Cognitive and emotional impairment in stroke survivors: insights from a multi-center study on inpatient rehabilitation therapy.

BACKGROUND: Individuals recovering from stroke often experience cognitive and emotional impairments, but rehab programs tend to focus on motor skills. The aim of this investigation is to systematically assess the change of magnitude of cognitive and emotional function subsequent to a conventional rehabilitative protocol administered to stroke survivors within a defined locale in China. METHODS: This is a multicenter study; a total of 1884 stroke survivors who received in-hospital rehabilitation therapy were assessed on admission (T0) and discharge (T1). The tool of InterRAI was used to assess cognitive, emotional, and behavioral abnormality. RESULTS: The patients aged >60 years, with a history of hypertension, and long stroke onset duration were more exposed to functional impairment (all p < 0.05). Both cognitive and emotional sections were significantly improved at T1 compared to T0 (p < 0.001). Initially, 64.97% and 46.55% of patients had cognitive or emotional impairment at T0, respectively; this percentage was 58.55% and 37.15% at T1. CONCLUSION: Many stroke survivors have ongoing cognitive and emotional problems that require attention. It is essential to focus on rehabilitating these areas during the hospital stay, especially for older patients, those with a longer recovery, and those with hypertension history.

Alexithymic traits are closely related to impulsivity and cognitive and empathic dysfunctions in intimate partner violence perpetrators: New targets for intervention.

Clinical psychologists are interested in studying factors that interfere with the behavioral regulation of perpetrators of intimate partner violence against women (IPVAW), as well as the way these factors affect the risk of future recidivism after interventions that are designed for them are completed. Although several variables have been proposed as risk factors for IPVAW, the role of alexithymia and its relationships with other cognitive and empathic variables in IPVAW perpetrators has been neglected. Thus, the main aim of this study was to compare the alexithymic and cognitive and empathic traits in a carefully selected sample of IPVAW perpetrators (n = 47; mean age = 39) with a control group matched on sociodemographic characteristics (n = 41; mean age = 42). Moreover, we also aimed to study whether alexithymic traits are related to cognitive and empathic alterations in IPVAW perpetrators. Compared to controls, IPVAW perpetrators had higher alexithymic and self-reported impulsivity traits and worse attention and executive functioning (e.g., verbal fluency and cognitive flexibility) performance than controls. Moreover, they also presented greater personal distress, compared to controls. Notably, we observed that higher alexithymia was associated with high self-reported impulsivity, worse cognitive and empathic performance in both groups. Our study identifies different cognitive targets for specific neuropsychological rehabilitation interventions designed to prevent violence recidivism in the long term through their effects on emotional information processing and behavioral regulation.

Development of an early intervention programme for adolescents with emotion dysregulation and their families: Actions for the treatment of adolescent personality (ATraPA).

AIM: Borderline personality disorder and severe emotion dysregulation in adolescence is a major public health concern. Dialectical Behaviour Therapy is a promising treatment for suicidality in adolescents. The aim of this work is to present an adaptation of this intervention to the Spanish national health system, Actions for the Treatment of Adolescent Personality (ATraPA). METHOD: Data consists of a description of the different ATraPA subprogrammes, including interventions for adolescents aged 13 to 17 and their families. Participants were referred to ATraPA from different hospitals within the region of Madrid, Spain. RESULTS: ATraPA has been developed as an intensive outpatient treatment and it comprises different subprogrammes. ATraPA-TAI is an intensive outpatient treatment, including a skills-based group, individual therapy and email therapy. ATraPA-FAL is a psychoeducational intervention for families, including emotion regulation strategies for parents themselves. Finally, the Alternatives Group is offered to adolescents during the hospital admission, with the aim of promoting alternative coping skills. The group of therapists provides a support network to the professionals involved in ATraPA. CONCLUSIONS: ATraPA has been successfully implemented in a Child and Adolescent Psychiatry Service within the Spanish national health system. Future studies should address the efficacy of ATraPA using a controlled design.

Impact of baseline neurocognitive functioning on outcomes following rehabilitation of executive function training for veterans with history of traumatic brain injury.

Traumatic brain injury (TBI) is common among Veterans, and sequelae frequently include deficits in attention and executive function and problems with emotional regulation. Although rehabilitation has been shown to be effective, it is not clear how patient characteristics such as baseline cognitive status may impact response to rehabilitation in this sample. Explore the relationship between baseline neuropsychological status and postintervention functional outcomes in Veterans with chronic TBI. Thirty-three Veterans with chronic mild-severe TBI completed a neuropsychological evaluation, a functional assessment of executive function (EF), and measures of emotional and everyday functioning pre- and post-EF training or control training. Performance on baseline neuropsychological measures was used to cluster participants. Participants' performance at baseline and postintervention assessments was compared by cluster using multivariate analyses of variance (MANOVAs). Cognitive Difficulty (CD; n = 19) and Cognitively Normal (CN; n = 14) clusters were identified. CD was characterized by z ≤ -.75 on neuropsychological measures of overall attention/EF, working memory, and memory. CD participants performed worse on functional EF assessment and endorsed more PTSD symptoms and community integration problems, at baseline. CD participants improved post-EF training, but not control training, on neuropsychological and functional measures. CN participants did not show statistically significant improvement. For Veterans with chronic TBI, cognitive assessment can aid in identifying functional impairment and assist treatment planning. Cognitive rehabilitation training appears to be a beneficial treatment option for TBI patients with cognitive, emotional, and daily living difficulties.

A mind full of self: Self-referential processing as a mechanism underlying the therapeutic effects of mindfulness training on internalizing disorders.

The aim of the current review is to advance the hypothesis that change in self-referential processing is a key but under-examined mechanism through which mindfulness training confers its therapeutic benefits for individuals with internalizing disorders. Consequently, we integrated neuroscientific studies on aberrant self-referential processing in internalizing disorders with contemplative science scholarship examining the effects of mindfulness training on the self-referential system. Reviewing these literatures yielded four major conclusions: (1) internalizing disorders can be characterized by excessive self-referential processing and emotion dysregulation; (2) mindfulness training has moderate effects on reducing internalizing symptoms; (3) mindfulness training promotes the shifting from narrative self-focus to present-centered experiential awareness; (4) such mindfulness-induced changes in self-reference is accompanied by reduced activation in overactive self-referential brain regions that have been implicated in internalizing disorders. Clinical and research implications related to delineating the role of self-referential processing in producing the therapeutic effects of mindfulness training are discussed.

[Disability after stroke: a longitudinal study in moderate and severe stroke patients included in a multidisciplinary rehabilitation program]. / Ictus y discapacidad: estudio longitudinal en pacientes con discapacidad moderada-grave tras un ictus incluidos en un programa de rehabilitacion multidisciplinar.

INTRODUCTION: Stroke is a recognized cause of disability among adults. However the impact that the deficits that occur after a moderate/severe stroke have on long-term disability, as well as the response of the resultant deficits to rehabilitation, are not completely understood. PATIENTS AND METHODS: A total of 396 patients with a modified Rankin score >= 3 after an ischemic (n = 221) or hemorrhagic (n = 175) stroke were included in this study. All patients were assessed with cognitive, behavior, emotional, motor and functional domains. All patients were assessed at baseline and six months after inclusion in a multidisciplinary rehabilitation program. RESULTS: Risk of falling (Berg Balance Scale < 45 in 83.1% of the sample at baseline and 49.5% at follow-up) and functional problems (82.8% with a Barthel Index < 75 at baseline and 53% at follow-up) were the most prevalent deficits. Emotional disturbances were those that most improved while behavioral problems were those that did less. Although global disability improved during treatment among most patients, only 11% of our patients, especially those with preserved cognitive function at baseline, could be classified as patients with mild disability at follow-up. CONCLUSIONS: Stroke consequences are multidimensional. The symptoms that the stroke can cause in multiple domains, as well as the pattern of recovery are widely diverse, with prevalence of behavioral long-term disturbances.

TITLE: Ictus y discapacidad: estudio longitudinal en pacientes con discapacidad moderada-grave tras un ictus incluidos en un programa de rehabilitacion multidisciplinar.Introduccion. Los ictus son causa frecuente de discapacidad en el adulto; sin embargo, la repercusion que los deficits que acontecen tras un ictus moderado-grave tiene sobre el grado de discapacidad final, asi como la respuesta de estos a programas de rehabilitacion, no se ha estudiado por completo. Pacientes y metodos. Se incluyeron 396 pacientes con Rankin modificado >= 3 despues de un ictus isquemico (n = 221) o hemorragico (n = 175). En todos los pacientes se evaluo su situacion cognitiva, conductual, emocional, motora y funcional. Todos los pacientes fueron incluidos en un programa de rehabilitacion multidisciplinar y reevaluados tras seis meses de tratamiento. Resultados. El riesgo de caida (escala de equilibrio de Berg < 45 en el 83,1% de la muestra) y los deficits funcionales (indice de Barthel < 75 en el 82,8% de la muestra) fueron los problemas mas prevalentes en el momento del ingreso, mientras que los conductuales lo fueron en el del alta (55,1% de la muestra). Los problemas emocionales fueron los que mas mejoraron, mientras que los conductuales fueron los que menos lo hicieron. El nivel de discapacidad global mejoro tras el tratamiento, aunque solo un 11% de los pacientes, especialmente los que tenian buena situacion cognitiva en el ingreso, lograron alcanzar una discapacidad leve. Conclusiones. Las consecuencias del ictus son multidimensionales. La afectacion de las distintas esferas y el patron de recuperacion son diferenciales, con predominio a largo plazo de los problemas conductuales.

Reductions in Alexithymia and Emotion Dysregulation After Training Emotional Self-Awareness Following Traumatic Brain Injury: A Phase I Trial.

OBJECTIVES: To examine the acceptability and initial efficacy of an emotional self-awareness treatment at reducing alexithymia and emotion dysregulation in participants with traumatic brain injury (TBI). SETTING: An outpatient rehabilitation hospital. PARTICIPANTS: Seventeen adults with moderate to severe TBI and alexithymia. Time postinjury ranged 1 to 33 years. DESIGN: Within subject design, with 3 assessment times: baseline, posttest, and 2-month follow-up. INTERVENTION: Eight lessons incorporated psychoeducational information and skill-building exercises teaching emotional vocabulary, labeling, and differentiating self-emotions; interoceptive awareness; and distinguishing emotions from thoughts, actions, and sensations. MEASURES: Toronto Alexithymia Scale-20 (TAS-20); Levels of Emotional Awareness Scale (LEAS); Trait Anxiety Inventory (TAI); Patient Health Questionnaire-9 (PHQ-9); State-Trait Anger Expression Inventory (STAXI); Difficulty With Emotion Regulation Scale (DERS); and Positive and Negative Affect Scale (PANAS). RESULTS: Thirteen participants completed the treatment. Repeated-measures analysis of variance revealed changes on the TAS-20 (P = .003), LEAS (P < .001), TAI (P = .014), STAXI (P = .015), DERS (P = .020), and positive affect (P < .005). Paired t tests indicated significant baseline to posttest improvements on these measures. Gains were maintained at follow-up for the TAS, LEAS, and positive affect. Treatment satisfaction was high. CONCLUSION: This is the first study published on treating alexithymia post-TBI. Positive changes were identified for emotional self-awareness and emotion regulation; some changes were maintained several months posttreatment. Findings justify advancing to the next investigational phase for this novel intervention.

[An inclusive misunderstanding--why noncategorization in special education for people with emotional and social behavior disorders complicates the cooperation with child and adolescent psychiatry]. / Ein inklusives Missverständnis--Warum die Dekategorisierung in der Verhaltensgestörtenpädagogik die Kooperation mit der Kinder- und Jugendpsychiatrie erschwert.

The welcomed coeducation of children and adolescents with and without disabilities is going into dangerous territory since it has become burdened with a number of illusionary expectations. The constraints applied by real-life and meaningful circumstances should be taken into account, especially for children with emotional and social behavior disorders. Practicable prevention and intervention measurements cannot be generated without profound knowledge about disorders among this heterogeneous group of people. Abandoning all previously relevant terminology («noncategorization¼), demanded by some radical inclusion advocates, leads to a situation that is helplessly confronted with its duties but lacks the basic skills and the necessary support stemming from an interdisciplinary dialogue. The contact with child and adolescent psychiatry is threatened to the disadvantage of the profession.

[School well-being of students with and without special educational needs--a comparison of students in inclusive and regular classes]. / Schulisches Wohlbefinden von SchülerInnen mit und ohne sonderpädagogischen Förderbedarf--Integrations- und Regelklassen im Vergleich.

OBJECTIVE: The present study examines the academic well-being of students with and without special educational needs (SEN) in inclusive classes compared to students from regular classes in which no child with SEN is taught. In addition, the relationships between the school well-being and emotional problems, conduct problems, hyperactivity/inattention, peer relationship problems and prosocial behavior are analyzed. METHOD: A total of 1115 students from the 4th and 7th grade (37 % 4th graders, 63 % 7th graders) participated in the survey, 126 of whom had been diagnosed as having SEN. The subscale Well-Being at School taken from the FEESS 3­4 (Rauer & Schuck, 2004) and the SDQ (Goodman, 1997) were used for measurement. RESULTS: Results indicate high reliabilities for the subscale Well-Being in School for students both with and without SEN for both grades 4 and 7. Furthermore, it could be shown that the variance explained for school well-being can be connected to elements on the students' individual level as well as on the class-specific level. Significant predictors of school well-being were sex, behavioral difficulties and strengths as well as the school grade. The SEN status (no SEN vs. SEN) and the class setting (regular vs. inclusive class) did not influence the school well-being significantly.

Reading interventions for middle and secondary students with emotional and behavioral disorders: a quantitative review of single-case studies.

Many students with emotional and behavioral disorders (EBD) experience learning problems in reading at the middle and secondary school levels. Yet, the academic performance of students with EBD is often overlooked in the research literature. The purpose of this article was to provide a quantitative synthesis of the published, peer-reviewed, single-case research literature on reading interventions for students with or at-risk for EBD. An omnibus nonoverlap effect size of .59 with a 95% confidence interval (CI) = [.54, .64] was found consisting of 219 phase contrasts and 44 participants across the 11 studies included in the review. The findings are discussed in the context of improving the academic and behavioral outcomes of middle and secondary students with EBD.

He Looks Normal But Challenges of Family Caregivers of Veterans Diagnosed with a Traumatic Brain Injury.

PURPOSE: To describe the experience of family caregivers providing care to veterans with traumatic brain injury (TBI). DESIGN/METHODS: Using a qualitative design, interviews were conducted with a purposeful sample of women caregivers. Data were analyzed using content analysis procedures. FINDINGS: Findings resulted in the key concept phrased by participants as "He looks normal but." This phrase conceptualizes the participants' description of their experience caring for a brain injured veteran who could appear normal to others but the caregiver's description revealed substantial cognitive, social, and emotional deficits. Concepts include (a) Becoming aware of his disabilities, (b) Observing his troubling symptoms, (c) Dealing with his memory loss, (d) Being fearful of his anger, (e) Sensing his loneliness, (f) Acknowledging the effects on the children, and (g) Managing the best I can. CONCLUSIONS/CLINICAL RELEVANCE: A better understanding of the needs of caregivers of veterans with TBI may allow clinicians to better support caregivers.

Mediators and moderators of chronic pain outcomes in an online self-management program.

OBJECTIVES: Little is known about the moderators and mediators of change in online pain interventions based on cognitive-behavior therapy (CBT). We hypothesized that the effects of painACTION.com, an online pain self-management program, on pain-related outcomes would be mediated by changes in depression, anxiety, and stress, as well as the use of coping strategies. We also examined potential moderators of change. METHODS: First, the efficacy of painACTION.com and moderators of the intervention effects were evaluated using a pooled sample from previous back, neuropathic, and arthritis pain studies. Next, we explored whether the intervention effect on the primary outcomes, pain severity, and patient global impression of change (PGIC), was mediated by coping strategies or emotional functioning. RESULTS: Compared with controls, experimental participants evidenced significant improvement in pain, emotional functioning, and coping strategies from baseline to follow-up. There were no clear moderators of intervention effects. Changes in emotional factors, particularly stress levels, mediated the relationship between the intervention and outcome (pain severity) over time. DISCUSSION: This study supports the effectiveness of online interventions when CBT and self-management targets pain levels, emotional factors, and wellness-focused coping. The importance of stress as a mediator of pain severity is discussed. The absence of moderators may indicate that the intervention is effective for a wide variety of patients with chronic pain.

Task sequencing for students with emotional and behavioral disorders: a systematic review.

We reviewed studies utilizing task sequencing to improve academic outcomes for children with emotional and/or behavioral disorders (EBD) in educational settings. Task sequencing interventions included high-probability, high-preference, and task interspersal interventions. Although task sequencing is commonly used in research, a synthesis of recent applications in educational settings for students with EBD is absent. Systematic searches of electronic databases and ancestral references identified 11 studies meeting inclusion criteria. These 11 studies were reviewed and analyzed for (a) participant characteristics, (b) experimental design, (c) type of academic outcome as the dependent variable, (d) intervention description, (e) certainty of evidence and research quality, and (f) reported student academic outcomes. Implications for continued applied practice and future research are discussed.

[The clinical and functional rationale for the application of the baths containing the Siberian Stag velvet antler extracts in the rehabilitative treatment of the patients presenting with arterial hypertension and concomitant chronic psychoemothional overtension].

We have developed the method for the treatment of the patients presenting with arterial hypertension and concomitant chronic psychoemothional overtension. The method consists of the application of the baths containing the Siberian Stag velvet antler extracts in combination with exercise therapy and massage. A total of 35 patients with arterial hypertension and concomitant chronic psychoemothional overtension were enrolled in the study. It was shown that inclusion of the baths containing the Siberian Stag velvet antler extracts in the combined treatment of arterial hypertension and concomitant chronic psychoemothional overtension has positive effect on the parameters of the main homeostatic systems, enhances the working capacity of the patients, promotes their psychological stability, and increases the adaptive potential of the organism.

[Neuropsychotherapy in brain injury rehabilitation]. / Neuropsicoterapia en la rehabilitación del daño cerebral.

INTRODUCTION: Persons who have suffered brain damage can experience a wide range of cognitive, behavioural and emotional disorders. However, neuropsychological rehabilitation usually focuses, almost exclusively, on the cognitive deficits and pays very little attention to the emotional challenges associated with the psychological impact of the lesion. It is in this more personal side of brain damage where neuropsychotherapy can be of great aid to facilitate the process of acceptance and adaptation following a neurological lesion. DEVELOPMENT: In this article, we describe the theoretical and conceptual aspects of psychotherapy oriented towards persons with brain damage, the implications of cognitive deficits in the practice of neuropsychotherapy and the evidence regarding its effectiveness. CONCLUSIONS: In the past, neuropsychotherapy was considered to be of little use in the rehabilitation of brain damage. Today, however, a growing number of professionals are acknowledging its importance in the management of the psychological/emotional suffering associated with brain damage. The aim of neuropsychological rehabilitation is not just to promote the recovery of the altered brain functions, but also to improve the individual's functional capacity, deal with his or her experiences of loss and help him or her to again find a meaning to life.

TITLE: Neuropsicoterapia en la rehabilitacion del daño cerebral.Introduccion. Las personas que han sufrido lesiones cerebrales pueden experimentar un amplio abanico de alteraciones cognitivas, conductuales y emocionales. No obstante, la rehabilitacion neuropsicologica acostumbra a centrarse, de manera casi exclusiva, en los deficits cognitivos y presta escasa atencion a los retos emocionales asociados al impacto psicologico de la lesion. En esta faceta mas personal del daño cerebral es donde la neuropsicoterapia puede ser de gran utilidad para facilitar el proceso de aceptacion y adaptacion despues de una lesion neurologica. Desarrollo. En el presente articulo se describen los aspectos teoricos y conceptuales de la psicoterapia orientada a personas con daño cerebral, implicaciones de los deficits cognitivos en la practica de la neuropsicoterapia y evidencias sobre su efectividad. Conclusiones. En el pasado se considero que la neuropsicoterapia tenia escasa utilidad en la rehabilitacion del daño cerebral. Hoy en dia, cada vez son mas los profesionales que reconocen su importancia en el abordaje del sufrimiento psicologico/emocional asociado al daño cerebral. El objetivo de la rehabilitacion neuropsicologica no es unicamente promover la recuperacion de las funciones cerebrales alteradas, sino tambien mejorar la capacidad funcional del individuo, tratar con sus experiencias de perdida y ayudarle a encontrar, de nuevo, sentido a la vida.

Relationships between alexithymia, affect recognition, and empathy after traumatic brain injury.

OBJECTIVES: To determine (1) alexithymia, affect recognition, and empathy differences in participants with and without traumatic brain injury (TBI); (2) the amount of affect recognition variance explained by alexithymia; and (3) the amount of empathy variance explained by alexithymia and affect recognition. PARTICIPANTS: Sixty adults with moderate-to-severe TBI; 60 age and gender-matched controls. PROCEDURES: Participants were evaluated for alexithymia (difficulty identifying feelings, difficulty describing feelings, and externally-oriented thinking); facial and vocal affect recognition; and affective and cognitive empathy (empathic concern and perspective-taking, respectively). RESULTS: Participants with TBI had significantly higher alexithymia; poorer facial and vocal affect recognition; and lower empathy scores. For TBI participants, facial and vocal affect recognition variances were significantly explained by alexithymia (12% and 8%, respectively); however, the majority of the variances were accounted for by externally-oriented thinking alone. Affect recognition and alexithymia significantly accounted for 16.5% of cognitive empathy. Again, the majority of the variance was primarily explained by externally-oriented thinking. Affect recognition and alexithymia did not explain affective empathy. CONCLUSIONS: Results suggest that people who have a tendency to avoid thinking about emotions (externally-oriented thinking) are more likely to have problems recognizing others' emotions and assuming others' points of view. Clinical implications are discussed.

Postsecondary employment experiences among young adults with an autism spectrum disorder.

OBJECTIVE: We examined postsecondary employment experiences of young adults with an autism spectrum disorder (ASD) and compared these outcomes with those of young adults with different disabilities. METHOD: Data were from Wave 5 of the National Longitudinal Transition Study-2 (NLTS2), a nationally representative survey of young adults who had received special education services during high school. We examined the prevalence of ever having had, and currently having, a paid job at 21 to 25 years of age. We analyzed rates of full-time employment, wages earned, number of jobs held since high school, and job types. RESULTS: Approximately one-half (53.4%) of young adults with an ASD had ever worked for pay outside the home since leaving high school, the lowest rate among disability groups. Young adults with an ASD earned an average of $8.10 per hour, significantly lower than average wages for young adults in the comparison groups, and held jobs that clustered within fewer occupational types. Odds of ever having had a paid job were higher for those who were older, from higher-income households, and with better conversational abilities or functional skills. CONCLUSIONS: Findings of worse employment outcomes for young adults with an ASD suggest that this population is experiencing particular difficulty in successfully transitioning into employment. Research is needed to determine strategies for improving outcomes as these young adults transition into adulthood.

Factors associated with admission to a day school treatment program.

In this study the authors examine the individual and family characteristics of youth (N = 105) admitted over a five year period to a day school treatment program in a western New York community. All had exhausted alternative school placements within their home school districts and had a history of severe emotional or behavioral problems. Consistent with national patterns, more males (78%) than females were admitted, but in contrast to national trends, more Caucasians (63.8%) than students of color (36.2%) were admitted. Most lived in female headed single-parent households (51.4%). A few were foster children living with relatives or in non-relative foster homes (14.3%). Poverty was common with 45.7% of these youth eligible for free lunches. Most were on psychotropic medications (57.1%) and had histories of outpatient (62.9%) and inpatient hospitalizations (23.6%) at admission. Involvement in the juvenile justice system was common with nearly a quarter involved in the juvenile justice system (n = 25; 23.8%).

Combinations of resting RSA and RSA reactivity impact maladaptive mood repair and depression symptoms.

We examined whether the combined indices of respiratory sinus arrhythmia at rest (resting RSA) and in response to a sad film (RSA reactivity) predict effective and ineffective responses to reduce sadness (adaptive vs. maladaptive mood repair) in women with histories of juvenile-onset depression (n=74) and no history of major mental disorders (n=75). Structural equation models were used to estimate latent resting RSA, depression, and adaptive and maladaptive mood repair and to test the study hypotheses. Results indicated that combinations of resting RSA+RSA reactivity (RSA patterns) predicted maladaptive mood repair, which in turn, mediated the effects of RSA pattern on depression. Further, RSA patterns moderated the depressogenic effects of maladaptive mood repair. RSA patterns were unrelated to adaptive mood repair. Our findings suggest that mood repair is one mechanism through which physiological vulnerabilities adversely affect mental health.

Problematizing the neurochemical subject of anti-depressant treatment: the limits of biomedical responses to women's emotional distress.

In this article we situate empirical research into women's problematic experiences of anti-depressant medication within broader debates about pharmaceuticalization and the rise of the neurochemical self. We explore how women interpreted and problematized anti-depressant medication as it impeded their recovery in a number of ways. Drawing upon Foucauldian and feminist work we conceptualize anti-depressants as biotechnologies of the self that shaped how women thought about and acted upon their embodied (and hence gendered) subjectivities. Through the interplay of biochemical, emotional and socio-cultural effects medication worked to shape women's self-in-recovery in ways that both reinscribed and undermined a neurochemical construction of depression. Our analysis outlines two key discursive constructions that focused on women's problematization of the neurochemical self in response to the side-effects of anti-depressant use. We identified how the failure of medication to alleviate depression contributed to women's reinterpretation of recovery as a process of 'working' on the emotional self. We argue that women's stories act as a form of subjugated knowledge about the material and discursive forces shaping depression and recovery. These findings offer a gendered critique of scientific and market orientated rationalities underpinning neurochemical recovery that obscure the embodied relations of affect and the social conditions that enable the self to change.