Working with trauma : interpersonal and process issues in therapy for people suffering from the effects of traumatic experience

While the issue of avoidance in PTSD is well-documented in terms of symptom presentation, little has been done to address the problem posed to therapists of clients engaging in an avoidance of traumatic material within therapy. The current study uses a two-part approach, combining quantitative and qualitative methods to address avoidance in therapy for PTSD. In Part 1, a correlational design is used to compare clients' coping styles of "monitoring" and "blunting" (Miller, 1980) with change in symptoms over a course of therapy. The results indicate some support for the notion that coping style is relevant to symptom change over a course of therapy for PTSD. A blunting coping style was found to be significantly negatively correlated with degree of improvement in intrusive thoughts and a monitoring coping style significantly positively correlated with improvement in avoidance symptoms over the period. However, the possibility that these results are a function of significant correlations at the outset of therapy is considered. Furthermore, the low response rate resulted in the collection of insufficient data to fully test the hypotheses and, as a result, the study was treated as an exploratory, preliminary analysis and used to highlight research questions for a second phase of the research. In Part 2 of the study, a discourse analytic approach was used to generate avoidant discursive practices in transcribed material from therapy sessions with clients with PTSD. Both clients and therapists were found to use a range of discursive practices which resulted in the conversation moving away from expressions of negative affect or an exploration of traumatic material. Putative explanations for the observed behaviours are discussed and the need for therapists to be aware of these processes and their own emotional reactions to client's traumatic memories is emphasised. Differences in presentation between clients with histories of sexual abuse and those experiencing non-abusive isolated experiences of trauma are raised. The nature of avoidance within therapy is discussed and the impact of the overarching discourse of the therapeutic setting and the associated roles and power dynamics within the dyad are explored. Implications for improving the effectiveness of therapy and suggestions for future research in the field of avoidance in PTSD are proposed and, in particular, a call made for a more process-focused and "dyad-orientated" approach to practice and research in this area

Taking your participants home: Self care within the research process

Background: On the long and often stressful road to qualifying as a Counselling Psychologist the issue of self care is addressed early within the training. Yet this idea of self care relates to therapeutic practice, with little consideration of self care during the research process. With the training route now at Doctoral level, all practitioners will undertake a significant research project as part of the qualifying portfolio. Aims and Scope: This paper explores the process issues encountered in conducting research into the experience of Childhood Sexual Abuse (CSA), and raises questions about the way self-care is addressed within the research process. The article reflects upon a Content Analysis of 202 personal accounts of CSA with the aim of exploring the presence of Stockholm syndrome and PTSD within CSA. Literature from self care within the clinical application of psychology and trauma-based work is discussed as a starting point for the development of self care within a research context. Conclusion: Recommendations are made for changes in research practice and ethical review, and a clear role for Counselling Psychologists to lead in this development

Associations between combinations of job demands and job control among 6,16,818 people aged 55-64 in paid work with their labour market status 11 years later: a prospective cohort study.

BACKGROUND: Given current discussions about extending working lives, more knowledge is needed on working conditions associated with labour market status in older age. OBJECTIVE: To explore associations between combinations of job demands and job control among workers aged 55-64 years and their labour market status 11 years later. METHODS: A population-based prospective cohort study using nationwide register data. The 616,818 individuals in Sweden aged 55-64 who in 2001 were in paid work were categorised using a job exposure matrix based on tertiles (reference = medium control/medium demands). Participants were followed up in 2012 regarding their main labour market status (paid work, old-age pension, no income/social assistance, sickness absence/disability pension, emigrated, dead; reference = old-age pension) using multinomial logistic regression for odds ratios (OR) and 95% confidence intervals (CI). The fully adjusted analyses included adjustment for sociodemographic factors and unemployment or sickness absence/disability pension for more than half the year in 2001. RESULTS: Those in occupations with low job control at baseline were less likely to be in paid work at follow-up (OR low demands/low control 0.74, CI 0.71-0.78; high demands/low control 0.81, CI 0.75-0.87). Those in occupations with baseline high demands were less likely to have no income/social assistance at follow-up (OR high demands/low control 0.71, CI 0.52-0.96; high demands/high control 0.59, CI 0.47-0.75). CONCLUSION: Job demands and control when aged 55-64 were associated with labour market status 11 years later: high control was associated with greater chance of being in paid work, and high demands were associated with lower risk of no income/social assistance

Sick leave among people in paid work after age 65: A Swedish population-based study covering 1995, 2000, 2005 and 2010

AIMS: Extending working life into older age groups is discussed in many countries. However, there is no knowledge about how this affects rates of sick leave. The aim of this work was to investigate rates of sick leave among people in paid work after retirement age and if such rates have changed over time. METHODS: Swedish nationwide register data on people aged >65 years and living in Sweden in 1995, 2000, 2005 and 2010 were analysed. All people with a sufficiently high work income to be eligible for public sick leave benefits were included. The proportions in paid work and compensated rates of sick leave for people aged 66-70 and ≥71 were analysed by sex, educational level, country of birth, living area, and employment type and sector. RESULTS: The percentage of people in paid work at ages 66-70 years increased from 65 years were lower in 2010 than in 1995, despite much higher rates of labour market participation in 2010

The impact of fathers' military deployment on child adjustment. The support needs of primary school children and their families separated during active military service: A pilot study

BACKGROUND: Although direct exposure to war-related trauma negatively impacts children's psychological well-being, little is known about this impact within the context of parental military deployment to a combat zone and 'indirect' experience of the effects of armed conflict. This study investigates the impact of father's military deployment to Afghanistan on child well-being in primary schoolchildren and compares measures of adjustment with a matched group of children with fathers deployed on military training (non-combat) deployment. METHOD: Data were collected within primary schools in 2011-2012 from 52 children aged 8-11 years with fathers deploying to Afghanistan ( n = 26) and fathers deploying on military training ( n = 26) via self-completion of questionnaires assessing symptoms of anxiety, depression, stress and levels of self-esteem. Data were collected in both groups, at pre-, mid- and post-parental deployment. Class teachers and parents (non-deployed) completed a measure of child behaviour and parents completed a measure of parenting stress and general health. RESULTS: Unexpectedly child adjustment difficulties were not significantly raised in children whose parents deployed to Afghanistan. Ratings of behavioural difficulties and depression were low in both groups. However, clinically elevated levels of anxiety and stress symptoms were reported by both groups of children at each stage of deployment. No associations between parental stress, parental mental health and child adjustment were found. CONCLUSION: High levels of children's anxiety and stress reported during fathers' active military service warrant further investigation. Implications for school and health monitoring and CAMHS community liaison work are discussed

'I Once Stared at Myself in the Mirror for Eleven Hours.' Exploring mirror gazing in participants with body dysmorphic disorder

This study provides insight into the lived experience of mirror gazing using Interpretative Phenomenological Analysis and Photo Elicitation. A total of 10 participants who identified themselves as suffering from body dysmorphic disorder took photographs that related to their body dysmorphic disorder experience. Photographs were discussed in interviews. It was found that mirror gazing in body dysmorphic disorder is an embodied phenomenon. Motivations for mirror gazing were confusing, complex and masochistic. Overall, participants described mirrors as being controlling, imprisoning and disempowering forces that had a crippling and paralysing effect on life. It is argued that health psychologists must ask clients about their embodied experiences when looking in the mirror

Remodeling of chromatin structure within the promoter is important for bmp-2-induced fgfr3 expression

Fibroblast growth factor receptor 3 (FGFR3) plays an important role in cartilage development. Although upregulation of FGFR3 expression in response to bone morphogenetic protein-2 (BMP-2) has been reported, the molecular mechanisms remain unknown. In this study, we used in vivo approaches to characterize BMP-2-induced alterations in the chromatin organization of the FGFR3 core promoter. Chromatin immunoprecipitation analysis demonstrated that the binding of Brg1, a component of the SWI/SNF remodeling complex, may selectively remodel a chromatin region (encompassing nucleotide –90 to +35), uncovering the transcription start site and three Sp1-binding sites, as revealed by nuclease digestion hypersensitivity assays. We then showed an increase in the association of Sp1 with the proximal promoter, followed by the recruitment of p300, resulting in a change of the histone ‘code’, such as in phosphorylation and methylation. Collectively, our study results suggest a model for BMP-2-induced FGFR3 expression in which the core promoter architecture is specifically regulated

Long-range activation of FKBP51 transcription by the androgen receptor via distal intronic enhancers

Androgen receptor (AR) is a ligand-controlled transcription factor frequently deregulated in prostate carcinomas. Since there is scarce information on the action of AR on the chromatin level, we have elucidated the molecular mechanisms underlying the androgen-dependent regulation of immunophilin FKBP51 in prostate cancer cells. In comparison to the canonical AR target PSA, FKBP51 is more rapidly and strongly induced by androgen, with the regulation occurring merely at the transcriptional level. FKBP51 locus harbors 13 in silico-predicted androgen response elements (AREs), with most of them located downstream from transcription start site (TSS) and capable of binding AR in vitro. Chromatin immunoprecipitation assays in VCaP and LNCaP prostate cancer cells indicate that activation of the locus by the AR relies on four major intronic sites, with the compound ARE-containing sites ≥90 kb downstream from the TSS playing critical roles. Binding of agonist-loaded AR onto these sites in vivo was accompanied with significant recruitment of RNA polymerase II and BRM-containing chromatin remodeling complexes to the FKBP51 locus, which resulted in changes in the histone density of the locus. Our results indicate that very distal AREs act as genuine and robust enhancers, highlighting the importance of long-range regulation of transcription by the AR