Community based cognitive therapy in the treatment of posttraumatic stress disorder following the Omagh bomb

Studies in academic research centres with selected patients have shown that several cognitive behaviour therapies are effective in the treatment of PTSD following traumas affecting individuals or small groups. Little information is available on the extent to which these positive findings will generalize to more routine clinical settings with less selected patients or to a trauma that affects a whole community. The present study addresses these generalization issues. A consecutive series of 91 patients with PTSD resulting from a car bomb which exploded in the centre of Omagh, Northern Ireland in August 1998 were treated with cognitive therapy, along lines advocated by Ehlers and Clark (2000). There were no major exclusion criteria and 53% of patients had an additional axis I disorder (comorbidity). Therapists were NHS staff with heavy caseloads and modest prior training in CBT for PTSD. A brief training in specialist procedures for PTSD was provided. Patients received an average of eight treatment sessions. Significant and substantial improvements in PTSD were observed. Degree of improvement was comparable to that in previously reported research trials. Comorbidity was not associated with poorer outcome, perhaps because comorbid patients were given more sessions of treatment (average 10 vs 5 sessions). Patients who were physically injured improved less than those who were not physically injured. Overall, the results indicate that the positive findings obtained in research settings generalize well to a frontline, non-selective service.     

Managed Care's Reconstruction of Human Existence: The Triumph of Technical Reason

To achieve its goals of managing and restricting access to psychiatric care, managed care organizations rely on an instrument, the outpatient treatment report, that carries significant implications about how they view psychiatric patients and psychiatric care. In addition to involving ethical transgressions such as violation of patient confidentiality, denial of access to care, spurious use of concepts like quality of care, and harassment of practitioners, the managed care approach also depends on an overly technical, instrumental interpretation of human beings and psychiatric treatment. It is this grounding of managed care in technical reason that I will explore in this study. I begin with a review of a typical outpatient treatment report and show how, with its dependence on the DSM-IV, on behavioral symptoms and patient 'functioning', on the biomedical model of psychiatric illness, and on gross quantitative measures, the report results in a crude, skeletonized view of the human being as a congeries of behavioral symptoms and functions. I then develop the managed care construal of human existence further by showing its grounding in technical reason, exploring the latter in its modern embodiment and deriving it and its opposite, practical reason, from Aristotle's distinction between technical and practical reason, techne and phronesis. In this analysis of the role of technical reason in managed care, I point out that managed care did not have to develop its rationale de novo but could rather lift its arguments, e.g. the biomedical model, from contemporary psychiatry and simply apply them in a restrictive manner. Finally, I conclude this study by arguing for psychiatry's status as a discipline of practical knowledge.     

Children's reasoning about physics within and across ontological kinds

Reasoning about seven physics principles within and across ontological kinds was examined among 188 5- and 7-year-olds and 59 adults. Individuals in all age groups tended to appropriately generalize what they learned across ontological kinds. However, children also showed sensitivity to ontological kind in their projections: when learning principles with reference to people they were more likely to assume that the principles apply to another person than to an inanimate object, and when learning with reference to an inanimate object they were more likely to assume that the principles apply to another inanimate object than to a person. Five-year-olds, but not 7-year-olds, projected concepts learned about people to a greater extent than principles learned about inanimate objects, closely paralleling the findings of Carey for the biological domain (Carey, S. (1985). Conceptual change in childhood. Cambridge, MA: MIT Press). Results from a separate sample of 22 5-year-olds suggest that the primary findings cannot be explained by response perseveration. The present findings indicate that children understand physics principles that apply to both animate and inanimate objects, but distinguish between these ontological kinds.     

Investigating individual differences in children's real-time sentence comprehension using language-mediated eye movements

Individual differences in children's online language processing were explored by monitoring their eye movements to objects in a visual scene as they listened to spoken sentences. Eleven skilled and 11 less-skilled comprehenders were presented with sentences containing verbs that were either neutral with respect to the visual context (e.g., Jane watched her mother choose the cake, where all of the objects in the scene were choosable) or supportive (e.g., Jane watched her mother eat the cake, where the cake was the only edible object). On hearing the supportive verb, the children made fast anticipatory eye movements to the target object (e.g., the cake), suggesting that children extract information from the language they hear and use this to direct ongoing processing. Less-skilled comprehenders did not differ from controls in the speed of their anticipatory eye movements, suggesting normal sensitivity to linguistic constraints. However, less-skilled comprehenders made a greater number of fixations to target objects, and these fixations were of a duration shorter than those observed in the skilled comprehenders, especially in the supportive condition. This pattern of results is discussed in terms of possible processing limitations, including difficulties with memory, attention, or suppressing irrelevant information.     

Self-reported parental abuse relates to autobiographical memory style in patients with eating disorders

Previous research has shown a relationship between levels of self-reported childhood abuse and overgeneral memory style. This relationship was further clarified in patients with an eating disorder (ED). Patients and healthy controls completed a task in which they had to generate specific autobiographical memories to emotional cue words. The results showed that first, the ED group, relative to the controls, produced more first memories that were "overgeneral" and fewer first memories that were specific. Second, in the ED group, the level of self-reported parental abuse was positively correlated with the tendency to produce overgeneral memories to negative cues. This effect remained significant even after levels of depressed mood were controlled for.     

Using genetic programming to discover nonlinear variable interactions

Psychology has to deal with many interacting variables. The analyses usually used to uncover such relationships have many constraints that limit their utility. We briefly discuss these and describe recent work that uses genetic programming to evolve equations to combine variables in nonlinear ways in a number of different domains. We focus on four studies of interactions from lexical access experiments and psychometric problems. In all cases, genetic programming described nonlinear combinations of items in a manner that was subsequently independently verified. We discuss the general implications of genetic programming and related computational methods for multivariate problems in psychology.     

Behavioral dysexecutive symptoms in normal aging

Executive deficits of normal aging such as deficits in planning, organization or decision making are likely to affect elderly individuals in their daily life functioning. Therefore, executive functioning in aging seems to be interesting to study not only in cognitive terms but also in relation to the behavioral area. This pilot study aimed to investigate the nature of behavioral dysexecutive problems in a sample of normal elderly adults as measured by the Dysexecutive Questionnaire. Factor analysis showed that five interpretable factors could be derived from the DEX: intentionality (factor 1), interference management (factor 2), inhibition (factor 3), planning (factor 4), and social regulation (factor 5), suggesting that different components may underlie the behavioral dysexecutive symptoms of normal aging. The relationship between these factors and neuropsychological measures of Executive Functions were also briefly explored.     

Interactions between coincident and orthogonal cues to texture boundaries

Arrays with horizontal or vertical texture boundaries formed by element orientation and length cues were displayed, and the texture boundary formed by one cue was specified as the target. The boundaries formed by the two cues were coincident on some trials and orthogonal on others. Observers' accuracy in reporting the orientation of the target boundary was improved by a coincident nontarget boundary and was worsened by an orthogonal one. Conditional mutual information measures are used to show how effects due to contextual modulation can be distinguished from effects due to additive combination of the cues. The results of five experiments are interpreted as evidence that the transmission of information about specific texture boundary cues is modulated by task context but not by a coincident or orthogonal boundary in another cue. We therefore distinguish between the effects of "context," as shown by the effects of any variable not called the target, and "modulatory contextual effects," as shown by the effects of one variable on the transmission of information specifically about another.     

Feeling safe at work: Development and validation of the Psychological Safety Inventory

Psychological safety, defined as perceptions that an individual within a team is supported and feels safe to take interpersonal risks, voice opinions, and share ideas, is vital for organizational effectiveness. However, there is no consensus on how workplace psychological safety should be measured. We developed the Psychological Safety Inventory (PSI) in response to organizational needs to accurately assess psychological safety. A 70-item version of the PSI was administered to 497 employees from Canada, the United States, and the United Kingdom. Based on factor analytic findings, we reduced the preliminary PSI to a 30-item, five-factor scale. The PSI showed high reliability and correlated as anticipated with convergent measures. Overall, the PSI is a valid and reliable measure of workplace psychological safety.