[Participation and Information in Child and Youth Psychiatry]. / Partizipation und Informationspraxis in der Kinder- und Jugendpsychiatrie.

Participation and Information in Child and Youth Psychiatry Participation is part of children's legal rights - even in psychiatric treatment. However, former studies show that most children have barely been informed about their treatment and that their opinion has not been taken into account in any decision making process. Nowadays there is an increased awareness about involving children in the decision making process and in informing them about treatment. This subject has also gathered more importance through legal actions changed in favor of the children. We have investigated to what extend children in in-patient treatment in the child and adolescent psychiatry feel informed about and included in decisions concerning their treatment. N = 114 children of the age between 12-18 years have been asked via a written survey. Results show that more than half of the young people feel that they do have the possibility to take part in decision-making. Only a third of the participants felt sufficiently informed before and during their hospital stay.

Fear of negative and positive evaluation and reactivity to social-evaluative videos in social anxiety disorder.

Social anxiety disorder (SAD) is marked by persistent fear of being scrutinized by others. This and most diagnostic symptoms relate to some form of fear of negative evaluation (FNE). More recent accounts of SAD, such as the Bivalent Fear of Evaluation Model, however, complement FNE with fear of positive evaluation (FPE), described as distress and avoidance of positive feedback. An explicit test of the incremental validity of FPE in discriminating SAD patients from controls - over and on top of the explanatory power of FPE - is currently missing and generally, well controlled laboratory experiments with positive and negative social stimuli in this patient group are rare. To fill this gap, we exposed 35 patients with SAD and healthy controls (HCs) to short social-evaluative video clips with actors expressing negative and positive as well as neutral statements while recording reactivity on experiential measures (valence, arousal, and approval ratings) as well as on facial electromyography and electrocardiography. In addition, participants completed questionnaire measures of FNE and FPE. Results revealed that FPE questionnaire scores as well as experiential (valence and appreciation) and electromyographical reactivity measures to positive videos improved prediction of group membership beyond the predictive power of FNE questionnaires scores and reactivity to negative videos. Results document the importance of FPE to more fully characterize and understand social anxiety and SAD. Implications include amendments to future diagnostic criteria, theoretical models, and treatment approaches for SAD.

Neutral is negative enough-Peer victimization influences cardiac, facial-muscular and experiential reactions to both negative evaluative and neutral social stimuli.

Physiological stress responses vary as a function of adverse childhood experiences. However, previous studies concentrate on familial sources of childhood adversity. Potential long-term effects of peer victimization on physiology and affective responses are less known. This study examined cardiac, facial-muscular, and experiential responses to social evaluative stimuli in ninety-four healthy subjects with various degrees of experienced peer victimization. In a social conditioning task, peer victimization was associated with similarly attenuated cardiac and facial-muscular responses to negative and neutral stimuli, while differentiated physiological responses to negative and neutral stimuli were found in subjects without peer victimization. Overall, increased ratings of arousal, valence and disapproval for negative compared to neutral stimuli were found. Contrary to the physiological response, peer victimization was associated with more negative ratings of negative stimuli one month after acquisition. The results suggest that the physiological and experiential reactivity towards both negative and neutral social stimuli is affected by the experience of peer victimization. Peer victimization causes generalized autonomic dysregulation and memory recall biases during social learning impeding adequate response preparation to social stressors.

Childhood abuse and depression in adulthood: The mediating role of allostatic load.

BACKGROUND: Traumatic experiences during childhood are considered a major risk factor for depression in adulthood. Childhood trauma may induce physiological dysregulation with long-term effects of increased allostatic load until adulthood, which may lead to depression. Thus, our aim was to investigate whether allostatic load - which represents a multi-system measure of physiological dysregulation - mediates the association between childhood trauma and adult depression. METHODS: The study sample consisted of 324 depressed inpatients participating in the Munich Antidepressant Response Signature (MARS) project and 261 mentally healthy control participants. The mediation analysis using a case-control approach included childhood trauma, i.e., physical and sexual abuse, as predictor variables and an allostatic load index comprised of 12 stress-related biomarkers as mediator. Age and sex were included as covariates. RESULTS: Mediation analyses revealed that the influence of physical abuse, but not sexual abuse, during childhood on depression in adulthood was mediated by allostatic load. This effect was moderated by age: particularly young (18-42 years) and middle-aged (43-54 years) adults with a history of physical abuse during childhood exhibited high allostatic load, which in turn was associated with increased rates of depression, but this was not the case for older participants (55-81 years). CONCLUSIONS: Results support the theoretical assumption of allostatic load mediating the effect of physical abuse during childhood on depression in adulthood. This predominantly holds for younger participants, while depression in older participants was independent of physical abuse and allostatic load. The effect of sexual abuse on depression, however, was not mediated by allostatic load. Identifying allostatic load biomarkers prospectively in the developmental course of depression is an important target for future research.

Social Pavlovian conditioning: Short- and long-term effects and the role of anxiety and depressive symptoms.

Today's stressors largely arise from social interactions rather than from physical threat. However, the dominant laboratory model of emotional learning relies on physical stimuli (e.g. electric shock) whereas adequate models of social conditioning are missing, possibly due to more subtle and multilayered biobehavioral responses to such stimuli. To fill this gap, we acquired a broad set of measures during conditioning to negative social unconditioned stimuli, also taking into account long-term maintenance of conditioning and inter-individual differences. Fifty-nine healthy participants underwent a classical conditioning task with videos of actors expressing disapproving (US-neg) or neutral (US-neu) statements. Static images of the corresponding actors with a neutral facial expression served as CS+ and CS-, predicting US-neg and US-neu, respectively. Autonomic and facial-muscular measures confirmed differential unconditioned responding whereas experiential CS ratings, event-related potentials, and evoked theta oscillations confirmed differential conditioned responding. Conditioning was maintained at 1 month and 1 year follow-ups on experiential ratings, especially in individuals with elevated anxiety and depressive symptoms, documenting the efficiency of social conditioning and its clinical relevance. This novel, ecologically improved conditioning paradigm uncovered a remarkably efficient multi-layered social learning mechanism that may represent a risk factor for anxiety and depression.

No praise, please: Depressive symptoms, reactivity to positive social interaction, and fear of positive evaluation.

BACKGROUND: Depression is characterized by depressed mood and loss of interest or pleasure. Resulting alterations in emotional reactivity have been explained by three different accounts: 'positive attenuation', 'negative potentiation', and 'emotion context insensitivity'. Despite the importance of depression-related emotional alteration in social interactions, research with naturalistic interpersonal stimuli is scarce and underlying mechanisms largely unknown. METHODS: Hence, the present study examined subjective emotional reactivity to brief negative, positive, and neutral social-evaluative videos as a function of depressive symptoms in an adult sample (N = 84). Fear of positive evaluation (FPE) and fear of negative evaluation (FNE), often conceptualized as cognitive components of social anxiety, were examined as possible mediators. RESULTS: Results revealed that more depression symptoms were related to diminished pleasantness responses to both positive and neutral videos. When considering all three video conditions simultaneously, only responses to positive videos remained significantly related to depression scores, supporting the 'positive attenuation' account. Moreover, FPE was found to uniquely mediate the relationship between depressive symptoms and pleasantness responses to positive videos. CONCLUSIONS: Results indicate that emotional reactivity to positive interpersonal stimuli is relevant for theoretical and clinical considerations of depression. This research underlines the importance of FPE not only for understanding social anxiety but also depression.

Chronic Smoking, Trait Anxiety, and the Physiological Response to Stress.

BACKGROUND AND OBJECTIVES: Both chronic smoking and trait anxiety have been associated with dysregulations in psychobiological stress response systems. However, these factors have not been studied in conjunction. We expected trait anxiety and smoking status to attenuate stress reactivity. Furthermore, we expected an allostatic load effect resulting in particularly attenuated stress reactivity in high-anxious smokers. In addition, high-anxious smokers were expected to exhibit increased urges to smoke in response to stress. METHODS: 115 smokers and 37 nonsmokers, aged 18-64 years, completed a laboratory session including mental stressors such as evaluated public speaking and mental arithmetic. Trait anxiety was assessed using Spielberger's State-Trait Anxiety Inventory. Cardiovascular autonomic indices, salivary cortisol, and the desire to smoke were measured at baseline, during stressors, and at recovery. RESULTS: Regression analyses showed that smokers exhibited attenuated cardiovascular stress responses in comparison to nonsmokers. Higher trait anxiety predicted attenuated systolic blood pressure responses to stress. No interaction effect of smoking status and trait anxiety was found in stress response measures. Higher trait anxiety predicted an increased desire to smoke in response to stress among smokers. CONCLUSION: Results indicate that both smoking status and trait anxiety are associated with blunted sympatho-adrenal cardiovascular stress reactivity. Elevated urges to smoke in response to stress found among smokers with high trait anxiety suggest an important role of anxiety in smoking propensity and relapse.

Criticism hurts everybody, praise only some: Common and specific neural responses to approving and disapproving social-evaluative videos.

Social evaluation is a ubiquitous feature of daily interpersonal interactions and can produce strong positive or negative emotional reactions. While previous research has highlighted neural correlates of static or dynamic facial expressions, little is known about neural processing of more naturalistic social interaction simulations or the modulating role of inter-individual differences such as trait fear of negative/positive evaluation. The present fMRI study investigated neural activity of 37 (21 female) healthy participants while watching videos of posers expressing a range of positive, negative, and neutral statements tapping into several basic and social emotions. Unpleasantness ratings linearly increased in response to positive to neutral to negative videos whereas arousal ratings were elevated in both emotional video conditions. At the whole brain level, medial prefrontal and rostral anterior cingulate cortex activated strongly in both emotional conditions which may be attributed to the cognitive processing demands of responding to complex social evaluation. Region of interest analysis for basic emotion processing areas revealed enhanced amygdala activation in both emotional conditions, whereas anterior and posterior insula showed stronger activity during negative evaluations only. Individuals with high fear of positive evaluation were characterized by increased posterior insula activity during positive videos, suggesting heightened interoception. Taken together, these results replicate and extend studies that used facial expression stimuli and reveal neurobiological systems involved in processing of more complex social-evaluative videos. Results also point to vulnerability factors for social-interaction related psychopathologies.

Gender differences in experiential and facial reactivity to approval and disapproval during emotional social interactions.

Negative social evaluations represent social threats and elicit negative emotions such as anger or fear. Positive social evaluations, by contrast, may increase self-esteem and generate positive emotions such as happiness and pride. Gender differences are likely to shape both the perception and expression of positive and negative social evaluations. Yet, current knowledge is limited by a reliance on studies that used static images of individual expressers with limited external validity. Furthermore, only few studies considered gender differences on both the expresser and perceiver side. The present study approached these limitations by utilizing a naturalistic stimulus set displaying nine males and nine females (expressers) delivering social evaluative sentences to 32 female and 26 male participants (perceivers). Perceivers watched 30 positive, 30 negative, and 30 neutral messages while facial electromyography (EMG) was continuously recorded and subjective ratings were obtained. Results indicated that men expressing positive evaluations elicited stronger EMG responses in both perceiver genders. Arousal was rated higher when positive evaluations were expressed by the opposite gender. Thus, gender differences need to be more explicitly considered in research of social cognition and affective science using naturalistic social stimuli.

Exposure to social-evaluative video clips: Neural, facial-muscular, and experiential responses and the role of social anxiety.

Engaging in social interaction often implies being evaluated. Receiving positive evaluations from others may elicit affiliative emotions whereas negative evaluations are likely to trigger withdrawal and defensive social behavior. Evolution has equipped humans with efficient systems to detect, appraise, and regulate responses to such evaluative communications and to express complementary responses. The current study investigates neural, facial-muscular, and experiential responses to short videos delivering neutral, positive, and negative audiovisual messages as well as their relation to individual differences in social anxiety. Fifty-eight participants (32 female) watched 90 videos with male and female actors displaying positive, negative, and neutral statements. Experientially, ratings of valence and arousal showed the expected category differences. Neurally, larger centro-parietal late positive event related potentials were found for emotional (positive and negative) videos compared to neutral videos. Facial electromyography revealed reduced corrugator muscle and increased zygomaticus major muscle activity for positive videos compared to neutral and negative videos. Cognitive components of social anxiety were related to a more unpleasant experience of negative videos and a less pleasant experience of positive videos. Thus, a set of neural, facial-muscular, and experiential responses contribute to social interaction in the context of relatively naturalistic social-evaluative stimuli.

"Don't put me down but don't be too nice to me either": fear of positive vs. negative evaluation and responses to positive vs. negative social-evaluative films.

BACKGROUND AND OBJECTIVES: The bivalent fear of evaluation (BFOE) model suggests that fears of negative evaluation (FNE) and positive evaluation (FPE) are distinct features in social anxiety disorder as well as in non-clinical variations of social anxiety. The constructs can be measured utilizing the Brief Fear of Negative Evaluation Scale ­ Revised (BFNE-R) and the Fear of Positive Evaluation Scale (FPES), respectively. Whereas the distinction between FNE and FPE has been well examined in survey studies, concomitant evidence from laboratory tasks is scarce. METHODS: The present study tested whether subjective unpleasantness responses to short films simulating positive and negative evaluation from others are related to individual differences in FNE and FPE. Ninety-eight unselected individuals watched 24 short films displaying actors expressing positive, negative and neutral sentences and rated their responses on unpleasantness. Furthermore, pride responses to positive films were examined since these can be expected to discriminate between FPE and FNE. RESULTS: As expected, higher BFNE-R scores were related to more unpleasant responding to negative films, whereas higher FPES scores were related to more unpleasant responding to positive films. Furthermore, experience of pride following positive films correlated positively with BFNE-R, but negatively with FPES scores. LIMITATIONS: Participants were university students which limits representativeness. CONCLUSIONS: The study revealed that measures of FNE and FPE show distinct relationships with positive and negative social feedback which provides further evidence for the BFOE model in a laboratory setting.

Maladaptive behavioral consequences of conditioned fear-generalization: a pronounced, yet sparsely studied, feature of anxiety pathology.

Fear-conditioning experiments in the anxiety disorders focus almost exclusively on passive-emotional, Pavlovian conditioning, rather than active-behavioral, instrumental conditioning. Paradigms eliciting both types of conditioning are needed to study maladaptive, instrumental behaviors resulting from Pavlovian abnormalities found in clinical anxiety. One such Pavlovian abnormality is generalization of fear from a conditioned danger-cue (CS+) to resembling stimuli. Though lab-based findings repeatedly link overgeneralized Pavlovian-fear to clinical anxiety, no study assesses the degree to which Pavlovian overgeneralization corresponds with maladaptive, overgeneralized instrumental-avoidance. The current effort fills this gap by validating a novel fear-potentiated startle paradigm including Pavlovian and instrumental components. The paradigm is embedded in a computer game during which shapes appear on the screen. One shape paired with electric-shock serves as CS+, and other resembling shapes, presented in the absence of shock, serve as generalization stimuli (GSs). During the game, participants choose whether to behaviorally avoid shock at the cost of poorer performance. Avoidance during CS+ is considered adaptive because shock is a real possibility. By contrast, avoidance during GSs is considered maladaptive because shock is not a realistic prospect and thus unnecessarily compromises performance. Results indicate significant Pavlovian-instrumental relations, with greater generalization of Pavlovian fear associated with overgeneralization of maladaptive instrumental-avoidance.