A review of research on smoking among United States Veterans with posttraumatic stress disorder (2006–2016)

Posttraumatic stress disorder (PTSD) is one of the most common psychiatric disorders diagnosed in U.S. veterans. PTSD is associated with high smoking prevalences and difficulty quitting in the general U.S. population. The current study reviewed research on smoking and PTSD in U.S. veteran samples to summarize past research and identify areas in need of additional inquiry. MEDLINE and PsycINFO searches identified papers on smoking in samples of U.S. veterans with PTSD published from January 2006 through December 2016. Thirty-four articles met all of the inclusion criteria: (a) part of the sample consisted of U.S. veterans with PTSD or PTSD symptoms, and (b) the study examined some aspect of smoking behavior. U.S. veterans with PTSD were more likely to report smoking, heavy smoking, nicotine dependence, and late-onset smoking compared to veterans without PTSD. Smoking behaviors (e.g., current smoking, heavy smoking, smoking expectancies) differed by PTSD symptoms and by combat exposure. Smoking cessation feasibility studies examined the integration of smoking treatment into PTSD clinics and found favorable outcomes. Future research on veterans with PTSD would benefit from extending topics beyond rates of smoking to better understand the treatment needs of veterans. Research on smoking-related behaviors can help identify areas to target for interventions.     

Mothers’ neural responses to infant faces are associated with activation of the maternal care system and observed intrusiveness with their own child

Certain infant facial characteristics, referred to as baby schema, are thought to automatically trigger parenting behavior and affective orientation toward infants. Electroencephalography (EEG) is well suited to assessing the intuitive nature and temporal dynamics of parenting responses, due to its millisecond temporal resolution. Little is known, however, about the relations between neural processing of infant cues and actual parenting behavior in a naturalistic setting. In the present study we examined the event-related potentials (ERPs) of mothers (N = 33) watching infant faces of varying attractiveness, in relation to activation of the maternal care system and the mothers’ observed parenting behavior (sensitivity, nonintrusiveness) with their own child (2–6 years old). The results revealed that, irrespective of the cuteness of the infant face, mothers’ neural processing of infant faces involved both early P1 and P2 components (related to orienting/detecting processes) and late positive potentials (LPPs; related to more controlled cognitive evaluation/attentional engagement). Increased early detection and processing of infant faces (reflected by P1 and P2 activity) was related to increased activation of the parental care system. In later stages of face processing, increased attentional engagement with infant faces (as reflected by LPP activity) was associated with more intrusiveness of a mother with her own child during interaction. These findings suggest that individual variations in responses to infant stimuli are associated with individual differences in parental care system activation and parenting quality. Furthermore, the parental care system might be activated relatively automatically, but actual parenting and caregiving behavior requires more conscious control.     

Reduction of Health Care Costs and Improved Appropriateness of Incoming Test Orders: the Impact of Genetic Counselor Review in an Academic Genetic Testing Laboratory

The goal of this study was to evaluate the impact of genetic counselor (GC) review of incoming test orders received in an academic diagnostic molecular genetics laboratory. The GC team measured the proportion of orders that could be modified to improve efficiency or sensitivity, tracked provider uptake of GC proposed testing changes, and calculated the health care dollar savings resulting from GC intervention. During this 6-month study, the GC team reviewed 2367 incoming test orders. Of these, 109 orders (4.6%) were flagged for review for potentially inefficient or inappropriate test ordering. These flagged orders corresponded to a total of 51 cases (1–5 orders for each patient), representing 54 individuals and including 3 sibling pairs. The GC team proposed a modification for each flagged case and the ordering providers approved the proposed change for 49 of 51 cases (96.08%). For the 49 modifications, the cost savings totaled $98,750.64, for an average of $2015.32 saved per modification. This study provides evidence of the significant contribution of genetic counselors in a laboratory setting and demonstrates the benefit of laboratories working with ordering providers to identify the best test for their patients. The review of test orders by a genetic counselor both improves genetic test ordering strategies and decreases the amount of health care dollars spent on genetic testing.     

A Phenomenological Inquiry Into Counselor of Color Broaching Experiences

Broaching, or the acknowledgment of racial and cultural factors, is a strategy for counselors working with diverse client populations. In this phenomenological study, the authors explored the lived experiences of 8 professional counselors of color regarding their broaching behaviors. The authors present 4 resulting themes (intentionality, considering impacts on client experiences, influence of counselor's discomfort on broaching, and broaching skills and practices) and discuss implications for counselor practice and training.     

The intersubjective responsibility of durational trauma: Contributions of Bergson and Levinas to the philosophy of trauma

Continental Philosophy Review - In public discourse trauma is predominantly framed as an overwhelming event undergone by the individual. In this article I first provide a brief genealogy to trace...     

Need for speed: Evaluating slopes of OCD recovery in behavior therapy enhanced with d-cycloserine

Evidence suggests that the antibiotic d-cycloserine (DCS) enhances the treatment effects of exposure and response prevention (ERP) for Obsessive-Compulsive Disorder (OCD). Further, evidence suggests that the effects of DCS diminish partway through treatment, but it is unclear to what extent. In an effort to evaluate these issues, the current study re-analyzes data from a 10-session randomized controlled trial of ERP + DCS versus ERP + placebo in a sample of 22 adults with OCD. We analyzed repeated-measures mixed models with random slopes and intercepts across different intervals: sessions 1-10, 1-5, and 6-10. The results indicate that the course of ERP was 2.3 times faster over the full 10 sessions for the DCS compared to the placebo group, and nearly six times quicker in the first half of ERP. Further interpretation of the results suggests that DCS does not amplify the effects of ERP, but instead initiates treatment effects sooner in treatment. In addition, DCS does not necessarily lose its effect over repeated use, but instead may exhaust its maximum utility after effectively jump-starting ERP. Ultimately, DCS may provide a means for curtailing treatment costs, decreasing treatment dropout and refusal rates, and enhancing access to care.     

Brief Report: Physician Narcissism,Ego Threats,and Confidence in the Face of Uncertainty

Although adequate self‐esteem is essential for psychological health, people with high but fragile self‐esteem have been shown to exhibit defensive, often aggressive behavior when their self‐esteem is threatened. We measured physician narcissism (as a proxy for high but fragile self‐esteem) and used a subtle manipulation to examine how physicians who varied in levels of narcissism responded to an ego threat. We found that physicians high in narcissism, as compared with those lower in narcissism, were more likely to respond to ego threat by attempting to bolster their self‐image. Concerned about self‐image, physicians in this situation may be insufficiently receptive to new information and instead attempt to justify initial opinions.     

Priming attachment security improves attitudes towards a range of therapies

We sought to understand how attachment orientation influenced attitudes towards different types of psychological therapies. In two studies, we (1) examined attachment orientation as a predictor of attitudes towards different therapies and (2) tested whether attachment security priming could improve attitudes. Study 1 (n = 339) found associations between attachment orientation and attitudes towards, and likelihood of using different therapies. Positive and negative attitudes about different therapies mediated the relationship between attachment avoidance and likelihood of use. Study 2 (n = 412) showed that primed security (vs. neutral prime) improved attitudes towards relational, non‐relational and distanced‐relational therapies for those with a fearful‐avoidant attachment orientation. For relational and distanced‐relational therapies, the mechanism of this effect was increased cognitive openness. Attachment orientation is a determinant of therapy attitudes and anticipated help‐seeking behaviour. Priming security may promote open‐minded decision‐making about some therapies. Findings are discussed with relevance to attachment theory, research and clinical practice.     

Initiation of evidence-based psychotherapies in Veterans with posttraumatic stress disorder

The Department of Veterans Affairs (VA) requires that all VA hospitals and clinics provide access to evidence-based psychotherapies (EBPs). Despite these widespread dissemination efforts, only a minority of Veterans receive EBP services. Reasons for these low rates of EBP utilization are largely unknown. This study examined the characteristics of Veterans with posttraumatic stress disorder (PTSD) who did (Initiation group) and did not (No-Initiation group) initiate a VA-approved EBP after participating in an information session. Veterans chose their preferred treatment from a menu of EBPs. Results demonstrated that Veterans in the No-Initiation group had longer periods of time between their referral and first EBP visit. Among Veterans in the Initiation group, the majority (68%) initiated a trauma-focused EBP as their first or second treatment, suggesting that providing a range of treatment options did not negatively impact their willingness to engage in PTSD treatment. Results are discussed in terms of VA initiatives to improve access to and initiation of mental health care for Veterans.     

Longitudinal relationships between speech perception,phonological skills and reading in children at high‐risk of dyslexia

Speech perception deficits are commonly reported in dyslexia but longitudinal evidence that poor speech perception compromises learning to read is scant. We assessed the hypothesis that phonological skills, specifically phoneme awareness and RAN, mediate the relationship between speech perception and reading. We assessed longitudinal predictive relationships between categorical speech perception, phoneme awareness, RAN, language, attention and reading at ages 5½ and 6½ years in 237 children many of whom were at high risk of reading difficulties. Speech perception at 5½ years correlated with language, attention, phoneme awareness and RAN concurrently and was a predictor of reading at 6½ years. There was no significant indirect effect of speech perception on reading via phoneme awareness, suggesting that its effects are separable from those of phoneme awareness. Children classified with dyslexia at 8 years had poorer speech perception than age‐controls at 5½ years and children with language disorders (with or without dyslexia) had more severe difficulties with both speech perception and attention control. Categorical speech perception tasks tap factors extraneous to perception, including decision‐making skills. Further longitudinal studies are needed to unravel the complex relationships between categorical speech perception tasks and measures of reading and language and attention.