Georg Wiedemann

Repeated exposure of flight phobics to flights in virtual reality.

The present study examined the effects of repeated exposure of flight phobics to flights in virtual reality (VR). Flight phobics were randomly assigned either to complete one VR test flight followed by four VR exposure flights (VR group; N=15) in one lengthy session or to complete one VR test flight followed by a lengthy relaxation training session (relaxation group; N=15). All participants completed a second VR test flight at the end of the session. Fear reports and physiological fear reactions (heart rate, skin conductance level) during VR exposures were registered, and fear of flying was assessed psychometrically from 3 weeks before to 3 months after exposure. Exposure to VR flights elicited subjective and physiological fear responses in flight phobics, and these responses attenuated within and across VR flights. Fear reduction associated with repeated VR exposure was greater than fear reduction caused by relaxation training. Fear of flying improved in both treatment groups, but several outcome measures indicated greater effects in the VR treated group than in the relaxation group. These findings indicate that exposure in virtual reality may offer a new and promising approach for the treatment of fear of flying.

Anxiety in patients with an automatic implantable cardioverter defibrillator: what differentiates them from panic patients?

OBJECTIVE Anxiety seems to be a frequent problem in patients with an automatic implantable cardioverter defibrillator (AICD). Distressing experiences before or after AICD implantation such as resuscitation, or AICD shocks are suspected as causes for enhanced anxiety levels. A closer examination of the level and structure of anxiety in AICD patients and a comparison with panic patients might help to examine additionally both conditioning and cognitive models of anxiety. METHODS There were 61 AICD patients examined with a specifically designed AICD questionnaire and standardized anxiety and depression questionnaires. Subgroups of AICD patients without, with some, and with definite anxiety related to AICD shocks were compared with panic patients and healthy control subjects. RESULTS Although fear of dying was greatly reduced by AICD implantation, approximately one third of the AICD patients, especially patients with definite anxiety related to AICD shocks, were characterized both by enhanced anxiety levels and avoidance behavior. These patients were comparable with panic patients in most questionnaire scores. Anxiety levels were not associated with objective AICD shock experiences or medical variables. CONCLUSIONS Anxiety in AICD patients seems to be unrelated to traumatic experiences, a finding that casts doubt on pure conditioning models of anxiety. Presumably, a life-threatening cardiac disorder increases the likelihood for catastrophic interpretations of bodily signs, especially in anxiety prone AICD patients. In accordance with cognitive models of panic disorder, this cognitive dysfunction could lead to anxiety and depression levels comparable with those of panic patients.

Negative Symptoms of Schizophrenia as Primary Target of Cognitive Behavioral Therapy: Results of the Randomized Clinical TONES Study

Clinical studies on cognitive behavioral therapy (CBT) that include schizophrenia patients primarily on the basis of negative symptoms are uncommon. However, those studies are necessary to assess the efficacy of CBT on negative symptoms. This article first gives an overview of CBT on negative symptoms and discusses the methodological problems of selecting an adequate control group. Furthermore, the article describes a clinical study (the TONES-Study, ISRCTN 25455020), which aims to investigate whether CBT is specifically efficacious for the reduction of negative symptoms. This multicenter randomized clinical trial comparing CBT with cognitive remediation (CR) for control of nonspecific effects is depicted in detail. In our trial, schizophrenia patients (n = 198) participated in manualized individual outpatient treatments. Primary outcome is the negative syndrome assessed with the positive and negative syndrome scale, analyzed with multilevel linear mixed models. Patients in both groups moderately improved regarding the primary endpoint. However, against expectation, there was no difference between the groups after treatment in the intention to treat as well as in the per-protocol analysis. In conclusion, psychotherapeutic intervention may be useful for the reduction of negative symptoms. However, there is no indication for specific effects of CBT compared with CR.

Efficacy of a One-Session Virtual Reality Exposure Treatment for Fear of Flying

The authors examined the efficacy of a 1-session virtual reality (VR) exposure treatment and sought to determine whether VR exposure is the active treatment component. Forty-five patients with fear of flying were randomly assigned to (a) cognitive treatment plus VR exposure with motion simulation, (b) cognitive treatment plus VR exposure without motion simulation, or (c) cognitive treatment alone. Fear of flying was assessed before, immediately after, and 6 months after treatment. Posttreatment and 6-month follow-up assessments revealed reduced fear of flying only in the VR exposure groups. VR exposure with or without motion simulation yielded comparable treatment outcomes. Dismantling of treatment components indicated that exposure to visual and acoustic stimuli is the main active component of VR exposure therapy. Motion simulation as part of VR exposure does not seem to further enhance treatment effects.

Virtual reality for the psychophysiological assessment of phobic fear: responses during virtual tunnel driving

An overall assessment of phobic fear requires not only a verbal self-report of fear but also an assessment of behavioral and physiological responses. Virtual reality can be used to simulate realistic (phobic) situations and therefore should be useful for inducing emotions in a controlled, standardized way. Verbal and physiological fear reactions were examined in 15 highly tunnel-fearful and 15 matched control participants in 3 virtual driving scenarios: an open environment, a partially open tunnel (gallery), and a closed tunnel. Highly tunnel-fearful participants were characterized by elevated fear responses specifically during tunnel drives as reflected in verbal fear ratings, heart rate reactions, and startle responses. Heart rate and fear ratings differentiated highly tunnel-fearful from control participants with an accuracy of 88% and 93%, respectively. Results indicate that virtual environments are valuable tools for the assessment of fear reactions and should be used in future experimental research.

Altered processing of pain-related information in patients with fibromyalgia

Pressure pain thresholds (PPTs) and event‐related potentials (ERPs) elicited by emotional words were analyzed in 12 patients with fibromyalgia (FM) and 12 matched healthy subjects. PPTs were assessed at the middle finger of both hands, before and after the experiment. Overall, FM patients and healthy subjects did not differ in PPT. Nevertheless, FM patients as compared with healthy controls were characterized by a significant enhancement of pain sensitivity from the beginning to the end of the experiment indicating a long lasting sensitization due to repeated stimulation. ERPs were recorded during a language decision task where subjects had to react to unpleasant pain‐related and emotionally neutral words depending on syntactic or orthographic cues. An emotional category effect was observed on N400 and P300 components of the ERP, indicating that unpleasant words elicited more positive amplitudes than neutral words. A significant group effect was observed on P200 amplitudes, showing reduced amplitudes in FM patients as compared to healthy controls. Furthermore, unpleasant pain‐related compared to neutral words triggered significantly enhanced late positive slow waves in healthy controls, while a comparable effect was not found in FM patients. The ERP and PPT data suggest that FM patients are characterized by an altered cognitive processing of pain‐related information and by an abnormal adaptation to mechanical pain stimuli, respectively.

Phylo- and Ontogenetic Fears and the Expectation of Danger: Differences Between Spider- and Flight-Phobic Subjects in Cognitive and Physiological Responses to Disorder-Specific Stimuli

To compare specific phobias with an assumed phylogenetic or ontogenetic origin in responses to fear-relevant (FR) stimuli, 17 spider- and 17 flight-phobic participants were exposed to pictures of spiders, flight accidents, or mushrooms randomly followed by either a startling noise or nothing else. While both groups showed a disorder-specific expectancy bias, only spider-phobic participants exhibited a disorder-specific covariation bias. Spider-phobic participants also showed enhanced skin conductance responses (SCRs), event-related brain potentials (ERPs), and startle responses triggered by disorder-specific FR pictures while flight-phobic participants showed only disorder-specific enhanced SCRs. In sum, our direct comparison between ontogenetic and phylogenetic phobias revealed that the former is characterized by biased and enhanced responses triggered by disorder-specific FR stimuli presumably based on a biological preparedness.

The precuneus and the insula in self-attributional processes

Attributions are constantly assigned in everyday life. A well-known phenomenon is the self-serving bias: that is, people’s tendency to attribute positive events to internal causes (themselves) and negative events to external causes (other persons/circumstances). Here, we investigated the neural correlates of the cognitive processes implicated in self-serving attributions using social situations that differed in their emotional saliences. We administered an attributional bias task during fMRI scanning in a large sample of healthy subjects (n = 71). Eighty sentences describing positive or negative social situations were presented, and subjects decided via buttonpress whether the situation had been caused by themselves or by the other person involved. Comparing positive with negative sentences revealed activations of the bilateral posterior cingulate cortex (PCC). Self-attribution correlated with activation of the posterior portion of the precuneus. However, self-attributed positive versus negative sentences showed activation of the anterior portion of the precuneus, and self-attributed negative versus positive sentences demonstrated activation of the bilateral insular cortex. All significant activations were reported with a statistical threshold of p ≤ .001, uncorrected. In addition, a comparison of our fMRI task with data from the Internal, Personal and Situational Attributions Questionnaire, Revised German Version, demonstrated convergent validity. Our findings suggest that the precuneus and the PCC are involved in the evaluation of social events with particular regional specificities: The PCC is activated during emotional evaluation, the posterior precuneus during attributional evaluation, and the anterior precuneus during self-serving processes. Furthermore, we assume that insula activation is a correlate of awareness of personal agency in negative situations.

Pressure pain thresholds asymmetry in left- and right-handers: Associations with behavioural measures of cerebral laterality

Pressure pain threshold (PPT) asymmetry of the left and right third digits was assessed in 12 right‐handed and 12 left‐handed subjects using an automatised pressure algometer. A clear PPT asymmetry was found in right‐handed participants, while left‐handed participants revealed no PPT asymmetry. The PPT asymmetry of right‐handed participants was due to a reduced PPT or increased pain sensitivity at the left hand. Behavioural laterality tests revealed a right ear or left hemisphere advantage for the processing of verbal material (consonant‐vocal syllables) and a left visual field or right hemisphere advantage for the processing of emotional faces in all participants. PPT asymmetry was not associated with cerebral laterality assessed with these tests. We conclude that PPT asymmetry is associated with handedness, but neither PPT asymmetry nor handedness are closely associated with measures of cerebral laterality.

Collaboration in outpatient antipsychotic drug treatment: analysis of potentially influencing factors.

Knowledge of factors relevant for medication adherence and patient collaboration is still limited. Our study aims at exploring the contribution of a variety of factors to collaboration in outpatients with schizophrenia and schizoaffective disorder. We obtained self-rated and observer-rated data from 108 outpatients during an interview 6 months after hospital discharge. The compliance rating scale (CRS) classified 76% of the patients as collaborative. Factors related to the patient, illness, treatment, and social environment were analysed in two-step explorative correlation and regression analyses in order to determine their relative contribution to collaboration. Only trust in medication and lack of insight were associated with collaboration, and they accounted for 38% of the variance. Neither medication side effects nor neuropsychological functioning correlated with collaboration. The conceptualisation of medication adherence is complex, and there are a number of unresolved methodological problems. The data indicate that illness and treatment-related subjective attitudes may be more relevant than side effects, cognitive functioning or any sociodemographic variable.