Beyond the screen – The potential of smartphone apps and immersive technologies in exposure-based interventions for phobias

Specific phobias are extremely common among adults. They are characterized by strong emotional reactions and avoidance behavior when exposed to the feared stimuli. Specifically fears concerning heights or animals such as spiders are highly prevalent, followed by fear of social situations such as fear of public speaking. The gold standard in treating specific phobias is exposure-based therapy. However, exposure-based therapy is limited in its practicability in clinical routine and poses a high hurdle for affected individuals. Virtual and augmented reality (VR/AR) smartphone apps offer attractive platforms to simulate exposure situations and by that increase the accessibility of mental health services in general. Thus, novel smartphone-based treatments hold the potential to facilitate the dissemination of exposure-based treatments for specific phobias. The studies presented as part of this thesis aimed at investigating three newly developed interventions for fear of heights, fear of public speaking and fear of spiders, using the currently available advanced technologies. In the first study (Bentz et al., 2021), a stand-alone, automated and gamified VR exposure app Easyheights was developed using 360° images. The app’s effectiveness to reduce fear of heights and avoidance behavior was investigated in a randomized controlled trial in an adult population with clinical and subclinical fear of heights. The repeated use of the app led to reduced fear and avoidance behavior in a real-life situation on a tower. For the second study (Müller, Fehlmann et al., 2022), the developed stand-alone, automated and gamified VR exposure app Fearless Speech aimed at reducing public speaking anxiety (PSA) and avoidance of eye contact. A virtual audience with 360° videos was used for the exposure and gaze control for the eye contact training. The app was investigated in a randomized controlled trial in healthy adults with subclinical PSA. After the repeated use of the app, participants showed reduced fear and improved eye contact in a real-life speech situation. The third study (Zimmer et al., 2021) examined the developed stand-alone, automated and gamified AR exposure app Phobys. In comparison to VR, AR has only recently been introduced to clinical research. The app was designed to reduce fear, disgust and avoidance behavior in adults with clinical and subclinical fear of spiders. The results of the randomized controlled trial showed that repeatedly using the app led to reduced fear, disgust and avoidance behavior in a real-life situation with a real spider. The results of these studies support the potential of stand-alone, automated VR and AR interventions delivered through smartphone apps. The developed apps allow for a high-quality user experience with a highly realistic environment, gaze control for an easy navigation as well as the possibility of interaction. In addition, gamification elements foster engagement with the apps. All three investigated apps offer low-threshold and low-cost treatment for individuals affected by specific phobias. Testing the effectiveness of these newly developed apps in real-life settings sets them apart from previous studies. Hence, this thesis highlights the potential of using smartphone apps with immersive technologies to advance and disseminate exposure-based treatments for specific phobias

The Impact of Individual Investment Behavior for Retirement Welfare: Evidence from the United States and Germany

Much of the industrialized world is undergoing a significant demographic shift, placing strain on public pension systems. Policymakers are responding with pension system reforms that put more weight on privately managed retirement funds. One concern with these changes is the effect on individual welfare if individuals invest suboptimally. Using micro-level data from the United States and Germany, we compare the optimal expected lifetime utility computed using a realistically calibrated model with the actual utility as reflected in empirical asset allocation choices. Through this analysis, we are able to identify the population subgroups with relatively large welfare losses. Our results should be helpful to public policymakers in designing programs to improve the performance of privately organized retirement systems.Asset Allocation, Retirement Welfare, Pension Reform

Futtermittel-spezifisches IgG und IgE vor und nach Eliminationsdiäten bei allergischen Hunden

Serum food allergen-specific antibody testing is widely offered to identify suitable ingredients for diets to diagnose adverse food reaction (AFR) in dogs with allergic skin disease. Antibody concentrations in blood samples obtained during an unsuccessful diet to help in the choice of diet changes may be influenced by the previous diet. The objective of this paper was to measure food antigen-specific IgE and IgG for the most commonly used 16 food antigens before and after an elimination diet. Levels of food-specific serum IgE and IgG antibodies were measured by enzyme-linked immunosorbent assay (ELISA). Dogs had detectableIgE antibodies to beef, pork, lamb and cows’ milk; and detectable IgG antibodies to beef, pork, lamb, cows’ milk, chicken and turkey. Of 19 dogs with complete data sets, 14 dogs showed clear improvement during diet and in 7 dogs AFR could be diagnosed by deterioration on rechallenge and subsequent improvement on refeeding the diet. Serum was obtained before and 6-8 weeks after beginning such a diet. There was no significant difference in pre- and post-diet levels for any of the individual allergens nor for the total IgE and IgG concentrations of all antigens (P=0.55 and P=0.53 respectively). In these 19 dogs in which an elimination diet was used for the diagnosis of food allergy and in which 14 were probably food allergic and 7 were proven food allergic there were no significant differences in food-specific antibodies before and after an elimination diet of 6-8 weeks

Mechanical losses in low loss materials studied by Cryogenic Resonant Acoustic spectroscopy of bulk materials (CRA spectroscopy)

Mechanical losses of crystalline silicon and calcium fluoride have been analyzed in the temperature range from 5 to 300 K by our novel mechanical spectroscopy method, cryogenic resonant acoustic spectroscopy of bulk materials (CRA spectrocopy). The focus lies on the interpretation of the measured data according to phonon-phonon interactions and defect induced losses in consideration of the excited mode shape.Comment: 4 pages, 4 figures, proceedings of the PHONONS 2007, submitted to Journal of Physics: Conference Serie

Effects of karate training versus mindfulness training on emotional well-being and cognitive performance in later life

In a randomized controlled trial, we investigated the effects of karate versus a mindfulness-based stress reduction (MBSR) intervention on well-being and cognitive functioning in older adults. Fifty-five adults (52-81 years old) participated in twice-weekly karate versus MBSR sessions or no training for 8 weeks. In pre- and postassessments, subjective well-being, health, cognitive functioning, and chronic stress were measured. Preassessment hair cortisol served as physiological stress marker. The results showed an improvement for the karate group, but not the MBSR and control group, in subjective mental health and anxiety as well as cognitive processing speed. The MBSR group showed by trend as a decrease in stress. No significant correlation between preassessment hair cortisol and postassessment outcomes could be established. But the higher the level of baseline self-reported perceived stress, the higher the increase in depression, anxiety, and chronic stress. Generally, it can be assumed that karate and MBSR showed only small training effects concerning the assessed emotional and cognitive parameters

Effectiveness of a stand-alone, smartphone-based virtual reality exposure app to reduce fear of heights in real-life: a randomized trial

Smartphone-based virtual reality (VR) applications (apps) might help to counter low utilization rates of available treatments for fear of heights. Demonstration of effectiveness in real-life situations of such apps is crucial, but lacking so far. Objective of this study was to develop a stand-alone, smartphone-based VR exposure app-Easy Heights-and to test its effectiveness in a real-life situation. We performed a single-blind, parallel group, randomized controlled trial. We recruited 70 participants with fear of heights, aged 18-60 years. Primary outcome was performance in a real-life Behavioral Avoidance Test (BAT) on a lookout tower after a single 1-h app use (phase 1) and after additional repeated (6 × 30 min) app use at home (phase 2). After phase 2, but not phase 1, participants in the Easy Heights condition showed significantly higher BAT scores compared to participants in the control condition (Cohen's d = 1.3, p = 0.0001). Repeated use of our stand-alone, smartphone-based VR exposure app reduces avoidance behavior and fear, providing a low-threshold treatment for fear of heights

The relevance of private actors in the transnational sphere for just peace governance

"Vor dem Hintergrund der Bedeutungszunahme privater Akteure in den internationalen Beziehungen (wird im) Arbeitspapier systematisch (aufgezeigt), welche Rolle diese nicht-staatlichen Akteure in Konflikten um Anerkennung, um prozedurale oder distributive Gerechtigkeit spielen. Rebellengruppen, kriminelle Organisationen, transnationale Unternehmen, zivilgesellschaftliche Organisationen oder ethnische Diasporas - sie tragen einerseits zur Multiplikation von Gerechtigkeitsansprüchen im transnationalen Raum bei; andererseits beteiligen sie sich an neuen, innovativen Governance-Formen, um Gerechtigkeitskonflikte beizulegen. Im Working Paper wird die Frage gestellt, unter welchen Bedingungen die Einbeziehung der Gerechtigkeitsansprüche privater Akteure einer friedlichen Konfliktlösung zuträglich ist oder sie behindert. Diese Ambivalenz nichtstaatlicher Akteure wird im Hinblick auf die Begriffstrias Frieden, Governance und Gerechtigkeit konzeptionalisiert." (Autorenreferat

Effectiveness of a smartphone-based, augmented reality exposure app to reduce fear of spiders in real-life : A randomized controlled trial

Although in vivo exposure therapy is highly effective in the treatment of specific phobias, only a minority of patients seeks therapy. Exposure to virtual objects has been shown to be better tolerated, equally efficacious, but the technology has not been made widely accessible yet. We developed an augmented reality (AR) application (app) to reduce fear of spiders and performed a randomized controlled trial comparing the effects of our app (six 30-min sessions at home over a two-week period) with no intervention. Primary outcome was subjective fear, measured by a Subjective Units of Distress Scale (SUDS) in a Behavioural Approach Test (BAT) in a real-life spider situation at six weeks follow-up. Between Oct 7, 2019, and Dec 6, 2019, 66 individuals were enrolled and randomized. The intervention led to significantly lower subjective fear in the BAT compared to the control group (intervention group, baseline: 7.12 [SD 2.03] follow-up: 5.03 [SD 2.19] vs. control group, baseline: 7.06 [SD 2.34], follow-up 6.24 [SD 2.21]; adjusted group difference -1.24, 95 % CI -2.17 to -0.31; Cohen’s d = 0.57, p = 0.010). The repeated use of the AR app reduces subjective fear in a real-life spider situation, providing a low-threshold and low-cost treatment for fear of spiders

Early Exanthema Upon Vemurafenib Plus Cobimetinib Is Associated With a Favorable Treatment Outcome in Metastatic Melanoma: A Retrospective Multicenter DeCOG Study

Background: The combination of BRAF and MEK inhibitors has become standard of care in the treatment of metastatic BRAF V600-mutated melanoma. Clinical factors for an early prediction of tumor response are rare. The present study investigated the association between the development of an early exanthema induced by vemurafenib or vemurafenib plus cobimetinib and therapy outcome. Methods: This multicenter retrospective study included patients with BRAF V600-mutated irresectable AJCC-v8 stage IIIC/D to IV metastatic melanoma who received treatment with vemurafenib (VEM) or vemurafenib plus cobimetinib (COBIVEM). The development of an early exanthema within six weeks after therapy start and its grading according to CTCAEv4.0 criteria was correlated to therapy outcome in terms of best overall response, progression-free (PFS), and overall survival (OS). Results: A total of 422 patients from 16 centers were included (VEM, n=299; COBIVEM, n=123). 20.4% of VEM and 43.1% of COBIVEM patients developed an early exanthema. In the VEM cohort, objective responders (CR/PR) more frequently presented with an early exanthema than non-responders (SD/PD); 59.0% versus 38.7%; p=0.0027. However, median PFS and OS did not differ between VEM patients with or without an early exanthema (PFS, 6.9 versus 6.0 months, p=0.65; OS, 11.0 versus 12.4 months, p=0.69). In the COBIVEM cohort, 66.0% of objective responders had an early exanthema compared to 54.3% of non-responders (p=0.031). Median survival times were significantly longer for patients who developed an early exanthema compared to patients who did not (PFS, 9.7 versus 5.6 months, p=0.013; OS, not reached versus 11.6 months, p=0.0061). COBIVEM patients with a mild early exanthema (CTCAEv4.0 grade 1-2) had a superior survival outcome as compared to COBIVEM patients with a severe (CTCAEv4.0 grade 3-4) or non early exanthema, respectively (p=0.047). This might be caused by the fact that 23.6% of patients with severe exanthema underwent a dose reduction or discontinuation of COBIVEM compared to only 8.9% of patients with mild exanthema. Conclusions: The development of an early exanthema within 6 weeks after treatment start indicates a favorable therapy outcome upon vemurafenib plus cobimetinib. Patients presenting with an early exanthema should therefore be treated with adequate supportive measures to provide that patients can stay on treatment

High density lipoprotein mediates anti-inflammatory transcriptional reprogramming of macrophages via the transcriptional repressor ATF3

High Density Lipoprotein (HDL) mediates reverse cholesterol transport and it is known to be protective against atherosclerosis. In addition, HDL has potent anti-inflammatory properties that may be critical for protection against other inflammatory diseases. The molecular mechanisms of how HDL can modulate inflammation, particularly in immune cells such as macrophages, remain poorly understood. Here we identify the transcriptional repressor ATF3, as an HDL-inducible target gene in macrophages that down-regulates the expression of Toll-like receptor (TLR)-induced pro-inflammatory cytokines. The protective effects of HDL against TLR-induced inflammation were fully dependent on ATF3 in vitro and in vivo. Our findings may explain the broad anti-inflammatory and metabolic actions of HDL and provide the basis for predicting the success of novel HDL-based therapies