Publications by authors named "Michael Rufer"

81 Publications

Rumination about obsessive symptoms and mood maintains obsessive-compulsive symptoms and depressed mood: An experimental study.

J Abnorm Psychol 2021 Jul;130(5):435-442

Department of Psychology.

Rumination is common in individuals diagnosed with obsessive-compulsive disorder (OCD). We sought to clarify the causal role of rumination in the immediate and intermediate maintenance of obsessive-compulsive symptoms and depressed mood. In total, 145 individuals diagnosed with OCD were asked to read aloud their most distressing obsessive thought (OT). OT activation was followed by a thought-monitoring phase in which frequency of the OT was assessed. Participants were randomly allocated to one of three experimental conditions: rumination about obsessive-compulsive symptoms, rumination about mood, or distraction. Ratings of distress, urge to neutralize, and depressed mood and frequency ratings of the OTs were taken before and after the experimental manipulation. Obsessive-compulsive symptom severity and affect were assessed 2, 4, and 24 hr after the laboratory experiment using ecological momentary assessment. Compared to distraction, both types of rumination resulted in an immediate reduced decline of distress, urge to neutralize, depressed mood, and frequency of OTs, with medium to large effect sizes. Rumination about obsessive-compulsive symptoms did not have a stronger immediate effect than rumination about mood. Rumination about obsessive-compulsive symptoms increased obsessive-compulsive symptom severity and reduced positive affect compared to rumination about mood 24 hr later. Regarding negative affect, there was no difference in effect between the two types of rumination in the intermediate term. To conclude, rumination in OCD has an immediate and intermediate maintaining effect on obsessive-compulsive symptoms and mood and may require additional psychological interventions that supplement cognitive behavioral therapy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/abn0000677DOI Listing
July 2021

Do Chronic Pain Patients Wish Spiritual Aspects to Be Integrated in Their Medical Treatment? A Cross-Sectional Study of Multiple Facilities.

Front Psychiatry 2021 17;12:685158. Epub 2021 Jun 17.

Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland.

Chronic pain is a complex, multidimensional experience. Spirituality is hypothesized to impact pain experience in various ways. Nevertheless, the role that spirituality plays in multimodal pain therapy remains controversial and, to date, quantitative data on whether and for which patients spiritual aspects should be considered in the treatment of chronic pain is lacking. The aim of this study was thus to investigate the proportion and characteristics of patients with chronic pain who wish spiritual aspects to be integrated in their treatment. Two hundred nine patients with chronic pain were recruited from five inpatient departments and outpatient clinics in the German-speaking part of Switzerland. Patients filled out validated questionnaires, such as the Hospital Anxiety and Depression Scale (HADS), the Resilience Scale (RS-11), the Spiritual and Religious Attitudes in Dealing with Illness (SpREUK), and the 12-item Spiritual Well-Being Scale (FACIT-Sp-12). More than 60% (CI: 55.5-67.9%) of the patients wanted to address spiritual aspects in their treatment. These patients were significantly younger, had higher levels of education, and suffered from more frequent and more severe pain than patients who did not wish to address spiritual aspects. Furthermore, there were high correlations with existing spiritual resources and higher scores of spirituality. These results confirm that the majority of chronic pain patients wish spiritual aspects to be considered in their treatment. Additionally, the finding that these patients had more spiritual resources underlines the importance of integrating spiritual aspects in a resource-oriented, patient-centered care approach for this condition.
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http://dx.doi.org/10.3389/fpsyt.2021.685158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8247432PMC
June 2021

Comparing perspectives: patients' and health care professionals' views on spiritual concerns and needs in chronic pain care - a qualitative study.

BMC Health Serv Res 2021 May 26;21(1):504. Epub 2021 May 26.

Centre for Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland.

Background: The spiritual aspect of care is an often neglected resource in pain therapies. The aim of this study is to identify commonalities and differences in chronic pain patients' (CPP) and health care professionals' (HCP) perceptions on the integration of spiritual care into multimodal pain therapy.

Methods: We conducted a qualitative exploratory study with 42 CPPs and 34 HCPs who were interviewed in 12 separate groups in five study centres specialising in chronic pain within German-speaking Switzerland. The interviews were transcribed and subjected to a qualitative content analysis. Findings were generated by juxtaposing and analysing the statements of (a) HCP about HCP, (b) HCP about CPP, (c) CPP about HCP, and (d) CPP about CPP.

Results: Views on spiritual concerns and needs in chronic pain care can be described in three distinct dimensions: function (evaluating the need / request to discuss spiritual issues), structure (evaluating when / how to discuss spiritual issues) and context (evaluating why / under which circumstances to discuss spiritual issues). CPPs stress the importance of HCPs recognizing their overall human integrity, including the spiritual dimension, and would like to grant spiritual concerns greater significance in their therapy. HCPs express difficulties in addressing and discussing spiritual concerns and needs with chronic pain patients. Both parties want clarification of the context in which the spiritual dimension could be integrated into treatment. They see a need for greater awareness and training of HCPs in how the spiritual dimension in therapeutic interactions might be addressed.

Conclusions: Although there are similarities in the perspectives of HCPs and CPPs regarding spiritual concerns and needs in chronic pain care, there are relevant differences between the two groups. This might contribute to the neglect of the spiritual dimension in the treatment of chronic pain.

Trial Registration: This study was part of a larger research project, registered in a primary (clinicaltrial.gov: NCT03679871 ) and local (kofam.ch: SNCTP000003086 ) clinical trial registry.
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http://dx.doi.org/10.1186/s12913-021-06508-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8152324PMC
May 2021

Interfering with fear memories by eye movement desensitization and reprocessing.

Int J Psychophysiol 2021 08 24;166:9-18. Epub 2021 Apr 24.

Department of Consultation- Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland. Electronic address:

Objective: Pharmacologic and behavioral interventions that block reconsolidation of reactivated fear memory have demonstrated only limited success in modifying stronger and long-standing fear memories. Given the efficacy of Eye Movement Desensitization and Reprocessing (EMDR) in treating PTSD, pursuit eye movements are a promising and novel intervention for studies of human memory reconsolidation. Here, we examined the efficacy of pursuit eye movements in interfering with reconsolidation of conditioned fear memories.

Methods: We conducted a 3-day differential Pavlovian fear conditioning procedure in healthy adults, using videos of biologically prepared stimuli (tarantulas), partly reinforced with electrical shocks while recording skin conductance response (SCR) as a measure of autonomic conditioned responses. Fear conditioning was performed on Day 1. On Day 2, 38 participants were randomized into groups performing pursuit eye movements either immediately after fear memory reactivation, when the fear memory was stable, or 10 min later, when the fear memory was assumed to be more labile. On Day 3, fear memory strength was assessed by SCR to both reactivated and nonreactivated fear memories.

Results: Strong differential conditioning to the spider stimuli were observed during both fear acquisition and fear memory reactivation. Reactivated fear memory conditioned responses of participants performing pursuit eye movements after a 10-min delay were significantly smaller in the reinstatement phase (0.16 μS; 95% CI [0.02, 0.31]).

Conclusions: Pursuit eye movements were effective in reducing fear-conditioned SCR in reinstatement. This result supports the theoretical proposition that EMDR can interfere with reactivated fear memory reconsolidation.
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http://dx.doi.org/10.1016/j.ijpsycho.2021.04.006DOI Listing
August 2021

Including the Spiritual Dimension in Multimodal Pain Therapy. Development and Validation of the Spiritual Distress and Resources Questionnaire (SDRQ).

J Pain Symptom Manage 2021 Feb 23. Epub 2021 Feb 23.

Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland.

Context: Valid instruments for assessing spiritual resources and distress in pain therapy are scarce. The Spiritual Distress and Resources Questionnaire (SDRQ) was developed to fill this gap.

Goals: The objective of this study was to investigate the SDRQ's psychometric properties.

Methods: We presented the SDRQ to 219 patients with chronic pain conditions and examined its measurement properties, namely reliability and structural, convergent and discriminant validity. To investigate test-retest reliability, the SDRQ was presented a second time to a subsample of 58 randomly selected participants.

Results: Factor analysis required a grouping of the 22 SDRQ items into four subscales: spiritual distress, spiritual coping, immanence and transcendence, the latter two representing spiritual resources. Cronbach's alpha was high for spiritual distress (0.93), transcendence (0.85), and immanence (0.81) while it was somewhat lower but still satisfactory for spiritual coping (0.70). The construct validity of the SDRQ was shown by correlations with established measures in the field. Higher levels of spiritual distress were associated with signs of more severe illness, such as emotional distress and pain intensity.

Conclusion: The results from this study suggest that the SDRQ is an easy-to-use, reliable and valid screening instrument for assessing spiritual distress, spiritual resources and spiritual coping in patients with chronic pain. The SDRQ has the potential to be used with patients suffering from other chronic diseases and to disseminate the palliative approach to pain treatment to other areas of medicine.
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http://dx.doi.org/10.1016/j.jpainsymman.2021.02.021DOI Listing
February 2021

[Spirituality and health care. The perspective of patients with chronic pain].

Schmerz 2021 Jan 8. Epub 2021 Jan 8.

Professur für Spiritual Care, Theologische Fakultät, Universität Zürich, Zürich, Schweiz.

Background: Chronic pain affects all aspects of human life, which raises spiritual questions that should be included within the framework of multimodal care.

Objectives: We investigated the perspective of patients with chronic pain around spiritual concerns and their potential integration into care.

Materials And Methods: We conducted five focus group interviews and two small group interviews. In total, 42 patients with chronic pain in outpatient or inpatient pain care at the time of the study participated. The interviews were transcribed and thematically analyzed.

Results: Three themes emerged: (1) Chronic pain permeates the entity of a person's existence. (2) Spiritual resources are potentially supportive in living with chronic pain. (3) Patients appreciate the opportunity to engage with health care professionals in a dialog that encompasses spiritual concerns. For participants, these concerns have considerable relevance. In many cases participants associated them with religious convictions, but not exclusively. They often related feeling that their pain experience was dismissed.

Conclusion: Finding strategies for effectively dealing with chronic pain represents a turning point in life. Open discussion with health care professionals that allow for spiritual issues facilitates this process.
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http://dx.doi.org/10.1007/s00482-020-00524-3DOI Listing
January 2021

Eine Zukunft für die medizinische Lehre oder der Weg zum «Teach me».

Praxis (Bern 1994) 2021 01;110(1)

Psychiatrische Universitätsklinik Zürich.

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http://dx.doi.org/10.1024/1661-8157/a003602DOI Listing
January 2021

Alexithymia and automatic processing of facial emotions: behavioral and neural findings.

BMC Neurosci 2020 05 29;21(1):23. Epub 2020 May 29.

Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstrasse 10, 04103, Leipzig, Germany.

Background: Alexithymia is a personality trait characterized by difficulties identifying and describing feelings, an externally oriented style of thinking, and a reduced inclination to imagination. Previous research has shown deficits in the recognition of emotional facial expressions in alexithymia and reductions of brain responsivity to emotional stimuli. Using an affective priming paradigm, we investigated automatic perception of facial emotions as a function of alexithymia at the behavioral and neural level. In addition to self-report scales, we applied an interview to assess alexithymic tendencies.

Results: During 3 T fMRI scanning, 49 healthy individuals judged valence of neutral faces preceded by briefly shown happy, angry, fearful, and neutral facial expressions. Alexithymia was assessed using the 20-Item Toronto Alexithymia Scale (TAS-20), the Bermond-Vorst Alexithymia Questionnaire (BVAQ) and the Toronto Structured Interview for Alexithymia (TSIA). As expected, only negative correlations were found between alexithymic features and affective priming. The global level of self-reported alexithymia (as assessed by the TAS-20 and the BVAQ) was found to be related to less affective priming owing to angry faces. At the facet level, difficulties identifying feelings, difficulties analyzing feelings, and impoverished fantasy (as measured by the BVAQ) were correlated with reduced affective priming due to angry faces. Difficulties identifying feelings (BVAQ) correlated also with reduced affective priming due to fearful faces and reduced imagination (TSIA) was related to decreased affective priming due to happy faces. There was only one significant correlation between alexithymia dimensions and automatic brain response to masked facial emotions: TAS-20 alexithymia correlated with heightened brain response to masked happy faces in superior and medial frontal areas.

Conclusions: Our behavioral results provide evidence that alexithymic features are related in particular to less sensitivity for covert facial expressions of anger. The perceptual alterations could reflect impaired automatic recognition or integration of social anger signals into judgemental processes and might contribute to the problems in interpersonal relationships associated with alexithymia. Our findings suggest that self-report measures of alexithymia may have an advantage over interview-based tests as research tools in the field of emotion perception at least in samples of healthy individuals characterized by rather low levels of alexithymia.
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http://dx.doi.org/10.1186/s12868-020-00572-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7257227PMC
May 2020

Alexithymia and automatic processing of facial emotions: behavioral and neural findings.

BMC Neurosci 2020 05 29;21(1):23. Epub 2020 May 29.

Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstrasse 10, 04103, Leipzig, Germany.

Background: Alexithymia is a personality trait characterized by difficulties identifying and describing feelings, an externally oriented style of thinking, and a reduced inclination to imagination. Previous research has shown deficits in the recognition of emotional facial expressions in alexithymia and reductions of brain responsivity to emotional stimuli. Using an affective priming paradigm, we investigated automatic perception of facial emotions as a function of alexithymia at the behavioral and neural level. In addition to self-report scales, we applied an interview to assess alexithymic tendencies.

Results: During 3 T fMRI scanning, 49 healthy individuals judged valence of neutral faces preceded by briefly shown happy, angry, fearful, and neutral facial expressions. Alexithymia was assessed using the 20-Item Toronto Alexithymia Scale (TAS-20), the Bermond-Vorst Alexithymia Questionnaire (BVAQ) and the Toronto Structured Interview for Alexithymia (TSIA). As expected, only negative correlations were found between alexithymic features and affective priming. The global level of self-reported alexithymia (as assessed by the TAS-20 and the BVAQ) was found to be related to less affective priming owing to angry faces. At the facet level, difficulties identifying feelings, difficulties analyzing feelings, and impoverished fantasy (as measured by the BVAQ) were correlated with reduced affective priming due to angry faces. Difficulties identifying feelings (BVAQ) correlated also with reduced affective priming due to fearful faces and reduced imagination (TSIA) was related to decreased affective priming due to happy faces. There was only one significant correlation between alexithymia dimensions and automatic brain response to masked facial emotions: TAS-20 alexithymia correlated with heightened brain response to masked happy faces in superior and medial frontal areas.

Conclusions: Our behavioral results provide evidence that alexithymic features are related in particular to less sensitivity for covert facial expressions of anger. The perceptual alterations could reflect impaired automatic recognition or integration of social anger signals into judgemental processes and might contribute to the problems in interpersonal relationships associated with alexithymia. Our findings suggest that self-report measures of alexithymia may have an advantage over interview-based tests as research tools in the field of emotion perception at least in samples of healthy individuals characterized by rather low levels of alexithymia.
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http://dx.doi.org/10.1186/s12868-020-00572-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7257227PMC
May 2020

Recovery from pathological skin picking and dermatodaxia using a revised decoupling protocol.

J Cosmet Dermatol 2020 Nov 29;19(11):3038-3040. Epub 2020 Mar 29.

Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Objective: Pathological skin picking (PSP) is characterized by repetitive scratching, biting, and picking of the skin. The disorder is subsumed under the section "obsessive-compulsive and related disorders" in the DSM-5. A related body-focused repetitive disorder, which has received less empirical attention so far, is dermatophagia or dermatodaxia (eating or biting/gnawing of the skin). Habit reversal training (HRT) is regarded as the treatment of choice demonstrating improvement at a medium effect size relative to control conditions.

Methods: The present case report describes a 50-year-old man with a lifetime history of PSP and dermatodaxia of the fingertips who stopped excessive nail-biting approximately 10 years ago using a treatment method known as decoupling. Yet, his PSP and dermatodaxia remained treatment-refractory after treatment with both decoupling (conventional protocol) and HRT.

Results: Using a revised protocol of decoupling, the man was able to fully stop PSP and dermatodaxia; only the tendency to fidget nervously with his hands remained. The case report describes the revised protocol. Scores on the Skin Picking Scale Revised (SPS-R) dropped from 15 to 0.

Discussion: The revised decoupling protocol is an easy to use technique that holds promise in this underdiagnosed and undertreated condition. Yet, rigorous randomized controlled studies are needed to ascertain its efficacy.
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http://dx.doi.org/10.1111/jocd.13378DOI Listing
November 2020

Hospital-based bereavement care provision: A cross-sectional survey with health professionals.

Palliat Med 2020 04 23;34(4):547-552. Epub 2019 Dec 23.

Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland.

Background: An in-hospital death is a profound experience for those left behind and has been associated with family members' psychological morbidity. Supporting bereaved family members is an essential part of end-of-life care and includes attentive presence, information-giving, and emotional and practical support. The actual adoption of hospital-based bereavement care, however, remains little understood.

Aim: To investigate hospital-based bereavement care provision and associated barriers.

Design: Cross-sectional survey using an online questionnaire.

Setting/participants: Health professionals ( = 196) from two University-affiliated acute and psychiatric hospitals in Switzerland.

Results: The most frequent bereavement services (⩾40%) were viewing the deceased, giving information on available support, and making referrals; the most often named barriers were lack of time and organizational support. Acute care health professionals faced statistically significant more structural barriers (55.1% vs 21.4% lack of time, 47.8% vs 25.9% lack of organizational support) and felt insufficiently trained (38.4% vs 20.7%) compared to mental health professionals ( ⩽ 0.05). Nurses provided more immediate services compared to physicians, such as viewing the deceased (71.3% vs 49.0%) and sending sympathy cards (37.4% vs 16.3%) ( ⩽ 0.01). In contrast, physicians screened more often for complex bereavement disorders (10.2% vs 2.6%) and appraised bereavement care as beyond their role (26.5% vs 7.8%) ( ⩽ 0.05).

Conclusion: The study indicates that many barriers to bereavement care exist in hospitals. More research is required to better understand enabling and limiting factors to bereavement care provision. A guideline-driven approach to hospital-based bereavement care that defines best practice and required organizational support seems necessary to ensure needs-based bereavement care.
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http://dx.doi.org/10.1177/0269216319891070DOI Listing
April 2020

Facial mimicry, facial emotion recognition and alexithymia in post-traumatic stress disorder.

Behav Res Ther 2019 11 4;122:103436. Epub 2019 Jul 4.

University Hospital Zurich, Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, Switzerland. Electronic address:

Individuals with post-traumatic stress disorder (PTSD) show abnormalities in higher-order emotional processes, including emotion regulation and recognition. However, automatic facial responses to observed facial emotion (facial mimicry) has not yet been investigated in PTSD. Furthermore, whereas deficits in facial emotion recognition have been reported, little is known about contributing factors. We thus investigated facial mimicry and potential effects of alexithymia and expressive suppression on facial emotion recognition in PTSD. Thirty-eight PTSD participants, 43 traumatized and 33 non-traumatized healthy controls completed questionnaires assessing alexithymia and expressive suppression. Facial electromyography was measured from the muscles zygomaticus major and corrugator supercilii during a facial emotion recognition task. Corrugator activity was increased in response to negative emotional expressions compared to zygomaticus activity and vice versa for positive emotions, but no significant group differences emerged. Individuals with PTSD reported greater expressive suppression and alexithymia than controls, but only levels of alexithymia predicted lower recognition of negative facial expressions. While automatic facial responses to observed facial emotion seem to be intact in PTSD, alexithymia, but not expressive suppression, plays an important role in facial emotion recognition of negative emotions. If replicated, future research should evaluate whether successful interventions for alexithymia improve facial emotion recognition abilities.
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http://dx.doi.org/10.1016/j.brat.2019.103436DOI Listing
November 2019

Stigma as a Barrier to Mental Health Service Use Among Female Sex Workers in Switzerland.

Front Psychiatry 2019 5;10:32. Epub 2019 Feb 5.

Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zürich, Zurich, Switzerland.

Many sex workers suffer from mental health problems, but do not seek help. To examine stigma-related and non stigma-related barriers to care and perceived need for treatment among female sex workers in Switzerland. Mental health service use, barriers to care, perceived need and presence of illness, symptoms, and psychiatric diagnoses were assessed among 60 female sex workers in Zürich, Switzerland. Mental health service use was defined as use of psychiatric medication, psychotherapy, or substance use services for at least 1 month during the past 6 months. Adjusting for symptom levels, mental health service use was predicted by lower stigma-related, not by structural, barriers as well as by more perceived need for treatment and higher age. Sex workers with mental health problems would benefit from non-stigmatizing mental health care as well as from interventions to reduce public and self-stigma associated with mental illness and sex work. Limitations are the cross-sectional data, limited sample size, and recruitment from an information center for sex workers. Interventions that aim to increase mental health service use among sex workers should take stigma variables into account.
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http://dx.doi.org/10.3389/fpsyt.2019.00032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6370716PMC
February 2019

Impaired Recognition of Positive Emotions in Individuals with Posttraumatic Stress Disorder, Cumulative Traumatic Exposure, and Dissociation.

Psychother Psychosom 2018 1;87(2):118-120. Epub 2018 Mar 1.

Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland.

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http://dx.doi.org/10.1159/000486342DOI Listing
October 2018

Does trait anxiety influence effects of oxytocin on eye-blink startle reactivity? A randomized, double-blind, placebo-controlled crossover study.

PLoS One 2018 4;13(1):e0190809. Epub 2018 Jan 4.

Division of Clinical and Health Psychology, Department of Psychology, University of Fribourg, Fribourg, Switzerland.

Background: Previous research has demonstrated that the neuropeptide oxytocin modulates social behaviors and reduces anxiety. However, effects of oxytocin on startle reactivity, a well-validated measure of defense system activation related to fear and anxiety, have been inconsistent. Here we investigated the influence of oxytocin on startle reactivity with particular focus on the role of trait anxiety.

Methods: Forty-four healthy male participants attended two experimental sessions. They received intranasal oxytocin (24 IU) in one session and placebo in the other. Startle probes were presented in combination with pictures of social and non-social content. Eye-blink startle magnitude was measured by electromyography over the musculus orbicularis oculi in response to 95 dB noise bursts. Participants were assigned to groups of high vs. low trait anxiety based on their scores on the trait form of the Spielberger State-Trait Anxiety Inventory (STAI).

Results: A significant interaction effect of oxytocin with STAI confirmed that trait anxiety moderated the effect of oxytocin on startle reactivity. Post-hoc tests indicated that for participants with elevated trait anxiety, oxytocin increased startle magnitude, particularly when watching non-social pictures, while this was not the case for participants with low trait anxiety.

Conclusion: Results indicate that effects of oxytocin on defense system activation depend on individual differences in trait anxiety. Trait anxiety may be an important moderator variable that should be considered in human studies on oxytocin effects.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0190809PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5754118PMC
February 2018

Alexithymia Is Associated with Tinnitus Severity.

Front Psychiatry 2017 6;8:223. Epub 2017 Nov 6.

Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.

Objective: Alexithymia is considered to be a personality trait with a tendency to express psychological distress in somatic rather than emotional form and, therefore, may play a vital role in somatization. Although, such a propensity can be found in patients suffering from tinnitus, the relationship between alexithymic characteristics and the subjective experience of tinnitus severity remains yet unclear. Our aim was to evaluate which alexithymic characteristics are linked to the subjective experience of tinnitus symptomatology.

Methods: We evaluated tinnitus severity (Tinnitus Handicap Inventory, THI), alexithymia (20-item Toronto Alexithymia Scale, TAS-20), and depression (Beck Depression Inventory, BDI) in 207 outpatients with tinnitus. Correlation analyses and multiple regression analyses were calculated in order to investigate the relationship between alexithymic characteristics, tinnitus severity, and depression.

Results: Highly significant positive correlations were found between THI total score and TAS-20 total score as well as BDI score. Regarding the TAS-20 subscales, multiple regression analyses showed that only the TAS-20 subscale "difficulty in identifying feelings" (DIF) and the BDI significantly predicted the subjective experience of tinnitus severity. Regarding the THI subscales, only higher scores of the THI subscale "functional" demonstrated an independent moderate association with higher scores for DIF.

Conclusion: We found an independent association between the subjective experience of tinnitus severity and alexithymic characteristics, particularly with regard to limitations in the fields of mental, social, and physical functioning because of tinnitus and the difficulty of identifying feelings facet of alexithymia. These findings are conducive to a better understanding of affect regulation that may be important for the psychological adaptation of patients suffering from tinnitus.
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http://dx.doi.org/10.3389/fpsyt.2017.00223DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5681746PMC
November 2017

Locus Coeruleus Activity Mediates Hyperresponsiveness in Posttraumatic Stress Disorder.

Biol Psychiatry 2018 02 7;83(3):254-262. Epub 2017 Sep 7.

Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland. Electronic address:

Background: Patients with posttraumatic stress disorder (PTSD) are hyperresponsive to unexpected or potentially threatening environmental stimuli. Research in lower animals and humans suggests that sensitization of the locus coeruleus-norepinephrine system may underlie behavioral and autonomic hyperresponsiveness in PTSD. However, direct evidence linking locus coeruleus system hyperactivity to PTSD hyperresponsiveness is sparse.

Methods: Psychophysiological recording and functional magnetic resonance imaging were used during passive listening to brief, 95-dB sound pressure level, white noise bursts presented intermittently to determine whether behavioral and autonomic hyperresponsiveness to sudden sounds in PTSD is associated with locus coeruleus hyperresponsiveness.

Results: Participants with PTSD (n = 28) showed more eye-blink reflexes and larger heart rate, skin conductance, and pupil area responses to loud sounds (multivariate p = .007) compared with trauma-exposed participants without PTSD (n = 26). PTSD participants exhibited larger responses in locus coeruleus (t = 2.60, region of interest familywise error corrected), intraparietal sulcus, caudal dorsal premotor cortex, and cerebellar lobule VI (t ≥ 4.18, whole-brain familywise error corrected). Caudal dorsal premotor cortex activity was associated with both psychophysiological response magnitude and levels of exaggerated startle responses in daily life in PTSD participants (t ≥ 4.39, whole-brain familywise error corrected).

Conclusions: Behavioral and autonomic hyperresponsiveness in PTSD may arise from a hyperactive alerting/orienting system in which processes related to attention and motor preparation localized to lateral premotor cortex, intraparietal sulcus, and posterior superior cerebellar cortex are modulated by atypically high phasic noradrenergic influences originating in the locus coeruleus.
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http://dx.doi.org/10.1016/j.biopsych.2017.08.021DOI Listing
February 2018

Trichotillomania: the impact of treatment history on the outcome of an Internet-based intervention.

Neuropsychiatr Dis Treat 2017 21;13:1153-1162. Epub 2017 Apr 21.

Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland.

Background: Many patients suffering from trichotillomania (TTM) have never undergone treatment. Without treatment, TTM often presents with a chronic course. Characteristics of TTM individuals who have never been treated (untreated) remain largely unknown. Whether treatment history impacts Internet-based interventions has not yet been investigated. We aimed to answer whether Internet-based interventions can reach untreated individuals and whether treatment history is associated with certain characteristics and impacts on the outcome of an Internet-based intervention.

Methods: We provided Internet-based interventions. Subjects were characterized at three time points using the Massachusetts General Hospital Hairpulling Scale, Hamilton Depression Rating Scale, and the World Health Organization Quality of Life questionnaire.

Results: Of 105 individuals, 34 were untreated. Health-related quality of life (HRQoL) was markedly impaired in untreated and treated individuals. Symptom severity did not differ between untreated and treated individuals. Nontreatment was associated with fewer depressive symptoms (=0.002). Treatment history demonstrated no impact on the outcome of Internet-based interventions.

Conclusion: Results demonstrate that Internet-based interventions can reach untreated TTM individuals. They show that untreated individuals benefit as much as treated individuals from such interventions. Future Internet-based interventions should focus on how to best reach/support untreated individuals with TTM. Additionally, future studies may examine whether Internet-based interventions can reach and help untreated individuals suffering from other psychiatric disorders.
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http://dx.doi.org/10.2147/NDT.S128592DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5407455PMC
April 2017

Mobile Sensing and Support for People With Depression: A Pilot Trial in the Wild.

JMIR Mhealth Uhealth 2016 Sep 21;4(3):e111. Epub 2016 Sep 21.

ETH Zürich, Department of Management, Technology and Economics, Zürich, Switzerland.

Background: Depression is a burdensome, recurring mental health disorder with high prevalence. Even in developed countries, patients have to wait for several months to receive treatment. In many parts of the world there is only one mental health professional for over 200 people. Smartphones are ubiquitous and have a large complement of sensors that can potentially be useful in monitoring behavioral patterns that might be indicative of depressive symptoms and providing context-sensitive intervention support.

Objective: The objective of this study is 2-fold, first to explore the detection of daily-life behavior based on sensor information to identify subjects with a clinically meaningful depression level, second to explore the potential of context sensitive intervention delivery to provide in-situ support for people with depressive symptoms.

Methods: A total of 126 adults (age 20-57) were recruited to use the smartphone app Mobile Sensing and Support (MOSS), collecting context-sensitive sensor information and providing just-in-time interventions derived from cognitive behavior therapy. Real-time learning-systems were deployed to adapt to each subject's preferences to optimize recommendations with respect to time, location, and personal preference. Biweekly, participants were asked to complete a self-reported depression survey (PHQ-9) to track symptom progression. Wilcoxon tests were conducted to compare scores before and after intervention. Correlation analysis was used to test the relationship between adherence and change in PHQ-9. One hundred twenty features were constructed based on smartphone usage and sensors including accelerometer, Wifi, and global positioning systems (GPS). Machine-learning models used these features to infer behavior and context for PHQ-9 level prediction and tailored intervention delivery.

Results: A total of 36 subjects used MOSS for ≥2 weeks. For subjects with clinical depression (PHQ-9≥11) at baseline and adherence ≥8 weeks (n=12), a significant drop in PHQ-9 was observed (P=.01). This group showed a negative trend between adherence and change in PHQ-9 scores (rho=-.498, P=.099). Binary classification performance for biweekly PHQ-9 samples (n=143), with a cutoff of PHQ-9≥11, based on Random Forest and Support Vector Machine leave-one-out cross validation resulted in 60.1% and 59.1% accuracy, respectively.

Conclusions: Proxies for social and physical behavior derived from smartphone sensor data was successfully deployed to deliver context-sensitive and personalized interventions to people with depressive symptoms. Subjects who used the app for an extended period of time showed significant reduction in self-reported symptom severity. Nonlinear classification models trained on features extracted from smartphone sensor data including Wifi, accelerometer, GPS, and phone use, demonstrated a proof of concept for the detection of depression superior to random classification. While findings of effectiveness must be reproduced in a RCT to proof causation, they pave the way for a new generation of digital health interventions leveraging smartphone sensors to provide context sensitive information for in-situ support and unobtrusive monitoring of critical mental health states.
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http://dx.doi.org/10.2196/mhealth.5960DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5052463PMC
September 2016

Effects of Posture and Stimulus Spectral Composition on Peripheral Physiological Responses to Loud Sounds.

PLoS One 2016 1;11(9):e0161237. Epub 2016 Sep 1.

Department of Psychiatry and Psychotherapy, University Hospital Zurich, Zurich, Switzerland.

In the "loud-tone" procedure, a series of brief, loud, pure-tone stimuli are presented in a task-free situation. It is an established paradigm for measuring autonomic sensitization in posttraumatic stress disorder (PTSD). Successful use of this procedure during fMRI requires elicitation of brain responses that have sufficient signal-noise ratios when recorded in a supine, rather than sitting, position. We investigated the modulating effects of posture and stimulus spectral composition on peripheral psychophysiological responses to loud sounds. Healthy subjects (N = 24) weekly engaged in a loud-tone-like procedure that presented 500 msec, 95 dB sound pressure level, pure-tone or white-noise stimuli, either while sitting or supine and while peripheral physiological responses were recorded. Heart rate, skin conductance, and eye blink electromyographic responses were larger to white-noise than pure-tone stimuli (p's < 0.001, generalized eta squared 0.073-0.076). Psychophysiological responses to the stimuli were similar in the sitting and supine position (p's ≥ 0.082). Presenting white noise, rather than pure-tone, stimuli may improve the detection sensitivity of the neural concomitants of heightened autonomic responses by generating larger responses. Recording in the supine position appears to have little or no impact on psychophysiological response magnitudes to the auditory stimuli.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0161237PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5008836PMC
August 2017

E-mail support as an adjunct to cognitive-behavioral group therapy for social anxiety disorder: Impact on dropout and outcome.

Psychiatry Res 2016 Oct 22;244:151-8. Epub 2016 Jul 22.

Department of Psychiatry and Psychotherapy, University Hospital of Zürich, Zürich, Switzerland.

The present study evaluates the impact of semi-individualized e-mail support as an adjunct to cognitive behavioral group therapy (CBGT) for social anxiety disorder (SAD) on dropout and outcome. The effectiveness of additional semi-individualized e-mail support was evaluated for the whole sample and for a subsample of patients at risk of dropping out of therapy. A total of 91 patients with SAD were allocated either to the intervention condition (CBGT with e-mail support), or to the control condition (CBGT without e-mail support). Anxiety symptoms, depression, global symptomatology and life satisfaction were assessed at pretreatment, post-treatment and follow-up (3, 6 and 12 months). From pre-treatment to post-treatment, both groups improved significantly on all symptom measures. Therapy gains were maintained at the 1-year follow-up. Subsample analyses showed that CBGT+e-mail was more effective than CGBT alone in reducing symptom severity among patients missing at least two therapy sessions. Additionally, in this subgroup, those receiving additional e-mail support showed a tendency towards lower dropout rates. Based on the results of this study, semi-individualized e-mail support between sessions seems to enhance the effectiveness of CBGT for SAD patients at risk of dropping out of treatment and should be considered as an additional tool in clinical practice.
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http://dx.doi.org/10.1016/j.psychres.2016.07.038DOI Listing
October 2016

Observer-Rated Alexithymia and its Relationship with the Five-Factor-Model of Personality.

Psychol Belg 2016 May 26;56(2):118-134. Epub 2016 May 26.

Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany.

Studies examining the relationship between alexithymia and personality exclusively employed self-report measures of alexithymia. In the present study, we examined the relationship of both observer-rated and self-reported alexithymia with the Big Five personality dimensions. We administered the Toronto Structured Interview for Alexithymia (TSIA) as an interview-based measure of alexithymia and, in addition, two self-report questionnaires, the 20-item Toronto Alexithymia Scale (TAS-20) and the Bermond-Vorst Alexithymia Questionnaire (BVAQ). Fifty-one university students were interviewed and completed the alexithymia scales and the NEO Five-Factor Inventory. In contrast to TAS-20 and BVAQ, the Difficulty identifying feelings (DIF) scale of the TSIA was found to be unrelated to neuroticism, suggesting that the frequently reported association between DIF and neuroticism could be due to the use of self-report scales. In contrast, the affective dimension of alexithymia, measured by the BVAQ, was even negatively related with neuroticism. Thus, a paucity of fantasy and little emotional arousal goes together with increased emotional stability. Furthermore, we revealed negative correlations between interview-based alexithymia scores and openness to experience and agreeableness, which cross-validated the self-report findings. Finally, extraversion and conscientiousness each showed only one negative correlation, namely with subscales of the BVAQ. Taken together, our findings show that on the basis of interviews there is no evidence for a relation of DIF with neuroticism, while associations of alexithymia with low openness to experience and low agreeableness emerged irrespective of assessment approach. The relations of alexithymia with personality are discussed in the light of different measurement approaches.
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http://dx.doi.org/10.5334/pb.302DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5854197PMC
May 2016

Obsessive-compulsive and posttraumatic stress symptoms among civilian survivors of war.

BMC Psychiatry 2016 Apr 27;16:115. Epub 2016 Apr 27.

Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Culmannstrasse 8, 8091, Zürich, Switzerland.

Background: Several psychological sequelae have been identified in civilian war survivors. However, little is known about the prevalence of obsessive-compulsive symptoms and their relationship to trauma in this population.

Method: Fifty-one adult civilian survivors of the Kosovo War (28 males) who had immigrated to Switzerland completed the Revised Obsessive-Compulsive Inventory Scale, the Posttraumatic Stress Diagnostic Scale and the Hopkins Symptom Checklist. Data were analysed using multiple regression analyses.

Results: Overall, 35 and 39% of the sample scored above the cut-offs for likely obsessive-compulsive disorder and posttraumatic stress disorder, respectively. Participants with high levels of posttraumatic stress symptoms were significantly more likely to have obsessive-compulsive symptoms, and vice versa. In multiple regression analysis, gender and severity of posttraumatic stress symptoms were predictors of obsessive-compulsive symptoms, whereas number of traumatic life event types and depressive symptoms were not.

Conclusion: Given the small sample size, the results of this study need to be interpreted cautiously. Nevertheless, a surprisingly high number of participants in our study suffered from both obsessive-compulsive and posttraumatic stress symptoms, with obsessive-compulsive symptoms tending to be more pronounced in women. It remains, therefore, critical to specifically assess both obsessive-compulsive and posttraumatic stress symptoms in civilian war survivors, and to provide persons afflicted with appropriate mental health care.
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http://dx.doi.org/10.1186/s12888-016-0822-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4848828PMC
April 2016

Predicting symptoms in major depression after inpatient treatment: the role of alexithymia.

Nord J Psychiatry 2016 Jul 3;70(5):392-8. Epub 2016 Mar 3.

d Thomas Suslow, LIFE - Leipzig Research Centre for Civilisation Diseases, University of Leipzig, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, and Department of Psychiatry and Psychotherapy , University of Münster , Münster , Germany.

Alexithymia has been considered to have a negative influence on the course of symptoms in various psychiatric disorders. Only a few studies of depressed patients have examined whether alexithymia predicts the outcome of therapeutic interventions or the course of symptoms in naturalistic settings. This prospective study investigated whether alexithymia is associated with depressive symptoms after a multimodal inpatient treatment. Forty-five inpatients suffering from acute major depression were examined in the initial phase of treatment and then again after seven weeks. Patients took part in a multimodal treatment programme comprising psychodynamic-interactional oriented individual and group therapy. The majority of patients were taking antidepressants during study participation. To assess alexithymia and depressive symptoms, the 20-item Toronto Alexithymia Scale (TAS-20), the Beck Depression Inventory II (BDI-II) and the Hamilton Depression Scale (HAMD) were administered at baseline and follow-up. When controlling for baseline depressive symptoms along with trait anxiety, high scores in the externally oriented thinking (EOT) facet of alexithymia at baseline predicted high severity of depressive symptoms at follow-up (for self-reported as well as interviewer-based scores). Inpatients suffering from major depression with a more pronounced external cognitive style might benefit less from a routine multimodal treatment approach (including psychodynamic interactional therapy, antidepressant medication, and complementary therapies). Intervention programmes might modify or account for alexithymic characteristics to improve the course of depressive symptoms in these patients.
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http://dx.doi.org/10.3109/08039488.2016.1146796DOI Listing
July 2016

Which tinnitus-related characteristics affect current health-related quality of life and depression? A cross-sectional cohort study.

Psychiatry Res 2016 Mar 28;237:114-21. Epub 2016 Jan 28.

Department of Otorhinolaryngology, University Hospital Zurich, Zurich, Switzerland.

Tinnitus is sometimes associated with lower health-related quality of life (HRQoL) and depressive symptoms. However, only limited evidence exists identifying which tinnitus characteristics are responsible for these associations. The aim of this cross-sectional study was to assess associations between tinnitus, HRQoL, depressive symptoms, subjective tinnitus loudness and audiometrically assessed tinnitus characteristics (e.g., hearing threshold). Two hundred and eight outpatients reporting tinnitus completed questionnaires on tinnitus (Tinnitus Handicap Inventory, THI), HRQoL (World-Health-Organisation Quality of Life Short Form Survey, WHOQOL-BREF), and depressive symptoms (Beck Depression Inventory, BDI), and underwent audiometry. Patients with higher THI scores exhibited significantly lower HRQoL, and higher depression scores. THI total-score, THI subscales, and subjective tinnitus loudness explained significant variance of WHOQOL-BREF and BDI. Audiometrically measured features were not associated with WHOQOL-BREF or BDI. Overall, we confirmed findings that different features of tinnitus are associated with HRQoL and depressive symptoms but not with audiometrically assessed tinnitus characteristics. Consequently, physicians should evaluate THI total score, its sub-scores, and subjective tinnitus loudness to reliably and quickly identify patients who potentially suffer from depressive symptoms or significantly lower HRQoL. Supporting these patients early might help to prevent the development of reactive depressive symptoms and impairment of HRQoL.
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http://dx.doi.org/10.1016/j.psychres.2016.01.065DOI Listing
March 2016

Affective regulation in trichotillomania before and after self-help interventions.

J Psychiatr Res 2016 Apr 29;75:7-13. Epub 2015 Dec 29.

Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Culmannstrasse 8, 8091, Zürich, Switzerland.

Objective: Trichotillomania (TTM) is characterized by recurrent hair-pulling behaviours that cause significant distress. Deficits in affective regulation have been reported in individuals with TTM. We aimed to investigate temporal stability of affective regulation in TTM individuals.

Methods: Eighty-one TTM individuals underwent an online intervention. Affective Regulation Scale (ARS), Massachusetts General Hospital Hair-Pulling Scale (MGH-HPS), and Beck Depression Inventory (BDI) scores were obtained at baseline, post-treatment (4 weeks), and follow-up (6 months). We examined the effect of phenotypes including hair-pulling severity and depressive symptoms on absolute and relative stability of affective regulation over time, using multiple linear and hierarchical regression analyses.

Results: The ARS total-score from the present TTM sample was significantly lower than the score from non-hair pullers (p < 0.001). ARS total-scores inversely correlated with the MGH-HPS total-scores at baseline (p = 0.001) and post-treatment (p = 0.02), and with BDI total-scores at all time-points (p < 0.001). Although ARS total-scores significantly increased, all ARS sub-scores, except guilt sub-scores, did not change over time, indicating absolute stability. Baseline ARS total-, and sub-scores (except tension) were found to predict their ARS follow-up scores (all p < 0.01), confirming relative stability (i.e., the extent to which the inter-individual differences remained the same over time). The relative stability of ARS total-scores and all but two sub-scores (irritability and guilt) were independent from BDI baseline scores.

Conclusions: Individuals with TTM reported deficits in affective regulation that demonstrated mostly high relative stability and partly absolute stability. Therefore, targeting to improve affective regulation in individuals with TTM during therapy is warranted.
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http://dx.doi.org/10.1016/j.jpsychires.2015.12.020DOI Listing
April 2016

[Obsessive-compulsive Disorder: Prevalence, Comorbidity and Remission from the Ages of 20 to 50].

Praxis (Bern 1994) 2015 Nov;104(24):1323-8

6 Collegium Helveticum, a Joint Research Institute between the University of Zurich & ETH Zurich.

Individuals with obsessive-compulsive disorder (OCD) experience recurrent obsessive and/or compulsive thoughts and behaviours which cause them distress, and significantly impair their daily lives. The disorder is thought to have a chronic course and a low rate of remission, as evidenced by mainly clinical samples. Longitudinal psychiatric epidemiological studies are few and far between. This article presents the findings relating to OCD from one such study, the Zurich Study: OCD defined according to DSM-5 criteria had a high prevalence rate and frequently a chronic course but it had a long-term remission rate of almost 60%, which is higher than hitherto believed. OCD was generally highly comorbid with other disorders and particularly closely associated with social phobia.
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http://dx.doi.org/10.1024/1661-8157/a002205DOI Listing
November 2015

Alexithymia is associated with attenuated automatic brain response to facial emotion in clinical depression.

Prog Neuropsychopharmacol Biol Psychiatry 2016 Feb 22;65:194-200. Epub 2015 Oct 22.

Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany; Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany.

Background: Alexithymia is a clinically relevant personality trait related to difficulties in recognizing and describing emotions. Previous studies examining the neural correlates of alexithymia have shown mainly decreased response of several brain areas during emotion processing in healthy samples and patients suffering from autism or post-traumatic stress disorder. In the present study, we examined the effect of alexithymia on automatic brain reactivity to negative and positive facial expressions in clinical depression.

Methods: Brain activation in response to sad, happy, neutral, and no facial expression (presented for 33 ms and masked by neutral faces) was measured by functional magnetic resonance imaging at 3 T in 26 alexithymic and 26 non-alexithymic patients with major depression.

Results: Alexithymic patients manifested less activation in response to masked sad and happy (compared to neutral) faces in right frontal regions and right caudate nuclei than non-alexithymic patients.

Conclusions: Our neuroimaging study provides evidence that the personality trait alexithymia has a modulating effect on automatic emotion processing in clinical depression. Our findings support the idea that alexithymia could be associated with functional deficits of the right hemisphere. Future research on the neural substrates of emotion processing in depression should assess and control alexithymia in their analyses.
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http://dx.doi.org/10.1016/j.pnpbp.2015.10.006DOI Listing
February 2016

Internet-based self-help for trichotillomania: a randomized controlled study comparing decoupling and progressive muscle relaxation.

Psychother Psychosom 2015 24;84(6):359-67. Epub 2015 Sep 24.

Department of Psychiatry and Psychotherapy, University Hospital Zurich, Switzerland.

Background: Trichotillomania (TTM) is characterized by recurrent hair-pulling that results in substantial hair loss. A previous pilot study demonstrated that the online self-help intervention 'decoupling' (DC) might be effective at reducing hair-pulling symptoms, with a stronger effect than progressive muscle relaxation (PMR). We aimed to extend these findings using a more robust randomized clinical trial design, including diagnostic interviews by phone, a 6-month follow-up and e-mail support.

Methods: One hundred five adults with TTM were recruited online and randomly allocated to either DC (n = 55) or PMR (n = 50). The intervention lasted 4 weeks, with severity of TTM assessed at 3 time points (before intervention, immediately after intervention and at the 6-month follow-up) using the Massachusetts General Hospital Hair-Pulling Scale (MGH-HPS). Both intention-to-treat and completer analyses were conducted.

Results: Intention-to-treat analysis demonstrated highly significant and comparable symptom reductions (MGH-HPS) in both the DC and PMR groups (p < 0.001, partial x03B7;2 = 0.31) that persisted through 6 months of follow-up. Participants' subjective appraisals favoured DC in some areas (e.g. greater satisfaction with DC than PMR). Completer analyses demonstrated the same pattern as the intention-to-treat analyses.

Conclusions: Despite subjective appraisals in favour of DC, symptom reduction was comparable in the two groups. While the results suggest that even short Internet-based interventions like DC and PMR potentially help individuals with TTM, a partial effect of unspecific factors, like regression towards the mean, cannot be ruled out. Therefore, longitudinal studies with non-treated controls are warranted.
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http://dx.doi.org/10.1159/000431290DOI Listing
March 2016

[MOSS- Mobile Sensing and Support Detection of depressive moods with an app and help those affected].

Ther Umsch 2015 Sep;72(9):553-5

1 Klinik für Psychiatrie und Psychotherapie, Universitätsspital, Universität Zürich.

Major depression is regarded as a significant and serious disease with an increasing prevalence worldwide. However, not all individuals with depressive pressive symptoms seek help for their problems. These untreated "hidden" individuals with depressive symptoms require the design and dissemination of evidence-based, /ow-cost and scalable mental health interventions. Such interventions provided by mobile applications are promising as they have the potential to support people in their everyday life. However, as of today it is unclear how to design mental health applications that are effective and motivating yet non-intrusive. In addressing this problem, the MOSS application is a recent endeavor of a Swiss project team from Universitiitsspital Zurich, ETH Zurich, University of St. Gallen and makora AG, to support people with depressive symptoms. In particular, evidence-based micro-interventions are recommended and triggered by individual characteristics that are derived from self-reports, smartphone interactions and sensor data. After one year of development, the study team now conducts a first empirical study and thus, recruits people affected by depressive symptoms to improve not only the application as such but with it, the delivery of mental health interventions in the long run.
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http://dx.doi.org/10.1024/0040-5930/a000717DOI Listing
September 2015
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