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Dammann G, Rudaz M, Benecke C, Riemenschneider A, Walter M, Pfaltz MC, Küchenhoff J, Clarkin JF, Gremaud-Heitz DJ. Facial Affective Behavior in Borderline Personality Disorder Indicating Two Different Clusters and Their Influence on Inpatient Treatment Outcome: A Preliminary Study. Front Psychol 2020; 11:1658. [PMID: 32849013 PMCID: PMC7403199 DOI: 10.3389/fpsyg.2020.01658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/18/2020] [Indexed: 11/13/2022] Open
Abstract
Background The purpose of the present study was threefold: first, to investigate the facial affective behavior in patients with a borderline personality disorder (BPD); second, to examine whether these patients could be divided into clusters according to facial affective behavior; and third, to test whether these clusters would influence the inpatient treatment outcome. Methods Thirty inpatients with BPD were assessed with the Structured Clinical Interviews for DSM-IV Axis I and II Disorders (SCID I, SCID II) and had to complete a series of questionnaires before and directly after the 12-week long inpatient treatment. Facial affective behavior was recorded during the structured interview for personality organization (STIPO) and afterward coded with the emotional facial action coding system (EMFACS). Measures on psychopathology [beck depression inventory (BDI), Spielberger state and trait anxiety inventory (STAI), Spielberger state and trait anger inventory (STAXI), and symptom cheklist-90-revised (SCL-90-R)], interpersonal problems [Inventory of Interpersonal Problems (IIP)], and personality organization [inventory of personality organization (IPO)] were administered. Results Cluster analysis before the treatment yielded two groups that differed in general facial expressivity, and regarding the display of anger, contempt, and disgust. The effect sizes of the repeated measures ANOVAs showed that persons with higher scores on the affective facial expressions benefitted more from the treatment in terms of STAI state anxiety, STAXI state and trait anger, IIP total, and the two scales primitive defenses and identity diffusion of the IPO, whereas persons with lower scores benefitted more on the scale IPO reality testing. Conclusion Our results indicated some initial trends for the importance of facial affective behavior in patients with BPD and their treatment outcome.
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Affiliation(s)
- Gerhard Dammann
- Psychiatric Hospital, University of Basel, Basel, Switzerland
- Münsterlingen Psychiatric Hospital, Münsterlingen, Switzerland
- University Hospital for Psychiatry and Psychotherapy, Paracelsus Medical University, Salzburg, Austria
| | - Myriam Rudaz
- Münsterlingen Psychiatric Hospital, Münsterlingen, Switzerland
- University Hospital for Psychiatry and Psychotherapy, Paracelsus Medical University, Salzburg, Austria
- Department of Family and Child Sciences, Florida State University, Tallahassee, FL, United States
- *Correspondence: Myriam Rudaz,
| | - Cord Benecke
- Institute of Psychology, Clinical Psychology, University of Kassel, Kassel, Germany
| | | | - Marc Walter
- Psychiatric Hospital, University of Basel, Basel, Switzerland
| | - Monique C. Pfaltz
- Department of Psychiatry, University Hospital Zurich, Zurich, Switzerland
| | | | - John F. Clarkin
- Personality Disorders Institute, Cornell University Medical School, New York, NY, United States
| | - Daniela J. Gremaud-Heitz
- Psychiatric Hospital, University of Basel, Basel, Switzerland
- Münsterlingen Psychiatric Hospital, Münsterlingen, Switzerland
- University Hospital for Psychiatry and Psychotherapy, Paracelsus Medical University, Salzburg, Austria
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Datz F, Wong G, Löffler-Stastka H. Interpretation and Working through Contemptuous Facial Micro-Expressions Benefits the Patient-Therapist Relationship. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16244901. [PMID: 31817282 PMCID: PMC6950517 DOI: 10.3390/ijerph16244901] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 11/27/2019] [Accepted: 11/28/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The significance of psychotherapeutic micro-processes, such as nonverbal facial expressions and relationship quality, is widely known, yet hitherto has not been investigated satisfactorily. In this exploratory study, we aim to examine the occurrence of micro-processes during psychotherapeutic treatment sessions, specifically facial micro-expressions, in order to shed light on their impact on psychotherapeutic interactions and patient-clinician relationships. METHODS In analyzing 22 video recordings of psychiatric interviews in a routine/acute psychiatric care unit of Vienna General Hospital, we were able to investigate clinicians' and patients' facial micro-expressions in conjunction with verbal interactions and types. To this end, we employed the Emotion Facial Action Coding System (EmFACS)-assessing the action units and microexpressions-and the Psychodynamic Intervention List (PIL). Also, the Working Alliance Inventory (WAI), assessed after each session by both patients and clinicians, provided information on the subjective quality of the clinician-patient relationship. RESULTS We found that interpretative/confrontative interventions are associated with displays of contempt from both therapists and patients. Interestingly, displays of contempt also correlated with higher WAI scores. We propose that these seemingly contradictory results may be a consequence of the complexity of affects and the interplay of primary and secondary emotions with intervention type. CONCLUSION Interpretation, confrontation, and working through contemptuous microexpressions are major elements to the adequate control major pathoplastic elements. Affect-cognitive interplay is an important mediator in the working alliance.
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Affiliation(s)
- Felicitas Datz
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, A-1090 Vienna, Austria;
| | - Guoruey Wong
- Faculté de Médecine, Université de Montréal, Montréal, QC H3T 1J4, Canada;
| | - Henriette Löffler-Stastka
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, A-1090 Vienna, Austria;
- Teaching Center, Medical University of Vienna, A-1090 Vienna, Austria
- Correspondence:
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Levels of Structural Integration and Facial Expressions of Negative Emotions. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2016; 62:224-38. [PMID: 27594600 DOI: 10.13109/zptm.2016.62.3.224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES For a clinically relevant understanding of facial displays of patients with mental disorders it is crucial to go beyond merely counting frequencies of facial expressions, but include the contextual information of the expression. We assume that patients with different levels of structural integration differ in the contextual embedding of their negative facial expressions of emotions. METHODS Facial affective behaviour of 80 female participants during an OPD interview was analysed using FACS (Facial Action Coding System) and the RFE coding system (Referencesof- Facial-Expression coding system; Bock et al. 2015).Using the RFE coding system, 2192 negative facial expressions of emotions were attributed to different references (e.g., interactive, self-related, object-related) by relying on contextual variables. RESULTS Pure frequency of negative facial affect was not related to level of structural integration. Negative facial expressions of emotions directed towards the interviewer (interactive reference), as well as negative facial expressions directed towards the displayer's whole self were associated with lower levels of structural integration. In contrast, negative facial affects directed to single aspects of the self, to single aspects of objects, or to external situations were associated with higher levels of structural integration. CONCLUSIONS The differentiation of references of facial affective behavior allows a deeper understanding of the connection between facial displays and structural levels of psychic integration.
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