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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.
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.
There is multiple evidence that emotionally arousing events are preferentially processed, and better remembered than neutral events. In the present dissertation I investigated whether those strong emotional memories are affected by acute and chronic stress. Moreover, I was interested in whether already established emotional memories can be changed by behavioral intervention. According to the modulation hypothesis, emotionally arousing events promote attention and memory processes via noradrenergic and glucocorticoid actions. Recent models suggest that stress hormones differentially impact mnemonic processing, namely encoding, (re-) consolidation and memory retrieval, depending on timing and duration of the stressor relative to the learning experience. Acute stress around the time of encoding has been found to enhance memory, whereas chronic stress has been associated with memory impairments. Furthermore, consolidated memories are not resistant to modifications. Following reactivation, memories can turn into an unstable state and undergo a process called reconsolidated in order to persist. During this vulnerable state, memories are prone to modification, for instance by pharmacological blockade or interference learning. Here, the modulation of newly formed emotional and neutral memories as well as existing emotional and neutral memories was investigated in a well-established picture viewing and recognition memory paradigm using behavioral and neurophysiological measures (event-related potential, ERPs). More elaborative processing of emotional, relative to neutral stimuli has been related to the late positive potential (LPP). During encoding of emotional and neutral pictures, enhanced LPPs (starting at about 400 ms after stimulus onset) are usually observed for emotionally arousing relative to neutral pictures, indicating preferential attention allocation and processing. During recognition, correctly recognized old items evoke larger ERP amplitudes than correctly identified new items. This difference, the ERP old/new effect, was used to measure mnemonic processing during retrieval. The ERP old/new effect over centro-parietal sensor sites (400-800 ms) has been associated with recollection processes, and is enhanced for emotional, compared to neutral materials. Three studies are presented, that investigated 1) the influence of acute stress prior to encoding on long-term memory and its neural correlates, 2) the impact of chronic stress on encoding and memory, and 3) the influence of interference on already established memories (reconsolidation), always contrasting emotionally arousing and neutral scenes. Study 1 investigated subsequent recognition memory after encoding following acute stress using a socially evaluated cold pressure test, while study 2 tested the influence of chronic stress investigating breast cancer survivors about two years after cancer treatment. In study 3, one day after encoding, reconsolidation of the reactivated picture memory was targeted with an interfering learning task. In all three studies, recognition memory was tested one week later. High-density electroencephalograms (EEGs; 257 electrodes) were recorded to measure brain potentials. The results showed, in line with previous research, that emotionally arousing scenes were preferentially processed, as indicated by larger LPPs, and were better remembered than neutral scenes, as indicated by enhanced memory performance and larger ERP old/new differences. Experiencing acute stress prior to encoding enhanced the centro-parietal ERP old/new effect for emotionally arousing pictures at recognition, corroborating that acute stress facilitates memory for emotional scenes (Study 1). In contrast, attenuated LPPs for unpleasant pictures and impaired memory performance for arousing pictures were observed in breast cancer survivors (Study 2), indicating altered attention to emotion and subsequent emotional memory storage in chronically stressed individuals. When memory reactivation was followed by an interfering learning task, recognition memory and ERP old/new differences were attenuated for emotionally arousing scenes, selectively, showing the possibility that emotional memories might be modulated by behavioral interventions (Study 3). The results of all three studies are discussed and integrated into a model of memory modulation by stress and interference. The results highlight the importance of understanding the role of emotional arousal in the processes of memory formation, retrieval and reconsolidation. Moreover, shedding light on the differential effects of acute and chronic stress, interference and their possible interactions might help to prevent and even modify impairing memories that are one of the major concerns in stress- and fear-related mental disorders.
Quality of Life in Young Adults With Cerebral Palsy: A Longitudinal Analysis of the SPARCLE Study
(2021)
Introduction: While most people with cerebral palsy (CP) will have a life expectancy similar to that of the general population, international research has primarily focused on childhood and adolescence; and knowledge about the quality of life (QoL) of young adults with CP, its trajectories, and associated factors remains scarce.
Methods: This longitudinal study included young adults with CP living in five European regions and who had previously participated in the SPARCLE cohort as children and/or adolescents. Their QoL in the psychological well-being and social relationships domains was estimated using age-appropriate validated instruments (KIDSCREEN-52 in childhood/adolescence and WHOQOL-Bref in young adulthood). We used generalized linear mixed-effect models with random intercept to estimate long-term trajectories of QoL in both domains and to investigate whether severity of impairment, pain, and seizure influenced these trajectories. We sought to identify potentially different trajectories of QoL from childhood to adulthood using a shape-based clustering method.
Results: In total, 164 young adults with CP aged 22–27 years participated in the study. Psychological well-being linearly decreased by 0.78 points (scale 0–100) per year (95% confidence interval (CI) −0.99 to −0.56) from childhood to young adulthood, whereas QoL in the social relationships domain increased (β coefficient 1.24, 95% CI 0.92–1.55). Severity of impairment was associated with reduced QoL in all life periods of the study (childhood, adolescence, and young adulthood): motor impairment with social relationships, and more nuancedly intellectual disability with psychological well-being and social relationships. At all periods, frequent pain significantly reduced psychological well-being, and seizures were associated with lower QoL in the social relationships domain. In both domains, we identified a group of individuals with CP who presented a reverse trajectory compared with the general QoL trajectory.
Conclusion: Identification of QoL trajectories and their associated factors yields improved knowledge about the experience of individuals with CP until young adulthood. Further studies are needed to better understand the determinants that have the greatest influence on the different shapes of long-term trajectories of QoL.
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.
Purpose
The continuum of mental health/illness has been subject to scientific debate for decades. While current research indicates that continuum belief interventions can reduce mental health stigma and improve treatment seeking in affected populations, no study has yet systematically examined measures of continuum beliefs.
Methods
This preregistered systematic review summarizes measures of continuum beliefs. Following the PRISMA statement, three scientific databases (PubMed, PsycInfo and PsycArticles via EBSCOhost, Web of Science) are searched, instruments are described and discussed regarding their scope, and methodological quality.
Results
Overall, 7351 records were identified, with 35 studies reporting relevant findings on 11 measures. Most studies examined general population samples and used vignette-based measures. Schizophrenia and depression were most commonly examined, few studies focused on dementia, ADHD, OCD, eating disorders, and problematic alcohol use, or compared continuum beliefs across disorders. Validity was very good for most measures, but reliability was rarely tested. Measures mostly assessed beliefs in the normality of mental health symptoms or the normality of persons with such symptoms but rarely nosological aspects (i.e., categorical v continuous conceptualization of mental disorders).
Conclusions
Current research provides psychometrically sound instruments to examine continuum beliefs for a variety of mental disorders. While studies suggest utility for general population samples and mental health professionals, more research is necessary to corroborate findings, for instance, regarding age (e.g., in adolescents), gender, or type of mental disorder. Future research should also compare self-report ratings, and vignette-based measures, include measures of nosological concepts to fully grasp the continuum concept of mental illness.
Preregistration
PROSPERO: CRD42019123606.
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.
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.
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.
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.
Background: Interpersonal skills deficits and dysfunctional metacognitive beliefs have been implicated in the etiology and maintenance of depression. This study aimed to investigate the association between changes in these skills deficits and change in depressive symptoms over the course of treatment with Cognitive Behavioral Analysis System of Psychotherapy (CBASP) and Metacognitive Therapy (MCT).
Methods: In this prospective, parallel group observational study, data was collected at baseline and after 8 weeks of an intensive day clinic psychotherapy program. Based on a shared decision between patients and clinicians, patients received either CBASP or MCT. Ninety patients were included in the analyses (CBASP: age M = 38.7, 40.5% female, MCT: age M = 44.7, 43.3% female). Interpersonal deficits were assessed with the short-form of the Luebeck Questionnaire for Recording Preoperational Thinking (LQPT-SF) and the Impact Message Inventory (IMI-R). Metacognitive beliefs were assessed with the Metacognition Questionnaire-30 (MCQ-30). The Quick Inventory of Depressive Symptomatology (QIDS-SR16) was utilized to assess depressive symptoms. A regression analysis was conducted to assess variables associated with outcome. ANCOVAs were utilized to investigate whether improvement in skills deficits is dependent on type of treatment received.
Results: Improvements in preoperational thinking and increases in friendly-dominant behavior were associated with change in depressive symptoms. There was no association between reductions in dysfunctional metacognitive beliefs and a decrease in depressive symptoms. While both treatment groups showed significant improvements in interpersonal and metacognitive skills, there was no significant between-group difference in the change scores for either of these skills.
Conclusion: Our findings suggest that changes in interpersonal skills seem to be of particular relevance in the treatment of depression. These results have to be replicated in a randomized-controlled design before firm conclusions can be drawn.
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.
Fear is an emotional state, characterized by the activation of a defense system that is designed to ensure the organism’s survival. This system enables a rapid recognition of threats and organizes defensive response patterns in order to adaptively cope with the threatening environment. Yet, to ensure its flexibility under changing environmental conditions, inhibitory pathways exist that modulate the activation of this defense system, if a previously threatening cue no longer predicts any harm – a memory-formatting process referred to as fear extinction, leading to a reduction of defensive responding. Fear extinction is presumed to at least partially underlie exposure treatment of anxiety disorders, which is why the facilitation of this learning process may promote such treatment’s efficacy. Animal models suggested, that the stimulation of the vagus nerve or the superior colliculus (SC) – a midbrain structure mediating visual attentional processing – target these inhibitory extinction pathways and, thus, facilitate fear extinction. However, as it is unclear whether similar mechanisms exist in humans, this thesis manuscript examined how non-invasive stimulation of these inhibitory pathways by transcutaneous vagus nerve stimulation (tVNS) or SC-recruiting visual attentional manipulation impact on human fear extinction.
To this end, we conducted three studies using multiple-day single-cue fear conditioning and extinction paradigms. First, we elaborated on fear that is established in these paradigms by examining defensive responding that is elicited by an innocuous conditioned stimulus, which has either been paired (fear learning group) with an aversive unconditioned stimulus (US; an electric shock) or was unpaired (control group; study 1). During the following extinction training, either tVNS vs. sham stimulation was applied (study 1, study 2) or participants were instructed, to either generate saccadic eye movements (strong SC activation) vs. smooth eye pursuits (low SC activation; study 3). During subsequent sessions, extinction consolidation as well as the short- and long-term extinction recall was tested (study 2, study 3).
Conditioned fear in the fear learning group was characterized by elevated cognitive risk assessments (US-expectancy ratings), as well as increased cardiac deceleration and startle reflex potentiation compared to controls. Cardiac deceleration was positively correlated to startle potentiation, but was decoupled from cognitive risk assessments (study 1). Initial, short- and long-term extinction of these defensive responses was facilitated by tVNS on all three response levels (cognitive, physiological, behavioral; study 1, study 2). In contrast, saccades facilitated initial extinction only for physiological and behavioral elements of the defensive response pattern, while extinction consolidation and recall was impaired by any eye movement manipulation (study 3) for physiological and behavioral indicators of defensive responding.
Taken together, the data of the experimental series suggest, that on a behavioral level, conditioned fear may best be conceived as attentive immobility – a defense strategy elicited by inevitable distal threats, that is uniformly expressed across species and is accompanied by cardiac deceleration and startle reflex potentiation. In addition, it was shown that such rather automatic defensive adaptations are independent from verbally expressed threat expectancies. As expected, tVNS impacted on fear extinction on both levels, strongly in line with the suggestion, that vagal stimulation activates cortical and subcortical neural pathways involved in extinction learning, consolidation and recall. TVNS may, thus, be a promising adjuvant for exposure treatment of mental disorders. In contrast, SC-recruiting visual attentional manipulation only affected subcortically mediated defensive responding, in line with rodent findings, indicating that the SC specifically inhibits subcortical parts of the neural defense system. However, as extinction recall was impaired by any type of visual attentional manipulation, this appeared to have functioned as a form of avoidance, initially attenuating fear but preventing extinction consolidation and, thus, impairing sustained fear reduction. Both non-invasive stimulation techniques may therefore increase initial defensive flexibility in the face of no-longer threat-signaling stimuli, but only tVNS may achieve long-term effects on multiple response levels.
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.
Background
While evidence concerning Quality of Life (QoL) in youth with cerebral palsy (CP) in comparison to the general population has been accumulating, there is a lack of studies exploring differences on a wider range of positive and negative mental health outcomes in emerging adults.
Methods
This binational case control study is part of the SPARCLE cohort study on QoL and participation of youth with CP. QoL (WHOQOL-BREF), depression (PHQ-9), anxiety (GAD-7) and self-efficacy (GSE) were assessed in 198 emerging adults with CP and 593 emerging adults from the general population, matched for country of residence, age and gender. ANCOVAs with impairment and pain as covariates were run.
Results
Similar levels of QoL were found in both samples, except for the environmental domain, with better QoL for emerging adults with CP compared to the general population. There were significant descriptive differences regarding depression with worse levels in the CP sample, however, also worse levels of self-efficacy. Pain as a covariate had a significant negative impact on all measures, leading to poorer self-efficacy while worsening depression and anxiety; impairment had a significant worsening impact on physical QoL and self-efficacy only.
Conclusion
Similar expressions of mental health outcomes in emerging adults with CP and the general population indicate the high adaptive capability of emerging adults with CP.
A paradigm was developed to experimentally investigate the dysregulation of affective reactivity in clinical depression. The literature so far reported evidence for three directions of dysregulation - negative potentiation, positive attenuation, and emotion context insensitivity. Therefore a paradigm was designed to allow to test all three hypotheses simultaneously. Furthermore, to enable generalization across the specific stimuli used in the experiment, stimuli of two sensory modalities were used - pictures and sounds. Because it was hypothesized, that the specificity of affective reactivity of depressed patients will be especially prominent in long lasting affective situations, a categorically blocked presentation mode was chosen. Regarding the dependent variables, a multimethod approach was conducted. Besides self-report ratings of the feeling state, startle responses, skin conductance responses, heart rate, and the electromyogram of the corrugator and zygomatic muscle were recorded. In a separate session, BOLD-responses during picture viewing were collected by functional magnetic resonance imaging (fMRI). Both sessions were conducted with three samples: a healthy student sample, a depressed outpatient sample, and a healthy age and gender matched control sample. The results of the patient sample support an integration of the emotion context insensitivity and the negative potentiation hypothesis. Patients reported generally to feel more unpleasant and more aroused than healthy controls. Skin conductance and startle responses were modulated by valence to a smaller degree in the patients than in the controls. No group differences were found in the facial muscle activity. BOLD-responses were potentiated during unpleasant compared to neutral pictures in the patient but not in the control group in the amygdala, the insular cortex and the orbito frontal cortex. A model to integrate these results is developed. Its central assumption is, that the inability to respond to affective stimuli is an aversive experience and therefore leads to a negativity bias in attention and cognition. Direction of further research and implications for psychotherapies are discussed.
Many orally dosed APIs are bioavailable only when formulated as an enteric dosage form to protect them from the harsh environment of the stomach. However, an enteric formulation is often accompanied with a higher development effort in the first place and the potential degradation of fragile APIs during the coating process. Ready-to-use enteric hard capsules would be an easily available alternative to test and develop APIs in enteric formulations, while decreasing the time and cost of process development. In this regard, Lonza Capsugel® Next Generation Enteric capsules offer a promising approach as functional capsules. The in vivo performance of these capsules was observed with two independent techniques (MRI and caffeine in saliva) in eight human volunteers. No disintegration or content release in the stomach was observed, even after highly variable individual gastric residence times (range 7.5 to 82.5 min), indicating the reliable enteric properties of these capsules. Seven capsules disintegrated in the distal part of the small intestine; one capsule showed an uncommonly fast intestinal transit (15 min) and disintegrated in the colon. The results for this latter capsule by MRI and caffeine appearance differed dramatically, whereas for all other capsules disintegrating in the small intestine, the results were very comparable, which highlights the necessity for reliable and complementary measurement methods. No correlation could be found between the gastric residence time and disintegration after gastric emptying, which confirms the robust enteric formulation of those capsules.
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.
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
The learning theory of panic disorder differs between panic attacks and anxious apprehension as distinct emotional states. Acute panic is accompanied by extreme fear, experience of strong body symptoms reflecting autonomic surge and flight tendencies. In contrast, anxious apprehension is associated with hypervigilance towards bodily sensations and increased distress when subtle somatic symptoms are identified. Following animal models, these clinical entities reflect different stages of defensive reactivity depending upon the imminence of interoceptive or exteroceptive threat cues with lowest distance to threat during panic attacks. We tested this model by investigating the dynamics of defensive reactivity in a large group of patients suffering from panic disorder and agoraphobia (PD/AG) prior to a multicenter controlled clinical trial. Three hundred forty-five patients participated in a standardized behavioral avoidance test (being entrapped in a small, dark chamber for 10 minutes). Defensive reactivity was assessed measuring avoidance and escape behavior, self reports of anxiety and panic symptoms, autonomic arousal (heart rate and skin conductance), and potentiation of the startle reflex before and during the exposure period of the behavioral avoidance test. While 125 patients showed strong anxious apprehension during the task (as indexed by increased reports of anxiety, elevated physiological arousal, and startle potentiation), 72 patients escaped from the test chamber. Active escape was initiated at the peak of the autonomic surge accompanied by an inhibition of the startle response as predicted by the animal model. These physiological responses were observed during 34 reported panic attacks as well. We found evidence that defensive reactivity in PD/AG patients is dynamically organized ranging from anxious apprehension to panic with increasing proximity of interoceptive threat. Importantly, the patients differed quite substantially according defensive reactivity during the behavioral avoidance test despite all patients received the same principal diagnosis. These differences can be explained in part by differences in the disposition according to two genetic variants previously associated with panic disorder. Patients carrying the risk variant of a polymorphism in the neuropeptide S receptor gene showed an overall increased heart rate during the whole behavioral avoidance test reflecting an enhanced sympathomimetic activation and consequently arousal level. During the entrapment situation in which heart rate further increased over an already elevated baseline level, risk variant carriers were prone to experience more panic symptoms. This is in line with the learning perspective of panic disorder, postulating that internal cues of elevated arousal increase the chance of experiencing another panic attack once they have been associated with aversive responses. Furthermore, the risk variant of a polymorphism in the monoamine oxidase A gene was observed to augment the occurrence of panic attacks and escape behavior preparation. In addition, we find evidence that suggest an enhanced resistance to corrective learning experiences as indicated by a lack of a reduction of avoiding and escaping behavior during repeated test chamber exposures in wait-list control patients carrying the risk gene variant. Both effects may strengthen the learning mechanism hypothesized to be involved in the pathogenesis of panic disorder. Exteroceptive and interoceptive cues previously associated with the initial panic attack might trigger subsequent attacks in risk allele carriers more rapidly while simultaneously the opportunity to dissolve once established associations due to contradictory experiences is limited. Now, differential dispositions regarding defensive reactivity in PD/AG patients has to be linked to mechanisms supposed to be involved in exposure based therapy. First outcome evaluations of the clinical trial indicated that a behavioral therapy variant suggested to be linked with higher fear activation during exposure exercises is more effective than another. Further analyses have to proof whether those patients showing a clear specific fear response during the behavioral avoidance test benefit more than others from exposure based therapy.
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.
Abstract
Background
The need to optimize exposure treatments for anxiety disorders may be addressed by temporally intensified exposure sessions. Effects on symptom reduction and public health benefits should be examined across different anxiety disorders with comorbid conditions.
Methods
This multicenter randomized controlled trial compared two variants of prediction error‐based exposure therapy (PeEx) in various anxiety disorders (both 12 sessions + 2 booster sessions, 100 min/session): temporally intensified exposure (PeEx‐I) with exposure sessions condensed to 2 weeks (n = 358) and standard nonintensified exposure (PeEx‐S) with weekly exposure sessions (n = 368). Primary outcomes were anxiety symptoms (pre, post, and 6‐months follow‐up). Secondary outcomes were global severity (across sessions), quality of life, disability days, and comorbid depression.
Results
Both treatments resulted in substantial improvements at post (PeEx‐I: dwithin = 1.50, PeEx‐S: dwithin = 1.78) and follow‐up (PeEx‐I: dwithin = 2.34; PeEx‐S: dwithin = 2.03). Both groups showed formally equivalent symptom reduction at post and follow‐up. However, time until response during treatment was 32% shorter in PeEx‐I (median = 68 days) than PeEx‐S (108 days; TRPeEx‐I = 0.68). Interestingly, drop‐out rates were lower during intensified exposure. PeEx‐I was also superior in reducing disability days and improving quality of life at follow‐up without increasing relapse.
Conclusions
Both treatment variants focusing on the transdiagnostic exposure‐based violation of threat beliefs were effective in reducing symptom severity and disability in severe anxiety disorders. Temporally intensified exposure resulted in faster treatment response with substantial public health benefits and lower drop‐out during the exposure phase, without higher relapse. Clinicians can expect better or at least comparable outcomes when delivering exposure in a temporally intensified manner.
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.
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.
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.
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.
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.
Mobile Apps for Sexual and Reproductive Health Education: a Systematic Review and Quality Assessment
(2023)
Purpose of Review
The aim of this study was to present the current state of research on mobile health apps for sexual and reproductive health (SRH) education. Apps were analysed based on contents (by using the World Health Organization’s SRH framework), features, intended audiences and quality of evidence (by applying the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach). Taking German sexuality education apps as an example, the rapid development in the field of SRH apps over the last 3 years has been revealed by comparing the quality of apps available in 2019 with apps from 2022.
Recent Findings
SRH apps allow health information to be disseminated quickly, at low thresholds and in a practical and cost-effective manner. Moreover, they allow for anonymous usage independently of time and place. In the absence of network coverage, offline use is also possible. Previous research focused on individual SRH aspects (e.g. human immunodeficiency virus (HIV), contraception). However, some studies were designed to cover a broader range of SRH topics, but identified only a few relevant apps.
Summary
To improve SRH, it would be helpful if the apps would be of high-quality design and be made up of relevant content. Furthermore, they should be tailored to the target group and have been tested in real-life settings. A total of 50 SRH apps with sufficiently high-quality ratings were included. The apps cover a variety of SRH topics, but they often lack field-based evaluation. The effectiveness of SRH apps has not yet been sufficiently studied in a scientific manner. Only 9 apps were deemed to be adequate for a moderate GRADE level. Despite this grading, the study nevertheless shows that there are several apps that could potentially promote SRH.
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.
Dense sensor event-related brain potentials were measured in participants with spider phobia, high anxiety sensitive individuals and non-fearful controls during viewing of medical emergency, spider and standard emotional (pleasant, unpleasant, neutral) pictures. Compared to non-fearful controls spider phobia participants showed a significantly enlarged late positive potential (LPP) during the encoding of phobia-relevant pictures whereas high anxiety sensitive individuals showed a significantly greater Early Posterior Negativity (EPN) during the encoding of medical emergency pictures and a significantly greater Late Positive Potential (LPP) during the encoding of highly arousing unpleasant visual material. Moreover, within group comparisons of the spider phobia group revealed comparable LPP evoked by spider pictures and emotional (unpleasant and pleasant) picture contents indicating that at the level of early stimulus evaluation, the effects of selective attention seem to be related to emotional relevance of the stimulus rather than reflecting a fear-specific response.
Background: Only approximately a third of people with depressive symptoms seek professional health care. Furthermore, people labelled as mentally ill may experience stigmatisation, which can impede help-seeking behaviour.
Aim: To examine the effects of three vignette-based interventions endorsing biopsychosocial causal beliefs and strengthening self-efficacy on help-seeking intention and behaviour, as well as the predictive values of these variables and previous treatment experience.
Method: A quasi-experimental online study utilising a fractioned factorial design was carried out. People were screened for depressive symptoms and their current treatment status. After baseline assessment, they were randomly allocated into one of 24 groups receiving a combination of interventional messages. Actual help-seeking behaviour was measured at follow-ups 3 and 6 months after baseline.
Results: Altogether, N = 1,368 participants were included in the final analyses and N = 983 provided data on their help-seeking behaviour within 3 to 6 months after the baseline assessment. The intention to seek help from a general practitioner or a mental health professional was significantly influenced by the interventions. However, help-seeking behaviour was not influenced by the interventions. On a conceptual level, biopsychosocial causal beliefs (β = 0.09–0.23) and self-efficacy to seek help (β = 0.16–0.25) predicted help-seeking intention. There was a negative interaction effect of both self-efficacy beliefs on intention and behaviour, which changed depending on depression severity. In all models, the intention was the main predictor of actual behaviour. Treatment experience predicted both help-seeking intention and behaviour.
Conclusion: Biopsychosocial causal beliefs and self-efficacy have a direct effect on help-seeking intention. Interventions should include information on how to actually seek help as a means to strengthen self-efficacy beliefs and simulate previous treatment experience. Further research is needed to investigate the respective interaction effects on intention and behaviour.
Clinical Trial Registration: https://drks.de/search/de/trial/DRKS00023557, German Clinical Trials Register: DRKS00023557. Registered 11 December 2020. World Health Organization, Universal Trial Number: U1111–1264-9954. Registered 16 February 2021.
Background
Only about half the people with depression seek professional health care services. To constitute the different predictors and associating variables of health care utilisation, we model the process and aim to test our hypothesised Seeking Mental Health Care Model. The model includes empirical influences on the help-seeking process to predict actual behaviour and incorporates superordinate (stigma, treatment experiences) as well as intermediate attitudinal variables (continuum and causal beliefs, depression literacy and self-efficacy).
Method
All variables are examined in an online study (baseline, three- and six-month follow-up). The sample consisted of adults with depressive symptoms (PHQ-9 sum score ≥ 8), currently not receiving mental health care treatment. To examine the prediction of variables explaining help-seeking behaviour, a path model analysis was carried out (lavaan package, software R).
Results
Altogether, 1368 participants (Mage = 42.38, SDage = 15.22, 65.6% female) were included, 983 participating in at least one follow-up. Model fit was excellent (i.e., RMSEA = 0.059, CFI = 0.989), and the model confirmed most of the hypothesised predictions. Intermediary variables were significantly associated with stigma and experiences. Depression literacy (ß = .28), continuum beliefs (ß = .11) and openness to a balanced biopsychosocial causal model (ß = .21) significantly influenced self-identification (R2 = .35), which among the causal beliefs and self-efficacy influenced help-seeking intention (R2 = .10). Intention (ß = .40) prospectively predicted help-seeking behaviour (R2 = .16).
Conclusion
The Seeking Mental Health Care Model provides an empirically validated conceptualisation of the help-seeking process of people with untreated depressive symptoms as a comprehensive approach considering internal influences. Implications and open questions are discussed, e.g., regarding differentiated assessment of self-efficacy, usefulness of continuum beliefs and causal beliefs in anti-stigma work, and replication of the model for other mental illnesses.
Trial registration
German Clinical Trials Register: DRKS00023557. Registered 11 December 2020. World Health Organization, Universal Trial Number: U1111–1264-9954. Registered 16 February 2021.
Task shielding is an important executive control demand in dual-task performance enabling the segregation of stimulus–response translation processes in each task to minimize between-task interference. Although neuroimaging studies have shown activity in left dorsolateral prefrontal cortex (dlPFC) during various multitasking performances, the specific role of dlPFC in task shielding, and whether non-invasive brain stimulation (NIBS) may facilitate task shielding remains unclear. We therefore applied a single-blind, crossover sham-controlled design in which 34 participants performed a dual-task experiment with either anodal transcranial direct current stimulation (atDCS, 1 mA, 20 min) or sham tDCS (1 mA, 30 s) over left dlPFC. Task shielding was assessed by the backward-crosstalk effect, indicating the extent of between-task interference in dual tasks. Between-task interference was largest at high temporal overlap between tasks, i.e., at short stimulus onset asynchrony (SOA). Most importantly, in these conditions of highest multitasking demands, atDCS compared to sham stimulation significantly reduced between-task interference in error rates. These findings extend previous neuroimaging evidence and support modulation of successful task shielding through a conventional tDCS setup with anodal electrode over the left dlPFC. Moreover, our results demonstrate that NIBS can improve shielding of the prioritized task processing, especially in conditions of highest vulnerability to between-task interference.
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.
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.
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.
Moral rules are a cornerstone of many societies. Most moral rules are concerned with the welfare of other individuals, reflecting individuals’ innate aversion against harming other individuals. Harming others is associated with aversive experiences, implying that individuals who are sensitive to the aversiveness of these experiences are more likely to follow moral rules than individuals who are insensitive to the aversiveness of these experiences. Individuals’ sensitivity for aversive experiences depends on individuals’ ability to integrate the underlying neural and physiological processes: Individuals who are more efficient in integrating these processes are more sensitive to the aversiveness that is associated with moral rule violations than individuals who are less efficient in integrating these processes. Individuals who differ in their ability to integrate these processes may, thus, also differ in their inclination to follow moral rules. We tested this assumption in a sample of healthy individuals (67 males) who completed measures of moral rule adherence and integration abilities. Moral rule adherence was assessed with self-report measure and integration abilities were assessed with a resting state measure of heart rate variability (HRV), which reflects prefrontal–(para-)limbic engagement during the integration of physical and neural processes. We found a positive association between individuals’ HRV and individuals’ moral rule adherence, implying that individuals with efficient integration abilities were more inclined to follow moral rules than individuals with inefficient integration abilities. Our findings support the assumption that individuals with different integration abilities also differ in moral rule adherence, presumably because of differences in aversiveness sensitivity.
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.
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.
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.