Marit Hauschildt

Heart rate variability in response to affective scenes in posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) is characterized by psychophysiological abnormalities, such as an altered baseline heart rate and either hyper- or hyporeactivity to a wide range of stimuli, implying dysfunctional arousal regulation. Heart rate variability (HRV) has been established as an important marker of arousal regulatory ability. The aim of the present study was to examine HRV in PTSD under different affective conditions and to explore the role of potential moderating factors. To meet this purpose, videos of varying emotional valence were presented to trauma-exposed participants with PTSD (n=26), trauma-exposed participants without PTSD (n=26), as well as non-trauma-exposed controls (n=18) while HRV was recorded. The PTSD group showed lower HRV than non-trauma-exposed controls at baseline (corrected for age) and throughout different affective conditions implying decreased parasympathetic activity and an inflexible response regulation. There was a negative relationship between HRV and self-report of both depression and state dissociation.

Do it yourself? Self-help and online therapy for people with obsessive-compulsive disorder

Purpose of review In spite of advances in the understanding and treatment of obsessive-compulsive disorder (OCD), for most patients some symptoms persist even after therapeutic intervention. Another large subgroup does not seek treatment at all, particularly due to shame or fear of stigma. The treatment gap in OCD is large and self-help is increasingly seen as a low-threshold form of intervention for individuals with minor symptoms or who are currently treatment-reluctant. Our review summarizes the expanding but still small literature on self-help and Internet interventions for OCD and provides advice on how to conduct (Internet) studies on self-help. Strategies to deal with methodological problems that notoriously plague Internet research are discussed. Recent findings Despite methodological limitations inherent in most studies considered for the current review, as well as the unreplicated nature of some of the more recent findings, self-help tools hold some promise. In particular, self-help interventions that are rooted in evidence-based concepts may be helpful as an add-on to standard interventions and as (initial) therapeutic strategies for those who are presently reluctant to participate in face-to-face treatment. Summary The current review identifies self-help, which is based on evidence-based concepts, as a promising clinical tool for the treatment of OCD. The current literature suggests that self-help can be a facilitator and aid to standard face-to-face interventions, rather than a rival.

Neither Saints nor Wolves in Disguise Ambivalent Interpersonal Attitudes and Behaviors in Obsessive-Compulsive Disorder

Inflated responsibility is ascribed a pivotal role in the pathogenesis of obsessive-compulsive disorder (OCD). The aim of the study was to assess interpersonal attitudes and behaviors contributing to enhanced responsibility in OCD. In particular, we tested the hypothesis that individuals diagnosed with OCD share stronger latent aggression toward others, resulting in a high degree of interpersonal ambivalence. A total of 176 participants with OCD, 42 participants with anxiety or depression as well as 42 healthy controls completed the Responsibility and Interpersonal Behaviors and Attitudes Questionnaire (RIBAQ). The factor analysis confirmed three factors: (1) inflated worry/responsibility, (2) latent aggression/calculating behavior and (3) suspiciousness/distrust. Whereas the psychiatric group displayed enhanced scores relative to healthy participants regarding responsibility and suspiciousness, OCD patients achieved significantly higher scores on the latent aggression dimension relative to both control groups. Results are consistent with the notion that participants with OCD show both inflated levels of (authentic) responsibility and latent aggression.

THE MORE IT IS NEEDED, THE LESS IT IS WANTED: ATTITUDES TOWARD FACE-TO-FACE INTERVENTION AMONG DEPRESSED PATIENTS UNDERGOING ONLINE TREATMENT

Many individuals suffering from depression do not actively seek treatment. Self‐help strategies represent low‐threshold treatment options that are particularly relevant for milder cases. The present study addressed two important issues: (1) we examined depressed individuals’ motives and attitudes that may represent barriers to face‐to‐face treatment; (2) we examined if the participation in an online treatment program facilitates or compromises their willingness to undergo face‐to‐face treatment. We recruited 210 participants with depression for a trial on the efficacy of an online treatment program for depression. Participants were randomly allocated either to a self‐help treatment (Deprexis) or to a wait‐list control group. All participants filled out a newly developed 42‐item questionnaire called Psychotherapy Expectations, Concerns, and Hopes Inventory (PECHI). The scale measures attitudes toward face‐to‐face treatment and was administered at baseline and 8 weeks later. Principal component analysis of the PECHI revealed five dimensions: hope for symptomatic improvement, fear of poor alliance with the therapist, skill acquisition, skepticism and resentment of psychotherapy, and self‐stigma. Attitudes toward treatment were stable over time and neither modulated by group status nor by self‐reported or objective symptom decline. Correlation analyses revealed that current levels of depression and well‐being were potent predictors of attitudes toward treatment, suggesting that when the patient feels more depressed, doubts about the effectiveness of therapy emerge more strongly. To conclude, results suggest that Deprexis neither promotes nor reduces negative attitudes toward psychotherapy, nor does it increase barriers to enter face‐to‐face treatments. An alarming paradox emerged: when a depressed person is in greatest need of help, motivation to seek face‐to‐face treatment is lowest. Depression and Anxiety 00:1‐11, 2012.

Impact of emotionality on memory and meta-memory in schizophrenia using video sequences

BACKGROUND AND OBJECTIVES A vast amount of memory and meta-memory research in schizophrenia shows that these patients perform worse on memory accuracy and hold false information with strong conviction compared to healthy controls. So far, studies investigating these effects mainly used traditional static stimulus material like word lists or pictures. The question remains whether these memory and meta-memory effects are also present in (1) more near-life dynamic situations (i.e., using standardized videos) and (2) whether emotionality has an influence on memory and meta-memory deficits (i.e., response confidence) in schizophrenia compared to healthy controls. METHOD Twenty-seven schizophrenia patients and 24 healthy controls were administered a newly developed emotional video paradigm with five videos differing in emotionality (positive, two negative, neutral, and delusional related). After each video, a recognition task required participants to make old-new discriminations along with confidence ratings, investigating memory accuracy and meta-memory deficits in more dynamic settings. RESULTS For all but the positively valenced video, patients recognized fewer correct items compared to healthy controls, and did not differ with regard to the number of false memories for related items. In line with prior findings, schizophrenia patients showed more high-confident responses for misses and false memories for related items but displayed underconfidence for hits when compared to healthy controls, independent of emotionality. LIMITATIONS Limited sample size and control group; combined valence and arousal indicator for emotionality; general psychopathology indicator. CONCLUSIONS Emotionality differentially moderated memory accuracy, biases in schizophrenia patients compared to controls. Moreover, the meta-memory deficits identified in static paradigms also manifest in more dynamic settings near-life settings and seem to be independent of emotionality.

Veridical and false memory for scenic material in posttraumatic stress disorder

The question whether memory aberrations in posttraumatic stress disorder (PTSD) also manifest as an increased production of false memories is important for both theoretical and practical reasons, but is yet unsolved. Therefore, for the present study we investigated veridical and false recognition in PTSD with a new scenic variant of the Deese-Roediger-McDermott (DRM) paradigm, which was administered to traumatized individuals with PTSD (n=32), traumatized individuals without PTSD (n=30), and non-traumatized controls (n=30). The PTSD group neither produced higher rates of false memories nor expressed more confidence in errors, but did show inferior memory sensitivity. Whereas depressive symptoms did not correlate with veridical nor false recognition, state dissociation was positively associated with false memories.

Efficacy of Metacognitive Training for Depression: A Randomized Controlled Trial

cruited shortly after admission to a psychosomatic outpatient day clinic (RehaCentrum Hamburg) according to the following inclusion criteria: diagnosis of a single episode or recurrent major depressive disorder or dysthymia (verified by the Mini International Psychiatric Interview) and age between 18 and 65 years. The exclusion criteria were lifetime psychotic symptoms (i.e. hallucinations, delusions, or mania), suicidality (Suicidal Behaviors Questionnaire Revised score ≥ 7), or intellectual disability (estimated IQ <70). Personality disorders and (changes in) medication were tolerated. All participants provided written informed consent prior to participation. The study was approved by the Ethics Committee of the German Psychological Association and was registered at the German Clinical Trials Register (No. DRKS00007907). The following instruments were administered at baseline (t0), 4 weeks (t1) and 6 months later (t2) by raters blind to diagnostic status: primary outcome measure: Hamilton Depression Rating Scale (HDRS) and secondary outcome measures: Beck Depression Inventory (Cronbach’s α at t0 = 0.88), Dysfunctional Attitudes Scale (α = 0.84), Rosenberg Self-Esteem Scale (α = 0.86), World Health Organization Quality of Life Assessment (α = 0.81). At t1, patients additionally filled out the Client Satisfaction Questionnaire (ZUF-8), measuring ‘general satisfaction’ with overall treatment. All patients participated in a standard intensive psychosomatic outpatient treatment program (=treatment as usual, TAU) 5 days a week for 8 h a day, which included a wide range of physical, occupational, and psychological interventions. The frequency and duration of sessions for adjunct interventions (D-MCT/HT) were equivalent across conditions (8 sessions of 60 min over a period of 4 weeks). For D-MCT, a treatment manual is available in German; materials in other languages can be downloaded at no cost via www.uke.de/depression. HT consisted of one walking and one psychoeducation session on health topics (e.g. stress reduction) per week. We conducted 2 intention-to-treat (ITT) and 1 complete-case (CC) analysis. To address missing data, last observation carried forward and multiple imputation (20 imputations) were utilized. For the CC analysis, only patients who completed assessments at all visits were considered. For all analyses, difference scores (t0 to t1 and t0 to t2, respectively) served as dependent variables, and baseline scores were entered as a covariate. Effect sizes are expressed as η p 2 (with η p 2 ≈ 0.01, η p 2 ≈ 0.06, and η p 2 ≈ 0.14 corresponding to small, medium, and large effects and a Cohen’s d of ≈ 0.2, ≈ 0.5, and ≈ 0.8, respectively). The ITT sample ( fig. 1 ) consisted of 84 patients (62 women and 22 men) with a mean age of 45.5 years (SD = 9.89). Almost two thirds of the patients (n = 49, 58.33%) were currently in a relationship. Thirty-six patients (43%) were diagnosed with a single episode of major depressive disorder, 47 (56%) with recurrent depression, and 1 with dysthymia (1%). The mean illness duration was approximately 96 months (SD = 104.96). On average, patients exEffective pharmacological and psychological treatments for depression exist. However, even if optimal treatment were accessible to all patients, the burden of depression would be reduced by only 30% [1] , partly due to dropout [2] and relapse rates after treatment [3] . Improving treatment for depression is crucial and is less a question of developing novel treatments than of determining how existing treatments can be enhanced and applied in a more straightforward and cost-effective manner. For example, low-intensity variants could be delivered by individuals without formal health care training instead of highly trained personnel [4] . To meet this need, metacognitive training for depression (DMCT) has been developed as a low-threshold, easy-to-administer, cognitive behavioral therapy-based group intervention. The aim of D-MCT is to reduce depressive symptoms by changing the patient’s cognitive biases through a metacognitive perspective. In addition to depressive thought patterns typically targeted in cognitive behavioral therapy (e.g. overgeneralization), a number of general cognitive biases, which have been identified by basic cognitive research, form the core of D-MCT (e.g. mood-congruent memory [5] ). As in metacognitive therapy according to Wells [6] , dysfunctional coping strategies are targeted (i.e. thought suppression, rumination). D-MCT also addresses the content of depressive thought patterns. Modeled after metacognitive training for psychosis [7] , D-MCT challenges cognitive biases through creative and engaging exercises (e.g. insight elicited by ‘aha experiences’). However, the content of the training is based on empirical findings in depressive patients. Use of standardized multimedia presentations reduces the time needed for preparation and administration; moreover, this packaging increases D-MCT’s accessibility to a wide range of health care providers. Safety, feasibility and effectiveness of a beta version were confirmed in an open-label pilot study [8] . The aim of the current study was to investigate the efficacy of D-MCT as an add-on intervention. We conducted a parallel, accessor-blind randomized controlled trial comparing two add-on group interventions: D-MCT (experimental group) and health training (HT, active control group). Between 2012 and 2013, patients were consecutively reReceived: August 17, 2015 Accepted: December 29, 2015 Published online: May 27, 2016

Perceptual properties of obsessive thoughts are associated with low insight in obsessive-compulsive disorder.

Abstract Obsessions are traditionally defined as bothersome and repetitive thoughts that the patient is unable to resist. Preliminary evidence suggests that in a subgroup of patients with obsessive-compulsive disorder (OCD), obsessions are experienced as partially perceptual. The present study explored the frequency of perceptually laden obsessions and their relationship with illness insight and depression. Twenty-six patients with OCD were administered the newly developed Sensory Properties of Obsessions Questionnaire. Participants were asked to endorse on a 5-point Likert scale whether their obsessions were associated with perceptual features. Participants showed moderate symptom severity. A total of 73% affirmed that their obsessions contained perceptual features. The predominant perceptual channels were visual, tactile, and somatic (i.e., bodily sensations). The extent of perceptual aspects associated with obsessions was strongly correlated with lack of insight (Yale-Brown Obsessive-Compulsive Scale item 11) but not depression severity. The present study suggests that obsessive thoughts are frequently accompanied by perceptual sensations, which concurs with models assuming a continuum between hallucinations and intrusions. Apparently, the more “real” or authentic the obsessive thought is experienced, the less the afflicted person is able to dismiss its content as fully irrational or absurd.

Attentional bias for affective visual stimuli in posttraumatic stress disorder and the role of depression

An attentional bias for trauma-related verbal cues was frequently demonstrated in posttraumatic stress disorder (PTSD) using variants of the emotional Stroop task (EST). However, the mechanisms underlying the Stroop-effect are ill-defined and it is yet unclear how the findings apply to different paradigms and stimulus modalities. To address these open questions, for the first time a spatial-cuing task with pictorial cues of different emotional valence was administered to trauma-exposed individuals with and without PTSD, and non-trauma-exposed controls. Groups did not show different response profiles across affective conditions. However, a group effect was evident when comparing depressed with non-depressed individuals: Those with depression showed delayed attending towards trauma-related cues and faster attending away from negative cues. In correlational analyses, attentional avoidance was associated with both depression and PTSD symptom severity. These findings highlight the need for research on trauma populations and anxiety in general to pay closer attention to depression as an important confound in the study of emotional information processing.

Investigating the Corrective Effect of Forewarning on Memory and Meta-Memory Deficits in Schizophrenia Patients:

A number of recent studies investigating (meta-)memory have detected that memory accuracy is decreased in schizophrenia and that at the same time patients hold false information with strong conviction. The aim of the present study was to test whether increasing meta-memory awareness (i.e., forewarning) could attenuate this pattern of results. Forty-seven schizophrenia patients and 47 healthy controls were administered two pictures of a visual false memory paradigm, one with forewarning and the second without. After both pictures, a recognition task required participants to make old-new discriminations along with confidence ratings. Results showed that, although the standard memory and meta-memory response patterns were replicated in this study, in which schizophrenia patients show decreased memory accuracy and knowledge corruption, the initial forewarning did not influence the robustness of these meta-memory deficits within schizophrenia patients.