Affective psychotherapy in post-traumatic reactions guided by affective neuroscience: memory reconsolidation and play

This paper reviews the affective neuroscience dealing with the effects of traumatic events. We give an overview of the normal fear reactions, the pathological fear reaction, and the character of emotional episodic memories. We find that both emotions and emotional memories are a tripartite unit of sensory information, autonomic reaction, and motor impulse (the PRM complex). We propose that emotions and movements are part and parcel of the same complex. This is our main finding from the review of affective neuroscience, and from here we focus on psychotherapy with post-trauma reactions. The finding of the process of memory reconsolidation opens up a new treatment approach: affective psychotherapy focused on reconsolidation. The meaning of reconsolidation is that an emotional memory, when retrieved and being active, will rest in a labile form, amenable to change, for a brief period of time, until it reconsolidates in the memory. This leads us to the conclusion that emotions, affects, must be evoked during the treatment session and that positive emotion must come first, because safety must be part of the new memories. In the proposed protocol of affective psychotherapy based on reconsolidation the emotional episodic memory is relived in a safe and positive setting, focused in turn on the sensory experience, the autonomic reaction, and the motor impulse. Then it is followed by a fantasy of a different positive version of the same event. All in all treatment should provide a series of new memories without fear related to the original event. With the focus on the motor program, and the actions, there is a natural link to art therapy and to the mode of play, which can rehearse and fantasize new positive actions

Epidemiology of subdural haemorrhage during infancy : A population-based register study

Objectives To analyse subdural haemorrhage (SDH) during infancy in Sweden by incidence, SDH category, diagnostic distribution, age, co-morbidity, mortality, and maternal and perinatal risk factors; and its association with accidents and diagnosis of abuse. Methods A Swedish population-based register study comprising infants born between 1997 and 2014, 0-1 years of age, diagnosed with SDH-diagnoses according to the (International Classification of Diseases, 10th version (ICD10), retrieved from the National Patient Register and linked to the Medical Birth Register and the Death Cause Register. Outcome measures were: 1) Incidence and distribution, 2) co-morbidity, 3) fall accidents by SDH category, 4) risk factors for all SDHs in the two age groups, 0-6 and 7-365 days, and for ICD10 SDH subgroups: S06.5 (traumatic SDH), I62.0 (acute nontraumatic), SDH and abuse diagnosis. Results Incidence of SDH was 16.5 per 100 000 infants (n = 306). Median age was 2.5 months. For infants older than one week, the median age was 3.5 months. Case fatality was 6.5%. Male sex was overrepresented for all SDH subgroups. Accidental falls were reported in 1/3 of the cases. One-fourth occurred within 0-6 days, having a perinatal risk profile. For infants aged 7-365 days, acute nontraumatic SDH was associated with multiple birth, preterm birth, and small-for-gestational age. Fourteen percent also had an abuse diagnosis, having increased odds of being born preterm, and being small-for-gestational age. Conclusions The incidence was in the range previously reported. SDH among newborns was associated with difficult birth and neonatal morbidity. Acute nontraumatic SDH and SDH with abuse diagnosis had similar perinatal risk profiles. The increased odds for acute nontraumatic SDH in twins, preterm births, neonatal convulsions or small-for-gestational age indicate a perinatal vulnerability for SDH beyond 1st week of life. The association between prematurity/small-for-gestational age and abuse diagnosis is intriguing and not easily understood.Peer reviewe

Neurobiology of Sleep Disturbances in PTSD Patients and Traumatized Controls: MRI and SPECT Findings

OBJECTIVE: Sleep disturbances such as insomnia and nightmares are core components of post-traumatic stress disorder (PTSD), yet their neurobiological relationship is still largely unknown. We investigated brain alterations related to sleep disturbances in PTSD patients and controls by using both structural and functional neuroimaging techniques. METHOD: Thirty-nine subjects either developing (n = 21) or not developing (n = 18) PTSD underwent magnetic resonance imaging and a symptom-provocation protocol followed by the injection of 99mTc-hexamethylpropyleneamineoxime. Subjects were also tested with diagnostic and self-rating scales on the basis of which a Sleep Disturbances Score (SDS; i.e., amount of insomnia/nightmares) was computed. RESULTS: Correlations between SDS and gray matter volume (GMV)/regional cerebral blood flow (rCBF) were computed in the whole sample and separately in the PTSD and control groups. In the whole sample, higher sleep disturbances were associated with significantly reduced GMV in amygdala, hippocampus, anterior cingulate, and insula; increased rCBF in midbrain, precuneus, and insula; and decreased rCBF in anterior cingulate. This pattern was substantially confirmed in the PTSD group, but not in controls. CONCLUSION: Sleep disturbances are associated with GMV loss in anterior limbic/paralimbic, PTSD-sensitive structures and with functional alterations in regions implicated in rapid eye movement-sleep control, supporting the existence of a link between PTSD and sleep disturbance

Novel Avenues for Plant Protection: Plant Propagation by Somatic Embryogenesis Enhances Resistance to Insect Feeding

Somatic embryogenesis (SE), a clonal propagation method utilizing somatic cells, occurs under conditions that activate plant stress adaptation mechanisms such as production of protective secondary metabolites. Surprisingly, possible differences in susceptibility to insect pests between SE-generated and conventionally cultivated plants have not been previously explored. Here, we recorded frequencies and levels of bark-feeding damage by pine weevils (Hylobius abietis) in two large field trials, consisting of emblings (SE-propagated plants) and seedlings from 50 half-sib Norway spruce (Picea abies) families. We found that emblings were less frequently attacked by pine weevils, and when attacked, they were damaged to a lesser extent than seedlings. Moreover, we detected significant additive genetic variation in damage levels received by plants, indicating a heritable component to differences in resistance to insect herbivory among half-sib families. We present first-time evidence that emblings can be more resistant than seedlings to herbivorous insect damage, thus, SE appears to confer a previously unknown plant protection advantage. This finding indicates novel avenues to explore mechanisms underlying plant resistance and new approaches to develop non-toxic measures against insect pests

Circularity bias in abusive head trauma studies could be diminished with a new ranking scale

AbstractCausality in abusive head trauma has never been fully established and hence no gold standard exists for the diagnosis. Implications hereof include bias introduced by circular reasoning and a shift from a trustful doctor patient relationship to a distrustful one when the caregiver statement is questioned. In this paper we examine seven recent abusive head trauma studies including 476 diagnosed abuse cases for circular reasoning as well as the role of the caregiver statement in the diagnosis. Secondly, we present a novel ranking scale for the diagnosis of abusive head trauma designed to minimize circular reasoning. We found circularity to be a potential source of bias in all seven studies. The caregiver statement (lack of trauma mechanism or trauma mechanism considered incompatible with clinical findings) was listed as a diagnostic item in 329 (69%) of 476 cases. Applying our ranking scale to the abuse cases showed that the demands of our ranking scale were not fulfilled in 440 (92%) cases. We conclude that most abuse cases in the studies were, to some extent, diagnosed on criteria based on circular reasoning. The caregiver statement was one of the most frequently used diagnostic items. Hypothetically, caregivers offer no or inadequate explanation to the clinical findings in assumed abuse cases. Thus, when this feature is encountered, it is regarded as indicative of abuse adding further to the risk of circularity bias.We propose the use of our novel ranking scale in abusive head trauma research in an effort to minimize circular reasoning

Post-traumatic stress disorder: neurobiology and effects of eye movement desensitization and reprocessing

The aim of this study was to evaluate a new psychotherapy method, eye movement desensitization and reprocessing (EMDR) in the treatment of post-traumatic stress disorder (PTSD) and to study the biological reactions in PTSD during a script-driven symptom provocation. PTSD is a disorder that may occur after a major psychological trauma. It is characterised by the phenomenon of reliving, bringing the person back to the sensations and reactions that prevailed during the traumatic event. This intrusion is often followed by avoidance of trauma-related reminders, irritability and emotional numbing. The disorder is longstanding to chronic and is a major contributor to psychiatric morbidity. In this study drivers and other personnel in the Stockholm public transportation system participated. The subjects had experienced a person under train accident or assault at work. Fifty-three subjects, one-third women, participated and were diagnostically evaluated as PTSD or non-PTSD subjects. They were assessed with interview based and self-evaluation symptom scales. In comparison these two groups differed sharply in the scores on psychiatric symptoms, social functioning and well-being. The trauma load was higher in the PTSD group as compared to the non-PTSD group. The 21 subjects diagnosed with PTSD were randomly assigned to a treatment group and a waiting-list control group. The primary outcome variable was remission of PTSD. The treatment with EMDR followed the standard protocol. The therapy was given in five one-and-a-half hour sessions. When the therapy group was compared with the waiting list group there were significant differences in remission rate (67%, 11%, respectively) and in the interview based scales. Subsequently, also the waiting-list group received therapy and 20 subjects completed therapy which was assessed immediately after treatment, at eight months and at 35 months. The initial positive results remained and were consolidated (remisson rate 65% at 35 months). There was also significant improvement over time in social functioning and work capacity. The effect size comparing scores on the Global Assessment of Functioning (GAF) scale before treatment and at 35 months, was for the total treatment group 1.3 and in the immediate remitters 3.0. Heart rate and blood pressure increased significantly during the symptom provocation, both in the PTSD and the non-PTSD group and also both before and after therapy, irrespective of outcome. This was evaluated as a reaction to a fear signal which was not identical with the anxiety reaction that characterised the PTSD group. The total group reacted after the symptom provocation with increased blood flow distribution in the right hemisphere and this was more pronounced in the PTSD subjects and even more in the assaulted subjects. The PTSD group showed higher activity in limbic areas involved in memory and emotion. After therapy there was a trend towards normalisation of tracer distribution with a decrease in limbic and an increase in pre-frontal areas. There was no difference in the size of the hippocampi in the PTSD and the non-PTSD group, but such a difference was observed comparing the remitters with the non-remitters. Summarising, we found that EMDR was effective in ameliorating PTSD symptoms in this sample and we also found physiological differences in PTSD subjects as compared to non-PTSD subjects regarding regional cerebral blood flow

Parents' experiences of seeking health care and encountering allegations of shaken baby syndrome : A qualitative study

Objectives - To explore parents' experiences of seeking health care for their children and instead being accused by healthcare professionals of Shaken Baby Syndrome/Abusive Head Trauma (SBS/AHT), being reported to Social Services, undergoing judiciary processing, and the impact of these events on family (dis)integration. Methods - Design: A qualitative study based on qualitative content analysis. Participants: Twelve parents in Sweden, mothers and fathers, seeking health care for their infants, encountering allegations of SBS/AHT, losing custody of their infants, and being subjected to a judiciary process, and finally regaining custody of their children. Data collection: In-depth interviews. Results - An overarching theme 'Fighting for protection of their child after being trapped by doctors' and four sub-themes were developed to reflect the parents' experiences, reactions and interpretations. The first sub-theme, 'Being accused of injuring the child', illuminated the shock experienced when seeking care and instead being accused of being a perpetrator. The second, 'Chaos and powerlessness', refers to the emotions experienced when losing custody of the child and being caught in the enforcement of legislation by the authorities. The third, ' The unified fight against the doctors' verdict ', illustrates the parents' fight for innocence, their worry for the lost child, and their support and resistance. The fourth, 'The wounded posttraumatic growth', describes the emotions, grief, panic, anxiety, and challenges in reuniting the family, but also the parents' reflections on personal growth. Unanimously, they had experienced the authorities' inability to reconsider, and expressed a deep mistrust of paediatric care. Conclusions - Being wrongly accused of child abuse and alleged SBS/AHT evoked emotions of intense stress, but parents endured because of a successful fight to regain custody of their child. However, the trauma had a long-term impact on their lives with residual posttraumatic stress symptoms and mistrust towards healthcare services and the authorities. The results provide important inferences for restoring system failures within child protection services

Do Inter-Country Differences in the Frequency of Abusive Head Trauma Reflect Different Proportions of Overdiagnosis of Abuse or True Differences in Abuse?

Non peer reviewe