Why did adolescents have sleep problems after earthquakes? Understanding the role of traumatic exposure,fear, and PTSD

To examine the relationships between trauma exposure, fear, post‐traumatic stress disorder, and sleep problems in adolescents, 746 adolescent survivors of the 2008 Wenchuan earthquake in China were assessed at 1 year (T1) and 1.5 years (T2) after the earthquake using a trauma exposure questionnaire, a fear questionnaire, a child posttraumatic stress disorder symptom scale, and a subscale on child sleep problems. The results showed that T1 trauma exposure were not directly associated with sleep problems at T1 and T2, but played a positive role in sleep problems at both T1 and T2 indirectly through T1 posttraumatic stress disorder and T1 fear. T1 trauma exposure was also positively and indirectly associated with T2 sleep problems through T1 posttraumatic stress disorder via T1 sleep problems, or through T1 fear via the path from T1 posttraumatic stress disorder to T1 sleep problems. These findings indicated that fear and posttraumatic stress disorder 1 year after the earthquake played a mediating role in the relationship between trauma exposure at 1 year after the earthquake, and sleep problems at both 1 year and 1.5 years after the earthquake, respectively. In particular, posttraumatic stress disorder also had a multiple mediating effect in the path from trauma exposure to sleep problems via fear. Furthermore, the findings indicated that sleep problems were relatively stable between 1 and 1.5 years after an earthquake.     

Effects of Group Functional Behavior-Based Cognitive-Behavioral Therapy for Obsessive-Compulsive Behavior in a Youth With Autism Spectrum Disorder

Individuals with Autism Spectrum Disorder (ASD) often present with comorbid Obsessive Compulsive Behaviors (OCBs), but little research exists on effective intervention for OCBs. Using a single-case experimental design, this study highlights the efficacy of a Group Functional Behavior-based Cognitive-Behavior Therapy (Fb-CBT) to reduce OCBs in an 11-year-old youth with ASD. Tailored to the individual needs of this youth, Fb-CBT included traditional CBT components (e.g., psychoeducation, cognitive-behavioral skills training, and exposure and response prevention) coupled with functional behavior assessment and intervention. Time-series parent report data and standardized measures showed clinically significant decreases in OCBs, an increase in psychosocial functioning, and high consumer satisfaction.     

Does mere exposure enhance positive evaluation,independent of stimulus recognition? A replication study in Japan and the USA1

Abstract: In order to examine whether the mere exposure effect, the finding that exposure to a stimulus enhances a positive evaluation of it, occurs in Japan as well as in the USA, a test was carried out using a novel auditory stimulus. Japanese and American people were asked to listen to repeatedly presented Tagalog (the native Filipino language) utterances. They were then asked to estimate their liking for each utterance and whether they recognized it as one presented during the first exposure stage. The mere exposure effect was found in both cultures. Further, it resulted from only exposure frequency, not recognition. Implications for preference and the role of culture are discussed.     

The evaluative connotation of processing fluency: Inherently positive or moderated by motivational context?

A fundamental question for evaluation research is whether cues can impact evaluative responses directly or only in combination with contextual information. Focusing on the experience of processing fluency, the current work tested whether manipulating this cue’s motivational context would moderate its evaluative impact. Because fluently processed stimuli can be assumed to communicate safety, owing to implicit signals of either familiarity (through processes monitoring perception-memory coordination), we reasoned that motivation to avoid negative events should heighten preferences for fluently processed stimuli. Following a motivation manipulation, prevention-focused, but not promotion-focused, participants preferred stimuli that they were able to process quickly (Experiment 2) and that were preceded by concordant primes (Experiment 1). These findings suggest that the value of fluent processing reflects its relation to contextual features, such as one’s current motivational state.     

The path or the goal? Decision vs. information focus in biased information seeking after preliminary decisions

Research on the phenomenon of selective exposure to information demonstrates that after preliminary or final decisions, people show a preference for supporting rather than conflicting information (confirmation bias). In this article, we examine conditions that increase or decrease distortions in the search for information. We report on four experiments indicating that the confirmation bias is influenced by whether people focus on their decision or on the presented pieces of information during the information search. Focusing on the decision, for example, because a reward for a correct decision is promised or simply because participants repeatedly think of it, increases the confirmation bias. On the other hand, if participants focus on the available pieces of information because they have to invest money in order to search for information or because they have to evaluate the individual pieces of information, the confirmation bias decreases. Implications for theoretical understanding and interventions for decision-making situations are discussed.     

Understanding patterns of attitude change: When implicit measures show change, but explicit measures do not

A common assumption in research on attitudes is that indirect measures assess relatively stable implicit attitudes, whereas traditional self-report measures assess more recently acquired explicit attitudes that coexist with old, presumably stable implicit attitudes. This assumption seems difficult to reconcile with research showing experimentally induced changes on implicit but not explicit measures. The present research tested a process-account of such asymmetrical patterns. Specifically, we argue that implicit measures show experimental effects that do not emerge on explicit measures when (a) the pairing of an attitude object with positive or negative valence creates new automatic associations in memory, and, at the same time, (b) the consideration of additional information about the attitude object eliminates the impact of automatic associations on self-reported evaluative judgments. Results from three studies support these predictions. Implications for research on attitude change are discussed.     

A Solution-Focused Intervention with a Youth in a Domestic Violence Situation: Longitudinal Evidence

This article reports on a 4-year therapeutic intervention combining in-person and email communication with a 13-year-old Greek-Cypriot teenager who witnessed and later was the victim of severe domestic violence. The intervention is based on an empowerment philosophy and solution-focused strategies, and its usefulness is evaluated by three standardized measures at five time points between the years 1999 and 2003. Pertinent cultural and ethical dynamics of the interventional context are highlighted. The intervention may have helped to produce better perpetrator–youth relations, remission of the client’s depression and post-traumatic stress symptoms, and improvement in his academic performance. Implications and limitations are discussed.     

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.     

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.