A thematic analysis of practitioners' understanding of domestic abuse in terms of post‐traumatic stress disorder (PTSD) and complex‐PTSD (C‐PTSD)

There is a growing body of evidence suggesting that domestic abuse (DA) should be conceptualised within the complex post‐traumatic stress disorder (C‐PTSD) model. Recently, in the draft of the International Classification of Diseases, Eleventh Revision, produced by the World Health Organization (WHO), C‐PTSD was included as a separate criterion in which DA is incorporated (ICD‐11, WHO, 2018). In this study, a thematic analysis was used to explore to what extent practitioners working with DA survivors are familiar with PTSD and C‐PTSD. Research into such a prevalent and detrimental problem as DA is important to understand whether the development of theoretical knowledge about DA and C‐PTSD is addressed in practice. In a Women's Centre in South London, six semi‐structured interviews with middle‐aged female practitioners were conducted to investigate each counsellor's experiences, knowledge and reflections. Six final themes were constructed to summarise the main results. The findings demonstrate limited practitioner understanding of DA in terms of C‐PTSD, which seems to impact not only the effectiveness of treatment plans with DA survivors, but also counsellors’ own psychological and physical states. It is also indicated that DA can be conceptualised within the C‐PTSD model that corresponds with previous literature indicating the complex nature of DA. The overall results of the current research acknowledge that DA sectors should not be neglected and better funding and effective psychoeducation in this field are needed.     

Resistance and outcome expectations in cognitive‐behavioural therapy for generalised anxiety disorder

Greater client resistance has been consistently found to be negatively associated with outcome in psychotherapy. However, the pathways through which resistance impacts such outcomes are underexplored. Given that client outcome expectation (OE) has been identified as an important common factor in psychotherapy, the goals of the present study were to examine: (a) the impact of resistance on subsequent client and therapist OE (COE & TOE, respectively); and (b) whether COE and/or TOE mediate the relationship between resistance and outcome. These relationships were tested among 44 clients with severe generalised anxiety disorder treated with cognitive‐behavioural therapy in the context of a randomised controlled trial (Westra, Constantino, & Antony, 2016). Resistance was measured at a mid‐treatment session, and COE and TOE were assessed at baseline and immediately after the resistance session. Treatment outcome was measured via client‐rated worry severity at post‐treatment. As predicted, higher resistance was associated with lower subsequent COE and TOE; B = ?.73, p < .001 and B = ?.46, p < .001, respectively. In turn, lower post‐resistance COE predicted higher post‐treatment worry (B = ?.5, p < .001), indicating mediation. In contrast, TOE did not mediate the relationship between resistance and outcome (B = ?.02, p = .876). These results suggest that resistance can be demoralising to both clients and therapists. However, only lower client morale may be detrimental to therapy outcome. This study contributes to understanding outcome pathways through two common therapy processes.     

Toward a social psychophysiology of vagally mediated heart rate variability: Concepts and methods in self‐regulation,emotion, and interpersonal processes

Theory and research on self‐regulation, emotional adjustment, and interpersonal processes focus increasingly on parasympathetic functioning, using measures of vagally mediated heart rate variability (vmHRV) or respiratory sinus arrhythmia (RSA). This review describes models of vmHRV in these areas, and issues in measurement and analysis. We propose a framework organizing theory and research as examining (a) vmHRV as an individual difference or a situational response, and (b) resting, reactive, or recovery levels. Evidence supports interpretation of individual differences in resting vmHRV as a broad biomarker for adaptive functioning, but its specificity and underlying mechanisms require elaboration. Individual differences in vagal reactivity (i.e., trait‐like differences in vmHRV decreases during challenge or stress) are less commonly studied in adults and results are mixed. Many stressors and challenges evoke temporary decreases in vmHRV, and in some research self‐regulatory effort evokes increases. In a smaller literature, positive interpersonal experiences and some restorative processes increase resting vmHRV, whereas depletion of self‐regulatory capacity through related effort decreases it. Greater attention to conceptual distinctions regarding vmHRV constructs and several methodological issues will strengthen future research. Importantly, researchers should exercise caution in equating vmHRV with specific psychosocial constructs, especially in the absence of converging assessments and precise experimental manipulations.     

Clinical cut‐off point for the Distrust dimension of the Dimensional Clinical Personality Inventory 2 (IDCP‐2)

The Clinical Dimensional Personality Inventory 2 (IDCP ‐2) is a 206‐item self‐report tool developed for the assessment of 12 dimensions (divided into 47 factors) of personality pathology. One of the scales comprising the instrument, the Distrust scale, is intended to provide psychometric information on traits closely related to the Paranoid Personality Disorder (PPD ). In the present research, we used the Item Response Theory and the Receiver Operating Characteristic curve analysis to establish a clinical meaningful cutoff for the Distrust scale. Participants were 1,679 adults, among outpatients diagnosed with PPD , outpatients diagnosed with other PD s, and adults from the community. The Wright map revealed that outpatients were located at the very high levels on the latent continuum of the Distrust scale, with a very large effect size for the mean difference between patients and non‐patients. The ROC curve supported a cutoff at −1.00 score in theta standardization which yielded 0.87 of sensitivity and 0.54 of specificity. Findings from the present investigation suggest the IDCP ‐2 Distrust scale is useful as a screening tool of the core features of the PPD . We address potential clinical applications for the instrument and discuss limitations from the present study.     

Alexithymia as a potential source of symptom over‐reporting: An exploratory study in forensic patients and non‐forensic participants

The traditional interpretation of symptom over‐reporting is that it indicates malingering. We explored a different perspective, namely that over‐reporting of eccentric symptoms is related to deficits in articulating internal experiences (i.e., alexithymia). Given that alexithymia has been linked to sleep problems and that fatigue may fuel inattentive responding to symptom lists, we administered measures of alexithymia (TAS ‐20) and symptom over‐reporting (SIMS ), but also sleep quality (SLEEP ‐50) to forensic psychiatric outpatients (n = 40) and non‐forensic participants (n = 40). Forensic patients scored significantly higher on all three indices than non‐forensic participants. In the total sample as well as in subsamples, over‐reporting correlated positively and significantly with alexithymia, with r s being in the 0.50–0.65 range. Sleep problems were also related to over‐reporting, but in the full sample and in the forensic subsample, alexithymia predicted variance in over‐reporting over and above sleep problems. Although our study is cross‐sectional in nature, its results indicate that alexithymia as a potential source of over‐reporting merits systematic research.     

The Destiny of Creation: Theological Ethical Reflections on Laudato Si'

In this essay, I ask what the precise relation is between Laudato si's theology and its claims about our individual and corporate responsibility for the environment and the plight of the poor. To do so, I first clarify the relationship between the theological claims and its account of moral norms, situating the text within the history of western ethical theory. I then turn to reconstruct the submerged theology of the encyclical, focusing on Pope Francis's accounts of the techno‐economic paradigm and the possibility of an “integral ecology” paradigm. I end by assessing the text in terms of the coherence and plausibility of its argument as an ethical and theological statement.