Faculty Bibliography

This article discusses empirical research findings that demonstrate psychobiological dysregulation among violently traumatized mothers of very young children and then describes what effects this dysregulation can have on the mother-infant relationship. Out of this research, the first author developed CAVES originally as an experimental evaluation technique and test-intervention. The theoretical premise, evidence-base, and signature features of the CAVES are described along with a case example showing how it quickly became the foundation for a new brief psychotherapeutic model for traumatized parents and their very young children ages 0 to 4, CAVEAT. The essentials of CAVEAT as a 16-session manualized treatment model are also presented with a case example as illustration. (PsycInfo Database Record (c) 2022 APA, all rights reserved) Abstract (German) Dieser Artikel diskutiert empirische Forschungsergebnisse, die bei gewalt- sam traumatisierten Muttern von Kleinkindern eine psychobiologische Dysregulation nachweisen, und beschreibt deren Auswirkungen auf die Mutter-Kind-Beziehung. Aus dieser Forschung entwickelte der Erstautor die CAVES als experimentelle Evaluationstechnik und Test-Intervention. Die theoretischen Grundlagen, die Evidenzbasis und Hauptmerkmale der CAVES werden zusammen mit einem Fallbeispiel beschrieben, das zeigt, wie CAVES zu einem neuen Modell fur eine kurze Psychotherapie fur traumatisierte Eltern und ihre Kinder im Alter von 0 bis 4 wurde (CAVEAT). Das Behandlungsmodell der CAVEAT mit 16 Sitzungen, das auch als Manual besteht, wird anhand eines Fallbeispiels veranschaulicht (PsycInfo Database Record (c) 2022 APA, all rights reserved)

BACKGROUND:The pandemic caused by coronavirus disease 2019 (COVID-19) has forced governments to implement strict social mitigation strategies to reduce the morbidity and mortality from acute infections. These strategies, however, carry a significant risk for mental health, which can lead to increased short-term and long-term mortality and is currently not included in modeling the impact of the pandemic. METHODS:We used years of life lost (YLL) as the main outcome measure, applied to Switzerland as an example. We focused on suicide, depression, alcohol use disorder, childhood trauma due to domestic violence, changes in marital status, and social isolation, as these are known to increase YLL in the context of imposed restriction in social contact and freedom of movement. We stipulated a minimum duration of mitigation of 3 months based on current public health plans. RESULTS:The study projects that the average person would suffer 0.205 YLL due to psychosocial consequence of COVID-19 mitigation measures. However, this loss would be entirely borne by 2.1% of the population, who will suffer an average of 9.79 YLL. CONCLUSIONS:The results presented here are likely to underestimate the true impact of the mitigation strategies on YLL. However, they highlight the need for public health models to expand their scope in order to provide better estimates of the risks and benefits of mitigation.

Introduction/UNASSIGNED:The present study investigates the association of lifetime interpersonal violence (IPV) exposure, related posttraumatic stress disorder (IPV-PTSD), and appraisal of the degree of threat posed by facial avatars. Methods/UNASSIGNED:We recorded self-rated responses and high-density electroencephalography (HD-EEG) among women, 16 of whom with lifetime IPV-PTSD and 14 with no PTSD, during a face-evaluation task that displayed male face avatars varying in their degree of threat as rated along dimensions of dominance and trustworthiness. Results/UNASSIGNED:The study found a significant association between lifetime IPV exposure, under-estimation of dominance, and over-estimation of trustworthiness. Characterization of EEG microstates supported that lifetime IPV-PTSD modulates emotional appraisal, specifically in encoding and decoding processing associated with N170 and LPP evoked potentials. EEG source localization demonstrated an overactivation of the limbic system, in particular the parahippocampal gyrus, in response to non-threatening avatars. Additionally, dysfunctional involvement of attention-related processing anterior prefrontal cortex (aPFC) was found in response to relatively trustworthy avatars in IPV-PTSD individuals compared with non-PTSD controls. Discussion/UNASSIGNED:This study showed that IPV exposure and related PTSD modulate individuals' evaluation of facial characteristics suggesting threat. Atypical processing of these avatar characteristics was marked by group differences in brain regions linked to facial processing, emotion regulation, and memory.

Objectives: Toxic stress in young children, also known as adverse childhood experiences (ACEs), may lead to changes in their nervous system, affect their development, and influence their mental and physical health. Pediatricians and child and adolescent psychiatrists are uniquely positioned to help families in difficult situations to reduce the risk of recurring trauma. They are also in the best position to make accurate diagnoses and to design appropriate, multimodal treatment plans. This often can involve treatment of several family members, particularly because trauma is often transmitted intergenerationally and needs to be addressed accordingly. This Symposium will bring the audience up to date on work being conducted on ACEs in a number of areas. It will introduce participants to the latest research findings in the ACE literature on young children. It will focus on recent neurophysiological findings related to the transgenerational carryover of maternal ACEs. New information about the role of fathers in ACE research will be provided, and targeted interventions that may be used in primary care settings will be described.
Method(s): This Symposium will consist of 5 parts: 1) a presentation on ACEs and opportunities for intervention in Early Head Start (EHS) programs; 2) a review of transgenerational effects of maternal ACEs and their implications for future studies; 3) a review of the literature on the roles of fathers in ACE studies and paternal risk factors for child maltreatment; 4) a discussion of maternal ACEs, PTSD, and maternal attribution of child emotional comprehension; and 5) a brief summary discussion of the program as a whole followed by a question-and-answer session.
Result(s): Participants will learn that ACEs are associated with numerous chronic health problems in young children. They will be able to recognize that there are various screening methods that effectively assess for ACEs. At the end of the Symposium, participants will identify the importance of individual and systems-level approaches that can help promote resilience and counteract ACEs.
Conclusion(s): Screening and intervention for ACEs are feasible and should be part of most child and adolescent psychiatry and pediatrics' programs. This Symposium offers up-to-date information on the latest ACE-related research. STRESS, CAN, EC
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Objectives: This study investigated the following: 1) how maternal interpersonal violence (IPV)-PTSD and/or maternal exposure to violent events during childhood might affect children's capacities of emotion comprehension; and 2) how traumatized mothers perceive their own child's capacities for emotion comprehension.
Method(s): This longitudinal follow-up study of mothers and toddlers included 37 mothers exposed to IPV with PTSD and 26 mothers without PTSD. The study also included their school-age children (mean age = 7.1 years, SD = 1.2). Measures included the Test of Emotional Comprehension (TEC). The TEC investigates children's understanding of emotions ranging from basic comprehension (ie, external causes on emotions) to a deeper, more complex type of understanding (ie, mixed emotions, possibility of regulating emotions). Both children and mothers responded, with mothers asked to respond as they imagined their child would. Data analyses included Mann-Whitney U nonparametric group comparisons and logistic regression modeling.
Result(s): Mothers with IPV-PTSD compared with control subjects underestimated their children's capacities for emotional comprehension (U = 327.5, p < 0.05). When looking at specific maternal adverse childhood experiences (ACEs), physical abuse and exposure to family violence were associated with higher levels of maternal misattribution of child responses on the TEC after covarying for socioeconomic status and maternal depression (p < 0.01).
Conclusion(s): Mothers who have childhood exposure to physical abuse and family violence are more likely to make errors in emotional comprehension when asked to take their school-age child's perspective. Mothers suffering from related PTSD tend to underestimate their children's capacity for emotional comprehension. These findings will be contextualized in light of published findings from the toddler phase of this study and discussed in terms of their implications for intervention. AGG, PAT, CAN
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Parental Reflective Functioning is a parent's capacity to infer mental states in herself and her child. Parental Reflective Functioning is linked to the quality of parent-child attachment and promotes parent-child mutual emotion regulation. We examined neural correlates of parental reflective functioning and their relationship to physical abuse. Participants were mothers with (n = 26) and without (n = 22) history of childhood physical abuse. Parental reflective functioning was assessed by coding transcripts of maternal narrative responses on interviews. All mothers also underwent magnetic resonance imaging while watching video clips of children during mother-child separation and play. Parental reflective functioning was significantly lower among mothers with histories of childhood physical abuse. When mothers without history of childhood physical abuse watched scenes of separation versus play, brain activation was positively correlated with parental reflective functioning in the ventromedial prefrontal cortex, and negatively associated with the dorsolateral prefrontal cortex and insula. These associations were not present when limiting analyses to mothers reporting abuse histories. Regions subserving emotion regulation and empathy were associated with parental reflective functioning; yet these regions were not featured in maltreated mothers. These data suggest that childhood physical abuse exposure may alter the psychobiology that is linked to emotional comprehension and regulation.

The aim of this study was to examine the effects of maternal interpersonal violence-related posttraumatic disorder (IPV-PTSD) on child appraisal of emotion, as measured by high-density electroencephalography (HD-EEG) during an Emotional Face-matching Task (EFMT). We recorded HD-EEG in 47 children of mothers with and without IPV-PTSD during an Emotional Face-matching Task (EFMT). Mothers and children each performed the EFMT. Behavioral results demonstrated that both mothers who were directly exposed to violent events, and their children, presented attentional bias toward negative emotions when processing facial stimuli. EEG findings confirmed differences in emotion appraisal between children of IPV-PTSD mothers and non-PTSD controls at scalp-level and in terms of source localization upon which children of IPV-PTSD mothers demonstrated decreased activation of the right dorsolateral prefrontal cortex (dlPFC) in response to angry and fearful faces as compared to non-PTSD children with respect to the N170 component. Our study, to our knowledge, is the first to show that maternal IPV-PTSD significantly affects a mother's own and her child's neural activity in response to facial expressions of negative emotion. These findings are potentially important to the development and study of effective interventions to interrupt intergenerational cycles of violence and trauma.

The aim of this study was to examine associations between maternal mentalization, interactive behavior, and child symptoms in families in which mothers suffer from interpersonal violence-related posttraumatic stress disorder (IPV-PTSD). Fifty-six mothers and children (aged 12-42 months) including mothers with a diagnosis of IPV-PTSD were studied. Mentalization was measured by the Parental Reflective Functioning (PRF) Scale. Interactive behavior during free-play was measured via the CARE-Index. Child symptoms were measured by the Infant-Toddler Social and Emotional Assessment (ITSEA). Data analyses included non-parametric correlations and multiple linear regression. Results showed that lower IPV-PTSD and higher Maternal Reflective Functioning (MRF) were related to greater maternal sensitivity. Lower MRF and greater controlling behavior were related to child dysregulation. MRF was found to be lower in the subgroup of IPV-PTSD when the child's father was the perpetrator of IPV. Both MRF and interactive behavior are thus likely to be important targets for intervention during sensitive periods of early social-emotional development.

Early life stress in humans (i.e. maltreatment, violence exposure, loss of a loved one) and in rodents (i.e. disrupted attachment or nesting, electric shock, restraint, predator odor) occurs during critical steps of neural circuit formation. ELS in humans is associated with increased risk for developmental psychopathology, including anxious and depressive phenotypes. The biological mechanisms underlying these potentially persistent maladaptive changes involve long-term epigenetic modifications, which have been suggested to be potentially transmissible to subsequent generations. DNA methylation is an epigenetic mechanism that modifies gene expression patterns in response to environmental challenges and influences mutation rates. It remains to be seen whether a functionally relevant fraction of DNA methylation marks can escape genome-wide erasures that occur in primordial germ cells and after fertilization within the zygote. Early life-stress-triggered changes in epigenetic mediated transmission of acquired behavioral traits among humans have been assessed mainly by targeting genes involved in the hypothalamic-pituitary-adrenal (HPA) axis, such as NR3C1 and FKBP5. Recently, researchers examining epigenetic transmission have begun to apply genome-wide approaches. In humans, reduced representation bisulfite sequencing (RRBS) was performed on peripheral samples that were obtained from individuals who were prenatally exposed to the "Dutch Hunger Winter", resulting in two Differentially Methylated Regions (DMRs) in INSR and CPTIA genes that were functionally, biologically and technically validated, and significantly associated with birth weights and LDL cholesterol levels in offspring. In rodents, non-genomic intergenerational transmission of anxiety which was associated with differentially methylated enhancers that were putatively involved in lipid signaling and synaptic/neurotransmission in hippocampal granule cells, was discovered also using RRBS. Finally, transgenerational transmission of altered behaviors was associated with sperm-derived microRNAs produced by ELS male mice. The field of epigenetic transmission is just beginning to enter the epigenomic era by using genome-wide analyses. Such approaches remain of strong interest to human studies, first in order to help to assess the relevance of the previous targeted studies, and second to discover new important epigenetic modifications of potential clinical importance. New discoveries may help to assess how transmittable the negative impact of stress may be to offspring. The latter may open doors for future treatments and resilience-promoting interventions, as well as new approaches to treat the effects of childhood trauma before the onset of psychiatric disorder.