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Psychological and Physiological Trauma Research
Seize Your Journeys
_______________________ Traumatic stress is found in many competent, healthy, strong, good people. No one can completely protect themselves from traumatic experiences. Many people have long-lasting problems following exposure to trauma. Up to 8% of persons will have PTSD at some time in their lives. People who react to traumas are not going crazy. What is happening to them is part of a set of common symptoms and problems that are connected with being in a traumatic situation, and thus, is a normal reaction to abnormal events and experiences. Having symptoms after a traumatic event is NOT a sign of personal weakness. Given exposure to a trauma that is bad enough, probably all people would develop PTSD. By understanding trauma symptoms better, a person can become less fearful of them and better able to manage them. By recognizing the effects of trauma and knowing more about symptoms, a person will be better able to decide about getting treatment. _______________________
Sleep Disorders DSMIV-R
“The sleep disorders are organized into four major sections according to presumed etiology.
Primary Sleep Disorders are those in which none of the etiologies listed below (i.e., another mental disorder, a general medical condition, or a substance) is responsible. Primary Sleep Disorders are presumed to arise from endogenous abnormalities in sleep-wake generating or timing mechanisms, often complicated by conditioning factors. Primary Sleep Disorders in turn are divided into Dyssomnias (characterized by abnormalities in the amount, quality, or timing of sleep) and Parasomnias (characterized by abnormal behavioral or physiological events occurring in association with sleep, specific sleep stages, or sleep-awake transitions). Sleep Disorder Related to Another Mental Disorder involves a prominent complaint of sleep disturbance that results from a diagnosable mental disorder (often a Mood Disorder or Anxiety Disorder) but that is sufficiently severe to warrant independent clinical attention. Presumably, the pathophysiological mechanisms responsible for the mental disorder also affect sleep-awake regulation. Sleep Disorder Due to a General Medical Condition involves a prominent complaint of sleep disturbance that results from the direct physiological effects of a general medical condition on the sleep-wake system. Substance-Induced Sleep Disorder involves prominent complaints of sleep disturbance that result from the concurrent use, or recent discontinuation of use, of a substance (including medications). That systematic assessment in individuals who present with prominent complaints of sleep disturbance includes an evaluation of the specific type of sleep complaint and a consideration of concurrent mental disorders, general medical conditions, and substance (including medication) use that may be responsible for the sleep disturbance. Five distinct sleep stages can be measured by polysomnography: rapid eye movement (REM) sleep and four stages of non-rapid eye movement (NREM) sleep (stages 1, 2, 3, and 4). Stage 1 NREM sleep is a transition from wakefulness to sleep and occupies about 5% of time spent asleep in healthy adults. Stage 2 NREM sleep, which is characterized by specific EEG waveforms (sleep spindles and K complexes), occupies about 50% of time spent asleep. Stages 3 and 4 NREM sleep (also known collectively as slow-wave sleep) are the deepest levels of sleep and occupy about 10%-20% of sleep time. REM sleep, during which the majority of typical storylike dreams occur, occupies about 20%-25% of total sleep. These sleep stages have a characteristic temporal organization across the night. NREM stages 3 and 4 tend to occur in the first one-third to one-half of the night and increase in duration in response to sleep deprivation. REM sleep occurs cyclically throughout the night, alternating with NREM sleep about every 80-100 minutes. REM sleep periods increase in duration toward the morning. Human sleep also varies characteristically across the life span. After relative stability with large amounts of slow-wave sleep in childhood and early adolescence, sleep continuity and depth deteriorate across the adult age range. This deterioration is reflected by increased wakefulness and stage 1 sleep and decreased stages 3 and 4 sleep. Because of this, age must be considered in the diagnosis of a Sleep Disorder in any individual. Polysomnography is the monitoring of multiple electrophysiological parameters during sleep and generally includes measurement of EEG activity, electroculographic activity, and electromyographic activity. Additional polysomnographic measures may include oral or nasal airflow, respiratory effort, chest and abdominal wall movement, oxyhemoglobin saturation, or exhaled carbon dioxide concentration; these measures are used to monitor respiration during sleep and to detect the presence and severity of sleep apnea. Measurement of peripheral electromyographic activity may be used to detect abnormal movements during sleep. Most polysomnographic studies are conducted during the person’s usual sleeping hours—that is, at night. However, daytime polysomnographic studies also are used to quantify daytime sleepiness. The most common daytime procedure is the Multiple Sleep Latency Test (MSLT), in which the individual is instructed to lie down in a dark room and not resist falling asleep; this protocol is repeated fives times during the day. Sleep latency (the amount of time required to fall asleep) is measured on each trial and is used as an index of physiological sleepiness. The converse of the MSLT is also used: In the Repeated Test of Sustained Wakefulness (RTSW), the individual is placed in a quiet, dimly lit room and instructed to remain awake; this protocol is repeated several times during the day. Again, sleep latency is measured, but is it used here as an index of the individual’s ability to maintain wakefulness. Standard terminology for polysomnographic measures is used throughout the test in this section. Sleep continuity refers to the overall balance of sleep and wakefulness during a night of sleep. “Better” sleep continuity indicates consolidated sleep and wakefulness; “worse” sleep continuity indicates disrupted sleep with more wakefulness. Specific sleep continuity measures include sleep latency—the amount of time required to fall asleep (expressed in minutes); intermittent wakefulness—the amount of awake time after initial sleep onset (expressed in minutes); and sleep efficiency—the ratio of actual time spent asleep to time spent in bed (expressed as a percentage, with higher numbers indicating better sleep continuity). Sleep architecture refers to the amount and distribution of specific sleep stages. Sleep architecture measures include absolute amount of REM sleep and each NREM sleep stage (in minutes), relative amount of REM seep and NREM sleep stages (expressed as a percentage of total sleep time), and latency between sleep onset and the first REM period (REM latency). The text for each of the Sleep Disorders contains a section describing its relationship to corresponding disorders in The International Classification of Sleep Disorders: (ICSD) diagnostic and Coding Manual, published in 1990 by the American Sleep Disorders Association. FUNCTIONAL NEUROANATOMY In order to best understand this atlas it is important to have a sense of the functional neuroanatomy of the brain. Over the next several pages there is a brief summary of the 5 major brain systems that relate to behavior, along with the general location seen on SPECT of these areas.
The Deep Limbic System
Functions
Problems
The Basal Ganglia System
Functions
Problems
The Prefrontal Cortex
Functions
Problems
The Cingulate Gyrus
Problems
The Temporal Lobes
Functions
Problems
Non-dominant Side (usually the right)
Secure Attachments as a Defense Against Trauma “All people mature and thrive in a social context that has profound effects on how they cope with life’s stresses. Particularly early in life, the social context plays a critical role in fuffering an individual against stressful situations, and in building the psychological and biological capacities to deal with further stresses. The primary function of parents can be thought of as helping children modulate their arousal by attuned and well-timed provision of playing, feeding, comforting, touching, looking, cleaning, and resting—in short, by teaching them skills that will gradually help them modulate their own arousal. Secure attachment bonds serve as primary defenses against trauma-induced psychopathology in both children and adults (Finkelhor & Browne, 1984). In children who have been exposed to severe stressors, the quality of the parental bond is probably the single most important determinant of long-term damage (McFarlane, 1988).” van der Kolk, Bessel, Alexander C. McFarlane, and Lars Weisaeth, eds. 1996. Traumatic stress: The effects of overwhelming experience on mind, body, and society. New York and London: Guilford Press. .p. 185 _______________________
Sleep Disorders
“The sleep disorders are organized into four major sections according to presumed etiology. Primary Sleep Disorders are those in which none of the etiologies listed below (i.e., another mental disorder, a general medical condition, or a substance) is responsible. Primary Sleep Disorders are presumed to arise from endogenous abnormalities in sleep-wake generating or timing mechanisms, often complicated by conditioning factors. Primary Sleep Disorders in turn are divided into Dyssomnias (characterized by abnormalities in the amount, quality, or timing of sleep) and Parasomnias (characterized by abnormal behavioral or physiological events occurring in association with sleep, specific sleep stages, or sleep-awake transitions). Sleep Disorder Related to Another Mental Disorder involves a prominent complaint of sleep disturbance that results from a diagnosable mental disorder (often a Mood Disorder or Anxiety Disorder) but that is sufficiently severe to warrant independent clinical attention. Presumably, the pathophysiological mechanisms responsible for the mental disorder also affect sleep-awake regulation. Sleep Disorder Due to a General Medical Condition involves a prominent complaint of sleep disturbance that results from the direct physiological effects of a general medical condition on the sleep-wake system. Substance-Induced Sleep Disorder involves prominent complaints of sleep disturbance that result from the concurrent use, or recent discontinuation of use, of a substance (including medications). That systematic assessment in individuals who present with prominent complaints of sleep disturbance includes an evaluation of the specific type of sleep complaint and a consideration of concurrent mental disorders, general medical conditions, and substance (including medication) use that may be responsible for the sleep disturbance. Five distinct sleep stages can be measured by polysomnography: rapid eye movement (REM) sleep and four stages of non-rapid eye movement (NREM) sleep (stages 1, 2, 3, and 4). Stage 1 NREM sleep is a transition from wakefulness to sleep and occupies about 5% of time spent asleep in healthy adults. Stage 2 NREM sleep, which is characterized by specific EEG waveforms (sleep spindles and K complexes), occupies about 50% of time spent asleep. Stages 3 and 4 NREM sleep (also known collectively as slow-wave sleep) are the deepest levels of sleep and occupy about 10%-20% of sleep time. REM sleep, during which the majority of typical storylike dreams occur, occupies about 20%-25% of total sleep. These sleep stages have a characteristic temporal organization across the night. NREM stages 3 and 4 tend to occur in the first one-third to one-half of the night and increase in duration in response to sleep deprivation. REM sleep occurs cyclically throughout the night, alternating with NREM sleep about every 80-100 minutes. REM sleep periods increase in duration toward the morning. Human sleep also varies characteristically across the life span. After relative stability with large amounts of slow-wave sleep in childhood and early adolescence, sleep continuity and depth deteriorate across the adult age range. This deterioration is reflected by increased wakefulness and stage 1 sleep and decreased stages 3 and 4 sleep. Because of this, age must be considered in the diagnosis of a Sleep Disorder in any individual. Polysomnography is the monitoring of multiple electrophysiological parameters during sleep and generally includes measurement of EEG activity, electroculographic activity, and electromyographic activity. Additional polysomnographic measures may include oral or nasal airflow, respiratory effort, chest and abdominal wall movement, oxyhemoglobin saturation, or exhaled carbon dioxide concentration; these measures are used to monitor respiration during sleep and to detect the presence and severity of sleep apnea. Measurement of peripheral electromyographic activity may be used to detect abnormal movements during sleep. Most polysomnographic studies are conducted during the person’s usual sleeping hours—that is, at night. However, daytime polysomnographic studies also are used to quantify daytime sleepiness. The most common daytime procedure is the Multiple Sleep Latency Test (MSLT), in which the individual is instructed to lie down in a dark room and not resist falling asleep; this protocol is repeated fives times during the day. Sleep latency (the amount of time required to fall asleep) is measured on each trial and is used as an index of physiological sleepiness. The converse of the MSLT is also used: In the Repeated Test of Sustained Wakefulness (RTSW), the individual is placed in a quiet, dimly lit room and instructed to remain awake; this protocol is repeated several times during the day. Again, sleep latency is measured, but is it used here as an index of the individual’s ability to maintain wakefulness. Standard terminology for polysomnographic measures is used throughout the test in this section. Sleep continuity refers to the overall balance of sleep and wakefulness during a night of sleep. “Better” sleep continuity indicates consolidated sleep and wakefulness; “worse” sleep continuity indicates disrupted sleep with more wakefulness. Specific sleep continuity measures include sleep latency—the amount of time required to fall asleep (expressed in minutes); intermittent wakefulness—the amount of awake time after initial sleep onset (expressed in minutes); and sleep efficiency—the ratio of actual time spent asleep to time spent in bed (expressed as a percentage, with higher numbers indicating better sleep continuity). Sleep architecture refers to the amount and distribution of specific sleep stages. Sleep architecture measures include absolute amount of REM sleep and each NREM sleep stage (in minutes), relative amount of REM seep and NREM sleep stages (expressed as a percentage of total sleep time), and latency between sleep onset and the first REM period (REM latency). The text for each of the Sleep Disorders contains a section describing its relationship to corresponding disorders in The International Classification of Sleep Disorders: (ICSD) diagnostic and Coding Manual, published in 1990 by the American Sleep Disorders Association. _________________
Substance Dependence “Features The essential feature of Substance Dependence is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems. There is a pattern of repeated self-administration that can result in tolerance, withdrawal, and compulsive drug-taking behavior. A diagnosis of Substance Dependence can be applied to every class of substances except caffeine. The symptoms of Dependence are similar across the various categories of substances, but for certain classes some symptoms are less salient, and in a few instances not all symptoms apply (e.g., withdrawal symptoms are not specified for Hallucinogenic Dependence). Although not specifically listed as a criterion item, “craving” (a strong subjective drive to use the substance) is likely to be experienced by most (if not all) individuals with Substance Dependence. Dependence is defined as a cluster of three or more of the symptoms listed below occurring at any time in the same 12-month-period. Tolerance (Criterion 1) is the need for greatly increased amounts of the substance to achieve intoxication (or the desired effect) or a markedly diminished effect with continued use of the same amount of the substance. The degree to which tolerance develops varies greatly across substances. Furthermore, for a specific drug, varied degrees of tolerance may develop for its different central nervous system effects. For example, for opioids, tolerance to respiratory depression and tolerance to analgesia develop at different rates. Individuals with heavy use of opioids and stimulants can develop substantial (e.g., 10-f0ld) levels of tolerance, often to a dosage that would be lethal to a nonuser. Alcohol tolerance can also be pronounced, but is usually less extreme than for amphetamine. Many individuals who smoke cigarettes consume more than 20 cigarettes a day, an amount that would have produced symptoms of toxicity when they first started smoking. Individuals with heavy use of cannabis or phencyclidine (PCP) are generally not aware of having developed tolerance (although it has been demonstrated in animal studies and in some individuals). Tolerance may be difficult to determine by history alone when the substance used is illegal and perhaps mixed with various diluents or with other substances. In such situations, laboratory tests may be helpful (e.g., high blood levels of the substance coupled with little evidence of intoxication suggest that tolerance is likely). Tolerance must also be distinguished from individual variability in the initial sensitivity to the effects of particular substances. For example, some first-time drinkers show very little evidence of intoxication with three or four drink, whereas others of similar weight and drinking histories had slurred speech and incoordination. Withdrawal (Criterion 2a) is a maladaptive behavioral change, with physiological and cognitive concomitants, that occurs when blood or tissue concentrations of a substance decline in an individual who had maintained prolonged heavy use of the substance. After developing unpleasant withdrawal symptoms, the persons is likely to take the substance to relieve or to avoid those symptoms (Criterion 2b), typically using the substance throughout the day beginning soon after awakening. Withdrawal symptoms, which are generally the opposite of the acute effects of the substance, vary greatly across the calluses of substances, and separate criteria sets for Withdrawal are provided for most of the classes. Marked and generally easily measured physiological signs of withdrawal are common with alcohol, opioids, and sedatives, hypnotics, and anxiolytics. Withdrawal signs and symptoms are often present, but may be less apparent, with stimulants such as amphetamines and cocaine, as well as with nicotine and cannabis. No significant withdrawal is seen even after repeated use of hallucinogens. Withdrawal from phencyclidine and related substances has not yet been described in humans (although it has been demonstrated in animals). Neither tolerance nor withdrawal is necessary or sufficient for a diagnosis of Substance Dependence. However, for most classes of substances, a past history of tolerance or withdrawals is associated with a more severe clinical course (i.e., an earlier onset of Dependence, higher levels of substance intake, and a greater number of substance-related problems). Some individuals (e.g., those with Cannabis Dependence) show a pattern of compulsive use without obvious signs of tolerance or withdrawal. Conversely, some general medical and postsurgical patients without Opioid Dependence may develop a tolerance to prescribed opioids and experience withdrawal symptoms without showing any signs of compulsive use. The specifiers With Physiological Dependence and Without Physiological Dependence are provided to indicate the presence or absence of tolerance or withdrawal. The following items describe the pattern of compulsive substance use that is characteristic of Dependence. The individual may take the substance in larger amounts or over a longer period than was originally intended (e.g., continuing to drink until severely intoxicated despite having set a limit of only one drink) (Criterion 3). The individual may express a persistent desire to cut down or regulate substance use. Often, there have been many unsuccessful efforts to decrease or discontinue use (Criterion 4). The individual may spend a great deal of time obtaining the substance, using the substance, or recovering from its effects (Criterion 5). In some instances of Substance Dependence, virtually all of the person’s daily activities revolve around the substance. Important social, occupational, ore recreational activities may be given up or reduced because of substance use (Criterion 6). The individual may withdraw from family activities and hobbies in order to use the substance in private or to spend more time with substance-using friends. Despite recognizing the contributing role of the substance to a psychological or physical problem (e.g., sever depressive symptoms or damage to organ systems), the person continues to use the substance (Criterion 7). The key issue in evaluating this criterion is not eh existence of the problem, but rather the individual’s failure to abstain from using the substance despite having evidence of the difficulty it is causing.
Specifiers Tolerance and withdrawal may be associated with a higher risk for immediate general medical problems and a higher relapse rate. Specifiers are provided to note their presence or absence: With Physiological Dependence. This specifier should be used when Substance Dependence is accompanied by evidence of tolerance (Criterion 1) or withdrawal (Criterion 2). Without Physiological Dependence. This specifier should be used when there is no evidence of tolerance (Criterion 1) or withdrawal (Criterion 2). In these individuals, Substance Dependence is characterized by a pattern of compulsive use (at least three items from Criteria 3-7).”
Diagnostic and Statistical Manual of Mental Disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. P. 193-195.
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PTSD, DID, and EMDR Posttraumatic Stress Disorder "The essential feature of Posttraumatic Stress Disorder us the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criteria A1). The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2). The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F). Traumatic events that are experienced directly include, but are not limited to, military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness. For children, sexually traumatic events may include developmentally inappropriate sexual experiences without threatened or actual violence or injury. Witnessed events include, but are not limited to, observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster or unexpectedly witnessing a dead body or body parts. Events experienced by others that are learned about include, but are not limited to, violent personal assault, serious accident, or serious injury experienced y a family member or a close friend; learning about the sudden, unexpected death of a family member or a close friend; or learning that one's child has a life threatening disease. The disorder may be especially sever or long lasting when the stressor is of human design (e.g., torture, rape). the likelihood of developing this disorder may increase as the intensity of and physical proximity to the stressor increase. The traumatic event can be reexperienced in various ways. Commonly the person has recurrent and intrusive recollections of the event (Criterion B1) or recurrent distressing dreams during which the event can be replayed or otherwise represented (Criterion B2). In rare instances, the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at that moment (Criterion B3). These episodes, often referred to as "flashbacks," are typically brief but can be associated with prolonged distress and heightened arousal. Intense psychological distress (Criterion B4) or physiological reactivity (Criterion B5) often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g., anniversaries of the traumatic event; cold, snowy weather or uniformed guards for survivors of death camps in cold climates; hot, humid weather for combat veterans of the South Pacific; entering any elevator for an woman who was reaped in an elevator). Stimuli associated with the trauma are persistently avoided. The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event (Criterion C1) and to avoid activities, situations, or people who around recollections of it (Criterion C2). This avoidance of reminders may include amnesia for an important aspect of the traumatic event (Criterion C3). Diminished responsiveness to the external work, referred to as "psychic numbing" or "emotional anesthesia," usually begins soon after the traumatic event. The individual may complain of having markedly diminished interest or participation in previously enjoyed activities (Criterion C4), of feeling detached or estranged from other people (Criterion C5), or of having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness and sexuality) (Criterion C6). The individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span) (Criterion C7). The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma. these symptoms may include difficulty falling or staying asleep that may be to recurrent nightmares during which the traumatic event is relived (Criterion D1), hypervigilance (Criterion D4), and exaggerated startle response (Criterion D5). Some individuals report irritability or outburst of anger (Criterion D2) or difficulty concentrating or completing tasks (Criterion D3)."
Dissociative Identity Disorder (DID) "The essential feature of Dissociative identity Disorder is the presence of two or more distinct identities or personality states (Criterion A) that recurrently take control of behavior (Criterion B). There is an inability to recall important personal information, the extent of which is too great to be explained by ordinary forgetfulness (Criterion C). The disturbance is not due tot eh direct physiological effects of a substance or a general medical condition (Condition D.). In children, the symptoms cannot be attributed to imaginary playmates or other fantasy play. Dissociative Identity Disorder reflects a failure to integrate various aspects of identity, memory, and consciousness. Each personality state may be experienced as if it has a distinct personal history, self-image, and identity, including a separate name. Usually there is a primary identity that carries the individual's given name and is passive, dependent, guilty, and depressed. The alternate identities frequently have different names and characteristics that contrast with the primary identity (e.g., are hostile, controlling, and self-destructive). Particular identities may emerge in specific circumstances and may differ in reported age and gender, vocabulary, general knowledge, or predominant affect. Alternate identities are experienced as taking control in sequence, ore at the expense of the other, and may deny knowledge of one another, be critical of one another, or appear to be in open conflict. Occasionally, one or more powerful identities allocate time to the others. Aggressive or hostile identities may at times interrupt activities or place the others in uncomfortable situations. Individuals with this disorder experience frequent gaps in memory for personal history, both remote and recent. The amnesia is frequently asymmetrical. The more passive identities tend to have more constricted memories, whereas the more hostile, controlling, or "protector" identities have more complete memories. An identity that is not in control may nonetheless gain access to consciousness by producing auditory or visual hallucinations (e.g., a voice giving instructions). Evidence of amnesia may be uncovered by reports from others who have witnessed behavior that is disavowed by the individual or by the individual's own discoveries (e.g., finding items of clothing at home that the individual cannot remember having bought). There may be loss of memory not only for recurrent periods of time, but also an overall loss of biographical memory for some extended period of childhood, adolescence, or even adulthood. Transitions among identities are often triggered by psychosocial stress. The time required to switch from one identity to another is usually a matter of seconds, but, less frequently, may b gradual. Behavior that may be frequently associated with identity switches include rapid blinking, facial changes, changes in voice or demeanor, or disruption in the individual's train of thoughts. The number of identities reported ranges from 2 to more than 100. Half of reported cases include the individuals with 10 or fewer identities." Diagnostic and Statistical Manual of Mental Disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. EMDR Eye Movement Desensitization and Reprocessing "Eye Movement Desensitization and Reprocessing (EMDR)1 integrates elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies2. EMDR is an information processing therapy and uses an eight phase approach. During EMDR1 the client attends to past and present experiences in brief sequential doses while simultaneously focusing on an external stimulus. Then the client is instructed to let new material become the focus of the next set of dual attention. This sequence of dual attention and personal association is repeated many times in the session. Eight Phases of Treatment The first phase is a history taking session during which the therapist assesses the client's readiness for EMDR and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviors that will be needed by the client in future situations. During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client is then able to use stress reducing techniques whenever necessary, during or between sessions. However, one goal is not to need these techniques once therapy is complete. In phase three through six, a target is identified and processed using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if available), a negative belief about self, related emotions and body sensations. The client also identifies a preferred positive belief. The validity of the positive belief is rated, as is the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his/her eyes back and forth following the therapist's fingers as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client. Athough eye movements are the most commonly used external stimulus, therapists often use auditory tones, tapping, or other types of tactile stimulation. The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens. After this, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client's report the clinician will facilitate the next focus of attention. In most cases a client-directed association process is encouraged. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing. When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements. After several sets, clients generally report increased confidence in this positive belief. The therapist checks with the client regarding body sensations. If there are negative sensations, these are processed as above. If there are positive sensations, they are further enhanced. In phase seven, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the self-calming activities that were mastered in phase two. The next session begins with phase eight, re-evaluation of the previous work, and of progress since the previous session. EMDR treatment ensures processing of all related historical events, current incidents that elicit distress, and future scenarios that will require different responses. The overall goal is produce the most comprehensive and profound treatment effects in the shortest period of time, while simultaneously maintaining a stable client within a balanced system. After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioral and personal change, which are further enhanced with standard EMDR procedures." www.emdr.com __________________ Major Depressive Disorder “Diagnostic Features The essential feature of Major Depressive Disorder is a clinical course that is characterized by one or more Major Depressive Episodes without a history of Manic, Mixed, or Hypomanic Episodes (Criteria A and C). Episodes of Substance-Induced Mood Disorder (due to the direct physiological effects of a drug of abuse, a medication, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Major Depressive Disorder. In addition, the episodes must not be better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified (Criterion B). The fourth digit in the diagnostic code for Major Depressive Disorder indicates whether it is a Single Episode (used only for first episodes) or Recurrent. It is sometimes difficult to distinguish between a single episode with waxing and waning symptoms and two separate episodes. For purposes of this manual, an episode is considered to have ended when the full criteria for eh Major Depressive Episode have not been met for at least 2 consecutive months. During this 2-month period, there is either complete resolution of symptoms or the presence of depressive symptoms that no longer meet the full criteria for a Major Depressive Episode (In Partial Remission). The fifth digit in the diagnostic code for Major Depressive Disorder indicates the current state of the disturbance. If the criteria for a Major Depressive Disorder are met, the severity of the episode is notes as Mild, Moderate, Severe Without Psychotic Features, or Severe With Psychotic Features. If the criteria for a Major Depressive Episode are not currently met, the fifth digit is used to indicate whether the disorder is In Partial Remission or In Full Remission. If Manic, Mixed, or Hypomanic Episodes develop in the course of Major Depressive Disorder, the diagnosis is changed to a Bipolar Disorder. However, if manic or hypomanic symptoms occur as a direct effect of antidepressant treatment, use of other medications, substance use, or toxin exposure, the diagnosis of Major Depressive Disorder remains appropriate and an addition diagnosis of Substance-induced Mood Disorder, With Manic features (or With Mixed Features), should be noted. Similarly, if manic or hypomanic symptoms occur as a direct effect of a general medical condition, the diagnosis of Major Depressive Disorder remains appropriate and an additional diagnosis of Mood Disorder Due to a General Medical Condition, With Manic Features (or With Mixed Features), should be noted.” p. 369 “Course Major Depressive Disorder may begin at any age, with an average age at onset in the mid-20s. Epidemiological data suggest that the age at onset is decreasing for those born more recently. The course of Major Depressive Disorder, Recurrent, is variable. Some people have isolated episodes that are separated by many years without any depressive symptoms, whereas others have clusters of episodes, and still others have increasingly frequent episodes as they grow older. Some evidence suggests that the periods of remission generally last longer early in the course of the disorder. The number of prior episodes predicts the likelihood of developing a subsequent Major Depressive Episode. At least 60% of individuals with Major Depresssive Disorder, Single Episode, can be expected to have a second episode. Individuals who have had tow episodes have a 70% chance of having a third, and individuals who have had three episodes have a 90% chance of having a fourth. About 5%-10% of individuals with Major Depressive Disorder, single Episode, subsequently develop a Manic Episode (i.e., develop Bipolar I Disorder). Major Depressive Episodes may end completely (in about two-thirds of cases), or only partially or not at all (in about one-third of cases). For individuals who have only partial remission, there is a greater likelihood of developing additional episodes and of continuing the pattern of partial interepisode recovery. The longitudinal course specifiers With Full Interepisode Recovery and Without Full Interepisode Recovery may therefore have prognostic value. A number of individuals have pre-existing Dysthymic Disorder prior to the onset of Major Depressive Disorder, single Episode. Some evidence suggests that these individuals are more likely to have additional Major Depressive Episodes, have poorer interepisode recovery, and may require additional acute-phase treatment and a longer period of continuing treatment to attain and maintain a more thorough and longer-lasting euthymic state. Follow-up naturalistic studies suggested that 1 year after the diagnosis of a major Depressive Episode, 40% of individuals still have symptoms that are sufficiently severe to meet criteria for a full Major Depressive Episode, roughly 20% continue to have some symptoms that no longer meet full criteria for a Major Depressive Episode (i.e., major Depressive Disorder, In Partial Remission), and 40% have no Mood Disorder. The severity of the initial Major Depressive Episode appears to predict persistence. Chronic general medical conditions are also a risk factor for more persistent episodes. Episodes of Major Depressive Disorder often follow a severe psychosocial stressor, such as the death of a loved one or divorce. Studies suggest that psychosocial events 9stressors) may play a more significant role in the precipitation of the first or second episodes of Major Depressive Disorder and may play less of a role in the onset of subsequent episodes. Chronic general medical conditions and Substance Dependence (particularly Alcohol or Cocaine Dependence) may contribute to the onset or exacerbation of Major Depressive Disorder. It is difficult to predict whether the first episode of a Major Depressive Disorder in a young person will ultimately evolve into a Bipolar Disorder. Some data suggest that the acute onset of severe depression, especially with psychotic features and psychomotor retardation, in a young person without prepubertal psychopathology is more likely to predict a bipolar disorder. A family history of Bipolar Disorder may also be suggestive of subsequent development of Bipolar Disorder.” p. 372-373
Diagnostic and statistical manual of mental disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association.
________________ Major Depressive Disorder “Diagnostic Features The essential feature of Major Depressive Disorder is a clinical course that is characterized by one or more Major Depressive Episodes without a history of Manic, Mixed, or Hypomanic Episodes (Criteria A and C). Episodes of Substance-Induced Mood Disorder (due to the direct physiological effects of a drug of abuse, a medication, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Major Depressive Disorder. In addition, the episodes must not be better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified (Criterion B). The fourth digit in the diagnostic code for Major Depressive Disorder indicates whether it is a Single Episode (used only for first episodes) or Recurrent. It is sometimes difficult to distinguish between a single episode with waxing and waning symptoms and two separate episodes. For purposes of this manual, an episode is considered to have ended when the full criteria for eh Major Depressive Episode have not been met for at least 2 consecutive months. During this 2-month period, there is either complete resolution of symptoms or the presence of depressive symptoms that no longer meet the full criteria for a Major Depressive Episode (In Partial Remission). The fifth digit in the diagnostic code for Major Depressive Disorder indicates the current state of the disturbance. If the criteria for a Major Depressive Disorder are met, the severity of the episode is notes as Mild, Moderate, Severe Without Psychotic Features, or Severe With Psychotic Features. If the criteria for a Major Depressive Episode are not currently met, the fifth digit is used to indicate whether the disorder is In Partial Remission or In Full Remission. If Manic, Mixed, or Hypomanic Episodes develop in the course of Major Depressive Disorder, the diagnosis is changed to a Bipolar Disorder. However, if manic or hypomanic symptoms occur as a direct effect of antidepressant treatment, use of other medications, substance use, or toxin exposure, the diagnosis of Major Depressive Disorder remains appropriate and an addition diagnosis of Substance-induced Mood Disorder, With Manic features (or With Mixed Features), should be noted. Similarly, if manic or hypomanic symptoms occur as a direct effect of a general medical condition, the diagnosis of Major Depressive Disorder remains appropriate and an additional diagnosis of Mood Disorder Due to a General Medical Condition, With Manic Features (or With Mixed Features), should be noted.” p. 369 “Course Major Depressive Disorder may begin at any age, with an average age at onset in the mid-20s. Epidemiological data suggest that the age at onset is decreasing for those born more recently. The course of Major Depressive Disorder, Recurrent, is variable. Some people have isolated episodes that are separated by many years without any depressive symptoms, whereas others have clusters of episodes, and still others have increasingly frequent episodes as they grow older. Some evidence suggests that the periods of remission generally last longer early in the course of the disorder. The number of prior episodes predicts the likelihood of developing a subsequent Major Depressive Episode. At least 60% of individuals with Major Depresssive Disorder, Single Episode, can be expected to have a second episode. Individuals who have had tow episodes have a 70% chance of having a third, and individuals who have had three episodes have a 90% chance of having a fourth. About 5%-10% of individuals with Major Depressive Disorder, single Episode, subsequently develop a Manic Episode (i.e., develop Bipolar I Disorder). Major Depressive Episodes may end completely (in about two-thirds of cases), or only partially or not at all (in about one-third of cases). For individuals who have only partial remission, there is a greater likelihood of developing additional episodes and of continuing the pattern of partial interepisode recovery. The longitudinal course specifiers With Full Interepisode Recovery and Without Full Interepisode Recovery may therefore have prognostic value. A number of individuals have pre-existing Dysthymic Disorder prior to the onset of Major Depressive Disorder, single Episode. Some evidence suggests that these individuals are more likely to have additional Major Depressive Episodes, have poorer interepisode recovery, and may require additional acute-phase treatment and a longer period of continuing treatment to attain and maintain a more thorough and longer-lasting euthymic state. Follow-up naturalistic studies suggested that 1 year after the diagnosis of a major Depressive Episode, 40% of individuals still have symptoms that are sufficiently severe to meet criteria for a full Major Depressive Episode, roughly 20% continue to have some symptoms that no longer meet full criteria for a Major Depressive Episode (i.e., major Depressive Disorder, In Partial Remission), and 40% have no Mood Disorder. The severity of the initial Major Depressive Episode appears to predict persistence. Chronic general medical conditions are also a risk factor for more persistent episodes. Episodes of Major Depressive Disorder often follow a severe psychosocial stressor, such as the death of a loved one or divorce. Studies suggest that psychosocial events 9stressors) may play a more significant role in the precipitation of the first or second episodes of Major Depressive Disorder and may play less of a role in the onset of subsequent episodes. Chronic general medical conditions and Substance Dependence (particularly Alcohol or Cocaine Dependence) may contribute to the onset or exacerbation of Major Depressive Disorder. It is difficult to predict whether the first episode of a Major Depressive Disorder in a young person will ultimately evolve into a Bipolar Disorder. Some data suggest that the acute onset of severe depression, especially with psychotic features and psychomotor retardation, in a young person without prepubertal psychopathology is more likely to predict a bipolar disorder. A family history of Bipolar Disorder may also be suggestive of subsequent development of Bipolar Disorder.” p. 372-373 Diagnostic and statistical manual of mental disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. ________________ DID-PTSD-EMDR Dissociative Identity Disorder (DID) "The essential feature of Dissociative identity Disorder is the presence of two or more distinct identities or personality states (Criterion A) that recurrently take control of behavior (Criterion B). There is an inability to recall important personal information, the extent of which is too great to be explained by ordinary forgetfulness (Criterion C). The disturbance is not due tot eh direct physiological effects of a substance or a general medical condition (Condition D.). In children, the symptoms cannot be attributed to imaginary playmates or other fantasy play. Dissociative Identity Disorder reflects a failure to integrate various aspects of identity, memory, and consciousness. Each personality state may be experienced as if it has a distinct personal history, self-image, and identity, including a separate name. Usually there is a primary identity that carries the individual's given name and is passive, dependent, guilty, and depressed. The alternate identities frequently have different names and characteristics that contrast with the primary identity (e.g., are hostile, controlling, and self-destructive). Particular identities may emerge in specific circumstances and may differ in reported age and gender, vocabulary, general knowledge, or predominant affect. Alternate identities are experienced as taking control in sequence, ore at the expense of the other, and may deny knowledge of one another, be critical of one another, or appear to be in open conflict. Occasionally, one or more powerful identities allocate time to the others. Aggressive or hostile identities may at times interrupt activities or place the others in uncomfortable situations. Individuals with this disorder experience frequent gaps in memory for personal history, both remote and recent. The amnesia is frequently asymmetrical. The more passive identities tend to have more constricted memories, whereas the more hostile, controlling, or "protector" identities have more complete memories. An identity that is not in control may nonetheless gain access to consciousness by producing auditory or visual hallucinations (e.g., a voice giving instructions). Evidence of amnesia may be uncovered by reports from others who have witnessed behavior that is disavowed by the individual or by the individual's own discoveries (e.g., finding items of clothing at home that the individual cannot remember having bought). There may be loss of memory not only for recurrent periods of time, but also an overall loss of biographical memory for some extended period of childhood, adolescence, or even adulthood. Transitions among identities are often triggered by psychosocial stress. The time required to switch from one identity to another is usually a matter of seconds, but, less frequently, may b gradual. Behavior that may be frequently associated with identity switches include rapid blinking, facial changes, changes in voice or demeanor, or disruption in the individual's train of thoughts. The number of identities reported ranges from 2 to more than 100. Half of reported cases include the individuals with 10 or fewer identities." Diagnostic and Statistical Manual of Mental Disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. PTSD, DID, and EMDR Posttraumatic Stress Disorder "The essential feature of Posttraumatic Stress Disorder us the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criteria A1). The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2). The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F). Traumatic events that are experienced directly include, but are not limited to, military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness. For children, sexually traumatic events may include developmentally inappropriate sexual experiences without threatened or actual violence or injury. Witnessed events include, but are not limited to, observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster or unexpectedly witnessing a dead body or body parts. Events experienced by others that are learned about include, but are not limited to, violent personal assault, serious accident, or serious injury experienced y a family member or a close friend; learning about the sudden, unexpected death of a family member or a close friend; or learning that one's child has a life threatening disease. The disorder may be especially sever or long lasting when the stressor is of human design (e.g., torture, rape). the likelihood of developing this disorder may increase as the intensity of and physical proximity to the stressor increase. The traumatic event can be reexperienced in various ways. Commonly the person has recurrent and intrusive recollections of the event (Criterion B1) or recurrent distressing dreams during which the event can be replayed or otherwise represented (Criterion B2). In rare instances, the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at that moment (Criterion B3). These episodes, often referred to as "flashbacks," are typically brief but can be associated with prolonged distress and heightened arousal. Intense psychological distress (Criterion B4) or physiological reactivity (Criterion B5) often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g., anniversaries of the traumatic event; cold, snowy weather or uniformed guards for survivors of death camps in cold climates; hot, humid weather for combat veterans of the South Pacific; entering any elevator for an woman who was reaped in an elevator). Stimuli associated with the trauma are persistently avoided. The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event (Criterion C1) and to avoid activities, situations, or people who around recollections of it (Criterion C2). This avoidance of reminders may include amnesia for an important aspect of the traumatic event (Criterion C3). Diminished responsiveness to the external work, referred to as "psychic numbing" or "emotional anesthesia," usually begins soon after the traumatic event. The individual may complain of having markedly diminished interest or participation in previously enjoyed activities (Criterion C4), of feeling detached or estranged from other people (Criterion C5), or of having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness and sexuality) (Criterion C6). The individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span) (Criterion C7). The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma. these symptoms may include difficulty falling or staying asleep that may be to recurrent nightmares during which the traumatic event is relived (Criterion D1), hypervigilance (Criterion D4), and exaggerated startle response (Criterion D5). Some individuals report irritability or outburst of anger (Criterion D2) or difficulty concentrating or completing tasks (Criterion D3)."
EMDR Eye Movement Desensitization and Reprocessing "Eye Movement Desensitization and Reprocessing (EMDR)1 integrates elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies2. EMDR is an information processing therapy and uses an eight phase approach. During EMDR1 the client attends to past and present experiences in brief sequential doses while simultaneously focusing on an external stimulus. Then the client is instructed to let new material become the focus of the next set of dual attention. This sequence of dual attention and personal association is repeated many times in the session. Eight Phases of Treatment The first phase is a history taking session during which the therapist assesses the client's readiness for EMDR and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviors that will be needed by the client in future situations. During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client is then able to use stress reducing techniques whenever necessary, during or between sessions. However, one goal is not to need these techniques once therapy is complete. In phase three through six, a target is identified and processed using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if available), a negative belief about self, related emotions and body sensations. The client also identifies a preferred positive belief. The validity of the positive belief is rated, as is the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his/her eyes back and forth following the therapist's fingers as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client. Athough eye movements are the most commonly used external stimulus, therapists often use auditory tones, tapping, or other types of tactile stimulation. The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens. After this, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client's report the clinician will facilitate the next focus of attention. In most cases a client-directed association process is encouraged. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing. When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements. After several sets, clients generally report increased confidence in this positive belief. The therapist checks with the client regarding body sensations. If there are negative sensations, these are processed as above. If there are positive sensations, they are further enhanced. In phase seven, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the self-calming activities that were mastered in phase two. The next session begins with phase eight, re-evaluation of the previous work, and of progress since the previous session. EMDR treatment ensures processing of all related historical events, current incidents that elicit distress, and future scenarios that will require different responses. The overall goal is produce the most comprehensive and profound treatment effects in the shortest period of time, while simultaneously maintaining a stable client within a balanced system. After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioral and personal change, which are further enhanced with standard EMDR procedures." www.emdr.com
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NeuroBiology of Trauma
Affect Regulation: Mentalization, and the development of the self.
Title: Affect regulation, mentalization, and the development of the self. Author(s): Koh, Eugen Source: Australian & New Zealand Journal of Psychiatry, Vol 38(1-2), Jan 2004. pp. 87-88. Publisher: United Kingdom: Blackwell Publishing. Abstract: Provides a review of the book "Affect regulation, mentalization, and the development of the self", which presents a cohesive set of ideas through a systematic critical analysis and integration of relevant literature from different disciplines--developmental psychology, neurobiology, behavioural genetics, the philosophy of the mind and psychoanalysis. The reviewer concludes that this book will be a feast for researchers. Clinicians may find the writing rather dense and jargonistic. Many will undoubtedly be rewarded for their efforts in digesting all 500 and more pages. Many reviewers have already declared this book to be a classic and comparisons have been made with another classic, Daniel Stern's "The interpersonal world of the infant," the reviewer agrees with both points. _____
Title: Affect Regulation, Mentalization, and the Development of the Self. Author(s): Altman, Neil Address: Altman, Neil, 127 W. 79th St. #3, New York, NY, US, 10024 Source: Journal of Child Psychotherapy, Vol 29(3), Dec 2003. pp. 431-435. Publisher: United Kingdom: Taylor & Francis. Abstract: This book by Fonagy et al is a major advance in psychoanalytic developmental theory. On the one hand, the theories of Freud, Mahler, Daniel Stern, Klein, and Bion are revised and extended in the light of the ideas developed in this work. On the other hand, the psychoanalytic developmental tradition is brought together with philosophy, behavioral genetics, cognitive psychology, neuroscience, infancy and child development empirical research, and attachment theory. It performs the valuable function of bringing together many psychoanalytic strands under one roof. Further, the book demonstrates the points of interface between psychoanalysis and other disciplines, placing all these disciplines into a larger integrated framework centering around concepts of mentalization. In the process, many core psychoanalytic concepts are reframed, rethought in a sense, in the context of the new integration proposed here. _____
Title: Affect regulation: Two clinical approaches. Author(s): Landau, David, Private Practice, Albuquerque, NM, US Address: Landau, David, 300 San Mateo Blvd, NE, Suite 805, Albuquerque, NM, US, 87108, dlandaumd@hotmail.com Source: Psychoanalytic Psychology, Vol 20(1), Win 2003. pp. 170-173. Publisher: US: American Psychological Assn/Educational Publishing Foundation. Abstract: The panel on affect was presented in the Spring 2001 Meeting of Division 39 (Psychoanalysis) of the American Psychological Association. Judith Levene and Kenneth Barish presented a theoretical framework and clinical experiences indicating how their work attempts to facilitate affect regulation. David Landau discussed several similar qualities shared in these papers. _____
Title: The relationship between attachment strategies and psychopathology in adolescence. Author(s): Brown, Lucy Scott, William Harvey Clinic, London, United Kingdom; Wright, John, John.Wright@Plymouth.ac.uk, Clinical Teaching Unit, Plymouth Primary Care Trust, United Kingdom Address: Wright, John, Clinical Teaching Unit, Department of Psychology, 4/5 Rowe Street, Plymouth, United Kingdom, PL4 8AA, John.Wright@Plymouth.ac.uk Source: Psychology & Psychotherapy: Theory, Research & Practice, Vol 76(4), Dec 2003. pp. 351-367. Publisher: United Kingdom: British Psychological Society. Abstract: Few studies consider the role of attachment on the development of psychopathology during adolescence. The scarcity of studies in this area is surprising given that adolescence is a critical period of psychological adjustment. This study investigates attachment patterns in adolescence and their relationship to symptomatology and interpersonal difficulties. A two-sample comparative design was employed so that a clinical group of adolescents were compared with a matched non-clinical group, on attachment classifications (using a modified Separation Anxiety Test), reported interpersonal difficulties and clinical symptoms. Significant differences were found between the clinical and non-clinical groups on attachment classifications. Adolescents with ambivalent attachment patterns reported significantly more interpersonal difficulties and symptoms compared to young people classified as having secure and avoidant attachment classifications. The results are suggestive of specific differences in the way difficulties are reported. The findings are consistent with two strategies of affect regulation. It is proposed that a 'hyperactivating' strategy and a 'deactivating' strategy may be operating among those adolescents with ambivalent and avoidant attachment classifications, respectively. _____
Title: Affective, behavioral, and cognitive functioning in adolescents with multiple suicide attempts. Author(s): Esposito, Christianne, Brown Medical School, Providence, RI, US; Spirito, Anthony, Anthony_Spirito@Brown.edu, Brown Medical School, Providence, RI, US; Boergers, Julie, Brown Medical School, Providence, RI, US; Donaldson, Diedre, Brown Medical School, Providence, RI, US Address: Spirito, Anthony, Brown University, Center for Alcohol and Addiction Studies, Box G-BH, Providence, RI, US, 02912, Anthony_Spirito@Brown.edu Source: Suicide & Life-Threatening Behavior, Vol 33(4), Win 2003. pp. 389-399. Publisher: US: Guilford Publications. Abstract: The purpose of this study was to examine affective, behavioral, and cognitive functioning in adolescents with multiple suicide attempts. Forty-seven adolescents with a history of multiple suicide attempts (MA) were compared to 74 single suicide attempters (SA) on psychiatric diagnosis, depressive symptoms, affect regulation, self-mutilation, alcohol use, and hopelessness. Results revealed that the MA group was more likely to be diagnosed with a mood disorder, and reported more severe depressive symptoms and anger, in comparison to the SA group. Behaviorally, the MA group had higher rates of disruptive behavior disorders and higher levels of affect dysregulation and serious self-mutilation than the SA group. Further, greater levels of hopelessness were reported by the MA than the SA group. After controlling for a mood disorder diagnosis, only differences in anger, affect dysregulation, and serious self-mutilation remained significant. Overall, results suggest that treatment with adolescent suicide attempters might specifically target anger and affect dysregulation to reduce risk for future suicidal behavior. _____
Title: Frontolimbic Response to Negative Feedback in Clinical Depression. Author(s): Tucker, Don M., dtucker@egi.com, Department of Psychology, University of Oregon, Eugene, OR, US; Luu, Phan, Department of Psychology, University of Oregon, Eugene, OR, US; Frishkoff, Gwen, Department of Psychology, University of Oregon, Eugene, OR, US; Quiring, Jason, Department of Psychology, University of Oregon, Eugene, OR, US; Poulsen, Catherine, Department of Psychology, University of Oregon, Eugene, OR, US Address: Tucker, Don M., Electrical Geodesies, Inc., 1600 Millrace Drive, Suite 307, Eugene, OR, US, 97403, dtucker@egi.com Source: Journal of Abnormal Psychology, Vol 112(4), Nov 2003. pp. 667-678. Publisher: US: American Psychological Assn. Abstract: Functional neuroimaging suggests that limbic regions of the medial frontal cortex may be abnormally active in individuals with depression. These regions, including the anterior cingulate cortex, are engaged in both action regulation, such as monitoring errors and conflict, and affect regulation, such as responding to pain. The authors examined whether clinically depressed subjects would show abnormal sensitivity of frontolimbic networks as they evaluated negative feedback. Depressed subjects and matched control subjects performed a video game in the laboratory as a 256-channel EEG was recorded. Speed of performance on each trial was graded with a feedback signal of A, C, or F. By 350 ms after the feedback signal, depressed subjects showed a larger medial frontal negativity for all feedback compared with control subjects with a particularly striking response to the F grade. This response was strongest for moderately depressed subjects and was attenuated for subjects who were more severely depressed. Localization analyses suggested that negative feedback engaged sources in the anterior cingulate and insular cortices. These results suggest that moderate depression may sensitize limbic networks to respond strongly to aversive events. _____
Title: Affect regulation, mentalization, and the development of the self. Author(s): Mollon, Phil Source: Psychoanalytic Quarterly, Vol 72(4), Oct 2003. pp. 1045-1051. Publisher: US: Psychoanalytic Quarterly. Abstract: Presents a few of the many informative and intriguing ideas and insights to be found in this book. The current author states that many familiar psychoanalytic concepts are given new freshness and depth through the presentation of clinical and research data and associated theorizing. Some analysts may be wary of the intercourse of psychoanalysis and developmental research, fearing that it can bring about a dilution of, or flight from, the fundamental and anxiety-laden work of exploring the unconscious mind. However, the author believes that any analyst who immerses him- or herself in this book will find that nothing of psychoanalysis need be lost and much is to be gained. _____
Title: An evaluation of affect and binge eating. Author(s): Deaver, Christine M., North Dakota State U, Fargo, ND, US; Miltenberger, Raymond G. , North Dakota State U, Fargo, ND, US; Smyth, Joshua, North Dakota State U, Fargo, ND, US; Meidinger, Amy, North Dakota State U, Fargo, ND, US; Crosby, Ross, Neuropsychiatric Research Institute, Fargo, ND, US Source: Behavior Modification, Vol 27(4), Sep 2003. pp. 578-599. Publisher: US: Sage Publications. Abstract: The affect regulation model of binge eating suggests that binge eating occurs because it provides momentary relief from negative affect. The purpose of this study was to evaluate change in affect during binge eating to evaluate the merits of this model. Participants were young adult women from a midwestern university. Binge eaters recorded their level of pleasantness using the affect grid at 2-minute intervals before, during, and after binge eating episodes and regular meals. Controls recorded in a similar manner during meals. The results showed a different pattern of affect for binge eaters during binge eating episodes and normal meals and for binge eaters and controls at normal meals. The results support the affect regulation model of binge eating and suggest that binge eating is negatively reinforced because it produces momentary relief from negative affect. _____
Title: Tattooing as a Means of Acute Affect Regulation. Author(s): Anderson, Michael, Wright State U School of Medicine, Dept of Psychiatry, Dayton, OH, US; Sansone, Randy A, Randy.sansone@kmcnetwork.org, Kettering Medical Ctr, Psychiatry Education, Kettering, OH, US Address: Sansone, Randy A., Sycamore Primary Care Ctr, 2115 Leiter Road, Miamisburg, OH, US, 45342, Randy.sansone@kmcnetwork.org Source: Clinical Psychology & Psychotherapy, Vol 10(5), Sep-Oct 2003. pp. 316-318. Publisher: US: John Wiley & Sons. Abstract: In this report, we describe the case of a 19-year-old male who acutely used the process of tattooing, and its associated physical pain, to regulate negative affective states. While tattooing has been described in the literature as serving individuals in a variety of ways (e.g. establishing a sense of individuality, externalizing important feelings), we are unaware of any prior case reports describing this affective function. Indeed, in this case, tattooing may have functioned more like self-harm behaviour, and we discuss this potential implication. _____
Title: Comparison of ego defenses among physically abused children, neglected, and non-maltreated children. Author(s): Finzi, Ricky, School of Social Work, Bar Ilan University, Ramat Gan, Israel; Har-Even, Dov, Psychology Department, Bar Ilan University, Ramat Gan, Israel; Weizman, Abraham, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Address: Finzi, Ricky, Geha Mental Health Center, Petah Tiqva, Israel, 49100 Source: Comprehensive Psychiatry, Vol 44(5), Sep-Oct 2003. pp. 388-395. Publisher: United Kingdom: Elsevier Science. Abstract: The nature and level of ego functioning were assessed in 41 recently detected physically abused children, and in two control groups of 38 neglected and 35 non-abused/non-neglected children (aged 6 to 12 years), using the Child Suicidal Potential Scales (CSPS). The results obtained in this study support the hypothesis that the influences of parental violence on the child's ego functions are detrimental, as reflected by significantly higher impairments in affect regulation (like irritability, anger, passivity, depression), low levels of impulse control, distortions in reality testing, and extensive operation of immature defense mechanisms in the physically abused children in comparison to the controls. Significant differences between the physically abused and the non-abused/non-neglected children were found for all mechanisms except displacement. The differences between the physically abused and neglected children for regression, denial and splitting, projection, and introjection (high scores for the physically abused children), and for compensation and undoing (higher scores for the neglected children) were also significant. It is suggested that physically abused children should be distinguished as a high-risk population for future personality disorders. _____
Title: Savoring Versus Dampening: Self-Esteem Differences in Regulating Positive Affect. Author(s): Wood, Joanne V., jwood@watarts.uwaterloo.ca, Department of Psychology, University of Waterloo, Waterloo, ON, Canada; Heimpel, Sara A., Department of Psychology, University of Waterloo, Waterloo, ON, Canada; Michela, John L., Department of Psychology, University of Waterloo, Waterloo, ON, Canada Address: Wood, Joanne V., Department of Psychology, University of Waterloo, Waterloo, ON, Canada, N2L 3G1, jwood@watarts.uwaterloo.ca Source: Journal of Personality & Social Psychology, Vol 85(3), Sep 2003. pp. 566-580. Publisher: US: American Psychological Assn. Abstract: Five studies examined the hypotheses that when people experience positive affect, those low in self-esteem are especially likely to dampen that affect, whereas those high in self-esteem are especially likely to savor it. Undergraduate participants' memories for a positive event (Study 1) and their reported reactions to a success (Study 2) supported the dampening prediction. Results also suggest that dampening was associated with worse mood the day after a success (Study 2), that positive and negative affect regulation are distinct, that self-esteem is associated with affect regulation even when Neuroticism and Extraversion are controlled (Studies 3 and 4), and that self-esteem may be especially important for certain types of positive events and positive affect regulation (Study 5). _____
Title: Physical, emotional, and behavioral reactions to breaking up: The roles of gender, age, emotional involvement, and attachment style. Author(s): Davis, Deborah, debdavis@unr.nevada.edu, U Nevada, Reno, NV, US; Shaver, Phillip R., U California, Davis, CA, US; Vernon, Michael L., U Nevada, Reno, NV, US Address: Davis, Deborah, Dept of Psychology, U Nevada, Reno, Reno, NV, US, 89557, debdavis@unr.nevada.edu Source: Personality & Social Psychology Bulletin, Vol 29(7), Jul 2003. pp. 871-884. Publisher: US: Sage Publications. Abstract: Associations between gender, age, emotional involvement, and attachment style and reactions to romantic relationship dissolution were studied in a survey of more than 5,000 Internet respondents. It was hypothesized that individual reactions to breakups would be congruent with characteristic attachment behaviors and affect-regulation strategies generally associated with attachment style. Attachment-related anxiety was associated with greater preoccupation with the lost partner, greater perseveration over the loss, more extreme physical and emotional distress, exaggerated attempts to reestablish the relationship, partner-related sexual motivation, angry and vengeful behavior, interference with exploratory activities, dysfunctional coping strategies, and disordered resolution. Attachment-related avoidance was weakly and negatively associated with most distress/proximity-seeking reactions to breakups and strongly and positively associated with avoidant anal self-reliant coping strategies. Security (low scores on the anxiety and avoidance dimensions) was associated with social coping strategies (e.g., using friends and family as "safe havens"). Attachment insecurity, particularly anxiety, was associated with using drugs and alcohol to cope with loss. _____
Title: Familien- und Paarbeziehungen bei Personlichkeitsstorungen--Aspekte der Dynamik und Therapie. Translated Title: Family and couples relationships in personality disorders - aspects of dynamics and therapy. Author(s): Reich, Gunter, Ambulanz fur Familientherapie und fur Ess-Storungen, Klinik und Poliklinik fur Psychosomatik und Psychotherapie, Gottingen, Germany Address: Reich, Gunter, Ambulanz fur Familientherapie und fur Ess-Storungen, Klinik und Poliklinik fur Psychosomatik und Psychotherapie, Humboldtallee 38, 37073, Gottingen, Germany Source: PTT: Personlichkeitsstorungen Theorie und Therapie, Vol 7(2), Jul 2003. pp. 72-83. Publisher: Germany: Schattauer. Abstract: Personality disorders play a significant role in the clinical concepts of family and couples therapy. Research on the family background offers an increasingly differentiated picture of pathogenesis and interpersonal dynamics. Parental neglect, intrusive control and a lack of emotional resonance seem to contribute to many personality disorders (especially Cluster B and Cluster C) as basic factors. Family disturbances of impulse control, of interpersonal and intergenerational boundaries, aggressive acting out, abuse and sexual assaults seem to be closely associated with antisocial and borderline disorders. In their couples relationships these patients often suffer from the deep fear of abandonment and simultaneously from the fear of being dominated. Interventions in family and couples therapy must be differentiated along the distinction between "over steered" and "under steered" systems. The dimension of loyalty remains in effect also in severely traumatizing family systems and has to be taken absolutely into account. Family and couples therapeutic interventions aim at the improvement of interpersonal boundaries, impulse and affect regulation as well as the development of relational "mutuality". _____
Title: Attachment-Based Family Therapy for Depressed Adolescents: Programmatic Treatment Development. Author(s): Diamond, Guy, gdiamond@psych.upenn.edu, Ctr for Intervention Science, Children's Hosp of Philadelphia, Philadelphia, PA, US; Siqueland, Lynne, Ctr for Intervention Science, Children's Hosp of Philadelphia, Philadelphia, PA, US; Diamond, Gary M., Dept of Behavioral Sciences, Ben-Gurion U of the Negev, Israel Address: Diamond, Guy, Ctr for Family Intervention Science, Children's Hosp of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA, US, 19104, gdiamond@psych.upenn.edu Source: Clinical Child & Family Psychology Review, Vol 6(2), Jun 2003. pp. 107-127. Publisher: Netherlands: Kluwer Academic Publishers. Abstract: Few effective psychosocial treatment models for depressed adolescents have been developed, let alone ones that use the developmentally potent context of the family as the focus of intervention. Attachment-based family therapy (ABFT) is a brief, manualized treatment model tailored to the specific needs of depressed adolescents and their families. Attachment theory serves as the main theoretical framework to guide the process of repairing relational ruptures and rebuilding trustworthy relationships. Empirically supported risk factors for depression are the primary problem states that therapists target with specific treatment strategies or tasks. Parent problem states include criticism/hostility, personal distress, parenting skills, and disengagement. Adolescent problem states include motivation, negative self-concept, poor affect regulation, and disengagement. Intervention tasks include relational reframing, building alliances with the adolescent and with the parent, addressing attachment failures, and building competency. A small, randomized clinical trial provides initial support for the model. Several process research studies, using both qualitative and quantitative methods, have helped refine the clinical guidelines for each treatment task. _____
Title: Autobiographical memory specificity and affect regulation: An experimental approach. Author(s): Raes, Filip, filip.raes@psy.kuleuven.ac.be, U Leuven, Dept of Psychology, Leuven, Belgium; Hermans, Dirk, U Leuven, Dept of Psychology, Leuven, Belgium; de Decker, An, U Leuven, Dept of Psychology, Leuven, Belgium Eelen, Paul, U Leuven, Dept of Psychology, Leuven, Belgium; Williams, J. Mark G., U Oxford, Dept of Psychiatry, Oxford, United Kingdom Address: Raes, Filip, Dept of Psychology, U Leuven, Tiensestraat 102, B-3000, Leuven, Belgium, filip.raes@psy.kuleuven.ac.be Source: Emotion, Vol 3(2), Jun 2003. pp. 201-206. Publisher: US: American Psychological Assn. Abstract: This study investigated J. M. G. Williams's (1996) affect-regulation hypothesis that level of specificity of autobiographical memory (AM) is used to minimize negative affect. It was found that a negative event leads to more reports of subjective stress in high- as compared with low-specific participants. Also, afterward, high-specific participants rated their unprompted memories for the event as more unpleasant. The results indicate that, relative to high specificity, being less specific in the retrieval of AMs is associated with less affective impact of a negative event. Results are discussed within the affect-regulation model. It is suggested that future research take a more functional perspective on AM specificity. _____
Title: The ecology of attachment in the family. Author(s): Hill, Jonathan, jonathan.hill@liverpool.ac.uk, U Liverpool, Dept of Psychiatry, Liverpool, United Kingdom; Fonagy, Peter, Menniger Clinic, Child & Family Ctr, Topeka, KS, US; Safier, Ellen, Menniger Clinic, Topeka, KS, US; Sargent, John, Menniger Clinic, Dept of Education & Research, Topeka, KS, US Address: Hill, Jonathan, U Child Mental Health, Royal Liverpool Children's Hosp, Alder Hey, Eaton Road, Liverpool, United Kingdom, L12 2AP, jonathan.hill@liverpool.ac.uk Source: Family Process, Vol 42(2), Sum 2003. pp. 205-221. Publisher: US: Family Process. Abstract: In this article we outline a conceptualization of attachment processes within the family. We argue that the key elements of attachment processes are affect regulation, interpersonal understanding, information processing, and the provision of comfort within intimate relationships. Although these have been described and assessed primarily in terms of individual functioning and development, they are equally applicable in family systems, provided three farther steps are taken. First, the description of attachment processes at the individual level is applied to the family using the concept of shared frames or representations of emotions, cognitions, and behaviors. Second, there is an explicit formulation of the way in which individual and family processes are linked. Third, there is a conceptualization of the nature and quality of the dynamic between attachment and other processes in family life. In this "ecology" of family processes, those that entail heightened affect and a need to create certainty through action, particularly in response to threats to safety, attachment needs, and discipline challenges, are contrasted with exploratory processes characterized by low affect, tolerance of uncertainty, and opportunities to review existing assumptions and knowledge. _____
Title: The Adult Attachment Interview and psychoanalytic outcome studies. Author(s): Gullestad, Siri Erika, s.e.gullestad@psykologi.uio.no Address: Gullestad, Siri Erika, Dept of Psychology, P.O. Box 1094, N-0317, Oslo, Norway, s.e.gullestad@psykologi.uio.no Source: International Journal of Psychoanalysis, Vol 84(3), Jun 2003. pp. 651-668. Publisher: United Kingdom: Inst of Psychoanalysis. Abstract: During the last two decades, the Adult Attachment Interview (AAI) has attracted growing interest from psychoanalysts concerned with empirical research. The paper discusses the application of Crittenden's Dynamic-Maturational AAI method for assessing the outcome of psychoanalysis. The aim is to demonstrate, through a case presentation, how therapeutic change can be expressed in the AAI. The pre- and post-treatment interviews of one patient, having completed a four-times-a-week psychoanalysis, are presented. It is demonstrated that the detailed discourse analysis of the AAI, based on transcribed tape-recorded interviews, focuses subtle formal elements of language and speech reflecting dominant patterns of affect regulation and object relating. The AAI text analysis provides possibility for coding procedural memory as conveyed by the handling of the relationship to the interviewer, incorporating the dynamic relationship between researcher and subject and thus complying with a methodological prerequisite regarded by many psychoanalysts as necessary for capturing data that are relevant to psychoanalysis. On this background, the method emerges as promising for psychoanalytic outcome studies. _____
Title: Violence and Serotonin: Influence of Impulse Control, Affect Regulation, and Social Functioning. Author(s): Krakowski, Menahem, krakow@NKI.RFMH.org, Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, US Address: Krakowski, Menahem, Nathan Kline Institute for Psychiatric Research, 140 Old Orangeburg Road, Orangeburg, NY, US, 10962, krakow@NKI.RFMH.org Source: Journal of Neuropsychiatry & Clinical Neurosciences , Vol 15(3), Sum 2003. pp. 294-305. Publisher: US: American Psychiatric Assn. Abstract: There has been much interest in the role of serotonin in aggressive behavior during the past two decades, but no simple one-to-one causal relationship has been found between this biological variable and aggression. The influence of serotonin is best analyzed within a broader framework that includes consideration of its role in the inhibition of impulses, the regulation of emotions and social functioning, domains that are closely linked to aggression. Impulsivity and strong emotional states often accompany violent acts. Aggressive individuals are likely to experience general difficulties with impulse control and emotional regulation, and they show impaired social cognition and affiliation. Serotonergic dysfunction will influence aggression differently, depending on the individual's impulse control, emotional regulation, and social abilities. Yet, aggressive acts occur in a broader social context. As such, serotonergic function has an effect not only on the individual but also on the group dynamics, and it is in turn influenced by these dynamics. Whether aggression will occur when serotonin dysfunction is present will depend on individual differences as well as the overall social context. _____
Title: The Relationship Between Cognitive Appraisal, Affect, and Catastrophizing in Patients With Chronic Pain. Author(s): Jones, David A., jones4783@rogers.com, Department of Psychology, Social Science Centre, University of Western Ontario, London, ON, Canada; Rollman, Gary B., Department of Psychology, Social Science Centre, University of Western Ontario, London, ON, Canada; White, Kevin P., Department of Medicine, University of Western Ontario, London, ON, Canada; Hill, Marilyn L., Department of Psychology, Social Science Centre, University of Western Ontario, London, ON, Canada; Brooke, Ralph I., School of Dentistry, Faculty of Medicine and Dentistry, University of Western Ontario, London, ON, Canada Address: Jones, David A., 411-564 Belmont Ave W, Kitchener, ON, Canada, N2M 5N6, jones4783@rogers.com Source: Journal of Pain, Vol 4(5), Jun 2003. pp. 267-277. Publisher: United Kingdom: Elsevier Science. Abstract: A study was conducted to clarify the nature of catastrophizing in patients with chronic pain. Information regarding 3 affective experience and 3 affect regulation dimensions was gathered from a heterogeneous sample of 104 chronic pain patients by using a semistructured clinical interview and the Affect Regulation and Experience Q-Sort (AREQ). Self-report questionnaires included visual analog pain scales, the Coping Strategies Questionnaire (CSQ), Multidimensional Pain Inventory (MPI), McGill Pain Questionnaire (MPQ), and Center for Epidemiological Studies Depression scale (CES-D). Hierarchical multiple regression was used to demonstrate the relative contributions of affective and cognitive appraisal components of catastrophizing. 31% of the variance in CSQ-Catastrophizing scores was explained by a combination of cognitive appraisal variables and AREQ scores, even after adjusting for pain severity and chronicity, age, and sex of participants. Results of the study strongly suggest that, rather than thinking of catastrophizing primarily as a cognitive coping construct, it should be described as an elaborate construct made up of both cognitive appraisal and affective components. Implications for tailoring interventions to match individual styles of affect regulation are discussed. _____
Title: Attachment theory and affect regulation: The dynamics, development, and cognitive consequences of attachment-related strategies. Author(s): Mikulincer, Mario, mikulm@mail.biu.ac.il, Department of Psychology, Bar-Ilan U, Ramat Gan, Israel; Shaver, Phillip R., Dept of Psychology, U California, Davis, CA, US; Pereg, Dana, Department of Psychology, Bar-Ilan U, Ramat Gan, Israel Address: Mikulincer, Mario, Department of Psychology, Bar-Ilan University, Ramat Gan, Israel, 52900, mikulm@mail.biu.ac.il Source: Motivation & Emotion , Vol 27(2), Jun 2003. pp. 77-102. Publisher: Netherlands: Kluwer Academic Publishers. Abstract: Attachment theory (J. Bowlby, 1982/1969, 1973) is one of the most useful and generative frameworks for understanding both normative and individual-differences aspects of the process of affect regulation. In this article we focus mainly on the different attachment-related strategies of affect regulation that result from different patterns of interactions with significant others. Specifically, we pursue 3 main goals: First, we elaborate the dynamics and functioning of these affect-regulation strategies using a recent integrative model of attachment-system activation and dynamics (P. R. Shaver & M. Mikulincer, 2002). Second, we review recent findings concerning the cognitive consequences of attachment-related strategies following the arousal of positive and negative affect. Third, we propose some integrative ideas concerning the formation and development of the different attachment-related strategies. _____
Title: Hostile, volatile, avoiding, and validating couple-conflict types: An investigation of Gottman's couple-conflict types. Author(s): Holman, Thomas B., thomas_holman@byu.edu, Brigham Young U, Provo, UT, US; Jarvis, Mark O., U Texas, Austin, TX, US Address: Holman, Thomas B., Marriage, Family, and Human Development Program, 380 SWKT, Bringham Young U, Provo, UT, US, 84602-5309, thomas_holman@byu.edu Source: Personal Relationships, Vol 10(2), Jun 2003. pp. 267-282. Publisher: United Kingdom: Blackwell Publishing. Abstract: Using two very different sets of survey data, we investigated Gottman's (1994a, 1999) observational findings regarding couple-conflict types. We hypothesized that defensible couple-conflict types could be established using survey data based on an individual's perception of the style he or she uses in couple-conflict situations. Furthermore, we hypothesized that membership type would be related to relationship quality indicators such as satisfaction, stability, communication processes, and affect regulation. Our results showed that survey data can reliably produce couple-conflict types similar to Gottman's. We further found that, on satisfaction, stability, positive communication, and soothing, hostile couple-conflict types had the lowest mean scores and validating couple-conflict types the highest mean scores. The types related in the opposite manner to negative communication, the Four Horsemen of the Apocalypse, and flooding. The other couple-conflict-type means--volatile and avoiding--are almost always between the extreme means of the hostile and validating couple-conflict types. Implications for research and practice conclude the article. _____
Title: Adult antisocial behavior and affect regulation among primary crack/cocaine-using women. Author(s): Litt, Lisa Caren, llitt@chpnet.org, St Luke's-Roosevelt Hosp Ctr, Women's Health Project Treatment & Research Ctr, New York, NY, US; Hien, Denise A., St Luke's-Roosevelt Hosp Ctr, Women's Health Project Treatment & Research Ctr, New York, NY, US; Levin, Deborah, St Luke's-Roosevelt Hosp Ctr, Women's Health Project Treatment & Research Ctr, New York, NY, US Address: Litt, Lisa Caren, Women's Health Project Treatment & Research Ctr, 411 West 1114th St, Suite 3B, New York, NY, US, 10025, llitt@chpnet.org Source: Psychology of Women Quarterly, Vol 27(2), Jun 2003. pp. 143-152. Publisher: United Kingdom: Blackwell Publishing. Abstract: The relationship between deficits in affect regulation and Adult Antisocial Behavior (ASB) in primary crack/cocaine-using women was explored in a sample of 80 inner-city women. Narrative early memories were coded for two components of affect regulation, Affect Tolerance and Affect Expression, using the Epigenetic Assessment Rating Scale. ASB was measured by the adult criteria of Antisocial Personality Disorder on the SCID-SAC. Analyses compared primary crack/cocaine-using women with and without ASB on the affect regulation measures. Findings using memories of primary caretakers revealed that women with ASB had significantly poorer capacity for Affect Tolerance and Affect Expression than women without ASB, suggesting that ASB is significantly associated with differences in the capacity to regulate emotional experience among primary crack/cocaine-using women. _____
Title: Role of affective self-regulatory efficacy in diverse spheres of psychosocial functioning. Author(s): Bandura, Albert, bandura@psych.stanford.edu, Stanford U, Dept of Psychology, Stanford, CA, US; Caprara, Gian Vittorio , caprara@uniroma1.it, U Roma "La Sapienza", Dipartimento di Psicologia, Rome, Italy; Barbaranelli, Claudio, U Roma "La Sapienza", Dipartimento di Psicologia, Rome, Italy; Gerbino, Maria, U Roma "La Sapienza", Dipartimento di Psicologia, Rome, Italy; Pastorelli, Concetta, U Roma "La Sapienza", Dipartimento di Psicologia, Rome, Italy Address: Bandura, Albert, Dept of Psychology, Stanford U, Stanford, CA, US, 94305-2130, bandura@psych.stanford.edu Source: Child Development, Vol 74(3), May 2003. pp. 769-782. Publisher: United Kingdom: Blackwell Publishing. Abstract: This prospective study with 464 older adolescents (14 to 19 years at Time 1; 16 to 21 years at Time 2) tested the structural paths of influence through which perceived self-efficacy for affect regulation operates in concert with perceived behavioral efficacy in governing diverse spheres of psychosocial functioning. Self-efficacy to regulate positive and negative affect is accompanied by high efficacy to manage one's academic development, to resist social pressures for antisocial activities, and to engage oneself with empathy in others' emotional experiences. Perceived self-efficacy for affect regulation essentially operated mediationally through the latter behavioral forms of self-efficacy rather than directly on prosocial behavior, delinquent conduct, and depression. Perceived empathic self-efficacy functioned as a generalized contributor to psychosocial functioning. It was accompanied by prosocial behavior and low involvement in delinquency but increased vulnerability to depression in adolescent females. _____
Title: Trauma and defences: Their roots in relationship. Author(s): Knox, Jean, jm.knox@btinternet.com, Private practice, Oxford, United Kingdom Address: Knox, Jean, 209 Woodstock Rd, Oxford, United Kingdom, OX2 7AB, jm.knox@btinternet.com Source: Journal of Analytical Psychology, Vol 48(2), Apr 2003. Special Issue: Trauma: Clinical and theoretical aspects. pp. 207-233. Publisher: England: Blackwell Publishing. Abstract: In this paper the differing psychodynamic models of defences are outlined and compared with an attachment theory perspective in which affect regulation plays a central role. Behavioural and intrapsychic distance regulation (defensive exclusion) are seen as the main strategies for affect regulation and are the manifestations of the habitual pattern of emotional regulation in the relationship between the child and the primary caregiver. A new perspective on unconscious fantasy is offered, in which fantasies are seen to be actively created as defensive narratives to protect the development of healthy narcissism and to become integrated into a person's internal working models. Archetypal defences are explored from a developmental perspective and some neurobiological issues relevant to defences are highlighted. _____
Title: Affect regulation and the development of psychopathology. Author(s): Allen, Jon G., Menninger Clinic, Topeka, KS, US Source: Bulletin of the Menninger Clinic, Vol 67(1), Mar 2003. pp. 68-69. Publisher: US: Menninger Foundation. Abstract: States that the author's thesis is simply stated as being the fact that psychopathology results from a failure of the organism to regulate affect. Although the topic is inherently relevant to clinical practice, and the author addresses therapeutic considerations explicitly, the greatest value of the book for clinicians is said to be its systematic synthesis of research pertinent to affect regulation. _____
Title: Adult attachment style and burnout in elementary school teachers. Author(s): Diaz, Elizabeth (Betsy) Jane, U New Mexico, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 63(8-B), Mar 2003. pp. 3969. Publisher: US: Univ Microfilms International. Abstract: This study examined adult attachment style and its effect on teacher burnout in 181 female elementary school teachers in school districts surrounding a large urban area in the southwestern United States. Adult attachment style was measured by the Multi-item Measure of Adult Romantic Attachment/Experiences in Close Relationships Questionnaire (MMARA/ECR) which categorized teachers into Secure, Dismissing, Preoccupied or Fearful clusters. Teacher burnout was measured by the Maslach Burnout Inventory-Educators Survey's (MBI-ES) three subscales of a sense of personal accomplishment (PA), emotional exhaustion (EE), and depersonalization (DP). The study explored how adult attachment style mediates these three aspects of teacher burnout. It also examined questions raised by recent research about relationships between adult attachment style and experiences of work and stress. A univariate repeated measures design was used to assess the hypotheses in this study, with adult attachment style used as a between-factor with four levels, and educator burnout as a within-factor with its three subscales considered as repeated measures. The first hypothesis was that MBI-ES subscale score profiles of PA, EE and DP would differ by adult attachment style cluster. The second hypothesis was that there would be significant mean score differences in the PA, EE, and DP subscales by adult attachment style membership. Results for teacher burnout subscale scores indicated that the profiles of subscale scores were not flat, and that the profiles of those scores for the adult attachment style groups were not parallel. There were no significant reported score differences between MMARA/ECR clusters on the MBI-ES subscale of EE. On the MBI-ES subscale of PA, the Secure MMARA/ECR cluster reported significantly higher scores than the Fearful and Preoccupied clusters, but not the Dismissing cluster. On the MBI-ES subscale of DP, the Secure and Dismissing MMARA/ECR clusters reported significantly lower scores than the Fearful and Preoccupied clusters. The results were discussed in terms of variations in affect regulation and information processing observed among persons with different adult attachment styles, and the resulting implications of those differences for teacher pre- and in-service education and supervision. _____
Title: Accuracy of metacognitive monitoring affects learning of texts. Author(s): Thiede, Keith W., U Illinois, Dept of Educational Psychology, Chicago, IL, US; Anderson, Mary C. M., U Illinois, Dept of Educational Psychology, Chicago, IL, US; Therriault, David, U Illinois, Dept of Psychology, Chicago, IL, US Address: Thiede, Keith W., U Illinois, Dept of Educational Psychology (m/c 147), 1040 West Harrison Street, Chicago, IL, US, 60607-7133, kthiede@uic.edu Source: Journal of Educational Psychology, Vol 95(1), Mar 2003. pp. 66-73. Publisher: US: American Psychological Assn. Abstract: Metacognitive monitoring affects regulation of study, and this affects overall learning. The authors created differences in monitoring accuracy by instructing participants to generate a list of 5 keywords that captured the essence of each text. Accuracy was greater for a group that wrote keywords after a delay (delayed-keyword group) than for a group that wrote keywords immediately after reading (immediate-keyword group) and a group that did not write keywords (no-keyword group). The superior monitoring accuracy produced more effective regulation of study. Differences in monitoring accuracy and regulation of study, in turn, produced greater overall test performance (reading comprehension) for the delayed-keyword group versus the other groups. The results are framed in the context of a discrepancy-reduction model of self-regulated study. _____
Title: Primitive mental states, Volume 2: Psychobiological and psychoanalytic perspectives on early trauma and personality development. Author(s): Goodman, Nancy R., Ngoodman@compuserve.com Address: Goodman, Nancy R., 6917 Arlington Road, Suite 220, Bethesda, MD, US, 20814, Ngoodman@compuserve.com Source: Journal of the American Psychoanalytic Association, Vol 51(2), Spr 2003. pp. 674-678. Publisher: US: Analytic Press. Abstract: The 10 chapters in this collection, the 2nd in a series on primitive states, take readers on a journey: first into the detailed activity of affect communication and then into the broader world of biology, neurology, genetics, affect regulation, archeology, and chaos theory. The book's dust jacket shows a thriving toddler stop a depiction of the double helix. while biology is present in the book, for these authors it is the explanatory power of projective identification that is considered the DNA of all communication. Analysts and therapists with other theories of mind may find the ubiquitous presence of this idea a challenge to their reading and yet welcome the fund of knowledge and clinical acuity presented in these chapters. _____
Title: The annihilating power of absoluteness: Superego analysis in the severe neuroses, especially in character perversion. Author(s): Wurmser, Leon, New York Freudian Society, New York, NY, US Address: Wurmser, Leon, 904 Crestwick Road, Towson, MD, US, 21286 Source: Psychoanalytic Psychology, Vol 20(2), Spr 2003. pp. 214-235. Publisher: US: American Psychological Assn/Educational Publishing Foundation. Abstract: Many find the concept of a superego not relevant anymore. Yet, there is much evidence for the cardinal relevance of what is meant with this theoretical construct. This is particularly true for the treatment of severely disturbed patients--especially those with severe forms of character perversion and addictions. The archaic superego serves in its absoluteness as primitive affect regulation. The more we assume a stance of authority, the more we tend to get enmeshed in very important regressive transference-countertransference enactments of these superego figures, functions, and affects. The working alliance breaks apart because the regression can merely be experienced, not reflected upon. This is particularly true for cases of character perversion, especially those of a severe sadomasochistic nature. _____
Title: Affect regulation, emotional intelligence and addiction: A five-factor personality model and neuropsychological study to assess treatment outcome and efficacy in heroin users. Author(s): Fortino, Denise M., Saybrook Inst., US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 63(7-B), Feb 2003. pp. 3471. Publisher: US: Univ Microfilms International. Abstract: The purpose of this study was to investigate whether five personality variables related to the perception, communication, and regulation of affect were able to predict treatment outcome and efficacy in male and female heroin users (N = 95). Predictor variables included alexithymia, negative affect (neuroticism), absorption, self-consciousness, and repressive coping. Criterion variables included outcome scores assessing abstinence, successful management of interpersonal relationships in family and social settings, and a total outcome score consisting of both the drug-related and interpersonal criteria. The study also involved a neuropsychological test of cerebral laterality to explore associations with the predictor variables and whether the response patterns of heroin users distinguished them from non-users. The personality model explained nearly 46% of the variance in scores for abstinence from illicit drug use among males, and nearly 30% among the entire group in scores for total outcome; effect sizes were large in both cases. As expected, alexithymia and negative affect were negatively correlated with abstinence and successful management of interpersonal relationships, while absorption, repressive coping, and self-consciousness were positively correlated with abstinence and/or interpersonal relationships. In males, each personality variable correlated negatively with one or more of the criterion variables, except for repressive coping which showed a positive correlation. In females, only alexithymia correlated negatively with criterion variables, and neither negative affect nor repressive coping correlated significantly with any criterion variables. The sample as a whole scored significantly higher on negative affect and self-consciousness, and lower on repressive coping compared to non-clinical groups. However, there were no significant differences for absorption or alexithymia. When gender groups were compared, females scored significantly lower than males on alexithymia, but were also significantly higher on negative affect, absorption, repressive coping, and self-consciousness, and had more favorable results on all outcomes. The neuropsychological test (line-bisecting task) revealed participants to be overwhelmingly left-hemispheric predominant compared with right-handed college students (t = 7.59, p = .001, mean difference = 26.023, d = 1.49), suggesting possible cortical differences between heroin users and non-users. The implications of these findings for designing interventions, preventing relapse, and identifying strengths as well as vulnerabilities were discussed. _____
Title: The function of sexual fantasies for sexual offenders: A preliminary model. Author(s): Gee, Dion, University of Melbourne, Melbourne, Australia; Ward, Tony, psychology@vuw.ac.nz, University of Melbourne, Melbourne, Australia; Eccleston, Lynne, University of Melbourne, Melbourne, Australia Address: Ward, Tony, School of Psychology, Victoria University of Wellington, PO Box 600, Wellington, New Zealand, psychology@vuw.ac.nz Source: Behaviour Change, Vol 20(1), 2003. pp. 44-60. Publisher: Australia: Australian Academic Press. Abstract: Although the content of sexual fantasy has been extensively researched, very little contemporary research has investigated the function of sexual fantasy within the context of offending. In this study, a qualitative analysis was used to develop a descriptive model of the phenomena of sexual fantasy during the offence process. Twenty-four adult males convicted of sexual offences provided detailed retrospective descriptions of their thoughts, emotions and behaviours before, during and after their offences. A data-driven approach to model development (grounded theory) was undertaken to analyse the interview transcripts. A preliminary model was developed to elucidate the function of sexual fantasy in the process of sexual offending, as well as the physiological and psychological variables associated with it. The sexual fantasy function model (SFFM) comprises four categories that describe the various functions of sexual fantasy in the offence process. These categories are affect regulation, sexual arousal, coping, and modelling. The strengths of the SFFM are discussed and its clinical implications are reviewed. Finally, the limitations of the study are presented, and future research directions discussed. _____
Title: Toward the development and validation of a metacognitive scale for gambling behaviour. Author(s): Millar, Golden Melanie, U Toronto, Canada Source: Dissertation Abstracts International Section A: Humanities & Social Sciences , Vol 64(4-A), 2003. pp. 1176. Publisher: US: Univ Microfilms International. Abstract: The purpose of this dissertation was to develop a reliable and valid self-report measure, the Gambling Metacognition Questionnaire (GMCQ), to assess metacognitive processes within pathological gamblers. The construct of metacognition as defined by Ann Brown (1987) served as the theoretical basis for the psychometric scale. Three separate studies aimed at item development, assessment of reliability and validity, and examination of the clinical sensitivity of the scale were conducted. Study 1 focused on item generation and refinement utilizing both the empirical literature and 10 expert consultants. Results of Study 1 showed that the metacognitive scale obtained a sufficient degree of content validity. In Study 2, a sample of 94 individuals with clinically significant gambling problems were recruited to determine the psychometric properties of the metacognitive scale, specifically, the underlying scale structure, indices of reliability and validity, and the influence of demographic characteristics and social conventionality on scale performance. Results of Study 2 produced the GMCQ a 12-item measure consisting of three subscales, namely, Reflective Concern, Preoccupation with Winning, and Affect Regulation. Findings also suggest the GMCQ displays an appropriate level of internal reliability and content validity, and is not unduly influenced by respondent's age, income, ethnicity, or level of social conventionality. Study 3 focused on assessing the clinical sensitivity of the GMCQ, in particular examining the relationship between severity of gambling pathology and scores on the GMCQ. Four separate samples of gamblers, specifically, 22 sub-clinical gamblers, 94 active untreated pathological gamblers, 20 pathological gamblers entering treatment, and 8 gamblers immediately post-treatment were recruited. Results show scores on the GMCQ are positively related to level of disordered gambling and that GMCQ scores significantly distinguished between types of gambling behaviour. Results are contextualized within the current literature on the cognitive psychology of pathological gambling and the role of metacognition within clinical psychopathology. _____
Title: The effect of peer victimization on social behavior and children's ability to negotiate conflict. Author(s): Caldwell, Melissa Sue, U Illinois At Urbana-Champaign, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 64(3-B), 2003. pp. 1484. Publisher: US: Univ Microfilms International. Abstract: The present study investigated a model of stress-generation in which peer victimization, via its effects on children's psychological and social adjustment, influences the quality of children's social interactions. 206 children (103 dyads) completed measures of peer victimization, emotional distress, and social cognition, as well as participated in a conflict-negotiation task with a peer. As anticipated, victimized children were more likely than less victimized peers to exhibit socially maladaptive behavioral displays (e.g., conflict-negotiation competence and affect-regulation competence). Elucidating the process by which experiences with victimization lead to such maladaptive and potentially stress-inducing peer responses, a self-blaming attributional style was found to account for the association between victimization and less effective regulation of negative affect, and affect-regulation competence mediated the association between victimization and peer responses. Demonstrating the importance of sex, however, boys reported significantly greater emotional distress than girls when victimized. And finally, dyadic climate (i.e., conflictual and cooperative dyadic qualities) was found to significantly predict affect-regulation competence. These results contribute to empirical and theoretical work in the area of peer relation and stress-generation research by extending current understanding of individual- and dyadic-level correlates and processes of victimization. _____
Title: Emotional arousal during therapy for posttraumatic stress disorder with childhood sexual abuse survivors. Author(s): Gleiser, Kari A., Boston U., US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 64(3-B), 2003. pp. 1491. Publisher: US: Univ Microfilms International. Abstract: This process-outcome psychotherapy study examined the influence of emotional arousal and habituation on symptom reduction in two brief therapies for adult female survivors of childhood sexual abuse (CSA) with Posttraumatic Stress Disorder (PTSD). Although affect regulation and emotional processing have been long regarded as essential markers of therapeutic progress in healing from trauma, there is a paucity of rigorous empirical investigation of affective process variables contributing to good therapeutic outcome. This study explored the relationship of observer-rated emotional arousal and habituation to PTSD symptom reduction in 46 adult female survivors of CSA: 21 in a 14-session cognitive-behavioral exposure therapy (CBT), and 25 in a 14-session supportive present-centered therapy (PCT). Researchers rated from videotapes clients' peak and modal negative affective arousal, and the presence/absence of eight categorical emotions (e.g. fear, sadness, anger, shame) across an early and late session. Six hypotheses investigated whether extremes of overly restricted or unmodulated emotional arousal and reduced rates of between-session habituation were significantly related to poorer treatment outcome, and whether this relationship changed depending on the type of treatment. Participants who experienced more habituation of negative affect arousal (expressions of distress manifest in facial expressions, voice intonation, and body language) exhibited more PTSD symptom (e.g. nightmares, intrusive memories, avoidance of triggers) improvement. Higher peak arousal and lower modal arousal at the beginning of therapy were related to more symptom reduction. Although overall negative affect arousal was higher among CBT clients than PCT clients, this interaction did not relate to improvement on PTSD symptomatology. The data did not show support for any correlations between observer-rated negative affect arousal and clients' subjective report of distress, or for any relationship between expression of categorical emotions and symptom improvement. Finally, no association was found for the therapy group by habituation interaction in predicting PTSD symptom reduction. These findings provide support for the centrality of emotional engagement and habituation in treating PTSD, and highlight the need to develop more empirically supported ways of assessing constructs related to emotional processing and regulation. For clinicians, monitoring and helping regulate clients' emotional arousal in PTSD therapies is crucial for achieving good outcome. _____
Title: Integrating attachment theory and control mastery theory: Implications for adult psychotherapy. Author(s): Walthall, Amy Dian, The Wright Inst., US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 64(3-B), 2003. pp. 1512. Publisher: US: Univ Microfilms International. Abstract: Attachment theory and control mastery theory, two psychodyamically-informed theories of human motivation developed in the 20th century, will be compared and a clinical integration using aspects of both theories will be proposed. Attachment theory and control mastery theory are similar in that they both focus on the role of "real experience" as opposed to the inner world of fantasy. Both theories propose that children actively adapt to the psychological limitations and expectations of caregivers. Both share a concept of the internalization of these experiences: control mastery theory discusses "pathogenic beliefs," while attachment theory describes, "internal working models." These theories differ, however, in their emphases regarding the psychic mechanisms that serve to maintain psychopathology. While control mastery theory emphasizes the role of guilt and loyalty, attachment theory places more emphasis on how the process of defensive exclusion shapes the individual's later capacity to both modulate affect and organize inner experiences. Control mastery theory's notion of unconscious planning will be discussed and compared to Bowlby's writings on this subject as well as the work of later attachment theorists. How these differences might effect psychotherapy will be discussed by using fictional clinical vignettes. The vignettes will be viewed through the lens of each theory and similarities and differences will be discussed. Last, the author will propose an integration of these theories by focusing in particular on how control mastery theory's notion of unconscious planning, learning, and testing could enrich attachment theory's understanding the role of affect regulation and the idea of individual differences in relational strategies. _____
Title: The maternal environment: Facilitating the emotional foundations of the mind. Author(s): Uzuncan, Temre Ann, The Wright Inst., US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 64(3-B), 2003. pp. 1528. Publisher: US: Univ Microfilms International. Abstract: This study provides an extensive review of neuropsychological, attachment, object-relations, and self psychology literature pertaining to the emotional development of the infant. Current neuropsychological findings now provide empirical and measurable rationale for the significance of psychoanalytic theories, as proposed by Melanie Klein, Wilfred Bion, D. W. Winnicott, and Heinz Kohut, over half of a century ago. There is now evidence to support that the mother or primary caregiver has a unique and critical role in facilitating the development of the infant's brain, particularly the orbitofrontal region of the cortex, which is primarily involved in emotional and cognitive functioning. This study examines the nature of the nonverbal interactions that occur between the caregiver and infant to demonstrate that the development and subsequent regulatory processes of the infant's brain are directly influenced by the quality of the caregiver's emotional engagement with the child. Longitudinal attachment studies are reviewed to illustrate that repeated patterns of the caregiver-infant relationship are internalized in the infant's brain to form mental representations that ultimately influence all dimensions of thought processing, including perceptions, emotions, memories, and behaviors. Research has shown that failure of the caregiver to emotionally regulate the infant in the first year of life has a profound impact on the infant's subsequent ability to cope effectively in times of adaptation and stress. Various forms of psychopathology are currently being viewed as disorders of affect regulation. This study will review aspects of personality, mood, anxiety, and substance-related disorders to demonstrate that affect dysregulation can have severe consequences in socioemotional functioning. The study then takes into consideration clinical implications for therapeutic techniques that emphasize affect regulation. Taking into consideration the neuropsychological evidence pertaining to emotional development and affect regulation, it is proposed that the therapeutic task of the clinician is to parallel the early maternal environment in which emotional engagement, attunement, containment, and face-to-face communication are necessary elements for psychological growth. In this approach, affects serve as the primary mode of communication in which unconscious nonverbal feelings are recognized and therefore worked through. _____
Title: The relationship between excessive exercise and alexithymia in adult women. Author(s): Hentel, Allyson Beth, Adelphi U, Inst Advanced Psychological Studies, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 63(12-B), 2003. pp. 6095. Publisher: US: Univ Microfilms International. Abstract: This study examined the presence of alexithymia and its associated personality characteristics in women who exercise moderately, women who exercise excessively and women diagnosed with an eating disorder. A sample of 138 were assessed for excessive exercise status using the Obsessive Exercise Scale and the Commitment to exercise scale. Women were assigned one of two groups: Moderate Exercise and Excessive Exercise. Women were assigned to Eating Disorder group based on self-report. Participants were administered a questionnaire packet including: Toronto Alexithymia Scale-20, Affect Regulation Scale, Affect Intensity Measure, COPE, Brief Symptom Inventory-18, and Eating Disorder Inventory-2. Women who engage in excessive exercise demonstrated a higher rate alexithymia and its associated features as compared to their moderate exercise counterparts. Specifically, the women who engage in excessive exercise demonstrated: difficulties identifying and differentiating their feelings from bodily sensations, difficulty communicating their feelings to others, a tendency towards using activity and oral passive/somatic based affect regulation strategies, a propensity to experience more extreme affect states and a higher incidence of somatic symptoms. Alternatively, these women are not apt to use different cognitive coping styles than their moderate exercise counterparts. The secondary goal of this study was to shed greater insight into the relationship between excessive exercise and eating disorders. Results of study indicated that while there is a high incidence of co-morbidity between these psychological disorders, they are not the same diagnostic entities nor do they always co-exist. _____
Title: Memory for the cognitive components of and the affective reactions to an event. Author(s): Ewell, Fontaine Michele, The Catholic U America, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 63(12-B), 2003. pp. 6132. Publisher: US: Univ Microfilms International. Abstract: The study's purpose was to clarify the concept of repression in terms of its content as well as its mechanisms, to compare commonly used measures of repression to establish construct validity, and to address the larger issues of the effects of emotion on memory for information and accuracy of emotion memory. Participants were 131 undergraduate students who watched six film clips chosen to evoke various emotions (positive and negative). Participants completed measures assessing personality, emotional reaction, emotion recall, and cognitive recall. Repression was measured using two categorical scales (a combination of the Marlowe-Crowne Social Desirability Scale and the Taylor Manifest Anxiety Scale, and the Mainz Coping Inventory) and two continuous scales (the Defense Mechanism Inventory and the Balanced Inventory of Desirable Responding). Some overlap was found between repression measures. Results suggest that the MAS/MC combination and the DMI measure affective components of repression, the MCI measures cognitive components, and the BIDR measures both. Repressors (compared to nonrepressors) reported less negative and more positive emotion prior to the experiment and reported less negative emotion after the films. Repression affected the reporting of some, but not all emotions. Thus, there was evidence for repression of negative but not positive emotions. In fact, repressors reported more positive affect perhaps as distraction against negative. Two weeks after seeing the films, repressors as a group accurately remembered their immediate, post-film negative emotions, whereas nonrepressors underestimated theirs. For all participants, initially intense negative emotions were underestimated at recall, whereas initially weak negative emotions were overestimated. Repressors recalled more plot-irrelevant cognitive details of the films than did nonrepressors. Repression occurred primarily at encoding as affect regulation rather than at retrieval, and was determined to be a partial rather than total phenomenon. Repressors vary in terms of being affect regulators or utilizing cognitive coping, suggesting there are different types of repression. Hence, results from studies using different measures of repression may not be comparable. Results contribute to clarifying the concept of repression as well as have implications for contrasting "empirical" versus "clinical" repression. _____
Title: Insufficient responsiveness in ambivalent mother-infant relationships: Contextual and affective aspects. Author(s): Harel, Judith, jharel@psy.haifa.ac.il, Department of Psychology, University of Haifa, Haifa, Israel; Scher, Anat , anats@construct.haifa.ac.il, Department of Education, University of Haifa, Haifa, Israel Address: Harel, Judith, Department of Psychology, University of Haifa, Mount Carmel, Haifa, Israel, 31905, jharel@psy.haifa.ac.il Source: Infant Behavior & Development, Vol 26(3), 2003. pp. 371-383. Publisher: United Kingdom: Elsevier Science. Abstract: The present study focused on mother-infant relationships across different situations in order to compare the ways secure and ambivalent-resistant dyads modulate positive and negative emotionality. Sixty-one Israeli mothers and their 12-month-old non-risk infants participated in a sequence of free play, Ainsworth Strange Situation, and a task involving filling out questionnaires, one of which referred to anxiety in the dyad. A comparison between the mothers of secure (n = 49) and ambivalent (n = 12) infants indicated that the latter group displayed less positive affect in play, reported more separation anxiety, but, at the same time, did not respond in a sufficient way to their child's bids for attention after experiencing a stressful separation. This pattern of results throws further light on the antecedents and correlates of ambivalent mother-child relationships. _____
Title: Treating the lesbian batterer: Theoretical and clinical considerations--A contemporary psychoanalytic perspective. Author(s): Coleman, Vallerie E., Private practice, Santa Monica, CA, US Address: Coleman, Vallerie E., 3231 Ocean Park Boulevard, Suite 205, Santa Monica, CA, US, 90405-3232 Source: Journal of Aggression, Maltreatment & Trauma , Vol 7(1-2), 2003. pp. 159-205. Publisher: US: Haworth Press. Abstract: The phenomenon of lesbian battering challenges mainstream assumptions about battering and defies traditional ways of defining and understanding domestic violence. This article identifies and illuminates variables critical to understanding and treating lesbian batterers. In particular, intrapsychic factors in the treatment of lesbian batterers are considered via an integration of the theoretical constructs of personality development with attachment theory, state and affect regulation, shame, pathological vindictiveness, and variables specific to lesbian domestic violence. Finally, two case examples and treatment considerations are discussed. _____
Title: Self-mutilation and homeless youth: The role of family abuse, street experiences, and mental disorders. Author(s): Tyler, Kimberly A., ktyler2@unl.edu, U Nebraska, Department of Sociology, Lincoln, NE, US; Whitbeck, Les B., U Nebraska, Lincoln, NE, US; Hoyt, Dan R., U Nebraska, Lincoln, NE, US; Johnson, Kurt D., U Nebraska, Lincoln, NE, US Address: Tyler, Kimberly A., Department of Sociology, University of Nebraska, 717 Oldfather Hall, Lincoln, NE, US, 68588-0324, ktyler2@unl.edu Source: Journal of Research on Adolescence, Vol 13(4), 2003. pp. 457-474. Publisher: United Kingdom: Blackwell Publishing. Abstract: Self-mutilation, which is the act of deliberately harming oneself, has been overlooked in studies of homeless and runaway youth. Given their high rates of abuse and mental health disorders, which are associated with self-mutilation, homeless and runaway youth provide an ideal sample in which to investigate factors associated with self-mutilation among a nonclinical population. Based on interviews with 428 homeless and runaway youth aged 16 to 19 years in 4 Midwestern states, the current study revealed widespread prevalence of self-mutilation among these young people. Multivariate analyses indicated that sexual abuse, ever having stayed on the street, deviant subsistence strategies, and meeting diagnostic criteria for depression were positively associated with self-mutilation. The findings are interpreted using stress theory and affect-regulation models. _____
Title: "With a little help from my friends": Affect regulation and emergence of group experience in treatment of young adolescents. Author(s): Federici-Nebbiosi, Susanna, susi@isipse.it, Training Institute in Psychoanalytic Self Psychology and Relational Psychoanalysis, Italy Address: Federici-Nebbiosi, Susanna, Via Tacito 7, 00193, Rome, Italy, susi@isipse.it Source: Psychoanalytic Inquiry, Vol 23(5), 2003. pp. 713-733. Publisher: US: Analytic Press. Abstract: The pair group provides a powerful and most useful regulatory function for adolescents. A group-based approach aims to create an intersubjective field in which an adult group conductor and the individual group members interact with the complex dynamics of the pair group. The author maintains that the core task in her approach is to understand and follow the pair group and help it learn to self-regulate and self-organize so that each member becomes aware of the affective meaning of "belonging to the group system." The group members thus develop the ability to explore new ways of relatedness-with self and others-through coconstruction of an environment of shared intimacy and safety. Clinical vignettes illustrate an approach that aims to strengthen affect regulation in young adolescent groups in the public school setting. _____
Title: Organizing patterns in a dyad and in a group: Theoretical and clinical implications. Author(s): Nebbiosi, Gianni, nebbiosi@iol. it, Training Institute in Psychoanalytic Self Psychology and Relational Psychoanalysis, Italy Address: Nebbiosi, Gianni, Via Tacito 7, 00193, Rome, Italy, nebbiosi@iol.it Source: Psychoanalytic Inquiry, Vol 23(5), 2003. pp. 750-770. Publisher: US: Analytic Press. Abstract: This paper describes the importance of group experience in relation to affect regulation for the individual and the group. After surveying work that has significantly influenced the psychoanalytic perspective on the group, the author illustrates how group experience can be a key affect regulator during some developmental phases and can have an important role in development of a person's identity. From an intersubjective perspective, the author emphasizes how group identity is attained through shared and repeated expectations that regulate the affective life of the group-what he calls group organizing principles. Last, using clinical examples, the author emphasizes the importance of affect regulation and the creation of expectations and group organizing principles in the therapeutic arena. _____
Title: Commentary on Nebbiosi's "Organizing patterns in a dyad and in a group: Theoretical and clinical implications". Author(s): Silver, Damon L., Institute of Contemporary Psychotherapy and Psychoanalysis, Washington, DC, US Address: Silver, Damon L., 4501 Connecticut Avenue NW, Washington, DC, US, 20008 Source: Psychoanalytic Inquiry, Vol 23(5), 2003. pp. 771-783. Publisher: US: Analytic Press. Abstract: Comments on the article by G. Nebbiosi which describes the importance of group experience in relation to affect regulation for the individual and the group. The current author states that Nebbiosi's thinking about dyadic and group experience from an intersubjective perspective is reflective of current trends in psychoanalysis- with the emphasis in contemporary theory shifting toward the affective dimension of self-experience. His formulations regarding the essential role of affect regulation in establishing dyadic and group organizing principles are consistent with the main point in intersubjectivity theory-that affects are organizers of self-experience. Nebbiosi develops an overarching conceptual framework and clearly elucidates the central role these organizing principles have in the formation of group identity and group cohesion. _____
Title: Empathy and sensitive responsiveness. Author(s): Pines, Malcolm, Private Practice, London, England; Marrone, Mario, Private Practice, London, England Source: Cortina, Mauricio (Ed); Marrone, Mario (Ed); 2003. Attachment theory and the psychoanalytic process. London, England: Whurr Publishers, Ltd.. pp. 42-61 Abstract: Notes that the concept of empathy closely relates to the concept of sensitive responsiveness developed by attachment theorists. An important notion in attachment theory is that sensitive responsiveness provided by attachment figures plays a major mediating role as psychic organizer of children's development. Topics discussed include sensitive responsiveness and affect regulation, applications of developmental research to psychotherapy, the psychoanalytic concept of empathy, empathy for oneself, reciprocal empathy, and sympathy _____
Title: Of Butterflies and Roaring Thunder: Nonverbal Communication in Interaction and Regulation of Emotion. Author(s): Kappas, Arvid, International U Bremen, School of Humanities and Social Sciences, Bremen, Germany; Descoteaux, Jean, U Laval, Ecole de Psychologie, Pavillon Savard, PQ, Canada Address: Kappas, Arvid, International U Bremen, School of Humanities & Social Sciences, Res. IV, P.O. Box 750561, D-28725, Bremen, Germany Source: Philippot, Pierre (Ed); Dept of Psychology; U Louvain; et al; 2003. Nonverbal behavior in clinical settings. Series in affective science. London: Oxford University Press. pp. 45-74. Abstract: In this chapter, the authors discuss the "meaning" of nonverbal behavior, specifically facial actions, as it relates to intrapersonal processes and to the regulatory aspects of nonverbal communication for the individual and in dyadic interaction. The chapter highlights problems with current notions that the authors view as "myths" and proposes a model to illustrate the interactive and dynamic nature of affect regulation in a social context, the superlens model of affective communication. _____
Title: The development of attachment and affect regulation in infancy and childhood with possible clues to psychological gender. Author(s): Schore, Judith R., California Inst for Clinical Social Work, CA, US Source: Sanville, Jean Bovard (Ed); Ruderman, Ellen Bassin (Ed); 2003. Therapies with women in transition: Toward relational perspectives with today's women. Madison, CT, US: International Universities Press, Inc. pp. 77-89 Abstract: This chapter explores the development of attachment and affect regulation in infancy through childhood with possible clues to psychological gender. Topics discussed include attachment bond formation, and attachment categories and gender issues. Conference: Committee on Psychoanalysis Reflections 2000 Series. Conference Note: This paper is based on a panel presentation entitled 'Attachment Theory and the Regulation of Affect: Developmental Changes for Women Across the Lifespan' presented at the aforementioned committee series. _____
Title: Disorders of impulse control. Author(s): Sher, Kenneth J., U Missouri, Dept of Psychology, Columbia, MO, US; Slutske, Wendy S., U Missouri, Dept of Psychology, Columbia, MO, US Source: Stricker, George (Ed); Widiger, Thomas A. (Ed); et al; 2003. Handbook of psychology: Clinical psychology, Vol. 8. New York, NY, US: John Wiley & Sons, Inc. pp. 195-228 Abstract: In this chapter we review research and theory across several different conditions that appear to have deficits in impulse control in common. The construct of disorders of impulse control is similar to disinhibitory psychopathology, a term used by E. E. Gorenstein and J. P. Newman (1980) to refer to a range of conditions across the life span marked by a failure in self-control. The chapter focuses on a select subset of clinical disorders, specifically drug and alcohol use disorders and pathological gambling. For each of these disorders, there appear to be multiple etiological mechanisms that convey risk for the development of disorder. We have termed these mechanisms positive affect regulation, negative affect regulation, pharmacological vulnerability, and deviance proneness. _____
Title: Attachment theory and family systems theory as frameworks for understanding the intergenerational transmission of family violence. Author(s): Alexander, Pamela C., University of Maryland, Department of Psychology, College Park, MD, US; Warner, Stephanie, University of Maryland, MD, US Source: Erdman, Phyllis (Ed); Caffery, Tom (Ed); 2003. Attachment and family systems: Conceptual, empirical, and therapeutic relatedness. The family therapy and counseling series. New York, NY, US: Brunner-Routledge. pp. 241-257 Abstract: Following a brief overview of attachment theory, the authors argue that the following mechanisms are relevant to understanding and predicting intergenerational transmission. First attachment theory is a cognitive theory about the development of mental models of intimate relationships. Second, attachment theory is also a theory of affect regulation. Finally, one particular type of insecure attachment (disorganized attachment) not only is prevalent among abused children and among the children of traumatized adults, but, through the mechanisms of role reversal, dissociation, and shame, may greatly increase the child's potential to engage in abusive behavior toward others. In this review, the authors attempt to highlight the importance of considering the family context when inferring the effects of insecure attachment on the cycle of violence. The clinical implications of research for the development of effective prevention and treatment interventions are explored. _____
Title: A guided-imagery treatment approach for eating disorders. Author(s): Esplen, Mary Jane, U Toronto, Dept of Psychiatry, Psychotherapy Division, Toronto, ON, Canada Source: Sheikh, Anees A. (Ed); 2003. Healing images: The role of 8magination in health. Imagery and human development series. Amityville, NY, US: Baywood Publishing Co, Inc. pp. 275-299 Abstract: Anorexia and bulimia nervosa are characterized by extreme attempts to control body shape and weight, a set of attitudes frequently described as a morbid fear of becoming fat, and concerns regarding weight and shape which have an undue influence in the evaluation of the self. The theoretical literature has suggested that at least a subgroup of individuals with eating disorders may have difficulty in modulating affects or in self-soothing. This conceptualization suggests the need to design treatments that specifically target the problem of affect regulation to assist these patients to comfort themselves. This chapter will review the literature on self-soothing and proposes a conceptual model of guided imagery therapy to address the difficulty of affect regulation. Despite the various hypnotic/imagery suggestions offered, a number of common elements are apparent, including the following: 1) the identification of the need to decrease arousal and promote comfort; 2) the recommendation to incorporate taped exercises for practice outside of therapy; and 3) the identification of the use of metaphors/ symbols as being a useful way to explore personal issues. Three case examples are provided.
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