A02: Context effects on threat processing in dependence of testosterone levels

Katja Bertsch is a Professor for Clinical Psychology and Psychotherapy at the Julius-Maximilians-University Würzburg.

Professor Ute Habel is a distinguished academic at RWTH Aachen University, renowned for her expertise in neuropsychology. Her research delves into the neural mechanisms of emotions, cognition, and psychiatric disorders, utilizing advanced neuroimaging techniques such as fMRI. With a prolific output of publications, she significantly contributes to the understanding of brain function in both health and disease. As a dedicated educator, she mentors students and fosters interdisciplinary collaborations, making substantial impacts on both academic research and clinical practices in neuropsychology and psychiatry.

Prof Dr Sabine C Herpertz studied human medicine in Bonn, obtained her doctorate in Frankfurt aM and habilitated in psychiatry and psychotherapy at RWTH Aachen University. Between 2002 and 2003, she held a professorship for Experimental Psychopathology at RWTH Aachen University before taking over the Chair of Psychiatry and Psychotherapy at the University of Rostock between 2003 and 2009. Since 2009, she has been Chair of General Psychiatry at Heidelberg University Hospital, Medical Director of the clinic of the same name and spokesperson for the Centre for Psychosocial Medicine. Her research focuses on the investigation of emotions and social functions in patients with personality disorders and trauma-associated disorders using experimental psychopathology and neuroscientific methods, in particular functional imaging. Reactive aggression is another focus of her research in personality disorders. She is Past President of the International Society for the Study of Personality Disorders (ISSPD) and has published many book chapters and journal articles on personality disorders. A second focus of her research is the development and evaluation of psychotherapeutic interventions.

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While anyone can behave aggressively, some people are more prone to aggression than others. We present a neuro-cognitive model and consider several inter-individual differences that confer risk for aggression. Forms of atypical cognitive function include a hyperreactive acute threat response, poor emotion regulation, and mechanisms involved in choosing when to aggress. We show dysfunction in the neural systems mediating these functions may account for aggression in people high in psychopathy/callous unemotional traits, irritability/anger, hostility, impulsivity, and low in frustration tolerance. We then review promising interventions including psychological therapies and pharmaceuticals that might influence the neuro-cognitive underpinnings of these constructs. Although there is no overwhelming “one size fits all” approach to treating aggression, identifying the neural mechanisms implicated in these traits may improve individualized treatments.

High levels of trait anger and aggressive behavior are common and problematic phenomena in patients with borderline personality disorder (BPD). In BPD, patterns of reactive aggression often lead to functional impairment affecting important areas of life. Despite the high burden on individuals and their social environment, there are no specific, cost-effective treatments to reduce aggression in BPD. In previous studies, we and others have been able to infer specific biobehavioral mechanisms underlying patterns of reactive aggression in BPD that can be used as potential treatment targets. To address this, we developed a mechanism-based anti-aggression psychotherapy (MAAP) for the group setting that specifically targets the biobehavioral mechanisms underlying outward-directed aggression in BPD. A previously conducted proof-of-concept study had suggested beneficial effects for this neglected group of patients. In this multicenter, confirmatory, randomized-controlled-clinical-trial, MAAP, which consists of multifaceted, evidence-based treatment elements adapted from other sophisticated treatment programs such as Dialectical Behavior Therapy and Mentalization-Based Treatment, is tested for efficacy against a non-specific supportive psychotherapy (NSSP) program focusing on non-specific general factors of psychotherapy at seven different sites in Germany. Both treatment arms, based on one individual and 13 group therapeutic sessions (1.5 h per session, twice a week), are delivered over a period of 7–10 weeks. A total of N = 186 patients will be recruited, half of whom will be cluster-randomized to MAAP. Outcomes are assessed at baseline, immediately, and 4, 12, 20, and 24 weeks post-treatment using ecological momentary assessment, clinical interviews, questionnaires, and online tasks. If proven superior, MAAP can be incorporated into standard psychiatric care, filling a critical gap in the current therapeutic landscape by offering a structured, cost-effective, and evidence-based treatment that directly targets the biobehavioral mechanisms underlying reactive aggression in BPD. By potentially improving clinical outcomes and reducing the burden of reactive aggression in BPD, MAAP could be beneficial for both individuals and their social environments. The study’s large, multicenter design enhances the generalizability of the results, making them more relevant for broader clinical applications.