Evaluation of a brief cognitive behavioral group intervention to reduce depersonalization in students with high levels of trait test anxiety: a randomized controlled trial

Background and objectives: Students with high levels of test anxiety frequently experience depersonalization during examinations. We investigated whether a brief cognitive behavioral group intervention reduces these symptoms.Design: Randomized controlled trial.Methods: Students with high levels of trait test anxiety and impairing depersonalization symptoms during their last oral examination were randomized. While the intervention group (n = 22) received a group training, a control group (n = 16) underwent an active waiting time protocol. Effects of the intervention on depersonalization severity and its appraisal, attention focus, emotion regulation, anxiety, heart rate, and heart rate variability within the Trier Social Stress Test for groups were examined. A follow-up assessment was conducted after a university oral examination. Registration number: DRKS00010190.Results: Depersonalization and its appraisal significantly changed within the intervention group, but not within the control group. The intervention group reported significantly less self-focused attention and fear and used the coping strategy reappraisal significantly more often. No significant Group × Time interaction was detected regarding heart rate and heart rate variability. Follow-up results give a first indication of the reduction of depersonalization through the intervention in a naturalistic setting.Conclusion: The intervention seems promising for treating depersonalization in students with high levels of trait test anxiety.

Die Cambridge Depersonalisation Scale-Situational (CDS-S) zur Erfassung von situationsabhängigem Depersonalisationserleben

Zusammenfassung. Depersonalisations- / Derealisationssymptome sind während der Konfrontation mit angstbesetzten Reizen oder Situationen häufig. Zur Erfassung dieses situationsbezogenen Depersonalisationserlebens wurde die Cambridge Depersonalisation Scale adaptiert. Die psychometrischen Gütekriterien der CDS-Situational (CDS-S) wurden in 2 Studien untersucht. 53 Patientinnen und Patienten mit Sozialer Angststörung und 32 gesunde Kontrollprobandinnen und Kontrollprobanden führten zweimal im Abstand von 4 Monaten den Trier Social Stress Test durch und schätzten anschließend die Schwere der Depersonalisation / Derealisation (CDS-S) und der Angst während des Tests ein. Ferner bearbeiteten 26 Studierende mit Prüfungsangst und 43 Studierende ohne Prüfungsangst die CDS-S direkt nach einer mündlichen Prüfung sowie 7 Tage später. Je nach Studie waren Cronbachs α (α ≥ .88), Item-Trennschärfen, Split-Half-Reliabilität ( rtt ≥ .74) und Retest-Reliabilität ( rtt = .40 – .88) zufriedenstellend bis sehr gut. Die Überprüfung der Veränderungssensitivität, Konstruktvalidität und faktoriellen Validität ergab zufriedenstellende Ergebnisse. Die CDS-S erfasste in 2 Studien situationsbezogenes Depersonalisations- / Derealisationserleben hinreichend reliabel und valide und ist zur Messung von Depersonalisations- / Derealisationssymptomen im sozialen und Leistungskontext zu empfehlen.

Depersonalization Under Academic Stress: Frequency, Predictors, and Consequences

BACKGROUND

Based on the assumptions that depersonalization symptoms are relevant for test anxiety maintenance, we examined their frequency, psychological predictors, association with anxiety symptoms, and association with test performance.

SAMPLING AND METHODS

In Study 1, 203 students rated their test anxiety severity and depersonalization in their last oral examination. In Study 2, we assessed test anxiety 1 week before an oral examination, depersonalization, safety behaviors, self-focused attention, and negative appraisals of depersonalization directly after the examination, and post-event processing 1 week later among 67 students.

RESULTS

In Study 1, 47.3% reported at least one moderate depersonalization symptom. In Study 2, test anxiety and negative appraisals of depersonalization significantly predicted depersonalization. Depersonalization was linked to a higher intensity of safety behaviors and post-event processing but not to self-focused attention. It was not related to performance.

CONCLUSION

Results are limited by the non-random sampling and the small sample size of Study 2. However, by showing that depersonalization contributes to the processes the maintenance of test anxiety, the findings confirm that depersonalization - normally understood as an adaptive mechanism to cope with stressful events - can become maladaptive.

Cognitive fatigue in patients with myasthenia gravis

INTRODUCTION

Cognitive fatigue has frequently been reported in myasthenia gravis (MG). However, objective assessment of cognitive fatigability has never been evaluated.

METHODS

Thirty-three MG patients with stable generalized disease and 17 healthy controls underwent a test battery including repeated testing of attention and concentration (d2-R) and Paced Auditory Serial Addition Test. Fatigability was based on calculation of linear trend (LT) reflecting dynamic performance within subsequent constant time intervals. Additionally, fatigue questionnaires were used.

RESULTS

MG patients showed a negative LT in second d2-R testing, indicating cognitive fatigability. This finding significantly differed from stable cognitive performance in controls (P < 0.05). Results of Paced Auditory Serial Addition Test testing did not differ between groups. Self-assessed fatigue was significantly higher in MG patients compared with controls (P < 0.001), but did not correlate with LT.

CONCLUSIONS

LT quantifies cognitive fatigability as an objective measurement of performance decline in MG patients. Self-assessed cognitive fatigue is not correlated with objective findings. Muscle Nerve 56: 449-457, 2017.