Treatment of a Case Example With PTSD and Chronic Pain

This commentary reviews the case of GH, a survivor of a road traffic collision, who has chronic pain and posttraumatic stress disorder (PTSD). The case formulation, assessment strategy, and treatment plan are informed by the relevant experimental literature and empirically supported treatments using a cognitive behavioral perspective. Given this framework, the commentary includes a focus on the treatment of PTSD with an eye toward generalizing the therapeutic strategies to chronic pain problems. Psychoeducation, imaginal exposure to the traumatic event, in vivo exposure to avoided activities, and cognitive interventions including coping self-statements, correction of logical errors, decatastrophizing and developing alternative explanations are all included in the recommendations as part of a standard cognitive behavioral treatment for PTSD. Added to this standard PTSD protocol is the suggested use of interoceptive exposure to address GH’s feared bodily sensations. In the assessment domain, standard measures for pain and PTSD assessment are suggested along with tracking of depression and anxiety sensitivity. Some recognition of more recent approaches to cognitive behavioral therapy (e.g., Acceptance and Commitment Therapy) is given in considering potential obstacles to treatment.     

Supporting Integrity of Discrete Trial Teaching via Tiered Consultation: A Pilot Study

Empirically supported consultation procedures for supporting implementation of evidence-based interventions for Autism Spectrum Disorder (ASD), such as performance feedback, may be challenging to implement in public schools. Educators may find performance feedback aversive, and support personnel may find its directiveness incompatible with their professional roles. This pilot study extends recent advances in implementation science, by investigating the influence of tiered consultation on intervention integrity of Discrete Trial Teaching (DTT). A less intensive form of implementation support was examined for its feasibility and effectiveness. Collaborative Student Data Review (CSDR) includes discussion, general feedback, and modeling. Preliminary findings indicate that CSDR is a feasible and acceptable form of implementation support, and that it shows potential as a form of implementation support for DTT.     

Tactile-Based Pantomime Grasping: Knowledge of Results is Not Enough to Support an Absolute Calibration

Tactile-based pantomime-grasping requires that a performer use their right hand to ‘grasp’ a target previously held in the palm of their opposite hand – a task examining how mechanoreceptive (i.e., tactile) feedback informs the motor system about an object property (i.e., size). Here, we contrasted pantomime-grasps performed with (H+) and without (H?) haptic feedback (i.e., thumb and forefinger position information derived from the grasping hand touching the object) with a condition providing visual KR (VKR) related to absolute target object size. Just-noticeable-difference (JND) scores were computed to determine whether responses adhered to – or violated – Weber's law. JNDs for H+ trials violated the law, whereas H? and VKR trials adhered to the law. Accordingly, results demonstrate that haptic feedback – and not KR – supports an absolute tactile-haptic calibration.     

Longitudinal investigation of reciprocal relationship between stress reactions and hardiness

Although many studies have examined hardiness as a protective factor against stress reactions, to the authors' knowledge no studies have yet examined the impact of stress reactions on hardiness. However, there is theoretical support for this notion. In this longitudinal study of 1,571 Marine recruits who participated in a highly stressful training program, the authors applied regression-based cross-lagged analyses to examine associations between stress reactions and hardiness over time for both men and women, and they investigated social support as a moderator of these relationships. Men who were hardier at Time 1 (T1) reported lower stress reactions at Time 2 (T2), and men who experienced more stress reactions at T1 were less hardy at T2. Although the negative impact of stress reactions on hardiness was strongest when social support was low for both genders, stress reactions predicted enhanced hardiness when social support was high for women only.     

The driver vigilance telemetric control system (DVTCS): Investigating sensitivity to experimentally induced sleep loss and fatigue

Vigilance technologies are used in the Australian rail industry to address the risks associated with driver sleepiness and fatigue. The aim of this study was to investigate whether a new device, designed to detect lowered states of arousal using electrodermal activity (EDA), would be sensitive to experimentally induced sleepiness and fatigue. Fifteen individuals (7 of them female, 9 male; 18–32 years of age) spent 3 consecutive days in the laboratory, which included 1 night of sustained wakefulness (28 h). The participants completed a 10-min psychomotor vigilance task (PVT) and fatigue and sleepiness ratings every 2 h, and a 30-min driving simulator every 4 h. As was expected, simulated driving, PVT, and subjective ratings indicated increasing levels of sleepiness and fatigue during sustained wakefulness. The EDA device output did not coincide with these findings. The results indicated that the EDA indicator was not sensitive to increased sleepiness and fatigue at the levels produced in the present study.     

Family-of-origin maltreatment, posttraumatic stress disorder symptoms, social information processing deficits, and relationship abuse perpetration

In this study, the authors examined the interrelations among family-of-origin maltreatment variables, posttraumatic stress disorder (PTSD) symptoms, social information processing deficits, and male-to-female psychological and physical intimate relationship abuse perpetration in adulthood among a community sample of 164 men and their partners. In bivariate analyses, higher family-of-origin childhood parental rejection was associated with the perpetration of psychological and physical abuse in adulthood, and childhood exposure to interparental violence was also associated with adult psychological abuse perpetration. Structural equation modeling analyses indicated that when childhood variables and other study variables were considered together, only childhood parental rejection was associated with the abuse perpetration outcomes, and these effects were indirect through PTSD symptoms and social information processing deficits. Results indicate a need for further investigation into the mechanisms accounting for the impact of early maltreatment on the development of abusive intimate relationship behavior.     

Computer-assisted intervention improves patient-centered diabetes care by increasing autonomy support.

OBJECTIVE: To determine if a patient-centered, computer-assisted diabetes care intervention increased perceived autonomy support, perceived competence (from self-determination theory), and if these constructs mediated the effect of the intervention on ADA/NCQA recommended diabetes care outcomes. DESIGN: A randomized controlled trial of 866 adult type 2 diabetes patients in heterogeneous primary care settings in Colorado. MAIN OUTCOME MEASURES: Perceived autonomy support, perceived competence, patient satisfaction, glycemic control (HbA1c), ratio of total to HDL cholesterol, diabetes distress, and depressive symptoms. RESULTS: The computer-assisted intervention increased patient perception of autonomy support relative to a computer-based control condition ( p = .05). Change in perceived competence partially mediated the effects of increased autonomy support on the change in lipids, diabetes distress, and depressive symptoms. The construct of autonomy support was found to be separate from that of patient satisfaction. CONCLUSIONS: A patient-centered, computer-assisted intervention was effective in improving diabetes self-management outcomes, in part, because it increased patients' perception that their autonomy was supported which changed perceived competence. These findings support the self-determination model for health behavior change and the chronic care model and support the further study of the use of these technologies to motivate patients to improve their health outcomes.     

Parental characteristics and interactional dysfunction in families with child behavior problems: A preliminary investigation

Thirty-six families with a preteenage behavior problem child were assessed on measures of marital discord, parental psychopathology, and three parental cognitive factors: knowledge of behavioral principles, tolerance for child deviancy, and expectations regarding their child's behavior. Nine nonproblem families with demographic characteristics similar to the problem families were also assessed. Correlational analyses across all families revealed a strong association between marital discord and the parental index of child behavior problems. While a number of significant associations were discovered between the various measures of marital discord, parental psychopathology, and parental cognitive factors, no other measure besides marital discord was associated with parental perception of child behavior problems. The nonproblem families and 15 of the problem families also participated in home observations obtained through random audio recordings during high interaction periods. These observational data indicated a significant relationship between parental perception of child behavior problems and parental negative behavior toward the child, but no significant relationship between parental perception of child behavior problems and child behavior, even when child behavior was weighted by parents' reactions to that behavior. Through sequential analysis, several contingent relations between parent and child behavior were discovered. Findings are discussed in relation to family systems theory.