Unified Protocol Versus Self-Acceptance Group Therapy for Emotional Disorders in People With Severe Shame.

BACKGROUND: Severe shame is a distressing negative emotion, accompanied by intense feelings of worthlessness that contributes to a broad panoply of psychological disorders. This study aimed to compare the effects on shame dysregulation of two transdiagnostic treatments, the Unified Protocol (UP) and Self-Acceptance Group Therapy (SAGT). We additionally addressed the question of whether borderline personality disorder (BPD) can properly be regarded as an emotional disorder. The focus was on outcome measures, primarily shame that cut across individual diagnostic categories and capture emotional dysfunction broadly conceived. METHODS: Individuals suffering from a range of emotional disorders (including BPD) and high levels of shame were randomly allocated to treatment by either UP (N = 280) or SAGT (N = 282). Outcomes were measures of emotion dysfunction-shame, loneliness, neuroticism, emotional dysregulation, positive and negative affect-measured pre-treatment, post-treatment and at 3- and 6-month follow-ups. RESULTS: UP was superior to SAGT in showing better post-treatment retention of therapeutic gains on all outcome measures over the 6-month follow-up period. Compared with those without a BPD diagnosis, those diagnosed with BPD showed significantly higher neuroticism and emotion dysregulation at baseline and a similar post-treatment reduction in almost all outcomes. CONCLUSIONS: The results support the use of both the UP and SAGT in the treatment of severe shame. The superiority of the UP over SAGT in reducing negative emotionality is interpreted in terms of the specific mechanisms targeted by the UP. The results provide support for the theoretical rationale for the UP as a treatment for dysregulated shame and for emotional dysfunction generally.

"Self" and "other": A conceptual bridge linking normal with pathological personality.

The goal of this paper is to try and close the gap between the ways in which pathological and normal personality, including their development, are conceptualized. To this end, attention is drawn to parallels that exist between the ways self-function is conceptualized in contemporary personality psychology and in recent iterations of the major psychiatric nosologies, particularly ICD-11. Conceptualizations in both normal and abnormal personality see a fundamental dichotomy between self as identity and self as socially interdependent (vs autonomous). Evidence is reviewed supporting a basic dichotomy between two categories of personality pathology that can be subsumed under the labels "Acting Out" and "Anxious-Inhibited." It is suggested that fundamental to the personality pathology subsumed under "Acting Out" is a deficient interdependent self, while a defective self-identity is proposed to underlie the personality pathology subsumed under "Anxious-Inhibited."

Impaired Pavlovian conditioned inhibition in offenders with personality disorders.

Certain types of violent offending are often accompanied by evidence of personality disorders (PDs), a range of heterogeneous conditions characterized by disinhibited behaviours that are generally described as impulsive. The tasks previously used to show impulsivity deficits experimentally (in borderline personality disorder, BPD) have required participants to inhibit previously rewarded responses. To date, no research has examined the inhibition of responding based on Pavlovian stimulus-stimulus contingencies, formally "conditioned inhibition" (CI), in PDs. The present study used a computer-based task to measure excitatory and inhibitory learning within the same CI procedure in offenders recruited from the "personality disorder" and the "dangerous and severe personality disorder" units of a high-security psychiatric hospital. These offenders showed a striking and statistically significant change in the expression of inhibitory learning in a highly controlled procedure: The contextual information provided by conditioned inhibitors had virtually no effect on their prepotent associations. Moreover, this difference was not obviously attributable to nonspecific cognitive or motivational factors. Impaired CI would reduce the ability to learn to control associative triggers and so could provide an explanation of some types of offending behaviour.

Alcohol-related violence defined by ultimate goals: a qualitative analysis of the features of three different types of violence by intoxicated young male offenders.

Based upon a functional approach to understanding aggression, we aimed to identify the occurrence of and to describe the features of three types of alcohol-related violence defined a priori by ultimate goals: (1) violence in pursuit of nonsocial profit-based goals, (2) violence in pursuit of social dominance goals, and (3) violence as defence in response to threat. A sample of 149 young men with offences of violence that were alcohol related was interviewed. Cases were classified and detailed information from the first ten cases in each class (N=30) was subjected to thematic analysis. Intoxicated violence in pursuit of nonsocial profit-based goals was opportunistic and motivated by the desire for more alcohol or drugs. Violence, in these cases, although serious, appeared to be brief. Intoxicated violence in pursuit of social dominance goals was typically precipitated by past or current insult or injury, and was accompanied by strong anger and an adrenaline rush. Attacks were ferocious, and robbing the victim was not uncommon, perhaps to inflict additional humiliation. Feelings of pride and satisfaction were typical and expressions of remorse were uncommon. Regarding intoxicated violence as defence in response to threat, attacks were often expected, and in some cases the respondent made a pre-emptive strike. Weapon use was common in this group. Fear was experienced, but so too was anger. Feelings of excitement were not reported and remorse was common. Further validation of these types is warranted, and the potential implications of these findings for prevention and treatment are discussed.

Exploring the link between personality disorder and criminality in a community sample.

This study sought to identify, among a sample of 224 community residents with DSM-diagnosed personality disorder (PD), those personality and criminal history features associated with a combination of antisocial and borderline PDs (APD/BPD). After identifying first- and higher-order factors through factor analysis of IPDE item scores, forensic history and personality correlates of the identified higher-order factors were identified using regression analysis. Those having APD/BPD were more likely than the remainder to have received a conviction for violence and a custodial sentence. They showed higher trait anger and impulsivity and a greater history of aggression, and scored significantly higher on a higher-order "psychopathy" factor. In contrast, anankastic traits were inversely related to criminal history variables. It is concluded that APD/BPD represents a particularly criminogenic blend of traits likely to be overrepresented in high-secure forensic samples, and underrepresented in community PD samples. Future research should address the mechanisms through which PDs are related to criminality.

Brief report: changes in brain function during acute cannabis intoxication: preliminary findings suggest a mechanism for cannabis-induced violence.

BACKGROUND: Recent evidence suggests that cannabis use may be associated with antisocial and violent behaviour, raising the question: What brain mechanisms mediate the disinhibiting effects of cannabis on behaviour? AIMS/HYPOTHESES: To examine whether an electrocortical measure of affective impulsivity, Go/No Go contingent negative variation, is affected by acute cannabis intoxication. METHODS: Slow brain potentials were recorded in a Go/No Go noise avoidance task from five habitual cannabis users before, during and after they smoked a cannabis reefer containing 11 mg D-9-tetrahydrocannabinol. RESULTS: Slow brain potentials developed normally in both Go and No Go conditions before and during cannabis smoking but were severely disrupted 20-40 minutes later, coincident with peak intoxication. Cannabis effects on Go/No Go brain activity resembled those reported to occur in patients with lateral prefrontal cortex lesions. CONCLUSION/IMPLICATIONS: Our findings are preliminary, calling for larger-scale studies, to confirm the present findings and to investigate whether brain responses to cannabis intoxication differentiate those who are predisposed to suffer adverse consequences of cannabis use from those who are not.