Using Prolonged Exposure and Cognitive Processing Therapy to Treat Veterans With Moral Injury-Based PTSD: Two Case Examples

Moral injury refers to acts of commission or omission that violate individuals’ moral or ethical standards. Morally injurious events are often synonymous with psychological trauma, especially in combat situations—thus, morally injurious events are often implicated in the development of posttraumatic stress disorder (PTSD) for military service members and veterans. Although prolonged exposure (PE) and cognitive processing therapy (CPT) have been well established as effective treatments for veterans who are struggling with PTSD, it has been suggested that these two evidence-based therapies may not be sufficient for treating veterans whose PTSD resulted from morally injurious events. The purpose of this paper is to detail how the underlying theories of PE and CPT can account for moral injury-based PTSD and to describe two case examples of veterans with PTSD stemming from morally injurious events who were successfully treated with PE and CPT. The paper concludes with a summary of challenges that clinicians may face when treating veterans with PTSD resulting from moral injury using either PE or CPT.     

An Emotion Regulation Treatment for Young People With Complex Substance Use and Mental Health Issues: A Case-Series Analysis

Individuals accessing treatment within the youth alcohol and other drug (AoD) sector represent a highly vulnerable population who present with complex patterns of substance use and mental health comorbidity. Current treatments often fail to address this complexity. Emotion regulation (ER) has been identified as a promising transdiagnostic treatment target for this population of young people. The current study aimed to investigate the acceptability and feasibility of an adjunct ER intervention, ERIC (Emotion Regulation and Impulse Control) in young people receiving AoD treatment at a residential rehabilitation service. A mixed methods case series design was utilized. Ten participants aged between 16–20 years old completed 4–6 sessions of ERIC as an adjunct to their existing residential treatment. Participants undertook a post intervention feedback session and completed a number of self-report measures of ER, depression and anxiety at baseline and 2 weeks after receiving ERIC. Qualitative feedback from young people following the delivery of ERIC was positive, and suggested that ERIC was a viable and useful intervention. Participants reported that the components of ERIC, which involved metaphors and experiential exercises, were particularly beneficial and memorable. Pre-post measures indicated that 60% of the young people had both reliable and clinically significant reductions in overall emotion dysregulation, while reliable and clinically significant reductions in depression and anxiety were observed in 50% and 60% of participants respectively. Results support the acceptability of ERIC for this cohort of young people with complex substance use and mental health needs. Furthermore, these findings support the viability of delivering flexible and adjunctive ER treatments to young people seeking AoD treatment.     

Analyse me

The poem Analyse Me evolved from my desire to understand where and how the creative fitted into the scheme of military veteran mental health treatments in Australia. In 2016, as an Australian Army veteran and a creative writer, I undertook to conduct craft of writing workshops for veterans. However, I found creative arts, in all modes, were not as widely incorporated into treatments and research as I thought. The poem is a creative response to my frustration and disbelief of the results of my research and is a representation of my findings conceptualised to be the clinical and externally measurable treatment modes at one extreme, contrasted against the less definable use of the imagination or the creative at the other. The poem highlights the broad expanse between these extremes. It underlines a view on the difference of gender in treatment and the divide between the detached, clinical analysis and the more personal, intuitive creative response. Analyse Me does not deny the use of one modality over, or to the exclusion, of the other but rather indicates they both have purpose and can be mutually supportive and beneficial.     

Reduction of anxiety sensitivity in relation to nicotine withdrawal symptoms during smoking cessation: an examination among successful quitters

Anxiety sensitivity has been implicated as a potential risk factor for post-quit withdrawal symptoms. The present study examined relations between the extent of change in anxiety sensitivity and the course of nicotine withdrawal symptoms experienced during the initial two weeks of a quit attempt among treatment-seeking smokers. The sample consisted of 29 adult daily smokers (34% female; M_age = 47.7, SD = 13.1) who successfully quit and maintained their abstinence. After adjusting for the effects of gender, treatment condition, use of nicotine replacement therapy, nicotine dependence, alcohol use problems, baseline levels of anxiety sensitivity, and reductions in negative affect, greater reductions in anxiety sensitivity were related to faster decreases in withdrawal symptoms. The current data suggest that there may be merit to employ anxiety sensitivity reduction methods for the management of emergent withdrawal symptoms in smoking cessation treatment.     

Using Video Self-Modeling as a Small Group Reading Fluency Intervention for Elementary School Students

Video self-modeling (VSM) has been used widely in the literature to teach a range of prosocial behaviors. More recently, VSM has been explored as both a supplement and stand-alone option to teach academic skills, particularly oral reading fluency. However, the literature is relatively sparse pertaining to the effects of video modeling, void of any current literature exploring the effects of video modeling as a component to small group reading interventions. The present study implemented a multiple baseline design across participants, with an alternating treatment design directly comparing a small group reading intervention with and without VSM. Nonoverlap of all pairs was used to measure the effects of the small group intervention with and without VSM relative to baseline, as well as to compare the two intervention packages to one another. Nonoverlap of all pairs scores indicated moderate to strong effects for both interventions across all participants, with little difference between the two interventions.     

Treatment Utility of Universal Screening for Behavioral Risk: A Manipulated Assessment Study

In recent years, schools have started implementing preventive practices such as universal screening. Yet, researchers have not evaluated the extent to which universal screening contributes to academic and behavioral outcomes. The purpose of this study was to evaluate the treatment utility of universal screening for behavioral risk. Student participants were randomly assigned to two groups, corresponding to a different method of identification (office discipline referrals and universal screening). Participants identified as at risk, based on their office discipline referral data or universal screening data, and selected for intervention, received a Tier 2 intervention. Data were analyzed using a fixed-effects regression model. Analyses identified no statistically significantly differences between the two groups with regard to various academic and behavioral outcomes, suggesting universal screening did not contribute to changes in student functioning.     

The practices of existential psychotherapists: development and application of an observational grid

Within the major therapeutic paradigms, observational instruments have been developed to assess orientation-specific interventions or processes. However, to date, no such instrument exists to assess existential practices. Recent research indicates the key practices of existential therapists, and forms an empirical basis on which to develop an observatory grid. This paper describes the development of such a grid, and its exploratory testing with eight clients of four Portuguese existential psychotherapists. A total of 32 sessions were observed and both speaking turn and whole-session analysis showed that it was feasible to assess existential therapy using the instrument, although psychometric findings recommend further refinement of the tool. Session-rating data suggest that the chief practices applied by existential therapists were relational, followed by the use of hermeneutic interventions and reformulations. Interventions based on phenomenological and existential assumptions were observable in practice but limited in frequency. Further refinements and developments of the observational grid, together with additional research – using a range of therapists from different schools of existential therapy – are recommended.     

Understanding Social Factors in the Context of Trauma: Implications for Measurement and Intervention

One of the most important factors predicting the presence of posttraumatic stress disorder (PTSD) after trauma exposure is social support, yet the construct is theoretically complex and remains variably defined. To better inform the trauma literature on the impact of social factors, a theoretical review of social support and PTSD was conducted, and implications for measurement and intervention are outlined. Type of trauma, sex of participant, timing of social support, and support providers are described as significant moderators of the association between social factors and PTSD. The developmental trajectory of the association between social factors and PTSD occurrence is outlined, emphasizing the positive influence of social support initially following trauma, and the deterioration effect of PTSD symptoms on social support over the longer term. Possibilities for future research and intervention at multiple levels and at different time points are described.     

Creating a Space for Acknowledgment and Generativity in Reflective Group Supervision

Small group supervision is a powerful venue for generative conversations because of the multiplicity of perspectives available and the potential for an appreciative audience to a practitioner's work. At the same time, the well‐intentioned reflections by a few practitioners in a room can inadvertently duplicate normative discourses that circulate in the wider culture and the profession. This article explores the use of narrative practices for benefiting from the advantages of group supervision while mindful of the vulnerability that comes with sharing one's work among colleagues. The reflective group supervision processes described were modified from the work of Tom Andersen and Michael White to provide a venue that encourages the creative multiplicity of group conversation while discouraging unhelpful discourses which constrain generative conversation.