Implementation of Cognitive Therapy for PTSD in routine clinical care: Effectiveness and moderators of outcome in a consecutive sample

ObjectiveTrauma-focused psychological treatments are recommended as first-line treatments for Posttraumatic Stress Disorder (PTSD), but clinicians may be concerned that the good outcomes observed in randomized controlled trials (RCTs) may not generalize to the wide range of traumas and presentations seen in clinical practice. This study investigated whether Cognitive Therapy for PTSD (CT-PTSD) can be effectively implemented into a UK National Health Service Outpatient Clinic serving a defined ethnically mixed urban catchment area.MethodA consecutive sample of 330 patients with PTSD (age 17–83) following a wide range of traumas were treated by 34 therapists, who received training and supervision in CT-PTSD. Pre and post treatment data (PTSD symptoms, anxiety, depression) were collected for all patients, including dropouts. Hierarchical linear modeling investigated candidate moderators of outcome and therapist effects.ResultsCT-PTSD was well tolerated and led to very large improvement in PTSD symptoms, depression and anxiety. The majority of patients showed reliable improvement/clinically significant change: intent-to-treat: 78.8%/57.3%; completer: 84.5%/65.1%. Dropouts and unreliable attenders had worse outcome. Statistically reliable symptom exacerbation with treatment was observed in only 1.2% of patients. Treatment gains were maintained during follow-up (M = 280 days, n = 220). Few of the selection criteria used in some RCTs, demographic, diagnostic and trauma characteristics moderated treatment outcome, and only social problems and needing treatment for multiple traumas showed unique moderation effects. There were no random effects of therapist on symptom improvement, but therapists who were inexperienced in CT-PTSD had more dropouts than those with greater experience.ConclusionsThe results support the effectiveness of CT-PTSD and suggest that trauma-focused cognitive behavior therapy can be successfully implemented in routine clinical services treating patients with a wide range of traumas.     

A job-seeking self-efficacy scale for people with physical disabilities: preliminary development and psychometric testing

People with disabilities are at an increased risk of unemployment. The role of interventions aiming to enhance the employment prospects of people with disabilities is receiving increased attention. However, evaluation is hampered by the paucity of measures specific to the needs of the target population. The purpose of the present study was to develop and conduct preliminary testing of the psychometric properties of a job-seeking self-efficacy (JSS) scale that reflected the experiences of people with physical disabilities. Job-seeking self-efficacy was defined as perceived ability to perform the skills involved in seeking employment that are salient to people with disabilities. Scale development and testing involved four studies and resulted in the 12-item JSS scale and six-item managing disability at interview (MDI) component, both of which were unidimensional and had high internal consistency. In addition, there was evidence of construct and concurrent validity. Greater jobseeking self-efficacy and perceived ability to manage disability at interview were associated with more positive psychological well-being. Only the MDI component was associated with physical functioning: lower perceived ability to manage disability at interview was associated with greater impairment of physical functioning. The pattern of associations supported the rationale for a separate component reflecting the need to resolve practical issues linked to access and availability of facilities before participation in the interview procedure per se .     

Visualizing homelessness: a study in photography and estrangement

This article reports a qualitative study of how homeless people visualize their life in hostels and on the streets of London. Using a photo‐production technique, the research enabled participants to show their situation as well as to tell about their experiences. Participants were given cameras and asked to take photographs typical of their day as homeless people, this material being the subject of a subsequent interview. This provided both visual and text data that were analysed together so as to establish different engagements of the participants with the city and with domiciled people. Presenting the material from six of the participants, these different engagements are described with reference to issues of estrangement, exclusion and visualization employed as explanatory concepts. The article identifies and compares the different ways in which homeless people attempt not only to survive but also to [make their home] in the city. Copyright © 2005 John Wiley & Sons, Ltd.     

Effects of message framing and temporal context on college student drinking behavior

This study evaluated the interactive effects of message framing and temporal context on college student alcohol use. Participants (n = 228) were randomly assigned to read an alcohol prevention message that varied by message frame (gains vs. losses) and temporal context (short- vs. long-term consequences). Participants returned to the lab one month later to report their drinking behavior over the past month. As predicted, students exposed to the gain-framed message reported lower alcohol use (drank less frequently, drank fewer alcoholic beverages per drinking occasion, and engaged in less binge drinking) as compared to students exposed to the loss-framed message, but only if they read about short-term consequences of alcohol use. Message frame had no effect when participants were exposed to long-term consequences. This investigation extends previous research by demonstrating the effectiveness of message framing for reducing health-damaging behaviors and by identifying temporal context as a moderator of framing effects.     

Recognizing National Hockey League greatness with an ignorance-based heuristic.

This study examined whether people adhered to the recognition heuristic (i.e., inferred that a recognized hockey player had more total career points than an unrecognized player) and whether using this heuristic could yield accurate decisions. On paired comparisons, having participants report whether they recognized each player plus any knowledge they had about each player permitted players to be classified as either unrecognized (UR), merely recognized (MR), or recognized with additional knowledge (RK), thus producing six possible trial types. Participants adhered to the recognition heuristic on 95% of MR-UR trials and were accurate on 81% of those trials. They chose the recognized player on 98% of RK-UR trials, yielding 94% accuracy. Women had less knowledge and recognized fewer players than men, yet they were nearly as accurate as men. Future research should examine the conditions under which the recognition heuristic is an adaptive strategy.     

The effect of insulin-induced hypoglycemia on NaCl hunger in the adrenalectomized rat

Rats that have developed a polydipsia for a saccharinglucose solution (S-G) are less likely after ADX to drink quantities of NaCl which are necessary for adequate body maintenance. Their appetite for the S-G interferes with the more regulatory NaCl appetite. It was hypothesized, then, that a need-related, S-G polydipsia established via insulin administration prior to ADX would result in an even greater dysfunction after ADX when S-G and NaCl were available as drinking fluids. And,a fortiori, rats with simultaneous adrenal insufficiency (via ADX) and an insulin-induced hypoglycemia would be so maximally responsive to S-G that they would be maximally resistant to NaCl regulation. Anda fortiori, rats with simultaneous adrenal insufficiency (via ADX) and an insulin-induced hypoglycemia would show maximum inertia to reverse a preoperatively-established S-G preference to a NaCl preference. The results were mixed. Preference for NaCl was equal in all ADX animals regardless of experimental condition. However, while ADX rats with a previous need-related S-G polydipsia sustain considerably long periods of weight loss (indicating poor adaptation), the insulin-injected, ADX rats manifest markedly more adaptive weight gains. The results are discussed in light of hierarchies and cross-linkages in behavioral and physiochemical homeostasis.     

Pavlovian conditioning of drug reactions: Some implications for problems of drug addiction

This paper reviews the classical conditioning of drug reactions, with special emphasis on the relationship of this phenomenon to drug addiction. Several aspects of drug addiction such as drug craving, high relapse tendencies, and the recurrence of withdrawal symptoms are reviewed and interpreted in light of classical conditioning theory and data. A theory is proposed that attempts to account for various aspects of the addictive process. The implications and empirical methods for testing this theory are outlined.     

Potassium chloride preference in normal,sodium—and sodium—potassium—deficient rats

KCl water preference was examined in diet-replete, sodium-and sodium—potassium-deficient postpubertal rats of different ages. While diet-replete rats displayed a KCl preference-aversion profile similar to that found using other salts, when retested 30 days later, these same animals had no KCl preference. Na-and Na—K-deficient rats preferred KCl over a broad range of concentrations when tested in early postpuberty and the Na—K-deficient group had a markedly reduced KCl preference threshold (0.12%) when compared to all other groups in the study. But Na-and Na—K-deficient rats older by 2 1/2 months did not prefer KCl. The notion of specific food hungers can be invoked to account for some of the preferences. But hedonics, age and KCl experience must also be considered based on (1) the quantities of KCl consumed, (2) the preference reversals within animals, as well as (3) the significantly increased heart—and kidney—body weight ratios in the rats with the greatest KCl preference.