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Rameckers SA, van Emmerik AAP, Grasman RPPP, Arntz A. Non-fear emotions in changes in posttraumatic stress disorder symptoms during treatment. J Behav Ther Exp Psychiatry 2024; 84:101954. [PMID: 38479086 DOI: 10.1016/j.jbtep.2024.101954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 12/31/2023] [Accepted: 02/19/2024] [Indexed: 05/15/2024]
Abstract
BACKGROUND AND OBJECTIVES Posttraumatic stress disorder (PTSD) is not only associated with fear but also with other emotions. The present study aimed to examine if changes in shame, guilt, anger, and disgust predicted changes in PTSD symptoms during treatment, while also testing if PTSD symptoms, in turn, predicted changes in these emotions. METHODS Participants (N = 155) with childhood-related PTSD received a maximum of 12 sessions of eye movement desensitization and reprocessing or imagery rescripting. The data was analyzed using Granger causality models across 12 treatment sessions and 6 assessment sessions (up until one year after the start of treatment). Differences between the two treatments were explored. RESULTS Across treatment sessions, shame, and disgust showed a reciprocal relationship with PTSD symptoms, while changes in guilt preceded PTSD symptoms. Across assessments, anger was reciprocally related to PTSD, suggesting that anger might play a more important role in the longer term. LIMITATIONS The individual emotion items were not yet validated, and the CAPS was not administered at all assessments. CONCLUSIONS These findings partly differ from earlier studies that suggested a unidirectional relationship in which changes in emotions preceded changes in PTSD symptoms during treatment. This is in line with the idea that non-fear emotions do play an important role in the treatment of PTSD and constitute an important focus of treatment and further research.
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Affiliation(s)
- Sophie A Rameckers
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands.
| | | | - Raoul P P P Grasman
- Department of Psychological Methods, University of Amsterdam, Amsterdam, the Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
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Cenkner DP, Held P, Zalta AK. A latent profile analysis of moral emotions following moral transgressions. J Clin Psychol 2024; 80:1754-1766. [PMID: 38581701 DOI: 10.1002/jclp.23691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 03/01/2024] [Accepted: 03/27/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE Moral transgressions (MTs), events that violate one's moral code, are associated with the moral emotions of guilt and shame. However, there may be different patterns by which people experience guilt and shame that affect distress following MTs. METHOD Undergraduates (N = 1371) exposed to an MT completed self-report assessments. This study used latent profile analysis (LPA) to examine profiles based on guilt cognitions, internalized shame, and distress in relation to a reported MT. Cognitive flexibility, years since the MT, and deliberate and intrusive rumination were examined as variables to determine how these factors predicted profile membership. RESULTS Results from the LPA revealed a three-profile solution: a low moral distress profile (n = 1002), a moderate moral distress profile (n = 262), and a shame prominent profile (n = 107). Results indicated that higher levels of deliberate and intrusive rumination and lower levels of cognitive flexibility significantly increased the likelihood of belonging to the moderate moral distress or shame prominent profiles compared to the low moral distress profile. Higher levels of intrusive rumination and lower levels of cognitive flexibility also significantly increased the likelihood of belonging to the shame prominent profile over the moderate distress profile. CONCLUSION Three different profiles emerged, with the shame prominent profile being driven primarily by internalized shame. Results suggest that intrusive rumination and cognitive inflexibility are risk factors to experiencing adverse responses to MTs.
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Affiliation(s)
- David P Cenkner
- Department of Psychological Science, University of California, Irvine, Irvine, California, USA
| | - Philip Held
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Alyson K Zalta
- Department of Psychological Science, University of California, Irvine, Irvine, California, USA
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Zangri RM, Blanco I, Pascual T, Vázquez C. Unlocking the past: efficacy of guided self-compassion and benefit-focused online interventions for managing negative personal memories. Cogn Emot 2024:1-15. [PMID: 38635402 DOI: 10.1080/02699931.2024.2337132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/21/2024] [Indexed: 04/20/2024]
Abstract
Positive reappraisal strategies have been found to reduce negative affect following the recall of negative personal events. This study examined the restorative effect of two mood-repair instructions (self-compassion vs benefit-focused reappraisal) and a control condition with no instructions following a negative Mood Induction Procedure by using the guided recall of a negative autobiographical event. A total of 112 university students participated in the online study (81% women, Mage: 21.0 years). Immediately following the negative memory recall, participants were randomised to each condition [(self-compassion: n = 36, benefit-focused: n = 39) or a control condition (n = 37)]. Repeated measures ANOVAs 3 (Repair condition) × 3 (Time of mood assessment: pre-recall, post-recall, post-regulation) showed that, as expected, negative mood (sadness, shame, and guilt) worsened significantly after the guided recall in all groups (p < .001). After the mood-repair intervention, participants in the self-compassion and benefit-focused conditions showed a significant reduction in negative mood (p < .019), while such improvement was not observed in the control group. Self-compassion and benefit-focused reappraisal functioned similarly as mood repair strategies after experiencing negative affect induced by the recall of negative personal memories. Implications in the context of autobiographical memory biases are discussed.
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Affiliation(s)
- Rosaria Maria Zangri
- Department of Clinical Psychology, Complutense University of Madrid, Madrid, Spain
| | - Ivan Blanco
- Department of Clinical Psychology, Complutense University of Madrid, Madrid, Spain
| | - Teodoro Pascual
- Faculty of Health Sciences, Camilo José Cela University, Madrid, Spain
| | - Carmelo Vázquez
- Department of Clinical Psychology, Complutense University of Madrid, Madrid, Spain
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Stein J, El-Haj-Mohamad R, Stammel N, Vöhringer M, Wagner B, Nesterko Y, Böttche M, Knaevelsrud C. Changes in trauma appraisal during brief internet-based exposure and cognitive restructuring treatment for Arabic-speaking people with PTSD. Eur J Psychotraumatol 2024; 15:2324631. [PMID: 38511498 PMCID: PMC10962287 DOI: 10.1080/20008066.2024.2324631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/01/2024] [Indexed: 03/22/2024] Open
Abstract
Background: Maladaptive trauma appraisal plays an important role in the development and maintenance of posttraumatic stress disorder (PTSD). While studies have demonstrated the effectiveness of exposure and cognitive treatments for PTSD symptomatology, the effect of such treatments on specific trauma appraisals is still not well understood.Objective: The study investigated the effect of an exposure and a cognitive restructuring internet-based treatment on specific trauma appraisals in Arabic-speaking participants with PTSD.Method: 334 participants received either an exposure (n = 167) or a cognitive restructuring (n = 167) internet-based treatment. PTSD symptom severity (PCL-5) and specific trauma appraisals (TAQ) were assessed at pre- and post-treatment. Changes in specific trauma appraisals within and between the two treatments were analyzed using multi-group change modelling. Associations between changes in PTSD symptom severity and changes in trauma appraisals were evaluated using Pearson product-moment correlation. For both treatments, participants with versus without reliable improvement were compared regarding changes in specific trauma appraisals using Welch tests. Analyses were performed on 100 multiple imputed datasets.Results: Both treatments yielded significant changes in shame, self-blame, fear, anger, and alienation (all ps < .001). Changes in betrayal were only significant in the cognitive restructuring treatment (p < .001). There was no evidence of differences between treatments for any specific trauma appraisal. Changes in PTSD symptom severity were significantly associated with changes in trauma appraisals (all ps < .001). In both treatments, participants who experienced reliable improvement in PTSD symptom severity showed significantly larger pre- to post-treatment changes in specific trauma appraisals compared to those without reliable improvement. Again, differences in betrayal were only significant in the cognitive restructuring treatment.Conclusions: The findings indicate that both treatments are effective in reducing trauma appraisals in Arabic-speaking people with PTSD. Changes in trauma appraisal seem to be associated with changes in PTSD symptomatology.Trial registration: German Clinical Trials Register identifier: DRKS00010245.
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Affiliation(s)
- Jana Stein
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
- Department for Transcultural and Traumatic Stress Studies, Center ÜBERLEBEN, Berlin, Germany
| | - Rayan El-Haj-Mohamad
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
- Department for Transcultural and Traumatic Stress Studies, Center ÜBERLEBEN, Berlin, Germany
| | - Nadine Stammel
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Max Vöhringer
- Department for Transcultural and Traumatic Stress Studies, Center ÜBERLEBEN, Berlin, Germany
| | - Birgit Wagner
- Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
| | - Yuriy Nesterko
- Department for Transcultural and Traumatic Stress Studies, Center ÜBERLEBEN, Berlin, Germany
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Maria Böttche
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Christine Knaevelsrud
- Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
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Müller-Engelmann M, Bahnemann L, Kümmerle S. The effects of a combination of cognitive interventions and loving-kindness meditations (C-METTA) on guilt, shame and PTSD symptoms: results from a pilot randomized controlled trial. Eur J Psychotraumatol 2024; 15:2308439. [PMID: 38323870 PMCID: PMC10851818 DOI: 10.1080/20008066.2024.2308439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/22/2023] [Indexed: 02/08/2024] Open
Abstract
Background: Trauma-related guilt and shame are crucial for the development and maintenance of PTSD (posttraumatic stress disorder). We developed an intervention combining cognitive techniques with loving-kindness meditations (C-METTA) that specifically target these emotions. C-METTA is an intervention of six weekly individual treatment sessions followed by a four-week practice phase.Objective: This study examined C-METTA in a proof-of-concept study within a randomized wait-list controlled trial.Method: We randomly assigned 32 trauma-exposed patients with a DSM-5 diagnosis to C-METTA or a wait-list condition (WL). Primary outcomes were clinician-rated PTSD symptoms (CAPS-5) and trauma-related guilt and shame. Secondary outcomes included psychopathology, self-criticism, well-being, and self-compassion. Outcomes were assessed before the intervention phase and after the practice phase.Results: Mixed-design analyses showed greater reductions in C-METTA versus WL in clinician-rated PTSD symptoms (d = -1.09), guilt (d = -2.85), shame (d = -2.14), psychopathology and self-criticism.Conclusion: Our findings support positive outcomes of C-METTA and might contribute to improved care for patients with stress-related disorders. The study was registered in the German Clinical Trials Register (DRKS00023470).
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Affiliation(s)
- Meike Müller-Engelmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe-University Frankfurt, Frankfurt/Main, Germany
- Faculty Human Sciences, Department Psychology, Medical School Hamburg, Hamburg, Germany
| | - Luisa Bahnemann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe-University Frankfurt, Frankfurt/Main, Germany
| | - Stella Kümmerle
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe-University Frankfurt, Frankfurt/Main, Germany
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Glad KA, Aakvaag HF, Wentzel-Larsen T, Dyb G, Thoresen S. What will others think of me? The longitudinal association between trauma-related shame and guilt and psychopathology after a terror attack. BJPsych Open 2024; 10:e30. [PMID: 38205599 PMCID: PMC10790223 DOI: 10.1192/bjo.2023.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/09/2023] [Accepted: 11/14/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Trauma-related shame and guilt have been identified as important factors for mental health following interpersonal trauma. For survivors of terror and disasters, however, the role of shame and guilt remains largely unknown. AIMS To explore the long-term occurrence of trauma-related shame and guilt among survivors of a terror attack, and the potential importance of these emotions for mental health. METHOD A total of 347 survivors (48.7% female, mean age at the time of the attack: 19.25 years, s.d. = 4.40) of the 2011 massacre on Utøya island, Norway, participated in face-to-face, semi-structured interviews. Trauma-related shame and guilt were measured with items from the Shame and Guilt After Trauma Scale at 2.5 and 8.5 years post-terror attack. Post-traumatic reactions and anxiety/depression at 8.5 years post-terror attack were measured with the University of California at Los Angeles PTSD Reaction Index and the Hopkins Symptom Checklist-25, respectively. Associations between trauma-related shame/guilt and post-trauma psychopathology were analysed by multiple linear regressions. RESULTS Trauma-related shame and guilt were prevalent among survivors at both 2.5 and 8.5 years post-terror attack. In unadjusted analyses, shame and guilt, at both time points, were significantly associated with post-traumatic stress reactions and anxiety/depression. Shame remained significantly associated with mental health when adjusted for guilt. Both earlier and current shame were uniquely related to mental health. CONCLUSIONS Trauma-related shame and guilt may be prevalent in survivors of mass trauma several years after the event. Shame, in particular, may play an important role for long-term mental health. Clinicians may find it helpful to explicitly address shame in treatment of mass trauma survivors.
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Affiliation(s)
- Kristin Alve Glad
- Division for Disasters, Terror and Stress Management, Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Helene Flood Aakvaag
- Division for Disasters, Terror and Stress Management, Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Tore Wentzel-Larsen
- Division for Disasters, Terror and Stress Management, Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway; and Division for Service Research and Innovation, Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Grete Dyb
- Division for Disasters, Terror and Stress Management, Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway; and Institute of Clinical Medicine, University of Oslo, Norway
| | - Siri Thoresen
- Division for Disasters, Terror and Stress Management, Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway; and Department of Psychology, University of Oslo, Norway
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McCann JP, Tipsword JM, Brake CA, Badour CL. Trauma-Related Shame and Guilt as Prospective Predictors of Daily Mental Contamination and PTSD Symptoms in Survivors of Sexual Trauma. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:11117-11137. [PMID: 37386852 PMCID: PMC10602615 DOI: 10.1177/08862605231179721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Mental contamination (MC), the experience of dirtiness in the absence of a physical contaminant, has established links with posttraumatic stress disorder (PTSD). Shame and guilt have well-documented relationships with symptoms of PTSD and may play a role in the development and maintenance of MC. The present study examined whether trauma-related shame and guilt prospectively predicted daily MC and symptoms of PTSD among 41 women with a history of sexual trauma. Women completed baseline and twice-daily assessments of MC and symptoms of PTSD over a 2-week period and baseline measures of trauma-related shame and guilt. Two sets of hierarchical mixed linear regression models examined individual and combined fixed effects of baseline trauma-related guilt (guilt cognitions and global guilt) and shame in predicting daily trauma-related MC and symptoms of PTSD. Trauma-related shame positively predicted both daily MC and PTSD. This association remained robust even when accounting for the experience of trauma-related guilt. Neither trauma-related guilt cognitions nor global guilt predicted daily MC or PTSD. While other studies have addressed shame related to sexual assault, this is the first study to demonstrate a positive prospective relationship between shame and trauma-related MC. Findings regarding PTSD and shame are consistent with a growing literature. Further research is needed to better understand the temporal relationships between trauma-related shame, MC, and symptoms of PTSD, including how these variables interact and change over the course of PTSD treatment. A better understanding of the factors influencing the development and maintenance of MC can inform efforts to more easily target and improve MC, and subsequently PTSD.
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Affiliation(s)
| | | | - C. Alex Brake
- Department of Psychiatry & Human Behavior, Warren Alpert Medical School of Brown University
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8
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Zhang T, Wakefield CE, Ren Z, Chen W, Du X, Shi C, Lai L, Zhao C, Gao Y, Chen Z, Zhou Y, Wu T, Cai M. Effects of digital psychological interventions on physical symptoms in cancer patients: A systematic review and meta-analysis. Gen Hosp Psychiatry 2023; 84:47-59. [PMID: 37385139 DOI: 10.1016/j.genhosppsych.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 05/12/2023] [Accepted: 05/25/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE This meta-analysis was to assess the efficacy of digital psychological interventions to improve physical symptoms (i.e., fatigue, pain, disturbed sleep, and physical well-being) among cancer patients, as well as to evaluate the variables that possibly moderate intervention effects. METHODS Nine databases were searched for the literature up to February 2023. Two reviewers independently conducted a quality assessment. Effect sizes were reported as the standardized mean difference (Hedge's g) and estimated using a random-effects model. RESULTS The meta-analysis included 44 randomized clinical trials comprising 7200 adults with cancer. Digital psychological interventions were associated with significant improvements in short-term fatigue (g = -0.33; 95% CI, -0.58 to -0.07) and disturbed sleep (g = -0.36; 95% CI, -0.57 to -0.15), but with non-significant changes in pain (g = -0.23; 95% CI, -0.68 to 0.21) and physical well-being (g = 0.31; 95% CI, -0.18 to 0.80). Additionally, no alleviation in long-term physical symptoms was observed. In subgroup analysis, results suggest that the country significantly moderated the effectiveness of digital psychological interventions in alleviating fatigue. CONCLUSIONS Digital psychological interventions can be effective for improving short-term fatigue and disturbed sleep in patients with cancer. Clinicians could consider digital psychological interventions as a possible and efficient addition to better manage some of the physical symptoms during and after cancer treatment.
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Affiliation(s)
- Tao Zhang
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Claire Elizabeth Wakefield
- School of Clinical Medicine, UNSW Medicine and Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Sydney, New South Wales, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia
| | - Zhihong Ren
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China.
| | - Wenke Chen
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Xiayu Du
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Congrong Shi
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Lizu Lai
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Chunxiao Zhao
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Yujun Gao
- Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhuang Chen
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Yubu Zhou
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Tong Wu
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Manqi Cai
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
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Kuck S, Arntz A, Rameckers SA, Lee CW, Boterhoven de Haan KL, Fassbinder E, Morina N. Intraindividual variability and emotional change as predictors of sudden gains in imagery rescripting and EMDR for PTSD in adult survivors of childhood abuse. Clin Psychol Psychother 2023; 30:1029-1046. [PMID: 37078854 DOI: 10.1002/cpp.2855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/06/2023] [Accepted: 04/04/2023] [Indexed: 04/21/2023]
Abstract
Sudden gains, defined as large and stable improvements in symptom severity during psychological treatment, have consistently been found to be associated with better outcomes across treatments and diagnoses. Yet, insights on coherent predictors of sudden gains and on emotional changes around sudden gains in post-traumatic stress disorder (PTSD) are lacking. We aimed at replicating a measure of intraindividual variability as a predictor for sudden gains and testing its independence from change during treatment. Furthermore, we expected changes in emotions of guilt, shame and disgust prior to sudden gains to predict sudden gains. Data from a pre-registered randomized controlled trial (RCT) of eye-movement desensitization and reprocessing (emdr) and Imagery Rescripting (ImRs) for PTSD in 155 adult survivors of childhood abuse were used. Intraindividual variability of PTSD symptoms in both treatments did not predict sudden gains status and was not independent of change during treatment. In the EMDR condition, levels of shame during treatment predicted sudden gains and shame decreased shortly before a sudden gain in both treatments. Reductions in all emotions during sudden gains were significantly higher for participants with sudden gains than for comparable intervals in non-sudden gainers. Our findings do not support the predictive validity of intraindividual variability for sudden gains. The decrease of guilt, shame and disgust during sudden gains warrants further research on their role as a mechanism of treatment change for PTSD.
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Affiliation(s)
- Sascha Kuck
- Institute of Psychology, University of Münster, Münster, Germany
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Sophie A Rameckers
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Christopher W Lee
- Division of Psychiatry, University of Western Australia, Crawley, Western Australia, Australia
| | | | - Eva Fassbinder
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
| | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany
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Maddaus M. Cardiothoracic surgeons as second victims: We, too, are at risk. J Thorac Cardiovasc Surg 2023; 166:881-889. [PMID: 36528438 DOI: 10.1016/j.jtcvs.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/11/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Michael Maddaus
- Department of Surgery, University of Minnesota Medical School, Minneapolis, Minn.
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11
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Biermann M, Schulze A, Vonderlin R, Bohus M, Lyssenko L, Lis S. Shame, self-disgust, and envy: An experimental study on negative emotional response in borderline personality disorder during the confrontation with the own face. Front Psychiatry 2023; 14:1082785. [PMID: 36970260 PMCID: PMC10030617 DOI: 10.3389/fpsyt.2023.1082785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/13/2023] [Indexed: 03/10/2023] Open
Abstract
BackgroundA markedly negative self-image and pervasive shame proneness have consistently been associated with borderline personality disorder (BPD). The present experimental study investigated the intensity of negative emotional responses with a focus on shame in BPD compared to healthy control persons (HCs) during an experimental paradigm promoting self-awareness, self-reflection, and self-evaluation. Furthermore, the relationship between levels of state shame during the experiment and shame proneness in BPD compared to HCs was examined.MethodsA sample of 62 individuals with BPD and 47 HCs participated in the study. During the experimental paradigm, participants were presented with photos of (i) the own face, (ii) the face of a well-known person, and (iii) of an unknown person. They were asked to describe positive facets of these faces. Participants rated the intensity of negative emotions induced by the experimental task as well the pleasantness of the presented faces. Shame-proneness was assessed using the Test of the Self-Conscious Affect (TOSCA-3).ResultsIndividuals with BPD experienced significantly higher levels of negative emotions than HCs both before and during the experimental task. While HC participants responded to their own face particularly with an increase in shame compared to the other-referential condition, the BPD patients responded above all with a strong increase of disgust. Furthermore, the confrontation with an unknown or well-known face resulted in a strong increase of envy in BPD compared to HC. Individuals with BPD reported higher levels of shame-proneness than HCs. Higher levels of shame-proneness were related to higher levels of state shame during the experiment across all participants.ConclusionOur study is the first experimental study on negative emotional responses and its relationship to shame proneness in BPD compared to HC using the own face as a cue promoting self-awareness, self-reflection, and self-evaluation. Our data confirm a prominent role of shame when describing positive features of the own face, but they emphasize also disgust and envy as distinct emotional experience characterizing individuals with BPD when being confronted with the self.
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Affiliation(s)
- Miriam Biermann
- Department of Psychiatric and Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- *Correspondence: Miriam Biermann,
| | - Anna Schulze
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ruben Vonderlin
- Department of Psychiatric and Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Martin Bohus
- Department of Psychiatric and Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Clinical Psychology, Ruhr University Bochum, Bochum, Germany
- McLean Hospital, Harvard Medical School, Boston, MA, United States
| | - Lisa Lyssenko
- Department of Public Health, Freiburg University of Education, Freiburg, Germany
| | - Stefanie Lis
- Department of Psychiatric and Psychosomatic Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Lai L, Liu Y, McCracken LM, Li Y, Ren Z. The efficacy of acceptance and commitment therapy for chronic pain: A three-level meta-analysis and a trial sequential analysis of randomized controlled trials. Behav Res Ther 2023; 165:104308. [PMID: 37043967 DOI: 10.1016/j.brat.2023.104308] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 03/09/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023]
Abstract
The current study included randomized controlled trials (RCTs) to assess the benefits of Acceptance and commitment therapy (ACT) for chronic pain. Searches were conducted in Web of Science, PsycINFO, PubMed, Scopus, Cochrane Library, and Embase from inception until September 30, 2022. Thirty-three RCTs, including 2293 participants, were included. Small to medium effect sizes for pain intensity/physical function favoring ACT were found both at post-treatment (pain intensity: g = 0.44; physical function: g = 0.59) and follow-up (pain intensity: g = 0.34; physical function: g = 0.56). The effect sizes on psychological outcomes were significant at post-treatment (depression: g = 0.43; anxiety: g = 0.43; quality of life: g = 0.45) and follow-up (depression: g = 0.43; anxiety: g = 0.35; quality of life: g = 0.43). The results of the trial sequential analyses indicated that pooled estimates were unlikely to be incidental findings, as effects of multiple testing were controlled and power was adequate. Face-to-face ACT yielded significantly larger effects on physical outcomes than internet-delivered ACT. Participants with chronic headache and fibromyalgia showed greater benefit from ACT compared to those with non-specific pain or mixed pain. In addition, the longer the follow-up duration, the smaller the effect sizes for pain intensity/physical function at follow-up. The present meta-analysis suggests sufficient evidence for the significant benefits of ACT for people with chronic pain.
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Affiliation(s)
- Lizu Lai
- School of Psychology, Central China Normal University, and Key Laboratory of Human Development and Mental Health of Hubei Province, China; Key Laboratory of Adolescent CyberPsychology and Behavior (Ministry of Education), National Intelligent Society Governance Experiment Base (Education), Central China Normal University, Wuhan, China
| | - Yinong Liu
- School of Psychology, Central China Normal University, and Key Laboratory of Human Development and Mental Health of Hubei Province, China; Key Laboratory of Adolescent CyberPsychology and Behavior (Ministry of Education), National Intelligent Society Governance Experiment Base (Education), Central China Normal University, Wuhan, China
| | - Lance M McCracken
- Division of Clinical Psychology, Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Ying Li
- School of Psychology, Central China Normal University, and Key Laboratory of Human Development and Mental Health of Hubei Province, China; Key Laboratory of Adolescent CyberPsychology and Behavior (Ministry of Education), National Intelligent Society Governance Experiment Base (Education), Central China Normal University, Wuhan, China
| | - Zhihong Ren
- School of Psychology, Central China Normal University, and Key Laboratory of Human Development and Mental Health of Hubei Province, China; Key Laboratory of Adolescent CyberPsychology and Behavior (Ministry of Education), National Intelligent Society Governance Experiment Base (Education), Central China Normal University, Wuhan, China.
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Kong F, Meng S, Deng H, Wang M, Sun X. Cognitive Control in Adolescents and Young Adults with Media Multitasking Experience: a Three-Level Meta-analysis. EDUCATIONAL PSYCHOLOGY REVIEW 2023. [DOI: 10.1007/s10648-023-09746-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
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14
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Hoppen TH, Schlechter P, Arntz A, Rameckers SA, Ehring T, Morina N. A brief measure of guilt and shame: validation of the Guilt and Shame Questionnaire (GSQ-8). Eur J Psychotraumatol 2022; 13:2146720. [PMID: 38872599 PMCID: PMC9766484 DOI: 10.1080/20008066.2022.2146720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 11/04/2022] [Indexed: 12/23/2022] Open
Abstract
Background: Guilt and shame regulate basic human processes such as social cognition and relations. Both emotions are also involved in the aetiology and maintenance of trauma-related mental disorders such as posttraumatic stress disorder (PTSD). However, a concise scale that adequately captures these constructs is currently lacking, impeding research efforts to understand them more thoroughly.Objective: To this end, we developed the eight-item Guilt and Shame Questionnaire (GSQ-8) in English, German, and Dutch.Method: We examined the reliability and validity of the GSQ-8 in a clinical sample of adults seeking treatment for childhood-trauma-related posttraumatic stress disorder (n = 209), a sample of adults who had suffered at least one traumatic life event reporting different levels of PTSD symptoms (n = 556), and a non-clinical sample of adults (n = 156).Results: Theory-driven confirmatory factor analyses confirmed two correlated latent factors guilt and shame with four items for each factor. Across all samples, two-factor models yielded better model fit than one-factor solutions. Measurement invariance across the three samples, gender, and Dutch and German language was mostly established. Guilt and shame composite scores were associated with PTSD symptoms, depressive symptoms, life satisfaction, mental health-related quality of life, and self-blame, thus supporting scale validity. Importantly, both subscales predicted PTSD symptoms, depression, life satisfaction, and mental health-related quality of life over and above cognitions of self-blame.Conclusions: The GSQ-8 is a parsimonious, reliable, and valid tool to assess guilt and shame in clinical, sub-clinical, and non-clinical populations, allowing applications across a broad range of research questions.
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Affiliation(s)
- Thole H Hoppen
- Institute of Psychology, Division of Clinical Psychology and Psychotherapy, University of Münster, Münster, Germany
| | | | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Sophie A Rameckers
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Thomas Ehring
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany
| | - Nexhmedin Morina
- Institute of Psychology, Division of Clinical Psychology and Psychotherapy, University of Münster, Münster, Germany
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15
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Kip A, Diele J, Holling H, Morina N. The relationship of trauma-related guilt with PTSD symptoms in adult trauma survivors: a meta-analysis. Psychol Med 2022; 52:2201-2211. [PMID: 35781354 PMCID: PMC9527673 DOI: 10.1017/s0033291722001866] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/23/2022] [Accepted: 06/01/2022] [Indexed: 11/23/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a severe condition that is associated with trauma-related guilt. We aimed at providing a comprehensive quantitative systematic review on the relationship between trauma-related guilt and adult PTSD. Database searches in Medline, PsycINFO, PTSDpubs and Web of Knowledge resulted in the inclusion of 163 eligible studies with a total of 35 020 trauma survivors. The studies reported on 157 cross-sectional and 19 longitudinal data points. Overall, we included 135 studies not included in previous meta-analyses. Random-effect models yielded a moderate cross-sectional correlation (r = 0.38, 95% CI 0.35-0.42, p < 0.001, I2 = 90.3%) and a small to moderate predictive correlation (r = 0.21, 95% CI 0.13-0.29, p < 0.001, I2 = 66.7%). The association appeared to be stable over time and was robust to sensitivity analyses. All symptom clusters significantly correlated with guilt. No effects were found for military v. civilian populations or clinical v. non-clinical samples. Effects were smaller for high-quality studies and larger for instruments based on DSM-5. Further significant moderators were type of guilt measure and trauma type. The largest association was found among participants reporting war-related trauma (r = 0.44, 95% CI 0.36-0.51) and the smallest among survivors of motor-vehicle accidents (r = 0.18, 95% CI 0.02-0.33). The results underpin the role of trauma-related guilt in the onset and maintenance of PTSD symptoms, which have important clinical implications. Future studies should further explore the change interactions of guilt and PTSD symptoms.
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Affiliation(s)
- Ahlke Kip
- Institute of Psychology, University of Münster, Münster, Germany
| | - Judith Diele
- Institute of Psychology, University of Münster, Münster, Germany
| | - Heinz Holling
- Institute of Psychology, University of Münster, Münster, Germany
| | - Nexhmedin Morina
- Institute of Psychology, University of Münster, Münster, Germany
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Schär S, Vehlen A, Ebneter J, Schicktanz N, de Quervain DJF, Wittmann L, Götzmann L, grosse Holtforth M, Protic S, Wettstein A, Egloff N, Streitberger K, Schwegler KIM. Guilt is effectively induced by a written auto-biographical essay but not reduced by experimental pain. Front Behav Neurosci 2022; 16:891831. [PMID: 36035017 PMCID: PMC9403731 DOI: 10.3389/fnbeh.2022.891831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionThe aim of the present study was (1) to validate the method of guilt-induction by means of a written auto-biographical essay and (2) to test whether experimental pain is apt to alleviate the mental burden of guilt, a concept receiving support from both empirical research and clinical observation.MethodsThree independent groups of healthy male participants were recruited. Group allocation was not randomized but within group pain/sham administration was counterbalanced over the two test-days. Groups were tested in the following consecutive order: Group A: guilt induction, heat-pain/sham, N = 59; Group B: guilt induction, cold-pressure-pain/sham, N = 43; Group C: emotionally neutral induction, heat-pain/sham, N = 39. Guilt was induced on both test-days in group A and B before pain/sham administration. Visual analog scale (VAS) guilt ratings immediately after pain/sham stimulation served as the primary outcome. In a control group C the identical heat-pain experiment was performed like in group A but a neutral emotional state was induced.ResultsA consistently strong overall effect of guilt-induction (heat-pain: p < 0.001, effect size r = 0.71; CPT-pain p < 0.001, r = 0.67) was found when compared to the control-condition (p = 0.25, r = 0.08). As expected, heat- and cold-pressure-stimuli were highly painful in all groups (p < 0.0001, r = 0.89). However, previous research supporting the hypothesis that pain is apt to reduce guilt was not replicated.ConclusionAlthough guilt-induction was highly effective on both test-days no impact of pain on behavioral guilt-ratings in healthy individuals could be identified. Guilt induction per se did not depend on the order of testing. The result questions previous experimental work on the impact of pain on moral emotions.
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Affiliation(s)
- Selina Schär
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Antonia Vehlen
- Abteilung für biologische und klinische Psychologie, University of Trier, Trier, Germany
| | - Julia Ebneter
- Psychology Department, University of Bern, Bern, Switzerland
| | - Nathalie Schicktanz
- Division of Cognitive and Molecular Neuroscience, University of Basel, Basel, Switzerland
| | | | - Lutz Wittmann
- International Psychoanalytic University, Berlin, Germany
| | - Lutz Götzmann
- Institute of Philosophy, Psychoanalysis and Cultural Studies, Berlin, Germany
| | - Martin grosse Holtforth
- Psychology Department, University of Bern, Bern, Switzerland
- Psychosomatic Medicine, Department of Neurology, Inselspital, University Hospital, Bern, Switzerland
| | - Sonja Protic
- International Psychoanalytic University, Berlin, Germany
- Institute of Criminological and Sociological Research, Belgrade, Serbia
| | - Alexander Wettstein
- Department of Research and Development, University of Teacher Education Bern, Bern, Switzerland
| | - Niklaus Egloff
- Psychology Department, University of Bern, Bern, Switzerland
| | - Konrad Streitberger
- Department of Anesthesiology and Pain Medicine, Pain Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kyrill I. M. Schwegler
- Division of Cognitive and Molecular Neuroscience, University of Basel, Basel, Switzerland
- *Correspondence: Kyrill I. M. Schwegler
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17
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Dunsmoor JE, Cisler JM, Fonzo GA, Creech SK, Nemeroff CB. Laboratory models of post-traumatic stress disorder: The elusive bridge to translation. Neuron 2022; 110:1754-1776. [PMID: 35325617 PMCID: PMC9167267 DOI: 10.1016/j.neuron.2022.03.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/18/2022] [Accepted: 02/28/2022] [Indexed: 12/14/2022]
Abstract
Post-traumatic stress disorder (PTSD) is a debilitating mental illness composed of a heterogeneous collection of symptom clusters. The unique nature of PTSD as arising from a precipitating traumatic event helps simplify cross-species translational research modeling the neurobehavioral effects of stress and fear. However, the neurobiological progress on these complex neural circuits informed by animal models has yet to produce novel, evidence-based clinical treatment for PTSD. Here, we provide a comprehensive overview of popular laboratory models of PTSD and provide concrete ideas for improving the validity and clinical translational value of basic research efforts in humans. We detail modifications to simplified animal paradigms to account for myriad cognitive factors affected in PTSD, which may contribute to abnormalities in regulating fear. We further describe new avenues for integrating different areas of psychological research underserved by animal models of PTSD. This includes incorporating emerging trends in the cognitive neuroscience of episodic memory, emotion regulation, social-emotional processes, and PTSD subtyping to provide a more comprehensive recapitulation of the human experience to trauma in laboratory research.
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Affiliation(s)
- Joseph E Dunsmoor
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Austin, TX, USA; Center for Psychedelic Research and Therapy, University of Texas at Austin Dell Medical School, Austin, TX, USA.
| | - Josh M Cisler
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Austin, TX, USA; Institute for Early Life Adversity Research, University of Texas at Austin, Austin, TX, USA; Center for Psychedelic Research and Therapy, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Gregory A Fonzo
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Austin, TX, USA; Institute for Early Life Adversity Research, University of Texas at Austin, Austin, TX, USA; Center for Psychedelic Research and Therapy, University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Suzannah K Creech
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Austin, TX, USA; Institute for Early Life Adversity Research, University of Texas at Austin, Austin, TX, USA
| | - Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin Dell Medical School, Austin, TX, USA; Institute for Early Life Adversity Research, University of Texas at Austin, Austin, TX, USA; Center for Psychedelic Research and Therapy, University of Texas at Austin Dell Medical School, Austin, TX, USA.
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18
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Shi C, Taylor S, Witthöft M, Du X, Zhang T, Lu S, Ren Z. Attentional bias toward health-threat in health anxiety: a systematic review and three-level meta-analysis. Psychol Med 2022; 52:604-613. [PMID: 35341486 DOI: 10.1017/s0033291721005432] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Attentional bias toward health-threat may theoretically contribute to the development and maintenance of health anxiety, but the empirical findings have been controversial. This study aimed to synthesize and explore the heterogeneity in a health-threat related attentional bias of health-anxious individuals, and to determine the theoretical model that better represents the pattern of attentional bias in health anxiety. Four databases (Web of Science, PubMed, PsycINFO, and Scopus) were searched for relevant studies, with 17 articles (N = 1546) included for a qualitative review and 16 articles (18 studies) for a three-level meta-analysis (N = 1490). The meta-analytic results indicated that the health anxiety group, compared to the control group, showed significantly greater attentional bias toward health-threat (g = 0.256). Further analyses revealed that attentional bias type, paradigm, and stimuli type were significant moderators. Additionally, compared to the controls, health-anxious individuals displayed significantly greater attention maintenance (g = 0.327) but nonsignificant attention vigilance to health-threat (g = -0.116). Our results provide evidence for the attention maintenance model in health-anxious individuals. The implications for further research and treatment of elevated health anxiety in the context of coronavirus disease-2019 (COVID-19) were also discussed.
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Affiliation(s)
- Congrong Shi
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Steven Taylor
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Xiayu Du
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Tao Zhang
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Shan Lu
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Zhihong Ren
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
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