The Role of Theory-Specific Techniques and Therapeutic Alliance in Promoting Positive Outcomes: Integrative Psychotherapy for World Trade Center Responders.

World Trade Center responders demonstrate high symptom burden, underscoring the importance of refining treatment approaches for this cohort. One method is examining the impact of therapy techniques on outcomes, and the interactions between technique and alliance on outcomes. This study a) examined the interaction of early treatment techniques on integrative psychotherapy outcomes and b) explored whether associations differed at varying levels of alliance. Twenty-nine adult responders diagnosed with partial or full posttraumatic stress disorder received outpatient psychotherapy and completed weekly measures of alliance, technique, and symptom distress. Analyses indicated significant interactions between 1) alliance and psychodynamic interventions on outcomes and 2) alliance and cognitive behavioral (CB) interventions on outcomes. Clients with high alliance had better outcomes when their therapist used fewer CB techniques. No meaningful differences were found between technique and outcomes for clients with lower alliance. These findings reiterate the critical roles technique and responsiveness to the alliance play in engendering successful outcomes.

Sudden gains and deteriorations in the treatment of posttraumatic stress disorder in World Trade Center responders.

This study sought to examine the prevalence of sudden gains and deteriorations (i.e., symptom reduction/improvement during treatment) and their influence on treatment outcomes among World Trade Center responders with probable posttraumatic stress disorder. Thirty-six outpatient clients received at least three sessions of integrative psychotherapy, which included elements of psychodynamic and cognitive-behavioral therapy approaches, under routine clinical conditions. Approximately 19% of clients experienced a sudden gain and 27% of clients experienced a sudden deterioration. Those who experienced deteriorations had worse therapy outcomes compared with those who did not. Clinical implications are discussed, including the importance of routine monitoring of client treatment response for sudden deteriorations to enhance positive treatment outcomes. Future research with larger samples is needed to further evaluate the mechanisms of sudden gains and sudden deteriorations in this population.

Perceived discrimination and its association with psychological distress among newly arrived immigrants before and after September 11, 2001.

OBJECTIVES: We compared the evolution of perception of discrimination from 1998 to 2007 among recent Arab (Muslim and non-Muslim) and Haitian immigrants to Montreal; we also studied the association between perception of discrimination and psychological distress in 1998 and 2007. METHODS: We conducted this cross-sectional comparative research with 2 samples: one recruited in 1998 (n = 784) and the other in 2007 (n = 432). The samples were randomly extracted from the registry of the Ministry of Immigration and Cultural Communities of Quebec. Psychological distress was measured with the Hopkins Symptom Checklist-25. RESULTS: The perception of discrimination increased from 1998 to 2007 among the Arab Muslim, Arab non-Muslim, and Haitian groups. Muslim Arabs experienced a significant increase in psychological distress associated with discrimination from 1998 to 2007. CONCLUSIONS: These results confirm an increase in perception of discrimination and psychological distress among Arab Muslim recent immigrant communities after September 11, 2001, and highlight the importance this context may have for other immigrant groups.

Looking for resilience: understanding the longitudinal trajectories of responses to stress.

Taking advantage of two large, population-based, and longitudinal datasets collected after the 1999 floods in Mexico (n=561) and the September 11, 2001 terrorist attacks in New York (n=1267), we examined the notion that resilience may be best understood and measured as one member of a set of trajectories that may follow exposure to trauma or severe stress. We hypothesized that resistance, resilience, recovery, relapsing/remitting, delayed dysfunction, and chronic dysfunction trajectories were all possible in the aftermath of major disasters. Semi-parametric group-based modeling yielded the strongest evidence for resistance (no or mild and stable symptoms), resilience (initially moderate or severe symptoms followed by a sharp decrease), recovery (initially moderate or severe symptoms followed by a gradual decrease), and chronic dysfunction (moderate or severe and stable symptoms), as these trajectories were prevalent in both samples. Neither Mexico nor New York showed a relapsing/remitting trajectory, and only New York showed a delayed dysfunction trajectory. Understanding patterns of psychological distress over time may present opportunities for interventions that aim to increase resilience, and decrease more adverse trajectories, after mass traumatic events.