"I Cannot Tell Anyone:" There are Many Reasons.

Purpose: The purpose of this study was to investigate variables associated with difficulty disclosing past trauma. Across several prevalence studies, 26% of adults never disclosed childhood abuse until adulthood when they were asked in a research survey or interview question. In this Institutional Review Board approved study, group differences were examined (ability and inability to disclose a traumatic event) as well as predictors for difficulty disclosing past trauma. Method: A non-clinical population (N = 693) was examined to determine prevalence rates and group differences between participants unable to tell someone about a past traumatic event (10%) compared to those who could disclose past traumatic events (90%). Variables included pathological dissociative processing, internalized shame, coping strategies (task, emotion, avoidance), and cumulative trauma exposure. Logistic regression analyses were conducted to determine predicting variables for disclosure difficulties. Findings: The group that had difficulty disclosing a past traumatic event had more cumulative trauma, pathological dissociative processing, emotion-oriented coping, and shame. In the first logistic regression analyses, interpersonal traumatic events were predictors for the inability to disclose a traumatic event (classified 90% of group membership). In the second logistic regression, shame and cumulative traumatic exposure were predicting factors (classified 90% of group membership). Conclusion: Difficulty speaking about a traumatic event was associated with interpersonal adult and childhood traumatic events, more internalized shame, and cumulative trauma exposure. It is recommended that clinicians working with patients with substantial traumatic exposure address shame, pathological dissociative processing, and emotion-oriented coping strategies if they detect trauma disclosure difficulties.

"They Can't Believe They're a Tiger": Insights from pediatric speech-language pathologist mobile app users and app designers.

BACKGROUND: Children with communication disorders experience difficulty in one or more areas of articulation and speech, language, fluency, voice and social communication, and they work with speech-language pathologists (SLPs) to improve their communication. With the rise of adoption and use for mobile applications among special education and healthcare service providers, SLPs also have implemented, and for some, contributed to the design of, mobile applications (apps) during clinical practice. However, how these mobile apps are designed and implemented for clinicians to facilitate their clients' communication and learning experiences during therapy remains underinvestigated. AIMS: This qualitative research study investigated how mobile apps were designed for clinicians to target assessment and intervention goals. Additionally, it focused on how clinicians adopted these apps while integrating therapy techniques to facilitate their clients' learning. METHODS AND PROCEDURES: Informed by the Research, Practice, and Design for iPad Apps (iRPD) framework and the Consolidated Framework for Implementation Research (CFIR), semi-structured interviews were conducted with 37 licensed pediatric SLPs, including 23 SLPs who have used apps and 14 SLPs who have contributed to the design of their own mobile apps. Two rounds of qualitative coding via template analysis and thematic analysis were then used to analyse client and clinician characteristics, clinical practice, therapy tools, app characteristics, influential factors and app design and use recommendations. OUTCOMES AND RESULTS: Results showed SLPs utilise different genres of assistive, educational and recreational game apps to support children's communication development when working with children who have diverse disorders and therapy needs across different age groups. SLPs who have designed their own apps emphasised the importance of following evidence-based practice, well-researched teaching methods and learning theories. Additionally, multiple financial, sociocultural, political and ethical factors contributed to the design, adoption and implementation of mobile apps during services. CONCLUSIONS AND IMPLICATIONS: By understanding the clinician's app use practices situated in various therapy activities and techniques, we specified a list of design recommendations for app designers who are interested in creating mobile apps for supporting children's speech and language development. By bringing insights from both clinical practitioners as well as those with additional technical design backgrounds, this study contributes to the understanding of clinical practice needs and strategies and will lead to the most optimal app design and adoption practice to support the well-being of children with communication disorders. WHAT THIS PAPER ADDS: What is already known on the subject Speech language pathologist (SLPs) implement mobile apps for clients with diverse therapy needs, and their app adoption and use are influenced by multifaceted factors. Although prior studies have reported SLPs' mobile app use, additional information is still needed. For example, the research literature does not include how specific technology is used during therapy practice, or specific details about challenges and needs in implementing and utilising the technology. Additional research also needs to include influential factors (e.g., financial, sociocultural, political, ethical) that are considered when selecting, implementing, assessing and designing an app. The lack of research in these areas directly affects the understanding of clinical mobile technology practices and further hinders clinicians' abilities to advocate for better clinical and design decisions towards identifying and implementing effective mobile apps that facilitate children's communication. What this study adds to existing knowledge This qualitative study is the first known empirical research that interviewed pediatric speech-language pathologists who have used and designed mobile apps for children who receive speech-language therapy across different clinical settings. By investigating experiences from clinician stakeholders to illustrate a holistic overview of app design and development to deployment, this study reported finding on (1) how clinicians use mobile apps to help children to participate in different therapy activities, and (2) a list of recommended design and development guidelines that informs the design and use of mobile apps that best support and motivate children to engage in therapy. What are the potential or actual clinical implications of this work? This study disseminates clinician-reported practices of app design and use with pediatric clients across different speech-language disorders, and identifies gaps and needs for clinicians and researchers who are interested in understanding the role of mobile technology in relationship to human communication and interaction. Additionally, the paper demonstrates that SLPs have instrumental roles rather than passive users in influencing the design and implementation of different genres of mobile apps through evidence-based clinical practice, and call for partnerships across clinicians, special educators and technologists to support children's communication development.

Facebook groups for people who stutter: An extension of and supplement to in-person support groups.

INTRODUCTION: Online support group experiences, using social networking websites like Facebook, have shown much promise in past research unrelated to stuttering. Therefore, this study aimed to determine the utility of a Facebook-based stuttering support group that was created as an extension of and supplement to an in-person stuttering support group as a means of providing psychosocial support for people who stutter (PWS). METHOD: A qualitative approach that was inspired by ethnography was used to explore the experiences of seven participants (six participants who stutter and one participant who does not stutter) who digitally connect on a private Facebook-based stuttering support group that was created as an extension of and supplement to an already existing in-person stuttering support group. The main question posed to the participants related to describing their experiences being a member of the Facebook-based stuttering support group. RESULTS: Data analysis revealed two major themes, which included the benefits and challenges of participating in a Facebook-based stuttering support group.  Each major theme contained five subthemes. Specific results are discussed with reference to past research, as well as implications for practice and recommendations for future research. CONCLUSIONS: There are numerous benefits and challenges associated with being a member of a Facebook-based stuttering support group.  However, the overall utility of a Facebook-based stuttering support group, used in tandem with an in-person stuttering support experience, seems to provide members with a useful and impactful way to gain psychosocial support from other PWS.

ATTACHMENT AND MEMORY STABILITY.

Previous studies confirm that attachment representations are very stable and are rooted in semantic and episodic autobiographic memory systems. The Adult Attachment Interview (AAI) provides a means to assess secure, insecure, and disorganized (U) states of mind; it incorporates a fine-grained analysis of attachment-related memories. The AAI is not a measure to determine false versus true memories or to claim it can identify veridical truth; however, longitudinal research studies demonstrate that the AAI is highly stable in how (degree of coherence) the speaker discusses past events. This IRB approved study (n = 130) examined a non-clinical sample of active individuals. The results indicated that passive states of mind was a predictor variable for unresolved loss and unresolved childhood abuse and both passive states of mind and more Adverse Childhood Experiences (ACEs) predicted overall lack of resolution (U). Lack of memory and dissociative amnesia were not significant predictors. This study and previous studies demonstrate that retrospective reporting of ACEs remain stable over time. These findings suggest that clinical focus should follow the attachment protocol of examining the state of mind of the speaker. Autobiographical memory systems reveal enduring Internal Working Models (IWMs) that influence how memories are stored and recounted.

Creative Flow and Physiologic States in Dancers During Performance.

Pre-professional and professional dancers (n = 60) participated in this ambulatory psychophysiology study that investigated performance flow and heart rate and autonomic nervous system (ANS) function during three time periods: baseline rest, performance, and post-performance rest. To gather these results, the psychophysiology laboratory traveled to the concert hall to collect data on dancers. The self-report Flow State Scale (FSS) measured global flow, challenge-skill balance, sense of control, and autotelic experiences; it addresses important features of the creative experience of performing artists. These data were collected immediately following the performance. The flow measures were compared with physiologic responses to performance [heart rate, pre-ejection period (PEP), root mean square differences of successive R-R (heartbeat) intervals (RMSSD), cardiac autonomic balance, and cardiac autonomic regulation]. The regression analyses indicated that greater sympathetic nervous system (SNS) activation with performance (PEP change from base to performance) explained 8.8% of the variance in sense of control, whereas less cardiac autonomic regulation explained 13.8% of the variance in autotelic experiences. The sample was then divided into high and low flow groupings and four autonomic groups. During performance, the high autotelic group and high sense of control group had a higher distribution of dancers with co-inhibition of both ANS branches than had the low autotelic and sense of control groups who employed more co-activation of both ANS branches (chi-square analyses). These novel findings add to the growing information about the interaction of both branches of the ANS during creative performance flow states.

Cumulative Psychological Trauma, Emotional Regulation, and Orthopedic Injury in a Sample of Pre-Professional and Professional Dancers and College Athletes.

OBJECTIVE: Strong evidence identifies cumulative trauma exposure and a history of childhood adversity as predictive factors for physical and psychological disorders. In this study, dancers and athletes were examined to determine the relationship among childhood adversity, cumulative trauma exposure, stress responses, and injuries (including the need for orthopedic surgery). METHODS: In this cross-sectional study, 287 pre-professional and professional dancers (n=185) and college athletes (n=102) participated. Seven self-report measures were completed. Descriptive statistical analyses were calculated, followed by a 2 x 2 multivariate analysis (MANCOVA, age and gender were covariates): 1) dancer and athlete groups, and 2) participants who had orthopedic surgery vs no surgery. Stepwise linear regression analyses were calculated to predict cumulative injuries in multiple body regions. RESULTS: The MANCOVA result indicated that dancers and athletes shared similar cumulative injuries to multiple regions of their bodies. Compared to athletes, dancers were exposed to more childhood trauma and experienced more anxiety and emotional difficulties. Participants who underwent orthopedic surgery also had more cumulative trauma and injuries as well as more difficulty with emotional regulation. In both dancers and athletes, increased exposure to childhood and adult traumatic events were significant predictive factors associated with injury. CONCLUSION: Both dancers and athletes frequently perform within a culture that is pressured and promotes behavior that ignores pain and injury. It is recommended that coaches, educators, and healthcare workers understand the influence of cumulative trauma on risk for orthopedic injury and incorporate trauma-informed care.

History of childhood adversity and coping strategies: Positive flow and creative experiences.

BACKGROUND: Acquiring more complex coping strategies despite a history of childhood adversity may transpire in settings outside the family home. OBJECTIVES: The objectives of this cross-sectional study included investigating coping strategies under stressful situations in a non-clinical sample of active athletes and performing artists. PARTICIPANTS AND SETTING: In this community and university sample (n = 577), 40.4% had no ACEs, 43.4% had 1-3 ACEs, and 16.3% had ≥4 ACEs. METHODS: A series of multivariate analyses (gender and age included as covariates) were conducted to examine differences between the three ACE groups. RESULTS: Results indicated no between-subject differences between the three ACE groups for flow-like experiences during preferred activities, although gender differences were significant (p < .001). Individuals in the ≥4 ACEs group endorsed more intense creative experiences compared to the no-ACE and 1-3 ACEs groups (p = .006, η2 = .048); however, in the third MANCOVA they had heightened anxiety, internalized shame, dissociative processing, emotion-oriented coping, and cumulative trauma (p < .001, η2 = .132). There were no group differences for task-oriented and avoidant-oriented coping, a finding that highlights the ability of active individuals to engage in effective coping strategies under stressful situations. CONCLUSION: Regardless of past childhood adversity history, this non-clinical high achieving sample was able to engage in a range of coping strategies under stress.

Shame and Anxiety: The Mediating Role of Childhood Adversity in Dancers.

The combination of shame, anxiety, and a history of childhood maltreatment can have devastating effects on self-esteem and on the morbidity and mortality of an individual. Shame is a natural emotion evoked in social evaluative settings. Without some degree of shame, goal attainment is less likely. However, high levels of shame may increase pathology and decrease performance. In this crosssectional study, pre-professional and professional dancers were divided into two shame groupings: low (N = 193) and high (N = 25). Chi square and multivariate analyses of covariance (age and gender as covariates) were conducted to determine group differences for cumulative adverse childhood experiences (ACEs), anxiety, self-esteem, and shame factors. The high shame group had a greater distribution of childhood adversity (especially emotional, physical and sexual abuse, and emotional neglect). They also had clinical levels of anxiety and low self-esteem. In the path analyses, the causal model demonstrated that childhood adversity had a direct effect on anxiety and shame and an indirect effect on self-esteem. Shame and anxiety had a direct effect on self-esteem. Helping dancers become resistant to shame may decrease anxiety and buffer the effects of a history of childhood adversity. As internalized shame decreases, dancers may enhance their self-esteem, wellbeing, and ability to pursue and achieve their career goals.

Childhood Adversity and the Creative Experience in Adult Professional Performing Artists.

Childhood adversity is identified as any exposure to abuse, neglect or family dysfunction. Greater exposure to childhood adversity has been strongly identified with increased morbidity and mortality. The aim of this study was to examine differences in creative experiences, fantasy proneness, dispositional flow, exposure to adult traumatic events, and psychopathology (internalized shame, trait anxiety), amongst professional performing artists who experienced no childhood adversity, some adversity, or substantial adversity. This cross-section IRB approved study examined 234 professional performers (dancers, opera singers, actors, directors, musicians). Self-report measurements were included to examine the following psychological factors: adverse childhood experiences (ACEs), experience of creativity questionnaire, dispositional flow, trait anxiety, internalized shame, fantasy, and total adult and childhood traumatic events. The sample was divided into three groups based on ACE scores: 0 ACE (n = 93), 1-3 ACEs (n = 95), ≥4 ACEs (n = 42). The MANCOVA (with age and gender as covariates) results revealed no significant (p = 0.280) differences between all three ACE groups for the nine flow scales (optimal performance measurements). Performing artists with ≥4 ACEs had significantly stronger creative experiences (p = 0.006) related to distinct creative processing, absorption, and a transformational sense of self and the world. They were also more fantasy prone, shame-based, anxious, and experienced more cumulative past traumatic events (p < 0.001). Although the high ACE group experienced greater negative effects, they also endorsed positive creative performance experiences.

Depersonalization, adversity, emotionality, and coping with stressful situations.

Depersonalization is defined as persistent or recurrent episodes of feeling detached or estranged from a sense of self and the world. This study addressed the primary question: Do nonclinical individuals who endorse high symptomatic depersonalization have inherently more intense emotional responses, along with more childhood adversity and past trauma? In this IRB approved study, participants who met clinical levels of depersonalization (n = 43, 16.3%) were compared to a group without clinical levels of depersonalization (n = 221, 83.7%). Adverse childhood experiences, adult traumatic events, emotional overexcitability, coping strategies under stress, and anxiety were examined in both groups. The variables to assess depersonalization severity included the Dissociative Experience Scale-II, Cambridge Depersonalization Scale, and Multiscale Dissociation Inventory. The results indicated that clinical levels of depersonalization were identified in 16.3% of the sample. The high depersonalization group had significantly more adverse childhood experiences, in particular, emotional abuse and neglect. They also experienced more adult traumatic events, higher levels of anxiety, more emotional overexcitability, and they employed a less adaptive emotion-oriented coping strategy under stress. It is recommended that treating depersonalization symptoms should include examining childhood adversity, especially emotional abuse and neglect. Based on study findings, emotion regulation skills should be promoted to help individuals with elevated depersonalization manage their emotion-oriented coping strategies, anxiety, and emotional overexcitability.

Adverse childhood experiences (ACE) and adult attachment interview (AAI) in a non-clinical population.

Adverse childhood experiences (ACE) tend to be interrelated rather than independently occurring. There is a graded effect associated with ACE exposure and pathology, with an increase when ACE exposure is four or more. This study examined a sample of active individuals (n=129) to determine distribution patterns and relationships between ACEs, attachment classification, unresolved mourning (U), and disclosure difficulty. The results of this study demonstrated a strong relationship between increased ACEs and greater unresolved mourning. Specifically, the group differences for individuals who experienced no ACE (n=42, 33%), those with 1-3 ACEs (n=48, 37.8%), and those with ≥4 ACEs (n=37, 29.1%) revealed a pattern in which increased group ACE exposure was associated with greater lack of resolution for past trauma/loss experiences, more adult traumatic events, and more difficulty disclosing past trauma. Despite ≥4 ACEs, 51.4% of highly exposed individuals were classified as secure in the Adult Attachment Interview. Resilience in this group may be related to a combination of attachment security, college education, and engagement in meaningful activities. Likewise, adversity may actually encourage the cultivation of more social support, goal efficacy, and planning behaviors; factors that augment resilience to adversity.

A Psychophysiological Case Study of Orchestra Conductors.

The psychological and physiological effects of performance were investigated in two professional orchestral conductors, with data collected prior to, during, and after a rehearsal and a public performance. The participants were given a battery of psychological self-report tests (anxiety, dissociation, health inventory, fantasy proneness, shame, and flow). Ambulatory physiological monitoring (Vivometric LifeShirt® system) was conducted during both a rehearsal and public performance to gather information about the autonomic nervous system and heart rate variability (HRV). One conductor had a history of asthma and anxiety, and the second conductor had coronary artery disease. The results revealed within-subject and between-subject differences in autonomic nervous system responses and HRV during several conditions (pre-performance rest, stair-climbing, rehearsal, and performance). Based on heart rate, the physiological demands of professional conducting are reflective of work intensities considered "hard." Both conductors experienced high flow states. Anxiety and coronary artery disease may have attenuated HRV resilience in this study. It is recommended that noninvasive methods be implemented to assess cardiac autonomic activity in professional conductors, particularly during engagement in their professional activities. The findings suggest a need to further study anxiety, respiratory conditions, and cardiovascular risks for conductors.

Posttraumatic Stress Disorder and Psychopathology in Dancers.

This study investigated the prevalence of posttraumatic stress disorder (PTSD) in pre-professional and professional dancers (n=209) who were exposed to traumatic events. Nine self-report instruments assessed (1) adverse childhood experiences, (2) past traumatic events, (3) coping strategies under stressful situations, and (4) fantasy proneness. The psychopathology variables included (5) anxiety, (6) depression, (7) dissociation, (8) shame, and (9)) PTSD diagnostic scale. Statistical calculations included descriptive, distributional, and multivariate analysis of covariates (MANCOVA). Results indicate that dancers had a significantly higher distribution of PTSD (20.2%) compared to the normal population (7.8%). They also had a higher frequency of family members with mental illness, an inability to speak about their trauma, and more suicidal thoughts. The PTSD group of dancers had higher levels of psychopathology (anxiety, depression, dissociation, and shame) and they had more childhood adversity and adult trauma. Compared to the no-PTSD group, the PTSD group had higher scores on fantasy proneness and emotion-oriented coping strategies. These coping strategies may increase psychological instability. Addressing early abuse and trauma is recommended. Clinicians may help dancers alter their internal working models that their self is worthless, others are abusive, and the world is threatening and dangerous. By understanding PTSD in dancers, medical and mental health treatment protocols may be established to address the debilitating, and often hidden, symptoms of PTSD.

Perfectionism, shame, and self-concept in dancers: a mediation analysis.

Perfectionism has been linked to various forms of physiological and psychological maladjustment. This study examined the inter-relationships between multi-dimensional aspects of perfectionism (self-oriented, other-oriented, and socially prescribed), internalized shame, and total self-concept in elite dancers (N = 24) as compared to a control group of healthy, active non-dancers (N = 23). All participants completed psychometric self-report measures targeting the variables of interest. Multivariate analysis of covariance (gender as covariate) indicated that the dancers had higher levels of self-oriented perfectionism than the control group. Building on the findings of Ashby, Rice, and Martin, we examined a model in which dancers' shame mediates the relationship between maladaptive aspects of perfectionism and self-concept. Analysis revealed internalized shame to fully mediate the relationship between dancers' socially prescribed perfectionism and total self-concept; however, shame did not mediate self-concept in the control group. We conclude that dancers would benefit from programs that enhance self-esteem and reduce the negative effects of internalized shame and self-oriented and socially prescribed perfectionism.

Unresolved mourning, supernatural beliefs and dissociation: a mediation analysis.

Unresolved mourning is marked by disorganized behavior and states of mind. In this study, we speculated that pathological dissociation would mediate the effects of unresolved mourning on supernatural beliefs. This hypothesis was determined based on findings that indicate an association between higher levels of dissociation, stronger beliefs in the supernatural and unresolved mourning. We examined two groups of participants, one classified as non-unresolved (non-U) (n = 56) and the other as unresolved (n = 26) (U) with respect to past loss/trauma as measured by the Adult Attachment Interview (AAI). Two self-report instruments were administered to measure supernatural beliefs and dissociation. As hypothesized, the multivariate analysis of variance indicated mean differences between the two groups. The unresolved group had greater belief in the supernatural and more pathological dissociative processes. The mediation analysis demonstrated that pathological dissociation fully mediated the effects of unresolved mourning on supernatural beliefs.

Exposing shame in dancers and athletes: shame, trauma, and dissociation in a nonclinical population.

The relationship between shame, past traumatic events, and dissociation in a nonclinical university and community sample of pre-professional/professional dancers (n = 140) and recreational/competitive athletes (n = 99) was investigated in this cross-sectional study, which was approved by an institutional review board. Participants completed 3 self-report measures (i.e., the Dissociative Experiences Scale, Internalized Shame Scale, Traumatic Events Questionnaire), and the analyses included correlation, multivariate analysis of variance, and a series of regression analyses. The investigation indicated that dancers had increased shame and dissociation in comparison to athletes, and males had more traumatic experiences and increased dissociation relative to females. In the regression analyses, being a dancer, traumatic experiences, and shame predicted dissociation. Clinical recommendations include integrating shame treatment with dissociative-disordered patients and noting that dancers may need more psychological skill training to manage shame and dissociation.

Dancing with the Muses: dissociation and flow.

This study investigated dissociative psychological processes and flow (dispositional and state) in a group of professional and pre-professional dancers (n=74). In this study, high scores for global (Mdn=4.14) and autotelic (Mdn=4.50) flow suggest that dancing was inherently integrating and rewarding, although 17.6% of the dancers were identified as possibly having clinical levels of dissociation (Dissociative Experiences Scale-Taxon cutoff score≥20). The results of the multivariate analysis of variance indicated that subjects with high levels of dissociation had significantly lower levels of global flow (p<.05). Stepwise linear regression analyses demonstrated that dispositional flow negatively predicted the dissociative constructs of depersonalization and taxon (p<.05) but did not significantly predict the variance in absorption/imagination (p>.05). As hypothesized, dissociation and flow seem to operate as different mental processes.

Dissociation and the Adult Attachment Interview in artists and performing artists.

Attachment patterns were investigated in a group of professional and pre-professional artists (n = 51). Given the high level of absorption/imagination required of artists, this study examined normative and pathological dissociation (PD) and considered links with Adult Attachment Interview responses, with particular attention to the AAI classification Unresolved (U) for past loss or trauma. Results indicated: (1) artists had elevated mean scores for absorption/imagination, (2) all but one artist had adverse trauma or loss experiences, (3) 17 (36%) met criteria for PD and 9 (53%) of those in the PD range had a classification of Unresolved (U) on the Adult Attachment Interview (AAI), (4) U was associated with PD, but not normative dissociation (absorption/imagination), (5) even with a primary U classification many individuals had an alternate secure/autonomous classification, and (6) 88% of the artists were classified as secure/autonomous in a three-way analysis on the AAI, but in a four-way analysis 27.5% were classified as U. Although 36% presented with PD, the majority of artists studied were stable, coherent and autonomous.

Loss and disorganization from an attachment perspective.

In this article, it is hypothesized that disorganizing, disorienting, and unresolved states of mind about loss experiences, as classified by the Adult Attachment Interview (AAI) coding system, may offer insight into the bereaved mind and may guide clinical treatment approaches. This article discusses pre-loss attachment organizations and the disorganizing/disorienting markers of unresolved loss found in the AAI. Although sometimes subtle in nature, the unresolved, disorganized, and disorienting indices--defined as lapses in monitoring of reason, discourse and behavior--provide concrete markers for assessing the degree of resolution for loss experiences. An attachment-based grief treatment model can add to existing models implemented in prolonged grief disorder treatment.

"Down will come baby": prenatal stress, primitive defenses and gestational dysregulation.

Knowledge of maternal stress and its direct influence on the developing embryo and fetus (prenate) can influence psychotherapeutic treatment decisions, especially when treating patients who are severely traumatized and dissociative. Not only may maternal stress alter prenate neurobiological attachment and stress systems in the limbic-hypothalamus-pituitary-adrenal axis (LHPA) and limbic-autonomic nervous system (L-ANS), but it may also shape the development of prenate 'fixed action patterns' built from primitive defensive reflex activation. As a result, the offspring's defensive, mating and caregiving behavior may all be biased towards survival in a threatening world and may be more readily transmitted to subsequent generations. This theoretical article provides a prenatal relational model that outlines experience- dependent prenate development that is contingent on and concordant with maternal regulation and dysregulation. Not only anxiety, depression and anger, but also posttraumatic stress and dissociation in the mother, may affect the neurobiology of the prenate.