Holocaust survivors in a primary care setting: fifty years later

Past studies have not assessed the prevalence of emotional disturbances in Holocaust survivors seeking medical treatment in a family practice environment. The present study examined the prevalence of lifetime (the presence of symptomatology at any time) and current posttraumatic stress disorder (PTSD) symptoms, general anxiety, and depression in Holocaust survivors seeking medical treatment in a primary care setting. 20 of the 27 Holocaust survivors in our sample received a current diagnosis of PTSD and reported significant symptoms of depression and general anxiety. Although 74% of the survivors were currently diagnosed with PTSD, participants in this study had reported an overall decline in reexperiencing, hyperarousal, and overall PTSD symptoms but exhibited increased avoidance and numbing symptoms throughout the lifespan. These preliminary results suggest that removing avoidance as a defense mechanism during the course of psychotherapy may leave these survivors without an adequate way for coping with their trauma, subsequently increasing their vulnerability to psychopathology. Implications for psychological interventions are provided.     

Safety behavior can hamper the extinction of fear of movement-related pain: An experimental investigation in healthy participants

Excessive fear of movement-related pain (FMRP), and its associated avoidance behavior, is considered a major risk factor for disability in chronic musculoskeletal pain. The current study aimed to investigate whether engaging in safety behavior, conceptualized as an avoidance response, hampers the extinction of FMRP. In a differential conditioning paradigm, we used joystick movements as conditioned stimuli (CSs) and a painful electrocutaneous stimulus as the unconditioned stimulus (US). In the Safety group, participants received the opportunity to avoid the pain-US by pressing a safety button during the extinction phase, whereas in the Control group, this option was not included. In a subsequent test phase, this safety button was no longer available. In two experiments, results demonstrate successful acquisition and extinction. Retrospective FMRP ratings in both experiments revealed a return of fear of pain in the test phase in the Safety group, but not in the Control group. In Experiment 1, mean eyeblink startle reflex amplitudes partly corroborated the self-report findings on fear of pain. The present results suggest that performing safety behavior during cognitive-behavioral interventions, i.e., exposure, might increase the risk of a return of FMRP.     

The development of a psychoanalytic outcome study: choices, conflicts, and consensus

This article tells the story of the development of an outcome study of psychoanalysis and describes the debate that took place over critical methodological issues. The protocol committee included career psychotherapy researchers who have conducted rigorous outcome studies, clinical psychoanalysts, study methodologists, and a statistician with clinical trial expertise. The committee worked for two years to develop the study design. This project is based on the premise that clinical psychoanalysis is a treatment. Areas specifically addressed are the goals and hypothesis of the study, inclusion and exclusion criteria, choice of psychotherapies as comparison treatments, definition of treatments and selection of therapists, use of medication, development of a treatment adherence measure, randomization of patient assignment vs. patient self-selection, and primary outcome measures. The execution of this outcome study will require significant effort and resources. A positive result would boost the standing of psychoanalysis, but the results may not support the primary hypothesis that there are therapeutic benefits unique to psychoanalysis and that psychoanalysis can effect demonstrable changes in a patient's mental life and adaptation that are not achieved by treatments of different orientation and/or lesser intensity. However, more important than whatever specific results emerge is what executing such a study requires of our field: the process of addressing the clinical issues that a study design requires, the creation of a network of analysts around the country working on a common project, and the joining of the clinical psychoanalytic community with a community of psychodynamic researchers.     

An Evaluation of an Ambiguous Loss Based Psychoeducational Support Group for Family Members of Persons Who Hoard: A Pilot Study

The current study is a pilot evaluation of a six-week psychoeducational-support group based in an ambiguous loss framework for family members of people who hoard. Findings suggest that participants who completed the six-week intervention group (N?=?8) indicated positive results at the two-month follow up interview, reporting an increased understanding of family members’ hoarding behaviors and their own experiences related to the hoarding behavior and its impact on the family system. Participants also reported that having personal and professional support from others who understand hoarding behavior was helpful to them in lowering psychological distress and improving interactions with their family members.     

Perceptual cues used in reproduction of inspired volume

Man is capable of reproducing an inspired lung volume (IV) with relative precision (±3 %–8 %). To investigate the importance of cues which may be used to determine IV, we performed two experiments. In each, the subject inspired a “standard” breath (from resting end~xpired lung volume) corresponding to 25%, 50%, or 75% of inspiratory capacity (IC) and then expired nearly completely. From this expired volume, the subject either tried to reproduce the tidal volume (i.e., volume of air inspired) of the first breath (volume reproduction) or to reproduce the previous end-inspired lung volume (position reproduction). The constant error indicated that subjects overestimated tidal volume by about 200 ml. Despite this overestimation, the variability of reproduction was less for volume reproduction than for position reproduction when IV was small. The JND for volume reproduction increased linearly with increasing IV, whereas the JND for position reproduction was similar at all IVs so that the Weber ratio decreased. These observations suggest that, in the perception of inspired volume, the sensation of end-inspired position is important when the inspired volume is large, but that subjects apparently rely on some other cue to reproduce small lung volumes accurately.     

Visual and verbal modes of information processing and their relation to the effectiveness of cognitively-based anxiety-reduction techniques

This study examined the interaction between preferred modes of information processing (visual and verbal) and two cognitively-based anxiety-reduction techniques. One technique was based on the use of images as a coping strategy while the other employed a self-instructional approach. Thirty-six subjects reporting high levels of dental fear were assigned to one of three groups (two types of treatment and a no-treatment control). One-half of the subjects in each group had been identified as preferring the visual mode of information processing while for the other half the verbal mode was preferred. After treatment, subjects viewed an anxiety-inducing videotape depicting a visit to the dentist. Results indicated that, while both treatments were significantly effective in reducing self-reports of discomfort while viewing the videotape, there was no significant interaction between the type of treatment and preferred cognitive mode. The results were interpreted as indicating that treatment may override individual cognitive styles. Furthermore, the data suggested that the normal individual has the ability to adapt to divergent and non-preferred forms of information processing.     

The interrelationships and reliability of a multilevel behavior-based assessment package for distressed couples

Twenty-six couples interested in improving their marital relationships participated in a multi-level behavior based assessment battery. The measures included self-reported, self-monitored, and observed components, all of which were examined for their interrelationships. Test-retest reliability was carried out with six of the couples. Self-reported measures, self-monitored pleasing behaviors, observed positive nonverbal and some negative verbal interactions were found to be consistent. In general, the various levels of measurement were found to be significantly related to each other. Some of the findings were applied to coercion and reciprocity formulations of marital interactions.     

Cognitive and Behavioural Attention in Children with Low-Moderate and Heavy Doses of Prenatal Alcohol Exposure: a Systematic Review and Meta-analysis

Neuropsychology Review - Attention problems are thought to be a hallmark feature of prenatal alcohol exposure (PAE). Despite decades of research however, these findings have never been pooled to...