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- Psychologie (10) (entfernen)
Das Triple-X-Syndrom ist die häufigste Chromosomenstörung im weiblichen Geschlecht und dennoch wenig bekannt und erforscht. Um die wissenschaftliche Datenlage für die Betroffenen, werdenden Eltern und genetischen Berater zu verbessern wurde die vorliegende Studie durchgeführt. Ziel der Studie war es zu untersuchen, ob bei Mädchen und Frauen mit Triple-X-Karyotyp häufiger psychische Probleme und Verhaltensauffälligkeiten auftreten als bei Mädchen und Frauen mit einem regelrechten Chromosomensatz. Insgesamt konnten 72 Mädchen und Frauen mit Triple-X und 69 mit einem regelrechten Chromosomensatz in die Studie eingeschlossen werden. Durch drei in Altersgruppen aufgeteilte Kohorten konnte verglichen werden, ob mögliche Auffälligkeiten altersabhängig auftreten, wie sich der Entwicklungsverlauf vom Kind zur erwachsenen Frau darstellt und ob dabei Zusammenhänge erkennbar sind. Bei den Mädchen im Alter von vier bis sieben Jahren zeigten sich im Vergleich zur Kontrollgruppe bereits signifikante Unterschiede in Bezug auf schulische Kompetenzen, soziale Probleme und Aufmerksamkeitsprobleme. In der Altersgruppe der Mädchen von acht bis 17 Jahren haben sich diese Auffälligkeiten noch verstärkt und die Ergebnisse aus dem Fragebogen "Child Behavior Checklist" weisen über alle Skalen hinweg einen deutlichen Unterschied zwischen der Triple-X-Gruppe und der Kontrollgruppe auf. Dies betrifft insbesondere die Bereiche "Schulische Kompetenzen", "Internalisierende Auffälligkeiten", "Sozialer Rückzug", "Soziale Probleme" und "Aufmerksamkeits-probleme". In der Gesamtintensität der Auffälligkeiten haben die Triple-X-Mädchen im Mittel signifikant schlechtere Werte als die Mädchen der Kontrollgruppe. Auch ist der Anteil der Mädchen, die in den klinisch auffälligen Bereich fallen, in der Triple-X-Gruppe signifikant erhöht. Die Untersuchungen zum Selbstwertgefühl machen deutlich, dass Mädchen mit Triple-X-Karyotyp ein vermindertes Selbstwertgefühl im Vergleich zur Kontrollgruppe aufweisen. Auch unterscheiden sich Triple-X-Mädchen in Bezug auf ihr Emotionsregulationsverhalten. Sie haben eine Tendenz zu eher maladaptiven Bewältigungsstrategien und sie zeigen insbesondere beim "Problemorientierten Handeln" und auch in Bezug auf die Emotion "Angst" signifikante Unterschiede zur Kontrollgruppe. Für die Gruppe der Erwachsenen konnte nachgewiesen werden, dass sich Triple-X-Frauen in ihren Persönlichkeitsmerkmalen von Frauen mit einem regelrechten Chromosomensatz unterscheiden. Die Ergebnisse lassen darauf schließen, dass Triple-X-Frauen häufiger emotional labil und ängstlich reagieren und auch eher zurückhaltend und introvertiert und weniger leistungsorientiert sind. Sie haben eine geringere Lebenszufriedenheit und neigen dazu weniger sozial verantwortlich zu handeln. Triple-X-Frauen sind in ihrem täglichen Leben stärker durch körperliche und psychische Symptome beeinträchtigt, wenngleich diese Beeinträchtigungen nicht so stark sind, dass sie in den klinisch auffälligen Bereich fallen.
Cognitive performance is contingent upon multiple factors. Beyond the impact of en-vironmental circumstances, the bodily state may hinder or promote cognitive processing. Af-ferent transmission from the viscera, for instance, is crucial not only for the genesis of affect and emotion, but further exerts significant influences on memory and attention. In particular, afferent cardiovascular feedback from baroreceptors demonstrated subcortical and cortical inhibition. Consequences for human cognition and behavior are the impairment of simple perception and sensorimotor functioning. Four studies are presented that investigate the mod-ulatory impact of baro-afferent feedback on selective attention. The first study demonstrates that the modulation of sensory processing by baroreceptor activity applies to the processing of complex stimulus configurations. By the use of a visual masking task in which a target had to be selected against a visual mask, perceptual interference was reduced when target and mask were presented during the ventricular systole compared to the diastole. In study two, selection efficiency was systematically manipulated in a visual selection task in which a target letter was flanked by distracting stimuli. By comparing participants" performance under homogene-ous and heterogeneous stimulus conditions, selection efficiency was assessed as a function of the cardiac cycle phase in which the targets and distractors were presented. The susceptibility of selection performance to the stimulus condition at hand was less pronounced during the ventricular systole compared to the diastole. Study one and two therefore indicate that inter-ference from irrelevant sensory input, resulting from temporally overlapping processing traces or from the simultaneous presentation of distractor stimuli, is reduced during phases of in-creased baro-afferent feedback. Study three experimentally manipulated baroreceptor activity by systematically varying the participant- body position while a sequential distractor priming task was completed. In this study, negative priming and distractor-response binding effects were obtained as indices of controlled and automatic distractor processing, respectively. It was found that only controlled distractor processing was affected by tonic increases in baro-receptor activity. In line with study one and two these results indicate that controlled selection processes are more efficient during enhanced baro-afferent feedback, observable in dimin-ished aftereffects of controlled distractor processing. Due to previous findings that indicated baro-afferent transmission to affect central, rather than response-related processing stages, study four measured lateralized-readiness potentials (LRPs) and reaction times (RTs), while participants, again, had to selectively respond to target stimuli that were surrounded by dis-tractors. The impact of distractor inhibition on stimulus-related, but not on response-related LRPs suggests that in a sequential distractor priming task, the sensory representations of dis-tractors, rather than motor responses are targeted by inhibition. Together with the results from studies one through three and the finding of baroreceptor-mediated behavioral inhibition tar-geting central processing stages, study four corroborates the presumption of baro-afferent signal transmission to modulate controlled processes involved in selective attention. In sum, the work presented shows that visual selective attention benefits from in-creased baro-afferent feedback as its effects are not confined to simple perception, but may facilitate the active suppression of neural activity related to sensory input from distractors. Hence, due to noise reduction, baroreceptor-mediated inhibition may promote effective selec-tion in vision.
The efficacy and effectiveness of psychotherapeutic interventions have been proven time and again. We therefore know that, in general, evidence-based treatments work for the average patient. However, it has also repeatedly been shown that some patients do not profit from or even deteriorate during treatment. Patient-focused psychotherapy research takes these differences between patients into account by focusing on the individual patient. The aim of this research approach is to analyze individual treatment courses in order to evaluate when and under which circumstances a generally effective treatment works for an individual patient. The goal is to identify evidence based clinical decision rules for the adaptation of treatment to prevent treatment failure. Patient-focused research has illustrated how different intake indicators and early change patterns predict the individual course of treatment, but they leave a lot of variance unexplained. The thesis at hand analyzed whether Ecological Momentary Assessment (EMA) strategies could be integrated into patient-focused psychotherapy research in order to improve treatment response prediction models. EMA is an electronically supported diary approach, in which multiple real-time assessments are conducted in participants" everyday lives. We applied EMA over a two-week period before treatment onset in a mixed sample of patients seeking outpatient treatment. The four daily measurements in the patients" everyday environment focused on assessing momentary affect and levels of rumination, perceived self-efficacy, social support and positive or negative life events since the previous assessment. The aim of this thesis project was threefold: First, to test the feasibility of EMA in a routine care outpatient setting. Second, to analyze the interrelation of different psychological processes within patients" everyday lives. Third and last, to test whether individual indicators of psychological processes during everyday life, which were assessed before treatment onset, could be used to improve prediction models of early treatment response. Results from Study I indicate good feasibility of EMA application during the waiting period for outpatient treatment. High average compliance rates over the entire assessment period and low average burdens perceived by the patients support good applicability. Technical challenges and the results of in-depth missing analyses are reported to guide future EMA applications in outpatient settings. Results from Study II shed further light on the rumination-affect link. We replicated results from earlier studies, which identified a negative association between state rumination and affect on a within-person level and additionally showed a) that this finding holds for the majority but not every individual in a diverse patient sample with mixed Axis-I disorders, b) that rumination is linked to negative but also to positive affect and c) that dispositional rumination significantly affects the state rumination-affect association. The results provide exploratory evidence that rumination might be considered a transdiagnostic mechanism of psychological functioning and well-being. Results from Study III finally suggest that the integration of indicators derived from EMA applications before treatment onset can improve prediction models of early treatment response. Positive-negative affect ratios as well as fluctuations in negative affect measured during patients" daily lives allow the prediction of early treatment response. Our results indicate that the combination of commonly applied intake predictors and EMA indicators of individual patients" daily experiences can improve treatment response predictions models. We therefore conclude that EMA can successfully be integrated into patient-focused research approaches in routine care settings to ameliorate or optimize individual care.