Michele A. Schottenbauer

Nonresponse and Dropout Rates in Outcome Studies on PTSD: Review and Methodological Considerations

Abstract Post-traumatic stress disorder (PTSD) represents a frequent consequence of a variety of extreme psychological stressors. Lists of empirically supported treatments for PTSD usually include cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR), but nonresponse and dropout rates in these treatments often are high. We review the treatment dropout and nonresponse rates in 55 studies of empirically supported treatments for PTSD, review the literature for predictors of dropout and nonresponse, discuss methodological inconsistencies in the literature that make comparisons across studies difficult, and outline future directions for research. Dropout rates ranged widely and may have depended, at least in part, on the nature of the study population. It was not uncommon to find nonresponse rates as high as 50%. Standard methods of reporting dropout and nonresponse rates are needed for reporting outcomes. We suggest guidelines for collecting data to help identify characteristics and predictors of dropouts and nonresponders.

Contributions of Psychodynamic Approaches to Treatment of PTSD and Trauma: A Review of the Empirical Treatment and Psychopathology Literature

Abstract Reviews of currently empirically supported treatments for post-traumatic stress disorder (PTSD) show that despite their efficacy for many patients, these treatments have high nonresponse and dropout rates. This article develops arguments for the value of psychodynamic approaches for PTSD, based on a review of the empirical psychopathology and treatment literature. Psychodynamic approaches may help address crucial areas in the clinical presentation of PTSD and the sequelae of trauma that are not targeted by currently empirically supported treatments. They may be particularly helpful when treating complex PTSD. Empirical and clinical evidence suggests that psychodynamic approaches may result in improved self–esteem, increased ability to resolve reactions to trauma through improved reflective functioning, increased reliance on mature defenses with concomitant decreased reliance on immature defenses, the internalization of more secure working models of relationships, and improved social functioning. Additionally, psychodynamic psychotherapy tends to result in continued improvement after treatment ends. Additional empirical studies of psychodynamic psychotherapy for PTSD are needed, including randomized controlled outcome studies.

Group Cohesiveness, Group-Derived Collective Self-Esteem, Group-Derived Hope, and the Well-Being of Group Therapy Members

I. D. Yalom’s (1995) hypothesis that group therapy cohesiveness is the precursor to the development of group-derived collective self-esteem (CSE), hope for the self (HS), and psychological well-being (personal self-esteem and depression) was tested. Participants were 102 university counseling center group therapy clients from process (n 54) and theme (n 48) groups. Path analyses supported Yalom’s theory that cohesiveness is the primary group factor and that it directly related to curative group factors such as CSE and HS. Additional path analyses showed that the relationship between group therapy CSE and personal self-esteem was moderated by HS, such that a significant relationship between CSE and personal self-esteem was no longer found once HS was entered into the model. Implications of these findings for research and practice are discussed. In his theory, Yalom (1995) described cohesiveness as the primary curative group factor in group therapy, arguing that it facilitated greater collective self-esteem (CSE), hope for the self, and well-being. He described cohesiveness as the “necessary precondition for effective therapy” (Yalom, 1995, p. 50), and he argued that the experience of being in a cohesive group enabled group members to engage in the necessary self-disclosure and the personal exploration that is the hallmark of effective therapy. Yalom (1995) specifically stated that cohesiveness was an agent of change in members’ lives through “the interrelation of group self esteem and self esteem” (Yalom, 1995, p. 107). He described the importance of group self-esteem, as do many group dynamic researchers, and he argued that cohesiveness alters personal self-esteem through acceptance and empathy from the group. Although Yalom did not directly define group self-esteem or cite the CSE literature, he described the importance of the development of group self-esteem, derived from cohesiveness and distinct from personal selfesteem. Yalom also theoretically linked the relationship between group therapy cohesiveness, group-derived self-esteem, and group-derived hope; however, there is little empirical support for the notion that cohesiveness is the primary group factor that facilitates the development of group self-esteem or hope. In addition, social psychologists have recognized the distinction between cohesiveness and group self-esteem, yet group therapy researchers have failed to empirically examine cohesiveness in relation to group self-esteem or group-derived hope.

Attachment and affective resolution following a stressful event: General and religious coping as possible mediators

The current study replicated and extended previous research on mediators of attachment qualities and outcome (affective resolution), including appraisal, coping, and religious coping. Structural equation models were used to analyze the responses on an Internet survey for a primarily Christian sample of 1,289 adults (416 men and 873 women). As expected, appraisal was a significant mediator of ambivalent attachment qualities and coping, as well as ambivalent attachment qualities and religious coping. Avoidance coping significantly mediated ambivalent attachment qualities and affective resolution; it also mediated avoidant attachment qualities and affective resolution. Fit indices for models were adequate only when differences between interpersonal and non-interpersonal events were taken into account. Substantial similarities were found in the relationships among variables for the two models examined, one including coping in general and the other including religious coping. Religious coping provided additional explanatory value to more secular models of coping in a highly religious sample. The implications for assimilating religious coping into mainstream coping research are discussed.

Computers, anxiety, and gender: an analysis of reactions to the Y2K computer problem

The current study investigated computer attitudes, anxiety, behavior, and gender in the context of a computer-related uncertain event with potentially far-reaching implications, the Y2K computer problem. Internet-based data collection resulted in a sample of 1500 participants who completed questionnaires on a research website. Path analyses showed that Y2K anxiety and preparations were significantly predicted by a number of variables, including computer anxiety and negative attitudes toward computers, trait anxiety, and gender. Trait anxiety significantly predicted computer anxiety and negative attitudes toward computers. Gender significantly predicted Y2K anxiety, trait anxiety, and computer anxiety, but indirect effects of gender on Y2K anxiety as mediated by the other variables were not significant, suggesting that womens higher levels of trait and computer anxiety did not explain their greater Y2K anxiety. The path model with the best overall fit included computer anxiety predicting negative attitudes computers rather than vice versa. Implications for interventions aimed at reducing situation-specific computer anxiety are discussed, including the importance of targeting anxiety directly, not just negative thoughts about computers.

Relationship between family religious behaviors and child well-being among third-grade children

While there is growing empirical evidence that religion can have a positive impact on the health and well-being of adults and adolescents, less is known about its influence on the welfare of children. The current paper examined the relative importance of family religiosity and religious behaviors on multiple measures of childrens well-being (general health, academic achievement, social skills, and behavior problems) and sought to identify whether religious variables contribute above and beyond non-religious measures of family caregiving. Parent use of religious coping and family religious behaviors, the latter defined as attendance at religious or spiritual programs, predicted several aspects of child well-being above and beyond parenting styles. Parental religious coping significantly predicted child social skills and externalizing behaviors above and beyond parenting styles. Family religious service attendance significantly predicted child health and social skills, and inversely predicted internalizing behaviors, above and beyond both parenting styles and parent use of religious coping.

Religious coping research and contemporary personality theory : An exploration of Endler's (1997) integrative personality theory

Notable weaknesses in the literature on religion and mental health include theoretical inconsistencies and lack of integration with contemporary personality theory. The current study explored a potential solution to these theoretical limitations. A modified form of Endlers (1997) interactive model of personality was applied to the prediction of religious coping and tested using structural equation modelling. As predicted by the model, personality dispositions predicted coping directly, as well as indirectly through perception of the situation and situational anxiety. These patterns were, as expected, found to interact with the type of situation. Results indicated that having a positive disposition appears to buffer ones negative perceptions of situations over which one has little control. Participants tended to use more religious coping in low-control situations; in high-control situations, participants tended not to use negative religious coping techniques such as pleading for miracles.

Psychotherapy integration as practiced by experts.

Twenty-four psychotherapists who were experts in psychotherapy integration and had a mean of 32 years of clinical experience completed a questionnaire assessing their practice history and fidelity to various psychodynamic, cognitive-behavioral, humanistic, and family systems theories. They then completed the 100-item Psychotherapy Process Q set (Jones, Hall, & Parke, 1991) modified to be a self-report questionnaire, based on a client they had treated using integrative therapy. Most therapists reported some influence of all 4 orientations, but almost three-quarters indicated that only 1 was a salient influence. Principal components factor analysis revealed 4 factors representing 4 integrative practice styles, which were then correlated with prior prototypes of cognitive-behavioral, psychodynamic, and interpersonal therapies. The first factor, accounting for just over half the variance, most resembled cognitive-behavioral therapy. The second factor shared elements of several orientations, whereas the third factor most resembled psychodynamic therapy. The responses of more than half the therapists loaded on more than 1 factor. Findings demonstrate a diversity of theoretical influences and practices among these experts. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

The Spanish Version of the Draw-A-Person Questionnaire (DAPQ).

The present study evaluates the discriminating ability and psychometric properties of the Spanish version of the Draw-A-Person Questionnaire (DAPQ). The DAPQ is an instrument that uses both free-response and fixed-response methodologies and has been recently translated into Spanish. A group of 60 psychiatric patients of Latin American origin is compared to a sample of matched Latino comparison participants. Participants are closely matched by gender, age, education level, and perceived ethnic identification. The results on the Spanish version of the DAPQ are similar to those of the English version. The Spanish DAPQ is able to differentiate psychiatric inpatients from a normal comparison group. The psychiatric group has significantly more negative scores and more socially undesirable answers when describing their figures than the matched sample does.

Attachment, Well-Being, and Religious Participation Among People with Severe Mental Disorders

SUMMARY Traditional mental health models have frequently asserted that religious participation among those individuals with severe mental disorders is either harmful or a manifestation of their illness. Newer research, however, has found that this is not always the case. The current study examined the relationship between attachment states of mind and religious participation among a sample of consumers diagnosed with severe mental illness at a community mental health agency. We found a correspondence between attachment states of mind and participation in religious activities. Specifically, consumers who preferred interpersonal closeness with others reported a higher frequency of prayer, church service attendance, and scripture reading than those who preferred interpersonal distance. Our results suggest that people who prefer a particular interpersonal distance from humans also maintain a similar relationship with their God-object.