Habituation of salivary cortisol and cardiovascular reactivity to a repeated real-life and virtual reality Trier Social Stress Test.

BACKGROUND: Although the Trier Social Stress Test (TSST) constitutes a valid paradigm for social stress induction, less is known about the effects of a virtual reality (VR) TSST on short- and long-term hypothalamic-pituitary-adrenal (HPA) axis and sympathetic-adreno-medullar (SAM) axis responses. Hence, this study set out to evaluate reactivity and habituation of self-reported stress and HPA and SAM reactivity in a real TSST and VR-TSST when compared to a placebo TSST. METHOD: Sixty-eight healthy young adults (50% female) were randomly assigned to either a real TSST, a VR-TSST, or a placebo TSST, all of which were conducted three times (one day and one week post initial exposure). Social presence, self-reported stress, salivary cortisol, heart rate (HR), and heart rate variability (HRV) were analyzed using ANOVAs and multilevel models. FINDINGS: On the first exposure, both the real and VR-TSST showed significantly stronger cortisol and cardiovascular responses than the placebo. On the second visit, the cortisol response was still significantly high-and the HRV response low-for the real and VR-TSST. The third visit resulted in HR, HRV, and cortisol responses comparable to the placebo group. Furthermore, the real TSST induced more self-reported stress than the placebo on all three visits, the VR-TSST only on the first two visits. Social presence was stable across conditions and had no association with stress markers. CONCLUSION: These findings imply that the replicability of stress exposures at shorter intervals seems problematic for the traditional TSST, and for the VR-TSST.

Virtual and real-life ostracism and its impact on a subsequent acute stressor.

While ostracism constitutes a social stressor with negative effects on physical and mental health, social inclusion seems to increase resilience. This may be true not only for face-to-face settings, but also for computer-mediated interactions. Hence, this study examined the differences between ostracism and social inclusion in real-life or Virtual Reality (VR) regarding self-reported stress, neuroendocrine and cardiovascular reactivity in a subsequent real-life socio-evaluative task. 84 females were randomly assigned to a 3 (agency: face-to-face/human controlled VR-avatar/computer VR-agent) x 2 (inclusion status: inclusion/exclusion) between-subject design using a Cyberball paradigm. Subsequently, they were exposed to a real-life Trier Social Stress Test (TSST). Results indicate that the experience of ostracism constitutes a threat to fundamental social needs independent of agency. Excluded participants showed cardiovascular reactivity during TSST; also face-to-face and avatar excluded individuals had elevated salivary cortisol levels. Included participants reported more perceived social support during Cyberball and showed a blunted cortisol response to the TSST. These results suggest that face-to-face and avatar-related ostracism provokes responses in the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system (SNS). Furthermore, they reveal that social inclusion may act as a stress-protector as it alters HPA- and SNS-related stress responsiveness to subsequent stressors.

Physical Presence, Social Presence, and Anxiety in Participants with Social Anxiety Disorder During Virtual Cue Exposure.

Although social anxiety disorders (SADs) are increasingly treated by means of virtual cue exposure, the mechanisms leading to sufficient anxiety levels and thus to a success of virtual reality exposure therapy are still poorly understood. Also, most studies with SAD participants fail to evaluate social presence, although it may be a more appropriate indicator for virtual social stress scenarios than physical presence. Hence, for the first time, this study sets out to examine the link between social presence, physical presence, and emotional responses to phobogenic virtual social stimuli. A group of n = 12 participants with SAD and n = 12 healthy controls were exposed to three social tasks in an interactive virtual environment (VE). Self-report measures of physical and social presence as well as state anxiety were used alongside heart rate measures to evaluate the virtual experience. Results show significantly higher anxiety levels-both self-report and physiological-in SAD participants than in controls. Also, socially anxious subjects reported to experience more copresence and mutual attention as well as a higher sense of being in the VE than their healthy peers. In sum, social presence experiences may be more predicative of the anxiety response in SAD individuals than physical presence. Especially attentional processes seem to crucially shape the interplay between presence and affective responses.

Agency and Gender Influence Older Adults' Presence-Related Experiences in an Interactive Virtual Environment.

While virtual humans are increasingly used to benefit the elderly, considerably little is still known about older adults' virtual experiences. However, due to age-related changes, older adults' perceptions of virtual environments (VEs) may be unique. Hence, our objective was to examine possible gender differences in immersion, flow, and emotional states as well as physical and social presence in elderly males and females interacting either with a computer-controlled agent or a human-controlled avatar. Seventy-eight German-speaking older adults were randomly assigned to an avatar or an agent condition and were exposed to a brief social encounter in a virtual café. Results indicate no overall gender differences, but a significant effect of agency on social presence, physical presence, immersion, and flow. Participants in the avatar condition reported higher levels in all measures, except for involvement. Furthermore, significant gender × agency interactions were found, with females showing more social presence, spatial presence, and flow when interacting with a human-controlled avatar and more realism when conversing with an agent. Also, all participants showed significant changes in their affect post exposure. In sum, older adults' virtual experiences seem to follow unique patterns, yet, they do not preclude the elderly from successfully participating in VEs.

Impact of self-esteem and sex on stress reactions.

Positive self-evaluation is a major psychological resource modulating stress coping behavior. Sex differences have been reported in self-esteem as well as stress reactions, but so far their interactions have not been investigated. Therefore, we investigated sex-specific associations of self-esteem and stress reaction on behavioral, hormonal and neural levels. We applied a commonly used fMRI-stress task in 80 healthy participants. Men compared to women showed higher activation during stress in hippocampus, precuneus, superior temporal gyrus (STG) and insula. Furthermore, men outperformed women in the stress task and had higher cortisol and testosterone levels than women after stress. Self-esteem had an impact on precuneus, insula and STG activation during stress across the whole group. During stress, men recruit regions associated with emotion and stress regulation, self-referential processing and cognitive control more strongly than women. Self-esteem affects stress processing, however in a sex-independent fashion: participants with lower self-esteem show higher activation of regions involved in emotion and stress regulation, self-referential processing and cognitive control. Taken together, our data suggest that men are more engaged during the applied stress task. Across women and men, lower self-esteem increases the effort in emotion and stress processing and cognitive control, possibly leading to self-related thoughts in stressful situations.

Temperament differentially influences early information processing in men and women: Preliminary electrophysiological evidence of attentional biases in healthy individuals.

Preferential processing of threat-related information is a robust finding in anxiety disorders. The observation that attentional biases are also present in healthy individuals suggests factors other than clinical symptoms to play a role. Using a dot-probe paradigm while event-related potentials were recorded in 59 healthy adults, we investigated whether temperament and gender, both related to individual variation in anxiety levels, influence attentional processing. All participants showed protective attentional biases in terms of enhanced attention engagement with positive information, indexed by larger N1 amplitudes in positive compared to negative conditions. Taking gender differences into account, we observed that women showed enhanced attention engagement with negative compared to neutral information, indicated by larger P2 amplitudes in congruent than in incongruent negative conditions. Attentional processing was influenced by the temperament traits negative affect and effortful control. Our results emphasize that gender and temperament modulate attentional biases in healthy adults.

Attentional biases in healthy adults: Exploring the impact of temperament and gender.

BACKGROUND: Attentional biases such as faster attentional orienting toward negative information were consistently replicated in high-anxious and depressive individuals, but findings in healthy individuals are inconsistent so far. METHODS: Using a dot-probe paradigm, we investigated whether temperament traits and gender, which are linked to (sub)clinical symptoms and attentional processing, influenced attentional biases in healthy adults. RESULTS: All participants showed protective attentional biases in terms of orienting their attention away from negative information. In both genders higher values of negative affect were compensated with stronger attentional engagement with positive stimuli. This effect was more pronounced in men than in women. Effortful control fulfilled its regulative function in terms of stronger avoidance of negative stimuli only among men. LIMITATIONS: Reaction times after probe detection provide only a snapshot of attention and allow only for an indirect assessment of visual attention. Future research should emphasize methods that allow for continuous monitoring of attention allocation, therefore results of the present study await replication in psychophysiological or eye-tracking studies. CONCLUSION: Our results highlight the importance of considering influencing factors such as gender and temperament traits for attentional biases in healthy adults.

Health-Related Quality of Life in Patients with Subjective Cognitive Decline and Mild Cognitive Impairment and its Relation to Activities of Daily Living.

BACKGROUND: Health related quality of life (HRQOL) is an important issue in the context of dementia care. OBJECTIVES: The purpose of this study was to investigate HRQOL in patients with subjective cognitive decline (SCD) and mild cognitive impairment (MCI) and its relation to Activity of Daily Living (ADL). METHODS: In this cross sectional study, four experimental groups (each n = 98), controls, SCD, naMCI and aMCI, were compared. For data collection, neuropsychological methods (NTBV) and psychological questionnaires (SF-36 and B-ADL) were used. Multivariate analysis of variance was calculated to detect differences in HRQOL between groups. Correlations between HRQOL and ADL were explored. RESULTS: The dimensions of HRQOL showed mainly consistent differences between the control and the SCD group and MCI subgroups. In almost every dimension of HRQOL, the control group scored higher than subjects with SCD, naMCI, or aMCI. The controls showed low to moderate negative correlations between HQROL and B-ADL in some dimensions of the HRQOL. In the SCD group, low negative correlations with ADL were observed in some HRQOL scales. Low to moderate correlations were found between each scale of the SF-36 and the B-ADL in both MCI subtypes. We found gender differences in HRQOL. CONCLUSION: In conclusion, we could demonstrate that patients with SCD report reduced quality of life. This knowledge is important to get a better understanding of the individuals with SCD and may pave the way for the development of early intervention.

The impact of sex hormone concentrations on decision-making in females and males.

Human decision-making has been frequently studied and sex differences have been reported. Interestingly, previous results of hormone concentration on decision-making are somewhat inconsistent, regarding the impact of menstrual cycle phase in women or the influence of testosterone concentration on decision-making in women and men. However, the influence of the female sex hormone concentration (estradiol, progesterone) and the impact of oral contraceptive intake have rarely been examined and data regarding the effect of daytime variations of male testosterone are lacking. Moreover if personality factors such as sensation seeking, impulsivity, and anxiety influence decision-making, sex-specific effects, act as modulators is unclear. In the present study 71 women and 45 men were enrolled. All participants performed an evaluated decision-making task measuring risk-taking behavior on the basis of contingencies (Haegler et al., 2010), which can be carried out several times without a learning effect. Saliva samples were collected to obtain estradiol, progesterone, and testosterone levels. Additionally, all participants completed questionnaires measuring various personality factors. Data analysis revealed no sex differences in decision-making and no significant impact of testosterone concentration on behavioral performance in women or men. However, a significant negative correlation between progesterone concentration of women in the luteal phase and their performance in the risk-averse condition was obtained. Interestingly, a significant correlation between trait anxiety and decision-making occurred in females and males. Despite similar risky decision-making of women and men and no influence of testosterone concentration, menstrual cycle phase showed an effect on risk taking in women. In contrary to other studies, our findings provide rather subtle evidence for hormonal influences in decision-making, which may be primarily explained by task factors.

Afraid to be there? Evaluating the relation between presence, self-reported anxiety, and heart rate in a virtual public speaking task.

The link between anxiety and presence in a virtual environment (VE) is still a subject of an unresolved debate, with little empirical research to support theoretical claims. Thus, the current study analyzed presence, self-reported anxiety, and a physiological parameter (heart rate [HR]) in a sample of 30 high anxious and 35 low anxious participants. Both groups delivered a 5 minute speech in a virtual lecture hall. Results indicate no mediating influences of presence on group differences in self-reported state anxiety during the speech, but point toward negative correlations between state anxiety and the iGroup Presence Questionnaire (IPQ) scales "sense of being there" and "realism." Furthermore, HR was found to be unrelated to self-reported presence. Only the IPQ scale "spatial presence" showed a marginally significant influence on group differences in state anxiety. The present results support the assumption that presence and anxiety are logically distinct, meaning that presence does not directly influence the intensity of an emotion felt in a VE. Rather, it constitutes a precondition for an emotion to be at all elicited by a VE. Also, HR has proven to be no adequate substitute measure for presence, since it only assesses anxiety not presence. It may, however, mediate the interplay between trait anxiety and state anxiety. Possible implications of the current findings are discussed alongside the problem of using presence questionnaires that seem to be prone to subjective bias (i.e., participants confusing presence and emotion).

Association of menstrual cycle phase with the core components of empathy.

Evidence has accumulated that emotion recognition performance varies with menstrual cycle phase. However, according to some empathy models, facial affect recognition constitutes only one component of empathic behavior, besides emotional perspective taking and affective responsiveness. It remains unclear whether menstrual cycle phase and thus estradiol and progesterone levels are also associated with the two other empathy constructs. Therefore, we investigated 40 healthy right-handed females, 20 during their follicular phase and 20 during their midluteal phase and compared their performance in three tasks tapping the empathic components as well as self-report data. Salivary hormone levels were obtained and correlated with performance parameters. Subjects were matched for age and education and did not differ in neuropsychological function. Analysis of empathy performance revealed a significant effect of phase in emotion recognition, showing higher accuracy in the follicular group. Regarding affective responsiveness, we observed a significant difference in reaction times, with faster responses for sad and angry stimuli in the midluteal group. No significant group difference emerged for emotional perspective taking. Furthermore, significant correlations between progesterone levels and emotion recognition accuracy and affective responsiveness emerged only in the luteal group. However, groups did not differ in self-reported empathy. Our results indicate that menstrual cycle phase and thus ovarian hormone concentration are differentially related to empathic behavior, particularly emotion recognition and responsiveness to negative situations, with progesterone covarying with both in the luteal phase.

Culture but not gender modulates amygdala activation during explicit emotion recognition.

BACKGROUND: Mounting evidence indicates that humans have significant difficulties in understanding emotional expressions from individuals of different ethnic backgrounds, leading to reduced recognition accuracy and stronger amygdala activation. However, the impact of gender on the behavioral and neural reactions during the initial phase of cultural assimilation has not been addressed. Therefore, we investigated 24 Asians students (12 females) and 24 age-matched European students (12 females) during an explicit emotion recognition task, using Caucasian facial expressions only, on a high-field MRI scanner. RESULTS: Analysis of functional data revealed bilateral amygdala activation to emotional expressions in Asian and European subjects. However, in the Asian sample, a stronger response of the amygdala emerged and was paralleled by reduced recognition accuracy, particularly for angry male faces. Moreover, no significant gender difference emerged. We also observed a significant inverse correlation between duration of stay and amygdala activation. CONCLUSION: In this study we investigated the "alien-effect" as an initial problem during cultural assimilation and examined this effect on a behavioral and neural level. This study has revealed bilateral amygdala activation to emotional expressions in Asian and European females and males. In the Asian sample, a stronger response of the amygdala bilaterally was observed and this was paralleled by reduced performance, especially for anger and disgust depicted by male expressions. However, no gender difference occurred. Taken together, while gender exerts only a subtle effect, culture and duration of stay as well as gender of poser are shown to be relevant factors for emotion processing, influencing not only behavioral but also neural responses in female and male immigrants.

Usability of therapy controllers in elderly patients with deep brain stimulation.

BACKGROUND: Technical devices are becoming more prevalent in society and also in medical care. Older adults need more support to learn new technologies than younger subjects. So far, no research has been done on the usability of patient controllers in deep brain stimulation in an elderly population. The aim of the study was to investigate the factors influencing the performance of elderly DBS patients with respect to usability aspects of Medtronic Access therapy controllers. METHODS: Time, mistakes and frequency of use of the controller were compared in 41 elderly DBS patients who prior to the study had already owned a therapy controller for more than six years. One group (n = 20, mean age = 66.4 years) was watching an instructional video and then completed practical assignments on a model implantable pulse generator (IPG). The other group (n = 21, mean age = 65.9 years) completed the tasks without having seen the video before. Any errors that patients made were documented and also corrected so that all of them received hands-on training. After six months all patients were re-evaluated on the dummy IPG in order to compare the effects of hands-on alone vs. video-based training combined with hands-on. RESULTS: The group that had seen the video before significantly outperformed the control group at both assessments with respect to number of errors. Both groups performed faster after six months compared to baseline and tend to use the controller more often than at baseline. CONCLUSION: Our results indicate that elderly DBS patients who have been using the controller for several years still have various difficulties in operating the device. However, we also showed that age-specific training may improve the performance in older adults. In general, the design of DBS patient controllers should focus on the specific needs of the end-users. But as changes to medical devices take a long time to be implemented, video instructions with age-specific content plus hands-on training may improve learning for older adults.

[Pandora's digital box: mental disorders in cyberspace]. / Die digitale Büchse der Pandora: Psychische Störungen im Cyberspace.

The emersion of the Internet did not only change human communication and information seeking, it also contributed to manifold alterations in the manifestation, perception and treatment of mental disorders. Thus, one focus of current psychological research lies on the relationship between the new medium and psychosocial functioning. This review embraces recent results on this topic following a discussion from two different perspectives: first, it poses the question, whether the Internet - due to its very specific character - is capable of creating new mental disorders and second, it asks whether rare disorders may possibly be uncovered by the Internet or if already known disorders may be sustained and intensified by the online medium. Accordingly, the first part of this review deals with the conceptual basis of problematic Internet use, Internet addiction and problematic online-gaming as an example of specific internet use. Predisposing psychosocial factors, such as social isolation, depression and compulsive behavior are reviewed as potential triggers for these new internet- related disorders. The second part however draws upon two already existing groups of psychological disorders: eating disorders in relation to Pro-Ana and Pro-Mia on the one hand and Body Integrity Identity Disorder (BIID) on the other hand. Recent research is discussed to explore the sustaining and intensifying effect of the Internet on these disorders.

Geropsychology: the gender gap in human aging--a mini-review.

Differences between women and men in terms of gender gaps at late stages of their lives are the focus of this mini-review. We approach the matter by taking up the position of complex yet promising standpoints, the bio-psycho-social perspective on the one hand and approaches of developmental psychology on the other. Lifespan perspectives and the brain-behavior relationship are integrated and applied to geropsychological models. Research on gender differences is presented and examined, particularly regarding physiological and psychological differences between aging men and women; additionally, gender discrepancies in psychopathology are discussed. Prevailing concepts of 'active aging' are introduced and their implications for the review of divergent gender differences are considered.

Aging and technology in medical care: using the example of patient controllers in deep brain stimulation.

Deep brain stimulation is a neurosurgical therapy for patients with advanced movement disorders (e.g., Parkinson's disease). This therapy involves the use of a patient controller for home-use. So far, there are four different patient controllers available on the European market. However, use and acceptance of the patient controller is relatively low. The main end-user group is patients above the age of 60 years. This article compares the design of the different interfaces, with a special focus on gerotechnological aspects (display, acoustic signals, coloring, lettering, cognitive load and haptics). We suggest strategies to optimize the use and acceptance of these devices, which have already entered the market. Moreover, future directions of deep brain stimulation and the usability of patient controllers are discussed.

A resting state network in the motor control circuit of the basal ganglia.

BACKGROUND: In the absence of overt stimuli, the brain shows correlated fluctuations in functionally related brain regions. Approximately ten largely independent resting state networks (RSNs) showing this behaviour have been documented to date. Recent studies have reported the existence of an RSN in the basal ganglia - albeit inconsistently and without the means to interpret its function. Using two large study groups with different resting state conditions and MR protocols, the reproducibility of the network across subjects, behavioural conditions and acquisition parameters is assessed. Independent Component Analysis (ICA), combined with novel analyses of temporal features, is applied to establish the basis of signal fluctuations in the network and its relation to other RSNs. Reference to prior probabilistic diffusion tractography work is used to identify the basal ganglia circuit to which these fluctuations correspond. RESULTS: An RSN is identified in the basal ganglia and thalamus, comprising the pallidum, putamen, subthalamic nucleus and substantia nigra, with a projection also to the supplementary motor area. Participating nuclei and thalamo-cortical connection probabilities allow this network to be identified as the motor control circuit of the basal ganglia. The network was reproducibly identified across subjects, behavioural conditions (fixation, eyes closed), field strength and echo-planar imaging parameters. It shows a frequency peak at 0.025 +/- 0.007 Hz and is most similar in spectral composition to the Default Mode (DM), a network of regions that is more active at rest than during task processing. Frequency features allow the network to be classified as an RSN rather than a physiological artefact. Fluctuations in this RSN are correlated with those in the task-positive fronto-parietal network and anticorrelated with those in the DM, whose hemodynamic response it anticipates. CONCLUSION: Although the basal ganglia RSN has not been reported in most ICA-based studies using a similar methodology, we demonstrate that it is reproducible across subjects, common resting state conditions and imaging parameters, and show that it corresponds with the motor control circuit. This characterisation of the basal ganglia network opens a potential means to investigate the motor-related neuropathologies in which the basal ganglia are involved.

General and specific responsiveness of the amygdala during explicit emotion recognition in females and males.

BACKGROUND: The ability to recognize emotions in facial expressions relies on an extensive neural network with the amygdala as the key node as has typically been demonstrated for the processing of fearful stimuli. A sufficient characterization of the factors influencing and modulating amygdala function, however, has not been reached now. Due to lacking or diverging results on its involvement in recognizing all or only certain negative emotions, the influence of gender or ethnicity is still under debate. This high-resolution fMRI study addresses some of the relevant parameters, such as emotional valence, gender and poser ethnicity on amygdala activation during facial emotion recognition in 50 Caucasian subjects. Stimuli were color photographs of emotional Caucasian and African American faces. RESULTS: Bilateral amygdala activation was obtained to all emotional expressions (anger, disgust, fear, happy, and sad) and neutral faces across all subjects. However, only in males a significant correlation of amygdala activation and behavioral response to fearful stimuli was observed, indicating higher amygdala responses with better fear recognition, thus pointing to subtle gender differences. No significant influence of poser ethnicity on amygdala activation occurred, but analysis of recognition accuracy revealed a significant impact of poser ethnicity that was emotion-dependent. CONCLUSION: Applying high-resolution fMRI while subjects were performing an explicit emotion recognition task revealed bilateral amygdala activation to all emotions presented and neutral expressions. This mechanism seems to operate similarly in healthy females and males and for both in-group and out-group ethnicities. Our results support the assumption that an intact amygdala response is fundamental in the processing of these salient stimuli due to its relevance detecting function.

Amygdala activation during recognition of emotions in a foreign ethnic group is associated with duration of stay.

Cultural differences in emotion recognition performance have frequently been reported, whereby duration of stay in a foreign culture seems to be a crucial factor. Furthermore, cultural aspects influence the neural correlates of face and emotion processing thereby also affecting the response of the amygdala. Here, the exposure to a foreign culture and its influence on the cerebral correlates of facial emotion recognition were examined in 24 Asian and 24 age-matched European males. Subjects performed an explicit emotion recognition task and were imaged with a 3 T MR-scanner. Results demonstrate a significant cultural influence on the specific recognition of disgust and anger, with higher accuracy among the Europeans, while the functional data indicate generally elevated amygdala activation in Asians compared to Europeans. Moreover, a significant inverse correlation between duration of stay and amygdala response emerged, with stronger activation in those subjects with shorter duration of stay in Europe. The observed amygdala hyperactivation in Asians may reflect novelty aspects but might also be associated with greater effort and motivation in immigrants, thus it possibly reflects one neural correlate of the "alien-effect". We conclude that exposure to a foreign culture and duration of stay affect the behavioral and neural response to facial expressions of emotions.