The Association Between Service Connection and Treatment Outcome in Veterans Undergoing Residential PTSD Treatment.

The Department of Veterans Affairs has invested significant time and resources into the treatment of posttraumatic stress disorder (PTSD). Despite concerted efforts, a significant portion of patients do not respond optimally to trauma-focused treatment. One of the factors that has been hypothesized to be associated with treatment response is participation in the Veterans Benefits Administration service-connected disability process. This factor may be particularly relevant in the residential treatment setting, where most participants are engaged in the compensation seeking process. We conducted a retrospective chart review of 105 veterans who completed Cognitive Processing Therapy (CPT) in a residential rehabilitation program. ANCOVAs that adjusted for baseline PTSD severity compared symptom change between those who were and were non-compensation seeking at the time of treatment. Compensation seeking status was associated with significantly less symptom improvement over the course of CPT after adjusting for baseline PTSD severity (F(1, 102) = 4.29, p < .001, η2 = .03). Sensitivity analyses did not detect a similar effect during a prior coping skills phase of treatment. During CPT, clinically significant change was met by 66.7% of non-compensation seeking veterans (M = -15, SD = 14.56) and by 40.1% of the compensation seeking group (M = -7.1, SD = 12.24). Compensation-seeking may be associated with reduced response to trauma-focused treatment in certain settings. Future research is needed to better understand the mechanisms underlying this effect.

Discriminating Coercive from Sadomasochistic Sexuality.

Sadomasochistic (SM) sexual interest is reported by a wide range of individuals. Within the sex offender literature, the presence of SM interest is often viewed as a herald of criminal sexual behavior; however, research indicates that SM interests are not predictive of coercive sexual behavior. In the current study, we measured a range of sexual fantasies and behaviors, and then applied cluster analyses to determine (1) if individuals endorsed elevated SM interests also endorsed coercive fantasies and, (2) to explore cluster membership correlates using measures of sensation seeking, externalizing and antisocial behaviors, attitudes toward rape, and empathic capacity. A total of 550 participants were recruited through a variety of on-line discussion areas. A four cluster solution best fit the data with distinct clusters observed for those endorsing SM behaviors and those reporting coercive sexual behavior. Additional analyses revealed greater endorsement of victim blaming attitudes and lower empathic concern among members of the coercive sexual behavior cluster. Elevated sensation seeking and externalizing behaviors were reported by members of clusters marked by SM and coercive sexual behavior. Results provide further support for the differentiation between SM and coercive sexual behaviors as representative of individuals with divergent attitudes, traits, and behaviors.

Social anxiety and the accuracy of predicted affect.

Social anxiety is theorised to arise from sustained over-activation of a mammalian evolved system for detecting and responding to social threat with corresponding diminished opportunities for attaining the pleasure of safe attachments. Emotional forecasting data from two holidays were used to test the hypothesis that greater social anxiety would be associated with decreased expectations of positive affect (PA) and greater anticipated negative affect (NA) on a holiday marked by group celebration (St. Patrick's Day) while being associated with greater predicted PA for daters on a romantic holiday (Valentine's Day). Participants completed symptom reports, made affective forecasts and provided multiple affect reports throughout each holiday. Higher levels of social anxiety were associated with greater anticipated PA for Valentine's Day daters, but lower experienced PA on the holiday; this was not found for trait anxiety and depression. Alternatively, trait anxiety, depression and social anxiety were associated with less predicted PA for St. Patrick's Day, greater anticipated NA and diminished experienced PA/greater NA during the holiday. Results are discussed in light of perceived hope for rewarding safe emotional contact for those daters in contrast to the greater possibility for social threat associated with group celebration typical of St. Patrick's Day.