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.     

The role of repeated interviewing in children's responses to cross‐examination‐style questioning

The negative effect of cross‐examination‐style questioning on children's accuracy is likely to be due to the complex and credibility‐challenging questions that characterize the interview. Given that cross‐examination occurs after at least one prior interview, however, it is equally possible that repeated interviewing per se impairs children's accuracy, and that the questions asked have little bearing on children's responses. To examine this issue, 5‐ and 6‐year‐old children (n= 82) and 9‐ and 10‐year‐old children (n= 103) took part in a surprise event and were then interviewed using an analogue of direct examination. Either 1 week or 6 months later, half of the children were re‐interviewed with an analogue of cross‐examination designed to challenge their direct examination responses. Remaining children were re‐interviewed with the same questions that were asked during direct examination. Children's accuracy decreased following their second interview, irrespective of age or delay; however, delay particularly impacted younger children's second interview performance. Children's accuracy was most impaired following a cross‐examination‐style interview. Overall, cross‐examination‐style questioning appears to be particularly detrimental to obtaining accurate event reports from children.     

THE FINAL CHAPTER IN THE STRUGGLE FOR CULTURAL AUTONOMY

This article describes the efforts made by Yiddishist intellectuals to rehabilitate Yiddish culture after the Second World War and turn it into an organising element of the ethnic identity of diaspora Jewry—especially in America. The article investigates the efforts to establish a world organisation for Yiddish culture and make Yiddish the lingua franca of diaspora Jewry. In addition, it traces the renewed discussion in Yiddish journals in America, especially Di tsukunft, on the status of Yiddish worldwide as the language of the Jewish people, focusing on the rising status of Palestine and the establishment of the State of Israel as a central component of this discussion. The emphasis here will be on the importance that this debate attributed to the status of Yiddish in Israel.     

BETWEEN THE HAMMER OF THE RELIGIOUS ESTABLISHMENT AND THE ANVIL OF THE ETHNIC COMMUNITY

This article examines the ambivalent status of rabbis of communities of Ethiopian immigrants who serve within the framework of the religious establishment in Israel. On the one hand, they function in their communities as spiritual leaders who are committed to Jewish law and act as representatives of the religious establishment. On the other, they belong to an excluded ethnic community which perceives them as traitors. Our findings indicate that the marginal status of the Ethiopian rabbis prevents their inclusion and strengthens components of their ethnic identity. Thus, diverse behaviour patterns and various syncretic combinations between religious and cultural elements have been created in their identity.     

Coping With Losses and Past Trauma In Old Age: The Separation-Individuation Perspective

Abstract

Old age is a stage in life in which numerous changes associated with loss can be expected to occur in major life domains. Deterioration of health; retirement; relocation; occupational and financial loss; loss of social roles, identity, status, and support; and the loss of spouse and significant others (siblings, friends) pose an ongoing threat to everyday functioning, forcing the individual to adapt. Thus, effective functioning in daily life represents a major developmental task for the aging (Bakes & Carstensen, 1996; Marsiske, Lang, Bakes, & Bakes, 1995). There is marked variability in adjustment among the elderly, and despite the numerous losses associated with aging, many elderly people are well adjusted and report experiencing high levels of well-being (George & Clipp, 1991;Wetle, 1990).     

Maternal Knowledge and Behaviors Regarding Discipline: The Effectiveness of a Hands-on Education Program in Positive Guidance

This study examined which method is most effective in supporting parents to use positive guidance techniques, a lecture-based only parent training series or a lecture-based plus hands-on parent training series. Maternal characteristics of depression, stress level, and attitudes towards positive guidance were explored as possible moderators. In this sample of 49 mother–child dyads, results indicated that the cognitive understanding of the use of positive guidance over time of the participants in the lecture-based only versus the lecture-based plus hands-on groups did not significantly differ. However, both groups improved in their cognitive understanding of positive guidance over time. Results also indicated that the behavioral use of positive guidance over time of the participants in both groups significantly differed. Further investigation revealed that, although the two groups did not differ in their behavioral use of positive guidance before the program, the lecture-based plus hands-on group improved over time whereas the lecture-based only group did not. Depression, stress level, and attitudes towards positive guidance did not moderate the effects of being in either group on participants’ behavioral use of positive guidance. Findings showed that all participants gained a better understanding of effective parenting techniques, but a hands-on component in parent training programs may be necessary for parents to incorporate these strategies into their parenting behaviors. The results have implications for early childhood professionals working with parents to address children’s behavior issues, as well as for the design of parent-support programs.     

The role of illness perceptions in the attachment-related process of affect regulation

Abstract

Based on the predictions of the attachment theory and the Common Sense Model of illness perceptions, the current study focused on the role played by illness perceptions in explaining the path linking attachment orientations to negative affect during recovery from cardiac illness. We predicted two putative mechanisms: (1) illness perceptions would mediate the direct association between attachment-related insecurity (especially attachment anxiety) and levels of distress at follow-up and (2) illness perceptions would interact with attachment orientations (attachment avoidance in particular) in explaining patients' distress. The sample consisted of 111 male patients admitted to the Cardiac Care Unit of the Meir Medical Center, located in the central region of Israel. Patients completed a measure of attachment orientations during hospitalization (baseline). One month later, patients' illness perceptions were measured. Patients' depression and anxiety symptoms were measured at baseline and at the six-month follow-up. The associations between attachment-related anxiety and anxiety symptoms at follow-up were fully mediated by illness perceptions. Attachment-related avoidance was found to interact with illness perceptions in the prediction of depressive symptoms at follow-up. The findings shed light on the possible dynamics among personality, cognitive appraisals, and affect regulation efforts when coping with illness.     

EVALUATION OF BEHAVIORAL SKILLS TRAINING FOR TEACHING FUNCTIONAL ASSESSMENT AND TREATMENT SELECTION SKILLS TO PARENTS

Scant research has addressed the issue of teaching parents to conduct a functional assessment and design a treatment for problem behavior. The present study utilized behavioral skills training to teach parents how to conduct ABC recording, write a summary statement based on the data collected, and make appropriate treatment choices. Eight parents participated in one 3‐h class in which a trainer used instructions, modeling, rehearsal, and feedback to teach these three skill sets. Prior to class, during class, directly after class training, and 1 to 2 weeks following class, the participants viewed videos showing a problem behavior serving a different function in the context of a parent child interaction. The percentage of correct responding for each dependent variable (ABC recording, summary statement, and treatment choices) was calculated, and baseline and post‐treatment scores were compared via a multiple baseline across participants design. The results showed an increase in the percentage correct for most skills for most participants. These results show that it is possible to teach parents to conduct a functional assessment and choose proper treatment strategies. Copyright © 2012 John Wiley & Sons, Ltd.     

Therapeutic Implications of Religious-Related Emotional Abuse

Religion can play a positive role in preventing all types of abuse. Consequently, it is often difficult to believe that religion or a particular manner of religious awareness can also be conducive to the degradation and humiliation of individuals, and that it can be maneuvered to justify abusive behavior. In this article we discuss the emotional repercussions of religious-related abuse in the family, an aspect that is rarely documented in the field of psychotherapy, but has many negative consequences. Religious-oriented emotional abuse is traceable to several levels of human functioning: the individual's internal level of experiencing themselves, the interpersonal and systemic levels, where the individual enters relationships, as well as within the framework of the individual's relationship with God.     

Yoga Practice May Buffer the Deleterious Effects of Abuse on Women's Self-Concept and Dysfunctional Coping

Women who experienced abuse as children or adults can suffer from symptoms such as dissociations, physiological regulation difficulties, and mood disturbances that might not respond to traditional interventions. Given the benefits of yoga, we hypothesized that yoga practice would ameliorate the negative impact of abuse on psychological functioning. Our findings suggest that frequent yoga practice might ameliorate the negative impact of abuse history on self-concept and coping skills. In addition, our findings suggest that women who incorporate yoga into other areas of life could get the greatest psychological benefits. Given the preliminary nature of this study, further research into the benefits of yoga on women who have child or adult abuse histories is warranted.