Saturday, August 24, 2013

The Wisdom of Tenderness: Jean Vanier on Lived Compassion, L'Arche, and Becoming Human

From NPR's On Being with Krista Tippett, this is a replay of an engaging and uplifiting conversation with Jean Vanier, a Canadian Catholic philosopher turned theologian, humanitarian, and the founder of L'Arche, an international federation of group homes for people with developmental disabilities and those who assist them.

Via Wikipedia:
In recognition of his contributions and humanness to the marginalized, Jean Vanier has received numerous distinctions and awards including the Companion of the Order of Canada, the Legion of Honour (France) and many awards from faith groups, among them the Paul VI International Prize, the Community of Christ International Peace Award, the Rabbi Gunther Plaut Humanitarian Award and the Gaudium et Spes Award. The asteroid 8604 was officially named Vanier in his honour in 2010.[6] He received the Pacem in Terris Peace and Freedom Award in 2013.[7]

The Wisdom of Tenderness: Jean Vanier on Lived Compassion, L'Arche, and Becoming Human

August 22, 2013

Considered by some to be a living saint, Jean Vanier created L'Arche, a model of community for people with mental disabilities that celebrates power in smallness and light in the darkness of human existence. The French Canadian philosopher and Catholic social innovator speaks about his understanding of humanity and God that has been shaped by Aristotle, Mother Teresa, and people who would once have been locked away from society.

Recommended Reading

Heart of L'Arche: A Spirituality for Every Day (L'Arche Collection)
Author: Jean Vanier
Publisher: Crossroad Publishing Company (1995)
Binding: Paperback, 96 pages

Becoming Human
Author: Jean Vanier
Publisher: Paulist Pr (1999)

Becoming Human is one of Jean Vanier's most beloved books, providing insight into his theology, anthropology, and spirit. And, The Heart of L'Arche (out of print but available used) is his lovely, slim history and introduction to L'Arche.

Links and Resources

L'Arche Internationale
This multilingual site serves as a great introduction to the mission, vision, and scope of the the worldwide movement that Vanier founded and now has roots in 131 communities. 
L'Arche USA
The central Web site for the 16 L'Arche communities in the United States. Pay attention to the photo gallery and letters to the communities from Jean Vanier, which are particularly compelling. 
Faith and Light (Foi et Lumiere)
Vanier also co-founded this worldwide association of organizations working to encourage people with disabilities in their spiritual lives.

"Journey to L’Arche"
Dutch Catholic priest and prolific spiritual author Henri Nouwen spent his professional life teaching at Notre Dame, Yale, and Harvard. But in the last decade of his life he lived at L'Arche Daybreak, near Toronto, Canada. Here's a sermon he gave on "meeting God in a whole new way" through being a member of this community.


In the Room with Jean Vanier

From a converted farmhouse at the Bishop Claggett Center in rural Maryland, a rare interview with Jean Vanier. Watch his conversation with Krista Tippett and observe how he speaks with his whole body, especially his hands.

Friday, August 23, 2013

Early PTSD Symptom Trajectories: Persistence, Recovery, and Response to Treatment

In a summary of results from the Jerusalem Trauma Outreach and Prevention Study, researchers identified three primary PSTD symptom trajectories: (1) Rapid Remitting (rapid decrease in symptoms from 1- to 5-months; 56% of the sample), (2) Slow Remitting (progressive decrease in symptoms over 15 months; 27%) and (3) Non-Remitting (persistently elevated symptoms; 17%).

Interestingly, 125 of the 957 subjects received cognitive behavioral therapy (CBT) of between one and nine months. The CBT seemed to help the slow remitting group but had no benefit for the other two groups.

A parallel study was conducted alongside the main study - and funded by Lundbeck Pharmaceuticals, makers of escitalopram. The effect of the SSRI (escitalopram) did not differ from placebo or wait list conditions. So this confirms what we already knew, i.e., that SSRIs and other antidepressants don't offer anything of value to trauma survivors with PTSD.

Early PTSD Symptom Trajectories: Persistence, Recovery, and Response to Treatment: Results from the Jerusalem Trauma Outreach and Prevention Study (J-TOPS)

Isaac R. Galatzer-Levy, Yael Ankri, Sara Freedman, Yossi Israeli-Shalev, Pablo Roitman, Moran Gilad, Arieh Y. Shalev


Uncovering heterogeneities in the progression of early PTSD symptoms can improve our understanding of the disorder's pathogenesis and prophylaxis. 

To describe discrete symptom trajectories and examine their relevance for preventive interventions. 

Latent Growth Mixture Modeling (LGMM) of data from a randomized controlled study of early treatment. LGMM identifies latent longitudinal trajectories by exploring discrete mixture distributions underlying observable data. 

Hadassah Hospital unselectively receives trauma survivors from Jerusalem and vicinity. 

Adult survivors of potentially traumatic events consecutively admitted to the hospital's emergency department (ED) were assessed ten days and one-, five-, nine- and fifteen months after ED admission. Participants with data at ten days and at least two additional assessments (n = 957) were included; 125 received cognitive behavioral therapy (CBT) between one and nine months. 

We used LGMM to identify latent parameters of symptom progression and tested the effect of CBT on these parameters. CBT consisted of 12 weekly sessions of either cognitive therapy (n = 41) or prolonged exposure (PE, n = 49), starting 29.8±5.7 days after ED admission, or delayed PE (n = 35) starting at 151.8±42.4 days. CBT effectively reduced PTSD symptoms in the entire sample. 
Main Outcome Measure

Latent trajectories of PTSD symptoms; effects of CBT on these trajectories. 

Three trajectories were identified: Rapid Remitting (rapid decrease in symptoms from 1- to 5-months; 56% of the sample), Slow Remitting (progressive decrease in symptoms over 15 months; 27%) and Non-Remitting (persistently elevated symptoms; 17%). CBT accelerated the recovery of the Slow Remitting class but did not affect the other classes. 

The early course of PTSD symptoms is characterized by distinct and diverging response patterns that are centrally relevant to understanding the disorder and preventing its occurrence. Studies of the pathogenesis of PTSD may benefit from using clustered symptom trajectories as their dependent variables.
Full Citation: 
Galatzer-Levy IR, Ankri Y, Freedman S, Israeli-Shalev Y, Roitman P, et al. (2013, Aug 22). Early PTSD Symptom Trajectories: Persistence, Recovery, and Response to Treatment: Results from the Jerusalem Trauma Outreach and Prevention Study (J-TOPS). PLoS ONE 8(8): e70084. doi: 10.1371/journal.pone.0070084
Funding: Dr. YIS received an investigator-initiated grant from Lundbeck Pharmaceuticals for this study and for a collaborative study (principal investigator: Dr. Joseph Zohar) entitled “Prevention of PTSD by Escitalopram.” The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.
Competing interests: The authors have declared that no competing interests exist.

Recent events repeatedly show the extent of devastation and trauma caused by war, violence and disasters. Post-traumatic stress disorder (PTSD) transforms survivors' initial reactions to life-long illness. Chronic PTSD is prevalent, debilitating, and tenacious [1][3]. It occurs in a significant proportion of those who express acute PTSD symptoms after trauma exposure[4][6]. Preventing PTSD is a major humanitarian and public health challenge [7].

Numerous studies have shown that early, trauma-focused, cognitive behavioral therapy (CBT) reduces the prevalence of chronic PTSD among survivors with acute PTSD (e.g., [8][10]). However, the effectiveness of this family of resource-demanding interventions is limited by barriers to receiving care [11][13], by our inability to identify survivors who might remit without treatment (up to 45% of those with Acute PTSD [3], [8], [9]) as well as those who do not recover despite properly dispensed treatment (about 20%; [9]).

Previous studies of early PTSD [4], [5], [14], [15] used central tendency statistics to document the progressively decreasing prevalence of PTSD and PTSD symptoms in cohorts of survivors followed longitudinally. Subsequent meta-analyses of risk factors for PTSD [16], [17] are based on that approach. Central tendency statistics assess groups as a whole by examining change to their arithmetic mean over time. Their use implies that the mean (and dispersion around the mean) accurately and parsimoniously describes the sample studied and its reference population.

When multiple latent sub-populations are present, however, the progression of the mean does not provide an accurate picture [18], [19], in which case exploring heterogeneities of symptoms' progression better discerns underlying ‘longitudinal’ phenotypes. Uncovering these phenotypes may improve our understanding of the pathogenesis of PTSD and its early prevention.

Latent Growth Mixture Modeling (LGMM) uses maximum-likelihood estimation to uncover discrete longitudinal mixture distributions and identify latent subpopulations, or classes. Predictors of those classes, as well as the rates of change over time, can be modeled within the same framework. Studies using LGMM-based techniques to model latent subpopulations by their symptom severity have identified common patterns of response to potentially traumatic events (PTEs) and predictors of these patterns [20][24]. They, thereby, uncovered diagnostically meaningful patterns of stress response [18], [20], [25]. Indeed, LGMM-based techniques are emerging as a methodology to study treatment effects across disorders and identify distinct trajectories of remission, placebo response, and response to active treatment[26][28]. To date, however, no studies have modeled PTSD symptom progression at multiple intervals across the first year that follow trauma exposure or examined the effects of treatment in this context. This study examines the critical period in the formation of PTSD, namely the aftermath of trauma exposure and the effect of preventive early intervention.

The current investigation used LGMM to examine patterns of PTSD symptom progression during the fifteen months that follow traumatic events in a large cohort of trauma-exposed, initially symptomatic individuals. In an attempt to pursue the effect of treatment, we included members of this cohort who received cognitive behavioral therapy (CBT) and then examined them separately. We used LGMM's unconditional model to uncover clusters of symptoms trajectories in the entire cohort and LGMM conditional model to evaluate the effect of CBT on these trajectories.


Participants and Procedures

This study utilized data collected for the Jerusalem Trauma Outreach and Prevention Study (J-TOPS; [9], [13], ClinicalTrial.Gov identifier: NCT0014690) between 2004 and 2009. The J-TOPS combined a large systematic outreach and follow-up study of recent trauma survivors with an embedded, randomized, controlled trial of early interventions for survivors with acute PTSD. The study's procedures and results have been fully described in previous publications [9], [13]. The study's data is available upon request to the primary investigator (AYS). They are briefly reviewed here.

Screening, assessment and treatment allocation

J-TOPS's participants were adults (age: 18–70) consecutively admitted to Hadassah University Hospital emergency department (ED) following potentially traumatic events (PTEs; for full eligibility see [9], [13]). Eligible participants (n = 4,743) were screened by short telephone interviews, and those with PTEs that met DSM-IV PTSD criterion A (“a traumatic event;” n = 1996) received a structured, telephone-based interview that included an assessment of PTSD symptoms (see below). Participants with Acute PTSD symptoms in that assessment (n = 1502) were invited for clinical interviews, which only n = 756 attended. Participants with clinical-interview based Acute PTSD (save the one month duration) in the clinical assessments (n = 397) were invited for treatment unless they had chronic PTSD at the time of the traumatic event, suffered current or lifetime psychosis or bipolar disorder, or had current substance abuse or suicidal ideation. Participants who accepted the invitation (n = 296) were randomized to Prolonged Exposure therapy (PE [29][31]), Cognitive Therapy (CT [32]), a double-blinded SSRI/placebo condition, and a waiting list that was followed by Delayed PE at five months (for full description see [9], [13]). The results of the original study showed significant and similar efficacy for all three CBT-based interventions (PE, Late-PE, and CT). In this work, we collectively refer to these interventions as ‘CBT.’ The effect of the SSRI (escitalopram) did not differ from placebo or waitlist. 

Unrelated to treatment eligibility or participation, the J-TOP included a large follow-up study. Participants seen at 10 days (n = 1996) were re-evaluated seven (n = 1784) and fifteen (n = 1022) months after ED admission. Participants of the first clinical assessment (n = 756) were re-evaluated five months after the traumatic event (n = 604) regardless of treatment participation. Telephone- and clinical interviewers were blind to subjects' participation in the embedded steps (i.e., attending clinical interviews for telephone interviewers and attending treatment for clinical interviewers). Participants provided oral consent to be interviewed by telephone and written informed consent for clinical assessments, randomization, and treatment. All procedures were approved and monitored by the Hadassah University Hospital's institutional review board.

Current Study Sample

We utilized individuals who had data available at ten days and at least two additional time points. Additionally, individuals whose data were collected at inconsistent time intervals from the rest of the sample (as determined by being further than two standard deviations from the mean data collection time for each assessment) were not included. The final sample for the current study was n = 957, with 125 receiving CBT (PE: n = 49; CT = 41; Late PE n = 35). The mean age of the current sample was 36.29 years (SD = 12.04). Mean length of stay in the emergency room was 5.72 hours (SD = 6.31). Individuals in the current sample came to the emergency room primarily due to motor vehicle accidents (84.1%) followed by terrorist attacks (9.4%), then work accidents (4.4%) then other types of incidents (2.0%).

We assessed if individuals who were included in this work differed from those excluded from the analysis. Using a Pearson's χ2, we compared those who were retained from those who were removed on gender [χ2 (1,1501) = .08, p = .78], and on reported exposure to a PTE (with three levels indicating no exposure, exposure to the same type of event, and exposure to another type of event [χ2 (2,1500) = 3.80, p = .15]). Using an independent samples t-test, we also compared those who were included with those excluded on age [t (2, 1500) = −0.55, p = .59], general distress at 10 days (see instruments below; [t (2, 1500) = −1.04, p = .30], and PTSD symptoms at 10 days [t (2, 1500) = −1.78, p = .08]. We further examined the trend difference in initial PTSD symptoms score and found that that these groups were substantively non-distinct (respectively, for those included and excluded, mean PSS-I scores were 10.70, SD = 3.11 vs. 10.41, SD = 3.10). We also conducted an analysis of variance (ANOVA) to estimate effect size of the difference and found a trivial effect (η2 = .002). Finally, we compared the demographics and initial PTSD symptom severity of those who were removed because they fell more than two standard deviations outside of the mean data collection dates (n = 40). These individuals did not significantly differ in age [t (2, 995) = 1.15, p = .25], initial symptom levels at the first interview [t (2, 995) = −1.64, p = .10], or gender [χ2(1, 996) = 0.21, p = .65]. As such, we concluded that individuals who were removed to improve the analysis were not a substantively distinct population from those who were retained.

Timing of assessments

Successive telephone assessments in this sample took place, respectively 9.21 SD = 3.20, 221.34 SD = 33.90 and 468.07 SD = 109.32 days after ED admission. We refer to these time lags as ‘ten days,’ ‘seven months’ and ‘fifteen months.’ The clinical interviews took place 29.51 SD = 4.93 and 143.00 SD = 32.33 days after ED admission (alias ‘one month’ and ‘five months’).


The Clinician-Administered PTSD Scale (CAPS) [33] is a widely used structured clinical interview for evaluating the presence of PTSD and the severity of PTSD symptoms. In this study, the CAPS was administered during clinical assessments only, and thus was not useful as a measure of symptom trajectories. We use it to evaluate the concurrent validity of the PTSD Symptom Scale (below).

Structured Clinical Interview for DSM-IV (SCID) [34] is a widely used structured clinical interview for evaluating the presence of DSM-IV symptoms and diagnostic status. In this study, the SCID was administered during the clinical assessments only. We utilized this scale to examine the prevalence of anxiety disorders and Major Depressive Disorder current and lifetime diagnoses broadly in this sample and as they relate to individuals who fall into the modeled trajectories. Because the entire sample did not receive a clinical interview, however, this data is only presented on the subset that did.

The PTSD Symptom Scale (PSS) quantified PTSD symptoms at all time-points. The PSS is a structured, diagnostic instrument that follows DSM-IV 17 PTSD symptom criteria [35]. The PSS interviewer version (PSS-I; [35]) was used during telephone interviews, with items dichotomized into present vs. absent statements about each PTSD symptom criterion (score range: 1 to 17). The self-administered version of the PSS (PSS-SR; [36]) was used during clinical assessments. This version uses a 1–4 symptom severity score for each item. A score of two or more was considered an endorsement of the presence of a symptom (score range: 1 to 17). The PSS-SR total scores during the clinical interviews were highly correlated with concurrent CAPS total scores (at one month: r = .77, p<.001; at five months: r = .84, p<.001). Measurement equivalence between telephone-based PSS-I and clinically administered PSS-SR scales was established by examining the correlations between the proximal five months clinical interviews and seven months telephone interviews. The Pearson's correlation coefficient revealed a strong relationship between the scores (r = .75, p<.001). Additionally, telephone-based PSS-I scores at seven months correlated significantly with the five months CAPS total score (r = .76, p<.001). Based on this evidence of measurement equivalence, we conducted our analysis utilizing both PSS-I dichotomous scores and in-person PSS-R dichotomized symptom scores.

The Kessler-6 (K6) is a brief 6-item self-report instrument that measures general distress. It was administered during telephone interviews. The K6 items are rated on a five-point scale from zero (“none of the time”) to four (“all of the time”), yielding a total score ranging from 0 to 24. The K6 strongly discriminates between community cases and non-cases of DSM-IV/SCID disorders with Receiver Operating Characteristic (ROC) curve of 0.87–0.88 for all disorders with Global Assessment of Functioning (GAF) scores of 0–70 and 0.95–0.96 when disorders had GAF scores of 0–50 [37].

The occurrence of new PTEs during follow-up was evaluated by asking subjects, during seven and fifteen months' interviews, whether they incurred a traumatic event since their inclusion in the study. Responses were coded as ‘no incident’, ‘incident of the same nature’ and ‘different incident.’ This variable was dummy coded for trajectory analysis to indicate presence/absence of any recent incident.

Data Analytic Plan

We utilized Mplus 6.0 [38], employing robust full information maximum-likelihood (FIML) procedures to identify heterogeneous latent classes of PTSD symptom severity over time using LGMM. These modeling techniques allowed us to test whether the population under study is composed of a mixture of discrete distributions characterized as classes of individuals with differing profiles of growth [39], while also allowing for the modeling of covariates as predictors of class membership and slope parameters [40].

Unconditional Model

We compared a progressive number of classes characterized by linear only or linear and quadratic parameters while accounting for non-specific psychological distress by residualizing PTSD symptom scores at 10 days and 7 months on K6 scores. We accounted for the effect of eventual trauma exposure during the study by regressing PTSD symptom scores at 7 and 15 months on our dummy-coded trauma-re-exposure variable as a time variant covariate. We compared progressive nested trajectory models by assessing relative fit based on reductions in the Bayesian Information Criterion (BIC), sample-size adjusted Bayesian Information Criterion (SSBIC), Aikaike Information Criterion (AIC), and significance indicated by the Bootstrap Likelihood Ratio Test (BLRT), along with parsimony and interpretability equally weighed. Entropy was also examined but not utilized to determine the number of classes; all criteria were consistent with recommendations from the literature [41].

Conditional Model

After establishing our best-fitting model, we first regressed class membership and then the freely estimated slopes within each class on a dummy-coded variable indicating the receipt of treatment. Next, we examined further covariates as predictors of the classes including age, gender, and ten days symptom severity in the three clusters of PTSD symptomatology including avoidance, arousal, and intrusions. We analyzed these separately from the treatment variable because we wanted to examine the effect of the treatment variable.


Symptom progression in the entire sample

By examining mean level PTSD symptom severity across our five measurement points, we found that, as mean level symptoms decrease in the entire sample, the standard deviation increases, indicating that the mean is characterizing an increasingly wide distribution of symptoms and suggesting that the distribution is becoming increasingly non-normal (Table 1).
Table 1 Study Groups' Comparisons.
Table 1. Study Groups' Comparisons. doi: 10.1371/journal.pone.0070084.t001

Treatment allocation

We examined differences between those who received CBT and those who did not. No significant difference was observed between the treatment and non-treatment groups by gender [χ2 (1, 956) = 2.44, p = .12)]. Significant differences between these groups were observed onage, the treatment group being slightly older (respectively, in years, 39.30, SD = 12.25 vs. 35.77, SD = 11.79; t (1, 956) = −3.11, p<.01). Participants who received treatment had higherPTSD symptom severity at 10 days (i.e., prior to treatment initiation) (PSS-I total score = 11.63, SD = 2.85 vs. 10.11, SD = 3.25; t (1, 956) = −4.95, p<.001) and higher ten days' K6 scores prior to treatment initiation (mean = 19.15, SD = 4.45 vs. 17.60, SD = 5.26; t (1, 956) = −3.14, p<.01). Because t-tests are sensitive to sample size, we examined the effect size by group, using a one-way ANOVA and those were as follows: for age (η2 = .01), for ten days' PSS-I scores (η2 = .03) and for 10 days K6 (η2 = .01). Based on accepted psychometric standards [42], we concluded that differences between groups were trivial.

Unconditional Model: Uncovering latent classes

Based on the AIC, BIC, SSBIC, and BLRT, we found that successive models continued to demonstrate improved fit through four classes, both with linear only, and linear+quadratic parameters, with linear+quadratic parameters consistently out-performing linear alone (Table 2). However, both with linear only and linear+quadratic parameters, the addition of a fourth class served only to split a class into two parallel trajectories with no substantive distinction in symptom levels. As a result, the four-class model was rejected for being less parsimonious and less interpretable, and the three-class model with linear+quadratic parameters was retained.
Table 2 Fit Indices for One- to Four-Class Growth Mixture Models of PTSD Symptom Severity (n = 957).
Table 2. Fit Indices for One- to Four-Class Growth Mixture Models of PTSD Symptom Severity (n = 957). doi: 10.1371/journal.pone.0070084.t002
This model identified three substantively distinct classes. The largest class (Rapid Remitting; 56% of the sample) displayed a precipitous drop in symptoms from 1 to 5 months as captured by a significant negative slope (Est = −26.72, SE = 2.28, p<.001), indicating a significant overall drop in symptoms from 10 days to five months, accompanied by a significant positive quadratic parameter, indicating a curvilinear rate of change (Est = 17.16.23, SE = 1.93,p<.001). The second largest class (Slow Remitting; 27%) demonstrated a relatively consistent rate of symptom reduction across time points, as indicated by a significant negative slope (Est= −8.83, SE = 2.50, p<.001) and a non-significant quadratic parameter (Est = 1.95, SE = 0.63,p = .23). Finally, the smallest class (Non-Remitting; 17%) demonstrated consistently high symptom severity across time points with no significant change over time, indicated by a non-significant slope (Est = −1.19, SE = 1.68, p = .48) and a non-significant quadratic parameter (Est = −2.67, SE = 1.62, p = .10; Figure 1). Members of the rapid remitting class also reached lower PTSD symptom levels at 15 months compared to those of slow remitting class, and the latter had lower levels of PTSD symptoms than the non-remitting class (Table 1). The frequency of full PTSD in the entire sample is 21.8% while rates of sub-syndromal PTSD based on meeting at least 2 of the three symptom cluster criteria is 15.8% based on the PSS.
Figure 1 Three Trajectory Model of PTSD Symptom Severity Recovery Trajectories (n = 957).
Figure 1. Three Trajectory Model of PTSD Symptom Severity Recovery Trajectories (n = 957). doi: 10.1371/journal.pone.0070084.g001
To assess trajectories while accounting for general levels of distress, we regressed symptom levels at 10 days and 7 months on initial K6 scores. These variables improved entropy indicating that accounting for general distress improves identification of class membership. Levels of general distress at 10 days were significantly positively associated with PTSD symptom at 10 days (Est = 0.11, SE = 0.01, p<.001), and marginally so at 7 months (Est = 0.02, SE = 0.01, p = .07) across the entire population.

Novel trauma exposure, during the study, was not significantly associated with differences between classes in concurrent PTSD symptom levels at seven (Est = 0.07, SE = 0.24, p = .76) and 15 months (Est = 0.34, SE = 0.20, p = .08).

Finally, to assess if the trajectories were biased by the selection of individuals with 3 or more time points, we conducted the same analysis with all the participants. This analysis revealed weaker overall fit in terms of entropy, but recovered the same classes in roughly the same proportions.

Conditional model: Effect of treatment and other covariates on latent trajectory classes

To examine the effect of treatment on the LGMM parameters we first we regressed class membership on our dummy-coded yes/no treatment variable, conducted in the MPlus environment using a multinomial logistic regression. Results of these analyses did not approach significance suggesting that receiving treatment did not affect class membership.

Following the examination of the effects of treatment on class, we explored further covariates as predictors of the latent classes using the same modeling framework. We examined the following variables: gender, age, and total levels of PTSD symptomatology at 10 days based on the three symptom domains (intrusions, avoidance, arousal). Gender and intrusions were not significantly different between the three identified classes and none of these covariates differentiated the Rapid and the Slow Remitting classes. Compared to the Rapid Remitting class, however, the Non-Remitting class was significantly older (Est = 0.04, SE = 0.01,p<.001), marginally more likely to have higher levels of avoidance symptomatology (Est = 0.11,SE = 0.06, p = .10) and significantly more likely to have higher levels of arousal symptomatology (Est = 0.26, SE = 0.09, p<.01). This class was also significantly more likely to be older then the Slow Remitting class (Est = 0.02, SE = 0.01, p<.05) and more likely to have significantly higher levels of both avoidance (Est = 0.19, SE = 0.08, p<.05) and arousal symptom severity (Est = 0.22, SE = 0.10, p<.05).

Next, we regressed the random slope parameter of each class on the treatment variable while controlling for distress at 10 days. General distress at 10 days significantly predicted the slopes across classes (Est = −0.42, SE = 0.04, p<.001). However, this analysis revealed non-significant effect of treatment on the Rapid Remitting and the Non-Remitting Classes and a significant negative effect in the Slow Remitting Class (Table 3). These findings indicate that individuals in the Slow Remitting Class, but not other classes, benefit from treatment: treatment serves to accelerate their symptom decline over time.
Table 3 Growth Factor Parameter Estimates for Treatment on the Slope of the 3-Classes (n = 957).
Table 3. Growth Factor Parameter Estimates for Treatment on the Slope of the 3-Classes (n = 957). doi: 10.1371/journal.pone.0070084.t003
In the above analyses we retained individuals who received late PE because of concerns that removing them from the analyses could bias the sample. Hypothetically, however early and delayed PE could have differentially affected symptom trajectories. We therefore repeated the analysis with these individuals removed, which resulted in similar effect of treatment on class membership and slopes.

Post-hoc analyses: Trajectories, PTSD, other Diagnoses, and Demographics

We examined the relationship between the LGMM-identified trajectories and meeting PTSD diagnostic criteria at different time points. We also examined gender differences by class. To conduct this analysis we saved the most probable class assignments for analysis outside of the model and conducted a series of χ2 comparisons in SPSS 19. The classes differed in thelikelihood of meeting PTSD diagnostic criteria at five, seven and fifteen months (Table 1). There were no significant differences by gender in relation to class, and no statistically significant differences the proportion of individuals in treatment by class (Table 1). We also examined differences in age between the classes using a two-tailed ANOVA. The overall test was significant [F (2,954) = 11.60, p<.001]; however, the effect size was trivial (η2 = .02).

Next by comparing mean symptoms and the standard deviation from the mean, we observe no noticeable reduction in PTSD symptom levels in the Non-Remitting class from 10 days (μ = 12.17, SD = 3.14) to 15 months (μ = 12.17, SD = 2.37), a moderate reduction in total symptoms in the Slow Remitting class from 10 days (μ = 10.39, SD = 3.16) to 15 months (μ = 6.19, SD = 2.87), and a large reduction in total symptoms in the Rapid Remitting class from 10 days (μ = 9.71, SD = 3.09) to 15 months (μ = 1.78, SD = 1.80). The resulting confidence intervals indicate separation between classes at all time-points (Table 1).

Finally, we examined the prevalence of one month DSM IV Anxiety Disorders (i.e., any anxiety disorder other than PTSD) and Major Depressive Disorder (MDD) among participants who attended the first clinical interview (n = 514) and conducted a series of pearson χ2 analyses to test if meeting these diagnoses differed between latent trajectory classes. The prevalence of anxiety disorders in the entire sample was 27.8% (n = 143) and that of current MDD 38.5% (n = 198). The trajectory groups had similar prevalence of current anxiety disorders. They differed, however in the prevalence of current MDD [(respectively for Non Remitting, Slow Remitting and Rapid Remitting 66.0% 47.4% and 21.2%; χ2(4, 423) = 76.58, p<.001] with significant differences between every two trajectory groups (for Slow Remitting vs. Rapid Remitting [χ2(1, 426) = 31.65, p<.001]; for Non-Remitting vs. Slow Remitting [χ2(1, 225) = 8.23, p<.01] for Non-Remitting vs. the Rapid Remitting [χ2(1, 374) = 70.25, p<.001]).


The current study evaluated the occurrence of latent classes characterized by their trajectory of symptom change from 10 days to 15 months post-trauma among a large cohort of recent trauma survivors. Among 957 who were followed 125 (13.1%) received efficacious CBT and we tested the relationship between receiving treatment and the identified trajectories.

We identified three latent classes of symptom change: A large class characterized by a precipitous drop in symptoms from one to five month (Rapid Remitting, 56%), a class characterized by a slow linear decline of symptoms over 15 months (Slow Remitting, 27%) and a class characterized by a failure to remit and no reduction in symptoms (Non-remitting, 17%).

We also examined demographic and symptom levels at 10-days as predictors of symptom trajectory classes and found that the Non-remitting class was predictable by older age, higher levels of initial hyperarousal symptoms and, less consistently, elevated avoidance symptoms. Testing the robustness of these and other putative predictors requires in-depth classifier analyses of this and other longitudinal.

Examining the relationship between receipt of treatment and the three classes we, firstly, found no evidence that receiving treatment affected class membership and secondly found that, within classes, treatment accelerated the rate of recovery in the Slow Remitting class alone and had no effect on the two other classes.

As such, these findings indicate the early CBT is effective – or necessary - for a subset of symptomatic trauma survivors. The finding concerning unnecessary CBT for rapid remitters replicates a previous finding of our group [9] and other groups [43]. However, the occurrence of a non-remitting and treatment resistant group is a novelty. Importantly, in both non-remitting and rapid remitting groups, treatment was followed by an apparent improvement, but such improvement did not differ from the spontaneous recovery of those untreated within each group. The relatively small proportion of subjects in the non-remitting group emphasizes the contribution of the latent trajectory approach to discerning pertinent outcome groups within entire cohorts. These findings have broad relevance for understand the natural course of PTSD, the differential effects of treatment, and the heuristics of further discovery.

Regarding the Natural Course of PTSD, our findings indicate that heterogeneities in individuals' symptom trajectories following trauma are not random events, but rather cluster into typical, minimally overlapping subsets. Our findings also suggest that the resulting subsets are highly informative with regard to the occurrence and the severity of chronic PTSD. These populations appear to be more informative and less error prone then the use of diagnostic status as an outcome. Firstly, we find the 91% of individuals who qualify for a PTSD diagnosis at 15-months fall into the Non-Remitting trajectory. Further, among those who meet PTSD criteria at 15 months those in the non remitting group have significantly higher symptom severity Differences in symptom severity at fifteen months suggest that individuals on the slow and rapid remitting group who still meet PTSD symptom criteria might be on their way to recovery.

Our work differs from previously reported studies (i.e. [22], [44]) in that it does not include survivors without initial significant elevations in symptoms. As a previous analysis of these data has shown [9], [14], such individuals are very unlikely to develop PTSD. The current results reflect, therefore, symptom trajectories among survivors at high risk – rather than among entire cohorts of individuals exposed to potentially-traumatic events. In the context of the current study, we strove to identify heterogeneous responses among those who are initially highly symptomatic, to attempt to predict these sub-populations, and to examine the differential effects of treatment as it relates to these sub-populations.

From a treatment and prevention perspective, the finding of an unremitting and treatment-resistant trajectory is equally important. First, the majority of patients with chronic PTSD at 15 months (n = 129 of n = 192; 67.2%) come from this small group. Second, symptom levels of those who remain with 15 months' PTSD in the non-remitting group are significantly and meaningfully higher than those of the other classes (30.1% higher than in the slow remitting group and 52.7% higher than the rapid remitting group), evoking the question of fundamental differences between the resulting conditions (e.g., potential for further recovery, neuro-cognitive underpinning). It is therefore important to further explore this group, in this and subsequent studies.

Looking at ways to predict this group, the non-remitting group in this work separated from the other groups as early as 10 days after the traumatic event (symptom levels and confidence intervals do not overlap). However, this post-hoc observation is not yet mature for clinical use as a predictor nor is it informative about underlying neuro-behavioral mechanisms. Attaching biographical information (e.g., prior trauma, childhood adversity) as well as neuropsychological, biological and recovery-environment factors to this trajectory may lead to better – and specific - understanding of this catastrophic course of early PTSD symptoms.

The non-remitting group should also be amenable, as such, to longitudinal neuro-cognitive and neuro-imaging studies looking into putative changes in the ways the CNS transmutes an initial reaction into chronic, entrenched disturbance. Finding analogous trajectories in PTSD-related biomarkers would buttress this ‘irreversible acquisition’ trajectory in biological findings. Recent and similar trajectories in animal models of conditioned fear provide encouraging evidence to the existence of such analogies [45], [46]. Better understanding the dynamics of non-remission may hold a key for further discovery other mental disorders with identifiable onset and non-remitting course in a subset of patients.

Our unexpected finding of treatment (CBT) resistance in this group makes these patients eager candidates for other treatment approaches. However, even when effective, novel therapies for small proportion of survivors are unlikely to generate a significant signal in studies of entire affected groups. This highlights the importance of identifying pertinent subpopulations for assessing treatment effects: one treatment could be highly effective in the aggregate while ineffective for a minority – and vice versa. Indeed, the use of LGMM has already revealed informative description of distinct courses of recovery in randomized clinical trials of depression, in which it differentiated the effects of treatment from that of natural recovery and placebo [27],[28], [47]. These efforts are in line with the emergence of trait-sanctioned therapies for medical conditions (e.g., receptor-specific therapies for breast cancer, multiple myeloma).

The slow remitting trajectory is similarly interesting. The unique effect of treatment on members of this cluster suggests a special sensitivity to the effects of CBT, and thus might allow a better allocation of patients to early treatment. It would be interesting as well to explore the reasons for such responsiveness via exploring membership in this trajectory class.

The finding of positive treatment effect in this otherwise progressively remitting class is also in line with a previous and very intriguing observation from epidemiological studies [3], according to which early treatment (though studied retrospectively) accelerated recovery but did not reduce the overall burden of PTSD. Granted, accelerating recovery by months or years has profound clinical and personal implications. Nonetheless, the putative category of ‘recover-able’ trauma survivors is extremely interesting to follow as it may optimally teach us about recovery mechanisms that may not exist in the other two groups, and how to engage them. Again – studying recovery in entire cohorts may not be sensitive enough.

The finding of a rapidly remitting subgroup is in line with previous CBT studies, in which patients with less than full Acute PTSD symptoms recovered with or without treatment [8], [9]. Identifying who will follow this course has broad public health implications, as it could lead to the better allocating survivors to therapy and better use of treatment resources.

Further, our observation can inform the heuristics of uncovering the pathogenesis of PTSD. The finding of pertinent classes of symptom trajectories challenges the use of central tendency statistics to enhance discovery in the area of nascent PTSD. Central tendency statistics may collapse heterogeneous populations and obfuscate the identification of relevant subpopulations. To take advantage of the methodology presented here, future studies should collect multiple data points at timing and intervals that are critical for understanding the underlying problems, and with an eye towards imputation of missing cases (e.g., by collecting enriched initial assessments).

We found some indication that current depression differentiates trajectories. These data are limited, however, because full clinical assessments were not conducted on the entire cohort. This is potentially valuable information as it indicates that depression symptomatology in the acute phase may be predictive of chronic posttraumatic stress. This finding is consistent with other findings in the literature that have demonstrated that depression, in part, influences the development and maintenance of PTSD [48]. Finally, despite evaluating the same construct (PTSD symptoms) and establishing measurement equivalence, the use of different versions of the PSS at different time points should be seen as limitation of this study.


This work uncovered one of, possibly, several symptom trajectory scenarios in recent trauma survivors. Rape survivors, or victims of repeated or protracted violence, may have different longitudinal paths. This may also be true in deployed combatants, whose survival in a battlefield may require a suppression of initial symptoms, and result in their delayed emergence [49]. Nonetheless the approach outlined here emphasized a robust methodology for uncovering systematic clustering patterns within response heterogeneities. Its ultimate challenge will be its ability to better inform clinical and biological studies of the pathogenesis of trauma and stress-related disorders and uncover robust predictors of symptoms persistence and chronicity.

Author Contributions

Conceived and designed the experiments: AS. Performed the experiments: MG. Analyzed the data: IGL. Contributed reagents/materials/analysis tools: MG. Wrote the paper: AS IGL YA SF YIS PR.

Documentary - The Truth About Personality

Horizon: Michael Mosley put on his thinking cap for The Truth About Personality.

BBC Two's Horizon produced this episode on the Truth About Personality with Michael Mosley as our anxious and curious host. Here is some of the review of this episode (of what appears to be a rather lame series, this episode withstanding) from The Telegraph UK:
Mosley’s personal experience forming the narrative thread through the science bits. Mosley said from the get-go that he was pessimistic and anxious. So he went to the University of Essex, where a slimy electronic skull cap showed that his right brain was much more active than his left (very bad, apparently).

Then, at the Massachusetts Institute of Technology, Mosley put on two bracelets that were straight out of the Seventies’ sci-fi drama Blake’s 7. They measured the activity of his autonomic nervous system, which showed his “arousal level” – that’s just anxiety, by the way, nothing exciting – to be rather high.

Having established scientifically that he was indeed pessimistic and anxious, Mosley did an actual experiment – with method, results and conclusion – to see if he could be engineered into cheering up. “Cognitive bias modification” was a fancy way of asking Mosley to repeatedly choose the one picture of a cheerful face out of a screen full of miserable ones. More profound, perhaps, were Mosley’s attempts at mindfulness meditation, which he learned from Andy Puddicombe, a former Buddhist monk. 
Mosley then started to witter about whether he was feeling more cheerful or not, sounding like a clubber who’d taken an ecstasy pill and wasn’t sure if it was working. But there was still more fascinating science to come – especially at the macabre Quebec Brain Bank, where hundreds of human brains are pickled in Lock & Lock food containers. Their data indicated that a lack of maternal love in early life could make the brain less able to deal with stress 
Like the programme’s approach to difficult science, the results of Mosley’s seven-week self-improvement programme were admirably clear. When Mosley went back to the Essex boffins, his right brain and his left were much more in balance. Just this breath going in, just this breath going out – that’s the meditative secret to true happiness. Oh, and always search out the one happy face on your train to work.
It's cool television - and nothing we are likely to see in the US on any of our hundreds of stations producing mind-numbing and soul-deadening drivel.

The Truth About Personality

Michael Mosley explores the latest science about how our personalities are created and whether they can be changed.

Despite appearances, Mosley is a pessimist who constantly frets about the future. He wants to worry less and become more of an optimist. He tries out two techniques to change this aspect of his personality – with surprising results.

He travels to the frontiers of genetics and neuroscience to find out about the forces that shape all our personalities.

Human Brains Are Hardwired for Empathy and Friendship

U.Va. psychologist James A. Coan conducted an fMRI study that monitored statistical associations between brain activations indicating self-focused threat to those indicating threats to a familiar friend or an unfamiliar stranger.

The results strongly suggest that we are hardwired to empathize because we closely associate people who are close to us – friends, spouses, lovers – with our very selves. As Coan told an interviewer, "People close to us become a part of ourselves, and that is not just metaphor or poetry, it’s very real."

One of the statements from the summary, to me, does not follow from the research:
In other words, our self-identity is largely based on whom we know and empathize with.
Well, no. The study suggests that we empathize with people who have become part of our lives through some form of familiarity and/or intimacy. We make them a part of us, not the other way around. With the increase in familiarity and empathy, the person who was other becomes like me and I feel the same concern for that person as I do for myself.

First the abstract to the original study, which is sequestered behind a paywall, then below that is the summary of the article based off of the press release.

Familiarity promotes the blurring of self and other in the neural representation of threat

Lane Beckes, James A. Coan and Karen Hasselmo
Received September 16, 2011
Accepted April 16, 2012


Neurobiological investigations of empathy often support an embodied simulation account. Using functional magnetic resonance imaging (fMRI), we monitored statistical associations between brain activations indicating self-focused threat to those indicating threats to a familiar friend or an unfamiliar stranger. Results in regions such as the anterior insula, putamen and supramarginal gyrus indicate that self-focused threat activations are robustly correlated with friend-focused threat activations but not stranger-focused threat activations. These results suggest that one of the defining features of human social bonding may be increasing levels of overlap between neural representations of self and other. This article presents a novel and important methodological approach to fMRI empathy studies, which informs how differences in brain activation can be detected in such studies and how covariate approaches can provide novel and important information regarding the brain and empathy.
Full Citation:
Beckes, L, Coan, JA, Hasselmo, K. (2013, May 3). Familiarity promotes the blurring of self and other in the neural representation of threat. Social Cognitive and Affective Neuroscience; 8(6): 670-677. doi: 10.1093/scan/nss046

Here is the summary of the research from Medical Xpress.

Human brains are hardwired for empathy, friendship, study shows

by Fariss Samarrai

U.Va. psychologist James A. Coan conducted the study. "People close to us become a part of ourselves, and that is not just metaphor or poetry, it’s very real," he said. Credit: Dan Addison

Perhaps one of the most defining features of humanity is our capacity for empathy – the ability to put ourselves in others' shoes. A new University of Virginia study strongly suggests that we are hardwired to empathize because we closely associate people who are close to us – friends, spouses, lovers – with our very selves.

"With familiarity, other people become part of ourselves," said James Coan, a U.Va. psychology professor in the College of Arts & Sciences who used functional magnetic resonance imaging brain scans to find that people closely correlate people to whom they are attached to themselves. The study appears in the August issue of the journal Social Cognitive and Affective Neuroscience.

"Our self comes to include the people we feel close to," Coan said.

In other words, our self-identity is largely based on whom we know and empathize with.

Coan and his U.Va. colleagues conducted the study with 22 young adult participants who underwent fMRI scans of their brains during experiments to monitor brain activity while under threat of receiving mild electrical shocks to themselves or to a friend or stranger.

The researchers found, as they expected, that regions of the brain responsible for threat response – the anterior insula, putamen and supramarginal gyrus – became active under threat of shock to the self. In the case of threat of shock to a stranger, the brain in those regions displayed little activity. However when the threat of shock was to a friend, the brain activity of the participant became essentially identical to the activity displayed under threat to the self.

"The correlation between self and friend was remarkably similar," Coan said. "The finding shows the brain's remarkable capacity to model self to others; that people close to us become a part of ourselves, and that is not just metaphor or poetry, it's very real. Literally we are under threat when a friend is under threat. But not so when a stranger is under threat."

Coan said this likely is because humans need to have friends and allies who they can side with and see as being the same as themselves. And as people spend more time together, they become more similar.

"It's essentially a breakdown of self and other; our self comes to include the people we become close to," Coan said. "If a friend is under threat, it becomes the same as if we ourselves are under threat. We can understand the pain or difficulty they may be going through in the same way we understand our own pain."

This likely is the source of empathy, and part of the evolutionary process, Coan reasons.

"A threat to ourselves is a threat to our resources," he said. "Threats can take things away from us. But when we develop friendships, people we can trust and rely on who in essence become we, then our resources are expanded, we gain. Your goal becomes my goal. It's a part of our survivability."

People need friends, Coan added, like "one hand needs another to clap."

Thursday, August 22, 2013

Documentary - Samsara

File:Samsara Film Poster.jpg

Samsara is a 2011 documentary film, directed by Ron Fricke and produced by Mark Magidson, who also collaborated on Baraka (1992), another documentary film that relies on images and music to not so much tell a story as create a feeling.

Samsara was filmed over four years in 25 countries around the world. It was shot in 70 mm format and output to digital format. The film premiered at the 2011 Toronto International Film Festival and received a limited release in August 2012.

The film is presented in two parts below, or you can watch the film in one part at YouTube.


Samsara is a Sanskrit word that means “the ever turning wheel of life” and is the point of departure for the filmmakers as they search for the elusive current of interconnection that runs through our lives.

Filmed over a period of almost five years and in twenty-five countries, Samsara transports us to sacred grounds, disaster zones, industrial sites, and natural wonders.

By dispensing with dialogue and descriptive text, the documentary subverts our expectations of a traditional documentary, instead encouraging our own inner interpretations inspired by images and music that infuses the ancient with the modern.

Samsara is a documentary film that explores the wonders of our world from the mundane to the miraculous, looking into the unfathomable reaches of man’s spirituality and the human experience. Neither a traditional documentary nor a travelogue, the film takes the form of a nonverbal, guided meditation.

Through powerful images, the film illuminates the links between humanity and the rest of nature, showing how our life cycle mirrors the rhythm of the planet.

Samsara was photographed entirely in 70mm film utilizing both standard frame rates and with a motion control time-lapse camera designed specifically for this project.

Samsara part 1 by polynikos12

Samsara part 2 by polynikos12

'No Such Thing' as Left- or Right-Brained People - An Evaluation of the Left-Brain vs. Right-Brain Hypothesis with Resting State Functional Connectivity Magnetic Resonance Imaging

A while back I posted some information on the supposed right-brain/left-brain dominance of how one sees a spinning dancer (above). Now there is new evidence that suggests there is not any real right- or left-brain people or personality types.

Main points:
Dr. Jeff Anderson, lead author of the study, explains:
"It is absolutely true that some brain functions occur in one or the other side of the brain. Language tends to be on the left, attention more on the right.  
But people don't tend to have a stronger left- or right-sided brain network. It seems to be determined more, connection by connection."
Jared Nielsen, a graduate student in neuroscience at the University of Utah and one of the study authors, adds:
"If you have a connection that is strongly left-lateralized, it relates to other strongly lateralized connection only if both sets of connections have a brain region in common."
Interesting. Here is the summary from Medical News Today - below that is the abstract and citation for the original article (it's Open Access).

'No such thing' as left or right brained people

Written by Honor Whiteman | Medical News Today
19 Aug 2013

We have all heard references to people being a "left-brained" or "right-brained" thinker. But researchers from the University of Utah say their latest research shows this is a myth.

Previous studies over the years have suggested that we use one half of our brain more often than the other, playing a part in the type of personality we have.
While the left side of the brain is usually associated with logical, analytical and detail-oriented behavior, the right side has been connected to creative, thoughtful and subjective thinking.

But a new study published in the journal PLOS ONE, suggests there is no evidence within brain imaging that proves some people are right-brained or left-brained.

The research team conducted a two-year study of 1,011 people who were part of the International Neuroimaging Data-Sharing Initiative (INDI), and who were between the ages of 7 and 29.

All participants had the functional lateralization of their brains measured. Functional lateralization means there are specific mental processes that take place in either the brain's left or right hemisphere.

Researchers have said the theory of "left-brained" or "right-brained" thinkers is nothing more than a myth

The scientists conducted the brain measurements using magnetic resonance imaging (MRI) analysis, which involved the participants lying in the scanner for 5 to 10 minutes while their "resting" brain measurements were taken. This allowed the researchers to correlate brain activity in one area of the brain and compare it with another.

The researchers then divided the brain into 7,000 regions and analyzed which regions of the brain showed more functional lateralization.

All connections in the brain were examined, and all possible combinations of the brain regions were correlated for each brain region that was left-lateralized or right-lateralized.

The results of the scan showed patterns indicating that a brain connection may be strongly left or right-lateralized. But they found no relationship that individuals "preferentially" used their left-brain network or right-brain more often.

Dr. Jeff Anderson, lead author of the study, explains:
"It is absolutely true that some brain functions occur in one or the other side of the brain. Language tends to be on the left, attention more on the right. 
But people don't tend to have a stronger left- or right-sided brain network. It seems to be determined more, connection by connection."
Jared Nielsen, a graduate student in neuroscience at the University of Utah and one of the study authors, adds:
"If you have a connection that is strongly left-lateralized, it relates to other strongly lateralized connection only if both sets of connections have a brain region in common."
Results of this study are groundbreaking, Nielsen says, as they may change the way people think about the "right-brain versus left-brain theory."

"Everyone should understand the personality types associated with the terminology 'left-brained' and 'right-brained' and how they relate to him or her personally," he says.

"However, we just do not see patterns where the whole left-brain network is more connected or the whole right-brain network is more connected in some people. It may be that personality types have nothing to do with one hemisphere being more active, stronger, or more connected."

Here is the abstract for the full article, available for free as an Open Access post at PLoS ONE:

Figure 5 Significant correlation of lateralized connections across subjects.

Figure 5. Significant correlation of lateralized connections across subjects.

An Evaluation of the Left-Brain vs. Right-Brain Hypothesis with Resting State Functional Connectivity Magnetic Resonance Imaging

Jared A. Nielsen, Brandon A. Zielinski, Michael A. Ferguson, Janet E. Lainhart, Jeffrey S. Anderson


Lateralized brain regions subserve functions such as language and visuospatial processing. It has been conjectured that individuals may be left-brain dominant or right-brain dominant based on personality and cognitive style, but neuroimaging data has not provided clear evidence whether such phenotypic differences in the strength of left-dominant or right-dominant networks exist. We evaluated whether strongly lateralized connections covaried within the same individuals. Data were analyzed from publicly available resting state scans for 1011 individuals between the ages of 7 and 29. For each subject, functional lateralization was measured for each pair of 7266 regions covering the gray matter at 5-mm resolution as a difference in correlation before and after inverting images across the midsagittal plane. The difference in gray matter density between homotopic coordinates was used as a regressor to reduce the effect of structural asymmetries on functional lateralization. Nine left- and 11 right-lateralized hubs were identified as peaks in the degree map from the graph of significantly lateralized connections. The left-lateralized hubs included regions from the default mode network (medial prefrontal cortex, posterior cingulate cortex, and temporoparietal junction) and language regions (e.g., Broca Area and Wernicke Area), whereas the right-lateralized hubs included regions from the attention control network (e.g., lateral intraparietal sulcus, anterior insula, area MT, and frontal eye fields). Left- and right-lateralized hubs formed two separable networks of mutually lateralized regions. Connections involving only left- or only right-lateralized hubs showed positive correlation across subjects, but only for connections sharing a node. Lateralization of brain connections appears to be a local rather than global property of brain networks, and our data are not consistent with a whole-brain phenotype of greater “left-brained” or greater “right-brained” network strength across individuals. Small increases in lateralization with age were seen, but no differences in gender were observed.

Full Citation
Nielsen JA, Zielinski BA, Ferguson MA, Lainhart JE, Anderson JS. (2013, Aug 14). An Evaluation of the Left-Brain vs. Right-Brain Hypothesis with Resting State Functional Connectivity Magnetic Resonance Imaging. PLoS ONE, 8(8): e71275. doi: 10.1371/journal.pone.0071275

Wednesday, August 21, 2013

Adam Grant: "Give and Take" - Authors at Google

Adam Grant, the youngest tenured professor at Wharton, stopped by the Googleplex to discuss his new book, Give and Take: A Revolutionary Approach to Success. Seems like an interesting new book.

Adam Grant: "Give and Take", Authors at Google

Published on Apr 30, 2013

Adam Grant stops by the Googleplex to discuss his latest work, Give and Take: A Revolutionary Approach to Success.

From the publicist:

Give and Take changes our fundamental ideas about how to succeed—at work and in life. For generations, we have focused on the individual drivers of success: passion, hard work, talent, and luck. But in today's dramatically reconfigured world, success is increasingly dependent on how we interact with others. Give and Take illuminates what effective networking, collaboration, influence, negotiation, and leadership skills have in common.

Using his own groundbreaking research as the youngest tenured professor at Wharton, Grant examines the surprising forces that shape why some people rise to the top of the success ladder while others sink to the bottom. In professional interactions, it turns out that most people operate as either takers, matchers, or givers. Whereas takers strive to get as much as possible from others and matchers aim to trade evenly, givers are the rare breed of people who contribute to others without expecting anything in return.

These styles have a dramatic impact on success. Although some givers get exploited and burn out, the rest achieve extraordinary results across a wide range of industries. Combining cutting-edge evidence with captivating stories, this landmark book shows how one of America's best networkers developed his connections, why the creative genius behind one of the most popular shows in television history toiled for years in anonymity, how a basketball executive responsible for multiple draft busts transformed his franchise into a winner, and how we could have anticipated Enron's demise four years before the company collapsed—without ever looking at a single number.

Robert Stolorow - Heidegger and Post-Cartesian Psychoanalysis

From The Humanistic Psychologist, Robert Stolorow published a new article offering a glimpse into his personal and professional development in relation to the philosophy of Martin Heidegger. This article is posted at, on Professor Stolorow's page, in advance of its appearance in the journal.

This article presents an overview of some of the basic ideas in his book, World, Affectivity, Trauma: Heidegger and Post-Cartesian Psychoanalysis (Routledge, 2011).

Full Citation:
Stolorow, RD. (2013). Heidegger and Post-Cartesian Psychoanalysis: My Personal, Psychoanalytic, and Philosophical Sojourn. The Humanistic Psychologist, 41(3): 209–218. doi: 10.1080/08873267.2012.724266

My Personal, Psychoanalytic, and Philosophical Sojourn

Robert D. Stolorow
Institute of Contemporary Psychoanalysis


The dual aim of this article is to show both how Heidegger’s existential philosophy enriches post-Cartesian psychoanalysis and how post-Cartesian psychoanalysis enriches Heidegger’s existential philosophy. Characterized as a phenomenological contextualism, post-Cartesian psychoanalysis finds philosophical grounding in Heidegger’s ontological contextualism, condensed in his term for the human kind of Being, Being-in-the-world. Specifically, Heidegger provides philosophical support (a) for a theoretical and clinical shift from mind to world, from the intrapsychic to the intersubjective; (b) for a shift from the motivational primacy of drives originating in the interior of a Cartesian isolated mind to the motivational primacy of relationally constituted affective experience; and (c) for contextualizing and grasping the existential significance of emotional trauma, which plunges us into a form of Being-toward-death. Post-Cartesian psychoanalysis, in turn, (a) relationalizes Heidegger’s conception of finitude, (b) expands Heidegger’s conception of relationality, and (c) explores some ethical implications of our kinship-in-finitude.
Here is one section of the paper that I found particularly interesting (because it deals with my work, trauma).


From a post-Cartesian perspective, developmental trauma is viewed, not as an instinctual flooding of an ill-equipped Cartesian container, as Freud (1926/1959) would have it, but as an experience of unbearable affect. Furthermore, the intolerability of affect states can be fully grasped only in terms of the relational systems in which they are felt. Developmental trauma originates within a formative relational context whose central feature is malattunement to painful affect—the absence of a context of human understanding in which that pain can be held and endured. Without such a relational home for the child’s emotional pain, it can only be felt as unbearable, overwhelming, disorganizing. Painful or frightening affect becomes lastingly traumatic when the attunement that the child needs to assist in its tolerance and integration is profoundly absent.

Two years prior to beginning to study Being and Time (Heidegger, 1927/1962), I wrote a description of a traumatized state that I experienced at a conference in 1992, at which I relived the terrible loss of my late wife, Dede, who had died 20 months earlier. An initial batch of copies of my newly published book, Contexts of Being: The Intersubjective Foundations of Psychological Life (Stolorow & Atwood, 1992), was sent hot off the press to a display table at the conference. I picked up a copy and looked around excitedly for Dede, who would be so pleased and happy to see it. She was, of course, nowhere to be found. I had awakened the morning of February 23, 1991 to find her lying dead across our bed, 4 weeks after her metastatic cancer had been diagnosed. Spinning around to show her my book and finding her gone instantly transported me back to that devastating moment in which I found her dead and my world was shattered,1 and I was once again consumed with horror and sorrow. Here is how I described my traumatized state:
There was a dinner at that conference for all the panelists, many of whom were my old and good friends and close colleagues. Yet, as I looked around the ballroom, they all seemed like strange and alien beings to me. Or more accurately, I seemed like a strange and alien being—not of this world. The others seemed so vitalized, engaged with one another in a lively manner. I, in contrast, felt deadened and broken, a shell of the man I had once been. An unbridgeable gulf seemed to open up, separating me forever from my friends and colleagues. They could never even begin to fathom my experience, I thought to myself, because we now lived in altogether different worlds. (Stolorow, 1999, pp. 464–465)
In the years following that painful experience at the conference dinner, I was able to recognize similar feelings in my patients who had suffered severe traumatization. I sought to comprehend and conceptualize the dreadful sense of alienation and estrangement that seemed to me to be inherent to the experience of emotional trauma. The key that I found that for me unlocked the meaning of trauma was what I came to call ‘‘the absolutisms of everyday life’’ (Stolorow, 1999):
When a person says to a friend, ‘‘I’ll see you later,’’ or a parent says to a child at bedtime, ‘‘I’ll see you in the morning,’’ these are statements . . . whose validity is not open for discussion. Such absolutisms are the basis for a kind of naıve realism and optimism that allow one to function in the world, experienced as stable and predictable. It is in the essence of emotional trauma that it shatters these absolutisms, a catastrophic loss of innocence that permanently alters one’s sense of Being-in-the-world. Massive deconstruction of the absolutisms of everyday life exposes the inescapable contingency of existence on a universe that is random and unpredictable and in which no safety or continuity of being can be assured. Trauma thereby exposes ‘‘the unbearable embeddedness of Being.’’ . . . As a result, the traumatized person cannot help but perceive aspects of existence that lie well outside the absolutized horizons of normal everydayness. It is in this sense that the worlds of traumatized persons are fundamentally incommensurable with those of others, the deep chasm in which an anguished sense of estrangement and solitude takes form. (p. 467)
Some two years after writing these words I read passages in Being and Time (Heidegger, 1927/1962) devoted to Heidegger’s existential analysis of angst, and I nearly fell off my chair. Both Heidegger’s phenomenological description and ontological account of angst bore a remarkable resemblance to what I had written about the phenomenology and meaning of emotional trauma. Thus, Heidegger’s existential philosophy—in particular, his existential analysis of angst—enables us to grasp trauma’s existential significance.

Like Freud, Heidegger made a sharp distinction between fear and anxiety. Whereas, according to Heidegger, that in the face of which one fears is a definite ‘‘entity within-the-world’’ (Heidegger, 1927/1962, p. 231), that in the face of which one is anxious is ‘‘completely indefinite’’ (p. 231) and turns out to be ‘‘Being-in-the-world as such’’ (p. 230). The indefiniteness of anxiety ‘‘tells us that entities within-the-world are not ‘relevant’ at all. . . . [The world] collapses into itself [and] has the character of completely lacking significance’’ (p. 231). Heidegger made clear that it is the significance of the average everyday world, the world as constituted by the public interpretedness of the ‘‘they’’ (das Man), whose collapse is disclosed in anxiety. Furthermore, insofar as the ‘‘utter insignificance’’ (p. 231) of the everyday world is disclosed in anxiety, anxiety includes a feeling of uncanniness, in the sense of ‘‘not-being-at-home’’ (p. 233). In anxiety, the experience of ‘‘Being-at-home [in one’s tranquilized] everyday familiarity’’ (p. 233) with the publicly interpreted world collapses, and ‘‘Being-in enters into the existential ‘mode’ of . . . ‘uncanniness’’’ (p. 233).

In Heidegger’s (1927/1962) ontological account of anxiety, the central features of its phenomenology—the collapse of everyday significance and the resulting feeling of uncanniness—are claimed to be grounded in what he called authentic (non-evasively owned) Being-toward-death. Existentially, death is not simply an event that has not yet occurred or that happens to others, as das Man would have it. Rather, it is a distinctive possibility that is constitutive of our existence—of our intelligibility to ourselves in our futurity and our finitude. It is ‘‘the possibility of the impossibility of any existence at all’’ (p. 307), which, because it is both certain and indefinite as to its when, always impends as a constant threat, robbing us of the tranquilizing illusions that characterize our absorption in the everyday world, nullifying its significance for us. The appearance of anxiety indicates that the fundamental defensive purpose (fleeing) of average every-dayness has failed and that authentic Being-toward-death has broken through the evasions that conceal it. Torn from the sheltering illusions of das Man, we feel uncanny—no longer safely at home.

I have contended that emotional trauma produces an affective state whose features bear a close similarity to the central elements in Heidegger’s existential interpretation of anxiety and that it accomplishes this by plunging the traumatized person into a form of authentic Being-toward-death (Stolorow, 2007). Trauma shatters the illusions of everyday life that evade and cover up the finitude, contingency, and embeddedness of our existence and the indefiniteness of its certain extinction. Such shattering exposes what had been heretofore concealed, thereby plunging the traumatized person into a form of authentic Being-toward-death and into the anxiety—the loss of significance, the uncanniness—through which authentic Being-toward-death is disclosed. Trauma, like death, individualizes us, in a manner that invariably manifests in an excruciating sense of singularity and solitude.

The particular form of authentic Being-toward-death that crystallized in the wake of the trauma of Dede’s death I characterize as a Being-toward-loss. Loss of loved ones constantly impends for me as a certain, indefinite, and ever-present possibility, in terms of which I now always understand myself and my world. My own experience of traumatic loss and its aftermath was a source of motivation for my efforts to relationalize Heidegger’s conception of finitude, to which efforts I now turn.


It is implicit in Heidegger’s ontological account that authentic existing presupposes a capacity to dwell in the emotional pain—the existential anxiety—that accompanies a nonevasive owning up to human finitude. It follows from my claims about the context-embeddedness of emotional trauma that this capacity entails that such pain can find a relational home in which it can be held. What makes such dwelling and holding possible?

Vogel provided a compelling answer to this question by elaborating what he claimed to be a relational dimension of the experience of finitude. Just as finitude is fundamental to our existential constitution, so too is it constitutive of our existence that we meet each other as ‘‘brothers and sisters in the same dark night’’ (Vogel, 1994, p. 97), deeply connected with one another in virtue of our common finitude. Thus, although the possibility of emotional trauma is ever present, so too is the possibility of forming bonds of deep emotional attunement within which devastating emotional pain can be held, endured, and eventually integrated. Our existential kinship-in-the-same-darkness is the condition for the possibility both of the profound contextuality of emotional trauma and of the mutative power of human understanding.

Critchley (2002) pointed the way toward a second, essential dimension of the relationality of finitude:
I would want to [emphasize] the fundamentally relational character of finitude, namely that death is first and foremost experienced as a relation to the death or dying of the other and others, in Being-with the dying in a caring way, and in grieving after they are dead. . . . [O]ne watches the person one loves . . . die and become a lifeless material thing. . . . [T]here is a thing—a corpse—at the heart of the experience of finitude . . . [which is] fundamentally relational. (pp. 169–170)
Authentic Being-toward-death entails owning up not only to one’s own finitude, but also to the finitude of all those we love. Hence, authentic Being-toward-death always includes Being-toward-loss as a central constituent. Just as, existentially, we are ‘‘always dying already’’ (Heidegger, 1927=1962, p. 298), so too are we always already grieving. Death and loss are existentially equiprimordial. Existential anxiety anticipates both death and loss.

Support for my claim about the equiprimordiality of death and loss can be found in the work of Derrida (1997), who contended that every friendship is structured from its beginning, a priori, by the possibility that one of the two friends will die first and that the surviving friend will be left to mourn: ‘‘To have a friend, to look at him, to follow him with your eyes, . . . is to know in a more intense way, already injured, . . . that one of the two of you will inevitably see the other die’’ (Derrida, 2001, p. 107). Finitude and the possibility of mourning are constitutive of every friendship.

In loss, all possibilities for Being in relation to the lost loved one are extinguished. Traumatic loss shatters one’s emotional world, and, insofar as one dwells in the region of such loss, one feels eradicated. As Derrida (2001) claimed, ‘‘Death takes from us not only some particular life within the world [but] someone through whom the world, and first of all our own world, will have opened up’’ (p. 107).
1. Borrowing a term from Harry Potter, I call such experiences portkeys to trauma (Stolorow, 2007, 2011).