Positive Reinforcement

“Clients should always be positively reinforced for expressing their doubts and concerns about therapy or the therapist. ”

Judith S. BeckBeck JSB Portait

Veterans with TBI and Suicidality

NewStudy-Graphic-72x72_edited-3Previous research has shown that, in recent years, there has been an increased rate of suicide in soldiers returning from war.  In addition, as many as 15-23% of returning soldiers have incurred traumatic brain injuries (TBI). A new study published in Rehabilitation Psychology aimed to identify risk and protective factors for suicide ideation or suicidal behavior among veterans who have experienced TBI.

Thirteen suicidal veterans in a TBI clinic completed 30 to 60 minute interviews that included structured questionnaires regarding suicidality, methods of coping/seeking support, and military service. Researchers identified a post-injury loss of sense of self, cognitive deficits secondary to TBI, and psychiatric and emotional difficulties as precipitating factors for suicide ideation or suicidal behavior. Social support, a sense of purpose and hopefulness, religion or spirituality, and mental health treatment were identified as protective factors.

This study helps to identify those precipitating factors that practitioners should target when working with a similar population. The authors note that concepts associated with perceived burdensomeness and thwarted belonging can be targeted using cognitive and behavioral strategies along with techniques that encourage the client to re-conceptualize his or her worth and meaning to others.


Brenner, L. A., Homaifar, B. Y., Adler, L. E., Wolfman, J. H., & Kemp, J. (2009). Suicidality and veterans with a history of traumatic brain injury: Precipitating events, protective factors, and prevention strategies. Rehabilitation Psychology, 54, 390-397.

Nervous Extramural Trainees


We are holding a two-day workshop for our extramural trainees today and tomorrow. Many new mental health professionals are just starting the program and will be sending an audiotape or CD of a therapy session to their supervisor next week. As usual, at least several are having automatic thoughts about sending the recordings—they’re nervous about what their supervisor will think. I gave them an analogy. If they were starting tennis lessons, the tennis pro wouldn’t care if they were novice, intermediate, or advanced players. He or she would just hope to advance them from where they’re starting. I hope this allayed their anxiety! We don’t have expectations of where any of our trainees start. We just hope we’ll be able to improve their proficiency.

Judith S. Beck, Ph.D., Director

PTSD Symptoms Benefited by Early Intervention CBT

NewStudy-Graphic-72x72_edited-3 A recent meta-analysis published in the American Journal of Psychiatry found trauma-focused Cognitive Behavioral Therapy (CBT) delivered within a 3-month period of traumatic events to be effective in the treatment of trauma-induced stress symptoms for patients with PTSD or acute stress disorder.

Research has demonstrated the effectiveness of “multiple-session trauma-focused psychological interventions to treat chronic PTSD,” but little had been done to evaluate the efficacy of early interventions. The present study analyzed randomized controlled trials of early interventions, assessing efficacy, the population receiving the greatest benefit, the best modalities of treatment, and the optimal timing of treatment.

The researchers performed a meta-analysis and systematic review of 25 studies whose interventions were designed to treat or prevent PTSD within 3 months of a traumatic event. The authors found that trauma-focused CBT was significantly more effective for patients than usual care or being on waiting lists in terms of reducing stress symptoms of trauma. The magnitude of the effects varied for this finding; CBT was found to be most effective for individuals diagnosed with acute PTSD or acute stress disorder. Participants who did not meet the diagnostic criteria of a psychological stress disorder gained only minimal benefits from trauma-focused CBT.

The authors concluded that trauma-focused CBT should be offered to patients suffering from acute PTSD or acute stress disorder. They also noted that further investigation could determine whether trauma-focused CBT should become part of initial screening programs for patients who have experienced major traumatic events.

Study authors: N. P. Roberts, N. J. Kitchiner, J. Kenardy, J. I. Bisson