Evaluation of a brief cognitive behavioral group intervention to reduce depersonalization in students with high levels of trait test anxiety: a randomized controlled trial.

Background and objectives: Students with high levels of test anxiety frequently experience depersonalization during examinations. We investigated whether a brief cognitive behavioral group intervention reduces these symptoms.Design: Randomized controlled trial.Methods: Students with high levels of trait test anxiety and impairing depersonalization symptoms during their last oral examination were randomized. While the intervention group (n = 22) received a group training, a control group (n = 16) underwent an active waiting time protocol. Effects of the intervention on depersonalization severity and its appraisal, attention focus, emotion regulation, anxiety, heart rate, and heart rate variability within the Trier Social Stress Test for groups were examined. A follow-up assessment was conducted after a university oral examination. Registration number: DRKS00010190.Results: Depersonalization and its appraisal significantly changed within the intervention group, but not within the control group. The intervention group reported significantly less self-focused attention and fear and used the coping strategy reappraisal significantly more often. No significant Group × Time interaction was detected regarding heart rate and heart rate variability. Follow-up results give a first indication of the reduction of depersonalization through the intervention in a naturalistic setting.Conclusion: The intervention seems promising for treating depersonalization in students with high levels of trait test anxiety.

Depersonalization Under Academic Stress: Frequency, Predictors, and Consequences.

BACKGROUND: Based on the assumptions that depersonalization symptoms are relevant for test anxiety maintenance, we examined their frequency, psychological predictors, association with anxiety symptoms, and association with test performance. SAMPLING AND METHODS: In Study 1, 203 students rated their test anxiety severity and depersonalization in their last oral examination. In Study 2, we assessed test anxiety 1 week before an oral examination, depersonalization, safety behaviors, self-focused attention, and negative appraisals of depersonalization directly after the examination, and post-event processing 1 week later among 67 students. RESULTS: In Study 1, 47.3% reported at least one moderate depersonalization symptom. In Study 2, test anxiety and negative appraisals of depersonalization significantly predicted depersonalization. Depersonalization was linked to a higher intensity of safety behaviors and post-event processing but not to self-focused attention. It was not related to performance. CONCLUSION: Results are limited by the non-random sampling and the small sample size of Study 2. However, by showing that depersonalization contributes to the processes the maintenance of test anxiety, the findings confirm that depersonalization - normally understood as an adaptive mechanism to cope with stressful events - can become maladaptive.

Cognitive fatigue in patients with myasthenia gravis.

INTRODUCTION: Cognitive fatigue has frequently been reported in myasthenia gravis (MG). However, objective assessment of cognitive fatigability has never been evaluated. METHODS: Thirty-three MG patients with stable generalized disease and 17 healthy controls underwent a test battery including repeated testing of attention and concentration (d2-R) and Paced Auditory Serial Addition Test. Fatigability was based on calculation of linear trend (LT) reflecting dynamic performance within subsequent constant time intervals. Additionally, fatigue questionnaires were used. RESULTS: MG patients showed a negative LT in second d2-R testing, indicating cognitive fatigability. This finding significantly differed from stable cognitive performance in controls (P < 0.05). Results of Paced Auditory Serial Addition Test testing did not differ between groups. Self-assessed fatigue was significantly higher in MG patients compared with controls (P < 0.001), but did not correlate with LT. CONCLUSIONS: LT quantifies cognitive fatigability as an objective measurement of performance decline in MG patients. Self-assessed cognitive fatigue is not correlated with objective findings. Muscle Nerve 56: 449-457, 2017.

Assessment of physical fatigability and fatigue perception in myasthenia gravis.

INTRODUCTION: Fatigue includes both performance fatigability and fatigue perception. METHODS: In 32 stable patients with generalized myasthenia gravis (MG) and 17 controls, time-dependent physical performance was assessed by the arm movement test (AMT) and 6-minute walk test (6MWT). MG patients presented with low quantitative MG scores (mean 0.5, SD 0.5) and without pathologic decrement. Fatigability was based on calculation of linear trend (LT) reflecting dynamic performance within subsequent constant time intervals. Perception of physical fatigue was analyzed using fatigue questionnaires. RESULTS: MG patients showed a negative LT in both AMT and 6MWT, significantly differing from stable performance in controls. LT inversely correlated with elevation of acetylcholine receptor antibodies (r = -0.59, P < 0.005) but not with quantitative MG score and fatigue perception. CONCLUSIONS: LT allows quantification of fatigability as an objective measurement of decline in individual performance, even in patients without obvious neuromuscular deficits in routine testing. The missing correlation of experienced fatigue supports the multidimensional fatigue model. Muscle Nerve 55: 657-663, 2017.

Reduction of depersonalization during social stress through cognitive therapy for social anxiety disorder: A randomized controlled trial.

Symptoms of depersonalization during feared social situations are commonly experienced by individuals with social anxiety disorder (SAD). Despite its clinical relevance, it is not addressed in standard treatment manuals and it remains unclear if depersonalization is reduced by well-established treatments. This study investigated whether cognitive therapy (CT) for SAD effectively reduces depersonalization and whether pre-treatment severity of depersonalization predicts or mediates treatment outcome. In a randomized controlled trial, patients underwent the standardized Trier Social Stress Test before and after CT (n=20) or a waitlist period (n=20) and were compared to healthy controls (n=21). Self-reported depersonalization was measured immediately after each stress test. Depersonalization significantly decreased following CT, especially in treatment responders (ηp2=0.32). Pre-treatment depersonalization did neither predict nor mediate post-treatment severity of social anxiety. Further prospective studies are needed for a better scientific understanding of this effect. It should be scrutinized whether SAD-patients suffering from depersonalization would benefit from a more specific therapy.