"Dwelling in the Past": The Role of Rumination in the Treatment of Posttraumatic Stress Disorder

Prolonged exposure, a cognitive behavioral therapy including both in vivo and imaginal exposure to the traumatic memory, is one of several empirically supported treatments for chronic posttraumatic stress disorder (PTSD). In this article, we provide a case illustration in which this well-validated treatment did not yield expected clinical gains for a client with PTSD and co-occurring major depression. After providing an overview of the literature, theory, and treatment protocol, we discuss the clinical cascade effect that underlying ruminative processes had on the treatment of this case. Specifically, we highlight how ruminative processes, focusing on trying to understand why the traumatic event happened and why the client was still suffering, resulted in profound emotional distress in session and in a lack of an "optimal dose" of exposure during treatment.     

An exploration of cognitive appraisals following spinal cord injury

This study explored the cognitive appraisals that people make following spinal cord injury (SCI) about their situation and their ability to cope with it. Appraisals are thought to be important in determining individual responses to different events and have been shown to predict psychological well-being following injury. A cross-sectional interview study was used. Ten individuals who had recently started rehabilitation at the National Spinal Injuries Centre following an SCI were interviewed. Eight men and two women with a variety of injury level and completeness participated. Interviews were semi-structured and aimed to elicit participants' appraisals of their experiences and their ability to cope. Interviews were analysed qualitatively using interpretative phenomenological analysis. Four super-ordinate themes emerged from the interviews. These were making sense of a traumatic experience, impact of the SCI, coping and altered view of self and life. The interviews revealed that appraisals following SCI are complex and relate not only to the individual but also to their context, life stage, roles and relationships. The study adds to the theoretical understanding of the appraisal process following SCI. Ideas for further research are generated and clinical implications for improving patient experiences and developing appraisal-focused interventions are considered.     

Lexically guided retuning of letter perception

Participants made visual lexical decisions to upper-case words and nonwords, and then categorized an ambiguous N-H letter continuum. The lexical decision phase included different exposure conditions: Some participants saw an ambiguous letter "?", midway between N and H, in N-biased lexical contexts (e.g., REIG?), plus words with unambiguous H (e.g., WEIGH); others saw the reverse (e.g., WEIG?, REIGN). The first group categorized more of the test continuum as N than did the second group. Control groups, who saw "?" in nonword contexts (e.g., SMIG?), plus either of the unambiguous word sets (e.g., WEIGH or REIGN), showed no such subsequent effects. Perceptual learning about ambiguous letters therefore appears to be based on lexical knowledge, just as in an analogous speech experiment (Norris, McQueen, & Cutler, 2003) which showed similar lexical influence in learning about ambiguous phonemes. We argue that lexically guided learning is an efficient general strategy available for exploitation by different specific perceptual tasks.     

Effectiveness of Cognitive-Behavioral Insomnia Treatment in a Community Sample of Older Individuals: More Questions than Conclusions

Effectiveness of two modified stimulus control insomnia interventions plus daily sleep self-monitoring for managing insomnia was investigated in a community sample of older adults. Significant post intervention improvement was observed in both interventions as well as in a self-monitoring only control condition. This unexpected finding led us to question the role of self-monitoring as a potential mediator of therapeutic change. Therefore, we compared long-term follow-up data from treated participants to data from similarly poor sleepers who only completed the questionnaire battery at Pre-test and long term follow-up, with no intervening treatment or self-monitoring. Both groups of poor sleepers reduced their reported amount of nocturnal wakefulness. However, only treated participants improved on their perceived frequency of insomnia episodes and insomnia-related distress. Our findings have implications both for the definition and the treatment of insomnia.     

Levels of processing effects on implicit and explicit memory tasks: using question position to investigate the lexical-processing hypothesis

One interpretation of levels of processing effects (LOP) on priming in implicit tests of memory is in terms of deficits in lexical processing during shallow study tasks. In two experiments the extent of lexical processing engaged in during standard shallow encoding tasks was manipulated by placing the encoding question either before or after the target stimulus. Clear evidence was found in explicit memory tasks that placing the question after the target stimulus increased the depth of processing of words presented in shallow encoding tasks. In contrast, there was no evidence of such an effect on the priming observed in implicit memory tasks. The results suggest that the role of lexical processing in LOP effects on priming requires further specification.     

Reliability and validity of the Women's Health Initiative Insomnia Rating Scale

The reliability and construct validity of the 5-item Women's Health Initiative Insomnia Rating Scale (WHIIRS) were evaluated in 2 studies. In Study 1, using a sample of 66,269 postmenopausal women, validity of the WHIIRS was assessed by examining its relationship to other measures known to be related to sleep quality. Reliability of the WHIIRS was estimated using a resampling approach; the mean alpha coefficient was .78. Test-retest reliability coefficients were .96 for same-day administration and .66 after a year or more. Correlations of the WHIIRS with the other measures were in the predicted directions. Study 2 used a sample of 459 women and compared the WHIIRS with objective indicators of sleep quality. Results showed that differences in the objective indicators could be detected by the WHIIRS. Findings suggest that a between-group mean difference of approximately 0.50 of a standard deviation on the WHIIRS may be clinically meaningful.     

Factor structure and measurement invariance of the Women's Health Initiative Insomnia Rating Scale

As part of the Women's Health Initiative Study, the 5-item Women's Health Initiative Insomnia Rating Scale (WHIIRS) was developed. This article summarizes the development of the scale through the use of responses from 66,269 postmenopausal women (mean age = 62.07 years, SD = 7.41 years). All women completed a 10-item questionnaire concerning sleep. A novel resampling technique was introduced as part of the data analysis. Principal-axes factor analysis without iteration and rotation to a varimax solution was conducted for 120,000 random samples of 1,000 women each. Use of this strategy led to the development of a scale with a highly stable factor structure. Structural equation modeling revealed no major differences in factor structure across age and race-ethnic groups. WHIIRS norms for race-ethnicity and age subgroups are detailed.     

Relative influences of affect and cognition on behavior: are feelings or beliefs more related to blood donation intentions?

This study tested the relative predictive power of affect and cognition on global attitude and behavioral intention within the tripartite model of attitude structure. Participants (N = 264) completed questionnaires that included an item regarding blood donation experience, five semantic differential items, four behavioral intention items, and one global attitude item. Participants were randomly assigned to either an affective or cognitive instruction set for the semantic differential items. As predicted, semantic differentials were more highly correlated with both global attitude and behavioral intention when completed under the affective instructions than under the cognitive instructions. In addition, donors' and non-donors' attitudes on the semantic differential scales were distinguished from one another only when they were elicited under the affective instruction set. Results provide support for the tripartite model of attitude structure. Future research should examine the relative importance of affect and cognition in less emotion-laden domains.     

Research in education: What influence on policy and practice?

This paper is set in a context where increased emphasis is being placed on the “consumer’s” role in research. It discusses the limitations of “knowledge base” approaches, which aim to deliver the findings of educational research to practitioners and policymakers. The tensions between what these consumers expect of research and what it can, in fact, offer are explored, and the conditions under which effective communication can be established are outlined and exemplified. It is argued, however, that the processes of such communication, if they are to establish the necessary engagement of consumers with researchers, will have to take account of the ways in which consumers are motivated and able to acquire new knowledge. In conclusion, it is argued that if the engagement is unsuccessful and the consumers are unconvinced of the value and validity of research findings for policy and practice, then researchers’ ideas will take a back seat in the debate about what is to count as high-quality work that should be funded. The function of research as the critical extension of knowledge may then be replaced by enquiry that comes up with the results the customer wants. Her current research interests are in the relationships among policy, practice and research, teachers’ thinking, provision for children with special educational needs and gender in education. Her best known recent book, with Donald McIntyre, isMaking Sense of Teaching (Open University Press).     

Interrelationships among subject variables believed to predict cerebral organization

A variety of subject variables have been proposed as having predictive value for determining cerebral organization. Subject variables proposed as likely candidates include strength of handedness, familial sinistrality, writing posture, and sex. The present study examined the interrelationships among these variables by means of a questionnaire given to 847 undergraduates.