Complicating Factors Associated with Mild Traumatic Brain Injury: Impact on Pain and Posttraumatic Stress Disorder Treatment

The nature of combat in Iraq and Afghanistan has resulted in high rates of comorbidity among chronic pain, posttraumatic stress disorder (PTSD), and mild traumatic brain injury (mTBI) in Veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF). Although separate evidence-based psychological treatments have been developed for chronic pain and PTSD, far less is known about how to approach treatment when these conditions co-occur, and especially when they co-occur with mTBI. To provide the best care possible for OEF/OIF Veterans, clinicians need to have a clearer understanding of how to identify these conditions, ways in which these conditions may interact with one another, and ways in which existing evidence-based treatments can be modified to meet the needs of individuals with mTBI. The purpose of the present paper is to review the comorbidity of pain, PTSD, and mTBI in OEF/OIF Veterans, and provide recommendations to clinicians who provide care to Veterans with these conditions. First, we will begin with an overview of the presentation, symptomatology, and treatment of chronic pain and PTSD. The challenges associated with mTBI in OEF/OIF Veterans will be reported and data will be presented on the comorbidity among all three of these conditions in OEF/OIF Veterans. Second, we will present recommendations for providing psychological treatment for chronic pain and PTSD when comorbid with mTBI. Finally, the paper concludes with a discussion of the need for a multidisciplinary treatment approach, as well as a call for continued research to further refine existing treatments for these conditions.     

Moral counselling: a method in development

This article describes a method of moral counselling developed in the Radboud University Medical Centre Nijmegen (The Netherlands). The authors apply insights of Paul Ricoeur to the non-directive counselling method of Carl Rogers in their work of coaching patients with moral problems in health care. The developed method was shared with other health care professionals in a training course. Experiences in the course and further practice led to further improvement of the method.     

The cost of a strategy

Abstract

Experiment 1 demonstrated a new kind of dual-task interference effect. The primary task was a speeded left-right discrimination of stimulus position (R1). The un speeded secondary task consisted of reporting verbally whether the stimuli were the same or different (R2). Stimulus exposure time was either 150 or 2000 msec. Two groups of subjects performed the primary task only, whereas two other groups performed both tasks and were instructed to emit R1 before R2. It was reasoned that the decision would be made to emit R1 before R2, and that this decision would produce a lengthening of R1. The results supported this prediction. Experiment 2 showed that the interference effect also occurred when the subjects were not explicitly instructed to emit R1 before R2, and was not due to either the mere presence of the second task or to response grouping. Experiments 3 and 4 compared two possible models for explaining the interference effect, i.e. the capacity-sharing model and the postponement model. As predicted by the postponement model, task difficulty did not interact, or interacted underadditively, with task overlap (Experiment 3), and the interference effect was not influenced by the amount of processing resources devoted to the primary task (Experiment 4). It was concluded that this new type of interference effect is best explained by the version of the postponement model that locates the bottleneck at the decision stage.     

Bidirectional links in the network of multiplication facts

In three experiments, we tested the hypothesis that activation of multiplication operand nodes (e.g., 3 and 8) can occur through presentation of their product (e.g., 24). In Experiments 1 and 2 we found activation of the operands when the product was presented as a cue in a number-matching task. In Experiment 3, activation also occurred in a parity-matching task, where the product (24) was not relevant to the parity matching on its operands (3 and 8). We concluded that bidirectional links exist among the operands and their product for multiplication problems and these links can be activated in a purely stimulus-driven manner. We suggest this may constitute the basis for the solution of simple divisions by mediation through the complementary multiplication facts.     

Suppression of extinction with TMS in humans: from healthy controls to patients

We review a series of studies exemplifying some applications of single-pulse and paired-transcranial magnetic stimulation (TMS) in the study of spatial attention and of its deficits. We will focus primarily on sensory extinction, the failure to consciously perceive a contralesional sensory stimulus only during bilateral stimulation of homologous surfaces. TMS studies in healthy controls show that it is possible either to interfere or modulate the excitability of the parietal cortex during sensory (i.e. tactile and visual) attentional tasks, thus reproducing a condition of virtual extinction. TMS studies in patients with unilateral (mainly right) brain damage show that the modulation of the unbalance in cortical excitability between the two cerebral hemispheres transiently improves contralesional sensory extinction. These studies show the possible application of TMS not only as a research method in healthy subjects, but also as a tool for inducing brain excitability changes in patients with sensory extinction, which could be useful for supporting the rehabilitation of this deficit.     

Number magnitude orients attention, but not against one’s will

Recent evidence has shown that uninformative numbers can trigger attention shifts congruent with the spatial representation of number magnitude (Fischer, Castel, Dodd, & Pratt, 2003). In the present study, three spatial-cuing experiments whose aim was to qualify the automaticity of this numbermediated orienting are described. Experiment 1 replicated the phenomenon, showing that uninformative numbers can evoke orienting in a simple detection task. In Experiment 2, target location was random, but the participants were encouraged to shift attention to the left in response to large numbers and to the right in response to small numbers. No evidence for strong automaticity was observed, since the participants’ performance was better when left-side targets were preceded by large numbers than when they were preceded by small numbers and vice versa. Experiment 3 corroborated this pattern by comparing gaze- and number-mediated cuing under conditions of real counterpredictiveness. The results indicate that unlike gaze-driven orienting, number-mediated orienting is not obligatory.     

Nameless Desire: Alexithymia and the Anorexic Patient

In this article, the author attempts to provide a psychoanalytic understanding of the anorexic patient who is disconnected from her affective experience and is considered to be alexithymic. Through her restrictive food ritual, this type of patient may organize her internal states by repeatedly creating an illusion of what it is that she needs and desires. The author asserts that the task of the therapist working with the anorexic patient with alexithymia is to be aware of his own sensation-based reverie as lived within the intersubjective arena. This will enable the therapist to assist the patient in building an affective vocabulary to accurately identify, differentiate, and label the internal signals of her body. It is suggested that the subjective emotional experience of the patient will continue to be reorganized, expanded, and enriched as the therapist and patient mutually influence one another in this unique relational matrix. A clinical vignette is provided to illustrate intersubjective treatment interventions with a difficult-to-reach anorexic patient.     

Is handedness recognition automatic? A study using a Simon-like paradigm

The authors used a modified Simon task (J. R. Simon, 1969) to assess the automatic recognition of handedness. Participants responded to the color of a circle in the center of the photograph of a right or a left hand, displayed in the center of the computer screen. A regular Simon effect was found for back views, whereas a reverse Simon effect was found for palm views. This pattern of results was found when the forearm was present (Experiment 2), when 1 finger at a time was rendered invisible (Experiment 3), and when the hands were connected to a body image (Experiment 4). When the hands were cut at the wrist, no effect emerged (Experiment 1). These findings suggest an automatic encoding of the relative position of the hand in relation to the body (imaginary or real) rather than the automatic encoding of handedness.     

Right-left prevalence with task-irrelevant spatial codes

The present work investigated the right-left prevalence effect caused by the automatic activation of horizontal and vertical spatial codes in a task (Simon task) in which spatial information is task-irrelevant. Experiment 1 showed a horizontal Simon effect and a vertical Simon effect with a two-dimensional stimulus-response set. In Experiments 2 and 3, the right-left prevalence was obtained in two-dimensional Simon tasks with two contralateral effectors and four effectors respectively. Experiment 4 showed that horizontal coding is based on multiple spatial codes, whereas only one spatial code was formed for vertical coding. On the whole, these results support the notion that the right-left prevalence effect is a general phenomenon affecting spatial coding, and suggest that the horizontal dimension is prevalent because it is based on multiple spatial codes.