The role of shame and self‐critical thinking in the development and maintenance of current threat in post‐traumatic stress disorder

There is increasing recognition of emotions other than fear in post‐traumatic stress disorder (PTSD), and recent research has looked at the role of shame. Cognitive theory suggests that PTSD is caused by traumatic experiences being processed in a way that causes ongoing current threat. In this paper we suggest that shame might contribute to the creation/maintenance of ongoing current threat as it attacks an individual's psychological integrity. A correlational design was used to investigate some of the factors that might contribute to a shame response within a PTSD sample. It was hypothesized that individuals with PTSD who report higher levels of shame would be more prone to engage in self‐critical thinking and less prone to engage in self‐reassuring thinking than individuals with PTSD who report lower levels of shame. Data were gathered using self‐report questionnaires, and results supported the hypotheses. It is suggested therapy for shame‐based PTSD needs to incorporate strategies to help individuals develop inner caring, compassion and self‐reassurance. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message: ? Some individuals with PTSD report high levels of shame. ? High levels of shame are associated with high levels of self‐critical thinking and low levels of self‐reassuring thinking. ? Therapy for shame‐based PTSD needs to incorporate strategies that help individuals develop inner caring, compassion and self‐reassurance.     

三重自我的动机层级:自我积极偏差的视角

目的:由个体自我、关系自我和集体自我构成的三重自我心理结构对人类的生存和繁衍具有重要意义。三种自我的动机层级关系一直存在争议。为此,本研究考察了三重自我的动机层级关系。方法:以大学生为被试,采用自我参照效价范式设计了三个实验。实验1初步考察中国人的三重自我动机层级。实验2、3旨在分离关系自我的个体身份特征,并探究其对三重自我动机层级可能带来的干扰作用。结果:当关系自我被"家庭关系(母亲和父亲)"表征时,三重自我的动机层级表现为"个体自我与关系自我平级(自我与不同类型特质词的链接方式相似,积极词链接肯定回答和消极词否定回答最快),集体自我次之"。当关系自我是亲密好友的关系表征时,三重自我动机则表现为与西方研究结论一致的"个体自我优先、关系自我次之、集体自我最末"的层级结构。结论:中国人三重自我的动机层级受到关系自我的身份特征的深刻影响。     

Self‐concept and attributions about other women in women with a history of childhood sexual abuse

Self‐concept literature and literature on childhood sexual abuse (CSA) suggests that women with a history of CSA may have particular ways of perceiving themselves, which, as well as impacting upon relationships within their everyday lives, may also have implications for therapy; whether this is on an individual basis or within a group. This research investigated self‐concept and attributions about other women using an adapted version of the self‐concept sorting task. Three groups of women were compared: women with a history of CSA, women experiencing depressed mood but without a history of CSA and a healthy non‐clinical comparison group of hospital staff. To some extent the current findings supported previous studies indicating that women attempting to cope with the consequences of a history of CSA have a negative self‐concept. However, there was evidence to suggest that certain self‐aspects are protective or protected. Similarly, there is some support for previous evidence of difficult relationships with mothers. Possible explanations for these findings were discussed and areas for future research suggested. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Massage: ? Although women with a history of CSA and depression have a negative view of themselves in comparison to a non‐clinical group, there is no qualitative difference between these two groups. ? Nor do women with a history of CSA have a more negative view of other women in general than women who are depressed. ? Therefore, being aware of the likelihood that an individual may preceive herself, but not other women negatively, a therapist may use therapy to actively increase awareness and address this issue.     

Migration as an Unconscious Search for Identity: Some Reflections on Language,Difference and Belonging

The author addresses some issues regarding patients who relocate and who struggle with adaptation to a new reality. She argues that emigration is a complex psychological phenomenon that requires a therapist to pay special attention to the issue of language, difference and identity, and suggests that the issues of different culture and language in analytic psychotherapy need to be considered as part of a wider cultural context to which we all belong, rather than a specialized area of interest. The paper illustrates, through the clinical example of an East European male patient, that the psychic work of emigration can be understood as a process of integrating splits between pre‐ and post‐migration selves. The author concludes that the analyst needs to let herself be involved as a ‘real person’ to reach the non‐interpretative aspects of the patient's psyche through a mutuality of shared experience to promote a change.     

The Breathing Boundary

All psychotherapy is dependent on a frame, a structure. We require boundaries in order to feel and provide containment. However, when working with patient groups who have been excluded from mainstream risk‐averse treatment we learn more about the nature of professional boundaries. A boundary needs to be nurtured and thought about. It needs to breathe and to come from thought. A rigid boundary is a different matter. Where is the humble concept of not knowing? What makes flexible guidelines become rigidified into inflexible codes and barriers? In interrogating techniques that do not work with people with intellectual disabilities we learn more about shared areas of social disability. This paper focuses on questions of analytic neutrality, affect, anger, transparency, and disability psychotherapy in the external as well as internal world.     

A Psychoanalysis of Being: An Approach to Donald Winnicott

This paper offers a brief résumé of Winnicott's approach to psychoanalysis through a reading that emphasizes his interest in the capacity to be as a fundamental acquisition of human subjectivity. This interest continued throughout his life. The paper argues that it is closely related to his interest in analytic communication and the emphasis in his paper ‘Communicating and not‐communicating leading to a study of certain opposites’ of the importance clinically of the patient's right not to communicate and the analyst's acceptance of it. It refers briefly to the richness of the arena opened up by his idea of the incommunicado self and its implications for both theory and practice. Three clinical vignettes are included to demonstrate Winnicott's way of working.     

On Not Being Able to Symbolize

This paper explores ideas from Marion Milner which the author has found helpful in conceptualizing work with a patient who felt tyrannized by her objects, terrified that she would be swallowed up by them never to re‐emerge. Her terror interfered with her capacity to symbolize. The paper looks at the concept of a bodily self and its creative engagement with the world especially in the form of fusion with the object. It places Milner's theory in the larger context of psychoanalytic and neuroscientific thinking from Freud and Winnicott to Damasio as well as relating it to philosophical and Romantic accounts of creative apperception and personal knowledge. Although confidentiality precludes a detailed account of the analysis, the author provides an outline of the gradual development of her capacity to symbolize alongside her growing sense of a continuous self. He further comments on her finding what Milner called ‘intuitive images’ to bridge intellect and intuition and to allow them to co‐exist peacefully. The patient brought drawings to sessions and the paper reflects on these as an index of change as well as on the importance of the process of creating them in relation to her anxiety over the tyranny of objects.     

Empirical analysis of factors in depressive cognition: The cognitive triad inventory

The purpose of this study was to examine the factor analytic evidence for the three components of Beck's cognitive triad (view of self, world, and future). Two hundred sixty college undergraduates participated in the study. Factor analytic results indicated that the three scales of the CTI generate five factors, which represent positively phrased “future” items, negatively phrased “future” items, positively phrased “world” items, negatively phrased “world” items, and positively phrased “self items”. The negatively phrased self items were distributed among the negatively phrased “world” and negatively phrased “future” factors. These findings partially support the utility of categorizing depressogenic cognitions into three constructs (self, world, and future) and also the notion that different cognitive operations or response styles may be elicited from positive vs. negative items.     

A gift or a yoke? Women’s and men’s responses to genetic risk information from BRCA1 and BRCA2 testing

This qualitative study explored the impact of genetic risk information from BRCA1/2 testing on individuals' subjective understandings of self and self-identity. In-depth interviews were conducted with 39 participants (34 women and 5 men) who had received test results from BRCA1/2 testing. Themes emerging from qualitative data analysis revealed that participants linked their positive results to becoming more aware of their physical selves (embodied self), their selves in relation to family (familial-relational self) and their selves in relation to wider kinship or social groups (social self). Genetic information was generally viewed as enabling; it allowed participants to take measures (surveillance or prophylactic surgery) to confront the disease. However, for a small minority of women, knowledge about their genetic risk had a profound and limiting effect on their agency. Rather than giving them a sense of control, they saw little opportunity to fight the disease. For a few people, identification of a genetic mutation thrust them into an uncertain state, that is in a position of being neither ill nor completely well. In one case, BRCA information led to a disruption of social identity. Further work is needed to assess the impact of age and life stage on psychological responses to genetic information on cancer susceptibility.     

ANALYSING MURIEL'S WEDDING WITH REFERENCE TO THE STORY OF 'CINDERELLA'

abstract    This paper analyses Muriel's Wedding , a film based on and inspired by the story of 'Cinderella'. Beginning with a discussion of fairy tales, it argues that interpretations of them are theoretically and culturally specific. Bearing this point in mind, Bettelheim's oedipal analysis of 'Cinderella' is compared with an alternative view developed in Muriel's Wedding . Hogan, the film's author and director, posits a different perspective; one where female friendship becomes integral to the psychological development of Muriel. The iconic significance of weddings is also discussed in relation to this. The paper draws on the pre-oedipal theories of Winnicott, and the more recent contributions of analytic feminist and relational theorists. Implicit in this is the contribution that can be made to clinical practice, and the notion there is a dialectical relationship between the fantasies of the inner world and the lived experience of the cultural world.     

A Jungian Approach to Analytic Work in the Twenty‐First Century

In Part 1 of this paper the authors summarize those key concepts in Jungian analytic theory which differentiate it from a psychoanalytic approach. To illustrate these perspectives and their application in clinical work, a patient is introduced. The authors elaborate on a particular dream with the proposition that it holds within it both an image of the internal world of the patient's personal psyche and something which might be viewed as archetypal and emerging from the collective unconscious. Part 2 focuses on more recent developments in Jungian analytic thinking. Michael Fordham's important work in extending Jungian theory into an understanding of infant development is summarized and illustrated by a clinical example. This is followed by a brief summary of how contemporary debate within the Jungian analytic community has been much affected by recent developments in areas outside the analytic discourse which have offered both a challenge to and an affirmation of certain Jungian concepts. Examples given are from emergence theory and neuroscience. The Jungian interest in such phenomena stems from a view of the human psyche as rooted in a wider world of matter, culture, history and an unconscious that is not only personal but also collective.     

大学生的公正世界信念及其对自尊的作用

目的:考察大学生的公正世界信念现状以及其对自尊的影响。方法:采用大学生公正世界信念量表(JWS)和自尊量表(SES)对861名在校大学生进行问卷调查。结果:(1)大学生公正世界信念及其各个维度存在显著的性别差异(t=-4.75~8.02,P0.001);(2)大学生公正世界信念、内在公正与终极公正都与自尊显著正相关(r=0.270~0.324,P0.01),内在不公正与自尊呈显著负相关(r=-0.126,P0.01);(3)在控制性别、年级等人口学变量后,大学生公正世界信念对自尊水平有独立预测作用。结论:大学生的公正世界信念对自尊水平具有正向作用。     

Comparison of Self-Administered Post Traumatic Stress Disorder Tool vs. Researcher Administered Tool in the Emergency Department

Background

Recent studies have shown that there is a high rate of post traumatic stress disorder in the inner city.

Some Consequences of being the Wrong Child: Effects of the Intergenerational Transmission of an Ideal‐Ego

In this paper the author considers a not uncommon group of patients seen in analytic work. These are people who present themselves for treatment because they feel that there is something ‘wrong with themselves’, and it is this belief about themselves that is their problem. They are usually people who have not achieved their potential in life; who may be dissatisfied in their relationships and/or with their level of success in their work. They often suffer from depression, symptoms of anxiety or psychosomatic complaints. In this way their belief in their sense of ‘wrongness’ is self‐confirming and to this extent they do have something wrong with them although the particular manifestations, of what is wrong, can vary considerably. However, it is what these people have in common, their fundamental belief in being ‘wrong’, which the author is going to address.     

A study on the structure of the intention to become ideal selves: from the viewpoint of the relationship to subjective ratings of ideal selves

This study examined the structure of the "intention to become ideal selves", the autonomous direct approaches in building into an ideal self. Only when people feel meanings or worth on an ideal self, do people have the intention to be it. It was predicted that if people feel meanings or worth on ideal selves, some affect related to it would rise. In addition, we predicted that the possibility to actualize ideal selves would directly or indirectly promote the intention to become ideal selves. A structural model based on these hypotheses was examined, controlling for sex and contents of ideal selves. The questionnaire was administered during class to 1 052 university students (F = 453, M = 599). The hypothetical structural model was examined by SEM and yielded a good estimate of model fit, and fully estimated the intention to become ideal selves. Although this structural model showed good estimates of model fit regardless of sex or contents of ideal selves, there were some differences in the standardized coefficient of the possibility to actualize ideal selves depending on the contents of ideal selves.     

Narrative representations of caregivers and self in maltreated pre-schoolers

This study examined narrative representations of parents and of self, as well as child behavior during the assessment, in maltreated (N = 56) and demographically comparable non-maltreated (N = 37) pre-school-aged children in a one-year longitudinal study. Maltreated children evidenced more negative representations of parents and of self at Time 2, including the juxtaposition of both a negative and a grandiose self. Over time there was a marginal interaction such that maltreated children portrayed fewer disciplining parent representations and nonmaltreated children portrayed more. Also over time, maltreated children portrayed marginally more grandiose self-representations and nonmaltreated children fewer. Furthermore, maltreated children demonstrated less responsivity to the examiner over time and nonmaltreated children demonstrated more. The deleterious effects of maltreatment on representations of self and of others, especially as development proceeds, are discussed, and the importance of providing attachment-informed intervention prior to the consolidation of these negative representations is highlighted.     

Possible selves and borderline personality disorder

Although clinical theories suggest that people with Borderline Personality Disorder (BPD) experience a confused sense of self, little empirical research has directly examined the self in BPD (Heard & Linehan, 1993; Westen & Cohen, 1993). In this study, 43 female participants, 15 with BPD and 28 without BPD, completed the closed-ended version of Markus and Wurf's (1987) Possible Selves Questionnaire (PSQ). Participants with BPD were less likely than controls to endorse positive possible selves as current, but more likely to endorse negative possible selves as current, probable, desired, and important. Participants with BPD linked negative and positive selves to their desired selves, which is consistent with the unstable sense of self characteristic of BPD.     

The self-aware diabetic patient software agent model

This work presents a self-aware diabetic patient software agent for representing a human diabetic patient. To develop a 24 h, stochastic and self-aware patient agent, we extend the original seminal work of Ackerman et al. [1] in creating a mathematical model of human blood glucose levels in three aspects. (1) We incorporate the stochastic and unpredictable effects of daily living. (2) The Ackerman model is extended into the period of night-time. (3) Patients' awareness of their own conditions is incorporated. Simulation results are quantitatively assessed to demonstrate the effectiveness of lifestyle management, such as adjusting the amount of food consumed, meal schedule, intensity of exercise and level of medication. In this work we show through the simulation that the average blood glucose can be reduced by as much as 51% due to careful lifestyle management. Self monitoring blood glucose is also quantitatively evaluated. The simulation results show that the average blood glucose is further dropped by 25% with the assistance of blood glucose samples. In addition, the blood glucose is perfectly controlled in the target range during the simulation period as a result of joint efforts of lifestyle management and self monitoring blood glucose. This study focuses on demonstrating how human patients' behavior, specifically lifestyle and self monitoring of blood glucose, affects blood glucose controls on a daily basis. This work does not focus on the insulin–glucose interaction of an individual human patient. Our conclusion is that this self-aware patient agent model is capable of adequately representing diabetic patients and of evaluating their dynamic behaviors. It can also be incorporated into a multi-agent system by introducing other healthcare components so that more interesting insights such as the healthcare quality, cost and performance can be observed.     

Am I the same person across my life span? An event‐related brain potentials study of the temporal perspective in self‐identity

While self‐identity recognition has been largely explored, less is known on how self‐identity changes as a function of time. The present work aims to explore the influence of the temporal perspective on self‐identity by studying event‐related brain potentials (ERP) associated with face processing. To this purpose, participants had to perform a recognition task in two blocks with different task demands: (i) identity recognition (self, close‐friend, unknown), and (ii) life stage recognition (adulthood ‐current‐, adolescence, and childhood). The results showed that the N170 component was sensitive to changes in the global face configuration when comparing adulthood with other life stages. The N250 was the earliest neural marker discriminating self from other identities and may be related to a preferential deployment of attentional resources to recognize own face. The P3 was a robust index of self‐specificity, reflecting stimulus categorization and presumably adding an emotional value. The results of interest emerged for the subsequent late positive complex (LPC). The larger amplitude for the LPC to the self‐face was probably associated with further personal significance. The LPC, therefore, was able to distinguish the continuity of the self over time (i.e., between current self and past selves). Likewise, this component also could discriminate, at each life stage, the self‐identity from other identities (e.g., between past self and past close‐friend). This would confirm a remarkable role of the LPC reflecting higher self‐relevance processes. Taken together, the neural representation of oneself (i.e., “I am myself”) seems to be stable and also updated across time.     

Negativity bias of the self across time: An event-related potentials study

To investigate the neural basis of self-evaluation across time as a function of emotional valence, event-related potentials were recorded among participants instructed to make self-reference judgments when evaluating their past, present and future selves. Results showed that, when evaluating present and past selves, negative words elicited a more positive ERP deflection in the time window between 650 ms and 800 ms (LPC) relative to positive words. However, when evaluating the future selves, there was no significant difference on the amplitude of the LPC evoked by negative versus positive words. Findings provided evidence for the effect of emotional valence on the self across time at a neurophysiological level and identified the time course of negative bias in the temporal self. More specifically, people were inclined to be relatively less negative and optimistic about their future self but had mixed emotions about past and present selves.