Personality Influences the Relationship Between Primary Emotions and Religious/Spiritual Well-Being

The study of human emotions and personality provides valuable insights into the parameters of mental health and well-being. Affective neuroscience proposes that several levels of emotions – ranging from primary ones such as LUST or FEAR up to higher emotions such as spirituality – interact on a neural level. The present study aimed to further explore this theory. Furthermore, we hypothesized that personality – formed by bottom-up primary emotions and cortical top-down regulation – might act as a link between primary emotions and religious/spiritual well-being. A total sample of 167 (78% female) student participants completed the Affective Neuroscience Personality Scale (primary emotions), the Big Five Personality Inventory and the Multidimensional Inventory of Religious/Spiritual Well-Being (higher emotions). Correlation analyses confirmed the link between primary and higher emotions as well as their relation to personality. Further regression analyses indicated that personality dimensions mediate the relationship between primary and higher emotions. A substantial interaction between primary emotions, personality dimensions, and religious/spiritual well-being could be confirmed. From a developmental perspective, cortical top-down regulation might influence religious/spiritual well-being by forming relevant personality dimensions. Hence, CARE as well as Agreeableness seem of special importance. Future studies might focus on implications for clinical groups.© 2018 Hiebler-Ragger, Fuchshuber, Dröscher, Vajda, Fink and Unterraine

Increased attachment security is related to early therapy drop-out in substance use disorders

Objectives: Previous research work suggests a positive association between secure attachment and increased therapy adherence (TA) in different patient groups. However, there is still a strong need for research focusing on the influence of attachment on TA in substance use disorder (SUD) treatment. Hence, this study attempts to investigate the predictive value of different attachment patterns concerning TA in SUD inpatients. Results: 122 (34 female) SUD inpatients completed the Attachment Style Questionnaire (ASQ) during the entry phase of therapeutic community treatment. After 6 weeks, subjects who remained in therapy (n = 47) completed the ASQ for a second time. In line with the literature, agglomerative Cluster Analysis suggested a two-cluster solution (Cluster I: increased secure attachment pattern; Cluster II: increased insecure attachment pattern). Notably, inpatients in Cluster I were more likely to drop out of treatment within the first 6 weeks (p < .001). Furthermore, subjects showed less “Confidence in Self and Others” (p < .05) after 6 weeks of treatment. Our findings indicate a negative predictive value of increased attachment security for TA in SUD inpatients. This finding probably mirrors a more realistic kind of self-assessment. More generally, the importance of considering attachment styles in SUD treatment is underlined.© The Author(s) 201

The relationship between existential well-being and mood-related psychiatric burden in Indian young adults with attachment deficits: a cross-cultural validation study

Background: Attachment and spirituality are thought to have deep evolutionary roots but are always interpreted within the framework of culture, religion and personal beliefs. While insecure attachment has been observed to be positively related with psychopathology, a positive mental health effect has often been described for spirituality. To examine the cross-cultural validation of previous research focused on Austrian young adults with Western socialization, we attempt to replicate our study examining the influence spirituality has on the connection between insecure attachment and mood-related psychiatric burden with Indian young adults. Methods: We investigated Avoidant (AV) and Anxious (AX) Attachment (ECR-RD), Religious (RWB) and Existential (EWB) Well-Being (MI-RSWB), and mood-related psychiatric burden (Anxiety, Depression, Somatization; BSI-18) in 443 (31% female) Indian young adults (age range: 18–30 years) with a Hindu upbringing. Results: Compared to young adults with a Roman Catholic upbringing in a Western socialization, Indian participants did not differ in AX and EWB but scored higher in mood-related psychiatric burden (eta2 = .04), AV (eta2 = .14), as well as RWB (eta2 = .28; all p < .01). As in previous research only AX (β = .40) positively predicted mood-related psychiatric burden (ΔR2 = .15, all p < .01), while EWB was an additional negative predictor (β = −.11, p < .05). Conclusions: Our findings emphasize the universal importance of attachment and spirituality for mental health as well as the potential influence of socialization on their development. Furthermore, they underline that Existential Well-Being – including hope for a better future, forgiveness, and the experience of sense and meaning – appears to have a compensating effect on the relation between insecure attachment and impaired mental health.© The Author(s) 202

Psychobiology of Attachment and Trauma—Some General Remarks From a Clinical Perspective

Attachment refers to a psychobiological principle that is deeply rooted in evolutionary development; it is thought to contribute a major advantage in the survival of the social group. Within individual development it indicates a primary motivational system that guides the initial transactions between mother and baby and furthermore mediates affective attunement and regulation. Psychosocial learning, in close interaction with genetics and epigenetics, also develops a decisive foundation for further brain development of the infant. Finally, the attachment pattern established forms an enduring, relational context for later affective, cognitive, and social development of the child. As an unconsciously active matrix for future personal relationships it has a particular impact on the comprehensive psychological functions of empathy and mentalization. Early adverse and traumatic experiences or major emotional neglect may lead to different levels of security versus insecurity or disorientation-disorganization of the attachment pattern that corresponds to characteristic features of neurobiological regulation.© 2019 Lahousen, Unterrainer and Kapfhamme

Unto the third generation: evidence for strong familial aggregation of physicians, psychologists, and psychotherapists among first-year medical and psychology students in a nationwide Austrian cohort census

Background: Medical students present higher numbers of physician relatives than expectable from the total population prevalence of physicians. Evidence for such a familial aggregation effect of physicians has emerged in investigations from the Anglo-American, Scandinavian, and German-speaking areas. In particular, past data from Austria suggest a familial aggregation of the medical, as well as of the psychological and psychotherapeutic, professions among medical and psychology undergraduates alike. Here, we extend prior related studies by examining (1) the extent to which familial aggregation effects apply to the whole nation-wide student census of all relevant (eight) public universities in Austria; (2) whether effects are comparable for medical and psychology students; (3) and whether these effects generalize to relatives of three interrelated health professions (medicine, psychology, and psychotherapy). Methods: We investigated the familial aggregation of physicians, psychologists, and psychotherapists, based on an entire cohort census of first-year medical and psychology students (n = 881 and 920) in Austria with generalized linear mixed models. Results: For both disciplines, we found strong familial aggregation of physicians, psychologists, and psychotherapists. As compared with previous results, directionally opposite time trends within disciplines emerged: familial aggregation of physicians among medical students has decreased, whilst familial aggregation of psychologists among psychology students has increased. Further, there were sex-of-relative effects (i.e., more male than female physician relatives), but no substantial sex-of-student effects (i.e., male and female students overall reported similar numbers of relatives for all three professions of interest). In addition, there were age-benefit effects, i.e., students with a relative in the medical or the psychotherapeutic profession were younger than students without, thus suggesting earlier career decisions. Conclusions: The familial aggregation of physicians, psychologists, and psychotherapists is high among medical and psychology undergraduates in Austria. Discussed are implications of these findings (e.g., gender equity, feminization of the medical field, ideas for curricular implementation and student counselling), study limitations, and avenues for future research.© The Author(s). 201

The Role of Attachment in Poly-Drug Use Disorder: An Overview of the Literature, Recent Findings and Clinical Implications

Background: Substance use disorders (SUDs) represent a worldwide epidemic with extensive costs to the individual and to society. Occasionally described as an attachment disorder, they have been linked to various impairments in self-regulation and social functioning. However, while there have been significant advances in the development and validation of treatment strategies for SUD in recent years, the components of these treatment approaches have yet to be fully explored. The characteristics of polydrug use disorder (PUD) especially need to be addressed in more detail, as this diagnosis is highly common in individuals seeking treatment, while simultaneously being associated with poor treatment success. Aim and Scope: This review aims at further exploring the relevance of attachment in PUD and its treatment. To this end, this review provides a concise summary of relevant theories on the development and treatment of SUD in general, including related parameters of attachment, emotion regulation, and neuroscience. Furthermore, several studies focused specifically on PUD are described in more detail. These studies explored the connections between attachment, personality structure, primary and higher emotions (including spirituality), as well as structural and functional neural parameters in inpatients with PUD as well as in healthy controls. Most notably, the described studies highlight that insecure attachment and impairments in personality structure are present in inpatients with PUD. In addition, these characteristics are paralleled by extensive impairments in white matter integrity, especially in tracts connected to facets of emotion regulation. Conclusions: Based on our findings, we emphasize conceptualization of PUD as an Attachment Disorder, on a behavioral as well as on a neural level. Furthermore, we point out the importance of an integrated bio-psycho-social approach in this research area. Consequently, future studies might more closely focus on the influence of attachment-based interventions on emotion regulation abilities as well as a potentially related neuroplasticity. Neuroplastic changes, which are still rather unexplored, might represent important parameters for the assessment of treatment outcomes especially in long-term SUD treatment.© 2019 Hiebler-Ragger and Unterraine

The non-invasive serum biomarker soluble Axl accurately detects advanced liver fibrosis and cirrhosis

Soluble Axl (sAxl) was recently shown to be strongly released into the blood during liver fibrogenesis and hepatocellular carcinoma suggesting sAxl as a biomarker of liver diseases. In this study we are the first to evaluate sAxl in human serum in comparison to Enhanced Liver Fibrosis (ELF) test and transient elastography (TE; Fibroscan) for its value to detect significant (F≥2), advanced fibrosis (F≥3), and cirrhosis (F4) in different liver disease etiologies and healthy controls. To properly determine the diagnostic accuracy of sAxl, a test cohort as well as a validation cohort was employed using liver biopsy as a reference method. Most notably, sAxl was confirmed to be an accurate biomarker of liver fibrosis and cirrhosis. Its accuracy was increased, if total serum albumin was added to build a sAxl/albumin ratio. Thereby an AUC of 0.763, 0.776, 0.826, and 0.832 was achieved corresponding to histological fibrosis stages F≥2, F≥3, F4 with liver biopsy as a reference method, and cirrhosis according to imaging techniques, respectively. With a cut-off of 1.29, a sensitivity, specificity, PPV, and NPV of 78.5%, 80.1%, 44%, 94.9% for the detection of cirrhosis was achieved. In comparison, ELF test and TE showed an AUC of 0.910, and 0.934, respectively, for the detection of cirrhosis. However, performance of TE was not possible in 14.4% of patients and both, ELF™ test and TE bear the disadvantage of high costs. In conclusion, the sAxl/albumin ratio is suggested as an accurate biomarker of liver fibrosis and cirrhosis. Due to its easy applicability and low costs it is suitable as screening parameter for significant to advanced liver fibrosis and cirrhosis, especially if TE is not available or not applicable.© The Author(s) 201

Depressive Symptoms and Addictive Behaviors in Young Adults After Childhood Trauma: The Mediating Role of Personality Organization and Despair

Background: There is substantial evidence that traumatic experiences in childhood increase the likelihood of mood pathology and addictive behaviors in adolescence and young adulthood. Furthermore, both forms of psychopathology have been linked to deficiencies in personality organization and a common primary emotion core. In this study, we intended to further investigate these interactions by assuming a mediating role of personality organization and despair regarding the relationship between childhood trauma and psychiatric symptom burden later in life. Methods: A total sample of 500 young adults (Age: M = 26; SD = 5.51; 63.2% female) were investigated. Structural Equation Modeling was applied in order to investigate the pathways between the latent variables Childhood Trauma, Structural Deficit, Despair (comprised of the primary emotions SEEKING and SADNESS), as well as symptoms of addiction and depression. Results: The results indicate that the influence of Childhood Trauma on Addictive Behaviors was mediated by Structural Deficit (p < 0.01), whereas its influence on Depressive Symptoms was mediated by Despair (decreased SEEKING and increased SADNESS) (p < 0.01). Furthermore, Addictive Behaviors seemed to be stronger represented in males (p < 0.001). The final model was able to explain 39% of the variance of Addictive Behaviors and 85% of the variance of Depressive Symptoms. Discussion: The findings underline the importance of early experiences in the development of adult affective and personality functioning, which is linked to the development of psychiatric disorders. Regarding clinical practice, addiction treatment might focus on the improvement of personality organization, while treatment of depressed patients should primarily emphasize the restructuring of dysfunctional primary emotion dispositions.© 2018 Fuchshuber, Hiebler-Ragger, Kresse, Kapfhammer and Unterraine

Do Primary Emotions Predict Psychopathological Symptoms? A Multigroup Path Analysis

Background: Research involving animal models has repeatedly proposed dysregulations in subcortically rooted affective systems as a crucial etiological factor in the development of a variety of psychiatric disorders. However, empirical studies with human participants testing these hypotheses have been sparse. Associations between primary emotions systems and different psychiatric symptoms were investigated in order to gain insights into the influence of evolutionary-rooted primary emotions on psychopathology. Material and Methods: The community sample included 616 adults (61.9% female). 243 reported a psychiatric lifetime diagnosis. By applying path analysis, we estimated paths between SEEKING, ANGER, FEAR, SADNESS, CARE, and PLAY (Affective Neuroscience Personality Scales; ANPS) and symptoms of substance abuse (Alcohol, Smoking, and Substance Involvement Screening Test; ASSIST) as well as depression, anxiety, and somatization (Brief Symptom Inventory; BSI-18). To examine the moderator effects of gender and psychiatric lifetime diagnosis, multigroup analysis was applied. Results: Substance abuse was associated with male sex (β = −.25), SADNESS (β = .25), and ANGER (β = .10). Depression was associated with SADNESS (β = .53), FEAR (β = .10), SEEKING (β = −.10), and PLAY (β = −.15). Anxiety was linked to SADNESS (β = .33), FEAR (β = .21) and PLAY (β = −.10). Somatization was associated with SADNESS (β = .26) and PLAY (β = −.12; all p .01). The model explained 14% of the variance of substance abuse, 52% of depression, 32% of anxiety, and 14% of somatization. Conclusions: The results further our understanding of the differential role of primary emotions in the development of psychopathology. In this, the general assumption that primary emotion functioning might be a valuable target in mental health care is underlined.© 2019 Fuchshuber, Hiebler-Ragger, Kresse, Kapfhammer and Unterraine