Exposure Therapy for Posttraumatic Stress Disorder: A Meta-Analysis

This meta-analysis compares the findings of empirical studies that employ either a traditional form of cognitive–behavioral-based exposure therapy or virtual reality exposure therapy (VRET) for the treatment of posttraumatic stress disorder (PTSD) to determine which is more viable and effective. Statistical analyses were performed on 26 studies to determine pre- to posttreatment effect sizes and interactions. Results demonstrated a trend toward significance in favor of traditional exposure therapy showing lower posttreatment PTSD. Limitations included a restricted number of relevant studies; future research on VRET for PTSD should orient more to experimental designs, larger samples, and increased use of control groups.     

Executive functioning deficits in preschool children with Fetal Alcohol Spectrum Disorders

Executive function (EF) deficit is a hallmark of Fetal Alcohol Spectrum Disorders (FASD), but the vast majority of available evidence comes from school-age children and adolescents. Very little is known about EF during the critical developmental period prior to 6 years of age in FASD. We evaluated EF in 39 children with FASD (3.0–5.5 years) and a comparison group of 50 age-matched, nonexposed controls. Measures included the EF Scale for Early Childhood and a Delay of Gratification task. Compared to age-matched controls, preschool children with FASD had impairments on the EF Scale and showed more impulsivity on the Delay of Gratification task. To confirm the EF Scale finding, FASD group performance was compared to a separate normative dataset (N = 1,400). Those with FASD performed below normal (M = –0.57, SD = 0.92). Within the FASD group, IQ was correlated with the EF Scale (partial r = .60, p = .001) and Delay of Gratification (partial r = .58, p = .005). EF Scale performance did not differ significantly across levels of FASD severity (fetal alcohol syndrome [FAS], partial FAS, or alcohol-related neurobehavioral disorder [ARND]). However, compared to normative data, those with FAS had the largest deficits (M = –0.91 SD from the mean, SE = 0.23), followed by partial FAS (M = –0.66 SD from the mean, SE = 0.26), then ARND (M = –0.36 SD from the mean, SE = 0.20). These novel data show that EF deficits manifest well before the age of 6 years in children with FASD, that they occur across the spectrum, and that EF may be most impaired in children with more severe forms of FASD and/or lower IQs.     

Executive function in preschool children prenatally exposed to methadone or buprenorphine

Although an increasing number of children are born with prenatal methadone or buprenorphine exposure, little is still known about the potential long-term effects of these opioids. The aim of this study was to investigate executive function (EF) in children of women in opioid maintenance therapy (OMT). A total of 66 children (aged 48–57 months) participated in the study, 35 of which had histories of prenatal methadone or buprenorphine exposure. EF was measured using a battery of neuropsychological tests and the Behavior Rating Inventory of Executive Function—Preschool Version (BRIEF-P). Results showed that children of women in OMT perform lower on tasks of short-term memory and inhibition compared to nonexposed children, which was mainly associated with lower maternal education and employment rate. The OMT group scored significantly lower on all EF tasks compared to the nonexposed group, although scores fell within the average range on all measures. The development of these children should be monitored to assess for the possible problem behaviors and to promote optimal outcomes.     

Emotional Processing Therapy for post traumatic stress disorder

While prolonged exposure is considered one of the “gold standard” and recommended treatments for post traumatic stress disorder (PTSD), it has been poorly utilised in clinical practice. Individuals with PTSD often find it too distressing to confront memories, and therapists may be uncomfortable using the therapy. A new Emotional Processing Therapy is described in which an emotional approach to prolonged exposure provides individuals with a new insight into how trauma is processed. A conceptual analysis of exposure suggests that it is exposure to distressing emotional experiences which is a key element. Viewing it as an emotion-based therapy, allows the creative addition of new emotional elements. Through exploring the individual’s emotional processing style, previously learned and unhelpful patterns can be addressed, and the addition of an “emotional preparation” phase helps them understand why it is important to face emotionally distressing memories before exposure sessions begin. Emotional Processing Therapy is intuitive and makes sense to those affected by PTSD. It is framed in an emotional context and is presented as part of a lifestyle change that may reduce the likelihood of psychological problems developing in the future.     

认知诊断CAT中项目曝光控制方法的比较

项目曝光率关系到题库建设和测验安全,是计算机化自适应测验(Computerized Adaptive Testing, CAT)需要考虑的重要问题。在认知诊断 CAT 情形下,首先基于传统 CAT 中 a-分层方法的思想提出按项目信息量对题库分层的分层多阶段(Stratified Multistage, SM)选题方法;然后将 SM 方法与项目合格(Item Eligibility, IE)方法相结合得到SMIE方法。在此基础上,开展模拟研究比较SM、IE、SMIE、最大修正优先指标(Maximum Modified Priority Index, MMPI)方法、限制阈值(Restrictive Threshold, RT)方法和限制进度(Restrictive Progressive, RPG)方法的选题表现。总体上,它们的测量精度从高到低依次为IE、SM、SMIE、RT、RPG和MMPI方法;项目曝光分布均匀性的优劣次序为MMPI、RPG、SMIE、RT、SM和IE方法;SMIE和RT方法能较好地平衡测量精度和项目曝光均匀性要求。     

The phenomenology and temporal distributions of autobiographical memories elicited with emotional and neutral cue words

In this study we examined whether the temporal distribution of autobiographical memory changes when different types of cue words are used to elicit the memories, and how the type of cue word affects the phenomenal characteristics of the memories. A total of 76 participants, ranging in age from 21 to 69 years, were presented with 22 cue words (emotional, emotion-provoking, and neutral). They were asked to recall a personal event and to complete the Autobiographical Memory Questionnaire (Rubin, Schrauf, & Greenberg, 2003, 2004) for each cue word. Results showed that the phenomenological properties of autobiographical memories which were cued with emotional and emotion-provoking words were rated higher than those of memories which were cued with neutral words, and that the peak in the temporal distributions of the autobiographical memories that were cued with emotional or emotion-provoking words were located later than the peak of the distribution of the memories that were cued with neutral words.     

Search for a curvilinear relationship between the sense of coherence and the intensity of PTSD in MVA survivors

Abstract

The relationship between the sense of coherence (SOC) and the intensity of posttraumatic stress disorder (PTSD) was examined in order to determine its nature and to resolve the inconsistencies between (1) a growing body of empirical research that indicates a linear relationship between these variables, and (2) the schema-based theories of PTSD that suggest a curvilinear relationship between cognitions and the intensity of PTSD. In this cross-sectional study an attempt was also made to identify some psychological factors that moderate this relationship. Participants were a sample of 1132 motor vehicle accident (MVA) survivors. The results showed that gender and temperamental predisposition to PTSD constituted moderator variables of the relationship between SOC and the intensity of PTSD. This supported both the empirical evidence on the linear and negative relationship between SOC and the intensity of PTSD and the theories that postulated the curvilinear relationship.     

Confirmatory Factor Analysis of the Posttraumatic Stress Disorder Checklist

Several studies have employed confirmatory factor analysis (CFA) to examine the latent structure of the Posttraumatic Stress Disorder (PTSD) Checklist (PCL; Weathers, Litz, Herman, Huska, & Keane, 1993), a measure that assesses PTSD symptomatology. Findings have failed to support the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision [DSM–IV–TR]; American Psychiatric Association, 2000) PTSD model, consisting of reexperiencing, avoidance/numbing, and arousal factors, and no consensus has emerged regarding the best fitting alternative model. Additionally, most studies have utilized homogeneous trauma samples. This study used CFA to examine the PCL factor structure in a sample with exposure to various traumatic events. Superior fit was demonstrated by a model specifying reexperiencing, avoidance, dysphoria, and arousal factors.     

Unrecognized Posttraumatic Stress Disorder as a Treatment Barrier for a Gang-Involved Juvenile Offender

This study examines the case of GH, an 18-year-old Latino male participating in an employment-based delinquency intervention for gang-affiliated youth. Although postintervention measures revealed that GH showed gains on key outcomes (i.e., delinquency, employment), he experienced sporadic treatment setbacks (e.g., work absenteeism, fighting) that disrupted his progress. A comprehensive psychological assessment suggested that his aggressive, illegal behavior and difficulty maintaining employment could have been influenced by previously undiagnosed posttraumatic stress disorder (PTSD). Excerpts from counseling sessions illustrated how reactive aggression, hypervigilance, sleep disruptions, and emotional numbing could have interfered with treatment gains and ultimately contributed to GH's re-arrest. Implications for early, accurate identification of PTSD in delinquency interventions for gang youth are discussed.