scholarly journals Trajectories of alliance ruptures in the psychotherapy of adolescents with borderline personality pathology: timing, typology and significance

2019 ◽  
Vol 22 (2) ◽  
Author(s):  
Nathalie Schenk ◽  
Ronan Zimmermann ◽  
Lukas Fürer ◽  
Mariane Krause ◽  
Sindy Weise ◽  
...  
Keyword(s):  
Therapeutic Alliance ◽  
Treatment Time ◽  
Clinical Sample ◽  
Borderline Personality ◽  
Personality Pathology ◽  
Mixed Effect ◽  
Identity Diffusion ◽  
Mixed Effect Models ◽  
Rupture Resolution ◽  
Alliance Ruptures

Jeremy Safran and his research group suggest that rupture-repair processes are important for the therapeutic change in patients with personality disorders. In this exploratory study, we describe alliance ruptures and resolutions on a session-by-session basis in a clinical sample of adolescents with Borderline Personality Pathology (BPP). Three research questions are addressed: i) Is there a typical trajectory of alliance ruptures over treatment time? ii) Which rupture and resolution markers occur frequently? iii) Which rupture markers are most significant for the therapeutic alliance? Ten patients who presented with identity diffusion and at least three Borderline Personality Disorder criteria were studied and treated with Adolescent Identity Treatment. Alliance ruptures and resolutions were coded in 187 therapy sessions according to the Rupture Resolution Rating System. Mixed-effect models were used for statistical analyses. Findings supported an inverted U-shaped trajectory of alliance ruptures across treatment time. The inspection of individual trajectories displayed that alliance ruptures emerge non-linearly with particular significant alliance ruptures appearing in phases or single peak sessions. Withdrawal rupture markers emerged more often compared to confrontation markers. However, confrontation markers inflicted a higher impact or strain on the immediate collaboration between patient and therapist compared to withdrawal markers. Clinicians should expect alliance ruptures to occur frequently in the treatment of adolescents with BPP. The findings support the theory of a dynamic therapeutic alliance characterised by a continuous negotiation between patients and therapists.

Repairing Ruptures in the Therapeutic Alliance

2019 ◽  
pp. 208-218
Author(s):  
Brian A. Sharpless
Keyword(s):  
Therapeutic Alliance ◽  
Premature Termination ◽  
Therapy Outcome ◽  
Rupture Resolution ◽  
Alliance Ruptures ◽  
Stage Process

:Ruptures (i.e., deteriorations or strains in the therapeutic alliance) are an inevitable part of any psychotherapy. They are not only common but are also clinically meaningful. If not adequately attended to, ruptures are associated with poor therapy outcome and premature termination. Fortunately, a strong research base is available that provides clinically useful guidance for identifying and resolving alliance ruptures. After a brief review of the theoretical and empirical literatures, a list of “markers” used to identify the two subtypes of ruptures (i.e., withdrawal and confrontation) is provided. Proper assessment of the subtype is critical, as they each require slightly different rupture resolution techniques across a four-stage process. Finally, a list of specific rupture resolution techniques is provided.

scholarly journals Suicidality and Personality Pathology in Adolescence: A Systematic Review

2021 ◽  
Author(s):  
Marta Moselli ◽  
Maria Pia Casini ◽  
Camilla Frattini ◽  
Riccardo Williams
Keyword(s):  
Personality Disorder ◽  
Personality Disorders ◽  
Borderline Personality ◽  
Personality Pathology ◽  
Suicidal Risk ◽  
Research Papers ◽  
Mediating Role ◽  
Identity Diffusion ◽  
Predictive Role

AbstractThis work presents a review of research papers examining the role of emerging personality pathology in suicidal ideation and behaviours in adolescence. Initially, 226 studies were selected in line with PRISMA guidelines, and 33 articles were finally included in this review. The data show percentages of any personality disorder diagnosis ranging from 19.5 to 22.8% in suicide attempters, while in autopsy studies, the rate of personality disorder diagnosis varied between 29.6 and 42.1%. The overwhelming majority of the studies focus on the role of borderline personality disorder (BPD) in suicidal behaviours, also highlighting its predictive role at a longitudinal level. Furthermore, the literature review shows that personality traits supposed to underlie BPD, such as affective instability, impulsivity and identity diffusion, have specific predictive links with suicidal conduct. Other personality pathology dimensions, such as aggressiveness, sadism and perfectionism that are associated with other personality disorders, namely, antisocial and narcissistic personality disorders, have also shown a significant mediating role for suicidal risk. Overall, these results seem to parallel the role of personality pathology in predicting suicide in adulthood and point to the relevance of assessing the presence of emerging patterns of personality disorders for the clinical management of suicidal risk in adolescence.

Identity disturbance in adolescence: Associations with borderline personality disorder

2011 ◽  
Vol 23 (1) ◽  
pp. 305-313 ◽  
Author(s):  
Drew Westen ◽  
Ephi Betan ◽  
Jared A. DeFife
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Clinical Sample ◽  
Borderline Personality ◽  
Personality Pathology ◽  
Developmental Task ◽  
Identity Disturbance ◽  
Adult Personality ◽  
Sturm Und Drang ◽  
Wide Range

AbstractAlthough establishing a coherent identity is often viewed as a normative developmental task of adolescence, an important question is whether forms of identity disturbance seen in adult personality disorders can also be distinguished in adolescents. If so, such disturbances would constitute an essential target for research and clinical interventions. The goal of this study is to investigate the nature of identity disturbance in an adolescent clinical sample and to explore its links with personality pathology, particularly borderline personality disorder. A national random sample of 139 psychiatrists and clinical psychologists completed a battery of instruments on a randomly selected adolescent patient in their care, including measures of Axis II symptoms and the Identity Disturbance Questionnaire—Adolescent Version, an instrument designed for clinically experienced observers that assesses a wide range of manifestations of potential identity disturbance among adolescents. Factor analysis of the Identity Disturbance Questionnaire—Adolescent Version yielded four clinically and conceptually coherent factors that resembled dimensions previously identified in adults: lack of normative commitment, role absorption, painful incoherence, and lack of consistency. As in adults, identity disturbance in adolescents is a clinically meaningful, multidimensional construct exhibiting significant relationships with different forms of severe personality pathology, most notably borderline personality disorder. As such, identity disturbance can be a manifestation of psychopathology above and beyond the typical Sturm und Drang (storm and stress) of adolescence.

Silence in the psychotherapy of adolescents with borderline personality pathology.

2020 ◽  
Author(s):  
Ronan Zimmermann ◽  
Lukas Fürer ◽  
Nathalie Schenk ◽  
Julian Koenig ◽  
Volker Roth ◽  
...  
Keyword(s):  
Borderline Personality ◽  
Personality Pathology

Beliefs about emotion shift dynamically alongside momentary affect

2019 ◽  
Author(s):  
Jennifer Veilleux ◽  
Elise Warner ◽  
Danielle Baker ◽  
Kaitlyn Chamberlain
Keyword(s):  
Self Efficacy ◽  
Daily Life ◽  
Borderline Personality ◽  
Personality Pathology ◽  
Emotional States ◽  
Assessment Study ◽  
Directed Action ◽  
Emotion Beliefs ◽  
Ecological Momentary ◽  
Momentary Assessment

This study examined if beliefs about emotion change across emotional contexts in daily life, and investigated whether people with prominent features of borderline personality pathology experience greater shifts in emotion beliefs during emotional states compared to people without borderline features. Undergraduate participants with (n = 49) and without borderline features (n = 50) completed a one week ecological momentary assessment study where 7x/day they provided ratings of affect, nine different beliefs about emotion and indicators of momentary self-efficacy. Results indicated a significant between-person element to emotion beliefs, supporting the notion of beliefs as relatively schematic. In addition, people with borderline features generally experienced greater instability of beliefs over time compared to people without borderline features. In addition, most of the beliefs about emotion shifted with either positive or negative affect. For many of the emotion beliefs, the relationships between affect and belief were moderated by borderline group. Finally, momentary beliefs about emotion also predicted momentary self-efficacy for tolerating distress and exerting willpower. Taken together, results confirm that beliefs about emotion can fluctuate in daily life and that there are implications for emotion beliefs for people who struggle with emotion regulation and impulsivity (i.e., people with features of borderline personality) as well as for self-efficacy in tolerating emotion and engaging in goal-directed action.

Positive Emotion in Borderline Personality Disorder

2019 ◽  
pp. 332-352
Author(s):  
Jill M. Hooley ◽  
Sara R. Masland
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Positive Emotions ◽  
Negative Emotions ◽  
Negative Mood ◽  
Severe Form ◽  
Borderline Personality ◽  
Negative Emotionality ◽  
Personality Pathology ◽  
Emotional Experiences

Borderline personality disorder (BPD) is a severe form of personality pathology characterized by high levels of negative emotionality. Because negative emotions are so central to the clinical presentation of BPD, the issue of how people with this disorder process and experience positive emotional experiences is relatively unexplored. This chapter provides an overview of what is currently known about positive emotions and BPD. Although the literature is characterized by many inconsistencies, our review suggests that people with BPD do indeed experience positive emotions. However, their recall of positive emotional experiences appears to be reduced, perhaps because such experiences are more transient, less stable, and more likely to be quickly replaced by negative emotions. Problems with the identification and accurate differentiation of positive emotions may also play a role. Such difficulties may conspire to create a psychological world for people with BPD that is characterized by a focus on negative mood and negative emotional experiences. In addition to focusing on negative affect, we suggest that it might also be clinically beneficial to make problems with positive affect a specific clinical target.

scholarly journals A hierarchical bivariate meta-analysis of diagnostic test accuracy to provide direct comparisons of immunoassays vs. indirect immunofluorescence for initial screening of connective tissue diseases

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Michelle Elaine Orme ◽  
Carmen Andalucia ◽  
Sigrid Sjölander ◽  
Xavier Bossuyt
Keyword(s):  
Connective Tissue ◽  
Indirect Immunofluorescence ◽  
Meta Analysis ◽  
Connective Tissue Diseases ◽  
Test Accuracy ◽  
Initial Screening ◽  
Case Control Studies ◽  
Cross Sectional ◽  
Mixed Effect ◽  
Mixed Effect Models

AbstractObjectivesTo compare indirect immunofluorescence (IIF) for antinuclear antibodies (ANA) against immunoassays (IAs) as an initial screening test for connective tissue diseases (CTDs).MethodsA systematic literature review identified cross-sectional or case-control studies reporting test accuracy data for IIF and enzyme-linked immunosorbent assays (ELISA), fluorescence enzyme immunoassay (FEIA), chemiluminescent immunoassay (CLIA) or multiplex immunoassay (MIA). The meta-analysis used hierarchical, bivariate, mixed-effect models with random-effects by test.ResultsDirect comparisons of IIF with ELISA showed that both tests had good sensitivity (five studies, 2321 patients: ELISA: 90.3% [95% confidence interval (CI): 80.5%, 95.5%] vs. IIF at a cut-off of 1:80: 86.8% [95% CI: 81.8%, 90.6%]; p = 0.4) but low specificity, with considerable variance across assays (ELISA: 56.9% [95% CI: 40.9%, 71.5%] vs. IIF 1:80: 68.0% [95% CI: 39.5%, 87.4%]; p = 0.5). FEIA sensitivity was lower than IIF sensitivity (1:80: p = 0.005; 1:160: p = 0.051); however, FEIA specificity was higher (seven studies, n = 12,311, FEIA 93.6% [95% CI: 89.9%, 96.0%] vs. IIF 1:80 72.4% [95% CI: 62.2%, 80.7%]; p < 0.001; seven studies, n = 3251, FEIA 93.5% [95% CI: 91.1%, 95.3%] vs. IIF 1:160 81.1% [95% CI: 73.4%, 86.9%]; p < 0.0001). CLIA sensitivity was similar to IIF (1:80) with higher specificity (four studies, n = 1981: sensitivity 85.9% [95% CI: 64.7%, 95.3%]; p = 0.86; specificity 86.1% [95% CI: 78.3%, 91.4%]). More data are needed to make firm inferences for CLIA vs. IIF given the wide prediction region. There were too few studies for the meta-analysis of MIA vs. IIF (MIA sensitivity range 73.7%–86%; specificity 53%–91%).ConclusionsFEIA and CLIA have good specificity compared to IIF. A positive FEIA or CLIA test is useful to support the diagnosis of a CTD. A negative IIF test is useful to exclude a CTD.

scholarly journals Neurophysiological and behavioural effects of conventional and high definition tDCS

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Fabio Masina ◽  
Giorgio Arcara ◽  
Eleonora Galletti ◽  
Isabella Cinque ◽  
Luciano Gamberini ◽  
...  
Keyword(s):  
Response Times ◽  
Power Reduction ◽  
Alpha Power ◽  
High Definition ◽  
Mixed Effect ◽  
State Dependency ◽  
Mixed Effect Models ◽  
Beta Power ◽  
Neurophysiological Data ◽  
Spectrum Density

AbstractHigh-definition transcranial direct current stimulation (HD-tDCS) seems to overcome a drawback of traditional bipolar tDCS: the wide-spread diffusion of the electric field. Nevertheless, most of the differences that characterise the two techniques are based on mathematical simulations and not on real, behavioural and neurophysiological, data. The study aims to compare a widespread tDCS montage (i.e., a Conventional bipolar montage with extracephalic return electrode) and HD-tDCS, investigating differences both at a behavioural level, in terms of dexterity performance, and a neurophysiological level, as modifications of alpha and beta power as measured with EEG. Thirty participants took part in three sessions, one for each montage: Conventional tDCS, HD-tDCS, and sham. In all the conditions, the anode was placed over C4, while the cathode/s placed according to the montage. At baseline, during, and after each stimulation condition, dexterity was assessed with a Finger Tapping Task. In addition, resting-state EEG was recorded at baseline and after the stimulation. Power spectrum density was calculated, selecting two frequency bands: alpha (8–12 Hz) and beta (18–22 Hz). Linear mixed effect models (LMMs) were used to analyse the modulation induced by tDCS. To evaluate differences among the montages and consider state-dependency phenomenon, the post-stimulation measurements were covariate-adjusted for baseline levels. We observed that HD-tDCS induced an alpha power reduction in participants with lower alpha at baseline. Conversely, Conventional tDCS induced a beta power reduction in participants with higher beta at baseline. Furthermore, data showed a trend towards a behavioural effect of HD-tDCS in participants with lower beta at baseline showing faster response times. Conventional and HD-tDCS distinctively modulated cortical activity. The study highlights the importance of considering state-dependency to determine the effects of tDCS on individuals.

scholarly journals Recombining Your Way Out of Trouble: The Genetic Architecture of Hybrid Fitness under Environmental Stress

2019 ◽  
Vol 37 (1) ◽  
pp. 167-182 ◽  
Author(s):  
Zebin Zhang ◽  
Devin P Bendixsen ◽  
Thijs Janzen ◽  
Arne W Nolte ◽  
Duncan Greig ◽  
...  
Keyword(s):  
Environmental Stress ◽  
Evolutionary Potential ◽  
Genetic Trait ◽  
Hybrid Fitness ◽  
Mixed Effect ◽  
Mixed Effect Models ◽  
Hybrid Genome ◽  
Chromosome Associations ◽  
Low Coverage ◽  
Negative Epistasis

Abstract Hybridization between species can either promote or impede adaptation. But we know very little about the genetic basis of hybrid fitness, especially in nondomesticated organisms, and when populations are facing environmental stress. We made genetically variable F2 hybrid populations from two divergent Saccharomyces yeast species. We exposed populations to ten toxins and sequenced the most resilient hybrids on low coverage using ddRADseq to investigate four aspects of their genomes: 1) hybridity, 2) interspecific heterozygosity, 3) epistasis (positive or negative associations between nonhomologous chromosomes), and 4) ploidy. We used linear mixed-effect models and simulations to measure to which extent hybrid genome composition was contingent on the environment. Genomes grown in different environments varied in every aspect of hybridness measured, revealing strong genotype–environment interactions. We also found selection against heterozygosity or directional selection for one of the parental alleles, with larger fitness of genomes carrying more homozygous allelic combinations in an otherwise hybrid genomic background. In addition, individual chromosomes and chromosomal interactions showed significant species biases and pervasive aneuploidies. Against our expectations, we observed multiple beneficial, opposite-species chromosome associations, confirmed by epistasis- and selection-free computer simulations, which is surprising given the large divergence of parental genomes (∼15%). Together, these results suggest that successful, stress-resilient hybrid genomes can be assembled from the best features of both parents without paying high costs of negative epistasis. This illustrates the importance of measuring genetic trait architecture in an environmental context when determining the evolutionary potential of genetically diverse hybrid populations.

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