CortiLove: A pilot study on hair steroids in the context of being in love and separation.

While romantic infatuation and separation influence psychological and physiological functioning, the hypothalamic-pituitary-adrenal axis with its biomarkers cortisol, dehydroepiandrosterone (DHEA), and progesterone central for coping and distress has been scarcely researched in this context. In particular, endocrine hair analyses assumed to be more valid than saliva or blood assessments for studying long-term processes have not yet been conducted in the context of romantic love. Thus, 101 female subjects in phases of infatuation (n = 16), separation (n = 14), long-term relationships (n = 40), and singlehood (n = 31) reported psychological distress and provided 1 cm hair samples for the assessment of long-term integrated cortisol, DHEA, and progesterone over the last month. Separated, infatuated, and single women exhibited higher cortisol levels than those in a long-term relationship (all ps ≤ .031), while self-reported distress was only evident in separated individuals. Further, no group differences for progesterone (p = .602), but higher DHEA levels in the separation (p = .009) and single group (p = .016) compared to the long-term relationship group were detected. This is the first study showing that compared to women in long-term relationships, infatuation, separation, and single groups exhibit higher levels of physiological, but not necessarily self-reported indicators of distress. These findings, albeit on a very small and preliminary sample, are discussed in the context of the stress-buffering effect of relationships, and provide important starting points for bigger, more balanced studies combining multimodal self-report and biological markers in psychological research of romantic love.

How to deal with non-detectable and outlying values in biomarker research: Best practices and recommendations for univariate imputation approaches.

Non-detectable (ND) and outlying concentration values (OV) are a common challenge of biomarker investigations. However, best practices on how to aptly deal with the affected cases are still missing. The high methodological heterogeneity in biomarker-oriented research, as for example, in the field of psychoneuroendocrinology, and the statistical bias in some of the applied methods may compromise the robustness, comparability, and generalizability of research findings. In this paper, we describe the occurrence of ND and OV in terms of a model that considers them as censored data, for instance due to measurement error cutoffs. We then present common univariate approaches in handling ND and OV by highlighting their respective strengths and drawbacks. In a simulation study with lognormal distributed data, we compare the performance of six selected methods, ranging from simple and commonly used to more sophisticated imputation procedures, in four scenarios with varying patterns of censored values as well as for a broad range of cutoffs. Especially deletion, but also fixed-value imputations bear a high risk of biased and pseudo-precise parameter estimates. We also introduce censored regressions as a more sophisticated option for a direct modeling of the censored data. Our analyses demonstrate the impact of ND and OV handling methods on the results of biomarker-oriented research, supporting the need for transparent reporting and the implementation of best practices. In our simulations, the use of imputed data from the censored intervals of a fitted lognormal distribution shows preferable properties regarding our established criteria. We provide the algorithm for this favored routine for a direct application in R on the Open Science Framework (https://osf.io/spgtv). Further research is needed to evaluate the performance of the algorithm in various contexts, for example when the underlying assumptions do not hold. We conclude with recommendations and potential further improvements for the field.

Lifetime Trauma History and Cognitive Functioning in Major Depression and Their Role for Cognitive-Behavioral Therapy Outcome.

Background: While cognitive-behavioral therapy (CBT) is the gold-standard psychological treatment for major depression (MD), non-response and lacking stability of treatment gains are persistent issues. Potential factors influencing treatment outcome might be lifetime trauma history and possibly associated primarily prefrontal-cortex- and hippocampus-dependent cognitive alterations. Method: We investigated MD and healthy control participants with (MD+T+, n = 37; MD-T+, n = 39) and without lifetime trauma history (MD+T-, n = 26; MD-T-, n = 45) regarding working memory, interference susceptibility, conflict adaptation, and autobiographical memory specificity. Further, MD+T+ (n = 21) and MD+T- groups (n = 16) were re-examined after 25 CBT sessions, with MD-T- individuals (n = 34) invited in parallel in order to explore the stability of cognitive alterations and the predictive value of lifetime trauma history, cognitive functioning, and their interaction for treatment outcome. Results: On a cross-sectional level, MD+T+ showed the highest conflict adaptation, but MD+T- the lowest autobiographical memory specificity, while no group differences emerged for working memory and interference susceptibility. Clinical improvement did not differ between groups and cognitive functioning remained stable over CBT. Further, only a singular predictive association of forward digit span, but no other facets of baseline cognitive functioning, lifetime trauma history, or their interaction with treatment outcome emerged. Discussion: These results indicate differential roles of lifetime trauma history and psychopathology for cognitive functioning in MD, and add to the emerging literature on considering cognitive, next to clinical remission as a relevant treatment outcome.

Cognitive functioning in posttraumatic stress disorder before and after cognitive-behavioral therapy.

Although substantial evidence suggests altered executive functioning and autobiographical memory in posttraumatic stress disorder (PTSD), the clinical significance of these findings remains unclear. Here, we investigated the effects of cognitive-behavioral therapy (CBT) on different aspects of cognitive functioning (working memory, interference susceptibility, conflict adaptation, autobiographical memory) in PTSD patients in a pre-post control group design with a nested cross-sectional element. Cross-sectional analyses at baseline were conducted on 58 PTSD patients, 39 traumatized (TC), and 45 non-traumatized controls (NTC). Intervention effects were investigated before and after 25 CBT sessions in 25 PTSD and 34 untreated NTC individuals assessed in parallel. At baseline, PTSD patients showed higher conflict adaptation than the NTC group and less autobiographical memory specificity than both control groups, suggesting particularly the latter to be a correlate of PTSD. No consistent evidence for treatment-induced improvements in cognitive functioning emerged on the group level or from associations between intra-individual clinical and cognitive changes. Analyses on the role of cognitive functioning on subsequent treatment effects revealed a predictive effect of backward digit span on CBT-induced reductions of depressiveness, but no other significant effects. Our findings highlight the need for further research to identify more relevant predictors of differential treatment response.

Victims of war-Psychoendocrine evidence for the impact of traumatic stress on psychological well-being of adolescents growing up during the Israeli-Palestinian conflict.

Violent conflicts are severe traumatic stressors with detrimental effects on physical and mental health, with children and adolescents being particularly at risk. For the hypothalamic-pituitary-adrenal (HPA) axis, characteristic patterns of dysregulation in trauma-exposed individuals have been shown. This study set out to investigate self-reported mental well-being in Palestinian adolescents growing up during the Israeli-Palestinian conflict. Hair cortisol concentrations (HCC) as a psychoendocrine marker for long-term HPA axis aberrations along with the potential protective factor sense of coherence (SoC; i.e., the global mindset to interpret the world and emerging stressors as comprehensible, manageable, and meaningful) were examined. Between 2014 and 2016, posttraumatic stress disorder (PTSD), depression, anxiety, HCC, and SoC were examined in 233 adolescents aged 11 to 16 from the West Bank. More than half of the participants reported trauma exposure, with 40% fulfilling the criteria of a preliminary PTSD diagnosis and a high prevalence of anxiety and depression. HCC was significantly elevated in the PTSD subgroup compared to the subgroup not exposed to any traumatic events (p = 0.046), with trauma-exposed individuals in between. HCC was further associated with typical sequelae of traumatic stress. Notably, SoC was inversely related to self-reported psychopathology, as well as to HCC in the trauma group. The results illustrate the situation of adolescents exposed to chronic traumatic stress and extend the literature on aberrant HPA axis functioning under such conditions. They also point out a central role of SoC, which may imply new strategies to aid individuals exposed to ongoing conflicts.

Ecological momentary assessment in posttraumatic stress disorder and coping. An eHealth study protocol.

Background: It is well known from cross-sectional studies that individual coping strategies significantly influence the pathogenesis of posttraumatic stress disorder (PTSD). Equally, undisputed is the role of biological processes, e.g. of the so-called 'stress hormone' cortisol for the trajectory of PTSD. Ecological momentary assessment (EMA), the repeated collection of self-reported momentary states via smartphones, is ideal for shedding light upon symptom fluctuations and coping strategies. EMA may also constitute a promising approach to provide closer associations to biomarkers than retrospective self-report. The mobile application 'CoachPTBS', created to facilitate transition into health-care systems, bridges waiting periods for trauma-specific psychotherapy. CoachPTBS offers tools akin to EMA that could elucidate coping with stress symptoms. Moreover, the app's self-management tools may improve coping strategies. However, these processes have never been examined in a combined, longitudinal fashion. Objective: The aim of the current study is to assess symptom fluctuations, coping strategies and long-term endocrine correlates of PTSD by a longitudinal, multimodal approach, combining traditional, online and EMA self-report with hair cortisol data and CoachPTBS as a possible novel mHealth tool. Method: 120 participants waiting for PTSD psychotherapy will be randomly grouped. After in-situ assessment and hair sample collection, 40 will receive CoachPTBS, using it daily throughout 4 weeks. A parallel group of 40 will participate in EMA, completing daily questionnaires on symptoms and coping. In between, online surveys will be conducted. After 6 weeks, a final interview and another hair sample collection will follow. Comparisons between these groups and waitlist-control, also consisting of 40 PTSD participants, and 40 non-traumatized participants assessed via EMA regarding aversive emotions and coping are planned. Discussion: Novel insights into the interplay of biological and coping strategies in PTSD are expected due to the innovative multimodal study design. Results will further explore benefits of eHealth tools on coping with PTSD.

Antecedentes: Es bien sabido por los estudios transversales que las estrategias de afrontamiento individuales influyen significativamente en la patogénesis del estrés postraumático (TEPT). Igualmente es indiscutible el rol de los procesos biológicos, por ej. De la llamada 'hormona del estrés', el cortisol para la trayectoria del TEPT. La evaluación ecológica del momento (EMA, por sus siglas en ingles), la que consiste en la colección repetida de estados momentáneos auto-reportados a través de teléfonos inteligentes, es ideal para arrojar luz sobre las fluctuaciones de los síntomas y estrategias de afrontamiento. La EMA puede constituir tambien un enfoque prometedor para proporcionar asociaciones más cercanas a los biomarcadores que el auto-reporte retrospectivo. La aplicación móvil 'CoachPTBS', creada para facilitar la transición en los sistemas de atención médica, une los periodos de espera para la psicoterapia específica para el trauma. CoachPTBS ofrece herramientas similares a EMA que podrían dilucidar el manejo de los síntomas de estrés. Además, las herramientas de autogestión de la aplicación pueden mejorar las estrategias de afrontamiento. Sin embargo, estos procesos nunca han sido examinados de manera longitudinal combinada.Objetivo: El objetivo de este estudio es evaluar las fluctuaciones de los síntomas, las estrategias de afrontamiento y los correlatos endocrinos a largo plazo del TEPT mediante un enfoque longitudinal y multimodal que combina el auto-reporte tradicional, en línea y EMA con información de cortisol capilar y CoachPTBS como una posible herramienta novedosa de salud móvil.Métodos: Se agruparán 120 participantes que esperan psicoterapia para TEPT. Después de una evaluación in situ y toma de muestra de cabello, 40 recibirán CoachPTBS, usándola diariamente durante cuatro semanas. Un grupo paralelo de 40 participará en EMA, completando cuestionarios diariamente acerca de los síntomas y afrontamiento. En el proceso, se realizaran encuestas en línea. Después de seis semanas, se realizará una entrevista final y otra recolección de muestras de cabello. Se planea una comparación entre estos grupos y la lista de espera, tambien consistente en 40 participantes con TEPT, y 40 participantes no traumatizados evaluados a través de EMA en relación a emociones adversas y afrontamiento.Discusión: Se esperan novedosas ideas en la interacción entre lo biológico y las estrategias de afrontamiento en TEPT debido al diseño innovador del estudio multimodal. Los resultados exploraran con mayor profundidad los beneficios de las herramientas de Salud 'electrónica' para hacer frente al TEPT.

Victims of War: Dehydroepiandrosterone Concentrations in Hair and Their Associations with Trauma Sequelae in Palestinian Adolescents Living in the West Bank.

Due to its anti-glucocorticoid properties, the steroid hormone dehydroepiandrosterone (DHEA) might play a role for coping with traumatic stress and posttraumatic stress disorder (PTSD). The majority of studies report elevated DHEA secretion and decreased cortisol/DHEA ratio associated with traumatic stress, however, contrasting results have also been published. One reason for this heterogeneity might be that in past studies, DHEA has been measured in plasma or saliva samples reflecting acute hormone levels. In comparison, the current study assessed the hair levels of DHEA and cortisol as long-term markers along with self-reported data on psychopathology and coping in 92 female adolescents aged 11⁻16 from the West Bank affected by the Israeli⁻Palestinian conflict. Results showed that trauma-exposed individuals had significantly higher DHEA levels (p = 0.013) and lower cortisol/DHEA ratios (p = 0.036) than participants from the non-trauma group. Furthermore, DHEA and cortisol/DHEA ratio emerged as associated with trauma load and timing, but not with coping. By applying the novel method of DHEA analysis from hair samples, this study adds to the growing literature on the interplay of DHEA, cortisol, traumatic stress and coping, and provides valuable starting points for further research.

Hair cortisol concentration in patients with active central serous chorioretinopathy is elevated - a pilot study.

PURPOSE: To investigate hair cortisol concentration (HCC), a biochemical correlate of long-term cortisol output patterns, and its relationship to active central serous chorioretinopathy (CSC). METHODS: Twenty-six participants were included in this observational pilot study (11 patients with active CSC and 15 healthy controls). Hair cortisol concentrations (HCCs) were determined from 3 cm hair strands collected near the scalp from patients and controls as an index of cumulative cortisol secretion over the 3-month period prior to hair sampling. RESULTS: Patients with CSC exhibited higher HCCs (mean value: 20.14, 95% CI: 14.89-27.16 pg/mg) than healthy controls (mean value: 11.06, 95% CI: 8.63-14.22 pg/mg, p = 0.008). Group differences were not affected by relevant covariates (BMI, smoking status, sex). CONCLUSION: Patients with active CSC have increased HCC, supporting the fact that cortisol is a major player in CSC pathogenesis.