Putting the Vicious Cycle to the Test: Evidence for the Cognitive Behavioral Model of Persistent Somatic Symptoms from an Online Study.

OBJECTIVE: In clinical practice, persistent somatic symptoms are regularly explained using a cognitive-behavioral model (CBM). In the CBM, predisposing, perpetuating, and precipitating factors are assumed to interact and to cause the onset and endurance of somatic symptoms. However, these models are rarely investigated in their entirety. METHODS: We conducted an online-survey during the Corona pandemic. 2,114 participants from the general German population completed questionnaires that measured different factors of the CBM. We used state negative affectivity and neuroticism as predisposing factors, fear of a COVID-19 infection as precipitating factor, and somatic symptoms, misinterpretation of bodily symptoms, attention allocation to bodily symptoms, and health anxiety as perpetuating factors. Moreover, we added safety and avoidance behavior as endpoints to the model. We conducted a psychological network analysis to exploratively study the relationships between the model's different factors and tested the assumptions of the CBM by evaluating a structural equation model (SEM) that incorporated all factors of the model. RESULTS: Network analyses revealed clustering in our data: Health anxiety and different cognitive factors are closely related, while somatic symptoms and state negative affectivity are strongly associated. Our SEM showed adequate fit. CONCLUSIONS: Our findings from an exploratory and a confirmatory approach give empirical support for the CBM, suggesting it as a suitable model to explain bodily symptoms in the general population and to possibly guide clinical practice. The network model additionally indicates the necessity to apply an individualized CBM for patients, depending on a preponderance of either persistent somatic symptoms or health concerns.

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.

[Genetic studies on forensic-psychiatric inpatients? : Clinical, ethical and legal considerations]. / Genetische Studien an forensisch Untergebrachten? : Klinische, ethische und juristische Überlegungen.

BACKGROUND: Research on people deprived of liberty raises serious questions, especially concerning behavioral genetic studies. QUESTION: Does including criminally detained patients with mental disorders in genetic studies lead to a gain of new knowledge and can this be ethically and legally justified? METHOD: Evaluation of existing literature and interdisciplinary reflection. RESULTS: After a review of research ethics and legal norms, we consider the benefits and risks of behavioral genetic research, taking the unique situation of test persons deprived of their liberty into account. The fundamental right to freedom of research also justifies foundational research in forensic psychiatry and psychotherapy. The possible future benefits of improving treatment plans must be weighed against the risks resulting from potential data leaks and inappropriate public reception of research results. Then we analyze possible threats to voluntary and informed consent to study participation in more detail by the ethical concept of vulnerability. Alongside problems with grasping complex issues, above all dependencies and power dynamics in the correctional system play a pivotal role. Recommendations on the ethical and legal inclusion of this study population are given. CONCLUSION: Including criminally detained study participants can be ethically and legally justified when autonomous consent is supported by specific organizational and legal procedures and measures, for example via a clear professional and organizational separation of correction and research.

[The Konstanz model project for refugees with mental disorders : Coordinated psychotherapeutic treatment involving trained peer support (KOBEG)]. / Konstanzer Modellprojekt für psychisch belastete Geflüchtete : Koordinierte psychotherapeutische Behandlung unter Einbezug von Gesundheitspat:innen (KOBEG).

Refugees with mental disorders are confronted with access barriers to the psychiatric and psychotherapeutic care system. In order to counter these barriers, a model project to support the health care and integration of mentally distressed refugees was established in the district of Konstanz (coordinated psychotherapeutic treatment involving trained peer support; KOBEG) and evaluated in an initial 3­year model phase. A coordination center refers the patients to local certified psychotherapists. Language and culturally sensitive trained mentors (peers) support and accompany the refugees during the therapy. The utilization of the refered therapy and the experiences of the participating therapists serve as indicators for the effectiveness of the peer-supported therapy referral. The effectiveness of therapeutic measures and support by trained peers was evaluated on the basis of the psychological symptom burden (symptom checklist 27) and functional impairment (work and social adjustment scale) before and after an average of 10 months of project participation. The study focuses on the refugees (use of services and mental distress) and the psychotherapists (reported experiences). Initial results showed an above-average stress level among the refugees at the time of the initial interview, a high participation rate and a low drop-out rate. The follow-up survey showed significant improvements in terms of psychological symptom burden as well as functional impairments. The (qualitative) survey among psychotherapists underlines the effectiveness of KOBEG, 93% of the therapists intend to continue working with refugees within the framework of the project.

Investigating measurement invariance of the Emotion Regulation Questionnaire-8 (ERQ-8) across 29 countries.

The widely used Emotion Regulation Questionnaire (ERQ) measures the habitual use of cognitive reappraisal and expressive suppression. Recently, a more economical 8-item version of the ERQ was proposed that showed good model fit. We assessed whether the latent constructs of the ERQ-8 are generalizable across different countries and cultures. To this end, we used data from the COVIDiSTRESS survey and investigated measurement invariance of the ERQ-8 in a large sample that included 11,288 individuals from 29 countries with diverse cultural backgrounds. Our analyses revealed configural and metric invariance of the ERQ-8 in 14 countries. The results suggest that emotion regulation strategies may not readily converge across all cultures. This underscores the importance of testing measurement invariance before interpreting observed differences and similarities between countries. Supplementary information: The online version contains supplementary material available at 10.1007/s12144-022-04220-6.

Scary symptoms? Functional magnetic resonance imaging evidence for symptom interpretation bias in pathological health anxiety.

Patients with pathological health anxiety (PHA) tend to automatically interpret bodily sensations as sign of a severe illness. To elucidate the neural correlates of this cognitive bias, we applied an functional magnetic resonance imaging adaption of a body-symptom implicit association test with symptom words in patients with PHA (n = 32) in comparison to patients with depression (n = 29) and healthy participants (n = 35). On the behavioral level, patients with PHA did not significantly differ from the control groups. However, on the neural-level patients with PHA in comparison to the control groups showed hyperactivation independent of condition in bilateral amygdala, right parietal lobe, and left nucleus accumbens. Moreover, patients with PHA, again in comparison to the control groups, showed hyperactivation in bilateral posterior parietal cortex and left dorsolateral prefrontal cortex during incongruent (i.e., harmless) versus congruent (i.e., dangerous) categorizations of body symptoms. Thus, body-symptom cues seem to trigger hyperactivity in salience and emotion processing brain regions in PHA. In addition, hyperactivity in brain regions involved in cognitive control and conflict resolution during incongruent categorization emphasizes enhanced neural effort to cope with negative implicit associations to body-symptom-related information in PHA. These results suggest increased neural responding in key structures for the processing of both emotional and cognitive aspects of body-symptom information in PHA, reflecting potential neural correlates of a negative somatic symptom interpretation bias.

Nucleus accumbens activation is linked to salience in social decision making.

Aberrant salience may explain hasty decision making and psychotic symptoms in schizophrenia. In healthy individuals, final decisions in probabilistic reasoning tasks are related to Nucleus accumbens (Nacc) activation. However, research investigating the Nacc in social decision making is missing. Our study aimed at investigating the role of the Nacc for social decision making and its link to (aberrant) salience attribution. 47 healthy individuals completed a novel social jumping-to-conclusion (JTC) fMRI-paradigm, showing morphed faces simultaneously expressing fear and happiness. Participants decided on the 'current' emotion after each picture, and on the 'general' emotion of series of faces. Nacc activation was stronger during final decisions than in previous trials without a decision, particularly in fear rather than happiness series. A JTC-bias was associated with higher Nacc activation for last fearful, but not last happy faces. Apparently, mechanisms underlying probabilistic reasoning are also relevant for social decision making. The pattern of Nacc activation suggests salience, not reward, drives the final decision. Based on these findings, we hypothesize that aberrant salience might also explain social-cognitive deficits in schizophrenia.

Reduced activity and connectivity of left amygdala in patients with schizophrenia treated with clozapine or olanzapine.

Obsessive-compulsive symptoms (OCS) in patients with schizophrenia are a common co-occurring condition, often associated with additional impairments. A subgroup of these patients develops OCS during treatment with second-generation antipsychotics (SGAs), most importantly clozapine and olanzapine. So far, little is known about possible neural mechanism of these SGAs, which seem to aggravate or induce OCS. To investigate the role of SGA treatment on neural activation and connectivity during emotional processing, patients were stratified according to their monotherapy into two groups (group I: clozapine or olanzapine, n = 20; group II: amisulpride or aripiprazole, n = 20). We used an fMRI approach, applying an implicit emotion recognition task. Group comparisons showed significantly higher frequency and severity of comorbid OCS in group I than group II. Task specific activation was attenuated in group I in the left amygdala. Furthermore, functional connectivity from left amygdala to right ventral striatum was reduced in group I. Reduced amygdala activation was associated with OCS severity. Recent literature suggests an involvement of an amygdala-cortico-striatal network in the pathogenesis of obsessive-compulsive disorder. The observed differential activation and connectivity pattern of the amygdala might thus indicate a neural mechanism for the development of SGA-associated OCS in patients with schizophrenia. Further neurobiological research and interventional studies are needed for causal inferences.

Impaired emotion processing and a reduction in trust in patients with somatic symptom disorder.

There is accumulating evidence for deficits in the perception and regulation of one's own emotions, as well as the recognition of others' emotions in somatic symptom disorder (SSD). However, investigations of SSD focusing on specific aspects of emotion processing and how these might interact are missing. We included 35 patients with SSD and 35 healthy controls who completed questionnaires on the perception and regulation of their own emotions, as well as experimental investigations of emotion recognition and trust. In line with previous studies, our results show that SSD patients in comparison to healthy controls have difficulties in the identification and description of own feelings (ηp2  = .381 and ηp2  = .315). Furthermore, we found that patients apply less cognitive reappraisal (ηp2  = .185) but tend to use more expressive suppression (ηp2  = .047). In contrast to previous studies, we found SSD patients to perform superior in emotion recognition, in particular for anger (d = 0.40). In addition, patients with SSD invested less in a trust game (d = 0.73). These results point to a higher sensitivity for negative emotions and less trust in others. Further, these findings suggest a dissociation between the ability to recognize one's own emotions versus others' emotions in SSD. Future interventions targeting emotion processing in SSD might focus on the identification of one's own emotions, prior to the training of emotion regulation.

Neural correlates of an attentional bias to health-threatening stimuli in individuals with pathological health anxiety.

BACKGROUND: An attentional bias to health-threat stimuli is assumed to represent the primary pathogenetic factor for the development and maintenance of pathological health anxiety (PHA; formerly termed "hypochondriasis"). However, little is known about the neural basis of this attentional bias in individuals with PHA. METHODS: A group of patients with PHA, a group of depressed patients and a healthy control group completed an emotional Stroop task with health-threat (body symptom and illness) words and neutral control words while undergoing functional MRI. RESULTS: We included 33 patients with PHA, 28 depressed patients and 31 controls in our analyses. As reflected in reaction times, patients with PHA showed a significantly stronger attentional bias to health-threat words than both control groups. In addition, patients with PHA showed increased amygdala and rostral anterior cingulate cortex activation for body symptom, but not for illness words. Moreover, only in patients with PHA amygdala activation in response to symptom words was positively associated with higher arousal and more negative valence ratings of the body symptom word material. LIMITATIONS: A control group of patients with an anxiety disorder but without PHA would have helped to define the specificity of the results for PHA. CONCLUSION: The attentional bias observed in patients with PHA is associated with hyperactivation in response to body symptom words in brain regions that are crucial for an arousal-related fear response (e.g., the amygdala) and for resolving emotional interference (e.g., the rostral anterior cingulate cortex). The findings have important implications for the nosological classification of PHA and suggest the application of innovative exposure-based interventions for the treatment of PHA.

Aberrant activity and connectivity of the posterior superior temporal sulcus during social cognition in schizophrenia.

Schizophrenia is associated with significant impairments in social cognition. These impairments have been shown to go along with altered activation of the posterior superior temporal sulcus (pSTS). However, studies that investigate connectivity of pSTS during social cognition in schizophrenia are sparse. Twenty-two patients with schizophrenia and 22 matched healthy controls completed a social-cognitive task for functional magnetic resonance imaging that allows the investigation of affective Theory of Mind (ToM), emotion recognition and the processing of neutral facial expressions. Moreover, a resting-state measurement was taken. Patients with schizophrenia performed worse in the social-cognitive task (main effect of group). In addition, a group by social-cognitive processing interaction was revealed for activity, as well as for connectivity during the social-cognitive task, i.e., patients with schizophrenia showed hyperactivity of right pSTS during neutral face processing, but hypoactivity during emotion recognition and affective ToM. In addition, hypoconnectivity between right and left pSTS was revealed for affective ToM, but not for neutral face processing or emotion recognition. No group differences in connectivity from right to left pSTS occurred during resting state. This pattern of aberrant activity and connectivity of the right pSTS during social cognition might form the basis of false-positive perceptions of emotions and intentions and could contribute to the emergence and sustainment of delusions.

Emotion dysregulation in hypochondriasis and depression.

BACKGROUND: The aim of this study was to explore whether certain aspects of emotion dysregulation (i.e., facets of alexithymia and rumination) are more closely linked to hypochondriasis than to depression and vice versa. METHODS: Nineteen patients with hypochondriasis (HYP), 33 patients with depression, and 52 healthy control participants completed the Toronto Alexithymia Scale, the Response Styles Questionnaire, and additional symptom and illness behaviour scales. A clinical interview was used to establish DSM-IV diagnoses and to exclude all cases with more than one axis I diagnosis. RESULTS: Depression patients reported more difficulties describing feelings and more symptom- and self-focused rumination than both HYP patients and healthy individuals, whereas HYP patients differed only from healthy individuals in regard to more difficulties in identifying feelings and more symptom-focused rumination. Multiple regression analyses, including all assessed facets of emotion dysregulation, showed that the degree of somatoform features (somatic symptoms, health anxiety, and illness behaviour) was specifically predicted by higher difficulties in identifying feelings scores, whereas depressive symptom levels were specifically predicted by higher rumination scores. CONCLUSIONS: Specific associations were found between difficulties in identifying feelings and key features of HYP, whereas depression was linked to a more generalized pattern of emotion regulation deficits. KEY PRACTITIONER MESSAGE: Emotion dysregulation can be found in hypochondriasis and depression Difficulties in identifying own feelings are specifically linked to somatic symptoms, health anxiety, and illness behaviour, whereas a more generalized pattern of emotion dysregulation is found in relation to depression Further research is needed to investigate whether the effectiveness of current treatments for depression, hypochondriasis, health anxiety, and related disorders could be improved by additional emotion regulation interventions.

Increased orbitofrontal cortex activation associated with "pro-obsessive" antipsychotic treatment in patients with schizophrenia.

BACKGROUND: Patients with schizophrenia have an approximately 10-fold higher risk for obsessive-compulsive symptoms (OCS) than the general population. A large subgroup seems to experience OCS as a consequence of second-generation antipsychotic agents (SGA), such as clozapine. So far little is known about underlying neural mechanisms. METHODS: To investigate the role of SGA treatment on neural processing related to OCS in patients with schizophrenia, we stratified patients according to their monotherapy into 2 groups (group I: clozapine or olanzapine; group II: amisulpride or aripiprazole). We used an fMRI approach, applying a go/no-go task assessing inhibitory control and an n-back task measuring working memory. RESULTS: We enrolled 21 patients in group I and 19 patients in group II. Groups did not differ regarding age, sex, education or severity of psychotic symptoms. Frequency and severity of OCS were significantly higher in group I and were associated with pronounced deficits in specific cognitive abilities. Whereas brain activation patterns did not differ during working memory, group I showed significantly increased activation in the orbitofrontal cortex (OFC) during response inhibition. Alterations in OFC activation were associated with the severity of obsessions and mediated the association between SGA treatment and co-occurring OCS on a trend level. LIMITATIONS: The main limitation of this study is its cross-sectional design. CONCLUSION: To our knowledge, this is the first imaging study conducted to elucidate SGA effects on neural systems related to OCS. We propose that alterations in brain functioning reflect a pathogenic mechanism in the development of SGA-induced OCS in patients with schizophrenia. Longitudinal studies and randomized interventions are needed to prove the suggested causal interrelations.

Reduced activation in the ventral striatum during probabilistic decision-making in patients in an at-risk mental state.

BACKGROUND: Patients with schizophrenia display metacognitive impairments, such as hasty decision-making during probabilistic reasoning - the "jumping to conclusion" bias (JTC). Our recent fMRI study revealed reduced activations in the right ventral striatum (VS) and the ventral tegmental area (VTA) to be associated with decision-making in patients with schizophrenia. It is unclear whether these functional alterations occur in the at-risk mental state (ARMS). METHODS: We administered the classical beads task and fMRI among ARMS patients and healthy controls matched for age, sex, education and premorbid verbal intelligence. None of the ARMS patients was treated with antipsychotics. Both tasks request probabilistic decisions after a variable amount of stimuli. We evaluated activation during decision-making under certainty versus uncertainty and the process of final decision-making. RESULTS: We included 24 AMRS patients and 24 controls in our study. Compared with controls, ARMS patients tended to draw fewer beads and showed significantly more JTC bias in the classical beads task, mirroring findings in patients with schizophrenia. During fMRI, ARMS patients did not demonstrate JTC bias on the behavioural level, but showed a significant hypoactivation in the right VS during the decision stage. LIMITATIONS: Owing to the cross-sectional design of the study, results are constrained to a better insight into the neurobiology of risk constellations, but not prepsychotic stages. Nine of the ARMS patients were treated with antidepressants and/or lorazepam. CONCLUSION: As in patients with schizophrenia, a striatal hypoactivation was found in ARMS patients. Confounding effects of antipsychotic medication can be excluded. Our findings indicate that error prediction signalling and reward anticipation may be linked to striatal dysfunction during prodromal stages and should be examined for their utility in predicting transition risk.

Simultaneous EEG and fMRI reveals a causally connected subcortical-cortical network during reward anticipation.

Electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) have been used to study the neural correlates of reward anticipation, but the interrelation of EEG and fMRI measures remains unknown. The goal of the present study was to investigate this relationship in response to a well established reward anticipation paradigm using simultaneous EEG-fMRI recording in healthy human subjects. Analysis of causal interactions between the thalamus (THAL), ventral-striatum (VS), and supplementary motor area (SMA), using both mediator analysis and dynamic causal modeling, revealed that (1) THAL fMRI blood oxygenation level-dependent (BOLD) activity is mediating intermodal correlations between the EEG contingent negative variation (CNV) signal and the fMRI BOLD signal in SMA and VS, (2) the underlying causal connectivity network consists of top-down regulation from SMA to VS and SMA to THAL along with an excitatory information flow through a THAL→VS→SMA route during reward anticipation, and (3) the EEG CNV signal is best predicted by a combination of THAL fMRI BOLD response and strength of top-down regulation from SMA to VS and SMA to THAL. Collectively, these findings represent a likely neurobiological mechanism mapping a primarily subcortical process, i.e., reward anticipation, onto a cortical signature.

Amygdala habituation: a reliable fMRI phenotype.

Amygdala function is of high interest for cognitive, social and psychiatric neuroscience, emphasizing the need for reliable assessments in humans. Previous work has indicated unsatisfactorily low within-subject reliability of amygdala activation fMRI measures. Based on basic science evidence for strong habituation of amygdala response to repeated stimuli, we investigated whether a quantification of habituation provides additional information beyond the usual estimate of the overall mean activity. We assessed the within-subject reliability of amygdala habituation measures during a facial emotion matching paradigm in 25 healthy subjects. We extracted the amygdala signal decrement across the course of the fMRI run for the two test-retest measurement sessions and compared reliability estimates with previous findings based on mean response amplitude. Retest-reliability of the session-wise amygdala habituation was significantly higher than the evoked amygdala mean amplitude (intraclass correlation coefficients (ICC)=0.53 vs. 0.16). To test the task-specificity of this finding, we compared the retest-reliability of amygdala habituation across two different tasks. Significant amygdala response decrement was also seen in a cognitive task (n-back working memory) that did not per se activate the amygdala, but was totally unreliable in that context (ICC~0.0), arguing for task-specificity. Together the results show that emotion-dependent amygdala habituation is a robust and considerably more reliable index than the mean amplitude, and provides a robust potential endpoint for within-subject designs including pharmaco-fMRI studies.

Induction and quantification of prefrontal cortical network plasticity using 5 Hz rTMS and fMRI.

Neuronal plasticity is crucial for flexible interaction with a changing environment and its disruption is thought to contribute to psychiatric diseases like schizophrenia. High-frequency repetitive transcranial magnetic stimulation (rTMS) is a noninvasive tool to increase local excitability of neurons and induce short-time functional reorganization of cortical networks. While this has been shown for the motor system, little is known about the short-term plasticity of networks for executive cognition in humans. We examined 12 healthy control subjects in a crossover study with fMRI after real and sham 5 Hz rTMS to the right dorsolateral prefrontal cortex (DLPFC). During scanning, subjects performed an n-back working memory (WM) task and a flanker task engaging cognitive control. Reaction times during the n-back task were significantly shorter after rTMS than after sham stimulation. RTMS compared with sham stimulation caused no activation changes at the stimulation site (right DLPFC) itself, but significantly increased connectivity within the WM network during n-back and reduced activation in the anterior cingulate cortex during the flanker task. Reduced reaction times after real stimulation support an excitatory effect of high-frequency rTMS. Our findings identified plastic changes in prefrontally connected networks downstream of the stimulation site as the substrate of this behavioral effect. Using a multimodal fMRI-rTMS approach, we could demonstrate changes in cortical plasticity in humans during executive cognition. In further studies this approach could be used to study pharmacological, genetic and disease-related alterations.

Understanding empathy deficits and emotion dysregulation in psychopathy: The mediating role of alexithymia.

Psychopathy is a severe personality disorder marked by a wide range of emotional deficits, including a lack of empathy, emotion dysregulation, and alexithymia. Previous research has largely examined these emotional impairments in isolation, ignoring their influence on each other. Thus, we examined the concurrent interrelationship between emotional impairments in psychopathy, with a particular focus on the mediating role of alexithymia. Using path analyses with cross-sectional data from a community sample (N = 315) and a forensic sample (N = 50), our results yielded a statistically significant mediating effect of alexithymia on the relationship between psychopathy and empathy (community and forensic) and between psychopathy and emotion dysregulation (community). Moreover, replacing psychopathy with its three dimensions (i.e., meanness, disinhibition, and boldness) in the community sample revealed that boldness may function as an adaptive trait, with lower levels of alexithymia counteracting deficits in empathy and emotion dysregulation. Overall, our findings indicate that psychopathic individuals' limited understanding of their own emotions contributes to their lack of empathy and emotion dysregulation. This underscores the potential benefits of improving emotional awareness in the treatment of individuals with psychopathy.

Neuronal and behavioral correlates of health anxiety: results of an illness-related emotional Stroop task.

BACKGROUND: Health anxiety (HA) is defined as the objectively unfounded fear or conviction of suffering from a severe illness. Predominant attention allocation to illness-related information is regarded as a central process in the development and maintenance of HA, yet little is known about the neuronal correlates of this attentional bias. METHODS: An emotional Stroop task with body symptom, illness, and neutral words was employed to elicit emotional interference in healthy participants with high (HA+, n = 12) and low (HA-, n = 12) HA during functional magnetic resonance imaging. RESULTS: Prolonged reaction times for indicating the color of symptom words and a decrease in rostral anterior cingulate cortex (rACC) activation were seen in HA+ participants. Emotional interference effects on the behavioral level were negatively related to rACC activity over the whole group. Groups did not differ during the processing of threatening illness words. CONCLUSION: The results indicate stronger attention allocation toward body symptom words already in subclinical HA. This attentional bias appears to be linked to hypoactivity of the rACC which impedes effective emotional interference reduction, leading instead to a ruminative processing of the stimulus content.

In the face of horror - secondary traumatisation and mental distress in employees and volunteers at national socialism related memorial sites.

Background: Employees and volunteers at national socialism related memorial sites in Germany (MemoS) are confronted with severely aversive documents of German history on a regular basis.Objective: Enhance knowledge on mental health in MemoS.Method: In an online study, mental distress, secondary traumatisation as well as potential risk and protective factors were assessed in MemoS and a control group.Results: 40.9% of MemoS reported at least one kind of secondary traumatic event experienced in the context of their work. Depression and general mental distress were higher in the MemoS than in controls, and symptoms of secondary traumatisation were significantly more common.Conclusions: Our results give clear evidence for mental distress and symptoms of secondary traumatisation in the MemoS group. This finding shows secondary traumatisation symptoms based on documents of atrocities that happened more than 70 years ago. Further, the high mental burden in the MemoS suggests the necessity of supervision for people dedicating their work life to assuring remembrance of the crimes of the Nazi era.

first systematic examination of mental health and trauma in employees and volunteers at national socialism related memorial sites in Germany.mental distress and secondary traumatisation symptom load significantly higher in people working at the memorial sites than in controls.findings indicate a need for support of the people working at the memorial sites.