Elevated perceived stress in university students due to the COVID-19 pandemic: Potential contributing factors in a propensity-score-matched sample.

OBJECTIVE: Onset of the Coronavirus Disease 2019 (COVID) pandemic has increased students' perceived burdens. The current study aimed to examine COVID-related changes and to identify potential factors that contribute to students' stress. METHOD: Adopting a cross-sectional cohort-study design, we examined perceived stress and depressive and anxiety symptoms with a specific focus on the role of study-related variables such as perceived study-related demands, study-related resources, academic procrastination, and stress-enhancing beliefs. Two cohorts (Npre-COVID = 2,175; NCOVID = 959) were recruited at the same university and matched with regard to their propensity score (age, gender, semester). RESULTS: Compared with the pre-COVID cohort, university students in the COVID cohort reported more perceived stress, more depressive and anxiety symptoms, more academic procrastination due to fear of failure, more stress-enhancing beliefs, more distress due to the housing situation, and more perceived study-related challenges (Cohen's d = 0.15-0.45). A stepwise regression analysis identified depressive symptoms, procrastination due to fear of failure, general self-efficacy, increased study demands, perceived difficulties with self-organized learning, distress due to housing, and stress-enhancing beliefs as predictors of perceived stress in the COVID cohort. DISCUSSION: Findings suggest that the switch to online-only education increased the study-related burden for students, primarily due to exams being replaced by a greater amount of regular coursework and imposing demands on self-organized learning. Possibly, stress-enhancing beliefs and procrastination due to fear of failure might have been elevated due to less opportunity for social referencing and lack of felt social support by peer students. CONCLUSION: Experienced increased burden in students during the COVID pandemic was mostly accounted for by a lack of perceived individual resources rather than by an increase in objective study-related demands.

Alpha-2 Adrenoreceptor Antagonist Yohimbine Potentiates Consolidation of Conditioned Fear.

BACKGROUND: Hyperconsolidation of aversive associations and poor extinction learning have been hypothesized to be crucial in the acquisition of pathological fear. Previous animal and human research points to the potential role of the catecholaminergic system, particularly noradrenaline and dopamine, in acquiring emotional memories. Here, we investigated in a between-participants design with 3 groups whether the noradrenergic alpha-2 adrenoreceptor antagonist yohimbine and the dopaminergic D2-receptor antagonist sulpiride modulate long-term fear conditioning and extinction in humans. METHODS: Fifty-five healthy male students were recruited. The final sample consisted of n = 51 participants who were explicitly aware of the contingencies between conditioned stimuli (CS) and unconditioned stimuli after fear acquisition. The participants were then randomly assigned to 1 of the 3 groups and received either yohimbine (10 mg, n = 17), sulpiride (200 mg, n = 16), or placebo (n = 18) between fear acquisition and extinction. Recall of conditioned (non-extinguished CS+ vs CS-) and extinguished fear (extinguished CS+ vs CS-) was assessed 1 day later, and a 64-channel electroencephalogram was recorded. RESULTS: The yohimbine group showed increased salivary alpha-amylase activity, confirming a successful manipulation of central noradrenergic release. Elevated fear-conditioned bradycardia and larger differential amplitudes of the N170 and late positive potential components in the event-related brain potential indicated that yohimbine treatment (compared with a placebo and sulpiride) enhanced fear recall during day 2. CONCLUSIONS: These results suggest that yohimbine potentiates cardiac and central electrophysiological signatures of fear memory consolidation. They thereby elucidate the key role of noradrenaline in strengthening the consolidation of conditioned fear associations, which may be a key mechanism in the etiology of fear-related disorders.

[Item Reduction to Improve Practicability of Neonatal Pain Assessment Tools - Comparison of NFCSshort and PIPP in Daily Clinical Practice]. / Itemreduktion zur Verbesserung der Praktikabilität neonatologischer Schmerzmesssysteme.

HINTERGRUND: Trotz über 50 psychometrisch validierter Beobachtungsverfahren gibt es bisher keinen Konsens über das praktikabelste Schmerzassessment bei Neugeborenen. Die Items von NFCSshort und PIPP wurden mit der Schmerzeinschätzung der prozedurbeteiligten Behandler verglichen und es wurde evaluiert, ob eine Itemreduktion zu Gunsten der Alltagsanwendung möglich wäre. MATERIAL UND METHODEN: 52 Neugeborene wurden in unserer Beobachtungsstudie einer klinisch indizierten peripheren Venenpunktion unterzogen. Patient und Monitordaten wurden standardisiert auf Video aufgezeichnet. Die Schmerzintensität wurden durch sieben unabhängige Untersucher mittels NFCSshort und PIPP bewertet und hinsichtlich der Variabilität zwischen den Untersuchern verglichen. ERGEBNISSE: Nur vier Items des PIPP (Herzfrequenz, Augenbrauenvorwölbung, zusammengekniffene Augen, betonte Nasolabialfalte) wiesen einen signifikanten Zusammenhang mit der geschätzten Schmerzhaftigkeit der Prozedur auf. Die Items 1 (Gestationsalter), 2 (Wachheitsgrad) und 4 (Sauerstoffsättigung) hatten bei keinem Untersucher Einfluss auf das Schmerzmessergebnis. Die Auswertung des NFCSshort zeigte bei zwei Untersuchern für das Item 1 (Vorwölbung der Augenbrauen) und bei einem Untersucher für das Item 2 (zusammengekniffene Augen) keine Einflüsse auf das Messergebnis. DISKUSSION: Die Ergebnisse der Studie legen eine Kürzung des PIPP um drei Items nahe, da diese keinen Einfluss auf das Schmerzmessergebnis zeigten. Eine Reduktion des PIPP um das Item Gestationsalter erscheint fraglich, da es in weiteren Studien als bedeutsames Item bewertet wurde. Ein Verzicht auf das Item Sauerstoffsättigung geht mit einem geringeren Messaufwand einher. Eine weitere Kürzung der bereits gekürzten Version (NFCSshort) auf weniger als fünf Items ist auf Basis unserer Ergebnisse nicht zu empfehlen. BACKGROUND: Despite more than 50 laboratory-evaluated measurement systems, there is no consensus on the most practicable pain assessment in newborns in daily practice. For this purpose, the items of NFCSshort and PIPP were compared to the pain assesment of the involved medical practitioner. The aim of the study was to evaluate whether an item reduction of the assesments in favor of everyday use is feasible. METHODS: In 52 neonates of a paediatric ward venous blood collection was performed in this observational study. Cameras recorded patients and monitor in a standardized way. The pain intensity was assessed with NFCSshort and PIPP by seven independent observers. The ratings were compared for variability between observers. RESULTS: Of the seven PIPP items, only four were significantly associated with procedural pain assessment for all seven observers (heart rate, brow bulge, eye squeeze, nasolabial furrow). For the NFCSshort, no significant association with procedural pain assessment was found for two observers for the item "brow bulge" and for one observer for the item "eye squeeze". CONCLUSION: The results of the study suggest a possible reduction of the PIPP by three items. Disregarding item 1 (gestational age) appears questionable, since its impact as context variable has been proven repeatedly. The waiver of item 4 (oxygen saturation) is associated with less measuring effort. A further reduction of the already shortened version of the NFCS with ten items (NFCSshort, five items) is not recommended by our results.

[Measurement of pain-related experiential avoidance: analysis of the Acceptance and Action Questionnaire-II-Pain in patients with chronic pain]. / Messung von schmerzbezogener Erlebensvermeidung: Analyse des Acceptance and Action Questionnaire-II-Pain bei Patienten mit chronischem Schmerz.

INTRODUCTION AND OBJECTIVE: Experiential avoidance is a core process variable in the concept of Acceptance and Commitment Theory (ACT) and has been connected to various disorders. A widely used instrument for the measurement of experiential avoidance is the Acceptance and Action Questionnaire II (AAQ-II). Recently, a pain-specific version for chronic pain patients was introduced in the Netherlands (AAQ-II­P). High scores indicate strong pain-related experiential avoidance. The aim of the current study was to measure pain-related experiential avoidance in a sample of chronic pain patients using the German translation of the AAQ-II­P and to analyze its psychometric qualities. METHODS: After a forward-backward translation procedure of the AAQ-II and adaptation to the pain context, a sample of N = 168 patients from a multidisciplinary pain center answered the German version of the AAQ-II­P. Additional questionnaires were administered to measure specific constructs of interest: chronic pain grade (CPG), pain catastrophizing (PCS), health-related quality of life (SF-12), psychopathology (HADS-D), personality (BFI­K) and mindfulness (KIMS-S). Reliability, factorial validity and construct validity of the AAQ-II­P were identified. RESULTS: The AAQ-II­P had high internal consistency (α = 0.89) and the one-factor solution explained 61% of the total variance. Correlations to personality and mindfulness subscales were low (maxima: r = 0.44 with neuroticism and r = -0.43 with acceptance). High correlations were shown for catastrophizing (r = 0.75), depression (r = 0.73) and anxiety (r = 0.66). Also, there was a substantial correlation to health-related quality of life, specifically the psychological total scale (r = -0.58). DISCUSSION AND CONCLUSION: The German AAQ-II­P has good reliability. Regarding factorial structure and construct validity, it is highly comparable to the original version. Direction and magnitude of the relationship to adjacent constructs mostly measure up to our expectations. Chronic pain patients inclined to pain-related experiential avoidance tend to indicate more pain catastrophizing and show restricted quality of life regarding psychological variables. Apparently, pain-related experiential avoidance can be relevant for popular target variables in psychotherapy.

Fear Extinction Recall Modulates Human Frontomedial Theta and Amygdala Activity.

Human functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) studies, as well as animal studies, indicate that the amygdala and frontomedial brain regions are critically involved in conditioned fear and that frontomedial oscillations in the theta range (4-8 Hz) may support communication between these brain regions. However, few studies have used a multimodal approach to probe interactions among these key regions in humans. Here, our goal was to bridge the gap between prior human fMRI, EEG, and animal findings. Using simultaneous EEG-fMRI recordings 24 h after fear conditioning and extinction, conditioned stimuli presented (CS+E, CS-E) and not presented during extinction (CS+N, CS-N) were compared to identify effects specific to extinction versus fear recall. Differential (CS+ vs. CS-) electrodermal, frontomedial theta (EEG) and amygdala responses (fMRI) were reduced for extinguished versus nonextinguished stimuli. Importantly, effects on theta power covaried with effects on amygdala activation. Fear and extinction recall as indicated by theta explained 60% of the variance for the analogous effect in the right amygdala. Our findings show for the first time the interplay of amygdala and frontomedial theta activity during fear and extinction recall in humans and provide insight into neural circuits consistently linked with top-down amygdala modulation in rodents.

[Applicability of Neonatal Pain Scores depending on Level of Education and Work Experience in Child Care]. / Anwendbarkeit neonataler Schmerzscores in Abhängigkeit von Ausbildungsstand und Berufserfahrung in der Kinderpflege.

INTRODUCTION: In management of pain the nursing staff plays a major role in measuring, preventing and treating pain. The influence of general work experience and experience with newborns was investigated by comparing PIPP and NRS measurements in groups with work experience and student nurses. METHODS: 44 students of the nursing school and 35 members of the staff of 2 university hospitals scored the Premature Infant Pain Profile PIPP - a 7 dimensional measurement tool - for 10 videos of painful procedures on preterm and newborn. The subjective impression of the patients' pain was obtained by a NRS. RESULTS: In contrast to the application of one dimensional measurement tools there were no differences between the groups with different experience levels. Also the work experience with newborn did not seem to influence the total PIPP score. Certainly both groups showed a moderate dispersion of the total values (e. g. Video 1: 10,5 [9-12] vs. 10 [3-11]). In NRS students rated the pain lower than experienced nurses. These results were not significant. CONCLUSION: The application of PIPP by students was equal to the application by experienced nurses. The work experience with newborn did not seem to influence the rating. Certainly both groups showed a moderate dispersion of total values (e. g. Video 1: 10,5 [9-12] vs. 10 [3-11]).

Fearfulness, neuroticism/anxiety, and COMT Val158Met in long-term fear conditioning and extinction.

Individual differences in long-term stability of fear memories are of potential relevance for stable dispositions related to threat processing, such as neuroticism/anxiety and fearfulness. As previous research suggests a prominent role of dopamine for the retention of conditioned and extinguished fear, dopaminergic gene polymorphisms may also relate to individual differences in fear stability. While the COMT Val158Met polymorphism causes individual differences in prefrontal dopamine, its associations with human long-term fear extinction are currently unknown. Here, n = 30/29/28 healthy male Val/Val, Val/Met and Met/Met carriers, respectively, underwent a two-day differential conditioning paradigm with fear acquisition and extinction on Day 1 and a recall test on Day 2 with recordings of EEG and ECG. Fearfulness but not neuroticism/anxiety predicted fear bradycardia (i.e., heart period slowing) during Day 1 fear acquisition while it did not affect extinction or Day 2 fear recall. In contrast, COMT Val158Met significantly modulated Day 2 fear recall as evident in fear bradycardia and Late Positive Potential (LPP) amplitudes while it did not affect Day 1 fear or extinction learning. Furthermore, exploratory analyses revealed that individual differences in fear bradycardia during Day 2 extinction recall depended on Day 1 extinction success. Importantly, this contingency was (a) modulated by COMT Val158Met and (b) significantly reduced in high vs. low neuroticism/anxiety. The present study indicates that (a) individual differences in dopaminergic genotypes may affect the long-term stability of fear memories and (b) fearfulness vs. neuroticism/anxiety might play distinct roles in initial fear reactions vs. long-term stability of fear memories, respectively.

Functional limitations in children and adolescents suffering from chronic pain: validation and psychometric properties of the German Functional Disability Inventory (FDI-G).

Our objective was to translate the Functional Disability Inventory (FDI) into German, to evaluate its validity and to assess functional limitation in a large cohort of children and adolescents with juvenile fibromyalgia syndrome (jFMS). We administered several questions (e.g., sociodemographics, school-related issues) and questionnaires to 329 patients and one parent. The questionnaires included, among others, a German version of the FDI, the CHAQ (parent report), KIDSCREEN, tender point score (TPS), Depression Inventory for Children and Adolescents (DIKJ) and others. Patients were asked about the severity of pain today (NRS = numerical rating scale) and other symptoms. Internal consistency was evaluated with Cronbach's alpha. Construct validity of the FDI was evaluated by correlating the FDI with the questionnaires as well as with the pain and other variables, e.g., days missed school. An exploratory factor analysis (EFA) was also performed. Mean age was 13.9 years (SD ±2.48). Means were for pain today 5.37 (±2.39) and for the TPS 39.71 (±21.56). Internal consistency was α = .90. Low-to-moderate correlations were obtained between the FDI and the CHAQ (ρ = .51**), KIDSCREEN (e.g., physical well-being ρ = -.62**; peers and social support ρ = -.28**) as well as the pain variables (NRS ρ = .24**; TPS ρ = .38**). Psychological variables were also correlated with the FDI (e.g., DIJK ρ = .28**). An EFA suggested a two-factor solution. The FDI is a valid instrument for measuring functional limitations in German children and adolescents with jFMS.

Prefrontal oscillations during recall of conditioned and extinguished fear in humans.

Human neuroimaging studies indicate that the anterior midcingulate cortex (AMC) and the ventromedial prefrontal cortex (vmPFC) play important roles in the expression and extinction of fear, respectively. Electrophysiological rodent studies further indicate that oscillatory neuronal activity in homolog regions (i.e., prelimbic and infralimbic cortices) changes during fear expression and fear extinction recall. Whether similar processes occur in humans remains largely unexplored. By assessing scalp surface EEG in conjunction with LORETA source estimation of CS-related theta and gamma activity, we tested whether a priori defined ROIs in the human AMC and vmPFC similarly modulate their oscillatory activity during fear expression and extinction recall, respectively. To this end, 42 healthy individuals underwent a differential conditioning/differential extinction protocol with a Recall Test on the next day. In the Recall Test, nonextinguished versus extinguished stimuli evoked an increased differential (CS(+) vs CS(-)) response with regard to skin conductance and AMC-localized theta power. Conversely, extinguished versus nonextinguished stimuli evoked an increased differential response with regard to vmPFC-localized gamma power. Finally, individuals who failed to show a suppressed skin conductance response to the extinguished versus nonextinguished CS(+) also failed to show the otherwise observed alterations in vmPFC gamma power to extinguished CS(+). These results indicate that fear expression is associated with AMC theta activity, whereas successful fear extinction recall relates to changes in vmPFC gamma activity. The present work thereby bridges findings from prior rodent electrophysiological research and human neuroimaging studies and indicates that EEG is a valuable tool for future fear extinction research.

Working with patients' treatment expectations - what we can learn from homeopathy.

The usual homeopathic remedy, "globules," does not contain any pharmacologically active ingredient. However, many patients and practitioners report beneficial effects of homeopathic treatment on various health outcomes. Experimental and clinical research of the last two decades analyzing the underlying mechanisms of the placebo effect could explain this phenomenon, with patients' treatment expectations as the predominant mechanism. Treatment expectations can be optimized through various factors, such as prior information, communication, and treatment context. This narrative review analyses how homeopathy successfully utilizes these factors. Subsequently, it is discussed what evidence-based medicine could learn from homeopathic practice to optimize treatment expectations (e.g., using an empathic, patient-centered communication style, deliberately selecting objects in practice rooms, or using clear treatment rituals and salient contextual stimuli) and thereby treatment effectiveness. Homeopathic remedy does not work beyond the placebo effect but is recommended or prescribed as an active treatment by those who believe in it. Thus, practitioners need to understand the manner in which homeopathy (as an example of inert treatment) works and are advised to reintegrate its underlying effective placebo mechanisms into evidence-based medicine. This promises to increase treatment efficacy, tolerability, satisfaction, and compliance with evidence-based treatments, and addresses the desires patients are trying to satisfy in homeopathy in an ethical, fully informed way that is grounded in evidence-based medicine.

Epidemiology of Pertussis and Pertussis-Related Complications in Adults: A German Claims Data Analysis.

INTRODUCTION: Pertussis is a highly contagious respiratory infection. It affects people of all ages, yet evidence of the impact of pertussis in adults with underlying conditions (UCs) is scarce. This study investigated the incidence and complication rate of pertussis in adult patients with and without UC. METHODS: A retrospective analysis was conducted using routinely collected German claims data between 2015 and 2019. Patients with and without different pneumological, cardiovascular, endocrinological, musculoskeletal, and psychological UCs were matched for incidence estimation. Logistic regression models were used to estimate the risk of pertussis depending on the presence of UCs. Negative binomial models were used to assess complication rates in patients with pertussis and with and without UC. RESULTS: In total, 4383 patients were diagnosed with pertussis during the study period. Patients with any UC had an increased risk for pertussis compared to matched patients without UC (odds ratio [OR] 1.72; 95% confidence interval [CI]1.60-1.84, p < 0.0001). Underlying asthma had the highest risk of pertussis (OR 2.70; 95% CI 2.50-2.91, p < 0.0001), followed by chronic obstructive pulmonary disease (OR 2.35; 95% CI 2.10-2.60, p < 0.0001) and depression (OR 2.08; 95% CI 1.95-2.22, p < 0.0001). Severe complications occurred in 10.8% of the pertussis cohort (13.4% with UC vs. 9.5% without UC). The UC-attributable effect on the risk of severe pertussis-related complications was significantly increased for any UC (incidence rate ratio [IRR] 1.29, 95% CI 1.19-1.39). The severe complication risk was also increased for patients aged 60+ (IRR 1.59, 95% CI 1.46-1.72). CONCLUSION: This study shows that adults with certain UCs have an increased risk for pertussis and are more likely to have complications. These results provide further evidence that pertussis is a relevant and impactful infectious disease in adults with and without certain UC, indicating that these patients need to be considered when developing vaccination recommendations to avoid pertussis and its associated complications. A graphical abstract is available with this article.

Skin Transillumination Improves Peripheral Vein Cannulation by Residents in Neonates: A Randomized Controlled Trial.

INTRODUCTION: Establishing peripheral vein access is challenging for pediatric residents and a painful procedure for neonates. We assessed the efficacy of a red light-emitting diode transilluminator during peripheral vein catheter insertion performed by pediatric residents. METHODS: Patients were stratified by current weight (≤1,500 g, >1,500 g) and randomized to the transillumination or the control group. The first three attempts were performed by pediatric residents, followed by three attempts by a neonatologist. The primary outcome was success at first attempt. Secondary comparisons included time to successful insertion and overall success rates of residents and neonatologists. RESULTS: A total of 559 procedures were analyzed. The success rate at resident's first attempt was 44/93 (47%) with transillumination versus 44/90 (49%) without transillumination (p = 0.88) in the strata ≤1,500 g and 103/188 (55%) with transillumination versus 64/188 (34%) without transillumination in the strata >1,500 g (p < 0.001). The overall success rate for residents was 86% in the transillumination versus 73% in the control group in the strata >1,500 g (p = 0.003) but not different in the strata ≤1,500 g (78/93 [84%] vs. 72/90 [80%], p = 0.57). There was no effect when the experience level of residents exceeded 6 months. Neonatologists' overall success rate and time to successful cannulation did not differ significantly in both weight strata. CONCLUSION: Transillumination improves the first-attempt success rate of peripheral vein cannulation performed by pediatric residents in neonates >1,500 g, while no benefit was found in infants ≤1,500 g.

The impact of pharmaceutical form and simulated side effects in an open-label-placebo RCT for improving psychological distress in highly stressed students.

Open-label placebo (OLP) may be utilized to reduce psychological distress. Yet, potential contextual effects have not been explored. We investigated the impact of pharmaceutical form and the simulation of side effects in a parallel group RCT (DRKS00030987). A sample of 177 highly stressed university students at risk of depression were randomly assigned by computer generated tables to a 1-week intervention with active or passive OLP nasal spray or passive OLP capsule or a no-treatment control group. After the intervention, groups differed significantly in depressive symptoms but not regarding other outcomes of psychological distress (stress, anxiety, sleep quality, somatization), well-being or treatment expectation. OLP groups benefitted significantly more compared to the no-treatment control group (d = .40), OLP nasal spray groups significantly more than the OLP capsule group (d = .40) and the active OLP group significantly more than the passive OLP groups (d = .42). Interestingly, before intervention, most participants, regardless of group assignment, believed that the OLP capsule would be most beneficial. The effectiveness of OLP treatments seems to be highly influenced by the symptom focus conveyed by the OLP rationale. Moreover, pharmaceutical form and simulation of side effects may modulate efficacy, while explicit treatment expectation seems to play a minor role.

The Hand-Withdrawal-Method - An Adapted and Simplified Method of Limits for Behavioral Heat Pain Assessment.

The method-of-limits (MLI) is an established psychophysical procedure, for example for determining thermal thresholds. The standard MLI relies on fixating the thermode at the stimulation site by means of a strap and requires the participant to terminate the increase in heat by pressing a button. This, however, raises concerns regarding safety and task complexity in specific populations, such as cognitively impaired individuals, people with high fear of pain or young children (< 6 years). In this study, we aimed at developing a simplified version of the commonly used MLI for testing heat pain threshold (HPT) and tolerance (HPTol), and at validating it as a first step in healthy adults. Heating is terminated by withdrawing the hand from the heat probe, thereby ensuring maximum control and safety. For validation, HPTs and HPTols were assessed with the novel "hand-withdrawal-method" (HWM) and compared to the standard MLI, using a within-subject design. Additionally, as one potential research area in which the HWM may be used, we explored expectancy-induced placebo hypoalgesic effects by comparing results of standard MLI with those of HWM. Our data confirm good concordance between the 2 methods. For none of the outcomes significant differences between the 2 methods were found. PERSPECTIVE: In the present study in healthy adults, an adapted simplified and safe method of limits was demonstrated to be equivalent to the standard method-of-limits. This novel behavioral "hand-withdrawal-method" seems promising for future investigations of pain sensitivity and placebo effects, especially for specific populations such as young children.

Can clouds dance? Part 2: an ERP investigation of passive conceptual expansion.

Conceptual expansion, one of the core operations in creative cognition, was investigated in the present ERP study. An experimental paradigm using novel metaphoric, nonsensical and literal phrases was employed where individual differences in conceptual knowledge organization were accounted for by using participants' responses to categorize the stimuli to each condition. The categorization was determined by their judgment of the stimuli on the two defining criteria of creativity: unusualness and appropriateness. Phrases judged as unusual and appropriate were of special interest as they are novel and unfamiliar phrases thought to passively induce conceptual expansion. The results showed a graded N400 modulation for phrases judged to be unusual and inappropriate (nonsense) or unusual and appropriate (conceptual expansion, novel metaphorical) relative to usual and appropriate (literal) phrases. The N400 is interpreted as indexing greater effort to retrieve semantic information and integrate the novel concepts presented through the phrases. Analyses of the later time-window showed an ongoing negativity that was graded in the same manner as the N400. The findings attest to the usefulness of investigating creative cognition using event-related electrophysiology.

Can clouds dance? Neural correlates of passive conceptual expansion using a metaphor processing task: Implications for creative cognition.

Creativity has emerged in the focus of neurocognitive research in the past decade. However, a heterogeneous pattern of brain areas has been implicated as underpinning the neural correlates of creativity. One explanation for these divergent findings lies in the fact that creativity is not usually investigated in terms of its many underlying cognitive processes. The present fMRI study focuses on the neural correlates of conceptual expansion, a central component of all creative processes. The study aims to avoid pitfalls of previous fMRI studies on creativity by employing a novel paradigm. Participants were presented with phrases and made judgments regarding both the unusualness and the appropriateness of the stimuli, corresponding to the two defining criteria of creativity. According to their respective evaluation, three subject-determined experimental conditions were obtained. Phrases judged as both unusual and appropriate were classified as indicating conceptual expansion in participants. The findings reveal the involvement of frontal and temporal regions when engaging in passive conceptual expansion as opposed to the information processing of mere unusualness (novelty) or appropriateness (relevance). Taking this new experimental approach to uncover specific processes involved in creative cognition revealed that frontal and temporal regions known to be involved in semantic cognition and relational reasoning play a role in passive conceptual expansion. Adopting a different vantage point on the investigation of creativity would allow for critical advances in future research on this topic.

Validation of criterion-based patient assignment and treatment effectiveness of a multidisciplinary modularized managed care program for headache.

This prospective observational study evaluates the validity of an algorithm for assigning patients to a multidisciplinary modularized managed care headache treatment program. N = 545 chronic headache sufferers [migraine (53.8 %), migraine + tension type (30.1 %), tension type (8.3 %) or medication overuse headache (6.2 %), other primary headaches (1.5 %)] were assigned to one of four treatment modules differing with regard to the number and types of interventions entailed (e.g., medication, psychological intervention, physical therapy, etc.). A rather simple assignment algorithm based on headache frequency, medication use and psychiatric comorbidity was used. Patients in the different modules were compared with regard to the experienced burden of disease. 1-year follow-up outcome data are reported (N = 160). Headache frequency and analgesic consumption differed significantly among patients in the modules. Headache-related disability was highest in patients with high headache frequency with/without medication overuse or psychiatric comorbidity (modules 2/3) compared to patients with low headache frequency and medication (module 0). Physical functioning was lowest in patients with chronic headache regardless of additional problems (modules 1/2/3). Psychological functioning was lowest in patients with severe chronicity with/without additional problems (module 2/3) compared to headache suffers with no/moderate chronicity (module 0/1). Anxiety or depression was highest in patients with severe chronicity. In 1-year follow-up, headache frequency (minus 45.3 %), consumption of attack-aborting drugs (minus 71.4 %) and headache-related disability decreased (minus 35.9 %). Our results demonstrate the clinical effectiveness and the criterion validity of the treatment assignment algorithm based on headache frequency, medication use and psychiatric comorbidity.

Even when you know it is a placebo, you experience less sadness: First evidence from an experimental open-label placebo investigation.

BACKGROUND: Recent studies demonstrate substantial effects of deceptive placebo on experimentally induced sadness, even on autonomic activity. Whether deception is necessary, remains to be elucidated. We investigated the effect of an open-label placebo (OLP) treatment, i.e. an openly administered placebo delivered with a convincing rationale for its sadness-protecting effect. METHODS: Eighty-four healthy females were randomized to an OLP group or a no-treatment control group. All participants received the same detailed information about the OLP effect, only the OLP group received an OLP nasal spray. Before and after the OLP intervention, participants underwent a sad mood induction procedure combining self-deprecating statements (Velten's method) and sad music. Sadness was assessed by the Positive and Negative Affect Schedule (PANAS-X). Autonomic activity was measured continuously. RESULTS: Participants in the OLP group reported a significantly attenuated increase in sadness upon mood induction and less sadness after induction compared to the control group (d = 0.79). Regardless of intervention, heart rate decreased during mood inductions with a more pronounced deceleration in the second mood induction. LIMITATIONS: Generalizability is limited due to the selective sample and the reliance on an experimentally controlled mood induction. CONCLUSION: OLP treatment had a beneficial effect on perceived sadness, at least at the subjective level. Hence, deception may not necessarily be required for placebos to modulate experienced sad mood. Investigating the beneficial effects of OLP in (sub-)clinical samples would seem a promising and required next step towards a clinical use of placebo-associated positive treatment expectations.

Pain modulation by your partner: An experimental investigation from a social-affective perspective.

BACKGROUND: Social context such as the relationship between a person experiencing pain and a caregiver has been shown to affect the experience of pain, yet, results are not consistent. Possibly, differential effects of interpersonal relationships are modulated by affective states expressed by social partners. Viewing partner pictures in experimental designs is not only associated with lowered perceived pain intensity, but also affects neural responses. However, the role of affective modulation is not clear. The present study aimed to systematically examine the pain modulating effects of stimuli varying in affect and social content including personal relevance using subjective report and psychophysiological measures of facial and autonomic activity. METHODS: Twenty-nine women underwent a tonic heat pain paradigm with simultaneous picture viewing to investigate the influence of their partners' faces with a neutral facial expression compared to strangers' happy, angry and neutral facial expressions on pain intensity and accompanying psychophysiological parameters (facial activity: corrugator muscle activity, autonomic activity: skin conductance level, heart rate). In addition to perceived partner support and relationship characteristics, the contribution of the affective value (valence, arousal) of the partner faces to the observed pain modulation was examined. RESULTS: Partner and happy faces reduced self-reported pain intensity and corrugator activity, the latter being lowest when viewing partner faces as compared to all other picture categories. As corrugator activity is indexing stimulus unpleasantness and a core feature of the facial pain expression, this physiological pattern matches well with the subjective ratings. Neutral objects, neutral and angry faces had no effect on pain self-report, although angry faces were rated as highly negative. Partner faces also led to increased skin conductance, being an index of motivational activation, and heart rate deceleration, possibly reflecting increased sensory intake. Partner-related pain modulation was primarily related to perceived arousal of the partner's picture, i.e., the intensity of the activation of approach motivation, and pain-related catastrophizing. DISCUSSION: Our results are partially consistent with emotional pain control models, especially regarding the modulatory influence of valence. Within the context of socially adaptive behavior, they particularly underline the social signal value of emotion and attachment figures. Clinically, our results imply that just looking at pictures of one's partner when undergoing acute painful procedures can have a robust hypoalgesic effect.

Conceptual expansion via novel metaphor processing: An ERP replication and extension study examining individual differences in creativity.

The aims of the present ERP study were twofold. First, to determine whether a previous study on creative cognition could be replicated, and second, to extend these findings by examining individual differences in creativity. Conceptual expansion, a capacity that is central to creativity, was induced via the processing of novel metaphors. Brain activity patterns in relation to these were compared to the processing of literal and nonsense phrases. The previous findings were replicated in that the N400, known for its sensitivity to semantic anomalies, indexed the originality of the phrases, while a post-N400 late component (LC), which is linked to semantic integration processes, indexed the appropriateness of the phrases. Moreover, only the LC was significantly sensitive to individual differences in creativity in the processing of these phrases. Differences at the level of semantic integration processes as well as the structure of knowledge organization are thereby implicated in individual differences in creativity.