Commitment to Connection in a Culture of Fear

SUMMARY

This article was originally presented at the May 2004 Learning from Women Conference sponsored by Harvard Medical School and the Jean Baker Miller Training Institute. It examines the ways in which cultural and personal denial of fear and vulnerability contribute to a sense of isolation. Fear is manipulated in hierarchical settings to ensure the preservation of existing power arrangements. In a culture built on exploitation of fear, people do not experience the safety necessary to let their inevitable vulnerabilities show. Unmitigated chronic fear is an unsafe context that leads to a traumatic sense of disempowerment and personal immobilization, whether it is in war, childhood sexual abuse, living with a battering partner, or, perhaps in a more subtle way, in being immersed in massages of un-safety, danger, and having no influence in the larger public domain. Through mutual empathy we can heal these places of fear and disconnection. Mutual empathy arises in a context of profound respect, authentic responsiveness, humility, non-defensiveness, an attitude of curiosity, mindfulness (staying with the “not knowing”), and an appreciation of the power of learning. Movement out of isolation helps us pass through fear to hope and ultimately leads to growth and more connection.     

Transfer of conditioned fear and avoidance: Concurrent measurement of arousal and operant responding

A reversal design was employed for the analysis of transfer of fear and avoidance through equivalence classes. Two 5-member equivalence classes (A1-B1-C1-D1-E1 and A2-B2-C2-D2-E2) were established. Then B1 and C1 were paired with shock (CS+) and served as S^Ds in avoidance training (B2 and C2 were trained as CS-/S^∆s for avoidance). Further avoidance training followed with D1 and E1 (as S^Ds) and D2 and E2 (as S^∆s), with the first presentation of each of these stimuli serving as the first transfer test. Afterwards, aversive conditioning contingencies were reversed: B2 and D2 were paired with shock and trained as S^Ds for avoidance, B1 and D1 were presented without shock (CS-/S^∆s). Transfer was tested again with C1, E1, C2 and E2. This reversal was implemented to allow for the within-subject replication of transfer effects upon changes in the function of only a subset of each class's elements. Avoidance (key presses) and conditioned fear (skin conductance and heart rate) were simultaneously measured. Results show a clear transfer effect for avoidance, with between- and within-subject replications. For physiological measures, transfer effects in the first test could only be imputed on the basis of group-based inferential statistical analysis. Evidence for between-subject replication was weaker, with only a limited proportion of participants meeting the individual criterion for transfer.     

What is being revealed in 2020?

The Covid-19 pandemic is exposing how humans have long related to nature, and revealing aspects of classism and racism that have long been ignored. Drawing on spiritual resources, such as Luther, might the polarizing, self versus other tendencies be overcome and the long pandemic rooted in economic class and racism more effectively addressed today? Can this result in a “new normal”?     

The effects of patient's frequency of attendance and etiology of symptoms,on the General Practitioners wellbeing

IntroductionThe presence of Medically Unexplained Symptoms and a high Frequency of Attendance negatively affects the General Practitioners’ (GP) wellbeing. Although, overlapping between both phenomena is partial, with a number of frequent attenders reporting medically unexplained symptoms during consultation, there is no evidence on how GP's well-being it is affected by the specific main effects of these factors and their interaction. Evidence is also scant on the psychological processes explaining the negative impact of attendance and the etiology of symptoms on GP's wellbeing.ObjectiveDrawing on the Job Demand-Control and the Conservation of Resource stress models, this paper tests the moderating effects of the GP’ perception of patient's attendance and etiology of symptoms on the relationship between patient's demands and feedback on the GP's wellbeing.MethodA total of 105 volunteer GPs self-reported on the study variables through an experience sampling methodology after 898 patients’ consultation. Patients attendance and etiology of symptoms were categorized according to the physician self-perception and an external criterion (organizational records).ResultsPerception of Patients Frequent Attendance and Medically Unexplained Symptoms were positively related to physician's Emotional Exhaustion. Contrary to expected the test of the moderation effects of patients characteristics on the relation between patient's demands and feedback and the GP's emotional exhaustion were stronger for normal attenders compared with frequent attenders. An ad hoc study shows this unexplained result is related to the GP's expectations on Frequent vs. normal attenders’ behaviors. No significant results were found when the external criterion of classification was used.ConclusionCombined analysis of Frequency of Attendance and Etiology of Symptoms lead to a better understanding of the GP's decreased wellbeing. Also, the perception of the strain level (demands/positive feedback levels) associated to the consultation with different types of patients contribute to explain the consequences for the GP's wellbeing, especially when GP's expectations on patient's behaviors are violated.     

White matter microstructure predicts individual differences in infant fear (But not anger and sadness)

We examine neural correlates of discrete expressions of negative emotionality in infants to determine whether the microstructure of white matter tracts at 1 month of age foreshadows the expression of specific negative emotions later in infancy. Infants (n = 103) underwent neuroimaging at 1-month, and mothers reported on infant fear, sadness, and anger at 6, 12, and 18 months using the Infant Behavior Questionnaire-Revised. Levels and developmental change in fear, sadness, and anger were estimated from mother reports. Relations between MRI and infant emotion indicated that 1-month white matter microstructure was differentially associated with level and change in infant fear, but not anger or sadness, in the left stria terminalis (p < 0.05, corrected), a tract that connects frontal and tempo-parietal regions and has been implicated in emerging psychopathology in adults. More relaxed constraints on significance (p < 0.10, corrected) revealed that fear was associated with lower white matter microstructure bilaterally in the inferior portion of the stria terminalis and regions within the sagittal stratum. Results suggest the neurobehavioral uniqueness of fear as early as 1 month of age in regions that are associated with potential longer-term outcomes. This work highlights the early neural precursors of fearfulness, adding to literature explaining the psychobiological accounts of affective development.

Highlights

• Expressions of infant fear and anger, but not sadness, increase from 6 to 18 months of age.
• Early neural architecture in the stria terminalis is related to higher initial levels and increasing fear in infancy.
• After accounting for fear, anger and sadness do not appear to be associated with differences in early white matter microstructure.
• This work identifies early neural precursors of fearfulness as early as 1-month of age.

     

Living with painful diabetic neuropathy: insights from focus groups into fears and coping strategies

Objective: Painful diabetic neuropathy (PDN) is known to negatively affect quality of life. Being physically active is a crucial part of successful diabetes self-management, but regimen adherence is often low. Coping strategies and fears have shown to be related to less physical activity (PA). The aim of the present study was to obtain more in-depth information on psychological risk factors leading to less PA in persons with PDN.

Design: Three semi-structured focus group interviews were conducted with a representative sample of persons with PDN (N?=?12). Data were transcribed verbatim and analysed using a hybrid method of thematic analyses and a grounded theory approach.

Main Outcome Measures: Fears and coping strategies related to PA in persons with PDN.

Results: Several specific fears were identified; fear of hypoglycaemia, fear of pain increase, fear of total exhaustion, fear of physical injury, fear of falling, fear of loss of identity, and fear of negative evaluation by others. To cope with these fears, avoidance, remaining active, cognitive distraction, and acceptance strategies were described.

Conclusion: In persons with PDN, diabetes-related fears and pain-related fears play a role in less engagement in PA, indicating the need for new methods for improving self-management in persons with PDN.