The PornLoS Treatment Program: Study protocol of a new psychotherapeutic approach for treating pornography use disorder.

Background: The introduction of Compulsive Sexual Behavior Disorder (CSBD) into the 11th International Classification of Diseases has raised expectations for better treatment options for CSBD. Furthermore, the treatment demand has increased, particularly for pornography use disorder (PUD), a subtype of CSBD. Presumably due to the easy access to Internet pornography an increasing prevalence of PUD is observed. Consequently, providing tailored and effective treatment is essential. Methods: This article provides an overview of the manualized short-term PornLoS Treatment Program (Pornografienutzungsstörung effektiv behandeln- Leben ohne Suchtdruck; translation: Treating pornography use disorder effectively - life without craving). The program combines 24 individual and 6 group psychotherapy sessions with an interdisciplinary approach by offering a novel treatment framework. This includes, e.g., a mobile app, establishment of self-help groups, and access to other social services such as couple counseling. The cognitive-behavioral treatment program contains interventions addressing psychoeducation, cue exposure, impulse control, cognitive restructuring, emotional regulation, and relapse management.We here also describe the study protocol of an ongoing four-arm randomized controlled trial. The aim is to test two variants of the PornLoS Treatment Program differing with respect to their treatment goal (abstinence or reduced pornography use) against cognitive-behavioral treatment as usual and against a waitlist control group. The primary outcome is the absence of a PUD diagnosis at the end of therapy. The total target sample size will comprise n = 316 patients with PUD across eight study sites. Results: The results will be presented at international conferences and published in a scientific peer-reviewed journal.

Fear of COVID-19 predicts increases in anxiety, depressive symptoms, health anxiety, psychosocial distress, and loneliness: Findings from a prospective two-year follow-up study.

The role of fear of COVID-19 in prospectively predicting changes in psychopathological symptoms during the COVID-19 pandemic remains unclear. The present data were obtained from a longitudinal non-probability sample in Germany, initially assessed at the beginning of the COVID-19 pandemic in Germany (April-May 2020) and reassessed after two years (n = 846; 83% female; mean age: 44.59 years, SD = 12.32; response rate: 19.5%). Multiple linear regressions were used to examine associations of fear of COVID-19 at baseline with depressive symptoms, anxiety, health anxiety, psychosocial distress, and loneliness controlling for (a) the respective symptom measure, and (b) all psychopathological symptoms at baseline. The data were weighted to minimize attrition and representativeness biases. Overall, loneliness decreased from the beginning of the COVID-19 pandemic until the two-year follow-up, whereas all other symptoms did not change. Fear of COVID-19 at the beginning of the pandemic predicted an increase in anxiety symptoms, health anxiety, psychosocial distress, and loneliness two years later. In addition, fear of COVID-19 predicted higher health anxiety, depressive symptoms, psychosocial distress, and loneliness, but not anxiety symptoms when controlling for all baseline symptom measures at once. Fear of COVID-19 seems to play a central role in predicting negative mental health outcomes, emphasizing the necessity of indicated prevention and intervention to decrease worry and manage anxiety, thereby reducing the negative impact on mental health caused by fear during future pandemics.

A threat from within: Learning to fear by observing aversive bodily symptoms in others.

Although observational fear learning has been implicated in the development of phobic-related fears, studies investigating observational learning of fear of bodily symptoms remain scarce. Therefore, the aim of the present study was to investigate whether fear in response to bodily symptoms can be acquired simply by observing a fearful reaction to provocation of aversive bodily symptoms in others. Forty healthy participants underwent an observational fear conditioning paradigm consisting of two phases. In the first phase, participants observed a demonstrator reacting to an aversive bodily symptom provocation (unconditioned stimulus or US, i.e., labored breathing) paired with one conditioned stimulus (CS+) but not with the other one (CS-, both CSs were geometric symbols presented on a screen the demonstrator was watching). In the second phase, participants were directly presented with the same conditioned stimuli, but in the absence of the US. Our results revealed enhanced conditioned fear responses in the beginning of the second phase to the CS + as compared to CS-, as indexed by greater skin conductance and subjective fear responses, as well as greater potentiation of startle eyeblink responses to the CS + as compared to the ITI. Taken together, these findings implicate that fear of bodily symptoms can be learned through observation of others, that is, without first-hand experience of bodily threat.

Role of interoceptive fear and maladaptive attention and behaviors in the escalation of psychopathology-a network analysis.

The complex interplay of fear, attention, and behavior toward bodily sensations with psychopathological symptoms and how they mutually influence and potentially reinforce one another remains to be fully elucidated. In this study, we used a network analytical approach to unravel these complex interactions. Specifically, we aimed to identify central symptoms and etiologically relevant factors that might be associated with anxiety and depressive core symptoms. To this end, the following clusters were assessed in 791 adults: interoceptive fear, interoceptive attention, maladaptive behaviors related to bodily sensations, and core symptoms of anxiety and depression. This network was modeled using a Gaussian Graphical Model. Central variables (nodes) were identified using centrality indices and bridge analysis. Self-examination and attention to bodily sensations emerged as central nodes. Moreover, time spent paying attention to bodily sensations, fear of anxiety-related sensations, and self-examination were identified as central bridge nodes, that is, central nodes connecting psychopathologically relevant symptom clusters. The present study indicates that fear of bodily sensations, the amount of attention and time spent focusing on somatic sensations, and self-examination are central factors. The findings suggest potential targets for future longitudinal studies on the impact of these factors for the escalation of anxiety and depressive symptoms.

Central variables were identified through centrality indices and bridge analysisAttention to bodily sensations and self-examination were identified as central nodesFear of bodily sensations and self-examination emerged as central bridge nodesTime spent paying attention to body sensations also emerged as central bridge nodeResults suggest possible targets for future experimental and longitudinal research.

Health anxiety amplifies fearful responses to illness-related imagery.

Severe health anxiety (HA) is characterized by excessive worry and anxiety about one's health, often accompanied by distressing intrusive imagery of signs of a serious illness or potentially receiving bad news about having a life-threatening disease. However, the emotional responses to these illness-related mental images in relation to HA have not been fully elucidated. Emotional responses to mental imagery of 142 participants were assessed in a well-controlled script-driven imagery task, systematically comparing emotional responses to illness-related imagery with neutral and standard fear imagery. The results revealed that participants reported higher anxiety, aversion, emotional arousal, and a stronger avoidance tendency during imagery of fear and illness-related scenes compared to neutral scenes. Importantly, the emotional modulation varied by the level of HA, indicating that individuals with higher HA experienced stronger emotional responses to illness-related imagery. This association between HA and fearful imagery could not be better accounted for by other psychological factors such as trait anxiety, anxiety sensitivity, somatic symptom severity, or symptoms of depression and anxiety. Fearful responding to standard threat material was not associated with HA. The present findings highlight the importance of considering fear responding to mental imagery in understanding and addressing HA.

Interoceptive threat leads to defensive mobilization in highly anxiety sensitive persons.

To study defensive mobilization elicited by the exposure to interoceptive arousal sensations, we exposed highly anxiety sensitive students to a symptom provocation task. Symptom reports, autonomic arousal, and the startle eyeblink response were monitored during guided hyperventilation and a recovery period in 26 highly anxiety sensitive persons and 22 controls. Normoventilation was used as a non-provocative comparison condition. Hyperventilation led to autonomic arousal and a marked increase in somatic symptoms. While high and low anxiety sensitive persons did not differ in their defensive activation during hyperventilation, group differences were detected during early recovery. Highly anxiety sensitive students exhibited a potentiation of startle response magnitudes and increased autonomic arousal after hyper- as compared to after normoventilation, indicating defensive mobilization evoked by the prolonged presence of feared somatic sensations.

Enhanced long-term recollection for emotional pictures: evidence from high-density ERPs.

The present study used behavioral and electrophysiological measures to investigate the processes mediating long-term recognition memory for emotional and neutral pictures. The results show enhanced memory recollection for emotional arousing pictures compared to neutral low arousing pictures. In accordance with the behavioral data, we observed enhanced old/new effects in the ERPs for emotionally arousing pictures in the recollection-sensitive old/new component at centro-parietal sites (500-800 ms). Moreover, early old/new effects were present over frontal and parietal sites (300-500 ms) irrespective of picture contents. Analysis of the subjective awareness, indexed by the confidence ratings, showed that the late parietal old/new effect was increased for high confidence responses whereas the early component (300-500 ms) was mainly driven by low confidence responses, an indication for familiarity based recognition processes.

Brain dynamics in spider-phobic individuals exposed to phobia-relevant and other emotional stimuli.

Dense sensor event-related brain potentials were measured in participants with spider phobia and nonfearful controls during viewing of phobia-relevant spider and standard emotional (pleasant, unpleasant, neutral) pictures. Irrespective of the picture content, spider phobia participants responded with larger P1 amplitudes than controls, suggesting increased vigilance in this group. Furthermore, spider phobia participants showed a significantly enlarged early posterior negativity (EPN) and late positive potential (LPP) during the encoding of phobia-relevant pictures compared to nonfearful controls. No group differences were observed for standard emotional materials indicating that these effects were specific to phobia-relevant material. Within group comparisons of the spider phobia group, though, revealed comparable EPN and LPP evoked by spider pictures and emotional (unpleasant and pleasant) picture contents. These results demonstrate a temporal unfolding in perceptual processing from unspecific vigilance (P1) to preferential responding (EPN and LPP) to phobia-relevant materials in the spider phobia group. However, at the level of early stimulus processing, these effects of increased attention seem to be related to emotional relevance of the stimulus cues rather than reflecting a fear-specific response.

Individual differences in fear-potentiated startle as a function of resting heart rate variability: implications for panic disorder.

BACKGROUND: Anticipatory anxiety, which can be indexed by the startle potentiation to a threat of shock, has been implicated in the development of panic disorder. Large individual differences exist in startle potentiation to threat of shock but few differences have been found between panic patients in general and non-anxious controls. The present studies explored resting heart rate variability (HRV) as a source of individual differences in startle potentiation in students at risk for panic disorder and in unmedicated panic patients. METHODS: Participants in Study 1 were 22 students high and 21 students low in anxiety sensitivity (AS). Nine unmedicated panic patients and 15 matched non-anxious controls were included in Study 2. Startle potentiation to the threat of shock was examined as a function of AS (Study 1) and diagnostic category (Study 2) as well as resting HRV. RESULTS: Whereas no differences in startle potentiation were found as a function of AS or panic disorder diagnosis in general, both studies revealed that low resting HRV was associated with exaggerated startle responses to the threat of shock. CONCLUSIONS: The present results replicate and extend the sparse literature on fear-potentiated startle in panic disorder. Low HRV was associated with more pronounced startle potentiation to both explicit and contextual cues. Thus, low HRV may be a useful endophenotype for at least some anxiety disorders.

Anticipation of interoceptive threat in highly anxiety sensitive persons.

Anticipatory anxiety plays a major role in the etiology of panic disorder. Although anticipatory anxiety elicited by expectation of interoceptive cues is specifically relevant for panic patients, it has rarely been studied. Using a population analogue in high fear of such interoceptive arousal sensations (highly anxiety sensitive persons) we evaluated a new experimental paradigm to assess anticipatory anxiety during anticipation of interoceptive (somatic sensations evoked by hyperventilation) and exteroceptive (electric shock) threat. Symptom reports, autonomic arousal, and defensive response mobilization (startle eyeblink response) were monitored during threat and matched safe conditions in 26 highly anxiety sensitive persons and 22 controls. The anticipation of exteroceptive threat led to a defensive and autonomic mobilization as indexed by a potentiation of the startle response and an increase in skin conductance level in both experimental groups. During interoceptive threat, however, only highly anxiety sensitive persons but not the controls exhibited a startle response potentiation as well as autonomic activation. The anticipation of a hyperventilation procedure thus seems a valid paradigm to investigate anticipatory anxiety elicited by interoceptive cues in the clinical context.

Startle reflex modulation and autonomic responding during anxious apprehension in panic disorder patients.

The present study explored anxious apprehension in panic disorder patients and controls in two threat conditions, darkness and threat of shock. Autonomic arousal and startle eyeblink reflexes were recorded in 26 panic disorder patients and 22 controls during adaptation, a safe condition, threat of shock, and darkness. Exposure to darkness resulted in a clear potentiation of the startle reflex. Panic patients but not controls responded with an increase in heart rate that was positively related to severity of agoraphobic avoidance. Threat of shock resulted in a startle potentiation that tended to be stronger in panic patients without comorbid depression than controls and attenuated in those patients who suffered from severe depression. These data suggest that only panic patients without depression belong to the fear disorders spectrum whereas panic patients with comorbid depression might rather belong to the distress disorders profile.