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PTSD After Sexual Trauma: Vulnerability and Resilience

This article will explore a range of psychological research investigating the factors that can contribute to one’s vulnerability and resilience to post-traumatic stress disorder (PTSD) after experiencing sexual trauma.

Trigger warning: Sexual trauma can be a distressing and uncomfortable topic; you may want to consider this before reading as a note of caution.

Definition and Consequences of Sexual Trauma

Sexual trauma is defined as “one or multiple sexual violations that invoke significant distress”, and any lasting emotional, psychological or physical symptoms that result from this. This can result from rape, incest, molestation, physical assault or any kind of force or pressure into sexual activity.

The consequences of sexual trauma can manifest in a multitude of ways, and many are ‘normal’ reactions. One reason why some experience PTSD after sexual trauma while others do not is that they go on to experience a wide range of other mental health problems other than PTSD, such as depression or substance abuse; however, they can and often do occur co-morbidly. Further consequences might include difficulty trusting others and establishing intimate relationships. Because of the diverse nature of PTSD, it is important to use an integrative, person by situation interactional model when analysing vulnerability and resilience to the disorder.

The current criteria as provided in the Diagnostic and Statistical Manual of Mental Disorders (DSM V) for PTSD (adapted for the context of sexual trauma) are as follows:

A: Exposure to sexual trauma e.g. rape, sexual assault, incest, molestation…

B: Intrusion Symptoms e.g. repeated thoughts / memories of the assault, nightmares, flashbacks…

C: Persistent avoidance of thoughts, feelings and situations associated with the sexual trauma

D: Negative alterations in cognitions and mood that are associated with the traumatic event

E: Alterations in arousal and reactivity associated with the trauma e.g. difficulty sleeping or concentrating, jumpiness, irritability…

F: Persistence of symptoms for more than one month

G: Significant symptom-related distress or functional impairment that is not due to any other factor than the trauma itself

H: Symptoms not due to medication, substance misuse or illness

Prevalence of PTSD After Sexual Trauma

It can be difficult to determine the exact prevalence of PTSD after sexual trauma as many incidences go unreported. However, there is still a considerable amount of research suggesting that sexual trauma is the most likely to induce PTSD. Women are more likely to experience PTSD after sexual trauma than men, and this is not accounted for by differences in perceived threat to life or injury. However, many more women than men are subject to sexual violence – a figure that is likely influenced again by lack of disclosure on mens’ behalf. Reported rates of PTSD in rape victims vary from 30 to 65% depending on how and when symptoms are assessed.

History of Sexual Abuse

 

There is significant evidence that a history of childhood sexual abuse can be a contributing factor increasing an individual’s vulnerability to PTSD after a sexual traumatic event when they are adults. Sexual abuse in childhood can cause chronic genital pain, which can make sexual assault or contact in future more physically traumatic and is linked with PTSD symptoms. Those who are sexually abused in childhood are twice as likely to be assaulted as adults, so any consequences of childhood abuse such as feelings of guilt, lack of perceived control and low self-esteem that are very common in these cases can carry on into adulthood and predispose someone to experience PTSD after future sexual traumatic experiences. Therefore, those who are more resilient to PTSD are less likely to have experienced such events in childhood.

Event Characteristics

In a representative sample, 58% of women who had experienced PTSD named sexual assault to be the worst traumatic event they had experienced, suggesting that there is something specific to sexual trauma that makes people particularly susceptible to experiencing the disorder.
It might be that the personally intrusive nature of sexual trauma both during and after the assault could be a factor making one more vulnerable to experiencing PTSD. For instance, rape victims with PTSD are more likely to have been attacked by a stranger, where they experienced a threat to their physical and personal integrity, or were injured or subjected to substantial verbal and physical force. Further, aspects of the medical environment such as the use of invasive medical instruments can bring about or exacerbate distressing symptoms. However, even when event characteristics are controlled for, sexual trauma alone predicts unique variance in the risk of one developing PTSD, suggesting there are other factors at play.

Neurobiology of Trauma: HPA Axis Dysregulation

The hypothalamic-pituitary-adrenal (HPA) axis is involved in the control of stress responses, and its dysregulation is strongly implicated in the development of PTSD. This has been observed in survivors of sexual trauma. Cortisol (stress hormone) is a major facet in the HPA axis, released when stimulated by corticotropin releasing hormone (CRH) and inhibited via negative feedback acting at the hypothalamic and pituitary levels. Its dysregulation leads to inappropriate fear responses. Intense psychological trauma such as sexual abuse can disrupt this HPA axis by increasing levels of CRH. The following diagram illustrates this process in patients with and without PTSD:

Increased CRH = thick black line
Decreased adrenal release of cortisol = thin black line
Increased negative feedback inhibition of HPA axis by cortisol = thick red lines (diagram from Yehuda, Hoge, MacFarlane, Vermetten, Lanius, Nievergelt, Hobfoll, Koenen, Neylan & Hyman, 2015)

Genetic Factors

Depending on a particular variation of the FKBP5 gene involved in the HPA axis, one can either be genetically predisposed, or provided with more resilience to PTSD.

Based on twin and adoption studies, the heritability estimate for PTSD is 30 to 40%. This is linked with heritable neurobiological endophenotypes, such as lower hippocampal and prefrontal cortical volume and increased amygdala (fight-or-flight) activity, because dysregulation of the HPA axis can interact with other impairments of neurological functioning, such as in the hippocampus, which plays a critical role in emotional memories. This might explain PTSD intrusion symptoms like flashbacks and nightmares.

Cognitive Functioning

To turn to an earlier point on history of sexual abuse, women who were abused in childhood tend to have lower hippocampal volume, which when coupled with a dysregulated HPA axis can result in poorer cognitive functioning, resulting in less effective coping strategies and thus a higher risk of PTSD symptoms.

Higher prefrontal cortex volume (associated with strategic thinking, will to live) is found in those who experience trauma but not PTSD. This is linked with high IQ, which is found to be the greatest factor for resilience to PTSD as it is associated with more effective coping mechanisms. On the other hand, maladaptive beliefs and attributional styles that a victim of sexual trauma might have when interpreting the assault can exacerbate feelings of powerlessness that can contribute to the manifestation of PTSD.

Attributing blame in a way that focuses on the past and believing that one is powerless in their recovery is also associated with poorer outcomes in PTSD. For instance, believing that the world is “completely dangerous”, that one is “entirely incompetent”, or that some entity had vicarious control over the event can lead to a sense of mental defeat. It is this state of mind that can lead to one becoming highly vulnerable to PTSD.

Social Influences

Social influences are critical in shaping outcomes resulting from sexual trauma. Lack of social support is highlighted as the most important risk factor in PTSD. If a victim of sexual trauma does not have a supportive network with whom they can disclose the abuse and make sense of what has happened to them in a secure and trusting relationship, they are much more likely to go on to experience PTSD.

After sexual trauma, many people can experience secondary victimisation, where negative or stigmatising reactions from others can lead to an increased risk of PTSD, as they might also blame themselves for what happened to them, or believe that the incident has permanently transformed them or their reputation. Some of these reactions are perpetuated by rape myths, such as the idea that people often lie about being raped or that men cannot be raped. This is why it is important for victims to turn to professionals or helplines specialising in sexual trauma.

Racial, Ethnic and Cultural Influences

Symptoms of PTSD are found across races, ethnicities and cultural groups. However, the ways in which trauma and PTSD symptoms, such as dissociative or somatic symptoms, are interpreted are culturally constructed and can have a profound influence over the extent to which an individual discloses their sexual traumatic experience. This in turn impacts the extent to which they are at risk of experiencing PTSD.

Sexual assault victims of ethnic minorities tend to report more negative social reactions from others. In a triethnic study, Hispanic rape victims were shown to be the most psychologically distressed by their traumatic experience, followed by Black and finally White victims. This might be in part due to the fact that Hispanic female victims tend to engage in more avoidance behaviours and feel more shame regarding sexual trauma. This latter point will be discussed further with regard to religion*.

Resilience to PTSD After Sexual Trauma

“[Resilience is] efficacious adaptation regardless of significant traumatic threats to personal and physical integrity” (Agaibi & Wilson, 2005)

Resilience and recovery can be defined in many ways; I took this definition from Agaibi and Wilson. However, resilience is multifaceted and includes many processes that evolve over time. In the event of sexual trauma, resilience is comprised of elements of the individual and their environment that can serve as protective factors. Post-traumatic growth is a term that refers to positive psychological changes that one can experience after a trauma. This is more effective for people with certain temperamental characteristics, such as extroversion and openness to experience.

All considered, it is important to remember that resilience is complex, and having these protective factors will not necessarily generate positive or adaptive responses to sexual traumatic experiences. What may be considered resilient in one context or in one individual may not be so in another.

Some important factors to recovery as reported by survivors of sexual trauma include:

– Disclosing the abuse

– Positive self-perception

– Religion or spirituality

– Community cohesiveness

– Self-efficacy (Read more on self-efficacy in my article, here)

– Having a creative outlet

– Developing prevention strategies

*Religion can be a double-edged sword in this case, because as much as it can be a source of comfort for some people, it can also be a source of guilt; for example in Catholicism, which might explain the aforementioned fact that Hispanic women feel a lot more shame and guilt following sexual abuse. In terms of prevention strategies, recent research highlights the benefit of empowerment self-defence – an intervention proven to reduce attempted assault by 50% within a year, influence community and social norms, facilitate social support, increase autonomy and promote active coping mechanisms.

Conclusion

There are a range of biological, psychological and social factors that interact and can cause an individual to be more vulnerable or resilient to PTSD after a sexual trauma. Knowledge of these influences can serve as a vital framework for improving post-sexual-traumatic outcomes. Successful recovery is subjective, but can be measured by whether the survivor regains control of his or her life and experiences overall better functioning.

If you would like to share your views, experiences or thoughts surrounding this topic, I would love to hear from you. Please leave a comment or send me a message:

Works Cited

Agaibi, C. E., & Wilson, J. P. (2005). Trauma, PTSD, and resilience a review of the literature. Trauma, Violence, & Abuse6(3), 195-216.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition: (DSM-5) (American Psychiatric Association, 2013).

Anderson, K. M. (2006). Surviving incest: The art of resistance. Families in Society: The Journal of Contemporary Social Services, 87(3), 409-416.

Anderson, K. M., & Hiersteiner, C. (2008). Recovering from childhood sexual abuse: Is a “storybook ending” possible?. The American Journal of Family Therapy36(5), 413-424.

Bennice, J. A., Resick, P. A., Mechanic, M., & Astin, M. (2003). The relative effects of intimate partner physical and sexual violence on post-traumatic stress disorder symptomatology. Violence and victims18(1), 87-94.

Binder, E. B., Bradley, R. G., Liu, W., Epstein, M. P., Deveau, T. C., Mercer, K. B., … & Schwartz, A. C. (2008). Association of FKBP5 polymorphisms and childhood abuse with risk of posttraumatic stress disorder symptoms in adults. Jama299(11), 1291-1305.

Bogar, C. B., & Hulse‐Killacky, D. (2006). Resiliency determinants and resiliency processes among female adult survivors of childhood sexual abuse. Journal of Counseling & Development84(3), 318-327.

Bolstad, B. R., & Zinbarg, R. E. (1997). Sexual victimization, generalized perception of control, and posttraumatic stress disorder symptom severity. Journal of anxiety disorders11(5), 523-540.

Bownes, I. T., O’Gorman, E. C., & Sayers, A. (1991). Assault characteristics and posttraumatic stress disorder in rape victims. ActaPsychiatricaScandinavica83(1), 27-30.

Bradley, R., Greene, J., Russ, E., Dutra, L., & Westen, D. (2005). A multidimensional metaanalysis of psychotherapy for PTSD. [Review]. American Journal of Psychiatry, 162, 214-227.

Brand, B. L., & Alexander, P. C. (2003). Coping with incest: The relationship between recollections of childhood coping and adult functioning in female survivors of incest. Journal of traumatic stress16(3), 285-293.

Brewin, C. R. (2011). The nature and significance of memory disturbance in posttraumatic stress disorder. Annual review of clinical psychology7, 203-227.

Carson, D. K., Council, J. R., & Vole, M. A. (1989). Temperament as a predictor of psychological adjustment in female adult incest victims. Journal of Clinical Psychology, 45(2), 330- 335.

Chivers-Wilson, K. A. (2006). Sexual assault and posttraumatic stress disorder: A review of the biological, psychological and sociological factors and treatments. Mcgill journal of medicine9(2), 111.

Dass-Brailsford, P. (2005). Exploring resiliency: academic achievement among disadvantaged black youth in South Africa:’general’section. South African Journal of Psychology35(3), 574-591.

Frazier, P. A. (2003). Perceived control and distress following sexual assault: a longitudinal test of a new model. Journal of personality and social psychology84(6), 1257.

Hughes, V. (2012). The roots of resilience. Nature490(7419), 165.

Lefley, H. P., Scott, C. S., Liabre, M., & Hicks, D. (1993). Cultural Beliefs About Rape and Victims’ Response in Three Ethnic Groups. American Journal of Orthopsychiatry63(4), 623-632.

Lira, L. R., Koss, M. P., & Russo, N. F. (1999). Mexican American women’s definitions of rape and sexual abuse. Hispanic journal of behavioral sciences21(3), 236-265.

Lorentzen, E., Nilsen, H., & Traeen, B. (2008). Will it never end? The narratives of incest victims on the termination of sexual abuse. Journal of sex research45(2), 164-174.

McCauley, J., Kern, D. E., Kolodner, K., Dill, L., Schroeder, A. F., DeChant, H. K., … & Bass, E. B. (1997). Clinical characteristics of women with a history of childhood abuse: unhealed wounds. Jama277(17), 1362-1368.

National Collaborating Centre for Mental Health (UK. (2005). Post-traumatic stress disorder: The management of PTSD in adults and children in primary and secondary care. Gaskell.

Ozer, E. J., Best, S. R., Lipsey, T. L., & Weiss, D. S. (2003). Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychological bulletin129(1), 52.

Radan, A. (2007). Exposure to violence and expressions of resilience in Central American women survivors of war. Journal of Aggression, Maltreatment & Trauma14(1-2), 147-164.

Resnick, H. S., Kilpatrick, D. G., Dansky, B. S., Saunders, B. E., & Best, C. L. (1993). Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. Journal of consulting and clinical psychology61(6), 984.

Rothbaum, B. O., Foa, E. B., Riggs, D. S., Murdock, T., & Walsh, W. (1992). A prospective examination of post-traumatic stress disorder in rape victims. Journal of Traumatic stress5(3), 455-475.

Sarkar, N. N., Sarkar, R. (2005) Sexual assault on woman: Its impact on her life and living in society. Sexual & Relationship Therapy, 20 (4), 407-419 Database: Academic Search Premier

Seal, K.H., Bertenhal, D., Miner, C., Sen, S., & Marmar, C. (2007).  Bringing the war back home.  Mental health disorders among 103788 US veterans returning from Iraq and Afghanistan seen at Department of Veterans Affairs Facilities.  Archives of Internal medicine, 167, 476 – 482.

Silva, R. R., Alpert, M., Munoz, D. M., Singh, S., Matzner, F., & Dummit, S. (2000). Stress and vulnerability to posttraumatic stress disorder in children and adolescents. American Journal of Psychiatry157(8), 1229-1235.

Stein, Murray B., John R. Walker, and David R. Forde. “Gender differences in susceptibility to posttraumatic stress disorder.” Behaviour research and therapy 38.6 (2000): 619-628.

Stein, M. B., Jang, K. L., Taylor, S., Vernon, P. A., & Livesley, W. J. (2002). Genetic and environmental influences on trauma exposure and posttraumatic stress disorder symptoms: a twin study. American Journal of Psychiatry159(10), 1675-1681.

Tedeschi, R. G., & Calhoun, L. G. (1996). The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma. Journal of traumatic stress9(3), 455-471.

Ullman, S. E., & Filipas, H. H. (2001). Predictors of PTSD symptom severity and social reactions in sexual assault victims. Journal of traumatic stress14(2), 369-389.

Valentine, L., & Feinauer, L. L. (1993). Resilience factors associated with female survivors of childhood sexual abuse. American Journal of Family Therapy21(3), 216-224.

Vera, Hazvinei A., “Resilience theory and trauma theory applied to adult women incest survivors” (2013). Theses, Dissertations, and Projects. Paper 601.

Wilkes, G. (2002). Introduction: A second generation of resilience research. Journal of Clinical Psychology, 58, 229– 232.

Yehuda, Hoge, MacFarlane, Vermetten, Lanius, Nievergelt, Hobfoll, Koenen, Neylan & Hyman, 2015

Yuan, N. P., Koss, M. P., & Stone, M. (2006). The psychological consequences of sexual trauma. Retrieved September27, 2007.

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Do Violent People Have Low Self-Esteem?

It is a widely held belief that low self-esteem triggers violent behaviour, the origin of which is unknown. Baumeister, Bushman and Campbell (2000) conducted a study investigating this view; the following article attempts to summarise the ideas stated in their paper, entitled ‘Self-esteem, narcissism, and aggression: Does violence result from low self-esteem or from threatened egotism?’.

People with low self-esteem are generally portrayed as risk averse, easily influenced and deficient in self-confidence. These characteristics are incongruous with aggression – even likely to dampen or inhibit it –  given that hostile behaviours are intrinsically risky.

Low self-esteem is correspondent to a lack of confidence in achievement, whereas aggression is typically executed with an expectation of overpowering another person.

Most pertinently, those harbouring low self-esteem are doubtful in their self-identity, whereas aggression is likely carried out to uphold high self-regard. For instance, Baumeister et al. point out,

“Violent men seem to have a strong sense of personal superiority, and their violence often seems to stem from a sense of wounded pride. When someone else questions or disputes their favorable view of self, they lash out in response.”

When large groups diverge in levels of self-esteem, those with greater self-esteem are typically more violent. Violent individuals such as murderers, rapists and wife beaters are all discernible by their firmly held convictions of self-dominance.

Moreover, manic depressive individuals tend to show more aggression throughout a manic phase, indicated by a highly positive self-view, than during a period of depression, which is characterised by low self-esteem. Being drunk is also shown to temporarily enhance self-esteem, in tandem with a propensity for violence.

Based on these data, should we jump to the reverse assumption, that high self-esteem triggers aggression? Baumeister et al. think not.

They suggest we should first determine whether especially nonviolent people also have high self-esteem.

To that end, an important distinction is made by the authors between stable and unstable self-esteem. In their study, they found that people whose self-esteem is high and stable are least inclined to be hostile, while those with high and unstable self-esteem are the most hostile.

Narcissism

Research shows a strong association between narcissism and elevated but volatile self-esteem. Narcissism is therefore conceivably linked to aggression and violence, particularly during an encounter in which a narcissist is faced with mistrust or challenge to their excessively flattering self-view.

Narcissists are deeply devoted and attached to such views, and they wish for others to agree with them. Therefore, when their self-view is threatened, they feel they must defend it.

That said, Baumeister et al. emphasise that narcissism should be understood as a risk factor rather than a direct cause of aggression, and that the more threatening sides of narcissism lie in feelings of superiority and entitlement rather than mere vanity or arrogance.

At this point, a frequent question introduced is whether outward egotism is simply a method of concealing deep-seated insecurities. For example, perhaps wife beaters actually feel inferior to their wives, using aggression as a cover-up.

In response to this question, Baumeister et al. ask,

“How can hidden low self-esteem cause aggression if non-hidden low self-esteem has no such effect?”

Studies too have discarded this view. For the most part, playground bullies and gang members do not have covert low self-esteem. Likewise, practically all studies show that narcissists have high self-esteem.

Overall, Baumeister et al. suggest it is time to put an end to the search for straightforward links between self-esteem and aggression. Research has refuted the age-old view that low self-esteem leads to violence, while the opposing view incriminating high self-esteem is overly simplistic. High self-esteem is a trait of both aggressive and non-aggressive people, and so endeavours to make direct predictions are unconvincing. By and large, it seems redundant to suppose any direct link between self-views and aggression.

 

Works Cited

Baumeister, R. F., Bushman, B. J., & Campbell, W. K. (2000). Self-esteem, narcissism, and aggression: Does violence result from low self-esteem or from threatened egotism?. Current directions in psychological science9(1), 26-29.

Baumeister, R. (1993). Self-esteem. New York: Plenum Press.

 

The Pursuit of Mindfulness

“It is not the man who has little, but the man who craves more, that is poor” – Seneca

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Integrated into our everyday lives are ideas of how we can achieve happiness – buy the next best car, gain a promotion, find your ideal partner… We are rarely made to feel content in our own skin and current state. Sadly, we have become accustomed to this; we see it everywhere and many of us recognise how such messages buy into our feelings of dissatisfaction and insecurity. Living in such an environment, how can we ever believe enough is enough? 

Psychologists Brickman and Campbell first coined the term ‘hedonic adaptation’ in 1971. They suggest each person has a ‘set point’ of happinesswhich remains constant until we experience sudden highs or downfalls. For instance, when receiving an exam grade, one might initially feel intense happiness or disappointment that will eventually return to that set point. The same goes in the context of a romantic relationship: we fall in love ecstatically, and over time reach a state of equilibrium that makes us think, “is this it?” – a thought which characterises many break-ups.18nat_married

Positive Psychology research has looked into the idea of a ‘hedonic treadmill’ – a permanent cycle of desire fuelled by dissatisfaction. Particularly in an environment where things like money and success are highly valued, once you’re on that treadmill, you don’t want to simply feel content. You want all your hard work to pay off with feelings of ecstasy and triumph; you sacrifice the present moment in the hope that it will bring you greater satisfaction in the future. In this way, many people obtain motivation as it serves a path for ambitions. However, it can lead to anxious or depressive states in cases where people devote themselves to unattainable goals or feel a lack of appreciation for what is already within their reach.

To help combat this negative cycle, a great body of recent research points to the value of mindfulness – focusing awareness on the present moment and all its encompassing sensations. In doing so, we can free ourselves from our attachment to the past and the future and find satisfaction in the present. Mindfulness has been found to significantly improve symptoms of mental disorders like anxiety, depression and ADHD. There are some great blog articles that write more in depth on mindfulness techniques, such as herehere and here.

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On the other hand, research has shown that our happiness levels are not always determined by the environment we are in; they are 50% heritable in our genes. In addition to this, it is found that not everyone is hedonically neutral – we all have differing set points meaning we feel pleasure differently. For example, people with depression can experience anhedonia – a total inability to feel pleasure. Some research suggests that hedonic set points can be raised using new antidepressant compounds that are currently being investigated.

Psychological research has thrown light on how our desires can lead to dissatisfaction, and provides interventions that can be used to reframe negative mind-sets. If you have any experience with subjects I have mentioned or have any ideas or questions, please comment or send me a message.

 

Works Cited

Brickman, P., & Campbell, D. T. (1971). Hedonic relativism and planning the good society. Adaptation-level theory, 287-305.

Eysenck, H. J., & Eysenck, M. W. (1994). Happiness: Facts and myths. Psychology Press.

Self-Efficacy: Turning Doubt Into Drive

 An efficacious attitude works as a driving force – an individual with a strong sense of efficacy is more likely to become self-motivated, committed and assured in the face of a challenge. With high self-efficacy, one can attempt goals and conquer stress more readily, and as a result, experience better wellbeing. On the contrary, those who have doubts about their own abilities ruminate on personal flaws, slacken efforts and lose faith in the face of failure – a mind-set that in the long run can act as a brake on one’s ambitions and increase proneness to mental illness. But how does one develop self-efficacy? Is it something that can be moulded and strengthened to the level we want it to be?

Efficacy beliefs shape the course of our lives – what goals we choose to pursue, how much we commit to those goals and how much effort we put into given endeavours. Our everyday realities are filled with obstacles, frustrations and limitations. However, it is not the difficulties we face that influence our strength and wellbeing, but the beliefs we hold about them. Our beliefs determine how much stress we experience when confronting challenges, and how long it takes before we give up altogether. We must, therefore, develop a robust sense of self-worth to sustain the enduring effort needed to flourish.

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Psychologist Albert Bandura, known primarily for his research on behavioural modelling, suggests we can improve our self-efficacy, ironically, through failure. After all, if people only experience straightforward successes, it becomes an expectation that makes them far more vulnerable when things don’t go as planned. Therefore, if one comes to realise their self-worth and capability through sustained effort in overcoming adversity, they can emerge with more resilience rather than disheartenment. He discovered this during his research on fear arousal, where he saw the mediating effect that strong self-efficacy had on phobics, war veterans and hurricane survivors in overcoming incapacitating trauma.

“In order to succeed, people need a sense of self-efficacy, to struggle together with resilience to meet the inevitable obstacles and inequities of life” – Albert Bandura

A second way in which Bandura suggests we can shape our efficacy beliefs is through second-hand experiences provided by social role models. When we see people similar to ourselves accomplish goals, we can foster our own beliefs that we too have it in us to master similar challenges. With this in mind, we can see others’ achievements not as unattainable comparisons, but as an inspirational framework to guide our own aspirations and plans of action we set ourselves. So, instead of becoming envious and measuring our success through triumphs over others, we can do so through focusing on our own self-improvement and sharing encouragement.

Finally, because our self-efficacy can vary as a function of our physical and mental state, it can be difficult to approach a task that arouses a sense of debility or anxiety. Some people experience a nervous state as an added driving force to their motivation, whereas others view it as a sign to remove themselves from the situation as quickly as possible. This can be a particularly tough thought pattern to eradicate in the moment, but through a structured process of identifying, eliminating and replacing maladaptive or irrational thoughts and behaviours (such as through cognitive behavioural therapy), we can transform what holds us back into a force that pushes us forward. For example, we can break down large challenges into smaller, more manageable steps.

Demetri-Martin_tumblr_lo9k5j8SE31qhtggqo1_500.jpgBandura offers some extremely useful suggestions for how we can manage our own levels of self-efficacy – a skill that can motivate us to change ineffective attitudes and behaviours that might be holding us back. However, these are not limited to themselves – there are a range of other methods to be explored if these do not fit for you or every aspect of life. If you have any ideas or have had personal experience trying the above strategies or any others, please comment or message me with your thoughts and suggestions.

 

WORKS CITED

Bandura, A. (1994). Self‐efficacy. John Wiley & Sons, Inc..

Bandura, A., & Adams, N. E. (1977). Analysis of self-efficacy theory of behavioral change. Cognitive therapy and research, 1(4), 287-310.

Bandura, A. (2005). The primacy of self‐regulation in health promotion. Applied Psychology, 54(2), 245-254.

Benight, C.C. & Bandura, A. (2004). Social cognitive theory of post-traumatic recovery: The role of perceived self-efficacy. Behaviour Research and Therapy, 42 (10), 1129–1148

Theories of Schizophrenia: Can They Work in Harmony?

In this article, I use illustrations taken from the website of Bryan Charnley, an artist who suffered with schizophrenia and very tragically took his own life soon after these self-portraits were completed. Each painting was created as an experiment to come “face-to-face” with his illness. I felt it would be appropriate to use them here as they demonstrate, far better than can be done with words, what schizophrenic symptoms can feel like.

Psychiatrist Eugen Bleuler first coined the term ‘schizophrenia’, originating from the Greek “schizo” meaning to tear or split, and “phren” meaning intellect. This could explain the common contemporary myth about the illness involving a split personality. In reality, schizophrenia comprises a range of distressing symptoms including delusions, hallucinations, incoherent thoughts and speech, catatonic behaviour, affective flattening, alogia and avolition. The varied nature of the illness makes it challenging to diagnose using a single modality. However, it is one of the most debilitating of mental illnesses, with more than 24 million sufferers worldwide, which compels scientists in a variety of fields to continue in their search. Psychological and biological accounts present quite distinct determinist perspectives, unless combined within the ‘diathesis-stress’ model – a more holistic explanation that is now the leading approach in providing aetiology for the illness.

Bryan Charnley: Self-Portrait (1991) “My mind seemed to be thought broadcasting very severely and it was beyond my will to do anything about it. I summed this up by painting my brain as an enormous mouth, acting independently of me… I feel I am always divided against my self by myself… the nail in the mouth expresses my social ineptitude and an inability to socialise which makes me a target…”

A genetic susceptibility for psychotic symptoms is problematic to trace back to a particular genetic locus or even a small amount of genes. Therefore, a range of methods provide evidence for the involvement of numerous specific genes and rare mutations within them. Findings strongly indicate a heritable aspect to the disease, such as the fact that those with a first-degree relative with schizophrenia are ten times more likely to develop symptoms than those without. Moreover, twin studies reveal an overall heritability estimate of 80%. These discoveries highlight schizophrenia to be one of the most heritable of mental disorders. However, it can be difficult for researchers to discriminate between findings that are due to one’s environment as opposed to genetic makeup. To overcome this issue, adoption studies have been conducted using adoptees with and without schizophrenic family members. One early study found that 16.6% of adopted children with schizophrenic mothers developed the illness while none did within the control group. These findings were supported by a more recent study, where adopted children with psychotic symptoms had a 21.4% chance of having biological relatives with schizophrenia, compared to 5.4% in those who did not.

The leading biochemical theory of schizophrenia is the dopamine hypothesis, which maintains that symptoms like hallucinations, thought disorder and behavioural problems are significantly correlated to excess activity of the neurotransmitter dopamine. Antipsychotic drugs such as phenothiazines act on symptoms of psychosis by blocking the brain’s dopamine receptor sites, lowering dopamine activity. While these drugs attenuate many symptoms of schizophrenia, they have side effects such as tremors similar to those shown in Parkinson’s Disease, which is known to be caused in part by low dopamine levels. This effect is interestingly reversed when Parkinson’s patients are administered L-dopa – a drug that raises dopamine levels – resulting in the display of psychotic symptoms. Post-mortem studies have also revealed increased levels of dopamine and a considerably greater number of dopamine receptors in the brains of deceased schizophrenia patients.

Cognitive theories of schizophrenia centre on attributional and interpretational biases regarding anomalous experiences. For instance, auditory hallucinations are typically experienced by around 10 to 15% of healthy individuals, but may be interpreted in a way that makes them believe they are becoming insane, or that they ought to listen to and adhere to what the voices say in order to avoid negative consequences. Such biases are associated with deficits in cognitive functioning, again linked to excess dopamine activity, resulting in a slow decline in abilities such as early stages of sensory information processing. As a result, some sufferers experience affective flattening – a symptom rendering them socially isolated with a lack of emotions – meaning schizophrenic patients who have developed paranoid beliefs are not in the presence of others who can disconfirm their ideas, leading to a spiralling self-fulfilling prophecy.

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The double-bind hypothesis suggests that schizophrenic symptoms result from a pattern of contradictory, hostile and blameful treatment from family members. For instance, families with high expressed emotion (EE) tend to place blame on the sufferer for their circumstances, and express this through shouting rather than talking through. Prior to these findings, it was advised that schizophrenic patients should go home to their families from their institution, however it has now been established that the median relapse rate in a high-EE environment is 48% compared to 21% in a low-EE environment, and that interventions to control EE in families is a more effective approach to improving symptoms. This assumption is associated with the diathesis-stress hypothesis, which intends to merge biological and psychological approaches. For instance, an individual who is genetically liable to schizophrenia may not develop symptoms of psychosis until they encounter certain life stressors that can transpire during early development, in dysfunctional family relationships or in adolescence.

The above approaches are similar in their use of empirical methods, problems with defining cause and effect and investigation into family influences. They also coincide in their discussion of the influence of dopamine, which in turn affects cognitions and the attribution of symptoms to external factors. However, they differ in that the biological approach looks at inherent traits such as genetics and biochemical composition and uses pharmacological treatments, whereas the psychological approach focuses on upbringing and cognitive processes, and family therapeutic or cognitive behavioural treatments. Overall, they work in harmony within the diathesis-stress approach, which claims a genetic predisposition to schizophrenia will only result in symptoms when activated by life stressors.

If you would like to know more about schizophrenia and learn about treatments available, there are many websites to refer to and helplines and services to contact. I have listed some below:

http://www.mind.org.uk/information-support/types-of-mental-health-problems/schizophrenia/

http://www.nhs.uk/Conditions/Schizophrenia/Pages/Treatment.aspx

http://www.samaritans.org/how-we-can-help-you

http://www.healthtalk.org/files/upload/Mental%20Wellbeing%20Resources.pdf

https://www.rethink.org/diagnosis-treatment/conditions/schizophrenia

http://www.time-to-change.org.uk/category/blog/schizophrenia

http://www.time-to-change.org.uk/

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Andreasen, N. C. (1982). Negative symptoms in schizophrenia: definition and reliability. Archives of General Psychiatry39(7), 784-788.




Andreasen, N. C., Flashman, L., Flaum, M., Arndt, S., Swayze, V., O'Leary, D. S., ... & Yuh, W. T. (1994). Regional brain abnormalities in schizophrenia measured with magnetic resonance imaging. Jama272(22), 1763-1769.




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Baker, C. A., & Morrison, A. P. (1998). Cognitive processes in auditory hallucinations: attributional biases and metacognition. Psychological Medicine,28(05), 1199-1208.




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Berry, N., Jobanputra, V., & Pal, H. (2003). Molecular genetics of schizophrenia: a critical review. Journal of Psychiatry and Neuroscience28(6), 415–429.




Bleuler, Eugen Dementia praecox or the group of schizophrenias. Oxford, England: International Universities Press Dementia praecox or the group of schizophrenias. (1950). 548 pp.




Cardno, A.G. & Gottesman, I.I. (2000). Twin studies of schizophrenia: From bowand-arrow concordances to star wars Mx and functional genomics. American Journal of Medical Genetics, 97, 12–17.




Davey, Graham C. (2008) Psychopathology: Research, Assessment and Treatment in Clinical Psychology, 235-255 John Wiley & Sons.




Davis, J.O. & Phelps, J.A. (1995). Twins with schizophrenia: Genes or germs. Schizophrenia Bulletin, 21(1), 13–18




Davis, K. L., & Kahn, R. S. (1991). Dopamine in schizophrenia: a review and reconceptualization. The American journal of psychiatry148(11), 1474.




Dickerson, F. B., Tenhula, W. N., & Green-Paden, L. D. (2005). The token economy for schizophrenia: review of the literature and recommendations for future research. Schizophrenia Research75(2), 405-416.




Freeman, D., Garety, P. A., Kuipers, E., Fowler, D., & Bebbington, P. E. (2002). A cognitive model of persecutory delusions. British Journal of Clinical Psychology41(4), 331-347.




Gejman, P.V., Sanders, A.R. & Kendler, K.S. (2011). Genetics of schizophrenia: New findings and challenges. Annual Review of Genomics and Human Genetics, 12, 121–144.




Gottesman, I.I., McGuffin, P. & Farmer, A.E. (1987). Clinical genetics as clues to the real genetics of schizophrenia (a decade of modest gains while playing for time). Schizophrenia, 13(1), 23-47.




Gottesman, I.I. & Bertelsen, A. (1989). Confirming unexpressed genotypes for schizophrenia: Risks in the offspring of Fischer’s Danish identical and fraternal discordant twins. Archives of General Psychiatry, 46(10), 867–872.




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Kety, S.S., Wender, P.H., Jacobsen, B., Ingraham, L.J. et al. (1994). Mental illness in the biological and adoptive relatives of schizophrenic adoptees: Replication of the Copenhagen study in the rest of Denmark. Archives of General Psychiatry, 51(6), 442–455.




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Morrison, A. P. (2001). The interpretation of intrusions in psychosis: an integrative cognitive approach to hallucinations and delusions. Behavioural and Cognitive Psychotherapy29(03), 257-276.




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Schiffman, J., Abrahamson, A., Cannon, T., LaBrie, et al. (2001). Early rearing factors in schizophrenia. International Journal of Mental Health, 30, 3–16.




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Segerbäck, D., Calleman, C. J., Schroeder, J. L., Costa, L. G., & Faustman, E. M. (1995). Formation of N-7-(2-carbamoyl-2-hydroxyethyl) guanine in DNA of the mouse and the rat following intraperitoneal administration of [14C] acrylamide. Carcinogenesis16(5), 1161-1165.




Sommer, I. E., Daalman, K., Rietkerk, T., Diederen, K. M., Bakker, S., Wijkstra, J., & Boks, M. P. (2010). Healthy individuals with auditory verbal hallucinations; who are they? Psychiatric assessments of a selected sample of 103 subjects.Schizophrenia Bulletin36(3), 633-641.




Tam, G. W., Redon, R., Carter, N. P., & Grant, S. G. (2009). The role of DNA copy number variation in schizophrenia. Biological psychiatry66(11), 1005-1012.




Waters, F., Allen, P., Aleman, A., Fernyhough, C., Woodward, T. S., Badcock, J. C., ... & Larøi, F. (2012). Auditory hallucinations in schizophrenia and nonschizophrenia populations: a review and integrated model of cognitive mechanisms. Schizophrenia Bulletin38(4), 683-693.




Walker, E. F., & Diforio, D. (1997). Schizophrenia: a neural diathesis-stress model. Psychological review104(4), 667.




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Weisman, A. G., Nuechterlein, K. H., Goldstein, M. J., & Snyder, K. S. (2000). Controllability perceptions and reactions to symptoms of schizophrenia: a within-family comparison of relatives with high and low expressed emotion.Journal of abnormal psychology109(1), 167.

The Pursuit of Mindfulness

“It is not the man who has little, but the man who craves more, that is poor” – Seneca

Integrated into our everyday lives are ideas of how we can6a00e554eecbdf88330120a7ad5e67970b-500wiachieve happiness – buy the next best car, gain a huge promotion, find your ideal partner… We are rarely made to feel content in our own skin and current state. Sadly, we have become accustomed to this; we see it everywhere and many of us recognise how such messages, particularly those in the media, buy into our feelings of dissatisfaction and insecurity. Living in such an environment, how can we ever believe enough is enough? 

Psychologists Brickman and Campbell first coined the term ‘hedonic adaptation’ in 1971. They suggest each person has a ‘set point’ of happiness18nat_married which remains constant until we experience sudden highs or downfalls. For instance, when receiving an exam grade, one might initially feel intense happiness or disappointment that will eventually return to that set point. The same goes in the context of a romantic relationship: we fall in love ecstatically, and over time reach a state of equilibrium that makes us think, “is this it?” – a thought which characterises many break-ups.

demandeuphoria_6642Positive Psychology research has looked into the idea of a ‘hedonic treadmill’ – a permanent cycle of desire fuelled by dissatisfaction. Particularly in an environment where things like money and success are highly valued, once you’re on that treadmill, you don’t want to simply feel content. You want all your hard work to pay off with feelings of ecstasy and triumph; you sacrifice the present moment in the hope that it will bring you greater satisfaction in the future. In this way, many people obtain motivation as it serves a path for ambitions. However, it can lead to anxious or depressive states in cases where people devote themselves to unattainable goals or feel a lack of appreciation for what is already within their reach.

To help combat this negative cycle, a great body of recent research points to the value of mindfulness – focusing awareness on the present moment and all its encompassing sensations. In doing so, we can free ourselves from our attachment to the past and the future and find satisfaction in the present. Mindfulness has been found to significantly improve symptoms of mental disorders like anxiety, depression and ADHD. There are some excellent blog articles that write more in depth on mindfulness techniques, such as here, here and here.

On the other hand, research has shown that our happiness levels are not always determined by the environment we are in; they are 50% heritable in our genes. In addition to this, it is found that not everyone is hedonically neutral – we all have differing set points meaning we feel pleasure differently. For example, people with depression can experience anhedonia – a total inability to feel pleasure. Some research suggests that hedonic set points can be raised using new antidepressant compounds that are currently being investigated.

Psychological research has thrown light on how our desires can lead to dissatisfaction, and provides interventions that can be used to reframe negative mind-sets. If you have any experience with subjects I have mentioned or have any ideas or questions, please comment or send me a message.

 

Works Cited

Brickman, P., & Campbell, D. T. (1971). Hedonic relativism and planning the good society. Adaptation-level theory, 287-305.

Eysenck, H. J., & Eysenck, M. W. (1994). Happiness: Facts and myths. Psychology Press.

Self-Efficacy: Turning Doubt into Drive

 An efficacious attitude works as a driving force – an individual with a strong sense of efficacy is more likely to become self-motivated, committed and assured in the face of a challenge. With high self-efficacy, one can attempt goals and conquer stress more readily, and as a result, experience better wellbeing. On the contrary, those who have doubts about their own abilities ruminate on personal flaws, slacken efforts and lose faith in the face of failure – a mind-set that in the long run can act as a brake on one’s ambitions and increase proneness to mental illness. But how does one develop self-efficacy? Is it something that can be moulded and strengthened to the level we want it to be?

Efficacy beliefs shape the course of our lives – what goals we choose to pursue, how much we commit to those goals and how much effort we put into given endeavours. Our everyday realities are filled with obstacles, frustrations and limitations. However, it is not the difficulties we face that influence our strength and wellbeing, but the beliefs we hold about them. Our beliefs determine how much stress we experience when confronting challenges, and how long it takes before we give up altogether. We must, therefore, develop a robust sense of self-worth to sustain the enduring effort needed to flourish.

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Psychologist Albert Bandura, known primarily for his research on behavioural modelling, suggests we can improve our self-efficacy, ironically, through failure. After all, if people only experience straightforward successes, it becomes an expectation that makes them far more vulnerable when things don’t go as planned. Therefore, if one comes to realise their self-worth and capability through sustained effort in overcoming adversity, they can emerge with more resilience rather than disheartenment. He discovered this during his research on fear arousal, where he saw the mediating effect that strong self-efficacy had on phobics, war veterans and hurricane survivors in overcoming incapacitating trauma.

“In order to succeed, people need a sense of self-efficacy, to struggle together with resilience to meet the inevitable obstacles and inequities of life” – Albert Bandura

A second way in which Bandura suggests we can shape our efficacy beliefs is through second-hand experiences provided by social role models. When we see people similar to ourselves accomplish goals, we can foster our own beliefs that we too have it in us to master similar challenges. With this in mind, we can see others’ achievements not as unattainable comparisons, but as an inspirational framework to guide our own aspirations and plans of action we set ourselves. So, instead of becoming envious and measuring our success through triumphs over others, we can do so through focusing on our own self-improvement and sharing encouragement.

Finally, because our self-efficacy can vary as a function of our physical and mental state, it can be difficult to approach a task that arouses a sense of debility or anxiety. Some people experience a nervous state as an added driving force to their motivation, whereas others view it as a sign to remove themselves from the situation as quickly as possible. This can be a particularly tough thought pattern to eradicate in the moment, but through a structured process of identifying, eliminating and replacing maladaptive or irrational thoughts and behaviours (such as through cognitive behavioural therapy), we can transform what holds us back into a force that pushes us forward. For example, we can break down large challenges into smaller, more manageable steps.

Demetri-Martin_tumblr_lo9k5j8SE31qhtggqo1_500.jpgBandura offers some useful suggestions for how we can manage our own levels of self-efficacy – a skill that can motivate us to change ineffective attitudes and behaviours that might be holding us back. However, these are not limited to themselves – there are a range of other methods to be explored if these do not fit for you or every aspect of life. If you have any ideas or have had personal experience trying the above strategies or any others, please comment or message me with your thoughts and suggestions.

 

Works Cited

Bandura, A. (1994). Self‐efficacy. John Wiley & Sons, Inc..

Bandura, A., & Adams, N. E. (1977). Analysis of self-efficacy theory of behavioral change. Cognitive therapy and research, 1(4), 287-310.

Bandura, A. (2005). The primacy of self‐regulation in health promotion. Applied Psychology, 54(2), 245-254.

Benight, C.C. & Bandura, A. (2004). Social cognitive theory of post-traumatic recovery: The role of perceived self-efficacy. Behaviour Research and Therapy, 42 (10), 1129–1148

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