Best professional practices when approaching religiosity/spirituality in psychotherapy in Brazil

The religiosity/spirituality (R/S) dimension is recognised as an important component of the concept of health advocated by the World Health Organization; however, it does not appear in the undergraduate Psychology curricula in the Brazilian context, revealing a gap in the way this theme has been covered. In order to identify the professional reality of Brazilian psychotherapists in relation to this theme, this study aimed to identify what constitutes the best professional practices when approaching R/S in psychotherapy. We interviewed 24 psychotherapists of both sexes, with a mean age of 36.43, from two medium‐sized cities of two Brazilian states. According to the interviewees, the best practices considered when addressing R/S, that is, the most appropriate actions/attitudes, are as follows: (a) Respect; (b) Knowing how to separate what is from the psychotherapist and from the patient/client; (c) Recognising the theme as an integrative dimension of the human being; (d) Knowing how to listen; (e) Questioning the role of R/S in the life of the patients/clients; (f) Knowledge about the subject matter; and (g) Not imposing knowledge, practices or doctrine. These practices were revealed as the skills, competencies and knowledge needed to deal with the subject and highlight important references to think about the theme in psychotherapy, guiding the formation of new professionals and updating practising psychotherapists.     

Being Human: Experiencing and Communicating

Haye’s article Living being and speaking being highlights a confusion that the traditional cognitive science has been making between cognition and representation, reducing semantics (meaning) to the syntax (computation with symbols). This traditional view cannot fully grasp the dependence of meaning on the relational context, opening space for the need to take into account the Bakhtinian notions of responsivity and addressivity to an other as defining features of the communicational social act. Socialized signs are conceived here as central tools to our relation to the world and to the others. We pursue some of the implications of this radical dialogical commitment specifying their implications to an ontological level of human beings: relationships are the ground for the depiction of human beings and otherness as a necessary complementarity of our own existence.     

Spermine improves recognition memory deficit in a rodent model of Huntington’s disease

Huntington’s disease (HD) is a progressive neurodegenerative disorder associated with motor and cognitive impairment. Intrastriatal administration of quinolinic acid (QA) causes neurodegeneration, glial proliferation and cognitive impairment in animals, which are similar to these seen in human HD. Since polyamines improve memory in cognitive tasks, we now tested if the post-training intrastriatal administration of spermine, an agonist of the polyamine site at the NMDA receptor, reverses the deficits in the object recognition task induced by QA. Bilateral striatal injections of QA (180 or 360 nmol/site) caused object recognition impairment, neuronal death and reactive astrogliosis. A single injection of spermine (0.1 and 1 nmol/site), 5 days after QA injection, reversed QA-induced impairment of object recognition task. Spermine (0.1 nmol/site) also inhibited QA-induced reactive astrogliosis measured by a semi-quantitative determination of GFAP immunolabelling, but did not alter neuronal death, measured by a semi-quantitative determination of fluoro-Jade C staining. These results suggest that polyamine binding sites may be considered a novel therapeutic target to prevent reactive astrogliosis and mnemonic deficits in HD.     

Microinfusions of flumazenil into the basolateral but not the central nucleus of the amygdala enhance memory consolidation in rats.

Extensive evidence indicates that benzodiazepine receptors in the amygdala are involved in regulating memory consolidation. Recent findings indicate that many other drugs and hormones influence memory through selective activation of the basolateral amygdala nucleus (BLA). This experiment examined whether the memory-modulatory effect of flumazenil, a benzodiazepine receptor antagonist, selectively involves the BLA. Bilateral microinfusions of flumazenil (12 nmol in 0.2 microl) into the BLA of rats administered immediately after training in an inhibitory avoidance task significantly enhanced 48-h retention performance whereas infusions into the central nucleus were ineffective. These findings indicate that the BLA is selectively involved in mediating flumazenil's influence on memory storage and are thus consistent with extensive evidence indicating that the BLA is involved in regulating memory consolidation.     

The effects of metabolic stress and vagotomy on emotional learning in an animal model of anxiety

The aim of the present study is to evaluate the role of the blood glucose (BG) level in emotional learning in the elevated plus maze (EPM), an animal model of anxiety. In Experiment 1, male Wistar rats were submitted to different EPM trial lengths (1- or 5-min). Blood samples were withdrawn before and after the maze exploration, through a polyethylene cannula chronically implanted into the jugular vein. In Experiment 2, the animals received either saline or 2-deoxy-D-glucose, a glucoprivic drug (2-DG, 250 or 500 mg kg(-1)) by i.p. route, 30 min before a 5-min EPM exposure and were retested in the maze (Trial1/Trial2 EPM procedure) 24 h later. In an independent group of rats, blood samples were withdrawn 0, 5, 15, and 30 min after 2-DG administration, through the jugular vein, to determine BG. In Experiment 3, the animals underwent a vagotomy and were tested in a Trial1/Trial2 EPM procedure four weeks later. The results showed that rats exploring the EPM for 5 min displayed increased fear and higher hyperglycemia than those exploring the EPM for 1 min. In addition, rats submitted to 5-min EPM Trial1 length displayed higher level of fear on Trial2, as well as higher percentage of shortening of the %Open arm entries and %Open arm time from Trial1 to Trial2, which characterizes the occurrence of emotional learning. In contrast, rats previously vagotomized or treated with 2-DG (500 mg kg(-1)) showed the same level of fear on both EPM trials and a low percentage of shortening, from Trial1 to Trial2, of the %Open arm entries and %Open arm time, indicating poor emotional learning. The data is discussed regarding the role of glycaemia in emotional learning in the EPM.     

Hand Grip and Load Force Coordination of the Ipsilesional Hand of Chronic Stroke Individuals

Object manipulation depends on a refined control of grip force (GF) and load force (LF). After a brain injury, the GF control is altered in the paretic hand but what happens with the non-paretic hand is still unclear. In this study, we compared the GF control and GF–LF coordination of the non-paretic hand of 10 stroke individuals who suffered right brain damage (RBD) and 10 who suffered left brain damage (LBD), with 20 healthy individuals during lifting and oscillation task, using an instrumented object. GF was recorded with a force transducer, and LF was estimated from the object weight and acceleration. Overall, the ipsilesional hand of stroke individuals, independent of the lesion side, presented similar GF control and GF–LF coordination. However, LBD individuals took longer to start lifting the object, which may be due to the need of more time to obtain somatosensory information from the contact with the object. The findings indicate that stroke individuals preserve their ability to control and coordinate GF and LF when using their ipsilesional hand for object manipulation and the left hemisphere may play an essential role in the processing of somatosensory information needed for the GF control.     

Antagonism of lateral amygdala alpha1-adrenergic receptors facilitates fear conditioning and long-term potentiation

Norepinephrine receptors have been studied in emotion, memory, and attention. However, the role of alpha1-adrenergic receptors in fear conditioning, a major model of emotional learning, is poorly understood. We examined the effect of terazosin, an alpha1-adrenergic receptor antagonist, on cued fear conditioning. Systemic or intra-lateral amygdala terazosin delivered before conditioning enhanced short- and long-term memory. Terazosin delivered after conditioning did not affect consolidation. In vitro, terazosin impaired lateral amygdala inhibitory postsynaptic currents leading to facilitation of excitatory postsynaptic currents and long-term potentiation. Since alpha1 blockers are prescribed for hypertension and post-traumatic stress disorder, these results may have important clinical implications.Although norepinephrine (NE) has been widely studied as an important modulator of memory and emotion, comparatively little is known about the role of NE in amygdala-dependent Pavlovian fear conditioning, a major model for understanding the neural basis of fear learning and memory. In fear conditioning, an emotionally neutral conditioned stimulus (CS; i.e., tone) is temporally paired with an aversive unconditioned stimulus (US; i.e., footshock). After very few pairings, a lasting, robust CS–US association is acquired, and the CS elicits stereotypical defensive responses, including behavioral freezing (Blanchard and Blanchard 1969; Bolles and Fanselow 1980).The lateral nucleus of the amygdala (LA) is a key structure underlying fear conditioning (LeDoux 2000). Convergence of CS and US information in LA is believed to play an important role in initiating synaptic plasticity. Long-term potentiation (LTP)-like changes in LA CS processing are critical for fear memory storage (LeDoux 2000; Blair et al. 2001; Maren 2001; Walker and Davis 2002). LA receives auditory CS inputs from the thalamus and cortex and connects directly and indirectly with the central nucleus of the amygdala to control expression of Pavlovian fear responses.Of the noradrenergic receptor subtypes, alpha1 receptors have received the least attention in fear conditioning. LA receives NE-containing inputs from the locus coeruleus that fire tonically and phasically in response to aversive stimuli like footshock (Pitkänen 2000; Tanaka et al. 2000; Aston-Jones and Cohen 2005). Alpha1-adrenergic receptors are expressed in LA, most likely on both excitatory and inhibitory neurons (Jones et al. 1985; Domyancic and Morilak 1997). Alpha1 receptor activation stimulates GABA-mediated miniature inhibitory postsynaptic currents in LA (Braga et al. 2004), suggesting that alpha1 receptors contribute to inhibition in fear conditioning pathways. Several elegant experiments recently demonstrated that LA inhibition gates synaptic plasticity necessary for fear conditioning, and this inhibitory gate can be influenced by neuromodulators including NE (Stutzmann and LeDoux 1999; Shumyatsky et al. 2002; Bissière et al. 2003; Shaban et al. 2006; Shin et al. 2006; Tully et al. 2007). However, the role of alpha1 receptor activity in gating amygdala LTP and fear learning has never been examined.We hypothesized that alpha1 blockers would facilitate fear learning, possibly by impairing LA inhibition and facilitating LA LTP. To test this hypothesis, we injected rats with terazosin, a selective alpha1-adrenergic receptor antagonist, systemically or directly into LA before or after fear conditioning. We examined in vitro the effect of terazosin on LA pyramidal cell inhibitory postsynaptic currents (IPSCs) and excitatory postsynaptic currents (EPSCs) in response to fiber stimulation of the thalamic CS input pathway to LA, as well as the effect of terazosin on LA LTP in this same pathway. We found that intra-LA terazosin facilitated fear conditioning when injected before but not after training. We also found that terazosin impaired IPSCs in LA pyramidal cells, leading to facilitated EPSCs and LTP.Behavioral experiments were conducted on adult, male Sprague–Dawley rats (Hilltop Laboratory Animals) weighing approximately 300 g upon arrival. Rats were individually housed, maintained on a 12/12 h light/dark schedule, and allowed free access to food and water. Testing was conducted during the light phase. All procedures and experiments were approved by NYU''s Animal Care and Use Committee.For systemic injections, terazosin (20 mg/kg; Sigma) was dissolved in saline and injected intraperitoneally (i.p.) 30 min prior to conditioning in 1 mL/kg volume. For bilateral infusions, terazosin (125 ng/0.25 µL) was dissolved in aCSF and infused into the LA at 0.1 µL/min 30 min prior to or immediately after fear conditioning. Bilateral guide cannulae (22 gauge; Plastics One) aimed at LA (−3.3 mm anterior, 5.2 mm lateral, −7 mm dorsal to bregma) were surgically implanted as previously described (Sotres-Bayon et al. 2009). Rats were given at least 7 d to recover from surgery before testing. For infusions, dummy cannulae were removed, and infusion cannulae (28 gauge, +1 mm beyond guides) were inserted into guides. Infusion cannulae were connected to a 1.0 μL Hamilton syringe via polyethylene tubing. Infusion rate was controlled by a pump (PHD22/2000; Harvard Apparatus), and infusion cannulae were left in place for an additional 60 sec to allow diffusion of the solution away from the cannula tip, then dummy cannulae were replaced. Upon completion of the experiment, rats were euthanized, brains removed, and cannulae placements verified histologically as previously described (Sotres-Bayon et al. 2009).Two contexts (A and B) were used for all testing as previously described (Schiller et al. 2008). The grid floors in Context B were covered with black Plexiglas inserts to reduce generalization. No odors were used and chambers were cleaned between sessions. CSs were 30 sec, 5 kHz, 80 dB tones, and USs were 1 sec, 0.8 mA scrambled electric footshocks. Experiments consisted of two phases separated by 48 h: (1) fear conditioning in Context A and (2) long-term memory (LTM) test in Context B. On Day 1, rats were placed in Context A, allowed 5 min to acclimate, and then received three CS–US pairings separated by variable 5 min ITIs. On Day 3, rats were placed in Context B and allowed 5 min to acclimate before receiving one CS-alone presentation.The index of fear in behavioral experiments was “freezing,” the absence of all non-respiratory movement (Blanchard and Blanchard 1971; Fanselow 1980). Following testing, freezing was manually scored from DVDs by a scorer blind to group specification. Graphs represent group means ± SEM. Statistical analysis was conducted with GraphPad Prism.Whole-cell electrophysiological recordings were obtained from LA pyramidal cells using in vitro coronal slices from rats aged P21–P30 d as described in Cunha et al. (2010). Terazosin was bath-applied for 10 min to achieve stable responses before testing. The cells were voltage-clamped using an Axopatch 200B amplifier at −35 mV for recording EPSCs and IPSCs. Synaptic responses were evoked with sharpened tungsten bipolar stimulating electrodes. Internal capsule fibers containing thalamic afferents were stimulated for paired-pulse facilitation (PPF) (ISI = 50 msec; 0.1 Hz) using a photoelectric stimulus isolation unit with a constant current output. Cells were rejected if access resistance (8–26 MΩ) changed more than 15%. Signals were filtered at 2 kHz and digitized (Digidata 1440 A; Axon Instruments), and peak amplitude, 10%–90% rise time, and IPSC decay time constants were analyzed offline using pCLAMP10.2 software (Axon Instruments).Brain slices for LTP experiments were prepared from rats aged 3–5 wk as in Johnson et al. (2008) and maintained on an interface chamber at 31°C. Glass recording electrodes (filled with aCSF, 5 MΩ resistance) were guided to LA neurons. Bipolar stainless steel stimulating electrodes (75 kΩ) were positioned medial to LA in internal capsule fibers. Orthodromic synaptic potentials were evoked via an isolated current generator (Digitimer; 100 μsec pulses of 0.3–0.7 mA). Evoked field potentials were recorded with an Axoclamp 2B amplifier and Axon WCP software (Axon Instruments). Data were analyzed offline using WCP PeakFit (Axon Instruments). LTP was measured as a change in evoked field potential amplitude.Baseline responses were monitored at 0.05 Hz for 30 min with a stimulus intensity of 40%–50% of maximum fEPSP before LTP induction. Terazosin (10 µM) was superfused for 15 min, and then LTP was elicited by three tetanus trains (100 Hz × 1 sec, 3 min ITI) with the same intensity and pulse duration as the baseline stimuli. In one experiment, picrotoxin (PTX; 75 µM) was present in the perfusion solution to block fast GABAergic signaling.     

Building Alliances with (In)Voluntary Clients: A Study Focused on Therapists’ Observable Behaviors

This study aimed to compare therapists’ observable behaviors to promote alliances with involuntary and voluntary clients during brief family therapy. The therapists’ contributions to fostering alliances were rated in sessions 1 and 4 using videotapes of 29 families who were observed in brief therapy. Using the System for Observing Family Therapy Alliances, trained raters searched for specific therapist behaviors that contributed to or detracted from the four alliance dimensions: engagement in the therapeutic process, an emotional connection with the therapist, safety within the therapeutic system, and a shared sense of purpose within the family. The results showed that when working with involuntary clients, therapists presented more behaviors to foster the clients’ engagement and to promote a shared sense of purpose within the family. However, in the fourth session, the therapists in both groups contributed to the alliance in similar ways. The results are discussed in terms of (a) the therapists’ alliance‐building behaviors, (b) the specificities of each client group, and (c) the implications for clinical practice, training, and research.     

Parents’ Positive Interpersonal Coping After a Child’s Death

Despite the challenging context of grieving for the death of a child, evidence shows that it is possible for parents to manage and preserve their relationship. The aim of this study was to examine parents’ perceptions of positive interpersonal coping processes that helped their relationship after the death of their child. Individual semi-structured interviews with 17 bereaved maritally committed parents were conducted. The interview guide included questions covering themes such as parents’ coping together, relationship strengths and mutual support. Data were analyzed through constructivist grounded theory methods. Three main themes were identified: search for meaning (reframing of partners’ different coping processes and the changes/difficulties in the relationship, and development of shared beliefs); communication with the partner (direct and indirect feedback, and mutual learning); and care-in-relation (caring for the partner and the relationship). Dyad-level interventions should aim at promoting mutual empathy, development of shared appraisals, and the identification and consideration of each other’s boundaries.     

The role of nucleus accumbens and dorsolateral striatal D2 receptors in active avoidance conditioning

The role of dopamine (DA) in rewarding motivated actions is well established but its role in learning how to avoid aversive events is still controversial. Here we tested the role of D2-like DA receptors in the nucleus accumbens (NAc) and the dorsolateral striatum (DLS) of rats in the learning and performance of conditioned avoidance responses (CAR). Adult male Wistar rats received systemic, intra-NAc or intra-DLS (pre- or post-training) administration of a D2-like receptor agonist (quinpirole) or antagonist ((−)sulpiride) and were given two sessions in the two-way active avoidance task. The main effects observed were: (i) sulpiride and lower (likely pre-synaptic) doses of quinpirole decreased the number of CARs and increased the number of escape failures; (ii) higher doses of quinpirole (likely post-synaptic) increased inter-trial crossings and failures; (iii) pre-training administration of sulpiride decreased the number of CARs in both training and test sessions when infused into the NAc, but this effect was observed only in the test session when it was infused into the DLS; (iv) post-training administration of sulpiride decreased CARs in the test session when infused into the NAc but not DLS. These findings suggest that activation of D2 receptors in the NAc is critical for fast adaptation to responding to unconditioned and conditioned aversive stimuli while activation of these receptors in the DLS is needed for a slower learning of how to respond to the same stimuli based on previous experiences.