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- BioMed Central (BMC) (3)
- Elsevier (2)
- Nature Publishing Group (2)
- Public Library of Science (PLoS) (2)
- SAGE Publications (2)
Background: Depression is a highly prevalent mental disorder, but only a fraction of those affected receive evidence-based treatments. Recently, Internet-based interventions were introduced as an efficacious and cost-effective approach. However, even though depression is a heterogenous construct, effects of treatments have mostly been determined using aggregated symptom scores. This carries the risk of concealing important effects and working mechanisms of those treatments.
Methods: In this study, we analyze outcome and long-term follow-up data from the EVIDENT study, a large (N = 1,013) randomized-controlled trial comparing an Internet intervention for depression (Deprexis) with care as usual. We use Network Intervention Analysis to examine the symptom-specific effects of the intervention. Using data from intermediary and long-term assessments that have been conducted over 36 months, we intend to reveal how the treatment effects unfold sequentially and are maintained.
Results: Item-level analysis showed that scale-level effects can be explained by small item-level effects on most depressive symptoms at all points of assessment. Higher scores on these items at baseline predicted overall symptom reduction throughout the whole assessment period. Network intervention analysis offered insights into potential working mechanisms: while deprexis directly affected certain symptoms of depression (e.g., worthlessness and fatigue) and certain aspects of the quality of life (e.g., overall impairment through emotional problems), other domains were affected indirectly (e.g., depressed mood and concentration as well as activity level). The configuration of direct and indirect effects replicates previous findings from another study examining the same intervention.
Conclusions: Internet interventions for depression are not only effective in the short term, but also exert long-term effects. Their effects are likely to affect only a small subset of problems. Patients reporting these problems are likely to benefit more from the intervention. Future studies on online interventions should examine symptom-specific effects as they potentially reveal the potential of treatment tailoring.
Clinical Trial Registration: ClinicalTrials.gov, Identifier: NCT02178631.
“Blood for Blood”? Personal Motives and Deterrents for Blood Donation in the German Population
(2021)
Over the last decades, various predictors have proven relevant for job performance [e.g., general mental ability (GMA), broad personality traits, such as the Big Five]. However, prediction of job performance is far from perfect, and further potentially relevant predictors need to be investigated. Narrower personality traits, such as individuals' character strengths, have emerged as meaningfully related to different aspects of job performance. However, it is still unclear whether character strengths can explain additional variance in job performance over and above already known powerful predictors. Consequently, the present study aimed at (1) examining the incremental validity of character strengths as predictors of job performance beyond GMA and/or the Big Five traits and (2) identifying the most important predictors of job performance out of the 24 character strengths, GMA, and the Big Five. Job performance was operationalized with multidimensional measures of both productive and counterproductive work behavior. A sample of 169 employees from different occupations completed web-based self-assessments on character strengths, GMA, and the Big Five. Additionally, the employees' supervisors provided web-based ratings of their job performance. Results showed that character strengths incrementally predicted job performance beyond GMA, the Big Five, or GMA plus the Big Five; explained variance increased up to 54.8, 43.1, and 38.4%, respectively, depending on the dimension of job performance. Exploratory relative weight analyses revealed that for each of the dimensions of job performance, at least one character strength explained a numerically higher amount of variance than GMA and the Big Five, except for individual task proactivity, where GMA exhibited the numerically highest amount of explained variance. The present study shows that character strengths are relevant predictors of job performance in addition to GMA and other conceptualizations of personality (i.e., the Big Five). This also highlights the role of socio-emotional skills, such as character strengths, for the understanding of performance outcomes above and beyond cognitive ability.
Introduction: The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) was developed for the treatment of persistent depressive disorder (PDD), where comorbid personality disorders (PD) are common. In contrast to other PD, comorbid borderline personality disorder (BPD) is often regarded as an exclusion criterion for CBASP. In clinical settings, however, subthreshold BPD symptoms are prevalent in PDD and may not be obvious at an initial assessment prior to therapy. As data on their impact on CBASP outcome are very limited, this naturalistic study investigates BPD features in PDD and their relevance for the therapeutic outcome of a multimodal CBASP inpatient program.
Method: Sixty patients (37 female, mean age 38.3, SD 11.9 years) meeting DSM-5 criteria for PDD underwent a 10 weeks CBASP inpatient program. BPD features (i.e., number of fulfilled DSM-5 criteria) together with childhood maltreatment and rejection sensitivity were assessed on admission. Before and after treatment, severity of depressive symptoms was measured using the Montgomery-Asberg Depression Rating Scale (MADRS) and the Beck Depression Inventory (BDI-II). BPD symptoms were assessed using the Borderline Personality Disorder Severity Index (BPDSI-IV) and the Borderline Symptom List (BSL-23). Intercorrelations of baseline characteristics and symptom change during treatment were analyzed.
Results: Patients with PDD met a mean of 1.5 (SD 1.6) BPD criteria with 4 patients fulfilling ≥5 criteria. BPD symptoms and depressive symptoms showed a strong correlation, and BPD symptoms were additionally correlated with emotional abuse and rejection sensitivity. There was no association between BPD features at baseline and improvement on the MADRS, however, BPD features tended to be associated with a lower response according to the BDI-II score after 10 weeks of treatment. Furthermore, BPD symptoms (i.e., abandonment, impulsivity and affective instability) were reduced after 10 weeks of CBASP treatment.
Discussion: BPD symptoms are prevalent in patients with PDD and highly intertwined with the experience of depressive symptoms. In this naturalistic study in PDD, BPD features at baseline did not limit the clinical response to CBASP. Future studies may extend the spectrum of PDD to comorbid subsyndromal or even syndromal BPD in order to develop tailored psychotherapeutic treatment for these complex affective disorders.
Abstract
Background
Comorbidities in mental disorders are often understood by assuming a common cause. The network theory of mental disorders offers an alternative to this assumption by understanding comorbidities as mutually reinforced problems. In this study, we used network analysis to examine bridge symptoms between anxiety and depression in a large sample.
Method
Using data from a sample of patients diagnosed with both depression and an anxiety disorder before and after inpatient treatment (N = 5,614, mean age: 42.24, 63.59% female, average treatment duration: 48.12 days), network models of depression and anxiety symptoms are estimated. Topology, the centrality of nodes, stability, and changes in network structure are analyzed. Symptoms that drive comorbidity are determined by bridge node analysis. As an alternative to network communities based on categorical diagnosis, we performed a community analysis and propose empirically derived symptom subsets.
Results
The obtained network models are highly stable. Sad mood and the inability to control worry are the most central. Psychomotor agitation or retardation is the strongest bridge node between anxiety and depression, followed by concentration problems and restlessness. Changes in appetite and suicidality were unique to depression. Community analysis revealed four symptom groups.
Conclusion
The estimated network structure of depression and anxiety symptoms proves to be highly accurate. Results indicate that some symptoms are considerably more influential than others and that only a small number of predominantly physical symptoms are strong candidates for explaining comorbidity. Future studies should include physiological measures in network models to provide a more accurate understanding.
Körpersignale sind elementar für die Aufrechterhaltung der Homöostase, um eine angemessene Regulation der Körperfunktionen zu ermöglichen und dadurch das Überleben des Individuums sicherzustellen. Die bisherige Forschung hat die dysfunktionale Wahrnehmung dieser interozeptiven Signale als wichtigen Bestandteil vieler Angst- und Gesundheitsprobleme identifiziert, da selbst leichte und harmlose Körperempfindungen eine übermäßig starke Mobilisierung von Abwehrreaktionen hervorrufen können. Obwohl das wissenschaftliche Interesse im Bereich Interozeption in den letzten Jahren stark gewachsen ist, wurde die Dynamik von Abwehrreaktionen als Reaktion auf Körpersignale bisher selten untersucht. Daher hatte die vorliegende Arbeit zum Ziel, die verhaltensbezogene und psychophysiologische Dynamik der defensiven Mobilisierung auf bedrohliche interozeptive Signale sowie den moderierenden Effekt von Dispositionsfaktoren und biologisch determinierten Verhaltensmarkern zu untersuchen.
In der ersten Studie wurden die Dynamik defensiver Mobilisierung auf eine näher-kommende externe Bedrohung mit einer sich annähernden interozeptiven respiratorischen Bedrohung, in Abhängigkeit von der Bedrohungsnähe und der Möglichkeit zur Vermeidung, bezüglich subjektiver, autonomer und respiratorische Reaktionen sowie Gehirnreaktionen und defensiver Reflexe verglichen.
In der zweiten Studie wurde die Mobilisierung defensiver Reaktionen während der wiederholten Vermeidung von kulminierender Atemnot analysiert, um eine detaillierte Analyse der Initiierung und Aufrechterhaltung von aktiven Vermeidungsverhalten zu erhalten.
Die dritte Studie unterweiterte die diese Befunde, indem die Rolle der maximalen freiwilligen Luftanhaltezeit als möglicher Prädiktor für eine übermäßig starke Mobilisierung defensiver Reaktionen bei der Konfrontation mit einer näherkommenden respiratorischen Bedrohung, in Abhängigkeit der Möglichkeit zur Vermeidung, untersucht wurde.
In der vierten Studie wurden die Prädiktoren für aktives Abwehrverhalten (d.h., Flucht oder aktive Vermeidung bei Konfrontation) während ansteigender Atemnot, induziert durch in der Intensität ansteigende inspiratorische Atemwiderstände gefolgt von einer kurzen Blockade der Einatmung, untersucht.
Die erste Studie zeigte, dass das defensive Aktivierungsmuster bei der Mobilisierung defensiver Reaktionen auf eine sich annähernde externe Bedrohung annähernd vergleichbar ist wie bei einer interozeptiven respiratorischen Bedrohung, unabhängig von der Möglichkeit zur Vermeidung. Zusätzlich wurde eine bedrohungsspezifische Mobilisierung des respiratorischen Systems bei der Konfrontation mit der unvermeidbaren interozeptiven Bedrohung beobachtet.
Die Daten der zweiten Studie demonstrierten, dass die Initiierung von erstmaligen Vermeidungsverhalten als Reaktion auf ansteigende Atemnot begleitet wird von physiologischen Erregungen als Indikatoren für eine Reaktionsvorbereitung. Diese verschwanden zunehmend mit wiederholter Vermeidung, was auf die Entwicklung von gewohnheitsmäßiger Vermeidung hindeutet.
Darüber hinaus wurde in der dritten Studie gezeigt, dass eine übermäßig starke Mobilisierung von Abwehrreaktionen auf eine sich annähernde unvermeidbare respiratorische Bedrohung durch eine reduzierte maximale freiwillige Luftanhaltezeit vorhergesagt wird, jedoch nicht, wenn die Möglichkeit zur Vermeidung vorhanden war.
Die vierte Studie demonstrierte, dass eine höhere Angstempfindlichkeit und eine kürzere freiwillige maximale Luftanhaltezeit mit aktivem Vermeidungsverhalten während ansteigender Atemnot assoziiert sind.
Zusammenfassend zeigen die vorliegenden Daten, dass die defensive Mobilisierung für eine exterozeptive Bedrohung vergleichbar ist wie für eine interozeptive Bedrohung und sich in Abhängigkeit der Bedrohungsnähe und dem verfügbarem Abwehrrepertoire ändert. Darüber hinaus ist die Neigung, Erregungsgefühle zu befürchten und eine verminderte Belastungstoleranz während freiwilligem Luftanhaltens mit einer erhöhten Angst- und Furchtreaktion auf Atemnotsymptome verbunden. Daher könnten diese dispositionellen und biologischen Verhaltensmarker bei der Konfrontation mit ansteigender Atemnot aktives Vermeidungsverhalten begünstigen und, wenn sie gewohnheitsmäßig ausgeführt werden, kann sich persistentes Vermeidungsverhalten entwickeln, welches das Risiko für die Entstehung einer ernsthaften psychischen Erkrankung erhöht.
Extinction learning is suggested to be a central mechanism during exposure-based cognitive behavioralpsychotherapy. A positive association between the patients’pretreatment extinction learning performance andtreatment outcome would corroborate the hypothesis. Indeed, there isfirst correlational evidence between reducedextinction learning and therapy efficacy. However, the results of these association studies may be hampered byextinction-training protocols that do not match treatment procedures. Therefore, we developed an extinction-trainingprotocol highly tailored to the procedure of exposure therapy and tested it in two samples of 46 subjects in total. Byusing instructed fear acquisition training, including a consolidation period overnight, we wanted to ensure that theconditioned fear response was well established prior to extinction training, which is the case in patients with anxietydisorders prior to treatment. Moreover, the extinction learning process was analyzed on multiple response levels,comprising unconditioned stimulus (US) expectancy ratings, autonomic responses, defensive brain stem reflexes, andneural activation using functional magnetic resonance imaging. Using this protocol, we found robust fearconditioning and slow-speed extinction learning. We also observed within-group heterogeneity in extinction learning,albeit a stable fear response at the beginning of the extinction training. Finally, we found discordance betweendifferent response systems, suggesting that multiple processes are involved in extinction learning. The paradigmpresented here might help to ameliorate the association between extinction learning performance assessed in thelaboratory and therapy outcomes and thus facilitate translational science in anxiety disorders
Development of the Greifswald questionnaire for the measurement of interprofessional attitudes
(2020)
Abstract
In crisis communication, warning messages are key to prevent or mitigate damage by informing the public about impending risks and hazards. The present study explored the influence of hazard type, trait anxiety, and warning message on different components of risk perception. A survey examined 614 German participants (18–96 years, M = 31.64, 63.0% female) using a pre–post comparison. Participants were randomly allocated to one of five hazards (severe weather, act of violence, breakdown of emergency number, discovery of a World War II bomb, or major fire) for which they received a warning message. Four components of risk perception (perceived severity, anticipatory worry, anticipated emotions, and perceived likelihood) were measured before and after the receipt. Also, trait anxiety was assessed. Analyses of covariance of risk perception were calculated, examining the effect of warning message, trait anxiety, and hazard type while controlling for age, gender, and previous hazard experience. Results showed main effects of hazard type and trait anxiety on every component of risk perception, except for perceived likelihood. The receipt of a warning message led to a significant decrease in anticipated negative emotions. However, changes across components of risk perception, as well as hazards, were inconsistent, as perceived severity decreased while perceived likelihood and anticipatory worry increased. In addition, three interactional effects were found (perceived severity × hazard type, perceived severity × trait anxiety, and anticipated emotions × hazard type). The findings point toward differences in the processing of warning messages yet underline the importance of hazard type, as well as characteristics of the recipient.
Our emotional experiences depend on our interoceptive ability to perceive and interpret changes in our autonomous nervous system. An inaccurate perception and interpretation of autonomic changes impairs our ability to understand and regulate our emotional reactions. Impairments in emotion understanding and emotion regulation increase our risk for mental disorders, indicating that interoceptive deficits play an important role in the etiology and pathogenesis of mental disorders. We, thus, need measures to identify those of us whose interoceptive deficits impair their emotion understanding and emotion regulation. Here, we used cardiac measures to investigate how our ability to engage prefrontal and (para-)limbic brain region regions affects our ability to perceive and interpret cardiac changes. We administered a heartbeat detection task to a sample of healthy individuals (n = 113) whose prefrontal-(para-) limbic engagement had been determined on basis of a heart rate variability recording. We found a positive association between heartbeat detection and heart rate variability, implying that individuals with higher heart rate variability were more accurate in heartbeat detection than individuals with lower heart rate variability. These findings suggest that our interoceptive accuracy depends on our prefrontal-(para-)limbic engagement during the perception and interpretation of cardiac changes. Our findings also show that cardiac measures may be useful to investigate the association between interoceptive accuracy and prefrontal-(para-)limbic engagement in a time- and cost-efficient manner.
Introduction: Following behavioral recommendations is key to successful containment of the COVID-19 pandemic. Therefore, it is important to identify causes and patterns of non-compliance in the population to further optimize risk and health communication.
Methods: A total of 157 participants [80% female; mean age = 27.82 years (SD = 11.01)] were surveyed regarding their intention to comply with behavioral recommendations issued by the German government. Latent class analysis examined patterns of compliance, and subsequent multinomial logistic regression models tested sociodemographic (age, gender, country of origin, level of education, region, and number of persons per household) and psychosocial (knowledge about preventive behaviors, risk perception, stigmatizing attitudes) predictors.
Results: Three latent classes were identified: high compliance (25%) with all recommendations; public compliance (51%), with high compliance regarding public but not personal behaviors; and low compliance (24%) with most recommendations. Compared to high compliance, low compliance was associated with male gender [relative risk ratio (RRR) = 0.08 (0.01; 0.85)], younger age [RRR = 0.72 (0.57; 0.93)], and lower public stigma [RRR = 0.21 (0.05; 0.88)]. Low compliers were also younger than public compliers [RRR = 0.76 (0.59; 0.98)].
Discussion: With 25% of the sample reporting full compliance, and 51% differing in terms of public and personal compliance, these findings challenge the sustainability of strict regulatory measures. Moreover, young males were most likely to express low compliance, stressing the need for selective health promotion efforts. Finally, the positive association between public stigma and compliance points to potential othering effects of stigma during a pandemic, but further longitudinal research is required to examine its impact on health and social processes throughout the pandemic.
Over the last years, there has been a resurge in the interest to study the relationship between interoception and emotion. By now, it is well established that interoception contributes to the experience of emotions. However, it may also be possible that interoception contributes to the regulation of emotions. To test this possibility, we studied the relationship between interoception and emotion regulation in a sample of healthy individuals (n = 84). We used a similar heartbeat detection task and a similar self-report questionnaire for the assessment of interoceptive accuracy and emotion regulation as in previous studies. In contrast to previous studies, we differentiated between male and female individuals in our analyses and controlled our analyses for individual characteristics that may affect the relationship between interoceptive accuracy and emotion regulation. We found sex-differences in interoceptive accuracy and emotion regulation that amounted to a sex-specific relationship between interoceptive accuracy and emotion regulation: Whereas interoceptive accuracy was related to reappraisal but not to suppression in male individuals, interoceptive accuracy was unrelated to reappraisal and suppression in female individuals. These findings indicate that the relationship between interoception and emotion regulation is far more complex than has been suggested by previous findings. However, these findings nonetheless support the view that interoception is essential for both, the regulation and experience of emotions.
Moral dilemmas often concern actions that involve causing harm to others in the attempt to prevent greater harm. But not all actions of this kind are equal in terms of their moral evaluation. In particular, a harm-causing preventive action is typically regarded as less acceptable if the harm is a means to achieve the goal of preventing greater harm than if it is a foreseen but unintended side-effect of the action. Likewise, a harm-causing preventive action is typically deemed less acceptable if it directly produces the harm than if it merely initiates a process that brings about the harmful consequence by its own dynamics. We report three experiments that investigated to which degree these two variables, the instrumentality of the harm (harm as means vs. side-effect; Experiments 1, 2, and 3) and personal force (personal vs. impersonal dilemmas; Experiments 2 and 3) influence deontological (harm-rejection) and utilitarian (outcome-maximization) inclinations that have been hypothesized to underly moral judgments in harm-related moral dilemmas. To measure these moral inclinations, the process dissociation procedure was used. The results suggest that the instrumentality of the harm and personal force affect both inclinations, but in opposite ways. Personal dilemmas and dilemmas characterized by harm as a means evoked higher deontological tendencies and lower utilitarian tendencies, than impersonal dilemmas and dilemmas where the harm was a side-effect. These distinct influences of the two dilemma conceptualization variables went undetected if the conventional measure of moral inclinations, the proportion of harm-accepting judgments, was analyzed. Furthermore, although deontological and utilitarian inclinations were found to be largely independent overall, there was some evidence that their correlation depended on the experimental conditions.
Much research has been devoted to the development of emotion recognition tests that can be used to investigate how individuals identify and discriminate emotional expressions of other individuals. One of the most prominent emotion recognition tests is the Reading the Mind in the Eyes Test (RME-T). The original RME-T has been widely used to investigate how individuals recognize complex emotional expressions from the eye region of adult faces. However, the RME-T can only be used to investigate inter-individual differences in complex emotion recognition during the processing of adult faces. To extend its usefulness, we developed a modified version of the RME-T, the Reading the Mind in the Eyes of Children Test (RME-C-T). The RME-C-T can be used to investigate how individuals recognize complex emotional expressions from the eye region of child faces. However, the validity of the RME-C-T has not been evaluated yet. We, thus, administered the RME-C-T together with the RME-T to a sample of healthy adult participants (n = 119). The Interpersonal Reactivity Index (IRI) and the Toronto Alexithymia Scale (TAS) were also administered. Participants’ RME-C-T performance correlated with participants’ RME-T performance, implying that the RME-C-T measures similar emotion recognition abilities as the RME-T. Participants’ RME-C-T performance also correlated with participants’ IRI and TAS scores, indicating that these emotion recognition abilities are affected by empathetic and alexithymic traits. Moreover, participants’ RME-C-T performance differed between participants with high and low TAS scores, suggesting that the RME-C-T is sensitive enough to detect impairments in these emotion recognition abilities. The RME-C-T, thus, turned out to be a valid measure of inter-individual differences in complex emotion recognition during the processing of child faces.
Despite major research interest regarding gender differences in emotion regulation, it is still not clear whether men and women differ in their basic capacity to implement specific emotion regulation strategies, as opposed to indications of the habitual use of these strategies in self-reports. Similarly, little is known on how such basic capacities relate to indices of well-being in both sexes. This study took a novel approach by investigating gender differences in the capacity for generating cognitive reappraisals in adverse situations in a sample of 67 female and 59 male students, using a maximum performance test of the inventiveness in generating reappraisals. Participants’ self-perceived efficacy in emotion regulation was additionally assessed. Analyses showed that men and women did not differ in their basic capacity to generate alternative appraisals for anxiety-eliciting scenarios, suggesting similar functional cognitive mechanisms in the implementation of this strategy. Yet, higher cognitive reappraisal capacity predicted fewer depressive daily-life experiences in men only. These findings suggest that in the case of cognitive reappraisal, benefits for well-being in women might depend on a more complex combination of basic ability, habits, and efficacy-beliefs, along with the use of other emotion regulation strategies. The results of this study may have useful implications for psychotherapy research and practice.
In the present study, we investigated whether inter-individual differences in vagally mediated heart rate variability (vmHRV) would be associated with inter-individual differences in empathy and alexithymia. To this end, we determined resting state HF-HRV in 90 individuals that also completed questionnaires assessing inter-individual differences in empathy and alexithymia. Our categorical and dimensional analyses revealed that inter-individual differences in HF-HRV were differently associated with inter-individual differences in empathy and alexithymia. We found that individuals with high HF-HRV reported more empathy and less alexithymia than individuals with low HF-HRV. Moreover, we even found that an increase in HF-HRV was associated with an increase in empathy and a decrease in alexithymia across all participants. Taken together, these findings indicate that individuals with high HF-HRV are more empathetic and less alexithymic than individuals with low HF-HRV. These differences in empathy and alexithymia may explain why individuals with high HF-HRV are more successful in sharing and understanding the mental and emotional states of others than individuals with low HF-HRV.
High-Frequency Binaural Beats Increase Cognitive Flexibility: Evidence from Dual-Task Crosstalk
(2016)
Increasing evidence suggests that cognitive-control processes can be configured to optimize either persistence of information processing (by amplifying competition between decision-making alternatives and top-down biasing of this competition) or flexibility (by dampening competition and biasing). We investigated whether high-frequency binaural beats, an auditory illusion suspected to act as a cognitive enhancer, have an impact on cognitive-control configuration. We hypothesized that binaural beats in the gamma range bias the cognitive-control style toward flexibility, which in turn should increase the crosstalk between tasks in a dual-task paradigm. We replicated earlier findings that the reaction time in the first-performed task is sensitive to the compatibility between the responses in the first and the second task—an indication of crosstalk. As predicted, exposing participants to binaural beats in the gamma range increased this effect as compared to a control condition in which participants were exposed to a continuous tone of 340 Hz. These findings provide converging evidence that the cognitive-control style can be systematically biased by inducing particular internal states; that high-frequency binaural beats bias the control style toward more flexibility; and that different styles are implemented by changing the strength of local competition and top-down bias.
The shared decline in cognitive abilities, sensory functions (e.g., vision and hearing), and physical health with increasing age is well documented with some research attributing this shared age-related decline to a single common cause (e.g., aging brain). We evaluate the extent to which the common cause hypothesis predicts associations between vision and physical health with social cognition abilities specifically face perception and face memory. Based on a sample of 443 adults (17–88 years old), we test a series of structural equation models, including Multiple Indicator Multiple Cause (MIMIC) models, and estimate the extent to which vision and self-reported physical health are related to face perception and face memory through a common factor, before and after controlling for their fluid cognitive component and the linear effects of age. Results suggest significant shared variance amongst these constructs, with a common factor explaining some, but not all, of the shared age-related variance. Also, we found that the relations of face perception, but not face memory, with vision and physical health could be completely explained by fluid cognition. Overall, results suggest that a single common cause explains most, but not all age-related shared variance with domain specific aging mechanisms evident.
People smile in various emotional contexts, for example, when they are amused or angry or simply being polite. We investigated whether younger and older adults differ in how well they are able to identify the emotional experiences accompanying smile expressions, and whether the age of the smiling person plays a role in this respect. With this aim, we produced 80 video episodes of three types of smile expressions: positive-affect smiles had been spontaneously displayed by target persons as they were watching amusing film clips and cartoons. Negative-affect smiles had been displayed spontaneously by target persons during an interaction in which they were being unfairly accused. Affectively neutral smiles were posed upon request. Differences in the accompanying emotional experiences were validated by target persons' self-reports. These smile videos served as experimental stimuli in two studies with younger and older adult participants. In Study 1, older participants were less likely to attribute positive emotions to smiles, and more likely to assume that a smile was posed. Furthermore, younger participants were more accurate than older adults at identifying emotional experiences accompanying smiles. In Study 2, both younger and older participants attributed positive emotions more frequently to smiles shown by older as compared to younger target persons, but older participants did so less frequently than younger participants. Again, younger participants were more accurate than older participants in identifying emotional experiences accompanying smiles, but this effect was attenuated for older target persons. Older participants could better identify the emotional state accompanying smiles shown by older than by younger target persons. Taken together, these findings indicate that there is an age-related decline in the ability to decipher the emotional meaning of smiles presented without context, which, however, is attenuated when the smiling person is also an older adult.
Children as young as 3 years can remember an object’s location within an arrangement and can retrieve it from a novel viewpoint (Nardini et al., 2006). However, this ability is impaired if the arrangement is rotated to compensate for the novel viewpoint, or, if the arrangement is rotated and children stand still. There are two dominant explanations for this phenomenon: self-motion induces an automatic spatial updating process which is beneficial if children move around the arrangement, but misleading if the children’s movement is matched by the arrangement and not activated if children stand still and only the arrangement is moved (see spatial updating; Simons and Wang, 1998). Another explanation concerns reference frames: spatial representations might depend on peripheral spatial relations concerning the surrounding room instead on proximal relations within the arrangement, even if these proximal relations are sufficient or more informative. To evaluate these possibilities, we rotated children (N = 120) aged between 3 and 6 years with an occluded arrangement. When the arrangement was in misalignment to the surrounding room, 3- and 4-year-olds’ spatial memory was impaired and 5-year-olds’ was lightly impaired suggesting that they relied on peripheral references of the surrounding room for retrieval. In contrast, 6-years-olds’ spatial representation seemed robust against misalignment indicating a successful integration of spatial representations.
Neurobiological theories suggest that inter-individual differences in vagally mediated heart rate variability (vmHRV) have the potential to serve as a biomarker for inter-individual differences in emotion regulation that are due to inter-individual differences regarding the engagement of prefrontal and (para-)limbic brain regions during emotion processing. To test these theories, we investigated whether inter-individual differences in vmHRV would be associated with inter-individual differences in emotion regulation. We determined resting state vmHRV in a sample of 176 individuals that had also completed a short self-report measure of reappraisal and suppression use. Resting state vmHRV was derived from short-term (300 s) and ultra-short-term (120 s, 60 s) recordings of participants’ heart rate to determine the robustness of possible findings. Irrespective of recording length, we found that an increase in resting state vmHRV was associated with an increase in self-reported reappraisal but not suppression use. However, this association was only evident among male but not female participants, indicating a sex-specific association between inter-individual differences in resting state vmHRV and inter-individual differences in self-reported emotion regulation. These findings, which are consistent with previous ones, support theoretical claims that inter-individual differences in vmHRV serve as a biomarker for inter-individual differences in emotion regulation. Combing (ultra-)short-term measures of resting state vmHRV with short self-report measures of emotion regulation may, thus, be useful for researchers who have to investigate the neurobiological mechanisms of emotion regulation in a time- and resource-efficient manner.
Recent research suggests that the P3b may be closely related to the activation of the locus coeruleus-norepinephrine (LC-NE) system. To further study the potential association, we applied a novel technique, the non-invasive transcutaneous vagus nerve stimulation (tVNS), which is speculated to increase noradrenaline levels. Using a within-subject cross-over design, 20 healthy participants received continuous tVNS and sham stimulation on two consecutive days (stimulation counterbalanced across participants) while performing a visual oddball task. During stimulation, oval non-targets (standard), normal-head (easy) and rotated-head (difficult) targets, as well as novel stimuli (scenes) were presented. As an indirect marker of noradrenergic activation we also collected salivary alpha-amylase (sAA) before and after stimulation. Results showed larger P3b amplitudes for target, relative to standard stimuli, irrespective of stimulation condition. Exploratory post hoc analyses, however, revealed that, in comparison to standard stimuli, easy (but not difficult) targets produced larger P3b (but not P3a) amplitudes during active tVNS, compared to sham stimulation. For sAA levels, although main analyses did not show differential effects of stimulation, direct testing revealed that tVNS (but not sham stimulation) increased sAA levels after stimulation. Additionally, larger differences between tVNS and sham stimulation in P3b magnitudes for easy targets were associated with larger increase in sAA levels after tVNS, but not after sham stimulation. Despite preliminary evidence for a modulatory influence of tVNS on the P3b, which may be partly mediated by activation of the noradrenergic system, additional research in this field is clearly warranted. Future studies need to clarify whether tVNS also facilitates other processes, such as learning and memory, and whether tVNS can be used as therapeutic tool.
Background: Controversy surrounds the questions whether co-occurring depression has negative effects on cognitivebehavioral therapy (CBT) outcomes in patients with panic disorder (PD) and agoraphobia (AG) and whether treatment for PD and AG (PD/AG) also reduces depressive symptomatology. Methods: Post-hoc analyses of randomized clinical trial data of 369 outpatients with primary PD/AG (DSM-IV-TR criteria) treated with a 12-session manualized CBT (n = 301) and a waitlist control group (n = 68). Patients with comorbid depression (DSM-IV-TR major depression, dysthymia, or both: 43.2% CBT, 42.7% controls) were compared to patients without depression regarding anxiety and depression outcomes (Clinical Global Impression Scale [CGI], Hamilton Anxiety Rating Scale [HAM-A], number of panic attacks, Mobility Inventory [MI], Panic and Agoraphobia Scale, Beck Depression Inventory) at post-treatment and follow-up (categorical). Further, the role of severity of depressive symptoms on anxiety/depression outcome measures was examined (dimensional). Results: Comorbid depression did not have a significant overall effect on anxiety outcomes at post-treatment and follow-up, except for slightly diminished post-treatment effect sizes for clinician-rated CGI (p = 0.03) and HAM-A (p = 0.008) when adjusting for baseline anxiety severity. In the dimensional model, higher baseline depression scores were associated with lower effect sizes at post-treatment (except for MI), but not at follow-up (except for HAM-A). Depressive symptoms improved irrespective of the presence of depression. Conclusions: Exposure-based CBT for primary PD/AG effectively reduces anxiety and depressive symptoms, irrespective of comorbid depression or depressive symptomatology.
Der vorliegende Übersichtsartikel belegt zunächst, warum das Extinktionslernen als ein zentraler Wirkmechanismus der Expositionsbehandlung angesehen wird. Nach Darstellung der lerntheoretischen Grundlagen wird ein Modell präsentiert, das die Grundlagen der Ausformung, Konsolidierung und des Abrufs des Extinktionsgedächtnisses beschreibt. Dieses Gedächtnismodell der Extinktion liefert die Basis für die Diskussion der aktuellen neurowissenschaftlichen Erkenntnisse zum Extinktionslernen. Durch diese Befunde im Tier-, aber auch im Humanbereich ist es gelungen, die neuronalen Schaltkreise der Extinktion relativ gut zu beschreiben. Der Übersichtsartikel gibt eine Zusammenfassung dieser aktuellen Befunde und geht außerdem auf einige Neurotransmittersysteme dieser Schaltkreise ein, zumindest in dem Maße, wie sie für die Befunde zur pharmakologischen Unterstützung des Extinktionslernens relevant sind. Anschließend wird ein integratives Modell vorgestellt, das den Ausgangspunkt für die Optimierung der Extinktion in der Expositionstherapie liefert. Den Abschluss bildet eine Kasuistik, in der diese Optimierungsstrategien nochmals am Beispiel der Behandlung einer Patientin mit Emetophobie für die Praxis verdeutlicht werden.
Neurobiological theories suggest that inter-individual differences in vagally mediated heart rate variability (vmHRV) have the potential to serve as a biomarker for interindividual differences in emotion regulation that are due to inter-individual differences regarding the engagement of prefrontal and (para-)limbic brain regions during emotion processing. To test these theories, we investigated whether inter-individual differences in
vmHRV would be associated with inter-individual differences in emotion regulation. We determined resting state vmHRV in a sample of 176 individuals that had also completed a short self-report measure of reappraisal and suppression use. Resting state vmHRV was derived from short-term (300 s) and ultra-short-term (120 s, 60 s) recordings of participants’ heart rate to determine the robustness of possible findings. Irrespective of recording length, we found that an increase in resting state vmHRV was associated with an increase in self-reported reappraisal but not suppression use. However, this association was only evident among male but not female participants, indicating a sex-specific association between inter-individual differences in resting state vmHRV and inter-individual differences in self-reported emotion regulation. These findings, which are consistent with previous ones, support theoretical claims that inter-individual differences in vmHRV serve as a biomarker for inter-individual differences in emotion regulation. Combing (ultra-)short-term measures of resting state vmHRV with short selfreport measures of emotion regulation may, thus, be useful for researchers who have to investigate the neurobiological mechanisms of emotion regulation in a time- and resource-efficient manner.
Despite the widespread use of oral contraceptives (OCs), remarkably little is known about the effects of OCs on emotion, cognition, and behavior. However, coincidental findings suggest that OCs impair the ability to recognize others’ emotional expressions, which may have serious consequences in interpersonal contexts. To further investigate the effects of OCs on emotion recognition, we tested whether women who were using OCs (n = 42) would be less accurate in the recognition of complex emotional expressions than women who were not using OCs (n = 53). In addition, we explored whether these differences in emotion recognition would depend on women’s menstrual cycle phase. We found that women with OC use were indeed less accurate in the recognition of complex expressions than women without OC use, in particular during the processing of expressions that were difficult to recognize. These differences in emotion recognition did not depend on women’s menstrual cycle phase. Our findings, thus, suggest that OCs impair women’s emotion recognition, which should be taken into account when informing women about the side-effects of OC use.
Two decades of research indicate that visual processing is typically enhanced for items that are in the space near the hands (near-hand space). Enhanced attention and cognitive control have been thought to be responsible for the observed effects, amongst others. As accumulating experimental evidence and recent theories of dual-tasking suggest an involvement of cognitive control and attentional processes during dual tasking, dual-task performance may be modulated in the near-hand space. Therefore, we performed a series of three experiments that aimed to test if the near-hand space affects the shift between task-component processing in two visual-manual tasks. We applied a Psychological Refractory Period Paradigm (PRP) with varying stimulus-onset asynchrony (SOA) and manipulated stimulus-hand proximity by placing hands either on the side of a computer screen (near-hand condition) or on the lap (far-hand condition). In Experiment 1, Task 1 was a number categorization task (odd vs. even) and Task 2 was a letter categorization task (vowel vs. consonant). Stimulus presentation was spatially segregated with Stimulus 1 presented on the right side of the screen, appearing first and then Stimulus 2, presented on the left side of the screen, appearing second. In Experiment 2, we replaced Task 2 with a color categorization task (orange vs. blue). In Experiment 3, Stimulus 1 and Stimulus 2 were centrally presented as a single bivalent stimulus. The classic PRP effect was shown in all three experiments, with Task 2 performance declining at short SOA while Task 1 performance being relatively unaffected by task-overlap. In none of the three experiments did stimulus-hand proximity affect the size of the PRP effect. Our results indicate that the switching operation between two tasks in the PRP paradigm is neither optimized nor disturbed by being processed in near-hand space.
Subjektives Stresserleben und dessen objektive Erfassung mittels des Antioxidativen Potentials
(2020)
Die Gefährdungsbeurteilung psychischer Belastungen ist seit der Novellierung des Arbeitsschutzgesetzes im Jahr 2013 für jeden Arbeitgeber Pflicht. Das stellt die Verantwortlichen Akteure des Arbeits- und Gesundheitsschutzes vor große Herausforderungen hinsichtlich der praktischen Umsetzung (Bamberg & Mohr, 2016), da der Gesetzgeber offengelassen hat, wie genau die Gefährdungsbeurteilung umzusetzen ist. Empfehlungen zu geeigneten Verfahren, wie sie in der DIN EN ISO 10075-3 formuliert werden, sind insofern kritisch zu bewerten, als dass von geeigneten Instrumenten neben der Erfassung der psychischen Belastung zudem die Erfassung der psychischen Beanspruchung gefordert wird. Dies kann vor allem bei schriftlichen Befragungen zu Verzerrungen führen (Podsakoff, Mackenzie, Lee & Podsakoff, 2003; Specter, 2006). Hier könnten parallel zu den Befragungsinstrumenten eingesetzte physiologische Maße Abhilfe schaffen.
Mit dieser Arbeit sollte die Eignung des Antioxidativen Potentials (AOP) als Indikator des oxidativen Stresses zur objektiven Erfassung des subjektiven Stresserlebens überprüft werden. Dazu wurden sechs Studien in unterschiedlichen Settings durchgeführt. Sie sollten die Zusammenhänge zwischen AOP, subjektivem Stresserleben und der Ernährung untersuchen. In keiner der Studien konnte das angenommene Wirkmuster vollständig bestätigt werden. Vielmehr ließen sich teils konträre Wirkrichtungen feststellen, so dass die Befundlage als inkonsistent bezeichnet werden muss. Ungeachtet methodischer Limitationen der Studien, verdeutlichen die Ergebnisse vor allem den hohen Forschungsbedarf der bezüglich der Wechselwirkungen von psychischen, physiologischen und behavioralen Prozessen in diesem Bereich noch besteht.
Zusammenfassend und basierend auf den durchgeführten Studien muss daher festgestellt werden, dass das AOP nicht als objektiver Parameter zur Erfassung des subjektiven Stresserlebens geeignet ist.
Transition wird bezeichnet als zielgerichteter, geplanter Wechsel der Kinder und Jugendlichen mit chronischen Erkrankungen von dem kindzentrierten zum erwachsenenzentrierten Gesundheitssystem (Blum et al., 1993). Transition soll ein strukturierter, gut implementierter, geplanter und absichtsvoller Prozess sein, welcher die Jugendlichen mit chronischen Erkrankungen, ihre Eltern und die involvierten Gesundheitsexpert*innen befähigt, den Wechsel von der Pädiatrie zur Erwach¬senen¬medizin erfolgreich abzuschließen (Blum et al., 1993; Huang et al., 2014; Kennedy et al., 2007).
Es ist notwendig den Prozess der Transition an die individuellen Bedürfnisse der Jugendlichen anzupassen und somit deren Unterstützung flexibler zu gestalten zu können, um dies zu erreichen, werden entsprechende Instrumente zur Erfassung von Konstrukten in der Transition benötigt. Von besonderem Interesse ist die Transitionsbereitschaft von Jugendlichen mit chronischen Erkrankungen.
Um die individuelle Bereitschaft zur Transition eines Jugendlichen mit chronischer Erkrankung feststellen zu können, fehlen zudem änderungssensitive Instrumente, die zugleich auch allgemein anwendbar sind, sodass eine Vergleichbarkeit zwischen verschiedenen Erkrankungen bzw. Versorgungsbereichen ermöglicht wird. Von diesem methodischen Defizit der Transitionsforschung ausgehend werden in der vorliegenden Arbeit folgende Konstrukte sowie deren Operationalisierung und Erfassung im Kontext der Transition psychometrisch genauer analysiert: gesundheitsbezogene und krankheitsspezifische Lebensqualität, Versorgungszufriedenheit, Transitionskompetenz, Patientenaktivierung und Patienten-empowerment.
Zusammenfassend zeigt sich, dass die Konstrukte krankheitsspezifische Lebens-qualität, Versorgungszufriedenheit, Transitionskompetenz, Patientenaktivierung und Patienten¬empowerment zur Erfassung von transitionsbezogenen Veränderungen bei Jugendlichen mit chronischen Erkrankungen geeignet sind. Lediglich die Erfassung die gesundheitsbezogene Lebensqualität sollte für zukünftige Studien geprüft werden.
Brain aging even in healthy older adults is characterized by a decline in cognitive functions including memory, learning and attention. Among others, memory is one of the major cognitive functions affected by aging. Understanding the mechanisms underlying age-related memory decline may help pave the road for novel treatment strategies. Here, we tried to elucidate the neural correlates associated with memory decline using structural and functional neuroimaging and neuromodulation with transcranial direct current stimulation (tDCS).
Over the course of three studies, we investigated 1) the influence of white matter integrity and grey matter volume on memory performance in healthy older adults, 2) the role of functional coupling within the memory network in predicting memory performance and the impact of tDCS in modulating retrieval performance in healthy older adults, 3) the effect of tDCS over the sensorimotor cortex on cognitive performance in young adults.
MRI was used to study associations of cognitive performance with white matter integrity and grey matter volume, and examine their causal relationship in the course of aging. White matter integrity was assessed by acquiring diffusion tensor imaging (DTI) and performing deterministic tractography based on constrained spherical deconvolution. Grey matter volume was estimated using fully automated segmentation. Both white matter integrity and grey matter volume were correlated with behavioral data of a verbal episodic memory task. Percentage of correct answers at retrieval was used to measure memory performance (Manuscript 1). In addition, anodal tDCS (atDCS) (1 mA, 20 min) was applied over CP5 (left temporoparietal cortex) to modulate memory formation in healthy older adults. Participants underwent resting-state fMRI before the stimulation. Functional connectivity analysis was performed to determine whether functional coupling within the memory network predicted initial memory performance, and to examine its association to tDCS-induced enhancement effect (Manuscript 2). Finally, atDCS (1 mA, 20 min) was applied over C3 (left sensorimotor cortex) to explore the effect of tDCS over the sensorimotor cortex on cognitive performance in young adults. During the stimulation, participants performed three tasks; gestural task, attentional load task and simple reaction time task (Manuscript 3).
Results showed that volumes of the left dentate gyrus (DG) and tractography-based fractional anisotropy (FA) of individual fornix pathways were positively related to memory retrieval in older adults. Brain-behavior associations were observed for correct rejections rather than hits of memory performance, indicating specificity of memory network functioning for detecting false associations. Thus, the data suggested a particular role of neural integrity that promotes successful memory retrieval in older adults. Subsequent mediation analysis showed that left DG volume mediated the effect of fornix FA on memory performance (48%), corrected for age, revealing a crucial role of hippocampal pathway microstructure in modulating memory performance in older adults (Manuscript 1). tDCS results showed that atDCS led to better retrieval performance and increasing learning curves, indicating that brain stimulation can induce plasticity of episodic memory processes in older adults. Combining tDCS and fMRI, hippocampo-temporoparietal functional connectivity was positively associated with initial memory performance in healthy older adults and was positively correlated with the magnitude of individual tDCS-induced enhancement, suggesting that individual tDCS responsiveness may be determined by intrinsic network coupling (Manuscript 2). Finally, our findings suggested that atDCS over left sensorimotor cortex reduced reaction times in the gestural-verbal integration task, specifically for incongruent pairs of gestures and verbal expressions, indicating the role of sensorimotor cortex in gestural-verbal integration in young adults (Manuscript 3).
The results of all three studies may help to elucidate age-related structural deterioration and functional coupling network underlying cognitive processes in healthy adults. Furthermore, these studies emphasized the importance of interventions like tDCS in modulating cognitive performance, specifically episodic verbal memory and gestural-verbal integration. By unveiling the specific role of brain structures and functional network coupling as well as the role of tDCS in modulating cognitive performance, our results contribute to a better understanding of brain-behavior associations, and may help to develop clinical interventional approaches, tailored for specific cognitive functions in aging.
Die vorliegende qualitativ-hermeneutische Dissertation untersucht auf der Basis von 20 Interviews die Motivation von Patientinnen der Plastischen Alterschirurgie, die einen größeren Eingriff (Facelift) anvisieren oder bereits haben vornehmen lassen. Sie kommt zu dem Ergebnis, dass das bisher gängige Prozedere die psychologischen Risiken und Nebenwirkungen einer solchen Operation vernachlässigt. Nach Sichtung der bewussten Beweggründe der Patientinnen und des sozialen Kontextes ihrer Entscheidung für eine OP beleuchtet die Arbeit komplexe Fragen des persönlichen Selbst- und Weltbilds, der Emotionalität und neurotischer Fixierungen. Das häufige Vorliegen von maladaptivem Coping, narzisstischem Selbstwertmanagement, niedriger sozioemotionaler Kompetenz, fehlender Sinnressourcen, wie auch der Neigung zum Selbstbetrug wirft ein problematisches Licht auf die Indikation. Unter Abwägung der Chancen und Risiken einer OP aus psychotherapeutischer Sicht erscheint es zweifelhaft, ob ein verjüngender Eingriff die Probleme der Patientinnen beheben kann, ob er unter ungünstigen Umständen nicht sogar mehr schadet als nützt. Dieses grundsätzliche psychologische Dilemma könnte berücksichtigt und minimiert werden durch ein verbindliches psychologisches Beratungs- und Aufklärungsgespräch im Vorfeld der Operation. So schließt die Arbeit mit dem Vorschlag eines kombinierten chirurgisch-psychologischen Vorgehens zur ganzheitlich konzipierten Therapie der Altersängste der Patientinnen, eine Neuerung, die sowohl im Dienst der Patienten wie auch im Dienst des behandelnden Chirurgen stünde.
Das Ziel der vorliegenden Studie bestand darin, einen möglichen Einfluss des Darbietungsmodus auf die Leistung von Vorschulkindern in einer Aufgabe zur Theory of Mind (ToM) zu überprüfen. Dazu wurden die Leistungen von 94 Kindern zwischen 3 und 5 Jahren in einer klassischen Ortsverlagerungsaufgabe zum Verständnis falscher Überzeugungen (Wimmer & Perner, 1983) untersucht. Den Kindern wurde die Originalgeschichte entweder live oder als Videofilm präsentiert. Erstmalig konnte ein signifikanter Effekt des Darbietungsmodus in einer Aufgabe zur ToM nachgewiesen werden. Dieser ergab sich in der Altersgruppe der 4-Jährigen. Unabhängig vom Darbietungsmodus antworteten 3-Jährige überzufällig falsch und 5-Jährige überzufällig korrekt. Der nachgewiesene Effekt des Darbietungsmodus wird auf dem Hintergrund bereits bestehender Theorien zum so genannten Videodefiziteffekt (VDE) diskutiert.
Psychological health is a result of the effective interplay between explicit and implicit attempts to regulate ones’ emotions (Koole & Rothermund, 2011). Emotion regulation refers to processes that influence the intensity, the duration and the type of emotion experienced (Gross & Thompson, 2007). While explicit emotion regulation comprises effortful mental processes, implicit emotion regulation refers to processes that require no monitoring and terminate automatically (Gyurak, Gross, & Etkin, 2011).
In the present thesis, explicit and implicit strategies to regulate emotions were investigated. In Study 1, a well-established paradigm (Gross & Levenson, 1993) was adapted to examine the up- and down-regulation of positive and negative emotions using two different explicit emotion regulation strategies. To infer on the neurobiological correlates, blood oxygen level dependent (BOLD) brain activity was recorded using functional magnetic resonance tomography. Furthermore, as a trait marker for the individual ability to regulate emotions, heart rate variability (HRV) was acquired during rest. In Study 2, implicit emotion regulation was examined. Therefore, a well-established fear extinction paradigm was compared to a novel approach based on the integration of new information during reconsolidation (Schiller et al., 2010). Autonomic arousal was measured via the skin conductance response during fear acquisition, fear extinction and after fear reinstatement. In Study 3, two dysfunctional emotion regulation strategies —worrying and rumination— were investigated. Excessive worrying and rumination are pathogenic characteristics of psychological disorders. Behavioral, autonomic and BOLD activity was recorded during worried and ruminative thinking as well as during neutral thinking.
The results showed that explicit emotion regulation was associated with modulated BOLD activity in the amygdala according to the regulation direction independent of the applied strategy and the valence of the emotion. In addition, increased dorsolateral prefrontal cortex (dlPFC) activity was observed during regulation compared to passively viewing emotional pictures. The findings are in line with previous research (Eippert etal., 2007; Kim &Hamann, 2007; Ochsner etal., 2004) and support the key role of the dlPFC during the explicit regulation of emotions. Similarly, implicit emotion regulation was associated with a decreased autonomic fear response, which was sustained after fear extinction during reconsolidation. The findings underscore the notion, that this novel technique might alter the initial fear memory resulting in a permanently diminished fear response (Nader, Schafe, & LeDoux, 2000; Schiller et al., 2010). Dysfunctional emotion regulation was associated with increased autonomic activity and fear potentiated startle (during worry) as well as increased BOLD activity in the insula (during worry and rumination) and increased BOLD activity in the amygdala (during rumination). In addition, neural activity in brain areas associated with the default mode network was observed. These findings stress the preserved negative emotional activity and the self-referential nature of the examined dysfunctional strategies. The results of all three studies are integrated into a neuro-biological model of emotion regulation focusing on the interplay between subcortical and prefrontal brain areas.
The fear of somatic sensations is highly relevant in the etiology and maintenance of various disorders. Nevertheless, little is known about this fear of body symptoms and many questions are yet unanswered. Especially physiological studies on interoceptive threat are rare. Therefore, the present thesis investigated defensive mobilization, autonomic arousal, and brain activation during the anticipation of, exposure to, and recovery from unpleasant body sensations. Symptoms were provoked using a standardized hyperventilation procedure in a sample of high (and as controls: low) anxiety sensitive individuals - a population high at risk for developing a panic disorder and high in fear of internal body symptoms.
In study one, anxious apprehension was investigated during anticipation of interoceptive threat (somatic sensations evoked by hyperventilation) and exteroceptive threat (electric shock). Symptom reports, autonomic arousal, and defensive mobilization assessed by the startle eyeblink response were analyzed. Extending the knowledge on anticipation of interoceptive threat, study two investigated the neural networks activated during anxious apprehension of unpleasant body sensations. Symptom reports and startle response data were collected during a learning session after which participants high and low in fear of somatic symptoms attended a fMRI session anticipating threat (hyperventilation – learned to provoke unpleasant symptoms) or safety (normal breathing). Study three examined the actual exposure to internal body symptoms, investigating symptoms reports, autonomic arousal, and the startle eyeblink response during guided breathing (hyperventilation and, as a non-provocative comparison condition, normoventilation) and during recovery. And finally, study four addressed changes in the defensive mobilization during repeated interoceptive exposure via a hyperventilation procedure. High and low anxiety sensitive persons went through two guided hyperventilation and normoventilation procedures that were spaced one week apart while symptom reports, breathing parameters, and startle response magnitudes were measured.
In study one it was demonstrated that the anticipation of exteroceptive threat led to a defensive and autonomic mobilization in high and low anxiety sensitive individuals, while during interoceptive threat only high anxiety sensitive participants were characterized by a potentiated startle response and autonomic activation. Imaging data of study two revealed that 1) during anticipation of hyperventilation all participants were characterized by an increased activation of a fear network consisting of anterior insula/ orbitofrontal cortex and rostral parts of the dorsal anterior cingulate cortex/ dorsomedial prefrontal cortex, 2) high fear individuals showed higher anxious apprehension than low fear controls during the entire context (safe and threat conditions), indexed by an overall stronger activation of the described network, and 3) while low fear controls learned that (undisclosed to all participants) in the fMRI scanner the threat cue was not followed by an unpleasant hyperventilation task, high fear participants continued to show stronger fear network activation to this cue. In study three it was demonstrated, that the hyperventilation procedure led to a marked increase in somatic symptoms and to autonomic arousal. While high and low anxiety sensitive groups did not differ during hyperventilation, in the early recovery only high anxiety sensitive individuals showed defensive mobilization, indicated by potentiated startle response magnitudes, and increased autonomic arousal after hyperventilation as compared to after normoventilation. Substantiating these findings, in study four all participants reported more symptoms during hyperventilation than during normoventilation, in both sessions. Nevertheless, only high anxiety sensitive participants displayed a potentiation of startle response magnitudes after the first hyper- vs. normoventilation. One week later, when the exercise was repeated this potentiation was no longer present and thus both groups no longer differed in their defensive mobilization. Even more, the number of reported baseline symptoms decreased from session one to session two in the high-AS group. While high anxiety sensitive persons reported increased baseline anxiety symptoms in session one, groups did not anymore differ in session two.
These data indicate that the standardized hyperventilation procedure is a valid paradigm to induce somatic symptoms. Moreover, it induces anxious apprehension especially in persons highly fearful of internal body symptoms. The repetition of interoceptive exposure, however, reduces associated fear in highly fearful individuals. Thus, this paradigm might provide an innovative method to study anxious apprehension and also treatment effects in patients with panic disorder. The present findings are integrated and discussed in the light of the current literature.
Welche Rolle Emotionen in unserem Leben spielen, kann nicht überschätzt werden. Um Emotionen als Teil unserer Persönlichkeit zu beschreiben, muss auch in Betracht gezogen werden, wie wir unsere Emotionen regulieren. Mit dem Ziel Emotionen zu beeinflussen, bedienen wir uns verschiedener Emotionsregulationsstrategien. Die Emotionsregulationsstrategie Reappraisal beinhaltet die (Re-)Konstruktion einer potenziell emotionsauslösenden Situation, die deren emotionale Auswirkungen verändert. Basierend auf Mischels Konzept der „construction competencies“ wurde der Reappraisal Inventiveness Test entwickelt (RIT, Weber, Loureiro de Assunção, Martin, Westmeyer, & Geisler, 2014). Der Test misst die Fähigkeit, möglichst viele verschiedene kognitive Umbewertungen für ärgerauslösende Situationen zu generieren. Bisherige Ergebnisse zur Validierung des RIT zeigen Zusammenhänge mit Offenheit für Erfahrung (NEO-FFI, Borkenau & Ostendorf, 2008) sowie Maßen für Einfallsreichtum (BIS, Jäger, Süß, & Beauducel, 1997). Ergebnisse zur diskriminanten Validität konnten in Hinblick auf Fragebogen zur habituellen Emotionsregulation (CERQ; Garnefski, Kraaij, & Spinhoven, 2001; ERQ, Abler & Kessler, 2009) mehrfach repliziert werden. Ziel der vorliegenden Arbeit ist, die psychometrische Überprüfung des RIT voranzutreiben sowie das Verfahren weiterzuentwickeln. Zu diesem Zweck wurden vier korrelative Studien durchgeführt. Aus den Befunden der Studien 1a und 1b kann auf geringe Zusammenhänge von Reappraisal Inventiveness mit ausgewählten exekutiven Funktionen, z.B. verbale Flüssigkeit, geschlossen werden. In Studie 2 wurde der RITÄrger für die Emotion Angst weiterentwickelt um zu prüfen, ob Reappraisal Inventiveness eine emotionsspezifische oder –unspezifische Fähigkeit ist. Ein eindimensionales Modell bewährte sich gegenüber einem zweidimensionalen Modell – demnach kann Reappraisal Inventiveness als eine emotionsübergreifende Fähigkeit mit emotionsspezifischen Ausprägungen verstanden werden. Im Rahmen der dritten Studie wurde der RITÄrger um ein Maß für die Motivation, Reappraisal Inventiveness zu nutzen, erweitert. Somit konnte der angenommene aber bisher fehlende Zusammenhang von Reappraisal Inventiveness und Neurotizismus als Indikator für emotionale Stabilität gezeigt werden. Zukünftige Studien sollten sich vor allem auf die praktische Anwendungsmöglichkeiten des RIT konzentrieren.
Body sensations play a crucial role in the etiology and maintenance of diverse anxiety and health problems (e.g., in panic disorder or respiratory diseases) as they may be perceived as threatening and consequently elicit anxious responses. The factors that may affect the perception of bodily sensations as a threat and thus modulate the anxious response to body sensations have so far rarely been studied. Therefore, the present thesis targeted at elucidating the effect of contextual (i.e., the predictability, expectation, and proximity of a threat) and dispositional factors (i.e., tendency to fear arousal sensations or trait fear of suffocation) on the defensive response to body sensations.
In study 1, it was investigated how a personality factor, that is, fear of suffocation, affects the acquisition of fear to body sensations (i.e., mild dyspnea induced by inspiratory resistive loads) and contexts when faced with a predictable and unpredictable respiratory threat (i.e., severe dyspnea). Study 2 aimed at examining the main and interactive effects of the tendency to fear arousal sensations, again a personality trait factor, and current arousal expectations as varied by situational variables on anxious responding to arousal sensations. In this study, expected and unexpected arousal sensations were induced by administering caffeine in coffee or bitter lemon soda, respectively. Moreover, in study 3, it was explored how subjective anxiety, bodily symptoms, and defensive respiratory responses change and might culminate into active defense behavior (i.e., escape/active avoidance) during increasing dyspnea that was evoked by inspiratory resistive loads increasing in intensity. For a detailed analysis of the factors that contribute to the initiation and maintenance of avoidance of or escape from increasing dyspnea, in study 4 changes in subjective, autonomic, somatic reflex and brain responses were analyzed during repeated avoidance of increasing dyspnea.
In study 1, it was demonstrated that only individuals who fear suffocation learned to fear mild dyspnea preceding the onset of severe dyspnea and developed anxiety during a context of unpredictable respiratory threat. Moreover, the data from study 2 indicate that individuals who fear arousal sensations show an increased attention allocation towards unexpected arousal sensations and higher threat appraisal when expecting arousal sensations. Increasing intensity of dyspnea as provoked in study 3 led to increased defensive respiratory responses that were associated with increased symptom reports in individuals with high compared to low fear of suffocation. Moreover, culminating dyspnea elicited repeated avoidance behavior preceded by increases in defensive respiratory mobilization. The analysis of repeated avoidance of increasing dyspnea in study 4 revealed that physiological fear responses might be involved in the initial initiation of this avoidance behavior while no indication of response preparation and physiological arousal was related to persistent avoidance.
Taken together, the present data suggest that the fear of suffocation, as well as the tendency to fear arousal sensations along with the predictability, expectation, or proximity of interoceptive threat, may increase the perceived threat and thus the anxious response to body sensations. Therefore, contextual and dispositional factors may set the stage for the culmination of body sensations into defensive action and might contribute to the development of pathological anxiety and fear of body sensations. The present findings are integrated into the current literature and discussed in relation to the development and maintenance of pathological anxiety and fear of body sensations.
Interoceptive sensations, that means, perceptions of the physiological body state, play an important role in the generation and expression of emotion. The focus of the research presented here is on respiratory sensations as specific interoceptive signals. Such respiratory sensations (like the feeling of dyspnea) play an important role in symptom perception in somatic (e.g., asthma) as well as in mental disorders (e.g., anxiety disorders). There are several different ways to manipulate respiratory sensations in an experimental environment, but many of them did not equal sensations in daily life. Here, stimuli (inspiratory resistive loads, caffeine) were used that trigger nearly naturally occurring interoceptive sensations. Taking into account that the elicited interoceptive experience also induces an unpleasant feeling state it is most likely that individuals show defensive physiological responding to such cues and try to avoid them. According to a bidirectional motivational system defensive behaviors are regulated by a defensive motivational system that is activated by threatening cues. From research with exteroceptive stimuli it is known that defensive responding is typically characterized by heightened autonomic arousal, increased respiration, and a potentiated startle eyeblink response. In contrast, only a few studies using interoceptive stimuli have incorporated the measurement of physiological data in their experimental designs. If included, studies show also heightened autonomic responding, whilst a heterogeneous respiratory as well as startle eyeblink responding is observed. Thus, the studies presented here were designed to clarify the factors that mediate defensive responding to interoceptive sensations. Study 1 investigated the influence of anxiety on the subjective, respiratory, and autonomic response to an individually determined inspiratory resistive load, while study 2 focuses on the effect of attentional modulation of the startle eyeblink response to a mild respiratory threat. In study 3 the modulation of subjective, respiratory and autonomic reactions by arousal expectations was examined. Therefore, caffeine, a respiratory stimulant, or a placebo were administered without the participants’ knowledge. The fourth study examined the influence of the process of worrying, a strategy to deal with unpleasant body symptoms, on defensive responding. Depending on the study design subjective, respiratory and autonomic (skin conductance level, heart rate) parameters were assessed as marker for defensive mobilization. In study 2 and 4 the startle eyeblink response was measured as further index of defensive activation. Besides that in study 2 also the P3 component of the event-related potential, as an index for attentional allocation, was recorded. The main findings of the presented dissertation are the following: Study 1 revealed that 1) only high anxiety sensitive individuals reporting also high suffocation fear respond to lower stimulus intensities with stronger defensive responding, and 2) that this group demonstrated a maladaptive compensatory breathing pattern. Additionally, study 2 exhibited that 1) the startle eyeblink response is relatively inhibited during a mild interoceptive threat, and 2) this inhibition corresponds to an attention allocation towards breathing as indicated by a reduced P3 amplitude to the startle noise as well as subjective report. Furthermore, highly anxiety sensitive individuals showed a more pronounced defensive responding if the interoceptive sensations were unexpected (study 3). Recently, study 4 demonstrated that worry led to an increased defensive response mobilization. All studies are discussed in the context of the theoretical background of the defensive response modulation to exteroceptive and interoceptive sensations with respect to mediating factors. Showing exaggerated defensive responding and maladaptive adaptation processes in high anxious individuals the results point towards the important role of interoceptive sensations in the etiology, maintenance and therapy of mental disorders, especially the anxiety disorders.
Aufgrund des Fortschritts in der Entwicklung von innovativen medizinisch-diagnostischen Technologien wie z. B. lab-on-a-chip Systemen, steht der Allgemeinbevölkerung eine Vielzahl an Selbsttests rezeptfrei und frei verkäuflich insbesondere über das Internet beziehbar zur Verfügung. Selbsttests werden definiert als Tests von Körperproben (z. B. Blut, Urin, Stuhl, Speichel), die auf die eigene Initiative des Konsumenten und ohne die Anwesenheit von medizinischem Personal zur Untersuchung von Erkrankungen bzw. Erkrankungsrisiken durchgeführt werden können. Das Ziel dieser Arbeit war es die psychologischen, situativen und anwendungsbezogenen Prädiktoren der Nutzung von medizinisch-diagnostischen Selbsttests zu untersuchen. Es wurden vier Studien durchgeführt, die auf den folgenden drei Erhebungen basierten: (1) einer Repräsentativerhebung von 2.527 Personen in Deutschland, (2) einem faktoriellen Survey mit 1248 Vignetten, die durch 208 Studenten beantwortet wurden sowie (3) einer On-line-Befragung von 505 Selbsttestern und 512 Nicht-Selbstestern, die repräsentativ im Hinblick auf die Verteilung von Alter und Geschlecht zur Teilnahme an der Studie einge-laden wurden. Die Ergebnisse zeigten, dass die Nutzung von Selbsttests durch die traditionellen gesundheitspsychologischen Prädiktoren, d.h. Selbstwirksamkeit, wahrgenommene Vulnerabilität, wahrgenommener Schweregrad und Handlungs-Ergebnis-Erwartung, vorhergesagt werden konnte. Nichtsdestotrotz war jedoch eine Adaptation der allgemeinen Konstrukte (z.B. allgemeine Selbstwirksamkeit) an die Situation „Selbsttestung“ notwendig, um die Vorhersagekraft zu verbessern (z.B. selbsttestbezogene Selbstwirksamkeit). Die klassischen Gesundheitsmodelle werden traditionell genutzt, um Gesundheit zu verbessern (z.B. Steigerung der sportlichen Tätigkeit), Krankheiten vorzubeugen (z.B. durch die Einschränkung von Alkohol- und Rauchverhalten) oder Krankheiten zu begrenzen (z.B. Gesundheitsscreenings, Selbstabtastung) und Gesundheit wieder aufzubauen (z.B. Verbesserung der Ernährung). Durch die Aufnahme von (a) Technikaffinität und (b) antizipiertem Affekt bzgl. der Anwendung eines Selbsttests konnte die Vorhersage der Nutzung eines Selbsttests verbessert werden. Darüber hinaus wurde eine Vielfalt an unterschiedlichen persönlichen Gründen für die Nutzung eines Selbsttests genannt. Die häufigsten Gründe waren zur Beruhigung bzw. Bestätigung bei Unsicherheit und Zweifel sowie eine höhere wahrgenommene Vulnerabilität für eine Krankheit. Der Hauptgrund für die Selbsttestung hing insbesondere von der Indikation ab, die untersucht wurde. Schließlich wurden als Grund für die Bevorzugung eines Selbsttests gegenüber der konventionellen Untersuchung bei einem Arzt vor allem praktische Gründe der Anwendung von Selbsttests genannt (z.B. schneller Erhalt der Testergebnisse, Vermeidung von Wartezeiten für Arzttermine). Die persönlichen Gründe für die Selbsttestung könnten die unterschiedlichen Häufigkeiten für die Nutzung von Selbsttests in Deutschland (8,5%) im Vergleich zu den Niederlanden (16%) und dem Vereinigten Königreich (13%) erklären. Beispielsweise wurden in den Niederlanden Präventionskampagnen (z.B. von der Kidney Association oder Municipal Health) durchgeführt, in denen die Nutzung von Selbsttests für die Untersuchung einer Nierenerkrankung und Chlamydien empfohlen und Tests kostenfrei an Laien versendet wurden. Demgegenüber wurden in Deutschland bislang noch keine solchen Kampagnen durchgeführt. Nichtsdestotrotz könnte der Bedarf an und die tatsächliche Nutzung von Selbsttests auch in Deutschland steigen, da die Verfügbarkeit von Selbsttests auf deutschsprachigen Internetseiten steigt und es einen Fachärztemangel insbesondere in ländlichen Gebieten gibt. Darüber hinaus spiegelt sich die große praktische und soziopolitische Relevanz des Themas “Selbsttestung” etwa auch in aktuellen Studien zur selbstständigen Behandlung von Krankheiten mit nicht verschreibungspflichtigen Medikamenten (sog. „Selbstmedikation“) wieder. Aus diesem Grund sollte in zukünftigen Studien das Verhalten sowie das emotionale Befinden der Tester nach Erhalt ihrer Testergebnisse genau exploriert werden. Schließlich gaben die Anwender von Selbsttests an, diese insbesondere genutzt zu haben, um sich selbst bzgl. ihres allgemeinen Gesundheitszustandes zu beruhigen. Da vergangene Studien jedoch bereits aufgezeigt haben, dass Informationen zur Sensitivität und Spezifität nur begrenzt in den Anwendungsbeschreibungen von Selbsttests zu finden sind, sollte die Allgemeinbevölkerung im Hinblick auf potentiell falsch-positive und falsch-negative Testergebnisse sowie weitere Handlungsmöglichkeiten besser aufgeklärt werden, um die Anwender nicht in falscher Gewissheit zu belassen.
Theoretischer Hintergrund Panikattacken (PA) sind ein in der Bevölkerung häufig auftretendes Phänomen, wie repräsentative epidemiologische Studien zeigen: Bis zu 20% der Personen erleben mindestens einmal im Leben einen Angstanfall oder eine Panikattacke; davon erfüllen aber nicht alle die geforderten Symptomkriterien einer klinisch relevanten »vollständigen Panikattacke«. Ein Teil der betroffenen Personen (ca. 2 – 4 %) erlebt weitere Panikattacken und erfüllt zudem die weiteren Diagnosekriterien einer Panikstörung. Lerntheoretische Modelle sehen eine besonders intensive, sogenannte initiale Panikattacke (iPA) als entscheidendes konditionierendes Ereignis für die Entwicklung einer Panikstörung. Dabei wird angenommen, dass neben der symptomatischen Schwere der Panikattacke weitere Faktoren die Krankheitsentwicklung beeinflussen. Relevant scheinen in dem vermuteten multifaktoriellen ätiologischen Geschehen u. a. sowohl Belastungen durch kritische Lebensereignisse als auch in zeitlicher Nähe zur iPA vorliegende psychische Erkrankungen zu sein. Eine weitere wichtige Rolle scheinen Charakteristika der iPA selbst sowie die Verarbeitung der Attacke und die Reaktion auf sie zu spielen. Die vorliegende Arbeit dient der vergleichenden Untersuchung initialer Panikattacken in einer bevölkerungsbasierten und in einer klinischen Stichprobe. Sie zielt auf die Identifizierung und Differenzierung möglicher, die Entwicklung einer Panikstörung begleitender Faktoren ab. Methode Die vorliegende Untersuchung basiert auf zwei Stichproben. Befragungsdaten der Study of Health in Pomerania – Life-Events and Gene-Environment Interaction in Depression (SHIPLEGENDE) bilden die Grundlage der bevölkerungsbasierten Stichprobe (N = 2400). Die Daten der klinischen Stichprobe (N = 234) wurden einerseits der Studie Mechanism of Action in CBT (MAC) entnommen; andererseits stammen sie von Patienten des ZPP des Instituts für Psychologie an der Universität Greifswald. Für die Untersuchung wurden übereinstimmende Erhebungsinstrumente und Auswertungsmethoden verwendet. Die iPA wurde mit dem neu entwickelten Interview zur Erfassung der initialen Panikattacke (iPA-Interview) erhoben. Psychische Störungen wurden strukturiert mittels der computergestützten Version des Münchener Composite International Diagnostic Interview (M-CIDI) erfasst. Die Stralsunder Ereignisliste (SEL) diente zur strukturierten Erhebung kritischer Lebensereignisse. Ergebnisse Rund 16 % der Befragten gaben an, mindestens einmal im Leben anfallartige Ängste erlebt zu haben. Knapp die Hälfte dieser Personen (7.6% aller Befragten) erlebte vollständige PA. Von diesen erfüllten ca. 46% die Kriterien einer Panikstörung (PD), ca. 18.4% im Zusammenhang mit einer komorbiden Agoraphobie. Initiale Panikattacken am Beginn einer Panikstörung waren nicht nur symptomatisch schwerer, sondern auch häufiger von einem Gefühl der Hilflosigkeit und Todesangst begleitet – insbesondere, wenn sie außerhalb des eigenen Zuhauses au traten. Sie verunsicherten anhaltend, initiierten als Bewältigungsversuche Selbstbeobachtung, häufige Arztbesuche und – sofern eine komorbide Agoraphobie vorlag – die Vermeidung von Situationen. Bereits im Vorfeld, aber auch nach der iPA, zeigte sich in beiden Stichproben eine erhöhte Komorbiditätsrate – vor allem bei Personen, die die Kriterien von PD und Agoraphobie erfüllten. Kritische Lebensereignisse traten häufiger im Vorfeld der Entwicklung von PD auf. Anhaltend belastende Lebensbedingungen schienen die Entwicklung einer komorbiden Agoraphobie zu begünstigen. Schlussfolgerungen Auf der Basis der vergleichenden Untersuchung einer bevölkerungsbasierten und einer klinischen Stichprobe unter Verwendung einer übereinstimmenden Methodik konnte bestätigt werden, dass initiale Panikattacken ausschlaggebende Ereignisse in der Entwicklung von PD darstellen, was im Einklang mit lerntheoretischen Modellen der PD steht. Zudem konnte gezeigt werden, dass nicht nur die iPA an sich, sondern auch Faktoren im zeitlichen Umfeld der iPA Einfluss auf die Krankheitsentwicklung haben können. Die erhöhte Komorbiditätsrate bei Vorliegen sowohl isolierter PA als auch PD zeigt, dass Panik häufig im Umfeld weiterer psychischer Auffälligkeiten auftritt. Diese Erkenntnis sowie der Befund, dass besonders anhaltende Belastungen schweren Formen der Panik vorausgehen, könnte als Ansatzpunkt zur Prävention und (Früh-)Intervention genutzt werden. Die Befunde dieser Untersuchung dürfen aufgrund der Erhebung im Querschnitt nicht kausal interpretiert werden und müssen noch durch eine Erhebung im Längsschnitt bestätigt werden. Dennoch sprechen die Ergebnisse dieser Arbeit für ein multifaktorielles Bedingungsgefüge der Ätiologie der Panikstörung.