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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. _______________________
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: Affect dysregulation and disorders of the self.
Title: Affect dysregulation and disorders of the self. Author(s): Schore, Allan N., U California at Los Angeles, David Geffen School of Medicine, Los Angeles, CA, US Source: 2003. New York, NY, US: W. W. Norton & Co, Inc. xvii, 403 pp. Abstract: This is the first volume in Schore's comprehensive treatment of affect, regulation, and human development. In Part I, Schore updates attachment theory by defining it as a regulation theory. He details the positive impact of early affective communications on the organization of a control system in the infant's development right brain. Because the right hemisphere is dominant for the processing of social, emotional, and bodily information, the relationally-influenced development and organization of this hemisphere has profound effects on a person's capacity for empathy, attention, and coping with stress. Schore presents a compelling biopsychosocial model of the relations between dynamic organizations of the right brain and essential adaptive human functions. The second part of this volume focuses on abnormal development and describes the negative impact of relational trauma on right brain development. Schore models both the origins of affect dysregulation that characterize various psychopathologies and the intergenerational transmission of a predisposition to personality disorders. Schore suggests that the nonverbal right hemisphere is dominant in basic human adaptive functions, and that impaired right brain functions lie at the core of all psychopathologies. Table of Contents: Acknowledgments Preface Part I: Developmental affective neuroscience ..The experience-dependent maturation of a regulatory system in the orbital-prefrontal cortex and the origin of developmental psychopathology ..The experience-dependent maturation of an evaluative system in the cortex ..Attachment and the regulation of the right brain ..Parent-infant communication and the neurobiology of emotional development
Part II: Developmental neuropsychiatry ..Early organization of the nonlinear right brain and the development of a predisposition to psychiatric disorders ..The effects of a secure attachment relationship on right-brain development, affect regulation, and infant mental health ..The effects of relational trauma on right-brain development, affect regulation, and infant mental health ..Dysregulation of the right brain: A fundamental mechanism of traumatic attachment and the psychopathogenesis of posttraumatic stress disorders ..Effect of early relational trauma on affect regulation: The development of borderline and antisocial personality disorders and a predisposition to violence Permissions References Index _____
Title: Affect regulation and the repair of the self. Author(s): Schore, Allan N., U California, David Geffen School of Medicine, Los Angeles, CA, US Source: 2003. New York, NY, US: W. W. Norton & Co, Inc. 363 pp. Abstract: The 2nd volume of A. Schore's comprehensive treatment of affect, regulation, and human development, this book applies his developmental theory to critical areas of early emotional development, psychoanalysis, and psychotherapy. Part 1 of the book offers psychoneurobiological models for describing the mechanisms basic to psychotherapeutic change. These chapters show how current neuroscientific findings confirm Schore's own hypothesis regarding the fundamental mechanisms of human communication. Part 2 explores the early organization of the biological substrate of the human unconscious mind. The description of the critical impact of early object relations on the development of internal psychic structures is elaborated. Schore's findings address numerous disciplines, from neuroscience to psychology, psychiatry, psychoanalysis, pediatrics, psychosomatic medicine, education, and social work. The biopsychosocial model that emerges from Schore's research highlights the integrative character of the biological and the psychological realms in early development and over the course of the human lifespan. Table of Contents: Part I: Developmentally oriented psychotherapy ..Interdisciplinary research as a source of clinical models ..Minds in the making: Attachment, the self-organizing brain, and the developmentally-oriented psychoanalytic psychotherapy ..Clinical implications of a psychoneurobiological model of projective identification ..Advances in neuropsychoanalysis, attachment theory, and trauma research: Implications for self psychology
Part II: Developmental Neuropsychoanalysis ..Early superego development: The emergence of shame and narcissistic affect regulation in the practicing period ..A century after Freud's project: Is a rapprochement between psychoanalysis and neurobiology at hand? ..The right brain, the right mind, and psychoanalysis ..The right brain as the neurobiological substratum of Freud's dynamic unconscious Appendix: Principles of psychotherapeutic treatment Permissions References Index _____
Title: Mental disorder and violence: Personality dimensions and clinical features. Author(s): Nestor, Paul G., U Massachusetts, Dept of Psychology, Boston, MA, US Address: Nestor, Paul G., Brockton VAMC, Psychiatry 116A, 940 Belmont St, Brockton, MA, US, 02301, paul.nestor@umb.edu Source: American Journal of Psychiatry, Vol 159(12), Dec 2002. pp. 1973-1978. Publisher: US: American Psychiatric Assn. Abstract: Examines the role of personality dimensions in the greater rates of violence that have now been established to accompany certain classes of mental disorders. Empirical studies are reviewed that have often used objective measures of personality and epidemiological samples with low levels of subject selection biases. The risk of violence may be understood in terms of four fundamental personality dimensions: 1) impulse control, 2) affect regulation, 3) narcissism, and 4) paranoid cognitive personality style. Low impulse control and affect regulation increase the risk for violence across disorders, especially for primary and comorbid substance abuse disorders. By contrast, paranoid cognitive personality style and narcissistic injury increase the risk for violence, respectively, in persons with schizophrenia spectrum disorders and in samples of both college students and individuals with personality disorders. This review supports the hypothesis that these four fundamental personality dimensions operate jointly, and in varying degrees, as clinical risk factors for violence among groups with these classes of mental disorders. _____
Title: Spatial but not verbal cognitive deficits at age 3 years in persistently antisocial individuals. Author(s): Raine, Adrian, U Southern California, Los Angeles, CA, US; Yaralian, Pauline S., U Southern California, Los Angeles, CA, US; Reynolds, Chandra, U Southern California, Los Angeles, CA, US; Venables, Peter H., U Southern California, Los Angeles, CA, US; Mednick, Sarnoff A., U Southern California, Los Angeles, CA, US Address: Raine, Adrian, U Southern California, Dept of Psychology, Los Angeles, CA, US, 90089-1061, raine@usc.edu Source: Development & Psychopathology, Vol 14(1), Win 2002. pp. 25-44. Publisher: US: Cambridge Univ Press. Abstract: Previous studies have repeatedly shown verbal intelligence deficits in adolescent antisocial individuals, but it is not known whether these deficits are in place prior to kindergarten or whether they are acquired throughout childhood. This study assesses whether cognitive deficits occur as early as age 3 yrs and whether they are specific to persistently antisocial individuals. Verbal and spatial abilities were assessed at ages 3 and 11 yrs, while antisocial behavior was assessed at ages 9 and 17 yrs. Persistently antisocial individuals had spatial deficits in the absence of verbal deficits at age 3 yrs compared to comparisons, and also spatial and verbal deficits at age 11 yrs. Age 3 spatial deficits were independent of social adversity, early hyperactivity, poor test motivation, poor test comprehension, and social discomfort during testing, and they were found in females as well as males. Findings suggest that early spatial deficits contribute to persistent antisocial behavior whereas verbal deficits are developmentally acquired. An early-starter model is proposed whereby early spatial impairments interfere with early bonding and attachment, reflect disrupted right hemisphere affect regulation and expression, and predispose to later persistent antisocial behavior. _____
Title: Trauma recovery in female survivors: Age, affect regulation and safe attachment. Author(s): Bolduc-Hicks, Lynda Lee , Massachusetts School Of Professional Psychology, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 63(5-B), Dec 2002. pp. 2573. Publisher: US: Univ Microfilms International. Abstract: The purpose of this retrospective study was to examine the relationship between age, Affect Regulation and Safe Attachment in adult female survivors of interpersonal trauma and identify differences between survivor groups differing in onset of trauma and recovery status. Clinicians working with trauma survivors in outpatient mental health settings completed assessments of resilience and recovery using the Multidimensional Trauma Recovery and Resiliency Scale (MTRR) designed to assess the ways in which survivors of trauma respond to their experiences. Pearson correlations were conducted using MTRR data for 125 female survivors of trauma to identify the relationship between age, Affect Regulation, and Safe Attachment with all survivors and the differences between survivors based on these areas of psychological functioning. Several hypotheses were explored in this study. First, it was hypothesized that there would be a positive relationship between age, Affect Regulation, and Safe Attachment within each of these three groups as a result of the interrelationship between affect and interpersonal relationships. Findings demonstrated that both domain scores for each group of survivors showed clear trends suggesting that Safe Attachment and Affect Regulation were positively related. Differences were postulated between the three groups of survivors on onset of trauma, recovery status and by the MTRR domains of Safe Attachment and Affect Regulation according to mean MTRR domain scores. A MANOVA was conducted to identify differences in variation in MTRR scores across recovery status and for onset of trauma. No distinctions between groups were found as a result of onset of trauma however a significant main effect was found for recovery status as it demonstrated the ability to distinguish stages of recovery based on mean scores. Significant interaction effects were revealed from mean scores on Safe Attachment concerning an expected trajectory of recovery for all survivors. Lastly, it was also hypothesized that mean scores would increase as a result of adult development or chronological age where older survivors of interpersonal violence would obtain higher MTRR mean scores independent of onset of exposure to interpersonal violence. Various findings for the Pearson Correlations and multivariate analysis of variance are discussed following clinical implications of the results. _____
Title: An investigation of relationships between affective experience, affect regulation, coping, and chronic pain. Author(s): Jones, David Alexander, U Western Ontario, Canada Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 63(5-B), Dec 2002. pp. 2587. Publisher: US: Univ Microfilms International. Abstract: Method. Information regarding three affective experience (AE) and three affect regulation (AR) dimensions was gathered from a heterogeneous sample of 104 chronic pain patients using the Affect Regulation and Experience Q-Sort (AREQ). Self-report questionnaires included visual analog pain scales, the Coping Strategies Questionnaire, Multidimensional Pain Inventory, McGill Pain Questionnaire, Profile of Mood States (Bipolar), and Center for Epidemiological Studies Depression scale. Four hypotheses regarding the roles of AE and AR were tested in separate studies. Study 1. The first study hypothesized that AR and AE dimensions in pain patients would be similar to, but show important differences from those demonstrated in psychiatric patients. Confirmatory factor analysis failed to show goodness of fit for the six AREQ scales, despite their demonstrating excellent internal consistency and strong factor loadings for five of the six scales. Exploratory analysis yielded five AE factors and six AR factors for pain patients. Study 2. Multiple regression was used to demonstrate that Catastrophizing is a complex construct characterized by both secondary cognitive appraisal and affective components. Thirty-one percent of the variance in Catastrophizing scores was explained by a combination of cognitive appraisal variables and six AREQ scales, even after pain severity and chronicity, age, and sex of participants were considered. Study 3. Hierarchical cluster analysis was used to show that subgroups of pain patients could be identified on the basis of their AR scores and the amount of intense negative affect they experienced. The cluster analysis identified four patient subgroups: Adaptive Copers, Emotionally Distressed, Avoidant Copers, and Externalizers. Cluster stability was confirmed by replicating cluster assignment using Modal Profile Analysis. Study 4. Canonical correlation was performed to identify relationships between the six AREQ variables, pain reports, and MPI pain outcome scores. One significant canonical correlate was identified, and hypotheses regarding specific relationships were generated for the four pain subgroups identified in Study 3. Conclusions. A clinical interview and the AREQ were useful tools for describing the important affective dimensions in pain patients, for developing affective profiles for chronic pain patients, clarifying the nature of Catastrophizing, and for characterizing subgroups of patients with different affective profiles. _____
Title: Adult attachment, developmental personality styles and interpersonal affect regulation. Author(s): Sherry, Alissa Rene', U Southern Mississippi, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 63(5-B), Dec 2002. pp. 2625. Publisher: US: Univ Microfilms International. Abstract: This study explores the relationships between developmental personality styles and (a) adult attachment and (b) affect regulation. These variables were examined among a sample of participants (N = 273) using Bartholomew's (Griffin & Bartholomew, 1994) Relationship Scales Questionnaire (RSQ), the Millon Clinical Multiaxial Inventory-III (MCMI-III), and an Interpersonal Affect Regulation Scale based on a method developed by Mikulincer, Orbach and Iavnieli (1998). In the first part of the study, adult attachment dimensions (secure, dismissing, preoccupied and fearful) were correlated using canonical correlation analysis (CCA) with the ten personality disorder scales on the MCMI-III (Avoidant, Paranoid, Schizotypal, Schizoid, Compulsive, Borderline, Antisocial, Narcissistic, Histrionic and Dependent). Findings indicated that the adult attachment dimensions were able to predict seven of the ten personality styles. These were Avoidant, Paranoid, Schizoid, Schizotypal, Histrionic, Dependent, and Borderline. In addition, secure attachment was negatively correlated with all of these personality styles except for Histrionic. In the second part of the study, a second CCA was conducted between the MCMI-III personality disorder scales and the interpersonal affect regulation scores. Interpersonal affect regulation was assessed by first having participants generate 10 traits that describe themselves and freely recall four scenarios of previous relationships. These scenarios varied in terms of whether the relationship had a positive or negative impact on the participant and whether a positive or negative event occurred during the relationship. The participants were then instructed to generate 10 traits that described each of the people in each of these scenarios. Finally, the participants rated the extent to which they possessed each of the generated traits on a scale ranging from 1 (a little) to 4 (extremely). Results indicated that positive relationship, regardless of the valence of the event, were able to predict five of the personality styles: Avoidant, Dependent, Histrionic, Narcissitic and Obsessive Compulsive. Results suggested that adult attachment theory may be a viable model in which to conceptualize developmental personality styles, with only moderate support for the concept of interpersonal affect regulation and its relation to personality styles. The specific relationships between the attachment dimensions and the personality styles are discussed. _____
Title: Initial validation of the Emotion Expression Scale for Children (EESC). Author(s): Penza-Clyve, Susan, U Maine, Dept of Psychology, ME, US; Zeman, Janice , U Maine, Dept of Psychology, ME, US Address: Penza-Clyve, Susan, Rhode Island Hosp, Div of Child & Family Psychiatry, 593 Eddy Street, Providence, RI, US, 02903, spenza@lifespan.org Source: Journal of Clinical Child & Adolescent Psychology, Vol 31(4), Dec 2002. pp. 540-547. Publisher: US: Lawrence Erlbaum. Abstract: The Emotion Expression Scale for Children (EESC) is a new self-report, scale designed to examine 2 aspects of deficient emotion expression: lack of emotion awareness and lack of motivation to express negative emotion. Validity was assessed using self-report measures of emotion regulation and self- and peer-report of internalizing and externalizing symptoms. Using a community sample of 208 4th- and 5th-grade children (aged 9-12 yrs), reliability analyses revealed high internal consistency and moderate test-retest reliability of the EESC. The results provide initial support for concurrent validity for the EESC factors evidenced by relations with measures of emotion management. Associations were found between the EESC and measures of internalizing symptoms. Sample vignettes from the Affect Regulation Interview are appended. _____
Title: The challenges of psychoanalytic developmental theory. Author(s): Tyson, Phyllis Address: Tyson, Phyllis, 677 Turquoise St, La Jolla, CA, US, 92037-1807, Phyllis@tysonz.com Source: Journal of the American Psychoanalytic Association, Vol 50(1), Win 2002. pp. 19-52. Publisher: US: AnaIytic Press. Abstract: Comments on the evolution of psychoanalytic developmental theory and on the challenges it currently faces--and poses. The author attempts to paint a broad picture of past and current psychoanalytic views of affect and then briefly surveys research from related fields that challenges analysts to reconsider not only their own notions about affect but also the models they use to understand mental development and function. The author examines the validity of a psychoanalytic developmental point of view, then examines affect and self-regulation in Freud's models of the mind. Affect and the behavioral sciences are discussed, as are affects and neurobiology. The author addresses the idea of nonlinear dynamic systems as a framework for understanding human behavior, as well as examining systems theory and structural theory. The author then describes the importance of self-as-agent in affect regulation. _____
Title: Affect optimization and affect complexity: Modes and styles of regulation in adulthood. Author(s): Labouvie-Vief, Gisela, Wayne State U, Dept of Psychology, Detroit, MI, US; Medler, Marshall, Wayne State U, Dept of Psychology, Detroit, MI, US Address: Labouvie-Vief, Gisela, Wayne State U, Dept of Psychology, 71 West Warren Avenue, Detroit, MI, US, 48202, gvief@sun.science.wayne.edu Source: Psychology & Aging, Vol 17(4), Dec 2002. pp. 571-587. Publisher: US: American Psychological Assn. Abstract: In this research, the authors hypothesize that affect regulation involves 2 independent strategies: affect optimization, the tendency to constrain affect to positive values, and affect complexity, the amplification of affect in the search for differentiation and objectivity. Community residents age 15 to 86 were assessed by using 2 convergent measurement domains: 1 based on measures of positive-negative affect and cognitive-affective complexity and 1 based on measures of coping and defense. Both domains yielded the hypothesized affect optimization and affect complexity dimensions. As predicted, the affect optimization dimensions are primarily related to relationship quality variables, and the affect complexity dimensions to socioeconomic status and education. Hence, positive affect and its maximization have different significance in the context of high- or low-affect complexity. Conference: Annual scientific meetings of the Gerontological Society of America., Nov, 1998, Philadelphia, PA, US _____
Title: Towards a psychodynamic understanding of binge drinking behavior in first-semester college freshmen. Author(s): Blandt, Catherine W. Address: Blandt, Catherine W., 990 Spring Run Lane, Martinsville, NJ, US, 08836, c_wildrick@yahoo.com Source: Journal of College Student Development, Vol 43(6), Nov-Dec 2002. pp. 775-791. Publisher: US: ACPA Executive Office. Abstract: Investigated the relationship between student characteristics and drinking behavior from a psychodynamic perspective. Respondents were 181 male and 196 female traditional-age (aged 18-19 yrs) college freshman attending a small, private university. Affect regulation, self-esteem, and object relations were measured with following instruments: the Toronto Alexithymia Scale, the Rosenberg Self-Esteem Scale, the Bell Object Relations and Reality Testing Inventory, and the College Alcohol Survey. Results reveal clear differences in the relationship between ego functioning and drinking behavior for men compared to women. Findings indicate that the meaning of alcohol use may differ for male and female students. Implications for methodology, theory, and practice are discussed. _____
Title: Affect regulation and addictive aspects of repetitive self-injury in hospitalized adolescents. Author(s): Nixon, Mary K., Children's Hosp of Eastern Ontario, Mental Health Patient Service Unit, Ottawa, ON, Canada; Cloutier, Paula F., Children's Hosp of Eastern Ontario, Mental Health Patient Service Unit, Ottawa, ON, Canada; Aggarwal, Sanjay, Queen's U, School of Medicine, Kingston, ON, Canada Address: Nixon, Mary K., Children's Hosp of Eastern Ontario, Mental Health Patient Service Unit, 401 Smyth Road, Ottawa, ON, Canada, K1H 8L1, nixon@cheo.on.ca Source: Journal of the American Academy of Child & Adolescent Psychiatry, Vol 41(11), Nov 2002. pp. 1333-1341. Abstract: The incidence of self-injurious behavior (SIB) in adolescent psychiatric inpatients has been reported to be as high as 61%, yet few data exist on the characteristics and functional role of SIB in this population. Because of the repetitive nature of SIB and its potential to increase in severity features of SIB and its specific reinforcing effects were examined. Participants were 42 self-injuring adolescents (aged 12-18 yrs) admitted to a hospital over a 4 mo period. Data sources consisted of self-report questionnaires and medical chart review. Reported urges to self-injure were almost daily in 78.6% of the adolescents, with acts occurring more than once a week in 83.3%. The two primary reasons endorsed for engaging in self-injury were "to cope with feelings of depression" and "to release unbearable tension." Of the sample, 97.6% endorsed three or more addictive symptoms. SIB in hospitalized adolescents serves primarily to regulate dysphoric affect and displays many addictive features. Those with clinically elevated levels of internalized anger appear at risk for more addictive features of this behavior. _____
Title: Introducing genetic psychophysiology. Author(s): de Geus, Eco J. C., Vrije U, Dept of Biological Psychology, Amsterdam, Netherlands Source: Biological Psychology, Vol 61(1-2), Oct 2002. pp. 1-10. Publisher: Netherlands: Elsevier Science. Abstract: Genetic psychophysiology examines interindividual variation in psychophysiological traits using behavioral genetic and molecular genetic techniques. It aims to delineate the pathways that lead from genomic variation to individual differences in cognitive abilities, affect regulation, and mental and physical health. This editorial provides an introduction to the twin design and gene finding strategies using psychophysiological endophenotypes. It also gives a brief outline of the papers presented in this special issue on genetic psychophysiology. Its main objective, and the objective of the entire special issue, is to interest psychophysiologists in the enormous potential of research in this area and to foster the development of collaborative relationships between psychophysiologists and molecular and behavioral geneticists that are necessary to move research in this area forward. _____
Title: Skills training in affective and interpersonal regulation followed by exposure: A phase-based treatment for PTSD related to childhood abuse. Author(s): Cloitre, Marylene, New York Presbyterian Hosp, Anxiety & Traumatic Stress Program, New York, NY, US; Koenen, Karestan C., Columbia U, Dept of Public Health, New York, NY, US; Cohen, Lisa R., St. Luke's-Roosevelt Hosp, Dept of Psychiatry, New York, NY, US; Han, Hyemee, Weill Medical Coll of Cornell U, Dept of Psychiatry, New York, NY, US Address: Cloitre, Marylene, 418 East 59th Street, Apartment 25B, New York, NY, US, 10022, mcloitre@med.cornell.edu Source: Journal of Consulting & Clinical Psychology, Vol 70(5), Oct 2002. pp. 1067-1074. Publisher: US: American Psychological Assn. Abstract: Fifty-eight women with posttraumatic stress disorder (PTSD) related to childhood abuse were randomly assigned to a 2-phase cognitive-behavioral treatment or a minimal attention wait list. Phase 1 of treatment included 8 weekly sessions of skills training in affect and interpersonal regulation; Phase 2 included 8 sessions of modified prolonged exposure. Compared with those on wait list, participants in active treatment showed significant improvement in affect regulation problems, interpersonal skills deficits, and PTSD symptoms. Gains were maintained at 3- and 9-month follow-up. Phase 1 therapeutic alliance and negative mood regulation skills predicted Phase 2 exposure success in reducing PTSD, suggesting the value of establishing a strong therapeutic relationship and emotion regulation skills before exposure work among chronic PTSD populations. _____
Title: Affect regulation in women with borderline personality disorder traits. Author(s): Yen, Shirley, Brown U Medical School, Dept of Psychiatry & Human Behavior, Providence, RI, US; Zlotnick, Caron, Brown U Medical School, Dept of Psychiatry & Human Behavior, Providence, RI, US; Costello, Ellen, Brown U Medical School, Dept of Psychiatry & Human Behavior, Providence, RI, US Address: Yen, Shirley, Brown U Medical School, Dept of Psychiatry & Human Behavior, 700 Butler Drive, Providence, RI, US, 02906 Source: Journal of Nervous & Mental Disease, Vol 190(10), Oct 2002. pp. 693-696. Publisher: US: Lippincott Williams & Wilkins. Abstract: Examined the relationship between specific dimensions of affect regulation and borderline traits in a sample of 39 female patients (mean age 35.5 yrs). Participants were administered the Personality Diagnostic Questionnaire-Revised to assess the degree of borderline traits and the Affect Intensity Measure and Affect Control Scale to assess dimensions of affect regulation, selected based on the biosocial theory of borderline personality disorder (BPD). Results from hierarchical regression analyses indicate that level of affect intensity and affect control were significantly associated with number of BPD traits, even after controlling for level of depression. Findings for affect control remained significant even after controlling for affect intensity. These results, consistent with biosocial theory of BPD, suggest that persons with BPD experience emotions more intensely and have greater difficulty in controlling their affective responses. _____
Title: The Inventory of Altered Self-Capacities (IASC): A standardized measure of identity, affect regulation, and relationship disturbance. Author(s): Briere, John, U Southern California, Los Angeles, CA, US; Runtz, Marsha , U Victoria, Victoria, BC, Canada Source: Assessment, Vol 9(3), Sep 2002. pp. 230-239. Publisher: US: Sage Publications. Abstract: Describes the Inventory of Altered Self-Capacities (IASC), a 63-item standardized measure of disturbed functioning in relation to self and others. The 7 scales of the IASC are Interpersonal Conflicts, Idealization-Disillusionment, Abandonment Concerns, Identity Impairment, Susceptibility to Influence, Affect Dysregulation, and Tension Reduction Activities. The psychometric properties of the IASC were examined in general population (n=620, aged 18-91 yrs), clinical (n=116; mean age 31 yrs), and university samples (n=290; mean age 20 yrs). The IASC was found to have internal consistency/reliability and validity in all 3 samples. Generally as predicted, IASC scales were associated with existing measures tapping borderline and antisocial personality features, depression, suicidality, substance abuse, somatization, and dysfunctional sexual behavior. _____
Title: Attachment-related psychodynamics. Author(s): Shaver, Phillip R.; Mikulincer, Mario Address: Shaver, Phillip R., U Calfornia, Davis, Dept of Psychology, One Shields Ave, Davis, CA, US, 95616-8686, prshaver@ucdavis.edu Source: Attachment & Human Development, Vol 4(2), Sep 2002. Special Issue: The psychodynamics of adult attachments--Bridging the gap between disparate research traditions. pp. 133-161. Publisher: United Kingdom: Taylor & Francis/Routledge. Abstract: Because there has been relatively little communication and cross-fertilization between the two major lines of research on adult attachment, one based on coded narrative assessments of defensive processes, the other on simple self-reports of "attachment style' in close relationships, we here explain and review recent work based on a combination of self-report and other kinds of method, including behavioral observations and unconscious priming techniques. The review indicates that considerable progress has been made in testing central hypotheses derived from attachment theory and in exploring unconscious, psychodynamic processes related to affect-regulation and attachment-system activation. The combination of self-report assessment of attachment style and experimental manipulation of other theoretically pertinent variables allows researchers to test causal hypotheses. We present a model of normative and individual-difference processes related to attachment and identify areas in which further research is needed and likely to be successful. One long-range goal is to create a more complete theory of personality built on attachment theory and other object relations theories. _____
Title: The dynamics of measuring attachment. Author(s): Bartholomew, Kim; Moretti, Marlene Address: Bartholomew, Kim, Simon Fraser U, Dept of Psychology, 8888 University Dr, Burnaby, BC, Canada, V5A 1S6, bartholo@sfu.ca Source: Attachment & Human Development, Vol 4(2), Sep 2002. Special Issue: The psychodynamics of adult attachments--Bridging the gap between disparate research traditions. pp. 162-165. Publisher: United Kingdom: Taylor & Francis/Routledge. Abstract: Comments on the paper by P. R. Shaver and M. Mikulciner about research and assessment related to the psychodynamics of adult attachment. The current authors specifically address the adult attachment interview (AAI) compared with self-report methods in measuring the dynamics of attachment. They noted the benefits of the AAI, but are also persuaded by Shaver and Mikulciner's article that self-reports of adult attachment are predictive of attachment-related dynamic processes. It is suggested that the joint use of self-reports and interviews would provide a useful way to further the study of attachment dynamics. _____
Title: Developmental origins of attachment styles. Author(s): Belsky, Jay Address: Belsky, Jay, Birkbeck Coll, Inst for the Study of Children, Families & Social Issues, 7 Bedford Square, London, United Kingdom, WC1E 7HX, j.belsky@bbk.ac.uk Source: Attachment & Human Development, Vol 4(2), Sep 2002. Special Issue: The psychodynamics of adult attachments--Bridging the gap between disparate research traditions. pp. 166-170. Publisher: United Kingdom: Taylor & Francis/Routledge. Abstract: Comments on the paper by P. R. Shaver and M. Mikulciner about research and assessment related to the psychodynamics of adult attachment. Shaver and Mikulciner make a strong case for their claim that social psychological, in contrast to the developmental psychological, approach to the study of attachment in adulthood is a valid way of tapping into the internal working model of the individual. However, the author notes that until Shaver and Mikulciner link their methods and measurements with indicators of antecedent developmental experience, developmenalists will have reason to question whether social psychologists are testing the same attachment theory that developmentalists believe themselves to be measuring. Attachment theory is not just a theory of the nature and functioning of the internal working model of self, other and of the self in close relationships, but a theory of the developmental origins of these very individual differences. _____
Title: Assessing adult attachment: Empirical sophistication and conceptual bases. Author(s): Bernier, Annie; Dozier, Mary Address: Bernier, Annie, U Montreal, Dept of Psychology, CP 6128 Succ. Centre-Ville, Montreal, PQ, Canada, H3C 3J7, annie.bernier@montreal.ca Source: Attachment & Human Development, Vol 4(2), Sep 2002. Special Issue: The psychodynamics of adult attachments--Bridging the gap between disparate research traditions. pp. 171-179. Publisher: United Kingdom: Taylor & Francis/Routledge. Abstract: Comments on the paper by P. R. Shaver and M. Mikulciner about research and assessment related to the psychodynamics of adult attachment. The authors further discuss such issues as the distinction between experimental sophistication and conceptual meaning, the experimental demonstration of causality, and the related yet clearly distinct concepts tapped by self-reports and interview methodologies. _____
Title: Attachment style measurement: A clinical and epidemiological perspective. Author(s): Bifulco, Antonia Address: Bifulco, Antonia, U London, Lifespan Research Group, Royal Holloway, 11, Bedford Square, London, United Kingdom, WC1B 3RA Source: Attachment & Human Development, Vol 4(2), Sep 2002. Special Issue: The psychodynamics of adult attachments--Bridging the gap between disparate research traditions. pp. 180-188. Publisher: United Kingdom: Taylor & Francis/Routledge. Abstract: Comments on the paper by P. R. Shaver and M. Mikulciner about research and assessment related to the psychodynamics of adult attachment. This comment highlights a position, somewhat overlooked in Shaver and Mikulciner's review, which sits between the developmental and personality approaches and their respective measurements of defensive processes and coding of brief self-report questionnaires. A case is made for using a narrative style of interview of attachment style, and four benefits of the narrative interview are discussed--its utility for assessing social context, its relevance for specific types of study, its relevance for models of attachment style and depression, and the advantage of objective assessment. _____
Title: Building bridges. Author(s): Carnelly, Katherine B.; Brennan, Kelly A. Address: Carnelly, Katherine B., U Southampton, Dept of Psychology, Highfield, Southampton, United Kingdom, SO17 1BJ Source: Attachment & Human Development , Vol 4(2), Sep 2002. Special Issue: The psychodynamics of adult attachments--Bridging the gap between disparate research traditions. pp. 189-192. Publisher: United Kingdom: Taylor & Francis/Routledge. Abstract: Comments on the paper by P. R. Shaver and M. Mikulciner about social psychological and developmental approaches to research and assessment related to the psychodynamics of adult attachment. The current authors discuss the use of self-report measures of attachment style, address the uses of the Adult Attachment Interview, and comment on the model presented by Shaver and Mikulciner. _____
Title: Attachment-related dynamics: What can we learn from self-reports of avoidance and anxiety? Author(s): Feeney, Judith A. Address: Feeney, Judith A., U Queensland, School of Psychology, Brisbane, Australia, 4072, j.feeney@psy.uq.edu.au Source: Attachment & Human Development , Vol 4(2), Sep 2002. Special Issue: The psychodynamics of adult attachments--Bridging the gap between disparate research traditions. pp. 193-200. Publisher: United Kingdom: Taylor & Francis/Routledge. Abstract: Comments on the paper by P. R. Shaver and M. Mikulciner about research and assessment related to the psychodynamics of adult attachment. Shaver and Mikulciner argue that self-report measures of adult attachment provide a useful tool for studying attachment-related dynamics, particularly when combined with experimental research techniques. Because the current author's response is generally favorable, the goals of this comment are to present additional data supporting Shaver and Mikulciner's position, draw attention to some aspects of empirical research not addressed by Shaver and Mikulciner, and comment briefly on a possible limitation of reliance on two-dimensional measures of adult attachment. _____
Title: Attachment-related psychodynamics: Another shake to the kaleidoscope. Author(s): Harris, Tirril Address: Harris, Tirril, London U, Kings Coll, Academic Psychiatry, St Thomas' site, Lambeth Palace Rd, London, United Kingdom, SE1 7EH Source: Attachment & Human Development, Vol 4(2), Sep 2002. Special Issue: The psychodynamics of adult attachments--Bridging the gap between disparate research traditions. pp. 201-206. Publisher: United Kingdom: Taylor & Francis/Routledge. Abstract: Comments on the paper by P. R. Shaver and M. Mikulciner reviewing research and assessment related to the psychodynamics of adult attachment. While Shaver and Mikulciner's review is thorough, the current author points out some additional conceptual distinctions in the study of adult attachment: fearful vs dismissive avoidance; adult attachment styles with parents vs other adults; interviews vs questionnaires; and the role of childhood attachment experiences. _____
Title: Measurement of adult attachment: The place of self-report and interview methodologies. Author(s): Jacobvitz, Deborah; Curran, Melissa; Moller, Naomi Address: Jacobvitz, Deborah, U Texas at Austin, Human Development & Family Sciences, 117 Gearing Hall, Austin, TX, US, 78712 Source: Attachment & Human Development , Vol 4(2), Sep 2002. Special Issue: The psychodynamics of adult attachments--Bridging the gap between disparate research traditions. pp. 207-215. Publisher: United Kingdom: Taylor & Francis/Routledge. Abstract: Comments on the paper by P. R. Shaver and M. Mikulciner about research and assessment related to the psychodynamics of adult attachment. This comment focuses on comparisons of narrative interviews, such as the Adult Attachment Interview (AAI), and self-report instruments assessing adults' styles of approaching romantic relationships. These different methodologies may lead to systematic differences in how individuals' attachment status is classified, specifically with regard to assessment of individuals who in the AAI would be classified as secure, preoccupied, dismissing, or unresolved. Such differences indicate that studies using the two methodologies may not be comparing like with like. The authors first clarify some of the potentially critical differences in how the two method assess individuals' attachment status followed by a comparison of findings in the two research traditions. _____
Title: Building bridges between social, developmental and clinical psychology. Author(s): Kobak, Roger Address: Kobak, Roger, U Delaware, Dept of Psychology, Newark, DE, US, 19716 Source: Attachment & Human Development, Vol 4(2), Sep 2002. Special Issue: The psychodynamics of adult attachments--Bridging the gap between disparate research traditions. pp. 216-222. Publisher: United Kingdom: Taylor & Francis/Routledge. Abstract: Comments on the paper by P. R. Shaver and M. Mikulciner about research and assessment related to the psychodynamics of adult attachment that is in both the social psychology and developmental psychology traditions. The current author focuses on improvements to Shaver and Mikulciner's model of the attachment behavioral system. First, it is suggested that a clearer distinction between the types of threats that activate the attachment system needs to be made. Second, a model of attachment system dynamics should incorporate individuals' expectations or what J. Bowlby (1973) terms forecasts of the attachment figure's availability. Finally, the author briefly discusses the clinical implications of Shaver and Mikulciner's paper. Despite the detailed descriptions of personality processes provided, the current approach to attachment style lacks an account of interpersonal and metacognitive processes in child and adult attachment relationships. _____
Title: Fearful-avoidance, disorganization, and multiple working models: Some directions for future theory and research. Author(s): Simpson, Jeffry A.; Rholes, W. Steven Address: Simpson, Jeffry A., Texas A & M U, Dept of Psychology, College Station, TX, US, 77843-4235, jas@psyc.tamu.edu Source: Attachment & Human Development, Vol 4(2), Sep 2002. Special Issue: The psychodynamics of adult attachments--Bridging the gap between disparate research traditions. pp. 223-229. Publisher: United Kingdom: Taylor & Francis/Routledge. Abstract: Comments on the paper by P. R. Shaver and M. Mikulciner about research and assessment related to the psychodynamics of adult attachment. First, the current authors focus on where fearful-avoidant individuals might fit within Shaver and Mikulciner's model, and discuss some critical ways in which fearful-avoidant adults are similar to and different from certain subcategories of dismissive adults on the Adult Attachment Interview, and how they bear conceptual similarities to Disorganized infants. Second, the authors discuss the hierarchical nature of working models and the importance of understanding when and how different types of working models independently or jointly affect information-processing and attachment-related behavior in adult relationships. Finally, the authors discuss one of the first behavioral observation studies to assess attachment orientations toward parents and toward romantic partners, the results of which highlight the importance of measuring different kinds of working models. _____
Title: Bowlby's secure base theory and the social/personality psychology of attachment styles: Work(s) in progress. Author(s): Waters, Everett; Crowell, Judith; Elliott, Melanie; Corcoran, David Treboux, Dominique Address: Waters, Everett, SUNY, Dept of Psychology, Stony Brook, NY, US, 11794-2500, everett.waters@sunysb.edu Source: Attachment & Human Development , Vol 4(2), Sep 2002. Special Issue: The psychodynamics of adult attachments--Bridging the gap between disparate research traditions. pp. 230-242. Publisher: United Kingdom: Taylor & Francis/Routledge. Abstract: Comments on the paper by P. R. Shaver and M. Mikulciner about research and assessment related to the psychodynamics of adult attachment. The authors addresses several areas highlighted in Shaver and Mikulciner's article: emphasis on the value of experimental analysis in attachment study; accessibility of attachment representations to empirical analysis; and emphasis on affect regulation. The authors provide detailed comments on the importance of contributions of social and personality psychology to attachment theory, noting also that these contributions can help preserve the legacy of J. Bowlby and M. Ainsworth and challenge developmentalists working within the secure base framework to be more explicit about what the key postulates of attachment theory are. _____
Title: Dialogue on adult attachment: Diversity and integration. Author(s): Shaver, Phillip R.; Mikulincer, Mario Address: Shaver, Phillip R., U California, Davis, Dept of Psychology, One Shields Ave, Davis, CA, US, 95616-8686, prshaver@ucdavise.edu Source: Attachment & Human Development , Vol 4(2), Sep 2002. Special Issue: The psychodynamics of adult attachments--Bridging the gap between disparate research traditions. pp. 243-257. Publisher: United Kingdom: Taylor & Francis/Routledge. Abstract: Responds to comments in this special issue of Attachment & Human Development on the authors' target article about research and assessment of adult attachment styles. The authors' discuss some of the common themes in these commentaries in three major sections: basic theoretical issues, comments on their model of attachment dynamics, and measurement issues. _____
Title: The influence of emotional and physiological reactivity on infant memory. Author(s): Hitchcock, Daniel F. A., Rutgers The State U New Jersey- New Brunswick, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 63(3-B), Sep 2002. pp. 1582. Publisher: US: Univ Microfilms International. Abstract: This study examined the influence of behavioral (arm, facial) and autonomic (HR, RSA(VNA), and adrenocortical) reactivity upon memory in infancy. Fifty-six 4-month-old infants learned an operant contingency task that was followed by extinction-induced frustration. Sixty-one percent of the infants remembered the task 7 days later. The behavioral and autonomic outcomes from learning and extinction were then assessed for differences between those remembering and those not remembering the task. Results revealed that during learning fewer infants in the Retention Group showed negative emotion. These infants also displayed more dynamic changes in HR and RSA(VNA). In addition, they showed more arm response, more positive emotion, and a more tempered cardiac response during extinction. The Retention Group also had a greater mean level of overall cortisol. Although not significant for the sample overall, this heightened cortisol occurred for those who showed a pre- to post-session cortisol increase. The results are discussed in the contexts of a biocognitive explanation of the role of emotion during memory encoding, as well as Porges' Polyvagal Theory of Emotion (Porges, 1995, 1997, 1998). Consistent with the idea that affect regulation and autonomic nervous system functioning are related to the encoding process for memory, the findings suggest that during learning and extinction greater amounts of positive emotion, accompanied by cognitively modulated cardiac function, promote enhanced attention thereby facilitating the encoding process for memory while greater amounts of negative emotion along with more extreme cardiac reactivity can impair it. _____
Title: A hangulat szabalyzasarol. A homeosztatikus kognitiv strategiak, erzelmi szabalyozasban betoltott szerepenek bizonyitekai. Translated Title: On Managing Moods: Evidence for the Role of Homeostatic Cognitive Strategies in Affect Regulation. Author(s): Forgas, Joseph P., jp.forgas@unsw.edu.au, University of New South Wales, Sydney, NSW, Australia Address: Forgas, Joseph P., jp.forgas@unsw.edu.au Source: Erdelyi Pszichologiai Szemle , Vol 3(3), Sep 2002. pp. 299-317. Publisher: Romania: Pro Studium et Practicum Psychologiae Assn. Abstract: What are the cognitive strategies that allow people to manage and maintain their daily mood fluctuations within reasonable limits? Despite intense recent interest in affective phenomena, spontaneous changes over time in mood effects have rarely been studied. These three experiments evaluated the temporal sequence of positivity and negativity in social responses by people who received an initial positive and negative mood induction. Following different mood manipulations, participants performed three kinds of serial social tasks: they generated person descriptions (Exp. 1), completed trait words (Exp. 2) or produced a series of self-descriptions (Exp. 3). Results were consistent with the operation of a spontaneous, homeostatic mood management mechanism,as initially mood-congruent responses were spontaneously reversed and replaced by mood-incongruent reactions over time. The implications of these results for recent affect-cognition theorizing, and for our understanding of people's everyday mood management strategies are discussed. _____
Title: Attachment, social rank and affect regulation: Speculations on an ethological approach to family interaction. Author(s): Sloman, Leon, U Toronto, Ctr for Addiction & Mental Health, Dept of Psychiatry, Toronto, ON, Canada; Atkinson, Leslie, U Toronto, Ctr for Addiction & Mental Health, Depts of Psychiatry & Psychology, Toronto, ON, Canada; Milligan, Karen , U Toronto, Ontario Inst for Studies in Education, Toronto, ON, Canada; Liotti, Giovanni, U Pontificia Salesiana, Roma Scuolo di Formazione in Psicoterapia Cognitiva, Roma, Italy Address: Sloman, Leon, Ctr for Addiction & Mental Healtth, 250 College Street, Toronto, ON, Canada, M5T 1R8, leon_sloman@camh.net Source: Family Process, Vol 41(3), Fal 2002. pp. 313-327. Publisher: US: Family Process. Abstract: The attachment and social rank systems are biological-evolutionary systems that can serve as models for conceptualizing family interaction. By exploring both their unique and interrelated impact on affect regulation, it is possible to differentiate between processes that foster healthy growth and those leading to individual psychopathology. This perspective facilitates the integration of biological and psychological models, and has therapeutic implications. It also integrates well with other family therapy models. _____
Title: Attach and affect regulation: A framework for family treatment of conduct disorder. Author(s): Keiley, Margaret K., Purdue U, West Lafayette, IN, US Source: Family Process, Vol 41(3), Fal 2002. pp. 477-493. Publisher: US: Family Process. Abstract: Conduct disorder (CD), a pervasive adolescent disorder with clinically significant antisocial behaviors, has been a difficult syndrome to treat successfully. Recently, research on affect regulation and attachment has suggested that attachment and affect regulation strategies may underlie the development of conduct disorder in adolescents, implying that attention to these factors might improve family treatment for CD. In this review of the research literature, the author discusses the role of attachment and affect regulation in the development and treatment of CD. In addition, the author presents information about the framework, intervention protocol, and preliminary evidence of effectiveness of an attachment- and affect regulation-based intervention that has been developed and implemented with multiple-family groups of parents and incarcerated adolescents. _____
Title: Attachment and coping with chronic disease. Author(s): Schmidt, Silke, U Hosp Hamburg Eppendorf, Dept of Medical Psychology, Hamburg, Germany; Nachtigall, Christof, U Jena, Inst of Psychology, Dept of Methodology, Jena, Germany; Wuethrich-Martone, Olivia, U Jena, Inst of Psychology, Dept of Methodology, Jena, Germany; Strauss, Bernhard, U Hosp Jena, Inst of Medical Psychology, Jena, Germany Address: Schmidt, Silke, U Hosp Hamburg Eppendorf, Dept of Medical Psychology, Martinistrasse 52, Pav. 73, Hamburg, Germany, D-20246, sischmid@uke.uni-hamburg.de Source: Journal of Psychosomatic Research, Vol 53(3), Sep 2002. pp. 763-773. Publisher: US: Elsevier Science. Abstract: Tested the hypothesis that attachment patterns have an influence on coping strategies (CSs) in patients with chronic disease, and that APs may predict the subjective emotional and physical health status during medical treatment. 150 patients (suffering from breast cancer, chronic leg ulcers, or alopecia) were investigated with an adult attachment interview and a coping interview. Self-reported CSs, social support, subjective health status, and quality of life were also assessed by self-report measures at 2 or more sampling points. Findings indicate a moderate effect of attachment patterns on CSs when controlling the influence of confounding variables. Insecure attachment was related to less flexible coping. CSs differed between the different types of insecure attachment; however, there were differences depending on the perspective of the coping behavior (self vs observer ratings) as well. It is concluded that 2 levels of coping should be differentiated--1 level corresponding with affect regulation, in particular the regulation of attachment-related emotions and concerns, while the other level shows a stronger tendency to outwardly oriented coping. A more secure attachment might be considered to be an important inner resource in the emotional adaptation to chronic diseases. _____
Title: Neubewertung der Entwicklung der Affektregulation vor dem Hintergrund von Winnicotts Konzept des "falschen Selbst". Translated Title: Reevaluation of the development of affect regulation against the background of Winnicott's concept of the "false self." Author(s): Fonagy, Peter, University College London, Psychoanalysis Unit, London, England; Target, Mary, University College London, Psychoanalysis Unit, London, England Address: Fonagy, Peter, University College London, Psychoanalysis Unit, Gower Street, London, England, WC1E 6BT, p.fonagy@ucl.ac.uk Source: Psyche: Zeitschrift fuer Psychoanalyse und ihre Anwendungen, Vol 56(9-10), Sep-Oct 2002. pp. 839-862. Publisher: Germany: J G Cotta sche Buchhandlung Nachfolger GmbH. Abstract: Presents central theories on the role of affect in the development of the self. Based on the theory of social biofeedback the authors conceptualize emotion with regard to the development of intentionality and mentalization. Early attachment experiences and specific mirroring processes encourage affect regulation, mentalization, the development of the self, the perception of others, and interactive compentencies. The authors provide empirical findings to prove how congruent or inconguent mirroring in early childhood contribute to the success or failures in constituting the self. A "new" perspective developed based on D. W. Winnicott's concept of the "false self" is presented. _____
Title: The impact of premature birth on fear of personal death and attachment styles in adolescence. Author(s): Lubetzky, Ofra, Tel-Aviv U, School of Medicine, Ramat Aviv, Israel; Gilat, Itzhak, Levinsky Coll of Education, Israel Address: Lubetzky, Ofra, PO Box 599, Herzliyya Pituach, Israel, 46105, lubetzky@netvision.net.il Source: Death Studies, Vol 26(7), Aug 2002. pp. 523-543. Publisher: United Kingdom: Taylor & Francis. Abstract: The differences between adolescents born pre-term (n=50; aged 14-16 yrs) and a matched sample of adolescents born full-term were examined in relation to fear of personal death, attachment styles, and the relation between the 2 variables. Findings revealed that adolescents born pre-term showed a higher level of fear of personal death and a lower frequency of secure attachment style than adolescents born full-term. In addition, secure full-term born adolescents exhibited a lower level of fear of personal death compared with insecure adolescents; whereas among those born pre-term, attachment styles did not affect the level of fear of personal death. Results are discussed in terms of the long-term impact of premature birth on affect regulation in adolescence. _____
Title: Maternal representations of the infant: Associations with infant response to the Still Face. Author(s): Rosenblum, Katherine L., U Michigan, Ann Arbor, MI, US; McDonough, Susan, U Michigan, Ann Arbor, MI, US; Muzik, Maria, U Michigan, Ann Arbor, MI, US; Miller, Alison, Brown U, Providence, RI, US; Sameroff, Arnold, U Michigan, Ann Arbor, MI, US Address: Rosenblum, Katherine L., U Michigan, Ctr for Human Growth & Development, 300 N. Ingalls Building, 1031NW, Ann Arbor, MI, US, 48109, katier@umich.edu Source: Child Development, Vol 73(4), Jul-Aug 2002. pp. 999-1015. Publisher: US: Blackwell Publishers. Abstract: Mothers' representations of their infants may influence early development of emotional self-regulation. This study examined the associations between characteristics of 100 mothers' (aged 16-42 yrs) narratives about their 7-month-old infants, maternal depression, and their infants' affect regulation during the Still Face procedure. Findings showed that 1) mothers' representations were linked with individual differences in their infants' behavior across the Still Face procedure, 2) the association between mothers' representations and their infants' behavior was mediated by parenting behavior, and 3) mothers' representations explained unique variance in their infants' affect regulation beyond the contribution of maternal depression. Although infants' displays of positive affect diminished while mothers held a still face, only infants of mothers in the balanced representation category returned to high levels of positive affect upon resuming interaction. These findings highlight the role of maternal representations in the process by which dyads repair temporary disruptions in interaction, as well as individual differences in infants' and mothers' responses to the Still Face. _____
Title: Effect of impaired recognition and expression of emotions on frontocingulate cortices: An fMRI study of men with alexithymia. Author(s): Berthoz, Sylvie; Artiges, Eric; Van de Moortele, Pierre-Francois; Poline, Jean-Baptiste; Rouquette, Stephanie; Consoli, Silla M.; Martinot, Jean-Luc , INSERM U334, SHFJ/CEA, Orsay, France Address: Martinot, Jean-Luc, INSERM U334, SHFJ/CEA, 4 Place du General Leclerc, 91401, Orsay, France, martinot@shfj.cea.fr Source: American Journal of Psychiatry, Vol 159(6), Jun 2002. pp. 961-967. Publisher: US: American Psychiatric Assn. Abstract: Searched for differential cerebral regional activation in response to emotional stimuli in Ss with alexithymia. Two groups of 8 men each were selected from 437 healthy Ss on the basis of high or low scores on the 20-item Toronto Alexithymia Scale. Using functional magnetic resonance imaging (fMRI), the authors compared the 2 groups for their regional cerebral activation in response to the presentation of pictures with validated positive or negative arousal capabilities. Men with alexithymia demonstrated less cerebral activation in the left mediofrontal-paracingulate cortex in response to highly negative stimuli and more activation in the anterior cingulate, mediofrontal cortex, and middle frontal gyrus in response to highly positive stimuli than men without alexithymia. Findings provide direct evidence that alexithymia, a personality trait playing a role in affect regulation, is linked with differences in anterior cingulate and mediofrontal activity during emotional stimuli processing. _____
Title: Sibling personality characteristics associated with the presence and absence of alcoholism. Author(s): Pilato, Ronald W., The Wright Inst., US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 62(11-B), Jun 2002. pp. 5420. Publisher: US: Univ Microfilms International. Abstract: Why do some siblings develop alcoholism and some do not, when they both share similar environmental and biological risk? This study utilized biologically related siblings, thereby limiting genetic and environmental variability, to study patterns of personality characteristics within families with one or more alcoholics. Personality differences between alcoholic and non-alcoholic siblings were evaluated both as indicators of risk (vulnerability to alcoholism) in the alcoholic siblings and as indicators of resiliency (resistance to alcoholism) in the non-alcoholic siblings. Participants responded to the MMPI-2, the Affect Regulation Scale (ARS), and the Defense Styles Questionnaire-40 (DSQ-40). The study tested two primary hypotheses. (1) Alcoholics and their non-alcoholic siblings (discordant pairs) were expected to differ significantly in personality characteristics, (2) Sibling pairs in which both siblings had alcoholism (concordant alcoholic pairs) and in which both siblings did not have alcoholism (concordant non-alcoholic pairs), were expected to be more similar in personality compared to discordant pairs. A combined clinical and community sample of recovering alcoholics and their siblings were recruited. Alcoholics had over 30 days of sobriety, no other drug addictions except nicotine, and the 145 sibling pairs were gender matched. Results indicated that non-alcoholic siblings reported significantly lower levels of aggression and unusual thought processes and significantly higher levels of emotional constraint. Non-alcoholic siblings reported healthier affect regulation strategies more frequently than their alcoholic siblings. These results suggest that lower emotionality and unusual thought processes, higher constraint and use of healthier affect regulation strategies are associated with resistance to developing alcoholism in siblings at high genetic and environmental risk. More frequent use of activities, contemplative practices and interpersonal skills might reflect less frequent need to regulate affect or serve a protective function. A tendency to constrain emotional stimulation such as aggression and negative affectivity may be associated with successful affect regulation through means other than using alcohol. Clinical interventions for high-risk individuals, based on the assessment of general personality traits, might focus on the development of more adaptive affect regulation strategies. _____
Title: Borderline-Stoerung und Verzerrungen der Aufmerksamkeit. Theoretische Modelle und empirische Befunde. Translated Title: Borderline personality disorder and attentional biases. Theoretical models and empirical findings. Author(s): Ceumern-Lindenstjerna, Ina-Alexandra v. , U Heidelberg, Psychiatrische Klinik, Abteilung Kinder- und Jugendpsychiatrie, Heidelberg, Germany; Brunner, R. , U Heidelberg, Psychiatrische Klinik, Abteilung Kinder- und Jugendpsychiatrie, Heidelberg, Germany; Parzer, P., U Heidelberg, Psychiatrische Klinik, Abteilung Kinder- und Jugendpsychiatrie, Heidelberg, Germany; Fiedler, P., Ruprecht-Karls-U Heidelberg, Inst fuer Psychologie, Abteilung Klinische Psychologie und Psychotherapie, Heidelberg, Germany; Resch, F., U Heidelberg, Psychiatrische Klinik, Abteilung Kinder- und Jugendpsychiatrie, Heidelberg, Germany Address: Ceumern-Lindenstjerna, Ina-Alexandra v., U Heidelberg, Psychiatrische Klinik Abteilung Kinder- und Jugendpsychiatrie, Blumenstrase 8, 69115, Heidelberg, Germany, ina_ceumern@med.uni-heidelberg.de Source: Fortschritte der Neurologie, Psychiatrie, Vol 70(6), Jun 2002. pp. 321-330. Publisher: Germany: Georg Thieme Verlag. Abstract: Comparatively describes three theoretical models of borderline personality disorder and their possible links to attentional biases. The dialectical behavior approach postulates a pronounced attentional narrowing to emotional stimuli in connection with deficits regarding affect regulation. The cognitive approach assumes that rigid dysfunctional schemata initiate a cognitive emotional circuit, which leads to a reinforcement of the symptomatology as a result of a biased perception and memory. Additionally the present article specifies the trauma approach which emphasizes the relation between borderline pathology and childhood trauma with recourse to theories of attentional biases in patients with traumatic experiences. Preliminary empirical findings suggest that patients with borderline personality disorder demonstrate a general attentional bias for any emotional negative stimuli and not a selective attentional bias to borderline-specific stimuli. Further studies should clarify, whether therapeutical interventions with the aim to influence attentional processes represent a useful complement to established therapies in patients with borderline personality disorder. _____
Title: Excessive exercise in anorexia nervosa and bulimia nervosa: Relation to eating characteristics and general psychopathology. Author(s): Penas-Lliedo, Eva, U Extremadura, Medical School, Dept of Pharmacology & Psychiatry, Badajoz, Spain; Vaz Leal, Francisco J. , U Extremadura, Medical School, Dept of Pharmacology & Psychiatry, Badajoz, Spain; Waller, Glenn, U London, St George's Hosp Medical School, Dept of General Psychiatry, London, United Kingdom Address: Penas-Lliedo, Eva, U of Extremadura, Medical School, Dept of Pharmacology & Psychiatry, Avenue of Elvas s/n, 06071, Badajoz, Spain, elledo@unex.es Source: International Journal of Eating Disorders, Vol 31(4), May 2002. pp. 370-375. Publisher: US: John Wiley & Sons. Abstract: Examined the presence of excessive exercise in different women with eating disorders and its psychopathological correlates. Case notes from 63 anorexia nervosa and 61 bulimia nervosa female patients were examined. Two-way multivariate analyses of variance (diagnosis*use of excessive exercise) were used to determine the impact of the 2 factors upon eating characteristics, as measured with the Eating Attitudes Test and Bulimic Investigatory Test, Edinburgh, and psychopathological symptoms, as measured with the Symptom Checklist-90-Revised. Results indicate that while high levels of depression were more likely among all patients who used excessive exercise, levels of anxiety and somatization were particularly high only among those anorexics who exercised excessively. Possible explanatory models are advanced to account for this pattern of findings, focusing on the possible use of exercise as an affect regulation strategy among anorexia nervosa patients. Further research is suggested to test and develop this model, and possible clinical implications are outlined. _____
Title: Child care as a relational context for early development: Research in neurobiology and emerging roles for social work. Author(s): Shapiro, Janet, Bryn Mawr Coll, Graduate School of Social Work & Social Research, Bryn Mawr, PA, US; Applegate, Jeffrey S., Bryn Mawr Coll, Graduate School of Social Work & Social Research, Bryn Mawr, PA, US Address: Shapiro, Janet, Bryn Mawr Coll, Graduate School of Social Work & Social Research, 300 Airdale Rd, Bryn Mawr, PA, US, 19010, jshapiro@brynmawr.edu Source: Child & Adolescent Social Work Journal, Vol 19(2), Apr 2002. pp. 97-114. Publisher: US: Kluwer Academic/Plenum Publishers. Abstract: The quality of child care in the U.S. is an important social problem, particularly for economically vulnerable families. This is highlighted by multidisciplinary research on the importance of early caregiving as a determinant of child health and wellbeing. This article examines center-based child care as an important relational and developmental context for infants and young children. Through an integration of psychosocial studies and emerging research in the cognitive neurosciences, this paper describes how developmental research on early emotional development can be utilized to inform our understanding of child care as a critical social and interpersonal context for infants and young children. In particular, this paper examines research on early interpersonal experience as a determinant of the capacity for affect regulation. Focusing on the application of theory to practice, this paper discusses the relevance of this research to informed direct practice, advocacy and program development. _____
Title: An attachment theory conceptualization of adults who have witnessed domestic violence as children: Adult attachment styles and implications for treatment. Author(s): Patton, Kimberly Anne , California School Of Professional Psychology - Berkeley/Alameda, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 62(9-B), Apr 2002. pp. 4231. Publisher: US: Univ Microfilms International. Abstract: This study indirectly examined the population of adults who have witnessed domestic violence as children within the context of attachment theory. Implications were drawn for treatment approaches, utilizing Bartholomew's and Horowitz's (1991) four adult attachment styles: secure, preoccupied, dismissing, and fearful. Up to the present time, there has been little research on adults who have witnessed domestic violence as children. The study expanded the research to include this population as well as derive unique treatment measures for these individuals. Treatment recommendations were formulated from synthesizing the literature on witnessing domestic violence and attachment theory. These recommendations were delineated for the four attachment styles, including general treatment considerations and trauma-focused treatment. The interventions included several treatment parameters for each attachment style, such as goals of treatment, psychopathology, the therapeutic relationship, affect regulation, and internal working models. Additionally, qualitative research was conducted exploring clinicians' treatment approaches with a domestic violence population. A nonrandom, national sample of 32 clinicians was recruited from domestic violence agencies. Participants completed a questionnaire requesting demographic information, perceptions of therapeutic issues with adults who have witnessed childhood domestic violence, treatment approaches with such clients, and the application of attachment concepts in therapy. Several areas were identified by clinicians as attachment-based clinical issues and treatment interventions for adult witnesses of childhood domestic violence. Addressing issues with self-esteem, affect, trauma, interpersonal relationships, and the therapeutic relationship were seen as important for all attachment styles. Group therapy, couples therapy, psychodynamic psychotherapy, and psychoeducation were seen as useful interventions for each of the attachment styles. In addition, cognitive-behavioral therapy was recommended for clients with insecure attachment styles. Recommendations for specific attachment styles were as follows: for individuals with a secure attachment style, treatment focused on accessing these clients' strengths to help them cope with past trauma. Preoccupied clients' poorly regulated affect, low self-esteem, rejecting interpersonal relationships, and inadequate defenses were a focus. With dismissing clients, interpersonal relationships, particularly the therapeutic relationship, behavioral problems, cognitive distortions, and emotional constriction were emphasized. For individuals with a fearful attachment style, trauma resolution, safety, coping, dysregulated affect, and chaotic relationships were seen as important clinical issues. _____
Title: The development and implementation of an affect regulation and attachment intervention for incarcerated adolescents and their parents. Author(s): Keiley, Margaret K., Purdue U, Marriage & Family Therapy Program, West Lafayette, IN, US Source: Family Journal-Counseling & Therapy for Couples & Families, Vol 10(2), Apr 2002. pp. 177-189. Publisher: US: Sage Publications. Abstract: Discusses the development, implementation, and curriculum of a multiple-family affect regulation and attachment intervention for incarcerated adolescents (aged 14-18 yrs) and their parents. Interviews with both adjudicated and non-adjudicated adolescents and their parents led to the development of an 8-wk intervention focusing on affect regulation and attachment issues. Among the most formidable barriers in the therapy process with this population is stopping the interactional cycle of aggression and silence between parent and child. An unintended positive consequence of the intervention has been the involvement of security officers and the lessening of conflicts between them and the incarcerated adolescents. _____
Title: The relationship between emotional intelligence and ego defense mechanisms. Author(s): Pellitteri, John , Queens Coll, Dept of Educational & Community Programs, Flushing, NY, US Address: Pellitteri, John, Queens Coll, Dept of Educational & Community Programs, 65-30 Kissena Blvs, Flushing, NY, US, 11367, Jpellitt@qc1.qc.edu Source: Journal of Psychology, Vol 136(2), Mar 2002. pp. 182-194. Publisher: US: Heldref Publications. Abstract: Examined the relationship between the components of emotional intelligence (perception of emotion, affect regulation, and emotional knowledge) and personality factors associated with adaptation, represented by the hierarchical model of defense mechanisms (M. Bond et al, 1983). 107 adults (aged 18-52 yrs) served as Ss. Bivariate correlation analyses yielded mixed results; the adaptive defense styles were correlated with overall emotional intelligence but not with the emotional perception and regulation components, as was hypothesized. Emotional knowledge was correlated with both adaptive and maladaptive defense styles and with general intelligence, as was expected. Implications for counseling and psychoeducational interventions are suggested. _____
Title: Reasons for alcohol use in young adulthood: Validation of a three-dimensional measure. Author(s): Labouvie, Erich, Rutgers U, Ctr of Alcohol Studies, Piscataway, NJ, US; Bates, Marsha E., Rutgers U, Ctr of Alcohol Studies, Piscataway, NJ, US Address: Labouvie, Erich, Rutgers U, Ctr of Alcohol Studies, 607 Allison Road, Piscataway, NJ, US, 08854-8001, ewl@rci.rutgers.edu Source: Journal of Studies on Alcohol, Vol 63(2), Mar 2002. pp. 145-155. Publisher: US: Alcohol Research Documentation. Abstract: Evaluated the reliability and validity of a measure of reasons for alcohol use, which is based on a cognitive mediational view of alcohol use as a means for affect regulation. Data from self-reports of 1,176 25-31 yr olds taken over a 13-yr period were used to obtain measures of reasons for use, coping use, sex-enhancing use, use intensity and use problems. Results show 3 hypothesized dimensions: social reasons, disinhibition reasons and suppression reasons. Although moderately correlated, the dimensions exhibited distinct relationships with other use variables. Increases in social reasons were related to decelerating increases in use intensity, but increases in disinhibition and suppression reasons were associated with accelerating increases in use intensity. Social reasons did not relate to use problems, whereas suppression reasons were strongly related to use problems even when controlling for use intensity. Suppression reasons not only motivate reactive coping use in response to the appraisal of stressful situations, they are also likely to instigate proactive coping use in anticipation of the possible occurrence of stressors, thereby blunting the emotional impact of encounters that would otherwise have been appraised as stressful and aversive. _____
Title: On managing moods: Evidence for the role of homeostatic cognitive strategies in affect regulation. Author(s): Forgas, Joseph P., U New South Wales, Sydney, Australia; Ciarrochi, Joseph V., U Wollongong, Australia Address: Forgas, Joseph P., U New South Wales, School of Psychology, Sydney, Australia, 2052, jp.forgas@unsw.edu.au Source: Personality & Social Psychology Bulletin, Vol 28(3), Mar 2002. pp. 336-345. Publisher: US: Sage Publications. Abstract: Examined the temporal sequence of positivity and negativity in social responses by people who received an initial positive and negative mood induction in 3 experiments. Following different mood manipulations, Ss performed three kinds of serial social tasks. In Exp 1, 60 Ss completed person description. In Exp 2, 55 Ss completed trait words. In Exp 3, 48 Ss produced a series of self-descriptions. Results were consistent with the operation of a spontaneous, homeostatic mood management mechanism. The authors found that initially mood-congruent responses were spontaneously reversed and replaced by mood-incongruent reactions over time. The implications of these results for recent affect-cognition theorizing, and for our understanding of people's everyday mood management strategies, are discussed. _____
Title: On the outer and inner reality of the father and its significance for the development of affect regulation: Perspectives from research on early attachment and emotion. Author(s): Lemche, Erwin , Dresden U of Technology, Medical Faculty Gustav Carus, Dept of Psychotherapy & Psychosomatics, Dresden, Germany; Stoeckler, Lothar, Free U Berlin, Berlin, Germany Address: Lemche, Erwin, Dresden U of Technology, Medical Faculty Gustav Carus, Dept of Psychotherapy & Psychosomatics, Fescherstrasse 74, 0137, Dresden, Germany Source: Psychoanalysis & Contemporary Thought, Vol 25(2), Spr 2002. pp. 115-163. Publisher: US: International Universities Press. Abstract: Discusses the question of what functions influence children's experience of real interactions with their fathers and mothers and their internalized mental representations in the development of affect regulation during infancy and early childhood. Following a review of empirical studies on the gender specificity of father-infant interactions, a model of the development of mental parental representations is presented that allows a more detailed description of the role played by these representations in emotion dispositions. It is proposed that according to the theory of early triangulation and current knowledge on representational development, children are not able to represent both parents cognitively in a common mental space before the age of 18 months. It is argued that this capacity for joint mental representation of both parental figures is essential for effective modulation and transformation of affective states. It is conjectured that this differentiated joint image of both mother and father is of crucial importance for the emergence of interindividually specific patterns of affect regulation in 3- to 5-yr olds. A model of emotion regulatory mechanisms based on observations from early expressive behavior is presented. _____
Title: Trauma, repetition, and affect regulation: The work of Paul Russell: Book review. Author(s): Teicholz, Judith Guss, (Ed); Kriegman, Daniel , (Ed) Source: Psychoanalytic Psychology, Vol 19(2), Spr 2002. pp. 409-415. Publisher: US: American Psychological Assn/Educational Publishing Foundation. Abstract: Review of book, Judith Guss Teicholz and Daniel Kriegman (Eds.), Trauma, Repetition, and Affect Regulation: The Work of Paul Russell. New York: Other Press, 1998, 154 pp., $22.00. Reviewed by Rafael Art. Javier. _____
Title: Depressive symptoms, stress, and weight concerns among African American and European American low-income female smokers. Author(s): Ludman, Evette J., Ctr for Health Studies, Group Health Cooperative, Seattle, WA, US; Curry, Susan J., Ctr for Health Studies, Group Health Cooperative, Seattle, WA, US; Grothaus, Louis C., Ctr for Health Studies, Group Health Cooperative, Seattle, WA, US; Graham, Elinor, U Washington, Dept of Pediatrics, US; Stout, James, U Washington, Dept of Pediatrics, US; Lozano, Paula, Ctr for Health Studies, Group Health Cooperative, Seattle, WA, US Address: Ludman, Evette J., Ctr for Health Studies, 1730 Minor Ave, Suite 1600, Seattle, WA, US, 98101, ludman.e@ghc.org Source: Psychology of Addictive Behaviors, Vol 16(1), Mar 2002. pp. 68-71. Publisher: US: American Psychological Assn/Educational Publishing Foundation. Abstract: The relationships between perceived stress, depressive symptoms, concern about weight gain and smoking dependence were examined among 83 European American and 175 African American female smokers bringing children to pediatric clinics serving a low-income population. Among African American women, but not European American women, greater stress and more depressive symptoms predicted greater smoking dependence, and less concern about weight gain predicted greater smoking dependence. Multivariate analyses confirmed the bivariate relationships among stress, depressive symptoms, and smoking dependence among African American women but reduced the relationship between weight concern and smoking dependence. The stronger relationships among stress, depressive symptoms, and smoking dependence among African American women may be indicative of smoking patterns more associated with affect regulation than are the smoking patterns of European American women. _____
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