An Intensive Outpatient Program for Veterans With Posttraumatic Stress Disorder and Traumatic Brain Injury

Post-9/11 service members may return from military service with a complicated set of symptoms and conditions, such as posttraumatic stress disorder (PTSD), depression, substance misuse, and traumatic brain injury (TBI), that interfere with reintegration and impair functioning. Although evidence-based treatments that facilitate recovery exist, their successful delivery at a sufficient dose is limited. Barriers to accessing treatment combined with challenges compiling a comprehensive treatment team further delay delivery of effective evidence-based care for PTSD, TBI, and co-occurring mental health conditions. This paper describes the development of a comprehensive, multidisciplinary, 2-week intensive day program for post-9/11 veterans with complex mental health concerns. The treatment program combines skill building groups, family education, and integrative health approaches with evidence-based individual PTSD or TBI care. Initial results from the first 132 participants were notable for a 97% completion rate, as well as statistically significant and clinically meaningful reductions in PTSD, neurobehavioral, and depression symptom severity for the 107 veterans who completed the PTSD track and the 21 who completed the TBI track. These data suggest the intensive program approach is an effective, well-tolerated model of treatment for post-9/11 veterans with PTSD and/or TBI. Future controlled studies should examine the effectiveness of this intensive model compared to standard evidence-based therapy delivery, as well as longitudinal outcomes.     

The neural correlates of orienting to walking direction in 6‐month‐old infants: An ERP study

The ability to detect social signals represents a first step to enter our social world. Behavioral evidence has demonstrated that 6‐month‐old infants are able to orient their attention toward the position indicated by walking direction, showing faster orienting responses toward stimuli cued by the direction of motion than toward uncued stimuli. The present study investigated the neural mechanisms underpinning this attentional priming effect by using a spatial cueing paradigm and recording EEG (Geodesic System 128 channels) from 6‐month‐old infants. Infants were presented with a central point‐light walker followed by a single peripheral target. The target appeared randomly at a position either congruent or incongruent with the walking direction of the cue. We examined infants' target‐locked event‐related potential (ERP) responses and we used cortical source analysis to explore which brain regions gave rise to the ERP responses. The P1 component and saccade latencies toward the peripheral target were modulated by the congruency between the walking direction of the cue and the position of the target. Infants' saccade latencies were faster in response to targets appearing at congruent spatial locations. The P1 component was larger in response to congruent than to incongruent targets and a similar congruency effect was found with cortical source analysis in the parahippocampal gyrus and the anterior fusiform gyrus. Overall, these findings suggest that a type of biological motion like the one of a vertebrate walking on the legs can trigger covert orienting of attention in 6‐month‐old infants, enabling enhancement of neural activity related to visual processing of potentially relevant information as well as a facilitation of oculomotor responses to stimuli appearing at the attended location.     

Organizing Components into Combinations: How Stage Transition Works

This paper investigates the nature of transition between stages. The Model of Hierarchical Complexity of tasks leads to a quantal notion of stage, and therefore delineates the nature of stage transition. Piaget's dialectical model of stage change was extended and precisely specified. Transition behavior was shown to consist of alternations in previous-stage behavior. As transition proceeded, the alternations increased in rate until the previous stage behaviors were “smashed” together. Once the smashed-together pieces became coordinated, new-stage behavior could be said to have formed. Because stage transition is quantal, individuals can only change performance by whole stage. We reviewed theories of the specific means by which new-stage behavior may be acquired and the emotions and personalities associated with steps in transition. Contemporary challenges in the society increasingly call for transition to postformal and postconventional responses on the part of both individuals and institutions as the examples illustrate.     

Cognitive-behavioural therapy for adolescents with bulimic symptomatology: The acceptability and effectiveness of internet-based delivery

Background

The evidence base for the treatment of adolescents with bulimia nervosa (BN) is limited.

Aims

To assess the feasibility, acceptability, and clinical outcomes of a web-based cognitive-behavioural (CBT) intervention for adolescents with bulimic symptomatology.

Method

101 participants were recruited from eating disorders clinics or from beat, a UK-wide eating disorders charity. The programme consisted of online CBT sessions (‘Overcoming Bulimia Online’), peer support via message boards, and email support from a clinician. Participants' bulimic symptomatology and service utilisation were assessed by interview at baseline and at three and six months. Participants' views of the treatment package were also determined.

Results

There were significant improvements in eating disorder symptoms and service contacts from baseline to three months, which were maintained at six months. Participants' views of the intervention were positive.

Conclusions

The intervention has the potential for use as a first step in the treatment of adolescents with bulimic symptomatology.     

Assessing Religion and Spirituality in Counseling: Some Reflections and Recommendations

In this article, the importance of conducting a religious and spiritual assessment in counseling is considered. Some essential dimensions of religion and spirituality to assess are described. The authors recommend assessment questions that can be asked during clinical interviews or included on written intake questionnaires. They also briefly describe a few standardized religious and spiritual assessment instruments. Finally, they offer suggestions for conducting spiritual assessments in school settings.