A Novel Approach to the Assessment of Fidelity to a Cognitive Behavioral Therapy for PTSD Using Clinical Worksheets: A Proof of Concept With Cognitive Processing Therapy

Fidelity monitoring is a critical indicator of psychotherapy quality and is central to successful implementation. A major barrier to fidelity in routine care is the lack of feasible, scalable, and valid measurement strategies. A reliable, low-burden fidelity assessment would promote sustained implementation of cognitive behavioral therapies (CBTs). The current study examined fidelity measurement for cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) using clinical worksheets. External raters evaluated patient worksheets done as a part of treatment, both guided by the therapist and completed independently as homework. Results demonstrated that fidelity ratings from CPT session worksheets were feasible and efficient. Notably, they were strongly correlated with observer ratings of the fidelity of CPT strategies that were present on the worksheets. Agreement among ratings conducted by individuals with a range of experience with CPT was acceptable to high. There was not a main effect of therapist-guided, in-session worksheet ratings on PTSD symptom change. However, patient competence in completing worksheets independently was associated with greater PTSD symptom decline and in-session, therapist-guided worksheet completion was associated with larger symptom decreases among patients with high levels of competence. With further research and refinement, rating of worksheets may be an efficient way to examine therapist and patient skill in key CPT elements, and their interactions, compared to the gold standard of observer ratings of therapy video-recordings. Additional research is needed to determine if worksheets are an accurate and scalable alternative to gold standard observer ratings in settings in which time and resources are limited.     

Parameters of Aggressive Behavior in a Treatment-Seeking Sample of Military Personnel: A Secondary Analysis of Three Randomized Controlled Trials of Evidence-Based PTSD Treatments

Aggressive behavior is prevalent among veterans of post-9/11 conflicts who have posttraumatic stress disorder (PTSD). However, little is known about whether PTSD treatments reduce aggression or the direction of the association between changes in PTSD symptoms and aggression in the context of PTSD treatment. We combined data from three clinical trials of evidence-based PTSD treatment in service members (N = 592) to: (1) examine whether PTSD treatment reduces psychological (e.g., verbal behavior) and physical aggression, and; (2) explore temporal associations between aggressive behavior and PTSD. Both psychological (Estimate = -2.20, SE = 0.07) and physical aggression (Estimate = -0.36, SE = 0.05) were significantly reduced from baseline to posttreatment follow-up. Lagged PTSD symptom reduction was not associated with reduced reports of aggression; however, higher baseline PTSD scores were significantly associated with greater reductions in psychological aggression (exclusively; ß = -0.67, 95% CI = -1.05, -0.30, SE = -3.49). Findings reveal that service members receiving PTSD treatment report substantial collateral changes in psychological aggression over time, particularly for participants with greater PTSD symptom severity. Clinicians should consider cotherapies or alternative ways of targeting physical aggression among service members with PTSD and alternative approaches to reduce psychological aggression among service members with relatively low PTSD symptom severity when considering evidence-based PTSD treatments.     

Ripples of contempt: aversive responses to others (mis)fortunes

Motivation and Emotion - In this short commentary we argue that feelings of contempt play a major role in schadenfreude (joy in the misfortunes of others) and “reverse...     

Use of a latency‐based demand assessment to identify potential demands for functional analyses

Unlike potential tangible positive reinforcers, which are typically identified for inclusion in functional analyses empirically using preference assessments, demands are most often selected arbitrarily or based on caregiver report. The present study evaluated the use of a demand assessment with 12 participants who exhibited escape‐maintained problem behavior. Participants were exposed to 10 demands, with aversiveness measured by average latency to the first instance of problem behavior. In subsequent functional analyses, results of a demand condition that included the demand with the shortest latency to problem behavior resulted in identification of an escape function for 11 of the participants. In contrast, a demand condition that included the demand with the longest latency resulted in identification of an escape function for only 5 participants. The implication of these findings is that for the remaining 7 participants, selection of the demand for the functional analysis without using the results of the demand assessment could have produced a false‐negative finding.     

Genetic Information,Rights, and Autonomy

Rights, autonomy, privacy, and confidentialityare concepts commonly used in discussionsconcerning genetic information. When theseconcepts are thought of as denoting absolutenorms and values which cannot be overriden byother considerations, conflicts among themnaturally occur.In this paper, these and related notions areexamined in terms of the duties and obligationsmedical professionals and their clients canhave regarding genetic knowledge. It issuggested that while the prevailing idea ofautonomy is unhelpful in the analysis of theseduties, and the ensuing rights, an alternativereading of personal self-determination canprovide a firmer basis for ethical guidelinesand policies in this field.     

Separation-individuation as a family transactional process in the transition to parenthood

This is a study of the impact of prebirth level of parental and marital individuation on the course of parent-infant and infant development during the first postnatal year. Support was found for the first hypothesis, namely, that a couple's composite individuation profile, taking into account the prebirth separation-individuation of the father and the mother, and their marriage, would be associated with positive infant development and parent-infant transactions related to separation-individuation and mutuality during the first postnatal year. A second hypothesis, that maternal individuation would most strongly predict infant and parent-infant development at 6 months, while paternal individuation would emerge at 1 year as a strong predictor, was not supported. It was found instead that prebirth maternal and paternal individuation were equally strong predictors at six months, while maternal individuation was the primary predictor at 12 months. Other findings on the direct and indirect associations between prebirth parental and marital individuation and postnatal parent-infant transactions suggest that early separation-individuation processes result from a complex configuration of triadic mother-father-infant transactions.     

Bad company and neo-Fregean philosophy

A central element in neo-Fregean philosophy of mathematics is the focus on abstraction principles, and the use of abstraction principles to ground various areas of mathematics. But as is well known, not all abstraction principles are in good standing. Various proposals for singling out the acceptable abstraction principles have been presented. Here I investigate what philosophical underpinnings can be provided for these proposals; specifically, underpinnings that fit the neo-Fregean’s general outlook. Among the philosophical ideas I consider are: general views on a priori justification; the idea of abstraction as reconceptualization, the idea that truth is prior to reference in the sense associated with Frege’s context principle; and various broadly relativistic views. The conclusions are by and large negative.     

Categorizing words using ‘frequent frames’: what cross‐linguistic analyses reveal about distributional acquisition strategies

Mintz (2003 ) described a distributional environment called a frame, defined as the co‐occurrence of two context words with one intervening target word. Analyses of English child‐directed speech showed that words that fell within any frequently occurring frame consistently belonged to the same grammatical category (e.g. noun, verb, adjective, etc.). In this paper, we first generalize this result to French, a language in which the function word system allows patterns that are potentially detrimental to a frame‐based analysis procedure. Second, we show that the discontinuity of the chosen environments (i.e. the fact that target words are framed by the context words) is crucial for the mechanism to be efficient. This property might be relevant for any computational approach to grammatical categorization. Finally, we investigate a recursive application of the procedure and observe that the categorization is paradoxically worse when context elements are categories rather than actual lexical items. Item‐specificity is thus also a core computational principle for this type of algorithm. Our analysis, along with results from behavioural studies ( Gómez, 2002 ; Gómez and Maye, 2005 ; Mintz, 2006 ), provides strong support for frames as a basis for the acquisition of grammatical categories by infants. Discontinuity and item‐specificity appear to be crucial features.     

CowLog: Open-source software for coding behaviors from digital video

We have developed CowLog, which is open-source software for recording behaviors from digital video and is easy to use and modify. CowLog tracks the time code from digital video files. The program is suitable for coding any digital video, but the authors have used it in animal research. The program has two main windows: a coding window, which is a graphical user interface used for choosing video files and defining output files that also has buttons for scoring behaviors, and a video window, which displays the video used for coding. The windows can be used in separate displays. The user types the key codes for the predefined behavioral categories, and CowLog transcribes their timing from the video time code to a data file. CowLog comes with an additional feature, an R package called Animal, for elementary analyses of the data files. With the analysis package, the user can calculate the frequencies, bout durations, and total durations of the coded behaviors and produce summary plots from the data.