Stress-induced Fos-like Immunoreactivity in the Pons and the Medulla Oblongata of Rats

Immunoreactivity of the immediate early gene c-fos was used to investigate changes in the activity of brainstem neurons in response to acute stressors like immobilization, formalin-induced pain, cold exposure, hemorrhage and insulin-induced hypoglycemia. Different stressors induced Fos-like immunoreactivity in different pontine and medullary neurons. A single, 3 hour immobilization was found to be a very strong stimulus that activated brainstem catecholaminergic (tyrosine hydroxylase-immunopositive) neurons and cells in the raphe and certain pontine tegmental nuclei, as well as in the reticular formation. Pain, induced by a subcutaneous injection of formalin was also effective on catecholamine-synthesizing neurons and on others cells in the nucleus of the solitary tract. Cold exposure activated cells mainly in the sensory spinal trigeminal and parabrachial nuclei and in the so-called "pontine thermoregulatory area". Moderate Fos-like immunoreactivity was induced by a hypotonic (25%) hemorrhage in medullary catecholaminergic neurons, the nucleus of the solitary tract and the Barrington nucleus. Among stressful stimuli used, insulin-induced hypoglycemia elicited the smallest Fos activation in the lower brainstem. The present observations indicate that different stressors may use different neuronal pathways in the central organization of the stress response.     

The compensation and capitalization models: A test of two approaches to individualizing the treatment of depression

Despite long-standing calls for the individualization of treatments for depression, modest progress has been made in this effort. The primary objective of this study was to test two competing approaches to personalizing cognitive-behavioral treatment of depression (viz., capitalization and compensation). Thirty-four adults meeting criteria for Major Depressive Disorder (59% female, 85% Caucasian) were randomized to 16-weeks of cognitive-behavioral treatment in which strategies used were selected based on either the capitalization approach (treatment matched to relative strengths) or the compensation approach (treatment matched to relative deficits). Outcome was assessed with a composite measure of both self-report (i.e., Beck Depression Inventory) and observer-rated (i.e., Hamilton Rating Scale for Depression) depressive symptoms. Hierarchical linear modeling revealed a significant treatment approach by time interaction indicating a faster rate of symptom change for the capitalization approach compared to the compensation approach (d = .69, p = .03). Personalizing treatment to patients' relative strengths led to better outcome than treatment personalized to patients' relative deficits. If replicated, these findings would suggest a significant change in thinking about how therapists might best adapt cognitive-behavioral interventions for depression for particular patients.     

Thought suppression mediates the relationship between negative affect and borderline personality disorder symptoms

The purpose of this study was to examine the relationships among negative affect, childhood sexual abuse (CSA), thought suppression, and diagnostic symptoms of borderline personality disorder (BPD) in a community sample (n=127). Findings suggest that the temperamental variable negative affect intensity/reactivity was a stronger predictor of BPD symptoms than CSA. In addition, results indicated that higher thought suppression mediated the relationship between negative affective intensity/reactivity and BPD symptoms, after controlling for a history of CSA. Overall, findings suggest that (a) negative affectivity may be a better predictor of BPD symptoms than CSA, and (b) chronic efforts to suppress unpleasant thoughts may be a regulation strategy underlying the relationship between intense negative emotions and BPD symptoms.     

Dialectical Behavior Therapy for Adolescents: Theory, Treatment Adaptations, and Empirical Outcomes

Dialectical behavior therapy (DBT) was originally developed for chronically suicidal adults with borderline personality disorder (BPD) and emotion dysregulation. Randomized controlled trials (RCTs) indicate DBT is associated with improvements in problem behaviors, including suicide ideation and behavior, non-suicidal self-injury (NSSI), attrition, and hospitalization. Positive outcomes with adults have prompted researchers to adapt DBT for adolescents. Given this interest in DBT for adolescents, it is important to review the theoretical rationale and the evidence base for this treatment and its adaptations. A solid theoretical foundation allows for adequate evaluation of content, structural, and developmental adaptations and provides a framework for understanding which symptoms or behaviors are expected to improve with treatment and why. We first summarize the adult DBT literature, including theory, treatment structure and content, and outcome research. Then, we review theoretical underpinnings, adaptations, and outcomes of DBT for adolescents. DBT has been adapted for adolescents with various psychiatric disorders (i.e., BPD, mood disorders, externalizing disorders, eating disorders, trichotillomania) and problem behaviors (i.e., suicide ideation and behavior, NSSI) across several settings (i.e., outpatient, day program, inpatient, residential, correctional facility). The rationale for using DBT with these adolescents rests in the common underlying dysfunction in emotion regulation among the aforementioned disorders and problem behaviors. Thus, the theoretical underpinnings of DBT suggest that this treatment is likely to be beneficial for adolescents with a broad array of emotion regulation difficulties, particularly underregulation of emotion resulting in behavioral excess. Results from open and quasi-experimental adolescent studies are promising; however, RCTs are sorely needed.     

Self-punishment as a regulation strategy in borderline personality disorder

Studies using the Thought Control Questionnaire (TCQ; Wells & Davies, 1994) suggest that the tendency to use self-punishment (e.g., shouting at oneself) in order to control unpleasant internal experiences (e.g., cognitive and emotional) is associated with psychopathology. To evaluate the role of self-punishment in borderline personality disorder (BPD), we first examined whether TCQ scales, including Self-Punishment, were different among adults with BPD (n = 31) when compared to those with other personality disorders (OPD; n = 24), elevated symptoms of major depressive disorder (MDD; n = 24), and healthy controls (n = 105). Findings indicated that Self-Punishment was elevated in the BPD group relative to other groups. Next, Self-Punishment was examined as a potential mediator in the relationship between negative affectivity and BPD symptom severity in all participants. Results indicated that Self-Punishment did not mediate this relationship, but did account for significant variance in BPD symptoms over and above negative affectivity. Implications and future research directions are discussed.     

Heightened sensitivity to facial expressions of emotion in borderline personality disorder

Individuals with borderline personality disorder (BPD) have been hypothesized to exhibit significant problems associated with emotional sensitivity. The current study examined emotional sensitivity (i.e., low threshold for recognition of emotional stimuli) in BPD by comparing 20 individuals with BPD and 20 normal controls on their accuracy in identifying emotional expressions. Results demonstrated that, as facial expressions morphed from neutral to maximum intensity, participants with BPD correctly identified facial affect at an earlier stage than did healthy controls. Participants with BPD were more sensitive than healthy controls in identifying emotional expressions in general, regardless of valence. These findings could not be explained by participants with BPD responding faster with more errors. Overall, results appear to support the contention that heightened emotional sensitivity may be a core feature of BPD.     

Perceived burdensomeness and suicide ideation in older adults

Older adults have the highest risk of death by suicide in the United States. Improving our understanding of the factors that lead to increased risk of suicide in older adults will greatly inform our ability to prevent suicide in this high-risk group. Two studies were conducted to test the effect of perceived burdensomeness, a component of the interpersonal-psychological theory of suicide (Joiner, 2005), on suicide ideation in older adults. Further, gender was examined as a moderator of this association to determine if perceived burdensomeness exerted a greater influence on suicide ideation in males. The results of these studies suggest that perceived burdensomeness accounts for significant variance in suicide ideation, even after predictors such as depressive symptoms, hopelessness, and functional impairment are controlled. Gender did not moderate the association. The implications of these findings for treatment of older adults with suicide ideation and elevated suicide risk are discussed.     

An analogue investigation of the relationships among perceived parental criticism, negative affect, and borderline personality disorder features: the role of thought suppression

The current study examined the relationships among biological predisposition, social environment, emotion regulation, and features characteristic of Borderline Personality Disorder (BPD). Using an analogue sample, we examined whether thought suppression mediated the relationship of negative affective intensity/reactivity and perceived parental criticism with a composite of BPD features including impulsivity, interpersonal sensitivity, and aggression. Results indicated that thought suppression fully mediated the relationship between negative affect intensity/reactivity and BPD features and partially mediated the relationship between BPD features and perceived parental criticism. Clinical implications, directions for further research, and limitations of the present study are discussed.     

A mediational model of trait negative affectivity, dispositional thought suppression, and intrusive thoughts following laboratory stressors

Two studies examined the relationships among trait negative affectivity, dispositional thought suppression, and intrusions in non-clinical samples. In Study 1 (N=87), participants were presented with a series of emotionally evocative images and intrusions were examined 48 h after presentation via self-report. In Study 2 (N=118), intrusions were examined using a behavioral Key-press and self-report at two time points (5 and 20 min) following exposure to a series of emotionally evocative images. In each study, participants were assessed for trait negative affectivity and the tendency to engage in thought suppression in response to unpleasant cognitions. Results from both studies support a model in which chronic thought suppression fully mediates the relationship between negative affectivity and the frequency of intrusions.