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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: Social Context in Children's Affect Regulation
Title: Influence of social context on children's affect regulation: A functionalist perspective. Author(s): Zeman, Janice, U Maine, Dept of Psychology, Orono, ME, US; Shipman, Kimberly Source: Journal of Nonverbal Behavior, Vol 22(3), Fal 1998. pp. 141-165. Publisher: US: Kluwer Academic/Plenum Publishers. Abstract: This study investigated the influence of social context (mothers, fathers, best friends, medium friends) and type of negative affect (anger, sadness, pain) on 66 second-grade and 71 fifth-grade children's goals and strategies for affect regulation. Hypothetical vignette methodology was used. Results indicated that children perceived parents to be more accepting of emotional expressivity than peers. Children endorsed instrumental, prosocial, and rule-oriented goals and verbal regulation strategies more for anger and sadness than pain. Girls endorsed affective more than aggressive strategies, whereas the opposite pattern held for boys. Older children endorsed more regulation strategies than younger children. _____
Title: The emerging field of emotion regulation: An integrative review. Author(s): Gross, James J., Stanford U, Dept of Psychology, Stanford, CA, US Source: Review of General Psychology, Vol 2(3), Sep 1998. Special Issue: New directions in research on emotion. pp. 271-299. Publisher: US: American Psychological Assn/Educational Publishing Foundation. Abstract: The emerging field of emotion regulation studies how individuals influence which emotions they have, when they have them, and how they experience and express them. This review takes an evolutionary perspective and characterizes emotion in terms of response tendencies. Emotion regulation is defined and distinguished from coping, mood regulation, defense, and affect regulation. In the increasingly specialized discipline of psychology, the field of emotion regulation cuts across traditional boundaries and provides common ground. According to a process model of emotion regulation, emotion may be regulated at five points in the emotion generative process: (a) selection of the situation, (b) modification of the situation, (c) deployment of attention, (d) change of cognitions, and (e) modulation of responses. The field of emotion regulation promises new insights into age-old questions about how people manage their emotions. _____
Title: Adult attachment style and affect regulation: Strategic variations in self-appraisals. Author(s): Mikulincer, Mario, Bar-Ilan U, Dept of Psychology, Ramat Gan, Israel Source: Journal of Personality & Social Psychology , Vol 75(2), Aug 1998. pp. 420-435. Publisher: US: American Psychological Assn. Abstract: Four studies examined the link between adult attachment style and strategic variations in self-appraisals. Whereas secure persons held a stable positive self-view, Studies 1-2 showed that avoidant persons showed a positive self-view and anxious-ambivalent persons a negative self-view, which were strengthened by distress arousal and weakened by factors that inhibit the activation of regulatory mechanisms. Studies 3-4 indicated that insecure persons' self-views varied in accordance with specific attachment-related concerns and needs. Avoidant persons' positive self-view was related to their attempts to validate their sense of self-reliance, and anxious-ambivalent persons' negative self-view was related to their attempts to win others' compassion and affection. Results are discussed in terms of attachment-related strategies of affect regulation. _____
Title: Adult attachment style and affect regulation: Strategic variations in subjective self-other similarity. Author(s): Mikulincer, Mario, Bar-Ilan U, Dept of Psychology, Ramat Gan, Israel; Orbach, Israel; Iavnieli, Daria Source: Journal of Personality & Social Psychology, Vol 75(2), Aug 1998. pp. 436-448. Publisher: US: American Psychological Assn. Abstract: Six studies examined the link between adult attachment style and subjective self-other similarity. In Studies 1-3, data were collected on representations of self-other similarity in the realms of traits and opinions. Studies 4-5 examined the effects of affective inductions on the link between attachment and self-other similarity. Study 6 examined the cognitive maneuvers people differing in attachment style use for changing self-other similarity upon distress arousal. Whereas avoidant persons underestimated self-other similarity and anxious-ambivalent persons overestimated it, secure persons provided more accurate similarity scores. These differences were exacerbated by negative affect and mitigated by positive affect. Insecure persons' distortions resulted from transformations they made in representations of the self and others. Results are discussed in terms of attachment theory. _____
Title: Proneness to distress and ambivalent relationships. Author(s): Moran, Greg, U Western Ontario, Office of the Provost & Vice-President, London, ON, Canada; Pederson, David R. Source: Infant Behavior & Development, Vol 21(3), Jul-Sep 1998. pp. 493-503. Publisher: US: Ablex Publishing Corp. Abstract: Mothers of preterm and full term infants completed R. Abidin's (1986) Parenting Stress Index at 8 months, E. Waters' (1995) Attachment Behavior Q-sort at 12 months, and the J. E. Bates et al (1979) Infant Characteristics Questionnaire at 18 months. These instruments provided assessments of fussy and difficult infant behaviors that were moderately stable over the 10 months. On the basis of home observations at 12 months, the infant-mother relationships were classified as secure, avoidant and ambivalent. J. Cassidy (1994) has proposed that infants in ambivalent relationships may have poor affect regulation. Consistent with Cassidy's view, mothers in ambivalent relationships reported more fussy and difficult infant behavior at each age than did mothers in secure or avoidant relationships. Mothers of preterm infants reported higher scores on the Child Domain of the Parenting Stress Index than mothers of full term infants. The birth groups did not differ on the 12- and 18-month assessments. _____
Title: Dual pathway model of bulimia nervosa: Longitudinal support for dietary restraint and affect-regulation mechanisms. Author(s): Stice, Eric, Stanford U, Dept of Psychiatry, Stanford, CA, US; Shaw, Heather; Nemeroff, Carol Source: Journal of Social & Clinical Psychology, Vol 17(2), Sum 1998. pp. 129-149. Publisher: US: Guilford Publications. Abstract: Provided a confirmatory test of the dual pathway model of bulimia nervosa using prospective data from a community sample of 218 adolescent females (aged 16-18 yrs). Measures of perceived societal pressure, body mass, ideal-body internalization, body dissatisfaction, dietary restraint, negative affect, and bulimic symptoms were completed by each participant early in the fall semester and late in the spring semester of her senior year in high school. Latent variable modeling indicated that negative affect and dietary restraint predicted future bulimic symptomatology. Further, these 2 factors mediated the effects of initial perceived pressure for a thin body, body mass, ideal body internalization, and body dissatisfaction on subsequent bulimic pathology. These findings provide additional support for the dual pathway model of bulimia, suggest variables that might be targeted in prevention and treatment efforts, and point to several directions for future research. _____
Title: Affect regulation as a stylistic process within adult attachment. Author(s): Fuendeling, James M., U California-Davis, Alzheimer's Disease Ctr, Sacramento, CA, US Source: Journal of Social & Personal Relationships, Vol 15(3), Jun 1998. pp. 291-322. Publisher: England: Sage Publications. Abstract: The literature on adult attachment indicates consistent differences in the emotional experiences of individuals according to their attachment styles. With the idea that these differences in experience are accompanied by systematic differences in the ways people with different attachment styles regulate their affect, a broad range of findings are reviewed and reorganized according to a process-level explanation of affect regulation, including specific mechanisms by which affect is regulated. This reexamination of findings does suggest consistent, or stylistic, ways of regulating affect that are particular to each attachment style. Variation is particularly evident in the management of attention, appraisal styles and the ability to interact with others as agents of affect regulation. Implications for future research are discussed. _____
Title: Attachment working models and the sense of trust: An exploration of interaction goals and affect regulation. Author(s): Mikulincer, Mario, Bar-Ilan U, Dept of Psychology, Ramat Gan, Israel Source: Journal of Personality & Social Psychology, Vol 74(5), May 1998. pp. 1209-1224. Publisher: US: American Psychological Assn. Abstract: Five studies examined the association between adult attachment style and the sense of trust in close relationships. Study 1 focused on the accessibility of trust-related memories. Studies 2-5 focused on trust-related goals and coping strategies, while using different data collection techniques (open-ended probes, diary methodology, lexical decision task). Findings showed that secure persons felt more trust toward partners, showed higher accessibility of positive trust-related memories, reported more positive trust episodes over a 3-week period, and adopted more constructive strategies in coping with the violation of trust than insecure persons. In addition, whereas intimacy attainment was the main trust-related goal for all the attachment groups, security attainment was an additional goal of anxious-ambivalent persons, and control attainment was an additional goal of avoidant persons. Findings are discussed in terms of attachment working models. _____
Title: Kann man "die Spirale aus Scham, Wut und Schuldgefuehlen durch Lachen aufloesen' ? Ueber Affektregulierung, metaphorische Affekttheorien und pathogene Ueberzeugungen in der Psychotherapie. Translated Title: Out of shame, anger and guilt through laughing? About affect-regulation, metaphorical affect-theories and pathogenic beliefs in psychotherapy. Author(s): Volkart, Reto, U Zuerich, Psychologisches Inst, Switzerland; Heri, Isabelle Source: Psychotherapeut, Vol 43(3), May 1998. pp. 179-191. Publisher: Germany: Springer-Verlag. Abstract: Examined how nonverbal behavior is assigned to emotions without a clear pattern of mimic expression. Ss: 60 videotaped psychotherapy sessions. The videotaped sessions were analyzed for nonverbal behavior associated with the emotions of shame, guilt and anger. The interactions between these emotions and their connection with shared laughter were examined. The successions of emotions were assessed. A sophisticated theory of internal affect triggers was explored. Implications for the use of metaphors in closely related concepts of emotions on consequences in action and therapy were addressed. Test used: Facial Action Coding System. (English abstract) _____
Title: Fear and anger regulation in infancy: Effects on the temporal dynamics of affective expression. Author(s): Buss, Kristin A., U Wisconsin, Dept of Psychology, Madison, WI, US; Goldsmith, H. Hill Source: Child Development, Vol 69(2), Apr 1998. pp. 359-374. Publisher: US: Blackwell Publishers. Abstract: Emotion regulation has been conceptualized as the extrinsic and intrinsic processes responsible for monitoring, facilitating, and inhibiting heightened levels of positive and negative affect. Regulation of distress is related to the use of certain behavioral strategies. This study examined whether putative regulatory behaviors widely assumed to be conceptually associated with these strategies are actually empirically associated with the changes in fearful and angry distress in a total of 148 6-, 12-, and 18-mo-old infants. The key finding was that the use of some putative regulatory behaviors (e.g., distraction and approach) reduced the observable intensity of anger but were less effective in reducing the intensity of fear. The results suggest (1) caution in assuming that postulated regulatory behaviors actually have general distress-reducing effects and (2) the likelihood that "distress" is too global a construct for research on emotion regulation. _____
Title: Attachment representations and representations of the self in relation to others: A study of preschool children in inner-city London. Author(s): McCarthy, Gerald, U London, Inst of Psychiatry, Child Psychiatry Unit, London, England Source: British Journal of Medical Psychology, Vol 71(1), Mar 1998. pp. 57-72. Publisher: United Kingdom: British Psychological Society. Abstract: Examined the relationship between attachment representations (ATRs) and representations of the self in relation to others in a sample of 42 children (aged 4-5.9 yrs). The relationship between children's ATRs and parents' style of regulating negative affect was also explored. The quality of ATRs was assessed using a modified version of the Separation Anxiety Test. Assessments of the representation of the self in relation to others consisted of (1) assessment of the child's view of self within the relationship with the attachment figure, using an incomplete doll story procedure; and (2) assessment of the child's perceptions of the way others view them using a puppet interview. Significant connections between ATRs, representations of self in relation to others, and parents' negative affect regulation were found. Children with secure ATRs had a significantly more positive view of the self in the relationship with the attachment figure than children with disorganized ATRs, and a significantly more positive perception of the way others view them than children with avoidant ATRs. Children with secure ATRs had parents with more adaptive ways of regulating their own negative affect than children with ambivalent or disorganized ATRs. _____
Title: Affects and agency: An interdisciplinary, psychoanalytic study. Author(s): Jurist, Elliot L., City U New York, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 58(9-B), Mar 1998. pp. 5123. Publisher: US: Univ Microfilms International. Abstract: There is currently a burgeoning interest in affects across a number of disciplines--philosophy, psychology, neuroscience and psychoanalysis. Yet, it remains unclear to what extent one can infer that a common set of problems and concerns exists. In this project, therefore, I undertake an interdisciplinary inquiry with the aim of providing conceptual clarity about the meaning and function of affects. In particular, I begin with the history of philosophy; then I turn to focus upon psychology--exploring the notion of 'basic emotions' as well as the question of whether affects can exist without cognition. This leads to an examination of recent work in neuroscience. My conclusion is that the perspectives of psychologists and neuroscientists are a necessary, but insufficient way to conceive of affects, and that to understand affects fully, one must consider the theme of agency. The capacity for regulation is a rich area in which to investigate how affects and agency are connected. I synthesize literature about regulation from developmental psychology, infant research and psychoanalysis, delineating three stages of development: pre-agency, agency proper, and self-conscious agency. More specifically, I propose that agency comes into being through 'affect regulation.' In enabling an infant to identify and modulate his/her affect states, affect regulation fosters the unfolding of a sense of agency. Affects are not simply found states in the mind; it is possible for them to be crafted and refined. Thus, I suggest that a new term, 'affectivity,' is required to characterize the ability that adults have to self-regulate affects. Clinical material is introduced to illustrate the concept of affectivity. My view supports the psychoanalytic assumption that affects contribute to the emergence of a sense of agency and that a sense of agency allows us to experience new and more differentiated affects. The claim that there is an integral relation between affects and agency depends upon a range of perspectives--about the brain and behavior, but also about subjective experience, which is both influenced by culture and is radically unique. In my conclusion, I stress the importance of preserving the scientific and hermeneutic aspects of psychoanalysis. _____
Title: Guided imagery treatment to promote self-soothing in bulimia nervosa: A theoretical rationale. Author(s): Esplen, Mary Jane, Mt Sinai Hosp, Dept of Psychiatry, Toronto, ON, Canada; Garfinkel, Paul E. Source: Journal of Psychotherapy Practice & Research, Vol 7(2), Spr 1998. pp. 102-118. Publisher: US: American Psychiatric Press. Abstract: Bulimia nervosa (BN) has been described as involving impairment in affect regulation and in self-soothing. Such a conceptualization suggests the need to design treatments that specifically target these problems in order to assist individuals with BN in comforting themselves. A model of guided imagery therapy suggests that imagery therapy has multiple levels of action and can assist these individuals in the regulation of affect by providing an external source of soothing and also by enhancing self-soothing. The model is illustrated with a case example and results are reported of a study in a clinical sample of BN. _____
Title: The tie that binds: Affect regulation, attachment, and psychoanalysis. Author(s): Silverman, Doris K., New York U, Postdoctoral Program in Psychoanalysis & Psychotherapy, New York, NY, US Source: Psychoanalytic Psychology, Vol 15(2), Spr 1998. pp. 187-212. Publisher: US: American Psychological Assn/Educational Publishing Foundation. Abstract: Psychoanalytic theory has both expanded and altered its constructs in response to clinical work. The attachment system is a construct in need of integration, and it requires its own motivational status in psychoanalytic theory. The author regards affect regulation (mutual and self-regulation) as a key aspect of the attachment system and as an addendum to Bowlby's ideas, one that is consistent with contemporary findings in infant research. A published case and 2 clinical cases are used to demonstrate the usefulness of the concepts of mutual and self-regulation in clinical work. Illustrated as well are the benefits of an integration of affect regulation and traditional motives for optimizing clinical work. The inclusion of these motivational constructs provides for a more comprehensive psychoanalytic theory that offers enriched explanations of complex psychic and behavioral phenomena. _____
Title: Neuropsychological characteristics of self-mutilating and other subgroups of borderline women. Author(s): Schmieder, Linda Marie, The Fielding Inst, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 58(8-B), Feb 1998. pp. 4471. Publisher: US: Univ Microfilms International. Abstract: Recent research has associated neuropsychological deficits with borderline personality disorder and with self-mutilation. These latest findings, along with the hypothesized early neural development, suggest that borderlines who experience preverbal trauma are more likely to act out their distress nonverbally, such as self-mutilation. In addition, there may be subgroups, distinguishable by neuropsychological characteristics, within the borderline continuum. This research examined the relationship between borderline pathology, self-mutilation, and neuropsychological deficits. Adult borderline women (n=28), self-mutilating adult borderline women (n=24), and a control group composed of participants who had similar clinical symptoms but did not qualify, either by intensity or range of symptoms, for the diagnosis of borderline (n=21), were assessed on 11 neuropsychological measures. The hypotheses were: (1) the borderline groups would exhibit greater neuropsychological dysfunction than the control group, (2) the borderline self-mutilating group would exhibit greater neuropsychological dysfunction than borderline non-mutilating group, and (3) the degree of neuropsychological dysfunction would reflect the functioning level of the individual. Results revealed that the self-mutilating group did not evidence more neuropsychological dysfunction than the borderline non-mutilating group, but the combined borderline group (self-mutilators and non-mutilators) did evidence statistically significantly more neuropsychological deficits than the control group. Further analysis of the groups, redefined by high, medium, and low functioning level, revealed that the low functioning group demonstrated statistically significantly more neuropsychological deficits, followed by the medium functioning group, and then by the high functioning group. The discussion chapter addressed the clinical implications of subgroups of borderline pathology that can be identified in a clinical setting. The theoretical implications, based on an integration of developmental object relations theory and neuropsychology, suggest that the impact of neuropsychological deficits from an early age would result in difficulties in affect regulation and a predictable pattern of symptoms, the severity of which is associated with the severity in neuropsychological dysfunction, that we identify as borderline personality disorder. _____
Title: The functions of self-mutilation. Author(s): Suyemoto, Karen L., Northeastern U, Dept of Counseling Psychology, Rehabilitation, & Special Education, Boston, MA, US Source: Clinical Psychology Review, Vol 18(5), 1998. pp. 531-554. Publisher: US: Elsevier Science/Pergamon. Abstract: While pathological self-mutilating behavior has been clinically examined for over 65 years, and much of the literature hypothesizes some function for the behavior, there has been little attempt to integrate or differentiate between different functional ideas. This review uses six functional models extracted from the literature to organize a discussion of the multiple functions of self-mutilation, acknowledging the overdetermined nature of the behavior and attempting to understand how self-mutilation can serve multiple functions simultaneously. Contextual information about the definition, prevalence, phenomenology, patient characteristics, associated diagnoses, and associated symptoms of self-mutilation is first presented. Six functional models are then presented: the environmental model, the antisuicide model, the sexual model, the affect regulation model, the dissociation model, and the boundaries model. Support for these models in the empirical and theoretical literature is presented and treatment implications are explored. _____
Title: Binge eating, substance use, and coping styles in a lesbian sample. Author(s): Heffernan, Karen, Rutgers the State U New Jersey - New Brunswick, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 58(7-B), Jan 1998. pp. 3924. Publisher: US: Univ Microfilms International. Abstract: The affect regulation model views binge eating as an attempt to manage negative emotions by eating. The precise nature of how food is used to regulate affect, and in response to which kinds of negative affects, remains unclear. A recent study of a lesbian sample found a high rate of binge eating related to the use of food for affect management. Thus, the present study addressed these questions in a lesbian sample, as a suitable population for further investigation of the mechanisms under consideration, and in order to replicate the earlier findings. It has been suggested that lesbians lack mainstream coping resources and are thus at risk for maladaptive coping efforts, which include disordered eating and substance abuse. However, data regarding stress, coping, and their relationships to disordered eating and substance use in this population are largely lacking. The present study investigated levels of stress, coping styles, rates of eating disturbances, problematic substance use, and the relationships among these variables. Specifically, it tested the hypothesis that stress would be more likely to be associated with binge eating, and with problematic substance use, in individuals with avoidant coping styles. The present study employed a self-report questionnaire to investigate these issues among a heterogeneous sample of 263 lesbians. The rate of bulimia nervosa was similar to that of heterosexual women, while the rate of binge eating was higher, replicating earlier findings. Almost half of the sample were at least moderately dissatisfied with their weight, almost one third engaged in dieting, and weight was positively associated with frequency of binge eating. While stress was moderately associated with binge eating, neither stress nor an avoidant coping style in general predicted binge eating. It was the specific use of food to manage emotions that predicted binge eating in this non-clinical sample. Emotions related to anger and frustration were most strongly associated with an increased urge to eat, particularly among individuals who reported binge eating. While participants who did not engage in binge eating reported using food significantly more for comfort than for distraction or anxiety reduction, those who reported binge eating used food equally for all three of these purposes. The level of perceived stress in this sample was not significantly higher than in the general female population. Participants also reported levels of social resources that were similar to their heterosexual counterparts. Neither high rates of heavy drinking nor drug use were found in this sample. Among those who did engage in excessive drinking, it was associated with an avoidant coping style. Overall, levels of stress, of social support, and coping style were not predictive of problematic substance use. The most significant predictor of alcohol use, and to a lesser extent, frequency of getting high, was reliance on bars as a primary social setting. Implications for conceptual models of binge eating, for psychotherapy, and for understanding the experiences of lesbians are discussed. _____
Title: Individual differences in social referencing. Author(s): Blackford, Jennifer Urbano, Vanderbilt U, Dept of Psychology & Human Development, Nashville, TN, US; Walden, Tedra A. Source: Infant Behavior & Development, Vol 21(1), 1998. pp. 89-102. Publisher: US: Ablex Publishing Corp. Abstract: The present study investigated the relation between age-related differences in temperamental fear and referencing, affect and behavior regulation, and quality of parent messages in 2 groups of infants (younger, 11 to 15 mo; older, 16 to 22 mo). 55 infants participated with a parent in a laboratory social referencing situation, involving 2 message conditions (positive/fearful). Temperamental fear was assessed by parent report. Quality of parents' messages was influenced by temperamental fear, with parents providing higher quality positive and lower quality fearful messages to high fear boys. Temperamental fear and regulation were related in the younger group of infants, with infants classified as low fear demonstrating affect and behavior regulation. Gender was related to affect regulation across both age groups; girls showed regulation, whereas boys did not. These findings indicate that individual differences in temperament are related to regulation and parents' messages, but not to child looking at parents. _____
Title: Maltreated adolescents: Victims caught between childhood and adulthood. Author(s): Rossman, B. B. Robbie, U Denver, Dept of Psychology, Denver, CO, US; Rosenberg, Mindy S. Source: Journal of Aggression, Maltreatment & Trauma, Vol 2(1), 1998. pp. 107-129. Publisher: US: Haworth Press. Abstract: Reviews literature on the developmental tasks of adolescence and the unique problems faced by adolescent victims of maltreatment. The developmental domains addressed include cognition, identity, behavior and affect regulation, family and peer relationships, and sexuality. Research on the co-occurrence of multiple types of victimization is discussed. The relationship between multiple victimization and violent crime, with a focus on parricide, is examined. The authors call for greater attention to the assessment and study of multiple forms of maltreatment and its outcomes in adolescence, since adolescence is one of the least researched developmental periods in terms of single or multiple victimization. _____
Title: Exercise of agency in personal and social change. Author(s): Bandura, Albert, Stanford U, Stanford, CA, US Source: Sanavio, E. (Ed); 1998. Behavior and cognitive therapy today: Essays in honor of Hans J. Eysenck. Oxford, England: Elsevier Science Ltd. pp. 1-29 Abstract: The value of a psychological theory is judged by three criteria. It must have explanatory power, it must have predictive power, and, in the final analysis, it must demonstrate operative power to improve the human condition. Well-founded theory provides solutions to human problems. In this chapter, the author has reviewed an agentic theoretical approach to human understanding and betterment and traced some of the applications of this theory at both the individual and macrosocial levels. Topics discussed include: behavioristic model, mind as digital computer, connectionist model of mind, marked decline of intervention research, physicalistic theory of human agency, mechanisms of human agency, multifaceted causal structure, efficacy determination of motivators, self-efficacy in threat management and affect regulation, self-efficacy and phobic behavior, self-efficacy pathways to depression, multifaceted applicability of social cognitive theory, reactive risk models vs. proactive mastery models, devising efficacious models with social utility, and macrosocial applications. _____
Title: Developmental roots of adolescent disturbance. Author(s): Tyson, Phyllis, U California-San Diego, Dept of Psychiatry, La Jolla, CA, US Source: Esman, Aaron H. (Ed); Flaherty, Lois T. (Ed); et al; 1998. Adolescent psychiatry: Developmental and clinical studies, Vol. 23. Annals of the American Society for Adolescent Psychiatry. Hillsdale, NJ, US: Analytic Press, Inc.. pp. 21-39 Abstract: Suggests that adolescent suffering often has as its sources the tensions of the adolescent process itself. Knowing what we now know about the challenges of that process, largely due to P. Blos, we recognize that labile affects, heightened anxiety, and mood swings are particularly characteristic of adolescence. Recognizing that "infantile factors continue exerting their effects," I have chosen to focus this paper on affect regulation and its developmental roots. I recognize that this subject is vast, with many interrelated genetic, environmental, and neurobiological as well as psychological contributors. My focus is primarily on the psychological, with the hope that, with better understanding of early development, we might better understand those adolescents who are unable to adaptively weather the affective storms of adolescence as they negotiate the second individuation process. I begin with 3 short clinical vignettes to focus this discussion. _____
Title: The interpersonal basis of emotional behavior and emotion regulation in adulthood. Author(s): Magai, Carol , Long Island U, Dept of Psychology, Brooklyn, NY, US; Passman, Vicki Source: Schaie, K. Warner (Ed); Lawton, M. Powell (Ed); 1998. Annual review of gerontology and geriatrics, Vol. 17: Focus on emotion and adult development. Annual review of gerontology and geriatrics. New York, NY, US: Springer Publishing Co. pp. 104-137 Abstract: Emphasizes the interpersonal nature of affect regulation and takes an individual-difference and normative-developmental approach to the role of emotional communication in affect regulation, while treating the construct from a life span developmental point of view. Covered are aspects of behavioural communication (facial and vocal affect) as well as verbal emotional expression. The authors next consider the broader social context of emotion expression, taking particular note of its application in close relationships of later life. _____
Title: The impact of pregnancy on the psychotherapeutic process: An integrated approach to working with the self-disordered client. Author(s): Robbins, Melissa, Women's Mental Health Collective, Somerville, MA, US Source: Robbins, Arthur (Ed); 1998. Therapeutic presence: Bridging expression and form. London, England: Jessica Kingsley Publishers, Ltd.. pp. 142-152 Abstract: Examines the problems facing a pregnant therapist working with self-disordered populations, and addresses the issues raised when utilizing a 'non-regressive' treatment model. Self-disordered is defined as clients with significant self-deficits in several areas including affect regulation, self-care, and relational capacities. These clients often struggle with eating disorders, substance abuse, have experienced trauma, or may be thought of as character disordered. Due to their tendency to either flee from therapy or regress in therapeutic relationships, and their need for structure and concrete help in managing the stresses and demands of daily life, the author utilizes 'an integrative model' of therapy. This model utilizes concepts drawn from self-psychology, ego psychology, and object relations, and incorporates them with active intervention strategies. The goal is to provide a therapeutic experience that supports the development and internalization of self-capacities through a therapeutic relationship. This chapter provides a brief literature review on the subject of the pregnant therapist, describes in more detail the 'integrative model', and provides clinical examples of how one might manage a pregnancy when working non- regressively with a self-disordered population. _____
Title: The development of marriage: A 9-year perspective. Author(s): Lindahl, Kristin, U Miami, Dept of Psychology, Coral Gables, FL, US; Clements, Mari; Markman, Howard Source: Bradbury, Thomas N. (Ed); 1998. The developmental course of marital dysfunction. New York, NY, US: Cambridge University Press. pp. 205-236 Abstract: The Denver Family Development Project (DFDP) began in 1981 to study how relationship quality in a group of satisfied and committed premarital couples changed over time during the 1st decade of their marriages. The authors sought to discover what individual or relationship characteristics ultimately lead to distress, divorce, or continued happiness. The authors present some of the results of the 1st 9 yrs of the DFDP and discuss their successes and failures in meeting the challenges of longitudinal work. Data collection across all time periods emphasized the following constructs: negative affect regulation, especially in the context of conflict, conflict management, and communication. Discussion includes changes in satisfaction and communication, marital development over the transition to parenthood, marital and family functioning (attachment, self-concept, parent-child affect regulation), dyadic parent-child interactions, and triadic family interactions (including peer relationships). Longitudinal issues include when to start the study, sample size, sample retention, measure decay, the impact of couples research on the participants, and seeking and keeping funding for longitudinal studies. _____
Title: Sexual revictimization: Risk factors and prevention. Author(s): Cloitre, Marylene, New York Hosp-Cornell Medical Ctr, Payne Whitney Clinic, New York, NY, US Source: Follette, Victoria M. (Ed); Ruzek, Josef I. (Ed); et al; 1998. Cognitive-behavioral therapies for trauma. New York, NY, US: Guilford Press. pp. 278-304 Abstract: Research data indicate that retraumatized women make up the largest subgroup of sexually assaulted women. Given this, sexual assault research should have as a priority the identification of the psychological characteristics of women with a history of childhood sexual abuse that put them "at risk" for adult sexual assault. It is also important to begin developing prevention programs for at-risk women and adolescent girls that target and reduce these risk factors. This chapter reviews the available data on the potential assault risk factors among women with a history of childhood abuse. It also presents a developing model of retraumatization and a cognitive-behavioral intervention designed to reduce risk for repeated sexual assaults. Topics discussed include theoretical orientation: a social-developmental perspective; affect regulation; interpersonal relatedness; posttraumatic stress disorder (PTSD) as a risk factor for retraumatization; a proposed treatment model: skills training in affect and interpersonal relatedness regulation/prolonged exposure; assessment; guidelines for selection; and clinical application. _____
Title: Affect regulation and narcissism: Trauma, alexithymia, and psychosomatic illness in narcissistic patients. Author(s): Krystal, Henry, Michigan State U, East Lansing, MI, US Source: Ronningstam, Elsa F. (Ed); 1998. Disorders of narcissism: Diagnostic, clinical, and empirical implications. Washington, DC, US: American Psychiatric Association. pp. 299-325 Abstract: The purpose of this chapter is to discuss how normal affect regulation and self-esteem regulation can be influenced by the occurrence of infantile psychic trauma or massive psychic trauma later in life. The impact of affect regression on the development of narcissistic disorders is discussed, as well as alexithymia with psychosomatic disorders and specific treatment strategies for narcissistic alexithymia patients. _____
Title: Affect regulation during psychosis. Author(s): Ellgring, Heiner, U Wurzburg, Inst fur Psychologie, Wurzburg, Germany; Smith, Marcia Source: Flack, William F. Jr. (Ed); Laird, James D. (Ed); 1998. Emotions in psychopathology: Theory and research. Series in affective science. London: Oxford University Press. pp. 323-335 Abstract: In this chapter, the authors describe dysregulation of the affect system as it applies to psychosis, specifically to individuals with schizophrenia. Models of emotion regulation in healthy individuals are also provided. The authors then present data related to facial expression, an efferent component of the affect system, and its role in affect regulation in schizophrenia. _____
Title: Affect regulation and psychopathology: Applications to depression and borderline personality disorder. Author(s): Westen, Drew, Harvard Medical School, Cambridge Hosp, Dept of Psychiatry, Cambridge, MA, US Source: Flack, William F. Jr. (Ed); Laird, James D. (Ed); 1998. Emotions in psychopathology: Theory and research. Series in affective science. London: Oxford University Press. pp. 394-406 Abstract: After defining the domain of affect regulation and psychopathology, the author outlines a model of affect regulation informed by evolutionary, behaviorist, cognitive, and psychodynamic theory and research. He then describes methodological issues confronting the attempt to assess affect regulation strategies in adults and reports on preliminary research using an observer-rated affect regulation Q-sort. Finally, the author applies the model and measure to depression and borderline personality disorder. _____
Title: VIII: Linkages between behavioral, psychosocial, and physical disorders. Author(s): Bach, Amy K., Boston U, Ctr for Study of Anxiety & Related Disorders, Boston, MA, US; Weisberg, Risa B.; Barlow, David H.; Sanderson, William C.; Foa, Edna B.; Miklowitz, David J.; McLean, Peter; Woody, Shelia Craighead, W. Edward; Vajk, Fiona C.; Allen, John J. B.; Schnyer, Rosa N.; Wagner, Amy W.; Lewine, Richard R. J.; Melamed, Barbara G.; LeResche, Linda; Woodward, Suzanne L.; Bower, Julienne E.; Pickering, Thomas G. Source: Blechman, Elaine A. (Ed); Brownell, Kelly D. (Ed); 1998. Behavioral medicine and women: A comprehensive handbook. New York, NY, US: Guilford Press. pp. 731-810 Abstract: "Anxiety Disorders" / Amy M. Bach, Risa B. Weisberg and David H. Barlow // "Panic Disorder" / William C. Sanderson // "Rape and Posttraumatic Stress Disorder" / Edna B. Foa // "Bipolar Disorders" / David J. Miklowitz // "Depression" / Peter McLean and Sheila Woody // "Depression and Comorbid Disorders" / W. Edward Craighead and Fiona C. Vajk // "Depression and Acupuncture" / John J. B. Allen and Rosa N. Schnyer // "Borderline Personality Disorder" / Amy W. Wagner // "Schizophrenia" / Richard R. J. Lewine // "Chronic Fatigue Syndrome" / Barbara G. Melamed // "Chronic Pain" / Linda LeResche // "Sleep and Sleep Disorders" / Suzanne L. Woodward // "Psychoneuroimmunology" / Julienne E. Bower // "Stress-Related Disorders" / Thomas G. Pickering // Four issues related to the linkages between behavioral, psychosocial, and physical disorders are raised within the chapters in this section: (1) male-female prevalence differences for anxiety and mood disorders; (2) physical and psychological comorbidity; (3) the importance of biology and the perception of health in determining the outcome of treatment approaches; (4) and the role affect regulation plays in understanding of the course and/or treatment of psychological disturbances. The chapters are preceded by a section editor's overview written by Barabra G. Melamed. _____
Title: Attachment theory and close relationships. Author(s): Simpson, Jeffry A., (Ed), Texas A & M U, Dept of Psychology, College Station, TX, US; Rholes, William Steven , (Ed) Source: 1998. New York, NY, US: Guilford Press. x, 438 pp. Abstract: "Attachment Theory and Close Relationships" discusses the application of attachment theory to adult relationships. This book integrates the important theoretical and empirical advances in this growing area of study and suggests new and promising directions for future investigation. Its balanced coverage of measurement issues, affect regulation, and clinical applications makes this a valuable sourcebook for scholars, students, and clinicians. It also serves as a supplemental text in advanced undergraduate or graduate-level courses. Table of Contents: Part I: Introduction ....Attachment in adulthood. ...............Author(s): Jeffry A. Simpson and W. Steven Rholes
Part II: Measurement issues ....Methods of assessing adult attachment: Do they converge? ...............Author(s): Kim Bartholomew and Phillip R. Shaver ....Self-report measurement of adult attachment: An integrative overview. ...............Author(s): Kelly A. Brennan, Catherine L. Clark and Phillip R. Shaver ....Adult attachment patterns: A test of the typological model. ...............Author(s): R. Chris Fraley and Niels G. Waller ....Working models of attachment: A theory-based prototype approach. ...............Author(s): Eva C. Klohnen and Oliver P. John
Part III: Affect regulation ....The relationship between adult attachment styles and emotional and cognitive reactions to stressful events. ...............Author(s): Mario Mikulincer and Victor Florian ....Attachment orientations, social support, and conflict resolution in close relationships. ...............Author(s): W. Steven Rholes, Jeffry A. Simpson and Jami Grich Stevens ....Adult attachment and relationship-centered anxiety: Responses to physical and emotional distancing. ...............Author(s): Judith A. Feeney
Part IV: Clinical applications ....The role of attachment in therapeutic relationships. ...............Author(s): Mary Dozier and Christine Tyrrell ....Dismissing-avoidance and the defensive organization of emotion, cognition, and behavior. ...............Author(s): R. Chris Fraley, Keith E. Davis and Phillip R. Shaver ....Childhood revisited: The intimate relationships of individuals from divorced and conflict-ridden families. ...............Author(s): Kate Henry and John G. Holmes ....The associations between adult attachment and couple violence: The role of communication patterns and relationship satisfaction. ...............Author(s): Nigel Roberts and Patricia Noller
Part V: Conceptual and empirical extensions ....Evolution, pair-bonding, and reproductive strategies: A reconceptualization of adult attachment. ...............Author(s): Lee A. Kirkpatrick ....Adult romantic attachment and individual differences in attitudes toward physical contact in the context of adult romantic relationships. ...............Author(s): Kelly A. Brennan, Shey Wu and Jennifer Loev Index _____
Title: Emotion regulation among school-age children: The development and validation of a new criterion Q-sort scale. Author(s): Shields, Ann , Bradley Hosp, East Providence, RI, US Cicchetti, Dante Source: Developmental Psychology, Vol 33(6), Nov 1997. pp. 906-916. Publisher: US: American Psychological Assn. Abstract: To foster the study of emotion regulation beyond infancy and toddlerhood, a new criterion Q-sort was constructed. In Study 1, Q-scales for emotion regulation and autonomy were developed, and analyses supported their discriminant validity. Study 2 further explored the construct validity of the Emotion Regulation Q-Scale within a sample of 143 maltreated and 80 impoverished children, aged 6 to 12 years. A multitrait-multimethod matrix and confirmatory factor analyses indicated impressive convergence among the Emotion Regulation Q-Scale and established measures of affect regulation. This new scale also was discriminable from measures of related constructs, including Q-sort assessments of ego resiliency. The use of this new measure was further supported by its ability to distinguish between maltreated and comparison children and between groups of well-regulated versus dysregulated children. _____
Title: Object relations and attachment: A comparison of Rorschach responses and adult attachment classifications. Author(s): Rothstein, Daniel N. , City U New York, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 58(5-B), Nov 1997. pp. 2698. Publisher: US: Univ Microfilms International. Abstract: This study investigated the association between the constructs of mental representation of interpersonal relationships posited by object relations theory and attachment theory, in an effort to contribute to the dialogue between psychoanalytic and attachment researchers. A nonclinical sample of 39 middle-class primiparous women were administered the Rorschach Inkblot Test and the Adult Attachment Interview (Main & Goldwyn, 1985) in their third trimester of pregnancy. Rorschach tests were scored with two object relations measures: Urist's (1977) Mutuality of Autonomy Scale, and Blatt et al.'s (1976) Developmental Analysis of the Concept of the Object Scale. It was hypothesized that securely attached subjects would have more structurally complex and more autonomous object representations on the Rorschach when compared to insecurely attached subjects. With attachment classifications as the independent variables, a series of one-way ANOVAs were performed: none of the planned tests for the hypotheses found significant differences in quality or developmental level of object representations among subjects grouped by security of attachment. A post hoc independent t-test of subjects grouped by minimizing and maximizing affective styles (Cassidy, 1994), rather than attachment category, indicated that affective minimizers had a greater number of Urist scale malevolent scores than affective maximizers. This post hoc finding is discussed as one indication of overlap, in the realm of affect regulation, between each theories' construct of object representations. The nonsignificant results for the planned hypotheses are discussed in terms of the degree of sensitivity of the Rorschach scales for use in a nonclinical population, as well as the effects of pregnancy on subjects' Rorschach responses. The significance of different modes of representation of thought is also addressed. Image and linguistic modes of representation, which were highlighted by the Rorschach and the Adult Attachment Interview, respectively, are compared. The question is raised whether differences in developmental level of object representations among attachment categories in a normal adult population are to be found in narrative representations, as opposed to imaged-based representations. _____
Title: Affect regulation in response to evaluative self-information: To ruminate or regulate. Author(s): Therriault, Nicole, Depaul U, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 58(5-B), Nov 1997. pp. 2755. Publisher: US: Univ Microfilms International. Abstract: The purpose of this research was to focus on the self-management of affect states elicited by receiving positively or negatively valenced information about the self. The studies here are refinements on Erber's (1996) Social Constraints Model (SCM) of affect regulation which challenges previous assumptions about the nature of regulation motivations and tendencies. Rather than unidirectional regulation towards positivity, Erber proposed that regulation of affect may be most likely in response to situational demands. Study 1 demonstrated that anticipation of self-perception accuracy adequately serves as a constraint to emotional experience, presumably because both a positive and negative affect state would interfere with the task demands. Subjects in Study 1 turned off both positive and negative videos much sooner when they expected to access accurate self-perceptions compared to those anticipating a mundane task, but their neutral video counterparts watched for equivalently long times regardless of the nature of their upcoming task. In Study 2, subjects were given either success or failure feedback prior to an anticipated self-perception accuracy task or a mundane task. In accordance with the SCM, subjects showed a preference for affect congruent material in the absence of constraints on their emotional state and exhibited affect regulatory behaviors when the affect would be expected to interfere with situational demands. Success subjects watched a positive video longer when they expected a mundane task, but watched a negative video longer when they expected to address their accurate self-perceptions. Similarly, Failure subjects watched the negative video more in the mundane task condition compared to their self-perception accuracy counterparts, but watched the positive video for nearly equal times regardless of the task. These studies are discussed for their implications for traditional hedonic theories and for theories of thought rumination. It is argued that the SCM can best account for our affect management because it addresses the likely interactions between ourselves and our situational context. _____
Title: Dimensions of emotional intelligence: Attachment, affect regulation, alexithymia and empathy. Author(s): Bekendam, Carol Corwin, The Fielding Inst, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 58(4-B), Oct 1997. pp. 2109. Publisher: US: Univ Microfilms International. Abstract: Emotional intelligence involves accurate appraisal and regulation of emotions in oneself and the ability to respond empathically to emotions in others (Mayer, Di Paolo, & Salovey, 1990). Despite the importance of empathy to effective interpersonal relations, until recently empathy has been a neglected topic of research. A study was conducted to investigate the relationships of Attachment Patterns (measured by the Adult Attachment Scale), styles of Affect Regulation (measured by the Affect Regulation Scale), Alexithymia (measured by the Toronto Alexithymia Scale--20 Items), and Empathy (measured by the Interpersonal Reactivity Index). Personal characteristics and history of child abuse were measured by a personal information questionnaire. The instruments were administered to 167 male parolees who were in group treatment for impulse disorders. Data analysis strategies included ANOVA, correlation analysis and hierarchical multiple regression analysis. Secure Attachment was hypothesized to be related to adaptive Affect Regulation Styles, Empathic Concern (IRI subscale), Perspective Taking (IRI subscale), low Personal Distress (IRI subscale) and absence of Alexithymia. Insecure Attachment was hypothesized to be related to maladaptive Affect Regulation Styles, Personal Distress, Alexithymia and a deficit in empathy. These hypotheses were supported. Specifically, the Preoccupied attachment pattern demonstrated vulnerability to negative emotions of others as measured by Personal Distress and the Fantasy Scale (IRI subscale), whereas Dismissive/Avoidant attachment pattern used fantasy the least, suggesting denial of negative emotions. The Fearful/Avoidant attachment pattern emerged as the most impaired group with high use of maladaptive Affect Regulation Styles, high Personal Distress, and high Alexithymia, lending support for the designation of the Fearful/Avoidant pattern as the adult version of the Disoriented/Disorganized Pattern of childhood Attachment research. The hypothesis that the Fearful/Avoidant Pattern would represent the most participants who reported a history of childhood abuse was not supported. The study lends support to Bowlby's (1969, 1980) theory of Attachment, the stress hypothesis of Alexithymia (Martin & Pihl, 1985) and the cognitive-developmental theory of emotional awareness (Lane & Schwartz, 1987). Implications for future research and recommendations for clinical treatment are presented. _____
Title: The relationship of cognitive and affective processes to the functioning of substance abusers in treatment. Author(s): Tsandikos, Stephanie Demetra , Fordham U, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 58(4-B), Oct 1997. pp. 2143. Publisher: US: Univ Microfilms International. Abstract: Cognitive variables such as commitment to abstinence and motivation for treatment are strong predictors for rehabilitative treatment success. Affective variables, such as affect regulation and expression, have been associated with the personality of substance abusers. The major objective of this study was to assess the cognitive variables of commitment to abstinence and motivation for treatment, and the affective variables of emotion regulation and affective fluency as they affected the response to drug abuse treatment. Paper/pencil inventories were given to 103 subjects who were seeking treatment at a private outpatient substance abuse rehabilitative treatment center. The Thoughts About Abstinence Scale and the resistance to treatment scales of the RAATE-QI were used to assess the cognitive variables of commitment to abstinence and motivation for treatment respectively. The Toronto Alexithymia Scale was used to assess the affective component of alexithymia, and the Ego Control Inventory and the emotional subscale of the Coping Resources Inventory were used to assess affect regulation. Severity of drug use was measured by the DAST-20, and frequency of drug use was measured by self-report questionnaire. Many of the results found in this study replicated prior research espousing the link between the cognitive factors and drug use in treatment. Affective factors were not as strongly linked to drug use behavior in treatment in this study. In the current study, relationships between the cognitive and affect variables and the drug use variables often behaved in a complex manner based on nonlinear relationships between these predictor variables and outcome variables. _____
Title: Attachment and emotion regulation in mothers and infants. Author(s): Kogan, Nina P., Yale U, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 58(4-B), Oct 1997. pp. 2154. Publisher: US: Univ Microfilms International. Abstract: A growing body of infant attachment research points to poorer social-emotional outcomes for infants with insecure attachment representations when compared to those with secure attachment representations. A second body of research links early emotional regulatory processes to social-emotional development. Both literatures have identified characteristics of the primary caregiving relationship that influence infants' organization and expression of behavior. Although the constructs of attachment and emotion regulation are clearly related, few studies have attempted to explore the association between the two. This study had two goals. The first was to examine the relation between infant attachment and emotion regulation through a comparison of behavior in the Strange Situation and in a separate stressful procedure. The second goal was to explore possible mechanisms through which infants adopt these emotional and behavioral patterns. Ninety-one 12-month-old infants and their mothers participated in the traditional Strange Situation, and then returned one week later for the Restrained Activity Protocol (RAP), a bundling procedure designed to elicit frustration and distress. Infant coping behaviors following the RAP were compared to attachment classification in the Strange Situation. Securely attached infants (N = 63) employed a greater number of coping strategies when left to comfort themselves, enabling them to regulate their affective state, as demonstrated by less intense negativity following the stressor. A comparison of 'attachment behaviors' revealed that in the post-RAP mother-infant reunion, infants exhibited higher levels of proximity-seeking, contact-maintenance, and resistance, but lower amounts of avoidance, as compared to the Strange Situation mother-infant reunions. The examination of maternal self-reported styles of affect regulation and adult attachment representations suggests the modes through which mothers transmit behavioral and affective schema to their infants. Mothers who reported greater competence in the regulation of difficult affect, and the use of more 'adaptive' coping mechanisms, were more likely to have 12-month-olds who were less reactive to stress, attempted a greater range of coping strategies in efforts to regulate negative affect, and were securely attached. Mothers who rated themselves as having secure attachment representations were likely to have securely attached infants who exhibited less intense negative affect following the stressor, and employed a more flexible repertoire of coping skills. The findings suggest a powerful connection between attachment and emotion regulation in infancy as well as in the context of the infant-caregiver relationship, and point to possible mechanisms of socialization that may be at least partially responsible for the intergenerational associations. _____
Title: Controlled study of psychiatric comorbidity in psychiatrically hospitalized young adults with substance use disorders. Author(s): Grilo, Carlos M., Yale U, School of Medicine, Yale Psychiatric Inst, New Haven, CT, US; Martino, Steve; Walker, Martha L.; Becker, Daniel F.; Edell, William S.; McGlashan, Thomas H. Source: American Journal of Psychiatry, Vol 154(9), Sep 1997. pp. 1305-1307. Publisher: US: American Psychiatric Assn. Abstract: Examined Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) axis I and axis II comorbidity in 70 psychiatrically hospitalized young adults (aged 18-37 yrs) with substance use disorders compared with 47 patients without substance abuse disorders. Structured diagnostic interviews were conducted with all Ss. High rates of co-occurrence of axis I disorders were observed, but no disorder coexisted in the group with substance use disorders at a significantly higher rate than in the group without substance use disorders. Among axis II disorders, borderline personality disorder was diagnosed significantly more frequently in the group with substance use disorders. The findings suggest that substance abuse can perhaps be regarded as due, in part, to deficits in affect regulation and impulse control, which are characteristic of persons with borderline personality disorder. _____
Title: Cognitive biases and affect persistence in previously dysphoric and never-dysphoric individuals. Author(s): Gilboa, Eva, Northwestern U, Evanston, IL, US; Gotlib, Ian H. Source: Cognition & Emotion, Vol 11(5-6), Sep-Nov 1997. Special Issue: The cognitive psychology of depression. pp. 517-538. Publisher: United Kingdom: Taylor & Francis/Psychology Press. Abstract: Persistence of affect and attentional and memory biases in 168 dysphoria-prone and nonvulnerable individuals were investigated. In 2 experiments, never dysphoric (ND) individuals and previously dysphoric (PD) individuals underwent a positive and a negative autobiographical mood-induction procedure (MIP). Following each MIP, individuals participated in an emotional Stroop task. Participants also rated their mood both immediately after, and 5 min after, each MIP. In addition, in Exp 2, incidental memory for Stroop stimuli was assessed. PD participants reported more persistent negative affect following a negative MIP than did ND participants. Although PD and ND participants did not differ from each other with respect to their performance on the emotion Stroop task, PD participants demonstrated significantly better memory for negative stimuli than did ND participants. Thus, affect dysregulation and memory biases of PD participants outlasted the dysphoric episode. These findings suggest that memory biases and affect regulation style may play a causal role in susceptibility to depression. _____
Title: Skills training treatment for adaptive affect regulation in a woman with binge-eating disorder. Author(s): Telch, Christy F., Stanford U, School of Medicine, Dept of Psychiatry & Behavioral Sciences, Stanford, CA, US Source: International Journal of Eating Disorders, Vol 22(1), Jul 1997. pp. 77-81. Abstract: This case study describes a skills training treatment for binge eating which focused on teaching adaptive affect regulation. A 36-year-old obese woman with a long history of severe binge eating received individual treatment specifically aimed at enhancing her emotion regulation abilities. By treatment end she no longer met criteria for binge eating disorder. _____
Title: Positive and negative symptoms in first degree relatives of schizophrenics. Author(s): Westerfield, Keith, New School For Social Research, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 57(12-B), Jun 1997. pp. 7747. Publisher: US: Univ Microfilms International. Abstract: Research in schizophrenia has always included studying the close relatives of schizophrenics and for good reason. Schizophrenia has been shown to aggregate within families. The positive/negative symptom distinction has had a long and important history in the study of schizophrenia. Although out of diagnostic fashion for a period of about 20 years, it has again become an important system of understanding the highly varied phenomenological presentation of schizophrenia and represents the major diagnostic alternative to the DSM-III-R. Much research has followed, and the distinction has provided important insights into the illness. However, very little research of the positive/negative distinction has focused on close relatives. This study was designed to fill that gap. There is a growing belief that the DSM-III-R personality disorders do not adequately capture the functioning of these schizophrenia-related individuals. Some clinicians have begun to think in terms of positive and negative symptoms in describing them. This study formally tests the relevance of the positive/negative distinction in a non-psychotic, but schizophrenia-related population. A sample of 150 non-psychotic first-degree relatives of schizophrenic probands was selected and assessed for the 104 personality symptoms contained in the eleven personality disorders of the DSM-III-R. These symptoms were rated for their positive and negative attributes according to the definitions found in the Scale for the Assessment of Positive Symptoms (SAPS) and Scale for the Assessment of Negative Symptoms (SANS). These symptoms were clustered using a formal cluster algorithm. The obtained cluster solution was compared with another cluster solution of the same symptoms from a study of a general psychiatric population as well as the DSM-III-R symptom classification itself. All three symptom organizations were tested for their relative strength of association with the positive/negative distinction as well as the functional categories of symptoms (affect, boundary disturbance, social involvement, personal concerns and thought/speech) that are another feature of the SAPS/SANS. Statistical results indicated that the cluster solution from the schizophrenia-related sample was distinct from the other two symptom organizations and had consistently stronger associations to the positive/negative symptom distinction as well as the functional categories of affect and boundary disturbance. These results verified the relevance of the positive/negative distinction in this population as well as the importance of affect regulation and the milder forms of boundary disturbance. Further research is suggested including the development of a SAPS/SANS type of instrument that is targeted specifically at assessing non-psychotic subjects. This has important implications in genetic research. Additionally, clinicians are encouraged to make the positive/negative distinction a viable alternative to the DSM-III-R descriptions. _____
Title: Towards a clinically and empirically sound theory of motivation. Author(s): Westen, Drew, Cambridge Hosp, Cambridge, MA, US Source: International Journal of Psycho-Analysis, Vol 78(3), Jun 1997. pp. 521-548. Publisher: England: Inst of Psychoanalysis. Abstract: The author outlines a theory of motivation that attempts to integrate psychoanalytic theory with current psychological thinking and research. Emotions and other sensory feeling states are evolved mechanisms for channelling behaviour in directions that foster adaptation. The avoidance of unpleasant states and pursuit of pleasant ones leads to goal-directed mental and behavioural processes, including defences and compromise formations. Affects provide a flexible motivational mechanism in humans, as they become associated with representations of perceived, feared, wished-for, or otherwise valued states through the interaction of environmental events and highly specific naturally selected biological proclivities. This reconceptualisation of motivation points towards a resolution of a contradiction in Freud's models of affect and motivation between a theory of drive-reduction and a theory of affect regulation, and of the apparent contradiction between motivational models that emphasise either sexual desire or relational needs. The model also has implications for the theory of transference, since it suggests that neutrality is not the feature of the analytic situation that evokes meaningful transferential processes. _____
Title: Affective instability and impulsivity in personality disorder: Results of an experimental study. Author(s): Herpertz, S., Technical U Aachen, Psychiatric Clinic, Aachen, Germany; Gretzer, A.; Steinmeyer, E. M.; Muehlbauer, V.; et al. Source: Journal of Affective Disorders, Vol 44(1), Jun 1997. pp. 31-37. Publisher: Netherlands: Elsevier Science Publishers BV. Abstract: Focused on the relationship between affective instability and impulsivity in personality disorder in 75 adults females with self-harming modes of behavior and in 25 control Ss. An affect-stimulation design based on the presentation of a short story which allowed for an analysis of affective responses in regard to quality, intensity, and alterations over time was used. Impulsive personalities showed a strong intensity of affective responses as well as a tendency towards rapid affect alterations. Findings support the theory of poor affect regulation in Ss with impulsive self-harming behavior. Results suggest that affective instability is a crucial part of impulsive personality functioning. _____
Title: Affect regulation and affective experience: Individual differences, group differences,and measurement using a Q-sort procedure. Author(s): Westen, Drew, Cambridge Hosp, Dept of Psychiatry, Cambridge, MA, US; Muderrisoglu, Serra; Fowler, Christopher; Shedler, Jonathan; et al. Source: Journal of Consulting & Clinical Psychology, Vol 65(3), Jun 1997. pp. 429-439. Publisher: US: American Psychological Assn. Abstract: This article describes the development of, and preliminary findings with, the Affect Regulation and Experience Q-Sort (the AREQ), an observer-based assessment of affect regulation and experience. In Study 1, 31 clinicians provided Q-sort descriptions of 90 patients. Factor scores correlated in predicted ways with criteria such as suicide attempts and hospitalizations, as well as with clinicians' ratings of functioning in a variety of domains. Correlations between prototype Q-sorts and actual Q-sort profiles for patients sharing a diagnosis (dysthymia, borderline personality disorder, and narcissistic personality disorder) also provided evidence for convergent and discriminant validity. The data also suggested the importance of distinguishing 2 kinds of negative affect that have very different correlates. Study 2 showed that the AREQ can be applied reliably using an interview that avoids many of the problems of self-report. _____
Title: Affect regulation and suicide attempts in adolescent inpatients. Author(s): Zlotnick, Caron, Brown U, Butler Hosp, Dept of Psychiatry & Human Behavior, Providence, RI, US; Donaldson, Deidre; Spirito, Anthony; Pearlstein, Teri Source: Journal of the American Academy of Child & Adolescent Psychiatry, Vol 36(6), Jun 1997. pp. 793-798. Publisher: US: Lippincott Williams & Wilkins. Abstract: Examined the relationship between affect dysregulation and self-destructive behaviors in adolescent suicide attempters. Measures of affect dysregulation, number of risk-taking behaviors in past year, presence of self-mutilative behaviors in past year, and number of different types of self-mutilative behaviors in past year were individually administered to adolescents (mean age 14.9 yrs) admitted to an inpatient unit who were either suicide ideators (n = 25) or suicide attempters (n = 37). Results show that suicide attempters reported significantly higher levels of affect dysregulation and a greater number of different types of self-mutilative behaviors in the past year than suicide ideators. In addition, the number of different types of self-mutilative behaviors in the past year had the strongest relationship to suicide attempts. It is concluded that suicidal behavior among adolescent psychiatric patients is related to poor affect regulation. A risk factor for suicidal behavior in adolescents is a broad range of self-mutilative acts in the year preceding the suicide attempt. _____
Title: Attachment, detachment and borderline personality disorder. Author(s): Sable, Pat Source: Psychotherapy: Theory, Research, Practice, Training, Vol 34(2), Sum 1997. pp. 171-181. Publisher: US: Div of Psychotherapy APA. Abstract: In an attempt to expand understanding of more severe pathology, attachment theory, developed by John Bowlby, is applied to borderline personality disorder in adults. Conceptualized as a condition of profound insecure attachment, with extreme vacillations between a desire for proximity and attachment and a dread and avoidance of engagement, borderline pathology reflects traumatic attachment experiences, beginning early in life. Besides the importance of trauma, disturbances in affect regulation and cognitive distortions are emphasized. The secure base of a therapeutic bond provides consistency, reliability, and affirmation while encouraging exploration of separation and loss experiences, both current and past, in order to modify inner working models of oneself and relationships with others. Implications for prevention are discussed. _____
Title: Emotion processing in borderline personality disorders. Author(s): Levine, Deborah, U Toronto, Psychiatric Service, Toronto, ON, Canada; Marziali, Elsa; Hood, Jane Source: Journal of Nervous & Mental Disease, Vol 185(4), Apr 1997. pp. 240-246. Publisher: US: Lippincott Williams & Wilkins. Abstract: Examines the ways in which adults with borderline personality disorder (BPD) experience and manage their feelings. Responses of 30 Ss who met the criteria for BPD on the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) were compared with 40 non-BPD controls on the following measures of emotion processing and affect regulation: (1) level of emotional awareness, (2) capacity to coordinate mixed valence feelings, (3) accuracy at identifying facial expressions of emotion, and (4) intensity of response to negative emotions. The results showed significant differences between the 2 groups on all measures. The borderlines showed significantly lower levels of emotional awareness, less capacity to coordinate mixed valence feelings, lower accuracy at recognizing facial expressions of emotion, and more intense responses to negative emotions than the non-BPD controls. The findings corroborate clinical observations of borderline patients' difficulties in regulating emotions. _____
Title: Psychodynamic mediators of the relationship between interpersonal negotiation strategies and adolescent problem behaviors. Author(s): Sachs, Charles Jonathan, Columbia U, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 57(9-B), Mar 1997. pp. 5930. Publisher: US: Univ Microfilms International. Abstract: This study tests a model of the relationship among perspective coordination maturity, self/other differentiation, affect regulation, and adolescent problem behaviors. The model specifies that self/other differentiation and affect regulation mediate two relationships. The first is the relationship between perspective coordination in thought and perspective coordination in action. The second is the relationship between perspective coordination developmental maturity and 'externalizing' (Achenbach & Edlebrock, 1978) problem behaviors. Selman and Schultz (1988) theorize that any developmental gap between the levels of perspective coordination in thought and action is mediated by self/other differentiation and affect regulation. This study tests that proposition, although the hypothesis here is that the psychodynamic variables mediate the thought/action relationship generally, not only when there is a developmental gap between these two perspective coordination components. The tests of the model also account for potentially confounding demographic, parenting style, and subject characteristic variables. Potential confounds considered here were identified on the basis of previous relevant research. The structure of the relationship among the major variables for male and female subject groups is also examined. Gender differences have been inconsistently reported in the perspective coordination literature. Self/other differentiation and affect regulation are hypothesized to account for this inconsistency. No support was found for the mediational model. Some support was found for an alternate, moderating model: self/other differentiation moderated the relationship between perspective coordination developmental status and one index of externalizing behavior. Affect regulation did not act as a moderator. The moderating effect of self/other differentiation also differed for male and female subjects. Male subjects with relatively mature perspective coordination status were especially likely to report few externalizing behaviors when their interpersonal boundaries were clearly defined. Female subjects with relatively mature perspective coordination status were especially likely to report few externalizing problems when their interpersonal boundaries were less rigid. Discussion focused primarily on two issues: the likely superiority of a moderating model over a mediating model, and the implications of the observed gender differences for Selman's Interpersonal Negotiation Strategy framework. _____
Title: Emotion socialization and affect regulation in children with attention deficit hyperactivity disorder. Author(s): Siegel, Hillary Ilene, Long Island U, the Brooklyn Center, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 57(9-B), Mar 1997. pp. 5932. Publisher: US: Univ Microfilms International. Abstract: The present study examined the development of emotion regulation and dysregulation in ADHD and non-ADHD mother-child pairs by exploring the quality of their attachment relationships, their affective organization/biases, their modes of emotion socialization and the methods of conflict resolution that are employed with these children. The mean age of the children was 9.4 years and the mean age of the mothers was 37.4 years. Both members of the mother-child dyad were separately administered specific measures that assessed the quality of their attachment relationship and their affect-specific biases. Additionally, dyad-specific modes of emotion socialization and conflict resolution were assessed through child and parental interviews. The results indicated several distinctions between ADHD and non-ADHD mother-child dyads. First, mothers of ADHD children were less likely to use rewarding socialization responses and more likely to use punishing and disregarding responses than were mothers of non-ADHD children. Second, ADHD children tended to make a greater amount of anger and/or shame attributions than non-ADHD children, and thus had a preponderance of negative affect biases that appeared to reflect the extreme emotionality and high-arousal interactions that characterize their socialization experiences. Third, mother's attachment style was differentiated by child's diagnostic status, such that, mothers of ADHD children were significantly more likely to have relationships which were classified as insecure than were mothers of non-ADHD children. Finally, securely attached mothers were found to use significantly more rewarding socialization behaviors than insecurely attached mothers, who demonstrated a tendency to utilize more punishing patterns of socialization. However, the results failed to detect differences in maternal disciplinary styles between ADHD and non-ADHD dyads. Unique patterns of interaction appear to evolve within ADHD mother-child dyads. Although the direction of the causal pathway is unclear, the diagnosis of ADHD seems to have powerful and distinct repercussions for the development of personality. _____
Title: Affect regulation and synchrony in mother-infant play as precursors to the development of symbolic competence. Author(s): Feldman, Ruth, Bar-Ilan U, Dept of Psychology, Ramat Gan, Israel; Greenbaum, Charles W. Source: Infant Mental Health Journal, Vol 18(1), Spr 1997. pp. 4-23. Publisher: US: John Wiley & Sons. Abstract: Examined relationships between organizing processes of affective communication in infancy and the development of symbolic competence. 36 mother-infant dyads were observed at 3 and 9 mo, and 32 dyads were reassessed at 24 mo. Mother and infant affective states during face-to-face play at 3 and 9 mo were coded in .25 sec frames. The underlying structure of infant affect and the time-lag synchrony between mother and infant affective states were assessed with time-series analyses. In addition, interactions at 3 and 9 mo were assessed for the global level of infant positive affect and maternal affect attunement. At 2 yrs, 3 dimensions of symbolic competence were evaluated: symbolic play, verbal IQ, and random, stochastic-cyclic organization of affective states, predicted all 3 domains of symbolic competence at 2 yrs. Maternal synchrony and attunement each had an independent contribution to the prediction of symbolic play and internal state talk. The microanalytic and global indices of affect each added meaningfully to the prediction of symbolic functioning. The organization of behavioral sequences into coherent affective configurations is discussed as a possible precursor to the general capacity to develop symbols. _____
Title: N-super(G)-nitro-L-arginine reverses L-arginine induced changes in morphine antinociception and distribution of morphine in brain regions and spinal cord of the mouse. Author(s): Bhargava, Hemendra N., U Illinois, Health Sciences Ctr, Dept of Pharmaceutics, Chicago, IL, US; Bian, Jing-Tan Source: Brain Research, Vol 749(2), Feb 1997. pp. 351-353. Publisher: Netherlands: Elsevier Science. Abstract: Studied effects of chronic administration of l-arginine on morphine antinociception (MA) in male mice. Ss were injected with vehicle l-arginine (200 mg/kg, intraperitoneal/ly (ip)), N-super(G)-nitro-l-arginine (l- NNA), (5mg/kg) or l-arginine (200 mg/kg) plus l-NNA (5mg/kg) twice a day for 4 days. On day 5, the antinociceptive response to morphine was determined by the tail flick test. l-arginine injections decreased MA, and produced significant decreases in morphine levels in midbrain, pons and medulla, hippocampus, corpus striatum, and spinal cord following morphine injection in comparison to vehicle-injected Ss. l-NNA given prior to each l-arginine injection reversed effects of the latter on MA and decreases in morphine levels in brain and spinal cord. Chronic l-NNA alone did not modify either MA or morphine distribution. Results suggest that decreases in MA by chronic treatment with l-arginine is related to decreases in the entry of morphine in the central sites. Reversal of l-arginine-induced effects by l-NNA suggests that the nitric oxide-nitric oxide synthase system may affect regulation of blood-brain barrier to morphine.
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