Putting the Vicious Cycle to the Test: Evidence for the Cognitive Behavioral Model of Persistent Somatic Symptoms From an Online Study.

OBJECTIVE: In clinical practice, persistent somatic symptoms are regularly explained using a cognitive-behavioral model (CBM). In the CBM, predisposing, perpetuating, and precipitating factors are assumed to interact and to cause the onset and endurance of somatic symptoms. However, these models are rarely investigated in their entirety. METHODS: We conducted an online survey during the COVID-19 pandemic. A total of 2114 participants from the general German population completed questionnaires that measured different factors of the CBM. We used state negative affectivity and neuroticism as predisposing factors, fear of a COVID-19 infection as the precipitating factor, and somatic symptoms, misinterpretation of bodily symptoms, attention allocation to bodily symptoms, and health anxiety as perpetuating factors. Moreover, we added safety and avoidance behavior as end points to the model. We conducted a psychological network analysis to exploratively study the relationships between the model's different factors and tested the assumptions of the CBM by evaluating a structural equation model (SEM) that incorporated all factors of the model. RESULTS: Network analyses revealed clustering in our data: Health anxiety and different cognitive factors are closely related, whereas somatic symptoms and state negative affectivity are strongly associated. Our SEM showed adequate fit. CONCLUSIONS: Our findings from an exploratory and a confirmatory approach give empirical support for the CBM, suggesting it as a suitable model to explain bodily symptoms in the general population and to possibly guide clinical practice. The network model additionally indicates the necessity to apply an individualized CBM for patients, depending on a preponderance of either persistent somatic symptoms or health concerns.

[Implementation and evaluation of a telephone hotline for professional mental health first aid during the COVID-19 pandemic in Germany]. / Implementierung und Evaluation einer Telefonhotline zur professionellen Ersthilfe bei psychischen Belastungen durch die COVID-19-Pandemie in Baden-Württemberg.

BACKGROUND: The COVID-19 pandemic represents a significant psychological burden for many people; however, especially during the first wave of the pandemic in Germany, little acute professional help was available for people in need. OBJECTIVE: In southern Germany, a telephone hotline for psychological first aid for COVID-19-related burdens was set up under the lead of the Baden-Wuerttemberg Ministry of Social Affairs and Integration, opened to the entire population and evaluated in April 2020. MATERIAL AND METHODS: In the period from 22 April to 24 July 2020, 753 volunteer psychotherapeutically trained counselors from different professional groups answered a total of 8096 calls. RESULTS: Depression symptoms (36%), anxiety symptoms (18%) and psychotic symptoms (19%) were most frequently reported. Every second call was related to a previous mental illness. During the counseling sessions, which lasted 25 min on average, a variety of psychological acute interventions were conducted. In the presence of unclear symptoms, psychotic symptoms or severe personality disorder symptoms, the counselors were able to help significantly less compared to the remaining calls in which other clearly defined symptoms were present. CONCLUSION: The results point to both the benefits and limitations of hotline services. The major benefits relate to the fast availability and effective professional help for people with clearly characterized symptoms. In the case of unclear or complex symptoms, immediate help by telephone seems to be possible only to a limited extent, but it could initiate access to further help offers. Overall, the results of this study provide a first indication that hotline services for psychological first aid are feasible under pandemic conditions.

Two-Year Follow-Up after Treatment with the Cognitive Behavioral Analysis System of Psychotherapy versus Supportive Psychotherapy for Early-Onset Chronic Depression.

BACKGROUND: Evidence on the long-term efficacy of psychotherapeutic approaches for chronic depression is scarce. OBJECTIVE: To evaluate the effects of the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) compared to Supportive Psychotherapy (SP) 1 year and 2 years after treatment termination. METHODS: In this study, we present 1- and 2-year follow-up assessments of a prospective, multicenter, evaluator-blinded, randomized clinical trial of outpatients with early-onset chronic major depression (n = 268). The initial treatment included 32 sessions of CBASP or SP over 48 weeks. The primary outcome was the rate of "well weeks" (Longitudinal Interval Follow-Up Evaluation; no/minimal symptoms) after 1 year and 2 years. The secondary outcomes were, among others, clinician- and self-rated depressive symptoms, response/remission rates, and quality of life. RESULTS: Of the 268 randomized patients, 207 (77%) participated in the follow-up. In the intention-to-treat analysis, there was no statistically significant difference between CBASP and SP patients in experiencing well weeks (CBASP: mean [SD] of 48.6 [36.9] weeks; SP: 39.0 [34.8]; rate ratio 1.26, 95% CI 0.99-1.59, p = 0.057, d = 0.18) and in remission rates (CBASP: 1 year 40%, 2 years 40.2%; SP: 1 year 28.9%, 2 years 33%) in the 2 years after treatment. Statistically significant effects were found in favor of CBASP 1 year after treatment termination regarding the rate of well weeks, self-rated depressive symptoms, and depression-related quality of life. CONCLUSIONS: CBASP lost its superiority over SP at some point between the first and the second year. This suggests the necessity of maintenance treatment for early-onset chronically depressed patients remitted with CBASP during the acute therapy phase, as well as the sequential integration of other treatment strategies, including medication for those who did not reach remission.

Cognitive Behaviour Therapy Complemented with Emotion Regulation Training for Patients with Persistent Physical Symptoms: A Randomised Clinical Trial.

INTRODUCTION: Persistent medically unexplained symptoms (MUS) are a major burden for health care. Cognitive behaviour therapy (CBT) is efficacious for patients with MUS, with small to medium effects. The current study investigates whether therapy outcomes of a CBT for MUS patients can be improved by complementing it with emotion regulation training. METHODS: In a multicentre trial 255 patients with at least three persisting MUS were randomised to 20 sessions of either conventional CBT (n = 128) or CBT complemented with emotion regulation training (ENCERT; n = 127). Somatic symptom severity and secondary outcomes were assessed at pre-treatment, therapy session 8, end of therapy, and 6-month follow-up. RESULTS: Linear mixed-effect models revealed medium to large effects in both study arms for almost all outcomes at the end of therapy and 6-month follow-up. ENCERT and CBT did not differ in their effect on the primary outcome (d = 0.20, 95% CI: -0.04 to 0.44). Significant time × group cross-level interactions suggested ENCERT to be of more benefit than conventional CBT for a few secondary outcomes. Moderator analyses revealed higher effects of ENCERT in patients with co-morbid mental disorders. DISCUSSION/CONCLUSIONS: Current findings are based on a representative sample. Results demonstrate that both CBT and ENCERT can achieve strong effects on primary and secondary outcomes in MUS patients. Our results do not indicate that adding a training in emotion regulation skills generally improves the effect of CBT across all patients with MUS. Large effect sizes of both treatments and potential specific benefits of ENCERT for patients with co-morbid mental disorders are discussed.

Scary symptoms? Functional magnetic resonance imaging evidence for symptom interpretation bias in pathological health anxiety.

Patients with pathological health anxiety (PHA) tend to automatically interpret bodily sensations as sign of a severe illness. To elucidate the neural correlates of this cognitive bias, we applied an functional magnetic resonance imaging adaption of a body-symptom implicit association test with symptom words in patients with PHA (n = 32) in comparison to patients with depression (n = 29) and healthy participants (n = 35). On the behavioral level, patients with PHA did not significantly differ from the control groups. However, on the neural-level patients with PHA in comparison to the control groups showed hyperactivation independent of condition in bilateral amygdala, right parietal lobe, and left nucleus accumbens. Moreover, patients with PHA, again in comparison to the control groups, showed hyperactivation in bilateral posterior parietal cortex and left dorsolateral prefrontal cortex during incongruent (i.e., harmless) versus congruent (i.e., dangerous) categorizations of body symptoms. Thus, body-symptom cues seem to trigger hyperactivity in salience and emotion processing brain regions in PHA. In addition, hyperactivity in brain regions involved in cognitive control and conflict resolution during incongruent categorization emphasizes enhanced neural effort to cope with negative implicit associations to body-symptom-related information in PHA. These results suggest increased neural responding in key structures for the processing of both emotional and cognitive aspects of body-symptom information in PHA, reflecting potential neural correlates of a negative somatic symptom interpretation bias.

Effects of stigmatizing media coverage on stigma measures, self-esteem, and affectivity in persons with depression - an experimental controlled trial.

BACKGROUND: Stigmatization of people with mental illness is still a significant problem even in Western society. Media is an important vector for public messaging that may lead to stigma (and potentially counteract it). There is an ongoing debate about the impact of news with potentially stigmatizing content on people with depression. This experimental study aimed at investigating the direct effects media reporting could have on people with depression, namely, higher levels of stigma attitudes and negative affect, as well as lower levels of self-esteem and positive affect. METHODS: Experimental study; target sample size n = 180 patients; eligibility criteria: clinical diagnosis of depressive episode or dysthymia, aged 18-70 years, sufficient cognitive abilities and German language skills; exclusion criteria: acute psychotic, manic or hypomanic episode, addiction symptoms, or suicidal ideation; parallel assignment to one of three arms (each n = 60): watching a short film about a negative event relating to depression (experimental group), about a negative event without relation to depression (control group 1), or about a neutral event relating to depression (control group 2); primary outcomes: degrees of stigma attitudes (stereotype awareness, stereotype agreement, self-concurrence, and self-stigmatization); secondary outcomes: degrees of self-esteem, positive and negative affect; statistical analyses: general linear models with repeated-measures; one-way ANOVAs of the change in scores, followed by Bonferroni-adjusted pairwise comparisons; IBM SPSS Statistics 24.0. RESULTS: Significant group × time interactions in stereotype agreement (medium effect: η = 0.10) and negative affect (large effect: η = 0.26); the level of stereotype agreement increased significantly more in the experimental group than in control groups 1 and 2. The level of negative affect increased significantly more in the experimental group and in control group 1 than in control group 2. All other interaction effects were non-significant. CONCLUSION: The present study allows statements about the direct effects of potentially stigmatizing media reporting on carriers of the stigmatized attribute, i.e., depression: Even single film presentations of familiar events that contain potentially stigmatizing content have an impact on stereotype agreement and negative affect. The impact of long-term exposure and change in other stigma-measures require a deeper understanding of stigma-processes. Potential explanations and implications for practice and future research are discussed. TRIAL REGISTRATION: Deutsche Register Klinischer Studien, Trial registration: DRKS00011855 . Registered 23 June 2017, retrospectively registered; for details see Additional file 1.

[Validation of a German Adaptation of the Self-Stigma of Depression Scale (SSDS) for Measuring Self-Stigmatization of People with Depression (SSDS-D)]. / Validierung einer deutschen, adaptierten Fassung der Self-Stigma of Depression Scale (SSDS) zur Messung von Selbststigmatisierung bei Personen mit Depression (SSDS-D).

The 16-item Self-Stigma of Depression Scale (SSDS) was developed to measure anticipated self-stigma hypothetically in case of depression. It is perfect for assessing anticipated self-stigma in community samples. However, in clinical samples measuring actual experienced instead of hypothetical self-stigma may be more appropriate. Aims of this study were the adaptation and validation of the SSDS specifically for people with depression. The abbreviation SSDS-D will be used in the following (D for depression) for this adapted version. All 16 items were translated into German and changed into indicative. Factor structure, internal consistency and construct validity were tested in two independent clinical samples (NA=550; NB=180). In sample A, the original structure of four factors (representing Shame, Self-Blame, Help-Seeking Inhibition, and Social Inadequacy) could be replicated in exploratory factor analyses with the exception of one item. In sample B, confirmatory factor analyses indicated a better fit for the empirically derived than for the alternatively tested original factor structure. Internal consistencies of subscales were satisfying to very good. Even controlled for current depressive symptoms, there were significant correlations to self-esteem and other self-stigma scales as expected, supporting the construct validity of SSDS-D. The SSDS-D appears to be a valid and reliable scale covering experienced self-stigma of people with depression. It may be used in clinical samples to identify correlates, test theoretical models and the efficacy of interventions.

The German version of the helping alliance questionnaire: psychometric properties in patients with persistent depressive disorder.

BACKGROUND: The Helping Alliance Questionnaire (HAQ) is a frequently used and highly relevant instrument to assess the therapeutic alliance. The questionnaire was translated into German by Bassler and colleagues (1995) and is available for patients (HAQ-P) and therapists (HAQ-T). Whereas the HAQ-P has been tested regarding psychometrics, the HAQ-T has not. This study aimed at further investigating the psychometric properties of both the HAQ-P and HAQ-T. We hypothesized that the instrument is reliable and shows factorial as well as convergent validity. METHODS: Within the framework of a multisite, randomized-controlled clinical trial, comparing the efficacy of Cognitive Behavioral Analyses System of Psychotherapy (CBASP) and supportive psychotherapy (SP) in the treatment of early onset persistently depressed outpatients, the HAQ was filled out by patients (n = 255) and therapists (n = 81). 66.0% of patients were female; average age at randomization was 44.9 years (SD = 11.8). Several confirmatory factor analyses were conducted to test different structures for the HAQ. In addition, correlations between the HAQ and the Inventory of Interpersonal Problems (IIP) were calculated to test for convergent validity. RESULTS: Goodness of fit indices for both a model with two different but strongly related factors named 'relation to the patient/ therapist ' and 'satisfaction with therapeutic outcome' and a second model with only one global helping alliance factor were comparable: Chi-Square-based indices rejected the models; RMSEA closely approached the threshold of good model fit, and CFI/ TLI and SRMR suggested that both models sufficiently fit the data. The internal consistency (Cronbach's α) calculated for the different scales of the HAQ ranges between questionable to good. Finally, the HAQ scores were significantly related to some of the IIP scores. CONCLUSIONS: The German versions of the HAQ offer sufficient reliable instruments for the quick assessment of different facets of the therapeutic alliance. The HAQ global scores can be used as indicators for the global impression of the patients and therapists perception of the quality of the therapeutic alliance. However, the small correlations found between the IIP and the HAQ puts the question of external validity into perspective. TRIAL REGISTRATION: This study analysed data from a RCT which was registered on ClinicalTrials.com ( NCT00970437 ). First submitted on September 1, 2009.

Impaired emotion processing and a reduction in trust in patients with somatic symptom disorder.

There is accumulating evidence for deficits in the perception and regulation of one's own emotions, as well as the recognition of others' emotions in somatic symptom disorder (SSD). However, investigations of SSD focusing on specific aspects of emotion processing and how these might interact are missing. We included 35 patients with SSD and 35 healthy controls who completed questionnaires on the perception and regulation of their own emotions, as well as experimental investigations of emotion recognition and trust. In line with previous studies, our results show that SSD patients in comparison to healthy controls have difficulties in the identification and description of own feelings (ηp2  = .381 and ηp2  = .315). Furthermore, we found that patients apply less cognitive reappraisal (ηp2  = .185) but tend to use more expressive suppression (ηp2  = .047). In contrast to previous studies, we found SSD patients to perform superior in emotion recognition, in particular for anger (d = 0.40). In addition, patients with SSD invested less in a trust game (d = 0.73). These results point to a higher sensitivity for negative emotions and less trust in others. Further, these findings suggest a dissociation between the ability to recognize one's own emotions versus others' emotions in SSD. Future interventions targeting emotion processing in SSD might focus on the identification of one's own emotions, prior to the training of emotion regulation.

Neural correlates of an attentional bias to health-threatening stimuli in individuals with pathological health anxiety.

BACKGROUND: An attentional bias to health-threat stimuli is assumed to represent the primary pathogenetic factor for the development and maintenance of pathological health anxiety (PHA; formerly termed "hypochondriasis"). However, little is known about the neural basis of this attentional bias in individuals with PHA. METHODS: A group of patients with PHA, a group of depressed patients and a healthy control group completed an emotional Stroop task with health-threat (body symptom and illness) words and neutral control words while undergoing functional MRI. RESULTS: We included 33 patients with PHA, 28 depressed patients and 31 controls in our analyses. As reflected in reaction times, patients with PHA showed a significantly stronger attentional bias to health-threat words than both control groups. In addition, patients with PHA showed increased amygdala and rostral anterior cingulate cortex activation for body symptom, but not for illness words. Moreover, only in patients with PHA amygdala activation in response to symptom words was positively associated with higher arousal and more negative valence ratings of the body symptom word material. LIMITATIONS: A control group of patients with an anxiety disorder but without PHA would have helped to define the specificity of the results for PHA. CONCLUSION: The attentional bias observed in patients with PHA is associated with hyperactivation in response to body symptom words in brain regions that are crucial for an arousal-related fear response (e.g., the amygdala) and for resolving emotional interference (e.g., the rostral anterior cingulate cortex). The findings have important implications for the nosological classification of PHA and suggest the application of innovative exposure-based interventions for the treatment of PHA.

Emotion dysregulation in hypochondriasis and depression.

BACKGROUND: The aim of this study was to explore whether certain aspects of emotion dysregulation (i.e., facets of alexithymia and rumination) are more closely linked to hypochondriasis than to depression and vice versa. METHODS: Nineteen patients with hypochondriasis (HYP), 33 patients with depression, and 52 healthy control participants completed the Toronto Alexithymia Scale, the Response Styles Questionnaire, and additional symptom and illness behaviour scales. A clinical interview was used to establish DSM-IV diagnoses and to exclude all cases with more than one axis I diagnosis. RESULTS: Depression patients reported more difficulties describing feelings and more symptom- and self-focused rumination than both HYP patients and healthy individuals, whereas HYP patients differed only from healthy individuals in regard to more difficulties in identifying feelings and more symptom-focused rumination. Multiple regression analyses, including all assessed facets of emotion dysregulation, showed that the degree of somatoform features (somatic symptoms, health anxiety, and illness behaviour) was specifically predicted by higher difficulties in identifying feelings scores, whereas depressive symptom levels were specifically predicted by higher rumination scores. CONCLUSIONS: Specific associations were found between difficulties in identifying feelings and key features of HYP, whereas depression was linked to a more generalized pattern of emotion regulation deficits. KEY PRACTITIONER MESSAGE: Emotion dysregulation can be found in hypochondriasis and depression Difficulties in identifying own feelings are specifically linked to somatic symptoms, health anxiety, and illness behaviour, whereas a more generalized pattern of emotion dysregulation is found in relation to depression Further research is needed to investigate whether the effectiveness of current treatments for depression, hypochondriasis, health anxiety, and related disorders could be improved by additional emotion regulation interventions.

Comparison of protocols for DNA extraction from long-term preserved formalin fixed tissues.

The current study compared the applicability of protocols to extract DNA from formalin fixed heart tissues that have been preserved for more than 50 years. Ten methods were tested: a cetyltrimethylammonium bromide (CTAB) standard protocol, seven variants of this standard protocol, and two commercial kits. In the case of younger specimens (fixed in 1951, 1934, or 1914), extracts with DNA concentrations ≥ 10.0 ng/µl were obtained with the standard CTAB protocol, two variants of the standard protocol including prolonged tissue digestion (72 h instead of 1-2h), and a commercial kit particularly recommended for DNA extraction from formalin fixed paraffin embedded tissues (FFPE Kit). With the FFPE Kit, DNA could also be extracted from older tissues (fixed in 1893, 1850/1851, or before 1820). In general, the purity of the DNA extracts, assessed from the ratio of the absorbance at 260 and 280 nm, was not very high. In spite of their rather low purity, the DNA extracts could, however, be used to amplify a 122-bp sequence and, in most cases, also a 171-bp sequence of the gene coding for human albumin by the polymerase chain reaction (PCR).

Neuronal and behavioral correlates of health anxiety: results of an illness-related emotional Stroop task.

BACKGROUND: Health anxiety (HA) is defined as the objectively unfounded fear or conviction of suffering from a severe illness. Predominant attention allocation to illness-related information is regarded as a central process in the development and maintenance of HA, yet little is known about the neuronal correlates of this attentional bias. METHODS: An emotional Stroop task with body symptom, illness, and neutral words was employed to elicit emotional interference in healthy participants with high (HA+, n = 12) and low (HA-, n = 12) HA during functional magnetic resonance imaging. RESULTS: Prolonged reaction times for indicating the color of symptom words and a decrease in rostral anterior cingulate cortex (rACC) activation were seen in HA+ participants. Emotional interference effects on the behavioral level were negatively related to rACC activity over the whole group. Groups did not differ during the processing of threatening illness words. CONCLUSION: The results indicate stronger attention allocation toward body symptom words already in subclinical HA. This attentional bias appears to be linked to hypoactivity of the rACC which impedes effective emotional interference reduction, leading instead to a ruminative processing of the stimulus content.

[Effect of personality disorders on course and treatment outcome of behaviour therapy in an outpatient sample]. / Der Einfluss von Persönlichkeitsstörungen auf den Verlauf und Ausgang von ambulanten Verhaltenstherapien.

The aim of the study was to examine if personality disorders (PD) or subclinical personality disorders (SPD) have negative impact on outcome and course of psychotherapies. The course of 360 patients (pt) with comorbid Axis II diagnoses treated at an outpatient unit were examined at 4 different time points in psychotherapy with the Beck Depression Inventory (BDI) and the Symptom Checklist (SCL-90-R). We found a significant decrease of symptoms over the time for all groups but no significant interaction between time and group. Pt with PD showed higher scores on BDI and SCL-90-R at all time points and pt with SPD at the beginning of the therapy than pt without SPD/PD. The pre-post analysis for the BDI and the SCL-90-R showed for all groups middle to high effect sizes (0,62

Predictors of Psychological Distress and Coronavirus Fears in the First Recovery Phase of the Coronavirus Disease 2019 Pandemic in Germany.

Objectives: While previous research has mainly focused on the impact of the first acute phase of the COVID-19 pandemic on mental health, little empirical knowledge exists about depression, anxiety, and somatic symptom levels and possible predictors of symptom levels in the pandemic's recovery phase. The present study aimed to analyze the mental burden of a convenience ample of the general German population during the first recovery phase of the pandemic and to identify significant predictors of symptom levels. Methods: Standardized measures of anxiety (GAD-2), depression (PHQ-2), somatic symptoms (PHQ-15), and health anxiety, as well as measures of COVID-19 fears and possible vulnerability factors, were administered through a national, cross-sectional online survey (n = 2160, mean age 42.7 years, 75% female), asking participants for their current symptom levels and their symptom levels prior to the COVID-19 pandemic. Results: Our findings show significantly elevated levels of depression, anxiety, somatic symptoms, and health anxiety in the recovery period compared to before the pandemic. The current prevalence rates based on self-reporting were 26.7% for depression, 24.5% for anxiety, and 29% for somatization. The strongest predictors of these symptom reports included domain-specific pre-existing symptom levels, neuroticism, biological COVID-19 risk factors, avoidance of illness information, and younger age. The most important predictors of COVID-19 fears were subjective COVID-19 risk perception, followed by pre-existing health anxiety, the number of biological COVID-19 risk factors, older age, neuroticism, avoidance of illness information and female gender. Discussion: These findings indicate the need for specific psychological programs to help individuals with enhanced psychological and biological vulnerability to cope better with the mental distress experienced during all phases of the ongoing COVID-19 crisis.

Do patients with pathological health anxiety fear COVID-19? A time-course analysis of 12 single cases during the "first wave" of the COVID-19 pandemic in Germany.

OBJECTIVE: Pre-existing health anxiety is associated with an intensified affective response to the novel COVID-19 pandemic in the general population. Still, results on the reaction of people with a diagnosis of pathological health anxiety (i.e., hypochondriasis) are scarce. METHODS: In the present study, we investigated the course of (health) anxiety related to SARS-CoV-2/COVID-19 in comparison to (health) anxiety related to other severe diseases (e.g., cancer) in a sample of 12 patients with the diagnosis of pathological health anxiety during the "first wave" of the COVID-19 pandemic in Germany. Both SARS-CoV-2 related anxiety and anxiety related to other severe diseases were assessed weekly over 16 measurement points (30.03.-19.07.2020) and primarily analyzed with fixed effects regression analyses. RESULTS: Unexpectedly, SARS-CoV-2 related anxiety was on average significantly lower than anxiety related to other severe diseases (d = -0.54, p < .001) and not significantly associated with anxiety related to other severe diseases or pre-COVID-19 health anxiety. CONCLUSION: It therefore appears premature to assume that SARS-CoV-2 related anxiety and other health worries are necessarily strongly interrelated and comparably high in people with pathological health anxiety.

Abnormalities in cognitive-emotional information processing in idiopathic environmental intolerance and somatoform disorders.

Idiopathic environmental intolerance (IEI) represents a functional somatic syndrome marked by diverse bodily complaints attributed to various substances in the environment. Evidence for abnormalities in affective information processing similar to somatoform disorders (SFD) has recently been found in people with IEI. In order to further investigate these cognitive-emotional abnormalities, we compared people with IEI (n=49), SFD only (n=43), and non-somatoform controls (n=54) with respect to their performance in the extrinsic affective Simon task (EAST). This task allowed us to dissociate indicators of automatic affective associations and emotional intrusion effects of both bodily complaints and IEI-trigger words. Negative association effects toward IEI-trigger words were strongest for IEI participants. Emotional intrusion effects of symptom words were larger both in IEI and SFD than in controls. The results of enhanced negative automatic evaluations of IEI-trigger words and greater attention allocation to symptom words support cognitive models of IEI.

[Increased prevalence of problematic alcohol consumption in university students]. / Zur erhöhten Prävalenz des problematischen Alkoholkonsums bei Studierenden.

OBJECTIVE: To compare the prevalence rates of problematic alcohol consumption in students and in the general population. METHODS: A sample of students (n=1 115) and a population sample (n=631) were assessed with the Patient Health Questionnaire (PHQ). The PHQ probes for problematic alcohol consumption with five questions. An "alcohol syndrome" is suspected if at least one of these indicators is present. RESULTS: The alcohol syndrome was present more frequently among students than in the population sample (30,1% versus 8,1%). The odds ratio, adjusted for age, gender and education, was OR=3,7. However, when the five indicators were analysed separately, only two of them were significantly more frequent in students than in the comparison sample. Both indicate a neglect of duties as a consequence of alcohol consumption. CONCLUSIONS: Intervention strategies aimed at students' alcohol consumption should focus on binge drinking and the risks associated with this problematic form of alcohol consumption.