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In den Studien dieser kumulativen Dissertationsarbeit wurde im Rahmen der Posttraumatic Growth and Depreciation Study (GRODES) der Universitätsmedizin Greifswald der Einfluss von Coping und Rumination auf posttraumatisches Wachstum (posttraumatic growth, PTG) und posttraumatische Minderung (posttraumatic depreciation, PTD) untersucht. Das Phänomen PTG bezeichnet die während oder nach der Verarbeitung eines traumatischen Ereignisses subjektiv als positiv bewerteten Veränderungen, die von der jeweiligen Person für sich als Bereicherung, als Gewinn angesehen werden. Diese Veränderungen manifestieren sich in den Dimensionen ‚persönliche Stärke‘, ‚Möglichkeiten im Leben‘, ‚Beziehung zu anderen Menschen‘, ‚Wert des Lebens‘ und ‚spirituell-existentielle Aspekte‘ (Tedeschi et al., 2018). Dem gegenüber steht das Konstrukt der posttraumatischen Minderung, das die infolge einer Traumaerfahrung negativ bewerteten Veränderungen auf denselben fünf Dimensionen bezeichnet (Baker et al., 2008). PTG und PTD sind nicht bidirektional zu verstehen. Sie können gleichzeitig erlebt werden; die Erfahrung von Zugewinn auf der einen Seite mindert nicht notwendigerweise das Empfinden von Verlust auf der anderen. PTG und PTD unterliegen verschiedenen Einflussfaktoren, wie Bewältigungsstil, Rumination, Selbstoffenbarung, Infragestellen von Grundüberzeugungen oder Zentralität des Ereignisses. Diese Faktoren werden ebenso wie die Zusammenhänge zwischen PTG und PTD selbst sowie zwischen PTG/PTD und PTBS-Symptomen in der vorliegenden Dissertationsarbeit untersucht. Um den entsprechenden Fragestellungen nachgehen zu können, war die vorherige Entwicklung eines Fragebogens, das Posttraumatic Growth and Depreciation Inventory – Expanded (PTGDI-X, Taku et al., 2021), zur simultanen Erfassung von PTG und PTD sowie die Überprüfung der psychometrischen Eigenschaften des Instrumentes und dessen interkulturelle Anwendbarkeit erforderlich. In einem weiteren Schritt wurde eine Kurzversion des Fragebogens, das Posttraumatic Growth and Depreciation Inventory – Expanded – Short Form (PTGDI-X-SF, Platte, Wiesmann, Tedeschi, Taku, et al., 2022), entwickelt und validiert, welche die Erhebung von PTG und PTD durch je zehn Fragen ermöglicht. Schließlich wurde auf Grundlage des PTGDI–X, der Impact of Event Scale – Revised (IES-R), des Rumination Inventory (ERRI) und des Brief COPE Inventory eine Online- Befragung durchgeführt. Die Antworten von 253 Erwachsene der deutschen Allgemeinbevölkerung wurden anschließend hinsichtlich der beschriebenen Fragestellungen untersucht. Alles in allem bestätigen die im Rahmen der vorliegenden Dissertationsarbeit gewonnenen Ergebnisse die Eignung des PTGDI-X und der zugehörigen Kurzform zur simultanen Erfassung von PTG und PTD in der Allgemeinbevölkerung Deutschlands. Dabei konnte gezeigt werden, dass PTG durch einen selbstständigen Coping-Stil und durch einen sozialen Coping-Stil begünstigt wird, wohingegen ein vermeidender Coping-Stil zu mehr PTD führt. Weiterhin war PTG mit positiver Selbstoffenbarung, Erschütterung von Grundüberzeugungen und bewusster Rumination assoziiert. Es zeigte sich ferner ein positiver Zusammenhang von PTD mit negativer Selbstoffenbarung, PTBS-Symptomen und kürzlichem intrusivem Ruminieren. Die vorliegende Dissertationsarbeit leistet einen wichtigen Beitrag in der Erforschung posttraumatischer Veränderungen und bei der Entwicklung der entsprechenden Erhebungsinstrumente. Es konnte nicht nur der bedeutsame Einfluss von Coping, Rumination und Selbstoffenbarung auf posttraumatische Veränderungen hervorgehoben werden, sondern auch die kulturelle Variabilität dieser Zusammenhänge verdeutlicht werden. Gewonnene Ergebnisse und damit zusammenhängende weiterführende Studien können zu klinischen Interventionen führen, die persönliches Wachstum fördern und negativ bewertete Veränderungen mildern. Untersuchungen zu der Beziehung zwischen PTG und PTD und den Einflussfaktoren auf PTG und PTD, insbesondere im interkulturellen Kontext, bieten sich als ergiebiges Feld für weitere Forschung an. Darüber hinaus sollte in zukünftigen Studien eine Übertragung der vorliegenden Untersuchungsbefunde auf klinische Stichproben überprüft werden.

Self-regulated learning (SRL) is critical for learning across tasks, domains, and contexts. Despite its importance, research shows that not all learners are equally skilled at accurately and dynamically monitoring and regulating their self-regulatory processes. Therefore, learning technologies, such as intelligent tutoring systems (ITSs), have been designed to measure and foster SRL. This paper presents an overview of over 10 years of research on SRL with MetaTutor, a hypermedia-based ITS designed to scaffold college students’ SRL while they learn about the human circulatory system. MetaTutor’s architecture and instructional features are designed based on models of SRL, empirical evidence on human and computerized tutoring principles of multimedia learning, Artificial Intelligence (AI) in educational systems for metacognition and SRL, and research on SRL from our team and that of other researchers. We present MetaTutor followed by a synthesis of key research findings on the effectiveness of various versions of the system (e.g., adaptive scaffolding vs. no scaffolding of self-regulatory behavior) on learning outcomes. First, we focus on findings from self-reports, learning outcomes, and multimodal data (e.g., log files, eye tracking, facial expressions of emotion, screen recordings) and their contributions to our understanding of SRL with an ITS. Second, we elaborate on the role of embedded pedagogical agents (PAs) as external regulators designed to scaffold learners’ cognitive and metacognitive SRL strategy use. Third, we highlight and elaborate on the contributions of multimodal data in measuring and understanding the role of cognitive, affective, metacognitive, and motivational (CAMM) processes. Additionally, we unpack some of the challenges these data pose for designing real-time instructional interventions that scaffold SRL. Fourth, we present existing theoretical, methodological, and analytical challenges and briefly discuss lessons learned and open challenges.

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. Results 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. Conclusion The results point to increased fMRI-activation in areas processing emotional distress and painful experiences in BPD patients. In particular, the emotional cascade reflecting attachment distress was evoked by combining monadic pictures, representing abandonment and aloneness, 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. Moreover, 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.

This study investigated whether tobacco smoking affected outcomes of brief alcohol interventions (BAIs) in at-risk alcohol-drinking general hospital patients. Between 2011 and 2012 among patients aged 18–64 years, 961 patients were allocated to in-person counseling (PE), computer-based BAI containing computer-generated individual feedback letters (CO), and assessment only. PE and CO included contacts at baseline, 1, and 3 months. After 6, 12, 18, and 24 months, self-reported reduction of alcohol use per day was assessed as an outcome. By using latent growth curve models, self-reported smoking status, and number of cigarettes per day were tested as moderators. In PE and CO, alcohol use was reduced independently of smoking status (IRRs ≤ 0.61, ps < 0.005). At month 24, neither smoking status nor number of cigarettes per day moderated the efficacy of PE (IRR = 0.69, ps > 0.05) and CO (IRR = 0.85, ps > 0.05). Up to month 12, among persons smoking ≤ 19 cigarettes per day, the efficacy of CO increased with an increasing number of cigarettes (ps < 0.05). After 24 months, the efficacy of PE and CO that have been shown to reduce drinking did not differ by smoking status or number of cigarettes per day. Findings indicate that efficacy may differ by the number of cigarettes in the short term.

IntroductionPatients and families affected by paediatric cancer experience psychosocial burden not only during active treatment but also during follow-up care. Use of health services during follow-up treatment should be organised according to patients’ and family members’ needs with regard to their physical and mental situation. This study aims (1) at analysing healthcare use (medical and psychosocial) and associated factors in follow-up care of paediatric cancer patients and (2) at investigating the psychosocial situation and support needs of children and their families during follow-up care. Based on the results, recommendations for healthcare planning and for the development of new and the optimisation of existing support offers will be derived.Methods and analysisWe will conduct a prospective observational study using a naturalistic explorative design with quantitative and qualitative methods. Paediatric cancer patients in follow-up care, their parents and siblings will be invited to fill out a questionnaire at three measurement points (baseline, 6 months follow-up, 12 months follow-up; target n=252 complete data sets over all measurement points). Additionally, parents will be interviewed using a semistructured interview guideline (target n=15–20) at baseline. Quantitative data will be analysed using descriptive statistics, linear mixed models and regression models. Moreover, explorative analyses will be conducted. Qualitative data will be analysed using qualitative content analyses.Ethics and disseminationThe study was approved by the Local Psychological Ethics Committee (LPEK-0281). Our findings will be published in scientific, peer-reviewed journals and presented to clinicians and researchers on conferences. To assure that results will be available to affected patients and families, a lay summary will be written and disseminated using several ways (upload on the homepage of the research group, upload on the homepage of the psychosocial working group in the Society for Paediatric Oncology/Haematology in Germany, sending to relevant patient organisations).Trial registration numberDRKS00025289.