Corinna N. Scheel

Structured group psychotherapy in adults with attention deficit hyperactivity disorder: results of an open multicentre study.

Attention deficit hyperactivity disorder (ADHD) is a serious mental disorder that often persists in adulthood. In a pilot study, a structured skills training group program for adult ADHD led to significant symptomatic improvements. The present study evaluated the programs effectiveness, feasibility, and patient acceptability in a multicenter setting. Seventy-two adult ADHD patients were assigned to 13 two-hour weekly sessions at 4 different therapy sites. The therapy was well tolerated and led to significant improvements of ADHD, depressive symptoms, and personal health status (p < 0.001). The factors treatment site and medication did not contribute to the overall improvement. Patients regarded the program topics “behavioral analyses,” “mindfulness,” and “emotion regulation” as the most helpful. In this multicenter study, the therapy program showed therapist-independent effects and seemed to be disorder-specific. This warrants the effort of organizing further controlled studies.

Time course of anger and other emotions in women with borderline personality disorder: A preliminary study

Borderline personality disorder (BPD) is characterized by emotional dysregulation including strong emotional reactions to emotional stimuli and a slow return to baseline emotions. Difficulties controlling anger are particularly prominent in BPD. To experimentally test emotional dysregulation with a special focus on anger, we investigated whether a standardized anger induction by a short story caused stronger and prolonged anger reactions in women with BPD (n=27) as compared to female healthy controls (n=26) and whether other emotions were affected by the anger induction. Although the anger reaction was not stronger in the BPD group, it was significantly prolonged. The BPD group showed also stronger negative emotions over the whole experiment. The study is the first to demonstrate prolonged anger reactions in BPD patients in an experimental setting.

Emotional Reactions to Standardized Stimuli in Women With Borderline Personality Disorder: Stronger Negative Affect, But No Differences in Reactivity

Emotional dysregulation is hypothesized to be a core feature of borderline personality disorder (BPD). In this study, we investigated the course of emotions in response to standardized emotion inductions in BPD. A total of 26 female BPD patients, 28 matched healthy control subjects, and 15 female patients with major depressive disorder listened to short stories inducing an angry, joyful, or neutral mood. Before and immediately after each story as well as 3 and 6 minutes later, participants rated their current anger, joy, anxiety, shame, and sadness. All 3 groups showed the same increase and decrease of emotions. However, strong group differences in the general level of all negative emotions occurred. While sadness was stronger both in BPD and major depressive disorder as compared with healthy controls, all other negative emotions were significantly increased in BPD only independent of comorbid depression. Extreme negative affectivity may be a more appropriate description of BPD-related emotional problems than emotional hyperreactivity.

You don’t like me, do you? Enhanced ERP responses to averted eye gaze in social anxiety

Social anxiety is associated with an attentional bias toward angry and fearful faces, along with an enhanced processing of faces per se. However, little is known about the processing of gaze direction, a subtle but important social cue. Participants with high or low social anxiety (HSA/LSA) observed eye pairs with direct or averted gaze while subjective ratings and event-related potentials (ERPs) were measured. Behaviorally, all participants rated averted gaze as more unpleasant than direct gaze. Neurally, only HSA participants showed a trend for higher P100 amplitudes to averted gaze and significantly enhanced processing at late latencies (Late positive potential [LPP]), indicative of a specific processing bias for averted gaze. Furthermore, HSA individuals showed enhanced processing of both direct and averted gaze relative to the LSA group at intermediate latencies (Early posterior negativity [EPN]). Both general and specific attentional biases play a role in social anxiety. Averted gaze--potential sign of disinterest--deserves more attention in the attentional bias literature.

Severity of Childhood Attention-Deficit Hyperactivity Disorder—A Risk Factor for Personality Disorders in Adult Life?

Some evidence points to an increased rate of cluster B and C personality disorders (PDs) in adult ADHD patients. In order to assess axis II disorders comprehensively we used the diagnostic instrument of the WHO. In sixty adult out-patients with ADHD according to DSM-IV criteria PDs were assessed with the International PD Examination (IPDE) and severity of childhood ADHD with the Wender-Utah-Rating Scale (WURS). We found at least one PD in 25% of cases. Cluster C PDs were most common (36.6%) followed by Cluster B (23.3%) and A (8.3%). Avoidant (21.7%) and borderline (18.3%) were the most frequent single PD entities. ADHD patients with PD suffered from significantly more severe childhood ADHD compared to those without co-occurring PD. Applying the IPDE we confirmed a high number of PDs among adult ADHD patients. Our findings point to a higher vulnerability for the development of PDs in patients with severe childhood ADHD.

Comparison of different strategies to decrease negative affect and increase positive affect in women with borderline personality disorder.

BACKGROUND In this study we compared the effect of different emotion regulation strategies on positive and negative emotions in patients with borderline personality disorder. METHODS Emotion regulation strategies were a distracting task, individual positive memory imagery, individual soothing imagery, and a neutral comparison condition. During two separate sessions, 17 participants watched either neutral or negative movie segments before using these strategies. RESULTS All three strategies influenced emotions into a favorable direction as compared to the neutral comparison condition. The positive memory image increased positive emotions significantly stronger than counting colors and distracting. DISCUSSION Different strategies seem to have similar effects in decreasing negative emotions. Positive emotions may be affected in particular by positive and soothing imagery techniques.

ADHD as a serious risk factor for early smoking and nicotine dependence in adulthood.

Objective: Tobacco smoking and ADHD frequently co-occur. So far, the bulk of research on the ADHD-smoking comorbidity has been done in children with ADHD and nonclinical adult samples. To assess smoking habits in adults with ADHD, the authors used the Fagerström Test for Nicotine Dependence (FTND). Method: In 60 adult outpatients, with an ADHD diagnosis according to Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria and 60 age- and gender-matched controls, smoking habits were assessed with the FTND. Results: The authors replicated earlier findings in children confirming a higher rate of smokers in the ADHD group. The adult smokers with ADHD suffered from more severe nicotine dependence and smoked significantly more often when being sick. Females with ADHD smoked significantly more often and started smoking at an earlier age. Conclusion: Applying the FTND, the authors confirmed a high rate of highly dependent smokers among adult ADHD patients. The authors’ findings point to a higher vulnerability for the development of nicotine dependence in women with ADHD.

Do patients with different mental disorders show specific aspects of shame

Shame is related to several mental disorders. We assume that facets of shame, namely bodily, cognitive and existential shame, may occur in typical patterns in mental and personality disorders. An excessive level of shame may lead to psychopathological symptoms. However, a lack of shame may also lead to distress, for instance as it may facilitate violation of social norms and thus may promote interpersonal problems. In this study we investigated facets of shame in females suffering from various mental disorders and personality disorders presumably associated with specific aspects of shame. Women suffering from borderline personality disorder (BPD, n=92), attention deficit hyperactivity disorder (ADHD, n=86), major depressive disorder (MDD, n=17), social anxiety disorder (SAD, n=33), and a community sample (COM, n=290) completed the SHAME questionnaire, which is a newly developed instrument to assess adaptive and maladaptive aspects of shame. BPD patients reported the highest level of existential shame compared to all other groups. Compared to the controls, SAD patients displayed stronger bodily and cognitive shame, and ADHD showed lower bodily shame. As assumed, specific aspects of shame were found in different patient groups. It may be important to specifically address these specific aspects of shame in psychotherapy.

Effects of Shame Induction in Borderline Personality Disorder

Shame is a powerful emotion with a strong link to borderline personality disorder. This study investigates shame levels in borderline personality disorder, compared to major depressive disorder and healthy women. A total of 25 women with borderline personality disorder, 25 women with major depression and 23 healthy women underwent a shame induction exercise. The self-reported intensity of shame, anger, anxiety, sadness, joy, annoyance, and boredom, was measured five times. Compared to participants with major depression and healthy women, patients with borderline personality disorder had higher baseline levels of shame, but there was no evidence of greater emotional intensity or a prolonged return to baseline after shame induction. They were the only group to express increased anger following the exercise. These findings strengthen the view of stronger emotional negativity in borderline personality disorder. The differences in the impact of shame on anger may contribute toward understanding emotion regulation difficulties in borderline personality disorder.

Outline of an empirical study on the effects of emotions on strategic behavior in virtual emergencies

The applicability of appropriate coping strategies is important in emergencies or traumatic experiences such as car accidents or human violence. In this context, emotion regulation and decision making are relevant. However, research on human reactions to traumatic experiences is very challenging and most existing research uses retrospective assessments of these variables of interest. Thus, we are currently developing and evaluating novel methods to investigate human behavior in cases of emergency. Virtual reality scenarios of emergencies are employed to enable an immersive interactive engagement (e.g., dealing with fire inside a building) based on the modification of Valves popular Source™ 2007 game engine. This paper presents our ongoing research project, which aims at the empirical investigation of human strategic behavior under the influence of emotions while having to cope with virtual emergencies.