Invited Special Review: Psychological Approaches for Managing Chronic Pain

Psychologists have had an important impact on the conceptualization, assessment, and treatment of chronic pain. Their contributions have been in the areas of emotional distress, behavioral limitations, cognitive mediating events, and psychosocial disruption of chronic pain. These foci have enabled them to clarify the multidimensional nature of chronic pain and to support the biopsychosocial framework as a conceptual guide for research and clinical purposes. Clinically, along with members of an interdisciplinary team, psychologists have a key role in the assessment and treatment of patients with chronic pain. Interdisciplinary collaboration allows the team to recognize important interactions between biomedical and psychosocial dimensions and to appreciate a broader conceptualization of patients' problems. The literature documents strong empirical support for operant-behavioral and cognitive-behavioral therapies for the treatment of chronic pain. On the other hand, although widely accepted from a clinical perspective, the use of motivational interviewing and motivational enhancement therapies is more recent and less well documented for use with patients with chronic pain.     

Block of glucocorticoid synthesis during re-activation inhibits extinction of an established fear memory

BackgroundThe pharmacology of traumatic memory extinction has not been fully characterized despite its potential as a therapeutic target for established, acquired anxiety disorders, including post-traumatic stress disorder (PTSD). Here we examine the role of endogenous glucocorticoids in traumatic memory extinction.MethodsMale C57BL/6J mice were injected with corticosterone (10 mg/kg, i.p.) or metyrapone (50 mg/kg, s.c.) during re-activation of a contextual fear memory, and compared to vehicle groups (N = 10–12 per group). To ensure that metyrapone was blocking corticosterone synthesis, we measured corticosterone levels following re-activation of a fear memory in metyrapone- and vehicle-treated animals.ResultsCorticosterone administration following extinction trials caused a long-lasting inhibition of the original fear memory trace. In contrast, blockade of corticosteroid synthesis with metyrapone prior to extinction trials enhanced retrieval and prevented extinction of context-dependent fear responses in mice. Further behavioral analysis suggested that the metyrapone enhancement of retrieval and prevention of extinction were not due to non-specific alterations in locomotor or anxiety-like behavior. In addition, the inhibition of extinction by metyrapone was rescued by exogenous administration of corticosterone following extinction trials. Finally, we confirmed that the rise in corticosterone during re-activation of a contextual fear memory was blocked by metyrapone.ConclusionsWe demonstrate that extinction of a classical contextual fear memory is dependent on endogenous glucocorticoid synthesis during re-activation of a fear memory. Our data suggest that decreased glucocorticoids during fear memory re-activation may contribute to the inability to extinguish a fear memory, thus contributing to one of the core symptoms of PTSD.     

Losing the Certainty of Self

In his theory of trauma, Ferenczi points to the disbelief of adults of a child's account of an event as an actual traumatizing factor. Ferenczi also states that of all the consequences of the trauma, which include identification with the aggressor, psychic coma, departure from the possibility of dreams, and a fall to the hell of nightmares, the most important and fundamental is the lack of certainty of self. The disbelief of the adults destroys the certainty of what is perceived and experienced; it has the power of annihilating the child's belief in his own perceptions, his trust in his own senses. The loss of certainty of self appears to be a common characteristic in patients with distinct psychic dynamics. We will analyze the loss of certainty of self in cases of patients of the NEPECC (Núcleo de Estudos em Psicanálise e Clínica da Contemporaneidade) [Center of Studies in Psychoanalysis and Contemporarity Clinic] at the Federal University of Rio de Janeiro.     

Beyond Thinness: The Influence of a Curvaceous Body Ideal on Body Dissatisfaction in Black and White Women

This study examined whether a curvaceous body ideal differentially influenced sources of body dissatisfaction in 116 Black and 222 White women at a northeastern U.S. university. We measured idealization of and dissatisfaction with three components of a curvaceous ideal: breast size, buttock size, and weight. Although most women preferred a curvaceous body shape, more White women preferred this ideal to be slender with medium breasts whereas more Black women preferred this ideal to be curvier with medium breasts and large buttocks. Women discrepant from these ideals reported more dissatisfaction. Dissatisfaction with the curvaceous ideal predicted appearance concerns. Findings highlight the need to consider valued body ideals other than thinness as potential sources of dissatisfaction among women of different racial/ethnic backgrounds.     

Learning as a context for differences and differences as a context for learning

In this paper we describe how we, as two trainers with multiple differences, engaged with a group of trainees in a process of deconstructing the differences between the participants in the training group, using the acronym Social GRRAACCEESS as a heuristic. We will explore how these differences reflexively influenced the process of learning, through teaching, training and supervision, within the group.     

The tell-tale tasks: a review of saccadic research in psychiatric patient populations

This review focuses on saccade research with adult psychiatric patients. It begins with an introduction of the various types of saccades and the tasks used to evoke them. The functional significance of the different types of eye movements is briefly discussed. Research findings regarding the saccadic performance of different adult psychiatric patient populations are discussed in detail, with particular emphasis on findings regarding error rates, response latencies, and any specific task parameters that might affect those variables. Findings regarding the symptom, neurocognitive, and neural correlates of saccadic performance and the functional significance of patients’ saccadic deficits are also discussed. We also discuss the saccadic deficits displayed by various patient groups in terms of circuitry (e.g. cortical/basal ganglia circuits) that may be implicated in the underlying pathophysiology of several of these disorders. Future directions for research in this growing area are offered.     

Variability in Adaptive Behavior in Autism: Evidence for the Importance of Family History

Adaptive behavior in autism is highly variable and strongly related to prognosis. This study explored family history as a potential source of variability in adaptive behavior in autism. Participants included 77 individuals (mean age = 18) with average or better intellectual ability and autism. Parents completed the Family History Interview about the presence of broader autism phenotype symptoms and major psychiatric disorders in first degree relatives. Adaptive behavior was assessed via the Vineland Adaptive Behavior Scales (VABS). Based on family history variables, age, and intelligence quotient (IQ), 87% of participants were correctly classified as having impaired or average VABS scores. Family history of depression and shyness accounted for the most variance in VABS scores, and they had the greatest influence on VABS Socialization scores in particular. Possible underlying mechanisms include genetics, psychosocial factors, and social resources. This study provides initial evidence of the importance of family history to adaptive behavior in autism and has implications for genetics and treatment.     

Developmental differences in error-related ERPs in middle- to late-adolescent males

Although there are some studies documenting structural brain changes during late adolescence, there are few showing functional brain changes over this period in humans. Of special interest would be functional changes in the medial frontal cortex that reflect response monitoring. In order to examine such age-related differences, the authors analyzed event-related potentials following errors in a visual flanker task and a go/no-go task in adolescent males, 15-16 and 18-20 years old. Response times and accuracy were comparable between groups on each task, but the younger group made more go/no-go errors, suggesting this task was more difficult. Error-related negativity, thought to be generated in the anterior cingulate cortex (ACC), had greater amplitude for the older adolescents on both tasks; thus the increased errors are not simply due to performance level differences. Results from this study suggest that the ACC, which supports response monitoring, is late to mature due to age-related structural or neurochemical changes.     

Regularity of symmetry verticality guides perceptual judgments of objects

Previous research indicated that most salient, real-world objects possess natural regularities that observers commonly assume in perceptual judgments of figural orientation and interpretation. Regularities include 3-dimensionality, bilateral symmetry, and the tendency for object tops to possess more salient information than bottoms. Thus, when observers interpret randomly shaped figures, they reliably impose volume, bilateral symmetry, and top and front orientation directions, even when figures are 2-dimensional and asymmetric. We confirmed generalizability for observers to assume these regularities with stimuli that vary in complexity, and we found evidence supporting another regularity, that of symmetry verticality (symmetry about a vertical axis). Findings support use of a family of perceptual heuristics corresponding to natural regularities that constrain stimulus indeterminacy and help guide judgment of object orientation and interpretation.