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Quality of Life (QoL) is a core patient-reported outcome in healthcare research. However, a conceptual, operational, and psychometric elaboration of QoL in the context of telemedical care (TM) was needed, as standardised instruments to assess QoL do not comprehensively represent essential aspects of intended outcomes of TM. Therefore, the overall aim of this thesis was to conceptualise QoL in the context of TM and to develop an instrument that can adequately assess QoL in TM.
Gefahrenlagen, wie schwere Unwetter, Terroranschläge oder die COVID-19-Pandemie, stellen aktuell und zukünftig eine Bedrohung unserer Gesellschaft dar. Im Fall dieser und weiterer Gefahren können Warnungen helfen, Schäden zu verhindern und Menschenleben zu retten, indem sie die Empfänger*innen informieren und Schutzmaßnahmen vermitteln. Das Protective Action Decision Model (PADM) (Lindell & Perry, 2012) bietet einen theoretischen Rahmen, der Verarbeitungsprozesse von Warnungen und die Entstehung von Schutzverhalten abbildet. Neben zahlreichen weiteren Elementen beinhaltet das PADM die Wahrnehmung von Risiko als zentralen Faktor. Im Sinne des Modells sowie bereits existierender Literatur wird Risikowahrnehmung jedoch häufig ausschließlich kognitiv abgebildet. Zudem untersuchen Studien vorwiegend einzelne Gefahrenlagentypen oder singuläre Ereignisse.
Die vorliegende Arbeit bildet mit drei Beobachtungsstudien sowie einer experimentellen Studie Verarbeitungsprozesse von Warnungen vor verschiedenen Gefahrenlagen ab. Untersucht wurde der Einfluss der Warnungen auf kognitive und affektive Facetten der Risikowahrnehmung und ihre Rolle bei der Suche nach Informationen sowie der Intention, Schutzverhalten auszuführen. Über Online-Befragungen erhielten die Teilnehmenden Warnungen zu verschiedenen Gefahrenlagen (schweres Unwetter, Großbrand, extreme Gewalttat, Ausfall der Notrufnummer, Fund einer Weltkriegsbombe, COVID-19-Pandemie, Gewitter), die Informationen zur Gefahr sowie Handlungsempfehlungen enthielten. Befragt wurden sie unter anderem hinsichtlich ihrer Risikowahrnehmung vor und nach Warnerhalt sowie ihrer Intention, die angegebenen Schutzmaßnahmen zu befolgen oder sich Informationen zu suchen. Zudem wurden Eigenschaften der Warnungsempfänger*innen erhoben.
Die Ergebnisse stärken die Rolle affektiver Risikowahrnehmung für die Verarbeitung
von Warnungen sowie die Entstehung von Schutzverhalten und Informationssuche. Dies gilt
jedoch nicht für alle Gefahrenlagen gleichermaßen, sodass der Einfluss von Eigenschaften der Gefahr, wie Häufigkeit oder Schweregrad, deutlich wird. Bezüglich der Eigenschaften der Empfänger*innen ergab sich ebenfalls kein einheitliches Bild. Basierend auf den Ergebnissen wird eine Erweiterung des PADM um ein Modellelement der affektiven Risikowahrnehmung vorgeschlagen.
Fortführende Forschung zu Warnungen sollte eine multifacettierte Sichtweise von Risikowahrnehmung anstreben. Darüber hinaus sollten Gefahrenlagen vergleichend untersucht und ihre Eigenschaften sowie Eigenschaften der Warnungen systematisch variiert werden.
Body dissatisfaction is pervasive among young women in Western countries. Among the many forces that contribute to body dissatisfaction, the overrepresentation of thin bodies in visual media has received notable attention. In this study, we proposed that prevalence-induced concept change may be one of the cognitive mechanisms that explain how beauty standards shift. We conducted a preregistered online experiment with young women (N = 419) and found that when the prevalence of thin bodies in the environment increased, the concept of being overweight expanded to include bodies that would otherwise be judged as “normal.” Exploratory analyses revealed significant individual differences in sensitivity to this effect, in terms of women’s judgments about other bodies as well as their own. These results suggest that women’s judgments about other women’s bodies are biased by an overrepresentation of thinness and lend initial support to policies designed to increase size-inclusive representation in the media.
Background
Longitudinal observational studies play on an important role for evidence-based research on health services and psychiatric rehabilitation. However, information is missing about the reasons, why patients participate in such studies, and how they evaluate their participation experience.
Methods
Subsequently to their final assessment in a 2-year follow-up study on supported housing for persons with severe mental illness, n = 182 patients answered a short questionnaire on their study participation experience (prior experiences, participation reasons, burden due to study assessments, intention to participate in studies again). Basic respondent characteristics as well as symptom severity (SCL-K9) were also included in the descriptive and analytical statistics.
Results
To help other people and curiosity were cited as the main initial reasons for study participation (>85%). Further motives were significantly associated with demographic and/or clinical variables. For instance, “relieve from boredom” was more frequently reported by men and patients with substance use disorders (compared to mood disorders), and participants ‘motive” to talk about illness” was associated with higher symptom severity at study entry. Furthermore, only a small proportion of respondents indicated significant burdens by study participation and about 87% would also participate in future studies.
Conclusions
The respondents gave an overall positive evaluation regarding their participation experience in an observational study on psychiatric rehabilitation. The results additionally suggest that health and social care professionals should be responsive to the expectations and needs of patients with mental illness regarding participation in research.
This article provides details on the development of a statistical learning algorithm developed for constructing personalized treatment plans for psychotherapy. The algorithm takes data collected via Ecological Momentary Assessment (EMA) as an input. From this, it constructs an idiographic disorder model that reflects the latent dimensions of this patient’s psychopathology and their temporal interrelations. The priority of individual problems is derived from this statistical model. Based on this, treatment modules from cognitive-behavioral therapy are ranked so that the problems with the highest priority are dealt with first. A case study is used to illustrate the different analysis steps of the algorithm from data collection to the treatment plan.
Background
Numerous wearables are used in a research context to record cardiac activity although their validity and usability has not been fully investigated. The objectives of this study is the cross-model comparison of data quality at different realistic use cases (cognitive and physical tasks). The recording quality is expressed by the ability to accurately detect the QRS complex, the amount of noise in the data, and the quality of RR intervals.
Methods
Five ECG devices (eMotion Faros 360°, Hexoskin Hx1, NeXus-10 MKII, Polar RS800 Multi and SOMNOtouch NIBP) were attached and simultaneously tested in 13 participants. Used test conditions included: measurements during rest, treadmill walking/running, and a cognitive 2-back task. Signal quality was assessed by a new local morphological quality parameter morphSQ which is defined as a weighted peak noise-to-signal ratio on percentage scale. The QRS detection performance was evaluated with eplimited on synchronized data by comparison to ground truth annotations. A modification of the Smith-Waterman algorithm has been used to assess the RR interval quality and to classify incorrect beat annotations. Evaluation metrics includes the positive predictive value, false negative rates, and F1 scores for beat detection performance.
Results
All used devices achieved sufficient signal quality in non-movement conditions. Over all experimental phases, insufficient quality expressed by morphSQ values below 10% was only found in 1.22% of the recorded beats using eMotion Faros 360°whereas the rate was 8.67% with Hexoskin Hx1. Nevertheless, QRS detection performed well across all used devices with positive predictive values between 0.985 and 1.000. False negative rates are ranging between 0.003 and 0.017. eMotion Faros 360°achieved the most stable results among the tested devices with only 5 false positive and 19 misplaced beats across all recordings identified by the Smith-Waterman approach.
Conclusion
Data quality was assessed by two new approaches: analyzing the noise-to-signal ratio using morphSQ, and RR interval quality using Smith-Waterman. Both methods deliver comparable results. However the Smith-Waterman approach allows the direct comparison of RR intervals without the need for signal synchronization whereas morphSQ can be computed locally.
Loneliness and lack of belonging as paramount theme in identity descriptions of Children Born of War
(2022)
Objective
Children Born of War (CBOW) are an international and timeless phenomenon that exists in every country involved in war or armed conflict. Nevertheless, little is known on a systematic level about those children, who are typically fathered by a foreign or enemy soldier and born to a local mother. In particular, the identity issues that CBOW often report have remained largely uninvestigated. In the current qualitative study we began filling this gap in the scientific literature by asking how CBOW construct their identity in self-descriptions.
Method
We utilized thematic content analysis of N = 122 German CBOWs' answers to an open-ended questionnaire item asking how they see themselves and their identity in the context of being a CBOW.
Results
We identified five key themes in CBOW' identity accounts. Loneliness and lack of belonging appeared as a paramount aspect of their self-descriptions next to narratives about belonging and positive relationship. On a less interpersonal basis, we found fighting and surviving and searching for truth and completion overarching aspects of their identities. There were also few accounts growing up unaffected by the fact of being born a CBOW. Although all themes portray different perspectives, they all (but the last one) clearly indicate the impeded circumstances under which CBOW had to grow up.
Conclusions
Integrating our findings with existing interdisciplinary literature regarding identity, we discuss implications for future research and clinical and political practice.
Most feedback we receive or give is correct (deterministic feedback), though a small fraction can be wrong for various reasons. Children need to cope with receiving some portion of wrong feedback (stochastic feedback). It is still unknown if better social functioning and communication skills or outstanding intelligence (IQ) or chronological age support children in the coping process. We tested a sample of 7-, 9-, and 11-year-old children (N = 60) who deduced a sequence of four left and right button presses from a red and green stochastic feedback signal that was wrong in 15 % of the trials. Children performed worse with stochastic than with deterministic feedback but improved in the repeated trials, especially after receiving positive feedback about whether true or false. Controlling for IQ improved and confirmed these effects, while social and communicative competence explained little or no variance.
Die Vereinbarkeit von Wissenschaft und Familie ist für Eltern im Allgemeinen und Frauen im Besonderen eine große Herausforderung. Tagungsteilnahmen sind wichtige Karrierebausteine und eine organisatorische Herausforderung für Eltern. In diesem Positionspapier wird ein Stimmungsbild zu familienfreundlicheren Kongressgestaltung in der Fachgruppe (FG) Klinische Psychologie und Psychotherapie der Deutschen Gesellschaft für Psychologie (DGPs) erfragt. 147 FG-Mitglieder (Rücklaufquote: 18.36 %) beantworteten Fragen zur Demographie, sowie Einstellungen gegenüber der FG-Tagung, Betreuungsmöglichkeiten und familienfreundlichen Maßnahmen. Von den Teilnehmenden waren 66 % Eltern, 45 % sagten wegen familiärer Verpflichtungen die FG-Tagung ab. Zusätzliche Kosten durch familiäre Verpflichtungen wurden als hoch eingeschätzt und familienfreundlichere Maßnahmen von vielen Teilnehmenden gewünscht. Familienfreundliche Konferenzen können ein klares Signal der Inklusion und Solidarität setzen und für die Aufrechterhaltung und Nachhaltigkeit wissenschaftlicher Kompetenz sorgen. Konkrete Empfehlungen für eine familienfreundliche Konferenzgestaltung werden als Checkliste im elektronischen Anhang zur Verfügung gestellt.
Abstract
Lately, the use of patient‐reported outcome measures (PROM) to adapt and improve ongoing psychotherapeutic treatments has become more widespread. Their main purpose is to support data‐informed, collaborative treatment decisions which include the patient's point of view on their progress. In case of nonresponse or deterioration, these systems are able to warn clinicians and guide the process “back on track” in treatment. In this case illustration, the Greifswald Psychotherapy Navigator System (GPNS) detected the deterioration of 19‐year‐old Sarah during the first eight sessions of cognitive‐behavioral therapy for social anxiety and depression. Here, the GPNS helped the therapist gain insight as to how Sarah's social anxiety affected their treatment and adjust her strategy accordingly. Using the symptom curves and progress scales of the GPNS, the therapist was able to then address her patient's struggles in detail during their sessions and with her supervisor. After adapting her therapeutic approach, the patient's deterioration could be averted while simultaneously strengthening their communication in the process. Clinical implications and the benefits of using PROM systems for evidence‐based personalization of psychotherapy are presented.
The COVID-19 pandemic is one of the most serious health and economic crises of the 21st century. From a psychological point of view, the COVID-19 pandemic and its consequences can be conceptualized as a multidimensional and potentially toxic stressor for mental health in the general population. This selective literature review provides an overview of longitudinal studies published until June 2021 that have investigated the impact of the COVID-19 pandemic on mental health in the European population. Risk and protective factors identified in the studies are summarized. Forty-two studies that met inclusion and search criteria (COVID-19, mental health, longitudinal, and Europe) in PubMed, PsycInfo, and Web of Science databases indicate differential effects of the pandemic on mental distress, depression, and anxiety, depending on samples and methods used. Age-specific (e.g., young age), social (e.g., female, ethnical minority, loneliness), as well as physical and mental health-related factors (e.g., pre-pandemic illness) were identified as risk factors for poor mental health. The studies point to several protective factors such as social support, higher cognitive ability, resilience, and self-efficacy. Increasing evidence supports the assumption of the pandemic being a multidimensional stressor on mental health, with some populations appearing more vulnerable than others, although inconsistencies arise. Whether the pandemic will lead to an increase in the prevalence of mental disorders is an open question. Further high-quality longitudinal and multi-national studies and meta-analyses are needed to draw the complete picture of the consequences of the pandemic on mental health.
Measuring mental workload at the workplace using (psycho-) physiological measurement techniques seems desirable but is difficult to implement. Conventional analysis techniques are designed to cover longer measurement durations, neglecting the demands of modern work places: high worker flexibility and constantly fluctuating mental workload. As an alternative analysis approach, measurement (resp. analysis) duration can be shortened and event-based pattern analysis of various physiological parameters can be performed. The effects of such approaches are demonstrated by experimental examples. Furthermore, an event-timestamp independent framework is presented. Focusing on occasionally occurring peaks and longer lasting plateaus in mental workload trajectories, an automatized analysis of workload during work processes becomes possible.
Practical relevance: With steadily increasing cognitive demands at work the risk of mental fatigue increases too. Mental workload is not directly observable at the workplace and the objective measurement and interpretation is complicated. Improving the overall assessment and analysis strategies for (physiological) mental workload indicators can benefit the quality of risk assessments of workplaces and processes as well as enable the possibility of demand-orientated control of (informational) assistance systems to prevent mental overload and resulting health constraints.
Noninvasive Modulation of Cognition in Older Adults – Neural Correlates and Behavioral Outcomes
(2022)
Background: The worldwide population will grow older in the upcoming years. Aging, even in the absence of pathological processes, is associated with decline in cognitive functioning. Age-related cognitive decline is not a uniform process affecting every function in the same way. Research should thus examine specific functions, such as episodic memory or executive functions differentially, especially in older samples. Neural correlates of these functions are well characterized in young adults. However, research on functional and structural neural substrates underlying specific cognitive functions in older adults is scarce, but needed for example to identify targets for noninvasive interventions against cognitive decline. Current advances in this field point towards the effectiveness of combined noninvasive interventions of cognitive training and transcranial direct current stimulation (tDCS). So far, evidence regarding such combined interventions in older adults is inconclusive and neural mechanisms of successful interventions are still unclear. This line of research could advance the development of noninvasive methods to modulate cognitive functions and therefore address the unmet need for treatment options against age-related cognitive decline.
Aims: The main aims of the present thesis were (i) to characterize functional and structural neural network correlates of two cognitive functions with high relevance for daily living, namely working memory updating and value-based decision making, (ii) to map out interventions of combined cognitive training and tDCS to modulate these cognitive functions in healthy older adults and adults with prodromal AD and (iii) to assess behavioral and neural outcomes of combined cognitive training (of either executive functions or visuo-spatial memory) and tDCS interventions.
Methods: In order to address these aims, the present thesis includes five papers. Paper I assessed functional and structural neural correlates of working memory updating and value-based decision-making performance in healthy older adults using functional magnetic resonance imaging and diffusion tensor imaging. Papers II and III comprise study protocols of a three-week cognitive training of working memory updating and value-based decision-making abilities with concurrent tDCS over the left dorsolateral prefrontal cortex in healthy older adults and adults with prodromal AD. Paper IV used mixed-model analysis to compute behavioral outcomes of this combined intervention in healthy older adults, including outcome measures of the trained tasks, measures of transfer to untrained tasks and assessment of long-term effects at four weeks and half a year after the intervention. In paper V neural alterations after cognitive training of visuo-spatial memory and active stimulation compared to the training and sham (placebo) stimulation were assessed in older adults using measures of functional network centrality and diffusion tensor imaging-derived measures of grey matter microstructure.
Results: Analyses revealed distinct functional and structural connectivity correlates of performance on the two cognitive tasks assessing working memory updating and value-based decision-making (paper I). Moreover, results showed a combined contribution of a specific white matter pathway (cingulum bundle) and frontoparietal functional connectivity to working memory updating performance, thereby providing information on possible network targets for modulation of working memory updating and value-based decision-making. The combined modulatory intervention of cognitive training and tDCS (papers II and IV) did not demonstrate group differences between concurrent active tDCS over sham tDCS in the trained tasks. However, analysis of a working memory transfer task revealed a beneficial effect of training and active tDCS over training and sham tDCS at post intervention and follow-up. Findings from paper V showed reduced functional network centrality after visuo-spatial memory training and active tDCS compared to training and sham tDCS in the stimulated brain area and its contralateral homologue. Additionally, after the training, measures of grey matter microstructural plasticity in the stimulated brain area were associated with beneficial training outcomes for the active but not the sham stimulation group.
Conclusion: Taken together, cognitive performance, functional and structural networks as well as the possibility of their modulation through combined cognitive training and tDCS interventions were investigated in older adults with and without cognitive impairment. The present thesis therefore contributes to the field of noninvasive neuromodulation in older adults by characterizing distinct neural correlates of two age-sensitive executive functions, which may be altered through modulatory interventions. Moreover, the present work shows that cognitive training with concurrent tDCS holds the potential to elicit transfer effects to untrained tasks and further may evoke neural plasticity on the functional and microstructural level. This work thus promotes the development of modulatory interventions against age-associated cognitive decline and holds promising implications for translation to clinical application.
Given the increasing prevalence of chronic kidney disease (CKD) and its impact on health care, it is important to better understand the multiple factors influencing health-related quality of life (HRQOL), particularly since they have been shown to affect CKD outcomes. Determinants of HRQOL as measured by the validated Kidney Disease Quality of Life questionnaire (KDQOL) and the Patient Health Questionnaire depression screener (PHQ-9) were assessed in a routine CKD patient sample, the Greifswald Approach to Individualized Medicine (GANI_MED) renal cohort (N = 160), including a wide range of self-reported data, sociodemographic and laboratory measures. Compared to the general population, CKD patients had lower HRQOL indices. Dialysis was associated with (1) low levels of physical functioning, (2) increased impairments by symptoms and problems, and (3) more effects and burden of kidney disease. HRQOL is seriously affected in CKD patients. However, impairments were found irrespective of eGFR decline and albuminuria. Rather, the comorbid conditions of depression and diabetes predicted a lower HRQOL (physical component score). Further studies should address whether recognizing and treating depression may not only improve HRQOL but also promote survival and lower hospitalization rates of CKD patients.
Background
Self-reported time-use in relation to health-related quality of life (HRQoL) has been widely studied, yet less is known about the directionality of the association and how it compares across genders when controlling for sociodemographic confounders.
Methods
This study focused on the working population of the most recent waves (2013–2018) of the Core-Study of the German Socio-Economic Panel (N = 30,518, 46.70% female, M = 39.24 years). It examined the relationship between three time-use categories (contracted, committed, & leisure time) and HRQoL (self-rated health & life satisfaction) in men and women via multigroup fixed effects cross-lagged panel models. The models controlled for sociodemographic background (age, household income, number of children living in household, employment status, education, & marital status), which was associated with time-use and psychosocial health in previous research.
Results
Contracted time showed consistent positive relationships with HRQoL across genders while associations with the other types of time use differed significantly between men and women and across indicators of HRQoL.
Conclusions
The way we spend our time directly predicts our health perceptions, but in the same vein our health also predicts how we can spend our time. Contracted time in particular was associated with positive HRQoL, across genders, and beyond sociodemographic predictors, highlighting the important role of employment in health, for men and women alike. The impact of commitments beyond contracted time-use—like household chores and childcare—however, continues to affect mainly women, which ultimately reflects in poorer health outcomes.
Although disaster research has acknowledged the role of social media in crisis communication, the interplay of new (e.g., mobile apps) and traditional media (e.g., TV, radio) in public warnings has received less attention, particularly from the recipients’ perspective. Therefore, we examined sociodemographic and psychosocial correlates of different types of media use (i.e., traditional, new, mixed) for receiving public warning messages in a population survey (N = 613, 63% female; Mage = 31.56 years). More than two-thirds (68%) reported mixed media use, with 20% relying on new media and 12% on traditional media. Traditional media users were older and reported lower levels of education, while new media users were significantly younger and reported lower trust toward traditional media (i.e., TV). Migrants were more likely to use new but not mixed media. In sum, most participants utilized a mixture of traditional and new media for warning purposes, which has implications for crisis communication. Though, vulnerable populations (e.g., older and less educated participants) mainly rely on traditional media, stressing the need for continued support. Thus, it is paramount to increasingly use mixed methods designs and concurrently examine multiple channels to reflect real-world warning practices and generate ecologically valid results.
Individual responses to behavioral treatment of anxiety disorders vary considerably, which requires a better understanding of underlying processes. In this study, we examined the violation and change of threat beliefs during exposure. From 8,484 standardized exposure records of 605 patients with different anxiety disorders, learning indicators were derived: expectancy violation as mismatch between threat expectancy before exposure and threat occurrence, expectancy change as difference between original and adjusted expectancy after exposure, and prediction-error learning rate as extent to which expectancy violation transferred into change. Throughout sessions, high threat expectancy but low occurrence and adjusted expectancy indicated successful violation and change of threat beliefs by exposure. Expectancy violation, change, and learning rate substantially varied between patients. Not expectancy violation itself, but higher learning rate and expectancy change predicted better treatment outcome. Successful exposure thus requires expectancy violation to induce actual expectancy change, supporting learning from prediction error as transdiagnostic mechanism underlying successful exposure therapy.
To a large extent health-related quality of life (HRQoL) is a product of life-course experiences. Therefore, we examined employment, marital, and reproductive life-course typologies as predictors of HRQoL in women and men. To determine life course clusters, sequence and cluster analysis were performed on the annual (waves 1990–2019) employment, marital, and children in household states of the German Socio-Economic Panel data (N = 8,998; age = 53.57, 52.52% female); separately for men and women. Using hierarchical linear regression analyses, and Tukey HSD post-hoc tests, associations between clusters and change in life satisfaction, subjective mental, and physical health were examined. Five life-course clusters were identified in the female and six in the male sample. Life courses differed greatly across gender regarding employment aspects (e.g., men generally work full-time vs. women underwent frequent transitions). The family aspects appeared similar – e.g., ‘starting a family’ or ‘marital separation’ clusters – but still differed in the particulars. Life course typologies were related to distinct patterns of HRQoL. For instance, both for men and women the ‘separated’ clusters, as well as the male ‘entering non-employment’ cluster were associated with a steeper decline in HRQoL. However, change in subjective mental health showed few associations. Distinct types of life courses and differential associations with sociodemographic background and HRQoL emerged for women and men. The analyses reveal a burden on individuals who experienced marital separation, and non-employment and thus present important target groups for health prevention, e.g., for physical health problems.
In recent years, online radicalization has received increasing attention from researchers and policymakers, for instance, by analyzing online communication of radical groups and linking it to individual and collective pathways of radicalization into violent extremism. But these efforts often focus on radical individuals or groups as senders of radicalizing messages, while empirical research on the recipient is scarce. To study the impact of radicalized online content on vulnerable individuals, this study compared cognitive and affective appraisal and visual processing (via eye tracking) of three political Internet memes (empowering a right-wing group, inciting violence against out-groups, and emphasizing unity among human beings) between a right-wing group and a control group. We examined associations between socio-political attitudes, appraisal ratings, and visual attention metrics (total dwell time, number of fixations). The results show that right-wing participants perceived in-group memes (empowerment, violence) more positively and messages of overarching similarities much more negatively than controls. In addition, right-wing participants and participants in the control group with a high support for violence directed their attention towards graphical cues of violence (e.g., weapons), differentness, and right-wing groups (e.g., runes), regardless of the overall message of the meme. These findings point to selective exposure effects and have implications for the design and distribution of de-radicalizing messages and counter narratives to optimize the efficacy of prevention of online radicalization.
The ventromedial prefrontal cortex (vmPFC) mediates the inhibition of defensive responses upon encounters of cues, that had lost their attribute as a threat signal via previous extinction learning. Here, we investigated whether such fear extinction recall can be facilitated by anodal transcranial direct current stimulation (tDCS). Extinction recall was tested twenty-four hours after previously acquired fear was extinguished. Either anodal tDCS or sham stimulation targeting the vmPFC was applied during this test. After stimulation ceased, we examined return of fear after subjects had been re-exposed to aversive events. Fear was assessed by reports of threat expectancy and modulations of autonomic (skin conductance, heart rate) and protective reflex (startle potentiation) measures, the latter of which are mediated by subcortical defense circuits. While tDCS did not affect initial extinction recall, it abolished the return of startle potentiation and autonomic components of the fear response. Results suggest hierarchical multi-level vmPFC functions in human fear inhibition and indicate, that its stimulation might immunize against relapses into pathological subcortically mediated defensive activation.