The ISTSS board approved the establishment of an ISTSS Foundation at its meeting held prior to the 1999 conference in Miami. In addition to the Foundation, the board took action on a variety of new and ongoing programs. The meeting concluded Sandy McFarlane's presidency and began the 2000 board's term under the presidency of John Fairbank.

The new Foundation, proposed by ISTSS Vice President Rachel Yehuda, will provide the society with a new level of major program and development continuity, a channel to provide funding to develop and support new leaders in the field, and a vehicle to provide resources and education for professionals and consumers as an extension of ISTSS. The ISTSS Foundation's approved mission statement includes three components:

1. Establish independent infrastructure through which ISTSS can provide programs and services for the public.
2. Secure grants and gifts with which the ISTSS can fulfill its mission and goals, serving its members and the public.
3. Support scientific and educational advances through grants and scholarships.

An independent board will lead the Foundation. A Foundation Steering Committee has been established to develop the operational mechanism for the Foundation. A proposal will be presented for board review at the 2000 Midyear Meeting.

Yehuda also presented the board with an opportunity for ISTSS to participate in a new nonprofit organization called the PTSD Alliance. The mission of the Alliance is to increase awareness and promote a better understanding of treatment options. The PTSD Alliance is a non-profit consortium created by Pfizer Inc., to be formally unveiled in February 2000. There are four organizations participating in the Alliance: 1) The Sidran Foundation; 2) The American Academy of Obstetrics and Gynecologists; 3) The Anxiety Disorder Association of America; and 4) ISTSS. Pfizer initiated the Alliance program in conjunction with FDA approval of Zoloft for treatment of PTSD.

Yehuda will serve as the ISTSS representative to the Alliance and Edna Foa will serve as alternate representative. The Alliance program will continue through mid-2001. Alliance products to be developed during that time include a consumer education brochure, video series, professional overview brochure with resources, teleconference series for clinicians and the public, media education, and an automated toll free information and referral phone line.

ISTSS participation in projects such as the Alliance provides the society with new organizational relationships and increased visibility.

The board also took action on these important issues:

• The ISTSS Annual Meeting: A task force will address strategic and structural issues surrounding the evolving and growing ISTSS annual meeting. Planning for future ISTSS meetings will be scheduled to avoid conflicts with related meetings or work in conjunction with them.
• Public Education: The board accepted the Public Education Committee proposal for pricing and distribution of the Public Education Brochure, the consumer-oriented adaptation of the ISTSS Childhood Trauma Remembered brochure. The committee will work to achieve the widest possible distribution of both publications. All ISTSS members will receive a copy of the new Public Education Brochure once it is printed in February.
• Student Section Award: Student Section Chair Joe Rudolph is working to develop communication among students and between students and senior members of ISTSS. New programs and initiatives include an online chat area on the ISTSS Web site and formalizing the student representative process. The board then approved a new ISTSS Student Research Award. The award, developed by ISTSS Treasurer Dan Kaloupek, will provide a small grant-funding mechanism for post-graduate student members of ISTSS to help them conduct research activities, including doctoral dissertations. The proposal is structured in a way so it addresses a broad range of professions and the circumstances in which people might find themselves. Award details and application information will be published in Traumatic StressPoints and on the ISTSS Web site in July 2000.
• Treatment Guidelines: The formal title of the recently completed ISTSS Treatment Guidelines is "Effective Treatments for Posttraumatic Stress Disorder: Practice Guidelines from the International Society for Traumatic Stress Studies." The project took two years to complete with the hard work of editor Edna Foa, co-editors Matt Friedman and Terry Keane, and dozens of writers and reviewers. The summary guidelines will be published in JTS, probably in July 2000. Guilford Press will publish the book and the editors are donating proceeds from the book to ISTSS.

Yet while the ISTSS Treatment Guidelines show that there has been a dramatic increase in the number of evidence-based treatments for people with PTSD, what has yet to emerge is the transfer of evidence-based interventions in practice. During the coming year ISTSS Past President Sandy McFarlane will constitute a task force to develop a plan to advance the treatment guidelines. The task force will consider identifying effective methods of disseminating the treatment guidelines; creating a consumer focused edition; identifying requirements for training service providers; developing approaches to ensure quality applications; updates to the guidelines.

• International Trauma Training: A proposal for an ISTSS Task Force to Improve the Quality of International Trauma Training was presented to the board by ISTSS member Stevan Weine. The task force will articulate and analyze problems related to international trauma training and bring issues to the board with a proposal for the next step in the project.
• Latin American Trauma Society: The development of a Latin American affiliate traumatic stress society is progressing through the efforts of ISTSS member Andy Stone. Stone met with the board to discuss the steps necessary to formalize the organization. The informal network includes contacts in Columbia, Mexico, Argentina, Spain, Portugal, Brazil, El Salvador, Cuba and Guatemala. There are also numerous Latin American expatriates living in North America who have expressed an interest in a Latin American affiliate society.
• United Nations Working Group: The ISTSS International Working Group on Traumatic Stress is working with the United Nations to develop a document to guide practice and public policy in countries torn by exposure to traumatic events. The report will emphasize public health principles and processes that can be employed to mitigate the effects of traumatic stress among the general population as well as other personnel effected by trauma.

Sandy McFarlane, 1999 ISTSS President, opened the board meeting with a review of recent ISTSS' recent accomplishments and opportunities. He emphasized the challenges faced by growing organizations, particularly the need to honor a diversity of opinions while working toward consensus. He thanked the 1999 Executive Committee and committee chairs. After lunch, ISTSS President-elect John Fairbank officially began his term as ISTSS President. Fairbank emphasized the need for continuity as new board members take office, and reviewed continuing ISTSS initiatives. Thematically, his administration will focus on the recognition of the need to address traumatic stress using interventions based on the principles of public health. This will form the 2000 Annual Meeting theme.

Shaking off the academic nature of the meeting for a moment, Lucy Berliner described receiving her award as "ultra cool" at the annual awards banquet.

Past President Matthew Friedman, MD, PhD, received the Lifetime Achievement Award, formerly known as the Pioneer Award. He is executive director of the National Center for Post-Traumatic Stress Disorder and professor of psychiatry and pharmacology at Dartmouth Medical School. Listed in The Best Doctors in America, Friedman also is a member of the Veteran Administration's Persian Gulf Expert Scientific Committee and the National Institute of Mental Health's Violence and Traumatic Stress Study Section.

"After I get beyond my delight, I must state categorically that I am much too young to receive such an award," Friedman said upon accepting the award. "Aren't lifetime awards for people who have run their course and now have little else to do but write their memoirs? I certainly hope not since I continue to look forward, not backward."

The Chaim Danieli Young Professional Award went to Michael D. De Bellis, MD, an assistant professor of psychiatry at the University of Pittsburgh Medical Center and director of the Developmental Traumatology Laboratory at Western Psychiatric Institute and Clinic in Pittsburgh. De Bellis was unable to attend the conference.

Yael Danieli, PhD, established the award in memory of her father. It recognizes excellence in service or research in the field of traumatic stress by an individual who has completed training within the last five years.

Berliner received the Sarah Haley Memorial Award for Clinical Excellence, which is presented to a clinician in direct service to traumatized individuals whose written and verbal communications to the field exemplify the work of Sarah Haley. Berliner is a social work clinician and researcher at Harborview Center for Sexual Assault and Traumatic Stress and is a clinical associate professor in the school of social work and in the department of psychiatry and behavioral sciences at the University of Washington, Seattle.

"We put such a premium on advancing knowledge and being scientific, but the thing that I like so much and value so much is that the heart of it for everyone is trying to do right by the people to whom something terrible has happened," Berliner said. "And that's always the thing that matters to every person [in ISTSS]."

The Robert S. Laufer Memorial Award for Outstanding Scientific Achievement, established by Ellen Frey-Wouters, PhD, in memory of her late husband, was presented to John Briere, PhD. This year held special meaning for the award because it marked the 10th anniversary of Robert Laufer's death.

"ISTSS is very important to me. To receive an award from this group is a quite cool thing," Briere said.

Briere is associate professor of psychiatry and psychology at the Kack School of Medicine at the University of Southern California and director of the Psychological Trauma Clinic at LAC-USC Medical Center. He is a fellow of the American Psychological Association, a past ISTSS board member and on the advisory board of American Professional Society on the Abuse of Children.

The Dart Award for Excellence in Reporting on Victims of Violence, established by the Dart Foundation, was given to Barbara Walsh, a reporter for the Portland Press Herald in Portland, Maine (For more information about the Dart Award, see Mediawatch.).

Don't worry, there's still time to pack up the outback gear and head down under for the 3rd World Conference on Traumatic Stress, "The Long-Term Outcomes of Trauma in Individuals and Society," March 16-19, in Melbourne, Australia.

In fact, interested parties can still register to attend; visit the ASTSS Web site at www.astss.org.au and download the preliminary program that includes registration materials.

Highlights of the conference are:

• A presidential debate will take on the topic, "Traumatologist — Scientist or Activist?" The world forum, chaired by Matt Friedman, will assemble a group of people who think globally about issues facing traumatized cultures to discuss what works and what doesn't in addressing these issues. A question-and-answer period will follow for audience members to address the panel about the particular problems facing their region or culture.
• The body, overlooked in the treatment approaches to post-traumatic syndromes, will be the focus of a plenary panel chaired by Bessel van der Kolk, titled "If the Body Keeps the Score, Who Keeps Score of the Body?" A hypothetical case, based on real situations experienced by clinicians and their patients, and moderated by Norman Swann, will weave through many of the challenges faced in working with traumatized individuals in an often re-traumatizing social system. The final plenary, a keynote speaker panel, will draw together the themes from the conference and look to future directions in the field of traumatic stress.
• One of the highlights of the conference will be an interview with Brian Keenan, author of An Evil Cradling (Viking Press, 1993), about the long-term effects of his period of captivity as a hostage of Lebanese terrorists. Bessel Van der Kolk will conduct the interview at a theatre outside of the conference venue. In order to fund this project, there will be a separate charge for attendance. Seating also is limited — so interested individuals will need to preregister. Pre-reading of Keenan's compelling account of his captivity is recommended.

For further information about the conference, contact: The Conference Organiser, Box 214, Brunswick East 3057, Victoria, Australia; phone, +61-3-9380 1429; fax, +61-3-9380 2722; or e-mail, conorg@ozemail.com.au.

For discussion of the programme, contact: Scientific Programme Coordinator, Dr. Di Clifton, 121 Fortescue Ave., Seaford 3198, Victoria, Australia; phone/fax, +61-3-9786 1918; or e-mail, dclifton@silas.cc.monash.edu.au.

I would like to start by thanking everyone that attended the student events at this year's ISTSS conference, especially Alexander McFarlane and John Fairbank. This is an exciting time to be involved with ISTSS and especially the student section.

Previously, I outlined three goals for the coming year. First, to enhance the student members' communication between conferences; second, to increase students' involvement in ISTSS; and third, to formalize the role and selection procedure of the student section chair.

First, ISTSS had developed a Web-based student bulletin board (BBS). The Student BBS is accessible from the ISTSS Web site at http://www.istss.org. This will greatly enhance the students' ability to communicate between meetings and generates an archive of the activities.

Second, I have begun drafting the roles and responsibilities of the student representative. I have some pragmatic administrative ideas for the position; however, it is important that the position reflect the students' needs and interests. Anyone interested in assisting me with this process, please contact me at joe_rudolph@ncsu.edu. I plan to post a draft on the student BBS for feedback by Feb. 1.

Third, I want to highlight some opportunities currently available to students. I have tried to identify experiences that we need to make recent graduates marketable as new professionals. The board of directors agreed to fund two $1,000 research awards. Danny Kaloupek, Alethea Smith and I put this proposal forth, designed to support graduate student research in trauma, including theses and dissertations. The board unanimously accepted the motion. I applaud the board's commitment to student development. The first awards will be available in November. The application procedures will be printed in the next issue of Traumatic StressPoints.

The editors of the Journal of Traumatic Stress and StressPoints have also approached me with positions. Dean Kilpatrick (JTS) has agreed to develop a student editor position. Elana Newman (StressPoints) is looking for students to serve as column editors and to submit brief articles. She will accept original articles and has a list of ideas for anyone interested in writing. These are great opportunities to develop professional writing skills. I am currently working with both editors to develop guidelines for the positions.

I would also like to identify three projects in development. First, we are working on guidelines and procedures to collect data from ISTSS members. Second, many of students have struggled to find graduate programs, post-docs, and jobs that are "trauma-friendly." I would like to see the student committee develop a list of training programs, jobs and grants. Third, as an international organization I would like to see us develop an international student council. This would provide a mechanism to develop partnerships with people in other countries and expand the number of research and training opportunities.

ISTSS thrives on ingenuity and initiative. While this is a small sample of opportunities, I am sure that we can generate more. But I need to hear your ideas. I look forward to hearing from anyone interested in the opportunities listed above and from those with additional ideas.

ISTSS has an ambitious media agenda, and that agenda was obvious and intense in November at the ISTSS 15th Annual Meeting in Miami.

Two complementary themes weave through all the society's media innovations. One is the journalism of trauma and the other is the trauma of journalists. The journalism of trauma refers to how reporters approach and interview victims of violence, how the stories are told and the pictures are displayed, how viewers react and how cycles of violence are intensified or diminished.

For the first time, and probably the last time, the ISTSS annual conference was the venue for the presentation of the Dart Award for Excellence in Reporting on Victims of Violence. Future award ceremonies will be before journalists, beginning with the American Society of Newspaper Editors in April in Washington, D.C.

Barbara Walsh received a $10,000 check at the awards banquet. She wrote a remarkable account of a Korean-American woman whose only son was shot and killed in Baltimore. The Portland, Maine reporter described her approach to the 27-installment story, her affection for her subject and her management of professional objectivity and intense identification.

"I wasn't sure which would come first, the birth of my child, or the trial of her son's killer," Walsh explained before a large evening audience.
We could experience the reporter's thoughtful navigation of professional intimacy: a journey that touched life and death issues, probed painful memory, and created strong attachment, but that maintained necessary distance. Every trauma therapist understands this. Or should.

For the first time, but not the last time, six Dart Fellows attended the conference as planned by the ISTSS Media Special Interest Group. The SIG organized a national competition for journalists, with at least five years of experience, who covered trauma and wanted an intense seminar on trauma science in conjunction with the society's annual meeting.

The group raised close to $20,000 to support this plan, reasoning that outstanding mid-career reporters and photographers would benefit from well-orchestrated exposure to our field, and would use this knowledge to improve their coverage of trauma stories.

We were not disappointed.

The six, consisting of Chris Bull, a Washington, D.C. author and magazine freelance writer; Gabrielle Crist, criminal courts reporter for the Fort Worth Star-Telegram; David Handschuh, New York Daily News photographer; Arlene Levinson, New York-based national writer for the Associated Press; Frank Smyth, a Washington, D.C. freelance journalist; and Deirdre Stoelzle, reporter and assistant city editor for the Casper (WY) Star-Tribune; were a vibrant, intelligent, inquisitive and diverse lot. They challenged the ISTSS pre-meeting presenters: Sandy Bloom, Heidi Resnick, Dean Kilpatrick, Matthew Friedman, Laurie Pearlman, Jack Saul and Steve Weine. And they agreed to help refine and to institutionalize this process in years to come.

Both the Dart Award and the Dart Fellows program advance our interest in trauma journalism. But what about the traumatized journalist?

In public and private discussions, it became clear that our colleagues in the media suffer direct and vicarious traumatic stress. Moreover, they come from a legacy that is stoic, self-denying and loath to admit emotional vulnerability.

Rick Bragg, veteran war correspondent and Pulitzer winner from The New York Times said, "How can I ask for clinical help when I'm just watching and reporting the war? My wounds are nothing compared to the soldiers'. And I can leave the battlefield. They can't." Chris Cramer, president of CNN, expressed similar sentiments at the journalism panel during the conference.

But both of these media leaders made it clear that they respected our field, and our genuine desire to help a new generation of journalists benefit from proven therapies for trauma workers. Journalists are trauma workers.

To increase our understanding of their working conditions, a program of ride-alongs will be launched. Credit Handschuh, vice president of the National Press Photographers Association, with this idea.

Handschuh will arrange opportunities for ISTSS leaders to accompany his colleagues on assignment, much as they benefit from ride-alongs with police. We hope to videotape parts of these joint ventures and present them at the meeting in San Antonio.

Bessel van der Kolk, Matt Friedman, John Fairbank and Laurie Pearlman have expressed interest. Let me know if you are interested, too. A ride-along with a journalist, particularly a photojournalist, will place the trauma therapist in an entirely new context. We will learn what it is like to witness without the opportunity to intervene. And we will appreciate the difficult burden borne by our media friends.

For more information, contact Roger Simpson, the chair of the ISTSS Media Group and the director of the new Dart Center in Seattle at newsboy@u.washington.edu. Roger now works closely with Elana Newman, editor of Stresspoints and research advisor to the Dart Foundation.

Researchers face a significant challenge when deciding how they will measure the constructs they are interested in studying. Psychometricians have long recommended the use of consultations with persons from a target population in the process of item development (Haynes, Richard, & Kubany, 1995). Consultation can improve the representativeness and relevance of items. This practice can also suggest additional facets and the need for construct refinement.

Developers of psychological instruments, however, have rarely used this strategy (Haynes et al., 1995), and those who have typically relied on interviews with individual members of the population. An alternative to individual interviews is the use of focus groups. This brief article will highlight the benefits of a focus group strategy as an aid to instrument construction and describe how this strategy was used in research on Gulf War veterans.

The focus group is a technique that involves a moderator-facilitated discussion among multiple participants. The moderator initiates conversation and then becomes an observer as the conversation flows under the direction of group members. While primarily used by marketing researchers, this technique has recently been recognized as potentially useful for the behavioral and social sciences and it may be of particular benefit to stress and trauma research.

Because participants respond to each other's comments as well as to questions posed by the moderator, a richer discussion of traumatic events and their effects may be elicited than in a one-on-one interview. Furthermore, participants may feel more comfortable discussing traumatic experiences with others that have had similar experiences and a more honest discussion tends to result.

The discussion among group members may also reveal information about the rules, norms and system of functioning of the population under study that is less likely to emerge when the researcher sets the agenda. Traumatized populations often come from very different backgrounds than the researchers who study them. Applying assumptions that underlie measures developed for non-traumatized populations may be problematic. Furthermore, different language may be appropriate for describing the experiences of traumatized populations than for other populations.

In a study being done by the National Center for PTSD, researchers are examining risk and resilience factors that may be related to health outcomes in Gulf War veterans. They put together a series of focus groups to assist in developing a survey to assess Gulf War-related experiences. Through this strategy, they learned a great deal about the terminology that Gulf War veterans use to describe their experiences.

For example, researchers found that Gulf War veterans refer to the threat of nuclear, biological and chemical warfare as NBCs, and researchers incorporated this colloquialism into their items. They also learned about specific events and circumstances that contributed to the veterans' experiences. For instance, they revealed details of life in the Gulf region that were crucial to researchers' measurement of difficult living conditions.

Finally, they were able to refine existing hypotheses regarding the relative importance of the risk and resilience factors. For example, researchers found that the perceived threat of NBC warfare may have been as detrimental to veterans as their actual exposure to combat.

In summary, researchers found the use of focus groups to be extremely helpful in their efforts to construct a survey instrument for Gulf War veterans. They believe that this method holds promise for enriching research on the experiences of other traumatized populations or subcultures with different ways of interacting with their environments.

ISTSS Research Methodology Special Interest Group sponsored this brief report. If you are interested in becoming a member of the group, please contact chairs Daniel and Lynda King, National Center for PTSD (116B-2), VA Boston Healthcare System, 150 S. Huntington Ave., Boston, MA 02130, e-mail: king.daniel@boston.va.gov or lking@world.std.com.

Over the past three years, we studied over 100 families who lived through a residential fire. The major aim of the investigation is to assess children's and adolescents' levels of psychological distress within a cross-sectional, longitudinal design.

More specifically, we are using a multi-method assessment strategy wherein children's and adolescents' functioning is being obtained at 1-, 6- and 12-month intervals following the fire.

With a $1.2 million research grant from the National Institute of Mental Health and through collaborative arrangements with other researchers, families residing in Virginia, West Virginia, North Carolina, South Carolina and Georgia have been examined. Our findings are interesting, although by no means fully analyzed or understood at this point in time.

Our initial findings provide important insights into this virtually unstudied area. Given the devastating consequences of fires and burns, ranking sixth among major causes of injury and death among persons newborn to 19 years, a compelling case for its systematic study certainly can be made. Identification of predictors of survivors' post-disaster functioning might provide important inroads into the understanding of this understudied event. One of the most valuable results of this investigation will hopefully be guidelines for the treatment of survivors of such traumatic events.

Initial Findings Vary Greatly
Approximately 55% of our families were of low socioeconomic status and about 52% were African-American or Hispanic American. Approximately 33% were single parents. They resided in both urban and rural areas, but most were poor. Moreover, 49% of our families lived in an apartment complex or trailers; furthermore, 76% experienced extensive or complete loss of their belongings and their dwelling. Of further concern, 63% had minimal or no home insurance. In about one-half of the cases, some member of the family was at home at the time of the fire; however, in the other half no one was at home.

Experiences of the families varied greatly as the families recounted their stories to us. Frequently in the midst of considerable distress, they invariably relayed details of helplessness and, in some instances, hopelessness as they felt little control over what had happened. Feelings of guilt were also present (e.g., "if only I had not gone to the store" or "if only I had checked the stove before going to bed"). Not unlike other victims or survivors of stressful events, they frequently questioned "Why me, why my family, why now?"

Three Predictors Stand Out
We have been impressed by the resilience of many of our families and struck by the fragility of others. There are, however, a couple of findings that cut across our survivors of residential fires. On several outcome measures (including measures of traumatic stress, anxiety and depression in the children and measures of parenting practices and psychopathology in the parents), it appears that the amount of subjective loss is the best predictor of negative outcomes. Loss is defined as subjective since the loss of a $15,000 trailer and personal belongings for one family might be as great as the loss of a $150,000 home and personal belongings to another family. In both instances, the loss is complete and potentially devastating.

The second best predictor has been the extent to which the parents now "need to know where the child is and what the child is doing." We view this measure as reflecting a degree of hyper-vigilance and overprotectiveness. In some instances, such hyper-vigilance is called for, in others it is not. In all cases, however, it is an understandable reaction on the part of parents who nearly lost or, in the least, could have lost their child in the fire. Yet, this normal reaction serves to potentiate the effects of the fire.

Although less clear, a third factor -on at least some of our measures - is the amount and quality of social support the child has and the types of coping strategies the child possesses. Perhaps to no surprise, social support and active, problem-focused coping appears to work best in averting negative outcomes.

We have not yet been able to determine the factors associated with negative outcomes in parents other than the amount of subjective loss as a result of the fire. At this point, socioeconomic status, minority status and other sociodemographic factors do not seem to serve as protective or risk factors. Being at home or not at home also does not seem to be associated with negative outcomes. We intend to explore our data more fully in the months ahead in order to ferret out potential significant influences beyond those we initially thought to be of predictive utility.

In short, although much remains to be determined, we also have learned a lot in our study. Mostly, we have learned that residential fires are potentially devastating to many families. But we have also learned that many of our suppositions are unfounded and that we need to go back to the drawing board to more fully understand our families and the effects that residential fires have upon them. We hope to have more definitive findings and more informed speculation on the import of those findings in the months ahead. In the interim, we thank the families for sharing their experiences with us and for making this journey with them so rewarding and fruitful.

Late in the afternoon before the start of the ISTSS 15th Annual Meeting, a group of young persons milling around the hotel lobby hailed me down. I was surprised to see Afrim Blyta and Yusuf Ulaj, new friends from Pristina, along with several of their colleagues, Enver Cesko, Zana Ferizi, and Majd Kam-Almaz. They were far more surprised to be transported from Kosovo to Miami to attend the ISTSS conference on short notice. But what a wonderful opportunity the trip presented for them and for ISTSS.

The Human Rights and Social Policies Special Interest Group hastily arranged a 7 a.m. meeting. More than 30 people attended, including ISTSS President John Fairbank, ESTSS President Ulrich Schnyder, Past Presidents Yael Danieli, Bessel van der Kolk and Matt Friedman, several other board members and distinguished ISTSS members.

The professionals from Kosovo told their stories and shared with members the formidable challenges in developing trauma mental health in Kosovo. One person said, "We feel like we are in a station, lots of people are telling us to get on their trains, and we are not sure how to decide which is the right one that is going to take us where we want to go."

A vigorous dialogue by attendees followed the stories where everyone asked each other difficult questions. Who is in charge? What is the role for international or regional experts? Shouldn't persons who receive trauma training get credentials? How do we integrate services for children and adults? How can we build affordable and more lasting structures that Kosovo can afford when the international community and its money leave? One overall question framed the dialogue: What kind of collaboration is needed to strengthen the relationship between needs, resources and goals? ISTSS and ESTSS leadership wants to facilitate the development of trauma mental health services in Kosovo, but there are obstacles and limits. It is imperative that the Kosovar professionals themselves make a plan of where they want mental health services to be in five years. Perhaps the society can help by refining the trauma mental health facets of their plan and finding ways to build trauma-focused collaborations with interested individuals and organizations associated with ISTSS.

At the meeting, the Kosovars were initiated into the relationship between mental health and human rights. They received generous gifts of informative, instructive books from Yael Danieli and Charles Marmar. I hesitated to give them a copy of my narrative non-fiction book, When History is a Nightmare: Lives and Memories of Ethnic Cleansing in Bosnia-Herzegovina." What would someone living in one historical nightmare derive from reading of another?

Before we embraced and said goodbye, Blyta pointed to the announcement for the ISTSS meeting next year in San Antonio and said, "Next year we will make a big presentation."
"It will be fantastic if you can," I said.

 I am so happy that the Kosovars came and that ISTSS members and leadership were so engaged with them. Besa in Kosovar means you are obligated to your word. Let's take up the challenge and make what we have said real.

Elana Newman, PhD
University of Tulsa

The TAB-P Protocol: The Complete Home-Study Course for Training in Cognitive Behavioral Based Psychotherapy for the Treatment of PTSD and other Anxiety Disorders by Larry D. Smyth, PhD. Havre de Grace, Maryland: The Red Toad Road Co., 1998 & 1999, six manuals and five videotapes and one study guide. $400

Larry Smyth assembled an impressive set of manuals and training tapes designed to teach his cognitive-behavioral approach to the treatment of PTSD and other anxiety disorders.
The course consists of six manuals, five videotapes and one study guide. In addition to the entire home study course, the Clinician's Manual for the Cognitive-Behavioral Treatment of Post Traumatic Stress Disorder and the Client's Manual for the Cognitive Behavioral Treatment of Anxiety Disorders are available for individual purchase without the videotapes and accompanying manuals.

Smyth uses a general cognitive behavioral paradigm, with an information-processing model as its basis. From this model, he conceptualizes PTSD as a specific phobia of memories, which cause both hyperarousal and avoidant/numbing behaviors.
He proposes that "the primary therapeutic task in PTSD treatment is activating the traumatic memories, while keeping physiological arousal in the moderate range, so secondary process thinking can be used to either rewrite the original codes and or revise the meta-cognitions that the traumatic material contradict."

To achieve this goal, Smyth conjectures that the TAB-P treatment outcome is dependent on the following components: (1) the quality of the collaborative therapeutic relationship (T); (2) the clinical complexity of a case; (3) implementation of effective cognitive reframing or assimilation techniques; (4) the use of brief exposure strategies (B), and (5) implementation of prolonged exposure strategies (P). Smyth teaches basic cognitive behavioral skills such as progressive relaxation, relaxation, thought stopping, exposure to introceptive cues and cognitive reframing in this course.

Treatment Follows a Basic Five-step Process
The treatment consists of five basic phases that can be extended based on particular case histories. Smyth has clear criteria to indicate the achievement of each phase, which allows both flexibility and consistency of treatment across different cases. Hence, treatment length depends on the needs of a client.

In the first phase, he conducts assessment, psychoeducation about PTSD, subjective units of distress and goal setting. In phase two, he reviews eye movement technique, relaxation training and introduction to rational thinking. In phase three, he uses cognitive restructuring in the context of some limited exposure to difficult experiences. To change thoughts, Smyth teaches clients through the use of Socratic questioning, metaphors and education. In phase four, he begins brief exposure trials more systematically with repeated trials. In phase five, he utilizes prolonged exposure. Finally, he implements relapse prevention in the termination phase coupled with a review on treatment goals, coping skills and current status.

As a component of treatment, Smyth uses a variant of the eye movement technique (EMT). He emphasizes that EMT is a component of cognitive-behavioral treatment, not a treatment in and of itself. In fact, he believes EMT is a form of anxiety management technique, akin to Wolpe's thought-stopping procedures. He further distinguishes his EMT work from Shapiro's EMDR by stating that he believes EMT is an easily learned technique that can be readily learned by an experienced clinician with an hour of instruction.

Package Serves as an Excellent Introduction
The treatment relies heavily on the client manual, which is a good general introduction to cognitive-behavioral treatment including the client's roles and responsibilities. The manual systematically reviews relaxation, cognitive problem-solving, correcting irrational thoughts and exposure. It contains areas to complete homework as well. The manual is actually geared to general anxiety disorders rather than PTSD, so it may be implemented in a variety of treatment protocols.

Smyth's entire package contains clear concise instructions, summaries and self-tests to help the clinician master the material. Smyth uses acronyms to help mastery of the material and has clear objectives for clinicians to learn portions of the treatment. The videos are extremely helpful in understanding the application of the treatment and provide very clear examples of treatment.

He attends very well to the issues of co-morbidity and complex PTSD, and encourages the adaptation of techniques in ways that address these issues but retain consistency of treatment. It was refreshing to see the materials address the true range of PTSD cases seen in clinical work by including case examples that vary by stressor and those that involve co-morbidity with other anxiety disorders.

Although all clinicians can benefit from the training, it seems especially useful to those clinicians learning how to integrate cognitive-behavioral practice into their treatment plans and those unfamiliar with PTSD. And even though the videotapes integrate the material extremely well, those clinicians familiar with PTSD and cognitive-behavioral treatments may not find the videotaped sessions as necessary. My clinical psychology graduate students who viewed a few segments of the videos found the sessions helpful in demonstrating techniques they were aware of but had never seen implemented.

Naturally, in a work of this scope, one expects to find some gaps in the material covered (e.g. treating co-morbid substance abuse, unique issues for clients based on stressor type). In fact, Smyth recognizes this reality and includes useful references for both clinicians and clients to further their understanding.

Research supports many of the program components, although this treatment itself has not undergone empirical investigation. In particular, the use of brief exposure techniques for PTSD only has been examined in children and, while clinically sensible, the use of brief exposure techniques prior to prolonged exposure needs more investigation. Smyth argues that PE enhances desensitization whereas BE enhances coping strategies, so the use of BE prior to PE prevents relapse. This proposition needs further support. In addition, the use of his version of the eye movement technique also needs empirical support. Given the detail of the manuals and videos, this empirical work could be readily accomplished and contribute to the field.