Emotional memory processing in post-traumatic stress disorder affected Colombian youth

Post-traumatic stress disorder (PTSD) is a neuropsychological condition caused by exposure to chronic stressors and extreme trauma. In past decades, Colombia (South America) has experienced high levels of armed conflict, which created an environment of chronic stress, resulting in an increased incidence of PTSD in children. Limited research exists on the effects of PTSD on emotional memory functioning of these Colombian youth living in chronically stressful environments. In the present study, 23 PTSD affected youth and 26 controls were asked to recall items from a memorised word list, as well as remembering details from a short emotional story. Although no significant differences were found for word list memory, deficits for emotional story content were found in the PTSD youth, particularly for facts involving negative emotional details. The latter may suggest a deficit in executive functioning for the integration of emotionally laden stimuli, perhaps induced as a by-product of their traumatic experiences.     

Cumulative lifetime stress exposure,depression, anxiety,and well-being in elite athletes: A mixed-method study

Research suggests that elite athletes are at increased risk of poor mental health, partly due to the intense demands associated with top-level sport. Despite growing interest in the topic, the factors that influence the mental health and well-being of elite athletes remain unclear. From a theoretical perspective, the accumulation of stress and adversity experienced over the life course may be an important factor. To investigate this possibility, we employed a mixed-method design to: (a) examine whether cumulative lifetime stress predicted depression, anxiety, and well-being in elite athletes; and (b) help explain why cumulative lifetime stress exposure might have resulted in poor mental health and well-being. Ninety-five elite athletes (M_age = 29.81, SD = 10.88) completed the Stress and Adversity Inventory, Patient Health Questionnaire, Generalized Anxiety Disorder 7-item scale, and the Scales of General Well-Being. Hierarchical regression analyses revealed that total count and severity of lifetime stressor exposure significantly predicted greater depression (β = .42, p < .001; β = .46, p < .001) and anxiety symptoms (β = .34, p = .003; β = .28, p = .018), and worse well-being (β = -.42, p < .001; β = -.30, p = .015). Semi-structured interviews were then conducted with six athletes. Thematic analysis revealed that cumulative lifetime stress exposure fostered poor mental health and well-being by promoting maladaptive long-term coping strategies, increasing susceptibility to future stress, and limiting interpersonal relationships. We believe these findings can help practitioners identify, and intervene accordingly with, elite athletes at risk of experiencing stress-related mental health problems.     

Reasoning about highly emotional topics: Syllogistic reasoning in a group of war veterans

Previous studies have generally found that emotion impairs logical reasoning. However, laboratory experiments have typically involved relatively mild levels of emotion where affect is not linked to personal experience. In this study we examined how army veterans reasoned about syllogisms of three types: neutral, generally emotional, and combat-related emotional. We also measured intensity of combat experience. Veterans were more likely to provide logically accurate answers when reasoning about combat-related compared to neutral problems. Participants with more intense combat experiences showed a reduced advantage in reasoning about combat-related emotional problems.     

'To walk the last bit on my own' - narcissistic independence or identification with good objects: issues of loss for a 13-year-old who had an amputation

This paper describes two years of psychotherapy with Michael, a 13-year-old boy who had undergone a recent emergency amputation of his leg and hip for bone cancer. The work follows Michael's struggle with the enormity of the loss, in the face of his, as well as the system's, use of denial. The amputation as an 'attack' on his physical and emotional autonomy strikes at his early adolescent development. The therapeutic process is aided by his capacity 'to go back to the unhappiness'. The therapy develops from his initial shock, to despair and self-blame, as he struggles with a tendency - in the middle period of the therapy - to lose his mind as well as his leg in a retreat to withdrawal and mindlessness, or to mania. He struggles between an omnipotent, at times self-destructive, wish to 'go it alone', versus a capacity to feel sad and to value life. His capacity to think about the trauma and to find meaning emerges. The paper raises questions about whether some trauma can ever be fully assimilated, and whether, for Michael, the mourning process could lead to a reintegrated sense of self and of a 'psychic intactness', dependent on the survival of his good 'internal couple'. Hospital and ward-based child psychotherapy and its limitations are explored.     

Thinking about and working with depressed mothers in the early months of their infant's life

This paper illustrates how my work has developed over the years and informed my thinking about, and work with, depressed mothers. It also describes the work of the Parent Infant Foundation in Sydney where pregnant women and mothers with infants and toddlers are seen in groups and individually through home visits. The relevance of the support of a peer group when doing such difficult work is described. The paper draws on a central theme: the depressed mother, returning to her own infant beginnings through pregnancy and birth, confronts a dead mother-dead infant dyad. Trauma from the mother's own infancy is seen to have created an internal, autistic, deadened, psychic space. It is argued that behind this deadness lies the primeval pain of abandonment and loss. The associated rage, previously repressed but now awakened by her alive infant and his powerful primitive demands, invade the mother's psyche. The internal deadness freezes her alive processes as mother to her baby. Unbearable pain is awakened - and she may be in terror and unable to move, or she may experience herself as drowning in something catastrophic. SUMMARY This paper illustrates how my work has developed over the     

Prenatal trauma and autism

Through the clinical history of a little girl, this paper explores some possible traumatic prenatal experiences of children who have autistic features from birth. It establishes a tentative connection between the precocity of the onset of pathology and potentially traumatic prenatal situations such as threats of miscarriage or pathological mental states in the pregnant mother. It is suggested that a psycho-physical retreat from the auditory experience of the mother's voice, which normally stimulates foetal proto-mental activity and may lead to the development of a 'sound-object', might contribute to the later autistic child's isolation and non-mental clinging to tactile sensations.     

The therapist with her back against the wall

This clinical paper describes once weekly psychotherapy with two boys with traumatic histories. The way in which the trauma enters the consulting room and the relationship with the therapist is explored. Technical issues are discussed, particularly the understanding of the countertransference and its modulation in communication with the patient. The therapist's intense personal anxiety about failure and about management of the difficulties that arise is linked to the impact of trauma.     

The role of the body as the medium in child psychotherapy: snapshots of therapy with an 11-year-old,severely abused,multiply placed girl

In Victoria, Australia, children with a history of abuse and severe attachment difficulties, and who have experienced multiple carers and placements, have been traditionally viewed by mental health services as unsuitable for psychoanalytic psychotherapy. A number of factors, including the lack of integrated, long-term case planning; unstable residential placement; and the belief that psychotherapeutic treatment will be of an extended duration, have influenced the decision not to provide individual psychotherapy for these children. Currently, the movement within mental health services is towards responsive and briefer treatment models. The child psychotherapist is challenged to re-think theory, technique and practice. This paper identifies contextual constraints that have led to these children being precluded from accessing psychotherapy. An alternative model of intervention is discussed and illustrated with clinical material. The contributions of Alvarez, Trevarthen, Schore and other writers are drawn on to underpin the clinical work. This model involves a change in technique and role and the use of a time-limited intervention. Intrinsic to the model is the understanding of the child's psycho-biological experience of trauma and disrupted attachment. The child's experiences are conveyed in the pre-verbal, gestural domain to enable history to be given voice.     

Fewer intrusions after an attentional bias modification training for perceptual reminders of analogue trauma

The present experimental analogue study used computerised attention training to investigate the role of attention bias in the prediction of intrusive memories. After exposure to a trauma film, participants in a training group (n=22) were presented with a variant of the exogenic cueing task (ECT) in which visual film reminders (i.e., stills from the trauma film) were always presented during invalid and neutral control stimuli always during valid trials. The purpose of this cue–location contingency was reinforcing the direction of attention away from film reminders. Control participants (n=23) performed a similar training without such a contingency. Post-training processing bias was assessed with a single target Rapid Serial Visual Presentation (RSVP) task, in which trauma-film reminders served as task-irrelevant distracters appearing shortly before a neutral target. The frequency of film-related intrusions was recorded in a take-home diary and at a follow-up session three days after film viewing. Participants who underwent attention training reported fewer film-related intrusions and showed less interference by visual film distracters than controls. Implications for research on attention bias after real-life trauma are discussed.     

Trauma Lives in Speech

The author approaches the topic through infant observation. At the age of eight months the baby moves in the borderland between the physical and the symbolic. When the baby hurts herself, she needs the mother's arms to protect her: at the same time, her budding spoken symbol "mama" is comforting in itself, it carries the memory of the mother's arms. Can speech - tone of voice, rhythm, pauses - and the moments of loss, absence, the losing of self also be intertwined? The author discusses the question of how trauma starts to live in speech through two patients. She talks about "a silent language" which speaks in between the words and sentences - changes the rhythm of speech, makes lose words, tears a hole in speech. This "silent language" talks about trauma, reaches for its very essence - a bodily experience and meaning to the wholeness/disruption of self.