A controlled trial of two mind-body interventions for grief in widows and widowers.

Objective: Following bereavement, yearning and grief rumination are repetitive cognitive processes that can lead to disordered grief. Mindfulness training (MT) has been shown to reduce maladaptive repetitive thought. The current quasi-randomized controlled trial examined the feasibility, acceptability, and preliminary efficacy of MT for bereavement-related grief. Method: Ninety-five widow(er)s (Mage = 67.5, 79% women, 98% White) between 6 months to 4 years post-loss were assigned to a 6-week MT intervention or a progressive muscle relaxation (PMR) intervention, or a wait-list condition. Outcome measures were grief severity (Revised Inventory of Complicated Grief), yearning (Yearning in Situations of Loss), rumination (Utrecht Grief Rumination Scale), and decentering (Experiences Questionnaire-Decentering) assessed at baseline, Weeks 2 and 4 of intervention, post-intervention, and 1-month post-intervention. Growth curve analysis examined group differences in rates of improvement in outcomes through follow-up and associations with improvement in grief severity. Results: The MT and PMR groups showed significant rates of decline in grief severity and yearning, though only the PMR group showed a greater rate of decline in grief severity than wait-list. All groups showed significant rates of decline in grief rumination. The PMR and wait-list groups showed significant rates of increase in decentering compared to the MT group. Conclusions: Results support the feasibility and acceptability of MT and PMR for widow(er)s as well as the preliminary efficacy of PMR for improving grief severity in widow(er)s compared to a wait-list control condition. With replication, PMR could be a standalone intervention for non-disordered grief or a component of treatment for disordered grief. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The importance of identifying underlying process abnormalities in alexithymia: Implications of the three-process model and a single case study illustration.

We present an in-depth case study of a rare individual (whom we will refer to as "Jane") who reported an inability to experience emotion. Jane completed a range of assessments measuring alexithymia, emotional awareness, and emotion recognition ability. She, along with 22 control participants, also underwent skin conductance (SC) measurement and facial electromyography (EMG) during exposure to affective images, and self reported the valence/arousal of their responses to those images. Jane scored high on alexithymia and low on emotional awareness; yet she performed well on emotion recognition measures and showed a typical pattern of valence ratings. Her SC responses and subjective arousal ratings were atypically low, and some of her EMG responses were also atypical. Jane's deficit profile highlights the dissociability of self-focused emotional awareness and other-focused emotion recognition ability, as well as the dissociability between the generation and representation of valence and arousal (with both subjective and objective measures).

Longitudinal Changes in Serum Glucose Levels are Associated with Metabolic Changes in Alzheimer's Disease Related Brain Regions.

BACKGROUND: The association between longitudinal changes in serum glucose level and longitudinal changes in [18F] Fluorodeoxyglucose-PET (FDG PET) measurements of Alzheimer's disease (AD) risk are unknown. OBJECTIVE: To investigate whether variation in serum glucose levels across time are associated with changes in FDG PET measurements of cerebral metabolic rate for glucose (rCMRgl) in brain regions preferentially affected by Alzheimer's disease (AD). METHODS: Participants are a subset of a prospective cohort study investigating FDG PET, apolipoprotein E (APOE) ɛ4, and risk for AD which includes data from baseline, interim, and follow up visits over 4.4±1.0-years. An automated brain-mapping algorithm was utilized to characterize and compare associations between longitudinal changes in serum glucose levels and longitudinal changes in rCMRgl. RESULTS: This study included 80 adults aged 61.5±5 years, including 38 carriers and 42 non-carriers of the APOE ɛ4 allele. Longitudinal increases in serum glucose levels were associated with longitudinal CMRgl decline in the vicinity of parietotemporal, precuneus/posterior cingulate, and prefrontal brain regions preferentially affected by AD (p < 0.05, corrected for multiple comparisons). Findings remained significant when controlled for APOE ɛ4 status and baseline and advancing age. CONCLUSIONS: Additional studies are needed to clarify and confirm the relationship between longitudinal changes in peripheral glucose and FDG PET measurements of AD risk. Future findings will set the stage on the use of FDG PET in the evaluation of possible interventions that target risk factors for the development of AD.

Impaired personal trait knowledge, but spared other-person trait knowledge, in an individual with bilateral damage to the medial prefrontal cortex.

Functional neuroimaging has revealed that in healthy adults retrieval of personal trait knowledge is associated with increased activation in the medial prefrontal cortex (mPFC). Separately, neuropsychology has shown that the self-referential nature of memory can be disrupted in individuals with mPFC lesions. However, it remains unclear whether damage to the mPFC impairs retrieval of personal trait knowledge. Therefore, in this neuropsychological case study we investigated the integrity of personal trait knowledge in J.S., an individual who sustained bilateral damage to the mPFC as a result of an anterior communicating artery aneurysm. We measured both accuracy and consistency of J.S.'s personal trait knowledge as well as his trait knowledge of another, frequently seen person, and compared his performance to a group of healthy adults. Findings revealed that J.S. had severely impaired accuracy and consistency of his personal trait knowledge relative to control participants. In contrast, J.S.'s accuracy and consistency of other-person trait knowledge was intact in comparison to control participants. Moreover, J.S. showed a normal positivity bias in his trait ratings. These results, albeit based on a single case, implicate the mPFC as critical for retrieval of personal trait knowledge. Findings also cast doubt on the likelihood that the mPFC, in particular the ventral mPFC, is necessary for storage and retrieval of trait knowledge of other people. Therefore, this case study adds to a growing body of evidence that mPFC damage can disrupt the link between self and memory.

Disrupted prefrontal activity during emotion processing in complicated grief: An fMRI investigation.

Complicated Grief, marked by a persistent and intrusive grief lasting beyond the expected period of adaptation, is associated with a relative inability to disengage from idiographic loss-relevant stimuli (O'Connor and Arizmendi, 2014). In other populations, functional magnetic resonance imaging (fMRI) studies investigating the neural networks associated with this bias consistently implicate the anterior cingulate cortex (ACC) during emotion regulation. In the present study, twenty-eight older adults were categorized into three groups based on grief severity: Complicated Grief (n=8), Non-Complicated Grief (n=9), and Nonbereaved, married controls (n=11). Using a block design, all participants completed 8 blocks (20 stimuli per block) of the ecStroop task during fMRI data acquisition. Differences in neural activity during grief-related (as opposed to neutral) stimuli across groups were examined. Those with Complicated Grief showed an absence of increased rostral ACC (rACC) and fronto-cortical recruitment relative to Nonbereaved controls. Activity in the orbitofrontal cortex (x=6, y=54, z=-10) was significantly elevated in the Non-Complicated Grief group when compared to Nonbereaved controls. Post hoc analysis evidenced activity in the dorsal ACC in the Complicated Grief and Nonbereaved groups late in the task. These findings, supported by behavioral data, suggest a relative inability to recruit the regions necessary for successful completion of this emotional task in those with Complicated Grief. This deficit was not observed in recruitment of the orbitofrontal cortex and the rACC during processing of idiographic semantic stimuli in Non-Complicated Grief.

Conceptual and methodological issues in research on mindfulness and meditation.

Both basic science and clinical research on mindfulness, meditation, and related constructs have dramatically increased in recent years. However, interpretation of these research results has been challenging. The present article addresses unique conceptual and methodological problems posed by research in this area. Included among the key topics is the role of first-person experience and how it can be best studied, the challenges posed by intervention research designs in which true double-blinding is not possible, the nature of control and comparison conditions for research that includes mindfulness or other meditation-based interventions, issues in the adequate description of mindfulness and related trainings and interventions, the question of how mindfulness can be measured, questions regarding what can and cannot be inferred from self-report measures, and considerations regarding the structure of study design and data analyses. Most of these topics are germane to both basic and clinical research studies and have important bearing on the future scientific understanding of mindfulness and meditation.

"Why are we doing this?": clinician helplessness in the face of suffering.

BACKGROUND: When the brutality of illness outstrips the powers of medical technology, part of the fallout lands squarely on front-line clinicians. In our experience, this kind of helplessness has cognitive, emotional, and somatic components. OBJECTIVES: Could we approach our own experiences of helplessness differently? Here we draw on social psychology and neuroscience to define a new approach. METHODS: First, we show how clinicians can reframe helplessness as a self-barometer indicating their level of engagement with a patient. Second, we discuss how to shift deliberately from hyper- or hypo-engagement toward a constructive zone of clinical work, using an approach summarized as "RENEW": recognizing, embracing, nourishing, embodying, and weaving--to enable clinicians from all professional disciplines to sustain their service to patients and families.

Virtually supportive: a feasibility pilot study of an online support group for dementia caregivers in a 3D virtual environment.

INTRODUCTION: Caregiver support groups effectively reduce stress from caring for someone with dementia. These same demands can prevent participation in a group. The present feasibility study investigated a virtual online caregiver support group to bring the support group into the home. While online groups have been shown to be helpful, submissions to a message board (vs. live conversation) can feel impersonal. METHOD: By using avatars, participants interacted via real-time chat in a virtual environment in an 8-week support group. RESULT: Data indicated lower levels of perceived stress, depression and loneliness across participants. Importantly, satisfaction reports also indicate that caregivers overcame the barriers to participation, and had a strong sense of the group's presence. DISCUSSION: This study provides the framework for an accessible and low cost online support group for a dementia caregiver. The study demonstrates the feasibility of interactive group in a virtual environment for engaging members in meaningful interaction.

Addressing moral distress: application of a framework to palliative care practice.

BACKGROUND: Moral distress is a pervasive reality of palliative care practice. An existing framework for understanding it has been proposed as a way to begin to address moral distress's detrimental effects on clinicians. OBJECTIVE: The objective was to illustrate the application of this adapted conceptual framework to a clinical case and to offer recommendations for enlarging the professional repertoire for responding to challenging cases involving moral distress. ANALYSIS: In the clinical case, clinicians are expected to respond to the patient's suffering based on four factors: empathy (emotional attunement), perspective taking (cognitive attunement), memory (personal experience), and moral sensitivity (ethical attunement). Each of these interrelated and iterative factors may become activated as clinicians care for patients with life-limiting conditions. This creates the foundations for clinicians' responses. When responses risk becoming aversive in the face of moral dilemmas, strategies are needed to foster principled compassion instead of unregulated moral outrage. A number of cognitive, attentional, affective, and somatic approaches derived from contemplative traditions are consistent with the framework. Combined with a systems-focused approach that incorporates organizational factors, they offer a means of improving professional repertoires for responding to difficult situations. CONCLUSION: Application of the proposed framework to a clinical case provides opportunities for understanding mechanisms of response that may be amenable to intervention and for suggesting appropriate alternative strategies and practices. A full understanding of the process can help to mitigate or to avoid the progression of distress and concurrently to appraise the situation that leads to moral distress or moral outrage.

A framework for understanding moral distress among palliative care clinicians.

BACKGROUND: Palliative care clinicians confront suffering as they care for people living with life-limiting conditions. When the degree of suffering becomes unjustified, moral distress can ensue. Promising work from neuroscience and social psychology has yet to be applied to clinical practice. OBJECTIVE: Our objective was to expand a social psychology model focusing on empathy and compassion in response to suffering to include an ethical dimension and to examine how the interrelationships of its proposed components can assist clinicians in understanding their responses to morally distressing situations. ANALYSIS: In the clinical context, responses to distressing events are thought to include four dimensions: empathy (emotional attunement), perspective taking (cognitive attunement), memory (personal experience), and moral sensitivity (ethical attunement). These dynamically intertwined dimensions create the preconditions for how clinicians respond to a triggering event instigated by an ethical conflict or dilemma. We postulate that if the four dimensions are highly aligned, the intensity and valence of emotional arousal will influence ethical appraisal and discernment by engaging a robust view of the ethical issues, conflicts, and possible solutions and cultivating compassionate action and resilience. In contrast, if they are not, ethical appraisal and discernment will be deficient, creating emotional disregulation and potentially leading to personal and moral distress, self-focused behaviors, unregulated moral outrage, burnout, and secondary stress. CONCLUSION: The adaptation and expansion of a conceptual framework offers a promising approach to designing interventions that help clinicians mitigate the detrimental consequences of unregulated moral distress and to build the resilience necessary to sustain themselves in clinical service.

Higher serum glucose levels are associated with cerebral hypometabolism in Alzheimer regions.

OBJECTIVE: To investigate whether higher fasting serum glucose levels in cognitively normal, nondiabetic adults were associated with lower regional cerebral metabolic rate for glucose (rCMRgl) in brain regions preferentially affected by Alzheimer disease (AD). METHODS: This is a cross-sectional study of 124 cognitively normal persons aged 64 ± 6 years with a first-degree family history of AD, including 61 APOEε4 noncarriers and 63 carriers. An automated brain mapping algorithm characterized and compared correlations between higher fasting serum glucose levels and lower [(18)F]-fluorodeoxyglucose-PET rCMRgl measurements. RESULTS: As predicted, higher fasting serum glucose levels were significantly correlated with lower rCMRgl and were confined to the vicinity of brain regions preferentially affected by AD. A similar pattern of regional correlations occurred in the APOEε4 noncarriers and carriers. CONCLUSIONS: Higher fasting serum glucose levels in cognitively normal, nondiabetic adults may be associated with AD pathophysiology. Findings suggest that the risk imparted by higher serum glucose levels may be independent of APOEε4 status. This study raises additional questions about the role of the metabolic process in the predisposition to AD and supports the possibility of targeting these processes in presymptomatic AD trials.

Behavioral neuroscience of emotion in aging.

Recent research on emotion and aging has revealed a stability of emotional experience from adulthood to older age, despite aging-related decrements in the perception and categorization of emotionally relevant stimuli. Research also shows that emotional expression remains intact with aging. In contrast, other studies provide evidence for an age-related decrease in autonomic nervous system physiological arousal, particularly in response to emotionally negative stimuli, and for shifts in central nervous system physiologic response to emotional stimuli, with increased prefrontal cortex activation and decreased amygdala activation in aging. Research on attention and memory for emotional information supports a decreased processing of negative emotional stimuli (i.e., a decrease in the negativity effect seen in younger adults), and a relative increase in the processing of emotionally positive stimuli (positivity effect). These physiological response and attentional/memory preference differences across increasingly older groups have been interpreted, within socioemotional selectivity theory, as reflecting greater motivation for emotion regulation with aging. According to this theory, as persons age, their perceived future time horizon shrinks, and a greater value is placed upon cultivating close, familiar, and meaningful relationships and other situations that give rise to positive emotional experience, and avoiding, or shifting attention from, those people and situations that are likely to elicit negative emotion. Even though there are central nervous system structural changes in emotion-relevant brain regions with aging, this shift in socioemotional selectivity, and perhaps the decreased autonomic nervous system physiological arousal of emotion with aging, facilitate enhanced emotion regulation with aging.

Hypometabolism in Alzheimer-affected brain regions in cognitively healthy Latino individuals carrying the apolipoprotein E epsilon4 allele.

OBJECTIVE: To investigate with fluorodeoxyglucose positron emission tomography whether regional reductions in the cerebral metabolic rate for glucose (CMRgl) previously found in cognitively healthy late-middle-aged apolipoprotein E (APOE) epsilon4 carriers extend to members of the Latino Mexican American community. DESIGN: Prospective cohort study. SETTING: Banner Alzheimer's Institute, Phoenix, Arizona. PATIENTS OR OTHER PARTICIPANTS: Eleven APOE epsilon4 carriers and 16 noncarriers from Arizona's Latino community (mean [SD] age, 54.6 [6.4] years) matched for sex, mean age, and educational level and who were predominantly of self-designated Mexican origin. MAIN OUTCOME MEASURE: A brain mapping algorithm was used to compare cross-sectional regional CMRgl in Latino APOE epsilon4 carriers vs noncarriers. RESULTS: Participant groups had similar distributions for age, sex, education, family history of dementia, clinical ratings, and neuropsychological test scores. Latino APOE epsilon4 carriers had lower CMRgl than the noncarriers in the posterior cingulate, precuneus, and parietal regions previously found to be preferentially affected in patients with Alzheimer disease (AD) and cognitively healthy non-Latino APOE epsilon4 carriers. Additionally, the Latino APOE epsilon4 carriers had lower CMRgl in the middle and anterior cingulate cortex, hippocampus, and thalamus. CONCLUSIONS: This study provides support for the relationship between APOE epsilon4 and risk of AD in Latino individuals. It illustrates the role of positron emission tomography as a presymptomatic endophenotype for the assessment of AD risk factors and supports the inclusion of Latino APOE epsilon4 carriers in proof-of-concept studies using fluorodeoxyglucose PET to evaluate promising presymptomatic treatments in cognitively healthy carriers of this common AD susceptibility gene.

Source memory and frontal functioning in Parkinson's disease.

The most extensively described pathological abnormality in Parkinson's disease (PD) is loss of dopaminergic neurons in the substantia nigra pars compacta and the ventral tegmental area, with degeneration of their striatal terminals. Because of the intimate connections between the striatum and the frontal lobes, individuals with PD often demonstrate impairments on those tasks relying on the prefrontal cortex (e.g., tests of executive functioning). Source memory, or memory for context, is believed to rely on the prefrontal cortex and has been previously associated with executive functioning performance, although it has received little attention in the PD literature. Executive functioning and source memory were measured in a group of nondemented PD patients and healthy control participants. Within the PD group, an anti-Parkinson's medication withdrawal manipulation was used to examine whether source memory was affected by phasic changes in dopamine levels. Compared to healthy control participants, PD patients were impaired in source memory (both on- and off-medication) and on a composite measure of executive functioning. Within the PD group, medication administration improved motor performance but did not have a significant effect on source memory.

Initial validity and reliability of the SCCAN: using tailored testing to assess adult cognition and communication.

PURPOSE: The Scales of Cognitive and Communicative Ability for Neurorehabilitation (SCCAN; L. Milman & A. Holland, 2007) was developed in the hospital setting to address changes in assessment practice. The SCCAN was designed to provide an overview of impairment and activity limitations across 8 cognitive scales (Speech Comprehension, Oral Expression, Reading, Writing, Orientation, Attention, Memory, and Problem Solving). The scales were developed using item response theory so that tailored testing could be implemented to reduce test administration time. This research investigated the validity and reliability of the SCCAN. METHOD: A battery of neuropsychological tests was administered to 40 neurologically healthy control participants and 51 participants diagnosed with left-hemisphere pathology, right-hemisphere pathology, or probable Alzheimer's disease. Analyses were performed to assess test sensitivity and specificity, construct validity, administration time, and reliability. RESULTS: The test accurately classified 95% of the control participants and 98% of the participants diagnosed with neurological disorders. Results indicate that the test also differentiated the performance profiles of the 3 clinical populations. In addition, test scores correlated significantly with external measures of the same cognitive areas. Mean administration time was 34 min. Test-retest stability (r = .96, p < .001) and internal consistency (r = .99, p < .001) coefficients were both significant, indicating that tailored testing procedures generated reliable test scores.

Emotional experience and facial expression in Alzheimer's disease.

Emotional experiences and facial muscle activity of individuals with Alzheimer's Disease (AD) (n = 13) and healthy elderly control subjects (n = 21) were measured while viewing emotion-eliciting images. Alzheimer's disease and control groups rated their emotional experiences similarly and in the expected directions on dimensions of valence and arousal. Change in corrugator activity while viewing images, compared to baseline, was comparable across groups and was greatest while viewing negative images. Change in zygomatic activity, however, was significantly different between AD and control groups, with AD subjects demonstrating an inverted pattern of activity compared to controls. These findings are discussed as possible consequences of frontal cortical system involvement accompanying the disease process.

Awareness of subtle emotional feelings: a comparison of long-term meditators and nonmeditators.

The authors explored whether meditation training to enhance emotional awareness improves discrimination of subtle emotional feelings hypothesized to guide decision-making. Long-term meditators and nonmeditators were compared on measures of self-reported valence and arousal, skin conductance response (SCR), and facial electromyography (EMG) to masked and nonmasked emotional pictures, and on measures of heartbeat detection and self-reported emotional awareness. Groups responded similarly to nonmasked pictures. In the masked condition, only controls showed discrimination in valence self-reports. However, meditators reported greater emotional clarity than controls, and meditators with higher clarity had reduced arousal and improved valence discrimination in the masked condition. These findings provide qualified support for the somatic marker hypothesis and suggest that meditation may influence how emotionally ambiguous information is processed, regulated, and represented in conscious awareness.

Transtorno de estresse pós-tramáutico e funções cognitivas / Post traumatic stress disorder and cognitive functions

O Transtorno de Estresse Pós-Traumático (TEPT) é um transtorno prevalente, associado a alterações neurobiológicas e cognitivas. O presente artigo é um estudo teórico sobre as aplicações da avaliação neuropsicológica no TEPT. Inicialmente são revisados aspectos conceituais do transtorno, bem como alterações neurobiológicas relacionadas aos prejuízos cognitivos comumente detectados. Finalmente, argumenta-se que a avaliação dos prejuízos nas funções de memória, atenção e, sobretudo, funções executivas são relevantes tanto para a intervenção clínica junto ao paciente quanto para o refinamento das teorias psicológicas do TEPT(AU)

Metamemory experiments in neurological populations: a review.

Metamemory refers to knowledge about one's memory capabilities and strategies that can aid memory, as well as the processes involved in memory self-monitoring. Although metamemory has been studied in cognitive psychology for several decades, there have been fewer studies investigating the neuropsychology of metamemory. In recent years, a growing number of studies of neurological patient groups have been conducted in order to investigate the neural correlates of metamemory. In this review, we examine the neuropsychological evidence that the frontal lobes are critically involved in monitoring and control processes, which are the central components of metamemory. The following conclusions are drawn from this literature: (1) There is a strong correlation between indices of frontal lobe function or structural integrity and metamemory accuracy (2) The combination of frontal lobe dysfunction and poor memory severely impairs metamemorial processes (3) Metamemory tasks vary in subject performance levels, and quite likely, in the underlying processes these different tasks measure, and (4) Metamemory, as measured by experimental tasks, may dissociate from basic memory retrieval processes and from global judgments of memory.

Metamemory for faces following frontal lobe damage.

Previous research has provided evidence of metamemory impairments in patients with frontal lobe damage on verbal episodic memory tasks. In the present study, we employed metamemory paradigms to investigate whether patients with frontal lesions show monitoring deficits on semantic memory tasks involving facial stimuli. Patients with frontal lobe damage and healthy control subjects made memory decisions to famous faces in a retrospective confidence judgment task and in a prospective feeling-of-knowing (FOK) task. Results indicated that frontal patients performed worse than controls on the retrospective confidence task, but there were no differences between the groups on the FOK task. These findings suggest that metamemory deficits in frontal patients are not confined to specific stimulus domains (words vs. faces) or memory systems (episodic vs. semantic). In addition, the dissociation between retrospective confidence judgments and FOK accuracy documented in this study and also in a recent report by Schnyer et al. suggesting that metamemory should not be considered a unitary function with a single neuroanatomic substrate.