ATTACHMENT AND MEMORY STABILITY.

Previous studies confirm that attachment representations are very stable and are rooted in semantic and episodic autobiographic memory systems. The Adult Attachment Interview (AAI) provides a means to assess secure, insecure, and disorganized (U) states of mind; it incorporates a fine-grained analysis of attachment-related memories. The AAI is not a measure to determine false versus true memories or to claim it can identify veridical truth; however, longitudinal research studies demonstrate that the AAI is highly stable in how (degree of coherence) the speaker discusses past events. This IRB approved study (n = 130) examined a non-clinical sample of active individuals. The results indicated that passive states of mind was a predictor variable for unresolved loss and unresolved childhood abuse and both passive states of mind and more Adverse Childhood Experiences (ACEs) predicted overall lack of resolution (U). Lack of memory and dissociative amnesia were not significant predictors. This study and previous studies demonstrate that retrospective reporting of ACEs remain stable over time. These findings suggest that clinical focus should follow the attachment protocol of examining the state of mind of the speaker. Autobiographical memory systems reveal enduring Internal Working Models (IWMs) that influence how memories are stored and recounted.

Cumulative Psychological Trauma, Emotional Regulation, and Orthopedic Injury in a Sample of Pre-Professional and Professional Dancers and College Athletes.

OBJECTIVE: Strong evidence identifies cumulative trauma exposure and a history of childhood adversity as predictive factors for physical and psychological disorders. In this study, dancers and athletes were examined to determine the relationship among childhood adversity, cumulative trauma exposure, stress responses, and injuries (including the need for orthopedic surgery). METHODS: In this cross-sectional study, 287 pre-professional and professional dancers (n=185) and college athletes (n=102) participated. Seven self-report measures were completed. Descriptive statistical analyses were calculated, followed by a 2 x 2 multivariate analysis (MANCOVA, age and gender were covariates): 1) dancer and athlete groups, and 2) participants who had orthopedic surgery vs no surgery. Stepwise linear regression analyses were calculated to predict cumulative injuries in multiple body regions. RESULTS: The MANCOVA result indicated that dancers and athletes shared similar cumulative injuries to multiple regions of their bodies. Compared to athletes, dancers were exposed to more childhood trauma and experienced more anxiety and emotional difficulties. Participants who underwent orthopedic surgery also had more cumulative trauma and injuries as well as more difficulty with emotional regulation. In both dancers and athletes, increased exposure to childhood and adult traumatic events were significant predictive factors associated with injury. CONCLUSION: Both dancers and athletes frequently perform within a culture that is pressured and promotes behavior that ignores pain and injury. It is recommended that coaches, educators, and healthcare workers understand the influence of cumulative trauma on risk for orthopedic injury and incorporate trauma-informed care.

Creative Flow and Physiologic States in Dancers During Performance.

Pre-professional and professional dancers (n = 60) participated in this ambulatory psychophysiology study that investigated performance flow and heart rate and autonomic nervous system (ANS) function during three time periods: baseline rest, performance, and post-performance rest. To gather these results, the psychophysiology laboratory traveled to the concert hall to collect data on dancers. The self-report Flow State Scale (FSS) measured global flow, challenge-skill balance, sense of control, and autotelic experiences; it addresses important features of the creative experience of performing artists. These data were collected immediately following the performance. The flow measures were compared with physiologic responses to performance [heart rate, pre-ejection period (PEP), root mean square differences of successive R-R (heartbeat) intervals (RMSSD), cardiac autonomic balance, and cardiac autonomic regulation]. The regression analyses indicated that greater sympathetic nervous system (SNS) activation with performance (PEP change from base to performance) explained 8.8% of the variance in sense of control, whereas less cardiac autonomic regulation explained 13.8% of the variance in autotelic experiences. The sample was then divided into high and low flow groupings and four autonomic groups. During performance, the high autotelic group and high sense of control group had a higher distribution of dancers with co-inhibition of both ANS branches than had the low autotelic and sense of control groups who employed more co-activation of both ANS branches (chi-square analyses). These novel findings add to the growing information about the interaction of both branches of the ANS during creative performance flow states.

History of childhood adversity and coping strategies: Positive flow and creative experiences.

BACKGROUND: Acquiring more complex coping strategies despite a history of childhood adversity may transpire in settings outside the family home. OBJECTIVES: The objectives of this cross-sectional study included investigating coping strategies under stressful situations in a non-clinical sample of active athletes and performing artists. PARTICIPANTS AND SETTING: In this community and university sample (n = 577), 40.4% had no ACEs, 43.4% had 1-3 ACEs, and 16.3% had ≥4 ACEs. METHODS: A series of multivariate analyses (gender and age included as covariates) were conducted to examine differences between the three ACE groups. RESULTS: Results indicated no between-subject differences between the three ACE groups for flow-like experiences during preferred activities, although gender differences were significant (p < .001). Individuals in the ≥4 ACEs group endorsed more intense creative experiences compared to the no-ACE and 1-3 ACEs groups (p = .006, η2 = .048); however, in the third MANCOVA they had heightened anxiety, internalized shame, dissociative processing, emotion-oriented coping, and cumulative trauma (p < .001, η2 = .132). There were no group differences for task-oriented and avoidant-oriented coping, a finding that highlights the ability of active individuals to engage in effective coping strategies under stressful situations. CONCLUSION: Regardless of past childhood adversity history, this non-clinical high achieving sample was able to engage in a range of coping strategies under stress.

Shame and Anxiety: The Mediating Role of Childhood Adversity in Dancers.

The combination of shame, anxiety, and a history of childhood maltreatment can have devastating effects on self-esteem and on the morbidity and mortality of an individual. Shame is a natural emotion evoked in social evaluative settings. Without some degree of shame, goal attainment is less likely. However, high levels of shame may increase pathology and decrease performance. In this crosssectional study, pre-professional and professional dancers were divided into two shame groupings: low (N = 193) and high (N = 25). Chi square and multivariate analyses of covariance (age and gender as covariates) were conducted to determine group differences for cumulative adverse childhood experiences (ACEs), anxiety, self-esteem, and shame factors. The high shame group had a greater distribution of childhood adversity (especially emotional, physical and sexual abuse, and emotional neglect). They also had clinical levels of anxiety and low self-esteem. In the path analyses, the causal model demonstrated that childhood adversity had a direct effect on anxiety and shame and an indirect effect on self-esteem. Shame and anxiety had a direct effect on self-esteem. Helping dancers become resistant to shame may decrease anxiety and buffer the effects of a history of childhood adversity. As internalized shame decreases, dancers may enhance their self-esteem, wellbeing, and ability to pursue and achieve their career goals.

Resistance Training Threshold for Elevating Bone Mineral Density in Growing Female Rats.

The purpose of this study was to determine the minimum amount of resistance exercise that would stimulate bone formation yielding an elevation in bone mineral density (BMD) during the growth period in female rats. Female rats were randomly divided into: Control (Con, n=8), 3 ladder climb resistance-trained group (3LC, n=8), 4 ladder climb resistance-trained group (4LC, n=8), 5 ladder climb resistance-trained group (5LC, n=8), and 6 ladder climb resistance-trained group (6LC, n=8). All exercised groups were conditioned to climb a vertical ladder with weights appended to their tail 3 days/wk for a total of 6 wks. After 6 wks, left tibia BMD (g/cm2) was significantly greater for 4LC (0.197±0.003), 5LC (0.200±0.004) and 6LC (0.202±0.003) when compared to Con (0.185±0.006). Left femur BMD (g/cm2) was significantly greater for 4LC (0.260±0.005), 5LC (0.269±0.004) and 6LC (0.272±0.006) when compared to Con (0.244±0.006). There were no significant differences in tibia and femur BMD between 4LC, 5LC, and 6LC groups. The results suggest that during growth, a high volume of resistance exercise was required to elicit an elevation in BMD in females.

Depersonalization, adversity, emotionality, and coping with stressful situations.

Depersonalization is defined as persistent or recurrent episodes of feeling detached or estranged from a sense of self and the world. This study addressed the primary question: Do nonclinical individuals who endorse high symptomatic depersonalization have inherently more intense emotional responses, along with more childhood adversity and past trauma? In this IRB approved study, participants who met clinical levels of depersonalization (n = 43, 16.3%) were compared to a group without clinical levels of depersonalization (n = 221, 83.7%). Adverse childhood experiences, adult traumatic events, emotional overexcitability, coping strategies under stress, and anxiety were examined in both groups. The variables to assess depersonalization severity included the Dissociative Experience Scale-II, Cambridge Depersonalization Scale, and Multiscale Dissociation Inventory. The results indicated that clinical levels of depersonalization were identified in 16.3% of the sample. The high depersonalization group had significantly more adverse childhood experiences, in particular, emotional abuse and neglect. They also experienced more adult traumatic events, higher levels of anxiety, more emotional overexcitability, and they employed a less adaptive emotion-oriented coping strategy under stress. It is recommended that treating depersonalization symptoms should include examining childhood adversity, especially emotional abuse and neglect. Based on study findings, emotion regulation skills should be promoted to help individuals with elevated depersonalization manage their emotion-oriented coping strategies, anxiety, and emotional overexcitability.

Adverse childhood experiences (ACE) and adult attachment interview (AAI) in a non-clinical population.

Adverse childhood experiences (ACE) tend to be interrelated rather than independently occurring. There is a graded effect associated with ACE exposure and pathology, with an increase when ACE exposure is four or more. This study examined a sample of active individuals (n=129) to determine distribution patterns and relationships between ACEs, attachment classification, unresolved mourning (U), and disclosure difficulty. The results of this study demonstrated a strong relationship between increased ACEs and greater unresolved mourning. Specifically, the group differences for individuals who experienced no ACE (n=42, 33%), those with 1-3 ACEs (n=48, 37.8%), and those with ≥4 ACEs (n=37, 29.1%) revealed a pattern in which increased group ACE exposure was associated with greater lack of resolution for past trauma/loss experiences, more adult traumatic events, and more difficulty disclosing past trauma. Despite ≥4 ACEs, 51.4% of highly exposed individuals were classified as secure in the Adult Attachment Interview. Resilience in this group may be related to a combination of attachment security, college education, and engagement in meaningful activities. Likewise, adversity may actually encourage the cultivation of more social support, goal efficacy, and planning behaviors; factors that augment resilience to adversity.

A Psychophysiological Case Study of Orchestra Conductors.

The psychological and physiological effects of performance were investigated in two professional orchestral conductors, with data collected prior to, during, and after a rehearsal and a public performance. The participants were given a battery of psychological self-report tests (anxiety, dissociation, health inventory, fantasy proneness, shame, and flow). Ambulatory physiological monitoring (Vivometric LifeShirt® system) was conducted during both a rehearsal and public performance to gather information about the autonomic nervous system and heart rate variability (HRV). One conductor had a history of asthma and anxiety, and the second conductor had coronary artery disease. The results revealed within-subject and between-subject differences in autonomic nervous system responses and HRV during several conditions (pre-performance rest, stair-climbing, rehearsal, and performance). Based on heart rate, the physiological demands of professional conducting are reflective of work intensities considered "hard." Both conductors experienced high flow states. Anxiety and coronary artery disease may have attenuated HRV resilience in this study. It is recommended that noninvasive methods be implemented to assess cardiac autonomic activity in professional conductors, particularly during engagement in their professional activities. The findings suggest a need to further study anxiety, respiratory conditions, and cardiovascular risks for conductors.

Posttraumatic Stress Disorder and Psychopathology in Dancers.

This study investigated the prevalence of posttraumatic stress disorder (PTSD) in pre-professional and professional dancers (n=209) who were exposed to traumatic events. Nine self-report instruments assessed (1) adverse childhood experiences, (2) past traumatic events, (3) coping strategies under stressful situations, and (4) fantasy proneness. The psychopathology variables included (5) anxiety, (6) depression, (7) dissociation, (8) shame, and (9)) PTSD diagnostic scale. Statistical calculations included descriptive, distributional, and multivariate analysis of covariates (MANCOVA). Results indicate that dancers had a significantly higher distribution of PTSD (20.2%) compared to the normal population (7.8%). They also had a higher frequency of family members with mental illness, an inability to speak about their trauma, and more suicidal thoughts. The PTSD group of dancers had higher levels of psychopathology (anxiety, depression, dissociation, and shame) and they had more childhood adversity and adult trauma. Compared to the no-PTSD group, the PTSD group had higher scores on fantasy proneness and emotion-oriented coping strategies. These coping strategies may increase psychological instability. Addressing early abuse and trauma is recommended. Clinicians may help dancers alter their internal working models that their self is worthless, others are abusive, and the world is threatening and dangerous. By understanding PTSD in dancers, medical and mental health treatment protocols may be established to address the debilitating, and often hidden, symptoms of PTSD.

Perfectionism, shame, and self-concept in dancers: a mediation analysis.

Perfectionism has been linked to various forms of physiological and psychological maladjustment. This study examined the inter-relationships between multi-dimensional aspects of perfectionism (self-oriented, other-oriented, and socially prescribed), internalized shame, and total self-concept in elite dancers (N = 24) as compared to a control group of healthy, active non-dancers (N = 23). All participants completed psychometric self-report measures targeting the variables of interest. Multivariate analysis of covariance (gender as covariate) indicated that the dancers had higher levels of self-oriented perfectionism than the control group. Building on the findings of Ashby, Rice, and Martin, we examined a model in which dancers' shame mediates the relationship between maladaptive aspects of perfectionism and self-concept. Analysis revealed internalized shame to fully mediate the relationship between dancers' socially prescribed perfectionism and total self-concept; however, shame did not mediate self-concept in the control group. We conclude that dancers would benefit from programs that enhance self-esteem and reduce the negative effects of internalized shame and self-oriented and socially prescribed perfectionism.

Unresolved mourning, supernatural beliefs and dissociation: a mediation analysis.

Unresolved mourning is marked by disorganized behavior and states of mind. In this study, we speculated that pathological dissociation would mediate the effects of unresolved mourning on supernatural beliefs. This hypothesis was determined based on findings that indicate an association between higher levels of dissociation, stronger beliefs in the supernatural and unresolved mourning. We examined two groups of participants, one classified as non-unresolved (non-U) (n = 56) and the other as unresolved (n = 26) (U) with respect to past loss/trauma as measured by the Adult Attachment Interview (AAI). Two self-report instruments were administered to measure supernatural beliefs and dissociation. As hypothesized, the multivariate analysis of variance indicated mean differences between the two groups. The unresolved group had greater belief in the supernatural and more pathological dissociative processes. The mediation analysis demonstrated that pathological dissociation fully mediated the effects of unresolved mourning on supernatural beliefs.

Exposing shame in dancers and athletes: shame, trauma, and dissociation in a nonclinical population.

The relationship between shame, past traumatic events, and dissociation in a nonclinical university and community sample of pre-professional/professional dancers (n = 140) and recreational/competitive athletes (n = 99) was investigated in this cross-sectional study, which was approved by an institutional review board. Participants completed 3 self-report measures (i.e., the Dissociative Experiences Scale, Internalized Shame Scale, Traumatic Events Questionnaire), and the analyses included correlation, multivariate analysis of variance, and a series of regression analyses. The investigation indicated that dancers had increased shame and dissociation in comparison to athletes, and males had more traumatic experiences and increased dissociation relative to females. In the regression analyses, being a dancer, traumatic experiences, and shame predicted dissociation. Clinical recommendations include integrating shame treatment with dissociative-disordered patients and noting that dancers may need more psychological skill training to manage shame and dissociation.

High volumes of resistance exercise are not required for greater bone mineral density during growth.

PURPOSE: The purpose of this study was to determine the minimum amount of resistance exercise that would stimulate bone formation, via an elevation in bone mineral density (BMD), during the growth period in male rats. METHODS: Forty male rats were randomly divided into control group (Con, n = 8), one ladder climb resistance-trained group (1LC, n = 8), two ladder climb resistance-trained group (2LC, n = 8), three ladder climb resistance-trained group (3LC, n = 8), and four ladder climb resistance-trained group (4LC, n = 8). All exercised groups were conditioned to climb a vertical ladder with weights appended to their tail 3 d·wk(-1) for a total of 6 wk. RESULTS: After 6 wk, left tibia BMD (mean ± SE) was significantly greater for 2LC, 3LC, and 4LC (0.233 ± 0.003 g·cm(-2)) when compared with Con (0.218 ± 0.003 g·cm). Left femur BMD was significantly greater for 2LC, 3LC, and 4LC (0.318 ± 0.003 g·cm(-2)) when compared with 1LC (0.299 ± 0.008 g·cm(-2)) and Con (0.289 ± 0.010 g·cm(-2)).There were no significant differences in BMD between 2LC, 3LC, and 4LC groups. CONCLUSION: The results suggest that during growth, a low amount of resistance exercise was just as effective as high volumes of strength training for stimulating bone modeling.

Dancing with the Muses: dissociation and flow.

This study investigated dissociative psychological processes and flow (dispositional and state) in a group of professional and pre-professional dancers (n=74). In this study, high scores for global (Mdn=4.14) and autotelic (Mdn=4.50) flow suggest that dancing was inherently integrating and rewarding, although 17.6% of the dancers were identified as possibly having clinical levels of dissociation (Dissociative Experiences Scale-Taxon cutoff score≥20). The results of the multivariate analysis of variance indicated that subjects with high levels of dissociation had significantly lower levels of global flow (p<.05). Stepwise linear regression analyses demonstrated that dispositional flow negatively predicted the dissociative constructs of depersonalization and taxon (p<.05) but did not significantly predict the variance in absorption/imagination (p>.05). As hypothesized, dissociation and flow seem to operate as different mental processes.

Dissociation and the Adult Attachment Interview in artists and performing artists.

Attachment patterns were investigated in a group of professional and pre-professional artists (n = 51). Given the high level of absorption/imagination required of artists, this study examined normative and pathological dissociation (PD) and considered links with Adult Attachment Interview responses, with particular attention to the AAI classification Unresolved (U) for past loss or trauma. Results indicated: (1) artists had elevated mean scores for absorption/imagination, (2) all but one artist had adverse trauma or loss experiences, (3) 17 (36%) met criteria for PD and 9 (53%) of those in the PD range had a classification of Unresolved (U) on the Adult Attachment Interview (AAI), (4) U was associated with PD, but not normative dissociation (absorption/imagination), (5) even with a primary U classification many individuals had an alternate secure/autonomous classification, and (6) 88% of the artists were classified as secure/autonomous in a three-way analysis on the AAI, but in a four-way analysis 27.5% were classified as U. Although 36% presented with PD, the majority of artists studied were stable, coherent and autonomous.

Extreme obesity reduces bone mineral density: complementary evidence from mice and women.

OBJECTIVE: To evaluate the effects of body adiposity on bone mineral density in the presence and absence of ovarian hormones in female mice and postmenopausal women. RESEARCH METHODS AND PROCEDURES: We assessed percentage body fat, serum leptin levels, and bone mineral density in ovariectomized and non-ovariectomized C57BL/6 female mice that had been fed various calorically dense diets to induce body weight profiles ranging from lean to very obese. Additionally, we assessed percentage body fat and whole body bone mineral density in 37 overweight and extremely obese postmenopausal women from the Women's Contraceptive and Reproductive Experiences study. RESULTS: In mice, higher levels of body adiposity (>40% body fat) were associated with lower bone mineral density in ovariectomized C57BL/6 female mice. A similar trend was observed in a small sample of postmenopausal women. DISCUSSION: The complementary studies in mice and women suggest that extreme obesity in postmenopausal women may be associated with reduced bone mineral density. Thus, extreme obesity (BMI > 40 kg/m2) may increase the risk for osteopenia and osteoporosis. Given the obesity epidemic in the U.S. and in many other countries, and, in particular, the rising number of extremely obese adult women, increased attention should be drawn to the significant and interrelated public health issues of obesity and osteoporosis.

Musculoskeletal adaptations to 16 weeks of eccentric progressive resistance training in young women.

We investigated the musculoskeletal adaptations and efficacy of a whole-body eccentric progressive resistance-training (PRT) protocol in young women. Subjects (n = 37; mean age, 24.3) were randomly assigned to one of 3 groups: high-intensity eccentric PRT (HRT), low-intensity eccentric PRT (LRT), or control. Subjects performed 3 sets of 6 repetitions at 125% intensity or 3 sets of 10 repetitions at 75% intensity in the HRT and LRT groups, respectively, 2 times per week for 16 weeks. Strength was determined by the concentric 1-repetition maximum (1RM) standard. Bone mass and body composition were measured by dual-energy x-ray absorptiometry (DXA). Blood and urine samples were obtained for deoxypyridinoline, osteocalcin, creatine kinase, and creatinine. Data were analyzed by repeated-measures analysis of variance with post hoc comparisons. Strength increased 20-40% in both training groups. Lean body mass increased in the LRT (0.7 +/- 0.6 kg) and HRT (0.9 +/- 0.9 kg) groups. Bone mineral content increased (0.855 +/- 0.958 g) in the LRT group only. Deoxypyridinoline decreased and osteocalcin increased in the HRT and LRT groups, respectively. These findings suggest that submaximal eccentric training is optimal for musculoskeletal adaptations and that the intensity of eccentric training influences the early patterns of bone adaptation.

Effects of an oral androgen on muscle and metabolism in older, community-dwelling men.

To determine whether oxymetholone increases lean body mass (LBM) and skeletal muscle strength in older persons, 31 men 65-80 yr of age were randomized to placebo (group 1) or 50 mg (group 2) or 100 mg (group 3) daily for 12 wk. For the three groups, total LBM increased by 0.0 +/- 0.6, 3.3 +/- 1.2 (P < 0.001), and 4.2 +/- 2.4 kg (P < 0.001), respectively. Trunk fat decreased by 0.2 +/- 0.4, 1.7 +/- 1.0 (P = 0.018), and 2.2 +/- 0.9 kg (P = 0.005) in groups 1, 2, and 3, respectively. Relative increases in 1-repetition maximum (1-RM) strength for biaxial chest press of 8.2 +/- 9.2 and 13.9 +/- 8.1% in the two active treatment groups were significantly different from the change (-0.8 +/- 4.3%) for the placebo group (P < 0.03). For lat pull-down, 1-RM changed by -0.6 +/- 8.3, 8.8 +/- 15.1, and 18.4 +/- 21.0% for the groups, respectively (1-way ANOVA, P = 0.019). The pattern of changes among the groups for LBM and upper-body strength suggested that changes might be related to dose. Alanine aminotransferase increased by 72 +/- 67 U/l in group 3 (P < 0.001), and HDL-cholesterol decreased by -19 +/- 9 and -23 +/- 18 mg/dl in groups 2 and 3, respectively (P = 0.04 and P = 0.008). Thus oxymetholone improved LBM and maximal voluntary muscle strength and decreased fat mass in older men.

Metabolic effects of nandrolone decanoate and resistance training in men with HIV.

Thirty human immunodeficiency virus (HIV)-infected men were randomized to a high dose of nandrolone decanoate weekly (group 1) or nandrolone plus resistance training (group 2) for 12 wk. For the two groups, nandrolone had no significant effects on total cholesterol, LDL cholesterol, LDL phenotype, or fasting triglycerides, although triglycerides decreased by 66 +/- 124 mg/dl for the entire population (P = 0.01). Group 2 subjects had a favorable increase of 5.2 +/- 7.7A in LDL particle size (P = 0.03), whereas there was no change in group 1. Lipoprotein(a) decreased by 7.3 +/- 6.8 mg/dl for group 1 (P = 0.002) and by 6.9 +/- 8.1 for group 2 (P = 0.013). However, HDL cholesterol decreased by 8.7 +/- 7.4 mg/dl for group 1 (P < 0.001) and by 10.6 +/- 5.9 for group 2 (P < 0.001). Percentages of HDL(2b) (9.7-12 nm) and HDL(2a) (8.8-9.7 nm) subfractions decreased similarly for the two groups, whereas HDL(3a) (8.2-8.8 nm) and HDL(3b) (7.8-8.2 nm) increased in the groups during study therapy (P < or = 0.02 for all comparisons). There was no evidence of a decreased insulin sensitivity in either group, whereas fasting glucose, fasting insulin, and homeostasis model assessment improved in group 2 (P < 0.05). These metabolic effects were favorable (other than for HDL), but changes were generally transient (except for HDL in group 2), with measurements returning to baseline 2 mo after the interventions were completed.