Social trauma : consequences of emotional maltreatment on physiological reactions to social rejection in subjects with social anxiety disorder

Iffland B. Social trauma : consequences of emotional maltreatment on physiological reactions to social rejection in subjects with social anxiety disorder. Bielefeld: Universität Bielefeld; 2013.A history of child maltreatment is associated with psychopathology, predominantly affective and anxiety disorders as well as substance abuse. In the past, research has primarily focused on the consequences of physical abuse, sexual abuse, physical neglect or combinations of these types of maltreatment. However, besides physical and sexual transgressions, child maltreatment does also involve emotional abuse and emotional neglect. Although it was suggested that the consequences of emotional maltreatment might be as severe as the outcomes of physical or sexual maltreatment, there is little knowledge about the unique effects of emotional maltreatment on psychopathology. However, there is a growing body of evidence for an association of emotional maltreatment by caretakers and psychopathology, particularly social anxiety. In addition to emotional maltreatment that involves abuse and neglect by parents and other caretakers, emotional abusive treatments (also referred to as emotional victimization) are highly prevalent among peers. Similar to emotional maltreatment by parents or caretakers, emotional peer victimization contributes to various forms of general psychopathology, e.g., depression, anger-hostility, dissociation, and drug use. However, peer victimization is particularly associated with characteristics of social anxiety disorder. Social anxiety disorder (SAD) is a common anxiety disorder, which is characterized by persistent fear of social or performance situations, fear of negative evaluation, social avoidance of general and new situations, as well as physiological symptoms in social situations. However, the mechanisms that associate emotional maltreatment by caretakers as well as peers and social anxiety are still unknown. Models of cognitive vulnerability suggest that negative learning experiences establish associative information structures in memory that activate various stereotype and pathological behavioral programs in similar situations. This conceptualization predicts that social events may provoke more intense reactions in emotional maltreated subjects as such situations trigger associative response elements of social traumatic experiences. A key element of emotional maltreatment is social rejection. Experiences of social rejection elicit negative mood, emotional distress, and activity of neural networks that are associated with the processing of physical pain. However, because physiological reactions to social rejection were found to be ambiguous, there remains a need for clarification of the impact and direction of social rejection on other physiological measures such as heart rate and skin conductance. In socially anxious subjects, social rejection elicited immediate and delayed effects on psychological outcomes. Therefore both, physiological reactions in healthy subjects as well as increased psychological reactions in socially anxious subjects were suggested in previous studies. However, a combination of these, i.e., an investigation of physiological reactions in socially anxious subjects, was not presented, yet. This might be of specific interest, as fear of social rejection is one of the core components of social anxiety. Accordingly, socially anxious subjects should present stronger and prolonged physiological reactions to social rejection. However, there is so far minimal evidence that experiences of aversive social situations evoke an associative network and an activation of associative memory processing. The aim of the present work was to address this point and to explore the impact of prior emotional maltreatment on physiological reactions to social rejection. In addition, it was assumed that associative memory representations are potential links between maltreatment and social anxiety disorder. Thus, the effect of a history of emotional maltreatment on the experience of potential traumatic social events was expected to be even stronger for subjects with SAD. In a first step, the association of emotional maltreatment with social anxiety was examined. Results indicate a relation of childhood maltreatment with psychopathology, and in particular, social anxiety symptoms. Moreover, it was demonstrated that the relative impact of emotional forms of abuse and neglect might even be higher than indicated by previous research on child maltreatment, which had mainly focused on physical and sexual types of abuse and neglect. Moreover, emotional maltreatment mediated the association of physical maltreatment and social anxiety. In addition to emotional maltreatment through parents and other caretakers, reports of emotional peer victimizations were independently related to social anxiety symptoms. Thus, it was concluded that symptoms of social anxiety are mainly predicted by emotional types of victimization, either in childhood through the caretakers, or during childhood and adolescence through peers. As a second step, physiological reactions to social rejection were examined in healthy subjects. The results suggest that social rejection evokes reactions of the autonomic nervous system (ANS) apparent in accelerated heart rates. Although the effects of social rejection did not imply changes of skin conductance levels, it was concluded that the autonomic nervous system is affected by experiences of social exclusion indicating that behavior activation rather than inhibition is associated with socially threatening events. After that the link between social rejection and physiological reactions had been established, it was examined whether these reactions are affected by histories of emotional maltreatment and symptoms of social anxiety. Data suggested that reactions to an episode of social exclusion were primarily influenced by the degree of relational peer victimization rather than by the diagnosis of SAD. While an increase in skin conductance immediately after the exclusion was observed for all groups of subjects, this physiological response was attenuated among the subjects with a history of peer victimization. In general, the results provided evidence for the existence and significance of associative networks and associative memory processing that is established by experiences of emotional maltreatment. In line with memory models of traumatic events and network models of emotional processing, a history of emotional maltreatment altered physiological reactions to a social challenge. After it has been demonstrated that experiences of emotional maltreatment place individuals at risk for symptoms of social anxiety disorder, findings indicate that associative information processing may account for an enhanced cognitive vulnerability for social anxiety. Although the mechanisms involved remain uncertain, it may be speculated that altered physiological reactivity in subjects with a history of emotional maltreatment contributes to the development of social anxiety. Importantly, the findings of the present research highlight the role of emotional forms of abuse and neglect in the development of a wide range of psychological disorders. Besides the impact of emotional maltreatment on social anxiety, the present research suggested influences of emotional maltreatment on various types of psychopathology. These findings establish a cross-diagnostical perspective on the consequences of emotional maltreatment. Assuming that experiences of emotional abuse and neglect account for various forms of symptomatology, it may be speculated that a plurality of patients would benefit from treatments that address these experiences. Therefore, the development of therapeutic interventions that combine disorder-specific treatments with an approach that focuses on adverse life experiences including social trauma should be a main goal of future clinical research

Varying Cognitive Scars – Differential Associations Between Types of Childhood Maltreatment and Facial Emotion Processing

Iffland B, Neuner F. Varying Cognitive Scars – Differential Associations Between Types of Childhood Maltreatment and Facial Emotion Processing. Frontiers in Psychology. 2020;11: 732.Background: Distorted cognitive processing has been found among survivors of child maltreatment. However, different types of abuse and neglect may bring about differences in emotion and attention processing. The present study aimed to detect differential associations between various types of childhood maltreatment and attentional biases in facial emotion processing. Methods: A non-clinical sample was recruited on University campus and consisted of 67 individuals with varying degrees of maltreatment. In an evaluative conditioning task, images of faces with neutral emotional expressions were either associated with short videos of intense negative statements, or associated with neutral videos. Subsequently, these faces were used as stimuli in a face in the crowd recognition task in which the familiar faces had to be recognized within a crowd of unfamiliar neutral faces. Results: In multiple linear regression analyses controlling for the intercorrelatedness of types of maltreatment, differential relationships between types of maltreatment and attentional bias were found. While emotional abuse was associated with faster detection of negatively associated faces, emotional neglect was associated with an impaired recognition of familiar stimuli regardless of the emotional content. Conclusion: Results indicated that interindividual differences in cognitive biases may be due to the activation of diverse cognitive schemas based on differential experiences of maltreatment

Emotional but not physical maltreatment is independently related to psychopathology in subjects with various degrees of social anxiety: a web-based internet survey

Iffland B, Sansen L, Catani C, Neuner F. Emotional but not physical maltreatment is independently related to psychopathology in subjects with various degrees of social anxiety: a web-based internet survey. BMC Psychiatry. 2012;12(1): 49.Background: Previous studies reported that social phobia is associated with a history of child maltreatment. However, most of these studies focused on physical and sexual maltreatment whilst little is known about the specific impact of emotional abuse and neglect on social anxiety. We examined the association between emotional maltreatment, including parental emotional maltreatment as well as emotional peer victimization, and social anxiety symptoms in subjects with various degrees of social anxiety. Methods: The study was conducted as a web-based Internet survey of participants (N = 995) who had social anxiety symptoms falling within the high range, and including many respondents who had scores in the clinical range. The assessment included measures of child maltreatment, emotional peer victimization, social anxiety symptoms and general psychopathology. Results: Regression and mediation analyses revealed that parental emotional maltreatment and emotional peer victimization were independently related to social anxiety and mediated the impact of physical and sexual maltreatment. Subjects with a history of childhood emotional maltreatment showed higher rates of psychopathology than subjects with a history of physical maltreatment. Conclusions: Although our findings are limited by the use of an Internet survey and retrospective self-report measures, data indicated that social anxiety symptoms are mainly predicted by emotional rather than physical or sexual types of victimization

Predicting the outcome of psychological treatments for borderline personality disorder and posttraumatic stress disorder: a machine learning approach to predict long-term outcome of Narrative Exposure Therapy vs. Dialectical Behavioral Therapy based treatment

Background: A comorbidity between Borderline Personality Disorder (BPD) and Posttraumatic Stress Disorder (PTSD) is common, severely disabling, and hard to treat. The choice of an optimal psychotherapy based on patient characteristics remains challenging. Objective: This study develops models to predict the outcome of two psychotherapies for comorbid BPD and PTSD. Method: Data from two trials comparing Narrative Exposure Therapy (NET, N = 40) with Dialectical Behavior Therapy-based treatment (DBT-bt, N = 40) was analysed. A cross-validated genetic algorithm was used to detect baseline predictors of change in PTSD symptoms. Results: In the NET group higher education, more baseline PTSD symptoms, more traumatic experiences, fewer baseline BPD symptoms, and not taking antipsychotic medication predicted better treatment outcome. This model (RMSE = 8.98) outperformed the prediction of PTSD symptom reduction with baseline PTSD symptoms alone (RMSE = 10.07) or with all available predictor variables (RMSE = 12.97). Only more baseline PTSD symptoms were selected to predict a better treatment outcome after DBT-bt. This model (RMSE = 9.41) outperformed the prediction of change in PTSD symptoms with all available predictor variables (RMSE = 14.43). Conclusion: Differences in treatment outcome between NET and DBT-bt may be predictable at baseline, to identify which one of both treatments may be most beneficial for individual patients. The small sample size may restrict the generalizability of the results.Antecedentes: La comorbilidad entre el Trastorno Límite de la Personalidad (TLP) y el Trastorno de Estrés Postraumático (TEPT) es frecuente, gravemente incapacitante y difícil de tratar. La elección de una psicoterapia óptima basada en las características del paciente sigue siendo un desafío. Objetivo: Este estudio desarrolla modelos para predecir el resultado de diferentes psicoterapias para el TLP y el TEPT. Método: Se analizaron los datos de dos ensayos que compararon la Terapia de Exposición Narrativa (NET, N = 40) con el tratamiento basado en la Terapia Dialéctica Conductual (DBT-bt, N = 40). Se utilizó un algoritmo genético validado para detectar los predictores basales de cambio en los síntomas del TEPT. Resultados: En el grupo NET, un mayor nivel educacional, más síntomas iniciales de TEPT, más experiencias traumáticas, menos síntomas iniciales de TLP y no tomar medicación antipsicótica predijeron un mejor resultado del tratamiento. Este modelo (RMSE = 8.98) superó la predicción de reducción de los síntomas de TEPT con los síntomas basales de TEPT solos (RMSE = 10.07) o con todas las variables predictoras disponibles (RMSE = 12.97). Solo se seleccionaron más síntomas basales de TEPT para predecir un mejor resultado del tratamiento después de la DBT-bt. Este modelo (RMSE = 9.41) superó la predicción del cambio en los síntomas de TEPT con todas las variables predictoras disponibles (RMSE = 14.43). Conclusión: Las diferencias en los resultados del tratamiento entre NET y DBT-bt pueden ser predecibles al inicio, para identificar cuál de ambos tratamientos puede ser más beneficioso. El pequeño tamaño de la muestra puede restringir la generalización de los resultados

Rapid heartbeat, but dry palms: reactions of heart rate and skin conductance levels to social rejection

Iffland B, Sansen L, Catani C, Neuner F. Rapid heartbeat, but dry palms: reactions of heart rate and skin conductance levels to social rejection. Frontiers in Psychology. 2014;5:956.Background: Social rejection elicits negative mood, emotional distress, and neural activity in networks that are associated with physical pain. However, studies assessing physiological reactions to social rejection are rare and results of these studies were found to be ambiguous. Therefore, the present study aimed to examine and specify physiological effects of social rejection. Methods: Participants (n = 50) were assigned to either a social exclusion or inclusion condition of a virtual ball-tossing game (Cyberball). Immediate and delayed physiological [skin conductance level (SCL) and heart rate] reactions were recorded. In addition, subjects reported levels of affect, emotional states, and fundamental needs. Results: Subjects who were socially rejected showed increased heart rates. However, social rejection had no effect on subjects' SCLs. Both conditions showed heightened arousal on this measurement. Furthermore, psychological consequences of social rejection indicated the validity of the paradigm. Conclusions: Our results reveal that social rejection evokes an immediate physiological reaction. Accelerated heart rates indicate that behavior activation rather than inhibition is associated with socially threatening events. In addition, results revealed gender-specific response patterns suggesting that sample characteristics such as differences in gender may account for ambiguous findings of physiological reactions to social rejection

Processing of affective words in adolescent PTSD—Attentional bias toward social threat

Klein F, Schindler S, Neuner F, et al. Processing of affective words in adolescent PTSD—Attentional bias toward social threat. Psychophysiology. 2019;56(11): e13444.Post-traumatic stress disorder (PTSD) is associated with a hypersensitivity to potential threat. This hypersensitivity manifests through differential patterns of emotional information processing and has been demonstrated in behavioral and neurophysiological experimental paradigms. However, the majority of research has been focused on adult patients with PTSD. To examine possible differences in underlying neurophysiological patterns for adolescent patients with PTSD after childhood sexual and/or physical abuse (CSA/CPA), ERP correlates of emotional word processing in 38 healthy participants and 40 adolescent participants with PTSD after experiencing CSA/CPA were studied. The experimental paradigm consisted of a passive reading task with neutral, positive (e.g., paradise), physically threatening (e.g., torment), and socially threatening (i.e., swearing, e.g., son of a bitch) words. A modulation of P3 amplitudes by emotional valence was found, with positive words inducing less elevated amplitudes over both groups. Interestingly, in later processing, the PTSD group showed augmented early late positive potential (LPP) amplitudes for socially threatening stimuli, while there were no modulations within the healthy control group. Also, region-specific emotional modulations for anterior and posterior electrode clusters were found. For the anterior LPP, highest activations have been found for positive words, while socially and physically threatening words led to strongest modulations in the posterior LPP cluster. There were no modulations by group or emotional valence at the P1 and EPN stage. The findings suggest an enhanced conscious processing of socially threatening words in adolescent patients with PTSD after CSA/CPA, pointing to the importance of a disjoined examination of threat words in emotional processing research. © 2019 The Authors Psychophysiology published by Wiley Periodicals, Inc. on behalf of Society for Psychophysiological Research

Attentional avoidance in peer victimized individuals with and without psychiatric disorders

Iffland B, Weitkämper A, Weitkämper NJ, Neuner F. Attentional avoidance in peer victimized individuals with and without psychiatric disorders. BMC Psychology. 2019;7(1): 12.Background Attentional biases are a relatively robust phenomenon among clinical populations but less pronounced in healthy participants. However, regarding the components of attentional biases and the directions of attention allocation, there are several inconsistencies in the literature. The present study examined whether these inconsistencies can be traced back to previous experiences of relational peer victimization in clinical populations. Methods Participants were subjects with a diagnosed psychiatric disorder (n = 30) and healthy controls (n = 31). Additionally, the sample was divided into two subgroups according to the participants’ reports of previous relational peer victimization (high peer victimization: n = 28; low peer victimization: n = 33). Attentional biases were measured by the Emotional Stroop task and a dot-probe task. Results In both samples, peer victimized participants showed delayed response times when color-naming negative and positive compared to neutral adjectives in the Emotional Stroop task. Likewise, the dot-probe task indicated attentional avoidance of both negative and positive words in peer victimized participants with and without a psychiatric disorder. Interestingly, presence of a psychiatric disorder did not have a significant effect on attentional biases. Conclusion Both tasks could detect that attentional processes were linked to the experience of peer victimization rather than to the current diagnostic status of the participants. Attentional avoidance of emotional stimuli may prevent victimized individuals from responding adequately to environmental stimuli, which may increase the risk for the development of psychopathology

Measuring Fear of Failure

<jats:p> Abstract. Fear of failure (FF) is a multidimensional construct encompassing anticipated negative consequences deriving from potential failures in evaluative achievement contexts, such as education or sports. The Performance Failure Appraisal Inventory (PFAI; Conroy et al., 2002 ) assesses five threat appraisals associated with FF and has been validated in various cultures, languages, and contexts. To date, there is no instrument measuring FF in an academic context in German. Thus, this study examined the psychometric properties of a German version of the PFAI in a sample of N = 326 university students. Confirmatory factor analyses supported a correlated five-factor structure that has already been established in previous validation studies as well as a bifactor structure. All dimensions demonstrated satisfactory internal consistencies and construct validity. Within the scope of this study, the German version of the PFAI was found to be a psychometrically sound measure to assess FF in an academic context amongst university students. </jats:p&gt

Peer Victimization Influences Attention Processing Beyond the Effects of Childhood Maltreatment by Caregivers

Iffland B, Neuner F. Peer Victimization Influences Attention Processing Beyond the Effects of Childhood Maltreatment by Caregivers. Frontiers in Psychology. 2022;13: 784147.**Background** Different types of maltreatment (emotional, physical, and sexual) lead to distortions in emotion and attention processing. The present study investigated whether the experience of peer victimization in childhood and adolescence has an additional influence on attention processing in adulthood. **Methods** Two non-clinical samples consisting of individuals with different levels of experiences of maltreatment were recruited. In an evaluative conditioning task, images of faces with neutral emotional expression were either associated with short videos of intense negative statements, or associated with neutral videos. Subsequently, these faces were used as stimuli in an emotional Stroop task as well as a dot-probe task. **Results** In both tasks, hierarchical regression analyses revealed that retrospective reports of relational peer victimization made an incremental contribution to the prediction of attentional biases beyond child maltreatment. In the emotional Stroop task, emotional abuse was the strongest predictor for an attentional bias showing delayed responses to negatively associated faces, while peer victimization was associated with faster responses to negatively associated faces. In the dot-probe task, relational peer victimization was the strongest predictor for an attentional bias. When the attentional bias was examined in more detail, though, peer victimization did not show incremental contributions although emotional abuse remained the strongest predictor for facilitated attention toward negatively associated neutral faces. **Conclusion** Experiences of peer victimization leave additional cognitive scars beyond effects of childhood maltreatment by caregivers. It is likely that attentional biases in the aftermath of victimization put individuals at risk for the development of psychopathology