Daniel Brown

Trauma-related dissociation: conceptual clarity lost and found

OBJECTIVE Imprecise conceptualizations of dissociation hinder understanding of trauma-related dissociation. An heuristic resolution for research and clinical practice is proposed. METHOD Current conceptualizations of dissociation are critically examined. They are compared with a new theory that incorporates classical views on dissociation with other contemporary theories related to traumatization, viewing dissociation as a lack of integration among psychobiological systems that constitute personality, that is, as a structural dissociation of the personality. RESULTS Most current views of dissociation are overinclusive and underinclusive. They embrace non-dissociative phenomena--rigid alterations in the level and field of consciousness--prevalent in non-traumatized populations, and which do not require structural dissociation. These views also largely disregard somatoform and positive symptoms of dissociation and underestimate integrative deficiencies, while emphasizing the psychological defensive function of dissociation. They do not offer a common psychobiological pathway for the spectrum of trauma-related disorders. Structural dissociation of the personality likely involves divisions among at least two psychobiological systems, each including a more or less distinct apperceptive centre, that is, a dissociative part of the personality. Three prototypical levels of structural dissociation are postulated to correlate with particular trauma-related disorders. CONCLUSIONS Limitation of the concept of dissociation to structural dividedness of the personality sets it apart from related but non-dissociative phenomena and provides a taxonomy of dissociative symptoms. It postulates a common psychobiological pathway for all trauma-related disorders. Trauma-related dissociation is maintained by integrative deficits and phobic avoidance. This conceptualization advances diagnosis, classification, treatment and research of trauma-related disorders.

Recovered Memories: The Current Weight of the Evidence in Science and in the Courts:

The authors critically review the main strategies that false-memory proponents have used to challenge the admissibility of testimony regarding recovered abuse memories in the courts: that the laboratory evidence fails to prove the existence of repression, that people rarely forget trauma, and that scientific studies claiming amnesia for trauma and abuse are fraught with a variety of methodological weaknesses. False-memory proponents who have advanced these arguments have made serious logical errors in their arguments and have misused the available scientific evidence. The authors review 68 data-based studies specifically on amnesia and later recovery of memories for childhood sexual abuse, each of which presents evidence favoring amnesia and recovered memories for sexual abuse in certain individuals. These studies were conducted using a variety of methodological approaches and progressive improvements in research design that addressed and answered each criticism advanced by false-memory proponents. These studies also include a number of recent studies using a clarifying interview strategy that demonstrated that the mechanisms operative in substantial forgetting and later recovery of abuse memories typically include a mixture of dissociative amnesia, cognitive avoidance, and misappraisal of the abuse, and rarely include ordinary forgetting. Data-based studies on the accuracy of recovered memories have demonstrated that recovered memories are no more or less accurate than continuous memories of childhood abuse and generally are reliable, except when a specific pattern of suggestive influences may have contaminated the memory. The authors offer a set of evidentiary criteria by which the court can assess suggestive influences. The authors also review the Frye-Daubert standards that have been applied in the courts. They argue that the current weight of the available scientific evidence on amnesia for childhood sexual abuse clearly meets the Daubert standards of admissibility.

Repressed Memory or Dissociative Amnesia: What the Science Says

Legal actions of alleged abuse victims based on recovered memories of childhood sexual abuse (CSA) have been challenged arguing that the concept of repressed memories does not meet a generally accepted standard of science. A recent review of the scientific literature on amnesia for CSA concluded that the evidence was insufficient. The issues revolve around: (1) the existence of amnesia for CSA, and (2) the accuracy of recovered memories. A total of 25 studies on amnesia for CSA now exist, all of which demonstrate amnesia in a subpopulation; no study failed to find it, including recent studies with design improvements such as random sampling and prospective designs that address weaknesses in earlier studies. A reasonable conclusion is that amnesia for CSA is a robust finding across studies using very different samples and methods of assessment. Studies addressing the accuracy of recovered abuse memories show that recovered memories are no more or no less accurate than continuous memories for abuse.

Pseudomemories: the standard of science and the standard of care in trauma treatment.

The pseudomemory (PM) debate has focused on individuals who do not remember sexual abuse and later recover these memories, often in therapy. This paper critically reviews experimental research on stress and memory and on suggestibility and memory in terms of its applicability to PM production in therapy. Three different kinds of suggestibility are identified--hypnotizability, postevent misinformation suggestibility, and interrogatory suggestibility. It is hypothesized that interrogatory suggestibility alone or the interaction of all three pose significant risk for PM production. It is argued that a better standard of science is needed before claims can be made about PM production in therapy, since no experimental studies have been conducted on memory performance or suggestibility effects in therapy. However, the findings derived from memory research on other populations, nevertheless, are useful to inform the standard of care in treating recovered memory patients.

Evidence-Based Hypnotherapy for Asthma: A Critical Review

Abstract Asthma is a chronic disease with intermittent acute exacerbations, characterized by obstructed airways, hyper-responsiveness, and sometimes by chronic airway inflammation. Critically reviewing evidence primarily from controlled outcome studies on hypnosis for asthma shows that hypnosis is possibly efficacious for treatment of symptom severity and illness-related behaviors and is efficacious for managing emotional states that exacerbate airway obstruction. Hypnosis is also possibly efficacious for decreasing airway obstruction and stabilizing airway hyper-responsiveness in some individuals, but there is insufficient evidence that hypnosis affects asthmas inflammatory process. Promising research needs to be replicated with larger samples and better designs with careful attention paid to the types of hypnotic suggestions given. The critical issue is not so much whether it is used but how it is used. Future outcome research must address the relative contribution of expectancies, hypnotizability, hypnotic induction, and specific suggestions.

Iatrogenic dissociative identity disorder—An evaluation of the scientific evidence.

In recent years there has been a remarkable increase in malpractice suits in which a retractor-plaintiff alleges that a defendant therapist has suggestively implanted a false dissociative identity disorder (DID) diagnosis. A critical examination of the arguments used by plaintiff expert witnesses demonstrates that the scientific evidence is insufficient, consisting largely of anecdotal case reports, non-data-based pro-false-memory opinion papers, and several methodologically questionable laboratory studies. These sparse data fail to meet a minimal standard of scientific evidence justifying the claim that a major psychiatric diagnosis like dissociative identity disorder per se can be produced through suggestive influences in therapy. However, some scientific evidence exists to show that behavioral reinforcement can affect the frequency and type of alter behavior manifesting in patients who already have DID. Plaintiff expert witnesses have confused alter creation with alter shaping. Based on the available scientific evidence, it is doubtful whether such plaintiff complaints could meet a Frye-Daubert standard in a test of admissibility of such testimony. Furthermore, current malpractice claims based in iatrogenic DID fail to consider other plausible alternative explanations for plaintiffs retraction beliefs, such as the manufacture of retraction beliefs through systematic exposure to post-treatment pro-false-memory suggestive influences and/or deceptive, factitious behavior on the part of plaintiff.

Phenomenological Differences among Self Hypnosis, Mindfulness Meditation, and Imaging

A survey of 122 subjects was conducted to investigate the differences in the phenomenological quality of the experiences engendered by three types of awareness discipline: self-hypnosis (21 subjects), waking dreaming (49 subjects) and mindfulness meditation (25 subjects from a 2-week retreat, and another group of twenty-seven subjects from a 2-day weekend retreat). A questionnaire, the Profile of Trance, Imaging, and Meditation Experience (TIME) was used in the survey Discriminant analyses were used to construct models of the differences in the phenomenological quality of the experiences among the three groups. A number of phenomenological dimensions, in the major areas of attention, thinking, memory, imagery, body sensations, emotions, time sense, reality sense, and sense of self, were found which could accurately distinguish among the experiences of practitioners of the three types of awareness training. Results show that while self hypnosis involves self-referential thinking, memory changes, and intense emotions, waking dreaming emphasizes the immediate impact of emerging images, which unfold in a thematic manner and have a sense of their own reality. Mindfulness meditators have difficulty managing distractions, but with experience learn greater awareness of bodily processes, and experience changes in the perception of time and self; mental processes seem to slow down, and awareness assumes an impersonal quality. No attributions as to the causes or sources of these phenomenological differences are made, as the survey was not large enough to provide comparison groups, subject matching, or other statistical controls necessary for causal analyses.

Acidic conditions ameliorate both adenosine triphosphate depletion and the development of hyperpermeability in cultured Caco-2BBe enterocytic monolayers subjected to metabolic inhibition

BACKGROUND We recently reported that moderate degrees of adenosine triphosphate (ATP) depletion induced by chronic glycolytic inhibition or hypoxia increase the permeability of Caco-2BBe enterocytic monolayers. Interestingly, the development of lactic acidosis induced by anaerobic glycolysis ameliorates the development of hyperpermeability caused by chronic ATP depletion. We sought to further elucidate the mechanism(s) responsible for the apparent protection against epithelial hyperpermeability afforded by mild acidosis under conditions of metabolic inhibition. METHODS Caco-2BBe monolayers growing on permeable supports in bicameral chambers were incubated with 2-deoxyglucose (2DOG) in a glucose-free (Glu-) environment to inhibit glycolysis. Permeability was determined by measuring the transepithelial flux of fluorescein sulfonic acid. Concentrations of intracellular calcium [Ca2+]i were determined fluorometrically by using fura-2. RESULTS When extracellular pH (pH0) was maintained at 7.4 or 5.5, incubation of monolayers for 24 hours with Glu-/2DOG increased permeability and depleted intracellular ATP levels. However, keeping pH0 at 7.0 to 6.0 ameliorated both the development of hyperpermeability and the depletion of ATP induced by Glu-/2DOG. These protective effects were observed under acidic conditions created either by addition to the medium of HCl or by incubation under an atmosphere containing 20% CO2. Incubation with Glu-/2DOG caused bulging of the apical membranes of cells (electron microscopy) and derangements in the perijunctional distribution of actin (fluorescence microscopy); however, these structural changes were ameliorated by mild acidosis. Acute chemical hypoxia at pH0 7.4 induced by Glu-/2DOG plus antimycin A decreased cellular ATP levels and elevated [Ca2+]i. Lowering pH0 to 6.8 ameliorated both the depletion of ATP and the increase in [Ca2+]i induced by Glu-/2DOG+antimycin A. CONCLUSIONS Moderate decreases in pH ameliorate the hyperpermeability induced by metabolic inhibition, possibly by diminishing ATP depletion and blunting increases in [Ca2+]i.

Differences in Experience among Mindfulness Meditators

A survey of 110 subjects was conducted to investigate the differences in the phenomenological quality of mindfulness mediators who attended retreats of either two days (twenty-seven subjects), two weeks (twenty-five subjects), or three months (fifty-eight subjects). A questionnaire, the Profile of Trance, Imaging, and Meditation Experience (TIME), was used for the survey. Discriminant analyses were used to construct models of the dimensions of experience along which the three groups differed. A number of phenomenological dimensions, in the major areas of attention, thinking, memory, imagery, body sensations, emotions, time sense, reality sense, sense of self, perception, and interpersonal interaction, were found which could accurately distinguish among the three groups of retreatants. No attributions as to the causes or sources of these phenomenological differences are made, as the survey was not large enough to provide comparison groups, subject matching or other statistical controls necessary for causal analyses.

Mastery of the mind East and West: excellence in being and doing and everyday happiness.

Western psychological research on positive psychology and Buddhism have recently converged in their emphasis on the development of positive states, like states of excellence and everyday happiness. Yet, these traditions differ in their approaches to positive states, with respect to a state‐trait and doing‐being distinction. Western scientific research on peak performance emphasizes discontinuous, time‐limited peak performance states wherein individuals do things extraordinarily well in sports and in the arts. The Eastern spiritual traditions emphasize continuous excellence of being, in the form of traits or character strengths. In both traditions mental imagery is a key ingredient to excellence training. With respect to everyday happiness, Western psychological research has focused on the role of meaning systems in the transformation of flow states into vital engagement in everyday life, while Buddhism stresses the role of meditation training to gain mastery over all levels of mind that leads to everyday happiness. Rorschach and tachistoscopic research on advanced meditators suggests that advance meditators have gained unusual mastery over states of mind not yet documented in the Western psychological research on positive psychology.