Publications by authors named "Roland Weierstall"

35 Publications

Effective Adoption of Tablets for Psychodiagnostic Assessments in Rural Burundi: Evidence for the Usability and Validity of Mobile Technology in the Example of Differentiating Symptom Profiles in AMISOM Soldiers 1 Year After Deployment.

Front Public Health 2021 15;9:490604. Epub 2021 Apr 15.

Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.

Research on the use of mobile technology in health sciences has identified several advantages of so-called mHealth (mobile health) applications. Tablet-supported clinical assessments are becoming more and more prominent in clinical applications, even in low-income countries. The present study used tablet computers for assessments of clinical symptom profiles in a sample of Burundian AMISOM soldiers (i.e., African Union Mission to Somalia; a mission approved by the UN). The study aimed to demonstrate the feasibility of mHealth-supported assessments in field research in Burundi. The study was conducted in a resource-poor setting, in which tablet computers are predestined to gather data in an efficient and reliable manner. The overall goal was to prove the validity of the obtained data as well as the feasibility of the chosen study setting. Four hundred sixty-three soldiers of the AMISOM forces were investigated after return from a 1-year military mission in Somalia. Symptoms of posttraumatic stress disorder (PTSD) and depression were assessed. The used data-driven approach based on a latent profile analysis revealed the following four distinct groups, which are based on the soldiers' PTSD and depression symptom profiles: Class 1: moderate PTSD, Class 2: moderate depression, Class 3: low overall symptoms, and Class 4: high overall symptoms. Overall, the four identified classes of soldiers differed significantly in their PTSD and depression scores. The study clearly demonstrates that tablet-supported assessments can provide a useful application of mobile technology in large-scale studies, especially in resource-poor settings. Based on the data collected for the study at hand, it was possible to differentiate different sub-groups of soldiers with distinct symptom profiles, proving the statistical validity of the gathered data. Finally, advantages and challenges for the application of mobile technology in a resource-poor setting are outlined and discussed.
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http://dx.doi.org/10.3389/fpubh.2021.490604DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8083058PMC
May 2021

Association of Fatigue Severity With Maladaptive Coping in Multiple Sclerosis: A Data-Driven Psychodynamic Perspective.

Front Neurol 2021 7;12:652177. Epub 2021 Apr 7.

Department of Psychology, University of Konstanz, Konstanz, Germany.

Fatigue in persons with multiple sclerosis (PwMS) is severely disabling. However, the underlying mechanisms remain incompletely understood. Recent research suggests a link to early childhood adversities and psychological trait variables. In line with these studies, this paper took a psychodynamic perspective on MS-fatigue. It was hypothesized that fatigue could represent a manifestation of maladaptive coping with intense emotions. The schema therapeutic mode model served as a theoretical and empirically validated framework, linking psychodynamic theory and empirical research methods. The study was based on a data set of = 571 PwMS that has also served as the basis for another publication. Data was collected online. The Schema Mode Inventory was used to quantify regulatory strategies to cope with emotionally stressful experiences. In addition, depressive symptoms (Beck's Depression Inventory - FastScreen), physical disability (Patient Determined Disease Steps), alexithymia (Toronto Alexithymia Scale-26), adverse childhood experiences (Childhood Trauma Questionnaire), and self-reported fatigue (Fatigue Scale for Motor and Cognitive Functions) were assessed. Latent profile analysis revealed three distinct groups of PwMS, based on their coping mode profiles: (1) PwMS with low maladaptive coping, (2) PwMS with avoidant/submissive coping styles, and (3) PwMS with avoidant/overcompensatory coping styles. Multivariate comparisons showed no significant difference in physical disability across the three groups. However, heightened levels of self-reported fatigue and depression symptoms occurred in PwMS with maladaptive coping styles. A path model uncovered that self-reported fatigue was robustly related to physical disability (β = 0.33) and detached/avoidant coping (Detached Protector; β = 0.34). There was no specific relation between any of the maladaptive coping modes and depression symptoms. Detached/avoidant coping was in turn predicted by childhood emotional abuse and neglect. The results indicate that childhood adversity and detached/avoidant coping styles may be associated with variability in MS-fatigue severity: PwMS that resort to detached/avoidant coping in response to negative emotions also tend to report heightened levels of fatigue, although they do not differ in their perceived disability from PwMS with low levels of fatigue and maladaptive coping. A link between MS-fatigue and the psychodynamic traumatic conversion model is discussed. The implications of these findings for therapeutic interventions require further study.
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http://dx.doi.org/10.3389/fneur.2021.652177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8058358PMC
April 2021

DNA methylation and psychotherapy response in trauma-exposed men with appetitive aggression.

Psychiatry Res 2021 01 27;295:113608. Epub 2020 Nov 27.

Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa; South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa. Electronic address:

Exposure to violence can lead to appetitive aggression (AA), the positive feeling and fascination associated with violence, and posttraumatic stress disorder (PTSD), characterised by hyperarousal, reexperience and feelings of ongoing threat. Psychotherapeutic interventions may act via DNA methylation, an environmentally sensitive epigenetic mechanism that can influence gene expression. We investigated epigenetic signatures of psychotherapy for PTSD and AA symptoms in South African men with chronic trauma exposure. Participants were assigned to one of three groups: narrative exposure therapy for forensic offender rehabilitation (FORNET), cognitive behavioural therapy or waiting list control (n = 9-10/group). Participants provided saliva and completed the Appetitive Aggression Scale and PTSD Symptom Severity Index at baseline, 8-month and 16-month follow-up. The relationship, over time, between methylation in 22 gene promoter region sites, symptom scores, and treatment was assessed using linear mixed models. Compared to baseline, PTSD and AA symptom severity were significantly reduced at 8 and 16 months, respectively, in the FORNET group. Increased methylation of genes implicated in dopaminergic neurotransmission (NR4A2) and synaptic plasticity (AUTS2) was associated with reduced PTSD symptom severity in participants receiving FORNET. Analyses across participants revealed a proportional relationship between AA and methylation of TFAM, a gene involved in mitochondrial biosynthesis.
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http://dx.doi.org/10.1016/j.psychres.2020.113608DOI Listing
January 2021

Long-term effects of psychotherapy in a context of continuous community and gang violence: changes in aggressive attitude in high-risk South African adolescents.

Behav Cogn Psychother 2020 Jan 31;48(1):1-13. Epub 2019 May 31.

Department of Clinical Psychology and Psychotherapy, Medical School Hamburg, Germany.

Background: Post-traumatic stress but also aggressive attitudes and behaviour can be found in adolescents living in a context of ongoing community and gang violence in the low-income urban areas of Cape Town, South Africa.

Aims: We investigated the long-term effects (15-20 months after therapy) of (a) Narrative Exposure Therapy for Forensic Offender Rehabilitation (FORNET) and (b) the cognitive behavioural intervention 'Thinking for a Change' (CBT) on post-traumatic stress disorder (PTSD) and aggression compared with a waiting list.

Method: Fifty-four young males participated in the treatment trial, of which 17 completed the FORNET intervention, 11 the CBT intervention, and 26 were on a waiting list. The primary outcome was the change score for the Appetitive Aggression Scale; secondary outcomes were the PTSD Symptom Scale-Interview change scores, and the number of perpetrated violent event types.

Results: The reduction in scores for PTSD that had been observed in FORNET completers at the first follow-up were still significant at the second long-term follow-up (Cohen's d = 0.86). In this treatment arm (FORNET), the scores for appetitive aggression were also significantly reduced (Cohen's d = 1.00). There were no significant changes observed for CBT or for the waiting list.

Conclusions: The study indicates that FORNET can successfully reduce post-traumatic stress as well as the attraction to violence even for individuals living under conditions of continuous traumatic stress.
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http://dx.doi.org/10.1017/S1352465819000365DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7035953PMC
January 2020

Imaginal retraining reduces alcohol craving in problem drinkers: A randomized controlled trial.

J Behav Ther Exp Psychiatry 2019 09 5;64:158-166. Epub 2019 Apr 5.

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

Background And Objectives: Retraining, a psychological intervention derived from the approach-avoidance paradigm, has yielded mixed results for the treatment of alcohol use disorder as well as other forms of addiction. The present study investigated the efficacy of an imaginal variant of retraining that allowed greater personalization of the content.

Methods: Within the framework of a randomized controlled trial (RCT), 84 individuals with self-reported alcohol-related problems were recruited over the Internet and allocated to either imaginal retraining (treatment manual dispatched as a pdf-file via email) or a wait-list control group (with care-as-usual). The intervention period was four weeks. Alcohol craving, as measured with a visual analogue scale (VAS), served as the primary outcome. Other emotional (e.g. self-esteem) and drinking-related variables served as secondary outcomes.

Results: Both per-protocol (PP) and intention-to-treat (ITT) analyses showed that imaginal retraining led to a significant reduction in alcohol craving compared to the control group at a large effect size. Self-esteem improved in the retraining condition relative to controls in the PP and one of the ITT analyses; 75% of the individuals in the treatment group reported less alcohol consumption in the treatment period, whereas drinking behavior remained essentially unchanged in the control group (p < .001) (the trial was registered at the German Clinical Trials Register, DRKS00015319).

Limitations: Whether the effects of imaginal retraining are sustained over time needs to be established. Attrition was significantly higher in the retraining group (40.5%) than in the control group (16.7%). Designs with an active control condition are needed as well as dismantling studies to explore which of the treatment's multiple components best predicts improvement. Future studies should verify participants' alcohol consumption levels using objective measures.

Conclusion: Imaginal retraining led to significant effects on the reduction of alcohol craving.
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http://dx.doi.org/10.1016/j.jbtep.2019.04.001DOI Listing
September 2019

Emotions towards magnetic resonance imaging in people with multiple sclerosis.

Acta Neurol Scand 2019 Jun 28;139(6):497-504. Epub 2019 Mar 28.

Institute of Neuroimmunology and Multiple Sclerosis, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.

Objectives: People with multiple sclerosis (pwMS) often have magnetic resonance imaging (MRI) examinations. While MRI can help guide MS management, it may be a source of anxiety for pwMS. We aimed to develop and validate a questionnaire on the "EMotions and Attitudes towards MRI" (MRI-EMA).

Material And Methods: The questionnaire was developed, tested in two samples of pwMS and validated in a sample of n = 457 pwMS using exploratory (EFA) and confirmatory factor analysis (CFA).

Results: EFA revealed four factors underlying the questionnaire: fear of MRI scan, fear of MRI results, feeling of control over the disease and feeling of competence in the patient-physician encounter. CFA confirmed the model fit. Receiving the MRI results, but not undergoing the procedure was associated with anxiety. Seeing MRI results gave participants a feeling of control over the disease. Only 50% felt competent to discuss MRI findings with their physician. Fear of MRI results was especially high and feeling of competence low in participants with a short disease duration and little MRI experience.

Conclusion: PwMS do not feel competent when discussing the role, MRI plays in their care. Receiving MRI results caused anxiety and provides some pwMS with a-perhaps false-feeling of control over the disease. The MRI-EMA constitutes a new tool for the assessments of pwMS' feelings towards MRI, that can be applied in future research and clinical settings.
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http://dx.doi.org/10.1111/ane.13082DOI Listing
June 2019

Transplantation experience as a predictor for quality of life during the first 6 months after lung transplantation.

Clin Transplant 2018 10 8;32(10):e13393. Epub 2018 Oct 8.

Department of Human Science, Medical School Hamburg, Hamburg, Germany.

Objective: Quality of life (QoL) is a crucial goal of post-transplant care. This study investigated predictors of QoL within the first 6 months after transplantation.

Methods: Forty patients were assessed 2 weeks (T1), 3 months (T2), and 6 months post-transplant (T3). In the quantitative part, the EuroQol questionnaire (EQ-5D) and visualization methods (Prism) were applied. In the qualitative part, interviews were analyzed. Regression analyses were used to investigate the impact of the pictorial ratings at T1 on QoL at T2 and T3. The pictorial variables were related to the interviews for an in-depth analysis.

Results: There was an increase in QoL between T1 and T2 that remained stable from T2 to T3. Smaller distances in the variable Prism_Lung (acceptance of the lung) and larger distances in the variable Prism_Transplantation (distance to the transplantation experience) were related to the increase in QoL between T1 and T2 and to an higher QoL at T2. High-QoL patients were able to create an equilibrium of defense and acceptance.

Conclusion: Psychological processes early after transplant are of significance for the development of QoL within the 6 months following the surgery. These insights demonstrate that a mixed methodological approach provides a helpful understanding of post-transplant processing.
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http://dx.doi.org/10.1111/ctr.13393DOI Listing
October 2018

The impact of an exercise training intervention on cortisol levels and post-traumatic stress disorder in juveniles from an Ugandan refugee settlement: study protocol for a randomized control trial.

Trials 2018 Jul 9;19(1):364. Epub 2018 Jul 9.

Medical School Hamburg MSH, Department of Psychology, Faculty of Human Sciences, Am Kaiserkai 1, 20457, Hamburg, Germany.

Background: Latest research demonstrates a significant improvement in stress-related symptoms in psychological disorders as a result of exercise training (ET). Controlled clinical trials further validate the significance of ET by demonstrating lower salivary cortisol levels in patients with post-traumatic stress disorder (PTSD) after intervention. A significant change in cortisol and dehydroepiandrosterone (DHEA) levels can already be found after an 8-12-week ET program. The proposed study aims to investigate the impact of an 8-week ET on PTSD symptoms and changes in cortisol levels in a juvenile refugee sample from the Democratic Republic of the Congo (DRC) at an Ugandan refugee settlement. It is the first to implement an ET intervention in a resource-poor, post-conflict setting.

Methods/design: In a randomized controlled trial, 198 adolescent participants aged 13-16 years from the DRC who, suffer from PTSD, will be investigated. The participants are based at the Nakivale refugee settlement, an official refugee camp in Uganda, Africa, which is among the largest in the world. The participants will be randomized into an Exercise Training (ET) group with a maximum heart rate (HR) of > 60%, an Alternative Intervention (AI) group with low-level exercises, and a Waiting-list Control (WC) group. After the 8-week interventional phase, changes in cortisol awakening response (CAR) and DHEA in the ET group that correspond to an improvement in PTSD symptoms are expected that remain at follow-up after 3 months.

Discussion: To date, there is no controlled and reliable longitudinal study examining the effects of an ET program on symptom severity in individuals with PTSD that can be explained with a harmonization of cortisol secretion. The presented study design introduces an intervention that can be implemented with little expenditure. It aims to provide a promising low-threshold and cost-effective treatment approach for the application in resource-poor settings.

Trial Registration: German Trials Register, ID: DRKS00014280 . Registered prospectively on 15 March 2018.
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http://dx.doi.org/10.1186/s13063-018-2753-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6038242PMC
July 2018

Appetitive and reactive aggression are differentially associated with the STin2 genetic variant in the serotonin transporter gene.

Sci Rep 2018 04 30;8(1):6714. Epub 2018 Apr 30.

Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa.

Appetitive aggression is a sub-category of instrumental aggression, characterised by the primary intrinsic enjoyment of aggressive activity. Aggression is heritable, and serotonergic and monoaminergic neurotransmitter systems have been found to contribute to the underlying molecular mechanisms. The aim of this study was to investigate the role that genetic variants in the serotonin transporter (SLC6A4) and monoamine oxidase A (MAOA) genes play in the aetiology of appetitive aggression in South African Xhosa males (n = 290). SLC6A4 5-HTTLPR, rs25531, and STin2 variants, as well as MAOA-uVNTR were investigated for their association with levels of appetitive aggression using Poisson regression analysis. The STin2 VNTR12 allele was found to be associated with increased levels of appetitive aggression (p = 0.003), but with decreased levels of reactive aggression (p = 7 × 10). This study is the first to investigate genetic underpinnings of appetitive aggression in a South African population, with preliminary evidence suggesting that SCL6A4 STin2 variants play a role in its aetiology, and may also be important in differentiating between appetitive and reactive aggression. Although the results require replication, they shed some preliminary light on the molecular dichotomy that may underlie the two forms of aggression.
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http://dx.doi.org/10.1038/s41598-018-25066-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5928100PMC
April 2018

Associations between societal disapproval and changes in symptoms of PTSD and appetitive aggression following treatment among high-risk South African males.

Eur J Psychotraumatol 2017 5;8(1):1369831. Epub 2017 Sep 5.

Department of Psychology, University of Konstanz, Konstanz, Germany.

: In violent communities, social rejection as a person with victim-offender attributes is associated with more intense symptoms of posttraumatic stress disorder (PTSD) and a higher propensity towards violence, i.e. appetitive aggression. Successful community reintegration encompassing adequate social acknowledgment of individuals with both a history of violence exposure and perpetration may be necessary to enhance the treatment effects of interventions addressing PTSD and aggression. : In this study, the effects of treatment and post-treatment traumatic events, violent offenses, and social acknowledgment (with sub-dimensions of general disapproval, family disapproval, and recognition as a person with both a history of violence exposure and commission) on changes in PTSD symptom severity and appetitive aggression from baseline to 8-month follow-up were investigated. : Data were collected from 54 males recruited through a Cape Town offender reintegration programme for an intervention study targeting trauma and aggression ( 28 treatment;  26 wait-list). Changes in PTSD symptom severity after treatment were assessed with the PTSD Symptom Scale-Interview, changes in appetitive aggression with the Appetitive Aggression Scale (AAS), post-treatment traumatic events with an adapted version of the Child's Exposure to Violence Checklist, offenses with an adapted checklist from the AAS, and social acknowledgment with an adapted form of the Social Acknowledgment Questionnaire. : Path analyses revealed negative relationships between ongoing societal disapproval and changes in PTSD symptom severity and appetitive aggression at 8-months, controlling for age. All other variables were non-significant, except for treatment, which was associated with PTSD symptom reduction. : As a complementary strategy to effective psychotherapeutic treatment, increased social acknowledgment may contribute significantly to the alleviation of PTSD symptoms and appetitive aggression. Psychological interventions should, therefore, not neglect the impact of societal factors on treatment effects.
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http://dx.doi.org/10.1080/20008198.2017.1369831DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5613914PMC
September 2017

The individual contribution of DSM 5 symptom clusters of PTSD, life events, and childhood adversity to frontal oscillatory brain asymmetry in a large sample of active combatants.

Biol Psychol 2017 10 25;129:305-313. Epub 2017 Sep 25.

Department of Psychology, University of Konstanz, Konstanz, Baden-Württemberg, Germany; MSH Medical School Hamburg, University of Applied Sciences and Medical University, Germany.

Post-Traumatic Stress Disorder (PTSD) has been linked to deviations in lateralized frontal functional oscillatory activity. This is possibly because left and right DLPFC have differential roles in regulating both memory and stress response, which are both dysfunctional in PTSD. However, previous results are heterogeneous, and could be attributable to individual symptom clusters, traumatic or aggressive life events, early life stress, or the interaction of these factors. In a large sample of active combatants (N=401), we regressed these factors on frontal electroencephalography (EEG) asymmetry across 5 frequency bands (delta: 2-4Hz; theta: 4-8Hz; alpha: 8-12Hz; beta: 12-24Hz; gamma: 24-48Hz). Negative cognition and mood was associated with stronger relative left delta and theta band power. Traumatic life events showed stronger right alpha and beta band power. Traumatic life events in interaction with hyperarousal predicted stronger relative right left-right imbalance (theta, alpha, and beta bands), whereas childhood adversity, in interaction with negative cognition and mood, predicted stronger relative left left-right imbalance (delta, theta, alpha and beta bands). The contribution of lateralized DLPFC dysfunction to PTSD is thus dependent on the individual complexities of subsymptom clusters and life history, and future studies need to take these factors into account.
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http://dx.doi.org/10.1016/j.biopsycho.2017.09.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5678498PMC
October 2017

More Than the Win: The Relation between Appetitive Competition Motivation, Socialization, and Gender Role Orientation in Women's Football.

Front Psychol 2017 13;8:547. Epub 2017 Apr 13.

Department of Psychology, Medical School HamburgHamburg, Germany.

The ability to produce peak performance plays a decisive role in the success of athletes in competitive contest situations. Levels of appetitive competition motivation (ACM), i.e., the desire to defeat an opponent independent of secondary reinforcing factors, were assessed in professional female football/soccer players in the premier and regional leagues, using club level as the measurement of sport success. Furthermore, the influence of social environments predominantly encouraging masculine and competitive play behavior and the players' perceptions of their own gender role orientations were investigated. Ninety female football players from the German premier league (44) and regional leagues (46) participated (age: = 24, = 5 years). Questionnaires ascertaining ACM and self-perceptions of gender via gender-role stereotypes, childhood play behavior and style of upbringing were utilized. Premier league athletes showed a significantly greater inclination toward direct sporting confrontations. Almost 50% of the variance in ACM between the premier and regional league athletes was determined by modern upbringing style and the development of gender roles not corresponding to classic female gender stereotypes. The results emphasize the significance of ACM as an important facet in competitive sports and illustrate the influence of socialization on athletic performance.
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http://dx.doi.org/10.3389/fpsyg.2017.00547DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5390493PMC
April 2017

Predicting domestic and community violence by soldiers living in a conflict region.

Psychol Trauma 2017 Nov 9;9(6):663-671. Epub 2017 Mar 9.

Department of Psychology, University of Konstanz.

Objective: Past research revealed war trauma and posttraumatic stress disorder (PTSD) symptoms as potential predictors for domestic and community violence in crisis regions and among soldiers in different armed conflicts. The impact of family violence and other adversities experienced in childhood as well as of a combat-enhanced appeal for aggressive behavior (appetitive aggression) remains to be specified.

Method: In the present study, the authors separately predicted violence against children, intimate partner violence and community violence in 381 Burundian soldiers returning from foreign deployment and living in a post- conflict region. Using path analysis, they aimed to disentangle the independent contributions and pathways of the following variables: Exposure to war trauma and childhood familial violence, PTSD and depression symptom severity, and appetitive aggression.

Results: Childhood familial violence had an independent effect on all contexts of violence and was the only significant predictor for violence against the soldiers' own children. Intimate partner violence was additionally predicted by depression symptom severity, while community violence was additionally predicted by PTSD symptom severity and appetitive aggression.

Conclusions: Besides war-related mental ill-health and appetitive aggression, violent experiences during childhood development must not be overlooked as a factor fueling the cycle of violence in conflict regions. (PsycINFO Database Record
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http://dx.doi.org/10.1037/tra0000262DOI Listing
November 2017

Feasibility and effectiveness of narrative exposure therapy and cognitive behavioral therapy in a context of ongoing violence in South Africa.

Psychol Trauma 2017 05 6;9(3):282-291. Epub 2016 Oct 6.

Department of Psychology, University of Konstanz.

Objective: In an observer-blinded intervention trial, we tested the reduction of posttraumatic stress symptoms, aggressive attitude, and behavior in young males living in a context of ongoing community and gang violence by means of (a) forensic offender rehabilitation narrative exposure therapy (FORNET), and (b) the cognitive-behavioral intervention "Thinking for a Change" (TFAC). A waiting list served as the control condition.

Method: A total of 39 young men were included in the data analysis: 15 completed FORNET, 11 underwent cognitive-behavioral therapy (CBT), and 13 were on a waiting list for later treatment. The primary efficacy endpoints were the PTSD Symptom Scale-Interview (PSS-I) severity score, the Appetitive Aggression Scale (AAS) score, and the number of perpetrated violent event types 8 months (on average) after treatment.

Results: Only in the sample receiving FORNET were posttraumatic stress disorder (PTSD) scores significantly reduced at the first follow-up (Cohen's d = -0.97) and significantly different from those of the control group (Cohen's d = -1.03). The changes in scores for appetitive aggression and perpetrated events were not significant for any of the treatment conditions.

Conclusions: The study shows that trauma-focused treatment can reduce the psychological symptoms of posttraumatic stress even for individuals living under unsafe conditions in low-income urban communities. However, achieving changes in violent behavior within a context of ongoing violence may require more than the treatment of trauma-related suffering, confrontation with one's offenses, or cognitive-behavioral interventions. (PsycINFO Database Record
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http://dx.doi.org/10.1037/tra0000197DOI Listing
May 2017

The interplay between trauma, substance abuse and appetitive aggression and its relation to criminal activity among high-risk males in South Africa.

Addict Behav 2017 01 10;64:29-34. Epub 2016 Aug 10.

Department of Clinical Psychology, University of Konstanz, Germany. Electronic address:

Background: In persistently unsafe environments, the cumulative exposure to violence predicts not only the development of posttraumatic stress disorder (PTSD), but also of increased aggression and violent outbursts. Substance use disorders interact with these developments, as drug consumption may blunt symptoms and also reduce the threshold for violent acts. Investigating the interplay between these variables and the possible cumulative effect of drug abuse on the attraction to cruelty is a crucial step in understanding the cycle of violence and developing intervention programs that address this cycle in violence-troubled communities such as low-income urban areas in South Africa.

Methods: Young males at risk (N=290) were recruited through a reintegration center for offenders in Cape Town. We assessed types of traumatic events experienced, PTSD symptom severity, appetitive aggression, committed offenses and patterns of drug abuse prior to the perpetration of violence.

Results: Path-analyses confirmed a positive relationship between exposure to traumatic events and PTSD symptom severity, appetitive aggression, the number of committed offenses and drug abuse prior to violence. PTSD symptoms were positively associated with the propensity toward aggression. Furthermore, more severe drug abuse was related to higher attraction to violence and more committed offenses.

Conclusions: We conclude that like exposure to violence, drug abuse may play a key role in the attraction to aggression and criminal acts. Measures of violence prevention and psychotherapeutic interventions for trauma-related suffering may not be effective without enduring drug abuse rehabilitation.
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http://dx.doi.org/10.1016/j.addbeh.2016.08.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5102240PMC
January 2017

The Sadomasochism Checklist: A Tool for the Assessment of Sadomasochistic Behavior.

Arch Sex Behav 2017 Apr 3;46(3):735-745. Epub 2016 Aug 3.

Department of Psychology, University of Konstanz, 78457, Constance, Germany.

Various scientific disciplines devoted to the study of sexual behavior are concerned with the understanding of sadomasochistic (SM) practices. However, only a fragmented body of theories, opinions, and studies is available, which limits the systematic study of this field. Empirical studies and tools for the assessment of SM tendencies are particularly sparse. Our aim was to develop a comprehensive tool for the assessment of an individual's engagement in SM practices. A comprehensive 24-item checklist of different types of SM play was generated with the assistance of members of the German SM community, covering both a dominance scale and a submission scale. The sadomasochism checklist was administered in an online study to a sample of 652 adults (345 female, 307 male), with 527 participants being active members in the SM community. Both the frequency of SM behavior and the attraction to the types of SM practices were assessed. Results revealed a one-factor structure for the dominance as well as the submission scale. The distinction between different types of practices (soft play, domination/submission, beating, toys, breath and bodily fluids) was confirmed using principal component analysis. Cronbach's alpha was appropriate. The total scores for the dominance and the submission scale distinguish between participants with different preferences for dominant and submissive practices. The newly developed scale is a reliable and valid tool for the assessment of the frequency of and attraction to SM behavior. It aims to provide the basis for future systematic studies on sadomasochism.
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http://dx.doi.org/10.1007/s10508-016-0789-0DOI Listing
April 2017

Appetitive Aggression in Women: Comparing Male and Female War Combatants.

Front Psychol 2015 5;6:1972. Epub 2016 Jan 5.

Department of Psychology, University of KonstanzKonstanz, Germany; Department of Clinical Psychology, Université LumièreBujumbura, Burundi.

Appetitive aggression refers to positive feelings being associated with the perpetration of violent behavior and has been shown to provide resilience against the development of PTSD in combatants returning from the battlefield. Until this point, appetitive aggression has been primarily researched in males. This study investigates appetitive aggression in females. Female and male combatants and civilians from Burundi were assessed for levels of appetitive aggression. In contrast to non-combatants, no sex difference in appetitive aggression could be detected for combatants. Furthermore, each of the female and male combatant groups displayed substantially higher levels of appetitive aggression than each of the male and female civilian control groups. This study demonstrates that in violent contexts, such as armed conflict, in which individuals perpetrate numerous aggressive acts against others, the likelihood for an experience of appetitive aggression increases- regardless of whether the individuals are male or female.
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http://dx.doi.org/10.3389/fpsyg.2015.01972DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4700207PMC
January 2016

Perpetuating the cycle of violence in South African low-income communities: attraction to violence in young men exposed to continuous threat.

Eur J Psychotraumatol 2016 7;7:29099. Epub 2016 Jan 7.

Department of Psychology, University of Konstanz, Reichenau, Konstanz, Germany.

Background: Life in the low-income urban communities of South Africa is imprinted by a cycle of violence in which young males predominantly are in the roles of both victim and perpetrator. There is some evidence that adolescents who show an attraction to cruelty can display high levels of psychosocial functioning despite the presence of posttraumatic stress symptoms. However, the role of appetitive aggression in the context of ongoing threats and daily hassles is not yet fully understood.

Objective: In this study, we examine the role of attraction to violence in areas of continuous traumatic stress exposure and its effect on posttraumatic stress disorder (PTSD) severity and violence perpetration.

Method: A sample of 290 young males from two low-income Cape Town communities was surveyed. We assessed appetitive aggression with the Appetitive Aggression Scale (AAS), PTSD symptoms with the PTSD Symptom Scale-Interview, the number of witnessed and self-experienced traumatic event types with an adaptation of the Child Exposure to Community Violence questionnaire, and the number of perpetrated violence event types with an adapted offence checklist from the AAS.

Results: Appetitive aggression scores were predicted by witnessed as well as self-experienced traumatic events. Higher appetitive aggression scores resulted in higher levels of PTSD severity and perpetrated violence.

Conclusions: Young males living in the low-income areas of South Africa may develop an attraction to cruelty in response to exposure to violence. Their willingness to fight in turn can increase the likelihood of continued violent behaviour. In contrast to previous research from postconflict areas, appetitive aggression and engagement in violence do not prevent the development of PTSD, but are instead associated with higher levels of posttraumatic stress. PTSD symptoms such as avoidance and hyperarousal, as well as an attraction to cruelty and thus the willingness to fight, might support survival in areas of ongoing conflict, but at the same time they could fuel the cycle of violence.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4706593PMC
http://dx.doi.org/10.3402/ejpt.v7.29099DOI Listing
January 2016

The Scent of Blood: A Driver of Human Behavior?

PLoS One 2015 23;10(9):e0137777. Epub 2015 Sep 23.

Department of Psychology, University of Konstanz, Konstanz, Baden-Württemberg, Germany.

The scent of blood is potentially one of the most fundamental and survival-relevant olfactory cues in humans. This experiment tests the first human parameters of perceptual threshold and emotional ratings in men and women of an artificially simulated smell of fresh blood in contact with the skin. We hypothesize that this scent of blood, with its association with injury, danger, death, and nutrition will be a critical cue activating fundamental motivational systems relating to either predatory approach behavior or prey-like withdrawal behavior, or both. The results show that perceptual thresholds are unimodally distributed for both sexes, with women being more sensitive. Furthermore, both women and men's emotional responses to simulated blood scent divide strongly into positive and negative valence ratings, with negative ratings in women having a strong arousal component. For women, this split is related to the phase of their menstrual cycle and oral contraception (OC). Future research will investigate whether this split in both genders is context-dependent or trait-like.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0137777PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4580480PMC
June 2016

Predictors of posttraumatic stress and appetitive aggression in active soldiers and former combatants.

Eur J Psychotraumatol 2015 21;6:26553. Epub 2015 Apr 21.

Department of Psychology, University of Konstanz, Konstanz, Germany.

Background: During the period between 1993 and 2005, the people of Burundi were trapped within a violent civil war. In post-conflict regions, symptoms of posttraumatic stress disorder (PTSD) were found to be widespread. At the same time, combatants often reported having perceived committing violence as exciting and appealing, an experience referred to as appetitive aggression. Both of these phenomena hamper the building of a functional and peaceful society.

Objective: This study aims to investigate the factors that are associated with the level of PTSD and appetitive aggression in former and still active combatants.

Methods: Semi-structured interviews were conducted with 948 male Burundians: 556 active soldiers and 392 ex-combatants. PTSD symptom severity was assessed using the PTSD Symptom Scale Interview, while appetitive aggression was assessed using the Appetitive Aggression Scale.

Results: Linear regression analyses revealed that the number of traumatic events, childhood maltreatment, and their interaction predicted PTSD symptom severity, whereas self-committed violence did not. The number of traumatic events and self-committed violence were associated with appetitive aggression. Childhood maltreatment alone was not associated with appetitive aggression; however, its interaction with self-committed violence did predict appetitive aggression. When controlling for predictors, ex-combatants reported a higher degree of PTSD symptomatology, whereas active soldiers reported a higher degree of appetitive aggression.

Conclusion: We conclude that childhood maltreatment is an additional, significant risk factor that exacerbates the psychological consequences of violent conflicts. Self-committed violence may not necessarily engender trauma-related disorders, but is highly related to appetitive aggression.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4408319PMC
http://dx.doi.org/10.3402/ejpt.v6.26553DOI Listing
April 2015

Differences in brain circuitry for appetitive and reactive aggression as revealed by realistic auditory scripts.

Front Behav Neurosci 2014 9;8:425. Epub 2014 Dec 9.

Department of Psychology, University of Konstanz Konstanz, Germany.

Aggressive behavior is thought to divide into two motivational elements: The first being a self-defensively motivated aggression against threat and a second, hedonically motivated "appetitive" aggression. Appetitive aggression is the less understood of the two, often only researched within abnormal psychology. Our approach is to understand it as a universal and adaptive response, and examine the functional neural activity of ordinary men (N = 50) presented with an imaginative listening task involving a murderer describing a kill. We manipulated motivational context in a between-subjects design to evoke appetitive or reactive aggression, against a neutral control, measuring activity with Magnetoencephalography (MEG). Results show differences in left frontal regions in delta (2-5 Hz) and alpha band (8-12 Hz) for aggressive conditions and right parietal delta activity differentiating appetitive and reactive aggression. These results validate the distinction of reward-driven appetitive aggression from reactive aggression in ordinary populations at the level of functional neural brain circuitry.
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http://dx.doi.org/10.3389/fnbeh.2014.00425DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4260506PMC
December 2014

Testosterone reactivity and identification with a perpetrator or a victim in a story are associated with attraction to violence-related cues.

Int J Law Psychiatry 2014 May-Jun;37(3):304-12. Epub 2013 Dec 22.

University of Konstanz, Department of Psychology, Germany.

Background: Recent field research has demonstrated that an attraction to aggressive behavior and cruelty is common among combatants and perpetrators involved in organized violence. The biological basis of this appetitive perception of aggression in humans has to date not been studied.

Aims: We examined testosterone as a potential hormonal moderator during induction of specifically appetitive aggressive behavior in the laboratory.

Method: To activate physiological responding related to appetitive aggression, 145 university students (72 women) listened to tape recordings of variants of a violent story. The perspective of the listener in the story was randomized between subjects. Participants were required to either identify as perpetrator, neutral observer, or victim. We assessed changes in saliva testosterone in response to the story. Subsequently, a series of pictorial stimuli (IAPS) with different valence ratings was presented and participants determined the length of viewing time with a button click. This viewing time for negative IAPS was assessed as a dependent variable indicating level of interest in violent scenes.

Results: Men identified themselves with the perpetrator more than women irrespective of the particular perspective presented by the story. Men who responded with an increase in saliva testosterone when adopting the perpetrator perspective chose to view the negative IAPS pictures for longer intervals than participants in other conditions or those who did not exhibit a release in testosterone.

Conclusions: Testosterone moderates attraction to cruel and violent cues in men, as indicated by extended deliberate viewing of violence cues.
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http://dx.doi.org/10.1016/j.ijlp.2013.11.016DOI Listing
December 2014

Analyzing the microfoundations of human violence in the DRC - intrinsic and extrinsic rewards and the prediction of appetitive aggression.

Confl Health 2013 May 17;7(1):11. Epub 2013 May 17.

Department of Politics and Public Administration, University of Konstanz, Universitaetstrasse 10, Konstanz, 78457, Germany.

Background: Civil wars are characterized by intense forms of violence, such as torture, maiming and rape. Political scientists suggest that this form of political violence is fostered through the provision of particular intrinsic and extrinsic rewards to combatants. In the field of psychology, the perpetration of this kind of cruelty is observed to be positively linked to appetitive aggression. Over time, combatants start to enjoy the fights and even the perpetration of atrocities. In this study, we examine how receiving rewards (intrinsic versus extrinsic) influence the level of appetitive aggression exhibited by former combatants.

Method: We surveyed 95 former combatants in the eastern provinces of the Democratic Republic of the Congo.

Results: Linear regression analyses reveal that intrinsic as well as extrinsic rewards are linked to the former combatants' Appetitive Aggression score. However, this relationship is partly determined by the way in which combatants are recruited: While abducted combatants seem to react more strongly to extrinsic rewards, the score of those that joined voluntarily is primarily determined by intrinsic rewards.

Conclusions: We conclude that receiving rewards influence the level of appetitive aggression. However, which type of rewards (intrinsic versus extrinsic) is of most importance is determined by the way combatants are recruited.
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http://dx.doi.org/10.1186/1752-1505-7-11DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3679747PMC
May 2013

Relations among appetitive aggression, post-traumatic stress and motives for demobilization: a study in former Colombian combatants.

Confl Health 2013 Apr 10;7(1). Epub 2013 Apr 10.

Clinical Psychology and Neuropsychology, University of Konstanz, Konstanz, Germany.

Background: Former combatants have frequently reported that aggressive behaviour can be appetitive and appealing. This appetitive aggression (AA) may be adaptive for survival in a violent environment, as it is associated with a reduced risk of combat-related psychological traumatization. At the same time, AA might impair motivation for re-integration to civil life after ending active duty. Whereas in Colombia those combatants who volunteered for demobilization were mostly tired of fighting, those who demobilized collectively did so mainly by force of the government. We predicted those who were demobilized collectively would still be attracted to violence, and benefit from the resilience against trauma-related mental suffering, moderated by appetitive aggression, as they would have continued fighting had they not been forced to stop.

Method: A sample of 252 former Colombian former combatants from paramilitary and guerrilla forces was investigated. Appetitive aggression was assessed using the Appetitive Aggression Scale (AAS) and post-traumatic stress disorder (PTSD) symptoms with the PTSD Symptom Scale-Interview (PSS-I). We distinguished between individual and group demobilization and assessed reasons for disarmament.

Results: Most of the guerrilla troops who demobilized individually and were tired of fighting reported both an attraction to violence as well as increased trauma symptoms, owing to their former engagement in violent behaviour. In contrast, among those who were demobilized collectively, appetitive aggression was associated with a reduced risk of PTSD. However, this effect was not present in those combatants in the upper quartile of PTSD symptom severity.

Conclusion: The influence of combat experience on traumatization, as well as the motivation for demobilization, differs remarkably between those combatants who demobilized individually and those who were members of a group that was forced to demobilize. This has important implications for the implementation of re-integration programmes and therapeutic interventions.
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http://dx.doi.org/10.1186/1752-1505-7-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3635948PMC
April 2013

Female attraction to appetitive-aggressive men is modulated by women's menstrual cycle and men's vulnerability to traumatic stress.

Evol Psychol 2013 Mar 20;11(1):248-62. Epub 2013 Mar 20.

Department of Psychology, University of Konstanz, Konstanz, Germany.

Many studies have reported that during high fertility points in the menstrual cycle, women demonstrate increased preference for men with masculinized faces and bodies. In this study, we analyzed whether appetitive aggression in men serves as an additional signal for a favored partner choice. Appetitive aggression describes the intrinsic motivation to act violently even when not being threatened. This study evaluated the responses of 1212 women to one of four descriptions regarding a soldier´s experience after returning from war. The four vignettes included trauma related symptoms with high or low appetitive aggression, or no trauma related symptoms with high or low appetitive aggression. Participants rated their desirability for the soldier in regards to potential long-term and short-term relationships. Results indicate that women preferred a soldier high in appetitive aggression as a short-term mate but not as a long-term relationship. This preference for the "warrior" was higher for women in their fertile window of the menstrual cycle. We conclude that women in their fertile window prefer men exhibiting higher appetitive aggression as a short-term partner, revealing appetitive aggression in men may serve as a signal for a higher genetic fitness.
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March 2013

Evaluative Conditioning with Facial Stimuli in Dementia Patients.

J Neurodegener Dis 2013 4;2013:854643. Epub 2012 Sep 4.

Department of Psychology-Gerontopsychology, University of Zürich, Binzmühlestrasse 14/24, 8050 Zürich, Switzerland.

We present results of a study investigating evaluative learning in dementia patients with a classic evaluative conditioning paradigm. Picture pairs of three unfamiliar faces with liked, disliked, or neutral faces, that were rated prior to the presentation, were presented 10 times each to a group of dementia patients (N = 15) and healthy controls (N = 14) in random order. Valence ratings of all faces were assessed before and after presentation. In contrast to controls, dementia patients changed their valence ratings of unfamiliar faces according to their pairing with either a liked or disliked face, although they were not able to explicitly assign the picture pairs after the presentation. Our finding suggests preserved evaluative conditioning in dementia patients. However, the result has to be considered preliminary, as it is unclear which factors prevented the predicted rating changes in the expected direction in the control group.
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http://dx.doi.org/10.1155/2013/854643DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4437290PMC
August 2015

Childhood adversities in relation to psychiatric disorders.

Psychiatry Res 2013 Mar 20;206(1):103-10. Epub 2012 Dec 20.

Department of Psychology, University of Konstanz, 78457 Konstanz, Germany.

Substantial evidence has documented that adverse childhood experiences exert deleterious effects on mental health. It is less clear to what extent specific maltreatment during specific developmental periods may vary between disorders rather than increasing vulnerability for any particular disorder. The present comparison of characteristics of childhood adversity (type and frequency of adversity, developmental period) between major depressive disorder (MDD), borderline personality disorder (BPD), schizophrenia, and psychiatrically healthy subjects examined how effects of adverse childhood experiences vary between disorders. Patients generally reported more adverse events than healthy subjects. Irrespective of diagnosis, emotional maltreatment was substantial in all patients. BPD was characterized by marked increase of adversities across age relative to MDD and schizophrenia. Fifty-six percent of BPD, 40% of MDD and 18% of schizophrenia cases experienced a significant degree of early childhood adversity. Stress pattern (type and time) varied between diagnoses, but not for patients with significant early adversities. Regression analyses confirmed early experiences as a predictor of BPD, but not of MDD and schizophrenia. Prepubescent experiences predicted affective and traumatic symptoms in BPD, and moderated the association with symptoms in MDD. Results indicate a dose-effect with differential impact of adverse childhood experiences in BPD, MDD, and schizophrenia, while early maltreatment beyond a certain degree affects mental health independent of diagnosis.
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http://dx.doi.org/10.1016/j.psychres.2012.11.003DOI Listing
March 2013

Appetitive aggression as a resilience factor against trauma disorders: appetitive aggression and PTSD in German World War II veterans.

PLoS One 2012 12;7(12):e50891. Epub 2012 Dec 12.

Department of Psychology, University of Konstanz, Konstanz, Germany.

Background: Repeated exposure to traumatic stressors such as combat results in chronic symptoms of PTSD. However, previous findings suggest that former soldiers who report combat-related aggression to be appetitive are more resilient to develop PTSD. Appetitive Aggression should therefore prevent widespread mental suffering in perpetrators of severe atrocities even after decades.

Methods And Findings: To test the long-term relationship between trauma-related illness and attraction to aggression, we surveyed a sample of 51 German male World-War II veterans (age: M = 86.7, SD = 2.8). War-related appetitive aggression was assessed with the Appetitive Aggression Scale (AAS). Current- and lifetime PTSD symptoms were assessed with the PSS-I. In a linear regression analysis accounting for 31% of the variance we found that veterans that score higher on the AAS show lower PSS-I symptom severity scores across their whole post-war lifetime (β = - .31, p = .014). The effect size and power were sufficient (f(2) = 0.51, (1-β) = .99). The same was true for current PTSD (β = - .27, p = .030).

Conclusions: Appetitive Aggression appears to be a resilience factor for negative long-term effects of combat experiences in perpetrators of violence. This result has practical relevance for preventing trauma-related mental suffering in Peace Corps and for designing adequate homecoming reception for veterans.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0050891PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3521013PMC
June 2013

Mental health 15 years after the killings in Rwanda: imprisoned perpetrators of the genocide against the Tutsi versus a community sample of survivors.

J Trauma Stress 2012 Aug;25(4):446-53

Department of Psychology, University of Konstanz, Konstanz, Germany.

Objectives of this study were to compare rates of mental health disorders in Rwandan genocide perpetrators with those of genocide survivors and to investigate potential predictors of symptoms of posttraumatic stress disorder (PTSD) and depression for both groups. We expected high rates of mental disorders in both study groups and hypothesized that symptom severity would be predicted by female gender, older age, lower level of education, higher level of trauma exposure, lower level of agreement to reconciliation, and the participation in killing. Structured clinical interviews were carried out with 269 imprisoned perpetrators (66% men) and 114 survivors (64% women). Significantly more survivors than perpetrators met symptom criteria for PTSD (46% vs. 14%) and suffered from anxiety symptoms (59% vs. 36%). A substantial proportion of both groups suffered from clinically significant depression (46% vs. 41%). PTSD severity in perpetrators was associated with trauma exposure, high levels of agreement to reconciliation, and no participation in killing; the severity of depression was associated with trauma exposure and no participation in killing. In the survivor sample, the severity of PTSD and depression were both correlated with female gender, trauma exposure, and low levels of agreement to reconciliation. Results suggest that both groups exhibit considerable psychiatric morbidity.
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http://dx.doi.org/10.1002/jts.21728DOI Listing
August 2012

Development of a 15-item odour discrimination test (Düsseldorf Odour Discrimination Test).

Perception 2012 ;41(2):193-203

Department of Psychology, University of Constance, Constance, Germany.

A key function of the olfactory system is the detection of differences in odour quality. Therefore, a test was developed to assess odour discrimination ability in normosmic humans. Out of six monomolecular substances (capric acid, coumarin, eugenol, geraniol, phenylethyl alcohol, and vanillin) quaternary mixtures were prepared. Within one item, three odour mixtures were presented (triangle forced-choice procedure). The deviant odour contained the same substances as the two remaining odours; however, the proportions were changed. Study 1 (120 participants) aimed to select items that contribute to a high internal consistency. Study 2 (104 participants) assessed test-retest reliability, parallel test reliability and test validity. Out of 45 items, a 15-item test (Düsseldorf Odour Discrimination Test, DODT) with an internal consistency of 0.61 and medium item difficulties was prepared. The test-retest reliability of the DODT was 0.66 (test interval = 4 weeks) and the parallel test reliability 0.42. The DODT correlated significantly with the University of Pennsylvania Smell Identification Test and to a lesser extent with the phenylethyl alcohol odour threshold test. As the DODT did not correlate with the odour discrimination test of the Sniffin' Sticks, the two tests seem to measure different performances of the olfactory system.
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http://dx.doi.org/10.1068/p7113DOI Listing
July 2012