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Hou S, Twayigira M, Luo X, Song L, Cui X, Xie Q, Shen Y, Yang F, Yuan X. The relationship between emotional neglect and non-suicidal self-injury among middle school students in China: the mediating role of social anxiety symptoms and insomnia. BMC Psychiatry 2023; 23:248. [PMID: 37055779 PMCID: PMC10100180 DOI: 10.1186/s12888-023-04735-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/30/2023] [Indexed: 04/15/2023] Open
Abstract
BACKGROUND: Non-suicidal self-injury (NSSI) is a vital public concern around the world, and it often starts in adolescence. Emotional neglect (EN) has been considered a distal risk factor for NSSI, but the effects of social anxiety symptoms (SA) and insomnia on this relationship have remained unclear. This study aimed to investigate the potential pathways from EN to NSSI, examining the role of SA and insomnia in this association. METHODS One thousand three hundred thirty seven Chinese middle school students (Mage = 13.040, SD = 0.981, 50.2% males) in China were enrolled in this cross-sectional study. Participants completed the Emotional Neglect sub-scale of Childhood Trauma Questionnaire (CTQ-SF), the Social Anxiety Scale for Adolescent (SAS-A), Athens Insomnia Scale (AIS) and non-suicidal self-injury assessment. Structural equation modelling (SEM) was used to test the possible mediation model among these variables. RESULTS 231(17.3%) students reported NSSI history during last year and 322 (24.1%) participants reported experiences of EN. Students who experienced EN have higher rates of NSSI compared to students without EN history (29.2% vs 13.5%). EN, SA, insomnia and NSSI were positively related to each other. Furthermore, both SA and insomnia played a mediating role in the relationship between EN and NSSI, the series mediating effect of SA and insomnia on this association was also significant after controlling for demographics. Indirect effects accounted for 58.26% of the total effects (EN → NSSI). CONCLUSIONS Our study revealed that EN was associated with NSSI, SA and insomnia play indirect roles in the association between EN and NSSI. The findings of our research may have implications for clinicians, families, and schools in their efforts to lower the risk of NSSI in adolescents.
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Affiliation(s)
- Shiyi Hou
- Department of Clinical Psychology, Central South University, The Third Xiangya Hospital, Changsha, 410013, Hunan, China
| | - Mireille Twayigira
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Xuerong Luo
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Lintong Song
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Xilong Cui
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Qiuxiang Xie
- Department of General Practice, Central South University, The Third Xiangya Hospital, Changsha, 410013, Hunan, China
| | - Yanmei Shen
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China
| | - Feilong Yang
- Department of Clinical Psychology, Central South University, The Third Xiangya Hospital, Changsha, 410013, Hunan, China
| | - Xiuhong Yuan
- Department of Clinical Psychology, Central South University, The Third Xiangya Hospital, Changsha, 410013, Hunan, China.
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The Mediating Role of Cognitive Flexibility in the Relationship between Traumatic Experiences in the Childhood Period and Substance Abuse Proclivity. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2021. [DOI: 10.1007/s10942-020-00385-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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3
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Carlton CN, Garcia KM, Sullivan-Toole H, Stanton K, McDonnell CG, Richey JA. From childhood maltreatment to adult inflammation: Evidence for the mediational status of social anxiety and low positive affect. Brain Behav Immun Health 2021; 18:100366. [PMID: 34704081 PMCID: PMC8526764 DOI: 10.1016/j.bbih.2021.100366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 10/04/2021] [Accepted: 10/08/2021] [Indexed: 01/02/2023] Open
Abstract
Prior work has established a robust association between childhood maltreatment and systemic inflammatory activation later in life; however, the mechanisms involved in this process remain incompletely understood. The purpose of this investigation was to examine potential mechanistic roles for social anxiety (SA) symptoms and low positive affect (PA) in the path from childhood maltreatment to elevations in circulating interleukin (IL)-6, a common biomarker of inflammatory activation. In addition, building on prior work establishing linkages between mindful awareness and reductions in systemic inflammation, we examined the potential role of trait mindfulness as a moderator of the relationships among childhood maltreatment, SA, low PA, and IL-6. A serial mediation model utilizing a large epidemiologic dataset (final N = 527) supported our central hypothesis that the direct effect of childhood maltreatment on IL-6 was fully serially statistically mediated by SA symptoms and low PA (but not high negative affect). Additionally, results indicated that individuals falling in the upper versus lower quartiles of SA symptoms demonstrated significantly elevated concentrations of IL-6, a finding that has not been previously reported. Trait mindfulness moderated the association between low PA and IL-6, to the exclusion of any paths related to negative affect. Additionally, results indicated that the effect of child maltreatment on IL-6 bypasses SA to indirectly impact IL-6 via negative affect. Overall, we conclude that childhood maltreatment and SA symptoms have a significant influence on IL-6, albeit indirectly via low PA, and the influence of PA on IL-6 may be uniquely susceptible to influence by individual differences in mindfulness.
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Affiliation(s)
| | | | - Holly Sullivan-Toole
- Virginia Tech, Department of Psychology, USA
- Temple University, Department of Psychology, USA
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4
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Neuroticism and positive coping style as mediators of the association between childhood psychological maltreatment and social anxiety. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02360-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5
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Ji H, Lü W. Childhood abuse and social anxiety symptoms among young adults: Moderating role of respiratory sinus arrhythmia suppression to social stress. CHILD ABUSE & NEGLECT 2021; 117:105118. [PMID: 34020292 DOI: 10.1016/j.chiabu.2021.105118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 04/02/2021] [Accepted: 05/06/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Childhood abuse (CA) has been considered as an environmental risk factor for the development of social anxiety symptoms. Respiratory sinus arrhythmia (RSA) is a biomarker that has been found to interact with environmental stressors to affect psychopathological symptoms. However, little is known whether RSA moderates the relationship between CA and social anxiety symptoms. OBJECTIVE The current study aimed to examine the relationships between CA and two forms of social anxiety symptoms including social performance anxiety symptoms (SPAS) and social interaction anxiety symptoms (SIAS), and the moderating role of baseline RSA and/or RSA suppression to a social-evaluative stress in these links. PARTICIPANTS AND SETTING A total of 157 Chinese undergraduate students (Mage = 18.96, SD = 0.85, 85 % females) participated in this study. METHOD Participants completed the short form of Childhood Trauma Questionnaire, Social Phobia Scale and Social Interaction Anxiety Scale to assess CA, SPAS and SIAS, and then underwent a social stress protocol (a public speech task) during which their baseline RSA and stress induced RSA were obtained. RESULTS CA was positively correlated with SPAS but was not correlated with SIAS. RSA suppression to social stress moderated the associations between CA and two forms of social anxiety symptoms, such that CA was positively associated with SPAS and SIAS among individuals with blunted RSA suppression, but not among those with greater RSA suppression. CONCLUSIONS Greater social stress RSA suppression as a better physiological regulation marker might ameliorate the negative effect of CA on social anxiety symptoms.
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Affiliation(s)
- Huayu Ji
- Shaanxi Key Laboratory of Behavior and Cognitive Neuroscience, Shaanxi Key Research Center for Children Mental and Behavior Health, School of Psychology, Shaanxi Normal University, China
| | - Wei Lü
- Shaanxi Key Laboratory of Behavior and Cognitive Neuroscience, Shaanxi Key Research Center for Children Mental and Behavior Health, School of Psychology, Shaanxi Normal University, China.
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6
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Park CHK, Lee JW, Moon J, Jeon DW, Lee SY, Shim SH, Kim SG, Lee J, Paik JW, Cho SJ, Kim MH, You S, Jeon HJ, Rhee SJ, Kim MJ, Kim J, Ahn YM. Early Trauma and Relationships among Recent Stress, Depressive Symptoms, Anxiety Symptoms, and Suicidal Ideation in Korean Women. J Korean Med Sci 2021; 36:e72. [PMID: 33724739 PMCID: PMC7961867 DOI: 10.3346/jkms.2021.36.e72] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 01/05/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Evidence continues to accumulate that the presence or absence of early trauma (ET) implies unique characteristics in the relationships between suicidal ideation and its risk factors. We examined the relationships among recent stress, depressive symptoms, anxiety symptoms, and suicidal ideation in Korean suicidal women with or without such a history. METHODS Using data on suicidal adult females, 217 victims and 134 non-victims of ET, from the Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior, we performed structural equation modeling to investigate the contribution of recent stress, depressive symptoms, and anxiety symptoms on suicidal ideation within each group according to the presence or absence of a history of ET. RESULTS Structural equation modeling with anxiety and depressive symptoms as potential mediators showed a good fit. Recent stress had a direct effect on both depressive symptoms and anxiety symptoms in both groups. Only anxiety symptoms for victims of ET (standardized regression weight, 0.281; P = 0.005) and depressive symptoms for non-victims of ET (standardized regression weight, 0.326; P = 0.003) were full mediators that increased suicidal ideation. Thus, stress contributed to suicidal ideation by increasing the level of anxiety and depressive symptoms for victims and non-victims, respectively. CONCLUSION Tailored strategies to reduce suicidal ideation should be implemented according to group type, victims or non-victims of ET. Beyond educating suicidal women in stress-management techniques, it would be effective to decrease anxiety symptoms for those with a history of ET and decrease depressive symptoms for those without such a history.
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Affiliation(s)
| | - Jae Won Lee
- Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital, Seoul, Korea
| | - Jungjoon Moon
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Dong Wook Jeon
- Department of Psychiatry, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sang Yeol Lee
- Department of Psychiatry, Wonkwang University Hospital, Iksan, Korea
| | - Se Hoon Shim
- Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Shin Gyeom Kim
- Department of Neuropsychiatry, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jeewon Lee
- Department of Neuropsychiatry, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jong Woo Paik
- Department of Psychiatry, Kyung Hee University Medical Center, Seoul, Korea
| | - Seong Jin Cho
- Department of Psychiatry, Gachon University Gil Medical Center, Incheon, Korea
| | - Min Hyuk Kim
- Department of Psychiatry, Wonju Severance Christian Hospital, Wonju, Korea
| | - Sungeun You
- Department of Psychology, College of Social Sciences, Chungbuk National University, Cheongju, Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Jin Rhee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Min Ji Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Korea
| | - Junghyun Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Yong Min Ahn
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Korea.
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7
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Early Life Adversity as a Moderator of Symptom Change following Selective Serotonin Reuptake Inhibitors and Cognitive Behavioral Therapy. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10158-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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8
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Viljoen M, Benecke RM, Martin L, Adams RCM, Seedat S, Smith C. Anxiety: An overlooked confounder in the characterisation of chronic stress-related conditions? PLoS One 2020; 15:e0230053. [PMID: 32298279 PMCID: PMC7162495 DOI: 10.1371/journal.pone.0230053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 02/20/2020] [Indexed: 12/25/2022] Open
Abstract
Although anxiety disorders are among the most prevalent of psychiatric disorders, childhood trauma-related studies seldom consider anxiety proneness as distinct aetiological contributor. We aimed to distinguish between trauma- and anxiety-associated physiological profiles. South African adolescent volunteers were categorised for trauma exposure (CTQ, mean score 39±11) and anxiety proneness (AP)(CASI, mean score 37±7, STAI-T, mean score 41±8). Circulating hormone and leukocyte glucocorticoid receptor levels, as well as leukocyte functional capacity, were assessed. AP was associated with lower DHEAs (P<0.05) and higher leukocyte GR expression (P<0.05). DHEAs was also negatively correlated with anxiety sensitivity (CASI, P<0.05). In conclusion, AP may have more predictive power than trauma in terms of health profile. Increased glucocorticoid sensitivity previously reported after trauma, may be a unique function of anxiety and not trauma exposure per se. DHEAs concentration was identified as potentially useful marker for monitoring progressive changes in HPA-axis sensitivity and correlated with psychological measures of anxiety.
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Affiliation(s)
- Monet Viljoen
- Department of Physiological Sciences, Science Faculty, Stellenbosch University, Stellenbosch, South Africa
| | - Rohan M. Benecke
- Department of Physiological Sciences, Science Faculty, Stellenbosch University, Stellenbosch, South Africa
| | - Lindi Martin
- Department of Psychiatry, Faculty of Health Sciences, Stellenbosch University, Bellville, Cape Town, South Africa
| | - Rozanne C. M. Adams
- Department of Physiological Sciences, Science Faculty, Stellenbosch University, Stellenbosch, South Africa
- Flow Cytometry and Imaging Unit, Central Analytical Facility, Stellenbosch University, Stellenbosch, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Health Sciences, Stellenbosch University, Bellville, Cape Town, South Africa
| | - Carine Smith
- Department of Physiological Sciences, Science Faculty, Stellenbosch University, Stellenbosch, South Africa
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9
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De Venter M, Illegems J, Van Royen R, Sabbe BGC, Moorkens G, Van Den Eede F. The Relationship Between Childhood Trauma and the Response to Group Cognitive-Behavioural Therapy for Chronic Fatigue Syndrome. Front Psychiatry 2020; 11:536. [PMID: 32595538 PMCID: PMC7304305 DOI: 10.3389/fpsyt.2020.00536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/26/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine the relationship between childhood trauma and the response to group cognitive-behavioural therapy (GCBT) for chronic fatigue syndrome (CFS). METHODS A single cohort study conducted in an outpatient university referral center for CFS including a well-documented sample of adult patients meeting the CDC criteria for CFS and having received 9 to 12 months of GCBT. A mixed effect model was adopted to examine the impact of childhood trauma on the treatment response in general and over time. The main outcome measures were changes in fatigue, as assessed with the Checklist Individual Strength (total score), and physical functioning, as gauged with the Short Form 36 Health Survey subscale, with the scales being completed at baseline, immediately after treatment completion and after 1 year. RESULTS We included 105 patients with CFS. Childhood trauma was not significantly associated with the response to GCBT over time on level of fatigue or physical functioning. CONCLUSION Childhood trauma does not seem to have an effect on the treatment response to dedicated GCBT for CFS sufferers over time. Therefore, in the allocation of patients to this kind of treatment, a history of childhood trauma should not be seen as prohibitive.
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Affiliation(s)
- Maud De Venter
- University Psychiatric Department, Campus Antwerp University Hospital (UZA), Edegem, Belgium.,Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp (UA), Antwerp, Belgium
| | - Jela Illegems
- Behaviour Therapy Division for Fatigue and Functional Symptoms, Antwerp University Hospital (UZA), Edegem, Belgium.,Department of Internal Medicine, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Rita Van Royen
- Behaviour Therapy Division for Fatigue and Functional Symptoms, Antwerp University Hospital (UZA), Edegem, Belgium.,Department of Internal Medicine, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Bernard G C Sabbe
- Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp (UA), Antwerp, Belgium
| | - Greta Moorkens
- Behaviour Therapy Division for Fatigue and Functional Symptoms, Antwerp University Hospital (UZA), Edegem, Belgium.,Department of Internal Medicine, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Filip Van Den Eede
- University Psychiatric Department, Campus Antwerp University Hospital (UZA), Edegem, Belgium.,Faculty of Medicine and Health Sciences, Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp (UA), Antwerp, Belgium.,Behaviour Therapy Division for Fatigue and Functional Symptoms, Antwerp University Hospital (UZA), Edegem, Belgium
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10
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Brühl A, Kley H, Grocholewski A, Neuner F, Heinrichs N. Child maltreatment, peer victimization, and social anxiety in adulthood: a cross-sectional study in a treatment-seeking sample. BMC Psychiatry 2019; 19:418. [PMID: 31882002 PMCID: PMC6935074 DOI: 10.1186/s12888-019-2400-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 12/09/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Childhood adversities, especially emotional abuse, emotional neglect, and peer victimization are considered to be crucial risk factors for social anxiety disorder (SAD). We investigated whether particular forms of retrospectively recalled childhood adversities are specifically associated with SAD in adulthood or whether we find similar links in other anxiety or depressive disorders. METHODS Prevalences of adversities assessed with the Childhood Trauma Questionnaire (CTQ) and a questionnaire of stressful social experiences (FBS) were determined in N = 1091 outpatients. Adversity severities among patients with SAD only (n = 25), specific phobia only (n = 18), and generalized anxiety disorder only (n = 19) were compared. Differences between patients with anxiety disorders only (n = 62) and depressive disorders only (n = 239) as well as between SAD with comorbid depressive disorders (n = 143) and SAD only were tested. RESULTS None of the adversity types were found to be specifically associated with SAD and severities did not differ among anxiety disorders but patients with depressive disorders reported more severe emotional abuse, physical abuse, and sexual abuse than patients with anxiety disorders. SAD patients with a comorbid depressive disorder also reported more severe adversities across all types compared to SAD only. CONCLUSION Findings indicate that particular forms of recalled childhood adversities are not specifically associated with SAD in adulthood. Previously established links with SAD may be better explained by comorbid depressive symptoms.
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Affiliation(s)
- Antonia Brühl
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Bremen, Grazer Strasse 2, 28359, Bremen, Germany. .,Department of Psychology, Institute of Clinical Psychology, Psychotherapy and Assessment, Outpatient clinic, Technische Universität Braunschweig, Humboldtstr. 33, 38106, Braunschweig, Germany.
| | - Hanna Kley
- 0000 0001 0944 9128grid.7491.bDepartment of Psychology, Clinical Psychology and Psychotherapy, Outpatient clinic, Bielefeld University, Morgenbreede 2-4, 33615 Bielefeld, Germany
| | - Anja Grocholewski
- 0000 0001 1090 0254grid.6738.aDepartment of Psychology, Institute of Clinical Psychology, Psychotherapy and Assessment, Outpatient clinic, Technische Universität Braunschweig, Humboldtstr. 33, 38106 Braunschweig, Germany
| | - Frank Neuner
- 0000 0001 0944 9128grid.7491.bDepartment of Psychology, Clinical Psychology and Psychotherapy, Outpatient clinic, Bielefeld University, Morgenbreede 2-4, 33615 Bielefeld, Germany
| | - Nina Heinrichs
- 0000 0001 2297 4381grid.7704.4Department of Psychology, Clinical Psychology and Psychotherapy, University of Bremen, Grazer Strasse 2, 28359 Bremen, Germany ,0000 0001 1090 0254grid.6738.aDepartment of Psychology, Institute of Clinical Psychology, Psychotherapy and Assessment, Outpatient clinic, Technische Universität Braunschweig, Humboldtstr. 33, 38106 Braunschweig, Germany
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11
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Kindheitstraumatisierungen und Behandlungsergebnis nach stationärer Psychotherapie. PSYCHOTHERAPEUT 2019. [DOI: 10.1007/s00278-019-0360-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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12
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Baugh LM, Cox DW, Young RA, Kealy D. Partner trust and childhood emotional maltreatment: The mediating and moderating roles of maladaptive schemas and psychological flexibility. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2019. [DOI: 10.1016/j.jcbs.2019.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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13
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Does prior traumatization affect the treatment outcome of CBT for panic disorder? The potential role of the MAOA gene and depression symptoms. Eur Arch Psychiatry Clin Neurosci 2019; 269:161-170. [PMID: 28712090 DOI: 10.1007/s00406-017-0823-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 07/09/2017] [Indexed: 01/27/2023]
Abstract
Although cognitive behavioral therapy (CBT) is highly effective in the treatment of anxiety disorders, many patients still do not benefit. This study investigates whether a history of traumatic event experience is negatively associated with outcomes of CBT for panic disorder. The moderating role of the monoamine oxidase A (MAOA) gene and depression symptoms as well as the association between trauma history and fear reactivity as a potential mechanism are further analyzed. We conducted a post-hoc analysis of 172 male and 60 female patients with panic disorder treated with CBT in a multi-center study. Treatment outcome was assessed at post-treatment using self-report and clinician rating scales. Fear reactivity before treatment was assessed via heart rate and self-reported anxiety during a behavioral avoidance test. Among females, we did not find any differences in treatment response between traumatized and non-traumatized individuals or any two-way interaction trauma history × MAOA genotype. There was a significant three-way interaction trauma history × MAOA genotype × depression symptoms on all treatment outcomes indicating that in traumatized female patients carrying the low-activity allele, treatment effect sizes decreased with increasing depression symptoms at baseline. No such effects were observed for males. In conclusion, we found no evidence for a differential treatment response in traumatized and non-traumatized individuals. There is preliminary evidence for poorer treatment outcomes in a subgroup of female traumatized individuals carrying the low-active variant of the MAOA gene. These patients also report more symptoms of depression symptomatology and exhibit a dampened fear response before treatment which warrants further investigation.
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14
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King G, Baker KD, Bisby MA, Chan D, Cowan CSM, Stylianakis AA, Zimmermann KS, Richardson R. A precision medicine approach to pharmacological adjuncts to extinction: a call to broaden research. Psychopharmacology (Berl) 2019; 236:143-161. [PMID: 30116858 DOI: 10.1007/s00213-018-4999-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/07/2018] [Indexed: 12/21/2022]
Abstract
There is a pressing need to improve treatments for anxiety. Although exposure-based therapy is currently the gold-standard treatment, many people either do not respond to this therapy or experience a relapse of symptoms after treatment has ceased. In recent years, there have been many novel pharmacological agents identified in preclinical research that have potential as adjuncts for exposure therapy, yet very few of these are regularly integrated into clinical practice. Unfortunately, the robust effects observed in the laboratory animal often do not translate to a clinical population. In this review, we discuss how age, sex, genetics, stress, medications, diet, alcohol, and the microbiome can vary across a clinical population and yet are rarely considered in drug development. While not an exhaustive list, we have focused on these factors because they have been shown to influence an individual's vulnerability to anxiety and alter the neurotransmitter systems often targeted by pharmacological adjuncts to therapy. We argue that for potential adjuncts to be successfully translated from the lab to the clinic empirical research must be broadened to consider how individual difference factors will influence drug efficacy.
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Affiliation(s)
- Gabrielle King
- School of Psychology, The University of New South Wales, Sydney, Australia.
| | - Kathryn D Baker
- School of Psychology, The University of New South Wales, Sydney, Australia
| | - Madelyne A Bisby
- School of Psychology, The University of New South Wales, Sydney, Australia
| | - Diana Chan
- School of Psychology, The University of New South Wales, Sydney, Australia
| | | | | | | | - Rick Richardson
- School of Psychology, The University of New South Wales, Sydney, Australia
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15
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Carvalho JN, Renner AM, Donat JC, de Moura TC, Fonseca RP, Kristensen CH. Executive functions and clinical symptoms in children exposed to maltreatment. APPLIED NEUROPSYCHOLOGY-CHILD 2018; 9:1-12. [PMID: 30295547 DOI: 10.1080/21622965.2018.1497989] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
There is evidence of an association between childhood maltreatment and lifelong cognitive impairment. Few studies investigate cognitive functioning in maltreated children. The objective of this study was to investigate whether there are differences in executive processing between maltreated and nonmaltreated children. Additionally, clinical symptoms were compared between groups and possible associations between clinical symptoms, and deficits in executive functions were investigated. The sample consisted of 55 children (8-12 years), 30 with a history of maltreatment and 25 with no history of maltreatment. An interview was conducted with the child's legal guardian and instruments were administered: Juvenile Victimization Questionnaire (JVQ), Child Behavior Checklist (CBCL), and Spence Children's Anxiety Scale (SCAS). The following clinical instruments were administered to the children: JVQ, Trauma Symptom Checklist for Children (TSCC), and Children's Depression Inventory (CDI). Children underwent neuropsychological assessment. Data were analyzed by comparing the groups for clinical and cognitive variables. Differences were found between the groups in all executive functions. Most clinical symptomatology scales showed differences between the groups. Few associations were found between clinical and executive impairment profiles. Cognitive stimulation interventions, focused on inhibitory control, should be proposed in combination with psychotherapy.
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Affiliation(s)
- Janaína Nuñez Carvalho
- Catholic University of Rio Grande do Sul, Postgraduate Psychology department, Porto Alegre, Brazil
| | - Anelise Meurer Renner
- Catholic University of Rio Grande do Sul, Postgraduate Psychology department, Porto Alegre, Brazil
| | - Júlia Candia Donat
- Catholic University of Rio Grande do Sul, Postgraduate Psychology department, Porto Alegre, Brazil
| | - Tayse Conter de Moura
- Catholic University of Rio Grande do Sul, Postgraduate Psychology department, Porto Alegre, Brazil
| | - Rochele Paz Fonseca
- Catholic University of Rio Grande do Sul, Postgraduate Psychology department, Porto Alegre, Brazil
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16
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Cohen JN, Drabick DAG, Blanco C, Schneier FR, Liebowitz MR, Heimberg RG. Pharmacotherapy for social anxiety disorder: Interpersonal predictors of outcome and the mediating role of the working alliance. J Anxiety Disord 2017; 52:79-87. [PMID: 29102818 PMCID: PMC5689479 DOI: 10.1016/j.janxdis.2017.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/13/2017] [Accepted: 10/18/2017] [Indexed: 12/27/2022]
Abstract
Social anxiety disorder (SAD) is highly prevalent and associated with high levels of impairment and distress. Therapies for SAD leave many patients symptomatic at the end of treatment, and little is known about predictors or mechanisms of treatment outcome. Given the interpersonal dysfunction fundamental to SAD, this study investigated whether prominent interpersonal features of SAD (submissive behavior, childhood maltreatment, suppression of anger, and depression) predicted attrition and response to pharmacotherapy and whether the working alliance mediated these relationships. This is the first study to examine the role of the working alliance in pharmacotherapy for SAD. One hundred thirty-eight treatment-seeking individuals with a primary diagnosis of SAD received 12 weeks of open treatment with paroxetine. Higher levels of depression predicted greater severity of SAD at the end of treatment, and higher levels of submissive behavior and childhood emotional maltreatment predicted a greater probability of attrition from treatment. The psychiatrist-assessed working alliance mediated response to pharmacotherapy for individuals who reported a history of emotional maltreatment. These results identify variables that predict pharmacotherapy outcome and emphasize the importance of the working alliance as a mechanism of treatment response for those with a history of emotional maltreatment. Implications for person-specific treatment selection are discussed.
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Affiliation(s)
- Jonah N Cohen
- Department of Psychology, 1701 North 13th Street, Weiss Hall, Temple University, Philadelphia, PA, 19122, USA
| | - Deborah A G Drabick
- Department of Psychology, 1701 North 13th Street, Weiss Hall, Temple University, Philadelphia, PA, 19122, USA
| | - Carlos Blanco
- Department of Psychiatry, Columbia University Medical Center, Harkness Pavilion, 180 Ft. Washington Avenue, New York, NY, 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Franklin R Schneier
- Department of Psychiatry, Columbia University Medical Center, Harkness Pavilion, 180 Ft. Washington Avenue, New York, NY, 10032, USA; New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Michael R Liebowitz
- Department of Psychiatry, Columbia University Medical Center, Harkness Pavilion, 180 Ft. Washington Avenue, New York, NY, 10032, USA
| | - Richard G Heimberg
- Department of Psychology, 1701 North 13th Street, Weiss Hall, Temple University, Philadelphia, PA, 19122, USA.
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17
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Berent D, Emilien G, Podgórski M, Kusideł E, Kulczycka-Wojdala D, Szymańska B, Macander M, Pawłowska Z. SSTR4, Childhood Adversity, Self-efficacy and Suicide Risk in Alcoholics. Transl Neurosci 2017; 8:76-86. [PMID: 28924491 PMCID: PMC5597949 DOI: 10.1515/tnsci-2017-0013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/16/2017] [Indexed: 12/29/2022] Open
Abstract
Background Patients with alcohol dependence (AD) are known to develop poor social skills, to report a higher number of adverse childhood experiences (ACEs) and to attempt suicide more frequently than the general population. The background for the association between ACEs and a higher risk of suicide still remains understudied. SSTR4 rs2567608 is a functional polymorphism of the gene for somatostatin receptor subtype 4, predominantly found in the CA1 hippocampus area and involved in memory formation. We hypothesize that the functional polymorphism SSTR4 rs2567608, general self-efficacy, and adverse childhood experiences influence the risk of suicide attempt in patients with AD. Methodology 176 patients with AD and 127 healthy controls were interviewed regarding 13 categories of ACEs and assessed with the General Self-Efficacy Scale. Genotyping for the SSTR4 rs2567608 polymorphism was performed according to the manufacturer’s standard PCR protocol. Results Patients with AD and the controls did not differ significantly according to the SSTR4 rs2567608 genotype and allele frequencies. Lower general self-efficacy, higher number of ACEs, and the SSTR4 rs2567608 TT genotype increased the risk of suicide attempt in patients with AD, and it persisted significant only in male patients with AD. Conclusions Our study supports previous findings on ACEs and general self-efficacy association with a risk for suicide. Additionally, we suggest that patients with AD of the SSTR4 rs2567608 TT genotype may be more vulnerable to ACEs and at a higher risk of suicide attempt.
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Affiliation(s)
- Dominika Berent
- Medical University of Warsaw, Department of Psychiatry II, Kondratowicza 8 Str., PL-03-242Warsaw, Poland
| | - Gerard Emilien
- Universite Claude Bernard Lyon 1, Departement de Biologie Humaine, 8 Avenue Rckfeller, 69373LYON Cedex 08, France
| | - Michał Podgórski
- Polish Mother's Memorial Hospital Research Institute, Department of Diagnostic Imaging, Rzgowska 281/289 Str., 93-338Lodz, Poland
| | - Ewa Kusideł
- University of Lodz, Department of Spatial Econometrics, Rewolucji 1905 r. 39 Str., 90-214Lodz, Poland
| | | | - Bożena Szymańska
- Medical University of Lodz, Central Scientific Laboratory, Mazowiecka 6/8 Str., 92-215Lodz, Poland
| | - Marian Macander
- Military Institute of Aviation Medicine, Safety Flight Department, Krasińskiego 54/56 Str., 01-755Warsaw, Poland
| | - Zofia Pawłowska
- Medical University of Lodz, Central Scientific Laboratory, Mazowiecka 6/8 Str., 92-215Lodz, Poland
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18
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The Role of Environmental Factors in the Aetiology of Social Anxiety Disorder: A Review of the Theoretical and Empirical Literature. BEHAVIOUR CHANGE 2017. [DOI: 10.1017/bec.2017.7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Social anxiety disorder (SAD) is characterised by a marked and persistent fear of social/performance situations, and a number of key environmental factors have been implicated in the aetiology of the disorder. Hence, the current article reviews theoretical and empirical evidence linking the development of SAD with parenting factors, traumatic life events, and aversive social experiences. Specifically, research suggests that the risk of developing SAD is increased by over-controlling, critical and cold parenting, an insecure attachment style, aversive social/peer experiences, emotional maltreatment, and to a lesser extent other forms of childhood maltreatment and adversity. Moreover, these factors may lead to posttraumatic reactions, distorted negative self-imagery, and internalised shame-based schemas that subsequently maintain SAD symptomatology. However, further research is necessary to clarify the nature, interactions, and relative contributions of these factors. It is likely that SAD develops via a complex interplay of biological and environmental factors, and that multiple aetiological pathways underlie the development of the disorder.
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19
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Norton AR, Abbott MJ. Bridging the Gap between Aetiological and Maintaining Factors in Social Anxiety Disorder: The Impact of Socially Traumatic Experiences on Beliefs, Imagery and Symptomatology. Clin Psychol Psychother 2016; 24:747-765. [DOI: 10.1002/cpp.2044] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 09/01/2016] [Accepted: 09/09/2016] [Indexed: 01/08/2023]
Affiliation(s)
- Alice R. Norton
- Clinical Psychology Unit, School of Psychology; The University of Sydney; Sydney NSW Australia
| | - Maree J. Abbott
- Clinical Psychology Unit, School of Psychology; The University of Sydney; Sydney NSW Australia
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20
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Hassan AN, Stuart EA, De Luca V. Childhood maltreatment increases the risk of suicide attempt in schizophrenia. Schizophr Res 2016; 176:572-577. [PMID: 27236409 DOI: 10.1016/j.schres.2016.05.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 05/12/2016] [Accepted: 05/17/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVES In this study, we evaluated the effect of several types of childhood trauma on lifetime suicide attempt in patients with schizophrenia spectrum disorders. METHODS We interviewed 361 participants with schizophrenia. Childhood trauma was collected using the Childhood Trauma Questionnaire (CTQ). Suicidal attempts were confirmed using subjective and objective validated scales. We applied an observational study design using propensity scores to match individuals with history of childhood trauma to those without past history of trauma. We used logistic regression models to estimate the effect of each type of childhood maltreatment on suicidal attempts controlling for demographics and known suicidal risk factors. RESULTS In our sample, 39.1% of the subjects had lifetime suicide attempt. After matching the two groups and controlling for demographics and clinical confounders, total trauma score and the majority of childhood maltreatment subtypes predicted suicide attempt (odds ratios ranged from 1.74 to 2.49 with p-values ranging from 0.001 to 0.02). Physical neglect was not significantly associated with suicide attempt in our sample (p=0.94). CONCLUSION Childhood maltreatment is confirmed to be a strong independent risk factor for suicidal attempts in schizophrenia. The risk is probably aggravated by the development of depressive symptoms and feeling of hopelessness in the adult life. Early screening and modified psychosocial treatment are recommended for psychotic individuals with trauma history.
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Affiliation(s)
- Ahmed N Hassan
- Group for Suicide Studies, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Canada
| | - Elizabeth A Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Vincenzo De Luca
- Group for Suicide Studies, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Canada.
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21
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Santacana M, Arias B, Mitjans M, Bonillo A, Montoro M, Rosado S, Guillamat R, Vallès V, Pérez V, Forero CG, Fullana MA. Predicting Response Trajectories during Cognitive-Behavioural Therapy for Panic Disorder: No Association with the BDNF Gene or Childhood Maltreatment. PLoS One 2016; 11:e0158224. [PMID: 27355213 PMCID: PMC4927091 DOI: 10.1371/journal.pone.0158224] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 06/13/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Anxiety disorders are highly prevalent and result in low quality of life and a high social and economic cost. The efficacy of cognitive-behavioural therapy (CBT) for anxiety disorders is well established, but a substantial proportion of patients do not respond to this treatment. Understanding which genetic and environmental factors are responsible for this differential response to treatment is a key step towards "personalized medicine". Based on previous research, our objective was to test whether the BDNF Val66Met polymorphism and/or childhood maltreatment are associated with response trajectories during exposure-based CBT for panic disorder (PD). METHOD We used Growth Mixture Modeling to identify latent classes of change (response trajectories) in patients with PD (N = 97) who underwent group manualized exposure-based CBT. We conducted logistic regression to investigate the effect on these trajectories of the BDNF Val66Met polymorphism and two different types of childhood maltreatment, abuse and neglect. RESULTS We identified two response trajectories ("high response" and "low response"), and found that they were not significantly associated with either the genetic (BDNF Val66Met polymorphism) or childhood trauma-related variables of interest, nor with an interaction between these variables. CONCLUSIONS We found no evidence to support an effect of the BDNF gene or childhood trauma-related variables on CBT outcome in PD. Future studies in this field may benefit from looking at other genotypes or using different (e.g. whole-genome) approaches.
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Affiliation(s)
- Martí Santacana
- Department of Mental Health, Consorci Sanitari de Terrassa, Terrassa, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - Bárbara Arias
- Anthropology Unit, Department of Animal Biology, Universitat de Barcelona, Barcelona, Spain
- CIBERSAM (Centro de Investigaciones Biomédicas en Red de Salud Mental), Instituto de Salud Carlos III, Madrid, Spain
| | - Marina Mitjans
- CIBERSAM (Centro de Investigaciones Biomédicas en Red de Salud Mental), Instituto de Salud Carlos III, Madrid, Spain
- Clinical Neuroscience, Max Planck Institute of Experimental Medicine, Göttingen, Germany
| | - Albert Bonillo
- Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
| | - María Montoro
- Department of Mental Health, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Sílvia Rosado
- Institute of Neuropsychiatry and Addictions, Hospital del Mar, Barcelona, Spain
| | - Roser Guillamat
- Department of Mental Health, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Vicenç Vallès
- Department of Mental Health, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Víctor Pérez
- CIBERSAM (Centro de Investigaciones Biomédicas en Red de Salud Mental), Instituto de Salud Carlos III, Madrid, Spain
- Institute of Neuropsychiatry and Addictions, Hospital del Mar, Barcelona, Spain
| | - Carlos G. Forero
- CIBERESP (Centro de Investigaciones Biomédicas en Red, Epidemiología y Salud Pública), Instituto de Salud Carlos III, Madrid, Spain
- Health Services Research Group, IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain
- Department of Experimental and Life Sciences (DCEXS), Universitat Pompeu Fabra, Barcelona, Spain
| | - Miquel A. Fullana
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain
- Institute of Neuropsychiatry and Addictions, Hospital del Mar, Barcelona, Spain
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22
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Versella MV, Piccirillo ML, Potter CM, Olino TM, Heimberg RG. Anger profiles in social anxiety disorder. J Anxiety Disord 2016; 37:21-9. [PMID: 26590429 DOI: 10.1016/j.janxdis.2015.10.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 08/21/2015] [Accepted: 10/31/2015] [Indexed: 11/26/2022]
Abstract
Individuals with social anxiety disorder (SAD) exhibit elevated levels of anger and anger suppression, which are both associated with increased depression, diminished quality of life, and poorer treatment outcomes. However, little is known about how anger experiences differ among individuals with SAD and whether any heterogeneity might relate to negative outcomes. This investigation sought to empirically define anger profiles among 136 treatment-seeking individuals with SAD and to assess their association with distress and impairment. A latent class analysis was conducted utilizing the trait subscales of the State-Trait Anger Expression Inventory-2 as indicators of class membership. Analysis revealed four distinct anger profiles, with greatest distress and impairment generally demonstrated by individuals with elevated trait anger, a greater tendency to suppress the expression of anger, and diminished ability to adaptively control their anger expression. These results have implications for tailoring more effective interventions for socially anxious individuals.
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23
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Cowan CSM, Callaghan BL, Kan JM, Richardson R. The lasting impact of early-life adversity on individuals and their descendants: potential mechanisms and hope for intervention. GENES BRAIN AND BEHAVIOR 2015; 15:155-68. [PMID: 26482536 DOI: 10.1111/gbb.12263] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 10/15/2015] [Accepted: 10/16/2015] [Indexed: 01/15/2023]
Abstract
The adverse effects of early-life stress are pervasive, with well-established mental and physical health consequences for exposed individuals. The impact of early adverse experiences is also highly persistent, with documented increases in risk for mental illness across the life span that are accompanied by stable alterations in neural function and hormonal responses to stress. Here, we review some of these 'stress phenotypes', with a focus on intermediary factors that may signal risk for long-term mental health outcomes, such as altered development of the fear regulation system. Intriguingly, recent research suggests that such stress phenotypes may persist even beyond the life span of the individuals, with consequences for their offspring and grand-offspring. Phenotypic characteristics may be transmitted to future generations via either the matriline or the patriline, a phenomenon that has been demonstrated in both human and animal studies. In this review, we highlight behavioral and epigenetic factors that may contribute to this multigenerational transmission and discuss the potential of various treatment approaches that may halt the cycle of stress phenotypes.
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Affiliation(s)
- C S M Cowan
- School of Psychology, The University of New South Wales, Sydney, Australia
| | - B L Callaghan
- Psychology Department, Columbia University, New York, NY, USA
| | - J M Kan
- School of Psychology, The University of New South Wales, Sydney, Australia
| | - R Richardson
- School of Psychology, The University of New South Wales, Sydney, Australia
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24
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Rossiter A, Byrne F, Wota AP, Nisar Z, Ofuafor T, Murray I, Byrne C, Hallahan B. Childhood trauma levels in individuals attending adult mental health services: An evaluation of clinical records and structured measurement of childhood trauma. CHILD ABUSE & NEGLECT 2015; 44:36-45. [PMID: 25636522 DOI: 10.1016/j.chiabu.2015.01.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 12/30/2014] [Accepted: 01/02/2015] [Indexed: 06/04/2023]
Abstract
Despite an increased awareness regarding the prevalence and impact of childhood trauma, especially childhood sexual abuse (CSA), few studies examine the clinical reporting of such childhood experiences. This study compared the prevalence of childhood trauma recorded in individual's clinical notes to those ascertained with a structured validated questionnaire, examined which forms of childhood trauma were less likely to be reported to the treating mental health team and established which demographic or clinical factors were associated with reporting of childhood trauma. The prevalence of childhood trauma was ascertained using both the Childhood Trauma Questionnaire (CTQ) and a lifetime retrospective clinical note review in 129 individuals attending a general adult mental health service. Individuals were evaluated for the presence of mental health disorders, impulsivity, symptom severity and disability. Using the CTQ, childhood trauma was noted in 77% of individuals and recorded in 38% of individual's clinical notes (p<0.001). The greatest differences between CTQ reporting and clinical note documentation were noted for emotional neglect (62% versus 13.2%), physical neglect (48.1% versus 5.4%) and CSA (24.8% versus 8.5%). Childhood trauma was associated with increased psychopathology and greater symptom severity, and was particularly prevalent for individuals with personality disorders. This study demonstrated high rates of childhood trauma amongst adults attending a general adult mental health service. Furthermore, we demonstrated high rates of either non-enquiry from mental health professionals and/or high rates of non-documentation of childhood trauma by mental health professionals. Given the disparity between reporting of childhood trauma in clinical notes and findings with the CTQ, the use of a standardised questionnaire for the assessment of childhood trauma should be considered when performing a comprehensive mental health history.
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Affiliation(s)
- Amy Rossiter
- Department of Psychiatry, Clinical Science Institute, National University of Ireland, Galway, Galway, Ireland
| | - Fintan Byrne
- Department of Psychiatry, Clinical Science Institute, National University of Ireland, Galway, Galway, Ireland; Department of Psychiatry, University Hospital Galway, Galway, Ireland
| | - Anna Paulina Wota
- Department of Psychiatry, Roscommon County Hospital, Roscommon, Ireland
| | - Zafar Nisar
- Department of Psychiatry, Roscommon County Hospital, Roscommon, Ireland
| | - Thomas Ofuafor
- Department of Psychiatry, Roscommon County Hospital, Roscommon, Ireland
| | - Ivan Murray
- Department of Psychiatry, Roscommon County Hospital, Roscommon, Ireland
| | - Charles Byrne
- Department of Psychiatry, Roscommon County Hospital, Roscommon, Ireland
| | - Brian Hallahan
- Department of Psychiatry, Clinical Science Institute, National University of Ireland, Galway, Galway, Ireland; Department of Psychiatry, University Hospital Galway, Galway, Ireland
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