The efficacy of ‘debriefing’ after childbirth: Is there a case for targeted intervention?

To review the efficacy of debriefing interventions for reducing posttraumatic stress (PTS) and/ or depressive symptoms in postnatal women. Background: Techniques referred to as debriefing have been adapted for use within maternity care settings to prevent the development of PTS symptoms or depression. There is a requirement to disaggregate methods and approaches used by existing studies, rather than review the research as a whole, to identify elements that may contribute to an efficacious intervention and to clarify what is currently a confused position. Methods: Papers assessing the utility of providing a brief psychological intervention involving discussion of a birth with the mother and a professional, to reduce symptoms of PTS or depression, were reviewed. Discussions could be structured or unstructured, and involve any aspect of discussing the birth, responses and coping strategies. Results: Nine papers (eight studies) were reviewed. While the majority of studies reported findings indicating that debriefing was ineffective for reducing PTS or depressive symptoms, there was evidence indicating that targeted interventions (for women who experienced a traumatic birth) were efficacious. Conclusion: There may be potential utility in providing a debriefing intervention for women who perceive their childbirth experience to have been traumatic. A diversity of approaches termed ‘debriefing’ highlight a requirement to consider alternative terminology; the term ‘childbirth review’ is suggested as a useful alternative. Further research evaluating the efficacy of debriefing using a targeted approach for trauma perception is recommended

Interpretation of Physiological Indicators of Motivation: Caveats and Recommendations

Motivation scientists employing physiological measures to gather information about motivation-related states are at risk of committing two fundamental errors: overstating the inferences that can be drawn from their physiological measures and circular reasoning. We critically discuss two complementary approaches, Cacioppo and colleagues’ model of psychophysiological relations and construct validation theory, to highlight the conditions under which these errors are committed and provide guidance on how to avoid them. In particular, we demonstrate that the direct inference from changes in a physiological measure to changes in a motivation-related state requires the demonstration that the measure is not related to other relevant psychological states. We also point out that circular reasoning can be avoided by separating the definition of the motivation-related state from the hypotheses that are empirically tested

What are the characteristics of perinatal events perceived to be traumatic by midwives?

Objective: there is potential for midwives to indirectly experience events whilst providing clinical care that fulfil criteria for trauma. This research aimed to investigate the characteristics of events perceived as traumatic by UK midwives. Methods: as part of a postal questionnaire survey conducted between December 2011 and April 2012, midwives (n=421) who had witnessed and/or listened to an account of an event and perceived this as traumatic for themselves provided a written description of their experience. A traumatic perinatal event was defined as occurring during labour or shortly after birth where the midwife perceived the mother or her infant to be at risk, and they (the midwife) had experienced fear, helplessness or horror in response. Descriptions of events were analysed using thematic analysis. Witnessed (W; n=299) and listened to (H; n=383) events were analysed separately and collated to identify common and distinct themes across both types of exposure. Findings: six themes were identified, each with subthemes. Five themes were identified in both witnessed and listened to accounts and one was salient to witnessed accounts only. Themes indicated that events were characterised as severe, unexpected and complex. They involved aspects relating to the organisational context; typically limited or delayed access to resources or personnel. There were aspects relating to parents, such as having an existing relationship with the parents, and negative perceptions of the conduct of colleagues. Traumatic events had a common theme of generating feelings of responsibility and blame Finally for witnessed events those that were perceived as traumatic sometimes held personal salience, so resonated in some way with the midwife's own life experience Key conclusions: midwives are exposed to events as part of their work that they may find traumatic. Understanding the characteristics of the events that may trigger this perception may facilitate prevention of any associated distress and inform the development of supportive interventions

Outcomes of psychological therapies for prisoners with mental health problems: a systematic review and meta-analysis

Objective: Prisoners worldwide have substantial mental health needs, but the efficacy of psychological therapy in prisons is unknown. We aimed to systematically review psychological therapies with mental health outcomes in prisoners and qualitatively summarize difficulties in conducting randomized clinical trials (RCTs). Method: We systematically identified RCTs of psychological therapies with mental health outcomes in prisoners (37 studies). Effect sizes were calculated and meta-analyzed. Eligible studies were assessed for quality. Subgroup and metaregression analyses were conducted to examine sources of between-study heterogeneity. Thematic analysis reviewed difficulties in conducting prison RCTs. Results: In 37 identified studies, psychological therapies showed a medium effect size (0.50, 95% CI [0.34, 0.66]) with high levels of heterogeneity with the most evidence for CBT and mindfulness-based trials. Studies that used no treatment (0.77, 95% CI [0.50, 1.03]) or waitlist controls (0.71, 95% CI [0.43, 1.00]) had larger effect sizes than those that had treatment-as-usual or other psychological therapies as controls (0.21, 95% CI [0.01, 0.41]). Effects were not sustained on follow-up at 3 and 6 months. No differences were found between group and individual therapy, or different treatment types. The use of a fidelity measure was associated with lower effect sizes. Qualitative analysis identified difficulties with follow-up and institutional constraints on scheduling and implementation of trials. Conclusions: CBT and mindfulness-based therapies are modestly effective in prisoners for depression and anxiety outcomes. In prisons with existing psychological therapies, more evidence is required before additional therapies can be recommended

The Importance of Statistical Power When Testing for Independence in Animal Movements

No abstract is available for this item