Biomedical subjects

Paul Gilbert

Publications and source records attributed to Paul Gilbert.

14 recordsLinked to original sources

PubMed2006

Social anxiety and the shame of psychosis: a study in first episode psychosis.

Social anxiety disorder (SaD) or social phobia is a co-morbid affective disorder in schizophrenia, present in up to one in three individuals. We employ 'social rank' theory to predict that one pathway to social anxiety in schizophrenia is triggered by the anticipation of a catastrophic loss of social status that the stigma of schizophrenia can entail. A group of 79 people with a first episode of psychosis were assessed for social anxiety: hypotheses were tested comparing 23 socially anxious and 56 non-anxious patients on measures of cognitive appraisals of shame/stigma of psychosis and perceived social status, controlling for depression, psychotic symptoms and general psychopathology. Participants with social anxiety experienced greater shame attached to their diagnosis and felt that the diagnosis placed them apart from others, i.e., socially marginalised them and incurred low social status. We propose a stigma model of social anxiety that makes testable predictions about how the shame beliefs may contaminate social interaction and thereby exacerbate and maintain social phobia.

Adolescent↗

PubMed2006

The interactive functioning of anxiety and depression in agonistic encounters and reconciliation.

This paper explores the well-known overlap of anxiety and depressive symptoms in mood and anxiety disorders. We suggest that the regulation of both negative and positive affects has served important adaptive functions (especially for coping with threats, losses, failures and defeats), and that in some contexts both affect systems require regulation at the same time (e.g. increased anxiety coupled with low positive affect). Here we will focus on how low positive and high negative affect in the individual experiencing losses and defeats regulates their competitive and acquisitive behaviors and in some cases may prevent, de-escalate, and possibly terminate on-going agonistic (hierarchical) encounters. When high negative affect (anxiety) and low positive affect (depression) fail to fulfill their adaptive roles, they tend to persist and often intensify. This may lead each affect control system to stimulate specific types of anxiety and depressive disorders, exhibiting features reminiscent of the original adaptive function of the behavior. Furthermore, as these different systems tend to operate in a synchronous fashion, the psychiatric syndromes they generate are often comorbid.

Adaptation, Psychological↗

PubMed2006

Reframing "prevention with positives": incorporating counseling techniques that improve the health of HIV-positive patients.

Federal HIV prevention strategy seeks to increase efforts by health care providers to identify and reduce their HIV-positive patients' transmission-related behaviors. Implementation of these recommendations will be hindered if providers perceive these efforts have the potential to harm their relationships with patients. Because transmission-related behaviors (unsafe sex and sharing needles) and the related issues of drug and alcohol use also jeopardize the health of HIV-positive patients, providers can use patient-centered counseling when addressing those behaviors. We suggest efforts to increase provider-delivered transmission-prevention counseling be reframed so that "prevention with positives" includes the goal of protecting HIV-positive patients' health. We review the specific consequences of these risky behaviors on HIV-positive patients' health and review brief counseling strategies appropriate for HIV care providers.

Counseling↗

PubMed2005

Olfactory dysfunction: a sequela of pediatric blunt head trauma.

OBJECTIVE: To evaluate olfactory function in children with blunt head trauma. METHODS: Eligible subjects were consecutive children presenting at San Diego Children's Hospital Emergency Department or Trauma Service with blunt head trauma. Thirty-seven head injured children mean age 10.11+/-2.74 were evaluated; 36 healthy age and gender matched community children, mean age 10.08+/-2.99, served as controls. The medical record was reviewed for clinical measures related to head injury (HI). All children underwent olfactory assessment with the San Diego Children's Odor Identification Test (SDOIT). Olfactory event-related potentials were recorded on a subset of head injured and control children. RESULTS: Three of 37 head injured children had olfactory dysfunction. The head injured hyposmics had signs of more severe head injury represented by lower Glasgow Coma Scores (GCS), 10.33+/-5.51, when compared to their normosmic counterparts with mean GCS of 14.06+/-2.82. When stratifying the head injured children by clinical measures, lower Glasgow Coma Score, and abnormalities on head CT scan were associated with poorer olfactory performance. CONCLUSION: Children with blunt head injury may suffer post-traumatic olfactory impairment. More severe head injuries are more likely to produce olfactory deficits. In cases of significant head injury, cranial nerve I evaluation is imperative.

Adolescent↗

PubMed2005

Evolution and depression: issues and implications.

Depression is well recognized to be rooted in the down-regulation of positive affect systems. This paper reviews some of the social and non-social theories that seek to explain the potential adaptive advantages of being able to tone down positive affect, and how dysfunctions in such affect control can occur in some contexts. Common to most evolutionary theories of depression is the view that loss of control over aversive events and/or major resources/rewards exert downward pressure on positive affect. Social theories, however, suggest that it is loss of control over the social environment that is particularly depressogenic. Two evolutionary theories (the attachment-loss, and the defeat-loss theories) are briefly reviewed and their interaction considered. It is suggested that phenotypes for toning down positive affect, in the face of loss of control, may become more severe in the context of socially hostile, unsupportive and/or excessively competitive environments. The paper briefly considers how human competencies for self-evaluation in relation to others, rumination, self-criticism, and modern social contexts can accentuate dysfunctional expressions of affect regulation.

Affect↗

PubMed2004

A much needed macro level view: a commentary on Henriques' "psychology defined".

To develop greater coherence, psychology must develop its macro and integrative approaches to the mind. In this illuminating paper, Henriques (this issue) outlines the kind of thinking that is needed. He skillfully illuminates the levels of emergence of mind from the material world and argues that the recursive self-regulative abilities of self-awareness set us apart from other animals. The interaction between an evolved mind, adapted to pursue strategic goals, while also being phenotypically shaped by both environment and our recently evolved cognitive competencies, is a core focus of psychology.

Animals↗

PubMed2004

Life events, entrapments and arrested anger in depression.

OBJECTIVES: A recent, evolution derived theory of depression has suggested that aroused but arrested defences of fight (arrested anger) and flight (entrapments) may be important components of depression. This study therefore set out to explore unexpressed anger and entrapment in depression. The focus was on the nature of severe life events and difficulties, the time course of arrested defences, fantasies of escaping, fantasies of expressing anger, and reasons for not acting on emotions/behaviours. METHODS: Fifty diagnosed depressed people, being treated for depression, were interviewed using the Life Event and Difficulties Schedule (LEDS). They then completed five further questionnaires: the escape inhibition questionnaire; the reasons for not escaping questionnaire; the anger inhibition questionnaire; the reasons for not expressing anger questionnaire, and the Beck Depression Inventory. RESULTS: In regard to arrested flight, 88% of the group acknowledged strong desires to escape difficulties in their life but many felt unable to. Transcript analysis from the LEDS also indicated strong themes of entrapment. 38.7% felt trapped before becoming depressed. Fantasies of escaping were common, but making actual plans to get away less common. A variety of reasons were given for not escaping: In regard to arrested anger, 82% felt they suppressed their anger and 56% felt this problem predated their depression. A number of different reasons were given for not expressing anger. Despite self-blame often being seen as important to depression, we found that for many severe life events and difficulties patients did not blame themselves. Rather they blamed external circumstances or other people and saw these as the source of their entrapment. CONCLUSIONS: Disturbances in fight/flight mechanisms are common in depression. For some these may predate a depression and may play a causal role, whilst for others these experiences emerge with the depression. Depression is related to chronic stress states and clinical attention to disturbances in flight/flight may throw light on these states and offer novel approaches to intervention.

Adult↗

PubMed2004

Interpersonal and role-related schema influence the relationship with the dominant 'voice' in schizophrenia: a comparison of three models.

BACKGROUND: Auditory hallucinations in psychosis often contain critical evaluations of the voice-hearer (for example, attacks on self-worth). A voice-hearer's experience with their dominant voice is a mirror of their social relationships in general, with experiences of feeling low in rank to both voices and others being associated with depression. However, the direction of the relationship between psychosis, depression and feeling subordinate is unclear. METHOD: Covariance structural equation modelling was used with data from 125 participants diagnosed with schizophrenia to compare three 'causal' models: (1) that depression leads to the appraisal of low social rank, voice power and distress; (2) that psychotic illness leads to voice activity (frequency, audibility), which in turn leads to depression and the appraisal of voices' power; (3) our hypothesized model, that perceptions of social rank and social power lead to the appraisal of voice power, distress and depression. RESULTS: Findings supported model 3, suggesting that the appraisal of social power and rank are primary organizing schema underlying the appraisal of voice power, and the distress of voices. CONCLUSIONS: Voices can be seen to operate like external social relationships. Voice content and experience can mirror a person's social sense of being powerless and controlled by others. These findings suggest important new targets for intervention with cognitive and social therapy.

Adult↗

PubMed2004

A pilot exploration of the use of compassionate images in a group of self-critical people.

Self-criticism has long been associated with a variety of psychological problems and is often a key focus for intervention in psychotherapy. Recent work has suggested that self-critics have underelaborated and underdeveloped capacities for compassionate self-soothing and warmth. This pilot study developed a diary for monitoring self-attacking and self-soothing thoughts and images. It also explored the personal experiences of a group of volunteer self-critics from the local depression support group who were given training in self-soothing and self-compassion. Although using small numbers, this study suggests the potential value of developing more complex methodologies for studying the capacity for self-compassion, interventions to increase self-compassion (including imagery techniques), and their effects on mental health.

Depression↗

PubMed2004

A behavioral assessment of hippocampal function based on a subregional analysis.

The purpose of this review is to determine whether specific subregions (dentate gyrus [DG], CA3, and CA1) of the hippocampus provide unique contributions to specific processes associated with intrinsic information processing exemplified by novelty detection, encoding, pattern separation, pattern association, pattern completion, retrieval, short-term memory and intermediate-term memory. Based on anatomical neural network organization, electrophysiology of cellular activity, lesions, early gene activation, and computational modeling, it can be shown that there exists extensive cooperation among the three subregions of the hippocampus, but there also exists reliable specificity of function for each of the subregions of the hippocampus. The primary process supported by the DG subregion of the hippocampus can be characterized by orthogonalization of sensory inputs to create a metric spatial representation. Furthermore the DG participates in conjunction with CA3 in supporting spatial pattern separation. The CA3 subregion of the hippocampus supports processes associated with spatial pattern association, spatial pattern completion, novelty detection, and short-term memory. The CA1 subregion of the hippocampus supports processes associated with temporal pattern association, temporal pattern completion, and intermediate-term memory. Furthermore, the CA3 in conjunction with CA1 supports temporal pattern separation. All the above-mentioned processes are assumed to reflect intrinsic processing of information within the hippocampus. The diversity of functions associated with the different subregions of the hippocampus suggests that one should not treat the hippocampus as a single entity, but rather that one should concentrate on elucidating further the functions of both dorsal and ventral subregions of the hippocampus and pathways that directly connect each of the subregions as well as their connections with the entorhinal cortex.

Animals↗

PubMed2003

Entrapment and arrested fight and flight in depression: an exploration using focus groups.

The fight/flight system has long been recognized to be a basic evolved defence system. However, recent interest has focused on the consequences of arousing these action tendencies but blocking their execution-that is arresting them. Previous research has shown that depressed people can have strong feelings of anger (fight) and desires to run away (flight), but these 'fight/flight' defences can become blocked, inhibited, and arrested, which increase stress. This study used three clinical focus groups and one of psychiatric nurses to explore depressed people's own ideas of entrapment and arrested anger. Participants felt that arrested escape (entrapments) and arrested anger were important aspects of the experience of depression. Depressed participants clarified distinctions between internal entrapment (feeling trapped in a state of depression), feeling trapped in a subordinate role, and external entrapment (feeling trapped in relationships or life circumstances). Participants also clarified key reasons for arrested anger. Nurses had similar perspectives on the reasons for entrapment in depression but also saw fear of change and opportunities as important sources of entrapment.

Adult↗

PubMed2002

Guilt, fear, submission, and empathy in depression.

BACKGROUND: This study compares self-focused motivations (fear of negative evaluation, social comparison, and fear of envy) and other-focused motivations (empathy and interpersonal guilt) in submissive behavior and depression. METHODS: The Beck Depression Inventory, Submissive Behavior Scale, Fear of Negative Evaluation Scale, Social Comparison Scale, Interpersonal Guilt Questionnaire, and Interpersonal Reactivity Inventory were administered to 50 patients hospitalized for depression and 52 students. RESULTS: Depressed patients were significantly higher in survivor guilt, omnipotent responsibility guilt, submissive behavior, fear of negative evaluation, fear of envy, and empathic distress, and lower in social comparison. LIMITATIONS: This research was limited in that it was a correlational study. CONCLUSIONS: This study suggests that altruistic concern about others may be an important factor in depression and submissive behavior. Evolutionary implications of these findings are discussed.

Adult↗

PubMed2002

Measuring vulnerability to threats to self-construction: the self and other scale.

Following a constructivist approach, we propose two dimensions or styles of self-construction that are related to different types of vulnerability to psychopathology. We have called these an 'insecure self' style associated with fear of exclusion, indifference, and rejection by significant others, and an 'engulfed self' style associated with fear of intrusion, control, and possession by significant others. In this paper, we report the psychometric properties of a new 14-item questionnaire, the Self and Other Scale (SOS), which is designed to measure the two types of threat vulnerability. We have produced two forms of the scale, one measuring frequency of beliefs, which was completed by 198 undergraduate psychologists, and one measuring endorsement of beliefs, which was completed by 179 undergraduate psychologists. The SOS has a 2-factor structure, as predicted from the theoretical model, and good internal reliability. We discuss the future development and use of the scale in research and clinical practice.

Adolescent↗

PubMedDate not supplied

Eating attitudes and striving to avoid inferiority.

Vulnerability to some psychopathologies may be related to feeling the need to compete, strive, and achieve in order to avoid inferiority and rejection. This study explored "insecure striving", (relating to a perceived need to strive to avoid inferiority and its consequence, rejection) in relationship to eating attitudes and appearance anxiety in students. Eating attitudes and appearance anxiety were associated with judgments of inferiority, insecure striving to avoid inferiority, and fear of losing out and were negatively associated to secure non-striving (social acceptance). Further work exploring the way people understand and react to the competitive dynamics of their social groups may illuminate important processes linked to eating disorders.

Adolescent↗