Entwicklung der Fünf-Item-Kurzskala STAI-SKD zur Messung von Zustandsangst

Estradiol and progesterone from pregnancy to postpartum: a longitudinal latent class analysis

Introduction

During the peripartum, women undergo significant hormonal changes that are crucial for fetal development and a healthy pregnancy and postpartum period for mother and infant. Although several studies have determined healthy norm ranges of estradiol and progesterone, there are discrepancies among the reports, rendering it unclear which hormone levels are linked to adverse health outcomes. To account for the impact of sex steroid patterns on health outcomes in mothers and children, a longitudinal assessment of different parameters is needed.

Materials and methods

We longitudinally assessed a cohort of 130 women over five months during pregnancy and postpartum. The women provided saliva samples and completed psychosocial questionnaires. Hormone analyses were conducted using enzyme-linked immunosorbent assay (ELISA). Different parameters of estradiol and progesterone were analyzed and evaluated in relation to psychometric variables. To examine the presence of heterogenous hormonal trajectories in the peripartum, we applied group-based trajectory modelling as a special case of latent-class group analysis.

Results

Estradiol and progesterone levels rose towards the end of pregnancy and dropped sharply after birth, with considerable individual variation, particularly during pregnancy. However, their ratio remained stable. We identified three estradiol trajectory subgroups and two progesterone subgroups. Age influenced progesterone levels, with older pregnant women having higher levels than younger women. Anxiety and depressive symptoms had a predictive value for trajectories of specific subgroups of women. The study also revealed two distinct subgroups regarding the course of estradiol and progesterone fluctuations as well as their ratio.

Conclusion

This study provides insights into the course and fluctuation of salivary estradiol and progesterone levels among healthy women during the peripartum period, highlighting significant variations in hormone levels but stability in their ratio during this time. The finding of distinct sex steroid courses in the peripartum is new and suggests the need for further research to explore their impact on health outcomes. Our preliminary results suggest that hormonal fluctuations at the end of pregnancy appear to be a normal occurrence and might even be a protective factor for associated psychological symptoms and sleep disturbances in women.

Test-reduced teaching for stimulation of intrinsic motivation (TRUST): a randomized controlled intervention study

BACKGROUND

The anatomy dissection course is a major part of the first two years of the traditional medical curriculum in Germany. The vast amount of content to be learned and the repeated examination is unanimously perceived by students and teachers as a major stress factor that contributes to the increase of psychosocial stress during the first two years of the course of study. Published interventions for specific stress reduction are scarce.

METHODS

In a randomized, controlled design two intervention groups were compared with a control group (CG) over the whole dissection course (nine measuring points before, during and after first and second semester). The 'Stress Management intervention (IVSM)' targeted at the setting of personal standards, the 'Friendly Feedback intervention (IVFF)' at the context of frequent testing. Quantitative surveys were distributed at nine measuring points. The questionnaire comprised validated instruments and self-developed items regarding stress, positive and negative affect, anxiety, intrinsic and extrinsic motivation, self-efficacy, and perceived performance.

RESULTS

Out of 195 students inscribed in the dissection course, 166 (85%) agreed to participate in the study. The experience of stress during the dissection course was significantly higher in the CG than in the IVFF. Anxiety and negative affect were lower in students of the IVFF while positive affect, intrinsic motivation, and self-efficacy were higher than in the CG. For anxiety and negative affect in the IVSM this was especially seen at the end of the second semester. The self-perceived increase in both knowledge and preparedness for the first big oral and written examination did not differ between the study groups. About three quarters of the participants would choose the intervention 'Friendly Feedback' if given the choice.

CONCLUSIONS

Replacing formal tests with friendly feedback has proven to be an effective measure to reduce stress and negative affect and foster positive affect, self-efficacy, and intrinsic motivation, while it did not impair self-perceived academic performance.

Interventions to alleviate anxiety and pain during venipuncture in children with chronic gastrointestinal and/or liver disease: A single-center prospective observational study

Objectives

The goal of this longitudinal study was to reduce anxiety and pain in children with chronic conditions from the gastrointestinal tract during venipuncture. These children undergo regular venipuncture as part of their medical management and the procedure is often accompanied with anxiety and pain. In addition, children as well as their parents and health care professionals (HCPs) often suffer "compassionate pain" because of emotional interference.

Method

In a realistic clinical setting, different psychological and medical interventions were examined: (1) Psychoeducational brochures and (2) four different medical-technical interventions during venipuncture. In a large hospital in Germany, 169 children, their parents, and HCPs were asked to rate anxiety and pain during venipuncture before and after the intervention.

Results

Children showed a clear preference for some of the medical-technical interventions. Using Linear Mixed Models anxiety and pain rated by the children themselves showed no significant reduction. However, parents and HCPs reported a significant reduction. Age, gender, and status of liver transplantation were associated with a reduction in anxiety and pain in most of the analyses.

Conclusion

Both psychoeducational brochures and medical-technical interventions had a positive impact on anxiety and pain. However, effectivity for the medical-technical interventions was lower than in previous studies utilizing individual interventions. Reasons for this difference as well as possibilities to improve the intervention are discussed. In addition, this study provides practical day-to-day information about the implementation of interventions for the work in pediatric units such as when and how to provide psychoeducational materials.

Optimistic vs Pessimistic Message Framing in Communicating Prognosis to Parents of Very Preterm Infants: The COPE Randomized Clinical Trial

Importance

In the neonatal intensive care unit, there is a lack of understanding about how best to communicate the prognosis of a serious complication to parents.

Objective

To examine parental preferences and the effects of optimistic vs pessimistic message framing when providing prognostic information about a serious complication.

Design, Setting, and Participants

This crossover randomized clinical trial was conducted at a single German university medical center between June and October 2021. Eligible participants were parents of surviving preterm infants with a birth weight under 1500 g. Data were analyzed between October 2021 and August 2022.

Interventions

Alternating exposure to 2 scripted video vignettes showing a standardized conversation between a neonatologist and parents, portrayed by professional actors, about the prognosis of a hypothetical very preterm infant with severe intraventricular hemorrhage. The video vignettes differed in the framing of identical numerical outcome estimates as either probability of survival and probability of nonimpairment (optimistic framing) or a risk of death and impaired survival (pessimistic framing).

Main Outcomes and Measures

The primary outcome was preference odds (ratio of preference for optimistic vs pessimistic framing). Secondary outcomes included state anxiety, perceptions of communication, and recall of numerical estimates.

Results

Of 220 enrolled parents (142 [64.5%] mothers; mean [SD] age: mothers, 39.1 [5.6] years; fathers, 42.7 [6.9] years), 196 (89.1%) preferred optimistic and 24 (10.1%) preferred pessimistic framing (preference odds, 11.0; 95% CI, 6.28-19.10; P < .001). Preference for optimistic framing was more pronounced when presented second than when presented first (preference odds, 5.41; 95% CI, 1.77-16.48; P = .003). State anxiety scores were similar in both groups at baseline (mean difference, -0.34; -1.18 to 0.49; P = .42) and increased equally after the first video (mean difference, -0.55; 95% CI, -1.79 to 0.69; P = .39). After the second video, state anxiety scores decreased when optimistic framing followed pessimistic framing but remained unchanged when pessimistic framing followed optimistic framing (mean difference, 2.15; 95% CI, 0.91 to 3.39; P < .001). With optimistic framing, participants recalled numerical estimates more accurately for survival (odds ratio, 4.00; 95% CI, 1.64-9.79; P = .002) but not for impairment (odds ratio, 1.50; 95% CI, 0.85-2.63; P = .16).

Conclusions and Relevance

When given prognostic information about a serious complication, parents of very preterm infants may prefer optimistic framing. Optimistic framing may lead to more realistic expectations for survival, but not for impairment.

Trial Registration

German Clinical Trials Register (DRKS): DRKS00024466.

Shame on Me? Love Me Tender! Inducing and Reducing Shame and Fear in Social Anxiety in an Analogous Sample

Background

Shame is considered an important factor in the development and maintenance of many psychological disorders, e.g., social anxiety disorder, and an interesting target point for therapeutic intervention.

Method

In the present experimental study, we used an online-adopted Autobiographical Emotional Memory Task (AEMT) to induce shame and tested different micro-interventions (self-compassion, cognitive reappraisal, and a control intervention) with respect to their potential to reduce shame intensity. One-hundred-and-fifteen healthy subjects participated in the study and completed a series of self-report questionnaires on self-compassion, shame, and social anxiety.

Results

The experimental shame induction was well accepted and successful (with significantly heightened feelings of shame); there were no study drop-outs. There was a significant time*condition interaction, which was due the self-compassion-based intervention resulting in a significantly larger reduction of shame than the control condition (counting fishes). In addition, the main effect of the factor experimental condition was further moderated (enhanced) by trait social anxiety and trait self-compassion.

Conclusion

The findings demonstrate the usefulness of online-adopted AEMT for the experimental induction of shame. They suggest that especially self-compassion interventions can be beneficial in alleviating intense shame experiences, which is in accordance with self-compassion theory. Overall, the results are promising in the context of experimental shame research and its potential clinical impacts call for further replication.

Risk factors and protective factors of acute postoperative pain: an observational study at a German university hospital with cross-sectional and longitudinal inpatient data

OBJECTIVES

Surgical fear is one of the most important psychological risk factors for postoperative pain, but less is known about the contribution of protective factors. This study investigated somatic and psychological risk and resilience factors of postoperative pain and validated the German version of the Surgical Fear Questionnaire (SFQ).

SETTING

University Hospital of Marburg, Germany.

DESIGN

Single-centre observational study and cross-sectional validation study.

PARTICIPANTS

Data for validating the SFQ were obtained from a cross-sectional observational study (N=198, mean age 43.6 years, 58.8% female) with persons undergoing different kinds of elective surgery. A sample of N=196 (mean age 43.0 years, 45.4% female) undergoing elective (orthopaedic) surgery was analysed to investigate somatic and psychological predictors of relevant acute postsurgical pain (APSP).

OUTCOME MEASURES

Participants completed preoperative and postoperative assessments at postoperative days 1, 2 and 7. Presurgical pain, age, gender, pain expectation, surgical setting, physical status, anaesthesia, surgical fear, pain catastrophising, depression, optimism and self-efficacy were examined as predictors.

RESULTS

Confirmatory factor analysis confirmed the original two-factor structure of the SFQ. Correlation analyses indicated good convergent and divergent validity. Internal consistency (Cronbach's α) was between 0.85 and 0.89. Blockwise logistic regression analyses for the risk of APSP revealed outpatient setting, higher preoperative pain, younger age, more surgical fear and low dispositional optimism as significant predictors.

CONCLUSIONS

The German SFQ is a valid, reliable and economical instrument with which the important psychological predictor surgical fear can be assessed. Modifiable factors that increase the risk of postoperative pain were higher pain intensity before surgery and being fearful about negative consequences of the surgery whereas positive expectations seem to buffer against postsurgical pain.

TRIAL REGISTRATION NUMBERS

DRKS00021764 and DRKS00021766.

Online learning during the Covid-19 pandemic: How university students' perceptions, engagement, and performance are related to their personal characteristics

University students faced unexpected challenges in online learning during the Covid-19 pandemic. Findings from early phases of the Covid-19 pandemic and before show that online learning experiences may vary from student to student and depend on several personal characteristics. However, the relative importance of different students' personal characteristics for their online learning experiences at later phases of the Covid-19 pandemic is still unclear. This cross-sectional, correlational study investigates how personal characteristics of university students are related to five dimensions of online learning perception and to their engagement and performance in online courses. In an online survey, 413 students from German universities provided full information on their online learning experiences and personal characteristics in terms of demographic information, Big Five personality traits, self-regulation skills, three facets of self-efficacy, and two types of state anxiety. Results of multiple regression analyses show that students' age was significantly positively related to all online learning perceptions and engagement in online courses. Our findings also confirm that self-regulation skills and academic and digital media self-efficacy are important factors in various online learning experiences. In contrast, students' personality traits and state anxiety were less important for most online learning experiences. Noteworthy, several bivariate associations between personal characteristics and online learning experiences are not reflected in the multiple regression model. This underscores the need to consider relevant variables simultaneously to evaluate their relative importance and to identify key personal characteristics. Overall, our results show valuable starting points for theory development and educational interventions.

Preparing patients according to their individual coping style improves patient experience of magnetic resonance imaging

MRI-related anxiety is present in 30% of patients and may evoke motion artifacts/failed scans, which impair clinical efficiency. It is unclear how patient anxiety can be countered most effectively. Habitual preferences for coping with stressful situations by focusing or distracting one’s attention thereof (coping style) may play a key role in this context. This study aimed to compare the effectiveness of two patient-preparation videos with informational vs. relaxational content and to determine whether the fit between content and coping style affects effectivity. The sample consisted of 142 patients (M = 48.31 ± 15.81 years). Key outcomes were anxiety, and cortisol as a physiological stress marker. When not considering coping style, neither intervention improved the patients’ reaction; only patient preparation that matched the patients’ coping style was associated with an earlier reduction of anxiety. This suggests that considering individual preferences for patient preparation may be more effective than a one-size-fits-all approach.

Effects of psychosocial stress and performance feedback on pain processing and its correlation with subjective and neuroendocrine parameters

OBJECTIVES

Previous research on stress-induced pain modulation suggests that moderate psychological stress usually leads to hyperalgesia while more severe threat results in hypoalgesia. However, existing studies often lack suitable control conditions imperative to identify mere stress effects. Similarly, research mainly focused on pure anticipation of a social threat, not taking into consideration actual experiences of social evaluation. Therefore, we set out to investigate actual social up- and downgrading combined with a standardized stress paradigm to evaluate short-term and prolonged changes in pain perception and their potential association with neuroendocrine and subjective stress parameters.

METHODS

We allocated 177 healthy women to four experimental conditions, either the standard version of the Trier Social Stress Test (TSST) followed by positive, negative or no performance feedback, or a well-matched but less demanding placebo version of the TSST. Stress responses were assessed with ratings, salivary alpha-amylase, and salivary cortisol. To capture putative effects of stress on pain, heat pain threshold, ratings of phasic heat pain stimuli, and conditioned pain modulation were measured.

RESULTS

Despite a largely successful stress induction, results do not support a reliable influence of experimentally induced social stress-with or without subsequent performance feedback-on pain in women. Further, we found no clear association of pain modulation and changes in neuroendocrine or subjective stress responses.

CONCLUSIONS

Our results contrast previous studies, which repeatedly demonstrated stress-induced hypo- or hyperalgesia. This might be due to methodological reasons as former research was often characterized by high heterogeneity regarding the applied stressors, low sample sizes, and lacking or inconclusive control conditions. Thus, our results raise the question whether pain modulation in women by experimental psychosocial stress might have been overestimated in the past. Future research is necessary, which should employ parametric stress induction methods including well-matched control tasks, taking into consideration the participants' gender/sex and the time course of the stress response relative to pain assessment. The study is registered as DRKS00026946 at 'Deutsches Register Klinischer Studien' (DRKS) and can be also found at the World Health Organization's search portal.

German University Students' Perspective on Remote Learning During the COVID-19 Pandemic: A Quantitative Survey Study With Implications for Future Educational Interventions

The COVID-19 pandemic forced German universities to adjust their established operations quickly during the first nationwide lockdown in spring 2020. Lecturers and students were confronted with a sudden transition to remote teaching and learning. The present study examined students' preparedness for and perspective on this new situation. In March and April 2020, we surveyed n = 584 students about the status quo of their perceived digital literacy and corresponding formal learning opportunities they had experienced in the past. Additionally, the students reported the direction of changes in key study characteristics they expected from this new situation. Moreover, they reported the extent to which they believe they will be able to master this new study situation successfully. Two categories of independent variables were considered: context-related variables and person-related variables. Our results show that students did not have many learning opportunities to promote their digital literacy, suggesting that they were not appropriately prepared for this new situation. Results for digital literacy vary by competence area. However, there is a positive correlation between past formal learning opportunities and corresponding digital competences. Master students reported more learning opportunities and higher digital literacy only in one competence area compared to bachelor students. Regarding the expected change of key study characteristics, some characteristics were expected to worsen and fewer to improve. A multiple regression analysis explained 54% of the estimated probability of successful remote learning. Students' age, state anxiety, positive state affect, general self-efficacy, the availability of an own workplace, past learning opportunities in digital content creation, and the estimated preparedness of lecturers for remote teaching were significant explaining factors. Our results provide valuable insights into the perspective of students on studying during the COVID-19 pandemic and beyond. We discuss important factors that should be addressed by educational measures in the future.

The COPE-Trial-Communicating prognosis to parents in the neonatal ICU: Optimistic vs. PEssimistic: study protocol for a randomized controlled crossover trial using two different scripted video vignettes to explore communication preferences of parents of preterm infants

BACKGROUND

One of the numerous challenges preterm birth poses for parents and physicians is prognostic disclosure. Prognoses are based on scientific evidence and medical experience. They are subject to individual assessment and will generally remain uncertain with regard to the individual. This can result in differences in prognostic framing and thus affect the recipients' perception. In neonatology, data on the effects of prognostic framing are scarce. In particular, it is unclear whether parents prefer a more optimistic or a more pessimistic prognostic framing.

OBJECTIVE

To explore parents' preferences concerning prognostic framing and its effects on parent-reported outcomes and experiences. To identify predictors (demographic, psychological) of parents' communication preferences.

DESIGN, SETTING, PARTICIPANTS

Unblinded, randomized controlled crossover trial (RCT) at the Division of Neonatology of the University Medical Center Mainz, Germany, including German-speaking parents or guardians of infants born preterm between 2010 and 2019 with a birth weight < 1500 g. Inclusion of up to 204 families is planned, with possible revision according to a blinded sample size reassessment.

INTERVENTION

Embedded in an online survey and in pre-specified order, participants will watch two video vignettes depicting a more optimistic vs. a more pessimistic framing in prognostic disclosure to parents of a preterm infant. Apart from prognostic framing, all other aspects of physician-parent communication are standardized in both videos.

MAIN OUTCOMES AND MEASURES

At baseline and after each video, participants complete a two-part online questionnaire (baseline and post-intervention). Primary outcome is the preference for either a more optimistic or a more pessimistic prognostic framing. Secondary outcomes include changes in state-anxiety (STAI-SKD), satisfaction with prognostic framing, evaluation of prognosis, future optimism and hope, preparedness for shared decision-making (each assessed using customized questions), and general impression (customized question), professionalism (adapted from GMC Patient Questionnaire) and compassion (Physician Compassion Questionnaire) of the consulting physician.

DISCUSSION

This RCT will explore parents' preferences concerning prognostic framing and its effects on physician-parent communication. Results may contribute to a better understanding of parental needs in prognostic disclosure and will be instrumental for a broad audience of clinicians, scientists, and ethicists.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00024466 . Registered on April 16, 2021.

Communicating the diagnosis of cancer or depression: Results of a randomized controlled online study using video vignettes

Background

Communicating a diagnosis is highly important, yet complex, especially in the context of cancer and mental disorders. The aim was to explore the communication style of an oncologist vs. psychotherapist in an online study.

Methods

Patients (N = 136: 65 cancer, 71 depression) were randomly assigned to watch a standardized video vignette with one of two communication styles (empathic vs. unempathic). Outcome measures of affectivity, information recall, communication skills, empathy and trust were applied.

Results

Regardless of diagnosis, empathic communication was associated with the perception of a significantly more empathic (p < 0.001, ηpartial2 = 0.08) and trustworthy practitioner (p = 0.014, ηpartial2 = 0.04) with better communication skills (p = 0.013, ηpartial2 = 0.05). Cancer patients reported a larger decrease in positive affect (p < 0.001, ηpartial2 = 0.15) and a larger increase in negative affect (p < 0.001, ηpartial2 = 0.14) from pre‐ to post‐video than depressive patients. Highly relevant information was recalled better in both groups (p < 0.001, d = 0.61–1.06).

Conclusions

The results highlight the importance of empathy while communicating both a diagnosis of cancer and a mental disorder. Further research should focus on the communication of a mental disorder in association with cancer.

Health behaviors and mental health during the COVID-19 pandemic: A longitudinal population-based survey in Germany

OBJECTIVE

To understand the mental health response to repeated and prolonged stress during the COVID-19 related lockdown and the role of specific health behaviors to buffer against this stress.

METHODS

In a longitudinal study with several measurement points covering three months during the COVID-19 pandemic, about 3500 randomly selected participants representative of the German population reported on their mental health (anxiety, depression, loneliness) and health behaviors (screen time, snack consumption, physical activity).

RESULTS

Symptoms of anxiety, depression, and loneliness were highest shortly after the lockdown came into effect. Over time, the symptoms were stable or went down slightly, corresponding to patterns of habituation. Among people with higher vulnerability to poor mental health during the lockdown (e.g., women), the proportion with high levels of anxiety, depression, and loneliness was considerably larger. These groups also reported fewer health-promoting behaviors. More screen time, more snacking, and less physical activity were related to higher symptoms of anxiety, depression, and loneliness across all time points. Changes in health behaviors over time mostly did not predict changes in mental health symptoms.

CONCLUSIONS

Mental health and engagement in protective health behaviors was lowest at the start of the lockdown. Health behaviors mostly returned to pre-lockdown levels within three months. Engaging in healthier behaviors was associated with better mental health. Policy implications of these findings are discussed. This study provides important insights into (unintended) side effects of an international crisis and can contribute to a better understanding of how to preserve mental health.

A Sorrow Shared Is a Sorrow Halved? Patient and Parental Anxiety Associated with Venipuncture in Children before and after Liver Transplantation

Taking blood via venipuncture is part of the necessary surveillance before and after liver transplantation. The spectrum of response from children and their parents is variable, ranging from a short and limited aversion to paralyzing phobia. The aim of this retrospective, cross-sectional study was to determine the level of anxiety amongst children during venipuncture, to compare the anxiety reported by children and parents, and to identify the factors affecting the children’s and parents’ anxiety in order to develop therapeutic strategies. In total, 147 children (aged 0–17 years, 78 female) and their parents completed questionnaires. Statistical analysis was performed using qualitative and quantitative methods. Results showed that the majority of children reported anxiety and pain during venipuncture. Younger children had more anxiety (self-reported or assessed by parents). Children and parental reports of anxiety were highly correlated. However, the child’s anxiety was often reported as higher by parents than by the children themselves. The child’s general anxiety as well as the parents’ perceived stress from surgical interventions (but not the number of surgical interventions) prompted parental report of child anxiety. For children, the main stressors that correlated with anxiety and pain were factors during the blood collection itself (e.g., feeling the puncture, seeing the syringe). Parental anxiety was mainly related to circumstances before the blood collection (e.g., approaching the clinic, sitting in the waiting room). The main stressors mentioned by parents were the child’s discomfort and their inability to calm the child. Results indicate that the children’s fear of factors during the blood collection, along with the parents’ perceived stress and helplessness as well as their anticipatory anxiety are important starting points for facilitating the drawing of blood from children before and after liver transplantation, thereby supporting a better disease course in the future.

Revisiting the Postulates of Etiological Models of Eating Disorders: Questioning Body Checking as a Longer-Term Maintaining Factor

Body checking (BC) is not only inherent to the maintenance of eating disorders but is also widespread among healthy females. According to etiological models, while BC serves as an affect-regulating behavior in the short term, in the longer term it is assumed to be disorder-maintaining and also produces more negative affect. The present study therefore aimed to empirically examine the proposed longer-term consequences of increased BC. In an online study, N = 167 women tracked their daily amount of BC over a total of 7 days: Following a 1-day baseline assessment of typical BC, participants were asked to check their bodies in an typical manner for 3 days and with a 3-fold increased frequency for 3-days. Before and after each BC episode, the impact of BC on affect, eating disorder symptoms, general pathology and endorsement of different functions of BC was assessed. Participants showed longer-term consequences of increased BC in terms of increased negative affect and general pathology, while eating disorder symptoms remained unaffected. In the case of typical BC, participants showed decreased general pathology and anxiety. Furthermore, the endorsement of a higher number of BC functions led to increased negative affect and an increased amount of typical BC. The findings support the theoretically assumed role of maladaptive BC in maintaining negative emotion in the longer term. However, though requiring replication, our finding of positive effects of typical BC calls into question the overall dysfunctionality of BC among non-clinical women who are not at risk of developing an eating disorder.

Creative Music Therapy with Premature Infants and Their Parents: A Mixed-Method Pilot Study on Parents' Anxiety, Stress and Depressive Symptoms and Parent-Infant Attachment

Premature birth is stressful for infants and parents and can adversely affect the parent–infant dyad. This mixed-methods pilot study evaluates whether creative music therapy (CMT) can alleviate anxiety, stress, and depressive symptoms in parents and support the bonding process with their infant. Sixteen parent couples were included. Ten couples were randomly allocated to the music therapy group (MTG) and six to the control group (CG). All couples completed psychological questionnaires measuring anxiety and depressive symptoms as well as an implicit measure of parent–infant attachment at two weeks postpartum (T1), at approximate neonatal intensive care unit (NICU) hospitalization halftime (T2), and two weeks after the infant had been discharged (T3). At T1 and T2, the parents additionally completed a questionnaire assessing the degree of stress they experienced at the NICU. Qualitative data were collected through a semi-structured, problem-centered interview with MTG parents at T3. The results of the quantitative analyses revealed reductions in anxiety levels from T1 to T2 (p = 0.002) as well as decreases in depressive symptoms from T2 to T3 (p = 0.022). No such changes were apparent in the CG. In fact, parental stress increased from T1 to T2 (p = 0.016). Significant increases in attachment across time were also observed within the MTG, but not in the CG. The qualitative inquiry confirmed that CMT can support the parent–infant relationship. Being in musical interaction evoked feelings of joy and relaxation in the parents and encouraged them to interact more profoundly with their infant. The results call for a more extensive powered follow-up study to further investigate CMT’s potential for parental well-being and parent–infant bonding.

Stop Thinking: An Experience Sampling Study on Suppressing Distractive Thoughts at Work

In modern work environments, it can be difficult for workers to avoid becoming distracted from their current task. This study investigates person-situation interactions to predict thought control activities (kind of self-control), which aim to stop distracting thoughts that enter the mind. Specifically, it was examined (1) how challenging work demands (time pressure, task complexity) activate workers' thought control to stop distractive thoughts (n level 2 = 143) and relate to the effort to do so (n level 2 = 91) in daily working life and (2) how these relationships differ according workers' general cognitive ability to suppress unwanted thoughts. To understand these person-situation interactions, an experience sampling study was combined with a laboratory task assessing the ability to suppress unwanted thoughts (think/no-think task). Multilevel modeling revealed that workers' engage more often and more intensively in thought control activities at a moderate level of time pressure but only when they had a higher general ability to suppress unwanted thoughts. For workers with a lower ability to suppress unwanted thoughts, increasing time pressure was negatively related to thought control activities, even at very low levels of time pressure. Thus, whether time pressure activates or hinders thought control depends on individuals' ability to suppress distractive thoughts.

Standardized patients in psychotherapy training and clinical supervision: study protocol for a randomized controlled trial

Background

Psychotherapy is highly effective and widely acknowledged for treating various mental disorders. Nevertheless, in terms of methods for teaching effective psychotherapeutic approaches and competencies, there has been a lack of investigation. Training and supervision are the main strategies for teaching therapist competencies, and standardized role-plays with simulated patients (i.e., trained individuals playing someone with a mental disorder) seem useful for evaluating training approaches. In medical education, this procedure is now internationally established. However, so far, little use has been made of standardized role-playing to evaluate training and supervision in the area of clinical psychology and psychotherapy.

Methods

In this study, standardized role-plays are used to evaluate methods for training and supervision. Central cognitive behavioral approaches for treating depression are taught in the training. The first experiment compares an active training approach (i.e., model learning) with a passive one (i.e., reading manual-based instructions). The second experiment compares a direct supervision technique (i.e., supervision based on video analysis) with an indirect one (i.e., supervision based on verbal reporting). In each experiment, 68 bachelor’s and master’s students of psychology will be randomly assigned to the experimental and control groups. Each student takes part in three role-plays (baseline, post and 3-month follow-up), which are all videotaped. Two independent raters assess therapist competencies in each role-play on the basis of a standardized competence scale.

Discussion

The research project aims to contribute to the development of specific training and supervision methods in order to improve psychotherapy training and patient care.

Trial registration

ISRCTN Registry, ISRCTN19173895. Registered on 10 December 2019.

Creative Flexibility Performance Is Neither Related to Anxiety, Nor to Self-Control Strength, Nor to Their Interaction

Previous research has reliably found that self-control strength moderates the anxiety-performance relationship for cognitive and perceptual-motor tasks that involve executive functioning. In the present preregistered experiment (N = 200; https://aspredicted.org/a775h.pdf), we investigated whether the interaction of anxiety and self-control also predicts creative flexibility performance. According to the Attentional Control Theory, anxiety can impair executive functioning. In the case that creative flexibility relies on executive functions, anxiety should therefore interfere with creative flexibility performance. However, self-control strength has been demonstrated to serve as a buffer against the negative effects of anxiety on executive functioning. Therefore, we assumed that there will be a negative relationship between anxiety and creative flexibility performance, and that this negative relationship would be more pronounced for participants who are low compared to high in momentary self-control strength. Analogous to the previous studies, we manipulated the participants’ self-control strength (ego depletion vs. no depletion) and subsequently induced a potentially threatening test situation. The participants then completed a measure of their state anxiety and a standardized test of creative flexibility. Contrary to our expectation, self-control strength, state anxiety, and their interaction did not predict creative flexibility performance. Complementary Bayesian hypothesis testing revealed strong support for the null hypothesis. Therefore, we conclude that, at least under certain conditions, creative flexibility performance may be unrelated to resource-dependent executive functions.

[Assessment of mental symptoms in intensive care unit patients : Suggestion for a German version of the Intensive Care Psychological Assessment Tool]

BACKGROUND

Intensive care unit (ICU) treatment may be associated with mental symptoms such as anxiety, depressed mood, hopelessness and nightmares in critically ill patients. While many physical symptoms can be detected via standardized measures, an instrument to assess mental symptoms is actually missing.

OBJECTIVES

An existing validated screening tool to detect mental symptoms in critically ill patients, the Intensive Care Psychological Assessment Tool (IPAT), has been translated into German and tested in two surgical ICUs and an intermediate care unit.

MATERIALS AND METHODS

In addition to the German translation of the IPAT, Stait-Trait-Anxiety-Inventory (STAI-SKD) and Hospital Anxiety and Depression Scale (HADS-D) were used to determine convergent validity. Within a survey period of 3 months, a total of 90 awake and fully oriented patients were included in the study.

RESULTS

Internal consistency of the German translation was lower than that of the original study. The initial factor structure was partially replicated. Convergent validity was demonstrated for depressive and anxiety symptoms, but not for the presence of delirium. Patients who completed the screening were frequently suffering from sleep disturbances, tension, anxiety and depressed mood. A total of 37% of the patients exceeded the cut-off and are considered at-risk patients for psychological sequelae.

DISCUSSION

With regard to test quality, the results of the German version are currently not satisfactory. This may be due to the small sample size and sample selectivity, which is also the largest limitation of the study. The instrument proved to be practicable if patients can complete it as an interview. The adaptation for external assessment seems to be useful to capture psychological stress in patients with impaired communication and perception.

Affect and worry during a checking episode: A comparison of individuals with symptoms of obsessive-compulsive disorder, anorexia nervosa, bulimia nervosa, body dysmorphic disorder, illness anxiety disorder, and panic disorder

Checking behavior (CB) occurs in a variety of disorders such as obsessive-compulsive (OCD), body dysmorphic (BDD), illness anxiety (IA), and panic disorder (PD), as well as anorexia (AN) and bulimia nervosa (BN). Etiological models of these disorders - with the exception of those for PD - postulate that CB mainly occurs in situations characterized by negative affect and serves to regulate it. We aimed to test these assumptions: N = 386 individuals with a self-reported diagnosis of one of the disorders rated their affect at baseline, directly before a remembered CB episode, during, immediately afterwards, and 15 and 60 minutes afterwards, and rated their endorsement of different functions of CB. The results show that transdiagnostically negative affect is significantly higher before CB compared to baseline, and is significantly reduced from before CB to all post-CB assessments. Reduction of negative affect and Attainment of certainty were the sole functions predicting the affective course during CB, and most prominently reported transdiagnostically. Assumptions of the etiological models were confirmed, suggesting that exposure and ritual prevention should be examined across disorders. As attainment of certainty seems to be predictive for the course of CB, this might be targeted in cognitive interventions.

Does precautionary information about electromagnetic fields trigger nocebo responses? An experimental risk communication study

BACKGROUND

Regarding electromagnetic fields from mobile communication technologies, empirical studies have shown that precautionary information given to lay recipients increases their risk perceptions, i.e. the belief that electromagnetic fields are dangerous. Taking this finding one step further, the current study investigates whether precautionary information also leads to higher symptom perceptions in an alleged exposure situation. Building on existing research on nocebo responses to sham electromagnetic fields, an interaction of the precautionary information with personality characteristics was hypothesised.

METHODS

An experimental design with sham exposure to an electromagnetic field of a WLAN device was deployed. The final sample is constituted by N = 137 participants. Participants received either only basic information about the safety of current WLAN exposure limits or in addition also precautionary information (e.g. 'prefer wired connections if wireless technology can be relinquished'). Subsequently, symptoms and other variables were assessed before and after sham exposure to a WLAN electromagnetic field.

RESULTS

Results are not in favour of the hypothesised effects. There was neither a main effect of precautionary information, nor were there any of the hypothesised interaction effects of precautionary information and personality characteristics on perceived symptoms under sham exposure. Exploratory analyses highlight the role of prior risk perception as a predictor of nocebo responses, and of symptom expectations as a mediator between these two variables.

CONCLUSIONS

As the statistical power to detect even small effects was relatively high, we interpret this as a robust indication that precautionary information does not lead to increased nocebo responses by itself. The implications for health authorities´ communication with the public are discussed.

Oxytocin facilitates social approach behavior in women

In challenging environments including both numerous threats and scarce resources, the survival of an organism depends on its ability to quickly escape from dangers and to seize opportunities to gain rewards. The phylogenetically ancient neurohormonal oxytocin (OXT) system has been shown to influence both approach and avoidance (AA) behavior in men, but evidence for comparable effects in women is still lacking. We thus conducted a series of pharmacological behavioral experiments in a randomized double-blind study involving 76 healthy heterosexual women treated with either OXT (24 IU) or placebo intranasally. In Experiment 1, we tested how OXT influenced the social distance subjects maintained between themselves and either a female or male experimenter. In Experiment 2, we applied a reaction time based AA task. In Experiment 3 we investigated effects on peri-personal space by measuring the lateral attentional bias in a line bisection task. We found that OXT specifically decreased the distance maintained between subjects and the male but not the female experimenter and also accelerated approach toward pleasant social stimuli in the AA task. However, OXT did not influence the size of peri-personal space, suggesting that it does not alter perception of personal space per se, but rather that a social element is necessary for OXT's effects on AA behavior to become evident. Taken together, our results point to an evolutionarily adaptive mechanism by which OXT in women selectively promotes approach behavior in positive social contexts.

The role of self-control strength in the development of state anxiety in test situations

Self-control strength may affect state anxiety because emotion regulation is impaired in individuals whose self-control strength has been temporarily depleted. Increases in state anxiety were expected to be larger for participants with depleted compared to nondepleted self-control strength, and trait test anxiety should predict increases in state anxiety more strongly if self-control strength is depleted. In a sample of 76 university students, trait test anxiety was assessed, self-control strength experimentally manipulated, and state anxiety measured before and after the announcement of a test. State anxiety increased after the announcement. Trait test anxiety predicted increases in state anxiety only in students with depleted self-control strength, suggesting that increased self-control strength may be useful for coping with anxiety.

Fear of crime in old age: precautious behaviour and its relation to situational fear

This study aimed to provide further insight into the question of why older adults show a higher precautionary behaviour regarding crime (behavioural fear), although they do not estimate their victimisation risk as higher than young adults and they do not experience fear more often. In two cross-sectional studies, the hypothesis was tested that the age-related increase in precautionary behaviour is an expression of higher dispositional fear with age. The vignette technique was employed to induce situational fear of crime across various situations as a proxy for dispositional fear. In contrast to the hypothesis, in Study 1 (young: 18-30 years, N = 179 vs. middle-aged: 50-64 years, N = 106), only younger adults reported higher situational fear in two vignettes. In Study 2 (young: 18-30 years, N = 129 vs. young-old: 65-84 years, N = 114), younger adults indicated higher situational fear again; however, young-old adults reported higher situational fear in other vignettes. The findings suggest that there is no general increase in the intensity of situational fear of crime with age and thus no age-related change in dispositional fear. Moreover, situational fear did not serve as mediator in the relationship between age and precautionary behaviour. Alternative accounts for the increase in behavioural fear of crime are discussed as well as emotion regulation mechanisms in response to the induction method.