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

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

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

ObjectiveSleep 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.MethodThirty-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.ResultsCorrelations 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.ConclusionSleep 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

Populationsundersökningen av kvinnor i Göteborg (Kvinnoundersökningen, KVUS) - undersökning 1968

The population study of women in Gothenburg is a population study based at the University of Gothenburg. The study started as a cross-sectional study in 1968 including 1462 women aged 38, 46, 50 and 60 years. The participants have after that been followed-up with regular examinations in 1974-75, 1980-81, 1992-1993, 2000-2001, 2004-2005, 2009-2010 and 2016-2017. In addition, new participants have been included. During the examinations 2004-2005 and 2016-2017, only women 38 and 50 years old were invited to participate with the purpose of enabling comparison of these age cohorts. The study comprises physical and mental disease as well as health, social and psychological circumstances and data regarding food and dental health. To study determinants among middle age women that have importance for the development of cardiovascular disease, diabetes, cancer, dementia and other mental illness in high age is possible because of the long running follow-ups, high participant rates, and thorough mapping of non-participants and data regarding morbidity and mortality. The study covers both longitudinal trends (change in individuals over time) and secular trends (changes in the population over time). This implies the possibility to study e.g. whether the increased consumption of oestrogenic hormones and new antidepressive agents in the population has influenced the occurrence of cardiovascular disease, dementia, depression and the proportion that are under treatment. The long-running follow-up has also made it possible to study the long term prognosis for these diseases and whether the risk for prolonged illness increases with older age. In addition, women from different birth cohorts are examined at certain ages to investigate secular trends in health related variables, such as obesity and dental health. The questionnaires have been changed as little as possible between each survey. Data from 1968 and 1974 are available from SND. The population study of women in Gothenburg collaborates with the H70 study which started in 1971, a cross-sectional study of men and women in Gothenburg aged 70 years. It is coordinated by several researcher groups, especially the groups handling general medicine, epidemiology, psychiatry and geriatrics. When the participants turned 70 years old, they were invited to participate in the H70 study (1992, 2000), and a follow-up examination of 75 years old participants 2005-2006. Purpose: The purpose of this study was initially to investigate anemia and health factors related to menopause, but has later also included examination of determinants among middle age women that have importance for the development of cardiovascular disease, diabetes, cancer, dementia and other mental illness in high age.Kvinnoundersökningen i Göteborg är en populationsstudie som bedrivs vid Göteborgs universitet. Studien startade 1968 som en tvärsnittsstudie omfattande 1462 kvinnor i åldrarna 38, 46, 50, 54 och 60 år. Sedan dess har deltagarna genomgått regelbundna uppföljningar 1974-75, 1980-81, 1992-1993, 2000-2001, 2004-2005, 2009-2010 och 2016-2017. Samtidigt har nya deltagare tillkommit. Vid undersökningarna 2004-2005 samt 2016-2017 inbjöds endast kvinnor 38 och 50 år gamla att delta för att möjliggöra en jämförelse av dessa ålderskohorter. Studien omfattar såväl kroppsliga och psykiska sjukdomar, hälsa, sociala och psykologiska faktorer som tand- och kostdata. Att studera faktorer hos kvinnor i medelåldern som har betydelse för utveckling av bland annat hjärtkärlsjukdom, diabetes, cancer, demens och andra psykiska sjukdomar i hög ålder är möjligt i kvinnostudien tack vare en lång uppföljningstid, hög deltagarfrekvens, och noggrann kartläggning av bortfall samt sjukdoms- och dödlighetsdata. Studien ger möjlighet att studera både longitudinella trender (förändring över tid hos individer) och sekulära trender (förändring i befolkningen över tid). Man har bl. a. studerat huruvida den ökade förbrukningen av östrogena hormoner och nya antidepressiva läkemedel i befolkningen har påverkat förekomsten av hjärtkärlsjukdom, demens och depression samt andelen som har behandling. De långa uppföljningstiderna har också gjort det möjligt att studera långtidsprognosen för dessa sjukdomar och om risken för långvarig sjukdom ökar med stigande ålder. I studien jämförs även kvinnor från olika födelsekohorter vid vissa åldrar för att studera sekulära trender i hälsorelaterade variabler, som exempelvis fetma och tandhälsa. Frågorna i enkäterna har i så så liten grad som möjligt ändrats mellan varje undersökningsomgång. Data från undersökningen 1968 och 1974 finns hos SND. Kvinnoundersökningen samarbetar med H70-studien som startade 1971, en studie av manliga och kvinnliga 70-åringar i Göteborg och koordineras av flera forskargrupper, framför allt inom allmänmedicin, epidemiologi, psykiatri och geriatrik. Kvinnor i Kvinnoundersökningen erbjöds de åren de fyllde 70 år att delta i H70-studien (1992, 2000) samt till en uppföljning av 75-åringar som genomfördes 2005-2006. Syfte: Syftet med studien var från början att undersöka anemi och hälsofaktorer relaterad till menopaus, men har sedan omfattat även att undersöka faktorer hos kvinnor i medelåldern som har betydelse för utveckling av bland annat hjärtkärlsjukdom, diabetes, cancer, demens och andra psykiska sjukdomar i hög ålder

Populationsundersökningen av kvinnor i Göteborg (Kvinnoundersökningen, KVUS) - undersökning 1974

The population study of women in Gothenburg is a population study based at the University of Gothenburg. The study started as a cross-sectional study in 1968 including 1462 women aged 38, 46, 50 and 60 years. The participants have after that been followed-up with regular examinations in 1974-75, 1980-81, 1992-1993, 2000-2001, 2004-2005, 2009-2010 and 2016-2017. In addition, new participants have been included. During the examinations 2004-2005 and 2016-2017, only women 38 and 50 years old were invited to participate with the purpose of enabling comparison of these age cohorts. The study comprises physical and mental disease as well as health, social and psychological circumstances and data regarding food and dental health. To study determinants among middle age women that have importance for the development of cardiovascular disease, diabetes, cancer, dementia and other mental illness in high age is possible because of the long running follow-ups, high participant rates, and thorough mapping of non-participants and data regarding morbidity and mortality. The study covers both longitudinal trends (change in individuals over time) and secular trends (changes in the population over time). This implies the possibility to study e.g. whether the increased consumption of oestrogenic hormones and new antidepressive agents in the population has influenced the occurrence of cardiovascular disease, dementia, depression and the proportion that are under treatment. The long-running follow-up has also made it possible to study the long term prognosis for these diseases and whether the risk for prolonged illness increases with older age. In addition, women from different birth cohorts are examined at certain ages to investigate secular trends in health related variables, such as obesity and dental health. The questionnaires have been changed as little as possible between each survey. Data from 1968 and 1974 are available from SND. The population study of women in Gothenburg collaborates with the H70 study which started in 1971, a cross-sectional study of men and women in Gothenburg aged 70 years. It is coordinated by several researcher groups, especially the groups handling general medicine, epidemiology, psychiatry and geriatrics. When the participants turned 70 years old, they were invited to participate in the H70 study (1992, 2000), and a follow-up examination of 75 years old participants 2005-2006. Purpose: The purpose of this study was initially to investigate anemia and health factors related to menopause, but has later also included examination of determinants among middle age women that have importance for the development of cardiovascular disease, diabetes, cancer, dementia and other mental illness in high age.Kvinnoundersökningen i Göteborg är en populationsstudie som bedrivs vid Göteborgs universitet. Studien startade 1968 som en tvärsnittsstudie omfattande 1462 kvinnor i åldrarna 38, 46, 50, 54 och 60 år. Sedan dess har deltagarna genomgått regelbundna uppföljningar 1974-75, 1980-81, 1992-1993, 2000-2001, 2004-2005, 2009-2010 och 2016-2017. Samtidigt har nya deltagare tillkommit. Vid undersökningarna 2004-2005 samt 2016-2017 inbjöds endast kvinnor 38 och 50 år gamla att delta för att möjliggöra en jämförelse av dessa ålderskohorter. Studien omfattar såväl kroppsliga och psykiska sjukdomar, hälsa, sociala och psykologiska faktorer som tand- och kostdata. Att studera faktorer hos kvinnor i medelåldern som har betydelse för utveckling av bland annat hjärtkärlsjukdom, diabetes, cancer, demens och andra psykiska sjukdomar i hög ålder är möjligt i kvinnostudien tack vare en lång uppföljningstid, hög deltagarfrekvens, och noggrann kartläggning av bortfall samt sjukdoms- och dödlighetsdata. Studien ger möjlighet att studera både longitudinella trender (förändring över tid hos individer) och sekulära trender (förändring i befolkningen över tid). Man har bl. a. studerat huruvida den ökade förbrukningen av östrogena hormoner och nya antidepressiva läkemedel i befolkningen har påverkat förekomsten av hjärtkärlsjukdom, demens och depression samt andelen som har behandling. De långa uppföljningstiderna har också gjort det möjligt att studera långtidsprognosen för dessa sjukdomar och om risken för långvarig sjukdom ökar med stigande ålder. I studien jämförs även kvinnor från olika födelsekohorter vid vissa åldrar för att studera sekulära trender i hälsorelaterade variabler, som exempelvis fetma och tandhälsa. Frågorna i enkäterna har i så så liten grad som möjligt ändrats mellan varje undersökningsomgång. Data från undersökningen 1968 och 1974 finns hos SND. Kvinnoundersökningen samarbetar med H70-studien som startade 1971, en studie av manliga och kvinnliga 70-åringar i Göteborg och koordineras av flera forskargrupper, framför allt inom allmänmedicin, epidemiologi, psykiatri och geriatrik. Kvinnor i Kvinnoundersökningen erbjöds de åren de fyllde 70 år att delta i H70-studien (1992, 2000) samt till en uppföljning av 75-åringar som genomfördes 2005-2006. Syfte: Syftet med studien var från början att undersöka anemi och hälsofaktorer relaterad till menopaus, men har sedan omfattat även att undersöka faktorer hos kvinnor i medelåldern som har betydelse för utveckling av bland annat hjärtkärlsjukdom, diabetes, cancer, demens och andra psykiska sjukdomar i hög ålder

Association between anxiety and depression and all-cause mortality: a 50-year follow-up of the Population Study of Women in Gothenburg, Sweden

Objectives This study aimed to examine the association between anxiety disorders and/or major depression disorder (ADs/MDD) and all-cause mortality in a 50-year perspective and to examine specific risk and health factors that may influence such an association.Design Observational population study, 1968–2019.Setting The Population Study of Women in Gothenburg, Sweden (PSWG).Participants In 1968–1969, 899 (out of 1462) women from PSWG were selected according to date of birth for a psychiatric investigation, including diagnostic evaluation. Eight hundred (89%) were accepted. Twenty-two women were excluded. Of the 778 included, 135 participants (17.4 %) had solely ADs, 32 (4.1%) had solely MDD and 25 (3.2%) had comorbid AD/MDD.Primary and secondary outcome measures Associations between ADs, MDD, comorbid AD/MDD and all-cause mortality with adjustments for potential confounding factors. Differences between the groups concerning health and risk factors and their association with mortality.Results In a fully adjusted model, ADs were non-significantly associated with all-cause mortality (HR 1.17, 95% CI 0.98 to 1.41). When examining age during risk time as separate intervals, a significant association between mortality and AD was seen in the group of participants who died at the age of 65–80 years (HR 1.70, 95% CI 1.26 to 2.29). In the younger or older age interval, the association did not reach significance at the 95% level of confidence. Among confounding factors, smoking and physical activity were the strongest contributors. The association between smoking and mortality tended to be further increased in the group with ADs versus the group without such disorders (HR 2.10, 95% CI 1.60 to 2.75 and HR 1.82, 95% CI 1.56 to 2.12, respectively).Conclusions This study suggests potential links between ADs, age and mortality among women with 50 years of follow-up, but does not provide definitive conclusions due to the borderline significance of the results

Gray matter density in limbic and paralimbic cortices is associated with trauma load and EMDR outcome in PTSD patients

There is converging evidence of gray matter (GM) structural alterations in different limbic structures in Post-Traumatic Stress Disorder (PTSD) patients. The aim of this study was to evaluate GM density in PTSD in relation to trauma load, and to assess the GM differences between responders (R) and non-responders (NR) to EMDR therapy. Magnetic Resonance Imaging (MRI) scans of 21 subjects exposed to occupational trauma, who developed PTSD (S), and of 22 who did not (NS), were compared by means of an optimized Voxel-Based Morphometry (VBM) analysis as implemented in SPM. Within S, further comparisons were made between 10 R and 5 NR. A regression analysis between GM density and the Traumatic Antecedents Questionnaire (TAQ) was also performed on all 43 subjects. Results showed a significantly lower GM density in S as compared to NS in the left posterior cingulate and the left posterior parahippocampal gyrus. Moreover, NR showed a significantly lower GM density as compared to R in bilateral posterior cingulate, as well as anterior insula, anterior parahippocampal gyrus and amygdala in the right hemisphere. Regression analysis showed that GM density negatively correlated with trauma load in bilateral posterior cingulate, left anterior insula, and right anterior parahippocampal gyrus. In conclusion, a GM lower density in limbic and paralimbic cortices were found to be associated with PTSD diagnosis, trauma load, and EMDR treatment outcome, suggesting a view of PTSD characterized by memory and dissociative disturbances

A randomized controlled trial of two weight-reducing short-term group treatment programs for obesity with an 18-month follow-up

We found in an earlier study that participants in a short-term treatment program for obesity showed a good weight reduction (10.4 kg