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Bockhop F, Greving S, Zeldovich M, Krenz U, Cunitz K, Timmermann D, Kieslich M, Andelic N, Buchheim A, Koerte IK, Roediger M, Brockmann K, Bonfert MV, Berweck S, Lendt M, Staebler M, von Steinbuechel N. Applicability and clinical utility of the German rivermead post-concussion symptoms questionnaire in proxies of children after traumatic brain injury: an instrument validation study. BMC Neurol 2024; 24:133. [PMID: 38641780 PMCID: PMC11027521 DOI: 10.1186/s12883-024-03587-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/26/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND The German Rivermead Post-Concussion Symptoms Questionnaire (RPQ) can be used to assess post-concussion symptoms (PCS) after traumatic brain injury (TBI) in adults, adolescents, and children. METHODS In this study, we examined the psychometric properties of the German RPQ proxy version (N = 146) for children (8-12 years) after TBI at the item, total and scale score level. Construct validity was analyzed using rank correlations with the proxy-assessed Post-Concussion Symptoms Inventory (PCSI-P), the Patient Health Questionnaire 9 (PHQ-9), and the Generalized Anxiety Disorder Scale 7 (GAD-7). Furthermore, sensitivity testing was performed concerning subjects' sociodemographic and injury-related characteristics. Differential item functioning (DIF) was analyzed to assess the comparability of RPQ proxy ratings for children with those for adolescents. RESULTS Good internal consistency was demonstrated regarding Cronbach's α (0.81-0.90) and McDonald's ω (0.84-0.92). The factorial validity of a three-factor model was superior to the original one-factor model. Proxy ratings of the RPQ total and scale scores were strongly correlated with the PCSI-P (ϱ = 0.50-0.69), as well as moderately to strongly correlated with the PHQ-9 (ϱ = 0.49-0.65) and the GAD-7 (ϱ = 0.44-0.64). The DIF analysis revealed no relevant differences between the child and adolescent proxy versions. CONCLUSIONS The German RPQ proxy is a psychometrically reliable and valid instrument for assessing PCS in children after TBI. Therefore, RPQ self- and proxy-ratings can be used to assess PCS in childhood as well as along the lifespan of an individual after TBI.
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Affiliation(s)
| | - Sven Greving
- University Medical Center Göttingen, Göttingen, Germany
| | - Marina Zeldovich
- Institute of Psychology, University Innsbruck, Innsbruck, Austria
- Faculty of Psychotherapy Science, Sigmund Freud University Vienna, Vienna, Austria
| | - Ugne Krenz
- University Medical Center Göttingen, Göttingen, Germany
| | - Katrin Cunitz
- Institute of Psychology, University Innsbruck, Innsbruck, Austria
| | - Dagmar Timmermann
- University Medical Center Göttingen, Göttingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Division of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Göttingen, Germany
| | - Matthias Kieslich
- Department of Paediatric Neurology, Goethe-University Frankfurt/Main, Frankfurt/Main, Germany
| | - Nada Andelic
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Department of Health and Society, University of Oslo, Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Anna Buchheim
- Institute of Psychology, Faculty of Psychology and Sport Science, University of Innsbruck, Innsbruck, Austria
| | - Inga K Koerte
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig‑Maximilians‑Universität München, Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Mass General Brigham, Bosten, USA
| | - Maike Roediger
- Department of Pediatric Intensive Care Medicine and Neonatology, University Hospital Münster, Münster, Germany
| | - Knut Brockmann
- Department of Pediatrics and Adolescent Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Michaela V Bonfert
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children With Medical Complexity, Ludwig‑Maximilians‑Universität München, Munich, Germany
| | - Steffen Berweck
- Specialist Center for Paediatric Neurology, Neurorehabilitation and Epileptology, Schoen Klinik, Vogtareuth, Germany
| | - Michael Lendt
- Neuropediatrics, St. Mauritius Therapeutic Clinic, Meerbusch, Germany
| | - Michael Staebler
- Neurological Rehabilitation Center for Children, Adolescents and Young Adults, Hegau-Jugendwerk GmbH, Gailingen am Hochrhein, Germany
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Schurz M, Berenz JP, Maerz J, Perla R, Buchheim A, Labek K. Brain Activation for Social Cognition and Emotion Processing Tasks in Borderline Personality Disorder: A Meta-Analysis of Neuroimaging Studies. Brain Sci 2024; 14:395. [PMID: 38672044 PMCID: PMC11048542 DOI: 10.3390/brainsci14040395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/15/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
The present meta-analysis summarizes brain activation for social cognition and emotion-processing tasks in borderline personality disorder (BPD). We carried out two meta-analyses to elaborate on commonalities and potential differences between the two types of tasks. In the first meta-analysis, we implemented a more liberal strategy for task selection (including social and emotional content). The results confirmed previously reported hyperactivations in patients with BPD in the bilateral amygdala and prefrontal cortex and hypoactivations in bilateral inferior frontal gyri. When applying a stricter approach to task selection, focusing narrowly on social cognition tasks, we only found activation in prefrontal areas, particularly in the anterior cingulate and ventromedial prefrontal cortex. We review the role of these areas in social cognition in healthy adults, suggesting that the observed BPD hyperactivations may reflect an overreliance on self-related thought in social cognition.
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Affiliation(s)
- Matthias Schurz
- Department of Psychology, Faculty of Psychology and Sport Science, and Digital Science Center (DiSC), University of Innsbruck, Universitätsstrasse 15, 6020 Innsbruck, Austria
| | - Jan-Patrick Berenz
- Department of Psychology, Faculty of Psychology and Sport Science, University of Innsbruck, Universitätsstrasse 15, 6020 Innsbruck, Austria
| | - Jeff Maerz
- Department of Psychology, Faculty of Psychology and Sport Science, University of Innsbruck, Universitätsstrasse 15, 6020 Innsbruck, Austria
| | - Raphael Perla
- Department of Psychology, Faculty of Psychology and Sport Science, and Digital Science Center (DiSC), University of Innsbruck, Universitätsstrasse 15, 6020 Innsbruck, Austria
| | - Anna Buchheim
- Department of Psychology, Faculty of Psychology and Sport Science, University of Innsbruck, Universitätsstrasse 15, 6020 Innsbruck, Austria
| | - Karin Labek
- Department of Psychology, Faculty of Psychology and Sport Science, University of Innsbruck, Universitätsstrasse 15, 6020 Innsbruck, Austria
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von Steinbuechel N, Zeldovich M, Timmermann D, Krenz U, Koerte IK, Bonfert MV, Berweck S, Kieslich M, Henrich M, Brockmann K, Buchheim A, Roediger M, Lendt M, Auer C, Neu A, Kaiser A, Driemeyer J, Greving S, Wartemann U, Pinggera D, Thomé C, Suss J, Muehlan H, Cunitz K. Final Validation of the Quality of Life after Brain Injury for Children and Adolescents (QOLIBRI-KID/ADO) Questionnaire. Children (Basel) 2024; 11:438. [PMID: 38671655 PMCID: PMC11049366 DOI: 10.3390/children11040438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/18/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024]
Abstract
Until recently, no disease-specific health-related quality of life (HRQoL) questionnaire existed for pediatric traumatic brain injuries (TBIs). In this revalidation study, the psychometric properties and the validity of the 35-item QOLIBRI-KID/ADO questionnaire in its final German version were examined in 300 children and adolescents. It is the first self-reported TBI-specific tool for measuring pediatric HRQoL in individuals aged between 8 and 17 years. The six-factor model fits the data adequately. The questionnaire's internal consistency was excellent for the total score and satisfactory to excellent for the scale scores. Intraclass correlations indicated good test-retest reliability, and the measure's construct validity was supported by the overlap between the QOLBRI-KID/ADO and the PedsQL, which measures generic HRQoL. The discriminant validity tests showed that older children and girls reported a significantly lower HRQoL than comparison groups, and this was also true of children who were anxious or depressed, or who suffered from post-concussion symptoms, replicating the results of the questionnaire's first developmental study. Our results suggest that the QOLIBRI-KID/ADO is a reliable and valid multidimensional tool that can be used together with the adult version in clinical contexts and research to measure disease-specific HRQoL after pediatric TBI throughout a person's life. This may help improve care, treatment, daily functioning, and HRQoL after TBI.
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Affiliation(s)
- Nicole von Steinbuechel
- Institute of Psychology, University of Innsbruck, Universitaetsstr. 5-7, 6020 Innsbruck, Austria; (N.v.S.); (M.Z.); (A.B.)
| | - Marina Zeldovich
- Institute of Psychology, University of Innsbruck, Universitaetsstr. 5-7, 6020 Innsbruck, Austria; (N.v.S.); (M.Z.); (A.B.)
- Faculty of Psychotherapy Science, Sigmund Freud University Vienna, 1020 Vienna, Austria
| | - Dagmar Timmermann
- Department of Psychosomatic Medicine and Psychotherapy, Division of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Waldweg 37A, 37073 Goettingen, Germany;
| | - Ugne Krenz
- University Medical Center Goettingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (U.K.); (S.G.)
| | - Inga K. Koerte
- cBRAIN/Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilian University Hospital, LMU University, Nussbaumstrasse 5, 80336 Munich, Germany;
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Mass General Brigham, 55 Fruit Street, Boston, MA 02114, USA
| | - Michaela V. Bonfert
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, Dr. Von Hauner Children’s Hospital, LMU University Hospital, Haydnstr. 5, 80336 Munich, Germany;
| | - Steffen Berweck
- Specialist Center for Paediatric Neurology, Neurorehabilitation and Epileptology, Schoen Klinik, Krankenhausstraße 20, 83569 Vogtareuth, Germany;
| | - Matthias Kieslich
- Department of Paediatric Neurology, Hospital of Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; (M.K.); (M.H.)
| | - Marlene Henrich
- Department of Paediatric Neurology, Hospital of Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany; (M.K.); (M.H.)
| | - Knut Brockmann
- Interdisciplinary Pediatric Center for Children with Developmental Disabilities and Severe Chronic Disorders, Department of Pediatrics and Adolescent Medicine, University Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany;
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Universitaetsstr. 5-7, 6020 Innsbruck, Austria; (N.v.S.); (M.Z.); (A.B.)
| | - Maike Roediger
- Department of Pediatrics and Adolescent Medicine, General Pediatrics, Intensive Care Medicine and Neonatology & Department of Pediatric Cardiology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany;
| | - Michael Lendt
- Neuropediatrics, St. Mauritius Therapeutic Clinic, Strümper Straße 111, 40670 Meerbusch, Germany;
| | - Christian Auer
- Johannes Kepler University Linz, Altenberger Straße 69, 4020 Linz, Austria;
- Department of Neurosurgery, Kepler Univesity Hospital GmbH, Wagner-Jauregg-Weg 15, 4020 Linz, Austria
| | - Axel Neu
- Department of Neurology and Neuropediatry, VAMED Klinik Geesthacht GmbH, Johannes-Ritter-Straße 100, 21502 Geesthacht, Germany; (A.N.); (A.K.)
| | - Alexander Kaiser
- Department of Neurology and Neuropediatry, VAMED Klinik Geesthacht GmbH, Johannes-Ritter-Straße 100, 21502 Geesthacht, Germany; (A.N.); (A.K.)
| | - Joenna Driemeyer
- Department of Pediatrics, University of Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany;
| | - Sven Greving
- University Medical Center Goettingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany; (U.K.); (S.G.)
| | - Ulrike Wartemann
- Department of Neuropediatrics, VAMED Klinik Hohenstücken GmbH, Brahmsstraße 38, 14772 Brandenburg an der Havel, Germany;
| | - Daniel Pinggera
- Department of Neurosurgery, Tirol Kliniken GmbH, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (D.P.); (C.T.)
| | - Claudius Thomé
- Department of Neurosurgery, Tirol Kliniken GmbH, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria; (D.P.); (C.T.)
| | - Joachim Suss
- Department of Pediatric Surgery, Wilhelmstift Catholic Children’s Hospital, Liliencronstraße 130, 22149 Hamburg, Germany;
| | - Holger Muehlan
- Department of Health and Prevention, University of Greifswald, Robert-Blum-Str. 13, 17487 Greifswald, Germany;
| | - Katrin Cunitz
- Institute of Psychology, University of Innsbruck, Universitaetsstr. 5-7, 6020 Innsbruck, Austria; (N.v.S.); (M.Z.); (A.B.)
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Von-Siebold-Str. 5, 37075 Goettingen, Germany
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Krol L, Hagmayer Y, von Steinbuechel N, Cunitz K, Buchheim A, Koerte IK, Zeldovich M. Reference Values for the German Version of the Quality of Life after Brain Injury in Children and Adolescents (QOLIBRI-KID/ADO) from a General Population Sample. J Pers Med 2024; 14:336. [PMID: 38672963 PMCID: PMC11051333 DOI: 10.3390/jpm14040336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/07/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Assessment of health-related quality of life (HRQoL) after pediatric traumatic brain injury (TBI) has been limited in children and adolescents due to a lack of disease-specific instruments. To fill this gap, the Quality of Life after Traumatic Brain Injury for Children and Adolescents (QOLIBRI-KID/ADO) Questionnaire was developed for the German-speaking population. Reference values from a comparable general population are essential for comprehending the impact of TBI on health and well-being. This study examines the validity of the German QOLIBRI-KID/ADO in a general pediatric population in Germany and provides reference values for use in clinical practice. Overall, 1997 children and adolescents aged 8-17 years from the general population and 300 from the TBI population participated in this study. The questionnaire was tested for reliability and validity. A measurement invariance (MI) approach was used to assess the comparability of the HRQoL construct between both samples. Reference values were determined by percentile-based stratification according to factors that significantly influenced HRQoL in regression analyses. The QOLIBRI-KID/ADO demonstrated strong psychometric properties. The HRQoL construct was measured largely equivalently in both samples, and reference values could be provided. The QOLIBRI-KID/ADO was considered reliable and valid for assessing HRQoL in a general German-speaking pediatric population, allowing for clinically meaningful comparisons between general and TBI populations.
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Affiliation(s)
- Leonie Krol
- Department of Psychology, Clinical Psychology, Experimental Psychopathology, and Psychotherapy, University of Marburg, 35037 Marburg, Germany
| | - York Hagmayer
- Georg-Elias-Müller Institute for Psychology, Georg-August-University, 37073 Goettingen, Germany;
| | - Nicole von Steinbuechel
- Institute of Psychology, University of Innsbruck, 6020 Innsbruck, Austria; (N.v.S.); (K.C.); (A.B.)
| | - Katrin Cunitz
- Institute of Psychology, University of Innsbruck, 6020 Innsbruck, Austria; (N.v.S.); (K.C.); (A.B.)
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, 37075 Goettingen, Germany
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, 6020 Innsbruck, Austria; (N.v.S.); (K.C.); (A.B.)
| | - Inga K. Koerte
- cBRAIN/Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, LMU University Hospital, Ludwig-Maximilian University, 80337 Munich, Germany;
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women’s Hospital, Mass General Brigham, Harvard Medical School, Boston, MA 02115, USA
| | - Marina Zeldovich
- Institute of Psychology, University of Innsbruck, 6020 Innsbruck, Austria; (N.v.S.); (K.C.); (A.B.)
- Faculty of Psychotherapy Science, Sigmund Freud University Vienna, Freudplatz 1, 1020 Vienna, Austria
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Zeldovich M, Krol L, Timmermann D, Krenz U, Arango-Lasprilla JC, Gioia G, Brockmann K, Koerte IK, Buchheim A, Roediger M, Kieslich M, von Steinbuechel N, Cunitz K. Corrigendum: Psychometric evaluation and reference values for the German Postconcussion Symptom Inventory (PCSI-SR8) in children aged 8-12 years. Front Neurol 2024; 15:1372640. [PMID: 38529034 PMCID: PMC10962279 DOI: 10.3389/fneur.2024.1372640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/01/2024] [Indexed: 03/27/2024] Open
Abstract
[This corrects the article DOI: 10.3389/fneur.2023.1266828.].
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Affiliation(s)
- Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Leonie Krol
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
| | - Dagmar Timmermann
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
| | - Ugne Krenz
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
| | | | - Gerard Gioia
- Division of Pediatric Neuropsychology, Safe Concussion Outcome Recovery and Education Program, Children's National Health System, Department of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine, Rockville, MA, United States
| | - Knut Brockmann
- Interdisciplinary Pediatric Center for Children with Developmental Disabilities and Severe Chronic Disorders, Department of Pediatrics and Adolescent Medicine, University Medical Center Goettingen, Goettingen, Germany
| | - Inga K. Koerte
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universitaet Muenchen, Munich, Germany
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Maike Roediger
- Department of Pediatric and Adolescent Medicine- General Pediatrics- Intensive Care Medicine and Neonatology, University Hospital Muenster, Muenster, Germany
| | - Matthias Kieslich
- Department of Paediatric Neurology, Goethe-University Frankfurt/Main, Frankfurt, Germany
| | - Nicole von Steinbuechel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Katrin Cunitz
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Goettingen, Germany
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Gander M, Buchheim A, Sevecke K. Personality Disorders and Attachment Trauma in Adolescent Patients with Psychiatric Disorders. Res Child Adolesc Psychopathol 2024; 52:457-471. [PMID: 37889355 PMCID: PMC10896792 DOI: 10.1007/s10802-023-01141-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 10/28/2023]
Abstract
This study examined how personality disorders (PD) differ with respect to gender, attachment status and traumatic childhood experiences in adolescent psychiatric inpatients. In particular, we investigated attachment-related traumatic material underlying adolescent PD. Our sample consisted of 175 inpatient adolescents aged 14 to 18 years (77% female, Mage = 15.13, SD = 1.35; 23% male, Mage =14.85, SD = 1.41). Thirty-nine patients (22%) fulfilled the diagnostic criteria for a PD according to the SCID-II PD: 51% avoidant, 13% obsessive-compulsive, 13% antisocial, 19% borderline, 2% paranoid and 2% histrionic. In the total sample, eighty-three (47%) of our inpatients were classified with an unresolved attachment status using the Adult Attachment Projective Picture System (AAP). We did not find any significant gender differences for patients with and without a PD. Our results revealed a higher percentage of unresolved attachment status in patients with a PD. The in-depth analysis of the total sample showed that patients with a PD demonstrated more traumatic material in their attachment interviews indicating a greater severity of attachment trauma. Furthermore, patients with a PD reported higher scores on emotional and physical neglect. Intervention strategies targeting traumatic attachment-related themes might be useful to treat adolescents with PD.
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Affiliation(s)
- Manuela Gander
- Institute of Psychology, University of Innsbruck, Universitätsstrasse 5-7, Innsbruck, 6020, Austria.
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, Milserstrasse 10, 6060 Hall in Tirol, Tirol, Austria.
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Universitätsstrasse 5-7, Innsbruck, 6020, Austria
| | - Kathrin Sevecke
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, Milserstrasse 10, 6060 Hall in Tirol, Tirol, Austria
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, Innsbruck, 6020, Austria
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Gander M, Buchheim A, Kohlböck G, Sevecke K. Unresolved attachment and identity diffusion in adolescence. Dev Psychopathol 2024:1-10. [PMID: 38305076 DOI: 10.1017/s0954579424000014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
This study examined the severity of unresolved attachment underlying adolescent identity diffusion. Our sample consisted of 180 inpatient adolescents aged 14 to 18 years (77% female, M age = 15.13, SD = 1.35; 23% male, M age = 14.85, SD = 1.41) and 84 age-matched non-clinical adolescents (52% female, M age = 16.14, SD = 1.21; 48% males, M age = 15.98, SD = 1.07). We used the Adult Attachment Projective Picture System (AAP) interview to assess attachment representations and the Assessment of Identity Development in Adolescence (AIDA) questionnaire to evaluate the severity of identity diffusion. Our results demonstrate a higher amount of unresolved attachment and identity diffusion in the patient sample than in the control sample. Furthermore, patients with an unresolved attachment status scored higher on identity diffusion than those with no unresolved attachment pattern. Interestingly, this was not found in the control group. Furthermore, patients with a greater severity of unresolved attachment showed the highest maladaptive identity development scores. Psychotherapeutic interventions integrating attachment-related aspects might be useful to treat young people with identity diffusion.
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Affiliation(s)
- Manuela Gander
- University of Innsbruck, Institute of Psychology, Innsbruck, Austria
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, Hall in Tirol, Austria
| | - Anna Buchheim
- University of Innsbruck, Institute of Psychology, Innsbruck, Austria
| | - Gabriele Kohlböck
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, Hall in Tirol, Austria
| | - Kathrin Sevecke
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, Hall in Tirol, Austria
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, Innsbruck, Austria
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Zeldovich M, Krol L, Timmermann D, Krenz U, Arango-Lasprilla JC, Gioia G, Brockmann K, Koerte IK, Buchheim A, Roediger M, Kieslich M, von Steinbuechel N, Cunitz K. Psychometric evaluation and reference values for the German Postconcussion Symptom Inventory (PCSI-SR8) in children aged 8-12 years. Front Neurol 2023; 14:1266828. [PMID: 38046588 PMCID: PMC10693295 DOI: 10.3389/fneur.2023.1266828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/23/2023] [Indexed: 12/05/2023] Open
Abstract
Background Post-concussion symptoms (PCS) are a common consequence of pediatric traumatic brain injury (pTBI). They include cognitive, emotional, and physical disturbances. To address the lack of age-adapted instruments assessing PCS after pTBI, this study examines the psychometric properties of the German 17-item post-TBI version of the Postconcussion Symptom Inventory (PCSI-SR8) in children aged 8-12 years. The study also aims to establish reference values based on data from a pediatric general population sample to better estimate the prevalence and clinical relevance of PCS after pTBI in clinical and research settings. Methods A total of 132 children aged 8-12 years from a post-acute TBI sample and 1,047 from a general population sample were included in the analyses. The questionnaire was translated from English into German and linguistically validated using forward and backward translation and cognitive debriefing to ensure comprehensibility of the developed version. Reliability and validity were examined; descriptive comparisons were made with the results of the English study. Measurement invariance (MI) analyses between TBI and general population samples were conducted prior to establishing reference values. Factors contributing to the total and scale scores of the PCSI-SR8 were identified using regression analyses. Reference values were calculated using percentiles. Results Most children (TBI: 83%; general population: 79%) rated at least one symptom as "a little" bothersome. The German PCSI-SR8 met the psychometric assumptions in both samples and was comparable to the English version. The four-factor structure comprising physical, emotional, cognitive, and fatigue symptoms could be replicated. The MI assumption was retained. Therefore, reference values could be provided to determine the symptom burden of patients in relation to a comparable general population. Clinical relevance of reported symptoms is indicated by a score of 8, which is one standard deviation above the mean of the general population sample. Conclusion The German version of the PCSI-SR8 is suitable for assessment of PCS after pTBI. The reference values allow for a more comprehensive evaluation of PCS following pTBI. Future research should focus on validation of the PCSI-SR8 in more acute phases of TBI, psychometric examination of the pre-post version, and child-proxy comparisons.
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Affiliation(s)
- Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Leonie Krol
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
| | - Dagmar Timmermann
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
| | - Ugne Krenz
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
| | | | - Gerard Gioia
- Division of Pediatric Neuropsychology, Safe Concussion Outcome Recovery and Education Program, Children's National Health System, Department of Pediatrics and Psychiatry and Behavioral Sciences, George Washington University School of Medicine, Rockville, MA, United States
| | - Knut Brockmann
- Interdisciplinary Pediatric Center for Children with Developmental Disabilities and Severe Chronic Disorders, Department of Pediatrics and Adolescent Medicine, University Medical Center Goettingen, Goettingen, Germany
| | - Inga K. Koerte
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universitaet Muenchen, Munich, Germany
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Maike Roediger
- Department of Pediatric and Adolescent Medicine- General Pediatrics- Intensive Care Medicine and Neonatology, University Hospital Muenster, Muenster, Germany
| | - Matthias Kieslich
- Department of Paediatric Neurology, Goethe-University Frankfurt/Main, Frankfurt, Germany
| | - Nicole von Steinbuechel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Goettingen, Goettingen, Germany
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Katrin Cunitz
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
- Department of Psychiatry and Psychotherapy, University Medical Center Goettingen, Goettingen, Germany
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9
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Köhler-Dauner F, Peter L, Fegert JM, Ziegenhain U, Buchheim A. The role of attachment representation in the relationship between childhood maltreatment, mental health and parental load: A mediation analysis. Child Abuse Negl 2023; 144:106334. [PMID: 37454555 DOI: 10.1016/j.chiabu.2023.106334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/15/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Franziska Köhler-Dauner
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany.
| | - Lena Peter
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Jörg M Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Ute Ziegenhain
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
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10
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Jaywant A, Aulitzky W, Avari J, Buchheim A, Dubin M, Galffy M, Khoodoruth MAS, Maytal G, Skelin M, Sperner-Unterweger B, Barnhill JW, Fleischhacker WW. Multinational perspectives on changes to psychiatric care during the COVID-19 pandemic: a survey of practicing psychiatrists. Neuropsychiatr 2023; 37:115-121. [PMID: 36600105 PMCID: PMC9812354 DOI: 10.1007/s40211-022-00452-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/11/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has resulted in significant upheaval in psychiatric care. Despite survey data collected from psychiatric patients and broad samples of individuals in single countries, there is little quantitative or qualitative data on changes to psychiatric care from the perspective of mental health providers themselves across developing countries. METHODS To address this gap, we surveyed 27 practicing psychiatrists from Central and Eastern Europe, as well as Africa, the Middle East, and Latin America. RESULTS Respondents observed a marked increase in anxiety in their patients, with increased (though less prominent) symptoms of depression, somatization, and addiction. They reported largescale changes in the structure of psychiatric treatment, chiefly a decline in psychiatric admissions and closing/repurposing of psychiatric beds. Results supported strong "buy in" from clinicians regarding the use of telehealth, though some clinicians perceived a reduction in the ability to connect with, and build alliances with, their patients. Finally, clinicians described an improvement in the image and meaning of psychiatry in society, increased awareness of mental illness, and greater value placed on mental health in the general population. CONCLUSIONS These changes warrant further empirical study as to their potential long-term ramifications, particularly as the COVID-19 pandemic persists and new waves of infection occur periodically throughout the world. The increased psychiatric burden on the population coupled with the apparent salience of mental health and well-being in the public consciousness represents a global opportunity for psychiatry to advocate for further treatment, research, and education.
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Affiliation(s)
- Abhishek Jaywant
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.
- Weill Cornell Medicine/NewYork-Presbyterian Hospital, 525 E 68th St, Baker F-1232, 10065, New York, NY, USA.
| | | | - Jimmy Avari
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | | | - Marc Dubin
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | | | | | - Guy Maytal
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - Marta Skelin
- University Psychiatric Hospital Vrapce, Zagreb, Croatia
| | | | - John W Barnhill
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
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11
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Hennig-Fast K, Meissner D, Steuwe C, Dehning S, Blautzik J, Eilert DW, Zill P, Müller N, Meindl T, Reiser M, Möller HJ, Falkai P, Driessen M, Buchheim A. The Interplay of Oxytocin and Attachment in Schizophrenic Patients: An fMRI Study. Brain Sci 2023; 13:1125. [PMID: 37626482 PMCID: PMC10452454 DOI: 10.3390/brainsci13081125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/02/2023] [Accepted: 07/18/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Attachment theory offers an important framework for understanding interpersonal interaction experiences. In the present study, we examined the neural correlates of attachment patterns and oxytocin in schizophrenic patients (SZP) compared to healthy controls (HC) using fMRI. We assumed that male SZP shows a higher proportion of insecure attachment and an altered level of oxytocin compared to HC. On a neural level, we hypothesized that SZP shows increased neural activation in memory and self-related brain regions during the activation of the attachment system compared to HC. METHODS We used an event-related design for the fMRI study based on stimuli that were derived from the Adult Attachment Projective Picture System to examine attachment representations and their neural and hormonal correlates in 20 male schizophrenic patients compared to 20 male healthy controls. RESULTS A higher proportion of insecure attachment in schizophrenic patients compared to HC could be confirmed. In line with our hypothesis, Oxytocin (OXT) levels in SZP were significantly lower than in HC. We found increasing brain activations in SZP when confronted with personal relevant sentences before attachment relevant pictures in the precuneus, TPJ, insula, and frontal areas compared to HC. Moreover, we found positive correlations between OXT and bilateral dlPFC, precuneus, and left ACC in SZP only. CONCLUSION Despite the small sample sizes, the patients' response might be considered as a mode of dysregulation when confronted with this kind of personalized attachment-related material. In the patient group, we found positive correlations between OXT and three brain areas (bilateral dlPFC, precuneus, left ACC) and may conclude that OXT might modulate within this neural network in SZP.
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Affiliation(s)
- Kristina Hennig-Fast
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, 80336 Munich, Germany (H.-J.M.); (P.F.)
- Department of Psychiatry and Psychotherapy, University of Bielefeld, 33615 Bielefeld, Germany
| | - Dominik Meissner
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, 80336 Munich, Germany (H.-J.M.); (P.F.)
| | - Carolin Steuwe
- Department of Psychiatry and Psychotherapy, University of Bielefeld, 33615 Bielefeld, Germany
| | - Sandra Dehning
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, 80336 Munich, Germany (H.-J.M.); (P.F.)
| | - Janusch Blautzik
- Department of Radiology, Ludwig-Maximilians University, 81377 Munich, Germany
| | - Dirk W. Eilert
- Department of Psychology, University Innsbruck, 6020 Innsbruck, Austria
| | - Peter Zill
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, 80336 Munich, Germany (H.-J.M.); (P.F.)
| | - Norbert Müller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, 80336 Munich, Germany (H.-J.M.); (P.F.)
| | - Thomas Meindl
- Department of Radiology, Ludwig-Maximilians University, 81377 Munich, Germany
| | - Maximilian Reiser
- Department of Radiology, Ludwig-Maximilians University, 81377 Munich, Germany
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, 80336 Munich, Germany (H.-J.M.); (P.F.)
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, 80336 Munich, Germany (H.-J.M.); (P.F.)
| | - Martin Driessen
- Department of Psychiatry and Psychotherapy, University of Bielefeld, 33615 Bielefeld, Germany
| | - Anna Buchheim
- Department of Psychology, University Innsbruck, 6020 Innsbruck, Austria
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12
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Flechsig A, Bernheim D, Buchheim A, Domin M, Mentel R, Lotze M. One Year of Outpatient Dialectical Behavioral Therapy and Its Impact on Neuronal Correlates of Attachment Representation in Patients with Borderline Personality Disorder Using a Personalized fMRI Task. Brain Sci 2023; 13:1001. [PMID: 37508932 PMCID: PMC10377139 DOI: 10.3390/brainsci13071001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: BPD is characterized by affect dysregulation, interpersonal problems, and disturbances in attachment, but neuroimaging studies investigating attachment representations in BPD are rare. No study has examined longitudinal neural changes associated with interventions targeting these impairments. (2) Methods: We aimed to address this gap by performing a longitudinal neuroimaging study on n = 26 patients with BPD treated with Dialectic Behavioral Therapy (DBT) and n = 26 matched healthy controls (HCs; post intervention point: n = 18 BPD and n = 23 HCs). For functional imaging, we applied an attachment paradigm presenting attachment related scenes represented in drawings paired with related neutral or personalized sentences from one's own attachment narratives. In a prior cross-sectional investigation, we identified increased fMRI-activation in the human attachment network, in areas related to fear response and the conflict monitoring network in BPD patients. These were especially evident for scenes from the context of loneliness (monadic pictures paired with individual narrative sentences). Here, we tested whether these correlates of attachment representation show a near-to-normal development over one year of DBT intervention. In addition, we were interested in possible associations between fMRI-activation in these regions-of-interest (ROI) and clinical scores. (3) Results: Patients improved clinically, showing decreased symptoms of borderline personality organization (BPI) and increased self-directedness (Temperament and Character Inventory, TCI) over treatment. fMRI-activation was increased in the anterior medial cingulate cortex (aMCC) and left amygdala in BPD patients at baseline which was absent after intervention. When investigating associations between scores (BPI, TCI) and functional activation, we found significant effects in the bilateral amygdala. In contrast, aMCC activation at baseline was negatively associated with treatment outcome, indicating less effective treatment effects for those with higher aMCC activation at baseline. (4) Conclusions: Monadic attachment scenes with personalized sentences presented in an fMRI setup are capable of identifying increased activation magnitude in BPD. After successful DBT treatment, these increased activations tend to normalize which could be interpreted as signs of a better capability to regulate intensive emotions in the context of "social pain" towards a more organized/secure attachment representation. Amygdala activation, however, indicates high correlations with pre-treatment scores; activation in the aMCC is predictive for treatment gain. Functional activation of the amygdala and the aMCC as a response to attachment scenes representing loneness at baseline might be relevant influencing factors for DBT-intervention outcomes.
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Affiliation(s)
- Ariane Flechsig
- Functional Imaging Unit, Department of Diagnostic Radiology and Neuroradiology, University of Greifswald, 17475 Greifswald, Germany
| | - Dorothee Bernheim
- Department of Psychiatry and Psychotherapy, University Hospital of Greifswald, 17475 Greifswald, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Ulm, 89075 Ulm, Germany
| | - Anna Buchheim
- Department of Psychology, University of Innsbruck, 6020 Innsbruck, Austria
| | - Martin Domin
- Functional Imaging Unit, Department of Diagnostic Radiology and Neuroradiology, University of Greifswald, 17475 Greifswald, Germany
| | - Renate Mentel
- Department of Psychiatry and Psychotherapy, University Hospital of Greifswald, 17475 Greifswald, Germany
| | - Martin Lotze
- Functional Imaging Unit, Department of Diagnostic Radiology and Neuroradiology, University of Greifswald, 17475 Greifswald, Germany
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13
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von Steinbuechel N, Krenz U, Bockhop F, Koerte IK, Timmermann D, Cunitz K, Zeldovich M, Andelic N, Rojczyk P, Bonfert MV, Berweck S, Kieslich M, Brockmann K, Roediger M, Lendt M, Buchheim A, Muehlan H, Holloway I, Olabarrieta-Landa L. A Multidimensional Approach to Assessing Factors Impacting Health-Related Quality of Life after Pediatric Traumatic Brain Injury. J Clin Med 2023; 12:3895. [PMID: 37373590 DOI: 10.3390/jcm12123895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/25/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
In the field of pediatric traumatic brain injury (TBI), relationships between pre-injury and injury-related characteristics and post-TBI outcomes (functional recovery, post-concussion depression, anxiety) and their impact on disease-specific health-related quality of life (HRQoL) are under-investigated. Here, a multidimensional conceptual model was tested using a structural equation model (SEM). The final SEM evaluates the associations between these four latent variables. We retrospectively investigated 152 children (8-12 years) and 148 adolescents (13-17 years) after TBI at the recruiting clinics or online. The final SEM displayed a fair goodness-of-fit (SRMR = 0.09, RMSEA = 0.08 with 90% CI [0.068, 0.085], GFI = 0.87, CFI = 0.83), explaining 39% of the variance across the four latent variables and 45% of the variance in HRQoL in particular. The relationships between pre-injury and post-injury outcomes and between post-injury outcomes and TBI-specific HRQoL were moderately strong. Especially, pre-injury characteristics (children's age, sensory, cognitive, or physical impairments, neurological and chronic diseases, and parental education) may aggravate post-injury outcomes, which in turn may influence TBI-specific HRQoL negatively. Thus, the SEM comprises potential risk factors for developing negative post-injury outcomes, impacting TBI-specific HRQoL. Our findings may assist healthcare providers and parents in the management, therapy, rehabilitation, and care of pediatric individuals after TBI.
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Affiliation(s)
- Nicole von Steinbuechel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
| | - Ugne Krenz
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
| | - Fabian Bockhop
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
| | - Inga K Koerte
- cBRAIN/Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LMU University Hospital, Ludwig-Maximilian University, Nussbaumstrasse 5, 80336 Munich, Germany
| | - Dagmar Timmermann
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
| | - Katrin Cunitz
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
| | - Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
| | - Nada Andelic
- Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Department of Health and Society, University of Oslo, 0316 Oslo, Norway
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, 0424 Oslo, Norway
| | - Philine Rojczyk
- cBRAIN/Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LMU University Hospital, Ludwig-Maximilian University, Nussbaumstrasse 5, 80336 Munich, Germany
| | - Michaela Veronika Bonfert
- Department of Pediatric Neurology and Developmental Medicine, LMU Center for Development and Children with Medical Complexity, Dr. von Hauner Children's Hospital, LMU University Hospital, Haydnstr. 5, 80336 Munich, Germany
| | - Steffen Berweck
- Specialist Center for Paediatric Neurology, Neurorehabilitation and Epileptology, Schoen Klinik, Krankenhausstraße 20, 83569 Vogtareuth, Germany
| | - Matthias Kieslich
- Department of Paediatric Neurology, Hospital of Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Knut Brockmann
- Interdisciplinary Pediatric Center for Children with Developmental Disabilities and Severe Chronic Disorders, Department of Pediatrics and Adolescent Medicine, University Medical Center, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Maike Roediger
- Department of Pediatric Intensive Care Medicine and Neonatology, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany
| | - Michael Lendt
- Neuropediatrics, St. Mauritius Therapeutic Clinic, Strümper Straße 111, 40670 Meerbusch, Germany
| | - Anna Buchheim
- Institut für Psychologie, Universität Innsbruck, Innrain 52 f, 6020 Innsbruck, Austria
| | - Holger Muehlan
- Department of Health and Prevention, University of Greifswald, Robert-Blum-Str. 13, 17487 Greifswald, Germany
| | - Ivana Holloway
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, Waldweg 37A, 37073 Göttingen, Germany
| | - Laiene Olabarrieta-Landa
- Departamento de Ciencias de la Salud, Universidad Pública de Navarra, Campus de Arrosadía, 31006 Pamplona, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), 31008 Pamplona, Spain
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14
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Bockhop F, Cunitz K, Zeldovich M, Buchheim A, Beissbarth T, Hagmayer Y, von Steinbuechel N. Influence of Sociodemographic, Premorbid, and Injury-Related Factors on Post-Traumatic Stress, Anxiety, and Depression after Traumatic Brain Injury. J Clin Med 2023; 12:3873. [PMID: 37373567 DOI: 10.3390/jcm12123873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/02/2023] [Accepted: 06/04/2023] [Indexed: 06/29/2023] Open
Abstract
Psychopathological symptoms are common sequelae after traumatic brain injury (TBI), leading to increased personal and societal burden. Previous studies on factors influencing Post-traumatic Stress Disorder (PTSD), Generalized Anxiety Disorder (GAD), and Major Depressive Disorder (MDD) after TBI have produced inconclusive results, partly due to methodological limitations. The current study investigated the influence of commonly proposed factors on the clinical impairment, occurrence, frequency, and intensity of symptoms of PTSD, GAD, and MDD after TBI. The study sample comprised 2069 individuals (65% males). Associations between psychopathological outcomes and sociodemographic, premorbid, and injury-related factors were analyzed using logistic regression, standard, and zero-inflated negative binomial models. Overall, individuals experienced moderate levels of PTSD, GAD, and MDD. Outcomes correlated with early psychiatric assessments across domains. The clinical impairment, occurrence, frequency, and intensity of all outcomes were associated with the educational level, premorbid psychiatric history, injury cause, and functional recovery. Distinct associations were found for injury severity, LOC, and clinical care pathways with PTSD; age and LOC:sex with GAD; and living situation with MDD, respectively. The use of suitable statistical models supported the identification of factors associated with the multifactorial etiology of psychopathology after TBI. Future research may apply these models to reduce personal and societal burden.
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Affiliation(s)
- Fabian Bockhop
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany
| | - Katrin Cunitz
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany
| | - Marina Zeldovich
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany
| | - Anna Buchheim
- Institute of Psychology, Faculty of Psychology and Sport Science, University of Innsbruck, 6020 Innsbruck, Austria
| | - Tim Beissbarth
- Department of Medical Bioinformatics, University Medical Center Göttingen, 37073 Göttingen, Germany
| | - York Hagmayer
- Georg-Elias-Müller Institute for Psychology, Georg-August-University, 37073 Göttingen, Germany
| | - Nicole von Steinbuechel
- Institute of Medical Psychology and Medical Sociology, University Medical Center Göttingen, 37073 Göttingen, Germany
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15
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Eilert DW, Buchheim A. Attachment-Related Differences in Emotion Regulation in Adults: A Systematic Review on Attachment Representations. Brain Sci 2023; 13:884. [PMID: 37371364 DOI: 10.3390/brainsci13060884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 05/24/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
In recent years, there has been an increase in the prevalence of mental disorders connected with affective dysregulation and insecure attachment. Therefore, it is even more important to understand the interplay between an individual's attachment representation and patterns of emotion regulation. To our knowledge, this is the first systematic review to examine this association. PsycInfo, PsyArticles, and PubMed were searched for studies that examined attachment-related differences in emotion regulation in adults. To examine the unconscious attachment representation, only studies using the Adult Attachment Interview or the Adult Attachment Projective Picture System were included. Thirty-seven peer-reviewed studies (with a total of 2006 subjects) matched the PICO criteria. Emotion regulation was measured via four objective approaches: autonomic nervous system, brain activity, biochemistry, or nonverbal behavior. Across all measurements, results reveal a significant correlation between attachment representation and emotion regulation. Secure attachment correlates consistently with balanced emotion regulation, whereas it is impaired in insecure and dysfunctional in unresolved attachment. Specifically, unresolved individuals display counterintuitive responses and fail to use attachment as a resource. Insecure-dismissing attachment is associated with an emotionally deactivating strategy, while on a physiological, biochemical, and nonverbal level, emotional stress is still present. There is still a lack of studies examining preoccupied individuals. In addition to interpreting the results, we also discuss the risk of bias, implications for psychotherapy and coaching, and an outlook for future research.
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Affiliation(s)
- Dirk W Eilert
- Institute of Psychology, University of Innsbruck, 6020 Innsbruck, Austria
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, 6020 Innsbruck, Austria
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16
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Gander M, Lenhart L, Steiger R, Buchheim A, Mangesius S, Birkl C, Haid-Stecher N, Fuchs M, Libal A, Dabkowska-Mika A, Gizewski ER, Sevecke K. Attachment Trauma Is Associated with White Matter Fiber Microstructural Alterations in Adolescents with Anorexia Nervosa before and after Exposure to Psychotherapeutic and Nutritional Treatment. Brain Sci 2023; 13:brainsci13050798. [PMID: 37239270 DOI: 10.3390/brainsci13050798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
In the present study, we explore the role of attachment for microstructural white matter (WM) changes in adolescents with anorexia nervosa (AN) before and after exposure to short-term and nutritional treatment. The case sample consisted of 22 female adolescent inpatients with AN (mean age: 15.2 ± 1.2 years) and the control sample were 18 gender-matched healthy adolescents (mean age: 16.8 ± 0.9 years). We performed a 3T MRI in the patient group during the acute state of AN and after weight restoration (duration: 2.6 ± 1 months) and compared the data to a healthy control group. To classify attachment patterns, we used the Adult Attachment Projective Picture System. In the patient sample, over 50% were classified with an attachment trauma/unresolved attachment status. Prior to treatment exposure, fractional anisotropy (FA) reductions and concordant mean diffusivity (MD) increases were evident in the fornix, the corpus callosum and WM regions of the thalamus, which normalized in the corpus callosum and the fornix post-therapy in the total patient sample (p < 0.002). In the acute state, patients with an attachment trauma demonstrated significant FA decreases compared to healthy controls, but no MD increases, in the corpus callosum and cingulum bilaterally, which remained decreased after therapy. Attachment patterns seem to be associated with region-specific changes of WM alterations in AN.
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Affiliation(s)
- Manuela Gander
- Institute of Psychology, Leopold-Franzens-University of Innsbruck, 6020 Innsbruck, Austria
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, 6060 Hall in Tirol, Austria
| | - Lukas Lenhart
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Ruth Steiger
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Anna Buchheim
- Institute of Psychology, Leopold-Franzens-University of Innsbruck, 6020 Innsbruck, Austria
| | - Stephanie Mangesius
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Christoph Birkl
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Nina Haid-Stecher
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, 6060 Hall in Tirol, Austria
| | - Martin Fuchs
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, 6060 Hall in Tirol, Austria
| | - Anna Libal
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, 6060 Hall in Tirol, Austria
| | - Agnieszka Dabkowska-Mika
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Elke Ruth Gizewski
- Department of Neuroradiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Neuroimaging Research Core Facility, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Kathrin Sevecke
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, 6060 Hall in Tirol, Austria
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, 6020 Innsbruck, Austria
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17
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Diamond D, Keefe JR, Hörz-Sagstetter S, Fischer-Kern M, Doering S, Buchheim A. Changes in Attachment Representation and Personality Organization in Transference-Focused Psychotherapy. Am J Psychother 2023; 76:31-38. [PMID: 36695536 DOI: 10.1176/appi.psychotherapy.20220018] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The aim of this article was to construct an empirical bridge between object relations theory and attachment theory by investigating how researchers in both traditions have contributed to understanding and assessing identity diffusion (a keystone of personality pathology) and object relations in patients with borderline personality disorder during 1 year of transference-focused psychotherapy (TFP). METHODS The Adult Attachment Interview (AAI) and the Structured Interview of Personality Organization (STIPO) were administered to patients (N=104, all women) before and after 1 year of treatment. This study was part of a randomized controlled trial in which 104 patients with borderline personality disorder were randomly assigned to receive either TFP (a manualized, structured psychodynamic treatment approach) or treatment by experienced community psychotherapists. Changes on the AAI in attachment representations, narrative coherence, and reflective function were examined for their associations with changes on the STIPO in identity, object relations, and aggression. RESULTS Patients who shifted from disorganized (unresolved) to organized attachment on the AAI after 1 year of TFP (but not treatment by experienced community psychotherapists) showed hypothesized improvements in domains of personality organization on the STIPO, including identity, object relations, and aggression. Those who did not change from disorganized (unresolved) to organized attachment improved only in the domain of aggression. CONCLUSIONS These findings highlight the centrality of identity diffusion to borderline personality disorder pathology and the importance of targeting it in treatment. Furthermore, the results suggest that identity may be indexed by measures of attachment security, narrative coherence, and personality organization.
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Affiliation(s)
- Diana Diamond
- Department of Psychiatry, Weill Cornell Medical College, New York City (Diamond); Department of Psychology, City University of New York, New York City (Diamond); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe); Department of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin (Hörz-Sagstetter); Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna (Fischer-Kern, Doering); Institute of Psychology, University of Innsbruck, Innsbruck, Austria (Buchheim)
| | - John R Keefe
- Department of Psychiatry, Weill Cornell Medical College, New York City (Diamond); Department of Psychology, City University of New York, New York City (Diamond); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe); Department of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin (Hörz-Sagstetter); Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna (Fischer-Kern, Doering); Institute of Psychology, University of Innsbruck, Innsbruck, Austria (Buchheim)
| | - Susanne Hörz-Sagstetter
- Department of Psychiatry, Weill Cornell Medical College, New York City (Diamond); Department of Psychology, City University of New York, New York City (Diamond); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe); Department of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin (Hörz-Sagstetter); Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna (Fischer-Kern, Doering); Institute of Psychology, University of Innsbruck, Innsbruck, Austria (Buchheim)
| | - Melitta Fischer-Kern
- Department of Psychiatry, Weill Cornell Medical College, New York City (Diamond); Department of Psychology, City University of New York, New York City (Diamond); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe); Department of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin (Hörz-Sagstetter); Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna (Fischer-Kern, Doering); Institute of Psychology, University of Innsbruck, Innsbruck, Austria (Buchheim)
| | - Stephan Doering
- Department of Psychiatry, Weill Cornell Medical College, New York City (Diamond); Department of Psychology, City University of New York, New York City (Diamond); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe); Department of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin (Hörz-Sagstetter); Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna (Fischer-Kern, Doering); Institute of Psychology, University of Innsbruck, Innsbruck, Austria (Buchheim)
| | - Anna Buchheim
- Department of Psychiatry, Weill Cornell Medical College, New York City (Diamond); Department of Psychology, City University of New York, New York City (Diamond); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe); Department of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin (Hörz-Sagstetter); Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna (Fischer-Kern, Doering); Institute of Psychology, University of Innsbruck, Innsbruck, Austria (Buchheim)
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18
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Konvalin F, Reinhard MA, Behr E, Weigel-Weinberger F, Nenov-Matt T, Barton BB, Zill P, Jobst A, Brakemeier EL, Buchheim A, Padberg F. Change of attachment representation after Cognitive Behavioral Analysis System of Psychotherapy. Journal of Affective Disorders Reports 2023. [DOI: 10.1016/j.jadr.2023.100495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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19
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Zechmeister-Koss I, Aufhammer S, Bachler H, Bauer A, Bechter P, Buchheim A, Christiansen H, Fischer M, Franz M, Fuchs M, Goodyear M, Gruber N, Hofer A, Hölzle L, Juen E, Papanthimou F, Prokop M, Paul JL. Practices to support co-design processes: A case-study of co-designing a program for children with parents with a mental health problem in the Austrian region of Tyrol. Int J Ment Health Nurs 2023; 32:223-235. [PMID: 36226745 DOI: 10.1111/inm.13078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 01/14/2023]
Abstract
Forms of collaborative knowledge production, such as community-academic partnerships (CAP), have been increasingly used in health care. However, instructions on how to deliver such processes are lacking. We aim to identify practice ingredients for one element within a CAP, a 6-month co-design process, during which 26 community- and 13 research-partners collaboratively designed an intervention programme for children whose parent have a mental illness. Using 22 published facilitating and hindering factors for CAP as the analytical framework, eight community-partners reflected on the activities which took place during the co-design process. From a qualitative content analysis of the data, we distilled essential practices for each CAP factor. Ten community- and eight research-partners revised the results and co-authored this article. We identified 36 practices across the 22 CAP facilitating or hindering factors. Most practices address more than one factor. Many practices relate to workshop design, facilitation methods, and relationship building. Most practices were identified for facilitating 'trust among partners', 'shared visions, goals and/or missions', 'effective/frequent communication', and 'well-structured meetings'. Fewer practices were observed for 'effective conflict resolution', 'positive community impact' and for avoiding 'excessive funding pressure/control struggles' and 'high burden of activities'. Co-designing a programme for mental healthcare is a challenging process that requires skills in process management and communication. We provide practice steps for delivering co-design activities. However, practitioners may have to adapt them to different cultural contexts. Further research is needed to analyse whether co-writing with community-partners results in a better research output and benefits for participants.
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Affiliation(s)
| | | | | | - Annette Bauer
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | | | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Hanna Christiansen
- Institut für Klinische Kinder- und Jugendpsychologie, Philipps-University, Marburg, Germany
| | - Maria Fischer
- Hilfe für Angehörige Psychisch Erkrankter Menschen in Tirol, Innsbruck, Austria
| | - Marianne Franz
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria.,Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Martin Fuchs
- Medical University Innsbruck, Innsbruck, Austria.,Abteilung für Kinder- und Jugendpsychiatrie, Tirol Kliniken GmbH, Hall in Tirol, Austria
| | - Melinda Goodyear
- School of Rural Health, Monash University, Melbourne, Victoria, Australia.,Emerging Minds, Hilton, South Australia, Australia
| | - Nadja Gruber
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria.,Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Alex Hofer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Laura Hölzle
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria.,Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Evi Juen
- Kinder- und Jugendhilfe, Landeck, Austria
| | | | - Mathias Prokop
- Univ. Klinik für Psychiatrie, Landeskrankenhaus-Universitätskliniken Innsbruck Tirol Kliniken GmbH, Innsbruck, Austria
| | - Jean Lillian Paul
- Mental Health Research Program, The Village, Ludwig Boltzmann Gesellschaft, Innsbruck, Austria.,Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
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20
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Buchheim A, Kernberg OF, Netzer N, Buchheim P, Perchtold-Stefan C, Sperner-Unterweger B, Beckenbauer F, Labek K. Differential neural response to psychoanalytic intervention techniques during structural interviewing: A single-case analysis using EEG. Front Hum Neurosci 2023; 16:1054518. [PMID: 36684843 PMCID: PMC9846161 DOI: 10.3389/fnhum.2022.1054518] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/02/2022] [Indexed: 01/05/2023] Open
Abstract
Background Previous studies detected changes in the electroencephalographic (EEG) signal as an effect of psychoanalytic interventions. However, no study has investigated neural correlates of specific psychoanalytic interventions in the EEG power spectrum yet. In the present case study, we contrasted three types of interventions (clarification, confrontation, and interpretation) and a neutral control condition during a structural psychoanalytic interview conducted while EEG was recorded. Methods A 27-year-old male patient diagnosed with major depressive disorder and borderline personality disorder with recurrent suicidal and self-injurious behavior underwent a structural interview while recording EEG. Two independent experts selected by consensus the characteristic episodes of the four conditions (clarification, confrontation, interpretation, and neutral control) within the interview, which were included in the EEG analyses. Fast Fourier transformation (FFT) was applied to subsegments of the intervention type to analyze the EEG power spectra. Alpha and beta power from central, frontal, and parietal sites were considered in linear mixed-effects models with segments as a random factor with maximum-likelihood estimates due to the lack of balance in the length of the interview segments. Results The interventions "interpretation" and "confrontation" showed a significantly lower alpha power compared with the control condition in the central electrodes. In the frontal and parietal sites of the alpha power and all beta power sites, the omnibus tests (full model/model without intervention) and comparisons relative to control conditions showed no significant overall result or failed significance after alpha error correction. Conclusion Incisive interventions, such as confrontation with discrepancies and interpretation of unconscious intrapsychic conflicts, may have provoked temporary emotional lability, leading to a change in psychic processing akin to interference from external stimuli. This conclusion is consistent with the finding that interpretations, which are potentially the most concise interventions, had the strongest effects on alpha power. Using EEG during therapeutic psychoanalytic intervention techniques might be a helpful tool to evaluate differential responses to the psychotherapeutic process on a neural level. However, this single-case result has to be replicated in a larger sample and does not allow generalizations.
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Affiliation(s)
- Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria,*Correspondence: Anna Buchheim,
| | - Otto F. Kernberg
- New York-Presbyterian Hospital–Westchester Division, New York, NY, United States
| | - Nikolaus Netzer
- Hermann Buhl Institute, University of Innsbruck, Eurac Research, Innsbruck, Austria,Eurac Research, Bolzano, Italy
| | - Peter Buchheim
- Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany
| | | | - Barbara Sperner-Unterweger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | | | - Karin Labek
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
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21
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Keefe JR, Levy KN, Sowislo JF, Diamond D, Doering S, Hörz-Sagstetter S, Buchheim A, Fischer-Kern M, Clarkin JF. Reflective functioning and its potential to moderate the efficacy of manualized psychodynamic therapies versus other treatments for borderline personality disorder. J Consult Clin Psychol 2023; 91:50-56. [PMID: 36174134 DOI: 10.1037/ccp0000760] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Impaired reflective functioning (RF) is common among patients with borderline personality disorder (BPD). Transference-focused psychotherapy (TFP) has been demonstrated to improve RF compared to other common BPD treatments. If RF reflects a treatment mechanism for TFP, differences in pretreatment RF may also serve as a prescriptive factor for TFP's effects. METHOD A total of 194 patients with BPD were randomized across two clinical trials to receive TFP (n = 83), dialectical behavior therapy (DBT; n = 31), supportive psychodynamic therapy (SPT; n = 28), or an enhanced treatment as usual (eTAU; n = 52). A mixed-effects model was used to examine whether baseline RF interacted with treatment condition to predict slopes of change in the Brief Symptom Inventory, the shared symptom outcome between trials. Moderation of changes in RF was also examined. RESULTS Treatment interacted with baseline RF to predict BSI slopes (p = .011). In TFP/SPT, RF did not predict outcomes, β = -0.00, p = .973, while higher RF was associated with relatively better outcomes in DBT/eTAU, β = -0.54, p < .001. Patients with poor RF (scores of 0/1) benefitted more from TFP/SPT, while patients with relatively ordinary RF (score of 4) had better outcomes in DBT/eTAU. Treatment effects on RF change were also moderated by baseline RF (p = .014), such that TFP improved RF most strongly among poor RF patients, SPT only among very poor RF patients, and DBT/eTAU not at all. DISCUSSION Low RF may reflect a deficit that may be targeted by TFP and other manualized psychodynamic treatments for BPD, which may be especially helpful among patients presenting with low RF. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- John R Keefe
- Department of Psychiatry and Behavioral Sciences
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22
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Karabatsiakis A, de Punder K, Doyen-Waldecker C, Ramo-Fernández L, Krause S, Gumpp AM, Bach AM, Fegert JM, Kolassa IT, Gündel H, Ziegenhain U, Buchheim A. Reactivity of the Oxytocinergic and Neuroendocrine System Following the Adult Attachment Projective Picture System in Men of Recent Fatherhood: Results from an Exploratory Pilot Study with a Cross-Sectional Design. Brain Sci 2022; 12:brainsci12101314. [PMID: 36291248 PMCID: PMC9599157 DOI: 10.3390/brainsci12101314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/22/2022] [Accepted: 09/24/2022] [Indexed: 11/16/2022] Open
Abstract
The attachment representation (AR) of individuals affects emotional and cognitive information processes and is considered an important modulating factor of neuroendocrine stress responses. The neuropeptide oxytocin is studied as one biomolecular component underpinning this modulation. A validated procedure used in attachment-related research is the Adult Attachment Projective Picture System (AAP). To date, only a limited number of studies investigated oxytocin and neuroendocrine reactivity in the context of an attachment-related stimulus similar to the APP. In this pilot study, N = 26 men of recent fatherhood were exposed to the AAP to classify AR and to investigate salivary changes in oxytocin, cortisol and dehydroepiandrosterone (DHEA) after AAP stimulation. We observed increased oxytocin levels in response to AAP exposure, and this increase was more pronounced in fathers with unresolved/disorganized AR. No significant changes in cortisol and DHEA concentrations were observed in response to AAP administration. Interestingly, differences in basal cortisol levels (before the AAP) also depended on AR classification. Here, the group of men with unresolved/disorganized AR showed higher levels of cortisol compared to fathers with organized AR. To conclude, the finding of increased salivary oxytocin levels in response to the AAP further indicates its validity as an instrument to stimulate the attachment system.
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Affiliation(s)
- Alexander Karabatsiakis
- Department of Clinical Psychology II, Institute of Psychology, University of Innsbruck, 6020 Innsbruck, Austria
- Correspondence:
| | - Karin de Punder
- Department of Clinical Psychology II, Institute of Psychology, University of Innsbruck, 6020 Innsbruck, Austria
| | - Cornelia Doyen-Waldecker
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University, 89081 Ulm, Germany
- Institute of Psychology and Education, Clinical & Biological Psychology, Ulm University, 89081 Ulm, Germany
| | - Laura Ramo-Fernández
- Institute of Psychology and Education, Clinical & Biological Psychology, Ulm University, 89081 Ulm, Germany
| | - Sabrina Krause
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University, 89081 Ulm, Germany
| | - Anja Maria Gumpp
- Institute of Psychology and Education, Clinical & Biological Psychology, Ulm University, 89081 Ulm, Germany
| | - Alexandra Maria Bach
- Institute of Psychology and Education, Clinical & Biological Psychology, Ulm University, 89081 Ulm, Germany
| | - Jörg Michael Fegert
- Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University Hospital, 89081 Ulm, Germany
| | - Iris-Tatjana Kolassa
- Institute of Psychology and Education, Clinical & Biological Psychology, Ulm University, 89081 Ulm, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University, 89081 Ulm, Germany
| | - Ute Ziegenhain
- Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University Hospital, 89081 Ulm, Germany
| | - Anna Buchheim
- Department of Clinical Psychology II, Institute of Psychology, University of Innsbruck, 6020 Innsbruck, Austria
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23
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Buchheim A, George C, Gündel H. Editorial: Neuroscience of human attachment volume II. Front Hum Neurosci 2022; 16:1018528. [PMID: 36118974 PMCID: PMC9471664 DOI: 10.3389/fnhum.2022.1018528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 08/18/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
- *Correspondence: Anna Buchheim
| | - Carol George
- Department of Psychology, Mills College, Oakland, CA, United States
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University, Ulm, Germany
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24
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Maerz J, Buchheim A, Rabl L, Riedl D, Viviani R, Labek K. The interplay of Criterion A of the Alternative Model for Personality Disorders, mentalization and resilience during the COVID-19 pandemic. Front Psychol 2022; 13:928540. [PMID: 35959052 PMCID: PMC9358045 DOI: 10.3389/fpsyg.2022.928540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/04/2022] [Indexed: 01/07/2023] Open
Abstract
Background and aims The COVID-19 pandemic has been accompanied by a worsening of mental health levels in some, while others manage to adapt or recover relatively quickly. Transdiagnostic factors such as personality functioning are thought to be involved in determining mental health outcomes. The present study focused on two constructs of personality functioning, Criterion A of the Alternative Model for Personality Disorders (AMPD, DSM-5) and mentalization, as predictors of depressive symptoms and life satisfaction during the COVID-19 pandemic. A second focus of the study was to examine whether this relationship was mediated by resilience. Methods Linear regression analyses were used to examine the relationship between personality functioning measured by Criterion A (AMPD, DSM-5) and mentalizing abilities as predictors, and depression and life satisfaction as mental health outcomes. To assess the hypothesis that this relationship is mediated by resilience a structural equation modeling approach was conducted. Data from N = 316 individuals from the general population were collected. Results Linear regression models revealed highly significant associations between Criterion A/mentalization and both outcome measures. Structural equation models showed a significant partial mediation by resilience of these relationships. Conclusion Our results support the hypothesis that mentalizing serves as a protective function by promoting resilience to the impact of stress and threats. Criterion A and mentalization performed similarly as predictors of mental health outcomes, providing empirically overlapping operationalizations of personality functioning. This finding emphasizes the importance of personality functioning in positive and negative mental health outcomes. Furthermore, our results are consistent with a mediating role of resilience.
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Affiliation(s)
- Jeff Maerz
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Luna Rabl
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - David Riedl
- University Hospital of Psychiatry II, Medical University Innsbruck, Innsbruck, Austria
| | - Roberto Viviani
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
- Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany
| | - Karin Labek
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
- *Correspondence: Karin Labek,
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25
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Buchheim A, Ziegenhain U, Kindler H, Waller C, Gündel H, Karabatsiakis A, Fegert J. Identifying Risk and Resilience Factors in the Intergenerational Cycle of Maltreatment: Results From the TRANS-GEN Study Investigating the Effects of Maternal Attachment and Social Support on Child Attachment and Cardiovascular Stress Physiology. Front Hum Neurosci 2022; 16:890262. [PMID: 35923749 PMCID: PMC9341217 DOI: 10.3389/fnhum.2022.890262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Childhood maltreatment (CM) is a developmental risk factor and can negatively influence later psychological functioning, health, and development in the next generation. A comprehensive understanding of the biopsychosocial underpinnings of CM transmission would allow to identify protective factors that could disrupt the intergenerational CM risk cycle. This study examined the consequences of maternal CM and the effects of psychosocial and biological resilience factors on child attachment and stress-regulatory development using a prospective trans-disciplinary approach. Methods Mother-child dyads (N = 158) participated shortly after parturition (t 0), after 3 months (t 1), and 12 months later (t 2). Mothers' CM experiences were assessed at t 0, attachment representation at t 1 and psychosocial risk and social support were assessed at t 1 and t 2. At t 2, dyads participated in the Strange Situation Procedure (SSP). Children's attachmen status were classified as organized vs. disorganized, including their level of disorganized behavior, and heart rate (HR) and respiratory sinus arrhythmia (RSA) were recorded as stress response measures of the autonomic nervous system. Maternal caregiving during SSP was assessed using the AMBIANCE scale. Child's single nucleotide polymorphisms rs2254298 within the oxytocin receptor (OXTR) and rs2740210 of the oxytocin gene (OXT) were genotyped using DNA isolated from cord blood. Results Maternal CM experiences (CM+) were significantly associated with an unresolved attachment status, higher perceived stress and more psychological symptoms. These negative effects of CM were attenuated by social support. As expected, maternal unresolved attachment and child disorganized attachment were significantly associated. Maternal caregiving did not mediate the relationship between maternal and child attachment but influenced children's HR and RSA response and disorganized behavior. Moreover, the rs2254298 genotype of the OXTR gene moderated the stress response of children from mothers with CM. Children carrying the rs2740210 risk allele of the OXT gene showed more disorganized behavior independent from maternal CM experiences. Conclusion We replicated and extended existing CM and attachment models by co-examining maternal attachment, social support, and child genetic susceptibility on child attachment and cardiovascular stress regulation. The findings contribute to an extended understanding of risk and resilience factors and enable professionals to target adequate services to parents and children at risk.
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Affiliation(s)
- Anna Buchheim
- Department of Clinical Psychology II, Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Ute Ziegenhain
- Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University Hospital, Ulm, Germany
| | | | - Christiane Waller
- Department of Psychosomatic Medicine and Psychotherapy, Nuremberg General Hospital, Paracelsus Medical University, Nürnberg, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University, Ulm, Germany
| | - Alexander Karabatsiakis
- Department of Clinical Psychology II, Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Jörg Fegert
- Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm University Hospital, Ulm, Germany
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26
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Labek K, Dommes L, Bosch JE, Schurz M, Viviani R, Buchheim A. A Short Functional Neuroimaging Assay Using Attachment Scenes to Recruit Neural Correlates of Social Cognition—A Replication Study. Brain Sci 2022; 12:brainsci12070855. [PMID: 35884660 PMCID: PMC9313198 DOI: 10.3390/brainsci12070855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/22/2022] [Accepted: 06/27/2022] [Indexed: 11/22/2022] Open
Abstract
Attachment theory provides a conceptual framework to understand the impact of early child–caregiver experiences, such as loss or separation, on adult functioning and psychopathology. In the current study, scenes from the Adult Attachment Projective Picture System (AAP), a validated, commonly used standardized diagnostic instrument to assess adult attachment representations, were used to develop a short fMRI assay eliciting the neural correlates of encoding of potentially hurtful and threatening social situations such as social losses, rejections or loneliness. Data from healthy participants (N = 19) showed activations in brain areas associated with social cognition and semantic knowledge during exposure to attachment-related scenes compared to control scenes. Extensive activation of the temporal poles was observed, suggesting the use of semantic knowledge for generating social concepts and scripts. This knowledge may underlie our ability to explain and predict social interactions, a specific aspect of theory of mind or mentalization. In this replication study, we verified the effectiveness of a modified fMRI assay to assess the external validity of a previously used imaging paradigm to investigate the processing of emotionally negatively valenced and painful social interactions. Our data confirm the recruitment of brain areas associated with social cognition with our very short neuroimaging assay.
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Affiliation(s)
- Karin Labek
- Institute of Psychology, Faculty of Psychology and Sport Science, University of Innsbruck, 6020 Innsbruck, Austria; (M.S.); (R.V.); (A.B.)
- Correspondence:
| | - Lisa Dommes
- Department of Psychiatry and Psychotherapy III, Ulm University Medical Center, 89075 Ulm, Germany; (L.D.); (J.E.B.)
| | - Julia Eva Bosch
- Department of Psychiatry and Psychotherapy III, Ulm University Medical Center, 89075 Ulm, Germany; (L.D.); (J.E.B.)
| | - Matthias Schurz
- Institute of Psychology, Faculty of Psychology and Sport Science, University of Innsbruck, 6020 Innsbruck, Austria; (M.S.); (R.V.); (A.B.)
| | - Roberto Viviani
- Institute of Psychology, Faculty of Psychology and Sport Science, University of Innsbruck, 6020 Innsbruck, Austria; (M.S.); (R.V.); (A.B.)
- Department of Psychiatry and Psychotherapy III, Ulm University Medical Center, 89075 Ulm, Germany; (L.D.); (J.E.B.)
| | - Anna Buchheim
- Institute of Psychology, Faculty of Psychology and Sport Science, University of Innsbruck, 6020 Innsbruck, Austria; (M.S.); (R.V.); (A.B.)
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Bernheim D, Buchheim A, Domin M, Mentel R, Lotze M. Neural Correlates of Attachment Representation in Patients With Borderline Personality Disorder Using a Personalized Functional Magnet Resonance Imaging Task. Front Hum Neurosci 2022; 16:810417. [PMID: 35280201 PMCID: PMC8908102 DOI: 10.3389/fnhum.2022.810417] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 02/07/2022] [Indexed: 11/20/2022] Open
Abstract
Background Fear of abandonment and aloneness play a key role in the clinical understanding interpersonal and attachment-specific problems in patients with borderline personality disorder (BPD) and has been investigated in previous functional Magnet Resonance Imaging (fMRI) studies. The aim of the present study was to examine how different aspects of attachment representations are processed in BPD, by using for the first time an fMRI attachment paradigm including personalized core sentences from the participants’ own attachment stories. We hypothesized that BPD patients would show increased functional involvement of limbic brain regions associated with fear and pain (e.g., the amygdala and the anterior cingulate cortex) when presented personalized attachment relevant stimuli representing loneliness compared to healthy controls (HC). Methods We examined the attachment classifications of 26 female BPD patients and 26 female HC using the Adult Attachment Projective Picture System (AAP). We used an fMRI-adapted attachment paradigm to investigate the neural correlates of attachment. All participants were presented three personalized (vs. neutral) sentences extracted from their AAP attachment narrative, combined with standardized AAP pictures representing being alone (monadic) or in interactive (dyadic) attachment situations. Results As expected, the classification of unresolved attachment was significantly greater in BPD compared to HC. BPD patients showed increased fMRI-activation in brain areas associated with fear, pain, and hyperarousal than HC when presented with personalized attachment-relevant alone stimuli. In particular, pictures with monadic attachment situations induced greater anterior medial cingulate cortex, anterior insula, amygdala, thalamus and superior temporal gyrus activation in the patient group. Conclusion The results point to increased fMRI-activation in areas processing emotional distress and painful experiences in BPD patients. In particular, the emotional cascade reflecting attachment distress was evoked by combining monadic pictures, representing abandonment and aloneness, with the patients’ personalized narrative material. Our results confirmed and replicated previous results that illustrate once again the high relevance of aloneness and feelings of abandonment for BPD in the context of attachment trauma. Moreover, our results support the hypothesis of hypermentalization in response to attachment distress as a core feature of social-cognitive impairment in BPD associated with common treatment implications across different therapeutic orientations.
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Affiliation(s)
- Dorothee Bernheim
- Department of Psychiatry and Psychotherapy, University Hospital of Greifswald, Greifswald, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Ulm, Ulm, Germany
| | - Anna Buchheim
- Department of Psychology, University of Innsbruck, Innsbruck, Austria
- *Correspondence: Anna Buchheim,
| | - Martin Domin
- Functional Imaging Unit, Department of Diagnostic Radiology and Neuroradiology, University of Greifswald, Greifswald, Germany
| | - Renate Mentel
- Department of Psychiatry and Psychotherapy, University Hospital of Greifswald, Greifswald, Germany
| | - Martin Lotze
- Functional Imaging Unit, Department of Diagnostic Radiology and Neuroradiology, University of Greifswald, Greifswald, Germany
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Gander M, Karabatsiakis A, Nuderscher K, Bernheim D, Doyen-Waldecker C, Buchheim A. Secure Attachment Representation in Adolescence Buffers Heart-Rate Reactivity in Response to Attachment-Related Stressors. Front Hum Neurosci 2022; 16:806987. [PMID: 35250517 PMCID: PMC8891161 DOI: 10.3389/fnhum.2022.806987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/26/2022] [Indexed: 12/14/2022] Open
Abstract
To date, we know very little about the effects of the differences in attachment classifications on the physiological correlates of stress regulation in adolescent age groups. The present study examined for the first time heart rate (HR) and heart rate variability (HRV) during an attachment interview in adolescents. HR and HRV data were collected during a baseline assessment as well as during the administration of the Adult Attachment Projective Picture System (AAP) in a community-based sample of 56 adolescents (26 females and 30 males, mean age = 16.05 years [SD = 1.10]). We additionally used the Adult Attachment Interview (AAI) in 50% of our sample to test the convergent validity. Adolescents with a secure attachment representation showed a higher HRV from baseline to the AAP interview compared to those with an insecure-dismissing (Ds) and the unresolved group. A comparison between the two insecure attachment groups showed no significant difference related to HR and HRV. Cohen’s Kappa (κ = 0.81) revealed an almost perfect agreement between the AAP and the AAI for the four-group classification. Our results indicate that adolescents with a secure attachment representation are more capable of dealing with attachment-related distress which is represented in higher HRV during an attachment interview.
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Affiliation(s)
- Manuela Gander
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
- *Correspondence: Manuela Gander,
| | | | | | - Dorothee Bernheim
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | | | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
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29
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Lenhart L, Gander M, Steiger R, Dabkowska-Mika A, Mangesius S, Haid-Stecher N, Fuchs M, Buchheim A, Sevecke K, Gizewski Elke R. Attachment status is associated with gray matter recovery in adolescent anorexia nervosa: Findings from a longitudinal study. Eur J Neurosci 2022; 55:1373-1387. [PMID: 35083790 PMCID: PMC9305298 DOI: 10.1111/ejn.15614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 01/02/2022] [Accepted: 01/23/2022] [Indexed: 11/29/2022]
Abstract
The aim of the present study was to investigate whether grey matter (GM) reductions in acute anorexia nervosa (AN) are (i) valid for adolescents (age 14–18 years), (ii) reversible following short‐term psychotherapeutic and nutritional therapy and (iii) depend on psychological components like attachment trauma. 3T MRI including a high‐resolution T1 MPRAGE was performed in 22 female adolescents in the acute state of AN (age: 15.2 ± 1.2 years) and after weight restoration (duration: 2.6 ± 1 months, n = 18) and compared with 18 gender‐matched healthy controls. The Adult Attachment Projective Picture System was used to classify resolved and unresolved attachment patterns. GM decreases were localized in extensive cortical areas including the insula, prefrontal and cingulate cortices as well as subcortical regions during acute AN, which partially increased after therapy with a relative sparing of the hippocampus and parahippocampal gyrus. The resolved group showed more GM recovery in regions of the left hippocampus and parahippocampal gyrus, bilateral cerebellar regions, right precuneus and adjacent cingulate cortices relative to the unresolved pattern. Structural anomalies in adolescent AN that recovered after treatment may be primarily the consequence of malnutrition, whereas several regions did not display significant recovery. Attachment status seems to influence region‐specific GM recovery.
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Affiliation(s)
- Lukas Lenhart
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.,Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - Manuela Gander
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, Innsbruck, Austria.,Department of Child and Adolescent Psychiatry, Tirol Kliniken, Hall in Tirol, Austria
| | - Ruth Steiger
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - Agnieszka Dabkowska-Mika
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - Stephanie Mangesius
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - Nina Haid-Stecher
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, Hall in Tirol, Austria
| | - Martin Fuchs
- Department of Child and Adolescent Psychiatry, Tirol Kliniken, Hall in Tirol, Austria
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Kathrin Sevecke
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, Innsbruck, Austria
| | - Ruth Gizewski Elke
- Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
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30
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Gulde M, Köhler-Dauner F, Mayer I, Ziegenhain U, Fegert JM, Buchheim A. Negative effects of the SARS-CoV-2 pandemic: The interlinking of maternal attachment representation, coping strategies, parental behavior, and the child's mental health. Front Pediatr 2022; 10:939538. [PMID: 36389380 PMCID: PMC9663916 DOI: 10.3389/fped.2022.939538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022] Open
Abstract
For more than two years, young families have been confronted with a large number of restrictions and following burdens as a result of the SARS-CoV-2 pandemic. In fact, it became evident, that the current circumstances are particularly stressful for child's mental health. With regard to the child's mental health in times of a pandemic, additional factors within the family, such as maternal attachment representations as well as coping strategies and parental behavior, may play an important role. This study aims to investigate the interplay of maternal attachment representation, coping strategies, parental behavior and child's mental health during the SARS-CoV-2 pandemic. In this longitudinal study, previously collected data regarding maternal attachment representation and newly attained data from the SARS-CoV-2-pandemic-assesment (lack of coping strategies, children's mental health and parental behavior) were combined and analyzed. The data were collected in an online survey since beginning of the pandemic, including N = 73 mothers. A path model was calculated in form of multiple linear regression. A path model could be confirmed, which indicates that insecure maternal attachment representation predicts lack of coping strategies during the pandemic [b = 5.55, 95%-CI = (4.51; 6.55), p = 0.001]. Furthermore, lack of coping strategies predicts harmful parental behavior during the pandemic [b = -0.77, 95%-CI = (-1.27; -0.21), p = 0.007], which in turn predicts children's mental health problems, namely behavioral problems [b = -0.08, 95%-CI = (-0.14; -0.01), p = 0.027]. Presence of short-time work and decrease in income since beginning of the pandemic were used as control variables. This means that since the pandemic mothers with insecure attachment representation have an increased risk of having only a few coping mechanisms available, leading to harmful parental behaviors and ultimately affecting the mental health of their children. In conclusion, the pandemic could potentially have a particularly negative influence on mothers with an insecure attachment type and therefore on their children. Therefore, tailored interventions for families should be offered that both focus on the different types of mental health problems in children and support parents in their coping skills.
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Affiliation(s)
- Manuela Gulde
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Franziska Köhler-Dauner
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Inka Mayer
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Ute Ziegenhain
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Jörg M Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
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31
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Köhler-Dauner F, Buchheim A, Hildebrand K, Mayer I, Clemens V, Ziegenhain U, Fegert JM. Maternal attachment representation, the risk of increased depressive symptoms and the influence on children's mental health during the SARS-CoV-2-pandemic. J Child Fam Stud 2021; 31:392-408. [PMID: 34803359 PMCID: PMC8595056 DOI: 10.1007/s10826-021-02162-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 05/26/2023]
Abstract
The social distancing measures and the related closure of education institutions have confronted young families, in particular, with various challenges. Additional risk factors such as an insecure or even unresolved maternal attachment representation may affect mental health of mothers and their children in times of increased stress such as during the ongoing pandemic. We aimed to analyze the interplay between maternal attachment representation and mother's and children's mental health before and during the SARS-CoV-2-pandemic. 91 mothers completed a "SARS-CoV-2 pandemic survey" examining the pandemic-related stress of their families including their own depressive symptomology and their children's mental health. Our mediation analysis demonstrates that the mothers' depressive symptomology significantly and fully mediated the relationship between maternal attachment representations and children's mental health during the pandemic. In contrast, the indirect effect of the maternal attachment representation on children's mental health before the pandemic through the depressive symptoms experienced by the mothers before the pandemic did not reach significance alongside the total and direct effect. The quality of the maternal attachment representation, promoted by childhood maltreatment, seems to be one relevant risk factor for the mothers' and children's mental health during a stressful time like a pandemic. The risk for mothers to develop depressive symptoms in times of a pandemic is significantly influenced by their current representation of previous attachment experiences. In addition, the mental well-being of mothers showed a considerable influence on the children's mental health during a pandemic. The results underline the necessity to consider unique needs of family members and to offer specific support in the current crisis focusing on attachment issues.
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Affiliation(s)
- Franziska Köhler-Dauner
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm Medical University of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
| | - Anna Buchheim
- Institut für Psychologie, Universität Innsbruck, Innrain 52 f, 6020 Innsbruck, Austria
| | - Katherina Hildebrand
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm Medical University of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
| | - Inka Mayer
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm Medical University of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
| | - Vera Clemens
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm Medical University of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
| | - Ute Ziegenhain
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm Medical University of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
| | - Jörg M. Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm Medical University of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
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32
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Tmej A, Fischer-Kern M, Doering S, Hörz-Sagstetter S, Rentrop M, Buchheim A. Borderline patients before and after one year of transference-focused psychotherapy (TFP): A detailed analysis of change of attachment representations. Psychoanalytic Psychology 2021. [DOI: 10.1037/pap0000302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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33
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Bürgin D, Kind N, Schröder M, Clemens V, Fegert JM, Eckert A, Buchheim A, O'Donovan A, Boonmann C, Schmid M. The Stress of Caring-Resilience and HPA-Axis Activity in Hair Samples of Youth Residential Caregivers. Front Psychiatry 2020; 11:556486. [PMID: 33408649 PMCID: PMC7779549 DOI: 10.3389/fpsyt.2020.556486] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 11/30/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Professional caregivers in youth residential care institutions experience frequent verbal and physical aggression as well as multiple stressors as part of their everyday work, leading to high levels of burnout and staff turnover. Resilience might buffer against psychophysiological stress response and therefore be crucial for well-being in professional caregivers. Objectives: We aimed to investigate if measures related to resilience [sense of coherence (SoC), self-efficacy and self-care] and attachment security of caregivers were cross-sectionally associated with stress markers in hair samples [cortisol and dehydroepiandrosterone (DHEA)]. Method: Participants (n = 134; 64.2% women) reported on individual resilience measures and provided hair samples for cortisol and DHEA assays. Attachment was assessed in a subsample using the Adult Attachment Projective Picture System (AAP, n = 69). Linear regression models were fitted to estimate the association between resilience measures and the Cortisol:DHEA ratio, cortisol and DHEA, controlling for gender and age. Results: SoC was associated with a lower Cortisol:DHEA ratio (β = -0.36, p < 0.001), driven by a positive association between SoC and DHEA levels (β = 0.28, p = 0.002). Self-care was also associated with lower Cortisol:DHEA ratios (β = -0.24, p = 0.005), due to self-care being associated with higher DHEA (β = 0.21, p = 0.016). HPA-axis measures were not associated with self-efficacy nor with attachment patterns in a subsample. Conclusions: Our findings imply that youth residential care institutions might benefit from programs focusing on enhancing SoC and self-care practices. Fostering a meaningful, comprehensible and manageable professional climate in caregiving environments and implementing self-care in routine practices might enhance not only well-being but also physical health of professional caregivers and in this way buffer adverse health effects of chronic stressors.
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Affiliation(s)
- David Bürgin
- Child and Adolescent Psychiatric Research Department, University Psychiatric Hospitals, University of Basel, Basel, Switzerland
| | - Nina Kind
- Child and Adolescent Psychiatric Research Department, University Psychiatric Hospitals, University of Basel, Basel, Switzerland
| | - Martin Schröder
- Child and Adolescent Psychiatric Research Department, University Psychiatric Hospitals, University of Basel, Basel, Switzerland
| | - Vera Clemens
- Department for Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Jörg M. Fegert
- Department for Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Anne Eckert
- Neurobiological Laboratory for Brain Aging and Mental Health, Transfaculty Research Platform, University of Basel, Basel, Switzerland
| | - Anna Buchheim
- Institute of Psychology, University Innsbruck, Innsbruck, Austria
| | - Aoife O'Donovan
- Department of Psychiatry and Weill Institute for Neurosciences, University of California, San Francisco, CA, United States
- Mental Health Services, San Francisco Veterans Affairs Medical Center, San Francisco, CA, United States
| | - Cyril Boonmann
- Child and Adolescent Psychiatric Research Department, University Psychiatric Hospitals, University of Basel, Basel, Switzerland
| | - Marc Schmid
- Child and Adolescent Psychiatric Research Department, University Psychiatric Hospitals, University of Basel, Basel, Switzerland
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Leutritz AL, Colic L, Borchardt V, Cheng X, Zhang B, Lison S, Frommer J, Buchheim A, Strauss B, Fonagy P, Nolte T, Walter M. Attachment-specific speech patterns induce dysphoric mood changes in the listener as a function of individual differences in attachment characteristics and psychopathology. Psychol Psychother 2020; 93:754-776. [PMID: 31746134 DOI: 10.1111/papt.12258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 10/21/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Early childhood experiences influence cognitive-emotional development, with insecure attachment predisposing to potential psychopathologies. We investigated whether narratives containing attachment-specific speech patterns shape listeners' emotional responses and social intentions. DESIGN First, 149 healthy participants listened to three narratives characteristic for secure, insecure-preoccupied, and insecure-dismissing attachment. Following each narrative, the well-being and interpersonal reactivity as a particular aspect of emotional reactivity of the listener were assessed. Likewise, psychopathological aspects of personality were evaluated. A follow-up study compared 10 psychosomatic patients with a current depressive episode and/or personality disorder with distinct depressive symptoms and 10 age- and gender-matched healthy controls. METHODS Effects of narratives on listeners' mental state were tested with repeated-measures AN(C)OVA. Mediating effects in the listener (attachment characteristics in the context of personality traits) were explored. Narrative effects were compared between patients and controls. RESULTS Listening to insecure attachment narratives reduced well-being in controls. Nevertheless, tendency for social interaction was highest following the insecure-preoccupied narrative. Importantly, listeners' individual attachment characteristics mediated the relationship between well-being/interpersonal reactivity following the insecure-preoccupied narrative and levels of psychopathology. Furthermore, compared with healthy participants, patients showed higher emotional reactivity following exposure to the insecure-preoccupied narrative, represented by lower well-being and lower estimation of friendliness towards the narrator. CONCLUSIONS Exposure to attachment-specific speech patterns can result in dysphoric mood changes. Specifically, the insecure-preoccupied narrative influenced the listeners' emotional state, which was further mediated by the individual attachment patterns and psychopathological personality characteristics. This deepens the understanding of interpersonal processes, especially in psychotherapeutic settings. PRACTITIONER POINTS In clinical populations, insecure-preoccupied attachment has a high prevalence. In this study, listening to a narrative characteristic of insecure-preoccupied speech patterns resulted in reduced well-being in healthy listeners. Patients with depressive symptoms showed a higher emotional reactivity towards the insecure-preoccupied narrative compared to healthy controls. While working on (childhood) traumata, for example, in group therapy or inpatient settings, therapists should raise awareness to possible mood changes through discourse-conveyed attachment characteristics in listeners as a 'side effect'.
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Affiliation(s)
- Anna Linda Leutritz
- Clinical Affective Neuroimaging Laboratory, Magdeburg, Germany.,Department of Psychiatry and Psychotherapy, Otto von Guericke University, Magdeburg, Germany
| | - Lejla Colic
- Clinical Affective Neuroimaging Laboratory, Magdeburg, Germany.,Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Viola Borchardt
- Clinical Affective Neuroimaging Laboratory, Magdeburg, Germany
| | - Xuemei Cheng
- Department of Mechanical and Electrical Engineering, Beijing Polytechnic College, China
| | - Bin Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Sarah Lison
- Department of Psychosomatics and Psychotherapy, Otto von Guericke University, Magdeburg, Germany
| | - Jörg Frommer
- Department of Psychosomatics and Psychotherapy, Otto von Guericke University, Magdeburg, Germany
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Austria
| | - Bernhard Strauss
- Institute of Psychosocial Medicine and Psychotherapy, University Hospital Jena, Germany
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, UK.,Anna Freud National Centre for Children and Families, London, UK
| | - Tobias Nolte
- Anna Freud National Centre for Children and Families, London, UK.,Wellcome Trust Centre for Neuroimaging, University College London, UK
| | - Martin Walter
- Clinical Affective Neuroimaging Laboratory, Magdeburg, Germany.,Leibniz Institute for Neurobiology, Magdeburg, Germany.,Max Planck Institute for Biological Cybernetics, Tübingen, Germany.,Center for Behavioral Brain Sciences, Magdeburg, Germany.,Department of Psychiatry and Psychotherapy, University Hospital Jena, Germany
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35
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Gander M, Buchheim A, Bock A, Steppan M, Sevecke K, Goth K. Unresolved Attachment Mediates the Relationship Between Childhood Trauma and Impaired Personality Functioning in Adolescence. J Pers Disord 2020; 34:84-103. [PMID: 31990614 DOI: 10.1521/pedi_2020_34_468] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The present study investigates the mediating effect of attachment trauma on the relationship between childhood maltreatment and personality functioning in 199 adolescents (12-18 years) using a novel approach of an in-depth analysis of attachment-related traumatic contents during an attachment interview (AAP). Our findings demonstrate that adolescents with a high amount of traumatic attachment-related material show a lower resilience when facing traumatic childhood experiences, resulting in a greater severity of personality dysfunction. In particular, the associations between emotional abuse and neglect and the domains of identity, empathy, self-direction, and intimacy were mediated by the severity of attachment trauma. These results advance our understanding of the different nuances of attachment-related traumatic material and how they might shape personality structure in an adolescent age group.
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Affiliation(s)
- Manuela Gander
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, Austria
| | - Anna Buchheim
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, Austria.,Institute of Psychology, University of Innsbruck.,Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Tirol Kliniken, Austria
| | - Astrid Bock
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, Austria
| | - Martin Steppan
- Institute of Psychology, University of Basel, Switzerland
| | - Kathrin Sevecke
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, Austria
| | - Kirstin Goth
- Department of Child and Adolescent Psychiatry, Psychiatric University Clinics, Basel, Switzerland
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36
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Janjic T, Pereverzyev S, Hammerl M, Neubauer V, Lerchner H, Wallner V, Steiger R, Kiechl-Kohlendorfer U, Zimmermann M, Buchheim A, Grams AE, Gizewski ER. Feed-forward neural networks using cerebral MR spectroscopy and DTI might predict neurodevelopmental outcome in preterm neonates. Eur Radiol 2020; 30:6441-6451. [PMID: 32683551 PMCID: PMC7599175 DOI: 10.1007/s00330-020-07053-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/11/2020] [Accepted: 06/30/2020] [Indexed: 11/28/2022]
Abstract
Objectives We aimed to evaluate the ability of feed-forward neural networks (fNNs) to predict the neurodevelopmental outcome (NDO) of very preterm neonates (VPIs) at 12 months corrected age by using biomarkers of cerebral MR proton spectroscopy (1H-MRS) and diffusion tensor imaging (DTI) at term-equivalent age (TEA). Methods In this prospective study, 300 VPIs born before 32 gestational weeks received an MRI scan at TEA between September 2013 and December 2017. Due to missing or poor-quality spectroscopy data and missing neurodevelopmental tests, 173 VPIs were excluded. Data sets consisting of 103 and 115 VPIs were considered for prediction of motor and cognitive developmental delay, respectively. Five metabolite ratios and two DTI characteristics in six different areas of the brain were evaluated. A feature selection algorithm was developed for receiving a subset of characteristics prevalent for the VPIs with a developmental delay. Finally, the predictors were constructed employing multiple fNNs and fourfold cross-validation. Results By employing the constructed fNN predictors, we were able to predict cognitive delays of VPIs with 85.7% sensitivity, 100% specificity, 100% positive predictive value (PPV) and 99.1% negative predictive value (NPV). For the prediction of motor delay, we achieved a sensitivity of 76.9%, a specificity of 98.9%, a PPV of 90.9% and an NPV of 96.7%. Conclusion FNNs might be able to predict motor and cognitive development of VPIs at 12 months corrected age when employing biomarkers of cerebral 1H-MRS and DTI quantified at TEA. Key Points • A feed-forward neuronal network is a promising tool for outcome prediction in premature infants. • Cerebral proton magnetic resonance spectroscopy and diffusion tensor imaging can be used for the construction of early prognostic biomarkers. • Premature infants that would most benefit from early intervention services can be spotted at the time of optimal neuroplasticity. Electronic supplementary material The online version of this article (10.1007/s00330-020-07053-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- T Janjic
- Department of Neuroradiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria. .,Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria.
| | - S Pereverzyev
- Department of Neuroradiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - M Hammerl
- Department of Paediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria
| | - V Neubauer
- Department of Paediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria
| | - H Lerchner
- Department of Neuroradiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - V Wallner
- Department of Neuroradiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - R Steiger
- Department of Neuroradiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - U Kiechl-Kohlendorfer
- Department of Paediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria
| | - M Zimmermann
- Department of Paediatrics II, Neonatology, Medical University of Innsbruck, Innsbruck, Austria
| | - A Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - A E Grams
- Department of Neuroradiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
| | - E R Gizewski
- Department of Neuroradiology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.,Neuroimaging Research Core Facility, Medical University of Innsbruck, Innsbruck, Austria
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Gerhardt C, Hamouda K, Irorutola F, Rose M, Hinkelmann K, Buchheim A, Senf-Beckenbach P. Insecure and Unresolved/Disorganized Attachment in Patients With Psychogenic Nonepileptic Seizures. J Acad Consult Liaison Psychiatry 2020; 62:337-344. [PMID: 33358452 DOI: 10.1016/j.psym.2020.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/17/2020] [Accepted: 05/17/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Psychogenic nonepileptic seizures (PNES) are still poorly understood and difficult to treat. Attachment theory could add new aspects to the understanding of the multifactorial genesis and maintenance of PNES and the therapeutic needs of this patient group. OBJECTIVE The aim of the present study is to systematically assess attachment in adult patients with PNES with a focus on the role of unresolved/disorganized attachment. METHODS A cross-sectional design was chosen to compare patients with confirmed PNES (n = 44) and healthy controls (n = 44) matched for gender, age, and education. Attachment was assessed using the Adult Attachment Projective Picture System. Psychometric questionnaires included the Childhood Trauma Questionnaire; Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) axis II disorders, Patient Questionnaire; the Somatoform Dissociation Questionnaire; and the Patient Health Questionnaire. RESULTS We found significantly less secure (P = 0.006) and more unresolved/disorganized (P = 0.041) attachment classifications in the PNES group. Among patients with PNES, 7% were classified secure and 43% were classified unresolved/disorganized. Patients with an unresolved attachment representation were significantly more likely to be screened positive for personality pathology in the Structured Clinical Interview for DSM-IV axis II disorders, Patient Questionnaire (P = 0.03) and to report more emotional abuse in the Childhood Trauma Questionnaire (P = 0.007) than patients with other attachment classifications. CONCLUSIONS Our findings suggest that unresolved/disorganized attachment might be the predominant attachment style in patients with PNES and might be associated with more severe personality pathology. This could be of therapeutic relevance. The present study is the first to assess adult attachment in patients with PNES using a semi-structured interview in comparison to matched healthy controls.
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Affiliation(s)
- Carola Gerhardt
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität zu Berlin, and Berlin Institute of Health, Department of Psychosomatic Medicine, Berlin, Germany.
| | - Karim Hamouda
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität zu Berlin, and Berlin Institute of Health, Department of Psychosomatic Medicine, Berlin, Germany
| | - Freddy Irorutola
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität zu Berlin, and Berlin Institute of Health, Department of Psychosomatic Medicine, Berlin, Germany
| | - Matthias Rose
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität zu Berlin, and Berlin Institute of Health, Department of Psychosomatic Medicine, Berlin, Germany
| | - Kim Hinkelmann
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität zu Berlin, and Berlin Institute of Health, Department of Psychosomatic Medicine, Berlin, Germany
| | - Anna Buchheim
- Department of Psychology, Clinical Psychology, University of Innsbruck, Innsbruck, Austria
| | - Philine Senf-Beckenbach
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt- Universität zu Berlin, and Berlin Institute of Health, Department of Psychosomatic Medicine, Berlin, Germany
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Hörz-Sagstetter S, Volkert J, Rentrop M, Benecke C, Gremaud-Heitz DJ, Unterrainer HF, Schauenburg H, Seidler D, Buchheim A, Doering S, Feil MG, Clarkin JF, Dammann G, Zimmermann J. A Bifactor Model of Personality Organization. J Pers Assess 2020; 103:149-160. [PMID: 31917610 DOI: 10.1080/00223891.2019.1705463] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of this study was to explore the viability of a bifactor model for the Inventory of Personality Organization (IPO), which is a self-report measure of personality functioning based on Kernberg's model of personality organization. A heterogeneous, predominantly clinical sample (N = 616) completed the German 83-item version of the IPO. Confirmatory and Exploratory Factor Analyses were applied to explore the factor structure of the IPO. We were able to establish a bifactor model with a general factor of personality functioning and three specific factors (Aggression, Reality Testing, Moral Values), which represent additional dimensions of personality organization. Virtually all items showed substantial positive loadings on the general factor, explaining roughly 66% of the common variance. Furthermore, we found support for convergent and discriminant validity of general and specific factors with regard to interview-based assessments of personality disorders and personality organization. The results lend support to a bifactor approach to Kernberg's model of personality organization. We also present a 30-item brief form of the IPO that efficiently implements the bifactor approach and may be further validated in future studies.
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Affiliation(s)
| | - Jana Volkert
- Department of Psychosocial Prevention, University of Heidelberg, Germany
| | | | - Cord Benecke
- Department of Psychology, University of Kassel, Germany
| | | | - Human-Friedrich Unterrainer
- Department of Psychiatry and Psychosomatic Medicine, Medical University of Graz, Austria and Center for Integrative Addiction Research (CIAR), Grüner Kreis Society, Vienna, Austria
| | - Henning Schauenburg
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Germany
| | - Daniel Seidler
- Department of Psychosomatic Medicine and Psychotherapy, Heinrich-Heine-University Medical Faculty, Dusseldorf, Germany
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Austria
| | - Stephan Doering
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Austria
| | - Markus G Feil
- Psychotherapeutic Outpatient Clinic for Violent and Sexual Offenders, Munich, Germany
| | - John F Clarkin
- Personality Disorders Institute, Cornell University, White Plains, USA
| | - Gerhard Dammann
- Psychiatric Clinic, Münsterlingen, Switzerland and Paracelsus Medical University Salzburg, Austria
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Fuchshuber J, Tatzer J, Hiebler-Ragger M, Trinkl F, Kimmerle A, Rinner A, Buchheim A, Schrom S, Rinner B, Leber K, Pieber T, Weiss E, Lewis AJ, Kapfhammer HP, Unterrainer HF. The Influence of an Attachment-Related Stimulus on Oxytocin Reactivity in Poly-Drug Users Undergoing Maintenance Therapy Compared to Healthy Controls. Front Psychiatry 2020; 11:460506. [PMID: 33101071 PMCID: PMC7544992 DOI: 10.3389/fpsyt.2020.460506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 08/26/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Substance use disorders (SUDs) have been described as a dysfunctional way to compensate for deficiencies in that person's underlying attachment system. Furthermore, the neuropeptide oxytocin (OT), which is a critical component of the neurobiology of the attachment system, has been shown to effectively reduce addictive behavior and therefore has been discussed as a potential medication in SUD treatment. This study investigates variation in peripheral OT plasma levels as a function of exposure to an attachment-related stimulus in SUD patients compared to healthy controls (HCs). METHODS A total sample of 48 men, 24 inpatients in maintenance treatment who were diagnosed with poly-drug use disorder (PUD) and 24 HC, was investigated. A 15-min exposure to the Adult Attachment Projective Picture System (AAP) was used as an attachment-related stimulus and coded for attachment status. Blood samples before and after the AAP-assessment were taken and assayed for OT levels. Variation in baselines level of OT was examined in relation to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), the Adult Attachment-Scale (AAS), and the Brief Symptom Inventory (BSI). RESULTS Following the AAP stimulus controls showed no significant difference in OT levels elevation from baseline compared to the PUD group's OT levels. Furthermore, in the PUD group only OT-baseline-levels may be negatively associated with the AAS subscale "Comfort with Closeness" and "Anxiety" and lifetime substance use. DISCUSSION Our results suggest that peripheral OT levels in poly-drug users undergoing maintenance treatment are not significantly different in responsiveness to an attachment related stimulus compared to HC. With regard to non-significant tendencies observed in this study which hint toward decreased OT-reactivity in the PUD group, further research is needed to explore this hypothesis with increased statistical power.
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Affiliation(s)
- Jürgen Fuchshuber
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria.,CIAR: Center for Integrative Addiction Research, Grüner Kreis Society, Vienna, Austria
| | - Jasmin Tatzer
- CIAR: Center for Integrative Addiction Research, Grüner Kreis Society, Vienna, Austria.,Institute of Psychology, University of Graz, Graz, Austria
| | - Michaela Hiebler-Ragger
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria.,CIAR: Center for Integrative Addiction Research, Grüner Kreis Society, Vienna, Austria
| | - Florian Trinkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria.,CIAR: Center for Integrative Addiction Research, Grüner Kreis Society, Vienna, Austria
| | - Andreas Kimmerle
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria.,CIAR: Center for Integrative Addiction Research, Grüner Kreis Society, Vienna, Austria
| | - Anita Rinner
- CIAR: Center for Integrative Addiction Research, Grüner Kreis Society, Vienna, Austria
| | - Anna Buchheim
- Department of Clinical Psychology, Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Silke Schrom
- Department of Biomedical Research, Medical University Graz, Graz, Austria
| | - Beate Rinner
- Department of Biomedical Research, Medical University Graz, Graz, Austria
| | - Klaus Leber
- Department of Neurosurgery, Medical University Graz, Graz, Austria
| | - Thomas Pieber
- Department of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Elisabeth Weiss
- Department of Clinical Psychology, Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Andrew J Lewis
- Discipline of Psychology, College of Science, Health, Engineering & Education, Murdoch University, Perth, WA, Australia
| | - Hans-Peter Kapfhammer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria
| | - Human Friedrich Unterrainer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, Graz, Austria.,CIAR: Center for Integrative Addiction Research, Grüner Kreis Society, Vienna, Austria.,Department of Religious Studies, University of Vienna, Vienna, Austria
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40
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Köhler-Dauner F, Roder E, Krause S, Buchheim A, Gündel H, Fegert JM, Ziegenhain U, Waller C. Reduced caregiving quality measured during the strange situation procedure increases child's autonomic nervous system stress response. Child Adolesc Psychiatry Ment Health 2019; 13:41. [PMID: 31695745 PMCID: PMC6824052 DOI: 10.1186/s13034-019-0302-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 10/12/2019] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Dysfunctional maternal behavior has been shown to lead to disturbances in infant's regulatory capacities and alterations in vagal reactivity. We aim to investigate the autonomic nervous system (ANS) response of the child during the strange situation procedure (SSP) in relation to the quality of maternal behavior. METHODS Twelve month after birth, 163 mother-child-dyads were investigated during the SSP. Heart rate (HR) and both, the parasympathetic branch (PNS) via the respiratory sinus arrhythmia (RSA) and the sympathetic branch (SNS) via the left ventricular ejection time (LVET) of the ANS were continuously determined during the SSP using electrocardiogram (ECG) and impedance cardiogram (ICG) measures. Maternal behavior was assessed by using the AMBIANCE measure. RESULTS The ANS response in infants of mothers with disruptive behavior compared to infants of non-disruptive mothers was significantly altered during the SSP: HR increased especially when infants of disruptive mothers were alone with the stranger (F (1, 161) = 4.15, p = .04) with a significant vagal withdrawal when being in contact with the stranger despite of presence of the mother (F (1, 161) = 5.11, p = .03) and a significant increase in vagal tone during final reunion (F (1, 161) = 3.76, p = .05). HR increase was mainly based on a decrease in LVET (F (1, 161) = 4.08, p = .05) with a maximum infant's HR when the stranger came into the room instead of the mother. CONCLUSION Both, SNS and PNS branches of the child are significantly altered in terms of an ANS imbalance, especially during contract to a stranger, in relation to dysfunctional maternal behavior. Our findings suggest the importance of supporting high quality caregiving that enables the infant to adapt adequately to stressful interpersonal situations which is likely to promote later health.
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Affiliation(s)
- Franziska Köhler-Dauner
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm Medical University of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
| | - Eva Roder
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Ulm, Ulm, Germany
| | - Sabrina Krause
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Ulm, Ulm, Germany
| | - Anna Buchheim
- Institute of Psychology, University Innsbruck, Innsbruck, Austria
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Ulm, Ulm, Germany
| | - Jörg M. Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm Medical University of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
| | - Ute Ziegenhain
- Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital of Ulm Medical University of Ulm, Steinhövelstraße 5, 89075 Ulm, Germany
| | - Christiane Waller
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Ulm, Ulm, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany
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Bernheim D, Gander M, Keller F, Becker M, Lischke A, Mentel R, Freyberger HJ, Buchheim A. The role of attachment characteristics in dialectical behavior therapy for patients with borderline personality disorder. Clin Psychol Psychother 2019; 26:339-349. [DOI: 10.1002/cpp.2355] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/11/2019] [Accepted: 01/14/2019] [Indexed: 11/12/2022]
Affiliation(s)
- Dorothee Bernheim
- Department of Psychiatry and PsychotherapyUniversity Hospital Greifswald Greifswald Germany
- Department of Child and Adolescent Psychiatry and PsychotherapyUniversity Hospital Ulm Ulm Germany
| | - Manuela Gander
- Department of PsychologyUniversity of Innsbruck Innsbruck Austria
| | - Ferdinand Keller
- Department of Child and Adolescent Psychiatry and PsychotherapyUniversity Hospital Ulm Ulm Germany
| | - Mathias Becker
- Department of Psychiatry and Psychotherapy, Helios‐Clinic Stralsund Germany
| | | | - Renate Mentel
- Department of Psychiatry and PsychotherapyUniversity Hospital Greifswald Greifswald Germany
| | - Harald J. Freyberger
- Department of Psychiatry and PsychotherapyUniversity Hospital Greifswald Greifswald Germany
- Department of Psychiatry and Psychotherapy, Helios‐Clinic Stralsund Germany
| | - Anna Buchheim
- Department of PsychologyUniversity of Innsbruck Innsbruck Austria
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Abstract
Borderline personality disorder is associated with predominant insecure and unresolved attachment representations, linked history of trauma, impaired cognitive functioning and oxytocin levels, and higher limbic activations. Two randomized clinical trials on transference-focused psychotherapy assessed change of attachment representation and reflective functioning. The first showed that transference-focused psychotherapy was superior, demonstrating significant improvements toward attachment security and higher reflective functioning. The second randomized clinical trial study on transference-focused psychotherapy compared with therapy as usual replicated these results and additionally showed a significant shift from unresolved to organized attachment in the transference-focused psychotherapy group only, suggesting its effectiveness in traumatized patients.
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Affiliation(s)
- Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innrain 52, Innsbruck 6020, Austria.
| | - Diana Diamond
- City University of New York, Personality Disorders Institute, Weill Medical Center of Cornell University, New York University, New York, NY, USA
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Buchheim A, Labek K, Taubner S, Kessler H, Pokorny D, Kächele H, Cierpka M, Roth G, Pogarell O, Karch S. Modulation of Gamma Band Activity and Late Positive Potential in Patients with Chronic Depression after Psychodynamic Psychotherapy. Psychother Psychosom 2018; 87:252-254. [PMID: 29768272 DOI: 10.1159/000488090] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 03/02/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Karin Labek
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Svenja Taubner
- Institute of Psychosocial Prevention, University Hospital Heidelberg, Heidelberg, Germany
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Dan Pokorny
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University, Ulm, Germany
| | - Horst Kächele
- International Psychoanalytic University, Berlin, Germany
| | - Manfred Cierpka
- Institute of Psychosocial Prevention, University Hospital Heidelberg, Heidelberg, Germany
| | - Gerhard Roth
- Brain Research Institute, University of Bremen, Bremen, Germany
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Susanne Karch
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
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Gander M, Diamond D, Buchheim A, Sevecke K. Use of the Adult Attachment Projective Picture System in the formulation of a case of an adolescent refugee with PTSD. J Trauma Dissociation 2018; 19:572-595. [PMID: 29547072 DOI: 10.1080/15299732.2018.1451803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Forced displacements and their psychosocial consequences in adolescent refugees and their families have received increasing attention in recent years. Although supportive family relations play a key role in buffering the impact of traumatization in adolescents, parental ability to provide such is often subject to extreme pressure. Under conditions of forced dislocation and fear, maladaptive interpersonal strategies in the parent-child relationships may develop, contributing to the onset of psychopathology. We explore new aspects of attachment-related issues for the understanding and treatment of adolescent refugees who have experienced multiple traumas in their childhood. We used a multimethod assessment battery including the Adult Attachment Projective Picture System (AAP), the Structured Clinical Interview, the Youth Self Report and the Wechsler Intelligence Scale in an adolescent boy with post-traumatic stress disorder (PTSD). Our subject was an adolescent refugee from the Middle East who demonstrated an unresolved attachment when confronted with loss and fear. His responses on the AAP evoked aspects of insecure-unresolved attachment, including his belief that it is not safe to trust in attachment figures, his limited access to traumatic attachment experiences, his impaired ability to take concrete actions when dealing with threatening attachment situations and the unintentional role-reversal shed new light on our understanding of his traumatic experiences, family functioning and psychopathological symptoms. Our results demonstrate the utility of the AAP in an adolescent refugee with PTSD by expanding our knowledge of a diverse range of experiences across the interpersonal, cognitive, cultural and developmental contexts that formed the basis for an individualized treatment plan.
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Affiliation(s)
- Manuela Gander
- a Department of Child and Adolescent Psychiatry , Medical University of Innsbruck , Innsbruck, Austria
| | - Diana Diamond
- b The Graduate Center , City College of the City University of New York , New York, USA
| | - Anna Buchheim
- c Institute of Psychology , University of Innsbruck , Innsbruck, Austria
| | - Kathrin Sevecke
- a Department of Child and Adolescent Psychiatry , Medical University of Innsbruck , Innsbruck, Austria
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Gander M, Sevecke K, Buchheim A. Disorder-specific attachment characteristics and experiences of childhood abuse and neglect in adolescents with anorexia nervosa and a major depressive episode. Clin Psychol Psychother 2018; 25:894-906. [PMID: 30216616 PMCID: PMC6585713 DOI: 10.1002/cpp.2324] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 07/15/2018] [Accepted: 07/31/2018] [Indexed: 11/08/2022]
Abstract
For the first time, the present study investigates disorder‐specific attachment characteristics and childhood trauma in adolescent inpatients with anorexia nervosa (n = 30, girls/boys: 28/2, age: M = 14.84, SD = 1.20), a major depressive episode (n = 30, girls/boys: 27/3, age: M = 15.14, SD = 1.50), and controls (n = 60, girls/boys: 44/16, age: M = 16.10, SD = 1.20). We used the Structured Clinical Interview to diagnose Axis I disorders, the Adult Attachment Projective Picture System to classify attachment representations, and the Childhood Trauma Questionnaire to assess child maltreatment. Our findings demonstrate an overrepresentation of the unresolved attachment status in the patient samples. A one‐way analysis of variance succeeded by Bonferroni post hoc tests indicated that adolescents with anorexia nervosa show more isolation and dissolution of boundaries between life and death when confronted with situations of solitude. Although they report moderate to severe levels of traumatic childhood experiences, they tend to minimize those. Adolescents with a major depressive episode report higher levels of emotional abuse and neglect in their childhood, leaving them in a state of failed protection and danger during attachment distress. Integrating these attachment‐related characteristics into specific psychotherapeutic interventions might be associated with a better outcome in that age group.
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Affiliation(s)
- Manuela Gander
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, Innsbruck, Austria
| | - Kathrin Sevecke
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
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Borchardt V, Surova G, van der Meer J, Bola M, Frommer J, Leutritz AL, Sweeney‐Reed CM, Buchheim A, Strauß B, Nolte T, Olbrich S, Walter M. Exposure to attachment narratives dynamically modulates cortical arousal during the resting state in the listener. Brain Behav 2018; 8:e01007. [PMID: 29877060 PMCID: PMC6043700 DOI: 10.1002/brb3.1007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 04/14/2018] [Accepted: 04/20/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Affective stimulation entails changes in brain network patterns at rest, but it is unknown whether exogenous emotional stimulation has a prolonged effect on the temporal dynamics of endogenous cortical arousal. We therefore investigated differences in cortical arousal in the listener following stimulation with different attachment-related narratives. METHODS Resting-state EEG was recorded from sixteen healthy subjects for ten minutes each with eyes closed: first at baseline and then after passively listening to three affective narratives from strangers about their early childhood experiences (prototypical for insecure-dismissing, insecure-preoccupied, and secure attachment). Using the VIGALL 2.1 algorithm, low or high vigilance stages in consecutive EEG segments were classified, and their dynamic profile was analyzed. Questionnaires assessed the listeners' emotional response to the content of the narrative. RESULTS As a general effect of preceding affective stimulation, vigilance following the stimulation was significantly elevated compared to baseline rest, and carryover effects in dynamic vigilance profiles were observed. A difference between narrative conditions was revealed for the insecure-dismissing condition, in which the decrease in duration of high vigilance stages was fastest compared to the other two conditions. The behavioral data supported the observation that especially the insecure narratives induced a tendency in the listener to affectively disengage from the narrative content. DISCUSSION This study revealed carryover effects in endogenous cortical arousal evoked by preceding affective stimulation and provides evidence for attachment-specific dynamic alterations of brain states and individual differences in emotional reactivity.
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Affiliation(s)
- Viola Borchardt
- Clinical Affective Neuroimaging LaboratoryMagdeburgGermany
- Department of Behavioral NeurologyLeibniz Institute for NeurobiologyMagdeburgGermany
| | - Galina Surova
- Clinical Affective Neuroimaging LaboratoryMagdeburgGermany
- Clinic for Psychiatry and PsychotherapyUniversity of LeipzigLeipzigGermany
| | | | - Michał Bola
- Laboratory of Brain ImagingNeurobiology CenterNencki Institute of Experimental Biology of Polish Academy of SciencesWarsawPoland
| | - Jörg Frommer
- Clinic for Psychosomatic Medicine and PsychotherapyUniversity Clinic MagdeburgMagdeburgGermany
| | - Anna Linda Leutritz
- Clinical Affective Neuroimaging LaboratoryMagdeburgGermany
- Clinic for Psychiatry and PsychotherapyOtto von Guericke University MagdeburgMagdeburgGermany
| | - Catherine M. Sweeney‐Reed
- Neurocybernetics and RehabilitationDepartment of Neurology and Stereotactic NeurosurgeryOtto von Guericke UniversityMagdeburgGermany
| | - Anna Buchheim
- Institute of PsychologyUniversity of InnsbruckInnsbruckAustria
| | - Bernhard Strauß
- Institute of Psychosocial Medicine and PsychotherapyUniversity Hospital JenaJenaGermany
| | - Tobias Nolte
- Anna Freud National Centre for Children And FamiliesLondonUK
- Wellcome Trust Centre for NeuroimagingUniversity College of LondonLondonUK
| | - Sebastian Olbrich
- Clinic for Psychiatry and PsychotherapyUniversity of LeipzigLeipzigGermany
- Clinic for Psychiatry, Psychotherapy and PsychosomaticUniversity Clinic ZurichZurichSwitzerland
| | - Martin Walter
- Clinical Affective Neuroimaging LaboratoryMagdeburgGermany
- Department of Behavioral NeurologyLeibniz Institute for NeurobiologyMagdeburgGermany
- Clinic for Psychiatry and PsychotherapyEberhard‐Karls UniversityTuebingenGermany
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Buchheim A, Hörz-Sagstetter S, Doering S, Rentrop M, Schuster P, Buchheim P, Pokorny D, Fischer-Kern M. Change of Unresolved Attachment in Borderline Personality Disorder: RCT Study of Transference-Focused Psychotherapy. Psychother Psychosom 2018; 86:314-316. [PMID: 28903103 DOI: 10.1159/000460257] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 02/06/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
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48
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Müller LE, Bertsch K, Bülau K, Herpertz SC, Buchheim A. Emotional neglect in childhood shapes social dysfunctioning in adults by influencing the oxytocin and the attachment system: Results from a population-based study. Int J Psychophysiol 2018; 136:73-80. [PMID: 29859994 DOI: 10.1016/j.ijpsycho.2018.05.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/16/2018] [Accepted: 05/30/2018] [Indexed: 02/06/2023]
Abstract
Early life maltreatment (ELM) is the major single risk factor for impairments in social functioning and mental health in adulthood. One of the most prevalent and most rapidly increasing forms of ELM is emotional neglect. According to bio-behavioral synchrony assumptions, the oxytocin and attachment systems play an important mediating role in the interplay between emotional neglect and social dysfunctioning. Therefore, the aim of the present study was to investigate whether fear and avoidance of social functioning, two important and highly prevalent facets of social dysfunctioning in adulthood, are shaped by emotional neglect, plasma oxytocin levels and attachment representations. We assessed emotional neglect as well as other forms of ELM with the Childhood Trauma Questionnaire, current attachment representations with the Adult Attachment Projective Picture System, and fear and avoidance of social situations with the Liebowitz Social Anxiety Scale in a population-based sample of N = 121 men and women. Furthermore, 4.9 ml blood samples were drawn from each participant to assess peripheral plasma oxytocin levels. Applying a sequential mediation model, results revealed that emotional neglect was associated with lower plasma oxytocin levels which in turn were associated with insecure attachment representations which were related to elevated fear and avoidance of social situations (a1d21b2: F3,117 = 20.84, P < .001). Plasma oxytocin and current attachment representations hence fully and sequentially mediate the effects of emotional neglect on social fear and avoidance, two important facets of adult social dysfunctioning, confirming bio-behavioral synchrony assumptions.
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Affiliation(s)
- Laura E Müller
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Voßstr. 2, 69115 Heidelberg, Germany.
| | - Katja Bertsch
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Voßstr. 2, 69115 Heidelberg, Germany
| | - Konstatin Bülau
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Voßstr. 2, 69115 Heidelberg, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Voßstr. 2, 69115 Heidelberg, Germany
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innrain 52f, 6020 Innsbruck, Austria
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49
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Labek K, Berger S, Buchheim A, Bosch J, Spohrs J, Dommes L, Beschoner P, Stingl JC, Viviani R. The iconography of mourning and its neural correlates: a functional neuroimaging study. Soc Cogn Affect Neurosci 2018; 12:1303-1313. [PMID: 28449116 PMCID: PMC5597887 DOI: 10.1093/scan/nsx058] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 04/02/2017] [Indexed: 12/30/2022] Open
Abstract
The present functional neuroimaging study focuses on the iconography of mourning. A culture-specific pattern of body postures of mourning individuals, mostly suggesting withdrawal, emerged from a survey of visual material. When used in different combinations in stylized drawings in our neuroimaging study, this material activated cortical areas commonly seen in studies of social cognition (temporo-parietal junction, superior temporal gyrus, and inferior temporal lobe), empathy for pain (somatosensory cortex), and loss (precuneus, middle/posterior cingular gyrus). This pattern of activation developed over time. While in the early phases of exposure lower association areas, such as the extrastriate body area, were active, in the late phases activation in parietal and temporal association areas and the prefrontal cortex was more prominent. These findings are consistent with the conventional and contextual character of iconographic material, and further differentiate it from emotionally negatively valenced and high-arousing stimuli. In future studies, this neuroimaging assay may be useful in characterizing interpretive appraisal of material of negative emotional valence.
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Affiliation(s)
- Karin Labek
- Institute of Psychology, University of Innsbruck, Tyrol, Austria
| | - Samantha Berger
- Institute of Psychology, University of Innsbruck, Tyrol, Austria
| | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Tyrol, Austria
| | - Julia Bosch
- Department of Psychiatry and Psychotherapy III, University of Ulm, Baden-Württemberg, Germany
| | - Jennifer Spohrs
- Department of Psychiatry and Psychotherapy III, University of Ulm, Baden-Württemberg, Germany
| | - Lisa Dommes
- Department of Psychiatry and Psychotherapy III, University of Ulm, Baden-Württemberg, Germany.,Psychosomatic and Psychotherapy Clinic, University of Ulm, Baden-Württemberg, Germany
| | - Petra Beschoner
- Psychosomatic and Psychotherapy Clinic, University of Ulm, Baden-Württemberg, Germany
| | - Julia C Stingl
- Federal Institute for Drugs and Medical Devices, Bonn, Germany.,Center for Translational Medicine, University of Bonn Medical School, Bonn, Germany
| | - Roberto Viviani
- Institute of Psychology, University of Innsbruck, Tyrol, Austria.,Department of Psychiatry and Psychotherapy III, University of Ulm, Baden-Württemberg, Germany
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50
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Krause S, Boeck C, Gumpp AM, Rottler E, Schury K, Karabatsiakis A, Buchheim A, Gündel H, Kolassa IT, Waller C. Child Maltreatment Is Associated with a Reduction of the Oxytocin Receptor in Peripheral Blood Mononuclear Cells. Front Psychol 2018. [PMID: 29535656 PMCID: PMC5835067 DOI: 10.3389/fpsyg.2018.00173] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: Child maltreatment (CM) and attachment experiences are closely linked to alterations in the human oxytocin (OXT) system. However, human data about oxytocin receptor (OXTR) protein levels are lacking. Therefore, we investigated oxytocin receptor (OXTR) protein levels in circulating immune cells and related them to circulating levels of OXT in peripheral blood. We hypothesized reduced OXTR protein levels, associated with both, experiences of CM and an insecure attachment representation. Methods: OXTR protein expressions were analyzed by western blot analyses in peripheral blood mononuclear cells (PBMC) and plasma OXT levels were determined by radioimmunoassay (RIA) in 49 mothers. We used the Childhood Trauma Questionnaire (CTQ) to assess adverse childhood experiences. Attachment representations (secure vs. insecure) were classified using the Adult Attachment Projective Picture System (AAP) and levels of anxiety and depression were assessed with the German version of the Hospital Depression and Anxiety scale (HADS-D). Results: CM-affected women showed significantly lower OXTR protein expression with significantly negative correlations between the OXTR protein expression and the CTQ sum score, whereas plasma OXT levels showed no significant differences in association with CM. Lower OXTR protein expression in PBMC were particularly pronounced in the group of insecurely attached mothers compared to the securely attached group. Anxiety levels were significantly higher in CM-affected women. Conclusion: This study demonstrated a significant association between CM and an alteration of OXTR protein expression in human blood cells as a sign for chronic, long-lasting alterations in this attachment-related neurobiological system.
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Affiliation(s)
- Sabrina Krause
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University, Ulm, Germany
| | - Christina Boeck
- Department of Clinical and Biological Psychology, Ulm University, Germany
| | - Anja M Gumpp
- Department of Clinical and Biological Psychology, Ulm University, Germany
| | - Edit Rottler
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University, Ulm, Germany
| | - Katharina Schury
- Department of Clinical and Biological Psychology, Ulm University, Germany
| | | | - Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University, Ulm, Germany
| | | | - Christiane Waller
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University, Ulm, Germany
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