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ABSTRACTBackground: Many healthcare workers (HCWs) endured psychologically traumatic events at work during the coronavirus disease 2019 (COVID-19) pandemic. For some, these events are re-experienced as unwanted, recurrent, and distressing intrusive memories. Simple psychological support measures are needed to reduce such symptoms of post-traumatic stress in this population. A novel intervention to target intrusive memories, called an imagery-competing task intervention (ICTI), has been developed from the laboratory. The intervention includes a brief memory reminder cue, then a visuospatial task (Tetris® gameplay using mental rotation instructions for approximately 20â min) thought to interfere with the traumatic memory image and reduce its intrusiveness. The intervention has been adapted and evaluated in a randomized controlled trial (RCT) with Swedish HCWs (ClinicalTrials.gov identifier: NCT04460014).Objective: We aimed to explore how HCWs who worked during the COVID-19 pandemic experienced the use of a brief intervention to reduce their intrusive memories of work-related trauma.Method: Interpretative phenomenological analysis was used for in-depth understanding of the lived experiences of HCWs who used the intervention. Seven participants from the RCT were interviewed by an independent researcher without prior knowledge of the intervention. Interviews were conducted via telephone and transcribed verbatim.Results: Four general themes were generated: 'Triggers and troublesome images', 'Five Ws regarding support - what, when, why, by/with who, for whom', 'Receiving it, believing it, and doing it' and 'The intervention - a different kind of help'; the last two included two subthemes each. The results reflect participants' similarities and differences in their lived experiences of intrusive memories, support measures, and intervention impressions and effects.Conclusion: HCWs' experiences of the novel ICTI reflect a promising appraisal of the intervention as a potential help measure for reducing intrusive memories after trauma, and gives us a detailed understanding of HCWs' needs, with suggestions for its adaption for future implementation.Trial registration: ClinicalTrials.gov identifier: NCT04460014.
Many healthcare workers experience images or 'flashbacks' of traumatic experiences from their work during the COVID-19 pandemic.To ensure that individual needs are met, there is a need to tailor and refine current psychological support measures and their use for healthcare workers.The imagery-competing task intervention was perceived as acceptable, indicating its potential utility as a help measure to reduce intrusive memories after trauma.
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Personal de Salud , Trauma Psicológico , Humanos , COVID-19/epidemiología , Personal de Salud/psicología , Trauma Psicológico/psicología , Trastornos por Estrés Postraumático/prevención & control , PandemiasRESUMEN
PURPOSE: We studied the views of nursing students on family-centered care (FCC) and their knowledge, opinions, self-rated competence, current practice, and perceived implementation barriers with regard to trauma-informed pediatric nursing care. METHODS: This survey was a descriptive correlational study. The sample consisted of 261 nursing students, 3rd and 4th years, who had completed the Child Health and Diseases Nursing Course. The data were obtained using the "Student Information Form," "Family-Centered Care Attitude Scale," and "trauma-informed care (TIC) Provider Survey." RESULTS: Nursing students were knowledgeable and held favorable opinions about TIC. The survey showed that students with higher levels and those with a hospitalization experience during childhood had higher scores regarding TIC. A positive relationship was found between the students' TIC to mean score and FCC attitude mean score. CONCLUSIONS: Nursing students are not competent to practice TIC, especially with pediatric patients. Therefore, they need to develop relevant skills for helping pediatric patients. PRACTICE IMPLICATIONS: Efforts to improve nursing students' trauma-informed pediatric care should highlight specific skills related to helping pediatric patients manage emotional responses to difficult medical experiences. By integrating TIC into the baccalaureate curricula, nursing educators can provide the students with appropriate skills and facilities so that they can provide holistic and highly effective care to highly vulnerable patients.
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Actitud del Personal de Salud , Enfermería de la Familia , Enfermería Pediátrica , Trauma Psicológico , Estudiantes de Enfermería , Estudiantes de Enfermería/psicología , Enfermería Pediátrica/educación , Enfermería Pediátrica/métodos , Enfermería de la Familia/educación , Enfermería de la Familia/métodos , Humanos , Hospitalización , Trauma Psicológico/psicología , Pacientes/psicología , Enfermería Holística/educación , Enfermería Holística/métodos , Niño , Masculino , Femenino , Competencia Clínica , Encuestas y CuestionariosRESUMEN
BACKGROUND: Trauma-focused treatments (TFTs) have demonstrated efficacy at decreasing depressive symptoms in individuals with PTSD. This systematic review and meta-analysis evaluated the effectiveness of TFTs for individuals with depression as their primary concern. METHODS: A systematic search was conducted for RCTs published before October 2019 in Cochrane CENTRAL, Pubmed, EMBASE, PsycInfo, and additional sources. Trials examining the impact of TFTs on participants with depression were included. Trials focusing on individuals with PTSD or another mental health condition were excluded. The primary outcome was the effect size for depression diagnosis or depressive symptoms. Heterogeneity, study quality, and publication bias were also explored. RESULTS: Eleven RCTs were included (n = 567) with ten of these using EMDR as the TFT and one using imagery rescripting. Analysis suggested these TFTs were effective in reducing depressive symptoms post-treatment with a large effect size [d = 1.17 (95% CI: 0.58~ 1.75)]. Removal of an outlier saw the effect size remain large [d = 0.83 (95% CI: 0.48~ 1.17)], while the heterogeneity decreased (I2 = 66%). Analysis of the 10 studies that used EMDR also showed a large effect [d = 1.30 (95% CI: 0.67~1.91)]. EMDR was superior to non trauma-focused CBT [d = 0.66 (95% CI: 0.31~1.02)] and analysis of EMDR and imagery rescripting studies suggest superiority over inactive control conditions [d = 1.19 (95% CI: 0.53~ 1.86)]. Analysis of follow-up data also supported the use of EMDR with this population [d = 0.71 (95% CI: 1.04~0.38)]. No publication bias was identified. CONCLUSIONS: Current evidence suggests that EMDR can be an effective treatment for depression. There were insufficient RCTs on other trauma-focused interventions to conclude whether TFTs in general were effective for treating depression. Larger studies with robust methodology using EMDR and other trauma-focused interventions are needed to build on these findings.
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Depresión/terapia , Trauma Psicológico/terapia , Psicoterapia , Depresión/psicología , Humanos , Trauma Psicológico/psicologíaRESUMEN
The Dutch protocol for Eye Movement Desensitization and Reprocessing (EMDR) uses two psychological myths as part of the therapeutic instruction: memory works as a video camera and individuals can have a photographic memory. This study explored how participants experience and evaluate such instructions and if these instructions affect their beliefs on memory. Participants received a video, photo, or a control instruction. Participants indicated on a visual analog scale how vivid and emotional they expected to recall the traumatic memory, how credible the therapeutic instruction was, and how reliable they would consider a therapist providing such an instruction. Next, participants completed a memory belief survey. Participants who received the video instruction were most likely to expect to vividly recall a memory. The credibility of the instructions and the reliability of the therapist providing the instruction were at chance level, which might pose problems for the therapeutic alliance and therapy outcome.
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Desensibilización y Reprocesamiento del Movimiento Ocular , Trauma Psicológico , Psicoterapia , Humanos , Memoria , Recuerdo Mental , Países Bajos , Trauma Psicológico/psicología , Trauma Psicológico/terapia , Psicoterapia/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: Fibromyalgia (FM) is a generalized, widespread chronic pain disorder affecting 2.7% of the general population. In recent years, different studies have observed a strong association between FM and psychological trauma. Therefore, a trauma-focused psychotherapy, such as eye movement desensitization and reprocessing (EMDR), combined with a non-invasive brain stimulation technique, such as multifocal transcranial current stimulation (MtCS), could be an innovative adjunctive treatment option. This double-blind randomized controlled trial (RCT) analyzes if EMDR therapy is effective in the reduction of pain symptoms in FM patients and if its potential is boosted with the addition of MtCS. METHODS: Forty-five patients with FM and a history of traumatic events will be randomly allocated to Waiting List, EMDR + active-MtCS, or EMDR + sham-MtCS. Therapists and patients will be kept blind to MtCS conditions, and raters will be kept blind to both EMDR and MtCS. All patients will be evaluated at baseline, post-treatment, and follow-up at 6 months after post-treatment. Evaluations will assess the following variables: sociodemographic data, pain, psychological trauma, sleep disturbance, anxiety and affective symptoms, and wellbeing. DISCUSSION: This study will provide evidence of whether EMDR therapy is effective in reducing pain symptoms in FM patients, and whether the effect of EMDR can be enhanced by MtCS. TRIAL REGISTRATION: ClinicalTrials.gov NCT04084795 . Registered on 2 August 2019.
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Desensibilización y Reprocesamiento del Movimiento Ocular , Fibromialgia/terapia , Trauma Psicológico/psicología , Estimulación Transcraneal de Corriente Directa , Dolor Crónico , Método Doble Ciego , Fibromialgia/psicología , Humanos , Ensayos Clínicos Pragmáticos como Asunto , Calidad de Vida , Resultado del Tratamiento , Listas de EsperaRESUMEN
OBJECTIVE: Exposure to traumatic life events is associated with increased risk of posttraumatic stress disorder (PTSD) and other mental health problems such as suicidal ideation (SI), alcohol use disorder (AUD), and decreased quality of life (QOL). Mindfulness, which involves attending to the present moment, may help individuals cope with traumatic events by increasing acceptance of trauma-related experiences and decreasing trauma-related negative affect and avoidance of trauma reminders. The current study evaluated whether mindful attention to the present moment mediated the association between number of lifetime traumas and mental health. METHOD: The sample consisted of 1,268 trauma-exposed U.S. veterans who participated in the National Health and Resilience in Veterans Study, a nationally representative study of U.S. veterans. On average, the sample was 60.6 years of age (SD = 15.2, range = 20-94), predominantly male (89.8%), Caucasian (75.0%), and noncombat veterans (59.2%). RESULTS: Path analyses revealed that mindfulness partially mediated the relation between number of lifetime traumas and PTSD symptoms (ß = -.55), AUD (ß = -.17), and QOL (ß = .38), and fully mediated the relation between number of lifetime traumas and SI (ß = -.36). CONCLUSIONS: The relationship between lifetime trauma burden and various mental health issues of relevance to U.S. veterans may be mediated by mindfulness, or the ability to pay attention to the present moment. Interventions that bolster mindfulness may help mitigate the negative impact of cumulative traumas in this population. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Alcoholismo/psicología , Atención Plena , Trauma Psicológico/psicología , Calidad de Vida/psicología , Resiliencia Psicológica , Trastornos por Estrés Postraumático/psicología , Ideación Suicida , Veteranos/psicología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos , Adulto JovenRESUMEN
INTRODUCTION: One route to advancing psychological treatments is to harness mental health science, a multidisciplinary approach including individuals with lived experience and end users (e.g., Holmes, E. A., Craske, M. G., & Graybiel, A. M. (2014). Psychological treatments: A call for mental-health science. Nature, 511(7509), 287-289. doi:10.1038/511287a). While early days, we here illustrate a line of research explored by our group-intrusive imagery-based memories after trauma. METHOD/RESULTS: We illustrate three possible approaches through which mental health science may stimulate thinking around psychological treatment innovation. First, focusing on single/specific target symptoms rather than full, multifaceted psychiatric diagnoses (e.g., intrusive trauma memories rather than all of posttraumatic stress disorder). Second, investigating mechanisms that can be modified in treatment (treatment mechanisms), rather than those which cannot (e.g., processes only linked to aetiology). Finally, exploring novel ways of delivering psychological treatment (peer-/self-administration), given the prevalence of mental health problems globally, and the corresponding need for effective interventions that can be delivered at scale and remotely for example at times of crisis (e.g., current COVID-19 pandemic). CONCLUSIONS: These three approaches suggest options for potential innovative avenues through which mental health science may be harnessed to recouple basic and applied research and transform treatment development.
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Betacoronavirus , Infecciones por Coronavirus/terapia , Imágenes en Psicoterapia/tendencias , Salud Mental/tendencias , Neumonía Viral/terapia , Trauma Psicológico/terapia , Trastornos por Estrés Postraumático/terapia , COVID-19 , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/psicología , Emociones/fisiología , Humanos , Imágenes en Psicoterapia/métodos , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/psicología , Trauma Psicológico/epidemiología , Trauma Psicológico/psicología , SARS-CoV-2 , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/psicología , Pensamiento/fisiologíaRESUMEN
Converging evidence suggests that veterans with co-occurring PTSD/MDD represent a high-risk group for poor mental health compared to those with PTSD alone. To date, however, little is known about the specific factors that may increase vulnerability for and buffer risk for comorbid PTSD/MDD. The purpose of this study was to provide a population-based characterization of sociodemographic, risk, and protective variables associated with comorbid PTSD/MDD among U.S. military veterans. Data were analyzed from the National Health and Resilience in Veterans Study, a nationally representative survey of U.S. military veterans (n = 2,732). Analyses (1) compared veterans with PTSD alone and co-occurring PTSD/MDD on sociodemographic, military, and psychosocial characteristics; and (2) examined variables independently associated with PTSD/MDD status. Multivariable logistic regression analyses revealed that racial/ethnic minority status (odds ratio [OR] = 12.5), number of lifetime traumas (OR = 1.3), and time spent engaged in private religious/spiritual activities (OR = 1.8) were associated with PTSD/MDD status, while higher scores on measures of community integration (OR = 0.6) and dispositional optimism (OR = 0.7) were negatively associated with comorbid PTSD/MDD status. Relative importance analyses revealed that dispositional optimism (34%) and community integration (24%) explained the largest proportions of variance in PTSD/MDD comorbidity. Taken together, results of this study suggest that racial/ethnic minority status, greater lifetime trauma burden, and engagement in private religious/spiritual activities are key distinguishing characteristics of U.S. military veterans with comorbid PTSD/MDD vs. PTSD alone. They further underscore the need to study whether targeting community integration and optimism in prevention and treatment efforts may enhance clinical outcomes in this population.
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Trastorno Depresivo Mayor/epidemiología , Trauma Psicológico/epidemiología , Espiritualidad , Trastornos por Estrés Postraumático/epidemiología , Veteranos/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Comorbilidad , Trastorno Depresivo Mayor/etnología , Trastorno Depresivo Mayor/psicología , Humanos , Persona de Mediana Edad , Factores Protectores , Trauma Psicológico/etnología , Trauma Psicológico/psicología , Resiliencia Psicológica , Factores de Riesgo , Trastornos por Estrés Postraumático/etnología , Trastornos por Estrés Postraumático/psicología , Estados Unidos/epidemiología , Adulto JovenRESUMEN
AIMS: We explored the factors promoting long-term mental health among adolescent survivors of the 2008 Wenchuan earthquake in China. We examined the associations of their long-term mental health with disaster-related storytelling and school-based psychoeducation, and of school-based psychoeducation with disaster-related storytelling. METHODS: A secondary school-based cross-sectional survey was conducted 6 years after the disaster. Participants with traumatic experiences such as injury, loss, witnessing someone's death/injury and home destruction (N = 1028, mean age 15, standard deviation 1.38, male 51%) were eligible. Mental health/disaster education (MHE/DE) was defined as taking one or more lessons in MHE and/or DE at school since the earthquake. Experiences of storytelling about the disaster involved expressing distressing memories and feelings regarding the earthquake since the disaster happened, according to four groups: never expressed distressing memories and feelings, expressed them through writing/drawing, expressed them through talking to lay supporters and expressed them through talking to health professionals. Analysis of covariance was used to compare mean scores on five selected subscales of the Symptom Checklist-90 (SCL-90), the Athens Insomnia Scale (AIS) and the Psychotic-Like Experiences (PLEs) scale among the four storytelling groups. Linear regression analysis was used to identify the relationships between MHE/DE and current mental health as measured by the SCL-90, AIS and PLEs. The relationship between education and storytelling was probed by χ2 test. RESULTS: The talked-to-lay-supporters group showed better mental health on the SCL-90 (p ⩽ 0.001), AIS (p < 0.001) and PLEs (p = 0.004), while the consulted-health-professionals group showed worse mental health on the three dimensions of the SCL-90: depression (p = 0.05), anxiety (p = 0.02) and fear (p = 0.04), and on PLEs (p = 0.02) compared with the never-expressed group. MHE and DE were inversely associated with SCL-90, AIS and PLE scores. Participants who received these forms of education talked about their disaster experiences to lay supporters more than those who did not. CONCLUSIONS: MHE and DE at school may promote adolescents' mental health after a disaster. Experience of storytelling about the disaster to lay supporters may be helpful for long-term psychological recovery, and may be a potential mediating factor for school-based education and better mental health. Because of the cross-sectional nature of this study, causality cannot be inferred; therefore, further prospective intervention studies are needed to elucidate the effect of these factors on adolescent survivors' mental health.
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Desastres , Terremotos , Salud Mental , Narración , Trauma Psicológico/terapia , Servicios de Salud Mental Escolar , Estrés Psicológico/terapia , Adaptación Psicológica , Adolescente , China , Estudios Transversales , Femenino , Humanos , Masculino , Educación del Paciente como Asunto , Trauma Psicológico/psicología , Terapia por Relajación , Apoyo Social , Estrés Psicológico/psicologíaRESUMEN
Is the influence of religiousness on fearful, depressive and somatic symptoms and psychic traumatization overestimated? A representative cross-sectional study Objectives: The aim of this study is to prove if religious faith, spirituality and religious praxis are joined with lower depression, anxiety and physical pain-level and if subjects with traumatic experiences report more spirituality. Methods: In this consecutive study, 2508 adults of a representative sample in Germany were interviewed about religious faith and spirituality in relation to depression, anxiety, physical disorders as well as traumatic experiences. Results: Unlike our hypotheses people who are charged with mental (PHQ-4; Löwe et al. 2010) or physical disorders (GBB_8; Kliem et al. 2017) report more spirituality and more private religious/spiritual praxis than people without mental or physical problems. As expected people with traumatic experiences in their childhood (CTS; Grabe et al. 2012) describe significantly more spirituality than people without these experiences. Conclusions: Other than expected people with more mental or physical disorders report more spirituality and more private religious/spiritual praxis. It is to discuss if spirituality is less a protective factor for mental or physical disorders than disorders activate to look for spirituality and private religious/spiritual praxis.
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Ansiedad/psicología , Depresión/psicología , Miedo/psicología , Síntomas sin Explicación Médica , Trauma Psicológico/psicología , Religión y Psicología , Espiritualidad , Adulto , Ansiedad/epidemiología , Niño , Estudios Transversales , Depresión/epidemiología , Alemania/epidemiología , Humanos , Entrevistas como Asunto , Trauma Psicológico/epidemiologíaRESUMEN
Patients with post-traumatic stress disorder frequently and involuntarily experience intrusions, which are strongly linked to the trauma hotspot. Voluntary memory characteristics (i.e., vividness and unpleasantness) of this hotspot can be reduced by performing a dual-task, such as making horizontal eye movements, which is frequently used in Eye Movement Desensitization and Reprocessing. We tested whether such dual-task interventions would also reduce involuntary memory (i.e., intrusions). Moreover, we examined if changes in hotspot vividness and unpleasantness predicted intrusion frequency. Additionally, we examined whether the effects were dependent on dual-task modality. We tested this in three experiments. Participants watched a trauma film and performed one of the interventions 10-min post-film (1) Recall + Eye movements, (2) Recall + Counting, or (3) No-Task Control. Before and after the intervention, participants rated the hotspot vividness and unpleasantness. They recorded intrusive memories about the film in a diary for a week. Unexpectedly, we found that hotspot vividness and unpleasantness ratings were not affected by the intervention. However, the prolonged (experiment 2), but not standard (experiment 1), dual-task interventions resulted in a lower number of intrusions, regardless of modality. However, this effect was not replicated in experiment 3. We discuss potential explanations and present suggestions for future research.
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Atención , Movimientos Oculares , Memoria a Corto Plazo , Recuerdo Mental , Trauma Psicológico/psicología , Adolescente , Adulto , Desensibilización y Reprocesamiento del Movimiento Ocular , Femenino , Humanos , Masculino , Memoria , Trastornos por Estrés Postraumático/psicología , Trastornos por Estrés Postraumático/rehabilitación , Análisis y Desempeño de Tareas , Adulto JovenRESUMEN
The psychological burdens that patients experience while undergoing treatment for infertility in both men and women are well known and documented, especially within African populations. There are not many tested practical solutions to the problem, and clinical personnel have little time for personal counselling. This article described the development and delivery of an intervention designed to manage the psychological trauma that patients experience while dealing with infertility in resource poor settings. The Fertility Life Counselling Aid (FELICIA) has been developed to manage the psychological morbidity associated with infertility using cognitive behavioural therapy (CBT) based strategies. FELICIA provides a structured step by step guide to infertility counselling and is designed to be used by general community or hospital health workers rather than specialist psychologists or psychiatrists. This should make it a cost-effective option to deliver holistic care to patients treated for infertility, especially in resource poor settings.
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Terapia Cognitivo-Conductual/métodos , Infertilidad/psicología , Trauma Psicológico/terapia , Adulto , Consejo , Femenino , Humanos , Masculino , Salud Mental , Trauma Psicológico/etiología , Trauma Psicológico/psicologíaRESUMEN
BACKGROUND: Following resettlement in Australia, young traumatized refugees often face social challenges, including language and cultural barriers and social adjustment, which can lead to behavioral difficulties. Providing support at this vulnerable stage is therefore vital for reducing future setbacks. OBJECTIVE: The STARTTS Capoeira Angola program was developed to help traumatized adolescents successfully integrate into their school environments. As an Afro-Brazilian martial art that incorporates dance, Capoeira appeared an appropriate intervention for adolescent refugees due to its unique ethos of empowerment and group membership. METHOD: 32 refugeesfrom Middle Eastern and African countries (aged12-17) from the Intensive English Centre (IEC) department of the participant schools were assessed pre- and post- intervention using the Teacher's Strengths and Difficulties Scale (SDQ). Teachers were also asked to observe the students' functioning in a range of different situations at school. RESULTS/CONCLUSIONS: A significant overall decrease in behavioral problems was observed, which was associated with improvements in interpersonal skills, confidence, respect for self and others, self-discipline, and overall sense of responsibility.
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Baile , Violaciones de los Derechos Humanos/psicología , Artes Marciales , Trauma Psicológico/rehabilitación , Refugiados , Exposición a la Guerra , Adolescente , África/etnología , Asia Sudoriental/etnología , Australia , Niño , Femenino , Humanos , Masculino , Medio Oriente/etnología , Problema de Conducta , Trauma Psicológico/psicología , Campos de Refugiados , Respeto , Instituciones Académicas , Autoimagen , Autocontrol , Habilidades SocialesRESUMEN
Notions of ineffability, what cannot be put into words, vary depending on the historical and cultural context and, in particular, on shifting linguistic ideologies about the capabilities and limits of language. In recent decades psychoanalysts have embraced a modern notion of ineffability centered around traumatic bodily experiences that are thought to be inexpressible. However, these ideas break with Freudian ideas about language and, most importantly, with his understanding of the processes of interpretation that give meaning to both psychic pain and attempts to heal it. Contra Freud, current theories of ineffable trauma re-inscribe a dominance of the body over the psyche and over-simplify Freud's ideas about the retro-determination of trauma.
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Teoría Freudiana , Teoría Psicoanalítica , Terapia Psicoanalítica , Trauma Psicológico/psicología , Humanos , Curación Mental , Relaciones Metafisicas Mente-Cuerpo , Interpretación Psicoanalítica , Trauma Psicológico/terapiaRESUMEN
INTRODUCTION: Hypnotic suggestibility is elevated in the dissociative disorders but the relationship between dissociative tendencies and suggestibility in the general population seems to be constrained by additional factors. The diathesis-stress (DS) model stipulates that suggestibility interacts with trauma exposure to augment the propensity for dissociative states whereas the dual pathway to suggestibility (DPS) model proposes two developmental routes involving either dissociation preceded by trauma, or a healthy cognitive profile characterised by superior imagination. METHODS: This study sought to discriminate between these partially competing accounts and further considered the moderating role of anxious attachment. 209 participants completed psychometric measures of dissociative tendencies, trauma, and attachment, and a behavioural measure of suggestibility. RESULTS: In support of the DS model, trauma moderated the relationship between suggestibility and dissociation and, as predicted by the DPS model, dissociation moderated the relationship between trauma and suggestibility. Anxious attachment additionally moderated both effects. Model comparisons indicated that the DS model consistently provided a superior fit to the data. Further analyses showed that secure attachment independently predicted suggestibility, thereby supporting the non-dissociative pathway in the DPS model. CONCLUSIONS: These results suggest that high suggestibility confers vulnerability to dissociative states in individuals exposed to trauma and displaying an anxious attachment style.
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Ansiedad/psicología , Trastornos Disociativos/psicología , Trauma Psicológico/psicología , Sugestión , Adolescente , Adulto , Ansiedad/diagnóstico , Trastornos Disociativos/diagnóstico , Femenino , Humanos , Imaginación/fisiología , Masculino , Persona de Mediana Edad , Trauma Psicológico/diagnóstico , Autoinforme , Adulto JovenRESUMEN
Threat processing is central to understanding debilitating fear- and trauma-related disorders such as posttraumatic stress disorder (PTSD). Progress has been made in understanding the neural circuits underlying the "engram" of threat or fear memory formation that complements a decades-old appreciation of the neurobiology of fear and threat involving hub structures such as the amygdala. In this review, we examine key recent findings, as well as integrate the importance of hormonal and physiological approaches, to provide a broader perspective of how bodily systems engaged in threat responses may interact with amygdala-based circuits in the encoding and updating of threat-related memory. Understanding how trauma-related memories are encoded and updated throughout the brain and the body will ultimately lead to novel biologically-driven approaches for treatment and prevention.
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Encéfalo/fisiopatología , Miedo/fisiología , Memoria/fisiología , Trauma Psicológico/fisiopatología , Trastornos por Estrés Postraumático/fisiopatología , Estrés Psicológico/fisiopatología , Amígdala del Cerebelo/metabolismo , Amígdala del Cerebelo/fisiología , Amígdala del Cerebelo/fisiopatología , Encéfalo/metabolismo , Encéfalo/fisiología , Núcleo Amigdalino Central/fisiología , Núcleo Amigdalino Central/fisiopatología , Hormona Liberadora de Corticotropina/metabolismo , Miedo/psicología , Glucocorticoides/metabolismo , Hipocampo/metabolismo , Hipocampo/fisiología , Hipocampo/fisiopatología , Humanos , Hipotálamo/metabolismo , Hipotálamo/fisiología , Hipotálamo/fisiopatología , Interneuronas/metabolismo , Interneuronas/fisiología , Trauma Psicológico/metabolismo , Trauma Psicológico/psicología , Trastornos por Estrés Postraumático/metabolismo , Trastornos por Estrés Postraumático/psicología , Estrés Psicológico/metabolismo , Estrés Psicológico/psicología , Tálamo/metabolismo , Tálamo/fisiología , Tálamo/fisiopatologíaRESUMEN
Existen multitud de propuestas psicoterapéuticas que plantean Intervenciones corporales para abordar el sufrimiento psíquico, algunas de ellas faltas de un cimiento teórico sólido. Por otro lado, diferentes autores aceptan la presencia de experiencias arcaicas que mantienen su influencia a lo largo de la vida y que resultan inaccesibles a la palabra. Cuando la intervención verbal es insuficiente, se hace necesaria una reflexión sobre los límites de la acción terapéutica: la atención sobre el diálogo somático, el cuestionamiento del tabú de tocar o la integración de técnicas corporales que evoquen experiencias sensoriales y emocionales primigenias. Se revisará el significado del cuerpo para diferentes autores dentro del ámbito del psicoanálisis, tales como Freud, Reich, Bion, Winnicott, Anzieu o los teóricos del psicoanálisis relacional, en busca de un fundamento conceptual para las técnicas corporales
There are many psychotherapeutic proposals that offer corporal interventions to deal with psychic suffering, some of them lacking a solid theoretical foundation. On the other hand, different authors accept the presence of archaic experiences that maintain their influence throughout life and are inaccessible to the word. When verbal intervention is insufficient, it is necessary to reflect on the limits of therapeutic action: attention to somatic dialogue, questioning of the touch taboo or the integration of body techniques that evoke sensory and primordial emotional experiences. The meaning of the body within the psychoanalysis field, according to a range of authors such as Freud, Reich, Bion, Winnicott, Anzieu or relational psychoanalysis theorists, will be reviewed in search of a conceptual foundation for body techniques
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Humanos , Cinésica , Comunicación no Verbal , Interpretación Psicoanalítica , Terapia Psicoanalítica/métodos , Impulso (Psicología) , Acontecimientos que Cambian la Vida , Trauma Psicológico/psicología , Terapias Mente-Cuerpo/métodos , Relaciones Metafisicas Mente-Cuerpo , Teoría Freudiana , Relaciones Profesional-PacienteRESUMEN
BACKGROUND: Peri- and post-traumatic factors predict the differential development of stress-associated mental disorders. Prospective designs assessing these risk factors in real-time under controlled experimental conditions can overcome limitations of retrospective designs. Therefore, we aimed to investigate multi-sensory, experimental analogues of a traumatic experience delivered in Virtual Reality (VR) or Script-Driven Imagery (SDI). METHODS: In a randomised controlled crossover design, differences in the induced analogue trauma symptoms between multi-sensory analogue trauma by either VR or SDI versus a neutral condition were assessed in 127 non-clinical participants. RESULTS: Analogue symptoms (psychophysiological responses, coping behaviour and intrusive memories of the experimental trauma) increased following analogue trauma in both VR and SDI, with more analogue symptoms for VR. Psychophysiological arousal was in general higher in VR. LIMITATIONS: The analogue trauma situation of a car park fire that was used may be infrequent in real life. CONCLUSIONS: Multisensory (vision, olfaction, hearing) analogue trauma in VR and SDI offers a useful tool for the induction and real-time assessment of peri- and post-traumatic risk factors for analogue stress-associated psychopathology. VR was more effective in inducing analogue symptoms than SDI, even though the latter might be more personalised. New experimental models for studying trauma exposure and responses may contribute to a better understanding of risk factors and help to identify and protect individuals at risk.
Asunto(s)
Adaptación Psicológica , Imágenes en Psicoterapia , Memoria , Trauma Psicológico/psicología , Psicofisiología , Realidad Virtual , Nivel de Alerta , Estudios Cruzados , Femenino , Humanos , Masculino , Estudios Prospectivos , Adulto JovenRESUMEN
BACKGROUND: Survivors of sexual assault are vulnerable to long-term negative psychological and physical health outcomes, but few studies have investigated changes in cognition, emotional processing and brain function in the early stages after sexual assault. We used a multimodal approach to identify the cognitive and emotional correlates associated with sexual assault in women. METHODS: Twenty-seven female survivors of sexual assault were included within 4 weeks of the traumatic event, and they were compared with 20 age-matched controls. Participants underwent functional MRI while performing cognitive/emotional tasks (n-back, emotional go/no-go, mental imagery). We also measured diurnal salivary cortisol and conducted neuropsychological assessments of attention and memory abilities. RESULTS: Relative to the control group, the survivor group had lower levels of morning cortisol and showed attentional deficits. We observed no between-group differences in brain activation during the n-back or mental imagery tasks. During the emotional go/no-go task, however, the survivor group showed a lack of deactivation in the dorsal anterior cingulate cortex when processing emotional material, relative to neutral material. Exploratory analyses in the survivor group indicated that symptom severity was negatively associated with cerebellar activation when positive emotional (happy) content interfered with response inhibition, and positively associated with cerebellar activation when thinking of positive (happy) memories. LIMITATIONS: The small sample size was the main limitation of this study. CONCLUSION: Dysfunctions in the dorsal anterior cingulate cortex and the cerebellum may represent early functional brain modifications that alter higher cognitive processes when emotional material is involved.
Asunto(s)
Encéfalo/diagnóstico por imagen , Cognición , Emociones , Hidrocortisona/metabolismo , Trauma Psicológico/psicología , Delitos Sexuales/psicología , Adolescente , Adulto , Atención/fisiología , Encéfalo/fisiopatología , Estudios de Casos y Controles , Cerebelo , Ritmo Circadiano , Femenino , Neuroimagen Funcional , Giro del Cíngulo/diagnóstico por imagen , Giro del Cíngulo/fisiopatología , Humanos , Imagen por Resonancia Magnética , Memoria/fisiología , Persona de Mediana Edad , Pruebas Neuropsicológicas , Trauma Psicológico/diagnóstico por imagen , Trauma Psicológico/metabolismo , Trauma Psicológico/fisiopatología , Saliva/química , Adulto JovenRESUMEN
OBJECTIVE: This study explored factors related to substance misuse and recovery among Native mothers in a Pacific Northwest tribe, focusing on motherhood as a motivating factor in seeking treatment and sustaining recovery. METHOD: Using a community-based participatory research approach, we conducted a thematic analysis of 20 in-depth interviews and one focus group (N = 12) with Native women 18 years and older living on or near the reservation. RESULTS: Qualitative findings highlighted challenges, motivations and strategies for seeking treatment and recovery in four major themes: (a) the close relationship between interpersonal violence and substance misuse; (b) traditional healing in recovery; (c) community-specific challenges to recovery; and (d) the motivating role of motherhood in seeking treatment and successful recovery. CONCLUSIONS: A central finding of this work is that pregnancy and motherhood may be underexplored factors in Native women's substance use. Results support previous work suggesting that Native women are at high risk of interpersonal trauma and that trauma contributes to substance misuse. Findings offer several rich implications for treatment and recovery among Native mothers in tribal communities including the necessity of trauma-informed treatment, community and culturally-based interventions, more integration of treatment services with Child Protective Services, and drawing on motherhood as a motivation for seeking and succeeding in recovery.