RESUMEN
Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) are first-line treatments for posttraumatic stress disorder (PTSD) and have been disseminated throughout the U.S. Veterans Health Administration. Treatment non-completion is common and lessens clinical effectiveness; however, prior work has failed to identify factors consistently associated with non-completion. Semi-structured interviews were conducted with a national sample of veterans who recently completed (n = 60) or did not complete (n = 66) PE or CPT. Non-completer interviews focused on factors that contributed to veterans' decisions to drop out and efforts undertaken to complete PE/CPT. Completer interviews focused on challenges faced in completing treatment and facilitators of completion. Transcripts were coded using a mixed deductive/inductive approach; constant comparison was used to identify differences between completers and non-completers. Completers and non-completers differed in the extent of treatment-specific therapist support received, therapists' flexibility in treatment delivery, the type of encouragement offered by the care team and social supports, their interpretation of symptom worsening, the perceived impact of treatment on functioning, and the impact of stressors on their treatment engagement. Treatment-specific therapist support, more patient-centered and flexible treatment delivery, leveraging the full care team, and addressing functional concerns are potential targets for PE and CPT engagement interventions.
Asunto(s)
Terapia Cognitivo-Conductual , Terapia Implosiva , Trastornos por Estrés Postraumático , Veteranos , Humanos , Pacientes Desistentes del Tratamiento , Trastornos por Estrés Postraumático/psicología , Trastornos por Estrés Postraumático/terapia , Veteranos/psicologíaRESUMEN
The extent of intraspecific variation in trait-environment relationships is an open question with limited empirical support in crops. In organic agriculture, with high environmental heterogeneity, this knowledge could guide breeding programs to optimize crop attributes. We propose a three-dimensional framework involving crop performance, crop traits, and environmental axes to uncover the multidimensionality of trait-environment relationships within a crop. We modeled instantaneous photosynthesis (Asat ) and water-use efficiency (WUE) as functions of four phenotypic traits, three soil variables, five carrot (Daucus carota) varieties, and their interactions in a national participatory plant breeding program involving a suite of farms across Canada. We used these interactions to describe the resulting 12 trait-environment relationships across varieties. We found one significant trait-environment relationship for Asat (taproot tissue density-soil phosphorus), which was consistent across varieties. For WUE, we found that three relationships (petiole diameter-soil nitrogen, petiole diameter-soil phosphorus, and leaf area-soil phosphorus) varied significantly across varieties. As a result, WUE was maximized by different combinations of trait values and soil conditions depending on the variety. Our three-dimensional framework supports the identification of functional traits behind the differential responses of crop varieties to environmental variation and thus guides breeding programs to optimize crop attributes from an eco-evolutionary perspective.
Asunto(s)
Agricultura Orgánica , Fitomejoramiento , Fenotipo , Fósforo , Hojas de la Planta , Suelo , AguaRESUMEN
Tens of thousands of child sexual abuse (CSA) cases are reported to authorities annually. Although some of the child victims obtain psychological counseling or therapy, controversy exists about the potential consequences for the accuracy of victims' memory of CSA, both in childhood and adulthood. Yet, delaying needed therapeutic intervention may have detrimental effects on the victims' well-being and recovery. To address this controversy, this study examined whether psychological counseling during a CSA prosecution predicts accuracy or inaccuracy of long-term memory for CSA. Participants (N = 71) were CSA victims who took part in a longitudinal study of memory and legal involvement. Data regarding participants' counseling attendance during the prosecution and details of their CSA cases were gathered throughout legal involvement and shortly thereafter (Time 1). Ten to 16 years later (Time 2), participants were questioned about a range of topics, including the alleged abuse. Time 1 counseling attendance significantly predicted more correct answers to abuse-related questions and (for corroborated cases) fewer overreporting responses at Time 2. Counseling was unrelated to underreporting responses. These results held even with other potential influences, such as abuse severity, victim-defendant relationship, posttraumatic stress disorder criteria met, testifying in the case, and delay, were statistically controlled. Although further research is needed, this study provides evidence that psychological counseling received by CSA victims during or shortly after prosecutions may improve later memory for abuse-related information. (PsycINFO Database Record