Correcting Misperceptions About Cognitive Processing Therapy to Treat Moral Injury: A Response to Gray and Colleagues (this issue)

We respond to the commentary by Gray, Nash, and Litz (this issue) regarding the use of cognitive processing therapy (CPT) to address moral injury as described in our previous publication (Wachen et al., 2016). In their commentary, Gray et al. posit that CPT is inappropriate when applied to the treatment of war-related traumas involving “real moral and ethical transgressions” (i.e., moral injuries). However, Gray and colleagues’ assertions are centered on a premise that is incorrect, namely that CPT is based on the idea that “self-blame and guilt are inherently illogical or inaccurate,” and that CPT assumes that all beliefs associated with moral injury are erroneous. On the contrary, we acknowledge that self-blame and guilt may be accurate responses to warzone trauma, yet disagree that CPT is not suitable in these situations. This response serves to clarify some of the inaccurate interpretations of the treatment as stated by Gray and colleagues, and reiterates the position of CPT on many of the issues that were raised. Specifically, we discuss the use of Socratic questioning within CPT to address the issue of moral injury. Furthermore, we highlight the strong evidence base for the use of CPT in treating veterans and active military. Until it has been determined through empirical study, it is premature to assert that CPT is insufficient in addressing moral injury in combat personnel.     

Interprofessional Education: Current State in Psychology Training

Journal of Clinical Psychology in Medical Settings - Healthcare reform has led to the consideration of interprofessional team-based, collaborative care as a way to provide comprehensive,...     

Chronicles of communication and power: informed consent to sterilisation in the Namibian Supreme Court’s <Emphasis Type="Italic">LM</Emphasis> judgment of 2015

The 2015 judgment of the Namibia Supreme Court in Government of the Republic of Namibia v LM and Others set an important precedent on informed consent in a case involving the coercive sterilisation of HIV-positive women. This article analyses the reasoning and factual narratives of the judgment by applying Neil Manson and Onora O’Neill’s approach to informed consent as a communicative process. This is done in an effort to understand the practical import of the judgment in the particular context of resource constrained public healthcare facilities through which many women in southern Africa access reproductive healthcare. While the judgment affirms certain established tenets in informed consent to surgical procedures, aspects of the reasoning in context demand more particularised applications of what it means for a patient to have capacity and to be informed, and to appropriately accommodate the disruptive role of power dynamics in the communicative process.     

The Impact of Cumulative Minority Stress on Cognitive Behavioral Treatment With Gender Minority Individuals: Case Study and Clinical Recommendations

For sexual minority individuals (i.e., lesbian, gay, and bisexual [LGB] persons), minority stress includes experiences of discrimination, expectations of rejection, internalized negativity, and concealment of identity. Sexual minority stress has been linked to various negative mental health outcomes (e.g., depression, anxiety), and levels of psychiatric comorbidity are high among LGB people. However, little is known about the extension of minority stress models to gender minority individuals (i.e., transgender and gender nonconforming persons) and its impact on mental health in this particular group. Further, the influence of gender minority stress on the delivery and outcome of traditional cognitive behavioral therapy (CBT) approaches is unclear. A case study of CBT for chronic depression with a young, transgender individual is presented. This case study highlights potential barriers that may arise with gender minority clients when implementing evidence-based clinical interventions in the context of an individual’s minority stress history. Implications for cognitive-behavioral treatments with gender minority individuals and recommendations for clinicians and researchers are discussed.     

Sex Differences in the Contribution of Respiratory Sinus Arrhythmia and Trauma to Children’s Psychopathology

Respiratory sinus arrhythmia (RSA), a marker of parasympathetic activity, has been shown to moderate the relation between adversity and child behavioral outcomes; however, this work has been conducted in primarily Caucasian samples and limited in focus to family-level adversity. The current analysis extends the previous literature to examine the co-contribution of exposure to potentially traumatic events (PTEs), baseline RSA, and RSA withdrawal to internalizing and externalizing behavior in a sample of primarily African American youth (n = 92) recruited using neighborhood mapping techniques from communities high in epidemiological indicators of adversity. Exposure to PTEs was associated with lower baseline RSA. Complex interactions were observed between sex of the child, baseline RSA and RSA withdrawal, and PTE exposure predicting to internalizing behaviors. Among girls with high (4+) levels of PTEs, high baseline RSA and RSA withdrawal predicted higher internalizing; for RSA withdrawal only, the inverse was observed for girls with low PTE exposure, for whom high RSA withdrawal predicted lower internalizing. No associations were observed from RSA to externalizing, or among boys to internalizing. Findings are consistent with distinct patterns among primarily African American samples and suggest the need for sex-specific conceptualizations of the link between environmental adversity, physiological reactivity, and internalizing behaviors.     

WOMEN'S ATTITUDES TOWARD MEN An Integrated Threat Theory Approach

Three studies were conducted to measure the antecedents of women's attitudes toward men using the integrated threat model. Four types of threats were hypothesized to produce negative attitudes toward men: (1) realistic threat based on threats to women's political and economic power, (2) symbolic threat based on value differences, (3) intergroup anxiety experienced during social interaction with outgroup members, and (4) negative stereotypes of men. Negative contact was hypothesized to increase the perception of all four threats as well as to affect attitudes directly. The findings suggest that symbolic threat, intergroup anxiety, and negative contact are the strongest predictors of negative attitudes toward men. Contrary to expectation, realistic threat may not be important to women's attitudes toward men.     

How do students implement collaborative testing in real-world contexts?

Recent research has explored the effects of collaborative testing, showing costs and benefits during learning and for subsequent memory. However, no prior research is informative about whether and how students use collaborative testing in real-world contexts. Accordingly, the primary purpose of the current research was to explore the extent to which students use collaborative testing during self-regulated learning. We conducted three surveys (n = 692 across three samples) asking students about their use of collaborative testing, with a particular interest in conditions under which students report implementing collaborative testing. Among the key outcomes, a majority of students reported using collaborative testing when studying in a group. Additionally, students reported that key term definitions are the material most often used during collaborative testing. Students are also more motivated to use testing and believe testing is more effective and more fun when implemented in a group versus alone. Outcomes also shed light on metacognitive components of collaborative testing, with the student asking (versus answering) the question making the monitoring judgement whereas both students make the control decision about when to terminate practice. We discuss ways in which the collaborative memory literature can be extended to support more successful student learning.     

Does a simultaneous memory load affect older and younger adults’ implicit associative learning?

This study investigated the effects of a simultaneous memory load on implicit associative sequence learning using the Triplets Learning Task (TLT). Participants in the Simultaneous condition held a secondary task memory load during the TLT, while those in the Sequential condition also performed both tasks, but successively, rather than simultaneously. Thus, the Simultaneous condition had a memory load during the TLT, while the Sequential condition did not. Probe blocks without the secondary task allowed separation of effects on learning from effects on its expression. Results revealed that the simultaneous memory load affected older, but not younger adults, by suppressing the expression of learning, not learning itself. Thus, older and younger adults can learn probabilistic associations while holding a simultaneous memory load, but the load can limit the extent to which older adults adapt their performance to environmental structure. Results are consistent with theories which propose that implicit associative learning does not call on limited capacity resources, and highlight the importance of distinguishing effects of dual tasks on the expression of learning from those on learning itself.