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.     

Strength of hand preference and dual task performance by common marmosets

Study of avian and piscine species has shown that animals with stronger lateralization of the brain are able to perform two tasks presented simultaneously better than can animals with weaker lateralization. We investigated whether this might apply also to primates by testing common marmosets to see whether there is a relationship between the strength of hand preference, as an indicator of strength of brain lateralization, and the ability to carry out two tasks simultaneously. A model predator was introduced into the testing room while the marmoset was foraging. Marmosets with stronger hand preferences detected the ‘predator’ after shorter latency than those with weaker hand preferences. Furthermore, the marmosets with stronger hand preferences produced more mobbing (tsik) vocalizations when they reacted to the predators than did those with weaker hand preferences. There was no such association between hand preference and either latency to respond to the predator or mobbing reaction when the marmosets were not foraging at the time the predator was introduced. Hence, strength of lateralization is associated with the ability to perform foraging and predator detection simultaneously. These results are discussed with reference to the evolution of brain lateralization.     

Women Experiencing Psychological Abuse: Are They a Homogenous Group?

Dichotomizing women as “abused” versus “not abused” assumes that any psychological maltreatment results in similar outcomes. A national sample of women in conflictual relationships completed an online survey. Women with no incidence (N = 33), the lowest quartile (N = 86), and the top quartile (N = 81) of psychological maltreatment demonstrated significant differences in reactions to the maltreatment, mental health indicators, personality variables, perceived harm, problematic relationship schemas, and response styles. Women with no psychological abuse and women in the lowest quartile produced similar scores that were typically distinct from the top-quartile women. Effective treatment of women with lower amounts of psychological abuse might not require a unique intervention likely necessary for women experiencing much psychological abuse.     

Gender Differences in Reporting Psychological Abuse in a National Sample

Understanding the nature and impact of psychological abuse for males and females is crucial because it might be the precursor of other forms of violence. This study examines reported gender differences in psychologically abusive acts using a national sample of U.S. citizens. The data were collected anonymously from an online administration of the Measure of Psychological Abuse (MPAB). Other measures were included to assess outcomes that might occur due to psychological abuse. Results indicate that there are more similarities than differences in the gender reports of psychological abuse. Compared to males' reports, differences include female reports of certain behaviors leading to more negative emotional and behavioral impact and more negative outcomes due to being in a psychologically abusive relationship.     

Congregational Hermeneutics: A Tale of Two Churches

Abstract

The “AHRC Evangelicalism and Fundamentalism in Britain” (EFB) project ran over two years, from 2008 to 2009. The network addressed the question “To what extent have Evangelicals in Britain been Fundamentalist?”. This article develops one of the project papers. Drawing on my doctoral research, I explore the relationship between Evangelicalism and Fundamentalism through an ethnographic perspective on how two contrasting evangelical congregations did biblical hermeneutics. The congregational hermeneutics approach addresses the mix of hermeneutical discourses, practices, and artefacts within the churches and I show that congregational hermeneutics are revealing for questions of evangelical identity. I maintain that the language of ‘fundamentalising tendencies’ is to be preferred to more static conceptions, which are not well suited for describing dissonant tendencies within congregations. The study supports the view that fundamentalising tendencies are not identical with Evangelicalism and shows that implicit hermeneutical traditions can be found in such churches with the potential to shape broader congregational traditions.     

Holocaust and Hollywood: An Annotated Filmography

This paper offers a list of Hollywood movies pertaining to the Holocaust. Its aim is to facilitate the access of individuals, libraries, foundations, film clubs, and Holocaust-related study groups to this powerful material. These movies enhance empathy and knowledge regarding the Holocaust and thus serve an important psychoeducational function for all, but especially for those not directly affected by this great human tragedy.