Cognitive behaviour therapy of acute stress disorder: a four-year follow-up

The aim of this study was to index the long-term benefits of early provision of cognitive behavior therapy to trauma survivors with acute stress disorder. Civilian trauma survivors (n = 80) with acute stress disorder were randomly allocated to either cognitive behavior therapy (CBT) or supportive counseling (SC) - 69 completed treatment, and 41 were assessed four years post-treatment for post-traumatic stress disorder (PTSD) with the Clinician Administered PTSD Scale. Two CBT patients (8%) and four SC patients (25%) met PTSD criteria at four-year follow-up. Patients who received CBT reported less intense PTSD symptoms, and particularly less frequent and less avoidance symptoms, than patients who received SC. These findings suggest that early provision of CBT in the initial month after trauma has long-term benefits for people who are at risk of developing PTSD.     

Cognitive behaviour therapy for eating disorders: a "transdiagnostic" theory and treatment

This paper is concerned with the psychopathological processes that account for the persistence of severe eating disorders. Two separate but interrelated lines of argument are developed. One is that the leading evidence-based theory of the maintenance of eating disorders, the cognitive behavioural theory of bulimia nervosa, should be extended in its focus to embrace four additional maintaining mechanisms. Specifically, we propose that in certain patients one or more of four additional maintaining processes interact with the core eating disorder maintaining mechanisms and that when this occurs it is an obstacle to change. The additional maintaining processes concern the influence of clinical perfectionism, core low self-esteem, mood intolerance and interpersonal difficulties. The second line of argument is that in the case of eating disorders shared, but distinctive, clinical features tend to be maintained by similar psychopathological processes. Accordingly, we suggest that common mechanisms are involved in the persistence of bulimia nervosa, anorexia nervosa and the atypical eating disorders. Together, these two lines of argument lead us to propose a new transdiagnostic theory of the maintenance of the full range of eating disorders, a theory which embraces a broader range of maintaining mechanisms than the current theory concerning bulimia nervosa. In the final sections of the paper we describe a transdiagnostic treatment derived from the new theory, and we consider in principle the broader relevance of transdiagnostic theories of maintenance.     

Responsible engineering: the importance of character and imagination

Engineering Ethics literature tends to emphasize wrongdoing, its avoidance, or its prevention. It also tends to focus on identifiable events, especially those that involve unfortunate, sometimes disastrous consequences. This paper shifts attention to the positive in engineering practice; and, as a result, the need for addressing questions of character and imagination becomes apparent.     

Why Don't People Change? What Stops Them from Changing? An Integrative Commentary on the Special Issue on Resistance

This commentary discusses the four papers from the vantage point of a cognitive-developmental view. Psychotherapeutic change involving changes in core cognitive structures is seen as threatening an individual's personal sense of identity as well as security and safety needs. Core cognitive constructs are laid down early via the principle of covariation of events and form the basis of our tacit knowledge base. Subsequent changes in this tacit knowledge is difficult because the core cognitive constructs act like a mental filter to screen in confirming data and screen out disconfirming data. Ambiguous stimuli tend to be interpreted on the basis of preexisting cognitive constructs, even when the match between event and interpretation is not ideal. Several suggestions are given for increasing the probability of changes occurring in core cognitive constructs.     

Ethical challenges in a technological environment: The perspective of engineers versus managers

In his article ‘Better Communication Between Engineers and Managers: Some Ways to Prevent Many Ethically Hard Choices’¹ Michael Davis analyzes the causes of the disaster in terms of a communications gap between management and engineers. When the communication between (representatives of) both groups breaks down, the organization is in (moral) trouble. Crucial information gets stuck somewhere in the organization prohibiting a careful discussion and weighing of all (moral) arguments. The resulting judgment has therefore little (moral) quality. In this paper I would like to comment on some of Michael Davis’s interesting and thought-provoking insights and ideas. A company which implements Davis’s recommendations at least shows some sensitivity to organizational moral issues. But it might miss the point that moral trouble can also result from a common understanding between managers and engineers. Organizational members sometimes tend to be myopic with regard to safety issues. This paper:

Exploring Decision Making Around Therapist Self‐Disclosure in Cognitive Behavioural Therapy

Background

Therapist self‐disclosure (TSD) usage varies greatly among different psychotherapy orientations. Anecdotal evidence seems to suggest that there are reasons for its judicious use, and a small number of researchers have proposed guidelines for how TSD should be used to help therapists across psychotherapy models make decisions around disclosure. However, there is almost no literature specifically exploring how cognitive behaviour therapy (CBT) practitioners make decisions around employing TSD within the CBT framework.

Objective

This study aimed to explore how experienced CBT practitioners make decisions around TSD.

Method

In‐depth qualitative interviews were conducted with six clinical psychologists who were trained and experienced in CBT, and the interviews were analysed thematically.

Results

There were two overarching themes in terms of how they made decisions to self‐disclose: (A) the rules for TSD use, which included sub‐themes (a) it must have a clear purpose, (b) it must fit, (c) the therapist must maintain boundaries, and (d) the therapist must always reflect on his/her use of TSD; and (B) how they use TSD, which included subthemes of (a) using it as a tool for change and (b) using it to manage the therapeutic relationship.

Conclusion

Participants’ decisions on whether or not to self‐disclose were strongly influenced by the CBT model, and this process went beyond what is suggested in the transtheoretical literature. Understanding this process may lead to the development of CBT‐specific guidelines for making TSD‐related decisions.     

Do we feel the same level of guilt about the wrongdoings of close ones and distant ones? The mediating role of behavioural control

Understanding whether and why individuals' emotional responses are different to the same behaviour performed by different others is important for understanding phenomena in social interaction. Given that there is no relevant research in Eastern culture testing such issues, the present research including two studies was conducted with Chinese samples and investigated whether Easterners experience more vicarious guilt about close ones' immoral behaviours than distant ones' immoral behaviours and the underlying mechanism of the effect. Study 1 showed that people felt more guilty when recalling close ones' misdeeds than distant ones' misdeeds. Study 2 replicated the findings of Study 1 using the scenario method and demonstrated that behavioural control partially mediated the effect of relationship closeness on vicarious guilt, that is, people reported more behavioural control over close ones' immoral behaviours, which in turn resulted in more vicarious guilt. Implications for social interaction and directions for future research are discussed.     

Psychological Safety and Appreciation of Differences in Counselor Training Programs: Examining Religion,Spirituality, and Political Beliefs

This study focused on the extent to which religion, spirituality, and political beliefs predicted counseling students' perceptions of psychological safety and appreciation of differences in their programs. The authors used hierarchical regression models to analyze data from 264 students from 4 different institutions. Results indicated that student age, political conservatism, extrinsic religiosity, and intrinsic spirituality were significant predictors of perceived psychological safety and appreciation of differences. The authors discuss implications of these findings.     

Capturing the Structure of Distinct Types of Individual Differences in the Situation‐specific Experience of Emotions: The Case of Anger

The aim of this paper was to understand why some people experience certain emotions in a specific situation, whereas others do not. We postulate that these individual differences arise from individual differences in two underlying processes of emotion elicitation: (i) individual differences in the emotion components (appraisals and action tendencies) that situations activate in a person and (ii) individual differences in how these emotion components are related to subjective emotional experience. In this paper, we re‐analysed data from two studies on anger to capture the structure of these two types of individual differences by using clustering modelling techniques. Consistent results across the two studies demonstrated that individuals differ in anger because they (i) differ in how easy they experience anger‐relevant appraisals (Studies 1 and 2) and action tendencies (Study 2) in increasingly negative situations and (ii) differ in which of these components are necessary to experience anger. Copyright © 2011 John Wiley & Sons, Ltd.