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Sem New Develop Psych

by: Trever Reichert DDS

Sem New Develop Psych PSY 607

Marketplace > University of Oregon > Psychlogy > PSY 607 > Sem New Develop Psych
Trever Reichert DDS
GPA 3.99

Jennifer Freyd

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Jennifer Freyd
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This 28 page Class Notes was uploaded by Trever Reichert DDS on Tuesday September 8, 2015. The Class Notes belongs to PSY 607 at University of Oregon taught by Jennifer Freyd in Fall. Since its upload, it has received 54 views. For similar materials see /class/187251/psy-607-university-of-oregon in Psychlogy at University of Oregon.


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Date Created: 09/08/15
Effects on psycheemotionsrelationshipsdistress Part H May 5 2003 Discussion Leaders Carole Dorham Jennifer Hogansen amp Allison Lau Psy 607 Trauma as etiology Trauma as etiology Overview Six articles Brief summary of each Common themes CSA and longitudinal associations mechanisms oftransmission of psychopathology specificity of psychpathology mediators methodology eg correlation causality Discussion questions for the whole group Trauma as etiology Childhood Maltreatment Increases Risk for Personality Disorders During Early Adulthood Johnson Cohen Brown Smailes amp Bernstein 1999 The Study A communitybased longitudinal study investigating whether childhood maltreatment physical abuse sexual a use and neglect increases the risk for DSMIV personality disorders PDs during early adulthood Controlled effects of offspring age and sex difficult childhood temperament parental education and parental psychiatric disorders Assessed during maternal intervrews in 1975 1983 and 19851986 Combination of selfreports and official data obtained from the state registry of child abuse and neglect Retrospective selfreports of childhood maltreatment obtained from young adult offspring in 19911993 Trauma as etiology 3 Results Physical abuse associated with elevated antisocial and depressive PD symptoms Sexual abuse associated with elevated borderline PD symptoms Neglect associated with elevated symptoms of antisocial avoidant borderline narcissistic and passive aggressive PDs Trauma as etiology 4 Implications Given that childhood physical abuse sexual abuse and neglect are differentially related to certain PDs researchers need to investigate speci c etiologic models for each ofthe different PDs Etiologic theories pay little attention to childhood neglect Current and previous findings suggest that theoretical exploration should be devoted to the harmful effects of childhood neglect Still many questions about the mechanisms of association between selfreported childhood maltreatment and PDs Trauma as etiology Childhood Adversities Interpersonal Difficulties and Risk for Suicide Attempts During Late Adolescence and Early Adulthood Johnson Cohen Gould Kasen Brown amp Brook 2002 The Study An investigation based on data from a previous communitybased longitudinal study These data were used to investigate the following Do negative life events or severe interpersonal difficulties during adolescence mediate the association between childhood adversities and suicide attempts during late adolescence or early adulthood Does maladaptive parenting mediate the association between parental ts psychiatric symptoms and offspring suicide attemp Do adolescent psychiatric symptoms mediate the association between childhood adversities and suicide attempts during late adolescence or early adulthood as indicated by recent research Participants consisted of 659 families with children ages 1 11 who were interviewed in 1975 1983 1985 to 1986 and 19911993 Trauma as etiology Results The following childhood adversities were associated with increased offspring risk for suicide attempts during late adolescence or early adul ood High levels of school violence Harsh parental punishment Low maternal educational aspirations for their youth Maternal possessiveness and verbal abuse Childhood physical and sexual abuse Serious ghts with family members were the only negative life events that were signi cantly associated with increased offspring risk for suicide attempts during late dolescence or early a ul Extreme interpersonal dif culties during middle adolescence mediated the association between maladaptive parenting or abuse during childhood or early a olescence and suicide attempts during adolescence or early a ul h od Psychiatric disorders during adolescence neither moderated nor mediated the association between maladaptive arenting or abuse during childhood or early a olescen 39 attempts during late adolescence or early adul High level of maladaptive parental behavior during childhood and adolescence was associated with the risk for suicide attem ts during late adolescence or early adulthood a er controlling for parental psychiatric disorders Trauma as etiology Implications First h Prospective longitudinal study that investigates this mediational YPO hesls in a systematic way Findings sufggest that high levels of maladaptive parenting or child abuse gt di iculty developing social skills to maintain meaningful relationships with peers and adults gt tendency to become interpersonally isolated or relate to others in a dysfunctional way gt feelings of hopelessness despair and suicidal ideation andor e aVIor Possible to prevent onset of suicidal behavior among adolescents and young adults by raising the awareness among paren s educators and health professionals about the im act of interpersonal difficulties on the development of such suicidal aVIor Trauma as etiology Kendler K S Bulik C M Silberg J Hettema J M Myers J Prescott C A 2000 Childhood sexual abuse and adult psychiatric and substance use disorders in women An epidemiological and cotwin control analyses Archives of General Psychiatry 57 953959 Study aimed to examine the association between childhood sexual abuse CSA and the development of psychiatric and substance use disorders for women in adulthood Authors were particularly interested in further clarifying 4 aspects of this association 1 determine the magnitude ofthe relationship between CSA and adult adjustment 2 determine ifthere is a casual relationship between CSA and adult disorders or of the observed association is confounded be other related risk factors family environment and genetic predisposition 3 does the observed association reflect a reporter bias in that persons with disorders may be more likely to recall and report abuse and 4 does CSA have specific associations with 1 or 2 disorders or is CSA associated with a wide range of disorders Trauma as etiology 9 Study design Sample Participants were femalefemale twin pairs who were participating in an ongoing populationbased Virginia Twin Registry Women ages ranged from 1755 Ethnic breakdown of the sample was not specified though the authors noted that the sample is broadly representative of white women on the United Statesquot Procedure Twin pairs were included in the present study if both twins responded to mail questionnaire which indicated their willingness to participate in the current study Data pertaining to CSA were gathered via face to face mailin and telephone interviews Data was collected over about 8 years though it was not clear what information was collected at which wave Twins provided information on their own CSA their own substance and psychiatric disorder and these experiences in their cotwin Parents reported on their own psychiatric and substance use histories as well as the family environment in which the twins were reared nances stress parentchild relationship etc Analyses Data was analyzed using logistic regression procedures correcting forthe correlations embedded in the data not speci ed Odds ratios and conference intervals yielded from the logistic regressions were examined Trauma as etiology ResultsConclusion Nongenital CSA was signi cantly associated with increased risk for developing alcohol and other drug dependence Genital CSA was signi cantly associated with every disorder except panic disorder and EN All disorders were significantly associated with intercourse When controlling for family context the association between CSA and most disorders was re uce or panic disorder an ese association was strengthened Authors interpreted these results to suggest that little of the association be ween CSA and adult disorders can be accounted for by parental dIsorders Authors reported that their pattern of ndings suggest there is a causal relationship be ween CSA and psychiatric and substance use disorders In adulthood Authors attempted to rule out the possibility that reporter biasquot was accounting for the 0 served association Acknowledged that reports were inconsistent but that this was largely due to the fact that twins approximately 30 had not disclosed their SA experience to anyone Trauma as etiology 11 Some Limitations identified by the authors Sample was all women CSA experience may vary across genders Modest reliability in CSA self report and Twin report Reliability assessment requires the information is available to all informants this was not the case with CSA experiences Retrospective reports of potentially confounding variables such family environment and parental psychopathology Analyses did not attempt to examine the temporal relationship between CSA and onset of psychiatric or substance use disorders additional concerns Drawing causal conclusions based on correlational analyses Trauma as etiology 12 Nelson et al 2002 Association between self reported childhood sexual abuse and adverse psychosocial outcomes Results from a twin study Study aims to examine the association between CSA and adverse adult outcomes Sample 1991 same sex twin pairs 1159 females 832 males from an Australian volunteer twin panel Mean age of sample was around 30 years old SD 25 years Procedure Telephone interviews were conducted with both twins between 19962000 The twin pairs included in this study represented the young cohort of the Australian registr To be included in this study both twins had to respond endorse atleast one CSA question Trauma as etiology 13 Question components Five questions about CSA were used to create a composite CSA SCO re39 Forced sexual intercourse or any other form of sexual activity BEFORE the age of18 Any sexual contacts touching sexual body parts yours ort eirs etween or sexua intercoursebetween yoursel and anyone other than a mily member who was 5 or more years older than you BEFORE you were 16 years 0 Same as 2 but referring to family members listed parent stepparent grandparent uncle aunt brother sister cousin Have you ever been raped has someone ever had sexual intercourse with you when you did not want to by threatening you or using some degree of force apart form an experience of rape Have you ever been sexually molested someone touched or felt your genitals when you did not want them to A standardized psychiatric interview and an adapted version of SemiStructured Assessment for the Genetics of Alcoholism SSAGA were conducted via telephone Lifetime diagnoses were gathered for MD Conduct DO and Alcohol and Nicotine De endence Data was also gathered about marital history suicidal ideations and attempts traumatic events parental alcohol related problems family background and social anxie y Trauma as etiology 14 AnalysesResults Analyses Descriptive analyses were conducted overall and by gender CSA and a range of outcome variables including divorce and rape at or after age 18 were assessed using logistic regressions and survival analyses Odds ratios and confidence intervals were examined Results CSA prevalence rates at least one item endorsed were 167 women and 54 men Survival analyses revealed that CSA was most highly associated with conduct disorder suicide attempts and rape after a e 8 When comparing CSA discordant pairs the twin with CSA experiences was at increased risk for all adverse outcomes assessed Trauma as etiology 15 Read et al 2001 The contribution of early traumatic events to schizophrenia A traumagenic neurodevelopmental NT model Article proposes that for some schizophrenic adults adverse life eventslossesdeprivations may trigger as well as mol neurodevelopmental abnormalities A new diathesisstress model for some adults the diathesis is the abnormal neurodevelopmental process originating in traumatic events in childhood TN model Traumagenic Neurodevelopmental Neurological and biochemical abnormalities can be caused by child abuse Specifically overreactivity of HPA axis abnormal neurotransmitter systems and structural brain changes Such traumainduced abnormalities may contribute to our understanding of various aspects of schizophrenia Trauma as etiology 16 Biopsychosocial model Assumption that diathesis is a genetic predisposition Has impeded consideration of relevance of stress Example of a paradigm asking only those questions that confirm its central assumptions Extent to which we have achieved a balanced integration of bio psychosocial actually has declined over the decades for schizophrenia Need a more longitudinal inclusive approach to role of stressful life events than the current focus on perinatal events and events immediately preceding the first overt psychotic episode Trauma as etiology Neurodevelopmental theories Walker and DiForio 1997 posit that stressors can exacerbate symptoms but do not constitute causal factors constitutional vulnerability heightened sensitivity to stressors Activation of HPA axis is of one of the primary manifestations of the stress response Adrenal cortex stimulated by ACTH from pituitary releases glucocortinoides including cortisol Basically exposure to stressors can lead to permanent changes in the HPA axis impairing the system that serves to dampen HPA activation Call to clarify the nature of developmental changes in the HPA system especially response to stress and its relation to symptoms Read et al argue that exposure to traumatic events in childhood particularly physical and sexual abuse may be individual characteristics that predict sensitivity to stressors Trauma as etiology Relationship between childhood abuse and schizophrenia Widely assumed that child abuse is more related to depression anxiety PTSD etc and less related to more severe psychiatric disorders Child abuse among psychiatric inpatients In 13 studies of SMI women 4592 experienced CPA or CSA Child abuse and schizophrenia Research measures CSACPA related to measures of psychosis Clinical diagnoses Worse outcomes Specific symptomatology Schneiderian symptoms positive Trauma as etiology Neurodevelopmental effects of childhood abuse and neglect Repeated stressors can sensitize neurobiological processes so that the homestasis returned to is at a higher level of responsivity Evidence that child abuse can cause hyperresponsiver of the HPA axis neurotransmitterabnormalities structural abnormalities in the brain Deficits in cognitive functioning Other research implications Multiple pathways to positive and negative symptoms Specificity and severity weakness of NT model is that not all schizophrenic adults suffered traumatic events or neglect as children A postraumatic dissociative psychosis a focus on common etiology rather than symptoms challenge to reliability validity utility of schizophrenia construct Trauma as etiology Clinical implications Conclusion Assessment Clinicians identify an alarmingly small proportion of abuse Response of mental health staff to identified abuse Minimization of relationship between childhood abuse and schizophrenia genes versus family blaming Treatment Lack of effective treatments for survivors of child abuse who have been diagnosed with schizophrenia Summary NT model in need of further exploration Trauma as etiology 21 V dom 1999 critique of Johnson et al 1999 Specificity and overlap Importance of studying neglect Gender Ecological model consider the broader environment in which the child develops Need to take into account characteristics of the child eg temperament Need to move beyond retrospective accounts Trauma as etiology 22 Discussion Questions Johnson et al 1999 and Widom 1999 Why do7you suppose childhood neglect is given little attention in etiological s st u die How would we study and de ne childhood neglect DISCUSSon no les Neglect dirricul lo sludy examples riom pie yous sludies lnal don laccolml roi lecl7 also mann esied n cnid iams iepoiling lo cnid piolecliye Services culuia yanalons7 refeats culuia yaues ng Dirriculroicnidien lo define am iguous How mucn can cnidien designei negem From Socela ieslnclons7 Was illnlenllona7 Supte7 How do We measuie negecl7 How mucn do dmgsacoho usage play a 709 in neg lecl i As measuiemenl possiny lailte a look alpiesence of good lnings easei lnan asilting anoulansence ofgood lnin s How do you think that gender plays a role in the manifestation of formerly abused and neglected men and women7 mm 4 l J 4 Discussion noles Aie silualions different roigiis lnan noys7 is ila nsilt racloi lo ne ferns97 Farmy dynamics boys and gins may be liealed dn l elemy Johnson et al 2002 Fathers were not interviewed to assess paternal behavior and psychiatric symptoms Rather these were assessed during maternal and offspring interviews So how might this have impacted the results D scusson n poiling n y moms and snidien may nol coneale Wiln dad s iepoil moms and snidien iepoil may be affected by Socia desiianiily issue of gelling ralneis in yoyed i Trauma as etiology 23 Discussion questions con t2 Kendler et al 2000 What is the utility of a cotwin design in childhood abuse research a Discusson noles o consensus on uliily of a corlwin desgn diffCUM lo undeisland wny aulnois used il is use disoideis pulling y naid lo lei nolne snaied nelween lWins e g enyiionmenla iaiey examined Nelson et al 2002 What are some implications of using a widerange definition of CSA Whatarethe 39 g a d quot 39 39 n and prospective studies both practical and methodological A mess lo medlca charts elnica impmallon57 Trauma as etiology 24 Discussion questions con t3 Read et al 2001 The authors propose a Traumagenic Neurodevelopmental NT model as a potential explanation for findings in schizophrenia research is are there another disorder for which this model may be appropriate as well The authors discuss two extreme causal explanations for schizophrenia 1 an overreliance on a simplistic biological paradigm genes 2 familyblaming Is the NT model an integration of both perspectives If so how If not what would the model need i y Schizophrenia diagnosis Should be explored from eloogca mode Trauma as etiology Discussion leaders Julien Guillaumot and Sharilyn Lum April 28 2003 Trauma as Etiology Effects on psycheemotionsrelationshipsdistress PART I Discussion articles Fromm S 2001 Total Estimated Cost of Child Abuse amp Neglect In The United States 2001 From Prevent Child Abuse America Retrieved 17 April 2003 from httpwwwpr 39 quot 39 39 org learn more research docscost analvsis ndf Ross CA 2000 The Trauma Model A solution to the problem ofcomorbiditity in psychiatry Richardson Texas Manitou Communications Inc Pages 69219 Notes Discussion topics and questions are listed in bold print Facilitator summaries are listed in bullets under headings Summary ofthe discussion is listed in italics Discussion summaries comefrom in class participation in which class members separated into small groups where they answered specific questions then later brought their ideas to the larger class as a whole General Principles of the Trauma Model Ross 2000 0 De nition of Trauma 0 Measurement of Trauma 0 Trauma Dose Response Curves 0 Developmental Susceptibility o The Threshold Principle 0 Priming o The Noxious Effect of Active Disease 0 Heterogeneity Within Diagnostic Categories 0 Selection Bias 0 Treatment Failures Tend to be Trauma Model Cases 0 Treatment Intervention at Different System Levels 0 Animal Models of Trauma 0 Diagnostic Non Speci city 0f Selective Serotonin Reuptake Inhibitors SSRIs 0 When the Perpetrator is a Primary Attachment Figure Discussion leaders Julien Guillaumot and Sharilyn Lum April 28 2003 De nition of Trauma o PTSD is de ned in the DSMIVTR with two features 0 Person experienced was confronted with or witnessed an event that involved actual or threatened death or serious injury or a threat to the physical integrity 0 Person s response involved intense fear helplessness or horror 0 Trauma is not only related to the actual traumatic experience but also the impact on the person this de nition makes sense in that two people can experience a traumatic event differently which is why it is important to study the trauma response 0 Problem with DSM criteria according to Ross 0 fear helplessness and horror are just a few of the numerous experiences that someone can feel as a result of a traumatic experience others include numbing and detachment as in the DSM criteria for acute stress disorder 9 basic idea is that there is an extreme event and an extreme response 0 conventional definition only speaks of bad things happening but does not address the absence of such events ie absence of love affection and protection from parents Measurement of Trauma 0 Given this complex definition it is important to look at the development of appropriate and reliable measures in understanding trauma Trauma Dose Response Curves 0 Trauma model assumes that there is a doseresponse curve for trauma thinking about dose response curves in pharmacology there is a window where symptoms are reduced as your dose increases Just one aspect of trauma ie number of acts of abuse cannot generate a dose response curve when looking at symptoms developed 9 this is why simply looking at rates of reported sexual abuse in psychological disorders may not reveal the actual role of trauma across disorders Must look at numerous components in calculating trauma dosage ie for sexual abuse you have to look at things such as age at onset duration number of acts severity number of perpetrators degree of intimidation bizarreness of acts how closely related the perpetrator is to the survivor etc What is your reaction to trauma dose response curves In general the idea of increasing symptomatology ie higher scores on the DES to use Ross s example with greater levels of trauma makes sense Ross s explanation is simple enough for someone unfamiliar with the effects of trauma to understand However this simplicity is also a limitation Ross s presentation of dose response curves implies that the e ects of experiencing trauma are additive This belies the complexity and variability of the factors involved in trauma For instance in the case of sexual abuse how would factors such as the duration of abuse age at onset bizarreness of the acts and relationship to the perpetrator be weighted in determining a person s dose of trauma It seems as though Ross treats these factors as if they could be measured on the same scale Despite hesitation to fully accept the simple dose response model we agree with the possibility of shifting the dose response curve to the left or right depending on an Discussion leaders Julien Guillaumot and Sharilyn Lum April 28 2003 individual s unique combination of protective i e strong social support and risk i e lower trauma threshold factors Developmental Susceptibility 0 Trauma model assumes that there is a window of developmental susceptibility for problems developing from traumatic experiences 0 This window opens when someone experiences a trauma and never fully closes but rather it is a matter of decreasing vulnerability with increasing age 0 Important to look at developmental susceptibility when thinking about childhood trauma 0 On one hand a child s brain is more adaptable but also more capable of being affected by environmental input such as a traumatic experience The Threshold Principle 0 Trauma model assumes that people are born with set trauma thresholds but that if the trauma dose is set high enough everyone will develop psychological difficulties 0 Despite these thresholds other variables can affect susceptibility to trauma responses both positively and negatively Priming 0 Another assumption of the trauma model is that a trauma response to a given traumatic experience will be primed by a prior trauma ie war veterans who have experienced childhood abuse may have a higher risk for development PTSD The Noxious Effect of Active Disease 0 Trauma model looks at feedback loops within a trauma survivor s brain and social environment 9 unresolved trauma causes more trauma 0 Flashbacks from traumatic experiences 9 flashbacks alone can be traumatic which creates a cycle of trauma 0 How can therapy address the problem of feedback loops in trauma survivors Heterogeneity Within Diagnostic Categories 0 For any disease there are several developmental pathways 0 None of the psychiatric symptoms have any diagnostic specificity 9 etiologic heterogeneity there is no reason to expect that the brain would generate discrete sets of symptoms for discrete etiologies rather one should expect permutations and combinations of symptom patterns 0 What are the implications for a Trauma as Etiology Model Selection Bias 0 Problem of comorbidity arises from a biased sample of all individuals meeting criteria for one or more DSM disorders As a result the trauma model has low external validity for individuals who have not experienced significant trauma beyond the usual hardships of life 0 What is the problem with limiting ourselves with DSM defmed trauma Can subjective experience and self report be the critical variables in defining one s level Discussion leaders Julien Guillaumot and Sharilyn Lum April 28 2003 of trauma and if so what does it say of the trauma model s level of external validity Limiting ourselves with DSM defined trauma does not take into account the individual s subjective experience It does not take into account all forms of abuse especially di erent types of sexual abuse perpetrated when fear is not present It also does not include absences such as neglect Self report can also be problematic when someone is not de ning something as traumatic An example is when someone is dissociating or when trauma is causing problems in areas unseen by the client Minimization of trauma is often done by survivors as a means of protection Treatment Failures Tend to be Trauma Model Cases Ross states that patients can be divided into two treatment outcome categories successes and failures What is the limitation of such thinking and how does it contradict his approach thus far Limitations include the following Defining success is di icult in and ofitself It is important to identify and understand who is defining success such as a view is dichotomous in thinking why not have more of a continuum when thinking about failure and success Having just two categories is obviously limiting and sets more people up for failure people may find themselves stuck in the unsuccessful category even if improvements are made This perspective assumes a static outcome This view contradicts Ross s view because it is static and does not change over time He rarely speaks in dichotomous terms because of the great variation that exists between individuals Ross is not necessarily mainstream in his thinking and this view seems more conventional 00 O 0 Treatment Intervention at Different System Levels Ross states that brain scans should function as psychotherapy outcome measures Weigh the pros and cons of such an approach not only from a dichotomous as Ross claims outcomes to be treatment perspective but also from a psychoanalytic perspective Using brain scans as therapeutic outcome measures could o quoter a number of advantages From the perspective of advancing scientific knowledge brain imaging data could help to better understand the impact of trauma on the brain Such data might also provide better measures of the active ingredients of successful trauma therapy ifused in conjunction with well controlled studies Brain scans might also help us to avoid the problems of biased self reports and researcher expectancy effects Potential disadvantages of using brain scans as outcome measures warrant caution however The primary danger lies in relying solely on brain scan data to evaluate therapy outcome What if a post therapy brain scan suggests normalization but the client doesn t feel any improvement This would create a validation problem 7 shouldn t Discussion leaders Julien Guillaumot and Sharilyn Lum April 28 2003 the client s sense of improvement or lack thereof take precedence in determining whether therapy was a success 0 Regarding Ross s dichotomous perspective on therapy outcome the problem of false dichotomies is beyond the scope of this discussion but at minimum we would argue that successful outcomes fall along a continuum and depend on the goals of therapy using the results of a brain scan to categorize treatment as a success or failure glosses over the complexities of the brain and the trauma response Of the myriad factors likely relevant to interpreting the results of a brain scan di ering degrees of plasticity among individuals the e quotects of possible pharmacological interventions and the multiple brain regions involved not to mention their interconnections are just a few 0 Exactly what degree of change would qualifv as a successful outcome is unclear How much of a change is su icient to claim therapeutic success Moreover the di iculties in interpreting any brain imaging data would also apply Although imaging data have greatly expanded our understanding of brain structure and function they are correlational in nature Even ifa particular area lights up that doesn t necessarily tell us if that area is critical to improvement 0 Brain imaging data would certainly provide a useful tool for assessing therapy outcomes but should be used with other measures the most important being the client s perspective 0 From a psychodynamic perspective whether or not brain imaging shows significant change after therapy such data does not speak to the underlying processes responsible for change Brain imaging data cannot tell us how or why positive change occurred Animal Models of Trauma 0 When comparing human with animal models Ross states that humans will exhibit the same biological dysregulation seen in the lab animals but that because clinical presentations will normalize on antidepressants and relapse on discontinuation we need to account for spontaneous normalization of the biological dysregulation as part of the natural history of the active clinical disorder 0 What is Ross talking about and why should we control for such normalization Is it true that relapse systematically occurs on discontinuation Ho do humans differ from animals when it comes to dealing with psychological adjustment 0 Both animals and humans change and adapt biologically but with humans there are additional capacities such as emotions and thinking These difkrences put humans apart from animals As in any treatment research study one wants to control for all other factors that may be leading to an outcome Therefore Ross s suggestion of controlling for normalization makes sense while at the same time we have to ask ourselves if there is such a thing as normalization for a given mental disorder 0 For example can we confidently say that for people who are depressed this is about how long it should last and this is when it normally subsides We don t think so given that humans are difkrent from animals because emotions come into play In addition our abilities to think and use our minds are also critical Discussion leaders Julien Guillaumot and Sharilyn Lum April 28 2003 Diagnostic Non Speci city 0f Selective Serotonin Reuptake Inhibitors SSRIs Ross explains SSRIs are effective for numerous disorders illuminating their mechanism of action What is the problem with this assumption in light of the fact that SSREs seem to have the same effect on symptom reduction When the Perpetrator is a Primary Attachment Figure Ross states that the core target of trauma therapy is the problem of attachment to the perpretator He discusses transmarginal inhibition or Stockholm Syndrome In 1973 four Swedes held in a bank vault for six days during a robbery became attached to their captors a phenomenon dubbed the Stockholm Syndrome According to psychologists the abused bond to their abusers was a means to endure violence What do you make of this theory and why would it be adaptive to do this especially when looking at adult adult relationships The Trauma Model and DSM Disorders Ross 2000 Mood Disorders Schizophrenia and Other Psychotic Disorders Anxiety Disorders Substance Related Disorders Somatoform Disorders Dissociative Disorders Factitious Disorders Eating Disorders Sexual and Gender Identity Disorders Sleep Disorders Impulse control Disorders Borderline Personality Disorders Other Axis II Disorders Childhood Disorders Axis III Disorders Totals Estimated Cost of Child Abuse and Neglect in the US Fromm 2001 Can we truly estimate the cost of child abuse and neglect Trauma Treatment Issues Ted Gardner amp Linda Ivy Psychology 607 Trauma as Etiology 2 June 2003 Pharmacotherapy A Pill for Illhat Haunts You Key ideas 1 Medicine may be able to prevent PTSD by altering brain chemistry 2 Gene therapies may be able to make people less vulnerable to emotional injuries Key concerns Reducing suffering alters what makes us human Prozac went from treating severe depression to helping well people feel better even pets At what point do we decide someone should or should not take the drugs Would making the horrors seem not so horrible make us complacent about crime and war Isn t human suffering more than a matter of chemistry NH Lu 5 U1 What about the poss nYty for misuse or abuse Pharmacothera py Against Depression A Sugar Pill Is Hard to Beat Key Ideas 1 Time spent with patients may be important to helping them get well 2 Drugs are prescribed by primary care doctors who see patients for only a short time 3 Many research trials show that placebos work as well or better than antidepressant drugs 4 Nobody seems to know how or why anti depressants or placebos work 5 Placebos work in some of the same places of the brain as antidepressants prefrontal lobe Pharmacotherapy Against Depression A Sugar Pill Is Hard to Beat Considerations 1 Activation in prefrontal cortexquot is nonspecific 2 Possible that antidepressants work in a bottom up direction rather than topdown direction I Does this matter When told they were on placebo functioning deteriorated LU Other ndings 1 Changes in brain function in and symptomatology in OCD and depression have been found after successful CBT Baxter et al 1992 Brody et al 2001 Schwartz et al 1996 Pha rmacothera py Against Depression A Sugar Pill Is Hard to Beat Questions H N LU 4 5 Is it the therapy that works or the belief that the therapy works I Related to expectation and motivation If placebo changes brain function is it a placebo or an active treatment Is medication automatically more active than talk thera pyquot I Should medication be the implicit gold standard Placebo PTSD pill Ethical to not disclose placebo condition if patient improves To Speak or Not To Speak Pennebaker39s Writing Paradigm The Writing Paradigm 1 2 Spend 1530 minutes writing about deep emotions and thoughts about an emotional issue Time and duration varies from once a day for 35 days to once a week for a month People write about a great variety of topics and seem to take the assignment seriously To Speak or Not To Speak Pennebaker39s Writing Paradigm Results of Writing Studies Bene ts to writers of emotional experiences 1 2 Less visits to health center Improved immune functioning changes in autonomic and muscular actrvrty Longterm improvements in mood Significant reductions in stress Less absences from work G tting a new job more quickly after being laid o Improvements in grades To Speak or Not To Speak Pennebaker39s Writing Paradigm Considerations 1 Improvement does not appear to be a result of improved health habits such as more exercise or less smoking exce t one study showed less alcohol consumption Talking and writing about emotional experiences both seem to work better than writing about superficial topics Few individual differences are found to influence who benefits from writing gag personality education language cu ture To Speak or Not To Speak Pennebaker39s Writing Paradigm Why does it work 1 Perhaps active inhibition involves psychological work and disclosure reduces that workload 2 Perhaps building a coherent story about a trauma improves health by reducing flashbacks and ruminations Individuals who have benefited most from writing began with poorly organized descriptions and progressed to coherent stories To Speak or Not To Speak Pennebaker s Writing Paradigm Codi7g Computation of percenta e of negative emotion words sad angry positive emotion wor 5 happy laugh causal words because reason and insight words understand realize General Results 1 More positive emotion words related to better subsequent health A moderate number of negative emotion words predict health very high and very low negative emotion correlated with poorer health An increase in both causal and insight words over the course of writing was strongly associated with improved health I This increase in cognitive words covaried with ratings of coherence N w To Speak or Not To Speak Pennebaker39s Writing Paradigm Activity 1 Smallgroup coding of narrative from Exiled Voices article using Pennebaker s system pos neg causal insight 2 Develop an aternative system for coding written naratlves I May build on Pennebaker s system or may be a completely different approach To Speak or Not To Speak Pennebaker39s Writing Paradigm Compare with coding of Adult Attachment Interview AAI Grice s Maxims of rational or coherent discourse 1 Quality be truthful and have evidence for what you say 2 Quantity be succinct and yet complete 3 Relation be relevant to the topic at hand 4 Manner be clear and orderly To Speak or Not To Speak From AAI Classifications how might these map onto coping with trauma I Secure discussion and evaluation of attachment experiences are reasonably consistent clear relevant and succinct Results in high coherence score Dismissin parents described in positive terms that are unsupported or contra icted violation of maxim of quality no evidence for what they say many also described as being excessively succinct t violating quantity maXIm by using statements like I don emem er Preoccupied violate maxims of relevance quantity and manner Relevance violation tend to wander from topic to topic or move awa from context fo the query quantity violation usually too c embroiled in excessive y lengthy descriptions of past or current problems manner violation use of vague speech eg sort of excessive use of psychological jargon Unresolveddisorganized lapses in metacognitive monitoring Brief slips in monitoring of thinking during discussion of loss or other traumatic events Lapses in reasoning include incompatible ideas simultaneously alive and dead and state shilts To Speak or Not To Speak Repression Possibly Better Than Your Therapist Kedeeas 1 Some psychologists believe that people who talk about a traumatic event appear to get worse or at least fail to get better 2 A study with heart attack victims showed that those patients who minimized denied and distracted had better outcomes than those who thought about worried about and processed their experience 3 A study of widows and widowers and another with sexual abuse survivors showed better adjustment among those who said that they were not depressed but had elevated heart rates 4 Perhaps repression is an effective coping style that leads to the power of positive thinking To Speak or Not To Speak Repression Possibly Better Than Your Therapist Key Ideas 5 The trauma field has a history of encouraging people to talk about their trauma perhaps they have something to lose by paying attention to repression research Repression may seem anti American because of the emphasis on expression in our country Maybe different types of people are best treated by different methods repression may work for some but not for others 8 Maybe we don t know much about repressors because they don t show up for treatment 9 N To Speak or Not To Speak Repression Possibly Better Than Your Therapist DISCUSS0n I Catharsis rambling vs structured disclosure Catharsis not related to change without cognitive component I Disclosure on own time vs coerced disclosure I Is style of disclosure related to selfregulation Article talks about ramblers which may imply poor regulationorganization I High vs low neuroticism constant worry wears out immune system General Adaptation Syndrome Selye Article states high anxiety and low defensiveness thinking about it worrying about it processing it had far poorer outcome than their stiff lipped counterparts


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