Research from 2015

Type and Timing of Childhood Maltreatment and Severity of Shutdown Dissociation in Patients with Schizophrenia Spectrum Disorder

Dissociation, particularly the shutting down of sensory, motor and speech systems, has been proposed to emerge in susceptible individuals as a defensive response to traumatic stress. In contrast, other individuals show signs of hyperarousal to acute threat. A key question is whether exposure to particular types of stressful events during specific stages of development can program an individual to have a strong dissociative response to subsequent stressors. Vulnerability to ongoing shutdown dissociation was assessed in 75 inpatients (46M/29F, M = 31±10 years old) with schizophrenia spectrum disorder and related to number of traumatic events experienced or witnessed during childhood or adulthood. The Maltreatment and Abuse Chronology of Exposure (MACE) scale was used to collect retrospective recall of exposure to ten types of maltreatment during each year of childhood. Severity of shutdown dissociation was related to number of childhood but not adult traumatic events. Random forest regression with conditional trees indicated that type and timing of childhood maltreatment could predictably account for 31% of the variance (p < 0.003) in shutdown dissociation, with peak vulnerability occurring at 13-14 years of age and with exposure to emotional neglect followed by various forms of emotional abuse. These findings suggest that there may be windows of vulnerability to the development of shutdown dissociation. Results support the hypothesis that experienced events are more important than witnessed events, but challenge the hypothesis that “life-threatening” events are a critical determinant.

Schalinski I, Teicher MH (2015). Type and Timing of Childhood Maltreatment and Severity of Shutdown Dissociation in Patients with Schizophrenia Spectrum Disorder. PLoS ONE 10(5). Online [retrieved 8/11/2015]: e0127151. doi:10.1371/journal.pone.0127151

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Childhood Trauma Exposure Disrupts the Automatic Regulation of Emotional Processing

Early-life trauma is one of the strongest risk factors for later emotional psychopathology. Although research in adults highlights that childhood trauma predicts deficits in emotion regulation that persist decades later, it is unknown whether neural and behavioral changes that may precipitate illness are evident during formative, developmental years. This study examined whether automatic regulation of emotional conflict is perturbed in a high-risk urban sample of trauma-exposed children and adolescents. A total of 14 trauma-exposed and 16 age-, sex-, and IQ-matched comparison youth underwent functional MRI while performing an emotional conflict task that involved categorizing facial affect while ignoring an overlying emotion word. Engagement of the conflict regulation system was evaluated at neural and behavioral levels. Results showed that trauma-exposed youth failed to dampen dorsolateral prefrontal cortex activity and engage amygdala–pregenual cingulate inhibitory circuitry during the regulation of emotional conflict, and were less able to regulate emotional conflict. In addition, trauma-exposed youth showed greater conflict-related amygdala reactivity that was associated with diminished levels of trait reward sensitivity. These data point to a trauma-related deficit in automatic regulation of emotional processing, and increase in sensitivity to emotional conflict in neural systems implicated in threat detection. Aberrant amygdala response to emotional conflict was related to diminished reward sensitivity that is emerging as a critical stress-susceptibility trait that may contribute to the emergence of mental illness during adolescence. These results suggest that deficits in conflict regulation for emotional material may underlie heightened risk for psychopathology in individuals that endure

Marusak, H.A. , Martin, K.R., Etkin & Thomason, M.E. (2015). Childhood Trauma Exposure Disrupts the Automatic Regulation of Emotional Processing. Neuropsychopharmacology, 40, 1250–1258. Online [retrieved 8/11/2015]: http://www.nature.com/npp/journal/v40/n5/abs/npp2014311a.html

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Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program

Objective:

The primary aim of this study was to compare the impact of NAVIGATE, a comprehensive, multidisciplinary, team-based treatment approach for first-episode psychosis designed for implementation in the U.S. health care system, with community care on quality of life.

Method:

Thirty-four clinics in 21 states were randomly assigned to NAVIGATE or community care. Diagnosis, duration of untreated psychosis, and clinical outcomes were assessed via live, two-way video by remote, centralized raters masked to study design and treatment. Participants (mean age, 23) with schizophrenia and related disorders and ≤6 months of antipsychotic treatment (N=404) were enrolled and followed for ≥2 years. The primary outcome was the total score of the Heinrichs-Carpenter Quality of Life Scale, a measure that includes sense of purpose, motivation, emotional and social interactions, role functioning, and engagement in regular activities.

Results:

The 223 recipients of NAVIGATE remained in treatment longer, experienced greater improvement in quality of life and psychopathology, and experienced greater involvement in work and school compared with 181 participants in community care. The median duration of untreated psychosis was 74 weeks. NAVIGATE participants with duration of untreated psychosis of <74 weeks had greater improvement in quality of life and psychopathology compared with those with longer duration of untreated psychosis and those in community care. Rates of hospitalization were relatively low compared with other first-episode psychosis clinical trials and did not differ between groups.

Conclusions:

Comprehensive care for first-episode psychosis can be implemented in U.S. community clinics and improves functional and clinical outcomes. Effects are more pronounced for those with shorter duration of untreated psychosis.

Kane, J.M., Robinson, D.G., Schooler, N.R., Mueser, K.T., Penn, D.L., Rosenheck, R.A., Addington, J., [...] & Heinssen, R.K. (2015). Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program. The American Journal of Psychiatry, ahead of print. Online [retrieved 8/11/2015]: http://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.2015.15050632

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When Not Saying NO Does Not Mean Yes: Psychophysiological Factors Involved in Date Rape

To understand how a woman who does not want to be a willing sexual partner can at times acquiesce and not fight the date rape predator, the neurobiology of our responses to threat needs to be understood. Under situations of extreme threat, instead of responding just to danger signals with only the options to fight or flee, we also retain in our nervous system a primitive immobilization response that may reflexively be expressed when our body detects life threat. This primitive defense system is shared not only with other mammals, but also with reptiles, such as the turtle, that immobilize as a primary defensive strategy. The brain makes the decision without awareness, and the relative risks of stimuli are interpreted to be safe, dangerous, or life threatening. The polyvagal theory proposed by Stephen Porges may explain why many rape victims do not actively resist. According to the theory, the act of not responding is an immobilization fear response to life threat, which may be wrongly interpreted by the aggressor as a passive acquiescence. The woman's thoughts, intentions, and feelings are irrelevant—her body shuts down in preparation for severe injury and death. This misunderstanding may be exacerbated if judgment is clouded by alcohol. This discussion of the polyvagal theory supports the recently passed California law (Senate Bill 967) that requires the governing boards of California postsecondary institutions (colleges and universities) to adopt procedures and protocols requiring students to obtain “affirmative, unambiguous, and conscious decision by each participant to engage in mutually agreed-upon sexual activity.”

Porges S.W. & Peper, E. (2015). When Not Saying NO Does Not Mean Yes: Psychophysiological Factors Involved in Date Rape. Biofeedback, 43(1), 45-48. Online [retrieved 8/11/2015]: http://www.aapb-biofeedback.com/doi/abs/10.5298/1081-5937-43.1.01

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Maternal exposure to intimate partner abuse before birth is associated with autism spectrum disorder in offspring

We sought to determine whether maternal (a) physical harm from intimate partner abuse during pregnancy or (b) sexual, emotional, or physical abuse before birth increased risk of autism spectrum disorder. We calculated risk ratios for autism spectrum disorder associated with abuse in a population-based cohort of women and their children (54,512 controls, 451 cases). Physical harm from abuse during pregnancy was not associated with autism spectrum disorder. However, autism spectrum disorder risk was increased in children of women who reported fear of partner or sexual, emotional, or physical abuse in the 2 years before the birth year (abuse in the year before the birth year: risk ratio = 1.58, 95% confidence interval = 1.04, 2.40; abuse in both of the 2 years before the birth year: risk ratio = 2.16, 95% confidence interval = 1.33, 3.50). Within-family results were similar, although did not reach statistical significance. Association of intimat partner abuse before the child’s birth year with autism spectrum disorder in the child was not accounted for by gestation length, birth weight, maternal smoking or alcohol consumption during pregnancy, gestational diabetes, preeclampsia, or history of induced abortion.

Roberts, A.L., Lyall, K., Rich-Edwards, J.W., Ascherio, A. & Weisskopf, M.G. (2015). Maternal exposure to intimate partner abuse before birth is associated with autism spectrum disorder in offspring. Autism, ahead of print. Online [retrieved 8/11/2015]: http://www.ncbi.nlm.nih.gov/pubmed/25662292

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Symptoms of Dissociation in Humans Experiencing Acute, Uncontrollable Stress: A Prospective Investigation

OBJECTIVE: Peritraumatic dissociation has been associated with subsequent development of posttraumatic stress disorder, but supporting data have been largely retrospective. The current study was designed to assess the nature and prevalence of dissociative symptoms in healthy humans experiencing acute, uncontrollable stress during U.S. Army survival training.

METHOD: In study 1, 94 subjects completed the Clinician-Administered Dissociative States Scale after exposure to the stress of survival training. In study 2, 59 subjects completed the Brief Trauma Questionnaire before acute stress and the dissociative states scale before and after acute stress. A randomly selected group of subjects in study 2 completed a health problems questionnaire after acute stress.

RESULTS: In study 1, 96% of subjects reported dissociative symptoms in response to acute stress. Total scores, as well as individual item scores, on the dissociation scale were significantly lower in Special Forces soldiers compared to general infantry troops. In study 2, 42% of subjects reported dissociative symptoms before stress and 96% reported them after acute stress. Dissociative symptoms before and after stress were significantly higher in individuals who reported a perceived threat to life in the past. Forty-one percent of the variance in reported health problems was accounted for by poststress dissociation scores.

Discussion: Symptoms of dissociation were prevalent in healthy subjects exposed to high stress. Stress-hardy individuals (Special Forces soldiers) experienced fewer symptoms of dissociation, compared to individuals who were less hardy. These data support the idea that the nature of response to previously experienced threatening events significantly determines the nature of psychological and somatic response to subsequent stress.

Morgan, C.A., Hazlett, G., Wang, S., Richardson, E., Schnurr, P. & Southwick, S.M. (2015). Symptoms of Dissociation in Humans Experiencing Acute, Uncontrollable Stress: A Prospective Investigation. The American Journal of Psychiatry, 15888), 1239-1247. Online [retrieved 8/11/2015]: http://ajp.psychiatryonline.org/doi/full/10.1176/ajp.158.8.1239b

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Attachment representations of professionals − Influence on intervention and implications for clinical training and supervision

This study focuses on the attachment background of facilitators carrying out STEEP intervention, which may be a possible source of effectiveness variation. The attachment status of 161 professionals was assessed before STEEP training. 18 were followed up to evaluate the programme’s effectiveness regarding mother infant attachment. In the larger sample (n=161), 76% of trainees had insecure attachment representations. While attachment security had no impact on intervention efficacy, professionals with an unresolved attachment trauma were 4.4 times less effective than professionals with no unresolved attachment status. This study highlights the importance of including professional workers’ attachment status in intervention programs.

Suess G.J., Mali, A., Reiner, I., Fremmer-Bombik, E., Schieche, M. & Suess, E.S. (2015). Attachment representations of professionals − Influence on intervention and implications for clinical training and supervision. Mental Health & prevention, 3(3), 129-134. Online [retrieved 8/11/2015]: http://www.sciencedirect.com/science/article/pii/S2212657015000227

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Vicarious resilience from attachment trauma: reflections of long-term therapy with marginalized young people

The concept of vicarious resilience captures the therapist's emotional growth occurring as a direct result of therapeutic engagement with traumatized clients. Three chronological case scenarios are presented for exploration of vicarious resilience in relation to attachment trauma. The purpose is to increase awareness and appreciation of the positive functions it serves for client mentalization, therapist skill and resilience factors for both parties. The reflective methodology considers the intrapsychic worlds of the client and the therapist and details how the therapist comes to experience the client's distressing projections. The potential for vicarious resilience begins from the outset of the therapist's actions of containment upon these projections. Advancing early ideas, it is advocated that vicarious resilience requires the therapist to have both the capacity and willingness to maintain a constant reflective stance.

Tassie, A.K. (2015). Vicarious resilience from attachment trauma: reflections of long-term therapy with marginalized young people. Journal of Social Work Practice: Psychotherapeutic Approaches in Health, Welfare and the Community, 29(2), 191-204. Online [retrieved 8/11/2015]: http://www.tandfonline.com/doi/abs/10.1080/02650533.2014.933406

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Enactments in Transference: Embodiment, Trauma and Depression. What Have Psychoanalysis and the Neurosciences to Offer to Each Other

The current controversy within psychoanalysis whether or not ‘historical truth’ plays a role in successful patient treatment is fuelled by neuroscientific research in the field of Embodied Cognitive Science. The insights from the neurosciences provide an objective aspect to the subjective, ‘narrative’ aspect so important in psychoanalytical therapy. The author concludes that memory is always based on new and idiosyncratic (hermeneutic) narratives that take place in interactional situations in the present, which nevertheless contain traces of historical truth. Leuzinger-Bohleber regards neuroscientific findings of neuroscience as coherent with those from psychoanalysis, and, therefore, stresses the importance of prevention and early intervention, especially in light of new epigenetic research.

Leuzinger-Bohleber, M. (2015). Enactments in Transference: Embodiment, Trauma and Depression. What Have Psychoanalysis and the Neurosciences to Offer to Each Other. A Neuro-Psychoanalytical Dialogue for Bridging Freud and the Neurosciences, 33-46. Online [retrieved 8/11/2015]: http://link.springer.com/chapter/10.1007/978-3-319-17605-5_3

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Successful Therapy Of Treatment Resistant Adult ADHD With Cannabis: Experience From A Medical Practice With 30 Patients

Background: Attention deficit hyperactivity disorder [ADHD] may persist into adulthood. It may be treatment resistant to standard medication, that is methylphenidate, amphetamine derivatives and atomoxetine. Currently, no clinical studies have been conducted on cannabisbased medicines in ADHD, but a few case reports (Strohbeck-Kuehner P, et al. Cannabinoids 2008;3(1):1-3. Available online at http://cannabis-med.org/data/pdf/en_2008_01_1.pdf) and basic research (Adriani W, et al. Neurosci Biobehav Rev 2003;27:639-651.) suggest therapeutic benefits in this condition. In Germany, patients independent of medical condition may apply for an approval to use cannabis flowers from the pharmacy if the standard therapy of a certain disease or symptom is not efficient or associated with severe side effects.

Method: The medical certificates of 30 patients with adult ADHD of a medical practice (practice of FG), who were granted approval by the German Health Ministry to use cannabis flowers between 2012 and 2014 were analysed with regard to course of disease, previous treatment efforts, and effects of self-medication with cannabis or therapy with cannabis-based medications were analysed.

Results: Mean age of patients [28 male, 2 female] at first visit was 30 years [range: 21 to 51]. In 63% of cases ADHD was diagnosed only during adulthood. In all patients diagnosed in childhood [between 6 and 13 years of age] had previously been treated with methylphenidate. Further pharmacological treatment with was atomoxetine, deexamphetamine, lisdexamphetamine and amphetamine juice. Medication was usually discontinued due to side effects and often due to ineffectiveness. Eight patients continued to take stimulants and combined them with cannabis, by 22 patients were allowed to use it only. All patients had experienced an improvement of a variety of symptoms by cannabis flowers, including improved concentration and sleep, and reduced impulsivity, by the use of cannabis. In five cases dronabinol [THC] was tried, which was also effective. Many patients were diagnosed before with cannabis use disorders by psychiatrists in hospitals or medical practices due to misinterpretation of effective illegal self-medication. Patients

reported that their therapeutic experiences were not taken seriously by most physicians and that they were not listening to them due to strong prejudices. In many cases parents and/or spouses wrote testimonies on their observations confirming their statements.

Conclusion: For adult patients with ADHD, who experience side effects or do not profit from standard medication, cannabis may be an effective and well-tolerated alternative.

Milz, E. & Grotenhermen, F. (2015). Successful Therapy Of Treatment Resistant Adult ADHD With

Cannabis: Experience From A Medical Practice With 30 Patients. Cannabinoid Conference - 7th European Workshop on Cannabinoid Research and

IACM 8th Conference on Cannabinoids in Medicine, 17.-19. September 2015, Italy. Online [retrieved 8/11/2015]: http://www.drmilz.de/wp-content/uploads/Poster-CC-2015.pdf

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An Exploration of the Utilization of Art Materials in Sensorimotor Psychotherapy for Resolution of Attachment Trauma

This research investigates the researcher’s experience of the integration of art making within sensorimotor psychotherapy as they relate to the resolution of attachment trauma. The heuristic method of research inquiry was employed in which the researcher was the subject in the research. The basis for the research was an increasing awareness of attachment trauma present in her life history. A review of the literature yielded that a large body of research had been published on attachment theory, trauma, and art therapy. There existed at the time of the research inquiry a lack of literature exploring the utilization of art making in sensorimotor psychotherapy. Data was gathered in the form of artworks created during individual psychotherapy with a psychologist certified in sensorimotor psychotherapy and in the form of post-session reflective writings. The artworks and post-session writings were analyzed. Themes that substantiated the research inquiry emerged. Multiple meanings were derived from this research. A primary meaning was the recognition that the therapeutic alliance coupled with art making and sensorimotor psychotherapy provided a secure environment for integration of attachment trauma. Further research is warranted. There is a potential for development of methodology for incorporating art making into sensorimotor psychotherapy for clients with whom the process is merited. Future iterations of the developed protocol might include replications of the study and modification and expansion of the protocol. The protocol could be employed for processing other types of trauma. Additionally, there is a need for more art therapists who are concurrently trained in sensorimotor psychotherapy.

Snodgrass, S.L. (2015). An Exploration of the Utilization of Art Materials in Sensorimotor Psychotherapy for Resolution of Attachment Trauma. LMU/LLS Theses and Dissertations. Paper 149. Online [retrieved 8/11/2015]: http://digitalcommons.lmu.edu/etd/149

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Stress Enables Reinforcement-Elicited Serotonergic Consolidation of Fear Memory

Background

Prior exposure to stress is a risk factor for developing posttraumatic stress disorder (PTSD) in response to trauma, yet the mechanisms by which this occurs are unclear. Using a rodent model of stress-based susceptibility to PTSD, we investigated the role of serotonin in this phenomenon.

Methods

Adult mice were exposed to repeated immobilization stress or handling, and the role of serotonin in subsequent fear learning was assessed using pharmacologic manipulation and western blot detection of serotonin receptors, measurements of serotonin, high-speed optogenetic silencing, and behavior.

Results

Both dorsal raphe serotonergic activity during aversive reinforcement and amygdala serotonin 2C receptor (5-HT2CR) activity during memory consolidation were necessary for stress enhancement of fear memory, but neither process affected fear memory in unstressed mice. Additionally, prior stress increased amygdala sensitivity to serotonin by promoting surface expression of 5-HT2CR without affecting tissue levels of serotonin in the amygdala. We also showed that the serotonin that drives stress enhancement of associative cued fear memory can arise from paired or unpaired footshock, an effect not predicted by theoretical models of associative learning.

Conclusions

Stress bolsters the consequences of aversive reinforcement, not by simply enhancing the neurobiological signals used to encode fear in unstressed animals, but rather by engaging distinct mechanistic pathways. These results reveal that predictions from classical associative learning models do not always hold for stressed animals and suggest that 5-HT2CR blockade may represent a promising therapeutic target for psychiatric disorders characterized by excessive fear responses such as that observed in PTSD.

Baratta, M.V., Kodandaramaiah, S.B., Monahan, P.E., Yao, J., Weber, M.D., Lin, P.-A., Gisabella, B. & Ki A. Goosens (2015). Stress Enables Reinforcement-Elicited Serotonergic Consolidation of Fear Memory. Biological Psychiatry, in press. Online [retrieved 8/11/2015]: http://www.biologicalpsychiatryjournal.com/article/S0006-3223%2815%2900533-8/fulltext

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Auditory verbal hallucinations in schizophrenia and post-traumatic stress disorder: common phenomenology, common cause, common interventions?

Auditory verbal hallucinations (AVH: ‘hearing voices’) are found in both schizophrenia and post-traumatic stress disorder (PTSD). In this paper we first demonstrate that AVH in these two diagnoses share a qualitatively similar phenomenology. We then show that the presence of AVH in schizophrenia is often associated with earlier exposure to traumatic/emotionally overwhelming events, as it is by definition in PTSD. We next argue that the content of AVH relates to earlier traumatic events in a similar way in both PTSD and schizophrenia, most commonly having direct or indirect thematic links to emotionally overwhelming events, rather than being direct re-experiencing. We then propose, following cognitive models of PTSD, that the reconstructive nature of memory may be able to account for the nature of these associations between trauma and AVH content, as may threat-hypervigilance and the individual’s personal goals. We conclude that a notable subset of people diagnosed with schizophrenia with AVH are having phenomenologically and aetiologically identical experiences to PTSD patients who hear voices. As such we propose that the iron curtain between AVH in PTSD (often termed ‘dissociative AVH’) and AVH in schizophrenia (so-called ‘psychotic AVH’) needs to be torn down, as these are often the same experience. One implication of this is that these trauma-related AVH require a common trans-diagnostic treatment strategy. Whilst antipsychotics are already increasingly being used to treat AVH in PTSD, we argue for the centrality of trauma-based interventions for trauma-based AVH in both PTSD and in people diagnosed with schizophrenia.

Mccarthy-Jones, S. & Longden, E. (2015). Auditory verbal hallucinations in schizophrenia and post-traumatic stress disorder: common phenomenology, common cause, common interventions?. Front. Psychol. 6:1071. Online [retrieved 8/2/2015]: http://journal.frontiersin.org/article/10.3389/fpsyg.2015.01071/abstract

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Where is the Evidence for “Evidence-Based” Therapy?*

“Evidence-based therapy” has become quite the catchphrase. The term “evidence-based” comes from medicine. It gained attention in the 1990s and was, at the time, a call for critical thinking. It reflected the recognition that “we’ve always done it this way” is not a good enough reason to keep doing something. Medical decisions should reflect clinical judgment, patients’ values and preferences, and relevant scientific research.

But “evidence-based” has come to mean something very dif- ferent in the psychotherapy world. The term has been appropri- ated to promote a particular ideology and agenda. It has become a code word for manualised treatment—most often, brief, highly- structured cognitive behavioural therapy (CBT). “Manualised” means the therapy is literally conducted by following an instruc- tion manual. The treatment may be pre-scripted in a way that leaves little room for understanding patients as individuals.

Behind the “evidence-based” therapy movement lies what I will call the “master narrative”, a narrative that increasingly dominates the mental health landscape. The master narrative goes something like this: “In the dark ages, therapists practiced untested, unscientific therapy. Science shows that evidence- based therapies are superior.” This narrative has become a justi- fication for all-out attacks on traditional (i.e., psychodynamic) therapy—that is, psychotherapy that fosters self-understanding and insight in the context of a meaningful, ongoing therapy relationship.

Shedler, J. (2015). Where is the Evidence for “Evidence-Based” Therapy?*. The Journal of Psychological Therapies in Primary Care, Vol. 4, May 2015: pp. 47–59.  Online [retrieved 8/2/2015]: http://jungianstudies.org/wp-content/uploads/2015/07/Shedler-2015-Where-is-the-evidence-for-evidence-based-therapies-copy.pdf

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Does long term use of psychiatric drugs cause more harm than good?

We could stop almost all psychotropic drug use without deleterious effect, says Peter C Gøtzsche, questioning trial designs that underplay harms and overplay benefits. Allan H Young and John Crace disagree, arguing that evidence supports long term use.

Almost all psychotropic drugs could be stopped without causing any harm and with little loss of benefits, saving hundreds of thousands of lives and leading to happier and longer-lived populations, says a Danish expert in a head-to-head editorial debate.

Gøtzsche, P.C., Young, A.H. & Crace, J. (2015). Does long term use of psychiatric drugs cause more harm than good? BMJ;350:h2435. Online [retrieved 8/2/2015]:  http://www.bmj.com/content/350/bmj.h2435

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Dissociation in individuals denying trauma exposure: findings from two samples

A number of studies suggest that dissociation is reliably related to trauma exposure, and that inadequate regulation of posttraumatic distress may be a significant factor. We examined whether affect dysregulation predicts dissociation in those denying any lifetime exposure to trauma. These relationships were evaluated in a general population sample and a second sample of nontraumatized university students. In the first study, multivariate analyses indicated that, along with gender, affect dysregulation was a relatively strong predictor, accounting for 27% of the variance in dissociation. In the replication study, dissociation was associated with affect dysregulation, but not gender. Affect dysregulation seems to predict dissociative symptomatology in nontraumatized individuals. It is hypothesized that emotional distress, whether from trauma or other etiologies, motivates dissociation to the extent that it challenges the individual's compromised capacity for affect regulation. Treatment implications may include the potential helpfulness of interventions that increase emotion regulation skills.

Briere, J. & Runtz, M. (2015). Dissociation in individuals denying trauma exposure: findings from two samples. J Nerv Ment Dis., 203(6):439-42. Online [retrieved 8/2/2015]: http://www.ncbi.nlm.nih.gov/pubmed/25974057

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Hippocampal Volumes in a Sample of Trauma Patients: A Possible Neuro-Protective Effect of Dissociation.

Background: We sought to determine hippocampal volumes in a sample of inpatients in a Trauma Program specializing in posttraumatic stress disorder and dissociative disorders.

Methods: We measured whole brain and left and right hippocampal volumes on MRI in a sample of 20 inpatients in a Trauma Program and 20 controls.

Results: There were no differences between the two groups. Nineteen inpatients also completed a set of diagnostic and symptom measures; 16 met criteria for posttraumatic stress disorder (PTSD); the average score on the Dissociative Experiences Scale was (M = 45.4, SD = 20.1); and the average score on the secondary features of dissociative identity disorder section of the Dissociative Disorders Interview Schedule was (M = 9.1, SD = 4.9).

Conclusion: We hypothesized that dissociation may have a neuro-protective effect, which accounts for the normal hippocampal volumes in the patients, despite their PTSD and trauma histories.

Ross, C.A., Goode, C. & Schroeder, E. (2015). Hippocampal Volumes in a Sample of Trauma Patients: A Possible Neuro-Protective Effect of Dissociation. The Open Psychiatry Journal, 2015, 9, 7-10. Online [retrieved 8/2/2015]: http://www.bentham-open.com/contents/pdf/TOPJ/TOPJ-9-7.pdf

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Betray my trust, shame on me: Shame, dissociation, fear, and betrayal trauma.

Recent research suggests that betrayal is a fundamental dimension of trauma that may be a major factor contributing to posttraumatic distress (Freyd & Birrell, 2013). In the current study using a college student sample of female trauma survivors, (N = 124; 79% Caucasian; mean age = 20.40, SD = 3.60), we examined the contribution of high- and low-betrayal trauma history to shame, dissociation, and fear responses to threat. We hypothesized that (a) overall, shame and dissociation would be higher following interpersonal compared with noninterpersonal threat; (b) high- but not low-betrayal trauma history would predict increased shame and dissociation following interpersonal threat; and (c) low- but not high-betrayal trauma history would predict increased fear following noninterpersonal threat. Hypothesis 1 was not supported. There was no difference in overall shame and dissociation following interpersonal compared with noninterpersonal threat. Hypotheses 2 and 3 were supported. History of high- but not low-betrayal trauma predicted increases in shame (R² = .14) and dissociation (R² = .23) following interpersonal threat, whereas history of low- but not high-betrayal trauma predicted increases in fear (R² = .07) following noninterpersonal threat. These results contribute to growing evidence that perpetrator closeness matters when considering posttraumatic responses. Shame and dissociation warrant more clinical attention as possible barriers to effective exposure therapy among betrayal trauma survivors. (PsycINFO Database Record (c) 2015 APA, all rights reserved)

Platt, M.G., Freyd, J.J. (2015). Betray my trust, shame on me: Shame, dissociation, fear, and betrayal trauma. Psychological Trauma: Theory, Research, Practice, and Policy, Vol 7(4), Jul 2015, 398-404. Online [retrieved 8/2/2015]: http://www.ncbi.nlm.nih.gov/pubmed/25793317

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Intergenerational Transmission Of Attachment In Abused And Neglected Mothers: The Role Of Trauma-Specific Reflective Functioning.

There are still important gaps in our knowledge regarding the intergenerational transmission of attachment from mother to child, especially in mothers with childhood histories of abuse and neglect (CA&N). This study examined the contributions of reflective function concerning general attachment relationships, and specifically concerning trauma, as well as those of maternal attachment states of mind to the prediction of infant attachment disorganization in a sample of mothers with CA&N and their infants, using a 20-month follow-up design. Attachment and reflective functioning were assessed during pregnancy with the Adult Attachment Interview. Infant attachment was evaluated with the Strange Situation Procedure. The majority (83%) of infants of abused and neglected mothers were classified as insecure, and a significant proportion (44%) manifested attachment disorganization. There was a strong concordance between mother and child attachment, indicative of intergenerational transmission of attachment in parents with CA&N and their infants. Both unresolved trauma and trauma-specific reflective function made significant contributions to explaining variance in infant attachment disorganization. The findings of this study highlight the importance of trauma-specific mentalization in the intergenerational transmission of attachment by mothers with a history of childhood maltreatment, and provide new evidence of the importance of the absence of mentalization regarding trauma for infant attachment.

Berthelot, N., Ensink, K., Bernazzani, O., Normandin, L., Luyten, P. & Fonagy, P. (2015). Intergenerational Transmission Of Attachment In Abused And Neglected Mothers: The Role Of Trauma-Specific Reflective Functioning. Infant Mental Health Journal, 36(2), pp. 200–212.

Online [retrieved 8/2/2015]: http://onlinelibrary.wiley.com/doi/10.1002/imhj.21499/abstract

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Sexual Revictimization: The Impact of Attachment Anxiety, Accumulated Trauma, and Response to Childhood Sexual Abuse Disclosure

It has been proposed that a complexity of personal, interpersonal, and environmental factors is related to sexual revictimization among childhood sexual abuse survivors. In this study, we investigated the relations between attachment dimensions, exposure to accumulated childhood traumas, reaction to childhood sexual abuse disclosure, and adult sexual revictimization. Participants were 60 Israeli women with histories of childhood sexual abuse. Seventy percent of the women reported adult sexual revictimization. Revictimization was related to higher attachment anxiety but not to higher attachment avoidance. Revictimization was also related to emotional and physical child abuse but not to emotional and physical child neglect. Revictimization rates were higher among women who had received negative environmental responses following childhood sexual abuse disclosure than among women who had received supportive reactions and those who had not disclosed childhood sexual abuse at all. Findings were significant even after controlling for severity of childhood sexual abuse. The findings emphasize the role of various contextual-interpersonal factors on revictimization vulnerability among the survivors of childhood sexual abuse.

Brenner, I. & Galit, B.-A. (2015). Sexual Revictimization: The Impact of Attachment Anxiety, Accumulated Trauma, and Response to Childhood Sexual Abuse Disclosure. Violence and Victims, 30(1), 2015, pp. 49-65(17). Online [retrieved 8/2/2015]: http://www.ncbi.nlm.nih.gov/pubmed/25774414

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Inflammation and neuronal plasticity: a link between childhood trauma and depression pathogenesis

During the past two decades, there has been increasing interest in understanding and characterizing the role of inflammation in major depressive disorder (MDD). Indeed, several are the evidences linking alterations in the inflammatory system to Major Depression, including the presence of elevated levels of pro-inflammatory cytokines, together with other mediators of inflammation. However, it is still not clear whether inflammation represents a cause or whether other factors related to depression result in these immunological effects. Regardless, exposure to early life stressful events, which represent a vulnerability factor for the development of psychiatric disorders, act through the modulation of inflammatory responses, but also of neuroplastic mechanisms over the entire life span. Indeed, early life stressful events can cause, possibly through epigenetic changes that persist over time, up to adulthood. Such alterations may concur to increase the vulnerability to develop psychopathologies. In this review we will discuss the role of inflammation and neuronal plasticity as relevant processes underlying depression development. Moreover, we will discuss the role of epigenetics in inducing alterations in inflammation-immune systems as well as dysfunction in neuronal plasticity, thus contributing to the long-lasting negative effects of stressful life events early in life and the consequent enhanced risk for depression. Finally we will provide an overview on the potential role of inflammatory system to aid diagnosis, predict treatment response, enhance treatment matching, and prevent the onset or relapse of Major Depression.

Cattaneo, A., Macchi, F., Plazzotta, G., Veronica, B., Bocchio-Chiavetto, L., Riva, M.A. & Pariante, C.M. (2015). Inflammation and neuronal plasticity: a link between childhood trauma and depression pathogenesis. Front. Cell. Neurosci. 9:40. Online [retrieved 8/2/2015]: http://www.ncbi.nlm.nih.gov/pubmed/25873859

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The long-term impact of adverse caregiving environments on epigenetic modifications and telomeres

Early childhood is a sensitive period in which infant-caregiver experiences have profound effects on brain development and behavior. Clinical studies have demonstrated that infants who experience stress and adversity in the context of caregiving are at an increased risk for the development of psychiatric disorders. Animal models have helped to elucidate some molecular substrates of these risk factors, but a complete picture of the biological basis remains unknown. Studies continue to indicate that environmentally-driven epigenetic modifications may be an important mediator between adverse caregiving environments and psychopathology. Epigenetic modifications such as DNA methylation, which normally represses gene transcription, and microRNA processing, which interferes with both transcription and translation, show long-term changes throughout the brain and body following adverse caregiving. Recent evidence has also shown that telomeres (TTAGGG nucleotide repeats that cap the ends of DNA) exhibit long-term changes in the brain and in the periphery following exposure to adverse caregiving environments. Interestingly, telomeric enzymes and subtelomeric regions are subject to epigenetic modifications—a factor which may play an important role in regulating telomere length and contribute to future mental health. This review will focus on clinical and animal studies that highlight the long-term epigenetic and telomeric changes produced by adverse caregiving in early-life.

Blaze, J., Asok, A. & Tania L. Roth (2015). The long-term impact of adverse caregiving environments on epigenetic modifications and telomeres. Front Behav Neurosci. 2015; 9: 79. Online [retrieved 8/2/2015]:

 http://journal.frontiersin.org/article/10.3389/fnbeh.2015.00079/abstract

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Mindfulness as a Treatment Component for Adults Suffering from Post-Traumatic Stress Disorder

Post-Traumatic Stress Disorder has become a widely recognized and accepted mental health concern affecting many individuals. Various treatment approaches are used to alleviate the symptomology of this mental health condition including: different therapeutic approaches, psychotropic medication, and mindfulness. The purpose of this research project was to analyze and distill existing research pertaining to the neurological implications of trauma and mindfulness, with emphasis on how the latter is an effective treatment approach for the former. Data were analyzed in three phases: one, PTSD and Mindfulness; two, Mindfulness and the Brain and; three, Mindfulness and its Impact on the Brain for adults with PTSD. Findings show how that trauma not only impacts the three regions of the brain (hindbrain, midbrain, and forebrain), but a person’s body as a whole. Findings suggest that mindfulness may positively counteract the effects of PTSD due to activating and influencing different areas of the brain, which have been deregulated after encountering trauma, with particular impact upon the structure and function of the brain.

Hauck, J.L. (2015). Mindfulness as a Treatment Component for Adults Suffering from Post-Traumatic Stress Disorder. Master of Social Work, Clinical Research Papers. Paper 463. Online [retrieved 8/2/2015] http://sophia.stkate.edu/msw_papers/463

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Childhood sexual abuse by representatives of the Roman Catholic Church: A prevalence estimate among the Dutch population

Estimates of the extent of childhood sexual abuse (CSA) within in the Roman Catholic Church (RCC) in the general population are difficult to find. The independent Commission of Inquiry into sexual abuse of minors in the RCC in the Netherlands collected population-based data to estimate its prevalence. A large random online population sample was surveyed using a two-phase stratified sampling procedure. In Phase 1, 34,267 subjects aged 40 years and older were screened for childhood exposure to sexual abuse by non-family members, a history of institutionalization and a Roman Catholic upbringing. In Phase 2, a stratified subset of 2,462 subjects was assessed to obtain more detailed target information about sexual abuse reports within the RCC. We employed multiple imputation for the estimation of RCC CSA in the original Phase 1 sample. The prevalence of non-familial CSA in general (14.0%) was higher among women (17.2%) than among men (10.6%). The prevalence of CSA within the Dutch RCC (1.7%) was higher among men (2.7%) than among women (0.7%). As expected, older subjects reported more often CSA in the RCC than their younger counterparts. Respondents who stayed for some time in RCC run institutions for education or child protection had a higher risk to report sexual abuse. Although sexual abuse of minors by representatives of the RCC was a structural problem during a period that the Church was highly influential in the Netherlands, the estimated prevalence of the phenomenon is only a fraction of the prevalence rate of non-familial CSA.

Langeland, W., Hoogendoorn, A.W., Mager, D., Smit, J.H. & Draijer, N. (2015). Childhood sexual abuse by representatives of the Roman Catholic Church: A prevalence estimate among the Dutch population. Child Abuse & Neglect, 46, pp. 67–77.

Online [retrieved 8/2/2015]:  http://www.sciencedirect.com/science/article/pii/S0145213415001271

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Dissociative, Depressive, and PTSD Severity as Correlates of Non-Suicidal Self-Injury and Suicidality in Dissociative Disorder Patients.

The present study investigates whether symptom severity can distinguish patients diagnosed with dissociative identity disorder (DID) and dissociative disorder not otherwise specified (DDNOS) with a recent history of non-suicidal self-injury (NSSI) and suicide attempts from those without recent self-harm. Two hundred forty one clinicians reported on recent history of patient NSSI and suicide attempts. Two hundred twenty-one of these clinicians’ patients completed dissociative, depressive, and posttraumatic stress disorder symptomatology measures. Baseline cross-sectional data from a naturalistic and prospective study of dissociative disorder (DD) patients receiving community treatment was utilized. Analyses evaluated dissociative, depressive, and PTSD symptom severity as methods of classifying patients into NSSI and suicide attempt groupings. Results indicated that dissociation severity accurately classified patients into NSSI and suicidality groups, while depression severity accurately classified patients into NSSI groups. These findings point to dissociation and depression severity as important correlates of NSSI and suicidality in patients with DDs, and have implications for self-harm prevention and treatment.

Webermann A.R., Myrick, A.C., Taylor, C.L., Chasson, G.S. & Brand, B.L. (2015). Dissociative, Depressive, and PTSD Severity as Correlates of Non-Suicidal Self-Injury and Suicidality in Dissociative Disorder Patients. J Trauma Dissociation. 2015 Jul 25. [Epub ahead of print] Online [retrieved 8/2/2015]: http://www.ncbi.nlm.nih.gov/pubmed/26211678

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Psychological health, trauma, dissociation, absorption, and fantasy proneness among Danish spiritual practitioners.

Groups of spiritual practitioners (P) (n = 38), long-term residents in a center offering spiritual courses (R) (n = 8), and matched control groups from a general, population sample for P (CP) (n = 45) and for R (CR) (n = 14) were compared. P had high levels of education and tended to be in a committed relationship and belong to the Danish National Church, whereas R had a lower level of education and were unlikely to be in a committed relationship or belong to the Church, suggesting social marginality. All groups completed the Brief Symptom Inventory-53 (BSI-53), a measure of psychological distress. P did not differ from the control groups in the Global Severity scale (GSI) or the other subscales of the BSI-53 except for scoring lower on the phobic anxiety subscale. In contrast, R scored higher in the GSI and most BSI-53 subscales than P and the control groups, and published norms for Danish and US populations. P and R did not differ in the subscales of somatization or interpersonal sensitivity. These two groups also filled out measures of dissociation, general and severe trauma, absorption, and fantasy proneness. R scored higher than P in dissociation, severe trauma, and absorption. The GSI correlated with dissociation, a history of serious trauma and (weakly) with absorption, but not with general trauma or fantasy-proneness. Overall, the results do not support the view that most spiritual practitioners have higher psychological distress or are socially marginal, although there is a subset of more troubled individuals.

Cardeña, E., Reijman, S., Wimmelmann, C.L. & Jensen, C.G. (2015). Psychological health, trauma, dissociation, absorption, and fantasy proneness among Danish spiritual practitioners. Psychology of Consciousness: Theory, Research, and Practice, Vol 2(2), Jun 2015, 170-184. Online [retrieved 8/2/2015]: http://psycnet.apa.org/psycinfo/2015-12653-001/

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Childhood Adversity Narratives

Putnam, F., Harris, W., Lieberman, A., Putnam, K. & Amaya-Jackson, L. (2015). Childhood Adversity Narratives. Online [retrieved May.3.2015]:  http://www.canarratives.org/s/CAN_Narrative_4-26-15-v2L4.pptx

Frank Putnam MD and colleagues created one of the most powerful presentations on adverse childhood experiences and their effects in the hope that it will be widely disseminated and used to educate the public as well as researchers and clinicians about the prevalence, impact, treatment, and prevention of child abuse and neglect.  

The authors encourage everyone to use and share it. The slides are available on the website http://www.canarratives.org/

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Report questioning shaken baby syndrome seriously unbalanced

Dubowitz, H. & Alden, E.R. (2015). Report questioning shaken baby syndrome seriously unbalanced. AAP NEWS, 36(5):1. Online [retrieved May.3.2015]: http://aapnews.aappublications.org/content/36/5/1.2.full

Abstract

For a long time, child abuse stories made for important news. Now, suggesting that parents have been falsely accused makes for a far more compelling story, as is the case of a recently published article in the Washington Post, www.washingtonpost.com/graphics/investigations/shaken-baby-syndrome.

But like the back-and-forth over childhood immunizations, this is a false debate. The truth is that child abuse, including abusive head trauma, is a real problem that terribly injures and sometimes kills children. The Post’s report on the “disputed diagnosis” of shaken baby syndrome is disturbing. Indeed, the science has been shaken — but only by the media and a small number of physicians.

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Adverse Childhood Experiences: Informing Best Practices

Corwin, D.L., Alexander, R., Bair-Merritt, M. Block, R., Davis, M., James, L., Keeshin, B., Ismailji, T., Lewis-O’Connor, A. & Schneider, D. (2015). Adverse Childhood Experiences: Informing Best Practices. Online Collaborative Living Document - Online Collaborative Living Document Version 1.0 – 3/14/15. Online [retrieved May.3.2015]: http://www.avahealth.org/aces_best_practices/appendix.html

Abstract

This document is the product of an ongoing collaboration between the Academy on Violence and Abuse (AVA) and the National Health Collaborative on Violence and Abuse (NHCVA). It is intended to assist healthcare professionals and others who wish to integrate knowledge of adverse childhood experiences into patient care and other activities (e.g., education, human services, and justice).

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Epigenetics of Inflammation, Maternal Infection, and Nutrition

Claycombe, K.J., Brissette, C.A. & Ghribi, O. (2015). Epigenetics of Inflammation, Maternal Infection, and Nutrition. The Journal of Nutrition, 145(5). Online [retrieved May.3.2015]: http://jn.nutrition.org/content/early/2015/04/01/jn.114.194639.abstract

Abstract

Studies have demonstrated that epigenetic changes such as DNA methylation, histone modification, and chromatin remodeling are linked to an increased inflammatory response as well as increased risk of chronic disease development. A few studies have begun to investigate whether dietary nutrients play a beneficial role by modifying or reversing epigenetically induced inflammation. Results of these studies show that nutrients modify epigenetic pathways. However, little is known about how nutrients modulate inflammation by regulating immune cell function and/or immune cell differentiation via epigenetic pathways. This overview will provide information about the current understanding of the role of nutrients in the epigenetic control mechanisms of immune function.

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Inflammation and neuronal plasticity: a link between childhood trauma and depression pathogenesis

Cattaneo, A., Macchi, F., Plazzotta, G., Veronica, B., Bocchio-Chiavetto, L., Riva, M.A. & Pariante, C.M. (2015). Inflammation and neuronal plasticity: a link between childhood trauma and depression pathogenesis. Frontiers in Cellular Neuroscience, 9(40). Online [retrieved May.3.2015]: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4379909/

Abstract

During the past two decades, there has been increasing interest in understanding and characterizing the role of inflammation in major depressive disorder (MDD). Indeed, several are the evidences linking alterations in the inflammatory system to Major Depression, including the presence of elevated levels of pro-inflammatory cytokines, together with other mediators of inflammation. However, it is still not clear whether inflammation represents a cause or whether other factors related to depression result in these immunological effects. Regardless, exposure to early life stressful events, which represent a vulnerability factor for the development of psychiatric disorders, act through the modulation of inflammatory responses, but also of neuroplastic mechanisms over the entire life span. Indeed, early life stressful events can cause, possibly through epigenetic changes that persist over time, up to adulthood. Such alterations may concur to increase the vulnerability to develop psychopathologies. In this review we will discuss the role of inflammation and neuronal plasticity as relevant processes underlying depression development. Moreover, we will discuss the role of epigenetics in inducing alterations in inflammation-immune systems as well as dysfunction in neuronal plasticity, thus contributing to the long-lasting negative effects of stressful life events early in life and the consequent enhanced risk for depression. Finally we will provide an overview on the potential role of inflammatory system to aid diagnosis, predict treatment response, enhance treatment matching, and prevent the onset or relapse of Major Depression.

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Alterations of Mitochondrial DNA Copy Number and Telomere Length with Early Adversity and Psychopathology

Tyrka, A.R., Parade, S.H., Price, L.H., Kao, H.-T., Porton, B., Philip, N.S., Welch, E.S. & Carpenter, L.L. (2015). Alterations of Mitochondrial DNA Copy Number and Telomere Length with Early Adversity and Psychopathology. Biological Psychiatry [Epub ahead of print]. Online [retrieved May.3.2015]: http://www.ncbi.nlm.nih.gov/pubmed/25749099

Abstract

Background

Telomere shortening and alterations of mitochondrial biogenesis are involved in cellular aging. Childhood adversity is associated with telomere shortening, and several investigations have shown short telomeres in psychiatric disorders. Recent studies have examined whether mitochondria might be involved in neuropsychiatric conditions; findings are limited and no prior work has examined this in relation to stress exposure.

Methods

Two-hundred ninety healthy adults provided information on childhood parental loss and maltreatment and completed diagnostic interviews. Participants were categorized into four groups based upon the presence or absence of childhood adversity and the presence or absence of lifetime psychopathology (depressive, anxiety, and substance use disorders). Telomere length and mitochondrial DNA (mtDNA) copy number were measured from leukocyte DNA by quantitative polymerase chain reaction.

Results

Childhood adversity and lifetime psychopathology were each associated with shorter telomeres (p < .01) and higher mtDNA copy numbers (p < .001). Significantly higher mtDNA copy numbers and shorter telomeres were seen in individuals with major depression, depressive disorders, and anxiety disorders, as well as those with parental loss and childhood maltreatment. A history of substance disorders was also associated with significantly higher mtDNA copy numbers.

Conclusions

This study provides the first evidence of an alteration of mitochondrial biogenesis with early life stress and with anxiety and substance use disorders. We replicate prior work on telomere length and psychopathology and show that this effect is not secondary to medication use or comorbid medical illness. Finally, we show that early life stress and psychopathology are each associated with these markers of cellular aging.

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The ‘Maltreatment and Abuse Chronology of Exposure’ (MACE) Scale for the Retrospective Assessment of Abuse and Neglect During Development

Teicher M.H. & Parigger A. (2015). The ‘Maltreatment and Abuse Chronology of Exposure’ (MACE) Scale for the Retrospective Assessment of Abuse and Neglect During Development. PLoS ONE 10(2): e0117423. doi:10.1371/journal.pone.0117423. Online [retrieved May.3.2015]: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0117423

Abstract

There is increasing interest in childhood maltreatment as a potent stimulus that may alter trajectories of brain development, induce epigenetic modifications and enhance risk for medical and psychiatric disorders. Although a number of useful scales exist for retrospective assessment of abuse and neglect they have significant limitations. Moreover, they fail to provide detailed information on timing of exposure, which is critical for delineation of sensitive periods. The Maltreatment and Abuse Chronology of Exposure (MACE) scale was developed in a sample of 1051 participants using item response theory to gauge severity of exposure to ten types of maltreatment (emotional neglect, non-verbal emotional abuse, parental physical maltreatment, parental verbal abuse, peer emotional abuse, peer physical bullying, physical neglect, sexual abuse, witnessing interparental violence and witnessing violence to siblings) during each year of childhood. Items included in the subscales had acceptable psychometric properties based on infit and outfit mean square statistics, and each subscale passed Andersen’s Likelihood ratio test. The MACE provides an overall severity score and multiplicity score (number of types of maltreatment experienced) with excellent test-retest reliability. Each type of maltreatment showed good reliability as did severity of exposure across each year of childhood. MACE Severity correlated 0.738 with Childhood Trauma Questionnaire (CTQ) score and MACE Multiplicity correlated 0.698 with the Adverse Childhood Experiences scale (ACE). However, MACE accounted for 2.00- and 2.07-fold more of the variance, on average, in psychiatric symptom ratings than CTQ or ACE, respectively, based on variance decomposition. Different types of maltreatment had distinct and often unique developmental patterns. The 52-item MACE, a simpler Maltreatment Abuse and Exposure Scale (MAES) that only assesses overall exposure and the original test instrument (MACE-X) with several additional items plus spreadsheets and R code for scoring are provided to facilitate use and to spur further development.

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Perceptions of clinicians treating young people with first-episode psychosis for post-traumatic stress disorder

Gairns, S., Alvarez-Jimenez, M., Hulbert, C., McGorry, P. & Bendall, S. (2015). Perceptions of clinicians treating young people with first-episode psychosis for post-traumatic stress disorder. Early Intervention in Psychiatry, 9(1): 12–20. Online [retrieved May.3.2015]: http://onlinelibrary.wiley.com/doi/10.1111/eip.12065/full

Abstract

Aim

Evidence shows that approximately half of young people with first-episode psychosis have post-traumatic stress disorder. Yet, post-traumatic stress disorder is often left untreated in the presence of psychosis. To support the development of a post-traumatic stress disorder intervention for young people with first-episode psychosis, clinicians' perceptions of trauma-focused interventions were sought. Two research questions were explored: What treatment barriers were associated with treating young people with first-episode psychosis? What supports would be useful to implement post-traumatic stress disorder intervention?

Methods

A mixed-methods design incorporated quantitative and qualitative data from a questionnaire with qualitative data from two focus groups. Sixteen (of 20) case managers from an early psychosis intervention centre participated in the study (16 completed a questionnaire, eight participated in focus groups). Descriptive statistics were generated for quantitative data and qualitative material was examined using a grounded theory approach.

Results

The results showed that perceived barriers to delivering trauma-focused intervention were increased mental health risks for clients with psychosis, workload pressures and poor client engagement. Targeted training and formal professional guidance were thought to best scaffold an intervention.

Conclusions

Post-traumatic stress disorder intervention for first-episode psychosis clients should address engagement, make safeguarded provisions for family involvement and be sufficiently paced and flexible. Trauma-focused intervention is perceived with a degree of caution, is often not prioritized, lacks institutional support and requires more targeted training. It is important to conduct further research regarding the safety of trauma interventions alongside psychosis in order to address widespread concerns.

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Behind the closed doors of mentalizing. A commentary on “Another step closer to measuring the ghosts in the nursery: preliminary validation of the Trauma Reflective Functioning Scale”

Schimmenti, A. (2015). Behind the closed doors of mentalizing. A commentary on “Another step closer to measuring the ghosts in the nursery: preliminary validation of the Trauma Reflective Functioning Scale”. Frontiers in Psychology, 6: 380. Online [retrieved May.3.2015]: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4381487/

In his Clinical Diary, Ferenczi (1932/1988) suggested that an organizing life instinct allows the individual to survive child abuse. He called this instinct Orpha, and described it as a guardian angel who anesthetizes “the consciousness and sensitivity against sensations as they become unbearable” (p. 9). Ferenczi argued that a fragmentation however occurs in personality as a consequence of the abuse: the personality is split into a “capable part” as a “regulated mechanism” dealing with daily life and activities, secret parts that struggle in despair because they experience “the fire of suffering,” and another part containing “this suffering itself as a separate mass of affect, without contents and unconscious, the remains of the actual person” (p. 10).

Ferenczi's concept of Orpha tends to correspond to our current understanding of dissociation. In fact, child abuse and neglect (CA&N) in the context of attachment relationship can generate a severe impairment in the individual's ability to integrate mental states and their related affective contents into a consistent structure of meaning (Allen, 2013). The psychological cost of dissociation is high: dissociation may involve either a loss of continuity in subjective experience, and/or an inability to access information or control mental functions, and/or a sense of experiential disconnectedness (Cardeña and Carlson, 2011). How do these considerations relate to the “ghosts in the nursery” (Fraiberg et al., 1975), the haunting internal presences that lead parents to re-enact their own traumatic past by victimizing their child?

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Trauma changes everything: Examining the relationship between adverse childhood experiences and serious, violent and chronic juvenile offenders

Hahn Fox, B., Perez, N., Cass, E., Baglivio, M.T. & Epps, N. (2015). Trauma changes everything: Examining the relationship between adverse childhood experiences and serious, violent and chronic juvenile offenders. Child Abuse & Neglect [Epub ahead of print]. Online [retrieved May.3.2015]: http://www.ncbi.nlm.nih.gov/pubmed/25703485

Abstract

Among juvenile offenders, those who commit the greatest number and the most violent offenses are referred to as serious, violent, and chronic (SVC) offenders. However, current practices typically identify SVC offenders only after they have committed their prolific and costly offenses. While several studies have examined risk factors of SVCs, no screening tool has been developed to identify children at risk of SVC offending. This study aims to examine how effective the adverse childhood experiences index, a childhood trauma-based screening tool developed in the medical field, is at identifying children at higher risk of SVC offending. Data on the history of childhood trauma, abuse, neglect, criminal behavior, and other criminological risk factors for offending among 22,575 delinquent youth referred to the Florida Department of Juvenile Justice are analyzed, with results suggesting that each additional adverse experience a child experiences increases the risk of becoming a serious, violent, and chronic juvenile offender by 35, when controlling for other risk factors for criminal behavior. These findings suggest that the ACE score could be used by practitioners as a first-line screening tool to identify children at risk of SVC offending before significant downstream wreckage occurs.

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Childhood trauma and eating psychopathology: A mediating role for dissociation and emotion dysregulation?

Moulton, S.J., Newman, E., Power, K., Swanson, V. & Day, K. (2015). Childhood trauma and eating psychopathology: A mediating role for dissociation and emotion dysregulation? Child Abuse & Neglect, 39, pp. 167–174. Online [retrieved May.3.2015]: http://www.ncbi.nlm.nih.gov/pubmed/25124050

Abstract

The present study examined the relationship between different forms of childhood trauma and eating psychopathology using a multiple mediation model that included emotion dysregulation and dissociation as hypothesised mediators. 142 female undergraduate psychology students studying at two British Universities participated in this cross-sectional study. Participants completed measures of childhood trauma (emotional abuse, physical abuse, sexual abuse, emotional neglect and physical neglect), eating psychopathology, dissociation and emotion dysregulation. Multiple mediation analysis was conducted to investigate the study's proposed model. Results revealed that the multiple mediation model significantly predicted eating psychopathology. Additionally, both emotion dysregulation and dissociation were found to be significant mediators between childhood trauma and eating psychopathology. A specific indirect effect was observed between childhood emotional abuse and eating psychopathology through emotion dysregulation. Findings support previous research linking childhood trauma to eating psychopathology. They indicate that multiple forms of childhood trauma should be assessed for individuals with eating disorders. The possible maintaining role of emotion regulation processes should also be considered in the treatment of eating disorders.

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Trauma-focused therapy for refugees: Meta-analytic findings

Lambert, J.E. & Alhassoon, O.M. (2015). Trauma-focused therapy for refugees: Meta-analytic findings. Journal of Counseling Psychology, 62(1): 28-37. Online [retrieved May.3.2015]: http://psycnet.apa.org/journals/cou/62/1/28/

High levels of trauma-related psychological distress have been documented among ethnically diverse refugees. As the number of refugees worldwide continues to grow, determining the efficacy of established methods of trauma-focused therapy for this population is crucial. This meta-analysis examined the results of randomized controlled trials of psychotherapeutic intervention for traumatized adult refugees. Comparisons of 13 trauma-focused therapies to control groups from 12 studies were included in the analysis. The aggregate effect size for the primary outcome, posttraumatic stress disorder (PTSD), was large in magnitude, Hedge’s g = .91, p < .001, 95% CI [.56, 1.52]. The aggregate effect size for depression, assessed in 9 studies, was also large g = .63, p < .001, 95% CI [.35, .92]. We used metaregression to evaluate potential moderators of the PTSD effect size. Number of sessions significantly predicted magnitude of the effect size, and studies that utilized an active control group (e.g., supportive counseling) had significantly smaller effect size than those with a passive control group. There was no difference in outcome for studies where an interpreter was used to facilitate sessions and those where no interpreter was used. There also was no difference in outcome based on type of PTSD assessment. Results provide evidence in the efficacy of trauma-focused models for treating refugees, and also shed light on important areas for future research. (PsycINFO Database Record (c) 2015 APA, all rights reserved)

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Oxytocin receptor and vasopressin receptor 1a genes are respectively associated with emotional and cognitive empathy

Uzefovsky, F., Shalev, I., Israel, S., Edelman, S., Raz, Y., Mankuta, D. Knafo-Noam, A. & Ebstein, R.P. (2015). Oxytocin receptor and vasopressin receptor 1a genes are respectively associated with emotional and cognitive empathy. Hormones and Behavior 67, pp. 60–65. Online [retrieved May.3.2015]: http://www.ncbi.nlm.nih.gov/pubmed/25476609

Abstract

Empathy is the ability to recognize and share in the emotions of others. It can be considered a multifaceted concept with cognitive and emotional aspects. Little is known regarding the underlying neurochemistry of empathy and in the current study we used a neurogenetic approach to explore possible brain neurotransmitter pathways contributing to cognitive and emotional empathy. Both the oxytocin receptor (OXTR) and the arginine vasopressin receptor 1a (AVPR1a) genes contribute to social cognition in both animals and humans and hence are prominent candidates for contributing to empathy. The following research examined the associations between polymorphisms in these two genes and individual differences in emotional and cognitive empathy in a sample of 367 young adults. Intriguingly, we found that emotional empathy was associated solely with OXTR, whereas cognitive empathy was associated solely with AVPR1a. Moreover, no interaction was observed between the two genes and measures of empathy. The current findings contribute to our understanding of the distinct neurogenetic pathways involved in cognitive and emotional empathy and underscore the pervasive role of both oxytocin and vasopressin in modulating human emotions.

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Couple Therapy with Adult Survivors of Child Abuse: Gender, Power, and Trust

Wells, M.A. & Kuhn, V.P. (2015). Couple Therapy with Adult Survivors of Child Abuse: Gender, Power, and Trust. Socio-Emotional Relationship Therapy AFTA SpringerBriefs in Family Therapy pp 107-119. Online [retrieved May.3.2015]: http://link.springer.com/chapter/10.1007%2F978-3-319-13398-0_9

Abstract

Many couples in therapy have a history of childhood abuse. Sensitivity to power and difficulty with trusting one’s intimate partner are key concerns for these couples. This chapter presents the relational trust theory, which describes how gendered power imbalances in couple interactions can trigger distrustful emotional power responses from the adult-survivor partner(s). Drawing upon Socio-Emotional Relationship Therapy (SERT) approaches, the clinical processes described attend to gender, power, and emotions in couple interactions in order to help partners disentangle these dual influences of power and move from defensiveness with each other toward a more trusting position. Case examples show the problems generated by the intermingling of gendered power dynamics and adult-survivor  partner. As partners become better able to engage in processes of mutuality, distrustful adult-survivor power responses typically recede as a result of the adult survivor’s perception of the partner as trustworthy, thereby enhancing relational trust and couple intimacy.

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Epigenetic modification of the oxytocin receptor gene influences the perception of anger and fear in the human brain

Puglia, M.H., Lillard, T.S., Morris, J.P. & Connelly, J.J. (2015). Epigenetic modification of the oxytocin receptor gene influences the perception of anger and fear in the human brain. PNAS 112(11): 3308-3313. Online [retrieved May.3.2015]: http://www.pnas.org/content/112/11/3308.short

Abstract

In humans, the neuropeptide oxytocin plays a critical role in social and emotional behavior. The actions of this molecule are dependent on a protein that acts as its receptor, which is encoded by the oxytocin receptor gene (OXTR). DNA methylation of OXTR, an epigenetic modification, directly influences gene transcription and is variable in humans. However, the impact of this variability on specific social behaviors is unknown. We hypothesized that variability in OXTR methylation impacts social perceptual processes often linked with oxytocin, such as perception of facial emotions. Using an imaging epigenetic approach, we established a relationship between OXTR methylation and neural activity in response to emotional face processing. Specifically, high levels of OXTR methylation were associated with greater amounts of activity in regions associated with face and emotion processing including amygdala, fusiform, and insula. Importantly, we found that these higher levels of OXTR methylation were also associated with decreased functional coupling of amygdala with regions involved in affect appraisal and emotion regulation. These data indicate that the human endogenous oxytocin system is involved in attenuation of the fear response, corroborating research implicating intranasal oxytocin in the same processes. Our findings highlight the importance of including epigenetic mechanisms in the description of the endogenous oxytocin system and further support a central role for oxytocin in social cognition. This approach linking epigenetic variability with neural endophenotypes may broadly explain individual differences in phenotype including susceptibility or resilience to disease.

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Secure-Base Caregiving and Adult Attachment: Development Within the Client-Psychotherapist Relationship

Weeks, D.A. (2015). Secure-Base Caregiving and Adult Attachment: Development Within the Client-Psychotherapist Relationship. Dissertation, Walden University. Online [retrieved May.3.2015]: http://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=1334&context=dissertations

Abstract

Recent studies have shown significant improvements in the attachment security of adult therapy clients during therapy, supporting Bowlby’s theory that such improvement can be influenced by secure-base caregiving provided by mentors such as therapists. However, because these studies did not measure the secure-base variable, its relationship to client attachment development remains unknown. The present study is the first to evaluate that relationship by measuring clients’ pre and posttherapy attachment security using the Relationship Scales Questionnaire and therapists’ secure-base caregiving using the Client Attachment to Therapist and Working Alliance Inventory, Short Form. Of 21 initially insecure client participants, 17 experienced high levels of secure-base caregiving from their therapists (the SBC-High group) while 4 experienced low levels (the SBC-Low group). Comparison of pre and posttherapy group mean attachment scores, using the Wilcoxon Signed Ranks Test, found a statistically significant improvement (a = .01) in attachment security for the SBC-High group with no statistical change in attachment security for the SBC-Low group. These findings suggest that therapists and other mentors can positively influence the attachment development of their insecure mentees. Purposeful incorporation of this knowledge into the design and goals of existing graduate and professional mentoring programs can positively influence regenerative social change by promoting the attachment security of approximately one third of mentees expected to be insecurely attached, based on demographic studies. Improving their attachments can equip them to positively influence the attachments of all their future insecure clients who, like them, might then realize the multiple benefits associated with attachment security.