Sara L. Dolan

Research on psychotherapy efficacy and effectiveness : Between scylla and charybdis?

Clinical researchers have recently begun to explore differences between psychotherapy outcome studies that focus on efficacy and those that focus on effectiveness. The authors provide concise descriptions of these research models, followed by more extended consideration of the most important conceptual and empirical distinctions between the two. Research on the efficacy/effectiveness distinction is then put into context: The common treatment variables that also influence treatment outcomes are reviewed. Fifty years of research on psychotherapy outcomes are next considered; contemporary research on the efficacy and effectiveness research models is emphasized. A description and evaluation of current efforts to heighten the value of technique-focused research to clinicians follow. The authors conclude by anticipating some promising future directions in this research domain.

Executive dysfunction as a risk marker for substance abuse: The role of impulsive personality traits†

The relationships between family history of substance use, executive functions, impaired decision making, and current substance dependence are the focus of this study. Thirty-eight substance-dependent inpatients were compared with 30 community controls on performance on the Wisconsin Card Sorting Test, Trail-Making Test-B, the Stroop Color Word Test, the Wais-II Digit Span, and the Iowa Gambling Task. Recent alcohol use, depressive symptoms, and impulsivity were also assessed. As hypothesized, individuals with substance dependence exhibited poorer executive functioning. Family history status was modestly related to impaired performance on tests designed to measure the integrity of the dorsolateral prefrontal cortex. In particular, substance-dependent, family history positive individuals performed less well on the Wisconsin Card Sorting Test than substance-dependent individuals without a family history. Digit Span performances were worse among family history positive controls when compared with family history negative controls. Impulsive personality traits--specifically, difficulty thinking before acting (Urgency)--were related, as hypothesized, to executive functioning. Results indicate that family history status confers an increased risk of impairment beyond that conferred by recent substance abuse, and that impulsive personality traits are related to performance on tests of executive functions. Implications for criminality are discussed.

Neuropsychological Sequelae of PTSD and TBI Following War Deployment among OEF/OIF Veterans

Posttraumatic stress disorder (PTSD) and mild traumatic brain injury (mTBI) are highly prevalent among Veterans of the conflicts in Iraq and Afghanistan. These conditions are associated with common and unique neuropsychological and neuroanatomical changes. This review synthesizes neuropsychological and neuroimaging studies for both of these disorders and studies examining their co-occurrence. Recommendations for future research, including use of combined neuropsychological and advanced neuroimaging techniques to study these disorders alone and in concert, are presented. It is clear from the dearth of literature that addiitonal studies are required to examine and understand the impact of specific factors on neurocognitive outcome. Of particular relevance are temporal relationships between PTSD and mTBI, risk and resilience factors associated with both disorders and their co-occurrence, and mTBI-specific factors such as time since injury and severity of injury, utilizing comprehensive, yet targeted cognitive tasks.

Deployment-related TBI, persistent postconcussive symptoms, PTSD, and depression in OEF/OIF veterans.

OBJECTIVE A substantial proportion of the more than 2 million service members who have served in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) have experienced a traumatic brain injury (TBI). Understanding the long-term impact of TBI is complicated by the nonspecific nature of postconcussive symptoms (PCSs) and the high rates of co-occurrence among TBI, posttraumatic stress disorder (PTSD), and depression. The goal of the present research was to examine the relations among TBI, persistent PCSs, and symptoms of PTSD and depression among returning OEF/OIF veterans. METHOD 213 OEF/OIF veterans (87% male) completed a semistructured screening interview assessing deployment-related TBI and current, persistent PCSs. Participants also completed self-report measures of combat exposure and current symptoms of PTSD and depression. RESULTS Nearly half (46%) of sampled veterans screened positive for TBI, the majority of whom (85%) reported at least one persistent PCS after removing PCSs that overlapped with PTSD and depression. Veterans with deployment-related TBI reported higher levels of combat exposure and symptoms of PTSD and depression. Structural equation modeling was used to assess the fit of 3 models of the relationships among TBI, combat exposure, persistent PCSs, PTSD, and depression. Consistent with hypotheses, the best-fitting model was one in which the effects of TBI on both PTSD and depression were fully mediated by nonoverlapping persistent PCSs. CONCLUSIONS These findings highlight the importance of addressing persistent PCSs in order to facilitate the functional recovery of returning war veterans.

Urge-Specific and Lifestyle Coping Strategies of Alcoholics: Relationships of Specific Strategies to Treatment Outcome

BACKGROUND The present study examined the efficacy of various specific lifestyle and situation-specific coping skills by determining the relationship of each of these strategies to drinking outcomes. METHODS Patients with alcohol dependence in intensive day treatment (n=165) were participating in a randomized trial of naltrexone versus placebo and adjunctive communication and coping skills training or a control treatment. The alcohol version of the Urge-Specific Strategies (USS) questionnaire and the General Strategies for Alcoholics (GSA) were administered early in treatment. The USS assesses 16 situation-specific strategies taught in cue exposure treatment, communication skills training, or relaxation/meditation training to cope with experiencing an urge to drink (e.g., think of positive and negative consequences of drinking, use mastery messages, engage in an alternative behavior); the 21-item GSA assesses lifestyle change strategies taught in communication skills training and in the general treatment program (e.g., keep busy, exercise regularly, attend 12-Step meetings, avoid high-risk situations). Alcohol use and frequency of use of the skills were assessed 6 and 12 months following treatment. RESULTS Many specific behavioral and cognitive coping strategies were significantly related to drinking outcomes, including 13 urge-specific and 18 general lifestyle strategies, while other strategies were unrelated. CONCLUSIONS Since some strategies taught in treatment are more effective in preventing relapse than others; treatment may be improved by focusing on these specific strategies. Since results may be limited to this population, replication is needed in more diverse settings and without medication.

A test of whether coping styles moderate the effect of PTSD symptoms on alcohol outcomes

Coping style may partially account for the frequent co-occurrence of posttraumatic stress disorder (PTSD) and alcohol-use disorder (AUD). We hypothesized that avoidant and action-oriented coping styles would moderate the association between PTSD symptom severity and alcohol outcomes among U.S. Operation Enduring Freedom/Operation Iraqi Freedom veterans, such that PTSD symptoms would be most strongly and positively associated with negative alcohol-related consequences and drinking quantity when action-oriented coping was low and avoidant coping was high. The sample (N = 128; 85.2% male, M = 37.8 years old, 63.3% Caucasian) completed a diagnostic assessment for PTSD and AUD and self-report surveys measuring coping styles, drinking quantity, and negative alcohol-related consequences. Consistent with the main hypothesis, a 3-way interaction among PTSD symptom severity, avoidant coping, and action-oriented coping was found in the predicted direction (d = 0.47-0.55). Post hoc descriptive analyses indicated that veterans with a current diagnosis of PTSD, low action-oriented coping, and high avoidant coping had worse alcohol outcomes and were twice as likely to meet criteria for current AUD compared with veterans with fewer risk factors. Findings suggest that the combination of PTSD and maladaptive coping styles may be more important for understanding alcohol-related outcomes than the presence of any of these variables in isolation.

Sleep quality affects cognitive functioning in returning combat veterans beyond combat exposure, PTSD, and mild TBI history.

Objective: The purpose of this study was to determine how sleep quality affects cognitive functioning in returning combat veterans after accounting for effects of combat exposure, posttraumatic stress disorder (PTSD), and mild traumatic brain injury (mTBI) history. Method: This was a cross-sectional assessment study evaluating combat exposure, PTSD, mTBI history, sleep quality, and neuropsychological functioning. One hundred and nine eligible male Iraq/Afghanistan combat veterans completed an assessment consisting of a structured clinical interview, neuropsychological battery, and self-report measures. Results: Using partial least squares structural equation modeling, combat experiences and mTBI history were not directly associated with sleep quality. PTSD was directly associated with sleep quality, which contributed to deficits in neuropsychological functioning independently of and in addition to combat experiences, PTSD, and mTBI history. Combat experiences and PTSD were differentially associated with motor speed. Conclusions: Sleep affected cognitive function independently of combat experiences, PTSD, and mTBI history. Sleep quality also contributed to cognitive deficits beyond effects of PTSD. An evaluation of sleep quality may be a useful point of clinical intervention in combat veterans with cognitive complaints. Improving sleep quality could alleviate cognitive complaints, improving veterans’ ability to engage in treatment.

Military Deployment of an Adult Child: Ambiguous Loss and Boundary Ambiguity Reflected in the Experiences of Parents of Service Members

ABSTRACT This study explored the experiences of parents of service members, military family members who are often overlooked even though they are likely a vital source of support for their military adult-children. Reflections on deployment of military adult-children were gathered from 21 parents in semistructured group interviews. A framework of ambiguous loss, boundary ambiguity, and ambivalence was used to analyze comments reflecting pre-deployment, deployment, and post-deployment experiences. Pre-deployment anticipation of leave-taking was associated with boundary ambiguity and ambivalence for parents, tempered by safety concerns. During deployment ambiguity in parental role expectations and parameters complicated parents’ attempts to manage physical absence and maintain psychological presence. Post-deployment challenged parents with ambiguous psychological presence and disruption of family boundaries, complicated by changes associated with the effects of war.

Hypnosis in the Treatment of Morgellons Disease: A Case Study

Abstract Morgellons Disease is a condition involving painful skin lesions, fibrous growths protruding from the skin, and subcutaneous stinging and burning sensations, along with symptoms of anxiety, depression, fatigue, and memory and attention deficits. The etiological and physiological bases of these symptoms are unclear, making the diagnosis controversial and challenging to treat. There are currently no established treatments for Morgellons Disease. The following case example depicts treatment of a woman with Morgellons Disease using hypnotherapy. Data from this case example suggest that hypnotherapy is a promising intervention for the physical and psychological symptoms associated with Morgellons Disease.

Neuropsychological functioning, coping, and quality of life among returning war veterans.

PURPOSE The present research tested the hypothesis that action- and emotion-focused coping strategies would mediate the relationship between neuropsychological functioning and quality of life among a sample of returning Iraq/Afghanistan veterans. METHOD Veterans (N = 130) who served as part of the wars in Iraq and Afghanistan completed a diagnostic assessment of PTSD, a battery of questionnaires assessing coping style, traumatic brain injury (TBI), and quality of life, and neuropsychological tests measuring attention, learning and memory, working memory, inhibition, executive control, and visual motor coordination. RESULTS Executive control, immediate and delayed verbal recall, and visual motor coordination were associated with quality of life. However, after controlling for the effects of combat exposure, PTSD, and probable TBI, no measure of neuropsychological functioning was directly associated with quality of life. Mediation analyses indicated that delayed verbal recall influenced quality of life through its effect on action-focused coping. CONCLUSIONS Although replication is needed, these findings indicate that delayed verbal recall may indirectly influence quality of life among Iraq/Afghanistan veterans through its association with action-focused coping strategies. Psychologists who are working with veterans that are experiencing memory difficulties and poor quality of life may consider focusing on improving coping skills prior to rehabilitation of memory deficits. (PsycINFO Database Record