Adapting Cognitive Processing Therapy to Treat Co-Occurring Posttraumatic Stress Disorder and Mild Traumatic Brain Injury: A Case Study

This case study aims to provide evidence for the effectiveness of adapting a particular manualized cognitive behavioral therapy intervention to treat co-occurring posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI). This study presents the treatment of a woman who experienced co-occurring mTBI and PTSD following a motor vehicle accident, a dual diagnosis that was established through a flexible assessment approach involving interviews as well as standardized psychological, neuropsychological, and neurobehavioral testing. Treatment planning led to a-priori adaptation of Cognitive Processing Therapy (CPT) to treat both her PTSD symptoms and the sequelae associated with her mTBI. The therapist maintained fidelity to the manualized structure and content of CPT protocol, adapting portions of the treatment to add specific emphasis on issues of identity confusion and role loss in service of addressing these common functional impairments that can accompany mTBI. Discussion focuses on application of CPT for future treatment of comorbid PTSD and TBI amidst complicating factors, including role losses and medical and safety issues. This case study is especially relevant due to the prevalence of co-occurring PTSD and TBI across a variety of populations.     

Socrates’ Aversion to Being a Victim of Injustice

In the Gorgias, Plato has Polus ask Socrates if he would rather suffer injustice than perform it. Socrates’ response is justly famous, affirming a view that Polus himself finds incredible, and one that even contemporary readers find difficult to credit: “for my part, I would prefer neither, but if it had to be one or the other, I would choose to suffer rather than do what is unjust” (Gorgias 469c1-2). In this paper, we take up the part of Socrates’ response that Polus never engages and that has also been completely neglected by contemporary scholars, namely, Socrates’ explicit aversion to being a victim of injustice. We show that this same aversion—though one not nearly as strong as his aversion to doing injustice—appears in several texts, and we argue that the best explanation of such an aversion derives from two important features of Socratic philosophy, both of which have only recently been recognized in Socratic scholarship: (i) his virtue intellectualism, which conceives of virtue as a kind of craft that can be achieved in different degrees, and (ii) his conception of moral psychology, which allows for non-rational influences on how we perform the cognitive functions required for proper deliberation.     

Toward a Role Ethical Theory of Right Action

Despite its prominence in traditional societies and its apparent commonsense appeal, the moral tradition of Role Ethics has been largely neglected in mainstream normative theory. Role Ethics is the view that the duties and/or virtues of social life are determined largely by the social roles we incur in the communities we inhabit. This essay aims to address two of the main challenges that hinder Role Ethics from garnering more serious consideration as a legitimate normative theory, namely that it is ill-suited to support a theory of right action that can enhance moral reasoning, and that it countenances certain unjust roles such as that of slave or slave-owner. Taking inspiration from contemporary social science, we argue that proponents of Role Ethics can adopt a view that reduces the apparent diversity of role obligations to four prototypical types of role duties. We propose a contemporary version of Role Ethics that coheres with human moral psychology, and which lends itself to a relatively pragmatic theory of right action that precludes the possibility of unjust roles.     

Liberating narratives and the play of unforbidden pleasures: In brief dynamic therapy

Drawing upon the work of Adam Phillips and Ronald Britton the author highlights the intimidating and fear-inducing nature of the super-ego and the role of the therapist in supporting the judgements of the ego and liberating it from the domination of the super-ego. He goes on to explore the proposition that moral principles do not need to be oppressive in nature and that they can emanate from objects that are more akin to sexual or aesthetic objects. These themes are linked to Woodmansey’s conceptualistion of the punitive and humiliating super-ego, and the origin of the super-ego as an internalisation of an external conflict is outlined. The role of identifying a Cyclical Maladaptive Pattern as a focus and its contribution in identifying the super-ego and how it manifests in the client’s narrative are explored, as well as the crucial contribution of a playful stance on the part of therapist in subverting and undermining the intimidating strictures of the super-ego.     

A “spoon full of sugar” helps the medicine go down: How a participant friendly version of a psychophysics task significantly improves task engagement,performance and data quality in a typical adult sample

Few would argue that the unique insights brought by studying the typical and atypical development of psychological processes are essential to building a comprehensive understanding of the brain. Often, however, the associated challenges of working with non-standard adult populations results in the more complex psychophysical paradigms being rejected as too complex. Recently we created a child- (and clinical group) friendly implementation of one such technique – the reverse-correlation Bubbles approach – and noted an associated performance boost in adult participants. Here, we compare the administration of three different versions of this participant-friendly task in the same adult participants to empirically confirm that introducing elements in the experiment with the sole purpose of improving the participant experience, not only boosts the participant’s engagement and motivation for the task but results in a significantly improved objective task performance and stronger statistical results.     

A case-controlled field study evaluating ICD-11 proposals for relational problems and intimate partner violence

Background/Objective: Intimate partner relationship problems and intimate partner abuse and neglect — referred to in this paper as “relational problems and maltreatment” — have substantial and well-documented impact on both physical and mental health. However, classification guidelines, such as those found in the International Classification of Diseases (ICD-10), are vague and unlikely to support consistent application. Revised guidelines proposed for ICD-11 are much more operationalized. We used standardized clinical vignette conditions with an international panel of clinicians to test if ICD-11 changes resulted in improved classification accuracy. Method: English-speaking mental health professionals (N = 738) from 65 nations applied ICD-10 or ICD-11 (proposed) guidelines with experimentally manipulated case presentations of presence or absence of (a) individual mental health diagnoses and (b) relational problems or maltreatment. Results: ICD-11, compared with ICD-10, guidelines resulted in significantly better classification accuracy, although only in the presence of co-morbid mental health problems. Clinician factors (e. g., gender, language, world region) largely did not impact classification performance. Conclusions: Despite being considerably more explicated, raters’ performance with ICD-11 guidelines reveals training issues that should be addressed prior to the release of ICD-11 in 2018 (e. g., overriding the guidelines with pre-existing archetypes for relationship problems and physical and psychological abuse).     

Achievement-oriented and dependency-oriented parental psychological control: An examination of specificity to middle childhood achievement and dependency-related problems

Middle childhood is considered a sensitive phase for the development of both dependency and achievement-related problems. In order to target efficient prevention and treatment, it is necessary to identify unique associations with possible precursors. This study hypothesized that children’s dependency-related problems (i.e., separation anxiety and generalized anxiety) would uniquely relate to parental dependency-oriented psychological control and that children’s achievement-related problems (i.e., extrinsic motivation and maladaptive perfectionism) would uniquely relate to parental achievement-oriented psychological control. The study included 180 elementary school children. Results showed that higher levels of children’s separation anxiety uniquely related to more parental dependency-oriented psychological control, while higher levels of children’s extrinsic motivation uniquely related to more parental achievement-oriented psychological control. Contrary to the expectations, higher levels of children’s maladaptive perfectionism were associated with both dimensions of parental psychological control, and children’s generalized anxiety was not associated with any dimension. Study implications are discussed.     

Development and validation of a brief self-report measure of trauma exposure: the Trauma History Screen

Although information about individuals' exposure to highly stressful events such as traumatic stressors is often very useful for clinicians and researchers, available measures are too long and complex for use in many settings. The Trauma History Screen (THS) was developed to provide a very brief and easy-to-complete self-report measure of exposure to high magnitude stressor (HMS) events and of events associated with significant and persisting posttraumatic distress (PPD). The measure assesses the frequency of HMS and PPD events, and it provides detailed information about PPD events. Test-retest reliability was studied in four samples, and temporal stability was good to excellent for items and trauma types and excellent for overall HMS and PPD scores. Comprehensibility of items was supported by expert ratings of how well items appeared to be understood by participants with relatively low reading levels. In five samples, construct validity was supported by findings of strong convergent validity with a longer measure of trauma exposure and by correlations of HMS and PPD scores with posttraumatic stress disorder (PTSD) symptoms. The psychometric properties of the THS appear to be comparable or better than longer and more complex measures of trauma exposure.