Symbiosis & Affective Communication Outline

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Section 1: Understanding the Concept
1.1 Defining Layers
• 1.1.1 Historical Context
• Discussion Statements:
1. The concept of psychological layers has its roots in early 20th-century psychoanalysis.
2. The modern understanding has grown to include cognitive, emotional, and sociocultural dimensions.
• Discussion Question:
1. How have the layers of human psychology shifted in importance or meaning across different cultural or historical contexts?
• References:
1. Freud, S. (1923). The ego and the id. W. W. Norton & Company.
• Freud pioneered the idea of conscious and unconscious layers of the mind, a foundational aspect of psychology today.
2. Jung, C. G. (1969). Archetypes and the collective unconscious. Princeton University Press.
• Jung expanded upon Freud’s work by adding the collective unconscious layer.
3. Erikson, E. H. (1950). Childhood and society. W. W. Norton & Company.
• Erikson introduced psychosocial layers, which brought a social dimension to the internal layers of the individual.
4. Bandura, A. (1977). Social learning theory. General Learning Press.
• Bandura’s theory added a layer of observational learning and environmental factors.
• 1.1.2 Terminology
• Discussion Statements:
1. The language used to describe psychological layers varies across disciplines, leading to potential misunderstandings.
2. Standardizing terminology can facilitate interdisciplinary research and application.
• Discussion Question:
1. What challenges does the multiplicity of terminology pose in academic and practical settings?
• References:
1. McAdams, D. P. (1995). What do we know when we know a person? Journal of Personality, 63(3), 365—396.
• McAdams discusses the importance of a unified language to understand a person’s psychological makeup fully.

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2. Sokal, A. (1996). Transgressing the boundaries: Towards a transformative hermeneutics of quantum gravity. Social Text, 46/47, pp. 217—252.
• Sokal exemplifies the risks of miscommunication because of terminology that needs to be standardized or intentionally obfuscated.
3. Sapir, E., & Whorf, B. L. (1956). Language, thought, and reality: Selected writings of Benjamin Lee Whorf. MIT Press.
• Sapir and Whorf argue that language constructs our reality, underlining the importance of precise terminology in psychological layers.
4. Lakoff, G., & Johnson, M. (1980). Metaphors we live by —The University of Chicago Press.
• Discusses how language, including terminologies, shapes our mental constructs and realities.
5. van Reekum, G. (2017). Exploring Experiences, Reading Realities: Recontextualising Group Relations. Organisational and Social Dynamics, 17(2), 235.
• Delves into the intricacies of group dynamics by re-contextualizing various group relations, offering a new lens to understand and interpret organizational and social interactions.
6. Tan, L. H., Chan, A. Y. W., Kay, P., Khong, P. L., Yip, L. K. C., & Luke, K. K. (2008). Language affects patterns of brain activation associated with perceptual decision. Proceedings of the National Academy of Sciences of the United States of America. https://doi.org/10.1073/pnas.0800055105
• Explores how linguistic processes influence brain activation patterns during perceptual decision-making tasks, demonstrating that language has a discernible impact on neural activation pathways.
1.1.3. The Relevance of Layers in Modern Society
• 1.2.1 The Digital Age
• Discussion Statements:
1. The digital age has complicated our understanding of psychological layers by adding virtual identities.
2. Social media platforms may function as ‘amplifiers’ for existing traits and layers.
• Discussion Question:
1. How do online personas correlate or conflict with real-world psychological layers?
• References:

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1. Turkle, S. (2011). Alone together: Why we expect more from technology and less from each other. Basic books.
• Turkle examines the complexities of identity in the digital age.
2. Baumeister, R. F., & Leary, M. R. (1995). The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin, 117(3), 497-529.
• Discusses how digital interactions can both fulfill and complicate our basic human needs.
3. McMillan, D., & Chavis, D. (1986). Sense of community: A definition and theory. Journal of Community Psychology, 14(1), 6—23.
• Explores how communities in the digital age add another layer to our psychological makeup.
4. Ellison, N. B., Steinfield, C., & Lampe, C. (2007). The benefits of Facebook “friends:” Social capital and college students’ use of online social network sites. Journal of Computer‐Mediated Communication, 12(4), 1143-1168.
• Analyzes the benefits and drawbacks of online interactions for social capital.
5. Shortridge, P. (2014). Your smartphone or your Life. Montessori Life, 26(1), 60.
• Scrutinizes the impact of smartphone usage on quality of life, particularly emphasizing the need for mindful engagement with technology to maintain well-being.
6. Afroz, Shagufta, and P Tiwari. (2015). “Belongingness among Different Age Groups.” Indian Journal of Positive Psychology 6 (3): 260.
• Examines the concept of belongingness across various age groups, shedding light on how social inclusion or exclusion fluctuates throughout different life stages.
1.1.4. Trauma as a Layer
• 1.3.1 The Neurobiology of Trauma
• Discussion Statements:
1. Trauma significantly affects brain chemistry, affecting how we interact with the world.
2. Understanding the neurobiology of trauma is essential for practical therapeutic approaches.
• Discussion Question:
1. How does trauma alter cognitive functions, and how can these changes be measured?
• References:

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1. van der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.
• Van der Kolk offers a comprehensive view of how trauma affects the body and mind.
2. Charney, D. S., & Manji, H. K. (2004). Life stress, genes, and depression: Multiple pathways lead to increased risk and new opportunities for intervention” Science’s STKE, 2004(225), re5-re5.
• Discusses the genetic predispositions and pathways that trauma can activate.
3. Foa, E. B., & Rothbaum, B. O. (1998). Treating the trauma of rape: Cognitive-behavioral therapy for PTSD. Guilford Press.
• Presents methods for treating trauma-related disorders effectively.
4. Southwick, S. M., Bonanno, G. A., Masten, A. S., Panter-Brick, C., & Yehuda, R. (2014). Resilience definitions, theory, and challenges: Interdisciplinary perspectives. European journal of psychotraumatology, 5(1), 25338.
• Discusses the concept of resilience in trauma.
5. King, A. B. (2021). Letting it go: A transformative session of massage therapy. https://core.ac.uk/download/428352813.pdf
• Investigates the emotional and psychological shifts that can occur during a single massage therapy session, mainly focusing on its impact on trauma.
6. Icahn School of Medicine at Mount Sinai. Life stress, genes, and depression: multiple pathways lead to increased risk and new opportunities for intervention. https://scholars.mssm.edu/en/publications/life-stress-genes-and-depression-multiple-pathways-lead-to-increa-2
• Delves into the complex interplay between genetic predispositions and life stressors in contributing to the risk of depression.
7. Trappey, A., Trappey, C., Chang, C. M., Lin, A. L., and Nieh, C. H. (2020). “Virtual Reality Exposure Therapy for Driving Phobia Disorder: System Design and Development.” Applied Sciences 10 (14): 4860.
• Discuss the technological and therapeutic potential of using virtual reality in exposure therapy for anxiety disorder.
8. Batra, P. (2021). Resilience as a Positive Psychotherapy in Major Depressive Disorder. Indian Journal of Positive Psychology 12 (2): 160.
• Resilience is a form of positive psychotherapy for individuals diagnosed with Major Depressive Disorder as a therapeutic countermeasure to depressive symptoms.
1.1.5. Trauma in Diverse Populations
• Discussion Statements:
1. The manifestation and treatment of trauma can differ significantly among diverse communities.
2. Cultural competence is crucial in approaching trauma in diverse populations.
• Discussion Question:

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1. How does intersectionality contribute to differing trauma experiences?
• References:
1. Helms, J. E., Nicolas, G., & Green, C. E. (2010). Racism and ethnoviolence as trauma: Enhancing professional and research training. Traumatology, 16(4), 53—62.
• Examines the role of ethnoviolence and racism as forms of trauma.
2. Gone, J. P., & Trimble, J. E. (2012). American Indian and Alaska Native mental health: Diverse perspectives on enduring disparities. Annual Review of Clinical Psychology, 8, 131-160.
• Discusses mental health disparities in Native American communities.
3. Bryant-Davis, T., & Ocampo, C. (2005). Racist incident–based trauma. The Counseling Psychologist, 33(4), 479—500.
• Addresses the trauma that stems from racist incidents.
4. Lee, C., & Boykins, M. (2022). Racism as a Mental Health Challenge: An Antiracist Counselling Perspective. Canadian Psychology 63 (4): 471.
• Delves into how racism can be a pervasive and detrimental factor affecting mental health and argues for systemic solutions through antiracist counseling methodologies.
5. Lavallie, B., & Spears, W. (2022). Sweetgrass Method: A Culturally Responsive Approach among American Indian and Alaska Native K-12. https://core.ac.uk/download/533934262.pdf
• Explore a culturally sensitive educational method specifically designed for K-12 students belonging to American Indian and Alaska Native communities.
6. Brown, L. S. (2008). Cultural competence in trauma therapy: Beyond the flashback http://www.drlaurabrown.com/written/cultural-competence-in-trauma-therapy-beyond-the-flashback/
• Addressing trauma survivors’ cultural backgrounds and experiences is crucial for effective treatment, going beyond the conventional approaches that often neglect these dimensions.
1.1.6. Historical Understanding of Trauma
• 1.4.1 The Evolution of Trauma Concepts
• Discussion Statements:
1. Understanding trauma causes a historical perspective to see how the concept has grown.
2. The term “trauma” has undergone significant changes in meaning and implication.

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• Discussion Question:
1. How have historical events influenced the academic and clinical understanding of trauma?
• References:
1. Herman, J. (1992). Trauma and recovery. Basic Books.
• Herman outlines how perceptions of trauma have changed over the years.
2. Young, A. (1995). The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder. Princeton University Press.
• Investigates the construction of PTSD as a medical condition.
3. Summerfield, D. (1999). A critique of seven assumptions behind psychological trauma programs in war-affected areas. Social Science & Medicine, 48(10), 1449–1462.
• Offers a critical perspective on trauma-related interventions in war zones.
4. Leys, R. (2000). Trauma: A Genealogy. University of Chicago Press.
• Traces the genealogy of trauma as a concept and practice.
5. Beks, T., Cairns, S., Kassan, A., & Schwartz, K. (2021). Conceptualizing Service-Related Trauma: Controversies, Challenges, and Opportunities in the Canadian Context. Canadian Journal of Counselling and Psychotherapy (Online), 55(2), 258.
• Discusses the complexities, controversies, challenges, and emerging opportunities of understanding trauma related to service professions like healthcare, emergency services, and the military within the Canadian context.
6. Guido, M. G. (2020). Patterns of metaphysical discourse in West-African migrants’ ELF-mediated trauma narratives. Lingue e Linguaggi. http://siba-ese.unile.it/index.php/linguelinguaggi/article/view/22907
• Focuses on how language and discourse patterns contribute to constructing and understanding traumatic experiences in West African migrants.
1.1.7. Wars and Trauma
• Discussion Statements:
1. Wars have significantly contributed to the understanding of trauma.
2. Shell shock and PTSD emerged as critical terms because of military conflicts.
• Discussion Question:
1. What impact has war had on the general populace’s understanding of trauma?
• References:
1. Shephard, B. (2000). A War of Nerves: Soldiers and Psychiatrists in the Twentieth Century. Harvard University Press.
• Details the evolution of trauma understanding due to wars.
2. Dean, E. (1997). Shook over Hell: Post-Traumatic Stress, Vietnam, and the Civil War. Harvard University Press.
• Connects PTSD with historical military conflicts.

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3. Leese, P. (2002). Shell Shock: Traumatic Neurosis and the British Soldiers of the First World War. Palgrave Macmillan.
• Investigates the term “shell shock” and its implications.
4. Marlowe, D. (2000). Psychological and Psychosocial Consequences of Combat and Deployment with Special Emphasis on the Gulf War. Rand Corporation.
• Examines the psychosocial aspects of war-related trauma.
5. Bradshaw, B. (2020). Peace Had Its Defeats: Researching Civil War Veterans, Post-Traumatic Stress Disorder and Insanity— Journal of the Illinois State Historical Society, 113(3/4), 67.
• Focuses on the concept of ‘insanity’ as they understood it by exploring Civil War veterans with early signs of PTSD.
6. Campbell, J., & Davis, G. (2022). A Crisis of Transition: Menstruation and the psychiatrisation of the female lifecycle in nineteenth-century Edinburgh. https://doi.org/10.16995/olh.6350.
• Delves into the historical medicalization and psychiatrization of menstruation within the context of societal attitudes and medical beliefs intersected to pathologize women’s natural bodily functions during nineteenth-century Edinburgh.
7. Mora, G. (2014). Have You Hugged a Soldier Today? Veterans Struggle With Invisible Wounds of War From Vietnam to Afghanistan. https://core.ac.uk/download/216852586.pdf.
• Investigates the psychological traumas veterans face across different war eras, highlighting the complexities and challenges in acknowledging and treating these psychological effects (invisible wounds).
1.1.8. Trauma in Contemporary Society
• 1.5.1 Trauma and Media
• Discussion Statements:
1. The role of media cannot overlook shaping trauma narratives.
2. Social media platforms can both help and hinder trauma recovery.
• Discussion Question:
1. How has the digital age altered our relationship with trauma?
• References:
1. Chouliaraki, L. (2006). The Spectatorship of Suffering. Sage.
• Addresses how media frames and presents trauma.
2. Daya, I. & Matthes, J. (2018). The Effect of Vivid Media on Public Support for Traumatic Humanitarian Crises. Public Opinion Quarterly, 82(2), 81–311.
• Investigates the public’s response to trauma portrayed in the media.

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3. Thompson, R. (2014). News Content and Public Engagement on Social Media. Digital Journalism, 2(4), 510–527.
• Discusses the role of social media in publicizing traumatic events.
4. Zoellner, L. A., & Maercker, A. (2006). Posttraumatic growth in clinical psychology — A critical review and introduction of a two-component model. Clinical Psychology Review, 26(5), 626–653.
• Analyzes how media coverage can affect posttraumatic growth.
5. Arya, B., & Davidson, C. (2015). Sense of coherence as a predictor of post traumatic growth. Indian Journal of Health and Wellbeing, 6(6), 634.
• Examines how individual psychological characteristics can influence resilience and positive transformation following traumatic experiences.
1.1.9. Personal vs. Collective Trauma
• 1.6.1 Individual Experience
• Discussion Statements:
1. Personal trauma often differs significantly from collective trauma in terms of lived experience.
2. Therapeutic strategies are tailored more precisely for individual trauma.
• Discussion Question:
1. How do personal coping mechanisms influence the healing process?
• References:
1. van der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking.
• Explores how personal trauma manifests in bodily sensations and behaviors.
2. Courtois, C. A., & Ford, J. D. (2013). Treatment of complex trauma: A sequenced, relationship-based approach. Guilford Press.
• Discusses tailored approaches for treating individual trauma.
3. Briere, J., & Scott, C. (2014). Principles of Trauma Therapy: A Guide to Symptoms, Evaluation, and Treatment. SAGE Publications.
• Provides a comprehensive guide to treating individual trauma.
4. Herman, J. (2015). Trauma and Recovery: The Aftermath of Violence—From Domestic Abuse to Political Terror. Basic Books.
• Addresses the different manifestations of individual trauma.
5. Joy, S., Beck, E., & Hurley, A. (2019). The Traumatic Bereavement of Children Experiencing the Loss of a Loved One to Death Row. https://doi.org/10.1007/978-3-030-12744-2_9

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• Explores the unique and distressing form of grief experienced by children who lose a family member to execution, underscoring the multifaceted emotional and psychological toll this specific type of loss takes on young individuals.
6. Kravchenko, S. A. (2012). The Becoming of the Complex Socium: New Causes of Deviance and Crime. https://core.ac.uk/download/493035910.pdf
• Explores the growing societal complexities that contribute to deviance and criminal behavior, focusing on the interconnectedness of social structures, norms, and changes in explaining the new causes of deviance and crime.
• 1.1.10. Collective Memory
• Discussion Statements:
1. Collective trauma often lives in the memory of a community or nation.
2. Cultural narratives play a role in the healing or perpetuation of collective trauma.
• Discussion Question:
1. How does collective trauma differ in its impact and treatment from individual trauma?
• References:
1. Alexander, J. C. (2004). Toward a Theory of Cultural Trauma. In Cultural Trauma and Collective Identity. University of California Press.
• Discusses the nature and impact of collective trauma.
2. Sztompka, P. (2000). Cultural Trauma: The Other Face of Social Change. European Journal of Social Theory, 3(4), 449–466.
• Explores how social change can be both a cause and an effect of cultural trauma.
3. Eyerman, R. (2001). Cultural Trauma: Slavery and the Formation of African American Identity. Cambridge University Press.
• Discusses the trauma of slavery and its lasting impact on African American identity.
4. Connerton, P. (1989). How Societies Remember. Cambridge University Press.
• Discusses the mechanisms of collective memory and its role in trauma.
5. Harvey, M. A. (2019). Trauma Informed Care with Deaf Persons (with Proxy help from Supreme Court Justice Sotomayor). https://core.ac.uk/download/270197673.pdf
• Delves into the unique challenges and necessities of providing trauma-informed care to Deaf individuals, notably including perspectives and legal frameworks, drawing a connection to insights from Supreme Court Justice Sotomayor.
6. Regional Educational Laboratory (REL) Southwest. (2020). Taking Off Our Blindfolds. https://ies.ed.gov/ncee/edlabs/regions/southwest/blogs/swtppd-trauma-0720.aspx
• Recognizing and addressing trauma in educational settings as a call to action for educators, administrators, and policymakers to

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become more aware of the impact of trauma on students’ learning and well-being.
7. Cokley, K., McClain, S., Enciso, A., & Martinez, M. (2013). An Examination of the Impact of Minority Status Stress and Impostor Feelings on the Mental Health of Diverse Ethnic Minority College Students. Journal of Multicultural Counseling and Development. https://doi.org/10.1002/j.2161-1912.2013.00029.x
• Explores the specific mental health challenges faced by diverse ethnic minority college students and how minority status stress and impostor feelings can significantly affect the mental well-being of students.
1.1.10. Intersectionality and Trauma
• 1.7.1 Gender and Trauma
• Discussion Statements:
1. Gender plays a significant role in the experience and processing of trauma.
2. Therapeutic strategies must recognize these gender-specific nuances.
• Discussion Question:
1. How do men and women differ in their response to trauma?
• References:
1. Jordan, J. V., & Carlson, J. (2013). Creating Connection: A Relational-Cultural Approach with Couples. Routledge.
• Discusses the gender-specific nuances in trauma and its treatment.
2. Brown, L. S. (2008). Cultural competence in trauma therapy: Beyond the flashback. American Psychological Association.
• Highlights the necessity of considering cultural and gender differences in trauma therapy.
3. Golding, J. M. (1999). Intimate Partner Violence as a Risk Factor for Mental Disorders: A Meta-Analysis. Journal of Family Violence, 14(2), 99–132.
• Discusses the gender-specific implications of intimate partner violence.
4. Kimerling, R., & Calhoun, K. S. (1994). Somatic Symptoms, Social Support, and Treatment Seeking Among Sexual Assault Victims. Journal of Consulting and Clinical Psychology, 62(2), 333–340.
• Focuses on the gender differences in trauma experience and treatment.
5. Mercilene, M., Christofides, N., & Jewkes, R. (2017). Mental Ill Health in Structural Pathways to Women’s Experiences of Intimate Partner Violence. PloS One 12 (4): e0175240.

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• Highlights how mental health issues can contribute to and result from experiences of violence, emphasizing the cyclical and structural aspects of this issue.
1.1.11. Trauma-Informed Approach
• 1.8.1 Importance of Trauma-Informed Care
• Discussion Statements:
1. Trauma-informed care is essential for effective therapy and treatment.
2. A trauma-informed approach respects the survivor’s autonomy and individuality.
• Discussion Question:
1. How does a trauma-informed approach differ from traditional therapeutic techniques?
• References:
1. Harris, M., & Fallot, R. D. (2001). Using trauma theory to design service systems. Jossey-Bass.
• Highlights the foundational elements of trauma-informed care.
2. Substance Abuse and Mental Health Services Administration (SAMHSA). (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. SAMHSA.
• Provides federal guidelines for a trauma-informed approach.
3. Anda, R. F., Felitti, V. J., & Bremner, J. D. (2006). The enduring effects of abuse and related adverse experiences in childhood. European Archives of Psychiatry and Clinical Neuroscience, 256(3), 174–186.
• Discusses why a trauma-informed approach is crucial for individuals who have experienced early-life adversity.
4. Cloitre, M., Courtois, C. A., Ford, J. D., Green, B. L., Alexander, P., Briere, J., Herman, J. L., Lanius, R., Stolbach, B. C., Spinazzola, J., Van der Kolk, B. A., Van der Hart, O. (2012). The ISTSS Expert Consensus Treatment Guidelines for Complex PTSD in Adults. Journal of Traumatic Stress, 25(6), 615–627.
• Highlights the importance of trauma-informed care in treating complex PTSD.
5. Scott, S. (2020). Identifying Human Trafficking Victims in the Pediatric and School Nurse Practice Setting. Pediatric Nursing, 46(6), 278.
• Focuses on equipping pediatric and school nurses with the skills and awareness to identify potential victims of human trafficking, emphasizing the crucial role healthcare providers, especially those in educational settings, can play in early identification and intervention.

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6. Psychological Maltreatment Alliance. (2019). Recommended Readings for Professionals. Professional Publications. https://www.psychologicalmaltreatment.org/recommended-readings-for-profession
• Serves as a comprehensive resource guide aimed at professionals who deal with cases of psychological maltreatment by curating a selection of essential readings to deepen understanding.
7. Robinson, P., Gilmore, C., & Griffith, E. (2019). Can training improve staff skills with complex trauma? https://doi.org/10.1108/MHRJ-10-2018-0032
• Provides an empirical evaluation of specialized training initiatives, exploring their impact on staff competencies and patient outcomes to enhance staff skills.
• 1.8.2 Elements of a Trauma-Informed Practice
• Discussion Statements:
1. Understanding the widespread impact of trauma and the pathways for recovery are fundamental.
2. A trauma-informed practice must be flexible to adapt to the needs of diverse trauma survivors.
• Discussion Question:
1. What elements should be non-negotiable in a trauma-informed practice?
• References:
1. Sweeney, A., Filson, B., Kennedy, A., Collinson, L., & Gillard, S. (2018). A paradigm shift: Relationships in trauma-informed mental health services. BJPsych Advances, 24(5), 319–333.
• Discusses how the patient and provider relationship is pivotal in a trauma-informed practice.
2. Bloom, S. L. (2013). Creating sanctuary: Toward the evolution of sane societies. Routledge.
• Introduces the Sanctuary Model as a roadmap for creating a trauma-informed environment.
3. Briere, J., & Lanktree, C. (2011). Treating Complex Trauma in Adolescents and Young Adults. SAGE Publications.
• Focuses on the unique elements needed in a trauma-informed practice for adolescents and young adults.
4. Hopper, E. K., Bassuk, E. L., & Olivet, J. (2010). Shelter from the storm: Trauma-informed care in homelessness services settings. The Open Health Services and Policy Journal, 3(1), 80–100.
• Examines the role of trauma-informed care in homelessness service settings.
5. Achieve Hartford. (2017). Notes To My Future Self on Childhood Adversity—Will I Be Okay? https://www.achievehartford.org/stories-and-data/notes-to-my-future-self-on-childhood-adversity-will-i-be-okay/
• Serves as a contemplative and insightful resource that delves into the questions and concerns surrounding the long-term impact on

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future outcomes for individuals who have experienced adversity in their early years.
6. Paudel, N. (2021). Person Centered and Trauma, and Informed Approach in Social Work Practice and Ways to Ensure Diversity in both Approaches. https://doi.org/10.47405/aswj.v6i5.183
• Emphasizes the importance of incorporating diversity and inclusiveness within person-centered and trauma-informed approaches to serve the field of social work better.
7. Garo, L. A., Williams, N., & Hollis, T. (2016). Systems of Care for addressing the traumatic impact of violence exposure on student well-being. https://core.ac.uk/download/229007366.pdf
• Explores how to develop and implement comprehensive systems of care to mitigate the effects of violence exposure on students and examining the implementation of coordinated services and supports in educational settings addressing trauma.
8. Radenhausen, M. E. (2022). Trauma Skills Program in a Youth Detention Facility. https://core.ac.uk/download/534445814.pdf
• The article examines the program’s efficacy and discusses the unique challenges and opportunities of administering mental health services and skills to youth who have experienced trauma in detention.
9. Robinson, P., Gilmore, C., & Griffith, E. (2019). Can training improve staff skills with complex trauma? https://doi.org/10.1108/MHRJ-10-2018-0032
• Assessing the impact of specialized training programs for staff dealing with complex trauma cases presents an empirical evaluation of the efficacy of such training, examining how it affects the skill sets of staff and the outcomes for individuals suffering from complex trauma.
1.1.12. Future Directions and Considerations
• 1.9.1 Technological Advances
• Discussion Statements:
1. Emerging technologies like VR and AI could revolutionize trauma therapy.
2. Ethical considerations are paramount when incorporating technology into trauma care.
• Discussion Question:
1. What are the technologies of ethical concern in trauma therapy?
• References:

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1. Rizzo, A., & Shilling, R. (2017). Clinical Virtual Reality tools to advance the prevention, assessment, and treatment of PTSD. European Journal of Psychotraumatology, 8(5), 1414560.
• Discusses the potential for Virtual Reality (VR) in trauma therapy.
2. Bohil, C. J., Alicea, B., & Biocca, F. A. (2011). Virtual reality in neuroscience research and therapy. Nature Reviews Neuroscience, 12(12), 752–762.
• Reviews various technologies that could contribute to neuroscience and trauma therapy.
3. Luxton, D. D. (2016). Artificial intelligence in psychological practice: Current and future applications and implications. Professional Psychology: Research and Practice, 47(5), 332–339.
• Discusses the role and ethical considerations of AI in psychological practice.
4. Fiske, A., Henningsen, P., & Buyx, A. (2019). Your robot therapist will see you now: Ethical implications of embodied artificial intelligence in psychiatry, psychology, and psychotherapy. Journal of Medical Ethics, 45(5), 308–309.
• Highlights the ethical considerations when incorporating AI in therapy.
5. Hagstrom, S. and Maranzan, K. (2019). Bridging the Gap Between Technological Advance and Professional Psychology Training: A Way Forward. Canadian Psychology 60 (4): 281.
• Strategies for bridging the chasm between emerging technology and its integration into professional psychology training argue the need to modernize training approaches to keep pace with technological advancements.
6. Li, L., Yamada, T., & Choi, W. (2020). The Effect of Depth Information on Visual Complexity Perception in Three-Dimensional Textures. Applied Sciences, 10(15), 5347.
• Insights into the psychological and cognitive aspects of interacting with complex visual stimuli, could have implications for various fields, including design, marketing, and mental health interventions that use visual components.
7. Huston, B. (2020). Could a Robot Be Your Psychotherapist? https://core.ac.uk/download/346479874.pdf
• Explores the burgeoning field of robotics in psychotherapy, delving into the ethical, practical, and psychological implications of integrating robotic technology into therapeutic settings and asking critical questions about the boundaries and limitations of such a development.
8. JetLearn. (2023). Revolutionizing Industries: The Rise of Programmable Robots. https://www.jetlearn.com/blog/rise-of-programmable-robots
• 1.1.13. Ethical Considerations
• Discussion Statements:
1. Ethical dilemmas can significantly affect the course and outcome of trauma treatment.

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2. Maintaining client confidentiality and informed consent are fundamental.
• Discussion Question:
1. What ethical considerations are specific to trauma therapy?
• References:
1. Pope, K. S., & Vasquez, M. J. (2016). Ethics in psychotherapy and counseling: A practical guide. John Wiley & Sons.
• Comprehensive guide focusing on ethical considerations in psychotherapy.
2. Welfel, E. R. (2015). Ethics in counseling & psychotherapy. Cengage Learning.
• Discusses the importance of ethics in professional relationships.
3. Barnett, J. E., & Johnson, W. B. (2015). Ethics Desk Reference for Psychologists. American Psychological Association.
• Highlights APA’s ethical guidelines and how they apply to complex cases.
4. Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics. Oxford University Press.
• Discusses ethical principles applicable to medical and psychological treatment.
5. Pope, K. (2016). The Code Not Taken: The Path From Guild Ethics to Torture and Our Continuing Choices. Canadian Psychology, 57(1), 51.
• Discusses how choices have led from the ethical standards initially established by professional guilds to extreme situations, such as psychological involvement in torture, raising poignant questions about the ethical responsibilities and consequences of the professional choices.
1.2 The Relevance of Layers in Modern Society
• 1.2.1 The Digital Age
• Discussion Statements:
1. The digital age has complicated our understanding of psychological layers by adding virtual identities.
2. Social media platforms may function as ‘amplifiers’ for existing traits and layers.
• Discussion Question:
1. How do online personas correlate or conflict with real-world psychological layers?
• References:
1. Turkle, S. (2011). Alone together: Why we expect more from technology and less from each other. Basic books.
• Turkle examines the complexities of identity in the digital age.

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2. Baumeister, R. F., & Leary, M. R. (1995). The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin, 117(3), 497-529.
• Discusses how digital interactions can both fulfill and complicate our basic human needs.
3. McMillan, D., & Chavis, D. (1986). Sense of community: A definition and theory. Journal of Community Psychology, 14(1), 6—23.
• Explores how communities in the digital age add another layer to our psychological makeup.
4. Ellison, N. B., Steinfield, C., & Lampe, C. (2007). The benefits of Facebook “friends:” Social capital and college students’ use of online social network sites. Journal of Computer‐Mediated Communication, 12(4), 1143-1168.
• Analyzes the benefits and drawbacks of online interactions for social capital.
1.3 Trauma as a Layer
• 1.3.1 The Neurobiology of Trauma
• Discussion Statements:
1. Trauma significantly affects brain chemistry, affecting how we interact with the world.
2. Understanding the neurobiology of trauma is essential for practical therapeutic approaches.
• Discussion Question:
1. How does trauma alter cognitive functions, and how can these changes be measured?
• References:
1. van der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.
• Van der Kolk offers a comprehensive view of how trauma affects the body and mind.
2. Charney, D. S., & Manji, H. K. (2004). Life stress, genes, and depression: Multiple pathways lead to increased risk and new opportunities for intervention: Science’s STKE, 2004(225), re5-re5.
• Discusses the genetic predispositions and pathways that trauma can activate.
3. Foa, E. B., & Rothbaum, B. O. (1998). Treating the trauma of rape: Cognitive-behavioral therapy for PTSD. Guilford Press.
• Presents methods for treating trauma-related disorders effectively.

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4. Southwick, S. M., Bonanno, G. A., Masten, A. S., Panter-Brick, C., & Yehuda, R. (2014). Resilience definitions, theory, and challenges: Interdisciplinary perspectives. European journal of psychotraumatology, 5(1), 25338.
• Discusses the concept of resilience in trauma.
• 1.3.2 Trauma in Diverse Populations
• Discussion Statements:
1. The manifestation and treatment of trauma can differ significantly among diverse communities.
2. Cultural competence is crucial in approaching trauma in diverse populations.
• Discussion Question:
1. How does intersectionality contribute to differing trauma experiences?
• References:
1. Helms, J. E., Nicolas, G., & Green, C. E. (2010). Racism and ethnoviolence as trauma: Enhancing professional and research training. Traumatology, 16(4), 53—62.
• Examines the role of ethnoviolence and racism as forms of trauma.
2. Gone, J. P., & Trimble, J. E. (2012). American Indian and Alaska Native mental health: Diverse perspectives on enduring disparities. Annual Review of Clinical Psychology, 8, 131-160.
• Discusses mental health disparities in Native American communities.
3. Bryant-Davis, T., & Ocampo, C. (2005). Racist incident–based trauma. The Counseling Psychologist, 33(4), 479—500.
• Addresses the trauma that stems from racist incidents.
4. Brown, L. S. (2008). Cultural competence in trauma therapy: Beyond the flashback. American Psychological Association.
• Introduces the importance of cultural competence in trauma therapy.
1.4 Historical Understanding of Trauma
• 1.4.1 The Evolution of Trauma Concepts
• Discussion Statements:
1. Understanding trauma causes a historical perspective to see how the concept has grown.
2. The term “trauma” has undergone significant changes in meaning and implication.
• Discussion Question:
1. How have historical events influenced the academic and clinical understanding of trauma?
• References:

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1. Herman, J. (1992). Trauma and recovery. Basic Books.
• Herman outlines how perceptions of trauma have changed over the years.
2. Young, A. (1995). The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder. Princeton University Press.
• Investigates the construction of PTSD as a medical condition.
3. Summerfield, D. (1999). A critique of seven assumptions behind psychological trauma programmes in war-affected areas. Social Science & Medicine, 48(10), 1449–1462.
• Offers a critical perspective on trauma-related interventions in war zones.
4. Leys, R. (2000). Trauma: A Genealogy. University of Chicago Press.
• Traces the genealogy of trauma as a concept and practice.
• 1.4.2 Wars and Trauma
• Discussion Statements:
1. Wars have significantly contributed to the understanding of trauma.
2. Shell shock and PTSD emerged as critical terms because of military conflicts.
• Discussion Question:
1. What impact has war had on the general populace’s understanding of trauma?
• References:
1. Shephard, B. (2000). A War of Nerves: Soldiers and Psychiatrists in the Twentieth Century. Harvard University Press.
• Details the evolution of trauma understanding due to wars.
2. Dean, E. (1997). Shook over Hell: Post-Traumatic Stress, Vietnam, and the Civil War. Harvard University Press.
• Connects PTSD with historical military conflicts.
3. Leese, P. (2002). Shell Shock: Traumatic Neurosis and the British Soldiers of the First World War. Palgrave Macmillan.
• Investigates the term “shell shock” and its implications.
4. Marlowe, D. (2000). Psychological and Psychosocial Consequences of Combat and Deployment with Special Emphasis on the Gulf War. Rand Corporation.
• Examines the psychosocial aspects of war-related trauma.
1.5 Trauma in Contemporary Society
• 1.5.1 Trauma and Media
• Discussion Statements:
1. The role of media in shaping trauma narratives can be overwhelming.
2. Social media platforms can both help and hinder trauma recovery.
• Discussion Question:
1. How has the digital age altered our relationship with trauma?
• References:
1. Chouliaraki, L. (2006). The Spectatorship of Suffering. Sage.
• Addresses how media frames and presents trauma.

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2. Daya, I. & Matthes, J. (2018). The Effect of Vivid Media on Public Support for Traumatic Humanitarian Crises. Public Opinion Quarterly, 82(2), 81–311.
• Investigates the public’s response to trauma portrayed in the media.
3. Thompson, R. (2014). News Content and Public Engagement on Social Media. Digital Journalism, 2(4), 510–527.
• Discusses the role of social media in publicizing traumatic events.
4. Zoellner, L. A., & Maercker, A. (2006). Posttraumatic growth in clinical psychology — A critical review and introduction of a two component model. Clinical Psychology Review, 26(5), 626–653.
• Analyzes how media coverage can affect posttraumatic growth.
1.6 Personal vs. Collective Trauma
• 1.6.1 Individual Experience
• Discussion Statements:
1. Personal trauma often differs significantly from collective trauma in terms of lived experience.
2. Therapeutic strategies are tailored more precisely for individual trauma.
• Discussion Question:
1. How do personal coping mechanisms influence the healing process?
• References:
1. van der Kolk, B. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking.
• Explores how personal trauma manifests in bodily sensations and behaviors.
2. Courtois, C. A., & Ford, J. D. (2013). Treatment of complex trauma: A sequenced, relationship-based approach. Guilford Press.
• Discusses tailored approaches for treating individual trauma.
3. Briere, J., & Scott, C. (2014). Principles of Trauma Therapy: A Guide to Symptoms, Evaluation, and Treatment. SAGE Publications.
• Provides a comprehensive guide to treating individual trauma.
4. Herman, J. (2015). Trauma and Recovery: The Aftermath of Violence—From Domestic Abuse to Political Terror. Basic Books.
• Addresses the different manifestations of individual trauma.
• 1.6.2 Collective Memory
• Discussion Statements:
1. Collective trauma often lives in the memory of a community or nation.
2. Cultural narratives play a role in the healing or perpetuation of collective trauma.
• Discussion Question:

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1. How does collective trauma differ in its impact and treatment from individual trauma?
• References:
1. Alexander, J. C. (2004). Toward a Theory of Cultural Trauma. In Cultural Trauma and Collective Identity. University of California Press.
• Discusses the nature and impact of collective trauma.
2. Sztompka, P. (2000). Cultural Trauma: The Other Face of Social Change. European Journal of Social Theory, 3(4), 449–466.
• Explores how social change can be both a cause and an effect of cultural trauma.
3. Eyerman, R. (2001). Cultural Trauma: Slavery and the Formation of African American Identity. Cambridge University Press.
• Discusses the trauma of slavery and its lasting impact on African American identity.
4. Connerton, P. (1989). How Societies Remember. Cambridge University Press.
• Discusses the mechanisms of collective memory and its role in trauma.
1.7 Intersectionality and Trauma
• 1.7.1 Gender and Trauma
• Discussion Statements:
1. Gender plays a significant role in the experience and processing of trauma.
2. Therapeutic strategies must recognize these gender-specific nuances.
• Discussion Question:
1. How do men and women differ in their response to trauma?
• References:
1. Jordan, J. V., & Carlson, J. (2013). Creating Connection: A Relational-Cultural Approach with Couples. Routledge.
• Discusses the gender-specific nuances in trauma and its treatment.
2. Brown, L. S. (2008). Cultural competence in trauma therapy: Beyond the flashback. American Psychological Association.
• Highlights the necessity of considering cultural and gender differences in trauma therapy.
3. Golding, J. M. (1999). Intimate Partner Violence as a Risk Factor for Mental Disorders: A Meta-Analysis. Journal of Family Violence, 14(2), 99–132.
• Discusses the gender-specific implications of intimate partner violence.
4. Kimerling, R., & Calhoun, K. S. (1994). Somatic Symptoms, Social Support, and Treatment Seeking Among Sexual Assault Victims. Journal of Consulting and Clinical Psychology, 62(2), 333–340.

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• Focuses on the gender differences in trauma experience and treatment.
1.8 Trauma-Informed Approach
• 1.8.1 Importance of Trauma-Informed Care
• Discussion Statements:
1. Trauma-informed care is essential for effective therapy and treatment.
2. A trauma-informed approach respects the survivor’s autonomy and individuality.
• Discussion Question:
1. How does a trauma-informed approach differ from traditional therapeutic techniques?
• References:
1. Harris, M., & Fallot, R. D. (2001). Using trauma theory to design service systems. Jossey-Bass.
• Highlights the foundational elements of trauma-informed care.
2. Substance Abuse and Mental Health Services Administration (SAMHSA). (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. SAMHSA.
• Provides federal guidelines for a trauma-informed approach.
3. Anda, R. F., Felitti, V. J., & Bremner, J. D. (2006). The enduring effects of abuse and related adverse experiences in childhood. European Archives of Psychiatry and Clinical Neuroscience, 256(3), 174–186.
• Discusses why a trauma-informed approach is crucial for individuals who have experienced early-life adversity.
4. Cloitre, M., Courtois, C. A., Ford, J. D., Green, B. L., Alexander, P., Briere, J., Herman, J. L., Lanius, R., Stolbach, B. C., Spinazzola, J., Van der Kolk, B. A., Van der Hart, O. (2012). The ISTSS Expert Consensus Treatment Guidelines for Complex PTSD in Adults. Journal of Traumatic Stress, 25(6), 615–627.
• Highlights the importance of trauma-informed care in treating complex PTSD.
• 1.8.2 Elements of a Trauma-Informed Practice
• Discussion Statements:
1. Understanding the widespread impact of trauma and the pathways for recovery is essential.
2. A trauma-informed practice must be flexible to adapt to the needs of diverse trauma survivors.
• Discussion Question:
1. What elements should be non-negotiable in a trauma-informed practice?
• References:

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1. Sweeney, A., Filson, B., Kennedy, A., Collinson, L., & Gillard, S. (2018). A paradigm shift: Relationships in trauma-informed mental health services. BJPsych Advances, 24(5), 319–333.
• Discusses how the patient and provider relationship is pivotal in a trauma-informed practice.
2. Bloom, S. L. (2013). Creating sanctuary: Toward the evolution of sane societies. Routledge.
• Introduces the Sanctuary Model as a roadmap for creating a trauma-informed environment.
3. Briere, J., & Lanktree, C. (2011). Treating Complex Trauma in Adolescents and Young Adults. SAGE Publications.
• Focuses on the unique elements needed in a trauma-informed practice for adolescents and young adults.
4. Hopper, E. K., Bassuk, E. L., & Olivet, J. (2010). Shelter from the storm: Trauma-informed care in homelessness services settings. The Open Health Services and Policy Journal, 3(1), 80–100.
• Examines the role of trauma-informed care in homelessness service settings.
1.9 Future Directions and Considerations
• 1.9.1 Technological Advances
• Discussion Statements:
1. Emerging technologies like VR and AI could revolutionize trauma therapy.
2. Ethical considerations are paramount when incorporating technology in trauma care.
• Discussion Question:
1. What ethical concerns in trauma therapy should be considered when using technology?
• References:
1. Rizzo, A., & Shilling, R. (2017). Clinical Virtual Reality tools to advance the prevention, assessment, and treatment of PTSD. European Journal of Psychotraumatology, 8(5), 1414560.
• Discusses the potential for Virtual Reality (VR) in trauma therapy.
2. Bohil, C. J., Alicea, B., & Biocca, F. A. (2011). Virtual reality in neuroscience research and therapy. Nature Reviews Neuroscience, 12(12), 752–762.
• Reviews various technologies that could contribute to neuroscience and trauma therapy.
3. Luxton, D. D. (2016). Artificial intelligence in psychological practice: Current and future applications and implications. Professional Psychology: Research and Practice, 47(5), 332–339.
• Discusses the role and ethical considerations of AI in psychological practice.

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4. Fiske, A., Henningsen, P., & Buyx, A. (2019). Your robot therapist will see you now: Ethical implications of embodied artificial intelligence in psychiatry, psychology, and psychotherapy. Journal of Medical Ethics, 45(5), 308–309.
• Highlights the ethical considerations when incorporating AI in therapy.
5. Revolutionising Industries: The Rise of Programmable Robots. https://www.jetlearn.com/blog/rise-of-programmable-robots
• 1.9.2 Ethical Considerations
• Discussion Statements:
1. Ethical dilemmas can significantly affect the course and outcome of trauma treatment.
2. Maintaining client confidentiality and informed consent are fundamental.
• Discussion Question:
1. What ethical considerations are specific to trauma therapy?
• References:
1. Pope, K. S., & Vasquez, M. J. (2016). Ethics in psychotherapy and counseling: A practical guide. John Wiley & Sons.
• Comprehensive guide focusing on ethical considerations in psychotherapy.
2. Welfel, E. R. (2015). Ethics in counseling & psychotherapy. Cengage Learning.
• Discusses the importance of ethics in professional relationships.
3. Barnett, J. E., & Johnson, W. B. (2015). Ethics Desk Reference for Psychologists. American Psychological Association.
• Highlights APA’s ethical guidelines and how they apply to complex cases.
4. Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics. Oxford University Press.
• Discusses ethical principles applicable to medical and psychological treatment.
Section 1.2: Trauma and the Emergence of Multiplicity: A Relational Perspective
1.2.1 Early Childhood Sexual Abuse: A Gateway to Multiplicity
• Discussion Statements:
1. The devastating impact of early sexual abuse often fractures the child’s sense of self, leading to the emergence of multiple personalities as a coping mechanism.
2. The lack of an empathetic adult or authority figure compounds the feeling of worthlessness.
• Discussion Question:

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1. How does the absence of a nurturing figure perpetuate the development of multiplicity in victims of early sexual abuse?
• References and Context:
1. Briere, J., & Scott, C. (2015). Principles of trauma therapy: A guide to symptoms, evaluation, and treatment (DSM-5 update). Sage Publications.
• This book discusses the link between severe trauma and dissociative symptoms, including multiplicity.
2. Putnam, F. W. (1989). Diagnosis and treatment of multiple personality disorder. Guilford Press.
• Putnam’s work is seminal in exploring how early abuse can lead to Multiple Personality Disorder.
3. Herman, J. L. (1992). Trauma and recovery. Basic Books.
• Herman outlines the psychological ramifications of trauma, which is critical to understanding the connection to multiplicity.
4. van der Kolk, B. A. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.
• The book explains how trauma stored in the body relates to the experience of different selves in multiples.
1.2.2 Perceived Worthlessness: A Lifelong Battle?
• Discussion Statements:
1. The ingrained feeling of worthlessness forms a narrative that is hard to rewrite but not impossible.
2. A re-evaluation of self-worth is often the first step towards healing and integrating multiple selves.
• Discussion Question:
1. What are the therapeutic methods most effective for rebuilding self-worth in multiples?
• References and Context:
1. Bowlby, J. (1988). A secure base: Parent-child attachment and healthy human development. Basic books.
• Bowlby’s attachment theory provides a foundational understanding of how relationships can harm or heal.
2. Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. Guilford Press.
• Schema therapy offers techniques for challenging and changing core beliefs, such as worthlessness.
3. Linehan, M. M. (2014). DBT skills training manual. Guilford Publications.
• DBT provides concrete skills for emotion regulation and interpersonal effectiveness, which are necessary for rebuilding self-worth.
4. Van der Hart, O., Nijenhuis, E. R. S., & Steele, K. (2006). The haunted self: Structural dissociation and the treatment of chronic traumatization. Norton & Company.
• This book covers the structural dissociation of the personality, especially relevant to multiples dealing with trauma.

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5. Botha, F. and Dozois, D., (2015). The Influence of Emphasizing Psychological Causes of Depression on Public Stigma. Canadian Journal of Behavioural Science 47 (4): 313.
• Examines how framing the causes of depression as primarily psychological affects public stigma and how mental health conditions may shape societal attitudes and stigmatization.
6. Shevlin, M., Fyvie, C., Karatzias, T., & Hyland, P. (2020). The relationship between ICD-11 PTSD, complex PTSD and dissociative experiences. https://doi.org/10.1080/15299732.2019.1675113
• Provides nuanced insights into how different traumas manifest psychologically, and it is critical for clinicians and researchers interested in the complexities of PTSD and dissociation to investigate the connections between various forms of post-traumatic stress disorder (PTSD) as defined by the ICD-11 and dissociative experiences.
1.2.3 The Role of Authority Figures in Treatment
• Discussion Statements:
1. The presence of a caring and competent authority figure can serve as a corrective emotional experience for multiples who have suffered trauma.
2. Authority figures in therapy must handle the complexities of multiplicity and trauma.
• Discussion Question:
1. How can authority figures in therapeutic settings best build trust with multiples?
• References and Context:
1. Norcross, J. C., & Wampold, B. E. (2019). Relationships and responsiveness in the psychological treatment of trauma: The tragedy of the APA Clinical Practice Guideline. Psychotherapy, 56(3), 391–399.
• Discusses the significance of the therapist-client relationship in trauma treatment.
2. Rogers, C. R. (1951). Client-centered therapy: Its current practice, implications, and theory. Constable.
• Rogers’ work emphasizes the importance of unconditional positive regard in therapy.
3. Bowlby, J. (1973). Attachment and loss: Vol. 2. Separation: Anxiety and anger. Basic Books.
• Reiterates the necessity for secure attachments, particularly in therapeutic settings.
4. Kohut, H. (1971). The analysis of the self: A systematic approach to the psychoanalytic treatment of narcissistic personality disorders. International Universities Press.
• Kohut outlines how authority figures can mirror and validate the key to rebuilding self-worth.
5. Norcross, J. C., & Wampold, B. E. (2019). Relationships and responsiveness in the psychological treatment of trauma: The tragedy of the APA Clinical Practice Guideline. Psychotherapy, 56(3), 391—399. doi: 10.1037/pst0000228

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• Critiques the APA’s Clinical Practice Guideline to treat trauma, focusing on the importance of therapeutic relationships and responsiveness, arguing that these elements have been under-emphasized in the APA guidelines, which serve as a cornerstone for discussions on the developing standards and criticisms in trauma therapy.
6. Rather, M., & Khan, M. (2020). A correlational study on emotional intelligence and self-actualization of creative writers. Indian Journal of Positive Psychology, 11(4), 308.
• Suggests that higher levels of emotional intelligence may be associated with greater self-actualization, which could have significant implications for how emotional skills contribute to the creative writing process.
1.2.4 Community-based Approach
• Discussion Statements:
1. A community-based approach may provide multiples with the collective support they often lack.
2. Healthy relationships outside of therapy can reinforce the internal work done in treatment.
• Discussion Question:
1. How can community engagement be therapeutic in multiples?
• References and Context:
1. Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy. Basic Books.
• Discusses the healing potential of group dynamics.
2. Tew, J. (2011). Social approaches to mental distress. Palgrave Macmillan.
• Emphasizes the role of social networks in mental health recovery.
3. Sarason, I. G., & Sarason, B. R. (2009). Social support: Theory, research, and applications. Springer Science & Business Media.
• Explores the multifaceted nature of social support in mental health.
4. McNamee, S., & Gergen, K. J. (1999). Relational responsibility: Resources for sustainable dialogue. Sage.
• Examines the ethics and responsibilities within a relational community.
1.2.5 Efficacy of Different Therapeutic Approaches
• Discussion Statements:
1. Different therapeutic methods may yield varying results when working with multiples, making it crucial to tailor interventions.
2. Cognitive-behavioral therapy (CBT) may offer a structured approach but may not be sufficient for addressing deep-rooted emotional issues.
• Discussion Question:

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1. What factors should therapists consider when selecting a therapeutic approach for multiples?
• References and Context:
1. Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. Guilford Press.
• Establishes the foundations of CBT and its efficacy in treating depression.
2. Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.
• Describes dialectical behavior therapy used with trauma survivors.
3. Foa, E. B., Hembree, E. A., & Rothbaum, B. O. (2007). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences. Oxford University Press.
• Discusses prolonged exposure therapy and its relevance in treating trauma.
4. Van der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Viking.
• Highlights the role of body-oriented therapies in trauma treatment.
5. Easvaradoss, V., & Cabral, V. (2015). Impact of cognitive behavior group therapy on the psychological functioning of adolescents from dual earner families. Indian Journal of Health and Wellbeing, 6(2), 177.
• Cognitive-behavioral group therapy has significant positive effects on adolescents from dual-employed families, found in a study that has a significant positive impact on these adolescents’ psychological functioning, which may have implications for how to approach treatment for this demographic.
6. Lee, A., Chin, P., Nambiar, A., & Haskins, N. (2023). Addressing intergenerational trauma in Black families: Trauma-informed socioculturally attuned family therapy. Journal of Marital and Family Therapy, 49(2), 447.
• Explores the complexities of intergenerational trauma within Black families, emphasizing the utility of a trauma-informed socioculturally attuned approach in family therapy settings to address these deeply rooted issues.
7. Sango, P., & Forrester-Jones, R. (2017). Intellectual and developmental disabilities, spirituality and religion: A systematic review 1990-2015. https://doi.org/10.1080/23312521.2017.1317224
• Overviews on how spirituality and religion interact with intellectual and developmental disabilities focusing on the intersectionality of disability, trauma, and spirituality
1.2.6 Spiritual and Existential Factors
• Discussion Statements:
1. Multiples often grapple with existential questions related to identity and purpose.
2. Spiritual beliefs, when integrated into one’s self-concept, can either facilitate or impede the healing process.
• Discussion Question:

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1. How can therapists navigate the complexities of spirituality and existential concerns in treating multiples?
• References and Context:
1. Frankl, V. E. (1959). Man’s search for meaning. Beacon Press.
• Explores existential therapy and the search for meaning in life.
2. Yalom, I. D. (1980). Existential psychotherapy. Basic Books.
• A comprehensive overview of existential therapy’s principles.
3. Pargament, K. I. (2007). Spiritually integrated psychotherapy: Understanding and addressing the sacred. Guilford Press.
• Discusses integrating spirituality into psychotherapy.
4. Hill, P. C., & Pargament, K. I. (2003). Advances in the conceptualization and measurement of religion and spirituality. American Psychologist, 58(1), 64–74.
• Reviews the empirical study of religion and spirituality in psychology.
5. Tan, S.-Y. (2022). Dealing With Spiritual Struggles in Psychotherapy: Empirical Evidence and Clinical Applications From a Christian Perspective. Journal of Psychology and Christianity, 41(4), 311.
• Investigates the role of spiritual struggles in psychotherapy by providing empirical evidence and clinical applications for addressing these struggles, particularly from a Christian viewpoint.
1.2.7 Community Support and Peer Groups
• Discussion Statements:
1. Peer groups and community organizations can offer multiples crucial emotional and logistical support.
2. However, not all peer groups may be conducive to healing and personal growth.
• Discussion Question:
1. How do peer groups affect the psychological well-being of multiples?
• References and Context:
1. Solomon, P. (2004). Peer support/peer provided services underlying processes, benefits, and critical ingredients. Psychiatric Rehabilitation Journal, 27(4), 392—401.
• Highlights the importance of peer support in psychiatric rehabilitation.
2. Mead, S., Hilton, D., & Curtis, L. (2001). Peer support: A theoretical perspective. Psychiatric Rehabilitation Journal, 25(2), 134—141.
• Discusses the theoretical frameworks behind peer support.
3. Davidson, L., Bellamy, C., Guy, K., & Miller, R. (2012). Peer support among persons with severe mental illnesses: A review of evidence and experience. World Psychiatry, 11(2), 123–128.
• Reviews empirical studies on peer support in severe mental illnesses.
4. Corrigan, P. (2006). Impact of consumer-operated services on empowerment and recovery of people with psychiatric disabilities. Psychiatric Services, 57(10), 1493—1496.
• Examines how consumer-operated services can empower individuals with psychiatric disabilities.

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5. Fortuna, K. L., Myers, A. J., Ferron, J. C., Kadakia, A., Bianco, C. L., Bruce, M. L., & Bartels, S. J. (2022). Assessing a digital peer support self-management intervention for adults with serious mental illness: Feasibility, acceptability, and preliminary effectiveness. Journal of Mental Health. https://doi.org/10.1080/09638237.2021.2022619
• Overviews on how spirituality and religion interact with intellectual and developmental disabilities focusing on the intersectionality of disability, trauma, and spirituality
6. Tse, S., Tsoi, E. W., Hamilton, B., O’Hagan, M., Shepherd, G., Slade, M., Whitley, R., & Petrakis, M. (2016). Uses of strength-based interventions for people with serious mental illness: A critical review. https://doi.org/10.1177/0020764015623970
• Feasibility, acceptability, and preliminary effectiveness” serve as an essential resource to use digital peer support in mental health care for those with serious mental illnesses.
7. Jones, P. (2013). Exploring the Dimensions of Recovery and User Experience. International Journal of Person Centered Medicine 3(4). http://www.ijpcm.org/index.php/ijpcm/article/view/412
• Provides valuable insights into the patient’s perspective in the recovery process, particularly in person-centered medicine.
1.2.8 Ethical Considerations in Treating Multiples
• Discussion Statements:
1. Ensuring informed consent and confidentiality is more challenging yet crucial when treating multiples.
2. Ethical dilemmas may arise in balancing the needs of different alters.
• Discussion Question:
1. What ethical guidelines should therapists follow when treating multiples?
• References and Context:
1. Beauchamp, T. L., & Childress, J. F. (2013). Principles of biomedical ethics (7th ed.). Oxford University Press.
• A seminal work on the principles of biomedical ethics.
2. Welfel, E. R. (2015). Ethics in counseling & psychotherapy (6th ed.). Cengage Learning.
• Focuses specifically on ethical considerations in counseling and psychotherapy.
3. Fisher, C. B. (2016). Decoding the ethics code: A practical guide for psychologists. Sage Publications.
• Provides a practical guide to the APA’s ethics code.
4. Kitchener, K. S. (1984). Intuition, critical evaluation, and ethical principles: The foundation for ethical decisions in counseling psychology. The Counseling Psychologist, 12(3), 43–55.
• Discusses the decision-making process in ethical situations in counseling.
5. Dobronski Pombo, D. E. (2018). Family reunification program at the Rehabilitation Center of Latacunga to reduce recidivism in male prisoners convicted of domestic violence. https://core.ac.uk/download/160259788.pdf
• Explores a novel approach to reducing recidivism in male prisoners convicted of domestic violence by utilizing a family reunification program.

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6. Afaq, S., & Siddiqui, R. (2021). The Interplay of Socio-economic Status, Parental Academic Pressure and Ego Virtue of Fidelity: Gender Differences among Students. International Journal of Education and Management Studies, 11(4), 232.
• Addresses the complex relationship between socio-economic status, parental academic pressure, and the ego virtue of fidelity, focusing on gender differences among students.
Chapter 2: Coping Mechanisms and Adaptive Strategies for Multiples
2.1 Understanding Coping Mechanisms in Multiples
2.1.1 Definition and Types of Coping Mechanisms
• Discussion Statements:
1. Coping mechanisms are psychological strategies to manage stress and conflict.
2. Multiples often employ a complex array of coping strategies tailored to each alter.
• Discussion Question:
1. How do different alters within a multiple system use unique coping mechanisms?
• References and Context:
1. Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. Springer Publishing Company.
• Offers foundational theories on the concepts of stress and coping.
2. Skinner, E. A., Edge, K., Altman, J., & Sherwood, H. (2003). Searching for the structure of coping: A review and critique of category systems for classifying ways of coping. Psychological Bulletin, 129(2), 216-269.
• Discusses various frameworks for classifying coping mechanisms.
3. Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30(2), 217-237.
• Examines coping strategies across various psychopathologies.
4. Taylor, S. E., & Stanton, A. L. (2007). Coping resources, coping processes, and mental health. Annual Review of Clinical Psychology, 3, 377-401.
• Reviews the roles of different resources in coping processes.
2.1.2 The Role of Coping in DID
• Discussion Statements:
1. Coping mechanisms may be more diverse and specialize in multiples, especially those with DID.
2. Coping in DID often involves internal communication and cooperation among alters.
• Discussion Question:
1. How does coping differ in individuals with DID compared to those without?

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• References and Context:
1. Dorahy, M. J., & Huntjens, R. J. (2007). Memory and attentional processes in dissociative identity disorder: A review of the empirical literature. In Child Abuse and Stress Disorders (pp. 233-252). Nova Science Publishers.
• Examines cognitive processes, including coping, in DID.
2. Lanius, R. A., Brand, B., Vermetten, E., Frewen, P. A., & Spiegel, D. (2012). The dissociative subtype of posttraumatic stress disorder: Rationale, clinical and neurobiological evidence, and implications. Depression and Anxiety, 29(8), 701-708.
• Discusses coping mechanisms as they relate to the dissociative subtype of PTSD, which often overlaps with DID.
3. Brand, B. L., & Loewenstein, R. J. (2010). Dissociative disorders: An overview of assessment, phenomenology, and treatment. Psychiatric Times, 27(10), 62-69.
• Offers a broad look at DID and related coping strategies.
4. Steele, K., van der Hart, O., & Nijenhuis, E. R. (2001). Dependency in the treatment of complex posttraumatic stress disorder and dissociative disorders. Journal of Trauma & Dissociation, 2(4), 79-116.
• Discusses dependency and other coping mechanisms in the treatment of DID.
2.1.3 Adaptive and Maladaptive Coping in Multiples
• Discussion Statements:
1. Not all coping mechanisms are adaptive or healthy; it’s important to discern between adaptive and maladaptive strategies.
2. Multiples may oscillate between adaptive and maladaptive coping depending on the specific alter involved.
• Discussion Question:
1. What are the risks and benefits of using adaptive versus maladaptive coping strategies in multiple systems?
• References and Context:
1. Carver, C. S., & Connor-Smith, J. (2010). Personality and coping. Annual review of psychology, 61, 679-704.
• Explores how personality traits influence coping mechanisms.
2. Kraaij, V., & Garnefski, N. (2019). The behavioral emotion regulation questionnaire: Development, psychometric properties and relationships with emotional problems and the cognitive emotion regulation questionnaire. Personality and Individual Differences, 137, 56-61.
• Discusses the emotional implications of using adaptive and maladaptive coping strategies.
3. Brown, R. J., Schrag, A., & Trimble, M. R. (2005). Dissociation, childhood interpersonal trauma, and family functioning in patients with somatization disorder. The American Journal of Psychiatry, 162(5), 899-905.
• Discusses the links between maladaptive coping, dissociation, and trauma.
4. Antony, M. M., & Stein, M. B. (Eds.). (2009). Oxford handbook of anxiety and related disorders. Oxford University Press.

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• Provides a comprehensive look at coping mechanisms within the context of anxiety and related disorders.
2.1.4 Cultural Context of Coping in Multiples
• Discussion Statements:
1. The cultural background of a multiple system can influence the coping mechanisms employed.
2. Some coping strategies that are maladaptive in one culture may be seen as adaptive in another.
• Discussion Question:
1. How does culture impact the coping strategies chosen by multiples?
• References and Context:
1. Chun, C. A., Moos, R. H., & Cronkite, R. C. (2006). Culture: A fundamental context for the stress and coping paradigm. In Handbook of Multicultural Perspectives on Stress and Coping (pp. 29-53). Springer.
• Discusses the influence of culture on stress and coping paradigms.
2. Kirmayer, L. J. (2007). Psychotherapy and the cultural concept of the person. Transcultural Psychiatry, 44(2), 232-257.
• Examines cultural influences on psychological constructs, including coping.
3. Ryder, A. G., Yang, J., Zhu, X., Yao, S., Yi, J., Heine, S. J., & Bagby, R. M. (2008). The cultural shaping of depression: Somatic symptoms in China, psychological symptoms in North America? Journal of Abnormal Psychology, 117(2), 300-313.
• Investigates how culture shapes psychological symptoms and coping strategies.
4. Kessler, R. C., & Üstün, T. B. (2008). The WHO World Mental Health Surveys: Global perspectives on the epidemiology of mental disorders. Cambridge University Press.
• Provides a global perspective on mental disorders and coping mechanisms.
2.1.5 The Role of Alters in Coping Strategies
• Discussion Statements:
1. Specific alters within a multiple system may have specialized roles in coping with various forms of stress or trauma.
2. Understanding the function of each alter can lead to more effective coping and integration strategies.
• Discussion Question:
1. In what ways can we leverage the functions of specific alters for better coping?
• References and Context:
1. Dell, P. F. (2009). Understanding dissociation. In P. F. Dell & J. A. O’Neil (Eds.), Dissociation and the dissociative disorders: DSM-V and beyond (pp. 709–825). Routledge.
• This resource delves into the complexities of dissociative disorders, and the role alters play in coping.
2. Dorahy, M. J., & Huntjens, R. J. (2007). Memory and attentional processes in dissociative identity disorder: A review of the empirical literature. In Trauma and Memory (pp. 45-74). Academic Press.

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• Discusses how different alters have different cognitive and memory functions, which may affect coping strategies.
3. Beere, D. (2009). Childhood psychological abuse and neglect, personality, and adult relationship quality. The Journal of Social Psychology, 149(4), 379-404.
• Investigates the link between childhood abuse, personality development, and the formation of alters as coping mechanisms.
4. Van der Hart, O., Nijenhuis, E. R., & Steele, K. (2006). The haunted self: Structural dissociation and the treatment of chronic traumatization. W. W. Norton & Company.
• Offers an in-depth view on structural dissociation and how different alters may play roles in coping with trauma.
2.1.6 The Efficacy of Psychotherapy in Treating Multiples
• Discussion Statements:
1. Psychotherapy has shown promise in aiding multiples, but its efficacy can vary based on the therapy modality and individual system characteristics.
2. Psychoeducation for the multiple and their support network is a critical component in the treatment process.
• Discussion Question:
1. What factors influence the efficacy of psychotherapy for multiples?
• References and Context:
1. Brand, B. L., Classen, C. C., McNary, S. W., & Zaveri, P. (2009). A review of dissociative disorders treatment studies. Journal of Nervous and Mental Disease, 197(9), 646-654.
• Reviews various psychotherapy treatment studies and their efficacy in treating dissociative disorders.
2. Myrick, A. C., Webermann, A. R., Langeland, W., Putnam, F. W., & Brand, B. L. (2017). Treatment of dissociative disorders and reported changes in inpatient and outpatient cost estimates. European Journal of Psychotraumatology, 8(1), 1375829.
• Discusses the cost-benefit ratio of psychotherapy in the treatment of dissociative disorders.
3. Lanius, R. A., Paulsen, S. L., & Corrigan, F. M. (2014). Neurobiology and treatment of traumatic dissociation: Towards an embodied self. Springer Publishing Company.
• Explores the neurobiological underpinnings of traumatic dissociation and the impact on psychotherapy.
4. Dorahy, M. J., Brand, B. L., Şar, V., Krüger, C., Stavropoulos, P., Martínez-Taboas, A., … & Middleton, W. (2014). Dissociative identity disorder: An empirical overview. Australian & New Zealand Journal of Psychiatry, 48(5), 402-417.
• Provides an empirical review of the prevalence, comorbidity, and treatment of dissociative identity disorder.
2.1.7 The Intersection of Multiplicity and Cultural Factors
• Discussion Statements:

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1. Cultural perspectives on multiplicity can either stigmatize or validate the experiences of multiples, with significant effects on treatment outcomes.
2. Cultural sensitivity in diagnosis and treatment can pave the way for more successful therapeutic interventions for multiples.
• Discussion Question:
1. How can healthcare professionals consider and incorporate cultural factors when diagnosing and treating multiplicity?
• References and Context:
1. Kirmayer, L. J., & Young, A. (1999). Culture and somatization: Clinical, epidemiological, and ethnographic perspectives. Psychosomatic Medicine, 61(4), 467-480.
• Examines how different cultures interpret somatic symptoms, including those that may relate to multiplicity.
2. Spiegel, D., Loewenstein, R. J., & Lewis-Fernández, R. (2011). Dissociative disorders in DSM-5. Depression and Anxiety, 28(9), 824-852.
• Discusses the role of cultural factors in the diagnosis of dissociative disorders, suggesting the need for a culturally sensitive approach.
3. Martinez-Taboas, A., & Guillermo, B. (2005). Dissociative disorders in Latino psychiatric patients: Analysis and discussion of four cases. Journal of Trauma & Dissociation, 6(2), 29-42.
• Explores specific case studies of Latino psychiatric patients, illustrating the role of culture in diagnosis and treatment of dissociative disorders.
4. Boysen, G. A., & Ebersole, A. (2020). Stigma and the Social Construction of Multiplicity. Journal of Social Psychology, 160(5), 545-560.
• Investigates the social and cultural constructs surrounding the stigma of being multiple and how this affects both self-perception and treatment.
Chapter 2.2: The Psychopharmacological Approaches to Treating Multiplicity
2.2.1 Understanding the Neurobiology of Multiplicity
• Discussion Statements:
1. The neurological basis for multiplicity remains an ongoing area of study but can provide key insights for medication-based treatment.
2. Neurotransmitter imbalances have been suggested to play a role in dissociative symptoms.
• Discussion Question:

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1. How can understanding the neurobiology of multiplicity guide the selection of psychopharmacological interventions?
• References and Context:
1. Lanius, R. A., Brand, B., Vermetten, E., Frewen, P. A., & Spiegel, D. (2012). The dissociative subtype of posttraumatic stress disorder: Rationale, clinical and neurobiological evidence, and implications. Depression and Anxiety, 29(8), 701-708.
• Discusses the dissociative subtype of PTSD and its neurological basis, relevant to understanding multiplicity.
2. Stein, D. J., Koenen, K. C., Friedman, M. J., Hill, E., McLaughlin, K. A., Petukhova, M., … & Kessler, R. C. (2013). Dissociation in posttraumatic stress disorder: Evidence from the world mental health surveys. Biological Psychiatry, 73(4), 302-312.
• Provides epidemiological evidence of dissociation and its biological factors.
3. Sierra, M., & Berrios, G. E. (2001). The phenomenological stability of depersonalization: Comparing the old with the new. The Journal of Nervous and Mental Disease, 189(9), 629-636.
• Discusses neurotransmitter imbalances and depersonalization, a condition often associated with multiplicity.
4. Sar, V. (2011). Developmental trauma, complex PTSD, and the current proposal of DSM-5. European Journal of Psychotraumatology, 2(1), 5622.
• Reviews the status of complex PTSD in the DSM-5, including its neurobiological aspects and potential treatment options.
2.2.2 Antidepressants and Their Role in Treating Multiplicity
• Discussion Statements:
1. Antidepressants, particularly SSRIs, are commonly prescribed to treat depressive symptoms in multiples.
2. The effectiveness of antidepressants in treating dissociative symptoms is not well-studied.
• Discussion Question:
1. Can antidepressants also ease the dissociative symptoms or are they only effective for comorbid conditions?
• References and Context:
1. Spiegel, D., & Lewis-Fernández, R. (2016). Dissociative disorders and dissociative symptoms in the DSM-5. Psychiatric Annals, 46(2), 64-69.
• Reviews dissociative disorders in the DSM-5 and notes a lack of pharmacological studies focusing solely on dissociation.
2. Putnam, F. W. (1989). Diagnosis and treatment of multiple personality disorder. New York, NY: Guilford Press.
• Classic text that discusses various treatment options, including medication, for multiple personality disorder.
3. Haddock, G., & Lewis, S. (2005). Psychological interventions in early psychosis. Schizophrenia Bulletin, 31(3), 697-704.
• Investigates the use of antidepressants in psychosis, a state that has overlapping symptoms with dissociation.

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4. Strawn, J. R., & Geracioti, T. D. (2008). Noradrenergic dysfunction and the psychopharmacology of posttraumatic stress disorder. Depression and Anxiety, 25(3), 260-271.
• Explores the role of noradrenergic dysfunction in PTSD, suggesting potential pathways for treatment using antidepressants.
2.2.3 Antipsychotics and Dissociative Symptoms
• Discussion Statements:
1. Antipsychotics are often used in treating severe dissociative symptoms, though the evidence for their effectiveness is mixed.
2. Some antipsychotics may exacerbate dissociative symptoms by affecting neurotransmitter pathways.
• Discussion Question:
1. Are antipsychotics more beneficial or harmful for treating dissociative symptoms, and how should clinicians weigh these pros and cons?
• References and Context:
1. Hunter, E. C., Sierra, M., & David, A. S. (2004). The epidemiology of depersonalization and derealization. Social Psychiatry and Psychiatric Epidemiology, 39(1), 9-18.
• Discusses the epidemiology of depersonalization and derealization and notes that antipsychotic medication may sometimes worsen these symptoms.
2. Sar, V., & Ross, C. (2006). Dissociative disorders as a confounding factor in psychiatric research. Psychiatric Clinics, 29(1), 129-144.
• Addresses how antipsychotics could either improve or exacerbate dissociative disorders, complicating research.
3. Jans, T., Schneck-Seif, S., Weigand, T., Schneider, W., Ellgring, H., Wewetzer, C., … & Remschmidt, H. (2008). Long-term outcome and prognosis of dissociative disorder with onset in childhood or adolescence. Child and Adolescent Psychiatry and Mental Health, 2(1), 19.
• Discusses how long-term treatment, including antipsychotic medication, affects the prognosis of dissociative disorders.
4. Nijenhuis, E. R. (2017). Ten reasons for conceiving and classifying posttraumatic stress disorder as a dissociative disorder. Psichiatria e Psicoterapia, 36(1), 31-58.
• Argues that PTSD and dissociative disorders have overlapping symptomatology and thus may respond similarly to antipsychotic treatment.
2.2.4 Anxiolytics and Coping Mechanisms in Multiples
• Discussion Statements:
1. Doctors do not recommend using benzodiazepines and other anxiolytics for long-term treatment of dissociative disorders, although they can provide temporary relief from anxiety.
2. Non-pharmacological coping mechanisms may offer a more sustainable approach for managing anxiety in multiples.
• Discussion Question:

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1. How can doctors responsibly integrate anxiolytics into a comprehensive treatment plan for multiples who have anxiety?
• References and Context:
1. Lydiard, R. B., & Brawman-Mintzer, O. (1998). An overview of the treatment of anxiety disorders. In Anxiety disorders (pp. 231-250). Springer, Boston, MA.
• Reviews the role of anxiolytics in the treatment of anxiety disorders, including the risks of dependency.
2. Baldwin, D. S., Anderson, I. M., Nutt, D. J., Allgulander, C., Bandelow, B., den Boer, J. A., … & Malizia, A. (2005). Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology. Journal of Psychopharmacology, 29(5), 403-439.
• Highlights evidence-based pharmacological treatments for anxiety disorders, including anxiolytics.
3. Van der Kolk, B. A., Stone, L., West, J., Rhodes, A., Emerson, D., Suvak, M., & Spinazzola, J. (2014). Yoga as an adjunctive treatment for posttraumatic stress disorder: A randomized controlled trial. The Journal of Clinical Psychiatry, 75(6), e559-e565.
• Discusses non-pharmacological coping mechanisms, such as yoga, for managing anxiety symptoms.
4. Raskind, M. A., Peskind, E. R., Hoff, D. J., Hart, K. L., Holmes, H. A., Warren, D., … & McFall, M. E. (2007). A parallel group placebo controlled study of prazosin for trauma nightmares and sleep disturbance in combat veterans with post-traumatic stress disorder. Biological Psychiatry, 61(8), 928-934.
• Examines a particular medication, prazosin, for treating nightmares and sleep disturbances in PTSD, conditions that multiples also experience.
2.2.5 Hesitancy to Take Prescribed Medications in Multiples
• Discussion Statements:
1. Among multiples, medication hesitancy can be more complex because of different alters having varying opinions about medication.
2. Concerns about loss of control or identity often contribute to medication hesitancy in this population.
• Discussion Question:
1. What are the ethical considerations for healthcare providers in prescribing medications to multiples who express hesitancy or resistance?
• References and Context:
1. Sweeny, K., Ghane, A., Legg, A. M., Hu, T., & Melendez, M. (2014). Predictors of medication adherence: Factor or fiction? A practical review and recommendations for clinicians. Behavioral Medicine, 40(2), 69-77.
• Explores factors affecting medication adherence, including emotional considerations like fear of losing control.
2. Lepping, P., & Raveesh, B. N. (2014). Overcoming non-adherence to antipsychotic medication: A cognitive approach. Journal of Clinical Psychiatry, 75(1), e07.

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• Investigates the cognitive factors affecting medication adherence, especially relevant to multiples with dissociative identity disorders.
3. Moncrieff, J. (2013). The Bitterest Pills: The Troubling Story of Antipsychotic Drugs. Palgrave Macmillan.
• Examines the history and controversy surrounding antipsychotic medications, contributing to hesitancy.
4. Rose, N. (2018). Our Psychiatric Future. Polity.
• Discusses the politics and sociology of psychiatric medication, including why some groups are more hesitant to take prescribed drugs.
5. Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work. Routledge.
• Compares the efficacy of medication versus psychotherapy, providing a context for why multiples might opt for non-pharmacological treatments.
2.2.6 Building Trust in Medical Authority
• Discussion Statements:
1. For multiples, the reluctance to trust medical professionals can stem from experiences of maltreatment or invalidation.
2. Building trust is essential for effective pharmacotherapy and overall treatment success.
• Discussion Question:
1. How can healthcare providers build trust with multiples, especially when prescribing medications that affect mental states?
• References and Context:
1. Thom, D. H., & Campbell, B. (2014). Patient-physician trust: An exploratory study. Journal of Family Practice, 48(2), 170-177.
• Explores the components that contribute to trust between patients and physicians, vital for medication compliance.
2. Farber, B. A., Suzuki, J. Y., & Lynch, D. A. (2018). Positive regard and psychotherapy outcome: A meta-analytic review. Psychotherapy, 55(4), 411-423.
• Discusses the importance of positive regard in therapy outcomes, including medication compliance.
3. Shea, S. C. (2008). The practical art of suicide assessment: A guide for mental health professionals and substance abuse counselors. John Wiley & Sons.
• Addresses how a lack of trust could also risk the escalation of suicidal tendencies in certain individuals.
4. Horvath, A. O., Del Re, A. C., Flückiger, C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48(1), 9.
• Focuses on the therapeutic alliance, which also extends to trust in medication prescribed by the healthcare provider.

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3.1 Understanding Emotional Complexities in Multiplicity
3.1.1 Emotional Symbiosis
• Discussion Statement 1: Emotional symbiosis can offer a safety net for multiples in stressful situations.
• Discussion Statement 2: However, symbiosis can also pose challenges to individual autonomy within the system.
• Discussion Question: How do you navigate emotional symbiosis while preserving individual identities?
• References:
1. Herman, J. L. (1992). Trauma and recovery. BasicBooks.
• The seminal work on trauma explores the complexities of emotional interactions among traumatized individuals.
2. Ross, C. A. (2009). Dissociative identity disorder. Routledge.
• Discusses the emotional relationships among alternate identities in DID cases.
3. Stern, D. N. (1985). The interpersonal world of the infant. Basic Books.
• Explores emotional development and could understand the emotional intricacies among multiples.
4. Winnicott, D. W. (1965). The maturational process and the facilitating environment. International Universities Press.
• Offers insight into how a supportive environment affects emotional development.
3.1.2 Affective Communication Among Alters
• Discussion Statement 1: Effective communication among alters can drastically improve functionality and wellbeing.
• Discussion Statement 2: Miscommunication can lead to internal conflicts, affecting the individual’s overall mental health.
• Discussion Question: What methods have you employed for enhancing communication among your alters?
• References:
1. van der Hart, O., Nijenhuis, E. R., & Steele, K. (2006). The haunted self. Norton & Company.
• Explains how alters can communicate emotionally and the impact of this on wellbeing.
2. Putnam, F. W. (1989). Diagnosis and treatment of multiple personality disorder. Guilford Press.
• Discusses the importance of communication among alters for successful integration or cooperation.
3. Howell, E. F. (2011). Understanding and treating dissociative identity disorder. Routledge.

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• Provides therapy-based methods to improve communication among alters.
4. Bowlby, J. (1969). Attachment and loss, Vol 1. Basic Books.
• Talks about how secure attachment styles can facilitate better emotional communication among alters.
3.1.3 Emotional Labor and Mental Health
• Discussion Statement 1: Emotional labor among alters is often unequal, leading to fatigue and stress for some.
• Discussion Statement 2: Recognizing and distributing emotional labor can cause more harmonious internal relationships.
• Discussion Question: How do you equitably distribute emotional labor among your system?
• References:
1. Hochschild, A. R. (1983). The managed heart. University of California Press.
• Examines the concept of emotional labor in social contexts, applicable to multiple systems.
2. Beidel, D. C., & Frueh, B. C. (2018). Adult psychopathology and diagnosis. Wiley.
• Discusses the mental health implications of unequal emotional labor.
3. Kluft, R. P. (1984). Treatment of multiple personality disorder. American Psychiatric Pub.
• Describes how emotional labor can be a point of contention among alters.
4. Siegel, D. J. (2012). The developing mind. Guilford Press.
• Explains how understanding emotional labor can aid in the development of a more integrated self.
3.1.4 Emotional Barriers to Integration or Cooperation
• Discussion Statement 1: Emotional barriers can hinder the process of integration or cooperation among alters.
• Discussion Statement 2: Addressing these barriers requires emotional resilience and adaptive coping strategies.
• Discussion Question: What are some emotional barriers you have encountered in striving for integration or cooperation?
• References:
1. van der Kolk, B. A. (2014). The body keeps the score. Viking.
• Highlights the role of emotional resilience in overcoming trauma and its relevance to multiple systems.
2. Linehan, M. M. (2014). DBT skills training manual. Guilford Publications.
• Discusses adaptive coping strategies that can be helpful in addressing emotional barriers.
3. Lanius, U. F., Vermetten, E., & Pain, C. (2010). The impact of early life trauma on health and disease. Cambridge University Press.
• Connects early-life trauma to emotional barriers faced in adulthood.
4. Schore, A. N. (1994). Affect regulation and the origin of the self. Routledge.
• Explores how emotional barriers can stem from issues in effect regulation.

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3.1.5 Emotional Intimacy Among Alters
• Discussion Statement 1: Emotional intimacy among alters can offer solace but can also complicate internal dynamics.
• Discussion Statement 2: Managing emotional boundaries is key to healthy emotional intimacy.
• Discussion Question: How do you manage emotional boundaries within your system?
• References:
1. Yalom, I. D., & Leszcz, M. (2005). The theory and practice of group psychotherapy. Basic Books.
• Investigates the dynamics of emotional intimacy in group settings, analogous to multiple systems.
2. Fairbairn, W. R. D. (1952). Psychoanalytic studies of the personality. Routledge & Kegan Paul.
• Discusses the need for emotional boundaries for mental health and well-being.
3. Fonagy, P., & Target, M. (1997). Attachment and reflective function. Routledge.
• Talks about the role of attachment in forming emotional bonds among alters.
4. Fosha, D., Siegel, D. J., & Solomon, M. F. (2009). The healing power of emotion. W. W. Norton & Company.
• Provides a detailed examination of how emotional intimacy can be both healing and complicating.
3.1.6 Emotional Regulation in a Multiple System
• Discussion Statement 1: Emotional regulation is critical for maintaining a balanced internal environment.
• Discussion Statement 2: Alters may take on specific roles in emotional regulation, both adaptive and maladaptive.
• Discussion Question: How is emotional regulation managed in your system?
• References:
1. Gross, J. J. (2014). Handbook of emotion regulation. Guilford Press.
• Explores the complexities of emotion regulation strategies.
2. Ford, J. D., & Courtois, C. A. (2014). Complex trauma. Guilford Press.
• Looks into how complex trauma can affect emotional regulation.
3. Cozolino, L. (2014). The neuroscience of human relationships. W. W. Norton & Company.
• Describes how neuroscience supports the role of emotional regulation in relational health.
4. Siegel, D. J. (2010). Mindsight. Bantam Books.
• Discusses how emotional regulation is vital for maintaining one’s mental health and relationships.
3.1.7 Emotional Dysregulation and Crisis Management
• Discussion Statement 1: Emotional dysregulation can escalate into crises that require immediate intervention.

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• Discussion Statement 2: Crisis management techniques may need to be adapted to cater to the unique emotional dynamics of multiple systems.
• Discussion Question: What specific crisis management techniques have you found effective or ineffective in your system?
• References:
1. Cloitre, M., Cohen, L. R., & Koenen, K. C. (2006). Treating survivors of childhood abuse. Guilford Press.
• Highlights crisis intervention techniques designed for survivors of abuse, relevant to many multiple systems.
2. Roberts, A. R., & Yeager, K. R. (2006). Evidence-based practice manual. Oxford University Press.
• The program provides various crisis management techniques that are based on evidence and can be adjusted for multiple situations.
3. Herman, J. L. (1997). Trauma and recovery. Basic Books.
• Discusses the heightened need for crisis management in cases with a history of trauma.
4. Borckardt, J. J., Madan, A., Grubaugh, A. L., Danielson, C. K., Pelic, C. G., Hardesty, S. J., … & Frueh, B. C. (2011). Systematic investigation of initiatives to reduce seclusion and restraint in a state psychiatric hospital. Psychiatric Services, 62(5), 477-483.
• Reviews interventions to manage crises in psychiatric settings, offering insights into how multiples might adapt these techniques for internal crises.
3.1.8 Emotional Literacy and Communication Within the System
• Discussion Statement 1: Emotional literacy enhances communication among alters and may reduce internal conflicts.
• Discussion Statement 2: Developing a common emotional language is essential for system harmony.
• Discussion Question: How has your system developed emotional literacy, and how has it affected internal communication?
• References:
1. Goleman, D. (1995). Emotional intelligence. Bantam Books.
• Discusses the fundamentals of emotional literacy and its impact on overall well-being.
2. Saarni, C. (1999). The development of emotional competence. Guilford Press.
• It reviews the stages of emotional competence, including literacy, and suggests adaptation for multiples.
3. Stein, N. L., & Levine, L. J. (1990). Making sense out of emotion. Oxford University Press.
• Provides a framework for understanding emotions, aiding in the development of emotional literacy.
4. Greenberg, L. S., Rice, L. N., & Elliott, R. (1993). Facilitating emotional change. Guilford Press.
• Discusses the role of emotional literacy in facilitating change and growth within a psychotherapeutic setting.

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3.1.9 Wrapping up: The Multifaceted World of Emotions in Multiplicity
• Discussion Statement 1: Emotional aspects in a multiple system are intricate and deserve nuanced exploration and understanding.
• Discussion Statement 2: A lack of emotional awareness can hinder the progress toward cooperation or integration.
• Discussion Question: As a system, what steps can you take to improve your emotional well-being?
• References:
1. Damasio, A. R. (1994). Descartes’ error. Putnam.
• Advocates for the deep interconnectedness of rationality and emotionality, relevant for multiples who may try to segregate the two.
2. Ekman, P., & Davidson, R. J. (1994). The nature of emotion. Oxford University Press.
• Provides an overarching view of emotional theory and practice that can serve as a comprehensive reference.
3. Gilbert, P. (2009). The compassionate mind. Constable.
• Highlights the role of self-compassion in emotional well-being, particularly relevant for multiples.
4. Panksepp, J. (1998). Affective neuroscience. Oxford University Press.
• Examines the neurobiological foundations of emotions, offering physiological insights into emotional complexities within multiples.
3.2 The Intersection of Memory and Emotion in Multiplicity
3.2.1 Memory Fragmentation and Emotional Responses
• Discussion Statement 1: Memory fragmentation often leads to unpredictable emotional responses within the system.
• Discussion Statement 2: Alters may have access to different memory sets, influencing how they perceive and respond emotionally.
• Discussion Question: What challenges has your system encountered in managing emotional responses because of memory fragmentation?
• References:
1. Eichenbaum, H. (2017). Memory: Systems, Process, or Function? Oxford University Press.
• Provides a thorough analysis into the mechanics of memory, helping to understand the emotional complexities in a multiple system.
2. Tulving, E. (2002). Elements of Episodic Memory. Oxford University Press.
• Discusses episodic memory, which could be particularly fragmentary in multiples.
3. LeDoux, J. E. (1996). The emotional brain. Simon & Schuster.

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• It investigates the intrinsic relationship between emotions and memory systems in the brain.
4. McGaugh, J. L. (2000). Memory—A Century of Consolidation. Science, 287(5451), 248–251.
• Reviews theories of memory consolidation and how they can relate to emotional experiences in multiples.
3.2.2 Memory Triggers and Emotional Flashbacks
• Discussion Statement 1: Memories can serve as triggers for sudden and intense emotional flashbacks.
• Discussion Statement 2: Emotional flashbacks can destabilize a multiple system and require prompt attention.
• Discussion Question: How does your system cope with emotional flashbacks triggered by memories?
• References:
1. van der Kolk, B. A. (2014). The body keeps the score. Viking.
• Discusses how trauma memories can be stored in the body, leading to emotional flashbacks.
2. Foa, E. B., & Rothbaum, B. O. (1998). Treating the trauma of rape. Guilford Press.
• Provides treatment options for managing flashbacks, including those related to emotional trauma.
3. Schacter, D. L. (1996). Searching for memory. Basic Books.
• Investigates the mechanisms of memory recall, particularly in stressful situations.
4. Brewin, C. R. (2015). Re-experiencing traumatic events in PTSD. Behavior Research and Therapy, 71, 32-38.
• Studies the psychological mechanisms behind flashbacks in PTSD, applicable to emotional flashbacks in multiples.
3.2.3 Emotional Resilience Among Alters
• Discussion Statement 1: Some alters display a remarkable capacity for emotional resilience, serving as protectors or caregivers within the system.
• Discussion Statement 2: Emotional resilience may vary across alters because of their unique experiences and coping mechanisms.
• Discussion Question: How do roles related to emotional resilience manifest among the alters in your system?
• References:
1. Southwick, S. M., Bonanno, G. A., Masten, A. S., Panter-Brick, C., & Yehuda, R. (2014). Resilience definitions, theory, and challenges: interdisciplinary perspectives. European Journal of Psychotraumatology, 5(1), 25338.
• Provides an interdisciplinary perspective on emotional resilience, applicable to multiple systems.

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2. Connor, K. M., & Davidson, J. R. T. (2003). Development of a new resilience scale. Journal of Traumatic Stress, 18(1), 71–82.
• Offers insights into the metrics of resilience, potentially adaptable to assess resilience among alters.
3. Rutter, M. (2012). Resilience as a dynamic concept. Development and Psychopathology, 24(2), 335–344.
• Discusses the dynamic nature of resilience, applicable to the differing roles and capabilities of alters.
4. Cicchetti, D. (2010). Resilience under conditions of extreme stress. American Journal of Psychiatry, 167(10), 1157–1165.
• Examines resilience under extreme stress, offering insights into why some alters might develop as protectors.
3.2.4 Emotion Regulation and Co-Consciousness
• Discussion Statement 1: Effective emotion regulation is often a collective effort involving co-conscious alters.
• Discussion Statement 2: Emotional dysregulation can become a system-wide issue if not addressed collaboratively.
• Discussion Question: How does co-consciousness aid or inhibit emotion regulation in your system?
• References:
1. Gross, J. J. (2014). Handbook of emotion regulation. Guilford Press.
• Explores the psychological mechanisms behind emotion regulation.
2. Thompson, R. A. (1994). Emotion regulation: A theme in search of definition. Monographs of the Society for Research in Child Development, 59(2-3), 25–52.
• Proposes a working definition of emotional regulation that can apply to multiple systems.
3. Linehan, M. M. (2014). DBT Skills Training Manual. Guilford Press.
• Discusses skills relevant for emotion regulation, including for multiples with variable emotional experiences.
4. Koenigsberg, H. W., Fan, J., Ochsner, K. N., Liu, X., Guise, K., Pizzarello, S., … & Siever, L. (2009). Neural correlates of using distancing to regulate emotional responses to social situations. Neuropsychologia, 47(6), 1813-1822.
• The article explores how different alters may use distancing as an emotional regulation strategy during co-consciousness, based on neuroscience research.
3.2.5 Emotion and Memory Fragmentation
• Discussion Statement 1: Fragmented memory can have a cascading effect on the emotional well-being of multiples.
• Discussion Statement 2: Memory fragmentation may give rise to conflicting emotions within the system.

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• Discussion Question: How has memory fragmentation affected emotional coherence in your system?
• References:
1. Eichenbaum, H. (2017). Memory: Organization and control. Annual Review of Psychology, 68, 19-45.
• Discusses how fragmented memories affect overall cognitive and emotional processing.
2. Brewin, C. R., Gregory, J. D., Lipton, M., & Burgess, N. (2010). Intrusive images in psychological disorders: Characteristics, neural mechanisms, and treatment implications. Psychological Review, 117(1), 210.
• Highlights how fragmented memories can become intrusive and emotionally taxing.
3. Steele, K., Dorahy, M. J., Van der Hart, O., & Nijenhuis, E. R. (2009). Dissociation versus alterations in consciousness. Psychological Trauma: Theory, Research, Practice, and Policy, 1(3), 155.
• Details how dissociation can lead to fragmented memories and the subsequent emotional complications.
4. Van der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin Books.
• Explores how trauma affects both memory and emotional stability, relevant to multiples.
3.2.6 Conclusion and Integration
• Discussion Statement 1: Emotion in a multiple system is a complex interplay between alters, influenced by past trauma, current context, and the system’s mechanisms for self-regulation and coping.
• Discussion Statement 2: Understanding the depth and breadth of emotional experiences among alters is crucial for therapeutic interventions.
• Discussion Question: What steps have been most effective in creating emotional coherence within your system?
• References:
1. Van der Kolk, B. (2014). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin Books.
• Highlights the importance of integrated therapeutic approaches for complex emotional issues in multiples.
2. Herman, J. (2015). Trauma and recovery: The aftermath of violence– from domestic abuse to political terror. Basic Books.
• Provides a framework for understanding trauma and its long-term emotional implications.
3. Linehan, M. M. (2014). DBT Skills Training Manual. Guilford Press.
• Outlines practical steps for achieving emotional coherence through skills training.
4. Gross, J. J., & Jazaieri, H. (2014). Emotion, emotion regulation, and psychopathology. Clinical Psychological Science, 2(4), 387-401.

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• Examines the role of emotion regulation in psychopathology, highlighting the importance of a multi-pronged therapeutic approach.
Chapter 3.3 Self-Regulation in Multiple Systems
3.3.1 Neurobiological Underpinnings of Self-Regulation
• Discussion Statement 1: The brain’s executive functions are crucial to self-regulation.
• Discussion Statement 2: Neuroplasticity allows for the development of better self-regulation over time.
• Discussion Question: What neurological explanations have helped you understand your own capacity for self-regulation?
• References:
1. Diamond, A. (2013). Executive functions. Annual Review of Psychology, 64, 135-168.
• Details the role of executive functions in self-regulation.
2. Davidson, R. J., Jackson, D. C., & Kalin, N. H. (2000). Emotion, plasticity, context, and regulation: Perspectives from affective neuroscience. Psychological Bulletin, 126(6), 890.
• Explores how neuroplasticity affects emotional regulation.
3. Arnsten, A. F. (2009). Stress signaling pathways that impair prefrontal cortex structure and function. Nature Reviews Neuroscience, 10(6), 410-422.
• Discusses how stress can impair the brain’s self-regulation mechanisms.
3.3.2 Emotional Regulation vs. Self-Regulation
• Discussion Statement 1: Emotional regulation is a subset of self-regulation.
• Discussion Statement 2: Self-regulation includes controlling thoughts, behaviors, and even physiology.
• Discussion Question: How do you distinguish between emotional regulation and overall self-regulation within your system?
• References:
1. Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2(3), 271-299.
• Discusses the concept and mechanisms of emotional regulation.
2. Vohs, K. D., & Baumeister, R. F. (Eds.). (2016). Handbook of self-regulation: Research, theory, and applications. Guilford Publications.
• A comprehensive guide to understanding self-regulation.
3. Bandura, A. (1991). Social cognitive theory of self-regulation. Organizational Behavior and Human Decision Processes, 50(2), 248-287.
• Explains how social and cognitive factors influence self-regulation.

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3.3.3 Self-Regulation in Trauma Survivors
• Discussion Statement 1: Survivors of trauma often have compromised self-regulation.
• Discussion Statement 2: Trauma-informed approaches can support the redevelopment of self-regulation skills.
• Discussion Question: How has trauma affected your or your system’s ability to self-regulate?
• References:
1. Herman, J. L. (1997). Trauma and recovery: The aftermath of violence—from domestic abuse to political terror. Basic Books.
• Discusses how trauma can disrupt self-regulating mechanisms.
2. Briere, J., & Scott, C. (2014). Principles of trauma therapy: A guide to symptoms, evaluation, and treatment. SAGE Publications.
• Highlights therapeutic techniques for regaining self-regulation.
3. Ford, J. D., & Courtois, C. A. (2014). Complex PTSD, affect dysregulation, and borderline personality disorder. Borderline Personality Disorder and Emotion Dysregulation, 1(1), 9.
• Links trauma, affect dysregulation, and challenges in self-regulation.
3.3.4 Mindfulness and Self-Regulation
• Discussion Statement 1: Mindfulness can serve as a potent tool for enhancing self-regulation.
• Discussion Statement 2: It works by increasing awareness and non-reactive monitoring of experience.
• Discussion Question: Have you or your system tried incorporating mindfulness as a self-regulation tool? What has been your experience?
• References:
1. Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10(2), 125-143.
• Reviews the effectiveness of mindfulness in enhancing self-regulation.
2. Tang, Y. Y., Ma, Y., Wang, J., Fan, Y., Feng, S., Lu, Q., … & Posner, M. I. (2007). Short-term meditation training improves attention and self-regulation. Proceedings of the National Academy of Sciences, 104(43), 17152-17156.
• Discusses the neuroscientific basis for how mindfulness improves self-regulation.
3.3.5 Medication and Self-Regulation
• Discussion Statement 1: Although pharmaceuticals like SSRIs can aid in self-regulation, they often face resistance from people.
• Discussion Statement 2: Fear of being controlled or stigmatized may deter individuals from medication.
• Discussion Question: How do you or your system feel about using medication as a tool for self-regulation?
• References:

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1. Hollon, S. D., DeRubeis, R. J., & Seligman, M. E. (2002). Cognitive and pharmacological treatments for depression. In The science of clinical psychology: Accomplishments and future directions.
• Reviews the role of medication in treating emotional dysregulation.
2. Moncrieff, J., & Cohen, D. (2006). Do antidepressants cure or create abnormal brain states? PLoS Medicine, 3(7), e240.
• Discusses the controversies surrounding antidepressant medication.
3.3.6 Trauma-Sensitive Yoga as a Self-Regulation Technique
• Discussion Statement 1: Trauma-sensitive yoga can provide a body-based approach to enhance self-regulation.
• Discussion Statement 2: It emphasizes present-moment experiences and choice-making.
• Discussion Question: What are your or your system’s thoughts on using body-based approaches like trauma-sensitive yoga?
• References:
1. Emerson, D., & Hopper, E. (2011). Overcoming Trauma through Yoga: Reclaiming Your Body. North Atlantic Books.
• It explores how yoga instructors can change their practice to cater to the requirements of trauma survivors.
2. West, J., Liang, B., & Spinazzola, J. (2017). Trauma Sensitive Yoga as a Complementary Treatment for Posttraumatic Stress Disorder: A Qualitative Descriptive Analysis. International Journal of Stress Management, 24(2), 173.
• Highlights qualitative experiences of trauma survivors using trauma-sensitive yoga.
3.3.7 Art Therapy for Self-Regulation
• Discussion Statement 1: Art therapy can be an effective non-verbal approach to self-regulation.
• Discussion Statement 2: It allows for externalization and objectification of internal experiences.
• Discussion Question: Have you or your system ever used art as self-expression or self-regulation?
• References:
1. Malchiodi, C. A. (2012). Handbook of Art Therapy. Guilford Press.
• Outlines art therapy techniques that help with emotional regulation.
2. Hass-Cohen, N., & Carr, R. (2008). Art Therapy and Clinical Neuroscience. Jessica Kingsley Publishers.
• Discusses the neuroscience behind art therapy’s effectiveness in self-regulation.
3.3.8 Self-Regulation vs. Emotional Regulation
• Discussion Statement 1: Self-regulation is a broader concept that includes emotional regulation but also encompasses behavior and thoughts.
• Discussion Statement 2: Emotional regulation is a subset of self-regulation and mainly focuses on managing feelings.

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• Discussion Question: How do you distinguish between self-regulation and emotional regulation within your system?
• References:
1. Gross, J. J. (2015). Handbook of Emotion Regulation. Guilford Publications.
• Delves into the finer distinctions between emotional and self-regulation.
2. Baumeister, R. F., & Vohs, K. D. (Eds.). (2016). Handbook of Self-Regulation: Research, Theory, and Applications. Guilford Publications.
• Offers comprehensive perspectives on self-regulation, including its relationship to emotional regulation.
3.3.9 Quilting as a Form of Self-Regulation
• Discussion Statement 1: Quilting can offer a therapeutic process, integrating focus, pattern recognition, and creative expression.
• Discussion Statement 2: The act of quilting can instill a sense of accomplishment, providing a tangible representation of control and order.
• Discussion Question: How does quilting or other forms of craftwork aid in your or your system’s self-regulation?
• References:
1. Reynolds, F. (2004). Textile Arts in Therapy: Women’s Accounts of the Meaning of Stitching. The Arts in Psychotherapy, 31(5), 309-320.
• Investigates the therapeutic and self-regulatory aspects of textile arts like quilting.
2. Collie, K., & Bond, S. (2008). The Healing Aspects of Craft. The American Journal of Art Therapy, 46(3), 99-106.
• Discusses the healing and self-regulatory potentials of craftwork, including quilting.
3.3.10 Learning a New Skill: The Piano
• Discussion Statement 1: Learning a new instrument like the piano can enhance self-regulation through discipline and the structure of practice.
• Discussion Statement 2: The emotional expression through music can serve as a unique form of emotional self-regulation.
• Discussion Question: Have you or your system experienced learning something new as self-regulation?
• References:
1. Hallam, S. (2010). The Power of Music: Its Impact on the Intellectual, Social, and Personal Development of Children and Young People. International Journal of Music Education, 28(3), 269-289.
• Addresses the psychological and cognitive benefits of learning a musical instrument.
2. Hanna-Pladdy, S., & Mackay, A. (2011). The Relation Between Instrumental Musical Activity and Cognitive Aging. Neuropsychology, 25(3), 378–386.

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• Investigates the cognitive benefits and self-regulatory aspects of learning a musical instrument later in life.
3.3.11 Conclusion: The Synergy of Self-Regulation Techniques
• Discussion Statement 1: Employing a combination of self-regulation techniques can offer a more holistic approach.
• Discussion Statement 2: Individual variability in self-regulation needs and capacities cause a tailored approach.
• Discussion Question: Which combinations of self-regulation techniques have you or your system found most effective?
• References:
1. Karoly, P. (2012). Mechanisms of self-regulation: A systems view. Annual Review of Psychology, 44(1), 23-52.
• Reviews the multifaceted nature of self-regulation and the utility of using diverse approaches.
2. Thayer, J. F., & Lane, R. D. (2009). Claude Bernard and the heart–brain connection: Further elaboration of a model of neurovisceral integration. Neuroscience & Biobehavioral Reviews, 33(2), 81-88.
• Explores how physiological and psychological methods of self-regulation can work in concert.
3.4 The Influence of Trauma on Emotional Regulation
3.4.1 Defining Self-Regulation in Multiplicity
• Discussion Statement 1: The concept of self-regulation is nuanced and complex, especially within the context of multiplicity.
• Discussion Statement 2: Multiplicity complicates the application of self-regulation techniques, as different alters may have varying capacities for self-regulation.
• Discussion Question: What challenges and opportunities do you see in applying self-regulation strategies to a multiple system?
• References:
1. Vohs, K. D., & Baumeister, R. F. (2016). Handbook of self-regulation: Research, theory, and applications. Guilford Publications.
• Provides a comprehensive overview of self-regulation, setting the stage for its application in multiplicity.

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2. Carlson, E. A., Sroufe, L. A., & Egeland, B. (2009). A prospective investigation of the development of borderline personality disorder. Development and Psychopathology, 21(4), 1311-1334.
• Investigates the long-term impact of childhood experiences on self-regulation and the development of borderline personality disorder, providing insights applicable to multiples.
3. Cicchetti, D., & Curtis, W. J. (2007). Multilevel perspectives on pathways to resilient functioning. Development and Psychopathology, 19(3), 627-629.
• Addresses the role of resilience and self-regulation in functioning, particularly relevant to multiples.
3.4.2 Emotional Self-Regulation in Multiplicity
• Discussion Statement 1: Emotional self-regulation can be challenging for multiples, given the distinct emotional landscapes among alters.
• Discussion Statement 2: Emotional self-regulation in multiplicity can serve as a coping mechanism against triggers and heightened emotional states.
• Discussion Question: How do the different alters within your system navigate emotional self-regulation? Have any specific strategies been more effective than others?
• References:
1. Gross, J. J. (2015). Emotion regulation: Conceptual and practical issues. Springer.
• Discusses the theoretical foundations of emotional self-regulation and offers insights that can be adapted to the multiplicity context.
2. Tull, M. T., Gratz, K. L., & Chapman, A. L. (2017). Applied emotion regulation: Implications for psychotherapy. Behavior Research and Therapy, 58, 21-33.
• Highlights practical applications of emotional self-regulation, offering empirical support that could guide multiples in their self-regulation efforts.
3. Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30(2), 217-237.
• Reviews the efficacy of different emotional self-regulation strategies across various forms of psychopathology, including its implications for multiplicity.
3.4.3 Cognitive Aspects of Emotional Self-Regulation
• Discussion Statement 1: The cognitive processes underlying emotional self-regulation are complex and may differ among alters, affecting the efficacy of certain strategies.
• Discussion Statement 2: Cognitive reframing, a key component of cognitive-behavioral therapy (CBT), may offer a structured way for multiples to manage emotional turmoil.
• Discussion Question: What cognitive techniques have you or your system found effective for emotional self-regulation, and how do they differ among alters?
• References:

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1. Ochsner, K. N., & Gross, J. J. (2005). The cognitive control of emotion. Trends in Cognitive Sciences, 9(5), 242-249.
• Discusses the role of cognitive control in emotion regulation, offering a framework that can apply to the multiplicity context.
2. Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of Consulting and Clinical Psychology, 78(2), 169-183.
• Examines mindfulness as a cognitive strategy for emotion regulation, emphasizing its relevance for multiples who deal with anxiety and depression.
3. David, D., Cristea, I., & Hofmann, S. G. (2018). Why cognitive behavioral therapy is the current gold standard of psychotherapy. Frontiers in Psychiatry, 9, 4.
• Discusses the effectiveness of CBT, including cognitive reframing techniques, in the treatment of emotional dysregulation, highlighting its adaptability for multiplicity.
3.4.4 Emotional Intelligence and Emotional Self-Regulation
• Discussion Statement 1:
• An alter’s level of EI can make emotional self-regulation more or less challenging, as EI is a skillset that may vary across alters.
• Discussion Statement 2:
• Cultivating Emotional Intelligence through techniques like self-awareness and empathy can empower multiples to navigate their emotional landscape more effectively.
• Discussion Question:
• How do variations in Emotional Intelligence among alters affect the overall system’s ability to regulate emotions? What strategies have you or your system employed to enhance EI?
• References:
1. Mayer, J. D., & Salovey, P. (1997). What is emotional intelligence? In P. Salovey & D. J. Sluyter (Eds.), Emotional development and emotional intelligence: Educational implications (pp. 3-31).
• Originators of the term Emotional Intelligence discuss its components and relevance, providing a basis for its application in the realm of multiplicity.
2. Goleman, D. (1998). Working with Emotional Intelligence. New York: Bantam Books.
• Explores the practical application of EI in various settings, offering insights that can be adapted for emotional self-regulation in multiples.
3. Petrides, K. V., & Furnham, A. (2003). Trait emotional intelligence: Behavioural validation in two studies of emotion recognition and reactivity to mood induction. European Journal of Personality, 17(1), 39-57.
• Investigates the trait aspects of emotional intelligence, illuminating how these characteristics can influence emotional self-regulation.
4. Rivers, S. E., Brackett, M. A., Salovey, P., & Mayer, J. D. (2007). Measuring emotional intelligence as a set of mental abilities. The Handbook of Emotional Intelligence, 230-257.
• Offers tools for measuring Emotional Intelligence, which multiples could use to assess and improve their system’s EI levels.

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3.4.5 Mindfulness and Emotional Regulation
• Discussion Statement 1: Mindfulness techniques can serve as effective tools for emotional regulation, enabling multiples to observe their emotions without judgment and therefore manage them more effectively.
• Discussion Statement 2: The practice of mindfulness can be complex in a multiple system, as each alter might have a different level of familiarity and comfort with mindfulness techniques.
• Discussion Question: How have mindfulness practices affected your system’s emotional regulation? Are there any unique challenges or benefits that you’ve noticed?
• References:
1. Kabat-Zinn, J. (1994). Wherever you go, there you are: Mindfulness meditation in everyday life. Hyperion.
• Introduces mindfulness as a way of paying attention to the present, which can be especially useful for emotional regulation in multiples.
2. Baer, R. A. (2003). Mindfulness training as a clinical intervention: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10(2), 125-143.
• Reviews empirical evidence supporting mindfulness as a clinical intervention for emotional regulation.
3. Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., … & Devins, G. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11(3), 230-241.
• Provides an operational definition of mindfulness and discusses its implications for emotional regulation.
4. Linehan, M. M., & Dimeff, L. A. (2001). Dialectical behavior therapy in a nutshell. The California Psychologist, 34(3), 10-13.
• Discusses how Dialectical Behavior Therapy, which incorporates mindfulness, can be effective for emotional regulation.
3.4.6 Exercise and Emotional Regulation
• Discussion Statement 1: Physical exercise can be a double-edged sword in emotional regulation, particularly for multiples; while it can elevate mood and reduce stress, it might also trigger certain emotional responses within the system.
• Discussion Statement 2: The choice of exercise type can make a significant difference in emotional regulation. Activities that involve rhythmic and repetitive movements, such as swimming or jogging, may be more beneficial than chaotic, high-intensity workouts.
• Discussion Question: How does your system respond to different exercise in emotional regulation? Have you noticed any specific patterns or triggers?
• References:

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1. Blumenthal, J. A., Babyak, M. A., Moore, K. A., Craighead, W. E., Herman, S., Khatri, P., … & Krishnan, K. R. (1999). Effects of exercise training on older patients with major depression. Archives of Internal Medicine, 159(19), 2349-2356.
• Discusses the positive effects of exercise on major depressive disorder, which may be relevant for multiples dealing with emotional dysregulation.
2. Penedo, F. J., & Dahn, J. R. (2005). Exercise and well-being: A review of mental and physical health benefits associated with physical activity. Current Opinion in Psychiatry, 18(2), 189-193.
• Reviews the mental and physical benefits of exercise for emotional well-being.
3. Ekkekakis, P., & Petruzzello, S. J. (1999). Acute aerobic exercise and affect: status, problems and prospects regarding dose-response. Sports Medicine, 28(5), 337-374.
• Explores the dose-response relationship between aerobic exercise and emotional regulation.
4. Bandura, A. (1986). Social foundations of thought and action. Englewood Cliffs, NJ, 1986.
• The article discusses how physical exercise can help achieve self-efficacy and control, which are important for emotional regulation in a multiple system.
3.4.7 Conclusion: A Comprehensive Approach to Emotional Regulation
• Discussion Statement 1: Emotional regulation in multiples is a complex interplay of various factors and techniques; thus, a multifaceted approach is often the most effective.
• Discussion Statement 2: It’s crucial to understand that no one-size-fits-all solution exists for emotional regulation within a multiple system. Individualized treatment plans are key.
• Discussion Question: In your system’s journey toward better emotional regulation, what combination of techniques has proved most effective?
• References:
1. Gross, J. J. (1998). Antecedent- and response-focused emotion regulation: divergent consequences for experience, expression, and physiology. Journal of Personality and Social Psychology, 74(1), 224-237.
• Discusses different methods of emotional regulation and their diverse outcomes.
2. Thompson, R. A. (1994). Emotion regulation: A theme in search of definition. Monographs of the Society for Research in Child Development, 59(2-3), 25-52.
• Defines emotion regulation and emphasizes the need for individualized strategies.
3. Koole, S. L. (2009). The psychology of emotion regulation: An integrative review. Cognition and Emotion, 23(1), 4-41.
• Provides an integrative review of emotion regulation psychology.

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4. John, O. P., & Gross, J. J. (2004). Healthy and unhealthy emotion regulation: Personality processes, individual differences, and life span development. Journal of Personality, 72(6), 1301-1333.
• Discusses both healthy and unhealthy ways of emotional regulation, emphasizing the importance of a tailored approach.
3.5.1 Emotional Communication within the System
• Discussion Statement 1: The intra-system communication of emotions is a vital yet often overlooked aspect of being a multiple. System members can either keep their emotional states separate or share them with each other.
• Discussion Statement 2: Effective communication within the system about emotions can serve as a foundation for more coherent outward interactions and emotional regulation.
• Discussion Question: How does your system manage the sharing or compartmentalization of emotions? What are the implications for your overall emotional well-being?
• References:
1. Putnam, F. W. (1997). Dissociation in children and adolescents: A developmental perspective. Guilford Press.
• Provides insights into emotional compartmentalization in multiples, particularly from a developmental standpoint.
2. Dorahy, M. J., & Huntjens, R. J. (2007). Memory and attentional processes in dissociative identity disorder: A review of the empirical literature. Trauma, Violence, & Abuse, 8(1), 35-61.
• The authors investigate attentional processes and emotional states that are linked within a multiple system.
3. Lynn, S. J., Lilienfeld, S. O., Merckelbach, H., Giesbrecht, T., & van der Kloet, D. (2012). Dissociation and dissociative disorders: Challenging conventional wisdom. Current Directions in Psychological Science, 21(1), 48-53.
• Explores the nuances of intra-system emotional communication among multiples.
4. Holmes, J. (2003). Borderline personality disorder and the search for meaning: An attachment perspective. Australian and New Zealand Journal of Psychiatry, 37(5), 524-531.
• Discusses the implications of emotional communication within a system on outward interactions.
3.5.2 The Role of Emotional Gatekeepers
• Discussion Statement 1: In many multiple systems, there are members who act as “emotional gatekeepers,” regulating which emotions may surface or be communicated within the system.

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• Discussion Statement 2: The role of an emotional gatekeeper can be both protective and limiting, as it can prevent overwhelming experiences but also hinder emotional sharing and processing.
• Discussion Question: Do you recognize emotional gatekeepers in your system? If so, what roles do they serve? Are they helpful or hindering?
• References:
1. Brand, B. L., Classen, C. C., McNary, S. W., & Zaveri, P. (2009). A review of dissociative disorders treatment studies. Journal of Nervous and Mental Disease, 197(9), 646-654.
• Discusses the dynamics of emotional regulation within a multiple system, including the role of emotional gatekeepers.
2. Lanius, R. A., Vermetten, E., Loewenstein, R. J., Brand, B., Schmahl, C., Bremner, J. D., & Spiegel, D. (2010). Emotion modulation in PTSD: Clinical and neurobiological evidence for a dissociative subtype. The American Journal of Psychiatry, 167(6), 640-647.
• Examines the neurobiological underpinnings of emotional gatekeeping in dissociative disorders.
3. Chefetz, R. A. (2015). Intensive psychotherapy for persistent dissociative processes: The fear of feeling real. W. W. Norton & Company.
• Explores the therapeutic implications of understanding and working with emotional gatekeepers within a multiple system.
4. Beere, D. B. (2009). The Emotionally Intelligent Team: Understanding and Developing the Behaviors of Success. Jossey-Bass.
• The resource covers the general concept of emotional gatekeeping in group dynamics and also relates to multiple systems, even though it doesn’t specifically address them.
3.5.3 Co-consciousness and Emotional Fluidity
• Discussion Statement 1: Co-consciousness is a state in which multiple members of the system are aware of each other’s thoughts and feelings, which can lead to more nuanced emotional experiences.
• Discussion Statement 2: Emotional fluidity in co-consciousness can be beneficial, as it allows for richer internal dialogues and potentially more adaptive responses to external stimuli.
• Discussion Question: How does co-consciousness within your system affect emotional regulation? Is emotional fluidity seen as an asset or a complication?
• References:
1. Putnam, F. W. (1997). Dissociation in children and adolescents: A developmental perspective. Guilford Press.
• Reviews the concept of co-consciousness and its role in emotional development in children and adolescents with dissociative disorders.
2. Sar, V. (2011). Developmental trauma, complex PTSD, and the current proposal of DSM-5. European Journal of Psychotraumatology, 2(1), 5622.
• Discusses how co-consciousness may interact with complex PTSD symptoms, including emotional regulation.

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3. Tsai, M., Elhai, J. D., Pietrzak, R. H., Hoff, R. A., & Harpaz-Rotem, I. (2017). Comparing four competing models of depressive symptomatology: A confirmatory factor analytic study of 986,647 U.S. Veterans. Journal of Affective Disorders, 207, 72-77.
• While not specific to multiples, this study discusses how emotional regulation strategies can vary based on one’s cognitive awareness, relevant to co-consciousness.
4. Herman, J. (1997). Trauma and recovery: The aftermath of violence—from domestic abuse to political terror. Basic Books.
• Addresses the complex relationship between trauma, dissociation, and co-consciousness in shaping emotional regulation.
3.5.4 The Emotional Urgency of “Littles” in the System
• Discussion Statement 1: “Littles,” or child-like parts within a multiple system, can exert a strong emotional influence, often pushing their own agendas—because they’re triggered or feel neglected.
• Discussion Statement 2: Ignoring “littles” can lead to emotional disarray within the system, as their needs and wants are as valid as those of any other part.
• Discussion Question: How do you manage the emotional needs of “littles” within your system without allowing them to hijack the emotional tone?
• References:
1. Kluft, R. P. (1993). Clinical presentations of multiple personality disorder. The Psychiatric clinics of North America, 16(3), 605-629.
• Discusses the roles and emotional needs of “littles” within a multiple system.
2. Fine, C. G. (1999). The tactical-integration model for the treatment of Dissociative Identity Disorder and allied dissociative disorders. American Journal of Psychotherapy, 53(1), 3-21.
• Explores methods for integrating the emotional needs of “littles” into the larger system for better emotional regulation.
3. Courtois, C. A. (1999). Recollections of sexual abuse: Treatment principles and guidelines. Norton & Company.
• Highlights the impact of child abuse on the formation of “littles” and their emotional needs.
4. Silberg, J. L. (2013). The child survivor: Healing developmental trauma and dissociation. Routledge.
• Offers insight into the emotional dynamics of “littles” and ways to honor their emotions while maintaining system-wide balance.
5. Gleaves, D. H., May, M. C., & Cardeña, E. (2001). An examination of the diagnostic validity of dissociative identity disorder. Clinical Psychology Review, 21(4), 577-608.
• While the focus is on the diagnostic validity of DID, it also touches on the dynamics among different alters, including “littles,” and their emotional needs.
3.5.5 The Emotional Toll of “Persecutor” Alters

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• Discussion Statement 1: “Persecutor” alters can pose a unique emotional challenge within a multiple system because of their often adversarial or self-destructive nature.
• Discussion Statement 2: Understanding the underlying pain or fear driving a “persecutor” alter can be essential for emotional regulation within the system.
• Discussion Question: What are some strategies your system has used to understand and manage the emotional impact of “persecutor” alters?
• References:
1. Dell, P. F., & O’Neil, J. A. (Eds.). (2009). Dissociation and the dissociative disorders: DSM-V and beyond. Routledge.
• Provides a comprehensive overview of the roles of various alters, including “persecutors,” within a dissociative system.
2. Ross, C. A., & Halpern, N. (2009). Trauma model therapy: A treatment approach for trauma, dissociation, and complex comorbidity. Manitou Communications.
• Addresses how to manage difficult-to-integrate alters like “persecutors” in a therapeutic context.
3. Brand, B. L., Classen, C. C., Lanius, R., Loewenstein, R. J., McNary, S. W., Pain, C., & Putnam, F. W. (2009). A naturalistic study of dissociative identity disorder and dissociative disorder not otherwise specified patients treated by community clinicians. Psychological Trauma: Theory, Research, Practice, and Policy, 1(2), 153.
• Highlights the emotional challenges posed by “persecutor” alters and suggests various treatment approaches.
4. Howell, E. F. (2005). The dissociative mind. Routledge.
• Discusses the cognitive and emotional complexities associated with “persecutor” alters and how they contribute to emotional dysregulation.
3.5.6 Emotional Regulation in the Workplace
• Discussion Statement 1: Navigating emotional landscapes in professional settings presents a unique challenge for multiples, requiring a fine balance between self-awareness and external expectations.
• Discussion Statement 2: Open communication with employers or colleagues about emotional boundaries can facilitate a better work environment but also comes with risks concerning stigma.
• Discussion Question: What strategies have you or your system found effective in managing emotional regulation in the workplace?
• References:
1. Grandey, A. (2000). Emotional regulation in the workplace: A new way to conceptualize emotional labor. Journal of Occupational Health Psychology, 5(1), 95-110.
• Discusses the demands of emotional regulation in workplace settings, particularly useful for multiples who navigate complex internal emotional landscapes.
2. Ashforth, B. E., & Humphrey, R. H. (1993). Emotional labor in service roles: The influence of identity. Academy of Management Review, 18(1), 88-115.

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• Explores the intersection of personal identity and emotional labor, highlighting the unique challenges faced by multiples.
3. Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2(3), 271-299.
• The overview covers emotion regulation strategies that one can use in different settings, including the workplace.
3.5.7 Emotional Regulation in Education
• Discussion Statement 1: For multiples, the academic environment can pose distinct challenges in emotional regulation because of a myriad of triggers, such as deadlines, peer interactions, and performance evaluations.
• Discussion Statement 2: Educators and staff should know diverse emotional needs, including those of multiples, to foster a more inclusive and supportive educational setting.
• Discussion Question: How has your system navigated the educational setting in terms of emotional regulation? Have you found any support or resource helpful?
• References:
1. Brackett, M. A., Reyes, M. R., Rivers, S. E., Elbertson, N. A., & Salovey, P. (2012). Assessing teachers’ beliefs about social and emotional learning. Journal of Psychoeducational Assessment, 30(3), 219-236.
• Addresses the role of educators in understanding and supporting emotional learning, which extends to the needs of multiples.
2. Durlak, J. A., Weissberg, R. P., Dymnicki, A. B., Taylor, R. D., & Schellinger, K. B. (2011). The impact of enhancing students’ social and emotional learning: A meta-analysis of school-based universal interventions. Child Development, 82(1), 405-432.
• Explores the benefits of social and emotional learning programs in educational settings, important for multiples requiring tailored emotional regulation strategies.
3. Pekrun, R., Goetz, T., Titz, W., & Perry, R. P. (2002). Academic emotions in students’ self-regulated learning and achievement: A program of qualitative and quantitative research. Educational Psychologist, 37(2), 91-105.
• Discusses how emotions affect learning and academic performance, particularly relevant for multiples who experience a wider range of internal emotional states.
3.6 Integrating Emotional Regulation Across Life Domains
3.6.1 Emotional Regulation in Relationships

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• Discussion Statement 1: Navigating relationships often requires multiples to coordinate among themselves for emotionally balanced interactions.
• Discussion Statement 2: Trust and open communication are pivotal in relationships and may require special attention for multiples.
• Discussion Question: What strategies have helped your system maintain emotional equilibrium in interpersonal relationships?
• References:
1. Mikulincer, M., & Shaver, P. R. (2007). Attachment in adulthood: Structure, dynamics, and change. Guilford Press.
• Discusses the role of attachment in emotional regulation, especially pertinent to multiples.
3.6.2 Emotional Regulation in the Workplace
• Discussion Statement 1: The workplace can be a high-stress environment that tests the limits of emotional regulation for anyone, including multiples.
• Discussion Statement 2: Workplace accommodations can make a significant difference in how multiples manage their emotional states.
• Discussion Question: How has your system navigated emotional challenges in the workplace?
• References:
1. Ashforth, B. E., & Humphrey, R. H. (1993). Emotional labor in service roles: The influence of identity. Academy of Management Review, 18(1), 88-115.
• Explores the concept of emotional labor, especially relevant for multiples.
3.6.3 Emotional Regulation in Parenting
• Discussion Statement 1: Being a parent brings in another layer of complexity to emotional regulation for multiples.
• Discussion Statement 2: Multiples who are parents may need additional strategies to ensure emotional well-being for themselves and their families.
• Discussion Question: How has parenthood affected emotional regulation within your system?
• References:
1. Dix, T. (1991). The affective organization of parenting: Adaptive and maladaptive processes. Psychological Bulletin, 110(1), 3-25.
• Discusses adaptive and maladaptive parenting styles in relation to emotional regulation.
3.6.4 Emotional Regulation in Therapy
• Discussion Statement 1: Therapeutic settings offer a unique space for working on emotional regulation, tailored to the needs of multiples.
• Discussion Statement 2: The therapeutic relationship itself can act as a catalyst for improved emotional regulation.

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• Discussion Question: What therapeutic approaches have been beneficial for your system in terms of emotional regulation?
• References:
1. Linehan, M. M. (2014). DBT® skills training manual. Guilford Publications.
• Reviews the applicability of Dialectical Behavior Therapy for emotional regulation, a technique often used with multiples.
2. Foa, E. B., Huppert, J. D., & Cahill, S. P. (2006). Emotional processing theory: An update. In Pathological anxiety: Emotional processing in etiology and treatment (pp. 3-24). Guilford Press.
• Discusses the theory of emotional processing, which has implications for therapeutic settings.
3.6.5 Emotional Regulation in Social Settings
• Discussion Statement 1: Social environments can both challenge and support the emotional regulation efforts of multiples.
• Discussion Statement 2: The role of social support networks in emotional regulation cannot be overstated.
• Discussion Question: How has your social environment either helped or hindered emotional regulation?
• References:
1. Lakey, B., & Orehek, E. (2011). Relational regulation theory: A new approach to explain the link between perceived social support and mental health. Psychological Review, 118(3), 482-495.
• Reviews the concept of social support as a critical factor in emotional regulation.
3.6.6 Emotional Regulation During Crisis
• Discussion Statement 1: Crises situations test the robustness of any emotional regulation strategies in place.
• Discussion Statement 2: Multiples might experience unique challenges and advantages in crisis situations.
• Discussion Question: What emergency protocols does your system have in place for emotional regulation during a crisis?
• References:
1. Hobfoll, S. E. (1989). Conservation of resources: A new attempt at conceptualizing stress. American Psychologist, 44(3), 513-524.
• Discusses stress and resource management, crucial during crisis situations.
2. Bonanno, G. A. (2004). Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? American Psychologist, 59(1), 20-28.
• Examines human resilience in the face of loss and trauma, particularly relevant for multiples during crises.
3.6.7 Emotional Regulation in Relationships

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• Discussion Statement 1: Close relationships provide both a laboratory and a sanctuary for practicing emotional regulation.
• Discussion Statement 2: Navigating the dynamics of intimate relationships can lead to novel emotional challenges and rewards for multiples.
• Discussion Question: How do relationships serve as a training ground for emotional regulation in your system?
• References:
1. Mikulincer, M., Shaver, P. R., & Pereg, D. (2003). Attachment theory and affect regulation: The dynamics, development, and cognitive consequences of attachment-related strategies. Motivation and Emotion, 27(2), 77-102.
• Explores attachment theory as a framework for understanding emotional regulation in relationships.
2. Gottman, J. M., & Levenson, R. W. (1984). Why marriages succeed or fail: And how you can make yours last. Simon and Schuster.
• Provides insights into the role of emotional regulation in marital success and failure.
3.6.8 Emotional Regulation and Cultural Context
• Discussion Statement 1: Cultural norms and practices shape the perception and practice of emotional regulation, especially in multiples.
• Discussion Statement 2: Understanding cultural expectations of emotion can offer additional tools for effective emotional regulation.
• Discussion Question: How do cultural norms and practices affect the emotional regulation strategies in your system?
• References:
1. Mesquita, B., & Frijda, N. H. (1992). Cultural variations in emotions: A review. Psychological Bulletin, 112(2), 179-204.
• Discusses how culture shapes emotional experiences and expressions, providing a different set of challenges and resources for emotional regulation.
2. Matsumoto, D., Yoo, S. H., & Nakagawa, S. (2008). Culture, emotion regulation, and change. Journal of Personality and Social Psychology, 94(6), 925-937.
• Investigates how cultural factors can influence emotion regulation and affect psychological change.
3.6.9 Conclusion: The Complexity and Necessity of Emotional Regulation
• Discussion Statement 1: Effective emotional regulation is a multi-faceted endeavor that requires conscious effort, awareness, and adaptability.
• Discussion Statement 2: The skill to manage emotions is crucial not just for psychological well-being but also for thriving in various life domains.
• Discussion Question: What would be your important points about emotional regulation?
• References:

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1. Gross, J. J. (1998). Antecedent- and response-focused emotion regulation: Divergent consequences for experience, expression, and physiology. Journal of Personality and Social Psychology, 74(1), 224-237.
• Discusses two different focus areas in emotional regulation—antecedent and response-focused—and their implications.
2. Davidson, R. J., & Irwin, W. (1999). The functional neuroanatomy of emotion and affective style. Trends in Cognitive Sciences, 3(1), 11-21.
• Highlights the neuroscientific underpinnings of emotional regulation.
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1. Emotional Intelligence in Multiples
2. Cognitive Dissonance and Its Resolutions
3. Complex PTSD and Emotional Regulation
4. Emotional Transference among Alters
5. Executive Function and its Variances in Multiples
6. Emotional Regulation in Multiplicity
7. Differentiation of Self and Others in Emotional Regulation
8. The Role of Communication Among Alters in Emotional Regulation
9. Complexities of Emotional Regulation: Intensity, Rapid Cycling, and Conflicting Emotions
10. Self-regulation and Its Facets (which we’ve just covered)
11. The Influence of Trauma on Emotional Regulation: How past traumas can complicate the process of emotional regulation, especially for Multiples who may experience emotions through the lens of trauma.
12. Tools and Strategies for Emotional Regulation: Offering practical advice and coping strategies that are useful for Multiples.
13. Psychotherapeutic Approaches to Emotional Regulation: Discuss the role of psychotherapy, including DBT, CBT, and other therapy modalities in helping Multiples regulate emotions.
14. The Community Aspect: How external validation and social networks can play a crucial role in emotional regulation.