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Post-traumatic stress disorder (PTSD) after traumatic birth can have a debilitating effect on parents already adapting to significant life changes during the post-partum period. Cognitive therapy for PTSD (CT-PTSD) is a highly effective psychological therapy for PTSD which is recommended in the NICE guidelines (National Institute for Health and Care Excellence, 2018) as a first-line intervention for PTSD. In this paper, we provide guidance on how to deliver CT-PTSD for birth-related trauma and baby loss and how to address common cognitive themes.
Key learning aims
(1) To recognise and understand the development of PTSD following childbirth and baby loss.
(2) To understand how Ehlers and Clark’s (2000) cognitive model of PTSD can be applied to post-partum PTSD.
(3) To be able to apply cognitive therapy for PTSD to patients with perinatal PTSD, including traumatic baby loss through miscarriage or birth.
(4) To discover common personal meanings associated with birth trauma and baby loss and the steps to update them.
Adaptation to intimate partner violence (IPV) exposure involves alterations in transdiagnostic processes including effortful control (EC), and yet little attention has been given to the ways such processes interact with family-level factors, such as caregivers’ psychopathology. This study used latent change score modeling to compare trajectories of EC and caregivers’ depressive (CD) symptoms between children and adolescents (N = 365) ages 7–17 who had witnessed IPV (IPV+; 45.3%) and those who had not (IPV−) across 3 years. Findings suggested that IPV exposure moderated relationships between EC and CD. CD was higher and EC was lower for IPV+ relative to IPV− participants, although there was significant variation around mean-level CD and EC in both groups. CD and EC were only linked for IPV+ participants, where higher baseline CD was associated with lower EC that lagged behind IPV− participants’ EC across the 3 years of the study. Rates of change for CD significantly varied for the IPV+ group only, indicating that individual difference factors interacted with IPV exposure to influence changes in CD. These findings inform literature on transdiagnostic adaptation processes and point to the potential utility of interventions to reduce IPV and CD in supporting EC in children and adolescents across contexts.
Pregnancy is a time of increased vulnerability to psychopathology, yet limited work has investigated the extent to which variation in psychopathology during pregnancy is shared and unshared across syndromes and symptoms. Understanding the structure of psychopathology during pregnancy, including associations with childhood experiences, may elucidate risk and resilience factors that are transdiagnostic and/or specific to particular psychopathology phenotypes. Participants were 292 pregnant individuals assessed using multiple measures of psychopathology. Confirmatory factor analyses found evidence for a structure of psychopathology consistent with the Hierarchical Taxonomy of Psychopathology (HiTOP). A common transdiagnostic factor accounted for most variation in psychopathology, and both adverse and benevolent childhood experiences (ACEs and BCEs) were associated with this transdiagnostic factor. Furthermore, pregnancy-specific anxiety symptoms most closely reflected the dimension of Fear, which may suggest shared variation with manifestations of fear that are not pregnancy-specific. ACEs and BCEs also linked to specific prenatal psychopathology involving thought problems, detachment, and internalizing, externalizing, antagonistic, and antisocial behavior. These findings extend the dimensional and hierarchical HiTOP model to pregnant individuals and show how maternal childhood risk and resilience factors relate to common and specific forms of psychopathology during pregnancy as a period of enhanced vulnerability.
Surveys are a powerful technique in cognitive behavioural therapy (CBT). A form of behavioural experiment, surveys can be used to test beliefs, normalise symptoms and experiences, and generate compassionate perspectives. In this article, we discuss why and when to use surveys in CBT interventions for a range of psychological disorders. We also present a step-by-step guide to collaboratively designing surveys with patients, selecting the appropriate recipients, sending out surveys, discussing responses and using key learning as a part of therapy. In doing so, we hope to demonstrate that surveys are a flexible, impactful, time-efficient, individualised technique which can be readily and effectively integrated into CBT interventions.
Key learning aims
After reading this article, it is hoped that readers will be able to:
(1) Conceptualise why surveys can be useful in cognitive behavioural therapy.
(2) Implement collaborative and individualised survey design, delivery and feedback as part of a CBT intervention.
Therapist cognitions about trauma-focused psychological therapies can affect our implementation of evidence-based therapies for post-traumatic stress disorder (PTSD), potentially reducing their effectiveness. Based on observations gleaned from teaching and supervising one of these treatments, cognitive therapy for PTSD (CT-PTSD), ten common ‘misconceptions’ were identified. These included misconceptions about the suitability of the treatment for some types of trauma and/or emotions, the need for stabilisation prior to memory work, the danger of ‘retraumatising’ patients with memory-focused work, the risks of using memory-focused techniques with patients who dissociate, the remote use of trauma-focused techniques, and the perception of trauma-focused CBT as inflexible. In this article, these misconceptions are analysed in light of existing evidence and guidance is provided on using trauma-focused CT-PTSD with a broad range of presentations.
Key learning aims
(1) To recognise common misconceptions about trauma-focused CBT for PTSD and the evidence against them.
(2) To widen understanding of the application of cognitive therapy for PTSD (CT-PTSD) to a broad range of presentations.
(3) To increase confidence in the formulation-driven, flexible, active and creative delivery of CT-PTSD.
Childhood exposure to intimate partner violence (IPV) can have lasting effects on well-being. Children also display resilience following IPV exposure. Yet, little research has prospectively followed changes in both maladaptive and adaptive outcomes in children who experience IPV in early life. The goal of the current study was to investigate how child factors (irritability), trauma history (severity of IPV exposure), maternal factors (mental health, parenting), and early intervention relate to trajectories of behavior problems (internalizing and externalizing problems) and resilience (prosocial behavior, emotion regulation), over 8 years. One hundred twenty mother-child dyads participated in a community-based randomized controlled trial of an intervention for IPV-exposed children and their mothers. Families completed follow-up assessments 6–8 months (N = 71) and 6–8 years (N = 68) later. Although intention-to-treat analyses did not reveal significant intervention effects, per-protocol analyses suggested that participants receiving an effective dose (eight sessions) of the treatment had fewer internalizing problems over time. Child irritability and maternal parenting were associated with both behavior problems and resilience. Maternal mental health was uniquely associated with child behavior problems, whereas maternal positive parenting was uniquely associated with child resilience. Results support the need for a dyadic perspective on child adjustment following IPV exposure.
Around a quarter of patients treated in intensive care units (ICUs) will develop symptoms of post-traumatic stress disorder (PTSD). Given the dramatic increase in ICU admissions during the COVID-19 pandemic, clinicians are likely to see a rise in post-ICU PTSD cases in the coming months. Post-ICU PTSD can present various challenges to clinicians, and no clinical guidelines have been published for delivering trauma-focused cognitive behavioural therapy with this population. In this article, we describe how to use cognitive therapy for PTSD (CT-PTSD), a first line treatment for PTSD recommended by the National Institute for Health and Care Excellence. Using clinical case examples, we outline the key techniques involved in CT-PTSD, and describe their application to treating patients with PTSD following ICU.
Key learning aims
(1) To recognise PTSD following admissions to intensive care units (ICUs).
(2) To understand how the ICU experience can lead to PTSD development.
(3) To understand how Ehlers and Clark’s (2000) cognitive model of PTSD can be applied to post-ICU PTSD.
(4) To be able to apply cognitive therapy for PTSD to patients with post-ICU PTSD.
Research on producer willingness to adopt individual best pasture management practices (BMPs) is extensive, but less attention has been paid to producers simultaneously adopting multiple, complementary BMPs. Applications linking primary survey data on BMP adoption to water quality biophysical models are also limited. A choice-experiment survey of livestock producers is analyzed to determine willingness to adopt pasture BMPs. Sediment abatement curves are derived by linking estimates of producer responsiveness to incentives to adopt rotational grazing with a biophysical simulation model. Current cost share rates of $24/acre should yield a 12% decrease in sediment loading from pastures.
Background: The UK Department of Health Improving Access to Psychological Therapies (IAPT) initiative set out to train a large number of therapists in cognitive behaviour therapies (CBT) for depression and anxiety disorders. Little is currently known about the retention of IAPT CBT trainees, or the use of CBT skills acquired on the course in the workplace after training has finished. Aims: This study set out to conduct a follow-up survey of past CBT trainees on the IAPT High Intensity CBT Course at the Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London (KCL), one of the largest IAPT High Intensity courses in the UK. Method: Past trainees (n = 212) across 6 cohorts (2008-2014 intakes) were contacted and invited to participate in a follow-up survey. A response rate of 92.5% (n = 196) was achieved. Results: The vast majority of IAPT trainees continue to work in IAPT services posttraining (79%) and to practise CBT as their main therapy modality (94%); 61% have become CBT supervisors. A minority (23%) have progressed to other senior roles in the services. Shortcomings are reported in the use of out-of-office CBT interventions, the use of disorder-specific outcome measures and therapy recordings to inform therapy and supervision. Conclusions: Past trainees stay working in IAPT services and continue to use CBT methods taught on the course. Some NICE recommended treatment procedures that are likely to facilitate patients’ recovery are not being routinely implemented across IAPT services. The results have implications for the continued roll out of the IAPT programme, and other future large scale training initiatives.
We report an experimental study of photocarrier lifetime, transport, and excitation spectra in silicon-on-insulator doped with sulfur far above thermodynamic saturation. The spectral dependence of photocurrent in coplanar structures is consistent with photocarrier generation throughout the hyperdoped and undoped sub-layers, limited by collection of holes transported along the undoped layer. Holes photoexcited in the hyperdoped layer are able to diffuse to the undoped layer, implying (μτ)h ∼ 5 × 10−9 cm2/V. Although high absorptance of hyperdoped silicon is observed from 1200 to 2000 nm in transmission experiments, the number of collected electrons per absorbed photon is 10−4 of the above-bandgap response of the device, consistent with (μτ)e < 1 × 10−7cm2/V.
An excellent collection... breaks new ground in many areas. Should make a substantial impact on the discussion of the contemporary influence of Anglo-Saxon Culture. Conor McCarthy, author of Seamus Heaney and the Medieval Imagination
Britain's pre-Conquest past and its culture continues to fascinate modern writers and artists. From Henry Sweet's Anglo-Saxon Reader to Seamus Heaney's Beowulf, and from high modernism to the musclebound heroes of comic book and Hollywood, Anglo-Saxon England has been a powerful and often unexpected source of inspiration, antagonism, and reflection. The essays here engage with the ways in which the Anglo-Saxons and their literature have been received, confronted, and re-envisioned in the modern imagination. They offer fresh insights on established figures, such as W.H. Auden, J.R.R. Tolkien, and David Jones, and on contemporary writers such as Geoffrey Hill, Peter Reading, P.D. James, and Heaney. They explore the interaction between text, image and landscape in medieval and modern books, the recasting of mythic figures such as Wayland Smith, and the metamorphosis of Beowulf into Grendel - as a novel and as grand opera. The early medieval emerges not simply as a site of nostalgia or anxiety in modern revisions, but instead provides a vital arena for creativity, pleasure, and artistic experiment.
Contributors: Bernard O'Donoghue, Chris Jones, Mark Atherton, Maria Artamonova, Anna Johnson, Clare A. Lees, Sian Echard, Catherine A.M. Clarke, Maria Sachiko Cecire, Allen J. Frantzen, John Halbrooks, Hannah J. Crawforth, Joshua Davies, Rebecca Anne Barr
Four milking regimes using automatic cluster removers (ACR) were tested over a 19-week period, from mid to late lactation. Each treatment group consisted of 16 slow-milking cows. The milking regimes used were: an ACR setting of 200 ml/min (Control); raised ACR setting from 200 to 500 in steps of 100 ml/min (Raised ACR); raised ACR as above in conjunction with pre-milking teat stimulation (Raised ACR+Stim); and terminating the milking when an ACR threshold of 200 ml/min was reached or when a predetermined maximum milking duration was reached (Timer). All incremental treatments were applied in blocks of 6 or 7 weeks duration. ACR thresholds were raised from 200 to 500 ml/min without observed loss of milk production when compared with controls. However, even up to an ACR setting of 500 ml/min there was little reduction in the group milking duration even when used with teat stimulation. In contrast, the Timer treatment resulted in a 34% reduction of the maximum milking duration for the group without significant loss of milk yield. For all groups, including Control, strip yield was occasionally very high and highly variable. Willingness of cows to enter the milking platform, behaviour during milking, teat condition and incidence of mastitis were similar for all treatment groups. The results indicated that simple truncation of milking at a predetermined maximum duration could be a most potent and inexpensive method of milking a herd more quickly. Such a method could be employed by using a simple timer in any dairy regardless of the level of sophistication of the milking system.
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