Clinical research on behavioral activation as treatment for post‐traumatic stress disorder: A brief review and meta‐analysis

Behavioral activation (BA), an effective treatment for depression, has recently been receiving attention as a possible intervention for PTSD. BA interventions could be particularly useful in treating underserved populations (i.e., individuals with lower socioeconomic status). A literature search was conducted, which identified seven outcome studies that examined the effectiveness of stand‐alone BA treatment for individuals with PTSD. All studies identified for this brief review demonstrated clinically significant reductions in PTSD symptoms using BA as an intervention. A meta‐analysis of these few studies revealed a nonsignificant effect (Cohen's d = 0.713, p = .512) despite reporting an average symptom reduction of 25.8%. Other studies utilizing BA treatment for PTSD do so in tandem with other interventions and were excluded from analysis. This brief review summarizes the literature on the use of BA as a stand‐alone treatment for PTSD and suggests that future research seek to confirm the usefulness of BA as a potential treatment modality for mental health‐care providers treating individuals with PTSD.     

Holocaust survivors in a primary care setting: fifty years later

Past studies have not assessed the prevalence of emotional disturbances in Holocaust survivors seeking medical treatment in a family practice environment. The present study examined the prevalence of lifetime (the presence of symptomatology at any time) and current posttraumatic stress disorder (PTSD) symptoms, general anxiety, and depression in Holocaust survivors seeking medical treatment in a primary care setting. 20 of the 27 Holocaust survivors in our sample received a current diagnosis of PTSD and reported significant symptoms of depression and general anxiety. Although 74% of the survivors were currently diagnosed with PTSD, participants in this study had reported an overall decline in reexperiencing, hyperarousal, and overall PTSD symptoms but exhibited increased avoidance and numbing symptoms throughout the lifespan. These preliminary results suggest that removing avoidance as a defense mechanism during the course of psychotherapy may leave these survivors without an adequate way for coping with their trauma, subsequently increasing their vulnerability to psychopathology. Implications for psychological interventions are provided.     

Recognition memory for source and occurrence: The importance of recollection

Previous recognition memory studies indicate that when both recollection and familiarity are expected to contribute to recognition performance (e.g., discriminating studied items from nonstudied items) the dual-process and the unequal-variance signal detection models provide comparable accounts of performance. When familiarity is not expected to be useful (e.g., when items from two equally familiar sources are discriminated between), the dual-process model provides a significantly better account of performance. In the present study, source recognition was tested under conditions in which familiarity could have been used to perform a list-discrimination task; participants were required to discriminate between strong studied items, weak studied items, and new items. The dual-process model provided a better account of performance than did the unequal-variance model. Moreover, the results indicated that the unequal-variance assumption in a single-process signal detection model was not a valid substitution for recollection and that recollection was used to make recognition judgments even when assessments of familiarity were useful.     

The relationship between social anxiety and social support in adolescents: a test of competing causal models

This study compared the strength of competing causal models in explaining the relationship between perceived support, enacted support, and social anxiety in adolescents. The social causation hypothesis postulates that social support causes social anxiety, whereas the social selection hypothesis postulates that social anxiety causes social support. The reciprocal model combines the two hypotheses by arguing that the causal relationship between social support and social anxiety is largely reciprocal. This study tests a modification of the reciprocal model by specifying perceptions of support as a mediating construct. Two waves of data with an interval of three months were collected on 357 college students. Structural equation modeling was used to compare the reciprocal and mediated reciprocal causal models. The study found some support for the mediated reciprocal model, but the magnitude of the relationships were weaker than expected. Limitations and suggestion for future research are discussed.     

Unfolding interpersonal behavior

Models of interpersonal traits have traditionally contained two independent dimensions, one referring to dominance as the opposite of submissiveness and the other referring to agreeableness as the opposite of quarrelsomeness. These models are primarily based on psychometric analyses of the co-occurrence of interpersonal characteristics. The present article reviews literature based on event-contingent recording studies that examine whether the structure of interpersonal behavior as revealed in its everyday occurrence is consistent with this model of interpersonal traits. Evidence from studies of the effects of hierarchical social role situations, the relations between behaviors and affect, and the effects of alterations in serotonin are used to evaluate whether dominance, submissiveness, agreeableness, and quarrelsomeness are related, opposite, or independent behavioral systems. The pattern of findings suggests that agreeableness and quarrelsomeness may be part of the same behavioral system while dominance and submissiveness may have separate underlying behavioral systems.     

Accuracy of self-reports of alcohol offenders in a rural midwestern county

Self-reports of drinking are of doubtful accuracy as heavy drinkers tend to underreport consistently amounts drunk as well as other alcohol-related data. A sample of 60 people cited for DWI in a rural midwestern county in southeast Nebraska during routine alcohol-dependency evaluations indicated that 10% underreported their Breath Alcohol Content at the time of arrest and 38% their previous number of DWI citations. Subjects were grouped by age (over and under 30) and by accuracy (accurate and inaccurate reporters). A 2 x 2 analysis of variance of later DWI arrests was significant as younger subjects showed greater risk. Those who underreported number of past DWI citations were significantly lower on their self-reported BAC at the time of arrest than accurate reporters. Age and underreporting alcohol-related data are as important for practitioners to attend to as scores on the Michigan Alcoholism Screening Test or SCID measuring alcoholic tendencies.     

Outcome and epidemiological research on personality disorders: implications for classification

The construct of personality disorder has an overall definition that describes chronicity. However, the findings of outcome research indicate that while many patients stop meeting criteria for specific categories of disorder over time, they often continue to suffer from dysfunctional traits. One can also interpret epidemiological findings on personality disorders as overestimating disorders due to a failure to distinguish them from traits. Taken together, these findings point to the need for a revision of the classification of personality disorders that would separate enduring traits from reversible symptoms.     

Neurobiological dimensional models of personality: a review of the models of Cloninger, Depue, and Siever

Neurobiological dimensional models of personality aim to account for the structure of personality traits and disorders through links to neurotransmitter systems. Three such models are reviewed: those of Cloninger, Depue, and Siever. While these proposals have heuristic value, none of them has obtained strong empirical support. Our current understanding of neurobiology is insufficient to develop a model of personality on this basis. At this point, dimensions of personality should be derived from factor analysis rather than from neurobiological theories.     

Maladaptive conflict monitoring as evidence for executive dysfunction in children with chromosome 22q11.2 deletion syndrome

Using an adaptation of the Attentional Networks Test, we investigated aspects of executive control in children with chromosome 22q11.2 deletion syndrome (DS22q11.2), a common but not well understood disorder that produces non-verbal cognitive deficits and a marked incidence of psychopathology. The data revealed that children with DS22q11.2 demonstrated greater difficulty than controls in locating and processing target items in the presence of distracters. Importantly, children with DS22q11.2 showed a deficit in the ability to monitor and adapt to stimulus conflict. These data provide evidence of inadequate conflict adaptation in children with DS22q11.2, a problem that is also present in schizophrenia. The findings of specific executive dysfunction in this group may provide a linkage between particular genetic abnormalities and the development of psychopathology.     

Interference with spatial working memory: An eye movement is more than a shift of attention

In the present experiments, we examined whether shifts of attention selectively interfere with the maintenance of both verbal and spatial information in working memory and whether the interference produced by eye movements is due to the attention shifts that accompany them. In Experiment 1, subjects performed either a spatial or a verbal working memory task, along with a secondary task requiring fixation or a secondary task requiring shifts of attention. The results indicated that attention shifts interfered with spatial, butnot with verbal, working memory, suggesting that the interference is specific to processes within the visuospatial sketchpad. In Experiment 2, subjects performed a primary spatial working memory task, along with a secondary task requiring fixation, an eye movement, or an attention shift executed in the absence of an eye movement. The results indicated that both eye movements and attention shifts interfered with spatial working memory. Eye movements interfered to a much greater extent than shifts of attention, however, suggesting that eye movements may contribute a unique source of interference, over and above the interference produced by the attention shifts that accompany them.