Grant James Devilly

Psychometric properties of the credibility/expectancy questionnaire

The present research evaluated the psychometric properties of the credibility/expectancy questionnaire, a quick and easy-to-administer scale for measuring treatment expectancy and rationale credibility for use in clinical outcome studies. The results suggested that this questionnaire derives the two predicted factors (cognitively based credibility and relatively more affectively based expectancy) and that these factors are stable across different populations. Furthermore, the questionnaire demonstrated high internal consistency within each factor and good test-retest reliability. The expectancy factor predicted outcome on some measures, whereas the credibility factor was unrelated to outcome. The questionnaire is appended to the paper, yet the authors stress care when utilizing the scale. During the administration of the questionnaire, the participant sees two sections--one related to thinking and one related to feeling. However, the researcher needs to be aware that the 2 factors derived are not grouped into those questions. Instead credibility was found to be derived from the first three think questions and expectancy was derived from the fourth think question and the two feel questions.

Australian guidelines for the treatment of adults with acute stress disorder and post-traumatic stress disorder

Over the past 2–3 years, clinical practice guidelines (CPGs) for post-traumatic stress disorder (PTSD) and acute stress disorder (ASD) have been developed in the USA and UK. There remained a need, however, for the development of Australian CPGs for the treatment of ASD and PTSD tailored to the national health-care context. Therefore, the Australian Centre for Posttraumatic Mental Health in collaboration with national trauma experts, has recently developed Australian CPGs for adults with ASD and PTSD, which have been endorsed by the National Health and Medical Research Council (NHMRC). In consultation with a multidisciplinary reference panel (MDP), research questions were determined and a systematic review of the evidence was then conducted to answer these questions (consistent with NHMRC procedures). On the basis of the evidence reviewed and in consultation with the MDP, a series of practice recommendations were developed. The practice recommendations that have been developed address a broad range of clinical questions. Key recommendations indicate the use of trauma-focused psychological therapy (cognitive behavioural therapy or eye movement desensitization and reprocessing in addition to in vivo exposure) as the most effective treatment for ASD and PTSD. Where medication is required for the treatment of PTSD in adults, selective serotonin re-uptake inhibitor antidepressants should be the first choice. Medication should not be used in preference to trauma-focused psychological therapy. In the immediate aftermath of trauma, practitioners should adopt a position of watchful waiting and provide psychological first aid. Structured interventions such as psychological debriefing, with a focus on recounting the traumatic event and ventilation of feelings, should not be offered on a routine basis.

A prospective longitudinal study of the prevalence of post-traumatic stress disorder resulting from childbirth events

BACKGROUND Childbirth has been linked to postpartum impairment. However, controversy exists regarding the onset and prevalence of post-traumatic stress disorder (PTSD) after childbirth, with seminal studies being limited by methodological issues. This longitudinal prospective study examined the prevalence of PTSD following childbirth in a large sample while controlling for pre-existing PTSD and affective symptomatology. METHOD Pregnant women in their third trimester were recruited over a 12-month period and interviewed to identify PTSD and anxiety and depressive symptoms during the last trimester of pregnancy, 4-6 weeks postpartum, 12 weeks postpartum and 24 weeks postpartum. RESULTS Of the 1067 women approached, 933 were recruited into the study. In total, 866 (93%) were retained to 4-6 weeks, 826 (89%) were retained to 12 weeks and 776 (83%) were retained to 24 weeks. Results indicated that, uncontrolled, 3.6% of women met PTSD criteria at 4-6 weeks postpartum, 6.3% at 12 weeks postpartum and 5.8% at 24 weeks postpartum. When controlling for PTSD and partial PTSD due to previous traumatic events as well as clinically significant anxiety and depression during pregnancy, PTSD rates were less at 1.2% at 4-6 weeks, 3.1% at 12 weeks and 3.1% at 24 weeks postpartum. CONCLUSIONS This is the first study to demonstrate the occurrence of full criteria PTSD resulting from childbirth after controlling for pre-existing PTSD and partial PTSD and clinically significant depression and anxiety in pregnancy. The findings indicate that PTSD can result from a traumatic birth experience, though this is not the normative response.

Statistical and reliable change with eye movement desensitization and reprocessing: Treating trauma within a veteran population

Fifty-one war veterans with posttraumatic stress disorder symptomatology were randomly allocated to one of three conditions: two sessions of eye movement desensitization and reprocessing (EMDR), an equivalent procedure without EMDR, or a standard psychiatric support control condition. There was an overall significant main effect of time from pre- to posttreatment, with a reduction in symptomatology for all groups. However, no statistically significant differences were found between the groups. Participants in the two treatment conditions were more likely to display reliable improvement in trauma symptomatology than subjects in the control group. By 6-month follow-up, reductions in symptomatology had dissipated and there were no statistical or reliable differences between the two treatment groups. Overall, the results indicated that, with this war veteran population, improvement rates were less than has been reported in the past. Also, where improvements were found, eye movements were not likely to be the mechanism of change. Rather, the results imply that other nonspecific or therapeutic processes may account for any beneficial effects of EMDR.

Vicarious Trauma, Secondary Traumatic Stress or Simply Burnout? Effect of Trauma Therapy on Mental Health Professionals:

Objectives: The aim of the present study was to perform an assessment for secondary traumatic stress (STS), vicarious trauma (VT) and workplace burnout for Australian mental health professionals involved in clinical practice. Methods: Recruited directly by mail, randomly selected participants were invited to submit a questionnaire by post or online. Of the 480 participants contacted, 152 mental health professionals completed the questionnaire, which contained measures of STS, VT and burnout. Results: Exposure to patients’ traumatic material did not affect STS, VT or burnout, contradicting the theory of the originators of STS and VT. Rather, it was found that work-related stressors best predicted therapist distress. Conclusions: These findings have significant implications for the direction of research and theory development in traumatic stress studies, calling into question the existence of secondary trauma-related phenomena and enterprises aimed at treating the consultants.

Ready! Fire! Aim! The Status of Psychological Debriefing and Therapeutic Interventions: In the Work Place and After Disasters

Psychological debriefing (PD) is a brief, short-term intervention aimed at mitigating long-term distress and preventing the emergence of posttraumatic stress. In recent years, it has become a ubiquitous intervention, one which has evolved as almost prescriptive following harrowing events and grew through a practical need to offer assistance to those who are exposed to severe trauma. Despite disturbing data from the recent refereed literature of psychology, it is still referred to as the “standard of care” for disaster and crisis response and its use in many quarters continues. This article critically reviews the evidence for and against its use and outlines the weaknesses in the research. The emphasis of this review is on the appropriateness of debriefing in organizations. This article also proposes a set of hypothesized constructs that may, in part, be responsible for the paradoxical effects found in some outcome studies on debriefing. Guidelines are also proposed to help organizations and professionals react appropriately using evidence-based interventions.

The effect of playing violent video games on adolescents: Should parents be quaking in their boots?

Abstract Debate regarding the psychological and behavioural effects of playing violent video games has recently led to claims that violent video games increase aggression effects in adolescents, and that this issue has now been settled. However, other researchers have found either no detrimental effects from game playing or even positive (cathartic) effects. In this research we demonstrate that these different conclusions are not mutually exclusive and can be explained by the method of assessment and analytic techniques utilised. We had adolescents play a violent video game (Quake II) and took measurements of anger both before, during and after game play. The results demonstrated that some people increase, some decrease and the majority show no change in anger ratings. Unlike past research, we also demonstrate that these changes are mediated by the players feelings immediately prior to game play and a labile temperament – one predisposed to aggression – and that these variables predict peoples reactions with an average 73% concordance rate.

Post-trauma debriefing: the road too frequently travelled

See page 766 The meta-analysis by Arnold van Emmerik and colleagues in todays Lancet about the efficacy of post-trauma psychological debriefing stands among the more potent entries in an increasing litany of reports, reviews, and consensus statements. The latest report raises significant concerns about this ubiquitous intervention. Despite limitations from poor data-quality and uneven design in the studies assessed, the analysis is consistent with those of other researchers, indicating that debriefing: (1) yielded no demonstrable effect on subsequent resolution of traumatic exposure and may inhibit or delay resolution for some participants; (2) showed a smaller effect than calculated for non-intervention controls, suggesting that natural proclivities toward resilience may be more potent than this style of intervention and (3) yielded lower effect-sizes than alternative interventions against which it was compared, raising the strong likelihood that other approaches are more likely to help. The findings echo and extend assessments of multiple randomised trials in Cochrane Collaboration reviews. 1 Although such meta-analyses have been criticised for lacking studies of group debriefing within the specific occupational settings in which the practice originated (rather than in traumatised individuals more generally), well-designed quasi-experimental field studies in those contexts have also yielded negative or equivocal findings, 2–4 which leaves the burden of proof about efficacy with proponents of debriefing. The implications for practice are unequivocal. Calls for caution and restraint have been heard from many responsible scientists and practitioners, 5–9 and are underscored in conclusions from consensus panels 10 and empirically-based practice guidelines that have recommended limitation 11,12 or contraindication. 13,14 But despite direct and publicised warnings from well-established researchers in trauma response and intervention, 15,16 reports from New York City after the attacks on the World Trade Center indicated that more than 9000 purveyors of debriefing and other popularised interventions—more than three counsellors for every person believed to have died in the attack—swarmed there, advocating intervention for any person even remotely connected to the tragedy. 17 Given the evidence, why should use of debriefing techniques not only persist but also seemingly flourish? Post-traumatic stress disorder is much debated. 18 Progressive dilution of both stressor and duration criteria has so broadened application that it can now prove difficult to diagnostically differentiate those who have personally endured stark and prolonged threat from those who have merely heard upsetting reports of calamities striking others. Moreover there are few systematic data about the normal course of resolution after traumatic exposure …

Psychological debriefing and the workplace: defining a concept, controversies and guidelines for intervention

Critical incident stress debriefing (CISD), a specific form of psychological debriefing, has gained widespread acceptance and implementation in the few short years since it was first proposed (Mitchell, 1983). However, there has been recent doubt cast on this practice and confusion regarding the terminology used. This article explores the claims frequently made by proponents regarding its use, counterclaims of ineffectiveness by its detractors, and general consensus regarding its specific use and the use of more generic psychological debriefing. We conclude that the recently introduced critical incident stress management (CISM) and its proposed progenitor, CISD, are currently poorly defined and relatively indistinct in the treatmentoutcome literature and should be treated similarly. Current expert consensus and meta-analytic reviews suggest that CISD is possibly noxious, generic psychological debriefing is probably inert and that more emphasis should be placed on screening for, and providing, early intervention to those who go on to develop pathological reactions. A set of generic guidelines for the minimisation and management of workplace traumatic stress responses is also proposed.

Childbirth and criteria for traumatic events

OBJECTIVE for some women childbirth is physically and psychologically traumatic and meets Criterion A1 (threat) and A2 (intense emotional response) for Posttraumatic Stress Disorder of the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV).This study differentiates Criterion A1 and A2 to explore their individual relationship to prevalence rates for posttraumatic stress, each other, and associated factors for childbirth trauma. DESIGN AND SETTING women were recruited at three hospitals from October 2008 to October 2009. Questionnaires were completed at recruitment and at 14 days post partum. PARTICIPANTS women in the third trimester of pregnancy (n=890) were recruited by a research midwife while waiting for their antenatal clinic appointment. Participants were over 17 years of age, expected to give birth to a live infant, not undergoing psychological treatment, and able to complete questionnaires in English. FINDINGS this study found 14.3% of women met criteria for a traumatic childbirth. When the condition of A2 was removed, the prevalence rate doubled to 29.4%. Approximately half the women who perceived threat in childbirth did not have an intense negative emotional response. Predictors of finding childbirth traumatic were pre-existing psychiatric morbidity, being a first time mother and experiencing an emergency caesarean section. KEY CONCLUSIONS the fear response is an important diagnostic criterion for assessing psychologically traumatic childbirth. The identification of risk factors may inform maternity service delivery to prevent traumatic birth and postpartum approaches to care to address long-term negative consequences. IMPLICATIONS FOR PRACTICE prevention and treatment of traumatic childbirth are improved through knowledge of potential risk factors and understanding the womans subjective experience.