Jürgen Hoyer

Separating Optimism and Pessimism: A Robust Psychometric Analysis of the Revised Life Orientation Test (LOT-R)

The internal structure of the revised Life Orientation Test (LOT-R, German version; M. F. Scheier, C. S. Carver, & M. W. Bridges, 1994) was analyzed in a sample of 46,133 participants who ranged in age from 18 years to 103 years. Confirmatory factor analysis showed that dispositional optimism, as measured by the LOT-R, is bidimensional, consisting of an Optimism and a Pessimism factor. Consistent with previous results, there were small to moderate negative correlations between Optimism and Pessimism, but the strength of the association continuously decreased with age. The relative independence of the 2 dimensions occurred in both genders and across different age groups of patients with different medical disorders.

Physical activity and prevalence and incidence of mental disorders in adolescents and young adults

BACKGROUND Although positive effects of physical activity on mental health indicators have been reported, the relationship between physical activity and the development of specific mental disorders is unclear. METHOD A cross-sectional (12-month) and prospective-longitudinal epidemiological study over 4 years in a community cohort of 2548 individuals, aged 14-24 years at outset of the study. Physical activity and mental disorders were assessed by the DSM-IV Composite International Diagnostic Interview (CIDI) with an embedded physical activity module. Multiple logistic regression analyses controlling for age, gender and educational status were used to determine the cross-sectional and prospective associations of mental disorders and physical activity. RESULTS Cross-sectionally, regular physical activity was associated with a decreased prevalence of any and co-morbid mental disorder, due to lower rates of substance use disorders, anxiety disorders and dysthymia. Prospectively, subjects with regular physical activity had a substantially lower overall incidence of any and co-morbid mental disorder, and also a lower incidence of anxiety, somatoform and dysthymic disorder. By contrast, the incidence of bipolar disorder was increased among those with regular physical activity at baseline. In terms of the population attributable fraction (PAF), the potential for preventive effects of physical activity was considerably higher for men than for women. CONCLUSIONS Regular physical activity is associated with a substantially reduced risk for some, but not all, mental disorders and also seems to reduce the degree of co-morbidity. Further examination of the evidently complex mechanisms and pathways underlying these associations might reveal promising new research targets and procedures for targeted prevention.

Die Erfassung sozialer Phobie durch die Social Interaction Anxiety Scale (SIAS) und die Social Phobia Scale (SPS)

Zusammenfassung. Die vorliegende Arbeit berichtet erste Analysen zur Reliabilitat und Validitat sowie klinische cut-off-Werte der deutschen Bearbeitung der Social Interaction Anxiety Scale und der Social Phobia Scale (Mattick & Clarke, 1989). Die Skalen wurden 43 Patienten mit Sozialer Phobie, 69 Patienten mit anderen psychischen Storungen und 24 Kontrollpersonen ohne psychische Storungen vorgelegt. Die ermittelten Werte fur die innere Konsistenz und Test-Retest-Korrelation sprechen fur eine sehr hohe Reliabilitat. Hinweise auf eine konvergente Validitat ergaben sich aus hohen Korrelationen mit konstruktnahen Mesinstrumenten zur Sozialen Phobie, wahrend die Korrelationen zu Depressions- und Angstmasen erwartungsgemas geringer ausfielen. Die beiden Skalen diskriminieren Soziophobiker sehr gut von Personen ohne psychische Storung und Angstpatienten, wahrend die Diskriminationsleistung von depressiven Patienten geringer ausgepragt ist. Die ermittelten cut-off-Werte liegen deutlich unter den amerikanischen We...

Hair Cortisol as a Biomarker of Traumatization in Healthy Individuals and Posttraumatic Stress Disorder Patients

BACKGROUND Previous evidence on endocrine correlates of posttraumatic stress disorder (PTSD) has been rather inconsistent. The analysis of cortisol in hair is a recent methodological development that may increase the quality of long-term cortisol assessments in such research. Here, we use this method to closely assess hair cortisol relationships with trauma-related characteristics and PTSD symptom patterns. METHODS Hair cortisol concentrations (HCC), diurnal salivary cortisol, and relevant psychometric data were assessed in matched groups of 28 PTSD patients and 27 traumatized and 32 nontraumatized healthy control subjects. Cortisol levels were quantified by liquid chromatography tandem mass spectrometry. RESULTS Posttraumatic stress disorder patients and traumatized control subjects exhibited 59% and 51% lower HCC than nontraumatized control subjects, respectively. Hair cortisol concentrations were found to be negatively related to the severity of intrusion symptoms, the number of different lifetime traumatic events, the frequency of traumatization, and the time interval since traumatization. The overall pattern of HCC associations was not reflected in short-term salivary cortisol findings. CONCLUSIONS Our results indicate that trauma exposure per se, either in the absence or presence of PTSD, is a crucial correlate of long-term basal cortisol levels. Particularly, the experience of multiple events with a longer time since traumatization and an increased severity of intrusion symptoms may be related to hypocortisolism. The fact that HCC findings were not consistently seen in salivary cortisol data underscores the importance of the method of cortisol assessment and highlights the utility of hair cortisol analyses for future biological psychiatry research.

Worry Exposure versus Applied Relaxation in the Treatment of Generalized Anxiety Disorder

Background: Worry exposure (WE) is a core element of cognitive-behavioral treatment for generalized anxiety disorder (GAD). Its efficacy as a stand-alone treatment method (without further cognitive-behavioral therapy interventions) has never been tested.We aimed to examine whether WE alone is as efficacious as the empirically supported stand-alone treatment for GAD, applied relaxation (AR). Methods: In a randomized controlled study, 73 outpatients meeting DSM-IV criteria for GAD as primary diagnosis were allocated to either WE or AR or a waiting list control group; in a 2nd randomization procedure the waiting list subjects were reallocated to WE or AR. The treatment was manualized (15 sessions with WE or AR), included 6-month and 1-year follow-ups, as well as last observation carried forward and completer analyses, and was controlled for allegiance effects.The Hamilton Anxiety Rating Scale and the State-Trait Anxiety Scale were used as primary outcome measures. Self-report scales of anxiety, worrying and depression including negative metacognition about worrying and thought suppression served as secondary outcome measures. Results: The dropout rate was moderate. The pre-/posttreatment effects were high for the Hamilton Anxiety Rating Scale (standardized mean difference >1) and for the State-Trait Anxiety Inventory (standardized mean difference >0.87). The proportion of patients reaching high end state functioning was 48% (WE) and 56% (AR). WE and AR did not differ with regard to dropout rate or treatment effects. The treatment effects were stable at 6 month and 1 year follow-up. Conclusion: This is the first study to show that a stand-alone exposure in sensu technique – WE – is efficacious in the treatment of GAD. Both AR and WE seem to represent effective principles of change in GAD.

Assessing Psychological Flexibility: What Does It Add above and beyond Existing Constructs?.

The construct of psychological flexibility (PF) is a central concept in acceptance and commitment therapy. It is defined as the process of contacting the present moment fully as a conscious human being and persisting in or changing behavior in the service of chosen values. PF is hypothesized to be an important aspect of healthy psychological functioning. Despite its potential importance, the distinctness of PF from other constructs has not been adequately demonstrated, and psychometric evaluations of measures designed to assess it are limited. This study aimed at extending current knowledge about PF by examining the construct in 2 help-seeking samples, including panic disorder with agoraphobia (n = 368), clinically relevant social phobia (n = 209), and 2 nonclinical samples including students (n = 495) and individuals visiting an employment office (n = 95). Results across all samples indicate that PF, as measured by the Acceptance and Action Questionnaire (2nd version; AAQ-II), is a unitary construct with a 1 factor model. PF correlated with other variables largely consistent with predictions, differentiated patients from healthy controls, and showed preliminary indications of treatment sensitivity. Incremental validity was partially demonstrated, especially for indices of functioning. Surprisingly, PF also explained unique variance above more established measures for some indices of symptomatology. Results suggest that PF adds some incremental clinical validity, yet further and more stringent tests are required to fully elucidate its strengths and limitations.

Die deutsche Version des Life-Orientation-Tests (LOT-R) zum dispositionellen Optimismus und Pessimismus

Zusammenfassung. Die Relevanz des Konstruktes Optimismus fur eine Vielzahl psychologischer und medizinischer Bereiche ist in zahlreichen Studien eindrucksvoll demonstriert worden. Das in der Forschung mit Abstand am haufigsten eingesetzte Messinstrument zur Erfassung des dispositionellen Optimismus ist der Life-Orientation-Test (LOT-R). Die deutsche Ubersetzung des LOT-R wird vorgestellt und anhand von Daten von 4938 Personen im Alter von 18-101 Jahren gepruft. Es werden psychometrische Kennwerte, Gutekriterien und Normwerte sowohl fur die Subskalen Optimismus und Pessimismus als auch fur die Gesamtskala berichtet. Damit liegt eine verbesserte Basis fur den Forschungseinsatz und die vergleichende Bewertung von Befunden mit diesem Instrument vor.

Association between generalized anxiety levels and pain in a community sample: Evidence for diagnostic specificity

BACKGROUND It is unclear whether generalized anxiety disorder (GAD) has a specific relationship to pain syndromes, going beyond the established association of pain with anxiety syndromes in general. METHODS Mental disorders were assessed in a community sample (N=4181; 18-65 years) using the DSM-IV/M-CIDI. Several threshold definitions were used to define GAD and medically unexplained pain. RESULTS The association between pain and GAD (odds ratio, OR=5.8 pain symptoms; OR=16.0 pain disorder) is stronger than the association between pain and other anxiety disorders (OR=2.4 pain symptoms; OR=4.0 pain disorder). This association extends to subthreshold level definitions of GAD with some indication for a non-linear dose-response relationship. The GAD-pain link cannot sufficiently be explained by demographic factors, comorbid mental or physical disorders. CONCLUSIONS The association of pain and generalized anxiety is not artifactual. Compared to other anxiety syndromes, it appears to be stronger and more specific suggesting the need to explore clinical and public health implications.

Interpersonal Subtypes Within Generalized Anxiety Disorder

In this study, we addressed the heterogeneity in interpersonal problems across patients with generalized anxiety disorder (GAD). We assessed interpersonal problems by the Inventory of Interpersonal Problems (IIP–C; Horowitz, Alden, Wiggins, & Pincus, 2000) in a sample of 78 GAD patients. We used IIP–C profiles describing interpersonal characteristics of the total GAD sample as well as clustered GAD interpersonal subtypes. Although the overall sample was located in the friendly submissive quadrant of the circumplex model, this was true only for the Exploitable cluster, which includes more than 50% of the patients. Importantly, clusters of GAD patients with other locations reporting predominantly Cold, Nonassertive, or Intrusive interpersonal problems were also identified. The 4 clusters did not differ in terms of gender, comorbid disorders, or the severity of depression or anxiety. Thus, the assessment of interpersonal problems provides additional diagnostic information covering the heterogeneity of GAD patients. This information could be used for differential indication and individual case formulation in GAD.

How specific is specific phobia? Different neural response patterns in two subtypes of specific phobia

Specific phobia of the animal subtype has been employed as a model disorder exploring the neurocircuitry of anxiety disorders, but evidence is lacking whether the detected neural response pattern accounts for all animal subtypes, nor across other phobia subtypes. The present study aimed at directly comparing two subtypes of specific phobia: snake phobia (SP) representing the animal, and dental phobia (DP) representing the blood-injection-injury subtype. Using functional magnetic resonance imaging (fMRI), brain activation and skin conductance was measured during phobogenic video stimulation in 12 DP, 12 SP, and 17 healthy controls. For SP, the previously described activation of fear circuitry structures encompassing the insula, anterior cingulate cortex and thalamus could be replicated and was furthermore associated with autonomic arousal. In contrast, DP showed circumscribed activation of the prefrontal and orbitofrontal cortex (PFC/OFC) when directly compared to SP, being dissociated from autonomic arousal. Results provide preliminary evidence for the idea that snake and dental phobia are characterized by distinct underlying neural systems during sustained emotional processing with evaluation processes in DP being controlled by orbitofrontal areas, whereas phobogenic reactions in SP are primarily guided by limbic and paralimbic structures. Findings support the current diagnostic classification conventions, separating distinct subtypes in DSM-IV-TR. They highlight that caution might be warranted though for generalizing findings derived from animal phobia to other phobic and anxiety disorders. If replicated, results could contribute to a better understanding of underlying neurobiological mechanisms of specific phobia and their respective classification.