Emotional awareness,gender, and peculiar body-related beliefs

Research has broadly established that emotional disturbances are associated with body image disturbances. This is the first study to examine links between facets of emotional awareness and peculiar body-related beliefs (PBB), or beliefs about an imagined or slight defect in one's appearance or bodily functioning. In a sample of college students (n=216), we found that low emotional clarity (the extent to which the type and source of emotions are understood) was associated with higher PBB in both women and men, and the relation between emotional clarity and PBB was further moderated by attention to emotions (the extent to which emotions are attended to) and gender. Men with low attention to emotions and women with high attention to emotions both experienced higher levels of PBB if they also reported low levels of emotional clarity. This interactive effect was not attributable to shared variance with body mass index, neuroticism or affect intensity.     

Neuroscience,mind and meaning: an attempt at synthesis in a Relational Affective Hypothesis

This paper sets out a falsifiable Relational Affective Hypothesis, describing a neurological and relational pathway, through which affect and sensations arising from the interior of the body are translated, in a relational context, into language and a capacity for symbolisation. It describes the role of psychodynamic defences in narcissistic disorder, which can result in collapse in the function of this pathway. The hypothesis arose from clinical psychodynamic work with patients with severe and complex narcissistic disorders. They are characterised as severe, because they are at high risk of completed suicide and so are commonly treated in locked units, and complex because of their anorexic and bulimic eating patterns, tendency towards somatisation and the co-occurrence of autistic difficulties. A more or less profound failure of symbolisation is a feature common to these presentations. This interdisciplinary thinking offers a perspective on brain and psychological development, taking into account the complex interplay between genetic, environmental, relational and dynamic influences. It can be tested empirically and has implications for psychoanalytic thinking, psychiatry and neuroscience.     

Surviving as a personality disorder service

Personality disorder services working along psychotherapeutic lines gained appeal with Health Care Commissioners following the publication of the National Institute for Health and Clinical Excellence (NICE) guidelines for Borderline & Antisocial Personality Disorders and the emerging successful application of psychoanalytically derived approaches. In parallel to this creative development, the economic downturn has faced the National Health Service (NHS) with considerable challenges in its ongoing survival. The potential for creative pursuit often then sits in competition, juxtaposed with the need to survive. We examine the impact of this dynamic upon the therapeutic efforts of a newly established personality disorder service. We suggest that both conscious and unconscious aspects stirred up within such encounters are demanding of the need for development of a capacity within each to bear contact with unfamiliar experiences. Through attention to that development, both patient and clinician may further enliven and enrich individual and collective identities, such that the potential to survive creatively is actualized.     

Attentional bias to violent images in survivors of dating violence

This study investigated the time-course characteristics of attentional bias, such as vigilance and maintenance, towards violent stimuli in dating violence (DV) survivors. DV survivors with PTSD symptoms (DV-PTSD group; n=14), DV survivors without PTSD symptoms (Trauma Control group; n=14), and individuals who were never exposed to dating violence (NDV group; n=15) viewed slides that presented four categories of images (violent, dysphoric, positive, and neutral) per slide, for ten seconds. Our results revealed that the DV-PTSD group spent more time on violent stimuli than did the Trauma Control or NDV groups. The DV survivors, both with and without PTSD symptoms, spent more time on dysphoric stimuli and less time on happy stimuli than did the NDV group. In addition to the effects of PTSD, researchers should also be considering the effects of simple traumatic exposure.     

Sport-Based Group Therapy Program for Boys with ADHD or with Other Behavioral Disorders

A group of children with Attention Deficit Hyperactivity Disorder (ADHD) was compared to children with other behavior and emotional problems. All the participants participated together in 20 weekly sessions for 1 academic year. The participants were assessed with three questionnaires on three different occasions: before the beginning of the group, at the completion of the group, and 1 year after the completion of the group. The results showed that the children indicated improvement in two behavior domains while their parents indicated improvement in the children's behavior in five domains. The most striking improvement was reduction of anxiety.     

A Child With Autism Spectrum Disorder Teaches Siblings to Skateboard: Effects on Sibling Skills and Family Social Behavior

Abstract

Children with autism spectrum disorder (ASD) may have few common activities with their siblings who do not have ASD, and this can limit their opportunities for social play. In this study, we used a multiple-baseline across skills design to assess the effects of a boy with ASD following an activity schedule to teach his favorite activity of skateboarding to his two siblings who do not have ASD. Family social behavior was also measured before and after sibling training. After training by the boy with ASD, both of the siblings’ skateboarding skills improved, and measures of family social behavior also increased. Results suggest that sibling relationships may benefit when a child with ASD teaches siblings to play.     

A Program Intervention for Pediatric Bipolar Disorder: Preliminary Results

The effectiveness of a behaviorally based day treatment program for young children diagnosed with Pediatric Bipolar Disorder (PBD) was evaluated using pretreatment and posttreatment mean scores from the Child Behavior Checklist (CBCL). Data were evaluated in aggregate and using the clinically significant change method for children diagnosed with PBD, Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), Adjustment Disorder, and no diagnosis/clinical and subclinical groups. Significant effects were found for all groups except the no diagnosis/subclinical group on the Internalizing scale and for all groups on the Externalizing scale. Clinically significant change was supported for the PBD, ADHD, ODD, and Adjustment Disorder groups. Implications and limitations of the study are discussed.     

Confounding of Big Five Personality Assessments in Emotional Disorders by Comorbidity and Current Disorder

Foremost cross‐sectional studies of personality in common mental disorders show similar Big Five trait profiles [i.e. high neuroticism (N), low conscientiousness (C) and low extraversion (E)]. It remains undecided whether this lack of distinct personality profiles is partly due to comorbidity among disorders or contamination by current state. Using data from the Netherlands Study of Depression and Anxiety, we investigated 1046 participants with panic disorder (PD), social anxiety disorder (SAD) and/or major depressive disorder (MDD) and 474 healthy controls. Personality traits at baseline and two‐year follow‐up were assessed with the NEO‐Five Factor Inventory. The Composite International Diagnostic Interview was used to determine the presence of emotional disorders at baseline and at two‐year follow‐up; the Life Chart Interview determined symptom severity in the month prior to baseline and during follow‐up. By analysing pure cases and investigating the effects in remitted cases, PD participants were found to be higher in N, but not lower in E and C than controls. Pure PD participants were also lower in N and higher in E than SAD and MDD participants. Both SAD and MDD participants were characterized by high levels of N and low levels of E, irrespective of comorbidity or current disorder state. Future studies should be more attentive to confounding of personality profiles by comorbidity and state effects. Copyright © 2012 John Wiley & Sons, Ltd.     

Treating PTSD in active duty service members using cognitive processing therapy or prolonged exposure therapy: Examining everyday practice at a military outpatient clinic

The Institute of Medicine has stressed the need for evaluations of evidence-based treatments (EBTs) for posttraumatic stress disorder (PTSD) among active duty service members (AD) using a variety of evaluation approaches (Institute of Medicine, 2012). The current study examined the clinical files of 134 service members who completed treatment for PTSD using either prolonged exposure (PE) or cognitive processing therapy at an outpatient clinic. At the completion of each session, therapists made a clinical rating as to whether or not the session was protocol adherent. The total number of treatment sessions and the proportion of sessions rated as being protocol adherent were calculated. Multi-level models estimated the change in patient PTSD and other psychological symptoms over time as a function of clinician-rated protocol adherence and total number of sessions. Approximately 65% of clinic encounters were rated by therapists as being protocol adherent. Significant reductions in PTSD and psychological symptoms were associated with protocol adherence, and this was particularly true for patients who began treatment above clinical thresholds for both PTSD and other psychological symptoms. However, as the number of sessions increased, the impact of protocol adherence was attenuated. Patient characteristics, including gender, ethnicity, and co-morbidity for other psychiatric disorders were not related to symptom change trajectories over time. These findings suggest that protocol adherence and efficiency in delivery of EBTs for the treatment of PTSD with AD is critical.     

Emotion Dysregulation in Comorbid Posttraumatic Stress Disorder and Substance Use Disorders: A Narrative Review

Co-occurrence of substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) is extremely common and is associated with elevated dropout and relapse rates. Given that PTSD/SUD co-occurrence rates among veterans have been found to be as high as 55?75%, it is important to identify mechanisms that may affect the interplay of both disorders. Emotion dysregulation (ED) presents a candidate mechanism that may underlie poor treatment response in co-occurring PTSD/SUD. This article proposes a transdiagnostic emotion regulation framework that considers ED conceptualized as a combination of low ability to tolerate emotional distress (low distress tolerance) and difficulties in the goal-directed use of emotion regulation strategies as a key risk factor in co-occurring PTSD/SUD. The authors review empirical findings from self-report and laboratory-based studies of ED in PTSD. They describe psychological explanations of the emotion-substance relationship and review studies documenting ED in SUDs and in co-occurring PTSD/SUD. The literature on ED in PTSD/SUD suggests that (a) patients with PTSD may resort to substances to cope with trauma-related symptoms due to ED, and (b) ED may maintain SUD symptoms and interfere with psychological treatment. Longitudinal studies on bidirectional relationships between ED and substance use in PTSD are needed, particularly research examining the course of ED in PTSD patients who use substances versus those who do not.