Treatment of pharmacotherapy-refractory posttraumatic stress disorder among Cambodian refugees: a pilot study of combination treatment with cognitive-behavior therapy vs sertraline alone

Cambodian refugees with posttraumatic stress disorder (PTSD) represent a cohort in severe need of treatment, but little information is available to guide treatment choices. We selected a sample of pharmacotherapy-refractory individuals to test the efficacy of combination treatment with sertraline and cognitive-behavior therapy (CBT) for treating PTSD. Participants in this pilot study were ten Khmer-speaking women who had been at a mean age of 22-26 years during the Pol Pot period (1975-1979). These patients were randomly assigned to either sertraline alone or combined treatment. We found that combined treatment offered additional benefit in the range of medium to large effect sizes for PTSD and associated symptoms. Our findings indicate that substantial gains can be achieved by adding CBT to pharmacotherapy for PTSD, and that a program of CBT emphasizing information, exposure, and cognitive-restructuring can be successfully modified for Khmer-speaking refugees.     

The Meta-Cognitive Beliefs Questionnaire: development of a measure of obsessional beliefs

A 67 item self-report questionnaire called the Meta-Cognitive Beliefs Questionnaire (MCBQ) was developed to assess endorsement of beliefs about the importance of control and negative consequences associated with unwanted, ego-dystonic intrusive thoughts, images and impulses. The MCBQ and a battery of questionnaires that assessed symptoms and cognitions of worry, obsessive-compulsive disorder, anxiety, and depression were administered to large samples of undergraduate students. Beliefs about control of intrusive thoughts and perceived negative consequences due to uncontrolled mental intrusions had a unique significant relationship with obsessions, and to a lesser extent, worry. These findings are consistent with current cognitive behavioral theories that suggest an important role for meta-cognitive beliefs in the pathogenesis of obsessions.     

Suppressing unwanted memories: where there is a will,there is a way?

Research suggests that suppressing unwanted thoughts, generally, is an ineffective thought control strategy, because suppression attempts oftentimes fail, and, furthermore, result in a paradoxical increase of unwanted thoughts, later on. The present study sought to investigate whether manipulated expectations about suppression efficacy determine actual effects of suppression attempts. To test this hypothesis, participants listened to an audiotaped story, and were subsequently appointed to one of four conditions: a no-instruction-control (n = 20), suppression (n = 20), suppression-works (n = 20; participants were told that suppression generally is a fruitful strategy), or suppression-does-not-work (n = 25; participants were told that suppression primarily has paradoxical effects) condition. Two hours later, participants' memories of the story were tested, and several metamemory questions were answered. Induced expectations actually determined the perceived efficacy of suppression attempts, as well as thought frequency, although perceived or actual accuracy of recollections was not affected by the instructions.     

Higher levels of state depression in masculine than in feminine nations

Studies using identical measures have identified different levels of depression in different countries or cultures. Until now, however, explanations for such differences, other than methodological ones, have not been empirically addressed. It was hypothesized and found that soft or feminine nations in which both women and men are offered equal opportunities for the fulfillment of multiple social roles that are associated with good self-rated health would score significantly lower on national depression levels than tough or masculine societies in which such opportunities exist to a clearly lesser extent. Analyses of data collected in 14 nations in Europe (total N>5000) demonstrated that higher scores on Hofstede's national masculinity index and lower ones on national wealth were independent predictors of higher national depression levels. National trait neuroticism did not mediate the relationship between national masculinity and national depression levels.     

Perseverative responding in a violation-of-expectation task in 6.5-month-old infants

In the present research, 6.5-month-old infants perseverated in a violation-of-expectation task designed to examine their reasoning about width information in containment events. After watching a familiarization event in which a ball was lowered into a wide container, the infants failed to detect the violation in a test event in which the same ball was lowered into a container only half as wide as the ball (narrow-container test event). This negative result (which was replicated in another experiment) was interpreted in terms of a recent problem-solving account of infants' perseverative errors in various means-end tasks (Aguiar, A., & Baillargeon, R. (2000). Perseveration and problem solving in infancy. In H. W. Reese (Ed.), Advances in child development and behavior (Vol. 27, pp. 135-180). San Diego, CA: Academic Press). It was assumed that the infants in the present experiments (1) did not attend to the relative widths of the ball and container in their initial analysis of the narrow-container test event, (2) categorized the event as similar to the familiarization event shown on the preceding trials, and (3) retrieved the expectation they had formed for that event ("the ball will fit into the container"), resulting in a perseverative error. This interpretation was supported by additional experiments in which different modifications were introduced that led to non-perseverative responding, indicating that 6.5-month-old infants could detect the violation in the narrow-container test event. The present findings are important for several reasons. First, they provide the first demonstration of perseverative responding in a violation-of-expectation task. Second, they make clear the breadth and usefulness of the problem-solving account mentioned above. Finally, they add to the evidence for some degree of continuity between infants' and adults' problem-solving abilities.     

The future of the American Group Psychotherapy Association: whither we goest?

The author describes his perspective about what the future holds for the American Group Psychotherapy Association (AGPA). Utilizing Nitsun's (1996) construct of the "anti-group" as an organizing metaphor, he delineates the destructive forces both within and outside the organization that are currently affecting it, and then describes how they can be transformed into instruments for positive development. He suggests that the AGPA can and must continue to provide a "holding environment" (Winnicott, 1960) for professionals interested in working with people in groups. In addition, he asserts that the organization will build upon its remarkable response to the September 11, 2001 debacle in the United States to expand its services to those who have been traumatized. Beyond this, he underscores the importance of the AGPA consolidating and expanding its various educational offerings into a coherent package that will meet the needs of any and all who are interested in learning about how to work effectively with groups. In these and other ways, he contends that the AGPA will thereby confirm Nitsun's assertion that anti-group forces can be transformed, and that organizations that confront these forces constructively can not only survive but thrive.     

Interidentity amnesia for neutral,episodic information in dissociative identity disorder

Interidentity amnesia is considered a hallmark of dissociative identity disorder (DID) in clinical practice. In this study, objective methods of testing episodic memory transfer between identities were used. Tests of both recall (interference paradigm) and recognition were used. A sample of 31 DID patients was included. Additionally, 50 control subjects participated, half functioning as normal controls and the other half simulating interidentity amnesia. Twenty-one patients subjectively reported complete one-way amnesia for the learning episode. However, objectively, neither recall nor recognition scores of patients were different from those of normal controls. It is suggested that clinical models of amnesia in DID may be specified to exclude episodic memory impairments for emotionally neutral material.     

A categorical and dimensional perspective on depression within a nonclinical sample of couples

The present study investigated the role of psychosocial variables that are indicators for depressive symptomatology within a couple. The variables chosen for this study were conflict communication, marital adjustment, attachment, attribution style, and personality traits--all potentially specific indicators. A global factor analysis on all our measures revealed that our individual and relational measures were stable findings. We wanted to compare a dimensional and categorical view of depression. First, we focused on the total nonclinical sample, considering depression on a continuum, and studying the selected characteristics along with the varying degree of depressive complaints. The results highlighted the importance of individual characteristics (neuroticism and life satisfaction) covarying with the level of depressive symptomatology in the nonclinical sample (n = 186 couples). Second, in addition to this correlational design, we compared the group of most depressed subjects and their partners with a control sample (n = 34). Both approaches pointed to the same conclusion: individual characteristics covaried with mild depression, whereas couple characteristics only came into the picture with a higher level of depressive complaints. The lowest levels of depressive complaints were associated with individual co-morbidity only, whereas increasing complaints went along with additional relational complaints. Implications for assessment and future research are discussed.     

Pathways to violence in the children of mothers who were depressed postpartum

The impact of postnatal depression on a child's risk for violent behavior was evaluated in an urban British community sample (N=122 families). Mothers were interviewed during pregnancy, at 3 months postpartum, and when the child was 1, 4, and 11 years of age. Mothers, teachers, and children reported on violent symptoms at age 11. Structural equation modeling revealed that the child's violence was predicted by the mother's postnatal depression even when her depression during pregnancy, her later history of depression, and family characteristics were taken into account. Violence was associated with symptoms of attention-deficit/hyperactivity disorder and problems with anger management. Children were most violent if mothers had been depressed at 3 months and at least once thereafter.