The Effect of Concurrent Depression on PTSD Outcomes in Trauma-Focused Psychotherapy: A Meta-Analysis of Randomized Controlled Trials

The co-occurrence of depression with posttraumatic stress disorder (PTSD) is common and associated with greater severity and impairment than PTSD alone, but the effects on PTSD treatment outcomes are unclear. This study investigated the impact of baseline depression on PTSD symptom change and dropout in a meta-analysis of 44 randomized controlled trials (N = 4,866) of trauma-focused psychotherapies for PTSD. Analyses included 107 active (k = 71) and control (k = 36) conditions. Baseline depression was indexed within samples as (a) continuous symptom severity (e.g., Beck Depression Inventory), standardized across depression measures and (b) proportion of patients with comorbid depressive disorder diagnosis. Among active conditions reporting continuous depression scores (k = 62), greater depression severity predicted smaller PTSD treatment effect sizes (ß = -.36, p = .002), but not dropout (ß = .25, p = .18). Categorical depressive diagnosis rates (k = 29)—reported less frequently—were not associated with treatment effects or dropout in active conditions. Greater depression severity may reflect a risk factor for attenuated response in PTSD psychotherapies, potentially demanding complementary strategies within trauma-focused interventions. Variability between trials in baseline depression symptoms may suggest the need to consider this sample characteristic when comparing treatment outcomes across studies.     

Exploring a patient's shift from relative silence to verbal expressiveness: Observations on an element of the analyst's participation

By tracing a portion of close process of a patient's shifts from a relatively silent and inhibited stance to one in which he is beginning to verbalize more about his experience and fantasy, I will illustrate some tensions between the analyst's role as facilitating expressiveness and as occupying a place in the patient's internalized world. Since the analyst's functions as facilitator and as internal object (often an obstacle to the patient's expressiveness) are sometimes in conflict with one another, it is important for the analyst to be able to work internally with this conflict as he works with his patient. Splitting processes between these two functions may provide the analyst with cues related to the patient's and the analyst's resistance to understanding the patient's communication of unconscious conflict and the patient's recruitment of the analyst into the patient's internalized world.     

A thematic analysis of young people's experience of counselling in five secondary schools in the UK

Aim: To investigate young people's views on the effects of school‐based counselling, and what they found helpful and unhelpful. Method: Eleven semi‐structured interviews were conducted and thematically analysed. Findings: Participants expressed predominantly positive views of school‐based counselling with changes in three main domains: emotional, interpersonal and behavioural. Participants viewed these changes as having had an important effect on their lives. The most commonly cited helpful aspects of counselling were related to talking or getting things out, and counsellor qualities. Conclusions: School‐based counselling is viewed positively by those who have experienced it, and appears to be an appropriate and valuable intervention for young people.     

Improving the efficacy of appearance-based sun exposure interventions with the terror management health model

The terror management health model (TMHM) suggests that when thoughts of death are accessible people become increasingly motivated to bolster their self-esteem relative to their health, because doing so offers psychological protection against mortality concerns. Two studies examined sun protection intentions as a function of mortality reminders and an appearance-based intervention. In Study 1, participants given a sun protection message that primed mortality and shown a UV-filtered photo of their face reported greater intentions to use sun protection on their face, and took more sunscreen samples than participants shown a regular photo of their face. In Study 2, reminders of mortality increased participants’ intentions to use facial sun protection when the UV photo was specifically framed as revealing appearance consequences of tanning, compared to when the photo was framed as revealing health consequences or when no photo was shown. These findings extend the TMHM, and provide preliminary evidence that appearance-based tanning interventions have a greater influence on sun protection intentions under conditions that prime thoughts of death. We discuss implications of the findings, and highlight the need for additional research examining the applicability to long-term tanning behaviour.     

The theory of planned behaviour and breast self-examination: Assessing the impact of past behaviour,context stability and habit strength

This study applied the theory of planned behaviour (TPB) to the prediction of breast self-examination (BSE) intentions and behaviour, and tested whether the frequency of past behaviour and context stability moderates intention–behaviour and habit–behaviour relations. Seventy-seven females completed measures of the TPB, frequency of past behaviour, context stability and habit strength (Self-Report Habit Index). BSE behaviour was assessed at 1-month follow-up (n?=?66). The TPB explained 33% of the variance in BSE intentions and 11% of the variance in time 2 BSE. The frequency of past behaviour moderated the intention–behaviour relationship such that the intention was only positively related to time 2 BSE behaviour when the frequency of past behaviour was low. Context stability and the combination of the frequency of past behaviour?×?context stability moderated the habit–behaviour relationship such that habit strength was only positively related to time 2 BSE behaviour when context stability and the combination of frequency of past behaviour?×?context stability were high. The results are consistent with the proposal that behaviours that are performed frequently in stable contexts are predominantly under the control of habitual processes, whereas behaviours that are performed infrequently in unstable contexts are predominantly under the control of intentional processes.     

Front-line services,complexity, research and policy

The evidence-based culture of modern mental health policy and service delivery is being extended through funded efforts to accelerate implementation of research findings in practice settings. In this paper, we argue that this linear model of research and policy-making is profoundly ill adapted to the nature of practice realities and real-world policy-making processes. Both need to be re-conceptualised using the theoretical and practical resources deriving from modern complexity theory. A short case study illustrates the nature of ‘complexity’, the reframing of the notion of ‘evidence’ it implies and the different relationship between research, practice and policy that flows from this more attuned model of mental health and therapeutic processes.     

Parent Retrospective Recollections of Bullying and Current Views, Concerns, and Strategies to Cope with Children’s Bullying

In this study, parent history of bullying was examined in terms of general involvement with bullying, specific types of bullying experienced, level of hurtfulness associated with the experience, and when bullying occurred. Parent current views, levels of concern, and strategies used to cope with bullying were also evaluated. Finally, the aforementioned constructs were analyzed for existing predictive relationships. Two-hundred-sixty parents from a public school district in the Northeast completed an online survey. Results revealed that 90.3 % of parents reported seeing and/or engaging in bullying during their youth. Few parents reported involvement as a bully, but comparable numbers of participants indicated being victimized or acting as a bystander. Additional findings suggest that a parent’s historical involvement with bullying was predictive of some of their current views, level of concern, and strategies implemented in association with bullying. Future research should attempt to account for the remaining variance among these variables. Implications for parents and school personnel are described, with recommendations for the increase of involvement by parents in anti-bullying initiatives.