FORSCHUNG

Im Rahmen meiner wissenschaftlichen Tätigkeit widme ich mich insbesondere der Weiterentwicklung diagnostischer und interventionsbasierter Verfahren für das kinder- und jugendpsychiatrische Setting unter Berücksichtigung bindungsbezogener Aspekte. Meine Forschungsarbeiten konzentrieren sich vor allem auf die Relevanz von Bindungstraumata als Risiko- und Schutzfaktoren für die Entstehung, Entwicklung und den Verlauf von Persönlichkeitsstörungen, Essstörungen und Depression bei Kindern und Jugendlichen. Dabei interessiere ich mich auch für die neurobiologischen Korrelate von Bindung in der Adoleszenz. Durch meine Arbeit in der Kinder- und Jugendpsychiatrie verfüge ich über eine mehrjährige klinische Erfahrung in der stationären und ambulanten Krankenversorgung mit jungen Menschen und deren Angehörigen.

 

ORCID: 0000-0001-9669-5561

 

AUSWAHL LAUFENDER UND ABGESCHLOSSENER FORSCHUNGSPROJEKTE                                                                             

 

WISSENSCHAFTLICHE FÖRDERUNGEN UND PREISE                                                                                                                           

 

BESCHREIBUNG LAUFENDER UND ABGESCHLOSSENER FORSCHUNGSPROJEKTE (ENGLISCH)

 

Attachment and adolescent personality pathology - Novel treatment approaches  

The study of attachment, its assessment and clinical applications during adolescence demonstrated a far-reaching insight into underlying mechanisms of personality development and psychopathology. However, there is a paucity of research on attachment trauma in child and adolescent psychiatric settings. Our research focuses on the role of attachment trauma in children and adolescents with mental disorders and its impact on emotion regulation, psychopathology and psychotherapy. We extend prior research by using a novel methodology that allows exploring the nature of traumatizing attachment-related experiences in adolescents with different psychiatric disorders. This approach elucidated a deeper understanding of nuances attachment trauma and traumatic childhood experiences in patients with personality pathology, Anorexia Nervosa, Depression and Non-Suicidal Self-Injury Disorder. Based on our results, we derived a novel attachment-based treatment tailoring to treat attachment trauma in child and adolescent psychiatry. This approach might have the potential to optimize the outcome and might be a useful adjunct to first-line in-patient psychiatric treatment particularly for patients with personality disturbances. In different case studies our study group already demonstrated how the implementation of individual attachment characteristics helped clinicians to gain a broader understanding of an adolescent’s psychopathological symptoms, formulate therapeutic goals and develop a treatment plan.

Research Team and Co-operation partners:  PD Manuela Gander, PhD; Univ.-Prof. Dr. Kathrin Sevecke, MUI; Univ.-Prof. Dr. Anna Buchheim, LFU; Prof. Dr. Carol George, Mills College, Oakland; Dr. Alexander Karabatsiakis, LFU; Prof. Dr. Elke Gizewksi, Dr. Lukas Lenhart, Dr. Ruth Steiger, Department of Radiology, MUI; Kirstin Goth, PhD, Psychiatric University Clinics Basel;

 

Selected publications

Gander, M., Buchheim, A., Kohlböck, G. & Sevecke, K. (2024). Unresolved attachment and identity diffusion in adolescence. Development and Psychopathology, 1-10. doi: 10.1017/S0954579424000014

Gander, M., Buchheim, A. & Sevecke, K. (2023). Personality disorders and attachment trauma in adolescent patients with psychiatric disorders. Research in Child and Adolescent Psychopathology, 1-15. doi: 10.1007/s10802-023-01141-1

Gander, M., Buchheim, A., Bock, A., Steppan, M., Sevecke, K. & Goth, K. (2020). Unresolved attachment mediates the relationship between childhood trauma and impaired personality functioning in adolescence. Journal of Personality Disorders, 34, 84-103. doi: 10.1521/pedi_2020_34_468

Gander, M., Sevecke, K. & Buchheim, A. (2018). Disorder-specific attachment characteristics and experiences of childhood abuse and neglect in adolescents with anorexia nervosa and a major depressive episode. Clinical Psychology and Psychotherapy, 25, 894-906. doi: 10.1002/cpp.2324

Gander, M., Sevecke, K. & Buchheim, A. (2015). Eating disorders in adolescence: Attachment issues from a developmental perspective. Frontiers in Psychology, 6, 1-12. doi: 10.3389/fpsyg.2015.01136 (IF: 2.8)

 

 

Personality functioning and attachment in adolescent patients with non-suicidal self-injury

With prevalence rates of more than 50%, non-suicidal self-injury (NSSI) represents a frequent phenomenon in child and adolescent psychiatric settings. As clinicians we are increasingly challenged to provide support and care to these vulnerable young individuals. In our clinic we experienced that NSSI behaviour carry heavy psychosocial and psychological burdens and is related to poorer outcomes. In particular, adolescents reporting high levels of relational trauma and impairments in personality functioning are at an increased risk for engaging in severe and prolonged NSSI behavior. This often results in greater symptom severity, worse therapeutic compliance and higher drop-out rates.  Our research focuses on attachment trauma and personality pathology to advance our knowledge of NSSI behaviour from adolescence to adulthood. We aim to develop more effective and efficient treatments for psychiatric patients with NSSI that support adolescents to face traumatic aspects related to their attachment status and their maladaptive personality functioning.

 

Research Team: PD Manuela Gander, PhD; Univ.-Prof. Dr. Kathrin Sevecke; Dr. Martin Fuchs, Child and Adolescent Psychiatry, MUI

 

Selected publications

Gander, M., Fuchs, M., Franz, N., Jahnke-Majorkovits, A.C., Buchheim, A., Bock, A. & Sevecke, K. (2021). Non-suicidal self-injury and attachment trauma in adolescent inpatients with psychiatric disorders. Comprehensive Psychiatry,  111: 152273. doi: 10.1016/j.comppsych.2021.152273

 

Attachment, personality pathology and structural brain alterations in adolescents with anorexia nervosa

Anorexia Nervosa (AN) is a serious psychiatric disorder reaching a lifetime prevalence up to 0.9% in females. This condition commonly develops during adolescence, which is a crucial time for personal, social, and biological development. Patients with AN often report traumatic experiences during their upbringing like emotional abuse, parental divorce, or mental health problems of their parents. The quality of an attachment relationship to their caregivers significantly affects the way adolescents deal with the exposure to adverse life events. Over the last two decades, researchers have begun to examine neurobiological substrates that contribute to the course and outcome of eating disorders with a growing use of quantitative neuroimaging methods to examine the relationship between structural brain abnormalities and psychopathology. Several studies have revealed brain alterations in AN patients and concluded that reduced gray matter (GM) and white matter volumes as well as ventricular enlargement are linked to malnourishment and completely recover after weight restoration in adults (Seitz et al., 2014; Seitz et al., 2016). In addition to global brain volume reductions, an increasing number of analyses have applied voxel-based morphometry in adult patients with acute AN to localize regional patterns of brain atrophy in a more precise way (King et al., 2015; Mühlau et al., 2007; Seitz et al., 2014; Titova et al., 2013). Despite a growing number of neuroimaging studies investigating structural alterations in acute AN, there is still a relative lack of i) longitudinal studies which hold the potential to differentiate between state-related effects, e.g. due to acute undernutrition, and more enduring abnormalities, ii) studies in younger age groups (i.e. 14-18 years), and iii) studies that included psychological components like attachment status and personality pathology which was shown to impact therapeutic response of AN patients regarding weight restoration. In this context, research focusing on unresolved attachment status - a category that is characterized by threatened abandonment, parental loss, or maltreatment - is still underrepresented in the literature. Our research explores altered brain structures in the acute disease state and after in-patient psychotherapeutic treatment and weight restoration (BMI for-age ≥ 5^th percentile) in a cohort of underweight adolescents with acute AN (i.e. age range from 14 to 18 years). Furthermore, we investigate whether variances in GM recovery may be related to the patients’ attachment status and personality pathology. Concerning attachment status, first data from our study demonstrates more GM recovery in patients with a resolved attachment status compared to those with an unresolved attachment status (see figures below, Lehnhart, Gander et al., 2022). 

 

 

 

 

 

 

 

 

 (A) gray matter decreases in Anorexia Nervosa patients relative to healthy controls at baseline time point (blue color), (B) increases in Anorexia Nervosa patients from pre to post therapy (orange color), (C) decreases in weight-restored Anorexia Nervosa patients at time-point to relative to healthy controls (blue color) (Lenhart, Gander et al., 2022, European Journal of Neuroscience)

 

 

 

 

 

 

 

Voxel clusters of the significant interaction of gray matter increases from the baseline to follow-up time point in anorexia nervosa patients with a resolved/organized vs. an unresolved/disorganized attachment pattern (Lenhart, Gander et al., 2022, European Journal of Neuroscience)

 

Research Team and Co-operation partners:  PD Manuela Gander, PhD; Univ.-Prof. Dr. Kathrin Sevecke, Child and Adolescent Psychiatry, MUI; Dr. Lukas Lenhart, Dr. Ruth Steiger, Prof. Dr. Elke Gizewksi, Department of Radiology, MUI

 

Selected publications

Gander, M., Lenhart, L., Steiger, R., Buchheim, A., Mangesius, S., Birkl, C., Haid-Stecher, N., Fuchs, M., Libal, A., Dabkowska-Mika, A., Gizewski, R. & Sevecke, K. (2023). Attachment trauma is associated with white matter fiber microstructural alterations in adolescents with Anorexia Nervosa before and after exposure to psychotherapeutic and nutritional treatment. Brain Sciences, 13 (5), 7. doi: 10.3390/brainsci13050798

Lenhart, L.*, Gander, M.*, Steiger, R., Dabkowska-Mika, A., Mangesius, S., Haid-Stecher, N., Fuchs, M., Buchheim, A., Sevecke, K. & Gizewski, E.R. (2022). Attachment status is associated with grey matter recovery in adolescent anorexia nervosa: Findings from a longitudinal study. European Journal of Neuroscience, 55(5), 1373-1387. doi: 10.1111/ejn.15614

*both authors contributed equally

 

Validity and clinical utility of the Adult Attachment Projective Picture System (AAP) in adolescence

The contribution of attachment to human development and clinical risk is well established for children and adults, yet there is relatively limited knowledge about attachment in adolescence.  A major contributor to this phenomenon is poor availability of construct valid attachment measures for this age group.  The Adult Attachment Projective Picture System (AAP) is a validated free-response measure of attachment status based on “story” responses to a battery of seven picture stimuli depicting attachment situations.  Researchers and clinicians are increasingly using the AAP in adolescents as it is economical in its use and it provides valuable information on states of mind regarding attachment that can be applied in the clinical context. In several published research studies that followed a study design analogous to the design used to validate the AAI – a predominant measure used in adult attachment research - we showed good validity and reliability data for the AAP in adolescent age groups. Our results poise the AAP to be used in clinical intervention and large-scale research investigating normative and atypical developmental correlates and sequelae of attachment, including psychopathology in adolescence. Our study group is currently employing this narrative instrument for assessing attachment in young patients with mental disorders. In several case studies we could demonstrate how the use of the AAP improved our understanding of adolescent psychopathology and lay out the foundation for developing attachment-based therapeutic practices for adolescent psychiatric settings.

 

Research Team: PD Manuela Gander, PhD; Univ.-Prof. Dr. Anna Buchheim, LFU; Prof. Dr. Carol George, Mills College, Oakland; Univ.-Prof. Dr. Kathrin Sevecke; Ann-Christin Jahnke-Majorkovits, PhD, Child and Adolescent Psychiatry, MUI

 

Selected Publications

Gander, M., Diamond, D., Buchheim, A. & Sevecke, K. (2018). Use of the Adult Attachment Projective Picture System in the formulation of a case of an adolescent refugee with PTSD. Journal of Trauma & Dissociation, 16, 1-24. doi: 10.1080/15299732.2018.1451803

Gander, M., Oberhofer, B., Sevecke, K. & Buchheim, A. (2017). Integration bindungsdiagnostischer Aspekte in die kunsttherapeutische Behandlung bei Persönlichkeitsstörungen im Jugendalter [Integration of attachment-related aspects into art therapy in adolescent personality disorders]. Persönlichkeitsstörungen: Theorie und Therapie, 4, 277-288.

Gander, M., George, C., Pokorny, D. & Buchheim, A. (2016) Assessing attachment representations in adolescents: Discriminant validation of the adult attachment projective picture system. Child Psychiatry and Human Development, 48 (2), 270-282. doi: 10.1007/s10578-016-0639-2 

Gander, M. & Sevecke, K. (2015). Bindungsbezogene Aspekte bei einer Jugendlichen mit einer Borderline-Persönlichkeitsstörung [Attachment issues in an adolescent girl with a borderline personality disorder]. Persönlichkeitsstörungen: Theorie und Therapie, 19 (3),213-223.

Buchheim, A., Gander, M. & Juen, F. (2014). Klinische Bindungsforschung mit dem Adult Attachment Projective Picture System: Methodik, klinische Anwendungen und Perspektiven. Psychotherapie Forum, 19, 42-49. doi: 10.1007/s00729-014-0011-6

 

Physiological underpinnings of adolescent attachment

The last decades have seen a continuous increase of studies focusing on the psychological, physiological, and neurobiological underpinnings of attachment that can influence various affective and social behaviors in humans. It is hypothesized that one’s attachment quality, which matures between an infant and its primary caregiver, is responsible for shaping an individual’s future relationships (i.e. romantic relationships, parent-child relationships) and has a regulatory effect on how individuals respond to attachment-related stressors. In his regard the study of neurophysiological correlates of attachment in adolescent age groups is still a relatively untapped area of research. At present it is still unclear whether results on adolescent attachment security/insecurity and physiological functioning are different from those reported in childhood and adulthood. To close this gap of knowledge our research team investigates physiological parameters during an attachment interview (AAP) in adolescents between 14 and 18 years of age to enhance our understanding of an individual’s physiological regulation in response to attachment-related stress. Our first findings demonstrate that secure adolescents showed a higher heart-rate variability (HRV) suggesting that they are more capable of dealing with attachment-related stressors. HRV is increasingly recognized as a marker of feeling safe and connected in social environments and thus our results might have important implications for psychotherapy research. Studies testing the efficacy of novel attachment-based treatments that foster the security in attach-ment-relationships in adolescence might benefit from including physiological parameters like HRV as a primary outcome variable.  

 

Research team: PD Manuela Gander, PhD; Univ.-Prof. Dr. Anna Buchheim, LFU; Dr. Alexander Karabatsiakis, LFU; Katharina Nuderscher, Msc, Department of Sport Science; Dorothee Bernheim, Child and Adolescent Psychiatry, University of Ulm

 

Selected Publications

Gander, M., Karabatsiakis, A., Nuderscher, K., Bernheim, D., Doyen-Waldecker, C. & Buchheim, A. (2022). Secure attachment representation in adolescence buffers heart-rate reactivity in response to attachment-related stressors.  Frontiers in Human Neuroscience, 17(16): 806987. doi: 10.3389/fnhum.2022.806987

Gander, M. & Buchheim, A. (2015). Attachment classification, psychophysiology and frontal EEG asymmetry across the lifespan. Frontiers in Human Neuroscience, 9 (79), 1-16. doi: 10.3389/fnhum.2015.00079

 

Get Fit 4 Mental Health

A growing number of studies have demonstrated the value of developing and implementing mental health programs that support young people to achieve academically, develop self-awareness, reduce stress and build social skills. Furthermore, schools often collaborate with community mental health organizations and are important for early identification and referral of children and adolescents with mental disorders. The aim of the present study is to scientifically evaluate an innovative teacher training program on mental health in young people. The program was developed by psychologists and psychiatrists of the Medical University of Innsbruck and the LFU and it includes evidence-based practices (i.e. START program and digital storytelling).   

Research team: Univ.-Prof. Dr. Kathrin Sevecke, MUI; Andre Leonhardt, Msc, MUI/LFU; PD Manuela Gander, PhD, LFU