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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 and the development of psychopathology.
Author(s): Bradley, Susan J., U Toronto, Dept of Psychiatry, Toronto, ON, Canada Source: 2000. New York, NY, US: Guilford Press. xii, 324 pp. ISBN: 1-57230-548-7 (hardcover) Abstract: The volume presents current findings on such risk factors as loss, trauma, and abuse; temperamental or stress reactivity; brain insult; attachment difficulties; and sensitivity to expressed emotion or familial conflict. Showing that these traits and experiences have all been linked to psychological problems, the author demonstrates that they also share a tendency to disrupt the regulation of affect. She details the development of affect regulation, with special attention to the influence of learning and experience on the physiology, chemistry, and structure of the brain. The book shows how disruptions in this aspect of development make some individuals more likely than others to experience heightened states of distress or emotional arousal. Chapters then address links to behavioral disorders, affective spectrum disorders, and the psychoses. The book will be a resource for practitioners, students, and researchers in clinical psychology, psychiatry, and related mental health disciplines; and as a text in graduate-level courses. Table of Contents: Part I: Overview ..The model and its rationale
Part II: The evidence ..An introduction to affect regulation and its development ..Constitutional and genetic factors ..The caregiving environment ..Stress, trauma, and abuse ..Coping: Learning and experience ..The neurobiology of affect regulation ..Therapeutic considerations
Part III: Clinical syndromes ..Internalizing disorders: Anxiety, mood, and relational disorders ..Externalizing disorders: The disruptive behavior disorders ..Psychotic disorders
Part IV: Final remarks ..Future directions References Index _____
Title: Transforming aggression: Psychotherapy with the difficult-to-treat patient. Author(s): Lachmann, Frank M., Private Practice, New York, NY, US Address: Lachmann, Frank M., Private Practice, New York, NY, US; Lachmann, Frank M., Private Practice, New York, NY, US Source: 2000. Northvale, NJ, US: Jason Aronson, Inc. xiii, 262 pp. Abstract: Designed to avoid escalating spirals of aggression and prevent therapeutic stalemates, the process of change begins with an understanding of the nature, causes, and function of the patient's aggression. Distinguishing between reactive and eruptive aggression, the author identifies the specific adverse developmental conditions that contribute to the latter. Some of the factors examined are experiences of abuse, deception, and neglect; early failure to establish self-soothing and affect regulation; deficiencies in the mother-infant dyad that interfere with the development of self-cohesion and increase self-fragmentation; neurological abnormalities; and an intolerance of feelings of shame. The therapeutic process is presented with rich clinical material that highlights the effects of spontaneity, humorous exchanges, improvisational interplay, and non-interpretive comments rather than rigorous attention to technically correct interventions. The dimensions of the transference are richly elaborated, and the devaluations of the therapist characteristic of these patients are deeply and broadly understood. Table of Contents: Preface Acknowledgments ..Self psychology strikes back ..The aggressive toddler and the angry adult ..The view from Motivational Systems Theory ..State transformations in psychoanalytic treatment ..State transformations and trauma ..State transformations through creativity ..The transformation of reactive aggression into eruptive aggression ..It's better to be feared than pitied ..The empathy that enrages ..A requiem for countertransference ..A systems view ..Self psychology and the varieties of aggression References Credits Index _____
Title: A Jacksonian and biopsychosocial hypothesis concerning borderline and related phenomena. Author(s): Meares, Russell , Westmead Hosp, Dept of Psychiatry, Wentworthville, NSW, Australia; Stevenson, Janine; Gordon, Evian Source: Australian & New Zealand Journal of Psychiatry , Vol 33(6), Dec 1999. pp. 831-840. Publisher: Australia: Blackwell Science Asia. Abstract: Developed an etiological model for borderline personality disorder (BPD). The postulates of neurologist J. Hughlings Jackson are used to provide a preliminary explanatory framework for borderline phenomena. The findings concerning abuse in the early history of BPD and other conditions, notably somatization disorder and dissociative states, are briefly reviewed. Other data, including family studies, with significance in the etiology of BPD are also reviewed. It is hypothesized that the symptoms of BPD are due to the failure of "experience-dependent' maturation of a cascade of neural networks, with prefrontal connections, which become active relatively late in development and which coordinate disparate elements of CNS function. These networks subserve higher psychological functions, including attentional focus and affect regulation, and underpin the reflective function necessary to the emergence of self as the stream of consciousness, which appears at about the age of 4 yrs. Adverse developmental circumstances may produce an interrelated set of symptom clusters, with associated neural network disturbances, that are amenable to investigation with psychometric and brain imaging techniques. _____
Title: Relations among child language skills, maternal socializations of emotion regulation, and child behavior problems. Author(s): Stansbury, Kathy, U New Mexico, Dept of Psychology, Albuquerque, NM, US; Zimmermann, Laura K. Source: Child Psychiatry & Human Development, Vol 30(2), Win 1999. pp. 121-142. Publisher: US: Kluwer Academic. Abstract: Research has linked language delays in young children to behavior problems and risk for psychopathology. The authors hypothesized that low language skill would affect normal socialization of emotion regulation, which in turn would affect the development of behavior problems. Seventy-eight mother/preschool-age child pairs participated in two mildly frustrating situations. Parents (aged 27-45 yrs) of children (aged 33-59 months) with low verbal comprehension used more unexplained compliance demands than other parents. Further, children whose parents used more unexplained compliance demands used fewer cognitive and distraction strategies, and more instrumental strategies. Children's use of physical self-comforting was positively related to overall, internalizing, and externalizing behavior problems. Findings supported the original hypothesis. _____
Title: Made to measure: Adapting emotionally focused couple therapy to partners' attachment styles. Author(s): Johnson, Susan M., U Ottawa, School of Psychology, Ottawa, ON, Canada; Whiffen, Valerie E. Source: Clinical Psychology: Science & Practice, Vol 6(4), Win 1999. pp. 366-381. Publisher: England: Oxford Univ Press. Abstract: This article summarizes the theory, practice, and empirical findings on emotionally focused couple therapy (EFT), now one of the best documented and validated approaches to repairing close relationships. EFT is based on an attachment perspective of adult intimacy. The article considers how individual differences in attachment style have an impact on affect regulation, information processing, and communication in close relationships and how the practice of EFT is influenced by these differences. _____
Title: Attachment and marital functioning: Comparison of spouses with continuous-secure, earned-secure, dismissing, and preoccupied attachment stances. Author(s): Paley, Blair, U California, Neuropsychiatric Inst & Hosp, Los Angeles, CA, US; Cox, Martha J.; Burchinal, Margaret R.; Payne, C. Chris Source: Journal of Family Psychology, Vol 13(4), Dec 1999. pp. 580-597. Publisher: US: American Psychological Assn. Abstract: In a sample of 138 couples, the present study examined whether individuals' marital functioning related to both their own and their partner's attachment stance. Earned-secure wives managed their affect as well as continuous-secure wives during problem-solving discussions and better than preoccupied or dismissing wives. However, preoccupied and dismissing wives did not exhibit markedly different patterns of affect regulation in their marriages. Regarding individuals' marital functioning and partners' attachment stance, neither husbands' behavior nor perceptions related to their wives' attachment stance. However, wives of continuous-secure husbands exhibited more positive marital behavior than wives of dismissing and earned-secure husbands. Findings are discussed in terms of how attachment working models may account for both continuities and discontinuities between earlier caregiving experiences and functioning in adult relationships. Conference: Society for Research in Child Development., Mar, 1995, Indianapolis, IN, US _____
Title: Contributions of positive and negative affect to adolescent substance use: Test of a bidimensional model in a longitudinal study. Author(s): Wills, Thomas Ashby, Ferkauf Graduate School of Psychology, Health Psychology Training Program, Bronx, NY, US; Sandy, James M.; Shinar, Ori; Yaeger, Alison Source: Psychology of Addictive Behaviors, Vol 13(4), Dec 1999. pp. 327-338. Publisher: US: American Psychological Assn/Educational Publishing Foundation. Abstract: Contributions of bidimensional affect measures to adolescent substance (tobacco, alcohol, and marijuana) use were measured. Participants (baseline N = 1,702) were surveyed at age 12.4 years and followed longitudinally through age 15.4 years. Multiple regression indicated negative affect related to higher levels of substance use and positive affect related to lower levels of substance use. Buffer interactions indicated that the relationship of negative affect to substance use was reduced among persons with higher positive affect. Clustering analyses indicated 5 different patterns of affect over time; affect patterns were systematically related to change in substance use over time. Structural modeling analysis indicated that relationships of affect to substance use were mediated through coping motives. The findings are discussed with respect to resiliency research and affect-regulation models of substance use. _____
Title: Image control and symptom expression in posttraumatic stress disorder. Author(s): Laor, Nathaniel, Tel-Aviv Community Mental Health Ctr, Tel Aviv, Israel; Wolmer, Leo; Wiener, Zeev; Weizman, Ronit; Toren, Paz; Ron, Samuel Source: Journal of Nervous & Mental Disease, Vol 187(11), Nov 1999. pp. 673-679. Publisher: US: Lippincott Williams & Wilkins. Abstract: Despite the devastating impact of affective dysregulation in posttraumatic stress disorder (PTSD), there has been little research on how trauma relates to affect regulation. This study examines the relationship between the cognitive capacity to control mental images and symptoms of Israeli individuals with (N = 23) and without (N = 23) PTSD after exposure to SCUD missile attacks during the Gulf War. The capacity to control mental images, symptoms of posttrauma, anxiety, and anger were assessed. PTSD Ss with a high image control reported a higher capacity to control anger, lower levels of anger state and expression, and lower levels of intrusive symptoms compared with PTSD subjects with low image control. In individuals without PTSD, results show that the better the image control, the lower the control of anger and the higher the expression of anger. Image control seems to play different functions in the emotional regulation of normal subjects (facilitatory) and PTSD patients (protective). _____
Title: Depressive styles and the regulation of negative affect: A daily experience study. Author(s): Fichman, Laura, Arizona State U, Program for Prevention Research, Tempe, AZ, US; Koestner, Richard; Zuroff, David C.; Gordon, Laurel Source: Cognitive Therapy & Research, Vol 23(5), Oct 1999. pp. 483-495. Publisher: US: Kluwer Academic/Plenum Publishers. Abstract: An experience-sampling methodology was used to explore the relation between depressive personality styles and daily mood regulation. 95 female college students completed the Depressive Experiences Questionnaire and recorded their affect and use of specific mood-regulation strategies twice daily over a 2 wk period. It was hypothesized that active, distracting strategies would be more effective in alleviating negative affect than would passive, emotion-focused strategies, and that self-criticism and dependency would be associated with poor mood management. Results indicate that engaging in a pleasant, rewarding activity was successful in reducing negative affect, whereas venting prolonged negative affect. Self-criticism was related to poor mood management, as it was associated with venting and failing to spend time with others. Dependency was associated with venting, consumption-based self-indulgence, and being less likely to spend time alone when regulating negative affect. _____
Title: Affects, regulation of relationship, transference and countertransference. Author(s): Krause, Rainer, U des Saarlandes, Saarbruecken, Germany; Merten, Joerg Source: International Forum of Psychoanalysis, Vol 8(2), Oct 1999. pp. 103-114. Publisher: Sweden: Taylor & Francis. Abstract: This reprinted article originally appeared in ( Zeitschrift fuer Psychosomatische Medizin und Psychoanalyse, 1996, Vol 42 [3],261-280. Discusses the results of research projects dealing with the exchange of affects within different types of relationships. Different conceptualizations of transference and countertransference, as specific forms of creating relationships, are examined. Transference is a ubiquitous phenomenon, found in nearly every relationship in a specific form of affective script. Interactions between different groups of structural disturbances and overt behaviors occur according to these scripts. Differences between successful psychotherapeutic relationships and everyday relationships include the lack of overt interactive reactions by the psychotherapists to the unconscious affective advances made by the patient. Instead, the psychotherapist develops those affects the patient is unable to generate, although they are urgently needed by the situational meaning structure. _____
Title: Erotized transference and self-mutilation. Author(s): Tillman, Jane G., Austin Riggs Foundation, Stockbridge, MA, US Source: Psychoanalytic Review, Vol 86(5), Oct 1999. pp. 709-719. Publisher: US: Guilford Publications. Abstract: In psychoanalytic work, the optimal progression of treatment includes securing a working therapeutic alliance, the ability to use interpretation, and the development and working through of a transference neurosis. In some patients this progression may be wildly askew. The author presents the work with 2 patients (both women in their 30s) with psychotic liabilities who developed erotized transferences to their outpatient psychotherapists followed by the onset of a new symptom--severe self-mutilation by cutting. In the context of such a transference, both patients were unable to maintain a reliable working alliance. Their ego strength was severely compromised, with the event of deep cutting taking each referring outpatient therapist by surprise. In both cases, the self-mutilating behavior first occurred in the context of an erotized psychotic transference. This symptom suggests not only difficulty with affect regulation and cognition, but also relational difficulty within an erotized dyadic treatment. Perverse dynamics, sadomasochistic trends, difficulty with affect regulation, and severe self/other boundary disturbance were present in both cases. The author focuses on the symptom of self-mutilation as an attempt to manage an overwhelming psychotically erotized transference. _____
Title: Musica, perdidas y regulacion del afecto. Translated Title: Music, losses and affect regulation. Author(s): Rose, Gilbert Source: Revista de Psicoanalisis, Vol 56(4), Oct-Dec 1999. pp. 735-748. Publisher: Argentina: Asociacion Psicoanalitica Argentina. Abstract: Hypothesizes that music influences the regulation of affects through internalization. An individual seeks music as a temporal/rhythmic, sustaining environment within which he/she can feel both stimulated and protected, as it happens in neonatal life through the responsive presence of the mother. At that time, the infant and its primary caretaker form together a joint nonverbal system which releases tension and contains affects within tolerable limits. Music is a transformation of this interpersonal system of affect regulation into an abstract, intrapsychic level; through sensorimotor sensorimotor stimulation, it embraces and evokes early internalizations in all their unconscious, symbolic, memorial and affectomotor aspects. Affective interaction with music may itself become internalized. Ideally, all these internalizations retain the power to promote a comforting and positively tuned affect regulation. Through it, music acts as an auxiliary ego in support of an optimal equilibrium between observing and experiencing aspects of the ego and, therefore, supports affect regulation. _____
Title: Adult attachment and affect regulation: A test of a stylistic model. Author(s): Fuendeling, James Mervyn, Michigan State U, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 60(3-B), Sep 1999. pp. 1341. Publisher: US: Univ Microfilms International. Abstract: This project pursues the idea that consistent differences in the emotional experiences of individuals with different attachment styles are accompanied by systematic differences in the ways they regulate their affect. A broad range of findings, when reorganized according to a process level explanation of affect regulation, supports this idea. In order to further explore this model of affect regulation styles, a study was conducted in which 135 undergraduate participants responded to standard self report measures of attachment styles. Affect regulation was assessed using both a free response method developed for the study, and a revised version of the Ways of Coping Checklist (Folkman & Lazarus, 1980; Vitaliano, Russo, Carr, Maiuro & Becker, 1985). Results were mixed in terms of their support for specific hypotheses, but clearly support the larger idea that attachment styles include distinct styles of affect regulation. Differences were found in attributions and appraisal, where secures tended to see a situation as less threatening than did fearful avoidants, and blamed themselves for situations less than avoidants in general. Differences were also found in expression of both positive and negative emotions. Secures were more likely to be expressive of positive emotions, and avoidants were more likely to be expressive of negative emotions. These findings for expression were complex, and included interactions of attachment style with situation. Effects were also observed for rumination, introduction of new goals, and scales of Ways of Coping. Implications of results on the validity of the self report measure are discussed, as well as theoretical implications of the findings. _____
Title: Paternal contributions to the etiology of Gender Identity Disorder: A study of attachment, affect regulation, and gender conflict. Author(s): Cook, Cassandra Graham , City U New York, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 60(1-B), Jul 1999. pp. 0361. Publisher: US: Univ Microfilms International. Abstract: The goal of this study was to formulate hypotheses concerning the contribution of paternal dynamics to the etiology of Childhood Gender Identity Disorder (GID) in boys. Six fathers of sons diagnosed with GID were interviewed using the Adult Attachment Interview (AAI), the Early Memories Test, and the Fatherhood Interview, a semi-structured interview designed for this project to assess the fathers' experience of their sons' cross-gender symptoms. AAI transcripts were scored using both Main & Goldwyn's (1998) scoring system and Fonagy et al's (1998) Reflective Functioning Manual. According to Main's system, every father in this sample evidenced clinically significant levels of Unresolved Trauma, and no subject was classified as Secure. The dramatic over-representation of Insecure and Unresolved Trauma classifications in this sample was understood as suggesting that these fathers' are very likely to have formed insecure attachment relationships with their sons, as well as to have manifested, when stressed, the kinds of frightened and frightening behaviors that may lead a sensitive and highly reactive child to feel anxious and unsafe in establishing a masculine identification. The low levels of reflective functioning obtained on this sample were seen as suggestive of these fathers' difficulties in forming accurate and detailed inner representations of their children. Significantly, however, this sample also provided clear clinical evidence that overall reflective functioning scores may not capture certain key capacities which interact to determine the quality of parents' internal representations of their children. It was proposed that the capacity to take responsibility for one's own role in relationships is critical to the constructive use of reflective capacities, and also that the absence of well-developed reflective capacities in the specific domain of the relationship with the child may render the more general capacity for reflective functioning relatively useless in the process of preventing the intergenerational transmission of trauma. Finally, traumatic attachment-related experiences in these fathers' histories were found to be intimately related to past and present experiences of gender. The identification of two distinct attitudes toward the child's cross-gender symptoms led to the formation of hypotheses concerning two distinct dynamic pathways for paternal reinforcement of cross-gender symptomatology. _____
Title: Affect regulation strategies as a pathway to resilient adaptation in a high-risk population. Author(s): Torres Clemente, Monica P., Boston U, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 60(1-B), Jul 1999. pp. 0378. Publisher: US: Univ Microfilms International. Abstract: Although personality attributes have been extensively investigated in research exploring resilient adaptation in high risk individuals, the role of emotional regulation for competent functioning has been insufficiently studied. The current project examines emotional regulation skills, emotional expression, levels of alexithymia and coping mechanisms as potential mediators facilitating resilient adaptation. The sample consisted of 120 Black and Latina female students enrolled at an inner city community college. The majority of women in the study had experienced multiple psychosocial risks. Participants completed self-report measures that included: Affect Regulation Scale, Negative Mood Regulation Scale, Cope Scale, Toronto Alexithymia Scale, Social Skills Inventory, Symptoms Checklist-10, and the Social Adjustment Scale. Resilience was defined as high functioning despite severe adversity. Two-tailed t-tests revealed that resilient individuals had a higher capacity to differentiate feelings from somatic states, a propensity toward emotional expression, and were more likely to seek emotional support compared with the non-resilient women. The study also found that generalized emotional regulation difficulty, consisting of the use of maladaptive affect regulation strategies and marked by displays of less constructive coping, characterized non-resilient women. Specifically, the study revealed that non-resilient women relied on oral/somatic and sexual/aggressive strategies to cope with negative affects. Hierarchical multiple regressions indicated that three mediating variables, social control, the belief that one can regulate negative mood states, and the tendency to seek emotional support, significantly enhanced functioning. Interaction effects revealed that the expectation that sexual/aggressive strategies would help alleviate negative affect operated as a vulnerability factor. Women with high scores on this variable were more seriously affected by risks than were women low on this attribute. Results of the factor analysis illuminated an underlying cluster of cognitive-affective variables comprising the somatic/forfeiture factor, such as oral passivity, which were found to operate as a vulnerability mechanism. There were also significant differences detected between Latina and Black women with respect to coping and affect regulation styles. It is concluded that affect regulatory functions are important pathways for adaptation in inner city Black and Latina women exposed to multiple risks. These findings suggest that clinical interventions should focus on modifying less adaptive affect regulation strategies. _____
Title: Substance use and psychological adjustment in homeless adolescents: A test of three models. Author(s): MacLean, Michael G., State U New York, Coll at Buffalo, Dept of Psychology, Buffalo, NY, US; Paradise, Matthew J.; Cauce, Ana Mari Source: American Journal of Community Psychology, Vol 27(3), Jun 1999. pp. 405-427. Publisher: Netherlands: Kluwer Academic/Plenum Publishers. Abstract: Three models of adolescent substance use, the deviance-prone, affect-regulation, and normative development models, were assessed regarding their ability to predict the substance use of 354 high-risk homeless adolescents (aged 13-19 yrs) with high rates of deviance, depression, and substance use. Hierarchical multiple regression analyses that included tests for curvilinear and gender interaction effects were performed. Results support the deviance-prone model most strongly, with delinquency but not aggressive behavior predicting substance use. The affect-regulation model received support for females but not for males. With respect to the normative development model, results did not indicate that moderate substance users were better off than abstainers in terms of negative affect or interpersonal relationships. Conference: Annual Convention of the American Psychological Society., 8th, Jun, 1996, San Francisco, CA, US _____
Title: Identification and evaluation of cognitive affect regulation strategies: Development of a new self-report measure. Author(s): Wolfsdorf, Barbara Anne, U Miami, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 59(12-B), Jun 1999. pp. 6499. Publisher: US: Univ Microfilms International. Abstract: People's ability to regulate their emotions is an important component of mental health and well being. To some extent, psychological disorder is defined by the presence of affect dysregulation. Despite the importance of affect regulation, relatively little is known about the cognitive strategies that people use when faced with acute negative affect, and the strategies that are effective in reducing such affect. This limitation in the literature may be due, in part, to the lack of a comprehensive measure of cognitive affect regulation strategies. Three studies were conducted to address this gap in current understanding of cognitive affect regulation. This work yielded a broad-based self-report measure of 15 specific strategies (e.g., thought suppression and mental distraction, reframing and growth, and acceptance). Results provide preliminary support for the psychometric adequacy of this measure. The new measure then was used in a laboratory study to examine which strategies were used and which were useful within a nonclinical population. Results suggest that when faced with acute negative affect, individuals used cognitive affect regulation strategies at low to moderate levels. Findings also demonstrate few differences in strategy use based on gender or history of depression. Finally, only one cognitive affect regulation strategy (thought suppression and mental distraction) was associated with a reduction in acute negative affect. This research provides a new tool for future investigations and represents an important starting point for the understanding of cognitive affect regulation. _____
Title: Clinical implications of psychosocial research on bulimia nervosa and binge-eating disorder. Author(s): Stice, Eric, U Texas, Dept of Psychology, Austin, TX, US Source: Journal of Clinical Psychology, Vol 55(6), Jun 1999. pp. 675-683. Publisher: US: John Wiley & Sons. Abstract: Bulimia nervosa and binge-eating disorder are characterized by a persistent course, are associated with comorbid psychopathology, and can result in serious medical complications. Although current treatments for these disorders show promise, they are not effective for approximately 40% of clients. Significant advances have been made in psychosocial research on the etiology and maintenance of bulimia nervosa and binge-eating disorder, as well as on the predictors of treatment response. This article reviews these advances and discusses the clinical implications of these findings. Research on etiology and maintenance suggests that eating-disorder treatments might be improved by focusing greater attention on promoting healthy weight-control techniques, increasing resiliency to sociocultural pressures to be thin, reducing thin-ideal internalization, and fostering adaptive affect-regulation skills. Research on the predictors of response to treatment suggests that matching treatments to client characteristics might further bolster intervention effectiveness. _____
Title: Dialectical behavior therapy for binge-eating disorder. Author(s): Wiser, Susan, Santa Clara U, Santa Clara, CA, US; Telch, Christy F. Source: Journal of Clinical Psychology, Vol 55(6), Jun 1999. pp. 755-768. Publisher: US: John Wiley & Sons. Abstract: Binge-eating episodes have alternately been described as stemming from strict dieting behaviors driven by overvalued ideas of weight and shape, or as arising from problematic interpersonal experiences. A third way of conceptualizing an eating binge is as a maladaptive emotion-regulation strategy, suggesting that facilitating more adaptive and effective affect regulation capacities may be a useful treatment. Dialectical Behavior Therapy (DBT), a treatment aimed at increasing emotion regulation skill, is currently being adapted for use with a binge-eating disorder population. Assumptions underlying the treatment, methods in treatment delivery, and goals of the treatment package are discussed. A pilot study currently underway of group DBT therapy for individuals with Binge-Eating Disorder is described, including the use of affect regulation, mindfulness, emotion regulation, and distress tolerance skills. _____
Title: Adult attachment, emotional control, and marital satisfaction. Author(s): Feeney, Judith A., U Queensland, Dept of Psychology, Queensland, Australia Source: Personal Relationships, Vol 6(2), Jun 1999. pp. 169-185. Publisher: United Kingdom: Blackwell Publishers. Abstract: This study extends previous research into the relations among attachment style, emotional experience, and emotional control. Questionnaire measures of these variables were completed by a broad sample of 238 married couples. Continuous measures of attachment showed that insecure attachment (low Comfort with closeness; high Anxiety over relationships) was related to greater control of emotion, regardless of whether the emotion was partner-related or not. Insecure attachment was also associated with less frequent and intense positive emotion and with more frequent and intense negative emotion, although these links depended on context (partner-related or not), attachment dimension, and gender. Emotional control added to the prediction of marital satisfaction, after controlling for attachment dimensions; the most robust links with satisfaction were inverse relations with own control of positive emotion and with partner's control of negative emotion. The results are discussed in terms of attachment theory, affect regulation, and communication in marriage. _____
Title: Classifying affect-regulation strategies. Author(s): Parkinson, Brian, Brunel U, Dept of Human Sciences, Uxbridge, England; Totterdell, Peter Source: Cognition & Emotion, Vol 13(3), May 1999. pp. 277-303. Publisher: United Kingdom: Taylor & Francis/Psychology Press. Abstract: Presents a provisional classification of deliberate strategies for improving unpleasant affect based on conceptual judgements concerning their similarities and differences. Self-reported upward affect-regulation strategies were collected using questionnaires, interviews, and group discussions, in conjunction with an examination of existing literature on related topics. A total of 162 distinct strategies were identified and a preliminary categorization was developed. The authors then conducted a card-sort task in which 24 Ss (aged 17-55 yrs) produced separate classifications of the strategies. The similarity matrix arising from co-occurrence data was subjected to hierarchical cluster analysis and the obtained typology provided independent support for the authors' proposed distinctions between strategies implemented cognitively and behaviorally, between diversion and engagement strategies, and between active distraction and direct avoidance, and for specific lower-level groupings of strategies relating to venting, reappraisal, and seeking social support. Potential refinements and applications of the resulting classification system are considered. _____
Title: Object relations, ego development, and affect regulation in severely addicted substance abusers. Author(s): Santina, Maureen Rose, Columbia U., US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 59(11-B), May 1999. pp. 6077. Publisher: US: Univ Microfilms International. Abstract: Fifty severely addicted substance abusers were compared to 50 nonaddicted controls on measures of object relations, alexythymia, ego development, psychopathology, and experienced level of childhood trauma. Substance abusers were selected from residents at a therapeutic community program, and were all diagnosed with severe chemical dependency. Controls were selected from volunteers who responded to ads placed in supermarkets, and were screened to eliminate subjects who reported substance abuse problems. Subjects were administered the Bell Object Relations and Reality Testing Inventory (BORRTI), the Sentence Completion Test for ego development, the Toronto Alexythymia Scale, the Symptom Checklist-90, and the Childhood Trauma Questionnaire. Data were analyzed using univariate ANOVAs and discriminant analysis to evaluate differences between groups on each variable, and Pearson's r was used to determine correlations between constructs. Substance abusers displayed significant difficulties in several areas: ability to recognize, differentiate and ameliorate emotions; difficulties in forming secure, gratifying, and supportive relationships; chronic feelings of alienation and isolation; and egocentricity. Addicts reported significantly greater levels of experienced childhood trauma and psychopathology than did controls. Alexythymia and experienced level of childhood trauma were highly correlated with object relational deficits across the whole sample. Ego development was weakly correlated with some measures and not correlated with others. It was concluded that object relations theories of addiction received empirical support, and that object relational deficits should be addressed in the treatment of addicts. The high level of experienced childhood trauma reported by addicts raised the issue of prevalence of PTSD symptoms among addicts. It was suggested than PTSD and dissociative symptoms may cause clients to discontinue treatment if it is too confrontive. _____
Title: Revisiting the alcoholic personality: Object relations, affect regulation, and defense styles in alcoholic sibling pairs. Author(s): Vieten, Cassandra, California Inst Integral Studies, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 59(11-B), May 1999. pp. 6108. Publisher: US: Univ Microfilms International. Abstract: Psychodynamic theories suggest that impaired object relations, poor affect regulation, and immature defense styles might contribute to the development of alcoholism and other addictions. Adoption and twin studies show that there is a heritable component to alcoholism as well. By studying families with alcoholic members, this study looked at how object relations, affect regulation, and defense styles might be related to alcoholism and influenced by genetics or family environment. Sibling pairs concordant and discordant for alcoholism responded to the Bell Object Relations and Reality Testing Inventory, the 40-item version of the Defense Styles Questionnaire, and the Affect Regulation Scale. Difference scores were constructed by subtracting the scores of one member of a pair from the other member. Using these difference scores, sibling pairs concordant for alcoholism with sibling pairs discordant for alcoholism were compared. If these variables were related to alcoholism, the discordant sibling pairs should have had higher difference scores than the concordant sibling pairs. The only significant difference observed between pairs was on the individual defense style of Displacement. However, when alcoholics were compared with non-alcoholics across the whole sample, alcoholics had significantly higher scores on the Reality Distortion scale of the Bell Inventory and were more likely to exceed the clinical cutoff score (>60) on the Alienation and Insecure Attachment scales. It may be that these variables are not associated with alcoholism to the degree that was theorized. However, the difference observed in the full sample suggests that there may be a relationship. False sibling pairs were constructed by matching unrelated individuals and maintaining the proportion of pairs concordant and discordant for gender and alcoholism diagnosis. These false sibling pairs were compared to the real sibling pairs, and there were no differences between pairs. The real sibling pairs were no more similar than the false sibling pairs, suggesting that these variables may be more influenced by nonshared environment than by shared environment. Intercorrelations between measures were high, suggesting that these measures tap into a similar dimension of personality, or capture different aspects of personality that are highly correlated with one another. _____
Title: Investigating the link between secrecy and health: Empirical findings and theoretical implications. Author(s): Finkenauer, Catrin, Utrecht U, Dept of Child & Adolescent Studies, Utrecht, Netherlands Source: Gedrag & Gezondheid: Tijdschrift voor Psychologie & Gezondheid , Vol 27(1-2), Apr 1999. pp. 2-7. Publisher: Netherlands: Uitgeverij De Tijdstroom BV. Abstract: Inhibition theory (IT; J. W. Pennebaker, 1989) postulates that the physical work associated with inhibitory behavior (i.e., secrecy) represents an important stress for the body leading to vulnerability to stress-related illnesses. Based on IT, this study tested whether emotional secrecy is negatively associated with (1) physical health, assessed through symptom reporting, and (2) subjective well-being, assessed through ratings of satisfaction with various life domains. The study also examined whether these relations could be explained by Negative Affectivity, as assessed by the Negative Emotionality Scale (A. Tellegen, 1982), or by unhealthy stress-related behaviors such as alcohol or cigarette consumption. Ss were 377 15-75 yr olds. Path analysis revealed that, independent of Negative Affectivity, secrecy negatively affected physical health. No direct impact of secrecy on subjective well-being was observed. Rather, the impact of secrecy on subjective well-being was mediated by physical health. Three theoretical explanations for these results are presented (IT, affect regulation, and opacity of the secret-keeper) and implications for future research on secrecy and physical and subjective well-being are discussed. _____
Title: The relationship between eating disorders and childhood trauma. Author(s): de Groot, Janet, Toronto Hosp, General Div, Toronto, ON, Canada; Rodin, Gary M. Source: Psychiatric Annals, Vol 29(4), Apr 1999. pp. 225-229. Publisher: US: SLACK. Abstract: Reviews the research regarding the relationship between childhood sexual abuse (CSA) and the development of eating disorders. Most evidence suggests that CSA is a risk factor for eating disorders, particularly bulimia nervosa. This relationship is not specific and CSA may also lead to other psychological disturbances, including depression and borderline personality disorder, in the presence of other risk factors. The association of CSA and bulimia nervosa may occur because of common underlying psychopathology, particularly disturbed affect regulation and the tendency to dissociate. Eating disorders and other psychological disturbances are most likely to be associated with CSA when there is also a history of other physical and emotional abuse, and when the family environment is chaotic and unsupportive. It is concluded CSA and other forms of abuse reflect gross empathic failure to respond to the needs of the child. _____
Title: Mood and forbidden foods' influence on perceptions of binge eating. Author(s): Guertin, Tracey L., Purdue U, West Lafayette, IN, US; Conger, Anthony J. Source: Addictive Behaviors, Vol 24(2), Mar-Apr 1999. pp. 175-193. Publisher: US: Elsevier Science. Abstract: This study consists of two experiments investigating the effects of induced mood and food type on perceptions of eating in imagined and real eating situations. A total of 212 female undergraduates representing the continuum of bulimic symptomatology were induced with either elated or depressed moods using a standardized mood-induction procedure. They were then either asked to imagine themselves in a situation with either forbidden or non-forbidden foods (Exp 1) or else were presented with a buffet of forbidden or non-forbidden foods and asked to eat (Exp 2). Ss subsequently reported their perception of their eating behavior (i.e., amount of control, meal rating: from a snack to a binge; and meal feeling: from great to bad). Results revealed limited support for affect regulation models of bulimia nervosa when the participants consumed food, but no support for the theory when they imagined eating. Conversely, forbidden foods were found to influence perceptions in the imagined eating situation, but not when the participants ate. Implications of these results are discussed. _____
Title: A three-pathway psychobiological model of craving for alcohol. Author(s): Verheul, Roel, Amsterdam Inst for Addiction Research, Amsterdam, Netherlands; van den Brink, Wim; Geerlings, Peter Source: Alcohol & Alcoholism, Vol 34(2), Mar-Apr 1999. pp. 197-222. Publisher: United Kingdom: Oxford Univ Press. Abstract: In this review of the psychological, psychophysiological, neurobiological, and psychopharmacological literature on craving for alcohol, it is argued that converging evidence from these disciplines suggests a three-pathway psychobiological model of craving. The three pathways are described as (1) reward craving, or desire for the rewarding or stimulating effects of alcohol; (2) relief craving, or desire for the reduction of tension or arousal; and (3) obsessive craving, or lack of control over intrusive thoughts about drinking. Essential to this model is the appreciation of the role of individual differences in affect regulation strategies or personality styles, conditionability, sensitivity to alcohol's effects, and related dysregulations in distinct neural circuitries or neurotransmitter systems. These factors are of crucial importance to a proper understanding of the nature of craving, its underlying mechanisms, and different manifestations. The putative implications of this three-pathway model for the assessment of alcohol craving, diagnosis and treatment of alcoholism, and future research on craving, are discussed. _____
Title: Stressor appraisals, coping, and post-event outcomes: An investigation of the dimensionality and antecedents of stress-related growth. Author(s): Armeli, Stephen, U Delaware, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 59(9-B), Mar 1999. pp. 5163. Publisher: US: Univ Microfilms International. Abstract: The present study addressed several limitations of previous research on positive outcomes from stressful life events (i.e., stress-related growth). Specifically, conflicting results have been found concerning the factor structure of reports of growth. In addition, few studies have adequately examined stress-related growth within the transactional model of stress and coping. To examine these issues, we surveyed a sample of university alumni and a sample of college students about a recent stressful life event. Using confirmatory analyses, we assessed several competing factor models of Park, Cohen, and Murch's (1996) Stress-Related Growth Scale (SRGS). In addition, we examined how reports of growth varied as a function of individuals' event appraisals and coping strategies. To assess the interactive effects of event appraisals and coping strategies on reports of growth, we used a cluster-analytic approach to identify naturally occurring appraisal and coping profiles. Results for both samples were similar. Confirmatory factor analysis indicated that the SRGS should be regarded as a multidimensional instrument comprised of distinct dimensions such as affect-regulation, treatment of others, self-understanding, religiousness, belongingness, personal strength, optimism, and life satisfaction. The validity of these scales was supported by their differential relationships with various event appraisals, coping strategies, and indices of mental health. Results from the cluster analyses revealed five theoretically relevant event profiles. Differences in reports of growth across these groupings were consistent with several theoretical models of growth. Specifically, overall growth was highest for individuals who reported highly stressful situations, for which they had adequate coping and support resources, and for which they used adaptive coping strategies. In general, these results support a multidimensional perspective of stress-related growth, and indicate that high levels of overall growth are dependent on the interactive effects of event stressfulness, pre-event resources, and adaptive coping. However, these results also suggest that most individuals report some benefits from stressful situations, and certain types of growth (e.g., increases in self-understanding and treating others nicely) might be more of a function of event stressfulness than pre-event resources and coping strategies. _____
Title: The effects of parental bonding, adult attachment, and levels of psychological distress on the ability to discriminate facial expressions of emotion. Author(s): Purvis, Donna Marie, U Southern Mississippi, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 59(8-B), Feb 1999. pp. 4541. Publisher: US: Univ Microfilms International. Abstract: Previous research in the area of attachment and affect regulation has provided support for the notion that attachment is related to the ability to regulate affect and the ability to regulate affect is related to the ability to accurately perceive facial expressions of emotion. The present study investigated the direct and indirect role that attachment plays in discrimination of facial expressions of emotion. There was no support found for the hypothesis that participants with secure attachment styles were better at discriminating facial expressions of emotion. There was also no support found for the hypothesis that individuals with high levels of psychological distress (poor regulators of affect) would perform worse on a facial discrimination task. Finally, there was no support found for the hypothesis that attachment and current levels of psychological distress exhibit interactive effects on the ability to discriminate facial expressions of emotion. Pertinent methodological and statistical issues, however, cast doubt on the reliability of these findings. _____
Title: Examining an affect regulation model of substance abuse in schizophrenia: The role of traits and coping. Author(s): Blanchard, Jack J., U New Mexico, Dept of Psychology, Albuquerque, NM, US; Squires, Daniel; Henry, Tracy; Horan, William P.; Bogenschutz, Michael; Lauriello, John; Bustillo, Juan Source: Journal of Nervous & Mental Disease, Vol 187(2), Feb 1999. pp. 72-79. Publisher: US: Lippincott Williams & Wilkins. Abstract: Examined an affect regulation model of comorbid substance use in schizophrenia with a focus on personality traits and coping. It was hypothesized that maladaptive coping and the traits of negative affect (NA) and disinhibition (DIS), but not trait positive affect (PA), would be associated with greater substance use problems. 39 patients (mean age 42 yrs) with schizophrenia or schizoaffective disorder completed measures of personality traits, coping, and negative consequences associated with substance use. Traits were differentially associated with coping in that NA and DIS, but not PA, were associated with maladaptive coping including the use of drugs and alcohol to cope with stress. Alternatively, PA, but not DIS or NA, was related to adaptive coping strategies. Individuals high in NA and endorsing the use of drugs and alcohol to cope reported the greatest number of negative consequences from substance use. These results are consistent with an affect regulation model of substance use. _____
Title: Such order from confusion sprung: Adaptive competence and affect regulation. (emotion, self regulation, coping). Author(s): Frankel, Carl B., Pacific Graduate School Of Psychology, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 60(6-B), Jan 1999. pp. 3000. Publisher: US: Univ Microfilms International. Abstract: How do people process information to accomplish adaptive competence, that is, to maintain useful order, despite the confusion and unpredictability of the changing circumstances in which they live? Human adaptive competence does not hinge primarily on cognition, despite the substantial advantages cognition confers. Rather, affects appraise adaptive pressures in terms of circumstances' changing contingencies (fact of affect onset), urgency (intensity of affect and rate of affect onset), category ('basic' affect type), harm (intensity of negative valence), benefit (intensity of positive valence) and uncertainty (intensity of anxiety vs. confidence). Affects are real-time control signals in an adaptive control framework, organizing and motivating the avoidance of what are expected to be avoidable negative affects, worst affects first, and the pursuit of what are expected to be attainable positive affects. As long as affects are an adequately accurate appraisal of adaptive pressures, using realized and expected affects favorably to regulate future affects accomplishes adequate adaptive competence. _____
Title: Interior experience within analytic process. Author(s): Slochower, Joyce, City U New York, Hunter Coll, New York, NY, US Source: Psychoanalytic Dialogues, Vol 9(6), 1999. pp. 789-809. Publisher: US: Analytic Press. Abstract: Considers the feeling of interiority as it evolves within the treatment relationship. A capacity to access and sustain one's interiority reflects a sense of personal solidity within which the validity of subjective process and privacy is taken for granted. When this capacity is relatively undeveloped, individuals rely on the "other" (including the analyst) to help them contact, elaborate, or manage their affective experience. Quite paradoxically, the analyst's active investigation of dynamic or intersubjective process may obfuscate rather than clarify this core difficulty. The author suggests 2 alternative approaches to the treatment situation that stand in some tension and yet also complement each other. One emphasizes the "active" investigation of dynamic and dyadic process, wherein the analyst works interpretively and/or around relational issues. The other is organized around the "interior" dimension of the treatment experience, emphasizing the patient's need to develop or manage her affective process in the relative absence of input from the analyst. Two clinical situations are described, one involving a patient needy for affect regulation and the other a patient with affect articulation difficulty. _____
Title: How attachment theory can contribute to the understanding of affective functioning in psychoanalysis. Author(s): Ammaniti, Massimo, Rome U "La Sapienza", Psychology Faculty, Rome, Italy Source: Psychoanalytic Inquiry, Vol 19(5), 1999. Special Issue: Attachment research and psychoanalysis: 2. Clinical implications. pp. 784-796. Publisher: US: Analytic Press. Abstract: Focuses on the implications of attachment theory for psychoanalysis, particularly in understanding affect regulation, experience, and representation within the therapeutic context. A vignette is presented about clinical observations of a 24-yr-old male who suffers from substance dependence and mood disorder. In particular, considering the narrative structure of the patient's communication, the attachment strategies are investigated. It is suggested that mental representations of attachment could be conceived of as a network whose different attachment strategies could be activated by the interaction with others. In the clinical context, the interaction between patient and psychoanalyst can activate the more secure strategies if the patient had in his personal history secure attachment experience and also if it is not the dominant strategy. _____
Title: Representation, symbolization, and affect regulation in the concomitant treatment of a mother and child: Attachment theory and child psychotherapy. Author(s): Slade, Arietta, City Coll of New York, Psychological Ctr, New York, NY, US Source: Psychoanalytic Inquiry, Vol 19(5), 1999. Special Issue: Attachment research and psychoanalysis: 2. Clinical implications. pp. 797-830. Publisher: US: Analytic Press. Abstract: Considers the role of representation, particularly shifts in metacognitive monitoring, reflective functioning, and mentalization in the intensive treatment of a young child and his mother. Topics discussed include representational processes in attachment theory and research; parental representations of the child; metacognition, mentalization, and the mother-child relationship; representation, symbolization, and psychotherapy; dyadic treatment phase; and concomitant treatment phase. _____
Title: Selbstverletzendes Verhalten als dysfunkionale Bewaeltigungsstrategie--Eine Befragung Betroffener im Internet. Translated Title: Self-mutilation behavior as a dysfunctional coping strategy--An internet interview of sufferers. Author(s): Teegen, Frauke , U Hamburg, Psychologisches Institut III, Hamburg, Germany; Wiem, Sabine Source: Zeitschrift fuer Klinische Psychologie, Psychiatrie und Psychotherapie, Vol 47(4), 1999. pp. 386-398. Publisher: Germany: Verlag Ferdinand Schoningh. Abstract: Assessed the characteristics of self-mutilating behavior and factors of vulnerability. Ss were also screened for co-morbid disorders using the following test: the Symptoms Checklist (Revised) (SCL-90-R), the Dissociation Questionnaire (DIS-Q) (Vanderlinden et al, 1993), and the Fragebogen zur Abschaetzung psychosomatischen Krankheitserlebens (FAPK 1,3) (Koch, 1982). Ss were 11 males and 90 females with a mean age of 27 yrs in the US and Europe who took part in an Internet-based study. 74% of the Ss had received psychotherapy, 73% reported traumatic life events, and 65% experienced sexual abuse during childhood. Results show extreme deficits of reality-orientation, affect-regulation, social competence, and a dissociative coping style. _____
Title: Unearthing the seeds of marital distress: What we have learned from married and remarried couples. Author(s): Prado, Lydia M., U Denver, Ctr for Marital & Family Studies, Denver, CO, US; Markman, Howard J. Source: Cox, Martha J. (Ed); Brooks-Gunn, Jeanne (Ed); 1999. Conflict and cohesion in families: Causes and consequences. The advances in family research series. Mahwah, NJ, US: Lawrence Erlbaum Associates, Publishers. pp. 51-85 Abstract: Considers how communication deficits reflecting affect regulation predictive of marital marital breakup are transferred from 1st-marriage to 2nd-marriage relationship systems. The authors' thesis is that it is not the number or content of problem areas that is related to marital dissatisfaction and divorce, but rather how the problem areas and conflicts are managed. They find that, for women, negative affect in the 1st relationship correlated negatively with negative affect in the 2nd marriage. The negative affect of the husbands of these women also correlated negatively with the ex-husband's negative affect. Thus, women appear to be using different strategies for problem solving in their 2nd marriages as compared with their 1st. The possible implications of this finding are discussed. _____
Title: The familiar and the strange: Hopfield network models for prototype-entrained attachment-mediated neurophysiology. Author(s): Smith, Thomas S., U Rochester, Dept of Anthropology, Rochester, NY, US; Stevens, Gregory T.; Caldwell, Sarah Source: Franks, David D. (Ed); Smith, Thomas S. (Ed); 1999. Mind, brain, and society: Toward a neurosociology of emotion, Vol. 5. Social perspectives on emotion. Stamford, CT, US: JAI Press, Inc. pp. 213-245 Abstract: By showing how cognitive, normative, and cultural phenomena are linked to the neurophysiology underlying attachment and social interaction, the authors point in the direction of further modeling the deep biological foundations of social behavior. Hopfield networks provide useful computational frameworks for studying cognitive prototypes. The authors show that Hopfield networks can be useful in studying how behavior and cognition work in tandem, within the context of social interaction, to regulate activity in core brain systems--in effect, controlling comfort and modulating arousal. Topics discussed are: affect regulation; behavioral mechanisms of opioid and arousal regulation; social mechanisms of opioid and arousal regulation; cognitive mechanisms of opioid and arousal regulation; Hopfield networks; a Hopfield network model of arousal modulation; transference and the generalization of attachment; resistance of working models to change later in life; inconsistent, incoherent, or fragmented working models; cognitive dissonance and balance theory; dependency, prototype building and interaction pressures; joint reconstruction of cognitive structures; interaction ritual and normativity; intimacy, talk, transitional objects, and symbolism; and culture and comfort. _____
Title: Affect, imagery, and attachment: Working models of interpersonal affect and the socialization of emotion. Author(s): Magai, Carol, Long Island U, Dept of Psychology, Brooklyn, NY, US Source: Cassidy, Jude (Ed); Shaver, Phillip R. (Ed); 1999. Handbook of attachment: Theory, research, and clinical applications. New York, NY, US: Guilford Press. pp. 787-802 Abstract: The author considers attachment research in conjunction with contemporary theories and research on human emotion. Topics include: comparison of attachment and affect theory constructs; modern developmental and personality psychology: the emotion-attachment interface (affect regulation, internal working models and interpretative biases). _____
Title: The client's perspective: Adult attachment style, gender and the self-reported experience of anxiety, anger and depression. Author(s): Searle, Barbara Schmich, U Notre Dame, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 59(6-B), Dec 1998. pp. 3075. Publisher: US: Univ Microfilms International. Abstract: The purpose of this study was to contribute to the prototypical descriptions of the emotional experience of men and women in each of four adult attachment styles: secure, and three insecure styles, preoccupied, avoidant-fearful, and avoidant-dismissing (Bartholomew & Horrowitz, 1991). The study focused on three emotions, anxiety, anger and depression, which are associated with insecure attachment patterns. In order to investigate the experience of these three emotions, the following aspects of emotionality were addressed in reference to each attachment style and each gender: the extent to which these emotions are trait-like characteristics, the particular aspects of anger and depression which are prominent, and the affect regulation strategies generally used in response to feelings of anxiety, anger and depression. Fifty undergraduate men and 50 undergraduate women were given eight self-report measures: an attachment style questionnaire, standardized measures of the three target emotions, surveys of affect regulation strategies, and a measure of social desirability response set. Data were analyzed by a series of factorial 2 (gender) x 4 (attachment style) MANOVAs and followed up with a series of discriminant analyses. Social desirability was found to have a differential effect within attachment categories, and adjusted scores were created to compensate for this effect. Secure subjects were found to be less anxious than the avoidant-fearful, have less inwardly directed anger than the avoidant-dismissing and to be less depressed than each of the three insecurely attached groups. The insecurely attached groups were found to experience different forms of depression. The depression of the preoccupied is characterized by sad mood and instrumental helplessness, the depression of the avoidant-fearful by guilt and social introversion, the depression of the avoidant-dismissing by low energy and social introversion. Greater gender differences were found in affect regulation strategies than in the experience of the target emotions. Gender differences within attachment categories were non-significant. These results provide information for a descriptive emotional profile of each attachment group, potentially useful in the counseling situation for making appropriate affective interventions and promoting secure emotionality. _____
Title: The influence of working models of attachment on emotion regulation. Author(s): Flack, Amy Marie, California School of Professional Psychology - Berkeley/alameda, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 59(6-B), Dec 1998. pp. 3092. Publisher: US: Univ Microfilms International. Abstract: The purpose of this study was to examine how working models of attachment are associated with the ways in which young adults modulate their emotions. In a sample of 64 ethnically diverse community college students between the ages of 18 and 35 years, three kinds of working models of attachment were assessed with the Adult Attachment interview: Dismissing of attachment, Secure, and Preoccupied with attachment. Affect regulation was measured using the 40-item Affect Intensity Measure in addition to three subfactors derived from a factor analysis of this measure: positive affectivity, negative reactivity, and negative intensity. Gender was also examined with regard to overall affect intensity (positive and negative emotions combined), and with respect to the three subfactors that separate positive from negative intensity. The first hypothesis was supported; women reported experiencing greater amounts of affect intensity than males. Women were also found to report more negative reactivity than males in the present study. Given these results, gender was used as a covariate in the remaining analyses. Results partially supported the second hypothesis; participants with Dismissing working models of attachment reported significantly less affect intensity in their daily lives than those with Secure working models of attachment. However, Dismissing individuals did not report experiencing less intense affect than Preoccupied individuals. The third hypothesis was not supported in the present study. Participants with Preoccupied working models of attachment did not report experiencing greater levels of affect intensity than Secure or Dismissing individuals. Rather, those with Preoccupied attachment styles were found to report significantly less affect intensity in their daily lives than Secure individuals, and were not found to be different from Dismissing individuals. No differences existed between attachment styles when affect intensity was divided into positive and negative factors. These findings reflect the notion that individuals with Secure working models of attachment can safely experience intense emotions, while both Dismissing and Preoccupied individuals limit the experience of their emotions. The results are discussed in terms of possible variations in the manifestation of defense mechanisms designed to limit emotional experience that are particular to Dismissing and Preoccupied individuals. _____
Title: Perceived relatedness and self-regulatory motivations in the adjustment of maltreated children. Author(s): River, Vincent Bryan, U Texas at Austin, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 59(6-B), Dec 1998. pp. 3099. Publisher: US: Univ Microfilms International. Abstract: 42 moderately to severely maltreated, inner city children (MCs) were assessed for perceptions of relatedness, self-regulatory motivations and symptomatology. In normal development, middle childhood is seen as a time of increasing internal organization, partly based upon quality of earlier attachment experience, and leading to increased self-regulation and autonomy. Study of MCs permits analysis of the association between relationship disturbance and self-regulatory development. While links from relationship disturbance to dysregulation are hypothesized, little is known about particular developmental pathways MCs may take. Self-reported relatedness feelings and self-regulatory motivations were predicted to yield valid indices of developmental attainments in attachment-like relatedness and self-regulation. Relative immaturity on both was expected for MCs, together with greater emotional dysregulation. Overall, trends in most expected directions were observed, but significant effects were mild. As expected, relatedness disturbance differentiated better and poorer affect regulation. Particular insecure relatedness styles did correspond with styles of affective dysregulation. Few MCs were found capable of forming a secure attachment with another caregiver if their primary attachment to mother was insecure. Those who did were not significantly better adjusted than insecure children. The expected association was found between relatedness and self-regulatory development. However, some insecure children showed greater than expected self-regulation development and more resilient adaptation. Relatedness and self-regulatory development impacted different aspects of functioning. Negative perceptions of relatedness with mother most strongly predicted affective dysregulation. Self-regulatory developmental level most strongly predicted variations in behavioral disturbance and global adjustment. Findings support the ecological-transactional model of abuse effects (Cicchetti & Lynch, 1995) in which internalization of relationship models mediates, but does not determine, self-regulatory development. Secondly, more mature self-regulatory development appears to serve a mild buffering role in adjustment of MCs. By middle childhood, self-regulation style more strongly predicted social adaptation than did quality of attachment/relatedness. However, even better self-regulated MCs did not function resiliently at levels comparable with normal children. This study's mild findings point to the complex interrelations involved in studying abuse impact on the development of relatedness and self-regulation. However, child self-report measures seem sufficiently robust to differentiate resilient MCs from those with self-regulatory disturbance. _____
Title: Why should we lower our defenses about defense mechanisms? Author(s): Norem, Julie K., Wellesley Coll, Dept of Psychology, Wellesley, MA, US Source: Journal of Personality, Vol 66(6), Dec 1998. Special Issue: Defense mechanisms in contemporary personality research. pp. 895-917. Publisher: US: Blackwell Publishers. Abstract: Personality and social psychologists already use ideas that are closely related to defense mechanisms, but few of our paradigms include extensive theoretical or empirical treatment of such mechanisms. Yet defense mechanisms focus on negative affect and protection of the self, and many of the controversies, issues, and impasses contemporary researchers confront also concern negative affect and self-protection. This article discusses whether we might find systematic consideration of defense mechanisms and defensive processing to be broadly useful across several related areas of personality and social psychology in which the relationships between self and affect are implicated. Areas considered include positive illusions and adaptation, the interpretation of reports of negative affect, and related concepts from the coping, self-regulation, affect regulation, and goals literature. Thinking about defense mechanisms would seem to have both specific value for sharpening our understanding of different possible interpretations of our data, and broad heuristic value for thinking about personality integration and social behavior. _____
Title: Defenses, personality structure, and development: Integrating psychodynamic theory into a typological approach to personality. Author(s): Weinberger, Daniel A., Metro Health Medical System, Family Achievement Clinic, Beachwood, OH, US Source: Journal of Personality, Vol 66(6), Dec 1998. Special Issue: Defense mechanisms in contemporary personality research. pp. 1061-1080. Publisher: US: Blackwell Publishers. Abstract: Psychodynamic theory does not conceptualize motivated unconscious defenses primarily in terms of individual traits. Rather, a person's mechanisms of defense are understood in terms of his or her personality structure and level of psychological development. This paper outlines the way in which this perspective has been integrated into a configural approach to personality assessment. The six-group typology based on the Weinberger Adjustment Inventory (WAI) identifies higher-order personality organization through the intersection of self-reported high/low distress and high/moderate/low self-restraint. The framework incorporates a developmental perspective by assessing affect regulation in conjunction with the internalization of self-regulatory controls. The primary defenses of prototypic members of each of the six groups are highlighted, and hypothesized links to personality traits, stages of ego development, attachment styles, and proneness to specific personality disorders are discussed. _____
Title: Negative affectivity as a mediator of the association between adult attachment and marital satisfaction. Author(s): Davila, Joanne, State U New York, Coll at Buffalo, Dept of Psychology, Buffalo, NY, US; Bradbury, Thomas N.; Fincham, Frank Source: Personal Relationships, Vol 5(4), Dec 1998. pp. 467-484. Publisher: United Kingdom: Blackwell Publishers. Abstract: Although the association between adult attachment and marital satisfaction is well documented, research has not examined processes by which attachment affects satisfaction. Drawing on attachment-oriented conceptualizations of affect regulation, the present study tested the hypothesis that negative affectivity mediates the association between attachment and marital satisfaction. Data from two samples of married couples were used to test the hypothesis. In both samples, negative affectivity mediated the association between some aspects of attachment insecurity and marital dissatisfaction, although attachment also retained a direct association with marital satisfaction in a number of cases. Results are discussed in terms of attachment-oriented conceptualizations of the function of negative emotion in marriage, and the empirical and conceptual overlap between attachment and negative affectivity. _____
Title: Infant affect and affect regulation during the still-face paradigm with mothers and fathers: The role of infant characteristics and parental sensitivity. Author(s): Braungart-Rieker, Julia, U Notre Dame, Dept of Psychology, Notre Dame, IN, US; Garwood, Molly Murphy; Powers, Bruce P.; Notaro, Paul C. Source: Developmental Psychology, Vol 34(6), Nov 1998. pp. 1428-1437. Publisher: US: American Psychological Assn. Abstract: This laboratory study examined mothers' and fathers' sensitivity during face-to-face interactions with their infants as well as infants' affective and regulatory responses during mother-infant versus father-infant still face (SF). The degree to which infant gender and temperament as well as parental sensitivity predicted SF responses was also examined. Participants included 94 healthy, primarily White, middle-class 4-month-olds and their parents. Results indicated that mothers and fathers were equally sensitive toward their infants. Infants' affect and regulatory behaviors were also significantly stable across mother- and father-infant SF situations, although several differences in mean levels of regulation emerged. Finally, the extent to which exogenous and endogenous variables predicted infant SF responses differed as a function of which affect or regulatory variable was being examined and with which parent the infant was experiencing SF. _____
Title: Anxiety- and gender-related differences in the regulation of worrisome thoughts: A social information processing perspective. Author(s): Williams, Laura Lynn, The Ohio State U, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 59(5-B), Nov 1998. pp. 2443. Publisher: US: Univ Microfilms International. Abstract: The present study examined children's reported frequency and efficacy of strategies for regulating their worrisome thoughts in response to a description of social conflict (fight with a friend) and achievement (studying for a test) vignettes. The 195 children were in sixth through eighth grades; they completed the State Trait Anxiety Inventory for Children and the Regulation of Children's Worries Questionnaire (RCW). Children who endorsed higher levels of trait anxiety generally reported using maladaptive affect regulation strategies significantly more often than did participants with lower scores on trait-anxiety, and they rated these responses as significantly more effective to improve their negative mood. Furthermore, children who rated situations as more worrisome and more difficult to control generally reported using affect regulation strategies significantly more often than did children with lower ratings of situational worry and controllability, and they rated these responses as significantly more effective in improving their negative mood. High trait-anxious girls rated internalizing, maladaptive strategies as more effective than did low trait-anxious girls. Compared to boys, girls generally rated seeking social support more frequently and as more efficacious to regulate worrisome thoughts. Several directions for future research are suggested. _____
Title: Temperamental fear, initial reaction, and regulation in a social referencing situation. Author(s): Blackford, Jennifer Urbano, Vanderbilt U, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 59(3-B), Sep 1998. pp. 1388. Publisher: US: Univ Microfilms International. Abstract: Two studies were performed to investigate the relations between temperamental fear, initial reaction, and regulation in a social referencing situation. Study 1 examined the structure of temperamental fear in children 13-17 months of age. Structural equations modeling was performed on the items from the Infant Behavior Questionnaire (Rothbart, 1981). Temperamental fear was best represented by two context-specific, orthogonal subtypes-social fear and non-social fear. Study 2 examined the context-specific relation between temperamental fear, initial reaction, and regulation. A model approach was used to test for relations among each of the sub-types of temperamental fear, initial reaction, and regulation in two different contexts (social/non-social). There was no evidence for context-specific relations among temperamental fear, initial reaction, and regulation. However, an interesting model did for the non-social context. Social fear predicted affect regulation and the relation was mediated by initial affect response. _____
Title: Neuropsychological sequelae of cerebellar tumor resection in children. Author(s): Levisohn, Alyssa Sharon, Boston U, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 59(3-B), Sep 1998. pp. 1407. Publisher: US: Univ Microfilms International. Abstract: Studies of survivors of childhood cerebellar tumors reveal long-term deficits in multiple cognitive and affective functions after surgery and radiation treatment. Investigation of the effects of the lesion independent of the known deleterious effects of radiation is important for understanding the role of the cerebellum in cognitive and affective development as well as for informing treatment and rehabilitation strategies. If the cerebellar contribution to cognition and affect is significant, then damage to this structure in a child may potentially impact upon a whole range of psychological processes, either as immediate consequence, and as these processes fail to develop normally later on. The present study aimed to investigate the effect of cerebellar tumor resection on neuropsychological functioning in the absence of radiation treatment. There were three specific hypotheses: (1) Localized cerebellar damage is associated with a range of cognitive deficits; (2) Damage to the cerebellar vermis is associated with disrupted affect regulation; (3) Cognitive and affective deficits are more apparent in older than younger children. Cognitive, motor, affective, and neuroanatomical imaging data were available from 19 children. Deficits in visuospatial function, language, and verbal memory were common and were dissociable from deficits in motor function or affect, indicating distinct cerebellar substrates. Vermis lesions were associated with affect dysregulation. All types of deficits were more apparent in older than younger children. The functional domains of cognition in which older children had difficulty, such as initiation and organization of speech and visuospatial skills, are normally not yet developed in very young children. The results show that neuropsychological changes occur with cerebellar tumor resection even in the absence of radiation treatment. Clinically, it is important to recognize that circumscribed cerebellar damage could produce problems with visuospatial function, language, memory, or affect regulation. Consideration of the patient's age and specific lesion site may aid our understanding of the great variability in neurobehavioral outcomes in these children. Finally, in the ongoing debate regarding the role of the cerebellum in non-motor mental processes, the results of the present study indicate a significant contribution of this structure to cognition and the regulation of affect. _____
Title: Conflict and aggression in couples therapy: A self psychological vantage point. Author(s): Livingston, Martin S., Private Practice, New York, NY, US Source: Family Process, Vol 37(3), Fal 1998. pp. 311-321. Publisher: US: Family Process. Abstract: The intent of this article is to correct the misconception that self psychology fails to deal with conflict and aggression. Self psychology does, in fact, have a definite view of conflict and aggression that leads to clear implications for treatment. The author focuses on the applicability of these ideas to psychoanalytic work with couples. Clinical material are presented to illustrate the application of these concepts. Conflict and aggression are not seen as an interference or resistance to be handled or removed; the occurrence of conflict and aggression is viewed as an opportunity to address underlying issues. The aim of technique thus becomes the deepening of therapeutic process. The key issue is not the management of conflict and rage; it is the strengthening of functions of affect regulation, containment, and self-cohesion. The emphasis is on the underlying narcissistic vulnerability of both members of the couple, especially during times of conflict. The therapist's attunement to underlying vulnerability is an important aspect of a self-psychological approach. _____
Title: Darth Vader vs. Superman: Aggression and intimacy in two preadolescent boys' groups. Author(s): Braucher, David, Jewish Board of Family & Children's Services, Bronx, NY, US Source: Journal of Child & Adolescent Group Therapy, Vol 8(3), Sep 1998. pp. 115-134. Publisher: US: Kluwer Academic/Plenum Publishers. Abstract: This article chronicles the author's experience with 2 preadolescent boys' groups run over the course of one academic year at an out-patient mental health clinic. The boys in the groups suffered a variety of traumas and displayed a range of acting-out behaviors. The purpose of the groups was to help the members develop better affect regulation and a tolerance for intimacy. Through their natural inclination toward peer relations, they learned to moderate their aggressive behavior and self-concept in order to satisfy frustrated dependency needs in an age appropriate manner. Both groups developed therapeutic cultures that evolved from the boys' common behavior problems. As the boys felt accepted by their group, they learned self-acceptance and integrated previously disowned parts of themselves. Their ability for self-observation increased, and they practiced a variety of coping behaviors. Their relationships inside and outside of the group became more satisfying, decreasing the amount of their frustration and hostility.
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