Does Traumatic Brain Injury Attenuate the Exposure Therapy Process?

Research indicates that exposure therapy is efficacious for combat-related posttraumatic stress disorder (PTSD) comorbid with traumatic brain injury (TBI) as is shown by reduced PTSD treatment outcome scores. What is unknown, however, is whether the process of fear extinction is attenuated in veterans with TBI history. Increased PTSD symptomatology and possible cognitive deficits associated with TBI sequelae may indicate additional or longer exposure sessions to achieve habituation and extinction comparable to individuals without TBI history. As such, a more extensive course of treatment may be necessary to achieve comparable PTSD treatment outcome scores for individuals with TBI history. Using a sample of veterans with combat-related PTSD, some of whom were comorbid for TBI, this study compared process variables considered relevant to successful treatment outcome in exposure therapy. Individuals with and without TBI demonstrated similar rates of fear activation, length and number of exposure sessions, within-session habituation, between-session habituation, and extinction rate; results remained consistent when controlling for differential PTSD symptomatology. Furthermore, results indicated that self-perception of executive dysfunction did not impact the exposure process. Results suggest that individuals with PTSD and TBI history engage successfully and no differently in the exposure therapy process as compared to individuals with PTSD alone. Findings further support exposure therapy as a first-line treatment for combat-related PTSD regardless of TBI history.     

The Revised Memory and Behavior Problems Checklist--Nursing Home: instrument development and measurement of burden among certified nursing assistants

Confirmatory factor analysis of the Revised Memory and Behavior Problems Checklist--Nursing Home (RMBPC) replicated the factor structure of the community-based RMBPC (L. Teri et al., 1992). The reliability of the total score was high as indexed by estimates of internal consistency (alpha = .95), test-retest reliability (r = .86), and interrater reliability between 2 interviewers (r = .88). Notably, the interrater reliability between 2 independent certified nursing assistants (CNAs) regarding residents' behavior problem frequency was more modest (r = .46), possibly reflecting the degree to which resident behaviors capture individual CNA's attention. This may have implications for the interpretation of data from the Minimum Data Set. CNAs reported moderately severe burden associated with behavior problems in 47% of residents under their care.     

“I Didn’t Know It Existed Before You Called”: Protestant Clergy Experience, Education and Perceptions Regarding Genetics

Despite the intrinsic role religious/spiritual (hereafter, R/S) beliefs have in patient clinical decision-making and crisis coping, there is little research exploring the relationship that exists between clergy (professionals who provide R/S counsel and guidance) and genetic counseling patients. This qualitative, exploratory study was designed to explore Protestant clergy (N?=?8) perceptions of and experience with genetics-related issues. Data analysis revealed that a wide range of R/S perceptions regarding genetics-related issues exist within Protestantism, Protestant clergy have a basic understanding of genetic testing and conditions, and while directive counseling is inherent to Protestant clergy counseling, there appears to exist two opposing styles: unbiased and biased. Based on this information, there are two main implications for genetic counseling clinical practice. First, R/S assessments need to be increasingly implemented into genetic counseling sessions, so that the psychosocial needs of patients with specific R/S beliefs can be identified and addressed. An increase in R/S assessments may be accomplished by increased exposure in genetic counselor training, continuing education opportunities, and by establishing relationships with board-certified, professional chaplains. Second, genetic counselors can influence the genetic education and experience of clergy by raising awareness within their own R/S assemblies. Doing so can also serve to further educate genetic counselors in the R/S beliefs of their own traditions, thus increasing sensitivity, empathy and the quality of care provided.     

Further tests of Schmidt's schema theory: development of a schema rule for a coincident timing task

The present study investigated the generalizability of Schmidt's (1975) schema theory to an open-skill (Poulton, 1957) situation. Subjects attempted to time a preferred-hand button press so that it was coincident with the lighting of the last of a series of run way lights whose apparent velocity was 4023 mm/sec. Prior to five trials of performance on the criterion task, subjects received 40 trials in which they either (a) watched (low response requirements) or (b) responded with the nonpreferred hand (high response requirements) to a stimulus moving at (a) a constant (2235, 3129, 4917, or 5812 mm/sec) velocity (low stimulus variability) or (b) different velocities (high stimulus variability) from trial to trial. Subjects receiving high stimulus variability and high response requirements during training had significantly lower absolute error on the criterion task than did those in the other conditions. The results were discussed in terms of the type of practice which facilitates development of a schema rule for coincident-timing situations.     

Personal reflections: barriers and strategies in increasing diversity in psychology

In this article, six faculty and students of color who participated in a panel discussion at a symposium during the National Multicultural Conference and Summit of 2003 talk about the barriers they encountered and continue to encounter in their graduate training and places of employment. They also discuss strategies they found to be effective, enhancing, and positive and suggest other possibilities. The contributors describe their relationships with dominant-group and minority peers and talk about how issues of social class, disability, and sexual orientation as well as color have been part of their experience.     

Written prayers and religious coping in a paediatric hospital setting

Hospitalised children represent a threatened future to parents. Such stressors call forth people's coping styles. Some individuals cope religiously or spiritually, and religious coping through prayer may be utilised. A sample of prayers written in a paediatric hospital chapel was coded by styles of religious coping evident within them. Styles associated with coping to gain control of their situation and with coping by seeking comfort from God were present. Seeking to cope for gaining control of a situation was more common than seeking comfort from God during the event. Written prayers did not contain evidence of coping by making meaning. Regression analysis showed that the probability of writing a prayer to gain control decreased over time and a trend towards increasing probability of writing a prayer expressing coping by seeking God's comfort. Clinical implications are discussed. Future research should include a larger sample and cognitive interviews with prayer writers.     

Further Tests of Schmidt’s Schema Theory

The present study investigated the generalizability of Schmidt’s (1975) schema theory to an open-skill (Poulton, 1957) situation. Subjects attempted to time a preferred-hand button press so that it was coincident with the lighting of the last of a series of runway lights whose apparent velocity was 4023 mm/sec. Prior to five trials of performance on the criterion task, subjects received 40 trials in which they either (a) watched (low response requirements) or (b) responded with the nonpreferred hand (high response requirements) to a stimulus moving at (a) a constant (2235, 3129, 4917, or 5812 mm/sec) velocity (low stimulus variability) or (b) different velocities (high stimulus variability) from trial to trial. Subjects receiving high stimulus variability and high response requirements during training had significantly lower absolute error on the criterion task than did those in the other conditions. The results were discussed in terms of the type of practice which facilitates development of a schema rule for coincident-timing situations.