Varying Cognitive Scars – Differential Associations Between Types of Childhood Maltreatment and Facial Emotion Processing

Iffland B, Neuner F. Varying Cognitive Scars – Differential Associations Between Types of Childhood Maltreatment and Facial Emotion Processing. Frontiers in Psychology. 2020;11: 732.Background: Distorted cognitive processing has been found among survivors of child maltreatment. However, different types of abuse and neglect may bring about differences in emotion and attention processing. The present study aimed to detect differential associations between various types of childhood maltreatment and attentional biases in facial emotion processing. Methods: A non-clinical sample was recruited on University campus and consisted of 67 individuals with varying degrees of maltreatment. In an evaluative conditioning task, images of faces with neutral emotional expressions were either associated with short videos of intense negative statements, or associated with neutral videos. Subsequently, these faces were used as stimuli in a face in the crowd recognition task in which the familiar faces had to be recognized within a crowd of unfamiliar neutral faces. Results: In multiple linear regression analyses controlling for the intercorrelatedness of types of maltreatment, differential relationships between types of maltreatment and attentional bias were found. While emotional abuse was associated with faster detection of negatively associated faces, emotional neglect was associated with an impaired recognition of familiar stimuli regardless of the emotional content. Conclusion: Results indicated that interindividual differences in cognitive biases may be due to the activation of diverse cognitive schemas based on differential experiences of maltreatment

Are school-based mental health interventions for war-affected children effective and harmless?

Ertl V, Neuner F. Are school-based mental health interventions for war-affected children effective and harmless? BMC Medicine. 2014;12(1): 84.In recent years, different approaches to large-scale mental health service provision for children in war-affected, mainly low-and middle-income, countries have been developed. Some school-based programs aiming at both strengthening resilience and reducing symptoms of trauma-related distress have been evaluated. In an article published in BMC Medicine, Tol and colleagues integrate their findings of the efficacy of universal school-based intervention across four countries and do not recommend classroom-based intervention as a treatment of trauma-related symptoms, since no consistent positive effects were found. On the contrary, for some children this type of universal intervention may impair recovery. Since universal school-based programs similar to the one evaluated here are widely implemented, Tol et al.'s results are highly relevant to inform the field of mental health service provision in war-affected countries

Effectiveness of Psychosocial Interventions Targeting Hazardous and Harmful Alcohol Use and Alcohol-Related Symptoms in Low- and Middle-Income Countries: A Systematic Review

Preuße M, Neuner F, Ertl V. Effectiveness of Psychosocial Interventions Targeting Hazardous and Harmful Alcohol Use and Alcohol-Related Symptoms in Low- and Middle-Income Countries: A Systematic Review. Frontiers in Psychiatry. 2020;11: 768.Background: In low- and middle-income countries (LMIC), the mismatch between the number of individuals needing and those receiving treatment for alcohol use disorders (AUD) is substantial. In order to provide suggestions for the scaling up of effective service provision we systematically reviewed the current evidence on the effectiveness of AUD-focused psychosocial interventions in LMIC. Methods: We used a systematic review methodology following the PRISMA guidelines. Twelve electronic databases listing published and grey literature were searched and only randomized-controlled trials (RCTs) were included. Where possible, effect sizes were calculated using Hedges' g indices. Results: Twenty-one RCTs conducted in 15 different LMIC between 1992 and 2018 fulfilled inclusion criteria. Most studies employed brief one-on-one interventions facilitated by trained primary care staff. Eighty-six percent of RCTs based their interventions on the principles of motivational interviewing (MI) with the majority supplementing MI-based interventions with alcohol-tailored elements of cognitive-behavioral therapy (CBT). The remaining RCTs employed CBT-components exclusively. Just over 40% of studies included in quantitative analyses (n=17) yielded an at least medium-sized effect (g≥.50) of the respective intervention compared to alcohol-related and unrelated control conditions or waiting list. Only half of the trials implementing the widely applied MI-based approaches (or MI-based approaches blended with CBT-elements) were superior to their respective control conditions. Conclusion: To date, a relatively small number of RCTs investigating AUD-focused treatments has been conducted in LMIC. The majority of between condition effect size estimates were small and no type of intervention can clearly be recommended over another. No RCTs were conducted in conflict-affected areas in LMIC although they would merit particular attention since AUD is often linked to trauma-related mental health disorders. More RCTs in LMIC are required and alternatives to MI-based approaches should be investigated. This systematic review summarizes properties of effective interventions and provides implications for future research

Transgenerational consequences of PTSD: risk factors for the mental health of children whose mothers have been exposed to the Rwandan genocide

Roth M, Neuner F, Elbert T. Transgenerational consequences of PTSD: risk factors for the mental health of children whose mothers have been exposed to the Rwandan genocide. International Journal of Mental Health Systems. 2014;8(1): 12.Background: Understanding how parental Posttraumatic Stress Disorder (PTSD) may or may not affect the development and mental health in the offspring is particularly important in conflict regions, where trauma-related illness is endemic. In Rwanda, organised atrocities and the genocide against the Tutsi of 1994 have left a significant fraction of the population with chronic PTSD. The aim of the present investigation was to establish whether PTSD in mothers is associated with symptoms of depression, anxiety, and aggressive and antisocial behaviour in their children. Methods: A community sample of 125 Rwandan mothers who experienced the genocide of 1994 and their 12-year-old children were interviewed. Using a structured interview, symptoms of maternal PTSD and children's depression, anxiety, and aggressive and antisocial behaviour were assessed by trained and on-site supervised local B. A. psychologists. The interview also included a detailed checklist of event types related to family violence. Results: In showing that a maternal PTSD was not associated with child's psychopathology, the results contradict the assumption of straight "trans-generational trauma transmission". Instead, a child's exposure to maternal family violence posed a significant risk factor for a negative mental health outcome. Furthermore, it was not maternal PTSD-symptoms but mother's exposure to family violence during her own childhood that was associated with the magnitude of adversities that a child experiences at home. Conclusions: Contrary to a simple model of a trans-generational transmission of trauma, neither maternal PTSD nor maternal traumatic experiences were directly associated with symptoms of anxiety, depression, or antisocial and aggressive behaviour in the children. Instead, the present results suggest a relationship between parental child rearing practices and children's mental health. Furthermore, the study details the "cycle of violence", showing a significant link between maternal violence against a child and its mother's experience of childhood maltreatment

Emotional but not physical maltreatment is independently related to psychopathology in subjects with various degrees of social anxiety: a web-based internet survey

Iffland B, Sansen L, Catani C, Neuner F. Emotional but not physical maltreatment is independently related to psychopathology in subjects with various degrees of social anxiety: a web-based internet survey. BMC Psychiatry. 2012;12(1): 49.Background: Previous studies reported that social phobia is associated with a history of child maltreatment. However, most of these studies focused on physical and sexual maltreatment whilst little is known about the specific impact of emotional abuse and neglect on social anxiety. We examined the association between emotional maltreatment, including parental emotional maltreatment as well as emotional peer victimization, and social anxiety symptoms in subjects with various degrees of social anxiety. Methods: The study was conducted as a web-based Internet survey of participants (N = 995) who had social anxiety symptoms falling within the high range, and including many respondents who had scores in the clinical range. The assessment included measures of child maltreatment, emotional peer victimization, social anxiety symptoms and general psychopathology. Results: Regression and mediation analyses revealed that parental emotional maltreatment and emotional peer victimization were independently related to social anxiety and mediated the impact of physical and sexual maltreatment. Subjects with a history of childhood emotional maltreatment showed higher rates of psychopathology than subjects with a history of physical maltreatment. Conclusions: Although our findings are limited by the use of an Internet survey and retrospective self-report measures, data indicated that social anxiety symptoms are mainly predicted by emotional rather than physical or sexual types of victimization

Recording visual evoked potentials and auditory evoked P300 at 9.4T static magnetic field.

peer reviewedSimultaneous recording of electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) has shown a number of advantages that make this multimodal technique superior to fMRI alone. The feasibility of recording EEG at ultra-high static magnetic field up to 9.4 T was recently demonstrated and promises to be implemented soon in fMRI studies at ultra high magnetic fields. Recording visual evoked potentials are expected to be amongst the most simple for simultaneous EEG/fMRI at ultra-high magnetic field due to the easy assessment of the visual cortex. Auditory evoked P300 measurements are of interest since it is believed that they represent the earliest stage of cognitive processing. In this study, we investigate the feasibility of recording visual evoked potentials and auditory evoked P300 in a 9.4 T static magnetic field. For this purpose, EEG data were recorded from 26 healthy volunteers inside a 9.4 T MR scanner using a 32-channel MR compatible EEG system. Visual stimulation and auditory oddball paradigm were presented in order to elicit evoked related potentials (ERP). Recordings made outside the scanner were performed using the same stimuli and EEG system for comparison purposes. We were able to retrieve visual P100 and auditory P300 evoked potentials at 9.4 T static magnetic field after correction of the ballistocardiogram artefact using independent component analysis. The latencies of the ERPs recorded at 9.4 T were not different from those recorded at 0 T. The amplitudes of ERPs were higher at 9.4 T when compared to recordings at 0 T. Nevertheless, it seems that the increased amplitudes of the ERPs are due to the effect of the ultra-high field on the EEG recording system rather than alteration in the intrinsic processes that generate the electrophysiological responses

Long-term consequences of traumatic experiences: an assessment of former political detainees in romania

BACKGROUND: Research has suggested that organized violence and torture have long-term psychological effects that persist throughout the lifespan. The present survey aimed at examining the prevalence of posttraumatic stress disorder (PTSD), and other disorders and symptoms, all present in old age, as long-term consequences of politically motivated violence in a comparison design. METHODS: A group of former political detainees (N = 59, mean age 73.5 years) who had been arrested by the Romanian communist regime were compared to an age- and gender-matched control group (N = 39). PTSD was assessed using a structured clinical interview (CIDI). The investigation of the clinical profile was further accomplished by self-rating measures for anxiety, depression, and health-related functioning, as well as by clinician-administrated interviews for substance abuse, dissociation, and somatization symptoms. RESULTS: Lifetime prevalence of PTSD was 54%. In the case of participants left untreated, PTSD persisted, often over four decades, such that current PTSD was diagnosed still in a third of the survivors. Other clinical conditions such as somatization, substance abuse, dissociative disorders, and major depression were also common among the former political detainees and often associated with current PTSD. CONCLUSION: Our findings suggest that political detention may have long-term psychological consequences that outlast the changes in the political system

Automatic activation of alcohol cues by child maltreatment related words: a replication attempt in a different treatment setting

Potthast N, Neuner F, Catani C. Automatic activation of alcohol cues by child maltreatment related words: a replication attempt in a different treatment setting. BMC Research Notes. 2017;10(17): 17.Background A growing body of research attempts to clarify the underlying mechanisms of the association between emotional maltreatment and alcohol dependence (AD). In a preceding study, we found considerable support for a specific priming effect in subjects with AD and emotional abuse experiences receiving alcohol rehabilitation treatment. We concluded that maltreatment related cues can automatically activate an associative memory network comprising cues eliciting craving as well as alcohol-related responses. Generalizability of the results to other treatment settings remains unclear because of considerable differences in German treatment settings as well as insufficiently clarified influences of selection effects. As replication studies in other settings are necessary, the current study aimed to replicate the specific priming effect in a qualified detoxification sample. Results 22 AD subjects (n = 10 with emotional abuse vs. n = 12 without emotional abuse) participated in a priming experiment. Comparison data from 34 healthy control subjects were derived from the prior study. Contrary to our hypothesis, we did not find a specific priming effect. Conclusions We could not replicate the result of an automatic network activation by maltreatment related words in a sample of subjects with AD and emotional abuse experiences receiving qualified detoxification treatment. This discrepancy might be attributed to reasons related to treatment settings as well as to methodological limitations. Future work is required to determine the generalizability of the specific priming effect before valid conclusions regarding automatic activation can be drawn

Narrative Exposure Therapy (NET) for survivors of violence and forced migration. A glimpse at the intervention

Schauer M, Elbert T, Neuner F. Narrative Expositionstherapie (NET) für Menschen nach Gewalt und Flucht Ein Einblick in das Verfahren. Psychotherapeut. 2017;62(4):306-313.Narrative Exposure Therapy (NET) provides an effective treatment module for children as well as adults who have suffered from multiple and complex traumatization due to violent interpersonal experiences and forced displacement. The chronological processing of a narration of the individual biography of the refugee through NET enables survivors of traumatic stress to obtain a holistic review of their life and thus the integration of life events into a narrative. This process activates resources and enables corrective relationship experiences by revisiting previous social painful situations together with the therapist. Due to the close and interactive nature of the therapy, attachment repair can occur and shame can be reduced as clients discuss memories without being met with rejection or devaluation. This further assists the development of a positive sense of identity. As an empathic listener, the therapist supports the safe recall or even reliving of the most arousing and meaningful life - events, the positive as well as the negative ones. The NET procedure enables recognition of the person and the life history, testifying to human rights violations and regaining dignity

Are drinking motives universal? Characteristics of motive types in alcohol-dependent men from two diverse populations

Ertl V, Preuße M, Neuner F. Are drinking motives universal? Characteristics of motive types in alcohol-dependent men from two diverse populations. Frontiers in Psychiatry. 2018;9: 38.Background and Aims: Since alcohol use disorders are among the most prevalent and destructive mental disorders, it is critical to address factors contributing to their development and maintenance. Drinking motives are relevant driving factors for consumption. Identifying groups of drinkers with similar motivations may help to specialize intervention components and make treatment more effective and efficient. We aimed to identify and describe distinct motive types of drinkers in dependent males from two diverse cultures (Uganda and Germany) and to explore potential differences and similarities in addiction-related measures. Moreover, we investigated specific links between motive types and childhood maltreatment, traumatic experiences, and symptoms of comorbid psychopathologies. Methods: To determine distinct drinking motive types, we conducted latent class analyses concerning drinking motives (Drinking Motive Scale) in samples of treatment-seeking alcohol-dependent men (N = 75). Subsequently we compared the identified motive types concerning their alcohol consumption and alcohol-related symptoms (Alcohol Use Disorders Identification Test), history of childhood maltreatment (Childhood Trauma Questionnaire), trauma exposure (Violence, War and Abduction Exposure Scale), psychopathology (Posttraumatic Stress Diagnostic Scale, Depression-section of the Hopkins Symptom Checklist, and Brief Symptom Inventory) and deficits in emotion regulation (Difficulties in Emotion Regulation Scale). Results: We found two congruent drinking motive types in both contexts. Reward-oriented drinking motives like the generation of positive feelings and enhancing performance were endorsed almost equally by both motive types, whereas high relief motive endorsement characterized one group, but not the other. The relief motive type drank to overcome aversive feelings, withdrawal, and daily hassles and was characterized by higher adversity in general. Emotional maltreatment in childhood and psychopathological symptoms were reported to a significantly greater extent by relief drinkers (effect sizes of comparisons ranging from r = 0.25 to r = 0.48). However, the motive types did not differ significantly on alcohol consumption or alcohol-related symptoms and traumatic experiences apart from childhood maltreatment. Conclusion: The chronology of addiction development and patterns of drinking motivation seem to be similar across cultures, i.e., that motive targeting interventions might be applicable cross-culturally. Addressing comorbid symptomatology should be a key treatment component for relief drinkers, whereas finding alternatives for the creation of positive feelings and ways to counteract boredom and inactivity should be a general treatment element. Introductio