Just Think About It: How Can Cognitive Therapy Contribute to the Treatment of Posttraumatic Stress Disorder?

[Clin Psychol Sci Prac 17: 128–133, 2010] As documented by the review by Hassija and Gray (2010 ), reports of the death of cognitive therapy (CT) for posttraumatic stress disorder (PTSD) are greatly exaggerated. CT has shown evidence of efficacy with adult PTSD comparable with that of prolonged exposure therapy (PE). The cognitive restructuring interventions provided by CT also are an integral component of evidence‐based PTSD psychotherapies, such as PE for adults and trauma‐focused cognitive‐behavior therapy for children and adolescents. Moreover, CT offers a “present‐centered” alternative to PTSD psychotherapy that can include, but does not require, trauma memory narrative disclosure. Inclusion of systematic approaches to not only changing thoughts but also enhancing thinking—i.e., self‐regulatory information processing—represents an important next step in the development of models of CT for PTSD.     

Self‐referential processing in adolescents: Stability of behavioral and ERP markers

The self‐referential encoding task (SRET)—an implicit measure of self‐schema—has been used widely to probe cognitive biases associated with depression, including among adolescents. However, research testing the stability of behavioral and electrocortical effects is sparse. Therefore, the current study sought to evaluate the stability of behavioral markers and ERPs elicited from the SRET over time in healthy, female adolescents (n = 31). At baseline, participants were administered a diagnostic interview and a self‐report measure of depression severity. In addition, they completed the SRET while 128‐channel ERP data were recorded to examine early (P1) and late (late positive potential [LPP]) ERPs. Three months later, participants were readministered the depression self‐report measure and the SRET in conjunction with ERPs. Results revealed that healthy adolescents endorsed, recalled, and recognized more positive and fewer negative words at each assessment, and these effects were stable over time (rs = .44–.83). Similarly, they reported a faster reaction time when endorsing self‐relevant positive words, as opposed to negative words, at both the initial and follow‐up assessment (r = .82). Second, ERP responses, specifically potentiated P1 and late LPP positivity to positive versus negative words, were consistent over time (rs = .56–.83), and the internal reliability of ERPs were robust at each time point (rs = .52–.80). As a whole, these medium‐to‐large effects suggest that the SRET is a reliable behavioral and neural probe of self‐referential processing.     

Sleep duration estimates of Canadian children and adolescents

The objective of this study was to provide contemporary sleep duration estimates of Canadian school‐aged children and adolescents and to determine the proportion adhering to the sleep duration recommendations. This study included 24 896 participants aged 10–17 years from the 2013/2014 Canadian Health Behaviour in School‐aged Children study (HBSC), a nationally representative cross‐sectional study. Bedtime and wake‐up times were reported by participants and their sleep duration was calculated. Participants were then classified as having a sleep duration that met the recommended range (9–11 h per night for 10–13‐year‐olds or 8–10 h per night for 14–17‐year‐olds), a sleep duration that was shorter than the recommended range or a sleep duration that was longer than the recommended range. An estimated 68% of children aged 10–13 years and 72% of adolescents aged 14–17 years sleep for the recommended amount per night when averaged across all days of the week. Short sleepers represent 31% of school‐aged children and 26% of adolescents. Long sleepers are rare (<2% overall). Children and adolescents sleep ~1 h more at weekends compared to weekdays. Approximately 5% of the participants typically went to bed after midnight on weekdays and 31% did so at weekends; these proportions reached 11 and 45%, respectively, within 16–17‐year‐olds. In general, differences in sleep times between boys and girls are small and not clinically significant. In conclusion, almost one‐third of Canadian children and adolescents sleep less than the recommended amount. Public health efforts should continue to monitor the sleep of Canadian children and adolescents and identify subgroups of the population more likely to be affected by insufficient sleep.     

What is the relationship between dissociation and self‐harming behaviour in adolescents?

Deliberate self‐harm in adolescents is an increasing clinical problem, but there is a limited understanding of the mechanisms causing or maintaining this behaviour. One proposed mechanism is that of dissociation. However, the role this mechanism may play is unclear: although some suggest that adolescents engage in self‐harm to end the aversive experience of dissociation, others propose that self‐harm is used to purposefully trigger a dissociative state to avoid emotional pain. This systematic review is the first to evaluate the available evidence regarding the relationship between dissociation and deliberate self‐harm in adolescents (aged 18 or younger). Nineteen relevant studies were identified. These studies were limited by cross‐sectional design and poor methods of measurement, but some important conclusions could be drawn. The majority of studies found a positive correlation between the severity of dissociation and the severity and frequency of deliberate self‐harm in adolescents, and a small number of results suggest that dissociation mediates the relationship between childhood trauma and adolescent self‐harm.     

Children's psychosocial functioning and parents' quality of life in paediatric short stature: The mediating role of caregiving stress

Objectives

On the basis of the multidimensional model of the caregiving process, this study aimed (a) to compare the levels of quality of life (QoL) and psychological problems of children with short stature and the levels of caregiving stress and QoL of their parents, between diagnostic, treatment, and current height deviation groups, and (b) to examine the direct and indirect links, via caregiving stress, between children's psychosocial functioning and their parents' QoL.

Method

The sample was collected in 5 European countries and comprised 238 dyads of 8‐ to 18‐year‐old children and adolescents with a clinical diagnosis of growth hormone deficiency or idiopathic short stature and one of their parents. The children completed self‐report measures of height‐related QoL (Quality of Life in Short Stature Youth Core Module) and psychological problems (Strengths and Difficulties Questionnaire); the parents reported on their own QoL (EUROHIS‐QOL‐8 Index) and caregiving stress (Quality of Life in Short Stature Youth Effects on Parents subscale).

Results

Children who were treated and who achieved normal height reported better QoL compared to those untreated and with current short stature. Parents of children with idiopathic short stature and current short stature presented greater caregiving stress than parents of children with growth hormone deficiency and achieved normal height. Children's better psychosocial functioning was indirectly associated with parents' better QoL, via less caregiving stress, and these links were invariant across diagnoses, treatment status, and current height deviation.

Conclusions

These results suggest that, along with growth hormone treatments, multidisciplinary interventions in paediatric endocrinology should be family‐centred, by targeting both the children's psychosocial functioning and the parents' stress, in order to improve individual and family adaptation.     

Differential performances on the WRAML in children and adolescents diagnosed with epilepsy,head injury,and substance abuse

Assessment of memory in children and adolescents has been limited because of the lack of standardized instruments available. The recently released Wide Range Assessment of Memory and Learning (WRAML; Sheslow & Adams, 1990) was used in this exploratory study to examine memory skills in children and adolescents with conditions affecting neuropsychological functioning. Diagnostic categories included epilepsy, traumatic brain injury, and substance abuse, as well as a nonneurological comparison group with psychiatric disturbance. Results indicated that children with epilepsy scored significantly below those with substance abuse or psychiatric disorders on the Verbal Memory Index. Within‐group comparisons suggested that all clinical groups had more difficulty with tasks that purportedly measure auditory attentional skills. Children with epilepsy demonstrated greater variability in memory performances, suggesting possible problems with both attention and memory factors. The WRAML appears to be a potentially useful assessment tool in the measurement of memory processes in children, although further research is needed concerning subtest specificity.     

Are qualitative and quantitative sleep problems associated with delinquency when controlling for psychopathic features and parental supervision?

The aim of this study was to explore the relationship between sleep, including both qualitative and quantitative aspects, and delinquent behaviour while controlling for psychopathic features of adolescents and parental supervision at bedtime. We analysed data from a nationally representative sample of 4855 Finnish adolescents (mean age 15.3 years, 51% females). Sleep problems, hours of sleep and delinquency were evaluated via self‐report. Psychopathic features were measured with the Antisocial Process Screening Device – Self‐Report. In negative binomial regressions, gender and sleep‐related variables acted as predictors for both property and violent crime after controlling for psychopathic features and parental supervision at bedtime. The results suggest that both sleep problems (at least three times per week, at least for a year) and an insufficient amount of sleep (less than 7 h) are associated with property crime and violent behaviour, and the relationship is not explained by gender, degree of parental supervision at bedtime or co‐occurring psychopathic features. These results suggest that sleep difficulties and insufficient amount of sleep are associated with delinquent behaviour in adolescents. The significance of addressing sleep‐related problems, both qualitative and quantitative, among adolescents is thus highlighted. Implications for a prevention technique of delinquent behaviour are discussed.     

Interpersonal mediators linking acculturation stressors to subsequent internalizing symptoms and self‐esteem in latino adolescents

The specific aim of this study was to examine pathways leading to internalizing symptoms and self‐esteem in Latino adolescents. Adolescent feelings of interpersonal humiliation, family conflict and commitment, and friendships with peers were investigated as potential mediators linking acculturation stress to subsequent adolescent self‐esteem and internalizing symptoms. Path analyses on data from a sample of 288 Latino adolescents (average age 15 years; 66% foreign‐born) showed that acculturation conflicts and perceived discrimination were risk factors for both internalizing problems at baseline and parent–adolescent conflict 6 months later. Baseline internalizing problems, and Time 2 variables (humiliation, parent–adolescent conflict, negative peer relationships, and changes in familism) mediated the effects of acculturation stress on Time 3 (T3) internalizing symptoms and self‐esteem. Latino cultural involvement was a key cultural asset, impacting T3 internalizing symptoms and self‐esteem by decreasing feelings of humiliation and by promoting familism. Familism was also a critical cultural asset associated with lower parent–adolescent conflict and higher self‐esteem. Study limitations and implications for practice with Latino families were discussed. © 2009 Wiley Periodicals, Inc.     

Sleep hygiene behaviours in Iranian adolescents: an application of the Theory of Planned Behavior

Poor sleep quality and inadequate sleep in adolescents are a rising trend globally. The Theory of Planned Behaviour (TPB)—which centres on an individual's attitude toward performing the behaviour, subjective norms and perceived behavioural control—has been applied to examine sleep hygiene behaviours in young adults. We expanded on prior works by using a longitudinal design to examine the effects of TPB factors, together with sleep hygiene knowledge and planning constructs, on sleep hygiene behaviours and on sleep quality and health in a group of Iranian adolescents. A total of 1822 healthy adolescents (mean age = 13.97) from 25 high schools in Qazvin, Iran, completed a self‐reported survey at baseline and 6 months later. Structural equation modelling (SEM) was used to delineate the pathway from adolescents’ sleep hygiene knowledge, TPB constructs of their behavioural intentions and sleep hygiene behaviours and their sleep quality and self‐reported health. The SEM model demonstrated that although behavioural intention, coping planning and action planning predicted the sleep hygiene behaviours positively 6 months later with acceptable model fit [comparative fit index (CFI) = 0.936; Tucker–Lewis index (TLI) = 0.902; root mean square error of approximation (RMSEA) = 0.080; standardized root mean square residual (SRMR) = 0.044], sleep hygiene knowledge did not predict behavioural intentions significantly. Sleep hygiene behaviours were associated with sleep quality and psychiatric wellbeing. Thus, the TPB, combined with coping and action planning, is useful in understanding the sleep hygiene behaviours of adolescents. Health‐care providers may want to emphasize TPB constructs and coping and action planning to improve adolescents’ sleep hygiene behaviours, rather than rely solely upon increasing adolescents’ sleep hygiene knowledge.     

In‐session behaviours and adolescents' self‐concept and loneliness: A psychodrama process–outcome study

As adolescents spend many hours a day in school, it is crucial to examine the ways in which therapeutic practices in schools promote their well‐being. This longitudinal pilot study examined the contribution of school‐based psychodrama group therapy to the self‐concept dimensions and perceived loneliness of 40 Israeli adolescents (aged 13–16, 60% boys) in public middle schools. From a process–outcome perspective, we also examined the understudied trajectory of adolescents' in‐session behaviours (process variables) and its associations with changes in their self‐concepts and loneliness (outcome variables). Psychodrama participants reported increases in global, social, and behavioural self‐concepts and a decrease in loneliness compared to the control group. In‐session productive behaviours increased and resistance decreased throughout the therapy, but varied process–outcome relationships were found. The study suggests that conducting further research into the process–outcome relationships in psychodrama group therapy is warranted to pinpoint specific mechanisms of change. Suggestions for future studies are provided.     

Self‐efficacy and future career expectations of at‐risk adolescents: The contribution of a tutoring program

Tutoring and mentoring programs may be a promisingintervention to help at‐risk children who may be in need of a positive influence in their lives. The purpose of the current study was to examine the contribution of tutoring to at‐risk adolescents’ self‐efficacy and future career expectations. Ninety‐eight tutees and 147 college student tutors completed the Self‐Efficacy Questionnaire for Children, the Work and Education subscale of the Future Expectations Scale for Adolescents, and a background questionnaire twice: first at the beginning and then toward the end of 8 months of tutoring. Both tutees and tutors reported higher levels of tutees’ social and emotional self‐efficacy as well as future expectations toward the end of the year. Tutors also reported higher levels of tutee academic self‐efficacy. Increased self‐efficacy was associated with increased levels of future expectations. Changes in academic and social self‐efficacy predicted changes in tutees’ future career expectations. Implications for theory and research are discussed.     

Perceived stress is associated with smaller hippocampal volume in adolescence

Perceived stress has been associated with decreased hippocampal, amygdala, and prefrontal cortex volume, as well as decreased memory and executive functioning performance in adulthood. Parents' perceived stress has been linked to decreased hippocampal volume in young children. However, no studies have investigated the links between self‐perceived stress and brain structure or function in adolescents. Additionally, findings from previous research with younger or older samples are inconsistent, likely in part due to inconsistencies in participants' age range. In this study, we investigated the associations among self‐perceived stress, family socioeconomic factors (family income, parental education), subcortical (hippocampus, amygdala) volumes, prefrontal cortical thickness and surface area, and memory and executive functioning performance in adolescents. One hundred and forty‐three participants (12–20 years old) were administered a cognitive battery, a questionnaire to assess perceived stress, and a structural MRI scan. Higher levels of perceived stress were associated with decreased adolescent hippocampal volume. This study provides empirical evidence of how experience may shape brain development in adolescence—a period of plasticity during which it may be possible to intervene and prevent negative developmental outcomes.     

The relationship between attachment strategies and psychopathology in adolescence

Aim: The majority of research investigating attachment and psychopathology has focused largely on children, and more recently adults. By comparison, few studies have considered the role of attachment on the development of psychopathology during adolescence. The scarcity of studies in this area is surprising given that adolescence is a critical period of psychological adjustment. This study investigates attachment patterns in adolescence and their relationship to symptomatology and interpersonal difficulties. Method: A two‐sample comparative design was employed so that a clinical group of adolescents were compared with a matched non‐clinical group, on attachment classifications (using a modified Separation Anxiety Test), reported interpersonal difficulties and clinical symptoms. Results: Significant differences were found between the clinical and non‐clinical groups on attachment classifications. Adolescents with ambivalent attachment patterns reported significantly more interpersonal difficulties and symptoms compared to young people classified as having secure and avoidant attachment classifications. The results are suggestive of specific differences in the way difficulties are reported. Conclusion: The findings are consistent with two strategies of affect regulation. It is proposed that a ‘hyperactivating’ strategy and a ‘deactivating’ strategy may be operating among those adolescents with ambivalent and avoidant attachment classifications, respectively. The implications of using self‐report measures in clinical work and for evidence‐based practice are discussed.     

Monitoring adherence to beclomethasone in asthmatic children and adolescents through four different methods

Background:  Suboptimal adherence to inhaled steroids is a known problem in children and adolescents, even when medications are administered under parental supervision. This study aimed to verify the adherence rate to beclomethasone dipropionate (BDP) by four currently available methods.
Methods:  In this concurrent cohort study, 102 randomly selected asthmatic children and adolescents aged 3–14 years were followed for 12 months. Adherence rate was assessed every 2 months by self and/or parent report, pharmacy dispensing data, electronic device (Doser^®; Meditrack Products, Hudson, MA, USA) monitor, and canister weight.
Results:  Mean adherence rates to BDP by self and/or parent report, pharmacy records, Doser, and canister weight were 97.9% (95% CI 88.0–98.6), 70.0% (95% CI 67.6–72.4), 51.5% (95% CI 48.3–54.6), and 46.3% (95% CI 44.1–48.4), respectively. Agreement analysis between (Doser) and canister weight revealed a weighted kappa equal to 0.76 (95% CI 0.65–0.87).
Conclusions:  Adherence was a dynamic event and rates decreased progressively for all methods over the 12-month follow-up. Canister weight and electronic monitoring measures were more accurate than self/parent reports and pharmacy records. Rates obtained by these two methods were very close and statistical analysis also showed a substantial agreement between them. As measurements by canister weight are less costly compared with currently available electronic devices, it should be considered as an alternative method to assess adherence in both clinical research and practice.     

Examining the nonkin support networks of orphaned adolescents participating in a family‐based economic‐strengthening intervention in Uganda

In this study, we examined the nonkin support networks of orphaned adolescents participating in a family‐based economic‐strengthening intervention in HIV‐impacted communities in Uganda. We analyzed data from a cluster randomized experimental study for orphaned adolescents aged 11–17 years. Participants were randomly assigned to either the control condition, which received bolstered standard of care (BSOC) services, or the treatment condition, which received BSOC services plus an economic‐strengthening intervention. We conducted binary logistic regression analyses to examine the effect of the intervention on participants’ nonkin support networks. Results indicated that the existing social support networks for orphaned adolescents are small, limited, and usually comprised individuals with similar socioeconomic situations and challenges. Because orphaned adolescents are socially isolated and the threshold for nonkin supportive services is very low, the BSOC services provided to the control condition appeared to be instrumental in their survival and well‐being. Availability of personal savings was associated with higher odds of identifying at least one supportive nonkin tie. The extended family system is still the primary and major source of social support to orphaned children in HIV‐affected communities. In the absence of public safety nets, building social assets, over and above offering economic opportunities to extended families supporting orphaned children, is critical.     

Empirically based comparisons of the reliability and validity of common quantification approaches for eyeblink startle potentiation in humans

Startle potentiation is a well‐validated translational measure of negative affect. Startle potentiation is widely used in clinical and affective science, and there are multiple approaches for its quantification. The three most commonly used approaches quantify startle potentiation as the increase in startle response from a neutral to threat condition based on (1) raw potentiation, (2) standardized potentiation, or (3) percent‐change potentiation. These three quantification approaches may yield qualitatively different conclusions about effects of independent variables (IVs) on affect when within‐ or between‐group differences exist for startle response in the neutral condition. Accordingly, we directly compared these quantification approaches in a shock‐threat task using four IVs known to influence startle response in the no‐threat condition: probe intensity, time (i.e., habituation), alcohol administration, and individual differences in general startle reactivity measured at baseline. We confirmed the expected effects of time, alcohol, and general startle reactivity on affect using self‐reported fear/anxiety as a criterion. The percent‐change approach displayed apparent artifact across all four IVs, which raises substantial concerns about its validity. Both raw and standardized potentiation approaches were stable across probe intensity and time, which supports their validity. However, only raw potentiation displayed effects that were consistent with a priori specifications and/or the self‐report criterion for the effects of alcohol and general startle reactivity. Supplemental analyses of reliability and validity for each approach provided additional evidence in support of raw potentiation.     

Emotional functioning among children with neurofibromatosis type 1 or Noonan syndrome

While neurofibromatosis type 1 (NF1) and Noonan syndrome (NS) are clinically distinct genetic syndromes, they have overlapping features because they are caused by pathogenic variants in genes encoding molecules within the Ras‐mitogen‐activated protein kinase signaling pathway. Increased risk for emotional and behavioral challenges has been reported in both children and adults with these syndromes. The current study examined parent‐report and self‐report measures of emotional functioning among children with NF1 and NS as compared to their unaffected siblings. Parents and children with NS (n = 39), NF1 (n = 39), and their siblings without a genetic condition (n = 32) completed well‐validated clinical symptom rating scales. Results from parent questionnaires indicated greater symptomatology on scales measuring internalizing behaviors and symptoms of attention deficit hyperactivity disorder (ADHD) in both syndrome groups as compared with unaffected children. Frequency and severity of emotional and behavioral symptoms were remarkably similar across the two clinical groups. Symptoms of depression and anxiety were higher in children who were also rated as meeting symptom criteria for ADHD. While self‐report ratings by children generally correlated with parent ratings, symptom severity was less pronounced. Among unaffected siblings, parent ratings indicated higher than expected levels of anxiety. Study findings may assist with guiding family‐based interventions to address emotional challenges.     

Extinction and drug‐induced reinstatement of cocaine seeking following self‐administration or conditioned place preference in adolescent and adult rats

Adolescence marks a particularly vulnerable period to developing substance use disorders, and people who start using drugs in adolescence are more likely to relapse. A limited number of studies have investigated age difference in relapse following re‐exposure to the drug after a period of abstinence. Using a cocaine self‐administration paradigm, we showed no age difference in acquisition or extinction of self‐administration. Interestingly, adolescent rats displayed impaired cocaine‐primed reinstatement of cocaine seeking. Using the same dose as that self‐administered in the first experiment, we then investigated age differences in acquisition and extinction of conditioned place preference, as well as locomotor sensitization. While there were no differences in locomotor activity or acquisition of preference, adolescents failed to extinguish their preference, even when the number of extinction sessions was doubled from what adults received. Taken together, these results suggest that while cocaine has similar rewarding and reinforcing effects regardless of age, adolescents may attribute stronger salience to the drug‐associated context. In addition, re‐exposure to cocaine itself may not be a strong relapse trigger in adolescence. Overall, these findings suggest that we should focus more on alleviating drug‐context salience compared to re‐exposure to substance in order to reduce relapse of drug seeking in adolescents.