Parents' experiences of palliative care decision-making in neonatal intensive care units: An interpretative phenomenological analysis.

AIM: This work explores the experiences and meaning attributed by parents who underwent the decision-making process of withholding and/or withdrawing life-sustaining treatment for their newborn. METHODS: Audio-recorded face-to-face interviews were led and analysed using interpretative phenomenological analysis. Eight families (seven mothers and five fathers) whose baby underwent withholding and/or withdrawing of life-sustaining treatment in three neonatal intensive care units from two regions in France were included. RESULTS: The findings reveal two paradoxes within the meaning-making process of parents: role ambivalence and choice ambiguity. We contend that these paradoxes, along with the need to mitigate uncertainty, form protective psychological mechanisms that enable parents to cope with the decision, maintain their parental identity and prevent decisional regret. CONCLUSION: Role ambivalence and choice ambiguity should be considered when shared decision-making in the neonatal intensive care unit. Recognising and addressing these paradoxical beliefs is essential for informing parent support practices and professional recommendations, as well as add to ethical discussions pertaining to parental autonomy and physicians' rapport to uncertainty.

Body shape rather than facial emotion of others alters interpersonal distance in patients with anorexia nervosa.

OBJECTIVE: The study investigated interpersonal distance in patients with anorexia nervosa (AN), focussing on the role of other's facial expression and morphology, also assessing physiological and subjective responses. METHOD: Twenty-nine patients with AN and 30 controls (CTL) were exposed to virtual characters either with an angry, neutral, or happy facial expression or with an overweight, normal-weight, or underweight morphology presented either in the near or far space while we recorded electrodermal activity. Participants had to judge their preferred interpersonal distance with the characters and rated them in terms of valence and arousal. RESULTS: Unlike CTL, patients with AN exhibited heightened electrodermal activity for morphological stimuli only, when presented in the near space. They also preferred larger and smaller interpersonal distances with overweight and underweight characters respectively, although rating both negatively. Finally, and similar to CTL, they preferred larger interpersonal distance with angry than neutral or happy characters. DISCUSSION: Although patients with AN exhibited behavioural response to emotional stimuli similar to CTL, they lacked corresponding physiological response, indicating emotional blunting towards emotional social stimuli. Moreover, they showed distinct behavioural and physiological adjustments in response to body shape, confirming the specific emotional significance attached to body shape.

Heterogeneity of emotion regulation strategies in patients with alcohol use disorder during the first year of abstinence: a clustering analysis.

AIMS: Studies examining the use of specific emotion regulation (ER) strategies in patients with severe alcohol use disorder (AUD) are mainly focused on intergroup comparisons to the detriment of intragroup variability. Yet, these patients are in fact characterized by emotional deficits of varying severity, and we seek to identify different patterns of ER strategies in people with AUD during their first year of abstinence. METHODS: Based on the ER strategies used by a large sample of patients with AUD, we applied cluster analysis to identify the existence of subgroups using distinct patterns of adaptive and nonadaptive strategies. To characterize these groups, we compared their clinical characteristics and then their emotional regulation strategies to those of control consumers. RESULTS: A first cluster, representing 61% of the sample, is constituted by individuals with high adaptive strategy scores and high nonadaptive strategy scores; a second cluster, representing 39% of the sample, corresponds to individuals with low adaptive strategy scores and high nonadaptive strategy scores. The individuals in these two clusters differed in terms of anxiety level and abstinence time. Compared with control consumers, the use of nonadaptive ER strategies remained lower for the two clusters, while the use of adaptative strategies differed. CONCLUSIONS: Our results support the idea of considering the heterogeneity of emotional capacities in individuals with AUD during the first year of abstinence. The identification of these profiles suggests either the existence of different adaptive ER capacities at baseline or a specific recovery of adaptive strategies over this period.

Autobiographical memories cued by self-statements in patients with alcohol use disorder: linking self-conceptions to past events.

The study examined the personal sense of identity in alcohol use disorder (AUD) through the relation between autobiographical memories and individuals' self-conception. The AUD detoxified patients and control participants were asked to create a list of self-statements to which they associated for the three main autobiographical memories illustrating them. The group variable was not associated with the number of positive self-statements, but it was associated with the number of negative self-statements. Furthermore, for the autobiographical memories cued by a positive self-statement, the group was related to the number of positive memories and general memories, while no relation was observed for the memories cued by a negative self-statement. Our results also support that AUD patients' memories cued by self-statements are older and more alcohol-related. Hierarchical regression analyses in the AUD patients demonstrated that the use of adaptive emotional regulation strategies was the only significant predictor of the use of positive or negative self-statements.

Considering management behaviours to identify vulnerable caregivers of persons with dementia.

BACKGROUND: Persons with dementia gradually disengage from daily activities, and therefore require increasing daily support. Caregivers face a dilemma as to whether they should encourage the persons with dementia in terms of initiative and autonomy, or supervise and take charge of tasks, which may cause distress for both parties. This study seeks to better understand how caregivers manage the disengagement of the persons with dementia and the repercussions on their caregiving experience. METHODS: A total of 217 caregivers participated. Their management behaviours and the characteristics of their caregiving experiences were assessed with questionnaires. A cluster analysis was first performed to identify possible profiles of management behaviours and comparison, which were then compared to identify the caregiving experience associated with each profile. RESULTS: The first cluster (25.8% of the sample) corresponds to caregivers with high negative control behaviour scores and high positive stimulation behaviour scores; the second cluster (43.8% of the sample) corresponds to caregivers with low positive stimulation behaviour scores and high negative control behaviour scores; and the third cluster (30.4% of the sample) corresponds to caregivers with low negative control behaviour scores and high positive stimulation behaviour scores. Caregivers in Clusters 2 and 3 differ in terms of anxiety, depression, burden, gratification, health and financial problems. Cluster 1 is an intermediate profile with similar characteristics to Cluster 3. CONCLUSIONS: Our results support the idea of considering management behaviours to identify vulnerable caregivers and highlight the deleterious role of negative control behaviours, especially when they are not offset by positive protective stimulation behaviours.

How do maternal emotional regulation difficulties modulate the mother-infant behavioral synchrony?

Mother-infant synchrony is one of the most important processes in the development of socio-affective competencies in children. While maternal abilities and psychopathology are related to maladaptive mother-infant synchrony, it is as yet unclear how maternal emotion regulation difficulties contribute to it. Based on a panel of behavioral indicators (i.e., gaze, vocal, and motor), the present study examined mother-infant synchrony at 6 months of age in a modified version of Ainsworth's Strange Situation (n = 72 dyads). Mother-infant interaction sequences were characterized by indicators of complexity (LZ complexity of joint behavioral sequences) and of synchronization quality (cross-recurrence plot quantification). Results showed that mothers' touch was greater in the reunion condition than in the initial condition. Mothers' motor behaviors were associated with the global levels of infants' behavioral involvement in the reunion condition, unlike the symmetrical influence observed between mothers and infants in the initial condition. Results show that maternal anxiety mediates the relationships between mothers' emotion regulation difficulties and gaze, vocal, and motor synchrony between mothers and infants in the initial and reunion conditions. This study emphasizes the central role of maternal emotion regulation difficulties in the establishment of maladaptive synchrony and in the adjustments of maternal physical contacts with infants.

High emotional experience during autobiographical retrieval in women with Korsakoff syndrome.

INTRODUCTION: In this exploratory study, we investigated gender differences regarding autobiographical memory in KS. METHOD: We invited 33 patients with KS and 35 matched control participants to retrieve autobiographical memories and, afterward, to rate mental time travel during retrieval, emotional value and importance of memories. RESULTS: Analysis demonstrated lower specificity (i.e., lower ability to retrieve memories situated in a specific time and space), mental time travel, and importance in patients with KS compared to control participants. Analysis also demonstrated no significant difference between patients with KS and control participants regarding emotion. Critically, analysis demonstrated no significant differences neither women and men with KS, nor between women and men in the control group, regarding autobiographical specificity, mental time travel, or importance. However, women with KS attributed higher emotional value for memories compared to men with KS, and the same results were observed in the control group. DISCUSSION: These findings demonstrate that the higher emotional experience during autobiographical retrieval, as observed in the general population, can also be observed in KS.

Characterizing the determinants of sexual dissatisfaction among heterosexuals: The specific role of dyadic coping.

Sexual satisfaction is the most frequently studied sexual component of human sexuality related to its link with relationship satisfaction and stability (S. Sprecher & R. M. Cate, 2004. The handbook of sexuality in close relationships, pp. 235-256. Mahwah, NJ: Taylor & Francis). Previous studies have shown that sexual satisfaction is affected by personal, interpersonal, social and cultural variables, but few studies have considered the associations between these variables. The aim of this study was to evaluate a complex model of sexual satisfaction considering these various levels of variables and their associations. The study was conducted online and comprised 457 individuals in the final sample. The French version of the index of sexual satisfaction evaluated the level of sexual dissatisfaction. Personal, interpersonal, social and cultural variables were assessed with questionnaires and their associations were investigated with the partial least squares-path method. The association between dyadic coping (positive and negative) and sexual dissatisfaction was mediated by relationship satisfaction. The model also showed three sequential mediations through dyadic coping and relationship satisfaction: first between intra-individual vulnerability and sexual dissatisfaction, second between intra-individual resources and sexual dissatisfaction, and third between conjugal characteristics and sexual dissatisfaction. The simple and sequential mediations were stronger for positive dyadic coping. The relationship between intra-individual resources and positive dyadic coping was significantly stronger in women, while the relationship between conjugal characteristics and positive dyadic coping was stronger in men. Dyadic coping plays a key role in sexual dissatisfaction. Clinical interventions should reinforce positive self-image (particularly in women), support emotional and physical vulnerabilities, and promote more supportive dyadic coping (particularly in men in a long-term relationship).

Sex Differences in Korsakoff's Syndrome for Inhibition but Not for Episodic Memory or Flexibility.

BACKGROUND AND OBJECTIVES: While sex differences in cognitive abilities have been extensively studied in healthy populations, little is known about these differences in patients with Korsakoff syndrome (KS). METHODS: We investigated sex differences in verbal episodic memory, inhibition, and flexibility in 25 patients with KS and 25 control participants. RESULTS: The analysis demonstrated no significant differences between women with KS and men with KS on episodic memory and flexibility, but higher inhibition was observed in women with KS compared with men with KS. Regarding control participants, no significant differences were observed between women and men on inhibition or flexibility, but higher verbal episodic memory was observed in women compared with men. Verbal episodic memory and flexibility seem to be equally affected in women and men with KS, whereas inhibition seems to be more affected in men than in women with KS. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Our findings highlight cognitive sex differences in KS in executive function. Critically, our findings are the first quantitative data about episodic performances (and cognitive performances in general) of women and men with KS. (Am J Addict 2020;29:129-133).

Cognitive and Emotional Empathy in Anorexia Nervosa: The Role of Attachment Insecurity, Intrapersonal, and Interpersonal Emotional Competences.

The present research examined a model that evaluates the mediating role of both intrapersonal and interpersonal emotional competences (ECs) between attachment insecurity and the cognitive and emotional dimensions of empathy in patients with anorexia nervosa (AN). Women with AN completed the Experiences in Close Relationships Scale, the Profile of Emotional Competence, the Interpersonal Reactivity Index, the State-Trait Anxiety Inventory, and the Beck Depression Inventory. The results revealed that intrapersonal EC mediated the relationships between attachment insecurity (i.e., attachment anxiety and attachment avoidance) and emotional empathy in patients with AN. Importantly, a high emotional empathy in AN was associated with increased depression and anxiety symptoms. The results also indicated that a high level of attachment avoidance was indirectly associated with lower cognitive empathy through lower levels of interpersonal EC in AN. The present study emphasizes the importance of differentiating affective empathy from cognitive empathy and suggests clinical interventions in patients with AN.

Decreased emotional eating behavior is associated with greater excess weight loss five years after gastric banding.

While significant weight loss has been observed in the first two years following adjustable gastric banding (AGB), research on the long-term effectiveness of gastric restriction (e.g., 5 years) both on weight loss and eating behavior changes is scarce. The present study examined obese patients' changes in eating behavior preoperatively and 5 years after AGB and examined their associations with excess weight loss (EWL). Specifically, we focused on the association between the modification of three eating behavior profiles (i.e., restrained eating, emotional eating and external eating) and %EWL at 5 years. Among the 197 participants who underwent AGB, 136 completed the clinical assessments (weight, depression with the BDI, eating behavior with the DEBQ) before surgery, and after 5 years. Resultsshowed that the mean percentage of EWL was 47% after 5 years. Moreover, patients reported lower emotional eating and external eating after 5 years in comparison to the baseline, whereas there were no differences concerning restrained eating. Importantly, patients who presented higher %EWL at 5 years also reported a greater decrease in emotional eating between the two sessions than those with low %EWL. Our study underlines that eating behaviors are major variables involved in weight loss after gastric restriction. Results showed that emotional and external eating decreased significantly at 5 years whereas restrained eating behaviors did not vary between the pre- and postoperative stages. Moreover, the data suggest that a decrease in emotional eating accounts for the extent of EWL.

Characterisation of self-defining memories in criminals with antisocial personality disorder.

Early aversive events are key factors in the development of antisocial personality disorder (ASPD) and are known to impact the ability to produce specific autobiographical memories and to modify self-construction. The present study assessed identity construction in forensic inpatients suffering from ASPD by comparing the characteristics (specificity, integration, valence, topic and period) of self-defining memories (SDM) of persons with ASPD hospitalised in a forensic hospital to those of control participants. Offenders with ASPD had difficulty in retrieving purely specific single events and tended to recall memories comprising multiple events. In addition, they produced significantly less meaning-making from their past experiences (low integration). These characteristics of SDM could be due to a defensive process used by offenders with ASPD in which they do not integrate aversive experiences, thereby creating a vicious circle where maladjustment of their personality is maintained.

Effect of intrapersonal emotional competences on the relationship between attachment insecurity and severity of eating disorder symptoms in patients with restrictive anorexia.

OBJECTIVE: Attachment insecurity and emotional competences (EC) form a key part of conceptual models of anorexia nervosa (AN). We explored the relationship between attachment dimensions and EC on the severity of eating disorders in patients diagnosed with restrictive AN. METHOD: Sixty-three female patients with restrictive AN and 63 healthy participants completed self-report measures (eating symptoms, EC, attachment, depression, and anxiety). RESULT: Patients with restrictive AN used fewer adaptive and more maladaptive regulation strategies and showed low levels of intrapersonal EC. The partial least squares path modeling analysis showed that high levels of attachment anxiety or avoidance lead to a decrease in intrapersonal EC, which in turn contributes to greater severity of eating symptoms in anorexic patients. CONCLUSIONS: Lower intrapersonal EC played an important mediating role in the effects of attachment insecurity on the severity of eating disorders. The joint use of therapeutic programs that target both EC and attachment processes constitutes a promising approach.

Determining Sexual Offender Profiles From Life Trajectories.

To study qualitatively the development of a heteroaggressive behavior, we applied retrospective analytical method based on categorization of life events. The aim of this study was to establish the life trajectories of sexual offenders through interviews with second sources: the inmate's relatives and psychologists. The life trajectories of incarcerated sexual offenders were retraced to build individual life charts. These life charts grouped individual life events into four main domains: health, life events, the relational sphere, and the judicial and prison sphere. In a sample of 40 inmate participants, four different profiles of sex offenders and therefore life trajectories were identified according to the abovementioned domains: (a) "Early life events and behavior disorders" (n = 14), (b) "Abandonment issues" (n = 4), (c) "Behavior and socioaffective disorders" (n = 9), and (d) "Behavioral hyperadaptation and coldness" (n = 13). Expert judges classified the life trajectories with satisfactory interjudge agreement (k = 0.70). This research has clinical implications for integrating different life events into developmental trajectories and focusing psychological support for the individual.

Effect of marital satisfaction on self-regulation efforts in couples: Value of heart rate variability measurements.

This study explored self-regulatory efforts during the viewing of couple interactions and their association with relationship satisfaction. High-frequency heart rate variability (HF-HRV) was measured for each participant during a video recall of a recent couple interaction to quantify the self-regulatory processes governed by parasympathetic activity. Among 30 couples, HF-HRV was measured continuously during three specific periods to explore its change over time using a video-recall procedure: (1) resting state; (2) viewing of couple interactions (expressing daily life situations and conflictual interactions); and (3) recovery. Results of multilevel models revealed a u-shaped pattern of HF-HRV responses for men and women across the three periods with a nadir at the midway through the process. This pattern of physiological change (vagal suppression) reflects a flexible response to a stressful situation. Nevertheless, the pattern of physiological responses varied according to the level of relationship satisfaction. Men who were more satisfied in their couple relationship presented greater vagal suppression than dissatisfied men. In contrast, no significant HF-HRV changes were found in women over the different periods of the video-recall procedure and no moderating effect of relationship satisfaction. We discuss the different patterns of physiological responses observed both for men and women in terms of interindividual variability according to the level of their relationship satisfaction. The present study highlights the important role of relationship satisfaction in regulatory processes.

Schadenfreude, malicious and benign envy are associated with low body mass index in restrictive-type anorexia nervosa.

PURPOSE: According to the Cognitive-Interpersonal Maintenance Model of anorexia nervosa, social factors are involved in the maintenance and development of this disorder. Therefore, this study aimed to test whether patients with restrictive-type anorexia nervosa (AN-R) experience malicious envy (negative emotions associated with the wish that others lack their superior quality), benign envy (negative emotions associated with the desire to reach and obtain the others' superior quality) and Schadenfreude (pleasure at the misfortunes of others) with a higher intensity than healthy controls (HC). METHODS: 26 AN-R patients and 32 HC completed scenarios that aimed to induce envy and Schadenfreude and completed questionnaires measuring envy, self-esteem and social comparison. RESULTS: AN-R patients reported more benign envy than HC. Interestingly, higher body mass index (BMI) was associated with less Schadenfreude, malicious and benign envy in AN-R only. CONCLUSIONS: This study shows that AN-R patients present higher motivation to evolve when facing others' superior quality (i.e., benign envy). It also underlines the importance of considering social factors in the maintenance of AN-R and the role of BMI when examining emotions related to others' fortune. LEVEL OF EVIDENCE: Level III, case-control analytic study.

Impaired Specificity of Future Thinking in Alcohol Use Disorders.

BACKGROUND: While there has been a body of work that has investigated past thinking in individuals with alcohol use disorders (AUD), little is known about future thinking in these individuals. METHODS: We invited participants with AUD and control participants to construct past and future events. We have also investigated the relationship between constructing past and future events and depression. RESULTS: By analyzing the specificity (i.e., the ability in constructing specific events situated in time and space) of these events, results demonstrated lower specificity of past and future thinking in AUD participants compared to control participants. No significant differences were observed between the specificity of past and future thinking in AUD or in control participants. Further, significant negative correlations were observed between depression and past/future thinking in AUD participants but not in controls. CONCLUSIONS: Difficulties in constructing specific future scenarios, as observed in AUD participants compared with controls, are presumably related to ruminative thinking and emotional avoidance aspects of depression, which should be investigated in future studies. More specifically, individuals with AUD may tend to construct general future scenarios to dwell on negative past events and/or to avoid coping with hopelessness and processing of upsetting or distressful future scenarios.

Future Thinking in Korsakoff Syndrome.

AIMS: Prior research has been mainly concerned with the ability of patients with Korsakoff syndrome (KS) to project themselves into the past. Little is known about the patients' ability to project themselves into the future. We therefore compared past and future thinking in patients with KS. METHODS: We invited patients with KS and control participants to retrieve past events and reconstruct future events. Participants were also invited to rate subjective characteristics (i.e. time travel, emotional feeling, and visual imagery) of the past and future events. RESULTS: Patients with KS demonstrated low specificity, time travel, and emotional experience during past and future thinking. However, while lower emotional experience was observed in patients with KS than in the control participants during future thinking, no significant differences were observed between the two populations during past thinking. Regarding within-group comparisons, patients with KS demonstrated no significant differences between past and future thinking in terms of specificity, time travel, and visual imagery; however, they demonstrated higher emotional experience during past than during future thinking. Regarding control participants, they demonstrated no significant differences between past and future thinking in terms of specificity, time travel, emotional experience, and visual imagery. CONCLUSION: Our findings demonstrate a diminished ability to construct specific future scenarios as well as a diminished subjective experience during future thinking in KS.

Compromises of integration, specificity and emotional content of self-defining memories in patients with opioid-use disorder.

Autobiographical memory plays a major role in the construction of identity. A particular type of memory has been described as more relevant in pursuit of personal goals: self-defining memory (SDM). In patients with opioid-use disorder (OUD), SDM recall has not yet been investigated despite deficits in the retrieval of autobiographical memories. This study aims to characterise SDM recall in OUD patients. Patients (N = 25) and non-dependent individuals (N = 25) were told to recall five SDM and to rate the emotion (valence and arousal) triggered during the retrieval. Specificity, valence, theme, integration and distance in time of the SDM were analysed while controlling for anxiety and depression levels. The SDM construction of the OUD patients was characterised by a lower specificity, more neutral memories and a lower integration, while emotions triggered during retrieval did not differ between the two groups. This may reflect an unsuccessful attempt to disconnect from one's own emotions in the OUD patients. This emotional disconnection and the difficulty of addressing meaning of past events may be due to substance use history coupled with the use of emotional strategies of avoidance. The implications for substance abuse relapse are discussed.

Emotion Regulation Processes and Psychoform and Somatoform Dissociation in Adolescents and Young Adults with Cumulative Maltreatment.

The relationship between childhood trauma and dissociative experiences is widely acknowledged. However, the association between emotion regulation difficulties (ERD), anxiety/depression and dissociation in adolescents and young adults with cumulative maltreatment (CM) remains unclear. The present study examined the role of ERD at both intrapersonal and interpersonal levels and anxiety/depression symptoms in the development of psychoform or somatoform dissociation in adolescents and young adults with CM. We assessed 58 participants with CM and 55 participants without childhood trauma history between the age of 12 and 22 years old. Participants completed self-reports of ERD, anxiety/depression, psychoform dissociation and somatoform dissociation. The results revealed that adolescents and young adults exposed to CM displayed high levels of psychoform and somatoform dissociation, ERD and anxiety/depression symptoms. It was also found that intrapersonal and interpersonal ERD predicted psychoform dissociation, whereas anxiety/depression predicted somatoform dissociation in adolescents and young adults with CM. Intrapersonal and interpersonal ERD and anxiety/depression are therapy targets for clinical interventions in adolescents and young adults with CM and dissociative symptoms.