Nathan Mascaro

The Role of Existential Meaning as a Buffer Against Stress

An ethnically diverse sample of 143 college undergraduates was used to test the hypothesis that a sense of existential meaning buffers against the effect of stress on depression and hope. Spiritual meaning as measured by the Spiritual Meaning Scale and personal meaning as measured by the framework subscale from the Life Regard Index-Revised were significantly negatively correlated with depressive symptoms and positively correlated with hope. Spiritual meaning, but not personal meaning, moderated the relationship between stress and depression such that there was a strong relationship between depression and stress for individuals with low levels of spiritual meaning but no relationship between stress and depression for individuals with high levels of spiritual meaning. It appears that, though both spiritual and personal meaning are inversely related to depression and positively related to hope, only spiritual meaning moderates the relationship between daily stress and depression.

Empirical Study on the Healing Nature of Mandalas

Mandalas were first used in therapy by Carl Jung, who found that the act of drawing mandalas had a calming effect on patients while at the same time facilitating psychic integration. There is a scarcity of controlled empirical studies of the healing impact of mandalas on mental health. Based on the efficacy of James Pennebaker’s written disclosure paradigm in promoting mental well-being (Pennebaker, 1997a, 1997b), the purpose of our study was to examine the benefits for those suffering from post traumatic stress disorder (PTSD) of processing traumatic events through the creation of mandalas. Benefits to participants were measured in terms of changes in the variables of PTSD symptoms, depressive symptoms, anxiety, spiritual meaning, and the frequency of physical symptoms and illness. Relative to those in the control condition, individuals assigned to the experimental mandala-creation group reported greater decreases in symptoms of trauma at the 1-month follow up. There were no other statistically significant outcome differences. Alternative modes of processing traumatic events (e.g., visually symbolically) may serve individuals who are either reluctant or unable to write about their experiences.

Comparing Virtual Reality Exposure Therapy to Present-Centered Therapy with 11 U.S. Vietnam Veterans with PTSD

Eleven Vietnam veterans with war-related posttraumatic stress disorder (PTSD) were randomly assigned to 10 sessions of either virtual reality exposure (VRE) therapy within a computer-generated virtual Vietnam environment or present-centered therapy (PCT) that avoided traumatic content and utilized a problem-solving approach. Participants were assessed at pretreatment, posttreatment, and 6 months posttreatment by an independent assessor blind to treatment condition. Nine participants completed treatment with one dropout per condition. No significant differences emerged between treatments, likely due to insufficient power. Although comparison of mean changes in PTSD symptoms for the VRE and PCT conditions yielded a moderate effect size (d = 0.56) in favor of VRE at 6 months posttreatment, changes in PTSD scores were more variable, and therefore less reliable, within the VRE condition. The utility of VRE with older veterans with PTSD is discussed.

Meaning Sensitive Psychotherapy: Binding Clinical, Existential, and Positive Psychological Perspectives

Meaning in life, defined as a sense of coherence and purpose that has personal, spiritual/self-transcendent, and implicit/normative-ethical components, plays an integral role in promoting psychological health, whether viewed from a clinical, existential, or positive psychological perspective. Clinical research focuses on the impact that one’s ability to make meaningful assumptions about self and world has on levels of anxiety, particularly posttraumatic stress disorder (PTSD) symptoms, as well as the link between alleviation of depressive symptoms and a sense of purpose motivating activation of meaningful behaviors. Positive psychological research emphasizes the resiliency against psychopathology and positive emotions experienced by individuals with a strong sense of meaning in life. The existential tradition deals with the intrinsic value in facing the tension between absurdity and malevolence we encounter in the world and the pervasiveness and intricacy of our encounters with coherence and virtue. Insofar as the concept of meaning in life winds its way from symptom focused, clinical concerns, through aspects of resiliency and positive emotions, and finally to concerns that transcend the dichotomy between positive and negative states, sensitivity to this concept results in a well-rounded and farsighted framework for the conduct of psychotherapy. This framework promotes the alleviation of acute distress, remediation of vulnerabilities for such distress, enhancement of positive well-being beyond the mere absence of or resiliency against psychopathology, and contact with frequently unnoticed or avoided aspects of existence that stir self-transcendent motivation and emotion. This chapter reviews research findings and theory informing a meaning sensitive approach to psychological well-being, details a framework for applying these findings in the practice of psychotherapy, and, where appropriate, suggests useful research directions.

Depression in Medical Students: Gene-Environment Interactions

This study investigated the interaction of genetic, environmental, and psychological factors in predicting depression and anxiety symptoms in medical students. First-year medical students (n = 141) completed measures of anxiety, depression, hope, and spiritual meaning at three time points during the first year. Buccal samples were utilized to genotype each individual at the s/l variant in the promoter region of the serotonin transporter gene (5-HTTLPR). A subset (n = 91) completed a measure of recent stressors. Mean levels of depression increased during year one of medical school. Presence of the s/s genotype in the promoter region of the 5-HTT gene was associated with greater increases in depression, but only in association with higher numbers of recent stressors. Spiritual meaning and hope were found to counteract genetic susceptibility to stress-related depressive symptoms in the more vulnerable s/s group.

The Challenge of Transporting Family-Based Interventions for Adolescent Substance Abuse from Research to Urban Community Settings

Motivated by concerns about the extent to which urban African American youth under-report substance abuse, the extent to which they are over-represented in drug-related criminal justice settings, and the extent to which research on adolescent substance abuse treatment has lagged in settings serving urban minority populations, the authors comment on some factors to consider when conducting family-based interventions and research with such populations. They offer recommendations based on experience implementing a community-based treatment program for urban substance-abusing adolescents, patient demographic data gathered from the program, and their attempt at adding a family-based treatment component to the program.

Current Status of Transcranial Direct Current Stimulation in Posttraumatic Stress and Other Anxiety Disorders

Several empirically supported treatments have been identified for posttraumatic stress disorder (PTSD), yet a sizable number of patients are either unable to tolerate these approaches or remain symptomatic following treatment. Transcranial direct current stimulation (tDCS) is a well-tolerated method of modulating neuronal excitability that may hold promise as a novel intervention in PTSD and related disorders. The current review summarizes literature on the disrupted neural circuitry in PTSD and discusses the rationale for the commonly targeted prefrontal cortex (PFC) as it relates to PTSD. We then review the few prior (case) studies that have evaluated tDCS in patients with PTSD (1 study) and other anxiety disorders (4 studies). There was considerable variability in both the methods/justification for selecting the targeted brain region(s) and the tDCS montage used, which obscured any clear trends in the data. Finally, we describe the rationale for our ongoing study that specifically targets the lateral temporal cortex as a method of treating the symptoms of hyperarousal and re-experiencing in PTSD. Overall, it is clear that additional work is needed to establish dosing (e.g., intensity and duration of sessions, number of sessions) and optimal treatment targets as well as to identify synergistic effects with existing treatments.

A Controlled Study of Group-Based Exposure Therapy with Vietnam-Era Veterans

Abstract Eighty-one Vietnam-era Veterans with PTSD were randomly assigned to either Group-Based Exposure Therapy (GBET) or Present-Centered Group Therapy (PCGT) and assessed blind to treatment condition at post, four months, and one year posttreatment. Both treatments lasted 16 weeks and groups met twice per week in cohorts of 10. GBET includes sharing and reviewing trauma narratives. PCGT included problem solving while avoiding traumatic material. Both treatments produced similar significant lasting reductions in PTSD with few dropouts (10%). GBET produced significantly greater improvement on measures of spirituality, personal meaning, and PTSD-related cognitions. Half of participants seemed to be exaggerating symptoms.