Critical Success Factors of Rural and Urban Special Education Administration

Perceptions and opinions are reported of special education administrators in Indiana and Massachusetts. The data that are presented reflect administrators' ratings of factors that they consider critical to their personal success on-the-job and factors they see as essential to successful functioning of their organizational unit. Discussion occurs within the context of operation of special services programs in single district units and those found in cooperative or intermediate unit structures.     

Hispanic Culture and Relational Cultural Theory

Abstract

Traditional personality theories do not consider the impact of culture on personality development. Yet, to provide culturally relevant services to the increasing Hispanic population in the U.S., more culturally relevant theories must be identified. This paper presents Relational Cultural Theory (RCT) as an alternative model to understanding Hispanic values and personality development. The RCT concepts ofmu-tuality, connections, growth-fostering relationships, “five good things,” power over, and self-boundaries are used to describe how Hispanic values can be viewed in a more culturally relevant way. A vignette shows how clinicians can use RCT as an alternative model to provide more effective treatment in their work with Hispanic populations.     

Interoceptive Exposure Therapy Combined with Trauma‐related Exposure Therapy for Post‐traumatic Stress Disorder: a Case Report

Trauma‐related exposure therapy is a useful but not universally effective treatment for post‐traumatic stress disorder. Anxiety sensitivity may play an important role in this disorder, as it does in panic disorder. Studies have shown that interoceptive exposure therapy reduces anxiety sensitivity in panic disorder. The present case study was a preliminary investigation of the merits of including interoceptive exposure therapy in the treatment of post‐traumatic stress disorder, in order to improve treatment outcome for a patient who had no history of panic disorder or panic attacks. Interoceptive exposure therapy (4 sessions) was one component of treatment, combined with trauma‐related exposure therapy (4 sessions of imaginal exposure followed by 4 sessions of in vivo exposure). Treatment outcome was assessed with the Clinician‐Administered Post‐traumatic Stress Disorder Scale, a self‐report measure of post‐traumatic stress disorder symptoms, and measures of symptoms and cognitions commonly associated with post‐traumatic stress disorder. Scores on all outcome measures decreased over the course of treatment, with gains maintained at 1‐ and 3‐month follow‐up. Symptoms of anxiety sensitivity and post‐traumatic stress disorder decreased during interoceptive exposure therapy. The results indicate that interoceptive exposure therapy is a promising adjunctive intervention for post‐traumatic stress disorder. Further research is needed into the merits of combining interoceptive exposure therapy and trauma‐related exposure therapy as a means of boosting treatment efficacy.     

Clinical effects of biofeedback treatment in migraine: The relation to achieved self-control and pretreatment predictors

Abstract

Factors contributing to the headache reduction six months after treatment of sixty-three migraine subjects were examined in three different studies. Subjects had originally been treated with either peripheral skin temperature biofeedback, biofeedback for blood-volume-pulse amplitude of the temporal artery, or applied relaxation. In Study 1 it was found that biofeedback subjects who had achieved self-control of the trained physiological parameter had significantly greater headache reductions than “nonlearners”. In Studies 2 and 3, potential predicting factors of clinical effects were studied. Age and whether subjects had achieved self-control emerged as (weak) predictors in different analyses using discriminant analysis. Using “PLS” (partial least squares projections to latent structures) a model emerged which gave a more complex picture, and which might indicate for example that there are different sets of factors which predict success and predict nonsuccess in treatment.     

Is Acoustic Startle a Viable Exposure Protocol for Posttraumatic Stress Disorder? A Clinical Case Study

Exaggerated startle is a common symptom (based on Diagnostic and Statistical Manual of Mental Disorders [fourth edition] Criterion D) for many patients with posttraumatic stress disorder (PTSD). Findings from previous studies suggest that exaggerated startle may be due to trauma exposure or pretrauma vulnerability factors for PTSD development. The present clinical case study reports on a patient with PTSD characterized by a very prominent startle response and preference against standard trauma-related exposure strategies. On the basis of recent findings that interoceptive exposure exercises (e.g. shaking head side to side, hyperventilation) elicit trauma-related memories (Wald & Taylor, 2008), the authors sought to determine whether repeated application of an acoustic startle stimulus would serve to diminish the prominent startle response and facilitate exposure and overall symptom reduction by eliciting trauma-related memories. The protocol was successful in eliciting vivid and distressing trauma-related memories. Over the course of seven exposure trials, the patient demonstrated a decrease in distress elicited during the protocol, improved mood, and reduced general anxiety and trauma-related distress. He also reported significantly decreased startle response to loud noises encountered during activities of daily living. Although preliminary, these finding suggest that the acoustic startle protocol may be a viable (interoceptive) exposure strategy for individuals with PTSD, particularly those with exaggerated startle responses and those who are not amenable to standard trauma-related exposure strategies.     

Internet-Based Therapy for Mild to Moderate Depression in Swedish Primary Care: Short Term Results from the PRIM-NET Randomized Controlled Trial

Depression presents a serious condition for the individual and a major challenge to health care and society. Internet-based cognitive behavior therapy (ICBT) is a treatment option supported in several trials, but there is as yet a lack of effective studies of ICBT in “real world” primary care settings. We examined whether ICBT differed from treatment-as-usual (TAU) in reducing depressive symptoms after 3 months. TAU comprised of visits to general practitioner, registered nurse, antidepressant drugs, waiting list for, or psychotherapy, or combinations of these alternatives. Patients, aged ≥ 18 years, who tentatively met criteria for mild to moderate depression at 16 primary care centers in the south-western region of Sweden were recruited and then assessed in a diagnostic interview. A total of 90 patients were randomized to either TAU or ICBT. The ICBT treatment included interactive elements online, a workbook, a CD with mindfulness and acceptance exercises, and minimal therapist contact. The treatment period lasted for 12 weeks after which both groups were assessed. The main outcome measure was Beck Depression Inventory-II (BDI-II). Additional measures were Montgomery Åsberg Depression Rating Scale – self rating version (MADRS-S) and Beck Anxiety Inventory (BAI). The analyses revealed no significant difference between the two groups at post treatment, neither on BDI-II, MADRS-S, nor BAI. Twenty patients (56%) in the ICBT treatment completed all seven modules. Our findings suggest that ICBT may be successfully delivered in primary care and that the effectiveness, after 3 months, is at par with TAU.     

Nature and Role of Change in Anxiety Sensitivity During NRT-Aided Cognitive-Behavioral Smoking Cessation Treatment

This study evaluated the associations between change in anxiety sensitivity (AS; fear of the negative consequences of anxiety and related sensations) and lapse and relapse during a 4-week group NRT-aided cognitive-behavioral Tobacco Intervention Program. Participants were 67 (44 women; M _age = 46.2 years, SD = 10.4) adult daily smokers. Results indicated that participants who maintained high levels of AS from pretreatment to 1 month posttreatment, compared to those who demonstrated a significant reduction in AS levels during this time period, showed a significantly increased risk for lapse and relapse. Further inspection indicated that higher continuous levels of AS physical and psychological concerns, specifically among those participants who maintained elevated levels of AS from pre- to posttreatment, predicted significantly greater risk for relapse. Findings are discussed with respect to better understanding change in AS, grounded in an emergent taxonic-dimensional factor mixture model of the construct, with respect to lapse and relapse during smoking cessation.     

Therapists' Experiences of Conducting Cognitive Behavioural Therapy Online vis-à-vis Face-to-Face

This study has explored therapists' experiences of conducting cognitive behavioural therapy (CBT) online and face-to-face. Eleven therapists partook in semi-structured interviews, which were thematically analysed using an abductive approach. The results indicate that the therapists viewed face-to-face therapy as a stronger experience than Internet-based CBT (ICBT), and the latter as being more manualised, but providing more work-time control. Several participants also thought that working alliance may be achieved faster and more easily in face-to-face therapy, and might worsen with fewer modalities of communication. Clinical implications in need of investigation are whether working with ICBT might buffer therapist exhaustion, and whether this therapy form can be improved by becoming less manual dependant in order to be easier to individualise.     

Exploring the lived experiences of infertility treatment and care by involuntarily childless women

This study explored the lived experiences of fertility treatment and care by South African women with infertility. A total of 21 women from different age and ethnic groups (age range = 26 to 41; whites = 53%, coloured = 47%) were interviewed for the study. The women responded to semi-structured interviews on their lived experiences of fertility treatment and care whilst undergoing treatment. The data were analysed using thematic analysis. Four main themes were identified in the study; including: lack of compassionate care from treatment care providers, the need for infertility clinics to integrate psychosocial support care, a need for continuing education for fertility staff, as well as financial support resourcing. Participants expressed a need for health care staff at fertility clinics to be more attentive to their emotional and psychological needs. In addition, participants perceived a need for psychosocial care as a result of the distressing nature of the treatment process. The women also felt that some health care staff lacked technical knowledge about the fertility treatments and this left them deprived of crucial information. The costly nature of fertility treatment presented as an added burden for participants. Overall, participants seemed to require a more individualised and patient centred form of fertility care.