Recovering from the earthquake : early childhood teachers and children collaboratively telling stories about their experiences

Purpose – Traumatic events can cause post-traumatic stress disorder due to the severity of the often unexpected events. The purpose of this paper is to reveal how conversations around lived experiences of traumatic events, such as the Christchurch earthquake in February 2011, can work as a strategy for people to come to terms with their experiences collaboratively. By encouraging young children to recall and tell of their earthquake stories with their early childhood teachers they can begin to respond, renew, and recover (Brown, 2012), and prevent or minimise more stress being developed. Design/methodology/approach – The study involved collecting data of the participating children taking turns to wear a wireless microphone where their interactions with each other and with teachers were video recorded over one week in November 2011. A total of eight hours and 21 minutes of footage was collected; four minutes and 19 seconds of that footage are presented and analysed in this paper. The footage was watched repeatedly and transcribed using conversation analysis methods (Sacks, 1995). Findings – Through analysing the detailed turn-taking utterances between teachers and children, the orderliness of the co-production of remembering is revealed to demonstrate that each member orients to being in agreement about what actually happened. These episodes of story telling between the teachers and children demonstrate how the teachers encourage the children to tell about their experiences through actively engaging in conversations with them about the earthquake. Originality/value – The conversation analysis approach used in this research was found to be useful in investigating aspects of disasters that the participants themselves remember as important and real. This approach offers a unique insight into understanding how the earthquake event was experienced and reflected on by young children and their teachers, and so can inform future policy and provision in post-disaster situations.

Living in a broken world : how young children's well-being is supported through playing out their earthquake experiences

The therapeutic value of play can be shown in spontaneous play situations following children’s experiences of traumatic events. Following the events of the Christchurch earthquakes in New Zealand in 2010 and 2011, an investigation was conducted of how children used the earthquake event as a catalyst in pretend play with peers and in discussions with teachers. Supporting children’s well-being is a focus area in New Zealand early childhood education as it is a strand of the national curriculum, Te Whāriki (Ministry of Education [MoE], 1996). In this article, children are observed engaging in pretend play episodes and with Learning Story books to explore personal reflections of the earthquake, prompting the children to make reference to things being ‘broken’ and needing 'fixing.' Analysis shows how the content of the pretend play experiences helped the children to come to terms with their experiences. Affording children time and interactional opportunities to play out and discuss traumatic experiences contributes to the psychological well-being of participants following a traumatic event.

Therapeutic practice with refugee clients: a qualitative study of therapist experience

Background There is limited research on the subjective experience of therapists and their understanding of therapeutic process when working with people from refugee backgrounds. Objective The present study provides a qualitative account of therapists’ conceptions of therapeutic practice and experiences of working therapeutically with refugee clients. Method Participants were 12 mental health workers who had worked therapeutically with people from refugee backgrounds, with an average of 7.6 years (range 1.5-16 years) experience in this field. Participants completed a semi-structured interview and completed a brief quantitative survey. Findings Thematic analysis revealed a number of super-ordinate themes. Four key themes are explored in the current study: principles of therapeutic practice; therapy as a relational experience; the role of context in informing therapeutic work with refugee clients; and the impact of therapeutic work on the therapist. Discussion The results revealed the complexity and demands of working with people from refugee backgrounds. Further, the lack of research evidence for the methods of therapeutic practice described in the current study highlights the distinction between naturalistic therapeutic practice and the current state of the evidence regarding therapeutic interventions for refugee clients. The findings have important implications for training and supporting therapists to work with people who have fled their countries of origin and who have often been exposed to highly traumatic events.

Recovery from first-episode psychosis and recovering self: A qualitative study

Objective The objective of this study was to explore the subjective factors associated with the experience of first-episode psychosis (FEP) and the very first stages of recovery to develop our understanding of this process and improve treatment outcomes. Method Interpretive Phenomenological Analysis was used to explore the experiences of 20 young people who had recently experienced FEP. Results Two broad superordinate themes captured essential thematic trends in the data: experiences of self-estrangement and self-consolidation. The concept of dialogical self was used to understand the effect of psychosis on self and the process of resuming familiar social positions to facilitate recovery. The concept of making meaning after traumatic events was also applied to the narratives of personal growth that participants formed. Those who reported subjective improvements in recovery were more likely to have developed a meaningful interpretation of their psychosis, strengthened relationships with others, and forged a stronger sense of self. Conclusions and Implications for Practice The experience of self-consolidation was strongly associated with the person’s resumption of familiar social roles and their ability to make meaning from their experience in a way that promoted personal growth. Although these processes are known to be part of personal recovery, this study highlights their importance in the very early stages of recovery immediately after the experience of FEP.

Enhanced cortisol suppression following administration of low-dose dexamethasone in first-episode psychosis patients

OBJECTIVE Impaired regulation of the hypothalamic-pituitary-adrenal (HPA) axis and hyper-activity of this system have been described in patients with psychosis. Conversely, some psychiatric disorders such as post-traumatic stress disorder (PTSD) are characterised by HPA hypo-activity, which could be related to prior exposure to trauma. This study examined the cortisol response to the administration of low-dose dexamethasone in first-episode psychosis (FEP) patients and its relationship to childhood trauma. METHOD The low-dose (0.25 mg) Dexamethasone Suppression Test (DST) was performed in 21 neuroleptic-naive or minimally treated FEP patients and 20 healthy control participants. Childhood traumatic events were assessed in all participants using the Childhood Trauma Questionnaire (CTQ) and psychiatric symptoms were assessed in patients using standard rating scales. RESULTS FEP patients reported significantly higher rates of childhood trauma compared to controls (p = 0.001) and exhibited lower basal (a.m.) cortisol (p = 0.04) and an increased rate of cortisol hyper-suppression following dexamethasone administration compared to controls (33% (7/21) vs 5% (1/20), respectively; p = 0.04). There were no significant group differences in mean cortisol decline or percent cortisol suppression following the 0.25 mg DST. This study shows for the first time that a subset of patients experiencing their first episode of psychosis display enhanced cortisol suppression. CONCLUSIONS These findings suggest there may be distinct profiles of HPA axis dysfunction in psychosis which should be further explored.

Workplace belongingness, psychological distress and resilience in emergency service workers

- Objective Ambulance personnel provide emergency medical services to the community, often attending to highly challenging and traumatic scenes in complex and chaotic circumstances. Currently the assessment of predictors of psychological well-being remains limited. The current study investigated whether workplace belongingness was significant in predicting psychological distress as well as the presence of resilience in ambulance personnel whilst controlling for more routinely examined factors. - Method Australian ambulance officers (N = 740) completed a survey battery including the Kessler 10 (Kessler & Mroczek, 1994), Brief Resilience Scale (Smith et al., 2008) and Psychological Sense of Organisational Membership (Cockshaw & Shochet, 2010) scale. - Results Controlling for more commonly examined factors such as severity of trauma exposure and length of service, hierarchical multiple regression analyses demonstrated that workplace belongingness was significantly associated with reduced distress levels and enhanced resilience levels. - Conclusions Results suggest that strategies to enhance a sense of workplace belongingness in emergency service organisations could promote the well-being of emergency workers despite routine exposure to potentially traumatic events.

Stress and Resilience in Combat-Related PTSD: Integration of Psychological Theory and Biological Mechanisms

Post-traumatic stress disorder (PTSD) is a debilitating psychiatric disorder that has a major impact on the ability to function effectively in daily life. PTSD may develop as a response to exposure to an event or events perceived as potentially harmful or life-threatening. It has high prevalence rates in the community, especially among vulnerable groups such as military personnel or those in emergency services. Despite extensive research in this field, the underlying mechanisms of the disorder remain largely unknown. The identification of risk factors for PTSD has posed a particular challenge as there can be delays in onset of the disorder, and most people who are exposed to traumatic events will not meet diagnostic criteria for PTSD. With the advent of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V), the classification for PTSD has changed from an anxiety disorder into the category of stress- and trauma-related disorders. This has the potential to refocus PTSD research on the nature of stress and the stress response relationship. This review focuses on some of the important findings from psychological and biological research based on early models of stress and resilience. Improving our understanding of PTSD by investigating both genetic and psychological risk and coping factors that influence stress response, as well as their interaction, may provide a basis for more effective and earlier intervention.

An imagery-based road map to tackle maladaptive motivation in clinical disorders

There is now a widespread recognition of the importance of mental imagery in a range of clinical disorders (1). This provides the potential for a transdiagnostic route to integrate some aspects of these disorders and their treatment within a common framework. This opinion piece argues that we need to understand why imagery is such a central and recurring feature, if we are to progress theories of the origin and maintenance of disorders. This will aid us in identifying therapeutic techniques that are not simply targeting imagery as a symptom, but as a manifestation of an underlying problem. As papers in this issue highlight, imagery is a central feature across many clinical disorders, but has been ascribed varying roles. For example, the involuntary occurrence of traumatic memories is a diagnostic criterion for PTSD (2), and it has been suggested that multisensory imagery of traumatic events normally serves a functional role in allowing the individual to reappraise the situation (3), but that this re-appraisal is disabled by extreme affective responses. In contrast to the disabling flashbacks associated with PTSD, depressed adults who experience suicidal ideation often report “flash forward” imagery related to suicidal acts (4), motivating them to self-harm. Socially anxious individuals who engage in visual imagery about giving a talk in public become more anxious and make more negative predictions about future performance than others who engage in more abstract, semantic processing of the past event (5). People with Obsessive Compulsive Disorder (OCD) frequently report imagery of past adverse events, and imagery seems to be associated with severity (6). The content of intrusive imagery has been related to psychotic symptoms (7), including visual images of the catastrophic fears associated with paranoia and persecution. Imagery has been argued (8) to play a role in the maintenance of psychosis through negative appraisals of imagined voices, misattribution of sensations to external sources, by the induction of negative mood states that trigger voices, and through maintenance of negative schemas. In addiction and substance dependence, Elaborated Intrusion (EI) Theory (9, 10) emphasizes the causal role that imagery plays in substance use, through its role in motivating an individual to pursue goals directed toward achieving the pleasurable outcomes associated with substance use...

Q-evankeliumi ja psykohistoria : Uuden testamentin eksegetiikan väitöskirja

In the course of my research for my thesis The Q Gospel and Psychohistory, I moved on from the accounts of the Cynics ideals to psychohistorical explanations. Studying the texts dealing with the Cynics and the Q Gospel, I was amazed by the fact that these texts actually portrayed people living in greater poverty than they had to. I paid particular attention to the fact that the Q Gospel was born in traumatising, warlike circumstances. Psychiatric traumatology helped me understand the Q Gospel and other ancient documents using historical approaches in a way that would comply with modern behavioural science. Even though I found some answers to the questions I had posed in my research, the main result of my research work is the justification of the question: Is it important to ask whether there is a connection between the ethos expressed by means of the religious language of the Q Gospel and the predominantly war-related life experiences typical to Palestine at the time. As has been convincingly revealed by a number of studies, traumatic events contribute to the development of psychotic experiences. I approached the problematic nature, significance and complexity of the ideal of poverty and this warlike environment by clarifying the history of psychohistorical literary research and the interpretative contexts associated with Sigmund Freud, Jacques Lacan and Melanie Klein. It is justifiable to question abnormal mentality, but there is no reliable return from the abnormal mentality described in any particular text to the only affecting factor. The popular research tendency based on the Oedipus complex is just as controversial as the Oedipus complex itself. The sociological frameworks concerning moral panics and political paranoia of an outer and inner danger fit quite well with the construction of the Q Gospel. Jerrold M. Post, M.D., Professor of Psychiatry, Political Psychology and Interna-tional Affairs at George Washington University, and founder and director of the Center for the Analysis of Personality and Political Behavior for the Central Intelligence Agency, has focused on the role played by charisma in the attracting of followers and detailed the psychological styles of a "charismatic" leader. He wrote the books Political Paranoia and Leaders and Their Followers in a Dangerous World: the Psychology of Political Behavior among others. His psychoanalytic vocabulary was useful for my understanding of the minds and motivations involved in the Q Gospel s formation. The Q sect began to live in a predestined future, with the reality and safety of this world having collapsed in both their experience and their fantasies. The deep and clear-cut divisions into good and evil that are expressed in the Q Gospel reveal the powerful nature of destructive impulses, envy and overwhelming anxiety. Responsible people who influenced the Q Gospel's origination tried to mount an ascetic defense against anxiety, denying their own needs, focusing their efforts on another objective (God s Kingdom) and a regressive, submissive earlier phase of development (a child s carelessness). This spiritual process was primarily an ecclesiastic or group-dynamical tactic to give support to the power of group leaders.

Developmental-like responses in injured mature central neurons

Traumatic insults to the central nervous system are frequently followed by profound and irreversible neuronal loss as well as the inability of the damaged neurons to regenerate. One of the major therapeutic challenges is to increase the amount of surviving neurons after trauma. Thus it is crucial to understand how injury affects neuronal responses and which conditions are optimal for survival to prevent neuronal loss. During development neuronal survival is thought to be dependent on the competition for the availability of survival-promoting molecules called neurotrophic factors. Much less is known on the survival mechanisms of mature neurons under traumatic conditions. Increasing amount of evidence points towards the possibility that after injury neuronal responses might aquire some developmental characteristics. One of the important examples is the change in the responses to the neurotransmitter GABA: it is inhibitory in the intact mature neurons, but can induce excitation during development and after trauma. An important step in the maturation of GABAergic transmission in the CNS is the developmental shift in the action of GABAA receptor from depolarization in immature neurons to hyperpolarization in mature neurons. GABAA-mediated responses are tightly linked to the homeostasis of the chloride anion (Cl-), which in neurons is mainly regulated by Na+-K+-2Cl- cotransporter NKCC1 and K+-Cl- cotransporter KCC2. Trauma-induced functional downregulation of KCC2 promotes a shift from hyperpolarizing GABAA-mediated responses to depolarizing. Other important consequences of neuronal trauma are the emergence of dependency of central neurons on brain-derived neuro¬trophic factor (BDNF) for survival, as well as the upregulation of neurotrophin receptor p75NTR. Our aim was to answer the question whether these post-traumatic events are interrelated, and whether the regulation of BDNF and KCC2 expression is different under traumatic conditions and in intact neurons. To study responses of injured mature central neurons, we used an in vitro and in vivo axotomy models. For in vitro studies, we lesioned organotypic hippocampal slices between CA3 and CA1 regions, which resulted in selective axotomy of the CA3 neurons and denervation of the CA1 neurons. Some experiments were repeated in vivo by lesioning the neurons of the corticospinal tract at the internal capsule level, or by lesioning spinal motoneurons at the ventral root. We show that intact mature neurons do not require BDNF for survival, whereas in axotomized neurons apoptosis is induced upon BDNF deprivation. We further show that post-traumatic dependency on BDNF is mediated by injury-induced upregulation of p75NTR. Post-traumatic increase in p75NTR is induced by GABAA-mediated depolarization, consequent opening of voltage-gated Ca2+ channels, and the activation of Rho kinase ROCK. Thus, post-traumatic KCC2 downregulation leads to the dependency on BDNF through the induction of p75NTR upregulation. Neurons that survive after axotomy over longer period of time lose BDNF dependency and regain normal KCC2 levels. This phenomenon is promoted by BDNF itself, since after axotomy contrary to normal conditions KCC2 is upregulated by BDNF. The developmentally important thyroid hormone thyroxin regulates BDNF expression during development. We show that in mature intact neurons thyroxin downregulates BDNF, whereas after axotomy thyroxin upregulates BDNF. The elevation of BDNF expression by thyroxin promoted survival of injured neurons. In addition, thyroxin also enhanced axonal regeneration and promoted the regaining of normal levels of KCC2. Thus we show that this hormone acts at several levels on the axotomy-initiated chain of events described in the present work, and could be a potential therapeutic agent for the injured neurons. We have also characterized a previously unknown downregulatory interaction between thyroxin and KCC2 in intact neurons. In conclusion, we identified several important interactions at the neurotrophin-protein and hormone-neurotrophin level that acquire immature-like characteristics after axotomy and elucidated an important part of the mechanism by which axotomy leads to the requirement of BDNF trophic support. Based on these findings, we propose a new potential therapeutic strategy where developmentally crucial agents could be used to enhance survival and regeneration of axotomized mature central neurons.

Memória, imaginação e transpiração no processo de fabricação do passado: a ficcionalização de si em Infância e Angústia, de Graciliano Ramos

O objetivo deste trabalho é investigar a proposta literária do escritor alagoano Graciliano Ramos que conceituamos como ficcionalização de si, a qual consiste na utilização de observação, experiência, imaginação e transpiração como ingredientes da elaboração ficcional. Para atingir a tal objetivo, buscamos traçar um breve panorama político-cultural da década de 1930, no sentido de situar a formação ideológica e a produção mais significativa do autor Caetés (1933), S. Bernardo (1934), Angústia (1936) e Vidas Secas (1938). Prosseguimos com a construção de um amplo painel sobre o papel da memória na escrita de si, concluindo sobre a impossibilidade da fidelidade absoluta na reprodução do real, uma vez que esta passa necessariamente pela subjetividade da linguagem, o que lhe confere um inegável caráter ficcional. Conceituamos autobiografia e refletimos sobre as profundas alterações percebidas no gênero autobiográfico, inserindo a produção de Graciliano Ramos no contexto memorialista. Defendemos a ideia de que o escritor antecipa, na década de 30, o que na década de 70 será denominado como autoficção. Construída a fundamentação teórica necessária, passamos a analisar e discutir trechos do romance Angústia, em contraponto com Infância. Confrontando as leituras destas obras, pudemos perceber o aproveitamento ficcional de acontecimentos traumáticos da infância do autor narrados em Infância na elaboração da fase infantil do personagem Luís da Silva, de Angústia

A Terapia de Exposição com Realidade Virtual para pacientes com TEPT controlada por um Sistema de Lógica Fuzzy

Nos últimos anos, a área da saúde vem explorando o potencial das novas tecnologias para diagnóstico e tratamentos de muitos distúrbios. Em especial, a tecnologia de Realidade Virtual se destaca por oferecer novas perspectivas de tratamento para diferentes distúrbios neuropsiquiátricos. Por outro lado, a ocorrência de problemas causados por situações traumáticas vem crescendo em todo o mundo. Nesse contexto, o Transtorno de Estresse Pós-Traumático (TEPT) é classificado como um transtorno de ansiedade que se caracteriza por gerar uma classe de comportamentos inadequados a situações que não representam perigo real. Em geral, este transtorno está relacionado à ocorrência de algum evento traumático de grande magnitude no passado. Vários trabalhos foram desenvolvidos utilizando ambientes virtuais tridimensionais (3D) para tratar e diagnosticar este distúrbio. Entretanto, percebe-se uma carência de sistemas que consigam controlar o nível de dificuldade das atividades desenvolvidas nesses ambientes. Nesse caso, esta dissertação tem por objetivo descrever o desenvolvimento e avaliar o potencial de utilização de dois sistemas: um que explora a Realidade Virtual (ARVET) para oferecer cenas virtuais que simulem os estímulos geradores de ansiedade similares aqueles da vida real; e outro que explora a Lógica Fuzzy (SAPTEPT) para classificar os níveis de ansiedade do paciente, possibilitando a análise quali-quantitativa de dados psicofisiológicos e psicométricos. As avaliações realizadas com especialistas na área mostraram que o ARVET pode proporcionar um alto grau de estímulos ansiogênicos e a integração com o SAPTEPT ocorreu de forma satisfatória mostrando o potencial que os sistemas têm de serem utilizados em pacientes reais.

Lethal Interpersonal Violence in the Middle Pleistocene

Evidence of interpersonal violence has been documented previously in Pleistocene members of the genus Homo, but only very rarely has this been posited as the possible manner of death. Here we report the earliest evidence of lethal interpersonal violence in the hominin fossil record. Cranium 17 recovered from the Sima de los Huesos Middle Pleistocene site shows two clear perimortem depression fractures on the frontal bone, interpreted as being produced by two episodes of localized blunt force trauma. The type of injuries, their location, the strong similarity of the fractures in shape and size, and the different orientations and implied trajectories of the two fractures suggest they were produced with the same object in face-to-face interpersonal conflict. Given that either of the two traumatic events was likely lethal, the presence of multiple blows implies an intention to kill. This finding shows that the lethal interpersonal violence is an ancient human behavior and has important implications for the accumulation of bodies at the site, supporting an anthropic origin.

Sexual Behavior Modulates Contextual Fear Memory Through Dopamine D1/D5 Receptors

Traumatic events always lead to aversive emotional memory, i.e., fear memory. In contrast, positive events in daily life such as sex experiences seem to reduce aversive memory after aversive events. Thus, we hypothesized that post-traumatic pleasurable ex

Trauma and the Memory of Politics

Edkins, Jenny, Trauma and the Memory of Politics (Cambridge: Cambridge University Press, 2003), pp.xvii+265 RAE2008