Memory reconsolidation, emotional arousal, and the process of change in psychotherapy: New insights from brain science

Trauma narratives: recommendations for investigative interviewing

In the investigation of a criminal event, the police may encounter witnesses or victims experiencing symptoms of being traumatized (e.g. anxiety, intrusive thoughts or avoidance of trauma-related stimuli). This may pose a challenge in investigative interviews where police interviewers aim to obtain reliable and detailed accounts. Based on previous theory and research, this theoretical paper aims to outline recommendations for police interviewers for approaching traumatized adult witnesses to facilitate communication, attend to the well-being of the individual and reach investigative aims. First, factors considered important for preparing for the interview and building rapport are presented. Then, different aspects of how to facilitate the interviewee's account will be described with an emphasis on how police interviewers can approach emotional reactions to maintain rapport.

Emotional processing in attachment-based family therapy for suicidal adolescents

Objective: This study examined proposed sequential pathways through which suicidal adolescents are thought to shift from secondary global distress and rejecting anger to primary adaptive hurt, grief and assertive anger in the context of attachment-based family therapy (ABFT). Method: Participants were 39 suicidal adolescents who had received 16 weeks of ABFT as part of a randomized clinical trial, and who had been assigned to one of three outcome groups (i.e., good responders, slow responders and non-responders). Adolescents' in-session emotions were observationally coded using the Classification of Affective-Meaning States. Results: Across outcome groups, adolescents evidenced shifts from global distress to maladaptive shame, from maladaptive rejecting anger to adaptive assertive anger, and from adaptive assertive anger to adaptive grief/hurt. Adolescents who did not respond to treatment evidenced higher rates of maladaptive global distress. Conclusions: Findings are discussed in the context of ABFT and sequential emotional processing theories.

Digging Deeper: An Object Relations Couple Therapy Update

Over the past two decades, neurobiology research has added clarity to the process of emotional and behavioral change. In turn, this has led to endorsement of interventions that appear to be most helpful in individual and couple therapy. In addition to research on emotional dysregulation, contemporary studies have focused on the construction of meaning and its relevance to interpersonal relationships. According to Lisa Barrett, Richard Lane, and others, the brain references concepts to rapidly arrive at the most probable conclusions. Encoded experience and memory fragments guide this process and are vital in understanding partners' emotional responses. These findings support an object relations perspective that emphasizes the importance of past relational experiences that inform the present. This is particularly relevant in work with couples, as each individual's beliefs, expectations, and capacity for intimacy are invariably tied to earlier relationships. Research findings on memory reconstruction provide a basis for interventions that can add to the existing treatment approach, as it is suggested that working in a specific way with emotionally based memories has the potential to modify and reduce their predictive power and ability to unleash beliefs and behaviors that work against intimacy. The therapist who is informed by emerging neuroscience research can better uncover and actively work with memories that may be compromising a couple's relationship.

Long-term follow-up of psilocybin-assisted psychotherapy for psychiatric and existential distress in patients with life-threatening cancer

BACKGROUND

A recently published randomized controlled trial compared single-dose psilocybin with single-dose niacin in conjunction with psychotherapy in participants with cancer-related psychiatric distress. Results suggested that psilocybin-assisted psychotherapy facilitated improvements in psychiatric and existential distress, quality of life, and spiritual well-being up to seven weeks prior to the crossover. At the 6.5-month follow-up, after the crossover, 60-80% of participants continued to meet criteria for clinically significant antidepressant or anxiolytic responses.

METHODS

The present study is a long-term within-subjects follow-up analysis of self-reported symptomatology involving a subset of participants that completed the parent trial. All 16 participants who were still alive were contacted, and 15 participants agreed to participate at an average of 3.2 and 4.5 years following psilocybin administration.

RESULTS

Reductions in anxiety, depression, hopelessness, demoralization, and death anxiety were sustained at the first and second follow-ups. Within-group effect sizes were large. At the second (4.5 year) follow-up approximately 60-80% of participants met criteria for clinically significant antidepressant or anxiolytic responses. Participants overwhelmingly (71-100%) attributed positive life changes to the psilocybin-assisted therapy experience and rated it among the most personally meaningful and spiritually significant experiences of their lives.

CONCLUSION

These findings suggest that psilocybin-assisted psychotherapy holds promise in promoting long-term relief from cancer-related psychiatric distress. Limited conclusions, however, can be drawn regarding the efficacy of this therapy due to the crossover design of the parent study. Nonetheless, the present study adds to the emerging literature base suggesting that psilocybin-facilitated therapy may enhance the psychological, emotional, and spiritual well-being of patients with life-threatening cancer.

Multivoxel pattern analysis reveals dissociations between subjective fear and its physiological correlates

In studies of anxiety and other affective disorders, objectively measured physiological responses have commonly been used as a proxy for measuring subjective experiences associated with pathology. However, this commonly adopted "biosignal" approach has recently been called into question on the grounds that subjective experiences and objective physiological responses may dissociate. We performed machine-learning-based analyses on functional magnetic resonance imaging (fMRI) data to assess this issue in the case of fear. Although subjective fear and objective physiological responses were correlated in general, the respective whole-brain multivoxel decoders for the two measures were different. Some key brain regions such as the amygdala and insula appear to be primarily involved in the prediction of physiological reactivity, whereas some regions previously associated with metacognition and conscious perception, including some areas in the prefrontal cortex, appear to be primarily predictive of the subjective experience of fear. The present findings are in support of the recent call for caution in assuming a one-to-one mapping between subjective sufferings and their putative biosignals, despite the clear advantages in the latter's being objectively and continuously measurable in physiological terms.

The effects of imagery rescripting on memory outcomes in social anxiety disorder

Imagery rescripting (IR) is an effective intervention for social anxiety disorder (SAD) that targets negative autobiographical memories. IR has been theorized to work through various memory mechanisms, including modifying the content of negative memory representations, changing memory appraisals, and improving negative schema or core beliefs about self and others. However, no prior studies have investigated the unique effects of rescripting itself relative to other IR intervention components on these proposed mechanisms. In this preliminary study, 33 individuals with SAD were randomized to receive a single session of IR, imaginal exposure (IE), or supportive counselling (SC). Memory outcomes were assessed at 1- and 2-weeks post-intervention and at 3-months follow-up. Results demonstrated that the content of participants' autobiographical memory representations changed in distinct ways across the three conditions. Whereas IR facilitated increases only in positive/neutral memory details, IE facilitated increases in both positive/neutral and negative memory details and SC facilitated no changes in memory details. Although memory appraisals did not differ across conditions, participants who received IR were more likely to update their negative memory-derived core beliefs. These unique effects of rescripting on memory representations and core beliefs enhance our understanding of the memory-based mechanisms of IR within the context of exposure-based learning for people with SAD.

Document recommendation based on interests of co-authors for brain science

Personalized knowledge recommendation is an effective measure to provide individual information services in the field of brain science. It is essential that a complete understanding of authors' interests and accurate recommendation are carried out to achieve this goal. In this paper, a collaborative recommendation method based on co-authorship is proposed to make. In our approach, analysis of collaborators' interests and the calculation of collaborative value are used for recommendations. Finally, the experiments using real documents associated with brain science are given and provide supports for collaborative document recommendation in the field of brain science.

Delayed reconfiguration of a non-emotional task set through reactivation of an emotional task set in task switching: an ageing study

In our everyday life, we frequently switch between different tasks, a faculty that changes with age. However, it is still not understood how emotion impacts on age-related changes in task switching. Using faces with emotional and neutral expressions, Experiment 1 investigated younger (n = 29; 18-38 years old) and older adults' (n = 32; 61-80 years old) ability to switch between an emotional and a non-emotional task (i.e. responding to the face's expression vs. age). In Experiment 2, younger and older adults also viewed emotional and neutral faces, but switched between two non-emotional tasks (i.e. responding to the face's age vs. gender). Data from Experiment 1 demonstrated that switching from an emotional to a non-emotional task was slower when the expression of the new face was emotional rather than neutral. This impairment was observed in both age groups. In contrast, Experiment 2 revealed that neither younger nor older adults were affected by block-wise irrelevant emotion when switching between two non-emotional tasks. Overall, the findings suggest that task-irrelevant emotion can impair task switching through reactivation of the competing emotional task set. They also suggest that this effect and the ability to shield task-switching performance from block-wise irrelevant emotion are preserved in ageing.

Spatial distancing reduces emotional arousal to reactivated memories

Memories are able to update and adapt with new information about the world after they are reactivated. However, it is unknown whether the labile period following reactivation makes episodic memories more amenable to emotion regulation, an application that holds great clinical promise. Here, we investigated the efficacy of cognitive reappraisal to down regulate negative affect in response to reactivated memories. Healthy young adults (N = 119) rated the emotionality of negative pictures. After a partial reactivation of each picture 2 days later, participants voluntarily engaged in a spatial distancing regulation tactic by imagining the reactivated object extremely far away from them. Compared with no-regulation and no-reactivation controls, self-reported arousal for regulated pictures dropped significantly 2 days after the manipulation, despite no significant difference in memory accuracy or valence. These results open up a new line of work that capitalizes on reactivation-based lability to selectively alter enduring arousal responses to emotional memories.

Braving the Elements: Ambivalence as Opportunities for Change in Individual Psychotherapy With Men Using Intimate Partner Violence

This study examines client utterances that can be understood as ambivalent in violence-focused therapy. The purpose is to enrich our scientific understanding of client contributions to therapy when they appear ambivalent to the therapeutic project and develop clinically relevant perspectives that enable us to help this and other client groups. Using constructivist grounded theory analysis of five completed therapies, we describe three categories of client ambivalence present throughout all five therapies: I am bad, but I am not that bad; I have tried and tried in vain; and I know it is wrong, but I have to, I have no choice. The categories are described and understood from a clinical perspective. They are developed on the basis of an interpretation of what seems to be at stake for the client in the here-and-now of therapy. Clinical implications are discussed.

Facilitating the Expression of Emotions by Alleged Victims of Child Abuse During Investigative Interviews Using the Revised NICHD Protocol

Children's testimony is often critical to the initiation of legal proceedings in abuse cases. In forensic interviews, the expression of emotions can powerfully enhance both the quality of children's statements and perceptions that their statements are coherent and credible. However, children rarely express their emotions when reporting abusive events. The Revised The National Institute of Child Health and Human Development (NICHD) Protocol (RP) was designed to emphasize socioemotional communication during forensic interviews and thus should be associated with more extensive and diverse expressions of emotions by alleged victims of abuse. The present study focused on forensic interviews (178 using the Revised and 100 using the Standard NICHD Protocol) with victims of physical child abuse whose allegations were corroborated using independent evidence. Detailed content coding showed that the RP was associated with the expression of more different emotions, more expression of abuse-related emotions, and more expression of emotions related to the interview context. Emotional expressiveness was associated with increased informativeness, and the association between the type of protocol and informativeness was fully mediated by emotional expressiveness. These results suggest that the Revised Protocol facilitates the expression of emotions by alleged victims of abuse in a way that enhances the value of children's testimony in multiple ways.

Development of social learning and play in BaYaka hunter-gatherers of Congo

High-fidelity transmission of information through imitation and teaching has been proposed as necessary for cumulative cultural evolution. Yet, it is unclear when and for which knowledge domains children employ different social learning processes. This paper explores the development of social learning processes and play in BaYaka hunter-gatherer children by analysing video recordings and time budgets of children from early infancy to adolescence. From infancy to early childhood, hunter-gatherer children learn mainly by imitating and observing others’ activities. From early childhood, learning occurs mainly in playgroups and through practice. Throughout childhood boys engage in play more often than girls whereas girls start foraging wild plants from early childhood and spend more time in domestic activities and childcare. Sex differences in play reflect the emergence of sexual division of labour and the play-work transition occurring earlier for girls. Consistent with theoretical models, teaching occurs for skills/knowledge that cannot be transmitted with high fidelity through other social learning processes such as the acquisition of abstract information e.g. social norms. Whereas, observational and imitative learning occur for the transmission of visually transparent skills such as tool use, foraging, and cooking. These results suggest that coevolutionary relationships between human sociality, language and teaching have likely been fundamental in the emergence of human cumulative culture.

Agreement Between Prospective and Retrospective Measures of Childhood Maltreatment: A Systematic Review and Meta-analysis

IMPORTANCE

Childhood maltreatment is associated with mental illness. Researchers, clinicians, and public health professionals use prospective or retrospective measures interchangeably to assess childhood maltreatment, assuming that the 2 measures identify the same individuals. However, this assumption has not been comprehensively tested.

OBJECTIVE

To meta-analyze the agreement between prospective and retrospective measures of childhood maltreatment.

DATA SOURCES

MEDLINE, PsycINFO, Embase, and Sociological Abstracts were searched for peer-reviewed, English-language articles from inception through January 1, 2018. Search terms included child* maltreatment, child* abuse, child* neglect, child bull*, child* trauma, child* advers*, and early life stress combined with prospective* and cohort.

STUDY SELECTION

Studies with prospective measures of childhood maltreatment were first selected. Among the selected studies, those with corresponding retrospective measures of maltreatment were identified. Of 450 studies with prospective measures of childhood maltreatment, 16 had paired retrospective data to compute the Cohen κ coefficient.

DATA EXTRACTION AND SYNTHESIS

Multiple investigators independently extracted data according to PRISMA and MOOSE guidelines. Random-effects meta-analyses were used to pool the results and test predictors of heterogeneity.

MAIN OUTCOMES AND MEASURES

The primary outcome was the agreement between prospective and retrospective measures of childhood maltreatment, expressed as a κ coefficient. Moderators of agreement were selected a priori and included the measure used for prospective or retrospective assessment of childhood maltreatment, age at retrospective report, sample size, sex distribution, and study quality.

RESULTS

Sixteen unique studies including 25 471 unique participants (52.4% female [SD, 10.6%]; mean [SD] age, 30.6 [11.6] years) contained data on the agreement between prospective and retrospective measures of childhood maltreatment. The agreement between prospective and retrospective measures of childhood maltreatment was poor, with κ = 0.19 (95% CI, 0.14-0.24; P < .001). Agreement was higher when retrospective measures of childhood maltreatment were based on interviews rather than questionnaires (Q = 4.1521; df = 1; P = .04) and in studies with smaller samples (Q = 4.2251; df = 1; P = .04). Agreement was not affected by the type of prospective measure used, age at retrospective report, sex distribution of the sample, or study quality.

CONCLUSIONS AND RELEVANCE

Prospective and retrospective measures of childhood maltreatment identify different groups of individuals. Therefore, children identified prospectively as having experienced maltreatment may have different risk pathways to mental illness than adults retrospectively reporting childhood maltreatment. Researchers, clinicians, and public health care professionals should recognize these critical measurement differences when conducting research into childhood maltreatment and developing interventions.

Emotional Awareness and Expression Therapy for Chronic Pain: Rationale, Principles and Techniques, Evidence, and Critical Review

PURPOSE OF REVIEW

Patients with chronic pain, especially primary or centralized pain, have elevated rates of psychosocial trauma and intrapersonal or intrapsychic conflict. To address these risk factors and potentially reduce pain, the authors developed emotional awareness and expression therapy (EAET). This article presents the rationale for EAET, describes its principles and techniques, reviews its development and early testing as well as recent clinical trials, and critically analyzes the evidence base.

RECENT FINDINGS

Four initial trials (between 2006 and 2011) demonstrated the efficacy of earlier versions of EAET. Four recent randomized, controlled trials of different EAET durations (1 to 8 sessions) and formats (individual or group) in patients with fibromyalgia, irritable bowel syndrome, pelvic pain, or medically unexplained symptoms support the earlier findings. EAET reliably reduces pain and interference, although improvements in anxiety and depression are less reliably achieved and may be delayed. The largest and best conducted trial found superiority of EAET over cognitive-behavioral therapy for fibromyalgia. Patient retention in EAET is high, and adverse events are rare. EAET merits inclusion as a treatment option for primary pain conditions, and it may be the preferred treatment for some patients. Research is needed on EAET with other pain conditions and samples, using better controls and comparison conditions, and on additional ways to motivate and help patients engage in successful emotional processing.

Relevance of ERK1/2 Post-retrieval Participation on Memory Processes: Insights in Their Particular Role on Reconsolidation and Persistence of Memories

Back in 1968, Misanin and his group posited that reactivation of consolidated memories could support changes in that trace, similar to what might happen during the consolidation process. Not until 2000, when Nader et al. (2000) studied the behavioral effect of a protein synthesis inhibitor on retrieved memories, could this previous statement be taken under consideration once again; suggesting that consolidated memories can become labile after reactivation. The process of strengthening after memory labilization was named memory reconsolidation. In recent years, many studies pointed towards a critical participation of the extracellular signal-regulated kinase (ERK)/mitogen activated protein kinases (MAPKs) pathway in different memory processes (e.g., consolidation, extinction, reconsolidation, among others). In this review article, we will focus on how this system might be modulating the processes triggered after retrieval of well-consolidated memories in mice.

Reconceptualising Exposure and Some Implications for Cognitive-Behavioural and Psychodynamic Practice

The concept of exposure is ubiquitous in the research and practice of clinical psychology, most notably in cognitive-behavioural models. Yet there remains confusion and ambiguity around how exposure in ‘exposure therapy’ is characterised. Current definitions are found to be inadequate, as each identifies certain features of the exposure process but omits others. As such, an elaborated model of exposure is presented, referred to here as the re-exposure-extinction learning process. This process involves a complex causal situation consisting of clinical features (the cause/causes, C), acting upon a person (the field, F), to bring about re-exposure to anxiety-provoking stimuli and then extinction learning, leading, over time, to therapeutic change (the effect/effects, E). Importantly, re-exposure and extinction learning are two processes distinct from the therapeutic procedures (i.e., techniques and methods) used to bring them about. Furthermore, these processes are not inherently tied to a particular model of therapy or clinical intervention. They are, therefore, logically independent of the procedures used to facilitate them. Considering this reconceptualisation, we propose that working in the transference, a cornerstone of psychodynamic psychotherapy, can be understood as a complementary and effective method of facilitating the re-exposure-extinction learning process. We argue that this is achieved through enabling a person to repeatedly re-evaluate their fearful expectations as they manifest in the unfolding dynamics of the therapeutic relationship. Finally, some clinical implications indicated by this elaborated model are explored.

In-session emotional expression predicts symptomatic and panic-specific reflective functioning improvements in panic-focused psychodynamic psychotherapy

In panic-focused psychodynamic psychotherapy (PFPP), exploration and interpretation of avoided and conflicted emotions and fantasies surrounding anxiety are thought to promote panic-specific reflective functioning (PSRF), which drives panic disorder improvements. Patient emotional expression within a session may be a marker of engaged processing and experiencing of affectively charged material. Degree of in-session expressed emotion, indicating both verbal and nonverbal emotions, was examined across three early therapy sessions for prediction of subsequent outcomes. We further investigated whether personality disorder traits, theorized to relate to constricted (obsessive-compulsive) or heightened (borderline) emotions, moderated this relationship. Emotional expression in Sessions 2, 5, and 10 of a 24-session PFPP protocol was assessed by blinded observers in 44 patients randomized to PFPP in a two-site randomized controlled trial of psychotherapies for panic disorder. Robust regressions were conducted to examine the relationship between average emotional expression across the measured sessions and symptom and PSRF changes subsequent to the sampled sessions, as well as moderation by personality disorder criteria, controlling for early outcomes. Higher levels of emotional expression across the early sessions predicted greater subsequent symptom and PSRF improvement. Elevations in expression of grief/sadness drove the symptomatic finding. Patients meeting more borderline criteria experienced a smaller and potentially negative relationship between emotional expression and symptom improvement. Emotional expression in PFPP may be an indicator of positive therapy process for patients without comorbid borderline personality traits, predicting prospective improvements in both a key mediator (PSRF) and symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Trauma Stabilisation as a Sole Treatment Intervention for Post-Traumatic Stress Disorder in Southeast Asia

Southeast Asia contains high numbers of traumatised populations arising from either natural disasters or interpersonal violence. Consequently, the need for empirically based trauma treatments, compromised by insufficiency in appropriately trained clinicians and mental health workers, makes the situation more challenging in addressing traumatic sequelae in local populations. In response, the humanitarian/ trauma capacity building organisation, Trauma Aid Germany, trained 37 therapists in psycho-traumatology, based on EMDR Therapy, which included trauma stabilisation techniques. This research analyses the impact of Trauma Stabilisation as a sole treatment intervention for Post-Traumatic Stress Disorder (PTSD) in adults. Each client was screened for PTSD utilising the Harvard Trauma Questionnaire - pre- and post-treatment. Analysis of the data considered only those interventions focussed on trauma stabilisation, including psychoeducation. Participants receiving trauma confrontation interventions were excluded from the data. Trauma stabilisation - as a sole treatment intervention, was highly effective in alleviating PTSD diagnoses. Results demonstrate PTSD symptoms were reduced in both clinical and sub-clinical trauma groups. The data set suggests trauma stabilisation, as a sole treatment intervention, was safe, effective, efficient and sufficient treatment intervention for PTSD. Furthermore, trauma stabilisation interventions have the advantage of being safe, flexible, and adaptable to the cultural and spiritual context in which they were are applied. The research findings also have implications regarding teaching and learning and the potential utilisation of paraprofessionals, and other allied health professionals in addressing the global burden of psychological trauma.

NEVER forget: negative emotional valence enhances recapitulation

A hallmark feature of episodic memory is that of "mental time travel," whereby an individual feels they have returned to a prior moment in time. Cognitive and behavioral neuroscience methods have revealed a neurobiological counterpart: Successful retrieval often is associated with reactivation of a prior brain state. We review the emerging literature on memory reactivation and recapitulation, and we describe evidence for the effects of emotion on these processes. Based on this review, we propose a new model: Negative Emotional Valence Enhances Recapitulation (NEVER). This model diverges from existing models of emotional memory in three key ways. First, it underscores the effects of emotion during retrieval. Second, it stresses the importance of sensory processing to emotional memory. Third, it emphasizes how emotional valence - whether an event is negative or positive - affects the way that information is remembered. The model specifically proposes that, as compared to positive events, negative events both trigger increased encoding of sensory detail and elicit a closer resemblance between the sensory encoding signature and the sensory retrieval signature. The model also proposes that negative valence enhances the reactivation and storage of sensory details over offline periods, leading to a greater divergence between the sensory recapitulation of negative and positive memories over time. Importantly, the model proposes that these valence-based differences occur even when events are equated for arousal, thus rendering an exclusively arousal-based theory of emotional memory insufficient. We conclude by discussing implications of the model and suggesting directions for future research to test the tenets of the model.

Computational Models of Anxiety: Nascent Efforts and Future Directions

Computational approaches to understanding the algorithms of the mind are just beginning to pervade the field of clinical psychology. In the present article, we seek to explain in simple terms why this approach is indispensable to pursuing explanations of psychological phenomena broadly, and we review nascent efforts to use this lens to understand anxiety. We conclude with future directions that will be required to advance algorithmic accounts of anxiety. Ultimately, the surplus explanatory value of computational models of anxiety, above and beyond existing neurobiological models of anxiety, impugns the naively reductionist claim that neurobiological models are sufficient to explain anxiety.

How to measure sustained psychic transformations in long-term treatments of chronically depressed patients: Symptomatic and structural changes in the LAC Depression Study of the outcome of cognitive-behavioural and psychoanalytic long-term treatments

Worldwide, the pressure on psychoanalysis to prove the results of its treatments according to the criteria of so-called evidence-based medicine has increased. While a large number of studies on the results of psychoanalytic short-term therapies are now available, such studies are still largely lacking on psychoanalysis and psychoanalytic long-term therapies. In a large multicentre study, the results of psychoanalytical and cognitive-behavioural longterm therapies in chronically depressed patients were compared, Both psychotherapies led to statistically highly significant changes in depressive symptoms three years after the start of the treatments However, the focus of psychoanalytic treatments is not exclusively on reducing psychopathological symptoms, but on changes in the inner world of the patients that are reminiscent of the goal of psychoanalyses that Freud has characterized as developing "the ability to love, work and enjoy life." In the German-speaking community, such transformations are called "structural changes." This article reports results on such structural changes achieved with the help of a sophisticated measuring instrument, the Operationalized Psychodynamic Diagnostics (OPD). These so-called structural changes are compared with symptomatic changes. Three years after the start of the treatments, significantly more patients in psychoanalytical treatments show such structural changes than patients in cognitive-behavioural treatments.

Selective neural sensitivity to familial threat in adolescents with weak family bonds

Familial stressors, such as weak familial connectedness, are associated with the development of maladaptive threat processing, yet little is known regarding how weak familial bonds impinge on biological mechanisms of threat processing. The present study leveraged multivoxel pattern analysis of fMRI data to compare the neural encoding of familial and nonfamilial threatening and non-threatening stimuli in adolescents who endorsed varying levels of connectedness to their families. Adolescents (N = 22, Mage = 14.38 years) reporting lower family connectedness 1 year earlier showed elevated sensitivity to familial threat, but not to nonfamilial threat in a neural network associated with threat processing, comprising left and right amygdala, and right inferior and middle temporal gyri. Results suggest that a learning history about one's social environment may shape neural mechanisms of threat processing by sensitizing them to risk-relevant stimuli. Such findings advance our understanding of how familial stressors contribute to disordered threat processing in adolescence.

A Theory of Everything: Overlapping Neurobiological Mechanisms of Psychotherapies of Fear and Anxiety Related Disorders

Similarities within the phenomenology, neurobiology, psychotherapeutic, and pharmacological treatments of distinctly categorized anxiety and fear related disorders suggest the involvement of common neurobiological mechanisms in their formation. This theory of integration is the focus of the Research Domain Criteria (RDoC) approach initiated by the NIH. The current article explores potential facets of overlap among mainstream methods of psychotherapy for anxiety, fear, and trauma related disorders. These overlaps include associative learning of safety, cognitive reappraisal and emotion regulation, therapist as a social safety cue, and contextualization. Temporal contextualization and placing memories in their time and place will be suggested as a potentially important, and less explored aspect of psychotherapy.

Outcome of Psychoanalytic and Cognitive-Behavioural Long-Term Therapy with Chronically Depressed Patients: A Controlled Trial with Preferential and Randomized Allocation

OBJECTIVE

For chronic depression, the effectiveness of brief psychotherapy has been limited. This study is the first comparing the effectiveness of long-term cognitive-behavioural therapy (CBT) and long-term psychoanalytic therapy (PAT) of chronically depressed patients and the effects of preferential or randomized allocation.

METHODS

A total of 252 adults met the inclusion criteria (aged 21-60 years, major depression, dysthymia, double depression for at least 24 months, Quick Inventory of Depressive Symptoms [QIDS] >9, Beck Depression Inventory II [BDI] >17, informed consent, not meeting exclusion criteria). Main outcome measures were depression self-rating (BDI) and rating (clinician-rated QIDS [QIDS-C]) by independent, treatment-blinded clinicians. Full remission rates (BDI ≤12, QIDS-C ≤5) were calculated. An independent center for data management and biostatistics analyzed the treatment effects and differences using linear mixed models (multilevel models and hierarchical models).

RESULTS

The average BDI declined from 32.1 points by 12.1 points over the first year and 17.2 points over 3 years. BDI overall mean effect sizes increased from d = 1.17 after 1 year to d = 1.83 after 3 years. BDI remission rates increased from 34% after 1 year to 45% after 3 years. QIDS-C overall effect sizes increased from d = 1.56 to d = 2.08, and remission rates rose from 39% after 1 year to 61% after 3 years. We found no significant differences between PAT and CBT or between preferential and randomized allocation.

CONCLUSIONS

Psychoanalytic as well as cognitive-behavioural long-term treatments lead to significant and sustained improvements of depressive symptoms of chronically depressed patients exceeding effect sizes of other international outcome studies.

Unconscious Psychological Treatments for Physiological Survival Circuits

The idea of targeting unconscious or implicit processes in psychological treatments is not new, but until recently it has not been easy to manipulate these processes without also engaging consciousness. Here we review how this is possible, using various modern cognitive neuroscience methods including a technique known as Decoded Neural-Reinforcement. We discuss the general advantages of this approach, such as how it can facilitate double-blind placebo-controlled studies, and minimize premature patient dropouts in the treatment of fear. We also speculate how this may generalize to other similar physiological survival processes.

Avoidance Behavior Prevents Modification of Fear Memory During Reconsolidation

Several studies have revealed that fear recovery is prevented when extinction training is conducted after retrieval of a fear memory. Postretrieval extinction training is related to modification of memory during reconsolidation. Providing new information during reconsolidation can modify the original memory. We propose that avoidance behavior is a relevant factor that prevents subjects from obtaining new safety information during reconsolidation. Postretrieval extinction training without avoidance behavior reduced the fear response to conditioned stimulus and prevented spontaneous recovery in the current study, which corresponded with previous studies. Under the condition of postretrieval extinction training with avoidance behavior, the fear response was not reduced as much as it was in the condition without avoidance. It is possible that avoidance behavior prevents receiving new safety information during postretrieval extinction training.

Memory Control: A Fundamental Mechanism of Emotion Regulation

Memories play a ubiquitous role in our emotional lives, both causing vivid emotional experiences in their own right and imbuing perception of the external world with emotional significance. Controlling the emotional impact of memories therefore poses a major emotion-regulation challenge, suggesting that there might be a hitherto unexplored link between the neurocognitive mechanisms underlying memory control (MC) and emotion regulation. We present here a theoretical account of how the mechanisms of MC constitute core component processes of cognitive emotion regulation (CER), and how this observation may help to understand its basic mechanisms and their disruption in psychiatric disorders.

Arts-Based Research Approaches to Studying Mechanisms of Change in the Creative Arts Therapies

The purpose of this preliminary qualitative research study is to explore the role and function of multiple dynamic interactive aesthetic and intersubjective phenomena in the creative arts therapies process relative to transformation in perception, behavior, relationship, and well-being. A group of doctoral students and faculty studied these phenomena in an analogous creative arts therapies laboratory context using a method called Intrinsic Arts-Based Research. Intrinsic Arts-Based Research is a systematic study of psychological, emotional, relational, and arts-based phenomena, parallel to those emergent in the creative arts therapies, using individual and collective intrinsic immersive and reflective experience in combination with qualitative and arts-based research methods. Our primary goal was to simulate the creative arts therapies experience in order to identify, document, and describe the complex transformative phenomena that occur at the nexus of arts-based expression, reflection, and relationships in the arts therapies. For the purposes of this paper transformation is defined as “…. a significant reconfiguration of perception and thought resulting in the lessening of psychic restraint and pain, allowing for the emergence of new psychological perspectives that contribute to living a more creative life” (Gerber et al., 2012, p. 45). Through a deductive thematic analysis of written accounts of these simulated creative arts therapies experiences by participant/researchers in the laboratory we identified three primary dynamic and interactive broad constructs that together, with more specific modifying themes, might account for and describe change within the creative arts therapies. These broad dynamic interactive themes are: ruptures, resolutions, and transformation; relationship and intersubjectivity; and, arts-based expressive processes. The more specific modifying themes include: dialectical rupture and resolution, relational attunements and ruptures, imaginational flow, transcendence and ruptures, sensory/kinesthetic/embodied ways of knowing, and intersubjective transcendence. We propose that change in the creative arts therapies is driven more by a dynamic system of interactive phenomena the varying combinations of which create conditions for relational attunement, imagination, dialectical tensions and creative resolutions, and the ultimately creative transformation.

Mnemonic emotion regulation: a three-process model

Emotion regulation comprises attempts to influence when and how emotions are experienced and expressed. It has mostly been conceived of as proactive (e.g. situation selection) or reactive (e.g. attentional distraction), but it may also be retroactive and involve memory. I term such past-oriented activity mnemonic emotion regulation and propose that it involves increasing or decreasing access to or altering the characteristics of a memory. People may increase access to a memory and make it more likely that it will be retrieved in the future, for example by rehearsing a pleasant memory. They may decrease access to a memory and make it less likely that intrusions will be experienced in the future, for example by repeatedly trying to stop an unpleasant memory from being retrieved. Finally, people may alter the characteristics of a memory and change its content or context, for example by replacing a negative impression with a productive interpretation. I discuss how mnemonic emotion regulation may be instigated (e.g. via elaborate rehearsal) as well as the different motives (e.g. hedonic motives) people may have for engaging in regulation. Also, I discuss possible benefits of, variations in, and improvements of mnemonic emotion regulation.

How to make a particular case for person-centred patient care: A commentary on Alexandra Parvan

In recent years, a person-centred approach to patient care in cases of mental illness has been promoted as an alternative to a disease orientated approach. Alexandra Parvan's contribution to the person-centred approach serves to motivate an exploration of the approach's most apt metaphysical assumptions. I argue that a metaphysical thesis or assumption about both persons and their uniqueness is an essential element of being person-centred. I apply the assumption to issues such as the disorder/disease distinction and to the continuity of mental health and illness.

Learning to actively cope with stress in female mice

Repeated exposure to a same-sex resident stranger enhances subsequent indications of active coping that generalize across multiple contexts in intruder male mice. Here we investigate female mice for comparable learning to cope training effects. Stress coping research focused on females is important because stress related mood and anxiety disorders are more prevalent in women than men. Female mice were monitored for coping behavior in open-field, object-exploration, and tail-suspension tests conducted after repeated exposure to a same-sex resident stranger. During repeated exposure sessions of training staged in the resident's home cage, behavioral measures of aggression and risk assessment were collected and plasma measures of the stress hormone corticosterone were obtained from separate samples of mice. Repeated exposure to a same-sex resident stranger subsequently enhanced active coping behavior exemplified by diminished freezing and increased center entries in the open-field, shorter object-exploration latencies, and a tendency toward decreased immobility on tail-suspension tests. Open-field locomotion considered as an index of non-specific activity was not increased by repeated sessions of exposure and did not correlate significantly with any measure of active coping. During repeated sessions of exposure to a same-sex resident stranger, risk assessment behavior and consistent but limited aggression occurred and corticosterone responses increased over repeated sessions. Exposure to a same-sex resident stranger is mildly stressful and promotes learning to actively cope in mice assessed in three different contexts.

Is Minority Stress in the Eye of the Beholder? A Test of Minority Stress Theory with Christians

Studies using minority stress theory have focused on the experiences of numerical and social power minorities, though majority individuals may also perceive themselves to be minorities. We explored minority stress theory among a sample of members of a numerically and socially dominant group: Christians in the USA. Perceiving oneself to be a member of a minority as a Christian was associated with stress indirectly via perceived experiences of faith-based discrimination (i.e., harassment due to being Christian). Being more open about one's religion moderated the relationship between experiences of faith-based discrimination and stress, such that those who were open about their faith reported a stronger relationship between experiences of faith-based discrimination and stress. These findings indicate that perceptions of minority status are important to understanding stress and have implications for minority/majority dialogues.

Treating anxiety disorders by emotion-focused psychodynamic psychotherapy (EFPP)-An integrative, transdiagnostic approach

Anxiety disorders are characterized by high levels of anxiety and avoidance of anxiety-inducing situations and of negative emotions such as anger. Emotion-focused therapy (EFT) and psychodynamic psychotherapy (PP) have underscored the therapeutic significance of processing and transforming repressed or disowned conflicted or painful emotions. Although PP provides sophisticated means of processing intrapsychic and interpersonal conflict, EFT has empirically tested a set of techniques to access, deepen, symbolize, and transform emotions consistent with current conceptualizations of emotions and memory. Based on our clinical experience, we propose that an integrative emotion-focused and psychodynamic approach opens new avenues for treating anxiety disorders effectively, and we present a transdiagnostic manual for emotion-focused psychodynamic psychotherapy. The therapeutic approach takes into account both the activation, processing, and modification of emotion and the underlying intrapsychic and interpersonal conflicts. The short-term treatment is based on the three phases of initiating treatment, therapeutic work with anxiety, and termination. Emotional poignancy (or liveliness) is an important marker for emotional processing throughout treatment. Instead of exposure to avoided situations, we endorse enacting the internal process of generating anxiety in the session providing a sense of agency and access to warded-off emotions. Interpretation serves to tie together emotional experience and insight into the patterns and the nature of underlying intrapersonal and interpersonal conflict. Treatment modules are illustrated by brief vignettes from pilot treatments.

Meaning and potential of interview data in depiction of life stories: interviews of three mothers caring for children with severe disabilities

[Purpose] This study aimed to review the meaning and potential of interview data for life story depiction. [Participants and Methods] The participants were three mothers who appeared to have positively accepted their daily lives while raising children with severe disabilities. Semi-structured interviews of these mothers were performed. By reference to Trajectory Equifinality Model, noteworthy experiences were extracted for individual cases from the complete records of the interviews. [Results] After the narration of their life stories, the mothers reached the following points: “Strange sense of satisfaction with living with this child,” “Both the child and I are happy,” and “The presence of this child allowed us to save our marriage.” [Conclusion] When one talks about oneself, the past is arranged in a form that explains the present, omitting or ignoring past experiences that are not related to the present. In other words, the present condition is not the point that the mothers has reached through the narration of their life stories, but the life story has been created to explain the present condition. This means that the life story will continue to change with each new context. This is the conclusion of this study with regard to the meaning and potential of interview data.

Narrative storytelling as mental health support for women experiencing gender-based violence in Afghanistan

RATIONALE

Experiencing gender-based violence (GBV) can have serious consequences for women's mental health. However, little is known about how to address the health consequences of GBV against women in high-prevalence settings where GBV is widely accepted as normal.

OBJECTIVE

This study examines the potential for narrative storytelling to support women's mental health and alleviate the suffering caused by GBV in high-prevalence settings. It adopts a symbolic interactionist perspective to explore the perceptions and lived experiences of women living in safe houses for GBV in Afghanistan.

METHOD

In-depth semi-structured interviews were carried out with women (n = 20) in two Afghanistan safe houses between March and May 2017. The data were analysed both inductively and deductively using thematic network analysis.

RESULTS

The findings reveal the stigmatising and traumatic experiences many women have had when telling their stories of GBV in this context. In contrast, storytelling under supportive conditions was perceived to be a highly valuable experience that could help formulate positive social identities and challenge broader social structures. The supportive conditions that contributed to a positive storytelling experience included the presence of a sympathetic non-judgemental listener and a supportive social environment.

CONCLUSIONS

These findings offer an alternative to biomedical models of mental health support for women experiencing GBV in high-prevalence settings. They raise the importance of tackling broader social changes that challenge patriarchal social structures, and highlight the potential role that narrative storytelling approaches can play in high-prevalence settings like Afghanistan.

Exploring the role of context on the existing evidence for reconsolidation of episodic memory

Recent research has provided evidence for memory modifications when a post-reactivation treatment (e.g., drugs, new learning) interferes with the memory re-stabilisation (reconsolidation) process. This finding contradicts the long-standing consolidation theory and has high practical and theoretical implications. With an object-learning paradigm, it was shown that episodic memory is highly susceptible to interfering material presented after its reactivation [Hupbach, A., Gomez, R., Hardt, O., & Nadel, L. (2007). Reconsolidation of episodic memories: A subtle reminder triggers integration of new information. Learning & Memory, 14, 47-53. doi: 10.1101/lm.365707 ]. The reactivation of a learned list (List 1) before a second learned list (List 2) led to intrusion errors from List 2 when trying to recall List 1, but not vice-versa. Their work has been widely cited and their findings have been explained according to reconsolidation theory. For the first time, we systematically explored the role of retrieval context as an alternative explanation for Hupbach's results. Our results showed that the intrusion effect occurs independently of the retrieval context (Experiment 1). Additionally, even when the intrusion rate probability is increased (i.e., List 1 memory test is performed in the List 2 learning context), the groups that did not reactivate the original list did not commit intrusion errors (Experiment 2). In sum, we found that the intrusion effect critically depends on the presence of reactivation, discarding alternative interpretations of the results.

Emotional awareness and expression therapy, cognitive behavioral therapy, and education for fibromyalgia: a cluster-randomized controlled trial

Patients with fibromyalgia (FM) experience increased lifetime levels of psychosocial adversity, trauma, and emotional conflict. To address these risk factors, we developed emotion awareness and expression therapy (EAET) and tested its benefits against an active control condition, FM education, and the field's gold standard intervention for FM, cognitive behavioral therapy (CBT) for symptom management. Adults with FM (N = 230) formed 40 treatment groups, which were randomized to EAET, CBT, or education and given 8, 90-minute sessions. Patient-reported outcomes were assessed at baseline, posttreatment, and 6-month follow-up (primary end point). Retention of patients to follow-up was excellent (90.4%). Intent-to-treat analyses indicated that although EAET did not differ from FM education on pain severity (primary outcome), EAET had significantly better outcomes than FM education on overall symptoms, widespread pain, physical functioning, cognitive dysfunction, anxiety, depression, positive affect, and life satisfaction (between-condition d's ranging from 0.29-0.45 SD) and the percentage of patients reporting being "very much/much" improved (34.8% vs 15.4%). Emotional awareness and expression therapy did not differ from CBT on the primary or most secondary outcomes, but compared to CBT, EAET led to significantly lower FM symptoms (d = 0.35) and widespread pain (d = 0.37) and a higher percentage of patients achieving 50% pain reduction (22.5% vs 8.3%). In summary, an intervention targeting emotional awareness and expression related to psychosocial adversity and conflict was well received, more effective than a basic educational intervention, and had some advantages over CBT on pain. We conclude that EAET should be considered as an additional treatment option for FM.

MDMA-assisted psychotherapy for PTSD: Are memory reconsolidation and fear extinction underlying mechanisms?

MDMA-assisted psychotherapy for treatment of PTSD has recently progressed to Phase 3 clinical trials and received Breakthrough Therapy designation by the FDA. MDMA used as an adjunct during psychotherapy sessions has demonstrated effectiveness and acceptable safety in reducing PTSD symptoms in Phase 2 trials, with durable remission of PTSD diagnosis in 68% of participants. The underlying psychological and neurological mechanisms for the robust effects in mitigating PTSD are being investigated in animal models and in studies of healthy volunteers. This review explores the potential role of memory reconsolidation and fear extinction during MDMA-assisted psychotherapy. MDMA enhances release of monoamines (serotonin, norepinephrine, dopamine), hormones (oxytocin, cortisol), and other downstream signaling molecules (BDNF) to dynamically modulate emotional memory circuits. By reducing activation in brain regions implicated in the expression of fear- and anxiety-related behaviors, namely the amygdala and insula, and increasing connectivity between the amygdala and hippocampus, MDMA may allow for reprocessing of traumatic memories and emotional engagement with therapeutic processes. Based on the pharmacology of MDMA and the available translational literature of memory reconsolidation, fear learning, and PTSD, this review suggests a neurobiological rationale to explain, at least in part, the large effect sizes demonstrated for MDMA in treating PTSD.