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See detailSelbstberichteter psychosozialer Stress und chronische Besorgnis, sowie Low-Frequency-Herzratenvariabilität, aber nicht Morgen- oder Tagescortisolspiegel, sagen somatoforme Symptome vorher
Schulz, André UL; Larra, M.; Rost, Silke UL et al

in Kubiak, T.; Wessa, M.; Witthöft, M. (Eds.) et al 15. Kongress der Deutschen Gesellschaft für Verhaltensmedizin und Verhaltensmodifikation - Abstractband (2016)

Im positiven Feedback-Modell zu Interozeption und Stress (Schulz & Vögele, 2015) wird postuliert, dass chronischer Stress zu einer Dysregulation der beiden physiologischen Stressachsen (HPA-Achse, ANS ... [more ▼]

Im positiven Feedback-Modell zu Interozeption und Stress (Schulz & Vögele, 2015) wird postuliert, dass chronischer Stress zu einer Dysregulation der beiden physiologischen Stressachsen (HPA-Achse, ANS) führt, was wiederum durch veränderte Interozeption zur Entstehung körperlicherSymptome beitragen kann. Dieser postulierte Zusammenhang basiert jedoch bislang auf einer Integration von Einzelbefunden und wurde bisher noch nicht an einer gemeinsamen Stichprobe überprüft. Bei einer studentischen Stichprobe (N=217; 113 w; Alter: 18-33 [M=23.0; SD=2.9] Jahre; BMI=22.2 [SD=2.8]) wurden selbstberichteter chronischer Stress (Trierer Inventar für Chronischen Stress/TICS) und somatoforme Symptome (Screening für Somatoforme Störungen/SOMS-2) erhoben. Alle Probanden lieferten Cortisol-Aufwachreaktionen (Erwachen,+15,+30,+45,+60 Min.) an zwei aufeinanderfolgenden Tagen, sowie ein Cortisol-Tagesprofil. Zusätzlich wurde im Labor in einer 10-minütigen Ruhemessung EKG zur Bestimmung der Ruhe-Herzratenvariabilität (RMSSD, pNN50, SDNN; Low- [0.06-0.14 Hz] und High-Frequency [0.15-0.4 Hz]) als Indikatoren des zentralen sympathischen und parasympathischen Tonus erfasst. Diejenigen TICS-Skalen, die psychosozialen Stress reflektieren, sowie „Chronische Besorgnis“ waren zwischen r=.16 und .26 mit somatoformen Symptomen korreliert. Die Skala „Chronische Besorgnis“ korrelierte außerdem positiv mit dem Tagescortisolspiegel (r=.19), sowie negativ mit SDNN (r=-.20), RMSSD (r=-.17), pNN50 (r=-.17), LF-Power (r=-.19) und HF-Power (r=-.16; alle ps < .05). Somatoforme Symptome korrelierten hingegen nicht mit Indikatoren der physiologischen Stressachsen. In einem Regressionsmodell mit Somatisierungsindex als Kriterium zeigte sich nur für die TICS-Skalen „Mangel an sozialer Anerkennung“ (b=.19) und „chronische Besorgnis“ (b=.25), sowie LF-HRV (b=.20) signifikante Vorhersagekraft. Die Annahmen des Modells zu Interozeption und Stress konnten nur teilweise bestätigt werden. Selbstberichteter Stress, vor allem „Besorgnis“, ist bei gesunden Probanden der beste Prädiktor für somatoforme Symptome. Auch höherer sympathischer Tonus könnte für somatoforme Symptome eine Rolle spielen. [less ▲]

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See detailInterozeption bei Depersonalisations-/Derealisationsstörung: veränderte Repräsentation afferenter Körpersignale auf Ebene des Kortex und des Hirnstamms
Schulz, André UL; Matthey, J. H.; Köster, S. et al

in Kubiak, T.; Wessa, M.; Witthöft, M. (Eds.) et al 15. Kongress der Deutschen Gesellschaft für Verhaltensmedizin und Verhaltensmodifikation - Abstractband (2016)

Die Depersonalisations-/Derealisationsstörung (DPD) ist durch eine subjektiv erlebte Distanz von Emotionen, sowie von Empfindungen des eigenen Körpers charakterisiert. Während viele neurophysiologische ... [more ▼]

Die Depersonalisations-/Derealisationsstörung (DPD) ist durch eine subjektiv erlebte Distanz von Emotionen, sowie von Empfindungen des eigenen Körpers charakterisiert. Während viele neurophysiologische Befunde ein verändertes Emotionserleben stützen, gibt es bislang keine neurophysiologischen Korrelate für eine veränderte Interozeption bei DPD. 27 Patienten mit DPD, sowie 27 gesunde Kontrollprobanden absolvierten zwei Herzschlagwahrnehmungstests: eine Herzschlagzählaufgabe (Schandry) und einen Test, bei dem zwischen Herzschlägen und exterozeptiven Signalen diskriminiert werden musste (Whitehead). Außerdem absolvierten die Probanden zwei psychophysiologische Verfahren, die interozeptive Signalübermittlung reflektieren: (1.) Herzschlag- evozierte Potenziale (HEPs), Indikatoren für die kortikale Verarbeitung afferenter Signale vom kardiovaskulären System und (2.) die kardiale Modulation der Schreckreaktion (CMS), welche als Index für die Verarbeitung kardio-afferenter Signale auf Ebene des Hirnstamms gilt. In den Herzschlagwahrnehmungstests gab es keine Gruppenunterschiede zwischen Patienten mit DPD und gesunden Kontrollprobanden, jedoch eine gegenläufige Tendenz beider Gruppen hinsichtlich der Genauigkeit über den Zeitverlauf (negative Lernkurve bei DPD). Bei der Kontrollgruppe zeigte sich ein intakter CMS-Effekt (geringere Schreckreaktionen während der frühen kardialen Phase), während sich bei den DPD-Patienten überhaupt kein CMS-Effekt beobachten ließ (Interaktion: p=.041). Ebenso wurden Gruppenunterschiede im HEP-Pattern beobachtet: gesunde Kontrollprobanden zeigten höhere HEP-Amplituden während der Aufmerksamkeitslenkung auf Körpersignale als während Ruhe. Dieser Effekt konnte bei DPD-Patienten nicht gefunden werden (Interaktion: p=.027). Die gegenläufigen Trends über den Zeitverlauf in verhaltensbasierten Indikatoren für Interozeption (Herzschlagwahrnehmung) bei DPD-Patienten gegenüber Kontrollprobanden impliziert, dass es Patienten weniger gut gelingt, ihre Aufmerksamkeit über längere Zeit auf Körperempfindungen zu fokussieren. Dieser Unterschied lässt sich auf veränderte Repräsentation afferenter Signale des kardiovaskulären Systems auf Hirnstammebene und auf kortikaler Ebene zurückführen. [less ▲]

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See detailBlood pressure and the perception of illusive pain
Scheuren, Raymonde UL; Duschek, Stefan; Schulz, André UL et al

in Psychophysiology (2016), 53(8), 1282-1291

Numerous studies have documented an inverse relationship between blood pressure and sensitivity to experimental nociceptive stimulation. The present study aimed to investigate possible associations ... [more ▼]

Numerous studies have documented an inverse relationship between blood pressure and sensitivity to experimental nociceptive stimulation. The present study aimed to investigate possible associations between blood pressure and the occurrence and intensity of paradoxical pain induced by the thermal grill paradigm. Thirty-one healthy subjects were stimulated three times for 1 minute with the non-noxious temperatures of 15°C and 41°C set at the interlaced cold and warm bars of a water bath-driven thermal grill. Blood pressure and heart rate were recorded concomitantly. On account of previous observations of an association between the sensitivity of the cardiac baroreflex and pain perception, this parameter was additionally obtained. Numerical rating scales were used to quantify subjective pain intensity and pain unpleasantness; subjects were classified as responders and non-responders to thermal grill stimulation based on pain intensity ratings. Responders exhibited lower systolic and diastolic blood pressure than non-responders, and inverse linear associations arose between blood pressure and pain intensity and unpleasantness. Baroreflex sensitivity was unrelated to pain ratings. The findings confirmed the hypothesis of a blood pressure dependence of paradoxical pain and support the notion that the cardiovascular and pain regulatory systems interact not only in the processing of pain elicited by noxious input, but also in non-noxiously generated illusive pain. While this finding is not consistent with the assumption of an involvement of the baroreflex system in mediating the observed interaction, psychological traits and neurochemical factors are alternatively considered. [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 detailRespiratory modulation of startle eye blink: a new approach to assess afferent signals from the respiratory system
Schulz, André UL; Schilling, T. M.; Vögele, Claus UL et al

in Philosophical Transactions : Biological Sciences (2016), 371(1708),

Current approaches to assess interoception of respiratory functions cannot differentiate between the physiological basis of interoception, i.e. visceral-afferent signal processing, and the psychological ... [more ▼]

Current approaches to assess interoception of respiratory functions cannot differentiate between the physiological basis of interoception, i.e. visceral-afferent signal processing, and the psychological process of attention focusing. Furthermore, they typically involve invasive procedures, e.g. induction of respiratory occlusions or the inhalation of CO2 enriched air. The aim of the current study was to test the capacity of startle methodology to reflect respiratory-related afferent signal processing, independent of invasive procedures. Forty-two healthy participants were tested in a spontaneous breathing and in a 0.25 Hz paced breathing condition. Acoustic startle noises of 105 dB(A) intensity (50 ms white noise) were presented with identical trial frequency at peak and on-going inspiration and expiration, based on a new pattern detection method, involving the online processing of the respiratory belt signal. The results show the highest startle magnitudes during on-going expiration compared to any other measurement points during the respiratory cycle, independent of whether breathing was spontaneous or paced. Afferent signals from slow adapting phasic pulmonary stretch receptors may be responsible for this effect. The current study is the first to demonstrate startle modulation by respiration. These results offer the potential to apply startle methodology in the non-invasive testing of interoception-related aspects in respiratory psychophysiology. [less ▲]

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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 detailMaking sense of what you sense: Disentangling interoceptive awareness, sensibility and accuracy
Forkmann, Thomas; Scherer, Anne; Meessen, Judith et al

in International Journal of Psychophysiology (2016), 109(1), 71-80

Garfinkel and Critchley (2013) recently proposed a three level model of interoception. Only few studies, however, have empirically tested this theoretical model thus far. The present study aimed at ... [more ▼]

Garfinkel and Critchley (2013) recently proposed a three level model of interoception. Only few studies, however, have empirically tested this theoretical model thus far. The present study aimed at investigating (1) the central assumptions of this model, i.e. that Accuracy, Sensibility and Awareness are distinguishable facets of interoception and that Interoceptive Accuracy is the basic level of interoception, and (2) whether cardiovascular activation (as indexed by heart rate) is differentially related to the three facets of interoception. Analyses were conducted on a total sample of N=159 healthy participants (118 female [74.2%]; mean age = 23.9 years, SD = 3.3, range = 19-45) who performed either the heartbeat tracking task, the heartbeat discrimination task or both. The results suggest that Accuracy, Sensibility and Awareness are empirically distinct facets of interoception, showing no correlation when based on heartbeat tracking, but moderate correlations when based on heartbeat discrimination. The assumption that Interoceptive Accuracy is the basic level of interoception could only be partially confirmed. Instead, we conclude that the level of objective physiological states should be considered as the most basic level of interoceptive signal processing. [less ▲]

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See detailInter-individual differences in cardiovascular reactivity and the perception of the thermal grill illusion of pain
Scheuren, Raymonde UL; Duschek, Stefan; Schulz, André UL et al

Speeches/Talks (2015)

Background: Evidence has been given that there exists a functional relationship between the cardiovascular and the pain regulatory system. Alterations in blood pressure and concomitant changes in ... [more ▼]

Background: Evidence has been given that there exists a functional relationship between the cardiovascular and the pain regulatory system. Alterations in blood pressure and concomitant changes in baroreceptor activation contribute to the modulation of pain sensitivity It could be shown that blood pressure, baroreflex sensitivity, and cardiac vagal tone (indexed by heart rate variability, HRV) are inversely associated to pain sensitivity. We aimed assessing the same cardiovascular parameters in a thermal grill paradigm to test the assumption of a relationship between inter-individual differences in autonomic cardiac control and the perception of the thermal grill illusion of pain (TGI). Methods: All participants (N = 52) were stimulated three times during one minute with the temperatures of 15°C and 41°C set at the interlaced cold and warm bars of the water-bath driven thermal grill. Blood pressure and heart rate were recorded concomitantly. Numerical rating scales (NRS; 0–100) were used to quantify subjective paradoxical pain intensity and pain unpleasantness perceptions. Results: A positive association between cardiac vagal tone and paradoxical pain sensitivity could be revealed. Higher resting HRV, as expressed by higher respiratory sinus arrhythmia (RSA), made it overall more likely to perceive the TGI. In contrast, blood pressure and the susceptibility to the TGI were inversely related. Volunteers displaying higher spontaneous blood pressure values in the first thermal grill stimulation phase did not feel the illusive pain as compared to those who presented significantly lower sympathetic arousal and perceived the TGI. Conclusion: The present physiological findings complement previous evidence of an impact of psychological characteristics on the individual disposition to paradoxical pain perceptions. [less ▲]

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See detailRelationship between cardiovascular reactivity and the perception of the thermal grill illusion of pain
Scheuren, Raymonde UL; Duschek, Stefan; Schulz, André UL et al

Poster (2015, September 03)

Alterations in blood pressure (BP) and concomitant changes in baroreceptor activation contribute to the modulation of pain sensitivity to warrant homeostatic regulation processes [1][2]. Numerous pain ... [more ▼]

Alterations in blood pressure (BP) and concomitant changes in baroreceptor activation contribute to the modulation of pain sensitivity to warrant homeostatic regulation processes [1][2]. Numerous pain studies have described an inverse relationship between BP and nociceptive sensitivity [3][4][5]. It is not known whether a similar relationship plays a role in the framework of the induction of pain in the absence of noxious stimulation. The thermal grill (TG) paradigm is commonly used to trigger this type of paradoxical pain also termed thermal grill illusion of pain (TGI). The goal of the present study was to explore the relationship between cardiovascular activity/reactivity and paradoxical pain sensitivity to get additional insight in the variability of responsiveness (responders and non-responders) to TG stimulation described in the literature [6][7]. We hypothesized that higher BP would be associated with stronger pain inhibitory effects in participants not perceiving the thermal grill illusion of pain (TGI). We moreover expected that the perception of paradoxical pain in the responder group would be paired with lower BP. We tested this hypothesis by comparing both groups with respect to their spontaneous cardiovascular activity (recorded in resting conditions) and their cardiovascular responses to TG stimulation. [less ▲]

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See detailInteroception and Stress
Schulz, André UL; Vögele, Claus UL

in Frontiers in Psychology (2015), 6(1), 993

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

in 45th Annual Congress of the European Association for Behavioural and Cognitive Therapies (EABCT) (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 detailCortical representation of afferent bodily signals in borderline personality disorder: neural correlates and raltionship to emotional dysregulation
Müller, L. E.; Schulz, André UL; Andermann, M. et al

in JAMA Psychiatry (2015), 72(11), 1077-1086

The ability to perceive and regulate one's own emotions has been tightly linked to the processing of afferent bodily signals (interoception). Thus, disturbed interoception might contribute to the core ... [more ▼]

The ability to perceive and regulate one's own emotions has been tightly linked to the processing of afferent bodily signals (interoception). Thus, disturbed interoception might contribute to the core feature of emotional dysregulation in borderline personality disorder (BPD), as increased levels of depersonalization, body image disturbances, and reduced sensitivity to physical pain suggest poor body awareness in BPD. OBJECTIVE: To determine neural correlates of disturbed body awareness in BPD and its associations with emotional dysregulation and to explore improvements in body awareness with BPD symptom remission. DESIGN, SETTING, AND PARTICIPANTS: Case-control study performed at Heidelberg University Hospital, Heidelberg, Germany. Heartbeat evoked potentials (HEPs), an indicator of the cortical representation of afferent signals from the cardiovascular system, were investigated in 34 medication-free patients with BPD, 31 healthy volunteers, and 17 medication-free patients with BPD in remission. The HEPs were assessed using 5-minute resting-state electroencephalograms and parallel electrocardiograms. Core BPD symptoms, history of childhood traumatization, and psychiatric disorders were assessed by means of self-reports and structured interviews. To measure neural correlates of disturbed body awareness, high-resolution T1-weighted structural magnetic resonance imaging scans were collected and analyzed using voxel-based morphometry and region-of-interest-based approaches. The study was performed between 2012 and 2014, and data analysis was performed in 2014. MAIN OUTCOMES AND MEASURES: Mean HEP amplitudes in resting-state electroencephalograms and their correlation with self-reported emotional dysregulation, as well as with gray matter volume. RESULTS: Patients with BPD had significantly reduced mean HEP amplitudes compared with healthy volunteers (F1,61 = 11.32, P = .001), whereas the mean HEP amplitudes of patients with BDP in remission lie somewhere in between these 2 groups of participants (P > .05). The HEP amplitudes were negatively correlated with emotional dysregulation (R = -0.30, P = .01) and positively associated with gray matter volume in the left anterior insula (R = 0.53, P < .05) and the bilateral dorsal anterior cingulate cortex (R = 0.47, P < .05), 2 structures that have been identified as core regions for interoception. CONCLUSIONS AND RELEVANCE: The results indicate state-dependent deficits in the cortical processing of bodily signals in patients with BPD, which appear to be associated with core features of BPD. The analysis of patients with BPD in remission suggests an improvement in cortical representation of bodily signals with symptom remission. Results recommend the integration of techniques to strengthen bodily awareness in psychotherapeutic interventions of BPD. [less ▲]

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

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

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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 detailInterozeption bei Depersonalisations-/Derealisationsstörung: veränderte kortikale Repräsentation afferenter Körpersignale bei intakter Repräsentation auf Hirnstammebene
Schulz, André UL; Matthey, J. H.; Köster, S. et al

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

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See detailInterozeptive Sensitivität bei Bulimia Nervosa und Binge-Eating-Störung
Van Dyck, Zoé UL; Schulz, André UL; Blechert, J. et al

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