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The study is an initial investigation of the feasibility of applying Bayesian sequential analyses to individual participant single-case data for rapid detection of whether or not the individual is benefitting from a low-intensity computerized cognitive training intervention for depression. Patients waiting for, or in follow-up from, outpatient psychological therapy will complete first a two-week period of daily symptom monitoring, followed by two different two-week cognitive training interventions. Data collected will be used to assess feasibility of a future formal case series using Bayesian sequential analyses to determine switching of interventions, and inform the analysis parameters for such a future study.

Background Interpretation biases (IBs) are central in panic disorder, and there is rich evidence showing that these are correlated with and predictive of panic-relevant symptomatology. However, experimental studies are needed to examine the potential causal effects of IBs, as predicted by cognitive models. Methods Panic-related IBs were manipulated via a sentence-completion Cognitive Bias Modification-Interpretation (CBM-I) training. The sample included N = 112 healthy participants reporting moderate levels of fear of bodily sensations. Participants were randomly allocated to a positive, negative, or control CBM-I condition. To test the trainings’ effect on panic-relevant cognitive processing, IBs were assessed via proximal and distal measures. Symptom provocation tasks were applied to test transfer to panic-relevant symptomatology. Results Results on the proximal measure showed that positive CBM-I led to more positive IBs compared to negative, and control training. Further, positive CBM-I led to more positive IBs on the distal measure as compared to negative CBM-I. However, there were no differential training effects on panic-related symptomatology triggered via the provocation tasks. Conclusion The findings indicate a limited generalization of the effects of CBM-I on IBs and panic-related symptoms. Potential means to improve generalization, such as applying more nuanced measures and combining CBM-I with psychoeducation are discussed.

Hintergrund: Ziel der vorliegenden Studie war die Überprüfung der Interrater-Reliabilität, Validität und Akzeptanz des DIPS Open Access 1.2 (DIPS-OA1.2) in einer Gelegenheitsstichprobe aus der Allgemeinbevölkerung. Methode: Sieben DIPS-zertifizierte Psychologinnen (B.Sc.) führten 144 Interviews durch. Anschließend wurden die durch die Interviewerin gestellten Diagnosen mit denen einer Gegenko­diererin verglichen. Außerdem füllten die Proband:innen nach dem Interview eine Fragebogenbatterie aus. Ergebnisse: Die Ergebnisse sprechen für eine gute bis sehr gute Interrater-Reliabilität aller überprüfbaren Oberklassen und Störungskategorien mit Ausnahme der früheren Diagnosen der Generalisierten Angststörung und der depressiven Störung aufgrund eines anderen medizinischen Krankheitsfaktors. Außerdem deuten die Ergebnisse auf eine gute Validität der Oberklasse Angststörungen sowie eine hohe Ak­zeptanz des DIPS-OA1.2 hin. Schlussfolgerungen: Die Ergebnisse der vorliegenden Studie sind vergleichbar mit denen der Studien zu den Vorgängerversionen des DIPS und deuten auf eine gute Reliabilität, Validität und Akzeptanz des DIPS-OA1.2 in einer Gelegenheitsstichprobe aus der Allgemeinbevölkerung hin. Vor diesem Hintergrund lässt sich festhalten, dass sich das DIPS-OA1.2 insbesondere auch für epidemiologische Studien eignet.

BACKGROUND: Euthymia has been described as a transdiagnostic construct characterized by the absence of mood disturbances and the presence of an integration of psychic forces, such as coping strategy and well-being. A multidimensional measure, the Euthymia Scale (ES), has been proposed to assess it. We investigated construct and concurrent validity of the ES.METHODS: Construct validity was studied via Rasch and Mokken analyses and compared with that of the 11-item Resilience Scale (RS-11) and 9-item Positive Mental Health Scale (PMH-Scale). A total of 951 participants were recruited (77.5% women; 24.86 ± 5.62 years).RESULTS: The ES, RS and PMH demonstrated similar sensitivity and construct validity. Findings indicate minor needs for adjustments only. As expected the ES demonstrated a strong negative correlation with neuroticism.LIMITATIONS: The convenience sample of subjects recruited primarily from female Italian university students and a community-based data collection limit the generalizability of the present findings. The cross-sectional design precludes the assessment of test-retest reliability, predictive and incremental validity. Only self-report measures and a Likert version of the ES were used.CONCLUSIONS: ES is the most comprehensive measure of euthymia. The RS-11 is a valid measure of a specific component of euthymia, namely subjective ability to cope with stress and empower well-being in face of life adversities. The PMH-Scale is a valid measure of overall positive mental health.

Background According to major cognitive accounts of panic disorder, bodily sensations can lead to automatic activation of an associative fear network, potentially triggering a cascade of cognitive, emotional, and physiological responses culminating in a panic attack. However, the evidence for the automatic associations assumed by these models is mixed. This may reflect the heterogeneous nature of panic disorder, in that the relative importance of different bodily sensations and symptoms varies between individuals. The current study aimed to test this possibility via measuring the associations between three different sets of panic symptoms (cognitive, respiratory, cardiac) and scores on three symptom-specific single target implicit association tests (STIATs). Methods A total of 226 unselected female participants aged 18–35 completed the STIATs as well as questionnaires assessing panic symptoms and related measures in a web-based study. Results Only limited evidence was found to support the idea of specific associations between STIAT stimuli sets and their related panic symptoms. Exploratory analyses indicated that there were only associations between STIAT scores and panic-relevant questionnaires amongst those participants who had experienced a panic attack in the previous 6 months. Conclusions The results have implications for measuring panic-relevant associations and understanding their role in panic disorder.

Introduction: The corona pandemic has been a life event causing negative consequences on mental health. Mental health consists of positive and negative dimensions. The present longitudinal study investigated how positive and negative dimensions changed over 15 months after the Covid-19 outbreak. Potential changes of excessive social media use (SMU) and its relationship with mental health were also investigated. Method: Data (N = 189) on distress (measured overall and as depression, anxiety, and stress), well-being and excessive SMU were collected at three time points (baseline, BL; 3-month follow-up, FU1; 15-month follow-up, FU2) via online surveys in Italy. Repeated analyses of variance were used to test differences among the three measurement time points. Mediational models were applied. Results: Distress did not change over time, well-being decreased and excessive SMU increased significantly. The relationship between distress at BL and excessive SMU at FU2 was significant (total effect, c: p

Individual responses to behavioral treatment of anxiety disorders vary considerably, which requires a better understanding of underlying processes. In this study, we examined the violation and change of threat beliefs during exposure. From 8,484 standardized exposure records of 605 patients with different anxiety disorders, learning indicators were derived: expectancy violation as mismatch between threat expectancy before exposure and threat occurrence, expectancy change as difference between original and adjusted expectancy after exposure, and prediction-error learning rate as extent to which expectancy violation transferred into change. Throughout sessions, high threat expectancy but low occurrence and adjusted expectancy indicated successful violation and change of threat beliefs by exposure. Expectancy violation, change, and learning rate substantially varied between patients. Not expectancy violation itself, but higher learning rate and expectancy change predicted better treatment outcome. Successful exposure thus requires expectancy violation to induce actual expectancy change, supporting learning from prediction error as transdiagnostic mechanism underlying successful exposure therapy. Bundesministerium für Bildung und Forschung https://doi.org/10.13039/501100002347

Modern conceptualizations suggest the independence of positive and negative mental health constructs. Research of positive constructs in psychotherapy is scarce. This study analyzed the development of patients' strengths during psychotherapy and whether pre-therapy strengths incrementally predict treatment outcome.Two hundred and two patients (56.44% female, mean age = 42.49) treated by 54 therapists underwent cognitive behavioral therapy. Patients' strengths in different contexts as well as psychopathology, interpersonal problems, and self-esteem were assessed at the beginning and end of therapy.Strengths increased in the contexts of everyday life (EvdayS; d = 0.44, p 0.001) and current problems (ProbS; d = 0.70, p 0.001). Strengths in the context of previous crises that were managed successfully (CrisesS) did not change. However, baseline scores of CrisesS were a significant incremental predictor of all outcomes.A differentiated assessment of positive constructs is useful for outcome prediction and the implementation of strength-based interventions.

Background Dysfunctional appraisals are a key mechanism in posttraumatic stress disorder (PTSD). Experimental manipulations of appraisals via Cognitive Bias Modification-Appraisal (CBM-App) training targeting cognitions related to the ‘self’ has shown to affect analog trauma symptoms. The present study aimed to conceptually replicate and extend previous findings by comparing a newly developed ‘world’ to the original ‘self’ training, and investigate the moderating role of locus of control (LOC) on intrusions. Methods Healthy participants (N = 173) were exposed to distressing films as an analog trauma induction. Next, participants received positive or negative CBM-App, targeting either self- or world-relevant appraisals. Dysfunctional appraisals and LOC were assessed pre- and post-training. During the week after the laboratory session, participants recorded their intrusions and associated distress in a diary. One week later, trauma-relevant symptomatology was assessed. Results Positive compared to negative CBM-App induced training-congruent appraisals, independent of the trained cognition (self vs. world). However, there was no effect on analog trauma symptoms and LOC did not moderate the training’s effect. Conclusions Our results underline the validity of CBM-App as a method to experimentally manipulate appraisals. However, since we did not fully replicate previous findings further research on mechanisms associated with transfer effects is warranted.

Evidence for a genetic influence on psychological treatment outcome so far has been inconsistent, likely due to the focus on candidate genes and the heterogeneity of the disorders treated. Using polygenic risk scores (PRS) in homogenous patient samples may increase the chance of detecting genetic influences. A sample of 342 phobic patients treated either for clinically relevant dental fear (n = 189) or other (mixed) phobic fears (n = 153) underwent highly standardized exposure-based CBT. A brief five-session format was used to treat dental fear, whereas longer multi-session treatments were used with the mixed-fear cohort. PRS were calculated based on large genetic studies of Neuroticism, Educational Attainment (EA), Intelligence, and four psychopathology domains. We compared PRS of post-treatment and follow-up remitters and non-remitters and regressed PRS on fear reduction percentages. In the dental fear cohort, EA PRS were associated with treatment outcomes, i.e. drop-out, short- and long-term remission state, fear reduction, and attendance of subsequent dental appointments. In the mixed fear treatment cohort, no gene effects were observable. Results indicate the importance of EA-related traits for outcomes following brief, but not long, standardized exposure-based CBT. Such use of PRS may help inform selection and tailoring of treatments.

Repetitive negative thinking (RNT) and addictive Facebook use have been shown to be associated with suicide ideation and suicidal behavior. The present longitudinal study aimed to investigate whether the association between addictive Facebook use and suicide-related outcomes is mediated by RNT. Data of 191 German Facebook users (Mage = 26.17, SDage = 6.63) were assessed at two measurement time points over a one-year period (first measurement = T1, second measurement = T2) via online surveys. The significant positive association between addictive Facebook use (T1) and suicide-related outcomes (T2) was significantly mediated by RNT (T1). In contrast, a check test that included RNT (T1) as predictor and addictive Facebook use (T1) as mediator revealed no significant mediation effect. The current results demonstrate that if addictive Facebook use leads to RNT suicide ideation and attempts become likely. Therefore, RNT and addictive Facebook use should be taken into account when assessing individuals for risk of suicide.

This study assesses how participants who have been treated for different phobic fears (spider fear, dental fear, blood-injury-injection fear, fear of heights, fear of flying, contamination fear, panic disorder with agoraphobia) with highly standardized exposure based fear treatments cope with the COVID-19 pandemic. Moreover, it aims to identify links between coping with the COVID-19 pandemic, long-term treatment outcome and their genetic disposition.

The systematic review derived from a multilab collaborative effort and will summarize the available evidence from analog experiments on the effect of post-exposure sleep on (a) intrusion frequency and (b) intrusion-related stress. For this purpose, we will summarize findings based on controlled studies comparing post-exposure sleep versus wakefulness by means of a meta-analysis of aggregated data and based on an individual participant data meta-analysis following a one step approach. Previous findings point in opposite directions and suggest both, a harmful and protective effect of post-exposure sleep. We aim to explain these divergent findings and to examine participant level moderators of the effect of sleep versus wakefulness / sleep deprivation on intrusive memories of analog trauma.

Pre-registration for the study "Feasibility randomized controlled trial using a ‘leapfrog’ design: optimizing an internet-delivered cognitive training intervention to reduce anhedonia".

Background The Sexual Interest and Desire Inventory-Female (SIDI-F) is a clinician-administered scale that allows for a comprehensive assessment of symptoms related to Hypoactive Sexual Desire Dysfunction (HSDD). As self-report questionnaires may facilitate less socially desirable responding and as time and resources are scarce in many clinical and research settings, a self-report version was developed (Sexual Interest and Desire Inventory- Female Self-Report; SIDI-F-SR). Aim To assess the psychometric properties of the SIDI-F-SR and to investigate the agreement between the SIDI-F and SIDI-F-SR. Methods A total of 170 women (Mage = 37, SD = 11, range = 20−69) with HSDD answered the SIDI-F, administered by a clinical psychologist via telephone, first, followed by the SIDI-F-SR, delivered as an Internet-based questionnaire. A subset of 19 women answered the SIDI-F-SR twice over a period of 14 weeks. Outcomes Convergent validity of the SIDI-F-SR was assessed via correlations with the desire subscale of the Female Sexual Function Index and the Female Sexual Distress Scale Revised. Internal consistency and test-retest reliability as well as intraclass correlation and predictors of absolute agreement between SIDI-F and SIDI-F-SR were examined. Results Test-retest-reliability was good (r = 0.74). Convergent validity was low but comparable between SIDI-F and SIDI-F-SR. Internal consistency of the SIDI-F-SR was acceptable (α = 0.76) and comparable to the SIDI-F (α = 0.74). When corrections for the restriction of range were applied, internal consistency of the SIDI-F-SR increased to 0.91. There was high agreement between SIDI-F and SIDI-F-SR (ICC = 0.86). On average, women scored about one point higher (indicated more desire) in the self-report vs the clinician-administered scale. Clinical Implications The SIDI-F-SR can be used in settings where time and resources are limited. Whether the clinical cutoff point for the SIDI-F is adequate for the SIDI-F-SR has yet to be determined. Strengths and limitations Large sample of diverse women with HSDD. Lack of control groups (ie, healthy controls, women with other sexual dysfunctions). Conclusion The SIDI-F-SR showed promising psychometric properties in a sample of women with HSDD. Velten J, Hirschfeld G, Meyers M, et al. Psychometric Properties of a Self-Report Version of the Sexual Interest and Desire Inventory-Female (SIDI-F-SR). J Sex Med 2021;18:990–995.

Background Visual attention to sexual stimuli is an important means to facilitate sexual arousal and is thereby relevant for healthy sexual functioning. Experimental studies suggest that sexual dysfunction is associated with less attention toward sexual stimuli. Aim The goal of this study was to use an eye-tracking-based free-viewing paradigm to investigate whether women in the clinical range of sexual function attend to a genital area in visual sexual stimuli differently than women with subclinical sexual function or those with normal sexual functioning. Methods Toward this goal, 69 women (Mage = 27.77, SD = 8.00, range = 19–54) with clinical (n = 30), subclinical (n = 23), and normal (n = 16) levels of sexual functioning watched a series of 10 pictures depicting heterosexual couples during vaginal intercourse while their eye movements were recorded. Each picture was presented twice—once with a distracting object (eg, a to-do list or household appliance) present in the picture and once without—for 8 seconds, each. Outcomes 5 eye-tracking measures indicative of different aspects of initial and sustained attention were analyzed. Results As hypothesized, 3 out of 5 eye-tracking measures (ie, first fixation duration, number of first fixations, and total fixation duration) indicated that women in the clinical group attended less to the genital area in the pictures than women with normal sexual functioning. For 2 indices (ie, first fixation duration and total fixation duration), women with subclinical (vs normal) sexual functioning also attended less to the genital area. In contrast to our hypothesis, the presence of a distracting object did not influence attention to the genital area in either of the sexual function groups. Clinical Implications This study provides further evidence of the role of attentional biases in sexual dysfunction in women. Strengths and Limitations Eye-tracking methodology allows for a continuous measurement of visual attention; this is one of the first studies using this methodology to assess differences in visual attention in women with and without sexual dysfunction. However, the cross-sectional nature of this study prevents causal interpretation of findings. Conclusion Future studies should use experimental paradigms to determine the causal role of visual attention for the development or maintenance of sexual dysfunction. Velten J, Milani S, Margraf J, et al. Visual Attention to Sexual Stimuli in Women With Clinical, Subclinical, and Normal Sexual Functioning: An Eye-Tracking Study. J Sex Med 2021;18:144–155.

Contrary to the well-documented link between parental and offspring clinical anxiety, little is known about the relationship between parental everyday-life anxieties (e.g., concerning family, finances, health) and offspring anxieties. To close this gap, we assessed the frequency of parental symptoms of DSM-IV anxiety disorders and everyday-life anxieties, as well as the frequency of offspring anxiety symptoms in a representative sample by self-report. Parents reported that 48.4% of the children were free of specific symptoms of DSM-IV anxiety disorders within the last 12 months, 39.2% showed low symptom load (1–3 symptoms) and 12.4% were moderately or severely strained (4–10 symptoms). Replicating previous studies, parental DSM-IV symptoms increased offspring risk for the same symptoms. In addition, parental everyday-life anxieties showed a positive relationship with offspring symptom severity. Demographic variables (female sex, low socioeconomic status and younger age) and parental anxiety markers explained 18% of variance in offspring symptom severity. The data are discussed in light of current models of familial transmission.

Abstract. Background: Stressful life events and suicide ideation regularly occur together. Yet, little is known about factors that buffer individuals against the development of suicide ideation. Aim: In a long-term follow-up study design, it was investigated whether positive mental health, that is, high levels of subjective and psychological well-being, buffers the association between stressful life events and suicide ideation. Method: A total of 126 German students (80.2% female; age: M = 24.29, SD = 5.21) were assessed at a baseline evaluation and again 24 months later. Data were collected using self-report questionnaires. Results: Linear hierarchical regression analysis was used to analyze the data. Positive mental health was considered to moderate the impact of stressful life events on suicide ideation – controlling for age and gender. Limitations: Current results are limited to university students. Conclusions: Positive mental health interacts with stressful life events, such that those with high levels of positive mental health show an attenuated increase in suicide ideation at elevated levels of stress. Positive mental health seems to confer resilience and should be focused on in counseling centers for students.

Anxiety disorders (ADs) are characterized by increased chronicity and comorbidity with other ADs. Although exposure is the most effective therapy option for ADs, some patients show poor treatment response and a heightened vulnerability for relapse after treatment completion. Hence, significant research effort needs to be devoted to improve the long-term effectiveness of exposure effects. Recent attempts to increase exposure therapy efficacy use strategies aimed at promoting the acquisition and retrieval of extinction memories. The present review illustrates the value and limitations of such extinction-based therapy approaches. We present and discuss recent findings from translational studies using cortisol and self-efficacy enhancement as an add-on to exposure therapy. We illustrate how the integration of findings from experimental research on fear extinction learning and self-efficacy could advance the development of more optimized treatments for ADs.

Affective styles appear to be relevant to the development of psychopathology, especially anxiety disorders. The aim of the current study was to investigate changes in affective styles in patients with panic disorder and specific phobia, as a result of undergoing cognitive-behavioral therapy, and to identify a possible link between certain affective styles and remission. The sample consisted of outpatients (N = 101) suffering from panic disorder, specific phobia, or agoraphobia who completed the Affective Style Questionnaire (ASQ) before and after therapy, as well as at a 6-month follow-up assessment. Multivariate analyses of variance were conducted to test for changes due to therapy. Logistic regression analyses were calculated to test for the impact of affective styles on remission from anxiety disorders, and hierarchical regression analyses were calculated to examine the association between changes in affective styles and symptom reduction. Results indicated significant increases on the ASQ subscales adjusting and tolerating after therapy. Concealing did not decrease significantly after therapy. In addition, higher scores on adjusting significantly predicted remission from anxiety disorders. Finally, we found a significant association between increases on the adjusting scale and the reduction of anxiety symptoms.

Background Cognitive models of panic disorder (PD) highlight the role of panic-related associations and interpretations. However, results are mixed and rely on specific measures. This study examined panic-related associations and interpretations using established and new paradigms in individuals varying on anxiety sensitivity (AS). Methods Associations were measured using a priming task and a novel Single Target Implicit Association Test (STIAT); interpretations were assessed using the Interpretation Bias Questionnaire (IBQ) and a novel Scrambled Sentences Task (SST). Symptoms were assessed via a provocation task (Straw Breathing Task, SBT). Results Panic-related interpretations correlated with AS and other PD-related measures. Of the association tasks, only the priming task correlated with one of the other PD-related measures. Panic-related interpretations assessed via the SST, but not priming, STIAT, and IBQ, predicted SBT reactivity. The relationship between AS and SBT reactivity was mediated by panic-related interpretations. Conclusions Our data provide support for panic-related interpretations as an important cognitive mechanism.

Cross-culturally measurement invariant instruments are useful for the assessment of mental symptoms across cultures. The current study aimed to investigate the psychometric properties and measurement invariance of the Depression, Anxiety and Stress Scales (DASS-21) (DASS) across Pakistan and Germany. German participants were recruited through an online survey (N = 1323), while Pakistani participants were recruited through online survey or paper-and-pencil survey (N = 1841). The DASS-21 showed good reliability, construct and structure validity in both countries. The DASS-21 indicated partial weak (stress subscale) and partial strong measurement invariance (depression and anxiety subscales) between both countries. Latent mean comparison of depression and anxiety symptoms between Pakistani and German students indicated that Pakistani university students experience more symptoms of depression and anxiety. Results suggest that the DASS-21 could be used in Pakistan and Germany, but caution should be taken when making direct comparisons between the two countries.

Adjustment disorder is among the most diagnosed mental disorders worldwide. However, until recently adjustment disorder was largely neglected in mental health research. Therefore, factors associated with adjustment disorder are highly understudied. The current study aimed to reveal the role of positive mental health (PMH) as a protective factor in the development of adjustment disorder symptoms when exposed to life stressors in young adulthood. Furthermore, the study looked at whether overall PMH plays a unique role when linking life stressors and adjustment disorder symptoms, or whether its role is comparable to that of subjective well-being (SWB). The sample consisted of 299 university students (age: M (SD) = 20.53 (2.06); 35.7% female). A structural equation modelling approach was used for data analysis. The results indicated that facing more life stressors over the last 12 months was related to lower levels of PMH and SWB. However, higher levels of PMH, but not SWB, were significantly linked to lower levels of adjustment disorder symptoms. The findings of the current study suggest that in emerging adulthood when young people face many challenges, promoting positive mental health may be an important step when fighting against the development of mental problems.

Great interest exists in maximizing exposure therapy efficacy in anxiety disorders. At the same time, reduced frequency and shortened duration of exposure sessions are required to meet the specific regularities in routine care settings. Extinction has emerged as the key mechanism of exposure treatment in anxiety disorders. Examining exposure treatment processes from the perspective of extinction learning might provide novel insights into variability in exposure treatment duration and outcome. The present study sought to examine the functional link between fear extinction, the ability to accomplish exposure in a predetermined time and exposure therapy outcome in specific phobia. Treatment-seeking individuals (N = 53) with spider phobia underwent a context-dependent fear conditioning paradigm prior to a standardized exposure. Spider-phobic participants who were able to complete exposure within the pre-determined time (i.e., completers) showed a more pronounced short- and long-term exposure therapy benefit. In the fear conditioning task, a more pronounced decline in CS-US contingency ratings during extinction (retrieval) was found in completers relative to non-completers. The failure to further extinguish US expectancy to the CSs in non-completers might offer a potential mechanistic explanation why non-completers have difficulties to accomplish all exposure steps in a fixed time and show less pronounced treatment gains. Our findings bear specific implications for the implementation of exposure treatment to routine care settings.

Obwohl heute für die meisten psychischen Störungen über die gesamte Lebensspanne hinweg wirksame psychotherapeutische Behandlungsangebote zur Verfügung stehen, besteht immer noch eine zu große Variabilität in Bezug auf den kurz- und langfristigen Erfolg solcher Interventionen. Das Feld der Therapiegenetik beschäftigt sich mit der Vorhersage des Erfolges psychotherapeutischer Behandlungen durch genetische oder epigenetische Marker. Dabei wird das Ziel verfolgt, zukünftig psychotherapeutische Interventionen auf der Basis solcher Marker individualisiert anzuwenden und dadurch die Effektivität der Behandlungsangebote weiter zu verbessern. In diesem Beitrag wird der aktuelle Stand der Forschung in diesem Feld dargestellt, methodologische Herausforderungen skizziert und die Entwicklung der noch jungen Disziplin, ausgehend von theoriegeleiteten Kandidatengenstudien, hin zu hypothesenfreien genomweiten Assoziationsstudien und der Verwendung polygener Risiko-Scores, nachgezeichnet. Der zweite Abschnitt dieses Übersichtsartikels widmet sich epigenetischen Prozessen und diskutiert kritisch erste Befunde, die sich mit Modifikation von DNA-Methylierungsmustern im Zuge psychotherapeutischer Intervention beschäftigen. Although effective psychotherapeutic treatment is now available for most mental disorders throughout the life span, there is still large variability in the short and long-term success of such interventions. The field of therapygenetics is concerned with predicting the success of psychotherapeutic treatments using genetic or epigenetic markers. The long-term goal is to individualize future psychotherapeutic interventions on the basis of such markers to further improve the effectiveness of treatment options. In this review, we present the current state of research, outline methodological challenges, and trace the development of this still young discipline from theory-based candidate gene studies to hypothesis-free genome-wide association studies. In the second part of this review, epigenetic processes are discussed, with a focus on recent studies investigating intervention-associated modifications of DNA methylation patterns.

Protective factors are relevant for mental health in general, however, universality of the instruments has been rarely tested. Therefore, the current study aimed to examine psychometric properties and cross-cultural measurement invariance of salutogenic constructs.Data was collected from university students of Pakistan (We found strong measurement invariance for the Positive Mental Health Scale, Life Satisfaction Scale, and partial strong measurement for the Resilience Scale, and Perceived Social Support Questionnaire.The results indicate that these scales could be recommended for the meaningful comparison of latent means across cultures. Understanding these differences would further advance our knowledge about the mechanism underlying positive mental health.Los factores de protección son relevantes para la salud mental en general. Sin embargo, la universalidad de los instrumentos ha sido raramente probada. Por lo tanto, el presente estudio tiene como objetivo examinar las propiedades psicométricas y la invariabilidad de las mediciones interculturales de constructos salutogénicos.Se recogieron datos de estudiantes universitarios de Pakistán (n = 1.841) y Alemania (n = 7.890). El análisis confirmatorio de un solo grupo (CFA) y el CFA de múltiples grupos fueron probados para examinar la estructura de factores propuesta y la invariabilidad de la medición de la Escala de Salud Mental Positiva, la Escala de Resiliencia, el Cuestionario de Apoyo Social Percibido y la Escala de Satisfacción de Vida a través de muestras de estudiantes de Pakistán y Alemania, respectivamente.Encontramos una fuerte invariancia en las mediciones de la Positive Mental Health Scale, la Life Satisfaction Scale, y una medición parcial fuerte en la Resilience Scale y el Perceived Social Support Questionnaire.Los resultados indican que estas escalas podrían recomendarse para la comparación significativa de los medios latentes entre culturas. La comprensión de estas diferencias aumentaría aún más nuestro conocimiento sobre el mecanismo que subyace a la salud mental positiva.

In the current study, we test for the specificity of deficits in fear acquisition and extinction for the anxiety disorders spectrum. We compared fear acquisition and fear extinction learning between a group of patients with either an anxiety disorder (n = 93) or depression (n = 103) attending for treatment in our outpatient center and a sample of healthy control participants (n = 60). To assess the specificity of the predictive validity of extinction learning and safety learning for the outcome of exposure-based treatments, patients additionally underwent disorder-specific cognitive behavior therapy (CBT). We found only very little evidence for differences in safety or extinction learning between healthy controls and patients with anxiety-disorders or depression using both a group-based categorical analytic approach, as well as a trans-diagnostic, dimensional analytic approach. On the contrary, for anxiety patients only, more favorable extinction learning and more favorable safety learning was associated with more favorable treatment outcome. In sum, this specific prediction of treatment outcome in anxiety patients confirms and extends current theoretical models of exposure-based treatments for anxiety disorders, but does not support the notion of general extinction learning deficits in the anxiety disorders spectrum.

Zusammenfassung. Theoretischer Hintergrund: Das BDI-II ist ein Selbstbeurteilungsinstrument zur Erfassung des Schweregrads einer Depression. Es liegen kaum Analysen mit Modellen aus der Item-Response-Theorie (IRT) vor. Fragestellung: Wie hoch ist die Messgenauigkeit des BDI-II über die unterschiedlichen Ausprägungen des latenten Traits (Depressivität) hinweg und sind die Kategorien der Items jeweils aufsteigend geordnet? Methode: Anhand von sechs großen Datensätzen aus verschiedenen klinischen Bereichen wurden psychometrische Analysen mit dem Graded Response Model durchgeführt. Ergebnisse: In allen Stichproben fand sich eine hohe interne Konsistenz. Die Schwellenwerte waren mit Ausnahme von Item 6 („Bestrafungsgefühle“) geordnet. Gemäß Testinformationsfunktion misst das BDI-II im mittleren bis hohen Depressionsbereich sehr gut (Reliabilität > .90) und im unteren Bereich gut. Schlussfolgerung: Für das BDI-II ergibt sich eine hohe und relativ gleichbleibende Messpräzision über einen weiten Bereich des latenten Traits, weshalb es insbesondere im klinischen, aber auch im nicht klinisch relevanten Wertebereich zur Erhebung des Schweregrades einer Depression gut geeignet ist., publishedVersion

Hormonal contraceptive use can aggravate existing symptoms of anxiety and depression and influence the response to pharmacologic treatment. The impact of hormonal contraceptive use on non-pharmacological treatment efficacy in anxiety disorders is less well explored. Oral contraceptives, which suppress endogenous sex hormone secretion, can alter fear extinction learning. Fear extinction is considered the laboratory proxy of exposure therapy in anxiety disorders. This study set out to examine whether oral contraceptive use is related to exposure-based treatment response in specific phobia. We recruited spider-phobic women (n = 28) using oral contraceptives (OC) and free-cycling women (n =26, No-OC). All participants were subjected to an identical in-vivo exposure. Exposure-based symptom improvement was assessed with several behavioral and subjective indices at pre-treatment, post-treatment and six-weeks follow-up. No–OC women showed higher pre-exposure fear levels on the FSQ and SPQ. OC women showed slightly less pronounced exposure benefit compared to their free-cycling counterparts (No-OC woman) as reflected by lower levels of fear reduction from pre-treatment to follow-up on the subjective level. After correction for multiple testing, OC and No-OC women showed differences in self-report measures (SPQ, FAS and SBQ) from pre- to follow-up treatment but not from pre-to post-treatment. These findings implicate that oral contraceptive use can account for differential exposure-based fear symptom improvement. Our study highlights the importance of monitoring and managing hormonal contraceptives use in the context of non-pharmacological exposure-based interventions.

Positive mental health (PMH), defined as the presence of general emotional, psychological, and social well-being is an important factor of general mental health. To allow for valid comparisons of PMH across different groups of interest, measurement invariant instruments are needed. The present study tested the measurement invariance of the nine-item Positive Mental Health Scale (PMH-Scale) across eight countries (i.e., France, Germany, Poland, Russia, Spain, Sweden, the United Kingdom, and the United States) as well as across genders, and age groups. Population-based online-panel surveys were conducted (N per country > 1,000). The PMH-Scale showed good to excellent internal consistency as well as unidimensionality in all subsamples. Convergent validity was supported by positive correlations with the Perceived Social Support Questionnaire (F-SozU K-6), discriminant validity was shown be negative correlations with the subscales of the Depression Anxiety Stress Scales 21 (DASS-21). The PMH-Scale showed scalar measurement invariance across countries, genders, and age groups. Comparisons of latent means showed small to medium group differences, with highest levels of PMH found in the French and US-American samples as well in participants between 45 and 54 years of age. Lowest levels of PMH were found in Russian participants. Gender differences in PMH were negligible. The PMH-Scale can be used to meaningfully compare the levels of PMH across the eight investigated countries, women, and men, as well as younger and older individuals. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

COVID-19-related burden has a significant impact on mental health and has led to an increase of depression, anxiety, and stress symptoms. Physical activity has been suggested to mitigate the negative effects of the pandemic and to foster mental health. The present study aimed to investigate, whether sense of control might mediate the supposed beneficial effects of physical activity on positive (PMH) and negative mental health (NMH) in unpredictable extraordinary situations. Data were assessed in a sample of 568 students (Mage = 19.90, SDage = 4.52) from Germany via an online survey in fall 2020. Mediation analyses revealed that sense of control mediated the relation between physical activity and PMH as well as depression, anxiety, and stress symptoms, respectively. The findings indicate that physical activity may be a promising strategy for fostering sense of control and thus mental health. Due to its practical implications and practicability, engagement in physical activity could be an effective way to reduce the NMH consequences of the current COVID-19 situation, and therefore should be addressed in actions for long-term prevention and intervention.

This study examined the consequences of media exposure to thin ideals compared to pictures of landscapes in healthy young women and women with eating and mixed mental disorders and investigated whether appearance-related cognitive factors and cognitive distortions moderate the effects. Two hundred seventy-five women in a multisite laboratory trial (174 in- or outpatients and 101 healthy women; Mage 22.87 years, SD = 3.94) were exposed to either thin ideals or to landscape pictures and guided through a vivid imagery of these pictures thereafter. Changes in body image dissatisfaction, mood, eating behavior, and physiological markers were assessed. After thin ideal exposure and even more after guided imagery, women's body image dissatisfaction increased and mood declined. The effect on mood was most pronounced in women with eating disorders, less in women with mixed disorders, and smallest in healthy controls. No effects were found on physiological measures. Higher values of appearance-related cognitive factors moderated the effect of thin ideal exposure and guided imagery on all psychological outcomes. Cognitive distortions moderated the effect of thin ideal exposure and guided imagery on mood. Findings indicate an overall susceptibility to viewing thin ideal pictures in magazines in young and especially in women with eating disorders. Though exposure in the laboratory resulted in psychological effects, it did not lead to a physiological stress response. The impact of thin ideal exposure on mood is in line with affect-regulation models in eating disorders, with appearance-related cognitive factors and cognitive distortions potentially accelerating such effects. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

We aimed to identify patterns of changes in suicidal ideation among university students six months after the COVID-19 outbreak, in comparison to the pre-pandemic suicidal ideation. Furthermore, we explored the links among these patterns and mental health indicators. 474 university students participated in the study in October-December 2019 and October-December 2020. The latent class change analysis revealed four groups: no-ideation (68.1%), stable low ideation (16.2%), increased ideation (8.9%), and decreased ideation (6.8%). Increased, in comparison to decreased ideation, was positively linked to changes in depression, stress, and anxiety. More loneliness during the pandemic was related to higher suicidal ideation.

Mindfulness-based interventions are effective at improving sexual dysfunctions in women, yet the mechanisms of action are less clear. Our objective was to investigate the impact of three mindfulness exercises on women’s sexual response. Forty-nine women participated in a laboratory session involving a series of 5-min exercises and erotic films. They completed three mindfulness-based exercises and a mental-imagery task. Genital and subjective arousal were measured continuously during erotic films, and genital arousal was measured during the exercises. A focus on the genitals led to greater genital arousal during the exercise. A focus on sensations in the body and on the genitals was associated with greater subjective sexual arousal during erotic films. Effects were small in size. Taken together, the focus of attention during a mindfulness practice may differentially affect genital and subjective sexual arousal and has implications for women experiencing difficulties in different aspects of sexual response.

The application of basic science research to the development and optimization of psychological treatments holds great potential. However, this process of clinical translation is challenging and time-consuming, and the standard route by which it proceeds is inefficient. Adaptive rolling designs, which originated within cancer treatment research, provide an alternative methodology with potential to accelerate development and optimization of psychological treatments. In such designs, multiple treatment options are tested simultaneously, with sequential Bayesian analyses used to remove poorly performing arms. Further, new treatment arms informed by the latest research findings can be introduced into the existing infrastructure as the trial progresses. These features dramatically reduce the sample sizes needed and offer a means for more rapid and efficient clinical translation. This article outlines the utility of such designs to clinical psychological science, focusing on a new variant termed the leapfrog design, and discusses their potential uses to accelerate clinical translation.

In Western cultural context, grandiose (overt) narcissism has been shown to be either unrelated or negatively related to negative mental health (depression, suicide ideation). Grandiose narcissism may be differently related to depression and suicide ideation variables in Eastern cultural contexts. The current study therefore aims to investigate associations between grandiose narcissism, depression, and suicide ideation in a sample of metropolitan Chinese students as well as in a sample of German students. A total of N = 935 Chinese students (73.3% female; Mage = 22.62, SDage = .89) and of N = 389 German students (75.6% female; Mage = 23.13, SDage = 2.94) completed paper-and-pencil and/or online measures of grandiose narcissism, depression, and suicide ideation. Grandiose narcissism was positively associated with depression and suicide ideation in Chinese students. Depression fully mediated the association between grandiose narcissism and suicide ideation – controlling for gender, age, and survey method. In contrast, in the German sample, no significant associations could be found. Grandiose narcissism obviously has different consequences in China than in Germany.

The retrieval of personal mastery experiences has been linked to adaptive functions, such as increased perceived self-efficacy and coping capability. Successful exposure leads to an increased mastery experience with respect to anxiety provoking situations, possibly due to a violation of expected negative outcomes. We investigated whether the reactivation and evaluation of mastery experiences after a brief virtual reality exposure (VRE) training can enhance self-efficacy and promote exposure therapy benefit in patients with acrophobia. Acrophobic participants (N = 56) were randomly assigned to a memory reactivation and evaluation (= VRE–MRE) intervention, a control (= memory reactivation; VRE–MR), or no intervention (= VRE) after VRE. The VRE–MRE condition involved the evaluation of mastery experiences associated with exposure and related events from the past. The effects of the VRE–MRE intervention were assessed on the level of behavioral avoidance and subjective fear at post-treatment and one-month follow-up. Relative to both the VRE–MR and VRE conditions, the VRE–MRE group showed an increase in self-efficacy and exhibited more pronounced reductions in behavioral avoidance, subjective fear at the initial approach distance, as well as scores on the acrophobia questionnaire (AQ) from pre- to post-treatment. The superior effects of the VRE–MRE intervention remained evident on the level of behavioral avoidance and associated subjective fear at the initial approach distance, but not on the AQ, from pre-treatment to follow-up. These findings indicate that the reactivation and evaluation of mastery experiences could be used as a strategy to increase exposure-based therapy in anxiety disorders.

The present study explored the Facebook Addiction Disorder (FAD) in an inpatient sample in Germany. Of the 112 Facebook users (71.4% women; age(years): M (SD) = 49.43 (9.17)), who were patients of a psychosomatic rehabilitation clinic with affective disorders and anxiety disorders as most common diagnoses, 28.6% reached the critical polythetic cutoff score of FAD, 0.9% researched the critical monothetic cutoff score, and 86.6% had enhanced values of withdrawal symptoms due to Facebook use. The mean level of FAD was significantly higher in inpatients with week depression than in inpatients with moderate depression. In the whole sample, FAD was significantly positively linked to duration of Facebook use and the personality trait narcissism. Present results provide first evidence of FAD in a non-student inpatient sample. They contribute to the understanding of the development of FAD and demonstrate that addictive Facebook use may impact persons who suffer from mental disorders, especially when they have enhanced levels of the personality trait narcissism. Practical applications for research and clinical treatment, as well as limitations of present results are discussed.

Objective Impairments in facial emotion recognition are an underlying factor of deficits in emotion regulation and interpersonal difficulties in mental disorders and are evident in eating disorders (EDs). Methods We used a computerized psychophysical paradigm to manipulate parametrically the quantity of signal in facial expressions of emotion (QUEST threshold seeking algorithm). This was used to measure emotion recognition in 308 adult women (anorexia nervosa [n = 61], bulimia nervosa [n = 58], healthy controls [n = 130], and mixed mental disorders [mixed, n = 59]). The M (SD) age was 22.84 (3.90) years. The aims were to establish recognition thresholds defining how much information a person needs to recognize a facial emotion expression and to identify deficits in EDs compared with healthy and clinical controls. The stimuli included six basic emotion expressions (fear, anger, disgust, happiness, sadness, surprise), plus a neutral expression. Results Happiness was discriminated at the lowest, fear at the highest threshold by all groups. There were no differences regarding thresholds between groups, except for the mixed and the bulimia nervosa group with respect to the expression of disgust (F(3,302) = 5.97, p = .001, η = .056). Emotional clarity, ED pathology, and depressive symptoms did not predict performance (RChange ≤ .010, F(1,305) ≤ 5.74, p ≥ .079). The confusion matrix did not reveal specific biases in either group. Conclusions Overall, within-subject effects were as expected, whereas between-subject effects were marginal and psychopathology did not influence emotion recognition. Facial emotion recognition abilities in women experiencing EDs compared with women experiencing mixed mental disorders and healthy controls were similar. Although basic facial emotion recognition processes seems to be intact, dysfunctional aspects such as misinterpretation might be important in emotion regulation problems. Clinical trial registration number DRKS-ID: DRKS00005709.

Cortisol administration prior to treatment can promote the efficacy of exposure-based treatments in specific phobia: cortisol has been proposed to reduce fear retrieval at the beginning of exposure and to enhance the acquisition and consolidation of corrective information learned during exposure. Whether cortisol exerts a beneficial therapeutic effect when given after exposure, e.g., by targeting the consolidation of new corrective information, has not been addressed so far to date. Here, we examined whether post-exposure cortisol administration promotes fear reduction and reduces return of fear following contextual change in specific phobia. Furthermore, the effect of cortisol on return of fear following contextual change (i.e., contextual renewal) was assessed. Patients with spider phobia (N = 43) were treated with a single session of in-vivo exposure, followed by cortisol administration (20 mg hydrocortisone) in a double-blind, placebo-controlled study design. Return of fear was assessed with behavioral approach tests (BATs) in the familiar therapy context (versus a novel unfamiliar context) at one-month and seven-month follow-up assessment. Exposure was effective in reducing fear from pre-treatment to post-treatment (i.e., 24 h after exposure) on fear-related behavioral (approach behavior during the BAT), psychophysiological (heart rate during the BAT) and subjective (fear during the BAT, spider-fear related questionnaires) measures of therapeutic outcome, with no add-on benefit of cortisol administration. Cortisol had no effect on contextual renewal at one-month follow-up. However, in a subsample (N = 21) that returned to the seven-month follow-up, an adverse effect of cortisol on fear renewal was found, with cortisol-treated patients showing an increase in subjective fear at the final approach distance of the BAT from post-treatment to seven-month follow-up. These and previous findings underline the importance of considering the exact timing of cortisol application when used as an add-on treatment for extinction-based psychotherapy: post-exposure cortisol administration does not seem to be effective, but might promote fear renewal at the subjective level.

Objective: Long-term follow-ups several years after receiving cognitive behavioral therapy (CBT) are scarce and most of the existing literature describes follow-up data of randomized-controlled trials. Thus, very little is known about the long-term effects of CBT in routine care. Methods: We investigated psychological functioning in a sample of 263 former outpatients who had received CBT for a variety of mental disorders such as depression, anxiety-, eating- or somatoform disorders 8.06 (SD 5.08) years after treatment termination. All participants completed a diagnostic interview as well as the Brief-Symptom Inventory (BSI) and the Beck Depression Inventory (BDI). Effect sizes and response rates according to Jacobson and Truax [J Consult Clin Psychol 1991;59:12–9] were calculated from pre- to posttreatment and from pretreatment to follow-up assessment. Results: Pre- to posttreatment effect sizes ranged between 0.75 (BDI) and 0.63 (BSI) and pretreatment to follow-up effect sizes were 0.92 (BDI) and 0.75 (BSI). Of all patients, 29% (BDI) and 17% (BSI) experienced clinically significant change at posttreatment and 42% (BDI) and 24% (BSI) at follow-up. Conclusion: The results point to the long-term effectiveness of CBT under routine conditions for a wide array of problems, especially when compared to the long-term effects of medical treatment. It is noteworthy that the results at follow-up were even better than at posttreatment, indicating further improvement. However, about a quarter of the patients did not respond sufficiently to therapy, neither concerning short-term nor long-term effects.

The Scrambled Sentences Task (SST) is a robust measure of interpretational processes in psychopathology. However, there is little evidence of its utility in measuring dysfunctional appraisals (DAs) of potentially traumatic events. We developed a novel SST for trauma-related DAs and examined its psychometric properties including convergent validity (correlations with PTSD-related symptoms and self-reported DAs), divergent validity (e.g., symptoms of depression and eating disorders), and retest reliability via an online study. Our sample (T1: N = 214, T2: N = 145) included participants who reported a potentially traumatic life event still eliciting distress. We found high correlations between the SST, PTSD-related symptoms ( r = .37-.51), and self-report measures of DAs ( r = .41-.58), indicating good convergent validity. Internal consistency (split-half = .78-.90) and retest reliability (ICC(3,1) = .73-.81) were also good. However, moderate to large correlations with symptoms of other disorders ( r = .17-.58) indicated limited divergent validity. Finally, the SST explained unique variance in PTSD-related symptoms above self-report measures of DAs. The results demonstrate the promise of the SST as a valid and reliable tool to assess DAs in the context of potentially traumatic life events. Further research should investigate the transdiagnostic role of trauma-related DAs in psychopathology and the relationship between the SST and self-report measures of DAs.

The number of studies on fear conditioning in children and adolescents has increased in recent years. Most of these studies exclusively focus on data of completers while dropout rates, reasons for dropout, and specific characteristics of non-completers are underreported. This study systematically investigated data of 283 children and adolescents between 8 and 17 years ( M = 11.10 , SD = 2.14) undergoing a differential fear conditioning paradigm using a female scream as unconditioned stimulus (US). The sample included 230 children and adolescents with a current primary anxiety disorder (separation anxiety disorder, social anxiety disorder, and specific phobia) and 53 non-anxious controls. The dropout rate was 24.1%. The most common reason to discontinue was being afraid of the US (59.1%) followed by the startle probe being too loud (15.2%). Logistic regressions revealed that younger age and a present anxiety disorder predicted dropout. There seem to be distinct characteristics potentially predicting dropout from fear conditioning paradigms. Thus, interpretability and generalizability of those paradigms are limited when non-completers are not considered. Future research should conscientiously look at these data more closely and investigate paradigms that work independent of age and diagnostic status.

The present study investigated problematic social media use (SMU) in Lithuania and in Germany. In two student samples (Lithuania: N = 1640; Germany: N = 727), problematic SMU, flow experienced during SMU, life satisfaction, depression, anxiety and stress symptoms were assessed by online surveys. Latent Class Analysis resulted in a four-group classification of participants due to their levels of problematic SMU characteristics: low-symptom, low-withdrawal, high-withdrawal, and high-symptom. The proportion of participants in the low-symptom group was significantly higher in Germany than in Lithuania. In contrast, significantly more Lithuanian participants belonged to both withdrawal groups. No significant country differences were found for the composition of the high-symptom group. In both countries, a series of Structural Equation Models showed that the level of flow, depression, anxiety and stress symptoms was the highest in the high-symptom group, and the lowest in the low-symptom group. Life satisfaction revealed the reversed result pattern. The current findings show that students from Lithuania and Germany can be grouped considering their problematic SMU level. Individuals in the four groups differ due to their level of mental health. Especially members of the high-symptom group might benefit from external controlling strategies of their time spent on SM, while members of the withdrawal groups are suggested to train their SMU self-control.