Childhood Sexual Assault,Quality of Life,and Psychiatric Comorbidity in Veterans With Military and Civilian Sexual Trauma

Veterans with military sexual trauma (MST) are at risk for a variety of psychiatric conditions, including posttraumatic stress disorder (PTSD) and depression. Survivors of MST are also likely to experience diminished quality of life (QoL). Individuals with higher lifetime incidence of sexual trauma may also be at increased risk for poorer outcomes in QoL and psychiatric symptomatology. The differences in psychological sequelae among those who have experienced sexual trauma as children, and those whose sexual trauma exposure is limited to adulthood are relatively understudied. The majority of sexual trauma literature has focused primarily on civilian trauma, and comparatively few studies have specifically examined psychosocial sequelae (e.g., QoL) in veterans with MST. This study examined how childhood sexual abuse (CSA) affects overall QoL as well as severity of PTSD and depressive symptoms. Veterans who reported CSA had significantly greater depression symptom severity than veterans who did not. No significant differences in PTSD symptom severity or QoL were found between veterans who did and did not report CSA. Results highlight the need for further examination of the relationship between CSA and depression in veterans with MST-related PTSD who also report CSA.     

Examination of the Relationship Between PTSD and Distress Tolerance in a Sample of Male Veterans With Comorbid Substance Use Disorders

Distress tolerance (DT), the perceived or actual ability to tolerate negative emotional or physical states, is inversely related to posttraumatic stress disorder (PTSD) symptoms in civilian, community samples. No studies to date have examined the relationship between DT and PTSD in clinical samples of veterans with a comorbid diagnosis of PTSD and a substance use disorder (SUD). Thus, the present study examined the relationship between DT and PTSD in a sample of predominately African American, male veterans (n = 75) diagnosed with comorbid PTSD and SUD (according to a structured clinical interview). Results of hierarchical linear regression models indicated that DT was inversely related to total PTSD symptom severity score, above and beyond depressive symptoms and SUD severity. Of the 4 symptom clusters, DT was inversely associated with intrusions and hyperarousal. These findings are discussed in light of previous work with civilian samples. Determining whether treatment incorporating DT skills would be useful for veterans undergoing PTSD treatment should be evaluated.     

Cognitive deficits of executive functions and decision‐making in obsessive‐compulsive disorder

The nature of cognitive deficits in obsessive‐compulsive disorder (OCD) is characterized by contradictory findings in terms of specific neuropsychological deficits. Selective impairments have been suggested to involve visuospatial memory, set shifting, decision‐making and response inhibition. The aim of this study was to investigate cognitive deficits in decision‐making and executive functioning in OCD. It was hypothesized that the OCD patients would be less accurate in their responses compared to the healthy controls in rational decision‐making on a version of the Cambridge gambling task (CGT) and on the color‐word interference test and on a version of the Tower of Hanoi test (tower test) of executive functioning. Thirteen participants with OCD were compared to a group of healthy controls (n = 13) matched for age, gender, education and verbal IQ. Results revealed significant differences between the OCD group and the healthy control group on quality of decision‐making on the CGT and for achievement score on the tower test. On these two tasks the OCD group performed worse than the healthy control group. The symptom‐dimension analysis revealed performance differences where safety checking patients were impaired on the tower test compared to contamination patients. Results are discussed in the framework of cognition and emotion processing and findings implicate that OCD models should address, specifically, the interaction between cognition and emotion. Here the emotional disruption hypothesis is forwarded to account for the dysfunctional behaviors in OCD. Further implications regarding methodological and inhibitory factors affecting cognitive information processing are highlighted.     

Revisiting ‘What works for whom?’: A qualitative framework for evaluating clinical effectiveness in child psychotherapy

This paper describes a framework for evaluating the effectiveness of child psychotherapy used by child psychotherapists in an inner city Child and Adolescent Mental Health Service (CAMHS). The Hopes and Expectations for Treatment Approach (HETA) involves using the assessment for psychotherapy that normally precedes treatment to derive a baseline from which to generate a set of hopes/expectations as regards the effects of the treatment on the part of parents and the psychotherapist, to be revisited one year after the start of the psychotherapy and/or at its completion. The Strength and Difficulties Questionnaire, for parents and schools, was also administered before and after the treatment. The characteristics of the first 30 children referred for psychotherapy over a particular time period are described. Of the first 15 children in this group to complete one year of individual psychotherapy, all showed change or significant change in the areas concerning parents' and therapists' hopes at the end-of-year review, as rated by parents and psychotherapists. A case of a child with conduct disorder is used to describe how the assessment generated a psychoanalytic formulation, how the therapist's understanding was fed back to the parents, and how the parents' and therapist's hopes and expectations were derived and recorded. This case illustrates powerfully the impact of trauma in the parents' backgrounds on the internal world of the child, and how the method provides a useful bridge between parent and child work. Feedback from the psychotherapists, the parents and the referrers using the framework is reviewed, and in conclusion the paper argues for the framework's value in promoting good practice in the treatment and management of complex cases and in enhancing awareness of the nature and scope of the psychotherapy process.     

An individual approach to psychotherapy with psychotic patients

In this paper I attempt to explore particular aspects of the therapeutic process, especially the unusual way in which the therapy of this 11-year-old girl, referred for possible or potential anorexia nervosa, came to a sudden end. The oedipal configuration provides a useful theoretical framework in which to consider the course and vicissitudes of treatment. The restoration of a link between the child and her father allowed a distance to be created between mother and daughter. The meaning of this is considered both in terms of external events and clinically within the transference relationship.     

‘Between the woods and frozen lake’: a child psychotherapist’s experiences of developing a grant application for an RCT feasibility study

Drawing on the six stages identified by Henton and Midgley (2012) in the narratives of five child psychotherapists involved in the IMPACT study on their evolving attitudes towards participation in outcome research, this paper explores another child psychotherapist’s internal and external world experiences of writing a National Institute of Health Research grant application for a randomised controlled trial feasibility study. It makes use of the key associations that came to mind on first reading Henton and Midgley’s article, outlines the practical and emotional stages of developing the grant proposal and briefly considers some of the wider implications of this kind of work on a personal, organisational and professional level.     

Eating Disorder Recovery

Abstract

Qualitative studies addressing the eating disorder recovery process from the client's point of view are notably absent in the literature. For this case study, we conducted a retrospective examination of the recovery process, as recounted by a 37-year-old female who was diagnosed with anorexia nervosa, binge eating/purging subtype at the age of 30. Two in-person interview sessions provided insight into coping skills, multidisciplinary intervention strategies, and long-term treatment challenges. In sum, the client's perspective can add new information to the understanding of eating disorder recovery from feminist and other theoretical frameworks.     

Developmental coordination disorder and internalizing problems in children: The environmental stress hypothesis elaborated

There is a growing literature connecting poor motor coordination to physical and mental health outcomes in children and adolescents. These studies suggest that children with disorders such as developmental coordination disorder (DCD) are at greater risk for depression and anxiety, as well as obesity, and poor physical fitness. With regard to internalizing problems (symptoms of depression and anxiety), there is also evidence to suggest that the environment may play an important role in the etiology of psychological distress in this population. Cairney, Veldhuizen, & Szatmari, 2010 used the phrase “environmental stress hypothesis” to highlight the role that negative exposure to personal and interpersonal stressors might play in accounting for higher rates of internalizing symptoms in children with DCD. In this paper, we elaborate further on this basic premise, offering a model linking DCD to internalizing problems based on Pearlin’s stress process framework. In addition to stressors (risk) and protective factors, we incorporate both physical activity and obesity into our stress model. Next, we review the existing literature to see if there is evidence supporting specific components (pathways) of the model. In doing so, areas in need of further research are identified. Implications for intervention are also provided.     

Parental Attitudes,Beliefs, and Responses to Childhood Obsessive Compulsive Disorder: The Parental Attitudes and Behaviors Scale

ABSTRACT

This paper documents preliminary examination of the factor structure and psychometric properties of the Parental Attitudes and Behaviors Scale (PABS), an OCD-specific measure of parental attitudes, beliefs, and behavioral strategies related to childhood OCD. Employing a sample of 123 youth (mean age = 11.7; 59% male, 79% Caucasian) diagnosed with OCD in an outpatient child anxiety clinic, we used exploratory factor analysis to produce a 3-factor solution representing the following domains of parental responses to childhood OCD: accommodation, empowerment, and hostility/blame. These scales demonstrated adequate internal consistency and concurrent validity, providing preliminary evidence for the psychometric integrity of the PABS.     

Methylphenidate improves some but not all measures of ATTENTION,as measured by the TEA-Ch in medication-naïve children with ADHD

The Test of Everyday Attention for Children (TEA-Ch) is a reliable neuropsychological assessment of attention control in children. Methylphenidate (MPH) is an effective treatment to improve attentional difficulties in children with attention deficit/hyperactivity disorder (ADHD). Previous studies investigating the effects of MPH on attention performance of children with ADHD have produced mixed results and prior MPH usage may have confounded these results. No previous study has tested the effects of MPH on the entire TEA-Ch battery. This study investigated the effects of MPH on attention performance using the entire TEA-Ch in 51 medication-naïve children with ADHD compared with 35 nonmedicated typically developing children. All children were tested at baseline and after 6 weeks: The children with ADHD were medication-naïve at baseline, received MPH for 6 weeks and were tested whilst on medication at the second testing session. A beneficial effect of MPH administration was found on at least one subtest of each of the three forms of attention (selective, sustained, and attentional control) assessed by the TEA-Ch, independent of practice effects. MPH aided performance on the TEA-Ch tasks that were inherently nonarousing and that might require top-down control of attention. It is recommended that the TEA-Ch measures—Sky Search Count (selective attention),Score! (sustained attention), Creature Counting Time Taken for older children (attentional control), and Same Worlds (attentional control) be prioritized for use in future pharmacological studies using MPH.