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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: Self-esteem and affect regulation: Expecting the best and preparing for the worst.
Title: Self-esteem and affect regulation: Expecting the best and preparing for the worst. Author(s): Bratslavsky, Ellen, Case Western Reserve U., US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 61(8-B), Mar 2001. pp. 4471. Publisher: US: Univ Microfilms International. Abstract: One of the puzzles of self-esteem is how people are able to maintain a positive self-view in the face of setbacks, rejections, and failures. In three studies I examine one of the ways of maintaining self-esteem, namely the use of anticipatory downward mood regulation by people with high and low self-esteem. The first experiment demonstrated that people with high self-esteem were more likely to engage in downward mood regulation in anticipation of failure feedback than people with low self-esteem. The second experiment examined mood regulation in anticipation of unknown feedback. People with high self-esteem regulated their mood downward in anticipation of unknown feedback as compared to people with low self-esteem. The third experiment examined whether people with high self-esteem prepare for feedback by engaging in affect regulation or social comparison. Results suggested that both processes of affect regulation and social comparison may play a role in preparing people for future disappointments. _____
Title: Smoking and moods in adolescents with depressive and aggressive dispositions: Evidence from surveys and electronic diaries. Author(s): Whalen, Carol K., U California, Dept of Psychology & Social Behavior, Irvine, CA, US; Jamner, Larry D.; Henker, Barbara; Delfino, Ralph J. Source: Health Psychology, Vol 20(2), Mar 2001. pp. 99-111. Publisher: US: American Psychological Assn. Abstract: Surveys and electronic diaries were used to examine depressive and externalizing dispositions as they relate to smoking and moods in 170 early adolescents. Negative moods were prevalent, with anger and anxiety reported on 26%-60% and sadness on 16%-40% of occasions. The risk of smoking, urges to smoke, and alcohol intake were elevated in teens with aggressive and depressive dispositions, as were diary reports of feeling hassled, angry, and sad. Girls high in depression and aggression also reported more anxiety, stress, and fatigue and less happiness and well-being than did their peers. For boys, depression seemed to dampen the elevated smoking risks associated with externalizing behaviors. Discussion focuses on gender differences in personality-smoking linkages, adolescent negative affectivity, the unique contributions of survey and diary methods, and the promise of targeted preventive interventions such as affect regulation training. _____
Title: Communicating feelings: An examination of the processes linking mothers' representations of their 7-month-old infant to early emotional development. Author(s): Rosenblum, Katherine Lisa , U Michigan, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 61(7-B), Feb 2001. pp. 3882. Publisher: US: Univ Microfilms International. Abstract: The present investigation was aimed towards elucidating the processes that linked maternal representations of their 7-month-old infant with individual differences in infant emotion regulation. Participants were 100 mother-infant dyads recruited from local pediatric clinics, and comprised a range of socio-economic and demographic circumstances. Mothers' representations of their infant were assessed via a semi-structured, attachment-based interview, and maternal behavior was observed in a variety of contexts, including a free play, teaching task, and the Still Face procedure. Infant emotion regulation was assessed along a number of behavioral and affective display dimensions upon resuming interaction with his or her parent following the Still Face procedure (i.e., the reengagement episode). Results indicated that mothers' representations were indeed related to differences in maternal behavior and infant emotion regulation. In general, mothers with balanced and positive/coherent representations were more sensitive, less rejecting, less intrusive and expressed more positive affect during interaction with their infant. Patterns of association between mothers' representations and behavior varied according to the nature of the interactive task, with a greater number of associations obtained for the more challenging, stress-inducing, tasks (i.e., the teaching task and Still Face procedure). In addition, the specific type of maternal behaviors associated with differences in mothers' representations varied according to the interactive task. Furthermore, mothers with balanced and positive/coherent representations had infants who demonstrated more positive affect and more attention seeking/contact maintenance upon resuming interaction following the still face, even when controlling for the amount of distress the infant displayed while his or her mother held a still face. Finally, results provided support for the hypothesis that some aspects of maternal behavior mediate the association between her representation of the infant and individual differences in infant emotion regulation. While maternal representation classifications were related to self-reported depressive symptomatology, in the present investigation, maternal depression was unrelated to infant behavior during the Still Face. Results are discussed emphasizing the important role that may be played by maternal representations in shaping mothers' behavioral and emotional responsivity and sensitivity to the infant, thus promoting intergenerational continuity in attachment representations and affect regulation style. _____
Title: Parental sensitivity, infant affect, and affect regulation: Predictors of later attachment. Author(s): Braungart-Rieker, Julia M., U Notre Dame, Dept of Psychology, Notre Dame, IN, US; Garwood, Molly M.; Powers, Bruce P.; Wang, Xiaoyu Source: Child Development, Vol 72(1), Jan-Feb 2001. pp. 252-270. Publisher: US: Blackwell Publishers. Abstract: This longitudinal study on 94 families examined the extent to which parent sensitivity, infant affect, and affect regulation at 4 months predicted mother-infant and father-infant attachment classifications at 1 yr. Parent sensitivity was rated from face-to-face interaction episodes; infant affect and regulatory behaviors were rated from mother-infant and father-infant still-face episodes at 4 months. Infants' attachment to mothers and fathers was rated from the Strange Situation at 12 and 13 mo. MANOVAs indicated that 4-mo parent and infant factors were associated with infant-mother but not infant-father attachment groups. Discriminant Function Analysis further indicated that 2 functions, "Affect Regulation" and "Maternal Sensitivity," discriminated infant-mother attachment groups; As and B1-B2s showed more affect regulation toward mothers and fathers than B3-B4s and Cs at 4 mo, and mothers of both secure groups were more sensitive than mothers ofCs. Finally, the association between maternal sensitivity and infant-mother attachment was partially mediated by infant affect regulation. _____
Title: Affect Regulation and the Development of Psychopathology. Author(s): Bradley, Susan J. Source: Depression & Anxiety, Vol 13(3), 2001. pp. 158-159. Publisher: US: John Wiley & Sons. Abstract: Review of Affect Regulation and the Development of Psychopathology; Susan J. Bradley, author. New York: The Guilford Press, 2000, 320 pp, $40 (hardcover). Reviewed by Richard Balon. _____
Title: Effects of a secure attachment relationship on right brain development, affect regulation, and infant mental health. Author(s): Schore, Allan N., U California-Los Angeles School of Medicine, Dept of Psychiatry & Biobehavioral Sciences, Northridge, CA, US Source: Infant Mental Health Journal, Vol 22(1-2), Jan-Apr 2001. Special Issue: Contributions from the decade of the brain to infant mental health. pp. 7-66. Publisher: US: John Wiley & Sons. Abstract: Integrates current interdisciplinary data from attachment studies on dyadic affective communications, neuroscience on the early developing right brain, psychophysiology on stress systems, and psychiatry on psychopathogenesis to provide a deeper understanding of the psychoneurobiological mechanisms that underlie infant mental health. This 1st part of a 2-part work details the neurobiology of a secure attachment, an exemplar of adaptive infant mental health, and focuses on the primary caregiver's psychobiological regulation of the infant's maturing limbic system, the brain areas specialized for adapting to a rapidly changing environment. The infant's early developing right hemisphere has deep connections into the limbic and autonomic nervous systems and is dominant for the human stress response, and in this manner the attachment relationship facilitates the expansion of the child's coping capacities. This model suggests that adaptive infant mental health can be fundamentally defined as the earliest expression of flexible strategies for coping with the novelty and stress that is inherent in human interactions. This efficient right brain function is a resilience factor for optimal development over the later stages of the life cycle. _____
Title: The effects of early relational trauma on right brain development, affect regulation, and infant mental health. Author(s): Schore, Allan N., U California-Los Angeles School of Medicine, Dept of Psychiatry & Biobehavioral Sciences, Northridge, CA, US Source: Infant Mental Health Journal, Vol 22(1-2), Jan-Apr 2001. Special Issue: Contributions from the decade of the brain to infant mental health. pp. 201-269. Publisher: US: John Wiley & Sons. Abstract: A primary interest of the field of infant mental health is in the early conditions that place infants at risk for less than optimal development. The fundamental problem of what constitutes normal and abnormal development is now a focus of developmental psychology, infant psychiatry, and developmental neuroscience. In the 2nd part of this sequential work, the author presents interdisciplinary data to more deeply forge the theoretical links between severe attachment failures, impairments of the early development of the right brain's stress coping systems, and maladaptive infant mental health. He comments on topics such as the negative impact of traumatic attachments on brain development and infant mental health, the neurobiology of infant trauma, the neuropsychology of a disorganized/disoriented attachment pattern associated with abuse and neglect, the etiology of dissociation and body-mind psychopathology, the effects of early relational trauma on enduring right hemispheric function, and some implications for models of early intervention. These findings suggest direct connections between traumatic attachment, inefficient right brain regulatory functions, and both maladaptive infant and adult mental health. _____
Title: Addiction as an attachment disorder: Implications for group therapy. Author(s): Flores, Philip J., Georgia School of Professional Psychology, GA, US Source: International Journal of Group Psychotherapy, Vol 51(1), Jan 2001. pp. 63-81. Publisher: US: Guilford Publications. Abstract: Presents a perspective on addiction that the author notes not only substantiates why group therapy is the treatment of choice for addiction, but also integrates diverse perspectives from 12-step abstinence-based models, self-psychology, and attachment theory into a complementary integrative formula. Attachment theory, self-psychology, and affect regulation theory characterize addiction as an attachment disorder induced by a person's misguided attempt at self-repair because of deficits in psychic structure. Vulnerability of the self is the consequence of developmental failures and early environmental deprivation leading to ineffective attachment styles. Substance abuse, as a reparative attempt, only exacerbates that condition because of physical dependence and further deterioration of existing physiological and psychological structures. Prolonged stress on existing structures leads to exaggerated difficulty in the regulation of affect, which leads to inadequate modulation of appropriate behavior and increased character pathology. _____
Title: Emotional distress regulation takes precedence over impulse control: If you feel bad, do it! Author(s): Tice, Dianne M., Case Western Reserve U, Dept of Psychology, Cleveland, OH, US; Bratslavsky, Ellen; Baumeister, Roy F. Source: Journal of Personality & Social Psychology, Vol 80(1), Jan 2001. pp. 53-67. Publisher: US: American Psychological Assn. Abstract: Why do people's impulse controls break down during emotional distress? Some theories propose that distress impairs one's motivation or one's ability to exert self-control, and some postulate self-destructive intentions arising from the moods. Contrary to those theories, three experiments found that believing that one's bad mood was frozen (unchangeable) eliminated the tendency to eat fattening snacks (Experiment 1), seek immediate gratification (Experiment 2), and engage in frivolous procrastination (Experiment 3). The implication is that when people are upset, they indulge immediate impulses to make themselves feel better, which amounts to giving short-term affect regulation priority over other self-regulatory goals. _____
Title: Continued attachment to parents: Its relationship to affect regulation and perceived stress among college students. Author(s): McCarthy, Christopher J., U Texas, Dept of Educational Psychology, Austin, TX, US; Moller, Naomi P., U Texas, Austin, TX, US; Fouladi, Rachel T. , U Texas, M. D. Anderson Cancer Ctr, Dept of Behavioral Science, Houston, TX, US Address: McCarthy, Christopher J., U Texas, Dept of Educational Psychology, George I. Sanchez Building, Suite 504, Austin, TX, US, 78712-1296, chris.macarthy@mail.utexas.edu Source: Measurement & Evaluation in Counseling & Development, Vol 33(4), Jan 2001. pp. 198-213. Publisher: US: American Counseling Assn. Abstract: The authors factor analyzed 4 self-report parental attachment (PA) inventories (the PBI, IPPA, PAQ, and CAS) designed for use with young adults to examine the construct validity of scores from these instruments and the overall factor structure of the attachment scales. The aim was to replicate the G. E. Heiss et al (1996) findings with a more specific focus on PA as opposed to general attachment style. The authors also evaluated whether factors derived from the 4 attachment measures were related to measures of emotional functioning, specifically, measures of confidence in coping with negative mood, awareness of one's own mood regulation strategies, and levels of perceived stress. Data were collected from 200 undergraduates (mean age 21.6 yrs; 60% female). The exploration of the relationships among the attachment measures showed several dimensions of attachment in young adults, including maternal attachment, paternal attachment, and parental overprotection. Preoccupation with one's parents was also assessed by 1 of the attachment measures and was reflected as a distinct dimension of attachment. The findings that these dimensions of PA were related to emotional functioning and levels of perceived stress provide evidence of the role of attachment in the well-being of young adults. _____
Title: Gazes, fires, and brain-body repair in Bronte Jane Eyre. Author(s): Straus, Nina Pelikan, Purchase Coll, State U New York, Humanities Div, Purchase, NY, US Address: Straus, Nina Pelikan, State U New York, Purchase Coll, 735 Anderson Hill Rd, Purchase, NY, US, 10577, Nina.Straus@purchase.edu Source: PsyART, Vol 5, 2001. pp. NP. Publisher: US: Univ of Florida. Abstract: The idea that the other's gaze can destroy but can also repair, thematized in Charlotte Brontke's Jane Eyre, now finds its cognitive base in the chemistry and anatomy of the body involving the development of neurons in the cortico-limbic areas of the brain. This paper suggests how neurobiological-psychoanalytic approaches to metaphor enable us to understand more clearly what stimulates readers' intense emotional reactions to Bronte's novel; how fire and gaze metaphors, in Bronte's handling, are never not connected to "the locus of the bodily-based self system" (Allan Schore, Affect Regulation and the Origin of the Self (1994). Critics of the novel have always noted the fire metaphors which connect childhood Jane's shame in the Red-room to the incendiary motifs of the "mad woman" Bertha, to Jane's "veins running fire" in passion for Rochester but also to feminist rage, and to the burning of Thornfield and Rochester's arm and eyes. The novel supports the neurological evidence that telling and reading of self-stories has therapeutic power: a power to repair brain-body networks that constitute the self. _____
Title: Hope when there is no hope: Discussion of Jill Scharff's case presentation. Author(s): Bromberg, Philip M., William Alanson White Psychoanalytic Inst, New York, NY, US Address: Bromberg, Philip M., 300 Central Park West, New York, NY, US, 10024 Source: Psychoanalytic Inquiry, Vol 21(4), 2001. pp. 519-529. Publisher: US: Analytic Press. Abstract: Comments on the article by J. S. Scharff concerning object relations therapy with a 35-yr-old female who is a survivor of childhood sexual trauma. The case material is viewed and discussed here from the vantage point of the 2 partners being an interpenetrating unit held in the grip of an "enactment"--an intrapsychic phenomenon that is played out interpersonally. The relationship between trauma, dissociation, shame, and affect regulation is explored in the context of impasse, repair, and psychoanalytic "technique." _____
Title: Shame reduction, affect regulation, and sexual boundary development: Essential building blocks of sexual addiction treatment. Author(s): Adams, Kenneth M., Kenneth M. Adams & Associates, Royal Oak, MI, US; Robinson, Donald W. Source: Sexual Addiction & Compulsivity , Vol 8(1), 2001. pp. 23-44. Publisher: United Kingdom: Taylor & Francis. Abstract: Sexual addiction is a compulsive cycle that attempts to compensate, soothe, and regulate the internal struggle. The cycle, in turn, creates more shame and dysregulation of affect. Sexual addiction treatment presents clinicians with unique challenges. This disorder has multiple facets to its etiology and requires multiple interventions at critical points in the process. Facing and reducing shame, developing affect regulation strategies to cope with feelings, impulses, and urges, and developing and maintaining sexual boundaries are key and necessary elements to successful treatment of sexual addiction. Intervention of both the addictive behavior and its causes is more likely to assure success than treatment of one area over the other. In treating both the behavior and its cause, the ability to form successful attachments and assimilate feelings and life experiences through a filter of hope, love, and worthiness is greatly increased. _____
Title: Un'indagine multi-tratto-multi-metodo sui costrutti della self-discrepancy theory. Translated Title: A multi-trait-multi-method study on the constructs of self-discrepancy theory. Author(s): Leone, Luigi, luigi.leone@uniroma1.it, U Roma "La Sapienza", Roma, Italy Address: Leone, Luigi, Dipartimento di Psicologia dei Processi di Sviluppo e Socializzazione, U "La Sapienza", Via dei Marsi 78, 00185, Roma, Italy, luigi.leone@uniroma1.it Source: Testing Psicometria Metodologia, Vol 8(1-2), 2001. pp. 33-54. Publisher: Italy: TPM. Abstract: Examined the convergent and discriminant validity of a set of self-discrepancy measures developed within the theoretical framework of self-discrepancy theory (SDT). SDT maintains that perceived discrepancies between actual self and 2 self-guides representing (1) ideals and aspirations and (2) duties and responsibilities play a crucial role in affect regulation. Even though the theory has received wide support, some issues concerning convergent and discriminant validity of self-discrepancy measures have been raised. 215 individuals (aged 15-59 yrs) participated in the study. Results show acceptable levels of convergent and discriminant validity of the measures. _____
Title: Assessment and treatment of the youthful suicidal patient. Author(s): Brent, David A., Western Psychiatric Inst & Clinic, Div of Child & Adolescent Psychiatry, Pittsburgh, PA, US Source: Hendin, Herbert (Ed); Mann, J. John (Ed); 2001. The clinical science of suicide prevention. Annals of the New York Academy of Sciences, vol. 932. New York, NY, US: New York Academy of Sciences. pp. 106-131 Abstract: Describes a framework for the assessment of suicidal risk in the adolescent that is based on existing epidemiological and clinical studies. The assessment of risk can then be used to determine the immediate disposition, intensity of treatment, and level of care. Furthermore, the assessment of psychiatric and psychological characteristics of the individual and family, as well as the motivation and precipitants for the suicidal episode, can be used to target areas of vulnerability and thereby help the patient reduce the risk of recurrent suicidal behavior. The approach to treatment, guided by the assessment, uses a model of suicidal behavior that is based on our clinical experience and the few extant clinical trials of the treatment of suicidal behavior. Recommended interventions involve treatment of psychopathology; amelioration of cognitive distortion and difficulties with social skills, problem solving, and affect regulation; and family psychoeducation and intervention. Given the chronic and recurrent nature of the conditions associated with adolescent suicide attempts, a long-term care plan involving both continuation and maintenance treatment is advocated. Further research is needed to identify the most effective approaches to the treatment of adolescent suicide attempters. Conference: Suicide Prevention 2000, May, 2000, New York, NY, US _____
Title: Affect and health-relevant cognition. Author(s): Salovey, Peter, Yale U, Dept of Psychology, New Haven, CT, US; Detweiler, Jerusha B.; Steward, Wayne T.; Bedell, Brian T. Source: Forgas, Joseph P. (Ed); 2001. Handbook of affect and social cognition. Mahwah, NJ, US: Lawrence Erlbaum Associates, Publishers. pp. 344-368 Abstract: Looks at modern research connecting emotional states to health cognition and, at times, to physical health outcomes. Pleasant (or unpleasant) affect may promote healthy (or unhealthy) perceptions, beliefs, and physical well-being. The authors review studies showing correlations between good moods and subjective health outcomes, and experimental research in which individuals report fewer physical symptoms and more salubrious health beliefs following happy as compared to sad mood induction. To understand these findings and suggest mechanisms linking pleasant feelings, salutary thoughts, and good health, research in other relevant domains is considered, including (1) direct effects of affect on the immune system; (2) individual difference variables associated with both mood and health; (3) associations among emotional experiences, the focus of attention, and the perception of physical symptoms; (4) the antecedents and consequences of social support; and (5) the use of health-promoting or health-damaging behaviors as affect-regulation strategies. _____
Title: Promoting the emotional development of preschoolers. Author(s): Ashiabi, Godwin S., U Tennessee, Dept of Child & Family Studies, Knoxville, TN, US Address: Ashiabi, Godwin S., 1021-1611 Laurel Avenue, Knoxville, TN, US, 37916-2052 Source: Early Childhood Education Journal, Vol 28(2), Win 2000. pp. 79-84. Publisher: US: Kluwer Academic/Plenum Publishers. Abstract: Examines evidence pertaining to the emotional development of preschoolers. The issues discussed include a synopsis of emotional expression, emotional understanding, the regulation of emotions, and their developmental significance. Furthermore, the role of the caregiver-child relationship as indicated by the security of attachment is provided. It is argued that caregivers influence the emotional development of children as they model, coach, and contingently respond to children. The implications of emotional development and the quality of the caregiver-child relationship for teachers as they pertain to affective displays, negotiation skills, affect regulation, and expectancies of children are discussed. Finally, some strategies for enhancing emotional development are suggested. _____
Title: A motivational perspective on risky behaviors: The role of personality and affect regulatory processes. Author(s): Cooper, M. Lynne, U Missouri, Dept of Psychology, Columbia, MO, US; Agocha, V. Bede; Sheldon, Melanie S. Source: Journal of Personality, Vol 68(6), Dec 2000. Special Issue: Personality processes and problem behavior. pp. 1059-1088. Publisher: US: Blackwell Publishers. Abstract: The present study tested a motivational model in which personality influences on risky behaviors were hypothesized to be primarily indirectly mediated, by shaping the nature and quality of emotional experience as well as characteristic styles of coping with these emotions. This model was tested in a representative community sample of 1,666 young adults, aged 18-25 yrs old. Results reveal strong support for the model, indicating that broad traits related to neuroticism and extraversion promote involvement in alcohol use and risky sex via distinct pathways. Neurotic individuals were prone to engage in risky behaviors as a way to cope with aversive mood states, whereas extraverted individuals were more likely to engage in risky behaviors as a way to enhance positive affective experience. In contrast, impulsivity directly predicted some forms of risk taking, and interacted with extraversion and neuroticism to predict motives for risky behaviors. The model provides a highly general though not complete account of risky behaviors. _____
Title: The prisoners of despair: Right hemisphere deficiency and suicide. Author(s): Weinberg, I. Source: Neuroscience & Biobehavioral Reviews, Vol 24(8), Dec 2000. pp. 799-815. Publisher: England: Elsevier Science. Abstract: Reviews literature concerning the inner experience of suicidal persons in terms of hemispheric asymmetry. The right hemisphere is involved in formation of polysemantic context, which is determined by multiple interconnections among its elements. Left hemisphere functioning leads to the formation of monosemantic context. It is hypothesized that, due to functional insufficiency of the right hemisphere, the suicidal person demonstrates a compensatory shift to left hemisphere functioning. This shift manifests itself in reversed asymmetry of neurotransmitters, a tendency to dissociation, alienated and negative perception of the body, lower sensitivity to pain, and disintegration of self-representation. Also possible are the overly general nature of personal memories, difficulties in affect regulation, and personality traits including low openness to experience and personal constriction. _____
Title: On the impact of mood on behavior: An integrative theory and a review. Author(s): Gendolla, Guido H. E., U Erlangen, Inst of Psychology, Erlangen, Germany Source: Review of General Psychology, Vol 4(4), Dec 2000. pp. 378-408. Publisher: US: American Psychological Assn/Educational Publishing Foundation. Abstract: Empirical evidence for effects of moods (both naturally occurring and experimentally manipulated) on behavior is reviewed in terms of an integrative theory: the mood-behavior model (MBM). It is posited that moods can influence behavior via 2 processes: (a) by informational effects on behavior-related judgments and appraisals, which in turn will result in behavioral adjustments (i.e., the informational mood impact on behavior), and (b) by influencing behavioral preferences and interests in compliance with a hedonic motive (i.e., the directive mood impact on behavior). The strength of the informational mood impact depends on moods' effective informational weight for behavior-related judgments and on mood-primed associations. The strength of the directive mood impact is predicted to be jointly determined by 2 variables: the strength of a hedonic motive and the instrumentality of possible acts for affect regulation. _____
Title: Impulskontrolle und Affektregulation bei Persoenlichkeitsstoerungen. Translated Title: Impulse control and affect regulation in personality disorders. Author(s): Herpertz, Sabine Christiane, Universitaetsklinikum der RWTH Aachen, Klinik fuer Psychiatrie und Psychotherapie, Aachen, Germany; Kunert, Hanns Juergen; Schuerkens, Anette; Steinmeyer, Eckhardt Michael; Sass, Henning; Freese, Roland; Flesch, Martin; Mueller-Isberner, Ruediger; Osterheider, Michael Source: Psychotherapie Psychosomatik Medizinische Psychologie, Vol 50(11), Nov 2000. pp. 435-442. Publisher: Germany: Georg Thieme Verlag. Abstract: Examined the interaction between affect dysregulation and impulse control disorder in patients with borderline and antisocial personality disorders in 2 experiments with women in Germany. Ss in Exp 1 were 75 former psychotherapy patients and 25 normal controls. The Ss were asked to rate their emotions on a 10-item scale as they listened to a short story. In Exp 2, 24 impulsive and emotionally unstable Ss with borderline personality disorders, 27 normal controls, and, during an extended phase, 23 Ss with low self-esteem disorders were presented visual stimuli of positive, neutral and negative valence. Measured were skin conductivity, startle latency, and heart frequency changes. The results suggest that in borderline personality disorder intense emotional responses occur in the context of specific stressors, in particular fear of being abandoned. No evidence was found for general emotional hyperreactivity. Instead, the Ss showed reduced emotional arousal. Regarding the psychopathic subtype of antisocial personality disorder, the results gave strong support for the theory of emotional detachment, which may predispose to violence through a lack of feeling of fear or compassion, which could counteract violent impulses. Consequences for psychotherapy are discussed. _____
Title: Regulation of negative affect during mother-child problem-solving interactions: Adolescent depressive status and family processes. Author(s): Sheeber, Lisa, Oregon Research Inst, Eugene, OR, US; Allen, Nicholas; Davis, Betsy; Sorensen, Erik Source: Journal of Abnormal Child Psychology, Vol 28(5), Oct 2000. pp. 467-479. Publisher: US: Kluwer Academic/Plenum Publishers. Abstract: Investigated whether 25 depressed adolescents (aged 12-19 yrs) differed from 25 nondepressed adolescents on 2 indices of affect regulation (i.e., duration of negative affective states and reciprocity of maternal negative affect) as well as whether these indices are related to microsocial family interactional processes. Analyses revealed that depressed teens differed from their nondepressed peers with regard to duration of negative affective states but not in their likelihood of reciprocating negative affect. Additionally, indices of adolescent affect regulation were related to family interactional processes. Duration of depressive affect was positively associated with maternal display of facilitative behavior contingent on adolescent depressive behavior. Duration of aggressive behavior was inversely related to maternal problem-solving responses to aggressive behavior. Finally, adolescent reciprocity of maternal depressive and aggressive behaviors was strongly associated with mothers' reciprocity of adolescents' negative affective behavior. _____
Title: The case of Katrina: Response summary. Author(s): Samoilov, Anna, Harvard Medical School, McLean Hosp, Belmont, MA, US; Goldfried, Marvin R. , State U New York, Stony Brook, NY, US Address: Samoilov, Anna, Harvard Medical School, McLean Hosp, 115 Mill St., Belmont, MA, US, 02178 Source: Cognitive & Behavioral Practice, Vol 7(4), Fal 2000. pp. 519-520. Publisher: US: Assn for Advancement of Behavior Therapy. Abstract: Responds to the comments made by K. A. Chase, G. C. Davison, R. J. Kohlenberg and M. Tsai, S. McMain, J. P. McCullough, Jr., and J. C. Norcross and N. A. Caldwell on the original article by A. Samoilov and M. R. Goldfried which examined the case of Katrina, a 25-yr-old, married woman with a history of multiple psychiatric hospitalizations due to recurrent, impulsive suicide attempts, pervasive suicidal ideation, depression, and intrusive memories of sexual abuse. Building on their unique theoretical and clinical backgrounds, the respondents presented curiously convergent views on the case of Katrina. The response papers highlighted Katrina's underlying deficit in affect regulation and the interaction between biological vulnerability and environmental stress as possible etiological factors in her illness. Most respondents suggested 2 main levels of interventions: skill-building interventions, and interventions with a focus on Katrina's in-session behaviors and therapeutic relationship. _____
Title: Therapeutic change in the psychiatric inpatient treatment of children: Looking beyond descriptive symptoms to psychological processes. Author(s): Hoffman, David Paul, California School Of Professional Psychology - Berkeley/Alameda, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 61(3-B), Sep 2000. pp. 1637. Publisher: US: Univ Microfilms International. Abstract: While outcome research attests to the effectiveness of child psychotherapy in reducing problematic emotional and behavioral symptoms, little is known about the psychological processes underlying therapeutic change. The aim of the present study is to expand the investigation of therapeutic change beyond behavioral symptoms by examining change in reality testing, divergent reasoning, self-perception, social processing and affect regulation which may occur with psychotherapy. The goal of the study is to evaluate both the efficacy of a particular child inpatient treatment program and to make a unique contribution to theories of change by exploring some of the internal mechanisms underlying symptom improvement. The present study analyzes changes in the Rorschach protocols of 41 conduct-disordered and depressed children treated in a psychiatric inpatient unit. It was hypothesized that impairments in reality testing, divergent reasoning, affect regulation, self-perception and social processing, as measured by Rorschach scales, would be evident at pre-treatment, and would improve over the course of treatment. Further, it was believed that changes in these processes during treatment would be significantly related to symptom reduction as assessed by the hospital staff. Significant results were revealed for each of the main hypotheses. At admission, children tended to show concrete thought processes, idiosyncratic and/or inaccurate perceptions, low levels of self- and interpersonally-focused attention, and disturbances in the control of emotions when compared to non-patient populations. As anticipated, externalizing difficulties, (i.e., aggression, hostility, and defiance) were associated with low levels of affect regulation, whereas, contrary to expectation, internalizing symptoms (i.e., depression, withdrawal, and anxiety) were associated with high levels of emotional control. Over the course of treatment, as expected, the present sample displayed increases in the conventionality and/or accuracy of their perceptions of the environment. Further, children carrying a primary diagnosis of conduct disorder demonstrated an increase in affect regulation and divergent reasoning. As expected, improvement in externalizing symptoms was predicted by increased control of negative affect and reduced self-focused attention. However, improvement in internalizing symptoms was best predicted by decreased levels of controlled negative affect. In sum, results support the notion that changes in specific intrapsychic processes occur with therapy and that these changes are associated with reductions in symptoms. _____
Title: Substance abuse and childhood maltreatment: Conceptualizing the recovery process. Author(s): Millar, Golden M., U Toronto, Dept of Adult Education, Community Development & Counselling Psychology, Toronto, ON, Canada; Stermac, Lana Source: Journal of Substance Abuse Treatment, Vol 19(2), Sep 2000. pp. 175-182. Publisher: US: Elsevier Science. Abstract: Research exploring the dual, yet related, issues of adulthood substance abuse and childhood maltreatment remains limited to the effects of such experiences on the individual. To date, clinical literature has failed to explore the ways in which individuals, particularly women, cope with and recover from these experiences. The current study applied a qualitative methodology to a sample of six women. Respondents had completed a minimum of 3 years of chemical-free living and self-identified as survivors of prolonged childhood sexual abuse. Women participated in a semi-structured interview to detail their recovery process. Results show support for a multifactorial process of recovery; specifically, strategies aimed at affect regulation, development of a new self-concept, and the forging of more adaptive attachment styles. The implications of these results are discussed in the context of improving clinical intervention strategies and encouraging additional research endeavors to understand this complex process. _____
Title: Adult attachment style and cognitive reactions to positive affect: A test of mental categorization and creative problem solving. Author(s): Mikulincer, Mario, Bar-Ilan U, Dept of Psychology, Ramat Gan, Israel; Sheffi, Elka Source: Motivation & Emotion, Vol 24(3), Sep 2000. pp. 149-174. Publisher: US: Kluwer Academic/Plenum Publishers. Abstract: Examined the moderating effect of attachment style on cognitive reactions to positive affect inductions in 3 studies. Ss were university students (aged 19-32 yrs) in Israel. Attachment styles assessed included secure, anxious-ambivalent, and avoidant. In Study 1, 110 Ss completed attachment style scales, were asked to retrieve a happy or a neutral memory, and performed a categorization task. Study 2 used the same affect induction while examining creative problem solving in 120 Ss using Remote Associates Test. Study 3 replicated Study 2 while using another affect induction (watching a comedy film) and controlling for trait anxiety scores in 120 Ss. The results suggest that securely attached persons react to positive affect with broader categorization and better performance in creative problem-solving tasks. Anxious-ambivalent persons show an opposite pattern of cognitive reactions to positive affect. Further, avoidant persons show no difference in their cognitive reactions to positive and neutral affect inductions. These findings emphasize the role that attachment-related strategies of affect regulation may play in episodes of positive affect. _____
Title: An affect-regulation model of alcohol consumption: Replication and extension of Cooper's model.(M. L. Cooper). Author(s): Weller, Jennifer Ann , Arizona State U., US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 61(2-B), Aug 2000. pp. 1101. Publisher: US: Univ Microfilms International. Abstract: The current study replicated and extended an affect-regulation model of alcohol consumption originally proposed by Cooper, Frone, Russell, and Mudar. This motivational model of alcohol consumption includes antecedants and consequences of drinking to enhance positive affect and drinking to cope with negative affect. Replication of this affect-regulation model using young adult data from a larger, ongoing study of children of alcoholics and controls suggested that drinking to enhance social and emotional experiences is phenomenologically different behavior from drinking to cope with anxious or depressive feelings. In addition, individuals who reported being motivated to drink to enhance positive affect demonstrated different drinking patterns than did individuals who reported motivation to drink to cope. Whereas a direct link was found between coping motives to drink and alcohol dependency symptoms, a similar link was not found between enhancement motives to drink and alcohol dependency symptoms. Several extensions of the original model were tested, including longitudinal versions of the model that included previously untested variables such as negative beliefs about the effects of alcohol on behavior, motives to limit one's drinking, and parental alcoholism. Implications for the fit of these models to the current data is discussed with respect to clinical interventions for problem drinking. _____
Title: Group dialectical behavior therapy for binge-eating disorder: A preliminary, uncontrolled trial. Author(s): Telch, Christy F., Stanford U School of Medicine, Stanford, CA, US; Agras, W. Stewart; Linehan, Marsha M. Source: Behavior Therapy, Vol 31(3), Sum 2000. pp. 569-582. Publisher: US: Assn for Advancement of Behavior Therapy. Abstract: Provides preliminary data regarding the efficacy of dialectical behavior therapy (DBT) adapted for the treatment of binge-eating disorder (BED). 11 women with BED participated in this uncontrolled trial and were administered the Eating Disorder Examination together with measures of weight, mood, and affect regulation at baseline and posttreatment. Data on binge eating and weight were also collected at 3- and 6-mo followup. 82% of women were no longer binge eating by treatment end. Improvement in emotion regulation was also evidenced. The improvement in binge eating was maintained during followup. _____
Title: Personality characteristics of adolescent suicide attempters. Author(s): Fritsch, Sandra, Rhode Island Hosp, Providence, RI, US; Donaldson, Deidre; Spirito, Anthony; Plummer, Barry Source: Child Psychiatry & Human Development, Vol 30(4), Sum 2000. pp. 219-235. Publisher: US: Kluwer Academic. Abstract: Explored both the personality characteristics and the symptoms of personality disorder of adolescent suicide attempters (ASAs), as well as the relationship between personality variables and hopelessness in this population. Two sample populations were used. First, 102 ASAs (aged 13-18 yrs) completed the Millon Adolescent Personality Inventory (MAPI) and the Hopelessness Scale for Children (HSC). A 2nd group of 35 ASAs (aged 11-17 yrs) were administered the HSC and the revised Diagnostic Interview for Borderlines (DIB). No distinctive personality characteristics or symptoms of personality disorders were found. However, affective distress seemed to be the most prominent feature in the presentation of these adolescents. Additionally, high scores on the HSC were associated with elevated scores on the Personality Style scales of the MAPI and higher (more dysfunctional) scores on Affect Regulation on the DIB. Results suggest that clinicians should focus most on the personality characteristic of sensitivity and on affect regulation when assessing ASAs. In addition, hopelessness is important to systematically assess because it appears to be related to a variety of dysfunctional personality characteristics that may affect follow-up outcome. _____
Title: Alexithymia, self-care, and satisfaction with life in college students. Author(s): Schmitz, Martha Josephine, U Missouri - Columbia, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 60(11-B), Jun 2000. pp. 5790. Publisher: US: Univ Microfilms International. Abstract: Alexithymia is a cognitive and emotional disturbance characterized by difficulty identifying and distinguishing feelings and externally-oriented thinking (Bagby, Parker, & Taylor, 1994a). The purpose of this research was to investigate the effects of alexithymia on life satisfaction. In particular, it was predicted that people with alexithymia would be less satisfied with life due to deficits in self-care and inability to modulate painful affective states (Krystal, 1977, 1979). A total of 534 university students (121 men, 413 women) completed a set of instruments, including the Toronto Alexithymia Scale-20 (Taylor, Bagby, & Parker, 1992), the Self-Nurturance Scale (Seal, 1990), the Affect Regulation Scale (Schaffer, 1993) and the Satisfaction with Life Scale (Diener, Emmons, Larsen, & Griffin, 1985). Results of a structural equation model indicated that non-alexithymic individuals were more self-nurturant than those with alexithymia. Those students who were more self-nurturant, and who used positive strategies to regulate painful emotions, also reported higher levels of life satisfaction. Individuals with alexithymia reportedly used more negative strategies to modulate affect and were also less satisfied with life. The indirect path between alexithymia and satisfaction with life was mediated by self-nurturance and by negative affect regulation. Thus, individuals with alexithymia reported less life satisfaction than other participants due to their more frequent use of negative affect regulation strategies and inability to self-nurture. _____
Title: Predictors of coping styles in response to infidelity among college students. Author(s): Vocaturo, Loran Catherine, Rutgers The State U New Jersey - New Brunswick, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 60(11-B), Jun 2000. pp. 5796. Publisher: US: Univ Microfilms International. Abstract: This study considers the role of relationship factors in determining individual coping styles in response to a partner's infidelity. This research is designed to be consistent with attachment theory in determining affect regulation and appraisals of threat within romantic relationships. Additionally, this study examined the relationship between attachment styles as defined by Bartholomew and Horowitz's (1991) four-category model of attachment with other relationship variables, namely, the caregiving system and commitment levels. Finally, this research explored gender differences in defining infidelity. Subjects were 227 students (108 undergraduate, 19 graduate) enrolled in research subject pools and introductory psychology courses. Subject's attachment style was determined via The Adult Attachment Scale (Bartholomew & Horowitz, 1991). Caregiving styles were determined by Kunce and Shaver's (1994) Caregiving Questionnaire. Commitment levels were measured with the Commitment Inventory developed by Adams and Jones (1997). Subjects were presented with a scenario depicting the discovery of their partner's sexual or emotional infidelity. Subjects were then asked to rate how much the scenario reflected infidelity and the level of distress they would feel in response to this event, and they then responded to the Ways of Coping Scale developed by Folkman and Lazarus (1988). The analysis revealed that individuals with secure attachment reported higher levels of secure caregiving and commitment to their partners. Additionally, securely attached persons tended to report more problem-focused coping while individual's with insecure attachment styles reported more emotion-focused coping strategies. The results imply, therefore, that attachment styles are related to how relationship stressors are appraised and responded to. Caregiving and commitment levels were not found to have a significant impact on the coping process. The analysis also revealed that men and women define infidelity differently, with men defining infidelity by sexual behaviors while women include emotional factors. Although men and women may define infidelity differently, the results indicate that infidelity, regardless of the type, produces a moderate degree of distress among men and women. Finally, the results suggest that attachment style is related more to coping styles in response to emotional infidelity than sexual infidelity. _____
Title: Affect dysregulation: Defense or deficit? Author(s): Glucksman, Myron L., New York Medical Coll, Dept of Psychiatry & Behavioral Sciences, Valhalla, NY, US Source: Journal of the American Academy of Psychoanalysis, Vol 28(2), Sum 2000. Special Issue: Neuroscience and Psychoanalysis. pp. 263-273. Publisher: US: Guilford Publications. Abstract: Explores both psychodynamic and neurobiological phenomena in those individuals who have either a limited or total absence of affective experience and expression. Disorders of affects are found across virtually the entire psychopathological spectrum, including bipolar, personality, anxiety, depressive, and dissociative disorders. The construct of affect regulation has evolved from clinical, developmental, and neurobiological studies. Social interaction (including emotional feedback between individuals), language, fantasies, dreams, play, facial expressions, defense mechanisms, autonomic, neurochemical, and musculoskeletal activity collectively influence emotional regulation. Normative affective development and regulation fails when the mother is unable to understand or read her infant's emotional cues. If the developmental sequences of mirroring, affective attunement, and parental processing of the child's inner affective life are deficient, a deficit of emotional experience and expression may result. A clinical presentation is given which illustrates the psychopathological and psychodynamic features of a patient with profound difficulties in identifying and expressing her feelings. Diagnostically, she manifests features of depression, depersonalization, and alexithymia. Conference: 43rd Winter Meeting of The American Academy of Psychoanalysis, 43, Jan, 2000, New York, NY, US _____
Title: Attachment style, representations of self and others, and affect regulation: Implications for the experience of depression. Author(s): Levy, Kenneth Neil, City U New York, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 60(9-B), Apr 2000. pp. 4895. Publisher: US: Univ Microfilms International. Abstract: The capacity for affect regulation is essential for healthy adaptation, and impairments in the ability to regulate affect increases an individual's vulnerability to a variety of psychological difficulties. An increasing number of studies have documented that both impaired mental representations and insecure attachment are related to increased risk for problems in affect regulation such as depression. However, there is a dearth of empirical data linking mental representations and insecure attachment to affect regulation and depression. The present study examined the hypothesis that differences in adult attachment styles are associated with differences in the content and structure of mental representations and with qualitatively different ways of modulating affects. One hundred twenty-eight undergraduates were classified into one of four attachment groups using the Relationship Questionnaire (Bartholomew & Horowitz, 1993). Mental representations were assessed using procedures developed by Blatt, Diamond, and their colleagues (Blatt et al., 1992; Diamond et al., 1995). Affect regulation was assessed using the Affect Regulation Scale (Levy, 1994), the Affect Regulation Questionnaire (Schaffer, 1992), and the Depressive Experiences Questionnaire (Blatt et al., 1979). Correlational, multivariate analyses of variance, and regression analyses revealed significant relationships among attachment patterns, mental representations, affect regulation, and depression. Secure and fearful individuals evidenced significantly more complex, differentiated, and integrated representations of self and others. While there were no differences in the self-report of adaptive affect regulation strategies, preoccupied and dismissive subjects reported using significantly more maladaptive affect regulation strategies. Preoccupied individuals tended toward oral-somatic and self-injurious behaviors to regulate affect, whereas dismissing individuals were more likely to employ sex, drugs, and violent fantasy and behaviors to regulate negative internal states. In contrast, secure and fearful individuals' narrative descriptions of feeling states evidenced higher developmental levels of affective organization than preoccupied and dismissing subjects. Finally, secure attachment was negatively related to depression, fearful attachment was related to an interpersonally-based depression, while anxious-ambivalent attachment was related to a more anaclitic needy depression. Findings are consistent with previous research and further contribute to our understanding by elaborating the relationship between adult attachment style, mental representations, and affect regulation. The developmental and clinical implications of these findings are discussed. _____
Title: Parental bonding, adult attachment, and differences in affect regulation. Author(s): Schreiber, Roxanne, U Southern Mississippi, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 60(9-B), Apr 2000. pp. 4968. Publisher: US: Univ Microfilms International. Abstract: In this study differences in affects organized along four dimensions of contrast (positive affect, negative affect, affect directed toward self-enhancement, and affect directed toward contact and union with others) were examined among a sample of participants (N = 100) as a function of either dominant parental bonding category (optimal, affectionate constraint, affectionless control, and absent/weak) or dominant attachment style (secure, preoccupied, dismissing, and fearful). Findings from this study were similar to those from previous research on emotion and attachment. Participants in the optimal bonding group and the secure attachment group reported the most positive affective experiences across all four dimensions of contrast, while participants in the affectionless control bonding group and the fearful attachment group reported the least positive experiences across all four dimensions of contrast. Participants in the dismissing attachment group reported significantly high levels of affect directed toward self-enhancement, and significantly low levels of affect directed toward contact and union with others, while participants in the preoccupied attachment group reported significantly high levels of affect directed toward contact and union with others. It is important to note that affective experiences also differed by caregiver gender (i.e., absent/weak paternal bonding was associated with significantly low levels of positive affect while absent/weak maternal bonding was associated with significantly high levels of affect directed toward self-enhancement). Unexpectedly, participants in the preoccupied attachment group did not report significantly high levels of negative affect and also did not differ from participants in the secure and dismissing attachment groups in affect directed toward self-enhancement. Possible reasons for these discrepancies are explored in the context of differing cognitive and affective working models, as well as differing manifestations of this style's parental care scores (high maternal care versus low paternal care) across gendered contexts. Differences were also noted in levels of paternal and maternal bonding across attachment styles. More specifically, (a) participants in the fearful attachment group reported significantly high levels of parental (maternal and paternal) overprotection, (b) participants in the dismissing attachment group reported significantly low levels of maternal overprotection, and (c) participants in the preoccupied attachment group reported significantly high levels of maternal care and significantly low levels of paternal care. The potential role these parental dimensions may play in the development of self and other working models is discussed. _____
Title: Substance use disorders in schizophrenia: Review, integration, and a proposed model. Author(s): Blanchard, Jack J., U Maryland, Dept of Psychology, College Park, MD, US; Brown, Seth A.; Horan, William P.; Sherwood, Andrea R. Source: Clinical Psychology Review, Vol 20(2), Mar 2000. pp. 207-234. Publisher: US: Elsevier Science/Pergamon. Abstract: Substance use disorders occur in approximately 40 to 50% of individuals with schizophrenia. Clinically, substance use disorders are associated with a variety of negative outcomes in schizophrenia, including incarceration, homelessness, violence, and suicide. An understanding of the reasons for such high rates of substance use disorders may yield insights into the treatment of this comorbidity in schizophrenia. This review summarizes methodological and conceptual issues concerning the study of substance use disorders in schizophrenia and provides a review of the prevalence of this co-occurrence. Prevailing theories regarding the co-occurrence of schizophrenia and substance use disorders are reviewed. Little empirical support is found for models suggesting that schizophrenic symptoms lead to substance use (self-medication), that substance use leads to schizophrenia, or that there is a genetic relationship between schizophrenia and substance use. An integrative affect-regulation model incorporating individual differences in traits and responses to stress is proposed for future study. _____
Title: Cognitive neuroscience, neurobiology and affect regulation: Implications for clinical social work. Author(s): Shapiro, Janet R., Bryn Mawr Coll, Graduate School of Social Work & Social Research, Bryn Mawr, PA, US; Applegate, Jeffrey S. Source: Clinical Social Work Journal, Vol 28(1), Spr 2000. pp. 9-21. Publisher: US: Kluwer Academic/Plenum Publishers. Abstract: The purpose of this article is to review and consider the ways in which recent advances in cognitive neuroscience and neurobiology inform a biopsychosocial perspective for understanding and intervening with at-risk families. Specifically, the authors focus on the ways in which such work contributes to an understanding of affect regulation as an important determinant and consequence of early interactive experience. In turn, this knowledge can be employed both in primary prevention and in later intervention with families whose well being has been compromised by affect dysregulation. _____
Title: Mental representations in stressful situations: The calming effect of significant others. Author(s): Mcgowan, Stephanie, State U New York At Albany, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 60(8-B), Mar 2000. pp. 4305. Publisher: US: Univ Microfilms International. Abstract: The relationship between mental representations of others and attachment style was investigated in order to explain affect regulation and self-esteem maintenance in stressful situations. Participants were asked to think about and describe either a significant other or acquaintance while waiting to take part in a potentially stressful event. In terms of anxiety, mood, and state self-esteem, no overall differences were found between individuals who thought of an acquaintance and individuals who thought of an important person in their life; however, an interaction between attachment style and other-condition was found. In the significant other condition, secure individuals had significantly lower levels of anxiety and negative affect than insecure individuals, but in the acquaintance condition, insecure individuals had slightly lower levels of anxiety and negative affect than secure individuals. Additional analyses suggested that, in particular, the self-model aspect of adult attachment seems to explain these differences. _____
Title: Borderline personality and obsessive-compulsive symptoms. Author(s): McKay, Dean, Fordham U, Dept of Psychology, Bronx, NY, US; Kulchycky, Sonia; Danyko, Stephen Source: Journal of Personality Disorders, Vol 14(1), Spr 2000. pp. 57-63. Publisher: US: Guilford Publications. Abstract: Diagnostic criteria for borderline personality disorder (BPD) are diverse, covering a broad range of symptoms. One criterion, self-mutilation, is a behavioral excess that may be considered a predictor of other psychopathological states. The present study sought to determine the extent to which 2 groups of BPD patients, those who mutilate (n = 20; mean age 32.7 yrs) and those who do not (n = 12; mean age 32.3 yrs), differed on measures of general psychopathology, depression, anxiety, and obsessive-compulsive symptoms. Results indicate that the only source of significant variation was the level of obsessive-compulsive symptoms, with mutilators exhibiting greater symptomatology. These findings support the idea that self-mutilation is a more severe form of psychopathology relative to the rest of the BPD population. Results are interpreted based on the affect regulation model of self-mutilation, and contrasted with contemporary models of impulse control in relation to obsessive-compulsive disorder. _____
Title: Rorschach interaction patterns, alexithymia, and closeness to parents in psychotic and psychosomatic patients. Author(s): Solano, Luigi, U di Roma "La Sapienza", Dipartimento di Psicologia, Rome, Italy; Toriello, A.; Barnaba, L.; Ara, R.; Taylor, G. J. Source: Journal of the American Academy of Psychoanalysis , Vol 28(1), Spr 2000. pp. 101-116. Publisher: US: Guilford Publications. Abstract: Explores the similarities and differences between 20 mentally ill patients (mean age 32.25 yrs) and 20 psychosomatically ill patients (32.40 yrs) on measures of alexithymia, perceived closeness to parents, and mental representations of interrelationships. The authors expected to find high but similar degrees of alexithymia in both groups, and low closeness to parents in both groups with possible differences with respect to relationships with mother and father. Additionally, they expected to find a prevalence of an avoidant relational style among psychosomatic Ss, and a prevalence of an ambivalent relational style among psychotic Ss. All Ss were given the Twenty-Item Toronto Alexithymia Scale, the Family Attitude Questionnaire, and the Rorschach Interaction Scale. Both the psychotic and psychosomatic Ss showed a lack of general closeness to parents and a high degree of alexithymia. In addition, the two groups showed a predominance of maladaptive Rorschach interaction patterns suggestive of internal working models associated with insecure attachment styles, poor affect regulation, and a defective "inner container". However, while the majority of the psychosomatic Ss showed an Avoidant interaction pattern, the majority of psychotic Ss were Ambivalent (55%) and Flexible (25%). _____
Title: Predicting adolescent smoking: A prospective study of personality variables. Author(s): Burt, Richard D., Fred Hutchinson Cancer Research Ctr, Div of Public Health, Cancer Prevention Research Program, Hutchinson Smoking Prevention Project, Seattle, WA, US; Dinh, Khanh T.; Peterson, Arthur V. Jr.; Sarason, Irwin G. Source: Preventive Medicine: An International Journal Devoted to Practice & Theory, Vol 30(2), Feb 2000. pp. 115-125. Publisher: US: Academic Press. Abstract: Investigated how personality variables measured at 5th grade predict daily smoking in 12th grade. 3,130 5th graders were assessed for a propensity toward Rebelliousness, Risk Taking, Problem Helplessness, Affect Regulation, and Early Maturation and susceptibility to Peer Compliance and Peer-Approval. Daily smoking status was determined for 94.7% of them 7 yrs later, in 12th grade. Rebelliousness and Risk Taking were the most significant predictors of smoking. There was no statistical evidence that the extent of prediction depended on gender or history of early smoking. No predictive evidence was seen for the other personality measures, including those describing susceptibility to peer influences. These results show that propensity toward rebelliousness and risk taking in childhood predict adolescent smoking. They suggest that smoking prevention programs would do well to address the needs and expectations of rebellious and risk-taking youth. _____
Title: The utilization of the Rorschach Ink Blot Test to determine affect dysregulation among an inpatient population of sexual trauma survivors. Author(s): Aspenleiter, Julie Ann, U Hartford, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering, Vol 61(6-B), Jan 2000. pp. 3269. Publisher: US: Univ Microfilms International. Abstract: This study examined the ability to regulate affect among individuals who report a history of abuse. The Rorschach structural summaries of sixty subjects were selected from an archival data base of an adult inpatient unit based on subjects' self report of having been the victim of sexual abuse prior to the age of 18 years. The subjects were divided into two groups and differentiated by severity and duration of abuse, victim's relationship to the perpetrator, and victim's age of onset of abuse. Specific Rorschach structural variables and ratios were compared statistically to determine variance between the two groups and the normative population. As hypothesized, subjects who reported a more severe history of abuse demonstrated greater dysregulation in the ability to modulate their emotions as determined by the Rorschach Ink Blot Test. Contrary to prediction, subject's dysregulation manifested as mostly avoidant with surprisingly only minimal indications of unmodulated expression of emotion. The author underscores the importance of clinicians taking into consideration the role of affect regulation in the treatment of trauma survivors. _____
Title: Attachment, stress, and coping in college students. Author(s): Kemp, Martha Allison , U Florida, US Source: Dissertation Abstracts International: Section B: The Sciences & Engineering , Vol 60(12-B), 2000. pp. 6368. Publisher: US: Univ Microfilms International. Abstract: This study explored the relationship between adult attachment style and responses to self-reported stress events in college students. The study was designed to test hypotheses about the buffering effects of secure attachment and specific affect regulation strategies used by people with the preoccupied, fearful, and dismissing attachment styles. Introductory psychology students (N = 1157) were prescreened using the Bartholomew and Horowitz four-category self-report measure of adult attachment. Scores on this measure were used to select 193 participants (101 women, and 92 men) in the four attachment categories. Participants wrote a narrative account of a recent stressful experience and completed the Impact of Event Scale (IES) and the Ways of Coping (Revised) (WOC) in relation to the stress event. Participants also described current levels of psychiatric symptoms on the Brief Symptom Inventory (BSI). Results generally supported hypotheses about the buffering effects of secure attachment with respect to significantly lower levels of distress on the IES intrusion scale and the BSI Global Severity Index (GSI) but not in relation to increased social support seeking on the WOC. As hypothesized, the preoccupied attachment group reported increased distress, as evidenced by significantly higher mean scores on the EES intrusion scale and the GSI of the BSI as well as elevated levels of escape avoidance responses on the WOC. As predicted, the fearful attachment group had elevated scores on the Depression scale of the BSI (significantly higher than the secure and dismissing groups, although not different from the preoccupied group). Results failed to support predictions that the dismissing group would have elevated scores on scales of avoidance (EES), distancing (WOC), or Hostility and Somatization (BSI). The relation between attachment style and measures of distress and coping was the same within each gender, but for 9 of the 20 measures, there was a significant gender effect, with women scoring higher than men in each case. Recommendations for future research included the use of alternatives to self-report to increase internal validity, particularly with regard to testing hypotheses about the dismissing attachment group. Results are discussed as supporting the utility of attachment theory in conceptualizing mental health issues, and planning interventions. _____
Title: A longitudinal model of social contact, social support, depression, and alcohol use. Author(s): Peirce, Robert S., Research Inst on Addictions, Buffalo, NY, US; Frone, Michael R.; Russell, Marcia; Cooper, M. Lynne; Mudar, Pamela Source: Health Psychology, Vol 19(1), Jan 2000. pp. 28-38. Publisher: US: American Psychological Assn. Abstract: The longitudinal relations among contact with one's social network (social contact), perceived social support, depression, and alcohol use were examined. An integrative model was developed from affect regulation theory and theories of social support and dysfunctional drinking. Data were obtained from a random sample of 1,192 adults. The 3-wave panel model was tested using structural equation modeling analysis. Results revealed that (a) social contact was positively related to perceived social support; (b) perceived social support was, in turn, negatively related to depression; and (c) depression was, in turn, positively related to alcohol use for 1 of 2 longitudinal lags. There was partial support for the feedback hypothesis that increased alcohol use leads to decreased contact with family and friends. Although the results generally supported the authors' hypotheses, the significant coefficients in the model were generally small in size. _____
Title: Religiosity, adult attachment, and why "singles" are more religious. Author(s): Granqvist, Pehr, Uppsala U, Dept of Psychology, Uppsala, Sweden; Hagekull, Berit Source: International Journal for the Psychology of Religion , Vol 10(2), 2000. pp. 111-123. Publisher: US: Lawrence Erlbaum. Abstract: Investigated the links of adult attachment style and relationship status to various indexes of religiosity. Ss were 156 university students (aged 18-51 yrs). Results showed a modest positive association between adult attachment security and those religiosity variables that tapped features of the individual's relationship with God. In support of a compensation hypothesis, singles, as compared to lovers, were found to be more religiously active, perceive a personal relationship with God, have experienced changes implying increased importance of religious beliefs, and have experienced a religiosity that is based on affect regulation to a larger extent. _____
Title: Relationship between self-soothing, aloneness, and evocative memory in bulimia nervosa. Author(s): Esplen, Mary Jane, Mt Sinai Hosp, Dept of Psychiatry, Toronto, ON, Canada; Garfinkel, Paul; Gallop, Ruth Source: International Journal of Eating Disorders, Vol 27(1), Jan 2000. pp. 96-100. Publisher: US: John Wiley & Sons. Abstract: The relationship between characteristics of self-soothing ability, the capacity for evocative memory, and aloneness were investigated in a clinical sample of 50 bulimia nervosa (BN) patients (aged 18-44 yrs). Individuals meeting Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) criteria for BN who participated in a randomized trial of guided imagery completed measures of Soothing Receptivity and a modified version of the UCLA-Loneliness Scale, resulting in the Aloneness/Evocative Memory Scale. A lower level of soothing receptivity (indicating a decreased capacity for self-soothing) was correlated with a decreased capacity for evocative memory. A lower level of soothing receptivity and decreased capacity for evocative memory were associated with a greater experience of aloneness. Results suggest the need for a more comprehensive understanding of the role of affect regulation and the experience of aloneness in BN and the need to develop treatments to specifically address these features of the illness. _____
Title: Affect regulation in alexithymia: An ethological study of displacement behavior during psychiatric interviews. Author(s): Troisi, Alfonso, U Rome Tor Vergata, Dept of Psychiatry, Rome, Italy; Belsanti, Sergio; Bucci, Anna Rosaria; Mosco, Cristina; Sinti, Fabiola; Verucci, Monica Source: Journal of Nervous & Mental Disease, Vol 188(1), Jan 2000. pp. 13-18. Publisher: US: Lippincott Williams & Wilkins. Abstract: Displacement activities (i.e., self-directed behaviors such as self-touching, scratching, and self-grooming) are a reliable ethological indicator of increased emotional and physiological arousal throughout the phylogenetic scale. This study hypothesized that, in alexithymic individuals, the failure to regulate cognitively distressing emotions might result in increased displacement behavior. The nonverbal behavior of 30 outpatients (aged 18-62 yrs) with depressive or anxiety disorders was video-recorded during psychiatric interviews. Before being interviewed, each patient completed the Twenty-Item Toronto Alexithymia Scale, the Beck Depression Inventory, and the state form of the State-Trait Anxiety Index. Patients with more pronounced alexithymic features showed a significantly higher frequency of displacement activities during interviews. These patients reported levels of self-rated anxiety and depression equivalent to those reported by nonalexithymic patients. Such a dissociation between cognitive appraisal of emotion and nonverbal behavior reflecting increased emotional arousal supports the view that alexithymia implies a failure to elevate emotions from a preconceptual level of organization to the conceptual level of mental representations. _____
Title: Beyond hedonism: Broadening the scope of affect regulation. Author(s): Hirt, Edward R., Indiana U, Dept of Psychology, Bloomington, IN, US; McCrea, Sean M. Source: Psychological Inquiry, Vol 11(3), 2000. pp. 180-183. Publisher: US: Lawrence Erlbaum. Abstract: Comments on the articles by R. J. Larsen, R. Erber and M. W. Erber, and D. M. Tice and E. Bratslavsky which examined the topic of emotion regulation. It is noted that these articles share the perspective that mood regulation can be brought into a more general self-regulation framework. The present authors focus on how such a perspective yields 2 important propositions, both of which move us beyond a simple hedonistic principle. First, constraints may be placed on the pursuit of positive mood states. Second, recent models of self-regulation emphasize that underlying motives determine how goals are pursued and the consequences of goal attainment or failure. The authors discuss each of these points and provide some further evidence for their importance in understanding mood regulation. _____
Title: Mood and emotion control: Some thoughts on the state of the field. Author(s): Tice, Dianne M., Case Western Reserve U, Dept of Psychology, Cleveland, OH, US; Wallace, Harry Source: Psychological Inquiry, Vol 11(3), 2000. pp. 214-217. Publisher: US: Lawrence Erlbaum. Abstract: Comments on the articles by R. J. Larsen and R. Erber and M. W. Erber which examined the topic of emotion regulation and responds to comments by K. L. Bell and S. D. Calkins, G. L. Clore and M. D. Robinson, N. Eisenberg and Q. Zhou, J. P. Forgas, A. Freitas and P. Salovey, E. R. Hirt and S. M. McCrea, A. S. R. Manstead and A. H. Fischer, J. D. Mayer, W. N. Morris, R. E. Thayer, and D. Watson on the article by D. M. Tice and E. Bratslavsky which placed emotional regulation and mood control in the context of general self-control and self-regulation. The present authors argue that the diversity of approaches expressed in these articles suggests that there is no dominant paradigm in the field of affect regulation; authors can't even agree on what affect regulation is. _____
Title: Compulsive cybersex: The new tea room. Author(s): Schwartz, Mark F., Masters & Johnson Clinic, St Louis, MO, US; Southern, Stephen Source: Sexual Addiction & Compulsivity, Vol 7(1-2), 2000. Special Issue: Cybersex: The dark side of the force. pp. 127-144. Publisher: United Kingdom: Taylor & Francis. Abstract: Cybersex has become the new tea room for meeting anonymous partners and engaging in a fantasy world in which survivors of childhood abuse escape the demands of daily life as well as the pain and shame of past trauma. Compulsive cybersex is described as a survival mechanism involving dissociative reenactment and affect regulation. Descriptive data from a clinical population of cybersex abusers (aged 17-66 yrs) were reviewed to construct four subtypes of cybersex addiction: male cybersex addicts, female cybersex addicts, loner cybersex addicts, and paraphiliac cybersex addicts. Treatment strategies for each of the subtypes are recommended. _____
Title: Integrative cognitive therapy for bulimic behavior. Author(s): Wonderlich, Stephen A., Neuropsychiatric Research Inst, Fargo, ND, US; Peterson, Carol B.; Mitchell, James E.; Crow, Scott J. Source: Miller, Katherine J. (Ed); Mizes, J. Scott (Ed); 2000. Comparative treatments for eating disorders. Springer series on comparative treatments for psychological disorders. New York, NY, US: Springer Publishing Co. pp. 258-282 Abstract: Integrative cognitive therapy (ICT) is a new treatment for individuals with eating disturbances that includes dietary restriction, binge eating, and purging behaviors. While the treatment retains many elements of contemporary cognitive behavior therapy approaches for bulimia nervosa, it is based on a broader model of cause and maintenance of bulimia nervosa which, consequently, places a greater clinical focus on other factors, such as cultural variables, cognitions reflecting self discrepancy, interpersonal schemas, interpersonal relationship patterns, and affect regulation. A model of bulimic behavior and therapist's skills and attributes are included in the treatment model. Integrative cognitive therapy is then applied to the assessment, conceptualization, and treatment planning for the case of Kristen, a 26-yr-old woman with an eating disorder. The therapeutic relationship, treatment implementation, and outcome for the case of Kristen are also discussed.
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