A Novel Approach to the Assessment of Fidelity to a Cognitive Behavioral Therapy for PTSD Using Clinical Worksheets: A Proof of Concept With Cognitive Processing Therapy

Fidelity monitoring is a critical indicator of psychotherapy quality and is central to successful implementation. A major barrier to fidelity in routine care is the lack of feasible, scalable, and valid measurement strategies. A reliable, low-burden fidelity assessment would promote sustained implementation of cognitive behavioral therapies (CBTs). The current study examined fidelity measurement for cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) using clinical worksheets. External raters evaluated patient worksheets done as a part of treatment, both guided by the therapist and completed independently as homework. Results demonstrated that fidelity ratings from CPT session worksheets were feasible and efficient. Notably, they were strongly correlated with observer ratings of the fidelity of CPT strategies that were present on the worksheets. Agreement among ratings conducted by individuals with a range of experience with CPT was acceptable to high. There was not a main effect of therapist-guided, in-session worksheet ratings on PTSD symptom change. However, patient competence in completing worksheets independently was associated with greater PTSD symptom decline and in-session, therapist-guided worksheet completion was associated with larger symptom decreases among patients with high levels of competence. With further research and refinement, rating of worksheets may be an efficient way to examine therapist and patient skill in key CPT elements, and their interactions, compared to the gold standard of observer ratings of therapy video-recordings. Additional research is needed to determine if worksheets are an accurate and scalable alternative to gold standard observer ratings in settings in which time and resources are limited.     

Work–family conflicts,cognitive appraisal,and burnout: Testing the mediation effect with structural equation modelling

Work–family conflict constitutes an important source of occupational stress predicting teachers’ burnout, and cognitive variables have shown to be core structures in explaining human adaptation to stress. Nevertheless, the role of cognitive appraisal needs to be fully analysed to comprehend how it can mediate the relationship between stress and burnout. In order to understand the potential mediation of cognitive appraisal in the relationship between stress and burnout, we adopted conceptual models of stress that highlighted the value of cognitive appraisal on positive and negative reactions to work demands. Also, we analysed the potential moderation of sex and age in the relationship between work–family conflict, cognitive appraisal, and burnout due to inconsistent findings on how these personal variables can interfere on these relations. In this study, we used structural equation modelling (SEM) to test the mediating of cognitive appraisal in the relationship between work–family conflicts and burnout. A survey with measures of work–family conflicts, cognitive appraisal, and burnout was administered to the participants consisting of 438 Portuguese teachers from kindergarten through high school, aged between 28 and 67 years (M = 46.85; SD = 7.88), 304 of whom were females (69.41%). The results confirmed that cognitive appraisal partially mediated the relationship between work–family conflict and burnout. The mediation effect of cognitive appraisal on the relationship between work–family conflict and burnout was invariant regardless of teachers’ sex or age. In sum, cognitive appraisal should be considered in order to understand teachers’ adaptation to work.     

The Perception of Persons with Anorexia Nervosa on Quality of Life: an Initial Investigation

Anorexia nervosa (AN) is an illness with a large impact on an individual’s quality of life, affecting relationships with friends and family, social inclusion, employment, personal development, and physical health, among other domains. However, most QoL studies primarily focus on health-related QoL without paying attention to the psychosocial and subjective aspects of QoL. In this study, QoL in persons with AN is investigated from a broad perspective. More specifically, this study aims at (1) gaining insight into the personal meaning of QoL of persons recovering from AN, (2) specifying the indicators of the QoL model of Schalock (J Intellect Disabil Res 48(3):203–216, 2004) for persons with AN, and (3) exploring the relationship between a specific treatment program and the perception on QoL of persons with AN. Therefore, in-depth interviews were conducted with 17 persons recovering from AN, who are supported by Empathie, a therapeutic center in Flanders, using solution-focused therapy and client-centered therapy, combined with a systemic orientation. The participants spontaneously mentioned the following themes when asked which elements are important to have a good QoL: interpersonal relationships, personal development, being able to relax, self-determination, and having a healthy lifestyle. Each domain of the QoL model of Schalock was operationalized into specific indicators for persons with AN. These indicators can help service providers to tailor their support strategies to the needs of each patient. The participants reported that being in therapy had positively influenced the following domains: interpersonal relationships, emotional well-being, self-determination, and social inclusion.     

The role of the amygdala in facial emotional expression during a discrimination task

A total of 50 patients with temporal lobe epilepsy with unilateral resection of the hippocampus and the amygdala were studied: --27 with left lobectomy (LTL group) and 23 with right lobectomy (RTL group)--; and 28 healthy control participants (HC group). The task consisted of identifying the dissimilar photograph from a group of photographs of the same face. The difference could correspond to the identity of the model or the facial expression (happiness, anger, sadness and fear). The results showed that when the difference in the photograph resided in the identity of the model, the RTL group made more mistakes than the HC group. When the facial expression was the distinguishing feature, mean response latency was longer in the LTL group than in the HC group. Comparison of the emotions revealed that the greatest differences were obtained with the fear expression, in all three participant groups. The dissociation of neural circuits responsible for processing facial expressions is discussed and, especially, the role of the left amygdala to discriminate between facial expressions.     

Preference for symmetry is experience dependent in newborn chicks (Gallus gallus)

Spontaneous pecking preferences toward symmetric or asymmetric stimuli were tested in newborn chicks (Gallus gallus). A preference for asymmetric patterns was found in na?ve chicks (either 24 or 48 hours old), although a preference for symmetry appeared at retest after chicks had experienced standard rearing conditions (Experiments 1 and 2). Only food-experienced chicks preferred symmetric patterns; food-deprived and hand-fed chicks did not show any preference (Experiment 3). A key factor that allowed for the emergence of a preference for symmetry may relate to the improving of pecking sensorimotor skills occurring during active food manipulation. Possible explanations are discussed for the late emergence of the preference for symmetry and for the preference for asymmetry found in na?ve chicks.     

Parent Proneness to Shame and the Use of Psychological Control

We examined the link between parent proneness to shame and two forms of psychological control, overprotection and critical/rejecting behavior, in parents of preschoolers. Because shame is self-condemning, proneness to shame affects intrapersonal and interpersonal functioning. We hypothesized that parents’ emotion-regulatory responses to shame would increase the likelihood of psychological control: anxiety by leading to overprotection mediated by a worrisome approach to the child, and anger/hostility by leading to critical/rejecting parenting mediated by negative reactivity to the child. Participants were 198 mother-father pairs with a child 3.6 to 4.5 years of age. Overprotective and critical/rejecting parenting were assessed using both self and spouse reports of parenting practices. In addition, parents completed measures of proneness to shame, worrisome overconcern about the child, and negative reactivity to the child. Structural equation modeling yielded results that supported mediation by negative approach to the child for mothers’ and fathers’ critical/rejecting behavior. For fathers but not mothers, shame was indirectly associated with overprotective parenting through worrisome approach to the child. Parents’ proneness to shame may be an important factor leading to the use of psychological control.     

Perception of the stereokinetic illusion by the common marmoset (<Emphasis Type="Italic">Callithrix jacchus</Emphasis>)

Stereokinetic illusions have never been investigated in non-human primates, nor in other mammalian species. These illusions consist in the perception of a 3D solid object when certain 2D stimuli are rotated slowly in the plane perpendicular to the line of sight. The ability to perceive the stereokinetic illusion was investigated in the common marmoset (Callithrix jacchus). Four adult marmosets were trained to discriminate between a solid cylinder and a solid cone for food reward. Once learning criterion was reached, the marmosets were tested in sets of eight probe trials in which the two solid objects used at training were replaced by two rotating 2D stimuli. Only one of these stimuli produced, at least to the human observer, the stereokinetic illusion corresponding to the solid object previously reinforced. At test, the general behaviour and the total time spent by the marmosets observing each stimulus were recorded. The subjects stayed longer near the stimulus producing the stereokinetic illusion corresponding to the solid object reinforced at training than they did near the illusion corresponding to the previously non-rewarded stimulus. Hence, the common marmosets behaved as if they could perceive stereokinetic illusions.