Adapting Cognitive Processing Therapy to Treat Co-Occurring Posttraumatic Stress Disorder and Mild Traumatic Brain Injury: A Case Study

This case study aims to provide evidence for the effectiveness of adapting a particular manualized cognitive behavioral therapy intervention to treat co-occurring posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI). This study presents the treatment of a woman who experienced co-occurring mTBI and PTSD following a motor vehicle accident, a dual diagnosis that was established through a flexible assessment approach involving interviews as well as standardized psychological, neuropsychological, and neurobehavioral testing. Treatment planning led to a-priori adaptation of Cognitive Processing Therapy (CPT) to treat both her PTSD symptoms and the sequelae associated with her mTBI. The therapist maintained fidelity to the manualized structure and content of CPT protocol, adapting portions of the treatment to add specific emphasis on issues of identity confusion and role loss in service of addressing these common functional impairments that can accompany mTBI. Discussion focuses on application of CPT for future treatment of comorbid PTSD and TBI amidst complicating factors, including role losses and medical and safety issues. This case study is especially relevant due to the prevalence of co-occurring PTSD and TBI across a variety of populations.     

Prism adaptation in schizophrenia

The prism adaptation test examines procedural learning (PL) in which performance facilitation occurs with practice on tasks without the need for conscious awareness. Dynamic interactions between frontostriatal cortices, basal ganglia, and the cerebellum have been shown to play key roles in PL. Disruptions within these neural networks have also been implicated in schizophrenia, and such disruptions may manifest as impairment in prism adaptation test performance in schizophrenia patients. This study examined prism adaptation in a sample of patients diagnosed with schizophrenia (N=91) and healthy normal controls (N=58). Quantitative indices of performance during prism adaptation conditions with and without visual feedback were studied. Schizophrenia patients were significantly more impaired in adapting to prism distortion and demonstrated poorer quality of PL. Patients did not differ from healthy controls on aftereffects when the prisms were removed, but they had significantly greater difficulties in reorientation. Deficits in prism adaptation among schizophrenia patients may be due to abnormalities in motor programming arising from the disruptions within the neural networks that subserve PL.     

A cascade of disparities: health and health care access for people with intellectual disabilities

People with ID represent approximately 2% of the population and, as a group, experience poorer health than the general population. This article presents recent conceptualizations that begin to disentangle health from disability, summarizes the literature from 1999 to 2005 in terms of the cascade of disparities, reviews intervention issues and promising practices, and provides recommendations for future action and research. The reconceptualization of health and disability examines health disparity in terms of the determinants of health (genetic, social circumstances, environment, individual behaviors, health care access) and types of health conditions (associated, comorbid, secondary). The literature is summarized in terms of a cascade of disparities experienced by people with ID, including a higher prevalence of adverse conditions, inadequate attention to care needs, inadequate focus on health promotion, and inadequate access to quality health care services. Promising practices are reviewed from the perspective of persons with ID, providers of care and services, and policies that influence systems of care. Recommendations across multiple countries and organizations are synthesized as guidelines to direct future action. They call for promoting principles of early identification, inclusion, and self-determination of people with ID; reducing the occurrence and impact of associated, comorbid, and secondary conditions; empowering caregivers and family members; promoting healthy behaviors in people with ID; and ensuring equitable access to quality health care by people with ID. Their broadscale implementations would begin to reduce the health disparity experienced by people with ID.     

Sex-related hemispheric lateralization of amygdala function in emotionally influenced memory: an FMRI investigation

The amygdala appears necessary for enhanced long-term memory associated with emotionally arousing events. Recent brain imaging investigations support this view and indicate a sex-related hemispheric lateralization exists in the amygdala relationship to memory for emotional material. This study confirms and further explores this finding. Healthy men and women underwent functional Magnetic Resonance Imaging (fMRI) while viewing a series of standardized slides that were rated by the subjects as ranging from emotionally neutral to highly arousing. Two weeks later, memory for the slides was assessed in an incidental recognition test. The results demonstrate a significantly stronger relationship in men than in women between activity of the right hemisphere amygdala and memory for those slides judged as arousing, and a significantly stronger relationship in women than in men between activity of the left hemisphere amygdala and memory for arousing slides. An ANOVA confirmed a significant interaction between sex and hemisphere regarding amygdala function in memory. These results provide the strongest evidence to date of a sex-related hemispheric lateralization of amygdala function in memory for emotional material. Furthermore, they underscore the view that investigations of neural mechanisms underlying emotionally influenced memory must anticipate, and begin to account for, the apparently substantial influence of sex.     

The Social Thoughts and Beliefs Scale: a new inventory for assessing cognitions in social phobia

Development and initial psychometric features of a new inventory to assess cognitions associated with social phobia are described. The Social Thoughts and Beliefs Scale (STABS) is designed to assess cognitions in individuals with social phobia. In the 1st study, an initial pool of 45 items was reduced to 21. In the 2nd study, psychometric features of the scale were examined in a sample of individuals with social phobia, other anxiety disorders, and no psychiatric disorder. Total scores and two factor scores significantly differentiated individuals with social phobia from those in the other groups and were found to have adequate test-retest reliability and internal consistency. Potential usefulness of the STABS for assessing cognitions associated with social phobia is discussed.     

Changes in behavior and behavioral intentions among middle-age women: results from an osteoporosis prevention program

The purpose of this study was to evaluate changes in behaviors and behavioral intentions that occurred among 342 middle-age women (M age 49.5 yr.) after participating in an Osteoporosis Prevention Program. The valid and reliable Osteoporosis Preventing Behaviors Survey (developed by Doheny and Sedlak) and a survey developed for this work were measures. Significant changes in behaviors were reported, especially increases in weight-bearing physical activity, dairy product intake, and decreases in consumption of caffeine-containing beverages. Many subjects reported intentions to increase physical activity and calcium intake. An Osteoporosis Prevention Program may help promote osteoporosis prevention behaviors, but intents must be followed up to check actual change.     

Sociability and susceptibility to the common cold

There is considerable evidence that social relationships can influence health, but only limited evidence on the health effects of the personality characteristics that are thought to mold people's social lives. We asked whether sociability predicts resistance to infectious disease and whether this relationship is attributable to the quality and quantity of social interactions and relationships. Three hundred thirty-four volunteers completed questionnaires assessing their sociability, social networks, and social supports, and six evening interviews assessing daily interactions. They were subsequently exposed to a virus that causes a common cold and monitored to see who developed verifiable illness. Increased sociability was associated in a linear fashion with a decreased probability of developing a cold. Although sociability was associated with more and higher-quality social interactions, it predicted disease susceptibility independently of these variables. The association between sociability and disease was also independent of baseline immunity (virus-specific antibody), demographics, emotional styles, stress hormones, and health practices.     

The Social Phobia and Anxiety Inventory: Reliability and Validity in an Adolescent Spanish Population

The objective of this study is to examine the factor structure and psychometric properties of the SPAI in a sample of adolescent Spaniards. The results obtained support the use of the correlated two-factor SPAI subscales and indicate high coefficient alpha values for the SPAI subscales. The results provide support for the use of the SPAI in an adolescent population in a non-English-speaking country. Both exploratory and confirmatory factor analyses of the Social Phobia subscale showed a four-factor structure, instead of a five-factor dimension, as suggested by previous studies. Effects for gender and age and gender interaction were found. Limitations and suggestions for future research are discussed.     

Dairy-product intake and hip fracture among older women: issues for health behavior

The purpose of this study was to examine the association between dairy-product intake and hip fracture among a national sample of women aged 50 years and older. Univariate analyses using SAS procedures showed dairy-product intake was significantly associated with hip fracture. Women who had suffered hip fracture reported higher dairy use than women who had not experienced these fractures, a finding that is dramatically inconsistent with the literature. This finding may reflect positive behavioral changes resulting from the hip fracture event. Further research must focus on changes in health behavior after fracture, which may assist in understanding the roles of specific theories of health behavior. Application of principles of health behavior could improve the effectiveness of preventive treatment programs for osteoporosis.