Implementation of Cognitive Therapy for PTSD in routine clinical care: Effectiveness and moderators of outcome in a consecutive sample

ObjectiveTrauma-focused psychological treatments are recommended as first-line treatments for Posttraumatic Stress Disorder (PTSD), but clinicians may be concerned that the good outcomes observed in randomized controlled trials (RCTs) may not generalize to the wide range of traumas and presentations seen in clinical practice. This study investigated whether Cognitive Therapy for PTSD (CT-PTSD) can be effectively implemented into a UK National Health Service Outpatient Clinic serving a defined ethnically mixed urban catchment area.MethodA consecutive sample of 330 patients with PTSD (age 17–83) following a wide range of traumas were treated by 34 therapists, who received training and supervision in CT-PTSD. Pre and post treatment data (PTSD symptoms, anxiety, depression) were collected for all patients, including dropouts. Hierarchical linear modeling investigated candidate moderators of outcome and therapist effects.ResultsCT-PTSD was well tolerated and led to very large improvement in PTSD symptoms, depression and anxiety. The majority of patients showed reliable improvement/clinically significant change: intent-to-treat: 78.8%/57.3%; completer: 84.5%/65.1%. Dropouts and unreliable attenders had worse outcome. Statistically reliable symptom exacerbation with treatment was observed in only 1.2% of patients. Treatment gains were maintained during follow-up (M = 280 days, n = 220). Few of the selection criteria used in some RCTs, demographic, diagnostic and trauma characteristics moderated treatment outcome, and only social problems and needing treatment for multiple traumas showed unique moderation effects. There were no random effects of therapist on symptom improvement, but therapists who were inexperienced in CT-PTSD had more dropouts than those with greater experience.ConclusionsThe results support the effectiveness of CT-PTSD and suggest that trauma-focused cognitive behavior therapy can be successfully implemented in routine clinical services treating patients with a wide range of traumas.     

An Evaluation of the Effects of Diagnostic Composition on Individual Treatment Outcome Within Transdiagnostic Cognitive–Behavioral Group Therapy for Anxiety

Recently, studies have supported the efficacy of treating anxiety disorders utilizing a transdiagnostic, or non-diagnosis-specific, framework (Erickson, D. H. (2003). Group cognitive behavioural therapy for heterogeneous anxiety disorders. Cognitive Behaviour Therapy, 32, 179–186; Garcia, M. S. (2004). Effectiveness of cognitive-behavioural group therapy in patients with anxiety disorders. Psychology in Spain, 8, 89–97; Norton, P. J., & Hope, D. A. (2005). Preliminary evaluation of a broad-spectrum cognitive-behavioral group therapy for anxiety. Journal of Behavior Therapy and Experimental Psychiatry, 36, 79–97). Transdiagnostic group treatment packages focus on the common aspects inherent across the anxiety disorders such as behavioral and cognitive avoidance, and faulty cognitive appraisals of threat potential or meaning (Barlow, D. H., Allen, L. B., & Choate, M. L. (2004). Toward a unified treatment for emotional disorders. Behavior Therapy, 35, 205–230). Although research supports the overall efficacy of transdiagnostic cognitive behavior therapy (CBT) for anxiety disorders (Norton, P. J., & Philipp, L. M. (2008). Transdiagnostic approaches to the treatment of anxiety disorders: A quantitative review. Psychotherapy: Theory, Research, Practice and Training, 45, 214–226), the effect of diagnostically mixed group composition on individual outcomes is less clear. This study investigated the relationship between group composition and treatment outcome within diagnostically heterogeneous groups with the purpose of determining if diagnostic heterogeneity differentially impacted treatment outcome for 84 individuals during a 12-week transdiagnostic cognitive–behavioral group anxiety treatment program (Norton, P. J. (2012a). Group cognitive-behavioral therapy of anxiety: A transdiagnostic treatment manual. New York: Guilford). The diagnostic makeup of the treatment group was examined at the beginning of treatment and at the end of treatment, and the results indicated that the diagnostic makeup of the treatment group had no significant impact on individual treatment outcome. These findings have direct implications for the delivery of transdiagnostic treatments, and are discussed in terms of their global implications for the transdiagnostic approach to the treatment of anxiety disorders.     

Understanding the multiframe caricature advantage for recognizing facial composites

Eyewitnesses often construct a “composite” face of a person they saw commit a crime, a picture that police use to identify suspects. We described a technique (Frowd, Bruce, Ross, McIntyre, & Hancock, 2007) based on facial caricature to facilitate recognition of these images: Correct naming substantially improves when composites are seen with progressive positive caricature, where distinctive information is enhanced, and then with progressive negative caricature, the opposite. Over the course of four experiments, the underpinnings of this mechanism were explored. Positive-caricature levels were found to be largely responsible for improving naming of composites, with some benefit from negative-caricature levels. Also, different frame-presentation orders (forward, reverse, random, repeated) facilitated equivalent naming benefit relative to static composites. Overall, the data indicate that composites are usually constructed as negative caricatures.     

Integration of motion parallax with binocular disparity specifying different surface shapes

We investigated the interaction between motion parallax and binocular disparity cues in the perception of surface shape and depth magnitude by the use of the random dot stimuli in which these cues specified sinusoidal depth surfaces undulating with different spatial frequencies. When ambiguous motion parallax is inconsistent with unambiguous disparity cue, the reasonable solution for the visual system is to convert the motion signal to the flow on the surface specified by disparity. Two experiments, however, found that the visual system did not always use this reasonable solution; observers often perceived the surface specified by a composite of the two cues, or the surface specified by parallax alone. In the perception of this composite of the two cues, the apparent depth magnitude increased with the increase of the depth magnitude specified by both cues. This indicates that the visual system can combine the depth magnitude information from parallax and disparity in an additive fashion. The interference with parallax by disparity implies that the parallax processing is not independent of the disparity processing.     

Treatment, Age, and Time-Related Predictors of Behavioral Outcome in Pediatric Brain Tumor Survivors

The research has shown that children surviving cancer are at risk for long-term emotional and behavioral problems secondary to the cumulative effects of cranial irradiation and chemotherapy. The purpose of this study was to investigate the emotional and behavioral outcome of children diagnosed with brain tumor and treated with cranial irradiation and chemotherapy by looking at the association between treatment, time, age, and cognitive-related variables on externalizing and internalizing behaviors at 3 years posttreatment. Fifty-four brain tumor survivors were administered a neuropsychological test battery, whereas the parents filled out the CBCL and Conners' Parent Rating Scale. The results indicate that chemotherapy treatment with vincristine, cytoxan, cisplantinum, and/or VP16 was related to poorer internalizing and externalizing behavioral outcome, especially attention, social withdrawal, and anxious–depressive symptomatology. Age at time of diagnosis or treatment, time since discontinuation of treatment, type and/or total dose of radiation therapy was not significantly correlated with any of the behavioral outcome scales. Verbal memory and learning deficits accounted for a significant portion of the variance in social withdrawal, whereas lower scores in overall intellectual functioning and verbal fluency was related to disturbances in attention, inhibition, and social functioning. The findings suggest that children treated with 1 or a combination of any of the aforementioned chemotherapy agents who exhibit declines in intellectual functioning and memory are at increased risk for long-term behavioral problems 3 years after treatment cessation. These findings support the importance for early psychotherapeutic and supportive intervention services immediately after treatment cessation, with the goal of circumventing these potentially debilitating emotional problems.     

Personality characteristics in primary benzodiazepine-dependent patients: Comparison with controls and polydrug users

The present study applied Karolinska Scales of Personality (KSP) to study (i) if patients with benzodiazepine dependence have a characteristic personality profile, (ii) if the personality characteristics in patients with benzodiazepine dependence differ from those of polydrug users and normal controls, (iii) if differences in treatment outcome existed between the groups, and (iv) if the possible difference in treatment outcome was associated with any particular personality characteristic shown by the patients. The personality characteristics of primary benzodiazepine dependent patients (BDZ) and a group of polydrug users (MIX) were studied initially (during the first week in project as an inpatient) and approximately one year after drug discontinuation, and a comparison was made with healthy controls on both test occasions. The results showed that the personality of both groups of patients differed significantly from the Controls in the following characteristics: Detachment, Socialization, Somatic Anxiety, Muscular Tension, Psychic Anxiety, and Psychasthenia. Significant differences existed between the polydrug and benzodiazepine users in Somatic and Psychic Anxiety as well as in Socialization. The MIX group differed significantly from the BDZ group and from the Controls in Suspicion. Results of treatment outcome indicated that the benzodiazepine dependent patients were significantly more successful in quitting their drug use compared to polydrug users. Further, the results demonstrated that patients scoring high in the investigated personality characteristics are those who fail the treatment goal of quitting their drug use, especially the patients with a high level of anxiety and detachment.     

Parental Monitoring,Association with Externalized Behavior,and Academic Outcomes in Urban African‐American Youth: A Moderated Mediation Analysis

African‐American adolescents exposed to neighborhood disadvantage are at increased risk for engaging in problem behavior and academic underachievement. It is critical to identify the mechanisms that reduce problem behavior and promote better academic outcomes in this population. Based on social disorganization and socioecological theories, the current prospective study examined pathways from parental monitoring to academic outcomes via externalizing behavior at different levels of neighborhood disadvantage. A moderated mediation model employing maximum likelihood was conducted on 339 African‐American students from 9th to 11th grade (49.3% females) with a mean age of 14.8 years (SD ± 0.35). The results indicated that parental monitoring predicted low externalizing behavior, and low externalizing behavior predicted better academic outcomes after controlling for externalizing behavior in 9th grade, intervention status, and gender. Mediation was supported, as the index of mediation was significant. Conversely, neighborhood disadvantage did not moderate the path from parental monitoring to externalizing behavior. Implications for intervention at both community and individual levels and study limitations are discussed.     

情境与互动：人际互倚及其模

人际互倚理论主要关注群体中个体之间的相互依附关系。文章介绍了互倚理论的历史发展,论述了人际互倚理论发展中研究方法的改进：从结果矩阵到转换细目表。方法的改进推动了重视情境的人际互倚情境模式的发展,使人际互倚理论从研究静态人际互倚关系转向研究动态人际互倚的转换过程。该文还对人际互倚研究进行了评价和展望     

互依性与团队协作

互依性是指团队成员在完成作业的过程中相互依赖的程度,分为作业互依性和产出互依性两大类。该文全面的阐述了互依性的概念、分类和测量方法,并重点介绍了20世纪90年代以后有关互依性在团队协作领域中的研究结果。总结发现,两类互依性与很多团队变量均有显著相关,特别是团队的结果变量。在对结果变量的影响上,两类互依性存在交互作用,或互依性与其他变量存在交互作用。文章最后提出了目前研究的局限性,以及未来的研究展望