First‐line therapy for post‐traumatic stress disorder: A systematic review of cognitive behavioural therapy and psychodynamic approaches

Background

Despite evidence supporting cognitive behavioural therapy (CBT)‐based interventions as the most effective approach for treating post‐traumatic stress disorder (PTSD) in randomised control trials, alternative treatment interventions are often used in clinical practice. Psychodynamic (PDT)‐based interventions are one example of such preferred approaches, this is despite comparatively limited available evidence supporting their effectiveness for treating PTSD.

Aims

Existing research exploring effective therapeutic interventions for PTSD includes trauma‐focused CBT involving exposure techniques. The present review sought to establish the treatment efficacy of CBT and PDT approaches and considers the potential impact of selecting PDT‐based techniques over CBT‐based techniques for the treatment of PTSD.

Results

The evidence reviewed provided examples supporting PDT‐based therapy as an effective treatment for PTSD, but confirmed CBT as more effective in the treatment of this particular disorder. Comparable dropout rates were reported for both treatment approaches, suggesting that relative dropout rate should not be a pivotal factor in the selection of a PDT approach over CBT for treatment of PTSD.

Conclusion/Implications

The need to routinely observe evidence‐based recommendations for effective treatment of PTSD is highlighted and factors undermining practitioner engagement with CBT‐based interventions for the treatment of PTSD are identified.     

Facilitation of attitude formation through communication: how perceived source expertise enhances the ability to achieve cognitive closure about complex environmental topics

Attitudes on which people have achieved cognitive closure are better predictors of future attitudes and behavior than open attitudes. In two experiments, we found that factors in communication (source identity, source consensus) can enhance people's ability to achieve cognitive closure on complex environmental topics through an increase in perceived source expertise. Results showed that participants perceived higher levels of source expertise and felt better able to achieve cognitive closure on the environmental technology of carbon dioxide capture and storage (CCS) when the information source had an expert identity compared to a non‐expert identity. The communication of consensus by the information source increased the level of expertise ascribed to the non‐expert source, resulting in an enhanced ability to achieve closure.     

“Hammered down on every side” versus “just being positive”: A critical discursive approach to health inequality

Socio‐economic and health inequality are strongly linked and are increasingly perpetuated by discourses of individual responsibility. However, little research from a critical discursive perspective has addressed how people affected themselves may account for this relationship. This research examined the ways in which people who are in debt, unemployed, or in insecure, minimum‐wage employment construct health and negotiate identities around it. Data from semistructured interviews with 6 participants were analysed and 3 main interpretative repertoires were identified: a medical repertoire of health as a lack of illness; health as adopting the “right” behaviours and attitudes; and health as being heavily influenced by external factors, such as income and life circumstances. The analysis focuses on how participants managed the tension between these latter 2 repertoires by adopting various subject positions around health: that it is “slipping” away from them; that it requires motivation; and that it is unattainable. Underpinning this is a “common‐sense” idea of health as something that is worked towards through culturally approved actions and attitudes.     

Choosing among multiple alternatives: Relative and overall reinforcer rates

Choice behavior among two alternatives has been widely researched, but fewer studies have examined the effect of multiple (more than two) alternatives on choice. Two experiments investigated whether changing the overall reinforcer rate affected preference among three and four concurrently scheduled alternatives. Experiment 1 trained six pigeons on concurrent schedules with three alternatives available simultaneously. These alternatives arranged reinforcers in a ratio of 9:3:1 with the configuration counterbalanced across pigeons. The overall rate of reinforcement was varied across conditions. Preference between the pair of keys arranging the 9:3 reinforcer ratio was less extreme than the pair arranging the 3:1 reinforcer ratio regardless of overall reinforcer rate. This difference was attributable to the richer alternative receiving fewer responses per reinforcer than the other alternatives. Experiment 2 trained pigeons on concurrent schedules with four alternatives available simultaneously. These alternatives arranged reinforcers in a ratio of 8:4:2:1, and the overall reinforcer rate was varied. Next, two of the alternatives were put into extinction and the random interval duration was changed from 60 s to 5 s. The ratio of absolute response rates was independent of interval length across all conditions. In both experiments, an analysis of sequences of visits following each reinforcer showed that the pigeons typically made their first response to the richer alternative irrespective of which alternative was just reinforced. Performance on these three‐ and four‐alternative concurrent schedules is not easily extrapolated from corresponding research using two‐alternative concurrent schedules.     

Minding the Dreamer Within: An Experimental Study on the Effects of Enhanced Dream Recall on Creative Thinking

Several studies have found an association between frequency of dream recall and creativity. We tested the hypothesis that training individuals to increase dream recall by means of a daily dream log would increase scores on the Torrance Test of Creative Thinking (TTCT). One hundred twenty‐five participants completed a baseline measure of creativity (TTCT, figural version) as well as of dream recall, dissociation, thinness of psychological boundaries, mindful‐attention awareness, and well‐being. Participants were randomly allocated to two groups: the experimental group (n = 55) received a daily dream log; while the control group (n = 32) received a similarly phrased log registering memories of a vivid episode from the previous day. After 27 days, all participants completed follow‐up measurements identical to those at baseline. A non‐randomized non‐intervention group (n = 35) was used to test for practice effects on the TTCT. There was significant selective increase for the “creative strengths” component, which was only observed in the experimental group. There were significant correlations between creativity and dissociation as well as between creativity and thinness of psychological boundaries. Enhanced dream recall through daily dream logging fosters aspects of creativity. Associations between creativity, dissociation, and thinness of boundaries, suggest that increased awareness to dreams increases creativity through a “loosening” of stereotyped thinking pattern.     

Validation of a questionnaire for measuring psychosocial factors associated with pharmaceutical care in Spanish community pharmacists

Pharmacotherapy follow-up (PTF) is the professional practice in which the pharmacist takes charge of the needs of the patients related to their drugs. OBJECTIVE: To validate a questionnaire to measure the ASE psychosocial determinants (attitude, social influence, self-efficacy) of PTF and the Prochaska & DiClemente's stage of change in Spanish community pharmacists. METHOD: Postal survey to 482 Asturian community pharmacists (test and retest). Validity was estimated in 134 pharmacists answering the test. Stability was estimated in 85 pharmacists answering the test and retest. Exploratory factorial analysis was used to investigate construct validity and produced 4 factors and 104 items. Those factors had high reliability (Cronbach's a between 0,87 and 0,96). DISCRIMINANT VALIDITY: Pharmacists in extreme stages of change showed significant differences of attitude, motivation and self-efficacy. Repeatability was good and the questionnaire appears valid and reliable.     

Imitation of hierarchical action structure by young children

To provide the first systematic test of whether young children will spontaneously perceive and imitate hierarchical structure in complex actions, a task was devised in which a set of 16 elements can be modelled through either of two different, hierarchically organized strategies. Three-year-old children showed a strong and significant tendency to copy whichever of the two hierarchical approaches they witnessed an adult perform. Responses to an element absent in demonstrations, but present at test, showed that children did not merely copy the chain of events they had witnessed, but acquired hierarchically structured rules to which the new element was assimilated. Consistent with this finding, children did not copy specific sequences of actions at lower hierarchical levels.