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,...     

Using functional near‐infrared spectroscopy to assess social information processing in poor urban Bangladeshi infants and toddlers

Children living in low‐resource settings are at risk for failing to reach their developmental potential. While the behavioral outcomes of growing up in such settings are well‐known, the neural mechanisms underpinning poor outcomes have not been well elucidated, particularly in the context of low‐ and middle‐income countries. In this study, we measure brain metabolic responses to social and nonsocial stimuli in a cohort of 6‐ and 36‐month‐old Bangladeshi children. Study participants in both cohorts lived in an urban slum and were exposed to a broad range of adversity early in life including extreme poverty, malnutrition, recurrent infections, and low maternal education. We observed brain regions that responded selectively to social stimuli in both ages indicating that these specialized brain responses are online from an early age. We additionally show that the magnitude of the socially selective response is related to maternal education, maternal stress, and the caregiving environment. Ultimately our results suggest that a variety of psychosocial hazards have a measurable relationship with the developing social brain.     

An Implementation Study of Relationship Checkups as Home Visitations for Low‐Income At‐Risk Couples

Couples with the greatest need for relationship health maintenance and intervention are often least able to afford and access it; therefore, accessible, affordable, effective, and brief interventions are needed to improve relationship health for those who need it most. Consequently, this paper examined whether a brief relationship intervention could be effectively implemented with a low‐income, underserved population. All enrolled participants (N = 1,312) received the Relationship Checkup, which consists of an assessment and a feedback session delivered in their homes or at a local clinic at their request. Measures assessed relationship satisfaction, communication, psychological and physical aggression, and intimacy at baseline and 1‐month follow‐up, and program and relationship satisfaction at 6‐month follow‐up. All participants reported significant improvements on all outcomes with small effect sizes. However, moderation analyses suggested that distressed couples reported significantly larger effects across the board. Overall, participants reported that they were highly satisfied with the intervention both immediately after its delivery and 6 months later. Findings provide preliminary support for the effectiveness of this brief checkup and point to the utility of offering these kinds of low‐cost brief interventions in flexible formats for those who might have the most difficulty accessing them.     

Utilizing a Creative Task to Assess Langerian Mindfulness

Despite the growing interest in mindfulness and its demonstrated benefits, there are concerns about the reliance on subjective assessment tools. This study focused on the measurement of Langerian mindfulness, which refers to the active process of noticing new things and flexibly responding to the current context. Some of its key features overlap with the construct of creativity, which can be used to create a direct assessment for central components of mindfulness. The aim is to start a discussion in the field about how a direct creativity-based tool to current subjective measures might best be used.     

Relations Between Instructional Practices and On-Task Behavior in Classrooms Serving American Indian Students

Achievement disparities between American Indian students and non-American Indian peers are persistent and well documented. Student engagement is a promising target for intervention given its relation to academic achievement. This study investigated the relation between specific teacher practices (opportunities to respond [OTRs], praise, and reprimands) and classroom on-task behavior in an urban, public K–8 school that serves primarily American Indian students. OTRs and praise were positively associated with student on-task behavior, whereas reprimands were negatively associated with on-task behavior. Results from multilevel logistic regression indicated that OTRs significantly increased the likelihood that a classroom was highly on-task, whereas the reprimands significantly decreased the likelihood. Praise did not have a significant effect after controlling for the other variables in the model. Results are interpreted in a context of evidence-based instructional practices for increasing OTRs and praise, decreasing reprimands, and ultimately enhancing on-task behavior in an urban classrooms serving primarily American Indian youth.     

Childhood Adversity and the Continued Exposure to Trauma and Violence Among Adolescent Gang Members

This study investigates interfaith groups from across the United States to understand how these religious settings may serve as mediating structures to facilitate individual political action. Based on a multilevel modeling analysis with 169 individuals from 25 interfaith groups, we found that core activities of the group, such as group members sharing community information (e.g., announcing upcoming events, political meetings, community issues) or sharing religious information (e.g., educating members about their religion) positively and negatively predicted individual political action as a result of group participation, respectively. Moreover, a sense that the interfaith group served as a community to work for local change, but not trust within the group, predicted political action as a result of group participation. However, this effect for a sense the group served as a community to work for local change was stronger and more positive as the degree of community information sharing in the group increased. These results show that a core activity of sharing community information may enhance the ability of a group to mediate political action. Overall, these findings demonstrate the potential role of interfaith groups to mediate political action, and show the importance of considering both individual and group characteristics when understanding these religious settings. Limitations and directions for future research are also discussed.     

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.     

Experiencing Gendered Seeing

This paper explores the concept of “gendered seeing”: the capacity to visually perceive another person's gender and the role that one's own gender plays in that perception. Assuming that gendered properties are actually perceptible, my goal is to provide some support from the philosophy of perception on how gendered visual experiences are possible. I begin by exploring the ways in which sociologists and psychologists study how we perceive one's sex and the implications of these studies for the sex/gender distinction. I then discuss feminist philosopher Linda Alcoff's concept of “interpretative horizons,” which highlights the role that one's social and political identities play in how we understand the world around us. I also discuss Elizabeth Grosz's notion (borrowed from Merleau‐Ponty) of double sensation. I then apply some work in the philosophy of perception on perceptual learning and the cognitive penetration of perception to gendered seeing. My hypothesis is that we can explain how one's interpretative horizons are acquired through some notion of perceptual learning. I conclude by suggesting some of the epistemic and ethical implications of gendered seeing.     

Demographic,Clinical, and Service Utilization Factors Associated with Suicide‐Related Visits among Alaska Native and American Indian Adults

Alaska Native and American Indian people (AN/AIs) are disproportionately affected by suicide. Within a large AN/AI health service organization, demographic, clinical, and service utilization factors were compared between those with a suicide‐related health visit and those without. Cases had higher odds of a behavioral health diagnosis, treatment for an injury, behavioral health specialty care visits, and opioid medication dispensation in the year prior to a suicide‐related visit compared to gender‐, age‐, and residence‐ (urban versus rural) matched controls. Odds of a suicide‐related visit were lower among those with private insurance and those with non‐primary care ambulatory clinic visits.