Structural neuroimaging of skin-picking disorder.

BACKGROUND: Skin-picking disorder (SPD) is conceptualized as an obsessive-compulsive and related disorder (OCRD). Patients with SPD excessively manipulate their skin, which leads to skin lesions, psychological distress, and functional impairment. The neuroanatomical facets of this disorder are still poorly understood. METHODS: A total of 220 participants (123 patients with a primary diagnosis of SPD and 97 healthy controls; mean age = 30 years, 80% female) were recruited for a voxel-based morphometry (VBM) study. VBM data were compared between patients and controls, and between three SPD subgroups, each characterized by a distinct age of symptom onset (before puberty, during puberty, adulthood). RESULTS: Relative to the healthy comparison group, patients with SPD had significantly less grey matter volume (GMV) in regions of interest (ROIs: insula, orbitofrontal cortex, pallidum, cerebellum, supramarginal gyrus) and in the frontal pole and occipital regions (whole-brain findings). Early onset of symptoms (before puberty) was associated with elevated levels of focused skin-picking, in addition to less GMV in specific ROIs (insula, orbitofrontal cortex) as well as in paracingulate/ superior temporal regions (whole-brain findings). CONCLUSIONS: SPD-related reductions in GMV were identified in brain regions involved in interoception, emotion regulation, and motor control. This partially aligns with findings for OCD. The detection of different age-of-onset groups based on clinical as well as morphometric data points to the heterogeneity of the disorder and warrants further investigation.

The pill you don't have to take that is still effective: neural correlates of imaginary placebo intake for regulating disgust.

A commonly established protocol for the administration of open-label placebos (OLPs)-placebos honestly prescribed-emphasizes the necessity of ingesting the pill for the placebo effect to manifest. The current functional magnetic resonance imaging study used a novel approach to OLP administration: the imaginary intake of an OLP pill for regulating disgust. A total of 99 females were randomly allocated to one of three groups that either swallowed a placebo pill (OLP Pill), imagined the intake of a placebo pill (Imaginary Pill) or passively viewed (PV) repulsive and neutral images. The imaginary pill reduced reported disgust more effectively than the OLP pill and was also perceived as a more plausible method to reduce emotional distress. Relative to the OLP pill, the imaginary pill lowered neural activity in a region of interest involved in disgust processing: the pallidum. No significant differences in brain activation were found when comparing the OLP pill with PV. These findings highlight that imagining the intake of an OLP emerged as a superior method for regulating feelings of disgust compared to the actual ingestion of a placebo pill. The study's innovative approach sheds new light on the potential of placebo interventions in emotion regulation.

Cookie cravings - Examining the impact of sugar content information on Christmas treat preferences via mobile eye-tracking.

BACKGROUND: Diets high in added sugar can promote the development of overweight. Especially during the Holiday season, when high-sugar food is abundant, people overeat and gain more weight than during other times of the year. The present study with mobile eye-tracking glasses (Pupil Labs Invisible) investigated how sugar content information affects food preference (liking/wanting) and visual attention (where and how long one is looking) in a buffet-like situation. METHODS: Fifty-eight participants who were well acquainted with the local Christmas traditions and foods (38 female, 19 male, one diverse; mean age = 25 years, SD = 6.3 years; mean body mass index = 22.2 kg/m2, SD = 3.2 kg/m2) were presented with four cookies and two non-food items (wrapped presents) in a free viewing task. Two of the displayed cookies were 'Christmas cookies' (cookies that are traditionally eaten only during the Holiday season) and two cookies had no Christmas association. The cookies were either labeled as cookies made with or without sugar, resulting in a 3 (Category: cookies with sugar, cookies without sugar, non-food) by 2 (Christmas association: yes, no) repeated-measures design. RESULTS: Analyses of variance indicated that participants reported higher wanting and liking for cookies with sugar, particularly Christmas cookies (interaction effect for wanting: p = .047, ηp2 = .059; interaction effect for liking: p = .017, ηp2 = .084). Sugar-free cookies were fixated more often (p = .028; d = 0.35) and shorter (p < .001; d = 0.64) than sugar cookies. CONCLUSION: Assuming that cookies are sugar-free reduced the reported preference for this product, which was associated with a more detail-oriented (critical) viewing pattern. The study's findings have potential implications for public health and can aid in developing targeted interventions to promote healthier food choices during festive periods. The new strategies should not focus on the sugar content of foods.

Would You Take an Open-Label Placebo Pill or Give One to Your Child? Findings from a Cross-Sectional Survey.

Background: Open-label placebos (OLPs), honestly prescribed regarding their inert nature, have been associated with positive health-related effects in both children and adults. However, OLPs are not always perceived by laypeople as a viable treatment option. Methods: A brief online survey with 806 adult participants (age range: 18-75 years; 29% parents) was conducted to identify predictor variables that are associated with the willingness to take an OLP pill (criterion 1) or to give an OLP to one's child (criterion 2). The survey covered aspects including the perceived plausibility of the treatment concept for both OLPs and deceptive placebos (DPs), self-reported knowledge about placebos, the expected effectiveness of OLPs in treating emotional/ somatic problems, and attitudes concerning taking pills in general. Multiple hierarchical regressions were carried out. Results: The expected effectiveness of OLPs in alleviating both emotional and physical ailments and the plausibility of the treatment concepts for both OLPs and DPs significantly predicted the willingness to use OLPs (R2 = 0.485). A similar finding was observed when predicting the willingness to administer an OLP to one's child (R2 = 0.443). Conclusion: Favorable expectations regarding the reduction of emotional and somatic symptoms with OLPs, along with a strong belief in the credibility of placebo mechanisms, play a vital role in influencing the willingness to accept this kind of treatment. These factors can be incorporated into psychoeducational programs.

Consequences of positive vs. negative information concerning the amount of sugar consumption on appetite, mood, and visual food cue attention: Findings from two online interventions.

BACKGROUND: Eating too much sugar is associated with many negative health effects. Two brief online interventions were carried out to investigate whether information about the negative consequences of eating high-sugar food vs. positive consequences of eating low-sugar food can change reported appetite, mood, and visual food cue attention. METHOD: For Study I, participants (n = 201) were allocated to one of three groups: Two groups were asked to list either the negative consequences of high-sugar consumption (negative focus) or the positive consequences of low-sugar consumption (positive focus). The third group carried out a control task (writing a shopping list). For Study II, 200 participants took part in a quiz with questions focusing on either positive, negative, or neutral consequences of high vs. low sugar consumption. Participants evaluated their appetite and mood before and after all interventions (list, quiz) and additionally completed a visual probe task with images depicting high vs. low-sugar food. RESULTS: In Study I, the positive focus increased appetite for low-sugar food. The negative focus reduced participants' positive mood but did not change reported appetite. In Study II, all quiz conditions decreased appetite for high-sugar foods but did not affect mood. None of the interventions influenced visual attention to the food images. CONCLUSION: Focusing on negative consequences of a high-sugar diet is less pleasant and is less effective in changing people's appetite than considering the positive aspects of a low-sugar diet. Thus, future interventions should instead spotlight the positive outcomes of a healthy diet.

A positive side effect of wearing face coverings for socially anxious females: Findings from a speech task.

Background: Wearing face masks has become more common due to the COVID-19 pandemic. Until now, it has not been investigated whether socially anxious individuals can reduce their acute anxiety symptoms by wearing face masks during a speech task. Method: Fifty-nine socially anxious females were asked to prepare and give an oral presentation. Participants were randomly allocated either to a group that was asked to wear a face mask during the task, or to a group that was not asked to wear a face mask during the task. Dependent variables included physiological parameters (systolic/diastolic blood pressure, heart rate) and self-reports (valence and arousal at baseline, as well as directly before and after the presentation). Results: The analyses showed that the group without face masks had a higher systolic blood pressure than the group with face masks, directly before as well as after the presentation. The two groups did not differ in the other measures. Conclusion: Wearing face masks has a small stress-reducing effect on socially anxious females.

Atypical cerebellar activity and connectivity during affective touch in adults with skin-picking disorder.

Excessive touching and picking of one's skin are core symptoms of skin-picking disorder (SPD). Previous research has shown that patients with SPD display difficulties in motor control and show altered reward responsivity. Considering the limited knowledge about neuronal mechanisms in SPD, particularly concerning the cerebellum, the analysis focused on this brain region due to its involvement in sensorimotor and affective functions. The participants of the present study received affective (caress-like), which is typically perceived as pleasant and can be passively enjoyed. A total of 132 female participants (70 patients with SPD, 62 healthy controls) received affective and nonaffective touch to their forearms (slow vs. fast brushing) during functional magnetic resonance imaging. This tactile stimulation was rated according to pleasure, arousal, and the urge to pick one's skin. Being touched was perceived as more negative and arousing by the SPD group, and elicited a greater urge to perform skin-picking. During affective touch, those participants with SPD were characterized by reduced activity in lobule VIII, reduced functional connectivity of lobule VIII with the hippocampus, and increased connectivity with the superior parietal lobule. Since VIII is involved in the inhibition of movement, the present findings point to deficient motor control in SPD in the context of affective-sensory processing.

Brain mechanisms for processing caress-like touch in skin-picking disorder.

Skin-picking disorder (SPD) is characterized by repetitive touching and picking of one's skin. The picking is typically experienced as pleasant although this behavior leads to tissue damage. The present functional magnetic resonance imaging (fMRI) study investigated how individuals with SPD react to caress-like touch, which stimulates C-tactile afferents. A standardized touch procedure was used. Seventy females with a primary diagnosis of SPD and 62 healthy females received CT-optimal brushing of their forearms (3 cm/s) and non-optimal brushing (30 cm/s) during an fMRI session. The two types of tactile stimulation were rated according to pleasure, arousal, and urge to pick one's skin. Relative to healthy controls, patients with SPD showed greater activation in parietal regions (supramarginal/angular gyrus) during CT-optimal touch. Moreover, the deactivation of the middle/ inferior frontal cortex displayed by control participants was absent in the SPD group. Being touched was rated as less pleasant, more arousing, and elicited a greater urge to perform skin-picking in participants with SPD. The mentioned frontal and parietal brain regions are sources of attentional control. They are involved in integrating somatosensory information and switching attention between external/internal stimuli. The present study adds to the limited database on the dysfunctional processing of touch in SPD. This study was preregistered on the German Clinical Trials Register (DRKS00022123, June 8th, 2020).

Effects of (non)deceptive placebos on reported sleep quality and food cue reactivity.

A lack of sleep can increase appetite, particularly for high-calorie food. The current study tested the effects of an open-label placebo for improving sleep quality and reducing food cue reactivity. In open-label placebo interventions, placebo recipients are informed that they are receiving a placebo without a pharmacologically active substance. Participants (n = 150) were randomly allocated to one of three groups that received either an open-label placebo to improve sleep quality, a deceptive placebo ("melatonin"), or no placebo. The placebo was administered daily before bedtime for 1 week. Sleep quality and reactivity to high-calorie food cues (appetite, visual attention to food images) were assessed. The deceptive placebo (but not the open-label placebo) reduced reported sleep-onset latency. The open-label placebo decreased perceived sleep efficiency. The placebo interventions did not change food cue reactivity. This study demonstrated that open-label placebos do not present an alternative to deceptive placebos for improving sleep quality. The undesirable open-label placebo effects found warrant further exploration.

(No) Effects of a Self-Kindness Intervention on Self-Esteem and Visual Self-Perception: An Eye-Tracking Investigation on the Time-Course of Self-Face Viewing.

Previous research has suggested a favorable impact of self-kindness on subjective well-being. The present experiment investigated the effects of an app-assisted self-kindness intervention for increasing self-esteem and self-face gaze, and for decreasing depression. We explored self-face processing via a time-course analysis of eye-tracking data. Eighty participants (56 female, 24 male; mean age: 23.2 years) were randomly allocated to one of two intervention groups, each receiving daily instructions to enhance either self-kindness or relaxation (active control). Following a one-week intervention period, both groups reported improved self-esteem (p = .035, ηpart2 = .068) and reduced depression (p < .001, ηpart2 = .17). The duration of self-face gaze increased in both groups (p < .001, ηpart2 = .21). Self-face processing was characterized by an early automatic attention bias toward the self-face, with a subsequent reduction in self-face bias, followed in turn by an attentional self-face reapproach, and then a stable self-face bias. We thus identified a complex temporal pattern of self-face inspection, which was not specifically altered by the intervention. This research sheds light on the potential for app-assisted interventions to positively impact psychological well-being, while also highlighting the complexity of self-face processing dynamics in this context. In the future, we propose the inclusion of personalized self-kindness statements, which may amplify the benefits of these interventions.

Non-Deceptive Placebos Can Promote Acts of Kindness: A Randomized Controlled Trial.

Placebos have often been used to reduce emotional distress but rarely to increase positive feelings. The present study investigated whether a placebo can promote acts of kindness (AoKs) that are associated with emotional well-being. A total of 160 university students were asked to perform an AoK daily for one week. They evaluated their emotional state (feelings of pleasantness, arousal, satisfaction) directly before and after the AoKs. This was monitored via a smartphone app. One group performed each AoK after taking a non-deceptive placebo; the other group received no placebo. Before and after the one-week program, the participants completed three questionnaires that assessed satisfaction with life, positive/negative affect, and flourishing. The participants reported higher pleasantness directly after engaging in an AoK and more satisfaction with life after the program. The motivation to carry out AoKs decreased strongly over the week. However, placebo receivers completed more AoKs than the no-placebo group. The results indicate that placebo treatment can promote the performance of acts of kindness.

A differentiated look at emotions: association between gaze behaviour during the processing of affective videos and emotional granularity.

The ability to distinguish between subtle differences among emotions of similar valence is labelled emotion differentiation (ED). Previous research has demonstrated that people high in ED are less likely to use disengagement regulation strategies (i.e. avoidance/distraction) during negative affective states.The present eye-tracking study examined associations between ED and visual attention/avoidance of affective stimuli. A total of 160 participants viewed emotional video clips (positive/ negative), which were concurrently presented with a non-affective distractor image. After each video, participants verbally described their experienced emotions with adjectives in an open-response format. Moreover, they completed an ED questionnaire.The computed ED specificity index for the negative videos (the number of specific adjectives divided by all adjectives used) was positively associated with the scores on the ED questionnaire and visual revisits for the negative videos (how many times the participants gazed back and forth between video and distractor). This viewing style might reflect more active exploratory behaviour directed toward acquiring information about the negative stimulus and its context. The ED measures were not associated with the gaze behaviour for positive videos.

Reduction of Pathological Skin-Picking Via Expressive Writing: A Randomized Controlled Trial.

Background: Expressive writing (EW: a personal form of writing about emotional distress, without regard to writing conventions) can improve physical and mental health. The present study investigated whether EW can reduce pathological skin-picking. In addition, the effects of two modalities of writing were contrasted with each other: computer vs. paper/pencil. Method: A total of 132 females with self-reported pathological skin-picking participated in a two-week intervention. They either carried out six EW sessions or wrote about six abstract paintings (control condition), using either paper/pencil or a computer. Before and after each session, participants rated their affective state and the urge to pick their skin via a smartphone application. Questionnaires for assessing skin-picking severity were completed before and after the two-week intervention. Results: The urge for skin-picking decreased directly after a writing session. The reduction was more pronounced in participants of the EW group, who also experienced reduced tension and increased feelings of relief at the end of a writing session. EW also reduced the severity of focused skin-picking after the two-week intervention. The writing modality had no differential effect on skin-picking symptoms. Conclusions: This study identified beneficial effects of EW on pathological skin-picking. A future study could investigate EW as a potential tool in the context of (online) psychotherapy for skin-picking disorder.

Evaluation of Affective Touch: A Comparison Between Two Groups of Younger and Older Females.

BACKGROUND: Caress-like touch activates C-tactile (CT) afferents present in the skin of humans. It is generally assumed that this type of touch provides beneficial effects throughout the lifespan. However, little is known about its processing in later adulthood. Moreover, emotional responses to interpersonal vs. self-touch have not been investigated in older adults. METHOD: A total of 132 females from two age groups (older: 60-96 years; younger: 18-30) participated in a well-validated method of tactile stimulation, in which CT-optimal vs. nonoptimal soft brushing (3 cm/s vs. 30 cm/s) was administered on the forearms of the participants, once by a female experimenter and once by the participant themselves. All participants rated their affective state in each of the conditions and tactile acuity was assessed. RESULTS: Relative to the younger group, older participants rated touch as more pleasant, independent of type (CT-optimal, non-optimal) and origin (experimenter, self). In the older group, the emotional differentiation of CT-optimal vs. non-optimal touch was reduced, which was associated with reduced tactile acuity. CONCLUSION: This study revealed an age-dependent enhancement of the perceived pleasantness of (self)touch. Interventions with auditory-guided CT-optimal self-touch could be easily implemented as part of training programs for older adults.

A randomized trial that compared brain activity, efficacy and plausibility of open-label placebo treatment and cognitive repappraisal for reducing emotional distress.

Placebo pills can reduce emotional distress even when recipients have been informed about the inert nature of the treatment. However, before such open-label placebos (OLPs) can be recommended for general clinical use, their efficacy and acceptability need to be further investigated and compared with established methods for emotion regulation, such as cognitive reappraisal (CR). The current study with functional magnetic resonance imaging compared the effects of an OLP pill with CR for reducing a specific form of emotional distress: disgust. Participants (150 healthy females) were randomly allocated to one of three groups, all of which were exposed to disgusting and neutral images (OLP, CR, PV: passive viewing). It was tested whether the three groups would differ in brain activity and reported disgust. Ratings for the perceived efficacy and plausibility of treatment were also compared between OLP and CR. Both OLP and CR increased the activity in a cognitive control region, the ventrolateral prefrontal cortex. Relative to PV and OLP, CR reduced activity in the putamen and pallidum. These regions play an important role in decoding disgust signals from different modalities. Self-reports indicated that CR was perceived as a more effective and plausible intervention strategy than OLP. In conclusion, CR was a superior method for disgust regulation compared to OLP, both on the subjective as well as the neurobiological level. Future OLP studies are needed to test whether the observed effects generalize to other forms of emotional distress.

Open-label placebo treatment for reducing overeating in children: A study protocol for a randomized clinical trial with an app-assisted approach.

Food advertising has become almost ubiquitous in Western societies. In adults as well as in children this omnipresence of food cues has been shown to trigger cravings and overeating, which can lead to overweight or even obesity. This is concerning because obesity is a leading cause of preventable diseases. The planned project aims at reducing craving and overeating in overweight/obese children using a placebo treatment. A total of 80 children (40 girls, 40 boys; aged between 8 and 12 years; body mass index >90th percentile) will take part in the study. A randomized controlled cross-over design will be implemented, which will include four weeks with daily placebo treatment and four weeks without placebo treatment. The placebo will be introduced without deception as an open-label placebo (OLP), that can help to control food cravings. The study will use an app-assisted approach: The children will rate the intensity of their cravings, the occurrence of binge-eating episodes, their emotional state, and placebo usage via a smartphone application. It is expected that the OLP will help the children to reduce cravings and body weight. If effective, this OLP approach could be implemented in weight-control programs for children.

Taking Placebos as Needed to Reduce Appetite: A Randomized Controlled Trial with Ecological Momentary Assessment.

Placebos can reduce appetite. However, when placebos are prescribed over a longer period of time, compliance and response rates are not always satisfactory. A new administration approach 'as needed' was tested to improve adherence to placebo treatment and its effectiveness. Participants could decide on the time of placebo intake (when their appetite had increased substantially). A randomized controlled trial was conducted over seven days. The participants were allocated to one of two groups: a placebo group (PG; n = 41) or a control group with no placebo treatment (CG; n = 34). During the intervention, participants used a mobile phone application to rate their daily appetite, mood, and the occurrence of binge-eating episodes in their normal environment. The placebo effect was short-lived; the placebo reduced self-reported appetite only on days 1 and 2 of the trial. The placebo neither influenced mood nor binge-eating frequency. This study found an app-assisted approach with continuous monitoring to be helpful for identifying the temporal course of the placebo response. Future placebo trials should implement this method.

Changes in food cue reactivity through affective and nonaffective touch: An event-related potential study.

Affective touch (gentle/slow brushing of the skin) can facilitate the allocation of processing resources to simultaneously present stimuli from different modalities. The present event-related potential (ERP) study investigated whether affective touch can enhance attention to visual cues of healthy food. Female participants (n = 117) were randomly assigned to three different groups that either received affective touch, nonaffective touch (fast brushing of the skin), or no touch during the presentation of pictures of healthy food (fruits and vegetables) and non-food. Electrocortical markers of motivated attention (frontal/parietal P300, late positive potential: LPP) and reported appetite for the depicted food items were compared between the three groups. Nonaffective touch was associated with reduced amplitudes of the frontal P300/LPP (300-1000 ms) for food pictures indexing reduced motivated attention. Affective touch did not influence food cue reactivity (P300/LPP, appetite). Effects of affective touch may be restricted to specific stimuli, e.g. those with social relevance.

Olfactory imagery as a retrieval method for autobiographical memories.

INTRODUCTION: The retrieval of autobiographical memories is influenced by several factors, such as sensory modality and the emotional salience of memory cues. This study aimed at investigating the interaction between sensory modalities (olfaction, vision) and emotional dimensions (valence, arousal) of imagery cues, on the frequency, quality, and age distribution of the autobiographical memories (AMs) elicited. METHOD: A total of 296 females (aged between 18 and 35 years) received one out of eight brief instructions for olfactory or visual imagery. The participants were asked to create a mental image with either high arousal/positive valence, high arousal/negative valence, low arousal/positive valence, or low arousal/negative valence (e.g., 'imagine an unpleasant and arousing odor/scene'); no specific stimulus was mentioned in the instruction. RESULTS: The approach used elicited imagery with autobiographical content in the majority of participants (78%). In terms of frequency, odor imagery, compared to visual imagery, turned out to be more effective at retrieving either unpleasant memories associated with experiences in adulthood, or pleasant childhood memories. In terms of quality, the imagery was rated as less vivid in the olfactory compared to the visual condition (irrespective of valence and arousal of the imagery instruction). Visual imagery was associated with the experience of more diverse emotions (happiness, sadness, anxiety, anger) than odor imagery, which was related primarily with disgust and happiness. CONCLUSION: Our findings indicate that nonspecific imagery induction is a useful approach in accessing AM. IMPLICATION: This approach presents promising clinical applications, such as in working with autobiographical memory narratives in psychotherapy.