German language adaptation of the Cogniphobia Scale for Headache Disorders (CS-HD) and development of a new short form (CS-HD-6).

OBJECTIVE: This study is part of the ODIN-migraine (Optimization of Diagnostic Instruments in migraine) project. It is a secondary, a priori analysis of previously collected data, and aimed to assess the psychometric properties and factor structure of the Cogniphobia Scale for Headache Disorders (CS-HD). We aimed to construct a German-language version and a short version. BACKGROUND: Cogniphobia is the fear and avoidance of cognitive exertion, which the patient believes triggers or exacerbates headache. High cogniphobia may worsen the course of a headache disorder. METHODS: The 15-item CS-HD was translated into German and back translated in a masked form by a professional translator. Modifications were discussed and carried out in an expert panel. A cross-sectional online survey including the CS-HD and further self-report questionnaires was conducted in a sample of N = 387 persons with migraine (364/387 [94.1%] female, M = 41.0 [SD = 13.0] years, migraine without aura: 152/387 [39.3%], migraine with aura: 85/387 [22.0%], and chronic migraine: 150/387 [38.8%]). RESULTS: Exploratory factor analysis resulted in two clearly interpretable factors (interictal and ictal cogniphobia). Confirmatory factor analysis yielded an acceptable to good model fit (χ2(89) = 117.87, p = 0.022, χ2/df = 1.32, RMSEA = 0.029, SRMR = 0.055, CFI = 0.996, TLI = 0.995). Item response theory-based analysis resulted in the selection of six items for the short form (CS-HD-6). Reliability was acceptable to excellent (interictal cogniphobia subscale: ω = 0.92 [CS-HD] or ω = 0.77 [CS-HD-6]; ictal cogniphobia subscale: ω = 0.77 [CS-HD] or ω = 0.73 [CS-HD-6]). The pattern of correlations with established questionnaires confirmed convergent validity of both the CS-HD and the CS-HD-6. CONCLUSION: Both the CS-HD and the CS-HD-6 have good psychometric properties and are suitable for the assessment of cogniphobia in migraine.

Bridging the feedback implementation gap: A comparison of empirical and rational decision rules in naturalistic psychotherapy.

Objective: Previous research indicates positive effects of feedback based on rational or empirical decision rules in psychotherapy. The implementation of these usually session-to-session-based feedback systems into clinical practice, however, remains challenging. This study aims to evaluate decision rules based on routine outcome monitoring with reduced assessment frequency. Method: Data routinely collected every 5-20 sessions of N = 3758 patients treated with CBT in an outpatient clinic (Msessions = 42.8, SD = 15.4) were used to develop feedback decision rules based on the expected treatment response and nearest neighbors approach, the reliable change index, and method of percental improvement. The detection of patients at risk of treatment failure served as primary endpoint. Results: Significantly lower reliable improvement, higher reliable deterioration rates, and smaller effect sizes were found for patients identified at risk of treatment failure by all rules. The nearest neighbors-based approach showed the highest sensitivity regarding the detection of reliably deteriorated cases. Conclusion: Consistent with previous research, the empirical models outperformed the rational rules. Still, the first-time used percental improvement-based rule also showed satisfactory results. Overall, the results point to the potential of basic feedback systems that might be easier to implement in practice than session-to-session based systems.

Cognitive-behavioral therapy for patients with post-COVID-19 condition (CBT-PCC): a feasibility trial.

BACKGROUND: The post-COVID-19 condition describes the persistence or onset of somatic symptoms (e.g. fatigue) after acute COVID-19. Based on an existing cognitive-behavioral treatment protocol, we developed a specialized group intervention for individuals with post-COVID-19 condition. The present study examines the feasibility, acceptance, and effectiveness of the program for inpatients in a neurological rehabilitation setting. METHODS: The treatment program comprises eight sessions and includes psychoeducational and experience-based interventions on common psychophysiological mechanisms of persistent somatic symptoms. A feasibility trial was conducted using a one-group design in a naturalistic setting. N = 64 inpatients with a history of mild COVID-19 that fulfilled WHO criteria for post-COVID-19 condition were enrolled. After each session, evaluation forms were completed and psychometric questionnaires on somatic and psychopathological symptom burden were collected pre- and post-intervention. RESULTS: The treatment program was well received by participants and therapists. Each session was rated as comprehensible and overall satisfaction with the sessions was high. Pre-post effect sizes (of standard rehabilitation incl. new treatment program; intention-to-treat) showed significantly reduced subjective fatigue (p < 0.05, dav = 0.33) and improved disease coping (ps < 0.05, dav = 0.33-0.49). CONCLUSIONS: Our results support the feasibility and acceptance of the newly developed cognitive-behavioral group intervention for individuals with post-COVID-19 condition. Yet, findings have to be interpreted cautiously due to the lack of a control group and follow-up measurement, the small sample size, and a relatively high drop-out rate.

The Human Affectome.

Over the last decades, theoretical perspectives in the interdisciplinary field of the affective sciences have proliferated rather than converged due to differing assumptions about what human affective phenomena are and how they work. These metaphysical and mechanistic assumptions, shaped by academic context and values, have dictated affective constructs and operationalizations. However, an assumption about the purpose of affective phenomena can guide us to a common set of metaphysical and mechanistic assumptions. In this capstone paper, we home in on a nested teleological principle for human affective phenomena in order to synthesize metaphysical and mechanistic assumptions. Under this framework, human affective phenomena can collectively be considered algorithms that either adjust based on the human comfort zone (affective concerns) or monitor those adaptive processes (affective features). This teleologically-grounded framework offers a principled agenda and launchpad for both organizing existing perspectives and generating new ones. Ultimately, we hope the Human Affectome brings us a step closer to not only an integrated understanding of human affective phenomena, but an integrated field for affective research.

Further Evidence for a Dimensional Latent Structure of Health Anxiety: Taxometric Analyses of the Whiteley Index Based on Two German Representative Samples.

Health anxiety is an intricate part of illness anxiety and somatic symptom disorder. Based on convenience samples, two out of three available studies indicate that it is a dimensional rather than a categorical construct. Using two representative datasets, this study investigates whether previous results can be clarified. Conventional taxometric analyses as well as comparison curve fit indices (CCFI) profile analyses (MAMBAC and MAXSLOPE procedures) were calculated with two datasets of the German adult population assessing the Whiteley Index (WI-14, N = 2,072; WI-7, N = 2,498). Mean CCFIs indicated a dimensional structure for both the WI-7 (mean CCFI = 0.42, mean CCFI profile = 0.40) and the WI-14 (mean CCFI = 0.44, mean CCFI profile = 0.32). The results support and extend previous findings by strongly suggesting a dimensional distribution of health anxiety in the general population. Implications for research and practice comprise the adoption of a dimensional description of psychopathology as well as transdiagnostic treatment approaches.

Early Adverse Effects of Behavioural Preventive Strategies During the COVID-19 Pandemic in Germany: An Online General Population Survey.

Background: Quarantine and physical distancing represent the two most important non-pharmaceutical actions to contain the COVID-19 pandemic. Comparatively little is known about possible adverse consequences of these behavioural measures in Germany. This study aimed at investigating potential early adverse effects associated with quarantine and physical distancing at the beginning of the countrywide lockdown in Germany in March 2020. Method: Using a cross-sectional online survey (N = 4,268), adverse consequences attributed to physical distancing, symptoms of psychopathology, and sociodemographic variables were explored in the total sample as well as in high-risk groups (i.e., people with a physical or mental condition). Results: The most frequently reported adverse effects were impairment of spare time activities, job-related impairment, and adverse emotional effects (e.g., worries, sadness). Participants with a mental disorder reported the highest levels of adverse consequences (across all domains) compared to participants with a physical disease or participants without any mental or physical condition. No significant association between the duration of the behavioural protective measures and the severity of adverse mental health effects was observed. Conclusion: Results showed that non-pharmaceutical actions were associated with adverse effects, particularly in people with mental disorders. The findings are of relevance for tailoring support to special at-risk groups in times of behavioural preventive strategies.

Remotely Provided Open-Label Placebo Reduces Frequency of and Impairment by Allergic Symptoms.

OBJECTIVE: Placebos being prescribed with full honesty and disclosure (i.e., open-label placebo [OLP]) have been shown to reduce symptom burden in a variety of conditions. With regard to allergic rhinitis, previous research provided inconclusive evidence for the effects of OLP, possibly related to a separate focus on either symptom severity or symptom frequency. Overcoming this limitation of previous research, the present study aimed to examine the effects of OLP on both the severity and frequency of allergic symptoms. METHODS: In a randomized-controlled trial, patients with allergic rhinitis ( N = 74) were randomized to OLP or treatment as usual (TAU). Because of the COVID-19 pandemic, OLP was administered remotely in a virtual clinical encounter. Participants took placebo tablets for 14 days. The primary outcomes were the severity and frequency of allergic symptoms. The secondary end point was allergy-related impairment. RESULTS: OLP did not significantly improve symptom severity over TAU ( F (1,71) = 3.280, p = .074, η2 = 0.044) but did reduce symptom frequency ( F (1,71) = 7.272, p = .009, η2 = 0.093) and allergy-related impairment more than TAU ( F (1,71) = 6.445, p = .013, η2 = 0.083), reflecting medium to large effects. The use of other antiallergic medication did not influence the results. CONCLUSIONS: Although OLP was able to lower the frequency of allergic symptoms and allergy-related impairment substantially, its effects on symptom severity were weaker. The remote provision of OLP suggests that physical contact between patients and providers might not be necessary for OLP to work.

The Somatoform Spectrum Within the Hierarchical Taxonomy of Psychopathology System: A Taxometric Test of the Latent Structure.

OBJECTIVE: The general understanding of disorders related to chronic somatic symptoms (e.g., somatic symptom disorder, functional somatic syndromes) is limited because of current categorical conceptualizations in traditional taxonomies. To improve clinical utility and validity, the Hierarchical Taxonomy of Psychopathology offers an empirically grounded dimensional approach. Therefore, the distribution of persistent somatic symptom distress observed in nature is highly relevant for informing decisions related to classification and treatment. This study analyzes the underlying structure of symptoms associated with the somatoform spectrum. METHOD: Taxometric analyses were used to examine the latent status of the somatoform spectrum, which was measured via a dimensional questionnaire devised as part of the Hierarchical Taxonomy of Psychopathology scale development effort. We generated Comparison Curve Fit Index (CCFI) profile analyses across a clinical sample of psychotherapy outpatients ( n = 487), a community sample of German adults ( n = 451), and a student sample from New Zealand ( n = 549). RESULTS: In the clinical sample (CCFI mean = 0.38) and in the student sample (CCFI mean = 0.36), a dimensional solution was clearly favored. Results in the community sample (CCFI mean = 0.51) were ambiguous. CONCLUSIONS: Across the three independent samples, qualitatively distinct subgroups within the distribution of chronic somatic symptoms could not be identified. Therefore, continuous representations seemed to best represent the structure of somatic symptoms. Implications of these findings for etiology and treatment are discussed.

Does practice really make perfect? A longitudinal analysis of the relationship between therapist experience and therapy outcome: A replication of Goldberg, Rousmaniere, et al. (2016).

Experience is often regarded as a prerequisite of high performance. In the field of psychotherapy, research has yielded inconsistent results regarding the association between experience and therapy outcome. However, this research was mostly conducted cross-sectionally. A longitudinal study from the U.S. recently indicated that psychotherapists' experience was not associated with therapy outcomes. The present study aimed at replicating Goldberg, Rousmaniere, et al. (2016) study in the German healthcare system. Using routine evaluation data of a large German university psychotherapy outpatient clinic, the effect of N = 241 therapists' experience on the outcomes of their patients (N = 3,432) was assessed longitudinally using linear and logistic multilevel modeling. Experience was operationalized using the number of days since the first patient of a therapist as well as using the number of patients treated beforehand. Outcome criteria were defined as change in general psychopathology as well as response, remission, and early termination. Several covariates (number of sessions per case, licensure, and main diagnosis) were also examined. Across all operationalizations of experience (time since first patient and number of cases treated) and therapy outcome (change in psychopathology, response, remission, and early termination), results largely suggest no association between therapists' experience and therapy outcome. Preliminary evidence suggests that therapists need fewer sessions to achieve the same outcomes when they gain more experience. Therapeutic experience seems to be unrelated to patients' change in psychopathology. This lack of findings is of importance for improving postgraduate training and the quality of psychotherapy in general. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Assessing attack-related fear in headache disorders-Structure and psychometric properties of the Fear of Attacks in Migraine Inventory.

OBJECTIVE: This study aimed to develop a self-report questionnaire for the assessment of attack-related fear in migraine, and to determine its factor structure as well as its psychometric properties by the primary analysis of a cross-sectional survey's data. BACKGROUND: High fear of attacks in migraine increases the burden of disease and is assumed to have a negative impact on the course of the disease. Little is known about the structure and dimensionality of attack-related fear, and a valid instrument for the comprehensive assessment is lacking. METHODS: Based on a literature search and interviews with persons with migraine as well as with experienced practitioners, a 46-item self-report questionnaire, the Fear of Attacks in Migraine Inventory (FAMI) was developed. A cross-sectional online survey comprising an assessment of diagnostic criteria of migraine and a battery of questionnaires including the FAMI was conducted (N = 387 persons with migraine, 364/387 [94.1%] women, M = 40.9 [SD = 13.1] years, migraine without aura: 153/387 [39.5%], migraine with aura: 85/387 [22.0%], and chronic migraine: 149/387 [38.5%]). RESULTS: Item selection led to 29 items for the FAMI. Exploratory factor analysis resulted in three clearly interpretable factors (fear of negative consequences; attention and anticipation; fear-avoidance); a confirmatory factor analysis yielded an acceptable to good model fit (χ2 (3) = 1328.84, p = 0.001, χ2 /df = 3.55, RMSEA = 0.085, SRMR = 0.073, CFI = 0.98, and TLI = 0.97). Reliability was good (fear-avoidance, ω = 0.85; attention and anticipation, ω = 0.88) to excellent (fear of negative consequences, ω = 0.91). Correlational analyses confirmed the convergent validity of the FAMI. CONCLUSIONS: The FAMI appears suitable and promising for the assessment of attack-related fear in migraine research and clinical care.

Matching research and practice: Prediction of individual patient progress and dropout risk for basic routine outcome monitoring.

OBJECTIVE: Despite evidence showing that systematic outcome monitoring can prevent treatment failure, the practical conditions that allow for implementation are seldom met in naturalistic psychological services. In the context of limited time and resources, session-by-session evaluation is rare in most clinical settings. This study aimed to validate innovative prediction methods for individual treatment progress and dropout risk based on basic outcome monitoring. METHODS: Routine data of a naturalistic psychotherapy outpatient sample were analyzed (N = 3902). Patients were treated with cognitive behavioral therapy with up to 95 sessions (M = 39.19, SD = 16.99) and assessment intervals of 5-15 sessions. Treatment progress and dropout risk were predicted in two independent analyses using the nearest neighbor method and least absolute shrinkage and selection operator regression, respectively. RESULTS: The correlation between observed and predicted patient progress was r = .46. Intrinsic treatment motivation, previous inpatient treatment, university-entrance qualification, baseline impairment, diagnosed personality disorder, and diagnosed eating disorder were identified as significant predictors of dropout, explaining 11% of variance. CONCLUSIONS: Innovative outcome prediction in naturalistic psychotherapy is not limited to elaborated progress monitoring. This study demonstrates a reasonable approach for tracking patient progress as long as session-by-session assessment is not a valid standard.

Open-Label Placebo Effects on Psychological and Physical Well-Being: A Conceptual Replication Study.

Background: Contrary to traditional placebos, open-label placebos (OLP) abstain from deception, i.e., participants are openly informed to receive an inert substance. Studies in clinical and healthy samples evidence the efficacy of OLPs. This study aims to conceptually replicate and expand findings of a recent OLP study in healthy participants while implementing a within-subject design and daily instead of retrospective assessments. Additionally, the effect of a brand name on the medicine container is tested and possible predictors of the OLP effects are explored. Method: Healthy participants (N = 75) received OLP and no placebo for 5 days each (randomized sequence) and answered daily questionnaires on sleep quality, bodily symptoms, mental well-being, and psychological distress. The medicine container of half the participants had a brand name, the remaining did not. Different personality traits and situational factors were assessed. Results: Mental and physical well-being did not differ between OLP and control phase, i.e., overall, no OLP effect emerged. Contrast analysis indicated that an OLP effect emerged for sleep quality and psychological distress when no brand name was present. Further, an OLP effect emerged in persons with higher expectations for bodily symptoms (r = .23, p = .046) and psychological distress (r = .24, p = .037). Conclusions: Methodological differences to the original study are discussed as an explanation for the failure to induce overall OLP effects. Future studies should continue to replicate previous findings and determine the exact conditions of successful implementation of OLP effects in healthy as well as clinical samples.

[Psychotherapy in the Context of Interdisciplinary Multimodal Pain Therapy: Update]. / Psychotherapie in der interdisziplinären multimodalen Schmerztherapie: Update.

Interdisciplinary multimodal pain therapy (IMPT) is based on the biopsychosocial model of pain and describes an integrated treatment for patients with chronic pain. IMPT incorporates a close cooperation of different disciplines, including physicians, psychotherapists, physiotherapists, and others. IMPT mainly aims to restore and increase patients' physical, social and psychological functional capacity. The efficacy of IMPT has been evidenced by systematic reviews and meta-analyses. A number of studies further indicate IMPT's cost-efficiency. Psychotherapy is an essential component of IMPT. Its main goal within the framework of IMPT is to identify and modify dysfunctional patterns of pain coping, and to diagnose and potentially treat psychological comorbidities. Pain psychotherapy comprises mostly cognitive-behavioral interventions which address dysfunctional coping at the three levels of the pain experience (i.e., cognitive, emotional, and behavioral). Research into the efficacy of pain psychotherapy is rather sparse and studies have mostly focused on chronic back pain, yet existing results show promising evidence both for psychotherapy within IMPT and for psychotherapy as a monotherapy. This paper aims at providing an overview of (a) commonly employed cognitive-behavioral psychotherapeutic approaches and strategies in the treatment of chronic pain, and (b) the existing empirical evidence of pain psychotherapy both within the framework of IMPT and as a monotherapy. Future research should include a wider range of pain diagnoses and also investigate the potential benefit of individually-tailored treatments.

Prospective study of nocebo effects related to symptoms of idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF).

The exact causes of Idiopathic Environmental Intolerance Attributed to Electromagnetic Fields (IEI-EMF, i.e., experience of somatic symptoms attributed to low-level electromagnetic fields) are still unknown. Psychological causation such as nocebo effects seem plausible. This study aimed to experimentally induce a nocebo effect for somatic symptom perception and examined whether it was reproducible after one week. We also examined whether these effects were associated with increased sympathetic activity and whether interoceptive accuracy (IAcc) moderated these relationships. Participants were recruited from the general population and instructed that electromagnetic exposure can enhance somatosensory perception. They participated twice in a cued exposure experiment with tactile stimulation and sham WiFi exposure in 50% of trials. The two sessions were scheduled one week apart (session 1: N = 65, session 2: N = 63). Before session 1, participants watched either a 6-min film on adverse health effects of EMF or a neutral film on trade of mobile phones. IAcc was assessed with the heartbeat detection paradigm. Electrodermal activity served as a measure of sympathetic activation. Evidence for a nocebo effect (i.e., increased self-reported intensity and aversiveness and electrodermal activity) during sham WiFi exposure was observed in both sessions. IAcc moderated the nocebo effect, depending on stimulus intensity. Contrary to previous findings, no difference emerged between the health-related EMF and the neutral films. Based on negative instructions, somatic perception and physiological responding can be altered. This is consistent with the assumption that IEI-EMF could be due to nocebo effects, suggesting an important role for psychological interventions.

Somatic Symptom Perception From a Predictive Processing Perspective: An Empirical Test Using the Thermal Grill Illusion.

OBJECTIVE: In a predictive processing perspective, symptom perceptions result from an integration of preexisting information in memory with sensory input. Physical symptoms can therefore reflect the relative predominance of either sensory input or preexisting information. In this study, we used the thermal grill illusion (TGI), which applies interlaced warm and cool temperatures to the skin to create a paradoxical heat-pain experience. Assuming that the TGI compared with single-temperature stimulation relies more importantly on an active integration process of the brain to create this paradoxical sensation, we tested the hypothesis whether a manipulation of the expectations during TGI would have more impact than during single-temperature stimulation. METHODS: Sixty-four participants received different temperature combinations (16/16°C, 40/40°C, 16/40°C) with neutral, positive ("placebo"), and negative ("nocebo") instructions. Subjective stimulus intensity was rated, and neuroticism and absorption (openness to absorbing and self-altering experiences) served as potential moderating factors. RESULTS: The TGI condition was rated highest. Overall, negative instructions increased (p < .001, d = 0.58), whereas positive instructions did not significantly change the TGI intensity perception (versus neutral; p = .144, d = 0.19). In the TGI condition, increased modulation of pain was observed with higher neuroticism (ß = 0.33, p = .005) and absorption (ß = 0.30, p = .010). CONCLUSIONS: Whereas negative instructions induced a nocebo effect, no placebo effect emerged after positive instructions. The findings are in line with the predictive processing model of symptom perception for participants with higher levels of neuroticism and absorption.

Determination of psychosocial factors in cluster headache - construction and psychometric properties of the Cluster Headache Scales (CHS).

BACKGROUND: Cluster headache (CH) is clinically associated with considerable psychosocial burden. However, instruments to assess and characterize psychosocial factors in cluster headache more specifically are lacking. This study aimed to develop a self-report questionnaire, which assesses the broadest possible spectrum of psychosocial factors in cluster headache, the Cluster Headache Scales (CHS). METHOD: Items of the Cluster Headache Scales were constructed based on a literature review and semi-structured interviews with several experts (including persons with cluster headache). A cross-sectional online survey was conducted to determine the psychometric properties and the factor structure of the Cluster Headache Scales. Data was analyzed using exploratory factor analysis as well as exploratory structural equation modelling (ESEM). RESULTS: In total, n = 342 subjects with cluster headache (mean age 47.8, 63% male, 51% with episodic cluster headache) were included. Factor analysis yielded eight clearly interpretable factors: Medical care, medication side effects, fear of attacks, disability, (auto)aggression, coping, physical activity, and financial burden, which are assessed via 36 items. The internal consistencies of the subscales were acceptable to excellent and ranged between Cronbach's alpha = .76 and .93. The pattern of correlations with related instruments provides first evidence for convergent validity. CONCLUSION: The CHS represents a reliable and valid self-report instrument for the assessment of psychosocial factors in persons with cluster headache, which appears useful for both clinical practice as well as research.Trial registration: The study was registered at the German Clinical Trials Register (www.drks.de, ID-Number: DRKS00016502).

Behavioral and electrodermal data on implicit nocebo conditioning using supraliminally presented visual stimuli.

This article contains intensity and aversiveness ratings of electrical stimuli and data on electrodermal activity (skin conductance level and skin conductance response) during an implicit conditioning procedure. Further, answers from a questionnaire on contingency awareness are provided. The experiment consisted of three phases. In the acquisition, two types of visual stimuli (CS+ and CS-) were coupled to weakly and moderately painful electrical stimuli presented to the participants' (N = 48) dominant hand. In the test phase, after both CS+ and CS- only the weakly painful electrical stimuli were presented. In the contingency test phase, no more electrical stimuli were presented and participants had the task to rate intensity and aversiveness as if an electrical stimulus had been presented. This phase served as a test for first-order contingency awareness. Afterwards participants filled in a questionnaire with five questions to assess their level of second-order contingency awareness. For more insight, please see Nocebo hyperalgesia induced by implicit conditioning (Bräscher and Witthöft, 2019).

The role of hedonics in the Human Affectome.

Experiencing pleasure and displeasure is a fundamental part of life. Hedonics guide behavior, affect decision-making, induce learning, and much more. As the positive and negative valence of feelings, hedonics are core processes that accompany emotion, motivation, and bodily states. Here, the affective neuroscience of pleasure and displeasure that has largely focused on the investigation of reward and pain processing, is reviewed. We describe the neurobiological systems of hedonics and factors that modulate hedonic experiences (e.g., cognition, learning, sensory input). Further, we review maladaptive and adaptive pleasure and displeasure functions in mental disorders and well-being, as well as the experience of aesthetics. As a centerpiece of the Human Affectome Project, language used to express pleasure and displeasure was also analyzed, and showed that most of these analyzed words overlap with expressions of emotions, actions, and bodily states. Our review shows that hedonics are typically investigated as processes that accompany other functions, but the mechanisms of hedonics (as core processes) have not been fully elucidated.

Nocebo hyperalgesia induced by implicit conditioning.

BACKGROUND AND OBJECTIVES: Nocebo hyperalgesia (i.e., increased pain sensitivity based on expectations) can be induced by conditioning, but is supposed to be mediated by conscious expectation. Although recent evidence points to the feasibility of subliminal conditioning of nocebo hyperalgesia with masked faces, face processing might be a special case and the practical implications of subliminal conditioning remain questionable. This study aimed to implicitly condition nocebo hyperalgesia using supraliminal cues. METHODS: Implicit differential nocebo conditioning (N = 48 healthy participants) was implemented by coupling high and low painful electric stimuli to varying visual stimuli that only differed in the symmetry/asymmetry of one component (CS+/CS-) and contained further distracting components. In the test phase, only the low painful stimulus followed both CS to test for conditioned nocebo effects in intensity and aversiveness ratings and electrodermal activity. A behavioral contingency test and a post-experimental questionnaire assessed contingency awareness. RESULTS: A conditioned effect emerged in the aversiveness (p = .036; η2 = 0.09), but not in the intensity rating (p = .195) while controlling for contingency awareness. Further, increased skin conductance levels in response to CS + emerged, irrespective of contingency awareness (p = .014, η2 = 0.13). No conditioned responses in skin conductance responses emerged (p = .872). LIMITATIONS: Expected effects only emerged in part of the outcome variables. CONCLUSIONS: The results support the notion that implicit conditioning of nocebo hypoalgesia is feasible using a novel experimental conditioning design with supraliminal stimulus presentation, although further research is needed. So far, implicitly conditioned nocebo effects might have been underestimated despite vast clinical implications.

[Placebo Responses in Chronic Pain: State of Research and Clinical Implications]. / Placeboeffekte bei chronischen Schmerzen: Forschungsstand und klinische Anwendung.

Placebo hypoalgesia has been found to play an important role in every health care by modulating patients' responses to pharmacologically active analgesic treatments. It may be seen as reflecting the capacity for endogenous pain modulation. Enhancing the efficacy of analgesic treatments by boosting endogenous pain modulation might be particularly relevant for chronic pain patients. Research into placebo hypoalgesic responses to chronic pain is sparse, however. In healthy subjects, placebo hypoalgesia is induced by expectations of pain relief through verbal information and learning experiences. Here we review the existing evidence on placebo hypoalgesia to chronic pain. To our knowledge, placebo hypoalgesia to chronic pain has been investigated experimentally in chronic back and chronic musculoskeletal pain, neuropathic pain after thoracotomy, and episodic migraine. Results point towards a maintenance of placebo hypoalgesic responses in chronic pain populations, thus highlighting the potential benefit of boosting placebo hypoalgesic responses in the treatment of chronic pain. Strategies on boosting placebo hypoalgesic responses in every day healthcare are presented.