Dissociation and interpersonal autonomic physiology in psychotherapy research: an integrative view encompassing psychodynamic and neuroscience theoretical frameworks

Interpersonal autonomic physiology is an interdisciplinary research field, assessing the relational interdependence of two (or more) interacting individual both at the behavioral and psychophysiological levels. Despite its quite long tradition, only eight studies since 1955 have focused on the interaction of psychotherapy dyads, and none of them have focused on the shared processual level, assessing dynamic phenomena such as dissociation. We longitudinally observed two brief psychodynamic psychotherapies, entirely audio and video-recorded (16 sessions, weekly frequency, 45 min.). Autonomic nervous system measures were continuously collected during each session. Personality, empathy, dissociative features and clinical progress measures were collected prior and post therapy, and after each clinical session. Two-independent judges, trained psychotherapist, codified the interactions\u2019 micro-processes. Time-series based analyses were performed to assess interpersonal synchronization and de-synchronization in patient\u2019s and therapist\u2019s physiological activity. Psychophysiological synchrony revealed a clear association with empathic attunement, while desynchronization phases (range of length 30-150 sec.) showed a linkage with dissociative processes, usually associated to the patient\u2019s narrative core relational trauma. Our findings are discussed under the perspective of psychodynamic models of Stern (\u201cpresent moment\u201d), Sander, Beebe and Lachmann (dyad system model of interaction), Lanius (Trauma model), and the neuroscientific frameworks proposed by Thayer (neurovisceral integration model), and Porges (polyvagal theory). The collected data allows to attempt an integration of these theoretical approaches under the light of Complex Dynamic Systems. The rich theoretical work and the encouraging clinical results might represents a new fascinating frontier of research in psychotherapy

A neurocognitive model of high anxiety trait in victims with post disasters experience

People with disasters experience are the most vulnerable victims of high anxiety trait. This behavior could develop overtime to pure anxiety if the individuals do not have any means of support. Hence, understanding this behaviour in the individuals is an essential means of unveiling anxiety emergence. Anxiety has been a phenomenon of focus over the years. Its manifestations have been extensively studied at the lower level of human functioning system (the body). Also, some researches have extended to the higher level of cognitive functions. Still, evidences showed that a precise approach have not been provided to elicit its emergence in human behavior. Meanwhile, extant literatures showed that anxiety disorders are the most prevalent psychological problems the world is facing today. More so, numerous numbers of people around the globe were suffering from these disorders. Therefore, this study examines how individuals with post disasters experience could develop anxiety by virtue of exposure to further events in the environment. This is a proactive measure to cater for wider emergence of anxiety disorders that might arise through disasters occurrence which is now a worldwide affair. This aspect was achieved through consideration for the role of neurocognitive mechanisms in the emergence of anxiety. The outcome of the investigation shows that, neurocognitive mechanisms play role in the emergence of anxiety. This was demonstrated through computational modeling concept to simulate those mechanisms identified through literatures and expert opinions. Increased activation of amygdala is observed to favor the development of anxiety while that of the prefrontal cortex favor the prevention of anxiety and vice versa. In addition, possible transformation of the individuals’ conditions was assessed using mathematical equations to show the possible changes overtim

Addressing neuroticism in psychological treatment

Neuroticism has long been associated with psychopathology and there is increasing evidence that this trait represents a shared vulnerability responsible for the development and maintenance of a range of common mental disorders. Given that neuroticism may be more malleable than previously thought, targeting this trait in treatment, rather than its specific manifestations (e.g., anxiety, mood, and personality disorders), may represent a more efficient and cost-effective approach to psychological treatment. The goals of the current manuscript are to (a) review the role of neuroticism in the development of common mental disorders, (b) describe the evidence of its malleability, and (c) review interventions that have been explicitly developed to target this trait in treatment. Implications for shifting the focus of psychological treatment to underlying vulnerabilities, such as neuroticism, rather than on the manifest symptoms of mental health conditions, are also discussed.First author draf

Response to Uncertain Threat in Acute Trauma Survivors

Uncertainty is often associated with subjective distress and a potentiated anxiety response. The heightened response to uncertainty may be a central mechanism via which anxiety-, trauma-, and stressor-related disorders are developed and maintained. The current study compared the neural response to predictable and unpredictable threat in acute trauma survivors to clarify the role of the response to uncertain threat in fear circuitry and further inform the nature of the development of PTSD in the context of uncertain threat. The novel study showed that anticipating unpredictable (primarily negative images) relative to predictable images increased activation in a frontoparietal network and was associated with decreased acute trauma symptoms, suggesting this network may be associated with an adaptive mechanism for responding to unpredictable threat. Results also showed increased PTSD symptoms was associated with more sustained activation during unpredictable vs. predictable blocks in the insula. Additionally, those with more severe PTSD symptoms had greater response to transient relative to sustained unpredictable (vs. predictable) conditions in the superior frontal gyrus. These findings extend previous work highlighting the insula’s role in sustained responsivity to unpredictability in anxiety disorders and PTSD to symptomatology in acute trauma survivors. Finally, widespread sustained activation of predominantly frontocentral and frontoparietal regions in unpredictable relative to predictable blocks was associated with increased intolerance of uncertainty

Etiological and gender perspectives of anxiety disorder development

This paper presents a comprehensive, integrative review of research on the biological, environmental, and cognitive etiology of anxiety. Causes of generalized anxiety disorder, specific and social phobias, panic disorder, and obsessive-compulsive disorder are discussed, as is the role of gender in anxiety development. Biological research concerning genetic heritability, neurobiological structure, and neurotransmitter functioning are reviewed. Environmental factors such as aversive events, parental interactions, environmental control, and learning are discussed, followed by research on cognitive distortions, attribution style, attention biases, and catastrophic cognitions. The review finds evidence of an interaction between biological, environmental and cognitive variables, as well as a mediating influence of gender. Research is still needed to determine the processes and interactions by which anxiety develops and the reasons for gender differences in disorder prevalence. The review shows that research and analysis have been inadequate in making connections between each of the biological, environmental, and cognitive factors. Although research has clearly indicated that each of the aforementioned variables influence anxiety disorder development, most studies have examined only one aspect of anxiety etiology, disregarding the impact of other potential causes

Childhood Interpersonal Trauma and its Repercussions in Adulthood: An Analysis of Psychological and Interpersonal Sequelae

Despite decades of prevention campaigns and research, childhood interpersonal trauma (i.e., psychological, physical and sexual abuse, psychological and physical neglect, witnessing interparental violence) remains an endemic problem with longstanding and deleterious negative effects on adult psycho-relational functioning. This chapter aims to present a comprehensive literature review of the repercussions associated with exposure to childhood interpersonal trauma. First, the nature and various forms of childhood interpersonal trauma are described. Subsequently, a review of the studies documenting disruptions in psychological and interpersonal functioning and the mechanisms explaining the development of each of these repercussions is unraveled. These repercussions include posttraumatic stress disorder, anxiety disorders, depression, personality disorders, affect dysregulation, substance use disorders, eating disorders, suicidal behaviors, alterations in attention and consciousness, disruptions in attributions, attachment, sexuality and violence in intimate relationships. Finally, suggestions for future research and intervention guidelines with childhood interpersonal trauma survivors are discussed

Empirically supported emerging and marginalized psychotherapies: Integration of non-concurrent multiple baseline design and hermeneutic single case efficacy design

According to APA division 12, at least two Randomized Clinical Trials (RCT) or alternatively nine Single Case Experimental Design (SCED) are required to be recognized as Empirically Supported Treatments (EST). Multiple baseline is the most suitable SCED in psychotherapy research because the treatment effects do not reverse after conclusion and do not require withdrawal in ABAB phases. Treatment's introduction is staggered sequentially across multiple participants, which allows the researcher to demonstrate that changes occur when treatment is introduced, simulating a waiting list. Hermeneutic Single Case Efficacy Design (HSCED) ensures time series analysis as the SCED, adding also qualitative and hermeneutic analysis that allow the recognition of bidirectional linkage between outcome and process variables. Furthermore, external judges assess the quality of the studies providing a verdict of good, mixed or poor outcome. To present systematic replication of multiple non-concurrent baseline HSCED as a way to empirically support both emerging and marginalized models of psychotherapy. After a phase of assessment and the collection of a stable three-point baseline, change in a convenience sample of five patients was tracked with quantitative (PHQ9, STAI, CORE-OM, PQ) and qualitative (HAT, CI) measures. Hermeneutic analysis and judge evaluation were conducted according HSCED protocol. Quantitative data show Clinical Significant and Global Reliable Change in all patients, supported by qualitative data. Hermeneutic analysis suggests specific outcome-to-process linkage and therapeutic interventions followed by shift in weekly outcome measures, supporting and refining the theoretical predictions of the manualized Intensive Transactional Analysis Psychotherapy. Combining multiple baseline design and HSCED, it is possible to support recognition as EST of emerging and marginalized treatments, involving less resources than RCT

Dopamine transporter and transmission of psychopathological risk. A review of gene-environment interplay

Research underlines that intergenerational transmission of psychopathological risk results from a complex interplay of genetic and environmental risk factors which predispose child to develop emotionalbehavioral problems. Mechanisms of transmission are poorly understood, but few studies have focused on the role played by dopamine transporter (DAT) gene. This review aims to examine mediating mechanism of DAT genotype-environmental interaction (GxE), DAT genotype-environmental correlation (rGE), and methylation status involved in transmission of psychopathological risk. The review of literature was made through researches in university libraries on paper material, and telematics systems research. Studies have evidenced that DAT is implicated in intergenerational transmission of psychopathological risk. Results are mixed regarding its genetic variants, but mechanisms through which this gene can affect both quality of parenting and child development are partially established. Only few studies have examined methylation mechanisms that can be implicated. Findings suggest to involve an improved focus on DAT genotypes, methylation status associated, and their relationship with environment to better understanding child’s vulnerability and resilience following exposure to contextual risk factors associated with parental psychopathological symptoms

Modeling Treatment Outcomes in Eating Disorders

Eating disorders are notoriously difficult and costly to treat, with only 40% of individuals with an eating disorder making a full recovery. Individually Tailored Service Allocation provides a dynamic treatment model defined by empirically accepted theory and consistently informed by data provided by the patient. The use of patient feedback allows for the tailoring of individual treatment plans to meet the unique and varied needs of each patient. Hierarchical Linear Modeling was used to examine the effect of Individually Tailored Service Allocation on eating disorder treatment outcomes. A total of 51 adult women meeting diagnostic criteria for an eating disorder participated in this study. Participants were randomly assigned to treatment as usual or individually tailored treatment groups. Changes in psychological dysfunction and distress were measured biweekly throughout the course of treatment using the Outcome Questionnaire 45. The results of this study indicate variability in levels of global psychological dysfunction (both within and between subjects) throughout the course of treatment appear to be the norm, rather than an exception, and this variability is related to eating disorder treatment outcomes. The choice of treatment methodology and level of Individually Tailored Service Allocation has the ability to drastically shift treatment outcomes