Integrated and Holistic Treatment Approach to PTSD and SUD: A Synergy

A review of the literature on integrated and holistic treatment approaches of posttraumatic stress disorder (PTSD) and substance use disorder (SUD) diagnoses is presented. Perspectives on the etiology of PTSD‐SUD comorbidity and the inter‐relation of symptoms are explored.     

Primary Care Providers’ Responses to Patient-Generated Family History

Family health history is one of the best predictors of an individual’s risk for common disease, yet it is underutilized in routine care. Although the Surgeon General has recommended consumers record their family health history and share it with their health care provider, providers’ perceptions of patient-generated family histories are unknown. To learn more about providers’ experience with and perceptions about patient-generated family histories, we mailed surveys to 301 providers and had a response rate of 24% (n = 68). Seventy-three percent felt a patient-generated computer pedigree would improve their ability to assess risk as compared to their current methods. Seventy percent felt a patient-generated computer pedigree would either have no effect on or would increase the number of patients that could be seen in a day. Results suggest that providers appreciate the potential benefits of patient-generated family histories. Genetic counselors and nurses are in a prime position to promote and facilitate the use of patient-generated family health histories in routine care.     

Developing Metacompetence in Low Intensity Cognitive‐Behavioural Therapy (CBT) Interventions: Evaluating a Self‐Practice/Self‐Reflection Programme for Experienced Low Intensity CBT Practitioners

Self‐practice/self‐reflection (SP/SR) is a targeted training and professional development strategy in which clinicians practice cognitive‐behavioural therapy (CBT) techniques and processes on themselves and then working through a structured process of self‐reflection. Previous studies with CBT trainees and experienced mental health practitioners have found that SP/SR or experiencing CBT “from the inside out” has been perceived by participants as increasing competency in a number of important areas and increasing therapist flexibility and artistry. Low intensity (LI) practitioners are identified as a relatively new addition to mental health service delivery in the UK. These workers are differentiated from traditional mental health practitioners by a shorter training period, the delivery of a circumscribed number of CBT interventions, and a very high weekly patient load. This study, the first of its kind, reports outcomes from an SP/SR programme undertaken by seven experienced LI CBT practitioners. Participants used the following measures to track their experience of the programme: time spent on programme, personal‐ and therapy‐related belief rating, goals attained, and perceived skill rated for average and most difficult patients. Results showed a positive change in work‐related skill and behaviour change, particularly when working with the more difficult patients. The findings are consistent with those found in other groups of therapists (e.g., trainee CBT therapists and highly experienced CBT therapists), suggesting that SP/SR may be a valuable addition to LI intensity training and professional development. These findings are discussed in the context of the particular needs of LI practitioners.     

The Social Ladder: A Rank-Based Perspective on Social Class

Scholars across the social sciences have studied social class for centuries. In this review, we suggest that social class is a fundamental means by which individuals are ranked on the social ladder of society. A rank-based perspective on social class shines light on several future areas of research: Specifically, understanding how social class ranks individuals vis-à-vis others leads to predictions about how class is signaled in interactions, influences social cognition and health, is shaped by global economic inequality trends, and changes across the life course. Importantly, our theory highlights the potential of experimental manipulations of social class rank for testing the causal role of social class in shaping basic patterns of cognition, emotion, and behavior. Future predictions regarding the channels of social class rank signals, along with how position on the social ladder shapes political attitudes and interacts with cultural values, are considered.     

A Relational Encounter with Race

Race remains one of the most highly charged subjects of discourse in our society. At a cultural level, white racial identity has become dissociatively split off from the rest of identity formation. A racialized subjectivity is usually carried by those with darker skin colors, whereas whiteness is experienced as an unmarked and invisible state. The author argues that whites have dissociated the historical position of the oppressor from collective consciousness, due to our inability to tolerate an identification with the aggressor. Our disavowal of race as constitutive of subjectivity ensures that race becomes a site for enactments.

This paper follows the transference-countertransference dynamics between an African American patient mandated to treatment and the author, a white analyst born in South Africa. The haunting presence of racial trauma infused the analysis. Focus is placed on the rich, often unmetabolizable experiences of race, including the ways in which the structure of the treatment recreated the racial dynamics of slavery.     

Addiction‐Specific CACREP Standards in Clinical Mental Health Counseling Programs: How Are They Met?

In 2009, the Council for Accreditation of Counseling and Related Educational Programs (CACREP) included training standards specific to addiction for clinical mental health counseling programs. This study surveyed CACREP‐accredited program coordinators to determine how addiction‐specific standards were addressed.     

Self-Esteem and Its Relationship to Mental Health and Quality of Life in Adults with Cystic Fibrosis

Research from the general population indicates an important role for self-esteem in mental health, but limited research in this area exists in the cystic fibrosis (CF) literature. This study aimed to explore the predictive value of self-esteem and health-related quality of life (HRQoL) in mental health symptoms in adults with CF. Seventy-four participants, recruited online, completed the Clinical Outcomes in Routine Evaluation-Outcome Measure 34 (CORE-OM), Rosenberg Self-esteem Scale and Cystic Fibrosis Questionnaire-Revised (CFQ-R). Comparably high levels of self-esteem were found, but HRQoL was lower than previous research. Thirty percent of participants scored within the clinical range for mental health difficulty. Hierarchical regression, controlling for gender, explored the value of four CFQ-R subscales (physical, social, emotional and role functioning) and self-esteem in predicting CORE-OM total score. Gender accounted for 8.2 % of the variance in mental health scores while the five independent variables accounted for a further 73.0 % of variance. Of the five variables, CFQ-R emotional functioning and self-esteem were significant predictors of mental health symptoms. Results are discussed in relation to clinical implications and potential uses for internet technologies to promote socialisation.     

Source confusion influences the effectiveness of the autobiographical IAT

We examined the claim that the autobiographical Implicit Association Test (aIAT) can detect concealed memories. Subjects read action statements (e.g., “break the toothpick”) and either performed the action or completed math problems. They then imagined some of these actions and some new actions. Two weeks later, the subjects completed a memory test and then an aIAT in which they categorized true and false statements (e.g., “I am in front of the computer”) and whether they had or had not performed actions from Session 1. For half of the subjects, the nonperformed statements were actions that they saw but did not perform; for the remaining subjects, these statements were actions that they saw and imagined but did not perform. Our results showed that the aIAT can distinguish between true autobiographical events (performed actions) and false events (nonperformed actions), but that it is less effective, the more that subjects remember performing actions that they did not really perform. Thus, the diagnosticity of the aIAT may be limited.