Process analysis of trauma-focused cognitive behavioural therapy for individuals with schizophrenia

Objective. Therapeutic alliance, modality, and ability to engage with the process of therapy have been the main focus of research into what makes psychotherapy successful. Individuals with complex trauma histories or schizophrenia are suggested to be more difficult to engage and may be less likely to benefit from therapy. This study aimed to track the in-session ‘process’ of working alliance and emotional processing of trauma memories for individuals with schizophrenia. Design. The study utilized session recordings from the treatment arm of an open randomized clinical trial investigating trauma-focused cognitive behavioural therapy (TF-CBT) for individuals with schizophrenia (N = 26). Method. Observer measures of working alliance, emotional processing, and affect arousal were rated at early and late phases of therapy. Correlation analysis was undertaken for process measures. Temporal analysis of expressed emotions was also reported. Results. Working alliance was established and maintained throughout the therapy; however, agreement on goals reduced at the late phase. The participants appeared to be able to engage in emotional processing, but not to the required level for successful cognitive restructuring. Conclusion. This study undertook novel exploration of process variables not usually explored in CBT. It is also the first study of process for TF-CBT with individuals with schizophrenia. This complex clinical sample showed no difficulty in engagement; however, they may not be able to fully undertake the cognitive–emotional demands of this type of therapy. Clinical and research implications and potential limitations of these methods are considered.

Neuronal Expression of Cd36, Cd44, and Cd83 Antigen Transcripts Maps to Distinct and Specific Murine Brain Circuits

Cells recruited by the innate immune response rely on surface-expressed molecules in order to receive signals from the local environment and to perform phagocytosis, cell adhesion, and others processes linked to host defense. Hundreds of surface antigens designated through a cluster of differentiation (CD) number have been used to identify particular populations of leukocytes. Surprisingly, we verified that the genes that encode Cd36 and Cd83 are constitutively expressed in specific neuronal cells. For instance, Cd36 mRNA is expressed in some regions related to circuitry involved in pheromone responses and reproductive behavior. Cd44 expression, reanalyzed and detailed here, is associated with the laminar formation and midline thalamic nuclei in addition to striatum, extended amygdala, and a few hypothalamic, cortical, and hippocampal regions. A systemic immune challenge was able to increase Cd44 expression quickly in the area postrema and motor nucleus of the vagus but not in regions presenting expressive constitutive expression. In contrast to Cd36 and Cd44, Cd83 message was widely distributed from the olfactory bulb to the brain stem reticular formation, sparing the striatopallidum, olivary region, and cerebellum. Its pattern of expression nevertheless remained strongly associated with hypothalamic, thalamic, and hindbrain nuclei. Unlike the other transcripts, Cd83 mRNA was rapidly modulated by restraint stress. Our results indicate that these molecules might play a role in specific neural circuits and present functions other than those attributed to leukocyte biology. The data also suggest that these surface proteins, or their associated mRNA, could be used to label neurons in specific circuits/regions. J. Comp. Neurol. 517:906-924, 2009. (C) 2009 Wiley-Liss, Inc.

Patterns of fos activation in rat raphe nuclei during feeding behavior

To analyze the differential recruitment of the raphe nuclei during different phases of feeding behavior, rats were subjected to a food restriction schedule (food for 2 h/day, during 15 days). The animals were submitted to different feeding conditions, constituting the experimental groups: search for food (MFS), food ingestion (MFI), satiety (MFSa) and food restriction control (MFC). A baseline condition (BC) group was included as further control. The MFI and MFC groups, which presented greater autonomic and somatic activation, had more FOS-immunoreactive (FOS-IR) neurons. The MFI group presented more labeled cells in the linear (LRN) and dorsal (DRN) nuclei; the MFC group showed more labeling in the median (MRN), pontine (PRN), magnus (NRM) and obscurus (NRO) nuclei; and the MFSa group had more labeled cells in the pallidus (NRP). The BC exhibited the lowest number of reactive cells. The PRN presented the highest percentage of activation in the raphe while the DRN the lowest. Additional experiments revealed few double-labeled (FOS-IR+ 5-HT-IR) cells within the raphe nuclei in the MFI group, suggesting little serotonergic activation in the raphe during food ingestion. These findings suggest a differential recruitment of raphe nuclei during various phases of feeding behavior. Such findings may reflect changes in behavioral state (e.g., food-induced arousal versus sleep) that lead to greater motor activation, and consequently increased FOS expression. While these data are consistent with the idea that the raphe system acts as gain setter for autonomic and somatic activities, the functional complexity of the raphe is not completely understood. (c) 2008 Elsevier B.V. All rights reserved.

THE ROLE OF THE SUPERIOR COLLICULUS IN PREDATORY HUNTING

Combining the results of behavioral, neuronal immediate early gene activation, lesion and neuroanatomical experiments, we have presently investigated the role of the superior colliculus (SC) in predatory hunting. First, we have shown that insect hunting is associated with a characteristic large increase in Fos expression in the lateral part of the intermediate gray layer of the SC (Wig). Next, we have shown that animals with bilateral NMDA lesions of the lateral parts of the SC presented a significant delay in starting to chase the prey and longer periods engaged in other activities than predatory hunting. They also showed a clear deficit to orient themselves toward the moving prey and lost the stereotyped sequence of actions seen for capturing, holding and killing the prey. Our Phaseolus vulgaris-leucoagglutinin analysis revealed that the lateral SCig, besides providing the well-documented descending crossed pathway to premotor sites in brainstem and spinal cord, projects to a number of midbrain and diencephalic sites likely to influence key functions in the context of the predatory behavior, such as general levels of arousal, motivational level to hunt or forage, behavioral planning, appropriate selection of the basal ganglia motor plan to hunt, and motor output of the primary motor cortex. In contrast to the lateral SC lesions, medial SC lesions produced a small deficit in predatory hunting, and compared to what we have seen for the lateral SCig, the medial SCig has a very limited set of projections to thalamic sites related to the control of motor planning or motor output, and provides conspicuous inputs to brainstem sites involved in organizing a wide range of anti-predatory defensive responses. Overall, the present results served to clarify how the different functional domains in the SC may mediate the decision to pursue and hunt a prey or escape from a predator. (C) 2010 IBRO. Published by Elsevier Ltd. All rights reserved.

Sexual and emotional variables influencing sexual response to erotica: a psychophysiological investigation

The relative contribution of attentional and emotional factors to the physiological and subjective sexual arousal elicited by erotic film was evaluated. Sexual arousal, attentional, and emotional responses were measured while 30 men were presented with a series of erotic film segments. Levels of physiological and subjective sexual arousal were higher when subjects became absorbed in the activities portrayed in the film and when they experienced the depicted erotic encounters as appetitive, than when they were distracted and perceived the encounters as aversive. The erotic film elicited a diminished startle response to a sudden burst of white noise presented during stimulation relative to the nature film, suggesting that at a physiological level the erotic segments of film were processed as more appetitive in valence. The level of sexual arousal elicited by the erotic segments was related to the extent to which subjects were entertained by the film, even though there was considerable anxiety generated by the portrayed sexual scenarios. Sexual response was not significantly correlated with trait measures of absorption (as indexed by the Tellegen Absorption Scale) nor with vividness of imagery (as assessed by the Betts Questionnaire upon Mental Imagery). Arousal was related to state-assessed attentional and emotional variables, and physiological measures of emotional response, demonstrating the multidimensional nature of the sexual response Future directions for comparing male sexual response patterns with female response patterns are suggested.

Leisure experiences in tourist attractions : exploring the motivations of local residents

This study was conducted to explore leisure motivations with regard to tourist attractions. A survey of a convenience sample of residents of Melbourne, Australia, was conducted. The sample was then segmented based on the likelihood of visiting a cross-section of Melbourne's tourist attractions in the next 6 months. Analysis using Unger and Kernan's (1983) Subjective Leisure Scale (SLS) was then undertaken to explore whether there were differences across the segments in terms of their leisure motivations. The results highlight that, within this context, intrinsic satisfaction, perceived freedom and arousal emerged as stronger underlying dimensions of motivations to visit tourist attractions, rather than mastery, spontaneity and involvement. This information provides insights for marketers of tourist attractions with regard to what residents are seeking when they visit local tourist attractions. The information can be used to develop more positive experiences at tourist attractions for this important sector of the market.

Experimental study of ostensibly shamanic journeying imagery in naďve participants II: phenomenological mapping and modified affect bridge

This study develops the methodological framework advanced in Rock, Baynes, and Casey's (2005) experimental study of ostensibly shamanic journeying imagery in naïve participants. Specifically, the present study experimentally investigates the impact of the word landscape, featured in Harner's (1990) shamanic journeying to the Lower World instructions, on the number of landscape-related images reported; examines the origins of ostensibly shamanic journeying images; and maps the phenomenological state effects of shamanic journeying to the Lower World. Sixtyeight naïve participants were randomly assigned to one of three conditions: either the original or a revised version of Harner's (1990) instructions coupled with monotonous percussion drumming at 8 beats-per-second for 15 minutes, or sitting quietly with eyes open for 15 minutes. Each participant's subjective experience was retrospectively assessed using the Phenomenology of Consciousness Inventory (PCI) (Pekala 1991) and a mental imagery checklist. Subsequently, participants were administered the Modified Affect Bridge for the purpose of exploring the origins of mental imagery experienced during the experimental conditions. The results indicated that there was a statistically significant difference between conditions with regard to the number of ostensibly shamanic journeying images reported, but not between treatment conditions with regard to the number of landscaperelated images reported. There were no significant relationships between condition and mental imagery derived from autobiographical memories. There were statistically significant differences between conditions with regard to the PCI dimensions of fear, altered state of awareness, and arousal.

Is life dissatisfaction the opposite of life satisfaction?

The circumplex model of affect proposes that states of affect can be categorised according to the two dimensions of valence and arousal. According to this model, satisfaction and dissatisfaction are located on the pleasant and unpleasant ends of the valence axis as bipolar opposites. This study investigated the relationship between these two adjectives when assessed with unipolar or bipolar response formats. This suggests that a reciprocal relationship exists between life satisfaction and dissatisfaction when a unipolar response format is employed, but not when a bipolar response format was used. These results are discussed in relation to current affect theory and subject wellbeing research.

Understanding the leisure motives of visitors to tourist attractions

In a period when tourism is contracting, and in a destination with an extensive range of visitor attractions, the importance of local residents visitation is accentuated. The aim of this study was to explore whether there are differences across segments of the local resident market in terms of their motives for engaging in leisure activities within the context of tourist attractions. This study was set within the context of Melbourne, Australia. Melbourne has changed in recent years in terms of the range of attractions available to residents. A sample of 1005 local residents was used as the basis of this study. Cluster analysis was used to segment the sample, based on the intended frequency of visitation to a set of attractions. The motives for engaging in leisure were then explored for each of the segments using Unger and Kernan's (1983) Subjective Leisure Scale (SLS), which encompasses six motivational domains namely intrinsic satisfaction, perceived freedom, arousal, mastery, involvement and spontaneity, was applied in this study of leisure activities was used as the basis of identifying the motives for visiting the attractions.

Psychological and interpersonal dimensions of sexual function and dysfunction.

To highlight the salient psychological and interpersonal issues contributing to sexual health and dysfunction; to offer a four-tiered paradigm for understanding the evolution and maintenance of sexual symptoms; and to offer recommendations for clinical management and research.

The "HEALTH" model- part 1 : treatment program guidelines for complex PTSD

This paper outlines the development and piloting of the “HEALTH” model for treatment of Complex PTSD in clients who have experienced multiple traumas across childhood and adulthood - particularly child sexual abuse and sexual assault in adulthood. As a guideline-based treatment model, HEALTH outlines six stages of intervention: (1) having a supportive therapist; (2) ensuring personal safety; (3) assisting with daily functioning; (4) self-regulation - learning to manage core PTSD symptoms; (5) treating Complex PTSD symptoms; and, finally, (6) having patience and persistence to enable “ego strengthening”. Using a case study approach, we provide both qualitative and quantitative assessment data for the individuals in the study, all of whom displayed numerous pre-treatment symptoms of Complex PTSD. Such programs are different to standard PTSD treatment programs that focus predominantly on core PTSD symptoms of re-experiencing, avoidance and arousal. The results of this study provided support for the use of guideline-based treatment programs that cater specifically for the needs of those who have suffered long-term/multiple trauma experiences by targeting Complex PTSD symptoms.

The role of absorption in women's sexual response to erotica : a cognitive-affective investigation

This study examined the effect of absorption on women's emotional and cognitive processing of erotic film. Absorption was experimentally manipulated using 2 different sets of test session instructions. The first, participant-oriented, instruction set directed participants to absorb themselves in the erotic film presentation, imagining that they were active participants in the sexual activities depicted. The second, spectator-oriented, instruction set directed participants to observe and assess the erotic film excerpt as impartial spectators. The participant-oriented instruction set was found to elicit greater subjective absorption in women than the spectator-oriented instruction set, and women reported greater subjective sexual arousal in the former set compared with the latter. Thus, it appears that the degree to which a woman becomes absorbed in an erotic stimulus may affect her subsequent subjective sexual arousal. Also, women reported greater degrees of positive affect when they took a participant-oriented perspective than when they viewed the erotic materials as impartial spectators. Thus, participants who were highly absorbed in the erotic film excerpt were more likely to view the stimulus favorably. By contrast, the degree to which women became absorbed in the stimulus had no effect on their reported negative affect. Future directions for examining female response patterns are suggested.

Conceptualizing women's sexual function : linear vs. circular models of sexual response

Introduction. The lack of an adequate empirical base for models of female sexual response is a critical issue within the female sexual dysfunction (FSD) literature.

Aim. The current research compared the extent to which a linear model of sexual response and Basson's circular model of female sexual response represent the sexual function of women with and without FSD.

Main Outcome Measures. Women's levels of sexual function/dysfunction were assessed with the Female Sexual Function Index and additional items measured women's endorsement of models of female sexual function as representing their own sexual experience.

Methods. An anonymous online survey assessing female sexual response and associated aetiological factors was completed by a random sample of 404 women.

Results. Although the linear model of sexual response was a good fit for women with and without sexual dysfunction, the relationship between sexual arousal and orgasm was mediated by sexual desire for women with FSD. The fit of the initial circular model of women's sexual response was poor for both groups. Following pathway modification, the modified circular model adequately represented the responses of both groups and revealed that a number of the relationships between sexual response variables were stronger for women with FSD.

Conclusions. The linear model was a more accurate representation of sexual response for women with normal sexual function than women with FSD and sexual arousal and orgasm was mediated by sexual desire for women with FSD. The modified circular model was a more accurate representation of the sexual response of women with FSD than women with normal sexual function.

Pictorial cues and sexual desire : an experimental approach

The cognitive processing of sexual and non-sexual pictorial stimuli was examined to see whether picture rating and recognition tasks have potential utility as a means of assessing levels of sexual desire. Previous research has revealed slower responding to sexual compared to neutral semantic cues in persons with lower self-reported sexual desire. The present study investigated whether sexual pictorial cues evoked a similarly slower responding in people reporting low sexual desire compared to other individuals. A total of 136 participants completed two self-report measures of sexual desire (the Hurlbert Index of Sexual Desire and the Sexual Desire Inventory) before carrying out tasks involving affective ratings and recognition memory for pictorial stimuli. Participants were classified into relatively low, average, and higher groups on the basis of their scores on the desire measures. The stimuli were selected from the International Affective Picture System, and the tasks included (1) rating the valence, arousal, and sense of dominance or control for each picture, (2) recognition of previously seen images, and (3) a second rating of pictures viewed earlier. Level of sexual desire did not influence responding in the male participants. Female participants with lower sexual desire rated sexual images less pleasant and less arousing than the other participants, and completed picture recognition tasks more quickly. Sexual desire levels significantly influenced the interest ratings women gave to sexual pictures. We also found sexual content induced delays. These delays were not significantly different among desire groups. The variation in responding linked to levels of sexual desire in women suggests that more investigation of this methodology in a clinically diagnosed population might contribute to an understanding of low desire, and help design interventions addressing distress due to lack of sexual desire.

What can prevalence studies tell us about female sexual difficulty and dysfunction?

Introduction. Many recent studies have investigated the prevalence of female sexual difficulty/dysfunction.
Aim. Investigate female sexual difficulty/dysfunction using data from prevalence studies.
Methods. We reviewed published prevalence studies excluding those that had not included each category of sexual difficulty (desire, arousal, orgasm, and pain), were based on convenience sampling, or had a response rate <50% or a sample size <100.
Main Outcome Measures. For each study we used the prevalence of any sexual difficulty as the denominator and calculated the proportion of women reporting each type of difficulty. For each category of sexual difficulty we used the prevalence of that difficulty lasting 1 month or more as the denominator and calculated the proportion of difficulties lasting several months or more and 6 months or more.
Results. Only 11 of 1,248 studies identified met our inclusion criteria. These studies used different measures of sexual dysfunction, so generating a simple summary prevalence was not possible. However, we observed consistent patterns in the published data. Among women with any sexual difficulty, on average, 64% (range 16–75%) experienced desire difficulty, 35% (range 16– 48%) experienced orgasm difficulty, 31% (range 12–64%) experienced arousal difficulty, and 26% (range 7–58%) experienced sexual pain. Of the sexual difficulties that occurred for 1 month or more in the previous year, 62–89% persisted for at least several months and 25–28% persisted for 6 months or more. Two studies investigated distress. Only a proportion of women with sexual difficulty were distressed by it (21–67%).
Conclusions. Desire difficulty is the most common sexual difficulty experienced by women. While the majority of difficulties last for less than 6 months, up to a third persist for 6 months or more. Sexual difficulties do not always cause distress. Consequently, prevalence estimates will vary depending on the time frame specified by researchers and whether distress is included in these estimates.