Stress, Glucocorticoids, and Damage to the Nervous System: The Current State of Confusion

An extensive literature demonstrates that glucocorticoids (GCs), the adrenal steroids secreted during stress, can have a broad range of deleterious effects in the brain. The actions occur predominately, but not exclusively, in the hippocampus, a structure rich in corticosteroid receptors and particularly sensitive to GCs. The first half of this review considers three types of GC effects: a) GC-induced atrophy, in which a few weeks' exposure to high GC concentrations or to stress causes reversible atrophy of dendritic processes in the hippocampus; b) GC neurotoxicity where, over the course of months, GC exposure kills hippocampal neurons; c) GC neuroendangerment, in which elevated GC concentrations at the time of a neurological insult such as a stroke or seizure impairs the ability of neurons to survive the insult. The second half considers the rather confusing literature as to the possible mechanisms underlying these deleterious GC actions. Five broad themes are discerned: a) that GCs induce a metabolic vulnerability in neurons due to inhibition of glucose uptake; b) that GCs exacerbate various steps in a damaging cascade of glutamate excess, calcium mobilization and oxygen radical generation. In a review a number of years ago, I concluded that these two components accounted for the deleterious GC effects. Specifically, the energetic vulnerability induced by GCs left neurons metabolically compromised, and less able to carry out the costly task of containing glutamate, calcium and oxygen radicals. More recent work has shown this conclusion to be simplistic, and GC actions are shown to probably involve at least three additional components: c) that GCs impair a variety of neuronal defenses against neurologic insults; d) that GCs disrupt the mobilization of neurotrophins; e) that GCs have a variety of electrophysiological effects which can damage neurons. The relevance of each of those mechanisms to GC-induced atrophy, neurotoxicity and neuroendangerment is considered, as are the likely interactions among them.     

Interaction of asthmatics and their spouses: A preliminary study of individual differences

Some asthmatics show evidence of airways reactivity triggered by strong emotions. Six case studies of married patients with severe asthma are reported. The videotaped interactions of the asthmatic and his/her spouse were coded for affect and behavior. Repeated measures of pulmonary function and affective state were recorded before and after two interaction tasks. Over the course of the experimental period, two patients' pulmonary function improved and four patients' deteriorated. In general, decreased pulmonary function was associated with more self-rated hostility and depression. The results are discussed in terms of their implications for the intra- and interpersonal factors that are important in asthma management.     

Dimensional asymmetry in attributional inference

A number of bipolar personality dimensions were investigated, some of which were selected a priori as being primarily concerned with interpersonal differences in skill (such as unintelligence-intelligence), and others of which were thought to describe differences in preferences (such as indoor-outdoor). Two findings emerged. First, persons at opposite poles of skill dimensions were assumed to possess differential role-taking ability: a skillful person was perceived as relatively more competent at portraying the opposite behavior than was an unskilled person. Second, attributions based upon skillful behavior tend to be less affected by contextual factors than attributions based upon unskillful behavior. An alternative interpretation of the results is discussed.     

Counterfactual Production and Achievement Orientation in Competitive Athletic Settings1

Two studies examined the impact of achievement orientation on counterfactual production in competitive sporting situations. In Study 1, participants created counterfactuals after reading 4 vignettes. Results indicated that participants reading about winners created more subtractive and downward counterfactuals than did participants reading about losers, while participants reading about losers created more additive and upward counterfactuals than did participants reading about winners. In Study 2, using participants in 3-on-3 basketball games, achievement orientation interacted with game outcome to produce adaptive responses for participants who held a mastery orientation and maladaptive responses for participants who held an outcome orientation. In addition to achievement orientation, the margin of victory played an important role in determining the type of counterfactual produced. The implications of these findings are discussed.     

Description and Immediate Impacts of a Preventive Intervention for Conduct Problems

A population-based randomized intervention trial for the prevention of conduct problems (i.e., oppositional defiant disorder and conduct disorder) is described. The LIFT (Linking the Interests of Families and Teachers) intervention was designed for all first- and fifth-grade elementary school boys and girls and their families living in at-risk neighborhoods characterized by high rates of juvenile delinquency. The 10-week intervention strategy was carefully targeted at proximal and malleable antecedents in three social domains that were identified by a developmental model of conduct problems. From 12 elementary schools, 671 first and fifth graders and their families participated either in the theory-based universal preventive intervention or in a control condition. The intervention consisted of parent training, a classroom-based social skills program, a playground behavioral program, and systematic communication between teachers and parents. A multiple measure assessment strategy was used to evaluate participant satisfaction and participation, fidelity of implementation, and the immediate impacts of the program on targeted antecedents.     

Interpersonal Skills Training to Reduce Aggressive and Delinquent Behavior: Limited Evidence and the Need for an Evidence-Based System of Care

The prevention of aggressive and delinquent behavior during childhood and adolescence is one of the highest priorities for public health and crime prevention. The most common approach to preventing or treating these conduct problems has been to provide interpersonal skills training to the affected youth. This paper reviews all randomized controlled trials evaluating interpersonal skills training programs as an intervention to reduce conduct problems. Research shows that such programs have weak empirical support as isolated interventions. An alternative evidence-based system of care is described. Such a system would include behavioral parent training and behavioral classroom-based interventions for young children at risk of developing problems, as well as multisystemic family therapy or multidimensional treatment foster care for chronic delinquents. Within such a network of services, interpersonal skills training could play an important supportive role. Such a system holds the greatest promise for reducing the prevalence of aggressive and delinquent behavior in communities.     

‘Informal polygamy’: a suitable case for treatment?

The authors describe an atypical family structure which they term 'informal polygamy' and give two examples from their therapeutic practice. They go on to outline a number of dilemmas in helping such families, including whether such a family structure is more usefully viewed as transitional or stable.     

Electrophysiological evidence for size invariance in masked picture repetition priming

This experiment examined invariance in object representations through measuring event-related potentials (ERPs) to pictures in a masked repetition priming paradigm. Pairs of pictures were presented where the prime was either the same size or half the size of the target object and the target was either presented in a normal orientation or was a normal sized mirror reflection of the prime object. Previous masked repetition priming studies have found a cascade of priming effect sensitive to perceptual (N190/P190) and semantic (N400) properties of the stimulus. This experiment found that both early (N190/P190 effects) and later effects (N400) were invariant to size, whereas only the N190/P190 effect was invariant to mirror reflection. The combination of a small prime and a mirror reflected target led to no significant priming effects. Taken together, the results of this set of experiments suggests that object recognition, more specifically, activating an object representation, occurs in a hierarchical fashion where overlapping perceptual information between the prime and target is necessary, although not always sufficient, to activate a higher level semantic representation.     

Book Reviews

Books reviewed in this article:
Lynn Hoffman, Family Therapy: An Intimate History
Ned L. Gaylin, Family, Self and Psychotherapy: A Person–centred Perspective
Roy Resnikoff, Bridges for Healing. Integrating Family Therapy and Psychopharmacology
John Sharry, Solution–Focused Groupwork
S.H. McDaniel, D.D. Lusterman and C. Philpot (eds), Casebook for Integrating Family Therapy: An Ecosystemic Approach
Carole Kayrooz, A Systemic Treatment of Bulimia Nervosa
George W. Burns, 101 Healing Stories. Using Metaphors in Therapy
Marcia Sheinberg and Peter Frankel, The Relational Trauma of Incest: A Family Based Approach to Treatment