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This article discusses the complexities of treating posttraumatic stress disorder (PTSD) and the importance of tailoring therapy to individual patients. The author presents a case study of a man named John who experiences acute stress disorder (ASD) and later develops PTSD after the sudden death of his fiancée. The therapist uses a combination of psychoeducation, cognitive restructuring, and exposure therapy to help John process his guilt and traumatic memories. The article emphasizes the need for therapists to listen to their patients, adapt treatment plans, and acknowledge their own limitations. [Extracted from the article]

Prediction of treatment response to trauma-focused psychotherapy remains a difficult task. This study evaluated treatment response to Brief Eclectic Psychotherapy for posttraumatic stress disorder (BEPP) dependent on pre-treatment variables, symptom progression, and manual adherence. We tested differences in pre-treatment variables and symptom time course between treatment responders and non-responders in 27 patients, using exact regression analyses and general linear models. Associations of therapists´ adherence to the treatment manual during different therapy phases with response status were also studied using independent samples t-test. Lower education and complete inability to work were negatively related to therapy outcome. Significant differences in symptom time course between responders and non-responders were detected from session nine onwards, whereas adherence to treatment was not related to outcome during any treatment phase. Our results indicate that early identification of treatment response may meaningfully expand previous research on outcome predicton based on pre-treatment variables in trauma-focused psychotherapy. Furthermore, adaptations of treatment protocols for specific groups of patients with increased risk of poor treatment outcomes may be advisable. If replicated by more naturalistic designs, our results could contribute towards limiting the requirement of strict manual adherence to efficacy studies in posttraumatic stress disorder treatment research.

Objective: Decreased heart rate variability (HRV) has been reported to be a predictor of mortality after myocardial infarction (MI). Patients beliefs and perceptions concerning their illness may play a role in decreased HRV. This study investigated if illness perceptions predict HRV at 3 months following acute MI. Methods: 130 patients referred to a tertiary cardiology center, were examined within 48 h and 3 months following acute MI. At admission, patients cognitive representations of their MI were assessed using the German version of the self-rated Brief Illness Perception Questionnaire (Brief IPQ). At admission and after 3 months (follow-up), frequency and time domain measures of HRV were obtained from 5-min electrocardiogram (ECG) recordings during stable supine resting. Results: Linear hierarchical regression showed that the Brief IPQ dimensions timeline (β coefficient = 0.29; p = 0.044), personal control (β = 0.47; p = 0.008) and illness understanding (β = 0.43; p = 0.014) were significant predictors of HRV, adjusted for age, gender, baseline HRV, diabetes, beta-blockers, left ventricular ejection fraction (LVEF), attendance of cardiac rehabilitation, and depressive symptoms. Conclusions: As patients negative perceptions of their illness are associated with lower HRV following acute MI, a brief illness perception questionnaire may help to identify patients who might benefit from a specific illness perceptions intervention.

Clinical interviewing is the basic method to understand how a person feels and what are the presenting complaints, obtain medical history, evaluate personal attitudes and behavior related to health and disease, give the patient information about diagnosis, prognosis, and treatment, and establish a bond between patient and physician that is crucial for shared decision making and self-management. However, the value of this basic skill is threatened by time pressures and emphasis on technology. Current health care trends privilege expensive tests and procedures and tag the time devoted to interaction with the patient as lacking cost-effectiveness. Instead, the time spent to inquire about problems and life setting may actually help to avoid further testing, procedures, and referrals. Moreover, the dialogue between patient and physician is an essential instrument to increase patient's motivation to engage in healthy behavior. The aim of this paper was to provide an overview of clinical interviewing and its optimal use in relation to style, flow and hypothesis testing, clinical domains, modifications according to settings and goals, and teaching. This review points to the primacy of interviewing in the clinical process. The quality of interviewing determines the quality of data that are collected and, eventually, of assessment and treatment. Thus, interviewing deserves more attention in educational training and more space in clinical encounters than it is currently receiving. [ABSTRACT FROM AUTHOR]

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