Harriet J. Rosenberg

A Randomized Controlled Trial of Cognitive-Behavioral Treatment for Posttraumatic Stress Disorder in Severe Mental Illness

A cognitive-behavioral therapy (CBT) program for posttraumatic stress disorder (PTSD) was developed to address its high prevalence in persons with severe mental illness receiving treatment at community mental health centers. CBT was compared with treatment as usual (TAU) in a randomized controlled trial with 108 clients with PTSD and either major mood disorder (85%) or schizophrenia or schizoaffective disorder (15%), of whom 25% also had borderline personality disorder. Eighty-one percent of clients assigned to CBT participated in the program. Intent-to-treat analyses showed that CBT clients improved significantly more than did clients in TAU at blinded posttreatment and 3- and 6-month follow-up assessments in PTSD symptoms, other symptoms, perceived health, negative trauma-related beliefs, knowledge about PTSD, and case manager working alliance. The effects of CBT on PTSD were strongest in clients with severe PTSD. Homework completion in CBT predicted greater reductions in symptoms. Changes in trauma-related beliefs in CBT mediated improvements in PTSD. The findings suggest that clients with severe mental illness and PTSD can benefit from CBT, despite severe symptoms, suicidal thinking, psychosis, and vulnerability to hospitalizations.

Expressive disclosure and health outcomes in a prostate cancer population.

Objective: This pilot study explored the feasibility and the efficacy of a brief, well-defined psychosocial intervention (expressive disclosure) in improving behavioral, medical, immunological, and emotional health outcomes in men with diagnosed prostate cancer. Method: Thirty prostate cancer patients receiving outpatient oncology care were randomized into experimental (disclosure) and control (non-disclosure) groups. All had been previously treated by surgery or radiation within the last 4 years and were being monitored without further intervention for change in PSA levels. Psychological and physical health surveys were administered and peripheral blood for PSA levels and immune assays was obtained upon study enrollment and again at 3 and 6 months post enrollment. Multivariate analyses were used to examine how the expressive disclosure impacted the hypothesized domains of functioning: physical and psychological symptoms; health care utilization; and immunocompetence. Results: Compared to controls, patients in the expressive disclosure condition showed improvements in the domains of physical symptoms and health care utilization, but not in psychological variables nor in disease relevant aspects of immunocompetence. Conclusions: Study results support the feasibility of an expressive disclosure intervention for men with prostate cancer. The intervention was well accepted by this population, and participation/adherence was quite high. Results provide only limited support for the hypothesis that a written emotional disclosure task can positively impact health outcomes in a cancer population. However, this pilot study may have lacked adequate power to detect possible intervention benefits. Further studies with larger samples are needed to better assess the interventions impact on psychological well-being and immunocompetence.

A comparative study of trauma and posttraumatic stress disorder prevalence in epilepsy patients and psychogenic nonepileptic seizure patients.

Summary: Purpose: This study tests the hypothesis that trauma histories, including histories of physical and sexual abuse, and posttraumatic stress disorder (PTSD) are more prevalent in psychogenic non–epileptic seizure (NES) patients than in epilepsy patients.

The Relationship between Trauma, PTSD, and Medical Utilization in Three High Risk Medical Populations

Objective: Increased use of medical and psychiatric services has been reported as a correlate of exposure to trauma. Recent studies suggest that: 1) physical and sexual abuse traumas are particularly associated with increased utilization and 2) posttraumatic stress disorder (PTSD), a common sequela of abuse, mediates the relationship between trauma exposure and elevated utilization. The goal of this study was to explore the relationships between trauma, abuse, PTSD, and medical utilization in three medical help seeking groups reported to be at high risk for trauma exposure. Method: One hundred and seven patients receiving care at a university-affiliated medical center were surveyed for trauma history and PTSD using the Trauma History Questionnaire (THQ) and the PTSD Checklist (PCL). The sample included: forty-eight gynecologic outpatients, thirty-five inpatients with seizure disorders, and twenty-four psychiatric inpatients with non-PTSD admitting diagnoses. Medical utilization data were obtained from a computerized medical center data base. Results: Ninety-six patients reported a trauma history. Of these patients, sixty-six reported abuse and forty-five qualified for PTSD diagnoses. Total number of traumas and reported sexual and physical abuse correlated significantly with elevated medical utilization and PTSD prevalence. PTSD diagnosis was not significantly correlated with utilization, but the five highest utilizers received PTSD diagnoses. Conclusions: Study results supported hypotheses regarding the relation of trauma exposure to medical utilization, but were less clear about the mediating role of PTSD. These findings suggest that routine screening of high-risk patient groups might promote timely identification of trauma history and PTSD, and subsequently impact health care utilization.

A Clinical Trial Comparing Interviewer and Computer-Assisted Assessment Among Clients With Severe Mental Illness

OBJECTIVE Demographic, behavioral, and diagnostic information should routinely be collected from clients with severe mental illness, and data gathering should employ the most efficient techniques available. Surveys are increasingly conducted via Web-based computer-assisted interviewing (CAI), but this technique is not well validated for patients with severe mental illness. A randomized clinical trial of 245 clients was carried out to compare face-to face and computer-assisted interviewing (233 clients completed two surveys). METHODS Self-report data were collected on demographic characteristics, substance abuse, risk behaviors for blood-borne diseases, trauma history, and posttraumatic stress disorder. Each client was assessed twice and randomly assigned to one of the four possible combinations of interviewer and computer (computer and computer, N=53; computer and interviewer, N=56; interviewer and computer, N=59; and interviewer and interviewer, N=65). The two formats were compared on feasibility, client preference, cost, reliability, convergent validity, and criterion validity. RESULTS This study demonstrated the feasibility of CAI across a variety of inpatient and outpatient settings. All participants who began the CAI process completed the interview and responded to over 95% of the survey items. Participants liked using the computers as well as they liked face-to-face interviews, and they completed the CAI as quickly. CAI produced data as reliable and valid as face-to-face interviews produced and was less expensive, and results were available more quickly. The two formats were similar in criterion validity. CONCLUSIONS CAI appears to be a viable technology for gathering clinical data from the population with severe mental illness and for transforming such information into a useful, quickly accessible form to aid in clinical decision making.

The Midlife Crisis Revisited

Publisher Summary This chapter focuses on midlife crisis. It reexamines the concept, particularly as it emerged in the 1960s and 1970s in the social science literature. It also revisits a group of men and their families who were first studied in the early 1970s in an attempt to assess the impact of the midlife transition. Terms like “midlife crisis” and “male menopause” has been used by the so called “baby-boomers”, but they used to describe rather different narratives. Understanding midlife crises is most congruent with the specific narrative psychology perspective articulated by Gergen and Gergen. They argued that people must draw on basic narrative forms such as tragedy, romantic epic, or comedy to understand and represent their lives and, concomitantly, to reflect their identity or moral character. Midlife crisis contains a time-specific plot alteration that would characterize as a precipitant to a regressive movement—that is, movement toward a negative state.

Cognitive restructuring I: The common styles of thinking.

You might also like these other newsletters: Please enter a valid email address Sign up Oops! Please enter a valid email address Oops! Please select a newsletter We respect your privacy. Sometimes stress can lead to a chain reaction of thoughts that starts with a small, simple problem and leads to full-blown anxiety and panic over unrealistic fears. We all get ourselves worked up from time to time, but these irrational thoughts can cause undue stress. With cognitive restructuring , you can learn to control those thoughts, and not just stay positive, but be realistic, too. Cognitive restructuring, also called cognitive reframing, is a behavioral technique associated with cognitive therapy. Cognitive restructuring helps people to learn to think, and therefore, act, differently. Like most people, you probably get irritated, angry, frustrated, and anxious. You might worry about the possible ramifications at work, getting a late start on your day, or missing an important meeting. From those thoughts comes stress. You have two options: Is it worth all this stress? Instead, focus your energy on how to prevent getting stuck in traffic again and avoiding future stress. How to Change Your Thoughts Begin evaluating your thoughts and fears, and figure out if they are rational or irrational. Ask yourself these questions about your thoughts and fears: What is truly the worst possible outcome of this situation? Could this really harm me or my family? Am I looking at this situation correctly; what proof do I have of my fears? Can I really handle this situation even though I doubt myself? What can I do to change this situation? Start by writing your thoughts down on paper, and also note the facts that you know.

The Language of Sexual Abuse: An Exploratory Lexical Analysis

Abstract We sought to determine whether the psychological effects of sexual abuse systematically affect the language of abuse survivors. To accomplish this, we used a computerized lexical analysis system to compare the Rorschach responses of 30 female psychiatric inpatient abuse survivors with those of a matched group of female psychiatric inpatients with no abuse history. We then replicated the results in a holdout sample of 20 additional female inpatients. Our findings suggest that childhood sexual abuse has enduring and identifiable effects on the language of abuse survivors.