Physiological and subjective measures of anxiety during flooding

Patterns of physiological arousal and subjective reports of anxiety were examined during individual sessions of imaginal flooding of five phobic subjects. A curvilinear pattern of increased, followed by decreased, arousal characterized changes in heart rate, respiration rate and subjective anxiety. Heart rate tended to reach its peak level before respiration rate and subjective anxiety. Intercorrelations between these measures were generally positive and significant. Comparisons between periods of high and low subjective arousal revealed a significantly greater correlation for low than for high arousal only for the subjective anxiety by respiration-rate correlation.     

Brief Imaginal Exposure for PTSD: Trajectories of Change in Distress

Preliminary evidence shows that brief, condensed imaginal exposure only interventions can be effective in the treatment of PTSD, but we need to understand its mechanisms of action. Consistent with extinction learning and retrieval processes, the present study examined whether a pattern of between-session distress reduction observed during standard prolonged exposure (PE) therapy would be observed and predict outcome. Sixty-three patients with PTSD were enrolled in two clinical trials using our treatment protocol consisting of six daily 50-min sessions focusing on imaginal exposure and processing only. Individual patient trajectories of distress reduction were examined over the course of the five imaginal exposure sessions (Sessions 2-6). Overall, significant linear distress reduction was observed for anticipatory (d = 1.18), peak (d = 1.83), and ending imaginal exposure distress (d = 1.21). Consistent with extinction learning, the steeper slope of peak distress (d = 1.03) and end distress (d = 0.68) across imaginal exposure sessions strongly predicted decreases in PTSD symptoms. Distress reduction across sessions was predicted by higher baseline avoidance and hyperarousal but not reexperiencing symptoms. This condensed format of daily 50-min sessions without in vivo exposure may be operating via similar extinction learning processes as longer protocols. Our clinical observations suggest that the brief daily format may offer the advantage of allowing each session to build on the previous one to promote meaningful shifts in the retrieval of the trauma memory. Brief imaginal exposure and processing may be a viable option for PTSD patients in settings where brief interventions are needed. Understanding potential change processes and baseline predictors of change brings us closer toward precision medicine in treating PTSD.     

A Practice-Specificity-Based Model of Arousal for Achieving Peak Performance

The authors propose a practice-specificity-based model of arousal for achieving peak performance. The study included 37 healthy male physical education students whom they randomly assigned to a high-arousal (n = 19) or low-arousal group (n = 18). To manipulate participants' level of arousal, the authors used motivational techniques. They used heart rate and the Sport Competition Anxiety Test (R. Martens, 1977) to measure the level of arousal that participants achieved. At the determined and given arousal state, the 2 groups performed the task (basketball free throws) for 18 sessions. Both groups performed a retention test at the 2 arousal levels immediately after the last exercise session, in the posttest, and after 10 days. Results showed that both groups learned the task similarly and achieved their peak performance at their experienced arousal level. When tested at an arousal level that differed from the one that they experienced throughout practice sessions, participants' performance had deteriorated significantly. Performance of the task seemed to have integrated with the arousal level of the participants during the task learning. The findings of this study suggest a practice-specificity-based explanation for achieving peak performance.     

Old Fears Die Hard: Return of Public Speaking Fear in a Virtual Reality Procedure

Exposure-based therapy is an effective treatment for social anxiety, but some patients relapse. We used a novel virtual reality procedure to examine spontaneous recovery (i.e., a return of fear over time) and fear renewal (i.e., the return of fear after a context switch) in individuals with fear of public speaking. On Day 1, 32 participants received exposure training before a virtual audience. On Day 8, participants completed a spontaneous recovery phase, followed by a fear renewal test, in which they gave a presentation in front of a new (context switch) or the same audience (no context switch). After exposure, participants exhibited a lower heart rate, subjective distress, negative valence, and arousal. One week later, participants showed spontaneous recovery of heart rate, and the context switch group showed renewal of subjective distress, negative valence, and arousal. Future studies can use this procedure to test interventions aimed at improving long-term exposure effects in individuals with public speaking fear.     

Effects of erotic stimuli on sexually functional and dysfunctional women: Multiple measures before and after sex therapy

A group of 11 women entering sex therapy for treatment of low arousal, and a comparison group of 11 women experiencing no arousal deficit, viewed an erotic film, listened to an erotic audiotape, and engaged in sexual fantasy during two experimental sessions. Session I occurred pre-treatment for the low arousal group. Session II occurred post-treatment. The adequate arousal group was tested at comparable points in time. Sexual arousal was measured subjectively by self-rating and physiologically by a vaginal photoplethysmograph. Contrary to expectation, the two groups showed equivalent significant increases in physiological response during the erotic stimuli in both sessions. However, the adequate arousal group rated subjective arousal significantly higher than the low arousal group in Session I, while no difference was found between the groups in Session II. Significant correlations were present between physiological response and ratings of several affective reactions to the audiotape, though few significant correlations were found between physiological and subjective sexual arousal measures. These data indicate a discrepancy between genital responses and ratings of sexual arousal for which several interpretations are offered.     

A practice-specificity-based model of arousal for achieving peak performance

The authors propose a practice-specificity-based model of arousal for achieving peak performance. The study included 37 healthy male physical education students whom they randomly assigned to a high-arousal (n = 19) or low-arousal group (n = 18). To manipulate participants' level of arousal, the authors used motivational techniques. They used heart rate and the Sport Competition Anxiety Test (R. Martens, 1977) to measure the level of arousal that participants achieved. At the determined and given arousal state, the 2 groups performed the task (basketball free throws) for 18 sessions. Both groups performed a retention test at the 2 arousal levels immediately after the last exercise session, in the posttest, and after 10 days. Results showed that both groups learned the task similarly and achieved their peak performance at their experienced arousal level. When tested at an arousal level that differed from the one that they experienced throughout practice sessions, participants' performance had deteriorated significantly. Performance of the task seemed to have integrated with the arousal level of the participants during the task learning. The findings of this study suggest a practice-specificity-based explanation for achieving peak performance.     

Progressive and imaginal relaxation training for elderly persons with subjective anxiety.

Elders exposed to either progressive or imaginal relaxation procedures reported significant relaxation effects and showed improvement on measures of personal functioning. The results of the Physical Assessment Scale of the Relaxation Inventory indicated that relaxation responses were acquired within and across sessions. Large, consistent changes in relaxation occurred in all 4 sessions. The Symptom Checklist-90-R, which measures self-reported personal adjustment, showed significant positive changes following relaxation training and at 1-month follow-up. Elders who imagined muscle tension release profited as much as those engaged in actual muscle tension-release activities. This finding is of importance for older adults who may experience physical limitations that contraindicate muscle-tension-release procedures.     

Interoceptive Exposure Therapy Combined with Trauma‐related Exposure Therapy for Post‐traumatic Stress Disorder: a Case Report

Trauma‐related exposure therapy is a useful but not universally effective treatment for post‐traumatic stress disorder. Anxiety sensitivity may play an important role in this disorder, as it does in panic disorder. Studies have shown that interoceptive exposure therapy reduces anxiety sensitivity in panic disorder. The present case study was a preliminary investigation of the merits of including interoceptive exposure therapy in the treatment of post‐traumatic stress disorder, in order to improve treatment outcome for a patient who had no history of panic disorder or panic attacks. Interoceptive exposure therapy (4 sessions) was one component of treatment, combined with trauma‐related exposure therapy (4 sessions of imaginal exposure followed by 4 sessions of in vivo exposure). Treatment outcome was assessed with the Clinician‐Administered Post‐traumatic Stress Disorder Scale, a self‐report measure of post‐traumatic stress disorder symptoms, and measures of symptoms and cognitions commonly associated with post‐traumatic stress disorder. Scores on all outcome measures decreased over the course of treatment, with gains maintained at 1‐ and 3‐month follow‐up. Symptoms of anxiety sensitivity and post‐traumatic stress disorder decreased during interoceptive exposure therapy. The results indicate that interoceptive exposure therapy is a promising adjunctive intervention for post‐traumatic stress disorder. Further research is needed into the merits of combining interoceptive exposure therapy and trauma‐related exposure therapy as a means of boosting treatment efficacy.     

Trauma in Resettled Iraqi Refugees: Differences between Those Seeking Psychological Treatment and Those Not Seeking Psychological Treatment

Psychological distress experienced by resettling refugees has been well documented, with posttraumatic stress disorder (PTSD) and depression being prevalent outcomes. This study examined psychological and physiological measures of trauma exposure in 2 groups of Iraqi refugees resettled in Australia, those seeking psychological treatment (n = 25) versus those not seeking treatment (n = 22). Data from a group of healthy sex- and age-matched controls (n = 32) were collected to facilitate norm comparisons for physiological arousal. Continuous recording of electrocardiogram data examined resting heart rate (HR). Refugees seeking treatment had significantly higher levels of PTSD symptomology and depression levels compared to non-treatment-seeking refugees; however, there was no difference in the number of trauma events endorsed. Finally, resting HR was significantly higher in both refugee groups compared with healthy controls; however, there was no difference between the refugee groups. Clinical consideration of this excessive trauma exposure and elevated autonomic arousal is warranted.     

Avatar-based therapy within prison settings: pilot evaluation

The paper presents an introduction of a newly developed, avatar-based virtual reality therapy, as an addition to the therapeutic programme, within a therapeutic community prison in the UK. The participants had six group sessions facilitated by a counsellor. The aim of the project was to investigate whether this approach would improve mental health outcomes for the prisoners, interpersonal relationships within the prison and facilitate the achievement of personal goals for the prisoners. The sample size (n?=?4) was insufficient to make firm conclusions about the mental health outcomes. However, the qualitative analysis showed a strong engagement with the programme in addressing personal issues, the development of insight and empathy, and improvements in relationships within the participants and with the counsellor. Further research with a larger sample is needed to establish efficacy of this type of therapy with the prison population.     

Procedures for Identifying Persons with Potential for Public School Administrative Positions by William C. Schutz

This investigation is based on over 400 American Group Psychotherapy Association members involved in 41 intensive, two-day training experiences for mental health professionals. The participants completed a questionnaire immediately after their group sessions to evaluate the process and leadership variables that contributed to a constructive learning experience. A similar questionnaire was mailed to participants three to four months later to explore the impact of training on group interventions within their clinical practices. One third of the trainees responded to the follow-up survey. Overall, the findings suggest that successful outcomes are related to a range of group processes, such as self-disclosure, feedback, and interpersonal support, as well as personal qualities and technical expertise modeled by the leaders of the training groups. Both the immediate and delayed assessments demonstrate that the groups were regarded as highly valuable learning opportunities.     

Cumulative trauma and midlife well-being in American women who served in Vietnam: effects of combat exposure and postdeployment social support

Background and Objectives: Research increasingly demonstrates that trauma exposure can have cumulative effects, yet much remains to be learned about effects of cumulative trauma, particularly regarding longer term adjustment. One such trauma, combat exposure, is insufficiently understood, especially for women, who are increasingly engaged in professional combat activities. Design: The study comprised a cross-sectional survey assessing multiple aspects of current well-being in women approximately 25 years after their service in Vietnam during the Vietnam War. Methods: Participants were 1374 women (78% military and 22% nonmilitary; mean age = 59.7). This study investigated the relations between three separate categories of trauma exposure (childhood, adulthood, and combat) and well-being and examined whether perceived social support at return from Vietnam moderated the association between combat exposure and well-being. Results: While both childhood and adulthood trauma exposure related to midlife well-being, combat exposure still uniquely predicted outcomes. Further, postdeployment perceived social support moderated the association of combat and well-being: recollected higher perceived social support at homecoming buffered participants from the links between combat exposure and well-being. Conclusions: These results may have important implications for interventions to reduce the impact of traumatic experiences, particularly in light of the increasing exposure of women to direct combat events.     

Classical conditioning of blood pressure inMacaca mulatta with cardiac rate controlled

The interaction of heart rate and blood pressure responses was studied in four male rhesus monkeys (M. mulatta) during classical delay conditioning and extinction. During initial conditioning sessions, heart rate was held constant by means of an external cardiac pacemaker; in follow-up conditioning sessions, the heart was free of constraint. Observations were made after these conditioning sessions, (a) during several sessions given over to continued training while different pacing rates were in effect; (b) during a series of extinction sessions in which the heart was paced and unpaced; and, (c) when a heart rate CR was simulated by manipulation of the pacer with no conditioned or unconditioned stimuli present. Throughout all sessions, systolic and diastolic pressures were measured at each heart beat. It was found that blood pressure conditioning was largely unaffected when heart rate changes were prevented during acquisition. Extinction of blood pressure responses was also seen to proceed relatively unimpeded when the heart was paced at a fixed frequency. During the postacquisition conditioning sessions, the several different pacing rates that were tested did not produce any significant differential effects in the blood pressure CRs. Simulated heart rate CRs were accompanied by small changes in pressures, sometimes opposite in direction from the pressure CRs observed during unpaced conditioning trials.     

A Comparative Study of Groups of High and Low Intelligence in Learning a Maze

In accordance with the determination of base-line heart rate and running in an activity wheel, 14 Long-Evans male rats were given ten 30 minute sessions of Immobile-Avoid conditioning followed by 30 minute sessions of Active-Avoid conditioning. Control Ss were yoked to the experimental Ss.

Experimental Ss made significantly fewer responses in the immobile-avoid period and significantly more responses in the active-avoid period than did the yoked control Ss. Heart rate was correlated with skeletal activity both for experimental and control Ss. For experimental Ss, low heart rate was concomitant with a low amount of activity in the immobile-avoid period and high heart rate was concomitant with greater skeletal activity in the active-avoid period.

These results support the position that heart rate is secondary to responses of the somatic-motor system and that heart rate during immobile-avoid or active avoid conditioning is more closely related to the level of somatic-motor activity than to the emotional stress which purportedly motivates instrumental avoidance behavior.     

Emotional processing in posttraumatic stress disorder

The emotional deficits associated with posttraumatic stress disorder (PTSD) are the least understood and the most understudied aspect of the syndrome. In this study, the connection was evaluated between trauma-context reactivity and subsequent emotional deficits in PTSD. Combat veterans with PTSD and well-adjusted veteran control participants were exposed to reminders of combat, after which their emotional behavior was assessed in response to a series of emotionally evocative images. Under the neutral condition, both groups exhibited emotional behavior modulated by stimulus valence. Partially consistent with the conceptual model described by B. Litz (1992), the PTSD group exhibited suppressed expressive-motor responses to positively valenced images, in comparison with the control group, only after being exposed to a trauma-related prime. Contrary to expectations, the PTSD group showed no augmentation of emotional response to negatively valenced cues after being exposed to trauma reminders. However, the PTSD group responded to all images, in both prime conditions, with higher heart rate reactivity, suggesting an automatic preparation for demand or threat in any uncertain emotional context. Possible causes and consequences of these results are discussed.     

Paradoxical olfactory function in combat Veterans: The role of PTSD and odor factors

Stress- and trauma-related disorders, including posttraumatic stress disorder (PTSD), are characterized by an increased sensitivity to threat cues. Given that threat detection is a critical function of olfaction and that combat trauma is commonly associated with burning odors, we sought a better understanding of general olfactory function as well as response to specific trauma-related (i.e. burning) odors in combat-related PTSD. Trauma-exposed combat Veterans with (n = 22) and without (n = 25) PTSD were assessed for general and specific odor sensitivities using a variety of tools. Both groups had similar general odor detection thresholds. However, the combat Veterans with PTSD, compared to combat Veterans with comparable trauma exposure but without PTSD, had increased ratings of odor intensity, negative valence, and odor-triggered PTSD symptoms, along with a blunted heart rate in response to burning rubber odor. These findings are discussed within the context of healthy versus pathological changes in olfactory processing that occur over time after psychological trauma.     

"Detoxification" of Vietnam War Trauma: A Combined Family-Individual Approach

Treatment with families of veterans suffering from the aftereffects of combat trauma in the Vietnam War often requires a preliminary phase of disjoint treatment, in which family members are seen separately, before conjoint treatment can proceed. In this disjoint phase of treatment, wives and children are introduced to the brutal realities of Vietnam combat experience and to an understanding of its sequelae. This disjoint phase of family therapy detoxifies combat experience so that it can be approached in subsequent conjoint sessions along with more traditional family therapy issues.     

Effects of dilemma type,language, and emotion arousal on utilitarian vs deontological choice to moral dilemmas in Chinese–English bilinguals

The present study examines how dilemma type (personal or impersonal moral dilemma), language (native or foreign) and emotion arousal to a dilemma could affect Chinese–English bilinguals' deontological vs utilitarian moral choices regarding 39 moral dilemmas. How emotion arousal plays a mediating role in the effects of dilemma type and language on moral choices is also investigated. As shown in multilevel analyses, participants made fewer utilitarian choices for personal dilemmas than impersonal dilemmas. Although emotion arousal of dilemmas significantly mediated this effect of dilemma type, the indirect effect of dilemma type through arousal on moral choices was inconsistent with the direct effect of dilemma type on moral choices. For the effect of language, participants made more utilitarian choices in the Footbridge (personal) dilemma that was presented in foreign language than in native language. However, this effect was not mediated by arousal, suggesting that it could not be attributed to the emotion‐reducing effect of foreign language. Moreover, there was no language effect on moral choices in analyses that included all 39 dilemmas or only 22 personal dilemmas, indicating the need in future research for further identifying the potential mediators that trigger the foreign language effect on moral choices.     

The effect of arousal on memory for emotionally-relevant information: a study of skydivers

The aim of the present study was to test memory for information under conditions of extreme arousal in an analogue design to mimic hyperarousal during trauma exposure. Prior to their skydive, 70 novice skydivers were administered measures of fear, heart rate, and anxiety sensitivity. Half the participants learnt a list of words that varied in both relevance to their skydive and valence (irrelevant/relevant, negative/neutral) on the plane (skydivers), and remaining participants learnt an identical list of words on the ground (delayed controls). Following the skydive, participants completed free recall and recognition tasks; heart rate, dissociation, and subjective arousal were also measured. Consistent with an attentional narrowing hypothesis, skydivers recalled comparable a comparable number of relevant words as delayed controls, but significantly less irrelevant words. In terms of recognition performance, skydivers displayed better recognition of relevant words but poorer recognition of irrelevant words than delayed controls. Valence of words did not alter the pattern of results. The implications of the findings are discussed in the context of understanding memory processes under conditions of high threat.