Psychophysiological ambulatory assessment of affective dysregulation in borderline personality disorder

Many experts now believe that pervasive problems in affect regulation constitute the central area of dysfunction in borderline personality disorder (BPD). However, data is sparse and inconclusive. We hypothesized that patients with BPD, in contrast to healthy gender and nationality-matched controls, show a higher frequency and intensity of self-reported emotions, altered physiological indices of emotions, more complex emotions and greater problems in identifying specific emotions. We took a 24-hour psychophysiological ambulatory monitoring approach to investigate affect regulation during everyday life in 50 patients with BPD and in 50 healthy controls. To provide a typical and unmanipulated sample, we included only patients who were currently in treatment and did not alter their medication schedule. BPD patients reported more negative emotions, fewer positive emotions, and a greater intensity of negative emotions. A subgroup of non-medicated BPD patients manifested higher values of additional heart rate. Additional heart rate is that part of a heart rate increase that does not directly result from metabolic activity, and is used as an indicator of emotional reactivity. Borderline participants were more likely to report the concurrent presence of more than one emotion, and those patients who just started treatment in particular had greater problems in identifying specific emotions. Our findings during naturalistic ambulatory assessment support emotional dysregulation in BPD as defined by the biosocial theory of [Linehan, M.M., 1993. Cognitive-Behavioral Treatment of Borderline Personality Disorder. The Guildford Press, New York.] and suggest the potential utility for evaluating treatment outcome.

[Emotion activation in personality disorders]

There are at least six psychotherapeutic treatments of personality disorders having received empirical and clinical validation in terms of their efficacy. These treatments are based on different theoretical models, namely the cognitive-behavioural, psychodynamic and interpersonal models. This article briefly presents these treatments, focusing on the process of therapeutic change. It is assumed that the process of emotional activation is one of the most interesting theoretical psychotherapy ingredient in treatments of these patients. The treatments are discussed regarding this hypothesis and its clinical implications.

Learning styles vary among general surgery residents: analysis of 12 years of data

PURPOSE: Understanding the learning styles of individuals may assist in the tailoring of an educational program to optimize learning. General surgery faculty and residents have been characterized previously as having a tendency toward particular learning styles. We seek to understand better the learning styles of general surgery residents and differences that may exist within the population. METHODS: The Kolb Learning Style Inventory was administered yearly to general surgery residents at the University of Cincinnati from 1994 to 2006. This tool allows characterization of learning styles into 4 groups: converging, accommodating, assimilating, and diverging. The converging learning style involves education by actively solving problems. The accommodating learning style uses emotion and interpersonal relationships. The assimilating learning style learns by abstract logic. The diverging learning style learns best by observation. Chi-square analysis and analysis of variance were performed to determine significance. RESULTS: Surveys from 1994 to 2006 (91 residents, 325 responses) were analyzed. The prevalent learning style was converging (185, 57%), followed by assimilating (58, 18%), accommodating (44, 14%), and diverging (38, 12%). At the PGY 1 and 2 levels, male and female residents differed in learning style, with the accommodating learning style being relatively more frequent in women and assimilating learning style more frequent in men (Table 1, p < or = 0.001, chi-square test). Interestingly, learning style did not seem to change with advancing PGY level within the program, which suggests that individual learning styles may be constant throughout residency training. If a resident's learning style changed, it tended to be to converging. In addition, no relation exists between learning style and participation in dedicated basic science training or performance on the ABSIT/SBSE. CONCLUSIONS: Our data suggests that learning style differs between male and female general surgery residents but not with PGY level or ABSIT/SBSE performance. A greater understanding of individual learning styles may allow more refinement and tailoring of surgical programs.

Beyond words: Sensory properties of depressive thoughts

Verbal thoughts (such as negative cognitions) and sensory phenomena (such as visual mental imagery) are usually conceptualised as distinct mental experiences. The present study examined to what extent depressive thoughts are accompanied by sensory experiences and how this is associated with symptom severity, insight of illness and quality of life. A large sample of mildly to moderately depressed patients (N = 356) was recruited from multiple sources and asked about sensory properties of their depressive thoughts in an online study. Diagnostic status and symptom severity were established over a telephone interview with trained raters. Sensory properties of negative thoughts were reported by 56.5% of the sample (i.e., sensation in at least one sensory modality). The highest prevalence was seen for bodily (39.6%) followed by auditory (30.6%) and visual (27.2%) sensations. Patients reporting sensory properties of thoughts showed more severe psychopathological symptoms than those who did not. The degree of perceptuality was marginally associated with quality of life. The findings support the notion that depressive thoughts are not only verbal but commonly accompanied by sensory experiences. The perceptuality of depressive thoughts and the resulting sense of authenticity may contribute to the emotional impact and pervasiveness of such thoughts, making them difficult to dismiss for their holder.

Changes in emotion recognition relate to hypertension status

Background: Emotional processing in essential hypertension beyond self-report questionnaire has hardly been investigated. The aim of this study is to examine associations between hypertension status and recognition of facial affect. Methods: 25 healthy, non-smoking, medication-free men including 13 hypertensive subjects aged between 20 and 65 years completed a computer-based task in order to examine sensitivity of recognition of facial affect. Neutral faces gradually changed to a specific emotion in a pseudo-continuous manner. Slides of the six basic emotions (fear, sadness, disgust, happiness, anger, surprise) were chosen from the „NimStim Set“. Pictures of three female and three male faces were electronically morphed in 1% steps of intensity from 0% to 100% (36 sets of faces with 100 pictures each). Each picture of a set was presented for one second, ranging from 0% to 100% of intensity. Participants were instructed to press a stop button as soon as they recognized the expression of the face. After stopping a forced choice between the six basic emotions was required. As dependent variables, we recorded the emotion intensity at which the presentation was stopped and the number of errors (error rate). Recognition sensitivity was calculated as emotion intensity of correctly identified emotions. Results: Mean arterial pressure was associated with a significantly increased recognition sensitivity of facial affect for the emotion anger (ß = - .43, p = 0.03*, Δ R2= .110). There was no association with the emotions fear, sadness, disgust, happiness, and surprise (p’s > .0.41). Mean arterial pressure did not relate to the mean number of errors for any of the facial emotions. Conclusions: Our findings suggest that an increased blood pressure is associated with increased recognition sensitivity of facial affect for the emotion anger, if a face shows anger. Hypertensives perceive facial anger expression faster than normotensives, if anger is shown.

All eyes on me?! Social anxiety and self-directed perception of eye gaze

To date, only little is known about the self-directed perception and processing of subtle gaze cues in social anxiety that might however contribute to excessive feelings of being looked at by others. Using a web-based approach, participants (n=174) were asked whether or not briefly (300 ms) presented facial expressions modulated in gaze direction (0°, 2°, 4°, 6°, 8°) and valence (angry, fearful, happy, neutral) were directed at them. The results demonstrate a positive, linear relationship between self-reported social anxiety and stronger self-directed perception of others' gaze directions, particularly for negative (angry, fearful) and neutral expressions. Furthermore, faster responding was found for gaze more clearly directed at socially anxious individuals (0°, 2°, and 4°) suggesting a tendency to avoid direct gaze. In sum, the results illustrate an altered self-directed perception of subtle gaze cues. The possibly amplifying effects of social stress on biased self-directed perception of eye gaze are discussed.

Experimental induction of psychotherapeutically relevant emotional states

Background: Emotion research in neuroscience targets brain structures and processes involved in discrete emotion categories (e.g. anger, fear, sadness) or dimensions (e.g. valence, arousal, approach-avoidance), and usually relies on carefully controlled experimental paradigms with standardized and often simple emotion-eliciting stimuli like e.g. unpleasant pictures. Emotion research in clinical psychology and psychotherapy is often interested in very subtle differences between emotional states, e.g. differences within emotion categories (e.g. assertive, self-protecting vs. rejecting, protesting anger or specific grief vs. global sadness), and/or the biographical, social, situational, or motivational contexts of the emotional experience, which are desired to be minimized in experimental neuroscientific research. Objective: In order to facilitate the experimental and neurophysiological investigation of psychotherapeutically relevant emotional experiences, the present study aims at developing a priming procedure to induce specific, therapeutically and biographically relevant emotional states under controlled experimental conditions. Methodology: N = 50 participants who reported negative feelings towards another close person were randomly assigned to 2 different conditions. They fulfilled 2 different sentence completion tasks that were supposed to prime either ‘therapeutically productive’ or ‘therapeutically unproductive’ emotional states and completed an expressive writing task and several self-report measures of specific emotion-related constructs. The sentence completion task consisted in max. 22 sentence stems drawn from psychotherapy patients’ statements that have been shown to be typical for productive or unproductive therapy sessions. The subjects of the present study completed these sentence stems with regard to their own negative feelings towards the close person. Results: There were a substantial inter-individual variability concerning the number of completed sentences, and significant correlations between number of completed sentences and problem activation in both conditions. No differences were observed in general mood or problem activation between both groups after priming. Descriptively, there were differences between groups concerning emotion regulation aspects. Significant differences between groups in resolution of negative feelings towards the other person were found. Discussion: The results point in the expected direction, however the small sample sizes (after exclusion of several subjects) and low power hinder the detection of convincing significant effects. More data is needed in order to evaluate the efficacy of this emotional priming procedure.

Effects of anxiety on decision making and visual search behaviour in complex sport situations

Introduction Current empirical findings indicate that the efficiency of decision making (both for experts and near-experts) in simple situations is reduced under increased stress (Wilson, 2008). Explaining the phenomenon, the Attentional Control Theory (ACT, Eysenck et al., 2007) postulates an impairment of attentional processes resulting in a less efficient processing of visual information. From a practitioner’s perspective, it would be highly relevant to know whether this phenomenon can also be found in complex sport situations like in the game of football. Consequently, in the present study, decision making of football players was examined under regular vs. increased anxiety conditions. Methods 22 participants (11 experts and 11 near-experts) viewed 24 complex football situations (counterbalanced) in two anxiety conditions from the perspective of the last defender. They had to decide as fast and accurate as possible on the next action of the player in possession (options: shot on goal, dribble or pass to a designated team member) for equal numbers of trials in a near and far distance condition (based on the position of the player in possession). Anxiety was manipulated via a competitive environment, false feedback as well as ego threats. Decision time and accuracy, gaze behaviour (e.g., fixation duration on different locations) as well as state anxiety and mental effort were used as dependent variables and analysed with 2 (expertise) x 2 (distance) x 2 (anxiety) ANOVAs with repeated measures on the last two factors. Besides expertise differences, it was hypothesised that, based on ACT, increased anxiety reduces performance efficiency and impairs gaze behaviour. Results and Discussion Anxiety was manipulated successfully, indicated by higher ratings of state anxiety, F(1, 20) = 13.13, p < .01, ηp2 = .40. Besides expertise differences in decision making – experts responded faster, F(1, 20) = 11.32, p < .01, ηp2 = .36, and more accurate, F(1,20) = 23.93, p < .01, ηp2 = .55, than near-experts – decision time, F(1, 20) = 9.29, p < .01, ηp2 = .32, and mental effort, F(1, 20) = 7.33, p = .01, ηp2 = .27, increased for both groups in the high anxiety condition. This result confirms the ACT assumption that processing efficiency is reduced when being anxious. Replicating earlier findings, a significant expertise by distance interaction could be observed, F(1, 18) = 18.53, p < .01, ηp2 = .51), with experts fixating longer on the player in possession or the ball in the near distance and longer on other opponents, teammates and free space in the far distance condition. This shows that experts are able to adjust their gaze behaviour to affordances of displayed playing patterns. Additionally, a three way interaction was found, F(1, 18) = 7.37 p = .01, ηp2 = .29, revealing that experts utilised a reduced number of fixations in the far distance condition when being anxious indicating a reduced ability to pick up visual information. Since especially the visual search behaviour of experts was impaired, the ACT prediction that particularly top-down processes are affected by anxiety could be confirmed. Taken together, the results show that sports performance is negatively influenced by anxiety since longer response times, higher mental effort and inefficient visual search behaviour were observed. From a practitioner’s perspective, this finding might suggest preferring (implicit) perceptual cognitive training; however, this recommendation needs to be empirically supported in intervention studies. References: Eysenck, M. W., Derakshan, N., Santos, R., & Calvo, M. G. (2007). Anxiety and cognitive performance: Attentional control theory. Emotion, 7, 336-353. Wilson, M. (2008). From processing efficiency to attentional control: A mechanistic account of the anxiety-performance relationship. Int. Review of Sport and Exercise Psychology, 1, 184-201.

Learning and emotion - perspectives for theory and research

There is growing interest in and knowledge about the interplay of learning and emotion. However, the different approaches and empirical studies correspond to each other only to a low extent. To prevent this research field from increasing fragmentation, a shared basis of theory and research is needed. The presentation aims at giving an overview of the state of the art, developing a general framework for theory and research, and outlining crucial topics for future theory and research. The presentation focuses on the influence of emotions on learning. First, theories about the impact of emotions on learning are introduced. Second, the importance of these theories for school learning are discussed. Third, empirical evidence resulting from school-based research about the role of emotions for learning is presented. Finally, further research demands are stressed.

Effects of anxiety on decision making and visual search Behaviour in dynamic, time-constrained situations

Einleitung Aktuelle empirische Befunde deuten darauf hin, dass Sportler/innen durch Stress und erhöhte Angst eine reduzierte Effizienz bei der Entscheidungsfindung aufweisen (Wilson, 2008). Erklärt werden kann dieser Befund durch die Attentional-Control-Theory (ACT, Eysenck et al., 2007), die postuliert, dass aufmerksamkeitslenkende Prozesse unter Angst gestört werden. Um diese Annahme für komplexe Situationen im Sport zu prüfen, wurden Fußballspieler unter erhöhten und regulären Druckbedingungen verglichen. Methode Je 11 Experten und Nicht-Experten hatten aus der Perspektive des Abwehrspielers die Aufgabe, in zwei mal 24 Spielsituationen so schnell und korrekt wie möglich verbal anzugeben, welche Aktion der ballführende Spieler (in naher vs. ferner Spielsituation) nach Ausblendung der Szene ausführen wird. Während im ersten Block der Druck nicht erhöht wurde, wurden Druckbedingungen im zweiten Block u.a. durch eine Wettkampfsituation und „falscher“ Ergebnisrückmeldung gesteigert. Entscheidungs- und Blickverhalten (u.a. Anzahl Fixationen), Pupillengröße, Zustandsangst und „Mental Effort“ (Wilson, 2008) wurden erfasst. Neben Expertiseunterschieden wurde erwartet, dass erhöhte Angst die Entscheidungseffizienz sowie das Blickverhalten stört (ACT-Annahme), was mit 2 (Experten/Nicht-Experten) x 2 (nahe/ferne Spielsituation) x 2 (hohe/reguläre Druckbedingung) ANOVAs (? = .05) mit Messwiederholungen auf den letzten beiden Faktoren geprüft wurde. Ergebnisse Druckmanipulationen führten zu höherer Zustandsangst und größeren Pupillendurchmessern. Neben Expertiseunterschieden – Experten antworteten schneller, korrekter und zeigten ein situationsangepasstes visuelles Suchverhalten – wiesen beide Gruppen in Drucksituationen längere Antwortzeiten und höheren Mental Effort auf. Erhöhter Druck führte bei Experten zur Reduktion der Fixationsortwechsel für ferne Spielsituationen. Nicht-Experten differenzierten ihr Suchverhalten weder zwischen Bedingungen noch für Spielsituationen. Diskussion Die Resultate bestätigen die ACT-Annahme, dass Angst und Stress die sportliche Leistung durch längere Reaktionszeiten, höhere kognitive Anstrengung und ein teilweise ineffizientes visuelles Suchverhalten negativ beeinflusst. Eine gestörte Balance zwischen Top-Down und Bottom-Up-Prozessen könnte die Ursache sein (Eysenck et al., 2007). Literatur Eysenck, M. W., Derakshan, N., Santos, R., & Calvo, M. G. (2007). Anxiety and cognitive performance: Attentional control theory. Emotion, 7, 336–353. Wilson, M. (2008). From processing efficiency to attentional control: A mechanistic account of the anxiety-performance relationship. International Review of Sport and Exercise Psychology, 1, 184– 201. 2 Vorträge und Poster