A Meta-Analysis of the Effectiveness of Military and Veterans Affairs (VA) Combat-Related PTSD Programs

A meta-analysis was conducted to examine the effectiveness of 55 treatment outcomes reported by military and Veterans Affairs (VA) treatment centers for combat-related posttraumatic stress disorder (PTSD). The analysis includes 46 tested treatment outcomes derived from 21 psychotherapy studies, and nine tested treatment outcomes derived from seven pharmacotherapy studies, which were obtained through PsychINFO and PsychARTICLES database searches, as well as a reference search. Analysis of all treatment outcomes suggested a statistically significant, and meaningful, decrease in PTSD symptoms between baseline and post-treatment time points, t(54) = 9.27, p < .001, d = 0.35. Additionally, analysis of outcomes between psychotherapy and pharmacotherapy treatments resulted in statistically significant differences in PTSD assessment scores at post-test, indicating a greater degree of change for psychotherapy than for pharmacotherapy.

The Importance of the First Psychotherapy Case in the Development of the Therapist's Professional Self as Viewed Through the Lens of Self Psychology

This paper explores the gap in the literature between what is herein referred to as the "first psychotherapy case" and its impact on the development of the trainee psychotherapist's professional self. The self psychology concepts of identity development, selfobject needs and fulfillment, narcissism, shame, countertransference, and structuralization are incorporated into the theoretical framework from which this developmental milestone is viewed. The theory's emphasis on early experiences and the development of self highlight the distinctiveness of the first case for the therapist. The beginning psychotherapy case poses a unique context for selfobject experiences and the developing self, involving both the therapist's presumably mature needs (assuming an existing cohesive nuclear self) and more infantile needs as the professional, peripheral self develops. As a result, the potential and important implications for the psychotherapist, the patient, training implications for the supervisor, and the ensuing treatment through termination are identified. The intent is to shed light on an area that is understudied thus far, and to begin a conversation as to why and how the impact of the first case on the psychotherapist should be examined. Implications, limitations, and ideas for future exploratory and qualitative research are also discussed.

The Experiences of American Indian Women Warriors

This article examines the unique experiences of American Indian (AI) female veterans through a generalized qualitative study. Revealed in this study were interesting cultural insights regarding a concentrated, yet largely misunderstood, population within the U.S. military. For this study, six participants were interviewed and data were analyzed to identify common experiences of AI female veterans. The analyses revealed unique roles assumed during military service, a strengthening of cultural values, identity development, and personal empowerment as a result of AI women having served in the military. Discussion, implications, and limitations of this study are also described.

An Acceptance and Commitment Approach to Issues of Behavioral Health Care in Soldiers

For over a decade, the U.S. military has been engaged in two distinct, yet equally deadly conflicts: Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). There are many physical and psychological effects of war necessitating the activation and interventions of a myriad of behavioral health professionals. The purpose of the paper was to understand how and if contemporary military culture may work to support or hinder application of an Acceptance and Commitment Therapy (ACT) approach to issues of psychological health among Soldiers. While the empirical research on efficacy with Soldiers is limited, a review of military culture revealed the promotion of rigid rule following, although effective in combat, influences the emotional control agenda and stigma while in garrison. However, empirical research demonstrating the clinical benefits and flexibility of ACT is rapidly emerging with civilian and Veteran populations. Suggested as a prevention technique utilized early in Soldier's training to increase psychological flexibility, ACT appears to demonstrate much promise in ameliorating the psychological consequences of war.

An Evaluation of Sport Psychology Service Delivery in Collegiate Athletics

Sport and Performance Psychology is an ever-evolving specialty. While its development continues, it has not been without its challenges. Sport and performance psychologists work in a variety of settings and often come from similar, yet inherently different, training backgrounds. Individuals from both sport sciences and psychology have made compelling arguments as to which approach provides quality services to their respective clients. The question that remains, however, is what are these quality services? Who are the clients and what do they need from professionals in the field?Collegiate student athletes inherently face a number of typical issues related to their age and development. They also face a number of atypical difficulties as a result of their status as student athletes. As such, they provide an adequate sample of potential presenting issues for sport and performance psychologists. This current study utilized a qualitative, exploratory method to evaluate the presenting issues that brought clients to seek services from professionals.This paper seeks to establish a foundation for the development of a theoretical basis of the psychology of human performance, including both performance and general mental health concerns, and how sport and performance psychologists can most effectively intervene in this process. This paper is based on an analysis of seven years of service delivery within a NCAA Division I athletic department.Results indicate that collegiate student athletes seek services related to performance enhancement and general mental health at relative equal frequency. As such, training and service delivery in both areas would be most beneficial and best serve this population.  

Back in Blue: The Successful Reintegration of Combat Veteran Law Enforcement Officers.

In the past ten plus years, several million national guard and reserve component military personnel have been deployed in support of the global war on terrorism. Tens of thousands of those personnel also serve as full-time law enforcement officers in police and sheriff's offices around the country. Life as a law enforcement officer is tough enough, but when combined with the psychological baggage brought on by months of war, reintegrating into civilian life and the role of a law enforcement officer can be extremely difficult. This article discusses a reintegration program specifically for law enforcement agencies that is designed to promote long-term psychological and social health in combat veteran officers. The program's costs are offset by the many assets (leadership, tactical training, etc.) these men and women bring to the department. By committing to the long-term successful reintegration of these individuals, departments enhance their own forces and improve community safety.

Multicultural education in Clinical Psychology Programs and the needs of racial minority trainees.

With more racial minorities entering the field of clinical psychology, the training needs of racial minority students in doctoral programs must be considered. Few studies address training in multicultural education from the perspective of racial minority students despite their increasing presence in the field. This may be due to assumptions educators make based on their level of competency in the area of multiculturalism. Thus, the goal of this exploratory study is to help determine the multicultural training needs of racial minorities enrolled in clinical psychology programs. This exploratory study was quantitative and used snowball sampling to survey racial minority trainees in doctoral programs in clinical psychology. Sixty one participants completed the survey. Results indicated that multicultural/diversity classes are valued by racial minority students and are relevant to them. However, the majority of students do not feel challenged, suggesting that their needs are not being fully met. It is recommended that their unique needs be included in the curriculum for multicultural education.

Utilizing Evidence-Based Psychology Practice in the University of Denver's Professional Psychology Center: A Proposal

As acceptance of the Evidence-based Psychology Practice (EBPP) model continues to grow (Pagoto, Spring, Coups, Mulvaney, Coutu, & Ozakinci, 2007), it seems pertinent to explore how this model can be applied in different settings. This topic is timely as practitioners in the field are being held ever more accountable for the efficacy of the treatments they employ (Pagoto et al., 2007). Increased scrutiny has resulted in a need to integrate research into practice in order to ensure continued relevance in the ever-changing realm of American health care (Luebbe, Radcliffe, Callands, Green & Thorn, 2007; Collins, Leffingwell & Belar, 2007; Chwalisz, 2003). This paper explores how the requirements set forth by the American Psychological Association Presidential Task Force on Evidence-Based Practice (2006) can be implemented at the University of Denver's (DU) Professional Psychology Center (PPC), a training clinic for students enrolled in the Psy.D. program at DU's Graduate School of Professional Psychology (GSPP). In doing so, the methods employed by Collins et al. (2007) at Oklahoma State University (OSU) are used as a template and modified to accommodate differences between these two institutions.

The Perpetration of Spousal Abuse by Male Combat Veterans: Recommendations for Individualized Group Domestic Violence Treatment for Veterans

Recent estimates suggest that spousal abuse is, in fact, on the rise in the U.S. military (The Miles Foundation, 2005). As research specific to the impact of posttraumatic stress disorder (PTSD) on U.S. soldiers has grown since the Vietnam War, clinicians and researchers have begun to investigate how combat-related trauma affects veterans in terms of aggression, hostility and social/emotional functioning. The training and stressors experienced by soldiers in the military are unique and affect all aspects of the veteran's functioning. This paper discusses questions related to why combat veterans may be at increased risk to commit spousal abuse (verbal, psychological, and physical), the relationship between PTSD, substance use, and violence, and the advantages to individualizing group domestic violence (DV) treatment programs for combat veterans. Recommendations will be made for a DV treatment program specifically for combat veterans who also suffer from PTSD.

Understanding Mastectomy from a Self Psychology Perspective: The Breast as a Self Object

For many women, if not all, breasts are an important component of bodyself-image; a woman may love them or dislike them, but she is rarely neutral" (Young, 2003, p.152). Breast cancer may be one of the oldest forms of cancer known to humans (American Cancer Society, 2010), and in 2008 in the United States over 182,000 women and almost 2,000 men were diagnosed with some form of breast cancer (American Cancer Society, 2008). In that same year 40,480 women and 450 men died from the disease. While any type of cancer diagnosis can instill a fear of mortality and incapacitation in the recipient, breast cancer holds a special meaning for women because of the significance placed on the breast both personally and societally. Removal of the breast tissue and muscle, or mastectomy, remains one of the primary forms of treatment for this disease. The breast plays an important role in a woman's identity, and the loss of one or both breasts due to breast cancer can have a monumental impact on her sense of self. A mastectomy affectsnot only a woman's relationship with herself, but with her family, friends, and society. It changes her outlook on life, her perception of her roles in the world, and her interest in interacting with others. Exploring these issues is important to understanding how doctors, nurses, mental health professionals, family members and support networks can best assist patients in coping with their illness. This paper attempts to understand the psychological issues and injuriesassociated with mastectomy through the lens of Self Psychology. It postulates that the breast itself is a selfobject for most women, and that its loss results in the fragmentation of the self. I will focus particularly on women between the ages of 25 and 40 years of age, in the marital and parental phases of developmental (Wolf, 1988), as the effect of a mastectomy on body image, sexuality, and genderbased roles such as motherhood has been shown to differ according to the age of the patient, with younger patients experiencing more distress (Ashing-Giwa et al, 2004).

I'm Not Who I Thought I Was: A Contextual Resolution to the Identity Loss of Combat PTSD.

Given the historical rates of combat post-traumatic stress disorder (PTSD), one can expect 30% of soldiers returning from current military conflicts to suffer from PTSD. For these individuals, various cognitive behavioral therapies (CBT) are the most commonly employed treatments. Unfortunately, however, symptom relapse can be expected with the various CBT approaches, as traumatic memories remain. Soldiers are imbued with a militarized identity, and the identity loss experienced by those soldiers who suffer from PTSD is particularly painful for this population, as the militarized identity effectively disavows personal suffering. For this reason, many combat veterans diagnosed with post-traumatic stress disorder experience undue, prolonged suffering as they struggle to make sense of the different person they fear they have become. This paper contrasts certain versions of Western philosophy, which view the self as a fixed and reified entity with certain versions of Eastern philosophy, which view the self as more contextual and fluid, in order to illuminate the value of employing third wave behavioral treatments, specifically Acceptance and Commitment Therapy (ACT), to treat the identity loss experienced by military veterans with PTSD. ACT echoes the Buddhist principle that attachment to verbally-constructed conceptual notions of self contribute to undue suffering, and that more vital living can be achieved by assuming a more contextual and experiential perspective on identity. Research and anecdotal accounts are cited to illustrate why treatment for identity loss associated with combat PTSD should be less focused on reconstructing a historically substance-oriented self and more focused on an epistemological reorientation to a deconstructed, contextual self.

Applying Positive Psychology in Early Childhood.

The purpose of this paper is to introduce a framework for applying positive psychology in elementary classrooms. The target age group is children in grades K-3 (ages 5 to 8) because this age group can benefit the most from an early introduction to strategies that promote positive development (Cowne & Hightower, 1989; White, 1996). The following sections will: (a) introduce constructs of positive psychology; (b) present developmental data on how these constructs can be applied to children ages 5 to 8 years; (c) present ideas for incorporating positive psychology practice into K-3 classrooms; (d) present strategies for incorporating positive psychology with multicultural considerations; and (e) present ideas on how to implement strategies based on positive psychology that are compatible with grade level standards and sociopolitical teaching expectations.

On the Edge of the World: Trauma and Twinship Selfobject Needs in Mrs. Dalloway

Alienation and aloneness appear as common themes in the experience of those impacted by trauma. Self psychology theorists, including contemporary proponents of intersubjectivity theory, have also discussed the ways in which alienation and disconnection from others permeate the experience of post-traumatic stress disorder. This discussion has highlighted the importance and centrality of twinship selfobject needs in providing a relational home for the emotional pain associated with trauma. These phenomena are especially apparent when one encounters the experiences of those combat veterans who have attempted to readjust to society upon returning home from military service. Using self psychology and intersubjectivity theory, this paper explores the ways that fiction, specifically Virginia Woolf's Mrs. Dalloway, can illuminate the ways that trauma negatively impacts twinship selfobject needs in combat veterans. In examining the character of Septimus Smith, this paper illustrates the estrangement, singularity, and alienation associated with post-traumatic stress, and how this state of being can collude with societal misunderstanding and repression to shatter the self's sense of belongingness with and connection to others.

Exploring How AFFECT (A Family Focused Emotion Communication Training) and Self Psychology Are Mutually Enhancing

This paper implicitly advocates for a rapprochement between psychodynamic and behavioral approaches to psychotherapy, by exploring the similarities and differences between self psychology and A Family Focused Emotion Communication Training (AFFECT), a behavioral parent training model. Self psychology, a theory with broad applicability, has been applied to several modalities besides behavioral ones. Generally speaking, self psychology and AFFECT are both relational approaches to psychotherapy that emphasize the impact of parent responsiveness, more specifically empathic attunement, on a child's emotional development and emotion regulation. Differentiating aspects of each model are identified to enhance the other model. AFFECT has relevance for pushing self psychology theory more in the direction of operations, which has implications for enhancing the research potential of self psychology, as well as for the training of the self-psychologist. Conversely, self psychology has relevance for coaching the parent with low self-esteem and decreased self-efficacy in AFFECT, which has potential implications for AFFECT treatment outcomes.

A Student's Perspective on Graduate Training in Sport Psychology

This article aims to add to the limited literature related to graduate training in applied sport psychology – specifically from the perspective of a current graduate student. The paper begins with a discussion about the evolving definitions of sport psychology and applied sport psychology as well as a brief history of sport psychology. Next, reasons why graduate students pursue the fields of sport psychology and applied sport psychology along with how this impacts their decisions related to graduate training are examined. Then, literature as well as personal experiences from the author related to education, supervision, practica and internships, mentorship, and certification are explored. Finally, recommendations are provided for students considering graduate training in applied sport psychology.