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2014 American Neuropsychiatric Association Annual Meeting Abstracts (Journal Article)
Background: Borderline personality disorder (BPD) is characterized by deficits in self-regulation, including impulsivity and affective instability. Transference-focused psychotherapy (TFP) is an evidence-based treatment with proven effectiveness in reducing symptoms across multiple cognitive-emotional domains in patients with BPD. In this study, longitudinal changes in neural activation patterns and predictors of treatment response were investigated using a dimensional symptom-based approach. Methods: A functional magnetic resonance imaging (fMRI) activation paradigm was used pre and post-TFP in patients with BPD, with statistical parametric analyses, to test hypotheses concerning the identification of frontolimbic biomarkers for clinical improvement. Using a within-subjects design, BPD subjects (N=10; mean age=27.8) were scanned pretreatment, and again after approximately one-year of TFP using a disorder-specific emotional linguistic go/no-go fMRI paradigm. Results: Analyses confirmed significant treatment related effects with relative increases in dorsal prefrontal cognitive control regions (dorsal anterior cingulate cortex, dorsolateral prefrontal cortex), and relative decreases in ventrolateral prefrontal and hippocampal areas following treatment. Clinical improvement in affective lability correlated positively with activity in left posterior-medial orbitofrontal cortex/ventral striatum (small-volume-corrected p value (psvc)=0.028); right amygdala/ parahippocampal activation correlated negatively with improvements in affective lability (psvc=0.005). Pretreatment hypoactivation in the left posterior-medial orbitofrontal cortex/ventral striatum predicted improvements in affective lability (psvc=0.013), and posttreatment improvements in constraint were predicted by pretreatment right anterior-dorsal anterior cingulate cortex hypoactivation (psvc=0.002). Conclusions: Individuals with BPD whose symptoms improved following TFP demonstrated modulation of neural activity in brain regions known to be implicated in behavioral inhibition in the context of negative emotional processing.
This book argues for the central role played by absorption in the functioning of the human mind. The importance of absorption makes itself felt in different ways; the two studies combined in this book concentrate on two of them. The first study, 'The Symbolic Mind', argues that, largely as a result of language acquisition, humans have two levels of cognition, which in normal circumstances are simultaneously active. Absorption is a (or the) means to circumvent some, perhaps all, of the associations that characterize one of these two levels of cognition, resulting in what is sometimes referred to as mysitcal experience, but which is not confined to mysticism and plays a role in various "religious" phenomena, and elsewhere. In the second study, 'The Psychology of the Buddha', Prof. Bronkhorst provides a theoretical context for the observation that absorption is a source of pleasure, grapples with Freud, and illustrates his observations through translations of ancient Buddhist texts from the Pali ans Sanskrit languages along with his psychological commentary.
Abstraction in perceptual symbol systems. (Journal Article)
After reviewing six senses of abstraction, this article focuses on abstractions that take the form of summary representations. Three central properties of these abstractions are established: ( i ) type-token interpretation; (ii) structured representation; and (iii) dynamic realization. Traditional theories of representation handle interpretation and structure well but are not sufficiently dynamical. Conversely, connectionist theories are exquisitely dynamic but have problems with structure. Perceptual symbol systems offer an approach that implements all three properties naturally. Within this framework, a loose collection of property and relation simulators develops to represent abstractions. Type-token interpretation results from binding a property simulator to a region of a perceived or simulated category member. Structured representation results from binding a configuration of property and relation simulators to multiple regions in an integrated manner. Dynamic realization results from applying different subsets of property and relation simulators to category members on different occasions. From this standpoint, there are no permanent or complete abstractions of a category in memory. Instead, abstraction is the skill to construct temporary online interpretations of a category's members. Although an infinite number of abstractions are possible, attractors develop for habitual approaches to interpretation. This approach provides new ways of thinking about abstraction phenomena in categorization, inference, background knowledge and learning.
Acceptance and Commitment Therapy for the Treatment of Adolescent Depression: A Pilot Study in a Psychiatric Outpatient Setting (Journal Article)
Based on promising results with adults, Acceptance and Commitment Therapy (ACT) presents as a treatment opportunity for depressed adolescents. We present a pilot study that compares ACT with treatment as usual (TAU), using random allocation of participants who were clinically referred to a psychiatric outpatient service. Participants were 30 adolescents, aged M = 14.9 (SD = 2.55), with 73.6% in the clinical range for depression. At posttreatment on measures of depression participants in the ACT condition showed significantly greater improvement statistically (d = 0.38), and 58% showed clinically reliable change with a response ratio of 1.59 in favor of ACT. Outcomes from 3-month follow-up data are tentative due to small numbers but suggest that improvement increased in magnitude. Measures of global functioning showed statistically significant improvement for both conditions, although clinical change measures favored only the ACT condition. The results support conducting a larger trial of ACT for the treatment of adolescent depression.
ACMHE Home Page (Web Article)
Website of the Association for Contemplative Mind in Higher Education. The website includes a bibliography related to contemplative practice and contemplative education, including several papers written by fellows of the Association available as PDFs on the website.
Activation of the anterior prefrontal cortex and serotonergic system is associated with improvements in mood and EEG changes induced by Zen meditation practice in novices (Journal Article)
To gain insight into the neurophysiological mechanisms involved in Zen meditation, we evaluated the effects of focused attention (FA) on breathing movements in the lower abdomen (Tanden) in novices. We investigated hemodynamic changes in the prefrontal cortex (PFC), an attention-related brain region, using 24-channel near-infrared spectroscopy during a 20-minute session of FA on Tanden breathing in 15 healthy volunteers. We found that the level of oxygenated hemoglobin in the anterior PFC was significantly increased during FA on Tanden breathing, accompanied by a reduction in feelings of negative mood compared to before the meditation session. Electroencephalography (EEG) revealed increased alpha band activity and decreased theta band activity during and after FA on Tanden breathing. EEG changes were correlated with a significant increase in whole blood serotonin (5-HT) levels. These results suggest that activation of the anterior PFC and 5-HT system may be responsible for the improvement of negative mood and EEG signal changes observed during FA on Tanden breathing.
Acute cortisol elevations cause heightened arousal ratings of objectively nonarousing stimuli (Journal Article)
To test the effects of cortisol on affective experience, the authors orally administered a placebo, 20 mg cortisol, or 40 mg cortisol to 85 men. Participants' affective responses to negative and neutral stimuli were measured. Self-reported affective state was also assessed. Participants in the 40-mg group (showing extreme cortisol elevations within the physiological range) rated neutral stimuli as more highly arousing than did participants in the placebo and 20-mg groups. Furthermore, within the 20-mg group, individuals with higher cortisol elevations made higher arousal ratings of neutral stimuli. However, cortisol was unrelated to self-reported affective state. Thus, findings indicate that acute cortisol elevations cause heightened arousal in response to objectively nonarousing stimuli, in the absence of effects on mood.
Adapting dialectical behavior therapy to help suicidal adolescents (2011, Journal Article)
Treating suicidal adolescents is fraught with challenges. Antidepressants may be associated with increased suicidal ideation in adolescents, although some data suggest that increased adolescent suicide rates are correlated with decreases in antidepressant prescribing. Adolescents hospitalized after a suicide attempt are likely to attempt suicide again after they are discharged. Such patients might not attend outpatient psychotherapy; a study of 167 adolescents discharged after a suicide attempt found that 26% never attended follow-up appointments and 11% went once. Emerging research supports the effectiveness of dialectical behavior therapy (DBT) for suicidal adolescents. DBT is a form of cognitive-behavioral therapy that combines individual therapy, skills training, and telephone coaching and is implemented by a therapist consultation team that meets weekly. This article reviews evidence supporting the efficacy of DBT for suicidal adolescents and describes principles of outpatient DBT for these patients as developed by Miller et al.
Adequate Relief in a Treatment Trial With IBS Patients: A Prospective Assessment (Journal Article)
OBJECTIVES: Adequate relief (AR) of irritable bowel syndrome (IBS) symptoms (IBS-AR) has been used as a primary end point in many randomized controlled trials of IBS and is considered by the Rome III committee to be an acceptable primary end point. However, controversy exists on whether baseline severity confounds the effect of the treatment outcome. The aim (1) is to compare a subjective report of IBS-AR with global assessment of improvement (IBS-GAI), change in IBS symptom severity scale (IBS-SSS), and IBS quality of life (IBS-QOL); (2) to explore whether initial IBS symptom severity influences the ability of these outcome measures to detect differences post treatment; and (3) to determine whether psychological symptoms influence the sensitivity of these measures, in a randomized controlled treatment trial. METHODS: A total of 289 adult IBS patients were recruited to a treatment trial. Baseline IBS-SSS scores were used to classify IBS severity as mild (<175), moderate (175–300), or severe (>300). Questionnaires were completed at baseline and after 3 weeks of treatment with sham acupuncture or wait-list control. RESULTS: IBS baseline severity (IBS-SSS) significantly affected the proportion of patients who reported IBS-AR at 3 weeks (mild, 70%; moderate, 49.7%; severe, 38.8%) (P<0.05). However, once the patients who reported IBS-AR at baseline (28.0%) were excluded from the analysis, baseline severity no longer affected the proportion of patients reporting IBS-AR. Baseline severity did not have a significant effect on patients reporting moderate or significant improvement on the IBS-GAI (mild, 30%; moderate, 25.3%; severe, 18.8%) (P=NS). Psychological symptoms had no significant correlations with responders after adjusting for baseline severity. CONCLUSIONS: These data suggest that IBS-AR as an end point is inversely related to baseline symptom severity. However, if patients who report AR at screening were excluded from study participation, baseline symptom severity was no longer confounded with a report of AR at the study end point.
Adiponectin, interleukin-6, and cardiovascular disease risk factors are modified by a short-term yoga-based lifestyle intervention in overweight and obese men (Journal Article)
OBJECTIVE: To investigate the effect of a short-term yoga-based lifestyle intervention on risk factors for cardiovascular disease (CVD) and markers of inflammation and endothelial function in overweight and obese men. DESIGN: Nonrandomized prospective lifestyle intervention study with pre-post design. SETTING AND LOCATION: Integral Health Clinic, an outpatient facility providing yoga-based lifestyle intervention programs for prevention and management of chronic diseases. SUBJECTS: Overweight and obese men (n=51) were enrolled in the study. Subjects who were physically unable to participate and those participating in other interventions were excluded from the study. INTERVENTION: A pretested intervention program including asanas (physical postures), pranayama (breathing exercises), group discussions, lectures, and individualized advice. OUTCOME MEASURES: The primary outcome measure was weight loss, and the secondary outcome measures were clinical and laboratory correlates of CVD risk, levels of interleukin-6 (IL-6), adiponectin, and endothelin-1 (ET-1). RESULTS: Men (n=51, body mass index [BMI] 26.26±2.42 kg/m(2)) were enrolled and underwent a yoga-based lifestyle intervention for 10 days. Of 51 subjects, 30 completed the study. There was a significant reduction in weight from Baseline to Day 10 (74.60±7.98, 72.69±8.37 kg, p<0.001, respectively), BMI (26.26±2.42, 25.69±2.47 kg/m(2), p<0.001, respectively), and systolic BP (121.73±11.58, 116.73±9.00, p=0.042, respectively). There was a significant reduction in plasma IL-6 from Baseline to Day 10 (median 2.24 vs. 1.26 pg/mL, respectively, p=0.012). There was a significant increase in the plasma adiponectin from Baseline to Day 10 (median 4.95 vs. 6.26 μg/mL, respectively, p=0.014). Plasma ET-1 level remained unchanged. CONCLUSION: These findings suggest that even a short-term yoga-based lifestyle intervention may be an important modality to reduce the risk for CVD as indicated by weight loss, reduction in systolic blood pressure, an increase in adiponectin, and decrease in IL-6 in overweight and obese men.
Adolescent Endometriosis-Related Pelvic Pain Treated with Acupuncture: Two Case Reports (Journal Article)
Background: Chronic pelvic pain in adolescents accounts for 10% of outpatient gynecology visits, and 70% of adolescent patients whose pelvic pain is unresponsive to initial therapy have endometriosis. To date, there has been no published research investigating the use of acupuncture for adolescents with chronic pelvic pain and/or endometriosis. Methods: This paper presents two case reports describing the impact of a course of acupuncture on adolescent girls with endometriosis-related chronic pelvic pain of more than 1 year. Results: Both patients, undergoing between 9 and 15 treatments over a 7- to 12-week period, experienced modest improvement in pain as measured by oral self-reports of pain on a scale from 1 to 10, as well as selfor family-reported improvement in headaches, nausea and fatigue. No adverse effects were reported. Conclusions: These case reports provide preliminary evidence that acupuncture may be an acceptable and safe adjunct treatment therapy for some adolescents with endometriosis-related pelvic pain refractory to standard antiendometriosis therapies. These observations suggest that a prospective, randomized controlled trial of the safety and efficacy of acupuncture for this population may be warranted.
Adolescents, substance abuse, and the treatment of insomnia and daytime sleepiness (Journal Article)
Adolescence is a time of change that can be both exciting and stressful. In this review, we focus on the central role that disturbed sleep and daytime sleepiness occupies in interactions involving substance abuse and negative health, social, and emotional outcomes. As a means of improving sleep and lowering risk for recidivism of substance abuse, we developed and implemented a six-session group treatment to treat sleep disturbances in adolescents who have received treatment for substance abuse. The components of the treatment are stimulus control instructions, use of bright light to regularize sleep, sleep hygiene education, cognitive therapy, and Mindfulness-Based Stress Reduction. Preliminary evidence indicates that participants who completed four or more sessions in the treatment program showed improved sleep and that improving sleep may lead to a reduction in substance abuse problems at the 12-month follow-up.
Adolescents with Asperger syndrome can use a mindfulness-based strategy to control their aggressive behavior (Journal Article)
Children and adolescents with Asperger syndrome occasionally exhibit aggressive behavior against peers and parents. In a multiple baseline design across subjects, three adolescents with Asperger syndrome were taught to use a mindfulness-based procedure called Meditation on the Soles of the Feet to control their physical aggression in the family home and during outings in the community. They were taught to shift the focus of their attention from the negative emotions that triggered their aggressive behavior to a neutral stimulus, the soles of their feet. Prior to training in the mindfulness-based procedure the adolescents had moderate rates of aggression. During mindfulness practice, which lasted between 17 and 24 weeks, their mean rates of aggression per week decreased from 2.7, 2.5 and 3.2 to 0.9, 1.1, and 0.9, respectively, with no instances observed during the last 3 weeks of mindfulness practice. No episodes of physical aggression occurred during a 4-year follow-up. This study suggests that adolescents with Asperger syndrome may successfully use a mindfulness-based procedure to control their aggressive behavior.

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