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.     

Postcolonial philosophy of religion

The issue of leadership is one that spans many organisations. While management literature has examined this topic in depth, little comment has been made regarding the legitimacy of traditional business leadership theories, developed primarily in the United States, for use in a values-based organisation such as the organised church. The unique spiritual nature of Christian organisations is in some ways at odds with the assumptions of traditional leadership models. That said, many churches in the United States and churches outside the United States, but influenced by US institutional structures, are desperately seeking improvement in both pastoral and organisational effectiveness. This research examines traditional treatment of leadership and identifies implications of traditional and more recent theories of leadership for pastoral leaders and Christian laypeople.     

The Effectiveness of Cognitive Behavioral Therapy for Generalized Anxiety Disorder in a Frontline Service Setting

The goal of the current study was to test the generalizability of cognitive behavioral therapy (CBT) for generalized anxiety disorder (GAD) in a frontline service setting. Twenty‐nine patients who presented to treatment clinics with problematic worry were provided CBT for GAD. Among the intent‐to‐treat sample, there were no significant changes in worry or depression from pre‐ to posttreatment. Treatment completers showed significant pre‐ to posttreatment reductions on measures of worry and depression. The magnitude of change was smaller than has been reported in randomized control trials (RCTs). Although the frontline service setting differed from RCT settings in multiple ways, treatment completers nonetheless achieved moderate to large decreases in self‐reported worry and depression.     

Angry at your boss: Who cares? Anger recognition and mediation effectiveness

The key to success for workplace mediators lies in establishing a relationship of understanding, empathy, and trust with the conflicting parties. Literature suggests that the recognition of parties’ emotions by the mediator is essential to obtain such a relation. Although anger is one of the most prevailing emotions in conflict, little is known about how parties react to the experience of anger recognition on the part of the mediator, how this affects their perceptions of mediation effectiveness, and whether this is moderated by the hierarchical position parties occupy. Drawing on theories of power, emotions, and conflict, this study tests the hypothesis that conflicting parties in workplace mediation who experience anger recognition on the part of the mediator perceive the mediation as more effective and that this is more so for subordinates than for supervisors. Data collected in real labour mediations support this. Implications for mediation theory and practice are discussed.     

School Effectiveness Findings 1979–2002

The London studies of school effectiveness in the 1970s provided evidence that the qualities of schools made a significant difference to pupil progress, after taking account of the characteristics and backgrounds of the pupils at the time of school entry. The purpose of this article is to review the further evidence that has accumulated since then in order to assess how far the findings have been confirmed or refuted, what new questions have arisen and what key challenges remain. The continuing areas of research and debate include school effects on behavioral outcomes, the effects of class size, the importance of parental involvement, the impact of intake mix, peer influences, and level of resources. There has been greater agreement on the many features fostering school effectiveness. However, questions remain on how to bring about desired changes. The paper concludes by drawing attention to 10 largely unanswered questions that matter for policy and practice.     

Cross-fertilization versus transmission: Recommendations for developing a bidirectional approach to psychotherapy dissemination research

Psychotherapy researchers are increasingly engaged in collaborations with clinical practitioners and mental health administrators. Each party brings its own perspectives, values, and agendas to bear in these encounters. Viable research—practice collaborations depend on understanding and negotiating some of the tensions in these relationships. In this article, we discuss the contexts that prevail for various participants in a psychotherapy dissemination study as well as the values, goals, costs, and benefits related to research participation. This article is a collaboration among the researchers, mental health administrators, therapists, and clients involved in an ongoing treatment dissemination study. Our recommendations for research—practice collaborations are based on our experiences and dialogues over the course of this study.     

Study of the adjustment of Western expatriates in Taiwan ROC with the Multicultural Personality Questionnaire

The present paper examined the validity of the Multicultural Personality Questionnaire (MPQ). As criteria of validity three levels of adjustment were used. The study took place among a sample of expatriates ( N = 102) during their assignment in Taiwan. The MPQ has scales for cultural empathy, open-mindedness, social initiative, emotional stability and flexibility. The MPQ scales appeared to be predictive of expatriates' personal, professional and social adjustment. In all three domains, emotional stability appeared most consistently as a predictor of adjustment. Social initiative was an additional strong predictor of psychological well-being, as was cultural empathy of satisfaction with life and of the amount of social support in the host country. Flexibility was a predictor of job satisfaction and social support. The study also examined the effects of marital status on adjustment. Married expatriates showed higher levels of adjustment than expatriates who were single or separated.     

The relationship of coping and its perceived effectiveness to positive and negative affect in sport

This article examined the ability of six different coping strategies and their perceived effectiveness in predicting positive and negative affect in sport. Furthermore, it was investigated whether perceived coping effectiveness moderated the influence of coping strategies on affect. British University athletes (N = 356) were requested to recall a recent important competition in their sport when they had a stressful or challenging experience. They were then asked to rate the extent to which they relied on a number of different coping strategies to deal with the situation and the degree to which they found these effective. In agreement with the theoretical predictions of Folkman (1984), problem-focused coping predicted positive affect whereas emotion-focused coping predicted negative affect. Furthermore, for almost all the coping variables, their perceived effectiveness predicted, in a positive way, positive affect and negatively, negative affect. Moreover, the perceived effectiveness of the coping strategies of seeking social support, venting of emotions, and behavioural disengagement, moderated the influence of those strategies on affect. Lastly, a comparison between high and low effective coping groups showed that the former was associated with more pleasant affective experiences.     

A test for conditional independence between response time and accuracy

An important distinction between different models for response time and accuracy is whether conditional independence (CI) between response time and accuracy is assumed. In the present study, a test for CI given an exponential family model for accuracy (for example, the Rasch model or the one‐parameter logistic model) is proposed and evaluated in a simulation study. The procedure is based on the non‐parametric Kolmogorov–Smirnov tests. As an illustrative example, the CI test was applied to data from an arithmetics test for secondary education.     

Revisiting the mediating role of leader–member exchange in transformational leadership: the differential impact model

Transformational leadership (TFL) has been proposed as an essential antecedent of leader–member exchange (LMX), which in turn affects outcomes in organizations. We extend this mediation hypothesis in two ways by proposing a differential impact model, which we test on three organizational outcomes: employee job satisfaction, employee organizational commitment, and leader effectiveness. First, we extend LMX’s mediational impact—which has previously only been tested for employee outcomes—to leader effectiveness. Second, we argue that this mediation will be stronger for outcomes that are more proximal rather than distal to dyadic relations between leader and followers (high proximity: job satisfaction; medium proximity: organizational commitment; low proximity: leader effectiveness). Meta-analytic structural equation modelling based on 132 studies revealed that LMX mediates TFL’s relationships with employee outcomes (more strongly for job satisfaction than for commitment), but not with leader effectiveness, whereas TFL showed a stronger direct link to leader effectiveness. The findings suggest that TLF and LMX contribute differentially to organizational outcomes depending on their proximity to dyadic relations between leaders and followers. The differential impact model uncovers leadership effectiveness processes, integrates influential leadership theories, and highlights the importance of distinguishing between different outcome measures and the processes facilitating them.