Toxic Environment of war: Maternal prenatal heavy metal load predicts infant emotional development

BackgroundPeople in war zones are exposed to heavy metal contamination deriving from new-generation weapons, in addition to exposure to psychologically traumatizing war events. Pregnant women and their children-to-be are particularly vulnerable to both biological and psychological war effects.ObjectiveThe aim of the current study was to analyse the impact of maternal prenatal heavy metal contamination on infant emotional development and to examine the potential moderating role of maternal symptoms of post-traumatic stress disorder (PTSD) in the association between heavy metal load and infant emotional development.MethodsThe participants were 502 Palestinian mothers, pregnant in their first trimester during the 2014 War on Gaza. The mothers were recruited at their delivery (T1) and followed at the infants’ age of 6–7 months (T2; N = 392). The load of five weapon-related heavy metals (chromium, mercury, vanadium, strontium, and uranium) was analysed by Inductively Coupled Plasma Mass Spectrometry (ICP/MS) from mothers’ hair samples at childbirth (T1). Assessment of maternal PTSD symptoms was based on the Harvard Trauma Questionnaire (HTQ) and infant emotional development on the Infant Behavior Questionnaire (IBQ), both reported by mothers (T2).ResultsTwo of the analysed metals, chromium and uranium, adversely predicted children’s early emotional development, indicated by decreased positive affectivity, increased negative emotionality, and problems in early orientation and regulation. Mother’s PTSD did not moderate the impact of heavy metal contamination on children’s emotional development.ConclusionsAdverse impact of war is not limited to those who experience it directly, but is passed on to future generations through multiple mechanisms. International organizations are obliged to protect parents and infants from the modern weaponry in wars.     

Analyse et comparaison de discours de patients douloureux chroniques durant une thérapie de soutien par opposition à l’utilisation de la thérapie Eye Movement Desensitization and Reprocessing (EMDR)

IntroductionThe use of EMDR – Eye Movement Desensitization and Reprocessing – being innovative in the area of chronic pain. If his efficiency as show in the specific litterature, the way its work it is really different than usual therapy.ObjectiveThe main objective of this work is to compare the speech of patients during the use of EMDR vs. supportive therapy in a supported unit of chronic pain to the hospital.MethodsForty-five patients divided into three groups received EMDR therapy (standard protocol), EMDR therapy (pain protocol) as well as supportive therapy. All interviews were transcribed and analyzed using the software Alceste.ResultsThe results show that the semantic classes differ between the three forms of therapy, as well as passive or active posture of the patient during the therapy.ConclusionThese results give us an additional insights into what happens in fine in different types of therapy.     

Inhibitory Learning for Anxiety-Related Disorders

This article reviews the articles in this issue that describe the strategies derived from the inhibitory learning model as applied to exposure therapy for anxiety disorders. The major principles of inhibitory learning are to create and strengthen nonthreat associations in memory (largely by engaging prefrontal cortical regions), and to effectively retrieve those nonthreat associations in the long term. Several case vignettes are provided that demonstrate how the principles of inhibitory learning (which include maximizing expectancy violations, limiting distraction, fear antagonistic actions, deepened extinction, elimination of safety behaviors, occasional reinforced extinction, increasing variability of exposures and offsetting reinstatement and context renewal effects) can be applied in clinical practice.     

From Traumatic Language to Posttraumatic Language: The Development of Language in Therapy According to the “Phenomenon of Hope” Model

Hope and language are part of the human development process starting from birth and continuing through all the stages of development. They are tools that help us to cope in complex situations. Environmental failure produces trauma, which damages the “self” and impairs the development of hope and language. The individual experiences “pessimistic hope” and “drained hope” and begins using “concrete language” and “pseudo-language.” Such profiles and languages indicate functional difficulties, including the inability to establish mature intimate personal relationships. When traumatic events such as those experienced in military combat compound childhood trauma (environmental failure), mental and functional difficulties buried by our defense systems may rise to the surface and worsen and chronic complex trauma may ensue. Psychotherapy for chronic complex trauma is complex. The therapeutic approach that is used in the “hope phenomenon” model includes five therapy stages that allow us to examine the effect of a trauma on personality and function. Here we examine the link between the five stages of therapy and the use of language. According to my experience, patients use concrete language and pseudo-language in the beginning of the therapeutic connection. As this connection and therapist-patient alliance evolves and deepens and the client and therapist move through the various stages, the patient then starts to use “plural language.” Concrete language and pseudo-language are used in the pessimistic hope and drawn hope stages, respectively, until a profile characterized by a realistic and mature hope emerges. This profile goes hand in hand with an ability to use plural language. This article examines the development of hope and language in a complex posttraumatic stress disorder (PTSD) patient who was treated using the hope phenomenon model. Consent for the therapy details to be used in this article was given by the patient.     

Working Through Countertransference: Navigating Between Safety and Paranoia for a Client With Complex Trauma History and Borderline Personality Organization

The aftermath of complex trauma deeply impacts one's self-organization and interpersonal relationships, often resulting in clients who present to therapy with borderline characteristics and are typically labeled as difficult to treat. Further clinical complications with paranoid features may quickly place the therapist at a loss with respect to managing perceived and/or actual threats to client safety. Using psychodynamic theories, especially Kleinian understandings of psychosis and Winnicottian approaches to early disturbance and its impact on the emergence of self, this article provides a detailed case illustration that explores how a critical reflection of countertransference as “enactment,” “communication,” and “imagination” can help the therapist to understand the client's unconscious symbolic psychic struggles and to guide treatment selections in the therapy process.     

Long-Term Guilt and Hostility Underlying Posttraumatic Stress Symptoms in War Combatants and Ex-Prisoners of War

The link between posttraumatic guilt and posttraumatic stress disorder has gained recognition over the past decades and was recently expressed in the modifications made to the diagnostic criteria for the disorder under the DSM-V. Yet, the psychological dynamics underlying this relation are still not fully understood. The present study introduces a model whereby different dynamics between guilt and hostility are related to posttraumatic stress disorder symptoms (PTSS), following different traumatic war experiences. One hundred and forty-four former prisoners of war (ex-POWs) and 143 comparable combatants participated in the study, 30 years after the war, reporting on their PTSS, guilt, and hostility. Moderation analyses revealed a three-way interaction, where high hostility buffered the effect of guilt on PTSS only among ex-POWs. This finding suggests a distinctive dynamic among guilt, hostility, and PTSS following diverse traumatic events. Specifically, it appears that hostility can have a mitigating effect on the negative outcomes of guilt for ex-POWs following trauma, but not for non-POW veterans. The theoretical reasoning and the clinical implications of these findings are discussed.     

Secondary traumatic stress in emergency medicine clinicians

Previously called Secondary Traumatic Stress (STS), secondary exposure to trauma is now considered a valid DSM-5 Criterion A stressor for posttraumatic stress disorder (PTSD). Previous studies have found high rates of STS in clinicians who treat traumatically injured patients. However, little research has examined STS among Emergency Medicine (EM) physicians and advanced practice providers (APPs). The current study enrolled EM providers (N = 118) working in one of 10 hospitals to examine risk factors, protective factors, and the prevalence of STS in this understudied population. Most of the participants were physicians (72.9%), Caucasian (85.6%), and male (70.3%) with mean age of 39.7 (SD = 8.9). Overall, 12.7% of the sample screened positive for STS with clinical levels of intrusion, arousal, and avoidance symptom clusters, and 33.9% had at least one symptom cluster at clinical levels. Low resilience and a history of personal trauma were positively associated with positive STS screens and STS severity scores. Borderline significance suggested that female gender and spending ≥10% of one’s time with trauma patients could be additional risk factors. Findings suggest that resilience-building interventions may be beneficial.     

Using Therapeutic Riding as an Intervention for Combat Veterans: An International Classification of Functioning,Disability, and Health (ICF) Approach

The aim of the study was to examine the effects of therapeutic horseback riding on posttraumatic stress symptoms, quality of life, and functioning of combat veterans using the International Classification of Functioning, Disability, and Health (ICF) as a framework. Fifty-one veterans and active duty service members participated in an 8-week therapeutic riding program. The study findings revealed clinically significant decrease in PTSD symptoms, improved social functioning, vitality, less interference of emotions on daily activities, and increased participation. Qualitative themes discovered included improved confidence, trust, acceptance of self and others, and gratitude. Qualitative and quantitative data linked to the ICF components.     

PTSD在中国的研究进展

PTSD是近十年来在中国精神病学界逐渐引起重视的一种反应性精神障碍。随着国外对PTSD的深入研究以及中国心理卫生事业的发展,相关领域的学者开始从事这一方面的研究并取得了不少成就。文章对中国PTSD的流行病学、神经生物学基础、病因学以及诊断和治疗等各个方面的研究作了初步总结和探讨。