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.     

Self-efficacy and affect responses to Sprint Interval Training

ObjectivesTo examine the influence of efficacious beliefs on affective states, enjoyment, and satisfaction after performing a maximal intensity exercise task (i.e. Sprint Interval Training (SIT).DesignAn experimental design was utilized and participants were randomized to a high self-efficacy feedback (HE), low self-efficacy feedback (LE), or no feedback control condition.MethodsCollege-aged men and women (n = 74) performed four 30-second maximal sprints, interspersed with 4-min breaks. Following each sprint interval, participants received either positive, negative or no feedback and SIT self-efficacy, affective states (i.e., positive well-being, psychological distress, fatigue), heart rate (HR), and ratings of perceived exertion (RPE) were assessed. Upon terminating the exercise session, enjoyment and satisfaction were assessed.ResultsThere was group equivalency in HR and RPE among participants of each group. The HE group had significantly less of a decline in SIT self-efficacy from pre to post SIT than both the LE and control groups, and reported significantly higher levels of exercise enjoyment than the other two groups. In addition, the HE and control groups reported significantly higher satisfaction than the LE group.ConclusionsWe recommend that exercisers receive positive feedback statements while performing SIT to minimize the decrease in SIT self-efficacy and to bolster feelings of enjoyment and satisfaction.     

“JEWISH TRAFFICKING” AND LONDON JEWS IN THE AGE OF MIGRATION

There are excellent accounts of the Jewish response to “trafficking” in women for prostitution during the late nineteenth and early twentieth centuries, but recent analyses of the white slavery phenomenon have raised new questions. This article concerns the response of Jews in England, and specifically the motivations and activities of those who founded the Jewish Association for the Protection of Girls and Women (JAPGW). The JAPGW set the model for initiatives carried out by Jewish communities throughout the British Empire and was a primary contributor to internationalisation of the issue on the part of the League of Nations after the First World War. The JAPGW’s motivations were complex: they involved a particular religious outlook, the response to antisemitism and assumptions along lines of class and gender. In addressing “Jewish trafficking”, Britain’s established Jewish community sought to take ownership of what it meant to be a Jew in British society.     

Subjectivist – observing and objective – participant perspectives on the world: Kant,aquinas and quantum mechanics

Theological thinking is influenced by perspectives on the relation of scientific knowledge to reality. Two paradigms for understanding the nature of human knowledge are considered in relation to quantum mechanics: the subjective-observing perspective of Kant, and the objective-participant perspective of Thomas Aquinas. I discuss whether quantum mechanics necessarily implies a subject centered perspective on reality, and argue, with reference to d'Espagnat's notion of veiled reality, that quantum non-separability challenges this view. I then explore whether the objective-participant perspective of Thomas Aquinas provides a more fruitful context for understanding quantum mechanics. I discuss quantum measurement in terms of the transition from potentiality to actuality, and knowledge as the latent intelligibility of the world realized. However, the negative nature of our knowledge of quantum non-separability also challenges this perspective. Our theological thinking in response to quantum knowledge must therefore proceed tentatively, balancing a via positiva, with a via negativa.     

Working with psychosis: Part 2 – encounters with an omnipotent super-ego

This is the second in a series of four papers presenting work with a man suffering from a bipolar disorder. The present paper describes the second year of the work and my encounters with an omnipotent super-ego which made ferocious attacks on the work, especially when there were any developments. The attacks were particularly disabling because my own implacable super-ego was mobilized in the counter-transference. Consequently developments seemed to melt away as my patient and I were often reduced to mindless states. I came to understand that these omnipotent attacks were stirred by feelings of infantile helplessness and dependency, and were a means of trying to manage a dread of falling to pieces and unintegration.     

Playing for time: A psychotherapist's experience of counselling young people

This article describes the experience of a psychotherapist working for several years with adolescents and young adults at a centre offering weekly psychoanalytic psychotherapy. It describes some of the pressures placed on the therapist by young people engaging in considerable degrees of acting out and the difficulties in holding on to a sense of valuable work in the face of different attacks.     

Enriching Foreign Qualifications Through Canadian Post-secondary Education: Who Participates and Why?

The Longitudinal Survey of Immigrants to Canada is employed to compare recent immigrant post-secondary education participants and non-participants with respect to a range of factors, including demographic, socio-economic, and cultural differences, official language competency, recognition of educational credentials and employment experiences, and social capital. A multilevel logit model was employed to identify the (changing) impact of factors on post-secondary participation. The cumulative post-secondary participation rate increased from 10% to 33% to 44% within 6 months, 2 years and 4 years of arrival, respectively. Gender, age, prior level of education, self-reported language proficiency, social capital and situational factors were significant in explaining the cumulative increase.     

Does Perceived Realism Really Matter in Media Effects?

Memory, perceived realism, and emotional responses to documentary and fictional film excerpts were investigated experimentally using adult participants. Documentary stimuli were perceived as more factual than their fiction counterparts at both semantic and syntactic levels. However, contrary to expectations, memory for visual and verbal information and the intensity of emotional reactions were greater overall for fiction films. Films whose content corresponded to well-known social themes and film genres also had a greater influence on memory and emotions. In general, it appears that perceived factuality does not have as compelling an influence on adults as it does on younger viewers. Results are interpreted in terms of the differences between cinematic attributes of documentary and fiction films and between the cognitive processes activated by these two film genres and by different themes.