1990 – B.F. Skinner, American psychologist and philosopher, invented the Skinner box (b. 1904).
B.F. Skinner
Burrhus Frederic Skinner (20 March 1904 to 08 August 1990) was an American psychologist, behaviourist, author, inventor, and social philosopher. He was a professor of psychology at Harvard University from 1958 until his retirement in 1974.
Considering free will to be an illusion, Skinner saw human action as dependent on consequences of previous actions, a theory he would articulate as the principle of reinforcement: If the consequences to an action are bad, there is a high chance the action will not be repeated; if the consequences are good, the probability of the action being repeated becomes stronger.
Skinner developed behaviour analysis, especially the philosophy of radical behaviourism, and founded the experimental analysis of behaviour, a school of experimental research psychology. He also used operant conditioning to strengthen behaviour, considering the rate of response to be the most effective measure of response strength. To study operant conditioning, he invented the operant conditioning chamber (aka the Skinner box), and to measure rate he invented the cumulative recorder. Using these tools, he and Charles Ferster produced Skinner’s most influential experimental work, outlined in their 1957 book Schedules of Reinforcement.
Skinner was a prolific author, publishing 21 books and 180 articles. He imagined the application of his ideas to the design of a human community in his 1948 utopian novel, Walden Two, while his analysis of human behaviour culminated in his 1958 work, Verbal Behaviour.
Skinner, John B. Watson and Ivan Pavlov, are considered to be the pioneers of modern behaviourism. Accordingly, a June 2002 survey listed Skinner as the most influential psychologist of the 20th century.
Education and Later Life
Skinner attended Hamilton College in New York with the intention of becoming a writer. He wrote for the school paper, but, as an atheist, he was critical of the traditional mores of his college. After receiving his Bachelor of Arts in English literature in 1926, he attended Harvard University, where he would later research and teach. While attending Harvard, a fellow student, Fred S. Keller, convinced Skinner that he could make an experimental science of the study of behaviour. This led Skinner to invent a prototype for the Skinner box and to join Keller in the creation of other tools for small experiments.
After graduation, Skinner unsuccessfully tried to write a novel while he lived with his parents, a period that he later called the “Dark Years”. He became disillusioned with his literary skills despite encouragement from the renowned poet Robert Frost, concluding that he had little world experience and no strong personal perspective from which to write. His encounter with John B. Watson’s behaviourism led him into graduate study in psychology and to the development of his own version of behaviourism.
Skinner received a PhD from Harvard in 1931, and remained there as a researcher for some years. In 1936, he went to the University of Minnesota in Minneapolis to teach. In 1945, he moved to Indiana University, where he was chair of the psychology department from 1946 to 1947, before returning to Harvard as a tenured professor in 1948. He remained at Harvard for the rest of his life. In 1973, Skinner was one of the signers of the Humanist Manifesto II.
Contributions to Psychology
Behaviourism
Skinner referred to his approach to the study of behaviour as radical behaviourism, which originated in the early 1900s as a reaction to depth psychology and other traditional forms of psychology, which often had difficulty making predictions that could be tested experimentally. This philosophy of behavioural science assumes that behaviour is a consequence of environmental histories of reinforcement (refer to applied behaviour analysis). In his words:
The position can be stated as follows: what is felt or introspectively observed is not some nonphysical world of consciousness, mind, or mental life but the observer’s own body. This does not mean, as I shall show later, that introspection is a kind of psychological research, nor does it mean (and this is the heart of the argument) that what are felt or introspectively observed are the causes of the behavior. An organism behaves as it does because of its current structure, but most of this is out of reach of introspection. At the moment we must content ourselves, as the methodological behaviorist insists, with a person’s genetic and environment histories. What are introspectively observed are certain collateral products of those histories.… In this way we repair the major damage wrought by mentalism. When what a person does [is] attributed to what is going on inside him, investigation is brought to an end. Why explain the explanation? For twenty-five hundred years people have been preoccupied with feelings and mental life, but only recently has any interest been shown in a more precise analysis of the role of the environment. Ignorance of that role led in the first place to mental fictions, and it has been perpetuated by the explanatory practices to which they gave rise.[25]
Foundations of Skinner’s Behaviourism
Skinner’s ideas about behaviourism were largely set forth in his first book, The Behaviour of Organisms (1938). Here, he gives a systematic description of the manner in which environmental variables control behaviour. He distinguished two sorts of behaviour which are controlled in different ways:
Respondent behaviours are elicited by stimuli, and may be modified through respondent conditioning, often called classical (or pavlovian) conditioning, in which a neutral stimulus is paired with an eliciting stimulus. Such behaviours may be measured by their latency or strength.
Operant behaviours are ’emitted’, meaning that initially they are not induced by any particular stimulus. They are strengthened through operant conditioning (aka instrumental conditioning), in which the occurrence of a response yields a reinforcer. Such behaviours may be measured by their rate.
Both of these sorts of behaviour had already been studied experimentally, most notably: respondents, by Ivan Pavlov; and operants, by Edward Thorndike. Skinner’s account differed in some ways from earlier ones, and was one of the first accounts to bring them under one roof.
The idea that behaviour is strengthened or weakened by its consequences raises several questions. Among the most commonly asked are these:
Operant responses are strengthened by reinforcement, but where do they come from in the first place?
Once it is in the organism’s repertoire, how is a response directed or controlled?
How can very complex and seemingly novel behaviours be explained?
Origin of Operant Behaviour
Skinner’s answer to the first question was very much like Darwin’s answer to the question of the origin of a ‘new’ bodily structure, namely, variation and selection. Similarly, the behaviour of an individual varies from moment to moment; a variation that is followed by reinforcement is strengthened and becomes prominent in that individual’s behavioural repertoire. Shaping was Skinner’s term for the gradual modification of behaviour by the reinforcement of desired variations. Skinner believed that ‘superstitious’ behaviour can arise when a response happens to be followed by reinforcement to which it is actually unrelated. This can be seen, for example, with lucky socks that athletes wear. If they wear a pair of socks once and they win, but do not wear them for the next game and they lose, this reinforces the wearing of the lucky socks during games. The more it happens, the stronger the superstition will become.
Control of Operant Behaviour
The second question, “how is operant behaviour controlled?” arises because, to begin with, the behaviour is “emitted” without reference to any particular stimulus. Skinner answered this question by saying that a stimulus comes to control an operant if it is present when the response is reinforced and absent when it is not. For example, if lever-pressing only brings food when a light is on, a rat, or a child, will learn to press the lever only when the light is on. Skinner summarized this relationship by saying that a discriminative stimulus (e.g. light or sound) sets the occasion for the reinforcement (food) of the operant (lever-press). This three-term contingency (stimulus-response-reinforcer) is one of Skinner’s most important concepts, and sets his theory apart from theories that use only pair-wise associations.
Explaining Complex Behaviour
Most behaviour of humans cannot easily be described in terms of individual responses reinforced one by one, and Skinner devoted a great deal of effort to the problem of behavioural complexity. Some complex behaviour can be seen as a sequence of relatively simple responses, and here Skinner invoked the idea of “chaining”. Chaining is based on the fact, experimentally demonstrated, that a discriminative stimulus not only sets the occasion for subsequent behaviour, but it can also reinforce a behaviour that precedes it. That is, a discriminative stimulus is also a “conditioned reinforcer”. For example, the light that sets the occasion for lever pressing may also be used to reinforce “turning around” in the presence of a noise. This results in the sequence “noise – turn-around – light – press lever – food.” Much longer chains can be built by adding more stimuli and responses.
However, Skinner recognised that a great deal of behaviour, especially human behaviour, cannot be accounted for by gradual shaping or the construction of response sequences. Complex behaviour often appears suddenly in its final form, as when a person first finds his way to the elevator by following instructions given at the front desk. To account for such behaviour, Skinner introduced the concept of rule-governed behaviour. First, relatively simple behaviours come under the control of verbal stimuli: the child learns to “jump,” “open the book,” and so on. After a large number of responses come under such verbal control, a sequence of verbal stimuli can evoke an almost unlimited variety of complex responses.
Operant Conditioning Chamber
An operant conditioning chamber (also known as a “Skinner box”) is a laboratory apparatus used in the experimental analysis of animal behaviour. It was invented by Skinner while he was a graduate student at Harvard University. As used by Skinner, the box had a lever (for rats), or a disk in one wall (for pigeons). A press on this “manipulandum” could deliver food to the animal through an opening in the wall, and responses reinforced in this way increased in frequency. By controlling this reinforcement together with discriminative stimuli such as lights and tones, or punishments such as electric shocks, experimenters have used the operant box to study a wide variety of topics, including schedules of reinforcement, discriminative control, delayed response (“memory”), punishment, and so on. By channelling research in these directions, the operant conditioning chamber has had a huge influence on course of research in animal learning and its applications. It enabled great progress on problems that could be studied by measuring the rate, probability, or force of a simple, repeatable response. However, it discouraged the study of behavioural processes not easily conceptualized in such terms – spatial learning, in particular, which is now studied in quite different ways, for example, by the use of the water maze.
Denial or abnegation (German: Verneinung) is a psychological defense mechanism postulated by psychoanalyst Sigmund Freud, in which a person is faced with a fact that is too uncomfortable to accept and rejects it instead, insisting that it is not true despite what may be overwhelming evidence.
The subject may use:
Simple denial: deny the reality of the unpleasant fact altogether.
Minimisation: admit the fact but deny its seriousness (a combination of denial and rationalisation).
Projection: admit both the fact and seriousness but deny responsibility by blaming somebody or something else.
Description
The theory of denial was first researched seriously by Anna Freud. She classified denial as a mechanism of the immature mind because it conflicts with the ability to learn from and cope with reality. Where denial occurs in mature minds, it is most often associated with death, dying and rape. More recent research has significantly expanded the scope and utility of the concept. Elisabeth Kübler-Ross used denial as the first of five stages in the psychology of a dying patient, and the idea has been extended to include the reactions of survivors to news of a death.
Many contemporary psychoanalysts treat denial as the first stage of a coping cycle. When an unwelcome change occurs, a trauma of some sort, the first impulse to disbelieve begins the process of coping. That denial, in a healthy mind, slowly rises to greater consciousness. Gradually becoming a subconscious pressure, just beneath the surface of overt awareness, the mechanism of coping then involves repression, while the person accumulates the emotional resources to fully face the trauma. Once faced, the person deals with the trauma in a stage alternately called acceptance or enlightenment, depending on the scope of the issue and the therapist’s school of thought. After this stage, once sufficiently dealt with, or dealt with for the time being, the trauma must sink away from total conscious awareness again. Left out of the conscious mind, the process of sublimation involves a balance of neither quite forgetting nor quite remembering. This allows the trauma to re-emerge in consciousness if it involves an ongoing process such as a protracted illness. Alternately, sublimation may begin the full resolution process, where the trauma finally sinks away into eventual forgetfulness. Occasionally this entire cycle has been referred to in modern parlance as denial, confusing the full cycle with only one stage of it. To further muddy discourse, the terms denial and cycle of denial sometimes get used to refer to an unhealthy, dysfunctional cycle of unresolved coping, particularly with regard to addiction and compulsion.
Unlike some other defence mechanisms postulated by psychoanalytic theory (for instance, repression), the general existence of denial is fairly easy to verify, even for non-specialists. However, denial is one of the most controversial defence mechanisms, since it can be easily used to create unfalsifiable theories: anything the subject says or does that appears to disprove the interpreter’s theory is explained, not as evidence that the interpreter’s theory is wrong, but as the subject’s being “in denial”. However, researchers note that in some cases of corroborated child sexual abuse, the victims sometimes make a series of partial confessions and recantations as they struggle with their own denial and the denial of abusers or family members. Use of denial theory in a legal setting, therefore, is carefully regulated and experts’ credentials verified. “Formulaic guilt” simply by “being a denier” has been castigated by English judges and academics. The main objection is that denial theory is founded on the premise that which the supposed denier is denying the truth. This usurps the judge (and jury) as triers of fact.
Denial is especially characteristic of mania, hypomania, and generally of people with bipolar affective disorder in the manic stage – in this state, one can deny, remarkably a long period of time, the fact that one has fatigue, hunger, negative emotions and problems in general, until one is physically exhausted.
Denial and Disavowal
Freud employs the term Verleugnung (usually translated either as “disavowal” or as “denial”) as distinct from Verneinung (usually translated as “denial” or as “abnegation”). In Verleugnung, the defence consists of denying something that affects the individual and is a way of affirming what he or she is apparently denying. For Freud, Verleugnung is related to psychoses, whereas Verdrängung is a neurotic defense mechanism. Freud broadened his clinical work on disavowal beyond the realm of psychosis. In “Fetishism” (1927), he reported a case of two young men each of whom denied the death of his father. Freud notes that neither of them developed a psychosis, even though “a piece of reality which was undoubtedly important has been disavowed [verleugnet], just as the unwelcome fact of women’s castration is disavowed in fetishists.”
Types
Denial of Fact
In this form of denial, someone avoids a fact by utilising deception. This lying can take the form of an outright falsehood (commission), leaving out certain details to tailor a story (omission), or by falsely agreeing to something (assent). Someone who is in denial of fact is typically using lies to avoid facts they think may be painful to themselves or others.
Denial of Responsibility
This form of denial involves avoiding personal responsibility by:
Blaming: a direct statement shifting culpability and may overlap with denial of fact
Minimising: an attempt to make the effects or results of an action appear to be less harmful than they may actually be
Justifying: when someone takes a choice and attempts to make that choice appear acceptable due to their perception of what is right in a situation
Regression: when someone acts in a way unbecoming of their age.
Someone using denial of responsibility is usually attempting to avoid potential harm or pain by shifting attention away from themselves.
Denial of Impact
Denial of impact involves a person’s avoiding thinking about or understanding the harms of their behaviour has caused to self or others, i.e. denial of consequences. Doing this enables that person to avoid feeling a sense of guilt and it can prevent him or her from developing remorse or empathy for others. Denial of impact reduces or eliminates a sense of pain or harm from poor decisions.
Denial of Awareness
This form of denial attempts to divert pain by claiming that the level of awareness was inhibited by some mitigating variable. This is most typically seen in addiction situations where drug or alcohol abuse is a factor, though it also occasionally manifests itself in relation to mental health issues or the pharmaceutical substances used to treat mental health issues. This form of denial may also overlap with denial of responsibility.
It was adapted by Stice et al. in 2000 from the validated structured psychiatric interview: The Eating Disorder Examination (EDE) and the eating disorder module of the Structured Clinical Interview for DSM-IV (SCID)16.
A study was made to complete the EDDS research; the process to create and finalise the questionnaire. A group of people eating-disorders researchers take a looked at a preliminary version of the questionnaire and made a final decision of which questions to put on the final questionnaire with the 22 questions.
The questionnaire starts off with questions about the patient’s feelings towards his/her physical appearance, specifically the weight.
Then, it proceeds to questions about having episodes of eating with a loss of control and how he/she felt after overeating.
The questions afterwards are about the patient’s experience on fasting, making themselves vomit and using laxatives to prevent weight gain.
It will then ask you how much body image problems impact your relationship and friendship with others.
Lastly, the questionnaire asks for the patient’s current weight, height, sex and age.
The EDDS questionnaire is used for researchers to provide some cures for the three types of eating disorder. It is more efficient than having an interview because it’s easier to get a result, from a group of participants, with the 22-questions questionnaire. Having to interview each participant is a harder and more time-consuming way to get a result. This questionnaire is also useful for primary care/ clinical purposes to identify patients with eating pathology.
In follow up studies of the reliability and validity of the EDDS, it was shown to be sufficiently sensitive to detect the effects of eating disorders prevention programs, response to such programs and the future onset of eating disorder pathology and depression. The EDDS shows both full and subthreshold diagnoses for anorexia nervosa, bulimia nervosa and binge eating disorder. EDDS is a continuous eating disorder symptom composite score. The PhenX Toolkit uses the EDDS for as an Eating Disorders Screener protocol.
The Cambridge Neuropsychological Test Automated Battery (CANTAB), originally developed at the University of Cambridge in the 1980s but now provided in a commercial capacity by Cambridge Cognition, is a computer-based cognitive assessment system consisting of a battery of neuropsychological tests, administered to subjects using a touch screen computer.
Outline
The CANTAB tests were co-invented by Professor Trevor Robbins and Professor Barbara Sahakian.
The 25 tests in CANTAB examine various areas of cognitive function, including:
General memory and learning.
Working memory and executive function.
Visual memory.
Attention and reaction time (RT).
Semantic/verbal memory.
Decision making and response control.
The CANTAB combines the accuracy and rigour of computerised psychological testing whilst retaining the wide range of ability measures demanded of a neuropsychological battery. It is suitable for young and old subjects, and aims to be culture and language independent through the use of non-verbal stimuli in the majority of the tests.
The CANTAB PAL touchscreen test, which assesses visual memory and new learning, received the highest rating of world-leading 4* grade from the Research Excellence Framework (REF) 2014. CANTAB and CANTAB PAL were highlighted in the Medical Schools Council ‘Health of the Nation’ 2015 publication.
The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, commonly called the Beers List, are guidelines for healthcare professionals to help improve the safety of prescribing medications for older adults 65 years and older in all except palliative setting.
They emphasize deprescribing medications that are unnecessary, which helps to reduce the problems of polypharmacy, drug interactions, and adverse drug reactions, thereby improving the risk–benefit ratio of medication regimens in at-risk people.
The criteria are used in geriatrics clinical care to monitor and improve the quality of care. They are also used in training, research, and healthcare policy to assist in developing performance measures and document outcomes. These criteria include lists of medications in which the potential risks may be greater than the potential benefits for people 65 and older. By considering this information, practitioners may be able to reduce harmful side effects caused by such medications. The Beers Criteria are intended to serve as a guide for clinicians and not as a substitute for professional judgement in prescribing decisions. The criteria may be used in conjunction with other information to guide clinicians about safe prescribing in older adults.
Brief History
Geriatrician Mark H. Beers formulated the Beers Criteria through a consensus panel of experts using the Delphi method. The criteria were originally published in the Archives of Internal Medicine in 1991 and updated in 1997, 2003, 2012, 2015, and most recently in January 2019.
In 2018, the American Geriatrics Society (AGS) partnered with CSIS Health Corp to provide the first and only licensed software application of the Beers Criteria for use in Electronic Health Records, Population Health Management, and Care Management platforms.
Management of Criteria
In 2011, the AGS convened an eleven-member multidisciplinary panel of experts in geriatric medicine, nursing, and pharmacotherapy to develop the 2012 edition of the AGS Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.
The 2012 AGS Beers Criteria differ from previous editions in several ways. In addition to using a modified Delphi process for building consensus, the expert panel followed the evidence-based approach that AGS has used since it developed its first practice guideline on persistent pain in 1998. The Institute of Medicine (IOM) in its 2011 report, Clinical Practice Guidelines We Can Trust, recommended that all guideline developers complete a systematic review of the evidence. Following the recommendation of the IOM, AGS added a public comment period that occurred in parallel to its standard invited external peer review process. In a significant departure from previous versions of the criteria, each recommendation is rated for quality of both the evidence supporting the panel’s recommendations and the strength of their recommendations.
In another departure from the 2003 criteria, the 2012 AGS Beers Criteria identify and group medications that may be inappropriate for older adults into three different categories instead of the previous two. The first category includes medications that are potentially inappropriate for older people because they either pose high risks of adverse effects or appear to have limited effectiveness in older patients, and because there are alternatives to these medications. The second category includes medications that are potentially inappropriate for older people who have certain diseases or disorders because these drugs may exacerbate the specified health problems. The third category includes medications that, although they may be associated with more risks than benefits in general, may be the best choice for a particular individual if administered with caution.
The 2012 AGS Beers Criteria was released in February 2012 via publication in the early online edition of the Journal of the American Geriatrics Society.
The most recent update to the Beers criteria was completed in 2019.
Style of the Publication
Drugs listed on the Beers List are categorised according to risks for negative outcomes. The tables include medications that have cautions, should be avoided, should be avoided with concomitant medical conditions, and are contraindicated and relatively contraindicated in the elderly population. An example of an included drug is diphenhydramine (Benadryl), a first-generation H1 antagonist with anticholinergic properties, which may increase sedation and lead to confusion or falls.
Evenly-suspended attention is the kind of direction-less listening – removed from both theoretical presuppositions and therapeutic goals – recommended by Sigmund Freud for use in psychoanalysis.
Outline
By attaching no preconceived importance to any particular part of the analyst’s discourse, and allowing their unconscious complete freedom to act, the analysand’s can best profit from the counterpart rule of free association on the part of the analysand.
Such “hovering” attention (as Freud put it in 1909 in the case of Little Hans) was a technical development on his part from the more aggressive listening and interpretation of the 1890s, as his shift from hypnosis to psychoanalysis took gradual shape.
Later Developments
Since Theodor Reik and his 1948 study Listening with the Third Ear, more analytic emphasis has been placed on the dialectic between evenly suspended attention, and the analyst’s cognitive working-over of what they hear. The part played by countertransference and by the analyst’s role responsiveness has also been highlighted.
Abstinence or the rule of abstinence is the principle of analytic reticence and/or frustration within a clinical situation.
It is a central feature of psychoanalytic theory – relating especially to the handling of the transference in analysis.
As Sigmund Freud wrote in 1914:
The cure must be carried through in abstinence. I mean by that not physical self-denial alone, nor the denial of every desire….But I want to state the principle that one must permit neediness and yearning to remain as forces favoring work and change.
Later Formulations
The validity of the abstinence principle has been rediscovered and re-affirmed in a variety of subsequent analytic traditions.
Jacques Lacan
Re-formulated the principle via the concept of ‘analytic bridge’ – the analyst necessarily playing the part of the unresponding dummy to bring the patient’s unconscious motivations out into the open.
Eric Berne
Saw analytic frustration as a means of avoiding playing a part in the patient’s life script.
R.D. Laing
In the context of the false self saw analytic abstinence operating in opposition to false self collusion: “It is in terms of basic frustration of the self’s search for a collusive complement for false identity that Freud’s dictum that analysis should be conducted under conditions of maximal frustration takes on its most cogent meaning”.
D.W. Winnicott
In the context of his notion of ‘holding’ the patient emphasised that understanding through verbal interpretation gave a deeper sense of holding than the physical act, use of which by the therapist could blur the symbolic nature of the analytic space.
Debates
The rule of abstinence has come under increasing challenge by Interpersonal and Intersubjective psychoanalysis, concerned about the inflexibility of the rule, and the way its relentless application may provoke unnecessary hostility, even an iatrogenic transference neurosis.
Defenders of the rule, against the practice of the warm supportive analyst, argue against the easy seductiveness of being overly ‘helpful’ in a self-defeating way already sketched out by Freud himself. The concept of optimal responsiveness – balancing frustration and gratification from moment to moment – offers some mediation in the dispute.
Affective neuroscience is the study of the neural mechanisms of emotion.
This interdisciplinary field combines neuroscience with the psychological study of personality, emotion, and mood. The putative existence of ‘basic emotions’ and their defining attributes represents a long lasting and yet unsettled issue in the field.
The term was coined by neuroscientist Jaak Panksepp, at a time when cognitive neuroscience focused on non-emotional cognition, such as attention or memory.
Brain Areas
Emotions are thought to be related to activity in brain areas that direct our attention, motivate our behaviour, and choose the significance of what is going on around us. Pioneering work by Paul Broca (1878), James Papez (1937), and Paul D. MacLean (1952) suggested that emotion is related to a group of structures in the centre of the brain called the limbic system, which includes the hypothalamus, cingulate cortex, hippocampi, and other structures. Research has shown that limbic structures are directly related to emotion, but other structures have been found to be of greater emotional relevance.
The following brain structures are currently thought to be involved in emotion:
Limbic System
Amygdala:
The amygdalae are two small, round structures located anterior to the hippocampi near the temporal poles.
The amygdalae are involved in detecting and learning which parts of our surroundings are important and have emotional significance.
They are critical for the production of emotion, and may be particularly so for negative emotions, especially fear.
Multiple studies have shown amygdala activation when perceiving a potential threat; various circuits allow the amygdala to use related past memories to better judge the possible threat.
Thalamus:
The thalamus is involved in relaying sensory and motor signals to the cerebral cortex, especially visual stimuli.
The thalamus plays an important role in regulating states of sleep and wakefulness.
Hypothalamus:
The hypothalamus is involved in producing a physical output associated with an emotion as well as in reward circuits.
Hippocampus:
The hippocampus is a structure of the medial temporal lobes that is mainly involved in memory.
It works to form new memories and also connects senses such as visual input, smell or sound to memories.
The hippocampus allows long term memories to be stored and retrieves them when necessary.
Memories are used within the amygdala to help evaluate stimulae.
Fornix:
The fornix is the main output pathway from the hippocampus to the mammillary bodies.
It has been identified as a main region in controlling spatial memory functions, episodic memory and executive functions.
Mammillary body:
Mammillary bodies are important for recollective memory.
Olfactory bulb:
The olfactory bulbs are the first cranial nerves, located on the ventral side of the frontal lobe.
They are involved in olfaction, the perception of odours.
Cingulate gyrus:
The cingulate gyrus is located above the corpus callosum and is usually considered to be part of the limbic system.
The parts of the cingulate gyrus have different functions, and are involved with affect, visceromotor control, response selection, skeletomotor control, visuospatial processing, and in memory access.
A part of the cingulate gyrus is the anterior cingulate cortex, which is thought to play a central role in attention and behaviourally demanding cognitive tasks.
It may be particularly important with regard to conscious, subjective emotional awareness.
This region of the brain may play an important role in the initiation of motivated behaviour.
The subgenual cingulate is more active during both experimentally induced sadness and during depressive episodes.
Other Brain Structures
Basal ganglia:
Basal ganglia are groups of nuclei found on either side of the thalamus.
Basal ganglia play an important role in motivation, action selection and reward learning.
Orbitofrontal cortex:
The orbitofrontal cortex is a major structure involved in decision making and the influence by emotion on that decision.
Prefrontal cortex:
The prefrontal cortex is the front of the brain, behind the forehead and above the eyes.
It appears to play a critical role in the regulation of emotion and behaviour by anticipating consequences.
It may play an important role in delayed gratification by maintaining emotions over time and organising behaviour toward specific goals.
Ventral striatum:
The ventral striatum is a group of subcortical structures thought to play an important role in emotion and behaviour.
One part of the ventral striatum called the nucleus accumbens is thought to be involved in the experience of pleasure.
Individuals with addictions experience increased activity in this area when they encounter the object of their addiction.
Insula:
The insular cortex is thought to play a critical role in the bodily experience of emotion, as it is connected to other brain structures that regulate the body’s autonomic functions (heart rate, breathing, digestion, etc.).
The insula is implicated in empathy and awareness of emotion.
Cerebellum:
A “Cerebellar Cognitive Affective Syndrome” has been described.
Both neuroimaging studies as well as studies following pathological cerebellar lesions (such as a stroke) demonstrate that the cerebellum has a significant role in emotional regulation.
Lesion studies have shown that cerebellar dysfunction can attenuate the experience of positive emotions.
While these same studies do not show an attenuated response to frightening stimuli, the stimuli did not recruit structures that normally would be activated (such as the amygdala).
Rather, alternative structures were activated, such as the ventromedial prefrontal cortex, the anterior cingulate gyrus, and the insula.
This may indicate that evolutionary pressure resulted in the development of the cerebellum as a redundant fear-mediating circuit to enhance survival.
It may also indicate a regulatory role for the cerebellum in the neural response to rewarding stimuli, such as money, drugs of abuse, and orgasm.
Lateral prefrontal cortex.
Primary sensorimotor cortex.
Temporal cortex.
Brainstem.
Right Hemisphere
The right hemisphere has been proposed as directly involved in emotion processing. Scientific theory regarding its role produced several models of emotional functioning. C.K. Mills was an early researcher who proposed a direct link between the right hemisphere and emotion processing, having observed decreased emotion processing in patients with lesions to the right hemisphere. In the late 1980s to early 1990s neocortical structures were shown to have an involvement in emotion. These findings led to the development of the right hemisphere hypothesis and the valence hypothesis.
Right Hemisphere Hypothesis
The right hemisphere hypothesis asserts that the right hemisphere is specialized for the expression and perception of emotion. It has been linked with mental strategies that are nonverbal, synthetic, integrative, holistic, and gestaltic. The right hemisphere is more in touch with subcortical systems of autonomic arousal and attention as demonstrated in patients that have increased spatial neglect when damage affects the right brain versus the left brain. Right hemisphere pathologies have been linked with abnormal patterns of autonomic nervous system responses. These findings would help signify the strong connection of the subcortical brain regions to the right hemisphere.
Valence Hypothesis
The valence hypothesis acknowledges the right hemisphere’s role in emotion, but asserts that it is mainly focused on the processing of negative emotions whereas the left hemisphere processes positive emotions. The two hemispheres have been the subject of much debate. One version states that the right hemisphere processes negative emotion leaving positive emotion to the left brain. A second version suggests that the right hemisphere predominates in experiencing both positive and negative emotion. More recently, the frontal lobe has been the focus of research, asserting that the frontal lobes of both hemispheres are involved in emotions, while the parietal and temporal lobes are involved in the processing of emotion. Decreased right parietal lobe activity has been associated with depression and increased right parietal lobe activity with anxiety arousal. The increasing understanding of the different hemispheres has led to increasingly complicated models, all based on the original valence model.
Cognitive Neuroscience
Despite their interactions, the study of cognition until the late 1990s, excluded emotion and focused on non-emotional processes (e.g. memory, attention, perception, action, problem solving and mental imagery). The study of the neural basis of non-emotional and emotional processes emerged as two separate fields: cognitive neuroscience and affective neuroscience. Emotional and non-emotional processes often involve overlapping neural and mental mechanisms.
Cognitive Neuroscience Tasks in Affective Neuroscience Research
Emotion Go/No-Go
The emotion go/no-go task has been used to study behavioural inhibition, particularly emotional modulation of this inhibition. A derivation of the original go/no-go paradigm, this task involves a combination of affective “go cues”, where the participant must rapidly make a motor response, and affective “no-go cues,” where a response must be withheld. Because “go cues” are more common, the task measures a subject’s ability to inhibit a response under different emotional conditions.
The task is common in tests of emotion regulation, and is often paired with neuroimaging measures to localize relevant brain function in both healthy individuals and those with affective disorders. For example, go/no-go studies converge with other methodology to implicate areas of the prefrontal cortex during inhibition of emotionally valenced stimuli.
Emotional Stroop
The emotional Stroop task, an adaptation to the original Stroop, measures attentional bias to emotional stimuli. Participants must name the ink colour of presented words while ignoring the words’ meanings. In general, participants have more difficulty detaching attention from affectively valenced words, than neutral words. This interference from valenced words is measured by the response latency in naming the colour of neutral words as compared with emotional words.
This task has been often used to test selective attention to threatening and other negatively valenced stimuli, most often in relation to psychopathology. Disorder-specific attentional biases have been found for a variety of mental disorders. For example, participants with spider phobia show a bias to spider-related words but not other negatively valenced words. Similar findings have been attributed to threat words related to other anxiety disorders. However, other studies have questioned these findings. In fact, anxious participants in some studies show the Stroop interference effect for both negative and positive words, when the words are matched for emotionality. This means that the specificity effects for various disorders may be largely attributable to the semantic relation of the words to the concerns of the disorder, rather than their emotionality.
Ekman 60 Faces Task
The Ekman faces task is used to measure emotion recognition of six basic emotions. Black and white photographs of 10 actors (6 male, 4 female) are presented, with each actor displaying each emotion. Participants are usually asked to respond quickly with the name of the displayed emotion. The task is a common tool to study deficits in emotion regulation in patients with dementia, Parkinson’s, and other cognitively degenerative disorders. The task has been used to analyse recognition errors in disorders such as borderline personality disorder, schizophrenia, and bipolar disorder.
Dot Probe (Emotion)
The emotional dot-probe paradigm is a task used to assess selective visual attention to and failure to detach attention from affective stimuli. The paradigm begins with a fixation cross at the centre of a screen. An emotional stimulus and a neutral stimulus appear side by side, after which a dot appears behind either the neutral stimulus (incongruent condition) or the affective stimulus (congruent condition). Participants are asked to indicate when they see this dot, and response latency is measured. Dots that appear on the same side of the screen as the image the participant was looking at will be identified more quickly. Thus, it is possible to discern which object the participant was attending to by subtracting the reaction time to respond to congruent versus incongruent trials.
The best documented research with the dot probe paradigm involves attention to threat related stimuli, such as fearful faces, in individuals with anxiety disorders. Anxious individuals tend to respond more quickly to congruent trials, which may indicate vigilance to threat and/or failure to detach attention from threatening stimuli. A specificity effect of attention has also been noted, with individuals attending selectively to threats related to their particular disorder. For example, those with social phobia selectively attend to social threats but not physical threats. However, this specificity may be even more nuanced. Participants with obsessive-compulsive disorder symptoms initially show attentional bias to compulsive threat, but this bias is attenuated in later trials due to habituation to the threat stimuli.
Fear Potentiated Startle
Fear-potentiated startle (FPS) has been utilised as a psychophysiological index of fear reaction in both animals and humans. FPS is most often assessed through the magnitude of the eyeblink startle reflex, which can be measured by electromyography. This eyeblink reflex is an automatic defensive reaction to an abrupt elicitor, making it an objective indicator of fear. Typical FPS paradigms involve bursts of noise or abrupt flashes of light transmitted while an individual attends to a set of stimuli. Startle reflexes have been shown to be modulated by emotion. For example, healthy participants tend to show enhanced startle responses while viewing negatively valenced images and attenuated startle while viewing positively valenced images, as compared with neutral images.
The startle response to a particular stimulus is greater under conditions of threat. A common example given to indicate this phenomenon is that one’s startle response to a flash of light will be greater when walking in a dangerous neighbourhood at night than it would under safer conditions. In laboratory studies, the threat of receiving shock is enough to potentiate startle, even without any actual shock.
Fear potentiated startle paradigms are often used to study fear learning and extinction in individuals with posttraumatic stress disorder and other anxiety disorders. In fear conditioning studies, an initially neutral stimulus is repeatedly paired with an aversive one, borrowing from classical conditioning. FPS studies have demonstrated that post-traumatic stress disorder patients have enhanced startle responses during both danger cues and neutral/safety cues as compared with healthy participants.
Learning
Affect plays many roles during learning. Deep, emotional attachment to a subject area allows a deeper understanding of the material and therefore, learning occurs and lasts. The emotions evoked when reading in comparison to the emotions portrayed in the content affects comprehension. Someone who is feeling sad understands a sad passage better than someone feeling happy. Therefore, a student’s emotion plays an important role during the learning process.
Emotion can be embodied or perceived from words read on a page or in a facial expression. Neuroimaging studies using fMRI have demonstrated that the same area of the brain that is activated when feeling disgust is activated when observing another’s disgust. In a traditional learning environment, the teacher’s facial expression can play a critical role in language acquisition. Showing a fearful facial expression when reading passages that contain fearful tones facilitates students learning of the meaning of certain vocabulary words and comprehension of the passage.
Models
The neurobiological basis of emotion is still disputed. The existence of basic emotions and their defining attributes represents a long lasting and yet unsettled issue in psychology. The available research suggests that the neurobiological existence of basic emotions is still tenable and heuristically seminal, pending some reformulation.
Basic Emotions
These approaches hypothesize that emotion categories (including happiness, sadness, fear, anger, and disgust) are biologically basic. In this view, emotions are inherited, biologically based modules that cannot be separated into more basic psychological components. Models following this approach hypothesize that all mental states belonging to a single emotional category can be consistently and specifically localised to either a single brain region or a defined network of brain regions. Each basic emotion category also shares other universal characteristics: distinct facial behaviour, physiology, subjective experience and accompanying thoughts and memories.
Psychological Constructionist Approaches
This approach to emotion hypothesizes that emotions like happiness, sadness, fear, anger and disgust (and many others) are constructed mental states that occur when brain systems work together. In this view, networks of brain regions underlie psychological operations (e.g. language, attention, etc.) that interact to produce emotion, perception, and cognition. One psychological operation critical for emotion is the network of brain regions that underlie valence (feeling pleasant/unpleasant) and arousal (feeling activated and energised). Emotions emerge when neural systems underlying different psychological operations interact (not just those involved in valence and arousal), producing distributed patterns of activation across the brain. Because emotions emerge from more basic components, heterogeneity affects each emotion category; for example, a person can experience many different kinds of fear, which feel differently, and which correspond to different neural patterns in the brain.
Meta-Analyses
A meta-analysis is a statistical approach to synthesizing results across multiple studies. Included studies investigated healthy, unmedicated adults and that used subtraction analysis to examine brain areas that were more active during emotional processing than during a neutral (control) condition.
Phan et al. 2002
In the first neuroimaging meta-analysis of emotion, Phan et al. (2002) analysed the results of 55 peer reviewed studies between January 1990 and December 2000 to determine if the emotions of fear, sadness, disgust, anger, and happiness were consistently associated with activity in specific brain regions. All studies used fMRI or PET techniques to investigate higher-order mental processing of emotion (studies of low-order sensory or motor processes were excluded). The authors’ tabulated the number of studies that reported activation in specific brain regions. For each brain region, statistical chi-squared analysis was conducted. Two regions showed a statistically significant association. In the amygdala, 66% of studies inducing fear reported activity in this region, as compared to ~20% of studies inducing happiness, ~15% of studies inducing sadness (with no reported activations for anger or disgust). In the subcallosal cingulate, 46% of studies inducing sadness reported activity in this region, as compared to ~20% inducing happiness and ~20% inducing anger. This pattern of clear discriminability between emotion categories was in fact rare, with other patterns occurring in limbic regions, paralimbic regions, and uni/heteromodal regions. Brain regions implicated across discrete emotion included the basal ganglia (~60% of studies inducing happiness and ~60% of studies inducing disgust reported activity in this region) and medial prefrontal cortex (happiness ~60%, anger ~55%, sadness ~40%, disgust ~40%, and fear ~30%).
Murphy et al. 2003
Murphy, et al. 2003 analysed 106 peer reviewed studies published between January 1994 and December 2001 to examine the evidence for regional specialisation of discrete emotions (fear, disgust, anger, happiness and sadness) across a larger set of studies. Studies included in the meta-analysis measured activity in the whole brain and regions of interest (activity in individual regions of particular interest to the study). 3-D Kolmogorov-Smirnov (KS3) statistics were used to compare rough spatial distributions of 3-D activation patterns to determine if statistically significant activations were specific to particular brain regions for all emotional categories. This pattern of consistently activated, regionally specific activations was identified in four brain regions: amygdala with fear (~40% of studies), insula with disgust (~70%), globus pallidus with disgust (~70%), and lateral orbitofrontal cortex with anger (80%). Other regions showed different patterns of activation across categories. For example, both the dorsal medial prefrontal cortex and the rostral anterior cingulate cortex showed consistent activity across emotions (happiness ~50%, sadness ~50%, anger ~ 40%, fear ~30%, and disgust ~ 20%).
Barrett et al. 2006
Barrett, et al. 2006 examined 161 studies published between 1990 and 2001. The authors compared the consistency and specificity of prior meta-analytic findings specific to each notional basic emotion. Consistent neural patterns were defined by brain regions showing increased activity for a specific emotion (relative to a neutral control condition), regardless of the method of induction used (for example, visual vs. auditory cue). Specific neural patterns were defined as separate circuits for one emotion vs. the other emotions (for example, the fear circuit must be discriminable from the anger circuit, although both may include common brain regions). In general, the results supported Phan et al. and Murphy et al., but not specificity. Consistency was determined through the comparison of chi-squared analyses that revealed whether the proportion of studies reporting activation during one emotion was significantly higher than the proportion of studies reporting activation during the other emotions. Specificity was determined through the comparison of emotion-category brain-localizations by contrasting activations in key regions that were specific to particular emotions. Increased amygdala activation during fear was the most consistently reported across induction methods (but not specific). Both meta-analyses associated the anterior cingulate cortex with sadness, although this finding was less consistent (across induction methods) and was not specific. Both meta-analyses found that disgust was associated with the basal ganglia, but these findings were neither consistent nor specific. Neither consistent nor specific activity was observed across the meta-analyses for anger or happiness. This meta-analysis introduced the concept of the basic, irreducible elements of emotional life as dimensions such as approach and avoidance.
Kober et al. 2008
Kober, et al. 2008 reviewed 162 neuroimaging studies published between 1990-2005 to determine if groups of brain regions showed consistent activation patterns while experiencing an emotion directly and (indirectly) as experienced by another. This analysis used multilevel kernel density analysis (MKDA) to examine fMRI and PET studies, a technique that prevents single studies from dominating the results (particularly if they report multiple nearby peaks) and that enables studies involving more participants to exert more influence upon the results. MKDA was used to establish a neural reference space that includes the set of regions showing consistent increases across all studies. This neural reference space was partitioned into functional groups of brain regions showing similar activation patterns by using multivariate techniques to determine co-activation patterns and then using data-reduction techniques to define the functional groupings, resulting in six groups. The authors discussed each functional group in terms of more basic psychological operations.
Group
Regions
Notes
Core Limbic
Left amygdala, hypothalamus, periaqueductal gray/thalamus regions, and amygdala/ventral striatum/ventral globus pallidus/thalamus regions.
Integrative emotional centre that plays a general role in evaluating affective significance.
Lateral Paralimbic
Ventral anterior insula/frontal operculum/right temporal pole/ posterior orbitofrontal cortex, the anterior insula/ posterior orbitofrontal cortex, the ventral anterior insula/ temporal cortex/ orbitofrontal cortex junction, the midinsula/ dorsal putamen, and the ventral striatum /mid insula/ left hippocampus.
Plays a role in motivation, contributing to the general valuation of stimuli and particularly in reward.
Plays a role in both the generation and regulation of emotion.
Cognitive/ Motor Network
Right frontal operculum, the right interior frontal gyrus, and the pre-supplementray motor area/ left interior frontal gyrus, regions.
Not specific to emotion, but instead appear to play a more general role in information processing and cognitive control.
Occipital/ Visual Association
V8 and V4 areas of the primary visual cortex, the medial temporal lobe, and the lateral occipital cortex.
Medial Posterior
Posterior cingulate cortex and area V1 of the primary visual cortex.
The authors suggest that these regions play a joint role in visual processing and attention to emotional stimuli.
Vytal et al. 2010
Vytal, et al. 2010 examined 83 neuroimaging studies published between 1993-2008 to examine whether neuroimaging evidence supports biologically discrete, basic emotions (i.e. fear, anger, disgust, happiness, and sadness). Consistency analyses identified brain regions associated with individual emotions. Discriminability analyses identified brain regions that were differentially active under contrasting pairs of emotions. This meta-analysis examined PET or fMRI studies that reported whole brain analyses identifying significant activations for at least one of the five emotions relative to a neutral or control condition. The authors used activation likelihood estimation (ALE) to perform spatially sensitive, voxel-wise (sensitive to the spatial properties of voxels) statistical comparisons across studies. This technique allows for direct statistical comparison between activation maps associated with each discrete emotion. Thus, discriminability between the five discrete emotion categories was assessed on a more precise spatial scale than in prior meta-analyses.
Consistency was first assessed by comparing the cross-study ALE map for each emotion to ALE maps generated by random permutations. Discriminability was assessed by pair-wise contrasts of emotion maps. Consistent and discriminable activation patterns were observed for the five categories.
Emotion
Peak
Regions
Happiness
Right superior temporal gyrus, left rostral anterior cingulate cortex.
9 regional brain clusters.
Sadness
Left medial frontal gyrus.
35 clusters – especially, left medial frontal gyrus, right middle temporal gyrus, and right inferior frontal gyrus.
Anger
Left inferior frontal gyrus.
13 clusters – bilateral inferior frontal gyrus, and in right parahippocampal gyrus.
Fear
Left amygdala.
11 clusters – left amygdala and left putamen.
Disgust
Right insula/right inferior frontal gyrus.
16 clusters – right putamen and the left insula.
Lindquist et al. 2012
Lindquist, et al. reviewed 91 PET and fMRI studies published between January 1990 and December 2007. The studies used induction methods that elicit emotion experience or emotion perception of fear, sadness, disgust, anger, and happiness. The goal was to compare basic emotions approaches with psychological constructionist approaches. A MKDA transformed the individual peak into a neural reference space. The density analysis was then used to identify voxels with more consistent activations for a specific emotion category than all other emotions. Chi-squared analysis was used to create statistical maps that indicated whether each previously identified and consistently active region was more frequently activated in studies of each emotion category than average, regardless of activations elsewhere in the brain. Chi-squared analysis and density analysis both defined functionally consistent and selective regions (regions that showed a more consistent activity increase) for one emotion category. Thus, a selective region could present increased activations to multiple emotions, as long as the response to one emotion was relatively stronger.
A series of logistic regressions were performed to identify regions that while consistent and selective to an emotion were additionally specific to that emotion. Specificity was defined as showing increased activations for only one emotional category. Strong support for basic emotions was defined as evidence that brain areas respond to only one emotional category. Strong support for the constructionist approach was defined as evidence that psychological operations consistently occur across many brain regions and multiple emotional categories.
The results indicated that many brain regions demonstrated consistent and selective activations in the experience or perception of one emotion category. Consistent with constructionist models, however, no region demonstrated functional specificity for the emotions of fear, disgust, happiness, sadness or anger.
The authors proposed different roles for the brain regions that have traditionally been associated with only one emotion category. The authors propose that the amygdala, anterior insula, orbitofrontal cortex each contribute to “core affect,” which are basic feelings that are pleasant or unpleasant with some level of arousal.
Region
Role
Amygdala
Indicating whether external sensory information is motivationally salient, novel and/or evokes uncertainty.
Anterior Insula
Represents core affective feelings in awareness across emotion categories, driven largely by body sensations.
Orbitofrontal Cortex
Functions as a site for integrating sensory information from the body and the world to guide behaviour.
Closely related to core affect, the authors propose that the anterior cingulate and dorsolateral prefrontal cortex play vital roles in attention. The anterior cingulate supports the use of sensory information for directing attention and motor responses during response selection while the dorsolateral prefrontal cortex supporting executive attention. In many psychological construction approaches, emotions relate an individual’s situation in the world to internal body states, referred to as “conceptualisation”. The dorsomedial prefrontal cortex and hippocampus were consistently active in this context: regions that play an important role conceptualising are also involved in simulating previous experience (e.g. knowledge, memory). Language is also central to conceptualising, and regions that support language, including ventrolateral prefrontal cortex, were also consistently active across studies of emotion experience and perception.
Adinazolam (marketed under the brand name Deracyn) is a tranquiliser of the triazolobenzodiazepine (TBZD) class, which are benzodiazepines (BZDs) fused with a triazole ring.
It possesses anxiolytic, anticonvulsant, sedative, and antidepressant properties. Adinazolam was developed by Dr. Jackson B. Hester, who was seeking to enhance the antidepressant properties of alprazolam, which he also developed. Adinazolam was never approved by the US Food and Drug Administration (FDA) and never made available to the public market, however it has been sold as a designer drug.
Side Effects
Overdose may include muscle weakness, ataxia, dysarthria and particularly in children paradoxical excitement, as well as diminished reflexes, confusion and coma may ensue in more severe cases.
A human study comparing the subjective effects and abuse potential of adinazolam (30 mg and 50 mg) with diazepam, lorazepam and a placebo showed that adinazolam causes the most “mental and physical sedation” and the greatest “mental unpleasantness”.
Pharmacodynamics and Pharmacokinetics
Adinazolam binds to peripheral-type benzodiazepine receptors that interact allosterically with GABA receptors as an agonist to produce inhibitory effects.
Metabolism
Adinazolam was reported to have active metabolites in the August 1984 issue of The Journal of Pharmacy and Pharmacology. The main metabolite is N-desmethyladinazolam. NDMAD has an approximately 25-fold high affinity for benzodiazepine receptors as compared to its precursor, accounting for the benzodiazepine-like effects after oral administration. Multiple N-dealkylations lead to the removal of the dimethylaminomethyl side chain, leading to the difference in its potency. The other two metabolites are alpha-hydroxyalprazolam and estazolam. In the August 1986 issue of that same journal, Sethy, Francis and Day reported that proadifen inhibited the formation of N-desmethyladinazolam.
In the psychology of defence mechanisms and self-control, acting out is the performance of an action considered bad or anti-social. In general usage, the action performed is destructive to self or to others.
The term is used in this way in sexual addiction treatment, psychotherapy, criminology and parenting. In contrast, the opposite attitude or behaviour of bearing and managing the impulse to perform one’s impulse is called acting in.
The performed action may follow impulses of an addiction (e.g. drinking, drug taking or shoplifting). It may also be a means designed (often unconsciously or semi-consciously) to garner attention (e.g. throwing a tantrum or behaving promiscuously). Acting out may inhibit the development of more constructive responses to the feelings in question.
In Analysis
Sigmund Freud considered that patients in analysis tended to act out their conflicts in preference to remembering them – repetition compulsion. The analytic task was then to help “the patient who does not remember anything of what he has forgotten and repressed, but acts it out” to replace present activity by past memory.
Otto Fenichel added that acting out in an analytic setting potentially offered valuable insights to the therapist; but was nonetheless a psychological resistance in as much as it deals only with the present at the expense of concealing the underlying influence of the past. Lacan also spoke of “the corrective value of acting out”, though others qualified this with the proviso that such acting out must be limited in the extent of its destructive/self-destructiveness.
Annie Reich pointed out that the analyst may use the patient by acting out in an indirect countertransference, for example to win the approval of a supervisor.
Interpretations
The interpretation of a person’s acting out and an observer’s response varies considerably, with context and subject usually setting audience expectations.
In Parenting
Early years, temper tantrums can be understood as episodes of acting out. As young children will not have developed the means to communicate their feelings of distress, tantrums prove an effective and achievable method of alerting parents to their needs and requesting attention.
As children develop they often learn to replace these attention-gathering strategies with more socially acceptable and constructive communications. In adolescent years, acting out in the form of rebellious behaviours such as smoking, shoplifting and drug use can be understood as “a cry for help.” Such pre-delinquent behaviour may be a search for containment from parents or other parental figures. The young person may seem to be disruptive – and may well be disruptive – but this behaviour is often underpinned by an inability to regulate emotions in some other way.
In Addiction
In behavioural or substance addiction, acting out can give the addict the illusion of being in control. Many people who suffer with addiction, either refuse to admit they struggle with it, or some do not even realise they have an addiction. For most people, when their addiction is addressed, they become defensive and act out. This can be a result of multiple emotions including shame, fear of judgement, or anger. It is important to be patient and understanding towards those who suffer with addiction, and to realise that most people want to break free from the symptoms and baggage that come with addiction, but do not know how or where to start. Thankfully, there are many preventative measures and programs than can help those who personally struggle with addiction, or for those who have a friend or family member that suffers with addiction.
In Criminology
Criminologists debate whether juvenile delinquency is a form of acting out, or rather reflects wider conflicts involved in the process of socialisation. Deviant behaviour is commonly associated with crime and social deviance. Many of those who are involved in crime, usually grew up in broken homes, or had no authority figure in their life. For some, a life of crime is all they have ever known. This could be a reason as to why there is a debate over whether or not juvenile delinquency is a form of acting out.
Alternatives
Acting out painful feelings may be contrasted with expressing them in ways more helpful to the sufferer, e.g. by talking out, expressive therapy, psychodrama or mindful awareness of the feelings. Developing the ability to express one’s conflicts safely and constructively is an important part of impulse control, personal development and self-care.
Mental Health Matters 
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