Factor structure and psychometric performance of the PCL-5 in a clinical sample of veterans seeking treatment in a VA PTSD outpatient clinic.

There is a clear need to improve the measurement of posttraumatic symptoms in veterans seeking trauma-focused treatment. We evaluated the structure and psychometric performance of the Posttraumatic Stress Disorder (PTSD) Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5) in a naturalistic sample of veterans engaging in evidence-based therapy in a Veterans Affairs (VA) PTSD outpatient clinic. We collected data from 500 sequential patients at the beginning and end of treatment, evaluating the PCL-5 factor structure followed by psychometric analyses. Results align with recent research following rigorous methods and advanced statistical techniques in suggesting a unidimensional factor structure for the PCL-5, with indications for its items representing a general factor with no clear support for multiple factors or subscales aligned with specific symptom clusters. In addition, psychometric analyses suggest a wider range of potential cutoff scores predicting PTSD diagnosis that may be specific to this population or setting. Given the remaining research questions surrounding the PCL-5 and its structure and functioning specifically, as well as the evolving conceptualizations of PTSD as a psychological disorder, further research is needed to guide clinical practice and future research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Metacognitive Reflection and Insight Therapy (MERIT) for Persons With a Schizophrenia Spectrum Disorder and Interpersonal Trauma.

Schizophrenia often involves a loss of metacognitive capacity, the ability to form complex and integrated representations of self and others. Independent of symptoms and neurocognition, deficits in synthetic metacognition are related to difficulties engaging in goal-directed activities in social and vocational settings. Against this backdrop, the authors provide a case report of the effects of metacognitive reflection and insight therapy (MERIT) provided over the course of seven months to assist a client with persistent schizophrenia. Eight elements of MERIT that stimulate and promote metacognitive capacity are presented. As illustrated in this article, these elements helped the client to move from a state in which he had virtually no complex ideas about himself or others to one in which he had developed integrated and realistic ideas about his own identity and that of others. He then could use these representations to understand and effectively respond to life challenges.