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Full-Text Articles in Medicine and Health Sciences

Epilogue: Reflections From International Mentors Of The Quality Improvement Training Programme In India, Karl Lorenz, Sydney Dy, Michelle Denatale, Michael W. Rabow, Odette Spruijt, Karen Anderson, Meera Agar, Jake Mickelsen, Nandini Vallath Apr 2021

Epilogue: Reflections From International Mentors Of The Quality Improvement Training Programme In India, Karl Lorenz, Sydney Dy, Michelle Denatale, Michael W. Rabow, Odette Spruijt, Karen Anderson, Meera Agar, Jake Mickelsen, Nandini Vallath

Research outputs 2014 to 2021

The article collates the narratives of experiences of the international faculty who mentored the quality improvement teams from India since 2017.


A Quantitative Exploration Of The Relationships Between Regular Yoga Practice, Microdosing Psychedelics, Wellbeing And Personality Variables, Stephen Bright, Eyal Gringart, Emily Blatchford, Samantha Bettinson Mar 2021

A Quantitative Exploration Of The Relationships Between Regular Yoga Practice, Microdosing Psychedelics, Wellbeing And Personality Variables, Stephen Bright, Eyal Gringart, Emily Blatchford, Samantha Bettinson

Research outputs 2014 to 2021

Objective:

The current study aimed to explore whether the subjective effects of microdosing psychedelics are comparable to those of yoga in relation to psychological wellbeing, depression, anxiety and stress. It also explored the relationship between yoga, microdosing and personality.

Method:

The sample comprised 339 participants, yoga (n = 131), microdose (n = 69), microdose and yoga (n = 54) and control (n = 85). All completed measures of personality (M5-50 and Tellegen Absorption Scale), mood (Depression, Anxiety and Stress Scale-21) and wellbeing (Ryff Scales of Psychological Wellbeing).

Results:

The yoga and microdosing groups scored significantly higher on psychological wellbeing and …


Meta-Analysis Of Genome-Wide Dna Methylation Identifies Shared Associations Across Neurodegenerative Disorders, Marta F. Nabais, Simon M. Laws, Tian Lin, Costanza L. Vallerga, Nicola J. Armstrong, Ian P. Blair, John B. Kwok, Karen A. Mather, George D. Mellick, Perminder S. Sachdev, Leanne Wallace, Anjali K. Henders, Ramona A. J. Zwamborn, Paul J. Hop, Katie Lunnon, Ehsan Pishva, Janou A. Y. Roubroeks, Hilkka Soininen, Magda Tsolaki, Patrizia Mecocci, Simon Lovestone, Iwona Kłoszewska, Bruno Vellas, Sarah Furlong, Fleur C. Garton, Robert D. Henderson, Susan Mathers, Pamela A. Mccombe, Merrilee Needham, Shyuan T. Ngo, Garth Nicholson, Roger Pamphlett, Dominic B. Rowe, Frederik J. Steyn, Kelly L. Williams, Tim J. Anderson, Steven R. Bentley, John Dalrymple-Alford, Javed Fowder, Jacob Gratten, Glenda Halliday, Ian B. Hickie, Martin Kennedy, Simon J. G. Lewis, Grant W. Montgomery, John Pearson, Toni L. Pitcher, Peter Silburn, Futao Zhang, Peter M. Visscher, Jian Yang, Anna J. Stevenson, Robert F. Hillary, Riccardo E. Marioni, Sarah E. Harris, Ian J. Deary, Ashley R. Jones, Aleksey Shatunov, Alfredo Iacoangeli, Wouter Van Rheenen, Leonard H. Van Den Berg, Pamela J. Shaw, Cristopher E. Shaw, Karen E. Morrison, Ammar Al-Chalabi, Jan H. Veldink, Eilis Hannon, Jonathan Mill, Naomi R. Wray, Allan F. Mcrae, The Alzheimer's Disease Neuroimaging Initiative, The Australian Imaging Biomarkers And Lifestyle Study Jan 2021

Meta-Analysis Of Genome-Wide Dna Methylation Identifies Shared Associations Across Neurodegenerative Disorders, Marta F. Nabais, Simon M. Laws, Tian Lin, Costanza L. Vallerga, Nicola J. Armstrong, Ian P. Blair, John B. Kwok, Karen A. Mather, George D. Mellick, Perminder S. Sachdev, Leanne Wallace, Anjali K. Henders, Ramona A. J. Zwamborn, Paul J. Hop, Katie Lunnon, Ehsan Pishva, Janou A. Y. Roubroeks, Hilkka Soininen, Magda Tsolaki, Patrizia Mecocci, Simon Lovestone, Iwona Kłoszewska, Bruno Vellas, Sarah Furlong, Fleur C. Garton, Robert D. Henderson, Susan Mathers, Pamela A. Mccombe, Merrilee Needham, Shyuan T. Ngo, Garth Nicholson, Roger Pamphlett, Dominic B. Rowe, Frederik J. Steyn, Kelly L. Williams, Tim J. Anderson, Steven R. Bentley, John Dalrymple-Alford, Javed Fowder, Jacob Gratten, Glenda Halliday, Ian B. Hickie, Martin Kennedy, Simon J. G. Lewis, Grant W. Montgomery, John Pearson, Toni L. Pitcher, Peter Silburn, Futao Zhang, Peter M. Visscher, Jian Yang, Anna J. Stevenson, Robert F. Hillary, Riccardo E. Marioni, Sarah E. Harris, Ian J. Deary, Ashley R. Jones, Aleksey Shatunov, Alfredo Iacoangeli, Wouter Van Rheenen, Leonard H. Van Den Berg, Pamela J. Shaw, Cristopher E. Shaw, Karen E. Morrison, Ammar Al-Chalabi, Jan H. Veldink, Eilis Hannon, Jonathan Mill, Naomi R. Wray, Allan F. Mcrae, The Alzheimer's Disease Neuroimaging Initiative, The Australian Imaging Biomarkers And Lifestyle Study

Research outputs 2014 to 2021

Background: People with neurodegenerative disorders show diverse clinical syndromes, genetic heterogeneity, and distinct brain pathological changes, but studies report overlap between these features. DNA methylation (DNAm) provides a way to explore this overlap and heterogeneity as it is determined by the combined effects of genetic variation and the environment. In this study, we aim to identify shared blood DNAm differences between controls and people with Alzheimer’s disease, amyotrophic lateral sclerosis, and Parkinson’s disease. Results: We use a mixed-linear model method (MOMENT) that accounts for the effect of (un)known confounders, to test for the association of each DNAm site with each …


Current Perspective On The Therapeutic Preset For Substance-Assisted Psychotherapy, Sascha B. Thal, Stephen J. Bright, Jason M. Sharbanee, Tobias Wenge, Petra M. Skeffington Jan 2021

Current Perspective On The Therapeutic Preset For Substance-Assisted Psychotherapy, Sascha B. Thal, Stephen J. Bright, Jason M. Sharbanee, Tobias Wenge, Petra M. Skeffington

Research outputs 2014 to 2021

The present narrative review is the first in a series of reviews about the appropriate conduct in substance-assisted psychotherapy (SAPT). It outlines a current perspective on preconditions and theoretical knowledge that have been identified as valuable in the literature for appropriate therapeutic conduct in SAPT. In this context, considerations regarding ethics and the spiritual emphasis of the therapeutic approaches are discussed. Further, current methods, models, and concepts of psychological mechanism of action and therapeutic effects of SAPT are summarized, and similarities between models, approaches, and potential mediators for therapeutic effects are outlined. It is argued that a critical assessment of …


Perceptual Oscillations In Gender Classification Of Faces, Contingent On Stimulus History, Jason Bell, David C. Burr, Kate Crookes, Maria Concetta Morrone Oct 2020

Perceptual Oscillations In Gender Classification Of Faces, Contingent On Stimulus History, Jason Bell, David C. Burr, Kate Crookes, Maria Concetta Morrone

Research outputs 2014 to 2021

Perception is a proactive ‘‘predictive’’ process, in which the brain takes advantage of past experience to make informed guesses about the world to test against sensory data. Here we demonstrate that in the judgment of the gender of faces, beta rhythms play an important role in communicating perceptual experience. Observers classified in forced choice as male or female, a sequence of face stimuli, which were physically constructed to be male or female or androgynous (equal morph). Classification of the androgynous stimuli oscillated rhythmically between male and female, following a complex waveform comprising 13.5 and 17 Hz. Parsing the trials based …


An Intervention With Dance And Yoga For Girls With Functional Abdominal Pain Disorders (Just In Time): Protocol For A Randomized Controlled Trial, Anna Philipson, Stefan Särnblad, Lars Ekstav, Mats Eriksson, Ulrika L. Fagerberg, Margareta Möller, Evalotte Mörelius, Anna Duberg Jan 2020

An Intervention With Dance And Yoga For Girls With Functional Abdominal Pain Disorders (Just In Time): Protocol For A Randomized Controlled Trial, Anna Philipson, Stefan Särnblad, Lars Ekstav, Mats Eriksson, Ulrika L. Fagerberg, Margareta Möller, Evalotte Mörelius, Anna Duberg

Research outputs 2014 to 2021

©Anna Philipson, Stefan Särnblad, Lars Ekstav, Mats Eriksson, Ulrika L Fagerberg, Margareta Möller, Evalotte Mörelius, Anna Duberg. Background: Functional abdominal pain disorders (FAPDs) affect many children worldwide, predominantly girls, and cause considerable long-term negative consequences for individuals and society. Evidence-based and cost-effective treatments are therefore strongly needed. Physical activity has shown promising effects in the practical management of FAPDs. Dance and yoga are both popular activities that have been shown to provide significant psychological and pain-related benefits with minimal risk. The activities complement each other, in that dance involves dynamic, rhythmic physical activity, while yoga enhances relaxation and focus. Objective: …


Pilot Service Evaluation Of A Brief Psychological Therapy For Self-Harm In An Emergency Department: Hospital Outpatient Psychotherapy Engagement Service, Peter J. Taylor, Kirsten Fien, Helen Mulholland, Rui Duarte, Joanne M. Dickson, Cecil Kullu Jan 2020

Pilot Service Evaluation Of A Brief Psychological Therapy For Self-Harm In An Emergency Department: Hospital Outpatient Psychotherapy Engagement Service, Peter J. Taylor, Kirsten Fien, Helen Mulholland, Rui Duarte, Joanne M. Dickson, Cecil Kullu

Research outputs 2014 to 2021

© 2020 The Authors. Psychology and Psychotherapy: Theory, Research and Practice published by John Wiley & Sons Ltd on behalf of British Psychological Society Background: Brief psychological therapies may be helpful for people who have recently self-harmed. The current paper reports on a service evaluation of a novel brief therapy service based within an Emergency Department, Hospital Outpatient Psychotherapy Engagement (HOPE) Service. This service combines elements of psychodynamic interpersonal and cognitive analytic therapy to help people who present with self-harm-related difficulties. The primary aim of this service evaluation was to ascertain the feasibility of HOPE in terms of attendance rates. …


Statements About The Pervasiveness Of Behavior Require Data About The Pervasiveness Of Behavior, Craig P. Speelman, Marek Mcgann Jan 2020

Statements About The Pervasiveness Of Behavior Require Data About The Pervasiveness Of Behavior, Craig P. Speelman, Marek Mcgann

Research outputs 2014 to 2021

Despite recent close attention to issues related to the reliability of psychological research (e.g., the replication crisis), issues of the validity of this research have not been considered to the same extent. This paper highlights an issue that calls into question the validity of the common research practice of studying samples of individuals, and using sample-based statistics to infer generalizations that are applied not only to the parent population, but to individuals. The lack of ergodicity in human data means that such generalizations are not justified. This problem is illustrated with respect to two common scenarios in psychological research that …


One-Year Outcome And Adherence To Pharmacological Guidelines In First-Episode Schizophrenia: Results From A Consecutive Cohort Study, Petros Drosos, Kolbjørn Brønnick, Inge Joa, Jan Olav Johannessen, Erik Johnsen, Rune Andreas Kroken, Helen Joy Stain, Wenche Ten Velden Hegelstad, Tor Ketil Larsen Jan 2020

One-Year Outcome And Adherence To Pharmacological Guidelines In First-Episode Schizophrenia: Results From A Consecutive Cohort Study, Petros Drosos, Kolbjørn Brønnick, Inge Joa, Jan Olav Johannessen, Erik Johnsen, Rune Andreas Kroken, Helen Joy Stain, Wenche Ten Velden Hegelstad, Tor Ketil Larsen

Research outputs 2014 to 2021

© Wolters Kluwer Health, Inc. All rights reserved. Background Remission in schizophrenia is difficult to achieve. Antipsychotic drugs are critical in the treatment of schizophrenia. International guidelines for the pharmacological treatment of schizophrenia recommend a 3-step algorithm with clozapine being the third-line antipsychotic agent. This study investigated the 1-year outcome and the application of the guidelines for the pharmacological treatment of nonremitted first-episode schizophrenia (FES) patients during the first year of follow-up. Methods A sample of 78 FES patients from the Norwegian TIPS (Early Treatment and Intervention in Psychosis) 2 study was assessed at the end of the first year …


Impact Of A Multimodal Exercise Program On Tibial Bone Health In Adolescents With Development Coordination Disorder: An Examination Of Feasibility And Potential Efficacy, Jocelyn L. Tan, Aris Siafarikas, Timo Rantalainen, Nicolas H. Hart, Fleur Mcintyre, Beth Hands, Paola Chivers Jan 2020

Impact Of A Multimodal Exercise Program On Tibial Bone Health In Adolescents With Development Coordination Disorder: An Examination Of Feasibility And Potential Efficacy, Jocelyn L. Tan, Aris Siafarikas, Timo Rantalainen, Nicolas H. Hart, Fleur Mcintyre, Beth Hands, Paola Chivers

Research outputs 2014 to 2021

© 2020, International Society of Musculoskeletal and Neuronal Interactions. All rights reserved. Objectives: Developmental coordination disorder (DCD) compromises bone health purportedly due to lower levels of physical activity. The potential of an exercise intervention to improve bone health parameters in adolescents with DCD has not previously been studied. This study thus aimed to determine the impact of a multimodal exercise intervention on bone health in this population at-risk of secondary osteoporosis. Methods: Twenty-eight adolescents (17 male, 11 female) aged between 12-17 years (Mage =14.1) with DCD participated in a twice weekly, 13-week generalised multimodal exercise intervention. Peripheral quantitative computed tomography …


An Exploratory Study Of The Relative Effects Of Various Protective Factors On Depressive Symptoms Among Older People, Caitlin Worrall, Michelle I. Jongenelis, Peter M. Mcevoy, Ben Jackson, Robert U. Newton, Simone Pettigrew Jan 2020

An Exploratory Study Of The Relative Effects Of Various Protective Factors On Depressive Symptoms Among Older People, Caitlin Worrall, Michelle I. Jongenelis, Peter M. Mcevoy, Ben Jackson, Robert U. Newton, Simone Pettigrew

Research outputs 2014 to 2021

© Copyright © 2020 Worrall, Jongenelis, McEvoy, Jackson, Newton and Pettigrew. Objective: The present study investigated the relative importance of various factors found to be negatively associated with depressive symptoms in older adults and assessed the potential moderating effect of sociodemographic characteristics for each factor. Method: Depressive symptoms were measured with the Center of Epidemiological Studies Depression Scale. Psychological, social, and physical health measures relating to the following factors were also administered: personal growth, purpose in life, self-esteem, self-efficacy, social support, self-rated health, life satisfaction, and physical activity. Multivariate linear regression analysis was used to investigate the most important factors …


A Qualitative Analysis Of Problematic And Non-Problematic Alcohol Use After Bariatric Surgery, Danielle L. Reaves, Joanne M. Dickson, Jason C. G. Halford, Paul Christiansen, Charlotte A. Hardman Jul 2019

A Qualitative Analysis Of Problematic And Non-Problematic Alcohol Use After Bariatric Surgery, Danielle L. Reaves, Joanne M. Dickson, Jason C. G. Halford, Paul Christiansen, Charlotte A. Hardman

Research outputs 2014 to 2021

OBJECTIVES: Bariatric surgery is an effective weight loss tool, but an under-communicated side effect may include the increased risk for alcohol problems. Few studies have examined contributors towards alcohol problems following surgery using a qualitative approach. Therefore, the current study aimed to generate insight informed by participants with problematic alcohol use following bariatric surgery, in comparison with participants without.

METHODS: Participants (14; females, n = 9; males, n = 5) completed semi-structured interviews using questions relating to alcohol use, relationship to food, support and surgical experiences. Thematic analysis was conducted to provide insight into the factors which influenced drinking behaviours …


Suicidal Ideation In The Perinatal Period: A Systematic Review, Avril O'Connor, Sadie Geraghty, Gemma Doleman, Annemarie De Leo Jan 2018

Suicidal Ideation In The Perinatal Period: A Systematic Review, Avril O'Connor, Sadie Geraghty, Gemma Doleman, Annemarie De Leo

Research outputs 2014 to 2021

Objective: To examine literature surrounding suicidal ideation and suicidality in the perinatal period. Design: Systematic Literature Review of published 15 research studies. Findings: There is a scarcity of prospective studies conducted in suicidal ideation during the perinatal period. More research is needed to ensure childbearing women at risk of suicidal ideation during pregnancy receive the appropriate care and maternity services required to support them throughout this period. Key conclusions: Midwives play an important role in screening women for possible emotional distress and mood disorders during pregnancy. Therefore, midwives need to have knowledge of risk factors so vulnerable women are monitored …


Women’S Experiences Of Vulvodynia: An Interpretative Phenomenological Analysis Of The Journey Toward Diagnosis, Rebekah Shallcross, Joanne M. Dickson, David Nunns, Kate Taylor, Gundi Kiemle Jan 2018

Women’S Experiences Of Vulvodynia: An Interpretative Phenomenological Analysis Of The Journey Toward Diagnosis, Rebekah Shallcross, Joanne M. Dickson, David Nunns, Kate Taylor, Gundi Kiemle

Research outputs 2014 to 2021

Vulvodynia is the experience of idiopathic pain characterized by burning, soreness, or throbbing in the external female genitalia or vulva and is estimated to be experienced by 4–16% of the female population, yet only half of women seek help regarding their symptoms. Of the women who do seek help, only around 2% obtain a diagnosis. Therefore, the aim of the current study was to explore the experiences of women with vulvodynia on their journey toward diagnosis, by using semi-structured interviews and an interpretative phenomenological analysis (IPA) methodology. Eight women were interviewed, and their experiences were analyzed and interpreted into three …


A Meta-Analysis Of The Prevalence Of Different Functions Of Non-Suicidal Self-Injury, Peter Taylor, Khowla Jomar, Katie Dhingra, Rebecca Forrester, Ujala Shahmalak, Joanne M. Dickson Jan 2017

A Meta-Analysis Of The Prevalence Of Different Functions Of Non-Suicidal Self-Injury, Peter Taylor, Khowla Jomar, Katie Dhingra, Rebecca Forrester, Ujala Shahmalak, Joanne M. Dickson

Research outputs 2014 to 2021

Background

A broad variety of different functions can underlie acts of Non-suicidal self-injury (NSSI). Whilst research so far has identified many of the commonly reported functions, no reliable estimates of prevalence currently exist for these different NSSI functions. Understanding the prevalence of NSSI functions represents a key to better understanding the phenomenology of NSSI and addressing the differing needs of the NSSI population. We conducted a systematic review and meta-analysis of the prevalence of NSSI functions in community and clinical samples.

Method

A literature search of electronic databases PsycINFO, Medline, and Web of Science from date of inception to March …


Goal Fluency, Pessimism And Disengagement In Depression, Joanne M. Dickson, Nicholas Moberly, Christian O'Dea, Matt Field Jan 2016

Goal Fluency, Pessimism And Disengagement In Depression, Joanne M. Dickson, Nicholas Moberly, Christian O'Dea, Matt Field

Research outputs 2014 to 2021

Despite the development of prominent theoretical models of goal motivation and its importance in daily life, research has rarely examined goal dysregulation processes in clinical depression. Here we aimed to investigate problematic aspects of goal regulation in clinically depressed adults, relative to controls. Depressed participants (n = 42) were recruited from two Improving Access to Psychological Therapy clinics in north-west England. Control participants (n = 51) were recruited from the same region. Participants generated personal approach goals (e.g., improve my marathon time) and avoidance goals (e.g., avoid getting upset over little things) and completed self-report measures of goal attainment likelihood …


The Nature Of Attachment Relationships And Grief Responses In Older Adults: An Attachment Path Model Of Grief, Yan Kho, Robert T. Kane, Lynn E. Priddis, Josephine Hudson Jan 2015

The Nature Of Attachment Relationships And Grief Responses In Older Adults: An Attachment Path Model Of Grief, Yan Kho, Robert T. Kane, Lynn E. Priddis, Josephine Hudson

Research outputs 2014 to 2021

Background: Various researchers have theorized that bereaved adults who report non-secure attachment are at higher risk of pathological grief. Yet past findings on avoidant attachment representations and grief have yielded limited and contradictory outcomes. Little research has been conducted with older adults to identify the psychological processes that mediate between self-reported attachment representations and the patterns of grief.

Objective: To examine the impacts of avoidant attachment and anxious attachment dimensions on emotion and non-acceptance, in response to the loss of a conjugal partner, and the mediating effect of yearning thoughts.

Design: Men (N = 21) and women (N …


The Interdependence Of Long And Short-Term Components In Unmasked Repetition Priming: An Indication Of Shared Resources, Matt R. Merema, Craig P. Speelman Jan 2015

The Interdependence Of Long And Short-Term Components In Unmasked Repetition Priming: An Indication Of Shared Resources, Matt R. Merema, Craig P. Speelman

Research outputs 2014 to 2021

It has been suggested that unmasked repetition priming is composed of distinct long-and short-term priming components. The current study sought to clarify the relationship between these components by examining the relationship between them. A total of 60 people (45 females, 15 males) participated in a computer-based lexical decision task designed to measure levels of short-term priming across different levels of long-term priming. The results revealed an interdependent relationship between the two components, whereby an increase in long-term priming prompted a decrease in short-term priming. Both long-term and short-term priming were accurately captured by a single power function over seven minutes …


The Relationship Between School Climate And Mental And Emotional Wellbeing Over The Transition From Primary To Secondary School, Leanne Lester Ms, Donna S. Cross Prof Jan 2015

The Relationship Between School Climate And Mental And Emotional Wellbeing Over The Transition From Primary To Secondary School, Leanne Lester Ms, Donna S. Cross Prof

Research outputs 2014 to 2021

Background: School climate has often been described as the “quality and character of school life”, including both social and physical aspects of the school, that can positively promote behaviour, school achievement, and the social and emotional development of students. Methods: The current study examined the relationship between students’ mental and emotional wellbeing and factors pertaining to school climate, focussing on the domains of safety, social relationships and school connectedness, during the last year of their primary schooling (age 11–12 years) and their first 2 years of secondary school. Data was collected using a self-completion questionnaire, four times over 3 years …


Day Occupation Is Associated With Psychopathology For Adolescents And Young Adults With Down Syndrome, Kitty-Rose R. Foley, Peter Jacoby, Stewart Einfeld, Sonya Girdler, Jenny Bourke, Vivienne Riches, Helen Leonard Jan 2014

Day Occupation Is Associated With Psychopathology For Adolescents And Young Adults With Down Syndrome, Kitty-Rose R. Foley, Peter Jacoby, Stewart Einfeld, Sonya Girdler, Jenny Bourke, Vivienne Riches, Helen Leonard

Research outputs 2014 to 2021

Background: Young adults with Down syndrome experience increased rates of emotional and behavioural problems compared with the general population. Most adolescents with Down syndrome living in Western Australia participate in sheltered employment as their main day occupation. Relationship between day occupation and changes in behaviour has not been examined. Therefore, the aim of this research was to explore any relationship between post school day occupations and changes in the young person's behaviour.Methods: The Down syndrome Needs Opinion Wishes database was used for case ascertainment of young adults aged 15 to 32 years with Down syndrome. Families of 118 young people …


Psychophysiological Research Of Borderline Personality Disorder: Review And Implications For Biosocial Theory, Tara Cavazzi, Rodrigo Becerra Jan 2014

Psychophysiological Research Of Borderline Personality Disorder: Review And Implications For Biosocial Theory, Tara Cavazzi, Rodrigo Becerra

Research outputs 2014 to 2021

According to the Biosocial theory, Borderline Personality Disorder (BPD) is developed by a biological predisposition to hyperarousal and hyperreactivity combined with an invalidating environment. Although widely supported by subjective measures, the impaired insight present in BPD may skew results, and thus psychophysiological measures have been suggested as an alternative method of examining possible biological differences in BPD. The current review aimed to critically assess psychophysiological research of BPD by electronic searching of relevant databases, with 22 articles meeting inclusion criteria. Results showed that in contrast to the hyperarousal proposed in the Biosocial theory, BPD was associated with hypoarousal and hyporeactivity …