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See detailEnhanced Cortical Processing of Cardio-Afferent Signals in Anorexia Nervosa
Lutz, Annika UL; Schulz, André UL; Voderholzer, U. et al

in Clinical Neurophysiology (2019)

Objective: To assess cardiac interoception in anorexia nervosa (AN) using a multidimensional approach. Methods: We assessed the physiological dimensions of cardioception, i.e. the peripheral signal itself ... [more ▼]

Objective: To assess cardiac interoception in anorexia nervosa (AN) using a multidimensional approach. Methods: We assessed the physiological dimensions of cardioception, i.e. the peripheral signal itself (heart rate, HR, and heart rate variability, HRV) and its cortical representation (heartbeat evoked potentials, HEPs), and the psychological dimensions of interoceptive accuracy (heartbeat perception) and interoceptive sensibility (confidence ratings). Electroencephalogram (EEG) and electrocardiogram (ECG) were recorded concurrently during rest and while performing a heartbeat perception task in a sample of 19 female in-patients with AN (DSM-5) and 19 healthy control women (HC). Results: HEPs, defined as mean EEG amplitude in a time window of 455-595 ms after the Rpeak of the ECG, were significantly larger in the AN than in the HC group across conditions (p = .002, d = 1.06). There was a trend toward better heartbeat perception in AN, but no group differences in HR, HRV, and confidence ratings. Conclusions: Individuals with AN showed an interoceptive profile of heightened cortical processing, a trend toward heightened interoceptive accuracy, and unaltered cardiac autonomic activation and interoceptive sensibility. Significance: In terms of neurobiological models of AN, enhanced cortical representations of interoceptive signals might reflect a mechanism, which promotes fasting by alleviating negative body states. [less ▲]

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See detailImpaired filter function in patients with somatoform disorders and major depression, as reflected by auditory evoked potentials in an oddball and an active distraction paradigm
Hutmacher, Djenna UL; Dierolf, Angelika UL; Lutz, Annika UL et al

in Abstractband Psychologie und Gehirn 2018 (2018)

Introduction: In the in influential perception-filter model of somatoform disorders (SD), three stages of symptom perception are postulated: (1) bodily signals, which may be amplified by stress, (2) a ... [more ▼]

Introduction: In the in influential perception-filter model of somatoform disorders (SD), three stages of symptom perception are postulated: (1) bodily signals, which may be amplified by stress, (2) a filter system, which distinguishes between relevant and irrelevant stimuli, and (3) cortical perception of physical symptoms. As there is dearth of evidence so far supporting the relationship between (1) bodily signals and (2) filter processes in SD, this study investigated if filter processes are altered in SD and if stress may affect filter mechanisms. Methods: Twenty-four patients with SD, 24 with depression and 24 healthy control individuals were assessed. Event-related potentials (ERPs) with two different auditory distraction procedures were recorded over four blocks, one before and three after either a socially evaluated cold pressor test (SECPT) or a control procedure. We manipulated both the frequency of and the attentional focus on stimuli to reflect filter processes. Results: We found smaller P3b amplitudes (reflecting memory storage) in patients with depression and SD, as compared to healthy controls. Furthermore, both patient groups showed a smaller P3a amplitude (reflecting attention), when counting the infrequent tone ("Oddball task") and a smaller N1 amplitude when counting the frequent tone ("active distraction"). In patients with SD, the SECPT had a decreasing effect on P3a amplitudes. Conclusions: Both late filter processes, reflecting attention (P3a) and memory storage (P3b), may be impaired in SD and depression. As acute stress affected attention in SD patients only, the impact of bodily signals (1) on filter processes (2) may be specific for SD. [less ▲]

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See detailSensing Your Body: Interoceptive Awareness and Medically Unexplained Symptoms
Flasinski, Tabea UL; Dierolf, Angelika UL; Voderholzer, Ulrich et al

in Abtracts of the 32nd Annual Conference of the European Health Psychology Society (2018)

According to contemporary theories of medically unexplained symptoms (MUS), alterations in interoception play a major role in symptom development and maintenance. Nevertheless, the mechanisms underlying ... [more ▼]

According to contemporary theories of medically unexplained symptoms (MUS), alterations in interoception play a major role in symptom development and maintenance. Nevertheless, the mechanisms underlying this relationship remains unclear. To address this unresolved issue, we investigated whether individuals with varying degrees of MUS differ in different facets of interoceptive awareness as assessed with the Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire. In study 1, 486 individuals were screened with an online version of the Screening for Somatoform Disorders (SOMS-2). Individuals with a SOMS index below 5 (low reporter, n=32) and above 20 (high reporter, n=32) were invited to fill in the MAIA. High symptom reporter had lower scores on the Not-Distracting, Not-Worrying, and Trusting subscales, and higher scores on the Emotional Awareness subscale (Cohen´s d=.70–1.16). In study 2, individuals with DSM-IV somatoform disorder (SFD; n=25) were compared to individuals with major depressive disorder (MDD; n=24) and healthy controls (HC; n=25). The SFD and MDD groups had lower scores on the Not-Distracting, Attention Regulation, Self-Regulation, and Trusting subscales than HC. The MDD group had lower scores than the SFD and HC groups on the Body Listening subscale (partial eta-squared=.18-.26). No differences with regard to Noticing of bodily sensations were found. Groups with subclinical SFD, SFD and MDD do not differ from healthy individuals in terms of actual body perception, whereas cognitive facets of interoception, such as distraction or self-regulation are differentially affected. This highlights the necessity of including specifically targeted mindfulness-based interventions [less ▲]

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See detailKardiale Modulation der Schreckreaktion bei hoher gegenüber niedriger Symptombelastung: afferente Signalübermittlung auf der Hirn-Körper-Achse beein usst frühe Stimulus-Verarbeitung bei hoher Symptombelastung
Dierolf, Angelika UL; Rost, Silke; Lutz, Annika UL et al

in Hennig, J.; Stark, R. (Eds.) Abstractband Psychologie und Gehirn 2018 (2018)

Somatische Belastungsstörungen (SBS) sind oftmals durch andauernde medizinisch- unerklärte Symptome gekennzeichnet, deren Entstehung größtenteils ungeklärt ist. Diese Studie hatte zum Ziel, die empirisch ... [more ▼]

Somatische Belastungsstörungen (SBS) sind oftmals durch andauernde medizinisch- unerklärte Symptome gekennzeichnet, deren Entstehung größtenteils ungeklärt ist. Diese Studie hatte zum Ziel, die empirisch bislang unbeantwortete Frage zu klären, ob Symptomentstehung auf veränderte Signalübermittlung auf der Hirn-Körper-Achse zurückzuführen ist. Zunächst wurden 486 Personen aus der Allgemeinbevölkerung anhand des SOMS-2 in Personen mit hoher Symptombelastung (HSB; unterstes Perzentil) und niedriger Symptombelastung (NSB; oberstes Perzentil) unterteilt. Personen mit HSB stellen eine besondere Risikogruppe für SBS dar. 28 HSB- und 31 NSB-Personen durchliefen ein Paradigma der kardialen Modulation der Schreckreaktion (CMS), ein Verfahren, das kardio-afferente Signalübermittlung prä-attentiv abbilden kann. Ihnen wurden je zehn akustische Schreckreize (105 dB) in sechs Zeitpunkten nach der kardialen R-Zacke (0, 100, 200, 300, 400, 500 ms) präsentiert. Als Indikator für die Schreckreaktion wurden die N1- und P2-Amplitude der auditorisch-evozierten Potenziale über Cz gemessen, da der Effekt der Hirn-Körper-Signalübermittlung im Kortex abgebildet werden sollte. Es zeigten sich geringere N1-Amplituden auf die Schreckreize, die während der systolischen Phase (200, 300 ms) im Vergleich zur diastolischen Phase (0 ms) präsentiert wurden (p=.0002), was für das Vorliegen eines CMS-Effekts spricht. Die HSB-Gruppe zeigte höhere P2-Amplituden als die NSB-Gruppe. Es zeigte sich außerdem, dass der CMS-Effekt bezüglich der N1-Komponente in der HSB-Gruppe geringer ist (p=.035), jedoch bezüglich der P2-Komponente stärker ist als in der NSB-Gruppe (p=.031). Afferente Signalübermittlung auf der Hirn-Körper-Achse könnte bei Personen mit HSB bereits frühe, automatischeWahrnehmungsprozesse verändern, die durch späte, aufmerksamkeits-gesteuerte Prozesse kompensiert werden. Diese prä-attentive Beeinflussung der Stimulus-Verarbeitung könnte ein Mechanismus der Symptomentstehung bei Personen mit HSB und SBS sein. [less ▲]

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See detailMood, emotions and eating disorders
Vögele, Claus UL; Lutz, Annika UL; Gibson, E. Leigh

in Agras, W. Stewart; Robinson, Athena (Eds.) The Oxford Handbook of Eating Disorders, Second Edition (2018)

Mood and emotions are intrinsically involved with eating. This chapter discusses basic mechanisms, findings, and models that help our understanding of the interactions between eating and emotions, in both ... [more ▼]

Mood and emotions are intrinsically involved with eating. This chapter discusses basic mechanisms, findings, and models that help our understanding of the interactions between eating and emotions, in both clinical and nonclinical populations. The finding that negative affect predicts EDs transdiagnostically, and that comorbidity with depressive disorders and anxiety disorders is the norm among patients with EDs suggests that EDs may not necessarily be restricted to domains of eating behavior and body image but may also be associated with significant difficulties in affective functioning. This chapter reviews the evidence relating to the notion that EDs are disturbances of mood regulation, in which regulatory strategies specifically related to eating and the body are used to diminish negative affect associated with food, body image, or stress. [less ▲]

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See detailGastric modulation of startle eye blink
Schulz, André UL; Van Dyck; Lutz, Annika UL et al

in Biological Psychology (2017), 127(1), 25-33

Abstract: Previous assessment methods of gastric interoception either rely on self-reports, or imply invasive procedures. We investigated the reliability of startle methodology as a non-invasive ... [more ▼]

Abstract: Previous assessment methods of gastric interoception either rely on self-reports, or imply invasive procedures. We investigated the reliability of startle methodology as a non-invasive alternative for the assessment of afferent gastric signals. Twenty-four participants were tested on three separate days, on which they were requested to ingest water (either 0, 300 or 600 ml), after 8 h of fasting. On each assessment day, eye blink responses (EMG) to 10 acoustic startle stimuli (105 dB) were assessed at 4 measurement points (before, 0, 7, 14 min. after ingestion). Increased normogastric responses (EGG), ratings of satiety and fullness, and higher heart rate variability (RMSSD) suggested effective non-invasive induction of gastric distention. Startle responses were lower directly after ingestion of 600 ml as compared to earlier and later measurements. These results suggest that startle methodology provides a reliable method to investigate afferent gastric signals. It could be useful to study possible dissociations between subjective reports and objective afferent gastric signals in eating or somatoform disorders. [less ▲]

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See detailAffective evaluation of body images in anorexia nervosa
Lutz, Annika UL; Herbert, Cornelia; Schulz, André UL et al

in Psychophysiology (2017), 54(S1),

Anorexia nervosa is characterized by fear of weight gain. This is reflected in amygdala activation during confrontation with distorted photographs of oneself simulating weight gain. In contrast ... [more ▼]

Anorexia nervosa is characterized by fear of weight gain. This is reflected in amygdala activation during confrontation with distorted photographs of oneself simulating weight gain. In contrast, photographs of emaciated women induce startle attenuation, suggesting a positive valuation of extreme slimness. To combine these findings, we applied an affective startle modulation paradigm containing photos of the participants simulating weight gain and photos simulating weight loss. We assessed eye-blink startle responses via EMG in 20 women with anorexia nervosa (AN; mean age = 25 years; mean BMI = 23) and 20 healthy control women (HC; mean age = 25 years; mean BMI = 23). We were able to replicate affective startle modulation of standard positive, negative, and neutral pictures, except for an absence of startle attenuation for positive pictures in AN. Body images did not modulate the startle response in either group. This was in contrast to the subjective ratings, in which the AN group indicated negative valence and high arousal for distorted body images. The body photographs used in our study emphasized general body shape and it appears that this was not threatening to AN patients. Photos highlighting body details might produce different results. Considering that body image exposure, a frequently used intervention tool for AN, aims at fear reduction through habituation, it is essential to determine which aspects of the body actually elicit fear responses to maximize therapy outcome. [less ▲]

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See detailThe Water Load Test As a Measure of Gastric Interoception: Development of a Two-Stage Protocol and Application to a Healthy Female Population
Van Dyck, Zoé UL; Vögele, Claus UL; Blechert, Jens et al

in PLoS ONE (2016), 11(9), 0163574

The sensitivity for one’s own internal body signals (i.e., interoception) has been demonstrated to play an important role in the pathogenesis of eating and weight disorders. Most previous measures ... [more ▼]

The sensitivity for one’s own internal body signals (i.e., interoception) has been demonstrated to play an important role in the pathogenesis of eating and weight disorders. Most previous measures assessing interoceptive processing have not, or only partly, captured perception of hunger and satiety cues, which is a core aspect of interoceptive deficits in eating disorders. In addition, methods used to measure sensitivity to gastric signals are heterogeneous and findings inconsistent. The primary aim of the present study was to establish a standardised test to measure gastric interoception, and to provide normative data using a non-clinical adult sample. The two-step Water Load Test (WLT-II) involves ingestion of non-caloric water until perceived satiation (step 1) and until maximum fullness (step 2). The WLT-II consists of several variables: Besides volumes of water ingested until satiation and maximum fullness expressed in ml, percentage of satiation to maximum fullness is calculated as an individual index of gastric interoception that is not confounded with stomach capacity. Ninety-nine healthy women participated in the study. Measures included the WLT-II, the heartbeat tracking test, a self-report questionnaire assessing subjective sensations, and the Eating Disorder Inventory-2. Twenty-eight participants underwent test-retest of the WLT-II. Results suggest that the WLT-II is a valid and reliable measure of gastric interoception. Importantly, satiation volume and percentage of satiation to maximum fullness were strongly positively related to self-reported bulimic symptoms, indicating that the WLT-II could emerge as a useful clinical tool to measure interoceptive processing in the field of eating disorders. [less ▲]

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See detailInterozeption bei Anorexia nervosa: Befunde auf subjektiver und elektrophysiologischer Ebene
Lutz, Annika UL; Schulz, André UL; Voderholzer, Ulrich et al

Scientific Conference (2016, September)

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See detailInterozeption bei Anorexia nervosa: Befunde auf subjektiver und elektrophysiologischer Ebene
Lutz, Annika UL; Schulz, André UL; Voderholzer, Ulrich et al

in 15. Kongress der Deutschen Gesellschaft für Verhaltensmedizin und Verhaltensmodifikation. Verhaltensmedizin 2.0 - von eHealth zu mHealth. 25. bis 27. Februar 2016, Johannes Gutenberg-Universität Mainz. Abstractband (2016, February)

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See detailGastrische Modulation der Schreckreaktion und gastrisch-evozierte Potenziale: zwei neue psychophysiologische Indikatoren für Interozeption des gastrointestinalen Systems
Schulz, André UL; Schaan, L.; Van Dyck, Zoé UL et al

in Kathmann, N. (Ed.) 42. Tagung Psychologie und Gehirn Abstractband (2016)

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See detailReduced early visual processing of own body images in anorexia nervosa: An event-related potentials study
Lutz, Annika UL; Herbert, Cornelia; Schulz, André UL et al

Poster (2016)

Introduction. Although body image distortion in anorexia nervosa (AN) has been extensively studied over the past decades, its underlying mechanisms are not yet fully understood. Neuro-imaging studies have ... [more ▼]

Introduction. Although body image distortion in anorexia nervosa (AN) has been extensively studied over the past decades, its underlying mechanisms are not yet fully understood. Neuro-imaging studies have identified functional and structural alterations in brain areas involved in visual body perception, but the time course of visual body processing in AN remains mostly unexplored. The current study used event-related brain potentials (ERPs) to investigate single processing steps along the time course, particularly the visual processing of physical body image characteristics (featural processing, P1) and the recognition of a body as such (configural processing, N1). Methods. Twenty in-patients with AN, and 20 healthy women viewed photographs of themselves, of another woman’s body and of their own and another woman’s standardized object (cup) with concurrent EEG recording. Results. Body images elicited an accentuation of the P1 component (105-160 ms), which was absent for the comparison between own-body and own-cup images in the AN group. Results regarding the N1 component suggest alterations in object processing in AN. Conclusions. Our results demonstrate that individuals with AN show reduced featural processing of their own body image, a process which, due to its position early in the visual processing stream, is unlikely to involve higher cognitive stimulus processing. This suggests a possible role of previously undetected pre-conscious mechanisms in body image disturbance. [less ▲]

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See detailInteroception in anorexia nervosa: evidence at cortical and self-report levels
Lutz, Annika UL; Schulz, André UL; Voderholzer, Ulrich et al

in Appetite (2016), 107

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See detailZentralnervöse Verarbeitung von Körpersignalen bei Anorexia nervosa
Lutz, Annika UL; Schulz, André UL; Voderholzer, Ulrich et al

Scientific Conference (2015, April)

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See detailBody perception and evaluation in anorexia nervosa
Lutz, Annika UL

Doctoral thesis (2015)

Body image disturbance is a prominent feature in anorexia nervosa (AN) and encompasses alterations across the different dimensions of body image, that is, perception, affect, cognition, and behaviour ... [more ▼]

Body image disturbance is a prominent feature in anorexia nervosa (AN) and encompasses alterations across the different dimensions of body image, that is, perception, affect, cognition, and behaviour. There is a wealth of research regarding the subjective experience of body image disturbance and evidence for underlying neuronal alterations is beginning to emerge. The present project was designed to assess basic processes underlying body image disturbance with the help of psychophysiological measurement techniques and self-other discrimination tasks. In study 1, using a self-other discrimination task with distorted body images, we were able to demonstrate interactions between perceptual factors and cognitive bias which may sustain a distorted and negative body image in healthy women. Study 2 showed a discrepancy between explicit negative ratings for body shapes and implicit neutral affect towards the same images, as assessed with an affective startle-modulation paradigm, in healthy women and women with AN. These results suggest that automatic fear responses to fat-distorted self-body pictures, as well as implicit approach motivation towards thin body images, as reported in previous studies, are not present in all patients with AN. In study 3 a differential alteration of featural and configural visual processing of body images was detected in an event-related brain potentials (EEG-ERP) paradigm. Individuals with AN showed a lack of discrimination between self-body and self-object pictures between 105 and 160 ms after stimulus onset (P1 component, featural processing) and an enhanced processing of body relative to neutral object pictures between 160 and 225 ms after stimulus onset (N1 component, configural processing). This suggests alterations in the basic visual processing of body shapes in AN, which might be related to influences of top-down attentional modulation. Study 4 showed enhanced processing of cardiac visceral signals in the central nervous system (CNS) in individuals with AN, which might either be a marker of psychopathology, in particular anxiety, or an indication of clinical improvement. In summary, the present results do not support the view of a global perceptual deficit in AN, but demonstrate the complexity of body image alterations in AN. It appears mandatory to further investigate basic processes underlying body image disturbances in AN and in healthy women to arrive at a comprehensive understanding of their nature and to provide a theoretical basis for body image interventions. The importance of using specific assessment methods, such as indicators of body-related processing in the CNS, is highlighted. [less ▲]

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See detailGastrisch-evozierte Potenziale: ein neurophysiologischer Indikator für die kortikale Repräsentation afferenter Signale aus dem gastrointestinalen System
Schaan, L.; Van Dyck, Zoé UL; Lutz, Annika UL et al

in Kaiser, J.; Fiebach, C. (Eds.) 41. Tagung Psychologie und Gehirn - Abstracts der Beiträge (2015)

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See detailGastrische Modulation der Schreckreaktion: eine prä-attentive Methode zur Abbildung afferenter Signale aus dem gastrointestinalen System
Schulz, André UL; Van Dyck, Zoé UL; Lutz, Annika UL et al

in Kaiser, J.; Fiebach, C. (Eds.) 41. Tagung Psychologie und Gehirn - Abstracts der Beiträge (2015)

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See detailAffektive Bewertung von Körperbildern bei Anorexia nervosa
Lutz, Annika UL; Herbert, C.; Schulz, André UL et al

in Wittchen, H.-U.; Härtling, S.; Hoyer, J. (Eds.) Abstractband - Wieviel Psychologie steckt in der Psychotherapie? (2015)

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See detailBody or cup? Alterations in featural and configural body image processing in anorexia nervosa
Lutz, Annika UL; Herbert, Cornelia; Schulz, André UL et al

in Psychophysiology (2015), 52(supplement 1), 123

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