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.     

Drawing to reconstruct: Pilot study on acknowledging prisoners' internal and external resources in a penitentiary institution

Since the first offender rehabilitation treatments, all theoretical approaches have been focusing on reducing risk factors that may influence recidivism, without satisfactory results. Recent resilience research has instead shown the important mediating or moderating role of protective factors and provided the theoretical principles for the Good Lives Model Comprehensive. This holistic model suggests the importance of integrating the reduction of risk factors with the reinforcement of protective factors in offenders' treatment programs. This combined action is considered the main condition through which offenders are motivated to change their life and develop a sense of agency on their current life conditions. This article presents a pilot study, aimed at analyzing the feasibility of a psychosocial intervention, based on graphic workshops. The purpose of the intervention is helping prisoners strive toward adaptation in jail, and facilitating the redesign of their life beyond bars. Drawing activities allowed prisoners to enhance their own internal and external resources, and recognize risk and protective factors that could influence their successful reintegration into society. The main limit of this study is directly linked to the setting of the penitentiary institution where the study was conducted, which is characterized by a high prisoners' turn over.     

A Review of the Use of Trauma Systems Therapy to Treat Refugee Children,Adolescents, and Families

ABSTRACT

Children and adolescents within refugee families face adverse childhood experiences emanating from multiple sources. These traumatic events can begin with persecution within their country of origin, during the migration process, and within their re-settled countries. More specifically, these children and their families are more prone to the four core stressors being: traumatic, acculturative, isolative and resettlement stress. Trauma Systems Therapy for Refugees (TST-R) is a promising treatment model to address child and adolescent mental health disparities revolving around direct and vicarious trauma. In TST-R, the treatment team systematically targets the needs of the child, while collaborating with cultural brokers from the refugee community, their school, and family unit. Researchers have used TST-R as an intervention for reducing trauma symptoms in Somali, Somali-Bantu, and Bhutanese children, adolescents, and their families. We review the strengths and limitations of this model. Further research is needed to determine its applicability to other communities within the United States and abroad.     

The role of stimulus preexposure in problem solving by Octopus vulgaris

Octopus vulgaris is able to open transparent glass jars closed with plastic plugs and containing live crabs. The decrease in performance times for removing the plug and seizing the prey with increasing experience of the task has been taken to indicate learning. However, octopuses’ attack behaviors are typically slow and variable in novel environmental situations. In this study the role of preexposure to selected features of the problem-solving context was investigated. Although octopuses failed to benefit from greater familiarity with the training context or with selected elements of the task of solving the jar problem, the methodological strategies used are instructive in potentially clarifying the role of complex problem-solving behaviors in this species including stimulus preexposure and social learning. Received: 27 April 1998 / Accepted after revision: 24 July 1998     

Family Traditions,Cultural Values,and the Clinician's Countertransference: Therapeutic Assessment of a Young Sicilian Woman

Despite recent advances in models and instruments to understand the role of a client's cultural background, clinical psychologists are not immune to implicit cultural biases that are potentially damaging to the therapeutic alliance. In this article, I present a Therapeutic Assessment with a young Sicilian woman conducted in a university-based student clinic in Italy. During the assessment, I assumed that because we were both Italians, my client shared my perspective (northern Italian) about family and individual values, which resulted in a therapeutic impasse when I responded on the basis of my individual and culturally shaped view of interpersonal and family relationships without appreciating important differences between my own and my client's microcultures. To overcome the impasse, I had to openly acknowledge such differences and reorient myself to my client's goals. I discuss the core processes involved in such a repair in the context of a cross-cultural psychological assessment.     

Protest Against Waste Contamination in the ‘Land of Fires’: Psychological Antecedents for Activists and Non‐activists

The ‘Land of Fires’ is a district in Italy characterized by illegal waste disposal, waste burning, and citizen protests over contamination. This study investigates the relevance of several psycho‐social factors that predict citizens' intention to protest, taking into account different research traditions. In addition, we hypothesize the effect of protest antecedents to be moderated by past participation behaviour (i.e. the level of activism). Hence, our study is a first attempt to explore the effect of protest antecedents as a function of the individual level of activism through a cross‐sectional survey study (N = 306). The results show significant effects of collective identity, sense of injustice, costs of protest, and perceived risk (cognitive dimension) on intention to protest. The effects of collective efficacy and perceived risk (affective dimension) are moderated by participants' level of activism, and these effects are significant only for non‐activists. The relevance of this new approach is discussed, as well as practical implications and possible further developments. Copyright © 2016 John Wiley & Sons, Ltd.     

Parenting Dimensions and Internalizing Difficulties in Italian and U.S. Emerging Adults: The Intervening Role of Autonomy and Relatedness

The present study examined the associations between emerging adults’ perceived parental psychological control and autonomy support, and their autonomy, relatedness and internalizing difficulties in Italy and the U.S. The participants included 494 Italian and 414 U.S. college students, between 18 and 28 years of age (Mean = 21.58, SD = 2.18). Our findings showed that dependency-oriented psychological control had no significant direct associations with autonomy, relatedness or internalizing difficulties. Moreover, the association between parental autonomy support and internalizing problems was fully intervened by autonomy and relatedness, whereas the association between achievement-oriented psychological control and anxiety and depressive symptoms was partially intervened by autonomy and relatedness. Finally, although parental psychological control and autonomy support had similar effects on maladjustment across the two countries, relatedness appeared to play a more central role as an intervening variable for anxiety in the Italian group than in the U.S. group. Overall, our findings highlighted the importance of examining parents’ contributions to emerging adults’ internalizing problems via autonomy support and psychological control across cultures.     

Mental rotation training: transfer and maintenance effects on spatial abilities

One of the aims of research in spatial cognition is to examine whether spatial skills can be enhanced. The goal of the present study was thus to assess the benefit and maintenance effects of mental rotation training in young adults. Forty-eight females took part in the study: 16 were randomly assigned to receive the mental rotation training (based on comparing pairs of 2D or 3D objects and rotation games), 16 served as active controls (performing parallel non-spatial activities), and 16 as passive controls. Transfer effects to both untrained spatial tasks (testing both object rotation and perspective taking) and visual and verbal tasks were examined. Across the training sessions, the group given mental rotation training revealed benefits in the time it took to make judgments when comparing 3D and 2D objects, but their mental rotation speed did not improve. When compared with the other groups, the mental rotation training group did show transfer effects, however, in tasks other than those practiced (i.e., in object rotation and perspective-taking tasks), and these benefits persisted after 1 month. The training had no effect on visual or verbal tasks. These findings are discussed from the spatial cognition standpoint and with reference to the (rotation) training literature.