Stress on the dance floor: the cortisol stress response to social-evaluative threat in competitive ballroom dancers

The social self-preservation theory states that humans have a fundamental motivation to preserve the social self and that threats to the social self perturb biological markers such as cortisol. Five studies were designed to examine the cortisol response to competitive ballroom dancing as a paradigm for real-life social-evaluative threat. Competitive dancing produced substantial increases in cortisol compared to a control day. These increases were not due to the physical strain of dancing and were greater than those found during social-evaluative laboratory stressors. Responses did not habituate across competitions and were mostly elevated under highly focused conditions of threat (couple vs. group competition). These findings support the notion of a social self-preservation system that is physiologically responsive to threats to the social self.     

The psychobiology of trait shame in young women: extending the social self preservation theory

OBJECTIVE: The social self preservation theory (SSPT) proposes that social evaluative threat evokes the emotion of shame, which then shapes a coordinated psychobiological response. While this is supported in acute stress studies, there is no data on chronic experiences of shame. DESIGN: We investigated the association of trait shame with activity of the hypothalamic-pituitary-adrenal (HPA) axis, of the sympathetic nervous system (SNS), and regulation of inflammation in n = 56 young women. MAIN OUTCOME MEASURES: Daily profiles of salivary cortisol and alpha-amylase were assessed as indices of HPA axis and SNS activity, respectively. Inflammatory regulation was assessed by lipopolysaccharide-stimulated production and glucocorticoid inhibition of interleukin-6 in vitro. RESULTS: Trait shame was associated with SNS (r = .49; p = .001), but not HPA activity (r = .14; ns). Shame was associated with inflammatory activity (r = .35; p = .006) and glucocorticoid sensitivity (r = -0.43; p = .001). Relationships were not mediated by HPA and SNS activity. CONCLUSIONS: Results support SSPT predictions with respect to chronic shame experience and inflammation. Results further suggest the importance of SNS activation related to shame, and the possibility that HPA activation may be limited acute experiences of shame.     

Textbook of applied psychoanalysis

In this paper, Bion's triad of papers ‘On arrogance’, ‘Attacks on linking’ and ‘A theory of thinking’ (1957, 1959, 1962) are drawn on to trace through and discuss how patient and psychotherapist learned to work together in the course of a three-times-a-week NHS psychotherapy, which lasted for just under two-and-a-half years, terminating with the ending of the therapist's training. Attention is paid to the constant oscillations of work with the patient, a young man, in which his narcissistic and grandiose defences, while crude and precarious, were clung to by him, and returned to throughout the work but with lessening conviction. These often apparently random oscillations could be understood in terms of what Bion describes as apparently scattered references to curiosity, arrogance and stupidity, which none the less provide the evidence of a continuing psychological disaster. Throughout were reminders of the limits to an NHS training psychotherapy, which could not be open-ended and which was brought to an end at a point at which the patient and psychotherapist had learned to talk to each other.     

Glucocorticoid sensitivity in humans-interindividual differences and acute stress effects

The hypothalamus pituitary adrenal (HPA)- axis is one of the major output systems of the neuroendocrine stress response. Its major end products, glucocorticoids (GCs), have a plethora of effects throughout the organism, most of which are believed to be protective against disturbances of homeostasis. However, negative effects have also been described under specific conditions of hyper- or hypo(re)activity of the HPA axis. Both beneficial and adverse effects of GCs ultimately depend on the target tissue sensitivity to these steroids. Recent findings suggest that GC sensitivity (a) may vary between different target tissues in the same organism, (b) shows large individual differences and (c) can be acutely changed in times of acute stress. In the present review, data are summarized which show differences in GC sensitivities in patients suffering from diverse somatic and psychiatric diseases, as well as chronically stressed individuals. Furthermore, studies are presented that show a rapid modulation of GC sensitivity in response to exercise or psychosocial stress in healthy adults. The response pattern of acute GC sensitivity modulation seems to be influenced by age and sex hormone status of the individual. While the GC signalling cascade may be subject to modulation at several levels, the pathway for acute modulation of GC sensitivity remains to be elucidated.     

Othering,blame and shame when working with people living with HIV

Significant advances in HIV treatment has meant that for the majority of patients with HIV, they are able to live a normal lifespan. However, HIV remains a highly stigmatizing disease with the potential to significantly impact on one’s social identity and sense of self. This paper draws on data from a qualitative study of interviews with five gay men, to explore the experiences of shame in relation to living with HIV. The paper adopts a psychoanalytic lens to highlight the mechanisms of splitting that may be involved at both a social and individual level, and the experience of shame among the participants. The paper aims to use this research data to supplement our understanding of what may be occurring ‘on the couch’ with patients who are living with HIV.     

Depression and cognitive sequelae registered within the first year among young Danish TBI survivors

The aim of the study was to determine the proportion of depression and cognitive sequelae among young (15-30 years) Danish TBI survivors referred to interdisciplinary evaluation through a nationwide government-initiated health initiative. The cross-sectional study is based on data from the “Danish register for young adults with acquired brain injury” on TBI survivors included from October 2013 to December 2016. The main measures were Major depression inventory, Trail making test A and B, Fluency, Word learning with selective reminding, Matrix reasoning, Coding and Glasgow outcome scale - extended (GOS-E). During the study period, 131 young TBI survivors were referred to one of five national outpatient clinics. Ninety-six had complete data and of these 14.6% fulfilled the ICD-10 diagnostic criteria for depression and 34.4% had cognitive sequelae. An association was found between depression and cognitive sequelae (p = 0.004). Patients with both depression and cognitive sequelae (n = 10) had a significantly lower mean score on GOS-E (p = 0.0001). Depression and cognitive sequelae were frequent and associated with a poorer global functional outcome among young TBI survivors referred within a year after trauma. This finding and the notion that only 20% of the expected TBI population was referred to this nationwide health initiative indicate an unacknowledged need for interdisciplinary follow-up.