A systematic review and meta-analysis of trauma-focused cognitive behavioral therapy for children and adolescents

BACKGROUND

Among minors, posttraumatic stress symptoms (PTSS) are a common consequence of traumatic events requiring trauma-focused treatment.

OBJECTIVE

This meta-analysis quantified treatment effects of trauma-focused cognitive behavioral therapy (TF-CBT) with PTSS as primary outcome and symptoms of depression, anxiety, and grief as secondary outcomes.

PARTICIPANTS AND SETTING

Inclusion criteria for individual settings: (1) patients aged between 3 and 21, (2) at least one traumatic event, (3) minimum 8 sessions of (4) TF-CBT according to Cohen, Mannarino and Deblinger (2006, 2017), (5) a quantitative PTSS measure at pre- and post-treatment, (6) original research only. Inclusion criteria for group settings: had to involve (1) psychoeducation, (2) coping strategies, (3) exposure, (4) cognitive processing/restructuring, (5) contain some reference to the manual and no minimum session number was required.

METHODS

Searched databases were PsychInfo, MEDLINE, Cochrane Library, PTSDPubs, PubMed, Web of Science, and OpenGrey.

RESULTS

4523 participants from 28 RCTs and 33 uncontrolled studies were included. TF-CBT showed large improvements across all outcomes from pre- to post-treatment (PTSS: g = 1.14, CI 0.97-1.30) and favorable results compared to any control condition including wait-list, treatment as usual, and active treatment at post-treatment (PTSS: g = 0.52, CI 0.31-0.73). Effects were more pronounced for group settings. We give pooled estimates adjusted for risk of bias and publication bias, which initially limited the quality of the analyzed data.

CONCLUSIONS

TF-CBT is an effective treatment for pediatric PTSS as well as for depressive, anxiety, and grief symptoms. It is superior to control conditions, supporting international guidelines recommending it as a first-line treatment.

Behavioural state affects motion-sensitive neurones in the fly visual system

The strength of stimulus-induced responses at the neuronal and the behavioural level often depends on the internal state of an animal. Within pathways processing sensory information and eventually controlling behavioural responses, such gain changes can originate at several sites. Using motion-sensitive lobula plate tangential cells (LPTCs) of blowflies, we address whether and in which way information processing changes for two different states of motor activity. We distinguish between the two states on the basis of haltere movements. Halteres are the evolutionarily transformed hindwings of flies. They oscillate when the animals walk or fly. LPTCs mediate, amongst other behaviours, head optomotor responses. These are either of large or small amplitude depending on the state of motor activity. Here we find that LPTC responses also depend on the motor activity of flies. In particular, LPTC responses are enhanced when halteres oscillate. Nevertheless, the response changes of LPTCs do not account for the corresponding large gain changes of head movements. Moreover, haltere activity itself does not change the activity of LPTCs. Instead, we propose that a central signal associated with motor activity changes the gain of head optomotor responses and the response properties of LPTCs.

Variability of blowfly head optomotor responses

Behavioural responses of an animal are variable even when the animal experiences the same sensory input several times. This variability can arise from stochastic processes inherent to the nervous system. Also, the internal state of an animal may influence a particular behavioural response. In the present study, we analyse the variability of visually induced head pitch responses of tethered blowflies by high-speed cinematography. We found these optomotor responses to be highly variable in amplitude. Most of the variability can be attributed to two different internal states of the flies with high and low optomotor gain, respectively. Even within a given activity state, there is some variability of head optomotor responses. The amount of this variability differs for the two optomotor gain states. Moreover, these two activity states can be distinguished on a fine timescale and without visual stimulation, on the basis of the occurrence of peculiar head jitter movements. Head jitter goes along with high gain optomotor responses and haltere oscillations. Halteres are evolutionary transformed hindwings that oscillate when blowflies walk or fly. Their main function is to serve as equilibrium organs by detecting Coriolis forces and to mediate gaze stabilisation. However, their basic oscillating activity was also suggested to provide a gain-modulating signal. Our experiments demonstrate that halteres are not necessary for high gain head pitch to occur. Nevertheless, we find the halteres to be responsible for one component of head jitter movements. This component may be the inevitable consequence of their function as equilibrium and gaze-stabilising organs.

Cognitive and neurobiological alterations in electromagnetic hypersensitive patients: results of a case-control study

BACKGROUND

Hypersensitivity to electromagnetic fields (EMF) is frequently claimed to be linked to a variety of non-specific somatic and neuropsychological complaints. Whereas provocation studies often failed to demonstrate a causal relationship between EMF exposure and symptom formation, recent studies point to a complex interplay of neurophysiological and cognitive alterations contributing to symptom manifestation in electromagnetic hypersensitive patients (EHS). However, these studies have examined only small sample sizes or have focused on selected aspects. Therefore this study examined in the largest sample of EHS EMF-specific cognitive correlates, discrimination ability and neurobiological parameters in order to get further insight into the pathophysiology of electromagnetic hypersensitivity.

METHOD

In a case-control design 89 EHS and 107 age- and gender-matched controls were included in the study. Health status and EMF-specific cognitions were evaluated using standardized questionnaires. Perception thresholds following single transcranial magnetic stimulation (TMS) pulses to the dorsolateral prefrontal cortex were determined using a standardized blinded measurement protocol. Cortical excitability parameters were measured by TMS.

RESULTS

Discrimination ability was significantly reduced in EHS (only 40% of the EHS but 60% of the controls felt no sensation under sham stimulation during the complete series), whereas the perception thresholds for real magnetic pulses were comparable in both groups (median 21% versus 24% of maximum pulse intensity). Intra-cortical facilitation was decreased in younger and increased in older EHS. In addition, typical EMF-related cognitions (aspects of rumination, symptom intolerance, vulnerability and stabilizing self-esteem) specifically differentiated EHS from their controls.

CONCLUSIONS

These results demonstrate significant cognitive and neurobiological alterations pointing to a higher genuine individual vulnerability of electromagnetic hypersensitive patients.

Multiscale character of the nonlinear coherent dynamics in the Rayleigh-Taylor instability

We report nonlinear solutions for a system of conservation laws describing the dynamics of the large-scale coherent structure of bubbles and spikes in the Rayleigh-Taylor instability (RTI) for fluids with a finite density ratio. Three-dimensional flows are considered with general type of symmetry in the plane normal to the direction of gravity. The nonlocal properties of the interface evolution are accounted for on the basis of group theory. It is shown that isotropic coherent structures are stable. For anisotropic structures, secondary instabilities develop with the growth rate determined by the density ratio. For stable structures, the curvature and velocity of the nonlinear bubble have nontrivial dependencies on the density ratio, yet their mutual dependence on one another has an invariant form independent of the density ratio. The process of bubble merge is not considered. Based on the obtained results we argue that the large-scale coherent dynamics in RTI has a multiscale character and is governed by two length scales: the period of the coherent structure and the bubble (spike) position.

Model flames in the Boussinesq limit: the case of pulsating fronts

We extend earlier work on the nonlinear behavior of premixed flames in a gravitationally stratified medium, subject to the Boussinesq approximation, in two dimensions. The main result is that the nature of the traveling burning front is largely determined by the form of the adopted boundary conditions on the side walls: while symmetric boundary conditions lead to stably scalloped traveling wave solutions, loss of symmetry leads to the development of pulsating fronts. However, despite differences in geometrical features, the symmetric and asymmetric systems obey the same scaling behavior for the average effective flame speed.

Kelvin-Helmholtz instability for relativistic fluids

We reexamine the stability of an interface separating two nonmagnetized relativistic fluids in relative motion, showing that, in an appropriate reference frame, it is possible to find analytic solutions to the dispersion relation. Moreover, we show that the critical value of the Mach number, introduced by compressibility, is unchanged from the nonrelativistic case if we redefine the Mach number as M= [beta/ (1- beta(2) )(1/2) ] [ beta(s) / (1- beta(2)(s) )(1/2) ](-1) , where beta and beta(s) are, respectively, the speed of the fluid and the speed of sound (in units of the speed of light).

Model flames in the Boussinesq limit: the effects of feedback

We have studied the fully nonlinear behavior of premixed flames in a gravitationally stratified medium, subject to the Boussinesq approximation. The key results include the establishment of criteria for when such flames propagate as simple planar flames, elucidation of scaling laws for the effective flame speed, and a study of the stability properties of these flames. The simplicity of some of our scaling results suggests that analytical work may further advance our understandings of buoyant flames.

Explosive energy release in magnetic shocks

We show that a magnetic shock whose initial density and/or magnetic perturbation exceeds the Hugoniot limit may lead to substantial and rapid energy release in low beta plasmas (such as occur in the magnetospheres of neutron stars). We illustrate this effect for a fast Magnetohydrodynamic perturbation, as well as for large density perturbations which can be naturally created in low beta plasmas. Using the Riemann solution and simulations, we show that slow modes of finite magnitudes and Alfvénic perturbations can generate strong density perturbations. These perturbations develop into shocks, resulting in efficient energy release.

Shear instability of fluid interfaces: stability analysis

We examine the linear stability of fluid interfaces subjected to a shear flow. Our main object is to generalize previous work to an arbitrary Atwood number, and to allow for surface tension and weak compressibility. The motivation derives from instances in astrophysical systems where mixing across material interfaces driven by shear flows may significantly affect the dynamical evolution of these systems.

Between search and research: how to find your way around? Review of the article "Thought Field Therapy- soothing the bad moments of Kosovo"

This article is based on a review of the article, "Thought Field Therapy-Soothing the Bad Moments of Kosovo," (Johnson, Shala, Sejdijaj, Odell, & Dabishevici [2001]). As it is assumed that it is the intention of the reviewed article to prove the effectiveness of TFT, the information given is evaluated in terms of how well this goal is attained. However, as a sample description is not provided and minimal methodological standards, such as some kind of standardized diagnostical procedure, are not met, it is not possible to appraise issues central to any empirical study. Furthermore the design of the study is not in accordance with the goal of the study, as any control for expectancy effects, natural remission, or even a comparison with other successful psychotherapeutic procedures is missing. The study provides very limited evidence for the effectiveness of TFT.

Plasmoid impacts on neutron stars and highest energy cosmic rays

Particle acceleration by electrostatic polarization fields that arise in plasmas streaming across magnetic fields is discussed as a possible acceleration mechanism of highest energy ( greater, similar10(20) eV) cosmic rays. Specifically, plasmoids arising in planetoid impacts onto neutron star magnetospheres are considered. We find that such impacts at plausible rates may account for the observed flux and energy spectrum of the highest energy cosmic rays.

Interface imprinting by a rippled shock using an intense laser

Perturbation imprinting at a flat interface by a rippled shock has been observed in a laser hydrodynamics experiment. A strong shock was driven through a three-layer target, with the first interface rippled, and the second flat. The chosen thickness of the second layer gave instability growth with opposite phases at the two interfaces, consistent with two-dimensional simulations and rippled shock theory.

Evidence for topological nonequilibrium in magnetic configurations

We use direct numerical simulations to study the evolution, or relaxation, of magnetic configurations to an equilibrium state. We use the full single-fluid equations of motion for a magnetized, nonresistive, but viscous fluid; and a Lagrangian approach is used to obtain exact solutions for the magnetic field. As a result, the topology of the magnetic field remains unchanged, which makes it possible to study the case of topological nonequilibrium. We find two cases for which such nonequilibrium appears, indicating that these configurations may develop singular current sheets.

Vicarious emotional experience and emotional expression in group psychotherapy

Emotional arousal is a key concept in most theories of change. To be able to understand the role of emotional expression better, two treatments, cognitive therapy (CT) and focused expressive psychotherapy (FEP; a manualized form of Gestalt therapy), with opposite process assumptions about the expression of emotions were compared. Additionally vicarious emotional experience in the sense of an underlying emotional contagion was examined. Clients suffering from major depression were rated for the expression of emotion in three randomly selected sessions of a 20-session treatment course. While the types of emotions generally experienced by CT clients and FEP clients did not differ significantly, differences in the subgroups of active and observing-group members were found. This indicated that the process assumptions made by the respective treatments were only valid for the actively participating clients and not for the observing group members. Emotional contagion as a process was not supported.

Historiography and historians of neuroscience: towards diversity in the ISHN

This article introduces and critiques the historiographical tradition of the history of the neurosciences as it has been established in the International Society for the History of the Neurosciences (ISHN). The founding members of the ISHN were practitioner-historians, practitioners of the neurosciences with an interest in the great moments, ideas and controversies in the history of their field. The historiographical precedent set by these clinician-historians emphasized those aspects of history most interesting to them. Academic historians bring a different approach to the history of neurosciences, particularly an interest in studying the intellectual and cultural contexts of both the inherited and the forgotten ideas about the nervous system. Their approach to history has not been well presented in the ISHN, in part because the current historiographical tradition does not address their interests. This article highlights the methodological and epistemological differences between academic and practitioner-historians and discusses the difficulties that other historical societies have faced in trying to bring them together. The article then suggests ideas for symposia that might facilitate an interdisciplinary dialogue and a revised historiographical tradition that speaks to the needs of both academic and historians and practitioner historians.

On the possibility of coherently stimulated recombination and cosmological structure generation: cosmological consequences

Given a specific physical mechanism for instabilities during cosmological recombination discussed in an earlier paper, we examine the nonlinear growth of density structures to form fractal-like structural patterns out to the horizon scale at that epoch (approximately 200 Mpc today). A model for such fractal patterns is presented. Such effects could explain observed large-scale structure patterns and the formation of objects at high z, while keeping microwave background anisotropies at the observed minimal levels. We also discuss possible microwave background implications of such a transition and note a potentially observable spectral signature at lambda approximately 0.18 mm as well as a weak line near the peak in the microwave background.

On the possibility of coherently stimulated recombination and cosmological structure generation: recombination instability

Possible instabilities during cosmological recombination may produce an epoch of nonlinear density growth and fractal-like structural patterns out to the horizon scale at that epoch (approximately 200 Mpc today). With this motivation, we examine the consequences of the change in effective radiative recombination reaction rate coefficients produced by intense stimulated emission. The proton-electron recombination is considered as a natural laser, leading to the formation of spatially nonuniform distributions of neutral matter earlier than the recombination epoch.

Base-rate estimates of criminal behavior by homeless mentally ill persons in New York City

OBJECTIVES

The study aimed to estimate the prevalence of homelessness among mentally disordered offenders entering the criminal justice and forensic mental health systems, to compare base rates of arrest for violent and nonviolent criminal charges among homeless and domiciled persons with mental illness, and to examine patterns in the categories of victims chosen by these two groups.

METHODS

The authors analyzed data from structured psychiatric interviews and criminal and psychiatric records of 77 homeless defendants and 107 domiciled defendants referred for psychiatric examination by the criminal and supreme courts in Manhattan over a six-month period.

RESULTS

Mentally disordered defendants had 40 times the rate of homelessness found in the general population, and 21 times the rate in the population of mentally ill persons in the city. The overall rate of criminal offenses was 35 times higher in the homeless mentally ill population than in the domiciled mentally ill population. The rate of violent crimes was 40 times higher and the rate of nonviolent crimes 27 times higher in the homeless population. Homeless defendants were significantly more likely to have been charged with victimizing strangers.

CONCLUSIONS

Homeless mentally ill persons appear to be grossly overrepresented among mentally disordered defendants entering the criminal justice and forensic mental health systems and to have a higher base rate of arrest for both violent and nonviolent crimes than domiciled mentally ill persons.

Obsessional harassment and erotomania in a criminal court population

The criminal behaviors of harassment and menacing are difficult to control, and of increasing concern to the general public and local law enforcement officials. In 1992, the New York State Legislature modified the Penal Law, responding to public fears and concerns that stalking behavior may become violent. Some persons charged with these types of offenses are suffering from psychiatric disorders. Among these disorders are those classified as Delusional Disorders. According to both DSM-III-R (1987-1993) and DSM-IV (1994), there are five specific types of Delusional Disorder: erotomanic, grandiose, jealous, persecutory and somatic. This type of disorder tends to be chronic. Forty eight cases of persons charged with harassment and menacing in the New York County Criminal and Supreme Court and referred for evaluation to the Forensic Psychiatry Clinic between January 1987 and January 1994 are reviewed. When cases of erotomania and other affectionate/amorous complaints were compared with persecutory/angry forms of harassing behavior, there was a great deal of similarity. When all harassers were compared to the Clinic population as a whole, major differences in ethnicity, age, educational level and sex were noted. Findings are presented regarding incidence, other demographic data, recidivism, violence and clinical diagnosis. The researchers conclude that erotomania does exist, however, there are other psychiatric disorders which can also be diagnosed in individuals accused of harassing and menacing behavior. From the point of view of the victim and the criminal justice system, the similarities in behavior patterns are more important than the different diagnoses.

Geriatric offenders examined at a forensic psychiatry clinic

This descriptive research paper reports on 52 geriatric defendants accused of criminal offenses and referred for forensic psychiatric evaluation. It addresses demographic and clinical variables in that population. The authors hope that the data will assist in planning for forensic and therapeutic services for geriatric persons in the criminal justice system.

The Mariel refugee and the New York Criminal Court

In the spring of 1980, the Mariel Boat Lift brought refugees from Communist Cuba to the shores of Florida. Most refugees came seeking political freedom, but many were sent by the Cuban Government directly from its prisons and mental institutions. Literal rejects of their own society, they arrived in this country and spent many months interned in refugee camps. As they moved out into local communities, their behavioral problems began to come to the attention of local authorities. This paper describes the "Marielitos" seen in the Forensic Psychiatry Clinic for the Criminal and Supreme Courts of New York between mid-1980 and mid-1985. It explores how their reactions to their new environment may be affected by their past psychiatric and criminal histories, their language barrier, and the stress of the emigration experience.

Geriatric felons examined at a forensic psychiatry clinic

Descriptive statistics are presented on 25 defendants in the geriatric age range (aged 62 to 78 years old). Demographic variables, criminal charges, medical, neurological and psychiatric illnesses, prior criminal offenses, and final dispositions of the cases are tabulated, and implications for the criminal justice system and social services are discussed.

Psychiatric evaluations of sexual offenders

Ninety-five defendants charged with sexual offenses were evaluated in a forensic psychiatry clinic. Their psychiatric diagnoses, as well as social, demographic, and criminal characteristics, were studied. Almost half were found to have personality disorders, while one-fifth were given a diagnosis of schizophrenia, affective disorder, or an atypical psychosis. Surprisingly few were diagnosed as having a paraphilia.

Forensic psychiatric evaluations of women accused of felonies: a three-year descriptive study

Descriptive statistics are presented for 95 female offenders evaluated in the Forensic Psychiatry Clinic for the New York Criminal and Supreme Court (First Judicial District). Demographic data, criminal charges, psychiatric diagnoses, prior mental health treatment, and victims of offenses are examined.

Women and arson: a demographic study

This study describes women accused of setting fires in the City of New York who were evaluated between 1980 and 1983 at the Forensic Psychiatry Clinic for the New York Criminal and Supreme Courts. Consideration is given to their age, ethnicity, history of prior mental illness, abuse of controlled substances, economic status, family background, education, and employment. Their methodology, planning, and targeting for their firesetting behavior, as well as reported motivations for engaging in arson, are also considered.

Education and training in forensic psychiatry

The author has chaired a national committee dedicated to developing standards for training in forensic psychiatry; he discusses the results of his work over the past several years, presenting the advantages and disadvantages of on-the-job training and formal fellowship programs.

The association of marijuana use with outcome of pregnancy

We analyzed interview and medical record data of 12,424 women to evaluate the relationship between marijuana usage and adverse outcomes of pregnancy. Low birthweight, short gestation, and major malformations occurred more often among offspring of marijuana users. When we used logistic regression to control for demographic characteristics, habits, and medical history data, these relationships were not statistically significant. The odds ratio for the occurrence of major malformations among marijuana users was 1.36, higher than odds ratios for other exogenous variables, and the 95 per cent confidence interval was 0.97-1.91. More data are needed to establish firmly or rule out an association between marijuana usage and major malformations. Until more information is available, women should be advised not to use marijuana during pregnancy.

Sex offenders: a descriptive analysis of cases studied at a forensic psychiatry clinic

This is a report on a descriptive study made of defendants charged with at least one count of sexual assault who were examined at the Forensic Psychiatry Clinic of the Supreme Court of the State of New York for the Borough of Manhattan during the calendar year 1974.

Laboratory evaluation of a rapid four-hour serological grouping of groups A,B,C, and G beta-streptococci by the Phadebact streptococcus test

Grouping of beta-hemolytic streptococcal isolates by staphylococcal coagglutination was performed with the Phadebact Streptococcus Test to determine whether such isolates could be accurately grouped serologically with 4 h after examination of the primary isolation plates. Of 132 clinical isolates, 131 were correctly grouped by the Phadebact method using the Lancefield precipitation method as the accepted standard. Of the correctly grouped streptococci, 119 were definitively grouped within 4 h after examination of the primary plates, and the remaining 12 isolates were grouped within 24 h. Since the Phadebact Streptococcus Test contains coagglutination reagents for groups A, B, C, and G, those isolates that failed to react were considered as positive for groups other than the four included in the test system. There were 23 such isolates in this study. Lancefield grouping of these isolates indicated that nine were group F, five were group D, and the remaining nine were not groupable with the Lancefield reagents employed in this study. The one Phadebact "failure" involved an isolate that produced a 4 + reaction with the Phadebact group A reagent and a 4 + reaction with Lancefield group F reagent.