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.     

Long-term memory of hierarchical relationships in free-living greylag geese

Animals may memorise spatial and social information for many months and even years. Here, we investigated long-term memory of hierarchically ordered relationships, where the position of a reward depended on the relationship of a stimulus relative to other stimuli in the hierarchy. Seventeen greylag geese (Anser anser) had been trained on discriminations between successive pairs of five or seven implicitly ordered colours, where the higher ranking colour in each pair was rewarded. Geese were re-tested on the task 2, 6 and 12 months after learning the dyadic colour relationships. They chose the correct colour above chance at all three points in time, whereby performance was better in colour pairs at the beginning or end of the colour series. Nonetheless, they also performed above chance on internal colour pairs, which is indicative of long-term memory for quantitative differences in associative strength and/or for relational information. There were no indications for a decline in performance over time, indicating that geese may remember dyadic relationships for at least 6 months and probably well over 1 year. Furthermore, performance in the memory task was unrelated to the individuals’ sex and their performance while initially learning the dyadic colour relationships. We discuss possible functions of this long-term memory in the social domain.     

A Response to Patricia A. Williams' “The Fifth R: Jesus as Evolutionary Psychologist”

Panentheism has recently become a widely accepted and appreciated concept among scholars in the science-theology dialogue, and its theological repercussions have been discussed to great extent. Yet, there remains to be studied in more detail the notion of the philosophical foundations of the term. A prominent gap in our understanding of these foundations is the potential similarity between the metaphysics of Hegel and Whitehead, their understanding of the transcendence and immanence of God, and their respective versions of panentheism. In this article, I present a critical reflection on the possible resemblance between process thought and Hegelian metaphysics and philosophy of God. In the last section I refer to those who use panentheism within the science-theology dialogue. I try to specify which of the two versions of panentheism, that of Hegel or Whitehead, is more popular among those scholars.     

The Catholic Church,moral doctrine,and HIV prevention in Recife,Brazil: Negotiating the contradictions between religious belief and the realities of everyday life

Religious beliefs have had a key role in shaping local responses to HIV and AIDS. As the world's largest Catholic country, Brazil is no exception. Yet little research has been conducted to document how religious doctrine is enacted in practice among its lay leaders and followers. In this article, we present ethnographic research from Recife, Brazil, conducted to understand the way in which religious doctrines are interpreted at a local level. Contextualised within the sociology of contemporary Brazilian Catholicism, we draw on interviews with clergy members, lay leaders, and parishioners to discuss how the Catholic Church's vision of sexuality translates into everyday lives of its followers. We explore the disjuncture between the Catholic ideals of fidelity and delaying sex until marriage with the everyday reality of the Church's followers, highlighting the role that gender plays in defining sexual roles and expectations. We conclude by posing questions for future research and HIV prevention strategies considering the formal institutional response of the Brazilian Catholic Church to AIDS on the one hand, and the social and cultural contexts in which Catholics live their daily lives on the other.     

Need Satisfaction Supportive Game Features as Motivational Determinants: An Experimental Study of a Self-Determination Theory Guided Exergame

Empirical studies have validated that basic needs satisfaction supported by video game play predicts motivation and engagement outcomes. However, few studies specifically manipulated game features for each of the three basic needs specified in the self-determination theory (SDT) to examine how the game features impact players' need satisfaction and game experience. The current study employed an in-house developed exergame and manipulated the game features in a 2 (autonomy-supportive game features: on vs. off) × 2 (competence-supportive game features: on vs. off) experiment to predict need satisfaction, game enjoyment, motivation for future play, effort for gameplay, self-efficacy for exercise using the game, likelihood of game recommendation, and game rating. The manipulated game features led to the corresponding need satisfaction. Manipulated autonomy-supportive and competence-supportive game features had main effects on most motivation and engagement outcomes. Need satisfaction of autonomy and need satisfaction of competence were both found to be mediators for the relationships between the game features and the motivation and engagement outcomes. The findings add evidence to support the underlying mechanism postulated by SDT for media enjoyment and motivation as well as the emerging entertainment research conceptualizing enjoyment as need satisfaction. The findings also have practical implications for intervention effort that intends to capitalize the motivational pull of video games.     

The Third-Person Effects of Political Attack Ads in the 2004 U.S. Presidential Election

This study examines the indirect effects of extensive negative political attack ads in the 2004 presidential election from a third-person effects perspective. Results of a survey using a probability sample of 496 college students indicate that these students believe attack ads harm others more than themselves. Moreover, the respondents tended to perceive attack ads in traditional media to have a greater harmful effect on self and others than attack ads on the Internet. Contingent factors that account for the magnitude of third-person effects include social distance and knowledge. Further, exposure to attack ads was found to be the strongest predictor of perceived harms of such ads on self and others, but only perceived harm on others is a significant predictor of support for restrictions on attack ads. The study contributes to research on the third-person effect by testing perceived harms of attack ads on self and others separately on likelihood to support restrictions.     

Anxiety in Swedish School Children: Situational Specificity,Informant Variability and Coping Strategies

In a school sample, 463 Swedish children aged between 8 and 12 years reported their experience of anxiety during 11 "typical" home and school setting activities. In addition to rating the frequency and type of anxiety experienced, the children reported whether they used coping strategies to reduce their anxiety. Parents and teachers also rated the anxiety levels in the same children. Nine percent of the children reported that they experienced anxiety "often" during at least 1 of the 11 home and school activities and 1.5% reported an anxiety level of "often" averaged across all of the 11 activities. The parents reported that 9% of the children experienced "moderate" to "very much" anxiety levels averaged across the home-related activities, whereas the teachers reported that 38.5% of the children had such anxiety levels at school. Overall, the children's ratings of their frequency levels of anxiety were found to depend more on age than on gender. The children and their parents both regarded anxiety to be most common during "leaving home for school" and "going to bed at night" activities. The correspondence between child, parent and teacher reports of overall anxiety in the children was low; similar findings were obtained for anxiety among children in the various setting activities. The 8-year-old children reported a higher use of various coping strategies than did the 12-year-olds. The results are discussed in view of the current literature on anxiety and fears in children.