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Although there are effective psychological treatments for post-traumatic stress disorder (PTSD), they remain inaccessible for many people. Digitally enabled therapy is a way to overcome this problem; however, there is little evidence on which forms of these therapies are most cost effective in PTSD. We aimed to assess the cost-effectiveness of the STOP-PTSD trial, which evaluated two therapist-assisted, internet-delivered cognitive behavioural therapies: cognitive therapy for PTSD (iCT-PTSD) and a programme focusing on stress management (iStress-PTSD).

Many patients are currently unable to access psychological treatments for post-traumatic stress disorder (PTSD), and it is unclear which types of therapist-assisted internet-based treatments work best. We aimed to investigate whether a novel internet-delivered cognitive therapy for PTSD (iCT-PTSD), which implements all procedures of a first-line, trauma-focused intervention recommended by the UK National Institute for Health and Care Excellence (NICE) for PTSD, is superior to internet-delivered stress management therapy for PTSD (iStress-PTSD), a comprehensive cognitive behavioural treatment programme focusing on a wide range of coping skills.

BackgroundMental ill health among ambulance staff is widespread. Evidence suggests that, with the right support, employees experiencing mental ill health can continue to work, symptom severity can be reduced and suicide prevented.AimsTo investigate ambulance staff perceptions and experiences of organisational mental health support.MethodsA cross-sectional online survey investigated work-related stressful life events and their potential psychological impact. The survey also examined staff perceptions and experiences of organisational support and acceptability of a proposed wellbeing intervention offering mandatory time to talk at work.FindingsA total of 540 ambulance staff responded. The majority reported having experienced work-related stressful life events (n=444; 82%). Associated psychological symptoms appeared to persist for years. Perceptions about organisational support related to support uptake. Stigma, fear and embarrassment were reported as barriers to disclosure and help-seeking. Mandatory time to talk at work would be acceptable (n=400; 74%).ConclusionThe association between work-related stressful events and psychological symptoms underscores the need for interventions supported at an organisation level.

Stress seems to trigger memory problems later in life.

Social support has been shown to facilitate adaptation after bereavement in some studies but not others. A felt sense of social disconnection may act as a barrier to the utilization of social support, perhaps explaining these discrepancies. Factorial and psychometric validity of the Oxford Grief-Social Disconnection Scale (OG-SD) was tested in a bereaved sample (N= 676). A three-factor solution (negative interpretation of others’ reactions to grief expression, altered social self, and safety in solitude) fit the data best and demonstrated excellent psychometric validity. A second three-wave longitudinal sample (N= 275) recruited 0 to 6 months following loss and followed up 6 and 12 months later completed measures of prolonged grief disorder, posttraumatic stress disorder, depression, and the OG-SD at each time point. High levels of baseline social disconnection were associated with concurrently high psychological distress. The extent to which social disconnection declined over time predicted resolution of psychological distress.

This review investigates how recent neuroimaging findings on vulnerability for depression and the mechanisms of mindfulness may serve to inform and enhance the understanding that is guiding the use of mindfulness training in the prevention and treatment of recurrent and chronic depression. In particular, we review evidence suggesting that alterations in default-mode-network activity and connectivity represent a fundamental deficit underlying cognitive vulnerability for depression and explore the ways in which mindfulness meditation may reverse such alterations. Furthermore, we discuss findings from studies that have investigated the effects of mindfulness on emotion-regulatory capacities. These findings suggest mindful emotion regulation has a characteristic neural signature that is particularly conducive to therapeutic learning. We conclude that training in mindfulness has unique strengths for addressing neural mechanisms associated with cognitive vulnerabilities for recurrent and chronic depression and propose future lines of research to more effectively harness this potential.

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ObjectivesAmbulance workers are regularly exposed to call-outs, which are potentially psychologically traumatic. The ability to remain objective and make adaptive appraisals during call-outs may be beneficial to this at-risk population. This pilot study investigated the links between cognitive appraisals, objectivity and coping in ambulance workers.MethodsForty-five ambulance workers from the London Ambulance Service, UK, were studied. Trauma exposure, post-traumatic stress disorder and depression symptoms were assessed using self-report measures. Positive and negative appraisals were measured in relation to two previous call-outs: one during which they coped well and one during which they did not.ResultsEnhanced coping was associated with making more positive appraisals during the call-out. Better coping was also related to greater levels of objectivity during these call-outs. Coping less well was associated with the use of more negative appraisals during the call-out.ConclusionsAmbulance workers may benefit from psychological interventions, which focus on cognitive reappraisal and enhancing objectivity to improve coping and resilience.

The Illustrated Song Slide, an American entertainment practice of the early cinema period with roots in 19th century magic lantern slide traditions, was popularized in vaudeville theaters over the course of the turn of the century and became a wide-spread form of spectacle with the rise of nickelodeons. Despite the number of recent studies that have clarified the Illustrated Song Slide's importance to the heterogeneous programs of early cinema exhibition spaces, the reasons behind its disappearance from this cultural landscape by 1914 remain obscured. The rise of standardization on all fronts of the cinema industry, as well as the prolific corroboration of its trade press in this endeavor, combine to effect an aesthetic judgment of the visual and live-performative aspects of the Illustrated Song Slide that progressively forces the ISS into the margins of early-cinema cultural practice. [ABSTRACT FROM AUTHOR]

The action of progesterone (P) on the estrogen stimulated uterine endometrium and isthmic oviduct of the ewe was studied. Changes in protein:DNA and RNA:DNA ratios, rate of in vitroprotein synthesis, alkaline phosphatase and peroxidase activity and the level of cytoplasmic receptors for estradiol (E2) and P were measured in the endometrium. Only receptor effects were measured in the oviduct. Progesterone decreased the level of both receptors in each tissue but did not decrease protein:DNA and RNA:DNA ratios or protein synthesis; P had little effect on alkaline phosphatase activity and there was no detectable peroxidase activity.These findings argue against the concept, based on studies in the rat, that the initial antiestrogenic effects of P are mediated by a specific effect on E2receptor replenishment.

This study identified predictor variables associated with outcome in middle childhood in a clinical preschool sample. These variables were examined in relation to functional level at outcome. At Time 1 the sample consisted of 129 children admitted to a psychiatric preschool program; 82 of these children comprised the follow-up sample at Time 2. The results indicated that the variables significantly associated with each child's outcome were IQ, the presence of diagnosis at Time 1 and the length of time each child was in the treatment program. Different predictors were important for different outcomes and a given predictor variable was not equally salient across all levels of outcome.

University students blind to group status rated boys with gender identity disorder and clinical control boys regarding their physical attractiveness. Ratings were made of the face and upper torso from photographs taken at the time of clinical assessment ( age, 8.1 years). On all five adjectives (attractive, beautiful, cute, handsome, and pretty), boys with gender identity disorder were judged to be more attractive than were the clinical control boys. Attractiveness correlated with extent of behavioral femininity in the clinical control group, but not in the group of boys with gender identity disorder. The extent to which the group differences in attractiveness were due to objective, structural differences in facial attractiveness vs. socially created, or subjective, processes is discussed.

ABSTRACTDelivering trauma-focused cognitive behavioural therapy to patients with PTSD during the COVID-19 pandemic poses challenges. The therapist cannot meet with the patient in person to guide them through trauma-focused work and other treatment components, and patients are restricted in carrying out treatment-related activities and behavioural experiments that involve contact with other people. Whilst online trauma-focused CBT treatments for PTSD have been developed, which overcome some of these barriers in that they can be delivered remotely, they are not yet routinely available in clinical services in countries, such as the UK. Cognitive therapy for PTSD (CT-PTSD) is a trauma-focused cognitive behavioural therapy that is acceptable to patients, leads to high rates of recovery and is recommended as a first-line treatment for the disorder by international clinical practice guidelines. Here we describe how to deliver CT-PTSD remotely so that patients presenting with PTSD during the COVID-19 pandemic can still benefit from this evidence-based treatment.

BackgroundMental ill health among ambulance staff is widespread. Evidence suggests that, with the right support, staff experiencing mental ill health can continue to work, symptom severity can be reduced and suicide prevented. To identify whether organisational support meets staff needs, this research explored the perceptions and experiences of staff working in a large ambulance trust covering the south west of England.MethodsBetween September and October 2018, ambulance staff were invited to complete an online questionnaire, which assessed demographics, work-related stressful life events, related psychological impact assessed by the avoidant subscale of Weiss and Marmar’s Impact of Event Scale-Revised, mental ill health sickness absence during the previous 12 months, perceptions and experiences of organisational support and acceptability of a proposed wellbeing intervention offering mandatory time-to-talk at work.ResultsOver 11% (N=540) of the workforce responded. The majority reported experiencing work-related stressful life events (n=444; 82%), that were associated with subsequent avoidant symptoms. Avoidant symptom severity peaked between six-months to five-years after an event (F(5,438) = 2.4, p=0.03), was associated with repeated exposure (F(4,439) = 2.9, p=0.01) and to sickness absence. A fifth of participants reported mental ill health sickness absence (21.6%), a third of which was not disclosed as related to mental health. Content analysis identified stigma, fear, as well as embarrassment, as barriers to disclosure and help-seeking. Perceptions and experiences of organisational support were significantly correlated (r(195) =0.46, p<0.001) and positive.ConclusionsSymptoms associated with work-related stressful life events can persist for years among ambulance staff. Given the association between organisational support and mental wellbeing, it is possible that an intervention, such as mandatory time-to-talk, supported at an organisation level could improve wellbeing among ambulance staff. Such an intervention needs to be evaluated in future research.

BackgroundRandomised controlled trials have established that face-to-face cognitive therapy for posttraumatic stress disorder (CT-PTSD) based on Ehlers and Clark's cognitive model of PTSD is highly effective and feasible with low rates of dropout. Access to evidence-based psychological treatments for PTSD is insufficient. Several studies have shown that therapist-assisted treatment delivery over the Internet is a promising way of improving access to cognitive behavioural therapy interventions.ObjectiveTo develop an Internet version of CT-PTSD that significantly reduces therapist contact time without compromising treatment integrity or retention rates.MethodsWe describe the development of an Internet version of CT-PTSD. It implements all the key procedures of face-to-face CT-PTSD, including techniques that focus on the trauma memory, such as memory updating, stimulus discrimination and revisiting the trauma site, as well as restructuring individually relevant appraisals relating to overgeneralisation of danger, guilt, shame or anger, behavioural experiments and planning activities to reclaim quality of life. A cohort of 10 patients meeting DSM-IV criteria for PTSD worked through the programme, with remote guidance from a therapist, and they were assessed at pre- and post-treatment on PTSD outcome, mood, work and social adjustment and process measures.ResultsNo patients dropped out. Therapists facilitated the treatment with 192 min of contact time per patient, plus 57 min for reviewing the patient's progress and messages. Internet-delivered CT-PTSD was associated with very large improvements on all outcome and process measures, with 80% of patients achieving clinically significant change and remission from PTSD.ConclusionsInternet-delivered cognitive therapy for PTSD (iCT-PTSD) appears to be an acceptable and efficacious treatment. Therapist time was reduced to less than 25% of time in face-to-face CT-PTSD. Randomised controlled trials are required to evaluate systematically the acceptability and efficacy of iCT-PTSD.Highlights of the articleiCT-PTSD was acceptable to patients and associated with very large improvements on PTSD outcome and process measures.iCT-PTSD required substantially less therapist time than CT-PTSD.iCT-PTSD may be associated with changes in employment status.Randomised controlled trials are required to systematically evaluate the acceptability and efficacy of iCT-PTSD.

Background: Research has demonstrated that Cognitive Therapy for PTSD(CT-PTSD), a version of trauma-focused cognitive-behavioural therapy developed by Ehlers and Clark's group (2000), is effective and feasible when offered in weekly and intensive daily formats. It is unknown whether patients with post-traumatic stress disorder (PTSD) could engage in and benefit from self-study assisted cognitive therapy, which would reduce therapist contact time.Objectives:This case report aims to illustrate this possibility.Design:A patient with PTSD and comorbid major depression, who developed these problems following a road traffic accident, was treated in six sessions of cognitive therapy with six self-study modules completed in-between sessions. The patient made a complete recovery on measures of PTSD, anxiety, and depression as assessed by self-report and independent assessment.Conclusion:Self-study assisted cognitive CT-PTSD reduced the therapist contact time to half of that normally required in standard CT-PTSD. This highlights the potential feasibility and therapeutic benefits of self-study modules in the brief treatment of PTSD. Further research is required to systematically evaluate the acceptability and efficacy of brief self-study assisted CT-PTSD.For the abstract or full text in other languages, please see Supplementary files under Reading Tools online