Binge-eating adolescent treatment (BEAT) - findings from a pilot study on effects and acceptance of a blended treatment program for youth with loss of control eating.

BACKGROUND: Loss of Control Eating (LOC) is the most prevalent form of eating disorder pathology in youth, but research on evidence-based treatment in this group remains scarce. We assessed for the first time the effects and acceptance of a blended treatment program for youth between 14 and 24 years with LOC (Binge-eating Adolescent Treatment, BEAT). METHODS: Twenty-four youths (mean age 19.1 years) participated in an active treatment of nine-weeks including three face-to-face workshops and six weekly email-guided self-help sessions, followed by four email guided follow-up sessions, one, three, six and 12 months after the active treatment. All patients completed a two-weeks waiting-time period before treatment begin (within-subject waitlist control design). RESULTS: The number of weekly LOC episodes substantially decreased during both the waiting-time (effect size d = 0.45) and the active treatment (d = 1.01) period and remained stable during the subsequent 12-months follow-up (d = 0.20). The proportion of patients with full-threshold binge-eating disorder (BED) diagnoses decreased and transformed into LOC during the study course, while the abstainer rate of LOC increased. Values for depressive symptoms (d = 1.5), eating disorder pathology (d = 1.29) and appearance-based rejection sensitivity (d = 0.68) all improved on average from pretreatment to posttreatment and remained stable or further improved during follow-up (d between 0.11 and 0.85). Body weight in contrast remained constant within the same period. Treatment satisfaction among completers was high, but so was the dropout rate of 45.8% at the end of the 12-months follow-up. CONCLUSIONS: This first blended treatment study BEAT might be well suited to decrease core symptoms of LOC, depressive symptoms and appearance-based rejection sensitivity. More research is needed to establish readily accessible interventions targeted more profoundly at age-salient maintaining factors such as appearance-based rejection sensitivity, while at the same time keeping dropout rates at a low level. TRIAL REGISTRATION: The trial was registered at the German Clinical Trials Register (ID: DRKS00014580; registration date: 21/06/2018).

Attention to faces in images is associated with personality and psychopathology.

Humans show a robust tendency to look at faces in images, but also differ consistently in the strength of this attentional preference. Previous research remained inconclusive as to how a stronger face preference may be indicative of an individual's personality or clinical characteristics. Here we investigated face preferences in 120 participants (primarily drawn from a student population) who freely viewed photos in an internet browser showing a person in the context of a visually rich environment while attention was assessed using a cursor-based technique. Participants differed consistently in the strength of their face preference across images. A stronger preference for faces was correlated positively with openness to experience, extraversion, agreeableness and empathizing and was correlated negatively with social anxiety, depression levels and alexithymia. Trait measures were linked through a strong common factor which was additionally correlated with face preference. We conclude that face preferences may be linked to personality traits and to psychopathology but that an attribution to a specific facet of psychopathology may not be warranted. Future research should investigate links between face preferences and personality features in more diverse samples and across differing social situations.

Correlates of interpersonal emotion regulation problems in Loss of Control eating (LOC) in youth: study protocol of the combined online and App based questionnaire, laboratory and randomized controlled online intervention i-BEAT trial.

BACKGROUND: Binge Eating Disorder (BED) represents a common eating disorder associated with marked health impairments. A subclinical variant, loss of control eating (LOC) is prevalent in youth. LOC is associated with similar mental distress as full-blown BED, increases the risk to develop a BED and promotes continuous weight gain. The etiology of LOC is not yet fully understood and specialized treatment for youth is scarce. METHODS: The i-BEAT study includes a cross-sectional and longitudinal online questionnaire study (N = 600), an App based daily-life approach and a laboratory virtual reality study in N = 60 youths (14-24 years) with and without LOC as well as a controlled randomized online treatment trial to investigate the feasibility, acceptance and efficacy of a CBT and an interpersonal emotion regulation module for youth (N = 120). The primary outcomes include self-reported as well as measured (heart rate variability, gaze behavior, reaction times in stop signal task) associations between emotion regulation problems (such as dealing with RS), psychological impairment and binge eating in a healthy control group and youth with LOC. Secondary outcomes encompass general eating disorder pathology, social anxiety, body mass index, hyperscanning behavior and therapists' rating of patients' condition pre and post treatment. Epigenetic correlates of RS are assessed in healthy controls and youth with LOC and explored before and after treatment. DISCUSSION: The expected findings will specify the role of interpersonal emotion regulation problems such as coping with the experience of social exclusion and rejection sensitivity (RS) in LOC and clarify, whether including a training to cope with RS adds to the efficacy of a cognitive behavioral treatment (CBT). TRIAL REGISTRATION: German Clinical Trial Register: DRKS00023706. Registered 27 November 2020, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00023706.

The Lausanne Infant Crying Stress Paradigm: Validation of an Early Postpartum Stress Paradigm with Women at Low vs. High Risk of Childbirth-Related Posttraumatic Stress Disorder.

Stress reactivity is typically investigated in laboratory settings, which is inadequate for mothers in maternity settings. This study aimed at validating the Lausanne Infant Crying Stress Paradigm (LICSP) as a new psychosocial stress paradigm eliciting psychophysiological stress reactivity in early postpartum mothers (n = 52) and to compare stress reactivity in women at low (n = 28) vs. high risk (n = 24) of childbirth-related posttraumatic stress disorder (CB-PTSD). Stress reactivity was assessed at pre-, peri-, and post-stress levels through salivary cortisol, heart rate variability (high-frequency (HF) power, low-frequency (LF) power, and LF/HF ratio), and perceived stress via a visual analog scale. Significant time effects were observed for all stress reactivity outcomes in the total sample (all p < 0.01). When adjusting for perceived life threat for the infant during childbirth, high-risk mothers reported higher perceived stress (p < 0.001, d = 0.91) and had lower salivary cortisol release (p = 0.023, d = 0.53), lower LF/HF ratio (p < 0.001, d = 0.93), and marginally higher HF power (p = 0.07, d = 0.53) than low-risk women. In conclusion, the LICSP induces subjective stress and autonomic nervous system (ANS) reactivity in maternity settings. High-risk mothers showed higher perceived stress and altered ANS and hypothalamic-pituitary-adrenal reactivity when adjusting for infant life threat. Ultimately, the LICSP could stimulate (CB-)PTSD research.

Stronger reactivity to social gaze in virtual reality compared to a classical laboratory environment.

People show a robust tendency to gaze at other human beings when viewing images or videos, but were also found to relatively avoid gaze at others in several real-world situations. This discrepancy, along with theoretical considerations, spawned doubts about the appropriateness of classical laboratory-based experimental paradigms in social attention research. Several researchers instead suggested the use of immersive virtual scenarios in eliciting and measuring naturalistic attentional patterns, but the field, struggling with methodological challenges, still needs to establish the advantages of this approach. Here, we show using eye-tracking in a complex social scenario displayed in virtual reality that participants show enhanced attention towards the face of an avatar at near distance and demonstrate an increased reactivity towards her social gaze as compared to participants who viewed the same scene on a computer monitor. The present study suggests that reactive virtual agents observed in immersive virtual reality can elicit natural modes of information processing and can help to conduct ecologically more valid experiments while maintaining high experimental control.

Education and Training in Clinical Psychology and Psychological Psychotherapy in Switzerland.

Switzerland offers Education in Clinical Psychology in the German and French language and training in Psychotherapy in German, French and Italian. Both education and training are structured along centralized guidelines and recognized at a federal level. After finishing one's studies, becoming a Psychological Psychotherapist requires between two and six years of postgraduate training and a financial investment of tens of thousands of Swiss Francs. Historically, it is quite common for Swiss psychotherapy trainings to incorporate a mix or combination of several psychotherapy schools such as cognitive behavioral, psychodynamic, systemic and humanistic. Foreign degrees obtained in EU countries are generally recognized, and the fulfillment of criteria is evaluated on an individual basis. Graduates find a diverse job market with opportunities to work in clinics and psychotherapeutical practices, but the absence of direct reimbursement via mandatory health insurance plans for psychological psychotherapists (not psychiatrists) lead many to work on patients' private payments or as a psychiatrist's employee. The ordering model, a potential new regulation allowing for the direct reimbursement of psychological psychotherapists' work, is planned to be decided upon throughout 2020.

Years of life lost estimates cannot always be taken at face value: Response to "COVID-19 - exploring the implications of long-term condition type and extent of multimorbidity on years of life lost: a modelling study".

In their recent analysis, Hanlon et al. set out to estimate the years of life lost (YLL) in people who have died with COVID-19 by following and expanding on the WHO standard approach. We welcome this research as an attempt to draw a more accurate picture of the mortality burden of this disease which has been involved in the deaths of more than 300,000 people worldwide as of May 2020. However, we argue that obtained YLL estimates (13 years for men and 11 years for women) are interpreted in a misleading way. Even with the presented efforts to control for the role of multimorbidity in COVID-19 deaths, these estimates cannot be interpreted to imply "how long someone who died from COVID-19 might otherwise have been expected to live". By example we analyze the underlying problem of data selection bias which, in the context of COVID-19, renders such an interpretation of YLL estimates impossible, and outline potential approaches to control for the problem.

Social anxiety modulates visual exploration in real life - but not in the laboratory.

In clinical reports, individuals high on social anxiety are often described to avoid gaze at other people, whereas several experimental studies employing images of persons yielded conflicting results. Here, we show that gaze avoidance crucially depends on the possibility of social interactions. We examined gaze behaviour in individuals with varying degrees of social anxiety in real-life and in a second group of participants using a closely matched laboratory condition. In the real-life situation, individuals with a higher degree of social anxiety had a reduced bias to look at near persons compared to individuals with a lower degree of social anxiety, while gaze behaviour in the laboratory group was not modulated by social anxiety. This effect was specific to social attention since there was no corresponding effect regarding fixations on objects. The presence of anxiety effects in real-life but not in the laboratory condition, where participants do not expect to be evaluated by gazed-at conspecifics, points to critical deficits of current laboratory research paradigms in eliciting authentic social attentional mechanisms, possibly leading to spurious results.

[E-Therapies for Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder]. / e-Therapien bei Anorexia nervosa, Bulimia nervosa und Binge-Eating-Störung.

E-Therapies for Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder Abstract. Eating disorders can often be treated with psychotherapy, but mostly due to a lack of trained clinicians, the majority of the persons concerned do not receive any treatment. In recent years, internet-based psychotherapy (e-therapy) was proposed and tested in several pilot projects as a novel possibility to offer a larger number of places on a treatment program with a constant number of available clinicians. Recent results are promising, but before an implementation into standard care can take place, more detailed knowledge must be provided as to which patients may be recommended this type of therapy as an equivalent alternative to traditional face-to-face therapy.

Visuo-tactile congruency influences the body schema during full body ownership illusion.

Previous research showed that full body ownership illusions in virtual reality (VR) can be robustly induced by providing congruent visual stimulation, and that congruent tactile experiences provide a dispensable extension to an already established phenomenon. Here we show that visuo-tactile congruency indeed does not add to already high measures for body ownership on explicit measures, but does modulate movement behavior when walking in the laboratory. Specifically, participants who took ownership over a more corpulent virtual body with intact visuo-tactile congruency increased safety distances towards the laboratory's walls compared to participants who experienced the same illusion with deteriorated visuo-tactile congruency. This effect is in line with the body schema more readily adapting to a more corpulent body after receiving congruent tactile information. We conclude that the action-oriented, unconscious body schema relies more heavily on tactile information compared to more explicit aspects of body ownership.

Artificial Faces Predict Gaze Allocation in Complex Dynamic Scenes.

Both low-level physical saliency and social information, as presented by human heads or bodies, are known to drive gaze behavior in free-viewing tasks. Researchers have previously made use of a great variety of face stimuli, ranging from photographs of real humans to schematic faces, frequently without systematically differentiating between the two. In the current study, we used a Generalized Linear Mixed Model (GLMM) approach to investigate to what extent schematic artificial faces can predict gaze when they are presented alone or in competition with real human faces. Relative differences in predictive power became apparent, while GLMMs suggest substantial effects for real and artificial faces in all conditions. Artificial faces were accordingly less predictive than real human faces but still contributed significantly to gaze allocation. These results help to further our understanding of how social information guides gaze in complex naturalistic scenes.

Social content and emotional valence modulate gaze fixations in dynamic scenes.

Previous research has shown that low-level visual features (i.e., low-level visual saliency) as well as socially relevant information predict gaze allocation in free viewing conditions. However, these studies mainly used static and highly controlled stimulus material, thus revealing little about the robustness of attentional processes across diverging situations. Secondly, the influence of affective stimulus characteristics on visual exploration patterns remains poorly understood. Participants in the present study freely viewed a set of naturalistic, contextually rich video clips from a variety of settings that were capable of eliciting different moods. Using recordings of eye movements, we quantified to what degree social information, emotional valence and low-level visual features influenced gaze allocation using generalized linear mixed models. We found substantial and similarly large regression weights for low-level saliency and social information, affirming the importance of both predictor classes under ecologically more valid dynamic stimulation conditions. Differences in predictor strength between individuals were large and highly stable across videos. Additionally, low-level saliency was less important for fixation selection in videos containing persons than in videos not containing persons, and less important for videos perceived as negative. We discuss the generalizability of these findings and the feasibility of applying this research paradigm to patient groups.

DJINNI: A Novel Technology Supported Exposure Therapy Paradigm for SAD Combining Virtual Reality and Augmented Reality.

The present paper explores the benefits and the capabilities of various emerging state-of-the-art interactive 3D and Internet of Things technologies and investigates how these technologies can be exploited to develop a more effective technology supported exposure therapy solution for social anxiety disorder. "DJINNI" is a conceptual design of an in vivo augmented reality (AR) exposure therapy mobile support system that exploits several capturing technologies and integrates the patient's state and situation by vision-based, audio-based, and physiology-based analysis as well as by indoor/outdoor localization techniques. DJINNI also comprises an innovative virtual reality exposure therapy system that is adaptive and customizable to the demands of the in vivo experience and therapeutic progress. DJINNI follows a gamification approach where rewards and achievements are utilized to motivate the patient to progress in her/his treatment. The current paper reviews the state of the art of technologies needed for such a solution and recommends how these technologies could be integrated in the development of an individually tailored and yet feasible and effective AR/virtual reality-based exposure therapy. Finally, the paper outlines how DJINNI could be part of classical cognitive behavioral treatment and how to validate such a setup.