Schizophrenia's genetic signalling protein and receptors

A search for genetic information about schizophrenia shows that a genetically expressed protein, NRG1, and two of its receptors, ErbB3 and ErbB4, are central to schizophrenia. Recent studies implicating NRG1 in schizophrenia often implicate it in bipolar disorder with the same evidence. But different studies focus on two different areas, myelin and neurotransmitters, and hence seem contradictory. Myelin implies neural speed, and neurotransmitters bring to mind, as an example, dopamine as a component of stress.

A myelin, or ErbB3, study (McIntosh, 2009), shows that NRG1/ErbB3 signaling failures cause oligodendrocyte activity to be impaired so that less "white matter" is produced resulting in a diminished "anterior internal capsule in subjects with both disorders" (p. 2). This effect is assumed to be developmental, and myelin formation in "frontal lobes, continues into late adolescence and beyond" (p. 3), giving optimism that new drugs based on NRG1 could reinforce myelination (p. 4).

Genetic loading for psychosis and the internal capsule (McIntosh, 2009)

Neurotransmitter, or ErbB4, studies have a brain-wide view with a focus on neuron development and transmitter activities such glutamatergic hypofunction (Li, 2007), failures in the formation of inhibitory synapses (Fazzari, 2010), and the "wiring" of GABA-mediated circuits (Fazzari, 2010), all in the context of schizophrenia. While bipolar disorder can be linked to schizophrenia in the context of ErbB4 (Chong, 2007), the more detailed material on neural activity focuses on schizophrenia.

As dopamine hyperactivity is part of the schizophrenia pharmacological model (Stone, 2007), and methamphetamine is used to simulate it experimentally (Homayoun, 2008), studies concentrating on stimulants may give clues about the neural activity of schizophrenia and bipolar disorder in relation to behavior.

The "white matter" study is optimistic that new drugs may reinforce myelination, and so raises an idea about myelination and plasticity with respect to maturity: could such drugs help the elderly retain plasticity?


References

Chong, V., Thompson, M., Beltaifa, S., Webster, M., Law A., and Weickertad, S. (2007). Elevated Neuregulin-1 and ErbB4 protein in the prefrontal cortex of schizophrenic patients: Schizophr Res. 2008 March ; 100(1-3): 270–280. doi:10.1016/j.schres.2007.12.474.

Fazzari, P., Paternain, A., Valiente, M., Pla, R., Luján, R., Lloyd, K., et al. (2010). Control of cortical GABA circuitry development by Nrg1 and ErbB4 signalling. Nature, 464(7293), 1376-1380. doi:10.1038/nature08928.

Homayoun, H., & Moghaddam, B. (2008). Orbitofrontal cortex neurons as a common target for classic and glutamatergic antipsychotic drugs. Proceedings of the National Academy of Sciences of the United States of America, 105(46), 18041-18046. doi:10.1073/pnas0806669105.

Li, B., Woo, R., Mei L., Malinow, R., (2007, May 24). The neuregulin-1 receptor ErbB4 controls glutamatergic synapse maturation and plasticity. Neuron, 54(4), 583-597.

McIntosh, A., Hall, J., Lymer, G., Sussmann, J., and Lawrie, S. (2009). Genetic risk for white matter abnormalities in bipolar disorder. International Review of Psychiatry, 21(4), 387-393. doi:10.1080/09540260902962180.

McIntosh, A., Hall, J., Lymer, G., Sussmann, J., and Lawrie, S. (2009). Genetic loading for psychosis and the internal capsule disorder. International Review of Psychiatry, 21(4), 387-393. doi:10.1080/09540260902962180.

Stone, J., Morrison, P., and Pilowski, L. (2007, January 26). Review: Glutamate and dopamine dysregulation in schizophrenia — a synthesis and selective review. Journal of Psychopharmacology June 2007 vol. 21 no. 4 440-452

Executive function in depression

Conduct disorder, ADHD, and anxiety disorder” (Sigelman & Rider, p. 482) are often comorbid with depression in children, showing an overlap between depression and ADHD in children.  In my writing about ADHD in children (van Vlaanderen, 2010), I describe evidence of an executive function (EF) component to ADHD, and James (2008) supports an EF component for depression because depressive hyper-activity occurs in the executive function regions.  He promotes the idea that EFs for the depressed can be enhanced with CBT in ways that are similar to my speculation that EF functioning can be enhanced for children with ADHD through psychoeducation. 

In depressed adults, James finds "rigid and concrete thinking, attentional problems" and "memory difficulties" (p. 10) associated with executive function deficit (EFD).  In adults with ADHD who had it as children, Barkley (2004) shows socialization problems that are similar to conduct disorder (CD) and oppositional defiant disorder (ODD) such as arrests and other anti-social behaviors, and Clark (2002) confirms that socialization problems are related to EFD in ADHD-affected children--even for children not diagnosed with CD or ODD.

Speculating along these lines, psychoeducational and -therapeutic strategies may be developed to help with depression (and adult ADHD) that will focus directly on EFD and can be evaluated by their efficacy with respect to EF.  With time, EF monitoring and imaging will improve, perhaps to the point where it can be part of individual evaluation.

References
Barkley, R., Fischer, M., Smallish, L., & Fletcher, K. (2004). Young adult follow-up of hyperactive children: antisocial activities and drug use. Journal of Child Psychology & Psychiatry, 45(2), 195-211. doi:10.1111/j.1469-7610.2004.00214.x.

Clark, C., Prior, M., & Kinsella, G. (2002). The Relationship Between Executive Function Abilities, Adaptive Behaviour, and Academic Achievement in Children with Externalising Behaviour Problems. Journal of Child Psychology & Psychiatry & Allied Disciplines, 43(6), 785-796. Retrieved from Academic Search Premier database.

James, I., Reichelt, F., Carlsonn, P., & McAnaney, A. (2008). Cognitive Behavior Therapy and Executive Functioning in Depression. Journal of Cognitive Psychotherapy, 22(3), 210-218. doi:10.1891/0889-8391.22.3.210.

Mckinley, C., (2010). The Treatment of Depression in Children. Retrieved October 19, 2010 from http://campus.yorkvilleu.ca/mod/forum/discuss.php?d=87127&parent=556350
http://campus.yorkvilleu.ca/mod/forum/discuss.php?d=87127&parent=556350

Sigelman, C.K., & Rider, E.A. (2009). Life-Span Human Development, 6th edition . Thomson Wadsworth.

van Vlaanderen, J., (2010). Executive function, working memory control, and ADHD. Retrieved October 19, 2010 from http://campus.yorkvilleu.ca/mod/forum/discuss.php?d=85380&parent=544331

Body work

Wohlrab reports that tattoos and piercing (collectively here as "body work") are mainstream for adolescents (Wohlrab, 2007). Those with body work are largely "Sensation Seekers," with multiple sexual relationships. "Previously" he says, body work was seen as "showing antisocial, aggressive, high-risk or deviant behaviours."

Koch reports that body work is still deviant, as multiple tattoos or piercings are likely to mean "regular marijuana use, occasional use of other illegal drugs, and a history of being arrested" (Koch, 2010).

Tattooing is tribal, having been introduced to modern society by crew of the explorer, James Cook (Utanga, 2006). Native tribes decorate their bodies for the "aesthetic and symbolic" and to show a connection with nature (Jefkin-Elnekave, 2006). The majority of contemporary tattoos are tribal- or nature-based, perhaps showing a desire for a natural connection as part of a rebellious expression rather than behavioral deviance (Wohlrab, 2007).

To show the extremes of body work as rebellious expression, the conceptual artist Orlan had herself physically reconstructed to represent the ideal "in classical works of art" (Mullis, 2006). With eight operations she represented "the body as meat" for audiences around the world via satellite.

Pain
While society has sanctioned piercings and tattoos as "socially normative practices" (Toste, 2010), and separates them from self-injury, pain still links them. Siorat says that tattoos are symbols of the pain of the "many hours under the needles" necessary to create them (Siorat, 2006). Tribal scarring can be different different from tribal body decorations in that it often represents the pain of war (Jefkin-Elnekave, 2006).

If we allow for gray area between body work and self-injury defined by pain, perhaps we can speculate about a biopsychological connection: depression. For this speculation, let's allow for a link through pain. The physical pain of self-injury can be an escape from the pain of depression (Dickstein, 2009) where the most common diagnosis for self-injury is depression followed by PTSD. If we allow for the "old school" view that body work, specifically tattooing, is representative of lower and criminal classes, and we can show depression at these social levels: "increased frequency of child exposure to poverty is a consistent predictor of adolescent and young adult anxiety and depression" (Ying, 2010). More challenges, and hence stresses, exist for the present adolescent generation than did for previous generations (TODAY Health, 2010), so perhaps body work is a way to cope and express the increasing stresses of the adolescent contemporary experience.

JefkiElnekave, D. (2006). Tribal identity through body art: Extraordinary people living in the remnants of itme. PSA Journal, 72(7), 22-25.

Koch, J., Roberts, A., Armstrong, M., & Owen, D. (2010). Body art, deviance, and American college students. Social Science Journal, 47(1), 151-161. doi:10.1016/j.soscij.2009.10.001.

Mullis, E. (2006, May). The violent aesthetic: A reconsideration of transgressive body art. Journal of Speculative Philosophy, pp. 85-92. Retrieved from Academic Search Premier database.

Wohlrab S, Stahl J, Rammsayer T, Kappeler P. Differences in personality characteristics between body-modified and non-modified individuals: associations with individual personality traits and their possible evolutionary implications. European Journal of Personality [serial online]. November 2007;21(7):931-951.

Dickstein, D. (2009). A closer look at non-suicidal self-injury in adolescents. (Cover story). Brown University Child & Adolescent Behavior Letter, 25(12), 1-6.

Siorat, C. (2006). The Art of Pain. Fashion Theory: The Journal of Dress, Body & Culture, 10(3), 367-380. Retrieved from Academic Search Premier database.

TODAY Health (2010). Students report more serious stress. Retrieved September 29, 2010, from http://today.msnbc.msn.com/id/34803404/ns/health-kids_and_parenting/

Ying, S., Fangbiao, T., Jiahu, H., & Yuhui, W. (2010). The Mediating Effects of Stress and Coping on Depression Among Adolescents in China. Journal of Child & Adolescent Psychiatric Nursing, 23(3), 173-180. doi:10.1111/j.1744-6171.2010.00238.x.

fMRI of recognition

Schulte-Rüther (2007) provides graphic evidence of the emotional processes of identifying emotions in others, using fMRI, in terms of empathy.   He pinpoints simpler recognition and related processing to specific parts of the brain.  He connects the empathic reaction to facial expressions with the areas used for theory-of-mind processing that utilize mirror neurons.

"self- (relative to the other-) task differentially activated the" (p. 1):

• medial prefrontal cortices (MPFC)
  
• Posterior cingulate cortex (PCC)/precuneus
• temporo-parietal junction bilaterally

Covariation of mirror neuron activation and empathic ability.

References

Schulte-Rüther, M., Markowitsch, H., Fink, G., & Piefke, M. (2007). Mirror Neuron and Theory of Mind Mechanisms Involved in Face-to-Face Interactions: A Functional Magnetic Resonance Imaging Approach to Empathy. Journal of Cognitive Neuroscience, 19(8), 1354-1372. Retrieved from Academic Search Premier database.

Cognitive agility

Executive function and memory rehabilitation

As dementia effectively means the loss of cognitive and memory abilities, helping the elderly maintain these abilities is a direct approach that forestalls dementia (Barclay, 2009) and should help the elderly maintain other aspects of their lives.  Cognitive rehabilitation, also cognitive remediation, focuses on executive function (EF) and memory in a way that creates common strategies for diverse therapies concerned with the prefrontal cortex--brain injuries, angioma, ADHD, schizophrenia, and dementia--with its cognitive flexibility, working memory, and planning functionalities.

As cognitive rehabilitation is time-costly, it tends to focus only on the immediate needs of lower-functioning cognitive abilities, and higher executive dysfunctions may never get addressed.  A universal antidote for high cost is, of course, computer automation, and this has not gone unnoticed by cognitive rehabilitators.  Virtual reality (VR) is emerging as a supportive strategy (Castelnuovo, 2003) that is being received with enthusiasm by both clinicians (Weiss, 2009) and patients (da Costa, 2004).  Efficacy-testing, which is also in early stages, is showing benefits for schizophrenics so far (Chan, 2010). 

Interestingly, Web surfing has been shown through imaging to stimulate decision-making components of EF in the elderly, though the benefit only comes with Internet experience (Parker-Pope, 2008).


References

Barclay, L. , Hall, C., Lipton, R., Sliwinski, M., Katz, MJ, Derby, C., Verghese, J. (2009). Cognitive activities delay onset of memory decline in persons who develop dementia. Neurology 73, 356-361

Castelnuovo, G., Lo Priore, C., Liccione, D., 3, Cioffi, G. (2003). Virtual Reality based tools for the rehabilitation of cognitive and executive functions: the V-STORE. PsychNology Journal, 1(3), 310-325.

Chan, C., Ngai, E., Leung, P., & Wong, S. (2010). Effect of the adapted virtual reality cognitive training program among Chinese older adults with chronic schizophrenia: a pilot study. International Journal of Geriatric Psychiatry, 25(6), 643-649. Retrieved from Academic Search Premier database.

da Costa, R., & de Carvalho, L. (2004). The acceptance of virtual reality devices for cognitive rehabilitation: a report of positive results with schizophrenia. Computer Methods & Programs in Biomedicine, 73(3), 173. doi:10.1016/S0169-2607(03)00066-X.

Parker-Pope, T. (2008, October 16). Surfing the Internet boosts aging brains. New York Times. Retrieved October 20, 2008, from http://well.blogs.nytimes. com/2008/10/16/does-the-internet-boost-your-brainpower

Weiss, P., Sveistrup, H., Rand, D., & Kizony, R. (2009). Video capture virtual reality: A decade of rehabilitation assessment and intervention. Physical Therapy Reviews, 14(5), 307-321. doi:10.1179/108331909X12488667117339.

ADHD and parenting

A study about ADHD and parenting styles reports that "aspects of the family environment and parental limit setting" appear to correlate with the growth of "executive functions in children" (Schroeder, 2009). But while it is recognized that children with ADHD suffer from executive function impairments such as "inhibition, working memory, set shifting, and planning" (Toplak, 2009), the improved parenting did not help them (Schroeder, 2009). Interventions in schools are effective (Fabiano, 2003), so presumably similar strategies could be used by parents too.

The Incredible Years program uses parent training intervention program to help "children with early onset conduct problems" (Incredible Years, 2010). An efficacy study of it reports that it should be considered as "a first-line intervention" that has "lasting positive effect on ADHD symptoms in pre-school children" (Jones, 2007, p. 9). Children retained a significant portion of the program's benefits "18 months after the end of intervention" (p. 9). But the study notes limitations: the children were pre-school (ADHD is not typically diagnosed until elementary school), and there are limitations to parent self-reporting (their biases will affect their reports). The benefits of the program, he persuasively argues, are significant if it can be used in lieu of, or forestalls, stimulant medication. Criticism of intervention programs that avoid medication should be balanced against the liabilities associated with stimulants: expense, possible negative side-effects, resistance to stimulant medication based on ethical issues. Fabiano echos this (Fabiano, 2003).

The program seeks to improve family communication with affective involvement by using less-harsh and consistent discipline (Incredible Years, 2010):

• using "attention and appreciation" to build "self-esteem"
• playing with children
• "ignoring negative behavior" by not making eye contact
• avoiding criticism and demands
• developing friendship and empathy skills

References

Incredible years (2010). Retrieved September 19, 2010 from http://www.incredibleyears.com/

Incredible years (2010). Agendas and Checklists for ADHD Protocol Retrieved September 19, 2010 from http://www.incredibleyears.com/Library/items/parent-training-program-ADHD-montreal_08.pdf

Jones, K., Daley, D., Hutchings, J., Bywater, T., & Eames, C. (2007). Efficacy of the Incredible Years Basic parent training programme as an early intervention for children with conduct problems and ADHD. Child: Care, Health & Development, 33(6), 749-756. doi:10.1111/j.1365-2214.2007.00747.x.

Schroeder, V., & Kelley, M. (2009). Associations Between Family Environment, Parenting Practices, and Executive Functioning of Children with and Without ADHD. Journal of Child & Family Studies, 18(2), 227-235. doi:10.1007/s10826-008-9223-0.

Toplak, M., Bucciarelli, S., Jain, U., & Tannock, R. (2009). Executive Functions: Performance-Based Measures and the Behavior Rating Inventory of Executive Function (BRIEF) in Adolescents with Attention Deficit/Hyperactivity Disorder (ADHD). Child Neuropsychology, 15(1), 53-72. doi:10.1080/09297040802070929.

Self-esteem in youth

Kutob reports low self-esteem in elementary and middle school girls in California and Arizona manifested as "low academic performance, social isolation, depression, anxiety, fatigue, headaches, and stomachaches"  (Kutob, 2010).   The low self-esteem was largely caused by cruel teasing and bullying associated with appearance: body weight.  Kutob promotes "zero tolerance" for teasing.  He blames society for allowing a "mindless acceptance and promotion of stereotypic definitions of personal value based on 'Hollywood' appearance standards."

Self-esteem issues can be cultural
Self-esteem for White and Hispanic girls declined by age 11, but, for Black girls, self-esteem remained the same "between the ages of 9 and 14."  The Black girls were immune.  As global self-esteem for Black and White children is equal (Jackson, 2009), the difference appears to be cultural.

Chinese children with "absent migrant parents" suffer low self-esteem (Li-Juan, 2010).  Loneliness predicts low self-concept, which is restored when their parents spend quality time with them.  Here, family affection links to self-esteem and -concept rather than appraisal.

Top down (social) and bottom up (biopsychological)
Low self-esteem for White and Hispanic girls in California and Arizona resulted from negative appraisal rather than self-concepts of appearance.  There seem to be distinct internal and external components of low self-esteem and poor self-concept.  Mentoring improves self-concept and reduces anxiety, but may not improve school behavior or relationships, and depression may remain (Schmidt, 2007).  Bonding in group therapy benefits self-esteem (Marmarosh, 2005), but those who attempt bonding to reduce depression often become more depressed (Cambron, 2010).

Top down
Low self-esteem includes normal reactions (Hendel, 2006):

• need to win
• pleasing others
• perfectionism
• self-criticism
• withdrawing

Bottom up
It is also associated with three indicators of psychological distress (Huajian, 2009):

• depression
• anxiety
• "low subjective well-being"

Exercise improves self-concept, and hence self-esteem

Psychomotor programs "correlated with increased global self-esteem and decreased depression and anxiety levels" (Peter PV Van de, 2005).  Increased physical self-concept elevates low self-esteem--whatever its cause.


Reference

Cambron, M., & Citelli, L. (2010). Examining the link between friendship contingent self-esteem and the self-propagating cycle of depression. Journal of Social & Clinical Psychology, 29(6), 701-726. Retrieved from Academic Search Premier database.

Hendel, A. (2006). Restoring Self-Esteem in Adolescent Males. Reclaiming Children & Youth, 15(3), 175-178. Retrieved from Academic Search Premier database.

Huajian, C., Qiuping, W., & Brown, J. (2009). Is self-esteem a universal need? Evidence from The People's Republic of China. Asian Journal of Social Psychology, 12(2), 104-120. doi:10.1111/j.1467-839X.2009.01278.x.

Jackson, L., Yong, Z., Witt, E., Fitzgerald, H., von Eye, A., & Harold, R. (2009). Self-concept, self-esteem, gender, race, and information technology use. CyberPsychology & Behavior, 12(4), 437-440. doi:10.1089/cpb.2008.0286.

Kutob, R., Senf, J., Crago, M., & Shisslak, C. (2010). Concurrent and longitudinal predictors of self-esteem in elementary and middle school girls. Journal of School Health, 80(5), 240-248. doi:10.1111/j.1746-1561.2010.00496.x.

Li-Juan, L., Xun, S., Chun-Li, Z., Yue, W., & Qiang, G. (2010). A survey in rural China of parent-absence through migrant working: The impact on their children's self-concept and loneliness. BMC Public Health, 101-8. doi:10.1186/1471-2458-10-32.

Marmarosh, C., Holtz, A., & Schottenbauer, M. (2005). Group cohesiveness, group-derived collective self-esteem, group-derived hope, and the well-being of group therapy members. Group Dynamics: Theory, Research, and Practice, 9(1), 32-44. doi:10.1037/1089-2699.9.1.32.

 

Peter PV Van de, V., Herman HV Van, C., Ans AD, D., Joseph JP, P., Guido GP, P., & Koen KK, K. (2005). Comparison of changes in physical self-concept, global self-esteem, depression and anxiety following two different psychomotor therapy programs in nonpsychotic psychiatric inpatients. Psychotherapy & Psychosomatics, 74(6), 353-361. Retrieved from Academic Search Premier database.

Schmidt, M., McVaugh, B., & Jacobi, J. (2007). Is mentoring throughout the fourth and fifth grades associated with improved psychosocial functioning in children?. Mentoring & Tutoring: Partnership in Learning, 15(3), 263-276. doi:10.1080/13611260701201943.

Ethical issues surrounding anxiety disorders

Many adolescents (and children) require proactive care for anxiety disorders.  In the most optimistic cases, early intervention can stem serious problems later on.  But for many suffering from anxiety disorders, proactive care means that their rights are limited, and they may be coerced into therapy and medications that they don't want.  There is endless ethical "gray area" between the two extremes: a happy alliance with the therapist, and an  apparent removal of basic rights.

In the happier purely voluntary form of therapy the counselor/client relationship is called the therapeutic alliance, "a collaborative nature of the partnership between counselor and client" (Hawaii State Department of Health), counseling ethics are easily applied as boundaries to the relationship to assure that the therapy is beneficial and that no harm comes to the client.

This is described succinctly as the "four principles for biomedical ethics" (Westra, 2009): respect for autonomy, nonmaleficence, beneficence, and justice.

The phrase "no harm" (Sheppard, 1999), may be added to stress nonmaleficence.  When clients are harming themselves or may be harmed, this comes to mean "preventing harm," and ethical issues become difficult.

Another more subtle situation that equally relevant situation involves what treatment is used, specifically prescribed drugs, rather than if treatment is used.

An approach to these contradictions is to show that adolescents that need to be controlled, have that need because they are victims.  Adolescents who have been sexually assaulted are at risk for PTSD (Lawyer, 2006), and PTSD as often as not leads to anger (Saigh, 2007).  That may require involuntary treatment if the anger is externalized as violence.  Angry adolsecents usually come from angry families (Avci,  2010), and  "school refusal" is most often positively reinforced by family members or cohorts from the surrounding environment (Kearney, 2004).  Other adolescents who "refuse school" are anxiously reacting to real threats at school (Dube, 2009).  Professionals agonize when young assault victims have to be placed in forensic units, really prisons, when they become threatening or self-injurious as a result of their victimization (Welsh, 1998).

Self-injury may be the most dramatic of issues, along with often related suicide, and it is usually an effort to distract from the pain of depression, or the result of low self-esteem depression (Dickstein, 2009) from negative appraisal by others, or assault (Weismoore, 2010).  Effectively, they have neurotransmitter dysfunctions (Dickstein, 2009).

Perhaps the best information is that adolescent "delinquents" have normal empathy, and that they apparently suffer from executive function disorders (Lardén, 2006).  The stresses that they face force them to limit their cognizance of others' feelings, and there is no self-reported empathy gap between girls and boys. 

References

Avci, R., & Güçray, S. (2010). An Investigation of violent and nonviolent adolescents' family functioning, problems concerning family members, anger and anger expression. Educational Sciences: Theory & Practice, 10(1), 65-76. Retrieved from Academic Search Premier database.

Dickstein, D. (2009). A closer look at non-suicidal self-injury in adolescents. (Cover story). Brown University Child & Adolescent Behavior Letter, 25(12), 1-6. Retrieved from Academic Search Premier database.

Dube, S., & Orpinas, P. (2009). Understanding excessive school absenteeism as School Refusal Behavior. Children & Schools, 31(2), 87-95. Retrieved from Academic Search Premier database.

Hawaii State Department of Health (2010). Therapeutic alliance curriculum activity quiz. Retrieved September 16, 2010, from http://www.amhd.org/About/ClinicalOperations/MISA/Training/Therapeutic%20Alliance%20Curriculum%20activity%20quiz.pdf

Kearney, C. (2007). Forms and functions of school refusal behavior in youth: an empirical analysis of absenteeism severity. Journal of Child Psychology & Psychiatry, 48(1), 53-61. doi:10.1111/j.1469-7610.2006.01634.x.

Lardén, M., Melin, L., Holst, U., & Långström, N. (2006). Moral judgement, cognitive distortions and empathy in incarcerated delinquent and community control adolescents. Psychology, Crime & Law, 12(5), 453-462. doi:1068-316X print/ISSN 1477-2744.

Lawyer, S., Ruggiero, K., Resnick, H., Kilpatrick, D., & Saunders, B. (2006). Mental health correlates of the victim-perpetrator relationship among-interpersonally victimized adolescents. Journal of Interpersonal Violence, 21(10), 1333-1353. Retrieved from Academic Search Premier database.

Saigh, P., Yasik, A., Oberfield, R., & Halamandaris, P. (2007). Self-Reported Anger Among Traumatized Children and Adolescents. Journal of Psychopathology & Behavioral Assessment, 29(1), 29-37. doi:10.1007/s10862-006-9026-9.

Sheppard, G., Schulz, W. and McMahon, S. (1999). The code of ethics. Canadian Counselling and Psychotherapy Association: Ottawa.

Weismoore, J., & Esposito-Smythers, C. (2010). The Role of Cognitive Distortion in the Relationship Between Abuse, Assault, and Non-Suicidal Self-Injury. Journal of Youth & Adolescence, 39(3), 281-290. doi:10.1007/s10964-009-9452-6.

Welsh, J. (1998). In whose ‘best interests’? Ethical issues involved in the moral dilemmas surrounding the removal of sexually abused adolescents from a community-based residential treatment unit to a locked, forensic adult psychiatric unit. Journal of Advanced Nursing, 27(1), 45-51. doi:10.1046/j.1365-2648.1998.00502.x.

Westra, A., Willems, D., & Smit, B. (2009). Communicating with Muslim parents: “the four principles” are not as culturally neutral as suggested. European Journal of Pediatrics, 168(11), 1383-1387. doi:10.1007/s00431-009-0970-8.

Emotion

Emotion and cognition are interrelated in creating meaning (Elliot & Greenberg, 2007).  People continually analyze their emotional reactions to experiences to make sense of them and to understand their environments.  This "affective-cognitive" process happens at automatic, or unconscious, levels just as it does at concious levels. 

 

Greenberg (2010) explains that emotion is "fundamental to the construction of self" but is "detrimental" to "self-organization."  Emotion is different from thought; it operates independently in its own sphere that includes the lymbic system and connections to the body's functioning systems including the organs and the immune system.  The limbic system has a native process that quickly produces emotion in the amygdala, and a slower complex process that combines emotion with thought through connections to the prefrontal cortex in the neocortex--where the executive function, well, executes its process.

 

Emotion-focused therapy (EFT) leverages emotion by attempting to substitute maladaptive, or bad, emotions with adaptive, or good ones.  Resilient people, EFT theory holds, use positive emotions to displace negative ones, and hence have better lives.  Anger, in EFT, can be adaptive or maladaptive.  In depression (where EFT is most commonly used), anger may be elicited as a response to a depression-causing emotion such as shame (perhaps caused by negative appraisal as we previously discussed), and the anger pushes out the shame because, as emotion-focused therapists believe, these two types of emotions cannot coexist.  The client will likely leave therapy feeling empowered.  When anger is maladaptive, such as in feelings of revenge, compassion is used as a substitute emotion, and the client feels soothed and, presumably, happy.

 

Because EFT uses a switching strategy, it is much like cognitive and behavioral therapies, except that it substitutes emotions rather than thoughts and behaviors.  It also has a speedy success rate as does CBT (Ellison, 2009), but because it is rooted in client-centered therapy, the client can naturally implement the process as part of basic self-actualization, making the process permanent.

 

References

 

Elliott, R., & Greenberg, L. (2007). The Essence of Process-Experiential/Emotion-Focused Therapy. American Journal of Psychotherapy, 61(3), 241-254. Retrieved from Academic Search Premier database.

 

Ellison, J., Greenberg, L., Goldman, R., & Angus, L. (2009). Maintenance of gains following experiential therapies for depression. Journal of Consulting and Clinical Psychology, 77(1), 103-112. doi:10.1037/a0014653.

 

Greenberg, L. (2010). Emotion-focused therapy: A clinical synthesis. Retreived October 3, 2010 from http://www.emotionfocusedclinic.org/documents/Emotion-FocusedTherapy_AClinicalSynthesis.L.S.Greenberg.Jan2010.doc

Phobias and behavioral conditioning

This writing shows the influence of pain in psychology; I don't think I would ever use such an example in real life as a child being burned with hot metal.

Phobias are learned behaviors, and can be unlearned.  Classical conditioning typically initiates a phobia, and operant conditioning maintains the phobia.  The first three examples are fictionalized scenarios developed from Dyce's lecture material (J. Dyce, personal communication, n.d.). 

In classical conditioning, unconditioned and conditioned processes are parallel:

1. Cherry-red hot metal is in the pre-learning phase of a conditioned stimulus.  As it has a pretty color, a person, perhaps a child, may be attracted rather than fearful.
2. The person touches it (unconditioned stimulus), and gets burned badly (unconditioned response), and learns that cherry-red metal inflicts pain when touched.
3. The sight of cherry-red metal (conditioned stimulus) results in fear (conditioned response) because of the injury.

In operant conditioning, an initial stimulus of fear is necessary to create phobic behavior:

1. Discriminative stimulus: The learning from the consequence of a previous experience creates a fear.
2. Operant response: A person avoids the activity.
3. Reinforcement: The consequence is a feeling of comfort from avoiding the activity (that reinforces the stimulus and response).

A person may have a minor car accident, and hence fear driving as conditioned response to the accident.  By avoiding driving, he further reinforces the influence of the minor accident, which makes the phobia more difficult to overcome.

In classical conditioning therapy, a new parallel conditioned stimulus is added by teaching someone how to correctly use hot metal.  Beneficial experiences of working with the hot metal without getting burned extinguish the fear of the hot metal.  This example might be found in the historical context of the "cottage blacksmith."

The person who suffered a burn, perhaps as a child, is introduced to the tools necessary for working with hot metal.  Then, using cold metal for practice to gradually reduce the fear, or desensitize the conditioned response, the person is taught how to pick up the metal.  After some practice, the person successfully holds the hot metal with the tools.  This begins the extinguishing process so that, with more experience, the fear reduces to normal, but necessary, caution, rather than acting as a phobia.

As reinforcement is a component of the operant model, operant therapies for phobias in children require that parents stop reinforcing the phobia, which presumably happens when parents help the child avoid the fear-causing stimulus (Lazarus, Davison, & Polefka, 1965) and reinforce the desired behavior (Glasscock, & MacLean, 1990).  In a case study of a girl who had developed a fear of dogs, the parents were asked to give social praise when the girl spent time playing with dogs recruited for her therapy. 

Assuming that the girl who had developed a fear of dogs had liked dogs prior to having a bad experience such as being bitten by a dog, then she, at a certain point, would like dogs again with the success of her therapy, which was classical desensitization (Glasscock, & MacLean, 1990).  At this point, another operant scenario takes place; her improved experiences with dogs reinforce her interactions with her family dog.  This develops an encouraging discriminative stimulus that further supports positive interactions that, in turn, provide further reinforcement.

References

Glasscock, S., & MacLean Jr., W. (1990). Use of contact desensitization and shaping in the treatment of dog phobia and generalized fear of the outdoors. Journal of Clinical Child Psychology, 19(2), 169. Retrieved from Psychology and Behavioral Sciences Collection database.

Lazarus, A., Davison, G., & Polefka, D. (1965). Classical and operant factors in the treatment of a school phobia. Journal of Abnormal Psychology, 70(3), 225-229. doi:10.1037/h0022130.

Challenges for GLBQ youth who are "coming out"

"Coming out" can be an exceedingly difficult process.  GLBQ youth are at high risk for "clinical disorders and maladaptive behaviors" (Orecchia, 2008, p. 66), and they face increased stress from the "coming out" process (Riley, 2010).  "Coming out" follows the social identity formation process for GLBTQ adolescents for which there is no "analogous development" (Riley, 2010, para. 5) process for heterosexual youth.  It is a dimensional process (Coleman, 1987) that occurs over a number of stages, and includes internal conflict and a sense of isolation (Orecchia, 2008):

• A youth becomes aware of being "different,"
• confusion occurs as he begins to feel same-sex attractions;
• the youth assumes the new identity, and
• commits to it as a "way of life."

"Coming out" is necessary to prevent isolation and loneliness that accompanies hiding one's identity (Orecchia, 2008).  By "coming out," youth risk verbal, physical, and sexual abuse because of their sexuality from the world at large, and, in many cases, rejection by their families.   GLBTQ youth "coming out" have higher rates of school failure, suffer higher substance abuse and arrest rates, are more likely to get STDs, mood disorders, and, most important, have higher suicide rates.  25% of homeless youth are GLITCH; only an approximate 5-10% of the population is GLBTQ.

The counselor of a GLBTQ client should remain neutral to the "coming out" process, and, when the client decides to go forward with it, should not hurry it.  The client's family should be included (Orecchia, 2008), as family reactions may go to fear, guilt, shock, anger, and denial (Riley, 2010).  Cultural and religious beliefs may have to be modified, and there are often embedded misconceptions of the causes of homosexuality that need to be dispelled (Orecchia, 2008).

Finally, the client needs to encouraged to empathically embrace the changes his family is going through.


Resources

Coleman, E. (1987). Assessment of sexual orientation. Journal of Homosexuality, 14(1/2), 9-24. Retrieved from Academic Search Premier database.

Orecchia, A (2008). Working with lesbian, gay, bisexual, transgender, and questioning youth: Role and function of the community counselor. Graduate Journal of Counseling Psychology, 1(1), 66‐77.

Riley, B. (2010). GLB Adolescent's “Coming out”. Journal of Child & Adolescent Psychiatric Nursing, 23(1), 3-10. doi:10.1111/j.1744-6171.2009.00210.x.

Big Five traits and personality disorders

There is a relationship between five factor, or "big 5," models of traits and the diagnostic approach to personality disorders, but that "the level of agreement" is derived from instruments that use these models.  The level of agreement may be a function of instrumentation, method of report, and data analysis.  In more recent years, discussion has focused on how the benefits of the highly-developed five factor model (FFM) can be blended with well-implemented personality disorder (PD) inventories, especially the DSM (American Psychiatric Association, 1994).

If diagnostic categories are limited, a more direct relationship between the two paradigms can be established; Morey (2002) did such a comparative study to attempt to correlate four diagnostic categories--borderline, schizotypal, avoidant, and obsessive-compulsive Personality--with five factor test results by comparing them to similar correlations within the community norm.  "The four personality disorder groups" "could each be distinguished from community norms" (Morey, 2002, p. 1) but differences between the groups with personality disorders were much smaller; those with personality disorders could be identified, but they could not be distinguished using the FFM trait instruments.  In other words, in their present state, Morey did not find any added benefit for using FFM instruments when assessing personality disorders.  With each of the four groups, he found neuroticism to be high, and agreeableness and conscientiousness to be low. 

Nonetheless, Morey shows that there is a relationship, albeit not specific enough for to help with personality order diagnosis.  Another relation is temporal; both PDs and traits are stable and can be shown to remain static over a period of years even when diagnosis may change, perhaps due to effective treatment (Warner, 2004).

If the diagnostic category is limited to the well-studied borderline personality disorder (BPD), then specific sub-dimensions of the five factor model are visible.  For instance, low agreeableness is shown by "self-consciousness and vulnerability in interpersonal situations" "accompanied by a hostile and suspicious approach to others" (Clarkin, Hull, Cantor, & Sanderson, 1993, p. 4).  Neuroticism from the FFM is visible as impulsiveness from the BPD criteron.

Widiger and Trull (and others) are emphatic that there is potential for crossover, or perhaps merger, between the FFM and PD diagnostic tools, specifically the DSM (2008).  They suggest that a lexical approach to diagnosis adapted from the FFM would create better classification, and hence better understanding by the community.  Better classification would help eliminate diagnostic redundancies within the existing inventories that waste clinicians' time, and the linguistic style of personality tests tends to be more acceptable to patients, and hence quicker to administer and more valuable for self-report. 

What Widiger and Trull don't mention, and perhaps should, is that the FFM is based on a long history of mathematical reasoning, and is not limited to the Lexical Hypothesis; Cattell's sources for his trait model included peer- and self-reports, and observed behaviors.  There is also a call for biological input data (Popkins, 1998).  Cattell's factor analysis equations have proved themselves, but are not yet perfected because, as presently implemented, they require subjective input at certain points (Rozalia, 2008).  This subjective input data could be replaced with data from other well-supported sources, perhaps likewise mathematically derived so as to create meta-equations, as it were, by linking existing equations as components of a bigger model.  A way to improve these equations would be to run them in reverse by inputing observed data where the results have been "out put" so as to recreate, and hence validate, input data, and in-so-doing validate the entire process.

References

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.

Clarkin, J., Hull, J., Cantor, J., & Sanderson, C. (1993). Borderline personality disorder and personality traits: A comparison of SCID-II BPD and NEO-PI. Psychological Assessment, 5(4),    472-476. doi:10.1037/1040-3590.5.4.472.

Dyce, J. (1997). The big five factors of personality and their relationship to personality disorders. Journal of Clinical Psychology, 53(6), 587-593. Retrieved from Academic Search Premier database.

Morey, L. C., Gunderson, J. G., Quigley, B. D., Shea, M. T., Skodol, A. E., McGlashan, T. H., et al. (2002). The representation of borderline,
avoidant, obsessive-compulsive, and schizotypal personality disorders by the five-factor model. Journal of Personality Disorders, 16, 215–234.

Popkins, N. (1998). The five-factor model: Emergence of a taxonomic model for personality psychology. Retreived December 10, 2010 from http://www.personalityresearch.org/papers/popkins.html

Rozalia, G. (2008). Q factor analysis (Q-methodology) as data analysis technique. Annals of the University of Oradea, Economic Science Series, 17(4), 871-876. Retrieved from Business Source Complete database.

Warner, M., Morey, L., Finch, J., Gunderson, J., Skodol, A., Sanislow, C., et al. (2004). The Longitudinal Relationship of Personality Traits and Disorders. Journal of Abnormal Psychology, 113(2), 217-227. doi:10.1037/0021-843X.113.2.217.

Widiger, T., & Trull, T. (2008, January). Further Comments Toward a Dimensional Classification of Personality Disorder. American Psychologist, pp. 62-63. doi:10.1037/0003-066X.63.1.62.

Pure lie: Behavioral learning perspective on personality

I wrote this for a grade knowing that the professor, who claims she is humanistic, is fully behavioral.  Watson was a felon; professors attempt to rationalize his activity in the context of his times, or zeitgeist.  Equating the effects emotional communication with terrifying and, admittedly, permanently damaging a child--effectively equating fear and affection--shows that psychology has a pathologically limited emotional range.  Fortunately, because of the rise of imaging technology, most of this material can to out with trash.

---

1) Pre-condition: Conditioned stimulus (CS-bell) causes no response.

2) Unconditioned stimulus (UCS-food) causes Unconditioned Response (UCR-salivation).

2) Combine CS-bell (conditioned stimulus) with UCS-food (unconditioned stimulus) while triggering UCR-salivation (unconditioned response) to create CR-salivation (conditioned response).

3) CS-bell (conditioned stimulus) causes CR-salivation (conditioned response)

---

As all of life is continual stimuli and responses paired with symbolic counter parts for these stimuli with often symbolic responses, behavioral responses comprise much of the learning process, which includes the learned responses to experiences that influence the development of the personality.  Pavlov laid the ground with animal experiments and that the same rules apply to humans in simple ways that can show emotional responses, such as fear, to otherwise neutral stimuli based on experiences.  Someone who has been robbed at night, for instance, may be afraid to go out at night; his behavior, and hence a component of his personality has been behaviorally learned by experience.

Pavlov was able to create neurotic behaviors in animals appeared to be similar to those in humans with experiments that altered and confused the presented stimulai, such as with his changing of the shapes of circles, further showing the effects of classical conditioning on personality.  Friedman and Schustack give an example of children who become anxious and confused when they cannot guess praise or punishment responses of their unstable and, hence, unpredictable parents.  Pavlov was primarily interested in behavioral responses; the thinking and feeling components of the effect classical conditioning on the personality was expanded by Watson, a contemporary to Pavlov, who developed conditioned emotional responses (Rilling, 2000).  Rilling writes that Watson actually absorbed ideas from psychoanalysts such as Freud whose entire work was the basis of personality, and proved certain aspects of their theories with classical conditioning experiments, even though he strongly disapproved of psychoanalytic theory. 

With his "Little Albert" experiment, Watson conditioned a small child to fear a rat that the child was previously unafraid of with a loud noise that produced fear when the child was playing with the rat.  Very significantly, Watson proved the transference component of Freud's theory of affect that shows emotional response, or learning, is redirected from one object to another.  The child's fear response to a rat was transferred to another similar but neutral object, a rabbit.  Watson explained the "transfer of emotion behavioristically" without the unconcious as a mediator as it had been in Freud's version of transference.

To show the importance of transference, in therapy it is used to describe the transfer of feelings.  In the broader sense, the transfer of feelings is describes emotional bonding.

transference: communication

References

Rilling, M. (2000). John Watson's paradoxical struggle to explain Freud. American Psychologist, 55(3), 301-312. doi:10.1037/0003-066X.55.3.301.

Depression: Social interventions

Behavioral Activation (BA) practitioners respond to difficulties in treating depression by focusing on mechanisms that reinforce depression, a process they describe as quite painful (Dimidjian, 2006).  Other difficult forms of CBT therapy tend to elicit a high dropout rate (Zayfert, 2005).  In addition, there are other barriers to successful therapy, ranging from low medication adherence (Prukkanone, 2010) to high relapse rates and the often high cost of therapy (Paykel, 2007). 

An alternative to medication and CBT is to attempt to reinforce social supports.  Depressed individuals may see themselves as outcasts, but even recalling a pleasurable group activity may help lift their spirits; this implies that feeling they have an important social role may reverse factors that reinforce depression (Scheff, 2009).  Social belonging can also reduce suicidal ideation (McLaren & Challis, 2009).  While social conflict increases depression, conflict resolution can reduce it (Vranceanu, 2009); when depressed individuals engage in dysfunctional social behaviors, it is often the result of misinterpreting social events (Steger, 2009). 

Social interventions may be most beneficial for clients with high social functioning, as pregnant women with depression benefited the most from a perception of social importance when they rated high on social functioning (O'Mahen, 2010).

An example of a reaction the difficulties in treating depression has been the development of Behavioral Activation (BA), which hones CBT  by focusing on the mechanisms that reinforce depression in way that even BA practitioners describe as painful (Dimidjian, 2006). 

This further shows the difficulty of depression treatment, as difficult forms of CBT therapy elicit a high dropout rate (Zayfert, 2005).  There are many other barriers to both medication and talk therapies: medication adherence is often low (Prukkanone, 2010), replase can be high, and a significant barrier is therapist cost (Paykel, 2007).

An alternative to medication and CBT is to attempt to reinforce social supports.  The depressed may see themselves as social outcasts, and even a memory of group activity can lift their spirits implying that a perception of importance in society can reverse depression reinforcers (Scheff, 2009).  A sense of belonging can reduce suicidal ideation (McLaren & Challis, 2009).  Social conflict increases depression, and hence a resolution of conflict can reduce it (Vranceanu, 2009), and dysfunctional social behavior that comorbid with depression is often the result of the misinterpretation of social events (Steger, 2009).

For pregnant women with depression, a perception of social importance benefited those who where high in social function.  So, perhaps these social effects apply most to the high social functioning clients.

References

DeMarco, C. (1998, June). On the impossibility of placebo effects in psychotherapy. Philosophical Psychology, p. 207. Retrieved from Academic Search Premier database.

Dimidjian, S., Hollon, S., Dobson, K., Schmaling, K., Kohlenberg, R., Addis, M., et al. (2006). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology, 74(4), 658-670. doi:10.1037/0022-006X.74.4.658.

Hougaard, E. (2010). Placebo and antidepressant treatment for major depression: Is there a lesson to be learned for psychotherapy?. Nordic Psychology, 62(2), 7-26. doi:10.1027/1901-2276/a000008.

O'Mahen, H., Flynn, H., & Nolen-Hoeksema, S. (2010). Rumination and interpersonal functioning in perinatal depression. Journal of Social & Clinical Psychology, 29(6), 646-667. Retrieved from Academic Search Premier database.

Paykel, E. (2007) Cognitive therapy in relapse prevention in depression. International Journal of Neuropsychoparmacology 10(1), 131-6.

Prukkanone, B., Vos, T., Burgess, P., Chaiyakunapruk, N., & Bertram, M. (2010). Adherence to antidepressant therapy for major depressive patients in a psychiatric hospital in Thailand. BMC Psychiatry, 1064-68. doi:10.1186/1471-244X-10-64.

Scheff, T. (2009). A Social theory and treatment of depression. Ethical Human Psychology & Psychiatry, 11(1), 37-49. doi:10.1891/1559-4343.11.1.37.

Vranceanu, A., Gallo, L., & Bogart, L. (2009). Depressive symptoms and momentary affect: the role of social interaction variables. Depression & Anxiety (1091-4269), 26(5), 464-470. doi:10.1002/da.20384.

Zayfert, C., DeViva, J., Becker, C., Pike, J., Gillock, K., & Hayes, S. (2005). Exposure Utilization and Completion of Cognitive Behavioral Therapy for PTSD in a “Real World” Clinical Practice. Journal of Traumatic Stress, 18(6), 637-645. doi:10.1002/jts.20072.

Placebos in therapy

It is widely known that antidepressants are extremely effective for depression.  It is also widely reported in clinical studies that placebos are nearly as effective, typically 10 to 15% behind the medications being tested; this placebo effect has grown in recent years (Hougaard, 2010).  This phenomena has raised speculation as to why this occurs and critical inquiry into the effectiveness of antidepressants (DeMarco, 1998).  Strictly speaking, a placebo is an inert version of a medication (or other therapy), but the placebo is not necessarily inert.  Extending this is an inquiry into psychotherapy:  perhaps psychotherapy is, in a sense, a placebo for the supports provided by family and society for those suffering from depression.

An attempt to lower the placebo effect is the use of a run-in phase, or test, to find and eliminate participants who respond to placebos (Hougaard, 2010).  But a meta-study found that studies that used a run-in phase were not significantly different from those that didn't.  Some find fault in the nature of antidepressant efficacy trials, showing that a majority of the depressed would not qualify to participate in the trials (Zimmerman, 2005).  Eliminating factors include comorbid anxiety, previous episodes, a possibility of suicide, or social impairments.

Two likely explanations for the placebo effect are an expectation for improvement by participants (that may be supported by industry advertising), and that the interaction between participants and clinicians initiates a healing phase (Hagen, 2010).  Explanations like these imply that efficacy trials themselves are therapy, and for this reason, psychotherapy should first be attempted, followed by medication.  The greatest efficacy for depression combines counseling and medicine; the combination shows 15-20% improved efficacy for chronic severe depression.  Counseling is the better long-term therapy as it helps prevents relapse.

There is temptation to use the placebo effect as it has fewer side effects than medications (Kirsch, 2002).  But their deceptive nature inhibits their use.  The best approach to the placebo effect is to attempt to understand why it is beneficial and to apply its components in ways that clients can accept.

References

DeMarco, C. (1998, June). On the impossibility of placebo effects in psychotherapy. Philosophical Psychology, p. 207. Retrieved from Academic Search Premier database.

Dimidjian, S., Hollon, S., Dobson, K., Schmaling, K., Kohlenberg, R., Addis, M., et al. (2006). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology, 74(4), 658-670. doi:10.1037/0022-006X.74.4.658.

Hagen, B., Wong-Wylie, G., & Piji-Zieber, E. (2010). Tablets or Talk? A critical review of the literature comparing antidepressants and counseling for treatment of depression. Journal of Mental Health Counseling, 32(2), 102-124. Retrieved from Academic Search Premier database.

Hougaard, E. (2010). Placebo and antidepressant treatment for major depression: Is there a lesson to be learned for psychotherapy?. Nordic Psychology, 62(2), 7-26. doi:10.1027/1901-2276/a000008.

Kirsch, I., Moore, T., Scoboria, A., & Nicholls, S. (2002). The emperor's new drugs: An analysis of antidepressant medication data submitted to the U.S. Food and Drug Administration. Prevention & Treatment, 5(1), 23. doi:10.1037/1522-3736.5.1.523a.

Zimmerman, M. (2005). Generalizability of antidepressant efficacy trials: Differences between depressed psychiatric outpatients who would or would not qualify for an efficacy trial. American Journal of Psychiatry 162, pp. 1370-1372, July 2005.  Retrieved October 24, 2010 from http://ajp.psychiatryonline.org/cgi/content/full/162/7/1370

Alzheimer's and relationships

AD is most commonly diagnosed with the Mini-Mental State Examination (MMSE), which may also provide false positive results for other AD-like dementia disorders (Mahoney, 2005).  But for the 11 million Americans who provide unpaid care to family elders diagnosed with AD, the distinction is immaterial as there is no cure for these types of dementia.  Their care is valued at $144 billion in the US per year, and their stress-related suffering is such that they often feel relief with the death of their AD-affected relative (Alzheimer's Association, 2010).

While the cause of AD is known to be a dysfunction of β-amyloid peptides in the brain (Srivareerat, 2009), there is no diagnosis for AD other than cognitive testing (Mahoney, 2005).  Remarkably, autopsies of AD patients for a study by Wilson show that approximately half didn't show a peptide dysfunction, and, according to his study, loneliness was instead implicated in the AD-like cognitive loss (Wilson, 2006).

Wilson shows that loneliness may cause neural decline that leads to AD-like dementia (Wilson, 2006), and he also shows in a later study that cognitive activity can help prevent AD-like decline (Wilson, 2007).  Together, his studies suggest care and preventive strategies that family members can implement through social support.

AD patients respond well to music, especially when it elicits positive memories (Howe, 2008).  Music is recommended for cognitive rehabilitation (Thaut, 2010) and it is socially connective, making it an ideal vehicle for manifesting Wilson's suggestions.

Geist is a caregiver for her AD-afflicted father and leverages her father's musical background to elicit responses from him as he has lost many of his cognitive abilties. (Geist, 2009).  He was brought home from a nursing facility when his death seemed likely, and has since been kept from retreating with the use of music.  He continues to express music and successfully gave a public musical performance despite his significant cognitive impairment.


References

Alzheimer's Association. (2010). Alzheimer’s Disease Facts and Figures. Retrieved October 29, 2010 from http://www.alz.org/documents_custom/report_alzfactsfigures2010.pdf

Geist, M. (2009). My father's musical lifeline. Prevention, 61(4), 161-163.

Howe, E. (2008, February) Key psychosocial interventions for Alzheimer’s disease: An update. Psychiatry MMC. Retrieved October 29, 2010 from http://www.psychiatrymmc.com/key-psychosocial-interventions-for-alzheimer%E2%80%99s-disease-an-update/

Johns Hopkins Medicine. (2010). Alzheimer's disease.
Johns Hopkins Health Alerts, Retrieved October 29, 2010 from http://www.johnshopkinshealthalerts.com/symptoms_remedies/alzheimers/35-1.html

Mahoney, R., Johnston, K., Katona, C., Maxmin, K., & Livingston, G. (2005). The TE4D-Cog: a new test for detecting early dementia in English-speaking populations. International Journal of Geriatric Psychiatry, 20(12), 1172-1179. doi:10.1002/gps.1412.

Srivareerat, M., Tran, T., Alzoubi, K., & Alkadhi, K. (2009). Chronic psychosocial stress exacerbates impairment of cognition and long-term potentiation in β-Amyloid rat model of Alzheimer's disease. Biological Psychiatry, 65(11), 918-926. doi:10.1016/j.biopsych.2008.08.021.

Thaut, M. (2010). Neurologic music therapy in cognitive rehabilitation. Music Perception, 27(4), 281-285. Retrieved from Academic Search Premier database.

Wilson, R., Krueger, K., Arnold, S., Schneider, J., Kelly, J., Barnes, L., Tang, Y., Bennett, D. (2006). Loneliness and risk of alzheimer disease. Retrieved October 27, 2010 from http://www.ageserve.com/PDF/Rush%20Loneliness%20Study.pdf

Wilson, R., Scherr, P., Schneider, J., Tang, Y., Bennett, D. (2007, June 27). Relation of cognitive activity to risk of developing Alzheimer disease. Neurology, 69, 1911-1920

Pets in therapy: Responsibility-based benefits

Animal domestication goes so far back in human history that domesticated animals have evolved with, and, hence, socially integrated into humanity; more children live with pets than both parents (Walsh, 2009).  As much of psychology, especially depression, benefits from social supports, it seems reasonable that "companion animals" should be able to help provide physical and mental well-being.  Two areas stand out in this context: programs for the elderly who suffer mental illness that bring specifically-trained dogs to visit them, and prison programs that leverage dog training as part of rehabilitation.

An elder mental health study demonstrated the strengths of animal-assisted therapy with a modest program that brought specifically trained dogs for 90-minute weekly visits to a nursing home six times (Moretti, 2010).  The elder patients, mostly women averaging age 85, suffered from dementia (47.6%), psychosis (33.3%) and depression (19.0%).  These patients showed a 50% decrease on the Geriatric Depression Scale and a 4.5 point increase on the Mini-Mental State Examination (MMSE).  The latter is significant as 4.5 is approximately the maximal range within MMSE categories (Family Practice Notebook, 2010).

Animal-leveraged prisoner rehabilitation programs can statistically stand on their own as they lower recidivism (Ormerod, 2008).  The use of animals, usually dogs, in prison programs forces prisoners to allow well-structured positive influences to resolve their disorders so that they can benefit from the program--that is, to become free again and stay free (Walsh, 2009).  Prisoners develop responsibility for their dogs, or, perhaps, "take ownership" of their dogs' well-being, reversing their previously irresponsible relationships with their environments.

The companionship component of the "companion animal" relationship with humanity can assist therapy for the suicidally depressed, further showing  responsibility-based benefits.  Pet owners who ideate suicide report that they would never act on the ideation because they do not want to leave their pets un-cared for (Walsh, 2009).

References

Family Practice Notebook. (2010). Mini-mental state exam. Retrieved October 30, 2010 from http://www.fpnotebook.com/neuro/exam/MnMntlStExm.htm

Moretti, F., Bernabei, V., Marchetti, L., Bonafede, R., Forlani, C., De Ronchi, D., et al. (2010). P01-364 - A Pet therapy intervention on elderly inpatients: an epidemiological study. European Psychiatry, 25577. doi:10.1016/S0924-9338(10)70572-1.

Ormerod, E. (2008). Companion Animals and Offender Rehabilitation – Experiences from a Prison Therapeutic Community in Scotland. International Journal of Therapeutic Communities 29(3). Retrieved November 1, 2010 from http://www.eftc-europe.com/tcjournal/issues/29.3.pdf#page=69

Walsh, F. (2009). Human-Animal Bonds I: The relational significance of companion animals. Family Process, 48(4), 462-480. doi:10.1111/j.1545-5300.2009.01296.x.

Operant conditioning

The three term contingency

Operant conditioning is described in three phases that describe behaviors, the influences that precede them, and their results:

1. what happens to influence a behavior--the antecedent or discriminative stimulus;
2. the behavior itself, or operant response; and
3. what happens as a result of the behavior--a consequence that reinforces the behavior, or an opposite consequence that punishes the behavior.

In a very simple context, a person gets hungry, eats, and no longer feels hunger as a result.  The loss of hunger supports a repeat of the behavior  At the very beginning of life, this three-term contingency is created so that the infant can obtain nourishment.

Discrimination describes what a person has learned from previous experience that will influence the operant response, or behavior that will take place.  The learning that occurs as a consequence of this behavior, which may be reinforcing or punishing, will influence future behaviors in their discriminant phases; this shows the cyclic nature of the three-term contingency.

The consequence, or third component, can be either a reinforcement, which increases the likelihood of the behavior being repeated, or, conversely, punishment, which reduces the likelihood of a behavior being repeated.

Punishment and reinforcement can be either negative or positive:

• Positive reinforcement means a benefit is given, or in the case of money a mediating benefit called a secondary reinforcer is given, which has the same effect as a reinforcer.
• Negative reinforcement creates a benefit by removing something that is undesirable, or aversive.  This is the effect of taking medicine.  The reinforcement process is avoidance reconditioning.
• Positive punishment describes the adding of something undesirable, or aversive.
• Negative punishment is the removal of something beneficial as a consequence.

Variations in reinforcements will affect learning and responses, such as schedules of reinforcement that describe the effectiveness of the timing and occurance of reinforcement, and conditioned reinforcers, such as money, that mediate tangible reinforcements such as food and clothes.

Bandura's social learning and Lewin's valence ideas

Bandura's learning theory goes beyond classical or operant theories by suggesting that behavior is influenced by observations of the surrounding environment that model behaviors.  The antecedent or discriminative stimulus component is learned socially rather than from personal experience (Friedman & Schustack, 2009).  Further, his most famous study shows how children, without the reinforcement component of operant conditioning, learn from a film how to "beat up" a large doll, and then immediately repeat the learning in real life (J. Dyce, personal communication, n.d.).  Self-regulation is also important to Bandura, as he says we are able to control behavior, giving us the concept of "free will," which is something neither pure behaviorists nor psychoanalytic schools provide (Friedman & Schustack, 2009).

Bandura's view of learning began as a social learning behavioral model, and is now described as social cognition, which shows his shift to a cognitive approach.  The observational learning component relies on cognition, or attention; memory, or retention; and abilities to work with what is learned, which is reproduction.  Further, there has to be motivation on the part of the learner to see that observed learning is reinforced into behavior, and also to share what has been learned in ways that may extend to the observed learning of others.  To initiate a behavior in the attention phase, the learned information must be attractive to the learner to motivate the learner to absorb, remember, and act on it.  This information is described in terms of distinctiveness, complexity, value, and affective, or emotional, valence.  Valence is a spatial concept that describes the emotional value of an event in social terms.  Motivation, which in the bigger picture is necessary for success, is related to a confident self-perception called self-efficacy that describes an individual's strength to overcome adversity and achieve goals.

His use of words such as vicarious and valence helps illustrate the social nature of his ideas.  Vicarious is used to describe the acquisition of the learning from the behavioral experiences of others.  The "emotional" attractiveness of observed objects is called valence (J. Dyce, personal communication, n.d.).  The term valence is used by Kurt Lewin, a social psychologist who described it in the contexts of "field theory" and "vectors" (Freeman, 1940) in ways that support Bandura's social modeling theory from an unusual, yet scientific, angle.  Freeman describes Lewin's field-theory as stating that "properties of behaviour" (1940, p. 1) are the product of "dynamic relationships between neural activities" (1940, p. 1).

References

Freeman, G. (1940). Concerning the 'field' in 'field' psychology. Psychological Review, 47(5), 416-424. doi:10.1037/h0063216.

Friedman, H.S. & Schustack, M.W.  (2009).  Personality: Classic theories and modern research (4th ed.).  Boston, MA: Allyn and Bacon.

Extinction for addiction: Conditioned compensatory response

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Note: this describes a purely-behavioral approach, which, by the nature of behaviorism, deliberately ignores underlying factors such as addiction vulnerability (compulsive-impulsive-obsessive continuum?).  In practice, such approaches are unconcerned with specific clients seeking, instead, beneficial statistical outcomes for agency and directorial self-benefit.

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Conditioned behavior is a key component of drug addiction, but the conditioned and unconditioned pairing stimuli and responses happen in different, or perhaps opposite, ways than would be expected from basic classical conditioning (J. Dyce, personal communication, n.d.).  In this case the conditioned response is called the conditioned compensatory response, and the conditioned stimulus is called a cue, which serves an important function in this model.  An accepted therapy for drug addiction uses another conditioned behavior process, extinction, in conjunction with this compensatory process.

Cues describe the components of an addict's environment; in lay terms, they serve as a reminder to the addict of his addiction.  As a conditioned stimulus, they stimulate craving for the drug that goes beyond a possible physical addiction, so much so that they cause craving when there is no physical addiction.

When extinction is used as a therapy, a recovering addict is exposed to the cues from his environment but not given the unconditioned stimulus, or drug, to create the unconditioned response, which is drug-induced euphoria.  Eventually, the effect of the cues, or the conditioned stimulus, to create the craving, or conditioned response, diminishes as a result of extinction, and the addict is cured of addiction--at least momentarily.  To maintain the therapeutic benefit of extinction, the addict has to avoid the cues, presumably by not returning to the drug-related cues of his past environment.

There are also internal cues, called pre-drug cues, that complicate the addict's experience and hopeful therapy by increasing tolerance and withdrawal symptoms (Siegel, 2005).  For example, drug-onset describes how a conditioned stimulus will cause a life-long alcoholic to relapse.  The taste of an alcoholic drink, a drug-onset cue, acts as a conditioned stimulus that is associated with the effect of alcohol that triggers the craving that defines addiction.

Siegel, S. (2005). Drug Tolerance, Drug Addiction, and Drug Anticipation. Current Directions in Psychological Science (Wiley-Blackwell), 14(6), 296-300. doi:10.1111/j.0963-7214.2005.00384.x.

Conditioned stimulus (CS cues) causes no response

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Conditioned compensatory responses

1) Pre-condition

Conditioned stimulus (CS cues ) causes no response

Unconditioned stimulus (UCS drug ) causes unconditioned response (UCR euphoria )

Combine CS-cue with UCS-drug to cause UCR-euphoria

2) CS-cue causes CR-craving, does not modify UCR-euphoria to become CR-euphoria

3) CS-cue causes CR-craving (CR) to create behavior to get drug (UCR)

Extinction

Gradual weakening of CR-craving (conditioned response) from CS-cue (conditioned stimulus) when no UCS-drug (unconditioned stimulus) is provided to cause UCR-euphoria (unconditioned response)

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Tolerance is learned:

The stimuli present at the time of drug administration are the conditional stimulus (CS),
while the effect produced by the drug is the unconditional stimulus (UCS).
drug effects involve disruption of the homeostatic level of physiological systems (e.g., alcohol lowers body temperature), and these disruptions elicit compensatory responses that tend to restore functioning to normal levels.
The compensatory, restorative response to a drug effect is the unconditional response (UCR).
usual predrug cues coming to elicit as a conditional response (CR) the compensatory, restorative response

In order to eliminate a CR, it is necessary to present the CS not followed by the UCS, a procedure termed extinction.

Research indicates that the loss of tolerance occurs as a result of extinction of drug-compensatory CRs.

"Conditioned Tolerance." Encyclopedia of Drugs, Alcohol, and Addictive Behavior. 2nd Ed. Ed. Rosalyn Carson-DeWitt. Macmillan-Thomson Gale, 2001.
http://www.enotes.com/drugs-alcohol-encyclopedia/conditioned-tolerance

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Understanding the basis of drug addiction, along with applying therapies to treat it, relies on behavioral science. 
cues associated with drug use (friends, place, smells, behaviors prior to use) cause craving as a CR which is the opposite of the drug pleasure.

Extinction drug approach -- extinction, provide cues but no drugs so that the response to the cues goes away -- without UCS, cravings go away

 conditional response that opposes, rather than being the same as, the unconditional response

drugs
the conditioned compensatory responses produced by taking heroin oppose the desired effects of the drug.

When a drug is taken in a new environment, there will be less conditioned compensatory response and the drug will have an enhanced effect.
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Drug use
cues associated with drug use (friends, place, smells, behaviors prior to use) cause craving which is a conditioned response CR which is craving -- which is not the drug (unlike food)

Hunger and drug are different because they use different bodily functions

Extinction drug approach -- extinction, provide cues but no drugs so that the response to the cues goes away -- without UCS, cravings go away

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interoceptive early-drug onset cues (DOCs) may become associated with the later, larger drug effect (intraadministration associations)

The findings suggest that associative analyses of tolerance should acknowledge the conditional responding elicited by DOCs, and extinction-based addiction treatments should incorporate extinction of DOC-elicited conditional responding.


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The phenomenon, although noted almost 150 years ago, has repeatedly been confirmed in epidemiological and experimental studies.

Siegel, S. (1999). Drug anticipation and drug addiction. The 1998 H. David Archibald Lecture. Addiction, 94(8), 1113-1124. doi:10.1080/09652149932901.

Behavioral learning perspective on personality

Behavioral learning perspective on personality

Life is a continual series of experiences that are paired with parallel, perhaps symbolic, meanings that enable us to use learning from previous experiences to help when people, and other intelligent organisms, have the same, or similar, experiences while going through life (J. Dyce, personal communication, n.d.).  Classical conditioning describes experiences in terms of stimuli and reactions or responses.  These are paired with parallel events that represent these experiences called conditioned stimuli, which were previously unrelated to the actual stimuli, and conditioned responses that resemble the original response.

Pavlov laid the ground work with animal experiments.  Watson showed that the same conditioning rules apply to humans with respect to emotional responses, such as fear, to otherwise neutral stimuli based with his well-known "Little Albert" experiment.  In the behavioral view, these emotional responses shape our personality.

Pavlov used food, dogs, and auditory stimuli to prove the principles of classical conditioning (J. Dyce, personal communication, n.d.):

1. Pre-condition: Conditioned stimulus (CS-bell) causes no response.
2. Unconditioned stimulus (UCS-food) causes Unconditioned Response (UCR-salivation).
3. Combine CS-bell (conditioned stimulus) with UCS-food (unconditioned stimulus) while triggering UCR-salivation (unconditioned response) to create CR-salivation (conditioned response).
4. CS-bell (conditioned stimulus) causes CR-salivation (conditioned response)

Someone who has been robbed at night, for instance, may develop a variety of fears that will typify his personality because of the experience such as a fear of going out at night or a fear of strangers.

Pavlov was able to create neurotic behaviors in animals that appeared to be similar to those in humans with experiments that altered and confused the animals when they were presented with confusing stimuli, such as changing the shapes of circles, that further revealed the effects of classical conditioning on personality (J. Dyce, personal communication, n.d.).  Friedman and Schustack give an example of children whose personalities are affected by their unstable parents; they become anxious and confused when they cannot predict praise or punishment responses from their parents (2010). 

As Pavlov was primarily interested in behavioral responses, the thinking and feeling components of classical conditioning that affect personality were expanded by Watson, a contemporary to Pavlov, who developed the concept of conditioned emotional responses (Rilling, 2000).  Rilling writes that Watson actually absorbed ideas from psychoanalysts such as Freud whose entire work was to theorize personality (2000).  Watson proved certain aspects of their theories with classical conditioning experiments, even though he was apparently unimpressed by psychoanalytic theory. 

With his "Little Albert" experiment, Watson conditioned a small child to fear a rat that the child was previously unafraid of by using a loud noise, or unconditioned stimulus, that produced fear in the child while he was playing with the rat (J. Dyce, personal communication, n.d.).  Importantly, Watson then showed that the child's fear response to the rat was transferred to another similar but neutral object, a rabbit.  Watson proved the transference component of Freud's theory of affect that shows emotional response, or learning, is redirected from one object to another (Rilling, 2000). As Rilling states, Watson explained the "transfer of emotion behavioristically" (p. 7) without the using the unconcious as a mediator as Freud had in his approach to transference.

Today the term transference is used in therapy to describe the transfer of feelings.  In a broader sense, the term may be used to describe the transfer of feelings in describing emotional bonding.

Rilling, M. (2000). John Watson's paradoxical struggle to explain Freud. American Psychologist, 55(3), 301-312. doi:10.1037/0003-066X.55.3.301.
Friedman, H.S. & Schustack, M.W.  (2009).  Personality: Classic theories and modern research (4th ed.).  Boston, MA: Allyn and Bacon.

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Notes:
1) pre-condition
Conditioned stimulus (CS Bell) causes no response
Unconditioned stimulus (UCS food) causes Unconditioned Response (UCR salivation)
2) combine CS-bell with UCS-food to cause UCR-salivation
3) CS-bell (conditioned stimulus) causes CR-salivation (conditioned response)
Conditioned stimulus (CS Bell)  causes conditioned response (CR salivation)
“the whole of behaviorism is but an expression of the fact that infancy and childhood slant our adult personalities” (Watson, 1924, p. 242)
Watson, J. B. (1924). Behaviorism. New York: Norton.
process of displaced emotion without producing a scrap of publishable data until he conducted the famous case study with the infant know to history as Little Albert (Watson & Rayner, 1920). This experiment was the tour de force of Watson's struggle to explain psychoanalytic concepts in terms of classical conditioning. The study confirmed Freud's prediction that affect could be transferred from one object to another. Historical research suggests that Watson and Rayner's (1920) experiment was inspired not only by Russian research on classical conditioning but also by Watson's major objective of explaining psychoanalytic concepts in terms of classical conditioning (Watson & Morgan, 1917).
For Watson, development from childhood to adulthood was a process by which the habits of childhood were replaced by the habits of adulthood.
Although Watson never entirely abandoned trying to explain personality development in terms of habit, he gradually turned his attention toward what was then for American psychologists the new method of classical conditioning (Watson, 1916b). Watson described the transition in his thinking from habit to the conditioned reflex as follows: “When I began to dig into the vague word HABIT … I saw the enormous contribution Pavlov had made, and how easily the conditioned response could be looked upon as the unit of what we had all been calling HABIT (Watson, 1937, p. •••). First, the conditioned reflex became Watson's unit for learning (1916b). Then, Watson returned to his long-standing interest of trying to explain the concepts of psychoanalysis in terms of concepts from learning theory. Soon after beginning his research program on classical conditioning, Watson was explaining Freud in terms of classical conditioning (Watson, 1916a).
adapting Pavlov's methods to study the emotions of infants. Pavlov had shown no interest in the emotions,
Pavlov's unconditioned stimulus was a tool that was helpful. An unconditioned stimulus could be used in the laboratory to produce unconditioned emotional responses. If unconditioned emotional responses could be produced at will in a laboratory, did conditioned emotional responses also exist?
Watson's most original contribution to learning theory was the discovery of a new category of conditioning called conditioned emotional responses that emerged from his research program on children's learning of fears (Watson & Rayner, 1920). The idea was that a central emotional state, such as conditioned fear, was established when a neutral stimulus was paired with an unconditioned stimulus that previously elicited a specific unconditioned emotional state, such as unconditioned fear.
Pavlov's salivary reflex and then went on to describe Bechterev's work on conditioned motor reflexes.
we believe that the ductless glands which are so important for the emotions are conditioned in the same way

conditioned emotional responses was used by Watson to compete with two psychoanalytic concepts that were part of Freud's theory of affect: transference and displacement

conditioned emotional reflexes. Any stimulus (non-emotional) which immediately (or shortly) follows an emotionally exciting stimulus produces its motor reaction before the emotional effects of the original stimulus have died down. A transfer (conditioned reflex) takes place (after many such occurrences) so that in the end the second stimulus produces in its train now not only its proper group of motor integrations, but an emotional set which belonged originally to another stimulus. Surely it is better to use even this crude formulation than to describe the phenomenon as is done in the current psychoanalytic treatises. (Watson, 1916a, p. 596)

Notice that Watson made a procedural slip by describing the normally ineffective backward conditioning procedure in which the unconditioned stimulus precedes the conditioned stimulus. The distinction between forward and backward conditioning was not as salient in Watson's day as it is now.

Instead of using the word acquisition to describe the learning of a conditioned emotional response, Watson borrowed a diminutive transfer from Freud's transference. With conditioned emotional responses, Watson at last had a concept that could explain the transfer of emotion behavioristically without an appeal to Freud's unconscious.

Watson and Rayner's (1920) experiment with Little Albert is well known. Less well known is that their experiment was designed to test a theory of emotions developed by Watson and Morgan (1917). Morgan earned his doctor of philosophy degree in psychology at Columbia University and spent a postdoctoral year with Watson at Johns Hopkins University. Watson and Morgan's theory was inspired, in part, by Freud's ideas about the emotional development of personality. Infancy was an important stage of personality development for Freud, and he traced psychopathology in adults back to events during infancy.
proposing behavioristic testing of the theory on infants in the laboratory with the method of Pavlov.
“We venture to predict that the one thing that will stand out as distinctly Freudian will be their utilization of the principle of Uebertragung [transference]. To our mind this is the essential concept in Freudian Psychology”
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that describe  the infant is a "blank slate"  previously neutral stimulus can come to have a learned effect on someone

pairing (associating) a unconditioned stimulus (which already produces an unconditioned response) with a neutral stimulus (conditioned stimulus)

likes and dislikes, the preferences and biases that define one�s personality, develop through emotional conditioning

conditioning processes may underlie many of people�s preferences for persons, events, things, places, and ideas.

most likes and preferences AND dislikes and biases that DEFINE our personality develop through EMOTIONAL CONDITIONINGorganism learns to respond to the conditioned stimulus with a conditioned response which is like the  unconditioned response.

• Linking neutral stimulus with pleasant event/feeling --> positive preference
• Linking neutral stimulus with upsetting event/feeling --> aversion or bias

Start as a "blank slate"

learn everything as a result of environmental effects to create responses

http://wilderdom.com/personality/L9-0LearningPerspectivesPersonality.html 

the learning perspective differ from perspectives that propose that a person is born with an innate nature or personality structure -- some biological theories call it temperament, trait theories call it dispositions, psychoanalysts call it drives or instincts and the humanists also use the term drives

paired associations:

"Many of our behaviors today are shaped by the pairing of stimuli. If you ever noticed certain stimuli, such as the smell of a cologne or perfume, a certain song, a specific day of the year, results in fairly intense emotions. Its not that the smell or the song are the cause of the emotion, but rather what that smell or song has been paired with...perhaps an ex-boyfriend or ex-girlfriend, the death of a loved one, or maybe the day you met you current husband or wife. We make these associations all the time and often don’t realize the power that these connections, or pairings have on us. But, in fact, we have been classically conditioned."

(from http://allpsych.com/personalitysynopsis/conditioning.html)