An empirical analysis of mental state talk and affect regulation in two single-cases of psychodynamic child therapy.

Literature has shown the importance of mentalizing techniques in symptom remission and emotional understanding; however, no study to date has looked at the dynamic relations between mental state talk and affect regulation in the psychotherapy process. From a psychodynamic perspective, the emergence of the child's capacity to regulate affect through the therapist's reflection on the child's mental states is a core aspect of treatment. In an empirical investigation of 2 single cases with separation anxiety disorder, who were treated in long-term psychodynamic play therapy informed with mentalization principles, the effect of therapists' and children's use of mental state talk on children's subsequent capacity to regulate affect in play was assessed. One case was a positive outcome case, whereas the other did not show symptomatic improvement at the end of treatment. Children's and therapists' utterances in the sessions were coded using the Coding System for Mental State Talk in Narratives, and children's play was coded by Children's Play Therapy Instrument, which generated an index of children's "affect regulation." Time-series Granger Causality tests showed that even though both therapists' use of mental state talk significantly predicted children's subsequent affect regulation, the association between child's mental state talk and affect regulation was only supported for the child who showed clinically significant symptom reduction. This study provided preliminary support that mental state talk in psychodynamic psychotherapy facilitates emotion regulation in play. (PsycINFO Database Record

Attachment and coping in psychosis in relation to spiritual figures.

BACKGROUND: Studies have found higher levels of insecure attachment in individuals with schizophrenia. Attachment theory provides a framework necessary for conceptualizing the development of interpersonal functioning. Some aspects of the attachment of the believer to his/her spiritual figure are similar to those between the child and his/her parents. The correspondence hypothesis suggests that early child-parent interactions correspond to a person's relation to a spiritual figure. The compensation hypothesis suggests that an insecure attachment history would lead to a strong religiousness/spirituality as a compensation for the lack of felt security. The aim of this study is to explore attachment models in psychosis vs. healthy controls, the relationships between attachment and psychopathology and the attachment processes related to spiritual figures. METHODS: Attachment models were measured in 30 patients with psychosis and 18 controls with the AAI (Adult Attachment interview) in relationship with psychopathology. Beliefs and practices related to a spiritual figure were investigated by qualitative and quantitative analyses. RESULTS: Patients with psychosis showed a high prevalence of insecure avoidant attachment. Spiritual entities functioned like attachment figures in two thirds of cases. Interviews revealed the transformation of internal working models within relation to a spiritual figure: a compensation process was found in 7 of the 32 subjects who showed a significant attachment to a spiritual figure. CONCLUSIONS: Attachment theory allows us to highlight one of the underlying dimensions of spiritual coping in patients with psychosis.

Short-term psychoanalytic child therapy for anxious children: a pilot study.

Few studies report treatment outcome for early childhood internalizing disorders following psychotherapy, especially psychodynamic techniques. We aimed to investigate effectiveness of a novel, developmentally appropriate, short-term psychodynamic treatment program for 4- to 10-year-olds with anxiety disorders in an outpatient setting. We conducted a quasi-experimental wait-list controlled study. Thirty children (12 females) with Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) anxiety disorders and their families received 20-25 sessions of manualized short-term Psychoanalytic Child Therapy (PaCT). We assessed outcome with standardized diagnostic interviews and parent reports of internalizing and total problems at all time points. Child puppet interviews and teacher reports were also available for pre-post treatment and follow-up analyses. While 18 families entered treatment immediately, 12 families were first wait-listed before receiving treatment. Analyses of symptom improvement were based on comparisons between groups (treatment vs. wait-list) as well as pre-post and 6-month follow-up data across all families (including wait-listed families). Among the 27 completers, 66.67% (n = 18) no longer met criteria for any anxiety disorder (59.88% in intent-to-treat analysis) while no children remitted across the wait-list interval. Parent-reported child internalizing and total problems significantly declined during treatment relative to wait-list. Child and teacher reports also revealed significant pre-post symptom reductions on internalizing and total problems. Diagnostic and symptom remission rates were maintained at 6-month follow-up except on child reports. This preliminary study adds to a growing database showing that psychodynamic treatments may offer an effective line of treatment for childhood internalizing symptoms and disorders in the eyes of clinicians, children, parents, and teachers.

Anxiety disorders and rapid cycling: data from a cohort of 8129 youths with bipolar disorder.

Anxiety disorders (ADs) are common in youths with bipolar disorder (BD). We examine psychiatric comorbidity, hospitalization, and treatment in youths with versus without AD and rapid cycling (four or more cycles per year). Data from the Integrated Healthcare Information Services cohort were used and included 8129 youths (ages ≤18 years). Prevalence of AD, demographic, type of AD, hospitalization, and use of psychotropics were compared between rapid and nonrapid cycling. Overall, 51% of the youths met criteria for at least one comorbid AD; they were predominantly female and were between 12 and 17 years of age. The most common comorbid ADs were generalized ADs and separation ADs. In the patients with rapid cycling, 65.5% met criteria for comorbid AD. The BD youths with AD were more likely to have major depressive disorders and other comorbid ADs, to be given more psychotropics, and to be hospitalized for depression and medical conditions more often than were those without AD.

Schisandra chinensis reverses visceral hypersensitivity in a neonatal-maternal separated rat model.

Visceral hypersensitivity is an important characteristic feature of functional gastrointestinal disorders, such as irritable bowel syndrome (IBS). This study evaluated the effect of Schisandra chinensis on visceral hyperalgesia induced by neonatal maternal separation (NMS) in an IBS rat model. The visceromotor responses to colorectal balloon distension (CRD) were measured by abdominal withdrawal reflex (AWR) and electromyographic (EMG) activities. NMS control rats (receiving vehicle) underwent aggravated visceral pain in response to CRD as compared to normal rats, evidenced by the reduced pain threshold, enhanced AWR scores and EMG responses. Treatment with a 70% ethanol extract of S. chinensis (0.3g/kg and 1.5g/kg/day) for 7 days resulted in an increase in the pain threshold (NMS control: 19.1±1.0mmHg vs low-dose: 24.8±1.3mmHg and high-dose: 25.2±1.8mmHg, p<0.01), and abolished the elevated AWR and EMG responses to CRD in NMS rats (AUC values of EMG response curve were: 1952±202 in NMS control group vs 1074±90 in low-dose group and 1145±92 in high-dose group, p<0.001), indicating that S. chinensis could reverse the visceral hypersensitivity induced by early-life stress event. The result of ELSA measurement shows that the elevated serotonin (5-HT) level in the distal colon of NMS rats returned to normal level after treatment with S. chinensis. Moreover, the increase in pain threshold in rats treated with S. chinensis was associated with a decline of the mRNA level of 5-HT(3) receptor in the distal colon. All available results demonstrate that S. chinensis can reverse visceral hypersensitivity induced by neonatal-maternal separation, and the effect may be mediated through colonic 5-HT pathway in the rat.

Analgesic effects of JCM-16021 on neonatal maternal separation-induced visceral pain in rats.

AIM: To investigate the pharmacological effect of JCM-16021, a Chinese herbal formula, and its underlying mechanisms. METHODS: JCM-16021 is composed of seven herbal plant materials. All raw materials of the formula were examined according to the quality control criteria listed in the Chinese Pharmacopeia (2005). In a neonatal maternal separation (NMS) model, male Sprague-Dawley rats were submitted to daily maternal separation from postnatal day 2 to day 14, or no specific handling (NH). Starting from postnatal day 60, rats were administered JCM-16021 (2, 4, 8 g/kg per day) orally twice a day for 28 d. Pain threshold pressure and electromyographic activities of external oblique muscles in response to colorectal distention recorded with a Power Lab System (AD Instruments International), were tested as pain indices. Changes in serotonin (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA) concentrations in the colon of rats were analyzed; the enterochromaffin cell numbers and serotonin transporter in the colon of rats were also evaluated with an immunohistochemistry method. RESULTS: NMS treatment significantly reduced pain threshold pressure (37.4 +/- 1.4 mmHg), as compared to that of NH rats (57.7 +/- 1.9 mmHg, P < 0.05). After JCM-16021 treatment, the pain threshold pressure significantly increased when compared to that before treatment (34.2 +/- 0.9 mmHg vs 52.8 +/- 2.3 mmHg in the high dose group, 40.2 +/- 1.6 mmHg vs 46.5 +/- 1.3 mmHg in the middle dose group, and 39.3 +/- 0.7 mmHg vs 46.5 +/- 1.6 mmHg in the low dose group, P < 0.05). Also JCM-16021 significantly and dose-dependently decreased electromyographic activity to the graded colorectal distension (CRD), (the mean DeltaAUC values were: 0.17 +/- 0.03, 0.53 +/- 0.15, 1.06 +/- 0.18, 1.22 +/- 0.24 in the high dose group; 0.23 +/- 0.04, 0.68 +/- 0.17, 1.27 +/- 0.26, 1.8 +/- 0.3 in the middle dose group; and 0.29 +/- 0.06, 0.8 +/- 0.16, 1.53 +/- 0.24, 2.1 +/- 0.21 in the low dose group for the pressures 20, 40, 60, 80 mmHg), as compared to the NMS vehicle group. The mean DeltaAUC values were: 0.57 +/- 0.12, 1.33 +/- 0.18, 2.57 +/- 0.37, 3.08 +/- 0.37 for the pressures 20, 40, 60, 80 mmHg (P < 0.05). JCM-16021 treatment significantly reduced the 5-HT concentrations (from high, middle and low dosage groups: 60.25 +/- 5.98 ng/100 mg, 60.32 +/- 4.22 ng/100 mg, 73.31 +/- 7.65 ng/100 mg), as compared to the NMS vehicle groups (93.11 +/- 9.85 ng/100 mg, P < 0.05); and increased the 5-HIAA concentrations (after treatment, from high, middle and low dosage groups: 54.24 +/- 3.27 ng/100 mg, 50.34 +/- 1.26 ng/100 mg, 51.37 +/- 2.13 ng/100 mg) when compared to that in the NMS vehicle group (51.75 +/- 1.98 ng/100 mg, P < 0.05); but did not change the enterochromaffin cell numbers in the colon of rats. In addition, NMS rats had higher SERT expression (n = 10) than NH rats (n = 8, P < 0.05). JCM-16021 treatment significantly decreased SERT expression when compared to the NMS group (P < 0.01-0.001). CONCLUSION: JCM-16021 can attenuate visceral hypersensitivity, and this analgesic effect may be mediated through the serotonin signaling pathway in the colon of rats.

An unusual clinical phenomenon: a case of bedtime ritual with apparent sexual overtones.

A 6-year-old boy attended a psychology clinic with a history of separation anxiety, delayed bedtime and problematic daytime behaviour. In addition, his mother described that at bedtime he would rock over a particular soft toy (teddy bear) on the floor of his bedroom with the bear straddled between his legs in what appeared to be a sexualized ritual. Clinical history taking and a psychological assessment led to a diagnosis of Separation Anxiety and sleep related Rhythmic Movement Disorder (RMD). Systematic desensitization, token-reward systems and play therapy were used to reduce separation anxiety. Alternative bedtime rocking routines without sexual overtones were developed and resulted in reduced time for sleep initiation, increased total sleep time and improved daytime behaviour. This case study demonstrates a case of severe RMD used as a self-soothing and anxiety-reduction strategy which was initially misinterpreted as a sexualized activity. Caution should be exercised in misinterpreting similar case presentations. Correct diagnosis was increased in this case with a psychologist with expertise in sleep and therefore presents a potentially unmet clinical need for sleep psychologists.

Maternal separation of rat pups increases the risk of developing depressive-like behavior after subsequent chronic stress by altering corticosterone and neurotrophin levels in the hippocampus.

Children that are abused have an increased risk for developing psychiatric disorders later in life, because of the negative effects of stress on the developing brain. We used a maternal separation model in rats to see how neurotrophins, stress hormones, behavior and the anti-oxidant potential of serum are affected. Rat pups were separated from their mothers for 3h/day on days 2-14. Maternal separation caused changes in levels of NGF and NT-3 in the dorsal and ventral hippocampus, increased basal corticosterone levels and decreased ACTH levels after acute restraint stress. The anti-oxidant potential of the rat serum was significantly lower in the maternal separation group. Depressive-like behavior, measured during a forced swim test, was seen in maternally separated rats after additional chronic stress during adulthood. Maternal separation caused downregulation of neurotrophins in the ventral hippocampus, possibly as an effect of high corticosterone levels, but compensatory mechanisms against cell death may be involved as neurotrophin levels increased in the dorsal hippocampus. Decreased anti-oxidant potential of serum could have been an effect of downregulated neurotrophin levels.

Nursing the child who is alone in the hospital.

Because of advances in medical technology, many critically burned children now survive horrendous injures that they would not have survived less than 10 years ago. Pediatric burn intensive care unit (BICU) nurses provide around the clock care, giving them greater contact with the children than any other health care professional. Often the children are alone in the hospital because their parents or care providers were injured or killed in the accident, live in another country, or are at home caring for other family members. Thematic analysis of data obtained during 112 hours of interviews and 134 hours of observation with 16 BICU nurses resulted in the identification of four categories of nurses' practices that helped the holistic healing of children who were alone on the BICU of a hospital in the southwestern United States: (a) being a parent-minded nurse; (b) sustaining human connections; (c) receiving the patient as a child; and (d) renewing the spirit of the child.

Placebo neural systems: nitric oxide, morphine and the dopamine brain reward and motivation circuitries.

Evidence suggests that the placebo response is related to the tonic effects of constitutive nitric oxide in neural, vascular and immune tissues. Constitutive nitric oxide levels play a role in the modulation of dopamine outflow in the nigrostriatal movement and the mesolimbic and mesocortical reward and motivation circuitries. Endogenous morphine, which stimulates constitutive nitric oxide, may be an important signal molecule working at mu receptors on gamma aminobutyric acid B interneurons to disinhibit nigral and tegmental dopamine output. We surmise that placebo induced belief will activate the prefrontal cortex with downstream stimulatory effects on these dopamine systems as well as on periaqueductal grey opioid output neurons. Placebo responses in Parkinson's disease, depression and pain disorder may result. In addition, mesolimbic/mesocortical control of the stress response systems may provide a way for the placebo response to benefit other medical conditions.

Communicating via expressive arts: the natural medium of self-expression for hospitalized children.

The study was undertaken at a play therapy unit in a Swedish hospital. The purpose was directed toward investigating what takes place during play therapy when children were given the opportunity to use expressive arts such as clay, paint, and/or textile, and the meaning children input into their art objects. The study describes an approach to working with hospitalized children when they visited the play therapy unit. During a three-year period, hospitalized children (n=22) participated in the study. The assumption was that given the opportunity to express themselves freely by using a variety of expressive arts, children will tell what they express in their art works. It might mirror their thoughts and feelings of being hospitalized. The result of the qualitative analyzes generated the themes fear, longing, and powerlessness. The results also showed that expressive arts were a medium for communication. Expressive arts should be used as a tool to help the child express her/himself when being hospitalized.

Anxiolytic properties of botanical extracts in the chick social separation-stress procedure.

RATIONALE: The recent growth in sales of natural products labeled as dietary supplements in the United States has renewed scientific interest in the study of the therapeutic effects of multi-component botanical products. OBJECTIVES: This study sought to determine whether botanical extracts derived from the Rutaceae family, Acori graminei, the Magnoliaceae family, Alchemilla vulgaris and Primula veris, which had previously been identified in bioassays as having potential anxiolytic activity, were active in the chick social separation-stress procedure. METHODS: Eight-day-old chicks received IP injections of test articles 30 min before being tested in the presence of two social companions or in isolation for a 3-min observation period. Dependent measures were: a) latency to adopt a ventral recumbent posture to index sedation, b) number of vocalizations to index separation-distress and c) a composite pain score (comprised of footlift frequency and footlift duration in response to 50 microl of 0.10% formalin injected into the plantar surface of the foot) to index stress-induced analgesia. RESULTS: Proprietal extracts NPS00033 from the Rutaceae plant family and NPS00039 (Relora) from the Magnoliaceae plant family screened positive in this chick model without causing sedation. CONCLUSIONS: These results suggest that botanical extracts Relora and NPS00033 may be useful in modulating anxiety states.

The use of child-centered play therapy and filial therapy with Head Start families: a brief report.

Play therapy and filial therapy show promise as effective ways to provide direct services to Head Start, addressing the needs of the children, the families, and the Head Start teachers and staff. This paper examines the utility of play and filial therapies for the Head Start population, presents a systemic explanation for the benefit of filial therapy, and provides a case example for illustration.

Iranian refugee children in Sweden: effects of organized violence and forced migration on preschool children.

Using play techniques, individual assessments were made of 50 preschool children from 47 Iranian refugee families living in Sweden, while their parents were interviewed about the children's exposure to violence and separation. Reenacting play involving war and persecution was performed by 19 of the children, most of them eyewitnesses to violence. The study demonstrated ways of obtaining information directly from young children to supplement parental reports.

Aloneness and the Isakower phenomenon.

Under the sway of the oedipal imperative, the Isakower phenomenon has long been regarded as a regressive perceptual defense against castration anxiety accompanying incestuous wishes, often stimulated by primal scene exposure-fantasy. Clinical material from the psychoanalytic psychotherapy of a borderline patient with object constancy deficits is offered to support a reconceptualization of the Isakower phenomenon: Following annihilatory rage and the destruction of extant inner objects, resulting in a regression to the "drive organization of memory," the face-breast imagery within the Isakower phenomenon arrives as a hallucinatory alternative to unbearable aloneness.

Impact of hyperbilirubinaemia and transient mother-child separation in the neonatal period on mother-child attachment in the 1st year of life.

Hyperbilirubinaemia (HyB) is the most common health disturbance in the neonatal period. The aim of this prospective study is to determine whether HyB and/or phototherapy (PhT) together with transient separation during the neonatal period are associated with impaired mother-child attachment after the 1st year of life. We divided 107 healthy term infants into three groups: 29 markedly icteric infants who underwent PhT (mother-child separation), 40 mildly icteric infants without PhT and a control group of 38 nonicteric infants. At the age of 1 year a paediatric examination and a Denver test were performed, and the mother-infants pairs were observed in Ainsworth's strange situation. The results show a similar distribution of the attachment patterns in the three different groups of infants. HyB and PhT do not negatively seem to affect the quality of attachment. Analysis of additional aspects showed that maternal coping and her perception of the child appear to be more important antecedents of the quality of attachment after the 1st year of life.