Investigating behavioral and psychophysiological reactions to conflict-related and individualized stimuli as potential correlates of repression

$\textbf {Background:}$ Repression is considered as a central defense mechanism in psychodynamic theory. It refers to the process by which “unbearable” mental contents (e.g., those related to internal conflicts) are kept out of consciousness. The process of repression is probably closely related to concepts of emotion regulation derived from a different theoretical background. This relationship is particularly relevant because it relates repression to current research in the affective neurosciences as well as to experimental studies on emotion regulation. Due to its complex and highly individual nature, repression has been notoriously difficult to investigate. We investigated repression with an individualized experiment in healthy subjects in order to establish methods to study repression in clinical populations. To this end we operationalized repression using individualized experimental conditions, and then studied potential behavioral [memory and reaction time (RT)] and psychophysiological correlates [skin conductance response (SCR)]. $\textbf {Method:}$ Twenty-nine healthy female subjects were asked to freely associate to individualized cue sentences. Sentences were generated from individual psychodynamic interviews based on operationlized psychodynamic diagnosis (OPD), and were comprised of three different types: positive, negative non-conflictual, and negative conflict-related sentences. Subjects were asked to name the first three associations coming into their mind. Afterward, the remaining time was used for free association. SCR during each association trial and RT of the first given association were recorded. The memory for the first three associations was subsequently tested in an unexpected recall. $\textbf {Results:}$ Associations to conflict-related cue sentences were associated with longer RTs and increased SCRs. Moreover, the unexpected recall task showed memory for these associations to be reduced. $\textbf {Conclusion:}$ We interpret these findings as possible correlates of repression, in line with a history of experimental research into repression using non-individualized cues. Consequently, we suggest that this experimental paradigm could serve to investigate repression in clinical populations

The influence of the behavioural inhibition system on the development of PTSD-like symptoms after presentation of a traumatic film in healthy subjects

$\bf Background:$ The Behavioural Inhibition System (BIS) as a neural system controlling motivation and behaviour, has previously been linked to multiple mental disorders, including Post-traumatic Stress Disorder (PTSD). BIS-sensitivity could increase the likelihood of PTSD development after trauma. However, previous studies have largely measured BIS-sensitivity retrospectively (i.e. after trauma, or even after onset of PTSD). $\bf Objective:$ The study aims to confirm the relationship between BIS-sensitivity prior to trauma and PTSD symptoms. $\bf Method:$ After assessment of BIS-sensitivity, N = 119 healthy participants watched a film with visually disturbing material. After 72 h, participants completed a questionnaire on PTSD-related symptoms (PCL-5). $\bf Results:$ In a multiple linear regression model, BIS-sensitivity significantly predicted PTSD symptoms, even after controlling for the decrease in mood, as well as for participants’ age and sex, two factors that had previously been shown to influence BIS-sensitivity. $\bf Conclusions:$ This is the first study to measure BIS-sensitivity before the occurrence of the (experimental) trauma and strengthens its role as a potential pre-traumatic risk factor.Antecedentes: El Sistema de Inhibición del Comportamiento (SIC) como un sistema neuronal que controla la motivación y el comportamiento, ha sido relacionado previamente con múltiples trastornos mentales, incluido el Trastorno de Estrés Postraumático (TEPT). La sensibilidad-SIC podría aumentar la probabilidad de desarrollo de TEPT después de un trauma. Sin embargo, los estudios previos han medido en gran medida la sensibilidad-SIC de forma retrospectiva (es decir, después de un trauma o incluso después del inicio de TEPT). Objetivo: El estudio tiene como objetivo confirmar la relación entre la sensibilidad-SIC antes del trauma y los síntomas del TEPT. Método: Después de la evaluación de la sensibilidad-SIC, N = 119 participantes sanos vieron una película con material visualmente perturbador. Luego de 72 horas, los participantes completaron un cuestionario sobre síntomas relacionados con el TEPT (PCL-5). Resultados: En un modelo de regresión lineal múltiple, la sensibilidad-SIC predijo significativamente los síntomas del TEPT, incluso después de controlar por disminución de ánimo, así como edad y sexo de los participantes, dos factores que previamente han demostrado influir en la sensibilidad-SIC. Conclusiones: Este es el primer estudio que mide la sensibilidad-SIC antes de la ocurrencia del trauma (experimental) y fortalece su rol como un potencial factor de riesgo pretraumático

Alexithymia and internet gaming disorder in the light of depression

$\it Background:$ Social and emotional deficits are assumed to be involved in the development and maintenance of internet gaming disorder (IGD). Alexithymia refers to a personality construct, which is characterized by deficits in emotional awareness and processing. The constructs of alexithymia and depression share similarities, and depression is a common comorbidity of IGD patients. The aim of this study was to analyze the relationship between alexithymia and IGD when controlling for depression symptom severity. Moreover, we compared alexithymia traits of IGD patients with those of non-pathological video gamers. $\it Methods:$ In a cross-sectional study n = 38 male IGD patients (EG) were recruited at specialized healthcare services in Germany. In addition, n = 39 male non-pathological video gamers (CG) were recruited via social media and bulletin board announcement. Both groups completed questionnaires measuring alexithymia (TAS-20), depression symptom severity (BDI) and IGD severity (s-IAT). $\it Results:$ Alexithymia and depression symptom severity both predicted IGD severity. Yet, when including both factors in multiple regression analysis, only alexithymia predicted IGD severity. The prevalence of alexithymia in the EG was 34.2 % (n = 13). None of the non-pathological video gamers scored above the cut-off indicating alexithymia. IGD patients showed higher traits of alexithymia in general and on each subscale, irrespective of whether or not they were currently consuming video games. As previously observed, depression symptom severity was significantly greater in IGD patients compared to healthy video gamers. Yet, group differences in alexithymia traits remained stable, with a ~29 % decrease of effectiveness in the relationship, when controlling for depression symptom severity and sociodemographic factors. $\it Conclusion:$ The results reveal that alexithymia is associated with and predicts IGD severity independently of depression symptom severity. Moreover, alexithymia is highly prevalent in IGD patients

Quality of life in internet use disorder patients with and without comorbid mental disorders

$\bf Introduction:$ Evidence from clinical studies on quality of life (QoL) in patients suffering from internet use disorders (IUD) is still limited. Furthermore, the impact of additional mental comorbidities on QoL in IUD patients has rarely been investigated yet. $\textbf {Materials and Methods:}$ In a cross-sectional clinical study 149 male subjects were analyzed for the presence and severity of an IUD as well as other mental disorders by experienced clinicians. The sample consisted of 60 IUD patients $\it with$ and $\it without$ comorbid mental disorders, 34 non-IUD patients with other mental disorders, and 55 healthy participants. Standardized clinical interviews (M.I.N.I. 6.0.0) and questionnaires on IUD symptom severity (s-IAT), QoL (WHOQOL-BREF), depression and anxiety symptoms (BDI-II and BAI), and general psychological symptoms (BSI) were used. $\bf Results:$ Internet use disorder patients showed significantly reduced QoL compared to healthy controls (Cohen's $\it d$ = 1.64–1.97). Furthermore, IUD patients suffering from comorbid mental disorders showed significantly decreased levels of physical, social, and environmental QoL compared to IUD patients without any comorbidity ($\it p$ < 0.05–0.001). Multiple linear regression analyses revealed that low levels of psychological, social and environmental QoL were mainly predicted by symptoms of depression. IUD factors were only significant predictors for the social and physical QoL. $\bf Discussion:$ Internet use disorder patients with comorbid mental disorder reported the lowest QoL. Depression symptom severity was the most significant predictor of low QoL in IUD. Strategies to reduce depressive symptoms should therefore be considered in IUD treatment to increase patients' QoL

Treatment-associated mRNA co-expression changes in monocytes of patients with posttraumatic stress disorder

PTSD is a prevalent mental disorder that results from exposure to extreme and stressful life events and comes at high costs for both the individual and society. Therapeutic treatment presents the best way to deal with PTSD-the mechanisms underlying change after treatment, however, remain poorly understood. While stress and immune associated gene expression changes have been associated with PTSD development, studies investigating treatment effects at the molecular level so far tended to focus on DNA methylation. Here we use gene-network analysis on whole-transcriptome RNA-Seq data isolated from $CD14^{+}$ monocytes of female PTSD patients ($\it N$ = 51) to study pre-treatment signatures of therapy response and therapy-related changes at the level of gene expression. Patients who exhibited significant symptom improvement after therapy showed higher baseline expression in two modules involved in inflammatory processes (including notable examples $\it IL1R2$ and $\it FKBP5$) and blood coagulation. After therapy, expression of an inflammatory module was increased, and expression of a wound healing module was decreased. This supports findings reporting an association between PTSD and dysregulations of the inflammatory and the hemostatic system and mark both as potentially treatment sensitive

What kind of patients receive inpatient and day-hospital treatment in departments of psychosomatic medicine and psychotherapy in Germany?

$\bf Introduction:$ Germany is one of the few countries with a medical specialty of psychosomatic medicine and psychotherapy and many treatment resources of this kind. $\bf Objective:$ This observational study describes the psychosomatic treatment programs as well as a large sample of day-hospital and inpatients in great detail using structured diagnostic interviews. $\bf Methods:$ Mental disorders were diagnosed according to ICD-10 and DSM-IV by means of Mini-DIPS and SCID-II. In addition to the case records, a modified version of the CSSRI was employed to collect demographic data and service use. The PHQ-D was used to assess depression, anxiety, and somatization. $\bf Results:$ 2,094 patients from 19 departments participated in the study after giving informed consent. The sample consisted of a high proportion of "complex patients" with high comorbidity of mental and somatic diseases, severe psychopathology, and considerable social and occupational dysfunction including more than 50 days of sick leave per year in half of the sample. The most frequent diagnoses were depression, somatoform and anxiety disorders, eating disorders, personality disorders, and somato-psychic conditions. $\bf Conclusions:$ Inpatient and day-hospital treatment in German university departments of psychosomatic medicine and psychotherapy is an intensive multimodal treatment for complex patients with high comorbidity and social as well as occupational dysfunction

The multicenter effectiveness study of inpatient and day hospital treatment in departments of psychosomatic medicine and psychotherapy in Germany

$\bf Background:$ Reliable outcome data of psychosomatic inpatient and day hospital treatment with a focus on psychotherapy are important to strengthen ecological validity by assessing the reality of mental health care in the field. This study aims to evaluate the effectiveness of inpatient and day hospital treatment in German university departments of Psychosomatic Medicine and Psychotherapy in a prospective, naturalistic, multicenter design including structured assessments. $\bf Methods:$ Structured interviews were used to diagnose mental disorders according to ICD-10 and DSM-IV at baseline. Depression, anxiety, somatization, eating disorder and posttraumatic stress disorder (PTSD) symptoms, as well as personality functioning were assessed by means of questionnaires on admission and at discharge. $\bf Results:$ 2,094 patients recruited by 19 participating university hospitals consented to participation in the study. Effect sizes for each of the outcome criteria were calculated for 4–5 sub-groups per outcome domain with differing severity at baseline. Pre-post effect sizes for patients with moderate and high symptom severity at baseline ranged from $\it d$ = 0.78 to $\it d$ = 3.61 with symptoms of PTSD, depression, and anxiety showing the largest and somatization as well as personality functioning showing somewhat smaller effects. $\bf Conclusions:$ Inpatient and day hospital treatment in German university departments of Psychosomatic Medicine and Psychotherapy is effective under field conditions. $\bf Clinical trial registration:$ https://drks.de/search/de/trial/DRKS00016412, identifier: DRKS00016412

Investigating the effect of proactive interference control training on intrusive memories

Intrusive re-experiencing is a hallmark symptom of posttraumatic Stress Disorder (PTSD). According to prominent models of intrusive phenomena, intrusive memories may result from impairments in the efficiency of working memory capacity (WMC), more specifically proactive interference control. Yet, experimental research is scarce. Therefore, the present study aimed to investigate experimentally the role of proactive interference control in intrusive memories. We randomly assigned 57 healthy participants to either receive a high interference control training or a low interference control training. Participants were then exposed to highly distressing film clips. WMC was assessed before and after the training. Intrusion symptoms were assessed directly post-training and after one week using an Intrusion Provocation Task (IPT), a one-week intrusions diary, and the retrospective intrusion subscale of the Impact of Event Sale – Revised (IES-R). Results indicated that both groups reported improvements in WMC and fewer intrusions on the second IPT post-training, with no differences between groups. Similarly, no group differences on intrusions were found at one-week follow-up (i.e., intrusion diary and IES-R). To conclude, these data are not consistent with the hypothesis that WMC plays a role in intrusive re-experiencing. Implications for future research are discussed.(TEPT). De acuerdo con los prominentes modelos de fenómenos intrusivos, las memorias intrusivas pueden resultar en deterioros en la eficiencia de la capacidad de memoria de trabajo (CMT), más específicamente del control proactivo de interferencias. Sin embargo, la investigación experimental a este respecto es escasa. Por lo tanto, el presente estudio tuvo como objetivo investigar experimentalmente el papel del control proactivo de interferencias en las memorias intrusivas. Asignamos aleatoriamente 57 participantes sanos a recibir, ya sea, un entrenamiento de control de alta interferencia o un entrenamiento de control de baja interferencia. Luego, los participantes fueron expuestos a videoclips de películas altamente angustiantes. La CMT fue evaluada antes y después del entrenamiento. Los síntomas de intrusión se evaluaron directamente después del entrenamiento y después de una semana utilizando una Tarea de Provocación de Intrusión (IPT), registro diario de intrusiones (por una semana), y la subescala de intrusión retrospectiva de la Escala del Impacto del Evento - Revisada (IES-R). Los resultados indicaron que ambos grupos experimentaron mejoras en la CMT y reducción de intrusiones en la segunda IPT posterior al entrenamiento, sin diferencias entre los grupos. De manera similar, no se encontraron diferencias de grupo en las intrusiones en el seguimiento de una semana (es decir, en el diario de intrusiones y la IES-R). Para concluir, estos datos no son consistentes con la hipótesis de que la CMT desempeña un papel en la re-experiencia intrusiva. Se discuten las implicaciones para futuras investigaciones