SUSAN J. BRADLEY Affect Regulation and the Development of Psychopathology New York: The Guilford Press, 2000, xii + 324 pages (ISBN 1-57230-548-7, us$40, Hardcover) Reviewed by LINDA M. MCMULLEN In her acknowledgements, Susan Bradley describes the spirit in which she presents her ideas as the offering of a gift. As with most acts of gift-giving, her gift reflects both the needs of the giver and the perceived wants of the receiver, and her act of giving embodies a mixture of careful consideration, commitment, enthusiasm, and caution. The extent to which this gift will be used, however, remains an uncertainty. Bradley offers an integrated theory of psychopathology built around the core notion of affect regulation. In her model, psychopathology develops as a consequence of a dynamic interplay between a vulnerable stress-reactive individual and a care-taking environment that is insufficiently attentive to the needs of this individual. This vulnerability to stress can result from a variety of genetic or constitutional factors (e.g., temperamental predispositions), biological factors (e.g., levels of neurotransmitters in the brain, deficits in the development or functions of specific regions of or connections in the brain), life events (e.g., trauma, maltreatment or abuse), patterns of learning and coping (e.g., inadequate language skills, few opportunities to learn from peers, ineffective coping strategies), and care-taking environments (e.g., unresponsive, highly emotionally expressive, conflict-ridden). Repeated interactions between a stress-reactive individual and an inappropriately sensitive environment are thought to lead to high levels of arousal in the individual which, in turn, result in ineffective coping strategies, less than optimal interactions with significant others, and potential changes in neurobiology. Although Bradley views the developmental failure to learn adaptive affect regulation as central to all forms of psychopathology, she cites certain factors as more likely involved in the development of specific classes of psychopathology. In the case of the internalizing disorders (e.g., anxiety and mood disorders), factors such as neuroticism, inhibition, and maternal depression, for example, are thought to be importantly involved, while in the externalizing disorders (e.g., the disruptive disorders), a propensity to aggressive responding to frustration, a hostile and critical care-taking environment, parental criminal history, and peer rejection (among other factors) are thought to be more salient. Evidence for distinguishing factors in the development of the psychotic disorders (e.g., schizophrenia) is less compelling, but early adversities and acute stress reactivity, particularly to negative emotions, are speculated to play a role in addition to other genetic/constitutional, psychosocial, and neurobiological factors that are common to other classes of psychopathology. Bradley's deep attachment to the notion of affect regulation as the core of all psychopathologies is clear throughout the book. She cites hundreds of studies from literatures on attachment, temperamental traits, physiological and psychological effects of stress, dysfunctional parenting, cognitive schemas, obstetrical complications, adverse life experiences, neurotransmitters, and psychotherapy (among other topics), all of which are presented as supporting her thesis. Although her description of these studies is a bit dry and decidedly uncritical, she nevertheless presents a convincing case. Deep attachment to her thesis is also refreshingly tempered from time to time, both with a recognition of the numerous possible combinations of the factors she is considering and the multiple possible effects of them on an individual, and with an admission that her model is still developing, that it will undoubtedly be revised and extended when new information becomes available on how the factors she cites contribute to the development of certain disorders, and that it will benefit from the reactions of her readers. …
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