O. Berndt Scholz

RELEVANCE OF MUSCULAR SENSITIVITY, MUSCULAR ACTIVITY, AND COGNITIVE VARIABLES FOR PAIN REDUCTION ASSOCIATED WITH EMG BIOFEEDBACK IN FIBROMYALGIA

18 patients suffering from primary fibromyalgia received nine training sessions using EMG biofeedback over a period of four weeks. Pre- and posttreatment measurement of the baseline EMG activity of the trapezius, muscular sensitivity, and cognitive variables (helplessness and belief of control) were taken. Analysis indicated a significant reduction occurred in general intensity of pain and in EMG activity as well as a significant increase in muscular sensitivity. Multiple regression analyses indicated that the increase in muscular sensitivity correlated with the decrease of EMG activity in the trapezius baseline. Self-reported pain reduction was predicted by a change in cognitive variables.

Proprioception in somatoform disorders.

20 patients with somatoform disorders as defined by DSM-IV and 20 healthy controls were examined for their proprioception. Several psychophysiological theories of somatoform disorders suggest biased proprioceptive abilities. The primary question is, whether we may find an inaccurate myogen perception in somatization as suggested by the approach of Bischoff or a more precise proprioception as may be derived from concepts of a higher awareness of body reactions. Furthermore it is expected, that somatoform patients perceive their muscle tension more intensely than do healthy subjects. Proprioceptive abilities were tested using a visual EMG biofeedback task. Resulting objective data and subjective ratings were analyzed within a psychophysiological regression approach which allows one to estimate the reliability, precision and intensity of proprioception. Results revealed that somatoform subjects demonstrated a more precise but not a more intense perception of muscle tension than did healthy controls.

On specific behavior of migraine patients in an anger-provoking situation.

SYNOPSIS

Biofeedback of baroreflex sensitivity in patients with mild essential hypertension

An attempt was made to reduce blood pressure by increasing the baroreflex sensitivity (BRS) via biofeedback. Six patients with mild essential hypertension and 5 normotensive participants were studied during 8 biofeedback sessions. Each session consisted of 5 trials, 5 min each. The first and the last trials served as baselines of heart rate, blood pressure, respiration, and BRS. During the3 middle trials the BRS was calculated online using the sequencing technique. The resulting value was used as a visual analogue feedback signal. Participants were asked to increase BRS. The mean BRS was 8.3 [ms/mmHg] for the hypertensive patients and 12.2 [ms/mmHg] for the normotensive participants. During biofeedback trials as well as across sessions neither the hypertensive nor the normotensive group showed a statistically significant increase of BRS, only heart rate variability increased significantly. Contrary to expectation blood pressure increased in both groups. One hypertensive subject made significant progress during the training by performing valsalva maneuvers.The data show that BRS is reduced in hypertensive subjects. The increase of the heart rate variability could be a sign of the activation of the baroreflex although the BRS itself did not increase. Despite the successful technical and organizational im plementation of this biofeedback approach, it was not effective to systematically reduce blood pressure. A further development in the direction of guiding the patient to use the valsalva breathing pattern and/or a prolonged duration of the biofeedback training might be promising.

Implicit memory for auditorily presented threatening stimuli: a process-dissociation approach.

The investigation of unconscious cognition involves especially problems with the methodology of measuring implicit and explicit proportions of different task performances. In this study the process dissociation procedure of Jacoby and its modification within the multinomial modelling framework for an indirect word-nonword-discrimination task is applied to a sample of 45 healthy students. The paradigm includes acoustically presented stimuli. During a learning phase, subjects listened to a series of neutral and threatening words. Performance was tested by letting subjects decide whether a presented stimulus (masked with white noise at signal-noise ratio of −17dB or unmasked) had been a word or a nonword. Within this paradigm, implicit cognition occurs when (a) a word is more probably correctly recognized as “word” after presentation during the learning phase (typical priming effect) or when (b) a nonword derived from a word is more probably falsely recognized as “word” after its corresponding word had been presented during the learning phase (effect of implicit cognition given perceptual fluency). Frequencies for hits and false alarms were analyzed within the multinomial model which allows estimating parameters for the correct discrimination of words (c), the response bias (b), the classical priming effect (u1), and the parameter for the priming effect of “old” nonwords (u2). Under masked stimuli the multinomial model showed implicit cognition, an effect not equally found for neutral and threatening words. Threatening words exhibited a significantly higher portion of implicit cognition than neutral ones. Given the statistical complexity of multinomial models, the application of this method was explained in detail.

Wie wirkt Expressives Schreiben? Differenzielle Wirkfaktoren des Schreibens über belastende Lebensereignisse

Hintergrund: Bisherigen Forschungsarbeiten zufolge kann die Bewältigung belastender Ereignisse durch das Aufschreiben stressbezogener Gedanken und Emotionen unterstützt werden. So wurden im Paradigma des Expressiven Schreibens [Pennebaker und Beall, 1986] trotz des geringen Aufwandes dieser Intervention positive Effekte auf verschiedene Aspekte psychischer und physischer Gesundheit berichtet. Die genauen Wirkmechanismen des Expressiven Schreibens sind jedoch noch nicht hinreichend geklärt. Probanden und Methode: In der vorliegenden Untersuchung wurde an einer Stichprobe von N = 53 Probanden in einem experimentellen, 2×2-faktoriellen Design mit Messwiederholungsfaktor geprüft, ob das mehrmalige gefühlsaktivierende Schreiben über belastende Ereignisse positive Auswirkungen auf die abhängigen Maβe Befindlichkeit, Depressivität und Belastungssymptomatik hat. Auβerdem wurde untersucht, inwieweit Veränderungen in Emotionsregulationsprozessen oder der Selbstwirksamkeitserwartung mit den Auswirkungen auf die abhängigen Maβe in Zusammenhang stehen. Ergebnisse: Die Ergebnisse dieser Arbeit deuten darauf hin, dass das Expressive Schreiben einen positiven Einfluss auf Übererregungssymptome und die Häufigkeit negativer Stimmung hat, jedoch keine Veränderung bewirken kann hinsichtlich des positiven Affekts oder Depressivität. Die Konstrukte Selbstwirksamkeitserwartung oder Strategien zur Emotionsregulation können nicht als Wirkmechanismen identifiziert werden, jedoch stellt sich die wahrgenommene Intensität der Schreibsitzungen als Mediator heraus. Schlussfolgerung: Expressives Schreiben wirkt in spezifischerem Ausmaβ auf das Belastungserleben ein als bisher angenommen wurde. Die Ergebnisse deuten auf Exposition als Wirkfaktor hin.

Multimethodale Schmerzmessung mit Hilfe des Pain Perception Profile von Tursky bei Patienten mit progressiv-systemischer Sklerose

Turskys pain perception profile [16] has been revised and adapted for use in German-speaking conditions, and this new modification is presented. It integrates six different methods of clinical and experimental methods of clinical and experimental pain measurement, which are intended to meet the enhanced demands put forward in pain research for multivariate measurement of pain by a variety of methods. The methods used are: (1) classification of three pain-related descriptive statements as they apply to the individual case; (2) use of these descriptive statements to keep a record in the form of a pain diary; (3) experimental determination of thermal pain thresholds; (4) determination of the behavior expressing the perception of thermal pain; (5) determination of sensitivity to pain by means of a standardized system for the estimation of the magnitude of thermal stimuli; and (6) in parallel with determination of the pain threshold and estimation of the magnitude of the stimulus, derivation of peripheral physiological parameters and the formulation of conclusions about the individuals way of handling pain. The various methods of investigation are presented, and results obtained with them in patients with chronic pain and in healthy volunteers are compared. The results document the many aspects of chronic pain and the necessity for multimodal measurement. In addition, they supply a means of achieving a better pain-related classification of pain patients on an experimental basis.Tursky’s pain perception profile [16] has been revised and adapted for use in German-speaking conditions, and this new modification is presented. It integrates six different methods of clinical and experimental methods of clinical and experimental pain measurement, which are intended to meet the enhanced demands put forward in pain research for multivariate measurement of pain by a variety of methods. The methods used are: (1) classification of three pain-related descriptive statements as they apply to the individual case; (2) use of these descriptive statements to keep a record in the form of a pain diary; (3) experimental determination of thermal pain thresholds; (4) determination of the behavior expressing the perception of thermal pain; (5) determination of sensitivity to pain by means of a standardized system for the estimation of the magnitude of thermal stimuli; and (6) in parallel with determination of the pain threshold and estimation of the magnitude of the stimulus, derivation of peripheral physiological parameters and the formulation of conclusions about the individual’s way of handling pain. The various methods of investigation are presented, and results obtained with them in patients with chronic pain and in healthy volunteers are compared. The results document the many aspects of chronic pain and the necessity for multimodal measurement. In addition, they supply a means of achieving a better pain-related classification of pain patients on an experimental basis.ZusammenfassungEine revidierte und für deutschsprachige Verhältnisse adaptierte Form des Pain Perception Profile von Tursky [16] wird beschrieben. Es handelt sich dabei um eine Kombination von sechs unterschiedlichen Methoden zur klinischen und experimentellen Schmerzmessung, mit denen die in der Schmerzforschung erhobenen Forderungen nach multimethodaler und multivariater Schmerzmessung erfüllt werden sollen. Es sind dies folgende Methoden: (1.) Die einzelfallbezogene Skalierung von drei schmerzbezogenen Deskriptorsätzen und (2.) die Anwendung dieser Deskriptoren in einem Schmerztagebuch. Experimentell werden (3.) thermische Schmerzschwellen bestimmt und (4.) das dabei gezeigte Ausdrucksverhalten registriert. Mittels einer standardisierten (5.) Größenschätzung thermischer Stimuli wird die Schmerzsensitivität bestimmt; parallel zu der Schwellenmessung und der Größenschätzung werden (6.) peripher-physiologische Parameter abgeleitet und daraus Rückschlüsse auf die Schmerzverarbeitung gezogen. Die einzelnen Untersuchungsmethoden werden dargestellt und einige der mit ihnen für chronische Schmerzpatienten (progressiv-systemische Sklerose) und Gesunde erhobenen Befunde werden miteinander verglichen. Die Ergebnisse belegen den Aspektreichtum des chronischen Schmerzes und die Forderung nach multimethodaler Messung. Darüber hinaus liefern sie Möglichkeiten, auf experimenteller Grundlage eine verbesserte schmerzbezogene Klassifizierung von Schmerzpatienten vorzunehmen.

Zur faktoriellen und kriterienbezogenen Validität des Fragebogens zur Psychotherapiemotivation (FPTM40)

Zusammenfassung. Die faktorielle und kriterienbezogene Validitat der Kurzform des Fragebogens zur Psychotherapiemotivation FPTM40 wurde an einer Stichprobe von 96 ambulanten und stationaren Psychotherapie-Patienten faktorenanalytisch und korrelations- bzw. regressionsstatistisch uberpruft. Die Analyse der kriterienbezogenen Validitat erfolgte anhand von Kennwerten des Inanspruchnahmeverhaltens (bisherige Behandlungserfahrungen, Anzahl therapeutischer Ziele, Lange der Therapie) und des Therapieerfolgs (Symptomreduktion, Grad der Erreichung therapeutischer Ziele). Die Ergebnisse zur faktoriellen Validitat stutzen im Gegensatz zu der von Schulz, Nubling und Ruddel (1995) berichteten 6-faktoriellen eine 5-faktorielle Losung. Die Ergebnisse zur kriterienbezogenen Validitat liefern nur wenige Hinweise auf substanzielle Beziehungen der FPTM40-Skalenwerte zum Inanspruchnahmeverhalten oder zum Therapieerfolg. Die Ergebnisse begrunden Zweifel an der Eignung des Verfahrens fur die selektive Indikation.

Functional irregularities of short-term and long-term memory storage in patients with Parkinson's disease and Huntington's disease

Memory performance of Parkinsons disease patients (PD patients). Huntingtons disease patients (HD patients) and healthy subjects were compared by a single-trial free recall task following the presentation of a stimulus list consisting of 30 nouns. The patient groups were categorized according to the severity of the disease into mild, moderate, and severe. Healthy subjects reproduced significantly more words than PD and HD patients, while the two patient groups did not differ in the total number of words reproduced. The differences between healthy and demented subjects are attributed to the impaired functional capacity of long-term memory; there were significant differences between healthy subjects and patients as well as between PD and HD patients. When taking the severity of the disease into consideration, varied influence on the capacity of long-term memory for PD and HD patients was found. Concerning short-term memory, neither a difference between healthy subjects and patients nor between both patient groups could be established. An effect of the severity of the disease could not be proven.

Helen Mayberg: «Therapieresistente Depression kann durch Tiefenhirnstimulation beeinflusst werden»

Helen Mayberg ist Professorin an den Abteilungen für Psychiatrie und Verhaltenswissenschaften sowie Neurologie an der Emory University School of Medicine in Atlanta, Georgia, USA. Als Neurologin hat sie sich mit ihren Studien zu Netzwerkmodellen von psychischen Störungen einen Namen im Bereich der neuropsychiatrischen Forschung gemacht. Ihre Erkenntnisse haben dazu geführt, dass mit der Tiefenhirnstimulation (oder engl. deep brain stimulation, DBS) eine neuartige Methode zur Reizung von Gehirnregionen entstanden ist, die bei Patientinnen und Patienten mit therapieresistenter Depression zur Anwendung kommt. Das Gespräch führte Dr. Urs Nater, Oberassistent am Lehrstuhl für Klinische Psychologie und Psychotherapie an der Universität Zürich.