A randomized pilot study of anger treatment for Iraq and Afghanistan veterans

Objective

Anger and aggression are serious problems for a significant proportion of veterans who have served in combat. While prior research has suggested that cognitive behavioral treatments may be effective for anger problems, there are few controlled studies of anger treatment in veterans and no studies of anger treatment focusing exclusively on veterans from the Iraq and Afghanistan wars. This randomized pilot study compared an adapted cognitive behavioral intervention (CBI) to a supportive intervention (SI) control condition for the treatment of anger problems in veterans returning from deployment in Iraq or Afghanistan.

Methods

25 veterans with warzone trauma, problems with anger, and one or more additional hyperarousal symptoms were randomized and 23 started treatment (CBI, n = 12; SI, n = 11). Outcome measures were administered at pre- and post- treatment and at 3 months post-treatment.

Results

CBI was associated with significantly more improvement than SI on measures of anger and interpersonal functioning. Gains were maintained at follow-up.

Conclusions

Findings suggest that CBI may be more effective than an active control providing psychoeducation, relaxation, and supportive therapy for treating anger problems in returning veterans. The findings need to be replicated in an adequately powered and more diverse sample.     

The Minnesota Multiphasic Personality Inventory-2 Restructured Form in National Guard soldiers screening positive for posttraumatic stress disorder and mild traumatic brain injury

The Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2 RF) was administered to 251 National Guard soldiers who had recently returned from deployment to Iraq. Soldiers were also administered questionnaires to identify posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI). On the basis of responses to the screening instruments, the National Guard soldiers who produced a valid MMPI-2 RF were classified into four groups: 21 soldiers who screened positive for PTSD only, 33 soldiers who screened positive for mTBI only, 9 soldiers who screened positive for both conditions, and 166 soldiers who did not screen positive for either condition. Results showed that the MMPI-2 RF was able to differentiate across the groups with the MMPI-2 RF specific problem scale Anxiety adding incrementally to MMPI-2 Restructured Clinical scales in predicting PTSD. Both MMPI-2 RC1 (Somatic Complaints) and MMPI-2 RF head pain complaints predicted mTBI screen but did not add incrementally to each other. Of note, all of the MMPI-2 RF validity scales associated with overreporting, including Symptom Validity-Revised (FBS-r), were not significantly elevated in the mTBI group. These findings support the use of the MMPI-2 RF in assessing PTSD in non-treatment-seeking veterans. This further suggests that a positive screen for mTBI alone is not associated with significant emotional disturbance.     

Sex differences in the factor structure of a modified Sexual Experiences Questionnaire

Sexual harassment has long been a problem in educational, employment, and military populations. It is unclear whether existing questionnaires used to measure sexual harassment in the U.S. military--particularly, derivatives of the Sexual Experiences Questionnaire--perform similarly in men and women. Using exploratory factor analyses in a mixed sample of active duty troops and veterans (289 men, 181 women), sex differences were found in one version's factor structure. Implications and suggestions for improving the validity of the questionnaire for men are offered.     

Peer-Reputational Influences and Academic Achievement: Exploring Gender Differences

This study explored the impact of peer-reputations for academic ability and affect/liking on academic outcomes in a sample of preadolescents. In light of the popular stereotypes regarding the differential academic abilities of girls and boys (favoring girls in English, and boys in math and science), it was hypothesized that peer-reputations in English would be more predictive of academic outcomes (measured via school-grades and standardized test-scores) for girls than for boys, while math and science reputations would be most predictive of boys’ academic outcomes. Further, it was also hypothesized that these links would be stronger for school-grades than for standardized test-scores. As expected, overall, peer-reputations were found to be predictive of school-grades but not standardized test-scores. Further, the results reveal that although ability reputations in most areas were predictive of grades for both sexes, gender differences were observed which were consistent with hypotheses. Results suggest that children’s peer-reputations may play an important role in their academic achievement, especially within domains most central to their gender identities.     

Client Views and Attitudes to Non-Invasive Prenatal Diagnosis for Sickle Cell Disease,Thalassaemia and Cystic Fibrosis

In the near future the availability of non-invasive prenatal diagnosis (NIPD) for single gene disorders will change the prenatal diagnosis options available to couples who are carriers of conditions such as cystic fibrosis, sickle cell disorder and thalassaemia. Client opinions about NIPD are needed to inform the implementation of NIPD for single gene disorders. This qualitative study used two focus groups (n?=?12) and one-to-one interviews (n?=?16) with carriers and support group representatives of sickle cell disease, thalassaemia and cystic fibrosis. Discussions were digitally recorded, transcribed verbatim and analysed using thematic analysis. Opinions about NIPD were very positive and participants valued the opportunity to have safe and early testing. Uptake of prenatal testing is likely to increase as women who had previously declined invasive testing expressed interest in having NIPD. Participant concerns about NIPD centred on the need for accuracy to be high to be used for subsequent decision making about termination of pregnancy. Participants also raised concerns that less thought may be given to having a blood test compared to an invasive test and that the perceived ease of a blood test may bring increased pressure to have testing. Participants thought NIPD should be offered through existing specialist services to ensure appropriate genetic counseling and support. Maintaining all testing options is important as some people may prefer invasive testing over NIPD if invasive testing was more accurate or if invasive testing could give information about other conditions such as Down syndrome.     

Mother-Child Attachment and Gender Identity in Preadolescence

We investigated the relations of two dimensions of attachment insecurity (avoidant with mother, preoccupied with mother) to three dimensions of gender identity (gender typicality, gender contentedness, felt pressure for gender differentiation) in preadolescent children. We hypothesized that attachment insecurity (of either sort) fosters felt pressure for gender differentiation but impedes the development of felt gender typicality and gender contentedness. Participants were 863 Black, Hispanic, and White fifth graders attending public schools in the southeast United States (443 girls, 420 boys; M age = 11.1 years). Each attachment measure was associated with each gender identity measure in the expected way, but some associations hinged on child gender or ethnicity/race. Avoidant attachment was negatively associated with felt gender typicality only for White children, negatively associated with gender contentedness for the entire sample, and positively associated with felt pressure for gender differentiation only for White children. Preoccupied attachment was negatively associated with felt gender typicality for the entire sample, negatively associated with gender contentedness only for boys, and positively associated with felt pressure for gender differentiation only for girls.     

Prospective memory in early and established psychosis: An Indian perspective

Individuals affected by psychosis often have deficits in several neurocognitive functions. Prospective memory (PM), the ability to remember to do things, is crucial for activities of daily living, social and occupational functioning, but very few studies have attempted to examine this domain of functioning in people with psychosis, particularly in India. A total of 71 patients with psychosis, (both early and established psychosis), and 140 age, gender and education-matched healthy controls were assessed using the Positive and Negative Symptom Scale, Hospital Anxiety and Depression scale, and Addenbrooke's Cognitive Examination. PM was assessed using the Cambridge Prospective Memory Test and the Prospective and Retrospective Memory Questionnaire (PRMQ). Group differences were evaluated using Mann–Whitney U-tests. Significantly greater cognitive deficits, higher anxiety and depression were evident in the psychosis group compared with controls. The psychosis group performed significantly poorer on both time- and event-based tests in CAMPROMPT than controls. These differences remained when controlling for age, education, general cognitive functioning and mood. The subjective measure of PM (PRMQ) did not differentiate the two groups. The PM performance of early and established psychosis patients was similar. Comparisons with cross-cultural data (PRMQ UK norms and CAMPROMPT and PRMQ Chinese data) revealed important differences in PM performance. Individuals with psychosis have significant deficits in both time- and event-based PM. CAMPROMPT emerged as a more sensitive PM measure compared with PRMQ. Results from cross-cultural comparisons underscore the need for cultural contextualization of assessments.     

Reliability of the Wraparound Observation Form: An Instrument to Measure the Wraparound Process

Within the past decade, the wraparound approach has gained significant popularity in providing services to children with challenging social and family needs. While a plethora of wraparound programs have been developed and studies have been conducted to assess their effectiveness, the need to develop instruments that measure the implementation of wraparound services is clear. The purpose of the present study was to evaluate the reliability of a scale that measures wraparound services. In this study, the Wraparound Observation Form (WOF), was developed to evaluate the implementation of the wraparound process in treatment planning meetings. The WOF includes 34 closed-ended items that requires the respondent to note the occurrence or non-occurrence of specific events or behaviors at treatment planning meetings. In the present study, two data collectors attended planning meetings and independently completed the WOF. The inter-rater reliability was 95%. The WOF appears to be a reliable instrument and be appropriate in evaluating wraparound services.