Suicide and self-inflicted injuries

The present study addressed itself to the problem of self-inflicted injuries (SII) in the Israeli army, and to the wider question whether non-fatal self injuries and suicide are part of the same phenomenon. The findings show that in some cases SII is an unsucessful suicide while in others SII is anything but a reflection of a death wish. It appears that the modus operandi is a major indication as to the intentions of the actor. The study also demonstrates the difference between the population of the suiciders and that of the SII victims. While suiciders seem to score higher on the Performance Prediction Score (PPS) and Combat Suitability Scale, the SII population seems to be overly represented in the lower parts of the PPS and the Combat Suitability Scale. The study used a data set that represents a 5 year period, and followed the consequences of the SII in terms of medical status and occupational assignment of the actors. The findings yielded some possible policy implications, in terms of a better classification of the relevant populations, and a possible attribution of a more refined meaning to the behavior. © 1994 Wiley-Liss, Inc.     

Propranolol and the prevention of post-traumatic stress disorder: is it wrong to erase the "sting" of bad memories?

The National Institute of Mental Health (Bethesda, MD) reports that approximately 5.2 million Americans experience post-traumatic stress disorder (PTSD) each year. PTSD can be severely debilitating and diminish quality of life for patients and those who care for them. Studies have indicated that propranolol, a beta-blocker, reduces consolidation of emotional memory. When administered immediately after a psychic trauma, it is efficacious as a prophylactic for PTSD. Use of such memory-altering drugs raises important ethical concerns, including some futuristic dystopias put forth by the President's Council on Bioethics. We think that adequate informed consent should facilitate ethical research using propranolol and, if it proves efficacious, routine treatment. Clinical evidence from studies should certainly continue to evaluate realistic concerns about possible ill effects of diminishing memory. If memory-attenuating drugs prove effective, we believe that the most immediate social concern is the over-medicalization of bad memories, and its subsequent exploitation by the pharmaceutical industry.     

Commentary on Paper by Aviva Gottlieb Zornberg

In this discussion, I stress two points. First, I have underlined the powerful understanding Dr. Zornberg brings to her exegesis of the book of Jonah via her competence as Biblical scholar, literary critic, and master of psychoanalytic theory. In her hands, Jonah becomes a fully minded person, not just a moral icon. Second, I have focused on her major thesis, that Jonah's need to escape, his repeated going down into and away from himself, evolves from his putative trauma, which is comprised of not only the horror of near death but also the shock of survival.     

Propranolol and the Prevention of Post-Traumatic Stress Disorder: Is it Wrong to Erase the “Sting” of Bad Memories?

The National Institute of Mental Health (Bethesda, MD) reports that approximately 5.2 million Americans experience post-traumatic stress disorder (PTSD) each year. PTSD can be severely debilitating and diminish quality of life for patients and those who care for them. Studies have indicated that propranolol, a beta-blocker, reduces consolidation of emotional memory. When administered immediately after a psychic trauma, it is efficacious as a prophylactic for PTSD. Use of such memory-altering drugs raises important ethical concerns, including some futuristic dystopias put forth by the President's Council on Bioethics. We think that adequate informed consent should facilitate ethical research using propranolol and, if it proves efficacious, routine treatment. Clinical evidence from studies should certainly continue to evaluate realistic concerns about possible ill effects of diminishing memory. If memory-attenuating drugs prove effective, we believe that the most immediate social concern is the over-medicalization of bad memories, and its subsequent exploitation by the pharmaceutical industry.     

Cognitive behavioral therapy in practice: treatment delivered by trainees at an outpatient clinic is clinically effective

Cognitive–behavioral therapy (CBT) is known to be effective for a number of disorders, and can be delivered effectively by trainees in controlled settings. However, the effectiveness of trainee therapists in general practice compared to that of more experienced therapists is unknown. In this study, the authors used a benchmarking strategy to compare the outcomes of naturalistic CBT delivered by trainee therapists to those of efficacy and effectiveness studies using primarily professional therapists. Patients (N = 249) with mood and anxiety disorders were treated by trainees (primarily by interns and postdocs) using nonstandardized nonmanualized CBT at an outpatient clinic in an urban academic medical center. Changes in anxiety and depression were assessed using effect sizes, reliable and clinically significant change, and benchmarked to efficacy and effectiveness studies. Symptoms of anxiety and depression significantly improved from start to end of treatment. Rates of improvement and recovery compared favorably to those achieved in other studies, with the exception of recovery rates in severe depression. Effect sizes were in the medium to large range, but generally lower than those achieved in other studies. Results suggest that CBT can be delivered effectively by trainees in an outpatient setting.     

Barriers and facilitators to public bicycle scheme use: A qualitative approach

The purpose of this study was to explore barriers and facilitators to using CityCycle, a public bicycle share scheme in Brisbane, Australia. Focus groups were conducted with participants belonging to one of three categories. Group one consisted of infrequent and non-cyclists (no bicycle riding over the past month), group two were regular bicycle riders (ridden a bicycle at least once in the past month) and group three was composed of CityCycle members. A thematic analytic method was used to analyse the data. Three main themes were found: Accessibility/spontaneity, safety and weather/topography. The lengthy sign-up process was thought to stifle the spontaneity typically thought to attract people to public bike share. Mandatory helmet legislation was thought to reduce spontaneous use. Safety was a major concern for all groups and this included a perceived lack of suitable bicycle infrastructure, as well as regular riders describing a negative attitude of some car drivers. Interestingly, CityCycle riders unanimously perceived car driver attitudes to improve when on CityCycle bicycles relative to riding on personal bicycles. Conclusions: In order to increase the popularity of the CityCycle scheme, the results of this study suggest that a more accessible, spontaneous sign-up process is required, 24/7 opening hours, and greater incentives to sign up new members and casual users, as seeing people using CityCycle appears critical to further take up.