Enhancing the Benefits of Written Emotional Disclosure Through Response Training

Writing about a personal stressful event has been found to have psychological and physical health benefits, especially when physiological response increases during writing. Response training was developed to amplify appropriate physiological reactivity in imagery exposure. The present study examined whether response training enhances the benefits of written emotional disclosure. Participants were assigned to either a written emotional disclosure condition (n = 113) or a neutral writing condition (n = 133). Participants in each condition wrote for 20 minutes on 3 occasions and received response training (n = 79), stimulus training (n = 84) or no training (n = 83). Heart rate and skin conductance were recorded throughout a 10-minute baseline, 20-minute writing, and a 10-minute recovery period. Self-reported emotion was assessed in each session. One month after completing the sessions, participants completed follow-up assessments of psychological and physical health outcomes. Emotional disclosure elicited greater physiological reactivity and self-reported emotion than neutral writing. Response training amplified physiological reactivity to emotional disclosure. Greater heart rate during emotional disclosure was associated with the greatest reductions in event-related distress, depression, and physical illness symptoms at follow-up, especially among response trained participants. Results support an exposure explanation of emotional disclosure effects and are the first to demonstrate that response training facilitates emotional processing and may be a beneficial adjunct to written emotional disclosure.     

Testing Case Formulation Hypotheses in Psychotherapy: Two Case Examples

We describe two cases that illustrate and demonstrate the effectiveness of a case formulation–driven approach to psychotherapy in which the therapist, in collaboration with the patient, develops a hypothesis (formulation) about the psychological mechanisms that cause and maintain the patient’s difficulties, uses the formulation to guide intervention, and collects data to test the formulation and evaluate the effectiveness of the intervention plan. As shown by the cases reported here, a key strength of this collaborative empirical process is that it enables the patient and therapist to quickly determine when a treatment is failing and take action to rescue it.     

Using Prolonged Exposure and Cognitive Processing Therapy to Treat Veterans With Moral Injury-Based PTSD: Two Case Examples

Moral injury refers to acts of commission or omission that violate individuals’ moral or ethical standards. Morally injurious events are often synonymous with psychological trauma, especially in combat situations—thus, morally injurious events are often implicated in the development of posttraumatic stress disorder (PTSD) for military service members and veterans. Although prolonged exposure (PE) and cognitive processing therapy (CPT) have been well established as effective treatments for veterans who are struggling with PTSD, it has been suggested that these two evidence-based therapies may not be sufficient for treating veterans whose PTSD resulted from morally injurious events. The purpose of this paper is to detail how the underlying theories of PE and CPT can account for moral injury-based PTSD and to describe two case examples of veterans with PTSD stemming from morally injurious events who were successfully treated with PE and CPT. The paper concludes with a summary of challenges that clinicians may face when treating veterans with PTSD resulting from moral injury using either PE or CPT.     

Psychosocial Implications of Foreign Accent Syndrome: Two Case Examples

Research on foreign accent syndrome (FAS), a rare form of speech disorder that typically follows some form of neurological insult, has concentrated almost exclusively on its neurogenic origins and motoric features, to the virtual neglect of its psychosocial implications for the patients who experience it. In this article we draw on the concepts and methods of personal construct theory to analyze two cases of FAS, demonstrating the significant and sometimes sweeping reconstruction of these persons’ sense of identity in the social world.     

A Comparison of Positive Versus Negative Emotional Expression in a Written Disclosure Study Among Distressed Students

This study investigated the effects of expressing through writing either positive feelings, negative feelings, or both about an upsetting event in order to assess which mode of expression facilitated greater emotional and cognitive processing. Undergraduate student participants with self-reported unresolved upsetting experiences were randomly assigned to one of three writing groups. After completing three writing sessions, they were evaluated at baseline, postexperimentally, and at 1-month follow-up. All groups experienced positive benefits; however, participants in the positive writing group showed greater adaptive cognitive changes than the other groups. Thus it appears that the written expression of positive feelings is as therapeutic as the written expression of negative emotions, which may prompt increased cognitive reorganization or benefit finding among a nonclinical sample.     

Written Exposure Therapy for Suicide in a Psychiatric Inpatient Unit: A Case Series

Patients with posttraumatic stress disorder (PTSD) are at an elevated risk of suicide. For patients hospitalized for suicide risk, psychosocial treatment and stabilization are routinely offered; however, the availability of evidence-based, manualized therapeutic interventions for PTSD is sparse. Typically, the short duration of hospitalization makes it difficult to accommodate evidence-based, trauma-focused treatments. This article presents the clinical course of four active-duty service members with PTSD who were hospitalized in a psychiatric inpatient unit for acute suicide risk and treated with Written Exposure Therapy for Suicide (WET-S). WET-S is a brief, five-session therapy based upon Written Exposure Therapy and augmented with Crisis Response Planning for Suicide Prevention. Both posttraumatic stress symptoms and suicidal ideation were reduced from pre- to posttreatment for three of the four patients treated. WET-S shows promise as a manualized therapeutic intervention that can be delivered on an inpatient psychiatric unit.     

书写和口传:中国宗教的两种类型

立足于中国宗教类型研究史的批判性解读,本文提出,中国宗教有两大类型:经典宗教和民间宗教。经典宗教是“文字本位”的,具有制定性特征,备有弘富的经藏系统;民间宗教及其经卷具有口传性、变异性和民众性。文章考察了中国宗教史上的经典传授和口头宣教的传统,认为一种宗教的社会地位的改变、宗教性质之转移往往和它宣教方式的变化有关;经典宗教和民间宗教的互动也带来了宣教方式(经典阅读和口头传教)的互渗。     

应对与积极情绪研究:意义应对、积极情绪应对、情绪表露和情绪粒度

研究者们发现了应激状态下积极情绪与消极情绪共生的现象,这对于缓解压力提高应对效能有重要意义,积极情绪的研究成为应激和应对领域一个新的方向。为进一步明晰应对过程中积极情绪发生的特点、机制以及它们之间的关系,以应对过程中积极情绪发生的不同阶段为基点,探讨意义指向应对(应对失败之后),积极情绪指向应对(应对初始阶段),以及积极情绪的拓展建构(应对行为之前,并进一步探讨了情绪表露和情绪粒度两个与积极情绪密切相关的因素)。以后研究的重点主要有以下几点:应激源类型的划分,意义指向应对、积极情绪指向应对以及情绪表露和情绪粒度的进一步研究,并积极关注临床实践。     

Cognitive,Emotional, and Language Processes in Disclosure

Previous studies have found that writing about upsetting experiences can improve physical health. In an attempt to explain this phenomenon, 72 first-year college students were randomly assigned to write about either their thoughts and feelings about coming to college or about superficial topics for three consecutive days. Measures of language use within the writing samples and cognitive measures of accessibility and schematic organisation were collected in the weeks before and after writing. As in previous studies, writing about college was found to reduce health centre visits for illness and to improve subjects' grade point average. Text analyses indicated that the use of positive emotion words and changes in words suggestive of causal and insightful thinking were linked to health change. Improved grades, although not linked to these language dimensions, were found to correlate with measures of schematic organisation of college-relevant themes. Implications for using written language to understand cognitive and health processes are discussed.     

Emotional Disclosure in Day-to-Day Living and Subjective Well Being

There is a large body of empirical research on emotional disclosure and its relationship to health and well being. However, emotional disclosure has been examined largely in the context of illness or trauma. Beneficial outcomes of emotional disclosure in day-to-day living have not been consistently observed in non-experimental studies, although a large proportion of individuals do report perceived benefits. The present study aimed at exploring the association of emotional disclosure with selected intrapersonal and interpersonal variables and their role in prediction of subjective well being in day-to-day living. The sample comprised of 209 adults who did not report presence of any major stressor in the recent past. In hierarchical regression analysis, lower affect intensity, higher emotional clarity, lower trait rumination, higher perceived support and higher emotional disclosure predicted higher subjective well being. In addition, trait rumination emerged as a significant moderator of the relationship between emotional disclosure and subjective well being.     

Visual Feedback in Written Imaginal Exposure for Posttraumatic Stress: A Preliminary Study

This study investigated the visual feedback hypothesis, which states that visual feedback from written trauma narratives contributes to the efficacy of written imaginal exposure for posttraumatic stress via the reuptake of traumatic content during production of the narrative. We tested a college sample (n = 61) with clinically elevated posttraumatic stress as measured with the Impact of Events Scale. Participants were randomly assigned to a writing with visual feedback condition, a writing without visual feedback condition, or a control condition. The hypothesis was not supported: Writing with and without visual feedback equally reduced intrusion and avoidance symptoms. Exploratory analyses, however, showed increased intrusion symptoms immediately after writing with visual feedback, which was in contrast with decreased symptom levels in the other conditions. These findings are in line with previous findings regarding immediate symptom development following writing interventions for posttraumatic stress and call for further exploration of the visual feedback hypothesis.     

Emotional Responses to APO E Genotype Disclosure for Alzheimer Disease

The purpose of our study is to assess the emotional responses to disclosing APO E genotype to asymptomatic older adults at increased risk for Alzheimer disease (AD). This is a longitudinal cohort study of volunteer subjects who were aged 50 years or over, asymptomatic for (AD), had a family history of AD, passed a psychological assessment, and participated in pre- and post-test genetic counseling and three follow-up visits over 10 months. We analyzed responses by three emotional constructs: depressed, worried, and relieved. Three hundred and twenty-eight subjects were screened, 76 received their APO E genotype. When emotional responses occurred it was immediate, between baseline and the 1 month follow-up. Emotional reactions did not change significantly past 1 month. Our results suggest that for emotionally stable persons, disclosing results of their APO E genotype, high risk subjects did not report more depression or worry and low risk subjects felt relieved by knowing the results. Future studies should evaluate the risks of disclosure to family members involved in the diagnostic work-up of a relative and include subjects from a broader range of emotional stability and socioeconomic background.     

Two Contemporary Examples of Christian Love

It is a mark of arrogance to try to minister in a liturgicalor ritual way to individuals of other religions. A hospitalchaplain is not a generic brand, all-purpose religious figurecapable of fulfilling the religious needs of any. A chaplainshould not try to fill in for specific religious ministers,but rather, he should see himself as a human companion to thosewho need human love and care. In doing this, he can surely bemotivated, informed, and sustained by his inner, spiritual life,but should not see himself as replacing the patient's own religiouspastor. Excellent examples of how to carry out pastoral dutiesin pluralist communities come from two contemporary Christians:Mother Theresa and Father Porphyrios. Both of whom remainednon-judgmental toward those for whom they cared, while maintaininga strict view of the historical teachings of Christianity andobedience to them.     

Cognitive Coping vs Emotional Disclosure in the Treatment of Anxious Children: A Pilot-Study

The present pilot-study was a first attempt to examine the effectiveness of the cognitive component of cognitive behaviour therapy for children with anxiety problems. A total of 24 highly anxious children were assigned to 1 of 2 intervention conditions: a Cognitive Coping intervention, which focussed primarily on the cognitive component of cognitive behaviour therapy, or an Emotional Disclosure intervention in which children were invited to write about their fears and anxious experiences. Children completed self-report questionnaires of anxiety disorders symptoms and worry at 3 points in time: (i) 6 weeks before treatment (i.e. baseline), (ii) at pre-treatment, and (iii) at post-treatment. The results showed, firstly, that levels of anxiety disorder symptoms and worry remained relatively stable over a 6-week waiting period and then decreased substantially after the interventions. This suggests that the children did not suffer from momentary anxiety and worry complaints and that treatments generally were effective in reducing these symptoms. Secondly, although within-group comparisons suggested that treatment effects were somewhat larger in the Cognitive Coping condition than in the Emotional Disclosure condition (effects sizes for anxiety disorders symptoms and worry were, respectively, 1.03 and 0.87 for Cognitive Coping vs 0.54 and 0.39 for Emotional Disclosure), statistical tests could not substantiate this impression, probably due to a lack of power as a result of the small numbers of children in both intervention conditions.     

Case Report: Smuggling Family Therapy Through

Therapists with a family systems orientation are, on occasion, called upon to work in settings where political constraint, cultural patterns or the unchangeable expectations of the clinical population make it impossible to identify the treatment as being directed at the family. Under these circumstances, family therapy concepts and techniques may be employed by smuggling them in under another label. This article describes a setting in which such a strategy was necessary.     

Mechanisms of Change in Written Exposure Treatment of Posttraumatic Stress Disorder

Although the effectiveness of exposure therapy for PTSD is recognized, treatment mechanisms are not well understood. Emotional processing theory (EPT) posits that fear reduction within and between sessions creates new learning, but evidence is limited by self-report assessments and inclusion of treatment components other than exposure. We examined trajectories of physiological arousal and their relation to PTSD treatment outcome in a randomized controlled trial of written exposure treatment, a protocol focused on exposure to trauma memories. Hierarchical linear modeling was used to model reduction in Clinician Administered PTSD Scale score as a predictor of initial activation and within- and between-session change in physiological arousal. Treatment gains were significantly associated with initial physiological activation, but not with within- or between-session changes in physiological arousal. Treatment gains were associated with larger between-session reductions in self-reported arousal. These findings highlight the importance of multimethod arousal assessment and add to a growing literature suggesting refinements of EPT.     

两种任务下情绪韵律的加工进程

采用ERP技术分别考察了情绪判断和性别判断任务下情绪韵律的加工进程。结果显示：在175-275ms时间段,情绪韵律的加工受实验任务的调节,情绪判断任务下存在效价主效应及负性偏向,愤怒比高兴和中性诱发了更正的P2成分,而性别判断任务则无效价效应。在后期评价加工及反应准备阶段（400-800ms）,两种任务下,愤怒都比高兴和中性诱发了更正的晚成分。上述结果说明,不同情绪韵律的识别存在不同的认知机制,并在一定程度上会受加工任务的调节。     

Candidate Name Exposure and Voting: Two Field Studies

Two studies clarify previous research on the impact of candidate name exposure in political election campaigns. In an election involving 27 candidates and 1157 voters, level of name exposure on campaign posters significantly predicted votes received, independent of other forms of campaigning. In the second study, name exposure levels were manipulated for hypothetical candidates, to eliminate potential confounds. Again, exposure significantly improved candidates' electoral performance'. The findings are interpreted as evidence for a direct effect of mere name exposure in electoral campaigns.