A study of silent disengagement and distressing emotion in psychotherapy

Abstract

Fifty-two psychotherapy sessions were coded for silences that reflect processes of client disengagement (e.g., withdrawal, resistance). The study examined the presence of these silences and clients' reports of in-session emotion and symptom change. Results indicated that disengagement predicted poorer proximal and distal outcome as measured by the Beck Depression Inventory for Primary Care (BDI-PC) and poorer proximal outcome on the Symptom Checklist-5, but it was not significantly predictive of Outcome Questionnaire-45 scores. Interitem analyses revealed that disengagement had a significant proximal effect on depressive mood and negative self-evaluative items assessed by the BDI-PC, but across time these effects were sustained for the negative self-evaluative items only.     

Representations of recent and remote autobiographical memories in hippocampal subfields

The hippocampus has long been implicated in supporting autobiographical memories, but little is known about how they are instantiated in hippocampal subfields. Using high‐resolution functional magnetic resonance imaging (fMRI) combined with multivoxel pattern analysis we found that it was possible to detect representations of specific autobiographical memories in individual hippocampal subfields. Moreover, while subfields in the anterior hippocampus contained information about both recent (2 weeks old) and remote (10 years old) autobiographical memories, posterior CA3 and DG only contained information about the remote memories. Thus, the hippocampal subfields are differentially involved in the representation of recent and remote autobiographical memories during vivid recall. © 2013 The Authors. Hippocampus Published by Wiley Periodicals, Inc.     

Association between white matter microstructure,executive functions,and processing speed in older adults: The impact of vascular health

Cerebral white matter damage is not only a commonly reported consequence of healthy aging, but is also associated with cognitive decline and dementia. The aetiology of this damage is unclear; however, individuals with hypertension have a greater burden of white matter signal abnormalities (WMSA) on MR imaging than those without hypertension. It is therefore possible that elevated blood pressure (BP) impacts white matter tissue structure which in turn has a negative impact on cognition. However, little information exists about whether vascular health indexed by BP mediates the relationship between cognition and white matter tissue structure. We used diffusion tensor imaging to examine the impact of vascular health on regional associations between white matter integrity and cognition in healthy older adults spanning the normotensive to moderate–severe hypertensive BP range (43–87 years; N = 128). We examined how white matter structure was associated with performance on tests of two cognitive domains, executive functioning (EF) and processing speed (PS), and how patterns of regional associations were modified by BP and WMSA. Multiple linear regression and structural equation models demonstrated associations between tissue structure, EF and PS in frontal, temporal, parietal, and occipital white matter regions. Radial diffusivity was more prominently associated with performance than axial diffusivity. BP only minimally influenced the relationship between white matter integrity, EF and PS. However, WMSA volume had a major impact on neurocognitive associations. This suggests that, although BP and WMSA are causally related, these differential metrics of vascular health may act via independent pathways to influence brain structure, EF and PS. Hum Brain Mapp, 2013. © 2011 Wiley Periodicals, Inc.     

Clinical impairment in premanifest and early Huntington's disease is associated with regionally specific atrophy

TRACK‐HD is a multicentre longitudinal observational study investigating the use of clinical assessments and 3‐Tesla magnetic resonance imaging as potential biomarkers for future therapeutic trials in Huntington's disease (HD). The cross‐sectional data from this large well‐characterized dataset provide the opportunity to improve our knowledge of how the underlying neuropathology of HD may contribute to the clinical manifestations of the disease across the spectrum of premanifest (PreHD) and early HD. Two hundred and thirty nine gene‐positive subjects (120 PreHD and 119 early HD) from the TRACK‐HD study were included. Using voxel‐based morphometry (VBM), grey and white matter volumes were correlated with performance in four domains: quantitative motor (tongue force, metronome tapping, and gait); oculomotor [anti‐saccade error rate (ASE)]; cognition (negative emotion recognition, spot the change and the University of Pennsylvania smell identification test) and neuropsychiatric measures (apathy, affect and irritability). After adjusting for estimated disease severity, regionally specific associations between structural loss and task performance were found (familywise error corrected, P < 0.05); impairment in tongue force, metronome tapping and ASE were all associated with striatal loss. Additionally, tongue force deficits and ASE were associated with volume reduction in the occipital lobe. Impaired recognition of negative emotions was associated with volumetric reductions in the precuneus and cuneus. Our study reveals specific associations between atrophy and decline in a range of clinical modalities, demonstrating the utility of VBM correlation analysis for investigating these relationships in HD. Hum Brain Mapp, 2013. © 2011 Wiley Periodicals, Inc.     

Physical Activity and Health Outcomes Among HIV-Infected Men Who Have Sex with Men: A Longitudinal Mediational Analysis

Background

Low physical activity is associated with depression, which may, in turn, negatively impact antiretroviral therapy (ART) adherence among HIV-infected individuals; however, prior studies have not investigated the relationships between physical inactivity and ART non-adherence.

Purpose

The purpose of this study was to examine the association of physical inactivity, depression, ART non-adherence, and viral load in HIV-infected men who have sex with men.

Methods

The sample (N?=?860) was from a large, multicenter cohort of HIV-infected patients engaged in clinical care.

Results

Across time, depression mediated the relationship between physical inactivity and ART non-adherence (γ?=?0.075) and the relationship between physical inactivity and viral load (γ?=?0.05). ART non-adherence mediated the relationship between depression and viral load (γ?=?0.002) and the relationship between physical inactivity and viral load (γ?=?0.009).

Conclusions

Low levels of physical activity predicted increased depression and poor ART adherence over time, which subsequently predicted higher viral load.     

Core features of suicide. Gender,age, alcohol and other putative risk factors in a low-incidence population

The aim of the study was to elucidate some supposed core features of suicide through a study of suicide in a low-incidence population. The material covered all suicides and undetermined deaths 1945–2004 in the Faroe Islands (a low-incidence population) and the study made use of all available information. Results showed that suicide rate had been low since the Second World War. However, there was an increase throughout the 1970s and 1980s. Supposed core features of suicide, such as gender, marital status, former psychiatric admittance, former suicidal behaviour, alcohol and method preference were confirmed. Others were not, such as an increasing rate with old age. In diagnostics, the role of psychiatric disorders was confirmed, but so was a substantial role of “no disorder”. Increase period revealed a high proportion of cases with alcohol involved and a substantial part included males, in age groups 25–64 years, unmarried, divorced and alcohol intoxicated. The main conclusion was that a low-incidence population of suicide population confirmed some supposed core features of the suicide phenomenon. Others, related to age and psychiatric disorders, were only partially confirmed. In periods of increase, the most vulnerable were the young and middle-aged males, unmarried, divorced, and alcohol played a crucial role.