Research from 2013

Is humor the best medicine? The buffering effect of coping humor on traumatic stressors in firefighters

Michael Sliter*, Aron Kale, & Zhenyu Yuan

Abstract

Although our understanding of workplace stressors has grown across the past 30 years, this research has generally ignored traumatic workplace stressors. This is a serious omission, given that many occupations (e.g., firefighters, emergency medical technicians, and police) are frequently exposed to traumatic stressors. As such, the first purpose of the current study was to examine the impact of exposure to traumatic stressors in firefighters. Post-traumatic stress disorder (PTSD), burnout, and absenteeism were investigated as cognitive, affective, and behavioral outcomes. Additionally, we sought to investigate coping humor as a mechanism for dealing with traumatic stressors. We frame these expectations by discussing humor from a transactional theory of emotion/coping perspective, as well as through humor's social bonding feature and its ability to combat the physiological impact of stressors. We surveyed 179 firefighters at two time points on relevant variables, with dependent variables collected at Time 2. The results indicated that traumatic events significantly predicted burnout, PTSD, and absenteeism and that coping humor buffered this relationship for burnout and PTSD. We discuss the implications of these findings and call for more research investigating occupations in which traumatic stressors are a concern, as well as for more integration of humor into the workplace literature.

Sliter, M., Kale, A., & Yuan, Z. (2013), Is humor the best medicine? The buffering effect of coping humor on traumatic stressors in firefighters. Journal of Organizational Behavior.

Online [retrieved on 11/2/2013]: http://onlinelibrary.wiley.com/doi/10.1002/job.1868/abstract

___________________________________________________________________________________________________________________________________________________________________

Dissociative part-dependent biopsychosocial reactions to backward masked angry and neutral faces: An fMRI study of dissociative identity disorder

Yolanda R. Schlumpf, Ellert R.S. NijenhuisSima Chalavi, Ekaterina V. Weder, Eva Zimmermann, Roger LuechingerRoberto La MarcaA.A.T. Simone Reinders, Lutz Jäncke

Abstract

Objective

The Theory of Structural Dissociation of the Personality (TSDP) proposes that dissociative identity disorder (DID) patients are fixed in traumatic memories as “Emotional Parts” (EP), but mentally avoid these as “Apparently Normal Parts” of the personality (ANP). We tested the hypotheses that ANP and EP have different biopsychosocial reactions to subliminally presented angry and neutral faces, and that actors instructed and motivated to simulate ANP and EP react differently.

Methods

Women with DID and matched healthy female actors (CON) were as ANP and EP (DIDanp, DIDep, CONanp, CONep) consecutively exposed to masked neutral and angry faces. Their brain activation was monitored using functional magnetic resonance imaging. The black-and-white dotted masks preceding and following the faces each had a centered colored dot, but in a different color. Participants were instructed to immediately press a button after a perceived color change. State anxiety was assessed after each run using the STAI-S. Final statistical analyses were conducted on 11 DID patients and 15 controls for differences in neural activity, and 13 DID patients and 15 controls for differences in behavior and psychometric measures.

Results

Differences between ANP and EP in DID patients and between DID and CON in the two dissociative parts of the personality were generally larger for neutral than for angry faces. The longest reaction times (RTs) existed for DIDep when exposed to neutral faces. Compared to DIDanp, DIDep was associated with more activation of the parahippocampal gyrus. Following neutral faces and compared to CONep, DIDep had more activation in the brainstem, face-sensitive regions, and motor-related areas. DIDanp showed a decreased activity all over the brain in the neutral and angry face condition. There were neither significant within differences nor significant between group differences in state anxiety. CON was not able to simulate genuine ANP and EP biopsychosocially.

Conclusions

DID patients have dissociative part-dependent biopsychosocial reactions to masked neutral and angry faces. As EP, they are overactivated, and as ANP underactivated. The findings support TSDP. Major clinical implications are discussed.

Schlumpf, Y.R.,  Nijenhuis, E.R.S., Chalavi, S.,  Weder, E.V., Zimmermann, E., Luechinger, R.  La Marca, R., Reinders, S. & Jäncke, L. (2013).  Dissociative part-dependent biopsychosocial reactions to backward masked angry and neutral faces: An fMRI study of dissociative identity disorder. Neuro Image: Clinical. Volume 3, pp 54–64bOnline [retrieved on 11/2/2013]: http://www.sciencedirect.com/science/article/pii/S2213158213000892

___________________________________________________________________________________________________________________________________________________________________

Distinguishing Simulated from Genuine Dissociative Identity Disorder on the MMPI-2

Abstract

Due to high elevations on validity and clinical scales on personality and forensic measures, it is challenging to determine if individuals presenting with symptoms of dissociative identity disorder (DID) are genuine or not. Little research has focused on malingering DID, or on the broader issue of the profiles these patients obtain on the MMPI-2, despite increasing awareness of dissociation.  This study sought to characterize the MMPI-2 profiles of DID patients and to determine the utility of the MMPI-2 in distinguishing DID patients from uncoached and coached DID simulators.  The analyses revealed that F, Fb, and Fp distinguished simulators from genuine DID patients.  Fp was best able to discriminate simulated DID. Utility statistics and classification functions are provided for classifying individual profiles as indicative of genuine or simulated DID.  Despite exposure to information about DID, the simulators were not able to accurately feign DID, which is inconsistent with the iatrogenic/sociocultural model of DID.  Given that dissociation was strongly associated with elevations in validity as well as clinical scales, including the scale 8 (i.e., Schizophrenia), considerable caution should be used in interpreting validity scales as indicative of feigning and scale 8 as indicative of schizophrenia among highly dissociative individuals.

Brand, B.L. & Chasson, G.S. (in press). Distinguishing Simulated from Genuine Dissociative Identity Disorder on the MMPI-2. Psychological Trauma: Theory, Research, Practice, & Policy.

___________________________________________________________________________________________________________________________________________________________________

Childhood maltreatment is associated with distinct genomic and epigenetic profiles in posttraumatic stress disorder

Divya Mehtaa,1, Torsten Klengela, Karen N. Conneelyb, Alicia K. Smithc, André Altmanna, Thaddeus W. Pacec,d, Monika Rex-Haffnera, Anne Loeschnera, Mariya Gonika, Kristina B. Mercere, Bekh Bradleyc,f, Bertram Müller-Myhsoka, Kerry J. Resslerc,e,g, and Elisabeth B. Bindera,c

Abstract

Childhood maltreatment is likely to influence fundamental biological processes and engrave long-lasting epigenetic marks, leading to adverse health outcomes in adulthood. We aimed to elucidate the impact of different early environment on disease-related genome-wide gene expression and DNA methylation in peripheral blood cells in patients with posttraumatic stress disorder (PTSD). Compared with the same trauma-exposed controls (n = 108), gene-expression profiles of PTSD patients with similar clinical symptoms and matched adult trauma exposure but different childhood adverse events (n = 32 and 29) were almost completely nonoverlapping (98%). These differences on the level of individual transcripts were paralleled by the enrichment of several distinct biological networks between the groups. Moreover, these gene-expression changes were accompanied and likely mediated by changes in DNA methylation in the same loci to a much larger proportion in the childhood abuse (69%) vs. the non-child abuse-only group (34%). This study is unique in providing genome-wide evidence of distinct biological modifications in PTSD in the presence or absence of exposure to childhood abuse. The findings that nonoverlapping biological pathways seem to be affected in the two PTSD groups and that changes in DNA methylation appear to have a much greater impact in the childhood-abuse group might reflect differences in the pathophysiology of PTSD, in dependence of exposure to childhood maltreatment. These results contribute to a better understanding of the extent of influence of differences in trauma exposure on pathophysiological processes in stress-related psychiatric disorders and may have implications for personalized medicine.

Klengela, T., Conneelyb, K.N., Smithc, A.K., Altmanna, A., Pacec,d, T.W., Rex-Haffnera, Loeschnera, M.A.,  Gonika, M. Mercere, K.B., Bradleyc,f, B., Müller-Myhsoka, B., Resslerc,e,g, K.J., &  Binder, E.B. (2013). Childhood maltreatment is associated with distinct genomic and epigenetic profiles in posttraumatic stress disorder. Proceedings of the National Academy of Sciences of the United States of America.

Online [retrieved on 11/2/2013]: http://www.pnas.org/content/early/2013/04/24/1217750110.abstract

___________________________________________________________________________________________________________________________________________________________________

‘Pseudoneurological’ symptoms, dissociation and stress-related psychopathology in healthy young adults

Petr Bob, Petra Selesova, Jiri Raboch and Lubomir Kukla

Abstract

Background

Somatoform dissociation is a specific form of dissociation with somatic manifestations represented in the form of ‘pseudoneurological’ symptoms due to disturbances or alterations of normal integrated functions of consciousness, memory or identity mainly related to trauma and other psychological stressors. With respect to the distinction between psychological and somatoform manifestations of dissociation current data suggest a hypothesis to which extent mild manifestations of ‘pseudoneurological’ symptoms in healthy young population may be linked to stress-related psychopathological symptoms or whether these symptoms more likely could be attributed to unexplained somatic factors.

Methods

With this aim we have assessed the relationship between somatoform dissociation and stress-related psychopathology (i.e. anxiety, depression, symptoms of traumatic stress, alexithymia) in a group of 250 healthy non-psychiatric and non-clinical young adults.

Results

Results of this study show that the symptoms of somatoform dissociation are significantly linked to stress-related psychopathology.

Conclusions

Findings of this study show that the ‘pseudoneurological’ symptoms may be linked to stress-related psychopathological processes which indicate that also mild levels of stress may influence somatic feelings and may lead to various somatoform dissociative symptoms.

Bob, P., Selesova, P., Raboch, J., & Kukla, L. (2013). ‘Pseudoneurological’ symptoms, dissociation and stress-related psychopathology in healthy young adults. BMC Psychiatry, 13:149.

Online [retrieved on 11/2/2013]: http://www.biomedcentral.com/1471-244X/13/149

___________________________________________________________________________________________________________________________________________________________________

Childhood trauma and dissociation in first-episode psychosis, chronic schizophrenia and community controls

Christine Braehler, Luc Valiquette, Darren Holowka, Ashok K. Malla, Ridha Joober, Antonio Ciampi, Nicole Pawliuk, Suzanne King

Abstract

Increasing evidence supports the role of childhood trauma in the etiology of psychosis but underlying mechanisms are poorly understood. Early maltreatment has been linked to dissociative symptoms in psychosis patients. We explored associations between childhood trauma (Childhood Trauma Questionnaire) and dissociation (Dissociative Experiences Scale) in first-episode psychotic patients (n=62), chronic psychotic patients (n=43), and non-psychotic community controls (n=66). Multivariate analyses of covariance were used to test associations between childhood trauma and dissociation by group while controlling for sex. Chronic patients reported the highest level of dissociation. More severe childhood trauma was associated with greater dissociative symptoms in all groups although most strongly in chronic patients. Emotional abuse showed the strongest associations with dissociation, with these being strongest for chronic patients, followed by first-episode patients — and least for controls. Men showed a stronger association between physical neglect and dissociation than women, irrespective of group. There were no significant group by sex interactions. Our findings replicate the strong association between childhood trauma and dissociative symptoms in chronic and first-episode psychotic patients relative to non-psychotic control subjects. We also demonstrate the salience of emotional abuse in explaining variance in dissociation, especially in chronic patients.

Braehler, C. Valiquette, L., Holowka, D., Malla, A.K., Joober, R., Ciampi, A., Pawliuk, N. & King, S. (2013). Childhood trauma and dissociation in first-episode psychosis, chronic schizophrenia and community control. Psychiatry Research, 210, 1, pp. 36–42.

Online [retrieved on 11/2/2013]: http://www.sciencedirect.com/science/article/pii/S0165178113003119

___________________________________________________________________________________________________________________________________________________________________

Phobias of Attachment-Related Inner States in the Psychotherapy of Adult Survivors of Childhood Complex Trauma

Giovanni Liotti

Abstract

The clinical case described in this article illustrates the value of taking into account the dynamics of disorganized attachment in the assessment of attachment-related phobias (phobia of attachment and phobia of attachment loss) during the psychotherapy of chronically traumatized patients. These seemingly opposite phobias typically coexist in the same patient, appear as phobias of both inner states (affect phobias) and relational experiences, and are linked to dissociated representations of self-with-other. Theory and research on attachment disorganization provide a clinician-friendly conceptual framework for capturing both the intrapsychic (e.g., intrusive and nonintegrated mental states) and the relational (e.g., dramatic unsolvable dilemmas in interpersonal exchanges) aspects of the attachment-related phobias. The therapeutic strategy and the key interventions that logically follow from a case formulation based on this conceptual framework are examined.

Quote from the article: „

„What is critical is not the particular way of assessing, during the clinical dialogues, the mental operations reflective of the presence of a phobia of attachment and a phobia of attachment loss, but rather the therapist’s keen awareness that these phobias are reciprocally nonintegrated, i.e., they take form in dissociated (compartmentalised) states rather than simply conflicting mental states. As a consequence, therapists’ interventions must aim at facilitating the integration of these mental states, not at solving a psychological conflict.““

Liotti, G. (2013). Phobias of Attachment-Related Inner States in the Psychotherapy of Adult Survivors of Childhood Complex Trauma. Journal of Clinical Psychology, 69, 11, pp. 1136–1147.

Online [retrieved on 11/2/2013]: http://onlinelibrary.wiley.com/doi/10.1002/jclp.22041/abstract

___________________________________________________________________________________________________________________________________________________________________

Childhood adversity and inflammatory processes in youth: A prospective study

Natalie Slopen, Laura D. Kubzansky, Katie A. McLaughlin, Karestan C. Koenen

Abstract

Background

Retrospective studies show that childhood adversity is associated with systemic inflammation in adulthood. Few prospective studies have examined whether childhood adversity influences inflammation in an observable manner during childhood or adolescence and if these effects are sustained over time.

Methods

Using longitudinal data from the Avon Longitudinal Study of Parents and Children, we examined associations between acute adverse events at seven time points prior to age 8 and inflammation at ages 10 and 15. Inflammatory markers at age 10 included interleukin-6 (IL-6; N = 4655) and C-reactive protein (CRP; N = 4647), and CRP was measured again at age 15 (N = 3286). We further evaluated whether body mass index (BMI), depression, or cigarette smoking mediated associations between adverse events and inflammation.

Results

Adverse events in middle childhood (occurring between ages 6 to 8), as well as cumulative adversity from birth to 8 years, were associated with higher levels of IL-6 and CRP at age 10. Adverse events reported in early childhood (1.5 years) or middle childhood, and cumulative adversity from birth through 8 years predicted increased levels of CRP at age 15, and these associations persisted after adjustment for CRP at age 10. Some, but not all, of these associations were mediated by BMI.

Conclusions

This study documents that exposure to adverse events prior to age 8 is associated with elevated inflammation at age 10 and in mid-adolescence. These findings provide prospective evidence for a biological mechanism by which early experiences may shape long-term health. Future studies with earlier assessments of inflammation are necessary in order to elucidate potential sensitive periods and mechanisms that link childhood adversity to later disease vulnerability.

Slopen, N., Kubzansky, L.D.,  McLaughlin, K.A., & Koenen, K.C. (2013). Childhood adversity and inflammatory processes in youth: A prospective study. Psychoneuroendocrinology, 38, 2, pp. 188–200.

Online [retrieved on 11/2/2013]:http://www.sciencedirect.com/science/article/pii/S0306453012001904