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.     

Mental Health Services Use Intentions Among Canadian Military Recruits

Identifying the factors associated with mental health services use (MHSU) is an important step in developing strategies to improve services access and delivery. The aims of the present study were to (a) identify personality and individual difference characteristics associated with MHSU intentions within the framework of the Theory of Planned Behavior (TPB) and (b) explore complex relationships that might exist between these characteristics and determinants of MHSU intentions identified in TPB, including attitudes, subjective norms, and perceived behavioral control. Data for 244 Canadian Armed Forces recruits who completed a MHSU questionnaire following mental health training were linked to personality data collected earlier. Multivariate analyses showed that the relationship between agreeableness and MHSU intentions was mediated by instrumental attitudes and subjective norms. The relationship between hardiness and MHSU intentions was mediated by subjective norms and self-efficacy. Findings suggest it may be worthwhile to consider mental health education initiatives to improve MHSU.     

A New Model for Acquiescence at the Interface of Psychometrics and Cognitive Psychology

ABSTRACT

When measuring psychological traits, one has to consider that respondents often show content-unrelated response behavior in answering questionnaires. To disentangle the target trait and two such response styles, extreme responding and midpoint responding, Böckenholt (2012a Böckenholt, U. (2012a). Modeling multiple response processes in judgment and choice. Psychological Methods, 17, 665–678. doi:10.1037/a0028111[Crossref], [PubMed], [Web of Science ®] , [Google Scholar]) developed an item response model based on a latent processing tree structure. We propose a theoretically motivated extension of this model to also measure acquiescence, the tendency to agree with both regular and reversed items. Substantively, our approach builds on multinomial processing tree (MPT) models that are used in cognitive psychology to disentangle qualitatively distinct processes. Accordingly, the new model for response styles assumes a mixture distribution of affirmative responses, which are either determined by the underlying target trait or by acquiescence. In order to estimate the model parameters, we rely on Bayesian hierarchical estimation of MPT models. In simulations, we show that the model provides unbiased estimates of response styles and the target trait, and we compare the new model and Böckenholt’s model in a recovery study. An empirical example from personality psychology is used for illustrative purposes.     

Factors Affecting the Adequacy and Preferability of Semiparametric Groups-Based Approximations of Continuous Growth Trajectories

Psychologists have long been interested in characterizing individual differences in change over time. It is often plausible to assume that the distribution of these individual differences is continuous in nature, yet theory is seldom so specific as to designate its parametric form (e.g., normal). Semiparametric groups-based trajectory models (SPGMs) were thus developed to provide a discrete approximation for continuously distributed growth of unknown form. Previous research has demonstrated the adequacy of the approximation provided by SPGM but only under relatively narrow, theoretically optimal conditions. Under alternative conditions, which may be more common in practice (e.g., higher dimension random effects, smaller sample sizes), this study shows that approximation adequacy can suffer. Furthermore, this study also evaluates whether SPGM's discrete approximation is preferable to a parametric trajectory model that assumes normally distributed random effects when in fact the distribution is modestly nonnormal. The answer is shown to depend on distributional characteristics of both repeated measures (binary or continuous) and random effects (bimodal or skewed). Implications for practice are discussed in light of empirical examples on externalizing behavior.     

Evaluating Group-Based Interventions When Control Participants Are Ungrouped

Individually randomized treatments are often administered within a group setting. As a consequence, outcomes for treated individuals may be correlated due to provider effects, common experiences within the group, and/or informal processes of socialization. In contrast, it is often reasonable to regard outcomes for control participants as independent, given that these individuals are not placed into groups. Although this kind of design is common in intervention research, the statistical models applied to evaluate the treatment effects are usually inconsistent with the resulting data structure, potentially leading to biased inferences. This article presents an alternative model that explicitly accounts for the fact that only treated participants are grouped. In addition to providing a useful test of the overall treatment effect, this approach also permits one to formally determine the extent to which treatment effects vary over treatment groups and whether there is evidence that individuals within treatment groups become similar to one another. This strategy is demonstrated with data from the Reconnecting Youth program for high school students at risk of school failure and behavioral disorders.     

Holism about value: some help for invariabilists

G.E. Moore’s principle of organic unity holds that the intrinsic value of a whole may differ from the sum of the intrinsic values of its parts. Moore combined this principle with invariabilism about intrinsic value: An item’s intrinsic value depends solely on its bearer’s intrinsic properties, not on which wholes it has membership of. It is often said that invariabilism ought to be rejected in favour of what might be called ‘conditionalism’ about intrinsic value. This paper is an attempt to show how invariabilism might be filled out in ways that allow its proponents to answer their conditionalist opponents. The main point consists in identifying how some amount of extrinsic part-value may contribute to whole-value that is nevertheless intrinsic. This enables an invariabilist to explain how the intrinsic value of a whole may differ from the sum of its intrinsic part-values, without abandoning the Moorean doctrine that intrinsic value supervenes on intrinsic properties (the proposal is nevertheless consistent with the view that invariabilist and conditionalist accounts might exist side by side). I finish with a brief explanation of how the main proposal could help construct invariabilist accounts of particular organic unities, looking beyond the more general argument they have with conditionalists.     

A broken relationship

These words were written at the conclusion of my Jungian analysis. As I wrote, I did not know the doctor's unexplained absence was due to an illness which would cause his death. Truly, the light that once glowed between us did not glow again.     

Religiosity and Fear of Death: A Theory-Oriented Review of the Empirical Literature

Do religious people fear death more or less than those who are nonreligious? According to two theories, religiosity and fear of death should be inversely correlated. A third theory suggests that moderately religious persons should be more fearful than those who are extremely religious or nonreligious. Yet a fourth theory predicts that religiosity and fear of death should be positively correlated. Eighty-four studies were located in which pertinent findings have been presented, several of which reached more than one conclusion based on different definitions of religiosity. Overall, 40 studies provided findings supporting the conclusion that religiosity and fear of death are inversely correlated, nine supported a curvilinear relationship, 27 supported a positive correlation, and 32 indicated that no significant relationship exists between religiosity and fear of death. Chi square analyses of several features of these conflicting studies suggest that there is probably a modest negative correlation between religiosity and fear of death among persons who are at least modestly religious. However, when nonreligious individuals are sampled alongside those who are both moderately and extremely religious, the overall relationship shifts to being curvilinear, and possibly even positive, depending on the aspect of religiosity being assessed. The implications of these conclusions for the four theories are discussed.