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Hautle LL, Kurath J, Jellestad L, Lüönd AM, Wingenbach TSH, Jansson B, Pfaltz MC. Larger comfortable interpersonal distances in adults exposed to child maltreatment: The role of depressive symptoms and social anxiety. Br J Psychol 2024. [PMID: 38651545 DOI: 10.1111/bjop.12705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/15/2024] [Accepted: 03/24/2024] [Indexed: 04/25/2024]
Abstract
Previous studies report a preference for larger comfortable interpersonal distance (CIPD) in individuals with child maltreatment (CM) when being approached by others. Yet, research on approaching others, as opposed to being approached, as well as on potential effects of social anxiety and depression is lacking. We investigated if CM and depressive symptoms influence CIPD and if social anxiety mediates the possible association of CM and CIPD when approaching a female stranger. One hundred ten participants with CM (CM) and 58 participants without CM (non-CM) experiences performed the stop-distance paradigm and stopped first when feeling uncomfortable (D1) and again when feeling very uncomfortable (D2). CM experiences were associated with a preference for larger CIPD, independent of depressive symptoms. All CM subtypes were associated with a larger D2. The relationship between CM and CIPD was partially mediated by social anxiety. These novel findings can help to develop interventions strengthening socially relevant skills and processes in those affected by CM, targeting alterations in social anxiety and depression.
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Affiliation(s)
- Lara-Lynn Hautle
- Medical Faculty, University of Zurich, Zürich, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zürich, Switzerland
| | - Jennifer Kurath
- Medical Faculty, University of Zurich, Zürich, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zürich, Switzerland
| | - Lena Jellestad
- Medical Faculty, University of Zurich, Zürich, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zürich, Switzerland
| | - Antonia M Lüönd
- Medical Faculty, University of Zurich, Zürich, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zürich, Switzerland
| | - Tanja S H Wingenbach
- Medical Faculty, University of Zurich, Zürich, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zürich, Switzerland
- School of Human Sciences, Faculty of Education, Health, and Human Sciences, University of Greenwich, London, UK
| | - Billy Jansson
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Monique C Pfaltz
- Medical Faculty, University of Zurich, Zürich, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zürich, Switzerland
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
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Bartoli E, Wadji DL, Oe M, Cheng P, Martin-Soelch C, Pfaltz MC, Langevin R. Perceived Acceptability of Child Maltreatment as a Moderator of the Association Between Experiences of Child Maltreatment and Post-Traumatic Symptoms: A Cross-Cultural Study. J Interpers Violence 2024:8862605241234348. [PMID: 38450674 DOI: 10.1177/08862605241234348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Despite the well-documented link between child maltreatment (CM) and mental health, evidence suggests substantial variability in the post-traumatic sequelae of CM across cultures. The perceived acceptability of CM in one's community might moderate the association between CM and mental health, but little research has been conducted on it so far. This study examined how the perceived acceptability of CM may influence the relationship between CM experiences and post-traumatic symptoms in individuals from four different continents and if the pattern of associations is the same across countries. We recruited a sample of 478 adults from Cameroon (n = 111), Canada (n = 137), Japan (n = 108), and Germany (n = 122). We administered online questionnaires and performed multiple group moderation analyses for total CM, neglect, physical abuse, emotional maltreatment, sexual abuse, and exposure to domestic violence (DV). A significant positive main effect of CM on post-traumatic symptoms was found in the overall sample and in Cameroon; in Germany, only neglect and emotional maltreatment were positively associated to post-traumatic symptoms. Moderation effects were identified; the perceived acceptability of neglect in Cameroon and Germany and of exposure to DV in Cameroon had a dampening effect on the relationship between CM experiences and post-traumatic symptoms. Our findings confirm that CM experiences entail long-term post-traumatic sequelae that can vary across cultures and CM subtypes and further our understanding of this issue by showing that the perceived acceptability of CM may be an understudied moderator.
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Lüönd AM, Thoma MF, Spiller TR, Weilenmann S, Jansson B, Pfaltz MC. Construct validity of the German version of the Emotion Reactivity Scale. BMC Psychol 2023; 11:423. [PMID: 38042821 PMCID: PMC10693029 DOI: 10.1186/s40359-023-01458-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/20/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND Emotional reactivity is an important construct to consider when studying mental disorders. This study was conducted to translate and assess the factor structure, construct validity and internal consistency of a German version of the Emotion Reactivity Scale (ERS), which is an originally English questionnaire assessing three components of emotional reactivity: sensitivity, intensity and persistence of emotions. METHODS The German ERS and a range of questionnaires used to assess convergent and discriminant validity were completed by 334 German speaking Swiss participants. RESULTS Confirmatory factor analysis showed strong support for a bi-factor model, with evaluation indices pointing to a unidimensional construct rather than to domain specific factors. The questionnaire showed good reliability and the factor structure was similar across gender. The ERS showed convergent validity with general psychopathology, behavioral inhibition, negative affect, orienting sensitivity, depressive symptoms and symptoms of disordered eating, and discriminant validity with behavioral activation and alcohol consumption. CONCLUSIONS Findings support the construct validity of the German ERS and suggest that it assesses a unidimensional construct with high internal consistency. Accounting for the unidimensional nature of the scale and aiming for efficient assessment tools, future research could, based on these findings, develop and evaluate the psychometric properties of a short version of the ERS.
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Affiliation(s)
- Antonia M Lüönd
- Medical Faculty, University of Zurich, Zurich, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Martina F Thoma
- Medical Faculty, University of Zurich, Zurich, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Tobias R Spiller
- Medical Faculty, University of Zurich, Zurich, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Sonja Weilenmann
- Medical Faculty, University of Zurich, Zurich, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Billy Jansson
- Department of Psychology and Social Work, Mid Sweden University, Kunskapens Väg 1, Östersund, Sweden
| | - Monique C Pfaltz
- Medical Faculty, University of Zurich, Zurich, Switzerland.
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland.
- Department of Psychology and Social Work, Mid Sweden University, Kunskapens Väg 1, Östersund, Sweden.
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Pfaltz MC, Schnyder U. Allostatic Load and Allostatic Overload: Preventive and Clinical Implications. Psychother Psychosom 2023; 92:279-282. [PMID: 37931612 PMCID: PMC10716872 DOI: 10.1159/000534340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 09/27/2023] [Indexed: 11/08/2023]
Affiliation(s)
- Monique C Pfaltz
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
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Spaaij J, de Graaff AM, Akhtar A, Kiselev N, McDaid D, Moergeli H, Pfaltz MC, Schick M, Schnyder U, Bryant RA, Cuijpers P, Sijbrandij M, Morina N. The effect of a low-level psychological intervention (PM+) on post-migration living difficulties - Results from two studies in Switzerland and in the Netherlands. Compr Psychiatry 2023; 127:152421. [PMID: 37708580 DOI: 10.1016/j.comppsych.2023.152421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/01/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023] Open
Abstract
AIMS OF THE STUDY After arriving in host countries, most refugees are confronted with numerous post-migration stressors (e.g., separation from family, discrimination, and employment difficulties). Post-migration living difficulties (PMLDs) significantly contribute to the development and persistence of mental disorders. Effective treatment approaches focusing on reducing post-migration stress are urgently needed. The aim of the present study was to examine the effect of a brief psychological intervention, Problem Management Plus (PM+), on PMLDs among Syrian refugees in two European countries. METHODS We merged data from two single-blind feasibility trials with Syrian refugees experiencing elevated levels of psychological distress and impaired functioning in Switzerland (N = 59) and the Netherlands (N = 60). Participants were randomised to receive either five sessions of PM+ or an enhanced care-as-usual control condition. PMLDs were assessed at baseline and 3 months after the intervention. To estimate treatment effect on PMLD, linear mixed model analysis was performed. RESULTS Three months after the intervention, participants in the PM+ condition reported significantly fewer PMLDs compared to the control condition. Further analyses at item-level showed that interpersonal and family related PMLDs, such as "worries about family back home" significantly improved over time in the PM+ condition. CONCLUSIONS This exploratory study suggests that brief psychological interventions have the potential to reduce PMLDs in refugees and asylum seekers. The reduction of post-migration stress in turn may subsequently lead to an overall reduction in psychological distress. CLINICAL TRIAL NUMBERS BASEC Nr. 2017-0117 (Swiss trial) and NL61361.029.17, 7 September 2017 (Dutch trial).
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Affiliation(s)
- Julia Spaaij
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anne M de Graaff
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Aemal Akhtar
- School of Psychology, University of New South Wales, Sydney, Australia; Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Nikolai Kiselev
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland; PluSport, Umbrella Organization of Swiss Disabled Sports, Volketswil, Switzerland; Swiss Research Institute of Public Health and Addiction (ISGF), University of Zürich, Zurich, Switzerland
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Hanspeter Moergeli
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Monique C Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Mid Sweden University, Department of Psychology and Social Work, Östersund, Sweden
| | - Matthis Schick
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
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Wadji DL, Oe M, Bartoli E, Martin-Soelch C, Pfaltz MC, Langevin R. How are experiences and acceptability of child maltreatment related to resilience and posttraumatic growth: a cross cultural study. Eur J Psychotraumatol 2023; 14:2264119. [PMID: 37830143 PMCID: PMC10578086 DOI: 10.1080/20008066.2023.2264119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/22/2023] [Indexed: 10/14/2023] Open
Abstract
Background: Post-traumatic growth (PTG) and resilience, regarded as positive psychological change following a traumatic experience, are under-researched across cultures in people exposed to child maltreatment (CM).Objective: We investigated how experiences and the perceived acceptability of CM are related to resilience and PTG in countries with different cultures, living standards, and gross national income.Method: A total of 478 adults from Cameroon (n = 111), Canada (n = 137), Japan (n = 108), and Germany (n = 122) completed an online survey with self-reported questionnaires, including the Brief Resilience Scale and the Post Traumatic Growth Inventory-Short Form.Results: Across countries, self-reported male gender and age were positively associated with resilience, while experiences of physical abuse and emotional maltreatment were negatively associated with resilience. Experiences of emotional maltreatment were positively associated with PTG. Higher levels of PTG and resilience were found amongst Cameroonian participants as compared to other countries.Conclusion: Our results suggest that positive changes following CM can vary significantly across cultures and that experiences of specific CM subtypes, but not the perceived acceptability of CM, may be important for a deeper understanding of how individuals overcome trauma and develop salutogenic outcomes. Our findings may inform CM intervention programmes for an enhanced cultural sensitivity.
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Affiliation(s)
- Dany Laure Wadji
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
| | - Misari Oe
- Department of Neuropsychiatry, School of Medicine, Kurume University, Kurume, Japan
| | - Eleonora Bartoli
- Department of Psychology and Sport Sciences, Goethe University of Frankfurt, Frankfurt, Germany
| | | | - Monique C. Pfaltz
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Rachel Langevin
- Department of Educational and Counselling Psychology, McGill University, Montreal, Canada
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Fares-Otero NE, Alameda L, Pfaltz MC, Martinez-Aran A, Schäfer I, Vieta E. Examining associations, moderators and mediators between childhood maltreatment, social functioning, and social cognition in psychotic disorders: a systematic review and meta-analysis. Psychol Med 2023; 53:5909-5932. [PMID: 37458216 PMCID: PMC10520610 DOI: 10.1017/s0033291723001678] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/11/2023] [Accepted: 05/23/2023] [Indexed: 07/24/2023]
Abstract
Childhood maltreatment (CM) has been related to social functioning and social cognition impairment in people with psychotic disorders (PD); however, evidence across different CM subtypes and social domains remains less clear. We conducted a systematic review and meta-analysis to quantify associations between CM, overall and its different subtypes (physical/emotional/sexual abuse, physical/emotional neglect), and domains of social functioning and social cognition in adults with PD. We also examined moderators and mediators of these associations. A PRISMA-compliant systematic search was performed on 24 November 2022 (PROSPERO CRD42020175244). Fifty-three studies (N = 13 635 individuals with PD) were included in qualitative synthesis, of which 51 studies (N = 13 260) with 125 effects sizes were pooled in meta-analyses. We found that CM was negatively associated with global social functioning and interpersonal relations, and positively associated with aggressive behaviour, but unrelated to independent living or occupational functioning. There was no meta-analytic evidence of associations between CM and social cognition. Meta-regression analyses did not identify any consistent moderation pattern. Narrative synthesis identified sex and timing of CM as potential moderators, and depressive symptoms and maladaptive personality traits as possible mediators between CM and social outcomes. Associations were of small magnitude and limited number of studies assessing CM subtypes and social cognition are available. Nevertheless, adults with PD are at risk of social functioning problems after CM exposure, an effect observed across multiple CM subtypes, social domains, diagnoses and illness stages. Maltreated adults with PD may thus benefit from trauma-related and psychosocial interventions targeting social relationships and functioning.
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Affiliation(s)
- Natalia E. Fares-Otero
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clínic Barcelona, Institute of Neurosciences (UBNeuro), Barcelona, Catalonia, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences University of Barcelona (UB), Barcelona, Catalonia, Spain
- Fundació Clínic per a la Recerca Biomèdica (FCRB), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Barcelona, Catalonia, Spain
| | - Luis Alameda
- Service of General Psychiatry, Treatment and Early Intervention in Psychosis Program, University Hospital (CHUV), Lausanne, Switzerland
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College of London, London, UK
- Department of Psychiatry, CIBERSAM, Institute of Biomedicine of Sevilla (IBIS), University Hospital Virgen del Rocio, University of Seville, Seville, Spain
| | - Monique C. Pfaltz
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Anabel Martinez-Aran
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clínic Barcelona, Institute of Neurosciences (UBNeuro), Barcelona, Catalonia, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences University of Barcelona (UB), Barcelona, Catalonia, Spain
- Fundació Clínic per a la Recerca Biomèdica (FCRB), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Barcelona, Catalonia, Spain
| | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Department of Psychiatry and Psychology, Hospital Clínic Barcelona, Institute of Neurosciences (UBNeuro), Barcelona, Catalonia, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences University of Barcelona (UB), Barcelona, Catalonia, Spain
- Fundació Clínic per a la Recerca Biomèdica (FCRB), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Network Centre for Biomedical Research in Mental Health (CIBERSAM), Health Institute Carlos III (ISCIII), Barcelona, Catalonia, Spain
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Wingenbach TSH, Peyk P, Pfaltz MC. It does not need two: Assessing physiological linkage from videos across the valence dimension. Psychophysiology 2023; 60:e14317. [PMID: 37118949 DOI: 10.1111/psyp.14317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/28/2023] [Accepted: 04/03/2023] [Indexed: 04/30/2023]
Abstract
The phenomenon of physiological linkage describes similar fluctuations of two individuals' physiology, for example, the cardiac inter-beat interval (IBI). Physiological linkage is a well-documented occurrence in research settings of interacting dyads but the literature on non-interacting dyads, that is, someone watching a video of another person, is sparse. The current study investigated whether physiological linkage, based on IBI, occurs from watching videos where strangers report about personal (neutral, positive, negative non-traumatic, and negative traumatic) experiences. Videos were produced with six individuals and then presented to observers (N = 26). Time-frequency-domain cross-wavelet analyses supplemented by threshold-free cluster enhancement (TFCE; to account for multiple testing) showed significant physiological linkage between the IBI of observers and persons in the videos for 16 out of the 21 tested videos. Although significant physiological linkage also emerged for neutral videos and positive, negative valence videos led to such associations more reliably. This study shows that physiological linkage can be investigated in highly controlled conditions based on video stimuli paving the path for experimental manipulation in future research. Furthermore, due to the provision of information on time and frequency, the use of cross-wavelet analysis is encouraged to learn more about factors modulating physiological linkage. The current study presents the next step toward identifying psychophysiological causal and modulating factors of physiological linkage.
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Affiliation(s)
- Tanja S H Wingenbach
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine Zurich, University of Zurich, Zurich, Switzerland
- Faculty of Education, Health, and Human Sciences, School of Human Sciences, University of Greenwich, London, UK
| | - Peter Peyk
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Monique C Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine Zurich, University of Zurich, Zurich, Switzerland
- Department of Psychology and Social Work, Mid Sweden University, Sundsvall, Sweden
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Wadji DL, Oe M, Cheng P, Bartoli E, Martin-Soelch C, Pfaltz MC, Langevin R. Associations between experiences of childhood maltreatment and perceived acceptability of child maltreatment: A cross-cultural and exploratory study. Child Abuse Negl 2023; 143:106270. [PMID: 37301113 DOI: 10.1016/j.chiabu.2023.106270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 05/17/2023] [Accepted: 05/28/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Acceptable parental behaviors and practices toward a child vary across countries and may impact the risk of exposure to maltreatment. Conversely, prior experiences of maltreatment as a child may influence the acceptability of child maltreatment (CM) behaviors. OBJECTIVE This exploratory study examined the association between CM experiences and perceived acceptability of CM using data from four countries representing different cultures, living standards, and gross national income. PARTICIPANTS AND SETTING We recruited a convenience sample of 478 adults from Cameroon (n = 111), Canada (n = 137), Japan (n = 108), and Germany (n = 122) through online postings on social media. METHODS We administered questionnaires and conducted a three-stage hierarchical multiple regression with perceived acceptability of CM subscales as the dependent variable. RESULTS In all countries, higher scores of childhood neglect were associated with greater perceived acceptability of neglect in one's community (p < .001). Equally, our results showed that higher scores of childhood neglect or sexual abuse were associated with greater perceived acceptability of sexual abuse (p < .044). However, we did not find a significant relationship between other forms of CM (i.e., physical abuse, emotional maltreatment, exposure to domestic violence), and their perceived acceptability. CONCLUSIONS Our findings suggest that experiences of some CM types, namely neglect and sexual abuse, may be associated with the perception that these are more acceptable within one's community. Perceived acceptability of CM might be a driver that can either prevent or perpetuate CM. Therefore, intervention and prevention programs could incorporate a deeper cross-cultural understanding and assessment of these social norms in order to foster meaningful behavioral changes.
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Affiliation(s)
- Dany Laure Wadji
- Department of Psychology, University of Fribourg, Fribourg, Switzerland; Sainte-Justine University Hospital Center, Montreal, Canada
| | - Misari Oe
- Department of Neuropsychiatry, School of Medicine, Kurume University, Kurume, Japan
| | - Polly Cheng
- Department of Psychology and Sport Sciences of the Goethe University of Frankfurt, Germany
| | - Eleonora Bartoli
- Department of Educational and Counselling Psychology, McGill University, Canada
| | | | - Monique C Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital, University of Zurich, Zurich, Switzerland; Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Rachel Langevin
- Department of Psychology and Sport Sciences of the Goethe University of Frankfurt, Germany.
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10
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Hautle LL, Kurath J, Jellestad L, Lüönd AM, Wingenbach TSH, Frühholz S, Jansson B, Niedtfeld I, Pfaltz MC. Individuals with and without child maltreatment experiences are evaluated similarly and do not differ in facial affect display at zero- and first-acquaintance. Borderline Personal Disord Emot Dysregul 2023; 10:17. [PMID: 37210564 DOI: 10.1186/s40479-023-00222-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/27/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Individuals with a history of child maltreatment (CM) are more often disliked, rejected and victimized compared to individuals without such experiences. However, contributing factors for these negative evaluations are so far unknown. OBJECTIVE Based on previous research on adults with borderline personality disorder (BPD), this preregistered study assessed whether negative evaluations of adults with CM experiences, in comparison to unexposed controls, are mediated by more negative and less positive facial affect display. Additionally, it was explored whether level of depression, severity of CM, social anxiety, social support, and rejection sensitivity have an influence on ratings. METHODS Forty adults with CM experiences (CM +) and 40 non-maltreated (CM-) adults were filmed for measurement of affect display and rated in likeability, trustworthiness, and cooperativeness by 100 independent raters after zero-acquaintance (no interaction) and 17 raters after first-acquaintance (short conversation). RESULTS The CM + and the CM- group were neither evaluated significantly different, nor showed significant differences in affect display. Contrasting previous research, higher levels of BPD symptoms predicted higher likeability ratings (p = .046), while complex post-traumatic stress disorder symptoms had no influence on ratings. CONCLUSIONS The non-significant effects could be attributed to an insufficient number of participants, as our sample size allowed us to detect effects with medium effect sizes (f2 = .16 for evaluation; f2 = .17 for affect display) with a power of .95. Moreover, aspects such as the presence of mental disorders (e.g., BPD or post-traumatic stress disorder), might have a stronger impact than CM per se. Future research should thus further explore conditions (e.g., presence of specific mental disorders) under which individuals with CM are affected by negative evaluations as well as factors that contribute to negative evaluations and problems in social relationships.
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Affiliation(s)
- Lara-Lynn Hautle
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Jennifer Kurath
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Lena Jellestad
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Antonia M Lüönd
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Tanja S H Wingenbach
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
- School of Human Sciences, Faculty of Education, Health, and Human Sciences, University of Greenwich, London, UK
| | - Sascha Frühholz
- Department of Psychology, Cognitive and Affective Neuroscience, University of Zurich, Zurich, Switzerland
| | - Billy Jansson
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Inga Niedtfeld
- Department of Psychosomatic Medicine, Medical Faculty Mannheim at, Central Institute of Mental Health, Heidelberg University, J5, 68159, Mannheim, Germany
| | - Monique C Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland.
- Medical Faculty, University of Zurich, Zurich, Switzerland.
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden.
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11
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Hautle LL, Jellestad L, Schenkel S, Wingenbach TSH, Peyk P, Schnyder U, Weilenmann S, Pfaltz MC. Adults with a history of childhood maltreatment with and without mental disorders show alterations in the recognition of facial expressions. Eur J Psychotraumatol 2023; 14:2214388. [PMID: 37317552 DOI: 10.1080/20008066.2023.2214388] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
Background: Individuals with child maltreatment (CM) experiences show alterations in emotion recognition (ER). However, previous research has mainly focused on populations with specific mental disorders, which makes it unclear whether alterations in the recognition of facial expressions are related to CM, to the presence of mental disorders or to the combination of CM and mental disorders, and on ER of emotional, rather than neutral facial expressions. Moreover, commonly, recognition of static stimulus material was researched.Objective: We assessed recognition of dynamic (closer to real life) negative, positive and neutral facial expressions in individuals characterised by CM, rather than a specific mental disorder. Moreover, we assessed whether they show a negativity bias for neutral facial expressions and whether the presence of one or more mental disorders affects recognition.Methods: Ninety-eight adults with CM experiences (CM+) and 60 non-maltreated (CM-) adult controls watched 200 non-manipulated coloured video sequences, showing 20 neutral and 180 emotional facial expressions, and indicated whether they interpreted each expression as neutral or as one of eight emotions.Results: The CM+ showed significantly lower scores in the recognition of positive, negative and neutral facial expressions than the CM- group (p < .050). Furthermore, the CM+ group showed a negativity bias for neutral facial expressions (p < .001). When accounting for mental disorders, significant effects stayed consistent, except for the recognition of positive facial expressions: individuals from the CM+ group with but not without mental disorder scored lower than controls without mental disorder.Conclusions: CM might have long-lasting influences on the ER abilities of those affected. Future research should explore possible effects of ER alterations on everyday life, including implications of the negativity bias for neutral facial expressions on emotional wellbeing and relationship satisfaction, providing a basis for interventions that improve social functioning.
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Affiliation(s)
- Lara-Lynn Hautle
- Medical Faculty, University of Zurich, Zurich, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Lena Jellestad
- Medical Faculty, University of Zurich, Zurich, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Sebastian Schenkel
- Medical Faculty, University of Zurich, Zurich, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Tanja S H Wingenbach
- Medical Faculty, University of Zurich, Zurich, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
- School of Human Sciences, Faculty of Education, Health, and Human Sciences, University of Greenwich, London, UK
| | - Peter Peyk
- Medical Faculty, University of Zurich, Zurich, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Ulrich Schnyder
- Medical Faculty, University of Zurich, Zurich, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Sonja Weilenmann
- Medical Faculty, University of Zurich, Zurich, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Monique C Pfaltz
- Medical Faculty, University of Zurich, Zurich, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
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12
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Spiller TR, Méan M, Ernst J, Sazpinar O, Gehrke S, Paolercio F, Petry H, Pfaltz MC, Morina N, Aebischer O, Gachoud D, von Känel R, Weilenmann S. Development of health care workers' mental health during the SARS-CoV-2 pandemic in Switzerland: two cross-sectional studies. Psychol Med 2022; 52:1395-1398. [PMID: 32787976 PMCID: PMC7450239 DOI: 10.1017/s0033291720003128] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/25/2020] [Accepted: 08/11/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Virus outbreaks such as the current SARS-CoV-2 pandemic are challenging for health care workers (HCWs), affecting their workload and their mental health. Since both, workload and HCW's well-being are related to the quality of care, continuous monitoring of working hours and indicators of mental health in HCWs is of relevance during the current pandemic. The existing investigations, however, have been limited to a single study period. We examined changes in working hours and mental health in Swiss HCWs at the height of the pandemic (T1) and again after its flattening (T2). METHODS We conducted two cross-sectional online studies among Swiss HCWs assessing working hours, depression, anxiety, and burnout. From each study, 812 demographics-matched participants were included into the analysis. Working hours and mental health were compared between the two samples. RESULTS Compared to prior to the pandemic, the share of participants working less hours was the same in both samples, whereas the share of those working more hours was lower in the T2 sample. The level of depression did not differ between the samples. In the T2 sample, participants reported more anxiety, however, this difference was below the minimal clinically important difference. Levels of burnout were slightly higher in the T2 sample. CONCLUSIONS Two weeks after the health care system started to transition back to normal operations, HCWs' working hours still differed from their regular hours in non-pandemic times. Overall anxiety and depression among HCWs did not change substantially over the course of the current SARS-CoV-2 pandemic.
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Affiliation(s)
- Tobias R. Spiller
- Department of Medicine, University of Zurich, Zurich, Switzerland
- University of Zurich and Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Marie Méan
- Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Jutta Ernst
- Center for Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Onur Sazpinar
- Department of Internal Medicine, Spital Zollikerberg, Zollikon, Switzerland
| | - Samuel Gehrke
- University of Zurich and Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | | | - Heidi Petry
- Center for Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Monique C. Pfaltz
- Department of Medicine, University of Zurich, Zurich, Switzerland
- University of Zurich and Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Naser Morina
- Department of Medicine, University of Zurich, Zurich, Switzerland
- University of Zurich and Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Oriane Aebischer
- Educational Unit, School of Medicine, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - David Gachoud
- Department of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
- Educational Unit, School of Medicine, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Roland von Känel
- Department of Medicine, University of Zurich, Zurich, Switzerland
- University of Zurich and Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Sonja Weilenmann
- University of Zurich and Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
- Department of Psychology, University of Zurich, Zurich, Switzerland
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13
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de Graaff AM, Cuijpers P, Acarturk C, Akhtar A, Alkneme MS, Aoun M, Awwad M, Bawaneh AY, Brown FL, Bryant R, Burchert S, Carswell K, Drogendijk A, Engels M, Fuhr DC, Hansen P, van 't Hof E, Giardinelli L, Hemmo M, Hessling JM, Ilkkursun Z, Jordans MJD, Kiselev N, Knaevelsrud C, Kurt G, Martinmäki S, McDaid D, Morina N, Naser H, Park AL, Pfaltz MC, Roberts B, Schick M, Schnyder U, Spaaij J, Steen F, Taha K, Uygun E, Ventevogel P, Whitney C, Witteveen AB, Sijbrandij M. Scalable psychological interventions for Syrian refugees in Europe and the Middle East: STRENGTHS study protocol for a prospective individual participant data meta-analysis. BMJ Open 2022; 12:e058101. [PMID: 35443961 PMCID: PMC9021771 DOI: 10.1136/bmjopen-2021-058101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The World Health Organization's (WHO) scalable psychological interventions, such as Problem Management Plus (PM+) and Step-by-Step (SbS) are designed to be cost-effective non-specialist delivered interventions to reduce symptoms of common mental disorders, such as anxiety, depression and post-traumatic stress disorder (PTSD). The STRENGTHS consortium aims to evaluate the effectiveness, cost-effectiveness and implementation of the individual format of PM+ and its group version (gPM+), as well as of the digital SbS intervention among Syrian refugees in seven countries in Europe and the Middle East. This is a study protocol for a prospective individual participant data (IPD) meta-analysis to evaluate (1) overall effectiveness and cost-effectiveness and (2) treatment moderators of PM+, gPM+ and SbS with Syrian refugees. METHODS AND ANALYSIS Five pilot randomised controlled trials (RCTs) and seven fully powered RCTs conducted within STRENGTHS will be combined into one IPD meta-analytic dataset. The RCTs include Syrian refugees of 18 years and above with elevated psychological distress (Kessler Psychological Distress Scale (K10>15)) and impaired daily functioning (WHO Disability Assessment Schedule 2.0 (WHODAS 2.0>16)). Participants are randomised into the intervention or care as usual control group, and complete follow-up assessments at 1-week, 3-month and 12-month follow-up. Primary outcomes are symptoms of depression and anxiety (25-item Hopkins Symptom Checklist). Secondary outcomes include daily functioning (WHODAS 2.0), PTSD symptoms (PTSD Checklist for DSM-5) and self-identified problems (PSYCHLOPS). We will conduct a one-stage IPD meta-analysis using linear mixed models. Quality of evidence will be assessed using the GRADE approach, and the economic evaluation approach will be assessed using the CHEC-list. ETHICS AND DISSEMINATION Local ethical approval has been obtained for each RCT. This IPD meta-analysis does not require ethical approval. The results of this study will be published in international peer-reviewed journals.
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Affiliation(s)
- Anne M de Graaff
- Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ceren Acarturk
- Department of Psychology, Koç University, Istanbul, Turkey
| | - Aemal Akhtar
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Mhd Salem Alkneme
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universitat Berlin, Berlin, Germany
| | - May Aoun
- Research and Development Department, War Child, Amsterdam, The Netherlands
| | - Manar Awwad
- Technical Unit, International Medical Corps, London, UK
| | | | - Felicity L Brown
- Research and Development Department, War Child, Amsterdam, The Netherlands
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Richard Bryant
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Sebastian Burchert
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universitat Berlin, Berlin, Germany
| | - Kenneth Carswell
- Department of Mental Health and Substance Abuse, World Health Organization, Geneve, Switzerland
| | | | - Michelle Engels
- International Federation of Red Cross and Red Crescent Societies Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | - Daniela C Fuhr
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Pernille Hansen
- International Federation of Red Cross and Red Crescent Societies Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | - Edith van 't Hof
- Department of Mental Health and Substance Abuse, World Health Organization, Geneve, Switzerland
| | | | - Mahmoud Hemmo
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Jonas M Hessling
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universitat Berlin, Berlin, Germany
| | | | - Mark J D Jordans
- Research and Development Department, War Child, Amsterdam, The Netherlands
- Amsterdam Institute of Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Nikolai Kiselev
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Christine Knaevelsrud
- Division of Clinical-Psychological Intervention, Department of Education and Psychology, Freie Universitat Berlin, Berlin, Germany
| | - Gülsah Kurt
- Department of Psychology, Koç University, Istanbul, Turkey
| | - Saara Martinmäki
- ARQ International, ARQ National Psychotrauma Centre, Amsterdam, The Netherlands
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, The London School of Economics and Political Science, London, UK
| | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Hadeel Naser
- Technical Unit, International Medical Corps, London, UK
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, The London School of Economics and Political Science, London, UK
| | - Monique C Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
- Department of Psychology and Social Work, Mid Sweden University, Sundsvall, Sweden
| | - Bayard Roberts
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthis Schick
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Ulrich Schnyder
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Julia Spaaij
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Frederik Steen
- Research and Development Department, War Child, Amsterdam, The Netherlands
| | - Karine Taha
- Research and Development Department, War Child, Amsterdam, The Netherlands
| | - Ersin Uygun
- Trauma and Disaster Mental Health Master Programme, Istanbul Bilgi University, Istanbul, İstanbul, Turkey
| | - Peter Ventevogel
- Public Health, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | | | - Anke B Witteveen
- Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, World Health Organization Collaborating Center for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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14
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Pfaltz MC, Halligan SL, Haim-Nachum S, Sopp MR, Åhs F, Bachem R, Bartoli E, Belete H, Belete T, Berzengi A, Dukes D, Essadek A, Iqbal N, Jobson L, Langevin R, Levy-Gigi E, Lüönd AM, Martin-Soelch C, Michael T, Oe M, Olff M, Ceylan D, Raghavan V, Ramakrishnan M, Sar V, Spies G, Wadji DL, Wamser-Nanney R, Fares-Otero NE, Schnyder U, Seedat S. Social Functioning in Individuals Affected by Childhood Maltreatment: Establishing a Research Agenda to Inform Interventions. Psychother Psychosom 2022; 91:238-251. [PMID: 35381589 PMCID: PMC9393832 DOI: 10.1159/000523667] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/12/2022] [Indexed: 12/30/2022]
Abstract
Childhood maltreatment (CM) is linked to impairments in various domains of social functioning. Here, we argue that it is critical to identify factors that underlie impaired social functioning as well as processes that mediate the beneficial health effects of positive relationships in individuals exposed to CM. Key research recommendations are presented, focusing on: (1) identifying attachment-related alterations in specific inter- and intrapersonal processes (e.g., regulation of closeness and distance) that underlie problems in broader domains of social functioning (e.g., lack of perceived social support) in individuals affected by CM; (2) identifying internal (e.g., current emotional state) and external situational factors (e.g., cultural factors, presence of close others) that modulate alterations in specific social processes; and (3) identifying mechanisms that explain the positive health effects of intact social functioning. Methodological recommendations include: (1) assessing social processes through interactive and (close to) real-life assessments inside and outside the laboratory; (2) adopting an interdisciplinary, lifespan perspective to assess social processes, using multi-method assessments; (3) establishing global research collaborations to account for cultural influences on social processes and enable replications across laboratories and countries. The proposed line of research will contribute to globally develop and refine interventions that prevent CM and further positive relationships, which - likely through buffering the effects of chronic stress and corresponding allostatic load - foster resilience and improve mental and physical health, thereby reducing personal suffering and the societal and economic costs of CM and its consequences. Interventions targeting euthymia and psychological well-being are promising therapeutic concepts in this context.
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Affiliation(s)
- Monique C. Pfaltz
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital, University of Zurich, Zurich, Switzerland
| | - Sarah L. Halligan
- Department of Psychology, University of Bath, Bath, United Kingdom
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Marie R. Sopp
- School of Education, Bar-Ilan University, Bar-Ilan, Israel
- Division of Clinical Psychology and Psychotherapy, Saarland University, Saarland, Germany
| | - Fredrik Åhs
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Rahel Bachem
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Eleonora Bartoli
- Faculty of Psychology, Goethe University of Frankfurt, Frankfurt, Germany
| | - Habte Belete
- Department of Psychiatry, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tilahun Belete
- Department of Psychiatry, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Azi Berzengi
- University of East Anglia, Norwich, United Kingdom
| | - Daniel Dukes
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
- Department of Special Education, University of Fribourg, Fribourg, Switzerland
| | - Aziz Essadek
- Interpsy EA4432, University of Lorraine, Lorraine, France
| | - Naved Iqbal
- Department of Psychology, Jamia Millia islamia, New Delhi, India
| | - Laura Jobson
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Monash, Australian Capital Territory, Australia
| | - Rachel Langevin
- Department of Educational and Counselling Psychology, McGill University, Montreal, Québec, Canada
| | | | - Antonia M. Lüönd
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital, University of Zurich, Zurich, Switzerland
| | | | - Tanja Michael
- Division of Clinical Psychology and Psychotherapy, Saarland University, Saarland, Germany
| | - Misari Oe
- Department of Neuropsychiatry, School of Medicine, Kurume University, Kurume, Japan
| | - Miranda Olff
- Department of Psychiatry, Amsterdam Neuroscience and Public Health, Amsterdam UMC, Amsterdam, The Netherlands
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - Deniz Ceylan
- Department of Psychiatry, Koç University School of Medicine, Koç, Turkey
| | | | | | - Vedat Sar
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Georgina Spies
- DSI/NRF South African Research Chairs Initiative in PTSD, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
- Department of Psychology, University of Yaounde 1, Yaounde, Cameroon
| | - Dany Laure Wadji
- Department of Psychological Sciences, University of Missouri St. Louis, St. Louis, Missouri, USA
- Department of Psychology, University of Fribourg, Fribourg, Switzerland
| | - Rachel Wamser-Nanney
- CIBERSAM: Biomedical Research Networking Center for Mental Health Network, Department of Psychiatry and Psychology, Bipolar and Depressive Disorders Unit, Institute of Neurosciences, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Ulrich Schnyder
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital, University of Zurich, Zurich, Switzerland
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
- DSI/NRF South African Research Chairs Initiative in PTSD, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
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15
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Weilenmann S, von Luckner A, Peyk P, Huber C, Schnyder U, Pfaltz MC. Experimental Induction of Emotional and Sexual Intimacy: Exploring the Validity of the German Fast Friends Procedure in Individuals with and without Childhood Maltreatment. Arch Sex Behav 2022; 51:1703-1719. [PMID: 34761346 DOI: 10.1007/s10508-021-02081-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/26/2021] [Accepted: 06/10/2021] [Indexed: 06/13/2023]
Abstract
The Fast Friends Procedure (FFP) is a widely used experimental paradigm to induce emotional intimacy. Besides exploring the validity of a German translation of the paradigm (n = 46), we developed an extension of the FFP that induces sexual intimacy and assessed heart rate, high-frequency heart rate variability, and electrodermal activity responses to the FFP and its extension. Furthermore, we examined its applicability to individuals with childhood maltreatment (n = 56), who frequently suffer from intimacy-related difficulties. Intimacy, positive affect, liking, and attraction increased during the FFP and partly during the sexual intimacy extension in both study groups. Moreover, both groups showed physiological responses consistent with positive social interactions. The use of the German FFP and its sexual intimacy extension can thus be recommended for research in the general population and in individuals with childhood maltreatment, although more studies are needed to further validate the paradigms.
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Affiliation(s)
- Sonja Weilenmann
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Haldenbachstrasse 18, 8091, Zürich, Switzerland.
- Medical Faculty, University of Zurich, Zurich, Switzerland.
| | - Alexander von Luckner
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Haldenbachstrasse 18, 8091, Zürich, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Peter Peyk
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Haldenbachstrasse 18, 8091, Zürich, Switzerland
| | - Charlotte Huber
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Haldenbachstrasse 18, 8091, Zürich, Switzerland
| | | | - Monique C Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Haldenbachstrasse 18, 8091, Zürich, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
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16
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Spaaij J, Kiselev N, Berger C, Bryant RA, Cuijpers P, de Graaff AM, Fuhr DC, Hemmo M, McDaid D, Moergeli H, Park AL, Pfaltz MC, Schick M, Schnyder U, Wenger A, Sijbrandij M, Morina N. Feasibility and acceptability of Problem Management Plus (PM+) among Syrian refugees and asylum seekers in Switzerland: a mixed-method pilot randomized controlled trial. Eur J Psychotraumatol 2022; 13:2002027. [PMID: 35126880 PMCID: PMC8812734 DOI: 10.1080/20008198.2021.2002027] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Syrian refugees in Switzerland face several barriers in accessing mental health care. Cost-effective psychological interventions are urgently needed to meet the mental health needs of refugees. Problem Management Plus (PM+) is an evidence-based, psychological intervention delivered by trained non-specialist 'helpers'. OBJECTIVE To assess the feasibility and acceptability of PM+ among Syrian refugees in Switzerland. METHODS We conducted a single-blind pilot randomized controlled trial (RCT) with Syrian refugees impaired by psychological distress (K10 > 15 and WHODAS 2.0 > 16). Participants were randomized to PM+ or Enhanced Treatment As Usual (ETAU). Participants were assessed at baseline, and 1 week and 3 months after the intervention, and completed measures indexing mental health problems and health care usage. Semi-structured interviews were conducted with different stakeholders. RESULTS N = 59 individuals were randomized into PM+ (n = 31) or ETAU (n = 28). N = 18 stakeholders were interviewed about facilitators and barriers for the implementation of PM+. Retention rates in the trial (67.8%) and mean intervention attendance (M = 3.94 sessions, SD = 1.97) were high. No severe events related to the study were reported. These findings indicate that the trial procedures and PM+ were feasible, acceptable and safe. CONCLUSIONS The findings support the conduct of a definitive RCT and show that PM+ might have the potential to be scaled-up in Switzerland. The importance, as well as the challenges, of implementing and scaling-up PM+ in high-income countries, such as Switzerland, are discussed.
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Affiliation(s)
- Julia Spaaij
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nikolai Kiselev
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christine Berger
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Institute, and Who Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anne M de Graaff
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Daniela C Fuhr
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Mahmoud Hemmo
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - David McDaid
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Hanspeter Moergeli
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - A-La Park
- Department of Health Policy, Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Monique C Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Matthis Schick
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Ulrich Schnyder
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Anna Wenger
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Medical Faculty, University of Zurich, Zurich, Switzerland
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17
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Lüönd AM, Wolfensberger L, Wingenbach TSH, Schnyder U, Weilenmann S, Pfaltz MC. Don't get too close to me: depressed and non-depressed survivors of child maltreatment prefer larger comfortable interpersonal distances towards strangers. Eur J Psychotraumatol 2022; 13:2066457. [PMID: 35957629 PMCID: PMC9359181 DOI: 10.1080/20008198.2022.2066457] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Childhood maltreatment (CM) is frequently linked to interpersonal problems such as difficulties in social relationships, loneliness, and isolation. These difficulties might partly stem from troubles regulating comfortable interpersonal distance (CIPD). OBJECTIVE We experimentally investigated whether CM manifests in larger CIPD and whether all subtypes of CM (i.e., physical, emotional, or sexual abuse and physical or emotional neglect) affect CIPD. METHODS Using the stop-distance method (i.e. a team member approached participants until the latter indicated discomfort), we assessed CIPD in 84 adults with a self-reported history of CM (24 with depressive symptoms) and 57 adult controls without a history of CM (without depressive symptoms). RESULTS Adults with CM showed a larger CIPD (Mdn = 86 cm) than controls (Mdn = 68 cm), and CIPD was largest for those with CM combined with current depressive symptoms (Mdn = 145 cm) (p's < .047). In the latter group, all subtypes of CM were associated with a larger CIPD compared to controls (p's < .045). In the CM group without depressive symptoms, only those with emotional abuse (p = .040) showed a larger CIPD than controls. CONCLUSIONS These results add to findings of differential socio-emotional long-term consequences of CM, depending upon the subtype of CM. Future research should explore whether a larger CIPD has a negative impact on social functioning in individuals exposed to CM, particularly in those with depressive symptoms. HIGHLIGHTS Adults with child maltreatment (CM) prefer larger physical distances.• This effect is more pronounced in those with CM and depressive symptoms.• Troubled regulation of physical distance might contribute to interpersonal problems.
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Affiliation(s)
- Antonia M Lüönd
- Medical Faculty, University of Zurich, Zürich, Switzerland.,Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zürich, Switzerland
| | - Lukas Wolfensberger
- Medical Faculty, University of Zurich, Zürich, Switzerland.,Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zürich, Switzerland
| | - Tanja S H Wingenbach
- Medical Faculty, University of Zurich, Zürich, Switzerland.,Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zürich, Switzerland
| | | | - Sonja Weilenmann
- Medical Faculty, University of Zurich, Zürich, Switzerland.,Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zürich, Switzerland
| | - Monique C Pfaltz
- Medical Faculty, University of Zurich, Zürich, Switzerland.,Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zürich, Switzerland.,Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
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18
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Ernst J, Jordan KD, Weilenmann S, Sazpinar O, Gehrke S, Paolercio F, Petry H, Pfaltz MC, Méan M, Aebischer O, Gachoud D, Morina N, von Känel R, Spiller TR. Burnout, depression and anxiety among Swiss medical students - A network analysis. J Psychiatr Res 2021; 143:196-201. [PMID: 34500349 DOI: 10.1016/j.jpsychires.2021.09.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/24/2021] [Accepted: 09/01/2021] [Indexed: 11/28/2022]
Abstract
It is well established that burnout in medical students is associated with depression and anxiety at a syndromal level. Moreover, there is an ongoing debate about the extent to which burnout overlaps with depression and anxiety. The emerging network approach to psychopathology offers a new perspective on the interrelations between mental disorders focusing on symptom-level association. In this cross-sectional study, we exploratively investigated the associations among burnout, depression, and anxiety in 574 swiss medical students using a network analytic approach for the first time. Symptoms of depression and anxiety were assessed with the Patient Health Questionnaire and Generalized Anxiety Disorder respectively. Burnout was assessed with two single-item questions, one referring to emotional exhaustion and the other to depersonalization. We found a dense network in which at least one dimension of burnout was related to eleven of the sixteen included symptoms. This suggests that burnout is closely related to depression and anxiety but also has its own characteristics. Notably, suicidal ideation was not associated with either emotional exhaustion or depersonalization after adjusting for the influence of the remaining symptoms of anxiety and depression. Hence, the well-documented relationship between burnout and suicidal ideation in medical students may be entirely mediated by the experience of anxiety and depression. Hence, the well-documented relationship between burnout and suicidal ideation in medical students might be fully mediated by the experience of anxiety and depression. The collection of the sample after the first wave of infections during the SARS-CoV2 pandemic and the non-representativeness of the investigated sample limit the study's generalizability.
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Affiliation(s)
- Jutta Ernst
- Center for Clinical Nursing Science, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Katja-Daniela Jordan
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sonja Weilenmann
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Onur Sazpinar
- Department of Internal Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Samuel Gehrke
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Heidi Petry
- Center for Clinical Nursing Science, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Monique C Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marie Méan
- Department of Internal Medicine, Lausanne University Hospital, Switzerland
| | - Oriane Aebischer
- Department of Internal Medicine, Ensemble Hospitalier de la Côte Morges, Switzerland
| | - David Gachoud
- Department of Internal Medicine, Lausanne University Hospital, Switzerland; Educational Unit, School of Medicine, Faculty of Biology and Medicine, University of Lausanne, Switzerland
| | - Naser Morina
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tobias R Spiller
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
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19
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Abstract
Background Health care workers are often affected by burnout, resulting in reduced personal well-being and professional functioning. Although emotional exhaustion is considered a core component of burnout, little is known about the dynamics of emotions and their relation to burnout. We used network analysis to investigate the correlation between the density of a negative emotion network, a marker for emotional rigidity in person-specific networks, and burnout severity. Methods Using an ecological momentary assessment design, the intensity of negative emotions of forty-three health care workers and medical students was assessed five times per day (between 6 am and 8 pm) for 17 days. Burnout symptoms were assessed at the end of the study period with the Maslach Burnout Inventory. Multilevel vector autoregressive models were computed to calculate network density of subject-specific temporal networks. The one-sided correlation between network density and burnout severity was assessed. The study protocol and analytic plan were registered prior to the data collection. Results We found a medium-sized correlation between the negative emotion network density and burnout severity at the end of the study period r(45) = .32, 95% CI = .09–1.0, p = .014). Conclusions The strength of the temporal interplay of negative emotions is associated with burnout, highlighting the importance of emotions and emotional exhaustion in reaction to occupational-related distress in health care workers. Moreover, our findings align with previous investigations of emotion network density and impaired psychological functioning, demonstrating the utility of conceptualizing the dynamics of emotions as a network. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-021-00670-y.
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Affiliation(s)
- Tobias R Spiller
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Culmannstrasse 8, 8091, Zurich, Switzerland.
| | - Sonja Weilenmann
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Culmannstrasse 8, 8091, Zurich, Switzerland
| | - Krithika Prakash
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA
| | | | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Culmannstrasse 8, 8091, Zurich, Switzerland
| | - Monique C Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Culmannstrasse 8, 8091, Zurich, Switzerland.,Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
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20
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Fares-Otero NE, Trautmann S, Pfaltz MC, Rodriguez-Jimenez R. Letter to the Editor: Targeting adverse stress-related consequences of the COVID-19 crisis in individuals with psychotic disorders and childhood maltreatment. J Psychiatr Res 2021; 138:453-455. [PMID: 33964683 PMCID: PMC9750188 DOI: 10.1016/j.jpsychires.2021.04.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/01/2021] [Accepted: 04/20/2021] [Indexed: 02/01/2023]
Affiliation(s)
- Natalia E. Fares-Otero
- Corresponding author. Department of Psychiatry, Biomedical Research Institute, University Hospital 12 de Octubre (imas12), Avda. de Córdoba s/n, 28041, Madrid, Spain
| | | | - Monique C Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, Faculty of Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Roberto Rodriguez-Jimenez
- Department of Psychiatry, Biomedical Research Institute, University Hospital 12 de Octubre (imas12), Faculty of Medicine, Complutense University of Madrid (UCM), Madrid, Spain; CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain
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21
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Weilenmann S, Schnyder U, Keller N, Corda C, Spiller TR, Brugger F, Parkinson B, von Känel R, Pfaltz MC. Self-worth and bonding emotions are related to well-being in health-care providers: a cross-sectional study. BMC Med Educ 2021; 21:290. [PMID: 34020633 PMCID: PMC8139026 DOI: 10.1186/s12909-021-02731-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 05/12/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Interacting with patients can elicit a myriad of emotions in health-care providers. This may result in satisfaction or put providers at risk for stress-related conditions such as burnout. The present study attempted to identify emotions that promote provider well-being. Following eudaimonic models of well-being, we tested whether certain types of emotions that reflect fulfilment of basic needs (self-worth, bonding with patients) rather than positive emotions in general (as suggested by hedonic models) are linked to well-being. Specifically, we hypothesized that well-being is associated with positive emotions directed at the self, which reflect self-worth, and positive as well as negative emotions (e.g., worry) directed at the patient, which reflect bonding. However, we expected positive emotions directed at an object/situation (e.g., curiosity for a treatment) to be unrelated to well-being, because they do not reflect fulfilment of basic needs. METHODS Fifty eight physicians, nurses, and psychotherapists participated in the study. First, in qualitative interviews, they reported their emotions directed at the self, the patient, or an object/situation during distressing interactions with patients. These emotions were categorised into positive emotions directed towards the self, the patient, and an object/situation, and negative emotions directed towards the patient that reflect bonding. Second, providers completed questionnaires to assess their hedonic and eudaimonic well-being. The well-being scores of providers who did and did not experience these emotions were compared. RESULTS Providers who experienced positive emotions directed towards the self or the patient had higher well-being than those who did not. Moreover, for the first time, we found evidence for higher well-being in providers reporting negative patient-directed emotions during distressing interactions. There was no difference between providers who did and did not experience positive object/situation-directed emotions. CONCLUSIONS These findings may point towards the importance of "eudaimonic" emotions rather than just positive emotions in interactions with patients. Emotions such as contentment with oneself, joy for the patient's improvement, and, notably, grief or worry for the patient may build a sense of self-worth and strengthen bonding with the patient. This may explain their association with provider well-being.
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Affiliation(s)
- Sonja Weilenmann
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Haldenbachstrasse 18, CH-8091, Zurich, Switzerland.
- University of Zurich, Zurich, Switzerland.
| | | | - Nina Keller
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Haldenbachstrasse 18, CH-8091, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Claudio Corda
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Haldenbachstrasse 18, CH-8091, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Tobias R Spiller
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Haldenbachstrasse 18, CH-8091, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Fabio Brugger
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Haldenbachstrasse 18, CH-8091, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Brian Parkinson
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Haldenbachstrasse 18, CH-8091, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Monique C Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Haldenbachstrasse 18, CH-8091, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
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22
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Pfaltz MC, Plichta MM, Bockisch CJ, Jellestad L, Schnyder U, Stocker K. Processing of an ambiguous time phrase in posttraumatic stress disorder: Eye movements suggest a passive, oncoming perception of the future. Psychiatry Res 2021; 299:113845. [PMID: 33740482 DOI: 10.1016/j.psychres.2021.113845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 02/27/2021] [Indexed: 10/22/2022]
Abstract
Metaphorically, the future can be perceived as approaching us (time-moving metaphor) or as being approached by us (ego-moving metaphor). Also, in line with findings that our eyes look more up when thinking about the future than the past, the future's location can be conceptualized in upwards terms. Eye movements were recorded in 19 participants with PTSD and 20 healthy controls. Participants with PTSD showed downward and healthy controls upward eye movements while processing an ego/time-moving ambiguous phrase, suggesting a passive (time-moving) outlook toward the future. If replicated, our findings may have implications for the conceptualization and treatment of PTSD.
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Affiliation(s)
- M C Pfaltz
- University of Zurich, Zurich, Switzerland; University Hospital Zurich, Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, Zurich, Switzerland.
| | - M M Plichta
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany
| | - C J Bockisch
- University of Zurich, Zurich, Switzerland; University Hospital Zurich, Departments of Neurology, Ophthalmology, and Otorhinolaryngology, Zurich, Switzerland
| | - L Jellestad
- University Hospital Zurich, Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, Zurich, Switzerland
| | - U Schnyder
- University of Zurich, Zurich, Switzerland
| | - K Stocker
- ETH Zurich, Chair of Cognitive Science; University of Zurich, Institute of Psychology, Zurich, Switzerland; UniDistance Suisse (Brig), Faculty of Psychology, Brig, Switzerland
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23
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Weilenmann S, Ernst J, Petry H, Pfaltz MC, Sazpinar O, Gehrke S, Paolercio F, von Känel R, Spiller TR. Health Care Workers' Mental Health During the First Weeks of the SARS-CoV-2 Pandemic in Switzerland-A Cross-Sectional Study. Front Psychiatry 2021; 12:594340. [PMID: 33815162 PMCID: PMC8012487 DOI: 10.3389/fpsyt.2021.594340] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 02/15/2021] [Indexed: 11/25/2022] Open
Abstract
Objective: The current SARS-CoV-2 pandemic poses various challenges for health care workers (HCWs). This may affect their mental health, which is crucial to maintain high quality medical care during a pandemic. Existing evidence suggests that HCWs, especially women, nurses, frontline staff, and those exposed to COVID-19 patients, are at risk for anxiety and depression. However, a comprehensive overview of risk and protective factors considering their mutual influence is lacking. Therefore, this study aimed at exploring HCWs' mental health during the SARS-CoV-2 pandemic in Switzerland, investigating the independent effect of various demographic, work- and COVID-related factors on HCWs' mental health. Methods: In an exploratory, cross-sectional, nation-wide online survey, we assessed demographics, work characteristics, COVID-19 exposure, and anxiety, depression, and burnout in 1,406 HCWs during the beginning of the SARS-CoV-2 pandemic in Switzerland. Network analysis was used to investigate the associations among the included variables. Results: Women (compared to men), nurses (compared to physicians), frontline staff (compared to non-frontline workers), and HCWs exposed to COVID-19 patients (compared to non-exposed) reported more symptoms than their peers. However, these effects were all small. Perceived support by the employer independently predicted anxiety and burnout after adjustment for other risk factors. Conclusion: Our finding that some HCWs had elevated levels of anxiety, depression, and burnout underscores the importance to systematically monitor HCWs' mental health during this ongoing pandemic. Because perceived support and mental health impairments were negatively related, we encourage the implementation of supportive measures for HCWs' well-being during this crisis.
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Affiliation(s)
- Sonja Weilenmann
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jutta Ernst
- Center for Clinical Nursing Science, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Heidi Petry
- Center for Clinical Nursing Science, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Monique C. Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Onur Sazpinar
- Department of Internal Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Samuel Gehrke
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tobias R. Spiller
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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24
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Fares-Otero NE, Pfaltz MC, Rodriguez-Jimenez R, Schäfer I, Trautmann S. Childhood maltreatment and social functioning in psychotic disorders: a systematic review protocol. Eur J Psychotraumatol 2021; 12:1943872. [PMID: 36877473 PMCID: PMC10075514 DOI: 10.1080/20008198.2021.1943872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Background: Childhood maltreatment (CM) is thought to play a key role in the etiology and course of psychotic disorders (PD). In addition, CM is related to neurobiological and clinical characteristics that can lead to poor social functioning. However, the extent to which CM and social functioning are directly associated in individuals with PD, is unclear. Therefore, we aim to systematically review the literature to provide an estimate on the strength of the association between CM and different domains of social functioning in PD and to summarize potential moderators and mediators of this association.Methods and analysis: To identify relevant studies, we will systematically search the following databases: Pubmed (Medline), PsycInfo, Embase, Web of Science (Core Collection), and Pilots (trauma), manually search reference lists and contact experts in the field. Studies will be included if they investigate and report on the association between CM (exposure) and social functioning (outcome) in adults with PD. Two independent reviewers will screen titles, abstracts and full texts according to eligibility criteria, perform data extraction and assess study quality according to a modified version of the Newcastle-Ottawa Scale.Analysis: Effect estimates will be pooled in a meta-analysis. Heterogeneity and publication bias will be assessed and the effects of potential moderators (genetic factors, type of diagnosis, duration of illness, type of CM and age at the time of CM exposure) will be analyzed using meta-regressions. Candidate moderators and mediators (neurocognition, cognitive schemas, comorbidities, stress sensitivity, attachment) will be also examined qualitatively.Ethics and dissemination: Because this review will make use of already published data, ethical approval will not be sought. This work has the potential to inform upcoming investigations on the association between the exposure to CM in PD and social functioning. PROSPERO registration number CRD42020175244.
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Key Words
- abuso infantil, negligencia, cognicivón social, relaciones interpersonales, funcionamiento en la comunidad, psicosis, revisión sistemática
- child abuse, neglect, social cognitive skills, interpersonal relationships, community functioning, psychosis, systematic review
- 人际关系
- 儿童虐待
- 忽视
- 社会功能
- 社会认知技能
- 精神病
- 系统综述
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Affiliation(s)
- Natalia E Fares-Otero
- Department of Psychiatry, Biomedical Research Institute, University Hospital 12 De Octubre (Imas12), Madrid, Spain.,Universidad Internacional de la Rioja, Spain
| | - Monique C Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, Faculty of Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Roberto Rodriguez-Jimenez
- Department of Psychiatry, Biomedical Research Institute, University Hospital 12 De Octubre (Imas12), Faculty of Medicine, University Complutense de Madrid (UCM), Madrid, Spain, CIBERSAM (Biomedical Research Networking Centre in Mental Health), Madrid, Spain
| | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastian Trautmann
- Department of Psychology, Medical School Hamburg, University of Applied Sciences and Medical University, Hamburg, Germany
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25
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Weilenmann S, Ernst J, Petry H, Pfaltz MC, Sazpinar O, Gehrke S, Paolercio F, von Känel R, Spiller TR. Health Care Workers' Mental Health During the First Weeks of the SARS-CoV-2 Pandemic in Switzerland-A Cross-Sectional Study. Front Psychiatry 2021. [PMID: 33815162 DOI: 10.1101/2020.05.04.20088625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023] Open
Abstract
Objective: The current SARS-CoV-2 pandemic poses various challenges for health care workers (HCWs). This may affect their mental health, which is crucial to maintain high quality medical care during a pandemic. Existing evidence suggests that HCWs, especially women, nurses, frontline staff, and those exposed to COVID-19 patients, are at risk for anxiety and depression. However, a comprehensive overview of risk and protective factors considering their mutual influence is lacking. Therefore, this study aimed at exploring HCWs' mental health during the SARS-CoV-2 pandemic in Switzerland, investigating the independent effect of various demographic, work- and COVID-related factors on HCWs' mental health. Methods: In an exploratory, cross-sectional, nation-wide online survey, we assessed demographics, work characteristics, COVID-19 exposure, and anxiety, depression, and burnout in 1,406 HCWs during the beginning of the SARS-CoV-2 pandemic in Switzerland. Network analysis was used to investigate the associations among the included variables. Results: Women (compared to men), nurses (compared to physicians), frontline staff (compared to non-frontline workers), and HCWs exposed to COVID-19 patients (compared to non-exposed) reported more symptoms than their peers. However, these effects were all small. Perceived support by the employer independently predicted anxiety and burnout after adjustment for other risk factors. Conclusion: Our finding that some HCWs had elevated levels of anxiety, depression, and burnout underscores the importance to systematically monitor HCWs' mental health during this ongoing pandemic. Because perceived support and mental health impairments were negatively related, we encourage the implementation of supportive measures for HCWs' well-being during this crisis.
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Affiliation(s)
- Sonja Weilenmann
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jutta Ernst
- Center for Clinical Nursing Science, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Heidi Petry
- Center for Clinical Nursing Science, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Monique C Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Onur Sazpinar
- Department of Internal Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Samuel Gehrke
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tobias R Spiller
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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26
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Fares-Otero NE, Pfaltz MC, Estrada-Lorenzo JM, Rodriguez-Jimenez R. COVID-19: The need for screening for domestic violence and related neurocognitive problems. J Psychiatr Res 2020; 130:433-434. [PMID: 32891919 PMCID: PMC7443252 DOI: 10.1016/j.jpsychires.2020.08.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/14/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Natalia E. Fares-Otero
- Corresponding author. Department of Psychiatry, Biomedical Research Institute, University Hospital 12 de Octubre (imas12), Avda. de Córdoba s/n, 28041, Madrid, Spain
| | - Monique C Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, Faculty of Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Roberto Rodriguez-Jimenez
- Department of Psychiatry, Biomedical Research Institute, University Hospital 12 de Octubre (imas12), Madrid, Spain; CIBERSAM (Biomedical Research Networking Centre in Mental Health), Spain; Faculty of Medicine, Complutense University of Madrid (UCM), Madrid, Spain
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Dammann G, Rudaz M, Benecke C, Riemenschneider A, Walter M, Pfaltz MC, Küchenhoff J, Clarkin JF, Gremaud-Heitz DJ. Facial Affective Behavior in Borderline Personality Disorder Indicating Two Different Clusters and Their Influence on Inpatient Treatment Outcome: A Preliminary Study. Front Psychol 2020; 11:1658. [PMID: 32849013 PMCID: PMC7403199 DOI: 10.3389/fpsyg.2020.01658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/18/2020] [Indexed: 11/13/2022] Open
Abstract
Background The purpose of the present study was threefold: first, to investigate the facial affective behavior in patients with a borderline personality disorder (BPD); second, to examine whether these patients could be divided into clusters according to facial affective behavior; and third, to test whether these clusters would influence the inpatient treatment outcome. Methods Thirty inpatients with BPD were assessed with the Structured Clinical Interviews for DSM-IV Axis I and II Disorders (SCID I, SCID II) and had to complete a series of questionnaires before and directly after the 12-week long inpatient treatment. Facial affective behavior was recorded during the structured interview for personality organization (STIPO) and afterward coded with the emotional facial action coding system (EMFACS). Measures on psychopathology [beck depression inventory (BDI), Spielberger state and trait anxiety inventory (STAI), Spielberger state and trait anger inventory (STAXI), and symptom cheklist-90-revised (SCL-90-R)], interpersonal problems [Inventory of Interpersonal Problems (IIP)], and personality organization [inventory of personality organization (IPO)] were administered. Results Cluster analysis before the treatment yielded two groups that differed in general facial expressivity, and regarding the display of anger, contempt, and disgust. The effect sizes of the repeated measures ANOVAs showed that persons with higher scores on the affective facial expressions benefitted more from the treatment in terms of STAI state anxiety, STAXI state and trait anger, IIP total, and the two scales primitive defenses and identity diffusion of the IPO, whereas persons with lower scores benefitted more on the scale IPO reality testing. Conclusion Our results indicated some initial trends for the importance of facial affective behavior in patients with BPD and their treatment outcome.
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Affiliation(s)
- Gerhard Dammann
- Psychiatric Hospital, University of Basel, Basel, Switzerland
- Münsterlingen Psychiatric Hospital, Münsterlingen, Switzerland
- University Hospital for Psychiatry and Psychotherapy, Paracelsus Medical University, Salzburg, Austria
| | - Myriam Rudaz
- Münsterlingen Psychiatric Hospital, Münsterlingen, Switzerland
- University Hospital for Psychiatry and Psychotherapy, Paracelsus Medical University, Salzburg, Austria
- Department of Family and Child Sciences, Florida State University, Tallahassee, FL, United States
- *Correspondence: Myriam Rudaz,
| | - Cord Benecke
- Institute of Psychology, Clinical Psychology, University of Kassel, Kassel, Germany
| | | | - Marc Walter
- Psychiatric Hospital, University of Basel, Basel, Switzerland
| | - Monique C. Pfaltz
- Department of Psychiatry, University Hospital Zurich, Zurich, Switzerland
| | | | - John F. Clarkin
- Personality Disorders Institute, Cornell University Medical School, New York, NY, United States
| | - Daniela J. Gremaud-Heitz
- Psychiatric Hospital, University of Basel, Basel, Switzerland
- Münsterlingen Psychiatric Hospital, Münsterlingen, Switzerland
- University Hospital for Psychiatry and Psychotherapy, Paracelsus Medical University, Salzburg, Austria
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Kiselev N, Morina N, Schick M, Watzke B, Schnyder U, Pfaltz MC. Barriers to access to outpatient mental health care for refugees and asylum seekers in Switzerland: the therapist's view. BMC Psychiatry 2020; 20:378. [PMID: 32680485 PMCID: PMC7366894 DOI: 10.1186/s12888-020-02783-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/08/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND More than 120,000 refugees and asylum seekers are currently living in Switzerland. The prevalence of mental disorders among this population is significantly higher than that in the general population. While effective treatment options and cross-cultural, specialized treatment centers exist, they tend to be overloaded by their target populations. General outpatient primary health care providers might be able to compensate for the lack of specialized treatment slots. To date, however, it is unknown how often and under what conditions (e.g., length of waiting lists) refugees and asylum seekers are treated outside of specialized centers and whether there are barriers that prevent providers in outpatient settings from treating more patients in this subgroup. The present study aimed to assess the challenges and barriers faced by psychiatrists and psychotherapists working in outpatient settings in Switzerland in treating refugees and asylum seekers to determine the potential capacity of this group to provide mental health care. METHODS An online survey was conducted during the winter of 2017/2018. The survey was constructed in three official languages and took 10-15 min to complete. Spearman's correlations, Mann-Whitney U-Tests, and Chi-squared tests were conducted to analyze the data. RESULTS Eight hundred and sixty-seven (N = 867) psychotherapists and psychiatrists working in outpatient settings completed the survey: 43% of them reported having treated between 1 and 9 refugees or asylum seekers in the past 12 months, and a further 13% reported treating 10 or more. Interpreters were used for almost every other patient with a refugee or asylum-seeker background. At the same time, the funding of interpreters, as well as the funding of treatment in general, were reported to be the biggest hurdles to treating more refugees and asylum seekers. CONCLUSIONS Given the low number of patients rejected for capacity reasons (between 2 and 5%) and the median waiting times for the admission of new patients ranging between 2 and 3 weeks, outpatient primary mental health care providers might treat more refugees and asylum seekers and relieve specialized treatment centers. However, barriers such as lack of funding of interpreters seem to hinder them. Appropriate steps by the authorities are needed to improve the current situation.
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Affiliation(s)
- Nikolai Kiselev
- grid.412004.30000 0004 0478 9977Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Naser Morina
- grid.412004.30000 0004 0478 9977Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Matthis Schick
- grid.412004.30000 0004 0478 9977Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Birgit Watzke
- grid.7400.30000 0004 1937 0650Department of Clinical Psychology and Psychotherapy Research, University of Zurich, Zurich, Switzerland
| | - Ulrich Schnyder
- grid.7400.30000 0004 1937 0650Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Monique C. Pfaltz
- grid.412004.30000 0004 0478 9977Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland ,grid.7400.30000 0004 1937 0650Medical Faculty, University of Zurich, Zurich, Switzerland
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Olff M, Bakker A, Frewen P, Aakvaag H, Ajdukovic D, Brewer D, Elmore Borbon DL, Cloitre M, Hyland P, Kassam-Adams N, Knefel M, Lanza JA, Lueger-Schuster B, Nickerson A, Oe M, Pfaltz MC, Salgado C, Seedat S, Wagner A, Schnyder U. Screening for consequences of trauma - an update on the global collaboration on traumatic stress. Eur J Psychotraumatol 2020; 11:1752504. [PMID: 32489523 PMCID: PMC7241533 DOI: 10.1080/20008198.2020.1752504] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
This letter provides an update on the activities of "The Global Collaboration on Traumatic Stress" (GC-TS) as first described by Schnyder et al. in 2017. It presents in further detail the projects of the first theme, in particular the development of and initial data on the Global Psychotrauma Screen (GPS), a brief instrument designed to screen for the wide range of potential outcomes of trauma. English language data and ongoing studies in several languages provide a first indication that the GPS is a feasible, reliable and valid tool, a tool that may be very useful in the current pandemic of the coronavirus disease 2019 (COVID-19). Further multi-language and cross-cultural validation is needed. Since the start of the GC-TS, new themes have been introduced to focus on in the coming years: a) Forcibly displaced persons, b) Global prevalence of stress and trauma related disorders, c) Socio-emotional development across cultures, and d) Collaborating to make traumatic stress research data "FAIR". The most recent theme added is that of Global crises, currently focusing on COVID-19-related projects.
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Affiliation(s)
- Miranda Olff
- Department of Psychiatry, Amsterdam Neuroscience & Public Health, Amsterdam UMC, Amsterdam, The Netherlands.,ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - Anne Bakker
- Department of Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands
| | - Paul Frewen
- Department of Psychiatry, Western University, London, Canada
| | - Helene Aakvaag
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Dean Ajdukovic
- Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia
| | - Douglas Brewer
- Ramsay Health Care, The Hollywood Clinic, Perth, Australia
| | - Diane L Elmore Borbon
- Policy Program, UCLA-Duke University National Center for Child Traumatic Stress, Washington, DC, USA
| | - Marylène Cloitre
- National Center for PTSD Dissemination and Training Division, Department of Psychiatry and Behavioral Sciences, VA Palo Alto Health Care System, Stanford University, Menlo Park, CA, USA
| | - Philip Hyland
- Department of Psychology, Maynooth University, Maynooth, Co. Kildare, Ireland
| | - Nancy Kassam-Adams
- Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Center for Pediatric Traumatic Stress, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Juliana A Lanza
- Traumatic Stress Unit, Psychiatric Emergency Hospital, Buenos City, Argentina.,Human Factors, Emergency Medical Care System (SAME), Buenos Aires City, Argentina
| | | | | | - Misari Oe
- Department of Neuropsychiatry, Kurume University School of Medicine, Kurume, Japan
| | - Monique C Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Carolina Salgado
- Department of Psychiatry, Medical School of Universidad Catolica Del Maule, Chile
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anne Wagner
- Department of Psychology, Ryerson University, Toronto, Canada and Remedy, Toronto, Canada
| | - Ulrich Schnyder
- Department of Psychiatry, Amsterdam Neuroscience & Public Health, Amsterdam UMC, Amsterdam, The Netherlands.,ARQ National Psychotrauma Centre, Diemen, The Netherlands.,Department of Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Psychiatry, Western University, London, Canada.,Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway.,Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia.,Ramsay Health Care, The Hollywood Clinic, Perth, Australia.,Policy Program, UCLA-Duke University National Center for Child Traumatic Stress, Washington, DC, USA.,National Center for PTSD Dissemination and Training Division, Department of Psychiatry and Behavioral Sciences, VA Palo Alto Health Care System, Stanford University, Menlo Park, CA, USA.,Department of Psychology, Maynooth University, Maynooth, Co. Kildare, Ireland.,Center for Injury Research and Prevention, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Center for Pediatric Traumatic Stress, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,University of Vienna, Vienna, Austria.,Traumatic Stress Unit, Psychiatric Emergency Hospital, Buenos City, Argentina.,Human Factors, Emergency Medical Care System (SAME), Buenos Aires City, Argentina.,Faculty of Psychology, Clinical Psychology, University of Vienna, Vienna, Austria.,UNSW School of Psychology, UNSW Sydney, Australia.,Department of Neuropsychiatry, Kurume University School of Medicine, Kurume, Japan.,Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland.,Department of Psychiatry, Medical School of Universidad Catolica Del Maule, Chile.,Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.,Department of Psychology, Ryerson University, Toronto, Canada and Remedy, Toronto, Canada.,Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Pfaltz MC, Passardi S, Auschra B, Fares-Otero NE, Schnyder U, Peyk P. Are you angry at me? Negative interpretations of neutral facial expressions are linked to child maltreatment but not to posttraumatic stress disorder. Eur J Psychotraumatol 2019; 10:1682929. [PMID: 31762947 PMCID: PMC6853207 DOI: 10.1080/20008198.2019.1682929] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 08/30/2019] [Accepted: 09/25/2019] [Indexed: 12/23/2022] Open
Abstract
Background: Individuals with a high prevalence of child maltreatment, e.g. those with borderline personality disorder, tend to see neutral facial expressions as negative. Objective: Our aim was to assess whether this bias is present in individuals with posttraumatic stress disorder (PTSD) and whether it is linked to child maltreatment. Methods: Thirty-nine PTSD participants, 44 traumatized and 35 non-traumatized healthy controls watched 300 one-second movies showing 30 neutral and 270 emotional facial expressions, and indicated whether they interpreted each as a neutral or as one of nine emotional expressions. Results: PTSD individuals did not perform differently than the two control groups in the recognition and interpretation of neutral facial expressions (p's < .300). Higher levels of childhood sexual and emotional abuse, and physical neglect were linked to more interpretations of neutral facial expressions as contempt (p's < .043), and (for sexual abuse and physical neglect) to more interpretations of neutral facial expressions as anger (p's < .014). Comparisons of statistical model fits suggested that childhood sexual abuse was the most relevant predictor of recognition accuracy in our sample. Alexithymia, state dissociation, interpersonal trauma, and number of experienced trauma types were not associated with deficits in the interpretation of neutral expressions. Conclusions: Child maltreatment, especially sexual abuse, may shape the interpretation of neutral facial expressions. Future research should explore whether the observed biases extend to real-life situations. If so, therapists might improve the therapeutic relationship with patients with a history of child maltreatment by paying more attention to their own non-verbal communication and their patients' responses to it. Furthermore, similarly to individuals with high depressive and high social anxiety symptoms, facial expression recognition training might counteract negativity bias in individuals with a history of childhood (sexual and emotional) abuse, and (physical) neglect.
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Affiliation(s)
- Monique C Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Sandra Passardi
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bianca Auschra
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Natalia E Fares-Otero
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrich Schnyder
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Peter Peyk
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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31
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Passardi S, Peyk P, Rufer M, Wingenbach TSH, Pfaltz MC. Facial mimicry, facial emotion recognition and alexithymia in post-traumatic stress disorder. Behav Res Ther 2019; 122:103436. [PMID: 31557692 DOI: 10.1016/j.brat.2019.103436] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 05/09/2019] [Accepted: 07/03/2019] [Indexed: 10/26/2022]
Abstract
Individuals with post-traumatic stress disorder (PTSD) show abnormalities in higher-order emotional processes, including emotion regulation and recognition. However, automatic facial responses to observed facial emotion (facial mimicry) has not yet been investigated in PTSD. Furthermore, whereas deficits in facial emotion recognition have been reported, little is known about contributing factors. We thus investigated facial mimicry and potential effects of alexithymia and expressive suppression on facial emotion recognition in PTSD. Thirty-eight PTSD participants, 43 traumatized and 33 non-traumatized healthy controls completed questionnaires assessing alexithymia and expressive suppression. Facial electromyography was measured from the muscles zygomaticus major and corrugator supercilii during a facial emotion recognition task. Corrugator activity was increased in response to negative emotional expressions compared to zygomaticus activity and vice versa for positive emotions, but no significant group differences emerged. Individuals with PTSD reported greater expressive suppression and alexithymia than controls, but only levels of alexithymia predicted lower recognition of negative facial expressions. While automatic facial responses to observed facial emotion seem to be intact in PTSD, alexithymia, but not expressive suppression, plays an important role in facial emotion recognition of negative emotions. If replicated, future research should evaluate whether successful interventions for alexithymia improve facial emotion recognition abilities.
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Affiliation(s)
- Sandra Passardi
- University Hospital Zurich, Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, Switzerland
| | - Peter Peyk
- University Hospital Zurich, Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, Switzerland
| | - Michael Rufer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Switzerland
| | - Tanja S H Wingenbach
- Social and Cognitive Neuroscience Laboratory, Centre of Biology and Health Sciences, Mackenzie Presbyterian University, Sao Paulo, Brazil
| | - Monique C Pfaltz
- University Hospital Zurich, Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zurich, Switzerland.
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32
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Affiliation(s)
- Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Monique C Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrich Schnyder
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Passardi S, Peyk P, Rufer M, Plichta MM, Mueller-Pfeiffer C, Wingenbach TSH, Hassanpour K, Schnyder U, Pfaltz MC. Impaired Recognition of Positive Emotions in Individuals with Posttraumatic Stress Disorder, Cumulative Traumatic Exposure, and Dissociation. Psychother Psychosom 2018; 87:118-120. [PMID: 29495010 DOI: 10.1159/000486342] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 12/12/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Sandra Passardi
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Peter Peyk
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Rufer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland
| | - Michael M Plichta
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, Goethe University, Frankfurt, Germany
| | - Christoph Mueller-Pfeiffer
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Tanja S H Wingenbach
- Social and Cognitive Neuroscience Laboratory, Centre for Health and Biological Sciences, Mackenzie Presbyterian University, Sao Paulo, Brazil
| | | | - Ulrich Schnyder
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Monique C Pfaltz
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Weilenmann S, Schnyder U, Parkinson B, Corda C, von Känel R, Pfaltz MC. Emotion Transfer, Emotion Regulation, and Empathy-Related Processes in Physician-Patient Interactions and Their Association With Physician Well-Being: A Theoretical Model. Front Psychiatry 2018; 9:389. [PMID: 30210371 PMCID: PMC6121172 DOI: 10.3389/fpsyt.2018.00389] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/02/2018] [Indexed: 01/10/2023] Open
Abstract
Physicians experience many emotionally challenging situations in their professional lives, influencing their emotional state through emotion contagion or social appraisal processes. Successful emotion regulation is crucial to sustain health, enable well-being, foster resilience, and prevent burnout or compassion fatigue. Despite the alarmingly high rate of stress-related disorders in physicians, affecting not only physician well-being, but also outcomes such as physician performance, quality of care, or patient satisfaction, research on how to deal with emotionally challenging situations in physicians is lacking. Based on extant literature, the present article proposes a theoretical model depicting emotions, emotion regulation, and empathy-related processes and their relation to well-being in provider-client interactions. This model serves as a basis for future research and interventions aiming at improving physician well-being and professional functioning. As a first step, interviews with 21 psychiatrists were conducted. Results of qualitative and initial quantitative analyses provided detailed descriptions of the model's components confirming its usefulness for detecting mechanisms linking emotion regulation and well-being in psychiatrist-patient interactions. Additionally, results lend preliminary support for the validity of the model, suggesting that successful regulation of emotions (i.e., achieving a desired emotional state) elicited by cyclical transfer processes in provider-client interactions is associated with both short- and long-term well-being and resilience. Furthermore, empathy-related emotions and their regulation seem to be linked to well-being. Based on the results of the present study, a prospective longitudinal study is under preparation, which is intended to inform effective interventions targeting emotion transfer, empathy-related processes, and emotion regulation in physicians' professional lives. The model and results are also potentially applicable to other health care and social services providers.
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Affiliation(s)
- Sonja Weilenmann
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | | | - Brian Parkinson
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Claudio Corda
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Monique C. Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
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Wingenbach TSH, Brosnan M, Pfaltz MC, Plichta MM, Ashwin C. Incongruence Between Observers' and Observed Facial Muscle Activation Reduces Recognition of Emotional Facial Expressions From Video Stimuli. Front Psychol 2018; 9:864. [PMID: 29928240 PMCID: PMC5997820 DOI: 10.3389/fpsyg.2018.00864] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 05/14/2018] [Indexed: 12/12/2022] Open
Abstract
According to embodied cognition accounts, viewing others' facial emotion can elicit the respective emotion representation in observers which entails simulations of sensory, motor, and contextual experiences. In line with that, published research found viewing others' facial emotion to elicit automatic matched facial muscle activation, which was further found to facilitate emotion recognition. Perhaps making congruent facial muscle activity explicit produces an even greater recognition advantage. If there is conflicting sensory information, i.e., incongruent facial muscle activity, this might impede recognition. The effects of actively manipulating facial muscle activity on facial emotion recognition from videos were investigated across three experimental conditions: (a) explicit imitation of viewed facial emotional expressions (stimulus-congruent condition), (b) pen-holding with the lips (stimulus-incongruent condition), and (c) passive viewing (control condition). It was hypothesised that (1) experimental condition (a) and (b) result in greater facial muscle activity than (c), (2) experimental condition (a) increases emotion recognition accuracy from others' faces compared to (c), (3) experimental condition (b) lowers recognition accuracy for expressions with a salient facial feature in the lower, but not the upper face area, compared to (c). Participants (42 males, 42 females) underwent a facial emotion recognition experiment (ADFES-BIV) while electromyography (EMG) was recorded from five facial muscle sites. The experimental conditions' order was counter-balanced. Pen-holding caused stimulus-incongruent facial muscle activity for expressions with facial feature saliency in the lower face region, which reduced recognition of lower face region emotions. Explicit imitation caused stimulus-congruent facial muscle activity without modulating recognition. Methodological implications are discussed.
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Affiliation(s)
- Tanja S. H. Wingenbach
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, United Kingdom
- Social and Cognitive Neuroscience Laboratory, Centre of Biology and Health Sciences, Mackenzie Presbyterian University, São Paulo, Brazil
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zürich, Switzerland
| | - Mark Brosnan
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, United Kingdom
| | - Monique C. Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zürich, Switzerland
| | - Michael M. Plichta
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zürich, Switzerland
- Department of Psychiatry, Psychosomatic Medicine, and Psychotherapy, University Hospital Frankfurt, Frankfurt, Germany
| | - Chris Ashwin
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, United Kingdom
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Müller-Engelmann M, Schnyder U, Dittmann C, Priebe K, Bohus M, Thome J, Fydrich T, Pfaltz MC, Steil R. Psychometric Properties and Factor Structure of the German Version of the Clinician-Administered PTSD Scale for DSM-5. Assessment 2018; 27:1128-1138. [PMID: 29766744 DOI: 10.1177/1073191118774840] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Clinician-Administered PTSD Scale (CAPS) is a widely used diagnostic interview for posttraumatic stress disorder (PTSD). Following fundamental modifications in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the CAPS had to be revised. This study examined the psychometric properties (internal consistency, interrater reliability, convergent and discriminant validity, and structural validity) of the German version of the CAPS-5 in a trauma-exposed sample (n = 223 with PTSD; n =51 without PTSD). The results demonstrated high internal consistency (αs = .65-.93) and high interrater reliability (ICCs = .81-.89). With regard to convergent and discriminant validity, we found high correlations between the CAPS severity score and both the Posttraumatic Diagnostic Scale sum score (r = .87) and the Beck Depression Inventory total score (r = .72). Regarding the underlying factor structure, the hybrid model demonstrated the best fit, followed by the anhedonia model. However, we encountered some nonpositive estimates for the correlations of the latent variables (factors) for both models. The model with the best fit without methodological problems was the externalizing behaviors model, but the results also supported the DSM-5 model. Overall, the results demonstrate that the German version of the CAPS-5 is a psychometrically sound measure.
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Affiliation(s)
| | | | - Clara Dittmann
- Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | | | - Martin Bohus
- Heidelberg University, Heidelberg, Germany.,University of Antwerp, Antwerp, Belgium
| | | | | | | | - Regina Steil
- Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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Morina N, Bryant RA, Doolan EL, Martin-Sölch C, Plichta MM, Pfaltz MC, Schnyder U, Schick M, Nickerson A. The impact of enhancing perceived self-efficacy in torture survivors. Depress Anxiety 2018; 35:58-64. [PMID: 28881455 DOI: 10.1002/da.22684] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 08/16/2017] [Accepted: 08/20/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Perceived self-efficacy (SE) is an important factor underlying psychological well-being. Refugees suffer many experiences that can compromise SE. This study tested the impact of enhancing perceived SE on coping with trauma reminders and distress tolerance in tortured refugees. METHODS Torture survivors (N = 40) were administered a positive SE induction in which they retrieved mastery-related autobiographical memories, or a non-SE (NSE) induction, and then viewed trauma-related images. Participants rated their distress following presentation of each image. Participants then completed a frustration-inducing mirror-tracing task to index distress tolerance. RESULTS Participants in the SE condition reported less distress and negative affect, and improved coping in relation to viewing the trauma-related images than those in the NSE condition. The SE induction also led to greater persistence with the mirror-tracing task than the NSE induction. CONCLUSIONS These findings provide initial evidence that promoting SE in tortured refugees can assist with managing distress from trauma reminders, and promoting greater distress tolerance. Enhancing perceived SE in tortured refugees may increase their capacity to tolerate distress during therapy, and may be a useful means to improve treatment response.
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Affiliation(s)
- Naser Morina
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Emma L Doolan
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Chantal Martin-Sölch
- Unit of Clinical and Health Psychology, Department of Psychology, University of Fribourg, Fribourg, Switzerland
| | - Michael M Plichta
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Monique C Pfaltz
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrich Schnyder
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Matthis Schick
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
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Mitteldorf C, Berisha A, Tronnier M, Pfaltz MC, Kempf W. PD-1 and PD-L1 in neoplastic cells and the tumor microenvironment of Merkel cell carcinoma. J Cutan Pathol 2017; 44:740-746. [PMID: 28569410 DOI: 10.1111/cup.12973] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/24/2017] [Accepted: 05/26/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Merkel cell carcinoma (MCC) is an aggressive neoplasm, which is often associated with Merkel cell polyomavirus (MCPyV). Programmed death-1 (PD-1) and its ligand PD-L1 are key players of the tumor microenvironment (TME). METHODS Fourteen paraffin-embedded tissue samples of MCC were stratified by their MCPyV detection. Apart from PD-L1 and PD-1, the TME was further characterized for the expression of CD33, FOXP3 and MxA. RESULTS We observed PD-1 in 2 of 12 tumors. PD-L1 expression by tumor cells was found in 7 of 8 MCPyV(+) samples and was detected particularly in the periphery. The tumor cells were surrounded by a shield of PD-L1/CD33 immune cells. Expression of PD-L1 by the tumor cells was higher in areas with a denser immune infiltrate. CD33(+) cells without direct tumor contact were PD-L1 negative. Only a low number of FOXP3(+) regulatory T-cells was admixed. Tumor cells of MCPyV(-) samples were mostly PD-L1 negative. CONCLUSIONS Our data demonstrate that PD-L1 expression occurs in tumor and immune cells, in areas in which they are close in contact. Interferon seems to play a role in this interaction. We postulate that PD-L1(+)/CD33(+) cells shield the tumor against attacking PD-1(+) immune cells. Therefore, next to anti-PD-1/PD-L1 antibodies, blockade of CD33 seems to be a promising therapeutic approach.
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Affiliation(s)
| | | | - Michael Tronnier
- Department of Dermatology, HELIOS-Klinikum Hildesheim, Hildesheim, Germany
| | - Monique C Pfaltz
- Department of Psychiatry and Psychotherapy, University Hospital Zürich, Zürich, Switzerland
| | - Werner Kempf
- Kempf und Pfaltz histologische Diagnostik, Zürich, Switzerland.,Department of Dermatology, University Hospital Zürich, Zürich, Switzerland
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39
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Pfaltz MC, Wu GWY, Liu G, Tankersley AP, Stilley AM, Plichta MM, McNally RJ. Cognitive and emotional processing of pleasant and unpleasant experiences in major depression: A matter of vantage point? J Behav Ther Exp Psychiatry 2017; 54:254-262. [PMID: 27693905 DOI: 10.1016/j.jbtep.2016.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/16/2016] [Accepted: 09/14/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES In nonclinical populations, adopting a third-person perspective as opposed to a first-person perspective while analyzing negative emotional experiences fosters understanding of these experiences and reduces negative emotional reactivity. We assessed whether this generalizes to people with major depression (MD). Additionally, we assessed whether the emotion-reducing effects of adopting a third-person perspective also occur when subjects with MD and HC subjects analyze positive experiences. METHODS Seventy-two MD subjects and 82 HC subjects analyzed a happy and a negative experience from either a first-person or a third-person perspective. RESULTS Unexpectedly, we found no emotion-reducing effects of third-person perspective in either group thinking about negative events. However, across groups, third-person perspective was associated with less recounting of negative experiences and with a clearer, more coherent understanding of them. Negative affect decreased and positive affect increased in both groups analyzing happy experiences. In MD subjects, decreases in depressive affect were stronger for the third-person perspective. In both groups, positive affect increased and negative affect decreased more strongly for the third-person perspective. LIMITATIONS While reflecting on their positive memory, MD subjects adopted their assigned perspective for a shorter amount of time (70%) than HC subjects (78%). However, percentage of time participants adopted their assigned perspective was unrelated to the significant effects we found. CONCLUSIONS Both people suffering from MD and healthy individuals may benefit from processing pleasant experiences, especially when adopting a self-distant perspective.
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Affiliation(s)
- Monique C Pfaltz
- Department of Psychology, Harvard University, Cambridge, MA, USA.
| | - Gwyneth W Y Wu
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Guanyu Liu
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | | | - Ashley M Stilley
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Michael M Plichta
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Zurich, Switzerland
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40
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Sijbrandij M, Acarturk C, Bird M, Bryant RA, Burchert S, Carswell K, de Jong J, Dinesen C, Dawson KS, El Chammay R, van Ittersum L, Jordans M, Knaevelsrud C, McDaid D, Miller K, Morina N, Park AL, Roberts B, van Son Y, Sondorp E, Pfaltz MC, Ruttenberg L, Schick M, Schnyder U, van Ommeren M, Ventevogel P, Weissbecker I, Weitz E, Wiedemann N, Whitney C, Cuijpers P. Strengthening mental health care systems for Syrian refugees in Europe and the Middle East: integrating scalable psychological interventions in eight countries. Eur J Psychotraumatol 2017; 8:1388102. [PMID: 29163867 PMCID: PMC5687806 DOI: 10.1080/20008198.2017.1388102] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/22/2017] [Indexed: 11/15/2022] Open
Abstract
The crisis in Syria has resulted in vast numbers of refugees seeking asylum in Syria's neighbouring countries as well as in Europe. Refugees are at considerable risk of developing common mental disorders, including depression, anxiety, and posttraumatic stress disorder (PTSD). Most refugees do not have access to mental health services for these problems because of multiple barriers in national and refugee specific health systems, including limited availability of mental health professionals. To counter some of challenges arising from limited mental health system capacity the World Health Organization (WHO) has developed a range of scalable psychological interventions aimed at reducing psychological distress and improving functioning in people living in communities affected by adversity. These interventions, including Problem Management Plus (PM+) and its variants, are intended to be delivered through individual or group face-to-face or smartphone formats by lay, non-professional people who have not received specialized mental health training, We provide an evidence-based rationale for the use of the scalable PM+ oriented programmes being adapted for Syrian refugees and provide information on the newly launched STRENGTHS programme for adapting, testing and scaling up of PM+ in various modalities in both neighbouring and European countries hosting Syrian refugees.
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Affiliation(s)
- Marit Sijbrandij
- Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, the Netherlands
| | - Ceren Acarturk
- Department of Psychology, Istanbul Sehir University, Istanbul, Turkey
| | - Martha Bird
- International Federation of Red Cross and Red Crescent Societies Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Sebastian Burchert
- Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Kenneth Carswell
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Joop de Jong
- Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, the Netherlands
| | - Cecilie Dinesen
- International Federation of Red Cross and Red Crescent Societies Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | - Katie S Dawson
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Rabih El Chammay
- Ministry of Public Health, Beirut, Lebanon.,Department of Psychiatry, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | | | - Mark Jordans
- Department of Research and Development, War Child, Amsterdam, the Netherlands.,Center for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christine Knaevelsrud
- Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - David McDaid
- Department of Health Policy, Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Kenneth Miller
- Department of Research and Development, War Child, Amsterdam, the Netherlands
| | - Naser Morina
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - A-La Park
- Department of Health Policy, Personal Social Services Research Unit, London School of Economics and Political Science, London, UK
| | - Bayard Roberts
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Yvette van Son
- Region Netherlands Centre and North, i-Psy Mental Health Care, Almere, the Netherlands
| | - Egbert Sondorp
- KIT Royal Tropical Institute, Amsterdam, the Netherlands
| | - Monique C Pfaltz
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Matthis Schick
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrich Schnyder
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Mark van Ommeren
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Peter Ventevogel
- Public Health Section, United Nations High Commissioner for Refugees, Geneva, Switzerland
| | | | - Erica Weitz
- Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, the Netherlands
| | - Nana Wiedemann
- International Federation of Red Cross and Red Crescent Societies Reference Centre for Psychosocial Support, Copenhagen, Denmark
| | | | - Pim Cuijpers
- Clinical, Neuro and Developmental Psychology, VU University, Amsterdam, the Netherlands
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Pfaltz MC, Schumacher S, Wilhelm FH, Dammann G, Seifritz E, Martin-Soelch C. Acoustic Emotional Processing in Patients With Borderline Personality Disorder: Hyper- or Hyporeactivity? J Pers Disord 2015; 29:809-27. [PMID: 25710735 DOI: 10.1521/pedi_2015_29_176] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Earlier studies have demonstrated emotional overreactions to affective visual stimuli in patients with borderline personality disorder (BPD). However, contradictory findings regarding hyper- versus hyporeactivity have been reported for peripheral physiological measures. In order to extend previous results, the authors investigated emotional reactivity and long-term habituation in the acoustic modality. Twenty-two female BPD patients and 19 female nonclinical controls listened to emotionally negative, neutral, and positive sounds in two identical sessions. Heart rate, skin conductance, zygomaticus/corrugator muscle, and self-reported valence/arousal responses were measured. BPD patients showed weaker skin conductance responses to negative sounds than controls. The elevated zygomaticus activity in response to positive sounds observed in controls was absent in BPD patients, and BPD patients assigned lower valence ratings to positive sounds than controls. In Session 2, patients recognized fewer positive sounds than controls. Across both groups, physiological measures habituated between sessions. These findings add to growing evidence toward partial affective hyporeactivity in BPD.
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Affiliation(s)
- Monique C Pfaltz
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Switzerland
| | - Sonja Schumacher
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Switzerland
| | - Frank H Wilhelm
- Division of Clinical Psychology, Psychotherapy, and Health Psychology, Department of Psychology, University of Salzburg, Austria
| | - Gerhard Dammann
- Psychiatric Clinic Muensterlingen, Switzerland.,Psychiatric University Hospital Basel, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Switzerland
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42
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Pfaltz MC, Kolodyazhniy V, Blechert J, Margraf J, Grossman P, Wilhelm FH. Metabolic decoupling in daily life in patients with panic disorder and agoraphobia. J Psychiatr Res 2015; 68:377-83. [PMID: 26028550 DOI: 10.1016/j.jpsychires.2015.04.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 04/17/2015] [Accepted: 04/30/2015] [Indexed: 11/28/2022]
Abstract
Various studies have assessed autonomic and respiratory underpinnings of panic attacks, yet the psychophysiological functioning of panic disorder (PD) patients has rarely been examined under naturalistic conditions at times when acute attacks were not reported. We hypothesized that emotional activation in daily life causes physiologically demonstrable deviations from efficient metabolic regulation in PD patients. Metabolic coupling was estimated as within-individual correlations between heart rate (HR) and indices of metabolic activity, i.e., physical activity (measured by 3-axial accelerometry, Acc), and minute ventilation (Vm, measured by calibrated inductive plethysmography, as proxy for oxygen consumption). A total of 565 daytime hours were recorded in 19 PD patients and 20 healthy controls (HC). Pairwise cross-correlations of minute-by-minute averages of these metabolic indices were calculated for each participant and then correlated with several indices of self-reported anxiety. Ambulatory HR was elevated in PD (p = .05, d = 0.67). Patients showed reduced HR-Acc (p < .006, d = 0.97) and HR-Vm coupling (p < .009, d = 0.91). Combining Vm and Acc to predict HR showed the strongest group separation (p < .002, d = 1.07). Discriminant analyses, based on the combination of Vm and Acc to predict HR, classified 77% of all participants correctly. In PD, HR-Acc coupling was inversely related to trait anxiety sensitivity, as well as tonic and phasic daytime anxiety. The novel method that was used demonstrates that anxiety in PD may reduce efficient long-term metabolic coupling. Metabolic decoupling may serve as physiological characteristic of PD and might aid diagnostics for PD and other anxiety disorders. This measure deserves further study in research on health consequences of anxiety and psychosocial stress.
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Affiliation(s)
- Monique C Pfaltz
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Switzerland
| | - Vitaliy Kolodyazhniy
- Department of Psychology, Division of Clinical Psychology, Psychotherapy, and Health Psychology, University of Salzburg, Austria; Ziemer Ophthalmic Systems AG, Switzerland
| | - Jens Blechert
- Department of Psychology, Division of Clinical Psychology, Psychotherapy, and Health Psychology, University of Salzburg, Austria
| | - Jürgen Margraf
- Department of Clinical Psychology and Psychotherapy, Ruhr-University Bochum, Germany
| | - Paul Grossman
- Department of Psychosomatic Medicine, Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Frank H Wilhelm
- Department of Psychology, Division of Clinical Psychology, Psychotherapy, and Health Psychology, University of Salzburg, Austria.
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43
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Mitteldorf C, Robson A, Tronnier M, Pfaltz MC, Kempf W. Galectin-3 Expression in Primary Cutaneous CD30-Positive Lymphoproliferative Disorders and Transformed Mycosis Fungoides. Dermatology 2015; 231:164-70. [DOI: 10.1159/000431313] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 04/28/2015] [Indexed: 11/19/2022] Open
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Abstract
Obsessive-compulsive disorder (OCD) is a severe anxiety disorder characterized by frequent obsessive thoughts and repetitive behaviors. Neuroticism is a vulnerability factor for OCD, yet the mechanisms by which this general vulnerability factor affects the development of OCD-related symptoms are unknown. The present study assessed a hierarchical model of the development of obsessive thoughts that includes neuroticism as a general, higher-order factor, and specific, potentially maladaptive thought processes (thought suppression, worry, and brooding) as second-order factors manifesting in the tendency toward obsessing. A total of 238 participants completed questionnaires assessing the examined constructs. The results of mediator analyses demonstrated the hypothesized relationships: A positive association between neuroticism and obsessing was mediated by thought suppression, worry, and brooding. Independent of the participant’s sex, all three mediators contributed equally and substantially to the association between neuroticism and obsessing. These findings extend earlier research on hierarchical models of anxiety and provide a basis for further refinement of models of the development of obsessive thoughts.
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Affiliation(s)
- Monique C. Pfaltz
- Department of Psychology, Division of Clinical Psychology and Psychiatry, University of Basel, Switzerland
- Department of Psychiatry and Psychotherapy, University Hospital Zurich, Switzerland
| | - Beatrice Mörstedt
- Department of Psychology, Division of Clinical Psychology and Psychiatry, University of Basel, Switzerland
| | - Andrea H. Meyer
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Switzerland
| | - Frank H. Wilhelm
- Department of Clinical Psychology, Psychotherapy, and Health Psychology, University of Salzburg, Austria
| | - Joe Kossowsky
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, University of Basel, Switzerland
- Boston Children’s Hospital, Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Boston, USA
| | - Tanja Michael
- Department of Clinical Psychology and Psychotherapy, Saarland University, Germany
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45
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Pfaltz MC, Michael T, Meyer AH, Wilhelm FH. Reexperiencing symptoms, dissociation, and avoidance behaviors in daily life of patients with PTSD and patients with panic disorder with agoraphobia. J Trauma Stress 2013; 26:443-50. [PMID: 23893375 DOI: 10.1002/jts.21822] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Panic attacks are frequently perceived as life threatening. Panic disorder (PD) patients may therefore experience symptoms of posttraumatic stress disorder (PTSD). The authors explored this in 28 healthy controls, 17 PTSD patients, and 24 PD patients with agoraphobia who completed electronic diaries 36 times during 1 week. Patient groups frequently reported dissociation as well as thoughts, memories, and reliving of their trauma or panic attacks. PTSD patients reported more trauma/panic attack thoughts (incidence rate ratio [IRR] = 2.9) and memories (IRR = 2.8) than PD patients. Patient groups relived their trauma or panic attacks equally frequently, and reported comparable bodily reactions and distress associated with trauma or panic attack memories. Clinical groups avoided trauma or panic attack reminders more often than healthy controls (avoidance of trauma- or panic attack-related thoughts (IRR = 8.0); avoidance of things associated with the trauma or panic attack (IRR = 40.7). PD patients avoided trauma or panic attack reminders less often than PTSD patients (avoidance of trauma- or panic attack-related thoughts [IRR = 2.5]; avoidance of things associated with the trauma or panic attack [IRR = 4.1]), yet these differences were nonsignificant when controlling for functional impairment. In conclusion, trauma-like symptoms are common in PD with agoraphobia and panic attacks may be processed similarly as trauma in PTSD.
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Affiliation(s)
- Monique C Pfaltz
- Department of Psychology, Harvard University, Cambridge, Massachusetts 02138-2044, USA.
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Abstract
OBJECTIVE Evidence suggests that childhood separation anxiety disorder may be associated with a heightened risk for the development of other disorders in adulthood. The authors conducted a meta-analysis to examine the relationship between childhood separation anxiety disorder and future psychopathology. METHOD PubMed, PsycINFO, and Embase were searched for studies published through December 2011. Case-control, prospective, and retrospective cohort studies comparing children with and without separation anxiety disorder with regard to future panic disorder, major depressive disorder, any anxiety disorder, and substance use disorders were included in the analysis. Effects were summarized as pooled odds ratios in a random-effects model. RESULTS Twenty-five studies met all inclusion criteria (14,855 participants). A meta-analysis of 20 studies indicated that children with separation anxiety disorder were more likely to develop panic disorder later on (odds ratio=3.45; 95% CI=2.37-5.03). Five studies suggested that a childhood diagnosis of separation anxiety disorder increases the risk of future anxiety (odds ratio=2.19; 95% CI=1.40-3.42). After adjusting for publication bias, the results of 14 studies indicated that childhood separation anxiety disorder does not increase the risk of future depression (odds ratio=1.06; 95% CI=0.78-1.45). Five studies indicated that childhood separation anxiety disorder does not increase the risk of substance use disorders (odds ratio=1.27; 95% CI=0.80-2.03). Of the subgroup analyses performed, differences in comparison groups and sample type significantly affected odds ratio sizes. CONCLUSIONS A childhood diagnosis of separation anxiety disorder significantly increases the risk of panic disorder and any anxiety disorder. These results support a developmental psychopathology conceptualization of anxiety disorders.
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Affiliation(s)
- Joe Kossowsky
- Department of Clinical Psychology and Psychotherapy, University of Basel, Switzerland.
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47
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Vriends N, Pfaltz MC, Novianti P, Hadiyono J. Taijin kyofusho and social anxiety and their clinical relevance in indonesia and Switzerland. Front Psychol 2013; 4:3. [PMID: 23382720 PMCID: PMC3563044 DOI: 10.3389/fpsyg.2013.00003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 01/03/2013] [Indexed: 11/20/2022] Open
Abstract
Background: Taijin Kyofusho Scale (TKS) is an interpersonal fear to offend others and is defined by Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as a culturally bound syndrome that occurs in Japan and Korea. Recently, cases with TKS have also been recognized in other cultures. The present questionnaire study investigated self-report TKS symptoms and social anxiety symptoms, and their clinical relevance in an Indonesian and Swiss sample. It also investigated whether self-construal is associated with TKS and social anxiety, and if self-construal is a mediator of the expected association between cultural background and social anxiety and TKS symptoms. Method: 311 Indonesian and 349 Swiss university students filled out the Liebowitz Social Anxiety Scale, the Taijin Kyofusho Scale, the Self-Construal Scale, self-report social phobia DSM-IV criteria, and rated their wish for professional help to deal with social fears. Results: TKS and social anxiety symptoms were higher in the Indonesian than the Swiss sample. TKS symptoms were associated with clinical relevance in Indonesia, whereas in Switzerland only social anxiety symptoms were associated with clinical relevance. Independent self-construal was negatively associated and interdependent self-construal was positively associated with TKS and social anxiety symptoms. Interdependent self-construal mediated the association between cultural background and these symptoms. Discussion: TKS might be a clinically relevant syndrome in all individuals or cultures with an interdependent self-construal or less independent self-construal. The proposal to include the fear of offending others in the DSM-V criteria of social phobia is supported by the present findings.
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Affiliation(s)
- N Vriends
- Department of Psychology, Division of Clinical Psychology and Psychotherapy, University Basel Basel, Switzerland
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Pfaltz MC, Grossman P, Michael T, Margraf J, Wilhelm FH. Physical activity and respiratory behavior in daily life of patients with panic disorder and healthy controls. Int J Psychophysiol 2010; 78:42-9. [DOI: 10.1016/j.ijpsycho.2010.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Revised: 04/28/2010] [Accepted: 05/05/2010] [Indexed: 10/19/2022]
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Wilhelm FH, Pfaltz MC, Grossman P, Roth WT. Distinguishing emotional from physical activation in ambulatory psychophysiological monitoring. Biomed Sci Instrum 2006; 42:458-63. [PMID: 16817651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Ambulatory monitoring has gained powerful new tools due to recent electronic and computer advances. The capability simultaneously to monitor numerous physiological parameters and behavior enhances the ecological validity of field assessment, but methodological challenges abound that can compromise attempts to understand biobehavioral relations in the real world. A major obstacle is that physiological dysregulation or emotion effects can be masked by variation in physical activity. Using a multi-channel ambulatory recording system, a wide array of self-report, physiological and environmental measurements was collected from 28 participants during quiet sitting, physical exercise and an emotion induction consisting of a short commercial flight. Half of the participants were selected to respond to flying with intense anxiety, the other half, with moderate excitement. Recorded channels included ECG, EDA, calibrated respiration pattern, and skin temperature, from which 17 physiological parameters were calculated. Accelerometry and self-report in an emotion diary served as manipulation checks. Results indicate that many parameters, including heart rate, respiratory sinus arrhythmia, and skin conductance level and its fluctuation rate, were strongly and nonspecifically affected by both anxiety and exercise. However, parameters of respiratory volume were particularly responsive to exercise, while certain parameters of irregularity in breathing were to anxiety. Several respiratory timing parameters were responsive to both exercise and excitement. We conclude that physiological measures provide information helping to distinguish emotional from physical activation. However, additional context awareness is necessary for confident data interpretation in ambulatory recording. This can be achieved by specific channels such as accelerometry, items in an electronic diary, semi-structured protocols, and statistical modeling.
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Affiliation(s)
- Frank H Wilhelm
- Institute for Psychology, University of Basel, Basel, Switzerland
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50
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Wilhelm FH, Pfaltz MC, Gross JJ, Mauss IB, Kim SI, Wiederhold BK. Mechanisms of virtual reality exposure therapy: the role of the behavioral activation and behavioral inhibition systems. Appl Psychophysiol Biofeedback 2005; 30:271-84. [PMID: 16167191 DOI: 10.1007/s10484-005-6383-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
J. A. Gray's (1975) theory distinguishes between two motivational systems, which he refers to as the behavioral activation system (BAS) and the behavioral inhibition system (BIS). D. C. Fowles (1980) has shown that heart rate responses reflect activity of the BAS, and electrodermal responses reflect activity of the BIS. Both BAS and BIS are reliably activated during in-vivo exposure to fearful situations (F. H. Wilhelm & W. T. Roth, 1998). However, due to the constraints imposed by virtual reality (VR), we hypothesized that VR exposure to fearful situations would activate the BIS alone. To test this hypothesis, a VR free-standing elevator simulation was presented to participants selected for high and low fear of heights. As predicted, the high-anxious group strongly responded electrodermally (effect size d = 1.53), but showed only minimal HR elevations during exposure (d = 0.12), and little other cardiovascular or respiratory changes. The low-anxious control group showed little electrodermal and HR reactivity (d = 0.28 and 0.12). A comparison with data from a previous study demonstrated that this pattern was in stark contrast to the large electrodermal and cardiovascular response observed during situational in-vivo exposure outside the laboratory. We conclude that the BIS, but not BAS, is selectively activated during VR exposure, causing discordance between self-report and commonly used physiological measures of anxiety. Results are discussed within the framework of E. B. Foa & M. J. Kozak's (1986) emotional processing theory of fear modification, suggesting different mechanisms underlying VR and in-vivo exposure treatments.
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Affiliation(s)
- Frank H Wilhelm
- Institute for Psychology, University of Basel, Basel, Switzerland.
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