Internal and external self-affirmation resources: validation and assessment of psychometric properties of the spontaneous self-affirmation measure using structural equation modeling

Introduction

People use coping strategies such as self-affirmation to manage threats to their self-esteem. In empirical research, self-affirmation often involves recalling personal values, strengths, or relationships to restore moral integrity. Research shows it improves attitude adjustment, resolves cognitive dissonance, and enhances well-being. Some studies stress the importance of distinguishing between different aspects of self-affirmation, like strengths or social relations. These aspects align with concepts in psychotherapy that differentiate between internal and external resource activation, benefiting health, self-esteem, and resilience. The aim of the current study was twofold: first, to independently test the three-factor structure of the Spontaneous Self-affirmation Measure (SSAM), and second, to integrate self-affirmation strategies into a broader resource activation framework as resilience factors. It also examined associations with self-esteem and effects of age, gender, and education on spontaneous self-affirmation.

Methods

1,100 participants (72% female, age 18-65) were recruited online. The original three-factor structure of the SSAM (with the factors Strengths, Values and Social relations) was examined using structural equation modeling. Further, a theory driven two-factor structure applying an internal and external resources framework was examined, integrating the factors of the SSAM into the taxonomy of resource activation (Internal resources: Strengths and Values; External resources: Social relations).

Results

The results of confirmatory factor analyses showed that both the original three-factor structure and the complementary two-factor structure with an Internal resources and External resources factor fit the data appropriately. All three factors of the original factor model showed a high reliability (Strengths: ω t = 0.91, Values: ω t = 0.91, Social relations: ω t = 0.92). We also found measurement invariance across age, gender, and education. Furthermore, group differences regarding gender, education and ethnicity in the utilization of spontaneous self-affirmation strategies were apparent. Finally, it was demonstrated that the Internal resources factor of the complementary two-factor model is significantly more strongly correlated with self-esteem than the External Resources factor [z = 12.80, p < 0.001, 95%CIdiff (0.24, 0.33)].

Discussion

The study confirms the validity of both the three-factor and two-factor structures of the SSAM. Integrating self-affirmation into the resource activation framework may facilitate applying findings from self-affirmation studies to clinical contexts.

Validation of the factor structure of the Experiences Questionnaire using Exploratory Graph Analysis

Introduction

Decentering describes the ability to shift the focus away from one's subjective experience onto the experience itself. The Experiences Questionnaire (EQ) is a self-report measure that was developed to systematically assess changes in Decentering ability. Although several studies show the validity of the questionnaire, there are discrepancies between the factorial structure of the Decentering scale of the EQ (EQ-D) found in the initial study (one factor) and other studies (two factors). Therefore, the current study aimed to assess the dimensionality of the EQ-D using Exploratory Graph Analysis (EGA).

Methods

In total, 1,100 participants were recruited online (790 female, 307 male, 3 non-binary; age 18 to 65 years). Participants completed the EQ and the Rosenberg Self-esteem scale (RSES).

Results

The bootstrapped EGA results revealed a two-dimensional structure of the EQ-D (Factor 1: Distanced Perspective, DP; Factor 2: Accepting Self-perception, AS) with high structural and item stability (all items > 0.70). The two dimensions of the EQ-D showed a high internal consistency (DP: ω = 0.74; AS: ω = 0.86) and discriminant validity with the rumination items of the EQ. Furthermore, a high convergent validity of the EQ was established, as the AS factor exhibited a significantly stronger correlation with self-esteem than the DP factor (z = 7.98, p < 0.001), which aligns with theoretical considerations suggesting that the AS factor encompasses aspects of self-compassion alongside decentering. We also found measurement invariance of the DP and AS factor across age, gender and country but not for education.

Discussion

These results support the EQ's validity, demonstrated in a larger sample with a new methodology, aligning with existing two-factor decentering models literature.

An English list of trait words including valence, social desirability, and observability ratings

To enable flexible and controlled research on personality, information processing, and interactions in socio-emotional contexts, the availability of highly controlled stimulus material, especially trait words and related attributes, is indispensable. Existing word databases contain mainly nouns and rating dimensions, and their role in studies within socio-emotional contexts are limited. This study aimed to create an English list of traits (ELoT), a database containing 500 trait adjectives rated by a large sample (n = 822, 57.42% female). The rating categories refer to the perceived valence associated with the traits and their social desirability and observability. Participants of different ages (18 to 65 years of age) and educational levels rated the words in an online survey. Both valence and social desirability ratings showed a bimodal distribution, indicating that most traits were rated either positive (respectively socially desirable) or negative (respectively socially undesirable), with fewer words rated as neutral. For observability, a bell-shaped distribution was found. Results indicated a strong association between valence and social desirability, whereas observability ratings were only moderately associated with the other ratings. Valence and social desirability ratings were not related to participants' age or gender, but observability ratings were different for females and males, and for younger, middle-aged, and older participants. The ELoT is an extensive, freely available database of trait norms. The large sample and the balanced age and gender distributions allow to account for age- and gender-specific effects during stimulus selection.

A Microanalysis of Mood and Self-Reported Functionality in Stroke Patients Using Ecological Momentary Assessment

Post-stroke depression has been repeatedly associated with the degree of functional and cognitive impairment. The present study aimed to conduct a microanalysis on this association and examined the association between mood and self-reported functionality in 20 stroke patients (6 females, age: M = 59.9, SD = 5.2) using ecological momentary assessments (EMA), a structured diary method capturing moment-to-moment variations. Mood and self-reported functionality were recorded via a smartphone-app eight times a day for seven consecutive days during inpatient rehabilitation care. The patients answered on average to 73.2% of the received prompts. Variability in patients' responses was caused by differences both between and within patients. Multilevel regression analyses revealed that mood and self-reported functionality were significantly associated at the same point in time, but only patients' mood predicted their self-reported functionality at the next assessment point in time-lagged analyses. These results remained stable after controlling for between-person differences as patients' age, staff-ratings of their awareness of illness, and their degree of functional independence. Patients' mood appeared to affect their future ratings of their functionality but not the other way around.

Development of the German social attitude barriers and facilitators to participation-scales: an analysis according to the Rasch model

Background

Social attitudes experienced by people with disabilities can strongly impact upon their health and quality of life. The extent to which social attitude measurement transcends specific cultures is unknown. Thus, the aim of the study was to develop German item banks to assess social attitude barriers and facilitators to participation and compare the construct definition with that developed in the United States.

Methods

The American version of the two item banks assessing social attitudes that act as barriers and facilitators in persons with disabilities was translated into German and culturally adapted. The sample consisted of 410 in- and outpatients treated for spinal diseases at a German University Hospital. The psychometric properties of the resulting 53 items-item pool were evaluated using Rasch analysis. A special focus was placed on the investigation of unidimensionality, local independence, differential item functioning (DIF) and targeting. To evaluate convergent and divergent validity correlations with perceived social support, depression and pain interference were calculated.

Results

Unlike the American version, both the barriers and facilitators item banks had to be divided into two subscales assessing attitudes that individuals with disabilities experience as being directed towards them (individual perception) or attitudes that respondents experience as being directed towards people with disabilities as a social group (societal perception). Four unidimensional scales were constructed. Fit to the Rasch model required item deletion and forming testlets to account for extensive local dependence. There was no evidence of DIF with regard to gender or age. Targeting of the subscales was moderate to good.

Conclusions

Results support a distinction between social attitudes at the individual and societal level, allowing a more specific assessment than is possible when this distinction is ignored.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05339-0.

Metacognitive judgements and abilities in patients with affective disorders

Objectives

Cognitive and metacognitive deficits depict important factors in depression, but the relationship between these concepts remains to be elucidated. The present study investigated the difference between patients with depression and controls in metacognitive judgements regarding the domain of attention. Furthermore, the associations between different metacognitive abilities, depressiveness and confidence were investigated, as well as in how far the derived correlates would predict depression.

Methods

Thirty patients with a major depressive episode and 30 healthy participants were enrolled in the current study. Attention and executive functioning ability were assessed including metacognitive judgements of performance and confidence with regard to the test performance in the Stroop test. To examine further aspects related to (meta-)cognitive abilities, decentering skills, aspects of self-conscious attention, self-assessed intelligence and metacognitive beliefs, judgements and monitoring tendencies were assessed.

Results

Albeit groups’ metacognitive judgements of performance did not differ, patients indicated to be significantly less confident in their judgements. Depressive patients showed less decentering abilities compared to healthy participants and there was a significant association between decentering and confidence ratings. Moreover, depressiveness was associated with dysfunctional self-consciousness and low cognitive confidence. Finally, lower decentering skills and higher dysfunctional self-attention were the best predictors for depressiveness.

Conclusions

Results favor the assumption that patients’ metacognitive abilities regarding the domain of attention are not generally deficient. Rather, the lower confidence in their judgements and dysfunctional (meta-)cognitive abilities, like decentering, metacognitive beliefs and aspects of self-conscious attention and intelligence, seem to mirror the patients’ impairments.

An Evaluation of Forced Distance Learning and Teaching Under Pandemic Conditions Using the Technology Acceptance Model

Research: Due to the sudden outbreak of COVID-19 and the resulting pandemic situation, universities were forced to rapidly change their traditional pedagogical and didactical approach by shifting from mostly face-to-face teaching to entirely virtual and online teaching methods. Through this, a “forced” distance learning and teaching situation emerged. This study aimed at investigating the effect of these innovations on the implementation, acceptance, and use of the virtual teaching offer within the framework of the technology acceptance model (TAM).

Methods: A total of 218 students and 69 lecturers of a German Medical Faculty completed online questionnaires on the acceptance, satisfaction, and usefulness of the forced distance learning (FDL) and teaching (FDT), respectively. An extended version of the TAM was used to assess the acceptance of the students and lecturers of FDL and FDT. In order to estimate the multivariate dependencies, path analysis was employed using structural equation modeling (SEM).

Results: In general, students and lecturers reported being satisfied with the implementation of the FDL and FDT. Regarding the TAM model, the fit indices suggested an acceptable model fit for both groups. The model of the students revealed that the perceived usefulness had a strong predictive power on the attitude toward using and the perceived ease of use also predicted the attitude. The existing technical infrastructure as well as the general media affinity and pandemic-related worries proved to be positively associated with the perceived usefulness while data security worries and organization of online teaching predicted the perceived ease of use in students. The strong positive predictive power of the perceived usefulness for the attitude toward using was also evident in the model for the lecturers and the technical infrastructure predicted the perceived ease of use in the lecturers.

Conclusion: The TAM is a suitable framework to represent the implementation, acceptance, and use of the virtual teaching offer during the special pandemic situation at the university. However, personal and structural context factors were important predictors for the perceived usefulness and the perceived ease of use in the student group. The forced situation for learning and teaching makes it more difficult to predict the actual use of virtual teaching offers solely based on attitude.

Dissociation of structural and functional connectomic coherence in glioma patients

With diffuse infiltrative glioma being increasingly recognized as a systemic brain disorder, the macroscopically apparent tumor lesion is suggested to impact on cerebral functional and structural integrity beyond the apparent lesion site. We investigated resting-state functional connectivity (FC) and diffusion-MRI-based structural connectivity (SC) (comprising edge-weight (EW) and fractional anisotropy (FA)) in isodehydrogenase mutated (IDHmut) and wildtype (IDHwt) patients and healthy controls. SC and FC were determined for whole-brain and the Default-Mode Network (DMN), mean intra- and interhemispheric SC and FC were compared across groups, and partial correlations were analyzed intra- and intermodally. With interhemispheric EW being reduced in both patient groups, IDHwt patients showed FA decreases in the ipsi- and contralesional hemisphere, whereas IDHmut patients revealed FA increases in the contralesional hemisphere. Healthy controls showed strong intramodal connectivity, each within the structural and functional connectome. Patients however showed a loss in structural and reductions in functional connectomic coherence, which appeared to be more pronounced in IDHwt glioma patients. Findings suggest a relative dissociation of structural and functional connectomic coherence in glioma patients at the time of diagnosis, with more structural connectomic aberrations being encountered in IDHwt glioma patients. Connectomic profiling may aid in phenotyping and monitoring prognostically differing tumor types.

Self-referential processing and perspective taking in patients with a borderline personality disorder

Divergent self- and other-referential processes play a particular role in the development and maintenance of borderline personality disorder (BPD). This study investigated self-referential processes in patients with BPD and age-matched controls. Participants performed a trait-judgment task, taking their own and the perspective of a close other person. Memory was assessed during recall of the previous choices. Results revealed over all more negative self-appraisals in patients than controls, which seemed due to making less positive self-referential choices rather than an increased choice of negative traits. Interestingly, taking another perspective, patients had a healthier, predominantly positive self-assessment, albeit still attenuated compared to controls. The characteristics of the appraisals were mirrored in memory performances. Moreover, self-esteem seems to be a potential protective factor, as self-appraisals were more positive with higher self-esteem. Altogether, this study shows significantly deviant self-referential processes in patients with BPD, suggesting that patients do not integrate what they believe others think about them into their self-concept.

Cortical volume reductions as a sign of secondary cerebral and cerebellar impairment in patients with degenerative cervical myelopathy

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Degenerative cervical myelopathy is the most common cause of chronic impairment of the spinal cord.

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MRI-based anatomical assessment of cerebral and cerebellar areas revealed significant tissue volume reduction in DCM patients compared to healthy controls.

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Disease severity correlated with cerebral and cerebellar atrophy in the primary motor cortex, primary somatosensory cortex and cerebellar areas.

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Chronic injury to the spinal cord seems to have impact on remote anatomical structures in the brain.

This study investigated supra- and infratentorial structural gray and white matter (GM, WM) alterations in patients with degenerative cervical myelopathy (DCM) as an indicator of secondary harm due to chronic cervical cord compression and micro trauma. With MRI-based anatomical assessment and subsequent voxel-based morphometry analyses, pre- and postoperative volume alterations in the primary motor cortex (MI), the primary somatosensory cortex (SI), the supplementary motor area (SMA), and the cerebellum were analyzed in 43 DCM patients and 20 controls. We assessed disease-related symptom severity by the modified Japanese Orthopaedic Association scale (mJOA). The study also explored symptom severity-based brain volume alterations as well as their association with clinical status. Patients had lower mJOA scores (p = .000) and lower GM volume than controls in SI (p = .016) and cerebellar regions (p = .001). Symptom severity-based subgroup analyses revealed volume reductions in almost all investigated GM ROIs (MI: p = .001; CB: p = .040; SMA: p = .007) in patients with severe clinical symptoms as well as atrophy already present in patients with moderate symptom severity. Clinical symptoms in DCM were associated with cortical and cerebellar volume reduction. GM volume alterations may serve as an indicator of both disease severity and ongoing disease progression in DCM, and should be considered in further patient care and treatment monitoring.

Decreased angiogenesis as a possible pathomechanism in cervical degenerative myelopathy

Endogenous immune mediated reactions of inflammation and angiogenesis are components of the spinal cord injury in patients with degenerative cervical myelopathy (DCM). The aim of this study was to identify alteration of certain mediators participating in angiogenetic and inflammatory reactions in patients with DCM. A consecutive series of 42 patients with DCM and indication for surgical decompression were enrolled for the study. 28 DCM patients were included, as CSF samples were taken preoperatively. We enrolled 42 patients requiring surgery for a thoracic abdominal aortic aneurysm (TAAA) as neurologically healthy controls. In 38 TAAA patients, CSF samples were taken prior to surgery and thus included. We evaluated the neurological status of patients and controls prior to surgery including NDI and mJOA. Protein-concentrations of factors with a crucial role in inflammation and angiogenesis were measured in CSF via ELISA testing (pg/ml): Angiopoietin 2, VEGF-A and C, RANTES, IL 1 beta and IL 8. Additionally, evaluated the status of the blood-spinal cord barrier (BSCB) by Reibers´diagnostic in all participants. Groups evidently differed in their neurological status (mJOA: DCM 10.1 ± 3.3, TAAA 17.3 ± 1.2, p < .001; NDI: DCM 47.4 ± 19.7, TAAA 5.3 ± 8.6, p < .001). There were no particular differences in age and gender distribution. However, we detected statistically significant differences in concentrations of mediators between the groups: Angiopoietin 2 (DCM 267.1.4 ± 81.9, TAAA 408.6 ± 177.1, p < .001) and VEGF C (DCM 152.2 ± 96.1, TAAA 222.4 ± 140.3, p = .04). DCM patients presented a mild to moderate BSCB disruption, controls had no signs of impairment. In patients with DCM, we measured decreased concentrations of angiogenic mediators. These results correspond to findings of immune mediated secondary harm in acute spinal cord injury. Reduced angiogenic activity could be a relevant part of the pathogenesis of DCM and secondary harm to the spinal cord.

Borderline personality disorder and childhood trauma: Exploring the buffering role of self-compassion and self-esteem

OBJECTIVES

The aim of the present study was to investigate whether patients with borderline personality disorder (BPD) show lower self-compassion and self-esteem than healthy controls and whether patients' self-compassion and self-esteem moderate the association between childhood trauma and the severity of their BPD symptoms.

METHOD

Self-reported self-compassion, self-esteem, and the current severity of BPD symptoms were assessed in 35 female patients with BPD and 35 age-matched control participants. Further, traumatic childhood experiences were recorded in the patient group.

RESULTS

Patients with BPD reported significantly lower self-compassion and self-esteem compared to healthy controls. In addition, self-compassion but not self-esteem moderated the positive correlation between childhood trauma and the severity of BPD symptoms.

DISCUSSION

Self-compassion appears to buffer the negative consequences of childhood traumatization. Therefore, cultivating self-compassion may be an important therapeutic aim for patients with BPD.

Asymmetric tumor-related alterations of network-specific intrinsic functional connectivity in glioma patients

Resting-state functional MRI (rs-fMRI) allows mapping temporally coherent brain networks, and intra- and inter-network alterations have been described in different diseases. This prospective study investigated hemispheric resting-state functional connectivity (RSFC) differences in the default-mode network (DMN) and fronto-parietal network (FPN) between patients with left- and right-hemispheric gliomas (LH PAT, RH PAT), addressing asymmetry effects the tumor might have on network-specific intrinsic functional connectivity under consideration of the prognostically relevant isocitrate-dehydrogenase (IDH) mutation status. Twenty-seven patients (16 LH PAT, 12 IDH-wildtype) and 27 healthy controls underwent anatomical and rs-fMRI as well as neuropsychological assessment. Independent component analyses were performed to identify the DMN and FPN. Hemispheric DMN- and FPN-RSFC were computed, compared across groups, and correlated with cognitive performance. Patient groups did not differ in tumor volume, grade or location. RH PAT showed higher contra-tumoral DMN-RSFC than controls and LH PAT. With regard to the FPN, contra-tumoral RSFC was increased in both patient groups as compared to controls. Higher contra-tumoral RSFC was associated with worse cognitive performance in patients, which, however, seemed to apply mainly to IDH-wildtype patients. The benefit of RSFC alterations for cognitive performance varied depending on the affected hemisphere, cognitive demand, and seemed to be altered by IDH-mutation status. At the time of study initiation, a clinical trial registration was not mandatory at our faculty, but it can be applied for if requested.

Ecological Momentary Assessment in Patients With an Acquired Brain Injury: A Pilot Study on Compliance and Fluctuations

Ecological Momentary Assessment (EMA) promises to be a suitable method for capturing the dynamics in self-assessments through repeated measurements in naturalistic environments using common mobile devices. Therefore, EMA could increase the power of neuropsychological assessment by obtaining a more fine-grained picture of symptoms, limitations, and strengths in patients with an acquired brain injury (ABI) in real-life situations. The present study examined 15 patients with an ABI with cognitive and motor impairments. Following a semirandomized high-frequency sampling plan to assess EMA's feasibility and applicability, data were collected across 7 days. At eight prompts per day, patients were asked about their current activities, the social context they were in, their current mood, performance judgments of their own functional status, and the frequency of self-reflections. The average compliance rate was 71.6%. The fluctuations in patients' responses were measured in terms of variance distributions within simple (intercept only) three-level models and root mean square of successive difference values. They were sufficient, as shown, for example, by the mean within-person variability of 44.9% across all of the items studied. There were no significant correlations between patients' age, severity of depressive symptoms, or their level of functioning and their compliance with study participation or the variability of their responses. The results support the feasibility and applicability of EMA as an assessment technique in patients with an ABI. There are, however, limitations that should be considered when planning an assessment of brain-injured patients using EMA.

Transcranial Direct Current Stimulation of the Medial Prefrontal Cortex Has No Specific Effect on Self-referential Processes

The processing of self-referential information can be influenced by transcranial magnetic stimulation (TMS). The present randomized controlled study investigated whether similar effects can be elicited through the application of transcranial direct current stimulation (tDCS) regarding the "self-serving bias" (SSB) and the "mnemic neglect effect" (MNE). Seventy-five healthy males (M age = 25; SD = 4.3) were investigated in a between-groups design with random assignment by applying anodal, cathodal, or sham tDCS to the medial prefrontal cortex (mPFC). After stimulation, the participants judged if 80 personality traits (40 positive, 40 negative) were self-descriptive or not. Finally, the participants had to recall the previously presented adjectives. All three stimulation groups showed the expected SSB and MNE. Still, and contrary to our hypotheses, tDCS revealed neither a significant interaction effect between groups and valence concerning the number of chosen self-referential traits (F (2,72) = 1.36, p = 0.26,η G 2 = 0.02) nor an interaction effect between groups, valence, and self-reference concerning the percentage of recalled words (F (2,71) = 0.69, p = 0.50,η G 2 = 0.01). However, a post hoc inspection of effect sizes revealed that less negative traits were indicated as self-referential in the anodal compared to the cathodal group (ES: -0.59; CI: -1.16 to -0.03). Moreover, the participants showed-regardless of self-reference and type of stimulation-a better recall with tDCS in comparison to sham stimulation. Our results indicate that tDCS of the mPFC in healthy young men has no influence on the SSB and the MNE. However, tDCS seems to improve memory performance.

Elated or sad mood induction affects the attention of patients with a bipolar disorder less than that of patients with a depressive disorder

Introduction: The role of acute mood states as mediating factors in cognitive impairment in patients with mania or depression is not sufficiently clear. Similarly, the extent to which cognitive impairment is trait or state-specific remains an open question. Therefore, the aim of this study was to investigate the effect of a mood-induction on attention in patients with an affective disorder.Methods: Twenty-two depressed bipolar patients, 10 manic bipolar patients, 17 with a depressive episode (MDE), and 24 healthy controls performed the Attention-Network-Test (ANT). In a within-participants design, elated and sad moods were induced by an autobiographic recall and measured on a self-report scale. Subsequently, participants performed the ANT again.Results: The modulating effect of the elated mood induction on attention was small. Only the MDE group displayed moderate improvements in selective attention and tonic alertness. Surprisingly, after the sad mood induction, patients with MDE improved moderately on phasic and tonic alertness. Phasic alertness was also enhanced in patients with mania. Finally, after the mood induction, patients with MDE showed the largest variability in attentional performance.Conclusions: Results showed only small effects of mood induction on attention. This supports the view that attention deficits reflect trait variables.

Patients with degenerative cervical myelopathy have signs of blood spinal cord barrier disruption, and its magnitude correlates with myelopathy severity: a prospective comparative cohort study

PURPOSE

The aim of this study is to detect the presence of blood spinal cord barrier (BSCB) disruption in patients with degenerative cervical myelopathy (DCM).

METHODS

In this prospective non-randomized controlled cohort study, 28 patients with DCM were prospectively included. All patients had indication for neurosurgical decompression. Furthermore, 38 controls with thoracic abdominal aortic aneurysm (TAAA) and indication for surgery were included. All patients underwent neurological examination. Regarding BSCB disruption and intrathecal immunoglobulin (Ig) concentrations, cerebrospinal fluid (CSF) and blood serum were examined for albumin, IgG, IgA and IgM. Quotients (Q) (CSF/serum) were standardized and calculated according to Reibers' diagnostic criteria.

RESULTS

Patients and controls distinguished significantly in their clinical status. AlbuminQ, as expression of BSCB disruption, was significantly increased in the DCM patients compared to the controls. Quotients of IgG and IgA differed significantly between the groups as an expression of intrathecal diffusion. In the subgroup analysis of patients with mild/moderate clinical status of myelopathy and patients with severe clinical status, the disruption of the BSCB was significantly increased with clinical severity. Likewise, IgAQ and IgGQ presented increased quotients related to the clinical severity of myelopathy.

CONCLUSION

In this study, we detected an increased permeability and disruption of the BSCB in DCM patients. The severity of BSCB disruption and the diffusion of Ig are related to the clinical status in our patient cohort. Having documented this particular pathomechanism in patients with DCM, we suggest that this diagnostic tool cloud be an important addition to surgical decision making in the future. These slides can be retrieved under Electronic Supplementary Material.

Psychological factors outmatched morphological markers in predicting limitations in activities of daily living and participation in patients with lumbar stenosis

BACKGROUND

Recent demographic changes have led to a large population of older adults, many of whom experience degenerative disc diseases. Degenerative lumbar spinal stenosis (DLSS) is associated with considerable discomfort and limitations in activities of daily living (ADL). Symptomatic DLSS is one of the most frequent indications for spinal surgery. The aim of this study was to identify sociodemographic variables, morphological markers, depression as well as fear of movement that predict ADL performance and participation in social life in patients with DLSS.

METHODS

Sixty-seven patients with DLSS (mean age 62.5 years [11.7], 50.7% females) participated in the study. Predictor variables were age, gender, duration of disease, three morphological markers (severity of the lumbar stenosis, the number of affected segments and presence of spondylolisthesis) as well as self-reported depression and fear of movement. Dependent variables were pain interference with the performance of ADLs, ADLs and participation in social life. Correlations between predictor and dependent variables were calculated before stepwise, linear regression analyses. Only significant correlations were included in the linear regression analyses.

RESULTS

Variance explained by the predictor variables ranged between 12% (R2 = .12; pain interference-physical) and 40% (R2 = .40; ADL requiring lower extremity functioning; participation). Depression and fear of movement were the most powerful predictors for all dependent variables. Among the morphological markers only stenosis severity contributed to the prediction of ADLs requiring lower extremity functioning.

CONCLUSION

Depression and fear of movement were more important predictors of the execution of ADLs and participation in social life compared to morphological markers. Elevated depressive symptoms and fear of movement might indicate limited adaptation and coping regarding the disease and its consequences. Early monitoring of these predictors should therefore be conducted in every spine centre. Future studies should investigate whether psychological screening or a preoperative psychological consultation helps to avoid operations and enables better patient outcomes.

Sense it and use it: interoceptive accuracy and sensibility in suicide ideators

BACKGROUND

Interoceptive deficits have been found to be associated with suicidal ideation and behavior. However, an objective measure of interoceptive accuracy has not been investigated in participants with suicide ideation, by now. This study aimed at investigating interoceptive accuracy and sensibility in persons with and without suicide ideation (SI) while controlling for severity of depressive symptoms.

METHOD

Ninety-five participants (age: M = 34.8, SD = 11.6, n = 56 female [58.9%]; n = 51 patients with a Major Depressive Disorder and n = 44 healthy participants) were assessed for interoceptive accuracy and sensibility, depression and SI.

RESULTS

Twenty-five participants (26%) reported SI. They showed interoceptive accuracy comparable to persons without SI (t = -.81, p = .422), but significantly lower interoceptive sensibility. After controlling for severity of depressive symptoms in a hierarchical linear regression analysis, most associations between interoceptive sensibility and SI disappeared.

CONCLUSION

Results suggest that suicide ideators do not lack the ability to perceive their own bodily signals but they feel less able to use them in a way that is advantageous for them. Differences between suicide ideators and non-ideators appear to be largely driven by depressive symptoms (depression bias).

The Aachen List of Trait Words

In this study, we present the Aachen List of Trait Words (ALoT), including a total of 606 German adjectives with English translations, describing personality traits. The lack of ratings regarding the social desirability of traits led us to create a German trait database. Ratings of valence and social desirability were obtained from 100 participants. Statistical analyses of 99 participants indicated that valence and social desirability ratings were strongly correlated. However, there are several words showing a weak or no relationship. Furthermore, uncommon words were rated less positively (or desirable) than more common traits. Word frequency and word length were positively correlated, showing that short terms were more common than long ones. Social desirability and valence ratings are presented together with several psycholinguistic variables known to influence word processing (e.g. word length) in the ALoT. Scores for each word are provided as supplemental materials. The ALoT is intended to provide stimulus material for experiments dealing with the affective processing of German trait adjectives.

Diffusion Tensor Imaging Reveals Microstructural Heterogeneity of Normal-Appearing White Matter and Related Cognitive Dysfunction in Glioma Patients

Immunohistochemical data based on isocitrate–dehydrogenase (IDH) mutation status have redefined glioma as a whole-brain disease, while occult tumor cell invasion along white matter fibers is inapparent in conventional magnetic resonance imaging (MRI). The functional and prognostic impact of focal glioma may however relate to the extent of white matter involvement. We used diffusion tensor imaging (DTI) to investigate microstructural characteristics of whole-brain normal-appearing white matter (NAWM) in relation to cognitive functions as potential surrogates for occult white matter involvement in glioma. Twenty patients (12 IDH-mutated) and 20 individually matched controls were preoperatively examined using DTI combined with a standardized neuropsychological examination. Tumor lesions including perifocal edema were masked, and fractional anisotropy (FA) as well as mean, radial, and axial diffusivity (MD, RD, and AD, respectively) of the remaining whole-brain NAWM were determined by using Tract-Based Spatial Statistics and histogram analyses. The relationship between extratumoral white matter integrity and cognitive performance was examined using partial correlation analyses controlling for age, education, and lesion volumes. In patients, mean FA and AD were decreased as compared to controls, which agrees with the notion of microstructural impairment of NAWM in glioma patients. Patients performed worse in all cognitive domains tested, and higher anisotropy and lower MD and RD values of NAWM were associated with better cognitive performance. In additional analyses, IDH-mutated and IDH-wildtype patients were compared. Patients with IDH-mutation showed higher FA, but lower MD, AD, and RD values as compared to IDH-wildtype patients, suggesting a better preserved microstructural integrity of NAWM, which may relate to a less infiltrative nature of IDH-mutated gliomas. Diffusion-based phenotyping and monitoring microstructural integrity of extratumoral whole-brain NAWM may aid in estimating occult white matter involvement and should be considered as a complementary biomarker in glioma.

How females think about themselves and how they assume that significant others think about them: The influence of perspective taking on self-referential processing

People maintain a positive self-concept through positive self-appraisals (Self-Serving Bias Effect, SSBE) and a diminished memory for self-threatening information (Mnemic-Neglect Effect, MNE). Other people also influence a person’s self-concept. This study investigated SSBE and MNE in 60 females by using a trait-judgment paradigm applying two perspectives (self- and third-person appraisals) and a recall task. Additionally, self-esteem was assessed as an associated factor. SSBE and MNE were found in both kinds of appraisal perspectives. Interestingly, participants saw themselves as even more positive in reflected appraisals. SSBE and self-esteem were associated only in self-appraisals, indicating a larger SSBE on self-appraisals with raising self-esteem. In conclusion, both what females think about themselves and how they assume that others think about them preserve their overall positive self-concept.

Anterior Cervical Decompression and Fusion or Posterior Foraminotomy for Cervical Radiculopathy: Results of a Single-Center Series

BACKGROUND

 Anterior cervical diskectomy and fusion (ACDF) or posterior foraminotomy (PF) are standard treatment options for cervical radiculopathy due to disk prolapse. Which method produces superior results has not yet been established. One reason for the dilemma, among others, is a lack of detailed outcome analysis in previous studies. We quantified outcome to compare both methods in our retrospective single-center series.

METHOD

 We conducted a retrospective analysis of 107 patients with cervical radiculopathy who were operated on via ACDF or via PF. Demographic data, symptoms, neurologic status, and pathology were recorded and correlated to outcome parameters such as Odom's criteria, visual analog scale values of radicular pain, Neck Disability Index values, and subjective satisfaction, which were also compared between both treatment groups. Intraoperative data, early and late complications, and reoperations were recorded and compared between both surgical groups.

RESULTS

 None of the recorded preoperative data were predictive for postoperative outcome parameters. Patients in the PF group reported better overall outcome (Odom's criteria) and greater relief of radicular and neck pain. Operative time and blood loss were less in the PF group. Both groups showed comparable early complication rates, but PF patients tended to have more late reoperations.

CONCLUSION

 Due to a better overall outcome as well as greater relief of radicular and neck pain in our cohort, we consider PF the first-line treatment if morphology of the pathology is suitable.

Development of a short scale for assessing economic environmental aspects in patients with spinal diseases using Rasch analysis

Background

Economic environmental factors represent important barriers to participation and have deleterious effects on quality of life (QOL) in persons with spinal diseases (SpD). While economic factors are anchored in the International Classification of Functioning, Disability and Health, their influence on QOL and participation from patients’ perspectives is an infrequent focus of research. The aim of the present research is to calibrate a culturally adapted Rasch-based questionnaire assessing economic QOL in patients with SpD.

Methods

The 11-items of the German economic-QOL-scale were answered by 325 patients with SpD on a four-point Likert-scale. Fit to the Rasch measurement model was investigated by testing for stochastic ordering of the items, unidimensionality, local independence, and differential item functioning (DIF).

Results

After adjusting for local dependency, fit to the Rasch model was achieved with a non-significant item-trait interaction (chi-square_df = 20 = 34.8, p = 0.021). The person separation reliability equaled 0.88, the scale was free from age- or gender-related DIF, and unidimensionality could be verified.

Conclusions

The Rasch-based German version of the economic-QOL-scale represents a suitable instrument to investigate the influences of economic factors on patients’ QOL at a group and individual level. It can be easily applied in research and practice and may be administered quickly in combination with other instruments. The short test duration implies a low test burden for patients and a minimum of time expenditure by clinicians when evaluating the results.

The Relationship Between Interoception and Metacognition

Abstract. Recently, Garfinkel and Critchley (2013) proposed to distinguish between three facets of interoception: interoceptive sensibility, interoceptive accuracy, and interoceptive awareness. This pilot study investigated how these facets interrelate to each other and whether interoceptive awareness is related to the metacognitive awareness of memory performance. A sample of 24 healthy students completed a heartbeat perception task (HPT) and a memory task. Judgments of confidence were requested for each task. Participants filled in questionnaires assessing interoceptive sensibility, depression, anxiety, and socio-demographic characteristics. The three facets of interoception were found to be uncorrelated and interoceptive awareness was not related to metacognitive awareness of memory performance. Whereas memory performance was significantly related to metamemory awareness, interoceptive accuracy (HPT) and interoceptive awareness were not correlated. Results suggest that future research on interoception should assess all facets of interoception in order to capture the multifaceted quality of the construct.

Resting vagal tone is negatively associated with suicide ideation

BACKGROUND

The present study aimed at investigating whether resting vagally mediated heart rate variability (HRV) as a trait-like biomarker of cognitive inhibitory control capacity is related to suicide ideation in a sample without suicide attempt history.

METHODS

Thirty-seven healthy students participated voluntarily (18 to 34 years, M=24.5, SD=4.1; 73.0% female). Time and frequency measures of HRV were derived from an electrocardiogram that was recorded using Einthoven's Triangle lead II. Participants filled in the Rasch-based Depression Screening and four questions concerning lifetime suicide ideation (SI). Bivariate Pearson's and partial (controlling for depression severity) correlation coefficients were calculated between SI and measures of vagally mediated HRV.

RESULTS

A significant correlation between the ln10-transformed high-frequency band of resting vagally mediated HRV and SI was found (r=-.33, p<.05). Correlations did not change substantially when controlling for depression. Mean heart rate as a time domain measure also significantly correlated with SI while controlling for depression (r=.36, p<.05). A trend correlation between SI and Root Mean Square of Successive Differences between interbeat intervals emerged.

LIMITATIONS

SI was assessed with a composite score of four items measuring SI. Future studies should consider using more comprehensive assessment instruments.

CONCLUSIONS

The relation between resting vagally mediated HRV and suicide ideation may be interpreted as indicating that reduced inhibitory cognitive control capacity may be a risk factor for suicidality. It may act already early in the suicidal process, before suicidal behavior develops and should be further investigated as potentially clinically important physiological predictor of suicidality.

Exploring the relationship of decentering to health related concepts and cognitive and metacognitive processes in a student sample

Background

Decentering, a central change strategy of Mindfulness-Based Cognitive Therapy, is a process of stepping outside of one’s own mental events leading to an objective and non-judging stance towards the self. The study aimed at investigating associated mechanisms of decentering.

Method

The present study investigated the relation of decentering, operationalized by means of the German Version of the Experiences Questionnaire, to severity of depressive symptoms, assessed by the adaptive Rasch-based depression screening, and self-focussed attention, assessed by the Questionnaire of Dysfunctional and Functional Self-Consciousness. Furthermore, the relationship between decentering and a) the ability to shift and allocate attention by means of the Stroop test, and b) metacognitive monitoring, i.e. the absolute difference between judged and real task performance, was investigated. These relationships were examined in 55 healthy students using Pearson’s correlations.

Results

In line with our assumptions, higher decentering scores were significantly associated with lower scores on severity of depressive symptoms, with higher functional- and lower dysfunctional self-focussed attention. Contrary to our expectations, results neither indicated a relationship between decentering and attention ability, nor between decentering and metacognitive monitoring.

Conclusions

The present results suggest that decentering is associated with concepts of mental health (i.e. less severity of depressive symptoms and higher functional self-focussed attention). Overall, the concept decentering seems to be mainly composed of self-focussed aspects when investigated in a healthy sample without intervention. Further investigations of associated concepts of decentering should consider aspects of self-relevance and emotional valence.

Implicit sequence learning in juvenile anorexia nervosa: neural mechanisms and the impact of starvation

BACKGROUND

Previous studies have reported that cognitive deficits occur in patients with anorexia nervosa (AN) and that these deficits may represent a predisposition towards developing AN or perpetuate the disorder. Specifically, dysfunctional implicit learning may contribute to the development of highly resistant dieting behaviours that are fundamental to the persistence of the disorder. Thus, the aims of this study were (a) to investigate implicit sequence learning in adolescent patients with AN before and after weight recovery and (b) to elucidate the associated neural mechanisms in acute AN relative to healthy controls.

METHODS

In a behavioural study, implicit sequence learning was assessed using a serial reaction time task in 27 adolescents with AN before (T1) and after weight recovery (T2) compared with age-matched healthy controls (HC) who were assessed at similar time intervals. The neural correlates of implicit sequence learning were subsequently investigated in 19 AN patients shortly after they were admitted to the hospital and 20 HC using functional magnetic resonance imaging (fMRI).

RESULTS

At T1, AN patients showed reduced sequence learning compared with HC. However, no behavioural differences between HC and AN patients were found at T2. At the neural level, acute AN patients showed reduced thalamic activation during sequence learning compared with HC subjects.

CONCLUSIONS

Our data suggest that the impaired implicit learning observed in adolescent AN patients before weight gain is a state-related dysfunction that normalises with weight gain. Thus, implicit learning deficits do not appear to represent a predisposition towards developing AN; rather, these deficits should be considered when planning psychotherapeutic interventions for acute AN. Reduced thalamic activation during the acute stage of AN may indicate a starvation-induced dysfunction of the neural circuitry that is involved in behavioural flexibility.

Brain volume reduction predicts weight development in adolescent patients with anorexia nervosa

BACKGROUND

Acute anorexia nervosa (AN) is associated with marked brain volume loss potentially leading to neuropsychological deficits. However, the mechanisms leading to this brain volume loss and its influencing factors are poorly understood and the clinical relevance of these brain alterations for the outcome of these AN-patients is yet unknown.

METHODS

Brain volumes of 56 female adolescent AN inpatients and 50 healthy controls (HCs) were measured using MRI scans. Multiple linear regression analyses were used to determine the impact of body weight at admission, prior weight loss, age of onset and illness duration on volume loss at admission and to analyse the association of brain volume reduction with body weight at a 1-year follow-up (N = 25).

RESULTS

Cortical and subcortical grey matter (GM) and cortical white matter (WM) but not cerebellar GM or WM were associated with low weight at admission. Amount of weight loss, age of onset and illness duration did not independently correlate with any volume changes. Prediction of age-adjusted standardized body mass index (BMI-SDS) at 1-year follow-up could be significantly improved from 34% of variance explained by age and BMI-SDS at admission to 47.5-53% after adding cortical WM, cerebellar GM or WM at time of admission.

CONCLUSION

Whereas cortical GM changes appear to be an unspecific reflection of current body weight ("state marker"), cortical WM and cerebellar volume losses seem to indicate a longer-term risk (trait or "scar" of the illness), which appear to be important for the prediction of weight rehabilitation and long-term outcome.

Neural correlates of positive and negative performance feedback in younger and older adults

BACKGROUND

Recent studies with younger adults have shown that performance feedback can serve as a reward, and it elicits reward-related brain activations. This study investigated whether performance feedback is processed similarly in younger and older adults and whether there are differential aging effects for positive and negative performance feedback.

METHODS

We used event-related fMRI in a choice reaction-time task and provided performance feedback after each trial.

RESULTS

Although younger and older adults differed in task-related activation, they showed comparable reward-related activation. Positive performance feedback elicited the strongest striatal and amygdala activation, which was reflected behaviorally in slightly faster reaction times.

CONCLUSIONS

These results suggest that performance feedback serves as a reward in both younger and older adults.

[Fearlessness about Death and Suicidal Behavior: Psychometric Properties of the German Version of the Revised Acquired Capability for Suicide Scale (ACSS-FAD)]

OBJECTIVES

The Acquired Capability of Suicide Scale (ACSS-FAD) assesses fearlessness about death according to the Interpersonal Theory of Suicide. Psychometric properties of the German version of the ACSS-FAD are investigated.

METHODS

Dimensionality and validity were analysed in a sample of N=268 undergraduate students.

RESULTS

Confirmatory factor analysis replicated the unidimensionality of the measure. Correlations with suicidal ideation (r= .05) and self-reported capability for suicide (r= .14) supported the validity of the scale, while the association with depression (r= - .20) is not in line with the theory. Male participants and participants reporting past self-injurious behaviour/suicidal attempts did not show higher levels of fearlessness about death.

CONCLUSION

The study demonstrates good psychometric properties of the German ACSS-FAD and largely supports the validity of the measure. However, future research needs to further investigate the validity of the ACSS-FAD (i.e. testing the utility of the instrument in predicting suicidal behaviour in patients at risk).

Effects of mindfulness-based cognitive therapy on self-reported suicidal ideation: results from a randomised controlled trial in patients with residual depressive symptoms

INTRODUCTION

The aim of the present study was to investigate the effects of mindfulness-based cognitive therapy (MBCT) on suicidal ideation in an open-label randomised controlled trial of patients with residual depressive symptoms. Furthermore, this study aimed at examining whether an effect of MBCT on suicidal ideation was dependent on a reduction in depression severity, worry and rumination, or an increase in mindfulness.

METHODS

One hundred and thirty participants were randomised to a treatment arm (treatment as usual plus MBCT) or a wait list arm. Change in depression, change in worry, change in rumination and change in mindfulness were entered as covariates in a repeated measures ANOVA in order to assess to what degree MBCT-induced changes in suicidal ideation were independent from changes in these parameters.

RESULTS

There was a significant group×time (pre vs. post) interaction on suicidal ideation indicating a significant reduction of suicidal ideation in the MBCT group, but not in the control group. The interaction remained significant after addition of the above covariates. Change in worry was the only covariate associated with change in suicidal ideation, causing a moderate reduction in the interaction effect size.

CONCLUSIONS

The results suggest that MBCT may affect suicidal ideation in patients with residual depressive symptoms and that this effect may be mediated, in part, by participants' enhanced capacity to distance themselves from worrying thoughts.

A mediation model of mindfulness and decentering: sequential psychological constructs or one and the same?

BACKGROUND

Mindfulness and decentering are closely related processes both assumed to promote well-being. While some researchers claim that mindfulness and decentering can be clearly differentiated others suggest to use these concepts interchangeably. The precise relation between mindfulness and decentering remains unclear and therefore the present study aims to determine the relation between mindfulness and decentering.

METHODS

In a structural equation modeling framework, a mediation model was tested among a sample group of 495 university students (average age 20.8 years, 30.3% female).

RESULTS

The identified model shows an acceptable fit to the data and illustrates the role of decentering as a mediator of the relationship between mindfulness and depressive symptoms by complementary mediation and indirect-only mediation.

CONCLUSION

The present results cannot sustain previous research, which converted mindfulness and decentering into one single variable. Rather the data suggests to treat mindfulness and decentering as two separable concepts and to regard decentering as an important working mechanism of mindfulness.

Does cognitive behavior therapy alter emotion regulation in inpatients with a depressive disorder?

Introduction

Emotion regulation plays an important role in the development and treatment of depression. The present study investigated whether the emotion regulation strategies, expressive suppression (ES) and cognitive reappraisal (CR) change in the course of cognitive behavior therapy (CBT) of depressive inpatients. Furthermore, it also examined whether changes in CR and ES correlated with positive treatment outcomes.

Methods

Forty-four inpatients from a psychotherapeutic hospital who suffered from a depressive disorder (mean age =36.4 years, standard deviation =13.4 years; 63.6% female) filled in the Emotion Regulation Questionnaire and the Beck Depression Inventory at admission and discharge. To detect changes in emotion regulation, and depression across treatment, data were analyzed using multivariate analyses of variance (MANOVA) for repeated measures, effect sizes, and Spearman correlations. A P-value of ≤0.05 was considered statistically significant.

Results

Depression severity (F[1]=10.42, P=0.003; η²=0.22) and CR (F[1]=4.71, P=0.04; η²=0.11) changed significantly across CBT treatment. ES remained virtually stable. Post-treatment scores of CR were also positively correlated with reduction in depressive symptoms across treatment (ρ=0.30, P=0.05).

Conclusion

The results suggest that CBT affects emotion regulation in depressive inpatients only for CR and that higher post-treatment scores in CR were related to greater reduction in depressive symptoms across treatment.

Measuring decentering in self-reports: Psychometric properties of the experiences questionnaire in a German sample

Decentering is described as referring to one's current mental experiences from an objective perspective. This study presents a psychometric evaluation of a German version of the Experiences Questionnaire (EQ-D), a self-report instrument designed to measure decentering. Confirmatory factor analysis on a sample of 506 university students indicates acceptable-to-good model fit (χ(2)=58.3; TLI=.92; CFI=.95; RMSEA=.067) for a second-order factor Overall Decentering comprising the two first-order factors Accepting Self-Perception and Distanced Perspective. Preliminary evidence for the validity of the EQ-D was demonstrated via negative correlations with measures of depression and depressive rumination. The present results stress the multidimensional nature of decentering and provide important suggestions for future research on how to investigate and operationalize the decentering construct.

Theory of mind and the brain in anorexia nervosa: relation to treatment outcome

OBJECTIVE

Converging evidence suggests deficits in theory-of-mind (ToM) processing in patients with anorexia nervosa (AN). The present study aimed at elucidating the neural mechanisms underlying ToM-deficits in AN.

METHOD

A total of 19 adolescent patients with AN and 21 age-matched controls were investigated using functional magnetic resonance imaging during performance of a ToM-task at two time points (in-patients: admission to hospital and discharge after weight recovery). Clinical outcomes in patients were determined 1 year after admission.

RESULTS

Irrespective of the time point, AN patients showed reduced activation in middle and anterior temporal cortex and in the medial prefrontal cortex. Hypoactivation in the medial prefrontal cortex at admission to hospital (T1) was correlated with clinical outcome at follow-up.

CONCLUSIONS

Hypoactivation in the brain network supporting theory of mind may be associated with a social-cognitive endophenotype reflecting impairments of social functioning in anorexia nervosa which is predictive for a poor outcome at 1-year follow-up.

Influence of cue exposure on inhibitory control and brain activation in patients with alcohol dependence

Alcohol dependence is a serious condition characterized by persistent desires to drink and unsuccessful efforts to control alcohol consumption despite the knowledge of dysfunction through the usage. The study at hand examined the influence of an alcohol exposure on inhibitory processes. Research provides evidence that trying to resist the temptation to drink exerts self-control, a limited resource which is used during all acts of inhibition. In line with this, studies demonstrate an impaired ability to regulate an already initiated response in alcohol-dependent and healthy subjects when confronted with alcohol-related stimuli. The related neuronal correlates in alcohol-dependent patients remain to be elucidated. The inhibition performance of 11 male alcohol-dependent patients during an alcohol exposure was compared with the task performance during a control condition. Behavioral data and neural brain activation during task performance were acquired by means of functional magnetic resonance imaging. The alcohol cue exposure led to subjectively stronger urges to drink which was accompanied by differential neural activation in amygdala and hippocampus. Moreover, the results revealed typical neural activation during inhibition performance across both conditions. Anyhow, we could not detect any behavioral deficits and only subtle neural differences between induction conditions during the performance of the inhibition task within the inferior frontal cortex. The results suggest that although the sample reports a subjectively stronger urge to drink after the alcohol cue exposure this effect was not strong enough to significantly impair task performance. Coherently, we discover only subtle differential brain activation between conditions during the inhibition task. In opposition to findings in literature our data do not reveal that an exposure to alcohol-related cues and thereby elicited cue reactivity results in impaired inhibition abilities.

Can executive control be influenced by performance feedback? Two experimental studies with younger and older adults

Executive control describes a wide range of cognitive processes which are critical for the goal-directed regulation of stimulus processing and action regulation. Previous studies have shown that executive control performance declines with age but yet, it is still not clear whether different internal and external factors—as performance feedback and age—influence these cognitive processes and how they might interact with each other. Therefore, we investigated feedback effects in the flanker task in young as well as in older adults in two experiments. Performance feedback significantly improved executive performance in younger adults at the expense of errors. In older adults, feedback also led to higher error rates, but had no significant effect on executive performance which might be due to stronger interference. Results indicate that executive functions can be positively influenced by performance feedback in younger adults, but not necessarily in older adults.