Shame, self-criticism and fears of compassion in Borderline Personality Disorder

BPD is a serious mental illness characterized by instability in interpersonal relationships, self-image, affect, and marked impulsivity. Although there are evidence based therapies for BPD that have been shown to be particularly effective in reducing severe impairments in behavioral control and emotion regulation (S3-Guideline; Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften, 2022), results of long-term studies show that more than half of those affected do not achieve good social and vocational functioning even 10 years after diagnosis (Zanarini et al., 2010, 2012). These findings suggest that further research into the underlying pathomechanisms is needed in order to develop even more tailored treatments. The aim of this dissertation was to contribute to a better understanding of the processing of self-related information, a domain that is thought to contribute the poor social integration of individuals with BPD. The focus of the underlying three studies was on the investigation of the negative self-conscious emotion shame, self-criticism and fears of compassion, representing major resistances in affiliative self-related processes respectively. Since there have been no translations and validations of the corresponding measuring instruments on self-criticism and fears of compassion to date, these were carried out within the framework of this thesis. Both, the translation and validation of the Forms of Self-Criticizing/-Attacking and Self-Reassuring Scale (FSCRS; Gilbert et al., 2004) and the Fears of Compassion Scales (FCS; Gilbert et al., 2011) resulted in German versions with good to excellent psychometric quality, comparable to those of the original English versions and offer further opportunities for research of these concepts in German-speaking countries. With regard to self-criticism, individuals with BPD reported higher levels of the hated self aspect of self-criticism in comparison to a mixed clinical sample and additionally higher levels of the inadequate and lower levels of the reassured self aspect of self-criticism compared to a sample from the general population and a healthy control (HC) sample. In addition to the general relevance of self-criticism in BPD, these findings point to the pronounced urge to self-attacking tendencies in the face of failure or distress, which distinguishes individuals with BPD from other clinical disorders. In the light of previous findings of impairments in processes of social approach and affiliation, fears of compassion seem to be specific resistances to these processes. While individuals with BPD differed on all three dimensions of fears of compassion (for self, for other, from others) from nonclinical participants, there were no differences in fears of compassion towards others compared to a mixed clinical sample. Furthermore, during an experimental paradigm addressing levels of state shame in BPD compared to healthy control persons, the mere confrontation with the own face resulted in higher levels of state shame and self-disgust and the confrontation with the face of another person in higher levels of envy in BPD in comparison to healthy control persons. While levels of state shame during the experimental confrontation with the own self was associated with elevated proneness to shame across both samples, this relation could not be found when analyzing the BPD and HC sample separately. This again underlines that the aversiveness of processes directed towards the own self is of particular importance for the psychopathology of BPD. Nevertheless, further longitudinal studies are required that capture the exact links between these concepts and BPD psychopathology. The development and research of treatments that are more tailored to these impairments is therefore of particular relevance. Therapeutic approaches such as Compassion Focused Therapy (CFT; Gilbert, 2014) that directly target shame and self-criticism have already been shown to be effective in other mental disorders (Craig et al., 2020) and might also be a potentially promising treatment in BPD

In situ detection of cracks during laser powder bed fusion using acoustic emission monitoring

Despite rapid development of laser powder bed fusion (L-PBF) and its monitoring techniques, there is still a lack of in situ crack detection methods, among which acoustic emission (AE) is one of the most sensitive. To elaborate on this topic, in situ AE monitoring was applied to L-PBF manufacturing of a high-strength Al92Mn6Ce2 (at. %) alloy and combined with subsequent X-ray computed tomography. By using a structure borne high-frequency sensor, even a simple threshold-based monitoring was able to detect AE activity associated with cracking, which occurred not only during L-PBF itself, but also after the build job was completed, i.e. in the cooling phase. AE data analysis revealed that crack-related signals can easily be separated from the background noise (e.g. inert gas circulation pump) through their specific shape of a waveform, as well as their energy, skewness and kurtosis. Thus, AE was verified to be a promising method for L-PBF monitoring, enabling to detect formation of cracks regardless of their spatial and temporal occurrence

Psychometric properties of the German version of the fears of compassion scales

The cultivation of compassion is associated with beneficial effects on physical and psychological health, satisfaction with life and social relationships. However, some individuals, especially those high in psychopathological symptoms or those with particular disorders such as borderline personality disorder (BPD) may demonstrate pronounced fears of engagement in compassionate experiences or behaviours. Furthermore, fears of compassion have been found to impede progress in psychotherapy. The 38‐item fears of compassion scales (FCS) is a self‐report questionnaire for measuring trait levels of fears of compassion (a) one receives from others (FCFO), (b) one feels towards others (FCTO) and (c) one feels for oneself (self‐compassion; FSC). The FCS is an internationally used instrument of proven validity and reliability in both clinical and nonclinical samples. In the present study, a German translation of the FCS including its three subscales was provided, and the psychometric properties were examined in 430 participants from four different samples: (a) a sample from the general population; (b) a mixed sample of psychiatric residential and outpatients; (c) a clinical sample of residential and outpatients with a primary diagnosis of BPD and (d) a sample of healthy control participants. Internal consistencies were excellent for the German version of the FSC and acceptable to excellent for its subscales. Correlations with established measures of mental health demonstrate its validity. Additionally, the German FCS discriminates significantly between individuals from the general population and patients, thus supporting its specificity. The German FCS is suitable to detect potential obstacles in cultivating compassion in psychotherapeutic treatments and beyond.N/

Predictors of Psychological Distress and Coronavirus Fears in the First Recovery Phase of the Coronavirus Disease 2019 Pandemic in Germany

Objectives: While previous research has mainly focused on the impact of the first acute phase of the COVID-19 pandemic on mental health, little empirical knowledge exists about depression, anxiety, and somatic symptom levels and possible predictors of symptom levels in the pandemic’s recovery phase. The present study aimed to analyze the mental burden of a convenience ample of the general German population during the first recovery phase of the pandemic and to identify significant predictors of symptom levels.Methods: Standardized measures of anxiety (GAD-2), depression (PHQ-2), somatic symptoms (PHQ-15), and health anxiety, as well as measures of COVID-19 fears and possible vulnerability factors, were administered through a national, cross-sectional online survey (n = 2160, mean age 42.7 years, 75% female), asking participants for their current symptom levels and their symptom levels prior to the COVID-19 pandemic.Results: Our findings show significantly elevated levels of depression, anxiety, somatic symptoms, and health anxiety in the recovery period compared to before the pandemic. The current prevalence rates based on self-reporting were 26.7% for depression, 24.5% for anxiety, and 29% for somatization. The strongest predictors of these symptom reports included domain-specific pre-existing symptom levels, neuroticism, biological COVID-19 risk factors, avoidance of illness information, and younger age. The most important predictors of COVID-19 fears were subjective COVID-19 risk perception, followed by pre-existing health anxiety, the number of biological COVID-19 risk factors, older age, neuroticism, avoidance of illness information and female gender.Discussion: These findings indicate the need for specific psychological programs to help individuals with enhanced psychological and biological vulnerability to cope better with the mental distress experienced during all phases of the ongoing COVID-19 crisis.publishe

Shame, self-disgust, and envy: An experimental study on negative emotional response in borderline personality disorder during the confrontation with the own face

Background A markedly negative self-image and pervasive shame proneness have consistently been associated with borderline personality disorder (BPD). The present experimental study investigated the intensity of negative emotional responses with a focus on shame in BPD compared to healthy control persons (HCs) during an experimental paradigm promoting self-awareness, self-reflection, and self-evaluation. Furthermore, the relationship between levels of state shame during the experiment and shame proneness in BPD compared to HCs was examined. Methods A sample of 62 individuals with BPD and 47 HCs participated in the study. During the experimental paradigm, participants were presented with photos of (i) the own face, (ii) the face of a well-known person, and (iii) of an unknown person. They were asked to describe positive facets of these faces. Participants rated the intensity of negative emotions induced by the experimental task as well the pleasantness of the presented faces. Shame-proneness was assessed using the Test of the Self-Conscious Affect (TOSCA-3). Results Individuals with BPD experienced significantly higher levels of negative emotions than HCs both before and during the experimental task. While HC participants responded to their own face particularly with an increase in shame compared to the other-referential condition, the BPD patients responded above all with a strong increase of disgust. Furthermore, the confrontation with an unknown or well-known face resulted in a strong increase of envy in BPD compared to HC. Individuals with BPD reported higher levels of shame-proneness than HCs. Higher levels of shame-proneness were related to higher levels of state shame during the experiment across all participants. Conclusion Our study is the first experimental study on negative emotional responses and its relationship to shame proneness in BPD compared to HC using the own face as a cue promoting self-awareness, self-reflection, and self-evaluation. Our data confirm a prominent role of shame when describing positive features of the own face, but they emphasize also disgust and envy as distinct emotional experience characterizing individuals with BPD when being confronted with the self

Implementierung und Evaluation einer Telefonhotline zur professionellen Ersthilfe bei psychischen Belastungen durch die COVID-19-Pandemie in Baden-Württemberg

Hintergrund: Die COVID-19-Pandemie stellt für viele Menschen eine deutliche psychische Belastung dar, für deren Bewältigung gerade während der ersten Welle der Pandemie sofort verfügbare professionelle Ansprechpartner fehlten. Ziel der Arbeit: In Baden-Württemberg wurde unter Federführung des Ministeriums für Soziales und Integration im April 2020 eine Telefonhotline zur psychologischen Ersthilfe bei Corona-assoziierten Problemen implementiert, für die gesamte Bevölkerung geöffnet und evaluiert. Material und Methoden: Im Zeitraum vom 22.04. bis zum 24.07.2020 nahmen 753 ehrenamtliche, psychotherapeutisch ausgebildete Berater*innen unterschiedlicher Berufsgruppen insgesamt 8096 Anrufe entgegen. Ergebnisse: Es wurden vor allem Depressions- (36 %), Angst- (18 %) und psychotische Symptome (19 %) berichtet. Dabei stand jeder zweite Anruf im Zusammenhang mit einer vorbestehenden psychischen Erkrankung. In den durchschnittlich 25- minütigen Beratungsgesprächen wurde eine Vielzahl psychologischer Akutinterventionen durchgeführt. Beim Vorliegen einer unklaren Symptomatik, psychotischer Symptomatik oder Symptomen schwerer Persönlichkeitsstörungen konnten die Berater*innen aus deren subjektiver Sicht signifikant weniger helfen als bei den restlichen Telefonaten, in denen klar umschriebene andere Symptome vorlagen. Diskussion: Die Ergebnisse weisen sowohl auf den Nutzen als auch die Grenzen von Hotlineangeboten hin. Der Nutzen besteht vor allem in der schnellen Verfügbarkeit sowie einer effektiven professionellen Hilfe bei klar charakterisierter Symptomatik. Bei unklarer oder komplexer Symptomatik scheint eine unmittelbare telefonische Hilfe zwar nur eingeschränkt möglich zu sein, sie kann den Zugang zu weiteren Hilfsangeboten jedoch einleiten. Insgesamt geben die Ergebnisse dieser Studie einen ersten Hinweis darauf, dass Hotlineangebote eine praktikable Möglichkeit zur psychologischen Ersthilfe unter Pandemiebedingungen darstellen

Trustworthiness appraisals of faces wearing a surgical mask during the Covid-19 pandemic in Germany: An experimental study.

BackgroundDuring the Covid-19 pandemic, the negative effects of wearing a mouth-nose cover (MNC) on interpersonal functioning have been discussed in public media but empirical studies on how wearing MNCs affect social judgements are sparse. In the present study, we investigated the effects of MNCs on trustworthiness appraisals, the influence of changes due to MNCs in evaluating joy, and the relationship between a social-cognitive appraisal bias and a participant's characteristics.MethodsAll participants (N = 165) judged the intensity of happiness and trustworthiness in calm facial stimuli presented with and without a surgical mask covering part of the face. We analysed the relationship of changes in judgements evoked by MNCs to participants' evaluations of MNCs as protective tools and explored their associations with the burden experienced by wearing MNCs, compliance to behaviour recommendations, their risk associated with the pandemic, and their levels of psychological distress.ResultsOverall, calm facial stimuli covered with MNCs were evaluated as less trustworthy and, to an even stronger extent, less happy than uncovered facial stimuli. However, participants varied in whether they showed a negative or positive evaluation of faces with MNCs; the negative bias was stronger in those participants who attributed lower protective potential to MNCs, experienced a higher burden while wearing MNCs, wore MNCs less often, and experienced a higher level of psychological distress.ConclusionsA negative bias in trustworthiness appraisals of faces with a positive emotional expression covered by MNCs is linked to a participant's evaluation of MNCs as inefficient and burdening and their experience of high psychological distress