Experimental Designs and the 'Emotion Stimulus Critique': Hidden Problems and Potential Solutions in the Study of Emotion.

Emotional experience is increasingly being measured using experimental tasks, but the stimuli used are often only proxies for the emotion being studied. Stimuli are intended to evoke a distinct emotional experience, but certain designs fail to adequately control for the actual experience in question. In this methodological paper, we review designs used in clinical psychology aimed at measuring emotion and develop the argument of the 'emotion stimulus critique'. Designs of neuroimaging studies on emotion in this context are given preference. We argue that studies often concentrate on standardization of the stimulus material (i.e. words, images, and movies) for eliciting an emotional experience, whereas standardization of the actual participant's experience is seldom performed. Our proposal discusses the use of standardized stimuli in experimental designs and contrasts this with the necessity of controlling for a participant's unique emotional response. We highlight the importance of each participant's 'inner metric', i.e. the individual's experiential anchor, which needs to be taken into account when examining the emotional correlates of psychiatric disorders or psychotherapeutic change. Implications of the emotion stimulus critique for research are discussed within the context of psychology, particularly clinical psychology and psychotherapy

Future Challenges in Psychotherapy Research for Personality Disorders.

Individuals with personality disorders are frequently seen in mental health settings. Their symptoms typically reflect a high level of suffering and burden of disease, with potentially harmful societal consequences, including costs related to absenteeism at work, high use of health services, ineffective or harmful parenting, substance use, suicidal and non-suicidal self-harming behavior, and aggressiveness with legal consequences. Psychotherapy is currently the first-line treatment for patients with personality disorders, but the study of psychotherapy in the domain of personality disorders faces specific challenges. Challenges include knowing what works for whom, identifying which putative mechanisms of change explain therapeutic effects, and including the social interaction context of patients with a personality disorder. By following a dimensional approach, psychotherapy research on personality disorders may serve as a model for the development and study of innovative psychotherapeutic interventions. We recommend developing the following: (a) an evidence base to make treatment decisions based on individual features; (b) a data-driven approach to predictors, moderators, and mechanisms of change in psychotherapy; (c) methods for studying the interaction between social context and psychotherapy

Out of control? Acting out anger is associated with deficient prefrontal emotional action control in male patients with borderline personality disorder

Item does not contain fulltextDifficulty in anger control and anger-related aggressive outbursts against others are frequently reported by patients with borderline personality disorder (BPD). Although male sex is a known predictor for aggression, hardly any study has addressed the neural correlates of deficient anger control in male patients with BPD. Building on previous reports in female BPD, we investigated the involvement of lateral antero- and dorsal prefrontal cortex in the control of fast emotional actions and its relation to self-reported tendencies to act out anger. 15 medication-free male patients with BPD and 25 age- and intelligence-matched healthy men took part in a social Approach-Avoidance task in the MR-scanner. This task allows the measurement of neural correlates underlying the control of fast behavioral tendencies to approach happy and avoid angry faces. Hypothesis-driven region-of-interest and exploratory whole brain analyses were used to test for activations of antero- and dorsolateral prefrontal regions and their relation with the amygdala during emotional action control as well as their association with self-reported anger out in male patients with BPD and healthy volunteers. Male patients with BPD showed reduced anterolateral prefrontal activations during emotional action control compared to healthy volunteers. Furthermore, anger out was negatively related to antero- and dorsolateral prefrontal activations, while it was positively related to amygdala activity in male patients with BPD. The current results suggest the involvement of antero- and dorsolateral prefrontal regions in controlling and overriding fast emotional actions. Deficits in lateral prefrontal emotion control seem to be a common neural mechanism underlying anger-related aggression. This article is part of the Special Issue entitled 'Current status of the neurobiology of aggression and impulsivity'.8 p

Oxytocin normalizes approach-avoidance behavior in women with borderline personality disorder

Background: Interpersonal deficits are a core symptom of borderline personality disorder (BPD), which could be related to increased social threat sensitivity and a tendency to approach rather than avoid interpersonal threats. The neuropeptide oxytocin has been shown to reduce threat sensitivity in patients with BPD and to modify approach-avoidance behavior in healthy volunteers. Methods: In a randomized, double-blind placebo-controlled between-subject design, 53 unmedicated women with BPD and 61 healthy women participated in an approach-avoidance task 75 min after intranasal substance administration (24 IU of oxytocin or placebo). The task assesses automatic approach–avoidance tendencies in reaction to facial expressions of happiness and anger.Results: While healthy participants responded faster to happy than angry faces, the opposite response pattern, that is, faster reactions to angry than happy faces, was found in patients with BPD. In the oxytocin condition, the "congruency effect" (i.e., faster avoidance of facial anger and approach of facial happiness vice versa) was increased in both groups. Notably, patients with BPD exhibited a congruency effect toward angry faces in the oxytocin but not in the placebo condition.Conclusions: This is the second report of deficient fast, automatic avoidance responses in terms of approach behavior toward interpersonal threat cues in patients with BPD. Intranasally administered oxytocin was found to strengthen avoidance behavior to social threat cues and, thus, to normalize fast action tendencies in BPD. Together with the previously reported oxytocinergic reduction of social threat hypersensitivity, these results suggest beneficial effects of oxytocin on interpersonal dysfunctioning in BPD

Erratum: Resilience Factors in Women with Severe Early-Life Maltreatment

<b><i>Introduction:</i></b> Early-life maltreatment (ELM) has long-lasting negative consequences and is the most important general risk factor for mental disorders. Nevertheless, a number of maltreated children grow up to become healthy adults and have therefore been called ‘resilient'. The aim of the current study is to investigate ‘resilience factors' in the context of severe ELM. <b><i>Method:</i></b> The study was part of the large multicenter project Understanding and Breaking the Intergenerational Cycle of Abuse (UBICA). A total of 89 women were examined, 33 with ELM and at least one lifetime mental disorder (nonresilient), 19 with ELM but without lifetime mental disorders (resilient), and 37 without ELM and without lifetime mental disorders (controls). ELM and other circumstances before the age of 18 years were assessed with the Childhood Experience of Care and Abuse (CECA) Interview. Additional relevant person and situation factors were measured with the Structured Clinical Interview for Mental Disorders (SCID-I), International Personality Disorder Examination (IPDE), Difficulties in Emotion Regulation Scale (DERS), Vulnerable Attachment Style Questionnaire (VASQ), Barratt Impulsiveness Scale (BIS), NEO Five-Factor Inventory (NEO-FFI), and Multiple-Choice Vocabulary Intelligence Test (MWT-B). Factor analyses and paired t tests were performed to identify those variables which differentiate best between the three groups. In addition, a discriminant analysis was conducted to detect the accuracy of assigning women to their specific group. <b><i>Results:</i></b> The factor analyses revealed 10 resilience factors based on which we could correctly assign 80% of the women to their group in the discriminant analysis. t tests of factor scores showed that resilient and nonresilient maltreated women mainly differed in current individual attributes (e.g. impulsivity, attachment style), while resilient and nonresilient maltreated women differed from controls in both their current individual attributes and their view of their situation as a child. <b><i>Conclusion:</i></b> The 4 variables neuroticism, extraversion, vulnerable attachment, and perceived loneliness during childhood were identified as most important in differentiating all three examined groups. Therefore, prevention and intervention programs focusing on the individual's development of secure attachment and social competence may be of particular importance in the context of ELM