Anger and predictors of drop-out from PTSD treatment of veterans and first responders.

Background: Drop-out is an important barrier in treating post-traumatic stress disorder (PTSD) with consequences that negatively impact clients, clinicians and mental health services as a whole. Anger is a common experience in people with PTSD and is more prevalent in military veterans. To date, no research has examined if anger may predict drop-out in military veterans or first responders. Aims: The present study aimed to determine the variables that predict drop-out among individuals receiving residential treatment for PTSD. Method: Ninety-five military veterans and first responders completed pre-treatment measures of PTSD symptom severity, depression, anxiety, anger, and demographic variables. Logistic regression analyses were used to determine if these variables predicted drop-out from treatment or patterns of attendance. Results: Female gender was predictive of drop-out. However, when analysed by occupation female gender was predictive of drop-out among first responders and younger age was predictive of drop-out in military participants. Anger, depression, anxiety and PTSD symptom severity were not predictive of drop-out in any of the analyses. No variables were found to predict attendance patterns (consistent or inconsistent) or early versus late drop-out from the programme. Conclusion: These results suggest that although anger is a relevant issue for treating PTSD, other factors may be more pertinent to drop-out, particularly in this sample. In contrast with other findings, female gender was predictive of drop-out in this study. This may indicate that in this sample, there are unique characteristics and possible interacting variables that warrant exploration in future research

Personal wellbeing in posttraumatic stress disorder (PTSD): Association with PTSD symptoms during and following treatment

© 2018 The Author(s). Background: It remains unclear to what extent treatment-related gains in posttraumatic stress disorder (PTSD) symptoms translate to improvements in broader domains of personal wellbeing, such as community connectedness, life achievement and security. We sought to determine whether: 1. personal wellbeing improves during the course of a treatment program and 2. changes in core symptom domains (PTSD, anxiety and depression) were associated with improvements in overall personal wellbeing. Methods: Participants (N=124) completed the PTSD Checklist, the Depression and Anxiety Stress Scales and the Personal Wellbeing Index at the start and end of a 4-week Trauma Focused CBT residential program, as well as 3- and 9-months post-treatment. Results: Personal wellbeing improved significantly across the 9-months of the study. Generalised estimating equations analyses indicated that (older) age and improvements in PTSD and depressive symptoms were independent predictors of personal wellbeing across time. Conclusions: Although personal wellbeing improved in tandem with PTSD symptoms, the magnitude of improvement was small. These findings highlight a need to better understand how improvements in personal wellbeing can be optimised following PTSD treatment

The Inter-Rater Consistency of Clinician Ratings of Posttraumatic Stress Disorder (PTSD) Therapy Content.

Effective communication between clinicians is essential for the success of mental health interventions in multidisciplinary contexts. This relies on a shared understanding of concepts, diagnoses and treatments. A major assumption of clinicians when discussing psychological treatments with each other is that both parties have a shared understanding of the theory, rationale and application of the respective technique. We aimed to determine to what extent there is inter-rater agreement between clinicians in describing the content of group therapy sessions. Pairs of clinicians, drawn from a large multidisciplinary team (13), were asked to provide ratings of the therapeutic content and emphasis of N = 154 group therapy sessions conducted during an intensive residential treatment program for post-traumatic stress disorder (PTSD). In most therapeutic content domains there was a moderate level of agreement between clinicians regarding session content (Cohen's Kappa 0.4 to 0.6), suggesting that clinicians have a broad shared understanding of therapeutic content, but that there are also frequent discordant understandings. The implications of these findings on multidisciplinary team communication, patient care and clinical handovers are discussed and directions for further research are outlined

Pathways to posttraumatic stress disorder.

Many descriptions and formulations of Post Traumatic Stress Disorder have presented trauma as an experience of intense threat-fear-terror that can (for some) cause lasting psychological injury. This does not capture the full range of traumatising experience that we see clinically and some people do not respond to treatments designed to address fear-threat-terror. We are therefore incorporating the growing literature on moral injury and the valuable model of psychosocial pillars into a more inclusive pathways model that highlights the significance of experiences of horror-shock-injustice-guilt in traumatic injury and the need for this to be accounted for in treatment. We believe that broadening our conceptualisation of PTSD in these ways will serve to better inform the provision of services for people with PTSD as well as help to articulate what clinicians have always implicitly understood

Conversation Among Primate Species

International audienceThe literature in psychology and sociolinguistic suggests that human interlocutors, when conversing, virtually sign a sort of contract that defines the exchange rules in both structural and social domains. These rules make the messages more understandable and the interaction more predictable, but they may also act as a social bond regulator. These rules can be very basic such as speech overlap avoidance, respect of response delays, turn-taking and vocal accommodation to the context and interlocutor’s social status. Interestingly, these rules are universally spread among human cultures questioning their biological basis and motivating the search for possible parallels with our primate cousins. Here, we will review the available literature on monkeys and apes. We will describe the different forms of vocal interactions, the temporal rules underlying these coordinated interactions, the non-random social selection of interlocutors and the context-dependent acoustic plasticity associated to these exchanges. The fact that primate species are socially varied, in terms of both social structure and social organisation, is another interesting aspect, since different social needs may predict different vocal interaction patterns and conversational rules. For example, duets, choruses and dyadic exchanges are not randomly distributed in the primate phylogeny and may even show different functions. Also, age proximity, kin membership, social affinity and hierarchy seem to play species-specific roles. Regarding plasticity, cases of vocal sharing and acoustic matching have been described in some species, notably in contact calls which are the calls the most frequently involved in dyadic exchanges. At last, a few studies also show that these ‘primitive’ conversational rules are often broken by juveniles and that the appropriate way to vocally interact with others may be socially learned, thus another aspect that do not seem strictly human