Name: use of a psychophysiological script-driven imagery experiment to study trauma-related dissociation in borderline personality disorder
Uploaded: 2018-03-08T13:30:00.000+00:00
Duration: 9 min 55 s
Description: Watch this Scientific Journal Video about Use of a Psychophysiological Script-driven Imagery Experiment to Study Trauma-related Dissociation in Borderline Personality Disorder at JoVE.com

We particularly thank Dr. Stefan Tsch&#246;ke and Luisa Steib for scientific advice and assistance with the recruitment of clinical participants, as well as all participants who enabled us to conduct the study and learn from them.

Our study was approved by the Ethical Committee at the Ulm University. All investigation proceedings were non-invasive and conducted in accordance with the guidelines for good clinical practice and the Declaration of Helsinki.
1. General procedures for the preparation of the psychophysiological experiment
<ol>
	<li>Obtain ethical approval for the protocol and written informed consent from all participants after giving them detailed information (including information about the possibility of earlier termination without any negative consequences).</li>
	<li>Prepare the introductory instruction for the experimental procedure and the participant tasks over the course of the experiment, record it, and save it in the appropriate format within the stimuli presentation software. 
	NOTE: Here is an example how to formulate the initial instruction: &#34;This measurement records your physiological activity while listening to scripts about personal events. This happens through the electrodes attached to your forehead, shoulders, and hand. Try to take a comfortable position in the chair. Your room is closed to shield noises. I can see you through the window, just as you can see me. If something is not right, you can always give me a sign and I&#39;ll be right next to you. It is important that you sit still during the measurement and do not move. There are regular breaks in which you can move. Overall, the investigation will take about half an hour. Each script presentation consists of four consecutive 30-second periods: rest condition, script listening, imagination, and relaxation. Please listen carefully to each script, and try to vividly imagine the illustrated experience in chronological order, both during the script presentation and afterwards, until you hear a new instruction. Each script is displayed totally three times. The measurement starts from now in about one minute, as soon as your physiological readings have reached a stable level. So you can relax first.&#34;</li>
	<li>Proceed similarly for the relaxation and self-report instruction that will be presented between each two scripts. 
	NOTE: Here is a possible formulation of such an instruction: &#34;Please relax. If you want, you can now move a little bit. Fill the questionnaire in by marking the answer options that best describe your feelings during the imagination of the event. Afterwards, try to find again a comfortable position, try to sit still again and continue to relax. Soon you will hear another script. Please listen carefully to it and try to imagine as vividly as possible and in chronological order the illustrated experience until you hear the next instruction.&#34;</li>
	<li>For the presentation of auditory instructions and scripts, use a stimulus computer and a scripting language-based computer software. Play back each script three times and insert four sequential 30-s periods within each script presentation as follows:&#160; resting baseline, read (listening to the spoken script), imagery (imagination of the described experience), and recovery (see Figure 2). In-between two script presentations, reserve a period of 1 - 2 minutes for filling the self-report measures in.</li>
	<li>Use an appropriate recording computer and software to collect physiological data during the experiment. Depending on the software for recording physiological data, prepare the necessary channels for the recording of physiological parameters (SC and HR).</li>
	<li>Set up markers or use separate channels for the depiction of the time course of the instructions and script presentations.
	<ol>
		<li>To subsequently facilitate the removal of artifacts from the physiological data, incorporate the possibility to flag movements. Save this recording set-up to allow its availability for all planned measurements.</li>
	</ol>
	</li>
</ol>
2. Participant selection
NOTE: For the selection and recruitment of the clinical study participants, available standards were considered (Sullivan-Bolyai et al., 2007)25.
<ol>
	<li>If possible, recruit clinical participants from a clinical setting for obtaining reliable information regarding the inclusion and exclusion criteria. Review medical records and clinical files, consult clinical-therapeutic staff (if possible), and ask participants to ascertain relevant information for the participant selection.</li>
	<li>Select clinical participants according to the following inclusion criteria: (a) ICD-10 diagnosis F60.31; (b) no medication (ask participants to abstain for 1 week prior to the laboratory experiment from any psychotropic medication or medication with potentially confounding autonomic effects, e.g. anticholinergic, &#945;- or &#946;-adrenergic blockers, digitals, and GABA-(A)-receptor-agonists including benzodiazepine); (c) legal competence, sufficient cognitive function, sufficiently stable psychological state, language proficiency; and (d) informed consent after detailed explanation of the objectives and procedure as well as answers to all the potential questions.</li>
	<li>Exclude potential clinical participants if the following criteria apply: (a) internal, neurological, musculoskeletal or endocrinological disorders; (b) acute suicidal ideation, history of schizophrenia-type disorders or bipolar disorder, substance abuse within the last week.</li>
	<li>Select control subjects with trauma histories, but without trauma-related or other psychological disorders and match those to the BPD group on age, gender, and education. 
	NOTE: If BPD participants are recruited from a clinical setting, it is possible to select controls by approaching stuff and trainees from the same institution. Since most people experience at least one threatening event during their lives, it is not difficult to find healthy subjects with trauma histories.</li>
</ol>
3. Clinical assessment
<ol>
	<li>Carry out an extensive evaluation of the psychological status of all participants with a focus on dissociative phenomena by clinically experienced investigators. Plan enough time for clinical assessment sessions (1 - 2 sessions of 60 - 90 min in length for each patient). Employ the following instruments (or equivalent ones):
	<ol>
		<li>Approach potential clinical participants and, after informed consent (see above), hand over self-report questionnaires and instruct the participant appropriately.</li>
		<li>Obtain information on age, graduation, marital and occupational status. 
		NOTE: In case study participants are recruited from a clinical setting, obtain sociodemographic from the documentation system of the clinic or routine data sets, if available.</li>
		<li>Inquire active substances consumed within the last weeks.</li>
		<li>Hand over the following instruments to the clinical participants.
		<ol>
			<li>Use the Childhood Trauma Questionnaire (CTQ)26, a 28-item questionnaire composed of five subscales, each containing 5 items (emotional abuse, emotional neglect, physical abuse, physical neglect, and sexual abuse) and one response bias subscale, the minimization and denial scale including three items; the items consist of statements to be rated by choosing one of five response options: (1) &#34;never true,&#34;&#160;(2) &#34;rarely true,&#34;&#160;(3) &#34;sometimes true,&#34;&#160;(4) &#34;often true,&#34;&#160;and (5) &#34;very often true.&#34;</li>
			<li>Use the Life Event Checklist27 for the further assessment of traumatic exposure.</li>
			<li>Use the Peritraumatic Dissociative Experiences Scale (PDEQ)28, a 10-item self-report questionnaire measuring the extent of dissociation during the traumatic event and in the subsequent minutes and hours, accompanied by the instruction to fill in the questionnaire relating to their most severe traumatic event from the Life Event Checklist; score items on a 5-point Likert scale from 1 (not at all true) to 5 (extremely true).</li>
			<li>Use the initial questions from the Structured Clinical Interview for DSM-IV-TR Axis I Disorders and the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-I and SCID-II)29,30 administrated as a self-rating screening instrument allowing a reduction of the number of domains to be evaluated for the diagnosis of Axis I and personality disorders.</li>
			<li>Use the Borderline Symptom List (BSL)31, a 99-item self-report instrument assessing the severity of borderline symptoms within the previous week on a 5-point Likert scale, with the following answer possibilities: &#34;not at all,&#34;&#160;&#34;a little,&#34;&#160;&#34;rather,&#34;&#160;&#34;much,&#34;&#160;and &#34;very strong&#34;; it contains the following scales: self-perception (19 items), affect regulation (13 items), self-destruction (12 items), dysphoria (10 items), loneliness (12 items), intrusions (11 items), and hostility (6 items).</li>
			<li>Use the Dissociative Experiences Scale (DES)32, a 28-item questionnaire to screen for dissociative symptoms; items assess the intensity of dissociative experiences from 0% of the time (never) to 100% of the time (always).</li>
			<li>Use the Symptom Check List-90-Revised (SCL-90-R)33, a 90-item self-report instrument evaluating a broad range of psychological problems and symptoms; it contains nine scales (Somatization, Obsessive-Compulsive, Interpersonal Sensitivity, Depression, Anxiety, Hostility, Phobic Anxiety, Paranoid Ideation, Psychoticism) and provides an index of symptom severity as the summary of the test; Construct items on a 5-point Likert-scale, from 0 (not at all) to 4 (very strong).</li>
		</ol>
		</li>
	</ol>
	</li>
	<li>Proceed similarly for the self-report assessment of the control subjects, except for the following: (a) do not hand any SCID-I and SCID-II questions to control participants (see below in the clinical interview section); (b) for reasons of effort-reduction, employ only a short SCL-version instead of SCL-90-R (namely SCL-14)34.</li>
	<li>Arrange an appointment soon for the clinical interview, making sure that the participant can fill in all self-report measures by then.</li>
	<li>At the beginning of the clinical Interview session, make sure that the participants filled in all self-report items in the first place, clarify unresolved items, and ask supplementary questions if necessary.</li>
	<li>Discuss in-depth the items of the CTQ and Life Event Checklist by asking questions about the type and time of the inquired experiences; if necessary, correct the reports accordingly.</li>
	<li>Use clinical standardized interviews for a differentiate diagnosis of both groups, as follows. 
	NOTE: For reasons of effort reduction, use less extensive, but equivalent diagnostic instruments, to screen for mental disorders within the control group.
	<ol>
		<li>Employ a broader battery of clinical diagnostic interviews for the clinical group: (a) the Clinician Administered PTSD Scale (CAPS)35 for the diagnosis of PTSD; (b) the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D)36 for diagnosing dissociative disorders; and (c) SCID-I and SCID-II interviews. Within the SCID interviews, conduct detailed inquiries only of the domains indicated by the self-report screening questions.</li>
		<li>Administrate only the Mini-International Neuropsychiatric Interview (M.I.N.I.)37 to control participants. Based on this short structured clinical interview that allows diagnosis of psychiatric disorders according to both DSM-IV and ICD-10 criteria, ascertain the absence of mental disorders as well as the report of at least one past traumatic experience for the inclusion in the control group.</li>
	</ol>
	</li>
</ol>
4. Procedures for the preparation of the psychophysiological experiment for each participant
<ol>
	<li>At the end of the clinical interview section, ask the participant to specify and vividly describe the following three types of events: a traumatic one (in case of several traumatic experiences, instruct the participant to choose the one perceived as the worst), as well as two further individual experiences, a neutral one (e.g., cleaning the house, getting up early, or accomplishing other usual, slightly unpleasant everyday duties) and an everyday moderately positive event (e.g., enjoyable, relaxing or fun activities).</li>
	<li>Within the event descriptions, inquire objective happenings (i.e., time, place, and context) as well as subjective information (i.e., emotions, sensory perception); take detailed notes allowing subsequent draft of the three verbal scripts (neutral, negative, and traumatic/aversive), which will be used as individualized emotional cues.</li>
	<li>Make an appointment for the psychophysiological experiment within the next few days. Instruct the participant not to use any hand lotion or cream before the experiment.</li>
	<li>Shortly after the clinical interview, compose verbal scripts of ca. 30 s duration that portray the three recalled personal experiences in the first person singular, present tense and register them on a voice recorder. Stick as much as possible to the individual formulations of the participants when describing their experiences (see Figure 1 for an example of traumatic script).
	<ol>
		<li>Save them as audio files in the appropriate format and transfer them in the software program on the stimulus computer, serving to present the recorded auditory scripts.</li>
	</ol>
	</li>
	<li>Randomize the order of the script presentation. Adopt and save the resulted order of the scripts in the presentation program and put it on record, to account for it during data analyses.</li>
	<li>Transfer and save the scripts in the resulting order into the presentation program. Use a scripting language based computer program which sends simultaneously auditory stimuli to a headphone and marker signals to the psychophysiological recording device at millisecond accuracy. 
	NOTE: To avoid overstraining severely traumatized persons, use a pseudorandomized script sequence by beginning with the presentation of either a neutral or positive script and not leaving any consecutive presentations of the traumatic script. Based on our experience, we cannot confirm the participation of severely traumatized persons in such experiments as being potentially stressful in any way. For this reason, we regard the randomization of scripts under these constraints as only optionally.</li>
	<li>Prepare the sheets and a pencil to collect subjective evaluative judgments of affective states during the script-driven imagery tasks. Employ a battery of visual analog 9-point Likert scales: (a) the Self-Assessment Manikin (SAM)38 to evaluate the degree of arousal and dominance of the imagery; (b) similarly constructed scales to assess a set of other discrete emotions (e.g., fear, disgust); and (c) a short version of the scale Dissociation Tension Scale-acute (DSS-4)39 to measure the state dissociation. 
	NOTE: There are also other instruments assessing responses to trauma-related memory. We also suggest the use of the Responses to Script-driven Imagery (RSDI)40 that additionally assesses re-experiences and re-experiencing and avoidance.</li>
	<li>Prepare receipts of monetary compensations as well as the corresponding amount of money. 
	NOTE: Our participants received 20 Euros.</li>
</ol>
5. Psychophysiological experiment
NOTE: Experimental set-up: The experiment followed the guidelines of psychophysiological measurements for the measurement of reactions to emotional cues41.
<ol>
	<li>Conduct the psychophysiological experimental session in a sound-attenuated and temperature- and humidity-controlled laboratory connected via wires and window to an adjoining portion of the laboratory in which the experimental equipment is located.</li>
	<li>Reserve enough time for conducting the physiological assessments (ca. 60 - 90 min per participant).</li>
	<li>Once the participant arrived at the laboratory, show him/her the facilities and the recording instruments and explain their function.</li>
	<li>Seat the participant in a comfortable chair and allow a period of adaptation to the recording environment while explaining again the procedure from the informed consent and answering any further questions.</li>
	<li>Ask participants whether they used any hand lotion in advance and, if necessary, ask them to clean and dry their hands. Clean the required contact skin areas with alcohol solution pads. Attach physiological monitoring devices.
	<ol>
		<li>Use adhesive, pregelled, 279 AgAg/Cl snap electrodes with circular contact areas, filled with an appropriate electrode gel: (a) for the SC measurement, place electrodes on the palmar surface (hypothenar and thenar eminence of the non-dominant hand); (b) for HR recording, use a Lead II configuration of three electrodes (two electrodes placed on the chest below the left and the right shoulder and reference electrode placed e.g. on the forehead). Apply headphones for the presentation of the instruction and scripts.</li>
	</ol>
	</li>
	<li>Perform a test run of the measurements to make sure that the participant hears the instructions and the physiological recordings are running well.</li>
	<li>Begin the assessment approximately five minutes later in order to allow physiological readings to stabilize.</li>
	<li>Pay attention to any movements of the participant during the experiment and, depending on the software, press a key/take notes to mark artifacts when necessary.</li>
	<li>At the end of the experiment, remove all devices and clean the skin areas if requested. Provide monetary compensation and receipts. Offer the participant the opportunity to show and explain the physiological recordings. Ask whether the participant needs to share thoughts and experiences or to receive any further assistance.</li>
	<li>Clean the electrodes with cold water to allow the removal of any gel rests.</li>
</ol>

The authors declare no conflict of interest.

The present protocol describes an integrated assessment of peripheral physiological responding, self-reports, and clinical assessments for the study of trauma-related dissociation in BPD. For the realization of this procedure, it is important to control for confounders of physiological activity, to ensure functional recordings of physiological data before measurements, and to collect clinical data by expert investigators.
Limits of such integrated assessments protocols may concern the sensitivity and specificity of the measurement, the imperfect covariation between subjective and psychophysiological levels, the role of individual variability as well as the adequacy of the stimuli. Particularly for studies using such a protocol of integrated clinical and psychophysiological assessment, a main limitation is related to small sample sizes in the majority of cases, which do not allow a finer differentiation among subgroups clinical participants and allow the calculation of underpowered models, at best. Another limitation regards the main memory contents related to the selected scripts: Whereas trauma-related scripts reflect episodic memory, everyday experiences as comparison scripts may have also involved semantic contents. Yet in part inevitable, the cross-sectional design impedes causal conclusions and allows correlative implications at best. Moreover, the retrospective recall may be prone to serious biases and influenced by characteristics such as age, pathology, and affective state.
Another possible limitation concerns the assessment of trauma-related dissociation. There are findings in the area of PTSD weakening the proven impact of PD on PTSD symptoms and arguing for a major role of the persistence of dissociative responding over time (e.g., Briere et al., 2005; Werner &#38; Griffin, 2012)43,44. Although in our study PD seemed to mainly influence later responding, the role of the time course of reactions and symptoms should not be underestimated in the search for alternative explanations. For this reason, the employed measures of state and trait dissociation should capture the actual level of persistent dissociation, such as the Shutdown Dissociation Scale (Shut-D)45.
This protocol has several advantages for researchers aiming to study trauma-related dissociation in clinical samples: Employing an integrated assessment with extensive psychodiagnostic testing and measurement of reliable peripheral psychophysiological parameters assure increased diagnostic validity and allows corroboration of findings across measures.
The further investigation of the role of trauma-related dissociation in the etiology of BPD and other clinical samples affected by psychological trauma should comprise larger samples, preferably prospective study designs, and a more thorough assessment of type, occurrence time, and number of traumatic events. Reactions to different types of aversive situations should be investigated, and several psychophysiological parameters should be involved. The selection of other clinical groups inclusive of resilient participants may provide significant clinically and therapeutically useful evidence.

In perceiving danger, humans experience anxiety and the body reacts rapidly within the defense cascade to minimize injury and ensure survival. Defense reactions include initial stages of increasing arousal and sympathetic activation and, in event of inescapable threats (e.g., child abuse, rape, torture), parasympathetically modulated &#34;shut-down&#34; dissociative reactions (e.g., bradycardia, vasodilatation, sensory deafferentation, alterations of consciousness and speech1,2) become predominant. According to the theories of reactivation of trauma-related associative memory networks3,4, the prevalent type of the peritraumatic psychophysiological reactions (arousal vs. dissociation) would result in one of the two major subtypes of clinical profiles and reaction patterns to trauma-related stimuli2. Considering the heterogeneity of responses to activation of trauma-related memory across various neuroimaging PTSD studies, Lanius et al. (2006)5 argued that &#34;grouping all PTSD subjects, regardless of their different symptom patterns, in the same diagnostic category may interfere with our understanding of posttrauma psychopathology&#34;. The influence of dissociative responding on the psychopathology and psychophysiology of traumatized persons has been studied in the area of PTSD. For example, Schalinski, Elbert &#38; Schauer (2011)6 showed that shut-down dissociation predicts PTSD and other comorbid disorders. The use of psychophysiological assessments pointed to modifications of the defense cascade allowing for a rapid flight in response to threat7,8. Schalinski et al. (2013)8 revealed that the type of traumatic events seems to influence the cardiac startle response. Another study9 indicated a pattern of &#34;blunted&#34; reactivity &#8212; an arousal-dissociation mix characterized by simultaneous activation of both autonomous nervous system branches &#8212; in more severely traumatized individuals. So far, no studies in this regard have been conducted on other clinical populations often affected by psychological trauma and dissociative symptoms (e.g., BPD).
In the research of human emotion and behavior, it is of particular importance to examine and integrate information from several levels: subjective (verbal expression, prosody), behavioral (motor, facial expression, etc.), physiological (trembling, sweating, heart rate, etc.). By arguing that assessments that omit one or more of these three modes of emotional expression can be highly misleading, Lang (1998)10 emphasized the relevance of multimodal assessment that involves procedures of observation of behavior, self-report/clinical measures, and psychophysiological measurement.
Extreme states of anxiety and pronounced physiological arousal are characteristic of anxiety, trauma-, and stressor-related disorders. According to the psychophysiological concept, these disorders may be conceived as an outcome of the modified autonomic reactivity (generally higher) to negative stimuli. These measurable psychophysiological response indices as part of the diagnostic criteria made them obvious targets for psychophysiological research. Particularly PTSD, as a psychological disorder with a definite event criterion (i.e., life-threatening experiences, such as accidents, physical/sexual assaults, natural disasters, incarceration, military combat, and torture), offered a valuable opportunity for psychophysiological assessments.
Various assessment designs using different paradigms, stimuli, and physiological parameters have been used for the study of PTSD. Monitoring peripheral physiological parameters provide reliable measures of changes in autonomic activity, related to emotional and cognitive states. Among these, skin conductance is a common measure with a long history in psychophysiological research and is regarded as a highly sensitive index11. Its monitoring is often combined with the recording of heart rate, a further autonomically dependent variable.
For the measurement of peripheral physiological parameters, the use of script-driven imagery experiments was a major paradigm for the investigation of emotional and physiological reactions to the activation of trauma-related memory. Within the script-driven imagery paradigm12, participants are asked to vividly imagine aversive situations triggered by short verbal scripts13,14,15,16. The subject is solicited to imagine a situation as if he/she was reliving the real course of events, including actions, persons, and emotions present during the real situation (see Figure 1 for an example of a traumatic script). The traumatic situation imagined is usually compared with other kinds of not-traumatic scenes.
Script-driven imagery was mainly employed in various populations affected by PTSD, e.g. Vietnam veterans15,17, victims of accidents18, and former political prisoners19. An enhanced reactivity to traumatic cues was usually found, but there are also several findings of absence of such a higher reactivity to trauma-related stimuli (e.g., Orr &#38; Roth, 2000; Davis et al., 1996)15,20. Growing knowledge on the psychophysiology of PTSD was followed by an increased bulk of psychophysiological research in the area of trauma-related and other psychological disorders. Meanwhile, however, script-driven imagery paradigms have been successfully applied to study dissociative processes in BPD 21,22.
This paper presents a protocol to investigate whether persons with BPD reporting high levels of PD predominantly exhibit dissociative reactions with suppression of autonomic responses during the script-driven trauma-related imagery23,24. Additionally, our study aimed at proving whether there are clinically different BPD subgroups, as tested by structured clinical interviews and symptom scales. The present protocol combines extensive, standardized clinical assessments with measuring physiological (HR and SC) and subjective responses within a script-driven imagery paradigm. Reactions to trauma-related personalized scripts compared to scripts portraying everyday events were analyzed. The protocol provides a model for the investigation of dissociative processes and their impact on psychopathological and psychophysiological features of BPD.

<table><tbody><tr><td>Experimental Runtime System (ERTS) Version 3.32</td><td>BeriSoft Cooperation, Frankfurt/Main, Germany</td><td></td><td>We used a scripting language based computer programme wich sends simultanously auditory stimuli to a headphone and marker signals to a psychophysiological recording device at millisecond accuracy.</td></tr><tr><td>Biopac MP150 system</td><td>Biopac Systems, Inc., Goleta, CA</td><td></td><td>We recorded the physiological data by using this hardware.</td></tr><tr><td>AcqKnowledge software</td><td>Biopac Systems, Inc.</td><td></td><td>We recorded the physiological data by using this software.</td></tr><tr><td>VOC</td><td></td><td></td><td>Format for the auditory files for instructions and script, compatibele with the stimulus presentation software.</td></tr></tbody></table>

use of a psychophysiological script-driven imagery experiment to study trauma-related dissociation in borderline personality disorder

This protocol offers a detailed description of a psychophysiological experiment using script-driven trauma-related imagery and standardized clinical instruments within a comparative design assessing physiological and psychopathological features of individuals with BPD. This method aims at studying the psychological and physiological effects of trauma-related dissociation. Since the psychodiagnostic classification of trauma-related disorders relies on the observation of evolutionarily determined responses to life-threat, an integrated assessment paradigm for the study of reactions to traumatic memories proposes a very appropriate methodological approach.
The employed script-driven imagery paradigm uses individual recall instructions to activate trauma-related memory networks and prompt associated emotional and physiological responses. These responses are measured by means of self-rating scales and physiological assessments. During the individual recall, participants are asked to vividly imagine traumatic and everyday experiences and other situations triggered by short personalized verbal scripts they authored beforehand together with the experimenters. A wide range of affective reactions and different physiological parameters can be measured. We used this paradigm to investigate dissociative states in BPD and to find physiological and affective correlates of dissociative states. Some of the participants were having severe traumatic antecedents.
To investigate different reaction patterns within the same diagnostic group, participants with different levels of traumatic histories, symptom severities, and co-morbidities should be included. By using short verbal scripts, the level of stress induced to participants is held as low as possible without affecting the validity of the object of investigation.

There are many behaviors reflected in emotional and physiological reactions that can be studied by script-driven imagery paradigms. For instance, the design is suitable to investigate patterns of emotional and physiological response to trauma-related memory. We were particularly interested in verifying whether there is a distinct BPD subgroup mainly characterized by a dissociative reaction pattern.
In our study42, the assessments took place at the Department of Psychiatry and Psychotherapy I of the University of Ulm/Centre for Psychiatry Suedwuerttemberg. The recruitment was realized at the in-patient section 2056 of the headquarters Weissenau, Centre for Psychiatry Suedwuerttemberg. We recruited 28 participants with a clinical diagnosis of BPD. The BPD group was divided according to the established cutoff score of 1.5 of the PDEQ questionnaire for a peritraumatic dissociative reaction (low vs. high): BPD and PD (n = 15) and BPD only (n = 13). A control group of 15 persons with trauma histories, but without trauma-related or other psychological disorders was recruited from the staff of the Centre for Psychiatry Suedwuerttemberg.
Our study investigated differences between groups with regard to physiological and psychological measures. Among representative findings demonstrating the efficacy of the protocol, significant group differences resulted with respect to the HR differences between trauma-related scripts and scripts of everyday events (positive and neutral), due to a significant decrease of HR during memory of traumatic events in participants with BPD and a history of PD as compared to the BPD only group and controls (Figure 3). Yet, the analyses of SC responses did not show such differences.
Regarding self-report ratings, traumatic memories triggered for instance more dissociation than both positive and neutral memories (Figure 4). Besides, subjects with BPD and PD rated all memories as more dissociation provoking than other BPD participants and controls. The analyses of clinical data added valuable insight in the clinical profiles of BPD participants affected by severe PD responses who also showed a higher traumatic exposure, more severe symptoms and more comorbid disorders than the other BPD participants in Table 1. A multiple linear regression analysis to determine predictors of HR responses to trauma-related memory within the clinical sample indicated that PD level was the strongest predictor, followed by borderline symptom severity and level of dissociative experiences (Table 2).
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/56111/56111fig1.jpg" /> 
Figure 1. Example of a personalized trauma-related script for the use within a script-driven experiment. <a href="https://cloudflare-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/56111/56111fig1large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/56111/56111fig2.jpg" /> 
Figure 2. Graphic representation of the experimental design. <a href="https://cloudflare-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/56111/56111fig2large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/56111/56111fig3.jpg" /> 
Figure 3. Means (and SE) of heart rate responses (difference score trauma-related minus everyday scripts) during memory of traumatic situations, by groups. This figure has been modified from the original figure [Bichescu-Burian et al.38], with permission from Psychophysiology. <a href="https://cloudflare-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/56111/56111fig3large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/56111/56111fig4.jpg" /> 
Figure 4. Means of self-rated levels of dissociation during memory of positive, neutral, and traumatic situations, by groups. This figure has been modified from the original figure [Bichescu-Burian et al.38], with permission from Psychophysiology. <a href="https://cloudflare-jove-com.bdigitaluss.remotexs.co/files/ftp_upload/56111/56111fig4large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td colspan="5">(A)</td>
		</tr>
		<tr>
			<td></td>
			<td>BPD and PD 
			(n = 15)</td>
			<td>BPD only 
			(n= 13)</td>
			<td>Control group 
			(n =15)</td>
			<td>p</td>
		</tr>
		<tr>
			<td>Demographics</td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>&#160;&#160; Age, M (SD)</td>
			<td>25.53 (9.4)</td>
			<td>24.38 (8.8)</td>
			<td>23.87 (6.3)</td>
			<td>n.s.</td>
		</tr>
		<tr>
			<td>&#160;&#160; Education (years), M (SD)</td>
			<td>10.40 (1.2)</td>
			<td>10.54 (1.3)</td>
			<td>11.13 (1.1)</td>
			<td>n.s.</td>
		</tr>
		<tr>
			<td>Traumatic events</td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>&#160;&#160; CAPS event types, M (SD)</td>
			<td>7.40 (2.9)a</td>
			<td>6.08 (3.0)</td>
			<td>3.87 (2.3)a</td>
			<td>&#60; .01</td>
		</tr>
		<tr>
			<td>&#160;&#160;&#160;&#160;&#160; Rape/rape attempt (%)</td>
			<td>13 (86.7)</td>
			<td>8 (61.5)</td>
			<td>2 (13.3)</td>
			<td>&#60; .001</td>
		</tr>
		<tr>
			<td>&#160;&#160; CTQ score, M (SD)&#160;</td>
			<td>88.47 (28.0)a</td>
			<td>69.54 (18.5) b</td>
			<td>39.67 (10.4) a, b</td>
			<td>&#60; .001</td>
		</tr>
		<tr>
			<td>&#160;&#160;&#160;&#160;&#160; Emotional abuse (SD)</td>
			<td>18.27 (6.7)a</td>
			<td>14.62 (5.9)a, b</td>
			<td>7.67 (2.0)b</td>
			<td>&#60; .001</td>
		</tr>
		<tr>
			<td>&#160;&#160;&#160;&#160;&#160; Emotional neglect (SD)</td>
			<td>19.27 (5.3)a</td>
			<td>16.31 (4.4)a, b</td>
			<td>9.60 (4.1)b</td>
			<td>&#60; .001</td>
		</tr>
		<tr>
			<td>&#160;&#160;&#160;&#160;&#160; Physical abuse (SD)</td>
			<td>12.07 (6.0)a</td>
			<td>9.38 (6.1)</td>
			<td>5.53 (0.9)a</td>
			<td>&#60; .01</td>
		</tr>
		<tr>
			<td>&#160;&#160;&#160;&#160;&#160; Physical neglect (SD)</td>
			<td>12.60 (4.3)a</td>
			<td>10.23 (3.1)a, b</td>
			<td>5.50 (0.8)b</td>
			<td>&#60; .001</td>
		</tr>
		<tr>
			<td>&#160;&#160;&#160;&#160;&#160; Sexual abuse (SD)</td>
			<td>14.53 (8.3)a</td>
			<td>10.92 (7.1)</td>
			<td>6.67 (5.2)a</td>
			<td>&#60; .05</td>
		</tr>
		<tr>
			<td>&#160;&#160;&#160;&#160;&#160; Unpredictability (SD)</td>
			<td>11.07 (3.9)a, b</td>
			<td>8.08 (3.2)a, c</td>
			<td>4.33 (2.2)b. c</td>
			<td>&#60; .001</td>
		</tr>
		<tr>
			<td>PDEQ score (SD)</td>
			<td>2.71 (0.7)a, b</td>
			<td>1.21 (.2)a, b, c</td>
			<td>0.86 (0.6)c</td>
			<td>&#60; .001</td>
		</tr>
		<tr>
			<td>Clinical symptoms</td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>&#160;&#160; BSL score, M (SD)</td>
			<td>2.52 (0.8)a, b</td>
			<td>1.78 (0.7)a, c</td>
			<td>0.48 (0.4)b, c</td>
			<td>&#60; .001</td>
		</tr>
		<tr>
			<td>&#160;&#160; DES score, M (SD)</td>
			<td>34.66 (20.9)a, b</td>
			<td>15.91 (11.8)a</td>
			<td>4.90 (2.5)b</td>
			<td>&#60; .001</td>
		</tr>
		<tr>
			<td>&#160;&#160; SCL-14 score, M (SD)</td>
			<td>2.21 (0.9)a, b</td>
			<td>1.36 (.6)a, c</td>
			<td>0.18 (0.1)b, c</td>
			<td>&#60; .001</td>
		</tr>
		<tr>
			<td colspan="5">Note. Significant differences between each pair of groups as revealed by post hoc comparisons are marked by identical characters.&#160;</td>
		</tr>
		<tr>
			<td colspan="5">(B)</td>
		</tr>
		<tr>
			<td colspan="2"></td>
			<td>BPD and PD 
			&#160;&#160; (n = 15)</td>
			<td>BPD only 
			&#160; (n = 13)</td>
			<td>&#160; p&#160;</td>
		</tr>
		<tr>
			<td colspan="2">Clinical symptoms</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td colspan="2">&#160;&#160; CAPS score, M (SD)</td>
			<td>83.7 (28.0)</td>
			<td>58.5 (25.9)</td>
			<td>&#60; .05</td>
		</tr>
		<tr>
			<td colspan="2">&#160;&#160; GSI score of the SCL-90-R, M (SD)</td>
			<td>2.1 (0.7)</td>
			<td>1.3 (0.6)</td>
			<td>&#60; .01</td>
		</tr>
		<tr>
			<td colspan="2">Diagnoses</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td colspan="2">&#160;&#160; PTSD, as diagnosed by CAPS (%)&#160;</td>
			<td>14 (93.3)</td>
			<td>7 (53.8)</td>
			<td>&#60; .05</td>
		</tr>
		<tr>
			<td colspan="2">&#160;&#160; Dissociative disorder, based on SCID-D (%)&#160;</td>
			<td>12 (80.0)</td>
			<td>1 (7.7)</td>
			<td>&#60; .001</td>
		</tr>
		<tr>
			<td colspan="2">&#160;&#160; Number of SCID-I diagnoses, M (SD)</td>
			<td>3.20 (1.5)</td>
			<td>1.77 (0.8)</td>
			<td>&#60; .01</td>
		</tr>
		<tr>
			<td colspan="2">&#160;&#160;&#160;&#160;&#160; Major depression disorder, by SCID-I (%)</td>
			<td>10 (66.7)</td>
			<td>5 (38.5)</td>
			<td>n.s.</td>
		</tr>
		<tr>
			<td colspan="2">&#160;&#160;&#160;&#160;&#160; Anxiety disorders, by SCID-I (%)&#160;</td>
			<td>8 (53.3)</td>
			<td>6 (46.2)</td>
			<td>n.s.</td>
		</tr>
		<tr>
			<td colspan="2">&#160;&#160;&#160;&#160;&#160; Substance use disorders, by SCID-I (%)</td>
			<td>9 (60.0)</td>
			<td>1 (7.7)</td>
			<td>&#60; .01</td>
		</tr>
		<tr>
			<td colspan="2">&#160;&#160;&#160;&#160;&#160; Eating disorders, by SCID-I (%)</td>
			<td>8 (53.3)</td>
			<td>2 (15.4)</td>
			<td>&#60; .05</td>
		</tr>
		<tr>
			<td colspan="2">&#160;&#160;&#160;&#160;&#160; Obsessive-compulsive disorders, by SCID-I (%)</td>
			<td>4 (26.7)</td>
			<td>1 (7.7)</td>
			<td>n.s.</td>
		</tr>
		<tr>
			<td colspan="2">&#160;&#160;&#160;&#160;&#160; Bipolar disorders, by SCID-I (%)</td>
			<td>1 (6.7)</td>
			<td>3 (23.1)</td>
			<td>n.s.</td>
		</tr>
		<tr>
			<td colspan="2">&#160;&#160;&#160;&#160;&#160; Adjustment disorders, by SCID-I (%)</td>
			<td>1 (6.7)</td>
			<td>2 (15.4)</td>
			<td>n.s.</td>
		</tr>
		<tr>
			<td colspan="5">Note. For continuous variables, t tests were calculated; for dichotomous variables, &#967;2 tests were applied.</td>
		</tr>
	</tbody>
</table>
Table 1. Clinical and other characteristics (A) of the three groups and (B) of the two clinical groups. This table was published in Bichescu-Burian et al.42, with permission from Psychophysiology.
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Model and significant predictor variables</td>
			<td>R2</td>
			<td>df</td>
			<td>p</td>
			<td>B</td>
			<td>SE</td>
			<td>&#946;</td>
			<td>t</td>
			<td>Partial regression 
			p</td>
		</tr>
		<tr>
			<td>Model 1</td>
			<td>.42</td>
			<td>5</td>
			<td>&#60; .01</td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>PDEQ score</td>
			<td></td>
			<td></td>
			<td></td>
			<td>-5.81</td>
			<td>&#160;1.96</td>
			<td>-.66</td>
			<td>-2.96</td>
			<td>&#60; .01</td>
		</tr>
		<tr>
			<td>BSL score</td>
			<td></td>
			<td></td>
			<td></td>
			<td>-5.67</td>
			<td>&#160;3.37</td>
			<td>-.60</td>
			<td>-1.68</td>
			<td>n.s.</td>
		</tr>
		<tr>
			<td>DES score</td>
			<td></td>
			<td></td>
			<td></td>
			<td>-0.18</td>
			<td>0.11</td>
			<td>-.47</td>
			<td>-1.66</td>
			<td>n.s.</td>
		</tr>
		<tr>
			<td>SCL-90-R score</td>
			<td></td>
			<td></td>
			<td></td>
			<td>-0.12</td>
			<td>&#160;3.60</td>
			<td>-.01</td>
			<td>-0.03</td>
			<td>n.s.</td>
		</tr>
		<tr>
			<td>DSS-4 score</td>
			<td></td>
			<td></td>
			<td></td>
			<td>-0.05</td>
			<td>0.75</td>
			<td>-.01</td>
			<td>-0.06</td>
			<td>n.s.</td>
		</tr>
		<tr>
			<td>Model 2</td>
			<td>.45</td>
			<td>4</td>
			<td>&#60; .01</td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>PDEQ score</td>
			<td></td>
			<td></td>
			<td></td>
			<td>-5.83</td>
			<td>&#160;1.81</td>
			<td>-.66</td>
			<td>-3.22</td>
			<td>&#60; .01</td>
		</tr>
		<tr>
			<td>BSL score</td>
			<td></td>
			<td></td>
			<td></td>
			<td>-5.75</td>
			<td>&#160;2.23</td>
			<td>-.60</td>
			<td>-2.57</td>
			<td>&#60; .05</td>
		</tr>
		<tr>
			<td>DES score</td>
			<td></td>
			<td></td>
			<td></td>
			<td>-0.18</td>
			<td>0.10</td>
			<td>-.47</td>
			<td>-1.70</td>
			<td>n.s.</td>
		</tr>
		<tr>
			<td>DSS-4 score</td>
			<td></td>
			<td></td>
			<td></td>
			<td>-0.04</td>
			<td>0.73</td>
			<td>-.01</td>
			<td>-0.06</td>
			<td>n.s.</td>
		</tr>
		<tr>
			<td>Model 3</td>
			<td>.48</td>
			<td>3</td>
			<td>&#60; .001</td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>PDEQ score</td>
			<td></td>
			<td></td>
			<td></td>
			<td>-5.85</td>
			<td>&#160;1.74</td>
			<td>-.66</td>
			<td>-3.36</td>
			<td>&#60; .01</td>
		</tr>
		<tr>
			<td>BSL score</td>
			<td></td>
			<td></td>
			<td></td>
			<td>-5.77</td>
			<td>&#160;2.15</td>
			<td>-.61</td>
			<td>-2.68</td>
			<td>&#60; .05</td>
		</tr>
		<tr>
			<td>DES score</td>
			<td></td>
			<td></td>
			<td></td>
			<td>-0.18</td>
			<td>0.10</td>
			<td>-.47</td>
			<td>-1.75</td>
			<td>n.s.</td>
		</tr>
	</tbody>
</table>
Table 2. Linear regression analyses within the BPD Sample (N = 28) for factors of HR responses to Traumatic Imagery. This table was published in Bichescu-Burian et al.42, with permission from Psychophysiology.

Watch this Scientific Journal Video about Use of a Psychophysiological Script-driven Imagery Experiment to Study Trauma-related Dissociation in Borderline Personality Disorder at JoVE.com

Use of a Psychophysiological Script-driven Imagery Experiment to Study Trauma-related Dissociation in Borderline Personality Disorder

We present a protocol of personalized script-driven trauma-related imagery and clinical assessments within a comparison design for investigating peritraumatic dissociation (PD), psychophysiological reactions, i.e. heart rate (HR) and skin conductance (SC), and psychological features of often severely traumatized individuals with borderline personality disorder (BPD).

This protocol offers a detailed description of a psychophysiological experiment using script-driven trauma-related imagery and standardized clinical ...

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12.3K Views.  Ulm University. We present a protocol of personalized script-driven trauma-related imagery and clinical assessments within a comparison design for investigating peritraumatic dissociation (PD), psychophysiological reactions, i.e. heart rate (HR) and skin conductance (SC), and psychological features of often severely traumatized individuals with borderline personality disorder (BPD).

Video: Use of a Psychophysiological Script-driven Imagery Experiment to Study Trauma-related Dissociation in Borderline Personality Disorder

Brain Imaging Investigation of the Neural Correlates of Emotional Autobiographical Recollection

Recollection of emotional autobiographical memories (AMs) is important to healthy cognitive and affective functioning 1 - remembering positive AMs is associated with increased personal well-being and self-esteem 2, whereas remembering and ruminating on negative AMs may lead to affective disorders 3. Although significant progress has been made in understanding the brain mechanisms underlying AM retrieval in general (reviewed in 4, 5), less is known about the effect of emotion on the subjective re-experience of AMs and the associated neural correlates. This is in part due to the fact that, unlike the investigations of the emotion effect on memory for laboratory-based microevents (reviewed in 6, 7-9), often times AM studies do not have a clear focus on the emotional aspects of remembering personal events (but see 10). Here, we present a protocol that allows investigation of the neural correlates of recollecting emotional AMs using functional magnetic resonance imaging (fMRI). Cues for these memories are collected prior to scanning by means of an autobiographical memory questionnaire (AMQ), therefore allowing for proper selection of emotional AMs based on their phenomenological properties (i.e., intensity, vividness, personal significance). This protocol can be used in healthy and clinical populations alike.

We present a protocol that allows investigation of the neural correlates of recollecting emotional autobiographical memories, using functional magnetic resonance imaging. This protocol can be used with both healthy and clinical participants.

Recollection of emotional autobiographical memories (AMs) is important to healthy cognitive and affective functioning 1 - remembering positive AMs is ...

Neuroscience

Brain Imaging Investigation of the Neural Correlates of Emotion Regulation

The ability to control/regulate emotions is an important coping mechanism in the face of emotionally stressful situations. Although significant progress has been made in understanding conscious/deliberate emotion regulation (ER), less is known about non-conscious/automatic ER and the associated neural correlates. This is in part due to the problems inherent in the unitary concepts of automatic and conscious processing1. Here, we present a protocol that allows investigation of the neural correlates of both deliberate and automatic ER using functional magnetic resonance imaging (fMRI). This protocol allows new avenues of inquiry into various aspects of ER. For instance, the experimental design allows manipulation of the goal to regulate emotion (conscious vs. non-conscious), as well as the intensity of the emotional challenge (high vs. low). Moreover, it allows investigation of both immediate (emotion perception) and long-term effects (emotional memory) of ER strategies on emotion processing. Therefore, this protocol may contribute to better understanding of the neural mechanisms of emotion regulation in healthy behaviour, and to gaining insight into possible causes of deficits in depression and anxiety disorders in which emotion dysregulation is often among the core debilitating features.

We present a protocol that allows investigation of the neural correlates of deliberate and automatic emotion regulation, using functional magnetic resonance imaging. This protocol can be used in healthy participants, both young and older, as well as in clinical patients.

The ability to control/regulate emotions is an important coping mechanism in the face of emotionally stressful situations. Although significant progress ...

Brain Imaging Investigation of the Impairing Effect of Emotion on Cognition

Emotions can impact cognition by exerting both enhancing (e.g., better memory for emotional events) and impairing (e.g., increased emotional distractibility) effects (reviewed in 1). Complementing our recent protocol 2 describing a method that allows investigation of the neural correlates of the memory-enhancing effect of emotion (see also 1, 3-5), here we present a protocol that allows investigation of the neural correlates of the detrimental impact of emotion on cognition. The main feature of this method is that it allows identification of reciprocal modulations between activity in a ventral neural system, involved in 'hot' emotion processing (HotEmo system), and a dorsal system, involved in higher-level 'cold' cognitive/executive processing (ColdEx system), which are linked to cognitive performance and to individual variations in behavior (reviewed in 1). Since its initial introduction 6, this design has proven particularly versatile and influential in the elucidation of various aspects concerning the neural correlates of the detrimental impact of emotional distraction on cognition, with a focus on working memory (WM), and of coping with such distraction 7,11, in both healthy 8-11 and clinical participants 12-14.

We present a protocol that allows investigation of the neural mechanisms mediating the detrimental impact of emotion on cognition, using functional magnetic resonance imaging. This protocol can be used with both healthy and clinical participants.

Emotions can impact cognition by exerting both enhancing (e.g., better memory for emotional events) and impairing (e.g., increased emotional ...

Exploring the Use of Isolated Expressions and Film Clips to Evaluate Emotion Recognition by People with Traumatic Brain Injury

The current study presented 60 people with traumatic brain injury (TBI) and 60 controls with isolated facial emotion expressions, isolated vocal emotion expressions, and multimodal (i.e., film clips) stimuli that included contextual cues. All stimuli were presented via computer. Participants were required to indicate how the person in each stimulus was feeling using a forced-choice format. Additionally, for the film clips, participants had to indicate how they felt in response to the stimulus, and the level of intensity with which they experienced that emotion.

This paper describes how to implement a battery of behavioral tasks to examine emotion recognition of isolated facial and vocal emotion expressions, and a novel task using commercial television and film clips to assess multimodal emotion recognition that includes contextual cues.

The current study presented 60 people with traumatic brain injury (TBI) and 60 controls with isolated facial emotion expressions, isolated vocal emotion ...

Experimental Paradigm for Measuring the Effects of Self-distancing in Young Children

Self-distancing (i.e., creating mental distance between the self and a stimulus by adopting a less egocentric perspective) has been studied as a way to improve adolescents' and adults' emotion regulation. These studies instruct adolescents and adults to use visual imagery or language to create distance from the self before engaging in self-regulation tasks and when thinking about past and future events. For example, adults are asked to recall past, negative emotional experiences from either a first-person perspective (no distance) or a third-person perspective (self-distanced). These studies show that a self-distanced perspective allows adults to cope more adaptively when recalling negative feelings. However, the self-distancing paradigm used with adults was not developmentally appropriate for young children. This modified self-distancing paradigm involves instructing children to think about their thoughts, feelings, and actions from different perspectives that vary in their distance from the self while completing a self-regulation task. The paradigm involves randomly assigning children to use one of three perspectives: self-immersed, third-person, or exemplar. In the self-immersed condition, children are asked to think about themselves using the first-person perspective (e.g., "How am I feeling?") and no distance is created from the self. In the third-person condition, children are asked to create distance from the self by using the third-person perspective (e.g., "How is [child's name] feeling?"). In the exemplar condition, the greatest distance from the self is created by asking children to pretend to be a media character and to think about that character's thoughts and feelings (e.g., "How is Batman feeling?"). Studies using the self-distancing paradigm with 4-6-year-olds have found that as the amount of distance from the self increases (self-immersed &lt; third-person &lt; exemplar), children perform better on self-regulation tasks. These findings suggest that the strategies implemented in the self-distancing protocol may be useful to include in self-regulation interventions for young children.

An experimental paradigm was created to measure the effects of self-distancing in young children (4-6-year-olds). Self-distancing is a process through which individuals adopt a less egocentric perspective. This paradigm has been used to examine the effects of self-distancing on young children&#39;s self-regulation.

Self-distancing (i.e., creating mental distance between the self and a stimulus by adopting a less egocentric perspective) has been studied as a way to ...

Developing Neuroimaging Phenotypes of the Default Mode Network in PTSD: Integrating the Resting State, Working Memory, and Structural Connectivity

Complementary structural and functional neuroimaging techniques used to examine the Default Mode Network (DMN) could potentially improve assessments of psychiatric illness severity and provide added validity to the clinical diagnostic process. Recent neuroimaging research suggests that DMN processes may be disrupted in a number of stress-related psychiatric illnesses, such as posttraumatic stress disorder (PTSD).
Although specific DMN functions remain under investigation, it is generally thought to be involved in introspection and self-processing. In healthy individuals it exhibits greatest activity during periods of rest, with less activity, observed as deactivation, during cognitive tasks, e.g., working memory. This network consists of the medial prefrontal cortex, posterior cingulate cortex/precuneus, lateral parietal cortices and medial temporal regions.
Multiple functional and structural imaging approaches have been developed to study the DMN. These have unprecedented potential to further the understanding of the function and dysfunction of this network. Functional approaches, such as the evaluation of resting state connectivity and task-induced deactivation, have excellent potential to identify targeted neurocognitive and neuroaffective (functional) diagnostic markers and may indicate illness severity and prognosis with increased accuracy or specificity. Structural approaches, such as evaluation of morphometry and connectivity, may provide unique markers of etiology and long-term outcomes. Combined, functional and structural methods provide strong multimodal, complementary and synergistic approaches to develop valid DMN-based imaging phenotypes in stress-related psychiatric conditions. This protocol aims to integrate these methods to investigate DMN structure and function in PTSD, relating findings to illness severity and relevant clinical factors.

This protocol describes the complementary neuroimaging techniques of resting state structural connectivity, task-induced deactivation, and structural connectivity analyses to examine the default network in post-traumatic stress disorder. The use of synergistic methods could potentially lead to improved diagnostics and assessments of severity, outcome, and other relevant clinical factors.

Complementary structural and functional neuroimaging techniques used to examine the Default Mode Network (DMN) could potentially improve assessments of ...

Medicine

Simultaneous Application of Transcranial Direct Current Stimulation during Virtual Reality Exposure

Transcranial direct current stimulation (tDCS) is a form of non-invasive brain stimulation that changes the likelihood of neuronal firing through modulation of neural resting membranes. Compared to other techniques, tDCS is relatively safe, cost-effective, and can be administered while individuals are engaged in controlled, specific cognitive processes. This latter point is important as tDCS may predominantly affect intrinsically active neural regions. In an effort to test tDCS as a potential treatment for psychiatric illness, the protocol described here outlines a novel procedure that allows the simultaneous application of tDCS during exposure to trauma-related cues using virtual reality (tDCS+VR) for veterans with posttraumatic stress disorder (NCT03372460). In this double-blind protocol, participants are assigned to either receive 2 mA tDCS, or sham stimulation, for 25 minutes while passively watching three 8-minute standardized virtual reality drives through Iraq or Afghanistan, with virtual reality events increasing in intensity during each drive. Participants undergo six sessions of tDCS+VR over the course of 2-3 weeks, and psychophysiology (skin conductance reactivity) is measured throughout each session. This allows testing for within and between session changes in hyperarousal to virtual reality events and adjunctive effects of tDCS. Stimulation is delivered through a built-in rechargeable battery-driven tDCS device using a 1 (anode) x 1 (cathode) unilateral electrode set-up. Each electrode is placed in a 3 x 3 cm (current density 2.22 A/m2) reusable sponge pocket saturated with 0.9% normal saline. Sponges with electrodes are attached to the participant&#8217;s skull using a rubber headband with the electrodes placed such that they target regions within the ventromedial prefrontal cortex. The virtual reality headset is placed over the tDCS montage in such a way as to avoid electrode interference.

This manuscript outlines a novel protocol to allow the simultaneous application of transcranial direct current stimulation during exposure to warzone trauma-related cues using virtual reality for veterans with posttraumatic stress disorder.

Transcranial direct current stimulation (tDCS) is a form of non-invasive brain stimulation that changes the likelihood of neuronal firing through ...

Exploring the Neural Correlates of Cognitive Reappraisal in Obsessive-Compulsive Disorder Using Task-based Functional Magnetic Resonance Imaging

Patients with obsessive-compulsive disorder (OCD) show heightened brain activity in limbic and orbitofrontal regions when confronted with negative emotions, which could be associated with impairments in emotion regulation skills. The ability to regulate emotions is a necessary coping mechanism when facing emotionally distressing situations, and deliberate emotion regulation strategies such as cognitive reappraisal have been extensively studied in the general population. Despite this, little is known about potential deliberate emotion regulation deficits in OCD patients and the associated neural correlates. Here, we describe a protocol to investigate the neural correlates of deliberate emotion regulation (cognitive reappraisal) using functional magnetic resonance imaging (fMRI) in OCD patients in comparison to a matched control sample. This protocol follows current gold standards for neuroimaging studies and includes both task activation and connectivity analysis (as well as behavioral data) to allow a more complete investigation. Therefore, we expect it will contribute to expanding the knowledge of the neural correlates of emotion (dys)regulation in OCD, and it could also be applied to explore emotion regulation deficits in other psychiatric disorders.

We introduce a protocol for exploring the neural correlates of a cognitive emotion regulation task, namely cognitive reappraisal, using functional magnetic resonance imaging. This protocol was used in patients with obsessive-compulsive disorder and healthy controls but can also be used in other clinical samples.

Patients with obsessive-compulsive disorder (OCD) show heightened brain activity in limbic and orbitofrontal regions when confronted with negative ...

Dissociative Disorders

Dissociative disorders represent complex psychological conditions characterized by disruptions in consciousness, memory, identity, or perception. These disruptions cause individuals to experience a disconnection from their thoughts, emotions, and memories. The phenomenon is not merely an occasional lapse in attention but a profound alteration in mental functioning that can severely impact daily life.
Dissociative Fugue 
A hallmark feature of dissociative disorders is the dissociative fugue state, wherein individuals undergo sudden and profound memory loss or even adopt a completely new identity. During this stage, affected individuals may unexpectedly travel to unfamiliar places and display behaviors consistent with their assumed identity. Such episodes often occur without any recollection of their past, creating significant challenges in personal and social contexts.
Trauma and Dissociation 
Dissociative disorders are strongly correlated with traumatic experiences. Chronic trauma, particularly during formative years, can overwhelm the mind&#39;s capacity to process events, leading to dissociation as a defense mechanism. This psychological response allows individuals to mentally detach from distressing events, creating a sense of distance from pain. It is common for individuals with post-traumatic stress disorder (PTSD) to exhibit symptoms of dissociation, as trauma and dissociation share psychological pathways.
Neurological Underpinnings
Research has identified structural changes in the brains of individuals with dissociative disorders, specifically in the hippocampus and amygdala, which are regions vital for memory and emotion regulation. Reduced volumes of these structures may hinder the brain&#39;s ability to process memories and regulate emotional responses effectively. These findings underscore the biological basis of dissociative symptoms, bridging the gap between psychological experiences and neurological mechanisms.
Understanding dissociative disorders requires recognizing their profound effects on mental functioning, their roots in trauma, and their basis in neurobiology, highlighting the complex interplay between mind and brain.

Dissociative disorders are psychological conditions where an individual&#39;s conscious awareness becomes dissociated or separated from their previous ...

KEY TERMS AND CONCEPTS

Dissociative Identity Disorder

Dissociative Identity Disorder (DID), previously termed multiple personality disorder, is a complex psychological condition characterized by the presence of two or more distinct identities or personality states. Each identity exhibits unique patterns of behavior, voice, and mannerisms and may possess separate memories and emotional responses. The alternating control between identities can result in memory gaps and challenges in recalling daily activities, often exacerbating the individual&#39;s distress.
Psychological Foundations
The origins of DID are deeply rooted in psychological and developmental factors. Research highlights extreme childhood trauma, particularly abuse, as a primary trigger. In such cases, individuals may dissociate to cope with overwhelming experiences, compartmentalizing distressing memories and emotions into distinct identities. This mechanism allows the individual to function while isolating traumatic events from conscious awareness. From a psychodynamic perspective, these identities serve as defenses against unacceptable impulses, with secondary personalities acting as outlets for suppressed emotions or desires. Learning theories suggest that dissociative behaviors are reinforced by the reduction of anxiety, making them more likely to recur in stressful situations.
Sociocultural and Biological Contributions
Sociocultural factors also influence the presentation and recognition of DID. Increased media portrayal of the disorder has heightened public and clinical awareness, contributing to a rise in diagnoses. However, this exposure may also shape the manifestation of symptoms in ways that align with cultural narratives.
Structural and functional brain differences are associated with DID on the biological front. Abnormal brain anatomy and activity often accompany DID. Brain scans reveal shrinkage in regions involved in memory and threat detection, along with heightened activity in areas that control and inhibit traumatic memories. These findings underscore the interplay between neurological adaptations and psychological processes in the disorder&#39;s development and progression.
This multifaceted approach to understanding DID reflects the intricate interplay of psychological, sociocultural, and biological factors, each contributing to the manifestation and management of this complex condition.

Dissociative Identity Disorder, or DID, formerly called multiple personality disorder, occurs when an individual exhibits two or more distinct personality ...