Meta‐Analysis of Counseling Outcomes for the Treatment of Posttraumatic Stress Disorder

This meta‐analysis of 152 published posttraumatic stress disorder (PTSD) clinical trials from 1990 to 2012 concluded that counseling generally produced a small to large effect of treatment across all comparison conditions at termination (d+ = 0.30 to 0.89). These gains were maintained at longest follow‐up (d+ = 0.58 to 0.86) for the wait‐list, treatment‐as‐usual, and single‐group comparisons, but not for the follow‐up placebo comparison (d+ = 0.15), probably because of the low power (j = 3 placebo studies). Clinical trial findings were synthesized using a random‐effects model. No effects of publication bias or moderating variables were evident. No difference was found between trauma‐focused and non‐trauma‐focused approaches. Implications for counseling practice and future PTSD outcome research are addressed.     

Present Moment Contact and Nonjudgment: Pilot Data on Dismantling Mindful Awareness in Trauma-Related Symptomatology

Conventional views purport that mindfulness includes two components: present moment contact (PMC) and nonjudgment. While mindfulness-based interventions that target a broad spectrum of psychopathology, including posttraumatic stress disorder (PTSD), emphasize “being present” as a key mechanism toward wellness, researchers have struggled to measure PMC and assess its clinical utility. Is there any inherent value in PMC or is its clinical utility contingent upon simultaneously engaging in nonjudgment? This pilot study introduces an experimental paradigm designed to dismantle mindfulness and examine the utility of these two components. Forty women with interpersonal victimization histories were assigned to either a nonjudgment condition or a control condition. Next, participants recalled their trauma and then wrote down whatever information was present in their awareness. PMC was measured in both conditions by assessing the frequency of present tense verbs used within these written protocols. As predicted, in the absence of nonjudgment, PMC was related to high negative affect and low positive affect, though unrelated to trauma intrusion frequency. In the nonjudgment condition, PMC was no longer related to state affect and inversely related to trauma intrusion frequency. These pilot data suggest that isolating PMC from nonjudgment may be unhelpful and perhaps iatrogenic.     

Cognitive phenomenology and conscious thought

How does mental content feature in conscious thought? I first argue that for a thought to be conscious the content of that thought must conscious, and that one has to appeal to cognitive phenomenology to give an adequate account of what it is for the content of a thought to be conscious. Sensory phenomenology cannot do the job. If one claims that the content of a conscious thought is unconscious, one is really claiming that there is no such thing as conscious thought. So one must either accept that there is such a thing as cognitive phenomenology, or deny the existence of conscious thought. Once it is clear that conscious thought requires cognitive phenomenology, there is a pressing question about the exact relationship between a thought’s cognitive phenomenological properties and its content. I conclude with a discussion of the nature of this relationship.     

Skills training in the long-term management of stress and occupational burnout

The current managed healthcare environment stresses brief and effective short-term therapy. However, often this short-term treatment does not lead to long-term behavioral changes and clients return to therapy many times for help with the same dysfunctional behavioral patterns. The main problem with these traditional forms of treatment is the assumption that clients have the basic skills to change their ineffective behaviors. Yet, many people lack the basic skills to manage our highly stressful society, and may take years to master new behavioral management skills. Examining the relationship between stress and coping, this study explored both short-and long-term approaches to behavioral change relative to occupational burnout, and focused upon the teaching of skills to manage stress. Subjects who participated in a 6-week stressmanagement program reported only temporary decreases in burnout, while those subjects who received 1-hour coping “refresher” sessions at 5 months, 11 months, and 17 months showed consistent decreases in burnout throughout a 2 1/2 year period. These results suggest that psychologists can be much more effective behavioral change agents through long-term approaches that emphasize teaching new skills to manage chronic behavioral problems. Given the changes in the health insurance industry and the way therapeutic services are provided, the field may need to rethink approaches that are grounded in personality theory and abnormal psychology to approaches that emphasize principles of learning theory.     

Characteristics of Buddhism in Australia

Research on Buddhism in Australia has tended to focus on demographics, ethnic identity and the migrant experience, and history. This paper uses the literature and material from Internet sites on Australian Buddhist groups to identify characteristics of Buddhism in Australia; it aims to both contribute to the understanding of the growth of Buddhism in Australia and to facilitate comparison with similar studies of American and European forms of Buddhism. New information is presented on the number of Buddhist groups in Australia, their geographical location, and the traditions and lineages represented. It is made apparent that more detailed information is needed, and suggestions are made for further research in a variety of areas.     

An evaluation of multi‐criteria methods in integrated assessment of climate policy

Those who conduct integrated assessments (IAs) are aware of the need to explicitly consider multiple criteria and uncertainties when evaluating policies for preventing global warming. MCDM methods are potentially useful for understanding tradeoffs and evaluating risks associated with climate policy alternatives. A difficulty facing potential MCDM users is the wide range of different techniques that have been proposed, each with distinct advantages. Methods differ in terms of validity, ease of use, and appropriateness to the problem. Alternative methods also can yield strikingly different rankings of alternatives. A workshop was held in which climate change experts and policy makers evaluated the usefulness of MCDM for IA. Participants applied several methods in the context of a hypothetical greenhouse gas policy decision. Methods compared include value and utility functions, goal programming, ELECTRE, fuzzy sets, stochastic dominance, min max regret, and several weight selection methods. Ranges, rather than point estimates, were provided for some questions to incorporate imprecision regarding weights. Additionally, several visualization methods for both deterministic and uncertain cases were used and evaluated. Analysis of method results and participant feedback through questionnaires and discussion provide the basis for conclusions regarding the use of MCDM methods for climate change policy and IA analyses. Hypotheses are examined concerning predictive and convergent validity of methods, existence of splitting bias among experts, perceived ability of methods to aid decision‐making, and whether expressing imprecision can change ranking results. Because participants gained from viewing a problem from several perspectives and results from different methods often significantly differed, it appears worthwhile to apply several MCDM methods to increase user confidence and insight. The participants themselves recommended such multimethod approaches for policymaking. Yet they preferred the freedom of unaided decision‐making most of all, challenging the MCDM community to create transparent methods that permit maximum user control. Copyright © 2002 John Wiley & Sons, Ltd.     

Comprehensive community-based education and neurorehabilitation for children and adolescents with traumatic brain injury

Children and adolescents who experience a traumatic brain injury (TBI) typically have sensory, cognitive, behavioral, and functional skill challenges that must be addressed in acute and post-acute rehabilitation settings. This article describes a community-based school that combines educational, medical, nursing, family, residential-living, and psychological services in a comprehensive program of pediatric neurorehabilitation. The operational, administrative, and clinical features of these service components are presented. A critical aspect of the program is an emphasis on applied behavior analysis procedures for purposes of assessment, treatment formulation, and evaluation. Data are reviewed to demonstrate demographics, patterns of service delivery, and outcome. The school program represents an educational alternative for students with TBI who are discharged from acute-care settings and require comprehensive support services to facilitate their transition and re-entry to public school and community living. © 1998 John Wiley & Sons, Ltd.     

Effects of peripheral immune activation on social behavior and adrenocortical activity in aggressive mice: Genotype-environment interactions

To explore genetic-developmental differences in the biobehavioral effects of induced illness, males from two lines of mice selectively bred for high or low levels of aggressive behavior were injected with endotoxin (Escherichia coli, LPS: 0.25 mg/kg, 1.25 mg/kg, or 2.5 mg, i.p.) or saline. Body temperature, weight, and locomotor activity were monitored immediately before and 8 and 24 hr after injection. Twenty-four hours after injection, social behaviors were assessed in a 10-min dyadic test, and hypothalamus, spleen, and serum were collected. In both lines, endotoxin treatment increased behavioral immobility ("freezing") and decreased social exploration. Other effects showed line differences: Males from the high-aggressive line had a lower threshold to endotoxin-induced effects on body temperature, weight loss, spleen weight, and corticosterone. Social reactivity (startle response to mild social investigation) increased in the high-aggressive line and decreased in the low-aggressive line after treatment. In the high-aggressive line only, endotoxin decreased attack frequency and increased latency to attack. The interactions between selected line (genotype) and endotoxin treatment (environment) demonstrate that genetic-developmental differences in social and aggressive behavior may indicate the extent to which immune stimuli (e.g., bacteria, viruses, cytokines) function as "biobehavioral stressors." Aggr. Behav. 23:93–105, 1997.© 1997 Wiley-Liss, Inc.     

Positive aspects of caregiving as a moderator of treatment outcome over 12 months

The authors examined the influence of positive aspects of caregiving (PAC) as a moderator of treatment outcome across 12 months in 1 of the original sites of the Resources for Enhancing Alzheimer's Caregiver Health I project. They used multilevel random coefficients regression analysis to predict time-varying PAC, depression, behavioral bother, and daily care burden in Alzheimer's caregivers (N = 243; mean age = 60.89, SD = 14.19). They found that time-varying PAC was predicted by time-varying daily care burden. They also found significant effects of time-varying PAC for depression, behavioral bother, and daily care burden. Notably, a PAC x Phase x Treatment effect was found for daily care burden, such that individuals who endorsed less PAC benefited most from the intervention across 12 months. The tendency to positively appraise the caregiving experience (i.e., PAC) in response to chronic stressors such as Alzheimer's caregiving may affect individuals' responsiveness to, and benefit from, interventions, whereas only daily care burden affected the tendency to find enjoyment in caregiving across 12 months. Future intervention research should assess individual PAC in order to better tailor interventions to caregiving needs.