Women's emotional adjustment to IVF: a systematic review of 25 years of research

This review provides an overview of how women adjust emotionally to the various phases of IVF treatment in terms of anxiety, depression or general distress before, during and after different treatment cycles. A systematic scrutiny of the literature yielded 706 articles that paid attention to emotional aspects of IVF treatment of which 27 investigated the women's emotional adjustment with standardized measures in relation to norm or control groups. Most studies involved concurrent comparisons between women in different treatment phases and different types of control groups. The findings indicated that women starting IVF were only slightly different emotionally from the norm groups. Unsuccessful treatment raised the women's levels of negative emotions, which continued after consecutive unsuccessful cycles. In general, most women proved to adjust well to unsuccessful IVF, although a considerable group showed subclinical emotional problems. When IVF resulted in pregnancy, the negative emotions disappeared, indicating that treatment-induced stress is considerably related to threats of failure. The concurrent research reviewed, should now be underpinned by longitudinal studies to provide more information about women's long-term emotional adjustment to unsuccessful IVF and about indicators of risk factors for problematic emotional adjustment after unsuccessful treatment, to foster focused psychological support for women at risk.     

Depression and anxiety as predictors of outcome after myocardial infarction

OBJECTIVE: The objective of this study was to investigate the significance of emotional distress immediately after a myocardial infarction as a predictor of physical, psychological, and social outcomes and resource use. METHODS: In an epidemiological survey, demographic and cardiological data were obtained for all patients from a defined geographical area who had had a myocardial infarction (according to diagnostic criteria of the Monitoring Trends and Determinants in Cardiovascular Disease [MONICA] trial). Hospital survivors were interviewed and were asked to complete self-report assessments on mental state and quality of life. Full replies were available at baseline for 347 subjects. Self-report follow-up questionnaire information was collected 3 months and 1 year later. RESULTS: Fifteen percent of patients scored as probable cases of anxiety or depression. They were more likely than noncases to report preinfarct distress and poor adjustment (as indicated on the 36-item Medical Outcome Study short form). There was an improvement at 3 months, but there was little overall or individual change after that time. Anxiety and depression did not predict subsequent mortality but did significantly predict poor outcome at 1 year on all dimensions of the 36-item short form quality-of-life measure and on specific measures of everyday activity and reports of chest pain, use of primary care resources, and secondary prevention lifestyle changes. CONCLUSIONS: Subjects who are distressed in the hospital are at high risk of adverse psychological and quality-of-life outcomes during the ensuing year. Our findings strengthen the argument for in-hospital identification and treatment of patients with depression and anxiety after myocardial infarction.     

Anxiety, emotional suppression, and psychological distress before and after breast cancer diagnosis

The authors examined the influence of anxiety and emotional suppression on psychological distress in 21 patients with breast cancer and 72 patients with benign breast tumor. The patients with breast cancer who suppressed emotion and had chronically high levels of anxiety felt higher levels of emotional distress both before and after the diagnosis. Such patients need psychological interventions, including encouragement to express and communicate their emotions, immediately after disclosure of the diagnosis to help maintain psychological adjustment in the face of the disease.     

Trait anxiety and reactions to patient-centered and doctor-centered styles of communication: an experimental study

OBJECTIVE: A patient-centered model of communication has often been advocated in preference to a doctor-centered model. The aim of the present study was to assess in an experimental setting how subjects' general level of anxiety affects their reactions to these two communication styles as measured by emotional reactions and satisfaction immediately after consultation. METHODS: Twenty students with low trait anxiety and 21 students with high trait anxiety each had a single consultation with a physician who performed the consultation using either a patient-centered or doctor-centered style of communication. Questionnaires about emotional state were completed by the students before and after the consultation, and a questionnaire about satisfaction was completed after the consultation. RESULTS: Students with low trait anxiety were significantly more satisfied with a patient-centered than a doctor-centered style of communication. There were no significant differences in emotional response to the two styles of communication. Students with high trait anxiety reacted emotionally more positively to a doctor-centered communication style, with significant and nearly significant change scores for the emotions of tension/anxiety and vigor/activity, respectively. No significant difference was found between satisfaction scores. CONCLUSIONS: Data indicate that differences between subjects' emotional traits may be of importance for a differentiated response to patient-centered and doctor-centered communication styles. Subjects' trait anxiety seems to be a significant factor that should be taken into account when assessing the effects of different communication styles.     

Acute experimental emotional stress and natural history of arterial hypertension

The role of experimental emotional stress in the genesis of arterial hypertension was studied. On immobilized rabbits during long-term electrical stimulation of the negative defence emotiogenic centers of the hypothalamus there was treaced development of the arterial hypertension from a transient phase of the struggle between pressor and depressor mechanisms to the phase of a stable dominance of pressor influences and effect on heart activity, including development of a sharp myocardial infarction. The role of different limbic and reticular structures, as well as of adrenal hormones and barocepor depressor mechanisms was revealed in dynamics of the arterial hypertension developmnet under hypothalamic stimulation. A leading role of the adrenergic substratum of the midbrain reticular formation was established in the mechanism of the stable arterial hypothalamic hypertension.     

Does an emotion‐focused two‐chair dialogue add to the therapeutic effect of the empathic attunement to affect?

An increasing amount of research suggests that it is beneficial to work explicitly with emotions in psychotherapy. Emotion‐focused therapy (EFT) utilizes interventions that are thought to enhance the evocativeness of emotional processing and facilitate explorations of new meaning. The purpose of this study was to examine the effect of such an intervention on therapeutic outcome. The intervention, a two‐chair dialogue drawn from emotion‐focused therapy, was added to the treatment conditions that consisted of empathically following the clients' emotional processes. The treatment comprised 2 phases. Using a multiple baseline design, 21 self‐critical clients (15 women and 6 men) with clinically significant symptoms of depression and/or anxiety first received 5, 7, or 9 sessions of a baseline treatment focused on alliance building, empathic attunement to affect, and therapeutic presence and genuineness. A two‐chair dialogue intervention was then added for 5 sessions. The symptoms were measured before each session using Beck's Depression Inventory, Beck's Anxiety Index, and Forms of Self‐Criticizing/Attacking and Self‐Reassuring Scale. An analysis using Hierarchical Linear Modelling revealed that the phase with the two‐chair dialogue had a larger impact on symptoms of anxiety and depression when compared to the baseline phase. On BDI‐II, there was a greater impact on somatic‐affective components than cognitive components. Self‐criticism was reduced when we used time as a predictor for both phases but not significantly more after introducing the intervention. The results corroborate that the two‐chair dialogue intervention is associated with change beyond what is shown when relationship conditions alone are being provided. Implications and limitations are discussed.     

Analysis of the profiles of functional psychomotor asymmetry and mental stress in patients with cardiovascular diseases]

The profile of functional sensomotor asymmetry (FSMA) was evaluated by a series of tests and inversion of emotional reflection. Altogether 70 healthy subjects and 114 cardiovascular diseases patients were examined. Among the patients there were 36 subjects with acute myocardial infarction, 28 with coronary heart disease, 26 with borderline hypertension and 24 with neurocirculatory dystonia (NCD). The highest emotional tension was recognized in myocardial infarction and coronary heart disease. NCD patients exhibit the left FSMA profile more frequently than healthy subjects.     

心肌梗塞不同时期心肌Ⅰ、Ⅲ型胶原重建的研究

目的:对心肌梗塞不同时期心脏各部位胶原重建进行定性、定位、定量研究。方法:应用免疫组化技术结合自动图象分析方法观察Ⅰ、Ⅲ型胶原分布及含量的变化。结果:心肌梗塞后坏死区Ⅰ、Ⅲ型胶原含量及Ⅰ/Ⅲ比值均增加,以Ⅰ型胶原为主,急性期胶原仍交织成网状,至恢复期坏死心肌全部被胶原取代,呈致密束状与心腔表面平行排列。室间隔(未梗塞区)两型胶原含量及比值均增加,急性期以Ⅲ型胶原增加明显,恢复期以Ⅰ型胶原增加为主。右室在急性期胶原含量无明显改变,恢复期变化同室间隔,也以Ⅰ型胶原为主。结论:心肌梗塞后胶原重建,梗塞区呈修复性纤维化,非梗塞区呈反应性纤维化,右室纤维化较左室晚。     

干细胞移植治疗缺血性心脏病：临床应用的可行性与安全性

背景：干细胞移植到受损的心脏组织,可以大量分化为心肌细胞,这项研究为缺血性心脏病治疗带来新的希望。 目的：探讨干细胞移植治疗缺血性心脏病的可行性与安全性。 方法：分析干细胞移植治疗缺血性心脏病安全性和可行性的多种试验方法。REPAIR-AMI试验是一项分析急性心肌梗死后即刻冠脉内移植骨髓祖细胞治疗效果的随机双盲、安慰剂对照的多中心研究;MAGIC Cell-3-DES试验是评价粒细胞集落刺激因子动员的干细胞疗法的安全性和冠脉内注射动员的外周血干细胞对急性心肌梗死和陈旧性心肌梗死的效果;BOOST试验是心肌梗死后经冠脉移植自体骨髓细胞的随机对照研究。PROTECT-CAD试验是一项随机、对照的直接将干细胞注入心肌治疗慢性缺血性心肌病的临床试验。 结果与结论：干细胞移植可以改善左心室的收缩功能和舒张功能以及冠脉血流储备,相关研究也得到验证。对于干细胞移植治疗缺血性心脏病,可以增加左室射血分数,临床事件较少,在药物洗脱支架治疗的基础上,干细胞治疗并不增加再狭窄风险。干细胞移植治疗缺血性心脏病安全可行,未来还需要进行大样本、长时间的大规模多中心的随机对照研究,来进一步评价其疗效和风险。     

Treating anxiety disorders by emotion‐focused psychodynamic psychotherapy (EFPP)—An integrative,transdiagnostic approach

Anxiety disorders are characterized by high levels of anxiety and avoidance of anxiety‐inducing situations and of negative emotions such as anger. Emotion‐focused therapy (EFT) and psychodynamic psychotherapy (PP) have underscored the therapeutic significance of processing and transforming repressed or disowned conflicted or painful emotions. Although PP provides sophisticated means of processing intrapsychic and interpersonal conflict, EFT has empirically tested a set of techniques to access, deepen, symbolize, and transform emotions consistent with current conceptualizations of emotions and memory. Based on our clinical experience, we propose that an integrative emotion‐focused and psychodynamic approach opens new avenues for treating anxiety disorders effectively, and we present a transdiagnostic manual for emotion‐focused psychodynamic psychotherapy. The therapeutic approach takes into account both the activation, processing, and modification of emotion and the underlying intrapsychic and interpersonal conflicts. The short‐term treatment is based on the three phases of initiating treatment, therapeutic work with anxiety, and termination. Emotional poignancy (or liveliness) is an important marker for emotional processing throughout treatment. Instead of exposure to avoided situations, we endorse enacting the internal process of generating anxiety in the session providing a sense of agency and access to warded‐off emotions. Interpretation serves to tie together emotional experience and insight into the patterns and the nature of underlying intrapersonal and interpersonal conflict. Treatment modules are illustrated by brief vignettes from pilot treatments.     

The path to a secure bond: emotionally focused couple therapy

Emotionally focused therapy (EFT) for couples combines experiential and systemic techniques to expand emotional responses and cycles of interaction. This approach has also been used to treat depression, chronic illness, and anxiety disorders. EFT appears to translate well across culture and class, focusing on universal key emotions and attachment needs. From the EFT perspective, adult love is a hardwired, adaptive attachment response. The therapist's in-session focus is on the processing of emotions and key interactional patterns as they occur in the present, because emotional experiences are the primary instruments of change in this approach. The therapist is a relationship consultant who offers a safe platform whereby each partner can distill, expand, and transform experience and find new ways to connect with the other. The case presented here illustrates the three stages of EFT: de-escalation, restructuring interactions, and consolidation.     

骨髓间充质干细胞在急性心肌梗死后心室重构中的应用☆

背景：动物实验和初期的临床研究表明,干细胞移植可以取代坏死心肌细胞、增加有功能心肌细胞的数量,改善心功能,从而为心肌梗死的治疗开辟了一条崭新的途径。 目的：观察心肌梗死后自体骨髓间充质干细胞移植及骨髓动员对心功能的影响。 方法：经猪髂前上棘抽取骨髓30 mL,培养得到骨髓间充质干细胞。15只猪分为3组,模型组仅建立心肌梗死模型,干细胞移植组在造模3 h后经冠状动脉注射骨髓间充质干细胞,干细胞动员组在造模3 h后连续5 d注射粒细胞集落刺激因子    150 μg/(kg•d)。 结果与结论：心肌梗死后8周,干细胞动员组、干细胞移植组左心室收缩、舒张末期内径都明显减小,射血分数较心肌梗死前提高,但差异无显著性意义(P > 0.05);干细胞动员组及干细胞移植组血清血管内皮生长因子水平较心肌梗死前有上升趋势(P < 0.05);干细胞动员组和干细胞移植组梗死交界区的毛细血管密度均大于模型组(P < 0.05)。提示心肌梗死后行自体骨髓间充质干细胞移植及骨髓动员均能明显改善心功能,但具体效果仍需进一步大样本实验研究。 关键词：缺血性心脏病;心力衰竭;骨髓间充质干细胞;血管再生;粒细胞集落刺激因子 doi:10.3969/j.issn.1673-8225.2012.10.009     

骨髓间充质干细胞移植治疗小型猪急性心肌梗死模型的作用研究

 观察骨髓间充质干细胞（MSCs）移植后对梗死心脏模型的治疗作用,以及3个月后移植细胞在梗死心肌内存活转化的情况。方法：20只中华小型猪建立急性心肌梗死模型后随机数字表法分为3个组,每组6只：即单纯建立心肌梗死模型组、生理盐水对照组（心肌梗死后,以生理盐水代替干细胞注射）及MSCs移植组（心肌梗死后进行MSCs移植）。手术操作3个月后,检测各组心脏的功能,用免疫荧光显微镜观察MSCs的存活及转化情况。结果：MSCs移植组与生理盐水对照组相比,心脏射血分数（EF%）明显改善[分别为(50.2±5.3)%和(58.9±1.5)%,P<0.01];心脏灌注缺损百分数（MDP%）显著减少[分别为(1.95±0.22)%和(-1.75±0.19)%,P<0.05]。免疫荧光及组织化学结果证实,MSCs移植3个月后仍然存活,并且部分实验显示,具有分化为心肌细胞及血管内皮细胞的迹象。结论：通过直接注射法将MSCs移植入心肌梗死模型后,在体内可存活达3个月,并能部分转化为心肌细胞和血管内皮细胞。同种异性MSCs移植后,能明显改善中华小型猪梗死模型心脏的功能。     

Influence of anxiety on the course of heart disease after acute myocardial infarction - risk factor or protective function?

BACKGROUND: There is a lack of clarity concerning the effect of anxiety on the course of cardiac events following myocardial infarction. Some studies have identified anxiety as a risk factor for further cardiac events. However, it is also considered to be a protective factor, as a higher level of anxiety may improve patient compliance and regular medical checkups. METHODS: A group of 76 patients with myocardial infarction underwent physical examination and had their anxiety levels assessed within the first week, and 31 months after myocardial infarction. Cardiac events were documented during the follow-up period. We investigated the predictive value for the occurrence of cardiac events of sociodemographic, psychological and physical parameters when evaluated within the first week after myocardial infarction. Compliancy and regularity of medical checkups were registered. RESULTS: Cardiac events occurred in 24 patients during a mean follow-up period of 31 months. The group of anxious patients not only suffered more often from cardiac events, these events also occurred earlier than in nonanxious patients. Age, gender, partner status, level of anxiety and comorbid diabetes at the time of first assessment proved to be discriminatory variables between patients suffering further cardiac incidents and those free of further events. Anxious patients were more likely to continue smoking, whereas less anxious patients were more likely to give up smoking.     

Psychological distress, physical illness and risk of myocardial infarction in the Caerphilly study

BACKGROUND: Studies have found associations between psychological distress (PD) and increased risk of myocardial infarction (MI). However, it is not clear whether the relationship reflects the subtle influence of pre-existing illness on both PD and MI. This study examines the association between PD and MI in a prospective epidemiological study of 1864 middle-aged men to examine if the association is explained by existing illness. METHOD: This study was a prospective cohort study modelling the association between PD, measured using the 30-item General Health Questionnaire (GHQ) and non-fatal myocardial infarction (NFMI) and fatal/non-fatal myocardial infarction (FNFMI).The relationship was modelled in a series of logistic regression models adjusted for age, then cigarette smoking, then social position, and finally for all sociodemographic characteristics, coronary heart disease (CHD) risk factors, and baseline CHD. RESULTS: PD was associated with a 70% and 68% increased risk of NFMI and FNFMI in fully adjusted analysis. However, PD was not associated with an increased risk of NFMI and FNFMI in analyses excluding those with baseline CHD. Further, being psychologically distressed and physically ill was associated with a greater than twofold risk of NFMI and FNFMI, 2.37 (95% CI 1.33-4.20) and 2.33 (95% CI 1.32-4.12) respectively. CONCLUSIONS: This study suggests that PD is a moderator of the increased risk of MI associated with existing physical illness. PD in men who are physically ill is a marker of an underlying chronic physical illness. The prospective association of PD with MI is not independent of baseline physical illness.     

Upward spirals of positive emotions counter downward spirals of negativity: Insights from the broaden-and-build theory and affective neuroscience on the treatment of emotion dysfunctions and deficits in psychopathology

This review integrates Fredrickson's broaden-and-build theory of positive emotions with advances in affective neuroscience regarding plasticity in the neural circuitry of emotions to inform the treatment of emotion deficits within psychopathology. We first present a body of research showing that positive emotions broaden cognition and behavioral repertoires, and in so doing, build durable biopsychosocial resources that support coping and flourishing mental health. Next, by explicating the processes through which momentary experiences of emotions may accrue into self-perpetuating emotional systems, the current review proposes an underlying architecture of state-trait interactions that engenders lasting affective dispositions. This theoretical framework is then used to elucidate the cognitive–emotional mechanisms underpinning three disorders of affect regulation: depression, anxiety, and schizophrenia. In turn, two mind training interventions, mindfulness and loving-kindness meditation, are highlighted as means of generating positive emotions that may counter the negative affective processes implicated in these disorders. We conclude with the proposition that positive emotions may exert a countervailing force on the dysphoric, fearful, or anhedonic states characteristic of psychopathologies typified by emotional dysfunctions.     

Patient affiliation in major illness

Affiliation preferences among 100 Israeli out-patients with major illness were assessed in waiting room interviews. Patients preferred healthy others over being with fellow sufferers or alone, and avoided illness as a discussion topic. Secondary preference for being alone rather than with co-patients rose slightly with reported anxiety. Findings contradict the emotional comparison hypothesis that misery seeks out co-sufferers.     

Brief report: factor structure of the Childhood Illness Attitude Scales (CIAS)

OBJECTIVE: To examine the factor structure of the Childhood Illness Attitude Scales (CIAS). The CIAS is a 35-item self-report measure based on the Illness Attitudes Scales, designed for use with school-age children. The CIAS measures fears, beliefs, and attitudes associated with health anxiety and abnormal illness behavior in childhood. METHODS: CIAS item responses for 201 school-age children were subjected to principal-components analysis with oblique rotation. RESULTS: The CIAS was best conceptualized as comprising four factors: fears, help seeking, treatment experience, and symptom effects. Further factor analysis supported the notion that the CIAS can also be conceptualized as having a hierarchical structure, with four lower-order factors loading onto a single higher-order factor of health anxiety. CONCLUSIONS: Results suggest that the CIAS possesses good psychometric properties, including factorial validity and internal consistency, and appears to be a psychometrically sound instrument for measuring children's health anxiety.     

Psychological functioning among mothers of children with insulin-dependent diabetes mellitus: a longitudinal study

Mothers of children with newly diagnosed insulin-dependent diabetes mellitus (IDDM) were assessed repeatedly over a period of 6 years in order to determine the psychological correlates of managing this chronic illness. Both maternal depression and overall emotional distress after the 1st year of the IDDM increased slightly with illness duration and were also influenced by other factors. Mothers' adjustment shortly after their children were diagnosed with IDDM was a strong predictor of their long-term emotional symptomatology. However, mothers' symptoms over time were not related to medical aspects of IDDM (i.e., the extent of the children's metabolic control, number of rehospitalizations, or their compliance with the medical regimen) and were also unrelated to the levels of depression or anxiety reported by their children. Mothers generally found it easier to cope with the IDDM the longer their children had the illness. However, the degree to which mothers perceived the IDDM to be bothersome or difficult to manage at any given point in time was associated with their overall levels of emotional distress.