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Friehs T, Milde C, Glombiewski JA, Kube T. Change in pain expectations but no open-label placebo analgesia: An experimental study using the heat pain paradigm. Eur J Pain 2024; 28:769-785. [PMID: 38108636 DOI: 10.1002/ejp.2216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/24/2023] [Accepted: 11/22/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Open-label placebos (OLP) prescribed without deception and with a convincing rationale have been shown to evoke powerful treatment effects. Patients' treatment expectations seem to influence the magnitude of the effect. OBJECTIVE We examined if two different OLP rationales increased pain tolerance and reduced pain intensity and unpleasantness in a standardized heat pain experiment. METHODS Participants (N = 71) who self-reported reoccurring pain for at least the last 3 months were randomly assigned to one of three groups. We compared a personal-emotional and a scientific-matter-of-fact rationale with a control group (CG) that received the same placebo without any rationale. The rationale suggested a desensitizing effect on pain perception and improved pain coping of the placebo, whereas in the CG it was introduced as an ointment for measurement. The primary outcomes were pre-post changes in pain tolerance, expected and experienced pain intensity and unpleasantness. RESULTS Participants showed a decrease in expected pain intensity, but not expected pain unpleasantness for both rationales. There were no differences in pain tolerance and experienced pain intensity and unpleasantness. CONCLUSIONS Our study suggests that evoking positive treatment expectations is not sufficient to elicit an OLP response. Possibly, the magnitude of expectations change in this study was not powerful enough to evoke an OLP effect. Additionally, it is possible that OLP effects in pain are unrelated to positive treatment expectations. The failure of OLP in our study is in contrast to a number of previous studies examining the effects of OLP in experimental and clinical pain. SIGNIFICANCE This study provides evidence that positive treatment expectations are not sufficient to evoke an open-label placebo effect in a standardized heat pain experiment. We showed that two different rationales improved participants treatment expectations, but failed to evoke a placebo effect in comparison to a control group that received the same placebo, labelled as an ointment to improve measurement quality.
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Affiliation(s)
- Thilo Friehs
- Pain and Psychotherapy Research Lab, Department for Adult Clinical Psychology and Psychotherapy, University of Kaiserslautern-Landau (RPTU), Landau, Germany
| | - Christopher Milde
- Pain and Psychotherapy Research Lab, Department for Adult Clinical Psychology and Psychotherapy, University of Kaiserslautern-Landau (RPTU), Landau, Germany
| | - Julia Anna Glombiewski
- Pain and Psychotherapy Research Lab, Department for Adult Clinical Psychology and Psychotherapy, University of Kaiserslautern-Landau (RPTU), Landau, Germany
| | - Tobias Kube
- Pain and Psychotherapy Research Lab, Department for Adult Clinical Psychology and Psychotherapy, University of Kaiserslautern-Landau (RPTU), Landau, Germany
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Haim-Nachum S, Kube T, Rozenkrantz L, Lazarov A, Levy-Gigi E, Michael T, Neria Y, Sopp MR. Does disconfirmatory evidence shape safety-and danger-related beliefs of trauma-exposed individuals? Eur J Psychotraumatol 2024; 15:2335788. [PMID: 38626065 PMCID: PMC11022916 DOI: 10.1080/20008066.2024.2335788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/11/2024] [Indexed: 04/18/2024] Open
Abstract
Recent accounts of predictive processing in posttraumatic stress disorder (PTSD) suggest that trauma-exposed individuals struggle to update trauma-related hypotheses predicting danger, which may be involved in the etiology and maintenance of this disorder. Initial research supports this account, documenting an association between trauma-exposure, impaired expectation updating, and PTSD symptoms. Yet, no study to date has examined biased belief updating in PTSD using a scenario-based approach.Objective: Here, we examined the predictive processing account among trauma-exposed and non-trauma-exposed individuals using a modified Trauma-Related version of the Bias Against Disconfirmatory Evidence task.Method: The task presents both danger-and safety-related scenarios highly relevant for trauma-exposed individuals. For each scenario, participants viewed several explanations and rated their plausibility. Their ability to update their initial interpretation following new-contradictory information was assessed.Results: Preregistered analyses did not reveal any significant findings. Based on indications that our sample may not have been sufficiently powered, we conducted exploratory analyses in an extended sample of participants. These analyses yielded a significant association between reduced belief updating and PTSD symptoms which was evident for disconfirming both safety and danger scenarios. However, the effect sizes we found were in the small-to-medium range.Conclusion: Although preliminary, our current findings support initial evidence that individuals with higher PTSD symptoms show a higher resistance to update their beliefs upon new disconfirmatory evidence. Our results should be interpreted cautiously in light of the extended sample and the limitations of the current study.
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Affiliation(s)
- Shilat Haim-Nachum
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Tobias Kube
- Department of Clinical Psychology and Psychotherapy, RPTU University of Kaiserslautern-Landau, Landau, Germany
| | | | - Amit Lazarov
- School of Psychological Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Einat Levy-Gigi
- Faculty of Education and the Brain Science Center, Bar-Ilan University, Ramat-Gan, Israel
| | - Tanja Michael
- Division of Clinical Psychology and Psychotherapy, Saarland University, Saarbrücken, Germany
| | - Yuval Neria
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
- Department of Epidemiology, Columbia University Irving Medical Center, New York, NY, USA
| | - M. Roxanne Sopp
- Division of Clinical Psychology and Psychotherapy, Saarland University, Saarbrücken, Germany
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Spaeth AM, Koenig S, Everaert J, Glombiewski JA, Kube T. Are depressive symptoms linked to a reduced pupillary response to novel positive information?-An eye tracking proof-of-concept study. Front Psychol 2024; 15:1253045. [PMID: 38464618 PMCID: PMC10920252 DOI: 10.3389/fpsyg.2024.1253045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/31/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction Depressive symptoms have been linked to difficulties in revising established negative beliefs in response to novel positive information. Recent predictive processing accounts have suggested that this bias in belief updating may be related to a blunted processing of positive prediction errors at the neural level. In this proof-of-concept study, pupil dilation in response to unexpected positive emotional information was examined as a psychophysiological marker of an attenuated processing of positive prediction errors associated with depressive symptoms. Methods Participants (N = 34) completed a modified version of the emotional Bias Against Disconfirmatory Evidence (BADE) task in which scenarios initially suggest negative interpretations that are later either confirmed or disconfirmed by additional information. Pupil dilation in response to the confirmatory and disconfirmatory information was recorded. Results Behavioral results showed that depressive symptoms were related to difficulties in revising negative interpretations despite disconfirmatory positive information. The eye tracking results pointed to a reduced pupil response to unexpected positive information among people with elevated depressive symptoms. Discussion Altogether, the present study demonstrates that the adapted emotional BADE task can be appropriate for examining psychophysiological aspects such as changes in pupil size along with behavioral responses. Furthermore, the results suggest that depression may be characterized by deviations in both behavioral (i.e., reduced updating of negative beliefs) and psychophysiological (i.e., decreased pupil dilation) responses to unexpected positive information. Future work should focus on a larger sample including clinically depressed patients to further explore these findings.
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Affiliation(s)
- Alexandra M. Spaeth
- Department of Psychology, University of Kaiserslautern-Landau, Landau, Germany
| | - Stephan Koenig
- Department of Psychology, University of Kaiserslautern-Landau, Landau, Germany
| | - Jonas Everaert
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
- Research Group of Quantitative Psychology and Individual Differences, KU Leuven, Leuven, Belgium
| | | | - Tobias Kube
- Department of Psychology, University of Kaiserslautern-Landau, Landau, Germany
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Ballou S, Kube T. Open-label placebo is an evidence-based treatment option for many chronic conditions. Pain 2024; 165:487-488. [PMID: 38207196 DOI: 10.1097/j.pain.0000000000003145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Affiliation(s)
- Sarah Ballou
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Tobias Kube
- Department of Clinical Psychology and Psychotherapy, RPTU Kaiserslautern-Landau, Germany
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Kube T, Riecke J, Heider J, Glombiewski JA, Rief W, Barsky AJ. Same same, but different: effects of likelihood framing on concerns about a medical disease in patients with somatoform disorders, major depression, and healthy people. Psychol Med 2023; 53:7729-7734. [PMID: 37309182 DOI: 10.1017/s0033291723001654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Research has shown that patients with somatoform disorders (SFD) have difficulty using medical reassurance (i.e. normal results from diagnostic testing) to revise concerns about being seriously ill. In this brief report, we investigated whether deficits in adequately interpreting the likelihood of a medical disease may contribute to this difficulty, and whether patients' concerns are altered by different likelihood framings. METHODS Patients with SFD (N = 60), patients with major depression (N = 32), and healthy volunteers (N = 37) were presented with varying likelihoods for the presence of a serious medical disease and were asked how concerned they are about it. The likelihood itself was varied, as was the format in which it was presented (i.e. negative framing focusing on the presence of a disease v. positive framing emphasizing its absence; use of natural frequencies v. percentages). RESULTS Patients with SFD reported significantly more concern than depressed patients and healthy people in response to low likelihoods (i.e. 1: 100 000 to 1:10), while the groups were similarly concerned for likelihoods ⩾1:5. Across samples, the same mathematical likelihood caused significantly different levels of concern depending on how it was framed, with the lowest degree of concern for a positive framing approach and higher concern for natural frequencies (e.g. 1:100) than for percentages (e.g. 1%). CONCLUSIONS The results suggest a specific deficit of patients with SFD in interpreting low likelihoods for the presence of a medical disease. Positive framing approaches and the use of percentages rather than natural frequencies can lower the degree of concern.
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Affiliation(s)
- Tobias Kube
- Harvard Medical School, Program in Placebo Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, 02115, Boston, MA, USA
- RPTU Kaiserslautern-Landau, Department of Clinical Psychology and Psychotherapy, Ostbahnstr. 10, 76829 Landau, Germany
| | - Jenny Riecke
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Gutenbergstr. 18, 35032 Marburg, Germany
| | - Jens Heider
- RPTU Kaiserslautern-Landau, Department of Clinical Psychology and Psychotherapy, Ostbahnstr. 10, 76829 Landau, Germany
- Schön Clinic Roseneck, Am Roseneck 6, 83209 Prien am Chiemsee, Germany
| | - Julia A Glombiewski
- RPTU Kaiserslautern-Landau, Department of Clinical Psychology and Psychotherapy, Ostbahnstr. 10, 76829 Landau, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Gutenbergstr. 18, 35032 Marburg, Germany
| | - Arthur J Barsky
- Harvard Medical School, Program in Placebo Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, 02115, Boston, MA, USA
- Brigham and Women's Hospital, Department of Psychiatry, 75 Francis Street, Boston, MA 02115, USA
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Kirchner L, Kube T, D'Astolfo L, Strahler J, Herbstreit R, Rief W. How to modify expectations of social rejection? An experimental study using a false-feedback paradigm. J Behav Ther Exp Psychiatry 2023; 81:101859. [PMID: 37182428 DOI: 10.1016/j.jbtep.2023.101859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 01/16/2023] [Accepted: 04/14/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Negative expectations (NEs) are fundamental to various mental disorders. Finding ways to modulate NEs would help to improve clinical treatment. The present study investigated how previously formed expectations of social rejection are revised in the context of novel positive social experiences, and whether their revision can be modulated by differentially shifting participants' attentional focus. METHODS Our sample of 124 healthy participants was randomly assigned to four experimental conditions and received manipulated social feedback in multiple alleged webcam conferences. All groups went through three experimental phases that began with predominantly negative social feedback, then either transitioned to predominantly positive social feedback or continued to predominantly negative social feedback, and ultimately transitioning to a phase with no explicit social feedback. The experimental conditions differed in what they were instructed to focus on when receiving positive social feedback. RESULTS Receiving novel positive social feedback led to substantial changes in social expectations, but this effect was not modulated by the instructions the participants were given. Descriptive trends revealed that both instructions improved NE modification, although this effect was not robust to extinction in one condition. LIMITATIONS To prevent our cover story from being compromised, we could not perform an immediate manipulation check of the instructions given. Nevertheless, some of the sample seemed suspicious about the cover story. CONCLUSION Our results suggest that established expectations of social rejection can be revised when unexpectedly experiencing social acceptance. Nevertheless, more research is needed on potential instructions that could be used to optimize the modification of NEs.
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Affiliation(s)
- Lukas Kirchner
- Philipps-University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany.
| | - Tobias Kube
- University of Koblenz-Landau, Ostbahnstraße 10, 76829, Landau, Germany
| | - Lisa D'Astolfo
- Philipps-University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Jana Strahler
- Albert-Ludwigs-University of Freiburg, Sandfangweg 4, 79102, Freiburg, Germany
| | - René Herbstreit
- Philipps-University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Winfried Rief
- Philipps-University of Marburg, Gutenbergstraße 18, 35032, Marburg, Germany
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Kube T. Factors influencing the update of beliefs regarding controversial political issues. J Soc Psychol 2023:1-23. [PMID: 37660358 DOI: 10.1080/00224545.2023.2253981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 08/05/2023] [Indexed: 09/05/2023]
Abstract
Selectively integrating new information contributes to belief polarization and compromises public discourse. To better understand factors that underlie biased belief updating, I conducted three pre-registered studies covering different controversial political issues. The main hypothesis was that cognitively devaluing new information hinders belief updating. Support for this hypothesis was found in only one of the three issues. The only factor that consistently influenced belief updating across issues was the discrepancy between prior beliefs and new information. These results suggest that usually people do use evidence to correct their beliefs, but may refuse to do so if doubts about its generalizability arise.
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Ongaro G, Ballou S, Kube T, Haas J, Kaptchuk TJ. Doctors Speak: A Qualitative Study of Physicians' Prescribing of Antidepressants in Functional Bowel Disorders. Cult Med Psychiatry 2023; 47:669-683. [PMID: 35764862 DOI: 10.1007/s11013-022-09795-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/28/2022]
Abstract
Tricyclic antidepressants (TCAs) are frequently prescribed for chronic functional pain disorders. Although the mechanism of action targets pain perception, treating patients with TCAs for disorders conceptualized as "functional" can promote stigmatization in these patients because it hints at psychological dimensions of the disorder. The goal of this study was to understand how physicians prescribe TCAs in the face of this challenge. We interviewed eleven gastroenterologists in tertiary care clinics specializing in functional gastrointestinal disorders, such as irritable bowel syndrome. We found that the physicians interviewed (1) were aware of the stigma attached to taking antidepressants for a medical condition, (2) emphasized biological, as opposed to psychological, mechanisms of action, (3) while focusing on biological mechanisms, they nevertheless prescribed TCAs in a way that is highly attentive to the psychology of expectations, making specific efforts to adjust patients' expectations to be realistic and to reframe information that would be discouraging and (4) asked patients to persist in taking TCAs despite common and, at times, uncomfortable side effects. In this context of shared decision making, physicians described nuanced understanding and behaviours necessary for treating the complexity of functional disorders and emphasized the importance of a strong patient-provider relationship.
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Affiliation(s)
- Giulio Ongaro
- Department of Anthropology, London School of Economics and Political Science, London, UK
| | - Sarah Ballou
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA.
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
| | - Tobias Kube
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
- Pain and Psychotherapy Research Lab, University of Koblenz-Landau, Mainz, Germany
| | - Julia Haas
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Ted J Kaptchuk
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
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Kube T. Biased belief updating in depression. Clin Psychol Rev 2023; 103:102298. [PMID: 37290245 DOI: 10.1016/j.cpr.2023.102298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 05/14/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023]
Abstract
Cognitive approaches to depression have benefitted from recent research on belief updating, examining how new information is used to alter beliefs. This review presents recent advances in understanding various sources of bias in belief updating in depression. Specifically, research has demonstrated that people with depression have difficulty revising negative beliefs in response to novel positive information, whereas belief updating in depression is not related to an enhanced integration of negative information. In terms of mechanisms underlying the deficient processing of positive information, research has shown that people with depression use defensive cognitive strategies to devalue novel positive information. Furthermore, the disregard of novel positive information can be amplified by the presence of state negative affect, and the resulting persistence of negative beliefs in turn perpetuates chronically low mood, contributing to a self-reinforcing negative feedback loop of beliefs and affect. Synthesising previous research, this review proposes a coherent framework of when belief change is likely to occur, and argues that future research also needs to elucidate why people with depression hesitate to abandon negative beliefs. Recent insights from belief updating have not only improved the understanding of the psychopathology of depression, but also have the potential to improve its cognitive-behavioural treatment.
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Affiliation(s)
- Tobias Kube
- Department of Clinical Psychology and Psychotherapy, RPTU Kaiserslautern-Landau, Germany.
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10
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Herzog P, Kaiser T, Rief W, Brakemeier EL, Kube T. Assessing Dysfunctional Expectations in Posttraumatic Stress Disorder: Development and Validation of the Posttraumatic Expectations Scale (PTES). Assessment 2023; 30:1285-1301. [PMID: 35549727 DOI: 10.1177/10731911221089038] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dysfunctional expectations are a particularly important subset of cognitions that influence the development and maintenance of various mental disorders. This study aimed to develop and validate a scale to assess dysfunctional expectations in posttraumatic stress disorder (PTSD), the "Posttraumatic Expectations Scale" (PTES). In a cross-sectional study, 70 PTSD patients completed the PTES, the Posttraumatic Cognitions Inventory (PTCI), as well as measures of the severity of symptoms of PTSD and depression. The results show that the PTES has excellent internal consistency and correlates significantly with the PTCI and PTSD symptom severity. A regression analysis revealed that the PTES explained variance of PTSD symptom severity above the PTCI, supporting the incremental validity of the PTES. While the original version of the PTES comprises 81 items, short scales were constructed using the BISCUIT (best items scales that are cross-validated, unit-weighted, informative and transparent) method. The current findings provide preliminary psychometric evidence suggesting that the PTES is an internally consistent and valid novel self-report measure in patients with PTSD. However, conclusions about the psychometric properties of the PTES are limited because of the absence of criterion-related validity, factor structure evidence, variability over time/response to intervention, and test-retest reliability. Future research should use the PTES in large-scale longitudinal studies to address these aspects to further validate the scale.
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Affiliation(s)
- Philipp Herzog
- Philipps-University Marburg, Germany
- University of Greifswald, Germany
- University of Koblenz-Landau, Germany
| | | | | | | | - Tobias Kube
- Philipps-University Marburg, Germany
- University of Koblenz-Landau, Germany
- Beth Israel Deaconess Medical Center, Boston, MA, USA
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11
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Abstract
BACKGROUND In two experimental studies, we tested the hypothesis that negative mood would hinder the revision of negative beliefs in response to unexpectedly positive information in depression, whereas positive mood was expected to enhance belief updating. METHODS In study 1 (N = 101), we used a subclinical sample to compare the film-based induction of sad v. happy mood with a distraction control group. Subsequently, participants underwent a well-established paradigm to examine intra-individual changes in performance-related expectations after unexpectedly positive performance feedback. In study 2, we applied the belief-updating task from study 1 to an inpatient sample (N = 81) and induced sad v. happy mood via film-clips v. recall of autobiographic events. RESULTS The results of study 1 showed no significant group differences in belief updating; the severity of depressive symptoms was a negative predictor of belief revision, though, and there was a non-significant trend suggesting that the presence of sad mood hindered belief updating in the subgroup of participants with a diagnosed depressive episode. Study 2 revealed that participants updated their expectations significantly less in line with positive feedback when they underwent the induction of negative mood prior to feedback, relative to positive mood. CONCLUSIONS By indicating that the presence of negative mood can hinder the revision of negative beliefs in clinically depressed people, our findings suggest that learning from new experiences can be hampered if state negative mood is activated. Thus, interventions relying on learning from novel positive experiences should aim at reducing state negative mood in depression.
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Affiliation(s)
- Tobias Kube
- Pain and Psychotherapy Research Lab, University of Koblenz-Landau, Ostbahnstr. 10, 76829 Landau, Germany
| | - Lukas Kirchner
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstraße 18, 35032 Marburg, Germany
| | - Thomas Gärtner
- Schön Klinik Bad Arolsen, Hofgarten 10, 34454 Bad Arolsen, Germany
| | - Julia Anna Glombiewski
- Pain and Psychotherapy Research Lab, University of Koblenz-Landau, Ostbahnstr. 10, 76829 Landau, Germany
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12
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Kube T, Herzog P. Differential associations of positive and negative expectations with depressive symptoms. J Clin Psychol 2023; 79:762-772. [PMID: 36103396 DOI: 10.1002/jclp.23442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/18/2022] [Accepted: 08/29/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Recent research suggests that dysfunctional expectations are a particularly important subtype of cognitions in depression. However, it is unclear whether depressive symptoms are related to the presence of negative expectations, the absence of positive expectations, or both. METHODS Using hierarchical linear regression analyses, the present study examined the predictive value of positive situation-specific expectations, negative situation-specific expectations, dispositional optimism, and dysfunctional attitudes for depressive symptoms 8 weeks later in a nonclinical sample (N = 157). It also examined whether the relationship between dispositional optimism and dysfunctional attitudes with depressive symptoms is mediated through situational expectations. RESULTS Cross-sectionally, depressive symptoms were more strongly associated with the presence of negative expectations than with the absence of positive expectations. In the longitudinal and mediation analyses, none of the cognitive variables had significant associations with depressive symptoms at follow-up beyond the strong influence of baseline depressive symptoms. CONCLUSIONS The presence of negative expectations was cross-sectionally more strongly associated with depressive symptoms than a lack of positive expectations, presumably due to higher variability in negative expectations in this nonclinical sample. The longitudinal and mediation analyses failed to find significant incremental effects of any of the cognitive variables because baseline depression explained the largest proportion of variance.
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Affiliation(s)
- Tobias Kube
- Department of Clinical Psychology and Psychotherapy, University of Koblenz-Landau, Landau, Germany
| | - Philipp Herzog
- Department of Clinical Psychology and Psychotherapy, University of Koblenz-Landau, Landau, Germany
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13
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Kube T, Riecke J, Heider J, Ballou SK, Glombiewski JA, Rief W, Barsky AJ. How the integration of normal medical test results can be improved in patients with somatoform disorders-An experimental study. Health Psychol 2023; 42:103-112. [PMID: 36548078 DOI: 10.1037/hea0001243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND We examined whether the difficulties of patients with somatoform disorders (SFDs) in integrating medical reassurance can be altered by preventing patients from devaluing reassuring information through defensive cognitive strategies. METHOD Patients with SFD (n = 60), patients with major depression (n = 32), and healthy volunteers (n = 37) watched a videotaped doctor's report, which provided medical reassurance for gastroenterological complaints. Subsequently, participants were asked about their perception of the report. In the SFD sample, patients' appraisal of the reassuring was experimentally modulated: In one condition, doubts about the validity of the doctor's diagnostic assessment were triggered; in another condition, the devaluation of medical reassurance was blocked through underscoring the validity of the doctor's diagnostic assessment; and a control condition received no manipulation. RESULTS As evident on all outcome variables, patients with SFD had more difficulty integrating medical reassurance than depressed and healthy people. Within the SFD sample, participants from the experimental condition blocking the devaluation of medical reassurance rated the likelihood of an undetected serious disease to be significantly lower than the other two conditions. They also reported less emotional concern and a lower desire to seek the opinion of another doctor. CONCLUSIONS By comparing patients with SFD to both a healthy and a clinical control group, the current study suggests that the difficulty in processing reassuring medical information is a specific psychopathological feature of SFD. Furthermore, our results suggest that the integration of medical reassurance can be improved by preventing patients from devaluing reassuring information through dismissive cognitive strategies. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - Jenny Riecke
- Department of Clinical Psychology and Psychotherapy
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Schamong I, D'Astolfo L, Bollmann S, Brakemeier E, Kube T. How expectations and therapeutic style influence counselling outcome. Couns and Psychother Res 2022. [DOI: 10.1002/capr.12609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Isabel Schamong
- Department of Clinical Psychology and Psychotherapy Philipps University Marburg Marburg Germany
| | - Lisa D'Astolfo
- Department of Clinical Psychology and Psychotherapy Philipps University Marburg Marburg Germany
| | - Simon Bollmann
- Department of Clinical Psychology and Psychotherapy Philipps University Marburg Marburg Germany
| | - Eva‐Lotta Brakemeier
- Department of Clinical Psychology and Psychotherapy Philipps University Marburg Marburg Germany
- Department of Clinical Psychology and Psychotherapy University of Greifswald Greifswald Germany
| | - Tobias Kube
- Department of Clinical Psychology and Psychotherapy Philipps University Marburg Marburg Germany
- Department of Clinical Psychology and Psychotherapy University of Landau Landau Germany
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Abstract
OBJECTIVE Placebos being prescribed with full honesty and disclosure (i.e., open-label placebo [OLP]) have been shown to reduce symptom burden in a variety of conditions. With regard to allergic rhinitis, previous research provided inconclusive evidence for the effects of OLP, possibly related to a separate focus on either symptom severity or symptom frequency. Overcoming this limitation of previous research, the present study aimed to examine the effects of OLP on both the severity and frequency of allergic symptoms. METHODS In a randomized-controlled trial, patients with allergic rhinitis ( N = 74) were randomized to OLP or treatment as usual (TAU). Because of the COVID-19 pandemic, OLP was administered remotely in a virtual clinical encounter. Participants took placebo tablets for 14 days. The primary outcomes were the severity and frequency of allergic symptoms. The secondary end point was allergy-related impairment. RESULTS OLP did not significantly improve symptom severity over TAU ( F (1,71) = 3.280, p = .074, η2 = 0.044) but did reduce symptom frequency ( F (1,71) = 7.272, p = .009, η2 = 0.093) and allergy-related impairment more than TAU ( F (1,71) = 6.445, p = .013, η2 = 0.083), reflecting medium to large effects. The use of other antiallergic medication did not influence the results. CONCLUSIONS Although OLP was able to lower the frequency of allergic symptoms and allergy-related impairment substantially, its effects on symptom severity were weaker. The remote provision of OLP suggests that physical contact between patients and providers might not be necessary for OLP to work.
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Affiliation(s)
- Tobias Kube
- From the Pain and Psychotherapy Research Lab (Kube, Glombiewski), University of Koblenz-Landau, Landau, Germany; Program in Placebo Studies, Beth Israel Deaconess Medical Center (Kube, Kirsch), Harvard Medical School, Boston, Massachusetts; Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology (Witthöft, Bräscher), Johannes Gutenberg University of Mainz, Mainz, Germany
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16
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Herzog P, Kube T, Fassbinder E. How childhood maltreatment alters perception and cognition - the predictive processing account of borderline personality disorder. Psychol Med 2022; 52:2899-2916. [PMID: 35979924 PMCID: PMC9693729 DOI: 10.1017/s0033291722002458] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/24/2022] [Accepted: 07/18/2022] [Indexed: 01/05/2023]
Abstract
Borderline personality disorder (BPD) is a severe mental disorder, comprised of heterogeneous psychological and neurobiological pathologies. Here, we propose a predictive processing (PP) account of BPD to integrate these seemingly unrelated pathologies. In particular, we argue that the experience of childhood maltreatment, which is highly prevalent in BPD, leaves a developmental legacy with two facets: first, a coarse-grained, alexithymic model of self and others - leading to a rigidity and inflexibility concerning beliefs about self and others. Second, this developmental legacy leads to a loss of confidence or precision afforded beliefs about the consequences of social behavior. This results in an over reliance on sensory evidence and social feedback, with concomitant lability, impulsivity and hypersensitivity. In terms of PP, people with BPD show a distorted belief updating in response to new information with two opposing manifestations: rapid changes in beliefs and a lack of belief updating despite disconfirmatory evidence. This account of distorted information processing has the potential to explain both the instability (of affect, self-image, and interpersonal relationships) and the rigidity (of beliefs about self and others) which is typical of BPD. At the neurobiological level, we propose that enhanced levels of dopamine are associated with the increased integration of negative social feedback, and we also discuss the hypothesis of an impaired inhibitory control of the prefrontal cortex in the processing of negative social information. Our account may provide a new understanding not only of the clinical aspects of BPD, but also a unifying theory of the corresponding neurobiological pathologies. We conclude by outlining some directions for future research on the behavioral, neurobiological, and computational underpinnings of this model, and point to some clinical implications of it.
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Affiliation(s)
- Philipp Herzog
- Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, D-23562 Lübeck, Germany
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University of Kiel, Niemannsweg 147, D-24105 Kiel, Germany
- Department of Psychology, University of Koblenz-Landau, Ostbahnstr. 10, 76829 Landau, Germany
| | - Tobias Kube
- Department of Psychology, University of Koblenz-Landau, Ostbahnstr. 10, 76829 Landau, Germany
| | - Eva Fassbinder
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University of Kiel, Niemannsweg 147, D-24105 Kiel, Germany
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17
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Feldmann M, Kube T, Rief W, Brakemeier EL. Testing Bayesian models of belief updating in the context of depressive symptomatology. Int J Methods Psychiatr Res 2022:e1946. [PMID: 36114811 DOI: 10.1002/mpr.1946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 07/08/2022] [Accepted: 08/31/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Predictive processing approaches to belief updating in depression propose that depression is related to more negative and more precise priors. Also, belief updating is assumed be negatively biased in comparison to normative Bayesian updating. There is a lack of efficient methods to mathematically model belief updating in depression. METHODS We validated a novel performance belief updating paradigm in a nonclinical sample (N = 133). Participants repeatedly participated in a non-self-related emotion recognition task and received false feedback. Effects of the feedback manipulation and differences in depressive symptoms on belief updating were analysed in Bayesian multilevel analyses. RESULTS Beliefs were successfully manipulated through the feedback provided. Depressive symptoms were associated with more negative updating than normative Bayesian updating but results were influenced by few cases. No evidence of biased change in beliefs or overly precise priors was found. Depressive symptoms were associated with more negative updating of generalised performance beliefs. CONCLUSIONS There was cautious support for negatively biased belief updating associated with depressive symptoms, especially for generalised beliefs. The content of the task may not be self-relevant enough to cause strong biases. Further explication of Bayesian models of depression and replication in clinical samples is needed.
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Affiliation(s)
- Matthias Feldmann
- Department for Clinical Psychology and Psychotherapy, Philipps University Marburg, Marburg, Germany.,Department for Clinical Psychology and Psychotherapy, University of Greifswald, Greifswald, Germany
| | - Tobias Kube
- Pain and Psychotherapy Research Lab, University of Koblenz-Landau, Landau, Germany
| | - Winfried Rief
- Department for Clinical Psychology and Psychotherapy, Philipps University Marburg, Marburg, Germany
| | - Eva-Lotta Brakemeier
- Department for Clinical Psychology and Psychotherapy, Philipps University Marburg, Marburg, Germany.,Department for Clinical Psychology and Psychotherapy, University of Greifswald, Greifswald, Germany
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18
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Rozenkrantz L, Kube T, Bernstein MH, Gabrieli JDE. How beliefs about coronavirus disease (COVID) influence COVID-like symptoms? - A longitudinal study. Health Psychol 2022; 41:519-526. [PMID: 35849379 DOI: 10.1037/hea0001219] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Evidence from psychosomatic and nocebo research has indicated that believing one will develop symptoms makes the experience of such symptoms more likely. We applied this idea in the context of coronavirus disease 2019 (COVID-19). Specifically, we assessed whether beliefs regarding COVID-19 predict COVID-like symptoms 3-4 weeks later, and what specific belief has the greatest influence on symptom experience. METHOD We conducted two studies with over 300 participants, approached at two successive timepoints, 3-4 weeks apart. Participants reported their experienced symptoms, COVID-19-related beliefs, demographics, and state anxiety. To target COVID-like symptoms, participants who reported having contracted COVID-19 or attributed their symptoms to another known cause were excluded. Regression analyses were conducted to test the predictive value of beliefs regarding COVID-19 on experienced symptoms. RESULTS A particular belief regarding one's estimated symptom severity if infected with coronavirus predicted the experience of symptoms 3-4 weeks later (β = .17, p = .011). This result persisted after controlling for potential confounds, including state anxiety (β = .22, p = .002). Findings were preregistered and replicated in a separate cohort. A novel scale for perception of the body's ability to fight diseases contributed to mediating the effect of estimated symptom severity on later experienced symptoms. CONCLUSIONS A particular belief about estimated symptom severity if infected with COVID predicted the experience of COVID-like physical symptoms several weeks later. These findings contribute to the understanding of the development of unexplained physical symptoms. Furthermore, identification of a particular belief that increases the likelihood of symptoms informs intervention that may mitigate its effects. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Liron Rozenkrantz
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology
| | - Tobias Kube
- Program in Placebo Studies, Beth Israel Deaconess Medical Center/Harvard Medical School
| | | | - John D E Gabrieli
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology
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19
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Schamong I, Bollmann S, Struck N, Kube T, D’Astolfo L, Brakemeier EL. Can we Modulate Therapeutic Interpersonal Style Experimentally to Address Alliance? A Proof-of-Concept Study. Cogn Ther Res 2022. [DOI: 10.1007/s10608-022-10308-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Abstract
Background
With a lack of experimental designs that explore which therapeutic style is helpful for which patient, the aim of this study was to test the feasibility of experimentally varying the therapeutic style under realistic conditions and to investigate how this affects alliance ratings by clients and counselors.
Methods
We defined two manualized therapeutic styles (neutral/distant relational style vs. high affiliation relational style) based on the interpersonal circumplex. In a randomized two-group design, 64 healthy university students (70% female, Mage = 23.78, SDage = 2.81) received a single psychological counseling session on interpersonal conflicts by one of four counselors and in one of the two styles. We checked the manipulation success using observer-rated degree of affiliation and ratings of counselors’ interpersonal behavior with the Interpersonal Message Inventory (IMI-R). A series of linear regression models analyzed whether the style predicted working alliance, assessed via the Working Alliance Inventory (WAI).
Results
In accordance with the hypotheses, significant differences in the rated degree of affiliation (p ≤ .001) and IMI-R ratings (p ≤ .001 in friendly, p = .003 in hostile dimension) were found between the two groups. Overall, alliance ratings were high across groups and raters (WAI overall scores ranging from 3.76 to 4.07). The style did not predict clients’ alliance ratings.
Conclusion
The experimental variation of the therapeutic style proved feasible under realistic conditions with high overall alliance ratings. The novel experimental design may provide a basis for further research.
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20
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Kube T, Körfer K, Riecke J, Glombiewski JA. How expectancy violations facilitate learning to cope with pain - An experimental approach. J Psychosom Res 2022; 157:110807. [PMID: 35390722 DOI: 10.1016/j.jpsychores.2022.110807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 03/21/2022] [Accepted: 03/28/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Expectations of painful sensations constitute a core feature of chronic pain. An important clinical question is whether such expectations are revised when disconfirming experiences are made (e.g., less pain than expected). This study examined how people adjust their pain expectations when the experience of decreasing pain is expected vs. unexpected. METHODS In a novel randomized between-subjects design, a subclinical sample of people who frequently experience pain was provided with painful thermal stimulations. Unbeknownst to participants, the temperature applied was decreased from trial to trial. Based on the experimental instructions provided, this experience of decreasing pain was expected in one condition (expectation-confirmation; n = 34), whereas it was unexpected in another (expectation-disconfirmation; n = 39). RESULTS Perceived pain intensity was lower in the expectation-confirmation condition than in the expectation-disconfirmation condition (p = .014, ηp2 = 0.083). The expectation-confirmation condition also showed a greater adjustment of their pain expectations than the expectation-disconfirmation condition (p = .046, ηp2 = 0.047). Across groups, large expectation violations (i.e., less pain than expected) were associated with increases in pain tolerance and the ability to cope with pain at a one-week follow-up. CONCLUSIONS In terms of assimilation, perceived pain intensity was shaped in the direction of pain expectations. The greater adjustment of expectations in the expectation-confirming condition is consistent with a confirmation bias in pain perception. Though participants who experienced large discrepancies between expected and experienced pain were hesitant to adjust their pain expectations immediately, expectation violations increased their ability to cope with pain one week later, suggesting some beneficial longer-term effects of expectation violations.
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Affiliation(s)
- Tobias Kube
- Pain and Psychotherapy Research Lab, University of Koblenz-, Landau, Germany.
| | - Karoline Körfer
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Germany
| | - Jenny Riecke
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Germany
| | - Julia A Glombiewski
- Pain and Psychotherapy Research Lab, University of Koblenz-, Landau, Germany
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21
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Kirchner L, Schummer SE, Krug H, Kube T, Rief W. How social rejection expectations and depressive symptoms bi-directionally predict each other - A cross-lagged panel analysis. Psychol Psychother 2022; 95:477-492. [PMID: 35099102 DOI: 10.1111/papt.12383] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 01/14/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although research suggests that social rejection expectations play a crucial role in the development and maintenance of depressive symptoms, it is not clear whether such expectations are a risk factor for depression or rather a consequence thereof. The present study addressed this issue by investigating the time-lagged bi-directional effects of social rejection expectations and depressive symptoms. METHODS In an online survey, participants (N = 347) completed measures of social rejection expectations, depressive symptoms, interpersonal competencies, and perceived social support at baseline and 2 months later. The relationships between the variables were examined using path models and cross-lagged path analyses. RESULTS Cross-lagged path analyses provided evidence for a substantial positive effect of social rejection expectations at baseline on depressive symptoms at follow-up in addition to the reverse effect. A mediator analysis indicated that neither interpersonal competencies nor perceived social support mediated these bi-directional effects. CONCLUSION The current results demonstrate that social rejection expectations and depressive symptoms bi-directionally predict each other. Thus, social rejection expectations appears to be both a risk factor for - and a symptom of - depression. In order to prevent a vicious circle of social rejection expectations and depressive symptoms, we recommend the early detection and treatment of social rejection expectations. Moreover, social rejection expectations should be specifically addressed in cognitive-behavioural treatment of depression.
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Affiliation(s)
- Lukas Kirchner
- Institute of Psychology, Philipps-University of Marburg, Marburg, Germany
| | | | - Henning Krug
- Institute of Psychology, Philipps-University of Marburg, Marburg, Germany
| | - Tobias Kube
- Institute of Psychology, University of Koblenz-Landau, Landau, Germany
| | - Winfried Rief
- Institute of Psychology, Philipps-University of Marburg, Marburg, Germany
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22
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Herzog P, Feldmann M, Kube T, Langs G, Gärtner T, Rauh E, Doerr R, Hillert A, Voderholzer U, Rief W, Endres D, Brakemeier EL. Inpatient psychotherapy for depression in a large routine clinical care sample: A Bayesian approach to examining clinical outcomes and predictors of change. J Affect Disord 2022; 305:133-143. [PMID: 35219740 DOI: 10.1016/j.jad.2022.02.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 02/16/2022] [Accepted: 02/20/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND A routinely collected dataset was analyzed (1) to determine the naturalistic effectiveness of inpatient psychotherapy for depression in routine psychotherapeutic care, and (2) to identify potential predictors of change. METHODS In a sample of 22,681 inpatients with depression, pre-post and pre-follow-up effect sizes were computed for various outcome variables. To build a probabilistic model of predictors of change, an independent component analysis generated components from demographic and clinical data, and Bayesian EFA extracted factors from the available pre-test, post-test and follow-up questionnaires in a subsample (N = 6377). To select the best-fitted model, the BIC of different path models were compared. A Bayesian path analysis was performed to identify the most important factors to predict changes. RESULTS Effect sizes were large for the primary outcome and moderate for various secondary outcomes. Almost all pretreatment factors exerted significant influences on different baseline factors. Several factors were found to be resistant to change during treatment: suicidality, agoraphobia, life dissatisfaction, physical disability and pain. The strongest cross-loadings were observed from suicidality on negative cognitions, from agoraphobia on anxiety, and from physical disability on perceived disability. LIMITATIONS No causal conclusions can be drawn directly from our results as we only used cross-lagged panel data without control group. CONCLUSIONS The results indicate large effects of inpatient psychotherapy for depression in routine clinical care. The direct influence of pretreatment factors decreased over the course of treatment. However, some factors appeared stable and difficult to treat, which might hinder treatment outcome. Findings of different predictors of change are discussed.
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Affiliation(s)
- Philipp Herzog
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany; University of Greifswald, Department of Clinical Psychology and Psychotherapy, Franz-Mehring-Straße 47, D-17489 Greifswald, Germany; University of Koblenz-Landau, Department of Clinical Psychology and Psychotherapy, Ostbahnstraße 10, D-76829 Landau, Germany.
| | - Matthias Feldmann
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany
| | - Tobias Kube
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany; University of Koblenz-Landau, Department of Clinical Psychology and Psychotherapy, Ostbahnstraße 10, D-76829 Landau, Germany
| | - Gernot Langs
- Schön-Klinik Bad Bramstedt, Psychosomatic Clinic, Birkenweg 10, D-24576 Bad Bramstedt, Germany
| | - Thomas Gärtner
- Schön-Klinik Bad Arolsen, Psychosomatic Clinic, Hofgarten 10, D-34454 Bad Arolsen, Germany
| | - Elisabeth Rauh
- Schön-Klinik Bad Staffelstein, Psychsomatic Clinic, Am Kurpark 11, D-96231 Bad Staffelstein, Germany
| | - Robert Doerr
- Schön-Klinik Berchtesgadener Land, Psychosomatic Clinic, Malterhöh 1, D-83471 Schönau am Königssee, Germany
| | - Andreas Hillert
- Schön-Klinik Roseneck, Psychosomatic Clinic, Am Roseneck 6, D-83209 Prien am Chiemsee, Germany
| | - Ulrich Voderholzer
- Schön-Klinik Roseneck, Psychosomatic Clinic, Am Roseneck 6, D-83209 Prien am Chiemsee, Germany; University Hospital of Munich, Department of Psychiatry and Psychotherapy, Nußbaumstraße 7, D-80336 München, Germany
| | - Winfried Rief
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany
| | - Dominik Endres
- Philipps-University of Marburg, Department of Theoretical Neuroscience, Gutenbergstraße 18, D-35032 Marburg, Germany
| | - Eva-Lotta Brakemeier
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany; University of Greifswald, Department of Clinical Psychology and Psychotherapy, Franz-Mehring-Straße 47, D-17489 Greifswald, Germany
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23
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Friehs T, Kube T. Erwartungen als Kernmechanismus des Placeboeffekts: Implikationen für die psychotherapeutische Praxis. Psychotherapeut 2022. [DOI: 10.1007/s00278-022-00591-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Friehs T, Rief W, Glombiewski JA, Haas J, Kube T. Deceptive and non-deceptive placebos to reduce sadness: A five-armed experimental study. Journal of Affective Disorders Reports 2022. [DOI: 10.1016/j.jadr.2022.100349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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25
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Herzog P, Barth C, Rief W, Brakemeier EL, Kube T. How Expectations Shape the Formation of Intrusive Memories: An Experimental Study Using the Trauma Film Paradigm. Cogn Ther Res 2022. [DOI: 10.1007/s10608-022-10290-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Abstract
Background
Although intrusions are the hallmark symptom of posttraumatic stress disorder, there is still limited knowledge about the processes that contribute to the development of intrusions. Here, we used the well-established trauma film paradigm (TFP) to investigate how expectations about the intensity and controllability of intrusions influence their occurrence.
Methods
90 healthy participants underwent the TFP before they were randomized to one of three conditions manipulating their expectations about intrusions: positive expectations group; negative expectations group; control group. The primary outcome was the frequency and severity of intrusive memories as assessed with an intrusion diary over seven days.
Results
The TFP was well implemented, as indicated by significant post-film anxiety and a substantial number of intrusions reported for the subsequent week. The three groups did not differ in their expectations about intrusions and, relatedly, in their experience of intrusions. A mediation analysis revealed that the influence of post-film anxiety on intrusive memories was fully mediated by expectations.
Conclusions
Despite the failure of the expectation manipulation, the results of the mediation analysis support the hypothesis that post-film expectations influence the formation of intrusive memories, suggesting that intrusions may result from maladaptive dynamics between emotional and cognitive processes following trauma(like) experiences.
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Kube T, Hofmann VE, Glombiewski JA, Kirsch I. Correction: Providing open-label placebos remotely-A randomized controlled trial in allergic rhinitis. PLoS One 2021; 16:e0252850. [PMID: 34077482 PMCID: PMC8171944 DOI: 10.1371/journal.pone.0252850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0248367.].
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Goli F, Roohafza H, Feizi A, Gholamrezaei A, Farzanegan M, Hashemi M, Kube T, Rief W. The Illness Belief Network Questionnaire: Development and Evaluation of a Psychosomatic Assessment Tool. Iran J Psychiatry 2021; 16:177-186. [PMID: 34221044 PMCID: PMC8233563 DOI: 10.18502/ijps.v16i2.5819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Objective: Patients’ beliefs and emotions toward an illness can influence their coping responses, illness behaviors, adherence to treatment, quality of life, and even the psychoneuroimmune responses. The aim of present study was to develop and validate a novel questionnaire assessing both rational and irrational beliefs of patients regarding their illness. Method: In a cross sectional methodological study, the items of the Illness Belief Network (IBN) were developed regarding patients and clients’ opinions about and attribution of their disease extracted from 400 clinical interviews and were coded based on Leventhal’s self-regulation model. An expert panel coded the items. A total of 400 patients with different medical conditions completed the questionnaire. Participants additionally rated the Illness Perceptions Questionnaire in its revised form (IPQ-R) to assess convergent validity. Construct validity was examined by conducting exploratory and confirmatory factor analysis. The Cronbach alpha and Intracluster Correlation Coefficient (ICC) were used for examining Internal consistency and test-retest reliability of the IBN. Results: The IBN questionnaire was finalized with 84 items, and the results of factor analysis revealed 5 factors: psychosocial causes, environmental causes, control, meaning, and consequence/timeline; extracted factors were confirmed by confirmatory factor analysis. Cronbach’s α coefficient for scale was 0.92 and it ranged from 0.79 to 0.89 for the subscales. IBN indicated excellent test-retest reliability results based on ICC 0.842(95%CI: 0.798-0.846). The correlation coefficients of all items exceeded the prespecified acceptable value of 0.40, indicating satisfactory item discriminant validity, and correlation between IBN and IPQ-R subscales were statistically significant (all p values < 0.01), indicating acceptable convergent validity. Conclusion: The IBN questionnaire is a valid and reliable phenomenological, non-judging, and clinical tool to assess patient’s rational and irrational or faith-based beliefs about the illness. This tool can be used to improve doctor-patient communication by exploring the complex nature of human thinking.
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Affiliation(s)
- Farzad Goli
- Danesh-e Tandorosti Institute, Isfahan, Iran.,Energy Medicine University, California, United States of America
| | - Hamidreza Roohafza
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Awat Feizi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Gholamrezaei
- Department of Chronic Diseases, Metabolism and Ageing, Translational Research Center for Gastrointestinal Disorders, Leuven, Belgium
| | - Mahboubeh Farzanegan
- Danesh-e Tandorosti Institute, Isfahan, Iran.,Energy Medicine University, California, United States of America
| | | | - Tobias Kube
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University of Marburg, Marburg, Germany
| | - Winfried Rief
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, Philipps University of Marburg, Marburg, Germany
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28
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Kube T, Hofmann VE, Glombiewski JA, Kirsch I. Providing open-label placebos remotely-A randomized controlled trial in allergic rhinitis. PLoS One 2021; 16:e0248367. [PMID: 33705475 PMCID: PMC7951912 DOI: 10.1371/journal.pone.0248367] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/23/2021] [Indexed: 12/12/2022] Open
Abstract
Background Placebos can reduce physical symptoms even when provided with full honesty and disclosure. Yet, the precise mechanisms underlying the effects of “open-label placebos” (OLPs) have remained subject of debate. Furthermore, it is unclear whether OLPs are similarly effective when provided remotely, as is sometimes required e.g. in the current COVID-19 pandemic. Methods In a randomized-controlled trial, we examined the effects of OLP plus treatment as usual (TAU) compared to TAU alone on symptom reduction in people with allergic rhinitis (N = 54) over the course of two weeks. Due to the COVID-19 pandemic, OLP was provided remotely (i.e. sent via postal service). To investigate the potential influence of the clinical encounter on the effects of OLP, we manipulated the perception of the virtual clinical encounter, both with respect to verbal and nonverbal factors (augmented vs. limited encounter). Results The results of the manipulation check confirmed that the augmented clinical encounter was evaluated more positively than the limited encounter, in terms of perceived warmth of the provider. Participants from all treatment groups showed significant symptom reduction from baseline to two weeks later, but OLP had no incremental effect over TAU. Participants benefitted more from OLP when they did not take any other medication against allergic symptoms than when taking medication on demand. When controlling for baseline symptoms, a significant treatment by encounter interaction was found, pointing to greater symptom improvement in the OLP group when the encounter was augmented, whereas the control group improved more when the encounter was limited. Discussion The study demonstrates that providing OLP and enhancing the encounter remotely is possible, but their effectiveness might be lower in comparison to previous studies relying on physical patient-provider interaction. The study raises questions for future research about the potential and challenges of remote placebo studies and virtual clinical encounters. The study has been registered as a clinical trial at ISRCTN (record number: 39018).
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Affiliation(s)
- Tobias Kube
- Pain and Psychotherapy Research Lab, University of Koblenz-Landau, Landau, Germany
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Verena E. Hofmann
- Pain and Psychotherapy Research Lab, University of Koblenz-Landau, Landau, Germany
| | - Julia A. Glombiewski
- Pain and Psychotherapy Research Lab, University of Koblenz-Landau, Landau, Germany
| | - Irving Kirsch
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
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Körfer K, Schemer L, Kube T, Glombiewski JA. An Experimental Analogue Study on the "Dose-Response Relationship" of Different Therapeutic Instructions for Pain Exposures: The More, The Better? J Pain Res 2020; 13:3181-3193. [PMID: 33293855 PMCID: PMC7719044 DOI: 10.2147/jpr.s265709] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/20/2020] [Indexed: 01/05/2023] Open
Abstract
Objective Novel suggestions derived from the inhibitory learning model on how to optimize exposure therapy have been debated with enthusiasm in the last few years, particularly with respect to the focus on expectancy violations. However, little is known about how this new approach directly compares to the traditional habituation rationale of exposure therapy. In the present study, we examined these two competing therapeutic instructions among healthy female participants in an experimental heat pain paradigm. Design and Methods Participants (N= 116) received a therapeutic instruction derived from either a habituation-based approach or the inhibitory learning model (expectation violation). Participants were repeatedly exposed to painful thermal stimulations until a predefined exposure goal was reached. Results The expectation violation instruction led to faster goal attainment and higher response rates than the habituation instruction. Both instructions led to increased pain tolerance in the short and long term (one-week follow-up). Conclusion Our results suggest that exposure treatments using an expectation violation instruction are especially time-effective. Although the findings from this analogue design cannot be directly generalized to populations with clinically relevant levels of chronic pain, they do point to some important theoretical and clinical implications for the treatment of pain.
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Affiliation(s)
- Karoline Körfer
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Lea Schemer
- Department of Clinical Psychology and Psychotherapy, University of Koblenz - Landau, Landau, Germany
| | - Tobias Kube
- Department of Clinical Psychology and Psychotherapy, University of Koblenz - Landau, Landau, Germany
| | - Julia A Glombiewski
- Department of Clinical Psychology and Psychotherapy, University of Koblenz - Landau, Landau, Germany
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Kube T, Hildebrandt A. “Ich denke, also sage ich vorher”: Wie “Predictive Processing-Modelle den Einsatz von Verhaltensexperimenten bei Depressionen optimieren können. Verhaltenstherapie 2020. [DOI: 10.1159/000510610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Verhaltensexperimente stellen eine wichtige Interventionsform bei depressiven Störungen dar, um dysfunktionale Annahmen zu modifizieren. Häufig ist jedoch zu beobachten, dass Patient*innen trotz einer fachgerechten Durchführung von Verhaltensexperimenten weiter an negativen Annahmen festhalten. Vor diesem Hintergrund diskutieren wir in diesem Artikel, wie der Einsatz von Verhaltensexperimenten bei Depressionen optimiert werden kann und beziehen uns dabei auf ein neues Störungsmodell, das interessante Implikationen hierzu liefern könnte. Dieses Störungsmodell aus der neurowissenschaftlichen Forschung zu “Predictive Processing” geht davon aus, dass depressive Störungen durch zwei Kernaspekte gekennzeichnet sind: (1) stark negative Erwartungen, die im Sinne von selbsterfüllenden Prophezeiungen zu negativen Erlebnissen führen und zunehmend “immun” gegen gegenteilige Erfahrungen machen; (2) das Fehlen von positiven Erwartungen, wodurch die Wahrscheinlichkeit von positiven Erlebnissen reduziert wird. Darauf aufbauend beschreiben wir zunächst, dass zur Modifikation negativer Erwartungen in einer ausführlichen Vorbesprechung erarbeitet werden sollte, welche möglichen positiven Erfahrungen aus dem Verhaltensexperiment die Patient*innen als glaubwürdig betrachten und zur Veränderung ihrer negativen Erwartungen nutzen würden. Auf diese sollte bei der Durchführung besonders geachtet werden, damit positive Erwartungsverletzungen auch als solche wahrgenommen werden. Zum anderen stellen wir dar, dass es nicht ausreichend ist, nur negative Erwartungen zu reduzieren, sondern auch explizit positive Erwartungen durch weitere Verhaltensexperimente gefördert werden sollten.
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Rebstock L, Schäfer LN, Kube T, Ehmke V, Rief W. Placebo prevents rumination: An experimental study. J Affect Disord 2020; 274:1152-1160. [PMID: 32663945 DOI: 10.1016/j.jad.2020.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/28/2020] [Accepted: 06/05/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Rumination is a risk factor for the development and maintenance of depressive symptoms and represents an important target for the treatment of depression. In the present study, we aimed to examine whether rumination can be reduced when participants are led to believe that they would receive medication that would prevent them from ruminating. METHODS In healthy participants (N= 91), an initial dysphoric state was induced via mood-suggestive music and autobiographic recall. Subsequently, participants were randomly assigned to one of two groups: an experimental group that received a deceptive active placebo via intranasal application accompanied by expectancy-enhancing instructions vs. a no-treatment control group. Then, rumination was induced via a rumination-activating task. The primary outcome was current rumination; experienced sadness was considered a secondary outcome. RESULTS Consistent with the hypothesis, participants receiving the placebo reported a significantly lower increase in current rumination (d= 0.57) and a higher decrease in sadness (d= 0.69) after the experimental induction than the control group. LIMITATIONS The external validity of this study might be limited due to the highly educated student sample. CONCLUSIONS The results suggest that rumination processes as well as experienced sadness can be positively influenced by placebo treatment. To evaluate its clinical potential, placebo-induced expectancy effects in rumination research should be further examined, particularly with clinically depressed patients. Also, the results imply that clinicians might consider the effects of expectations on patients' rumination tendencies, for example by explicitly addressing patients' expectations about rumination, mood, and the treatment in general.
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Affiliation(s)
- Lea Rebstock
- Department for Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstraße 18, 35032 Marburg, Germany.
| | - Leonora N Schäfer
- Department for Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstraße 18, 35032 Marburg, Germany
| | - Tobias Kube
- Department for Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstraße 18, 35032 Marburg, Germany; Department for Clinical Psychology and Psychotherapy, University of Koblenz-Landau, Ostbahnstraße 10, 76829 Landau, Germany
| | - Viktoria Ehmke
- Department for Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstraße 18, 35032 Marburg, Germany
| | - Winfried Rief
- Department for Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstraße 18, 35032 Marburg, Germany
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Abstract
Belief updating is a relatively nascent field of research that examines how people adjust their beliefs in light of new evidence. So far, belief updating has been investigated in partly unrelated lines of research from different psychological disciplines. In this article, we aim to integrate these disparate lines of research. After presenting some prominent theoretical frameworks and experimental designs that have been used for the study of belief updating, we review how healthy people and people with mental disorders update their beliefs after receiving new information that supports or challenges their views. Available evidence suggests that both healthy people and people with particular mental disorders are prone to certain biases when updating their beliefs, although the nature of the respective biases varies considerably and depends on several factors. Anomalies in belief updating are discussed in terms of both new insights into the psychopathology of various mental disorders and societal implications, such as irreconcilable political and societal controversies due to the failure to take information into account that disconfirms one’s own view. We conclude by proposing a novel integrative model of belief updating and derive directions for future research.
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Affiliation(s)
- Tobias Kube
- Program in Placebo Studies, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Koblenz-Landau
| | - Liron Rozenkrantz
- Program in Placebo Studies, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology
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Bernstein MH, Locher C, Kube T, Buergler S, Stewart-Ferrer S, Blease C. Putting the 'Art' Into the 'Art of Medicine': The Under-Explored Role of Artifacts in Placebo Studies. Front Psychol 2020; 11:1354. [PMID: 32774310 PMCID: PMC7387723 DOI: 10.3389/fpsyg.2020.01354] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 05/22/2020] [Indexed: 12/28/2022] Open
Abstract
Research in social psychology demonstrates that physical environmental factors – or “artifacts” such as provider clothing and office décor – can influence health outcomes. However, the role of artifacts in augmenting or diminishing health outcomes is under-explored in the burgeoning discipline of placebo studies. In this paper, we argue that a careful consideration of artifacts may carry significant potential in informing how placebo effects can be maximized, and nocebo effects minimized in clinical settings. We discuss the potential mechanisms, including classical conditioning, response expectancy, and mindsets, by which artifacts might enhance or diminish these effects. Next, we propose testable hypotheses to investigate how placebo and nocebo effects might be elicited by artifacts in care settings, and conclude by providing innovative research designs to advance this novel research agendum.
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Affiliation(s)
- Michael H Bernstein
- Center for Alcohol and Addiction Studies, School of Public Health, Brown University, Providence, RI, United States
| | - Cosima Locher
- School of Psychology, University of Plymouth, Plymouth, United Kingdom.,Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Tobias Kube
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.,Pain and Psychotherapy Research Lab, University of Koblenz-Landau, Landau, Germany
| | - Sarah Buergler
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Sif Stewart-Ferrer
- Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
| | - Charlotte Blease
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.,School of Psychology, University College Dublin, Dublin, Ireland
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34
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Kube T, Berg M, Kleim B, Herzog P. Rethinking post-traumatic stress disorder - A predictive processing perspective. Neurosci Biobehav Rev 2020; 113:448-460. [PMID: 32315695 DOI: 10.1016/j.neubiorev.2020.04.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 12/15/2022]
Abstract
Predictive processing has become a popular framework in neuroscience and computational psychiatry, where it has provided a new understanding of various mental disorders. Here, we apply the predictive processing account to post-traumatic stress disorder (PTSD). We argue that the experience of a traumatic event in Bayesian terms can be understood as a perceptual hypothesis that is subsequently given a very high a-priori likelihood due to its (life-) threatening significance; thus, this hypothesis is re-selected although it does not fit the actual sensory input. Based on this account, we re-conceptualise the symptom clusters of PTSD through the lens of a predictive processing model. We particularly focus on re-experiencing symptoms as the hallmark symptoms of PTSD, and discuss the occurrence of flashbacks in terms of perceptual and interoceptive inference. This account provides not only a new understanding of the clinical profile of PTSD, but also a unifying framework for the corresponding pathologies at the neurobiological level. Finally, we derive directions for future research and discuss implications for psychological and pharmacological interventions.
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Affiliation(s)
- Tobias Kube
- Harvard Medical School, Program in Placebo Studies, Beth Israel Deaconess Medical Center, Brookline Avenue 330, Boston, MA, 02115, USA; University of Koblenz-Landau, Pain and Psychotherapy Research Lab, Ostbahnstr. 10, 76829 Landau, Germany.
| | - Max Berg
- Philipps-University of Marburg, Department of Psychology, Division of Clinical Psychology and Psychological Treatment Gutenbergstraße 18, D-35032, Marburg, Germany
| | - Birgit Kleim
- University of Zurich, Department of Psychology, Binzmühlestrasse 14, Box 8, CH-8050, Zurich, Switzerland; Psychiatric University Hospital (PUK), Lenggstrasse 31, CH-8032, Zurich, Switzerland
| | - Philipp Herzog
- Philipps-University of Marburg, Department of Psychology, Division of Clinical Psychology and Psychological Treatment Gutenbergstraße 18, D-35032, Marburg, Germany; University of Greifswald, Department of Psychology, Clinical Psychology and Psychotherapy, Franz-Mehring-Straße 47, D-17489, Greifswald, Germany; Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, D-23562, Lübeck, Germany
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35
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Kube T, Schwarting R, Rozenkrantz L, Glombiewski JA, Rief W. Distorted Cognitive Processes in Major Depression: A Predictive Processing Perspective. Biol Psychiatry 2020; 87:388-398. [PMID: 31515055 DOI: 10.1016/j.biopsych.2019.07.017] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 07/11/2019] [Accepted: 07/18/2019] [Indexed: 01/04/2023]
Abstract
The cognitive model of depression has significantly influenced the understanding of distorted cognitive processes in major depression; however, this model's conception of cognition has recently been criticized as possibly too broad and unspecific. In this review, we connect insights from cognitive neuroscience and psychiatry to suggest that the traditional cognitive model may benefit from a reformulation that takes current Bayesian models of the brain into account. Appealing to a predictive processing account, we explain that healthy human learning is normally based on making predictions and experiencing discrepancies between predicted and actual events or experiences. We present evidence suggesting that this learning mechanism is distorted in depression: current research indicates that people with depression tend to negatively reappraise or disregard positive information that disconfirms negative expectations, thus resulting in sustained negative predictions and biased learning. We also review the neurophysiological correlates of such deficits in processing prediction errors in people with depression. Synthesizing these findings, we propose a novel mechanistic model of depression suggesting that people with depression have the tendency to predominantly expect negative events or experiences, which they subjectively feel confirmed due to reappraisal of disconfirming evidence, thus creating a self-reinforcing negative feedback loop. Computationally, we consider too much precision afforded to negative prior beliefs as the main candidate of pathology, accompanied by an attenuation of positive prediction errors. We conclude by outlining some directions for future research into the understanding of the behavioral and neurophysiological underpinnings of this model and point to clinical implications of it.
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Affiliation(s)
- Tobias Kube
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Koblenz-Landau, Landau, Germany; Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Philipps-University of Marburg, Marburg, Germany; Program in Placebo Studies, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
| | - Rainer Schwarting
- Department of Behavioral Neuroscience, Faculty of Psychology, Philipps-University of Marburg, Marburg, Germany
| | - Liron Rozenkrantz
- Program in Placebo Studies, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Julia Anna Glombiewski
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Koblenz-Landau, Landau, Germany; Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Philipps-University of Marburg, Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Philipps-University of Marburg, Marburg, Germany
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Kube T, Rozenkrantz L, Rief W, Barsky A. Understanding persistent physical symptoms: Conceptual integration of psychological expectation models and predictive processing accounts. Clin Psychol Rev 2020; 76:101829. [PMID: 32062101 DOI: 10.1016/j.cpr.2020.101829] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/23/2020] [Accepted: 01/23/2020] [Indexed: 01/11/2023]
Abstract
Persistent physical symptoms (PPS) are distressing, difficult to treat, and pose a major challenge to health care providers and systems. In this article, we review two disparate bodies of literature on PPS to provide a novel integrative model of this elusive condition. First, we draw on the clinical-psychological literature on the role of expectations to suggest that people with PPS develop dysfunctional expectations about health and disease that become increasingly immune to disconfirmatory information (such as medical reassurance) through cognitive reappraisal. Second, we invoke neuroscientific predictive processing accounts and propose that the psychological process of 'cognitive immunization' against disconfirmatory evidence corresponds, at the neurobiological and computational level, to too much confidence (i.e. precision) afforded to prior predictions. This can lead to an attenuation of disconfirming sensory information so that strong priors override benign bodily signals and make people believe that something serious is wrong with the body. Combining these distinct accounts provides a unifying framework for persistent physical symptoms and shifts the focus away from their causes to the sustaining mechanisms that prevent symptoms from subsiding spontaneously. Based on this integrative model, we derive new avenues for future research and discuss implications for treating people with PPS in clinical practice.
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Affiliation(s)
- Tobias Kube
- Harvard Medical School, Program in Placebo Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA; Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstr. 18, 35032 Marburg, Germany; Pain and Psychotherapy Research Lab, University of Koblenz-Landau, Ostbahnstr. 10, 76829 Landau, Germany.
| | - Liron Rozenkrantz
- Harvard Medical School, Program in Placebo Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA; Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Gutenbergstr. 18, 35032 Marburg, Germany
| | - Arthur Barsky
- Harvard Medical School, Program in Placebo Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115, USA; Department of Psychiatry, Harvard Medical School, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA 02115, USA
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Blease CR, Arnott T, Kelley JM, Proctor G, Kube T, Gaab J, Locher C. Attitudes About Informed Consent: An Exploratory Qualitative Analysis of UK Psychotherapy Trainees. Front Psychiatry 2020; 11:183. [PMID: 32231601 PMCID: PMC7083167 DOI: 10.3389/fpsyt.2020.00183] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 02/25/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Ethical informed consent to psychotherapy has recently been the subject of in-depth analysis among healthcare ethicists. Objective: This study aimed to explore counseling and psychotherapy students' views and understanding about informed consent to psychological treatments. Methods: Two focus groups were conducted with a total of 10 students enrolled in a Masters course in counseling and psychotherapy at a British university. Questions concerned participants' understanding of informed consent including judgments about client capacity; the kinds of information that should be disclosed; how consent might be obtained; and their experiences of informed consent, both as a client and as a therapist. Focus groups were audio-recorded, transcribed, and analyzed using qualitative content analysis. Coding was conducted independently by three authors. Results: Comments were classified into three main themes: (1) the reasons and justifications for informed consent; (2) informed consent processes; and (3) the hidden ethics curriculum. Some trainees expressed significant doubts about the importance of informed consent. However, participants also identified the need to establish the clients' voluntariness and their right to be informed about confidentiality issues. In general, the format and processes pertaining to informed consent raised considerable questions and uncertainties. Participants were unsure about rules surrounding client capacity; expressed misgivings about describing treatment techniques; and strikingly, most trainees were skeptical about the clinical relevance of the evidence-base in psychotherapy. Finally, trainees' experiences as clients within obligatory psychotherapy sessions were suggestive of a "hidden ethics curriculum"-referring to the unintended transmission of norms and practices within training that undermine the explicit guidance expressed in formal professional ethics codes. Some students felt coerced into therapy, and some reported not undergoing informed consent processes. Reflecting on work placements, trainees expressed mixed views, with some unclear about who was responsible for informed consent. Conclusions: This qualitative study presents timely information on psychotherapy students' views about informed consent to psychotherapy. Major gaps in students' ethical, conceptual, and procedural knowledge were identified, and comments suggested the influence of a hidden curriculum in shaping norms of practice. Implications: This exploratory study raises important questions about the preparedness of psychotherapy students to fulfill their ethical obligations.
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Affiliation(s)
- Charlotte R Blease
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.,School of Psychology, University College Dublin, Dublin, Ireland
| | - Tim Arnott
- School of Healthcare, University of Leeds, Leeds, United Kingdom
| | - John M Kelley
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.,Department of Psychology, Endicott College, Beverly, MA, United States
| | - Gillian Proctor
- School of Healthcare, University of Leeds, Leeds, United Kingdom
| | - Tobias Kube
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.,Pain and Psychotherapy Lab, University of Koblenz and Landau, Landau, Germany
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Cosima Locher
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland.,School of Psychology, University of Plymouth, Plymouth, United Kingdom
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Kube T, Kirchner L, Rief W, Gärtner T, Glombiewski JA. Belief updating in depression is not related to increased sensitivity to unexpectedly negative information. Behav Res Ther 2019; 123:103509. [PMID: 31715323 DOI: 10.1016/j.brat.2019.103509] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/25/2019] [Accepted: 11/02/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND People with depression differ from healthy people in the extent to which they use novel positive information to adjust negative expectations. In this study, we examined whether the two groups also differ in updating positive expectations after receiving unexpectedly negative information. METHODS Examining 76 people with depressive symptoms and 81 healthy controls, we used an adapted version of a previously validated paradigm. After the initial establishment of positive performance expectations, participants worked on the TEMINT performance test, whereupon half of the participants received standardized feedback that confirmed previous positive expectations while the other half received disconfirming negative feedback. Subsequently, participants' performance expectations were assessed again. Additionally, we assessed participants' appraisal of the feedback, particularly whether they tended to disregard it. RESULTS Results indicated that healthy subjects had overall more positive expectations than people with depressive symptoms, but the two samples did not differ in updating their expectations: both groups changed their expectations in a negative direction after receiving negative feedback; similarly, there were no differences between the two samples after receiving confirmatory positive feedback. Both people with and without depressive symptoms were more likely to disregard the feedback received if the feedback was negative, and such a negative appraisal of the feedback was associated with smaller expectation update. CONCLUSIONS In combination with prior work, the current findings suggest that people with depressive symptoms do not over-sensitively react to unexpectedly negative information; rather, the main problem of depression seems to be the integration of novel positive information, as shown previously.
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Affiliation(s)
- Tobias Kube
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, 35032, Marburg, Germany; University of Koblenz-Landau, Pain and Psychotherapy Research Lab, Ostbahnstraße 10, 76829, Landau, Germany.
| | - Lukas Kirchner
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Winfried Rief
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, 35032, Marburg, Germany
| | - Thomas Gärtner
- Schön Klinik Bad Arolsen, Hofgarten 10, 34454, Bad Arolsen, Germany
| | - Julia Anna Glombiewski
- University of Koblenz-Landau, Pain and Psychotherapy Research Lab, Ostbahnstraße 10, 76829, Landau, Germany
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Kube T, Meyer J, Grieshaber P, Moosdorf R, Böning A, Rief W. Patients’ pre- and postoperative expectations as predictors of clinical outcomes six months after cardiac surgery. PSYCHOL HEALTH MED 2019; 25:781-792. [DOI: 10.1080/13548506.2019.1659986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Tobias Kube
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Julia Meyer
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
| | - Philippe Grieshaber
- Department of Adult and Pediatric Cardiovascular Surgery, Justus-Liebig-University Giessen, Gießen, Germany
| | - Rainer Moosdorf
- Department of Cardiovascular Surgery, Heart Centre, Philipps-University of Marburg, Marburg, Germany
| | - Andreas Böning
- Department of Adult and Pediatric Cardiovascular Surgery, Justus-Liebig-University Giessen, Gießen, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany
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40
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Kube T, Rief W, Gollwitzer M, Gärtner T, Glombiewski JA. Why dysfunctional expectations in depression persist - Results from two experimental studies investigating cognitive immunization. Psychol Med 2019; 49:1532-1544. [PMID: 30131084 DOI: 10.1017/s0033291718002106] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Research has revealed that negative expectations impact depressive symptoms. However, research on the change of dysfunctional expectations in depression is lacking so far. Therefore, the present research aimed to fill this gap by testing the hypothesis that people with the major depressive disorder (MDD), contrary to healthy individuals, maintain their expectations despite experiences that positively disconfirm expectations. Further, it was hypothesized that cognitive immunization (a cognitive reappraisal of the disconfirming evidence) is a mechanism underlying the persistence of expectations. METHOD In Study 1, we compared individuals with MDD (N = 58) to healthy individuals (N = 59). Participants worked on the same performance test and received standardized feedback that either confirmed or disconfirmed their initial performance expectations. In Study 2, we investigated the effects of cognitive immunization on expectation change among 59 individuals reporting elevated levels of depression by varying the appraisal of expectation-disconfirming feedback. RESULTS Results from Study 1 show that in the expectation-disconfirming condition, healthy individuals changed their expectations, whereas individuals with MDD did not. No such difference between the two groups was found for expectation-confirming feedback. Results from Study 2 indicated that varying cognitive immunization impacted expectation change, thus suggesting a crucial role of cognitive immunization in expectation change. CONCLUSIONS These two studies indicated that individuals suffering from depression have more difficulties in changing their expectations after disconfirming experiences than do healthy individuals, and cognitive immunization might be a core mechanism underlying expectation persistence. Therefore, psychotherapeutic interventions should aim to inhibit cognitive immunization processes to enhance expectation change.
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Affiliation(s)
- Tobias Kube
- Department of Clinical Psychology and Psychotherapy,Philipps-University of Marburg,Gutenbergstraße 18, D-35032 Marburg,Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy,Philipps-University of Marburg,Gutenbergstraße 18, D-35032 Marburg,Germany
| | - Mario Gollwitzer
- Department of Psychological Methodology and Social Psychology,Philipps-University of Marburg,Gutenbergstraße 18, D-35032 Marburg,Germany
| | - Thomas Gärtner
- Schön Klinik Bad Arolsen,Hofgarten 10, D-34454 Bad Arolsen,Germany
| | - Julia Anna Glombiewski
- Department of Clinical Psychology and Psychotherapy,Philipps-University of Marburg,Gutenbergstraße 18, D-35032 Marburg,Germany
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Kube T, Glombiewski J, Rief W. Erwartungsfokussierte psychotherapeutische Interventionen bei Personen mit depressiver Symptomatik. Verhaltenstherapie 2019. [DOI: 10.1159/000496944] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Hope is a crucial aspect of human life and has been a topic of interest in many scholarly disciplines. The medical literature, however, has-with a few exceptions-failed to take account of conceptions of hope across other scholarly disciplines. Before exploring what makes hope a distinctive and important phenomenon in medical contexts, this article reviews prominent views on hope from philosophy, anthropology, theology, and psychology. To synthesize these different conceptions, the authors propose an integrative approach aimed at improving the understanding of hope in medicine. The authors use a modes-of-hoping framework to explain different phenomena related to hope in medicine, such as hope in the face of a dismal prognosis, in the disclosure of diagnostic information, and in the initiation of new treatments. Based on this tentative framework, possible directions for future empirical research are discussed. Beside further qualitative research into the patients' and physicians' understanding and experiences of hope, the authors urge a quantitative examination of the impact of hope (while recognizing that a quantitative approach might not able to capture hope's many intricacies). Finally, they discuss clinical and ethical implications with respect to a balance between physicians being honest and acknowledging patients' hope.
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Sarina S, Kube T, Yao W, Xu J, Sehouli J, Kaufmann AM. Validation of IFN-γ/IL-2 FluoroSpot assay for monitoring HPV L1-specific immuneresponses in Cervarix™ vaccinees. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- S Sarina
- Charité-Universitätsmedizin Berlin/Klinik für Gynäkologie, Labor Gynäkologische Tumorimmunologie, Berlin, Deutschland
| | - T Kube
- Charité-Universitätsmedizin Berlin/Klinik für Gynäkologie, Labor Gynäkologische Tumorimmunologie, Berlin, Deutschland
| | - W Yao
- Charité-Universitätsmedizin Berlin/Klinik für Hals, Nasen, Ohrenheilkunde, Berlin, Deutschland
| | - J Xu
- Charité-Universitätsmedizin Berlin/Klinik für Gynäkologie, Labor Gynäkologische Tumorimmunologie, Berlin, Deutschland
| | - J Sehouli
- Charité-Universitätsmedizin Berlin/Klinik für Gynäkologie, Berlin, Deutschland
| | - AM Kaufmann
- Charité-Universitätsmedizin Berlin/Klinik für Gynäkologie, Labor Gynäkologische Tumorimmunologie, Berlin, Deutschland
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Kube T, Rief W, Gollwitzer M, Glombiewski JA. Introducing an EXperimental Paradigm to investigate Expectation Change (EXPEC). J Behav Ther Exp Psychiatry 2018; 59:92-99. [PMID: 29253640 DOI: 10.1016/j.jbtep.2017.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/13/2017] [Accepted: 12/11/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVES Dysfunctional expectations are considered to be core features of various mental disorders. Clinical observations suggest that people suffering from mental disorders such as major depression tend to maintain dysfunctional expectations despite expectation-disconfirming evidence. Surprisingly, this clinically relevant phenomenon has not yet sufficiently been investigated in empirical studies. Therefore, we developed an experimental paradigm to investigate expectation change vs. maintenance, and the first step to test its validity is to apply it in healthy individuals. METHODS After conducting two pilot studies (n = 28; n = 37), the present study systematically examined whether it is possible to change healthy individuals' (n = 102) task-specific and generalized performance expectations through expectation-disconfirming experiences. Using a standardized instruction, we initially induced non-positive expectations regarding participants' ability to successfully work on an unknown test. Then, participants received standardized performance feedback that either confirmed or disconfirmed their expectations before assessing participants' expectations again after completing the Test for the Measure of Emotional Intelligence. RESULTS Results indicate that expectation-disconfirming feedback led to a significant change of both task-specific and generalized performance expectations. There was no expectation change in the expectation-confirming condition. LIMITATIONS As the present study examined expectation change among healthy individuals, the next step is to apply this paradigm in a clinical sample and to examine whether expectation change is less likely among people suffering from depression or other mental disorders characterized by dysfunctional expectations. CONCLUSIONS Focusing more rigorously on expectation maintenance among people with mental disorders could enable therapists to develop expectation-focused interventions aiming at enhancing expectation change.
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Affiliation(s)
- Tobias Kube
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany.
| | - Winfried Rief
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany
| | - Mario Gollwitzer
- Philipps-University of Marburg, Department of Psychological Methodology and Social Psychology, Gutenbergstraße 18, D-35032 Marburg, Germany
| | - Julia A Glombiewski
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany
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Kube T, Siebers VHA, Herzog P, Glombiewski JA, Doering BK, Rief W. Integrating situation-specific dysfunctional expectations and dispositional optimism into the cognitive model of depression - A path-analytic approach. J Affect Disord 2018; 229:199-205. [PMID: 29324367 DOI: 10.1016/j.jad.2017.12.082] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 11/17/2017] [Accepted: 12/31/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Dysfunctional expectations are considered to be core features of mental disorders and, in particular, major depression. The aim of the present study was to integrate two important types of expectations into the cognitive model of depression: situation-specific dysfunctional expectations (SDE) and dispositional optimism (DO). It was hypothesized that the influence of both DO and intermediate beliefs (IB) on depressive symptoms would be mediated via SDE. METHODS We examined 95 individuals (age M = 40.7, 68.1% female) with a diagnosed major depressive disorder from two inpatient clinics and one outpatient clinic. Measurements used in the study included the Depressive Expectations Scale, Dysfunctional Attitudes Scale, Life Orientation Test Revised, and Beck's Depression Inventory-II. Relationships between the constructs were analyzed using path-analytic models with bias-corrected bootstrapping confidence intervals. RESULTS Results indicate that the effect of IB on depressive symptoms was fully mediated via SDE, while the effect of DO on depressive symptoms was partly mediated via SDE. IB and DO moderately correlated with each other. LIMITATIONS Due to the cross-sectional design of the study, it is not possible to draw unambiguous conclusions regarding the causality of the suggested relationships. CONCLUSIONS The present study stresses the crucial role of dysfunctional expectations for major depression. Moreover, it reveals that SDEs as expectations with a high level of situational specificity may pose an important link between global cognitions and depressive symptoms. Given this situational specificity, SDEs are amenable to disconfirmation through behavioral experiments and may therefore be a promising target for cognitive-behavioral interventions.
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Affiliation(s)
- Tobias Kube
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany.
| | - Verena Helena Anna Siebers
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany
| | - Philipp Herzog
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany
| | - Julia Anna Glombiewski
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany
| | - Bettina Katharina Doering
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany
| | - Winfried Rief
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany
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Kube T, D'Astolfo L, Glombiewski JA, Doering BK, Rief W. Focusing on situation-specific expectations in major depression as basis for behavioural experiments - Development of the Depressive Expectations Scale. Psychol Psychother 2017; 90:336-352. [PMID: 27935247 DOI: 10.1111/papt.12114] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 11/07/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Dysfunctional expectations are considered to be core features of various mental disorders. The aim of the study was to develop the Depressive Expectations Scale (DES) as a depression-specific measure for the assessment of dysfunctional expectations. Whereas previous research primarily focused on general cognitions and attitudes, the DES assesses 25 future-directed expectations (originally 75 items) which are situation-specific and falsifiable. DESIGN AND METHODS To evaluate the psychometric properties of the DES, the scale was completed by 175 participants with and without severe depressive symptoms in an online survey. Participants additionally completed the Patient Health Questionnaire modules for depression (PHQ-9) and anxiety (GAD-7). People experiencing depressive symptoms were informed about the study with the help of self-help organizations. RESULTS Reliability analyses indicated excellent internal consistency of the scale. An exploratory factor analyses revealed four factors: social rejection, social support, mood regulation, and ability to perform. The DES sum score strongly correlated with the severity of depressive symptoms. The DES sum score also significantly correlated with symptoms of generalized anxiety. CONCLUSION The DES was shown to have excellent reliability; validity analyses were promising. As the DES items are situation-specific and falsifiable, they can be tested by the individual using behavioural experiments and may therefore facilitate cognitive restructuring. Thus, a structured assessment of patients' expectation with help of the DES can provide a basis for interventions within cognitive-behavioural treatment of depression. PRACTITIONER POINTS Assessing situation-specific expectations in patients experiencing depressive symptoms can provide a basis for the conduction of behavioural experiments to test patients' expectations. For the use of behavioural experiments, therapists should choose those dysfunctional expectations which a patient strongly agrees on. To modify patients' expectations, they should be exposed to situations where the discrepancy between patients' expectations and actual situational outcomes can be maximized. The Depressive Expectations Scale can be completed repeatedly to monitor a patient's progress within cognitive-behavioural treatment.
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Affiliation(s)
- Tobias Kube
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Germany
| | - Lisa D'Astolfo
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Germany
| | - Julia A Glombiewski
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Germany
| | - Bettina K Doering
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Germany
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Laferton JAC, Kube T, Salzmann S, Auer CJ, Shedden-Mora MC. Patients' Expectations Regarding Medical Treatment: A Critical Review of Concepts and Their Assessment. Front Psychol 2017; 8:233. [PMID: 28270786 PMCID: PMC5318458 DOI: 10.3389/fpsyg.2017.00233] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 02/06/2017] [Indexed: 01/29/2023] Open
Abstract
Patients’ expectations in the context of medical treatment represent a growing area of research, with accumulating evidence suggesting their influence on health outcomes across a variety of medical conditions. However, the aggregation of evidence is complicated due to an inconsistent and disintegrated application of expectation constructs and the heterogeneity of assessment strategies. Therefore, based on current expectation concepts, this critical review provides an integrated model of patients’ expectations in medical treatment. Moreover, we review existing assessment tools in the context of the integrative model of expectations and provide recommendations for improving future assessment. The integrative model includes expectations regarding treatment and patients’ treatment-related behavior. Treatment and behavior outcome expectations can relate to aspects regarding benefits and side effects and can refer to internal (e.g., symptoms) and external outcomes (e.g., reactions of others). Furthermore, timeline, structural and process expectations are important aspects with respect to medical treatment. Additionally, generalized expectations such as generalized self-efficacy or optimism have to be considered. Several instruments assessing different aspects of expectations in medical treatment can be found in the literature. However, many were developed without conceptual standardization and psychometric evaluation. Moreover, they merely assess single aspects of expectations, thus impeding the integration of evidence regarding the differential aspects of expectations. As many instruments assess treatment-specific expectations, they are not comparable between different conditions. To generate a more comprehensive understanding of expectation effects in medical treatments, we recommend that future research should apply standardized, psychometrically evaluated measures, assessing multidimensional aspects of patients’ expectations that are applicable across various medical treatments. In the future, more research is needed on the interrelation of different expectation concepts as well as on factors influencing patients’ expectations of illness and treatment. Considering the importance of patients’ expectations for health outcomes across many medical conditions, an integrated understanding and assessment of such expectations might facilitate interventions aiming to optimize patients’ expectations in order to improve health outcomes.
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Affiliation(s)
- Johannes A C Laferton
- Department of Psychology, Clinical Psychology and Psychotherapy, Psychologische Hochschule BerlinBerlin, Germany; Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps University of MarburgMarburg, Germany
| | - Tobias Kube
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg Marburg, Germany
| | - Stefan Salzmann
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps University of Marburg Marburg, Germany
| | - Charlotte J Auer
- Division of Psychotherapy and Psychiatry, University Hospital Lübeck Lübeck, Germany
| | - Meike C Shedden-Mora
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf Hamburg, Germany
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Kube T, Rief W, Glombiewski JA. On the Maintenance of Expectations in Major Depression - Investigating a Neglected Phenomenon. Front Psychol 2017; 8:9. [PMID: 28149287 PMCID: PMC5241292 DOI: 10.3389/fpsyg.2017.00009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 01/03/2017] [Indexed: 11/17/2022] Open
Abstract
In this perspective paper, we suggest that among patients suffering from major depressive disorder (MDD), dysfunctional expectations are maintained despite experiences that are contrary to these expectations. Surprisingly, this persistence of expectations in MDD has not yet been addressed by empirical studies. We argue that it is worthwhile to investigate this phenomenon with the aim of improving the treatment of MDD, and we provide a theoretical framework for understanding it. It is hypothesized that the persistence of expectations is primarily due to a process called immunization. That is, people experiencing depressive symptoms may cognitively reappraise the contradictory experience such that expectations do not need to be changed. There may be two mechanisms underlying this immunization: (1) the experience in the expectation-violating situation is considered to be an exception; or (2) the credibility of the information gained from the experience is called into question. Moreover, the maintenance of expectations may be particularly persistent if a person’s expectations reflect his or her self-concept, as self-concept has been shown to be associated with future expectations. To empirically examine the hypothesized maintenance of expectations in MDD, we propose an experimental approach which could provide important implications for the treatment of MDD within cognitive behavioral therapy. We suggest that psychological interventions such as behavioral experiments should more rigorously focus on patients’ appraisal of expectation-violating experiences in order to prevent immunization processes. Therapists should continuously examine whether patients’ expectations were modified and should address the reasons for the maintenance of expectations.
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Affiliation(s)
- Tobias Kube
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg Marburg, Germany
| | - Julia A Glombiewski
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg Marburg, Germany
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Kube T, Rief W. Are placebo and drug-specific effects additive? Questioning basic assumptions of double-blinded randomized clinical trials and presenting novel study designs. Drug Discov Today 2016; 22:729-735. [PMID: 27919806 DOI: 10.1016/j.drudis.2016.11.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/17/2016] [Accepted: 11/25/2016] [Indexed: 02/07/2023]
Abstract
Double-blinded randomized clinical trials (RCTs) assume that pharmacological interventions have drug-specific and unspecific components. Traditional RCTs postulate an additivity of these two components. In this review, we provide evidence from both clinical trials and experimental studies that questions this 'additive model'. Given that the evaluation of drug treatments in RCTs is based on the assumption of additivity, its violation has far-reaching consequences. Therefore, we discuss an interactive model that, in contrast to the additive model, considers interactions between placebo and drug-specific effects. Moreover, we discuss implications for future clinical trials and present novel study designs enabling researchers to consider the complex interplay of drug-specific and unspecific effects.
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Affiliation(s)
- Tobias Kube
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstrabe 18, D-35032 Marburg, Germany.
| | - Winfried Rief
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstrabe 18, D-35032 Marburg, Germany
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Auer CJ, Kube T, Laferton JAC, Salzmann S, Shedden-Mora M, Rief W, Moosdorf R. Welche Erwartungen sagen postoperative Depressivität und Ängstlichkeit bei herzchirurgischen Patienten am stärksten vorher? Zeitschrift für Klinische Psychologie und Psychotherapie 2016. [DOI: 10.1026/1616-3443/a000358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Depressivität und Ängstlichkeit beeinträchtigen den Behandlungserfolg von herzchirurgischen Patienten. Fragestellung: Untersucht wurde, ob und wie präoperative Patientenerwartungen mit postoperativer Depressivität und Ängstlichkeit zusammenhängen und welche präoperativen Erwartungen hierbei den höchsten prädiktiven Wert haben. Methoden: 124 aortocoronare Bypass-Patienten bearbeiteten eine Woche vor der Operation einen Fragebogen, der verschiedene Aspekte von Erwartungen mischt (Positive Health Expectation Questionnaire; PHES) und einen Fragebogen, der einzelne Erwartungsaspekte getrennt erfasst (Expected Illness Perception Questionnaire, IPQ-E) und eine Woche vor sowie eine Woche nach der Operation Fragen zu ihrer Depressivität und Ängstlichkeit (Hospital Anxiety and Depression Scale (HADS)). Ergebnisse: Postoperative Depressivität wird durch präoperative Erwartungen vorhergesagt (R2 = 0.32, F = 3.13, p = .02). Der einzig signifikante Prädiktor hierbei sind positive Gesundheitserwartungen gemessen mit dem PHES. Auch postoperative Ängstlichkeit wird durch präoperative Erwartungen vorhergesagt (R2 = 0.27, F = 2.55, p < .05). Bei der Vorhersage postoperativer Ängstlichkeit haben erwartete Konsequenzen gemessen mit dem IPQ-E den stärksten prädiktiven Wert. Schlussfolgerungen: Die Studie belegt die Relevanz von präoperativen Erwartungen bei herzchirurgischen Patienten. Interventionen, die auf die Verringerung von Depressivität herzchirurgischer Patienten abzielen, sollten den Fokus auf verschiedene Aspekte von Erwartungen legen. Bei der Verringerung postoperativer Ängstlichkeit könnten hingegen einzeln erfasste Erwartungsaspekte von Bedeutung sein.
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Affiliation(s)
- Charlotte J. Auer
- AG Klinische Psychologie und Psychotherapie, Philipps-Universität Marburg
| | - Tobias Kube
- AG Klinische Psychologie und Psychotherapie, Philipps-Universität Marburg
| | | | - Stefan Salzmann
- AG Klinische Psychologie und Psychotherapie, Philipps-Universität Marburg
| | - Meike Shedden-Mora
- Institut und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf
| | - Winfried Rief
- AG Klinische Psychologie und Psychotherapie, Philipps-Universität Marburg
| | - Rainer Moosdorf
- Klinik für Herz- und thorakale Gefäßchirurgie, Universitätsklinikum Gießen-Marburg
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