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

BACKGROUND: The spiritual aspect of care is an often neglected resource in pain therapies. The aim of this study is to identify commonalities and differences in chronic pain patients' (CPP) and health care professionals' (HCP) perceptions on the integration of spiritual care into multimodal pain therapy. METHODS: We conducted a qualitative exploratory study with 42 CPPs and 34 HCPs who were interviewed in 12 separate groups in five study centres specialising in chronic pain within German-speaking Switzerland. The interviews were transcribed and subjected to a qualitative content analysis. Findings were generated by juxtaposing and analysing the statements of (a) HCP about HCP, (b) HCP about CPP, (c) CPP about HCP, and (d) CPP about CPP. RESULTS: Views on spiritual concerns and needs in chronic pain care can be described in three distinct dimensions: function (evaluating the need / request to discuss spiritual issues), structure (evaluating when / how to discuss spiritual issues) and context (evaluating why / under which circumstances to discuss spiritual issues). CPPs stress the importance of HCPs recognizing their overall human integrity, including the spiritual dimension, and would like to grant spiritual concerns greater significance in their therapy. HCPs express difficulties in addressing and discussing spiritual concerns and needs with chronic pain patients. Both parties want clarification of the context in which the spiritual dimension could be integrated into treatment. They see a need for greater awareness and training of HCPs in how the spiritual dimension in therapeutic interactions might be addressed. CONCLUSIONS: Although there are similarities in the perspectives of HCPs and CPPs regarding spiritual concerns and needs in chronic pain care, there are relevant differences between the two groups. This might contribute to the neglect of the spiritual dimension in the treatment of chronic pain. TRIAL REGISTRATION: This study was part of a larger research project, registered in a primary (clinicaltrial.gov: NCT03679871 ) and local (kofam.ch: SNCTP000003086 ) clinical trial registry.

[Spirituality and health care. The perspective of patients with chronic pain]. / Spiritualität und Behandlung. Die Perspektive von Patienten mit chronischen Schmerzen.

BACKGROUND: Chronic pain affects all aspects of human life, which raises spiritual questions that should be included within the framework of multimodal care. OBJECTIVES: We investigated the perspective of patients with chronic pain around spiritual concerns and their potential integration into care. MATERIALS AND METHODS: We conducted five focus group interviews and two small group interviews. In total, 42 patients with chronic pain in outpatient or inpatient pain care at the time of the study participated. The interviews were transcribed and thematically analyzed. RESULTS: Three themes emerged: (1) Chronic pain permeates the entity of a person's existence. (2) Spiritual resources are potentially supportive in living with chronic pain. (3) Patients appreciate the opportunity to engage with health care professionals in a dialog that encompasses spiritual concerns. For participants, these concerns have considerable relevance. In many cases participants associated them with religious convictions, but not exclusively. They often related feeling that their pain experience was dismissed. CONCLUSION: Finding strategies for effectively dealing with chronic pain represents a turning point in life. Open discussion with health care professionals that allow for spiritual issues facilitates this process.

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

BACKGROUND: Alexithymia is a personality trait characterized by difficulties identifying and describing feelings, an externally oriented style of thinking, and a reduced inclination to imagination. Previous research has shown deficits in the recognition of emotional facial expressions in alexithymia and reductions of brain responsivity to emotional stimuli. Using an affective priming paradigm, we investigated automatic perception of facial emotions as a function of alexithymia at the behavioral and neural level. In addition to self-report scales, we applied an interview to assess alexithymic tendencies. RESULTS: During 3 T fMRI scanning, 49 healthy individuals judged valence of neutral faces preceded by briefly shown happy, angry, fearful, and neutral facial expressions. Alexithymia was assessed using the 20-Item Toronto Alexithymia Scale (TAS-20), the Bermond-Vorst Alexithymia Questionnaire (BVAQ) and the Toronto Structured Interview for Alexithymia (TSIA). As expected, only negative correlations were found between alexithymic features and affective priming. The global level of self-reported alexithymia (as assessed by the TAS-20 and the BVAQ) was found to be related to less affective priming owing to angry faces. At the facet level, difficulties identifying feelings, difficulties analyzing feelings, and impoverished fantasy (as measured by the BVAQ) were correlated with reduced affective priming due to angry faces. Difficulties identifying feelings (BVAQ) correlated also with reduced affective priming due to fearful faces and reduced imagination (TSIA) was related to decreased affective priming due to happy faces. There was only one significant correlation between alexithymia dimensions and automatic brain response to masked facial emotions: TAS-20 alexithymia correlated with heightened brain response to masked happy faces in superior and medial frontal areas. CONCLUSIONS: Our behavioral results provide evidence that alexithymic features are related in particular to less sensitivity for covert facial expressions of anger. The perceptual alterations could reflect impaired automatic recognition or integration of social anger signals into judgemental processes and might contribute to the problems in interpersonal relationships associated with alexithymia. Our findings suggest that self-report measures of alexithymia may have an advantage over interview-based tests as research tools in the field of emotion perception at least in samples of healthy individuals characterized by rather low levels of alexithymia.

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

BACKGROUND: An in-hospital death is a profound experience for those left behind and has been associated with family members' psychological morbidity. Supporting bereaved family members is an essential part of end-of-life care and includes attentive presence, information-giving, and emotional and practical support. The actual adoption of hospital-based bereavement care, however, remains little understood. AIM: To investigate hospital-based bereavement care provision and associated barriers. DESIGN: Cross-sectional survey using an online questionnaire. SETTING/PARTICIPANTS: Health professionals (n = 196) from two University-affiliated acute and psychiatric hospitals in Switzerland. RESULTS: The most frequent bereavement services (⩾40%) were viewing the deceased, giving information on available support, and making referrals; the most often named barriers were lack of time and organizational support. Acute care health professionals faced statistically significant more structural barriers (55.1% vs 21.4% lack of time, 47.8% vs 25.9% lack of organizational support) and felt insufficiently trained (38.4% vs 20.7%) compared to mental health professionals (p ⩽ 0.05). Nurses provided more immediate services compared to physicians, such as viewing the deceased (71.3% vs 49.0%) and sending sympathy cards (37.4% vs 16.3%) (p ⩽ 0.01). In contrast, physicians screened more often for complex bereavement disorders (10.2% vs 2.6%) and appraised bereavement care as beyond their role (26.5% vs 7.8%) (p ⩽ 0.05). CONCLUSION: The study indicates that many barriers to bereavement care exist in hospitals. More research is required to better understand enabling and limiting factors to bereavement care provision. A guideline-driven approach to hospital-based bereavement care that defines best practice and required organizational support seems necessary to ensure needs-based bereavement care.

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

BACKGROUND: Several psychological sequelae have been identified in civilian war survivors. However, little is known about the prevalence of obsessive-compulsive symptoms and their relationship to trauma in this population. METHOD: Fifty-one adult civilian survivors of the Kosovo War (28 males) who had immigrated to Switzerland completed the Revised Obsessive-Compulsive Inventory Scale, the Posttraumatic Stress Diagnostic Scale and the Hopkins Symptom Checklist. Data were analysed using multiple regression analyses. RESULTS: Overall, 35 and 39% of the sample scored above the cut-offs for likely obsessive-compulsive disorder and posttraumatic stress disorder, respectively. Participants with high levels of posttraumatic stress symptoms were significantly more likely to have obsessive-compulsive symptoms, and vice versa. In multiple regression analysis, gender and severity of posttraumatic stress symptoms were predictors of obsessive-compulsive symptoms, whereas number of traumatic life event types and depressive symptoms were not. CONCLUSION: Given the small sample size, the results of this study need to be interpreted cautiously. Nevertheless, a surprisingly high number of participants in our study suffered from both obsessive-compulsive and posttraumatic stress symptoms, with obsessive-compulsive symptoms tending to be more pronounced in women. It remains, therefore, critical to specifically assess both obsessive-compulsive and posttraumatic stress symptoms in civilian war survivors, and to provide persons afflicted with appropriate mental health care.

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

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

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

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

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

BACKGROUND: Trichotillomania (TTM) is characterized by recurrent hair-pulling that results in substantial hair loss. A previous pilot study demonstrated that the online self-help intervention 'decoupling' (DC) might be effective at reducing hair-pulling symptoms, with a stronger effect than progressive muscle relaxation (PMR). We aimed to extend these findings using a more robust randomized clinical trial design, including diagnostic interviews by phone, a 6-month follow-up and e-mail support. METHODS: One hundred five adults with TTM were recruited online and randomly allocated to either DC (n = 55) or PMR (n = 50). The intervention lasted 4 weeks, with severity of TTM assessed at 3 time points (before intervention, immediately after intervention and at the 6-month follow-up) using the Massachusetts General Hospital Hair-Pulling Scale (MGH-HPS). Both intention-to-treat and completer analyses were conducted. RESULTS: Intention-to-treat analysis demonstrated highly significant and comparable symptom reductions (MGH-HPS) in both the DC and PMR groups (p < 0.001, partial x03B7;2 = 0.31) that persisted through 6 months of follow-up. Participants' subjective appraisals favoured DC in some areas (e.g. greater satisfaction with DC than PMR). Completer analyses demonstrated the same pattern as the intention-to-treat analyses. CONCLUSIONS: Despite subjective appraisals in favour of DC, symptom reduction was comparable in the two groups. While the results suggest that even short Internet-based interventions like DC and PMR potentially help individuals with TTM, a partial effect of unspecific factors, like regression towards the mean, cannot be ruled out. Therefore, longitudinal studies with non-treated controls are warranted.

Neural circuits of emotion regulation: a comparison of mindfulness-based and cognitive reappraisal strategies.

Dealing with one's emotions is a core skill in everyday life. Effective cognitive control strategies have been shown to be neurobiologically represented in prefrontal structures regulating limbic regions. In addition to cognitive strategies, mindfulness-associated methods are increasingly applied in psychotherapy. We compared the neurobiological mechanisms of these two strategies, i.e. cognitive reappraisal and mindfulness, during both the cued expectation and perception of negative and potentially negative emotional pictures. Fifty-three healthy participants were examined with functional magnetic resonance imaging (47 participants included in analysis). Twenty-four subjects applied mindfulness, 23 used cognitive reappraisal. On the neurofunctional level, both strategies were associated with comparable activity of the medial prefrontal cortex and the amygdala. When expecting negative versus neutral stimuli, the mindfulness group showed stronger activations in ventro- and dorsolateral prefrontal cortex, supramarginal gyrus as well as in the left insula. During the perception of negative versus neutral stimuli, the two groups only differed in an increased activity in the caudate in the cognitive group. Altogether, both strategies recruited overlapping brain regions known to be involved in emotion regulation. This result suggests that common neural circuits are involved in the emotion regulation by mindfulness-based and cognitive reappraisal strategies. Identifying differential activations being associated with the two strategies in this study might be one step towards a better understanding of differential mechanisms of change underlying frequently used psychotherapeutic interventions.

[MOSS- Mobile Sensing and Support Detection of depressive moods with an app and help those affected]. / MOSS: Mobile Sensing and Support Mit einer App depressive Verstimmungen erkennen und Betroffenen helfen.

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

Increased cortical thickness in a frontoparietal network in social anxiety disorder.

Social anxiety disorder (SAD) is the second leading anxiety disorder. On the functional neurobiological level, specific brain regions involved in the processing of anxiety-laden stimuli and in emotion regulation have been shown to be hyperactive and hyper-responsive in SAD such as amygdala, insula and orbito- and prefrontal cortex. On the level of brain structure, prior studies on anatomical differences in SAD resulted in mixed and partially contradictory findings. Based on previous functional and anatomical models of SAD, this study examined cortical thickness in structural magnetic resonance imaging data of 46 patients with SAD without comorbidities (except for depressed episode in one patient) compared with 46 matched healthy controls in a region of interest-analysis and in whole-brain. In a theory-driven ROI-analysis, cortical thickness was increased in SAD in left insula, right anterior cingulate and right temporal pole. Furthermore, the whole-brain analysis revealed increased thickness in right dorsolateral prefrontal and right parietal cortex. This study detected no regions of decreased cortical thickness or brain volume in SAD. From the perspective of brain networks, these findings are in line with prior functional differences in salience networks and frontoparietal networks associated with executive-controlling and attentional functions.

Alexithymia and the labeling of facial emotions: response slowing and increased motor and somatosensory processing.

BACKGROUND: Alexithymia is a personality trait that is characterized by difficulties in identifying and describing feelings. Previous studies have shown that alexithymia is related to problems in recognizing others' emotional facial expressions when these are presented with temporal constraints. These problems can be less severe when the expressions are visible for a relatively long time. Because the neural correlates of these recognition deficits are still relatively unexplored, we investigated the labeling of facial emotions and brain responses to facial emotions as a function of alexithymia. RESULTS: Forty-eight healthy participants had to label the emotional expression (angry, fearful, happy, or neutral) of faces presented for 1 or 3 seconds in a forced-choice format while undergoing functional magnetic resonance imaging. The participants' level of alexithymia was assessed using self-report and interview. In light of the previous findings, we focused our analysis on the alexithymia component of difficulties in describing feelings. Difficulties describing feelings, as assessed by the interview, were associated with increased reaction times for negative (i.e., angry and fearful) faces, but not with labeling accuracy. Moreover, individuals with higher alexithymia showed increased brain activation in the somatosensory cortex and supplementary motor area (SMA) in response to angry and fearful faces. These cortical areas are known to be involved in the simulation of the bodily (motor and somatosensory) components of facial emotions. CONCLUSION: The present data indicate that alexithymic individuals may use information related to bodily actions rather than affective states to understand the facial expressions of other persons.

Metabotropic glutamate receptor 5 binding in patients with obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is a disabling, mostly chronic, psychiatric condition with significant social and economic impairments and is a major public health issue. However, numerous patients are resistant to currently available pharmacological and psychological interventions. Given that recent animal studies and magnetic resonance spectroscopy research points to glutamate dysfunction in OCD, we investigated the metabotropic glutamate receptor 5 (mGluR5) in patients with OCD and healthy controls. We determined mGluR5 distribution volume ratio (DVR) in the brain of ten patients with OCD and ten healthy controls by using [11C]ABP688 positron-emission tomography. As a clinical measure of OCD severity, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was employed. We found no significant global difference in mGluR5 DVR between patients with OCD and healthy controls. We did, however, observe significant positive correlations between the Y-BOCS obsession sub-score and mGluR5 DVR in the cortico-striatal-thalamo-cortical brain circuit, including regions of the amygdala, anterior cingulate cortex, and medial orbitofrontal cortex (Spearman's ρ's⩾ = 0.68, p < 0.05). These results suggest that obsessions in particular might have an underlying glutamatergic pathology related to mGluR5. The research indicates that the development of metabotropic glutamate agents would be useful as a new treatment for OCD.

Graphic representation of the burden of suffering in dizziness patients.

BACKGROUND: Dizziness adversely affects an individual's well-being. However, its impact is not only influenced by its physical manifestations, but also by its subjective importance to the patient. Appropriately assessing the subjective burden of dizziness is difficult. The Pictorial-Representation of Illness- and Self-Measure (PRISM), on which patients illustrate the distance between their 'self' and their illness, has been documented to indicate the perception of suffering in several different illnesses. Our study objectives were (1) to assess how useful the PRISM is in patients with dizziness; and (2) to determine which clinical, emotional and sociodemographic factors contribute to their burden of suffering. METHODS: A total of 177 outpatients with dizziness completed this cross-sectional study, in which the following measures were assessed of suffering rated using the PRISM tool; dizziness-related variables, like emotional distress (Hospital Anxiety and Depression-Scale, HADS); self-perceived severity of dizziness (Dizziness Handicap Inventory, DHI); and sociodemographic variables. RESULTS: Regression analyses identified the strongest association between PRISM-rated suffering and DHI (p < 0.001), explaining 34% of the variance in PRISM-rated suffering. The HADS score and having continuous dizziness versus transient attacks each explained roughly 2% of the variance in suffering. No significant associations with PRISM-rated suffering were found for sociodemographic variables or other dizziness characteristics. CONCLUSIONS: The PRISM is applicable to patients suffering from dizziness, demonstrating a significant association with the severity of dizziness and reliably distinguishing between those with low and high intensities of dizziness. The PRISM also reflects the multi-factorial aspects of suffering. Due to its immediate, timesaving and economical use, the PRISM could enable clinicians to identify vulnerable patients at risk for chronic symptoms and distress. Whether the PRISM can detect improvements and worsening of symptoms during treatment warrants further research.

Alexithymia and non-treatment: an Internet based study of 312 people with chronic anxiety.

BACKGROUND: Despite the availability of highly efficacious treatments, many individuals with anxiety disorders never receive adequate treatment. Alexithymic deficits, such as difficulties in recognizing feelings and focusing on emotional experiences, may contribute to low rates of help seeking. METHODS: Multiple Internet-based strategies (announcements of anxiety disorder websites, postings in online self-help forums, notices in anxiety chat rooms) were used to recruit a sample of 312 participants with chronic and clinically relevant anxiety symptoms. Those who had never received professional treatment (n = 49) were compared to those with current or previous treatment (n=263) with regard to alexithymia, anxiety, depression and health-related quality of life. RESULTS: Logistic regression analysis revealed that the strongest predictor for belonging to the never treated group was the externally oriented thinking facet of alexithymia. In addition, substantially more participants in the never treated group (49%) were considered high-alexithymic (20-item Toronto Alexithymia Scale total score ≥ 61) compared to the treated group (35%). CONCLUSIONS: The main finding was a strong relationship between the externally oriented thinking facet of alexithymia and the non-use of professional help for anxiety. Internet-based programs could be a promising first step in supporting this group of people to overcome their anxiety.

California Psychotherapy Alliance Scale (CALPAS): psychometric properties of the German version for group and individual therapy patients.

BACKGROUND: Valid and internationally used instruments measuring therapeutic alliance are fundamental for psychotherapy research and practice. The main goal of this study was to validate a German version of the California Psychotherapy Alliance Scale (CALPAS) for the individual and the group therapy setting. METHODS: A total of 203 patients undergoing individual or group therapy filled out the CALPAS right after a therapy session. To test convergent and discriminant validity, a subsample of group therapy patients were handed out the Group Climate Questionnaire (GCQ) and a short form of the Symptom-Checklist (SCL-K-9). RESULTS AND CONCLUSION: The German version of the CALPAS showed good psychometric properties. Further, therapeutic alliance was found to be stronger in the individual than in the group context, suggesting a less central (or different) role played by group therapists. Clinical implications and possible focus of future research are discussed.

Assessing alexithymia and emotional awareness: relations between measures in a German non-clinical sample.

The aim of this study was to evaluate psychometric properties and relations between two different methods of measuring alexithymia and one measure of emotional awareness in a German non-clinical sample. The 20-Item Toronto Alexithymia Scale (TAS-20), the Toronto Structured Interview for Alexithymia (TSIA), and the Levels of Emotional Awareness Scale (LEAS), which is a performance-based measure of emotional awareness, were administered to 84 university students. Both internal reliability and inter-rater reliability for the TSIA were acceptable. Results from exploratory factor analysis (EFA) based on all measures supported a three factorial solution previously obtained in an American sample using multiple methods of alexithymia and emotional ability measurement. In our three factor model direct self (TAS-20), direct other (TSIA), and indirect self (LEAS) measures were differentiated. The convergent validity of the TSIA was supported by a significant correlation with the LEAS. Our findings suggest that future research on alexithymia and emotional awareness can benefit from the use of a multi-method approach and should include objective measures.

Health-related quality of life and emotional distress in patients with dizziness: a cross-sectional approach to disentangle their relationship.

BACKGROUND: Dizziness is frequently encountered in medical practice, often takes a chronic course and can impair the health related quality of life (HRQoL). However results on the extent of this impairment of HRQoL are mixed. Furthermore, the relationship between dizziness and the HRQoL is only partially understood. The role of clinical symptoms of dizziness and psychosocial factors such as emotional distress on this relationship is for the most part unknown. METHODS: The cross-sectional study evaluated the HRQoL in 203 patients suffering from dizziness, using the Medical Outcomes Studies 36-Item Short-Form Health-Survey (SF-36). The results were correlated with the severity of dizziness, using the Dizziness Handicap-Inventory (DHI), with emotional distress, using the Hospital Anxiety and Depression-Scale (HADS) and with further clinical symptoms and psychosocial parameters. In a multivariate hierarchical regression analysis associated variables which explain significant variance of the mental and physical HRQoL (MCS-36, PCS-36) were identified. RESULTS: Patients suffering from dizziness showed a markedly reduced mental and physical HRQoL. Higher DHI and HADS scores were correlated with lower MCS-36 and PCS-36 scores. Taken together DHI and vertigo characteristics of dizziness explained 38% of the variance of PCS-36. Overall explained variance of PCS-36 was 45%. HADS and living with a significant other explained 66% of the variance of MCS-36 (overall variance explained: 69%). CONCLUSION: Both the physical and mental HRQoL are significantly impaired in patients with dizziness. While the impairment in PCS-36 can be explained by clinical symptoms of the dizziness, MCS-36 impairment is largely associated with psychosocial factors. To improve the patient's overall well-being significantly and permanently doctors have to keep in mind both, the clinical symptoms and the psychosocial factors. Therefore, in addition to the physical examination doctors should integrate a basic psychological examination into the daily routine with dizziness patients.

Gratitude and Religiosity in Psychiatric Inpatients with Depression.

Background: Gratitude and religiousness/spirituality are increasingly recognized resources that have potential influence on psychological states such as depression. However, only few studies have investigated this relationship in psychiatric patients. Objective: The present study examined gratitude in psychiatric inpatients with depression, exploring its relevance, course, and interaction with psychopathological and religious measures. Both general and religious gratitude will be evaluated. Methods: A total of 212 inpatients with depression completed a questionnaire both at the beginning and the end of treatment. Gratitude was measured with a general gratitude scale using the Gratitude Questionnaire and a religion-specific measure assessing gratitude to God as part of the Structure of Religiosity Test. The Beck Depression Inventory was used to evaluate depressive symptoms. General religiosity was assessed using the Centrality of Religiosity Scale. Results: Scores on the general and religious gratitude measures were in the upper range of these scales at baseline and demonstrated a significant increase during the hospital stay. Negative associations were found between general gratitude and depressive symptoms both on admission and at discharge (r = -0.505 and r = -0.478, respectively). General as well as religious gratitude was associated with the centrality of religiosity (r = 0.384 and r = 0.546, respectively). Religiosity accounted for approximately 10% of the variance in general gratitude on admission. Conclusions: Gratitude is highly prevalent in psychiatric patients with depression, and that may serve as a resource for these individuals. Both general and religious gratitude are associated with religiosity, which may also serve as a resource to these patients.

Deployment of attention to facial expressions varies as a function of emotional quality-but not in alexithymic individuals.

Background: Alexithymia is a risk factor for emotional disorders and is characterized by differences in automatic and controlled emotion processing. The multi-stimulus free-viewing task has been used to detect increased negative and reduced positive attentional biases in depression and anxiety. In the present eye-tracking study, we examined whether lexical emotional priming directs attention toward emotion-congruent facial expressions and whether alexithymia is related to impairments in lexical priming and spontaneous attention deployment during multiple face perception. Materials and methods: A free-viewing task with happy, fearful, angry, and neutral faces shown simultaneously was administered to 32 alexithymic and 46 non-alexithymic individuals along with measures of negative affect and intelligence. Face presentation was preceded by masked emotion words. Indices of initial orienting and maintenance of attention were analyzed as a function of prime or target category and study group. Results: Time to first fixation was not affected by prime category or study group. Analysis of fixation duration yielded a three-way interaction. Alexithymic individuals exhibited no prime or target category effect, whereas non-alexithymic individuals showed a main effect of target condition, fixating happy faces longer than neutral and angry faces and fearful faces longer than angry faces. Discussion: Our results show evidence of attentional biases for positive and fearful social information in non-alexithymic individuals, but not in alexithymic individuals. The lack of spontaneous attentional preference for these social stimuli in alexithymia might contribute to a vulnerability for developing emotional disorders. Our data also suggest that briefly presented emotion words may not facilitate gaze orientation toward emotion-congruent stimuli.