Developmentally Adapted Cognitive Processing Therapy for Adolescents Suffering from Posttraumatic Stress Disorder after Childhood Sexual or Physical Abuse: A Pilot Study

Although childhood sexual abuse and childhood physical abuse (CSA and CPA) have severe psychopathological consequences, there is little evidence supporting psychotherapeutic interventions for adolescents who have experienced CSA or CPA. To provide a treatment tailored to the specific needs of adolescents suffering from abuse-related posttraumatic stress disorder (PTSD), we modified Cognitive Processing Therapy (CPT) by adding new treatment modules and changing the therapy setting. To evaluate the feasibility and efficacy of Developmentally Adapted CPT (D-CPT), we treated 12 adolescents suffering from PTSD secondary to CSA or CPA. Patients were assessed prior to treatment (t0), post-treatment (t1), and 6 weeks after treatment (t2). Assessments included the Clinician-Administered PTSD Scale (CAPS), the UCLA PTSD Index (UCLA), the Children’s Depression Inventory (CDI), the Adolescent Dissociative Experiences Scale (A-DES), and the Borderline Symptom List (BSL-23). MANOVAs revealed that posttraumatic stress measurements and associated symptom measurements significantly differed across time points. When comparing t0 with t2, Cohen’s d was large with respect to the CAPS scores (d = 1.45, p < .001) and the UCLA scores (d = 1.91, p < .001). Cohen’s d had a medium magnitude with respect to the CDI scores (d = .78, p < .001), the A-DES scores (d = 0.64, p < .05), and the BSL-23 scores (d = 0.74, p < .01). D-CPT has the potential to reduce PTSD symptoms and comorbid psychopathology in adolescents with histories of CSA or CPA.     

“I Will Fear no Evil,for I Am with Me”: Mentalization-Oriented Intervention with PTSD Patients. A Case Study

Post traumatic stress disorder (PTSD) patients are described as suffering from a collapse of mentalization—the inability to understand and interpret their own behavior and that of others as emanating from intentional mental states. The present paper proposes an integrative focused intervention, called “traumatic mentalization change”, to improve and strengthen the mentalization abilities of PTSD patients. With the assistance of the therapist, patients learn how to embed their present self-states within their retrieved memories of the traumatic event and thus to change their traumatic narrative. These present selfstate images enrich the patients’ narratives with the emotional needs that were missing during the traumatic event by addressing mistaken attributions regarding these memories. In this way, the traumatic narrative changes, and the devastating selffeelings experienced during the original traumatic event are reduced. We demonstrate this intervention with a case study of a veteran PTSD patient who suffered from PTSD for 10 years after being involved in a terrorist attack. The neuro-clinical and clinical implications are discussed.     

Manualizing psychotherapy: Aaron T. Beck and the origins of Cognitive Therapy of Depression

Abstract

This paper examines the origins of psychiatrist Aaron T. Beck’s 1979 Cognitive Therapy of Depression (CTOD). CTOD was the first psychotherapy manual designed to be used in a randomized controlled trial (RCT). Making psychotherapy amenable to the RCT design had been a ‘holy grail’ for leading American psychotherapy researchers since the late 1960s. Beck’s CTOD – which standardized his treatment so it could be compared with drug treatments in a clinical trial – delivered that holy grail, and ushered in the manualized treatment revolution. Manuals are now a sine qua non in psychotherapy research. In this paper, I explore some of the personal, political, and economic variables that made the idea of a manual irresistible to Beck and to those who first championed him.     

The concept of risk and responsible conduct of research

Assessment of risk is one of the key issues in the field of responsible conduct of research which covers discourses of research ethics and research integrity. The principle of minimizing risks and balancing of risks and benefits is one of the main requirements of research ethics. In addition, the content of informed consent that is another fundamental principle of research ethics derives from the assessment of risks and benefits related to a particular research project. Risk assessment also plays a crucial role in methodological design of the research project. This is an important point where research ethics and research integrity discourses overlap. Firstly, because the choice of a control group (e.g., placebo control) is a key ethical issue related to the protection of the research subjects' interests. Secondly, because the quality of the research data, that is one of the key elements of research integrity, is closely connected to the choice of research methodology as well. The problem of biased interpretation or manipulation of risk related features of biomedical research should also be taken into account. Despite the importance of the concept of risk to the field of biomedical research, its relevance has not yet attracted a sufficient attention in the responsible conduct of research debate.     

Teaching ethics: More than an honor code

An honor code is certainly a good place to start teaching engineering students about ethics, but teaching students to live honorably requires far more effort than memorizing a code of ethics statement or applying it just to academic performance. In the School of Engineering at Grand Valley State University, we have followed the model provided by the United States Military Academy at West Point. For our students this involves an introduction to the Honor Code as part of a larger Honor Concept at the very beginning of their studies and then making it an integral part of their preparation as engineers. The challenge is significant because the culture at large does not support living with an Honor Concept. This paper will begin with a discussion of the cultural context in which we must teach, because that context has changed significantly in the years since many faculty members were students themselves. The rest of the paper will detail the approach that we have taken to teach ethics as an engineer’s way of life. “The shortest and surest way to live with honor in the world is to be in reality what we would appear to be. All human virtues increase and strengthen themselves by the practice and experience of them.” Plato An earlier version of this paper was presented at the 2005 conference, Ethics and Social Responsibility in Engineering and Technology, Linking Workplace Ethics and Education, co-hosted by Gonzaga University and Loyola Marymount University, Los Angeles, CA, USA, 9–10 June 2005.