References of "Vögele, Claus 50003275"
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See detailGlucocorticoid receptor signaling in leukocytes after early life adversity.
Elwenspoek, M.; Hengesch, X.; Leenen, F. et al

in Development and Psychopathology (in press)

Early life adversity (ELA) has been associated with inflammation and immunosenescence, as well as hyporeactivity of the HPA-axis. As the immune system and HPA-axis are tightly intertwined around the ... [more ▼]

Early life adversity (ELA) has been associated with inflammation and immunosenescence, as well as hyporeactivity of the HPA-axis. As the immune system and HPA-axis are tightly intertwined around the glucocorticoid receptor (GR) we examined peripheral GR functionality in the EpiPath cohort, where participants had either been exposed to ELA (separation from parents and/or institutionalization followed by adoption) (n=40) or had been reared by their biological parents (n=72). Expression of the strict GR target genes FKBP5 and GILZ as well as total and 1F and 1H GR transcripts were similar between groups. Furthermore, there were no differences in GR sensitivity, examined by the effects of dexamethasone on IL6 production in LPS-stimulated whole blood. Although we did not find differences in methylation at the GR 1F exon or promoter region, we identified a region of the GR 1H promoter (CpG 1-9) that showed lower methylation levels in ELA. Peripheral GR signaling was unperturbed in our cohort and the observed immune phenotype does not appear to be secondary to an altered glucocorticoid receptor response to glucocorticoids. To identify signaling pathways that may underlie the ELA immune phenotype, future research should focus on unbiased approaches, such as investigating whole genome methylation profiles. [less ▲]

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See detailMentalization and Criterion A of the AMPD: Results from a clinical and nonclinical sample
Zettl, M.; Volkert, J.; Vögele, Claus UL et al

in Personality Disorders: Theory, Research, and Treatment (in press)

Objective: Criterion A of the alternative model for the classification of personality disorders in the DSM-5 introduced the Level of Personality Functioning Scale (LPFS), a dimensional model for the ... [more ▼]

Objective: Criterion A of the alternative model for the classification of personality disorders in the DSM-5 introduced the Level of Personality Functioning Scale (LPFS), a dimensional model for the assessment of impairments in self and interpersonal functioning. The LPFS was developed based on a review of different measures of personality functioning, such as the Reflective Functioning Scale, a measure of mentalizing. This study investigated the empirical overlap between LPFS and mentalization. Methods: The study sample included adult inpatients (n = 55) with a mental disorder and a healthy adult control group (n = 55). All participants were examined regarding the LPFS using the Semi-Structured Interview for Personality Functioning DSM-5 (STiP-5.1); mentalizing was assessed with the Brief Reflective Functioning Interview and coded with the Reflective Functioning Scale. We used structural equation modeling to investigate the relationship between LPFS domains and mentalization. Correlation analysis was used to examine the agreement between interview-rated LPFS and self-report measures of personality dysfunction. Results: All domains of the LPFS were significantly related to mentalizing. Interview-rated LPFS was significantly associated with self-reported personality dysfunction. Conclusion: The findings support the notion that the LPFS and mentalization share a strong conceptual and operational overlap by demonstrating that both constructs are empirically interrelated. The results yield further support for the validity of the LPFS as a dimensional model for the assessment of personality disorder severity. [less ▲]

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See detailCommunity- and mHealth-based integrated management of diabetes in primary healthcare in Rwanda: the protocol of a mixed-methods study including a cluster randomised controlled trial (D²Rwanda)
Lygidakis, Charilaos UL; Uwizihiwe, JP; Kallestrup, P et al

in BMJ Open (2019), 9(7), 028427

Introduction In Rwanda, diabetes mellitus prevalence is estimated between 3.1% and 4.3%. To address non-communicable diseases and the shortage of health workforce, the Rwandan Ministry of Health has ... [more ▼]

Introduction In Rwanda, diabetes mellitus prevalence is estimated between 3.1% and 4.3%. To address non-communicable diseases and the shortage of health workforce, the Rwandan Ministry of Health has introduced the home-based care practitioners (HBCPs) programme: laypeople provide longitudinal care to chronic patients after receiving a six-month training. Leveraging technological mobile solutions may also help improve health and healthcare. The D²Rwanda study aims at: (a) determining the efficacy of an integrated programme for the management of diabetes in Rwanda, which will provide monthly patient assessments by HBCPs, and an educational and self-management mHealth patient tool, and; (b) exploring qualitatively the ways the interventions will have been enacted, their challenges and effects, and changes in the patients’ health behaviours and HBCPs’ work satisfaction. Methods and analysis This is a mixed-methods sequential explanatory study. First, there will be a one-year cluster randomised controlled trial including two interventions ((1) HBCPs’ programme; (2) HBCPs’ programme + mobile health application) and usual care (control). Currently, nine hospitals run the HBCPs’ programme. Under each hospital, administrative areas implementing the HBCPs’ programme will be randomised to receive intervention 1 or 2. Eligible patients from each area will receive the same intervention. Areas without the HBCPs’ programme will be assigned to the control group. The primary outcome will be changes in glycated haemoglobin. Secondary outcomes include medication adherence, mortality, complications, health-related quality of life, diabetes-related distress and health literacy. Second, at the end of the trial, focus group discussions will be conducted with patients and HBCPs. Financial support was received from the Karen Elise Jensens Fond, and the Universities of Aarhus and Luxembourg. Ethics and dissemination Ethics approval was obtained from the Rwanda National Ethics Committee and the Ethics Review Panel of the University of Luxembourg. Findings will be disseminated via peer-reviewed publications and conference presentations. Trial registration number NCT03376607; Pre-results. [less ▲]

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See detailRespiratory modulation of intensity ratings and psychomotor response times to acoustic startle stimuli
Münch, Eva Elisabeth; Vögele, Claus UL; Van Diest, Ilse et al

in Neuroscience Letters (2019), 711(1), 134388

Respiratory interoception may play an important role in the perception of respiratory symptoms in pulmonary diseases. As the respiratory cycle affects startle eye blink responses, startle modulation may ... [more ▼]

Respiratory interoception may play an important role in the perception of respiratory symptoms in pulmonary diseases. As the respiratory cycle affects startle eye blink responses, startle modulation may be used to assess visceral-afferent signals from the respiratory system. To ascertain the potential impact of brainstem-relayed signals on cortical processes, we investigated whether this pre-attentive respiratory modulation of startle (RMS) effect is also reflected in the modulation of higher cognitive, evaluative processing of the startle stimulus. Twenty-nine healthy volunteers received 80 acoustic startle stimuli (100 or 105 dB(A); 50 ms), which were presented at end and mid inspiration and expiration, while performing a paced breathing task (0.25 Hz). Participants first responded to the startle probes by 'as fast as possible' button pushes and then rated the perceived intensity of the stimuli. Psychomotor response time was divided into 'reaction time' (RT; from stimulus onset to home button release; represents stimulus evaluation) and 'movement time' time (MT; from home button release to target button press). Intensity judgements were higher and RTs accelerated during mid expiration. No effect of respiratory cycle phase was found on eye blink responses and MTs. We conclude that respiratory cycle phase affects higher cognitive, attentional processing of startle stimuli. [less ▲]

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See detailSocial Media as an Opportunity for Public Health Interventions: The #Metoo Movement as an Exemplar
Gomez Bravo, Raquel UL; Gomez Bravo, María; Lygidakis, Charilaos UL et al

in Journal of the International Society for Telemedicine and EHealth (2019), 7(e5), 1-7

Background: Social media have been used exponentially and globally, providing a means for billions of users to connect, interact, share opinions and criticise, becoming one of the main channels of ... [more ▼]

Background: Social media have been used exponentially and globally, providing a means for billions of users to connect, interact, share opinions and criticise, becoming one of the main channels of communication for users around the world. One of the most popular free social media networks is Twitter, with more than 100 million active users per day worldwide. Purpose: The aim of this study was to analyse a sample of the public conversations generated, using the hashtag #MeToo, around the topic of sexual abuse on Twitter. Methods: Using social media marketing software, the use of the #MeToo hashtag was analysed over a period of 60 days (14 September 2017 to 13 November of 2017). Results: The #MeToo conversation was mainly in English (79.3%), located in the United States (48.2% of cases), but with global repercussions. The volume of mentions of the #MeToo hashtag was far greater (97.7%), compared with other hashtags related to violence over this period of time, using mostly Twitter (96.2%). Conclusions: These results suggest that it is possible to describe different groups using the social media, and analyse their conversations to identify opportunities for successful public health interventions. If the topic is relevant for the general public, it will generate interest and conversations at the global level, supported by a universal and borderless channel such as Twitter. [less ▲]

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See detailTime for a Plot Twist: Beyond Confirmatory Approaches to Binge-Watching Research
Flayelle, Maèva UL; Maurage, Pierre; Vögele, Claus UL et al

in Psychology of Popular Media Culture (2019), 8(3), 308-318

The advent of the digital age with its progress in digital technology has been associated in recent years with an increase in binge-watching (i.e., seeing multiple episodes of the same TV series in one ... [more ▼]

The advent of the digital age with its progress in digital technology has been associated in recent years with an increase in binge-watching (i.e., seeing multiple episodes of the same TV series in one session). Binge-watching has now become the new normative way to consume TV shows. Nevertheless, along with its recent massive rise has come concerns about the associated mental and physical health outcomes. Currently available results suggest the potential harmfulness and even addictive nature of binge-watching. The psychological investigation of this behavior, however, is still in its infancy, with most studies using a confirmatory approach and assuming a priori its genuine addictive nature. In contrast, the current perspective paper argues the case for an exploratory approach as an initial step for conducting research on behaviors that − at first sight − look like addiction when applying a symptom-based approach. A qualitative understanding of the phenomenological characteristics of binge-watching as the foundation of an initial comprehensive discussion makes it possible to formulate hypotheses concerning its potentially addictive nature and to emphasize challenges and directions for future research. Here we propose an exploration of the dynamics of binge-watching behavior based on a model involving emotion regulation in the etiology and maintenance of problem binge-watching. [less ▲]

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See detailDie Rolle von Sport und Bewegung für die körperliche und psychische Gesundheit.
Vögele, Claus UL

in Schneider, Silvia; Margraf, Jürgen (Eds.) Lehrbuch der Verhaltenstherapie, Band 3: Psychologische Therapie bei Indikationen im Kindes- und Jugendalter (2019)

Physical activity plays an important role in children’s growth and development. Understanding why a child is active or inactive is, therefore, essential for prevention of and intervention in childhood ... [more ▼]

Physical activity plays an important role in children’s growth and development. Understanding why a child is active or inactive is, therefore, essential for prevention of and intervention in childhood obesity. This narrative review provides an up-to-date summary of the literature pertaining to biological, psychosocial and environmental factors affecting young children’s acquisition of physical activity behaviour. Physical activity-related traits are characterized by familial aggregation and influenced by genetic factors. Nevertheless, the genetic contribution to physical activity shows increasing expression with age, supporting the need for interventions in early childhood. In addition to genetic factors, a range of psychosocial and environmental factors that are associated with physical activity in children have been identified: boys are more active than girls, and children with active parents tend to be more active. Overall physical activity support provided by parents predicts children’s organized physical activity. Perceived road safety and threat posed by strangers are major causes of parental anxiety in relation to their children’s safety in the neighbourhood. Programmes designed to increase physical activity should promote the importance of physical activity to parents. In addition, improving perceived safety may help to ease parental restriction of their children's active transport and physical activity. [less ▲]

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See detailSurgery
Vögele, Claus UL; Powell, Rachael; Johnston, Marie

in Llewellyn, C.D.; Ayers, S.; McManus, C. (Eds.) et al Cambridge Handbook of Psychology, Health and Medicine (2019)

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See detailAssessing binge-watching behaviors: Development and validation of the “Watching TV Series Motives” and “Binge-Watching Engagement and Symptoms” questionnaires
Flayelle, Maèva UL; Canale, Natale; Vögele, Claus UL et al

in Computers in Human Behavior (2019), 90

The widespread practice of binge-watching (i.e. watching multiple episodes of a TV series in one session) recently generated concerns about associated negative outcomes. Its psychological investigation ... [more ▼]

The widespread practice of binge-watching (i.e. watching multiple episodes of a TV series in one session) recently generated concerns about associated negative outcomes. Its psychological investigation, however, remains fragmentary. Based on the previous phenomenological investigation of TV series watching, we developed and validated two original assessment instruments, assessing TV series watching motives and binge-watching engagement and symptoms, respectively. Preliminary items were created for each questionnaire, and a focus group with TV series viewers was conducted and analyzed to generate the final instruments. The questionnaires were then administered via an online survey (N=6556), together with complementary measures of affect, problematic Internet use and substance use. Exploratory and confirmatory factor analyses, along with correlational analyses, were performed to examine both structural and external validity of the scales. The factorial analyses resulted in a 4-factor model (i.e. emotional enhancement, enrichment, coping-escapism and social) for the Watching TV Series Motives Questionnaire (WTSMQ), and in a 7-factor model (i.e. engagement, positive emotions, desire-savoring, pleasure preservation, binge-watching, dependency and loss of control) for the Binge-Watching Engagement and Symptoms Questionnaire (BWESQ). The results suggest good psychometric properties for both scales. The current study thus provides theoretically-driven and psychometrically sound instruments for further research on binge-watching behaviors [less ▲]

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See detailHospitalisation
Powell, Rachael; Vögele, Claus UL; Johnston, Marie

in Llewellyn, C.D.; Ayers, S.; McManus, C. (Eds.) et al Cambridge Handbook of Psychology, Health and Medicine (2019)

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See detailVisceral-afferent signals from the cardiovascular system, but not urinary urge, affect startle eye blink
Schulz, André UL; Schilling, Thomas M.; Vögele, Claus UL et al

in Physiology and Behavior (2019), 199(1), 165-172

The aim of the current study was to investigate if startle methodology is suitable to reflect urinary urgency. Eighteen healthy men were tested on two separate days, each including an ingestion of fluid ... [more ▼]

The aim of the current study was to investigate if startle methodology is suitable to reflect urinary urgency. Eighteen healthy men were tested on two separate days, each including an ingestion of fluid until 80% of the subjective urge to micturate was reached. EMG responses to acoustic startle stimuli were assessed before and after micturition, as well as in the early and late cardiac cycle phases (230 vs. 530 ms after a cardiac R-wave). Sonographic assessment confirmed bladder-filling status. Emotional arousal, stress, urge and unpleasantness ratings, as well as mean blood pressure were higher before than after micturition. Startle eye blink responses were lower during the early than during the late cardiac cycle phase, but were not affected by bladder filling status. We conclude that startle methodology is suitable for the investigation of afferent signals from the cardiovascular system, but not to reflect urinary urgency. This result may be due to different neurophysiological mechanisms underlying afferent signals from the bladder compared to other visceral organs or interference with affective states or sympathetic activation associated with bladder filling. Notwithstanding, the present research protocol of fluid intake, sonographic assessment of the bladder, and subjective reports, can be applied to examine visceral-afferent signals from the bladder. [less ▲]

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See detailParental divorce is associated with an increased risk to develop mental disorders in women
Schaan, Violetta UL; Schulz, André UL; Schächinger, Hartmut et al

in Journal of Affective Disorders (2019), 257(1), 91-99

Background: Parental divorce has been associated with reduced well-being in young adults. It is, however, unclear whether this finding is clinically relevant as studies using structural clinical ... [more ▼]

Background: Parental divorce has been associated with reduced well-being in young adults. It is, however, unclear whether this finding is clinically relevant as studies using structural clinical interviews are missing. This study, therefore, investigated if young adults with divorced parents are at risk to develop mental disorders. Furthermore, differences in parental care, social connectedness, chronic stress and traumatic experiences between children of divorced and non-divorced parents were investigated. Methods: 121 women (mean age: 23 years) were interviewed using the Structured Clinical Interview for DSMIV Axis I (i.e., major mental disorders) and II (i.e., personality disorders) Disorders and asked to complete questionnaires assessing parental care, social connectedness (loneliness, attachment anxiety and avoidance), chronic stress, childhood trauma and depression. Results: Young adults of divorced parents had a higher risk for Axis I but not Axis II disorders as compared to young adults of non-divorced parents. Participants from divorced families as compared to non-divorced families reported more depression, loneliness, childhood trauma, attachment avoidance, attachment anxiety, chronic stress and less parental care. Limitations: Due to the cross-sectional design of this study, conclusions about causality remain speculative. Conclusion: The increased vulnerability of children of divorced parents to develop mental disorders, and to experience more chronic stress, loneliness, attachment avoidance, attachment anxiety, and traumatic experiences during childhood is alarming and highlights the importance of prevention programs and psycho-education during the process of parental divorce. Parental support with regard to adequate caregiving is needed to help parents to better support their children during and after their divorce. [less ▲]

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See detailFamily Violence Curricula in Europe (FAVICUE): a cross-sectional descriptive study protocol
Gomez Bravo, Raquel UL; Lygidakis, Charilaos UL; Feder, Gene et al

in BMJ Open (2019), 9

Introduction. Family violence (FV) is a widespread public health problem of epidemic proportions and serious consequences. Doctors may be the first or only point of contact for victims who may be hesitant ... [more ▼]

Introduction. Family violence (FV) is a widespread public health problem of epidemic proportions and serious consequences. Doctors may be the first or only point of contact for victims who may be hesitant or unable to seek other sources of assistance, and they tend not to disclose abuse to doctors if not specifically asked. A comprehensive healthcare response is key to a coordinated community-wide approach to FV, but most of the practising physicians have received either no or insufficient education or training in any aspect of FV. Training of medical students concerning FV is often delivered in an inconsistent or ad hoc manner. The main aim of this project, Family Violence Curricula in Europe (FAVICUE), is to (1) describe current FV education delivery in European medical universities (undergraduate period) and during the specialist training in general practice (GP)/family medicine (FM) (postgraduate residency programme), and (2) compare it with WHO recommendations for FV curriculum. Methods and analysis. This is the protocol of a cross-sectional descriptive study consisting of two self-report online surveys (for undergraduate and postgraduate training, respectively) with 40 questions each. For both surveys, general practitioners, residents, medical students and professionals involved in their education from countries of the European region will be identified through the European Regional Branch of the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA Europe) and will be invited to provide information regarding the training on FV. Descriptive tests will be carried out and a thematic analysis will be conducted on the open-ended questions. Ethics and dissemination Ethics approval has been obtained by the University of Luxembourg (ERP 17–015 FAVICUE). The results will provide important information concerning current curricula on FV, and can be used for mapping the educational needs and planning the implementation of future training interventions. They will be published and disseminated through WONCA Europe and its networks. [less ▲]

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See detailHerzschlag-evozierte Potenziale bei Bulimia nervosa
Lutz, Annika UL; Van Dyck, Zoé UL; Schulz, André UL et al

Poster (2019)

Die ursprüngliche Annahme, dass Essstörungspatient/innen unter einem umfassenden Defizit der interozeptiven Wahrnehmung leiden, wird inzwischen differenzierter betrachtet. Unterschiedliche Befunde ergeben ... [more ▼]

Die ursprüngliche Annahme, dass Essstörungspatient/innen unter einem umfassenden Defizit der interozeptiven Wahrnehmung leiden, wird inzwischen differenzierter betrachtet. Unterschiedliche Befunde ergeben sich je nach betrachtetem Organsystem (Herz, Magen), Verarbeitungsebene (neuronal, Selbstbericht) und Diagnose. Die bisherige Befundlage ist jedoch unübersichtlich und widersprüchlich. Für Bulimia nervosa (BN) wurde sowohl reduzierte, als auch unveränderte Herzschlagwahrnehmung berichtet. Mit dem vorliegenden Beitrag steuern wir weitere Ergebnisse zur Herzschlagwahrnehmung bei und ergänzen diese um einen physiologischen Indikator der kortikalen Verarbeitung kardio-afferenter Signale (Herzschlag-evozierte Potenziale, HEPs). Es wurden 22 Frauen mit akuter oder teilremittierter BN (BMI 23,94±3,61; Alter 31,86±11,20) und 22 gesunde Frauen untersucht (BMI 24,24±3,37; Alter 31,00±10,15). Die Stichproben wurden nach Alter und BMI parallelisiert. Die Teilnehmerinnen führten eine Herzschlagwahrnehmungsaufgabe nach Schandry durch, während ein 64-Kanal-EEG aufgezeichnet wurde. HEPs wurden als mittlere EEG-Amplitude von 455ms bis 595ms nach der R-Zacke berechnet. Die Ergebnisse zeigen keine signifikanten Gruppenunterschiede in Herzschlagwahrnehmung, HEPs und Herzrate. Dies bestätigt vorherige Befunde einer intakten Herzschlagwahrnehmung bei BN. Zusätzlich können wir von einer intakten kortikalen Verarbeitung kardio-afferenter Reize ausgehen. Die Wahrnehmung des Herzschlags ist insbesondere für die Verarbeitung und Regulation von Emotionen relevant. Auf Basis der vorliegenden und früheren Befunde ist davon auszugehen, dass defizitäre Emotionsregulation bei BN nicht auf veränderte Herzschlagwahrnehmung zurückzuführen ist. [less ▲]

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See detailNahrungsvermeidung versus Nahrungsaversion bei restriktiven Essstörungen.
Garcia-Burgos, David; Wilhelm, Peter; Vögele, Claus UL et al

in Zeitschrift für Psychiatrie, Psychologie und Psychotherapie (2019), 67(1), 1-9

The terms food avoidance and food aversion are often used interchangeably in the eating disorders (EDs) literature. However, they represent two different (but closely related) constructs that are the ... [more ▼]

The terms food avoidance and food aversion are often used interchangeably in the eating disorders (EDs) literature. However, they represent two different (but closely related) constructs that are the result of different processes. In patients suffering from anorexia nervosa, bulimia nervosa and avoidant / restrictive food intake disorder, food avoidance / restriction is usually assumed to be motivated by fear / anxiety (e. g., “intense fear of gaining weight or becoming fat” or “being afraid to eat after a frightening episode of choking”). In contrast, studies show that taste aversion often leads to food avoidance. Unlike fear-motivated avoidance in which the flavour of food becomes a signal for danger, avoidance produced by taste aversions involves a reduction in the amount consumed due to a hedonic downshift. Here the attractiveness of the flavour changes by its association with a nauseogenic event. It is noteworthy that both sources of food avoidance exhibit different behavioural characteristics, contents of learning, and activate different brain regions and neuromodulators. This is especially important for the understanding and treatment of the EDs and their most serious behavioural manifestation: the life-threatening food refusal. Finally, the clinical implications of such a distinction and promising future research directions are discussed. [less ▲]

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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), 130(9), 1620-1627

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 detailHealth benefits of walking in nature: a randomized controlled study under conditions of real-life stress.
Olafsdottir, Gunnthora; Cloke, Paul; Schulz, André UL et al

in Environment & Behavior (2018)

We investigated the effects of recreational exposure to the natural environment on mood and psychophysiological responses to stress. We hypothesized that walking in nature has restorative effects over and ... [more ▼]

We investigated the effects of recreational exposure to the natural environment on mood and psychophysiological responses to stress. We hypothesized that walking in nature has restorative effects over and above the effects of exposure to nature scenes (viewing-nature-on-TV) or physical exercise alone (walking-on-a-treadmill-in-a-gym) and that these effects are greater when participants were expected to be more stressed. Healthy university students (N=90) were randomly allocated to 1 of 3 conditions and tested during an exam-free period and again during their exam time. Mood and psychophysiological responses were assessed before and after the interventions, and again after a laboratory stressor. All interventions had restorative effects on cortisol levels (p < .001), yet walking in nature resulted in lower cortisol levels than did nature viewing (p < .05) during the exam period. Walking in nature improved mood more than watching nature scenes (p < .001) or physical exercise alone (p < .05). [less ▲]

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