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Danböck SK, Franke LK, Miedl SF, Liedlgruber M, Bürkner PC, Wilhelm FH. Experimental induction of peritraumatic dissociation: The role of negative affect and pain and their psychophysiological and neural correlates. Behav Res Ther 2023; 164:104289. [PMID: 36934622 DOI: 10.1016/j.brat.2023.104289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 02/21/2023] [Accepted: 03/05/2023] [Indexed: 03/12/2023]
Abstract
While research has elucidated processes underlying dissociative symptoms in patients with posttraumatic stress disorder, little is known about the circumstances under which trauma-related dissociation initially arises. To experimentally investigate causes and concomitants of peritraumatic dissociation, we subjected sixty-nine healthy women to aversive-audiovisual and painful-electrical stimulation in a 2(aversive/neutral film) x 2(pain/no pain) within-subject design while recording psychophysiological and fMRI-BOLD responses. Afterwards, participants rated negative-affect, pain, and dissociation for each condition. Using Bayesian multilevel regression models, we examined (1) whether aversive-audiovisual and painful-electrical stimulation elicit higher dissociation-levels than control conditions and (2) whether stronger negative-affect and pain responses (operationalized via self-report, psychophysiological, and neural markers) correlate with higher dissociation-levels. Several key findings emerged: Both aversive-audiovisual and painful-electrical stimulation elicited dissociation. Dissociation was linked to higher self-reported negative-affect, but we did not find enough evidence linking it to psychophysiological and neural negative-affect markers. However, dissociation was associated with higher levels of self-reported pain, a skin-conductance-response-based pain marker, and the fMRI-BOLD-based Neurologic-Pain-Signature. Results indicate that both aversive-audiovisual and painful stimuli can independently cause dissociation. Critically, pain responses captured via self-report, psychophysiological, and neural markers were consistently linked to higher dissociation-levels suggesting a specific, evolutionary meaningful, contribution of pain to the rise of dissociation.
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Affiliation(s)
- Sarah K Danböck
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris Lodron University of Salzburg, Hellbrunner Straße 34, 5020, Salzburg, Austria.
| | - Laila K Franke
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris Lodron University of Salzburg, Hellbrunner Straße 34, 5020, Salzburg, Austria
| | - Stephan F Miedl
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris Lodron University of Salzburg, Hellbrunner Straße 34, 5020, Salzburg, Austria
| | - Michael Liedlgruber
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris Lodron University of Salzburg, Hellbrunner Straße 34, 5020, Salzburg, Austria
| | - Paul-Christian Bürkner
- Cluster of Excellence SimTech, University of Stuttgart, Universitätsstraße 32, 70569, Stuttgart, Germany
| | - Frank H Wilhelm
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris Lodron University of Salzburg, Hellbrunner Straße 34, 5020, Salzburg, Austria
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Caulfield NM, Martin RL, Smith NS, Karnick AT, Norr AM, Capron DW. A preliminary assessment of the link between anxiety sensitivity cognitive concerns and suicidal thoughts through dissociative symptoms. J Trauma Dissociation 2022; 23:97-109. [PMID: 34633910 DOI: 10.1080/15299732.2021.1989112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Anxiety sensitivity (AS) and AS subfactors (physical, cognitive, and social) have been found to have robust associations with suicide risk. While the direct association between AS subfactors and suicide risk have been explored, little is known about how specific mechanisms, such as dissociation, might explain this relationship. This study aimed to run three analyses to examine the direct and indirect effects of suicidal thoughts and AS via dissociative symptoms. We predicted that dissociation would be a pathway through which AS physical concerns (ASPC) and AS cognitive concerns (ASCC) predicts suicidal ideation. Participants included 84 undergraduate students from a Southeastern University who were elevated on ASCC. Participants completed measures examining dissociative experiences, anxiety sensitivity, and current suicidal ideation. Results revealed that dissociation had a significant indirect effect with ASPC but not ASCC. The current preliminary study showed that ASCC had direct associations with suicide risk; however, those with lower levels of ASPC and dissociation may also be more likely to develop suicide risk. Future research should explore the possibility that the dissociation/ASPC and ASCC pathways are separate, but related, paths to suicidality.
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Affiliation(s)
- Nicole M Caulfield
- Department of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Rachel L Martin
- Department of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Nicole S Smith
- Department of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Aleksandr T Karnick
- Department of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
| | - Aaron M Norr
- Mental Health Research Education and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Daniel W Capron
- Department of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi, USA
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Trait dissociation as a predictor of induced dissociation by ketamine or esketamine in treatment-resistant depression: Secondary analysis from a randomized controlled trial. J Psychiatr Res 2021; 138:576-583. [PMID: 33991996 DOI: 10.1016/j.jpsychires.2021.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/22/2021] [Accepted: 05/01/2021] [Indexed: 01/09/2023]
Abstract
Dissociative symptoms are common, possibly severe, side effects associated with the use of ketamine and esketamine in depression. We investigated the relationship between trait dissociation and dissociation induced by ketamine and esketamine used as augmentation therapy in treatment-resistant depression (TRD). Adults with TRD were randomly assigned to receive a single intravenous infusion, with a duration of 40 min, of either esketamine 0.25 mg/kg or ketamine 0.5 mg/kg. We assessed trait dissociation with the Dissociative Experience Scale (DES) and, to evaluate induced dissociation, the Clinician-Administered Dissociative States Scale (CADSS) was used. Thirty-two subjects received esketamine and 29 received ketamine. The groups had similar median DES scores (p = 0.26). More than 30% of the patients in both groups had DES scores ≥30 points. The median CADSS score in the esketamine group was equivalent to that in the ketamine group (p = 0.40). Every 5 points increment in the DES was associated with a 10.9% (95% CI 4.5-17.8%) increase in the CADSS, in an exponential fashion when the two groups were pooled together. Subjects with high trait dissociation had a higher risk of induced dissociation state (relative risk [RR] 1.41, 95% CI 1.11-1.78) and very high induced dissociation (RR 3.05, 95% CI 1.14-8.15). Induced dissociation was not a serious adverse effect. The findings suggest that trait dissociation is a predictor of induced dissociation by Ketamine or Esketamine in TRD subjects. Screening for trait dissociation and counseling patients with high trait dissociation on the risks of dissociation by these drugs are recommended.
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Timmins MA, Berman ME, Nadorff MR, Amadi SC, Fanning JR, McCloskey MS. Does State Dissociation Mediate the Relation Between Alcohol Intoxication and Deliberate Self-Harm? Arch Suicide Res 2020; 24:231-242. [PMID: 30636569 DOI: 10.1080/13811118.2018.1563577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Research supports the notion that alcohol intoxication is a risk factor for deliberate self-harm (DSH). However, the underlying mechanisms for this relationship are poorly understood. We aimed to determine whether alcohol-induced dissociation mediated alcohol's effects on DSH. We used data from a dose-response study of alcohol intoxication and DSH to test the proposed model. Participants were assigned to reach target blood alcohol concentrations (BAC) ranging from 0.00% through 0.10% and then completed a behavioral measure of DSH. Dissociation was assessed using the Alcohol Dissociative Experiences Scale. BAC predicted both dissociation and DSH, but dissociation did not predict DSH. Although research on clinical populations suggests dissociation is related to DSH, our findings suggest dissociation does not mediate the effects of alcohol on self-harm.
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Affiliation(s)
- Matthew A Timmins
- Department of Psychology, Mississippi State University, Starkville, MS, USA
| | - Mitchell E Berman
- Department of Psychology, Mississippi State University, Starkville, MS, USA
| | - Michael R Nadorff
- Department of Psychology, Mississippi State University, Starkville, MS, USA
| | - Suzanne C Amadi
- Department of Psychology, Mississippi State University, Starkville, MS, USA
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Vogel M, Krippl M, Frenzel L, Riediger C, Frommer J, Lohmann C, Illiger S. Dissociation and Pain-Catastrophizing: Absorptive Detachment as a Higher-Order Factor in Control of Pain-Related Fearful Anticipations Prior to Total Knee Arthroplasty (TKA). J Clin Med 2019; 8:E697. [PMID: 31100954 PMCID: PMC6571957 DOI: 10.3390/jcm8050697] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 05/09/2019] [Accepted: 05/10/2019] [Indexed: 11/17/2022] Open
Abstract
Total Knee Arthroplasty (TKA) is the ultima-ratio therapy for knee-osteoarthritis (OA), which is a paradigmatic condition of chronic pain. A hierarchical organization may explain the reported covariation of pain-catastrophizing (PC) and dissociation, which is a trauma-related psychopathology. This study tests the hypotheses of an overlap and hierarchical organization of the two constructs, PC and dissociation, respectively, using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Childhood Trauma Screener (CTS), a shortened version of the Dissociative Experiences Scale (FDS-20), the Brief Symptom Inventory (BSI-18), the Pain-Catastrophizing Scale (PCS), and the Tampa Scale of Kinesiophobia (TSK) in 93 participants with knee-OA and TKA. Non-parametric correlation, linear regression, and an exploratory factor analysis comprising the PCS and the FDS-20 in aggregate were run. The three factors: 1) PC factor, 2) absorptive detachment, and 3) conversion altogether explained 60% of the variance of the two scales. Dissociative factors were related to childhood trauma, and the PC-factor to knee-pain. The latter was predicted by absorptive detachment, i.e., disrupted perception interfering with the integration of trauma-related experiences possibly including invasive surgery. Absorptive detachment represents negative affectivity and is in control of pain-related anxieties (including PC). The clinical associations of trauma, psychopathology, and maladaptation after TKA may be reflections of this latent hierarchical organization of trauma-related dissociation and PC.
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Affiliation(s)
- Matthias Vogel
- Universitätsklinik für Psychosomatische Medizin und Psychotherapie der Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany.
| | - Martin Krippl
- Institut für Psychologie der Otto-von-Guericke-Universität Magdeburg, Universitätsplatz 2, Geb. 24, 39106 Magdeburg, Germany.
| | - Lydia Frenzel
- Universitätsklinik für Psychosomatische Medizin und Psychotherapie der Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany.
| | - Christian Riediger
- Universitätsklinik für Orthopädie der Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany.
| | - Jörg Frommer
- Universitätsklinik für Psychosomatische Medizin und Psychotherapie der Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany.
| | - Christoph Lohmann
- Universitätsklinik für Orthopädie der Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany.
| | - Sebastian Illiger
- Universitätsklinik für Orthopädie der Otto-von-Guericke-Universität Magdeburg, Leipziger Straße 44, 39120 Magdeburg, Germany.
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Vannikov-Lugassi M, Soffer-Dudek N. No Time Like the Present: Thinking About the Past and the Future Is Related to State Dissociation Among Individuals With High Levels of Psychopathological Symptoms. Front Psychol 2018; 9:2465. [PMID: 30581402 PMCID: PMC6292924 DOI: 10.3389/fpsyg.2018.02465] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 11/21/2018] [Indexed: 11/16/2022] Open
Abstract
Several short-term pathways have been implicated in relation to dissociative experiences, among them are daily stress, sleepiness, and rumination. In addition, it has been claimed that mechanisms contributing to dissociative experiences may differ, according to specific psychopathological symptoms. Accordingly, this study had two aims. The first was to sample moment-to-moment increases or decreases in current stress, sleepiness, and rumination, in order to assess their temporal relations with state dissociation. Rumination was broken down to its basic two subcomponents: the negative value of the thoughts and thinking about the past (in comparison to present or future), in order to differentiate it from other repetitive thought patterns (e.g., worry). The second goal was to explore whether depression, anxiety, and obsessive–compulsive symptoms may moderate the links between the three mechanisms and specific state dissociation scales [specifically, depersonalization-derealization (DEP-DER) and absorption (ABS)]. Ninety-nine undergraduate students completed trait questionnaires and then answered state items four times a day for 4 days. These experience sampling data were analyzed using multilevel linear modeling (MLM) with Level 1 state measurements and Level 2 demographic and trait variables of the participants. Moments of stress, sleepiness, thinking about the past and negative thoughts were all associated both with state DEP-DER and with state ABS. Dissociation, negative thinking, stress, and sleepiness were positively associated with moments of thinking about the past and the future but inversely associated with moments of thinking about the present. Finally, in accordance with our expectations, the links between DEP-DER and hypothesized mechanisms were mostly moderated by depression and anxiety symptoms, whereas the links between ABS and hypothesized mechanisms were moderated mainly by obsessive–compulsive symptoms. Our findings are in accordance with literature on the efficacy of mindfulness as well as the maladaptive correlates of mind-wandering, as they suggest that dissociative detachment from one’s present occupation is associated with decreased well-being.
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Affiliation(s)
- Miriam Vannikov-Lugassi
- Consciousness and Psychopathology Laboratory, Department of Psychology, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Nirit Soffer-Dudek
- Consciousness and Psychopathology Laboratory, Department of Psychology, Ben-Gurion University of the Negev, Beersheba, Israel
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Michal M, Adler J, Reiner I, Wermke A, Ackermann T, Schlereth T, Birklein F. Association of Neglect-Like Symptoms with Anxiety, Somatization, and Depersonalization in Complex Regional Pain Syndrome. PAIN MEDICINE 2018; 18:764-772. [PMID: 27605590 DOI: 10.1093/pm/pnw214] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Many patients with complex regional pain syndrome (CRPS) report some foreignness of the affected limb, which is referred to as "neglect-like symptoms" (NLS). Despite similarities of the NLS reports to symptoms of body image disturbances in mental disorders, no study has been conducted to examine such associations. Methods We investigated 50 patients with CRPS and 45 pain control patients (N = 27, chronic limb pain; N = 18, migraine headache). NLS, anxiety, depression, depersonalization, and somatization were assessed using validated questionnaires. Results Seventy-two percent of the CRPS patients reported at least one NLS vs 29.6% and 33.3% in the two patient control groups. In limb pain controls, NLS correlated with pain intensity. In CRPS patients, NLS correlated with anxiety (rho = 0.658, P < 0.001), somatization (rho = 0.616, P < 0.001), depersonalization (rho = 0.634, P < 0.001), and pain catastrophizing (rho = 0.456, P < 0.01), but not with intensity of pain, duration of pain, or pain disability. Conclusions In CRPS patients, NLS could be a result of somatization, depression, anxiety, and depersonalization, but probably not of pain. Whether these associations are causative must be clarified in longitudinal psychological studies.
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Affiliation(s)
- Matthias Michal
- Departments of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Julia Adler
- Departments of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Iris Reiner
- Departments of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Andreas Wermke
- Departments of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | | | | | - Frank Birklein
- Neurology, University Medical Center Mainz, Mainz, Germany
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Dorahy MJ, McKendry H, Scott A, Yogeeswaran K, Martens A, Hanna D. Reactive dissociative experiences in response to acute increases in shame feelings. Behav Res Ther 2017; 89:75-85. [DOI: 10.1016/j.brat.2016.11.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 10/30/2016] [Accepted: 11/14/2016] [Indexed: 11/27/2022]
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Yılmaz S, Bilgiç A, Akça ÖF, Türkoğlu S, Hergüner S. Relationships among depression, anxiety, anxiety sensitivity, and perceived social support in adolescents with conversion disorder. Int J Psychiatry Clin Pract 2016; 20:10-8. [PMID: 26824691 DOI: 10.3109/13651501.2015.1117110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study aimed to assess the relationships of depression, anxiety, anxiety sensitivity, and perceived social support with conversion symptoms in adolescents with conversion disorder (CD). METHODS Fifty outpatients, aged 8-18 years, who had been diagnosed with CD and members of a control group were assessed using the psychological questionnaires. RESULTS Compared with controls, adolescents with CD scored higher on the Child Depression Inventory (CDI), Screen for Child Anxiety-related Emotional Disorders (SCARED), Childhood Anxiety Sensitivity Index (CASI) total, CASI physical and cognitive subscales, and Multidimensional Scale of Perceived Social Support family subscale. Multiple regression analysis showed that CDI, CASI total, and CASI cognitive scores predicted the Somatoform Dissociation Questionnaire (SDQ) scores and that CDI and CASI total scores predicted the Children's Somatization Inventory (CSI) scores of subjects. CONCLUSIONS This study suggest that adolescents with CD had poor psychosocial well-being, and depression, global anxiety sensitivity and anxiety sensitivity cognitive concerns are related to conversion symptoms.
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Affiliation(s)
- Savaş Yılmaz
- a Department of Child and Adolescent Psychiatry , Meram School of Medicine, Necmettin Erbakan University , Konya , Turkey
| | - Ayhan Bilgiç
- a Department of Child and Adolescent Psychiatry , Meram School of Medicine, Necmettin Erbakan University , Konya , Turkey
| | - Ömer Faruk Akça
- a Department of Child and Adolescent Psychiatry , Meram School of Medicine, Necmettin Erbakan University , Konya , Turkey
| | - Serhat Türkoğlu
- b Department of Child and Adolescent Psychiatry , Selcuk University, School of Medicine , Konya , Turkey
| | - Sabri Hergüner
- a Department of Child and Adolescent Psychiatry , Meram School of Medicine, Necmettin Erbakan University , Konya , Turkey
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López-Martínez AE. The overlap of PTSD and chronic pain: a challenge for rehabilitation interventions. PHYSICAL THERAPY REVIEWS 2014. [DOI: 10.1179/1743288x14y.0000000159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Choi K, Vickers K, Tassone A. Trait Emotional Intelligence, Anxiety Sensitivity, and Experiential Avoidance in Stress Reactivity and Their Improvement Through Psychological Methods. EUROPES JOURNAL OF PSYCHOLOGY 2014. [DOI: 10.5964/ejop.v10i2.754] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Stress pervades daily society, often with deleterious consequences for those prone to react intensely to it. Intervention techniques to attenuate stress reactivity are thus paramount. With that goal in mind, researchers have sought to identify and alter malleable psychological dispositional variables that influence stress reactivity. Trait emotional intelligence (TEI), anxiety sensitivity (AS), and experiential avoidance (EA) are increasingly receiving attention in these research efforts. The self-reported emotional component of stress reactivity has been emphasized in investigations and is our focus. Specifically, this paper overviews the role of TEI, AS, and EA in self-reported stress responses. We also discuss empirically supported psychological methods to adjust suboptimal levels of these variables in normal populations. Both psycho-educational (information, skills) and mindfulness-based interventions (specific mindfulness therapies or components) are covered. Findings include that (1) TEI, AS, and EA are each correlated with the emotional component of stress reactivity to both naturalistic and lab-based stressors; (2) preliminary support currently exists for psycho-educational intervention of TEI and AS but is lacking for EA; (3) adequate evidence supports mindfulness-based interventions to target EA, with very limited but encouraging findings suggesting mindfulness methods improve TEI and AS; and (4) although more research is needed, stress management approaches based on mindfulness may well target all three of these psychological variables and thus appear particularly promising. Encouragingly, some methods to modify dispositional variables (e.g., a mindfulness-based format of guided self-help) are easily disseminated and potentially applicable to the general public.
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Cohen ML, Testa SM, Pritchard JM, Zhu J, Hopp JL. Overlap between dissociation and other psychological characteristics in patients with psychogenic nonepileptic seizures. Epilepsy Behav 2014; 34:47-9. [PMID: 24681385 DOI: 10.1016/j.yebeh.2014.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 02/25/2014] [Accepted: 03/02/2014] [Indexed: 10/25/2022]
Abstract
Patients with psychogenic nonepileptic seizures (PNES) often report symptoms of dissociation. However, it is unclear how these symptoms relate to psychotherapeutic treatment, for example, with cognitive-behavioral therapy (CBT). Here, we investigated the degree of overlap between symptoms of dissociation and other psychiatric features that are more traditional targets for CBT. We used a hierarchical linear regression to measure the variance associated with dissociative symptoms (as assessed by the Dissociative Experiences Scale - DES) among 46 individuals with PNESs. The regression predictor variables are indices of participants' self-rated mood, self-efficacy, quality of life, locus of control, and life outlook (e.g., optimism). Results revealed that 70.2% of the variance associated with DES score was explained by psychological distress and locus of control. The other factors examined did not make a significant contribution to the regression model. These results suggest that traditional CBT targets - mood symptoms, mood distress, and dysfunctional beliefs about locus of control - overlap substantially with self-reported dissociative symptoms.
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Affiliation(s)
- Matthew L Cohen
- VA Maryland Healthcare System, Baltimore VA Medical Center, 10 N. Greene St., MH/116, Baltimore, MD, USA.
| | - S Marc Testa
- VA Maryland Healthcare System, Baltimore VA Medical Center, 10 N. Greene St., MH/116, Baltimore, MD, USA; University of Maryland School of Medicine, Department of Neurology, 110 S. Paca St., Baltimore, MD, USA.
| | - Jennifer M Pritchard
- University of Maryland School of Medicine, Department of Neurology, 110 S. Paca St., Baltimore, MD, USA.
| | - Jingkun Zhu
- University of Maryland School of Medicine, Department of Epidemiology and Public Health, 660 W. Redwood St., Baltimore, MD, USA.
| | - Jennifer L Hopp
- University of Maryland School of Medicine, Department of Neurology, 110 S. Paca St., Baltimore, MD, USA.
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López-Martínez AE, Ramírez-Maestre C, Esteve R. An examination of the structural link between post-traumatic stress symptoms and chronic pain in the framework of fear-avoidance models. Eur J Pain 2014; 18:1129-38. [PMID: 24677331 DOI: 10.1002/j.1532-2149.2014.00459.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND The tendency to respond with fear and avoidance can be seen as a shared vulnerability contributing to the development of post-traumatic stress disorder (PTSD) and chronic pain. Although several studies have examined which specific symptoms of PTSD (re-experiencing, avoidance, emotional numbing and hyperarousal) are associated with chronic pain, none has considered this association within the framework of fear-avoidance models. METHODS Seven hundred fourteen patients with chronic musculoskeletal pain were assessed. Of these, 149 patients were selected for the study based upon the following inclusion criteria: exposure to a traumatic event before the onset of pain (with scores equal to or higher than 8 points on the fear and hopelessness scales of the Stressful Life Event Screening Questionnaire Revised) and scores equal to or higher than 30 on the Davidson Trauma Scale. RESULTS Structural equation modelling was used to test the association between PTSD symptoms and pain outcomes (pain intensity and disability) using the mediating variables considered in the fear-avoidance models. The results show that emotional numbing and hyperarousal symptoms, but neither re-experiencing nor avoidance, affected pain outcome via anxiety sensitivity (AS), catastrophizing and fear of pain. PTSD symptoms increased the levels of AS, which predisposes to catastrophizing and, in turn, had an effect on the tendency of pain patients to respond with more fear and avoidance. CONCLUSIONS This study provides empirical support for the potential role of PTSD symptoms in fear-avoidance models of chronic pain and suggests that AS is a relevant variable in the relationship between both disorders.
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Affiliation(s)
- A E López-Martínez
- Faculty of Psychology, Department of Personality, Assessment and Psychological Treatment, University of Málaga, Spain
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