Patterns of adiposity, vascular phenotypes and cognitive function in the 1946 British Birth Cohort.

BACKGROUND: The relationship between long-term exposure to whole body or central obesity and cognitive function, as well as its potential determinants, remain controversial. In this study, we assessed (1) the potential impact of 30 years exposure to different patterns of whole body and central adiposity on cognitive function at 60-64 years, (2) whether trajectories of central adiposity can provide additional information on later cognitive function compared to trajectories of whole body adiposity, and (3) the influence of vascular phenotypes on these associations. METHODS: The study included 1249 participants from the prospective cohort MRC National Survey of Health and Development. Body mass index (BMI), waist circumference (WC), and vascular (carotid intima-media thickness, carotid-femoral pulse wave velocity) and cognitive function (memory, processing speed, reaction time) data, at 60-64 years, were used to assess the associations between different patterns of adult WC or BMI (from 36 years of age) and late midlife cognitive performance, as well as the proportion of this association explained by cardiovascular phenotypes. RESULTS: Longer exposure to elevated WC was related to lower memory performance (p < 0.001 for both) and longer choice reaction time (p = 0.003). A faster gain of WC between 36 and 43 years of age was associated with the largest change in reaction time and memory test (P < 0.05 for all). Similar associations were observed when patterns of WC were substituted with patterns of BMI, but when WC and BMI were included in the same model, only patterns of WC remained significantly associated with cognitive function. Participants who dropped one BMI category and maintained a lower BMI had similar memory performance to those of normal weight during the whole follow-up. Conversely, those who dropped and subsequently regained one BMI category had a memory function similar to those with 30 years exposure to elevated BMI. Adjustment for vascular phenotypes, levels of cardiovascular risk factors, physical activity, education, childhood cognition and socioeconomic position did not affect these associations. CONCLUSIONS: Longer exposure to elevated WC or BMI and faster WC or BMI gains between 36 and 43 years are related to lower cognitive function at 60-64 years. Patterns of WC in adulthood could provide additional information in predicting late midlife cognitive function than patterns of BMI. The acquisition of an adverse cardiovascular phenotype associated with adiposity is unlikely to account for these relationships

Schema Therapy with Emotionally Inhibited and Fearful Patients

Emotional inhibition and avoidance are frequent problems in psychotherapy and often block the therapeutic process. Most often patients learnt these behavioral patterns early in childhood as coping strategies to protect themselves from painful emotions such as fear, sadness or shame. Schema therapy (ST) was specifically designed for patients with such rigid and hard to break through behavioral patterns and has shown to be a successful treatment for patients with cluster-C-personality disorders, which extensively display inhibited and fearful behavior. ST provides a set of techniques to address emotional inhibition and avoidance. The schema mode model helps patients to understand the origin and persistence of their problems and therapists can directly apply specific techniques for each mode. The therapist creates a caring, warm, parent-like relationship (‘limited reparenting’) and by this helps the patient to feel safer with emotions and with other people. Simultaneously, the therapist empathically confronts the patient with the problematic consequences of his behavior and pushes for change. Moreover, experiential techniques are frequently applied to help the patient experience and regulate emotions and needs in a safe way. By this, the patient loses fear of emotions, the meaning of emotions is changed and, thus, the patient can reduce using dysfunctional coping mechanisms. In this article, we describe the rational and the specific techniques of ST and illustrate them with a case example