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Stress reduction correlates with structural changes in the amygdala.

Soc Cogn Affect Neurosci. 2010 Mar;5(1):11-7

Authors: Hölzel BK, Carmody J, Evans KC, Hoge EA, Dusek JA, Morgan L, Pitman RK, Lazar SW

Stress has significant adverse effects on health and is a risk factor for many illnesses. Neurobiological studies have implicated the amygdala as a brain structure crucial in stress responses. Whereas hyperactive amygdala function is often observed during stress conditions, cross-sectional reports of differences in gray matter structure have been less consistent. We conducted a longitudinal MRI study to investigate the relationship between changes in perceived stress with changes in amygdala gray matter density following a stress-reduction intervention. Stressed but otherwise healthy individuals (N = 26) participated in an 8-week mindfulness-based stress reduction intervention. Perceived stress was rated on the perceived stress scale (PSS) and anatomical MR images were acquired pre- and post-intervention. PSS change was used as the predictive regressor for changes in gray matter density within the bilateral amygdalae. Following the intervention, participants reported significantly reduced perceived stress. Reductions in perceived stress correlated positively with decreases in right basolateral amygdala gray matter density. Whereas prior studies found gray matter modifications resulting from acquisition of abstract information, motor and language skills, this study demonstrates that neuroplastic changes are associated with improvements in a psychological state variable.

PMID: 19776221 [PubMed - indexed for MEDLINE]

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Using self-determination theory to promote physical activity and weight control: a randomized controlled trial in women.

J Behav Med. 2010 Apr;33(2):110-22

Authors: Silva MN, Vieira PN, Coutinho SR, Minderico CS, Matos MG, Sardinha LB, Teixeira PJ

Behavior change interventions are effective to the extent that they affect appropriately-measured outcomes, especially in experimental controlled trials. The primary goal of this study was to analyze the impact of a 1-year weight management intervention based on self-determination theory (SDT) on theory-based psychosocial mediators, physical activity/exercise, and body weight and composition. Participants were 239 women (37.6 +/- 7.1 years; 31.5 +/- 4.1 kg/m(2)) who received either an intervention focused on promoting autonomous forms of exercise regulation and intrinsic motivation, or a general health education program (controls). At 12 months, the intervention group showed increased weight loss (-7.29%,) and higher levels of physical activity/exercise (+138 +/- 26 min/day of moderate plus vigorous exercise; +2,049 +/- 571 steps/day), compared to controls (P < 0.001). Main intervention targets such as more autonomous self-regulation (for treatment and for exercise) and a more autonomous perceived treatment climate revealed large effect sizes (between 0.80 and .96), favoring intervention (P < 0.001). Results suggest that interventions grounded in SDT can be successfully implemented in the context of weight management, enhancing the internalization of more autonomous forms of behavioral regulation, and facilitating exercise adherence, while producing clinically-significant weight reduction, when compared to a control condition. Findings are fully consistent with previous studies conducted within this theoretical framework in other areas of health behavior change.

PMID: 20012179 [PubMed - indexed for MEDLINE]

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The relations among measurements of informant discrepancies within a multisite trial of treatments for childhood social phobia.

J Abnorm Child Psychol. 2010 Apr;38(3):395-404

Authors: De Los Reyes A, Alfano CA, Beidel DC

Discrepancies between informants’ reports of children’s behavior are robustly observed in clinical child research and have important implications for interpreting the outcomes of controlled treatment trials. However, little is known about the basic psychometric properties of these discrepancies. This study examined the relation between parent-child reporting discrepancies on measures of child social phobia symptoms, administered before and after treatment for social phobia. Participants included a clinic sample of 81 children (7-16 years old [M = 11.75, SD = 2.57]; 39 girls, 42 boys) and their parents receiving treatment as part of a multisite controlled trial. Pretreatment parent-child reporting discrepancies predicted parent-child discrepancies at posttreatment, and these relations were not better accounted for by the severity of the child’s pretreatment primary diagnosis. Further, treatment responder status moderated this relation: Significant relations were identified for treatment non-responders and not for treatment responders. Overall, findings suggest that informant discrepancies can be reliably employed to measure individual differences over the course of controlled treatment trials. These data provide additional empirical support for recent work suggesting that informant discrepancies can meaningfully inform understanding of treatment response as well as variability in treatment outcomes.

PMID: 20013046 [PubMed - indexed for MEDLINE]

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Introspective duration estimation of reactive and proactive motor responses.

Acta Psychol (Amst). 2010 Jun;134(2):142-53

Authors: Gorea A, Mamassian P, Cardoso-Leite P

The metajudgment of motor responses refers to our ability to evaluate the accuracy of our own actions. Can humans metajudge the duration of their Reaction Times (RTs) to a light-flash and the accuracy of their reproduction of a reference time interval bounded by two light flashes (Anticipatory Response Time, ART)? A series of four distinct experiments shows that RT_Meta and ART_Metajudgments are possible but with accuracies about x2.4 and x3 poorer than the corresponding RT and ART ones. In order to reveal the origin of this drop in performance, we ask whether a visual feedback synchronous with subjects’ key-presses could improve performance. We show that overall the presence of a visual feedback does not significantly improve metajudgment accuracy although such a trend is noticeable in ART_Meta. We then compare these performances with the passive perceptual estimation of the played back (Pb) RT and ART time intervals when bounded by two (RT_Pb) and three (ART_Pb) light flashes. We show that RT_Meta and RT_Pb accuracies are close to equal, but that ART_Meta is about x2 less accurate than ART_Pb which in turn is x1.5 less accurate than ART. The latter observation fails however to reach statistical significance hence not sustaining proposals that active time estimation is more reliable than passive one. The whole dataset is accounted for by a clock-type model where duration estimation performance is limited by four noise sources (visual, clock-count, motor and proprioceptive+efference copy) plus one proper to ART_Meta task. It is proposed that the latter reflects the impossibility for the time-counting system to use the same time origin more than once.

PMID: 20170893 [PubMed - indexed for MEDLINE]

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Playing with Gladys: A case study integrating drama therapy with behavioural interventions for the treatment of selective mutism.

Clin Child Psychol Psychiatry. 2010 Apr;15(2):215-30

Authors: Oon PP

This case study examines an integrative approach combining drama therapy and the behavioural skill “shaping”, as offered to Gladys, a 5-year-old girl diagnosed with selective mutism. This study found that shaping, when implemented in the context of play, with play as the primary reinforcer, elicited from Gladys vocalization and eventually speech within a very short time. Her vocalizations allowed her to enter dramatic play, which in turn propelled spontaneous speech. This article looks at how the three elements of dramatherapy - the playspace, role-playing and dramatic projection - brought about therapeutic changes for Gladys. Aside from spontaneous speech, Gladys also developed positive self-esteem and a heightened sense of spontaneity. Subsequently, these two qualities helped her generalize her speech to new settings on her own. Gladys’s newly harnessed spontaneity further helped her become more sociable and resilient.This study advances the possibility of integrating a behavioural skill with drama therapy for the therapeutic benefits of a child with an anxiety-related condition like selective mutism.

PMID: 20194568 [PubMed - indexed for MEDLINE]

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Internet-based support for infertile patients: a randomized controlled study.

J Behav Med. 2010 Apr;33(2):135-46

Authors: Haemmerli K, Znoj H, Berger T

This study aimed to evaluate the efficacy and patient acceptance of the first German-language Internet-based treatment for infertile patients. Infertile patients (N = 124) were randomly assigned to either an 8-week Internet-based cognitive-behavioral treatment, or to a waiting-list control group. Participants were assessed at treatment start, post-treatment, and at a 5-month follow-up. Outcome measures included mental health and pregnancy rate. From pre- to posttest, treated participants in contrast to controls did not show significant improvement, although between-group effect sizes were in favor of the intervention group on all mental health measures (Cohen’s d ranged from 0.16 to 0.38). The intervention significantly reduced the depression level of clinically distressed and depressed participants. No effects were found regarding pregnancy rate. The treatment was assessed as positive or very positive by 80% of the participants; this finding coupled with the high demand for such support confirm that Internet-based interventions are a promising new approach for infertile patients that needs more development and testing.

PMID: 20039196 [PubMed - indexed for MEDLINE]

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Attentional bias away from positive social information mediates the link between social anxiety and anxiety vulnerability to a social stressor.

J Anxiety Disord. 2010 May;24(4):403-8

Authors: Taylor CT, Bomyea J, Amir N

Accumulating evidence suggests that social anxiety is associated with biased processing of positive social information. However, it remains to be determined whether those biases are simply correlates of, or play a role in maintaining social anxiety. The current study examined whether diminished attentional allocation for positive social cues mediates the link between social anxiety and anxiety reactivity to a social-evaluative task. Forty-three undergraduate students ranging in severity of social anxiety symptoms completed a baseline measure of attentional bias for positive social cues (i.e., modified probe detection task) and subsequently delivered an impromptu videotaped speech. Mediation analyses revealed that the tendency to allocate attention away from positive social stimuli mediated the effect of social anxiety on change in state anxiety in response to the stressor. The current findings add to a nascent empirical literature suggesting that aberrant processing of positive social information may contribute to the persistence of excessive social anxiety.

PMID: 20207102 [PubMed - indexed for MEDLINE]

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Web-based therapist-assisted cognitive behavioral treatment of panic symptoms: a randomized controlled trial with a three-year follow-up.

J Anxiety Disord. 2010 May;24(4):387-96

Authors: Ruwaard J, Broeksteeg J, Schrieken B, Emmelkamp P, Lange A

BACKGROUND: Internet-delivered treatment may reduce barriers to care in those unwilling or unable to access traditional forms of treatment. OBJECTIVE: To assesses the efficacy of web-based therapist-assisted cognitive behavioral treatment (web-CBT) of panic symptoms. DESIGN: A randomized waiting-list controlled trial with an uncontrolled three-year follow-up. PARTICIPANTS: A community sample of 58 participants with chronic panic symptoms of varying severity (immediate treatment: n=27, waiting-list control: n=31). OUTCOME MEASURES: The primary outcome measures were a one-week Panic Diary and the Panic Disorder Severity Scale - Self-Report (PDSS-SR); secondary measures were the Agoraphobic Cognitions Questionnaire (ACQ), the Body Sensations Questionnaire (BSQ), the Mobility Inventory - Alone subscale (MI-AAL), and the Depression Anxiety Stress Scales (DASS-42). RESULTS: In the RCT, 54 participants (93%) completed posttest measurements. With regard to the primary outcome measures, intention-to-treat ANCOVAs revealed that participants in the treatment condition improved more than the participants in the waiting-list control condition (p<.03), with a pooled between-group effect size of d=.7. After three years (n=47; 81% study compliance), effects were more pronounced. CONCLUSION: The results demonstrate the efficacy of therapist-assisted web-CBT in the treatment of panic symptoms.

PMID: 20227241 [PubMed - indexed for MEDLINE]

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Treatment preparatory to psychoanalysis: a reconsideration after twenty-five years.

J Am Psychoanal Assoc. 2010 Feb;58(1):27-57

Authors: Bernstein SB

The author’s initial article on treatment preparatory to psychoanalysis (1983) challenged the long-held belief that a therapy with the same analyst would contaminate a subsequent analytic transference. The current article reconsiders the original process of transition from therapy to analysis and describes methods that can further its effectiveness. Although specific noninterpretive interventions to enhance preparation for analysis are rarely written about, they are discussed among colleagues and in supervision. Levy (1987) has described a bias against the description of strategic or tactical choices in analysis. It is increasingly clear that some patients’ fear of exposing shameful defectiveness underlies their resistance to entering analysis, as does the originally described fear of an uncontrolled regression. It is useful to delay interpretation until shame sensitivity can be assessed and modulated. In the past there was pressure to keep the preparatory therapy brief so that the analyst would not become too well known to the patient. Less concern about strict anonymity allows more time for the patient’s resistances to abate before the recommendation is made. Methods are described and clinical illustrations show how a deepening process can be fostered, how indications of readiness for the transition can be assessed, and when and how the recommendation can be made.

PMID: 20234008 [PubMed - indexed for MEDLINE]

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Plying the steel: A reconsideration of surgical metaphors in psychoanalysis.

J Am Psychoanal Assoc. 2010 Feb;58(1):59-82

Authors: Ivey G

Among the metaphors that Freud used to describe psychoanalysis, the surgical is possibly the most deplored. It is considered an anachronistic remnant of a dubious medical ideology that psychoanalysis has largely renounced. However, while analysts today avoid surgical analogies, their patients continue to produce surgical fantasies about analytic treatment. This fact alone requires a serious consideration of the meanings that surgical metaphors have for them. A second reason for reconsidering the role of the surgical metaphor, from the analyst’s perspective, lies in its creative revival by W. R. Bion. Disregarding the shift away from surgical analogizing, Bion employed the metaphor to vividly portray various aspects of the analytic situation and the patient’s experience of them. A brief historical overview of the surgical metaphor in psychoanalysis is provided, followed by an account of the reasons for its demise and by a review of the criticisms that continue to be leveled at it. Bion’s use of surgical metaphors toward the end of his life is then explored. Finally, illustrations are given of the various ways in which patients use spontaneous surgical metaphors to depict transference and the analytic process. Though the analyst should not deliberately adopt surgical metaphors, it is important to remain open to these transference portrayals.

PMID: 20234009 [PubMed - indexed for MEDLINE]

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