Implementation of Cognitive Therapy for PTSD in routine clinical care: Effectiveness and moderators of outcome in a consecutive sample

ObjectiveTrauma-focused psychological treatments are recommended as first-line treatments for Posttraumatic Stress Disorder (PTSD), but clinicians may be concerned that the good outcomes observed in randomized controlled trials (RCTs) may not generalize to the wide range of traumas and presentations seen in clinical practice. This study investigated whether Cognitive Therapy for PTSD (CT-PTSD) can be effectively implemented into a UK National Health Service Outpatient Clinic serving a defined ethnically mixed urban catchment area.MethodA consecutive sample of 330 patients with PTSD (age 17–83) following a wide range of traumas were treated by 34 therapists, who received training and supervision in CT-PTSD. Pre and post treatment data (PTSD symptoms, anxiety, depression) were collected for all patients, including dropouts. Hierarchical linear modeling investigated candidate moderators of outcome and therapist effects.ResultsCT-PTSD was well tolerated and led to very large improvement in PTSD symptoms, depression and anxiety. The majority of patients showed reliable improvement/clinically significant change: intent-to-treat: 78.8%/57.3%; completer: 84.5%/65.1%. Dropouts and unreliable attenders had worse outcome. Statistically reliable symptom exacerbation with treatment was observed in only 1.2% of patients. Treatment gains were maintained during follow-up (M = 280 days, n = 220). Few of the selection criteria used in some RCTs, demographic, diagnostic and trauma characteristics moderated treatment outcome, and only social problems and needing treatment for multiple traumas showed unique moderation effects. There were no random effects of therapist on symptom improvement, but therapists who were inexperienced in CT-PTSD had more dropouts than those with greater experience.ConclusionsThe results support the effectiveness of CT-PTSD and suggest that trauma-focused cognitive behavior therapy can be successfully implemented in routine clinical services treating patients with a wide range of traumas.     

Pandora's box: An investigation of essay anxiety in adolescents

Abstract

This paper is an investigation into possible causes of essay anxiety experienced by adolescent students. The three students are presented as being representative of three broader categories: the non-starter, the non-completer and the non-exhibitor. Parallels are drawn between the student essay and student family relationships, and essay anxiety is explored in terms of the utilization of defences against the anxiety of loss. In the process, there is an attempt to appreciate some of the deeply rooted, inter-related, developmental factors - in particular, tolerance of aggressive impulses and the experience of the good object as modifying container - which might affect the student's ability to deal productively with an essay.     

Perceptual grouping based on temporal structure: Impact of subliminal flicker and visual transients

In two experiments we examined the perceived grouping of grids of equidistant dots, which are rapidly modulated over time so that alternate rows or columns are presented out of phase. In Experiment 1, we report that observers were able to group the grids consistent with the temporal modulation reliably, even at contrasts/frequencies for which flicker was not detectable. Moreover, flicker thresholds decreased with stimulus duration, whilst grouping thresholds did not change. In Experiment 2, we examined the impact of visual transients, by measuring performance when, either a mask or a contrast ramp was presented before and after the stimulus. Performance dropped substantially for both conditions, but remained significantly above chance. The results are discussed in relation to the role of temporal correlations in stimulus modulations and visual transients in grouping.     

The Mental Representations of Faces and Houses: Issues Concerning Parts and Wholes

We explore the integration of facial features and house parts to form holistic representations of complete objects. In Experiments 1, 2, and 3, we test for evidence of the holistic representation of houses and faces. We do so by testing for a complete over part probe advantage (CPA) in 2AFC recognition and matching tasks. We present evidence consistent with holistic features being represented for both types of stimuli. In Experiments 4 and 5, we examine further theeffect with faces. Experiment 4 shows thatfacial features used in the matching task contribute differentially to CPAs across varying probe delays but with a similar pattern to that found in the recognition task (Experiment 1). Experiment5 shows thatCPAs are mandatory and cannot be removed by precueing with the probe type or the name of the feature to be probed.     

Love: gloriously amoral and arational

I argue that an evaluational conception of love collides with the way we value love. That way allows that love has causes, but not reasons, and it recognizes and celebrates a love that refuses to justify itself. Love has unjustified selectivity, due to its arbitrary causes. That imposes a non-tradability norm. A love for reasons, rational love or evaluational love would be propositional, and it therefore allows that the people we love are tradable commodities. A moralized conception of love is no less committed to treating those we love as tradable commodities; it is just that they are tradable moral commodities. An evaluative criterion of adequacy, I suggest, encourages the opposite view – a non-rational and non-evaluational concept of love. Such a love can set up partial obligations, which may even demand that one sacrifice one's life. Only a love that has causes but not reasons can have the kind of value that we think love has, and thus it would only be rational to pursue and foster such a love.     

Holism and eclecticism in the theory of concepts

Abstract

Howard (1992) defines concepts as the information that a person has about a category, and argues for an eclectic theory of concepts on the basis of this definition. We argue that this definition is unacceptable and hence that eclecticism does not follow. First, the definition is circular as it stands. Secondly, when it is modified to avoid circularity, it implies conceptual holism, according to which concepts are not useful explanatory constructs in psychology. Thirdly, we argue that Howard's argument relies essentially on this unacceptable definition: alternative accounts of concepts, namely categorisational or representational views, do not support it. Having countered the argument for eclecticism, we then argue against it directly on methodological grounds.     

A simplicity principle in unsupervised human categorization

We address the problem of predicting how people will spontaneously divide into groups a set of novel items. This is a process akin to perceptual organization. We therefore employ the simplicity principle from perceptual organization to propose a simplicity model of unconstrained spontaneous grouping. The simplicity model predicts that people would prefer the categories for a set of novel items that provide the simplest encoding of these items. Classification predictions are derived from the model without information either about the number of categories sought or information about the distributional properties of the objects to be classified. These features of the simplicity model distinguish it from other models in unsupervised categorization (where, for example, the number of categories sought is determined via a free parameter), and we discuss how these computational differences are related to differences in modeling objectives. The predictions of the simplicity model are validated in four experiments. We also discuss the significance of simplicity in cognitive modeling more generally.     

Messages about sex in the workplace: A content analysis of primetime television

Because television has the potential to shape cultural beliefs about both sexual norms and appropriate workplace behavior, it seems important to examine TV’s portrayal of “sexual etiquette” in the workplace. In a content analysis of two episodes of every primetime comedy aired on all broadcast and cable networks during fall 2000, we coded every sexual remark and behavior made in a workplace scene. Across all networks, 85 percent of programs and one in four workplace interactions contained some type of sexual content. Overall, a viewer is likely to hear eleven sexual remarks and see two to three sexual behaviors in a workplace setting per hour; this jumps to twenty-three remarks and nine behaviors on cable networks. Sexual remarks were mostly explicit, made in an office setting, by White men, and were rarely (1.4%) about sexual harassment or discrimination. Although sexual content in the workplace was generally less common on broadcast than cable networks, a broadcast network (Fox) actually had the highest overall rate, with sexual content in 38 percent of workplace scenes. Given that research suggests that TV teaches youth about sexuality and cultivates sexual attitudes and beliefs consistent with televised portrayals, it is alarming that youth may learn from television that sex in the workplace is not only commonplace, but also to be tolerated and enjoyed.     

Giovanna Borradori,Philosophy in a Time of Terror: Dialogues with Jürgen Habermas and Jacques Derrida

Continental Philosophy Review -