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June 2019 - Volume 207 - Issue 6

  • John A. Talbott, MD
  • 0022-3018
  • 1539-736X
  • 12 issues / year
  • Psychiatry 89/142; Clinical Neurology 134/197
  • 1.940


Incongruence Between Implicit Attachment Schemes and Unconscious Attachment Representations
Katja Petrowski, PhD, Susan Schurig, Helmut Kirchmann, PhD, Sashi Singh

The Adult Attachment Interview and the Implicit Association Test were implemented with a group of patients with panic disorder (n = 157, mean age = 29, SD = 2.47) and a group of healthy individuals (n = 138). The securely attached individuals showed significantly more positive attitudes toward their mother than the insecurely attached individuals. In the healthy individuals, the secure and disorganized classifications showed significantly more positive attitudes toward the mother in comparison with the insecure attachment classification, as well as the patient group. In summary, implicit attachment patterns based on reaction times are not equivalent to an attachment representation based on language markers. For the disorganized attachment representation, no differences were present between the information processing of the memory/association network and the autobiographic memory function.

An Examination of the Association Between Emotion Reactivity and Distress Tolerance Among College Students
Kaitlyn M. Bruns, BA, Emily M. O'Bryan, MA, Alison C. McLeish, PhD

Participants were 113 undergraduates who completed a battery of self-report measures. As hypothesized, the results indicate that, after controlling for sex and negative affectivity, greater levels of emotion reactivity were significantly associated with lower levels of global distress tolerance (12.5% unique variance) and the four specific distress tolerance domains: tolerance (8.6% unique variance), absorption (11.4% unique variance), appraisal (8% unique variance), and regulation (8.1% unique variance). These findings suggest that individuals who tend to react more strongly to their emotions have greater difficulty tolerating emotional distress, and interventions that target emotion reactivity may be an effective way to improve distress tolerance and reduce the risk of developing psychopathology among undergraduates.

Addressing Loneliness in Complex PTSD
Yael Dagan, MD and Joel Yager, MD

Loneliness impacts both physical and psychological health and is associated with increases of all-cause mortality and suicidal behavior. To date, loneliness has not been widely studied in relation to complex posttraumatic stress disorder (PTSD), which is newly delineated in the International Classification of Diseases, characterized by PTSD symptoms in the context of significant early trauma, as well as "disturbances in self-organization" marked by affective dysregulation, negative self-concept, and disturbances in relationships. In this article, illustrating with case material, we suggest that loneliness plays a major role in the development of complex PTSD and in the preservation of its symptoms.

Evaluating the Indirect Effects of Trait Mindfulness Facets on State Tripartite Components Through State Rumination and State Experiential Avoidance
E. Marie Parsons, MA, Sarah E. Dreyer-Oren, BA, Joshua C. Magee, PhD, Elise M. Clerkin, PhD

The present study investigated whether specific trait mindfulness facets indirectly influenced state negative affect (NA), positive affect (PA), and physiological hyperarousal (PH) through state rumination and state experiential avoidance. Participants (n = 360, 68% female) rated trait mindfulness facets, then completed an interview task about life experiences intended to elicit state NA, PA, and PH. After the interview task, participants completed measures of state NA, PA, and PH, and state measures of rumination and experiential avoidance. Indirect effect results indicated that the relationships between Nonjudge, Nonreact, and Describe, and each of the state tripartite components indirectly flowed through state rumination. Further, there was a significant indirect effect of Nonjudge and Actaware on each of the three state tripartite components through experiential avoidance. Overall, strengthening the mindfulness skills of Nonjudge, Nonreact, Describe, and Actaware may have positive downstream effects via reducing reliance on maladaptive emotion regulation strategies, such as rumination or experiential avoidance.

Heart Rate Variability in Individual Psychotherapy: Associations With Alliance and Outcome
Paul Blanck, MS, Martin Stoffel, MS, Hinrich Bents, PhD, Beate Ditzen, PhD, Johannes Mander, PhD

Heart rate variability (HRV) can be conceptualized as a marker of an individual's capability to adaptively respond to its environment and has been linked with mental health. Although conceptually and empirically linked to social behavior and thus relevant in the therapeutic setting, HRV is seldom investigated directly within therapy sessions. In the present examination, we aimed at addressing this research gap by assessing patients' and therapists' HRVs both ambulatory within therapy sessions and under resting conditions. Drawing on polyvagal theory, we hypothesized that higher in-session HRV is accompanied with higher therapeutic alliance ratings. Further, we expected baseline HRV to predict symptomatic outcome and to increase over the course of therapy. In a sample of 53 outpatients receiving 25 sessions of cognitive behavioral therapy, we measured HRV, therapeutic alliance, and depressive symptoms on four occasions. Multilevel modeling analyses demonstrated that patients with higher in-session high-frequency HRV rated the therapeutic alliance higher. Baseline HRV predicted symptomatic outcome and increased over the course of therapy. Possible explanations involve a link between in-session HRV and in-session behavior and should be investigated in future studies. The results highlight the usefulness of in-session HRV as a promising process variable in psychotherapy research.

Acquired Hearing Loss, Anger, and Emotional Distress: The Mediating Role of Perceived Disability
Silvia Ferrari, MD, PhD, Daniele Monzani, MD, Chiara Gherpelli, Andrew MacKinnon, MD, Francesca Mongelli, MD, Gaia Federici, MD, Matilde Forghieri, MD, PhD, Gian Maria Galeazzi

The aim of the study was to test whether acquired hearing loss (AHL)-related perceived disability mediates the association between AHL and psychological outcomes, including anger. Two-hundred ninety-seven consecutive outpatients with AHL assessed by pure tone average (PTA) loss completed the following: Hearing Handicap Inventory for Adults (HHIA), State-Trait Anger Expression Inventory–2 (STAXI-2), Brief Symptom Inventory (BSI), Diagnostic Criteria for Use in Psychosomatic Research (DCPR), and Social Functioning Questionnaire. In the sample, composed of 44.5% males with a mean age of 53.8 and a mean PTA of 30.7, AHL was associated to perceived hearing handicap, also correlating to all psychological measures except DCPR demoralization. Associations were stronger between the HHIA–Emotional Subscale, STAXI-2 State Anger and Feeling Angry, and BSI-Somatization, Interpersonal Sensitivity, Depression, and Psychoticism. Perceived disability predicted the presence of almost all psychosocial outcomes and confirms to be the most significant target of clinical action.

WAIS-IV Performance in Patients With Schizophrenia
Inmaculada Fuentes-Durá, PhD, Juan Carlos Ruiz, PhD, Carmen Dasí, PhD, Marisa Navarro, MD, Pilar Blasco, PhD, Pilar Tomás, PhD

Wechsler Adult Intelligence Scale (WAIS) is one of the most widely used instruments to measure cognitive functioning. The aims of this study were 1) to obtain the cognitive profile of Spanish patients with schizophrenia on the WAIS-IV; 2) to compare their profile to the profile of a healthy control group; and 3) to compare the cognitive profile of patients with schizophrenia to the performance observed in two separate previous studies in Canada and China. A sample of 99 outpatients and 99 healthy control participants, matched on age, sex, and educational level, were measured using the WAIS-IV, including 10 core subtests, 4 indices, and 2 general intelligence scores to obtain their cognitive profile. Results showed that only the performance on the Verbal Comprehension Index and its subtests were similar in the patient and control groups.

Observation and Imitation of Social Emotions Are Essential for Improving Cognitive and Affective Theory of Mind in Schizophrenia
Pin-Yang Yeh, PhD, Lifa Yu, PhD, Nai-WenGuo, PhD, Wei-Che Lin, MD, PhD, Ching-KuanWu,MD

We examined the effect of observation and imitation on theory of mind (ToM) and whether computerized cognitive training (CCT) can improve ToM. Among 14 controlled trials, 264 of 494 people with schizophrenia received treatment. Observation and imitation of social emotions improved cognitive (g = 0.53; 95% confidence interval [CI], 0.29–0.76) and affective ToM (g = 0.54; 95% CI, 0.34–0.73), versus treatment as usual or cognitive rehabilitation alone. CCT did not significantly enhance affective ToM (p = 0.42); however, cognitive ToM improvements without CCT (g = 1.20; 95% CI, 0.78–1.61) were superior to those with CCT (g = 0.33; 95% CI, 0.02–0.64; p < 0.01). Observation and imitation of social emotions are essential for improving ToM in schizophrenia, but CCT may not improve ToM.

Effects of Mindfulness-Based Stress Reduction on Depression, Anxiety, and Pain in Patients With Postherpetic Neuralgia
Xingmin Zhu, BS, Ping Hu, BS, Zhengying Fan, MS, Wenxian Zhan, MS, Huijuan Wang, MS, Yang Yang, MS, Zubin Zhou, MS, Lan Ma, MS, Haiyan Gao, BS

The aim of this study was to explore the effects of mindfulness-based stress reduction (MBSR) on reducing the psychological and physical symptoms in patients with postherpetic neuralgia (PHN). A total of 50 patients with PHN from January 2017 to September 2018 were selected into the intervention group and the control group. Both groups received routine care, whereas the intervention group also was given an 8-week of MBSR. Psychological (depression and anxiety) and physical (pain) symptoms were assessed before and after the intervention. The study demonstrated evidence of MBSR effectiveness in reducing depression (p < 0.01), anxiety (p < 0.01), and pain (p < 0.01) scores after intervention for herpetic patients with neuralgia. MBSR can effectively alleviate depression, anxiety, and pain in patients with PHN. Our results provide clinical effectiveness evidence that MBSR works to improve the psychological and physical symptoms with the greatest improvement occurring during the 8-week program.

Facilitators and Barriers to Participating in a Randomized Controlled Trial of a Psychological Therapy for Substance Use
Ivan Shin Kai Thong, MSc, Fiona Ulph, PhD, Christine Barrowclough, PhD, Lynsey Gregg, PhD

Twenty-two cannabis users with schizophrenia spectrum disorders were recruited. They were involved in a randomized controlled trial exploring the effectiveness of motivational interviewing plus cognitive behavioral therapy. Semi structured interviews were conducted, and their responses were analyzed using thematic analysis. Thematic analysis identified facilitators such as therapeutic benefit, knowledge about medical conditions, awareness of own drug habits, helping others, confidentiality, rapport with researchers, desiring social contact, and views of significant others. Barriers identified were cognitive challenge, amount of assessments, duration, and discussions about the past. Based on these insights, we recommend informing participants about clinical equipoise, confidentiality, and demands of the study; minimizing demands on participants; acknowledging participants' efforts; involving potential participants' significant others during recruitment; advertising research as an opportunity to help; and training researchers in building rapport.

An Empirical Investigation of Alleged Mediumistic Writing: A Case Study of Chico Xavier's Letters
Denise Paraná, PhD, Alexandre Caroli Rocha, PhD, Elizabeth Schmitt Freire, PhD, Francisco Lotufo Neto, MD, PhD, Alexander Moreira-Almeida, MD, PhD

This study investigated a letter written by the influential Brazilian "medium" Chico Xavier, whose authorship was attributed to a deceased person. We identified the letter's pieces of information that were objectively verifiable, and we analyzed their accuracy based on documents and on interviews with the deceased's relatives, and the likelihood of Xavier's access to the information via ordinary means. All the 29 items of verifiable information conveyed on the letter were rated as "clear and precise fit." Fourteen

items (48.3%) conveyed information that was also very private. We concluded that ordinary explanations for accuracy of the information (i.e., fraud, chance, information leakage, and cold reading) were highly unlikely. We recommend further research on the phenomenon of mediumistic writing, particularly experimental controlled studies with exceptionally gifted mediums.

The Gray Degeneration of the Brain and Spinal Cord: A Story of the Once Favored Diagnosis With Subsequent Vessel-Based Etiopathological and Etiological Studies in Multiple Sclerosis
Aravind Ganesh, MD, DPhil (Oxon) and Frank W. Stahnisch, MD, MSc (Edin), PhD

In 1857, French-Austrian psychiatrist Bénédict Augustin More (1809–1873) published his infamous though highly successful Traité desdégénérescences physiques, intellectuelles et morales de l'espèce humaine, which was fully dedicated to the social problem of "degeneration" and its psychiatric and neurological underpinnings. European psychiatrists, neurologists, and pathologists integrated Morel's approach into their neuropsychiatric theories and searched for the somatic and morphological alterations in the human brain, as did the versatile pupil of Rudolph Virchow (1821–1902), Georg Eduard von Rindfleisch (18361908), in his Lehrbuch der pathologischen ewebelehre (1867). This can be seen as a starting point of research into the vascular genesis of "multiple sclerosis" by observing that the changes of blood vessels and nerve elements could be the result of inflammation and increased blood flow.

Religiosity and Severity of Symptoms in Croatian Patients With Major Depressive Disorder or Schizophrenia
Lana Kos, MD, Marina Šagud, MD, PhD, Alma Mihaljević-Peleš, MD, PhD, Mislav Kutleša, PhD, Tomislav Kovač, PhD, Vladimir Trkulja, MD, PhD

We examined and compared the relationship between religiosity and symptom severity in patients with major depressive disorder (MDD) rated by the Hamilton Depression Rating Scale and schizophrenia (rated by the Positive and Negative Syndrome Scale). The Duke University Religion Index, the Santa Clara Strength of Religious Faith (SCSORF) questionnaire, and the Brief Religious Coping scale scores were similar between patients with MDD (n = 50) and patients with schizophrenia (n = 50). In patients with MDD, higher organizational religious activity (ORA) (estimate = 2.28, 95% confidence interval [CI] = 0.37–4.19; p = 0.020) and higher negative religious coping (estimate = 0.43, 95% CI = 0.03–0.84; p = 0.037) were independently associated with more severe symptoms. In patients with schizophrenia, higher ORA was associated with lower negative symptoms (estimate = −1.99, 95% CI = −3.94 to −0.03; p = 0.046). Higher SCSORF was associated with lower ORA in both patient subsets, and thus indirectly with milder symptoms in patients with MDD and with more severe negative symptoms in patients with schizophrenia. The relationship between religiosity and symptom severity apparently differs in patients with MDD and those with schizophrenia.

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