Publications by authors named "Jürgen Margraf"

190 Publications

Corrigendum to "Vegetarian diet and mental health: Cross-sectional and longitudinal analyses in culturally diverse samples". Journal of Affective Disorders (2019) Pages 147-154.

J Affect Disord 2021 Sep 19. Epub 2021 Sep 19.

Ruhr-Universität Bochum, Clinical Child and Adolescent Psychology, Bochum, Germany. Electronic address:

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http://dx.doi.org/10.1016/j.jad.2021.09.011DOI Listing
September 2021

Consequences of exposure to the thin ideal in mass media depend on moderators in young women: An experimental study.

J Abnorm Psychol 2021 Jul;130(5):498-511

Faculty of Psychology.

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; 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).
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http://dx.doi.org/10.1037/abn0000676DOI Listing
July 2021

Efficacy of temporally intensified exposure for anxiety disorders: A multicenter randomized clinical trial.

Depress Anxiety 2021 Jul 22. Epub 2021 Jul 22.

Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany.

Background: The need to optimize exposure treatments for anxiety disorders may be addressed by temporally intensified exposure sessions. Effects on symptom reduction and public health benefits should be examined across different anxiety disorders with comorbid conditions.

Methods: This multicenter randomized controlled trial compared two variants of prediction error-based exposure therapy (PeEx) in various anxiety disorders (both 12 sessions + 2 booster sessions, 100 min/session): temporally intensified exposure (PeEx-I) with exposure sessions condensed to 2 weeks (n = 358) and standard nonintensified exposure (PeEx-S) with weekly exposure sessions (n = 368). Primary outcomes were anxiety symptoms (pre, post, and 6-months follow-up). Secondary outcomes were global severity (across sessions), quality of life, disability days, and comorbid depression.

Results: Both treatments resulted in substantial improvements at post (PeEx-I: d  = 1.50, PeEx-S: d  = 1.78) and follow-up (PeEx-I: d  = 2.34; PeEx-S: d  = 2.03). Both groups showed formally equivalent symptom reduction at post and follow-up. However, time until response during treatment was 32% shorter in PeEx-I (median = 68 days) than PeEx-S (108 days; TR  = 0.68). Interestingly, drop-out rates were lower during intensified exposure. PeEx-I was also superior in reducing disability days and improving quality of life at follow-up without increasing relapse.

Conclusions: Both treatment variants focusing on the transdiagnostic exposure-based violation of threat beliefs were effective in reducing symptom severity and disability in severe anxiety disorders. Temporally intensified exposure resulted in faster treatment response with substantial public health benefits and lower drop-out during the exposure phase, without higher relapse. Clinicians can expect better or at least comparable outcomes when delivering exposure in a temporally intensified manner.
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http://dx.doi.org/10.1002/da.23204DOI Listing
July 2021

A clinimetric analysis of the euthymia, resilience, and positive mental health scales.

J Affect Disord 2021 Nov 9;294:71-76. Epub 2021 Jul 9.

Department of Health Sciences, University of Florence, Florence, Italy; Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands. Electronic address:

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.
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http://dx.doi.org/10.1016/j.jad.2021.07.001DOI Listing
November 2021

A clinimetric analysis of the euthymia, resilience, and positive mental health scales.

J Affect Disord 2021 Nov 9;294:71-76. Epub 2021 Jul 9.

Department of Health Sciences, University of Florence, Florence, Italy; Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands. Electronic address:

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.
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http://dx.doi.org/10.1016/j.jad.2021.07.001DOI Listing
November 2021

A clinimetric analysis of the euthymia, resilience, and positive mental health scales.

J Affect Disord 2021 Nov 9;294:71-76. Epub 2021 Jul 9.

Department of Health Sciences, University of Florence, Florence, Italy; Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands. Electronic address:

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.
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http://dx.doi.org/10.1016/j.jad.2021.07.001DOI Listing
November 2021

Coronavirus (COVID-19) outbreak: Addictive social media use, depression, anxiety and stress in quarantine - an exploratory study in Germany and Lithuania.

J Affect Disord Rep 2021 Jul 17;5:100182. Epub 2021 Jun 17.

Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania, Ciurlionio 29-203, 03100, Vilnius, Lithuania.

Background: To slow down the spread of the COVID-19 pandemic, governments of many countries introduced various behavioral measures starting March 2020. The measures included domestic quarantine (not leaving home) for infected or potentially infected people. Due to the need for social distancing, online activity increased in spring 2020. This could foster the risk for addictive social media use (SMU). The present study investigated tendencies of addictive SMU and their relationship with depression, anxiety and stress symptoms specifically among individuals who stayed in domestic quarantine due to COVID-19 in Germany and Lithuania.

Methods: In Germany ( = 529; quarantine group:  = 157, non-quarantine group:  = 372) and in Lithuania ( = 325; quarantine group:  = 54, non-quarantine group:  = 271), data were assessed via online surveys in spring 2020.

Results: In both countries, persons in quarantine had higher levels of addictive SMU, depression, anxiety and stress symptoms than individuals who were not in quarantine. The difference was significant only for addictive SMU in the German sample. The significant positive correlations between addictive SMU and symptoms of depression, anxiety and stress were stronger in both quarantine groups than in the non-quarantine groups.

Limitations: The mostly female, young and well-educated composition of both investigated samples limits generalizability of the current findings.

Conclusions: Results reveal first evidence that the use of social media during domestic COVID-19 quarantine might contribute to the increase of addictive tendencies and negatively impact well-being. Alternative ways of daily routine during the quarantine are discussed.
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http://dx.doi.org/10.1016/j.jadr.2021.100182DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8214329PMC
July 2021

Visual attention and sexual arousal in women with and without sexual dysfunction.

Behav Res Ther 2021 Sep 18;144:103915. Epub 2021 Jun 18.

Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada. Electronic address:

Attention to sexual stimuli is a prerequisite to process such stimuli as sexually-meaningful and is an important means to facilitate sexual arousal. Attending to sexual cues is crucial for healthy sexual functioning. Studies suggest that sexual dysfunction is associated with less attention towards sexual stimuli. The goal of this study was to use an eye-tracking-based free-viewing paradigm to investigate whether women with sexual dysfunction visually attend to the genital area in dynamic sexual stimuli (i.e., erotic videos) differently than women with subclinical sexual function or those with typical sexual functioning. A total of 69 women (M = 27.77, SD = 8.00) with clinical (n = 30), subclinical (n = 23), and typical (n = 16) levels of sexual functioning watched four 1-min video clips depicting heterosexual couples engaging in vaginal intercourse or cunnilingus while the total fixation duration on the genital area as well as their subjective and genital sexual arousal were recorded. As hypothesized, the clinical group fixated on the genital area less than women with typical sexual functioning. A longer total fixation duration on the genital area was followed by increases in subjective arousal and genital arousal. The relationship between attention and arousal was not moderated by sexual functioning group. This study provides first evidence of the role of sustained visual attention for facilitating sexual arousal in women with and without sexual dysfunction.
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http://dx.doi.org/10.1016/j.brat.2021.103915DOI Listing
September 2021

Correction to: Your Fear is My Fear: The Relationship Between Parental and Offspring Anxieties.

Child Psychiatry Hum Dev 2021 Oct;52(5):782

Mental Health Research and Treatment Center, Ruhr-University Bochum, Massenbergstrasse 9-13, 44847, Bochum, Germany.

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http://dx.doi.org/10.1007/s10578-021-01207-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8405491PMC
October 2021

A longitudinal examination of the relationship between smoking and panic, anxiety, and depression in Chinese and German students.

Addict Behav Rep 2021 Dec 15;14:100347. Epub 2021 Apr 15.

Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Germany.

The present study examines the relationship between smoking and panic, depression, and anxiety over time and across two cultures, using data from the BOOM studies. The relationship between smoking and anxiety disorders, including panic requires further exploration, in order to reconcile inconsistent, contradictory findings and cross-cultural differences. Participants in the present study included 5,416 Chinese university students and 282 German university students. Participants completed surveys assessing smoking, panic, depression, and anxiety. Multiple logistic regressions were used to examine predict later mental health from smoking, as well as later smoking from mental health. In sum, across the regressions, smoking at baseline did not predict higher panic or depression at follow-up in either German or Chinese students. It did predict lower anxiety in German students. Anxiety at baseline, but not depression, predicted increased likelihood of smoking at follow-up in German students. The relationship between smoking and anxiety disorders is one that will require further exploration, in order to reconcile inconsistent, contradictory findings and cross-cultural differences. The present data point to a relationship between anxiety and later smoking, and also to a negative, though small, relationship between smoking and later anxiety in German students, and no prospective relationship in either direction in Chinese students.
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http://dx.doi.org/10.1016/j.abrep.2021.100347DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8193104PMC
December 2021

The relationship between social media use, anxiety and burden caused by coronavirus (COVID-19) in Spain.

Curr Psychol 2021 May 22:1-7. Epub 2021 May 22.

Department of Personality, Evaluation, and Psychological Treatments, University of Valencia, Valencia, Spain.

The outbreak of COVID-19 and national restrictions to slow down its spread have significantly changed people's everyday lives. Many people engage in intensive social media use (SMU) to stay up-to-date about the pandemic. The present study investigated the extent of SMU as source of COVID-19 information, and its relationship with anxiety and the experienced burden caused by the pandemic in Spain. Of the 221 participants, 52.5% reported to frequently use SM as information source. The use of other information sources such as print and online newspaper reports, television reports, and official governmental online sites was not associated with anxiety and burden caused by the current COVID-19 situation. However, SMU was significantly positively linked to both variables. Moreover, anxiety significantly mediated the relationship between SMU and the experienced burden. The findings show the potential negative effect of SMU on individual emotional state and behavior during the pandemic. They emphasize the significance of an accurate and conscious use of SM specifically during extraordinary circumstances such as the COVID-19 outbreak.
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http://dx.doi.org/10.1007/s12144-021-01802-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8140743PMC
May 2021

Neural adaptation of cingulate and insular activity during delayed fear extinction: A replicable pattern across assessment sites and repeated measurements.

Neuroimage 2021 08 19;237:118157. Epub 2021 May 19.

Department of Psychiatry and Psychotherapy and Center for Mind, Brain and Behavior - CMBB, Philipps-Universität Marburg, Germany.

Adapting threat-related memories towards changing environments is a fundamental ability of organisms. One central process of fear reduction is suggested to be extinction learning, experimentally modeled by extinction training that is repeated exposure to a previously conditioned stimulus (CS) without providing the expected negative consequence (unconditioned stimulus, US). Although extinction training is well investigated, evidence regarding process-related changes in neural activation over time is still missing. Using optimized delayed extinction training in a multicentric trial we tested whether: 1) extinction training elicited decreasing CS-specific neural activation and subjective ratings, 2) extinguished conditioned fear would return after presentation of the US (reinstatement), and 3) results are comparable across different assessment sites and repeated measures. We included 100 healthy subjects (measured twice, 13-week-interval) from six sites. 24 h after fear acquisition training, extinction training, including a reinstatement test, was applied during fMRI. Alongside, participants had to rate subjective US-expectancy, arousal and valence. In the course of the extinction training, we found decreasing neural activation in the insula and cingulate cortex as well as decreasing US-expectancy, arousal and negative valence towards CS+. Re-exposure to the US after extinction training was associated with a temporary increase in neural activation in the anterior cingulate cortex (exploratory analysis) and changes in US-expectancy and arousal ratings. While ICCs-values were low, findings from small groups suggest highly consistent effects across time-points and sites. Therefore, this delayed extinction fMRI-paradigm provides a solid basis for the investigation of differences in neural fear-related mechanisms as a function of anxiety-pathology and exposure-based treatment.
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http://dx.doi.org/10.1016/j.neuroimage.2021.118157DOI Listing
August 2021

Genes in treatment: Polygenic risk scores for different psychopathologies, neuroticism, educational attainment and IQ and the outcome of two different exposure-based fear treatments.

World J Biol Psychiatry 2021 Jun 18:1-14. Epub 2021 Jun 18.

Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany.

Objectives: 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.

Methods: A sample of 342 phobic patients treated either for clinically relevant dental fear ( = 189) or other (mixed) phobic fears ( = 153) underwent highly standardised 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.

Results: 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.

Conclusions: Results indicate the importance of EA-related traits for outcomes following brief, but not long, standardised exposure-based CBT. Such use of PRS may help inform selection and tailoring of treatments.
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http://dx.doi.org/10.1080/15622975.2021.1907708DOI Listing
June 2021

Psychometric Properties of a Self-Report Version of the Sexual Interest and Desire Inventory-Female (SIDI-F-SR).

J Sex Med 2021 05 24;18(5):990-995. Epub 2021 Apr 24.

Mental Health Research and Treatment Center, Clinical Psychology and Psychotherapy, Ruhr University Bochum, Bochum, Germany.

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.
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http://dx.doi.org/10.1016/j.jsxm.2021.03.001DOI Listing
May 2021

Using Three Indirect Measures to Assess the Role of Sexuality-Related Associations and Interpretations for Women's Sexual Desire: An Internet-Based Experimental Study.

Arch Sex Behav 2021 08 12;50(6):2471-2484. Epub 2021 Apr 12.

Clinical Psychology and Psychotherapy, Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr University Bochum, Massenbergstr. 9-13, 44787, Bochum, Germany.

Theoretical models emphasize the role of both automatic appraisals (i.e., associations) and conscious appraisals (i.e., interpretations) for sexual desire. Studies on sexuality-related appraisals have not combined self-report measures and experimental paradigms in order to compare the relevance of associations or interpretations. The aim of this study was to assess the relative contribution of both associations and interpretations to the explanation of low sexual desire in women. Toward this goal, indirect measures assessing associations (via a Single Target Implicit Association Test [STIAT]) and interpretations (via a Scrambled Sentences Test [SST] and a scenario task) were administered in a sample of 263 women (M = 27.90, SD 8.27) with varying levels of sexual desire and different sexual orientations (exclusively heterosexual women: 54.6%). Negative sexuality-related interpretations as assessed with two variants of the SST as well as the scenario task added to the explanation of lower sexual desire in women. Negative associations as measured with the STIAT were predictive of lower sexual desire only in women who did not indicate an exclusively heterosexual orientation. In this study, sexuality-related interpretations were more relevant to women's sexual desire than automatic associations. Future studies should assess the causal mechanism underlying sexuality-related interpretations (e.g., by evaluating whether these can be changed via cognitive bias modification techniques or psychological treatments).
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http://dx.doi.org/10.1007/s10508-020-01897-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8416817PMC
August 2021

Adherence to behavioral Covid-19 mitigation measures strongly predicts mortality.

PLoS One 2021 30;16(3):e0249392. Epub 2021 Mar 30.

Department of Clinical Child and Adolescent Psychology, Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany.

In the absence of vaccines or causal therapies, behavioral measures such as wearing face masks and maintaining social distance are central to fighting Covid-19. Yet, their benefits are often questioned by the population and the level of adherence to the measures is variable. We examined in representative samples across eight countries (N = 7,568) whether adherence reported around June 1, 2020 predicted the increase in Covid-19 mortality by August 31, 2020. Mortality increased 81.3% in low adherence countries (United States, Sweden, Poland, Russia), 8.4% in high adherence countries (Germany, France, Spain, United Kingdom). Across countries adherence and subsequent mortality increases correlated with r = -0.91. No African or South American countries were included in the present study, which limits the generalizability of the findings. While reported Covid-19 mortality is likely to be influenced by other factors, the almost tenfold difference in additional mortality is significant, and may inform decisions when choosing whether to prioritize individual liberty rights or health-protective measures.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249392PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8009358PMC
April 2021

The Effects of Modifying Dysfunctional Appraisals in Posttraumatic Stress Disorder Using a Form of Cognitive Bias Modification: Results of a Randomized Controlled Trial in an Inpatient Setting.

Psychother Psychosom 2021 Feb 23:1-17. Epub 2021 Feb 23.

Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr-Universität Bochum, Bochum, Germany.

Introduction: Dysfunctional appraisals about traumatic events and their sequelae are a key mechanism in posttraumatic stress disorder (PTSD). Experimental studies have shown that a computerized cognitive training, cognitive bias modification for appraisals (CBM-APP), can modify dysfunctional appraisals and reduce analogue trauma symptoms amongst healthy and subclinical volunteers.

Objective: We aimed to test whether CBM-APP could reduce dysfunctional appraisals related to trauma reactions in PTSD patients, and whether this would lead to improvements in PTSD symptoms.

Methods: We compared CBM-APP to sham training in a parallel-arm proof-of-principle double-blind randomized controlled trial amongst 80 PTSD patients admitted to an inpatient clinic. Both arms comprised a training schedule of 8 sessions over a 2-week period and were completed as an adjunct to the standard treatment programme.

Results: In intention-to-treat analyses, participants receiving CBM-APP showed a greater reduction in dysfunctional appraisals on a scenario task from pre- to posttraining (primary outcome) assessments, compared to those receiving sham training (d = 1.30, 95% CI 0.82-1.80), with between-group differences also found on the Posttraumatic Cognitions Inventory (PTCI; d = 0.85, 95% CI 0.39-1.32) and the PTSD Checklist for DSM-5 (PCL-5; d = 0.68, 95% CI 0.23-1.14), but not for long-term cortisol concentrations (d = 0.25, 95% CI -0.28 to 0.78). Reductions in dysfunctional appraisals assessed via the scenario task correlated with reductions on the PTCI, PCL-5, and hair cortisol concentrations from pre- to posttraining time points.

Conclusions: Results support dysfunctional appraisals as a modifiable cognitive mechanism, and that their proximal modification transfers to downstream PTSD symptoms. These findings could open new avenues for improving present therapeutic approaches.
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http://dx.doi.org/10.1159/000514166DOI Listing
February 2021

Behavioral measures to fight COVID-19: An 8-country study of perceived usefulness, adherence and their predictors.

PLoS One 2020 7;15(12):e0243523. Epub 2020 Dec 7.

Mental Health Research and Treatment Center, Department of Clinical Child and Adolescent Psychology, Ruhr-Universität Bochum, Bochum, Germany.

Behavioral measures, such as the wearing of facemasks and maintaining of distance to other people, have been central in fighting the COVID-19 pandemic and will continue to be important in curbing its spread. We therefore investigated their perceived usefulness, adherence and their predictors in representative online samples in eight countries (France, Germany, Poland, Russia, Spain, Sweden, U.K., U.S.). Of the 7,658 participants, 77.4% rated governmental measures (highest: Germany, lowest: France) as useful and 91.7% reported adherence to them. Adherence was lowest in Russia and Poland, where people felt particularly left alone and not well supported, and in the U.S. and Sweden, where governments showed ambivalent attitudes towards the measures. The highest adherence was reported in countries with very high mortality (U.K., Spain, France) or very positively perceived government communication (Germany). Female gender, higher age, belonging to a risk group, being affected physically and mentally, perception of governmental communication as guided by the interests of people, feeling of being well informed and the level of positive mental health positively predicted both outcomes, while being affected economically negatively predicted both outcomes. Country-specific results are considered in the light of the protection motivation theory and the theory of planned behavior together with potential ways to improve active participation of the population. Overall, we recommend the governments and authorities to stress that each individual can contribute to the control of the COVID-19 situation by adherence to the measures in the public communication. Moreover, they should emphasize the risk of unconscious infection of older individuals by younger people, as well as the importance of physical activity for the protection of mental and physical health especially during the pandemic.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0243523PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7721173PMC
January 2021

Visual Attention to Sexual Stimuli in Women With Clinical, Subclinical, and Normal Sexual Functioning: An Eye-Tracking Study.

J Sex Med 2021 01 4;18(1):144-155. Epub 2020 Dec 4.

Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada.

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 (M = 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.
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http://dx.doi.org/10.1016/j.jsxm.2020.10.005DOI Listing
January 2021

[Health Assistants Perspectives on Team-Led Program for Patients with Panic Disorder in General Practice - A Qualitative Study].

Psychiatr Prax 2021 Jul 3;48(5):258-264. Epub 2020 Dec 3.

Institut für Allgemeinmedizin, Klinikum der Ludwig-Maximilians-Universität München.

Aim Of The Study: Investigation of the perspective of medical assistants (MA) regarding their participation in behaviour-therapy oriented interventions in family practice.

Method: 15 MA (w, 39.5 years old), case managers in a general practitioner supported exercise programme for patients with panic disorder (ICD-10: F41.0), were interviewed using semi-structured interview guidelines on the recruitment and interaction of/with patients, communication of the exercises and implementation in everyday practice. The interviews (n = 14) were documented, transcribed and qualitatively analysed according to Mayring.

Results: MA perceived their contribution to the intervention regarding recruitment and monitoring of patients through telephone contacts as positive.

Conclusion: Strengthening the role of MAs' can help to provide targeted support for patients with mental health problems in GP care as part of a low-threshold intervention and relieve the workload on the GP.
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http://dx.doi.org/10.1055/a-1310-2389DOI Listing
July 2021

The association between depression symptoms, psychological burden caused by Covid-19 and physical activity: An investigation in Germany, Italy, Russia, and Spain.

Psychiatry Res 2021 01 26;295:113596. Epub 2020 Nov 26.

Mental Health Research and Treatment Center, Department of Clinical Psychology and Psychotherapy, Ruhr-Universität Bochum, Bochum, Germany. Electronic address:

The outbreak of Covid-19 required the re-organization of everyday life. While some people accepted this challenge, other experienced the current situation as a heavy burden that impedes the adaptation to the new life conditions. The present study investigated factors that can impact the level of burden caused by Covid-19. Burden, depression symptoms and frequency of physical activity (e.g., jogging, cycling) were assessed via online surveys in overall 1,931 people from four countries (Germany: N = 625; Italy: N = 936; Russia: N = 230; Spain: N = 140). Similar result patterns were found in all country-specific samples. Burden by Covid-19 was significantly positively associated with depression symptoms, while it was significantly negatively linked to physical activity. Moreover, physical activity buffered the association between depression symptoms and burden. The present cross-national findings emphasize the protective effect of physical activity specifically in times of Covid-19. This issue should be addressed in governmental programs to longitudinally protect mental and physical health and to enhance the willingness to adhere to the anti-Covid-19 measures among the population.
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http://dx.doi.org/10.1016/j.psychres.2020.113596DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7688416PMC
January 2021

[Bullying experiences in outpatients of a child and adolescent psychotherapy centre - A particularly vulnerable group?]

Z Kinder Jugendpsychiatr Psychother 2021 Mar 10;49(2):101-114. Epub 2020 Nov 10.

Forschungs- und Behandlungszentrum für Psychische Gesundheit, Klinische Kinder- und Jugendpsychologie, Fakultät für Psychologie, Ruhr-Universität Bochum, Deutschland.

Bullying experiences in outpatients of a child and adolescent psychotherapy centre - A particularly vulnerable group? Bullying has both short- and long-term effects on physical and mental health. Thus, more victimized children might tend to be found in clinical samples. This is the first study to examine the prevalence of bullying roles and modes in children/adolescents in a psychotherapeutic outpatient setting in Germany. 298 outpatients being treated in a child/adolescent psychotherapy centre (6-20 years, 50.7 % female) completed a questionnaire concerning their bullying experiences over the last 6 months. 24.5 % of the patients reported from a victim's perspective, independent of being perpetrators of bullying. 19.1 % reported solely as victims, 5.4 % as victims who also bullied (bully-victims), and 2.0 % as bullies. More than one-third of those with victim or bully-victim experiences had been polyvictimized, 86.2 % were victims solely of traditional bullying, and 1.4 % solely of cyberbullying. The exploratory comparison to general-population school samples seems to show significantly more patients with victim experiences and significantly less patients who bullied others. There seem to be no significant effects for bully-victims. Compared to an inpatient sample, significantly fewer adolescent patients seem to state being victims or bully-victims. Bullying is a topic of particular importance in the context of psychotherapy. These findings have implications for the psychotherapeutic practice as well as training settings.
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http://dx.doi.org/10.1024/1422-4917/a000761DOI Listing
March 2021

The anxious addictive narcissist: The relationship between grandiose and vulnerable narcissism, anxiety symptoms and Facebook Addiction.

PLoS One 2020 2;15(11):e0241632. Epub 2020 Nov 2.

Mental Health Research and Treatment Center, Department of Clinical Psychology and Psychotherapy, Ruhr-Universität Bochum, Bochum, Germany.

Vulnerable narcissism and grandiose narcissism share the core of the narcissistic self but are considered as separate forms of this personality trait. While previous research mainly focused on the mechanisms that connect grandiose narcissism and addictive use of the social platform Facebook, it remained unclear why individuals with enhanced levels of vulnerable narcissism are at risk to develop Facebook Addiction (FA). The present study investigated the links between vulnerable and grandiose narcissism, anxiety symptoms, and FA. In a sample of 327 Facebook users (age: M(SD) = 23.67(3.96), range: 18-56), both forms of narcissism were positively related to anxiety symptoms and FA. Moreover, the association between both forms of narcissism and FA was partly mediated by anxiety symptoms. Results enter new territory by revealing hidden similarities between vulnerable and grandiose narcissists, emphasizing that similar mechanisms might explain their enhanced risk to develop addictive tendencies of Facebook use. These findings should be considered when assessing individuals at risk for FA and when developing (therapeutic) intervention programs to deal with problematic use of social platforms.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241632PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605684PMC
December 2020

Does Trauma Shape Identity? Exploring the Links Between Lifetime Trauma Exposure and Identity Status in Emerging Adulthood.

Front Psychol 2020 15;11:570644. Epub 2020 Sep 15.

Center for Psychotraumatology, Vilnius University, Vilnius, Lithuania.

In emerging adulthood, coherent identity plays a protective role against the development of the disturbed psychosocial functioning and is seen as one of the defining characteristics of positive youth development. The factors that shape the identity are still understudied and little quantitative research has addressed, how trauma exposure is linked to emerging adults' identity. Therefore, the current study aimed to investigate how exposure to traumatic experiences over the lifetime is associated with current identity status among emerging adults in an academic environment and to explore links between different types of traumatic experiences as well as the severity of exposure to trauma and identity statuses. The study sample consisted of 1,614 first-year undergraduate students from Lithuania with the age range of 18-29 years ( = 19.09, = 1.05, 68.28% female). The three distinct identity profiles were identified using the Latent Class Analysis, representing , , and identity statuses. The results provided no clear evidence of links between traumatic experiences and identity status for overall exposure and most types of traumatic events. However, our study concerns the potential importance of severe traumatic experiences, such as sexual trauma, on identity.
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http://dx.doi.org/10.3389/fpsyg.2020.570644DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7522346PMC
September 2020

Large-group one-session treatment: Feasibility and efficacy in 138 individuals with phobic fear of flying.

Behav Res Ther 2020 12 24;135:103735. Epub 2020 Sep 24.

Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Massenbergstraße 9-13, D-44787, Bochum, Germany. Electronic address:

Recent research suggests that exposure-based large-group one-session treatments (LG-OSTs) may represent useful and efficient treatment options for different types of phobic fear. Although there are effective single session- and small group-interventions for the treatment of clinically relevant Fear of Flying (FoF), no LG-OST for this type of phobic fear has been realized so far. The present study aimed to investigate feasibility and efficacy of an LG-OST for the treatment of clinically relevant FoF. Two months after an initial diagnostics to assess FoF severity and confirm the underlying diagnoses (89% specific flight phobia; 10% agoraphobia), 138 patients attended the LG-OST consisting of psychoeducation, imparting of a breathing technique and a joint 2 ½ hour exposure flight in a chartered airplane (Airbus A320). FoF again was assessed at pre- and post-treatment as well as at 6-months follow-up with the latter again containing clinical diagnostics. Only a small decrease in FoF emerged in the pre-treatment interval. From pre-to post-treatment however, substantial reductions in FoF were observed with a large mean 'intention-to-treat' effect size of Cohen's d = 1.42 that remained stable over time (mean d = 1.44). At follow-up, 71% of the patients were rated as fully (55%) or partially remitted (16%). Also concerning the treatment of clinically relevant FoF, a LG-OST proved feasible and effective. Therefore, LG-OST can be regarded as a highly efficient and promising treatment tool which in terms of efficiency combines the advantages of one-session individual and group treatments.
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http://dx.doi.org/10.1016/j.brat.2020.103735DOI Listing
December 2020

Psychological Treatment of Low Sexual Desire in Women: Protocol for a Randomized, Waitlist-Controlled Trial of Internet-Based Cognitive Behavioral and Mindfulness-Based Treatments.

JMIR Res Protoc 2020 Sep 29;9(9):e20326. Epub 2020 Sep 29.

Clinical Psychology and Psychotherapy, Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany.

Background: Psychological therapies are effective treatments for hypoactive sexual desire dysfunction (HSDD; formerly hypoactive sexual desire disorder), a common sexual dysfunction among women. Access to evidence-based treatments, however, remains difficult. Internet-based interventions are effective for a variety of psychological disorders and may be a promising means to close the treatment gap for HSDD.

Objective: This article describes the treatment protocol and study design of a randomized controlled trial, aiming to study the efficacy of cognitive behavioral and mindfulness-based interventions delivered via the internet for women with HSDD to a waitlist control group. Outcomes are sexual desire (primary) and sexual distress (secondary). Additional variables (eg, depression, mindfulness, rumination) will be assessed as potential moderators or mediators of treatment success.

Methods: A cognitive behavioral and a mindfulness-based self-help intervention for HSDD will be provided online. Overall, 266 women with HSDD will be recruited and assigned either to one of the intervention groups, or to a waitlist control group (2:2:1). Outcome data will be assessed at baseline, at 12 weeks, and at 6 and 12 months after randomization. Intention-to-treat and completer analyses will be conducted.

Results: We expect improvements in sexual desire and sexuality-related distress in both intervention groups compared to the waitlist control. Recruitment has begun in January 2019 and is expected to be completed in August 2021. Results will be published in 2022.

Conclusions: This study aims to contribute to the improvement and dissemination of psychological treatments for women with HSDD and to clarify whether cognitive behavioral and/or mindfulness-based treatments for HSDD are feasible and effective when delivered via the internet.

Trial Registration: ClinicalTrials.gov NCT03780751; https://clinicaltrials.gov/ct2/show/NCT03780751.

International Registered Report Identifier (irrid): DERR1-10.2196/20326.
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http://dx.doi.org/10.2196/20326DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7556380PMC
September 2020

Inducing positive involuntary mental imagery in everyday life: an experimental investigation.

Memory 2020 10 27;28(9):1157-1172. Epub 2020 Sep 27.

Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany.

Positive involuntary mental imagery occurs frequently in daily life but evidence as to its functions and importance is largely indirect. The current study investigated a method to induce positive involuntary imagery in daily life, which would allow direct testing of its impact. An unselected student sample (= 80) completed a single session of a positive imagery cognitive bias modification (CBM) paradigm, which involved listening to and imagining brief positive imagery scripts. Participants then recorded any involuntary memories of the imagined training scenarios in a three-day diary before returning to the lab for a follow-up assessment. Participants were randomised to imagine the scenarios in either an emotionally involved or emotionally detached manner, providing a test of the role of emotion in the subsequent experience of involuntary memories. Participants reported experiencing involuntary memories of the training scenarios in their daily life, but the number recorded did not differ between the experimental conditions. Exploratory analyses suggested that more vivid imagery and recall testing were associated with a greater number of involuntary memories. The study highlights the potential of the imagery CBM paradigm to further our understanding of the functions and potential importance of positive involuntary mental imagery in daily life.
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http://dx.doi.org/10.1080/09658211.2020.1822413DOI Listing
October 2020

Your Fear is My Fear: The Relationship Between Parental and Offspring Anxieties.

Child Psychiatry Hum Dev 2021 Oct 18;52(5):772-781. Epub 2020 Sep 18.

Mental Health Research and Treatment Center, Ruhr-University Bochum, Massenbergstrasse 9-13, 44847, Bochum, Germany.

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.
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http://dx.doi.org/10.1007/s10578-020-01060-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8405516PMC
October 2021

Mental health and the wish to have a child: a longitudinal, cross-cultural comparison between Germany and China.

J Psychosom Obstet Gynaecol 2020 Sep 11:1-13. Epub 2020 Sep 11.

The Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Germany.

Background: The desire to have children has been declining globally, especially in industrialized nations. This study examines the physical health correlates, and positive and negative mental health correlates of the wish to have a child across time and in two countries.

Method: Questionnaire data were obtained from large-scale university samples of 12,574 participants in Germany and China.

Results: The wish to have a child (child wish) is related to positive and negative mental health in China and, to a lesser degree, in Germany. Child wish is positively related to some aspects of mental and somatic health for Chinese women and men, negatively to depression for Chinese and German men and Chinese women, and positively to stress for German men, with generally small effects. Effects hold when controlling for age, partnership status, and family affluence. Most relationships were almost equal between women and men (in both China and Germany), and between countries with the exception of two different paths in each gender group. That is, having a partner is associated with a higher child wish in both Chinese and German female students. In China, older female students are more likely to want to have a child, while older female students in Germany are less likely to want to have a child. Neither partnership nor age predict child wish for the next year.

Conclusion: In sum, Chinese students reported feeling more positively about having children when they were happy and healthy, with the exception that highly satisfied Chinese males report lower child wish in the next year. More depressed Chinese and German men and Chinese women reported lowered child wish, and stressed German men reported more child wish. Older students reported more (Chinese) or less (German) child wish depending on country.
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http://dx.doi.org/10.1080/0167482X.2020.1816959DOI Listing
September 2020

Predicting adaptive and maladaptive responses to the Coronavirus (COVID-19) outbreak: A prospective longitudinal study.

Int J Clin Health Psychol 2020 Sep-Dec;20(3):183-191. Epub 2020 Jun 28.

Mental Health Research and Treatment Center, Department of Psychology, Ruhr-Universität Bochum, Germany.

Background/objective: The outbreak of COVID-19 and the lack of vaccine made extraordinary actions such as social distancing necessary. While some individuals experience the restrictions on daily life as a heavy burden, others adapt to the situation and try to make the best of it. The present longitudinal study investigated the extent and predictors of the burden induced by the outbreak of COVID-19 in Germany.

Method: Data were assessed in October 2019 using the DASS-21 and the PMH-Scale, and in March 2020 adding a six-item measure of burden and a 2-item rating of sense of control.

Results: In a sample of 436 participants, about 28% stayed in self-quarantine, 22 persons had relevant symptoms and one person was positively tested for COVID-19. Most participants experienced medium to high levels of burden but tried to make the best of it. Stress symptoms in 2019 predicted a higher level of burden and PMH predicted a lower level of burden in March 2020. Remarkably, depression and anxiety symptoms did not significantly predict burden. The protective effect of PMH and the negative impact of stress symptoms were mediated by perceived sense of control.

Conclusions: The results emphasize the protective effect of PMH in extraordinary situations such as the current outbreak of COVID-19.
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http://dx.doi.org/10.1016/j.ijchp.2020.06.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7321043PMC
June 2020
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