Feasibility and Acceptability of Group-Facilitated Prolonged Exposure Therapy for PTSD in VA Residential Rehabilitation Treatment Programs

Prolonged Exposure therapy (PE) is a first-line treatment for posttraumatic stress disorder (PTSD); however, few VA patients receive this treatment. One of the barriers to PE receipt is that it is only available in an individual (one-on-one) format, whereas many VA mental health clinics provide the majority of their psychotherapy services in group format. In particular, PTSD residential rehabilitation treatment programs (RRTPs) offer most programming in group format. Consequently, strategies are needed to improve the scalability of PE by adapting it to fit the delivery setting. The current study was designed to pilot test a group-facilitated format of PE in RRTPs. Thirty-nine Veterans who were engaged in care in the PTSD RRTP at a Midwestern VA were recruited to participate in a Group-facilitated PE protocol. Participants engaged in twelve 90-minute sessions of Group PE over the course of 6 weeks, plus six 60-minute individual sessions for imaginal exposure. Group treatment followed the PE model and consisted of psychoeducation, treatment rationale, and in vivo exposure to reduce trauma-related avoidance and thereby improve PTSD symptoms. PTSD symptoms were measured via the PTSD Checklist for DSM-5 (PCL-5) and depression symptoms were measured via the Patient Health Questionnaire (PHQ-9) at baseline, endpoint (6 weeks), and at 2-month follow-up. Thirty-nine individuals initiated Group-facilitated PE and 34 completed treatment. The average number of group sessions attended was 11 out of 12. Acceptability ratings were high. Mean change (improvement) in the intent-to-treat sample at 2-month follow-up was 20.0 points on the PCL-5 (CI 18.1, 21.9; Cohen’s d = 1.1) and 4.8 points on the PHQ-9 (CI 4.1, 5.5, d = .8). These results suggest that adapted evidence-based interventions for PTSD can improve treatment access and efficiency for the RRTP setting. A group-based approach has the potential to improve the scalability of PTSD treatment by reducing required resources. A fully powered trial is now needed to test the effectiveness of Group-facilitated PE in the RRTP setting.     

Psychoticism and attentional flexibility

In three separate experiments, we tested the hypothesis that a systematic relationship between psychoticism (P) and visual selective attention is infrequently observed because the tasks typically used to test individual differences in efficiency of attentional mechanisms do not entail attentional flexibility. We manipulated the selection rule of the computerized divided visual attention (DIVA) task to be either (a) a predictable, or (b) a random manner, and a secondary task was added to check the quality of high P scorers’ performance in an interference condition; and we also introduced breaks between DIVA tasks to allow for cue utilization. Results revealed that low P scorers outperformed high P scorers in the regular selection rule alternation condition (cue utilization possible), whereas high P scorers performed better in random alternation condition – high P scorers also showed performance superiority in the dual task condition unless stimuli presentation was speeded up. Thus, P does not necessarily impair attentional performance; indeed, our data point to performance advantages of high P, especially attentional efficiency in tasks requiring small demands of attentional control.     

Effects of live exposure on symptoms of posttraumatic stress disorder: the role of reduced behavioral avoidance in improvement

Although the effectiveness of cognitive-behavioral treatment in posttraumatic stress disorder (PTSD) is well established, few studies examined its effects on individual PTSD symptoms and possible mechanisms of improvement in symptoms. In a previous randomized controlled study [Ba?og lu, M., Salciog lu, E., Livanou, M., Kalender, D., & Acar, G. (2005). Single-session behavioral treatment of earthquake-related posttraumatic stress disorder: A randomized waitlist controlled trial. Journal of Traumatic Stress, 18, 1-11] a single session of behavioral treatment involving self-exposure instructions was highly effective in reducing earthquake-related PTSD. In the present study we examined the effects of treatment on each PTSD symptom and which symptoms improved early in treatment. Because the intervention focused solely on behavioral avoidance, we hypothesized that avoidance would be the first symptom to change and that reduction in avoidance would generalize to all other symptoms. The results showed significant between-groups treatment effect on only behavioral avoidance early in treatment (week 6). At 6 months post-treatment recovery rates ranged from 60% to 89% for 15 PTSD symptoms, including the numbing symptoms. Lack of improvement in avoidance was associated with lack of improvement in 12 symptoms. The critical process in recovery thus appeared to be increased sense of control associated with reduction in avoidance. These findings imply that live exposure to fear cues designed to enhance sense of control might be sufficient for recovery from PTSD.     

The moderating role of attitude strength in selective exposure to information

Individuals prefer to receive information that is consistent with their attitudes. Three experiments examined whether attitude strength moderates this selective exposure effect. Experiments 1A and 1B found that participants preferred attitudinally consistent information but that this effect was more pronounced to the extent that the attitude was strongly held. Experiment 2 replicated these findings and ruled out an alternative interpretation that a general tendency to hold strong attitudes rather than issue-specific attitude strength moderates selective exposure. Discussion concerns the implications of these findings and the possibility that other variables moderate the selective exposure effect.     

自传记忆事件聚集现象中的组织和提取特点

事件聚集是在事件水平上组织自传记忆的结构,是一种反映自传记忆组织的提取现象.在利用矫正后的事件追随任务对62名成人进行测试后发现:①事件之间各种组织信息并不是分离的,而是以整合的方式来组织事件聚集结构,这些信息不仅包含客体的信息,更包含主观的感受.②自我在自传记忆组织中的作用是强化事件聚集本身所具有的联系.③自传记忆的提取中首先要满足当前自我的要求;进行直接提取失败后,被试根据自传记忆的层级关系进行生成搜索;生成提取策略也失败后,个体则会根据事件线索中任何可以利用的细节来完成回忆任务.     

暴力电子游戏的短期脱敏效应：两种接触方式比较

比较主、被动接触暴力电子游戏的脱敏效应,以44名男性大学生为被试,利用生物反馈仪测量被试主动参与游戏或被动观看游戏录像前后,及随后观看暴力视频过程中皮电与心率的变化（脱敏效应的生理指标）。结果表明：（1）暴力电子游戏可以产生脱敏效应。接触游戏15分钟后,暴力游戏组观看暴力视频过程中皮电的增加值明显小于非暴力游戏组;（2）游戏的接触方式对于脱敏效应的程度无显著影响,但主动参与组对于游戏内容知觉到更高的愉快与更低的沮丧     

某院医务人员职业暴露的现状调查

职业暴露是医务人员最常见的职业伤害,为探求有效的防护方法,对我院2005年至2008年报告的职业暴露进行了分析,结果发现医务人员职业暴露漏报严重,护士发生职业暴露最多（占57．4％）,主要为针刺伤（占85．2％）,暴露源以乙型肝炎为主（占53．2％）。应加强医务人员标准预防和职业安全知识的教育与培训,建立和健全职业暴露的监测体系。     

Preference for impossible figures in 4-month-olds

Can infants use interposition and line junction cues to infer three-dimensional (3D) structure? Previous work has shown that in a task that required 4-month-olds to discriminate between static two-dimensional (2D) pictures of possible and impossible cubes, infants exhibited a spontaneous preference for displays of the impossible cube but left open the question of whether they did so on the basis of purely local “critical regions” or whether they were able to employ more global clues. Here infants were presented with possible and impossible cubes in which the strictly local cues that could have derived from exterior binding contours were deleted. Results showed that infants were still able to discriminate possible cubes from impossible cubes, suggesting that longer looking infants are sensitive to global properties and that the capacity to integrate pictorial information to perceive aspects of global 3D shape may develop earlier than demonstrated previously using reaching tasks.     

Adult attachment, perceived stress, and PTSD among civilians exposed to ongoing terrorist attacks in Southern Israel

This study examined the relationships among exposure to terrorism, individual differences in adult attachment dimensions, perceived stress, and posttraumatic stress disorder (PTSD). A representative sample of 254 adults who had experienced more than 7 years of ongoing exposure (OGE) to rocket and mortar fire in southern Israel was compared to 308 individuals with no exposure (NE) to terrorism. OGE individuals reported significantly elevated levels of insecure attachment, perceived stress, and PTSD-symptoms as compared to the NE individuals. The associations between perceived stress and PTSD-symptoms were significantly stronger in the OGE group, compared to the NE group. For OGE individuals, the elevated level of perceived stress mediated the association between Attachment Anxiety and PTSD-symptoms. Theoretical and clinical implications of the findings are discussed.     

Flexible cue use in food-caching birds

An animal’s memory may be limited in capacity, which may result in competition among available memory cues. If such competition exists, natural selection may favor prioritization of different memory cues based on cue reliability and on associated differences in the environment and life history. Food-caching birds store numerous food items and appear to rely on memory to retrieve caches. Previous studies suggested that caching species should always prioritize spatial cues over non-spatial cues when both are available, because non-spatial cues may be unreliable in a changing environment; however, it remains unclear whether non-spatial cues should always be ignored when spatial cues are available. We tested whether mountain chickadees (Poecile gambeli), a food-caching species, prioritize memory for spatial cues over color cues when relocating previously found food in an associative learning task. In training trials, birds were exposed to food in a feeder where both spatial location and color were associated. During subsequent unrewarded test trials, color was dissociated from spatial location. Chickadees showed a significant pattern of inspecting feeders associated with correct color first, prior to visiting correct spatial locations. Our findings argue against the hypothesis that the memory of spatial cues should always take priority over any non-spatial cues, including color cues, in food-caching species, because in our experiment mountain chickadees chose color over spatial cues. Our results thus suggest that caching species may be more flexible in cue use than previously thought, possibly dependent upon the environment and complexity of available cues.