Kathleen M. Palm

Acceptance-Based Treatment for Smoking Cessation

This pilot study applied a theoretically derived model of acceptance-based treatment process to smoking cessation, and compared it to a pharmacological treatment based on a medical dependence model. Seventy-six nicotine-dependent smokers were randomly assigned to one of two treatments: Nicotine Replacement Treatment (NRT), or a smoking-focused version of Acceptance and Commitment Therapy (ACT). There were no differences between conditions at posttreatment; however, participants in the ACT condition had better long-term smoking outcomes at 1-year follow-up. As predicted by the acceptance process model, ACT outcomes at 1 year were mediated by improvements in acceptance-related skills. Withdrawal symptoms and negative affect neither differed between conditions nor predicted outcomes. Results were consistent with the functional acceptance-based treatment model.

Does Acceptance and Relationship Focused Behavior Therapy Contribute to Bupropion Outcomes? A Randomized Controlled Trial of Functional Analytic Psychotherapy and Acceptance and Commitment Therapy for Smoking Cessation☆

This study evaluated a treatment combining bupropion with a novel acceptance and relationship focused behavioral intervention based on the acceptance and relationship context (ARC) model. Three hundred and three smokers from a community sample were randomly assigned to bupropion, a widely used smoking cessation medication, or bupropion plus functional analytic psychotherapy (FAP) and acceptance and commitment therapy (ACT). Objective measures of smoking outcomes and self-report measures of acceptance and relationship processes were taken at pretreatment, posttreatment, 6-month, and 1-year follow-up. The combined treatment was significantly better than bupropion alone at 1-year follow-up with 7-day point prevalence quit rates of 31.6% in the combined condition versus 17.5% in the medication-alone condition. Acceptance and the therapeutic relationship at posttreatment statistically mediated 12-month outcomes. Bupropion outcomes were enhanced with an acceptance and relationship focused behavioral treatment.

Chronic Avoidance Helps Explain the Relationship Between Severity of Childhood Sexual Abuse and Psychological Distress in Adulthood

ABSTRACT Recent studies have found that chronic avoidance of unpleasant internal experiences (e.g., thoughts, emotions, memories) is a maladaptive means of affect regulation often adopted by women with a history of sexual victimization in childhood. The primary aim of this study was to replicate and extend previous findings suggesting that higher levels of experiential avoidance may account for the relationship between childhood sexual abuse (CSA) and psychological distress in adulthood. It was hypothesized that, in a sample of undergraduate females (n = 151), the relationship between severity of CSA (e.g., frequency, nature of victimization) and trauma-related psychological distress would be mediated by avoidance. Results supported this hypothesis. Findings are consistent with previous studies, and further suggest that the general tendency to avoid or escape from unpleasant internal experiences may be a specific factor that exacerbates psychological distress among women with a history of sexual victimization in childhood.

Vicarious Traumatization: Potential Hazards and Interventions for Disaster and Trauma Workers

Disaster and trauma workers often disregard their own reactions and needs when focusing on caring for those directly exposed to traumatic events. This article discusses the concept of vicarious traumatization, a form of post-traumatic stress response sometimes experienced by those who indirectly are exposed to traumatic events. It includes an examination of how vicarious trauma reactions are experienced across different professions, and suggestions on how to limit or prevent vicarious traumatization. The authors review self-care strategies as well as training and organizational considerations that may be beneficial for individuals and organizations to address.

Reaction to stressful life events: what predicts symptom severity?

This study examined the effect of Criterion A and non-Criterion A (as defined by the DSM-IV-TR) events on symptomatology related to Posttraumatic Stress Disorder (PTSD). Two hundred and forty-one college students completed a series of questionnaires related to symptoms of Posttraumatic Stress Disorder, psychological processes and psychopathology. Participants were divided into two groups: those that experienced a Criterion A traumatic life event as defined by the DSM-IV-TR, and those that experienced a non-Criterion A event. A chi-square analysis revealed a higher percentage of those with a Criterion A event meeting criteria for PTSD, although results indicated no differences on the overall severity of PTSD symptoms, or the re-experiencing, hyperarousal or avoidance subscales of PTSD symptoms between these two groups when time since event and distress were held constant. In a logistic regression analysis, the tendency to engage in thought suppression and level of distress were related to a diagnosis of PTSD, while type of event (Criterion A or non-Criterion A) was marginally related. Results are discussed in relation to ongoing discussion examining the description, classification and impact of a Criterion A event on PTSD symptoms, and the possible impact for treatment.

Evaluating Symptom Expression as a Function of a Posttraumatic Stress Disorder Severity

Little is known about the relative severity or typical sequence of Diagnostic and Statistical Manual (DSM-IV) symptoms of posttraumatic stress disorder (PTSD). Using data from the National Comorbidity Study-Replication (NCS-R) [Kessler, R. C., Berglund, P., Chiu, W. T., Demler, O., Heeringa, S., & Hiripi, E., et al. (2004). The US National Comorbidity Survey-Replication (NCS-R): design and field procedures. International Journal of Methods in Psychiatric Research, 13(2), 69-92], the current study used a logistic item response model to assess the degree to which DSM-IV symptoms combine to define a primary construct underlying PTSD, to identify which symptoms are associated with greater severity of PTSD, and to determine whether the symptoms and symptom patterns are influenced by gender. Results suggested that PTSD symptoms can be combined to assess a single dimension of PTSD severity, providing support for a continuum of symptom severity. However, several DSM-IV symptoms provided overlapping information, potentially reducing the effectiveness of these symptoms in describing a broad range of PTSD. More precise assessment of PTSD severity may help improve the descriptive value of PTSD measures relationship to continuous measures of treatment outcomes, and ultimately inform more effective treatments.

Sexual Victimization and Physical Health: An Examination of Explanatory Mechanisms

ABSTRACT There is a growing body of research illustrating a significant relationship between a history of sexual victimization and the development of physical health problems; however, few researchers have examined variables that mediate this relationship. The present study examined two potential mediating variables: experiential avoidance and current stress. Results indicated that current stress significantly mediated the relationship between adult sexual assault and physical health complaints, and experiential avoidance may be a partial mediator. Implications of the findings and future directions are discussed.

Smoking Characteristics of Adolescent Smokers With Post-traumatic Stress Disorder in a Psychiatric Inpatient Setting

Although there has been a gradual decline in adolescent smoking since the late 1990s, it continues to be a significant public health concern. Among adults, post-traumatic stress disorder (PTSD) seems to be a significant risk factor for increased smoking. This study examined smoking-related characteristics of adolescent smokers with and without PTSD receiving inpatient psychiatric services. In this study, we conducted structured clinical interviews with 191 adolescents (aged 13 to 17 years) who were hospitalized in an inpatient psychiatric facility. Results suggested that adolescent smokers with PTSD had higher nicotine dependence severity scores but were not more likely to meet criteria for nicotine dependence compared with those without PTSD. Future directions are discussed.