Effects of stress

Complex cognitive tasks such as mental arithmetic heavily rely on intact, well-coordinated prefrontal cortex (PFC) function. Converging evidence suggests that frontal midline theta (FMT) oscillations play an important role during the execution of such PFC-dependent tasks. Additionally, it is well- established that acute stress impairs PFC function, and recent evidence suggests that FMT is decreased under stress. In this EEG study, we investigated FMT oscillations during a mental arithmetic task that was carried out in a stressful and a neutral control condition. Our results show late- onset, sustained FMT increases during mental arithmetic. In the neutral condition FMT started to increase earlier than in the stress condition. Direct comparison of the conditions quantified this difference by showing stronger FMT increases in the neutral condition in an early time window. Between- subject correlation analysis showed that attenuated FMT under stress was related to slowed reaction times. Our results suggest that FMT is associated with stimulus independent mental processes during the natural and complex PFC- dependent task of mental arithmetic, and is a possible marker for intact PFC function that is disrupted under stress

Effects of empathic paraphrasing – extrinsic emotion regulation in social conflict

In the present study, we investigated the effects of empathic paraphrasing as an extrinsic emotion regulation technique in social conflict. We hypothesized that negative emotions elicited by social conflict can be regulated extrinsically in a conversation by a listener following the narrator’s perspective and verbally expressing cognitive empathy. Twenty participants were interviewed on an ongoing or recently self-experienced social conflict. The interviewer utilized 10 standardized open questions inviting participants to describe their perception of the conflict. After each of the 10 descriptions, the interviewer responded by either paraphrasing or taking notes (control condition). Valence ratings pertaining to the current emotional state were assessed during the interview along with psychophysiological and voice recordings. Participants reported feeling less negative after hearing the interviewer paraphrase what they had said. In addition, we found a lower sound intensity of participants’ voices when answering to questions following a paraphrase. At the physiological level, skin conductance response, as well as heart rate, were higher during paraphrasing than during taking notes, while blood volume pulse amplitude was lower during paraphrasing, indicating higher autonomic arousal. The results show that demonstrating cognitive empathy through paraphrasing can extrinsically regulate negative emotion on a short-term basis. Paraphrasing led to enhanced autonomic activation in recipients, while at the same time influencing emotional valence in the direction of feeling better. A possible explanation for these results is that being treated in an empathic manner may stimulate a more intense emotion processing helping to transform and resolve the conflict

Interaction of HPA axis genetics and early life stress shapes emotion recognition in healthy adults

Background: Early life stress (ELS) affects facial emotion recognition (FER), as well as the underlying brain network. However, there is considerable inter-individual variability in these ELS-caused alterations. As the hypothalamic-pituitary-adrenal (HPA) axis is assumed to mediate neural and behavioural sequelae of ELS, the genetic disposition towards HPA axis reactivity might explain differential vulnerabilities. Methods: An additive genetic profile score (GPS) of HPA axis reactivity was built from 6 SNPs in 3 HPA axisrelated genes (FKBP5, CRHR1, NR3C1). We studied two independent samples. As a proof of concept, GPS was tested as a predictor of cortisol increase to a psychosocial challenge (MIST) in a healthy community sample of n=40. For the main study, a sample of n=170 completed a video-based FER task and retrospectively reported ELS experiences in the Childhood Trauma Questionnaire (CTQ). Results: GPS positively predicted cortisol increase in the stress challenge over and above covariates. CTQ and genetic profile scores interacted to predict facial emotion recognition, such that ELS had a detrimental effect on emotion processing only in individuals with higher GPS. Post-hoc moderation analyses revealed that, while a less stress-responsive genetic profile was protective against ELS effects, individuals carrying a moderate to high GPS were affected by ELS in their ability to infer emotion from facial expressions. Discussion: These results suggest that a biologically informed genetic profile score can capture the genetic disposition to HPA axis reactivity and moderates the influence of early environmental factors on facial emotion recognition. Further research should investigate the neural mechanisms underlying this moderation. The GPS used here might prove a powerful tool for studying inter-individual differences in vulnerability to early life stress

On Perceived Stress and Social Support: Depressive, Anxiety and Trauma-Related Symptoms in Arabic-Speaking Refugees in Jordan and Germany

Current literature points toward several challenges in the access to sufficient and effective psychosocial care for Syrian refugees in host settings. This study is a comparative investigation into the relationship between “perceived social stress” and “perceived social support” on three of the most prevalent symptom dimensions in Syrian refugees across two host capitals, Berlin and Amman. Eighty nine Syrians refugees were recruited between January 2017 and March 2018. Participants were contacted through local institutions and organizations collaborating with the Charité—Universitätsmedizin Berlin. Assessments include the PHQ-9, GAD-7, HTQ, MSPSS, and PSS. Primary analyses consist of non- or parametric tests and multiple linear regression analyses. Subsample analyses showed relevant depressive, anxiety and trauma-related symptoms. Significant differences in PTSD symptoms (p < 0.04) were found. Participants reported high perceived stress and moderate to high social support. Linear regressions revealed that perceived stress had a significant negative effect (p < 0.01) on clinical outcomes in both subsamples. Perceived social support had a positive influence on depressive (p = 0.02) and PTSD symptoms (p = 0.04) for participants in Berlin. Analyses revealed significant positive effects of “significant others” (p = 0.05) on depressive- in Berlin and “family” (p = 0.03) support for PTSD symptoms in Amman. Study results show that levels of “perceived stress” appear to be the same across different host countries, whereas types of social support and their effect onmental health differ significantly depending on the host setting. Outcomes may guide future comparative study designs and investigations to promote well-being, integration, and the development of effective social support structures for the diverse needs of Arabic-speaking refugees

Faith-Based Coping Among Arabic-Speaking Refugees Seeking Mental Health Services in Berlin, Germany: An Exploratory Qualitative Study

Background: The benefits of faith-based coping or using religious and spiritual beliefs as a stabilizing force for interpreting stressful or distressing events are largely unexplored among the exodus of Arabic-speaking refugee populations from Muslim-majority countries, particularly those resettled in Europe. The present study aimed to explore the manifestation of faith-based coping strategies among Arabic-speaking refugee adults seeking mental healthcare services in Berlin, Germany and explore how favorable faith-based coping strategies can be optimized from a mental health service-delivery and broader integration perspective. Methods: A total of 17 qualitative interviews were conducted with Arabic-speaking refugee adults (six females, 11 males) seeking mental health services at the Charite Universitaetsmedizin in Berlin. Research questions aimed to solicit comprehensive perspectives from refugee adults on their mental health, with an emphasis on faith-based coping, and how this facilitated or impeded their integration into German society. Interview transcripts were translated to English from Arabic and analyzed using MAXQDA (2018) to highlight thematic patterns using a grounded theory approach. Results: Findings were structured into four themes, including: (I) faith-based coping methods during flight, (II) changes in faith practices upon arrival, (III) faith-based coping methods to address distress during integration, and (IV) advice for German mental healthcare providers. Participants who demonstrated a stronger commitment to faith were more likely to utilize faith-based coping strategies when seeking mental health services and facing the challenges of displacement and integration. Examples of faith-based coping included prayer, supplication, reciting scripture, and seeking help from a local religious leader. Conclusion: The findings suggest how faith and faith practices play a significant role in the mental health and integration of refugee populations in Germany and provide insight on how mental healthcare can be delivered in a culturally-sensitive manner, providing alternatives to the social, cultural, and linguistic barriers posed by the German health system. These findings are particularly relevant for mental health professionals, non-governmental organizations, and humanitarian aid agencies providing mental healthcare to Arabic-speaking populations recently resettled in Western contexts

Psychotherapy in Jordan: An Investigation of the Host and Syrian Refugee Community's Perspectives

Little is known about patient satisfaction, bias, stigma, and the effects of psychotherapy within the Kingdom of Jordan or the Arab world in general. The purpose of this study was to explore the perceptions of both the Jordanian host and refugee community members from the psychotherapeutic services offered at various mental health care settings in Jordan. A sample of 100 patients who received psychosocial expert interventions was recruited between October and December 2017 in Amman, Jordan. Participants were either from the host or Syrian refugee community or contacted through multiple organizations working in the mental health field. The Patient Satisfaction Questionnaire, which consists of four subscales covering 1) patient satisfaction, 2) bias toward therapy, 3) effects of therapy, and 4) stigma, was administered. As a means of investigation and exploration, descriptive statistics of participant responses are displayed. Results revealed overall high rates of satisfaction with provided services and perceived benefits of psychotherapeutic interventions. However, respondents showed ambivalence regarding bias and stigma. Subsample analyses indicated no significant differences between both communities. These findings give an understanding of perceptions surrounding psychotherapy in Jordan and some insights on therapeutic processes that may be useful for clinical applications and future research

A qualitative study on resilience in adult refugees in Germany

Background: Because refugees face significant adversities before, during, and after resettlement, resilience is of central importance to this population. However, strengths-based research on post-migration refugee experiences is sparse. Methods: We conducted semi-structured interviews with 54 adult refugee participants who arrived in Germany between 2013 and 2018 in their preferred language. We analyzed different aspects of resilience in these interviews using thematic analysis. Results: Nine themes were identified. Four themes manifest resilience in different ways and encompass cognitive as well as behavioral strategies for facing adversity, self-ascriptions of resilience as a personal trait or lasting characteristic, and the role of volunteering, work, and activism for refugee causes. Five themes capture factors that facilitate resilience: social support, experiencing migration as an opportunity generally and for women in particular, being a parent, and being young. Conclusions: This study adds to a growing body of knowledge about resilience among adult refugees. It may support clinicians working with refugees by making them aware of specific manifestations of resilience and factors promoting positive adaptation specific to this client group. It also contributes to a more strengths-based view on refugee mental health and processes of integration

Electroconvulsive therapy for negative symptoms in schizophrenia: a literature review from 2000 to 2021

Negative symptoms in schizophrenia remain a clinical challenge with small effect sizes and evidence for pharmacological or psychotherapeutic treatment approaches. Studies suggest that electroconvulsive therapy (ECT) holds some promise as a treatment option of often persistent negative symptoms with clinically meaningful effects. This review summarizes the existing evidence on the efficacy of ECT on negative symptoms in patients with schizophrenia. Thirty-five publications were included in this literature review comprising 21 studies, two meta-analyses, eight reviews and four case reports. Conclusions should be interpreted cautiously, given the small number and methodological shortcomings of the included publications with a variation of study designs and missing standardized protocols. Implications for future research and practice are critically discussed. Recommendations are given to provide more evidence that will meet the clinical challenge of reducing the negative symptoms in schizophrenia. Study designs that focus explicitly on negative symptoms and assess patients over longer follow up periods could be helpful. Future research should include control groups, and possibly establish international multicentered studies to get a sufficient study population. Findings suggest that patients with schizophrenia resistant to pharmacological treatment might benefit from ECT. A risk and benefit assessment speaks in favour of the ECT treatment. Future practice of ECT should include a combination treatment with antipsychotics. Whereas the use of anaesthetics and electrode placement does not seem to play a role, the recommendation regarding frequency of ECT treatments is currently three times a week, For the assessment of negative symptoms the assessment tool should be chosen carefully

Development of a culturally sensitive Arabic version of the Mini International Neuropsychiatric Interview (M.I.N.I.-AR) and validation of the depression module

Background: Arabic represents one of the most frequently spoken languages worldwide, especially among refugee populations. There is a pressing need for specialized diagnostic tools corresponding to the DSM-5 criteria in Modern Standard Arabic, which can be administered on Arabic speakers in the West and Arab region alike. Objectives: To develop and validate the culturally-adapted version of the most recent M.I.N.I. 7.0.2 into Modern Standard Arabic-a form of Arabic commonly used across all Arab countries. Methods: 102 participants were recruited between April 2019 to March 2020 at the Charite - Universitatsmedizin in Berlin. Symptoms were assessed with Arabic versions of rater-based and self-rated measures, including Mini International Neuropsychiatric Interview (M.I.N.I.), Patient Health Questionnaire (PHQ-9), and Harvard Trauma Questionnaire (HTQ). Arabic-speaking psychiatrists saw participants for diagnostic assessment. Results: Cohen's kappa (kappa) values were moderate for major depression, and slight for post-traumatic stress disorder, as well as generalized anxiety disorder. Moreover, kappa values indicated moderate agreement between M.I.N.I.-AR and PHQ-9 for depression, as well as HTQ for post-traumatic stress disorder, respectively. Conclusion: The translated and culturally adapted version of the M.I.N.I. addresses an existing need for a reliable, efficient, and effective comprehensive diagnostic tool using the most recent DSM-5 criteria in Modern Standard Arabic (MSA). Based on the obtained results, only a validation of the depression module (Module A) of the M.I.N.I-AR was possible. Study outcomes also show evidence for the validation of Module H covering Post-Traumatic Stress Disorder. Potential valuable contributions can be extended to this translation and validation

Mental Health and Integration: A Qualitative Study on the Struggles of Recently Arrived Refugees in Germany

Introduction: Forcibly displaced people are at particular risk of mental health problems and also face specific integration challenges upon resettlement. Existing literature suggests that there may be a bidirectional relationship between mental health and integration. The present study seeks to understand the relationship between integration processes and mental health problems or significant negative emotional experiences among adult refugees in Germany. Method: Applying a qualitative approach, we conducted 54 semi-structured interviews with refugees and asylum seekers who arrived in Germany between 2013 and 2018 currently residing in Berlin, Leipzig, or the Duisburg area in North Rhine-Westphalia. Data was collected between December 2018 and September 2019. We analyzed transcripts inductively using thematic analysis. Results: Five themes covering the various links between integration and mental health problems or significant negative emotional experiences were identified. First, we found that the mental health consequences of past adverse experiences, as well as ongoing worries about those left behind in the homeland, can seriously impede refugees' ability to pursue activities key to integration. Second, the process of applying for and securing asylum can result in uncertainty and fear, which, in turn, burden the individual and may impact motivation for integration. Third, many of our participants described mental health ramifications related to feeling stuck and thwarted in the pursuit of building a life, especially in securing employment. Fourth, some participants described feeling so overwhelmed by fundamental tasks throughout the integration process, namely, language learning and bureaucratic processes, that these take a psychological toll. Fifth, we identified several forms of social disconnection between refugees and members of the host community due to xenophobia, social and cultural differences, physical and emotional isolation in refugee camps, as well as with co-nationals and fellow refugees. Negative emotions, mistrust, and socio-cultural differences that emerge throughout the integration processes seem to erode social cohesion among refugee communities, potentially further threatening mental health. Conclusion: Mental health problems and integration processes appear to be closely related across different areas of integration. Innovative solutions to challenges identified by members of the refugee community in Germany stand to benefit mental health and integration outcomes simultaneously