Does Traumatic Brain Injury Attenuate the Exposure Therapy Process?

Research indicates that exposure therapy is efficacious for combat-related posttraumatic stress disorder (PTSD) comorbid with traumatic brain injury (TBI) as is shown by reduced PTSD treatment outcome scores. What is unknown, however, is whether the process of fear extinction is attenuated in veterans with TBI history. Increased PTSD symptomatology and possible cognitive deficits associated with TBI sequelae may indicate additional or longer exposure sessions to achieve habituation and extinction comparable to individuals without TBI history. As such, a more extensive course of treatment may be necessary to achieve comparable PTSD treatment outcome scores for individuals with TBI history. Using a sample of veterans with combat-related PTSD, some of whom were comorbid for TBI, this study compared process variables considered relevant to successful treatment outcome in exposure therapy. Individuals with and without TBI demonstrated similar rates of fear activation, length and number of exposure sessions, within-session habituation, between-session habituation, and extinction rate; results remained consistent when controlling for differential PTSD symptomatology. Furthermore, results indicated that self-perception of executive dysfunction did not impact the exposure process. Results suggest that individuals with PTSD and TBI history engage successfully and no differently in the exposure therapy process as compared to individuals with PTSD alone. Findings further support exposure therapy as a first-line treatment for combat-related PTSD regardless of TBI history.     

Factors influencing failure to show for a family evaluation

Abstract

An important issue in clinical practice concerns clients' failure to keep their initial evaluation appointments, which has been termed defection (Shapiro and Budman, 1973). Research findings and clinical impressions suggest that client defection can be related to three sets of factors: actuarial variables, client psychological and motivational variables, and client-clinician interaction prior to the initial appointment (Rubinstein and Lorr, 1956; Garfield, 1971). Among the actuarial variables, the following have been suggested as being related to clients' defection: referral source, distance client must travel for the appointment, client socioeconomic status (SES), and waiting time (Brill and Storow, 1960; Raynes and Warren, 1971; Lorion, 1973).     

Nicknames of notorious American twentieth‐century deviants: The decline of the folk hero syndrome

This report examines the public use of personal nicknames for notorious American Twentieth Century Deviants. The analysis documents the frequency of nicknames by decade in the twentieth century, the category of the deviant act committed by the person nicknamed, and the connotations of the nicknames. The relationship between the use of nicknames for deviants, and deviants as folk heroes is explored. The data indicate that the public use of personal nicknames for deviants peaks in the 1920's and 1930's and has been declining ever since. This phenomenon parallels the decline in American's belief in the “rags to riches” type of folk hero.