Evaluating a multimodal, clinical and work-directed intervention (RTW-PIA) to support sustainable return to work among employees with mental disorders: study protocol of a multicentre, randomised controlled trial.

BACKGROUND: Mental disorders (MDs) are one of the leading causes for workforce sickness absence and disability worldwide. The burden, costs and challenges are enormous for the individuals concerned, employers and society at large. Although most MDs are characterised by a high risk of relapse after treatment or by chronic courses, interventions that link medical-psychotherapeutic approaches with work-directed components to facilitate a sustainable return to work (RTW) are rare. This protocol describes the design of a study to evaluate the (cost-)effectiveness and implementation process of a multimodal, clinical and work-directed intervention, called RTW-PIA, aimed at employees with MDs to achieve sustainable RTW in Germany. METHODS: The study consists of an effectiveness, a health-economic and a process evaluation, designed as a two-armed, multicentre, randomised controlled trial, conducted in German psychiatric outpatient clinics. Sick-listed employees with MDs will receive either the 18-month RTW-PIA treatment in conjunction with care as usual, or care as usual only. RTW-PIA consists of a face-to-face individual RTW support, RTW aftercare group meetings, and web-based aftercare. Assessments will be conducted at baseline and 6, 12, 18 and 24 months after completion of baseline survey. The primary outcome is the employees´ achievement of sustainable RTW, defined as reporting less than six weeks of working days missed out due to sickness absence within 12 months after first RTW. Secondary outcomes include health-related quality of life, mental functioning, RTW self-efficacy, overall job satisfaction, severity of mental illness and work ability. The health-economic evaluation will be conducted from a societal and public health care perspective, as well as from the employer's perspective in a cost-benefit analysis. The design will be supplemented by a qualitative effect evaluation using pre- and post-interviews, and a multimethod process evaluation examining various predefined key process indicators from different stakeholder perspectives. DISCUSSION: By applying a comprehensive, multimethodological evaluation design, this study captures various facets of RTW-PIA. In case of promising results for sustainable RTW, RTW-PIA may be integrated into standard care within German psychiatric outpatient clinics. TRIAL REGISTRATION: The study was prospectively registered with the German Clinical Trials Register ( DRKS00026232 , 1 September 2021).

Structural brain changes in young males addicted to video-gaming.

Excessive video gaming has a number of psychological and social consequences. In this study, we looked at possible changes in gray and white matter and asked whether these changes are correlated to psychological measures. Twentynine players of violent videogames (mean daily playing time 4.7 h) and age matched controls were subjected to a battery of questionnaires assessing aggression, empathy, hostility, internet addiction and psychological well-being. Diffusion tensor and 3D T1-weighted MR images were obtained to examine gray (via voxel-based morphometry) and white (via tract-based spatial statistics) matter changes. Widespread regions of decreased gray matter in the players were found but no region showed increased intensity of gray matter. Density of gray matter showed a negative correlation with the total length of playing in years in the right posterior cingulate gyrus, left pre- and postcentral gyrus, right thalamus, among others. Furthermore, fractional anisotropy, a marker for white matter structure, was decreased in the left and right cingulum in the players. Both, gray and white matter changes correlated with measures of aggression, hostility, self esteem, and the degree of internet addiction. This study thus shows profound changes of brain structure as a function of excessive playing of violent video games.

Enlarged temporal integration window in schizophrenia indicated by the double-flash illusion.

INTRODUCTION: In the present study we were interested in the processing of audio-visual integration in schizophrenia compared to healthy controls. The amount of sound-induced double-flash illusions served as an indicator of audio-visual integration. We expected an altered integration as well as a different window of temporal integration for patients. METHODS: Fifteen schizophrenia patients and 15 healthy volunteers matched for age and gender were included in this study. We used stimuli with eight different temporal delays (stimulus onset asynchronys (SOAs) 25, 50, 75, 100, 125, 150, 200 and 300 ms) to induce a double-flash illusion. Group differences and the widths of temporal integration windows were calculated on percentages of reported double-flash illusions. RESULTS: Patients showed significantly more illusions (ca. 36-44% vs. 9-16% in control subjects) for SOAs 150-300. The temporal integration window for control participants went from SOAs 25 to 200 whereas for patients integration was found across all included temporal delays. We found no significant relationship between the amount of illusions and either illness severity, chlorpromazine equivalent doses or duration of illness in patients. CONCLUSIONS: Our results are interpreted in favour of an enlarged temporal integration window for audio-visual stimuli in schizophrenia patients, which is consistent with previous research.

Altered brain network organization in adults with Asperger's syndrome: decreased connectome transitivity and assortativity with increased global efficiency.

Introduction: Autism spectrum disorder (ASD) is a neurodevelopmental disorder that persists into adulthood with both social and cognitive disturbances. Asperger's syndrome (AS) was a distinguished subcategory of autism in the DSM-IV-TR defined by specific symptoms including difficulties in social interactions, inflexible thinking patterns, and repetitive behaviour without any delay in language or cognitive development. Studying the functional brain organization of individuals with these specific symptoms may help to better understand Autism spectrum symptoms. Methods: The aim of this study is therefore to investigate functional connectivity as well as functional network organization characteristics using graph-theory measures of the whole brain in male adults with AS compared to healthy controls (HC) (AS: n = 15, age range 21-55 (mean ± sd: 39.5 ± 11.6), HC: n = 15, age range 22-57 [mean ± sd: 33.5 ± 8.5]). Results: No significant differences were found when comparing the region-by-region connectivity at the whole-brain level between the AS group and HC. However, measures of "transitivity," which reflect local information processing and functional segregation, and "assortativity," indicating network resilience, were reduced in the AS group compared to HC. On the other hand, global efficiency, which represents the overall effectiveness and speed of information transfer across the entire brain network, was increased in the AS group. Discussion: Our findings suggest that individuals with AS may have alterations in the organization and functioning of brain networks, which could contribute to the distinctive cognitive and behavioural features associated with this condition. We suggest further research to explore the association between these altered functional patterns in brain networks and specific behavioral traits observed in individuals with AS, which could provide valuable insights into the underlying mechanisms of its symptomatology.

The effect of multisensory semantic congruency on unisensory object recognition in schizophrenia.

Multisensory, as opposed to unisensory processing of stimuli, has been found to enhance the performance (e.g., reaction time, accuracy, and discrimination) of healthy individuals across various tasks. However, this enhancement is not as pronounced in patients with schizophrenia (SZ), indicating impaired multisensory integration (MSI) in these individuals. To the best of our knowledge, no study has yet investigated the impact of MSI deficits in the context of working memory, a domain highly reliant on multisensory processing and substantially impaired in schizophrenia. To address this research gap, we employed two adopted versions of the continuous object recognition task to investigate the effect of single-trail multisensory encoding on subsequent object recognition in 21 schizophrenia patients and 21 healthy controls (HC). Participants were tasked with discriminating between initial and repeated presentations. For the initial presentations, half of the stimuli were audiovisual pairings, while the other half were presented unimodal. The task-relevant stimuli were then presented a second time in a unisensory manner (either auditory stimuli in the auditory task or visual stimuli in the visual task). To explore the impact of semantic context on multisensory encoding, half of the audiovisual pairings were selected to be semantically congruent, while the remaining pairs were not semantically related to each other. Consistent with prior studies, our findings demonstrated that the impact of single-trial multisensory presentation during encoding remains discernible during subsequent object recognition. This influence could be distinguished based on the semantic congruity between the auditory and visual stimuli presented during the encoding. This effect was more robust in the auditory task. In the auditory task, when congruent multisensory pairings were encoded, both participant groups demonstrated a multisensory facilitation effect. This effect resulted in improved accuracy and RT performance. Regarding incongruent audiovisual encoding, as expected, HC did not demonstrate an evident multisensory facilitation effect on memory performance. In contrast, SZs exhibited an atypically accelerated reaction time during the subsequent auditory object recognition. Based on the predictive coding model we propose that this observed deviations indicate a reduced semantic modulatory effect and anomalous predictive errors signaling, particularly in the context of conflicting cross-modal sensory inputs in SZ.

Cognitive control in adults with high-functioning autism spectrum disorder: a study with event-related potentials.

Introduction: Little is known about cognitive control in adults with high-functioning forms of autism spectrum disorder because previous research focused on children and adolescents. Cognitive control is crucial to monitor and readjust behavior after errors to select contextually appropriate reactions. The congruency effect and conflict adaptation are measures of cognitive control. Post-error slowing, error-related negativity and error positivity provide insight into behavioral and electrophysiological correlates of error processing. In children and adolescent with autism spectrum disorder deficits in cognitive control and error processing have been shown by changes in post-error slowing, error-related negativity and error positivity in the flanker task. Methods: We performed a modified Eriksen flanker task in 17 adults with high-functioning autism spectrum disorder and 17 healthy controls. As behavioral measures of cognitive control and error processing, we included reaction times and error rates to calculate congruency effects, conflict adaptation, and post-error slowing. Event-related potentials namely error-related negativity and error positivity were measured to assess error-related brain activity. Results: Both groups of participants showed the expected congruency effects demonstrated by faster and more accurate responses in congruent compared to incongruent trials. Healthy controls exhibited conflict adaptation as they obtained performance benefits after incongruent trials whereas patients with autism spectrum disorder did not. The expected slowing in reaction times after errors was observed in both groups of participants. Individuals with autism spectrum disorder demonstrated enhanced electrophysiological error-processing compared to healthy controls indicated by increased error-related negativity and error positivity difference amplitudes. Discussion: Our findings show that adults with high-functioning autism spectrum disorder do not show the expected upregulation of cognitive control in response to conflicts. This finding implies that previous experiences may have a reduced influence on current behavior in these patients which possibly contributes to less flexible behavior. Nevertheless, we observed intact behavioral reactions after errors indicating that adults with high-functioning autism spectrum disorder can flexibly adjust behavior in response to changed environmental demands when necessary. The enhancement of electrophysiological error-processing indicates that adults with high-functioning autism spectrum disorder demonstrate an extraordinary reactivity toward errors reflecting increased performance monitoring in this subpopulation of autism spectrum disorder patients.

Deficient Audiovisual Speech Perception in Schizophrenia: An ERP Study.

In everyday verbal communication, auditory speech perception is often disturbed by background noise. Especially in disadvantageous hearing conditions, additional visual articulatory information (e.g., lip movement) can positively contribute to speech comprehension. Patients with schizophrenia (SZs) demonstrate an aberrant ability to integrate visual and auditory sensory input during speech perception. Current findings about underlying neural mechanisms of this deficit are inconsistent. Particularly and despite the importance of early sensory processing in speech perception, very few studies have addressed these processes in SZs. Thus, in the present study, we examined 20 adult subjects with SZ and 21 healthy controls (HCs) while presenting audiovisual spoken words (disyllabic nouns) either superimposed by white noise (-12 dB signal-to-noise ratio) or not. In addition to behavioral data, event-related brain potentials (ERPs) were recorded. Our results demonstrate reduced speech comprehension for SZs compared to HCs under noisy conditions. Moreover, we found altered N1 amplitudes in SZ during speech perception, while P2 amplitudes and the N1-P2 complex were similar to HCs, indicating that there may be disturbances in multimodal speech perception at an early stage of processing, which may be due to deficits in auditory speech perception. Moreover, a positive relationship between fronto-central N1 amplitudes and the positive subscale of the Positive and Negative Syndrome Scale (PANSS) has been observed.

[Use of outpatient psychotherapy via video consultation]. / Nutzung der ambulanten Psychotherapie über die Videosprechstunde: Ein Drittel der Patienten wird nicht erreicht.

Background: Due to the hygiene measures during the coronavirus pandemic at the beginning of 2020, psychotherapy by personal attendance was no longer possible or only possible to a limited extent in many places in Germany. In its place, psychotherapy via video conference was used as an alternative option for treatment. Objective: The present study was concerned with the question of the actual use of this form of psychotherapy during the lockdown. Material and methods: Therapists in the psychotherapeutic training outpatient department of the Medical School of Hanover were questioned on their experiences and the experiences of patients with the use of the video consultation during running guideline psychotherapy. Data from 338 patents could be collated. The data contained information, for example on acceptance or rejection of the offer of a video consultation, on the reasons for rejection and on technical problems by the execution. Results: The presented data show that 35% of patients could not be reached by the video consultation. Approximately half of the patients from this group could not use this form of therapy due to the lack of technical equipment. The other half did not want therapy using the video consultation, although the technical requirements were available. In the group of patients who used the video consultation, the session was interrupted due to technical disturbances in 31% of the cases. In a further 10% of the cases the disturbances even led to a premature termination of the session. The presented data make it clear that the use of therapy via video consultation significantly decreases with increasing age and reduced education level. Conclusion: The results of the present study show that a considerable proportion of the patients could not be reached by the offer, despite the dissemination of the video consultation; therefore, in the case of further lockdowns special offers for this group should be considered. The authors recommend that the health insurance companies provide support for patients who do not have the technical requirements at their disposal. Patients who do not want to participate in this form of treatment need therapeutically motivating support.

Audiovisual Simultaneity Judgements in Synaesthesia.

Synaesthesia is a multimodal phenomenon in which the activation of one sensory modality leads to an involuntary additional experience in another sensory modality. To date, normal multisensory processing has hardly been investigated in synaesthetes. In the present study we examine processes of audiovisual separation in synaesthesia by using a simultaneity judgement task. Subjects were asked to indicate whether an acoustic and a visual stimulus occurred simultaneously or not. Stimulus onset asynchronies (SOA) as well as the temporal order of the stimuli were systematically varied. Our results demonstrate that synaesthetes are better in separating auditory and visual events than control subjects, but only when vision leads.

Enhanced attentional processing during speech perception in adult high-functioning autism spectrum disorder: An ERP-study.

Deficits in audiovisual speech perception have consistently been detected in patients with Autism Spectrum Disorder (ASD). Especially for patients with a highly functional subtype of ASD, it remains uncertain whether these deficits and underlying neural mechanisms persist into adulthood. Research indicates differences in audiovisual speech processing between ASD and healthy controls (HC) in the auditory cortex. The temporal dynamics of these differences still need to be characterized. Thus, in the present study we examined 14 adult subjects with high-functioning ASD and 15 adult HC while they viewed visual (lip movements) and auditory (voice) speech information that was either superimposed by white noise (condition 1) or not (condition 2). Subject's performance was quantified by measuring stimulus comprehension. In addition, event-related brain potentials (ERPs) were recorded. Results demonstrated worse speech comprehension for ASD subjects compared to HC under noisy conditions. Moreover, ERP-analysis revealed significantly higher P2 amplitudes over parietal electrodes for ASD subjects compared to HC.

A case series of serious and unexpected adverse drug reactions under treatment with cariprazine.

Reporting of new or unexpected adverse drug reactions of medicines that are subject to additional monitoring ("black triangle" label), such as the antipsychotic drug cariprazine, is of paramount importance to improve pharmacotherapy safety.

fMRI Revealed Reduced Amygdala Activation after Nx4 in Mildly to Moderately Stressed Healthy Volunteers in a Randomized, Placebo-Controlled, Cross-Over Trial.

Social stress contributes to major societal health burdens, such as anxiety disorders and nervousness. Nx4 has been found to modulate stress responses. We investigated whether dampening of such responses is associated with neuronal correlates in brain regions involved in stress and anxiety. In a randomized, placebo-controlled, double-blind, cross-over trial, 39 healthy males took a single dose (three tablets) of either placebo or Nx4, 40 to 60 minutes before an fMRI scan session. We here report on drug effects on amygdala responses during a face-matching task, which was performed during a complex test battery further including resting-state brain connectivity and a social stress experiment. The first of the Primary Outcomes, defined in a hierarchical order, concerned reduced amygdala effects after intake of verum compared to placebo. We found a statistically significant reduction in differential activations in the left amygdala for the contrast negative faces versus forms during verum versus placebo condition. Our results indicate that effects of Nx4 can be monitored in the brain. Previously noted effects on stress responses may thus be modulated by affective brain regions including the amygdala.

A Randomized Study of Food Pictures-Influenced Decision-Making Under Ambiguity in Individuals With Morbid Obesity.

BACKGROUND AND AIMS: In addition to craving responses to salient food cues, the anticipation of short-term rewarding consumption of palatable food may overrun the anticipation of long-term negative consequences of obesity. The present investigation addressed the potential interplay of food cravings and decision-making abilities in individuals with obesity. METHOD: Study 1 included 107 bariatric surgery candidates with class 2/3 obesity (OB-group) and study 2 included 54 individuals with normal weight/pre-obesity (nonOB-group). In both studies, standardized questionnaires concerning food cravings, food addiction, and psychopathology were administered. A cue-reactivity paradigm was used to measure craving responses toward semi-individualized images of highly palatable, processed food/fruit (appetitive food cues) compared to images of raw vegetables (non-appetitive food cues). Decision-making was measured with a modified computerized version of the Iowa Gambling Task (IGT) with food pictures. Both groups were divided into two subgroups that were randomized to different IGT conditions. In one IGT condition the advantageous IGT card decks were covered by pictures of palatable, processed food or fruit and the disadvantageous decks by images of raw vegetables (= congruent condition), and in the other IGT condition vice versa. RESULTS: Participants in the OB-group admitted on average higher craving responses toward palatable, processed food or fruit cues compared to pictures of raw vegetables. This was not the case in the nonOB-group. Contrary to our hypothesis, decision-making performance in both groups was worse when pictures of palatable, processed food or fruit were associated with advantageous IGT card decks compared to performance when those pictures were linked to the disadvantageous decks. The interference effect of food pictures processing on advantageous decision-making has been observed particularly in those individuals of the OB-group who exhibited high craving responses toward palatable, processed food cues or high levels of food addiction. DISCUSSION: The results indicate that food pictures processing interferes with decision-making, regardless of weight status. Opposed to the hypothesis, stronger tendencies to avoid than to approach pictures presenting processed, tasty food were observed. Further research should examine how cognitive avoidance tendencies toward processed, high energy food and approach tendencies toward healthy food can be transferred to real life situations.

Audiovisual integration during speech comprehension: an fMRI study comparing ROI-based and whole brain analyses.

Visual information (lip movements) significantly contributes to speech comprehension raising the question for the neural implementation of audiovisual (AV) integration during speech processing. To replicate and extend earlier neuroimaging findings, we compared two different analysis approaches in a slow event-related fMRI study of healthy native speakers of German who were exposed to AV speech stimuli (disyllabic nouns) with audio and visual signals being either congruent or incongruent. First, data was subjected to whole brain general linear model analysis after transformation of all individual data sets into standard space. Second, a region of interest (ROI) approach based on individual anatomy was used with ROI defined in areas identified previously as being important for AV processing. Standard space analysis revealed a widespread cortical network including the posterior part of the left superior temporal sulcus, Broca's region and its right hemispheric counterpart showing increased activity for incongruent stimuli. The ROI approach allowed to identify differences in activity between Brodmann areas 44 and 45, within Broca's area for incongruent stimulation, and also allowed to study activity of subdivisions of superior temporal regions. The complementary strengths and weaknesses of the two analysis approaches are discussed.

Brief Sensory Training Narrows the Temporal Binding Window and Enhances Long-Term Multimodal Speech Perception.

Our ability to integrate multiple sensory-based representations of our surrounding supplies us with a more holistic view of our world. There are many complex algorithms our nervous system uses to construct a coherent perception. An indicator to solve this 'binding problem' are the temporal characteristics with the specificity that environmental information has different propagation speeds (e.g., sound and electromagnetic waves) and sensory processing time and thus the temporal relationship of a stimulus pair derived from the same event must be flexibly adjusted by our brain. This tolerance can be conceptualized in the form of the cross-modal temporal binding window (TBW). Several studies showed the plasticity of the TBW and its importance concerning audio-visual illusions, synesthesia, as well as psychiatric disturbances. Using three audio-visual paradigms, we investigated the importance of length (short vs. long) as well as modality (uni- vs. multimodal) of a perceptual training aiming at reducing the TBW in a healthy population. We also investigated the influence of the TBW on speech intelligibility, where participants had to integrate auditory and visual speech information from a videotaped speaker. We showed that simple sensory trainings can change the TBW and are capable of optimizing speech perception at a very naturalistic level. While the training-length had no different effect on the malleability of the TBW, the multisensory trainings induced a significantly stronger narrowing of the TBW than their unisensory counterparts. Furthermore, a narrowing of the TBW was associated with a better performance in speech perception, meaning that participants showed a greater capacity for integrating informations from different sensory modalities in situations with one modality impaired. All effects persisted at least seven days. Our findings show the significance of multisensory temporal processing regarding ecologically valid measures and have important clinical implications for interventions that may be used to alleviate debilitating conditions (e.g., autism, schizophrenia), in which multisensory temporal function is shown to be impaired.

Auditory Deficits in Audiovisual Speech Perception in Adult Asperger's Syndrome: fMRI Study.

Audiovisual (AV) integration deficits have been proposed to underlie difficulties in speech perception in Asperger's syndrome (AS). It is not known, if the AV deficits are related to alterations in sensory processing at the level of unisensory processing or at levels of conjoint multisensory processing. Functional Magnetic-resonance images (MRI) was performed in 16 adult subjects with AS and 16 healthy controls (HC) matched for age, gender, and verbal IQ as they were exposed to disyllabic AV congruent and AV incongruent nouns. A simple semantic categorization task was used to ensure subjects' attention to the stimuli. The left auditory cortex (BA41) showed stronger activation in HC than in subjects with AS with no interaction regarding AV congruency. This suggests that alterations in auditory processing in unimodal low-level areas underlie AV speech perception deficits in AS. Whether this is signaling a difficulty in the deployment of attention remains to be demonstrated.

Audio-visual speech perception in adult readers with dyslexia: an fMRI study.

Developmental dyslexia is a specific deficit in reading and spelling that often persists into adulthood. In the present study, we used slow event-related fMRI and independent component analysis to identify brain networks involved in perception of audio-visual speech in a group of adult readers with dyslexia (RD) and a group of fluent readers (FR). Participants saw a video of a female speaker saying a disyllabic word. In the congruent condition, audio and video input were identical whereas in the incongruent condition, the two inputs differed. Participants had to respond to occasionally occurring animal names. The independent components analysis (ICA) identified several components that were differently modulated in FR and RD. Two of these components including fusiform gyrus and occipital gyrus showed less activation in RD compared to FR possibly indicating a deficit to extract face information that is needed to integrate auditory and visual information in natural speech perception. A further component centered on the superior temporal sulcus (STS) also exhibited less activation in RD compared to FR. This finding is corroborated in the univariate analysis that shows less activation in STS for RD compared to FR. These findings suggest a general impairment in recruitment of audiovisual processing areas in dyslexia during the perception of natural speech.

Deficient prepulse inhibition of the startle reflex in schizophrenia using a cross-modal paradigm.

OBJECTIVES: To investigate whether the typically reported deficient sensorimotor gating in patients with schizophrenia using unimodal paradigms can also be detected by a cross-modal paradigm which made use of an electrocutaneous-acoustic coupling of stimuli. METHODS: Twenty-one male schizophrenia patients took part in a prepulse inhibition (PPI) paradigm with an electrocutaneous prepulse and an acoustic startle-eliciting pulse. Their results were compared with those from nineteen healthy males. RESULTS: As expected, the patients showed significantly lower PPI than controls. No associations were found between measures of illness severity and PPI. DISCUSSION: To the best of our knowledge, this is the first study showing reduced PPI in patients with schizophrenia by using an electrocutaneous-acoustic prepulse-pulse combination. Hence, this study gives further evidence of a modality-independent sensorimotor gating deficit in schizophrenia. Furthermore, as PPI was also lower than usual in controls using unimodal paradigms, results are interpreted in favour of longer processing times of the electrocutaneous prepulse, which probably led to a shorter perceived stimulus onset asynchrony (SOA) in the brain.

Lack of Evidence That Neural Empathic Responses Are Blunted in Excessive Users of Violent Video Games: An fMRI Study.

The use of violent video games has been often linked to increase of aggressive behavior. According to the General Aggression Model, one of the central mechanisms for this aggressiveness inducing impact is an emotional desensitization process resulting from long lasting repeated violent game playing. This desensitization should evidence itself in a lack of empathy. Recent research has focused primarily on acute, short term impact of violent media use but only little is known about long term effects. In this study 15 excessive users of violent games and control subjects matched for age and education viewed pictures depicting emotional and neutral situations with and without social interaction while fMRI activations were obtained. While the typical pattern of activations for empathy and theory of mind networks was seen, both groups showed no differences in brain responses. We interpret our results as evidence against the desensitization hypothesis and suggest that the impact of violent media on emotional processing may be rather acute and short-lived.

Excessive users of violent video games do not show emotional desensitization: an fMRI study.

Playing violent video games have been linked to long-term emotional desensitization. We hypothesized that desensitization effects in excessive users of violent video games should lead to decreased brain activations to highly salient emotional pictures in emotional sensitivity brain regions. Twenty-eight male adult subjects showing excessive long-term use of violent video games and age and education matched control participants were examined in two experiments using standardized emotional pictures of positive, negative and neutral valence. No group differences were revealed even at reduced statistical thresholds which speaks against desensitization of emotion sensitive brain regions as a result of excessive use of violent video games.