Jill Littrell

Is the reexperience of painful emotion therapeutic

Recently, a great deal of attention has been focused on the health promoting benefits that can accrue from revisiting painful emotion. The rationales for revisiting painful emotions include those that assume reexperiencing emotion per se can be health-promoting. Another view stipulates that revisiting painful emotion will only yield benefit if there is some recasting/restructuring of the emotional memory. Research pertinent to the various rationales is discussed. Then research on the impact of emotional expression and outcomes studies of therapies designed to enhance emotional experience are reviewed. Good supporting evidence is found for the effectiveness of behavioral exposure therapies where the duration of emotional exposure is carefully controlled, as well as for the salutary impact of talking or writing about trauma by normally functioning individuals. On the other hand, studies evaluating the impact of experiencing and expressing painful emotion in an unstructured fashion with clinical samples suggest that the process can be harmful. Incorporating findings from the behavioral exposure literature and from the Pennebaker writing-about-trauma studies, the case for evoking emotional memories for the purpose of developing new responses is advanced. The dangers of encouraging emotional experience in absence of acquisition of a new response to the emotion-evoking material are discussed.

The mind-body connection: not just a theory anymore.

Abstract The field of psychoneuroimmunology has witnessed an explosion of empirical findings during the last two decades. Research has documented the mechanisms through which stressful emotions alter white blood cell function. Stress diminishes white blood cell response to viral infected cells and to cancer cells. Moreover, vaccination is less effective in those who are stressed and wounds heal less readily in those who are stressed. While stress decreases the activity of some white blood cells, stress does not compromise the function of all types of white blood cells. Indeed, some types of autoimmune disease, which involve particular subsets of white blood cells, are exacerbated by stress. The literature documents the efficacy of talk-therapy interventions in altering immune system parameters and enhancing the bodys ability to combat disease. The literature also documents the impact of the chronic stress of poverty on immune system function.

Predictors of depression in a sample of African-American homeless men: identifying effective coping strategies given varying levels of daily stressors.

In a sample of African-American, homeless or insecurely sheltered men, the occurrence of discrete stressors in the prior week contributed to the experience of depressive symptoms among this generally stressed population. Reliance on active, problem-focused coping strategies as opposed to emotion-coping strategies was associated with lower levels of depressive symptoms contradicting the hypothesis that active coping is counter-productive for African-American men. However, depressive symptoms increased, with added uncontrollable stress, even for active copers, contradicting a stress-buffering hypothesis. Under conditions of high uncontrollable stress, problem-focused coping was associated with lower levels of depressive symptoms than emotion-focused coping, however, additional discrete stressors exerted less impact on the level of depressive symptoms among the emotion-focused copers than the active, problem-focused copers.

Taking the Perspective that a Depressive State Reflects Inflammation: Implications for the Use of Antidepressants.

This paper reviews both the evidence that supports the characterization of depression as an inflammatory disorder and the different biochemical mechanisms that have been postulated for the connection between inflammation and depression. This association offers credible explanation for the short term efficacy of antidepressants, which have short term anti-inflammatory effects. Evidence for those anti-inflammatory effects is discussed. Evidence of the contrary long-term effects of antidepressants, which increase rather than decrease inflammation, is also reviewed. It is argued that this increase in inflammation would predict an increase in chronicity among depressed patients that have been treated with antidepressants drugs, which has been noted in the literature. A brief discussion of alternatives for decreasing inflammation, some of which have demonstrated efficacy in ameliorating depression, is presented.

In Defense of the Community Reinvestment Act

In the wake of the 2008 global financial crisis, the Community Reinvestment Act (CRA) of 1977 has probably received more media attention in the past 2 years than it garnered cumulatively over the previous 30 years. Numerous conservative pundits and commentators have blamed the CRA for the subprime crisis and the subsequent worldwide financial meltdown. Most social workers are probably unaware that the CRA is probably responsible for more investment, loans, and wealth creation in low and moderate income neighborhoods than any other single piece of federal legislation over the past 40 years. This article highlights the following features about the CRA that social workers need to know: The CRA was created and passed only because of grassroots community organizing; the CRA has been directly or indirectly related to 8 trillion dollars of investments, mortgage, and small business loans in low income neighborhoods since 1977; community organizing has always been the primary enforcement mechanism of the CRA; contrary to widespread right-wing media accounts, the CRA was not responsible for the housing bubble and worldwide financial crisis in 2008. In this article, we articulate the veridical factors contributing to the financial collapse. Presently, Congress is debating reforms for the financial sector, and the way banking functions will be transacted in the future remains unclear. Regardless of the eventual restructuring of finance, moving forward, social workers should continue to advocate for legislation that will ensure housing for low and moderate income people.

Expression of Emotion: When It Causes Trauma and When It Helps

The idea that clients should be encouraged to express strong emotion regarding the traumas they have suffered is widely assumed. This article asks whether the empirical literature supports the underlying assumption that emotional expression leads to positive outcomes (better health and dissipation of distress). Studies in which individuals who have been given an opportunity to express emotions about past traumas are compared with subjects placed in appropriate control conditions are reviewed. The empirical literature suggests that eliciting emotion is harmful when it is not associated with reappraisal of past trauma, but helpful when the reappraisal occurs. The following guideline emerges: if trauma is to be revisited, it should be accompanied by reappraisal. Since this is sometimes difficult to engineer, alternative approaches for working with victims of trauma, not involving revisiting the trauma, are offered. Additionally, it is suggested that it can be helpful to identify the nature of the problem arising from the traumatic experience and then provide therapeutic intervention that addresses the problem.

The beliefs predicting support for heroin legalization

Two studies were conducted for the purpose of identifying those beliefs and perceptions about heroin which predict being for or against heroin legalization. In Study One the results of a 45-item instrument assessing the attitudes and beliefs of 359 students at Georgia State University were factor analyzed. The identified factors were entered into a multiple regression predicting support for heroin legalization. In Study Two, an item from each of the six strongest factors identified in Study One was included in a questionnaire along with a two-item measure employed in Study One to identify support for legalization. A ninth item was added and the questions were asked in a polling of 805 representative Georgia citizens. The primary findings from Study One were replicated in Study Two. The factors are described and the implications of the findings for policy are discussed.

Obtaining Informed Consent When a Profession Labels Itself as Providing Treatment for Mental Illness

Abstract This paper examines when informed consent laws mandating explanation of the risks and benefits for proposed treatments (some talk intervention) and alternative to the proposed treatments (e.g., medications) apply to the social work profession. The reasons why an explanation of alternative treatments, including explaining medications, might be part of securing informed consent are proffered. Following this, consideration of how the task of explaining alternatives might be addressed is examined. The particular example of antidepressant medications provides a context for considering how to discuss medications as a treatment alternative. The kind of information a social worker might be obligated to possess and then impart to the client in fulfilling the task of obtaining informed consent is considered.

Controversies in Psychiatry and DSM-5: The Relevance for Social Work (Occasional Essay)

This essay addresses recent controversies surrounding the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5—the first major revision of the DSM since 1994), as well as questions regarding the safety and efficacy of psychotropic medications discussed in the public domain. Mental health professionals across a wide range of professions have signed a petition to the DSM-5 Task Force protesting changes in the new edition, and critiques of psychiatric medications are increasingly disseminated in the media. These issues have particular relevance for children in foster care, who receive diagnoses and medication at high rates. The general public is increasingly exposed to information on these topics through the media; as advocates and clinicians, it is important that social work practitioners be informed regarding these issues.

Perspectives Emerging From Neuroscience on How People Become Addicted and What to Do About It

This article reviews the new ideas emerging from neuroscience regarding the question of why some people are compelled to use drugs. During the process of drug exposure, the brains motivational system is changed and these changes, along with changes in the brains self-regulatory structures, compel an individual to use drugs. Ways to reverse those changes in an addicted brain have been identified, as have ways to enhance self-regulatory control. The information from neuroscience offers a new perspective on “loss of control” as well as offering implications for treatment.