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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.
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.
In der Vorrede zur ersten Auflage von Die Welt als Wille und Vorstellung legt Arthur Schopenhauer dem Leser seines Werkes seine Absicht nahe, welche in der Mitteilung eines „einzigen Gedankens“ besteht. Doch dieser mitzuteilende Gedanke wird an keiner Stelle des Werkes explizit und direkt als solchen von Schopenhauer ausgesprochen und genannt. Dies gibt bis heute in der Schopenhauer-Forschung Anlass zu kontroversen Auseinandersetzungen: Wie lautet Schopenhauers „einziger Gedanke“? Wo befindet er sich konkret? Und ist er überhaupt mitteilbar?
Trotz zahlreicher Forschungsarbeiten zur Thematik des „einzigen Gedankens“ wurde bisher der Einfluss der indischen Philosophie, genauer des Oupnek’hat, vernachlässigt, obwohl genauestens nachgewiesen und nachgezeichnet werden kann, mit welchen Quellen sich Schopenhauer zum Zeitpunkt der Entstehung seiner Philosophie intensiv beschäftigt hat. Auch verweist er selbst immer wieder auf bestimmte Stellen aus dem Oupnek’hat und zitiert Passagen an ganz wesentlichen Stellen in seinem Werk.
Um den „einzigen Gedanken“ im Werk Schopenhauers erfassen zu können, reicht es nicht aus, nur vom Hauptwerk selbst auszugehen, sondern es müssen ebenfalls die Jahre und Schriften während der Entstehung seiner Philosophie bis zum Hauptwerk berücksichtigt werden, und damit verbunden auch die Quellen, die Schopenhauer beeinflusst haben, wozu insbesondere das Oupnek’hat samt seinen eigenen Randnotizen gehört.
The daily dose of health information: A psychological view on the health information seeking process
(2021)
The search for health information is becoming increasingly important in everyday life, as well as socially and scientifically relevant Previous studies have mainly focused on the design and communication of information. However, the view of the seeker as well as individual
differences in skills and abilities has been a neglected topic so far. A psychological perspective on the process of searching for health information would provide important starting points for promoting the general dissemination of relevant information and thus improving health behaviour and health status. Within the present dissertation, the process of seeking health information was thus divided into sequential stages to identify relevant personality traits and skills. Accordignly, three studies are presented that focus on one stage
of the process respectively and empirically test potential crucial traits and skills: Study I investigates possible determinants of an intention for a comprehensive search for health information. Building an intention is considered as the basic step of the search process.
Motivational dispositions and self-regulatory skills were related to each other in a structural equation model and empirically tested based on theoretical investigations. Model fit showed an overall good fit and specific direct and indirect effects from approach and avoidance
motivation on the intention to seek comprehensively could be found, which supports the theoretical assumptions. The results show that as early as the formation of intention, the psychological perspective reveals influential personality traits and skills. Study II deals with the subsequent step, the selection of information sources. The preference for basic characteristics of information sources (i.e., accessibility, expertise, and interaction) is related to health information literacy as a collective term for relevant skills and intelligence as a personality trait. Furthermore, the study considers the influence of possible over- or underestimation of these characteristics. The results show not only a different predictive
contribution of health literacy and intelligence, but also the relevance of subjective and objective measurement.
Finally, Study III deals with the selection and evaluation of the health information previously found. The phenomenon of selective exposure is analysed, as this can be considered problematic in the health context. For this purpose, an experimental design was implemented in which a varying health threat was suggested to the participants. Relevant information was presented and the selective choice of this information was assessed. Health literacy was tested
as a moderator in a function of the induced threat and perceived vulnerability, triggering defence motives on the degree of bias. Findings show the importance of the consideration of the defence motives, which could cause a bias in the form of selective exposure. Furthermore, health literacy even seems to amplify this effect.
Results of the three studies are synthesized, discussed and general conclusions are drawn and implications for further research are determined.
This dissertation focusses on research into the personality construct of action vs. state orientation. Derived from the Personality-Systems-Interaction Theory (PSI Theory), state orientation is defined as a low ability to self-regulate emotions and associated with many adverse consequences – especially under stress. Because of the high prevalence of state orientation, it is a very important topic to investigate factors that help state-oriented people to buffer these adverse consequences. Action orientation, in contrast, is defined as a high ability to self-regulate own emotions in a very specific way: through accessing the self. The present dissertation demonstrates this theme in five studies, using a total of N = 1251 participants with a wide age range, encompassing different populations (students, non-student population (people from the coaching and therapy sector), applying different operationalisations to investigate self-access as a mediator or an outcome variable. Furthermore, it is tested whether the popular technique of mindfulness - that is advertised as a potent remedy for bringing people closer to the self -really works for everybody. The findings show that the presumed remedy is rather harmful for state-oriented individuals. Finally, an attempt to ameliorate these alienating effects, the present dissertation attempts to find theory-driven, and easy-to-apply solution how mindfulness exercises can be adapted.
The ability to acquire knowledge helps humans to cope with the demands of the environment. Supporting knowledge acquisition processes is among the main goals of education. Empirical research in educational psychology has identified several processes mediated through that prior knowledge affects learning. However, the majority of studies investigated cognitive mechanisms mediating between prior knowledge and learning and neglected that motivational processes might also mediate the influence. In addition, the impact of successful knowledge acquisition on patients’ health has not been comprehensively studied. This dissertation aims at closing knowledge gaps on these topics with the use of three studies. The first study is a meta-analysis that examined motivation as a mediator of individual differences in knowledge before and after learning. The second study investigated in greater detail the extent to which motivation mediated the influence of prior knowledge on knowledge gains in a sample of university students. The third study is a second-order meta-analysis synthesizing the results of previous meta-analyses on the effects of patient education on several health outcomes. The findings of this dissertation show that (a) motivation mediates individual differences in knowledge before and after learning; (b) interest and academic self-concept stabilize individual differences in knowledge more than academic self-efficacy, intrinsic motivation, and extrinsic motivation; (c) test-oriented instruction closes knowledge gaps between students; (d) students’ motivation can be independent of prior knowledge in high aptitude students; (e) knowledge acquisition affects motivational and health-related outcomes; and (f) evidence on prior knowledge and motivation can help develop effective interventions in patient education. The results of the dissertation provide insights into prerequisites, processes, and outcomes of knowledge acquisition. Future research should address covariates of learning and environmental impacts for a better understanding of knowledge acquisition processes.
Every action we perform, no matter how simple or complex, has a cognitive representation. It is commonly assumed that these are organized hierarchically. Thus, the representation of a complex action consists of multiple simpler actions. The representation of a simple action, in turn, consists of stimulus, response, and effect features. These are integrated into one representation upon the execution of an action and can be retrieved if a feature is repeated. Depending on whether retrieved features match or only partially match the current action episode, this might benefit or impair the execution of a subsequent action. This pattern of costs and benefits results in binding effects that indicate the strength of common representation between features. Binding effects occur also in more complex actions: Multiple simple actions seem to form representations on a higher level through the integration and retrieval of sequentially given responses, resulting in so-called response-response binding effects. This dissertation aimed to investigate what factors determine whether simple actions form more complex representations. The first line of research (Articles 1-3) focused on dissecting the internal structure of simple actions. Specifically, I investigated whether the spatial relation of stimuli, responses, or effects, that are part of two different simple actions, influenced whether these simple actions are represented as one more complex action. The second line of research (Articles 2, 4, and 5) investigated the role of context on the formation and strength of more complex action representations. Results suggest that spatial separation of responses as well as context might affect the strength of more complex action representations. In sum, findings help to specify assumptions on the structure of complex action representations. However, it may be important to distinguish factors that influence the strength and structure of action representations from factors that terminate action representations.
Diese Dissertationsschrift befasst sich mit der Erforschung des motorischen Gedächtnisses. Wir gehen der Frage nach, ob sich dort Analogien zu im deklarativen Gedächtnis bekannten kontextuellen und inhibitorischen Effekten finden lassen.
Der erste von drei peer reviewed Artikeln setzt sich mit der generellen Bedeutung von externen Kontextmerkmalen für einen motorischen Gedächtnisabruf auseinander. Wir veränderten zwei verschiedene Sätze motorischer Sequenzen entlang einer hohen Zahl entsprechender Merkmale. Signifikant unterschiedliche Erinnerungsleistungen wiesen auf eine Kontextabhängigkeit motorischer Inhalte hin. Die Erinnerungsleistung variierte entlang der seriellen Output-Position. Bei einem Kontextwechsel blieb die Erinnerungsleistung über den Abrufverlauf nahezu stabil, bei Kontextbeibehaltung fiel diese schnell signifikant ab.
Beide weiteren peer reviewed Artikel wenden sich dann der Inhibition motorischer Sequenzen zu. Im zweiten Artikel begutachten wir drei Sätze motorischer Sequenzen, die wir mit verschiedenen Händen ausführen ließen, auf ein selektives gerichtetes Vergessen. Die Vergessen-Gruppe zeigte dies nur, wenn für Satz Zwei und Drei dieselbe Hand benutzt wurde und somit ein hohes Interferenzpotenzial zwischen diesen Listen bestand. War dieses im Vergleich niedrig, indem beide Sätze mit verschiedenen Händen auszuführen waren, trat kein selektives gerichtetes Vergessen auf. Das deutet auf kognitive Inhibition als wirkursächlichen Prozess.
Im dritten Artikel schließlich untersuchen wir Effekte willentlicher kognitiver Unterdrückung sowohl des Gedächtnisabrufs als auch des Ausführens in einer motorischen Adaptation des TNT (think/no-think) – Paradigmas (Anderson & Green, 2001). Waren die Sequenzen in Experiment 1 anfänglich stärker trainiert worden, so zeigten willentlich unterdrückte (no-think) motorische Repräsentationen eine deutliche Verlangsamung in deren Zugänglichkeit und tendenziell auch in der Ausführung, - im Vergleich zu Basisraten-Sequenzen. Waren die Sequenzen in Experiment 2 dagegen nur moderat trainiert, wurden diese auch schlechter erinnert und deutlich verlangsamt ausgeführt. Willentliche kognitive Unterdrückung kann motorische Gedächtnisrepräsentation und deren Ausführung beeinflussen.
Unsere drei Artikel bestätigen motorische Analogien bekannter Kontext- und Inhibitionseffekte im deklarativen Gedächtnis. Wir führen ein selektives gerichtetes Vergessen motorischer Inhalte eindeutig auf Inhibition zurück und bestätigen darüber hinaus Effekte der willentlichen Unterdrückung motorischer Gedächtnisrepräsentation.
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.