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Soziale Phobie gilt als eine der am weitesten verbreiteten psychischen Störungen (Wittchen & Fehm, 2003; Magee et al., 1996). Obgleich zahlreiche Interventionsansätze zur Behandlung der sozialen Ängste zur Verfügung stehen, gibt es viele Betroffene, die nicht von den Behandlungsmöglichkeiten profitieren oder nach einer Therapie Rückfälle erleben. Aus diesem Grund beschäftigt sich die vorliegende Arbeit mit der Weiterentwicklung von Psychotherapie bei Sozialer Phobie. Sie greift verschiedene Forschungsperspektiven auf, um aktive Wirkfaktoren im therapeutischen Prozess zu identifizieren und für zukünftige Behandlungen nutzbar zu machen. Publikation 1 (Consbruch & Stangier, 2007) gibt einen Überblick über den aktuellen Forschungsstand bzgl. der Diagnostik, Ätiologie und Therapie bei Sozialer Phobie. Die in dieser Publikation dargestellten Forschungsarbeiten zur Behandlung sozialer Ängste vergleichen die therapeutische Wirksamkeit unterschiedlicher Therapieansätze und suchen so nach spezifischen Wirkfaktoren in der Behandlung Sozialer Phobien. Es zeigt sich, dass die kognitiv-verhaltenstherapeutische Behandlung am häufigsten untersucht wurde und dass sich ihre Effektivität durch die Berücksichtigung von Prozessen, die nach Clark und Wells (1995) an der Entstehung und Aufrechterhaltung der Sozialen Ängste beteiligt sind, erheblich verbessern lässt. Publikation 2 (Stangier, Consbruch, Schramm & Heidenreich, 2010) verlässt die ausschließlich an spezifischen Wirkmechanismen interessierte Forschungsperspektive und wendet sich der Frage nach dem Zusammenspiel von spezifischen und allgemeinen Wirkfaktoren zu. Sie vergleicht das Ausmaß der Aktivierung von allgemeinen Wirkfaktoren nach Grawe (1995) sowie deren Einfluss auf das Therapieergebnis in einer kognitiven Verhaltenstherapie (N=29) und einer interpersonellen Therapie (N=33). Die Ergebnisse zeigen, dass Therapeuten in der Interpersonellen Psychotherapie die Aktivierung von Bewältigung, Ressourcenorientierung und Motivationaler Klärung geringer einschätzten als Therapeuten in der kognitiven Verhaltenstherapie, während sie bezüglich der Problemaktivierung und der Güte der therapeutischen Beziehung keine Unterschiede angaben. Stärkere Ressourcenaktivierung stand in beiden Therapieansätzen mit besseren Therapieergebnissen in Beziehung, während höhere Problemaktualisierung nur in KVTBehandlungen zu verbessertem Outcome beitrug. Da die Ressourcenaktivierung in der KVTBedingung stärker ausgeprägt war als in der IPT-Bedingung, lassen sich die Ergebnisse so interpretieren, dass die Problemaktualisierung nur dann zu positiveren Therapieergebnissen führt, wenn sie durch ausreichende Ressourcenaktivierung gestützt wird. Die Studie legt somit nahe, dass spezifische Behandlungsansätze allgemeine Wirkfaktoren, die einen Einfluss auf das Therapieergebnis haben, in unterschiedlichem Maße nutzen. Durch das Fehlen von Angaben zur Therapieintegrität bleibt jedoch offen, welche Rolle individuelles Therapeutenverhalten bei der Aktivierung der allgemeinen und spezifischen Wirkfaktoren spielt. Um zukünftig die Therapieintegrität in der kognitiv-verhaltenstherapeutischen Behandlung von Sozialer Phobie sicherstellen zu können, wurde die Cognitive Therapy Competence Scale for Social Phobia (CTCS-SP) entwickelt, deren psychometrische Eigenschaften in Publikation 3 (Consbruch, Clark & Stangier, in press) dargestellt werden. Zur Bestimmung der Beobachterübereinstimmung wurden 161 Therapiesitzungen von jeweils 2 Ratern mit der CTCS-SP beurteilt. Die Ergebnisse der vorliegenden Untersuchung demonstrieren eine gute interne Konsistenz und gute Interraterreliabilität der Skala, wobei erstmals auch individuelle Items mit ausreichender Reliabilität gemessen werden konnten. Mit der CTCS-SP steht somit ein reliables Messinstrument zur Erfassung therapeutischer Kompetenz in der kognitivverhaltenstherapeutischen Behandlung der Sozialen Phobie zur Verfügung, welches – bei noch zu prüfender Validität - vielfältig eingesetzt werden kann, um die Erforschung
spezifischer und allgemeiner Wirkfaktoren in der kognitiv-verhaltenstherapeutischen Behandlung Sozialer Phobien zu vertiefen.
Während Bildungspolitiker heftig über die Abschaffung der Hauptschule streiten und Hamburger Bürger sich per Volksentscheid für den Erhalt des Gymnasiums ab Klasse 5 einsetzen, sind sich die meisten Bildungsforscher einig: Entscheidend ist nicht, wo, sondern wie Kinder unterrichtet und betreut werden. Wie kann es gelingen, pädagogische Interventionen den unterschiedlichen Lernvoraussetzungen so anzupassen, dass möglichst alle Schülerinnen und Schüler optimal gefördert werden? Um das herauszufi nden, bedarf es intensiver Anstrengungen in der Lehr-Lernforschung, wie sie in Frankfurt im Forschungszentrum IDeA unternommen werden.
The current work investigated the association of trait anxiety and the neural efficiency of cognitive processing for affectively neutral (not threat-related) information. In a sample of 46 healthy volunteers, three fMRI experiments were conducted to test the prediction derived from attentional control theory (Eysenck et al., 2007) that high as compared to low trait-anxious individuals expend more neural effort on tasks requiring the top-down control of attention to reach a given level of performance. In a colour-word Stroop task requiring the inhibition of irrelevant stimulus information and associated responses as well as in a working-memorymanipulation task requiring the shifting of attention between items in working memory, trait anxiety (as measured with the State-Trait Anxiety Inventory; Spielberger et al., 1970) was positively associated with task-related increases in the activation of two adjacent regions in the right dorsolateral prefrontal cortex (DLPFC). The finding that along with a stronger activation of this brain region commonly implicated in top-down control processes, the high-anxious subjects showed equal (working memory manipulation) or worse (Stroop) performance when compared to low-anxious subjects, does support the assumption that processing is less efficient in the high anxious. However, in contrast to the predictions, trait anxiety did not show a significant association with task-related brain activation in a task-switching paradigm requiring shifting between task sets. It is discussed how different attentional control demands of the task may account for differences in the effects of trait anxiety on overt behavioural performance and underlying neural processes. In addition to DLPFC activation, trait anxiety modulated the functional connectivity of distributed regions involved in processing of the Stroop and the working-memory-manipulation task. It is discussed how the observed differences in regional DLPFC activation and network connectivity relate to each other. A possible interpretation suggests that activation increases in the DLPFC reflect an attempt to compensate for suboptimal connectivity by investing more effort in prefrontally supported control processes. Overall, the current work shows an association of trait anxiety with the neural efficiency of cognitive processing in affectively neutral tasks involving attentional control. Furthermore, it suggests that investigations of neural efficiency should take into account difference in functional integration in addition to regional activation.
Which factors determine whether a stimulus is consciously perceived or unconsciously processed? Here, I investigate how previous experience on two different time scales – long term experience over the course of several days, and short term experience based on the previous trial – impact conscious perception. Regarding long term experience, I investigate how perceptual learning does not only change the capacity to process stimuli, but also the capacity to consciously perceive them. To this end, subjects are trained extensively to discriminate between masked stimuli, and concurrently rate their subjective experience. Both the ability to discriminate the stimuli as well as subjective awareness of the stimuli increase as a function of training. However, these two effects are not simple byproducts of each other. On the contrary, they display different time courses, with above chance discrimination performance emerging before subjective experience; importantly, the two learning effects also rely on different circuits in the brain: Moving the stimuli outside the trained receptive field size abolishes the learning effects on discrimination ability, but preserves the learning effects on subjective awareness.
This indicates that the receptive fields serving subjective experience are larger than the ones serving objective performance, and that the channels through which they receive their information are arranged in parallel. Regarding short term experience, I investigate how memory based predictions arising from information acquired on the trial before affect visibility and the neural correlates of consciousness. To this end, I vary stimulus evidence as well as predictability and acquire electroencephalographic data.
A comparison of the neural processes distinguishing consciously perceived from unperceived trials with and without predictions reveals that predictions speed up processing, thus shifting the neural correlates forward in time. Thus, the neural correlates of consciousness display a previously unappreciated flexibility in time and do not arise invariably late as had been predicted by some theorists.
Admittedly, however, previous experience does not always stabilize perception. Instead, previous experience can have the reverse effect: Seeing the opposite of what was there, as in so-called repulsive aftereffects. Here, I investigate what determines the direction of previous experience using multistable stimuli. In a functional magnetic resonance imaging experiment, I find that a widespread network of frontal, parietal, and ventral occipital brain areas is involved in perceptual stabilization, whereas the reverse effect is only evident in extrastriate cortex. This areal separation possibly endows the brain with the flexibility to switch between exploiting already available information and emphasizing the new.
Taken together, my data show that conscious perception and its neuronal correlates display a remarkable degree of flexibility and plasticity, which should be taken into account in future theories of consciousness.
In human neuroscientific research, there has been an increasing interest in how the brain computes the value of an anticipated outcome. However, evidence is still missing about which valuation related brain regions are modulated by the proximity to an expected goal and the previously invested effort to reach a goal. The aim of this dissertation is to investigate the effects of goal proximity and invested effort on valuation related regions in the human brain. We addressed this question in two fMRI studies by integrating a commonly used reward anticipation task in differential versions of a Multitrial Reward Schedule Paradigm. In both experiments, subjects had to perform consecutive reward anticipation tasks under two different reward contingencies: in the delayed condition, participants received a monetary reward only after successful completion of multiple consecutive trials. In the immediate condition, money was earned after every successful trial. In the first study, we could demonstrate that the rostral cingulate zone of the posterior medial frontal cortex signals action value contingent to goal proximity, thereby replicating neurophysiological findings about goal proximity signals in a homologous region in non-human primates. The findings of the second study imply that brain regions associated with general cognitive control processes are modulated by previous effort investment. Furthermore, we found the posterior lateral prefrontal cortex and the orbitofrontal cortex to be involved in coding for the effort-based context of a situation. In sum, these results extend the role of the human rostral cingulate zone in outcome evaluation to the continuous updating of action values over a course of action steps based on the proximity to the expected reward. Furthermore, we tentatively suggest that previous effort investment invokes processes under the control of the executive system, and that posterior lateral prefrontal cortex and the orbitofrontal cortex are involved in an effort-based context representation that can be used for outcome evaluation that is dependent on the characteristics of the current situation.
Functional near-infrared spectroscopy (fNIRS) is an established optical neuroimaging method for measuring functional hemodynamic responses to infer neural activation. However, the impact of individual anatomy on the sensitivity of fNIRS measuring hemodynamics within cortical gray matter is still unknown. By means of Monte Carlo simulations and structural MRI of 23 healthy subjects (mean age: (25.0 +- 2.8 years), we characterized the individual distribution of tissue-specific NIR-light absorption underneath 24 prefrontal fNIRS channels. We, thereby, investigated the impact of scalp-cortex distance (SCD), frontal sinus volume as well as sulcal morphology on gray matter volumes (V gray) traversed by NIR-light, i.e. anatomy-dependent fNIRS sensitivity. The NIR-light absorption between optodes was distributed describing a rotational ellipsoid with a mean penetration depth of (23.6 +- 0.7 mm) considering the deepest 5% of light. Of the detected photon packages scalp and bone absorbed (96.4 +- 9.7)% and absorbed (3,1 +- 1.8)% of the energy. The mean V gray volume (1.1 +- 0.4)cm 3 was negatively correlated (r = -.76) with the SCD and frontal sinus volume (r= -.57) and was reduced by in subjects with relatively large compared to small frontal sinus. Head circumference was significantly positively correlated with the mean SCD (r= .46) and the traversed frontal sinus volume (r= .43). Sulcal morphology had no significant impact on . Our findings suggest to consider individual SCD and frontal sinus volume as anatomical factors impacting fNIRS sensitivity. Head circumference may represent a practical measure to partly control for these sources of error variance.
Numorous psychotherapeutic approaches have been put forward to better treat patients with chronic psychological problems or severe personality disorders, among them Schema Therapy (Young, Klosko & Weishaar, 2003). Within Schema Therapy, there are two important theoretical constructs: early maladaptive schemas, which are conceptualized as stable and lasting emotional, behavioral and cognitive patterns regarding ourselves, the world and other people that have their origins in childhood or adolescence and schema modes, which are current states that describe the rapid shifts in emotion, cognition and behaviour that can be seen in patients with severe personality disorders. Schema Therapy has growing popularity with clinicians in the last decade, but only a few studies have tested the empirical validity of the schema mode model. Lobbestael, van Vreeswijk, Spinhoven, Schouten & Arntz (2010) developed and evaluated the Schema Mode Inventory to assess schema modes within the framework of a questionnaire. This instrument has been translated to the German language and the psychometric properties of the instrument indicate an adequate fit to the model established in the original Dutch study (paper 1).
In Schema Therapy, on the one hand mode concepts have been proposed without a focus on one specific disorder (Young et al., 2003), but on the other hand disorder-specific concepts have been established that form the basis for manualization and research. The most popular disorder specific mode concept is that of Borderline Personality Disorder (Arntz & van Genderen, 2009). In randomized controlled trials the effectiveness of Schema Therapy for Borderline Personality Disorder in the individual setting (Giesen-Bloo, van Dyck, Spinhoven, van Tilburg, Dirksen et al., 2006) and the group setting (Farrell, Shaw & Webber, 2009) was evaluated. Whereas Schema Therapy for Borderline Personality Disorder in the individual setting has been manualized (Arntz & van Genderen, 2009), a manual for group Schema Therapy is not yet available, Therefore, particularly since this last evaluation study, there has been a need to better describe, how the Schema Therapy mode model for Borderline Personality Disorder has been applied to the group setting (papers 2 & 3) as well as how both modalities of Schema Therapy treatment, individual and group, are combined in intensive psychotherapy settings such as inpatient or day care (papers 4 & 5). Lastly the question has been put forward as to how effective Schema Therapy for Borderline Personality Disorder is in intensive treatment environments, where it is assumed that the severity of the disorders treated is even higher. It is found that a combined program of individual and group Schema Therapy for Borderline Personality Disorder is effective in the inpatient setting. Subtle variations in treatment programs in three pilot studies leave room for the discussion of possible factors influencing treatment effects (paper 6). The results of all studies are discussed on the background of Schema Therapy’s development as a new psychotherapy approach for the treatment of complex disorders.
Event-related potentials (ERPs) are widely used in basic neuroscience and in clinical diagnostic procedures. In contrast, neurophysiological insights from ERPs have been limited, as several different mechanisms lead to ERPs. Apart from stereotypically repeated responses (additive evoked responses), these mechanisms are asymmetric amplitude modulations and phase-resetting of ongoing oscillatory activity. Therefore, a method is needed that differentiates between these mechanisms and moreover quantifies the stability of a response. We propose a constrained subspace independent component analysis that exploits the multivariate information present in the all-to-all relationship of recordings over trials. Our method identifies additive evoked activity and quantifies its stability over trials. We evaluate identification performance for biologically plausible simulation data and two neurophysiological test cases: Local field potential (LFP) recordings from a visuo-motor-integration task in the awake behaving macaque and magnetoencephalography (MEG) recordings of steady-state visual evoked fields (SSVEFs). In the LFPs we find additive evoked response contributions in visual areas V2/4 but not in primary motor cortex A4, although visually triggered ERPs were also observed in area A4. MEG-SSVEFs were mainly created by additive evoked response contributions. Our results demonstrate that the identification of additive evoked response contributions is possible both in invasive and in non-invasive electrophysiological recordings.
Ausgehend von dem sprachsystematischen und entwicklungsorientierten Therapiean-satz nach Reuter-Liehr (1993, 2008) wurde aufbauend auf der Definition der Lauttreue ein Entwicklungsstufenmodell formuliert. Dessen Gültigkeit wurde in der vorliegenden Arbeit an einer Stichprobe von 367 Haupt- und Gymnasialschülern der 5., 6. und 7. Klasse untersucht. Die Überprüfung der Validität erfolgte über zwei Messebenen. Zum einen wurde jede einzel-ne Laut-Buchstabenverbindung als eigenes Item betrachtet. Gemessen wurde, wie viele Laut-Buchstabenverbindungen einer bestimmten Entwicklungsstufe der Schüler korrekt geschrie-ben hat. Zum anderen erfolgte die Entwicklungsstufenanalyse auf Basis der Wortebene über die Auswertung der richtig und falsch geschriebenen Wörter. Hier bestimmt die hierarchie-schwierigste Stelle im Wort, welcher Entwicklungsstufe das Wort zugeordnet wird.
Das Entwicklungsstufenmodell gemäß der Definition der Lauttreue nach Reuter-Liehr hat sich mit Ausnahme einer Subskala ( <ie> am Ende einer Silbe, <ß> zu Beginn der Silbe) auf der Laut-Buchstabenebene als hoch valide erwiesen. Mit Hilfe der Häufigkeit des Vor-kommens des Buchstabens in der deutschen Schriftsprache sowie der Komplexität der Silben-struktur kann der Schwierigkeitsgrad eines Buchstabens oder einer Buchstabenkombination vorhergesagt werden. Eine Zusammenschau der Ergebnisse legt für die Laut-Buchstabenebene ein vierfaktorielles hierarchisches Leistungsprofil nahe, indem zwischen den Grundlegenden Phonemanalytischen Kompetenzen (GPhK), den Fortgeschrittenen Phonemanalytischen Kompetenzen (FPhK) sowie den Regel- und Speicherkompetenzen un-terschieden wird. Das mitsprechbare <ie> sowie das <ß> sind in ihrer Schwierigkeit eher mit den Regel- als mit den Phonemstellen vergleichbar. Die Ergebnisse auf Wortebene sprechen für ein Zwei-Faktoren-Modell, indem zwischen den Phonemanalytischen- (PhK = GPhK + FPhK) und den Fortgeschrittenen Rechtschreibkompetenzen (FRK = RK + SK) unterschieden wird.
Im Hinblick auf die Praxis liegt mit der Testauswertung auf der Laut-Buchstabenebene ein geeignetes Instrument für förderdiagnostische Zwecke vor. Die Entwicklungsstufenanaly-se auf Basis der korrekt und falsch geschriebenen Wörter hat sich als hoch ökonomisches und prognostisch valides Kurzauswertungsverfahren zur Identifikation von basal gestörten Recht-schreibern erwiesen.
Pattern recognition approaches, such as the Support Vector Machine (SVM), have been successfully used to classify groups of individuals based on their patterns of brain activity or structure. However these approaches focus on finding group differences and are not applicable to situations where one is interested in accessing deviations from a specific class or population. In the present work we propose an application of the one-class SVM (OC-SVM) to investigate if patterns of fMRI response to sad facial expressions in depressed patients would be classified as outliers in relation to patterns of healthy control subjects. We defined features based on whole brain voxels and anatomical regions. In both cases we found a significant correlation between the OC-SVM predictions and the patients' Hamilton Rating Scale for Depression (HRSD), i.e. the more depressed the patients were the more of an outlier they were. In addition the OC-SVM split the patient groups into two subgroups whose membership was associated with future response to treatment. When applied to region-based features the OC-SVM classified 52% of patients as outliers. However among the patients classified as outliers 70% did not respond to treatment and among those classified as non-outliers 89% responded to treatment. In addition 89% of the healthy controls were classified as non-outliers.