Using strategic psychotherapy: A case study of chronic PTSD after a terrorist attack

This article describes a case of chronic post traumatic stress disorder (PTSD). The patient came to psychotherapy three years after he was injured in a terrorist attack. He was in a state of dysfunction. The article elaborates on theoretical issues, the choice of strategic model of psychotherapy, the various phases of the therapeutic process and the specific difficulties that such a case presents.     

A Hmong Adaptation of the Beck Depression Inventory

We developed the Hmong Adaptation of the Beck Depression Inventory (HABDI) and evaluated the instrument's psychometric characteristics. Also examined was the relationship between depression and demographic variables such as age, sex, length of stay in America, English-speaking ability, and social support in Hmong refugees. One hundred twenty-three Hmong living in Fresno County, between the ages of 18 and 66, participated in the study. The new measure demonstrated a high coefficient alpha (.93), and test-retest reliability (.92), and a significant mean score difference between the nondepressed and the depressed groups. Individual items were distributed evenly and correlated highly with the total depression score. The HABDI correctly identified 94% of depressed and 78% of nondepressed in the Hmong sample. The results suggest that quality of social support and years of education play important roles in buffering Hmong refugees against depression, whereas length of stay in America and number of social supports do not.     

The corroboration requirement in child sex abuse cases

The sharp rise in reports of child abuse has led to efforts to protect children in family courts in child protective proceedings. Hearsay evidence of a child's prior statements may be admitted in child protective proceedings, but such evidence is legally insufficient to support an adjudication of abuse without corroborative evidence. Courts have admitted expert psychological, psychiatric or social work testimony about the child sex abuse syndrome as sufficient corroborative evidence. The testimony is called “validation” testimony. The scientific basis for such validation testimony in the absence of a disclosure by the child is very weak. Courts have also tended to accept the most minimal evidence as corroboration of the child's out-of-court statements, including other hearsay evidence. The socially valuable policy of protecting children by admitting weak evidence, such as validation testimony, or other hearsay, should be reviewed to ensure the evidence meets criteria of reliability in order to minimize erroneous determinations.     

Brief report: Validation of a reinforcer survey for use with geriatric patients

This paper describes a Geriatric Reinforcer Survey (GRS) which expands upon a previous Reinforcement Survey Schedule (RSS) developed by Cautela and Kastenbaum (1967). The GRS, an instrument designed to quickly assess reinforcer preference in geriatric populations, has two formats, one for individuals over 65 years of age who are still able to comprehend and write, and one designed to be filled out by relatives and staff familiar with an individual over 65 years of age who can no longer comprehend or write well. Reinforcer preference was determined by giving the GRS to a total of 107 geriatric persons in both home and institutional settings. Test-retest reliability was assessed on a subsample of 71 individuals over a 10-14-day period and was found to be r_s = 0.608, p <0.01 using the Spearman Rank-Order Correlation Coefficient. This indicated that the GRS had reasonable test-retest reliability. The validity of having a relative or familiar staff person fill out the GRS for a specific individual was also tested. Results of 43 administrations of the GRS to relatives of a geriatric person, using the Spearman Rank-Order Correlation Coefficient, showed a correlation of r_s = 0.488, p <0.01 when the responses of that person were compared to those of the individual. Results of 17 administrations of the GRS to staff familiar with a particular patient were r_s = 0.436, p < 0.05 when compared to responses made by the individual. This indicates that the GRS might be useful in structuring interventions for individuals who are incapacitated, and groups of geriatric persons. The GRS also has the potential to be a valuable research tool.     

Alvin I. Goldman's Epistemology and Cognition: An introduction

‘Epistemics: an enterprise linking traditional epistemology, first with cognitive science and, second, with social scientific and humanistic disciplines that explore the interpersonal and cultural processes impinging on knowledge and belief’ (Epistemology and Cognition, p. vii)     

Randomized controlled trial of yogic meditation techniques for patients with obsessive-compulsive disorder

The objective of this study was to compare efficacy of two meditation protocols for treating patients with obsessive-compulsive disorder (OCD). Patients were randomized to two groups-matched for sex, age, and medication status-and blinded to the comparison protocol. They were told the trial would last for 12 months, unless one protocol proved to be more efficacious. If so, groups would merge, and the group that received the less efficacious treatment would also be afforded 12 months of the more effective one. The study was conducted at Children's Hospital, San Diego, Calif. Patients were selected according to Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised (DSM-III-R) criteria and recruited by advertisements and referral. At baseline, Group 1 included 11 adults and 1 adolescent, and Group 2 included 10 adults. Group 1 employed a kundalini yoga meditation protocol and Group 2 employed the Relaxation Response plus Mindfulness Meditation technique. Baseline and 3-month interval testing was conducted using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Symptoms Checklist-90-Revised Obsessive Compulsive (SCL-90-R OC) and Global Severity Index (SCL-90-R GSI) scales, Profile of Moods scale (POMS), Perceived Stress Scale (PSS), and Purpose in Life (PIL) test. Seven adults in each group completed 3 months of therapy. At 3 months, Group 1 demonstrated greater improvements (Student's independent groups t-test) on the Y-BOCS, SCL-90-R OC and GSI scales, and POMS, and greater but nonsignificant improvements on the PSS and PIL test. An intent-to-treat analysis (Y-BOCS) for the baseline and 3-month tests showed that only Group 1 improved. Within-group statistics (Student's paired t-tests) showed that Group 1 significantly improved on all six scales, but Group 2 had no improvements. Groups were merged for an additional year using Group 1 techniques. At 15 months, the final group (N=11) improved 71%, 62%, 66%, 74%, 39%, and 23%, respectively, on the Y-BOCS, SCL-90-R OC, SCL-90-R GSI, POMS, PSS, and PIL; P<0.003 (analysis of variance). This study demonstrates that kundalini yoga techniques are effective in the treatment of OCD.     

Children's Cognition as the Foundation of Spirituality

The theory offered in this article articulates the position that the cognitive skills manifested by children are those which are necessary preconditions for spirituality. I argue that psychological theories that posit a hierarchical stage theory of cognition and affect are grounded on premises, which devalue these skills. Theories of children's spirituality have foundered in their ability to appreciate that children's cognition is organized through structures that are quintessential to spirituality, due to their misplaced reliance on these theories. I offer a critique of traditional psychological approaches and an alternative model of children's cognition, which reveals that the cognitive capacities of children are essential to the phenomenology of spirituality.     

Some reflections on postgraduate medical ethics education

Three goals of teaching medical ethics to physicians are reviewed. Components of a basic course in medical ethics are described with special attention to the roles of case conferences, ethics rounds, and role modeling. Obstacles to teaching ethics are also addressed.     

Transfer in discrimination learning: Do children mediate more than adults?

A series of four-dimensional, discrimination-learning problems were presented to second-, sixth-, eighth-, and twelfth-grade students (ages 7, 11, 13, and 17 years, respectively). One pretraining problem, using different dimensions, preceded the four experimental problems; these employed identical dimensions and stimulus values. Solutions were selected without dimensional replacement.Blank-trial probes enabled detection of initial predictions. Results clearly indicated that (1) older subjects made dramatically fewer intradimensional predictions (utilizing the solution dimension from the preceding problem) than did younger subjects, (2) all age groups demonstrated systematic changes over problems; these reflected the specific solution sequence experienced, and (3) there were consistent developmental differences in the speed with which subjects noted and utilized regularities across problems.The pattern of data is not congruent with the expectations of mediation theory. However, it is in accord with the transfer hypothesis, which is a recent extension of hypothesis theory. The transfer hypothesis provides a theoretical framework which suggests when we should observe “mediational” behavior (i.e., intradimensional transfer) and when to expect the inverse.