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Vrijsen JN, Grafton B, Koster EHW, Lau J, Wittekind CE, Bar-Haim Y, Becker ES, Brotman MA, Joormann J, Lazarov A, MacLeod C, Manning V, Pettit JW, Rinck M, Salemink E, Woud ML, Hallion LS, Wiers RW. Towards implementation of cognitive bias modification in mental health care: State of the science, best practices, and ways forward. Behav Res Ther 2024; 179:104557. [PMID: 38797055 DOI: 10.1016/j.brat.2024.104557] [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: 01/31/2024] [Revised: 04/17/2024] [Accepted: 05/06/2024] [Indexed: 05/29/2024]
Abstract
Cognitive bias modification (CBM) has evolved from an experimental method testing cognitive mechanisms of psychopathology to a promising tool for accessible digital mental health care. While we are still discovering the conditions under which clinically relevant effects occur, the dire need for accessible, effective, and low-cost mental health tools underscores the need for implementation where such tools are available. Providing our expert opinion as Association for Cognitive Bias Modification members, we first discuss the readiness of different CBM approaches for clinical implementation, then discuss key considerations with regard to implementation. Evidence is robust for approach bias modification as an adjunctive intervention for alcohol use disorders and interpretation bias modification as a stand-alone intervention for anxiety disorders. Theoretical predictions regarding the mechanisms by which bias and symptom change occur await further testing. We propose that CBM interventions with demonstrated efficacy should be provided to the targeted populations. To facilitate this, we set a research agenda based on implementation frameworks, which includes feasibility and acceptability testing, co-creation with end-users, and collaboration with industry partners.
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Affiliation(s)
- Janna N Vrijsen
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands; Depression Expertise Center, Pro Persona Mental Health Care, Nijmegen, the Netherlands.
| | - Ben Grafton
- Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Australia
| | - Ernst H W Koster
- Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium
| | - Jennifer Lau
- Youth Resilience Unit, Queen Mary University of London, UK
| | - Charlotte E Wittekind
- Department of Psychology, Clinical Psychology and Psychotherapy, LMU Munich, Germany
| | - Yair Bar-Haim
- School of Psychological Sciences, Tel-Aviv University, Tel Aviv-Yafo, Israel; School of Neuroscience, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Eni S Becker
- Behavioural Science Institute, Radboud University, Nijmegen, the Netherlands
| | - Melissa A Brotman
- Emotion and Development Branch, National Institute of Mental Health Intramural Research Program, National Institutes of Health, Bethesda, MD, USA
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, Conneticut, USA
| | - Amit Lazarov
- School of Neuroscience, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Colin MacLeod
- Centre for the Advancement of Research on Emotion, School of Psychological Science, University of Western Australia, Australia
| | - Victoria Manning
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia; Turning Point, Eastern Health, Melbourne, Victoria, Australia
| | - Jeremy W Pettit
- Department of Psychology and Center for Children and Families, Florida International University, Miami, FL, USA
| | - Mike Rinck
- Emotion and Development Branch, National Institute of Mental Health Intramural Research Program, National Institutes of Health, Bethesda, MD, USA
| | - Elske Salemink
- Department of Clinical Psychology, Faculty of Social and Behavioural Sciences, Utrecht University, the Netherlands
| | - Marcella L Woud
- Clinical Psychology and Experimental Psychopathology, Georg-Elias-Mueller-Institute of Psychology, University of Göttingen, Göttingen, Germany; Mental Health Research and Treatment Center, Ruhr-University Bochum, Bochum, Germany
| | | | - Reinout W Wiers
- Addiction Development and Psychopathology (ADAPT) Lab, Department of Psychology, and Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands
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Dietel FA, Rupprecht R, Seriyo AM, Post M, Sudhoff B, Reichart J, Berking M, Buhlmann U. Efficacy of a smartphone-based Cognitive Bias Modification program for emotion regulation: A randomized-controlled crossover trial. Internet Interv 2024; 35:100719. [PMID: 38370286 PMCID: PMC10869929 DOI: 10.1016/j.invent.2024.100719] [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: 10/24/2023] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 02/20/2024] Open
Abstract
Previous research has identified maladaptive emotion regulation as a key factor in psychopathology. Thus, addressing emotion regulation via scalable, low-threshold digital interventions - such as smartphone-based Cognitive Bias Modification (CBM) - holds important therapeutic potential. Using a randomized-controlled crossover trial, we tested the efficacy of an integrated CBM module within the Affect Regulation Training (ART, i.e., CBM-ART) that targeted emotion regulation through elements of appraisal-based and approach avoidance training. Undergraduate students reporting elevated stress were randomized to a one-week active intervention (Mindgames; including psychoeducation, a quiz, and CBM-ART; n = 40), active control training (Emo Shape; including placebo psychoeducation, a quiz, and a placebo swiping task; n = 36) or waitlist (n = 25). Before and after the intervention, we assessed emotion regulation, interpretation bias, stress and depression. We further tested post-training stress reactivity using an anagram task. Results indicated that the active intervention improved negative (OR = 0.35) and positive (OR = 2.40) interpretation biases and symptom measures (d = 0.52-0.87). However, active control training showed attenuated concurrent pre-post changes on interpretation biases (i.e., OR = 0.53 for negative, and OR = 1.49 for positive interpretations) and symptom measures (d = 0.26-0.91). The active intervention was rated positively in terms of acceptability and usability. These findings provide initial evidence for the efficacy and acceptability of an integrated app-based CBM intervention for emotion regulation in reducing interpretation biases and psychopathological symptoms, including stress. However, future studies should disentangle specific mechanisms underlying interventional effects.
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Machulska A, Woud ML, Brailovskaia J, Margraf J, Klucken T. Nicotine-related interpretation biases in cigarette smoking individuals. Sci Rep 2024; 14:4796. [PMID: 38413636 PMCID: PMC10899185 DOI: 10.1038/s41598-024-55256-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/21/2024] [Indexed: 02/29/2024] Open
Abstract
Addictive behaviors are characterized by information processing biases, including substance-related interpretation biases. In the field of cigarette smoking, such biases have not been investigated yet. The present study thus adopted an open-ended scenario approach to measure smoking-related interpretation biases. Individuals who smoke, those who ceased smoking, and those without a smoking history (total sample N = 177) were instructed to generate spontaneous continuations for ambiguous, open-ended scenarios that described either a smoking-related or neutral context. Overall, people who smoke generated more smoking-related continuations in response to smoking-relevant situations than non-smoking individuals or people who had stopped smoking, providing evidence for a smoking-related interpretation bias. When differentiating for situation type within smoking-relevant scenarios, smoking individuals produced more smoking-related continuations for positive/social and habit/addictive situations compared to negative/affective ones. Additionally, the tendency to interpret habit/addictive situations in a smoking-related manner was positively associated with cigarette consumption and levels of nicotine dependence. Exploratory analyses indicated that other substance-related continuations were correlated with their respective behavioral counterparts (e.g., the level of self-reported alcohol or caffeine consumption). The present study is the first to demonstrate smoking-related interpretation biases in relation to current cigarette smoking. Future studies should investigate the causal role of such biases in the initiation and/or maintainance of nicotine addiction and the merit of Interpretation-Bias-Modification training to support smoking cessation.
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Affiliation(s)
- Alla Machulska
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Siegen, Siegen, Germany.
| | - Marcella L Woud
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Psychology, Georg-August-University, Göttingen, Germany
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany
| | - Julia Brailovskaia
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany
- DZPG (German Center for Mental Health), Partner Site Bochum/Marburg, Bochum, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany
- DZPG (German Center for Mental Health), Partner Site Bochum/Marburg, Bochum, Germany
| | - Tim Klucken
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Siegen, Siegen, Germany
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Schindler-Gmelch L, Capito K, Steudte-Schmiedgen S, Kirschbaum C, Berking M. Hair Cortisol Research in Posttraumatic Stress Disorder - 10 Years of Insights and Open Questions. A Systematic Review. Curr Neuropharmacol 2024; 22:1697-1719. [PMID: 37550910 DOI: 10.2174/1570159x21666230807112425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 01/05/2023] [Accepted: 01/13/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Cortisol is one of the most extensively studied biomarkers in the context of trauma/posttraumatic stress disorder (PTSD). For more than a decade, hair cortisol concentrations (HCC) have been measured in this context, leading to a two-staged dysregulation model. Specifically, an elevated secretion during/immediately after trauma exposure eventually reverts to hyposecretion with increasing time since trauma exposure has been postulated. OBJECTIVE The aim of our systematic review was to re-evaluate the two-staged secretion model with regard to the accumulated diagnostic, prognostic, and intervention-related evidence of HCC in lifetime trauma exposure and PTSD. Further, we provide an overview of open questions, particularly with respect to reporting standards and quality criteria. METHOD A systematic literature search yielded 5,046 records, of which 31 studies were included. RESULTS For recent/ongoing (traumatic) stress, the predictions of cortisol hypersecretion could be largely confirmed. However, for the assumed hyposecretion temporally more distal to trauma exposure, the results are more ambiguous. As most studies did not report holistic overviews of trauma history and confounding influences, this may largely be attributable to methodological limitations. Data on the prognostic and intervention-related benefits of HCC remain sparse. CONCLUSION Over the last decade, important insights could be gained about long-term cortisol secretion patterns following lifetime trauma exposure and PTSD. This systematic review integrates these insights into an updated secretion model for trauma/PTSD. We conclude with recommendations for improving HCC research in the context of trauma/PTSD in order to answer the remaining open questions.
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Affiliation(s)
- Lena Schindler-Gmelch
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Klara Capito
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Susann Steudte-Schmiedgen
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | | | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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The relationship between multiple traumatic events and the severity of posttraumatic stress disorder symptoms – evidence for a cognitive link. Eur J Psychotraumatol 2023; 14:2165025. [PMID: 37052097 PMCID: PMC9879173 DOI: 10.1080/20008066.2023.2165025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background: Previous research has shown that multiple traumatic experiences cumulatively increase the risk for the development of severe symptoms of posttraumatic stress disorder (PTSD). Yet, little is known about the specific psychological mechanism through which this increased risk comes about.Objective: In the present study, we examined a possible cognitive link between multiple traumatic events and PTSD symptom severity through dysfunctional cognitions and expectations.Methods: A sample of patients with a diagnosed PTSD (N = 70; MAge = 42.06; 82% female) and high symptom burden (IES-R M = 79.24) was examined. On average, patients had experienced 5.31 different traumatic events. In a structural equation model, we tested the hypothesis that the relationship between multiple traumatic experiences and PTSD symptom severity is mediated through dysfunctional general cognitions and dysfunctional situation-specific expectations. General trauma-related cognitions were assessed with the Posttraumatic Cognition Inventory (PTCI) and trauma-related situational expectations were assessed with the Posttraumatic Expectations Scale (PTES).Results: The direct effect of the number of traumatic events on PTSD symptom severity was non-significant. Instead, as hypothesised, there was evidence for a significant indirect effect via dysfunctional general cognitions and situation-specific expectations.Conclusions: The current results further specify the cognitive model of PTSD by indicating that the relationship between the number of traumatic events and PTSD symptom severity is mediated through dysfunctional cognitions and expectations. These findings emphasise the importance of focused cognitive treatment approaches that seek to modify dysfunctional cognitions and expectations in people with multiple traumatic experiences.
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Hassdenteufel K, Müller M, Abele H, Brucker SY, Graf J, Zipfel S, Bauer A, Jakubowski P, Pauluschke-Fröhlich J, Wallwiener M, Wallwiener S. Using an Electronic Mindfulness-based Intervention (eMBI) to improve maternal mental health during pregnancy: Results from a randomized controlled trial. Psychiatry Res 2023; 330:115599. [PMID: 37988816 DOI: 10.1016/j.psychres.2023.115599] [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: 03/24/2023] [Revised: 09/08/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023]
Abstract
Prevalence rates of peripartum depression and anxiety are high and correlate with adverse maternal and neonatal outcomes. Mindfulness-based interventions (MBI) have been shown to reduce mental distress during pregnancy. A multicenter, randomized controlled study was conducted after screening for depressive symptoms. The intervention group (IG) was given access to an 8-week supervised eMBI between weeks 29 and 36 of pregnancy and followed up to 5 months postpartum. Psychometric data were collected using the Edinburgh Postnatal Depression Scale (EPDS), the State-Trait Anxiety Inventory (STAI), the Pregnancy-Related Anxiety Questionnaire (PRAQ-R), the Freiburg Mindfulness Inventory (FMI-14) as well as the Patient Health Questionnaire (PHQ). Out of 5299 pregnant women, 1153 scored >9 on the EPDS and N = 460 were included in the RCT. No significant interaction effects for depressive symptoms and anxiety were found. Pregnancy- and birth-related anxiety decreased significantly in the IG and 6 weeks after birth, the rate of women at risk for adverse mental outcome was significantly lower compared to the CG. Mindfulness scores improved significantly in the IG. The eMBI program did not show effective regarding general depressive or anxiety symptoms, however, positive results were demonstrated regarding pregnancy and birth-related anxiety and the prevention of postpartum depression.
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Affiliation(s)
- Kathrin Hassdenteufel
- Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg, Germany.
| | - Mitho Müller
- Department of Psychology, Ludwig Maximilian University, Munich, Germany
| | - Harald Abele
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Sara Yvonne Brucker
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Johanna Graf
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Armin Bauer
- Department of Women's Health, Research Institute for Women's Health, University Hospital Tübingen, Tübingen, Germany
| | - Peter Jakubowski
- Department of Women's Health, University Hospital Tübingen, Tübingen, Germany
| | | | - Markus Wallwiener
- Department of Gynecology, Martin Luther University of Halle-Wittenberg, Halle, Germany
| | - Stephanie Wallwiener
- Department of Obstetrics and Prenatal Medicine, Martin Luther University of Halle-Wittenberg, Halle, Germany
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Botschek T, Hußlein V, Peters EMJ, Brosig B. Hair cortisol as outcome parameter for psychological and neuropsychiatric interventions-a literature review. Front Psychiatry 2023; 14:1227153. [PMID: 37881597 PMCID: PMC10595010 DOI: 10.3389/fpsyt.2023.1227153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/22/2023] [Indexed: 10/27/2023] Open
Abstract
Background Studies measuring hair cortisol concentration (HCC) have been increasingly conducted to document stress-related, endocrine changes aggregated over time. Previous studies have shown that HCC reflects abnormalities in the hypothalamic-pituitary-adrenocortical axis (HPA axis) in the context of somatic diseases, such as Cushing's syndrome. HCC variations also reveal a corresponding alteration in HPA-axis-function in mental disorders, highlighting its potential role as a biomarker for interventions targeting mental health problems. Aims The aim of this study was to investigate the role of HCC in various psychological and neuropsychiatric interventions and to explore the extent to which HCC can serve as a predictive or outcome parameter in such interventions by conducting a PRISMA-compliant review of the literature. Methods From May to July 2022, the databases Web of Science, Google Scholar, PsychINFO, and ResearchGate were systematically searched using different combinations of relevant keywords. Studies of different types that examined HCC in the context of a wide range of psychological and neuropsychiatric interventions were included. Studies in languages other than English or German and animal studies were excluded. The MMAT tool was used, to assesses the Risk of bias. Results The initial search identified 334 studies. After applying the inclusion and exclusion criteria, 14 publications with a total number of 1,916 participants were identified. An association between HCC and PTSD, depressive disorders, and ongoing social and family stress can be documented. The effect of relaxation techniques, mental training, CBT, or PTSD therapy on HCC has been studied with equivocal results. Some studies found decreased HCC after treatment, while others did not show a clear effect. Baseline HCC appears to be of particular importance. In some studies, higher baseline HCC was associated with increased treatment response, providing a predictive value for HCC. Discussion HCC is increasingly being used as a biomarker for the mapping of psychological and neuropsychiatric interventions. However, due to the wide range of study populations and interventions, results are still heterogeneous. Nevertheless, HCC seems to be an encouraging biological parameter to describe the trajectory of different interventions aimed at improving mental health.
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Affiliation(s)
- Tim Botschek
- Family Psychosomatics, Department of Pediatrics and Neonatology, Justus-Liebig University Giessen, Gießen, Germany
| | - Vincent Hußlein
- Family Psychosomatics, Department of Pediatrics and Neonatology, Justus-Liebig University Giessen, Gießen, Germany
| | - Eva M. J. Peters
- Psychoneuroimmunology Laboratory, Department of Psychosomatic Medicine and Psychotherapy, Justus-Liebig University Giessen, Gießen, Germany
- Psychosomatics and Psychotherapy, Charité Center 12 Internal Medicine and Dermatology, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Burkhard Brosig
- Family Psychosomatics, Department of Pediatrics and Neonatology, Justus-Liebig University Giessen, Gießen, Germany
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Russell B, Mussap AJ. Rumination and threat-biased interpretation mediate posttraumatic stress and growth responses to military stressors. MILITARY PSYCHOLOGY 2023; 35:451-466. [PMID: 37615560 PMCID: PMC10453989 DOI: 10.1080/08995605.2022.2127618] [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: 07/07/2022] [Accepted: 09/14/2022] [Indexed: 10/14/2022]
Abstract
We examined the role of rumination and threat-biased interpretation in stress and growth responses to military stressors. Two online surveys were completed by 183 (survey 1) and 393 (survey 2) currently serving or retired military personnel. The surveys measured exposure to potential military stressors (exposure to combat, witnessing the consequences of war, and perceived moral injury), posttraumatic stress symptomatology (PTSS), posttraumatic growth (PTG), and personal wellbeing, with survey 1 including measures of rumination, and survey 2 including a measure of threat-biased interpretation. Path analyses revealed that indirect paths from both witnessing the consequences of war and experiencing betrayal to PTSS were mediated by intrusive rumination and threat-biased interpretation, and that indirect paths from both betrayal and transgressions by others to PTG were mediated by deliberate rumination and threat-biased interpretation. The results reveal the idiosyncratic nature of military stressors, their differential involvement with cognitions that underpin rumination about past events and interpretation of current events, and their relevance to posttraumatic stress and growth in military personnel.
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Affiliation(s)
- Brenton Russell
- School of Psychology, Deakin University, Melbourne, Australia
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Doering S, Herpertz S, Pape M, Hofmann T, Rose M, Imbierowicz K, Geiser F, Bierling AL, Weidner K, Rademacher J, Michalek S, Morawa E, Erim Y, Teigelack P, Teufel M, Hartmann A, Lahmann C, Peters EMJ, Kruse J, von Boetticher D, Herrmann-Lingen C, Nöhre M, de Zwaan M, Dinger U, Friederich HC, Niecke A, Albus C, Zwerenz R, Beutel M, Sattel HC, Henningsen P, Stein B, Waller C, Hake K, Spitzer C, Stengel A, Zipfel S, Weimer K, Gündel H, Kessler H. The multicenter effectiveness study of inpatient and day hospital treatment in departments of psychosomatic medicine and psychotherapy in Germany. Front Psychiatry 2023; 14:1155582. [PMID: 37608994 PMCID: PMC10440687 DOI: 10.3389/fpsyt.2023.1155582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023] Open
Abstract
Background Reliable outcome data of psychosomatic inpatient and day hospital treatment with a focus on psychotherapy are important to strengthen ecological validity by assessing the reality of mental health care in the field. This study aims to evaluate the effectiveness of inpatient and day hospital treatment in German university departments of Psychosomatic Medicine and Psychotherapy in a prospective, naturalistic, multicenter design including structured assessments. Methods Structured interviews were used to diagnose mental disorders according to ICD-10 and DSM-IV at baseline. Depression, anxiety, somatization, eating disorder and posttraumatic stress disorder (PTSD) symptoms, as well as personality functioning were assessed by means of questionnaires on admission and at discharge. Results 2,094 patients recruited by 19 participating university hospitals consented to participation in the study. Effect sizes for each of the outcome criteria were calculated for 4-5 sub-groups per outcome domain with differing severity at baseline. Pre-post effect sizes for patients with moderate and high symptom severity at baseline ranged from d = 0.78 to d = 3.61 with symptoms of PTSD, depression, and anxiety showing the largest and somatization as well as personality functioning showing somewhat smaller effects. Conclusions Inpatient and day hospital treatment in German university departments of Psychosomatic Medicine and Psychotherapy is effective under field conditions. Clinical trial registration https://drks.de/search/de/trial/DRKS00016412, identifier: DRKS00016412.
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Affiliation(s)
- Stephan Doering
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Comprehensive Clinical Center for Neurosciences and Mental Health (C3NMH), Medical University of Vienna, Vienna, Austria
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Magdalena Pape
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Tobias Hofmann
- Charité Center for Internal Medicine and Dermatology, Department of Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Matthias Rose
- Charité Center for Internal Medicine and Dermatology, Department of Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Katrin Imbierowicz
- Department of Psychosomatic Medicine and Psychotherapy, University of Bonn, Bonn, Germany
| | - Franziska Geiser
- Department of Psychosomatic Medicine and Psychotherapy, University of Bonn, Bonn, Germany
| | - Antonie Louise Bierling
- Department of Psychotherapy and Psychosomatic Medicine, Carl Gustav Carus Faculty of Medicine, Technische Universität, Dresden, Germany
- Institute for Material Science and Nanotechnology, Technical University of Dresden, Dresden, Germany
- Department of Clinical Psychology, Friedrich-Schiller University, Jena, Germany
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Carl Gustav Carus Faculty of Medicine, Technische Universität, Dresden, Germany
| | - Jörg Rademacher
- Department of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Silke Michalek
- Department of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Per Teigelack
- Clinic of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Martin Teufel
- Clinic of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Armin Hartmann
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine und Psychotherapy, Center for Mental Health, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Eva Milena Johanne Peters
- Department of Psychosomatic Medicine and Psychotherapy, Justus-Liebig University of Giessen, Giessen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus-Liebig University of Giessen, Giessen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Dirk von Boetticher
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
| | - Mariel Nöhre
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Ulrike Dinger
- Department of Psychosomatic Medicine and Psychotherapy, LVR-University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of General Internal Medicine and Psychosomatics, University Hospital, Heidelberg University, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University Hospital, Heidelberg University, Heidelberg, Germany
| | - Alexander Niecke
- Department of Psychosomatic Medicine and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christian Albus
- Department of Psychosomatic Medicine and Psychotherapy, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Rüdiger Zwerenz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Manfred Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Heribert Christian Sattel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Technical University of Munich, Munich, Germany
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Technical University of Munich, Munich, Germany
| | - Barbara Stein
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany
| | - Christiane Waller
- Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany
| | - Karsten Hake
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Rostock, Rostock, Germany
| | - Carsten Spitzer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Rostock, Rostock, Germany
| | - Andreas Stengel
- Internal Medicine VI, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Internal Medicine VI, Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Katja Weimer
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center, Ulm, Germany
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Campus Fulda, University of Marburg, Marburg, Germany
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10
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Schäfer SK, Lüder CC, Porcheret K, Hu X, Margraf J, Michael T, Holmes EA, Werner GG, Wilhelm I, Woud ML, Zeng S, Friesen E, Haim-Nachum S, Lass-Hennemann J, Lieb K, Kunzler AM, Wirth BE, Sopp MR. To sleep or not to sleep, that is the question: A systematic review and meta-analysis on the effect of post-trauma sleep on intrusive memories of analog trauma. Behav Res Ther 2023; 167:104359. [PMID: 37422952 DOI: 10.1016/j.brat.2023.104359] [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: 12/23/2022] [Revised: 06/05/2023] [Accepted: 06/18/2023] [Indexed: 07/11/2023]
Abstract
Distressing intrusive memories of a traumatic event are one of the hallmark symptoms of posttraumatic stress disorder. Thus, it is crucial to identify early interventions that prevent the occurrence of intrusive memories. Both, sleep and sleep deprivation have been discussed as such interventions, yet previous studies yielded contradicting effects. Our systematic review aims at evaluating existing evidence by means of traditional and individual participant data (IPD) meta-analyses to overcome power issues of sleep research. Until May 16th, 2022, six databases were searched for experimental analog studies examining the effect of post-trauma sleep versus wakefulness on intrusive memories. Nine studies were included in our traditional meta-analysis (8 in the IPD meta-analysis). Our analysis provided evidence for a small effect favoring sleep over wakefulness, log-ROM = 0.25, p < .001, suggesting that sleep is associated with a lower number of intrusions but unrelated to the occurrence of any versus no intrusions. We found no evidence for an effect of sleep on intrusion distress. Heterogeneity was low and certainty of evidence for our primary analysis was moderate. Our findings suggest that post-trauma sleep has the potential to be protective by reducing intrusion frequency. More research is needed to determine the impact following real-world trauma and the potential clinical significance.
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Affiliation(s)
- Sarah K Schäfer
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany; Leibniz Institute for Resilience Research (LIR), Mainz, Germany; Technische Universität Braunschweig, Department of Clinical Psychology, Psychotherapy and Psychodiagnostics, Brunswick, Germany.
| | - Charina C Lüder
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany.
| | - Kate Porcheret
- Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Xiaoqing Hu
- Department of Psychology, The University of Hong Kong, Jockey Club Tower, Centennial Campus, Hong Kong, China; The State Key Laboratory of Brian and Cognitive Sciences, The University of Hong Kong, Jockey Club Tower, Centennial Campus, Hong Kong, China; HKU-Shenzhen Institute of Research and Innovation, Shenzhen, China.
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany; DZPG (German Center for Mental Health), Germany.
| | - Tanja Michael
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany.
| | - Emily A Holmes
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Department of Psychology, Uppsala University, Uppsala, Sweden.
| | - Gabriela G Werner
- Department of Clinical Psychology & Psychotherapy, LMU Munich, Munich, Germany.
| | - Ines Wilhelm
- Division of Experimental Psychopathology and Psychotherapy, Department of Psychology, University of Zurich, Zurich, Switzerland; Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland; Department of Psychiatry and Psychotherapy, University of Luebeck, Luebeck, Germany.
| | - Marcella L Woud
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany.
| | - Shengzi Zeng
- Department of Psychology, The University of Hong Kong, Jockey Club Tower, Centennial Campus, Hong Kong, China.
| | - Edith Friesen
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany.
| | - Shilat Haim-Nachum
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.
| | - Johanna Lass-Hennemann
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany.
| | - Klaus Lieb
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany; Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.
| | - Angela M Kunzler
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany; Institute for Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Benedikt E Wirth
- Divison of Cognition & Action, Department of Psychology, Saarland University, Saarbrücken, Germany; Department of Cognitive Assistants, German Research Center for Artificial Intelligence (DFKI), Saarbrücken, Germany.
| | - M Roxanne Sopp
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Saarbrücken, Germany.
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11
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Hardarson JP, Gudmundsdottir B, Valdimarsdottir AG, Gudmundsdottir K, Tryggvadottir A, Thorarinsdottir K, Wessman I, Davidsdottir S, Tomasson G, Holmes EA, Thorisdottir AS, Bjornsson AS. Appraisals of Social Trauma and Their Role in the Development of Post-Traumatic Stress Disorder and Social Anxiety Disorder. Behav Sci (Basel) 2023; 13:577. [PMID: 37504024 PMCID: PMC10376637 DOI: 10.3390/bs13070577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 06/15/2023] [Accepted: 07/06/2023] [Indexed: 07/29/2023] Open
Abstract
Cognitive theories of post-traumatic stress disorder (PTSD) feature appraisal of trauma as a critical factor in the development and maintenance of the disorder. Here we explored appraisals of social trauma (severe rejection or humiliation). Participants were outpatients with social anxiety disorder (SAD) and clinically significant PTSD symptoms (PTSS) after social trauma (n = 15); two clinical control groups of either SAD (n = 32) or obsessive-compulsive disorder (OCD; n = 13); and a control group with no diagnoses (n = 38). Measures included a clinical interview to assess social trauma and related open-ended appraisals and the Posttraumatic Cognitions Inventory (PTCI). Raters blind to group assignment performed content analyses of appraisals. Results showed that the PTSS group scored significantly higher than either clinical group on the PTCI SELF subscale. Only the SELF subscale predicted a diagnosis of both PTSS and SAD. All but one PTSS participant reported primarily negative beliefs about their social trauma, and the most common categories were flawed self and others are critical or cruel. Post-traumatic appraisals implicated in the course of PTSD are significant in how individuals respond to social trauma, with negative self-cognitions linked to both PTSS and SAD.
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Affiliation(s)
| | - Berglind Gudmundsdottir
- Department of Medicine, University of Iceland, 102 Reykjavík, Iceland
- Department of Mental Health Services, Landspitali-The National University Hospital of Iceland, 101 Reykjavík, Iceland
| | | | | | | | | | - Inga Wessman
- Department of Psychology, University of Iceland, 102 Reykjavík, Iceland
| | - Soley Davidsdottir
- Icelandic Center for Treatment of Anxiety Disorders, 108 Reykjavík, Iceland
| | - Gunnar Tomasson
- Department of Medicine, University of Iceland, 102 Reykjavík, Iceland
| | - Emily A Holmes
- Department of Psychology, Uppsala University, 752 36 Uppsala, Sweden
| | | | - Andri S Bjornsson
- Department of Psychology, University of Iceland, 102 Reykjavík, Iceland
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12
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Kroener J, Greiner A, Sosic-Vasic Z. Cognitive bias modification for interpretation (CBM-I) for post-traumatic stress disorder: study protocol of an app-based randomised controlled trial. BMJ Open 2023; 13:e069228. [PMID: 36797017 PMCID: PMC9936272 DOI: 10.1136/bmjopen-2022-069228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
INTRODUCTION Previous studies indicate that computerised trainings implementing cognitive bias modification (CBM) for interpretation bias might be promising treatments for trauma-related cognitive distortions and symptoms. However, results are mixed, which might be related to the implemented task (sentence completion task), setting, or training duration. Within the present study, we aim to evaluate the efficacy and safety of an app-based intervention for interpretation bias using standardised imagery audio scripts, which is designed as a standalone treatment. METHODS AND ANALYSIS The study is a randomised controlled trial, implementing two parallel arms. 130 patients diagnosed with post-traumatic stress disorder (PTSD) will be allocated to either the intervention group or the waiting-list control group receiving treatment as usual. The intervention consists of 3 weeks of an app-based CBM training for interpretation bias using mental imagery, with three training sessions (20 min) per week. Two months after the last training session, 1 week of booster CBM treatment will be implemented, consisting of three additional training sessions. Outcome assessments will be conducted pretraining, 1 week post-training, 2 months post-training, as well as 1 week after the booster session (approximately 2.5 months after initial training termination). The primary outcome is interpretation bias. Secondary outcomes include PTSD-related cognitive distortions and symptom severity, as well as negative affectivity. Outcome assessment will be conducted by intention-to-treat analysis, as well as per-protocol analysis using linear mixed models. ETHICS AND DISSEMINATION The study was approved by the Ethics Committee of the State Chamber of Physicians in Baden-Wuerttemberg, Germany (number of approval: F-2022-080). Scientific findings will be published in peer-reviewed journals informing future clinical studies, which focus on the reduction of PTSD-related symptoms using CBM. TRIAL REGISTRATION NUMBER German Clinical Trials Register (DRKS00030285; https://drks.de/search/de/trial/DRKS00030285).
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Affiliation(s)
- Julia Kroener
- Department of Applied Psychotherapy and Psychiatry, Christophsbad GmbH & Co Fachkrankenhaus KG, Goppingen, Germany
- University of Ulm, Ulm, Germany
| | - Alexander Greiner
- Department of Applied Psychotherapy and Psychiatry, Christophsbad GmbH & Co Fachkrankenhaus KG, Goppingen, Germany
- University of Ulm, Ulm, Germany
| | - Zrinka Sosic-Vasic
- Department of Applied Psychotherapy and Psychiatry, Christophsbad GmbH & Co Fachkrankenhaus KG, Goppingen, Germany
- University of Ulm, Ulm, Germany
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13
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Würtz F, Steinman S, Blackwell SE, Wilhelm FH, Reinecke A, Adolph D, Margraf J, Woud ML. Effects of Training Body-Related Interpretations on Panic-Related Cognitions and Symptoms. COGNITIVE THERAPY AND RESEARCH 2023; 47:494-509. [PMID: 36788934 PMCID: PMC9910773 DOI: 10.1007/s10608-023-10358-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 02/12/2023]
Abstract
Background Interpretation biases (IBs) are central in panic disorder, and there is rich evidence showing that these are correlated with and predictive of panic-relevant symptomatology. However, experimental studies are needed to examine the potential causal effects of IBs, as predicted by cognitive models. Methods Panic-related IBs were manipulated via a sentence-completion Cognitive Bias Modification-Interpretation (CBM-I) training. The sample included N = 112 healthy participants reporting moderate levels of fear of bodily sensations. Participants were randomly allocated to a positive, negative, or control CBM-I condition. To test the trainings' effect on panic-relevant cognitive processing, IBs were assessed via proximal and distal measures. Symptom provocation tasks were applied to test transfer to panic-relevant symptomatology. Results Results on the proximal measure showed that positive CBM-I led to more positive IBs compared to negative, and control training. Further, positive CBM-I led to more positive IBs on the distal measure as compared to negative CBM-I. However, there were no differential training effects on panic-related symptomatology triggered via the provocation tasks. Conclusion The findings indicate a limited generalization of the effects of CBM-I on IBs and panic-related symptoms. Potential means to improve generalization, such as applying more nuanced measures and combining CBM-I with psychoeducation are discussed.
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Affiliation(s)
- Felix Würtz
- Mental Health Treatment and Research Center, Faculty of Psychology, Ruhr-University Bochum, Massenbergstraße 9-13, D-44787 Bochum, Germany
| | - Shari Steinman
- Psychology Department, West Virginia University, Morgantown, USA
| | - Simon E. Blackwell
- Mental Health Treatment and Research Center, Faculty of Psychology, Ruhr-University Bochum, Massenbergstraße 9-13, D-44787 Bochum, Germany
| | - Frank H. Wilhelm
- Division of Clinical Psychology and Psychopathology, Department of Psychology, Paris- Lodron University Salzburg, Hellbrunner Straße 34, 5020 Salzburg, Austria
| | - Andrea Reinecke
- Department of Psychiatry, University of Oxford, Oxford , UK
- Oxford Health NHS Foundation Trust, Oxford , UK
| | - Dirk Adolph
- Mental Health Treatment and Research Center, Faculty of Psychology, Ruhr-University Bochum, Massenbergstraße 9-13, D-44787 Bochum, Germany
| | - Jürgen Margraf
- Mental Health Treatment and Research Center, Faculty of Psychology, Ruhr-University Bochum, Massenbergstraße 9-13, D-44787 Bochum, Germany
| | - Marcella L. Woud
- Mental Health Treatment and Research Center, Faculty of Psychology, Ruhr-University Bochum, Massenbergstraße 9-13, D-44787 Bochum, Germany
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14
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Using expectation violation models to improve the outcome of psychological treatments. Clin Psychol Rev 2022; 98:102212. [PMID: 36371900 DOI: 10.1016/j.cpr.2022.102212] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/14/2022] [Accepted: 10/11/2022] [Indexed: 01/27/2023]
Abstract
Expectations are a central maintaining mechanism in mental disorders and most psychological treatments aim to directly or indirectly modify clinically relevant expectations. Therefore, it is crucial to examine why patients with mental disorders maintain dysfunctional expectations, even in light of disconfirming evidence, and how expectation-violating situations should be created in treatment settings to optimize treatment outcome and reduce the risk of treatment failures. The different psychological subdisciplines offer various approaches for understanding the underlying mechanisms of expectation development, persistence, and change. Here, we convey recommendations on how to improve psychological treatments by considering these different perspectives. Based on our expectation violation model, we argue that the outcome of expectation violation depends on several characteristics: features of the expectation-violating situation; the dynamics between the magnitude of expectation violation and cognitive immunization processes; dealing with uncertainties during and after expectation change; controlled and automatic attention processes; and the costs of expectation changes. Personality factors further add to predict outcomes and may offer a basis for personalized treatment planning. We conclude with a list of recommendations derived from basic psychology that could contribute to improved treatment outcome and to reduced risks of treatment failures.
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15
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Flechsenhar A, Kanske P, Krach S, Korn C, Bertsch K. The (un)learning of social functions and its significance for mental health. Clin Psychol Rev 2022; 98:102204. [PMID: 36216722 DOI: 10.1016/j.cpr.2022.102204] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 08/11/2022] [Accepted: 09/23/2022] [Indexed: 01/27/2023]
Abstract
Social interactions are dynamic, context-dependent, and reciprocal events that influence prospective strategies and require constant practice and adaptation. This complexity of social interactions creates several research challenges. We propose a new framework encouraging future research to investigate not only individual differences in capacities relevant for social functioning and their underlying mechanisms, but also the flexibility to adapt or update one's social abilities. We suggest three key capacities relevant for social functioning: (1) social perception, (2) sharing emotions or empathizing, and (3) mentalizing. We elaborate on how adaptations in these capacities may be investigated on behavioral and neural levels. Research on these flexible adaptations of one's social behavior is needed to specify how humans actually "learn to be social". Learning to adapt implies plasticity of the relevant brain networks involved in the underlying social processes, indicating that social abilities are malleable for different contexts. To quantify such measures, researchers need to find ways to investigate learning through dynamic changes in adaptable social paradigms and examine several factors influencing social functioning within the three aformentioned social key capacities. This framework furthers insight concerning individual differences, provides a holistic approach to social functioning, and may improve interventions for ameliorating social abilities in patients.
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Affiliation(s)
- Aleya Flechsenhar
- Department Clinical Psychology and Psychotherapy, Ludwig-Maximilians-University Munich, Germany.
| | - Philipp Kanske
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | - Sören Krach
- Department of Psychiatry and Psychotherapy, University of Lübeck, Germany
| | - Christoph Korn
- Section Social Neuroscience, Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
| | - Katja Bertsch
- Department Clinical Psychology and Psychotherapy, Ludwig-Maximilians-University Munich, Germany; NeuroImaging Core Unit Munich (NICUM), University Hospital LMU, Munich, Germany; Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany
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16
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Steil R, Fischer A, Gutermann J, Rosner R. Mental imagery in adolescent PTSD patients after child abuse: a comparison with matched healthy controls. BMC Psychiatry 2022; 22:64. [PMID: 35086493 PMCID: PMC8793273 DOI: 10.1186/s12888-022-03706-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/13/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Intrusive mental imagery (MI) plays a crucial role in the maintenance of posttraumatic stress disorder (PTSD) in adults. Evidence on the characteristics of MI in adolescents suffering from PTSD is sparse. The aim of this study was to thoroughly assess MI in an adolescent sample suffering from PTSD after the experience of childhood sexual abuse and/or childhood physical abuse (CA). METHODS Thirty-two adolescents with a primary diagnosis of PTSD after CA and 32 adolescents without any mental disorder and without a history of CA, matched for age and gender, completed questionnaires assessing the characteristics of negative and positive MI, as well as images of injury and death that lead to positive emotions (ID-images). RESULTS The PTSD group reported significantly more frequent, more vivid, more distressing and more strongly autobiographically linked negative MI compared to the control group. Although positive MI was highly present in both groups (PTSD: 65.6%; controls: 71.9%), no significant differences emerged between the two groups regarding the distinct characteristics of positive MI. The frequency of the ID-images did not significantly differ between the two groups (PTSD: 21.9%; controls: 9.4%), although the ID-images were more vivid in the PTSD group. DISCUSSION Negative MI appears to be crucial in adolescent PTSD, whilst positive MI are unexpectedly common in both the PTSD and the control group. The role of positive MI as well as that of ID-images remain unclear. Specific interventions for changing negative MI that are tailored to the developmental challenges in adolescents with PTSD should be developed. TRIAL REGISTRATION Some of the PTSD patients in this study were also part of a randomized controlled trial on Developmentally adapted Cognitive Processing Therapy (D-CPT). This trial was registered at the German Clinical Trial Registry (GCTR), DRKS00004787 , 18 March 2013.
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Affiliation(s)
- Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486 Frankfurt am Main, Germany
| | - Anne Fischer
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486 Frankfurt am Main, Germany
| | - Jana Gutermann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486 Frankfurt am Main, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstr. 25, 85072 Eichstätt, Germany
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17
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Blackwell SE, Ehring T, Gladwin TE, Margraf J, Woud ML. The relationship between self-traumatized and self-vulnerable automatic associations and posttraumatic stress symptoms among adults who have experienced a distressing life event. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02441-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AbstractConvergent evidence supports a crucial role for dysfunctional appraisals in the development and maintenance of post-traumatic stress disorder (PTSD). However, most research in this area has used self-report measures, assessing only explicit forms of such negative cognitions; the relevance of their more automatically-activated counterparts, as assumed by cognitive models, remains relatively unexplored. The current study aimed to further our understanding of the potential utility of measuring automatic dysfunctional associations in the context of posttraumatic stress. The relationship between scores on two different implicit association tests (IATs) and posttraumatic stress symptoms was investigated in a sample of adults (N = 279) who reported having experienced a potentially traumatic negative life event. Participants completed the two IATs (one assessing self-traumatized associations, the other self-vulnerable associations), a self-report measure of dysfunctional appraisals, and measures of posttraumatic stress symptoms and other aspects of psychopathology online. Scores indicating higher levels of dysfunctional associations on both IATs were associated with higher levels of posttraumatic stress symptoms. Only scores on the IAT measuring self-vulnerable associations, and not the IAT measuring self-traumatized associations, continued to show an association with posttraumatic stress symptoms after controlling for explicit dysfunctional appraisals. Overall, the results indicate the value of investigating PTSD-relevant automatic associations to further develop our understanding of cognitive processes implicated in posttraumatic stress.
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18
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Hummel KV, Schellong J, Trautmann S, Kummer S, Hürrig S, Klose M, Croy I, Weidner K, Kirschbaum C, Steudte-Schmiedgen S. The predictive role of hair cortisol concentrations for treatment outcome in PTSD inpatients. Psychoneuroendocrinology 2021; 131:105326. [PMID: 34182250 DOI: 10.1016/j.psyneuen.2021.105326] [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: 01/15/2021] [Revised: 04/30/2021] [Accepted: 06/11/2021] [Indexed: 11/18/2022]
Abstract
Psychological treatments of posttraumatic stress disorder (PTSD) are associated with non-response rates of up to 50%. This fact highlights the need to identify characteristics of poorer treatment outcome. Among others, previous evidence focused on the role of dysfunctional cortisol secretion which has been related to the development, maintenance and treatment of PTSD. Particularly, promising evidence stems from research using hair cortisol analysis which allows for a reliable assessment of cortisol secretion over several months. Another variable that has been linked to both HCC and non-response to treatment is childhood maltreatment (CM). In order to examine the predictive value of pre-treatment hair cortisol concentrations (HCC), treatment-related changes in HCC as well as CM for changes in PTSD symptomatology, we set up a prospective study in which we followed 52 female PTSD patients over the course of a trauma-focused inpatient treatment. Specifically, 3-month integrated HCC were assessed at treatment entry, at discharge and on average five months later accompanied by assessments of PTSD, overall and depressive symptomatology. CM was measured at treatment entry. Self-report indices improved following inpatient treatment. No evidence for pre-treatment HCC to be associated with changes in PTSD symptoms was revealed. However, attenuated pre-treatment HCC predicted less improvement in overall symptomatology from treatment entry to discharge. This effect lost significance after adjusting for baseline dissociative symptoms. Neither changes in HCC nor CM were predictive of treatment response. Pre-treatment cross-sectional analyses revealed no association between HCC and CM. The current hair cortisol data provided little evidence for a predictive role of lower long-term integrated cortisol secretion for poorer inpatient treatment outcome. If corroborated by further research in larger PTSD samples with much more methodological rigor, these data might be a valuable basis for future tailored research projects.
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Affiliation(s)
- Katrin V Hummel
- Faculty of Psychology, Technische Universität Dresden, Germany
| | - Julia Schellong
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Germany
| | | | - Sylvia Kummer
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Germany
| | - Sabine Hürrig
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Germany
| | - Michael Klose
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Germany
| | - Ilona Croy
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Germany
| | - Kerstin Weidner
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Germany
| | | | - Susann Steudte-Schmiedgen
- Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Germany.
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19
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Using Cognitive Bias Modification-Appraisal Training to Manipulate Appraisals about the Self and the World in Analog Trauma. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10257-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abstract
Background
Dysfunctional appraisals are a key mechanism in posttraumatic stress disorder (PTSD). Experimental manipulations of appraisals via Cognitive Bias Modification-Appraisal (CBM-App) training targeting cognitions related to the ‘self’ has shown to affect analog trauma symptoms. The present study aimed to conceptually replicate and extend previous findings by comparing a newly developed ‘world’ to the original ‘self’ training, and investigate the moderating role of locus of control (LOC) on intrusions.
Methods
Healthy participants (N = 173) were exposed to distressing films as an analog trauma induction. Next, participants received positive or negative CBM-App, targeting either self- or world-relevant appraisals. Dysfunctional appraisals and LOC were assessed pre- and post-training. During the week after the laboratory session, participants recorded their intrusions and associated distress in a diary. One week later, trauma-relevant symptomatology was assessed.
Results
Positive compared to negative CBM-App induced training-congruent appraisals, independent of the trained cognition (self vs. world). However, there was no effect on analog trauma symptoms and LOC did not moderate the training’s effect.
Conclusions
Our results underline the validity of CBM-App as a method to experimentally manipulate appraisals. However, since we did not fully replicate previous findings further research on mechanisms associated with transfer effects is warranted.
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