A randomized pilot study of anger treatment for Iraq and Afghanistan veterans

Objective

Anger and aggression are serious problems for a significant proportion of veterans who have served in combat. While prior research has suggested that cognitive behavioral treatments may be effective for anger problems, there are few controlled studies of anger treatment in veterans and no studies of anger treatment focusing exclusively on veterans from the Iraq and Afghanistan wars. This randomized pilot study compared an adapted cognitive behavioral intervention (CBI) to a supportive intervention (SI) control condition for the treatment of anger problems in veterans returning from deployment in Iraq or Afghanistan.

Methods

25 veterans with warzone trauma, problems with anger, and one or more additional hyperarousal symptoms were randomized and 23 started treatment (CBI, n = 12; SI, n = 11). Outcome measures were administered at pre- and post- treatment and at 3 months post-treatment.

Results

CBI was associated with significantly more improvement than SI on measures of anger and interpersonal functioning. Gains were maintained at follow-up.

Conclusions

Findings suggest that CBI may be more effective than an active control providing psychoeducation, relaxation, and supportive therapy for treating anger problems in returning veterans. The findings need to be replicated in an adequately powered and more diverse sample.     

Changes in illness-related cognitions rather than distress mediate improvements in irritable bowel syndrome (IBS) symptoms and disability following a brief cognitive behavioural therapy intervention

Objective

A previous randomised controlled trial demonstrated that a cognitive behavioural therapy (CBT) self-management intervention significantly improved irritable bowel syndrome (IBS) symptoms and disability compared to treatment as usual (TAU). The current study analysed additional data to establish whether; 1) cognitive, behavioural and emotional factors hypothesized to perpetuate IBS symptoms and disability changed following CBT and, 2) ascertain if changes in these factors over the intervention period mediated treatment effects 6-months later.

Method

IBS patients (CBT = 31, TAU = 33) completed measures pre-and-post intervention including: Brief Illness Perception Questionnaire, Hospital Anxiety & Depression Scale and Cognitive and Behavioural Responses to Symptoms Questionnaire. Path models were evaluated to determine whether changes in cognitive and behavioural factors over the treatment period mediated treatment effects.

Results

Compared to TAU, CBT patients showed significant positive changes on several cognitive variables but not anxiety and depression following intervention. Positive change in illness perceptions following intervention mediated the treatment effect on improved IBS symptom severity and social adjustment six months later. Changes in damaging beliefs mediated the effect on social adjustment.

Conclusions

Change in cognition rather than mood mediated treatment related improvements. Changing negative perceptions of IBS appears to be a particularly important treatment mechanism.     

The Acquisition and Function of Religious Beliefs: A Review and Synthesis of Proximate and Ultimate Perspectives

ABSTRACT

Two main scientific approaches have renewed in the last decade the scientific study of religion: the cognitive and the adaptationist. The former is focused on proximate causes, the latter is looking for ultimate causes of religious beliefs and behaviours. Both approaches are useful and promising. However, in both cases, various important aspects and contexts associated with the origin, acquisition, and transmission of religious beliefs have been neglected. The present paper offers an approach that conjoins both models after reviewing several critical issues, to highlight a distinction between cognitive conditions and structures, on one side; and developments or applications, on the other. As a result greater attention needs to be paid to religious functions and their cultural framework to better understand religion and to explain some current processes, like massive secularization in several areas.     

Cognitive Analytic Therapy: time and process

Cognitive Analytic Therapy (CAT) is an increasingly popular brief therapeutic approach for use with a variety of types of clinical problem. This paper outlines the key components of CAT and demonstrates its use by case examples. The history of CAT is traced, particularly the concept of Reciprocal Roles which was developed from Object Relations Theory. It is suggested that CAT has considerable potential as a collaborative, active therapy, with particular application to difficult patients such as those with borderline personality disorder. Some of the differences from other psychodynamic therapies are described, and an assessment of its future role is provided.     

Zapotec sacred places,enduring and/or ephemeral: Reverence,realignment and commodification at an archaeological-tourist site in Southern Mexico

The abundant and rightfully famous archaeological ruins of Mexico, besides attesting to the grand achievements of pre-Columbian Mesoamerican culture, also serve as foci for the preservation and/or reaffirmation of contemporary indigenous religion and identity. Additionally, those same ancient ruins have been, in many instances, tidied up and reconfigured variously as outdoor classrooms and museums for the dissemination of a narrative of Mexican national identity, as the country's premier tourist attractions, and thus as sites eventually prized far more as engines of economic development than as educational or religious contexts. Where indigenous peoples are often imagined as passive victims in this commodification of their sacred sites, the case study featured in this article, namely, the twentieth century management of the internationally renowned Zapotec site of Mitla, Oaxaca reveals a native community playing a very active role, arguably the lead role, in the exploitation of the economic potential of its famed ruins. Indeed, the Mitleyenos' entrepreneurially astute reconfiguration of their local sacred geography, a realignment that balanced unprecedented economic challenges with on-going devotional commitments, suggests that the designation of various sites and buildings as ‘sacred’, albeit an extremely pressing matter, is also much more contingent and more transient than is generally assumed.     

Materials used to support cognitive behavioural therapy for depression: a survey of therapists’ clinical practice and views

ABSTRACT

Use of supporting materials in cognitive behavioural therapy (CBT) is widely advocated, and homework increases effectiveness. The study aimed to identify materials most frequently used by CBT therapists to support CBT for depression, and those perceived clinically most effective. Questionnaires were sent to 3665 accredited CBT therapists asking about their use of resources commonly described in CBT manuals, and their views on effectiveness. Of 3665 approached by post/email, 994 (27%) responded. Another 33 completed the questionnaire via the study website. 818/1027 (80%) of respondents were accredited practitioners who deliver one-to-one therapy. Symptom measures, lists of problems/goals, activity schedules, behavioural activation diaries/plans, and case formulation worksheets were used “frequently” or “very frequently” by over 85% of respondents. Sleep diaries and computerised CBT were used least. Most resources were used within and between sessions. Activity schedules, behavioural activation diaries/plans, case formulation worksheets, thought records, and resources to support the identification of conditional beliefs were regarded as most effective. Symptom measures, sleep diaries, and computerised/online materials were considered only moderately effective. Therapists use a wide range of materials to support individual CBT. For delivering CBT, technology-enabled approaches should incorporate a range of materials to enable therapists to tailor treatment effectively.     

Inconsistent child-rearing: A reply to rosenthal

Abstract

In a reply to our paper (Kohlmann, Schumacher, & Streit, 1988), Rosenthal (in a Letter to the Editors, this issue) primarily gives some comments on findings regarding the association of inconsistent child-rearing behavior and anxiety in the child. Results of our study were compared to results from a study by Rosenthal, Finkelstein, Ni, and Robertson (1959).     

The law of large numbers in children's diversity-based reasoning

Adults increase the certainty of their inductive inferences by observing more diverse instances. However, most young children fail to do so. The present study tested the hypothesis that children's sensitivity to instance diversity is determined by three variables: ability to discriminate among instances (Discrimination); an intuition that large numbers of instances increase the strength of conclusion (Monotonicity); ability to detect subcategories and evaluate numerical differences between the subcategories, or Extraction. A total of 219 Chinese children aged 6 to 11 were tested for sensitivity to diversity by means of Discrimination, Monotonicity, and Extraction. The results indicated that children at all ages were able to discriminate instances and attend to set size. However, only 9- and 11-year-olds demonstrated Extraction and sensitivity to diversity. Furthermore, among all children diversity scores increased linearly with the level of Extraction. These results suggest that the law of large numbers plays a role in children's diversity-based reasoning.     

On the failure of cognitive ability to predict myside and one-sided thinking biases

Two critical thinking skills—the tendency to avoid myside bias and to avoid one-sided thinking—were examined in three different experiments involving over 1200 participants and across two different paradigms. Robust indications of myside bias were observed in all three experiments. Participants gave higher evaluations to arguments that supported their opinions than those that refuted their prior positions. Likewise, substantial one-side bias was observed—participants were more likely to prefer a one-sided to a balanced argument. There was substantial variation in both types of bias, but we failed to find that participants of higher cognitive ability displayed less myside bias or less one-side bias. Although cognitive ability failed to associate with the magnitude of the myside bias, the strength and content of the prior opinion did predict the degree of myside bias shown. Our results indicate that cognitive ability—as defined by traditional psychometric indicators—turns out to be surprisingly independent of two of the most important critical thinking tendencies discussed in the literature.     

The grim reasoner: Analytical reasoning under mortality salience

The human species enjoys uniquely developed capacities for analytical reasoning and rational decision making, but these capacities come with a price: They make us aware of our inevitable physical death. Drawing on terror management theory and dual-process theories of cognition, we investigate the impact of mortality awareness on analytical reasoning. Two experiments show that experimentally induced thoughts of death impair analytical reasoning performance, just as cognitive load would. When made aware of their own mortality, reasoners allocate their executive resources to the suppression of this disturbing thought, therefore impairing their performance on syllogisms that require analytic thought. This finding has consequences for all aspects of rational thinking that draw on executive resources, and calls for an integrated approach to existential psychology and the psychology of rational thought.