Just imagine sitting in the back seat of your car after a long day at work No-one is driving the car – it drives itself You tilt your head back and see a retractable glass roof solar cells built into the roof have helped charge the car’s battery and the roof’s electronic display function allows you to project and manipulate your mobile apps on the glass After you arrange your schedule for the following day You retract the roof and enjoy the breeze on your face until the car delivers you safely home This might be the future as imagined by Jörg Buchheim, President and CEO of Inalfa Roof Systems – a company based in the Netherlands that supplies sunroofs to hundreds of car and truck manufacturers Jörg has sought to take Inalfa’s expertise beyond the simple mechanics that go into designing an ordinary sunroof and become a leader in innovation that can keep up with the fast-moving technological developments that are constantly taking place elsewhere in the automotive industry with new designs and new generations of technology coming up every four years This rate of change requires us to continuously improve our technology in terms of comfort changes within the industry are driven by geography In order to be a leading contributor to this dynamic value chain and always a little bit better in cost efficiency than our competitors.” To guide Jörg and his team towards this goal Inalfa has adopted the slogan ‘Powered by spirit Spirit refers to the teamwork of thousands of employees spread throughout facilities in places as diverse as the Netherlands These employees all actively pursue the same objective of providing customers with the best possible product for their needs with individuals who attain their full strength through perfect teamwork but who always have their key goals in front of their eyes,” Jörg says Innovation refers to continuously developing solutions that meet the changing demands of customers and remain useful even through times of crisis The COVID-19 pandemic was a recent example of a crisis that has revealed to Inalfa which sunroof features will retain enduring importance in the future “We are in the process of coming up with a new generation of roofs and changing behaviours as a result of COVID-19 have shown us what we need to prioritise,” Jörg explains “We see car companies accelerating their investments in electric and autonomous vehicle technologies and we’re also seeing rising cost competitiveness we have begun developing roofs that are very cost-optimised they open wider and they are easy to integrate into new generations of cars.” Jörg refers to this new generation of roofs as the “roof of the future” which despite being cost-efficient must also possess enough advanced features to ensure that Inalfa remains the partner of choice for its many hundreds of loyal customers but who always have their key goals in front of their eyes “The roof of the future does not just open and close in the conventional way that you see today,” Jörg says “It circulates and conditions air inside the car and it contains 5G-integrated sensors for driver assistance It contains solar cells to maximise vehicle range and it has comfort functions like intelligent lighting and even dimming we will see roofs that are integrated for entertainment This is what our end clients are looking for and it is what is driving innovation at Inalfa today.” The process of narrowing down Inalfa’s growth strategy and its unique role in the industry has been characterised by ups and down Jörg was riding high on a slew of momentous achievements He had strengthened the company from the inside inspiring managers to broaden the experience and knowledge level within the organisation as a whole These successes led Jörg to make a bold prediction Inalfa will reach its goal of €2 billion turnover in 2020,” he said at the time Inalfa was on course to meeting its ambitious goal the crisis eventually came and COVID-19 forced Jörg to recalibrate the company’s growth strategy “We will certainly end up in 2020 below €2 billion and this is simply because the top line was not coming in as expected,” he reveals Inalfa’s sales dropped by more than 20% this year and according to the company’s projections demand may not return to its pre-pandemic level until 2023 Jörg does not see this setback as cause for despair it serves as the inspiration for how he will lead Inalfa over the coming years “We are really concentrating on getting our company fit for the future This means we are investing in developing our talent and improving our management to ensure a fine-tuned organisation,” he says Inalfa has begun shifting its investments into the countries where its operations are most cost-effective which is expected to compensate for slower growth elsewhere and make the company more competitive overall We are really concentrating on getting our company fit for the future “We are focused on our production capabilities and efficiency and have done a good job of optimising our production lines to a higher level of efficiency in Europe,” Jörg says “We’ve seen a significant change in our results through these activities and will certainly continue to optimise our footprint and increase profits in all regions.” Inalfa has reconfigured its growth plan to focus more on China where the company has boosted its market share in recent years Jörg has led the consolidation of Inalfa’s factory in South Korea restoring it to profitability and making it the preferred supplier of glass roofs to automotive giant Hyundai Inalfa Roof Systems operates manufacturing facilities in the Netherlands and distributes to major automotive markets around the world Each facility receives hardware and capital equipment from various strategic supply partners and assembles complete roof modules Every module is inspected before being packaged and shipped to the customer Roof modules are installed into vehicles at the customer’s facility Inalfa roof modules are designed to optimise space and minimise noise in order to improve the mobility experience The company holds more than 700 life patents and a global market share of approximately 25% delivering roof systems to almost every major car and truck manufacturer in the world “We have seen a big commitment from our Korean customers and we are on course to triple our revenue there,” he says no business expands across the globe without landing in some rough spots a new American factory in Georgia has proven most challenging “This factory is the biggest in our network and it is still facing some very complex challenges in industrialisation We’re currently looking into getting this company better structured and more productive,” Jörg says the geographical diversity of Inalfa’s network ensures that a problem somewhere can be solved elsewhere Inalfa has bucked conservative trends within the automotive industry by instituting workfrom-home provisions wherever feasible its suppliers and its customers remains fast and reliable “Nothing will deter us from delivering what we promise,” Jörg insists One consequence of the economic downturn precipitated by the COVID-19 pandemic has been the increasing pressure to prioritise where Inalfa is going to invest and to pinpoint exactly where future demand from customers will lie in what is a rapidly evolving industry Nothing will deter us from delivering what we promise This is the current challenge for the entire sector made all the more pertinent for Inalfa as it is in the process of developing and designing new products to meet the needs of the moment “We are adopting a road map that focuses on our major priorities We need to prioritise products by becoming more efficient in recognising the end customer’s needs,” Jörg says of the company’s immediate focus we cannot try out all different kinds of potential features to the extent we did so before “We need to work with limited investment and limited resources in a very efficient way to get the right things on time on paper This requires cutting the fat and becoming more efficient overall The customer will see this reflected in our affordable prices It’s important that we are using this situation as an opportunity to continue to raise our competitiveness.” Jörg is able to ensure that Inalfa maintains long-term relationships with both customers and suppliers “We involve our suppliers in the earliest stages of our innovations integrating them into our concepts and finding ways of maximising our profits and competitiveness together,” he explains Another important component to the company’s success is talent development which Jörg refers to as “people performance management” “Our organisation can generate sustainability when people enjoy their work and are committed to delivering high-quality products in a speedy fashion,” he says “It is the job of the management to provide this.” The CEO Magazine is more than a business title; it’s a source of information inspiration and motivation for the world’s most successful leaders Learn all about The CEO Magazine at TheCEO.com ' + scriptOptions._localizedStrings.webview_notification_text + ' " + scriptOptions._localizedStrings.redirect_overlay_title + " " + scriptOptions._localizedStrings.redirect_overlay_text + " The mission of the HBS Aerospace & Defense (A&D) Club is to help students make critical contributions to the space Establish mentorship and learning opportunities for students with successful HBS alumni in A&D Our marquee event is the HBS/MIT Technology and National Security Conference, which we host each spring in partnership with MIT Sloan’s Security and Technology Club This conference is a premier defense tech event that features esteemed speakers like sitting US Senators senior Department of Defense and Allied officials and CEOs of defense prime contractors and startups For companies interested in sharing employment opportunities please reach out to aero@studentclubs.hbs.edu Sara Ballantyne: sballantyne@mba2025.hbs.edu Sara is an MS/MBA: Engineering Sciences dual degree candidate interested in the future of the aviation and space industries from manufacturing to sustainability to novel technology development She previously worked at Blue Origin as a propulsion engineer leading rocket engine testing to support their lunar lander program Ben Buchheim-Jurisson: bbuchheimjurisson@mba2025.hbs.edu Ben is a JD/MBA candidate with interests in defense tech, space, and industrials. Prior to school, Ben served in the US Air Force and worked at Meta, and after graduation Ben will join Snowpoint Ventures Clif Luber: cluber@mba2025.hbs.edu Clif is an MBA candidate at HBS and served in the U.S He also worked previously at Anduril Industries and has interned at Defense Innovation Unit and Revolution VC Daniel Ackeret: dackeret@mba2025.hbs.edu Daniel is an MBA candidate interested in advanced manufacturing Daniel worked in Corporate Development and Strategy at RTX’s Pratt & Whitney business unit .css-s4id4f{font-family:Suisse Intl,"Helvetica Neue",Helvetica,Arial,sans-serif;font-size:1.9rem;line-height:2.2rem;font-weight:600;letter-spacing:-0.01em;}Schwab Cup Since 2016, the American Family Insurance Championship and Steve Stricker American Family Insurance Foundation have raised more than $17 million for charity. Nearly $9M of that has gone to the American Family Children’s Hospital in Madison. (Credit Doug Milne/Tom Buchheim) In a way, making it to the first tee box of a PGA TOUR Champions event with club in hand serves as validation for all the time, hard work and dedication one has invested towards the goal of success. Nowhere was that assertion more brightly illuminated than last Friday morning to kick off the start of the American Family Insurance Championship in Madison, Wisconsin. While Titus Nee’s on-course accomplishments may still be taking shape, the work and dedication which has gone into his nascent journey more than qualified the five-year-old to strike the ceremonial first tee shot. The gallery’s roar of enthusiasm over his swing wasn’t influenced as much by how far the ball went as it was by understanding how far he and his family have come. When determining the annual Madison event’s level of success, two heavily weighted factors, understandably, are with regard to the amount of drama and excitement produced inside the ropes. While those qualities are certainly big hits for a tournament’s sizzle reel, the most defining mark of triumph has less to do with the animated impressions left behind and more with the help it provides all year – and in many cases, all life – long. Dating to its 2016 inception, the American Family Insurance Championship in Madison, Wisconsin, has been a compelling source of action. But, on a grander stage, with its title sponsorship role, American Family Insurance has been – quite literally – the difference between life and death for many who’ve never even seen a shot of golf. It is only then, and through that, when a tournament truly sees the impact its making. Tipping the scale at a respectable 8.5 pounds, Titus came into the world in 2018, the week before Christmas, as a perfectly healthy baby boy…or, so it seemed. “He was diagnosed with a failure to thrive and, five weeks after he was born, it was recommended to take him to American Family Children’s Hospital,” said Titus’ mother, Nicole Nee. “He had been unable to gain any weight those first few weeks after birth, which resulted in a marathon of trying to figure out what was going on.” At just two months old, Titus underwent a complex surgery at American Family Children’s Hospital after being diagnosed with Pierre Robin Syndrome, a rare congenital birth. (Credit Doug Milne/Tom Buchheim) Pierre Robin Syndrome, a rare congenital birth defect characterized in part by an underdeveloped jaw and cleft pallet, was severely impacting Titus’ ability to breathe and eat. With only a tiny passageway to receive oxygen, Titus was getting a fraction of the air necessary to function. At just two months old, Titus underwent a complex surgery at American Family Children’s Hospital. To combat the syndrome, doctors were forced to break his lower jaw and place distractors on each side. Each day, the jaw was brought out millimeters with the goal being to further open the airway. “Being told it was going to be a 3–4-hour surgery, and that after that surgery your child was going to be in a medically-induced coma for a week just to help deal with the pain just drops your heart down into your stomach,” said Titus’ father, Eric. “Looking back on it now, just the amount of time and energy that every doctor put into explaining exactly what was going to happen made that process – not easy – but smoother.” Since 2016, the American Family Insurance Championship and Steve Stricker American Family Insurance Foundation have raised more than $17 million for charity. Nearly $9M of that has gone to the American Family Children’s Hospital in Madison to help with everything from equipment and wraparound services to family meals, therapeutic play with child specialists and even visits from the hospital’s facility dogs to provide comfort to patients, siblings and families. “I think a lot of the grit he has he got because the hospital poured everything into him, to Eric and I as parents and to Tenley and Tucker as siblings,” said Nicole. “A big part of the hospital I have always adored is what they do for siblings. The doctors, nurses, patients and parents are the heroes, but the unsung heroes are all the siblings.” Included in his 51-day hospital stint, Titus and the family experienced 56 doctor appointments, 40 therapist sessions and five surgeries. (Credit Doug Milne/Tom Buchheim) “There were always crafts and activities for them to do to pass the time and have fun,” said Eric about his seventh-grade daughter, Tenley, and fourth-grade son, Tucker. “They even got us presets as a way to help keep us happy,” added Tenley. “When they checked on Titus, they checked on us, too.” “We’re incredibly honored to have our name and brand associated with an award-winning professional golf tournament,” said Tracy Schweitzer, Chief Administrative Officer, American Family Insurance. “American Family has a deep and long-standing commitment as a company to support the communities where we live, work and raise our families.” Since its beginning, the American Family Insurance Championship has raised $17.2 million for the American Family Children’s Hospital and 847 other charitable organizations. “This PGA TOUR Champions event provides opportunities to doctors to where they can have those life touches and resources to impact the families the way they do,” said Eric. Included in his 51-day hospital stint, Titus and the family experienced 56 doctor appointments, 40 therapist sessions and five surgeries. “Titus does have another surgery coming up in August, but because of who and what American Family Children’s Hospital is, he isn’t scared of the hospital,” said Nicole. “I think that speaks volumes to everyone there, what the hospital is and how they do things there.” Titus’ August surgery will further widen his passageway to make possible more air coming in when he is sleeping. Ideally, he will begin kindergarten a week later and play in his first season of American League baseball. “Without events like the American Family Insurance Championship, doctors, nurses and anyone else who work in the hospital would not be able to do what they do,” said Eric. “It gives you a chance to fight another day.” Titus’ August surgery will further widen his passageway to make possible more air coming in when he is sleeping. Ideally, he will begin kindergarten a week later and play in his first season of American League baseball. (Credit Doug Milne/Tom Buchheim) “American Family Children’s hospital cares for kids from every corner of the nation, providing a place for healing and a state-of-the-art, family-friendly environment made possible from a very generous gift from American Family Insurance,” said Vice President of Pediatric Services and President at American Family Children’s Hospital at UW Health Nikki Stafford. “As a mom, feeling like you weren’t alone is something I would’ve never believed without the hospital," said Nicole. “He’s doing a lot better from when he had so many surgeries,” said 10-year-old Tucker. “He has grown so much, and I love to play football, baseball and basketball with him. I hope Titus can play whatever and whenever he wants.” Perhaps he’ll even take another swing at the game of golf. After all, it’s been pretty good for him so far. Copyright © 2025 PGA TOUR, Inc. All rights reserved. We replicated and extended existing CM and attachment models by co-examining maternal attachment, social support, and child genetic susceptibility on child attachment and cardiovascular stress regulation. The findings contribute to an extended understanding of risk and resilience factors and enable professionals to target adequate services to parents and children at risk. Volume 16 - 2022 | https://doi.org/10.3389/fnhum.2022.890262 This article is part of the Research TopicNeuroscience of Human Attachment: Volume IIView all 7 articles Introduction: Childhood maltreatment (CM) is a developmental risk factor and can negatively influence later psychological functioning A comprehensive understanding of the biopsychosocial underpinnings of CM transmission would allow to identify protective factors that could disrupt the intergenerational CM risk cycle This study examined the consequences of maternal CM and the effects of psychosocial and biological resilience factors on child attachment and stress-regulatory development using a prospective trans-disciplinary approach Methods: Mother-child dyads (N = 158) participated shortly after parturition (t0) Mothers’ CM experiences were assessed at t0 attachment representation at t1 and psychosocial risk and social support were assessed at t1 and t2 dyads participated in the Strange Situation Procedure (SSP) Children’s attachmen status were classified as organized vs including their level of disorganized behavior and heart rate (HR) and respiratory sinus arrhythmia (RSA) were recorded as stress response measures of the autonomic nervous system Maternal caregiving during SSP was assessed using the AMBIANCE scale Child’s single nucleotide polymorphisms rs2254298 within the oxytocin receptor (OXTR) and rs2740210 of the oxytocin gene (OXT) were genotyped using DNA isolated from cord blood Results: Maternal CM experiences (CM+) were significantly associated with an unresolved attachment status higher perceived stress and more psychological symptoms These negative effects of CM were attenuated by social support maternal unresolved attachment and child disorganized attachment were significantly associated Maternal caregiving did not mediate the relationship between maternal and child attachment but influenced children’s HR and RSA response and disorganized behavior the rs2254298 genotype of the OXTR gene moderated the stress response of children from mothers with CM Children carrying the rs2740210 risk allele of the OXT gene showed more disorganized behavior independent from maternal CM experiences Conclusion: We replicated and extended existing CM and attachment models by co-examining maternal attachment and child genetic susceptibility on child attachment and cardiovascular stress regulation The findings contribute to an extended understanding of risk and resilience factors and enable professionals to target adequate services to parents and children at risk subsequent approaches examining relevant transmission factors require a prospective research design and the implementation of trans-disciplinary methods The study TRANS-GEN was conceptualized to address this problem using a prospective design covering the first year of mother-child dyads. We focused on the role of the attachment system, the social support system and biological stress susceptibility in mother-child dyads, as these systems are known to affect the consequences of CM to the next generation (Brunner et al., 2015) A better understanding of the biopsychosocial underpinnings of ICM would allow for the identification of protective factors that could help to disrupt intergenerational effects the present study aimed at examining the consequences of maternal CM exposure and the buffering effects of maternal psychosocial (attachment status and psychological symptoms) and child biological resilience factors (OXTR rs2254298 and OXT rs2740210 genotype) on children’s attachment and cardiovascular stress regulation we summarize major findings from previous studies that address the relevant transmission systems to provide the rationale for the given hypotheses and our expanded ICM model we focused on the intergenerational effects of maternal attachment representation and maternal disruptive behavior on children’s attachment in addition to examining other possible influences on the mother-child dyad a child’s perceptions of and coping responses to stress are closely linked to the quality of the attachment relationship In sum, disorganized attachment is considered a developmental risk factor and documented as having a higher incidence in families with CM (Cyr et al., 2010) disorganized attachment is an outcome variable of interest in the present ICM study Our main interest was to study whether children with disorganized attachment are more susceptible to stress and how this response may be related to the behavior of the caregiver The parents’ adult attachment system is a major candidate for affecting the intergenerational transmission of CM and attachment to the next generation (van IJzendoorn and Bakermans-Kranenburg, 2019; Zajac et al., 2019). Adult attachment representation is assessed by evaluating narratives of attachment-related themes (Main and Goldwyn, 1998; George and West, 2012) The classification groups are analogous to the groups in children Secure adults are flexible and thoughtful when describing attachment experiences preoccupied) dismiss the importance of attachment events or are confused by and mentally entangled in caregiver insensitivity adults with an unresolved (disorganized) attachment are flooded and unable to regulate attachment-related trauma like showed higher insensitive parenting behavior These findings support the link between maternal CM experiences mental representation of their attachment history Khan and Renk (2019) suggested to co-examine the association between negative parenting behavior and CM by including maternal insecure attachment as a core influencing factor (Khan and Renk, 2019) Since there is an absence of research that addresses this missing link this association was of central interest in the present study The association between parenting stress and maternal CM and parenting difficulties is well-documented. Studies on ICM have shown that mothers who report more CM and current parenting stress are significantly less sensitive in the interaction with their children (Pereira et al., 2012; Savage et al., 2019; Bérubé et al., 2020) this study intended to add new aspects to the literature by identifying possible protective factors that buffer the negative consequences of parental perceived stress and disruptive behavior (e.g. This pattern suggests that future ICM studies should identify protective factors that buffer the negative transmission effects of mothers’ CM on psychopathology and impaired parenting Studies also confirmed the protective effect of social support on the association between CM and symptoms of adult post-traumatic stress disorder and depression (Schumm et al., 2006; Salazar et al., 2011; Evans et al., 2013) We propose that mothers with CM are at risk for psychopathology and experiencing higher parental stress levels we also examined the attenuating role of social support on the relationship between CM we additionally examined the role of institutional support since most studies focused on social support in ICM samples Both studies highlight the importance of supporting responsive caregiving that enables the children to adapt to stressful attachment-relevant situations we concluded that ICM studies should focus on the identification of protective factors that buffer the negative effects of maternal CM on child stress regulatory function Genetic polymorphisms might impact the physiological coupling of mental stress to biological stress response-processes changing dose-response relationships with effects from cellular up to systemic levels We proposed that children carrying the (A) risk allele rs2254298 may be more affected by the negative effects of CM on maternal parenting we investigated the proposed influence of child biological susceptibility in terms of genetic variability at rs2254298 (A vs G genotype) on child stress regulatory development in the context of ICM we expect that children carrying the C (risk) allele are more likely to demonstrate the negative consequences of maternal CM exposure we investigated the influence of the rs2740210 (C vs A genotype) on child attachment and disorganized behavior in the context of ICM Previous research indicated that the attachment system and child biological susceptibility (genetic features and stress reactivity) are central contributors to the path of maladaptation or resilience when mothers have experienced CM a deeper understanding of the contribution of each of these factors to ICM is essential to build up prevention models and intervention instruments we aimed to disentangle for the first time in this area of study risk and resilience factors influencing children’s development in the context of maternal CM by using a highly interdisciplinary and prospective study design to test the proposed models we further established a path model of ICM Figure 1. Adapted model from van IJzendoorn and Bakermans-Kranenburg (2019) for the root effects of the intergenerational cycle of maltreatment (ICM) and its effects on the level of attachment in mother-infant dyads Allelic discrimination of OXTR rs2254298 includes genotypes AA At least one A allele is considered a risk genotype for higher stress susceptibility The following hypothesis clusters were tested: unresolved attachment is more prevalent in mothers with CM H1.2) We expect a significant association between maternal and child attachment and mothers with unresolved attachment representation are more likely to have children with disorganized than organized attachment H1.3) Organized attachment representation is a potential buffer on child attachment in mothers exposed to CM; that is organized maternal attachment will be associated with child organized attachment H1.4) The effect of maternal attachment on child attachment is mediated by maternal caregiving behavior (disruptive/non-disruptive behavior) H1.5) We expect that higher maternal disruptive behavior is associated with higher child disorganization ratings during the SSP H1.6) Higher maternal disruptive behavior is related to a higher increase in HR and a steeper decline in respiratory sinus arrhythmia (RSA) in the child in response to the SSP Hypothesis cluster 2 – Social support H2.1) Maternal CM negatively influences the perception of receiving social support from others we expect to find a positive association between maternal CM load (CTQ sum score) and maternal psychological problems and distress levels H2.2) Social support has an attenuating effect on maternal psychopathology and distress levels we assume that the positive association between maternal CM load (CTQ sum score) and maternal psychological symptoms is mediated by perceived social support We also expect that the relationship between maternal CM load (CTQ sum score) and perceived stress in mothers is mediated by perceived social support such that higher exposure to CM is related to lower social support and higher perceived stress levels we hypothesize that perceived psychological stress also plays a mediating role in the association between maternal CM load and psychopathology H2.3) We assume that more perceived social support is associated with lower disruptive behavior H2.4) We hypothesize that the use of institutional support by mothers is associated with lower disruptive behavior toward their children Hypothesis cluster 3 – Child genetic features and stress susceptibility H3.1) We suggest that carrying at least one A allele (i.e. AA/AG genotype) of the rs2254298 polymorphism in the OXTR gene is associated with a higher stress susceptibility in the offspring as reflected in a higher increase in HR and a steeper decline in RSA during the SSP H3.2) We hypothesize that the carrying at least one C allele of the rs2740210 polymorphism (i.e. AC/CC genotype) of the OXTR gene is associated with higher child disorganization ratings assessed during the SSP in dyads where mothers are exposed to CM Demographics and clinical characteristics of mother-child dyads Prevalence rates of childhood maltreatment (CM) and the resulting classification of CM load At t1, all mothers were administered to the Adult Attachment Projective Picture System (AAP, George and West, 2012) conducted by trained psychologists. The AAP (George and West, 2001, 2012) is a validated free-response measure that assesses adult attachment representation It is based on the analysis of narrated “story” responses to a set of seven theoretically derived attachment-related drawings of scenes depicting solitude Individuals are asked to tell a story for each picture following a standardized set of probes All AAPs were transcribed verbatim from audio recordings for analysis and attachment classification Each picture stimulus is coded for content and defensive processes (for a more detailed description of the coding and classification procedure see George and West, 2011, 2012) The AAP classifies the four established attachment categories: secure attachment representations of the mothers were divided into two major classifications “organized” and “unresolved.” Organized attachment includes secure any frightening or threatening material (e.g. isolation) that may appear in the story is contained (i.e. The unresolved attachment refers to a group of individuals who are not able to regulate and contain or reorganize stories that evidence frightening or threatening material unresolved individuals are flooded and dysregulated by their attachment fears Maternal AAP classification was performed by two independent certified judges Inter-rater reliability showed significant concordance for the four-group classification (κ = 0.95 and for the two-group classification (organized vs This study also used the D-score for analysis The good psychometric properties of the SSP like high inter-rater-agreement are well-documented (e.g., De Wolff and van IJzendoorn, 1997; Solomon and George, 1999). The SSP was videotaped for later analysis. All videos were classified and rated by Judith Solomon, one of the co-developers of the category of the disorganized attachment pattern (Main and Solomon, 1986) The dyads participated in the laboratory procedure between 10 a.m the experimenter explained the procedures to the mothers while the dyad was in a “resting and relaxing phase,” which lasted approximately 15–20 min mothers were asked to connect the wireless lightweight mobile unit with seven disposable spot electrodes onto their child’s chest skin the dyads listened together to a digitally recorded lullaby to calm down The quality of maternal caregiving behavior was analyzed using the Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE; Bronfman et al., 1992) and performed in the context of the SSP at timepoint t2. Lyons-Ruth et al. (1999) developed the AMBIANCE scale to elaborate the work by Main and Hesse (1990) to assess mothers’ anomalous disruptive interactive behavior with their children and is a widely used and well-validated measure with good psychometric properties The scale evaluates disrupted maternal behaviors on five dimensions: (1) affective communication errors Behaviors on each of the dimensions are rated on a 7-point Likert scale and a sum score of the level of disruption is determined The level of disrupted communication was assigned based on the frequency and intensity of all disrupted behaviors mothers displayed in the course of the interaction with their children The current study used the AMBIANCE sum score of disruption A rater trained to reliability by the AMBIANCE developers scored all interactions and was blind to all other data collected in the study Perceived psychological stress over the past month was assessed using the Perceived Stress Scale (PSS-14, Cohen, 1988) at t1 and t2 The PSS-14 is the most widely used psychological self-report instrument for measuring perceived stress It assesses the degree to which life situations are appraised as stressful and overloaded individuals find their lives over the last month using 14-items rated on a 5-point Likert scale We observed a moderate and highly significant (r = 0.55 p < 0.001) correlation of the PSS-14 score between t1 and t2; therefore the mean value of the two time points was used for the statistical analysis The Brief Symptom Inventory (BSI, Wideman et al., 2013) was assessed at t1 and is a self-report instrument including 53 items measuring psychological symptoms during the last 7 days It covers the nine primary symptom dimensions: somatization Items are answered on a 5-point scale ranging from 0 (not at all) to 4 (extremely) Social support was assessed at t1 and t2 using the Postpartum Social Support Questionnaire (PSSQ, Hopkins and Campbell, 2008) The PSSQ is a 50-item self-report that measures social support received by women in recent motherhood; it evaluates emotional and instrumental social support received from the spouse-partner The PSSQ scores at t1 and t2 were significantly correlated (r = 0.79 so the mean value of the two time points was used in our statistics the use of parental-counseling services (institutional support) was assessed by an interview and coded as a dichotomous variable (yes/no) The child’s umbilical cord blood was used for the isolation of DNA The quantity and purity of isolated DNA were assessed with the high-sensitivity DNA quantification kit and a Qubit fluorometer (ThermoFisher Scientific Genotyping of rs2254298 and rs27401210 was conducted using a Taqman assay in combination with a QuantStudio 6 qPCR device following the protocol of the manufacturer (ThermoFisher Scientific Allelic discrimination of samples for the rs2254298 (GG vs CA/CC) was performed with the QuantStudio 6 genotyper operating software (ThermoFisher Scientific The results of the genotyping were translated into dichotomous variables (GG vs Timeline of the measures used and assessed in the TRANS-GEN study are summarized in Figure 2 Time line of the measures in the TRANS-GEN Study We decided to perform a step-wise approach in the analyses of the individual parameters assessed in the given study Then we conducted maximal likelihood path analyses and used the χ2 test comparative fit index (CFI) and the root mean square error of approximation (RMSEA) to decide on model fit The significance level was set at p < 0.05 for all analyses Intercorrelations of all study variables are shown in Supplementary Table 1 for the total cohort and in Supplementary Table 2 for the subsample of mothers with CM only (CM+) we present the results of hypotheses testing Our first set of hypotheses examined the attachment system We first examined the prevalence of unresolved attachment in CM mothers then tested the correspondence of maternal and child attachment by focusing on the impact of maternal organized attachment on the child’s attachment as a potential resilience factor We then explored if the effect of maternal attachment on child attachment is mediated by maternal caregiving behavior (disruptive/non-disruptive behavior) and how maternal disruptive behavior affects the child’s disorganized behavior and stress reactivity was examined using a χ2 test of independence testing the association between maternal exposure to CM (CM+/CM-) and maternal attachment representation (organized The results showed that from the mothers exposed to CM (n = 71) n = 11 (15.5%) showed unresolved attachment while none of the non-exposed mothers (n = 87) showed unresolved attachment (n = 0 indicating a significant higher percentage of mothers with unresolved attachment in the CM+ group Hypothesis H1.2 examined the distribution of children with disorganized attachment in the sample The results showed that from mothers with organized attachment (n = 139) only n = 18 children (13%) showed disorganized attachment The prevalence of children with disorganized attachment (n = 5 50%) was much higher in the group of mothers with unresolved attachment (n = 10) The statistical between-group comparison revealed a significant effect of this distribution indicating a higher percentage of children with disorganized attachment in the group of unresolved mothers than organized mothers we could demonstrate in a subgroup analysis considering only mothers with CM (CM+) that organized maternal attachment representation (AAP) was associated with organized child attachment patterns (SSP) x2 (1 In the group of mothers with an organized attachment (n = 56) n = 47 children (84%) showed an organized attachment while n = 9 children (16%) were disorganized the group of mothers with an unresolved attachment (n = 10) included n = 5 children with a disorganized attachment (equals 50%) and n = 5 with an organized attachment we investigated the mediating role of maternal disruptive behavior on the relationship between maternal attachment representation and child attachment Mediation analysis for testing H1.4 showed a direct effect of maternal attachment representation on child attachment (b = 1.76 via maternal disruptive behavior (b = 0.19 in contrast to maternal attachment representation maternal disruptive behavior did not sufficiently contribute to explaining child attachment we confirmed a significant correlation between maternal AMBIANCE scores and D-scores in the SSP of the children (r = 0.26 p = 0.008) demonstrating that higher maternal disruptive behavior toward their child was associated with a higher amount of disorganized behavior in their child we investigated the relationship between maternal disruptive behavior and the stress reactivity of the child using HR and RSA We found a significant correlation between AMBIANCE and HR (r = 0.17 p = 0.04) and AMBIANCE and RSA (r = −0.17 The correlation remained significant in the CM+ subgroup for RSA (r = −0.27 but there was no longer a significant association between AMBIANCE and HR (r = 0.13 Our second set of hypotheses examined the maternal support system We first investigated the impact of CM load (CTQ sum score) on perceived maternal stress We then examined the influence of the social support system in the context of ICM Two types of social support were explored: (1) social support from the partner and family assessed by the PSSQ and (2) the use of institutional support by the mothers we found positive associations between CM load (CTQ sum score) and maternal perceived stress (r = 0.31 p < 0.001) and psychological symptoms (r = 0.48 We also observed a positive association between perceived stress levels and psychological symptoms (BSI sum score) (r = 0.73 p < 0.001) and confirmed a negative association between maternal CM load and perceived social support greater social support was significantly associated with lower perceived stress p < 0.001 and less psychological symptoms the association between social support and psychological symptoms (r = −0.24 but the relationship between social support and perceived stress was no longer significant (r = −0.17 we tested the possibility that the relationship between maternal CM load (CTQ sum score) and maternal psychopathology was mediated by social support and perceived stress Mediation analysis revealed that both the direct effect of CM load on psychological symptoms (b = 0.37 p < 0.001) and the indirect effect via social support and perceived stress was significant (b = 0.08 indicating a partial mediating effect of social support and perceived stress on the development of psychological symptoms CM load was associated with lower social support (b = −0.81 p < 0.001) and lower social support was related to more perceived stress (b = −0.07 higher perceived stress levels were associated with more psychological symptoms (b = 1.40 Following the model by van IJzendoorn and Bakermans-Kranenburg (2019) (see the adapted model in Figure 1) we examined the influence of social support on maternal caregiving (disruptive behavior) using correlation analyses We observed no significant effect of social support on maternal disruptive behavior in both the total cohort (r = −0.13 p = 0.12) and the CM+ subgroup (r = −0.19 We hypothesized in H2.4 that maternal use of institutional support would be associated with lower disruptive behavior towards their children Our results demonstrate a significant association between the reported use of parental-counseling services (yes/no) and higher disruptive behavior (r = 0.20 indicating that these mothers sought institutional support more frequently Our third set of hypotheses examined genetic risk factors within the OXTR gene of the child in a two-step approach we investigated the SNP rs2254298 on child autonomic nervous system response during the SSP followed by the influence of rs2740210 on child attachment development we tested the effect of rs2254298 on the child’s autonomic nervous system reactivity Univariate analysis indicated there was no effect of carrying the A (risk) allele on RSA [F(1 p = 0.22]; M (SD) A (risk) allele carriers = −18.62% (38.88) M (SD) non-risk allele carriers = −7.92% (32.68) and HR reactivity [F(1 p = 0.97]; M (SD) A (risk) allele carriers = 19.56% (19.96) M (SD) non-risk allele carriers = 19.40% (18.51) during the SSP when we tested for effect modification by maternal CM (CM+/CM-) we observed a significant interaction between maternal CM exposure and the rs2254298 SNP on the HR response [F(1 p = 0.016; M (SD) CM+/A (risk) allele carriers = 27.95% (15.08); M (SD) CM-/A (risk) allele carriers = 13.97% (21.40); M (SD) CM+/ non-risk allele carriers = 14.63% (15.47); CM-/ non-risk allele carriers = 23.59% (20.07)] and the RSA response [F(1 p = 0.007; M (SD) CM+/A (risk) allele carriers = -37.16% (27.68); M (SD) CM-/A (risk) allele carriers = −6.26% (41.30); M (SD) CM+/ non-risk allele carriers = 0.52% (28.92); CM-/ non-risk allele carriers = −15.28% (34.32)] This result indicates that for children of CM+ mothers the autonomic nervous system stress response was moderated by the rs2254298 polymorphism (i.e. a higher HR increase and a steeper decline in RSA was observed in children with CM+ mothers that carried the risk allele) We also tested the effect of the rs2740210 polymorphism on child attachment and disorganized behavior Results for the total cohort showed a trend toward a significant effect of carrying the C (risk) allele on child attachment In the group of children carrying the C (risk) allele (n = 45) n = 12 children (27%) showed unresolved attachment while n = 33 children (73%) displayed organized attachment in the group of non-risk allele carriers (n = 48) n = 6 children (12.5%) showed unresolved attachment and n = 42 an organized attachment (87.5%) In the subgroup of children with mothers that experienced CM (CM+ group) there was no significant effect of carrying the C (risk) allele on child attachment n = 6 children (37.5%) showed unresolved attachment while n = 10 children (62.5%) displayed organized attachment In the group of non-risk allele carriers (n = 25) n = 4 children (16%) showed unresolved attachment and n = 21 an organized attachment (84%) We observed a significant effect of the C (risk) allele on child D-score [F(1 indicating that children carrying the risk allele showed more disorganized behavior (M (SD) C (risk) allele carriers = 3.87 (2.20); M (SD) non-risk allele carriers = 2.67 (1.63)] during the SSP When we tested for effect modification by maternal CM+/ CM- we observed no significant interaction between maternal CM+/CM- and the rs2740210 SNP on child attachment [x2 (1 p = 0.97; M (SD) CM+/C (risk) allele carriers = 4.14 (2.40); M (SD) CM-/C (risk) allele carriers = 3.67 (2.10); M (SD) CM+/ non-risk allele carriers = 2.87 (1.74); CM-/ non-risk allele carriers = 2.44 (1.22)] Using the (correlational) results presented in the Supplementary section, we developed a model of ICM by adapting the model proposed by van IJzendoorn and Bakermans-Kranenburg (2019) Child outcome variables were child attachment (organized/disorganized) and child autonomic nervous system response (change in RSA) Other variables that were included in the model were maternal CM (CTQ sum score) maternal attachment representation (organized/disorganized) maternal caregiving (level of disruptive behavior) and child genotypes rs2254298 and rs2740210 The model showed a good fit to the data with good fit indices [x2 (28) = 25.50 The path analysis was repeated for the CM+ sub-cohort and also here the model showed good fit indices [x2 (28) = 25.50 Next, we report the results of the individual paths of the model (see also Figure 3) Figure 3. Extended empirical pathway ICM model based on the theoretical model for the intergenerational transmission of attachment by van IJzendoorn and Bakermans-Kranenburg (2019) shown in Figure 1 (CM to AAP): CM (CTQ) showed a positive and statistically significant association with the attachment representation (AAP) indicating that higher maltreatment was associated with a higher likelihood for unresolved attachment (β = 0.54 The same findings resulted from the CM+ subgroup analyses (β = 0.43 (CM to BSI): The analysis of the association between CM and psychological symptoms (BSI) revealed a significant effect (β = 0.29 which highlights a dose-dependent association between adverse life stress and psychological symptoms This finding was replicated in the CM+ subgroup (β = 0.28 (CM to PSSQ): A significant and negative association was found between maternal CM and the self-reported resources of maternal social support (β = −0.44 The finding was comparable to the results for the CM+ subgroup (β = −0.31 a significant and positive association was found between maternal CM and self-reported perceived maternal stress (β = 0.26 but no significant association in the CM+ subgroup (β = 0.14 (PSSQ to PSS14): The association between social support and self-reported perceived maternal stress was not statistically significant (β = −0.17 The finding was similar for the CM+ subgroup (β = −0.07 (PSS14 to BSI): Self-reported perceived maternal stress showed a positive and statistically significant association with psychological symptoms (β = 0.63 The finding was the same for the CM+ subgroup (β = 0.67 (BSI to AMBIANCE:) Psychological symptoms were not significantly related to maternal disruptive behavior (β = 0.15 this association showed a trend toward significance for the CM+ subgroup (β = 0.27 (AAP to AMBIANCE): Maternal attachment representation was not significantly associated with maternal disruptive behavior both in the total cohort (β = 0.13 p = 0.21) and the CM+ subgroup (β = 0.18 (AAP to SSP): Maternal attachment representation (organized/unresolved; AAP) showed a positive and statistically significant association with the child attachment pattern (organized/disorganized; SSP; β = 0.29 The finding was similar for the CM+ subgroup (β = 0.36 (AMBIANCE to SSP): Maternal disruptive behavior was not significantly associated with child attachment patterns (SSP) in neither the total cohort (β = 0.02 p = 0.86) nor the CM+ subgroup (β = 0.01 (AMBIANCE to RSA): Maternal disruptive behavior did not show a significant association with stress reactivity in children (change in RSA) in the total cohort (β = −0.16 this association showed a trend toward significance in the CM+ subgroup (β = −0.24 (OXTR rs2254298 genotype on RSA): Child rs2254298 OXTR genotype was not significantly associated with stress reactivity in children (change in RSA; β = 0.11 the association was significant in the CM+ subgroup (β = 0.43 (RSA on SSP): Children’s stress reactivity (change in RSA) was not significantly associated with child attachment (SSP) in neither the total cohort (β = 0.03 p = 0.76) nor the CM+ subgroup (β = 0.07 (OXTR rs2740210 genotype on SSP): Both in the total cohort (β = 0.14 p = 0.16) and CM+ subgroup (β = 0.15 p = 0.38) there was no significant association between the rs2740210 OXTR genotype and child attachment The present study tested and replicated a proposed model of the intergenerational transmission of attachment (van IJzendoorn and Bakermans-Kranenburg, 2019) and extended it by studying maternal CM experiences using data collected from a cohort of 158 mother–child dyads This innovative approach combined examining the role of the attachment system The prospective design provided a more comprehensive understanding of the intergenerational transmission of CM than previous studies and allowed us to determine potential protective factors that could help to disrupt intergenerational effects We now discuss our findings in relation to our hypotheses and their contribution to the literature This pattern was replicated in our sample for mothers exposed to CM The study explored the effects of maternal resilience The subgroup analysis for CM+ mothers demonstrated a robust association between organized attachment for mothers and children We suggest that maternal organized attachment despite having experienced CM acts as a protective factor for child attachment Moreover, we agree with the view by van IJzendoorn and Bakermans-Kranenburg (2019) that further studies should include other mediating factors as plausible candidates to explain the gap beyond parental caregiving like sensitivity such as support and examining the repair of mismatches in parent–child interactions highlighting the need to assess both social support and perceived stress to fully describe their resilience synergy in attenuating the effects of ICM An explanation for this discrepancy could be the application of different instruments for the assessments of social support and maternal caregiving quality indicating that the rs274021 polymorphism interacts with maternal behavior to predict the development of psychiatric symptoms in children we could not find evidence for the interaction between early environmental stressors and the rs2740210 polymorphism on child disorganized behavior We suggest that future research should include biological factors with more attention since this information might be one explanatory factor for the heterogeneous findings reported in stress and attachment-related research The physiological impact of rs2254298 and rs2740210 on the regulation of the oxytonergic system and its reactivity upon stress needs centered investigation for example in saliva samples collected from mothers and children during the SSP could provide important biological insights further strengthen the necessity to co-assess SNPs within NR3C1 in the context of stress and attachment-focused research hypothesis-free approaches using genetic data could help to identify the physiological underpinnings of different attachment-based stress responses genome-wide association studies could be used These studies require much larger samples sizes which is a bottleneck for such a methodological approach Results of our path analysis confirmed results from the above-summarized literature: self-reported history of CM was associated with unresolved maternal attachment representation (all mothers with unresolved attachment representation have a history of CM) CM significantly affected the number of psychological symptoms the degree of perceived social support in both our total cohort and subgroup of mothers with CM CM influenced the degree of maternal perceived stress in the total cohort only Maternal perceived stress had a significant influence on psychological symptoms This implies that CM had an impact on mothers concerning several aspects relevant for caregiving within the intergenerational transmission of attachment and ICM that especially in the subgroup of mothers exposed to CM psychological symptoms affected maternal caregiving (disrupted behavior) this finding should be interpreted with caution The expected main attachment findings within our ICM model demonstrated that maternal attachment representation was highly associated with child attachment maternal disruptive behavior was not related to child attachment but showed a trend toward significantly influencing the stress reactivity in children in the subgroup of mothers with CM the genetic factor rs2254298 OXTR genotype showed an effect on the cardiac stress response in children that in mother–child dyads with a higher maltreatment load (CM+) the genetic predisposition had an impact on the child’s autonomic nervous system reactivity during the SSP The complexity and transdisciplinary approach in the present study examining the three systems –attachment and child biological susceptibility – adds to this literature by identifying relevant risk and protective factors in the ICM model: we confirmed a significant positive association between maternal disruptive behavior and disorganized behavior of the child there was a significant association between maternal disruptive behavior and their child’s autonomic nervous system response more disruptive behavior was related to a higher increase in HR maternal disruptive behavior was an expected risk factor for the child on a behavioral and biological level we could not confirm a significant effect of perceived social support on maternal caregiving quality which might be explained by the differential assessment of maternal caregiving quality mothers with high disruptive behavior requested institutional support more frequently than mothers with low disruptive behavior Our examination of the genetic variability within the OXTR gene (rs2254298) revealed a significant influence on the cardiac stress response of children from CM+ mothers; however this observation could not be replicated in the total sample we confirm a gene × environment interaction of maternal CM and the rs2254298 polymorphism and showed that the A (risk) allele is a risk factor for the cardiac stress response in the context of ICM we could show that children carrying the C (risk) allele displayed more disorganized behavior during the SSP the current study combined a multi-systems approach to understanding risk and buffering factors that demonstrate resilience in mothers who have experienced CM and factors that can interrupt developmental risk in their children We followed a two-step approach in the analyses of this manuscript we intended to replicate core findings from the literature regarding intergenerational paths in the transmission of CM we recruited a cohort of women who very recently became mothers from the population of Ulm Various effects might have led to discrepancies between results from single analyses vs the availability and consistency of data (sets) used in the analyses slightly differ We want to stimulate more research in this field also using our extended path to test the robustness of our initial findings reported here as well as by adding additional future variables that might help to better understand and disentangle intergenerational transmission of CM Our results are constrained by several limitations including the relatively small sample size Non-significant results might be the results of the relatively small number of participants The mothers in our study also had a relatively low CM load limiting the general validity of our findings highlighting the importance of replication in larger cohorts with more pronounced CM load The current findings further advance our understanding of risk and vulnerability factors and enable professionals to target and offer adequate services to parents and children at risk We would like to highlight the role of the OXTR as an important mediator of stress transmission from mother to child Future studies should explore the reactivity of the oxytocinergic system in mother–child dyads in the context of maternal attachment and ICM The consideration of genetic risk and resilience factors in future work could open the gate toward personalized and therefore more tailored treatment approaches The identification of more vulnerable groups based on OXT(R) genotypes could help to implement more tailored clinical interventions pharmacological treatments targeting the oxytocinergic system might improve stress-regulatory function One rather neglected feature in the context of ICM includes the role of paternal attachment as a potential risk or resilience factor and should be co-assessed in future studies The original contributions presented in this study are included in the article/Supplementary Material further inquiries can be directed to the corresponding author The studies involving human participants were reviewed and approved by Local Ethics Board at Ulm University Written informed consent to participate in this study was provided by the participants’ legal guardian/next of kin and HG conceptualized the design of the study UZ had the lead for the assessment of the child attachment data and mother-child interactions CW for the child cardiovascular assessments AK for the assessment and analyses of the genetic data AB for the assessment of the maternal attachment interviews (AAP) rated the AAP interviews together with a certified judge and wrote the manuscript with contributions from all co-authors UZ and AB were responsible for organizing the conduction of the statistical analyses by external experts see section “Acknowledgments” and HK conceptualized the manuscript design All authors approved the final version of the manuscript The project TRANS-GEN was funded by the German Federal Ministry of Education and Research BMBF (funding number: 01KR1304A) and was conducted between 2013 and 2016 The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be 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Volume 10 - 2016 | https://doi.org/10.3389/fnhum.2016.00548 This article is part of the Research TopicNeuroscience of Human AttachmentView all 16 articles there has been an increase of experimental research on automatic unconscious processes concerning the evaluation of the self and others Previous research investigated implicit aspects of romantic attachment using self-report measures as explicit instruments for assessing attachment style There is a lack of experimental procedures feasible for neurobiological settings We developed a reaction time (RT) experiment using a narrative attachment measure with an implicit nature and were interested to capture automatic processes when the individuals’ attachment system is activated We aimed to combine attachment methodology with knowledge from implicit measures by using a decision RT paradigm This should serve as a means to capture implicit aspects of attachment This experiment evaluated participants’ response to prototypic attachment sentences in association with their own attachment classification measured with the Adult Attachment Projective Picture System (AAP) First the AAP was administered as the standardized interview procedure to 30 healthy participants which were classified into a secure or insecure group both experimenter and participants were blind with respect to classifications One hundred twenty eight prototypically secure or insecure sentences related to the eight pictures of the AAP were presented to the participants reject) a continuous security scale was defined Both the AAP classification and security scale were related to the RTs Differentiated study hypotheses were confirmed for insecure sentences which were accepted faster by participants from the insecure attachment group (or with lower security scale) and rejected faster by participants from secure attachment group (or with higher security scale) The elaborating unconscious processes were more activated by insecure sentences with potential attachment conflicts The introduced paradigm is able to contribute to an experimental approach in attachment research The RT analysis with the narrative procedure might be of interest for a broader variety of questions in experimental and neurophysiological settings to capture unconscious processes in association with internal working models of attachment An electrophysiological model based on preliminary research is proposed for assessing the preconscious neuronal network related to secure or insecure attachment representations and assess attachment representations (secure insecure-preoccupied and unresolved trauma) based on the analysis of discourse patterns of verbatim transcripts Interview discourse analysis is less concerned with a specified response (as compared with attachment style measures) as how experiences and feelings are described In a very recent fMRI study, Yaseen et al. (2016) investigated the comparison of brain activity correlating with self-report (Relationship Scales Questionnaire a narrative attachment measure (AAI) during conscious appraisal of an attachment figure Interestingly the two measures elicited different brain responses While the AAI appeared to disproportionately correlate with conscious appraisal associated activity in Default Mode Network (DMN) and subcortical structures the RSQ seemed to tap Executive Frontal Network (EFN) structures more extensively “core-self”-related processes while the RSQ assessed higher-order cognitions involved in attachment The authors recommended in their conclusions that the AAP might be an appropriate alternative in this kind of research since this measure consists of a set of pictures feasible to present during an experimental setting This attachment experiment was a first attempt to assess a combination of conscious and unconscious processes in a self-report perception task we sought to improve on this approach by using this methodology in a reaction time (RT) paradigm The research question was to examine if the RTs differed with respect to an individual’s attachment representation in order to provide a paradigm to use in a neurobiological setting RT research has a long experimental tradition in psychology, beginning with the experiments by Helmholtz (1850). Helmholtz was interested in the time relations structured by the nervous systems of living beings not just from a physiological but also from a psychological point of view. In fact, at the time at which he performed his time experiments in frogs, Helmholtz carried out similar studies in human beings (Schmidgen, 2002) RT experiments are relatively inexpensive to execute and results are easy to obtain, even though the conclusive interpretations are still under discussion. According to Harris et al. (2014) RT experiments have become a standard paradigm for measuring behavioral reactions without taking into account underlying mental processes. Harris et al. (2014) suggested a sophisticated way to improve the analysis and interpretations of RT paradigms we use the term “unconscious” in association with the internal working models of attachment and “preconscious” when relating to information processing theory or neurobiological models There are several recent studies investigating implicit aspects of romantic attachment using self-report measures as explicit instruments for assessing attachment style (Marks and Vicary, 2015; De Carli et al., 2016) we were interested to capture automatic processes in the moment the attachment system is activated by using a narrative attachment measure with an implicit nature The AAP is designed to activate the individual’s attachment system and emphasizes the evaluation of unconscious defensive processes in the narratives we intended to combine attachment methodology with knowledge from implicit measures by using a RT paradigm The general question for this study addressed how a person accepts or rejects prototypic sentences belonging to the two major attachment categories (secure and insecure) using a modified version of the AAP (Buchheim et al., 2009) in a RT paradigm All participants were administered the standard AAP interview before the experiments started in order to assess their individual attachment representation The participants did not get any information about their attachment representation during the whole assessments The experimental design is described in the “Materials and Methods” Section in detail participants were presented pictures from the AAP accompanied with sentences representing different attachment patterns while assessing how long it took for them to make a decision (i.e. (1) We expected that participants would accept the prototypic sentences from the experiment more frequently when these sentences match with their own adult attachment classification (2) We expected group differences in reaction speed between participants with secure or insecure adult attachment classification assessed in the previous AAP interview These expectations were differentiated for four possible configurations of the stimulus (secure (2a) secure sentences will be accepted faster by securely attached participants (2b) secure sentences will be rejected faster by insecurely attached participants (2c) insecure sentences will be accepted faster by insecurely attached participants (2d) insecure sentences will be rejected faster by securely attached participants (3) The preference of secure or insecure prototypes in the experimental procedure was expressed by the continuous Adult Attachment Projective Relationship Choices Version 2 (AAP-RC) security scale (see below) We expected following correlations of the security scale with the reaction speed: the higher the security scale (3a) … the faster the acceptance of secure sentences (3b) … the slower the rejection of secure sentences (3c) … the slower the acceptance of insecure sentences (3d) … the faster the rejection of insecure sentences The AAP (George and West, 2012) assesses the attachment status in adults using a standardized set of eight picture stimuli The stimuli are line drawings that include a warm-up scene and seven attachment scenes of individuals in conceptually-defined attachment situations Four so called “alone pictures” depict scenes of a single person with no other persons visible in the picture Three so called “dyadic pictures” depict scenes of two or more persons in a potential attachment dyad The scenes portray characters in different age groups across the life span (e.g. The drawings contain only as much details necessary to connote the situation Features indicating details such as emotion Stimulus presentation is standardized so as to introduce increasingly distressing attachment scenes Participants are asked to tell a story to each picture using a standardized set of instructions: “What is going on in the picture what are the characters thinking or feeling and what might happen next.” AAP administration is done in person on an individual basis in a quiet location with no distraction and typically takes 30 min The stories are audio-recorded and analyses are done from verbatim transcripts cognitive disconnection (close attention to and confusion by attachment) and segregated systems (attachment fear and dysregulation) Buchheim et al. (2009) developed and used the first experimental adaption of the AAP in a double-blind placebo-controlled within-subject experimental design These researchers developed the AAP-RC stimulus set which is comprised of a set of statements that represent attachment-related sentences that describe the AAP picture stimuli The statements were schematic descriptions of secure as determined by two expert AAP judges (AB CG) who collectively had experience with over 300 AAP transcripts Attachment statements described common story response situations The study compared participant responses to the statement in an oxytocin and a placebo condition The eight AAP picture stimuli were presented over four sequences always presented in each sequence in the standardized order Each of the 32 picture presentations was accompanied by four prototype phrases each of them representing one of the four established attachment categories The participants were instructed to rank these phrases from the most to the least appropriate for each presentation The phrases were presented in a randomized balanced sequence in order to minimize simple memory effects across test sessions The experimental procedure consisted of 128 such screen sequences Examples of prototypical sentences from the Adult Attachment Projective Relationship Choices Version 2 (AAP-RC 2.0) instrument One of the 128 screen sequences presented in the course of the experimental procedure In the current study in the context of a diploma thesis (Wichmann, 2011 we first administered the AAP and next presented the AAP-RC 2.0 We conducted an Attachment Reaction Time analysis (ART) for the experimental condition The AAP was administered by a trained interviewer (TW) AAP verbatim protocols were coded by a certified AAP judge (AB) The structure of the administration procedure was as follows: the entire series of AAP picture stimuli were presented 16 times and each series was composed of eight pictures in the standardized AAP administration order Each picture presentation was accompanied by one stimulus sentence which was related to one of the four attachment representations The experimental procedure contained a measure for the individual responses (yes/no) to the prototypical sentences and the recorded RTs The interview and the experimental task took place in the same office. The experimental condition was conducted using a computer. The computer was a table mounted Dell computer with no internet-connection and no additionally installed software. The program used for the presentation and RT measurement was E-Prime (Schneider et al., 2002) Room lighting was artificial and participants sat 0.5 m from the monitor Answer responses were given via the computer keyboard At the beginning of the experiment the participants were told to put the index fingers of their hands on the keys: Y for “yes” and the key N for “no” The participants had to press a key to move on with the task A short practice task was given before to ensure that the participants had understood the task The practice task included three attachment neutral stimuli with drawings produced in a style similar to the AAP pictures All instructions were given on the computer screen and explained a second time after the test run Task scores are based on counts of agreements and rejections by four attachment representations Schema of evaluation of the AAP-RC 2.0 by a test person Participants were asked for voluntary participation The sample was comprised of 30 students from the University of Innsbruck (17 women The participants reported no neurological conditions and were not in psychological or psychiatric treatment The study was conducted according to the Helsinki Declaration with informed consent received from all participants The reported results concern three methodical approaches: the AAP attachment classification assessment; the computerized experimental method AAP-RC; and the ART experiment The results first describe the findings associated with each of the measures used in the study and second report the relations among them The attachment classification distribution was as follows: 10 (33%) F Because of the small frequencies in especially the preoccupied and unresolved groups insecure classifications were collapsed together and data analyses compared only secure (n = 10 Reactions to AAP-RC stimuli in the ART test were coded dichotomously as yes (endorsement, acceptance) or no (rejection). The frequencies a, b, c, d shown in Table 2 represent numbers of accepted sequences belonging to the four attachment prototypes The sets of 32 dichotomous items related to the attachment prototypes F as well as the joint set of 96 insecure type items can be understood as a scale in the psychometric sense These values of Cronbach α were satisfactory for the secure scale (0.77) for the U scale (0.82) for the joint insecure scale (0.88) they were not satisfactory for the Ds scale (0.64) and for the E scale (0.66) The correlation structure was investigated by means of the item-scale correlations and corrected item-scale correlations The correlation structure was satisfactory for the system of two scales it was not satisfactory for the more detailed system of four scales F Guided by the referred psychometric results, we have decided to base the analyses of AAP-RC on the secure-insecure dichotomy. In respect of this aspect we have defined a security index expressing the degree of security vs. insecurity by the formula (see Table 2): a/r = a/(a + b + c + d) The index is a proportion of accepted secure sentences related to all accepted sentences ranging from 0.00 (completely insecure) to 1.00 (completely secure) By the random answering independent of sentence prototype The analogously constructed complementary insecurity index (b + c + d)/(a + b + c + d) is mathematically redundant; summing up to one the following analyses utilize the security index as a central measure The program E-Prime stored the dichotomous reaction and the needed RT in milliseconds The hierarchically structured data sample consisted of 30 persons × 128 sentences = 3840 pairs of reactions and RTs Figure 2A: the average RT was about 1 s, ranging from 0 up to 15 s; exact values of measures and statistics see in Table 3 As commonly experienced by the duration time data the distribution was skewed and its normality was rejected by the Kolmogorov-Smirnov test (A) Original observation (range 0–15 s) Kolmogorov-Smirnov test of normality of the reaction time (RT) distribution Figure 2B: this was the case after applying the frequently recommended logarithmic transformation. Additional problems were caused by some extreme outlier values. Similarly, other transformations considered by Harris et al. (2014) did not lead to satisfactory results in this case Figure 2C: transformation based on quantiles in the total pooled sample of 3840 measurements resulted in a close approximation to the normal distribution; the variable was transformed by the linear function s(z) = 50–10z The resulting variable is interpreted as the speed of the reaction there were striking differences in the RTs between the 30 study participants on an average ranging from 0.32 s up to 2.41 s The reaction speed differed significantly by ANOVA (F(29,3810) = 74.17 p < 0.001; η2 = 0.36); a considerable portion of measurement variance was explained by the individual basic reaction speed Figure 2D: in regard to excluding the bias by individual basic reaction speed, we have normalized speed values intra-individually. The RTs for a test person were replaced by ranks 1 for the slowest reaction to 128 for the quickest one, and transformed to the s (speed) values according to the quantiles of the normal distribution N(50,10)1 the density curve of the obtained empirical distribution is less smooth than the previous one it is very close to the normal distribution N(50,10) and its normality in the sample of 3840 observations was not rejected by the exact Kolmogorov-Smirnov test The tests of study hypotheses (correlations t-tests) were based on the last described intra-individually normalized speed values The N = 3840 single values were aggregated to the intra-individual means for each of N = 30 study participants the following four aggregated values were relevant: speed of “yes” reactions to secure sentences; speed of “no” reactions to secure sentences; speed of “yes” reactions to insecure sentences; and speed of “no” reactions to insecure sentences The convergent validity of the AAP-RC security index was examined by its comparison with the secure and insecure attachment classifications (Figure 3) Mean of the AAP-RC security index in the secure group (n = 10 SD = 0.105) was greater than the mean in the insecure group (n = 20 SD = 0.087); this difference was significant according to the two-sided two-group t-test: t(28) = 3.866 Cohen’s d = 1.50 indicated a strong effect Adult attachment projective relationship choices version 1 (AAP-RC) security index in attachment groups by AAP 8 of 10 secure participants and 16 of 20 insecure participants were recognized correctly; the prediction was successful in 80% of cases in both groups the set of 128 measurements was divided by sentence prototype stimulus (secure insecure) and his/her answer reaction (yes as described above (see “Adult Attachment Reaction Time (ART): Reaction Time Analysis” Section) the intra-individual mean values of speed were computed resulting in the speed values of the following four stimulus-reaction combinations: (1) accept secure sentences; (2) reject secure sentences; (3) accept insecure sentences; and (4) reject insecure sentences These computations were based (a) on all 128 sentences and alternatively; (b) on 64 sentences relating to the alone pictures; and (c) on 64 sentences relating to the dyadic pictures These speed variables were compared by ANOVAs for 2 × 2 repeated measures in the whole sample of N = 30 participants. Results of analyses based on all, alone and dyadic stimuli are shown in Table 4: (a) The analysis based on the complete material has shown that the interaction of sentence prototype and answer was significant (p = 0.011) participants answered more quickly to “yes to secure” and “no to insecure” and more slowly to “no to secure” and “yes to insecure” It means that the “secure-conform” answers were given more quickly than “insecure-conform” ones none of the three ANOVA effects was significant the interaction effect (p = 0.005) and the main effect sentence prototype (p = 0.020) were significant The highest speed was observed for the combination “yes to secure”; the lowest speed and hence the highest time needed to answer was observed for the combination “yes to insecure” Speed of yes/no answers to secure/insecure prototype sentences The four speed variables (1–4) described in “Reaction Time to Accept or Reject Secure or Insecure Prototype Sentences” Section were compared between secure and insecure AAP attachment classification groups. As shown in Table 5 the significant group differences were found for “RC-insecure” prototype sentences: The insecure participants accepted the RC-insecure sentences more quickly than the secure participants The secure participants rejected the RC-insecure sentences more quickly than insecure participants Speed of answers in participants with secure and insecure attachment according to the AAP classification The first result was also confirmed for both subsets of alone and dyadic sentences The second result was confirmed for sentences connected to the dyadic pictures the differences between the secure and the insecure attachment group according to the AAP were significantly manifest for the RC-insecure sentences The AAP-RC security index (see “Relationship Choices, version 2.0 (AAP-RC): Psychometrical Analysis and Security Index” Section) ranges from completely insecure (0.0) to completely secure (1.0) reactions to the 128 stimuli. The correlations of the AAP-RC security index with variables concerning the reaction speed by four stimulus-reaction pairings are shown in Figures 4A–D Correlations between AAP-RC security-insecurity index and reaction speed (A) The RT speed of acceptance of secure sentences (Figure 4A) was not significantly correlated with the security index; according to ART both rather securely or insecurely attached persons reacted comparable quick in this case (B) The rejection speed of secure sentences (Figure 4B) was negatively correlated with the security index; the rather insecurely attached persons rejected the secure sentences more quickly (C) The acceptance speed of insecure sentences (Figure 4C) was negatively correlated with the security index; the rather insecurely attached persons accepted the insecure sentences more quickly (D) The rejection speed of insecure sentences (Figure 4D) was positively correlated with the security index; the rather securely attached persons rejected the insecure sentences more quickly Summarizing, the results of the experiment—especially for insecure prototype sentences—indicate a consistency between the attachment preferences and the higher speed of the corresponding reaction. The complete results of the experiment are summarized visually in Figures 4A–D which underlines the consistency of the different results Bowlby (1980) proposed that inner working models of attachment function automatically and outside of conscious awareness. RT analyses are a way to observe the implicit automatic reactions. Pietromonaco and Barrett (2000) recommend the use of implicit measures like RTs to capture the unconscious parts of attachment which are obscured when relying on self-report measures Therefore we chose a narrative attachment measure designed to elicit unconscious elements by focusing on defensive processes Our results reflect that implicit methodology can bring new and interesting insights in attachment related processes in the domain of neuroscience of human attachment Participants in our study were tested in an attachment RT experiment using the AAP picture stimuli accompanied by prototypic sentences representing different attachment representations (AAP-RC) Participants were not informed about their attachment classification prior to beginning the experimental session; therefore their reaction to the sentences was considered to be automatic and outside of conscious appraisal (i.e. We hypothesized that the participants would accept the prototype sentences in the attachment RT paradigm: (1) more frequently; (2) more quickly when sentences matched with their own representations of attachment classification; and (3) that this would correspond with their attachment prototype preferences in the RT experiment (ART) Overall most of our expected results were confirmed for secure vs The distribution of attachment classifications in our sample showed an overrepresentation of dismissing participants as compared to the distributions in samples with healthy controls (Bakermans-Kranenburg and van Ijzendoorn, 2009) one caveat of our study is that we did not have a representative distribution of attachment classifications The consequence was that data analyses for separate attachment groups was not possible and we were confined to comparisons of participants with secure and insecure attachment representations This remains a challenge for our next studies Given that participants did not know their own attachment classifications by the standard AAP procedure we can assume that they were not guided by informed conscious appraisals of attachment while evaluating the prototype sentences The fact that the different measures showed a considerable convergence supports the conclusion that we were able to capture both conscious and unconscious automatic reactions to attachment related stimuli The average RTs differed significantly between the study participants The considerable portion of variance of the originally measured RTs is explained by the individual basic speed of reactions to the presented stimuli This empirically found fact can be caused by different plausible reasons like overall speed or slowness of mental processes of the subject extended rational reasoning on the presented sentences or intensive imagination triggered by them However the authors pointed out that their attachment measure was a self-report instrument that captured explicit thoughts only However a notable strength in our study is that we used a free-response narrative attachment assessment measure which seems to be more appropriate for this kind of experimental approach because of its implicit nature Yet the role of social desirability should be clarified in future studies that all participants in our study accepted the prototype secure sentences faster than insecure prototypes there were significant differences between the two adult attachment groups Secure participants accepted more prototype secure sentences and showed faster RTs than insecure participants Insecure participants accepted more insecure sentences and did so faster than secure participants This result underscores the presence of automatic unconscious detection and appraisal processes when responding to attachment relevant information Parallel patterns were found in the AAP-RC with the RTs in the experiment Participants with higher preference for secure prototype secure sentences rejected insecure sentences more quickly Participants with higher preference for insecure prototype sentences accepted insecure sentences more quickly and rejected secure ones more quickly Our differential hypotheses addressed secure and insecure prototype sentences and we confirmed all hypotheses concerning the insecure prototypes In other words: “accept secure and reject insecure” goes fast and “reject secure and accept insecure” goes slow It seems that the “insecure-type” reactions demand more time Our findings are in line with those of Vrtička et al.’s (2012) study of attachment style These researchers used an explicit choice paradigm and found distinct effects of attachment avoidance and anxiety on subjective emotional judgments Their results supported the assumption that anxious attachment is associated with a hyperactivating tendency for the appraisal of social threat but may also involve an ambivalence influencing the judgment of information their results support thinking that proposes that insecure attachment seems to need more mental elaboration time Therefore we could have assumed in our study that individuals with preoccupied attachment representations associated with heightened emotional reactivity would show different RT patterns compared to dismissing individuals characterized by deactivating attachment related emotions This important differentiation should be the next step in future studies with a larger sample size According to previous research with the AAP we might have also expected particularly differentiated results for the analyses based on “alone pictures” compared to “dyadic” ones. Alone pictures represent scenarios of emptiness and loneliness and seem to elicit high affective arousal in participants (Buchheim and George, 2011) However the results of the present study showed that insecure individuals needed longer elaboration times confronted with the dyadic pictures This type of sentences (like in the AAP picture of the couple in the scenario “departure”) represents explicit attachment related scenarios between two or more persons (potential separation We might conclude that insecure individuals needed more elaboration time for processing these attachment related conflicts The observed differences should be verified in further investigations using a larger sample high security index scores were associated with prompt rejection of insecure prototype sentences Lower security index scores were associated with prompt acceptance of insecure sentences Some other hypotheses could not be confirmed significantly; there were no contrary findings nevertheless We might have demonstrated that the secure vs insecure attachment classification groupings could be observed with the implicit measure by observing the activation of inner working model in “real time.” Our results support the conceptualization of inner working models of attachment as guiding attention and interpretation outside of conscious awareness and the coherency of the association between mental representation and interpretation of attachment situations (Bowlby, 1980) The more operations are needed for the problem solution The time needed for the problem solution might then constitute an operationalization of the problem complexity and depends on numerous biasing factors Human processing time consists of the individual’s basal or momentary reaction speed including external disturbing influences The data-analytic procedure proposed in this article was designed with the aim to be robust against the mentioned biasing factors and could be a fruitful additional approach in an EEG analysis when using a similar paradigm The size of our sample of 30 participants was sufficient for the experimental investigation of the RT phenomena The number of 128 attachment prototype sentences was considerably larger than the sample size; this circumstance limited the use of more advanced psychometrical analyses (e.g. the sample sizes and the distribution of four particular attachment groups led us to the decision to confine the analyses to the two basic attachment classifications secure and insecure insecure analyses are often chosen as a comparison in the field of attachment However as we discussed it would have been valuable to differentiate the insecure attachment groups and the individuals’ RTs This aspect should be tested in further research In sum the present study served as a pilot study to test its feasibility in healthy participants. The next steps are the application of the RT experiment in clinical studies with a larger sample. Moreover, the AAP measure is constructed and validated for adults and adolescents only, so the application is limited to that age group and not feasible for children, where other measures should be used, like the Separation Anxiety Test (Klagsburn and Bowlby, 1976) the study has shown that the concept of immediate reactions to stimulus sentence could be beneficial for experimental attachment research contributing to measure the intensity of unconscious processes empirically we intend using psychometric procedures to continue and improve the development of the AAP-RC instrument in order to implement it in a neurobiological setting we have seen that stimuli with more distressing attachment content might need a longer RT for its elaboration than stimuli with more harmonious content Future studies need to replicate these findings using larger samples A further next step is to adapt the experiment for an EEG setting which could give further insight into the neural mechanisms of potential response delays during an implicit task In a very recent study by Leyh et al. (2016) the association between maternal attachment representation and brain activity (ERPs) underlying the perception of infant emotions was examined Securely attached mothers recognized emotions of infants more accurately than insecurely attached mothers ERPs yielded amplified N170 amplitudes for insecure mothers when focusing on negative infant emotions Secure mothers showed enlarged P3 amplitudes to target emotion expressions of infants compared to insecure mothers especially within conditions with frequent negative infant emotions P3 latencies were prolonged in insecure mothers One potential limitation of attachment research of preconscious perception with the help of the early brain potentials so far might be the predominant focus on face processing as the stimulus material Neural processing in secure and insecure subjects were not examined by attachment related material directly linked to the individuals’ own attachment representations using a paradigm where spontaneous preferences had to be given in a defined time frame In their studies it is even greater for nudes than to faces Overall N170 seems to be an indicator for the preconscious individual importance of visual stimuli Finally the analysis of P300 component—an indicator for emotional operations—might reveal interesting results (Nieuwenhuis et al., 2005; Schupp et al., 2007; Flaisch et al., 2008). However, assuming that P300 is a correlate of conscious perception (Dehaene et al., 2006) more early EEG components like cited above should be considered first to capturing modes of more unconscious processes In sum these neurophysiological and the other cited attachment studies investigating implicit aspects of romantic attachment using self-report measures as explicit instruments for assessing attachment style (Marks and Vicary, 2015; De Carli et al., 2016) suggest that early visual and auditory stimuli could be used as a change detector of emotionally preferred stimuli transposed to our tested and validated AAP RT paradigm we would expect that the specific (secure or insecure) attachment system paves the way for a specific ERP higher amplitudes or shorter latencies of the N170 or P300 to individual preferred stimuli which represent the own attachment representation One advantage of our paradigm would be to use attachment related material linked to the individuals’ inner working models of attachment in a RT setting This might extend previous studies in healthy samples and may provide some feasibility for clinical studies The measures based on RT reflect the overall activity of the brain needed for the elaboration of different stimuli The results of the referred study suggested that the overall time needed for the processing of “unpleasant” discomforting stimuli was higher than for “pleasant” The fact that RT showed convergence with the individual’ inner working model of attachment in our study has the potential to contribute to the validity of neurobiological experiments Therefore RT analysis with the proposed evaluation procedures might be of interest for a broader variety of questions concerning attachment in experimental and neurophysiological settings to capture automatic unconscious processes in association with internal working models of attachment The attachment experiment was developed by AB The study setup and data collection were organized and conducted by TW Coding of attachment interviews were conducted by AB DP performed the statistical data analysis and contributed substantially to the result interpretation DP developed the statistical procedure for RT analyses IS and AB provided important intellectual contribution in commenting and revising the manuscript DP and TW wrote major parts of the manuscript and edited its final version The publication is funded by the Faculty of Psychology and Sports Science Austria; Research Funding for Young Scientists This would not have been possible without the support of many colleagues Many thanks also to Florian Juen and Ann-Christine Jahnke-Majorkovits for rating the diverse attachment sentences and to Stefan Fischer for methodological advice at the beginning of the study Adult Attachment Projective Picture System; AAPRC Adult Attachment Projective Relationship Choices Version 1; AAPRC 2.0 Adult Attachment Projective Relationship Choices Version 2; ART Bakermans-Kranenburg The first 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system George C and Pokorny D (2016) A Reaction Time Experiment on Adult Attachment: The Development of a Measure for Neurophysiological Settings Received: 24 June 2016; Accepted: 14 October 2016; Published: 02 November 2016 Copyright © 2016 Wichmann, Buchheim, Menning, Schenk, George and Pokorny. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) distribution and reproduction in other forums is permitted provided the original author(s) or licensor are credited and that the original publication in this journal is cited † These authors have contributed equally to this work. Volume 9 - 2015 | https://doi.org/10.3389/fnhum.2015.00079 In recent years research on physiological response and frontal electroencephalographic (EEG) asymmetry in different patterns of infant and adult attachment has increased We review research findings regarding associations between attachment classifications and frontal EEG asymmetry the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenocortical axis (HPA) Studies indicate that insecure attachment is related to a heightened adrenocortical activity heart rate and skin conductance in response to stress which is consistent with the hypothesis that attachment insecurity leads to impaired emotion regulation Research on frontal EEG asymmetry also shows a clear difference in the emotional arousal between the attachment groups evidenced by specific frontal asymmetry changes we discuss neurophysiological evidence of attachment organization and present up-to-date findings of EEG-research with adults Based on the overall patterns of results presented in this article we identify some major areas of interest and directions for future research we can assume that despite they are theoretically related attachment style and developmental attachment patterns are not the same constructs it can be assumed that a secure attachment buffers physiological reactivity in response to stressors as these individuals can balance exploration and attachment they are more open in their emotional expressions and they can use attachment figures as a safe haven insecure attachment is related to deficits in emotion regulation as they either deactivate attachment distress (in case of the avoidant/dismissing group) or they show low autonomy and feelings of anger (ambivalent/preoccupied group) Thus it is expected that these individuals show a heightened physiological reactivity in response to attachment-related stressors The disorganized/unresolved group demonstrate a breakdown of defensive and coping strategies suggesting that they might display the highest physiological arousal These study results suggest that there is an association between the regulation of approach and withdrawal mechanisms within the prefrontal cortex and attachment dependent emotion regulation In line with the aforementioned hypothesis on physiological correlates we expect clear differences in the emotional arousal between the attachment groups evidenced by specific frontal asymmetry changes In this review we report on participants’ reaction to scenarios involving behaviors that are relevant for attachment purposes like sequences of separation and reunion Furthermore we discuss reactions as a function of an individual’s attachment classification In the following paragraphs we summarize studies on cardiovascular and galvanic skin response adrenocortical activity and EEG asymmetry for the different attachment classifications across the life span Especially during episodes of affect and vocal synchrony infant and maternal heart rate increased similarly compared to non-synchronous moments Beijersbergen et al. (2008) did one of the few studies that investigated physiological reactivity in adolescents during the AAI and a family interaction task Dismissing adolescents did not seem to be more stressed than secure adolescents in the AAI as indicated by their cardiovascular response The authors assume that they are probably less open to the challenge of the AAI and can cope with the interview in a somewhat superficial manner they exhibited an increased heart rate and electrodermal activity during the direct interaction task with their mother when trying to find a consensus in an area of disagreement indicating that it seems impossible for them to be uninvolved in direct interaction Until now it is still unclear how much intensity would be needed to cause dysregulation Furthermore, it is suggested that adrenocortical activity is also influenced by the quality of the caregiver (Gunnar et al., 1992; Spangler et al., 1994). For example, Schieche and Spangler (2005) explored the influence of maternal behavior infant-mother attachment and inhibition of exploratory behavior on the cortisol level during a problem-solving task in toddlers elevated cortisol was associated with low task orientation and exploration in infants These characteristics were in turn related to low supportive maternal presence and a reduced quality of maternal assistance during the challenge task In line with other findings adrenocortical activation was not found in infants with low inhibition in exploratory behavior those with a secure attachment classification showed the usual circadian pattern a decrease in cortisol from task onset to 30 min after the task Disorganized infants displayed increases in cortisol that were significantly different than changes elicited during the free play task These differences were not found in the organized attachment groups which support the hypothesis that adequate maternal care buffers an infant’s stress reactivity Even though these preliminary studies offer exciting data of the effects of maternal care on an infant’s stress response it will be important for future research to examine what particular aspects of maternal care are associated with adrenocortical response to stress Their results indicate that an avoidant attachment style in both partners leads to an increase in woman’s cortisol response during the conflict interaction task The authors argue that the mutual avoidance makes it difficult for the partners to negotiate their conflict and the woman’s sense of responsibility for doing it might generate a stress response even though she appears disengaged One explanation for this result might be that hypervigilant strategies lead to anticipatory stress appraisals for upcoming events and an inability to downregulate subjective and physiological response All of the aforementioned studies employed self-report questionnaires to assess attachment style There is only one study by Rifkin-Graboi assessing attachment and HPA activity using the AAI This study investigated relations between attachment and cortisol levels during daily life and interpersonal laboratory challenges wherein college aged men were asked to respond to hypothetical situations concerning separation Results show that dismissing subjects show comparatively higher cortisol during the challenges than the other attachment groups current research still lacks data on unresolved attachment status in adults These findings suggest that right frontal activation might be associated with a lower threshold for the expression of negative affect might be associated with a higher threshold and a disposition to express more positive emotions Dawson interpreted these results as the intensity the children were experiencing and also as a reaction of the prefrontal cortex to dysregulation As the intensity of the attachment increased children with that attachment representation tend to over react They measured ERP during an affective oddball paradigm in which participants viewed positive The authors found that avoidantly-attached adults displayed a bias towards more neural activation in response to negative images suggesting a greater motivational relevance of negative stimuli From an attachment perspective their favoring of negative over positive social stimuli could be a reason for their interpersonal withdrawal In contrast to them anxiously-attached adults demonstrated a bias towards neural activation in response to positive images which appears to be related to a greater motivational relevance of positive stimuli The behavior of striving for interpersonal closeness in anxiously-attached individuals might be reflective of their motivational balance favoring positive social stimuli Compared to the two insecure attachment groups the secure groups did not favor either positive or negative categories the larger face-elicited P1 in the insecure group might suggest a general state of higher vigilance and the larger N170 when viewing negative face stimuli might relate to their proneness to a negative bias The dismissing mother showed significantly stronger left hemisphere activation across all image types whereas the preoccupied mother displayed significantly stronger right hemisphere activation for all images except the neutral ones during which the activation in both hemispheres did not differ The mother with the secure pattern of attachment showed greater left hemisphere activation for all but parental personal images during which activation did not differ between the two hemispheres Since this pilot study includes only three participants a replication of these findings using a larger sample is necessary to draw further conclusions about EEG response to attachment-related visual stimuli A relatively new area of research is the study of how attachment classifications influence behavior and psychophysiology to social vs. nonsocial situations and stimuli (Vrtička and Vuilleumier, 2012). A recent study by Verbeke et al. (2014) measured resting-state cortical brain activity using EEG in 35 participants when they were alone in the room (condition 1) and when they were together (condition 2) Individuals who scored higher on anxious attachment style experienced an enhanced alpha beta and theta power when they were together with another person during the resting session these results did not occur in the avoidant group During the task-free resting state procedure implemented in this study adults with an anxious attachment style fail to have their need for approval met and consequently they become preoccupied with what other people might think about them The enhanced alpha power observed in anxiously-attached adults might provide protection for this internal information processing by blocking external interferences of the surrounding sensory input For a deeper analysis of these differences future research could add further biomarkers like heart rate or skin conductance the dismissing group demonstrated a greater increment in the N2 during reunion with excluders suggesting that their expectations for being rejected are more strongly violated by a re-initiation of fair play that follows the exclusion phase these individuals tend to have continued expectations of rejection even though they were re-included by their peers Studies on cardiovascular response in different attachment groups Studies on electrodermal reactivity in different attachment groups Adrenocortical response in different attachment groups Prefrontal EEG asymmetry in different attachment groups studies using physiological parameters support the hypothesis that a secure attachment representation buffers physiological reactivity in response to stressors Securely attached individuals are characterized by open they are better able to balance exploration (i.e. relatedness) and they show a greater openness to explore their own thoughts and feelings On a physiological level they respond with less cortisol increase lower skin conductance and more flexible prefrontal mechanisms during attachment-related stimuli compared to the other attachment groups it is still unknown in how far attachment security and physiological functioning are stable at the different stages of development from childhood to adulthood Investigating childhood and later adult attachment and analyze their influence on adult psychobiological processes could make a significant contribution towards understanding psychophysiology of human attachment AAI and self-report literatures should not be cited and discussed as if these measures were interchangeable An important issue for future research will be a neurophysiological distinctive comparison between infant attachment adult attachment and caregiving patterns to find out more about the underlying mechanisms at different stages of our lives which shape our emotional and physiological regulation Integrating the previously mentioned findings into such a conceptual model that also considers 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Attachment classification Received: 20 October 2014; Accepted: 31 January 2015; Published online: 19 February 2015 Copyright © 2015 Gander and Buchheim. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) *Correspondence: Manuela Gander, Institute of Psychology, University of Innsbruck, Innrain 52, 6020 Innsbruck, Austria e-mail:bWFudWVsYS5nYW5kZXJAdWliay5hYy5hdA== We examined the attachment classifications of 26 female BPD patients and 26 female HC using the Adult Attachment Projective Picture System (AAP). We used an fMRI-adapted attachment paradigm to investigate the neural correlates of attachment. All participants were presented three personalized (vs. neutral) sentences extracted from their AAP attachment narrative, combined with standardized AAP pictures representing being alone (monadic) or in interactive (dyadic) attachment situations. As expected, the classification of unresolved attachment was significantly greater in BPD compared to HC. BPD patients showed increased fMRI-activation in brain areas associated with fear, pain, and hyperarousal than HC when presented with personalized attachment-relevant alone stimuli. In particular, pictures with monadic attachment situations induced greater anterior medial cingulate cortex, anterior insula, amygdala, thalamus and superior temporal gyrus activation in the patient group. Volume 16 - 2022 | https://doi.org/10.3389/fnhum.2022.810417 Background: Fear of abandonment and aloneness play a key role in the clinical understanding interpersonal and attachment-specific problems in patients with borderline personality disorder (BPD) and has been investigated in previous functional Magnet Resonance Imaging (fMRI) studies The aim of the present study was to examine how different aspects of attachment representations are processed in BPD by using for the first time an fMRI attachment paradigm including personalized core sentences from the participants’ own attachment stories We hypothesized that BPD patients would show increased functional involvement of limbic brain regions associated with fear and pain (e.g. the amygdala and the anterior cingulate cortex) when presented personalized attachment relevant stimuli representing loneliness compared to healthy controls (HC) Methods: We examined the attachment classifications of 26 female BPD patients and 26 female HC using the Adult Attachment Projective Picture System (AAP) We used an fMRI-adapted attachment paradigm to investigate the neural correlates of attachment All participants were presented three personalized (vs neutral) sentences extracted from their AAP attachment narrative combined with standardized AAP pictures representing being alone (monadic) or in interactive (dyadic) attachment situations the classification of unresolved attachment was significantly greater in BPD compared to HC BPD patients showed increased fMRI-activation in brain areas associated with fear and hyperarousal than HC when presented with personalized attachment-relevant alone stimuli pictures with monadic attachment situations induced greater anterior medial cingulate cortex thalamus and superior temporal gyrus activation in the patient group Conclusion: The results point to increased fMRI-activation in areas processing emotional distress and painful experiences in BPD patients the emotional cascade reflecting attachment distress was evoked by combining monadic pictures with the patients’ personalized narrative material Our results confirmed and replicated previous results that illustrate once again the high relevance of aloneness and feelings of abandonment for BPD in the context of attachment trauma our results support the hypothesis of hypermentalization in response to attachment distress as a core feature of social-cognitive impairment in BPD associated with common treatment implications across different therapeutic orientations The AAP is a reliable and valid instrument used to assess the adult attachment representation Classifications include organized patterns (secure insecure-preoccupied) and a “disorganized” attachment pattern termed “unresolved” for trauma Brodmann’s areas 9/10) and right cuneus but decreased neural activity in the right anterior cingulate cortex (Brodmann’s areas 24/32) in women with BPD using personalized scripts of abandonment memories in an fMRI environment we hypothesized stronger fMRI-activations of the above mentioned “attachment network” among BPD patients when confronted with personalized narrative material vs neutral sentences in the context of the monadic AAP pictures we assumed an association between brain-activations of the “attachment network” and the participants’ attachment dysregulation rated by the number of “unresolved” AAP stories This study is part of a larger fMRI study of BPD patients treated with outpatient Dialectical Behavioral Therapy (DBT). Subject characteristics, inclusion and exclusion criteria, and diagnostic assessments were more in detail described in a publication focusing on the behavioral data only (Bernheim et al., 2019) The study was approved by the Ethical Commission of the University of Greifswald (BB 136/10) The study conforms to recognized standards of the Declaration of Helsinki All persons gave their informed consent prior to inclusion mental retardation (IQ < 70) or florid psychotic symptoms were excluded Only HC participants willing to receive psychiatric assessments and attachment interviews were included HC individuals with current or anamnestic psychiatric disorders a history of psychotherapeutic treatment or psychiatric medications were excluded Individuals who showed contraindications to fMRI procedures or who were pregnant were excluded While antidepressant medications are probably unavoidable in a BPD sample antipsychotic medication strongly alters brain activity nine of 26 patients (34.6%) took selective serotonin reuptake inhibitors (SSRI’s) but none of the patients received a neuroleptic medication Medication dosage was kept at minimum throughout the study The attachment classifications were judged using the AAP (George and West, 2001, 2012) The coding and classification procedure is described more in detail below we counted the number of individual AAP stories that were designated as “unresolved” All participants were presented with personalized AAP core sentences from their own narratives in the fMRI procedure and asked to rate them after scanning AAPs are transcribed verbatim from audio recordings for analysis Statistical evaluation of rating data was performed with SPSS (IBM coop.) version 21 We used chi square tests to compare ratings between samples (non-parametric testing needed because normal distribution of ratings cannot be expected) note: AAP example picture 2: “Window”) The task started with the instruction to carefully read the sentences and look at the pictures attentively. Each trial had the following order of presentation: sentence - picture – fixation cross (see Figure 1) Experimental setting during functional magnet resonance imaging (fMRI) Top line: Order of stimuli presentation during scanning Bottom line: Duration of presentation in seconds The individualized core sentences were paired to the respective AAP picture to constitute “personal” trials tailored to each participant. The same pictures were also paired to neutral sentences that described only the situational environmental elements depicted in the picture. These pairings were identical for all participants. The AAP picture stimuli are always administered in a designated order (George and West, 2012) presented the stimuli of each condition in sets comprising seven consecutive trials of the same condition we presented six sets of personalized trials (i.e. Three sets contained seven personalized sentence-picture-combinations and three sets contained seven neutral sentence-picture-combinations These sets were presented alternating between sets with personalized stimuli and sets with neutral textual stimuli there were 84 trials with a total duration of 25 min and sets of trials were presented in immediate succession with no periods of rest interleaved Participants were asked to rate autobiographic and emotional relevance for each of the personalized sentences after the fMRI measurement using a questionnaire (Buchheim et al., 2012; Bernheim et al., 2018) all participants were informed that they would be presented with several sentences All participants were instructed not to move their head or body during fMRI and to focus on the sentences and pictures presented Germany) with 32-channel head coil was used to acquire a T1 whole head volume for structural mapping T2*-weighted echo-planar images (EPIs) for functional mapping and gradient echo for unwarping of the EPIs Echo-planar images were characterized by a repetition time (TR) of 2,000 ms Each volume consisted of 33 slices (transversal; AC-PC aligned with additional 20° to minimize susceptibility artifacts in the frontobase) with voxel size of 2 mm × 2 mm × 3 mm and spacing between slices of 1 mm the first two dummy volumes in each session being automatically discarded to allow for T1 equilibration effect 34 phase and magnitude images were acquired in the same FOV by a gradient echo (GRE) sequence with TR = 488 ms and α = 60° to calculate a field map aiming at correcting geometric distortions in EPI images The T1-weighted three-dimensional image (MPRAGE) was used as spatial high-resolution structural image The total number of sagittal anatomical images/slices was 176 (R = 1,900 ms voxel size 1 mm × 1 mm × 1 mm Data was analyzed using SPM12 (Wellcome Department of Cognitive Neuroscience) implemented in MATLAB (MathWorks Unwarping of geometrically distorted EPIs was performed in the phase encoding direction using the FieldMap Toolbox Each time-series was realigned to the first image of each session and re-sliced EPIs were co-registered to the T1-weighted anatomical image and T1-weighted images were segmented to localize gray and white matter and cerebrospinal fluid This segmentation was the basis for spatial normalization to the Montreal Neurological Institute (MNI) template using the DARTEL approach of SPM being refined iteratively by diffeomorphic registration steps and used to spatially normalize the functional images while applying a Gaussian Kernel smoothing filter (9 mm × 9 mm × 9 mm full-width at half maximum) to improve spatial alignment and increase the signal-to-noise-ratio Six movement parameters estimated during the realignment procedure were introduced into the model as covariates to control for variance due to head displacements A temporal high-pass filter (128 s) was applied to remove slow signal drifts Individual statistical maps for main effects (personalized monadic pictures/personalized dyadic pictures) and contrasts (personalized monadic pictures minus personalized dyadic pictures; monadic pictures + personalized minus neutral sentences) were calculated using the general linear model First level contrast images of each subject were used for group statistics calculated as a random effect analysis at the second level A one-sample t-test was performed to assign significant activations A two-sample t-test was accomplished at the second level for between subject groups A linear regression was calculated for the patients U-scores and fMRI-activation during monadic picture presentation Anatomical classification of fMRI-activation (MNI-space) was performed using Anatomy Toolbox Version 1.7 (Eickhoff et al., 2005) and with Anatomy with Automated Anatomical Labeling (AAL) (Tzourio-Mazoyer et al., 2002) Differentiation of the cingulate cortex (AAL-mask) was performed by defining the MCC as the most rostral (z > 30) We corrected for the whole brain volume (p < 0.05 familywise error rate; FWE) by calculating main effects within each group We used a region of interest (ROI) approach and corrected for false positive results with pFWE < 0.05 corrected for ROI-volume for calculating interactions and differences between groups Following the core studies leading to our hypotheses Linear regression analysis was used to evaluate our expected association of aMCC-activation (ROI-approach; pFWE < 0.05) based on the number of unresolved rated AAP pictures in BPD patients Symptom severity of patients with Borderline Personality Disorder (BPD) and Healthy Control Subjects (HC) both groups differed significantly in their distribution of organized versus unresolved attachment representations BPD patients showed 42.3% organized and 57.5% unresolved classifications while healthy controls showed 84.6% organized and 15.4% unresolved classifications [χ2(3) = 14.73 BPD patients with organized versus unresolved attachment representations did not differ significantly concerning age or borderline/global symptom severity Analyzing the amount of number of individual AAP stories, that were designated as unresolved, the Between- group comparisons showed that BPD patients showed a significantly higher frequency of unresolved monadic stories than HCs (see Table 2) Within-group comparisons showed that BPD patients showed significantly more unresolved stories for monadic as compared with dyadic stimuli Number of “unresolved” rated narratives related to the Adult Attachment Projective Picture System (AAP) pictures in the AAP interview (BPD vs As mentioned above all participants were asked to rate the personalized AAP core sentences from their own narratives after scanning BPD patients rated the personalized sentences for all AAP pictures as significantly higher in autobiographical relevance [t(50) = 4.14 p < 0.001] and negative emotional valence [t(50) = 2.83 The major goal of our fMRI study was to differentiate between personalized and neutral narrative material combined with attachment pictures representing alone or dyadic situations in BDP patients versus healthy controls We first analyzed the main effects of all AAP pictures and personalized sentences and then compared monadic versus dyadic trials for each group A main effects analysis of all AAP pictures and personalized sentences participants in both groups showed bilateral frontotemporal and occipital activation pattern (see Supplementary Material 2) Borderline personality disorder patients showed increased fMRI-activation in the bilateral anterior insula, right STS, aMCC, and thalamus when confronted with monadic AAP pictures combined with personalized sentences (see Figure 2 and Table 3) Functional magnet resonance imaging-activation during observation of monadic Adult Attachment Projective (AAP) pictures with personalized sentences (BPD minus HC) The borderline personality disorder (BPD) patients showed increased fMRI-activation in the (A) right superior temporal sulcus (STS) (C) anterior medial cingulate cortex (aMCC) and thalamus (p < 0.05 Monadic AAP pictures and personalized sentences (BPD minus HC) The fMRI-activation did not differ between the two groups when confronted with dyadic AAP pictures and personalized sentences. Contrasting monadic minus dyadic pictures with personalized sentences, the BPD patients showed increased fMRI-activation in the left vmPFC, dMCC, left anterior insula, and right amygdala (see Figure 3 and Table 4) Functional magnet resonance imaging-activation during observation of monadic minus dyadic AAP pictures with personalized sentences (BPD minus HC) The BPD patients showed increased fMRI-activation in the (A) ventromedial prefrontal cortex (vmPFC) and (D) left anterior insula (p < 0.05 Monadic minus dyadic AAP pictures with personalized sentences (BPD minus HC) Borderline personality disorder patients as compared with the HC group showed a higher fMRI-activation in the right amygdala [MNI-coordinates (x when presented monadic AAP pictures and personalized minus neutral sentences We found increased fMRI-activation in the BPD group in the aMCC in linear correlation to the number of “unresolved” rated AAP pictures (“U-scores”) per AAP narrative when patients were confronted with monadic AAP pictures and personalized minus neutral sentences (coordinates: −6 The present study explored the neural signature of attachment representations in BPD patients (BPD) compared to healthy control subjects (HCs), using the Adult Attachment Projective Picture System (AAP; George and West, 2001, 2012) using an adapted fMRI procedure (Buchheim et al., 2012) activation of the circuit by nociceptive inputs from the thalamus induces fear and memories of similar events and triggers outcome prediction We suggest that increased thalamic activation in the BPD group might be associated with increased arousal during monadic picture presentation with personalized attachment material due to the fact that BPD patients demonstrated especially high number of traumatic fear indicators in the responses to the monadic AAP pictures whereas BPD patients showed a higher percentage of unresolved attachment representations may reflect increased levels of amygdala activation in response to personalized attachment statements as it activates the attachment system via representation Additionally, only BPD patients in our study showed a positive association between number of unresolved rated AAP pictures and aMCC activation during monadic personalized sentence presentation. The aMCC plays an important role in the integration of neural circuitry for affect regulation due to connection to both emotional-limbic structures including the amygdala and the prefrontal cortex (Stevens et al., 2011) Fear and pain representation overlap in the aMCC and support a more general role of this region for avoidance behavior the current result could be interpreted as a neural signature of increasing social pain for BPD patients with unresolved attachment representation when they have to consciously face autobiographical abandonment themes The study results must be considered in light of several limitations all attachment interviews were conducted before fMRI scanning to determine the participants’ attachment classification group and obtain the narrative material required to develop the personalized sentences for the fMRI procedure Repeating core sentences from their AAPs during fMRI scanning cannot exclude the potential confounding effects of memory patients did not report a recognition effect when asked after the fMRI experiment the content of personalized sentences was not analogous across the two groups (BPD This would have been impossible if we were to claim HC statements were less traumatic than the BPD statements and HC rated the personalized sentences as less personally relevant and less emotional negative than the BPD patients so we cannot generalize our results to male individuals 35% of our patients were taking antidepressant medications which might have had an additional effect on fMRI activation we had a wide range of patients with comorbidity of Posttraumatic Stress Disorder (PTSD; 39%); however no differences in the fMRI activation patterns could be found between patients with/without PTSD we did not include a psychophysiological control such as heart rate during scanning so we could not independently ensure our hypothesis of high arousal with thalamic hyperactivation in BPD patients while viewing personalized we had a multi-factorial design and calculated a number of different activation contrasts we did not waive multiple testing and included the risk of alpha error cumulation all results were hedged by ROI- and FWE correction future studies should investigate the functional connectivity between relevant neural areas in activation of the internal working model of attachment this is the first study in BPD patients and matched HC exploring the neural signature of attachment representation comparing the impact of different attachment-relevant stimuli The raw data supporting the conclusions of this article will be made available by the authors The studies involving human participants were reviewed and approved by the Ethical Commission of the University of Greifswald (BB 136/10) The patients/participants provided their written informed consent to participate in this study and ML recruited the subjects and were responsible for data acquisition DB and ML performed the statistical analysis All authors read and approved the final manuscript This study was supported by an intramural grant under Grant number “FONE-2013-02” and therapists who participated in this project The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fnhum.2022.810417/full#supplementary-material adult attachment projective picture system; BPD Attachment studies with borderline patients: a review Brain activity underlying emotional valence and arousal: a response-related fMRI study Human brain mechanisms of pain perception and regulation in health and disease Bakermans-Kranenburg The mediating role of mentalizing capacity between parents and peer attachment and adolescent borderline personality disorder The role of attachment characteristics in dialectical behavior therapy for patients with borderline personality disorder Change of attachment characteristics during dialectic behavioral therapy for borderline patients Dialectical behaviour therapy for post-traumatic stress disorder after childhood sexual abuse in patients with and without borderline personality disorder: a randomised controlled trial Development of the borderline symptom list Google Scholar “Internal working model in attachment relationships: elaborating a central construct in attachment theory,” in Handbook of Attachment “Attachment disorganization in borderline personality disorder and anxiety disorder,” in Disorganization of Attachment and Caregiving Neural response during the activation of the attachment system in patients with borderline personality disorder: an fMRI study Editorial: neuroscience of human attachment What works in the treatment of borderline personality disorder Psychotherapy for Borderline Personality: Focusing on Object Relations Google Scholar Do neural responses to rejection depend on attachment style Emotion recognition in borderline personality disorder - 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This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) Volume 10 - 2016 | https://doi.org/10.3389/fnhum.2016.00389 Individuals with borderline personality disorder (BPD) are characterized by emotional instability impaired emotion regulation and unresolved attachment patterns associated with abusive childhood experiences We investigated the neural response during the activation of the attachment system in BPD patients compared to healthy controls using functional magnetic resonance imaging (fMRI) Eleven female patients with BPD without posttraumatic stress disorder (PTSD) and 17 healthy female controls matched for age and education were telling stories in the scanner in response to the Adult Attachment Projective Picture System (AAP) an eight-picture set assessment of adult attachment The picture set includes theoretically-derived attachment scenes The picture presentation order is designed to gradually increase the activation of the attachment system Each picture stimulus was presented for 2 min Analyses examine group differences in attachment classifications and neural activation patterns over the course of the task Unresolved attachment was associated with increasing amygdala activation over the course of the attachment task in patients as well as controls showed activation in the right dorsolateral prefrontal cortex (DLPFC) and the rostral cingulate zone (RCZ) We interpret this as a neural signature of BPD patients’ inability to exert top-down control under conditions of attachment distress These findings point to possible neural mechanisms for underlying affective dysregulation in BPD in the context of attachment trauma and fear Attachment classifications are derived from the analysis of narratives with three organized/resolved patterns (also termed attachment status) preoccupied and unresolved with respect to trauma or loss Important for our study is the categorization into “resolved” (i.e. “unresolved” attachment patterns in adults The narratives of individuals who are unresolved demonstrate their inability to contain or integrate frightening thematic elements become dysregulated when attachment is activated during assessment Dysregulation can be momentary or prolonged but in either case the individual is unable to use defensive processes to remain organized and recover from conscious thoughts and feelings of frightening distress These studies have used various approaches to identify the neural correlates of distinctive attachment-related systems (caregiving or sexual system) Taking into account the differences in methods and aims these studies have reported a common neural activity for the romantic and maternal attachment in regions associated with reward and motivation and affective processing much less is known about the neural correlates of attachment representations when individuals are instructed to tell stories to attachment related pictures while being scanned in an fMRI environment Buchheim et al. (2006a,b) developed an fMRI paradigm to investigate the neural correlates of attachment representation while subjects tell stories to attachment pictures using the AAP stimuli (George et al., 1999; George and West, 2012) This validated narrative-based assessment is a set of stimuli and system of analysis that is theoretically derived using attachment theory and not a traditional open-ended free-response measurement (i.e. subjective interpretation of emotional stimuli) The results of this pilot study showed unresolved attachment to be associated with increasing activation of the right amygdala the left hippocampus and the right PFC over the course of the attachment task (i.e. from the first to the last attachment pictures) The present study investigated neural correlates of attachment narratives in borderline patients using the same paradigm. In this article, we focus on differences between “unresolved” and “resolved” subjects. Our design permitted analysis related to other linguistic features of the AAP, which were reported elsewhere (Buchheim et al., 2008) Based on research linking BPD to unresolved attachment we expected that amygdala activation in during the course of administering the attachment task (AAP) would be stronger in the patient group than the control group We also expected that neural signs of emotion regulation in the cognitive control system (DLPFC and/or anterior cingulate) would decrease or be absent in the patient group Figure 1. (A) Picture “Departure” from the Adult Attachment Projective Picture System (AAP) © (George et al., 1999). (B) Picture “Cemetery” from the AAP © (George et al., 1999) Resolved attachment status groups include secure Secure attachment is characterized by story elements that demonstrate the capacity to think about events and feelings and expectations for comfort from or mutual enjoyment in attachment relationships Dismissing attachment is characterized by evidence of physical and psychological distance from attachment figures and distress in story themes often deflecting needs for care and the desire for attachment figures’ comfort to other activities (e.g. Preoccupied attachment is characterized by representational confusion; the representation of people or events associated with story themes are diffused by vacillation among different and sometimes opposing ideas Transcript examples of a “resolved” and two “unresolved” stories to the AAP picture “Cemetery” Subjects were instructed in the AAP story telling task before they entered the scanner using two non-AAP “neutral” (i.e. The pictures were same size and drawn in the same style as the stimuli in the AAP set The goal was for subjects to understand the scope of the probes normally asked during in-person administration The training procedure was repeated two more times The fMRI acquisition started with the original AAP picture presentation and instructions subjects were visually presented the standard AAP instruction at the introduction of the stimulus (“what led up to that scene and what might happen next?”) for 10 s and a fixation cross for 10 s Afterwards each AAP picture was presented (120 s) along the original order of the measure (described in the “Materials and Methods” Section) Subjects were asked to talk about the picture for at least 2 min A fixation cross was shown for 15 s after the picture presentation until beginning a new cycle of instruction and the next picture presentation The total procedure included nine pictures the two neutral and seven standard AAP attachment scenes 1.5 Tesla Siemens Magnetom Symphony scanner (Siemens total acquisition time 25 min (=598 volumes Instructions and pictures were shown with fMRI compatible video-goggles (Resonance Technologies Speech was digitally recorded beginning at the onset of each picture using an fMRI compatible microphone and saved digitally on a computer using Cool Edit Pro (Syntrillium Software Cop Head movement was minimized by using padded earphones fixating the head within the gradient insert coil Group differences of the behavioral attachment data were analyzed using the exact Mann-Whitney U-test and the Kruskal-Wallis H-test and (SPSS version 14). We used non-parametric tests because of the non-normal distribution of the dependent variables. Preprocessing and statistical analysis of fMRI data were carried out with SPM2 2 and MATLAB 6.1 (MathWorks The first four functional images were discarded to account for equilibration effects Individual functional images were corrected for motion artifacts by realignment to the first volume of each session we excluded four control subjects because of excessive head movement (>2 mm within a trial cycle) in order to minimize movement effects Further preprocessing included spatial normalization (3 × 3 × 3 mm) and smoothing (FWHM 8 mm) The regression model for each subject was as follows: each of the nine pictures had three or two individual regressors with variable duration depending on the time of speech: Regressor 1 modeling the time from onset of picture till onset of speech; regressor 2 modeling the picture during speaking; and regressor 3 modeling the time from offset of speech till end of picture presentation (if the subject did talk for less than 2 min) each modeling all nine pictures: Regressor 4 (onset of every single word of all pictures as a stick function); regressor 5 Regressors of interest were convolved with a function that modeled a prototypical hemodynamic response before inclusion into the regression model A high-pass filter was set at a cutoff frequency of 240 s six more regressors modeled residual motion For each trial the variance of each voxel was estimated according to the General Linear Model Individual regionally specific effects of interest were calculated for each participant using linear contrasts resulting in a t-statistic for every voxel The effects of interests in this study were narrative story responses to the seven attachment pictures We calculated the contrast picture presentation for each subject during speech (regressor 2) + picture presentation before the subjects start to speak (regressor 1) vs thereby including potential mental processes before the actual speaking phase starts contrasts for single pictures were calculated seven contrasts for the attachment pictures ordered 1–7 Borderline patients differed significantly from controls in all clinical scales (Table 1) the majority of the BPD patients were judged unresolved (11/13 Ten of seventeen (59%) controls were judged resolved and seven (41%) were judged as unresolved we included 11 patients (all coded as unresolved) and 17 controls (n = 7 unresolved The overall distribution of attachment status differed significantly between borderline patients and controls (Fisher’s exact test Both control and patient groups showed activations in bilateral occipital cortex bilateral precentral and left inferior frontal gyrus for the main effect of picture presentation and bilateral medial and superior temporal gyrus medial occipital gyrus and cerebellum for the main effect of speech production Images of statistic parametric mapping are projected onto sections of the standard T1 template of SPM 2 Plots of contrast estimates for each condition were shown on the right The results of these analyses are shown in Table 3 An AAP effect was found in the amygdala in both unresolved groups (unresolved controls and unresolved BPD patients) An AAP effect in the RCZ was found only in the controls (resolved and unresolved) An AAP effect in the right DLPFC was found only in the unresolved controls In order to check that our results are not solely due to medication effects we performed an additional analysis including only patients taking no psychotropic drugs (n = 6) Results were the same: all CTRLs > unmedicated PATs unresolved: mPFC (−9 Z = 3.63); CTRLs resolved > unmedicated PATs unresolved: mPFC (−9 Z = 3.54); unmedicated PATs unresolved > CTRLs resolved: Amygdala (21 Z = 3.39); CTRLs unresolved > unmedicated PATs unresolved: DLPFC (48 The present study examined the neural correlates of attachment dysregulation in a group of BPD patients compared to controls This study used a paradigm that evaluated neural response patterns while subjects told attachment stories in response to AAP stimuli in the fMRI scanner The fMRI analysis model followed the logic of the design of the attachment measure the picture presentation sequence increasingly activates the attachment distress We labeled this increasing activation over the course of task as “AAP effect.” Due to the fact that almost all BDP patients were classified as unresolved we investigated only three classification groups: resolved controls unresolved controls and unresolved BDP patients all unresolved subjects (borderline and controls) showed the AAP effect reflected in an increasing amygdala activation showed the AAP effect in relation to increasing activation of the RCZ only the unresolved controls showed an AAP effect of increasing activation of the right DLPFC This effect was not found in the resolved controls or the unresolved patients We now discuss these results in the context of attachment research The predominant unresolved classification in the BPD patients was consistent with previous research (Fonagy et al., 2000; Agrawal et al., 2004; Bakermans-Kranenburg and van IJzendoorn, 2009; Buchheim and George, 2011) This was found using two independent attachment measures (AAI and AAP) How are these attachment findings related to the neural patterns found in the three groups (unresolved patients The stimuli used in the present study were not general emotional stimuli The AAP picture stimuli were selected specifically because of their ability to activate attachment distress by introducing themes like we interpret this amygdala activation as a neural correlate of negative emotional arousal that is associated with dysregulated attachment fear that is evident in the unresolved verbatim narratives resolved controls do not show the AAP effect in the amygdala Resolved attachment is defined by the ability to re-organize attachment related fearful and threatening themes emerging in their stories This re-organization appears to have blocked the AAP effect in the amygdala Attachment activation of resolved controls is not dysregulated by the negative emotions associated with distress As the amygdala activation AAP effect was found in both our BPD and unresolved controls the effect is likely to be related to adverse early experiences that are not necessarily specific to BPD diagnosis In order to disentangle the contribution of attachment and diagnosis it would be desirable to include a resolved BPD group This was not possible in the current study because the small number of resolved BDP patients precluded such an analysis Although a subgroup of the healthy participants showed the failure to reorganize their attachment distress in their narratives on a behavioral level (unresolved) they demonstrated the ability to control their distress on a neural level As the attachment stories in our study include distressing and potentially threatening themes one possible interpretation of this activation is that all control subjects monitored their stories for unfavorable outcomes how the story might continue (part of the instruction) This monitoring function seems to be impaired in the BPD patients of our sample An alternative interpretation is that activation in this region simply reflects emotional involvement this is unlikely given that the three groups showed a different pattern These findings suggested possible compensatory mechanisms for the impaired emotion regulation Resolved subjects in the present study demonstrated a low incidence of threatening situations in their narratives suggesting that the cognitive control system was not increasingly engaged over the course of the task interpret the accompanying right DLPFC activation as an effort in this group to cope with this increasing affective involvement we suggest that we provided a novel and interesting approach to understanding emotional instability in BPD patients with respect to attachment on a neural basis The participants in our task were actively talking about their subjective perception of attachment scenes reflecting their individual mental organization of these crucial topics in relation to their history of abuse There are several limitations to our study that need to be taken into account when interpreting our findings the number of resolved BPD patients (n = 2) was too small to include in our analysis and moreover we were not able to recruit a larger sample of BPD patients willing to participate in such a demanding paradigm (talking in the fMRI scanner) which limits the generalization of our results that unresolved attachment is the predominant classification group therefore future research would require a substantially large sample in order to include resolved BPD subjects Although this limits the interpretation of our data to a certain extent we were able to meaningfully evaluate the results using the three-group designations afforded by the participant attachment distribution in the current study we did not include a clinical control group This leads to questions as to whether our results may also be present in patients with other psychiatric disorders and not specific to BPD 5 out of 11 of the BPD subjects were under low dose medication This could be a confounding factor in comparing patients and controls although our control analyses of medication-free patients only speaks against this assumption Fourth, this study aimed to characterize differences between healthy participants and BPD patients using an attachment paradigm along the AAP system focusing on attachment related pictures only. Since this study has identified differences between controls and patients, it is rather difficult to interpret the data univocally in the absence of an adequate control stimulus set, which is the focus of a recent study with healthy controls (Labek et al., 2016) it would have been appropriate to add an established emotion-inducing paradigm for comparing neural responses to attachment plus to emotional involvement and/or emotional regulation capacities Strictly spoken without this contrasting paradigm we may not directly conclude that we have investigated emotional dysregulation in BPD patients compared to controls all results were derived from the three group analyses this might have inflated statistical results we also calculated separate analyses for those contrasts where only two groups were involved showing that increased degrees of freedom did not generally inflate our results Only mPFC activation in the contrast comparing resolved controls and unresolved patients does not surpass additional small volume correction overt speech in the scanner always is accompanied with head movements The head movement in this study was less than 2 mm and we took steps to eliminate residual influences including movement parameters as a covariate of no interest and modeling the onset of every spoken word Future studies may examine as to what extent psychotherapy has the potential to change brain activation from a more unresolved to a more resolved pattern The study setup and data collection were organized and conducted by HW Coding of attachment interviews were conducted by AB and CG HW and DP performed the statistical data analysis and contributed substantially to the result interpretation and DP provided important intellectual contribution in commenting and revising the manuscript and CG wrote the manuscript and edited its final version for technical assistance in fMRI data analysis Department of Psychiatry and retain Department of Diagnostic Radiology University of Ulm for 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Text | Google Scholar Clinical assessment of attachment patterns and personality disorder in adolescents and adults The amygdala’s response to face and emotional information and potential category-specific modulation of temporal cortex as a function of emotion Wittfoth-Schardt Oxytocin modulates neural reactivity to children’s faces as a function of social salience Prediction of the 10-year course of borderline personality disorder Spitzer M and Walter H (2016) Neural Response during the Activation of the Attachment System in Patients with Borderline Personality Disorder: An fMRI Study Received: 10 March 2016; Accepted: 19 July 2016; Published: 02 August 2016 Copyright © 2016 Buchheim, Erk, George, Kächele, Martius, Pokorny, Spitzer and Walter. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) Volume 7 - 2013 | https://doi.org/10.3389/fnhum.2013.00677 This case study describes 1 year of the psychoanalytic psychotherapy using clinical data a standardized instrument of the psychotherapeutic process (Psychotherapy process Q-Set A female dysthymic patient with narcissistic traits was assessed at monthly intervals (12 sessions) which took place immediately after therapy hours the patient looked at pictures of attachment-relevant scenes (from the Adult Attachment Projective Picture System AAP) divided into two groups: those accompanied by a neutral description and those accompanied by a description tailored to core conflicts of the patient as assessed in the AAP this patient presented defense mechanisms that influenced the relationship with the therapist and that was characterized by fluctuations of mood that lasted whole days following a pattern that remained stable during the year of the study The two modes of functioning associated with the mood shifts strongly affected the interaction with the therapist whose quality varied accordingly (“easy” and “difficult” hours) The PQS analysis showed the association of “easy” hours with the topic of the involvement in significant relationships and of “difficult hours” with self-distancing a defensive maneuver common in narcissistic personality structures the modes of functioning visible in the therapy hours were significantly associated with modulation of the signal elicited by personalized attachment-related scenes in the posterior cingulate (p = 0.017 cluster-level This region has been associated in previous studies to self-distancing from negatively valenced pictures presented during the scan The present study may provide evidence of the possible involvement of this brain area in spontaneously enacted self-distancing defensive strategies which may be of relevance in resistant reactions in the course of a psychoanalytic psychotherapy The main question we wanted to address was the extent to which the data from functional neuroimaging could be brought to bear on our theoretical understanding of the psychoanalytic process we were interested in verifying if existing interpretations of cortical activity gained in controlled experimental settings from neuroimaging studies would maintain their explanatory power in the context of the single case study of a psychoanalytic process A crucial issue was therefore the existence of an association between symptoms the character of the relationship with the therapist in individual therapy hours and variation in the signal from the attachment-relevant scenes probe in the scanner suffered from rapidly fluctuating affective states Waking up the morning she knew that “this will be an easy day” or “this will be a difficult day.” Her capacity for successful work and concentration was reduced when she felt depressed and in a “difficult day mood.” During these occasions she isolated herself and worked hard to hide her emotional vulnerability This chronic and fluctuating depressive pathology and a fragile vulnerable perception of self and others brought her in psychoanalytic treatment The PQS captures a wide range of events in the psychotherapeutic session attributable to both the therapist’s activity and the patient These scenes were alternately accompanied by sentences neutrally describing their content or by sentences that referred to the personally relevant content evoked by them as extracted by a previous AAP interview The contrast of interest was the difference between the signal evoked by the personalized and the neutral textual descriptions of the scenes This contrast detected neural substrates activated by the appraisal of the personal element in the attachment scenes at the net of generic activations due to the perceptual encoding of the scenes and reading the textual description Note that we did not have access to changes in brain function during therapy since the functional neuroimaging sessions necessarily took place after we were aided in our attempt in establishing a link between mind states and neural substrates by the oscillations of the patient between “difficult” and “easy” days a change in mood that may have been relatively stable from the therapy hour to the functional neuroimaging session the data we present document changes in these modes of emotional functioning that had consequences on the quality of the therapy hours The question of interest was the extent to which clinical data from the therapy hours and neural activation were reciprocally informative of the mental states at the base of the “easy” and “difficult” moods This focus also allowed us to sidestep the issue of change over the course of therapy which would possibly be confounded by habituation or learning effects in the neuroimaging data The analyst was a very experienced training analyst with an interest in research She agreed to take part in our study and to audiotape one therapy session a month for the PQS analysis She works in a private practice as a psychiatrist The patient also agreed to take part in the study. She was given information about the study and signed a declaration of her willingness to participate for 1 year and to be assessed with several questionnaires and the functional neuroimaging scans. The treatment was paid by the health insurance. This study was approved by the ethical committee by the University of Ulm in the context of the Hanse-Neuro-Psychoanalysis Study (Buchheim et al., 2008, 2012) The patient gave written informed consent to the publication of the data the case report should be written taking into consideration the need to protect the identity of the patient The clinical and behavioral outcome data served different purposes the monitoring of symptoms with self-rating scales documented changes in affective symptoms at the days of the data collection these data describe the level of symptoms and document changes during therapy (in the present case study these measures indicated a substantially stable state over the year of the study the clinical rating of the hour by the therapist and the PQS documented the exchange between patient and analyst during therapy through the clinical impression and an operationalized assessment instrument Variation in these data provided correlates to explore with the neuroimaging probe the AAP interview provided material on core attachment issues specific to the patient for the preparation of the stimuli used in the neuroimaging sessions it also provided an assessment of the attachment pattern of this patient at the beginning of study is not administrable on a monthly basis and for this reason could not be used as a clinical correlate of the neuroimaging data in the present setting a post-scan self-rating questionnaire was administered to evaluate reported involvement with the stimuli presented during the scan session These data were meant as an aid in interpreting the fMRI analysis the results section also reports on the patient using a more customary clinical description informed by psychoanalytic views We considered the clinical description an integral part of the results This description is meant to provide guidance on the psychopathology of this patient to be compared with the functional role of neural structures identified in the neuroimaging study The analyst rated on a clinical level dichotomously if the 12 sessions were “difficult” or “easy.” According to her documentation the classification in “difficult” or “easy” was very clearly identifiable The “difficult” sessions started with silence and remained quiet and inhibited The “easy” sessions started fluently and remained talkative In this study verbatim transcribed sessions were coded by two independent raters Two independent trained judges rated all 12 psychotherapy sessions and achieved a correspondence of kappa between 0.80 and 0.97 Because of the inherently correlational and explorative character of data obtained with the PQS we investigated the tendency of PQS scores to covary across items with a principal component analysis To compute significance levels of principal components we carried out 2000 Monte Carlo simulations in which principal component analyses were computed on data with the same item range and distribution Significance values were computed as quantiles of the first and second components of the simulations (to test the significance of the first and second component Significant components provide evidence that a set of therapy characteristics occur together suggesting the existence of recurrent interaction dynamics at each permutation the maximal (minimal) t-value obtained from conducting the test on the PQS item was recorded The significance levels of high (low) t-values were given by the quantiles of the recorded maximal (minimal) t-values To monitor the extent of emotional involvement and autobiographical character of the three core sentences during the course of the psychotherapy we administered a self-rating questionnaire to the patient after each fMRI session In the questionnaire the patient was asked to rate the personalized sentences from the AAP scenes used in the scanner by answering the following two questions: “How much of the sentence applies to you autobiographically?” and “How strong did this sentence move you emotionally?” The patient had to assign a score between 1 and 7 Attachment classification and fMRI-stimuli were derived from the AAP (George and West, 2012) an established and validated interview to assess attachment representations The stimuli are line drawings of a neutral scene and seven attachment scenes (e.g. The AAP classification system designates the four main adult attachment groups identified using the AAI classification system (secure Classifications are based on the rating of several scales (e.g. deactivation) on the basis of verbatim transcripts of the stories to the seven attachment activating stimuli The neuroimaging session took place on the same day as the recorded psychotherapy hour It consisted of the task in the scanner and in the administration of a rating instrument to assess the patient’s reaction to the items presented in the scanner In each trial, the patient looked at pictures of attachment-relevant AAP scenes, accompanied by a short descriptive text. Each picture was presented for 20 s, followed by a fixation point for about the same duration (Figure 1) The AAP consists of a set of seven of such pictures; this set was repeated 12 times Repetitions of the set were divided into two groups: those in which the descriptive text was a neutral rendering of the figures appearing in the scene (neutral trials) and those where the description was tailored to core conflicts of the patient as assessed in the initial AAP interview (personally relevant trials) Schematic representation of the AAP scenes and sentences used in the functional neuroimaging study (example of a personalized trial) MRI data were recorded using a 3-T Magnetom Allegra head scanner (Siemens 508 EPI T2*-weighted whole brain volumes were acquired (TR/TE = 2500/30 ms Sessions were repeated in monthly intervals for a year The post-scan self-rating scales were analyzed separately from neuroimaging data using the freely available package R (The R Foundation for Statistical Computing, www.r-project.org, Vienna, Austria; repeated measures regression: function lmer, package lme4, version 2.13.1; Bates and Maechler, 2009) The dependent variable (emotional involvement or extent of autobiographical character of the scene–sentence couple) was modeled in a repeated measurements linear model as an effect of the hour character (“easy” or “difficult”) and the personally relevant AAP scene as fixed effects and the session and the sentences as grouping variables for the random effects being self-centered and rather achievement oriented When she felt in her job that clients were not as satisfied with her work as she expected from herself she broke down and was ruminating anxiously if they will come back This pattern demonstrated that her self-esteem fluctuated according to the gratifying or frustrating experiences in relationships and how she evaluated the distance between the goals and aspirations Because of her harsh super-ego demand for perfection she was in an instable inner state and self-esteem could be diminished rapidly The patient lived in a long-lasting relationship she characterized the relationship with her husband as competitive with respect to their tendency to experience rivalry and envy there was a clear discrepancy between her self-perception and the perception that significant others had of the patient Although easier days were subjectively felt more pleasant by the patient her husband reportedly found it very difficult to deal with her seemingly unsolvable conflicts and to repeatedly considering separation One of her major unconscious defensive structure seemed to circle around fantasies of success and grandiosity, leading to her dependency to be admired by others and to bouts of insecurity disrupting her sense of grandiosity or specialness (for a description of the related dynamic, see Kernberg and Yeomans, 2013) According to the observations of the analyst collected over 1 year of clinical work the following topics may be considered key to the psychodynamic understanding of the patient and her treatment: On “difficult” days the patient showed a severely inhibited capacity to think and to express feelings and thoughts and fell into silence On “easy” days the patient talked expansively and her personality appeared strong The association of the fluctuating symptoms with unresolved loss experiences and fear due to uncontrollable guilt-feelings these two core issues could be retrieved in the formal assessment of the interaction between the patient and the therapist using the PQS methodology Since the patient demonstrated a complex chronic affective disorder with difficult personality traits and a rigid defensive structure, there was an indication for long-term psychoanalytic treatment with two sessions per week (Leichsenring and Rabung, 2011) thus creating a positive stable counterpole to her mood changes The positive stabilizing effect of the therapy was noticeable early in the treatment even though the total process was taking a very long time The treatment centered on the deeper understanding of her uncontrollable mood-shifts and her impaired self-perception and perception of others The question of failure and/or the continuing of the analytic work were constantly present The transference relationship was mirrored by her experiences of loss: she failed to prevent the unexpected deaths and for a long time the analyst and the patient failed to prevent the unexpected mood-shifts and to find ways how she could regulate and stabilize her affective instability the patients internalized a better perception of herself and it became easier for the patient to succeed regulating her mood toward the state characterizing “easy” days One major focus of the treatment was to increase the patient’s ability to react timely in case of severe events like illness or death and therefore to be able to process these potential traumatic events in a more controlled and integrated way The patient was administered the AAP interview at the beginning of the fMRI experiments and 1 year later On the one hand we assessed the patient’s attachment representation at the beginning of the fMRI assessment and on the other hand we extracted core sentences of the patient’s narratives in the AAP interview as the personalized stimulus material in the fMRI setting (see Section “Neuroimaging Task”) The patient was classified as unresolved (i.e. Unresolved stories typically leave characters without protection describe feelings of extreme mental distress that have not been diminished or transformed or leave threatening images looming without addressing them further The patient demonstrated a lack of resolution especially in the AAP Picture “Cemetery” where the loss of the father was associated with mourning loneliness and a present dialogue with the dead father Analysis of the CIPS-depressiveness score gave a mean value of 12.2 (SD 5.2, range 8–19), indicating affective symptoms of moderate intensity. The regression of the scores over time failed to demonstrate the existence of changes. Nominally, in the examined monthly sessions the patient became more depressed during the year she was monitored (Figure 2) but the result was far from significant (t = 1.05; df = 10 Plot of depressiveness scores (y-axis) over the 12 months of the study (x-axis) The general burden of symptom, as measured by the OQ subscale, was on average 41.75 (SD 5.0, range 33.53), indicating alternating degree of symptom severities crossing the line of norm values (Haug et al., 2004) The analysis of the PQS scores took place in three steps we undertook an explorative analysis to answer the question of whether there were consistent changes over therapy hours across different items of the PQS by carrying out a principal component analysis of the PQS scores This analysis aimed at detecting items that were high or low together in the same hour without imposing a priori constraints on what these items should be as would be the case if items had been grouped into preformed scores We also looked at whether these changes were consistent with a linear trend (i.e. we looked at the existence of items that were associated with the analyst’s classification of the hours in good and bad we looked at whether changes detected during the explorative analysis related to the changes associated with the analyst’s judgment Ten highest scoring items from the principal component analysis of the PQS Several items in the principal component analysis scored negative values The PQS manual contains specific indications to score items as distinctively low a low score on item 54 is given for rambling or incoherent communications and on item 23 for lack of a guiding discourse thread; on item 13 for the patients appearing bored or dull Considered together with items with high scores (whose interpretation is immediate) they show that component one prevalently collected items suggesting difficult or inhibited communication of the patient toward the analyst These occurred together with other items suggesting the presence of a tense The second component appears to characterize form and content of the intervention of the analyst (items 31 66) and the sometimes difficult reaction of the patient to them (items 1 Even if the main components did not appear to reflect a change over time it is conceivable that some other isolated item did we tested the regression of each item score over time separately correcting the significance level for the 100 tests Also this analysis failed to detect items reflecting a change over the year of therapy The item that was most associated with time was item 76 (“Therapist suggests that patient accept responsibility for his or her problems,” which however failed to reach significance (t = 4.22 two-tailed corrected for multiple comparisons) change over time in the PQS scores did not document a systematic change after 1 year of therapy relative to the beginning of the monitoring period together with the respective linear trends (on the x-axis by the monthly session) Both component scores display a small tendency to increase over time In the second step of the analysis we looked at the existence of items that were associated with the analyst’s classification of the hours in “easy” and “difficult.” Both easy and difficult hours occurred during this year and a logistic regression of the occurrence of easy hours over time showed the absence of a significant time trend (z = -0.53 The separate regression of each PQS item on the analyst indicator of the quality of the hour detected three significant items after correcting significance levels for multiple comparisons: item 12 (“Silences occur during the hour”) corrected); item 61 (“Patient feels shy and embarrassed (vs un-self-conscious and assured.),” t = -5.76 p = 0.03; item 54 (“Patient is clear and organized in self-expression”) item 7 (“Patient is anxious or tense (vs we looked at whether changes detected during the explorative principal component analysis in the form of component scores related to the changes associated with the analyst’s judgment There was a significant association between the first component scores and the analyst’s indicator of the quality of the hour (t = -5.03 was not significantly associated (t = 1.01 there was at least one set of PQS items that changed together across therapy hours These changes were not associated with a time trend indicating stability of the underlying psychotherapy pattern; however they were associated with the occurrence of “easy” and “difficult” days This result did not change if the PQS items were regressed individually on time and day difficulty We compared the clinical features of “difficult” and “easy” days with the first component from the PQS, obtained independently from information on the day difficulty (see Table 2) This comparison revealed convergent patterns emphasizing the difficulties of expression of the patient is consistent with the items in the first component detailing inhibited communication The identification by the analyst of unresolved feelings of loss corresponds to the items related to tense and sober mood We conclude that the PQS analysis could validate the subjective evaluations of the analyst Clinical characteristics compared to PQS-items (principal component analysis) The patient was asked after each fMRI session to rate personalized sentences from the fMRI task with respect of self-involvement and autobiographical content (see Section “Materials and Methods”) The analysis of emotional self-involvement revealed that the rating was on the whole significantly higher in the fMRI sessions that followed “easy” therapy hours (t = 2.08 This result did not change if the autobiographical rating was added as a confounding covariate to the model (t = 2.08) This expanded model also revealed that the autobiographical rating was in the individual items associated with the level of emotional involvement rating (t = 3.9 there was no significant change in ratings of the autobiographical character of the personalized sentences in association of the quality of the hour (t = 1.27 these self-rating data confirmed the existence of a qualitative difference between “easy” and “difficult” days that involved the stimuli presented in the scanner through the tendency of a higher self-rated emotional involvement on “easy” days there was an even stronger association at each individual rating between the level of self-involvement and the level of autobiographical character of the scene + text combination No area was significantly more active when looking at the neutral scenes (A) Parametric maps of activations detected in the personally relevant vs (B) Parametric maps of the interaction of the same contrast with hour quality Slices positioned at MNI coordinates x = -6 (left) and z = 40 (right) the parametric map was thresholded at p < 0.005 and a cluster size of 150 voxels (1.2 cm3) active at both the contrast personally relevant vs neutral and its interaction with hour quality; b Areas a and c (labeled in green) belong to the “default network system”; area d to the dorsal attentional network (in blue) The red label b refers to primary visual areas Activations for the contrast personalized vs smaller areas detected in the interaction failed to reach significance No significant interaction was observed in the opposite direction No effect was observed in the interaction with a negative time trend Recently, the issue of the relationship between Freudian thought or psychoanalytic theory and technique more generally and neuroscience has been the object of renewed interest (Carhart-Harris et al., 2008; Carhart-Harris and Friston, 2010; Solms and Panksepp, 2012; Zellner, 2012; Schmeing et al., 2013) we attempted to integrate a clinical description of the psychoanalytic process with two empirical instruments one providing an operationalized assessment of the therapeutic interaction and the other information on brain activity based on a functional neuroimaging probe Our aim was to explore the extent to which the two main mental states of the patient and their effect on the psychoanalytic interaction could be observed not only at the clinical level but also through the data delivered by these two additional instruments The analysis of the PQS data showed that sessions differed along a main axis This component was highly correlated with the judgment of the analyst on the quality of the sessions This analysis revealed that “easy” hours were associated with items describing the deeper understanding of relationship issues “difficult” hours with silence in the therapy hours and difficulties of the patient to feel at ease there was no evidence in the PQS data of a linear trend over time that reflected systematic changes from the initial to the final phases of the year monitored by the study the main change across sessions present in the PQS data was the one documented by the analyst through her judgment in a phase of therapy where the patient remained stable This source of change was not associated with a time trend as “easy” or “difficult” days did not occur more often at the beginning or end of the observation year This allows excluding the confounds of habituation or learning effects from the regressor representing quality of the hour We therefore considered the areas in this second group as those most likely involved in processing the personally relevant content of the stimuli Within this pattern of activation of areas associated to the self and personal relevance the posterior cingulate cortex was modulated by the interaction with the quality of the therapy hours that had immediately preceded the scan This association represent evidence of a neural substrates accompanying opposing mental states that the judgment of the analyst on the quality of the hour and the formal instrument for assessing the therapeutic exchange represented a coherent constellation of internally experienced and interpersonally exchanged affect The self-rating data collected after the scan confirmed the association between the enactment of a self-distancing strategy from the material and the quality of the hour the patient indicated that her overall emotional involvement with the visuotextual material was lower than on the “easy” days This corresponded to a higher activity in the posterior cingulate area associated in the previous studies with self-distancing emotion regulation strategies In view of the documented association between the quality of the hour and the quality of the interaction with the therapist and the clinical judgment of the therapist himself the present study provides evidence on the possible involvement of the posterior cingulate area in spontaneously enacted self-distancing emotion-handling strategies representing defensive maneuvers in the course of a psychoanalytic therapy Among the areas active in the contrast personally relevant vs. neutral there were also areas prevalently involved in attentional processes (dorsolateral prefrontal cortex; Figure 4A letter c) Also this area was modulated during the year of therapy showing a progressive increase of the signal due to personally relevant trials This suggests a dissociation of the areas detected in the contrast personally relevant vs with the posterior medial area associating with quality of the hour and the dorsolateral prefrontal areas associating with change over time The change over time in the dorsolateral prefrontal cortex might be due to a progressive loss of attentional pull of the non-relevant trials or to the increased recruitment of attentional resources in looking at scenes in the personally relevant trials From a clinical point of view it could mean that the patient was more effective in appraising and reflecting on her own personal core attachment-related issues this aspect of the psychotherapeutic interaction fell outside of the scope of the present study we were able to objectify the defensive structure of this patient during this phase of psychoanalytic treatment and the occurrence of difficult sessions This study was in part funded by the German Psychoanalytic Association whose generous support is here gratefully acknowledged The authors declare no conflict of interest International Psychoanalytic University Berlin for his encouragement and the inspiration for initiating this research for training and supervising the PQS scoring Der “Psychotherapie Prozess Q-Set” von Enrico E Bates, D. 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anxiety and depression: a meta-analysis Pubmed Abstract | Pubmed Full Text | CrossRef Full Text A narcissistic defence against affects and the illusion of self-sufficiency Pubmed Abstract | Pubmed Full Text Projective Identification and Psychotherapeutic Technique “Fifty years of psychotherapy process-outcome research: continuity and change,” in Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change Lambert (New Jersey: Wiley & Sons) “Random-effects analysis,” in Human Brain Function Penny (San Diego: Elsevier Academic Press) Pathological narcissism and narcissistic personality disorder doi: 10.1146/annurev.clinpsy.121208.131215 Pubmed Abstract | Pubmed Full Text | CrossRef Full Text Analysis of individual positron emission tomography activation maps by detection of high signal-to-noise pixel clusters Pubmed Abstract | Pubmed Full Text | CrossRef Full Text How is our self related to midline regions and the default-mode network Pubmed Abstract | Pubmed Full Text | CrossRef 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Front. Hum. Neurosci. 7:677. doi: 10.3389/fnhum.2013.00677 Copyright © 2013 Buchheim, Labek, Walter and Viviani. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) *Correspondence: Anna Buchheim, Institute of Psychology, University of Innsbruck, Innrain 52, 6020 Innsbruck, Austria e-mail:YW5uYS5idWNoaGVpbUB1aWJrLmFjLmF0 †Anna Buchheim and Karin Labek have contributed equally to the study. Volume 10 - 2016 | https://doi.org/10.3389/fnhum.2016.00627 has been characterized as the “hormone of affiliation” and is stimulated in mothers when interacting with their offspring Variations in maternal oxytocin levels were reported to predict differences in the quality of care provided by mothers the Adult Attachment Projective Picture System (AAP) as a valid measure to assess attachment representations was used as an activating attachment-related stimulus We investigated whether the AAP induces a release of oxytocin in mothers with a secure attachment representation and a stress-related cortisol response in mothers with an insecure attachment representation pre-post effects of AAP administration on plasma oxytocin and serum cortisol levels were investigated in n = 44 mothers 3 months after parturition Oxytocin levels increased from pre to post in the significant majority of 73% participants (p = 0.004) and cortisol decreased in the significant majority of 73% participants (p = 0.004) no association between alterations in oxytocin and cortisol were found; this suggests taking a model of two independent processes into considerations These results show that the AAP test procedure induces an oxytocin response Concerning the results within the four AAP representation subgroups our hypothesis of a particularly strong increase in oxytocin in secure mothers was not confirmed; however in secure mothers we observed a particularly strong decrease in cortisol allowing the replication of results in a larger study with sufficient sample size to draw final conclusions with respect to differences in OT and cortisol alterations depending on attachment representation one should keep in mind that this study investigated lactating mothers the generalizability of results is limited and future studies should investigate non-lactating healthy females as well as males and include a control stimulus condition These natural variations in parental oxytocin responses may predict differences in the quality of maternal/paternal caregiving attachment seems to be a strong predictor of oxytocin and cortisol levels in the periphery resulting in effects on state and trait anxiety These data support the notion that attachment representations may affect stress responses and suggest a specific role of oxytocin in both the attachment and the stress system These studies show that attachment representations are associated with characteristic oxytocin and cortisol responses in response to a social stress test when the caregiving system is activated and the mother becomes distressed by the situation or the child the mother’s attachment system is also likely activated Peripheral blood was collected to generate plasma and serum for the assessment of oxytocin and cortisol (i) We hypothesized an increase of oxytocin level after the AAP (ii) We expected a possible change in the cortisol level (iii) The investigation of attachment group differences was of exploratory nature we asumed a stronger oxytocin increase after the AAP in securely attached mothers compared to insecurely attached mothers and an increase in cortisol in the insecurely attached groups compared to the securely attached group Participants received another 40 € as a compensation for the participation in t1 The study was approved by the Ethics Committee of the Ulm University Written informed consent was obtained from all subjects in accordance with the Declaration of Helsinki Flowchart showing criteria of participants in- and exclusion All AAP protocols were analyzed by a highly experienced and reliable rater (A.B.) The personal codes of participants and time (“before” or “after” the AAP administration) were eliminated in the transcribed protocols the judge was blind with respect to the time sequence and personal pairings Mothers had their last meal 2–3 h before arriving in the laboratory between 12 pm and 1 pm Mothers were allowed to have a regular breakfast but they were asked to fast for at least 3 h prior to study participation They were allowed to drink water only but no coffee or tea before and during the AAP who breastfed their child during the study procedures were excluded from the analysis due to the known effects of breastfeeding on the oxytocin levels mothers were asked to first take care of their babies (e.g. then mothers were left alone for a short period (approximately 15–20 min) to bring the endocrine levels to a baseline level Following this short resting period the first venipuncture and blood collection was performed Afterwards mothers were introduced to the experimental procedures participants were asked to tell a story for each AAP picture: “What is happening in the scene?” “What led up to the scene?” “What are the characters thinking or feeling?” The procedure lasted about 20 min (see “AAP Duration” Section below) Missing duration values were caused by incorrect settings of voice recorders The AAP interviews were administered by trained psychologists in a standardized manner a second blood sample was collected again via venipuncture Mothers were allowed to hold their babies in their arms Mothers who needed to breastfeed during the AAP or during blood collection were excluded from further analyses infants were sleeping in their baby carriages during the experiment mothers were allowed to hold them in their arms After finishing the AAP procedure and the second blood sampling snacks and water were offered and mothers were able to take care of their babies Blood samples were drawn from antecubital veins into 7.5 ml vacutainer blood monovettes containing EDTA (Sarstedt Germany) and 7.5 ml Z-Gel monovettes (Sarstedt EDTA monovettes and tubes were ice-chilled and serum monovettes were stored at room temperature EDTA monovettes were centrifuged at 4°C at 1.300 g for 15 min and serum monovettes were centrifuged at 4°C at 1.500 g for 10 min Supernatants were stored at −80°C until further assay analysis Aliquots of 250 μl were stored at −80°C until analyses Oxytocin was determined by standardized RIA (RIAgnosis Determination of cortisol (nmol/l) was realized using a chemiluminescence-immuno-assay CLIA (IBL international—Hamburg) at the Institute of Biopsychology All procedures were performed according to the manufacturer’s protocols Tests of normal distribution for oxytocin and cortisol levels (n = 44) Other strict monotone transformations like inverse or square root did not lead to the distribution desirably satisfying the test assumption as well we decided to apply the conservative exact sign test This test compares the number of participants with increased and decreased parameter values because they are invariant to any strict monotone transformation The association between increase:decrease ratios for oxytocin and cortisol were tested by the exact Fisher’s test cortisol levels and psychometrical scales and subscales were tested by the Spearman’s rank correlation coefficient All these procedures are invariant to any strict monotone transformation of measured values as well This implies that tests for originally measured and log-transformed values are mutually equal we present means and standard deviations of originally measured hormone level values These statistical examinations were performed by two-sided tests using the significance level p = 0.05 Statistical analyses were performed using the software system IBM SPSS 23 The observed mean duration of the AAP recordings was 17.5 min (n = 35; time range 9–34 min; SD = 5.4 min) No significant Spearman’s correlation was found between the AAP duration on the one side and the pre and post values of the hormonal parameters oxytocin and cortisol on the other side (n = 35; oxytocin pre rs = 0.201 we found no significant differences in the duration of the AAP between the four different attachment representation groups (Kruskal-Wallis test Monte Carlo with 108 simulations: p = 0.764) The four attachment representations in the study sample of n = 44 mothers were distributed as follows: F (secure) 9 (21%) On average, oxytocin levels increased from 0.83 pg/ml (SD 0.57, SEM 0.08) to 0.98 pg/ml (SD 0.75, SEM 0.11) from pre to post AAP. The pre and post mean values of oxytocin and standard errors of mean are shown in Figure 2. The average change of measured oxytocin levels was +0.15 pg/ml (SD 0.46, SEM 0.07); see Figure 2 and the last row in Table 2 This increase was observed in the majority of mothers (73%); the increase:decrease relation 32:12 is significant by the exact sign test (p = 0.004 Means and standard errors of mean of oxytocin and cortisol levels before and after the Attachment Projective Picture System (AAP) administration Oxytocin levels before and after the Adult Attachment Projective Picture System (AAP) in the sample and four attachment groups Cortisol levels decreased from 650.2 nmol/l (SD 213.8, SEM 32.2) to 568.7 nmol/l (SD 211.3, SEM 31.9). The average change in cortisol level was −81.5 nmol/l (SD 212.6, SEM 32.1); see Figure 2 again and the last row in Table 3 A decrease of cortisol was observed by the majority of mothers (73%); the increase:decrease relation 12:32 is significant by the exact sign test (p = 0.004 Cortisol levels before and after the AAP in the sample and four attachment groups A significant increase in oxytocin levels and a significant decrease in cortisol levels were found. However, the changes were not significantly associated, see Figure 3 The concurrent oxytocin increase and cortisol decrease - shown on the logarithm scales here - were observed by the majority of 23 participants (52%) the frequencies of all four combinations of oxytocin/cortisol changes are shown The statistics and measures based on frequencies in this fourfold 2 × 2 table (23 3) did not find any association between the increase/decrease of oxytocin and cortisol (Pearson χ2(1) = 1.213; exact two-sided Fisher’s test p = 0.763 Changes of oxytocin and cortisol levels (on the logarithm base e scale) before and after the AAP administration No association (based on the case frequencies in four quadrants) between the oxytocin increase and cortisol decrease—both processes are likely independent Attachment types are indicated by colored dots: green: (F) secure; blue (Ds) dismissing; yellow (E) preoccupied and red (U) disorganized The values of oxytocin and cortisol levels between the four AAP groups were compared by the non-parametric Kruskal-Wallis test using the Monte Carlo approach with 107 simulations No significant differences between attachment groups were found for the oxytocin pre values (p = 0.055) cortisol pre values (p = 0.537) and cortisol post values (p = 0.908) Contrary to our expectation, the increase in oxytocin within the secure group was observed only in 33% cases; in all three insecure groups its proportion was over 80% (see Table 2) Comparing these proportions mutually between groups a general significant difference between the four groups was found (exact Fisher test for 4 × 2 table: p = 0.046) The mentioned increase proportion in the secure group was also significantly lower than the proportion in joint insecure groups (Fisher test for 2 × 2 table: p = 0.007 two-sided) According to our expectation, the decrease of the cortisol level was prevailing by securely attachment mothers (100%, see Table 3) no general significant difference between the four groups was found (exact Fisher test for 4 × 2 table: p = 0.178) As an exploratory result not corrected for the simultaneous inference the significantly higher decrease proportion was found in the secure group (Fisher test for 2 × 2 table: p = 0.047 two-sided) we found no significant association between hormonal changes of oxytocin and cortisol in our study setting more research is needed to get more detailed information about the HPA axis reaction in lactating mothers during an attachment stimulus One possible approach should be the investigation of the stress system in non-lactating mothers during an attachment stimulus evaluating the possible effect of lactation on HPA-axis response we excluded all breastfeeding mothers from our analyses it remained unclear whether the oxytocin response may also be due to the mother-child-contact during the AAP as mothers were allowed to be in visual or physical contact with their child during the experiments we cannot rule out the possibility that the mother-infant relationship might have triggered attachment-related feelings in all mothers independent of their individual attachment status More research is needed to clarify this issue resting time prior to the first blood sampling may take a minimum of 30 min which should be ameliorated in further studies cortisol findings in this study should interpret with caution controlling for duration of the AAP revealed no significant effects on time-dependent hormone levels Our aim was to perform the pre- and postmeasurements timely as exact as possible before and after the AAP interview Because the duration of this interview is not constant by its nature the time interval between two measurements could not be constant as well A main limitation of the study was the lack of placebo conditions where mothers were in contact with their child without the influence of the AAP Due to our study design this additional condition was not possible to include the oxytocin effect could be caused by other factors than the AAP procedure; for instance oxytocin release might have been stimulated by mother-child proximity and contact Also the cortisol effects may be affected by other factors like a stressful atmosphere by a crying child during the AAP or the relatively short habituation time before the basal blood collection a control group of non-lactating mothers and a non-attachment related narrative task as a control condition (placebo group) This study is the first to use the AAP as an instrument with the potential to activate the attachment and/or the caregiving system in an experimental setting Measuring stress- and attachment-related hormones our results confirmed that the AAP Oxytocin increase was similar in all attachment representation groups but was mainly driven by the insecure attachment groups who showed a significantly higher increase proportion of oxytocin compared to the secure group after the AAP cortisol decrease was observed over all attachment groups and was particularly pronounced within the secure attachment representation A more detailed investigation of the differential effects of secure and insecure attachment was limited by the small sample sizes of the attachment subgroups When interpreting these findings it should be kept in mind that the study investigated breastfeeding mothers the study indicates that the AAP might be able to induce an increase in oxytocin although this has to be replicated in future studies with non-lactating mothers as well as males This study was a pilot study to a larger BMBF-funded project on “Stress resilience in the transgenerational transmission of childhood maltreatment” The pilot study was conceptualized by I-TK The coding of attachment interviews were conducted by AB The study setup and data collection were organized by KS CD-W and SK controlled data entry and organized blood analyses DP designed and performed the statistical data analyses; DP also contributed substantially to the psychological result interpretation A-LH and AK provided important intellectual contribution in commenting and revising the manuscript AB and DP wrote the manuscript and edited its final version We would like to thank Traudl Hiller for substantial help in performing blood drawings and in the processing of blood samples Adult Attachment Projective Picture System; BPD Patterns of Attachment: A Psychological Study of the Strange Situation Google Scholar Responses to laboratory psychosocial stress in postpartum women Specifying the neurobiological basis of human attachment: brain hormones and behavior in synchronous and intrusive mothers vasopressin and social recognition in mammals transport and release of posterior pituitary hormones “From dialogue to internal working models: the co-construction of self in relationships,” in Minnesota symposia for child development Google Scholar CrossRef Full Text | Google Scholar Evidence of dysregulated peripheral oxytocin release among depressed women Effects of different kinds of couple interaction on cortisol and heart rate responses to stress in women Adult attachment and social support interact to reduce psychological but not cortisol responses to stress Boosting recovery rather than buffering reactivity: higher stress-induced oxytocin secretion is associated with increased cortisol reactivity and faster vagal recovery after acute psychosocial stress Parental oxytocin and early caregiving jointly shape children’s oxytocin response and social reciprocity Natural variations in maternal and paternal care are associated with systematic changes in oxytocin following parent-infant contact salivary and urinary oxytocin and parent-infant synchrony: considering stress and affiliation components of human bonding Representational models of relationships: links between caregiving and attachment (Special Issue: Defining the Caregiving System doi: 10.1002/(SICI)1097-0355(199623)17:3<198::AID-IMHJ2>3.0.CO;2-L CrossRef Full Text | Google Scholar “The caregiving behavioral system: A behavioral system approach to parenting,” in Handbook of Attachment: Theory Google Scholar PubMed Abstract | Google Scholar Social support and oxytocin interact to suppress cortisol and subjective responses to psychosocial stress socially reinforced learning and emotional empathy in humans Oxytocin and the neurobiology of attachment Utilizing attachment measures in custody evaluations: incremental validity CrossRef Full Text | Google Scholar CrossRef Full Text | Google Scholar Oxytocin increases amygdala reactivity to threatening scenes in females CrossRef Full Text | Google Scholar Meyer-Lindenberg Oxytocin and vasopressin in the human brain: social neuropeptides for translational medicine Balance of brain oxytocin and vasopressin: implications for anxiety A cross-sectional study to compare two blood collection methods: direct venous puncture and peripheral venous catheter Maternal behavior deficits in nulliparous oxytocin knockout mice Adult attachment representations predict cortisol and oxytocin responses to stress Hpa system regulation and adult attachment anxiety: individual differences in reactive and awakening cortisol Unresolved anger and sadness: Identifying vocal acoustical correlates Characterization of the oxytocin system regulating affiliative behavior in female prairie voles Menstrual cycle-related changes in plasma oxytocin are relevant to normal sexual function in healthy women dopamine and the neurobiology of attachment Maternal oxytocin response during mother-infant interaction: associations with adult temperament cortisol and attachment predict plasma oxytocin Vrtička Attachment representation modulates oxytocin effects on the processing of own-child faces in fathers Waller C and Buchheim A (2016) Effects of the Adult Attachment Projective Picture System on Oxytocin and Cortisol Blood Levels in Mothers Received: 02 March 2016; Accepted: 24 November 2016; Published: 08 December 2016 Copyright © 2016 Krause, Pokorny, Schury, Doyen-Waldecker, Hulbert, Karabatsiakis, Kolassa, Gündel, Waller and Buchheim. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher 94% of researchers rate our articles as excellent or goodLearn more about the work of our research integrity team to safeguard the quality of each article we publish Joerg Buchheim’s key responsibility will be to advance Kongsberg Automotive’s position as market leader and to make full use of the company’s significant potential through strong innovation He will also be tasked with further strengthening the company’s geographical footprint he successfully shaped a profitable growth path as President and CEO for the automotive roof specialist Inalfa Roof Systems He also played a pivotal role in profitably growing the Chinese market as President and CEO of HELLA a leading Tier 1 lighting and electronics company Kongsberg Automotive’s co-CEOs ad interim will return to their previous roles and responsibilities as CFO and Senior Vice President Off-Highway The Board of Directors would like to thank them both again for their exceptional professionalism and outstanding effort during the time they carried out their dual responsibilities Kongsberg Automotive is well-positioned to navigate out of the pandemic thanks to a strong order book resulting from successful business wins over the last years by leveraging its strengths of being close to its customers and by focusing on research and development as well as on sustainability Don't have an account? Subscribe “Our goal is to help stakeholders understand the future of mobility.” Home › News Releases › Managing Director China Jörg Buchheim to leave the Management Board of Hella will leave the HELLA Geschäftsführungsgesellschaft mbH by mutual amicable agreement effective 30 November 2015 Jörg Buchheim had been holding various managerial roles in HELLA’s Chinese operations before his appointment to the Management Board of HELLA as President & CEO China in January 2014 a role HELLA had created to address the disproportionate growth in the region and advance the development of its local structures HELLA’s Shareholder’s Committee has now decided to discontinue the role of President & CEO China in the HELLA Management Board thereby following the approach that has already been used for all other regions responsibility for the management of HELLA’s Chinese activities will be fully transferred to the divisional leadership and HELLA’s local corporate centers Jörg Buchheim will therefore leave the HELLA Management Board and the company by mutual agreement “China is and will continue to be one of the largest and most rapidly growing markets in the automotive industry It will remain a clear priority for us,” said Managing General Partner Dr Jürgen Behrend “We would like to thank Jörg Buchheim very much for his excellent collaboration and contribution to building the HELLA network in China.” Let us help you understand the future of mobility Δdocument.getElementById( "ak_js_1" ).setAttribute( "value" and trends shaping the future of electric mobility Tickets for this in-person event are limited and trends shaping the future of the software-defined vehicle and trends shaping the future of autonomous mobility Rex Hamilton of Marion are pleased to announce the marriage of their son Nathan … Home / Milestones / Weddings Rex Hamilton of Marion are pleased to announce the marriage of their son Nathan Ross Hamilton to Andrea Nicole Buchheim The day was made even more special by the newlyweds' daughter Andrea's sister Sara Kleve was her matron of honor Larkin Hamilton was a junior bridesmaid and Flower girls were the couple's daughter Charlie Hamilton and niece Greta Kleve Jason Hamilton and brothers-in-law Brett Buchheim and his younger brother Keegan Hamilton was his best man junior groomsman and nephew Liam Kleve was ring bearer Andrea is employed by Elevate Salon & Spa The couple honeymooned in Puerto Rico for one week before returning to Marion Posted in: Weddings Community May Elijah Decious People & Places May Marion and Rich Patterson Travel May The Gazette Get to Know Gives Back Podcast Apr Community Apr Bailey Cichon Curious Iowa Apr By NICOLE WINFIELD and COLLEEN BARRY - Associated Press Nation and World Apr Elijah Decious People & Places Apr Bryan Busch Health & Wellness Apr Veronica Lorson Fowler Home & Garden Apr The Gazette has been informing Iowans with in-depth local news coverage and insightful analysis for over 140 years independent journalism with a subscription today © 2025 The Gazette | All Rights Reserved 25 January 2021 – The Board of Directors of Kongsberg Automotive ASA announced today Mr Joerg Buchheim as new CEO and President of Kongsberg Automotive ASA He currently serves as President & CEO of Inalfa Roof Systems “Joerg Buchheim not only brings more than 20 years of diverse and international executive leadership experience in the automotive supply industry but also has a successful track record in both growing and realigning automotive supplier businesses” “His strategic vision and deep operational competencies make him the right leader to drive the success of Kongsberg Automotive in its next phase.” “I am honored to join the KA family,” said Joerg Buchheim “and am very much looking forward to working with the leadership team and entire workforce to drive the company forward and further develop the various business areas.” As a proven top executive in the global automotive supply arena Joerg Buchheim has successfully led complex automotive supplier businesses in situations of growth as well as restructuring Having served almost 15 years at tier-1 lighting and electronics specialist HELLA he played a pivotal role in profitably growing HELLA's business in China he held the overall responsibility for this growth region as President & CEO HELLA China and later also joined the Group Executive Board of HELLA Since 2016 Joerg Buchheim served as President & CEO of automotive roof specialist Inalfa Roof Systems where he successfully shaped the future of Inalfa Group by driving an encompassing turnaround program while setting the foundations for a profitable growth path To ensure a smooth leadership transition and KA's continued focus on business performance Mr. Norbert Loers and Mr. Robert Pigg will continue as Interim Co-CEOs until Mr Joerg Buchheim has been onboarded on May 1st The board would like to take this opportunity to thank both Mr Robert Pigg for their outstanding work and dedication in carrying out their dual responsibilities and professionally leading the company over the past months Kongsberg Automotive provides world class products to the global vehicle industry Our products enhance the driving experience EUR 1.1 billion and approximately 11.000 employees in 19 countries Kongsberg Automotive is truly a global supplier The company has more than 25 production facilities worldwide The product portfolio includes seat comfort systems and industrial driver interface products developed for global vehicle manufacturers Find more information at www.kongsbergautomotive.com Wolfgang Petersen's "Das Boot," based on the 1973 book by Lothar-Günther Buchheim was an enormous hit when it was released in Germany in 1981 Taking place on the real-life U-96 submarine as it patrolled the oceans during the Battle of the Atlantic in the 1940s and action-packed look at the lives of German soldiers as they struggled to survive — both the dangers and the utter tedium — in an extreme environment It starred Jürgen Prochnow as the submarine's commander a solider openly critical of the Nazi party and concerned that his crew was too young to handle the pressures of war "Das Boot" was released in the United States in February of 1982 and would go on to garner six Academy Award nominations "Das Boot" was also subject to multiple recuts The original German version ran 209 minutes The version seen in America had been edited down to a mere 149 minutes Eventually an expanded version was released on TV in England as a miniseries before Petersen finally settled on what would be called "The Director's Cut" in 1997 If you've seen a version of "Das Boot" called "The Original Uncut Version," it is a slightly shortened version of the miniseries and this is all nothing to say of the 2018 "Das Boot" remake miniseries the film wasn't historically accurate enough and the sets were built in accordance to them The exterior of U-96 was a nonfunctional shell that was filmed in the oceans off the coast of France and had to be salvaged before shooting could be completed Despite the efforts at accuracy, and the struggles of shooting at sea, Buchheim was unsatisfied with little details. Some of his complaints are listed on the website War History Online in screaming and crying and behaving the way actors do were not behaving in a professional manner there is a scene wherein a lower-ranking officer throws a greasy rag into the face of his captain This sort of behavior would not have been attempted on a real U-boat and the soldier in question would likely have been severely reprimanded Petersen, to dramatically depict hull pressure aboard a submarine filmed bolts flying off the walls in rapid succession only one bolt would be enough to cause alarm Multiple bolts loosening would pretty much spell out certain doom for the people aboard The Enigma machine — the infamously difficult-to-crack code-making machine — was a model from 1942 when the film took place in 1941 mostly the result of filmmaking continuity rather than historical inaccuracy (like when the actors say they're pointing to port when it's clear they are pointing starboard) These aren't even Buchheim's greatest complaints He was mostly concerned that "Das Boot" would glorify the German national character irresponsibly and make the Nazis look good and Petersen clearly intends to depict war — especially WWII — as an erosion of the human character Petersen did not want to make a nationalistic film — and to this critic's eye, he didn't — but he is a filmmaker with a flair for the dramatic, and will go out of his way to wring drama from a tense wartime situation. Buchheim was concerned that by showing a U-boat as a place of survival and unity, "Das Boot" would tip into propaganda again. Buchheim was sensitive to that, as he authored propaganda during the war and knew what the real thing looked like. Whether or not an average audience member thinks "Das Boot" is a glorification of German U-boats in WWII would have to come down to a matter of interpretation. Reporting by Stephen Nellis in San Francisco; Editing by Lincoln Feast Our Standards: The Thomson Reuters Trust Principles., opens new tab , opens new tab Browse an unrivalled portfolio of real-time and historical market data and insights from worldwide sources and experts. , opens new tabScreen for heightened risk individual and entities globally to help uncover hidden risks in business relationships and human networks. © 2025 Reuters. All rights reserved the German filmmaker whose World War II submarine epic "Das Boot" propelled him into a blockbuster Hollywood career that included the films "In the Line of Fire," "Air Force One" and "The Perfect Storm," has died Petersen died Friday at his home in the Los Angeles neighborhood of Brentwood after a battle with pancreatic cancer made two features before his 1982 breakthrough "Das Boot." Then the most expensive movie in German film history the 149-minute "Das Boot" (the original cut ran 210 minutes) chronicled the intense claustrophobia of life aboard a doomed German U-boat during the Battle of the Atlantic with Jürgen Prochnow as the submarine's commander "Das Boot" was nominated for six Oscars including for Petersen's direction and his adaptation of Lothar-Günther Buchheim's best-selling 1973 novel who grew up on the northern coast of Germany He would return to it in the 2000 disaster film "The Perfect Storm," a true-life tale of a fishing boat lost at sea "The power of water is unbelievable," Petersen said in a 2009 interview "I was always impressed as a kid how strong it is all the damage the water could do when it just turned within a couple of hours "Das Boot" launched Petersen as a filmmaker in Hollywood where he became one of the top makers of action adventures of massive cataclysms that spanned war (2004's "Troy," with Brad Pitt) pandemic (the 1995 ebolavirus-inspired "Outbreak") and other ocean-set disasters (2006's "Poseidon," about the capsizing of an ocean liner) Petersen is survived by second wife Maria-Antoinette Borgel a German script supervisor and assistant director whom he wed in 1978 23 March 2023) Julian Maier from MedUni Vienna's Institute of Pharmacology has been awarded the prestigious Rudolf Buchheim Prize 2022 by the German Society for Experimental and Clinical Pharmacology and Toxicology (DGPT) In a study the research team around Julian Maier led by Harald Sitte from MedUni Vienna's Institute of Pharmacology in cooperation with Volodymyr Korkhov from ETH Zurich resolved the structure of a cation transporter that has been little researched to date and also investigated mutations that occurred in patients Organic cation transporters have a great influence on the monoamine balance and play an important role in the physical absorption and excretion of drugs The study enables targeted research on substances that selectively interact with the transporter and was published in the journal Nature Communications Rudolf Buchheim (1820 - 1879) is the founder of pharmacology as an independent medical discipline Buchheim established the experimental testing of hypotheses and systematic research into substances and their effects The Rudolf Buchheim Prize is considered one of the most important awards for young scientists in the field of pharmacology and toxicology It is awarded by the DGPT to recognise special achievements of young scientists in experimental pharmacological and toxicological as well as clinical pharmacological basic research applied drug research and the transfer of results into practice and to promote their further development We use cookies that are technically necessary for the functionality of our website marketing and analysis purposes to optimise the user experience on our site data is processed both by us and by third-party providers some of which are based in third countries (e.g You can find more information about the tools and the partners in our data protection declaration in which we also explain exactly what data transfer to the USA can mean You can individually adjust or revoke your cookie settings at any time if you wish These cookies are necessary for the basic functions of the website You can block or delete them in your browser settings but you then run the risk that some parts of the website will not function properly Necessary to obtain consent for certain cookies and thus for the use of certain tools To track users on your website(s) or app(s) the default Matomo Tracking code in JavaScript uses 1st party cookies which are set on the domain of your website The expected tariff cost is significantly lower than the $4 billion to $5 billion crosstown rival General Motors estimates which Ford attributes to its higher mix of U.S.-built vehicles Please enable JS and disable any ad blocker Desert Hot Springs is dipping into its reserves to cover an estimated $1.5 million budget deficit The shortfall is largely due to unforeseen major expenses such as storm repairs and to a projected decline in revenue after a reduction in the city's cannabis tax rate “We are reacting to that lower revenue source just as any individual or business would react through their budgets,” said City Manager Frank Luckino The city's 2023-24 general fund budget anticipated $32,979,468 in revenue but expenses are now projected at $34,331,110 according to Deputy City Manager Doria Wilms She said Desert Hot Springs expects to use $1,549,914 in reserves which would leave the city with about $8.4 million in reserves after the fiscal year ends June 30 “Staff is recommending a one-time use of reserve funding to address this need and ensure proper maintenance of essential core city services like emergency response police and addressing homelessness as well as clean well-lit city streets and parks,” said Geoffrey Buchheim the city’s administrative services director He added that reserves can only be used in the short term and that if shortfalls continue the city would need to either find additional revenues or cut services The council approved the budget adjustments with a 4-1 vote on March 5 Councilmember Russell Betts was the dissenting vote In February, the city council approved lowering the city's cannabis cultivation tax from $10.20 to $5.75 per square foot to help relieve some of the financial burden on the struggling industry This reduced the city’s expected cannabis revenues by $1.9 million for the 2023-2024 fiscal year But due to increases in other revenues like transient occupancy tax from visitors the city estimates that its overall revenue will only decrease by $188,272 the major storm that walloped the desert in August after being a hurricane at sea It caused significant damage that required Desert Hot Springs to spend over $1 million on repairs Buchheim said the Federal Emergency Management Agency is expected to reimburse the cost for storm clean-up but that money will probably take more than a year to receive Desert Hot Springs removed 12 full and part-time positions Wilms said four staff members were laid off five positions were frozen and three contract staff members were released This included eliminating the economic development department which laid off the economic development director and administrative assistant Economic development is now under the purview of the city manager's office The city also eliminated the deputy city clerk position and reclassified one staff member to counter permit tech to avoid a layoff the city staff report states that it also reduced spending on supplies and reduced or terminated certain contract services Betts said he voted against the budget adjustments because he doesn't support how the city handled expenditures for the homeless access hub The city used $629,230 from one of its funds to make improvements at the hub and he doesn't remember the council approving it Luckino, the city manager, said the council gave direction to rehabilitate the building where the hub is located during the closed session in which it approved its purchase the public has a chance to weigh in on this stuff and we can't decide these things in closed session," Betts said Mayor Scott Matas said the city has been conservative with planning its spending but this was one of the years where it bought facilities and set policies to improve residents' quality of life "But that doesn't come without a price sometimes Wilms said city staff will present adjustments to the 2024-25 budget to the council in May and June which will keep a balanced budget and not use reserves meaning it has already approved a tentative spending plan for 2024-25 and makes adjustments as needed Ani Gasparyan covers the western Coachella Valley cities of Desert Hot Springs and Cathedral City a film was released which is still cited as one of Germany’s greatest cinematic triumphs on the harrowing experience of U-Boat patrol and its incredible ability to capture the terrifying and suspense filled life of U-Boat crews has captivated viewers for decades was not always an accurate portrayal of U-Boat life Rather than go scene by scene picking apart the movie here are a few stories of U-Boat life from the man who served on U-96 the commander and Buccheim are sitting down to lunch a brief break in the daily stress of U-boat life Suddenly a call comes down from the bridge “To the commander: masthead off the port bow!” He and the chief crowd onto the bridge tower straining through binoculars to find their foe pushing the ship to its fastest and filling the entire ship with a dull roar as they plow through the choppy sea the electric motors hum to life and then the ship is quiet again the commander and chief hover over the hydroplane operators including the men who are now drenched in sweat A watch officer is constantly adjusting the torpedo’s guidance tensely waiting for the commander’s orders The crew stands silently watching their leader move back and forth with the periscope the watch officer’s finger hovers just over the firing button The sleek metal torpedo explodes out of the tube Immediately the chief floods the tanks to compensate for the loss of weight; every kilogram counts when keeping the ship safely submerged The lone steamer had been cut in two by the torpedoes the two halves slowly sank while the U-Boat crew watched Suddenly the destroyer turns and approaches the submarine attempting to finish off what is left of the steamer The destroyer spots them and again heads straight for them The sub’s nose swings down into the murky depths of the Atlantic They are sitting almost immediately above the submarine The food bags and sausages hanging about the ship shake and sway back and forth as the vessel rocks and changes acceleration the destroyer continues to sweep overhead each explosion rattling them and their ship even more The destroyer knows exactly where they are A low call is heard “leakage above the water gauge,” and the control room erupts into a silent panic The commander calms his crew with the simple word “Gentlemen!” They cannot pump out the water with the destroyer overhead The noisy pumps would give away their position They sit silently and still waiting for more depth charges or the horrific crushing death of sinking to the bottom Water is still coming in through the leaks The commander requests a bearing on the destroyer The soundman is not ignoring him; the destroyer has stopped The sub’s electric motors push it forward underwater for another half hour The commander leans against the hull and relaxes These two stories help to give a more accurate picture of U-Boat life while a terrific film and a great piece of drama They had to sacrifice some accuracy for dramatic effect The movie lasts between 150 and almost 300 minutes It is almost impossible to condense the incredibly long and terrifying life of U-Boat combat into a picture (The Boat) and U-Boot Krieg (U-Boat War) by Lother-Guenther Buccheim on whose accounts the film Das Boot was based Gabe Christy is one of the authors writing for WAR HISTORY ONLINE DSP Alice was the name on everybody’s lips and had started to make her presence known on the international showjumping scene with Simone Blum in the saddle – winning five-star classes in Gothenburg the pair jumped to global fame when winning individual gold and team bronze at the World Equestrian Games in Tryon – the mare making four days of tough competition look like a walk in the park the couple crowned yet another impressive season with team silver at the European Championships in Rotterdam Was Alice always destined for stardom though World of Showjumping speaks with Alice’s former rider Steffen Buchheim about the now 13-year-old mare’s journey to the top “I got Alice to ride when she was 4-years-old and had her until she was sold to Simone and Hansi Blum at the beginning of her 7th year,” Steffen Buchheim tells she was very sensitive and also very sceptical – especially to men Any new person would be met with scepticism and while she liked some people faster than others there were some she never accepted at all once I got to know her all was good – luckily,” Buchheim smiles For the first two years that Buchheim rode Alice her owner Kai Uwe Fricke would drive the mare to him a couple of times a week “I also did a few shows with her in the spring when she was four and over the summer she went out on the field Then I started to ride her again after the summer and showed her in the autumn and spring before she got another break in the field As a 6-year-old she moved permanently to my stable,” Buchheim tells never on the jump itself but to everything around,” Buchheim continues “While her jump was something really special Alice would notice absolutely everything on her way but on the fence itself she was always there with you she had the tendency to over-jump a lot and would more often than not be one meter higher than the fences so you really had to make sure to be steady in the saddle,” Buchheim laughs “It got better with time and experience though she never made a fault on her own – if we ever got one it was my mistake.” “The most difficult part with Alice was to get her to relax,” Buchheim tells she got very easily tense so I had to work on getting her to relax and keep her nerves under control The only way to do that was to give her time.” At the beginning of year when she turned seven Alice won a 1.40m class straight away and after that it went fast “Simone’s husband Hansi was here to try her and thought it could work Shortly after I drove with Alice to Simone and the two of them clicked straight away Buchheim really enjoys watching Alice and Simone in action but Alice was really something special,” he says I wouldn’t have guessed back then that she would end up as World Champion!” Simone Blum confirms Buchheim’s story about Alice not being the easiest “Alice’s breeder has told me that she was untouchable as a foal – so he was happy when she was sold she was just fighting against people – she did not have a good opinion about human beings,” she tells she ended up with Steffen and he managed to win her heart over.” Simone’s husband Hansi Blum got to know about Alice through a friend he sent me a message saying ’I think I found you a horse – a mare with a lot of blood I looked into her eyes and I remember thinking I love bloody horses and she is always going I knew straight away that she could jump anything in the world,” Simone Blum recalls “We bought Alice at a time when I mostly was competing at national level and did some international two- and three-star shows We simply wanted to have a good young horse in our team,” Simone says she was still so careful and always jumping so high that it was enough for her to do the 1.40-1.45m classes we did the German Championship for women and we won – it was the first time she jumped a bit bigger classes,” Simone tells it is not so easy to get a chance to ride at the bigger shows,” Simone explains Otto (Becker) saw Alice in Mannheim and I think – for him too – it was love at first sight After that I was able to do the open German Championship and without jumping too many big classes Alice took me directly to five-star level Alice has always been full of temperament and even though she has been challenging to ride she always wanted to do a good job in the ring," Simone Blum closes off. No reproduction without written permission © 2025 World of Showjumping - All rights reserved Powered by Artionet - Generated with IceCube2.Net The basic factors in his reckoning change with each report; he must determine an escape route according to the strength of the sound of propellers and the approach angle of the destroyer His senses no longer supply him with any immediate information; he must guide the boat like a pilot flying blind his decisions based on indications given him by the instruments Against closed eyelids I see the grey-black cans twisting heavily as they shoot downward from the launches spin lazily into the depths leaving bubble trails and then explode in the darkness – blazing fireballs of magnesium The above passage is taken from Das Boot, written in 1973 by Lothar-Günther Buchheim and later turned into an iconic film. Although Buchheim wrote Das Boot as a work of fiction, he based it on his own experience of being embedded on a German U-Boat during the Second World War. His work paints a realistic picture of the discipline and high stakes associated with submarine service, a dark exploration of the frequently miserable and terrifying lives of the sailors that were tasked with stopping the supply convoys reaching Europe – at any cost. Winston Churchill would later say that: “The only thing that really frightened me during the war was the U-Boat peril.” But what was it exactly that made the submarines used by the Imperial German Navy and Kriegsmarine so feared BFBS unpicks over 100 years of sub-sea surface warfare and attempts to retell some of the most infamous U-Boat moments of two world wars between Britain and her allies We also look at some of the more technical features of the machines and the weapons they carried and how those weapons and tactics were combined to create a frequently deadly consequence Although U-Boat history can be traced to the mid-nineteenth century much of the early story is focused upon exploration of technologies that was hoped could lead to fit-for-purpose boats capable of conducting offensive operations beneath the waves And so we start our journey with U-Boats at the outbreak of World War One Germany boasted 48 submarines across 13 classes in operation or in the final stages of their shipbuilding The U-Boat played just as sinister a role in the First World War as it did in the second Chief among the significance of that was the sinking of the RMS Lusitania off the coast of Ireland on May 7 The U-Boat commander who engaged the ship did so following a decree from the Kaiser that effectively ended Prize Rules – a code protecting trade shipping during conflict - that ultimately provided authorisation to sink any ship in the waters around Britain the Lusitania was carrying passengers to Liverpool from New York but unbeknown to many was the fact the ship was also carrying munitions that would have ultimately found their way to the Western Front in France The sinking of the ship was a hugely controversial matter and the loss of life impacted British communities particularly in Liverpool where many of her crew hailed the Admiralty had assisted Cunard on the understanding that in times of war the ship would be used as a light merchant cruiser … she even had gun mounts on her deck for such an eventuality although they were never used It is perhaps partly why the Germans opted to target the luxury liner in ocean waters the Germany embassy in Washington had placed no less than 50 adverts in American newspapers warning passengers not to travel on the doomed ship many did and subsequently there was a large loss of civilian life – 1,198 souls Although there were American losses at the disaster of the Lusitania it did not result in the US declaring war on Germany and sending forces to Europe this was despite the widespread repulsion of a seemingly innocent ship being targeted in the manner it was was attacked off the south coast of England by a U-Boat which was carrying a large contingent of Americans and it is this event that led to the tensions and political sanctions that can ultimately be traced to the US eventually declaring war on Germany in 1917 Massacre Of U-27 And The Battle Of Jutland the U-Boat U-27 was sunk in the Western Approaches by Royal Navy ship HMS Baralong a heavily armed civilian vessel secretly disguised as such to cause confusion which was sailing under the flag of the neutral United States Baralong attacked the German vessel after receiving orders from Admiralty to take “no prisoners from U-Boats.” While survivors clambered to be rescued in the water the crew of HMS Baralong were ordered to fire on the unarmed survivors killing them all This extended to the survivors who had climbed aboard a rescue ship from which American witnesses would later testify of the atrocity This committing of a war crime by the crew of HMS Baralong caused an international incident and following the British Government’s refusal to court martial those responsible the massacre became a chief reason behind the Kaiser’s perusal of such deadly hostilities against civilian shipping The outcome of the attack on SS Sussex by German U-Boat SM UB-29 on March 24 1916 was that of harsh political sanctions being levied at Germany In response Germany did row back on its aggressive strategy against civilian vessels providing assurances to the Americans through what was called the Sussex Pledge This effectively returned the U-Boat’s to the former Prize Rules pre-dating the massacre of the German crew in August 1915 Due to the Sussex Pledge the Kaiser found his U-Boats a lesser force to be reckoned with in the seas around Britain which forced his navy into a surface action culminating in the Battle of Jutland Although the Battle of Jutland is recorded as a German victory it did not result in the all out control of the seas by the Kaiser which prompted him to drop the assurances of the Sussex Pledge and return to all out war on shipping however this time his navy placed high emphasis on the attacking of commerce in the hope it would bring the British to a surrender America declared war on Germany in April 1917 Over a million tonnes of cargo was lost in the preceding months of this declaration of war Throughout this feature we are focusing on the U-Boats of Germany across both the First and Second World Wars possessed more submarines than the Kaiser’s Germany the Royal Navy counted 80 among its massive fleet But because Germany was willing to use its submarines in warfare against commerce the U-Boats of the Kaiser effectively became infamous and perhaps this is why history focuses more on them But what was a typical U-Boat of the Imperial German Navy equipped with at the beginning of the Great War Germany possessed multiple classes of submarine and as the war progressed it continued to produce U-Boats right until the end Most of these crafts were powered by diesel with the exception of a very few at the start A limitation for the submarines of the era was that they could not remain submerged for that great a length of time Two hours was about the safe extent of it and interestingly this matter did not change too much between the period of the two world wars there is not a lot that did change among standard U-Boats from 1914 to 1939 in terms of the technology behind their existence a lot of which depended upon and was thanks to the diesel combustion engine The next great leap forward would not come until the introduction of nuclear-powered submarines in 1954 save for the use of the snorkel – a tube that allowed for air intake while submerged under the surface – in 1944 The limitations caused by matters related to the short amount of time a U-Boat could be submerged meant in reality much of the U-Boats’ terrifying work was completed on the surface Writing for Military History Magazine in September 2010 the historian Stephen Wilkinson discussed the importance of a U-Boat’s deck guns Hollywood once had us believe a U-boat’s deck guns were for fending off furious destroyer attacks after a crippled sub was forced to surface but the truth is that powerful deck ordnance was a far more effective and less expensive way to dispose of merchant ships which were the World War I U-boat’s primary target No sub commander would waste a torpedo—of which he had only a limited number—on a trudging collier or rusty banana boat there were some differences in the specifics of the armaments the U-Boat mentioned earlier whose crew were massacred by the British in 1915 – SM U-27 – counted four torpedo tubes and one 88 mm L/30 deck gun It had a crew of 35 and a top speed of 19 mph surfaced and 11 mph submerged and had a somewhat impressive range (surfaced) of over nine and a half thousand miles – not bad for the early twentieth century built as a minelayer from 1917 had just three torpedo tubes and one 105 mm deck gun It did however count six mine tubes for its main purposes of laying mines it had a crew of over 30 but was able to dive a little deeper than the 50 m associated with the older sub (75 m) Its range was further (11,340 miles surfaced) but this newer vessel was a fair bit slower at 13 mph surfaced U-Boats were required to immediately surrender This took place for the most part at Harwich in Essex The event was captured in the North Sea diary of Stephen King-Hall a Royal Navy officer who would go on to become a Member of Parliament and celebrated writer The Harwich forces of light cruisers and destroyers left on the evening of the 18th to meet the Huns and escort them to the place of surrender which was at the southern end of the Sledway or about seven miles east-north-east of Felixstowe and a thick fog hung over the water as the two destroyers cautiously felt their way down harbour ; but once through the boom defences it cleared somewhat The whole time one had to pinch oneself to make sure that one was really out there to collect U.-boats and that the whole thing was not a dream Suddenly a British Zepp droned out of the mist circled round and vanished again to the northward We were received by the German captain together with his torpedo officer and engineer 'Give me your papers.' The German then produced a list of his crew and the signed terms of surrender (i) The boat was to be in an efficient condition and auxiliary engines in good working order and the torpedoes Were to be clear of the tubes (5) There were to be no explosives on board (6) There were to be no booby traps or infernal machines on board This captain was a well-fed-looking individual with quite a pleasant appearance and he was wearing the Iron Cross of the first class He had apparently sunk much tonnage in another boat his old boat was next ahead of us going up harbour K-- then informed him that he would give him instructions where to go but that otherwise the German crew would work the boat under the supervision of our people which stated that he was to hand the boat over to us and then leave at once for the transport but he was too sensible and at once agreed to do whatever we ordered The German crew were clustered round the after-gun taking a detached interest in the proceedings The entry on this date ends with a description of the respect and honour the enemies still held for each other a motor-launch came alongside and the Germans were ordered to gather up their personal belongings and get into her without a sign of that emotion which he must have felt and then joined his crew in the motor-launch which took them to the destroyer in which they made passage to the transport outside the Imperial German Navy had succeeded in sinking over 5,000 vessels using their fleet of U-Boats an outcome of losing World War One was a directive that limited the tonnage of the German fleet and a ban on the building of submarines Germany secretly began the rebuilding of her U-Boat fleet The Weimer Republic was restrained under the Treaty of Versailles where ship building and the holding of military forces were concerned when Adolf Hitler came to power in the early 1930s he ordered the building and amassing of strengthened capability which included the production of the largest U-Boat fleet in the world heading into 1939 It is thanks to this that the longest continuous battle of the Second World War occurred – the Battle of the Atlantic The peril faced by the crews of the North Atlantic convoys is undisputed a film written for the screen by Tom Hanks who also starred in the leading role A cornerstone to the plot of Greyhound is that in the centre of the ocean the convoys had to pass through an area that was not reachable by aircraft and thus In the opening months and years of the war U-Boats were effective in locating and destroying ships carrying essential war cargo to England and Europe largely thanks to this area of no air cover the allies advanced technology to aid the convoys and their protection vessels – like those depicted in Greyhound – in locating the silent This in turn resulted in the U-Boats developing a strategy which saw them fighting in what was known as Wolfpacks These Wolfpacks mercilessly hunted down thousands of ships throughout the six years of the Battle of the Atlantic The number of Allied losses on the ocean slowed after the entering of the war by the USA it was still a deadly theatre to have to operate in The opening page of the 1973 Lothar-Günther Buchheim book Das Boot “Of the 40,000 German U-Boat men in World War II The torpedoes Kriegsmarine U-Boats used throughout the Battle of the Atlantic were responsible for the sinking of 3,000 Allied ships The early versions worked in one of two ways If the torpedo was fitted with a pistol trigger that relied on impact the warhead would explode upon meeting the hull of a ship (or another solid object) if they were fitted with a magnetic trigger the warhead would be exploded whenever the magnetic field around the torpedo changed once released as it meant torpedoes could be released to come into the closest magnetic contact with a target while under the keel of a ship The resulting shock wave from the explosion would be enough to rupture a ship’s keel Another and more advanced torpedo entered service later in the war which allowed the Germans to phase out the frequently problematic magnetic-triggered version running a distance before arming itself and then turning towards the closest and loudest thing around it But this new technology was not a silver bullet and it is thought that at least two U-Boats were lost due to their own torpedoes turning on them and detonating The age of the submarine really cemented itself in military terms during the Battle of the Atlantic Both sides scrambled their scientists and weapons experts to advance the methods that both aided detection and frustrated it both sides fine tuned and improved their Sonar abilities The Allies introduced Radar and to counter it U-Boats were fitted with radar warning receivers the introduction of the snorkel allowed for batteries to be recharged and for air to be supplied to a still submerged crew – making them evermore stealthy But the Allies responded by further improving their own detection methods yet again that even allowed for them to spot a snorkel mast beyond the range of visual detection A Close Look At The Type VII Submarine – The Workhorse Of The German U-Boat Fleet and many remained in service with other navies after the Second World War ended It was the most widely used type of U-Boat throughout the Battle of the Atlantic Range: 9,800 miles surfaced Max depth: 230 metres (tested) Crew: 52 Armament: 5 x Torpedo tubes with a total of 14 Torpedoes or 39 mines and 1 x 88 mm C/35 naval gun with 220 rounds the Royal Navy took receipt of 156 U-Boats and moored them in two locations off the coast of Northern Ireland and at Scarpa Flow Operation Deadlight was the name given to the scuttling operation undertaken to dispose of the captured vessels The Royal Navy plan was to tow the vessels to sites in the Atlantic off the coast of Ireland and use them as practical targets for bombing runs by the Royal Air Force Others would be destroyed with naval guns and some by placing explosive charges in their hulls the operation turned farcical when seveal U-Boats sunk while being towed out to sea due to poor conditions they had fallen into while being moored up and exposed to the elements All captured U-Boats earmarked for scuttling were disposed of by February 11 The golden age of the submarine may have entered the autumn of its year due to increasingly improved detection methods and technologies that exist in the modern day This is something former chair of the UK Foreign Affairs Select Committee Crispin Blunt MP discussed in an interview with BFBS to mark the 75th anniversary of the first atomic bombing Mr Blunt described the situation around submarines and their inability to remain undetected: Mr Blunt said: “The whole concept proceeds on the basis that the submarine is invisible there was a submarine research warfare scientist gleefully proclaiming the end of the submarine because accusation technology was advancing geometrically and (had) the ability to pick up all the signals that a submarine gives off If it is the case that submarines may one day soon become obsolete in their stealthy nature and nations like the UK and USA are no longer prepared to use them as the means to house their respective nuclear deterrents than perhaps history will look back at the two conflicts of the twentieth century - both impacted considerably and shaped by the U-Boat - as the submarine's true golden era. Das Boot by Lothar-Günther Buchheim is available in paperback by Orion Thanks to US Library of Congress - an extensive collection of historical images, paintings, articles and newspapers are available to be viewed online at www.loc.gov  Please select at least one newsletter to subscribe to: It would appear that you're about to be able to find every single one of your often-lost objects with an ecosystem that's not to be missed – Stick-N-Find complete with Bluetooth stickers and a fabulous radar app that works with them to track This lovely system is currently living in the crowd-funding operation known as indegogo a place not unlike KickStarter where users are able to pass some cash to start-up groups hoping to get their project off the ground in exchange for a promise that they'll get some of the earliest products produced We had a brief chat with one of the Stick-N-Find project creators today who had a few suggestions for how the product might be used On the indegogo funding page for this project it's shown that you simply sync with a Bluetooth sticker From there you never have to worry about losing the item the sticker is attached to again – as long as you're in-range This is what the creators of Stick-N-Find call the "Virtual Leash." As Buchheim explains the possibilities with this combination are nearly endless: Jim Buchheim: The virtual leash feature can even prevent you from forgetting things on your way out the door You could stick it in your car and find it in a parking lot or on the street the "find it" feature will alert you when your car is within range Besides the things that are lost all the time like your keys or remote you could also use Stick-N-Find to find anything Or relax knowing that your valuables are near when you valet your car or check your coat If you have any questions or need help you can email us Charlie Connelly The author of Das Boot would have hated the new TV adaptation – but he hated most things CHARLIE CONNELLY on the troubled mind which could never escape the terror of war beneath the waves One morning in the spring of 1983 there was a commotion at the Chicago Museum of Science and Industry In the cavernous basement gallery housing the 250-foot long U-505 submarine captured by the Americans in the Atlantic in 1944 a white-haired man walking with a crutch was railing at parents and children as they examined information boards packed with photographs of American naval ships aircraft and celebrating soldiers and sailors ‘You Americans glorify war,’ he was shouting ‘You should be teaching young people about the cruelty of war but instead you give them destroyers The man with the crutch was in fact a guest of honour at the museum that day had filled cinemas across the  US like no foreign language film had ever done before His response to being escorted into the vast hall was characteristically and irascibly idiosyncratic: expected to coo over the first U-boat he’d seen in the flesh since the war he instead made straight for the photo displays to protest what he regarded as the glamourisation of conflict exactly what his book was intended to counter Das Boot – the 1973 book and 1981 film – provides about as definitive an account of life on a U-boat during the Battle of the Atlantic short of actually being there the sudden and frantic bursts of activity and the sheer naked fear have never before or since been captured so viscerally was an abrasive and divisive character to put it mildly Even his obituary in the German current affairs magazine Der Spiegel called him a ‘dreadful autocrat’ and ‘egomaniac’ who in his later years was ‘irreconcilably misanthropic’ An old friend recalled of Buchheim after his death that ‘he always had something to complain about; he was like a dark cloud spreading an aura of terror’ Bewildering reactions to someone who had just died but Lothar-Günther Buchheim wouldn’t have cared By the end he hated just about everyone and the roots of his intense bitterness might have lain in the wartime experiences of which he wrote The original Das Boot novel was largely autobiographical It told the story of a 1941 Atlantic tour of duty by Type VIIC vessel U-96 through the eyes of Lieutenant Werner a correspondent from Goebbels’ propaganda ministry sent along to observe the mission in order to write a glowing account of Germany’s mastery of the seas What he found during his six weeks in the Atlantic was an extraordinary sense of comradeship loyalty and calmness under intense pressure iconoclastic disregard for the cause and those giving its orders among what in other circumstances would have been a young proud and idealistic crew and its taciturn captain known only as ‘the Old Man’ (the character is only 30 years old) played in the 1981 film by Herbert Grönemeyer joined the U-96 on patrol during the Battle of the Atlantic under Lieutenant-Commander Heinrich Lehmann-Willenbrock At the time Germany was running a hugely effective submarine blockade of Atlantic shipping destined for Britain that lasted until well into 1943 Successful it may have been but it was also incredibly dangerous: of the 41,000 men who served on the U-boats In its wartime career U-96 conducted 11 Atlantic patrols during which it sank 27 ships including with a combined loss of more than 700 lives on whom ‘the Old Man’ – played by Jürgen Prochnow – was based would become the sixth most successful U-boat commander of the war and was awarded the Knight’s Cross of the Iron Cross with Oak Leaves polished account of his 41 days on board for his propagandist employers but he was changed forever by his time in the Atlantic Sharing a confined space with 50 men for whom there was one toilet and no washing facilities Buchheim saw humanity at its rawest and most primal He also spent those 41 days with death as a constant companion with survival rates for U-boat crews significantly less than 50:50 For most military personnel there is at least a theoretical prospect of escape from calamity but for the U-boat crews there was no way out At the mercy of a vengeful enemy and surrounded by nothing but thousands of miles of water the crew of the U-96 knew exactly the kind of peril they were in It’s not even as if they were fighting open honourable battles: theirs was a stealth war sneaking around catching vulnerable ships unaware and slipping silently away once their work was done After the war Buchheim set about trying to establish himself as a painter The son of an artist mother from Weimar he’d studied art in Dresden and Munich prior to the outbreak of the Second World  War and showed great promise as a writer too As well as producing his own artworks Buchheim amassed a significant collection of German modern and symbolist art and wrote a number of critically-acclaimed monographs As a Kriegsmarine wartime propagandist he’d been out on tours with destroyers and minesweepers but something about the submarine and its crew kept nagging away at him practically embedded at the core of his being Could nothing in everyday life match the sheer unfiltered humanity of all those men confined in a small space Or was it how when the vessel was rocked by depth charges or sank to the floor of the Mediterranean off Gibraltar they’d all looked into the eyes of death and seen it reflected back in the eyes of their comrades In the mid-1960s Buchheim wrote a short story about his experiences named after the award presented to Lehmann-Willenbrock and published in a national newspaper destined to become an international bestseller as if the author was seeking to work through the traumas of that Atlantic autumn via the nib of his pen In its first two years Das Boot sold three million copies in Germany and was subsequently translated into 18 languages But for all its huge sales at home the book polarised opinion ‘I was either too hard on the Nazis or too soft on the Nazis it merely depended on one’s attitude to Nazis,’ Buchheim mused an account of the war portrayed Germans as heroic but flawed resigned to the fatal incompetence of authority Reviewers certainly didn’t approve of the ill-discipline portrayed on board and there were serious objections to the level of profanity used by the characters none of which seemed to discourage readers The book was translated into English for a UK edition but when the US publisher Alfred Knopf bought the rights they were not at all happy with the existing translation finding it reminiscent of ‘second-rate war films’ so publisher Robert Gottlieb and editor-translator Carol Brown Janeway set about a new version ‘He was a monster,’ recalled Janeway of her dealings with Buchheim but she recognised the core appeal of the novel and admired the intentions of the writer The new version sold millions despite the novelty of German soldiers being portrayed as human beings rather than psychopathic automatons which skilfully conveyed the long periods of inactivity and tedium of the voyage was unfamiliar to readers used to page-turning thrillers Clearly this was a book that unsettled as much as it enthralled and not everyone approved ‘One reason why it takes 463 pages to tell this simple story is that each incident is dressed in enough technical detail to earn every reader who stays the course an instant master’s degree,’ complained the New York Times which also condemned ‘the dullness of a crew with few ambitions higher than the navel’ the paper found Buchheim’s work to be ‘a straight but unsuccessful bid to soften history’s judgment on 40,000 men who volunteered to wage total war on civilians and were themselves almost totally destroyed 30,000 of them dying the terrible deaths they richly deserved and their victims did not’ Despite such snarky reviews – that Times comment was a pretty fair representation of the wider US coverage – the runaway success of the book made  a film adaptation inevitable Although  the rights stayed in Germany it was felt that an American slant was needed to make the film more appealing so Paul Newman was lined up to play ‘the Old Man’ and the action was moved forward to 1942 A far less nuanced portrayal of the German crew was being developed when Buchheim pulled the plug on the idea seeing the film developing into everything he despised Even when the project was handed on to Wolfgang Petersen the author still feared the dilution of the grim realities he’d described and the subsequent loss of his anti-war message if it lets the moviegoers experience hell in depth or will it simply fascinate them?’ he worried Although initially impressed by the production – ‘when I see the bunker sequence (at the U-boat base) I’m once again the young lieutenant walking along the row of basins inside that mammoth gloomy construction’ – he was soon falling out with Petersen Buchheim had assumed he’d be writing the screenplay but he and the director had significantly different visions for the film Finding the writer stubbornly unwilling to compromise before long Petersen had to wrest creative control from the story’s creator altogether prompting Buchheim to distance himself from the project entirely ‘It’s slipped away from me,’ he said in 1981 ‘Everyone’s calling it my film but it’s nothing of the sort.’ When Das Boot was released to wide acclaim earning six Oscar nominations and cementing a place among the greatest war films ever made Buchheim’s constant criticism only exacerbated his growing reputation as a curmudgeon It’s safe to say he would have hated Sky Atlantic’s new miniseries The German-made show picks up the story from the original film and book a 1,500-page epic that follows German soldiers in France towards the end of the war The new series is pitched as a sequel to the original It begins nine months later in France in 1942 with a new craft and inexperienced crew as the Battle of the Atlantic begins to turn against Germany now the Allies have cracked the Enigma code with a second narrative strand centred on a morphine-smuggling translator with ties to the Resistance The new production has proved as popular on British television as it has in the rest of Europe Das Boot is turning into quite the modern franchise something that would doubtless have enraged his creator It’s not even as if he had much to be miserable about: his earnings from the book and the 1981 film helped him concentrate on his artistic acquisitions and the final decades of his life were spent establishing and maintaining a gallery to exhibit his vast collection He’d intended to set up in his  Bavarian home town of Feldafing but when in the mid-1990s the local authority put the matter to a referendum Buccheim’s plans were comprehensively rejected as locals feared their small quiet town would become overrun with tourists Labelling his fellow citizens ‘gutter rats’ Buchheim took to provoking them as often as he could Usually this involved signs of his immense wealth such as being chauffeured in his Rolls-Royce to the local Aldi where he would bark insults at anyone who came near him as he selected his groceries after 20 years of irritable negotiation with municipalities across Bavaria the regional authority agreed to finance a 20 million euro building on the shores of Lake Stamberg designed by the renowned architect Günter Behnisch whose CV included Munich’s extraordinary Olympic Stadium Buchheim pronounced it a ‘Bavarian miracle’  then proceeded to tear Behnisch to shreds Confined to a wheelchair in his later years and wearing a black patch over  his left eye as a result of a medical condition Buchheim cut an ever more eccentric and misanthropic figure driving away friends and sympathetic colleagues until even his own son denounced him In a hard-hitting book published  after his father’s death Despot Yves Buchheim alleged not only that his father was far from the anti-Nazi his post-war writing suggested but also that the notorious skinflint was a serial tax-evader with secret fortunes tied up in Swiss bank accounts nothing of what one desires as a son from the father,’ Yves wrote ‘For him I was the cuckoo’s egg one of his wives had left in his nest ‘If this was the mafia I’d have had you shot long ago because you know too much” Were those 41 days he spent as a 23-year-old cooped up in a metal tube beneath the Atlantic looking death square in the face behind that unhappiness When you’ve lived something as intense and visceral as that those weeks defined the rest of his life and plausibly gave him a clear and prescient Consider what he told a journalist after his outburst in the Chicago museum in 1983 ‘The history of the Nazis is interesting but you people should know it could happen here in the US too,’ he said ‘Your racist problems are the same and you are lucky you’ve never known a lot of unemployment at any one time If a country is down and a guy comes along preaching happiness then explosive things can happen