Initiating Cognitive Processing Therapy (CPT) in Community Settings: A Qualitative Investigation of Therapist Decision-Making.

Various organizations have provided treatment guidelines intended to aid therapists in deciding how to treat posttraumatic stress disorder (PTSD). Yet evidence-based psychotherapies (EBPs) for PTSD in the community may be difficult to obtain. Although strides have been made to implement EBPs for PTSD in institutional settings such as the United States Veterans Affairs, community uptake remains low. Factors surrounding clients' decisions to enroll in EBPs have been identified in some settings; however less is known regarding trained therapists' decisions related to offering trauma-focused therapies or alternative treatment options. Thus, the aim of the current study was to examine therapist motivations to initiate CPT in community settings. The present study utilizes data from a larger investigation aiming to support the sustained implementation of Cognitive Processing Therapy (CPT) in community mental health treatment settings. Enrolled therapists participated in phone interviews discussing their opinions of CPT, preferred treatments for PTSD, and process in assessing appropriate PTSD treatments for clients. Semi-structured interviews (N = 29) were transcribed and analyzed using a directed content analysis approach. Several themes emerged regarding therapists' decision-making in selecting PTSD treatments. Therapist motivations to use EBPs for PTSD, primarily CPT, were identified at the client (e.g., perceived compatibility with client-level characteristics), therapist (e.g., time limitations), and clinic levels (e.g., leadership support). The results provide insight into the complex array of factors that affect sustainability of EBPs for PTSD in community settings and inform future dissemination of EBPs, including training efforts in community settings.

Plasma levels of one-carbon metabolism nutrients in women with anorexia nervosa.

OBJECTIVE: People who are ill with anorexia nervosa (AN) show altered availability of key plasma nutrients. However, little is known about the patterning of alterations that occurs across diverse nutrients during active phases of illness or about the persistence of any such alterations following remission of illness. METHOD: We compared plasma levels of one-carbon metabolism nutrients across women with active AN (AN-Active: n = 53), in remission from AN (AN-Remitted: n = 40), or who had no eating-disorder history (NED: n = 36). We also tested associations between body mass index (BMI) changes and changes in pre- to posttreatment nutrient levels, and explored the association between nutrient levels, on the one hand, and BMI and eating symptoms, on the other. Choline, betaine, and methionine were analyzed using mass spectrometry. Folate and B12 were analyzed using the AccuBind® ELISA kit. Eating-disorder symptoms were assessed by interview and self-report. RESULTS: Compared to NED individuals, AN-Active individuals exhibited significantly elevated B12 and (less-reliably) betaine. In AN-Active individuals, lower BMI was associated with higher B12. DISCUSSION: The observed alterations run contrary to the intuition that plasma nutrient levels should be directly responsive to nutritional status and suggest, instead, the existence of compensatory adaptations to malnutrition in individuals with active AN. Further study is required to clarify mechanisms that underlie such effects.

Recognition of vocal socioemotional expressions at varying levels of emotional intensity.

Nonverbal expressions of emotion can vary in intensity, from ambiguous to prototypical exemplars: for instance, facial displays of happiness may range from a faint smile to a full-blown grin. Previous work suggests that the accuracy with which facial expressions are recognized as the intended emotion increases with emotional intensity, although this pattern depends on the displayed emotion. Less is known about the association between emotional intensity and the recognition of vocal emotional expressions (affective prosody), which also convey information about others' socioemotional intent but are perceived and interpreted differently than facial expressions. The current study examined listeners' ability to recognize emotional intent in morphed vocal prosody recordings that varied in emotional intensity from neutral to prototypical exemplars of basic emotions (anger, disgust, fear, happiness, sadness) and social expressions (friendliness, meanness). Results suggest that listeners' accuracy in identifying the intended emotional intent in each recording increased nonlinearly with emotional intensity. This pattern varied by emotion type: for instance, accuracy for anger rose steeply with increasing emotional intensity before plateauing, whereas accuracy for happiness remained unchanged across low-intensity exemplars but increased thereafter. These findings highlight emotion-specific ways in which dynamic changes in emotional intensity inform perceptions of socioemotional intent in emotional prosody. Moreover, these results also point to potential challenges in emotional communication in social interactions that rely primarily on the voice, with many low-intensity expressions having a higher probability of being misinterpreted. (PsycInfo Database Record (c) 2021 APA, all rights reserved).