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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 (2020), 11(3), 191-202

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 detailHigh blood pressure responders show largest increase in heartbeat perception accuracy after post-learning stress following a cardiac interoceptive learning task
Schenk, Lara; Fischbach, Jean T. M.; Müller, Ruta UL et al

in Biological Psychology (2020), 154(1), 107919

Mental disorders with physical symptoms, e.g. somatic symptom disorder, are characterized by altered interoceptive accuracy (IAc), which can be explained by individual differences in interoceptive ... [more ▼]

Mental disorders with physical symptoms, e.g. somatic symptom disorder, are characterized by altered interoceptive accuracy (IAc), which can be explained by individual differences in interoceptive learning (IL). We investigated if stress facilitates IL. Seventy-three healthy participants performed a heartbeat counting task (HCT: T1) and a heartbeat perception training (HBPT). After exposure to a socially-evaluated cold pressor stress test (SECPT; n=48) or a control condition (n=25), two more HCTs were performed (T2: 30 minutes after SECPT; T3: 24 h later). After the HBPT, all participants showed an increase in IAc. We separated the stress group into high vs. low systolic blood pressures (SBP) responders (n=24 each), with high SBP responders showing the largest IAc increases. Only SBP, but not cortisol responsiveness significantly predicted IAc increase from T1 to T2. Our results indicate that post-learning autonomic stress response facilitates IL, whereas the HPA axis response may be less important for this effect. [less ▲]

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See detailEffects of rejection intensity and rejection sensitivity on social approach behavior in women
Schaan, Violetta; Schulz, André UL; Bernstein, Michael et al

in PLoS ONE (2020), 15(1), 0227799

Objective: Perceived rejection plays an important role for mental health and social integration. This study investigated the impact of rejection intensity and rejection sensitivity on social approach ... [more ▼]

Objective: Perceived rejection plays an important role for mental health and social integration. This study investigated the impact of rejection intensity and rejection sensitivity on social approach behavior. Method: 121 female participants were randomly assigned to one of three conditions differing in the degree of induced rejection (inclusion, medium rejection, severe rejection). Thereafter they were asked to interact with an unknown person during a touch-based cooperative task. Results: Participants high in rejection sensitivity sought significantly less physical contact than participants low in rejection sensitivity. Individuals in the medium rejection condition touched their partners more often than those in the included condition, while no difference between included and severely rejected participants could be observed. Conclusions: The results suggest that the intensity of rejection matters with regard to coping. While participants in the medium intensity rejection condition aimed to ‘repair’ their social self by seeking increased contact with others, severely rejected participants did not adapt their behavior compared to included participants. Implications for therapy are discussed. [less ▲]

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See detailFight, Flight, – Or Grab a Bite! Trait Emotional and Restrained Eating Style Predicts Food Cue Responding Under Negative Emotions
Schnepper, Rebekka; Georgii, Claudio; Elchin, Katharina et al

in Frontiers in Behavioral Neuroscience (2020), 14

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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 and Behavior (2020), 52(3), 248-274

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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See detailModulation of startle and heart rate responses by fear of physical activity in patients with heart failure and in healthy adults
Hoffmann, Jeremia Mark; Finke, Johannes B.; Schächinger, Hartmut et al

in Physiology and Behavior (2020), 225(1), 113044

Fear of physical activity (FoPA) is prevalent in patients with heart failure and associated with lower physical activity despite medical exercise prescriptions. The present study examined physiological ... [more ▼]

Fear of physical activity (FoPA) is prevalent in patients with heart failure and associated with lower physical activity despite medical exercise prescriptions. The present study examined physiological indicators of FoPA by assessing startle modulation and heart rate responses after affective priming with lexical stimuli of positive, neutral, and negative valence, as well as words related to physical activity as potentially phobic cues. After screening for FoPA in patients with heart failure and healthy adults, twenty participants each were assigned to one of three subsamples: a healthy control group and two cardiac patient groups scoring either low or high on FoPA. The high-FoPA group showed more pronounced startle potentiation and heart rate acceleration (i.e., mobilization of defensive behavior) in the phobic prime condition compared to controls. Differences in FoPA accounted for 30% of the startle potentiation by phobic priming, whereas general anxiety, depression, and disease severity were no significant predictors in patients with heart failure. These findings suggest that heart failure-associated FoPA elicits avoidance behavior at a largely automatic level, and might thereby contribute to low adherence to exercise regimen. Thus, FoPA should be addressed in the design of psychological interventions for cardiac patients to foster physical activity. [less ▲]

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See detailInteroception, stress and physical symptoms in stress-associated diseases
Schulz, André UL; Schultchen, Dana; Vögele, Claus UL

in European Journal of Health Psychology (2020), 27(1), 132-153

The brain and peripheral bodily organs continuously exchange information. Exemplary, interoception refers to the processing and perception of ascending information from the body to the brain. Stress ... [more ▼]

The brain and peripheral bodily organs continuously exchange information. Exemplary, interoception refers to the processing and perception of ascending information from the body to the brain. Stress responses involve a neurobehavioral cascade, which includes the activation of peripheral organs via neural and endocrine pathways and can thus be seen as an example for descending information on the brain-body axis. Hence, the interaction of interoception and stress represents bi-directional communication on the brain-body axis. The main hypothesis underlying this review is that the dysregulation of brain-body communication represents an important mechanism for the generation of physical symptoms in stress-related disorders. The aims of this review are, therefore, (1.) to summarize current knowledge on acute stress effects on different stages of interoceptive signal processing, (2.) to discuss possible patterns of abnormal brainbody communication (i.e., alterations in interoception and physiological stress axes activation) in mental disorders and chronic physical conditions, and (3.) to consider possible approaches to modify interoception. Due to the regulatory feedback loops underlying brain-body communication, the modification of interoceptive processes (ascending signals) may, in turn, affect physiological stress axes activity (descending signals), and, ultimately, also physical symptoms. [less ▲]

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See detailCortisol rapidly increases baroreflex sensitivity of heart rate control, but does not affect cardiac modulation of startle
Schulz, André UL; Richter, Steffen; Ferreira de Sá, Diana S. et al

in Physiology and Behavior (2020), 215(1), 112792

Cortisol, the final product of human HPA axis activation, rapidly modulates the cortical processing of afferent signals originating from the cardiovascular system. While peripheral effects have been ... [more ▼]

Cortisol, the final product of human HPA axis activation, rapidly modulates the cortical processing of afferent signals originating from the cardiovascular system. While peripheral effects have been excluded, it remains unclear whether this effect is mediated by cortical or subcortical (e.g. brainstem) CNS mechanisms. Cardiac modulation of startle (CMS) has been proposed as a method to reflect cardio-afferent signals at subcortical (potentially brainstem-) level. Using a single blind, randomized controlled design, the cortisol group (n = 16 volunteers) received 1 mg cortisol intravenously, while the control group (n = 16) received a placebo substance. The CMS procedure involved the assessment of eye blink responses to acoustic startle stimuli elicited at six different latencies to ECG-recorded R-waves (R + 0, 100, 200, 300, 400 and 500 ms). CMS was assessed at four measurement points: baseline, -16 min, +0 min, and +16 min relative to substance application. Baroreflex sensitivity (BRS) of heart rate (HR) control was measured non-invasively based on spontaneous beat-to-beat HR and systolic blood pressure changes. In the cortisol group, salivary cortisol concentration increased after IV cortisol administration, indicating effective distribution of the substance throughout the body. Furthermore, BRS increased in the cortisol group after cortisol infusion. There was no effect of cortisol on the CMS effect, however. These results suggest that low doses of cortisol do not affect baro-afferent signals, but central or efferent components of the arterial baroreflex circuit presumably via rapid, non-genomic mechanisms. [less ▲]

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See detailAltered interoceptive awareness in high habitual symptom reporters and patients with somatoform disorders
Flasinski, Tabea; Dierolf, Angelika UL; Rost, Silke et al

in Frontiers in Psychology (2020), 11(1), 1859

Objective. Altered interoception may play a major role in the etiology of medically unexplained symptoms (MUS). It remains unclear, however, if these alterations concerns noticing of signals or if they ... [more ▼]

Objective. Altered interoception may play a major role in the etiology of medically unexplained symptoms (MUS). It remains unclear, however, if these alterations concerns noticing of signals or if they are limited to the interpretation of signals. We investigated whether individuals with MUS differ in interoceptive awareness as assessed with the Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire. Methods. Study 1: 486 individuals completed the Screening for Somatoform Disorders (SOMS-2). 32 individuals each of the upper and lower decile of the SOMS distribution (low symptom reporters/LSR, high symptom reporters/HSR) completed the MAIA. Study 2: MAIA scores of individuals diagnosed with somatoform disorder (SFD; n = 26) were compared to individuals with major depressive disorder (MDD; n = 25) and healthy controls (HC; n = 26). Results. HSR had lower scores than LSR on the MAIA scales Not-Distracting and Not-Worrying. The SFD and MDD groups showed lower scores than HC on the MAIA scales Not-Distracting, Self-Regulation, and Trusting. The MDD group scored lower than the other two groups on the scales Body Listening and Attention Regulation. There were no group differences on the scale Noticing. Conclusion. HSR, SFD and MDD patients do not differ from HC in the awareness of noticing of interoceptive signal processing, whereas cognitive facets of interoception, such as distraction or self-regulation are differentially affected. This highlights the necessity of including specifically targeted interventions, which improve interoceptive awareness, in the prevention and treatment of SFDs. [less ▲]

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See detailCardiac cycle phases affect auditory-evoked potentials, startle eye blink and pre-motor reaction times in response to acoustic startle stimuli
Schulz, André UL; Vögele, Claus UL; Bertsch, Katja et al

in International Journal of Psychophysiology (2020), 157(1), 70-81

Startle stimuli evoke lower responses when presented during the early as compared to the late cardiac cycle phase, an effect that has been called ‘cardiac modulation of startle’ (CMS). The CMS effect may ... [more ▼]

Startle stimuli evoke lower responses when presented during the early as compared to the late cardiac cycle phase, an effect that has been called ‘cardiac modulation of startle’ (CMS). The CMS effect may be associated with visceral-afferent neural traffic, as it is reduced in individuals with degeneration of afferent autonomic nerves. The aim of this study was to investigate whether the CMS effect is due a modulation of only early, automatic stages of stimulus processing by baro-afferent neural traffic, or if late stages are also affected. We, therefore, investigated early and late components of auditory-evoked potentials (AEPs) to acoustic startle stimuli (105, 100, 95 dB), which were presented during the early (R-wave +230 ms) or the late cardiac cycle phase (R +530 ms) in two studies. In Study 1, participants were requested to ignore (n=25) or to respond to the stimuli with button-presses (n=24). In Study 2 (n=23), participants were asked to rate the intensity of the stimuli. We found lower EMG startle response magnitudes (both studies) and slower pre-motor reaction times in the early as compared to the late cardiac cycle phase (Study 1). We also observed lower N1 negativity (both studies), but higher P2 (Study 1) and P3 positivity (both studies) in response to stimuli presented in the early cardiac cycle phase. This AEP modulation pattern appears to be specific to the CMS effect, suggesting that early stages of startle stimulus processing are attenuated, whereas late stages are enhanced by baro-afferent neural traffic [less ▲]

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See detailMotivational Interviewing to Increase Physical Activity Behavior in Cancer Patients: A Pilot Randomized Controlled Trials
Lion, A; Backes, A; Duhem, C et al

in Integrative Cancer Therapies (2020), 19

OBJECTIVE: This pilot randomized controlled trial (RCT) aimed at evaluating the feasibility and potential efficacy of a motivational interviewing (MI) intervention to increase physical activity (PA ... [more ▼]

OBJECTIVE: This pilot randomized controlled trial (RCT) aimed at evaluating the feasibility and potential efficacy of a motivational interviewing (MI) intervention to increase physical activity (PA) behavior in cancer patients. METHODS: Participants were randomly assigned to an experimental group with standard care plus 12 MI sessions within 12 weeks or a control group with standard care only. The number of recruited participants and the modality of recruitment were recorded to describe the reach of the study. The acceptability of the study was estimated using the attrition rate during the intervention phase. The potential efficacy of the intervention was evaluated by analyzing the PA behavior. RESULTS: Twenty-five participants were recruited within the 16-month recruitment period (1.6 participants per month). Five participants (38.5%) from the experimental group (n = 13) and one participant (8.3%) from the control group (n = 12) dropped out of the study before the end of the intervention phase. No group by time interaction effect for PA behavior was observed at the end of the intervention. CONCLUSION: Due to the low recruitment rate and compliance, no conclusion can be drawn regarding the efficacy of MI to increase PA behavior in cancer patients. Moreover, the current literature cannot provide any evidence on the effectiveness of MI to increase PA in cancer survivors. Future RCTs should consider that the percentage of uninterested patients to join the study may be as high as 60%. Overrecruitment (30% to 40%) is also recommended to accommodate the elevated attrition rate. [less ▲]

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See detailNon-problematic and problematic binge-watchers do not differ on prepotent response inhibition: A preregistered pilot experimental study
Flayelle, Maèva; Verbruggen, Frederick; Schiel, Julie et al

in Human Behavior and Emerging Technologies (2020), 2

Binge‐watching (i.e., watching multiple episodes of a TV series back‐to‐back) has become standard viewing practice. Yet, this phenomenon has recently generated concerns regarding its potential negative ... [more ▼]

Binge‐watching (i.e., watching multiple episodes of a TV series back‐to‐back) has become standard viewing practice. Yet, this phenomenon has recently generated concerns regarding its potential negative outcomes on the long run. The presumed addictive nature of this behavior has also received increasing scientific interest, with preliminary findings reporting associations between binge‐watching, self‐control impairments, and heightened impulsivity. Nevertheless, previous studies only relied on self‐report data. The current preregistered study therefore investigated whether non‐problematic and problematic binge‐watchers differ not only in self‐report but also in experimental measures of behavioral impulsivity. Based on their viewing characteristics, 60 TV series viewers were allocated to one of three predetermined groups: non‐binge‐watchers, trouble‐free binge‐watchers (absence of negative impact) and problematic binge‐watchers (presence of negative impact). Participants performed tasks assessing response inhibition (Stop‐Signal Task) and impulsive reward seeking (Delay Discounting Task), and completed self‐reported questionnaires on sociodemographics, affect, symptoms of problematic binge‐watching, and impulsive personality traits. According to the preregistered analytic plan, one‐way analyses of covariance (ANCOVAs) were computed to compare the predetermined groups. With gender being controlled for, no differences were identified in self‐report impulsivity and response inhibition abilities. Trouble‐free binge‐watchers reported higher rates of delay discounting than non‐binge‐watchers. Although preliminary, our results challenge the notion that problematic binge‐watching is characterized by the same neuropsychological impairments as in addictive disorders as, contrary to our preregistered hypotheses, no differences emerged between non‐problematic and problematic binge‐watchers regarding self‐control variables considered as hallmarks of the latter. These results suggest the need for formulating and testing alternative conceptualizations of problematic binge‐watching. [less ▲]

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See detailThe Measurement of Resilience
Asheim, Geir; Bossert, Walter; d'ambrosio, Conchita UL et al

in Journal of Economic Theory (2020), 189

Resilience has become an important topic in many social sciences. Numerous individual choices and economic and demographic outcomes are likely to be influenced by people’s resilience. School performance ... [more ▼]

Resilience has become an important topic in many social sciences. Numerous individual choices and economic and demographic outcomes are likely to be influenced by people’s resilience. School performance, work absenteeism and burnout, longevity, the quality of sleep and health-risk behaviors such as substance abuse are some examples. Similarly, it is of high policy relevance to understand the determinants of both individual resilience (such as educational, marital and occupational status) and ecological resilience (such as climate change). Empirical work designed to uncover such relationships suffers from the absence of a resilience measure applicable in the context of large data sets. We fill this gap by proposing a specific measure that is characterized by a set of natural properties. After an introduction to the notion of resilience and its attributes, we argue why these conditions have intuitive appeal. Finally, we provide illustrating examples and derive our main characterization result. [less ▲]

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See detailTwin Research in the Post-Genomic Era: Dissecting the Pathophysiological Effects of Adversity and the Social Environment
Turner, Jonathan UL; D'Ambrosio, Conchita UL; Vögele, Claus UL et al

in International Journal of Molecular Sciences (2020), 21

The role of twins in research is evolving as we move further into the post-genomic era. With the re-definition of what a gene is, it is becoming clear that biological family members who share a specific ... [more ▼]

The role of twins in research is evolving as we move further into the post-genomic era. With the re-definition of what a gene is, it is becoming clear that biological family members who share a specific genetic variant may well not have a similar risk for future disease. This has somewhat invalidated the prior rationale for twin studies. Case co-twin study designs, however, are slowly emerging as the ideal tool to identify both environmentally induced epigenetic marks and epigenetic disease-associated processes. Here, we propose that twin lives are not as identical as commonly assumed and that the case co-twin study design can be used to investigate the effects of the adult social environment. We present the elements in the (social) environment that are likely to affect the epigenome and measures in which twins may diverge. Using data from the German TwinLife registry, we confirm divergence in both the events that occur and the salience for the individual start as early as age 11. Case co-twin studies allow for the exploitation of these divergences, permitting the investigation of the role of not only the adult social environment, but also the salience of an event or environment for the individual, in determining lifelong health trajectories. In cases like social adversity where it is clearly not possible to perform a randomised-controlled trial, we propose that the case cotwin study design is the most rigorous manner with which to investigate epigenetic mechanisms encoding environmental exposure. The role of the case co-twin design will continue to evolve, as we argue that it will permit causal inference from observational data. [less ▲]

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See detailBinge-Watching: What Do we Know So Far? A First Systematic Review of the Evidence
Flayelle, Maèva UL; Maurage, Pierre; Ridell Di Lorenzo, Kim et al

in Current Addiction Reports (2020), 7(1), 44-60

Purpose of Review: Along with the expansion of on-demand viewing technology, the practice of binge-watching (i.e., watching multiple episodes of TV series back-to-back) has recently gained increasing ... [more ▼]

Purpose of Review: Along with the expansion of on-demand viewing technology, the practice of binge-watching (i.e., watching multiple episodes of TV series back-to-back) has recently gained increasing research interest, given its potential harmfulness and presumed addictive characteristics. The present article provides the first systematic review of the evidence regarding this increasingly widespread behavior. Recent Findings: The results of this systematic review (including 24 studies and 17,545 participants) show that binge-watching remains an ill-defined construct as no consensus exists on its operationalization and measurement. Although such methodological disparities across studies hinder the comparability of results, the preliminary findings gathered here mainly point to the heterogeneous nature of binge-watching which covers at least two distinct realities, i.e., high but non-harmful engagement and problematic involvement in TV series watching. Summary: In these early stages of research, there is a major need for more consistency and harmonization of constructs and their operationalizations to move forward in the understanding of binge-watching. Just as important, future research should maintain the distinction between high and problematic involvement in binge-watching to avoid overpathologizing this common behavior. [less ▲]

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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 (2020), 32(3), 853-863

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 detailDistinctive body perception mechanisms in high versus low symptom reporters: a neurophysiological model for medically-unexplained symptoms
Schulz, André UL; Rost, Silke; Flasinski, Tabea et al

in Journal of Psychosomatic Research (2020), 137(1), 110223

OBJECTIVE: The neurophysiological processes involved in the generation of medicallyunexplained symptoms (MUS) remain unclear. This study tested three assumptions of the perception-filter model ... [more ▼]

OBJECTIVE: The neurophysiological processes involved in the generation of medicallyunexplained symptoms (MUS) remain unclear. This study tested three assumptions of the perception-filter model contributing to MUS: (I.) increased bodily signal strength (II.) decreased filter function, (III.) increased perception. METHODS: In this cross-sectional, observational study, trait MUS was assessed by a webbased survey (N=486). The upper and lower decile were identified as extreme groups of high (HSR; n=29; 26 women; Mage=26.0 years) and low symptom reporters (LSR; n=29; 21 women; Mage=28.4 years). Mean heart rate (HR) and heart rate variability (HRV), and cortisol awakening response (CAR) were assessed as indicators of bodily signal strength (I.). Heartbeat-evoked potentials (HEPs) were assessed during rest and a heartbeat perception task. HEPs reflect attentional resources allocated towards heartbeats and served as index of filter function (II.). Interoceptive accuracy (IAc) in heartbeat perception was assessed as an indicator of perception (III.). RESULTS: HSR showed higher HR and lower HRV (RMSSD) than LSR (I.), but no differences in CAR. HSR exhibited a stronger increase of HEPs when attention was focused on heartbeats than LSR (II.); there were no group differences in IAc (III.). CONCLUSIONS: The perception-filter model was partially confirmed in that HSR showed altered bodily signals suggesting higher sympathetic activity (I.); higher HEP increases indicated increased filter function for bodily signals (II.). As more attentional resources are mobilized to process heartbeats, but perception accuracy remains unchanged (III.), this overflow could be responsible for detecting minor bodily changes associated with MUS. [less ▲]

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See detailChildhood trauma affects stress-related interoceptive accuracy
Schaan, Violetta UL; Schulz, André UL; Rubel, Julian A. et al

in Frontiers in Psychiatry (2019), 10(1), 750

Early life adversity (ELA) may cause permanent disturbances in brain-body signaling. These disturbances are thought to contribute to physical symptoms and emotional dysregulation in adulthood. The current ... [more ▼]

Early life adversity (ELA) may cause permanent disturbances in brain-body signaling. These disturbances are thought to contribute to physical symptoms and emotional dysregulation in adulthood. The current study investigated the effects of childhood trauma on young adults’ interoceptive accuracy as an indicator of brain-body communication that may be dysregulated by ELA. Sixty-six participants completed an online-questionnaire followed by a laboratory session including the socially-evaluated cold pressor stress test during which ECG, salivary cortisol and interoceptive accuracy were assessed. Childhood trauma was negatively related to interoceptive accuracy (IAc) after the stressor. This stress-effect could not be observed for heart rate and cortisol, which were unrelated to IAc. Participants reporting higher baseline unpleasantness exhibited lower IAc after the stressor, while increases in unpleasantness due to the stressor were associated with higher IAc. Unpleasantness at baseline mediated the effect of childhood trauma on IAc after the stressor. [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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