Adaptation of CBT for Traumatized South African Indigenous Groups: Examples from Multiplex CBT for PTSD

This article describes how Culturally Adapted Multiplex CBT, a treatment that emphasizes somatic processing and emotion regulation, was adapted for a traumatized South African indigenous group, the Sepedi. A model of psychopathology is presented, the Multiplex Model of Trauma-Related Disorder, which depicts the processes that generate multiple comorbidities and prominent somatization in minority, refugee, and other non-Western populations. The nine dimensions of Culturally Adapted Multiplex CBT are discussed, and so too the “cultural adaptation diamond.” Concepts such as “explanatory model bridging” are presented. A culturally sensitive assessment measure of local somatic complaints and cultural syndromes (the Sepedi Symptom and Syndrome Addendum, or Sepedi SSA) is detailed, as well as how CBT techniques were implemented with this group—for example, modification of culturally specific catastrophic cognitions, doing exposure (e.g., interoceptive exposure), teaching attentional control and mindfulness techniques, and teaching “loving kindness.” Case examples with clinical outcomes are provided to further illustrate how Multiplex CBT was adapted for the South African indigenous group.     

Muscle dysmorphia: Current research and potential classification as a disorder

ObjectiveTo review the literature for scientific evidence in support of inclusion of Muscle Dysmorphia (MD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).DesignThe criteria proposed by Blashfield, Sprock, and Fuller (1990) were used for determining whether scientific evidence supports the introduction of MD as a new disorder into a disease classification system.MethodPeer-reviewed journal articles were identified by searching databases for articles published (in print and electronically) from 2001 to 2011.ResultsThe search identified 59 journal articles that specifically focused on MD, of which 39 were empirical journal articles. There is ample literature on MD, including a common set of diagnostic criteria and assessment instruments to measure MD. However, questions remain about the diagnostic reliability and validity, including inter-rater reliability, and whether MD represents a disorder that consists of symptoms that frequently co-occur. Also, evidence of syndrome differentiation is lacking. Only two of the five criteria proposed by Blashfield et al. have been met.ConclusionLiterature suggests that MD is associated with several indicators of clinical significance and distinctiveness. However the current review has found significant limitations and gaps in the scientific literature on MD. Possible options regarding the status of MD in the DSM-5 are proposed, including introducing MD as an example of an eating disorder not otherwise specified, retaining MD as a body dysmorphic disorder, introducing MD as a new disorder, or introducing MD as a provisional diagnosis in need of further study.     

Word-frequency and phonological-neighborhood effects on verbal short-term memory

Immediate memory span and maximal articulation rate were assessed for word sets differing in frequency, word-neighborhood size, and average word-neighborhood frequency. Memory span was greater for high- than low-frequency words, greater for words from large than small phonological neighborhoods, and greater for words from high- than low-frequency phonological neighborhoods. Maximal articulation rate was also facilitated by word frequency, phonological-neighborhood size, and neighborhood frequency. In a final study all 3 lexical variables were found to influence the recall outcome for individual words. These effects of phonological-word neighborhood on memory performance suggest that phonological information in long-term memory plays an active role in recall in short-term-memory tasks, and they present a challenge to current theories of short-term memory.     

Parental influences on academic performance in African-American students

We investigated the relationship between parental influences and academic outcomes for African-American students. Secondary data analysis was conducted on the National Survey of Family and Household data set. Multiple regression analysis showed that parenting style (nurture and control) and parental involvement significantly predicted academic outcomes. Research has traditionally focused on the reasons for the failure of African-American students to succeed in school. This study focused on factors that determine success. The problem of negative school outcomes may be alleviated by studying what works to promote school success rather than what does not work for African-American students.     

Flexibility and sharing of childcare duties in black families

With the increasing number of Black mothers participating in the labor force, rearing children without fathers present, and relying on extended family for support the question of the nature of role-flexibility and sharing in the family is raised. Sixty-four families participated in an examination of the relative influence of one- and two-parent Black families and the proximity of the grandmother on self-report measures of (a) household maintenance duties, (b) childcare duties, and (c) parental punishment behaviors. Parents, grandmothers, and at least one child between the ages of 7 and 14 years completed three types of self-report measures. Although the results indicated that mothers, fathers, and grandmothers were nominated as consistently participating in childcare and household maintenance duties, mothers were nominated for more than 60% of the childcare and household tasks. Moreover mothers and not fathers used the full range of discipline practices including corporal punishment. The hypothesis regarding role-sharing in Black household was not supported. Black mothers, like mothers in general, are primarily responsible for the maintenance of the house and the care of children.The preparation of this review was supported by Carter G. Woodson Institute for Afro-American and African Studies, National Science Foundation Grant PRM-8210411, Rockefeller and Spencer Foundations grants.     

Response bias on a locus of control measure by learning-disabled children

Four experiments were conducted to clarify the relationship between internal locus of control and achievement in learning-disabled and normal boys. The initial study yielded only a weak relationship between achievement and locus of control. Two subsequent experiments found differences on internality, and experiment 3 confirmed a pattern of second response choice bias for low-achieving boys. In Experiment 4 a significant interaction of diagnosis and test form resulted. Overall the tendency of learning-disabled and low-achieving boys to choose second response alternatives may have resulted in the popular but unsubstantiated notion that disabled children are less internally oriented than normal children.     

Cross-Lagged Relationships Between Insomnia and Posttraumatic Stress Disorder in Treatment-Receiving Veterans

Insomnia is a risk factor for the development of posttraumatic stress disorder (PTSD) while it is also plausible that PTSD symptoms can maintain insomnia symptoms. The present study examined longitudinal bidirectional relationships between insomnia and PTSD symptoms in treatment-seeking veterans. Participants were 693 ex-serving members of the Australian Defence Force who participated in an accredited, hospital-based outpatient PTSD program. Participants completed self-reported assessments of PTSD and insomnia symptoms at four time points: intake, discharge, 3-month, and 9-months posttreatment follow-up.Cross-lagged pathway analyses indicated significant bi-directional pathways between insomnia symptoms and PTSD symptoms at most time points. A final cross-lagged model between insomnia symptoms and the PTSD symptom clusters indicated that the PTSD symptom paths on insomnia symptoms, between intake and discharge, were attributable to reexperiencing PTSD symptoms. In contrast, across posttreatment follow-up time points there were significant paths of insomnia symptoms on all PTSD symptom clusters except from insomnia at 3-months to avoidance symptom at 9-months. PTSD symptoms and insomnia symptoms have bidirectional associations over time that may lead to the mutual maintenance or exacerbation of each condition following PTSD treatment. Where residual insomnia symptoms are present post-treatment, a sleep-focussed intervention is indicated and a sequenced approach to treatment recommended.