Prolonged Exposure Therapy for PTSD among Individuals in a Residential Substance Use Treatment Program: A Case Series

Clients with co-occurring posttraumatic stress disorder (PTSD) and substance use disorders present a unique challenge for clinicians in substance use treatment settings. Substance dependent individuals with PTSD tend to improve less during substance use treatment and relapse more quickly following abstinence attempts compared to those without PTSD. Recent scientific efforts have focused on understanding the potential benefit of providing PTSD treatment concurrent with substance use treatment. The current case study describes 4 individuals with PTSD in a residential substance use facility who received prolonged exposure therapy for treatment of PTSD, in addition to the substance use treatment. These individuals completed 9 bi-weekly 60-minute sessions of prolonged exposure, as well as in vivo and imaginal exposure homework between sessions. None of the clients met criteria for PTSD at the end of treatment, with these gains being maintained at 3- and 6-months post-treatment. Additionally, the clients did not relapse in response to undergoing exposure therapy. Implications for delivery of PTSD treatment in substance use treatment facilities are discussed.     

Depressive moods and marital happiness: within-person synchrony, moderators, and meaning

Recent studies using within-persons designs conceptually replicate and substantively extend prior research that has shown marital distress to be a robust risk factor for depression. The present investigation further extends this within-persons research tradition by increasing the frequency of assessments and by adding new moderators and measures in a sample of both newlywed (n = 24) and maritally distressed (n = 31) wives. In both samples, the average within-persons association between 21 daily assessments of wives' depressed mood and marital happiness approximated previous estimates of analogous effects (overall r = -.54). Wives reported worse depressive mood symptoms on days they experienced lower marital happiness, even after accounting for time and between-person variation in marital happiness. Each participant's within-persons mood and marital happiness association was then treated as a dependent variable to be predicted from theoretically relevant individual differences. Multilevel modeling showed that the negative within-person association between daily depressed mood and daily marital happiness was especially strong for women who were relatively high in depressive symptoms, who had avoidant attachment styles, and who were relatively low in marital adjustment.     

Longitudinal Associations Between Parental and Children’s Depressive Symptoms in the Context of Interparental Relationship Functioning

Using longitudinal, multi-informant data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development, the present study tested associations between trajectories of parental and child depressive symptoms from ages 11 to 15 years. Consistent with predictions, changes in mothers’ and fathers’ depressive symptoms were positively associated with change in children’s depressive symptoms over time. In addition, youth characteristics of sex and pubertal development moderated the trajectories, with children more advanced on pubertal development showing higher initial levels of depressive symptoms, and girls demonstrating steeper slopes of depressive symptoms over time. The context of interparental relationship functioning (i.e., marital conflict, marital conflict resolution) moderated both the trajectories of child depressive symptoms and the interplay between parental and child depressive symptoms in ways largely consistent with hypotheses. Implications of the findings are discussed in terms of treating youth depressive symptoms with a consideration of the broader family context, including parental and interparental functioning.     

Therapist Focus on Parent Involvement in Community-Based Youth Psychotherapy

Parent involvement in the treatment of childhood disruptive behavior problems is a critical component of effective care. Yet little is known about the amount of time therapists are involving parents in treatment and factors that predict therapists' efforts to involve parents in routine care. The purpose of this study is to examine therapists' within-session involvement of parents in community-based outpatient mental health treatment. The data are from a larger longitudinal observational study of psychotherapy for children ages 4-13 with disruptive behavior problems and include videotaped psychotherapy sessions coded for the therapeutic strategies delivered as well as measures of child, parent/family, and therapist characteristics at baseline. Parent involvement is defined as the proportion of time in the session that therapists direct treatment strategies towards parents. Results indicated that therapists directed treatment strategies towards parents an average of 44% of the time within a session. Multilevel modeling was used to examine client-level (child, parent, and family functioning) and provider-level (therapist experience and background) predictors of parent involvement. Therapists involved parents more when the child had higher levels of behavior problems, when the parent reported higher levels of internalized caregiver strain, and when the therapist was more experienced. The results highlight potential areas to target in efforts to increase parent involvement, including training less experienced therapists to increase their focus on directing strategies towards parents.     

Mood, motivation, and misinformation: aging and affective state influences on memory

Normative age differences in memory have typically been attributed to declines in basic cognitive and cortical mechanisms. The present study examined the degree to which dominant everyday affect might also be associated with age-related memory errors using the misinformation paradigm. Younger and older adults viewed a positive and a negative event, and then were exposed to misinformation about each event. Older adults exhibited a higher likelihood than young adults of falsely identifying misinformation as having occurred in the events. Consistent with expectations, strength of the misinformation effect was positively associated with dominant mood, and controlling for mood eliminated any age effects. Also, motivation to engage in complex cognitive activity was negatively associated with susceptibility to misinformation, and susceptibility was stronger for negative than for positive events. We argue that motivational processes underlie all of the observed effects, and that such processes are useful in understanding age differences in memory performance.     

It’s my safe space: The life-saving role of the internet in the lives of transgender and gender diverse youth

Abstract

Background: Public awareness of Transgender and Gender Diverse (TGD) identities has grown significantly; however, acceptance and support remain elusive for many TGD youth. Resultant experiences of marginalization and stigmatization contribute to elevated rates of psychological distress and suicidality among TGD youth. Emergent evidence suggests that the internet may offer TGD youth safety, support, and community previously unavailable.

Aim: The primary aim of this qualitative inquiry is to engage in an in-depth exploration of the online experiences and processes which help protect against psychological distress and promote well-being among TGD youth.

Methods: Data were culled from a mixed-methods, online study of sexual and gender minority youth from across the United States and Canada which followed Institutional Review Board approved protocols. Participants for this study represent a sample (n?=?260) of TGD participants aged 14–22 (x? = 17.30). Data were analyzed using Charmaz’ grounded theory strategies.

Results: Data revealed that the internet offers TGD youth affirming spaces that, for the most part, do not exist in their offline lives. Online, TGD youth were able to engage meaningfully with others as their authentic selves, often for the first time. These experiences fostered well-being, healing, and growth through five processes: 1. Finding an escape from stigma and violence, 2. Experiencing belonging, 3. Building confidence, 4. Feeling hope, and 5. Giving back.

Discussion: The unique and innovative ways in which participants use online spaces to foster resilience offer important insights to inform affirmative practices with TGD young people.     

Childhood maltreatment and maltreatment‐specific inferences: A test of Rose and Abramson's (1992) extension of the hopelessness theory

In extending the etiological chain of the hopelessness theory of depression (Abramson, Metalsky, & Alloy, 1989), Rose and Abramson (1992) proposed a developmental model by which childhood maltreatment may contribute to the development of a negative inferential style. Once developed, this negative inferential style leaves the individual vulnerable to developing hopelessness and symptoms of hopelessness depression. In the current cross‐sectional study, reports of childhood emotional, but not physical or sexual, maltreatment were significantly related to undergraduates' inferential styles. In addition, results from path analyses indicated that inferences about specific experiences of childhood emotional maltreatment mediated this relationship. Testing Rose and Abramson's entire model, results from path analyses supported a partial, but not full, mediation model.     

Help‐Seeking Behavior Prior to Nearly Lethal Suicide Attempts

T he association between help‐seeking and nearly lethal suicide attempts was evaluated using data from a population‐based, case‐control study of 153 13‐ to 34‐year‐old suicide attempt case‐patients treated at emergency departments in Houston, Texas, and a random sample of 513 control‐subjects. Measures of help‐seeking included whether the participant sought help for health/emotional problems in the past month, type of consultant contacted, and whether suicide was discussed during the interaction. Overall, friends/family were consulted most frequently (48%). After controlling for potential confounders, case‐patients were less likely than control‐subjects to seek help from any consultant (OR = 0.5, 95% CI = 0.3–0.8) or a professional (e.g., physician, counselor) consultant (OR = 0.5, 95% CI = 0.29–0.8). Among those who sought help, case‐patients were more likely than to discuss suicide (OR = 2.6, 95% CI = 1.2–5.4), particularly with professionals (OR = 11.8, 95% CI = 3.2–43.2). Our findings suggest that efforts to better understand the role of help‐seeking in suicide prevention, including help sought from family and friends, deserves further attention.     

ENVISIONING ONESELF AS A LEADER: COMPARISONS OF WOMEN AND MEN IN SPAIN AND THE UNITED STATES

In an examination of aspirations for leadership in the United States and Spain, male and female students envisioned themselves as a chief executive officer, vice president, or mid-level manager in an industry with a feminine image (clothing manufacturing) or a masculine image (auto manufacturing). Although men and women perceived these roles as equally positive, women perceived them as less possible and less facilitative of close relationships and gender relationships. Other gender effects included more positive perceptions of the roles by women in the feminine industry and by men in the masculine industry. Cross-nationally men perceived the roles as more positive than women did only in Spain, and U.S. students perceived the roles as more possible than Spanish students did.