Does attentional focus modulate affective information processing in male violent offenders with psychopathic traits?

Antisocial and psychopathic individuals are characterized by a reduced responsivity to affective information. Yet, the role of attentional processes as possible modulator of these deficits is poorly understood. The current study investigated early and late processing of emotional stimuli in a sample of incarcerated offenders while manipulating the attentional focus. Twenty-seven male violent offenders with psychopathic traits and 27 healthy controls completed two experimental tasks while electroencephalography (EEG) data were collected. Task 1 assessed indirect processing of emotional or neutral distractors during a perceptual judgment task, while Task 2 measured direct processing of the emotional or neutral stimuli and required participants to rate the stimuli regarding valence and arousal. EEG data indicated no differences in early stage processing (early posterior negativity) between the experimental groups. However, we found significant group differences with regard to the late processing stage (late positive potential, LPP). Controls showed increased LPP amplitudes in Task 2 as compared to Task 1, indicating that task demands (i.e., attentional focus) had an effect on the processing of the emotional stimuli. In contrast, LPP amplitudes in the violent offender group were largely unaffected by task demands, suggesting specific late alterations in the neural processing of emotional stimuli. In sum, this study provides new evidence for a modulatory impact of attention on affective information processing in male violent offenders with psychopathic traits.

Effects of group affiliation on neural signatures of fairness norm violations in antisocial violent offenders.

While norm-violating behavior in antisocial individuals has been widely studied, little is known about how these people react to unfair behavior directed towards them. Previous research yields inconclusive results with some evidence for rational and strategic behavior in antisocial individuals. Electrophysiological correlates as well as socio-contextual factors such as group affiliation that may inform decision making on fairness considerations have not been investigated in previous studies. This study compared fairness considerations of antisocial violent offenders (N = 25) and controls (N = 26) by using the Ultimatum Game where one player proposes a split of resources and the other player has to respond by accepting or declining the offer. Group affiliation of the proposer (in- vs. out-group) and fairness of offers (fair vs. unfair) were manipulated. We found no difference between groups regarding decision behavior. However, healthy participants showed an electrophysiological response to group affiliation, which was attenuated in the violent offender group. This data suggests intact understanding of social norms in antisocial violent offenders while electrophysiological response pattern may be linked to impaired emotional reactions to expectancy violations.

Believing is achieving - On the role of treatment expectation in neurofeedback applications.

In neurofeedback applications, neural activity is recorded, processed in real-time and fed back to the user in order to facilitate self-regulation of the putative neural mechanisms that underlie cognition and behavior. Numerous studies suggest that neurofeedback interventions are an efficacious treatment particularly for patients with attention-deficit/hyperactivity disorder (ADHD). In recent years, however, findings of several well-controlled studies raised doubts concerning the proposed mechanism of action behind the behavioral effect of neurofeedback. This study investigated the impact of expectation on the efficacy of a sensorimotor rhythm (SMR) training. In a within-subjects design 30 blinded volunteers with ADHD symptoms received a standard SMR training session after inducing no (no-expectancy condition), positive (placebo condition), and negative (nocebo condition) expectations regarding the effectiveness of neurofeedback (by telling them that they would train a specific frequency band that was previously shown to be either unrelated to attention, should improve attention, or interfere with attentional processes). After each training, participants were presented with a cognitive test and subsequently requested to rate their performance on it. We could show that participants were able to successfully modify their EEG signal during training. Further, we found an effect over trainings on objective attentional performance. Most importantly, we found that the expectancy of positive or negative treatment effects considerably changed participants' perception of neurofeedback's efficacy even in the absence of any objective evidence. This study presents strong first evidence for a substantial effect of self-confirming response expectancies as one factor underlying the efficacy of neurofeedback. Future research has to carefully consider the impact of such psychosocial mechanisms when evaluating the (specific) efficacy of neuromodulatory treatments.

Impaired attention toward the eyes in psychopathic offenders: Evidence from an eye tracking study.

Attention orienting to socially salient cues, such as the eyes of interaction partners, is assumed to be crucial for the development of intact social cognition. Dysfunctions in such basic processes that guide the perception of social cues have been suggested to play a role in the development of psychopathy. The present study investigated gaze patterns in two groups of incarcerated psychopathic and non-psychopathic offenders. While recording their eye movements, participants were asked to categorize either gender (task 1) or emotional expression (task 2) of facial images. Psychopaths exhibited significantly reduced attention orienting toward the eyes, as indicated by absolute dwell time as well as frequency of the initial fixation on the eye region. This pattern was evident across all emotional expressions and independent of the task. The present results suggest a pervasive impairment to attention orienting toward the eyes in psychopaths compared to non-psychopathic offenders. This impairment appears to affect not only general attention but also early attention shifts. Thus, our findings provide evidence that these dysfunctions might particularly contribute to the development of psychopathy instead of antisocial behavior per se. Future studies should further examine the origin, emergence, and consequences of these impairments in order to develop targeted interventions.

Investigating social-contextual determinants of cooperation in incarcerated violent offenders.

Antisocial and psychopathic personality traits constitute a severe and treatment resistant form of externalizing psychopathology. While deficits in social information processing have been extensively investigated in these individuals, less is known about their capacity for altruism and cooperation. In particular, no studies to date have investigated whether established social-contextual determinants of cooperation, e.g., group affiliation and number of expected interactions, can motivate cooperative behaviour in antisocial individuals. The present study compared cooperative behaviour of incarcerated violent offenders (N = 52) and controls (N = 46) by using an established social interaction paradigm (Give Some Dilemma) where two players divide monetary units between themselves and the counterpart. Group affiliation (in- vs. out-group) and number of expected interactions (single-trial vs. repeated-trial interactions) were manipulated. Violent offenders as compared to controls shared less monetary units with their counterparts, indicating an overall reduced cooperation. Both groups showed increased cooperation rates towards in-group members and in repeated interactions. Higher psychopathic traits were associated with lower cooperation in single-trial interactions in the violent offender group. Although cooperation was comparably reduced in violent offenders, behaviour in both groups was determined by the number of expected interactions as well as group affiliation, thus providing evidence for equivalent social-contextual determinants.

Neurofeedback, sham neurofeedback, and cognitive-behavioural group therapy in adults with attention-deficit hyperactivity disorder: a triple-blind, randomised, controlled trial.

BACKGROUND: Many studies suggest that electroencephalographic (EEG) neurofeedback might be beneficial in the treatment of attention-deficit hyperactivity disorder (ADHD). However, numbers of well controlled studies are low and neurofeedback techniques are regarded as highly controversial. The present trial examined the efficacy (compared with sham neurofeedback) and efficiency (compared with meta-cognitive therapy) of a standard EEG neurofeedback protocol in adults with ADHD. METHODS: We did a concurrent, triple-blind, randomised, controlled trial using authorised deception in adults with ADHD from one centre (University of Tübingen) in Tübingen, Germany. Participants were eligible if they fulfilled the DSM-IV-TR criteria for ADHD, were aged between 18 years and 60 years, and had no or stable use of medication for at least 2 months with no intention to change. We excluded participants who had comorbid schizophrenia or schizoaffective disorder, bipolar disorder, borderline personality disorder, epilepsy, or traumatic brain injury; substance abuse or dependence; or current or planned other psychological treatment. Those eligible were randomly assigned to three groups: a neurofeedback group which received 30 verum θ-to-ß neurofeedback sessions over 15 weeks, a sham neurofeedback group which received 15 sham followed by 15 verum θ-to-ß neurofeedback sessions over 15 weeks, or a meta-cognitive group therapy group which received 12 sessions over 12 weeks. Participants were assigned equally to one of the three interventions through a computerised minimisation randomisation procedure stratified by sex, age, and baseline symptom severity of ADHD. Participants were masked as to whether they were receiving neurofeedback or sham neurofeedback, but those receiving meta-cognitive therapy were aware of their treatment. Clinical assessors (ie, those assessing outcomes) and research staff who did the neurofeedback training were masked to participants' randomisation status only for neurofeedback and sham neurofeedback. The primary outcome was symptom score on the Conners' adult ADHD rating scale, assessed before treatment, at midtreatment (after 8 weeks), after treatment (after 16 weeks), and 6 months later. All individuals with at least one observation after randomisation were included in the analyses. This trial is registered with ClinicalTrials.gov, number NCT01883765. FINDINGS: Between Feb 1, 2013, and Dec 1, 2015, 761 people were assessed for eligibility. 656 (86%) were excluded and 118 (15%) were eligible for participation in this study. Eligible participants were randomly assigned to neurofeedback (38 [32%]), sham neurofeedback (39 [33%]), or meta-cognitive therapy (41 [35%]). 37 (97%) individuals for neurofeedback, 38 (97%) for sham neurofeedback, and 38 (93%) for meta-cognitive therapy were included in analyses. Self-reported ADHD symptoms decreased substantially for all treatment groups (B=-2·58 [95% CI -3·48 to -1·68]; p<0·0001) between pretreatment and the end of 6 month follow-up, independent of treatment condition (neurofeedback vs sham neurofeedback B=-0·89 [95% CI -2·14 to 0·37], p=0·168; neurofeedback vs meta-cognitive therapy -0·30 [-1·55 to 0·95], p=0·639). No treatment-related or trial-related serious adverse events were reported. INTERPRETATION: Our findings suggest that neurofeedback training is not superior to a sham condition or group psychotherapy. All three treatments were equivalently effective in reducing ADHD symptoms. This first randomised, sham-controlled trial did not show any specific effects of neurofeedback on ADHD symptoms in adults. FUNDING: German Research Foundation.

Experimental variation of social stress in virtual reality - Feasibility and first results in patients with psychotic disorders.

BACKGROUND AND OBJECTIVES: Social interaction might lead to increased stress levels in patients with psychotic disorders. Impaired social stress tolerance is critical for social functioning and closely linked with symptom relapse and hospitalization. We present an interactive office built-up in virtual reality (VR). METHODS: Patients with psychotic disorders (PP, N = 26 including N = 5 dropouts) and matched healthy controls (HC, N = 20) were examined with a VR simulating an open-plan office. In a randomized, controlled cross-over design, participants were introduced to virtual co-workers (avatars) and requested to ask them for task assistance. Social feedback in each of the two sessions was either cooperative or rejective in randomized order. RESULTS: The office environment was tolerable for most PP and all HC, five PP and none of the HC dropped out for any reason. Drop-outs reported simulator sickness, influence on thoughts and symptom exacerbations. Statistical trends indicated heightened paranoid ideations for PP after social rejection. State measures of paranoid ideations showed high convergent validity with conventional measures of delusions. Of note, measures of presence were higher for PP than for HC. LIMITATIONS: The exploratory design limits the robustness of the findings. Only statistical trends on paranoid ideation were found. CONCLUSION: The use of VR to assess the effects of social rejection is feasible and tolerable for most PP (87%). However, its implementation for PP is challenged by increased simulator sickness and an additional stress load for some patients. Further studies continuing on these first results that point towards an increased paranoid ideation evoked by negative social feedback and generally higher subjective presence are needed.

Empathy promotes altruistic behavior in economic interactions.

What are the determinants of altruism? While economists assume that altruism is mainly driven by fairness norms, social psychologists consider empathy to be a key motivator for altruistic behavior. To unite these two theories, we conducted an experiment in which we compared behavior in a standard economic game that assesses altruism (the so-called Dictator Game) with a Dictator Game in which participants' behavioral choices were preceded either by an empathy induction or by a control condition without empathy induction. The results of this within-subject manipulation show that the empathy induction substantially increased altruistic behavior. Moreover, the increase in experienced empathy predicted over 40% of the increase in sharing behavior. These data extend standard economic theories that altruism is based on fairness considerations, by showing that empathic feelings can be a key motivator for altruistic behavior in economic interactions.