Throughout the world, individuals, groups, and communities are faced with major incidents, crises, and disasters. The impact of disasters can be wide-ranging, involving death, severe injury, the loss of home, shelter, liberty, security, and food, in addition to social dislocation and destroyed infrastructure and networks. Victims can experience distress, anger, grief, and fear together with symptoms of anxiety, depression, and post-traumatic stress. First responders and those delivering longer-term social and psychological support can be adversely affected by direct exposure to the disaster, by learning about the details of the disaster from the testimony of victims, or by viewing distressing images or artifacts connected to the disaster.
To reduce the impact of disasters, communities and emergency services need to prepare plans to meet the physical, social, and psychological needs of those involved and undertake thorough testing of these plans to ensure they are fit for purpose. This planning needs to consider natural hazards such as forest fires, floods, drought, and biological hazards, including Covid-19, influenza, foot and mouth disease, and severe acute respiratory syndrome. Human and technological failings can also create hazards seen in transport crashes, the release of toxic substances, and armed conflict.
Contingency planning is used to reduce exposure to a hazard by identifying and protecting those at most risk of harm. However, it is impossible to prevent crises and disasters from happening, making it essential to provide appropriate and timely support. Initial support ensures that disaster survivors are taken to a safe place where their immediate needs for food, drinks, and shelter are met.
The aim of early psychosocial responses to disasters are fourfold: (a) to increase disaster preparedness to reduce the impact of hazards and vulnerabilities, (b) to respond to the immediate human needs for safety and survival, (c) to communicate care and provide psychological support, and (d) to provide an opportunity for survivors to process and create meaning from experiences.
Ideally, all early psychosocial interventions would be evidence-based and delivered by trained and monitored practitioners; however, often, this is not the case. Despite the development of an abundance of disaster-related models, few have been evaluated; this failure is due to a lack of agreement on the aims, scope, measures, and training required to deliver evidence-based interventions. Humanitarian and emergency response organizations look toward psychologists to provide them with the evidence-based interventions, evaluation tools, and guidance they need for dealing with disasters.
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Chelsea Ekstrand
The growing field of neuroimaging has offered exciting insights into the inner workings of the human brain in health and disease. Structural neuroimaging techniques provide detailed information about the physical properties and anatomy of the brain and nervous system, including cerebrospinal fluid, blood vessels, and different types of tissue. The most commonly used structural neuroimaging techniques are computed tomography (CT) and structural magnetic resonance imaging (MRI). CT uses X-rays to create a two-dimensional representation of neural tissue, whereas MRI quantifies differences in tissue density by manipulating molecules using magnetic fields, magnetic field gradients, and radio waves. Functional neuroimaging techniques provide a measure of when and where activity is occurring in the brain by quantifying underlying physiological processes. Functional neuroimaging techniques fall into two broad categories: measures of direct brain activity, including electroencephalography (EEG) and magnetoencephalography (MEG), and measures of indirect brain activity, such as positron emission tomography (PET), functional magnetic resonance imaging (fMRI), and functional near-infrared spectroscopy (fNIRS). Different functional neuroimaging techniques can be used to examine different physiological changes, including electrical activity, magnetic field changes, metabolic and neurotransmitter activity, and indirect measures of blood flow to offer insight into cognitive processing. Structural and functional neuroimaging have made a profound impact on understanding the brain both during normal functioning and in clinical pathology. Overall, neuroimaging is a powerful tool for both research and clinical practice and offers a noninvasive window into the central nervous system of humans in both health and disease.
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Darya Gaysina and Ellen J. Thompson
Psychological traits, including temperament, cognitive functions, and emotions, vary between people. The key aim of twin studies is to investigate the role of genetic factors (nature), environmental factors (nurture), and their interplay, in individual differences of various traits. In the last few decades, the classical twin design (i.e., univariate twin studies and multivariate twin studies), as well as other types of twin studies (e.g., children of twins studies) have been widely used in investigations of psychological traits. Importantly, large-scale twin studies have been established in different countries around the globe, and they have facilitated nature and nurture investigations across different geographical, social and cultural settings. However, when interpreting findings of twin studies, specific methodological assumptions and limitations need to be considered. For example, the equal environments assumption (EEA) suggests that similarities for both monozygotic and dizygotic twin pairs reared in the same family are roughly the same, but this may not always be the case.
Among the most important findings of twin studies of psychological traits is the establishment of relative contributions of genetic and environmental influences on health and behavior. Substantial contributions of genetic factors have been demonstrated for many psychological traits, but none of the studies psychological traits is 100% heritable. Also, twin studies have demonstrated that genetic effects can be modified by sex, age, as well as by environmental influences. Moreover, our genetic makeup can shape our environment. Taken together, studies using the twin design have made the significant contribution to our understanding of etiology of individual differences of many psychological traits.
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Ed Watkins
Worry and rumination are both forms of repetitive negative thought (RNT) characterized by repetitive and often uncontrollable thinking about negative content. Rumination is typically defined as repetitive thinking about the symptoms, causes, circumstances, meanings, and consequences of negative mood, personal concerns, and upsetting experiences, often with a focus on depressive experience. Worry is typically defined as repetitive thinking about future potential threat, imagined catastrophes, uncertainties, and risks and is conceptualized as an attempt to avoid negative events, prepare for the worst, and problem-solve. Worry and rumination are implicated in the exacerbation of negative mood and negative thinking, reduced central executive resources, impaired problem- solving, and prolonged sympathetic activation and emotional responses to stress and, as such, transdiagnostically contribute to the onset and maintenance of multiple emotional disorders, including major depression, anxiety disorders, insomnia, eating disorders, substance and alcohol abuse, and psychosis. Both worry and rumination are implicated in poor response to psychological interventions—greater reduction in RNT is associated with greater symptom improvement, whereas no change in RNT is associated with no improvement or worsening of symptoms. Rumination and worry appear to be moderately genetically heritable and predicted by environmental factors such as early adversity, stressful life events, and unhelpful parental styles. RNT is a common pathway between multiple risk factors, including neglect, abuse, bullying, and chronic stress, and later psychopathology. Pathological worry and rumination share an abstract processing style, negative biases in attention and interpretation, and impaired executive control and are mental habits. Both worry and rumination have been hypothesized to serve an avoidant function. Interventions that target these mechanisms appear to be effective at tackling RNT, particularly rumination-focused cognitive-behavioral therapy and mindfulness-based interventions. More efficient interventions for anxiety and depression may result from interventions that target multiple of these proximal mechanisms.
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Michelle L. Moulds, Jessica R. Grisham, and Bronwyn M. Graham
Cognitive behavioral therapy (CBT) is an evidence-based, structured, goal-oriented, time-limited intervention for psychological disorders. CBT integrates behavioral and cognitive principles and therapeutic strategies; practitioners and clients work collaboratively to identify patterns of behaving and thinking that contribute to the persistence of symptoms, with the goal of replacing them with more adaptive alternatives. In the treatment of anxiety problems, the primary focus of CBT is on reducing avoidance of feared stimuli (e.g., spiders) or situations (e.g., public speaking) and modifying biases in thinking (e.g., the tendency to interpret benign situations as threatening). At its broadest, CBT is an umbrella term; it describes a range of interventions targeting cognitive and behavioral processes—ranging from early, traditional CBT protocols to more recently developed approaches (e.g., mindfulness-based cognitive therapy). CBT protocols have been developed for the full range of anxiety disorders, and a strong evidence base supports their efficacy.
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Julia Browne, Corinne Cather, and Kim T. Mueser
Common factors, or characteristics that are present across psychotherapies, have long been considered important to fostering positive psychotherapy outcomes. The contextual model offers an overarching theoretical framework for how common factors facilitate therapeutic change. Specifically, this model posits that improvements occur through three primary pathways: (a) the real relationship, (b) expectations, and (c) specific ingredients. The most-well-studied common factors, which also are described within the contextual model, include the therapeutic alliance, therapist empathy, positive regard, genuineness, and client expectations. Empirical studies have demonstrated that a strong therapeutic alliance, higher ratings of therapist empathy, positive regard, genuineness, and more favorable outcome expectations are related to improved treatment outcomes. Yet, the long-standing debate continues regarding whether psychotherapy outcomes are most heavily determined by these common factors or by factors specific to the type of therapy used. There have been calls for an integration of the two perspectives and a shift toward evaluating mechanisms as a way to move the field forward. Nonetheless, the common factors are valuable in treatment delivery and should be a focus in delivering psychotherapy.
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Holly Bridge
The sensation of vision arises from the detection of photons of light at the eye, but in order to produce the percept of the world, extensive regions of the brain are required to process the visual information. The majority of information entering the brain via the optic nerve from the eye projects via the lateral geniculate nucleus (LGN) of the thalamus to the primary visual cortex, the largest visual area, having been reorganized such that one side of the brain represents one side of the world.
Damage to the primary visual cortex in one hemisphere therefore leads to a loss of conscious vision on the opposite side of the world, known as hemianopia. Despite this cortical blindness, many patients are still able to detect visual stimuli that are presented in the blind region if forced to guess whether a stimulus is present or absent. This is known as “blindsight.” For patients to gain any information (conscious or unconscious) about the visual world, the input from the eye must be processed by the brain. Indeed, there is considerable evidence from functional brain imaging that several visual areas continue to respond to visual stimuli presented within the blind region, even when the patient is unaware of the stimulus. Furthermore, the use of diffusion imaging allows the microstructure of white matter pathways within the visual system to be examined to see whether they are damaged or intact. By comparing patients who have hemianopia with and without blindsight it is possible to determine the pathways that are linked to blindsight function. Through understanding the brain areas and pathways that underlie blindsight in humans and non-human primates, the aim is to use modern neuroscience to guide rehabilitation programs for use after stroke.
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Åsa Jansson
Depression is defined in diagnostic literature as a mood disorder characterized by depressed mood, loss of interest or pleasure in activities, significant changes in weight, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, feelings of worthlessness or excessive guilt, difficulty concentrating, and suicidal ideation and/or attempts. Research suggests a link between depressed mood and monoamine depletion, elevated cortisol, and inflammation, but existing laboratory evidence is inconclusive. Current treatments for depression include selective serotonin reuptake inhibitors (SSRIs), cognitive behavioral therapy (CBT), and lifestyle changes; however, more severe forms of the disorder can require other medication, sometimes in combination with electroconvulsive therapy (ECT).
Disagreement persists over how to define and classify depression, in part due to its ambivalent relationship to melancholia, which has existed as a medical concept in different forms since antiquity. Melancholia was reconfigured in 19th-century medicine from traditional melancholy madness into a modern mood disorder. In the early 20th century, melancholia gradually fell out of use as a diagnostic term with the introduction of manic-depressive insanity and unipolar depression. Following the publication of DSM-III in 1980 and the introduction of SSRIs a few years later, major depressive disorder became ubiquitous. Consumption of antidepressants have continued to rise year after year, and the World Health Organization notes depression as the leading cause of disability worldwide.
At present, internationally recognized systems of classification favor a single category for depressive illness (alongside a circular mood disorder, bipolar I and II), but this view is challenged by clinicians and researchers who argue for the reinstatement of melancholia as a separate and distinct mood disorder with marked somatic and psychotic features.
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Scott O. Lilienfeld and Candice Basterfield
Evidence-based therapies stemmed from the movement toward evidence-based medicine, and later, evidence-based practice (EBP) in psychology and allied fields. EBP reflects a progressive historical shift from naïve empiricism, which is based on raw and untutored observations of patient change, to systematic empiricism, which refines and hones such observations with the aid of systematic research techniques. EBP traces its roots in part to the development of methods of randomization in the early 20th century. In American psychology, EBP has traditionally been conceptualized as a three-legged stool comprising high-quality treatment outcome evidence, clinical expertise, and patient preferences and values. The research leg of the stool is typically operationalized in terms of a hierarchy of evidentiary certainty, with randomized controlled trials and meta-analyses of such trials toward the apex. The most influential operationalization of the EBP research leg is the effort to identify empirically supported treatments, which are psychotherapies that have been demonstrated to work for specific psychological conditions. Still, EBP remains scientifically controversial in many quarters, and some critics have maintained that the research base underpinning it is less compelling than claimed by its proponents.
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Silvia Degni
Psychosomatics concerns those physical disorders not caused by an organic event but caused by psychological events. These disorders, called “psychosomatic,” may involve different organs and systems and it is possible a wide range of cases of possible psychosomatic disorders.
The term psychosomatics itself represents all the complexity and tension of this discipline. It contains a dualism that contrasts with the theory at the heart of psychosomatic medicine—the functional and synergistic unitary nature of soma and psyche.
The psychosomatic problem represents the original nucleus at the inception of the psychoanalytic movement that concerns itself precisely with the physical disorders devoid of an anatomopathological substratum. With the development of the libido theory and the resulting hypotheses on the development of neurosis, Freud proposed a model that integrates the somatic, psychic, and social component, and it represents in a convincing way physical diseases that occur as a result of psychological events. Freud created two distinct approaches in the explanation of psychosomatic disorders: the first makes use of a system of conversion of the psychic into the somatic, and the second raises problems of biological nature, in the sense that a psychological factor (anxiety) would directly activate the sympathetic system and therefore the organic functions it controls.
The conflict theory was the first major paradigm of psychosomatic medicine, and most efforts by the first generation of psychosomatists aimed to test this hypothesis and identify psychological conflicts that were typical of patients suffering from diseases considered psychosomatic in nature. Some scholars—such as Federn, Goddeck, Deutsch, Dumbar and Alexander, Schultz-Hencke, von Weizsäcker, Schilder, Schur, de Mitsherlich, de Boor—starting from the Freudian psychoanalysis, emphasize a particular psychoanalytic mechanism interpreted as a cause of psychosomatic disorders. The panorama of contemporary psychosomatics is certainly much more varied than the classical one, and new proposals and conceptions have emerged alongside the psychoanalytic model. The main contemporary models aim to integrate the knowledge of medicine and psychoanalysis into a coherent and unitary theoretical whole. The goal is therefore the unification of the ontological and scientific dualism that sees the body of medicine as opposed to the psyche of psychoanalysis. The contemporary theories all converge in the analysis of the original mechanisms of formation and development of subjectivity that is named according to the search to address ego, self, or identity.
