Intensive Cognitive Processing Therapy Associated With Reduced PTSD Treatment Dropout in a Case-Controlled Study of Treatment-Seeking Veterans

Cognitive Processing Therapy (CPT) is an empirically supported psychotherapy for posttraumatic stress disorder (PTSD). The complex issue of treatment attrition is a frequently cited concern regarding CPT and other evidence-based psychotherapies for PTSD. The current study investigated the feasibility and effectiveness of “intensive” CPT, a treatment-consistent modification of CPT in which sessions are conducted more frequently than standard protocol. Fifty-four military veterans (20% female; M_age = 46; 80% Caucasian) seeking outpatient treatment for PTSD were included in this study. Patients who elected to receive intensive CPT (n = 27) were matched with archival records of individuals who received standard CPT (n = 27). Patients across treatment conditions were matched based on baseline symptom severity as measured by the PTSD Checklist for DSM-5 (PCL-5; M_PCL-5 = 52.61). Treatment outcomes were compared and longitudinal multilevel modeling was used to compare rate of symptom change over time. Patients who elected to engage in intensive CPT were twice as likely to complete treatment (88.9%) as those who received standard CPT (44.4%), X²(1, N = 54) = 12.00, p = .001. On average, intensive CPT patients completed treatment in about 25% of the time as standard CPT patients (33.8 days vs. 125.7 days). Patients in intensive CPT also demonstrated greater benefit: 81.4% reported a clinically significant improvement in PCL-5 scores compared to 51.8% of those in standard CPT, X²(1, N = 54) = 5.33, p = .020, φ = −0.314. Intensive and standard CPT performed comparably in regard to final PCL-5 score, change over time, and screening cutoff. In addition, there were no differences in treatment outcomes based on licensure status of the provider nor whether treatment was delivered in person or virtually. Intensive CPT represents a novel, treatment-consistent adaptation that was utilized to treat a group of veterans with PTSD with minimal treatment dropout. Patients who elected to engage in more frequent treatment were more likely to complete treatment, did so in one quarter of the time, and reported similar to better treatment outcomes. Providers may consider encouraging their patients to participate in treatment as frequently as they are able. However, preliminary findings are based on a nonrandom sample and design limitations temper conclusions.     

国内城市社区健康教育和健康促进研究

分析了我国城市化加速发展过程中出现的城市社区健康问题及其影响因素.在对社区健康教育与健康促进的作用和意义进行探讨的基础上,提出解决这些城市健康问题的根本途径是城市社区健康教育与健康促进策略,并针对我国城市社区健康教育与健康促进的研究和发展现状提出对策建议.     

ICU中机械通气患者胃肠道功能障碍与预后的关系

为了探讨重症加强治疗病房机械通气患者胃肠道功能障碍与预后的关系,回顾性分析了我院中心ICU收治的68例非胃肠道疾病且行有创机械通气治疗超过48h患者的临床资料,并将患者分为胃肠道功能障碍组和非胃肠道功能障碍组,用统计软件分析发生胃肠道功能障碍的相关临床因素及发生胃肠道功能障碍后对病死率的影响。结果显示,统计分析显示胃肠道功能障碍组和非胃肠道功能障碍组在机械通气天数、APACHEⅡ评分、MODS的发生率、病死率间存在明显差异。因此,对危重病患者应重视其胃肠道功能障碍的防治。     

Casper or 'the cabinet of horrors'

This paper is an account of a four-times-a-week analysis with a very deprived, feral-like child. The author, who has come to understand feral children as very deprived children, turns to an historical account written in 1826 by Anselm von Feuerbach, the jurist who was asked to make enquiries into the identity of a savage and mysterious boy, Kaspar Hauser. The author describes how she has made use of the observations and thoughts of Anselm von Feurbach in her attempts to process her own thoughts and reflections around the unfolding clinical material and how the exploration of the differences and similarities between Casper and Kaspar Hauser helped her to gradually grasp the psychological essence of the patient. The question of an appropriate reading of the clinical material for theoretical purposes remains open.     

Delivering Intensive PTSD Treatment Virtually: The Development of a 2-Week Intensive Cognitive Processing Therapy–Based Program in Response to COVID-19

Of the many vulnerable groups affected by the spread of COVID-19, veterans have been especially impacted by the pandemic. Beginning in March 2020, nationwide shelter-in-place orders rapidly led to widespread job loss and economic upheaval; disruption and breakdown of multiple support systems; and increases in family stress, all of which may exacerbate underlying PTSD symptoms. Although telehealth has proven an effective means of delivering evidence-based psychotherapies for PTSD, little is known about the delivery of these treatments in an intensive, daily format over telehealth. There is growing need for intensive treatment options to reduce treatment-interfering barriers such as high dropout rates. In order to address this gap in the literature, this paper details several design considerations as well as patient selection procedures for a 2-week virtual intensive treatment program (vITP) for veterans with posttraumatic stress disorder (PTSD), consisting of daily individual Cognitive Processing Therapy (CPT) and other adjunctive interventions. We also describe two cases of veterans who successfully completed the vITP including their clinical outcomes, therapist reflections on the process, feedback regarding the program, as well as challenges patients encountered with the telehealth platform. Intensive evidence-based psychotherapy for PTSD delivered through a virtual format seems to show promise, but more systemic research is needed.     

Intensive Behavior Therapy for Tics and Co-Occurring ADHD: A Case Report

Tic disorders (TDs) can substantially impact daily child functioning across social, familial, and academic domains, leading to a significant public health impact. Additionally, an overwhelming majority of children with a TD have at least one co-occurring disorder. In particular, over 60% of children with a TD also meet criteria for attention-deficit/hyperactivity disorder (ADHD). Comprehensive Behavioral Intervention for Tics (CBIT) is a first-line treatment for youth with TDs and has been shown to be effective in reducing the frequency, duration, and severity of tics in children and adolescents. Nonetheless, access to trained CBIT providers remains limited, and common comorbid conditions are not addressed in standard CBIT. Thus, there is a need for CBIT interventions that can incorporate treatment strategies for TDs and common comorbidities. To address the critical need to address TD and common comorbidities simultaneously, the current case study presents and evaluates a 2-week intensive approach to address tic and ADHD symptoms concurrently in a peripubertal male. The child’s parents reported significant improvements in tic and ADHD symptoms following the end of treatment, which were maintained throughout three follow-up booster sessions. Clinical implications and future directions to modify and improve the proposed treatment are discussed.     

ICU患者的浅镇静：我们追求的目标？

镇静治疗是ICU综合治疗的重要组成部分。随着ICU的发展,先后颁布了3个有关ICU患者的镇静指南,镇静治疗的理念也逐渐发生改变。2013年美国重症医学会颁布的ICU成人患者疼痛、躁动、谵妄治疗指南推荐的镇静目标为浅镇静。该指南是以大量临床研究结论为基础提出的,更具有广泛代表性和推广价值。本文从浅镇静的理论基础、具体实施方案、镇静深度的监测、镇静药物的选择以及浅镇静的局限性等方面具体阐述ICU患者浅镇静策略的相关问题,以期ICU同道能更好地理解和临床实施ICU成人患者的浅镇静策略。     

Book review

Job's illness, loss, grief and integration. A psychological interpretation J. H. Kahn, M.D., F.R.C. Psych., D.P.M. Published by Pergamon Int. Library £6.00

Explorations in autism: A psycho-analytical study by Donald Meltzer, John Bremner, Shirley Hoxter, Doreen Wedell and ISCA Wittenberg