Patricia T. Spangler- PhD
- Professor (Assistant) at Uniformed Services University of the Health Sciences
Patricia T. Spangler
- PhD
- Professor (Assistant) at Uniformed Services University of the Health Sciences
About
50
Publications
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Introduction
Patricia T. Spangler is a research psychologist at the Center for the Study of Traumatic Stress, Uniformed Services University, where she investigates treatments for PTSD in military personnel and veterans. Because sleep symptoms present a significant obstacle to recovery, she is focused on developing treatments for posttraumatic nightmares and insomnia and is currently piloting Nightmare Deconstruction and Reprocessing, including investigation of biomarkers (HRV/EDA) of treatment response.
Current institution
Additional affiliations
March 2015 - present
June 2013 - present
September 2011 - March 2013
Publications
Publications (50)
Objectives:
Our objectives were to describe the frequency of therapists' dreams about their clients and clients' dreams about their therapists, to determine how therapists and clients who had such dreams differed from those who did not have such dreams, whether therapy process and outcome differed for those who had and did not have such dreams, an...
Nine adults who worked at least 1 year with patients at US hospice centers completed an in-person audiotaped dream session focusing on a dream about a patient. Data were analyzed using consensual qualitative research. Patients were generally manifestly present in participants' dreams, and dreams were typically realistic (ie, not bizarre). In the dr...
Forty-seven psychoanalytic therapists completed a questionnaire about dream work. Overall, results indicated that therapists had very positive attitudes toward dreams, worked with their own dreams, sought out dream training, and felt competent working with dreams. Therapists estimated that they worked with dreams with about half of their clients ab...
The authors coded 67 dreams into 5 categories for interpersonal content (7 positive, 20 negative, 9 agency, 16 nightmares, and 15 noninterpersonal); an additional 90 dreams were excluded because they had multiple or ambiguous interpersonal themes. The authors then compared the process (client involvement and therapist competence) and outcome (insig...
The authors interviewed eight experienced therapists regarding their dreams about clients and analyzed the transcribed interview data using consensual qualitative research. Results indicated that dreams typically were about difficulties with clients, intense personal concerns, and negative interpersonal interactions. Therapists used multiple method...
This book is based on the assumption that skills and methods contribute to the outcome of psychotherapy in addition to many other elements, such as the client, the therapist, the therapeutic relationship, and external factors. We suggest that what therapists do makes a meaningful difference, although there are often a number of skills and methods t...
This book is based on the assumption that skills and methods contribute to the outcome of psychotherapy in addition to many other elements, such as the client, the therapist, the therapeutic relationship, and external factors. We suggest that what therapists do makes a meaningful difference, although there are often a number of skills and methods t...
This book is based on the assumption that skills and methods contribute to the outcome of psychotherapy in addition to many other elements, such as the client, the therapist, the therapeutic relationship, and external factors. We suggest that what therapists do makes a meaningful difference, although there are often a number of skills and methods t...
This book is based on the assumption that skills and methods contribute to the outcome of psychotherapy in addition to many other elements, such as the client, the therapist, the therapeutic relationship, and external factors. We suggest that what therapists do makes a meaningful difference, although there are often a number of skills and methods t...
This book is based on the assumption that skills and methods contribute to the outcome of psychotherapy in addition to many other elements, such as the client, the therapist, the therapeutic relationship, and external factors. We suggest that what therapists do makes a meaningful difference, although there are often a number of skills and methods t...
This book is based on the assumption that skills and methods contribute to the outcome of psychotherapy in addition to many other elements, such as the client, the therapist, the therapeutic relationship, and external factors. We suggest that what therapists do makes a meaningful difference, although there are often a number of skills and methods t...
This book is based on the assumption that skills and methods contribute to the outcome of psychotherapy in addition to many other elements, such as the client, the therapist, the therapeutic relationship, and external factors. We suggest that what therapists do makes a meaningful difference, although there are often a number of skills and methods t...
This book is based on the assumption that skills and methods contribute to the outcome of psychotherapy in addition to many other elements, such as the client, the therapist, the therapeutic relationship, and external factors. We suggest that what therapists do makes a meaningful difference, although there are often a number of skills and methods t...
This book is based on the assumption that skills and methods contribute to the outcome of psychotherapy in addition to many other elements, such as the client, the therapist, the therapeutic relationship, and external factors. We suggest that what therapists do makes a meaningful difference, although there are often a number of skills and methods t...
This book is based on the assumption that skills and methods contribute to the outcome of psychotherapy in addition to many other elements, such as the client, the therapist, the therapeutic relationship, and external factors. We suggest that what therapists do makes a meaningful difference, although there are often a number of skills and methods t...
This book is based on the assumption that skills and methods contribute to the outcome of psychotherapy in addition to many other elements, such as the client, the therapist, the therapeutic relationship, and external factors. We suggest that what therapists do makes a meaningful difference, although there are often a number of skills and methods t...
This book is based on the assumption that skills and methods contribute to the outcome of psychotherapy in addition to many other elements, such as the client, the therapist, the therapeutic relationship, and external factors. We suggest that what therapists do makes a meaningful difference, although there are often a number of skills and methods t...
This book is based on the assumption that skills and methods contribute to the outcome of psychotherapy in addition to many other elements, such as the client, the therapist, the therapeutic relationship, and external factors. We suggest that what therapists do makes a meaningful difference, although there are often a number of skills and methods t...
This book is based on the assumption that skills and methods contribute to the outcome of psychotherapy in addition to many other elements, such as the client, the therapist, the therapeutic relationship, and external factors. We suggest that what therapists do makes a meaningful difference, although there are often a number of skills and methods t...
This book is based on the assumption that skills and methods contribute to the outcome of psychotherapy in addition to many other elements, such as the client, the therapist, the therapeutic relationship, and external factors. We suggest that what therapists do makes a meaningful difference, although there are often a number of skills and methods t...
Clinical Impact Statement
Question: This article describes one method for working with dreams and three methods for working with nightmares in psychotherapy and presents empirical evidence of the efficacy of these methods. Findings: We provide definitions of key terms, clinical examples of each approach, empirical evidence of the efficacy of each a...
Posttraumatic stress disorder (PTSD) is a significant problem for military service members. For many, PTSD symptoms do not fully remit with available treatments; however, little is known about patients with medication-resistant PTSD. The present research sought to examine the complex relationship of PTSD to patients’ quality of life (QoL) utilizing...
Objective:
Current pharmacologic treatments for posttraumatic stress disorder (PTSD) have shown limited efficacy, prompting a call to investigate new classes of medications. The current study investigated the efficacy of glutamate modulation with riluzole augmentation for combat-related PTSD symptoms resistant to treatment with selective serotonin...
Background:
Suicidal thoughts are common among veterans with posttraumatic stress disorder (PTSD). The aim of this study was to examine the prevalence and correlates of four courses of suicidal (SI) among veterans receiving residential PTSD treatment.
Methods:
A total of 1,807 veterans receiving residential PTSD treatment at Department of Vetera...
Using consensual qualitative research (CQR), we analyzed 13 interviews of experienced psychotherapists about general intentions for therapist self-disclosure (TSD), experiences with successful TSDs, experiences with unsuccessful TSDs, and instances of unmanifested urges to disclose. For TSD generally (i.e., not about a specific instance), typical i...
The essence of psychotherapy is embodied in the therapist (Wampold, 2013). Some therapists seem to be more effective than others, and even these therapists are differentially effective (e.g., Kraus, Castonguay, Boswell, Nordberg, & Hayes, 2011).
Recent surveys of therapists needs have focused on their needs of psychotherapy research (Tasca et al.,...
The increased prevalence of post-traumatic stress disorder (PTSD) among military personnel and veterans in the OEF/OIF/OND era has highlighted the challenges of treating PTSD and nightmares and other sleep disturbances which are among the most common refractory symptoms. This chapter introduces a psychotherapy called Nightmare Deconstruction and Re...
Both a manual on the various methods for working with dreams and an easily understandable description about dreamwork methods and PTSD nightmares for general readers, this book will benefit psychotherapists, counselors, academics, and students.
Working with Dreams and PTSD Nightmares: 14 Approaches for Psychotherapists and Counselors is an essentia...
Because current treatments for PTSD are suboptimal, there is an urgent need to develop novel treatments that
rapidly and robustly improve symptoms. Drugs that reduce glutamate activity may help reverse loss of
neuronal integrity and focal atrophy in brain regions implicated in PTSD pathophysiology (e.g., the
hippocampus). Riluzole is a glutamate mo...
The cognitive-experiential dream model was developed as a means for studying the effects of working with dreams in therapy. It provides clarity and structure that allow for training, replicability, and adherence checks in a research setting. The model comprises three stages: exploration, insight, and action. Assumptions underlying the model are tha...
We investigated changes over 12 to 42 months in 23 predoctoral trainees during their externship training in a psychodynamic/interpersonal psychotherapy clinic. Over time, trainees increased in client-rated working alliance and real relationship, therapist-rated working alliance, client-rated interpersonal functioning, ability to use helping skills...
We compare the results of a series of studies (Chui et al., Jackson et al.,
and Spangler et al.) investigating the effects of training undergraduate
students in helping skills courses to use insight skills (immediacy, challenges,
interpretation) after they had learned exploration skills. A comparison of
students and instructors indicated similarity...
After they had learned exploration skills, 132 undergraduate helping skills
students were taught to use the insight skill of immediacy. After training,
students increased in self-efficacy for using immediacy, and catharsis and
cohesion increased among lab group members. Students who completed
training first (nondelay) had higher self-efficacy post-...
After they learned exploration skills, 103 undergraduate helping skills
students were taught to use challenges. Prior to training, students’ selfefficacy
for using challenges did not change, although the quality of written
challenges and reflections of feelings did. After training, students rated
themselves as having more self-efficacy for using ch...
After they had learned exploration skills, 128 undergraduate helping skills
students were taught to use the insight skill of interpretation. After training,
students had higher self-efficacy for using interpretation and were rated by
both themselves and volunteer clients as using interpretation more often.
Students in a delay condition did not chan...
We briefly review the literature on helping skills training. We then provide
a rationale for the current series of studies, given methodological problems
and a lack of focus on teaching insight skills in the previous literature. Next,
we provide an overview of the rationale, methods, and analyses used in
common across three studies conducted to tea...
Two signature symptoms of posttraumatic stress disorder are nightmares and sleep disturbance. These symptoms often are refractory following treatment and are associated with the development of comorbid anxiety, depression, and suicidality. Despite evidence of the role nightmares and sleep disturbance play in PTSD, these symptoms are not targeted by...
Abstract The purpose of this study was to investigate the use and perceived effects of immediacy in 16 cases of open-ended psychodynamic psychotherapy. Of 234 immediacy events, most were initiated by therapists and involved exploration of unexpressed or covert feelings. Immediacy occurred during approximately 5% of time in therapy. Clients indicate...
(from the chapter) Imagine that you are conducting a large online quantitative survey of countertransference management strategies used by therapists in training. In addition to the quantitative measures included in the survey, you decide to add a single open-ended question asking participants to describe components of their unique clinical experie...
Our primary interest was determining the helpful (corrective) components of relational events (REs). We addressed this in two ways: (a) a qualitative analysis of the therapist interventions used when the clients were exploring versus not exploring the therapeutic relationship and (b) a more global qualitative analysis of the helpful therapist and c...
Design: Changes in interpersonal functioning are described in a case of brief interpersonal psychotherapy. Results: Although the client reported having more interpersonal problems than normative data both before and after therapy, she improved slightly on the Inventory of Interpersonal Problems. In an interview, the client reported more insight abo...
Immediacy was examined in a 17-session case of brief therapy with a bright, articulate, inner-city, African American female client seeing an interpersonally oriented, White, male therapist. The main types of therapist immediacy were reinforcing the client for in-session behavior, inviting the client to collaborate, inquiring about client reactions...
We begin this chapter with a brief history of dreams in psychotherapy. We then review the empirical evidence about the occurrence of dream work in ongoing therapy, the outcome of dream work, predictors of who benefits from dream work, and the process of dream work, and predictors of who benefits from dream work. Finally, we discuss new areas of int...
Questions
Questions (5)
The calculator we were using, psqicalculator.bracketglobal.com, is no longer working.
To anyone who has used the PSQI to assess sleep disturbance, how have you handled sleep efficiency responses if the participant reports not going to bed at all on some nights? Also, how would you handle responses to item 4 (During the past month, how many hours of actual sleep did you get at night?) that was either (1) a range of hours (e.g., 2-6) or (2) was more time than they spent in bed?
We're piloting a novel exposure-based treatment for PTSD nightmares and anticipate a fair proportion of dropouts. Because it's a pilot, we'd like to ask participants their reasons for dropping out and assess suicidality, nightmare, insomnia, PTSD symptom levels at drop-out both to determine participant safety and to gather information about the treatment tolerability.
Our research team would like to use the M.I.N.I. for a screening interview and would like to use the DSM-5 version if it has been revised.
We're interested in investigating EGR1/zif268 in PTSD patients, but I've found only animal model research. Is anyone aware of prior studies in humans?
