Cross-Lagged Relationships Between Insomnia and Posttraumatic Stress Disorder in Treatment-Receiving Veterans

Insomnia is a risk factor for the development of posttraumatic stress disorder (PTSD) while it is also plausible that PTSD symptoms can maintain insomnia symptoms. The present study examined longitudinal bidirectional relationships between insomnia and PTSD symptoms in treatment-seeking veterans. Participants were 693 ex-serving members of the Australian Defence Force who participated in an accredited, hospital-based outpatient PTSD program. Participants completed self-reported assessments of PTSD and insomnia symptoms at four time points: intake, discharge, 3-month, and 9-months posttreatment follow-up.Cross-lagged pathway analyses indicated significant bi-directional pathways between insomnia symptoms and PTSD symptoms at most time points. A final cross-lagged model between insomnia symptoms and the PTSD symptom clusters indicated that the PTSD symptom paths on insomnia symptoms, between intake and discharge, were attributable to reexperiencing PTSD symptoms. In contrast, across posttreatment follow-up time points there were significant paths of insomnia symptoms on all PTSD symptom clusters except from insomnia at 3-months to avoidance symptom at 9-months. PTSD symptoms and insomnia symptoms have bidirectional associations over time that may lead to the mutual maintenance or exacerbation of each condition following PTSD treatment. Where residual insomnia symptoms are present post-treatment, a sleep-focussed intervention is indicated and a sequenced approach to treatment recommended.     

The panic attack-posttraumatic stress disorder model: applicability to orthostatic panic among Cambodian refugees

This article examines the ability of the panic attack-posttraumatic stress disorder (PTSD) model to predict how panic attacks are generated and how panic attacks worsen PTSD. The article does so by determining the validity of the panic attack-PTSD model in respect to one type of panic attack among traumatized Cambodian refugees: orthostatic panic (OP) attacks (i.e. panic attacks generated by moving from lying or sitting to standing). Among Cambodian refugees attending a psychiatric clinic, the authors conducted two studies to explore the validity of the panic attack-PTSD model as applied to OP patients (i.e. patients with at least one episode of OP in the previous month). In Study 1, the panic attack-PTSD model accurately indicated how OP is seemingly generated: among OP patients (N = 58), orthostasis-associated flashbacks and catastrophic cognitions predicted OP severity beyond a measure of anxious-depressive distress (Symptom Checklist-90-R subscales), and OP severity significantly mediated the effect of anxious-depressive distress on Clinician-Administered PTSD Scale severity. In Study 2, as predicted by the panic attack-PTSD model, OP had a mediational role in respect to the effect of treatment on PTSD severity: among Cambodian refugees with PTSD and comorbid OP who participated in a cognitive behavioural therapy study (N = 56), improvement in PTSD severity was partially mediated by improvement in OP severity.     

The SF-36 Among Cambodian and Vietnamese Refugees: An Examination of Psychometric Properties

Among traumatized Cambodian (N=90) and Vietnamese (N=94) refugees attending a psychiatric clinic, the study examined the validity and psychometric properties of the Short Form-36 Health Survey (SF-36), a measure of self-perceived mental and physical health. In both patient samples, all eight SF-36 scales displayed excellent internal consistency (item-scale correlations and Cronbach's α). But, similar to other studies of Asian samples, (a) the Vitality (VT) scale did not separate from the Mental Health (MH) and General Health (GH) scales, as evidenced by item-scale and interscale correlations, and (b) the VT scale loaded as strongly (Vietnamese sample) or more strongly (Cambodian sample) than the MH scale on the so-called Mental Factor in a two-factor solution of the eight scales (with the GH scale also loading heavily on the same factor).     

A Distributed Connectionist Production System

DCPS is a connectionist production system interpreter that uses distributed representations. As a connectionist model it consists of many simple, richly interconnected neuron-like computing units that cooperate to solve problems in parallel. One motivation for constructing DCPS was to demonstrate that connectionist models are capable of representing and using explicit rules. A second motivation was to show how "coarse coding" or "distributed representations" can be used to construct a working memory that requires far fewer units than the number of different facts that can potentially be stored. The simulation we present is intended as a detailed demonstration of the feasibility of certain ideas and should not be viewed as a full implementation of production systems. Our current model only has a few of the many interesting emergent properties that we eventually hope to demonstrate: It is damage-resistant, it performs matching and variable binding by massively parallel constraint satisfaction, and the capacity of its working memory is dependent on the similarity of the items being stored.     

Symptom Presentation and Symptom Meaning Among Traumatized Cambodian Refugees: Relevance to a Somatically Focused Cognitive-Behavior Therapy

Among psychologically distressed Cambodian refugees, somatic complaints are particularly prominent. Cambodians interpret anxiety-related somatic sensations in terms of “Wind” (khyâl), an ethnophysiology that gives rise to multiple catastrophic interpretations; and they have prominent trauma-memory associations to anxiety-related somatic symptoms. In this article, we detail some of the common sensation-related dysphoric networks of Cambodian refugees, focusing on catastrophic cognitions and trauma associations. We argue that delineating symptom-related dysphoric networks is crucial to successfully adapt cognitive-behavioral interventions to treat panic disorder and posttraumatic stress disorder among Cambodian refugees, and that such an approach may be useful for the culturally sensitive adaptation of cognitive-behavior therapy for other traumatized non-Western groups.     

Therapists’ Perspectives of the Cotherapy Experience in a Training Setting

The experience of cotherapy has been sparsely addressed in the literature. This qualitative study’s goals were to explore (a) the usefulness of cotherapy as a training model (b) the impact of cotherapy on services provided; (c) the impact of being trained in a cotherapy model; and (d) factors that both facilitated and hindered the process of cotherapy. The authors conducted a focus group interview with seven participants who graduated from a COAMFTE accredited MFT master’s program. Participants unanimously reported they believed cotherapy impacted client outcomes and training. They also expressed that cotherapists’ unwillingness to address issues within the cotherapy team negatively impacted the cotherapy relationship and client outcomes. Data analysis yielded four main themes, including cotherapy as a vehicle for personal growth, accountability in the cotherapy relationship, need for safety in the cotherapy relationship, and cotherapy team’s need for supervision.