Perceived Barriers and Preliminary PTSD Outcomes in an Open Pilot Trial of Written Exposure Therapy With Latinx Immigrants

Latinx immigrants experience substantial disparities in mental health treatment access, particularly for posttraumatic stress disorder (PTSD). The availability of brief, flexible interventions in Spanish may assist in reducing these disparities. Written Exposure Therapy (WET) is a five-session PTSD intervention that appears as effective as longer, gold-standard interventions, but has yet to be tested among Latinx immigrants. To test the acceptability and preliminary effectiveness of WET, 20 Spanish-speaking, Latinx immigrants conducted structured interviews at pretreatment, were offered WET, and completed posttreatment structured interviews. Open thematic coding of pre- and posttreatment interview questions examined perceived barriers and benefits of WET. Quantitative components examined symptom change across PTSD (PCL-IV-C) and depression (PHQ-9). Quantitative results indicated clinically meaningful and statistically significant change in PTSD symptoms using intent-to-treat analyses (M_diff = 17.06, SD_diff = 9.97, range = 0–29, t(15) = 6.84, p < .001). Open thematic coding identified four barrier-related themes and three benefit-related themes at pretreatment. At posttreatment, three barrier-related themes and two benefit-related themes were identified. Qualitative results largely suggested that perceived barriers were common to other PTSD interventions (e.g., exposure components). Only one participant identified barriers specific to WET. Results suggested WET may reduce PTSD symptoms among Latinx immigrants. WET also appeared to be acceptable and primarily viewed as beneficial among this population. WET is a promising intervention with Latinx immigrants and warrants further testing larger trials, including testing implementation strategies that may improve access to care.     

晚期癌症患者家属的病情告知态度探究

本文采用自行设计的调查问卷,对200例晚期癌症患者家属进行问卷调查,以探讨晚期癌症患者家属对病情告知的态度。结果显示,认为病情应绝对保密者55例（27．5％）;暂时保密者107例（53．5%）;而不保密者38例（19．0％）。晚期癌症患者家属普遍采取“慈悲原则”,对患者病情持保密态度;癌症患者家属普遍缺乏病情告知策略。临床医生在执行知情同意时应该依据患者不同的家庭情况,有针对性地进行告知。     

Computer-based written emotional disclosure: the effects of advance or real-time guidance and moderation by Big 5 personality traits

Standard written emotional disclosure (WED) about stress, which is private and unguided, yields small health benefits. The effect of providing individualized guidance to writers may enhance WED, but has not been tested. This trial of computer-based WED compared two novel therapist-guided forms of WED – advance guidance (before sessions) and real-time guidance (during sessions, through instant messaging) – to both standard WED and control writing; it also tested Big 5 personality traits as moderators of guided WED. Young adult participants (n = 163) with unresolved stressful experiences were randomized to conditions, had three, 30-min computer-based writing sessions, and were reassessed six weeks later. Contrary to hypotheses, real-time guidance WED had poorer outcomes than the other conditions on several measures, and advance guidance WED also showed some poorer outcomes. Moderator analyses revealed that participants with low baseline agreeableness, low extraversion, or high conscientiousness had relatively poor responses to guidance. We conclude that providing guidance for WED, especially in real-time, may interfere with emotional processing of unresolved stress, particularly for people whose personalities have poor fit with this interactive form of WED.     

Spiritual Disclosure and Ego Resiliency: Validating Spiritual Competencies

Counselor spiritual and religious competency depends primarily on the ability to facilitate client spiritual disclosure. Little is known, however, about the empirical qualities of spiritual disclosure. In a sample of 318 adults (mean age = 44 years), spiritual disclosure independently predicted ego resiliency, a critical quality for stress‐related growth. Spiritual disclosure predicted ego resiliency over the partial mediators of the 5 factors of personality, general global disclosure, and congregational support. Implications for professional counseling ethics are discussed.     

医学书面语体的特征研究

以病历、医嘱、处方、检验报告、诊断学等教科书中书面语言为基础,对医学书面语体的内部结构和外部要素进行分析,认为医学书面语体作为一个相对新型的语体,在语词、句法、辞格和篇章等方面有显著的特征。还深入研究了这些特征与相关联的语言外部要素间联系。     

The effects of perpetrator age and abuse disclosure on the relationship between feelings provoked by child sexual abuse and posttraumatic stress

Abstract

The present study examined the relationship between feelings provoked by child sexual abuse (CSA) and posttraumatic stress disorder (PTSD) symptom scores in a sample of 163 female survivors of CSA. Finkelhor and Browne's traumagenic dynamics model was applied. The interactive effects of provoked feelings with perpetrator age and the existence of abuse disclosure were also studied. Results showed an overall relationship between feelings provoked by CSA and PTSD symptom scores. Feelings of stigma, betrayal, and powerlessness as a result of CSA were associated with PTSD symptom score when the entire group of CSA victims was analyzed. The role of traumatic sexualization was relevant only when analyzed in interaction with the age of the perpetrator and disclosure. The relationship between traumatic sexualization and PTSD symptom scores was only significant when the abuse was committed by an adult perpetrator and when a disclosure was made during the time of abuse, or a short time after the abuse had occurred.     

SOCIAL SHARING IN ANTICIPATION OF CARDIAC SURGERY: WHO TALKS MORE AND WHY

This study presents the stress and sharing model, which was developed in order to predict the extent to which patients anticipating cardiac surgery, share their emotions. The model hypothesizes that preoperative sharing of emotions mediated by need, is positively related to surgery-related stress measured independently, and in comparison to the roommates. The model was tested for surgery-related and surgery-unrelated feelings. One hundred and fifty-seven Greek patients participated in the study. The variables included in the model were measured daily, using self-reports. Results show a good fit of the model only for surgery-related feelings (χ²=4.688, p=0.321). The study shows that patients anticipating surgery share their emotions in the same way as patients recovering from stressful or traumatic events. Stressed patients experience the need to focus on the threat (verbally) and not to be ‘distracted’ by talking about irrelevant topics. These findings have important implications for the design of preparatory interventions for surgical patients.     

Memories of Childhood Threat,Fear of Disclosure and Paranoid Ideation: A Mediation Analysis Using a Nonclinical Sample

This study investigated whether associations between childhood memories of threat and adult paranoia could be partially mediated by factors associated with impeded interpersonal communication (concealment and fear of disclosure of personal and distressing information). University undergraduates (N = 179) completed a battery of psychometric scales. Mediation analysis identified a direct effect between early memories of threat and paranoid ideation (B = 0.11, 95% CI = [0.07, 0.14], p = .00). A mediated effect between these variables was also significant (B = .05, 95% CI = [0.02, 0.07], p = .01). However, although significant associations were identified between memories of threat and each of the mediating variables (self-concealment, fear of self-disclosure, anxiety, depression) only fear of self-disclosure displayed a significant association with paranoid ideation (B = .05, 95% CI = [0.02, 0.07], p = .01).     

Trauma and the transference‐countertransference: working with the bad object and the wounded self

This paper focuses on the transference‐countertransference dynamics that manifest in work with those individuals who experienced severe early relational trauma and, in particular, childhood sexual abuse. The literature is surveyed from Davies and Frawley's (1992a) seminal paper through to more current trauma‐related and sensorimotor approaches, which deepen our understanding greatly. The rapidly shifting, powerful, conflicting and kaleidoscopic transference‐countertransference dynamics are explored in the light of these views and in relation to a lengthy clinical example. The author elucidates the dual‐aspect of the traumatic complex, whereby the abuser figure, which is disavowed by the patient, becomes manifest in prosecuting the analyst for the ‘wounds’ that the analysis evokes. The paper also explores the particular nature of the splitting processes, whereby pressure is put on the analyst to adopt an idealized role, in particular to act as a self‐object, in order to enable the patient to safely express and ‘be’ themselves in an attempt to make up for what was not possible in childhood; the analyst will necessarily fail in this task. In the context of powerful masochisto‐sadistic dynamics, the analyst's masochism is likely to be called up in the spirit of caring ‘humanity’ (another inevitable enactment), which can impede the progress of the analysis if not addressed. The extreme woundedness, intense affect and moral outrage associated with these dynamics are characteristic and compelling. Issues relating to disclosure, enactment and analytic attitude are also discussed.     

Regrets and Advice from Mothers who have Disclosed their HIV + Serostatus to their Young Children

Qualitative interviews were conducted with mothers (N = 47) who had disclosed their HIV status to their child. Mothers described their preparation and the process of the disclosure event, and discussed any regrets they had about disclosing or the process of disclosing. They were also asked what advice they had for other HIV-positive mothers who were trying to determine whether to disclose their serostatus to their young children. Overall, the majority of the mothers (68%) did not regret disclosing their HIV status. Regrets fell into five categories: preparation, timing, context, content, and outcomes of the disclosure event. Based on these findings, mothers who have not disclosed their serostatus to their children need assistance with behavioral practice and support in order to prepare for the process. Furthermore, follow-up support for the children may be beneficial.