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Responding to Violence, Suicide, Psychosis and Trauma

Professor helps train mental-health workers in Iraq

July 04, 2009

Victims of traumatic events sometimes get so hung up thinking about what happened to them that they can’t let go of their torment.

Rigid, “black-and-white kinds of thoughts” play over and over in their minds and keep them from moving forward in life, says University of Richmond researcher Kristen P. Lindgren.

“Those kinds of thoughts can keep people stuck in their lives,” she said.

A licensed clinical psychologist, Lindgren has studied a technique called cognitive processing therapy that helps people escape those thoughts.

She worked at the Department of Veterans Affairs hospital in Seattle with veterans of wars from Vietnam to Iraq. They suffer from post-traumatic stress disorder and depression, and Lindgren says the therapy was so helpful that the VA plans to use it as a treatment model nationally.

And now, it might also help victims of torture in Iraq.

Lindgren, an assistant professor of psychology at UR for the past year, recently spent eight intensive days training mental-health workers in the Kurdish region of Iraq.

Their goal is to help victims of the violence waged against the people of Kurdistan during the 1980s and 1990s.

It was the most attentive class she has ever had, Lindgren said. The workers, primarily physician assistants at community clinics who have limited opportunities for advanced training, were eager to learn new techniques.

“I’ve never had a group of students who were so focused and literally writing down every word,” she said.

Lindgren describes herself as “very much the junior partner” on the pilot project organized by Johns Hopkins University. The team included Johns Hopkins researchers Paul Bolton and Judith K. Bass, as well as Debra Kaysen, Lindgren’s mentor when she did postdoctoral studies at the University of Washington.

Lindgren hopes that if the mental-health workers find that the technique helps their patients, she can return to Iraq within the year to expand the training.

The therapy technique encourages people to identify thoughts that are stuck in their minds and to challenge that way of thinking, she said.

The patients learn to come up with thoughts that are more flexible but believable.

“It’s not about thinking with rosecolored glasses,” she said.

Lindgren is optimistic the treatment will help the Kurds. In Iraq, the technique had to be adapted to account for cultural differences. Self-esteem, for example, didn’t translate very well. “The closest we could get was respect,” Lindgren said.

They also had to account for illiteracy because the technique involves written homework for patients.

If the therapy with those adaptations proves successful in Iraq, that should help answer lingering questions about its worth back home, she said. Because the technique is research-based and developed in university settings, some still question how well the therapy works in the real world, she said.

“If this is not the real world, I don’t know what is in terms of getting outside the ivory tower.”

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Contact Karin Kapsidelis at (804) 649-6119 or kkapsidelis@timesdispatch.com. To see more of the Richmond Times-Dispatch, or to subscribe to the newspaper, go to http://www.timesdispatch.com. Copyright (c) 2009, Richmond Times-Dispatch, Va. Distributed by McClatchy-Tribune Information Services. For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

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Filed under: Other Mental Health, trauma, , , , ,

Training Curbs Anger And Aggression In Adolescents With Tourette Syndrome

Article Date: 24 Apr 2009
In the first study to gauge the benefits of anger control training in adolescents with Tourette syndrome (TS), researchers at the Yale Child Study Center have found that cognitive behavioral therapy is helpful for short-term improvement in anger and aggression. The study is reported in the April issue of the Journal of the American Academy of Child and Adolescent Psychiatry. Children and adolescents with TS, a disorder characterized by tics-involuntary, rapid, sudden movements and vocalizations occurring repeatedly in the same way-should also be evaluated for the presence of disruptive behavior problems, according to lead author Denis Sukhodolsky, associate research scientist in the Yale Child Study Center. “In some cases, these disruptive behavior problems can cause more impairment than tics,” he said. “If disruptive behavior is present, cognitive behavioral interventions such as anger control training could be recommended to reduce the levels of aggression.” Sukhodolsky and his team studied 26 children and adolescents with TS (24 boys and two girls between the ages and 11 and 15) with moderate to severe levels of oppositional and defiant behavior. They were randomly assigned to a group that received 10 sessions of anger management or to a control group that received their usual treatment for 10 weeks. When faced with frustrating situations during anger control training, the children role-played appropriate behavior. They were asked to identify and evaluate the consequences of various actions for themselves and others who were involved in hypothetical conflicts. The children were also asked to recall frustrating situations and to problem-solve and role play behavior that would have diffused the problem. They also completed homework to practice “anger coping” skills and share their experiences at the next session. At the end of treatment, parents reported that disruptive behavior decreased by 52 percent in the anger management group, compared with a decrease of 11 percent in the control group. Clinicians who were unaware of the treatment rated 69 percent of the children who completed anger management training as improved compared with 15 percent in the control group. Sukhodolsky said this improvement was well maintained at a three-month follow-up. He and colleagues plan to conduct larger clinical trials to confirm their results. The study is part of a clinical research program directed by Professor Lawrence Scahill to develop and test interventions for children and adolescents. Other authors on the study were Lawrence Vitulano, Deidre H. Carroll, Joseph McGuire, and James Leckman, M.D. Citation: J. Am, Acad. Child Adolesc. Psychiatry, 48: 4 (April, 2009) Links: Denis Sukhodolsky Lawrence Scahill Source YALE

Filed under: Other Mental Health, Violence, , , , ,