when no feature was shared between targets, ignoring T1 was successful and virtually no attentional costs were apparent. A similar lack of costs was also observed when targets shared a task relevant feature that was unique to T1 but not to T2. Finally, matching the feature dimension of a target feature that was unique to T2, but not T1, also strongly attenuated the blink. However, it did not completely abolish Lag 1 sparing. The results are interpreted in the context of current models of the attentional blink.     

Can the effectiveness of health promotion campaigns be improved using self-efficacy and self-affirmation interventions? An analysis of sun protection messages

Health-risk communications frequently target self-efficacy in order to encourage adaptive responses. Research has also indicated that self-affirmation may be a useful supplementary or alternative intervention technique. This study compared the effects of self-efficacy, self-affirmation and a combination of these techniques for two risk messages. Young British females (N?=?677) read about ultraviolet light and skin cancer or skin ageing (‘photoageing’) and were randomly assigned to a single intervention (self-affirmation/self-efficacy), the combined intervention or no intervention. The efficacy intervention led to greater message acceptance and perceived risk in both the cancer and photoageing conditions, while the only main effect of self-affirmation was on acceptance of the photoageing message. However, self-affirmation moderated the effect of efficacy information. For photoageing messages, efficacy information was associated with greater message acceptance only amongst self-affirmed participants, but the opposite occurred for skin cancer messages. Although these findings should be interpreted cautiously, they imply that health promoters should select efficacy information if only one intervention is used but that self-affirmation can influence responsiveness to efficacy interventions for particular messages.     

Reading and Spelling Disabilities in Children with and Without a History of Early Language Delay: A Neuropsychological and Linguistic Study

Language delay is a frequent antecedent of literacy problems, and both may be linked to phonological impairment. Studies on developmental dyslexia have led to contradictory results due to the heterogeneity of the pathological samples. The present study investigated whether Italian children with dyslexia showed selective phonological processing deficits or more widespread linguistic impairment and whether these deficits were associated with previous language delay. We chose 46 children with specific reading deficits and divided them into two groups based on whether they had language delay (LD) or not (NoLD). LD and NoLD children showed similar, severe deficits in reading and spelling decoding, but only LD children showed a moderate impairment in reading comprehension. LD children were more impaired in phonological working memory and phonological fluency, as well as in semantic fluency, grammatical comprehension, and verbal IQ. These findings indicate the presence of a moderate but widespread linguistic deficit (not limited to phonological processing) in a subset of dyslexic children with previous language delay that does not generalize to all children with reading difficulties.     

The two sides of competition: Competition‐induced effort and affect during intergroup versus interindividual competition

Competition strongly affects individual effort and performance for both individuals and groups. Especially in work settings, these effort gains might come at the cost of individual well‐being. The present study tested whether competition increases both effort (as indicated by task performance) and stress (in terms of cardiovascular reactivity and affective response), and whether this effect is further qualified by the type of competition (interindividual vs. intergroup), using a cognitive computer‐based task and a 2 (Group: Yes, No) × 2 (Competition: Yes, No) × 2 (Gender) factorial design (N= 147). All participants either worked as a representative of a group or as an individual, and were offered performance‐related incentives distributed in a lottery. In the competition conditions, participants were informed that they competed with someone else, and that only the winning person/team would take part in the lottery. Consistent with expectations, competition increased both individual effort and cardiovascular reactivity compared to non‐competitive work. Moreover, for female participants, intergroup competition triggered increased effort and more positive affect than interindividual competition. Aside from documenting costly side‐effects of competition in terms of stress, this study provides evidence for a stress‐related explanation of effort gains during intergroup competition as compared to interindividual competition.