Effectiveness of an Anger Intervention for Military Members with PTSD: A Clinical Case Series.

OBJECTIVE: Problematic anger is a significant clinical issue in military personnel, and is further complicated by comorbid post-traumatic stress disorder (PTSD). Despite increasing numbers of military personnel returning from deployment with anger and aggression difficulties, the treatment of problematic anger has received scant attention. There are currently no interventions that directly target problematic anger in the context of military-related PTSD. The aim of this case series is to examine the effectiveness of an intervention specifically developed for treating problematic anger in current serving military personnel with comorbid PTSD. METHODS: Eight Australian Defence Force Army personnel with problematic anger and comorbid PTSD received a manualized 12-session cognitive behaviorally based anger intervention, delivered one-to-one by Australian Defence Force mental health clinicians. Standardized measures of anger, PTSD, depression, and anxiety were administered pre- and post-treatment. RESULTS: The initial mean severity scores for anger indicated a high degree of pre-treatment problematic anger. Anger scores reduced significantly from pre to post-treatment (d = 1.56), with 88% of participants exhibiting meaningful reduction in anger scores. PTSD symptoms also reduced significantly (d = 0.96), with 63% of participants experiencing a clinically meaningful reduction in PTSD scores. All of those who took part in the therapy completed all therapy sessions. CONCLUSIONS: This brief report provides preliminary evidence that an intervention for problematic anger not only significantly reduces anger levels in military personnel, but can also significantly reduce PTSD symptoms. Given that anger can interfere with PTSD treatment outcomes, prioritizing anger treatment may improve the effectiveness of PTSD interventions.

Preliminary outcomes of implementing cognitive processing therapy for posttraumatic stress disorder across a national veterans' treatment service.

BACKGROUND: Posttraumatic stress disorder (PTSD) is a significant problem for military veterans. There is an international imperative to improve access to effective treatments, but more research is needed to ascertain the extent to which treatments found to be efficacious in research settings translate to successful national implementation efforts. METHOD: This study reports the clinical outcomes for the first 100 clients treated following the implementation of cognitive processing therapy (CPT) across a national community-based veterans' mental health service that commenced in May 2012. The implementation included training and ongoing clinical supervision, leadership support, and updates to the service's data collection and intake system to support the delivery of CPT. The service implemented an intake screen (the Primary Care PTSD) that was used to allocate clients who screened positive for PTSD to CPT-trained therapists. An outcome measure for PTSD (the PTSD Checklist) was incorporated into the services' computerized records system. Clients who received CPT were assessed pretreatment and posttreatment. RESULTS: Statistically significant and clinically large improvements were found for self-reported PTSD (effect size = 1.01, P < .001). In addition, the study obtained high levels of treatment fidelity in the delivery of the CPT treatment. CONCLUSIONS: There is relatively little published research supporting the effectiveness of evidence-based PTSD treatments following national implementation efforts. This is the first study to systematically report CPT treatment outcomes from a national implementation effort, using service-based outcome monitoring data. Results indicate that when administered as part of routine clinical practice, CPT achieves large clinically significant improvements for PTSD comparable with those found in randomized controlled trials.

Numerical thought with and without words: Evidence from indigenous Australian children.

Are thoughts impossible without the words to express them? It has been claimed that this is the case for thoughts about numbers: Children cannot have the concept of exact numbers until they know the words for them, and adults in cultures whose languages lack a counting vocabulary similarly cannot possess these concepts. Here, using classical methods of developmental psychology, we show that children who are monolingual speakers of two Australian languages with very restricted number vocabularies possess the same numerical concepts as a comparable group of English-speaking indigenous Australian children.

The role of language in mathematical development: evidence from children with specific language impairments.

A sample (n=48) of eight-year-olds with specific language impairments is compared with age-matched (n=55) and language matched controls (n=55) on a range of tasks designed to test the interdependence of language and mathematical development. Performance across tasks varies substantially in the SLI group, showing profound deficits in production of the count word sequence and basic calculation and significant deficits in understanding of the place-value principle in Hindu-Arabic notation. Only in understanding of arithmetic principles does SLI performance approximate that of age-matched-controls, indicating that principled understanding can develop even where number sequence production and other aspects of number processing are severely compromised.

Age-related invariance of abilities measured with the Wechsler Adult Intelligence Scale--III.

Examination of measurement invariance tests the assumption that the model underlying a set of test scores is directly comparable across groups. The observation of measurement invariance provides fundamental evidence for the inference that scores on a test afford equivalent measurement of the same psychological traits among diverse groups. Groups may be derived from different psychosocial backgrounds or different clinical presentations. In the Wechsler Adult Intelligence Scale-III (WAIS-III)/Wechsler Memory Scale-III (WMS-III) Technical Manual (Psychological Corporation, 2002), there appears to be a breakdown in factor structure among the standardization cases in older adults. In this study, the authors evaluated the invariance of the measurement model of the WAIS-III across 5 age bands. All components of the measurement model were examined. Overall, the evidence pointed to invariance across age of a modified 4-factor model that included cross-loadings for the Similarities and Arithmetic subtests. These results support the utility of the WAIS-III as a measure of stable intelligence traits across a wide age range.