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Parpart H, Blass J, Meindl T, Blautzik J, Michl P, Beblo T, Engel R, Reiser M, Falkai P, Moeller HJ, Driessen M, Hennig-Fast K. Two Sides of the Same Coin in Female Borderline Personality Disorder: Self-Reported Guilt and Shame and Their Neurofunctional Correlates. Brain Sci 2024; 14:549. [PMID: 38928549 PMCID: PMC11201834 DOI: 10.3390/brainsci14060549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 05/17/2024] [Accepted: 05/24/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE Patients with borderline personality disorder (BPD) report to be especially prone to social emotions like shame and guilt. At the same time, these emotions seem to play an important role in BPD pathology. The present study aimed to deepen the knowledge about the processes behind shame and guilt in patients with BPD. METHODS Twenty patients with BPD and twenty healthy controls (HCs) took part in an experiment that induced shame and guilt by imagining scenarios during scanning using functional brain imaging. Participants also filled out self-report questionnaires and took part in diagnostic interviews. RESULTS BPD patients reported more proneness to guilt but not to shame than the HCs. There was no difference in the self-reported intensity rating of experimentally induced emotions between the groups. Between-group contrast of neural signals in the shame condition revealed a stronger activation of cingulate and fusiform gyrus for the BPD patients compared to the controls, and a more pronounced activation in the lingual gyrus and cuneus for the HCs. In the guilt condition, activation in the caudate nucleus, the fusiform gyrus, and the posterior cingulate cortex was stronger in BPD patients, while HC showed stronger activations in cuneus, lingual gyrus, and fronto-temporal regions. CONCLUSIONS Differences in the neuro-functional processes between BPD patients and HC were found, even though the two groups did not differ in their self-report of subjective proneness to guilt and emotional intensity of shame and guilt during the experiment. While the HCs may be engaged more by the emotional scenarios themselves, the BPD patients may be more occupied with cognitive regulatory and self-referential processing.
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Affiliation(s)
- Hella Parpart
- Department of Psychiatry and Psychotherapy, LMU Hospital, 80336 Munich, Germany
| | - Jakob Blass
- Department of Psychiatry and Psychotherapy, Universitätsklinikum OWL, 33617 Bielefeld, Germany
| | - Thomas Meindl
- Institute of Clinical Radiology, LMU Hospital, 80336 Munich, Germany
| | - Janusch Blautzik
- Institute of Clinical Radiology, LMU Hospital, 80336 Munich, Germany
| | - Petra Michl
- Department of Psychiatry and Psychotherapy, LMU Hospital, 80336 Munich, Germany
| | - Thomas Beblo
- Department of Psychiatry and Psychotherapy, Universitätsklinikum OWL, 33617 Bielefeld, Germany
| | - Rolf Engel
- Department of Psychiatry and Psychotherapy, LMU Hospital, 80336 Munich, Germany
| | - Maximilian Reiser
- Institute of Clinical Radiology, LMU Hospital, 80336 Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, LMU Hospital, 80336 Munich, Germany
| | | | - Martin Driessen
- Department of Psychiatry and Psychotherapy, Universitätsklinikum OWL, 33617 Bielefeld, Germany
| | - Kristina Hennig-Fast
- Department of Psychiatry and Psychotherapy, LMU Hospital, 80336 Munich, Germany
- Department of Psychiatry and Psychotherapy, Universitätsklinikum OWL, 33617 Bielefeld, Germany
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FARAJİ H, MUHTAR DÖÜHN, TEZCAN AE. Determination of First Object Relations and Emotion Regulation Difficulties in Borderline Personality Disorder with Objective and Projective Methods. PSIKIYATRIDE GUNCEL YAKLASIMLAR - CURRENT APPROACHES IN PSYCHIATRY 2023. [DOI: 10.18863/pgy.1165387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Evaluation of the disorders in the personality organization of the individual is only possible by examining the object relations functions, and it is known that the elimination of emotion regulation difficulties (ERD) has a central role in the treatment of borderline personality disorder (BPD). Therefore, this study, in which objective and projective methods were used together, was designed to determine the ERD of BPD patients and the relationship between the patients' object relations and emotion regulation difficulties. It is thought that the results of the study can be useful in the psychotherapy processes of BPD patients. For this purpose, the Sociodemographic Data Form, Rorschach Test, and Emotion Regulation Difficulty Scale developed by the researchers were applied to 37 individuals diagnosed with Borderline Personality Disorder according to DSM-5 criteria and 37 individuals who did not have any psychiatric diagnosis as a result of their psychiatric examination by a psychiatrist. As a result of the study, it was determined that there was a significant relationship between BPD and ERD, and this relationship could be determined through the Rorschach test, and it was determined that BPD constituted 55% of the variance of ERD. ERD, which can have significant disruptive effects on the lives of borderline patients, was associated with the patients' lack of satisfaction and inclusion in their relations with their first object, which is usually their parents, and it was determined negative qualities of first objects accounted for 23% of the variance of difficulty in emotion regulation. It is thought that the results of the study may contribute to the acceleration of the solution of interpersonal problems, which have a close relationship with ERD, of the patients and the standardization of the Rorschach Test.
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Konstantinou P, Trigeorgi A, Georgiou C, Michaelides M, Gloster AT, Georgiou E, Panayiotou G, Karekla M. Functional versus dysfunctional coping with physical pain: An experimental comparison of acceptance vs. avoidance coping. Behav Res Ther 2023; 167:104339. [PMID: 37329864 DOI: 10.1016/j.brat.2023.104339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/15/2023] [Accepted: 05/20/2023] [Indexed: 06/19/2023]
Abstract
This study compared acceptance vs. avoidance coping with acute physical pain, in a pain-induction experiment and examined both between and within-group differences, multi-methodically and multi-dimensionally using behavioral, physiological and self-report measures. The sample consisted of 88 University students (76.1% females; Mage = 21.33 years). Participants were randomly assigned to four instructed groups and participated twice in the Cold Pressor Task: (a) Acceptance followed by avoidance; (b) Avoidance followed by acceptance; (c) No instructions (control) followed by acceptance, and (d) No instructions (control) followed by avoidance. All analyses were conducted using repeated-measures ANOVAs. Randomized techniques analyses showed that participants receiving no instructions followed by acceptance reported significantly greater changes in physiological and behavioral measures across time. Low adherence to acceptance instructions was found, especially during the first phase. Exploratory analyses on actual techniques used (as opposed to taught technique) showed that participants using avoidance followed by acceptance exhibited significantly greater changes in physiological and behavioral measures across time. No significant differences were found for the self-report of negative affect outcome. Overall, our findings provide support to ACT theory, as participants might have to use firstly ineffective coping to understand what works best to cope with pain. This is the first study examining acceptance vs. avoidance coping both between and within individuals in physical pain, multi-methodically and multi-dimensionally.
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Affiliation(s)
| | - Andria Trigeorgi
- Department of Computer Science, University of Cyprus, Nicosia, Cyprus
| | - Chryssis Georgiou
- Department of Computer Science, University of Cyprus, Nicosia, Cyprus
| | | | | | - Eleni Georgiou
- Department of Computer Science, University of Cyprus, Nicosia, Cyprus
| | | | - Maria Karekla
- Department of Psychology, University of Cyprus, Nicosia, Cyprus.
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Pizarro-Campagna E, Terrett G, Jovev M, Rendell PG, Henry JD, Chanen AM. Cognitive Reappraisal Impairs Negative Affect Regulation in the Context of Social Rejection for Youth With Early-Stage Borderline Personality Disorder. J Pers Disord 2023; 37:156-176. [PMID: 37002936 DOI: 10.1521/pedi.2023.37.2.156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
Application of emotion regulation strategies might be susceptible to the context of social rejection for individuals with borderline personality disorder (BPD). This study compared the ability of 27 outpatient youths (15-25 years old) with early-stage BPD and 37 healthy controls (HC) to apply expressive suppression and cognitive reappraisal in standard and socially rejecting laboratory contexts. BPD youths were largely as able as HCs to regulate negative affect across instruction and contexts. However, cognitive reappraisal in the context of social rejection heightened BPD negative facial expression relative to HCs. Thus, while BPD emotion regulation ability was largely normative, cognitive reappraisal might be ineffective in the context of social rejection for this group, with social rejection acting as an accelerant that heightens the expression of negative affect. Given the common experience of perceived and actual social rejection for this group, clinicians should carefully consider treatments that include cognitive reappraisal strategies because they might be contraindicated.
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Affiliation(s)
| | - Gill Terrett
- School of Psychology, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Martina Jovev
- Orygen, Parkville Victoria, Australia, and Centre for Youth Mental Health, The University of Melbourne, Parkville Victoria, Australia
| | - Peter G Rendell
- School of Psychology, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Julie D Henry
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Andrew M Chanen
- Orygen, Parkville Victoria, Australia, and Centre for Youth Mental Health, The University of Melbourne, Parkville Victoria, Australia
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Kroener J, Schaitz C, Karabatsiakis A, Maier A, Connemann B, Schmied E, Sosic-Vasic Z. Relationship Dysfunction in Couples When One Partner Is Diagnosed with Borderline Personality Disorder: Findings from a Pilot Study. Behav Sci (Basel) 2023; 13:bs13030253. [PMID: 36975278 PMCID: PMC10045094 DOI: 10.3390/bs13030253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/23/2023] [Accepted: 02/28/2023] [Indexed: 03/14/2023] Open
Abstract
Relationship dysfunction—marked by frequent conflicts—is one of the hallmark features of borderline personality disorder (BPD). However, the BPD couple as a dyad and partner-related features have rarely been taken into account. The aim of the present study was to investigate hormonal, personality, and relationship relevant factors, such as relationship satisfaction, attachment, and trauma in both partners within a dyad where one partner is diagnosed with BPD. The total sample consisted of 26 heterosexual couples. All studies were conducted at 2 p.m. Primary outcomes: Neo-Five-Factor-Inventory, Childhood Trauma Questionnaire, Experiences in Close Relationships Scale. Secondary outcomes: Problem List, Partnership Questionnaire, Questionnaire for Assessing Dyadic Coping. Upon questionnaire completion, one saliva sample was taken via passive drool to assess baseline cortisol and testosterone levels. Results showed that females with BPD have higher scores on childhood maltreatment, dysfunctional attachment styles, and neuroticism than mentally healthy females. Furthermore, they have more relationship-related problems and are less satisfied in their romantic relationship. Male partners of women with BPD showed lower testosterone levels, higher levels of childhood maltreatment, dysfunctional attachment styles, neuroticism, and openness compared with the healthy control partners. Furthermore, childhood trauma, neuroticism as well as dysfunctional attachment styles displayed a significant positive correlation with relationship-related problems. Traumatic childhood experiences, insecure attachment styles as well as neurotic personality characteristics contribute to increased relationship disruptions in couples. Relevant hormonal and psychosocial parameters in BPD partners should be taken into account when treating females with BPD.
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Affiliation(s)
- Julia Kroener
- Christophsbad Goeppingen, Research Division of Applied Psychotherapy and Psychiatry, Faurndauer Straße 6-28, 73035 Goeppingen, Germany
- Department of Psychiatry and Psychotherapy III, University Clinic of Ulm, 89075 Ulm, Germany
- Correspondence: ; Tel.: +49-7161-601-8672
| | - Caroline Schaitz
- MSB Medical School Berlin, Psychotherapeutic Outpatient Facility, Rüdesheimer Straße 50, 14197 Berlin, Germany
| | - Alexander Karabatsiakis
- Department of Psychology, Clinical Psychology II, University of Innsbruck, 6020 Innsbruck, Austria
| | - Anna Maier
- Department of Psychiatry and Psychotherapy III, University Clinic of Ulm, 89075 Ulm, Germany
| | - Bernhard Connemann
- Department of Psychiatry and Psychotherapy III, University Clinic of Ulm, 89075 Ulm, Germany
| | - Elisa Schmied
- Christophsbad Goeppingen, Research Division of Applied Psychotherapy and Psychiatry, Faurndauer Straße 6-28, 73035 Goeppingen, Germany
| | - Zrinka Sosic-Vasic
- Christophsbad Goeppingen, Research Division of Applied Psychotherapy and Psychiatry, Faurndauer Straße 6-28, 73035 Goeppingen, Germany
- Department of Psychiatry and Psychotherapy III, University Clinic of Ulm, 89075 Ulm, Germany
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Chen S, Wang H, Yue J, Guan N, Wang X. Intervention methods for improving reduced heart rate variability in patients with major depressive disorder: A systematic review and meta-analysis. Compr Psychiatry 2022; 119:152347. [PMID: 36183449 DOI: 10.1016/j.comppsych.2022.152347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 07/27/2022] [Accepted: 09/22/2022] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Several studies have demonstrated that patients with major depressive disorder (MDD) commonly show reductions in heart rate variability (HRV) parameters. Thus, interventions for the improvement of low HRV may be advantageous in treating MDD. This systematic review and meta-analysis aimed to explore the improvement effects of current clinical treatments on low HRV in patients with MDD. METHODS Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the PubMed, EMBASE, PsycINFO, and CNKI databases were searched for relevant literature. Interventional studies of patients with confirmed MDD, which included baseline and post-intervention data and at least one HRV parameter as an outcome indicator, were included for meta-analysis. RESULTS Twenty-one studies were included in the review. Several studies affirmed the role of psychotherapy in improving low HRV in patients with MDD showing a significant increase in high-frequency and low-frequency power after psychotherapy in the meta-analysis. However, both pharmacotherapy studies and physiotherapy studies included in the meta-analysis showed significant heterogeneity. LIMITATIONS The main limitation of this study was the relatively small samples for the meta-analysis, and more high-quality randomized controlled trials in this field are wanted. CONCLUSIONS Psychotherapy was effective for improving low HRV in patients with MDD. However, the effect of pharmacotherapy or physical therapy on low HRV in MDD remains unclear. Regarding research methods, it is necessary to formulate and standardize operational guidelines for future HRV measurements.
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Affiliation(s)
- Shurui Chen
- Department of Psychiatry, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou 510630, China
| | - Hong Wang
- Department of Psychiatry, Fifth Affiliated Hospital of Sun Yat-sen University, No. 52 East Meihua Road, Zhuhai 519000, China
| | - Jihui Yue
- Department of Psychiatry, Fifth Affiliated Hospital of Sun Yat-sen University, No. 52 East Meihua Road, Zhuhai 519000, China
| | - Nianhong Guan
- Department of Psychiatry, Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou 510630, China
| | - Xianglan Wang
- Department of Psychiatry, Fifth Affiliated Hospital of Sun Yat-sen University, No. 52 East Meihua Road, Zhuhai 519000, China.
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Núñez D, Villacura-Herrera C, Celedón K, Ulloa JL, Ramos N, Spencer R, Fresno A. Identifying self-report measures of emotion regulation and evaluating their psychometric properties: a protocol for a systematic review. BMJ Open 2022; 12:e056193. [PMID: 35551079 PMCID: PMC9109083 DOI: 10.1136/bmjopen-2021-056193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Successful emotion regulation (ER) is critical for psychological health. Disturbances in this ability are associated with several psychiatric disorders. There are several self-report questionnaires to assess ER. However, there are no studies synthesising the evidence on their psychometric properties. We aim to identify all available instruments addressing ER in adolescents or adults and to critically appraise, compare and summarise the quality of their psychometric properties. For this, we will use COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria. METHOD AND ANALYSIS The search process to identify eligible studies will be conducted in April 2021 including the ProQuest, PubMed, Scopus and Web of Science databases with no restriction in terms of publication date. Eligibility criteria include peer-reviewed research articles written in English or Spanish by means of patient-reported outcome measures focused on ER among participants of 13 years or older. We will assess the quality of measures according to the COSMIN Risk of Bias Checklist. The psychometric properties will be assessed by the COSMIN updated criteria for good measurement. The available evidence will be addressed by the Grading of Recommendations, Assessment, Development and Evaluations approach. Our findings will be synthesised independently for each measure, including information on their sample, theoretical model and psychometric properties when possible. ETHICS AND DISSEMINATION Ethical approval is not required, as this study does not involve any participants or collection of primary data. Results are expected to be published in a peer-reviewed journal in the field of youth mental health and presented at relevant meetings and conferences. PROSPERO REGISTRATION NUMBER CRD42021249498.
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Affiliation(s)
- D Núñez
- Research Center on Cognitive Sciences, Faculty of Psychology, Universidad de Talca, Talca, Chile
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, ANID-Millennium Science Initiative Program, Santiago, Chile
| | - C Villacura-Herrera
- Research Center on Cognitive Sciences, Faculty of Psychology, Universidad de Talca, Talca, Chile
| | - K Celedón
- Research Center on Cognitive Sciences, Faculty of Psychology, Universidad de Talca, Talca, Chile
| | - J L Ulloa
- Research Center on Cognitive Sciences, Faculty of Psychology, Universidad de Talca, Talca, Chile
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths, Imhay, ANID-Millennium Science Initiative Program, Santiago, Chile
| | - N Ramos
- Research Center on Cognitive Sciences, Faculty of Psychology, Universidad de Talca, Talca, Chile
| | - R Spencer
- Research Center on Cognitive Sciences, Faculty of Psychology, Universidad de Talca, Talca, Chile
| | - A Fresno
- Research Center on Cognitive Sciences, Faculty of Psychology, Universidad de Talca, Talca, Chile
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Chennaz L, Valente D, Baltenneck N, Baudouin JY, Gentaz E. Emotion regulation in blind and visually impaired children aged 3 to 12 years assessed by a parental questionnaire. Acta Psychol (Amst) 2022; 225:103553. [PMID: 35279432 DOI: 10.1016/j.actpsy.2022.103553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 02/03/2022] [Accepted: 02/24/2022] [Indexed: 11/01/2022] Open
Abstract
Emotion regulation develops from the earliest years of a child's life and mostly through visual information. Considering the importance of emotion regulation in daily life situations, it is important to study the effect of visual experience on the development of this ability. This study is the first to examine the effect of visual experience and age in emotion regulation by comparing groups of children with different visual status and age. For this purpose, after testing the reliability and consistency of the French version of Emotion Regulation Checklist (ERC-vf) with 245 parents of blind, visually impaired and sighted children aged 3-5, 6-8 or 9-12 years, we conducted analyses on the effect of visual status and age on emotion regulation composite scores. The first result confirmed that the ERC-vf can be reliably used on populations of blind and visually impaired children. The second result revealed an effect of visual status on ER composite scores of emotion regulation: Blind children and visually impaired children each had significantly lower composite scores than sighted children. Moreover, the effect of age and the interaction between age and visual status were not significant on ER composite scores. The ER subscale results suggest, however, that age may have a variable effect for blind and visually impaired children as blind children's scores become lower and those of visually impaired children become equal to sighted children with age. The results of our study may help the children's entourage to better adapt their interactions in a context of visual impairment.
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Sorgi-Wilson KM, McCloskey MS. Emotion regulation strategies among individuals with borderline personality disorder relative to other groups: A review. Clin Psychol Psychother 2022; 29:1655-1678. [PMID: 35366040 DOI: 10.1002/cpp.2738] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/28/2022] [Accepted: 03/29/2022] [Indexed: 11/11/2022]
Abstract
Borderline personality disorder (BPD) is associated with difficulties in emotion regulation (ER) abilities. Investigations of ER strategies in BPD have been less robust. This systematic review identified 55 studies comparing ER strategy use between individuals diagnosed with BPD versus psychiatric and non-psychiatric comparison groups. Individuals with BPD reported more frequent maladaptive and less frequent adaptive ER strategy use than non-psychiatric controls. Results were less consistent relative to psychiatric comparison groups, though individuals with BPD reported greater self-criticism and avoidance. Groups responded comparably to instructed use of adaptive (but not maladaptive) ER strategies. This body of research would benefit from further examination of the roles of psychiatric comorbidity and problematic behaviours in the relationship between BPD and ER strategies.
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Affiliation(s)
- Kristen M Sorgi-Wilson
- Department of Psychology and Neuroscience, Temple University, Philadelphia, Pennsylvania, USA
| | - Michael S McCloskey
- Department of Psychology and Neuroscience, Temple University, Philadelphia, Pennsylvania, USA
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Cattaneo LA, Franquillo AC, Grecucci A, Beccia L, Caretti V, Dadomo H. Is Low Heart Rate Variability Associated with Emotional Dysregulation, Psychopathological Dimensions, and Prefrontal Dysfunctions? An Integrative View. J Pers Med 2021; 11:872. [PMID: 34575648 PMCID: PMC8465800 DOI: 10.3390/jpm11090872] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/26/2021] [Accepted: 08/29/2021] [Indexed: 11/29/2022] Open
Abstract
Several studies have suggested a correlation between heart rate variability (HRV), emotion regulation (ER), psychopathological conditions, and cognitive functions in the past two decades. Specifically, recent data seem to support the hypothesis that low-frequency heart rate variability (LF-HRV), an index of sympathetic cardiac control, correlates with worse executive performances, worse ER, and specific psychopathological dimensions. The present work aims to review the previous findings on these topics and integrate them from two main cornerstones of this perspective: Porges' Polyvagal Theory and Thayer and Lane's Neurovisceral Integration Model, which are necessary to understand these associations better. For this reason, based on these two approaches, we point out that low HRV is associated with emotional dysregulation, worse cognitive performance, and transversal psychopathological conditions. We report studies that underline the importance of considering the heart-brain relation in order to shed light on the necessity to implement psychophysiology into a broader perspective on emotions, mental health, and good cognitive functioning. This integration is beneficial not only as a theoretical ground from which to start for further research studies but as a starting point for new theoretical perspectives useful in clinical practice.
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Affiliation(s)
| | - Anna Chiara Franquillo
- Department of Human Sciences, LUMSA University, 00193 Rome, Italy;
- Consorzio Universitario Humanitas, 00193 Rome, Italy
| | - Alessandro Grecucci
- Department of Psychology and Cognitive Science, DiPSCo, University of Trento, Corso Bettini, 38068 Rovereto, Italy;
- Center for Medical Sciences, CISMed, University of Trento, 38122 Trento, Italy
| | - Laura Beccia
- Schema Therapy Center, 21047 Saronno, Italy; (L.A.C.); (L.B.)
| | - Vincenzo Caretti
- Department of Human Sciences, LUMSA University, 00193 Rome, Italy;
- Consorzio Universitario Humanitas, 00193 Rome, Italy
| | - Harold Dadomo
- Neuroscience Unit, Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy;
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Villanueva-Valle J, Díaz JL, Jiménez S, Rodríguez-Delgado A, Arango de Montis I, León-Bernal A, Miranda-Terres E, Muñoz-Delgado J. Facial and Vocal Expressions During Clinical Interviews Suggest an Emotional Modulation Paradox in Borderline Personality Disorder: An Explorative Study. Front Psychiatry 2021; 12:628397. [PMID: 33841202 PMCID: PMC8024539 DOI: 10.3389/fpsyt.2021.628397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/24/2021] [Indexed: 11/20/2022] Open
Abstract
Videotape recordings obtained during an initial and conventional psychiatric interview were used to assess possible emotional differences in facial expressions and acoustic parameters of the voice between Borderline Personality Disorder (BPD) female patients and matched controls. The incidence of seven basic emotion expressions, emotional valence, heart rate, and vocal frequency (f0), and intensity (dB) of the discourse adjectives and interjections were determined through the application of computational software to the visual (FaceReader) and sound (PRAAT) tracks of the videotape recordings. The extensive data obtained were analyzed by three statistical strategies: linear multilevel modeling, correlation matrices, and exploratory network analysis. In comparison with healthy controls, BPD patients express a third less sadness and show a higher number of positive correlations (14 vs. 8) and a cluster of related nodes among the prosodic parameters and the facial expressions of anger, disgust, and contempt. In contrast, control subjects showed negative or null correlations between such facial expressions and prosodic parameters. It seems feasible that BPD patients restrain the facial expression of specific emotions in an attempt to achieve social acceptance. Moreover, the confluence of prosodic and facial expressions of negative emotions reflects a sympathetic activation which is opposed to the social engagement system. Such BPD imbalance reflects an emotional alteration and a dysfunctional behavioral strategy that may constitute a useful biobehavioral indicator of the severity and clinical course of the disorder. This face/voice/heart rate emotional expression assessment (EMEX) may be used in the search for reliable biobehavioral correlates of other psychopathological conditions.
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Affiliation(s)
- Javier Villanueva-Valle
- Facultad de Psicología, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico.,Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Mexico City, Mexico
| | - José-Luis Díaz
- Facultad de Medicina Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Said Jiménez
- Facultad de Psicología, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico.,Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Mexico City, Mexico
| | - Andrés Rodríguez-Delgado
- Clínica de Trastornos de Personalidad, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Mexico City, Mexico
| | - Iván Arango de Montis
- Clínica de Trastornos de Personalidad, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Mexico City, Mexico
| | - Areli León-Bernal
- Facultad de Psicología, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico.,Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Mexico City, Mexico
| | - Edgar Miranda-Terres
- Clínica de Trastornos de Personalidad, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Mexico City, Mexico
| | - Jairo Muñoz-Delgado
- Facultad de Psicología, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico.,Dirección de Investigaciones en Neurociencias, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (INPRFM), Mexico City, Mexico
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Akyunus M, Gençöz T, Karakose S. The Mediator Role of Negative Cognitive Emotion Regulation Strategies Between Interpersonal Problems and Borderline Personality Beliefs. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2020. [DOI: 10.1007/s10942-020-00373-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mestre-Bach G, Fernández-Aranda F, Jiménez-Murcia S, Potenza MN. WITHDRAWN: Emotional regulation in gambling disorder. Curr Opin Behav Sci 2020. [DOI: 10.1016/j.cobeha.2019.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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14
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Schultebraucks K, Duesenberg M, Di Simplicio M, Holmes EA, Roepke S. Suicidal Imagery in Borderline Personality Disorder and Major Depressive Disorder. J Pers Disord 2020; 34:546-564. [PMID: 30785849 DOI: 10.1521/pedi_2019_33_406] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
A better understanding of suicidal behavior is important to detect suicidality in at-risk populations such as patients with borderline personality disorder (BPD), posttraumatic stress disorder (PTSD), and major depressive disorder (MDD). Suicidal tendencies are clinically assessed by verbal thoughts rather than by specifically asking about mental images. This study examines whether imagery and verbal thoughts about suicide occur and differ between patients with BPD with and without comorbid PTSD compared to patients with MDD (clinical controls). All patient groups experienced suicide-related images. Patients with BPD with comorbid PTSD reported significantly more vivid images than patients with MDD. Severity of suicidal ideation, number of previous suicide attempts, and childhood traumata were significantly associated with suicidal imagery across all patient groups. The authors demonstrate for the first time that suicide-related mental imagery occurs in BPD and is associated with suicidal ideation. This finding highlights the importance of assessing mental imagery related to suicide in clinical practice.
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Affiliation(s)
- Katharina Schultebraucks
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitäts-medizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Psychiatry, New York University School of Medicine, New York, New York
| | - Moritz Duesenberg
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitäts-medizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Martina Di Simplicio
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom.,Centre for Psychiatry, Brain Sciences Division, Imperial College London, London, UK
| | - Emily A Holmes
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Stefan Roepke
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Charité - Universitäts-medizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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15
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Reinhard MA, Dewald-Kaufmann J, Wüstenberg T, Musil R, Barton BB, Jobst A, Padberg F. The vicious circle of social exclusion and psychopathology: a systematic review of experimental ostracism research in psychiatric disorders. Eur Arch Psychiatry Clin Neurosci 2020; 270:521-532. [PMID: 31586242 DOI: 10.1007/s00406-019-01074-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 09/24/2019] [Indexed: 12/15/2022]
Abstract
Social exclusion (ostracism) is a major psychosocial factor contributing to the development and persistence of psychiatric disorders and is also related to their social stigma. However, its specific role in different disorders is not evident, and comprehensive social psychology research on ostracism has rather focused on healthy individuals and less on psychiatric patients. Here, we systematically review experimental studies investigating psychological and physiological reactions to ostracism in different responses of psychiatric disorders. Moreover, we propose a theoretical model of the interplay between psychiatric symptoms and ostracism. A systematic MEDLINE and PsycINFO search was conducted including 52 relevant studies in various disorders (some of which evaluated more than one disorder): borderline personality disorder (21 studies); major depressive disorder (11 studies); anxiety (7 studies); autism spectrum disorder (6 studies); schizophrenia (6 studies); substance use disorders (4 studies); and eating disorders (2 studies). Psychological and physiological effects of ostracism were assessed with various experimental paradigms: e.g., virtual real-time interactions (Cyberball), social feedback and imagined scenarios. We critically review the main results of these studies and propose the overall concept of a vicious cycle where psychiatric symptoms increase the chance of being ostracized, and ostracism consolidates or even aggravates psychopathology. However, the specificity and stability of reactions to ostracism, their neurobiological underpinnings, determinants, and moderators (e.g., attachment style, childhood trauma, and rejection sensitivity) remain elusive.
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Affiliation(s)
- Matthias A Reinhard
- Department of Psychiatry and Psychotherapy, University Hospital, LMU, Nussbaumstr. 7, 80336, Munich, Germany.
| | - Julia Dewald-Kaufmann
- Department of Psychiatry and Psychotherapy, University Hospital, LMU, Nussbaumstr. 7, 80336, Munich, Germany.,Hochschule Fresenius, University of Applied Sciences, Infanteriestr. 11a, 80797, Munich, Germany
| | - Torsten Wüstenberg
- Department of Psychiatry and Psychotherapy Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Richard Musil
- Department of Psychiatry and Psychotherapy, University Hospital, LMU, Nussbaumstr. 7, 80336, Munich, Germany
| | - Barbara B Barton
- Department of Psychiatry and Psychotherapy, University Hospital, LMU, Nussbaumstr. 7, 80336, Munich, Germany
| | - Andrea Jobst
- Department of Psychiatry and Psychotherapy, University Hospital, LMU, Nussbaumstr. 7, 80336, Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU, Nussbaumstr. 7, 80336, Munich, Germany
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16
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A Meta-analysis and Systematic Review of Emotion-Regulation Strategies in Borderline Personality Disorder. Harv Rev Psychiatry 2020; 27:217-232. [PMID: 31219881 DOI: 10.1097/hrp.0000000000000212] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Emotion dysregulation is often considered a core characteristic of individuals with borderline personality disorder (BPD). With the development and strength of a contemporary affective-science model that encompasses both healthy emotion regulation (ER) and emotion dysregulation, this model has increasingly been used to understand the affective experiences of people with BPD. In this meta-analysis and review, we systematically review six of the most commonly studied ER strategies and determine their relative endorsement in individuals with elevated symptoms of BPD compared to individuals with low symptoms of BPD and healthy controls, as well as to individuals with other mental disorders. Results from 93 unique studies and 213 different effect-size estimates indicated that symptoms of BPD were associated with less frequent use of ER strategies that would be considered more effective at reducing negative affect (i.e., cognitive reappraisal, problem solving, and acceptance) and more frequent use of ER strategies considered less effective at reducing negative affect (i.e., suppression, rumination, and avoidance). When compared to individuals with other mental disorders, people with BPD endorsed higher rates of rumination and avoidance, and lower rates of problem solving and acceptance. We also review important contributions from studies of ER in BPD that we were unable to incorporate into our meta-analysis. We conclude by discussing how the pattern of using ER strategies in BPD contributes to emotion dysregulation and also the potential reasons for this pattern, integrating both Gross's extended process model of ER and Linehan's updated theoretical account on the development of emotion dysregulation.
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17
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Haeyen S, Chakhssi F, Van Hooren S. Benefits of Art Therapy in People Diagnosed With Personality Disorders: A Quantitative Survey. Front Psychol 2020; 11:686. [PMID: 32351431 PMCID: PMC7174707 DOI: 10.3389/fpsyg.2020.00686] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/20/2020] [Indexed: 11/13/2022] Open
Abstract
Art therapy is widely used and effective in the treatment of patients diagnosed with Personality Disorders (PDs). Current psychotherapeutic approaches may benefit from this additional therapy to improve their efficacy. But what is the patient perspective upon this therapy? This study explored perceived benefits of art therapy for patients with PDs to let the valuable perspective of patients be taken into account. Using a quantitative survey study over 3 months (N = 528), GLM repeated measures and overall hierarchical regression analyses showed that the majority of the patients reported quite a lot of benefit from art therapy (mean 3.70 on a 5-point Likert scale), primarily in emotional and social functioning. The improvements are concentrated in specific target goals of which the five highest scoring goals affected were: expression of emotions, improved (more stable/positive) self-image, making own choices/autonomy, recognition of, insight in, and changing of personal patterns of feelings, behaviors and thoughts and dealing with own limitations and/or vulnerability. Patients made it clear that they perceived these target areas as having been affected by art therapy and said so at both moments in time, with a higher score after 3 months. The extent of the perceived benefits is highly dependent for patients on factors such as a non-judgmental attitude on the part of the therapist, feeling that they are taken seriously, being given sufficient freedom of expression but at the same time being offered sufficient structure and an adequate basis. Age, gender, and diagnosis cluster did not predict the magnitude of perceived benefits. Art therapy provides equal advantages to a broad target group, and so this form of therapy can be broadly indicated. The experienced benefits and the increase over time was primarily associated with the degree to which patients perceive that they can give meaningful expression to feelings in their artwork. This provides an indication for the extent of the benefits a person can experience and can also serve as a clear guiding principle for interventions by the art therapist.
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Affiliation(s)
- Suzanne Haeyen
- GGNet Centre of Mental Health, Apeldoorn, Netherlands.,KENVAK Research Centre for the Arts Therapies, Heerlen, Netherlands.,Department of the Arts & Psychomotor Therapies Education Programme, HAN University of Applied Sciences, Nijmegen, Netherlands
| | - Farid Chakhssi
- GGNet Centre of Mental Health, Apeldoorn, Netherlands.,Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - Susan Van Hooren
- KENVAK Research Centre for the Arts Therapies, Heerlen, Netherlands.,Department of the Arts Therapies Education Programme, Zuyd University of Applied Sciences, Heerlen, Netherlands.,Faculty of Psychology, Open University of the Netherlands, Heerlen, Netherlands
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18
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Mestre-Bach G, Fernández-Aranda F, Jiménez-Murcia S, Potenza MN. Emotional regulation in gambling disorder. Curr Opin Behav Sci 2020. [DOI: 10.1016/j.cobeha.2020.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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19
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Krause-Utz A, Walther JC, Lis S, Schmahl C, Bohus M. Heart rate variability during a cognitive reappraisal task in female patients with borderline personality disorder: the role of comorbid posttraumatic stress disorder and dissociation. Psychol Med 2019; 49:1810-1821. [PMID: 30198447 PMCID: PMC6650777 DOI: 10.1017/s0033291718002489] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/04/2018] [Accepted: 08/10/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Emotion dysregulation is a core feature of borderline personality disorder (BPD), which often co-occurs with posttraumatic stress disorder (PTSD). Difficulties in emotion regulation (ER) have been linked to lower high-frequency heart rate variability (HF-HRV), a measure of autonomous nervous system functioning. However, previous research on vagally-mediated heart rate in BPD revealed heterogeneous findings and the effects of comorbid PTSD and dissociation on HF-HRV are not yet completely understood. This study aim to investigate HF-HRV during resting-state and an ER task in female BPD patients with comorbid PTSD (BPD + PTSD), patients without this comorbidity (BPD), and healthy controls (HC). METHODS 57 BPD patients (BPD: n = 37, BPD + PTSD: n = 20) and 27 HC performed an ER task with neutral, positive, and negative images. Participants were instructed to either attend these pictures or to down-regulate their upcoming emotions using cognitive reappraisal. Subjective arousal and wellbeing, self-reported dissociation, and electrocardiogram data were assessed. RESULTS Independent of ER instruction and picture valence, both patient groups (BPD and BPD + PTSD) reported higher subjective arousal and lower wellbeing; patients with BPD + PTSD further exhibited significantly lower HF-HRV compared with the other groups. Higher self-reported state dissociation predicted higher HF-HRV during down-regulating v. attending negative pictures in BPD + PTSD. CONCLUSIONS Findings suggest increased emotional reactivity to negative, positive, and neutral pictures, but do not provide evidence for deficits in instructed ER in BPD. Reduced HF-HRV appears to be particularly linked to comorbid PTSD, while dissociation may underlie attempts to increase ER and HF-HRV in BPD patients with this comorbidity.
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Affiliation(s)
- Annegret Krause-Utz
- Institute of Clinical Psychology, Leiden University; Leiden Institute for Brain and Cognition; Leiden, The Netherlands
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim; Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Julia-Caroline Walther
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim; Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Stefanie Lis
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim; Medical Faculty, University of Heidelberg, Mannheim, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Mannheim; Medical Faculty, University of Heidelberg, Mannheim, Germany
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Martin Bohus
- Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim; Medical Faculty, University of Heidelberg, Mannheim, Germany
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20
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Marceau EM, Meuldijk D, Townsend ML, Solowij N, Grenyer BF. Biomarker correlates of psychotherapy outcomes in borderline personality disorder: A systematic review. Neurosci Biobehav Rev 2018; 94:166-178. [DOI: 10.1016/j.neubiorev.2018.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 08/24/2018] [Accepted: 09/04/2018] [Indexed: 12/18/2022]
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21
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Is the association of deliberate self-harm with emotional relief stable or dependent on emotional context? J Behav Ther Exp Psychiatry 2018; 60:61-68. [PMID: 29605669 DOI: 10.1016/j.jbtep.2018.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 03/06/2018] [Accepted: 03/18/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite strong support for the role of emotional relief in deliberate self-harm (DSH), no research has examined the impact of emotional distress on the strength of the DSH-relief association. Thus, it remains unclear whether the association of DSH with emotional relief is stable across emotional contexts or context-dependent. This study aimed to examine if the implicit DSH-relief association is stronger in the context of emotional distress (relative to a neutral emotional context). METHODS Young adult women with (n = 60) and without (n = 60) a history of recent recurrent DSH were randomly assigned to complete a novel version of the Implicit Association Test (IAT) assessing the DSH-relief association at baseline (following an initial neutral emotion induction) and again following either a neutral or negative (i.e., social rejection) emotion induction. RESULTS Consistent with hypotheses, the DSH-relief association was stronger among women with recent recurrent DSH (vs. those without DSH) at baseline. Contrary to hypotheses, however, whereas the DSH-relief association remained stable following both the neutral and negative emotion inductions among participants with DSH, it became stronger across both conditions for participants without DSH. LIMITATIONS The use of a community sample of young adult women may limit generalizability to other relevant populations (e.g., clinical populations, young men, adolescents). Additionally, the negative emotion induction may not have been powerful enough to affect the strength of the learned DSH-relief association among individuals with a repeated history of DSH. CONCLUSIONS Findings suggest that the repeated use of DSH to bring about emotional relief may engender associations of DSH with relief that are relatively insensitive to emotional context.
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