Sleep normalization and decrease in dissociative experiences: evaluation in an inpatient sample

We conducted a longitudinal study to investigate the relation between sleep experiences and dissociative symptoms in a mixed inpatient sample at a private clinic evaluated on arrival and at discharge 6 to 8 weeks later. Using hierarchical regression analyses and structural equation modeling, we found a link between sleep experiences and dissociative symptoms and determined that specifically decreases in narcoleptic experiences rather than insomnia accompany a reduction in dissociative symptoms. Although sleep improvements were associated with a general reduction in psychopathology, this reduction could not fully account for the substantial and specific effect that we found for dissociation. Our findings are consistent with Watson's (2001) hypothesis that disruptions in the sleep-wake cycle lead to intrusions of sleep phenomena into waking consciousness, resulting in dissociative experiences. Accordingly, sleep hygiene may contribute to the treatment or prevention of dissociative symptoms.     

The impact of dissociation and depression on the efficacy of prolonged exposure treatment for PTSD

This study investigates the impact of dissociative phenomena and depression on the efficacy of prolonged exposure treatment in 71 patients with posttraumatic stress disorder (PTSD). Diagnoses, comorbidity, pretreatment depressive symptoms, PTSD symptom severity, and dissociative phenomena (trait dissociation, numbing, and depersonalization) were assessed at pretreatment using semi-structured interviews and questionnaires. In a pretreatment behavioral exposure test, patients were imaginally exposed to (part of) their trauma memory for 9 min, during which subjective fear was assessed. At posttreatment and 6 months follow-up PTSD, depressive and dissociative symptoms were again assessed in the completers (n = 60). Pretreatment levels of dissociative and depressive symptoms were similar in dropouts and completers and none of the dissociative phenomena nor depression predicted improvement. Against expectations, dissociative phenomena and depression were associated with enhanced rather than impeded fear activation during the behavioral exposure test. However, these effects disappeared after controlling for initial PTSD severity. Hence, rather than supporting contraindication, the current results imply that patients presenting with even severe dissociative or depressive symptoms may profit similarly from exposure treatment as do patients with minimal dissociative or depressive symptoms.     

Anhedonia, Emotional Numbing, and Symptom Overreporting in Male Veterans with PTSD

We used measures of positive affect and emotional expression to distinguish and better understand veterans with PTSD with symptom overreporting presentation styles. Based on prior research, symptom overreporting was defined as scores greater than eight on the F(p) (Infrequency-Psychopathology) scale of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2). Data were drawn from an archival dataset of 227 combat veteran outpatients. Results were consistent with theory and research on the distinction between negative and positive affect. Major findings indicated that (a) veterans endorsing greater anhedonia had a greater likelihood of being classified as a symptom overreporter (controlling for PTSD symptoms), and (b) compared to non-symptom overreporting veterans, overreporters showed greater congruency in their presentation of diminished positive affect and their expression across self- and clinician-ratings. Our data suggest that diminished positive emotions and their behavioral expression are uniquely associated with veterans' psychological experiences, providing insight into the nature of symptom overreporters.     

To adjust or not adjust: Nonparametric effect sizes,confidence intervals,and real-world meaning

ObjectivesThe main objectives of this article are to: (a) investigate if there are any meaningful differences between adjusted and unadjusted effect sizes (b) compare the outcomes from parametric and non-parametric effect sizes to determine if the potential differences might influence the interpretation of results, (c) discuss the importance of reporting confidence intervals in research, and discuss how to interpret effect sizes in terms of practical real-world meaning.DesignReview.MethodA review of how to estimate and interpret various effect sizes was conducted. Hypothetical examples were then used to exemplify the issues stated in the objectives.ResultsThe results from the hypothetical research designs showed that: (a) there is a substantial difference between adjusted and non-adjusted effect sizes especially in studies with small sample sizes, and (b) there are differences in outcomes between the parametric and non-parametric effect size formulas that may affect interpretations of results.ConclusionsThe different hypothetical examples in this article clearly demonstrate the importance of treating data in ways that minimize potential biases and the central issues of how to discuss the meaningfulness of effect sizes in research.     

An Investigation of Counselor Interpretations in Client-Centered Therapy

Preliminary findings by the McGill Psychotherapy Process Research Team indicate that not only are interpretations used in client-centered therapy, but they are also efficient in producing in-session client change. Using the Hill Counsellor Verbal Response Category System—Revised (Friedlander, 1982) as a guide to locate interpretations, we investigated the qualitative differences between interpretations leading to different in-session client change events in six sessions conducted by Carl Rogers. The occurrence of in-session therapeutic phenomena were assessed using the Experiencing Scale (Klein, Mathieu, Gendlin, & Keisler, 1970) and the Category System of Good Moments (Mahrer & Nadler, 1986). Results indicate that significant in-session therapeutic phenomena are preceded by interpretations and that qualitative differences exist between interpretations that precede change events and those that do not. Implications for psychotherapy theory, research, and practice are discussed.     

Method Decisions: Quantitative and Qualitative Inquiry in the Study of Religious Phenomena

The conceptual and procedural differences between quantitative and qualitative methods have led many researchers to realize that some methodologies are better suited for studying some phenomena over other phenomena. However, practical guidelines for making these method decisions have yet to be developed. The primary purpose of this paper is to begin to provide such guidelines, especially in the study of religious phenomena. We first discuss the common mistake in Western psychology of considering methods as mere procedures rather than as the outcomes of different interpretations of the world. We then compare five features of a general quantitative interpretation with five features of a general qualitative interpretation. From this comparison, the advantages and disadvantages of each method strategy are discussed. Knowledge of these advantages and disadvantages allows methods to be better matched to the religious phenomena being studied.     

Exploring explicit learning strategies: A dissociative framework for research

To explain learning, comparative researchers invoke an associative construct by which immediate reinforcement strengthens animal's adaptive responses. In contrast, cognitive researchers freely acknowledge humans' explicit-learning capability to test and confirm hypotheses even lacking direct reinforcement. We describe a new dissociative framework that may stretch animals' learning toward the explicit pole of cognition. We discuss the neuroscience of reinforcement-based learning and suggest the possibility of disabling a dominant form of reinforcement-based discrimination learning. In that vacuum, researchers may have an opportunity to observe animals' explicit learning strategies (i.e., hypotheses, rules, task self-construals). We review initial research using this framework showing explicit learning by humans and perhaps by monkeys. Finally, we consider why complementary explicit and reinforcement-based learning systems might promote evolutionary and ecological fitness. Illuminating the evolution of parallel learning systems may also tell part of the story of the emergence of humans' extraordinary capacity for explicit-declarative cognition.     

Self-Enhancement: Food for Thought

ABSTRACT— Self-enhancement denotes a class of psychological phenomena that involve taking a tendentiously positive view of oneself. We distinguish between four levels of self-enhancement—an observed effect, an ongoing process, a personality trait, and an underlying motive—and then use these distinctions to organize the wealth of relevant research. Furthermore, to render these distinctions intuitive, we draw an extended analogy between self-enhancement and the phenomenon of eating. Among the topics we address are (a) manifestations of self-enhancement, both obvious and subtle, and rival interpretations; (b) experimentally documented dynamics of affirming and threatening the ego; and (c) primacy of self-enhancement, considered alongside other intrapsychic phenomena, and across different cultures. Self-enhancement, like eating, is a fundamental part of human nature.     

Hybrid preference machines based on inspiration from neuroscience

In the past, a variety of computational problems have been tackled with different connectionist network approaches. However, very little research has been done on a framework which connects neuroscience-inspired models with connectionist models and higher level symbolic processing. In this paper, we outline a preference machine framework which focuses on a hybrid integration of various neural and symbolic techniques in order to address how we may process higher level concepts based on concepts from neuroscience. It is a first hybrid framework which allows a link between spiking neural networks, connectionist preference machines and symbolic finite state machines. Furthermore, we present an example experiment on interpreting a neuroscience-inspired network by using preferences which may be connected to connectionist or symbolic interpretations.     

Dissociative style and individual differences in verbal working memory span

Dissociative style is mostly studied as a risk factor for dissociative pathology, but it may also reflect a fundamental characteristic of healthy information processing. Due to the close link between attention and working memory and the previous finding of enhanced attentional abilities with a high dissociative style, a positive relationship was also expected between dissociative style and verbal working memory span. In a sample of 119 psychology students, it was found that the verbal span of the high-dissociative group was about half a word larger than of the medium and low-dissociative groups. It is suggested that dissociative style may be one of only very few individual differences that is directly relevant to consciousness research.     

Acute dissociation after 1 night of sleep loss

Recent research has shown that dissociative symptoms are related to self-reports of deviant sleep experiences. The present study is the 1st to explore whether sleep loss can fuel dissociative symptoms. Twenty-five healthy volunteers were deprived of sleep for 1 night. Sleepiness and dissociative symptoms were assessed every 6 hr. The authors measured both spontaneous dissociative symptoms and dissociative symptoms induced by dot-staring during sensory deprivation. Sleepiness as well as spontaneous and induced dissociative symptoms were stable throughout the day but increased during the night. These findings provide further evidence for a robust relationship between disruptions in sleep patterns and dissociative symptoms.     

Identity as a Determinant of the Overreporting of Church Attendance in Canada

Recent work has demonstrated that Canadians overreport church attendance at rates similar to respondents in the United States. Overreporting in the United States has been attributed to the importance of religious identity; causes of Canadian overreporting have not been examined. This article draws upon Stryker's identity theory to explain why Canadian survey respondents overreport church attendance. The 2005 Canadian General Social Survey contains observed measures of attendance from both a conventional survey question and a time diary, allowing a direct and rigorous test of the identity explanation. Findings suggest that rates of Canadian overreporting, at about 50 percent, rival rates of overreporting in the United States. Moreover, like overreporting in the United States, Canadian overreporting may be affected by an identity process during the survey interview. Finally, implications for measuring religiosity in both countries are discussed.     

Groups and the mediation of dissociative experience: A Western and non-Western comparison

Since dissociative experience is generally devalued in our society and accepted, even honored, in many other cultures, groups play a crucial but very different role in the integration of dissociative experiences in both settings. This paper contrasts the role of groups in the treatment of patients with dissociative disorder in Western medical settings and the role of groups and community in integrating the experience of persons possessed by spirits or using trance in some non-Western societies. The link between trauma and dissociative sequelae is examined, with the speculation that subjectively painful and intense experiences may be normalized and thus hidden in non-Western cultures.Portions of this paper were presented at the spring 1994 meetings of Division 39, section 7, April 16, 1994, in Washington, DC. The author thanks Professor Michael Stocker for conceptual and editorial assistance.     

A Multimethod Analysis of Incompleteness and Visual “Not Just Right” Experiences in Body Dysmorphic Disorder

Individuals with body dysmorphic disorder (BDD) often report engaging in repetitive behaviors aimed at reducing feelings of imperfection anchored to their appearance. “Not just right” experiences (NJREs) and incompleteness (INC) are constructs related to perfectionism that have traditionally been studied in obsessive-compulsive disorder, though recent research has also linked these phenomena to BDD. We sought to replicate and extend this research via two studies. Study 1 examined BDD symptoms, INC, as well as harm avoidance (HA) in an unselected sample (N = 179); moderate associations were observed between symptoms and both INC and HA. Participants also completed a novel visual NJRE task in which they were shown appearance-related and non-appearance-related images meant to evoke an NJRE response (i.e., discomfort and urge to “fix” stimuli). BDD symptoms predicted reactivity to appearance-related NJRE stimuli above negative affect. Study 2 compared INC, HA, and task reactivity in a BDD sample (N = 50) to nonpsychiatric controls (N = 44). The BDD group evidenced greater INC, HA, and reactivity to both appearance and nonappearance NJRE stimuli, relative to controls; however, group differences did not remain after controlling for age and negative affect. These studies broadly corroborate previous research highlighting NJREs and INC as potential vulnerability factors relevant to BDD, though these phenomena may not be specific to BDD symptoms.     

Dissociative disorders in Vietnam combat veterans

A group of Vietnam combat veterans were surveyed to determine the quantity and quality of their dissociative symptoms. The results suggest that the symptoms of post-traumatic stress disorder (PTSD) and dissociative disorders in this group of patients may be much more closely intertwined than we have heretofore considered. Those who suffer from PTSD have a continuum of severity of dissociative symptoms ranging from the frequent experience of a partially forgotten traumatic experience to the rare occurrence of a full blown case of multiple personality disorder (MPD). Most cases of MPD are related to trauma during childhood in environments fraught with extreme ambivalence and victimization, in association with abandonment and betrayal. However, the high frequency of dissociative symptoms and even occasional occurrences of MPD in Vietnam veterans suggests a similarity in the environmental factors associated with the Vietnam war.     

Current Treatment Strategies for Dissociative Identity Disorders in Adult Sexual Abuse Survivors

SUMMARY

During the past decade, increasing numbers of clinicians and researchers have suggested that the dissociative disorders, including dissociative identity disorder (DID), may be more prevalent than previously hypothesized. The “rediscovery” of DID is due, in part, to the recognition that early childhood trauma in conjunction with the propensity to dissociate, are etiologic factors for the development of DID. The purpose of this article is to raise clinical consciousness regarding DID, discuss the definition and etiology of the dissociative disorders, their assessment, and an approach to treatment of the sexual abuse survivor who has DID. This treatment program, while integrating some of the techniques recommended by others, is unique in its step-by-step flexible organization as well as its multifaceted format. The author's experience to date suggests that the sooner that a dissociative disorder can be identified in the adult sexual abuse survivor client, the more rapid the therapeutic progress.     

MAPPING THE LANDSCAPE: LEVELS OF TRANSFERENCE INTERPRETATION3

The author argues that there are distinctly different kinds of transference interpretation, each of which might be valid in particular circumstances in analysis, but which contain and imply different understandings of what is meant by a ‘transference interpretation’. She suggests that transference interpretations may be at any one of four different levels, and she describes these levels as ranging from interpretations that point to links between current events in the analysis and events from the patient's history, through interpretations that link events in the patient's external life to the patient's often unconscious phantasies about the analyst and the analysis, to interpretations that focus on the use of the analyst and the analytic situation to enact unconscious phantasy configurations, sometimes pulling the analyst into the enactment. Material from four consecutive sessions of an analysis is presented to illustrate how all levels of transference interpretation may be part of a lively and meaningful analysis, but how the level of interpretation may change as the level of understanding deepens within a session and from one session to the next.     

Vietnam Veterans: Overreporting Versus Acceptable Reporting of Symptoms

Overreporting of symptoms among Vietnam combat veterans is a problem area with little research. Five hundred thirty Vietnam-era veterans were given the MMPI. They were divided according to two criteria, combat status and reporting status. For combat status, subjects were either in Vietnam (in-country) or in the military but not in Vietnam (Vietnam-era) between 1964 and 1975. For reporting status, the MMPI overreporting criteria of the subtle-obvious (S-O) items given by Green (1986) were used. Overreporters had an S-O total of > 160, and acceptable subjects were at or below this figure. Also, all subjects who responded randomly were excluded (MMPI Test-Retest scales > 4). Results indicated that a high number of subjects randomly responded to the MMPI, and that in-country veterans met the overreporting criteria in greater numbers than the Vietnam-era group. Also, multivariate analyses of variance (MANOVAs) showed significant differences among groups in four distinct areas—MMPI basic scales, Harris-Lingoes, Wiggins, and special subscales—for both reporting status and combat status, but not for the interaction. Post hoc analyses of variance (ANOVAs) showed that reporting status was especially robust. Two Vietnam in-country PTSD types, overreporters and "acceptable" patients, are discussed. Overreporters are more pathological and a distinct challenge in treatment relative to the other in-country veterans.     

Sleep Disturbances Among Combat Military Veterans: A Comparative Study Using Subjective and Objective Sleep Assessments

The sleep characteristics of 37 military veterans and active-duty service members (17 with PTSD and 20 without PTSD) of recent wars were analyzed to determine if combat deployment, with its associated sleep restriction, may be an alternative explanation for the sleep complaints found among combat veterans with PTSD (as determined by PTSD Checklist Military Version scores). Over a 1-week period, sleep data were collected using sleep actigraphy and self-report. Across the entire sample, subjective and objective assessment methods of sleep were strongly correlated, although there were some notable within-group differences. Specifically, although sleep duration between groups did not differ based on actigraphy, veterans without PTSD reported sleeping 1 h and 11 min (p = .002) longer than did veterans with PTSD. In an effort to determine why individuals without PTSD might be overreporting sleep, we found that symptoms of emotional arousal (anger, anxiety, and nightmares) were significantly correlated with self-reported sleep duration, suggesting a pattern of higher autonomic arousal found in veterans with PTSD. Thus, although sleeping for 6 h, the higher levels of emotional arousal reported by veterans with PTSD may mean that they do not perceive their sleep as restful. Further research is necessary to determine if the sleep architecture of veterans with PTSD is actually different from that of combat veterans without PTSD and if such differences are actually amenable to standard behavioral treatments for this disorder.