The relational context of aggression in borderline personality disorder: using adult attachment style to predict forms of hostility

Attachment theory provides a framework for understanding and predicting critical aspects of aggression in the personality disorders. An association between borderline personality disorder (BPD) and insecure forms of adult attachment marked by high relationship anxiety has been repeatedly observed in the empirical literature. Aggression also has been linked to insecure attachment. The present study extends previous work by exploring the degree to which the underlying attachment dimensions of relationship anxiety and avoidance are associated in BPD with the following forms of hostility: (a) direct aggression (verbal or physical) initiated towards others, (b) expectation/perception of aggression from others (including "reactive" counteraggression when/if provoked), (c) aggression directed towards the self in the form of suicidality or parasuicidality, and (d) affective experience of irritability or anger. The issue was studied in a sample of 92 patients diagnosed with BPD. Results show significant association between more fearful forms of attachment (simultaneous presence of relationship anxiety and avoidance) and the more reactive form of aggression involving expectation of hostility from others. Self-harm was significantly associated only with relational avoidance while anger and irritability were associated only with relational anxiety. Implications for understanding relational aspects of BPD aggression in research and clinical work are discussed.     

Social cognition and metacognition in social anxiety: A systematic review

Cognitive–behavioural and metacognitive approaches to emotional disorder implicate beliefs in social anxiety, but the types of beliefs differ across these perspectives. Cognitive models suggest that social beliefs about the self (i.e., high standards and conditional and unconditional beliefs) are central. In contrast, the metacognitive model gives centre stage to metacognitive beliefs (i.e., positive and negative beliefs about thinking) as main contributors to the maintenance of the disorder. Despite an expanding research interest in this area, the evidence for such contributions has not yet been reviewed. This study set out to systematically review relevant cross‐sectional, longitudinal, and experimental investigations of the direct and indirect (through cognitive processes, such as anticipatory processing, self‐focused attention, the post‐mortem, and avoidance) relationships of social and metacognitive beliefs with social anxiety. Clinical and nonclinical samples were included, and correlation and regression coefficients as well as results from group comparisons (e.g., t tests and analyses of variance) were extracted. Overall, 23 papers were located, through PsycINFO, PubMed, and Web of Science, and reviewed using narrative synthesis. The results showed a robust positive relationship between social beliefs and social anxiety that appeared to be mediated by cognitive processes. Specific metacognitive beliefs were found to positively contribute to social anxiety both directly and indirectly, through cognitive processes. The study's findings are limited to 2 models of social anxiety and other minor limitations (e.g., grey literature was excluded). With these accounted for, the results are discussed in terms of the conceptualization and treatment of social anxiety and suggestions for future research are made.     

Anxiety,stress and perfectionism in bipolar disorder

Background

Previous reports have highlighted perfectionism and related cognitive styles as a psychological risk factor for stress and anxiety symptoms as well as for the development of bipolar disorder symptoms. The anxiety disorders are highly comorbid with bipolar disorder but the mechanisms that underpin this comorbidity are yet to be determined.

Method

Measures of depressive, (hypo)manic, anxiety and stress symptoms and perfectionistic cognitive style were completed by a sample of 142 patients with bipolar disorder. Mediation models were used to explore the hypotheses that anxiety and stress symptoms would mediate relationships between perfectionistic cognitive styles, and bipolar disorder symptoms.

Results

Stress and anxiety both significantly mediated the relationship between both self-critical perfectionism and goal attainment values and bipolar depressive symptoms. Goal attainment values were not significantly related to hypomanic symptoms. Stress and anxiety symptoms did not significantly mediate the relationship between self-critical perfectionism and (hypo)manic symptoms.

Limitations

1.

These data are cross-sectional; hence the causality implied in the mediation models can only be inferred.

2.

The clinic patients were less likely to present with (hypo)manic symptoms and therefore the reduced variability in the data may have contributed to the null findings for the mediation models with (hypo)manic symptoms.

3.

Those patients who were experiencing current (hypo)manic symptoms may have answered the cognitive styles questionnaires differently than when euthymic.

Conclusion

These findings highlight a plausible mechanism to understand the relationship between bipolar disorder and the anxiety disorders. Targeting self-critical perfectionism in the psychological treatment of bipolar disorder when there is anxiety comorbidity may result in more parsimonious treatments.     

Obsessive fears about harm to self or others and overt aggressive behaviors in youth diagnosed with juvenile-onset bipolar disorder

BACKGROUND: Obsessive fear-of-harm, either fear of doing harm or fear of harm coming to self, may be closely associated with aggressive behaviors in juvenile-onset bipolar disorder. METHODS: We analyzed parent-report data on the Yale-Brown Obsessive Compulsive Scale (YBOCS) and Overt Aggression Scale (OAS) for 1601 children/adolescents with a clinician-assigned diagnosis of bipolar disorder. The summing of 6 YBOCS items rated "often" or "very often or almost constant" yielded a biphasic distribution of scores. Median-split was used to define meaningful subgroups contrasting high vs. low "fear-of-harm", which were then compared on parent-reported severe injury to self and others and on parent-reported suicide threats. RESULTS: High fear-of-harm was strongly associated with parent-reported severe injury to self and others. For self-injury, the estimated risk ratio for high vs. low fear-of-harm subgroups was 2.68 (95% confidence interval 1.87-3.86), indicating greater than doubling of risk associated with high fear-of-harm. For severe injury to others, the estimated risk ratio was 7.97 (95% confidence interval 4.19-15.2), suggesting a nearly eight-fold increased risk associated with high fear-of-harm. High fear-of-harm subjects were reported to make serious suicide threats much more frequently than low fear-of-harm subjects (odds ratio, estimated by ordinal logistic regression modeling methods, was 2.42 (95% CI 2.00 to 2.92; z=9.12, p<0.001). LIMITATIONS: Child report data was not obtained; clinician diagnosis was not validated via research interview. CONCLUSIONS: Obsessive fears about harm to self or others in a sample of children with a clinician-assigned diagnosis of bipolar disorder were found to be positively related to increased behavioral aggression towards self and others, as well as to frequent suicide threats.     

A metacognitive model of social anxiety: Implications for treatment

This article represents an attempt to clarify questions posed by evidence of varying pathways to change in social anxiety. A new perspective is developed which addresses these questions and, importantly, lays the foundation for an innovative treatment approach. Essentially, social anxiety is construed here as the product of a disorganization in which feelings and cognitions (both conscious and preconscious) about the self, about other people, and about the relations between self and others are organized. Specifically, the socially anxious client experiences others autocentrically: that is, in terms of how the other person perceives, evaluates and affects one's own self. The result is a narrowed capacity for experiencing others. The goal of treatment in the new approach advocated here is to allow the individual to understand, appreciate and share the feelings, thoughts and experience of other people. Therapy is directed toward getting clients out of themselves and into other people.     

The interrelationship between an anthropophobic tendency and narcissistic personality in adolescence

This study investigates the interrelationship between an anthropophobic tendency and narcissistic personality in adolescence. Previous research has proposed that anthropophobia and narcissistic personality disorders can be classified into subtypes. In recent studies, Okano (1998) suggested that the relationship between an anthropophobic tendency and narcissistic personality should be explained in terms of two dimensions (two-dimension model), instead of one dimension (one-dimension model). Questionnaires were administered to 305 adolescents who were enrolled in a university. In analysis 1, the relationship between an anthropophobic tendency and narcissistic personality, which are both within normal limits of anthropophobia and narcissism in adolescence, was examined with a two-dimension model. In analysis 2, the characteristics of self-consciousness and adaptiveness in adolescence, which were classified using a two-dimension model, were examined. The results were as follows: (1) an anthropophobic tendency and narcissistic personality could be explained with a two-dimension model; and (2) the characteristics of five subtypes were revealed in detail.     

Metamemory in narcolepsy

People with narcolepsy consistently report diminished memory function attributable to the disorder, however, objective evaluations of memory performance in this clinical group remain inconclusive. Previous evaluations of these subjective experiences have been primarily anecdotal with subjects required to provide global assessments of their memory function. The present study aimed to evaluate subjective assessments of memory dysfunction more extensively comparing responses by narcoleptics, subjects experiencing excessive daytime sleepiness, and controls, on the Metamemory in Adulthood (MIA) questionnaire. The results of the study indicate that subjects with narcolepsy have lower self efficacy for memory performance than either of the comparison groups, despite there being no significant difference between groups in relation to knowledge based aspects of memory functioning. This lowered self efficacy in narcolepsy is expressed through increased anxiety about memory function, decreased evaluations of memory capacity and increased perceptions of memory decline in relation to the comparison groups. It is argued that the negative cognitive self evaluations of narcoleptics potentially arise as a consequence of global psychosocial adjustment difficulties.     

首发广泛性焦虑障碍患者认知功能特点

目的:探讨首发广泛性焦虑障碍患者认知功能的特点。方法:应用广泛性焦虑障碍量表(GAD-7)、状态-特质焦虑问卷(STAI)、剑桥神经心理自动化成套测试软件(CANTAB)中RVP、DMS、IED 3项测验对48名首发广泛性焦虑障碍患者及48名正常对照施测,分析两组被试注意能力、工作记忆能力、执行功能的差异,并了解上述认知功能和总体焦虑水平、状态焦虑、特质焦虑的相关性。结果:首发广泛性焦虑障碍组RVP测验正确率显著低于对照组(t=-4.38,P0.05),平均反应时显著长于对照组(t=4.66,P0.05);DMS测验中多项延迟测试任务正确数都显著低于对照组(t=-6.31~-3.62,P0.05),平均反应时都显著长于对照组(t=3.45~4.17,P0.05);IED测验中总错误数(t=3.33,P0.05)、外维转换错误数(t=2.48,P0.05)、完成测试数(t=2.59,P0.05)显著大于对照组。首发广泛性焦虑障碍组DMS多项延迟测试反应时、IED外维转换错误数与GAD-7、SAI、TAI得分呈显著正相关(P0.05),RVP正确率与GAD-7、SAI得分成呈显著负相关(P0.05)。结论:首发广泛性焦虑障碍患者存在多项认知功能异常。     

Blushing and Social Anxiety: A Meta‐Analysis

Blushing was recently introduced in the DSM‐5 as a “hallmark” physiological response of social anxiety disorder, and it is now acknowledged as an important aspect of social anxiety. Three meta‐analyses were performed to examine the association between blushing and social anxiety. The relationship between blushing and social anxiety was strong for self‐perceived blushing, small for physiological blushing, and medium for observed blushing. In addition, the relationship between self‐perceived blushing and social anxiety was stronger when social anxiety was measured as a state and when blushing was measured using questionnaires with five or more items. Results suggest that socially anxious people perceive themselves as blushing more than do less socially anxious people and overestimate the intensity of their physiological blushing.     

Circadian symptom fluctuations in people with anxiety disorders

Circadian rhythm abnormalities have been demonstrated in people with depression, including a tendency toward maximal symptom severity in the morning. Although a few studies have suggested that symptoms in people with anxiety are worse later in the day, no detailed study of this observation has been reported. In 86 patients with anxiety disorders (63 with panic disorder or agoraphobia with panic attacks), anxiety symptoms tended to be more severe in the afternoon or evening than in the morning, with no abnormalities of heart rate or oral temperature. This is the first systematic demonstration of a circadian fluctuation of mood in any disorder other than depression.     

家庭结构对农村学前儿童性格特点的影响

本文比较了北京远郊区２９７名来自不同家庭结构儿童的性格特征，结果表明，来自两代人家庭的儿童在好奇心、坚持性、伙伴威望、与人关系及对劳动态度上的得分显著高于三代人家庭的儿童。非独生子女在独立性、坚持性、任性、与人关系、自我中心、劳动态度上得分显著高于独生子女。女孩在独立性、坚持性、自尊心、与人关系、劳动态度上得分显著高于男孩，这些结果，对于我们怎样对待三代人家庭，怎样对待独生子女都有参考意义。     

Vulnerability factors in OCD symptoms: cross‐cultural comparisons between Turkish and Canadian samples

Recent findings have suggested some potential psychological vulnerability factors for development of obsessive‐compulsive (OC) symptoms, including cognitive factors of appraisal and thought control, religiosity, self‐esteem and personality characteristics such as neuroticism. Studies demonstrating these associations usually come from Western cultures, but there may be cultural differences relevant to these vulnerability factors and OC symptoms. The present study examined the relationship between putative vulnerability factors and OC symptoms by comparing non‐clinical samples from Turkey and Canada, two countries with quite different cultural characteristics. The findings revealed some common correlates such as neuroticism and certain types of metacognition, including appraisals of responsibility/threat estimation and perfectionism/need for certainty, as well as thought–action fusion. However, culture‐specific factors were also indicated in the type of thought control participants used. For OC disorder symptoms, Turkish participants were more likely to utilize worry and thought suppression, while Canadian participants tended to use self‐punishment more frequently. The association with common factors supports the cross‐cultural validity of some factors, whereas unique factors suggest cultural features that may be operative in cognitive processes relevant to OC symptoms. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message: ? Despite cross‐cultural validity in the cognitive accounts for OCD, there are some evidences implying the impact of cultural characteristics on some cognitive factors across different cultures. Thus, it is important for clinicians who work with people from different cultural backgrounds to be vigilant for possible variations in the cognitive processes during psychotherapy and psychological assessment.     

Client Retrospective Accounts of Corrective Experiences in Motivational Interviewing Integrated With Cognitive Behavioral Therapy for Generalized Anxiety Disorder

A corrective experience (CE) is one “in which a person comes to understand or experience affectively an event or relationship in a different and unexpected way” (Castonguay & Hill, 2012, p. 5). CEs disconfirm clients’ expectations based on past problematic experiences, and can be emotional, relational, behavioral, and/or cognitive. This qualitative study explored corrective shifts among recovered participants (N = 8) who had received motivational interviewing (MI) integrated with cognitive behavioral therapy (CBT) in a randomized controlled trial comparing CBT alone to MI‐CBT for generalized anxiety disorder (Westra, Constantino, & Antony, 2016). We administered a posttherapy interview querying their experience of, and explanations for, any shifts in therapy. Grounded theory analysis yielded three core themes: in command of the worry train, experiencing myself in new ways in therapy, and oriented toward change. Findings are discussed in terms of MI theory, and clinical implications for therapists are provided.     

Attentional bias for psoriasis-specific and psychosocial threat in patients with psoriasis

Information processing biases relate to the manner in which people attend to particular types of information more readily than others. This bias, which is central to cognitive models of disorder, has not been explored in patients with psoriasis. The purpose of this study was to examine whether patients with psoriasis show an automatic attentional bias to classes of information relative to controls. Sixty patients and 60 age- and sex-matched controls completed a computer-based attentional interference task (the modified Stroop task). Patients with psoriasis showed significant interference for disease-specific, self-referent, and others' behavior stimuli relative to controls. In terms of information processing biases, the relationship between subject status (psoriasis patient vs. control) and color-naming interference was significantly stronger than that between anxiety, depression and worry, and interference. Recall bias was limited to disease-specific stimuli only. The observed bias to threat is more appropriately accounted for by participant's status (i.e., psoriasis patient or control) than by psychological distress.     

Uncertainty, anxiety, and brain oscillations

Influence of anxious expectation on spectral power and delta-gamma coupling was studied in 39 subjects (27 females) aged 19-30 years who also filled out the State Trait Anxiety Inventory. The situation of uncertainty was associated with general increase in spectral power of all EEG bands, which was particularly pronounced in high-trait anxiety subjects. In low-trait anxiety subjects, association between delta and gamma power significantly increased when they had to expect bad news but did not change when they expected good news. In high-trait anxiety subjects, this association tended to increase in both cases. Higher baseline delta power predicted higher gamma power in the situation where a bad news was expected. These findings are discussed in terms of Gray and McNaughton's theory of anxiety and evolutionary interpretation linking delta oscillations with reward motivation. Increase of delta-gamma coupling in anxiogenic situation is interpreted to reflect higher cortical arousal, which appears in a frustrating situation in subjects with higher activity of "motivational" delta system.     

The mechanisms of change in the treatment of borderline personality disorder with transference focused psychotherapy

We address how Transference Focused Psychotherapy (TFP) conceptualizes mechanisms in the cause and maintenance of borderline personality disorder (BPD) as well as change mechanisms both within the patient and in terms of specific therapists' interventions that engender patient change. Mechanisms of change at the level of the patient involve the integration of polarized representations of self and others; mechanisms of change at the level of the therapist's interventions include the structured treatment approach and the use of clarification, confrontation, and "transference" interpretations in the here and now of the therapeutic relationship. In addition, we briefly review evidence from our group regarding the following hypothesized mechanisms of change: contract setting, integration of representations, and changes in reflective functioning (RF) and affect regulation.     

中国道家认知疗法治疗焦虑障碍

目的：探讨中国道人知疗法对焦虑障碍的疗效。方法：将１４３名焦虑障碍患者随机分为三第一组使用道家认知疗法,第二组使用药物治疗、第三组使用道家认知疗法合并药物治疗,标准治疗期一个月,跟踪随访半年,结果：道家认知疗法有效缓解患者症状,与药物疗法相比,起效慢、但远期疗铲好;道家认知疗法结合药物治疗,可以取长补短,是治疗焦虑障碍的最佳选择。     

Subject selection biases in alcoholic samples: effects on cognitive performance

The effects of subject selection bias in research on cognitive deficits in sober alcoholics were studied in a sample of 523 subjects (98 controls, 276 ineligible alcoholics, 40 eligible alcoholics who declined to participate, and 144 eligible and participatory alcoholics). All subjects received the Shipley Institute of Living Scale (Vocabulary and Abstracting subscales) and measures of anxiety, depressive symptoms, childhood hyperkinesis and attentional deficit disorders were obtained. Results indicate that current guidelines for alcoholic subject selection are biasing analyses toward support of the null hypothesis. Declined alcoholics performed more poorly on the Shipley Abstracting than did the "Used" group, yet did not differ significantly from the Used alcoholic groups on depression or anxiety. Declined alcoholics did, however, report significantly fewer Hk/MBD symptoms than did other alcoholic groups. ANCOVAs that used the affective and childhood disorders as covariates did not alter the differences in cognitive performance described above.     

Relationship between assertiveness including consideration for others and adjustment in children

The relationship between assertiveness and internal and external adjustment was investigated. Elementary school children in grades four to six (n=207) and their classroom teachers (n=8) participated in the study. Internal and external adjustments were measured by using self-ratings, and self- and other- ratings respectively. The children responded to a questionnaires inquiring about assertiveness that included two components of assessment: "self expression" and "consideration for others". Then, the children were divided into 4 groups according to their scores on these two components of assertiveness. The results indicated that children scoring high on both components of assertiveness had higher self-rating scores than those scoring low on both components. Moreover, children that scored high on "consideration for others" tended to have high external adjustment. Also, boys that scored low on "self expression" had lower external adjustment as indicated by the negative ratings of teachers. Furthermore, girls that scored high on "consideration for others" had high external adjustment as indicated by positive ratings of teachers and same-sexed classmates.