Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis

A review of 2,647 studies of posttraumatic stress disorder (PTSD) yielded 476 potential candidates for a meta-analysis of predictors of PTSD or of its symptoms. From these, 68 studies met criteria for inclusion in a meta-analysis of 7 predictors: (a) prior trauma, (b) prior psychological adjustment, (c) family history of psychopathology, (d) perceived life threat during the trauma, (e) posttrauma social support, (f) peritraumatic emotional responses, and (g) peritraumatic dissociation. All yielded significant effect sizes, with family history, prior trauma, and prior adjustment the smallest (weighted r = .17) and peritraumatic dissociation the largest (weighted r = .35). The results suggest that peritraumatic psychological processes, not prior characteristics, are the strongest predictors of PTSD.     

Psychometric Properties of Two Implicit Associations Tests measuring Adult Attachment

Adult attachment style has consequences for mental health, interpersonal functioning and emotion regulation. This occurs partly deliberately, also referred to as explicit, and partly on an automatic level outside of conscious awareness, also referred to as implicit. Whereas explicit adult attachment can be assessed with self-report instruments, measurement of implicit adult attachment requires indirect methods. This paper describes the psychometric properties of two Implicit Association Tests measuring general adult attachment in a population sample. The study evaluated the reliability and the validity of the Avoidant Attachment IAT (ANX-IAT) and the Anxious Attachment IAT (AVOID-IAT). Validity was evaluated against self-report measures of adult attachment style (RQ), psychopathology (SQ-48), and well-being (MHC-SF). The split-half reliabilities of both IATs were good; the test-retest reliability of the ANX-IAT was adequate; however the AVOID-IAT had low test-retest reliability. Both IATs did not explain variance in psychopathology additional to explicit measures. The AVOID-IAT showed added value over explicit measurement of avoidant attachment in explaining variance in well-being, particularly regarding emotional and psychological well-being. The ANX-IAT did not explain variance in any measure of well-being additional to the explicit measure of anxious attachment. Our findings provide a basis from which more valid IATs measuring general adult attachment can be developed. Furthermore, they suggest that implicit avoidant attachment might be related to well-being, particularly emotional and psychological well-being. However, further research is needed to investigate the role of implicit general adult attachment in mental health and to optimize the two IATs in terms of validity before clinical use is recommended.     

Attachment Quality and Psychopathological Symptoms in Clinically Referred Adolescents: The Mediating Role of Early Maladaptive Schema

This study investigated relationships between attachment insecurity, maladaptive cognitive schemas, and various types of psychopathological symptoms in a sample of clinically referred adolescents (N = 82). A mediation model was tested in which maladaptive schemas operated as mediators in the relations between indices of attachment quality and conduct, peer, and emotional problems. Results revealed partial support for the hypothesized mediation effect: the schema domain of disconnection/rejection acted as a mediator in the links between insecure attachment and peer problems and emotional problems. Further analysis of these effects revealed that different types of maladaptive schemas were involved in both types of psychopathology. Altogether, findings suggest that treatment of adolescent psychological problems may need to target the improvement of attachment relationships with peers and parents and the correction of underlying cognitive schemas.     

Emotional risk factors and postconcussional disorder

Emotional risk factors were examined in 129 litigant and nonlitigant patients diagnosed with Postconcussional Disorder (PCD) following Mild Traumatic Brain Injury (MTBI). According to Millon Clinical Multiaxial Inventory (MCMI) criteria, four subgroups emerged: (a) 14.7% met criteria for an Axis I disorder, (b) 24.8% for an Axis II disorder, (c) 24.0% for bout Axis I and II disorders, and (d) 36.4% fell below threshold for psychopathology. Thus, 63.5% endorsed emotional pathology. Of the four groups, those with both Axis I and II psychopathology presented the greatest number of emotional complaints in a clinical interview and manifested the lowest neurocognitive test scores. Motor skills, verbal abilities, memory functioning, and IQ were primarily affected. With the exception of post-morbid emotional complaints, no significant differences were identified between litigants and nonlitigants. Our analysis suggests that the combination of both Axis I and II psychopathology is associated with greater impairment following MTBI.     

Love in therapy: A qualitative study of how clients perceive their therapists’ emotions

Relevant literature on attachment theory has explored the importance of emotional experience inside the therapeutic setting, highlighting that the active engagement of the therapist with the client is necessary in the process of change. However, less is known about the clients’ perception of the therapists’ emotional expression during a session. In this qualitative study, we used narrative thematic analysis to examine 10 semi-structured interviews with clients in an enriched systemic therapy approach. Focusing on the similarities of clients’ experiences, what emerged from the interviews were specific ‘perceived emotions’ and the related facial expressions of the therapists that were given attention by the clients. Based on our findings, six emotional themes were identified and are considered prominent: (i) ‘excitement’, (ii) ‘calmness’, (iii) ‘affection’, (iv) ‘empathy’, (v) ‘anger’ and (vi) ‘sadness’. Also, the analysis revealed two distinct functions of the expression of the therapist’s emotions: (i) they are an essential part of the therapeutic relationship and, (ii) they provide clients with alternative ways of experiencing emotions and motivate them to change. Therapists are invited to recognize the importance of their own emotional and facial expression in therapy considering it a form of self-disclosure. Suggestions for further research are also provided.     

大学生依恋与心理弹性——情绪调节与元情绪的多重中介

对982名大学生的依恋、情绪调节策略、元情绪及心理弹性进行测查,考察依恋与心理弹性间关系的内在机制。结构方程模型分析结果显示：（1）依恋、情绪调节与元情绪均能显著预测心理弹性;（2）依恋焦虑通过认知重评和元情绪间接预测心理弹性;（3）依恋回避不但直接负向预测心理弹性,还会通过认知重评和元情绪间接预测心理弹性。本研究结果显示,情绪调节策略和元情绪能够解释依恋与心理弹性间关系的内在机制。     

Early trauma,negative affect,and anxious attachment: the role of metacognition

Background and Objectives: Metacognition is linked to the etiology and maintenance of negative emotions and psychological disorder in the Self-Regulatory Executive Function Model. Although there is significant evidence supporting the model, little is currently known about the situational factors for developing dysfunctional metacognitions. The current study explored the hypothesis that early aversive experiences might be important and also tested if metacognitions could mediate the relationship between such experiences and psychological symptoms. Design and Methods: Three hundred and fifty non-clinical adults completed a retrospective early trauma measure, as well as measures of current metacognitive beliefs, negative affect, and anxious attachment. Results: Early emotional abuse positively and significantly correlated with several metacognitive belief dimensions but other forms of early trauma did not. Metacognition fully mediated the relationship between emotional abuse and negative affect. Anxious attachment was also positively and significantly associated with metacognitive beliefs and specific relationships remained after controlling for early emotional abuse and current negative affect. Conclusions: Findings are consistent with the ideas that: (i) early negative experiences, and emotional abuse in particular, could be a factor in the formation of problematic metacognitions and (ii) these metacognitions may be important in determining the effects of abuse on subsequent psychological symptoms.     

A Fundamental Polarity in Psychoanalysis: Implications for Personality Development,Psychopathology, and the Therapeutic Process

Interpersonal relatedness (attachment) and self-definition (separation) are fundamental psychological dimensions that are central to psychoanalytic thought, beginning with Freud, as well as in a wide range of nonpsychoanalytic formulations. These constructs provide a theoretical matrix that facilitates identifying continuities among personality development, variations in normal personality or character formation, concepts of psychopathology, and mechanisms of therapeutic action. The identification of these continuities enables us to consider many forms of psychopathology, not as diseases with assumed but as yet undocumented biological origins, but as distortions that derive from variations and disruptions of normal psychological development. Likewise, the identification of these continuities enables us to consider the relationship of mechanisms of therapeutic action to psychological development more generally. Validation of aspects of these formulations have been found in studies of depression and personality disorders as well as in systematic investigations of therapeutic change.     

Theory and Practice: Assessing the psychological presentation of gifted and talented clients: a multicultural perspective

Researchers suggest that gifted individuals have both strengths and areas of intrapersonal and interpersonal concerns as a result of their talents. The purpose of this paper is to apply a multicultural model of psychological assessment, the Multicultural Assessment Procedure (MAP), to better understand the social and emotional needs of gifted clients. This application is based on the following assumptions: a) giftedness is a sub-culture, b) people with special gifts also identify with and operate in multiple cultural contexts, and c) in order to be effective in working with gifted clients, one must accurately understand the interaction of the client’s multiple cultural identities. Implications for counselling practice are discussed.     

Comorbidity In Post-Traumatic Stress Disorder An Analysis of Community and Clinical Studies1

Post-traumatic stress disorder (PTSD) is alleged to be associated with high rates of concurrent psychological disorders. This paper considers the available literature regarding comorbidity in PTSD and reviews in detail the findings to date. This critical evaluation includes studies of clinical samples, veterans community surveys, and population surveys. It also presents new data drawn from 50 PTSD cases assessed at the Boston PTSD Center using a comprehensive, multidimensional diagnostic procedure. The data firmly support the notion that PTSD, regardless of the nature of the trauma, is associated with high rates of other major psychological disorders including substance abuse, major depression, and personality disorders. Despite these findings the issue of cause and effect surrounding comorbidity remains open at this time. More research is needed to determine if exposure to extreme stressors in fact produces the broad spectrum of psychopathology suggested by individuals with PTSD or whether individuals with intrinsic vulnerability are more likely to develop PTSD when exposed to extreme stressors. Implications of the findings from this review are discussed with respect to concepts in diagnosis and comorbidity.     

Associations between childhood trauma and emotion-modulated psychophysiological responses to startling sounds: a study of police cadets

Childhood trauma may confer risk for adult psychopathology by altering emotional and physiological responses to subsequent stressors. Few studies have distinguished effects of childhood trauma from effects of current Axis I psychopathology on adult psychophysiological reactivity. The authors exposed 90 psychiatrically healthy police cadets to startling sounds under increasing threat of shock while assessing their eyeblink electromyogram (EMG), skin conductance (SC), and heart rate responses. When compared with those who did not endorse early trauma (n = 65), cadets reporting childhood trauma (n = 25) reported less positive emotion and showed greater SC responses across all threat levels. They also showed threat-dependent elevations in reported negative emotions and EMG responses. Results suggest that childhood trauma may lead to long-lasting alterations in emotional and psychophysiological reactivity even in the absence of current Axis I psychopathology.     

Emotion Dysregulation,Mentalization and Romantic Attachment in the Nonclinical Adolescent Female Sample

The main goal of the current study is to verify the relationships between emotion dysregulation, mentalization, and romantic attachment in late adolescent girls (N = 120). Adolescence is a very dynamic and sensitive period, in which many changes occur in attachment and emotion regulation. The role of the primary attachment figures is gradually taken over by peers, and the beginnings of the development of romantic attachment are seen. In summary, this study was able to determine that the level of dysregulation of emotions in girls during late adolescence can be partially explained by mentalization and levels of anxiety (though not of avoidance) regarding a romantic partner, though attachment anxiety is more important for explaining emotion dysregulation than the level of mentalization. Only two aspects of emotion dysregulation show relationships with mentalization: nonacceptance of emotional responses and lack of emotional clarity. Adolescence is considered to be a critical period for interventions to protect against the onset of psychopathology. Confirmation of these relationships appears to be important for the design of therapeutic interventions. Our findings may suggest that attachment patterns, mentalization and emotion dysregulation may be good targets for therapeutic intervention in adolescence.     

Homelessness as psychological trauma. Broadening perspectives.

Most mental health literature on homelessness has focused on characteristics that may be risk factors for homelessness. The authors of this article argue that homelessness itself is a risk factor for emotional disorder and use the construct of psychological trauma--focusing on social disaffiliation and learned helplessness--to understand the potential effects of homelessness. Psychological trauma is likely among homeless individuals and families for three reasons. (a) The sudden or gradual loss of one's home can be a stressor of sufficient severity to produce symptoms of psychological trauma. (b) The conditions of shelter life may produce trauma symptoms. (c) Many homeless people--particularly women--become homeless after experiencing physical and sexual abuse and consequent psychological trauma. Research suggests that negative psychological responses to traumatic events can be prevented or mitigated by a supportive and empowering posttrauma environment. The implications of trauma theory for improving the psychosocial conditions of homeless people are discussed.     

The effects of torture-related injuries on long-term psychological distress in a Punjabi Sikh sample

Torture survivors often report chronic debilitating physical and psychological distress. Prior research on the relationship between physical and psychological trauma suggests that the 2 are not independent. Injury sustained during torture may increase the likelihood of subsequent distress as either a moderator or mediator. For long-term psychopathology in a sample of Punjabi Sikh survivors of human rights violations (N = 116), chronic injuries mediated the path between torture and posttraumatic stress disorder, specifically the severity of numbing symptoms. Although injuries were associated with major depression, torture was not, and injuries did not moderate the relationship between major depression and torture. Chronic injuries may represent trauma severity or persistent traumatic cues. These findings emphasize connections between physical and psychological trauma and the importance of an interdisciplinary approach to torture treatment.     

Transfer of attachment functions and adjustment among young adults in China

This study was designed to examine the process of attachment transfer from parents to peers, as well as factors related to this transfer process among Mainland Chinese. A total of 147 Chinese college students (with a mean age of 21.44) completed questionnaires that measured attachment style, attachment transfer, attachment support from various figures, loneliness, positive/negative affects, and self-esteem. Major findings of the current study include the following: (a) Hazan and Shaver's sequential model of attachment transfer was generalized to the Chinese sample; (b) the extent of attachment transfer was found to be associated with participants' emotional states (loneliness and positive affect) and was a significant predictor of these emotional states beyond the effects of attachment style and attachment support. As one of the first studies exploring the phenomenon of attachment transfer among young Chinese adults, conceptual and applied implications of these findings are discussed.     

Emotion Ideology Mediates Effects of Risk Factors on Alexithymia Development

Despite its connection to mental and behavioral health complications, elevated alexithymia tends to be associated with low responsiveness and high resistance to psychological intervention. To further understanding of potential treatment targets for clients with alexithymic traits, the present study explored the (a) independent contributions of various risk factors to statistical predictions of alexithymic trait severity, (b) generalizability of risk factor contributions across two culturally distinct samples, and (c) potential for emotion ideology (i.e., beliefs about emotion and emotional experience) to mediate such contributions. Preliminary results suggest emotion socialization and child abuse may be salient contributors to alexithymia severity, whereas effects of trauma exposure may be limited to samples with high overall exposure to alexithymia risk-factors. Moreover, emotion ideology mediates the relation between risk-factor exposure and alexithymia severity. Thus, psychotherapeutic interventions targeting emotion ideology may be beneficial when working with clients with elevated alexithymia.     

A New Model to Facilitate Individualized Case Conceptualization and Treatment of Social Phobia: An Examination and Reaction to Moscovitch's Model

Moscovitch's (2009) model of social phobia is put forth as an integration and extension of previous cognitive-behavioral models. The author asserts that his approach overcomes a number of shortcomings of previous models and will serve to better guide case conceptualization, treatment planning, and intervention implementation for clients with social phobia. Here I respond to these claims and examine the new and not-so-new aspects of Moscovitch's model. Moscovitch provides creative ways of thinking about feared stimuli and maladaptive methods for anxiety management used by clients with social phobia, and these notions may indeed expand our horizons, linking cognitive-behavioral thought to literatures on emotional suppression and emotion regulation. Other aspects of Moscovitch's thesis do provide heuristic and useful approaches to the assessment and treatment of social phobia which may be of great utility to the cognitive-behavioral clinician, but they do not provide a truly new approach to understanding the psychopathology or treatment of social phobia.     

The Relationship Between Childhood Onset Obesity and Psychopathology in Adulthood

We administered the Symptom Checklist (Derogatis, 1975; SCL-90-R) to 37 obese subjects in outpatient treatment for obesity. Patients with early onset obesity demonstrated a greater frequency and higher levels of emotional distress and psychiatric symptomatology than patients with late onset obesity. Individuals who developed obesity in childhood showed more psychopathology than those who developed obesity later in life. Overall, these findings support the belief that obesity is characteristically associated with greater internal psychological conflict. These findings further suggest that childhood obesity could serve as a predictor variable for possible future psychological disturbance in obese populations.     

Psychological and physiological responses to stress: The right hemisphere and the hypothalamo-pituitary-adrenal axis,an inquiry into problems of human bonding

In addition to repeated reexperiencing of the event, the delayed effects of severe psychological trauma, i.e., post traumatic stress disorder (PTSD), present a paradoxical mix of symptoms. There is enhancement of the self-preservative catecholamine states; anger and fear with a contrasting sense of meaninglessness and a blunting of the emotional responses of the attachment behavior so critical for species preservation. Hormonally, there is a striking separation of the catecholamine response, which stays elevated and that of the hypothalamo-pituitary-adrenal (HPA) axis, which may remain at normal levels. Pathophysiologically, the reexperiencing of the trauma and the arousal may be associated with dysfunction of the locus coeruleus, amygdala and hippocampal systems. This article explores the consequences of an additional dysfunction: a dissociation of the hemispheres that appears to be responsible for the alexithymic avoidance and failure of the cortisol response that so often follow severe psychological trauma. There is neurophysiological evidence that the left and right hemispheres subserve different emotional sets that correspond to “control” and “appraisal,” i.e., very approximately to the self and species preservative behavioral complexes, respectively. Several studies point to physiological dissociation of hemispheric functions during alexithymia. This raises the question: What has been lost if in this condition the right side no longer fully contributes to integrated cerebral function? Right hemispheric damaged children lose critical social skills and in adults the related sense of familiarity critical for bonding is lost. Such losses of social sensibilities may account for the lack of empathy and difficulties with bonding found in sociopathy and borderline personality: conditions now believed to result from repeated psychological trauma during development. On the other hand, systems that promote right hemispheric contributions provide solacing access to a “Higher Power.” They also appear to protect against socially disordered behavior, substance abuse, the failure of the HPA axis and some aspects of the pathophysiology of chronic disease.