Guideline-based programs in the treatment of complex PTSD

The term “post-traumatic stress disorder” (PTSD) is a relatively new diagnostic label, being formally recognized in 1980 in the Diagnostic Statistical Manual for Psychiatric Illness – Third Edition (DSM-III) of the American Psychiatric Association (APA, 1980). Complex Post-Traumatic Stress Disorder (CP) is a more recently discussed, and newly-classified, phenomenon, initially discussed in the early 1990s (Herman, 1992a). Thus, as research into effective treatments for CP is sparse, the treatment of CP is the topic of this study, in which a guideline-based treatment program developed by the researcher for the treatment of CP is implemented and evaluated. Ten individuals participated in this study, undertaking individualized, guideline-based treatment programs spanning a period of six months. In providing background information relevant to this study, an explanation is provided regarding the nature of CP, and the reasons for its consideration as a separate phenomenon to PTSD. The adequacy of the PTSD formulation in enabling effective assessment and treatment of CP is also explored, with endorsement of previous researchers’ conclusions that the CP construct is more useful than the PTSD construct for assessing and treating survivors of long-term and multiple forms of abuse. The PTSD classification is restrictive, and not necessarily appropriate for certain forms of trauma (such as prolonged trauma, or multiple forms of trauma), as such trauma experiences may lead to specific effects that lay outside those formerly associated with PTSD. Such effects include alterations in affect regulation, consciousness, self-perception, interpersonal relationships, and in systems of meaning. Following discussion regarding the PTSD/CP classification, an examination of treatment methods currently used in the treatment of PTSD, and a review of treatment outcome studies, takes place. The adequacy of primary treatment methods in treating CP symptoms is then examined, with the conclusion that a range of treatment methods could potentially be useful in the treatment of CP symptoms. Individuals with a diagnosis of CP may benefit from the adoption of an eclectic approach, drawing on different treatment options for different symptoms, and constantly evaluating client progress and re-evaluating interventions. This review of treatment approaches is followed by details of an initial study undertaken to obtain feedback from individuals who had suffered long-term/multiple trauma and who had received treatment. Participants in this initial study were asked open-ended questions regarding the treatment approach they had experienced, the most useful aspect of the treatment, the least useful aspect, and other strategies/treatment approaches that may have been useful – but which were not used. The feedback obtained from these individuals was used to inform the development of treatment guidelines for use in the main study, as were recommendations made by Chu (1998). The predominant focus of the treatment guidelines was “ego strengthening”, a term coined by Chu (1998) to describe the “initial (sometimes lengthy) period of developing fundamental skills in maintaining supportive relationships, developing self-care strategies, coping with symptomatology, improving functioning, and establishing a positive self identity” (p.75). Using a case study approach, data are then presented relating to each of the ten individuals involved in the treatment program: details of his/her trauma experience(s)and the impact of the trauma (as perceived by each individual); details of each individual’s treatment program (as planned, and as implemented); post-treatment evaluation of the positive and negative aspects of the treatment program (from the therapist’s perspective); and details of the symptoms reported by the individual post-treatment, via psychometric assessment and also during interview. Analysis and discussion of the data relating to the ten participants in the study are the focal point of this study. The evaluation of the effectiveness of each individual’s treatment has been based predominantly on qualitative data, obtained from an analysis of language (discourse analysis) used by participants to describe their symptoms pre- and post-treatment. Both blatant and subtle changes in the language used by participants to describe themselves, their behaviour, and their relationships pre- and post-treatment have provided an insight into the possible changes that occurred as a result of the treatment program. The language used by participants has been a rich source of data, one that has enabled the researcher to obtain information that could not be obtained using psychometric assessment methods. Most of the participants in this study portrayed notable changes in many of the CP symptoms, including being more stable and having improved capacity to explore their early abuse. Although no direct cause-effect relationship between the participants’ treatment program and the improvements described can be established from this study, the participants’ perception that the program assisted them with their symptoms, and reported many aspects of “ego strengthening”, is of major importance. Such self-perception of strength and empowerment is important if an individual is going to be able to deal with past trauma experiences. In fact, abreactive work may have a greater chance of succeeding if those who have experienced long-term or multiple trauma are feeling more empowered, and more stable, as were the participants in this study (post-intervention). In concluding this study, recommendations have been made in regard to the use of guideline-based treatment programs in the responsible treatment of CP. Strengths and limitations of this study have also been highlighted, and recommendations have been made regarding possibilities for future research related to CP treatment. On the whole, this study has supported strongly other research that highlights the importance of focusing on “ego strengthening” in assisting those who have suffered long-term/multiple trauma experiences. Thus, a guideline-based program focusing on assisting sufferers of long-term trauma with some, or all, of the symptoms of CP, is recommended as an important first stage of any treatment of individuals who have experienced long-term/multiple trauma, allowing them to develop the emotional and psychological strength required to deal with past traumatic events. Clinicians who are treating patients whose history depicts long-term or multiple trauma experiences (either from their childhood, or at some stage in their adult life) need, therefore, to be mindful of assessing individuals for symptoms of CP – so that they can treat these symptoms prior to engaging in any work associated directly with the past traumatic experiences.

Simple characterizations of the Nash and Kalai/Smorodinsky solutions

In this study we introduce two new properties, the Midpoint Outcome on a Linear Frontier (MOLF) and Balanced Focal Point (BFP) properties, to replace the Weak Pareto Optimality (WPO), Symmetry (SYM) and Independence of Equivalent Utility Representations (IEUR) properties in the axiomatic characterizations of the two most prominent solution concepts, namely the Nash and Kalai/Smorodinsky solutions, respectively.

Conserving the heritage spaces of Kuala Lumpur : a case study of the old Market Square (Medan Pasar)

Being one of the new Asian mega-cities today, the origins of Kuala Lumpur started as early as 1850s at the confluence between two rivers; Gombak and Klang. The history of Kuala Lumpur changed when tin was discovered in Ampang in I 857. To cater for the need of residents and miners, a small trading post was constructed at the confluence between these two rivers. This business activity expanded eastwards to the Klang River resulting in one of the busiest business centres in Kuala Lumpur. Shophouses were erected and streets formed. These rows of shophouses and streets, with the river located to the west, created a rectangular space, known as the Old Market Square (Medan Pasar) which later became the main focal point of Kuala Lumpur. Today, even though the native senlements, chaotic sheds and huts have totally disappeared, some of the original shophouses, streets and even spaces still exist. However, they are struggling to survive and to maintain their authenticity due to pressures of nearby developments. This article considers the status of the Old Market Square in regard to its historical evolution and its position in contemporary heritage legislation and policy.

Life during wartime : sexuality, recruitment and reality television

In 2010, Defence Force Recruiting (DFR) Navy Marketing entered into a media sponsorship package with the Australian version of the reality TV show So You Think You Can Dance (SYTYCD): Footage of the day aired on national television on SYTYCD and weekly ‘dancer bootcamp’ sessions training the dancers in Navy values featured on a dedicated and branded Navy section of the official SYTYCD website. This article analyses the Navy’s SYTYCD ‘integration opportunities’ to consider the role of reality television in the redefinition of the defence forces as a training and vocational pathway for young people. Underpinning such considerations is the conceptualization of the work of reality television through the prism of public and popular pedagogies. Taking sexuality as a focal point, the article will reflect on efforts to lift recruitment through an emphasis on the incorporation of diversity. Reading the work of Jasbir Puar against the Australian ‘archive’ of integration opportunities, this article contributes to queer critiques of homonormative and homonationalist tendencies in contemporary politics.

Single-subject research designs and data analyses for assessing elite athletes’ conditioning

Research in conditioning (all the processes of preparation for competition) has used group research designs, where multiple athletes are observed at one or more points in time. However, empirical reports of large inter-individual differences in response to conditioning regimens suggest that applied conditioning research would greatly benefit from single-subject research designs. Single-subject research designs allow us to find out the extent to which a specific conditioning regimen works for a specific athlete, as opposed to the average athlete, who is the focal point of group research designs. The aim of the following review is to outline the strategies and procedures of single-subject research as they pertain to the assessment of conditioning for individual athletes. The four main experimental designs in single-subject research are: the AB design, reversal (withdrawal) designs and their extensions, multiple baseline designs and alternating treatment designs. Visual and statistical analyses commonly used to analyse single-subject data, and advantages and limitations are discussed. Modelling of multivariate single-subject data using techniques such as dynamic factor analysis and structural equation modelling may identify individualised models of conditioning leading to better prediction of performance. Despite problems associated with data analyses in single-subject research (e.g. serial dependency), sports scientists should use single-subject research designs in applied conditioning research to understand how well an intervention (e.g. a training method) works and to predict performance for a particular athlete.

Plasmon-enhanced two-photon-induced isomerization for highly-localized light-based actuation of inorganic/organic interfaces

Two-photon initiated photo-isomerization of an azobenzene moiety adsorbed on silver nanoparticles (Ag NPs) is demonstrated. The azobenzene is linked to a materials-binding peptide that brings it into intimate contact with the Ag NP surface, producing a dramatic enhancement of its two-photon absorbance. An integrated modeling approach, combining advanced conformational sampling with Quantum Mechanics/Capacitance Molecular Mechanics and response theory, shows that charge transfer and image charges in the Ag NP generate local fields that enhance two-photon absorption of the cis isomer, but not the trans isomer, of adsorbed molecules. Moreover, dramatic local field enhancement is expected near the localized surface plasmon resonance (LSPR) wavelength, and the LSPR band of the Ag NPs overlaps the azobenzene absorbance that triggers cis to trans switching. As a result, the Ag NPs enable two-photon initiated cis to trans isomerization, but not trans to cis isomerization. Confocal anti-Stokes fluorescence imaging shows that this effect is not due to local heating, while the quadratic dependence of switching rate on laser intensity is consistent with a two-photon process. Highly localized two-photon initiated switching could allow local manipulation near the focal point of a laser within a 3D nanoparticle assembly, which cannot be achieved using linear optical processes.

Strategic positioning of Huawei on the international political stage

Huawei is a giant Chinese telecommunications company which has become the focus of contract exclusion and finger pointing by certain western governments. The argument used by the US and Australia has been that of “national security”. This paper explores the causes and reasons for these actions and to ascertain what key strategic approaches and positioning lie behind the high level political tension. The controversy which this exclusion has provided and the causes behind it are the focal point of this paper. Whether it be due to Cold War legacies or business competition, the exclusions do not sit well in this globalised economy.

Engineering education quality assurance within the school of engineering: a holistic approach

BACKGROUND Quality assurance is a key element of engineering education at Deakin University and is monitored through various mechanisms which also include the process of collecting students’ feedback within the Schools and faculties. The information received are then looked at holistically and action plan is developed to implement. This has proven to be very effective to ensure feedback received from the students has been properly addressed.
PURPOSE The School of Engineering at Deakin University, has initiated the formation of Engineering Educational Quality Working Group (QWG). The aim of QWG is to provide a focal point for learning and teaching quality and its assurance in undergraduate and postgraduate Engineering courses. The school approach complements Deakin University processes of collecting and analysing student feedback on unit curricula design, delivery and facilitator delivery performance; feedback regarding individual facilitator, unit evaluations and graduate course experiences.
DESIGN/METHOD The data are collected through face to face feedback from both on and off campus students. Feedback received from the end of trimester student evaluation process was also analysed.
RESULTS The motivation behind the practise is to close the loop for the feedback received from the students and take appropriate action against the feedback. This is to enhance overall delivery of engineering education at Deakin University.
CONCLUSIONS This paper outlines the activities planned by the QWG and elaborates on quality assurance approaches and key strategies to be implemented by the working group to achieve the desired quality as well as efficacy of those recommendations/actions undertaken at the school level.