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).
The overall goal of this personalized script-driven imagery experiment and clinical survey is to study trauma related dissociative phenomena in traumatized individuals with borderline personality disorder, or BPD. This method can help answer key questions in year of clinical psychology. Such as whether the prevailing type of primary reaction arousal versus disassociation would account for two major types of clinical profiles and reaction patterns for trauma-related stimuli.
The main advantage of this technique is the collaboration of findings across measures, within a single research survey. By using an integrated assessment including reliable psycho-physiological parameters and an extensive psycho-diagnostic battery. The implications of this technique extends towards diagnosis and therapy of borderline personality disorder, because there is a high prevalence of traumatic incidents among individuals with this diagnosis and particularly difficult to treat people that grew up with severe chronic dissociative disorders has been identified in the research and in clinical practice.
This method can provide insight into etiological mechanisms. It can also be applied to study other trauma-related disorders. Prior to the trial, record the introductory instructions for the experimental procedure and participant tasks over the course of the experiment and save them in the appropriate format within a scripting language-based stimuli presentation software.
Within the software, playback each script three times and insert four sequential 30-second periods within each script presentation as follows. Resting baseline, read, imagery and recovery. In between two script presentations, reserve a period of one to two minutes for filling self-report measures in.
Then depending on the software for recording physiological data, prepare the necessary channels for the recording of physiological parameters, skin conductants and heart rate. Set up markers or use separate channels for the depiction of the time course of the instructions and script presentations. Next carryout an extensive evaluation of the psychological status of all participants with a focus on dissociative phenomena by a clinically experienced investigator.
Plan enough time for each clinical assessment session. Prior to the interview session. Provide self-report questionnaires to obtain information on age, graduation, marital, occupational status, active substances consumed within the last weeks, and psychological status.
Finally, followup this clinical assessment session with a clinical interview that allows diagnosis of psychiatric disorders according to both DSM-IV and ICD-10 criteria. Ascertain the absence of mental disorders, as well as the report of at least one post-traumatic experience for the inclusion in the control group. After the clinical interview, ask the participant to specify and vividly describe the following three types of events.
A traumatic one as well as two further individual experiences, a neutral one, and an everyday moderately positive event. Within the description of the events, inquire objective happenings, such as time and place, as well as subjective information, like emotions or sensory perception. Take detailed notes allowing subsequent draft of the three verbal scripts which will be used as individualized emotional cues.
Make an appointment for the psycho-physiological experiment within the next few days, and instruct the participant not to use any hand lotion or cream before the experiment. Next, compose verbal scripts on a voice recorder, each 30 seconds in duration that portrayed the three recalled personal experiences in first-person singular and present tense. Save them as audio files in the appropriate format, and transfer them in the software program, on the stimulus computer, serving to present the recorded auditory scripts.
Then randomize the order of the script presentation. Adopt and save the resulted order in the script presentation program, and put it on record to account for it in the data analyses. Transfer and save the scripts in the resulting order into the presentation program.
Use a scripting language based computer program which sends simultaneously auditory stimuli to a headphone and marker signals to the psycho-physiological recording device at millisecond accuracy. Lastly, prepare the sheets and the pencil to collect subjective evaluative judgements of affective states during the script-driven imagery tasks using a battery of visual analog nine point Likert scales. Begin by escorting the participant into a sound attenuated and temperature and humidity controlled laboratory connected via wires and window to an adjoining portion of the laboratory in which the experiment and equipment is located.
Explain the function of the experimental equipment to the participant. Then seat the participant in a comfortable chair and allow a period of adaptation to the recording environment while explaining the procedure from the informed consent and answering any further questions. Clean the required contact skin areas with alcohol solution pads.
To attach the physiological monitoring devices, use adhesive pre-gelled 279 silver-silver chloride snap electrodes with circular contact areas, filled with an appropriate electrode gel. For the SC measurement, place electrodes on the palm or surface and for HR recording use a of three electrodes. Next apply headphones for the presentation of the instruction and scripts.
Perform a test run of the measurements to make sure that the participant hears the instructions and that the physiological recordings are running well. Then begin the assessment approximately five minutes later, in order to allow physiological readings to stabilize. Pay attention to any movements of the participants during the experiment and take notes to mark artifacts when necessary.
At the end of the experiment, remove all devices and clean the skin areas if requested. Debrief the participant about the experience, and escort them out of the testing room. Finally, clean the electrodes with cold water to allow the removal of any gel rests.
Results indicated significant HR differences between trauma-related scripts and scripts of everyday events, due to a significant decrease of HR during memory of traumatic events. In participants with borderline personality disorder, BPD, and a history of peritraumatic dissociation, PD, as compared to the BPD only group and controls. Regarding self-report ratings, traumatic memories figured more dissociation than both positive and neutral memories.
Subjects with BPD and PD rated all memories as more dissociation provoking than other BPD participants and the controls. Once mastered, this technique including clinical assessments can be done in two or three hours, if it is performed properly. While attempting this procedure, it's important to remember to control for confounders of physiological activity to ensure functional recordings of physiological data before measurements and to collect clinical data by expert investigators.
Following this procedure, other methods like other types of personalized and generic scripts, illustrating past and present life situations can be performed in order to answer additional questions regarding coping mechanisms in BPD and other clinical populations. After it's development this technique paved the way for researchers in the field of psycho-traumatology to explore emotional and physiological reactions to the activation of trauma-related memory in various populations affected by psychological trauma. After watching this video, you should have a good understanding of how to perform a script-driven experiment and clinical assessments for investigating dissociative phenomena, in individuals affected by psychological trauma.
