Name: use of a psychophysiological script-driven imagery experiment to study trauma-related dissociation in borderline personality disorder
Uploaded: 2018-03-08T13:30:00
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 ...

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 sensitiv...

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 study...

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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