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Weinfeld-Yehoudayan A, Czamanski-Cohen J, Cohen M, Weihs KL. A Theoretical Model of Emotional Processing in Visual Artmaking and Art Therapy. ARTS IN PSYCHOTHERAPY 2024; 90:102196. [PMID: 39281342 PMCID: PMC11391909 DOI: 10.1016/j.aip.2024.102196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2024]
Abstract
Current theoretical models of emotional processing rely mainly on detecting emotional processing through verbal, conscious, and cognitive processes. However, artmaking can potentially reveal embodied and implicit processes that may otherwise remain hidden in verbal expression. This paper attempts to close the scholarly gap by introducing a novel art-based emotional processing model that integrates emotional processing and art therapy literature, incorporating emotional meaning-making, awareness, acceptance, and memory consolidation. The art-based EP model explains the processes through which art creation may benefit emotional processing. It also elucidates the ways in which art therapy can be used to enhance therapeutic outcomes.
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Affiliation(s)
- Asnat Weinfeld-Yehoudayan
- School of Creative Arts Therapies, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Johanna Czamanski-Cohen
- School of Creative Arts Therapies, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
- The Emili Sagol Creative Arts Therapies Research Center, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Miri Cohen
- School of Social Work, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Karen L Weihs
- Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, United States
- Cancer Prevention and Control Program, University of Arizona, Comprehensive Cancer Center, Tucson, AZ, United States
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Eckland NS, Thompson RJ. State Emotional Clarity Is an Indicator of Fluid Emotional Intelligence Ability. J Intell 2023; 11:196. [PMID: 37888428 PMCID: PMC10607947 DOI: 10.3390/jintelligence11100196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 09/25/2023] [Accepted: 10/08/2023] [Indexed: 10/28/2023] Open
Abstract
Emotional clarity is one facet of emotional intelligence that refers to one's meta-understanding of and ability to identify and describe feelings. The existing research has largely focused on trait emotional clarity and its benefits for greater psychological well-being, more successful emotion regulation/coping, and diminished psychopathology. Researchers have begun to examine state or momentary emotional clarity in daily life. In this paper, we situate emotional clarity within the larger literature on emotional intelligence abilities. Then, we argue that state clarity relies on the ability to incorporate information from the dynamic contexts that emotions unfold in and should more closely reflect one's emotional intelligence ability relative to traditional trait measures. In addition, we review and make recommendations for measuring state emotional clarity in daily life and propose future research directions, focusing on how state emotional clarity could inform the study of emotion regulation, decision making, and goal pursuit in daily life.
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Affiliation(s)
- Nathaniel S. Eckland
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, USA
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3
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Intolerance of Uncertainty and Emotional Processing in Adolescence: Separating Between-Person Stability and Within-Person Change. Res Child Adolesc Psychopathol 2023; 51:871-884. [PMID: 36703018 PMCID: PMC9879745 DOI: 10.1007/s10802-022-01020-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2022] [Indexed: 01/28/2023]
Abstract
Previous research on the relation between Intolerance of Uncertainty (IU) and Emotional Processing (EP) during adolescence is limited. The present study aimed to clarify how IU and EP evolve over time, to what extent they are related, and whether changes in one precede or follow changes in the other. A total of 457 Italian adolescents (53.1% girls) aged 11 to 18 years (M = 14.1 ± 2.27) completed the IU and EP scales on three separate occasions three months apart (T1, T2, and T3). Data were modeled using a Random-Intercept Cross-Lagged Panel Model (RI-CLPM) that separates individual differences between individuals from intraindividual changes. Descriptive analyses showed that IU was relatively stable between T1 and T2 and decreased slightly between T2 and T3. Consistent with the view that emotion regulation improves as adolescents develop, EP difficulties were found to decrease between T1 and T2 and between T2 and T3. The RI-CLPM revealed a strong between-person effect, showing that individual differences in IU and EP remained consistent throughout the study. In addition, significant within-person change was found, with adolescents who increased their IU at T1 and T2 also increasing their EP difficulties at T2 and T3, respectively. The opposite effect had a smaller effect size. In sum, our study showed that IU and EP are intertwined in adolescents and that changes in IU precede corresponding changes in EP. These results suggest a priority of change between IU and EP and confirm the relationship between IU and emotion regulation problems in adolescence.
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Maroti D, Lumley MA, Schubiner H, Lilliengren P, Bileviciute-Ljungar I, Ljótsson B, Johansson R. Internet-based emotional awareness and expression therapy for somatic symptom disorder: A randomized controlled trial. J Psychosom Res 2022; 163:111068. [PMID: 36327532 DOI: 10.1016/j.jpsychores.2022.111068] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/11/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Somatic symptom disorder (SSD) is commonly encountered in health care settings. Cognitive-behavioural treatments have been most extensively studied, but they tend to have small effects of temporary duration. Emotional awareness and expression therapy (EAET) is a newly developed treatment for SSD, targeting emotional processing of trauma and conflict as a mechanism of symptom change. In an earlier uncontrolled study of self-guided, internet-administrated EAET (I-EAET), we found substantial reductions in somatic symptoms, prompting the need for a randomized controlled trial of I-EAET. METHODS We conducted a 2-arm RCT, comparing 10-week I-EAET (n = 37) to a waitlist control (WL; n = 37). Primary outcomes were reductions of somatic symptoms (PHQ-15) and pain intensity (BPI-4) at post-treatment, with a 4-month evaluation of effect duration. We also analysed emotional processing (EPS-25) and depression (PHQ-9) as possible mediators of I-EAET's effects. RESULTS Compared to controls, I-EAET significantly reduced somatic symptoms at both post-treatment and follow-up. I-EAET also reduced pain, depression, insomnia, and anxiety at post-treatment, but these effects were not retained at follow-up. As hypothesized, a facet of emotional processing partially mediated the treatment effect on somatic symptoms, even when controlling for depression. CONCLUSIONS Although treatment effects were smaller than in the previous uncontrolled trial, I-EAET is a promising treatment for SSD, with a minority of patients (around 20%) experiencing substantial clinical improvement. The benefits of I-EAET are partially mediated by improved emotional processing. Future research should identify and target patients who respond best to I-EAET and develop tailored treatment to enhance treatment effects. (Preregistered at clinicaltrials.gov: NCT04751825.).
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Affiliation(s)
- Daniel Maroti
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
| | - Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, MI, USA..
| | - Howard Schubiner
- Department of Internal Medicine, Ascension Providence-Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI, USA
| | - Peter Lilliengren
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden..
| | - Indre Bileviciute-Ljungar
- Department of Clinical Sciences, Karolinska Institute and Department of Rehabilitation Medicine, Danderyd Hospital, Stockholm, Sweden..
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
| | - Robert Johansson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Department of Psychology, Stockholm University, Stockholm, Sweden..
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Maroti D, Axelsson E, Ljótsson B, Andersson G, Lumley MA, Johansson R. Psychometric properties of the emotional processing scale in individuals with psychiatric symptoms and the development of a brief 15-item version. Sci Rep 2022; 12:10456. [PMID: 35729355 PMCID: PMC9213431 DOI: 10.1038/s41598-022-14712-x] [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] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 06/10/2022] [Indexed: 11/16/2022] Open
Abstract
The 25-item Emotional Processing Scale (EPS) can be used with clinical populations, but there is little research on its psychometric properties (factor structure, test-retest reliability, and validity) in individuals with psychiatric symptoms. We administered the EPS-25 to a large sample of people (N = 512) with elevated psychiatric symptoms. We used confirmatory factor analysis to evaluate three a priori models from previous research and then evaluated discriminant and convergent validity against measures of alexithymia (Toronto Alexithymia Scale-20), depressive symptoms (Patient Health Questionaire-9), and anxiety symptoms (Generalized Anxiety Disorder-7). None of the a priori models achieved acceptable fit, and subsequent exploratory factor analysis did not yield a clear factor solution for the 25 items. A 5-factor model did, however, achieve acceptable fit when we retained only 15 items, and this solution was replicated in a validation sample. Convergent and discriminant validity for this revised version, the EPS-15, was r = - 0.19 to 0.46 vs. TAS-20, r = 0.07- 0.25 vs. PHQ-9, and r = 0.29- 0.57 vs. GAD-7. Test-retest reliability was acceptable (ICC = 0.73). This study strengthens the case for the reliability and validity of the 5-factor structure of the EPS but suggest that only 15 items should be retained. Future studies should further examine the reliability and validity of the EPS-15.
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Affiliation(s)
- Daniel Maroti
- Department of Clinical Neuroscience, Karolinska Institutet, 171 65, Stockholm, Sweden.
| | - Erland Axelsson
- Department of Clinical Neuroscience, Karolinska Institutet, 171 65, Stockholm, Sweden
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Liljeholmen Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Karolinska Institutet, 171 65, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Karolinska Institutet, 171 65, Stockholm, Sweden
- Department of Behavioral Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Robert Johansson
- Department of Clinical Neuroscience, Karolinska Institutet, 171 65, Stockholm, Sweden
- Department of Psychology, Stockholm University, Stockholm, Sweden
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Pontone S, Lauriola M, Palma R, Panetta C, Tomai M, Baker R. Do difficulties in emotional processing predict procedure pain and shape the patient's colonoscopy experience? BMJ Open 2022; 12:e050544. [PMID: 35190415 PMCID: PMC8860019 DOI: 10.1136/bmjopen-2021-050544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Pain and fear of colonoscopy are inter-related; they make the colonoscopy experience unpleasant and impede adherence to colorectal cancer screening and prevention campaigns. According to previous research, fear and pain have been found to depend on patients' maladaptive cognitions and exaggerated emotional responses. The present study investigated whether emotional processing difficulties predicted colonoscopy pain and the associated catastrophising thoughts. DESIGN Prospective, observational, blinded. METHOD A sample of 123 patients was assessed for specific emotional processing difficulties (ie, suppression of emotions, unprocessed emotions, failure to control emotions, avoidance of emotional triggers and impoverished emotional experience) and anxiety-related variables (ie, worry, anxiety and depression) before colonoscopy. A trained medical doctor rated patients' behavioural manifestations of pain during colonoscopy. After complete recovery from sedation, the patients rated the endoscopy experience using perceived pain and situation-specific pain catastrophising scales. RESULTS About half of the patients were above the cut-off for anxiety before the procedure. Notwithstanding sedation, behavioural manifestations of pain during colonoscopy indicated probable or moderate pain for about one-third of the patients. Failure to control emotions, poor emotional experience and avoiding emotional triggers were positively correlated with behavioural manifestations of pain, self-reported pain and pain catastrophising. Regression analyses, controlling for gender, age, colonoscopy experience and sedation, revealed that avoidance of emotional triggers uniquely contributed to predicting pain outcomes. CONCLUSIONS Early identification of emotional processing difficulties associated with pain catastrophising can help define personalised psychological preparation paths to manage negative emotions in patients who fear colonoscopy pain.
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Affiliation(s)
- Stefano Pontone
- Department of Surgical Sciences, Sapienza University of Rome, Roma, Italy
| | - Marco Lauriola
- Department of Social and Developmental Psychology, Sapienza University of Rome, Roma, Italy
| | - Rossella Palma
- Department of Surgical Sciences, Sapienza University of Rome, Roma, Italy
| | - Cristina Panetta
- Department of Surgical Sciences, Sapienza University of Rome, Roma, Italy
| | - Manuela Tomai
- Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Roma, Italy
| | - Roger Baker
- Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, Poole, UK
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Hayes SC. Defusion and Acceptance as Treatment Processes in Cognitive Behavioral Therapy. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lauriola M, Donati MA, Trentini C, Tomai M, Pontone S, Baker R. The Structure of the Emotional Processing Scale (EPS-25). EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2021. [DOI: 10.1027/1015-5759/a000632] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. The Emotional Processing Scale (EPS) assesses emotional processing in terms of suppression, signs of unprocessed emotion, controllability of emotions, avoidance of emotional triggers, and impoverished emotional experience. Previous confirmatory factor analyses (CFA) yielded insufficient fit and questioned the EPS factors’ discriminant validity. The present study aimed to test unidimensional, five-factor, and bifactor models using exploratory structural equation modeling (ESEM) and CFA. We administered the scale to 350 Italian participants in good health and 346 gastrointestinal patients referred for endoscopy because of mild-to-severe gastrointestinal symptoms. ESEM models outperformed corresponding CFA models. The bifactor ESEM model was a good fit in single group analyses and achieved metric and scalar invariance in multigroup analyses. The inspection of latent mean differences revealed a consistent trend for patients to avoid emotional triggers and have less general emotional processing difficulties. The study clarified the EPS factor structure and supported its use to assess the emotional processing of medical patients and community participants.
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Affiliation(s)
- Marco Lauriola
- Department of Social and Developmental Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | | | - Cristina Trentini
- Dynamic and Clinical Psychology and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Manuela Tomai
- Dynamic and Clinical Psychology and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Stefano Pontone
- Department of Surgical Sciences, Faculty of Medicine and Dentistry, Sapienza University of Rome, Italy
| | - Roger Baker
- Clinical Research Unit, Faculty of Health and Social Sciences, Bournemouth University, UK
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Maroti D, Ljótsson B, Lumley MA, Schubiner H, Hallberg H, Olsson PÅ, Johansson R. Emotional Processing and Its Association to Somatic Symptom Change in Emotional Awareness and Expression Therapy for Somatic Symptom Disorder: A Preliminary Mediation Investigation. Front Psychol 2021; 12:712518. [PMID: 34690868 PMCID: PMC8528965 DOI: 10.3389/fpsyg.2021.712518] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/20/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: The aim of this study was to investigate emotional processing as a potential mediator in therapist-guided, internet-based Emotional Awareness and Expression Therapy (I-EAET) for somatic symptom disorder, using data from a previously published pilot study. Methods: Participants (N = 52) engaged in a 9-week I-EAET treatment. Before treatment and each week during treatment (i.e., 10 weekly measurements), emotional processing was assessed with the Emotional Processing Scale-25 (EPS-25), which contains five subscales, and somatic symptoms were assessed with the Patient Health Questionnaire-15 (PHQ-15). Results: Mediation analyses using linear mixed models showed that two EPS-25 subscales—Signs of Unprocessed Emotions and Impoverished Emotional Experience—were uniquely associated with somatic symptom reduction. The proportion of the mediated effect was 0.49, indicating that about half of the total association of the PHQ-15 with symptoms was accounted for by the two EPS-25 subscales. Conclusion: This preliminary mediation analysis suggests that improved emotional processing is associated with change in somatic symptoms in I-EAET. However, randomized controlled and comparison trials are needed to establish that I-EAET creates the change in emotional processing and that such changes are specific to I-EAET.
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Affiliation(s)
- Daniel Maroti
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Mark A Lumley
- Department of Psychology, Wayne State University, Detroit, MI, United States
| | - Howard Schubiner
- Department of Internal Medicine, Ascension Providence-Providence Hospital, Michigan State University College of Human Medicine, Southfield, MI, United States
| | - Henrik Hallberg
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Per-Åke Olsson
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Robert Johansson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Psychology, Stockholm University, Stockholm, Sweden
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10
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Pinheiro P, Gonçalves MM, Nogueira D, Pereira R, Basto I, Alves D, Salgado J. Emotional processing during the therapy for complicated grief. Psychother Res 2021; 32:678-693. [PMID: 34663184 DOI: 10.1080/10503307.2021.1985183] [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] Open
Abstract
OBJECTIVE Prior research, mainly conducted on depression, observed that clients' improved capability to process their emotions predicted better therapeutic outcomes. The current comparative study aimed to investigate whether emotional processing was related to therapeutic change in complicated grief. METHOD We analyzed two contrasting cases (good or poor outcome) treated with grief constructivist therapy. In both cases we investigated the association of emotional processing (Experiencing Scale) to (1) therapeutic outcome (Inventory of Complicated Grief), and (2) change in the type of grief-related emotions (Emotions Episodes). RESULTS The session-by-session growth of clients' emotional processing and the change of grief-related emotions were qualitatively explored throughout both cases. Compared with the poor outcome case, the good outcome case achieved more improvement in the ability to process emotions. Such improvement occurred alongside a deeper change in the type of grief-related emotions aroused, from maladaptive to more adaptive responses. CONCLUSION Our findings suggest that a higher emotional processing capability may be associated with the transformation of grief-related maladaptive emotions and with the improvement of complicated grief condition.
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Affiliation(s)
- Patrícia Pinheiro
- School of Psychology, University of Minho, Braga, Portugal.,Department of Social and Behavior Sciences, University of Maia, Maia, Portugal
| | | | - Daniela Nogueira
- Department of Social and Behavior Sciences, University of Maia, Maia, Portugal
| | - Rui Pereira
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Isabel Basto
- Department of Social and Behavior Sciences, University of Maia, Maia, Portugal.,Center for Psychology at the University of Porto, University of Porto, Porto, Portugal
| | - Daniela Alves
- School of Psychology, University of Minho, Braga, Portugal
| | - João Salgado
- Department of Social and Behavior Sciences, University of Maia, Maia, Portugal.,Center for Psychology at the University of Porto, University of Porto, Porto, Portugal
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Edwards DJ, Lowe R. Associations Between Mental Health, Interoception, Psychological Flexibility, and Self-as-Context, as Predictors for Alexithymia: A Deep Artificial Neural Network Approach. Front Psychol 2021; 12:637802. [PMID: 33868110 PMCID: PMC8044902 DOI: 10.3389/fpsyg.2021.637802] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/02/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Alexithymia is a personality trait which is characterized by an inability to identify and describe conscious emotions of oneself and others. Aim: The present study aimed to determine whether various measures of mental health, interoception, psychological flexibility, and self-as-context, predicted through linear associations alexithymia as an outcome. This also included relevant mediators and non-linear predictors identified for particular sub-groups of participants through cluster analyses of an Artificial Neural Network (ANN) output. Methodology: Two hundred and thirty participants completed an online survey which included the following questionnaires: Toronto alexithymia scale; Acceptance and Action Questionnaire 2 (AQQII); Positive and Negative Affect Scale (PANAS-SF), Depression, Anxiety, and Stress Scale 21 (DAS21); Multidimensional Assessment of Interoceptive Awareness (MAIA); and the Self-as-Context (SAC) scale. A stepwise backwards linear regression and mediation analysis were performed, as well as a cluster analysis of the non-linear ANN upper hidden layer output. Results: Higher levels of alexithymia were associated with increased psychological inflexibility, lower positive affect scores, and lower interoception for the subscales of “not distracting” and “attention regulation.” SAC mediated the relation between emotional regulation and total alexithymia. The ANNs accounted for more of the variance than the linear regressions, and were able to identify complex and varied patterns within the participant subgroupings. Conclusion: The findings were discussed within the context of developing a SAC processed-based therapeutic model for alexithymia, where it is suggested that alexithymia is a complex and multi-faceted condition, which requires a similarly complex, and process-based approach to accurately diagnose and treat this condition.
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Affiliation(s)
- Darren J Edwards
- Department of Public Health, Policy, and Social Sciences, Swansea University, Swansea, United Kingdom
| | - Rob Lowe
- Department of Psychology, Swansea University, Swansea, United Kingdom
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12
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Røssberg JI, Evensen J, Dammen T, Wilberg T, Klungsøyr O, Jones M, Bøen E, Egeland R, Breivik R, Løvgren A, Ulberg R. Mechanisms of change and heterogeneous treatment effects in psychodynamic and cognitive behavioural therapy for patients with depressive disorder: a randomized controlled trial. BMC Psychol 2021; 9:11. [PMID: 33482927 PMCID: PMC7821688 DOI: 10.1186/s40359-021-00517-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 01/15/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a prevalent psychiatric condition associated with significant disability, mortality and economic burden. Cognitive behavioral therapy (CBT) and psychodynamic psychotherapy (PDT) are found to be equally effective for patients with depression. However, many patients do not respond sufficiently to either treatment. To offer individualized treatment, we need to know if some patients benefit more from one of the two therapies. At present little is known about what patient characteristics (moderators) may be associated with differential outcomes of CBT and PDT, and through what therapeutic processes and mechanisms (mediators) improvements occur in each therapy mode. Presently only theoretical assumptions, sparsely supported by research findings, describe what potentially moderates and mediates the treatment effects of CBT and PDT. The overall aim of this study is to examine theoretically derived putative moderators and mediators in CBT and PDT and strengthen the evidence base about for whom and how these treatments works in a representative sample of patients with MDD. METHODS One hundred patients with a diagnosis of MDD will be randomized to either CBT or PDT. Patients will be treated over 28 weeks with either CBT (one weekly session over 16 weeks and three monthly booster sessions) or PDT (one weekly session over 28 weeks). The patients will be evaluated at baseline, during the course of therapy, at the end of therapy, and at follow-up investigations 1 and 3 years post treatment. A large range of patient and observer rated questionnaires (specific preselected putative moderators and mediators) are included. DISCUSSION The clinical outcome of this study may better guide clinicians when deciding what kind of treatment any individual patient should be offered. Moreover, the study aims to further our knowledge of what mechanisms lead to symptom improvement and increased psychosocial functioning. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03022071.
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Affiliation(s)
- J. I. Røssberg
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, 0424 Nydalen, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, P.O. Box 1171, 0318 Blindern, Oslo, Norway
- Division of Psychiatric Treatment Research, Oslo University Hospital, Oslo, Norway
| | - J. Evensen
- Nydalen Outpatient Clinic, P.O. Box 4959, 0424 Nydalen, Oslo, Norway
| | - T. Dammen
- Department of Behavioural Science in Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - T. Wilberg
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, 0424 Nydalen, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, P.O. Box 1171, 0318 Blindern, Oslo, Norway
| | - O. Klungsøyr
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, 0424 Nydalen, Oslo, Norway
| | - M. Jones
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, 0424 Nydalen, Oslo, Norway
| | - E. Bøen
- Department of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - R. Egeland
- Department of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - R. Breivik
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, 0424 Nydalen, Oslo, Norway
| | - A. Løvgren
- Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4959, 0424 Nydalen, Oslo, Norway
| | - R. Ulberg
- Institute of Clinical Medicine, University of Oslo, P.O. Box 1171, 0318 Blindern, Oslo, Norway
- Department of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
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Chung MC, Chen ZS. The Interrelationship Between Child Abuse, Emotional Processing Difficulties, Alexithymia And Psychological Symptoms Among Chinese Adolescents. J Trauma Dissociation 2021; 22:107-121. [PMID: 32673192 DOI: 10.1080/15299732.2020.1788689] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study examined the interrelationship between child abuse, emotional processing difficulties, alexithymia, and psychological symptoms with posttraumatic stress disorder (PTSD) symptoms from past traumas adjusted among Chinese adolescents. Eight hundred adolescents completed questionnaires measuring the preceding psychological constructs. After controlling for PTSD from past trauma, structural equation modeling showed that child abuse correlated with emotional processing difficulty which correlated with alexithymia. In turn, alexithymia correlated with psychological symptom severity. To conclude, child abuse can affect psychological health among Chinese adolescents. This relationship, however, is influenced by the degree to which processing distressing emotions and getting in touch with internal feelings is avoided.
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Affiliation(s)
- Man Cheung Chung
- Department of Educational Psychology, Ho Tim Building, Faculty of Education, The Chinese University of Hong Kong , Shatin, Hong Kong
| | - Zhuo Sheng Chen
- China University of Political Science and Law , Beijing, China
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Molavi P, Aziziaram S, Basharpoor S, Atadokht A, Nitsche MA, Salehinejad MA. Repeated transcranial direct current stimulation of dorsolateral-prefrontal cortex improves executive functions, cognitive reappraisal emotion regulation, and control over emotional processing in borderline personality disorder: A randomized, sham-controlled, parallel-group study. J Affect Disord 2020; 274:93-102. [PMID: 32469838 DOI: 10.1016/j.jad.2020.05.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/02/2020] [Accepted: 05/06/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Borderline personality disorder (BPD) is primarily characterized by deficient emotion regulation. Impaired cognitive control over negative emotions is central to emotion dysregulation in BPD. Respective executive dysfunctions are associated with hypoactivation of prefrontal regions, and consecutive alterations of fronto-limbic network functionality. Here, we investigated the effect of increasing activity of the dorsolateral prefrontal cortex (DLPFC) with repeated transcranial direct current stimulation (tDCS) on (1) executive dysfunctions and (2) whether improving cognitive control affects emotion dysregulation and emotional processing in BPD. METHODS Thirty-two patients diagnosed with BPD were randomly assigned to active stimulation (N = 16) or sham stimulation (N = 16) group in a randomized, sham-controlled, parallel-group design. They received 10 sessions of active (2 mA, 20 min, anodal left- cathodal right DLPFC) or sham tDCS over 10 days. Major executive functions, emotion regulation strategies, and emotional processing of the patients were assessed before and immediately after the intervention. RESULTS The active stimulation group showed a significant improvement in major executive function domains. Importantly, cognitive reappraisal strategy of emotion regulation and several factors of emotional processing involved in the control of emotion significantly improved in the active stimulation group after the intervention. Factors related to emotional expression were, however, not affected. LIMITATIONS The single-blind design, absence of follow-up measures, and the intrinsically limited focality of tDCS are limitations of this study. CONCLUSIONS Increasing activity of the DLPFC improves executive functioning in BPD and improves ´cognitive control over negative emotions. Cognitive control interventions could be a potential, symptom-driven therapeutic approach in BPD.
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Affiliation(s)
- Parviz Molavi
- Department of Psychiatry, Fatemi Hospital, School of Medicine, Ardabil University of Medical Science, Ardabil, Iran
| | - Samaneh Aziziaram
- Department of Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Sajjad Basharpoor
- Department of Psychology, University of Mohaghegh Ardabili, Ardabil, Iran.
| | - Akbar Atadokht
- Department of Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Institute for Working Environment and Human Factors, Dortmund, Germany; University Medical Hospital Bergmannsheil, Department of Neurology, Bochum, Germany
| | - Mohammed Ali Salehinejad
- Department of Psychology and Neurosciences, Leibniz Research Institute for Working Environment and Human Factors, Dortmund, Germany; Ruhr-University Bochum, International Graduate School of Neuroscience, Bochum, Germany.
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15
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Pinheiro P, Gonçalves MM, Sousa I, Salgado J. What is the effect of emotional processing on depression? A longitudinal study. Psychother Res 2020; 31:507-519. [PMID: 32558621 DOI: 10.1080/10503307.2020.1781951] [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: 10/24/2022] Open
Abstract
Emotional processing is an empirically established predictor of pre-post therapy improvement in depression. However, its relationship to symptom alleviation over time requires clarification. To clarify the contribution of emotional processing to gradual symptom improvement, we explored both (1) the effect of emotional processing on pre-post therapy changes in depressive symptoms (final outcome) and (2) its association with the intensity of clinical symptoms across sessions (session-by-session outcome). These relationships were estimated in a sample of 50 depressed clients treated with cognitive-behavioral therapy (CBT) or emotion-focused therapy (EFT). Emotional processing was measured by the Experiencing Scale during Emotion Episodes in five sessions taken across therapy. As expected, we found that a greater increase in emotional processing during treatment predicted a greater pre-post therapy improvement in depressive symptoms. Higher levels of emotional processing predicted next-session lower intensity on clinical symptoms, but the intensity of symptoms contributed to explaining the subsequent level of emotional processing achieved. Our observations suggest that clients' capabilities to process their emotions may both facilitate and be promoted by gradual improvement in symptoms. These results suggest the reciprocal predictive influence of emotional processing and symptoms on the therapeutic change in depression.
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Affiliation(s)
- Patrícia Pinheiro
- School of Psychology, University of Minho, Braga, Portugal.,Department of Social Science and Behavior, University Institute of Maia - ISMAI, Maia, Portugal
| | | | - Inês Sousa
- Department of Mathematics and Applications, Centre of Molecular and Environmental Biology, University of Minho, Braga, Portugal
| | - João Salgado
- Department of Social Science and Behavior, University Institute of Maia - ISMAI, Maia, Portugal.,Center for Psychology at the University of Porto, University of Porto, Porto, Portugal
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16
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A little less talk, a little more action: a dialogical approach to cognitive therapy. COGNITIVE BEHAVIOUR THERAPIST 2019. [DOI: 10.1017/s1754470x19000333] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Reappraisal strategies such as ‘thought challenging’ and ‘cost-benefits analysis’ are a hallmark of cognitive therapy, but sometimes fail to bring about lasting changes in the cognitive-affective structures underlying psychopathology. Modern theories of information processing suggest that experiential, action-based interventions such as chairwork may be a more efficacious route to cognitive modification. Based upon this hypothesis, a ‘dialogical’ approach to cognitive therapy is presented, which aims to bring about change through evocative, here-and-now interactions with parts of the self (self-to-self dialogues) and other individuals (self-to-other dialogues). Implementation principles and facilitation skills which guide this approach are outlined. To illustrate how dialogical interventions are utilized in clinical practice, chair-based strategies for socializing clients to the cognitive behavioural model, restructuring cognitions, facilitating emotional processing, resolving ambivalence, addressing distressing memories, building character strengths, and overcoming therapeutic impasses are described.
Key learning aims
As a result of reading this paper, the reader should:
(1)
Understand the limits of ‘standard’ cognitive techniques.
(2)
Appreciate some of the advantages of experiential methods of intervention, namely chairwork.
(3)
Learn how dialogical interventions are conceptualized, implemented, and facilitated in cognitive therapy.
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17
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Gay MC, Baker R, Vrignaud P, Thomas P, Heinzlef O, Haag P, Banovic I, Thomas S. Cross-cultural validation of a French version of the Emotional Processing Scale (EPS-25). EUROPEAN REVIEW OF APPLIED PSYCHOLOGY 2019. [DOI: 10.1016/j.erap.2019.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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18
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Emotion processing in intermittent explosive disorder. Psychiatry Res 2019; 273:544-550. [PMID: 30710810 DOI: 10.1016/j.psychres.2019.01.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 01/11/2019] [Accepted: 01/11/2019] [Indexed: 12/30/2022]
Abstract
Intermittent explosive disorder (IED), a disorder characterized by outbursts of affective aggression, is associated with deficits in regulating emotions. However, less is known about specific deficits in understanding and processing emotions in IED. This study sought to fill that gap by examining components of emotion processing (rumination, alexithymia, and empathy) in those with IED. Participants completed diagnostic interviews and self-report measures, and were categorized into three diagnostic groups: IED (n = 177), Psychiatric Control (PC; n = 171), and Healthy Volunteer (HV; n = 144). Those with IED reported more anger rumination and greater difficulty identifying their feelings than PC or HV participants. Interestingly, those with IED reported higher affective empathy scores than those in the HV group, with no other group differences on measures of empathy. Amongst those with IED, increased anger rumination and decreased sadness rumination predicted greater lifetime aggression, while increased sadness rumination predicted poorer quality of life. These findings suggest that although those with IED have a harder time recognizing their emotions, once they identify feeling angry, they spend more time focused this emotion than those with other disorders. These findings also suggest that cognitive intervention techniques may be beneficial for those with IED.
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19
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Changes in Emotion Processing following Brief Augmented Psychodynamic Interpersonal Therapy for Functional Neurological Symptoms. Behav Cogn Psychother 2018; 46:350-366. [DOI: 10.1017/s1352465817000807] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background: Functional neurological symptoms (FNS) are considered non-volitional and often very disabling, but are not explainable by neurological disease or structural abnormalities. Brief Augmented Psychodynamic Interpersonal Therapy (BAPIT) was adapted to treat the putative emotion processing deficits thought to be central to FNS aetiology and maintenance. BAPIT for FNS has previously been shown to improve levels of distress and functioning, but it is unknown whether improvements on such measures correlate with changes in emotion processing ‒ which this treatment focuses on. Aim: To determine (a) whether the recently developed Emotional Processing Scale-25 can be used to demonstrate BAPIT-associated changes in patients with FNS, and (b) whether changes in the EPS-25 are associated with changes in previously validated outcome measures. Method: 44 patients with FNS completed questionnaires including the EPS-25 and measures of clinical symptomology (health-related quality of life (SF-36), somatic symptoms (PHQ-15), psychological distress (CORE-10) and illness understanding (BIPQ)) pre- and post-therapy. Results: At group level, emotion processing improved following therapy (p = .049). Some measures of clinical symptomology also improved, namely health-related quality of life (p = .02) and illness understanding (p = .01). Improvements in the EPS-25 correlated with improvements in mental health-related quality of life and psychological distress. Conclusions: Emotion processing and some measures of clinical symptomology improved in patients with FNS following BAPIT. The EPS-25 demonstrated changes that correlated with previously validated outcome measures. The EPS-25 is a suitable measure of psychotherapy-associated change in the FNS patient population.
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21
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Sibelli A, Chalder T, Everitt H, Workman P, Bishop FL, Moss-Morris R. The role of high expectations of self and social desirability in emotional processing in individuals with irritable bowel syndrome: A qualitative study. Br J Health Psychol 2017; 22:737-762. [PMID: 28862389 DOI: 10.1111/bjhp.12264] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 07/21/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Although high levels of distress are associated with the onset and severity of Irritable bowel syndrome (IBS), it is unclear how this relates to emotional processing, particularly in relation to maintenance of symptoms and treatment outcome. This qualitative study embedded within a randomized controlled trial aimed to explore how individuals with refractory IBS experience, express, and manage their emotions after either therapist-delivered cognitive behavioural therapy (TCBT) or Web-based CBT (WBCBT) compared to treatment as usual (TAU). DESIGN Cross-sectional qualitative study. METHODS Fifty-two semi-structured interviews were conducted at post-treatment with 17 TCBT, 17 WBCBT, and 18 TAU participants. The transcripts were analysed using inductive thematic analysis with grounded theory elements. NVivo 11 was used to compare themes across groups. RESULTS Across all groups, high expectations of self was a recurring reason for how participants experienced and expressed their emotions. Three themes with subthemes captured how high expectations related to specific aspects of emotional processing: perceived causes of emotions, strategies for coping with emotions (bottling up, avoiding emotions, and active coping strategies), and the perceived interplay between emotions and IBS symptoms. CONCLUSIONS Patients recognized that their IBS symptoms both triggered and were triggered by negative emotions. However, there was a tendency to bottle up or avoid negative emotions for reasons of social desirability regardless of whether patients had CBT for IBS or not. Future psychological interventions in IBS may benefit from addressing negative beliefs about expressing emotions, promoting assertive emotional expression, and encouraging the experience of positive emotions. Statement of contribution What is already known on this subject? High levels of distress are consistently associated with both the onset and maintenance of IBS symptoms. Little is known about how this relates to the concept of emotional processing. Preliminary findings suggest a positive correlation between poor emotional processing and IBS. However, further studies need to confirm its role in relation to aetiology, maintenance of symptoms, and response to treatment. What does this study add? High expectations of self and social desirability seem to be important aspects shaping the way individuals with IBS experience, express, and manage their emotions. Emotional avoidance and bottling up were reported as key strategies to cope with negative emotions. The study revealed that bottling up is not perceived as an all-or-nothing strategy but can be applied selectively depending on the context. Psychological interventions in IBS may benefit from addressing not only illness-related causes of negative emotions but also personal and social triggers of distress.
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Affiliation(s)
- Alice Sibelli
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Weston Education Centre, King's College London, UK
| | - Hazel Everitt
- Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, UK
| | - Paul Workman
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | | | - Rona Moss-Morris
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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22
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Kimhy D, Wall MM, Hansen MC, Vakhrusheva J, Choi CJ, Delespaul P, Tarrier N, Sloan RP, Malaspina D. Autonomic Regulation and Auditory Hallucinations in Individuals With Schizophrenia: An Experience Sampling Study. Schizophr Bull 2017; 43:754-763. [PMID: 28177507 PMCID: PMC5472124 DOI: 10.1093/schbul/sbw219] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Auditory Hallucinations (AH) cause substantial suffering and dysfunction, yet remain poorly understood and modeled. Previous reports have linked AH to increases in negative emotions, suggesting a role for the autonomic nervous system (ANS) in underlying this link. Employing an Experience Sampling Method (ESM) approach, 40 individuals with schizophrenia completed a 36-hour ambulatory assessment of AH and cardiac autonomic regulation. Participants carried mobile electronic devices that prompted them to report 10 times/d the severity of their momentary AH, along with a Holter monitor that continuously recorded their cardiac autonomic regulation. The clocks of the devices and monitors were synchronized, allowing for high time-resolution temporal linking of the AH and concurrent autonomic data. Power spectral analysis was used to determine the relative vagal (parasympathetic) contribution to autonomic regulation during 5 minutes prior to each experience sample. The participants also completed interview-based measures of AH (SAPS; PSYRATS). The ESM-measured severity of AH was significantly correlated with the overall SAPS-indexed AH severity, along with the PSYRATS-indexed AH frequency, duration, loudness, degree of negative content, and associated distress. A mixed-effect regression model indicated that momentary increases in autonomic arousal, characterized by decreases in vagal input, significantly predicted increases in ESM-measured AH severity. Vagal input averaged over the 36-hour assessment displayed a small but significant inverse correlation with the SAPS-indexed AH. The results provide preliminary support for a link between ANS regulation and AH. The findings also underscore the highly dynamic nature of AH and the need to utilize high time-resolution methodologies to investigate AH.
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Affiliation(s)
- David Kimhy
- Department of Psychiatry, Columbia University, New York, NY;,New York State Psychiatric Institute, New York, NY
| | - Melanie M. Wall
- Department of Psychiatry, Columbia University, New York, NY;,New York State Psychiatric Institute, New York, NY
| | | | | | - C. Jean Choi
- New York State Psychiatric Institute, New York, NY
| | - Philippe Delespaul
- Departments of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Nicholas Tarrier
- Department of Psychology, University of Manchester, Manchester, UK
| | - Richard P. Sloan
- Department of Psychiatry, Columbia University, New York, NY;,New York State Psychiatric Institute, New York, NY
| | - Dolores Malaspina
- Department of Psychiatry & Child Psychiatry, New York University Medical Center, New York, NY
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23
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Chapman HR, Chipchase SY, Bretherton R. Understanding emotionally relevant situations in primary dental practice. 3. Emerging narratives. Br Dent J 2017; 219:491-6. [PMID: 26611308 DOI: 10.1038/sj.bdj.2015.888] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND AIMS Dentists experience considerable occupational stress. Stressful clinical situations can provoke high levels of negative emotions, and situations which are associated with positive emotions tend to be overlooked by practitioners. Reflection regarding difficult situations is encouraged to facilitate learning. Cognitive behavioural therapy (CBT) formulations may be applied to situations appraised both positively and negatively. Analysis and interpretation of the dentist's coping behaviour and the consequent outcomes facilitate learning and reflection upon individual interactions with patients. METHOD Twenty primary care dental practitioners in the greater Lincoln area participated in a semi-structured interview which explored their stressful and positive clinical experiences. Some of the episodes were analysed to create CBT formulations. RESULTS AND DISCUSSION CBT formulations are presented and the learning points highlighted by this structured presentation are discussed. In particular, it is suggested that this structured reconstruction of events, which highlights dentists' emotions, responses and the transactional effects of coping responses, might well facilitate objective reflective learning either individually or as part of peer to peer support. It should facilitate dentists' emotional processing of events and may thus contribute to stress reduction. CONCLUSION CBT formulations of positive and negative dental scenarios may be constructed. It is proposed that this is a useful technique to foster reflection and learning in clinical situations and should lead to improved communication skills and shared decision-making, resulting in fewer complaints and thereby reduced stress. It should also improve dentists' emotional processing.
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Affiliation(s)
- H R Chapman
- Paul Lowe Dentistry, 31 Farmhouse Way, Monkspath, Solihull, B90 4EH
| | | | - R Bretherton
- School of Psychology, University of Lincoln, Brayford Pool, Lincoln, LN6 7TS
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Chung MC, Di X, Wan KH. Exploring the interrelationship between alexithymia, defense style, emotional suppression, homicide-related posttraumatic stress disorder and psychiatric co-morbidity. Psychiatry Res 2016; 243:373-81. [PMID: 27449006 DOI: 10.1016/j.psychres.2016.05.057] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 05/30/2016] [Accepted: 05/31/2016] [Indexed: 11/19/2022]
Abstract
This study investigated the interrelationship between alexithymia, defense style, emotional suppression, posttraumatic stress disorder (PTSD) following homicide and psychiatric co-morbidity. One hundred and fifty male homicide perpetrators and 156 male perpetrators of non-violent crime completed the Posttraumatic Stress Diagnostic Scale (except for non-violent perpetrators), the General Health Questionnaire-28, the Defense Styles Questionnaire, the Courtauld Emotional Control Scale and the Toronto Alexithymia Scale-20. The results showed that 44% of homicide perpetrators met the criteria for PTSD. No significant differences were found between groups in alexithymia, defense style and psychiatric co-morbidity. Homicide perpetrators suppressed depression significantly more than the non-violent group. PLS analyses showed that alexithymia was significantly correlated with defense style. Defense styles were significantly correlated with emotional suppression which, in turn, was associated with homicide-related PTSD and psychiatric co-morbidity. To conclude, perpetrators can experience PTSD reactions following the act of homicide. The severity of these reactions and other psychological problems were related to difficulty getting in touch with distressing emotions, the defenses they used to protect themselves psychologically and the way they suppressed their emotion.
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Affiliation(s)
- Man Cheung Chung
- The Chinese University of Hong Kong, Department of Educational Psychology, Ho Tim Building, Faculty of Education, Shatin NT, Hong Kong, People's Republic of China.
| | - Xiaohu Di
- Faculty of Law, Nanjing University, People's Republic of China
| | - King Hung Wan
- Adjunct Researcher, Institute of Crime Prevention & Control, Faculty of Law, People's Republic of China
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25
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26
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McGillivray L, Becerra R, Harms C. Prevalence and Demographic Correlates of Alexithymia: A Comparison Between Australian Psychiatric and Community Samples. J Clin Psychol 2016; 73:76-87. [DOI: 10.1002/jclp.22314] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Rodrigo Becerra
- Edith Cowan University; Western Australia
- Fremantle Adult Mental Health Services
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Baker R, Gale L, Abbey G, Thomas S. Emotional Processing Therapy for post traumatic stress disorder. COUNSELLING PSYCHOLOGY QUARTERLY 2013. [DOI: 10.1080/09515070.2013.816840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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