Research

My research focus is in the area of Clinical Emotion Research and Psychotherapy Research and attempts to realize an integral approach to the study of emotion, cognition and interaction in mental disorders and within the therapy process. A specific feature is the analysis of non-verbal, especially mimic-affective behavior in real interactions (e.g. diagnostic interviews, psychotherapy sessions, play situations with children), especially the relationship-regulating function of affect mimic and language.

Several projects are currently underway, in which, for example, attempts are being made to record different forms of affect regulation in patients with mental disorders and healthy individuals, as well as to investigate their relationship to psychotherapeutic processes and treatment outcomes. The projects in the field of children and adolescents are also concerned with investigating the connection between affective and cognitive processes in connection with early behavioral problems; on the one hand, in order to develop a basic understanding of the conditions (psychological and social protective and risk factors) of disorders in childhood and adolescence as well as their development, and on the other hand, in order to further develop prevention programs, especially those concerning aggression and violent behavior, based on these findings. In this sense, the process questions are to be increasingly moved to the center of the research activities in the future. The aim here is to identify process characteristics of change-effective interventions that may be common to all schools of therapy.

The long-term goal of these research efforts is an empirically supported, cross-therapeutic understanding of the complex interrelationships of human experience and behavior and their determinants in mental disorders and healthy individuals, with particular attention to the complexity of the emotional system and its interaction with cognitions, behavior, and social context. The basic knowledge gained in this way serves as a basis for research into change processes and, building on this, for the research-based further development of psychotherapeutic methods, counseling approaches, and prevention programs.

On the significance of the female orgasm for women in Germany

Head of study: Catherina Reuter, technical supervision by Prof. Dr. Cord Benecke and Dr. Miriam Henkel.

Within the framework of a nationwide study on female sexuality, the significance of the female orgasm is to be researched from a salutogenetic perspective. The focus is on the subjective individual experience of orgasm as well as on orgasm problems and anorgasmia. The aim is to record different facets and also changes in the meaning of the female orgasm through a retrospective life-historical perspective. Through the qualitative research approach (Grounded Theory) the subjective perspective of women of all ages will be captured and a theory building will be possible. Thus, a contribution is to be made to close the existing gaps in sexual research and to form a basis for further qualitative and quantitative studies. An interdisciplinary discourse is to be promoted, and a contribution to the removal of taboos on female sexuality is to be made. First results are expected in 2023.

Affectivity, Relationship and Mental Disorder

Head: Prof. Dr. Cord Benecke. Cooperation with Prof. Dr. A. Buchheim (University of Innsbruck), Dr. P. Martius (Höhenried Clinic), PD Dr. R. Dahlbender (Soltau Clinic), Prof. Dr. G. Schüssler, Prof. Dr. W. Biebl (Med. University of Innsbruck), Dr. C. Haring (Psychiatric Hospital Hall), Prof. Dr. S. Doering (University of Vienna).

Supported by the Jubilee Fund of the Austrian National Bank and the Tyrolean Science Fund.

The areas of affectivity and relationship are considered essential for the understanding of mental disorders and their treatment across therapy schools. Up to now, firstly, few disorder-specific studies have been conducted and, moreover, mostly only individual components of affectivity and relational experience have been investigated. A total of 125 female subjects with various circumscribed mental disorders (depression, anxiety disorder, eating disorder, borderline personality disorder) and healthy control subjects will be studied with regard to affectivity and relationship experience using a broad range of methods, which will in particular take into account the complexity of the affect system (e.g., mimic-affective behavior, subjective experience, emotion recognition, emotion regulation). The central goal is the identification of prototypical, integrated affect-relationship patterns ("affect types") and their relation to different levels of mental disorder such as symptom burden, diagnostic affiliation, degree of integration of the mental structure. From the results we expect far-reaching implications across therapy schools, both in terms of understanding mental disorders and mental health, and in terms of indication and therapy planning, especially treatment focusing. Initial publications include.

Effectiveness of Transference-Focused Psychotherapy (TFP) for the Treatment of Borderline Personality Disorder

Head: Prof. Dr. S. Doering (University of Vienna). Cooperation with Prof. Dr. P. Buchheim (Munich), Prof. Dr. O.F. Kernberg (New York). Head of project group Kassel/Innsbruck: Prof. Dr. C. Benecke

Supported by the Jubilee Fund of the Austrian National Bank (Med. Uni. Innsbruck).

Borderline personality disorder (BPD) is a severe mental illness and represents a major challenge for psychotherapy. Transference-focused psychotherapy (TFP) for the treatment of borderline personality disorder was developed by Otto F. Kernberg in New York and is now available as a differentiated therapy manual. In an Austrian-German cooperation in close collaboration with the working group around Otto F. Kernberg in New York, this project is the first European evaluation study of TFP. For this purpose, 40 patients will be treated with TFP over a period of one year, and the therapeutic success will be compared with that of another 40 patients receiving psychotherapy under naturalistic conditions. It is hypothesized that TFP will result in significantly better treatment outcomes for patients with BPD, particularly with regard to self-harming behavior and utilization of health care services. Initial publications include.

Psychotherapy Outcome and Subgroups in Disorder-Specific Inpatient Treatment of Borderline Personality Disorder: A Prospective Controlled Matched-Sample Study.

Head: Dr. G. Dammann (University of Basel / Münsterlingen). Cooperation with Prof. Dr. J. Frommer (University of Magdeburg). Head of project group Innsbruck/Kassel: Prof. Dr. C. Benecke.

Supported by the Swiss National Science Foundation (University of Basel).

Borderline Personality Disorder is a heterogeneous, frequently diagnosed, serious mental illness. The disorder, which more strongly affects women, is prevalent in about 2% of the general population and in about 15% of psychiatric patients. Patients with a Borderline Personality Disorder suffer from an instability of their emotions, their behavior, and their identity, which has until now remained poorly understood.

Inpatient psychotherapy leads to improvement during the course of the illness, and is necessary for severely disturbed patients or during crises and exacerbations (e.g. severe self-harm). At present, it is still largely unclear which patients benefit from inpatient psychotherapeutic treatment and which respond poorly to it. This study will, therefore, contribute to the psychotherapy research on the relevant and predictive power of factors influencing the outcome of disorder-specific inpatient psychotherapy.

This prospective controlled matched-sample study will investigate a 12-week, disorder-specific, inpatient therapy that combines the elements of two manually guided, empirically supported behavioral treatments, and compare it to a non-specific inpatient treatment (treatment as usual). Stability of treatment gains will be assessed during a 1-year follow-up. In addition to a differentiated psychometric examination, basic mechanisms of emotion and identity consolidation will be investigated: the dyadic facial expressive behaviour between patient and therapist (measured through the Emotional Facial Action Coding System), the occurrence and frequency of symptoms for atypical depression and the matter and extent of the identity disturbances (examined with a multi-dimensional evaluation procedure). Publications in preparation.

What influence do emotion recognition and emotion regulation have on the functional outcome of schizophrenic patients?

Cooperation with Dr. A. Hofer, Prof. Dr. W. Fleischhacker (Med. Uni. Innsbruck).

Using a cross-sectional study of outpatients with schizophrenia/schizoaffective patients who are on a second-generation antipsychotic and a control group, we will investigate the relationship between emotion recognition and regulation and functional outcome. In particular, it will be investigated to what extent the type of stimulus (emotional faces vs. emotionally spoken sentences, as well as connections between facial expressions and prosody) has an influence on the ability to recognize and regulate emotions and, subsequently, on the functional outcome. First publications are available.

Evaluation of the Effectiveness of the Violence Prevention Program "FAUSTLOS" in Kindergartens

Head: Prof. Dr. M. Cierpka (University of Heidelberg). Head of the project group Kassel/Innsbruck: Prof. Dr. C. Benecke.

Supported by the Landesstiftung Baden-Württemberg (University of Heidelberg).

The FAUSTLOS curriculum, a program developed in Heidelberg to increase social-emotional competencies and prevent violence, is being evaluated in kindergarten. The effects of the program on the area of emotional development and the influence on the inner world of the child are to be researched first and foremost. Video analyses of the children's play behavior will be used to gain insights into the effects that go beyond the behavioral level. The study is based on a before-after control group design with a total of approximately 100 children. Data collection completed. First publications are available.

Affect regulation, mental representations and behavioral problems in preschool children

Cooperation with Prof. Dr. M. Cierpka (University of Heidelberg) and Dr. Florian Juen (University of Innsbruck).

This project is concerned with the development of mental representations, the development of affect regulation, and the acquisition of attachment styles in children aged 3 to 6 years. Furthermore, different developmental trajectories at this age will be related to the emergence of behavioral problems in order to identify possible risk and protective factors for further development. In addition to researching the correlation between mental representations and children's behavior, the further development of the MacArthur Story Stem Battery - a method for recording children's representations - and its evaluation are also the focus of interest. First publications are available.

Emotional and structural indicators in adolescence for the development of severe mental disorders

Head: Prof. Dr. Cord Benecke. Cooperation with Dr. med. Maria Steinmayr-Gensluckner (Med. University Innsbruck).

Supported by the Tyrolean Science Fund

Indicators of an increased risk for the development of severe mental disorders in adolescents are to be investigated by means of a longitudinal study. Existing findings in adults show that the type and/or severity of mental disorders are highly correlated with changes in the affect system (subjective experience, affect regulation, emotion recognition, affect facial expression), with the degree of integration of mental structure (self-object perception, self-control, etc.), with attachment and relationship patterns, and with self-representation. On this basis, in the longitudinal study planned here, the above-mentioned variables concerning affectivity, mental structure, attachment/relationship, and self-representation will be recorded on a sample of 14- to 16-year-old patients of the Department of Child and Adolescent Psychiatry as well as unremarkable control subjects and related to the presence and severity of mental disorders at the first time of the survey (cross-sectional questionnaire) as well as 5 years later (early adulthood; longitudinal questionnaire). We hope that the results will make it possible to differentiate early manifestations of severe mental disorders from the presence of acute developmental crises more reliably than is currently the case. Furthermore, since a differentiated knowledge of the underlying (and maintaining) psychological conditions of mental disorders is necessary for the planning of psychotherapeutic interventions, we hope that the results will be of significant benefit for the further development of targeted therapeutic and preventive interventions. First publication available.

Affective self-representation and mental disorder. An fMRI study.

Head: Prof. Dr. Cord Benecke. Cooperation with Prof. Dr. W. Biebl and Prof. Dr. M. Schocke (Med. University Innsbruck).

Self-representation and the emotions associated with it are attributed a central importance in psychopathology across schools. On a clinical-psychological level, the relationship between severity of mental disorder and changes in self-representation is now empirically well established. However, the assessment of affective self-representation is predominantly based on linguistic methods, be it in the form of questionnaires or language content analyses, so that only the consciously accessible part can be assessed. For the investigation of unconscious affects that may be linked to self-representation, other approaches are needed. In the research project planned here, an attempt will be made to record affective self-representation on three levels: verbal statements about oneself; nonverbal mimic-affective signals during self-description; brain activity during activation of self-representation. Patients with different mental disorders (borderline personality disorder, anorexia nervosa, depression, anxiety disorders) as well as mentally healthy control subjects will be studied. We assume that the groups differ with respect to affective self-representation on all three levels, as well as that the extent of negative affect associated with self-representation varies with the severity of the mental disorder. Knowledge of the unconscious affective aspects of self-representation in particular provides objective measures for evaluating treatments and thus more reliable estimation of relapse risks, in addition to the possibility of further developing psychotherapeutic interventions (e.g., affect-specific focusing). Data collection completed.

Development, validation and standardization of a questionnaire to assess emotion experience and emotion regulation (EER).

Direction: Dr. Doris Peham & Prof. Dr. Cord Benecke

Supported by the Tyrolean Science Fund

The aim of the present study is to revise and test the validity of a newly developed questionnaire for the assessment of emotion experience and emotion regulation (EER), which allows a differentiated assessment of subjective emotion experience and processes of emotion regulation. The emotional experience should also be able to capture clinically relevant states, which may occur rather rarely in the normal population and are therefore also missing in the commonly used procedures. Strategies of emotion regulation should be recorded in a broad range with the aim that the survey procedure can also be used in clinical-psychological contexts. This implies that presumably maladaptive responses to emotions should also be included in the regulation scales, which are more likely to indicate a failure of emotion regulation or, under certain circumstances, capture responses typical of mental disorders. The questionnaire constructed to date includes an emotion experience section and a regulation section (Benecke et al. 2008). The construction of the currently available version of the EER is based on a sample of n=662 and was subsequently administered to a total of 486 individuals in a first validation study. The test-statistical characteristics show that this is a very promising approach. At the same time, however, the results also show the necessity of revising individual scales. In the current study, the scales are to be subjected to a further revision. Then the revised version must be subjected to a renewed test-statistical examination (reliability; retest reliability; validity) on the basis of an extensive sample. In addition, the norm values for different age/gender/disorder groups, which are important for application in the clinical-psychological field, are to be determined. First publications are available.

DPG Practice Study

Directed by Prof. Dr. Cord Benecke, in cooperation with the DPG Research Commission and 11 psychoanalytic training institutes.

Funded by the German Psychoanalytic Society (DPG).

This is a large-scale naturalistic study to test the efficacy of psychoanalytically based psychotherapy, especially long-term psychoanalytic psychotherapy, with the collaboration of DPG institutes and DPG associated institutes. The study design tries to find a compromise between the demand for a documentation of the outpatient clinic activity as comprehensive as possible, the necessity to use internationally common instruments (e.g. diagnosis according to DSM-IV by means of SKID interviews), the collection of psychodynamically relevant variables, the recording of long-term effects, and the feasibility. The study is designed to meet the new study evaluation criteria of the Scientific Advisory Board for Psychotherapy (WBP). The follow-up study will include a sample of 1000 patients who will be examined over a period of at least 6 years after the start of treatment. In addition to the extraction and parallelization of specific disorder groups, this will allow the recording of the most frequent comorbidity clusters, as well as their changes through psychoanalytically based psychotherapies. The project is scheduled to run for 12 years. Data collection has begun.

Forms and functions of crying

Head: Prof. Dr. Cord Benecke

Humans are the only crying creatures. As far as is known, no animal produces emotional tears. In psychotherapy, crying is often given special importance. However, contemporary clinical theories as well as empirical studies on the topic are lacking. The study Forms and Functions of C rying attempts to approach the phenomenon in several ways. On the one hand, the videographed OPD interviews from the project "Affectivity, Relationship, and Mental Disorder" (see above) are examined qualitatively with regard to sequences in which subjects cry, in terms of thematic and interactive contexts. Here, first results are available and show, for example, that crying is centrally linked to an increased relatedness of relational representations, not or hardly related to psychopathological variables. Furthermore, semi-structured interviews with psychotherapists will be conducted with the aim to capture the meaning of crying within the psychotherapeutic process. The interview refers to different topics, such as different forms of crying, common occasions of crying, feelings associated with crying, differences between different disorders, function of crying in general, importance for the therapeutic process, crying as resistance, own reactions to patients' crying, etc. These interviews will be audio-recorded, transcribed and qualitatively analyzed. The research question is purely exploratory: the study serves to attempt to capture the existing treasure trove of clinical observations, experiences, concepts, ideas, etc., as broadly as possible and then to systematize them by means of qualitative content-analytic evaluation. Interviews are currently being conducted.

Cross-procedural process characteristics in psychotherapies with depressive patients

Cooperation with Prof. Dr. Dr. D. Huber and Dr. G. Klug (Klinikum Harlachingen, Munich) and Dr. H. Löffler-Stastka (Med. Uni. Vienna).

Within the framework of the Munich Depression Study (under the direction of D. Huber and G. Klug; randomized controlled study, comparison between analytic psychotherapy, depth psychology-based psychotherapy and cognitive behavioral therapy, 30 treatments per condition each), all treatments were extensively examined with regard to changes in various outcome areas (symptomatology, relationship patterns, structural level, etc.) by means of pre- post- and catamnesis surveys. In addition, all conducted therapy sessions were audiographed. The material comprises several thousand audio cassettes, and was given to the Benecke working group for evaluation. Process comparisons are planned, especially between successful and less successful treatments in connection with the type of treatment carried out. One hypothesis is that cross-procedural process characteristics of successful treatments can be identified. First publication in preparation.

Efficacy, sustainability, and cost-effectiveness of treatment for anxiety plus personality disorders (APS study): A randomized controlled comparative study between analytic psychotherapy and behavior therapy.

Homepage: www.aps-studie.de

Head: Prof. Dr. Cord Benecke, Prof. Dr. Dr. Dorothea Huber, Prof. Dr. Henning Schauenburg, Prof. Dr. Hermann Staats. In cooperation with Dr. Sibylle Kraemer, Dr. Michael Rentrop, Dr. Claas Lahmann (Munich), PD Dr. Martin Ohlmeier (Kassel), Dr. Hinrich Bents (Heidelberg), Prof. Dr. Heinrich Deserno (Berlin), Prof. Dr. Silke Wiegand-Grefe (Hamburg).

Supported by the German Society for Psychoanalysis, Psychotherapy, Psychosomatics and Depth Psychology (DGPT).

Research gaps currently exist in the field of psychotherapy of anxiety disorders: Lack of studies systematically considering comorbidity; Lack of studies examining sustainability of effects; Lack of investigation of long-term benefit-cost ratio; Lack of studies on differential indication. The APS study aims to address these gaps by comparing Analytic Psychotherapy (AP) and Cognitive Behavioral Therapy (VT) in a randomized controlled trial design. The sample includes 260 patients (130 per treatment modality). Because of the epidemiological significance, patients with the leading symptomatology of panic disorder with comorbidity in personality disorders are studied. A manual for analytic psychotherapy of patients with panic plus personality disorderswas created. The behavioral study therapists are free to choose their therapeutic approach. To ensure adherence, all sessions will be audio-graphically recorded and individual sessions from each treatment will be assessed for the actual intervention technique used by blinded raters. The hypotheses are that both VT and AP yield significant effects(benefit criterion), but that the effects prove to be more stable in patients treated with AP in the long-term catamnesis (uniformly six years after the start of treatment, independent of treatment type and duration), especially for patients with multiple comorbidity(necessity criterion), and that therefore comparable cost-benefit relations of the two psychotherapy methods are shown in the long-term catamnesis(cost-effectiveness criterion). In addition, we expect practice-relevant findings for both procedures from the process-outcome analyses. The total duration of the APS study is 10 years. Data collection has started.