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

Summary

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).

Abstract

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.

Introduction

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 "shut-down" dissociative reactions (e.g., bradycardia, vasodilatation, sensory deafferentation, alterations of consciousness and speech^1,2) become predominant. According to the theories of reactivation of trauma-related associative memory networks

Protocol

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

1. 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).
2. Prepare the introductory instruction for the experimental procedure and the particip....

Results

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^.......

Discussion

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.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Experimental Runtime System (ERTS) Version 3.32	BeriSoft Cooperation, Frankfurt/Main, Germany		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.
Biopac MP150 system	Biopac Systems, Inc., Goleta, CA		We recorded the physiological data by using this hardware.
AcqKnowledge software	Biopac Systems, Inc.		We recorded the physiological data by using this software.
VOC			Format for the auditory files for instructions and script, compatibele with the stimulus presentation software.