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Psychological and Physiological Trauma Research
Seize Your Journeys
_______________________ Traumatic stress is found in many competent, healthy, strong, good people. No one can completely protect themselves from traumatic experiences. Many people have long-lasting problems following exposure to trauma. Up to 8% of persons will have PTSD at some time in their lives. People who react to traumas are not going crazy. What is happening to them is part of a set of common symptoms and problems that are connected with being in a traumatic situation, and thus, is a normal reaction to abnormal events and experiences. Having symptoms after a traumatic event is NOT a sign of personal weakness. Given exposure to a trauma that is bad enough, probably all people would develop PTSD. By understanding trauma symptoms better, a person can become less fearful of them and better able to manage them. By recognizing the effects of trauma and knowing more about symptoms, a person will be better able to decide about getting treatment. _______________________
FUNCTIONAL NEUROANATOMY In order to best understand this atlas it is important to have a sense of the functional neuroanatomy of the brain. Over the next several pages there is a brief summary of the 5 major brain systems that relate to behavior, along with the general location seen on SPECT of these areas.
The Deep Limbic System
Functions
Problems
The Basal Ganglia System
Functions
Problems
The Prefrontal Cortex
Functions
Problems
The Cingulate Gyrus
Problems
The Temporal Lobes
Functions
Problems
Non-dominant Side (usually the right)
Secure Attachments as a Defense Against Trauma “All people mature and thrive in a social context that has profound effects on how they cope with life’s stresses. Particularly early in life, the social context plays a critical role in fuffering an individual against stressful situations, and in building the psychological and biological capacities to deal with further stresses. The primary function of parents can be thought of as helping children modulate their arousal by attuned and well-timed provision of playing, feeding, comforting, touching, looking, cleaning, and resting—in short, by teaching them skills that will gradually help them modulate their own arousal. Secure attachment bonds serve as primary defenses against trauma-induced psychopathology in both children and adults (Finkelhor & Browne, 1984). In children who have been exposed to severe stressors, the quality of the parental bond is probably the single most important determinant of long-term damage (McFarlane, 1988).” van der Kolk, Bessel, Alexander C. McFarlane, and Lars Weisaeth, eds. 1996. Traumatic stress: The effects of overwhelming experience on mind, body, and society. New York and London: Guilford Press. .p. 185 _______________________
Sleep Disorders
“The sleep disorders are organized into four major sections according to presumed etiology. Primary Sleep Disorders are those in which none of the etiologies listed below (i.e., another mental disorder, a general medical condition, or a substance) is responsible. Primary Sleep Disorders are presumed to arise from endogenous abnormalities in sleep-wake generating or timing mechanisms, often complicated by conditioning factors. Primary Sleep Disorders in turn are divided into Dyssomnias (characterized by abnormalities in the amount, quality, or timing of sleep) and Parasomnias (characterized by abnormal behavioral or physiological events occurring in association with sleep, specific sleep stages, or sleep-awake transitions). Sleep Disorder Related to Another Mental Disorder involves a prominent complaint of sleep disturbance that results from a diagnosable mental disorder (often a Mood Disorder or Anxiety Disorder) but that is sufficiently severe to warrant independent clinical attention. Presumably, the pathophysiological mechanisms responsible for the mental disorder also affect sleep-awake regulation. Sleep Disorder Due to a General Medical Condition involves a prominent complaint of sleep disturbance that results from the direct physiological effects of a general medical condition on the sleep-wake system. Substance-Induced Sleep Disorder involves prominent complaints of sleep disturbance that result from the concurrent use, or recent discontinuation of use, of a substance (including medications). That systematic assessment in individuals who present with prominent complaints of sleep disturbance includes an evaluation of the specific type of sleep complaint and a consideration of concurrent mental disorders, general medical conditions, and substance (including medication) use that may be responsible for the sleep disturbance. Five distinct sleep stages can be measured by polysomnography: rapid eye movement (REM) sleep and four stages of non-rapid eye movement (NREM) sleep (stages 1, 2, 3, and 4). Stage 1 NREM sleep is a transition from wakefulness to sleep and occupies about 5% of time spent asleep in healthy adults. Stage 2 NREM sleep, which is characterized by specific EEG waveforms (sleep spindles and K complexes), occupies about 50% of time spent asleep. Stages 3 and 4 NREM sleep (also known collectively as slow-wave sleep) are the deepest levels of sleep and occupy about 10%-20% of sleep time. REM sleep, during which the majority of typical storylike dreams occur, occupies about 20%-25% of total sleep. These sleep stages have a characteristic temporal organization across the night. NREM stages 3 and 4 tend to occur in the first one-third to one-half of the night and increase in duration in response to sleep deprivation. REM sleep occurs cyclically throughout the night, alternating with NREM sleep about every 80-100 minutes. REM sleep periods increase in duration toward the morning. Human sleep also varies characteristically across the life span. After relative stability with large amounts of slow-wave sleep in childhood and early adolescence, sleep continuity and depth deteriorate across the adult age range. This deterioration is reflected by increased wakefulness and stage 1 sleep and decreased stages 3 and 4 sleep. Because of this, age must be considered in the diagnosis of a Sleep Disorder in any individual. Polysomnography is the monitoring of multiple electrophysiological parameters during sleep and generally includes measurement of EEG activity, electroculographic activity, and electromyographic activity. Additional polysomnographic measures may include oral or nasal airflow, respiratory effort, chest and abdominal wall movement, oxyhemoglobin saturation, or exhaled carbon dioxide concentration; these measures are used to monitor respiration during sleep and to detect the presence and severity of sleep apnea. Measurement of peripheral electromyographic activity may be used to detect abnormal movements during sleep. Most polysomnographic studies are conducted during the person’s usual sleeping hours—that is, at night. However, daytime polysomnographic studies also are used to quantify daytime sleepiness. The most common daytime procedure is the Multiple Sleep Latency Test (MSLT), in which the individual is instructed to lie down in a dark room and not resist falling asleep; this protocol is repeated fives times during the day. Sleep latency (the amount of time required to fall asleep) is measured on each trial and is used as an index of physiological sleepiness. The converse of the MSLT is also used: In the Repeated Test of Sustained Wakefulness (RTSW), the individual is placed in a quiet, dimly lit room and instructed to remain awake; this protocol is repeated several times during the day. Again, sleep latency is measured, but is it used here as an index of the individual’s ability to maintain wakefulness. Standard terminology for polysomnographic measures is used throughout the test in this section. Sleep continuity refers to the overall balance of sleep and wakefulness during a night of sleep. “Better” sleep continuity indicates consolidated sleep and wakefulness; “worse” sleep continuity indicates disrupted sleep with more wakefulness. Specific sleep continuity measures include sleep latency—the amount of time required to fall asleep (expressed in minutes); intermittent wakefulness—the amount of awake time after initial sleep onset (expressed in minutes); and sleep efficiency—the ratio of actual time spent asleep to time spent in bed (expressed as a percentage, with higher numbers indicating better sleep continuity). Sleep architecture refers to the amount and distribution of specific sleep stages. Sleep architecture measures include absolute amount of REM sleep and each NREM sleep stage (in minutes), relative amount of REM seep and NREM sleep stages (expressed as a percentage of total sleep time), and latency between sleep onset and the first REM period (REM latency). The text for each of the Sleep Disorders contains a section describing its relationship to corresponding disorders in The International Classification of Sleep Disorders: (ICSD) diagnostic and Coding Manual, published in 1990 by the American Sleep Disorders Association. _________________
Substance Dependence “Features The essential feature of Substance Dependence is a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues use of the substance despite significant substance-related problems. There is a pattern of repeated self-administration that can result in tolerance, withdrawal, and compulsive drug-taking behavior. A diagnosis of Substance Dependence can be applied to every class of substances except caffeine. The symptoms of Dependence are similar across the various categories of substances, but for certain classes some symptoms are less salient, and in a few instances not all symptoms apply (e.g., withdrawal symptoms are not specified for Hallucinogenic Dependence). Although not specifically listed as a criterion item, “craving” (a strong subjective drive to use the substance) is likely to be experienced by most (if not all) individuals with Substance Dependence. Dependence is defined as a cluster of three or more of the symptoms listed below occurring at any time in the same 12-month-period. Tolerance (Criterion 1) is the need for greatly increased amounts of the substance to achieve intoxication (or the desired effect) or a markedly diminished effect with continued use of the same amount of the substance. The degree to which tolerance develops varies greatly across substances. Furthermore, for a specific drug, varied degrees of tolerance may develop for its different central nervous system effects. For example, for opioids, tolerance to respiratory depression and tolerance to analgesia develop at different rates. Individuals with heavy use of opioids and stimulants can develop substantial (e.g., 10-f0ld) levels of tolerance, often to a dosage that would be lethal to a nonuser. Alcohol tolerance can also be pronounced, but is usually less extreme than for amphetamine. Many individuals who smoke cigarettes consume more than 20 cigarettes a day, an amount that would have produced symptoms of toxicity when they first started smoking. Individuals with heavy use of cannabis or phencyclidine (PCP) are generally not aware of having developed tolerance (although it has been demonstrated in animal studies and in some individuals). Tolerance may be difficult to determine by history alone when the substance used is illegal and perhaps mixed with various diluents or with other substances. In such situations, laboratory tests may be helpful (e.g., high blood levels of the substance coupled with little evidence of intoxication suggest that tolerance is likely). Tolerance must also be distinguished from individual variability in the initial sensitivity to the effects of particular substances. For example, some first-time drinkers show very little evidence of intoxication with three or four drink, whereas others of similar weight and drinking histories had slurred speech and incoordination. Withdrawal (Criterion 2a) is a maladaptive behavioral change, with physiological and cognitive concomitants, that occurs when blood or tissue concentrations of a substance decline in an individual who had maintained prolonged heavy use of the substance. After developing unpleasant withdrawal symptoms, the persons is likely to take the substance to relieve or to avoid those symptoms (Criterion 2b), typically using the substance throughout the day beginning soon after awakening. Withdrawal symptoms, which are generally the opposite of the acute effects of the substance, vary greatly across the calluses of substances, and separate criteria sets for Withdrawal are provided for most of the classes. Marked and generally easily measured physiological signs of withdrawal are common with alcohol, opioids, and sedatives, hypnotics, and anxiolytics. Withdrawal signs and symptoms are often present, but may be less apparent, with stimulants such as amphetamines and cocaine, as well as with nicotine and cannabis. No significant withdrawal is seen even after repeated use of hallucinogens. Withdrawal from phencyclidine and related substances has not yet been described in humans (although it has been demonstrated in animals). Neither tolerance nor withdrawal is necessary or sufficient for a diagnosis of Substance Dependence. However, for most classes of substances, a past history of tolerance or withdrawals is associated with a more severe clinical course (i.e., an earlier onset of Dependence, higher levels of substance intake, and a greater number of substance-related problems). Some individuals (e.g., those with Cannabis Dependence) show a pattern of compulsive use without obvious signs of tolerance or withdrawal. Conversely, some general medical and postsurgical patients without Opioid Dependence may develop a tolerance to prescribed opioids and experience withdrawal symptoms without showing any signs of compulsive use. The specifiers With Physiological Dependence and Without Physiological Dependence are provided to indicate the presence or absence of tolerance or withdrawal. The following items describe the pattern of compulsive substance use that is characteristic of Dependence. The individual may take the substance in larger amounts or over a longer period than was originally intended (e.g., continuing to drink until severely intoxicated despite having set a limit of only one drink) (Criterion 3). The individual may express a persistent desire to cut down or regulate substance use. Often, there have been many unsuccessful efforts to decrease or discontinue use (Criterion 4). The individual may spend a great deal of time obtaining the substance, using the substance, or recovering from its effects (Criterion 5). In some instances of Substance Dependence, virtually all of the person’s daily activities revolve around the substance. Important social, occupational, ore recreational activities may be given up or reduced because of substance use (Criterion 6). The individual may withdraw from family activities and hobbies in order to use the substance in private or to spend more time with substance-using friends. Despite recognizing the contributing role of the substance to a psychological or physical problem (e.g., sever depressive symptoms or damage to organ systems), the person continues to use the substance (Criterion 7). The key issue in evaluating this criterion is not eh existence of the problem, but rather the individual’s failure to abstain from using the substance despite having evidence of the difficulty it is causing.
Specifiers Tolerance and withdrawal may be associated with a higher risk for immediate general medical problems and a higher relapse rate. Specifiers are provided to note their presence or absence: With Physiological Dependence. This specifier should be used when Substance Dependence is accompanied by evidence of tolerance (Criterion 1) or withdrawal (Criterion 2). Without Physiological Dependence. This specifier should be used when there is no evidence of tolerance (Criterion 1) or withdrawal (Criterion 2). In these individuals, Substance Dependence is characterized by a pattern of compulsive use (at least three items from Criteria 3-7).”
Diagnostic and Statistical Manual of Mental Disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. P. 193-195.
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PTSD, DID, and EMDR Posttraumatic Stress Disorder "The essential feature of Posttraumatic Stress Disorder us the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criteria A1). The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2). The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F). Traumatic events that are experienced directly include, but are not limited to, military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness. For children, sexually traumatic events may include developmentally inappropriate sexual experiences without threatened or actual violence or injury. Witnessed events include, but are not limited to, observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster or unexpectedly witnessing a dead body or body parts. Events experienced by others that are learned about include, but are not limited to, violent personal assault, serious accident, or serious injury experienced y a family member or a close friend; learning about the sudden, unexpected death of a family member or a close friend; or learning that one's child has a life threatening disease. The disorder may be especially sever or long lasting when the stressor is of human design (e.g., torture, rape). the likelihood of developing this disorder may increase as the intensity of and physical proximity to the stressor increase. The traumatic event can be reexperienced in various ways. Commonly the person has recurrent and intrusive recollections of the event (Criterion B1) or recurrent distressing dreams during which the event can be replayed or otherwise represented (Criterion B2). In rare instances, the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at that moment (Criterion B3). These episodes, often referred to as "flashbacks," are typically brief but can be associated with prolonged distress and heightened arousal. Intense psychological distress (Criterion B4) or physiological reactivity (Criterion B5) often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g., anniversaries of the traumatic event; cold, snowy weather or uniformed guards for survivors of death camps in cold climates; hot, humid weather for combat veterans of the South Pacific; entering any elevator for an woman who was reaped in an elevator). Stimuli associated with the trauma are persistently avoided. The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event (Criterion C1) and to avoid activities, situations, or people who around recollections of it (Criterion C2). This avoidance of reminders may include amnesia for an important aspect of the traumatic event (Criterion C3). Diminished responsiveness to the external work, referred to as "psychic numbing" or "emotional anesthesia," usually begins soon after the traumatic event. The individual may complain of having markedly diminished interest or participation in previously enjoyed activities (Criterion C4), of feeling detached or estranged from other people (Criterion C5), or of having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness and sexuality) (Criterion C6). The individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span) (Criterion C7). The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma. these symptoms may include difficulty falling or staying asleep that may be to recurrent nightmares during which the traumatic event is relived (Criterion D1), hypervigilance (Criterion D4), and exaggerated startle response (Criterion D5). Some individuals report irritability or outburst of anger (Criterion D2) or difficulty concentrating or completing tasks (Criterion D3)."
Dissociative Identity Disorder (DID) "The essential feature of Dissociative identity Disorder is the presence of two or more distinct identities or personality states (Criterion A) that recurrently take control of behavior (Criterion B). There is an inability to recall important personal information, the extent of which is too great to be explained by ordinary forgetfulness (Criterion C). The disturbance is not due tot eh direct physiological effects of a substance or a general medical condition (Condition D.). In children, the symptoms cannot be attributed to imaginary playmates or other fantasy play. Dissociative Identity Disorder reflects a failure to integrate various aspects of identity, memory, and consciousness. Each personality state may be experienced as if it has a distinct personal history, self-image, and identity, including a separate name. Usually there is a primary identity that carries the individual's given name and is passive, dependent, guilty, and depressed. The alternate identities frequently have different names and characteristics that contrast with the primary identity (e.g., are hostile, controlling, and self-destructive). Particular identities may emerge in specific circumstances and may differ in reported age and gender, vocabulary, general knowledge, or predominant affect. Alternate identities are experienced as taking control in sequence, ore at the expense of the other, and may deny knowledge of one another, be critical of one another, or appear to be in open conflict. Occasionally, one or more powerful identities allocate time to the others. Aggressive or hostile identities may at times interrupt activities or place the others in uncomfortable situations. Individuals with this disorder experience frequent gaps in memory for personal history, both remote and recent. The amnesia is frequently asymmetrical. The more passive identities tend to have more constricted memories, whereas the more hostile, controlling, or "protector" identities have more complete memories. An identity that is not in control may nonetheless gain access to consciousness by producing auditory or visual hallucinations (e.g., a voice giving instructions). Evidence of amnesia may be uncovered by reports from others who have witnessed behavior that is disavowed by the individual or by the individual's own discoveries (e.g., finding items of clothing at home that the individual cannot remember having bought). There may be loss of memory not only for recurrent periods of time, but also an overall loss of biographical memory for some extended period of childhood, adolescence, or even adulthood. Transitions among identities are often triggered by psychosocial stress. The time required to switch from one identity to another is usually a matter of seconds, but, less frequently, may b gradual. Behavior that may be frequently associated with identity switches include rapid blinking, facial changes, changes in voice or demeanor, or disruption in the individual's train of thoughts. The number of identities reported ranges from 2 to more than 100. Half of reported cases include the individuals with 10 or fewer identities." Diagnostic and Statistical Manual of Mental Disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. EMDR Eye Movement Desensitization and Reprocessing "Eye Movement Desensitization and Reprocessing (EMDR)1 integrates elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies2. EMDR is an information processing therapy and uses an eight phase approach. During EMDR1 the client attends to past and present experiences in brief sequential doses while simultaneously focusing on an external stimulus. Then the client is instructed to let new material become the focus of the next set of dual attention. This sequence of dual attention and personal association is repeated many times in the session. Eight Phases of Treatment The first phase is a history taking session during which the therapist assesses the client's readiness for EMDR and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviors that will be needed by the client in future situations. During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client is then able to use stress reducing techniques whenever necessary, during or between sessions. However, one goal is not to need these techniques once therapy is complete. In phase three through six, a target is identified and processed using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if available), a negative belief about self, related emotions and body sensations. The client also identifies a preferred positive belief. The validity of the positive belief is rated, as is the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his/her eyes back and forth following the therapist's fingers as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client. Athough eye movements are the most commonly used external stimulus, therapists often use auditory tones, tapping, or other types of tactile stimulation. The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens. After this, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client's report the clinician will facilitate the next focus of attention. In most cases a client-directed association process is encouraged. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing. When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements. After several sets, clients generally report increased confidence in this positive belief. The therapist checks with the client regarding body sensations. If there are negative sensations, these are processed as above. If there are positive sensations, they are further enhanced. In phase seven, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the self-calming activities that were mastered in phase two. The next session begins with phase eight, re-evaluation of the previous work, and of progress since the previous session. EMDR treatment ensures processing of all related historical events, current incidents that elicit distress, and future scenarios that will require different responses. The overall goal is produce the most comprehensive and profound treatment effects in the shortest period of time, while simultaneously maintaining a stable client within a balanced system. After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioral and personal change, which are further enhanced with standard EMDR procedures." www.emdr.com __________________ Major Depressive Disorder “Diagnostic Features The essential feature of Major Depressive Disorder is a clinical course that is characterized by one or more Major Depressive Episodes without a history of Manic, Mixed, or Hypomanic Episodes (Criteria A and C). Episodes of Substance-Induced Mood Disorder (due to the direct physiological effects of a drug of abuse, a medication, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Major Depressive Disorder. In addition, the episodes must not be better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified (Criterion B). The fourth digit in the diagnostic code for Major Depressive Disorder indicates whether it is a Single Episode (used only for first episodes) or Recurrent. It is sometimes difficult to distinguish between a single episode with waxing and waning symptoms and two separate episodes. For purposes of this manual, an episode is considered to have ended when the full criteria for eh Major Depressive Episode have not been met for at least 2 consecutive months. During this 2-month period, there is either complete resolution of symptoms or the presence of depressive symptoms that no longer meet the full criteria for a Major Depressive Episode (In Partial Remission). The fifth digit in the diagnostic code for Major Depressive Disorder indicates the current state of the disturbance. If the criteria for a Major Depressive Disorder are met, the severity of the episode is notes as Mild, Moderate, Severe Without Psychotic Features, or Severe With Psychotic Features. If the criteria for a Major Depressive Episode are not currently met, the fifth digit is used to indicate whether the disorder is In Partial Remission or In Full Remission. If Manic, Mixed, or Hypomanic Episodes develop in the course of Major Depressive Disorder, the diagnosis is changed to a Bipolar Disorder. However, if manic or hypomanic symptoms occur as a direct effect of antidepressant treatment, use of other medications, substance use, or toxin exposure, the diagnosis of Major Depressive Disorder remains appropriate and an addition diagnosis of Substance-induced Mood Disorder, With Manic features (or With Mixed Features), should be noted. Similarly, if manic or hypomanic symptoms occur as a direct effect of a general medical condition, the diagnosis of Major Depressive Disorder remains appropriate and an additional diagnosis of Mood Disorder Due to a General Medical Condition, With Manic Features (or With Mixed Features), should be noted.” p. 369 “Course Major Depressive Disorder may begin at any age, with an average age at onset in the mid-20s. Epidemiological data suggest that the age at onset is decreasing for those born more recently. The course of Major Depressive Disorder, Recurrent, is variable. Some people have isolated episodes that are separated by many years without any depressive symptoms, whereas others have clusters of episodes, and still others have increasingly frequent episodes as they grow older. Some evidence suggests that the periods of remission generally last longer early in the course of the disorder. The number of prior episodes predicts the likelihood of developing a subsequent Major Depressive Episode. At least 60% of individuals with Major Depresssive Disorder, Single Episode, can be expected to have a second episode. Individuals who have had tow episodes have a 70% chance of having a third, and individuals who have had three episodes have a 90% chance of having a fourth. About 5%-10% of individuals with Major Depressive Disorder, single Episode, subsequently develop a Manic Episode (i.e., develop Bipolar I Disorder). Major Depressive Episodes may end completely (in about two-thirds of cases), or only partially or not at all (in about one-third of cases). For individuals who have only partial remission, there is a greater likelihood of developing additional episodes and of continuing the pattern of partial interepisode recovery. The longitudinal course specifiers With Full Interepisode Recovery and Without Full Interepisode Recovery may therefore have prognostic value. A number of individuals have pre-existing Dysthymic Disorder prior to the onset of Major Depressive Disorder, single Episode. Some evidence suggests that these individuals are more likely to have additional Major Depressive Episodes, have poorer interepisode recovery, and may require additional acute-phase treatment and a longer period of continuing treatment to attain and maintain a more thorough and longer-lasting euthymic state. Follow-up naturalistic studies suggested that 1 year after the diagnosis of a major Depressive Episode, 40% of individuals still have symptoms that are sufficiently severe to meet criteria for a full Major Depressive Episode, roughly 20% continue to have some symptoms that no longer meet full criteria for a Major Depressive Episode (i.e., major Depressive Disorder, In Partial Remission), and 40% have no Mood Disorder. The severity of the initial Major Depressive Episode appears to predict persistence. Chronic general medical conditions are also a risk factor for more persistent episodes. Episodes of Major Depressive Disorder often follow a severe psychosocial stressor, such as the death of a loved one or divorce. Studies suggest that psychosocial events 9stressors) may play a more significant role in the precipitation of the first or second episodes of Major Depressive Disorder and may play less of a role in the onset of subsequent episodes. Chronic general medical conditions and Substance Dependence (particularly Alcohol or Cocaine Dependence) may contribute to the onset or exacerbation of Major Depressive Disorder. It is difficult to predict whether the first episode of a Major Depressive Disorder in a young person will ultimately evolve into a Bipolar Disorder. Some data suggest that the acute onset of severe depression, especially with psychotic features and psychomotor retardation, in a young person without prepubertal psychopathology is more likely to predict a bipolar disorder. A family history of Bipolar Disorder may also be suggestive of subsequent development of Bipolar Disorder.” p. 372-373
Diagnostic and statistical manual of mental disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association.
________________ Major Depressive Disorder “Diagnostic Features The essential feature of Major Depressive Disorder is a clinical course that is characterized by one or more Major Depressive Episodes without a history of Manic, Mixed, or Hypomanic Episodes (Criteria A and C). Episodes of Substance-Induced Mood Disorder (due to the direct physiological effects of a drug of abuse, a medication, or toxin exposure) or of Mood Disorder Due to a General Medical Condition do not count toward a diagnosis of Major Depressive Disorder. In addition, the episodes must not be better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified (Criterion B). The fourth digit in the diagnostic code for Major Depressive Disorder indicates whether it is a Single Episode (used only for first episodes) or Recurrent. It is sometimes difficult to distinguish between a single episode with waxing and waning symptoms and two separate episodes. For purposes of this manual, an episode is considered to have ended when the full criteria for eh Major Depressive Episode have not been met for at least 2 consecutive months. During this 2-month period, there is either complete resolution of symptoms or the presence of depressive symptoms that no longer meet the full criteria for a Major Depressive Episode (In Partial Remission). The fifth digit in the diagnostic code for Major Depressive Disorder indicates the current state of the disturbance. If the criteria for a Major Depressive Disorder are met, the severity of the episode is notes as Mild, Moderate, Severe Without Psychotic Features, or Severe With Psychotic Features. If the criteria for a Major Depressive Episode are not currently met, the fifth digit is used to indicate whether the disorder is In Partial Remission or In Full Remission. If Manic, Mixed, or Hypomanic Episodes develop in the course of Major Depressive Disorder, the diagnosis is changed to a Bipolar Disorder. However, if manic or hypomanic symptoms occur as a direct effect of antidepressant treatment, use of other medications, substance use, or toxin exposure, the diagnosis of Major Depressive Disorder remains appropriate and an addition diagnosis of Substance-induced Mood Disorder, With Manic features (or With Mixed Features), should be noted. Similarly, if manic or hypomanic symptoms occur as a direct effect of a general medical condition, the diagnosis of Major Depressive Disorder remains appropriate and an additional diagnosis of Mood Disorder Due to a General Medical Condition, With Manic Features (or With Mixed Features), should be noted.” p. 369 “Course Major Depressive Disorder may begin at any age, with an average age at onset in the mid-20s. Epidemiological data suggest that the age at onset is decreasing for those born more recently. The course of Major Depressive Disorder, Recurrent, is variable. Some people have isolated episodes that are separated by many years without any depressive symptoms, whereas others have clusters of episodes, and still others have increasingly frequent episodes as they grow older. Some evidence suggests that the periods of remission generally last longer early in the course of the disorder. The number of prior episodes predicts the likelihood of developing a subsequent Major Depressive Episode. At least 60% of individuals with Major Depresssive Disorder, Single Episode, can be expected to have a second episode. Individuals who have had tow episodes have a 70% chance of having a third, and individuals who have had three episodes have a 90% chance of having a fourth. About 5%-10% of individuals with Major Depressive Disorder, single Episode, subsequently develop a Manic Episode (i.e., develop Bipolar I Disorder). Major Depressive Episodes may end completely (in about two-thirds of cases), or only partially or not at all (in about one-third of cases). For individuals who have only partial remission, there is a greater likelihood of developing additional episodes and of continuing the pattern of partial interepisode recovery. The longitudinal course specifiers With Full Interepisode Recovery and Without Full Interepisode Recovery may therefore have prognostic value. A number of individuals have pre-existing Dysthymic Disorder prior to the onset of Major Depressive Disorder, single Episode. Some evidence suggests that these individuals are more likely to have additional Major Depressive Episodes, have poorer interepisode recovery, and may require additional acute-phase treatment and a longer period of continuing treatment to attain and maintain a more thorough and longer-lasting euthymic state. Follow-up naturalistic studies suggested that 1 year after the diagnosis of a major Depressive Episode, 40% of individuals still have symptoms that are sufficiently severe to meet criteria for a full Major Depressive Episode, roughly 20% continue to have some symptoms that no longer meet full criteria for a Major Depressive Episode (i.e., major Depressive Disorder, In Partial Remission), and 40% have no Mood Disorder. The severity of the initial Major Depressive Episode appears to predict persistence. Chronic general medical conditions are also a risk factor for more persistent episodes. Episodes of Major Depressive Disorder often follow a severe psychosocial stressor, such as the death of a loved one or divorce. Studies suggest that psychosocial events 9stressors) may play a more significant role in the precipitation of the first or second episodes of Major Depressive Disorder and may play less of a role in the onset of subsequent episodes. Chronic general medical conditions and Substance Dependence (particularly Alcohol or Cocaine Dependence) may contribute to the onset or exacerbation of Major Depressive Disorder. It is difficult to predict whether the first episode of a Major Depressive Disorder in a young person will ultimately evolve into a Bipolar Disorder. Some data suggest that the acute onset of severe depression, especially with psychotic features and psychomotor retardation, in a young person without prepubertal psychopathology is more likely to predict a bipolar disorder. A family history of Bipolar Disorder may also be suggestive of subsequent development of Bipolar Disorder.” p. 372-373 Diagnostic and statistical manual of mental disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. ________________ DID-PTSD-EMDR Dissociative Identity Disorder (DID) "The essential feature of Dissociative identity Disorder is the presence of two or more distinct identities or personality states (Criterion A) that recurrently take control of behavior (Criterion B). There is an inability to recall important personal information, the extent of which is too great to be explained by ordinary forgetfulness (Criterion C). The disturbance is not due tot eh direct physiological effects of a substance or a general medical condition (Condition D.). In children, the symptoms cannot be attributed to imaginary playmates or other fantasy play. Dissociative Identity Disorder reflects a failure to integrate various aspects of identity, memory, and consciousness. Each personality state may be experienced as if it has a distinct personal history, self-image, and identity, including a separate name. Usually there is a primary identity that carries the individual's given name and is passive, dependent, guilty, and depressed. The alternate identities frequently have different names and characteristics that contrast with the primary identity (e.g., are hostile, controlling, and self-destructive). Particular identities may emerge in specific circumstances and may differ in reported age and gender, vocabulary, general knowledge, or predominant affect. Alternate identities are experienced as taking control in sequence, ore at the expense of the other, and may deny knowledge of one another, be critical of one another, or appear to be in open conflict. Occasionally, one or more powerful identities allocate time to the others. Aggressive or hostile identities may at times interrupt activities or place the others in uncomfortable situations. Individuals with this disorder experience frequent gaps in memory for personal history, both remote and recent. The amnesia is frequently asymmetrical. The more passive identities tend to have more constricted memories, whereas the more hostile, controlling, or "protector" identities have more complete memories. An identity that is not in control may nonetheless gain access to consciousness by producing auditory or visual hallucinations (e.g., a voice giving instructions). Evidence of amnesia may be uncovered by reports from others who have witnessed behavior that is disavowed by the individual or by the individual's own discoveries (e.g., finding items of clothing at home that the individual cannot remember having bought). There may be loss of memory not only for recurrent periods of time, but also an overall loss of biographical memory for some extended period of childhood, adolescence, or even adulthood. Transitions among identities are often triggered by psychosocial stress. The time required to switch from one identity to another is usually a matter of seconds, but, less frequently, may b gradual. Behavior that may be frequently associated with identity switches include rapid blinking, facial changes, changes in voice or demeanor, or disruption in the individual's train of thoughts. The number of identities reported ranges from 2 to more than 100. Half of reported cases include the individuals with 10 or fewer identities." Diagnostic and Statistical Manual of Mental Disorders. 2000. 4th ed. Washington, D.C.: American Psychiatric Association. PTSD, DID, and EMDR Posttraumatic Stress Disorder "The essential feature of Posttraumatic Stress Disorder us the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criteria A1). The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behavior) (Criterion A2). The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F). Traumatic events that are experienced directly include, but are not limited to, military combat, violent personal assault (sexual assault, physical attack, robbery, mugging), being kidnapped, being taken hostage, terrorist attack, torture, incarceration as a prisoner of war or in a concentration camp, natural or manmade disasters, severe automobile accidents, or being diagnosed with a life-threatening illness. For children, sexually traumatic events may include developmentally inappropriate sexual experiences without threatened or actual violence or injury. Witnessed events include, but are not limited to, observing the serious injury or unnatural death of another person due to violent assault, accident, war, or disaster or unexpectedly witnessing a dead body or body parts. Events experienced by others that are learned about include, but are not limited to, violent personal assault, serious accident, or serious injury experienced y a family member or a close friend; learning about the sudden, unexpected death of a family member or a close friend; or learning that one's child has a life threatening disease. The disorder may be especially sever or long lasting when the stressor is of human design (e.g., torture, rape). the likelihood of developing this disorder may increase as the intensity of and physical proximity to the stressor increase. The traumatic event can be reexperienced in various ways. Commonly the person has recurrent and intrusive recollections of the event (Criterion B1) or recurrent distressing dreams during which the event can be replayed or otherwise represented (Criterion B2). In rare instances, the person experiences dissociative states that last from a few seconds to several hours, or even days, during which components of the event are relived and the person behaves as though experiencing the event at that moment (Criterion B3). These episodes, often referred to as "flashbacks," are typically brief but can be associated with prolonged distress and heightened arousal. Intense psychological distress (Criterion B4) or physiological reactivity (Criterion B5) often occurs when the person is exposed to triggering events that resemble or symbolize an aspect of the traumatic event (e.g., anniversaries of the traumatic event; cold, snowy weather or uniformed guards for survivors of death camps in cold climates; hot, humid weather for combat veterans of the South Pacific; entering any elevator for an woman who was reaped in an elevator). Stimuli associated with the trauma are persistently avoided. The person commonly makes deliberate efforts to avoid thoughts, feelings, or conversations about the traumatic event (Criterion C1) and to avoid activities, situations, or people who around recollections of it (Criterion C2). This avoidance of reminders may include amnesia for an important aspect of the traumatic event (Criterion C3). Diminished responsiveness to the external work, referred to as "psychic numbing" or "emotional anesthesia," usually begins soon after the traumatic event. The individual may complain of having markedly diminished interest or participation in previously enjoyed activities (Criterion C4), of feeling detached or estranged from other people (Criterion C5), or of having markedly reduced ability to feel emotions (especially those associated with intimacy, tenderness and sexuality) (Criterion C6). The individual may have a sense of a foreshortened future (e.g., not expecting to have a career, marriage, children, or a normal life span) (Criterion C7). The individual has persistent symptoms of anxiety or increased arousal that were not present before the trauma. these symptoms may include difficulty falling or staying asleep that may be to recurrent nightmares during which the traumatic event is relived (Criterion D1), hypervigilance (Criterion D4), and exaggerated startle response (Criterion D5). Some individuals report irritability or outburst of anger (Criterion D2) or difficulty concentrating or completing tasks (Criterion D3)."
EMDR Eye Movement Desensitization and Reprocessing "Eye Movement Desensitization and Reprocessing (EMDR)1 integrates elements of many effective psychotherapies in structured protocols that are designed to maximize treatment effects. These include psychodynamic, cognitive behavioral, interpersonal, experiential, and body-centered therapies2. EMDR is an information processing therapy and uses an eight phase approach. During EMDR1 the client attends to past and present experiences in brief sequential doses while simultaneously focusing on an external stimulus. Then the client is instructed to let new material become the focus of the next set of dual attention. This sequence of dual attention and personal association is repeated many times in the session. Eight Phases of Treatment The first phase is a history taking session during which the therapist assesses the client's readiness for EMDR and develops a treatment plan. Client and therapist identify possible targets for EMDR processing. These include recent distressing events, current situations that elicit emotional disturbance, related historical incidents, and the development of specific skills and behaviors that will be needed by the client in future situations. During the second phase of treatment, the therapist ensures that the client has adequate methods of handling emotional distress and good coping skills, and that the client is in a relatively stable state. If further stabilization is required, or if additional skills are needed, therapy focuses on providing these. The client is then able to use stress reducing techniques whenever necessary, during or between sessions. However, one goal is not to need these techniques once therapy is complete. In phase three through six, a target is identified and processed using EMDR procedures. These involve the client identifying the most vivid visual image related to the memory (if available), a negative belief about self, related emotions and body sensations. The client also identifies a preferred positive belief. The validity of the positive belief is rated, as is the intensity of the negative emotions. After this, the client is instructed to focus on the image, negative thought, and body sensations while simultaneously moving his/her eyes back and forth following the therapist's fingers as they move across his/her field of vision for 20-30 seconds or more, depending upon the need of the client. Athough eye movements are the most commonly used external stimulus, therapists often use auditory tones, tapping, or other types of tactile stimulation. The kind of dual attention and the length of each set is customized to the need of the client. The client is instructed to just notice whatever happens. After this, the clinician instructs the client to let his/her mind go blank and to notice whatever thought, feeling, image, memory, or sensation comes to mind. Depending upon the client's report the clinician will facilitate the next focus of attention. In most cases a client-directed association process is encouraged. This is repeated numerous times throughout the session. If the client becomes distressed or has difficulty with the process, the therapist follows established procedures to help the client resume processing. When the client reports no distress related to the targeted memory, the clinician asks him/her to think of the preferred positive belief that was identified at the beginning of the session, or a better one if it has emerged, and to focus on the incident, while simultaneously engaging in the eye movements. After several sets, clients generally report increased confidence in this positive belief. The therapist checks with the client regarding body sensations. If there are negative sensations, these are processed as above. If there are positive sensations, they are further enhanced. In phase seven, closure, the therapist asks the client to keep a journal during the week to document any related material that may arise and reminds the client of the self-calming activities that were mastered in phase two. The next session begins with phase eight, re-evaluation of the previous work, and of progress since the previous session. EMDR treatment ensures processing of all related historical events, current incidents that elicit distress, and future scenarios that will require different responses. The overall goal is produce the most comprehensive and profound treatment effects in the shortest period of time, while simultaneously maintaining a stable client within a balanced system. After EMDR processing, clients generally report that the emotional distress related to the memory has been eliminated, or greatly decreased, and that they have gained important cognitive insights. Importantly, these emotional and cognitive changes usually result in spontaneous behavioral and personal change, which are further enhanced with standard EMDR procedures." www.emdr.com
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NeuroBiology of Trauma
Affect Regulation
Affect Regulation is one of the major themes of our site. Affect Regulation: and Attachment I Affect Regulation: and Attachment II Affect Regulation: and Trauma. Affect Regulation and Delayed memories of Child abuse. Affect Regulation: mentalization and the development of the self. Affect Regulation: the relationships among affect regulation, self-esteem, object relations, and binge drinking behavior in college freshmen. Affect Regulation: Self-Esteem and affect regulation--expecting the best and preparing for the worst. Affect Regulation: Attachment style in married couples relation to current marital functioning, stability over time and method of assessment. Affect Regulation: and PTSD Post Traumatic Stress Disorder Affect Regulation: Dysregulation and Disorders of The Self Affect Regulation: Recurrent abortions in Bulimics: Implications regarding pathogenesis. Affect Regulation: Affect regulation and the Development of Psychopathology. Affect Regulation: Social Context in Children's Affect Regulation
Affect Regulation
Author(s): El-Mallakh, Rif S., NIMH Neuropsychiatry Branch, Neuropsychiatric Research Hosp, Washington, DC, US; Tasman, Allan Source: International Journal of Eating Disorders, Vol 10(2), Mar 1991. pp. 215-219. Publisher: US: John Wiley & Sons. Abstract: Describes the case of a 33-yr-old White female severe bulimic in which repeated pregnancies and abortions fulfilled the same calming function as repeated bingeing and vomiting. The cycle of incorporation and expulsion is central to affect regulation and is most compatible with the view that bulimics use their own bodies as transitional objects. Such symptoms represent overdetermination and reflect not only primitive deficits in regulation of internal states but also consequent unresolved conflicts. Self-psychology and object-relations theories have been used to conclude that the inability to relate adequately to an early mother figure is central to bulimia nervosa. Thus therapy must be flexible enough to deal with both primary and secondary issues. _____
Title: The emotional priming task: Results from a student population. Author(s): Power, Mick J., MRC Social Psychiatry Unit, U London Inst of Psychiatry, England; Brewin, Chris R.; Stuessy, A.; Mahony, T. Source: Cognitive Therapy & Research, Vol 15(1), Feb 1991. pp. 21-31. Publisher: US: Kluwer Academic/Plenum Publishers. Abstract: Used an emotional priming task to test an esteem regulation and a more general affect regulation interpretation of a phenomenon first reported by M. J. Power and C. R. Brewin. 52 undergraduates were primed with emotion terms related to love, fear, sadness, or anger. A target adjective was presented either 250 msec or 2,000 msec later; the S's task was to indicate whether the adjective was self-descriptive. At the longer duration for negative emotion primes, Ss endorsed fewer negative adjectives as self-descriptive and took longer to make these endorsements. The effect, however, was obtained with all 3 negative emotion types. Both the current and previous findings provide evidence for affect regulation rather than more specific esteem regulation processes. _____
Title: Cognitive-behavioral interventions in the psychoanalytic psychotherapy of borderline personality disorders. Author(s): Westen, Drew, U Michigan, Ann Arbor, US Source: Clinical Psychology Review, Vol 11(3), 1991. pp. 211-230. Publisher: US: Elsevier Science/Pergamon. Abstract: A pathology of affect regulation and object relations defines much of borderline pathology. Cognitive-behavioral interventions (e.g., modeling, limited self-disclosure) that target self-regulation and social-cognitive processes can be usefully integrated into psychodynamically oriented treatment of borderline patients. Strictly psychodynamic approaches tend to be limited by factors such as a lack of attention to processes by which conscious insight and coping strategies can be transformed into automatic or adaptive unconscious procedures in these patients. Cognitive approaches tend to be limited by rationalistic assumptions about motivation and an underestimation of the complexities of cognitive-affective interactions and unconscious processes. _____
Title: Early superego development: The emergence of shame and narcissistic affect regulation in the practicing period. Author(s): Schore, Allan N. Source: Psychoanalysis & Contemporary Thought, Vol 14(2), 1991. pp. 187-250. Publisher: US: International Universities Press Inc. Abstract: Traces the emergence and functional onset of shame, which is an inhibitor of hyperaroused states, in the early separation-individuation phase (age 12-28 mo). A prototypical model of shame is proposed in which the emerging self, in a hyperstimulated, grandiose, narcissistically charged state of heightened arousal, exhibits itself during a reunion with the caregiver. Despite an excited anticipation of a shared affect state with the mother, the infant unexpectedly experiences a misattunement, which triggers a shock-induced deflation of narcissistic affect. This intense physiological state of shame distress may reflect a sudden shift from sympathetic dominant to parasympathetic dominant autonomic nervous system activity. The caregiver's response is thus critical to the infant's affect regulation in the practicing period and to the developing ability to recover from shame. _____
Title: Infant social referencing. Author(s): Walden, Tedra A., Vanderbilt U, Dept of Psychology & Human Development, Nashville, TN, US Source: Garber, Judy (Ed); Dodge, Kenneth A. (Ed); 1991. The development of emotion regulation and dysregulation. Cambridge studies in social and emotional development. New York, NY, US: Cambridge University Press. pp. 69-88 Abstract: discuss data that support the position that processes of emotional regulation include the child's use of other persons in affect-inducing situations / consider affect regulation in the interpersonal context in which it occurs / one way in which young children use interpersonal information to regulate affect is by referring to others' reactions to events / they may then use information about others' responses to guide their own responses / describe the phenomenon of social referencing / and some early developmental changes in the referencing of others' affective expressions in situations of uncertainty / discuss one interpersonal factor, parental contingency, that qualifies social referencing effects _____
Title: Relationships, talk about feelings, and the development of affect regulation in early childhood. Author(s): Dunn, Judy, Pennsylvania State U, Coll of Health & Human Development, Dept of Human Development & Family Studies, PA, US; Brown, Jane Source: Garber, Judy (Ed); Dodge, Kenneth A. (Ed); 1991. The development of emotion regulation and dysregulation. Cambridge studies in social and emotional development. New York, NY, US: Cambridge University Press. pp. 89-108 Abstract: affect regulation . . . is, we suggest, of central significance in relationships; in documenting developments in this emotional control and influence over others, we are charting dramatic changes in the nature of children's relationships / it is the connections between children's needs and interests in their relationships, and their developing ability to influence emotions--their own and those of other people--that form one theme of this chapter / describe the developmental changes in children's use of others to meet their own needs and to influence their own emotional state and then consider evidence for their growing ability to influence others' emotional states, discussing the understanding that these behaviors reflect / a second theme of this chapter is the role that discourse about emotions and feeling states plays in these developments / [discuss the] issue of how the acquisition of language affects children's relationships / consider these issues using three longitudinal studies of children, observed at home with their mothers and older siblings Conference Note: Based on the workshop "The Development of Affect Regulation and Dysregulation," held at Vanderbilt University, Nashville, TN, May 1988. _____
Title: The regulation of sad affect: An information-processing perspective. Author(s): Garber, Judy, Vanderbilt U, Dept of Psychology & Human Development, Assistant Professor, Nashville, TN, US; Braafladt, Nancy; Zeman, Janice Source: Garber, Judy (Ed); Dodge, Kenneth A. (Ed); 1991. The development of emotion regulation and dysregulation. Cambridge studies in social and emotional development. New York, NY, US: Cambridge University Press. pp. 208-240 Abstract: concerned with the self-regulation strategies that children use to alter their negative emotions and to maintain or enhance their positive affect states / suggest that an information-processing framework can be used to describe both competent and maladaptive emotion regulation / two studies are presented in which the strategies accessed by normal school-age children to modify their negative moods are contrasted with the affect regulation strategies used by children who are experiencing the more intense negative emotional state of depression / offer several hypotheses derived from the information-processing perspective to explain the different emotion regulation strategies of depressed and nondepressed children / discuss how affect regulation strategies may be socialized in parent-child interactions / the impact on this socialization process when the mother is depressed is addressed in two other studies Conference Note: Based on the workshop "The Development of Affect Regulation and Dysregulation," held at Vanderbilt University, Nashville, TN, May 1988. _____
Title: To be noticed favorably: Links between private self and public self. Author(s): Baumgardner, Ann H., Michigan State U, East Lansing, US; Kaufman, Cynthia M.; Cranford, James A. Source: Personality & Social Psychology Bulletin, Vol 16(4), Dec 1990. Special Issue: Centennial celebration of The Principles of Psychology. pp. 705-716. Publisher: US: Sage Publications. Abstract: Draws parallels and distinctions between the spiritual self/social self dichotomy introduced by W. James (1890) and the current private self/public self dichotomy. Recent evidence for, and theoretical processes of, the affective components of the private self and public self are reviewed. A model of affect regulation is proposed that links the private self and public self such that the interplay between the two provides a fertile ground for understanding interpersonal relations more generally. Evidence in support of this model is introduced, which shows that individuals who have negative self-regard use social relations and their social selves to enhance their self-concepts. _____
Title: Affect regulation and psychopathology: Bridging the mind-body gap. Author(s): Bradley, Susan J., Hosp for Sick Children, Dept of Psychiatry, Toronto, ON, Canada Source: Canadian Journal of Psychiatry, Vol 35(6), Aug 1990. Special Issue: Child psychiatry. pp. 540-547. Publisher: Canada: Canadian Psychiatric Assn. Abstract: Presents a model of affect regulation, adapted from the J. M. Gorman et al tripartite model of panic anxiety, linking the reticular, limbic, and frontal systems of the brain with manifestations of psychopathology. Applications of the model to anxiety, obsessive-compulsive, and behavior disorders, as well as to depressive and psychotic symptoms are described. The model is used to explain how different intervention techniques (e.g., dynamic, behavioral, physical) can have similar results. The common mechanism may be the therapist's impact on the patient's ability to modulate affect. (French abstract) _____
Title: Preventing relapse in the treatment of nicotine addiction: Current issues and future directions. Author(s): Carmody, Timothy P., Dept of Veterans Affairs Medical Ctr, Psychology Service, San Francisco, CA, US Source: Journal of Psychoactive Drugs, Vol 22(2), Apr-Jun 1990. pp. 211-238. Publisher: US: Haight-Ashbury Publications. Abstract: Discusses smoking relapse (SR) in the context of cyclical episodes of smoking and quitting during a person's lifetime. Theories of the determinants of SR are reviewed, and methods designed to prevent SR are described. Three aspects of tobacco addiction that affect SR are biological-addiction mechanisms, conditioning processes, and cognitive-social learning factors. The major determinants of SR include nicotine withdrawal, stress, weight gain, social influences, conditioning factors, causal attributions, and environmental variables. Relapse prevention interventions are described that emphasize self-awareness, self-efficacy, affect regulation, and social support. Developments in pharmacological adjuncts to treatment are examined. _____
Title: Family developmental task assessment: A prerequisite to family treatment. Author(s): Farley, Joan E., U Colorado Health Science Ctr, Colorado Psychiatric Hosp, Denver, US Source: Clinical Social Work Journal, Vol 18(1), Spr 1990. pp. 85-98. Publisher: US: Kluwer Academic/Plenum Publishers. Abstract: Presents a developmental framework for assessing family function, based on an integration of family systems theory and ego psychological knowledge of growth. The framework organizes family information along 4 developmental lines: regulation of individuation, management of affect, regulation of sexual and aggressive impulses, and self-other observation. A scale for assessing the severity of the sociobiological stressor is also included. Use of the framework can aid the family therapist in selecting therapy modality and technique. _____
Title: Multiple networks and substance use. Author(s): Wills, Thomas A., Yeshiva U Albert Einstein Coll of Medicine, Ferkauf Graduate School of Psychology, Bronx, NY, US Source: Journal of Social & Clinical Psychology, Vol 9(1), Spr 1990. Special Issue: Social support in social and clinical psychology. pp. 78-90. Publisher: US: Guilford Publications. Abstract: Considers the relation between social networks (SCNs) and substance abuse among adolescents. SCNs may include elements inversely related to drug use (e.g., affect regulation, emotional support) and elements that may be conducive to drug use (e.g., normative beliefs, modeling). Adolescents are members of 2 SCNs (family and peer), and these networks have different effects on their behavior. A review of studies of support and substance abuse shows that peer and family support have opposite relations to substance use, and that structural and functional support make independent contributions to prediction of drug abuse. _____
Title: Attachment styles and fear of personal death: A case study of affect regulation. Author(s): Mikulincer, Mario, Bar-Ilan U, Ramat Gan, Israel; Florian, Victor; Tolmacz, Rami Source: Journal of Personality & Social Psychology, Vol 58(2), Feb 1990. pp. 273-280. Publisher: US: American Psychological Assn. Abstract: The relation between attachment styles and fear of personal death was assessed. We classified a sample of Israeli undergraduate students into secure, ambivalent, and avoidant attachment groups and assessed the extent of, and the meaning attached to, overt fear of personal death as well as the extent of fear at a low level of awareness. Ambivalent subjects exhibited stronger overt fear of death than did secure and avoidant subjects, and both ambivalent and avoidant subjects showed stronger fear of death at a low level of awareness than secure subjects. Ambivalent subjects were also more likely to fear the loss of their social identity in death, and avoidant subjects were more likely to fear the unknown nature of their death. Results are discussed in terms of the effects of attachment styles on affect regulation. _____
Title: The role of bulimic behaviors in affect regulation: Different functions for different patient subgroups? Author(s): Steinberg, Stacey, Northwestern U Medical School Inst of Psychiatry, Eating Disorders Program, Chicago, IL, US; Tobin, David L.; Johnson, Craig Source: International Journal of Eating Disorders, Vol 9(1), Jan 1990. pp. 51-55. Publisher: US: John Wiley & Sons. Abstract: Examined whether 40 bulimic patients with borderline personality disorder (BPD) would have a different affective experience during the binge-purge cycle than 35 bulimics without BPD. Ss rated adjectives describing their affective states before binge eating and after purging. Both groups reported reductions in anxiety and fragmentation after the binge-purge episode. The borderline group, however, experienced significantly greater reductions in anxiety and a decreased level of depression, while the nonborderline subgroup reported a slight increase in depression. The function of bingeing and purging for both groups is discussed. _____
Title: Communication and negative affect regulation in the family. Author(s): Lindahl, Kristin M., U Denver, Denver, CO, US; Markman, Howard J. Source: Blechman, Elaine A. (Ed); 1990. Emotions and the family: For better or for worse. Hillsdale, NJ, England: Lawrence Erlbaum Associates, Inc. pp. 99-115 Abstract: explores the interrelationships among marital communication, parent-child interactions, and children's psychological development, focusing on how negative affect regulation affects and is affected by these dimensions of family functioning / we define negative affect regulation as the processes and behaviors associated with responding to increased levels of negative emotions, primarily anger, hostility, and frustration, in a constructive manner / hypothesize that the regulation of negative affect is a critical task for successful marital and parent-child relationships, which in turn are related to children's psychological development / speculate that in distressed families, the presence of dysfunctional processes of affect regulation will be evidenced in communication patterns and in modes of emotional expression / hypothesize that children of distressed as compared to satisfied couples are more likely to experience negative affect, and that their parents will experience trouble helping them become aware of and control negative affect _____
Title: Affective modes in multimodality addiction treatment. Author(s): Frye, Robert Vaughn, Veterans Administration Medical Ctr, Denver, CO, US Source: Milkman, Harvey B. (Ed); Sederer, Lloyd I. (Ed); 1990. Treatment choices for alcoholism and substance abuse. Lexington, MA, England: Lexington Books/D. C. Heath and Com. pp. 287-307 Abstract: discusses the role of improved affect regulation as an integral adjunct to a cognitive-behavioral treatment regimen / clients may be trained in achieving an affective experience that may alter consciousness and awareness and produce positive changes in emotion, mood, and temperament / such states may be considered natural highs and may help fill the void caused by abstinence from psychoactive substances / affective modes may include stress management training such as deep relaxation and meditation; covert conditioning; biofeedback; charismatic therapy; creative therapies that use dance, music, art, movement, and drama; suggestion; and group marathon therapy treatment planning / change and recovery Conference Note: Based on presentations given at the Treatment Choices in Substance Abuse conference, sponsored by the Alcohol and Drug Abuse Division, Colorado Department of Health, Jun 3-4, 1988 at Denver, CO. _____
Title: Affect regulation, nicotine addiction, and smoking cessation. Author(s): Carmody, Timothy P., Veterans Administration Medical Ctr, Psychology Service, San Francisco, CA, US Source: Journal of Psychoactive Drugs, Vol 21(3), Jul-Sep 1989. pp. 331-342. Publisher: US: Haight-Ashbury Publications. Abstract: Examines affect regulation (i.e., the attempt to alleviate negative mood states with pharmacologic-, cognitive-, behavioral-, or environmental-change methods) in relation to (1) the initiation, development, and maintenance of cigarette smoking; (2) the process of smoking cessation (SC); and (3) the long-term maintenance of smoking abstinence vs relapse. Psychosocial factors and physiological mechanisms are explored that may be links between negative mood states, nicotine addiction, and SC. Implications for SC treatment are discussed in the areas of (1) the use of pharmacologic agents for the reduction of nicotine withdrawal symptoms, (2) nicotine replacement therapy, and (3) skills-training approaches to SC and relapse prevention. _____
Title: Regulating affect interpersonally: When low esteem leads to greater enhancement. Author(s): Baumgardner, Ann H., Michigan State U, East Lansing, US; Kaufman, Cynthia M.; Levy, Paul E. Source: Journal of Personality & Social Psychology , Vol 56(6), Jun 1989. pp. 907-921. Publisher: US: American Psychological Assn. Abstract: We tested the hypothesis that low self-esteem persons use self-presentation to improve their affect. In Experiments 1-3, Ss high in self-esteem (HSE) and low in self-esteem (LSE) responded publicly or privately to positive or negative feedback from a computer "personality test" (Experiments 1 and 2) or from a peer (Experiment 3). In public, LSE Ss complimented positive sources and derogated negative sources more than their counterparts did. Experiment 2 showed that this was not due to another person's awareness of the feedback, ruling out a strict impression management interpretation. In Experiment 4, some Ss were coaxed to compliment the source of feedback and others were coaxed to derogate the source of feedback. When publicly complimenting positive feedback or derogating negative feedback, LSE Ss generally showed a rise in esteem relative to their counterparts. Based on these findings, a model of affect regulation in interpersonal relations is proposed. _____
Title: The development of the ego: Biological and environmental specificity in the psychopathological developmental process and the selection and construction of ego defenses. Author(s): Greenspan, Stanley I., George Washington U School of Medicine & Health Sciences, Washington, DC, US Source: Journal of the American Psychoanalytic Association , Vol 37(3), 1989. pp. 605-638. Publisher: US: AnaIytic Press. Abstract: Discusses the relationship of ego functioning to differences in early sensory processing, integration, and differentiation. Auditory-verbal-affective vulnerabilities may be associated with disorders of thought and obsessive-compulsive patterns, especially when coupled with environments that tend to confuse affective meanings at behavioral-gestural and symbolic levels. Visual-spatial-affective vulnerabilities may be associated with disorders of affect regulation and hysterical patterns, especially when coupled with environments that lack empathy and/or limit setting. Spatial, motor movement (vestibular) vulnerabilities may be associated with phobic and/or counterphobic tendencies. _____
Title: Attachment in late adolescence: Working models, affect regulation, and representations of self and others. Author(s): Kobak, R. Rogers, U Delaware, Newark, US; Sceery, Amy Source: Child Development, Vol 59(1), Feb 1988. pp. 135-146. Publisher: US: Blackwell Publishers. Abstract: In 53 1st-yr college students, 3 kinds of working models of attachment were assessed: Dismissing of Attachment, Secure, and Preoccupied with Attachment. Affect regulation was evaluated with peer Q-sort ratings, and representations of self and others were assessed with self-report measures. The Secure group was rated as more ego-resilient, less anxious, and less hostile by peers and reported little distress and high levels of social support. The Dismissing group was rated low on ego-resilience and higher on hostility by peers and reported more distant relationships in terms of more loneliness and low levels of social support from family. The Preoccupied group was viewed as less ego-resilient and more anxious by peers and reported high levels of personal distress, while viewing their family as more supportive than the Dismissing group. _____
Title: Transference and information processing. Author(s): Westen, Drew, U Michigan, Ann Arbor, US Source: Clinical Psychology Review, Vol 8(2), 1988. pp. 161-179. Publisher: US: Elsevier Science/Pergamon. Abstract: Examines transference phenomena from an information processing perspective, delineates aspects of transference experience, and shows how experimental research documents processes involved in transference. It distinguishes between transference as person schemas/object representations, attachment, schema-triggered affect, interpersonal expectancies, scripts, and defenses, and argues for the importance of making such distinctions. The clinical utility of examining and working with transference phenomena in the alteration of dysfunctional schemas and maladaptive mechanisms of affect regulation is demonstrated. _____
Title: Program adherence and coping strategies as predictors of success in a smoking treatment program. Author(s): Kamarck, Thomas W., U Pittsburgh, PA, US; Lichtenstein, Edward Source: Health Psychology, Vol 7(6), 1988. Special Issue: Clinical health psychology. pp. 557-574. Publisher: US: American Psychological Assn. Abstract: 94 smokers (mean age 39 yrs) in a 6-wk behavioral smoking-cessation program were administered weekly questionnaires on their use of major program recommendations and other quitting strategies throughout treatment. An "affect-regulation" coping inventory was administered at the beginning and end of treatment. Adequate adherence was reported for most recommendations. Although a composite measure of adherence did not predict quitting success, adherence and coping assessments were associated with maintenance of treatment gains. Short-term maintenance was associated with an extensive affect-regulation repertoire and use of stimulus control strategies; long-term maintenance was associated with consistent self-monitoring of smoking during treatment. _____
Title: Interactional and cognitive strategies for affect regulation: Developmental perspective on childhood depression. Author(s): Cole, Pamela M., U Houston-University Park, Dept of Psychology, Houston, TX, US; Kaslow, Nadine J. Source: Alloy, Lauren B. (Ed); 1988. Cognitive processes in depression. New York, NY, US: Guilford Press. pp. 310-343 Abstract: discuss the major contemporary cognitive models of adult depression, to demonstrate their emphasis upon affect regulation / survey representative research in developmental psychology that describes the role of the parent-child interaction in affect regulation and the acquisition of cognitive, self-regulating strategies in the expanding repertoire of affect regulation strategies / highlight the significance of both interactional and cognitive strategies in adaptive affective functioning and the importance of parenting in the development of self-regulatory abilities / review the research on childhood depression, identifying the symptomatic features--interactional and individual--in children of different ages in terms of dysfunctions in parent-child interactions and in children's thinking / learned helplessness and hopeless attributions _____
Title: Smoking. Author(s): Russell, Peggy O., U of Pittsburgh School of Medicine, Dept of Psychiatry, Assistant Professor, Pittsburgh, PA, US; Epstein, Leonard H. Source: Blechman, Elaine A. (Ed); Brownell, Kelly D. (Ed); 1988. Handbook of behavioral medicine for women. Pergamon general psychology series, Vol. 149. Elmsford, NY, US: Pergamon Press, Inc. pp. 369-383 Abstract: smoking habit in women / review how it is initiated, maintained, and treated, as well as the specific factors which relate to women's general health status / smoking and cancer / chronic obstructive lung disease / heart disease / pregnancy / behavioral pharmacology / affect regulation / nicotine withdrawal / weight changes and smoking cessation _____
Title: Tricyclic treatment of generalized anxiety disorder. Author(s): Kahn, Richard J., Boston U, MA, US; McNair, Douglas M.; Frankenthaler, Laura M. Source: Journal of Affective Disorders, Vol 13(2), Sep-Oct 1987. Special Issue: Drug treatment of anxiety disorders. pp. 145-151. Publisher: Netherlands: Elsevier Science Publishers BV. Abstract: Reviews studies to determine the efficacy of tricyclic antidepressants (TCAs) in generalized anxiety states. Data from studies previously reported by the 1st author et al and by R. S. Lipman et al are discussed. The onset of efficacy of imipramine began at about 2 wks or later compared with chlordiazepoxide. Findings indicate that affect regulation by TCAs applies to so-called generalized anxiety as well as to depression and panic-phobic disorder. Guidelines are outlined for the possible clinical use of TCAs in anxiety disorders. _____
Title: The dynamic self-concept: A social psychological perspective. Author(s): Markus, Hazel, U Michigan Inst for Social Research, Ann Arbor; Wurf, Elissa Source: Annual Review of Psychology, Vol 38, 1987. pp. 299-337. Publisher: US: Annual Reviews. Abstract: Discusses research in social psychology that emphasizes the dynamic nature of the self-concept and views self-concept as an active, interpretive structure that is continually involved in the regulation of ongoing behavior. Issues addressed include the content and structure of self-concept, self-regulation (e.g., goal setting, cognitive preparation for action, cybernetic cycle), intrapersonal processes mediated by the self-concept (e.g., information processing, affect regulation, motivation), and interpersonal processes (e.g., social perception, situation and partner choice, interaction strategies). It is concluded that self-concept emerges in the literature as a critical component of the individual's affective and cognitive system. _____
Title: New research on affect regulation: Developmental, clinical, and theoretical considerations. Author(s): Solyom, Antal E., Wayne State U School of Medicine Source: Psychoanalytic Inquiry, Vol 7(3), 1987. pp. 331-347. Publisher: US: Analytic Press. Abstract: Based on longitudinal developmental studies and clinical assessments, the observable regulatory behaviors (ORBs) of affect states and their influence on ego development in infants are conceptualized. The affective system of the infant has somatic and behavioral domains, with the psychological domain not yet evident. Many of the affect ORBs in infancy can be considered precursors of psychological defense mechanisms. New methods for researching the development of the infant ORBs are described (e.g., the Infant Clinical Assessment Procedure). Observational and clinical case illustrations provide examples of some of the concepts and ORBs of affect states in infants. _____
Title: The borderline concept: A critical appraisal and some alternative suggestions. Author(s): Terman, David M. Source: Grotstein, James S. (Ed); Solomon, Marion F. (Ed); et al; 1987. The borderline patient: Emerging concepts in diagnosis, psychodynamics and treatment, Vols. 1 & 2. Psychoanalytic inquiry book series. Hillsdale, NJ, England: Analytic Press, Inc. pp. 61-71 Abstract: some of the prevailing attitudes concerning the nature of the so called borderline disorder may mitigate against the very therapeutic stance necessary to both understand and effectively treat people with a deeply damaged or distored psychological structure Terman addresses the issue of the borderline diagnosis from the standpoint of Self Psychology / he introduces us to the concept, borrowed from Gitelson, that the borderline disorder is a result of the nonresponding matrix of the selfobject environment / he believes further that the borderline diagnosis, based on what he calls the "open systems model," shows quantitative rather than qualitative differences from narcissistic peronality disorders / fundamentally, however, Terman believes the borderline disorder is characterized by a deficit of selfobject functions, not merely the mirroring and idealizing functions generally, but, specifically, deficits in affect regulation and other functions that contribute to the failure of cohesion of the borderline's sense of self / Terman places all of these deficits in the category of "matrix failures" Conference: The Borderline Syndrome: Differential Diagnosis and Psychodynamic Treatment, Mar, 1981, Los Angeles, CA, US Conference Note: These 2 volumes were also inspired by two additional conferences: "Dialogues on the Borderline," Earl D. Bond Symposium, Apr 3-4, 1981; and "Narcissistic and Borderline Disorders: Current Perspectives," Oct 2-3, 1982. _____
Title: Psychiatric and psychodynamic factors in cocaine dependence. Author(s): Khantzian, Edward J., Harvard Medical School, Cambridge Hosp, Dept of Psychiatry, Cambridge, MA, US Source: Washton, Arnold M. (Ed); Gold, Mark S. (Ed); 1987. Cocaine: A clinician's handbook. New York, NY, US: Guilford Press. pp. 229-240 Abstract: evidence suggesting that individuals are susceptible to cocaine dependence as a consequence of psychiatric disorders and other psychodynamic factors related to disturbances in affect regulation, self-esteem maintenance, self-other relations and self-care _____
Title: The dynamic self-concept: A social psychological perspective. Author(s): Markus, Hazel, U of Michigan-Ann Arbor, Inst for Social Research, Ann Arbor, MI, US; Wurf, Elissa Source: Rosenzweig, Mark R. (Ed); Porter, Lyman W. (Ed); 1987. Annual review of psychology, Vol. 38. Annual review of psychology. Palo Alto, CA, US: Annual Reviews, Inc. pp. 299-337 Abstract: types of self-representations / self-regulation / intrapersonal processes mediated by the self-concept / information processing / affect regulation / motivation / interpersonal processes mediated by the self-concept / social perception / interaction strategies / reactions to feedback _____
Title: Recent shifts in psychotherapeutic strategies with the characterologically difficult patient. Author(s): Frayn, Douglas H., Clarke Inst of Psychiatry, Toronto, Canada Source: Psychiatric Journal of the University of Ottawa , Vol 11(2), Jun 1986. pp. 77-81. Publisher: Canada: Canadian Medical Assn. Abstract: Suggests that patients who suffer from severe character pathology do not have homogeneous symptomatology but are best characterized by the predominance of preoedipal transferences that emerge during therapy. These transferences are often projections of parts of the patient onto the therapist (narcissistic transferences). The disturbances in basic trust, empathy, affect regulation, and object constancy make for difficulties in bringing about an early or secure therapeutic alliance. Shifts in psychotherapy techniques have expanded the criteria for acceptance to include a broader range of vulnerable patients, while stressing the need for a stable clinical situation and beginnings of an alliance prior to significant interpretive psychotherapy. It is concluded that considering these patients' long-standing interpersonal difficulties in the face of unrealistic high aspirations, coping should be seen as a valued sought-after goal. Conference Note: 27th Annual Meeting of the Group-Without-A-Name International Psychiatric Research Society (1985, Toronto, Canada). _____
Title: Childhood depression: Current perspectives and future directions. Author(s): Kaslow, Nadine J., Yale U School of Medicine; Wamboldt, Frederick S. Source: Journal of Social & Clinical Psychology, Vol 3(4), 1985. Special Issue: The emergence of research at the interface of social, clinical, and developmental psychology. pp. 416-424. Publisher: US: Guilford Publications. Abstract: Reports that the experience of depression in either children or adults can be viewed as a failure in the regulation of affect. Both internal (cognitive and behavioral) and external (interpersonal interactions) sources of affect regulation operate. The relative importance of these sources varies as a function of the individual's developmental stage and the nature of his/her current life situation. The research that examines relevant intra- and interpersonal factors that have been studied in depressed elementary school aged children is reviewed, and directions for future research are suggested. It is concluded that depressed children exhibit cognitive and behavioral patterns, some of which are developmentally based, that can be viewed as deficits in affect regulation. In addition, deficits occur in the interpersonal abilities of depressed children and often in the abilities of significant others in their social network. When both internal and external sources of affect regulation fail, clinically significant depression may result. (44 ref) _____
Title: A cognitive developmental approach to smoking prevention. Author(s): Glynn, Kathleen, Mt Sinai Medical Ctr, Dept of Behavioral Medicine, Milwaukee, WI; Leventhal, Howard; Hirschman, Robert Source: National Institute on Drug Abuse: Research Monograph Series, Mono 63, 1985. pp. 130-152. Publisher: US: US Department of Health & Human Services. Abstract: Presents a model of smoking prevention based on the premises that becoming a smoker involves an extended developmental history--including stages of preparation, initiation, experimentation, and maintenance--and that the experience of smoking is the product of processes involved in the perception and interpretation of the act of smoking. Varying motivations for smoking are suggested, including social compliance, affect regulation, and self-definition. Evidence supporting the stage model is reviewed, and a prevention project is reported in which 321 6th-8th graders served in experimental or control groups. The program, which was designed to alter the labels and evaluations of early smoking experiences, was associated with lower levels of smoking at an 18-mo follow-up than was observed in the control group. (42 ref) _____
Title: Research strategies to identify developmental vulnerabilities for drug abuse. Author(s): Greenspan, Stanley I., NIMH, Adelphi, MD Source: National Institute on Drug Abuse: Research Monograph Series , No 56, 1985. pp. 136-154. Publisher: US: US Department of Health & Human Services. Abstract: Discusses the theoretical perspectives of the development of psychopathology and preventive intervention in infancy with regard to predisposing risk factors for drug abuse. A developmental structuralist approach to etiologic and intervention research is presented, and the links between infancy and subsequent behaviors associated with drug use are illustrated. Case vignettes are presented to show how early intersensory integration, self-regulatory mechanisms, and affective development relate to subsequent processes and affective relationships that appear to be impaired in individuals prone to acting out, behaving antisocially, or using "feel good" substances, whether from a somatic, affective, or interpersonal stance. It is hypothesized that intersensory integration, self-regulatory mechanisms, affect regulation, attachment patterns, and eventually the symbolization of affect leading to interpersonal relations and the capacity to relate to both persons and social conventions provide the keys to predisposing risk factors associated with risk for or avoidance of drug use. (9 ref) _____
Title: A developmental view of affective disturbances in the children of affectively ill parents. Author(s): Cytryn, Leon, NIMH Lab of Developmental Psychology, Bethesda, MD; et al. Source: American Journal of Psychiatry, Vol 141(2), Feb 1984. pp. 219-222. Publisher: US: American Psychiatric Assn. Abstract: Reviews the various clinical and experimental studies of children of parents with affective illness, spanning infancy, childhood, and early adolescence. A clear tendency to early disturbances in these children was found that seems related to adult affective illness in the area of affect regulation and social interaction. A gradual coalescence of prodromal symptoms into a clinically diagnosable affective illness with advancing age is also noted. Although this suggests a developmental line of affective illness linking child and adult forms, many issues need further clarification. (43 ref) _____
Title: Affect development and its assessment in infancy. Author(s): Solyom, Antal E., U Michigan Medical School, Child Psychiatry Service, Ann Arbor Source: Infant Mental Health Journal, Vol 3(4), Win 1982. pp. 276-292. Publisher: US: John Wiley & Sons. Abstract: Approaches the complex issue of affect from a primarily clinical perspective that focuses on the infant as an individual and reviews 2 quantitative methods for assessing discrete affects in clinical settings: the Gaensbauer Scales and the Michigan Infant Affect Scales. Each consists of 2 components: (1) a systematically used procedure designed to elicit affective responses and (2) rating scales for quantitative measurement of the intensity of discrete affects. Affects are defined as both biobehavioral states and signals of social and intrapsychic communication. Discrete affects can reliably be identified, and their intensities scored, from at least 3 mo of age on. Affects are thought to play a central role in organizing, regulating, and motivating the infant's behaviors and social object relationships. A concept of "affective system" is proposed that integrates the modalities of affect expression and the mechanisms of affect regulation. Attachment behaviors are seen as part of the expression and/or regulation of affect states during social interactions. (55 ref)
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