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We comment on the papers by Schönbrodt et al. (2022) and Gärtner et al. (2022) on responsible research assessment from the perspective of clinical psychology and psychotherapy research.

The last survey of the Swiss Corona Stress Study in November 2020 has shown that the proportion of respondents with moderately severe to severe depressive symptoms was 18%, with the youngest group of 14-24 year olds being the most affected at 29%. Between 8 and 24 March 2021, an additional survey was conducted in the German speaking part of Northwestern Switzerland among 393 high school students with the majority being between 16 and 19 years old. The anonymous survey was completed by 97.5% of the students. The proportion of respondents with moderately severe to severe depressive symptoms was 27%. In this survey, additional questions were asked about school, social life and vaccination. The most significant stressor associated with depressive symptoms was perceived school pressure. 46% of the respondents indicated they were very or extremely stressed because of the pressure of school. Furthermore, the perception that school pressure has increased due to the pandemic (missed material due to closures, quarantine) was strongly correlated with depressive symptoms. Other factors included worries about poorer education or job opportunities and worries about damage to the social network. An additional factor analysis confirmed that stressors related to school build up the factor with the strongest correlation with depressive symptoms (with a large effect size).Other results- 69% of respondents would get vaccinated if the vaccine were available to them.- 41% of respondents would see the change to distance learning as a relief, 46% as a burden and 13% neither.- Only 4% of respondents said they were not at all afraid of infecting their parents/grandparents or another close person belonging to a risk group.- 29% of respondents have at least a moderate to severe fear of suffering from Long-COVID in case of infection.

Smartphone-based virtual reality (VR) applications (apps) might help to counter low utilization rates of available treatments for fear of heights. Demonstration of effectiveness in real-life situations of such apps is crucial, but lacking so far. Objective of this study was to develop a stand-alone, smartphone-based VR exposure app—Easy Heights—and to test its effectiveness in a real-life situation. We performed a single-blind, parallel group, randomized controlled trial. We recruited 70 participants with fear of heights, aged 18–60 years. Primary outcome was performance in a real-life Behavioral Avoidance Test (BAT) on a lookout tower after a single 1-h app use (phase 1) and after additional repeated (6 × 30 min) app use at home (phase 2). After phase 2, but not phase 1, participants in the Easy Heights condition showed significantly higher BAT scores compared to participants in the control condition (Cohen’s d = 1.3, p = 0.0001). Repeated use of our stand-alone, smartphone-based VR exposure app reduces avoidance behavior and fear, providing a low-threshold treatment for fear of heights.

The results of the third survey of the Swiss Corona Stress Study refer to the period from November 11-19, 2020, during which 11,612 people from all over Switzerland participated. Stress levels have increased significantly compared to the first survey during lockdown in April 2020. While the proportion of people reporting maximum stress levels was around 11% during the April lockdown, it rose to 20% in the second pandemic wave in November. The increase in stress was accompanied by an increase in depressive symptoms. The main drivers of psychological stress and depressive symptoms included burden due to a Covid-19-related change in work, school, or education, Covid-19-related financial losses, and fears about the future. These stressors have increased significantly, compared to the time of the April lockdown. Further factors were the fear that someone in the closest circle would become seriously ill or die from COVID-19, as well as the burden of social restrictions and burden from an increase in conflicts at home. While the proportion of respondents with moderately severe or severe (PHQ-9 ≥15) depressive symptoms was 3% before the pandemic, 9% during the April lockdown, and 12% during May, it increased to 18% in November. The risk for moderately severe or severe depressive symptoms was associated with age (with younger people showing the highest risk) and was increased in people experiencing financial losses due to the pandemic. In addition, people from the French-speaking part of Switzerland, which was most affected by the pandemic during the second wave, were at higher risk than people from the rest of Switzerland.

Purpose: The COVID-19 pandemic and governmental counter measurements, confinement in particular, have changed the routines of everyday life of people all over the world. To assess the psychological consequences of daily life changes during COVID-19 pandemic in the Iranian population.Method: We performed an anonymous online survey in the first 3 weeks of March 2020. Participants had to rate their stress levels and depressive symptoms during the last two weeks and before the pandemic retrospectively. The changes in psychological measurements and its association with socio-demographic factors and burdens due to confinement were assessed.Results: Overall, among the 3210 subjects who participated in our study, we observed an increase in both stress levels and average depression score. However, about 23% of subjects reported a decrease in their stress levels during the pandemic. The burden of childcare at home, restrictions in private life, and the burden of thoughts about the future were positively correlated with changes in stress levels and depression scores. On the other hand, feeling relieved in the pandemic condition, and enjoying more family time associated with less change in stress levels and depression scores. Being religious and older age were identified as resilience factors, whereas being a student, seeking a job, and having a psychiatric disorder history were identified as risk factors for depression.Conclusion: Stress levels and depressive symptoms have increased during COVID-19 pandemic and this increase is in relation to different social and personal burdens due to confinement strategy.

Although in vivo exposure therapy is highly effective in the treatment of specific phobias, only a minority of patients seeks therapy. Exposure to virtual objects has been shown to be better tolerated, equally efficacious, but the technology has not been made widely accessible yet. We developed an augmented reality (AR) application (app) to reduce fear of spiders and performed a randomized controlled trial comparing the effects of our app (six 30-min sessions at home over a two-week period) with no intervention. Primary outcome was subjective fear, measured by a Subjective Units of Distress Scale (SUDS) in a Behavioural Approach Test (BAT) in a real-life spider situation at six weeks follow-up. Between Oct 7, 2019, and Dec 6, 2019, 66 individuals were enrolled and randomized. The intervention led to significantly lower subjective fear in the BAT compared to the control group (intervention group, baseline: 7.12 [SD 2.03] follow-up: 5.03 [SD 2.19] vs. control group, baseline: 7.06 [SD 2.34], follow-up 6.24 [SD 2.21]; adjusted group difference -1.24, 95 % CI -2.17 to -0.31; Cohen’s d = 0.57, p = 0.010). The repeated use of the AR app reduces subjective fear in a real-life spider situation, providing a low-threshold and low-cost treatment for fear of spiders.

The mental consequences of the COVID-19 pandemic and the strict lockdown measures implemented by governments world-wide to fight it are currently unknown. We performed an online survey study in Switzerland and analyzed data acquired during confinement (wave 1) and during partial lifting of measures (partial deconfinement) (wave 2). Wave 1: Data from over 10’000 individuals living in Switzerland were collected between April 6 and 8, 2020, starting 3 weeks after the beginning of confinement. While 24.4% of the participants reported no change in stress levels, 49.6% of the participants reported an increase in stress levels during confinement as compared to the time before the COVID-19 pandemic. We identified several potential sources for people feeling more stressed during confinement, such as the burden related to changes at work or school, problems with childcare or not being able to spend more time with others. The changes in stress levels were highly correlated with changes in depressive symptoms. 57% of the participants reported an increase in depressive symptoms. Further, the prevalence of moderately severe or severe depressive symptoms (PHQ-9 score ≥ 15) increased from 3.4% before the COVID-19 pandemic to 9.1% during confinement. Interestingly, 26% of participants showed a decrease in stress level during confinement, suggesting that for those individuals the confinement involved a reduction of stressors and/or resulted in more time for recovery. Finally, we identified several behaviors amenable to change that were related to a reduced increase in stress level and depressive symptoms during confinement. Wave 2: Data from over 10’000 individuals living in Switzerland were collected between May 11 and June 1, 2020 during partial deconfinement. As for wave 1, we observed diverse reactions with regard to stress levels: While 28% of the participants reported no change in stress levels, 40% of the participants reported an increase in stress levels during partial deconfinement as compared to the time before the COVID-19 pandemic. We identified similar sources for people feeling more stressed as during confinement and the changes in stress levels were highly correlated with changes in depressive symptoms. 49.5% of the participants reported an increase in depressive symptoms. Further, the prevalence of moderately severe or severe depressive symptoms (PHQ-9 score ≥ 15) remained elevated with a prevalence rate of 11.7%. With regard to changeable behaviors during the pandemic, we found (as in wave 1) that spending more time pursuing new projects, spending more time pursuing hobbies at home, and light physical exercise were related to less stress increase.A comparison between the two waves indicated that while the waves did not substantially differ in the distributions of changes in stress levels or depressive symptoms, they did differ with regard to the distribution of anxiety ratings. Specifically, anxiety levels decreased from wave 1 to wave 2. Finally, we identified risk and resilience factors with regard to the development of depressive symptoms (present in both waves): A history of a prior psychiatric disorder was a risk factor for developing moderately severe or severe depressive symptoms during the pandemic. In a resilient group of people who had none or only minimal depressive symptoms before and during the pandemic, older people (≥ 55 years), men and individuals with no history of prior psychiatric disorder were overrepresented. Thus, advanced age, male gender and the absence of prior psychiatric disorder were identified as resilience factors.

Background: Public speaking anxiety (PSA) is the most widespread social fear, with prevalence estimates up to 30%. Anxious individuals typically avoid mutual gaze and report fears of being evaluated by others. We developed a virtual reality (VR) training application (app) aimed at increasing mutual gaze and tested its effectiveness to reduce fear of public speaking. Methods: We used a single-blind, parallel-group, randomised controlled trial design. Between June 18, 2019 and September 19, 2019, 89 participants aged 18–40 years with PSA were randomly assigned to a gaze training (treatment) or a control group. During training, participants were exposed to social situations and instructed to maintain eye contact with people in the VR. Assessments were done at baseline, after a first intervention (acute intervention on a single day: three gaze training sessions of 20 min; control: Google Street View), and after a second intervention phase (repeated intervention over two weeks: nine gaze training sessions of 20 min; control: no further intervention) two months later. The primary outcome measure was subjective fear, rated on the Subjective Units of Distress Scale (SUDS) in a real-life public speaking test (PST). Findings: Repeated, but not acute, gaze training led to a significant reduction of subjective fear as compared to the control group (treatment group, baseline: 48·95 [SD 19·52], post intervention 2: 26·60 [SD 19·23]; control group, baseline: 48·92 [SD 18·43], post intervention 2: 56·34 [SD 28·15]; adjusted mean group difference: −29·82, 95% CI: −41·77 to −17·87; Cohen’s d=−1·07, p

Placebo effects can be induced by learning and conditioning processes, which in turn are influenced and modulated by glucocorticoids. Accordingly, previous research has shown that intervention-related associative learning can be modulated through exogenous as well as endogenous glucocorticoids. Thus, the aim of this study was to elucidate whether placebo effects induced by conditioning is modulated by daily fluctuations of endogenous cortisol levels in healthy male and female subjects. Overall 77 participants underwent a two-phased placebo conditioning paradigm for pain analgesia. Subjects were randomized in two groups, which underwent placebo preconditioning either in the morning (08:00-10:00, i.e. with high endogenous cortisol levels) or in the afternoon (16:00-18:00, i.e. with low endogenous cortisol levels). Placebo effects were assessed two days later at noontime (12:00-13:00), with possible differences between groups as an indicator of glucocorticoid modulation on the placebo learning. Results indicated a significant conditioned placebo-induced analgesia, resulting in a placebo effect of small to medium size. Cortisol levels on conditioning day significantly differed between groups and cortisol levels were similar during assessment of placebo effects. Groups did not differ in their mean reduction in pain sensation, thus the placebo effect was not affected by differences in cortisol levels during the conditioning of placebo effects. The present study does not indicate a moderation of placebo conditioning by endogenous glucocorticoid levels.

Zusammenfassung: Hintergrund: Prämenstruelle dysphorische Störungen (PMDS) und schwere prämenstruelle Syndrome (PMS) treten häufig auf, bleiben jedoch oft unerkannt und unbehandelt. Begünstigt wird dies durch das Fehlen eines entsprechenden deutschsprachigen Screening-Instruments. Ziel dieser Studie war es, das englischsprachige Premenstrual Symptoms Screening Tool (PSST) ins Deutsche zu übertragen und seine Anwendung zu prüfen. Material und Methoden: Die deutschsprachige Version des PSST wurde als "Screening-Instrument für prämenstruelle Symptome" (SIPS) erstellt und ihre Güte an 47 Frauen mit und ohne PMDS/schwerem PMS internetbasiert mittels täglichen Symptomeinschätzungen bestimmt. Ergebnisse: Die Retest-Reliabilität des SIPS betrug r=0,69, das Cronbachsα 0,924. Als Validitätsmaß des SIPS zeigten sich signifikante Unterschiede zwischen Frauen mit und ohne PMDS/schwerem PMS, bestimmt durch das SIPS, bezüglich prospektiv erfasster prämenstrueller Symptomatik (F[2,44]=4,52, p

Current neurophysiological and psychological accounts view exposure therapy as the clinical analog of extinction learning that results in persistent modifications of the fear memory involved in the pathogenesis, symptomatology, and maintenance of anxiety disorders. Evidence from studies in animals and humans indicate that glucocorticoids have the potential to facilitate the processes that underlie extinction learning during exposure therapy. Particularly, glucocorticoids can restrict retrieval of previous aversive learning episodes and enhance consolidation of memory traces relating to non-fearful responding in feared situations. Thus, glucocorticoid treatment especially in combination with exposure therapy might be a promising approach to optimize treatment of anxiety disorders. This review examines the processes involved in aversive conditioning, fear learning and fear extinction, and how glucocorticoids might enhance restructuring of fear memories during therapy.

Heutzutage gilt Konfrontationstherapie als die effektivste Therapie zur Behandlung von Angststorungen. Bei der Konfrontationstherapie werden Patienten mit objektiv sicheren Situationen, die aber starkes subjektives Unbehagen (z.B. Angst oder Ekel) auslosen, konfrontiert bis das Unbehagen abnimmt. Bis zu den 70erJahren des 20. Jahrhunderts war Systematische Desensibilisierung die popularste Behandlungsmethode fur klinische Angste. Bei der Systematischen Desensibilisierung werden Patienten, wahrend sie sich in einem entspannten Zustand befinden, innerhalb gedanklicher Vorstellung mit angstauslosenden Reizen konfrontiert. Es zeigte sich jedoch, dass reine Konfrontation an aversive Reize genauso effektiv ist wie Systematische Desensibilisierung. Dies wird gestutzt durch Katamnesen von bis zu 9 Jahren, die zeigen, dass einmal erzielte Erfolge auch uber lange Zeitraume stabil bleiben und Ruckfalle selten sind. Daruber hinaus ist auch das Auftreten neuer Symptome (Symptomverschiebung) nach erfolgreichen Konfrontationstherapien nicht haufiger als in der Allgemeinbevolkerung [1–4].

Heroin dependence is a severe and chronically relapsing substance use disorder with limited treatment options. Stress is known to increase craving and drug-taking behavior, but it is not known whether the stress hormone cortisol mediates these stress effects or whether cortisol may rather reduce craving, for example, by interfering with addiction memory. The aim of the present study was to determine the effects of cortisol administration on craving in heroin-dependent patients and to determine whether the effects depend on the daily dose of heroin consumption. We used a double-blind, placebo-controlled, cross-over study in 29 heroin-dependent patients in a stable heroin-assisted treatment setting. A single oral dose of 20 mg of cortisol or placebo was administered 105 min before the daily heroin administration. The primary outcome measure was cortisol-induced change in craving. Secondary measures included anxiety, anger and withdrawal symptoms. For the visual analog scale for craving, we found a significant interaction (P=0.0027) between study medication and heroin-dose group (that is, daily low, medium or high dose of heroin). Cortisol administration reduced craving in patients receiving a low dose of heroin (before heroin administration: P=0.0019; after heroin administration: P=0.0074), but not in patients receiving a medium or high dose of heroin. In a picture-rating task with drug-related pictures, cortisol administration did not affect the ratings for the picture-characteristic craving in all the three heroin-dose groups. Cortisol also did not significantly affect secondary outcome measures. In conclusion, a single administration of cortisol leads to reduced craving in low-dose heroin addicts. The present findings might have important clinical implications with regard to understanding stress effects and regarding treatment of addiction.

The experience of fear is closely linked to the survival of species. Fear can be conceptualized as a brain state that orchestrates defense reactions to threats. To avoid harm, an organism must be equipped with neural circuits that allow learning, detecting, and rapidly responding to threats. Past experience with threat can transform neutral stimuli present at the time of experience into learned threat-related stimuli via associative learning. Pavlovian threat conditioning is the central experimental paradigm to study associative learning. Once learned, these stimulus-response associations are not always expressed depending on context or new experiences with the conditioned stimuli. Neural circuits mediating threat learning have the inherent plasticity to adapt to changing environmental threats. Encounters devoid of danger pave the way for extinction or reconsolidation to occur. Extinction and reconsolidation can both lead to changes in the expression of threat-induced defense responses, but differ in stability and have a different neural basis. This review presents the behavioral models and the system-level neural mechanisms in animals and humans of threat learning and modulation.