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A huge number of clinical studies and meta-analyses have shown that psychotherapy is effective on average. However, not every patient profits from psychotherapy and some patients even deteriorate in treatment. Due to this result and the restricted generalization of clinical studies to clinical practice, a more patient-focused research strategy has emerged. The question whether a particular treatment works for an individual case is the focus of this paradigm. The use of repeated assessments and the feedback of this information to therapists is a major ingredient of patient-focused research. Improving patient outcomes and reducing dropout rates by the use of psychometric feedback seems to be a promising path. Therapists seem to differ in the degree to which they make use of and profit from such feedback systems. This dissertation aims to better understand therapist differences in the context of patient-focused research and the impact of therapists on psychotherapy. Three different studies are included, which focus on different aspects within the field:
Study I (Chapter 5) investigated how therapists use psychometric feedback in their work with patients and how much therapists differ in their usage. Data from 72 therapists treating 648 patients were analyzed. It could be shown that therapists used the psychometric feedback for most of their patients. Substantial variance in the use of feedback (between 27% and 52%) was attributable to therapists. Therapists were more likely to use feedback when they reported being satisfied with the graphical information they received. The results therefore indicated that not only patient characteristics or treatment progress affected the use of feedback.
Study II (Chapter 6) picked up on the idea of analyzing systematic differences in therapists and applied it to the criterion of premature treatment termination (dropout). To answer the question whether therapist effects occur in terms of patients’ dropout rates, data from 707 patients treated by 66 therapists were investigated. It was shown that approximately six percent of variance in dropout rates could be attributed to therapists, even when initial impairment was controlled for. Other predictors of dropout were initial impairment, sex, education, personality styles, and treatment expectations.
Study III (Chapter 7) extends the dissertation by investigating the impact of a transfer from one therapist to another within ongoing treatments. Data from 124 patients who agreed to and experienced a transfer during their treatment were analyzed. A significant drop in patient-rated as well as therapist-rated alliance levels could be observed after a transfer. On average, there seemed to be no difficulties establishing a good therapeutic alliance with the new therapist, although differences between patients were observed. There was no increase in symptom severity due to therapy transfer. Various predictors of alliance and symptom development after transfer were investigated. Impacts on clinical practice were discussed.
Results of the three studies are discussed and general conclusions are drawn. Implications for future research as well as their utility for clinical practice and decision-making are presented.
This thesis focus on threats as an experience of stress. Threats are distinguished from challenges and hindrances as another dimension of stress in challenge-hindrance models (CHM) of work stress (Tuckey et al., 2015). Multiple disciplines of psychology (e.g. stereotype, Fingerhut & Abdou, 2017; identity, Petriglieri, 2011) provide a variety of possible events that can trigger threats (e.g., failure expe-riences, social devaluation; Leary et al., 2009). However, systematic consideration of triggers and thus, an overview of when does the danger of threats arises, has been lacking to date. The explanation why events are appraised as threats is related to frustrated needs (e.g., Quested et al., 2011; Semmer et al., 2007), but empirical evidence is rare and needs can cover a wide range of content (e.g., relatedness, competence, power), depending on need approaches (e.g., Deci & Ryan, 2000; McClelland, 1961). This thesis aims to shed light on triggers (when) and the need-based mechanism (why) of threats.
In the introduction, I introduce threats as a dimension of stress experience (cf. Tuckey et al., 2015) and give insights into the diverse field of threat triggers (the when of threats). Further, I explain threats in terms of a frustrated need for positive self-view, before presenting specific needs as possible deter-minants in the threat mechanism (the why of threats). Study 1 represents a literature review based on 122 papers from interdisciplinary threat research and provides a classification of five triggers and five needs identified in explanations and operationalizations of threats. In Study 2, the five triggers and needs are ecologically validated in interviews with police officers (n = 20), paramedics (n = 10), teach-ers (n = 10), and employees of the German federal employment agency (n = 8). The mediating role of needs in the relationship between triggers and threats is confirmed in a correlative survey design (N = 101 Leaders working part-time, Study 3) and in a controlled laboratory experiment (N = 60 two-person student teams, Study 4). The thesis ends with a general discussion of the results of the four studies, providing theoretical and practical implications.
This intervention study explored the effects of a newly developed intergenerational encounter program on cross-generational age stereotyping (CGAS). Based on a biographical-narrative approach, participants (secondary school students and nursing home residents) were invited to share ideas about existential questions of life (e.g., about one’s core experiences, future plans, and personal values). Therefore, the dyadic Life Story Interview (LSI) had been translated into a group format (the Life Story Encounter Program, LSEP), consisting of 10 90-min sessions. Analyses verified that LSEP participants of both generations showed more favorable CGAS immediately after, but also 3 months after the program end. Such change in CGAS was absent in a control group (no LSEP participation). The LSEP-driven short- and long-term effects on CGAS could be partially explained by two program benefits, the feeling of comfort with and the experience of learning from the other generation.
With the advent of highthroughput sequencing (HTS), profiling immunoglobulin (IG) repertoires has become an essential part of immunological research. The dissection of IG repertoires promises to transform our understanding of the adaptive immune system dynamics. Advances in sequencing technology now also allow the use of the Ion Torrent Personal Genome Machine (PGM) to cover the full length of IG mRNA transcripts. The applications of this benchtop scale HTS platform range from identification of new therapeutic antibodies to the deconvolution of malignant B cell tumors. In the context of this thesis, the usability of the PGM is assessed to investigate the IG heavy chain (IGH) repertoires of animal models. First, an innovate bioinformatics approach is presented to identify antigendriven IGH sequences from bulk sequenced bone marrow samples of transgenic humanized rats, expressing a human IG repertoire (OmniRatTM). We show, that these rats mount a convergent IGH CDR3 response towards measles virus hemagglutinin protein and tetanus toxoid, with high similarity to human counterparts. In the future, databases could contain all IGH CDR3 sequences with known specificity to mine IG repertoire datasets for past antigen exposures, ultimately reconstructing the immunological history of an individual. Second, a unique molecular identifier (UID) based HTS approach and network property analysis is used to characterize the CLLlike CD5+ B cell expansion of A20BKO mice overexpressing a natural short splice variant of the CYLD gene (A20BKOsCYLDBOE). We could determine, that in these mice, overexpression of sCYLD leads to unmutated subvariant of CLL (UCLL). Furthermore, we found that this short splice variant is also seen in human CLL patients highlighting it as important target for future investigations. Third, the UID based HTS approach is improved by adapting it to the PGM sequencing technology and applying a custommade data processing pipeline including the ImMunoGeneTics (IMGT) database error detection. Like this, we were able to obtain correct IGH sequences with over 99.5% confidence and correct CDR3 sequences with over 99.9% confidence. Taken together, the results, protocols and sample processing strategies described in this thesis will improve the usability of animal models and the Ion Torrent PGM HTS platform in the field if IG repertoire research.
The present work explores how theories of motivation can be used to enhance video game research. Currently, Flow-Theory and Self-Determination Theory are the most common approaches in the field of Human-Computer Interaction. The dissertation provides an in-depth look into Motive Disposition Theory and how to utilize it to explain interindividual differences in motivation. Different players have different preferences and make different choices when playing games, and not every player experiences the same outcomes when playing the same game. I provide a short overview of the current state of the research on motivation to play video games. Next, Motive Disposition Theory is applied in the context of digital games in four different research papers, featuring seven studies, totaling 1197 participants. The constructs of explicit and implicit motives are explained in detail while focusing on the two social motives (i.e., affiliation and power). As dependent variables, behaviour, preferences, choices, and experiences are used in different game environments (i.e., Minecraft, League of Legends, and Pokémon). The four papers are followed by a general discussion about the seven studies and Motive Disposition Theory in general. Finally, a short overview is provided about other theories of motivation and how they could be used to further our understanding of the motivation to play digital games in the future. This thesis proposes that 1) Motive Disposition Theory represents a valuable approach to understand individual motivations within the context of digital games; 2) there is a variety of motivational theories that can and should be utilized by researchers in the field of Human-Computer Interaction to broaden the currently one-sided perspective on human motivation; 3) researchers should aim to align their choice of motivational theory with their research goals by choosing the theory that best describes the phenomenon in question and by carefully adjusting each study design to the theoretical assumptions of that theory.
Hypothalamic-pituitary-adrenal (HPA) axis-related genetic variants influence the stress response
(2019)
The physiological stress system includes the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic-adrenal-medullary system (SAM). Parameters representing these systems such as cortisol, blood pressure or heart rate define the physiological reaction in response to a stressor. The main objective of the studies described in this thesis was to understand the role of the HPA-related genetic factors in these two systems. Genetic factors represent one of the components causing individual variations in physiological stress parameters. Five genes involved in the functioning of the HPA axis regarding stress responses are examined in this thesis. They are: corticotropin-releasing hormone (CRH), the glucocorticoid receptor (GR), the mineralocorticoid receptor (MR), the 5-hydroxytryptamine-transporter-linked polymorphic region (5-HTTLPR) in the serotonin transporter (5-HTT) and the brain-derived neurotrophic factor (BDNF) gene. Two hundred thirty-two healthy participants were genotyped. The influence of genetic factors on physiological parameters, such as post-awakening cortisol and blood pressure was assessed, as well as the influence of genetic factors on stress reactivity in response to a socially evaluated cold pressor test (SeCPT). Three studies tested the HPA-related genes each on three different levels. The first study examined the influences of genotypes and haplotypes of these five genes on physiological as well as psychological stress indicators (Chapter 2). The second study examined the effects of GR variants (genotypes and haplotypes) and promoter methylation level on both the SAM system and the HPA axis stress reactivity (Chapter 3). The third study comprised the characterization of CRH promoter haplotypes in an in-vitro study and the association of the CRH promoter with stress indicators in vivo (Chapter 4).
Early life adversity (ELA) poses a high risk for developing major health problems in adulthood including cardiovascular and infectious diseases and mental illness. However, the fact that ELA-associated disorders first become manifest many years after exposure raises questions about the mechanisms underlying their etiology. This thesis focuses on the impact of ELA on startle reflexivity, physiological stress reactivity and immunology in adulthood.
The first experiment investigated the impact of parental divorce on affective processing. A special block design of the affective startle modulation paradigm revealed blunted startle responsiveness during presentation of aversive stimuli in participants with experience of parental divorce. Nurture context potentiated startle in these participants suggesting that visual cues of childhood-related content activates protective behavioral responses. The findings provide evidence for the view that parental divorce leads to altered processing of affective context information in early adulthood.
A second investigation was conducted to examine the link between aging of the immune system and long-term consequences of ELA. In a cohort of healthy young adults, who were institutionalized early in life and subsequently adopted, higher levels of T cell senescence were observed compared to parent-reared controls. Furthermore, the results suggest that ELA increases the risk of cytomegalovirus infection in early childhood, thereby mediating the effect of ELA on T cell-specific immunosenescence.
The third study addresses the effect of ELA on stress reactivity. An extended version of the Cold Pressor Test combined with a cognitive challenging task revealed blunted endocrine response in adults with a history of adoption while cardiovascular stress reactivity was similar to control participants. This pattern of response separation may best be explained by selective enhancement of central feedback-sensitivity to glucocorticoids resulting from ELA, in spite of preserved cardiovascular/autonomic stress reactivity.
There is no longer any doubt about the general effectiveness of psychotherapy. However, up to 40% of patients do not respond to treatment. Despite efforts to develop new treatments, overall effectiveness has not improved. Consequently, practice-oriented research has emerged to make research results more relevant to practitioners. Within this context, patient-focused research (PFR) focuses on the question of whether a particular treatment works for a specific patient. Finally, PFR gave rise to the precision mental health research movement that is trying to tailor treatments to individual patients by making data-driven and algorithm-based predictions. These predictions are intended to support therapists in their clinical decisions, such as the selection of treatment strategies and adaptation of treatment. The present work summarizes three studies that aim to generate different prediction models for treatment personalization that can be applied to practice. The goal of Study I was to develop a model for dropout prediction using data assessed prior to the first session (N = 2543). The usefulness of various machine learning (ML) algorithms and ensembles was assessed. The best model was an ensemble utilizing random forest and nearest neighbor modeling. It significantly outperformed generalized linear modeling, correctly identifying 63.4% of all cases and uncovering seven key predictors. The findings illustrated the potential of ML to enhance dropout predictions, but also highlighted that not all ML algorithms are equally suitable for this purpose. Study II utilized Study I’s findings to enhance the prediction of dropout rates. Data from the initial two sessions and observer ratings of therapist interventions and skills were employed to develop a model using an elastic net (EN) algorithm. The findings demonstrated that the model was significantly more effective at predicting dropout when using observer ratings with a Cohen’s d of up to .65 and more effective than the model in Study I, despite the smaller sample (N = 259). These results indicated that generating models could be improved by employing various data sources, which provide better foundations for model development. Finally, Study III generated a model to predict therapy outcome after a sudden gain (SG) in order to identify crucial predictors of the upward spiral. EN was used to generate the model using data from 794 cases that experienced a SG. A control group of the same size was also used to quantify and relativize the identified predictors by their general influence on therapy outcomes. The results indicated that there are seven key predictors that have varying effect sizes on therapy outcome, with Cohen's d ranging from 1.08 to 12.48. The findings suggested that a directive approach is more likely to lead to better outcomes after an SG, and that alliance ruptures can be effectively compensated for. However, these effects
were reversed in the control group. The results of the three studies are discussed regarding their usefulness to support clinical decision-making and their implications for the implementation of precision mental health.
Knowledge acquisition comprises various processes. Each of those has its dedicated research domain. Two examples are the relations between knowledge types and the influences of person-related variables. Furthermore, the transfer of knowledge is another crucial domain in educational research. I investigated these three processes through secondary analyses in this dissertation. Secondary analyses comply with the broadness of each field and yield the possibility of more general interpretations. The dissertation includes three meta-analyses: The first meta-analysis reports findings on the predictive relations between conceptual and procedural knowledge in mathematics in a cross-lagged panel model. The second meta-analysis focuses on the mediating effects of motivational constructs on the relationship between prior knowledge and knowledge after learning. The third meta-analysis deals with the effect of instructional methods in transfer interventions on knowledge transfer in school students. These three studies provide insights into the determinants and processes of knowledge acquisition and transfer. Knowledge types are interrelated; motivation mediates the relation between prior and later knowledge, and interventions influence knowledge transfer. The results are discussed by examining six key insights that build upon the three studies. Additionally, practical implications, as well as methodological and content-related ideas for further research, are provided.