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Schlagworte
- Neuroendokrines System (2)
- Stressreaktion (2)
- Aktivierung (1)
- Akzeptanz (1)
- Anorexia nervosa (1)
- Genetische Variabilität (1)
- HPA (1)
- Hypothalamic-pituitary-adrenal axis (1)
- Körpererfahrung (1)
- Patientenorientierte Medizin (1)
- Patientin (1)
- Psychobiologie (1)
- Psychometrie (1)
- Psychotherapie (1)
- Rechte Hemisphäre (1)
- Reduktion (1)
- Stress (1)
- Stresstest (1)
- TSST-VR (1)
- Therapeut (1)
- Therapieerfolg (1)
- Trier Social Stress Test (1)
- Verstärkung (1)
- Verzerrung (1)
- Virtual Reality (1)
- Virtuelle Realität (1)
- behavioral genetics (1)
- physiological parameters (1)
- stress (1)
Institut
- Fachbereich 1 (4) (entfernen)
When do anorexic patients perceive their body as too fat? Aggravating and ameliorating factors
(2019)
Objective
Our study investigated body image representations in female patients with anorexia nervosa
and healthy controls using a size estimation with pictures of their own body. We also
explored a method to reduce body image distortions through right hemispheric activation.
Method
Pictures of participants’ own bodies were shown on the left or right visual fields for 130 ms
after presentation of neutral, positive, or negative word primes, which could be self-relevant
or not, with the task of classifying the picture as “thinner than”, “equal to”, or “fatter than”
one’s own body. Subsequently, activation of the left- or right hemispheric through right- or
left-hand muscle contractions for 3 min., respectively. Finally, participants completed the
size estimation task again.
Results
The distorted “fatter than” body image was found only in patients and only when a picture of
their own body appeared on the right visual field (left hemisphere) and was preceded by
negative self-relevant words. This distorted perception of the patients’ body image was
reduced after left-hand muscle contractions (right hemispheric activation).
Discussion
To reduce body image distortions it is advisable to find methods that help anorexia nervosa
patients to increase their self-esteem. The body image distortions were ameliorated after
right hemispheric activation. A related method to prevent distorted body-image representations
in these patients may be Eye Movement Desensitization and Reprocessing (EMDR)
therapy.
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.
In order to investigate the psychobiological consequences of acute stress under laboratory conditions, a wide range of methods for socially evaluative stress induction have been developed. The present dissertation is concerned with evaluating a virtual reality (VR)-based adaptation of one of the most widely used of those methods, the Trier Social Stress Test (TSST). In the three empirical studies collected in this dissertation, we aimed to examine the efficacy and possible areas of application of the adaptation of this well-established psychosocial stressor in a virtual environment. We found that the TSST-VR reliably incites the activation of the major stress effector systems in the human body, albeit in a slightly less pronounced way than the original paradigm. Moreover, the experience of presence is discussed as one potential factor of influence in the origin of the psychophysiological stress response. Lastly, we present a use scenario for the TSST-VR in which we employed the method to investigate the effects of acute stress on emotion recognition performance. We conclude that, due to its advantages concerning versatility, standardization and economic administration, the paradigm harbors enormous potential not only for psychobiological research, but other applications such as clinical practice as well. Future studies should further explore the underlying effect mechanisms of stress in the virtual realm and the implementation of VR-based paradigms in different fields of application.
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).