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Abstract Associative learning is a key feature of adaptive behaviour and mental health, enabling individuals to adjust their actions in anticipation of future events. Comprehensive documentation of this essential component of human cognitive development throughout different developmental periods is needed. Here, we investigated age-related changes in associative learning in key developmental stages, including infancy, childhood, adolescence, and adulthood. We employed a classical delay eyeblink conditioning paradigm that consisted of two sessions with a total of 48 paired trials. Our initial hypothesis was that performance in associative learning would increase linearly with age. However, our findings suggest that performance peaks during the primary school years: Children in this age-group exhibited superior performance compared to all other age-groups and displayed the most consistent and least variable learning. Adults and adolescents exhibited faster association learning than infants. An additional learning session supported learning in infants and adolescents indicating that during these developmental stages, consolidation processes are vital for learning. A comprehensive account of the development of associative learning may inform theories on aetiology and treatment options in clinical psychology and neurosciences.

Abstract Having control over your own behavior and impulses is a critical skill that influences children’s academic, social, and emotional development. This study investigates the stability and predictive relationships between parents’ ratings of their own and their children’s executive function and delay aversion. Using data from approximately 1700 families collected during the COVID-19 pandemic, we employed hierarchical structural equation models and cross-lagged panel models to analyze the temporal stability and directional influences of executive function and delay aversion assessments. Our analysis revealed a substantial latent correlation (r = 0.48, p

Abstract Background As summarized by the Lancet Psychiatry Commission on youth mental health (McGorry et al., 2024), the statistics on mental disorders in children are alarming and highlight the need to expand and optimize research on childhood mental health. Although patient and public involvement (PPI) of those affected has the potential to boost both the acceptance and outcomes of research studies, the active involvement of young children, that is, primary school children, in mental health research has been neglected. Methods Based on the results of our systematic literature analysis of PPI of children in mental health research, the concept development of the Children's Council ‘Mental Health’ was administered in cooperation with several stakeholders and focus groups (practitioners and researchers in the field of clinical psychology and psychotherapy across the lifespan, representatives from three self‐help organizations for mental disorders, children's focus group). The concept was further optimized in collaboration with the German Children's Fund (Deutsches Kinderhilfswerk e. V.). Results The Children's Council was successfully founded with five children aged between 6 and 9 years. Participation is positively received, and each meeting is evaluated using visual measurements. The results from the meetings are presented and discussed. They serve as basis for concrete recommendations for involving young children in mental health research. Conclusions To the best of our knowledge, this is the first structured approach involving young children in mental health research studies. The main goal of our study is the direct and immediate empowerment of children, in this case primary school children at the age of 6–12 years. This is associated with a child‐friendly exchange on topics related to mental health, as well as the enhancement of the education process on mental disorders and prevention.

BackgroundClinical diagnoses determine if and how therapists treat their patients. As misdiagnoses can have severe adverse effects, disseminating evidence-based diagnostic skills into clinical practice is highly important. ObjectiveThis study aimed to develop and evaluate a blended learning course in a multicenter cluster randomized controlled trial. MethodsUndergraduate psychology students (N=350) enrolled in 18 university courses at 3 universities. The courses were randomly assigned to blended learning or traditional synchronous teaching. The primary outcome was the participants’ performances in a clinical diagnostic interview after the courses. The secondary outcomes were diagnostic knowledge and participants’ reactions to the courses. All outcomes were analyzed on the individual participant level using noninferiority testing. ResultsCompared with the synchronous course (74.6% pass rate), participation in the blended learning course (89% pass rate) increased the likelihood of successfully passing the behavioral test (odds ratio 2.77, 95% CI 1.55-5.13), indicating not only noninferiority but superiority of the blended learning course. Furthermore, superiority of the blended learning over the synchronous course could be found regarding diagnostic knowledge (β=.13, 95% CI 0.01-0.26), course clarity (β=.40, 95% CI 0.27-0.53), course structure (β=.18, 95% CI 0.04-0.32), and informativeness (β=.19, 95% CI 0.06-0.32). ConclusionsBlended learning can help to improve the diagnostic skills and knowledge of (future) clinicians and thus make an important contribution to improving mental health care. Trial RegistrationClinicalTrials.gov NCT05294094; https://clinicaltrials.gov/study/NCT05294094

Introduction Germany and the European Union have experienced successive waves of refugees since 2014, resulting in over 1.6 million arrivals, including families with young children. These vulnerable populations often face xenophobia, discrimination, substandard living conditions and limited healthcare access, contributing to a high prevalence of mental health problems (MHP). Our primary goal is to proactively address MHP in refugee parents and prevent its potential impact on their children through effective early interventions. Using a low-threshold, primary care-based approach, we aim to enhance parenting skills and address parental psychopathology, creating a supportive environment for parents and children.Methods and analysis In this randomised controlled trial, 188 refugee parents of 6-year-old children or younger who meet the clinical cut-off on the MHP scale will participate. They are randomly assigned to either the experimental psychotherapeutic intervention, delivered by general practitioners (10-week Improve intervention), or treatment as usual, in a ratio of 1:1. The randomisation will be masked only for outcome assessors. Improve includes face-to-face sessions with general practitioners, an interactive online parenting programme (Triple P Online) and regular protocol-based telephone calls by psychologists. Primary outcomes will assess the intervention’s effects on parental and child MHP and parenting skills, with secondary outcomes including psychosocial and physical health indicators. Outcomes will be assessed at pre, post and at 3-month and 6-month follow-ups. The study is scheduled to run from February 2019 to July 2025.Ethics and dissemination The project Improve-MH (application number 602) was approved by the local ethics committee of Ruhr-University of Bochum and is being conducted in accordance with the Declaration of Helsinki. The study is also conducted in full accordance with the German Data Protection Act, and the Good Clinical Practice guideline (GCP) and is sensitive to specific ethical considerations. Results will be disseminated at scientific conferences, published in peer-reviewed journals and provided to consumers of healthcare.Trial registration number The trial was prospectively registered at the German Clinical Trials Register (Deutsches Register Klinischer Studien, DRKS-ID: DRKS00019072) on 16 March 2020.

Data-based predictions of individual Cognitive Behavioral Therapy (CBT) treatment response are a fundamental step towards precision medicine. Past studies demonstrated only moderate prediction accuracy (i.e. ability to discriminate between responders and non-responders of a given treatment) when using clinical routine data such as demographic and questionnaire data, while neuroimaging data achieved superior prediction accuracy. However, these studies may be considerably biased due to very limited sample sizes and bias-prone methodology. Adequately powered and cross-validated samples are a prerequisite to evaluate predictive performance and to identify the most promising predictors. We therefore analyzed resting state functional magnet resonance imaging (rs-fMRI) data from two large clinical trials to test whether functional neuroimaging data continues to provide good prediction accuracy in much larger samples. Data came from two distinct German multicenter studies on exposure-based CBT for anxiety disorders, the Protect-AD and SpiderVR studies. We separately and independently preprocessed baseline rs-fMRI data from n = 220 patients (Protect-AD) and n = 190 patients (SpiderVR) and extracted a variety of features, including ROI-to-ROI and edge-functional connectivity, sliding-windows, and graph measures. Including these features in sophisticated machine learning pipelines, we found that predictions of individual outcomes never significantly differed from chance level, even when conducting a range of exploratory post-hoc analyses. Moreover, resting state data never provided prediction accuracy beyond the sociodemographic and clinical data. The analyses were independent of each other in terms of selecting methods to process resting state data for prediction input as well as in the used parameters of the machine learning pipelines, corroborating the external validity of the results. These similar findings in two independent studies, analyzed separately, urge caution regarding the interpretation of promising prediction results based on neuroimaging data from small samples and emphasizes that some of the prediction accuracies from previous studies may result from overestimation due to homogeneous data and weak cross-validation schemes. The promise of resting-state neuroimaging data to play an important role in the prediction of CBT treatment outcomes in patients with anxiety disorders remains yet to be delivered.

BackgroundInternet-based cognitive behavioral interventions (iCBTs) are efficacious treatments for depression and anxiety. However, it is unknown whether adding human guidance is feasible and beneficial within a large educational setting. ObjectiveThis study aims to potentially demonstrate the superiority of 2 variants of a transdiagnostic iCBT program (human-guided and computer-guided iCBT) over care as usual (CAU) in a large sample of university students and the superiority of human-guided iCBT over computer-guided iCBT. MethodsA total of 801 students with elevated levels of anxiety, depression, or both from a large university in the Netherlands were recruited as participants and randomized to 1 of 3 conditions: human-guided iCBT, computer-guided iCBT, and CAU. The primary outcome measures were depression (Patient Health Questionnaire) and anxiety (Generalized Anxiety Disorder scale). Secondary outcomes included substance use–related problems (Alcohol Use Disorder Identification Test and Drug Abuse Screening Test—10 items). Linear mixed models were used to estimate the effects of time, treatment group, and their interactions (slopes). The primary research question was whether the 3 conditions differed in improvement over 3 time points (baseline, midtreatment, and after treatment) in terms of depression and anxiety symptoms. Results were analyzed according to the intention-to-treat principle using multiple imputation. Patients were followed exploratively from baseline to 6 and 12 months. ResultsIn both short-term and long-term analyses, the slopes for the 3 conditions did not differ significantly in terms of depression and anxiety, although both web-based interventions were marginally more efficacious than CAU over 6 months (P values between .02 and .03). All groups showed significant improvement over time (P

BackgroundInternational clinical guidelines recommend Family Interventions (FIs) especially for families of people at early stages of psychosis. The German S3 treatment guideline for schizophrenia gives FIs the highest level of clinical recommendation. However, some family relatives have limited access to these services due to health system constrains. Digital interventions have emerged as a solution to overcome this hindered access to evidence-based family interventions.ObjectiveThe present pilot study evaluates the feasibility and potential efficacy of the first German moderated online psychoeducation and support programme (ePSP) for relatives of people with early psychosis, with the additional purpose to improve accessibility and reduce waiting times.MethodsA pre-post study was performed. A brief recruitment period was pre-established (10 weeks) to test potential improvement of regular therapy waiting times in Germany. A total of 25 relatives of people with early psychosis were recruited and received the 12-week moderated online intervention. Assessments were conducted at baseline and at post intervention. Acceptance of the intervention and the user’s experience were also evaluated at post intervention.ResultsRecruitment, retention rates and qualitative data support the feasibility and acceptability of the ePSP. Significant positive effects of the interventions were found on key therapeutic targets, including both primary outcomes (i.e., perceived stress and beliefs about the illness). Twenty-one participants also completed the open-ended questions of the user experience questionnaire, which yielded three main themes: most important modules, difficulties in using the programme and ways to improve ePSP.DiscussionThese results provide preliminary efficacy estimates for a fully powered RCT to investigate superiority (or equipoise) effects of the ePSP in comparison to the routine face-to-face family therapy groups. This future RCT will also allow further exploration of ePSP to improve access to psychological therapy for relatives of young people with psychosis, also in relation to the new ground-breaking Digital Healthcare Act in Germany.

Background: Although earlier studies concluded that clinicians' prototypes of patients with mental disorders can influence diagnostic decisions, it remains unclear how presumably more or less prototypical features were identified in these studies. Therefore, the aim of the current study was to empirically identify therapists’ prototypes of major depression, generalized anxiety disorder, borderline personality disorder, and bipolar disorder. Method: Psychotherapists (N = 69) filled out an online survey and answered questions on the most common thoughts, feelings, behaviors, appearance, life circumstances, age, and gender of a typical person with each disorder. Additionally, they rated the DSM-5 criteria according to how much they think about each criterion when picturing a typical person with the respective disorder. Results: The most frequently mentioned features are reported and associations between features are visualized by means of network analyses. Besides some exceptions, therapists’ responses were mostly in line with the DSM-5 criteria and prevalence rates in patients with each disorder. Limitations: The main limitation is the fact that categorization of therapists’ responses into features depended on subjective decisions. Despite efforts to make this process as objective as possible, replication could lead to slightly different results. Conclusion: Therapists' prototypes might be helpful to make diagnostic decisions in typical situations but could lead to incorrectly diagnosing or overlooking a disorder in less typical situations. The results of the current study should inform further research on the influence of prototypes on diagnostic decisions. Additionally, the current findings should be used to increase therapists’ awareness of prototypes of different mental disorders and the importance of accurate diagnosis.

Future-oriented cognition plays a manifold role for adults’ mental health. The present study aimed to investigate the relationship between future-oriented cognition and mental health in N = 191 children aged between 3 and 7 years. Parents completed an online-questionnaire including children’s future-oriented cognition (e.g., episodic foresight; Children Future Thinking Questionnaire; CFTQ), children’s mental health problems (Strengths and Difficulties Questionnaire; SDQ), and wellbeing (Parent-rated Life Orientation Test of children; PLOT and Positive-Mental-Health Scale; PMH). More externalizing problems (especially hyperactivity) related to lower future-oriented cognition. For mental wellbeing, higher levels of optimism were associated with higher episodic foresight. Future-oriented cognition increased with age cross-sectionally. This increase was flatter at higher levels of wellbeing (indicated by lower pessimism). Results are discussed considering findings on the role of future-oriented cognition for mental health in adults and adolescents. Suggestions for future work are presented regarding the direction of the observed links and underlying mechanisms.

Abstract Background/aims Borderline personality disorder (BPD) is a severe mental disorder characterized by an unstable sense of self, intense and rapidly changing affect, as well as impulsive and self-destructive behaviors. Interpersonal relationships of individuals with BPD are characterized by marked instability, a lack of dependability, and quick changes between love and hate. For children of individuals with BPD, this can lead to permanent stress and attachment insecurity and an increased risk of adverse physical and mental health development. To reduce dysfunctional parenting and improve positive parenting, and in turn, to promote healthy child development, a group intervention for mothers with BPD was developed. This study aims to evaluate this first disorder-specific parenting intervention for BPD in a randomized controlled trial. Method In a parallel-group, two-arm, randomized controlled trial, an initial N = 178 mothers diagnosed with BPD and their children aged 6 months to 6 years are assigned to either the parenting intervention or a waiting control group. If taking place, participants of both groups continue their regular treatment for BPD diagnosis (e.g., individual therapy, medication). The primary outcomes are changes in parenting from baseline (day 0) to post intervention (week 12) and follow-up (6 months after group intervention; month 9). The waiting control group can attend the group intervention at the end of all assessments. Participants allocated to the intervention group are expected to show improvement in their parenting and a reduction in child abuse potential. Maternal emotion regulation and mental distress are analyzed as secondary outcomes. Discussion Mothers with BPD may need tailored help when reporting difficulties raising their children. The first disorder-specific parenting intervention has been developed to close this gap. ProChild is part of a large government-supported consortium, which aims to investigate different aspects of abuse and maltreatment in childhood and adolescence. Trial registration ClinicalTrials.gov NCT04169048 . Registered on Nov 19, 2019.

Background The desire to have children has been declining globally, especially in industrialized nations. This study examines the physical health correlates, and positive and negative mental health correlates of the wish to have a child across time and in two countries. Method Questionnaire data were obtained from large-scale university samples of 12,574 participants in Germany and China. Results The wish to have a child (child wish) is related to positive and negative mental health in China and, to a lesser degree, in Germany. Child wish is positively related to some aspects of mental and somatic health for Chinese women and men, negatively to depression for Chinese and German men and Chinese women, and positively to stress for German men, with generally small effects. Effects hold when controlling for age, partnership status, and family affluence. Most relationships were almost equal between women and men (in both China and Germany), and between countries with the exception of two different paths in each gender group. That is, having a partner is associated with a higher child wish in both Chinese and German female students. In China, older female students are more likely to want to have a child, while older female students in Germany are less likely to want to have a child. Neither partnership nor age predict child wish for the next year. Conclusion In sum, Chinese students reported feeling more positively about having children when they were happy and healthy, with the exception that highly satisfied Chinese males report lower child wish in the next year. More depressed Chinese and German men and Chinese women reported lowered child wish, and stressed German men reported more child wish. Older students reported more (Chinese) or less (German) child wish depending on country.

Abstract. Introduction: Adherence to Covid-19 safety measures reduces the spread of the pathogen and lowers mortality rates. The present study examines microlevel (including sociodemographics, health risk factors, and mental health) and perceived macrolevel variables (including freedom, justice, and wealth) concerning self-perceived and self-reported Covid-19 safety measure adherence across eight countries. Methods: Self-reported adherence to Covid-19 safety measures and its potential predictors were assessed in representative samples from eight countries (total N = 7,437; Germany, France, Spain, Poland, Russia, Sweden, UK, US) by online surveys (end of May 2020 to the beginning of June 2020). Results: Self-reported adherence was positively predicted by female sex, higher age, higher social status, belonging to a Covid-19 risk group, being personally affected (physically, economically, and mentally), and positive mental health. Adherence was negatively predicted by depression and anxiety. Perceptions of governmental communication as credible and honest, government communication being guided by political interests, the feeling of being well informed, and perceived country-level freedom positively predicted self-reported adherence. Perceived country-level justice negatively predicted adherence, and perceived country-wide wealth was unrelated to it. Conclusions: Self-reported adherence to COVID-19 safety protocols is negatively predicted by depression, anxiety, and perceived justice, is positively predicted by perceived freedom, and not predicted by perceived country-level wealth.

Avoidance-based emotion regulation plays a central role in the development and maintenance of anxiety disorders across the life span. However, measures for children that account for different avoidance strategies, are scarce. Derived from Gross' Process Model of Emotion Regulation, the Bochum Assessment of Avoidance-based Emotion Regulation for Children (BAER-C) was developed to assess avoidance strategies (cognitive avoidance, behavioural avoidance, verbal reassurance, and social reassurance) and reappraisal in anticipatory anxious situations. In the present study, the BAER-C was administered to 129 school children aged 8 to 14 and 199 children with anxiety disorders aged 8 to 16 and their parents, along with established measures on anxiety, psychopathology, and emotion regulation. Factor structure, internal consistency, convergent, divergent and construct validity were analysed. Results of the anxious sample showed a satisfactory internal consistency (McDonald's ω = .94) for all scales as well as positive correlations with anxiety symptoms (all rs > .17, all ps < .05). Factor analysis supported a five-factor model. This model was confirmed in the student sample. Children with an anxiety disorder scored higher on behavioural avoidance, verbal reassurance, and social reassurance than school children (F (5,304) = 12.63, p = .003, ηp2 = .17). Results for construct validity were ambiguous. Our analyses suggest that the BAER-C is a promising theory-based new instrument to reliably assess different avoidance strategies in children. More research is needed to further analyse construct validity with other emotion regulation questionnaires.

This descriptive study examined patient characteristics, treatment characteristics, and short-term outcomes among patients with Anorexia Nervosa (AN) and Bulimia Nervosa (BN) in routine clinical care. Results for patients receiving full-time treatment were contrasted with results for patients receiving ambulatory treatment. Data of a clinical trial including 116 female patients (18–35 years) diagnosed with AN or BN were subjected to secondary analyses. Patients were voluntarily admitted to one of nine treatment facilities in Germany and Switzerland. Patients received cognitive-behavioral interventions in accordance with the national clinical practice guidelines for the treatment of EDs under routine clinical care conditions, either as full-time treatment or ambulatory treatment. Assessments were conducted after admission and three months later. Assessments included a clinician-administered diagnostic interview (DIPS), body-mass-index (BMI), ED pathology (EDE-Q), depressive symptoms (BDI-II), symptoms of anxiety (BAI), and somatic symptoms (SOMS). Findings showed that treatment intensity differed largely by setting and site, partly due to national health insurance policies. Patients with AN in full-time treatment received on average 65 psychotherapeutic sessions and patients with BN in full-time treatment received on average 38 sessions within three months. In comparison, patients with AN or BN in ambulatory treatment received 8–9 sessions within the same time. Full-time treatment was associated with substantial improvements on all measured variables for both women with AN (d = .48-.83) and BN (d = .48-.81). Despite the relatively small amount of psychotherapeutic sessions, ambulatory treatment was associated with small increases in BMI (d = .37) among women with AN and small improvements on all measured variables among women with BN (d = .27-.43). For women with AN, reduction in ED pathology were positively related to the number of psychotherapeutic sessions received. Regardless of diagnosis and treatment setting, full recovery of symptoms was rarely achieved within three months (recovery rates ranged between 0 and 4.4%). The present study shows that a considerable amount of patients with EDs improved after CBT-based ED treatment in routine clinical care within three months after admission. Intensive full-time treatment may be particularly effective in quickly improving ED-related pathology, although full remission of symptoms is typically not achieved. A small amount of ambulatory sessions may already produce considerable improvements in BN pathology and weight gain among women with AN. As patient characteristics and treatment intensity differed largely between settings, results should not be interpreted as superiority of one treatment setting over another. Furthermore, this study shows that treatment intensity is quite heterogeneous, indicating the possibility for increasing effectiveness in the treatment of EDs in routine clinical care.

Abstract Background Regarding the controversy about the overdiagnosis of Attention Deficit/Hyperactivity Disorder (ADHD) in children and adolescents there are two main directions addressed as issue of age bias and issue of gender bias. In this relation, replication of findings demonstrating significant overdiagnosis is of importance which make the systematic evaluation of such occurrence necessary. Objective The seminal study by Bruchmüller, Margraf & Schneider, 2012 is replicated here, although in a different cultural context, in this case Iran, as ADHS might be perceived differently there. We assessed both gender bias and the impact of potential overdiagnosis on treatment recommendations. Methods A total of 344 licensed Iranian psychiatrists (mean age = 45.17, SD = 9.50) participated in this study. Each psychiatrist received a cover letter that introduced the study as well as a case vignette. Overall, there are eight different cases, one child with ADHD and three non-ADHD children, for both a boy (Ali) and a girl (Sara). Participants also received a questionnaire requesting their particular diagnosis, treatment recommendation and the therapist’s sociodemographic information. Chi square tests and multiple logistic regression were applied for data analyses. Results Overdiagnosis occurred in both girl and boy children, although overdiagnosis was 2.45 more likely in boys than in girls (p

The number of studies on fear conditioning in children and adolescents has increased in recent years. Most of these studies exclusively focus on data of completers while dropout rates, reasons for dropout, and specific characteristics of non-completers are underreported. This study systematically investigated data of 283 children and adolescents between 8 and 17 years ( M = 11.10 , SD = 2.14) undergoing a differential fear conditioning paradigm using a female scream as unconditioned stimulus (US). The sample included 230 children and adolescents with a current primary anxiety disorder (separation anxiety disorder, social anxiety disorder, and specific phobia) and 53 non-anxious controls. The dropout rate was 24.1%. The most common reason to discontinue was being afraid of the US (59.1%) followed by the startle probe being too loud (15.2%). Logistic regressions revealed that younger age and a present anxiety disorder predicted dropout. There seem to be distinct characteristics potentially predicting dropout from fear conditioning paradigms. Thus, interpretability and generalizability of those paradigms are limited when non-completers are not considered. Future research should conscientiously look at these data more closely and investigate paradigms that work independent of age and diagnostic status.

Although a substantial part of employees suffers from a mental illness, the work situation of this population still is understudied. Previous research suggests that people with a mental illness experience discrimination in the workplace, which is known to have detrimental effects on health. Building on the stereotype content model and allostatic load theory, the present study investigated whether employees with a mental illness become socially excluded at the workplace and therefore show more days of sick leave. Overall, 86 employees diagnosed with a mental disorder were interviewed and completed online-surveys. Path analyses supported the hypotheses, yielding a serial mediation: The interview-rated severity of the mental disorder had an indirect effect on the days of sick leave, mediated by the symptomatic burden and the social exclusion at the workplace. In the light of the costs associated with absenteeism the present paper highlights the harmfulness of discrimination. Organizations and especially supervisors need to be attentive for signs of exclusion within their teams and try to counteract as early as possible.

Abstract Background In children and adolescents, anxiety disorders (ADs) are among the most prevalent mental disorders. While there is a solid empirical foundation to support CBT as an evidence-based treatment for childhood ADs, the mechanisms underlying the efficacy of CBT are not well explored. Exposure is assumed to be vital to the efficacy of CBT in ADs, but empirical evidence (e.g., dismantling studies) showing that exposure is indeed a vital element of effective treatments is relatively scarce. The proposed meta-analysis aims to investigate the role of exposure in reducing symptoms of anxiety among children and adolescents. Methods A systematic search of several electronic databases including PubMed/MEDLINE, PsycINFO, Psyndex plus, Web of Science, Scopus, and EMBASE will be conducted (from inception onwards). We will include randomized and non-randomized clinical trials examining exposure and anxiety among children and adolescents. If feasible, we will also include experimental, quasi-experimental, and observational studies. The primary outcome will be improvement in anxiety levels (recovery or change in anxiety rating scale) after exposure. Three reviewers will independently screen all citations, abstract data, and full-text articles. The methodological quality (or risk of bias) of individual studies will be appraised using an appropriate tool. If feasible, we will conduct mixed effects meta-analysis. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., dose of exposure, age group, methodological quality). Discussion This systematic review and meta-analysis will examine the role of exposure in reducing symptoms of anxiety among youth. The review will provide information on the working mechanisms underlying the efficacy of CBT. Our findings will be of interest to mental health professionals, researchers, and policy makers who wish to support children and adolescents with anxiety disorders by guiding well-informed treatment decisions. Systematic review registration PROSPERO (CRD42019128667).

Previous research provides evidence of maternally transmitted body-related attentional biases in female adolescents. In contrast, it remains unclear whether a familial transmission of body-related attentional biases also exists within father-son dyads. Therefore, the current study examined n = 42 male adolescents and their fathers with respect to direct and indirect paternal influences on body-related attention patterns and specific body-related concerns in sons. Besides completing specific body image questionnaires, participants were shown pictures of their own and a respective peer’s body, while their eye movements were tracked. The fathers additionally viewed the body pictures of their own son and an adolescent peer. Contrary to the assumed direct and indirect paternal transmission processes, the sons’ body-related attention patterns were not significantly associated with the perceived amount of paternal body-related feedback, with the fathers’ attention patterns towards their own son’s and the adolescent peer’s body, or with the fathers’ attention patterns towards their own and the adult peer’s body. Similarly, no significant associations were found between direct or indirect paternal influences and the sons’ drives for muscularity and thinness, body dissatisfaction, and muscularity-related body-checking behavior. Comparing the present findings with previous research indicating a maternal transmission of body-related attentional biases and body-related concerns in female adolescents, alternative (not gender-linked) familial transmission processes, e.g., via one’s own mother, or a comparatively higher relevance of other sociocultural influences, e.g., via peers or the media, might be assumed for male adolescents.

Introduction: An increase of suicidal thinking within the COVID-19 pandemic has been postulated. Yet, direct comparisons with pre-COVID-19 rates are missing. Methods: The present study investigated whether levels and rates of suicidal ideation have changed between 2016 and 2020. Data of N = 664 university students (five cohorts: 2016: n = 105, 2017: n = 117, 2018: n = 108, 2019: n = 154, 2020: n = 180) were collected by online surveys. Results: The rate of students suffering from suicidal ideation was twice as high in 2020 than in previous years. Furthermore, levels of suicidal thinking and of depression were higher in 2020 than in 2019 and 2016. Limitations: The sample size of the current study was rather modest and suicide ideation was assessed with a single item only. Conclusions: The rate of students suffering from suicidal ideation was twice as high in 2020 than in previous years. Help-lines and online counselling should be promoted to the public and the possibilities of telepsychotherapy for suicidal people should be used and expanded.

The present study examines the relationship between smoking and panic, depression, and anxiety over time and across two cultures, using data from the BOOM studies. The relationship between smoking and anxiety disorders, including panic requires further exploration, in order to reconcile inconsistent, contradictory findings and cross-cultural differences. Participants in the present study included 5,416 Chinese university students and 282 German university students. Participants completed surveys assessing smoking, panic, depression, and anxiety. Multiple logistic regressions were used to examine predict later mental health from smoking, as well as later smoking from mental health. In sum, across the regressions, smoking at baseline did not predict higher panic or depression at follow-up in either German or Chinese students. It did predict lower anxiety in German students. Anxiety at baseline, but not depression, predicted increased likelihood of smoking at follow-up in German students. The relationship between smoking and anxiety disorders is one that will require further exploration, in order to reconcile inconsistent, contradictory findings and cross-cultural differences. The present data point to a relationship between anxiety and later smoking, and also to a negative, though small, relationship between smoking and later anxiety in German students, and no prospective relationship in either direction in Chinese students.

In treating childhood anxiety disorders, therapists use highly individualized anxiety hierarchies to assess anxiety-eliciting situations and to personalize treatment. In contrast, psychometric assessment of anxiety symptoms in children usually consists of standardized questionnaires, assessing either total anxiety or disorder-specific symptom scores, prioritizing comparability over individual information. To account for interindividual differences, the Anxiety and Avoidance Scale for Children (AVAC) was developed, following a precise, personalized, assessment approach. In responding to the questionnaire, children and parents identify the most anxiety-eliciting situations before starting treatment, and rate them for anxiety and avoidance. Ratings are repeated over the course of treatment. The aim of this study is to introduce the new questionnaire and present first data on psychometric properties. The AVAC was administered to 389 children with separation anxiety disorder (N = 148), social anxiety disorder (N = 110) or specific phobia (N = 131) aged 8 to 16 and their parents, along with other measures of anxiety and psychopathology before and after cognitive behavioral treatment. Results showed adequate to good test-retest reliability. The AVAC items correlated significantly with established anxiety questionnaires, indicating convergent construct validity. Regarding divergent construct validity, the AVAC showed only small correlations with externalizing symptoms, demonstrating its precision in measuring anxiety and avoidance. The questionnaire was also sensitive to change after treatment, with medium to large effects in the reduction of anxiety and avoidance. The present analyses suggest that the new personalized assessment approach with the AVAC is a reliable and valid assessment of individualized anxiety and avoidance, as well as change in those constructs over the course of CBT treatment.

The present study examines the relationship between obesity and mental health using longitudinal data. Participants with data at baseline and one-year follow-up were included from two countries: Germany (364) and China (9007). A series of structural equation models with three mediators and one moderator were conducted separately for female and male students in Germany and China. Zero-order correlations indicated that overweight/obesity was significantly related to later depression and anxiety in Chinese males. Additional effects of obesity on later mental health flowed through effects on attractiveness (Chinese and German females, and Chinese males), physical health (Chinese males), and life satisfaction (German females). Though overweight/obesity is related to mental health across many other studies, results in this study yield total effects between overweight/obesity and follow-up mental health only in Chinese males. The relationship between overweight/obesity and follow-up mental health was significantly mediated by follow-up attractiveness, or health state, or life satisfaction in German females, Chinese females, and Chinese male students, with no significant indirect effects found in German male students. This highlights the possible importance of culture in examining these effects.

Researcher teams around the globe including the "Project Lightspeed" are intensively working on vaccines to fight the Covid-19 pandemic. However, the availability of effective vaccines does not guarantee the vaccination willingness among the population. In spring 2021, we investigated the vaccination willingness and its potential predictors in representative online samples in nine countries (China, France, Germany, Poland, Russia, Spain, Sweden, U.K., U.S.). Of the 9,264 participants, 79.9% revealed Covid-19 vaccination willingness. The highest willingness was in the U.K., followed by Spain and China, the lowest in Russia. In most countries, the perception of governmental Covid-19 measures as useful and the use of television reports as Covid-19 information source positively predicted the willingness. Further factors such as demographic variables, mental and physical health status, evaluation of governmental communication, social media use, and general adherence to Covid-19 measures showed a country-specific predictive pattern. Recommendations how to increase the vaccination willingness are provided.

In the absence of vaccines or causal therapies, behavioral measures such as wearing face masks and maintaining social distance are central to fighting Covid-19. Yet, their benefits are often questioned by the population and the level of adherence to the measures is variable. We examined in representative samples across eight countries (N = 7,568) whether adherence reported around June 1, 2020 predicted the increase in Covid-19 mortality by August 31, 2020. Mortality increased 81.3% in low adherence countries (United States, Sweden, Poland, Russia), 8.4% in high adherence countries (Germany, France, Spain, United Kingdom). Across countries adherence and subsequent mortality increases correlated with r = -0.91. No African or South American countries were included in the present study, which limits the generalizability of the findings. While reported Covid-19 mortality is likely to be influenced by other factors, the almost tenfold difference in additional mortality is significant, and may inform decisions when choosing whether to prioritize individual liberty rights or health-protective measures.

In ambiguous situations, infants have the tendency to gather information from a social interaction partner to regulate their behavior [social referencing (SR)]. There are two main competing theories concerning SR’s function. According to social-cognitive information-seeking accounts, infants look at social interaction partners to gain information about the ambiguous situation. According to co-regulation accounts, infants look at social interaction partners to receive emotional support. This review provides an overview of the central developments in SR literature in the past years. We focus on the role of situational aspects such as familiarity of SR partners and situational threat, not only for SR (looking), but also for subsequent behavioral regulation (exploration, affect). As the competing accounts make different predictions concerning both contextual factors, this approach may reveal novel insights into the function of SR. Findings showed that a higher familiarity of SR partners consistently resulted in decreased looking (cf. social-cognitive accounts) and that higher threat remains largely understudied, but seemed to increase looking in the first few studies (cf. co-regulation accounts). Concerning behavioral regulation (exploration, affect) findings are mixed. We point out that moving toward a more complex situatedness may help to disentangle the heterogeneous results by considering the interaction between familiarity and threat rather than investigating the factors in isolation. From a general perspective, this review underlines the importance of situational factors and their interaction in eliciting a phenomenon, such as SR, but also in determining the nature of the phenomenon itself.

Associative learning can be observed from the neonatal period onward, providing opportunities to examine changes in basic learning and memory abilities. One method that is suitable to study associative learning is classical eyeblink conditioning (EBC) which is dependent on the cerebellum. Extinction learning can be systematically investigated in this paradigm by varying the context during learning and extinction. Because of methodological difficulties and ethical challenges, no studies have compared extinction learning using EBC across human development. Our goal was to test feasibility of a 3-day delay EBC paradigm that can be used from infancy to adulthood. Acceptance/safety was tested especially for infancy by investigating attrition rates and parental report on infant wellbeing. On a paradigm side, we tested if the paradigm leads to successful acquisition and extinction. An air puff served as unconditional stimulus (US) and a tone as conditional stimulus (CS). On day 1 during acquisition, participants received 36 US–CS pairings in context A. On day 2, participants received 12 acquisition trials in context A to consolidate association learning, followed by 48 extinction trials (tone alone presentations) in context B. Renewal was assessed on day 3 and incorporated 12 CS alone trials presented in both the acquisition context and the extinction context. Eyeblink responses were videotaped and coded offline. The protocol was tested with 12–36-months-old infants (N = 72), adolescents (N = 8), and adults (N = 8). Concerning the acceptance/safety side, attrition ranged from 21 to 58% in infant samples due to the complex preparation of the children for the paradigm. However, attrition is equal to or lower than other infant learning paradigms. Parents of infant samples were very interested in the paradigm and reported low levels of infant stress, exhaustion, and negative feelings during the sessions. Data quality was very high, and no participant had to be excluded because of insufficient data. Concerning the paradigm side, participants showed successful acquisition and extinction as a group. The procedure is ethically sound, feasible, tolerated by many infants, and acceptable among parents. The data show successful acquisition and extinction rates, making the paradigm a valuable tool for investigating developmental changes in extinction learning over the lifespan.

Metacognitive beliefs have repeatedly proven to play a role in anxiety disorders in children and adolescents, but few studies have investigated whether they change after cognitive behavioral therapy. This longitudinal intervention study explores whether positive and negative metacognitive beliefs in particular change after exposure-focused treatment, and if metacognitive changes predict reductions in anxiety symptoms. A sample of 27 children between 8 and 16 years of age with a primary diagnosis of specific phobia, separation-anxiety disorder or social phobia completed assessments of anxiety symptoms, metacognitive beliefs, worry and repetitive negative thoughts before and after 11 sessions of intensified exposure treatment. Metacognitive beliefs did not change significantly after intensified exposure, but post-hoc power analysis revealed a lack of power here. Change in negative metacognitive beliefs correlated with a change in anxiety symptoms, but did not independently contribute as a predictor variable. Differences between subsamples showed that patients with separation-anxiety disorder scored higher on negative metacognitive beliefs than those with specific or social phobia. Consideration of metacognition, and negative metacognitive beliefs in particular could help us further improve the understanding and treatment of anxiety disorders in children and adolescents and should therefore receive more attention in psychotherapy research.

Abstract Theoretical background Body image distortions such as perception biases are assumed to be precursors of eating disorders (ED). This study aims to investigate body image perceptions and symptoms of disturbed eating behavior among a sample of 11–17 year-old students in Germany. Methods A cross-sectional survey study was carried out among 1524 students of twelve secondary schools from all school types in North Rhine-Westphalia (Germany). A naturalistic photograph-rating consisting of photographs of young women’s bodies was used to examine children’s perceptions of female bodies (i.e., perceived average body size and perceived ideal body size of young women). Also, symptoms of disturbed eating behavior were examined. Results Compared to statistical data, children and adolescents underestimated the average body size of young women by more than two BMI-points (estimated average BMI = 20), with no differences between boys and girls. Also, girls and boys generally held a slim female thin-ideal (perceived ideal BMI = 19.5), which is nearly three BMI-points below the average body size in the young female population. Girls showed a slightly stronger female thin-ideal than boys. Among all subgroups, early-adolescent girls (13–14 years) displayed the strongest thin-ideal internalization. Nearly one-third of this group perceived a BMI below 18 as ideal female body size. Symptoms of disturbed eating behavior were common among youth and most frequent among adolescent girls (15–17 years). Girls who displayed a bias towards underestimation of female body size and girls who displayed an underweight female thin-ideal were more likely to report harmful dieting behaviors and psychological distress associated with eating, body, and weight. Conclusions This study found that 11–17 year-old girls and boys do not show accurate judgements regarding the average body size of young women. Instead, there is systematic and significant underestimation, indicating considerable perception biases, which may constitute a risk factor for the development and maintenance of ED. Symptoms of disturbed eating behavior were common, especially among girls, and associated with body-related perceptions. Future research will need to clarify the severity and course of these symptoms.

Behavioral measures, such as the wearing of facemasks and maintaining of distance to other people, have been central in fighting the COVID-19 pandemic and will continue to be important in curbing its spread. We therefore investigated their perceived usefulness, adherence and their predictors in representative online samples in eight countries (France, Germany, Poland, Russia, Spain, Sweden, U.K., U.S.). Of the 7,658 participants, 77.4% rated governmental measures (highest: Germany, lowest: France) as useful and 91.7% reported adherence to them. Adherence was lowest in Russia and Poland, where people felt particularly left alone and not well supported, and in the U.S. and Sweden, where governments showed ambivalent attitudes towards the measures. The highest adherence was reported in countries with very high mortality (U.K., Spain, France) or very positively perceived government communication (Germany). Female gender, higher age, belonging to a risk group, being affected physically and mentally, perception of governmental communication as guided by the interests of people, feeling of being well informed and the level of positive mental health positively predicted both outcomes, while being affected economically negatively predicted both outcomes. Country-specific results are considered in the light of the protection motivation theory and the theory of planned behavior together with potential ways to improve active participation of the population. Overall, we recommend the governments and authorities to stress that each individual can contribute to the control of the COVID-19 situation by adherence to the measures in the public communication. Moreover, they should emphasize the risk of unconscious infection of older individuals by younger people, as well as the importance of physical activity for the protection of mental and physical health especially during the pandemic.

The present study examines a broad range of longitudinal predictors of dimensional positive mental health (PMH) and negative mental health (NMH), using data from the BOOM study. Participants were drawn from university student samples in Germany (1,608), Russia (677) and China (12,057). A structural equation model was conducted with four groups of predictors and PMH/NMH as criteria (outcomes). Five of the six salutogenic predictors were predictive of both positive mental health (positively) and negative mental health, as measured by depression (negatively). Pathogenic predictors anxiety and depression were related to future depression, but not to positive mental health. Stress at baseline was related to both future positive mental health (negatively) and future depression (positively). Being male in this study was associated with increased future depression. Results hold across Germany, Russia, and China. Results support the conceptualization of positive and negative mental health as related, but independent dimensions across three cultures.

Bullying victimization by peers is highly prevalent in childhood and adolescence. There is convincing evidence that victimization is associated with adverse mental health consequences. In contrast, it has been found that perpetrators suffer no adverse mental health consequences. These findings originate from Western countries such as Germany but have rarely been investigated in collectivistic societies such as China. Furthermore, it has been rarely studied whether positive intrapersonal characteristics (e.g., personal resilience and self-efficacy) and interpersonal positive resources (e.g., social support) may mediate the impact of bullying on mental health. The current study used a path analytic model to examine, firstly, whether previous bullying experiences (both victimization and perpetration) are associated with current positive and negative mental health in university students and, secondly, whether these influences are mediated by social support, resilience, and self-efficacy. The model was tested in 5,912 Chinese and 1,935 German university students. It was found that in both countries, higher victimization frequency was associated with lower levels of social support, personal resilience, and self-efficacy, which in turn predicted poorer mental health. Moreover, and only in China, perpetration was negatively associated with social support and personal resilience but not self-efficacy. In contrast, in the German sample, perpetration experience was found to enhance one's self-efficacy, and the later was associated with better mental health. The results support a mediation model in which social support, personal resilience, and self-efficacy partially mediate the influence of victimization on mental health in both countries. For the relationship between perpetration and mental health, self-efficacy was the only full mediator in Germany, whereas in China, both social support and personal resilience were partial mediators. In conclusion, peer victimization has adverse effects on mental health in both Germany and China. Only in China, however, is perpetration also associated with adverse mental health outcomes. In contrast, getting ahead by bullying in an individualistic society such as Germany is associated with increased self-efficacy and mental health. The differences found between an individualistic country and a collectivistic country have important implications for understanding and planning interventions to reduce bullying.

Problems in infant mental health such as the ability to experience, regulate, and express emotional states is expressed in behavioral problems like excessive crying, feeding, and sleeping problems. Parenting programs are popular but their effectiveness on infant mental health remains uncertain. Possibly, because recent studies have focused only on parental and parent–child measures while they miss to assess infant behavioral measures. The goal of this pilot study is to fill in this gap by assessing infantile behavioral measures. We investigated the acceptance and first indicators of efficacy of the universal group parenting training Baby Triple P (BTP) compared to a care as usual (CAU) control condition focusing on early behavioral problems. In all, 49 couples were randomly allocated to receive either eight BTP sessions before birth and per telephone after birth or to take part in CAU. Infant behavior was assessed with a diary and a structured diagnostic interview. Parental self-report measures of partnership quality and parental competence were assessed before birth, 10 weeks after birth and at 6-month follow-up. Since the parent training was conducted before the birth of the child, the child’s mental health could not be assessed before the parent training. Thus, for this variable no within measurement (pre–post) could be carried out and intention-to-treat analysis was not possible. However, a between group analysis comparing BTP against CAU took place to assess effectiveness of BTP on children’s mental health. Mothers and fathers rated the program as feasible and relevant. Results indicate significant group differences in crying behavior 6 months after birth to the benefit of the intervention group. No beneficial outcomes were found for feeding and sleeping problems in infants or partnership quality, parental sense of competence in parents. Due to an unrepresentative high level of education of the participating parents and the small sample size, these findings can be considered preliminary. Nevertheless, these results allow to further investigate the effectivity of BTP in large-scale clinical trials. Behavioral diaries or diagnostic interviews for early mental health problems should be routinely implemented in randomized controlled trials (RCTs) in order not to miss possible behavioral changes in infants.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT02313493.

Prevalence rates for mental health problems are higher when an individual's socioeconomic status (SES) is low, but the underlying mechanisms are not clearly understood. We investigated associations between education as indicator for SES and depressive symptoms as well as positive mental health (PMH). Moreover, we hypothesized that low education is associated with a lack of psychosocial resources and more daily hassles, which in turn mediate the relationships between education and mental health. In a German representative sample (N = 7937), we cross-sectionally first examined whether a person's educational level was associated with depressive symptoms and PMH. Educational level was defined as the highest academic qualification achieved. Second, we investigated whether also sense of control, resilience, delay of gratification, cultural activity and daily hassles followed gradients along the educational level. Third, we investigated whether they mediated the relationship between education and mental health. Results showed that depressive symptoms measured by items from the DASS-42 depression subscale were more prevalent for persons with a low educational level, PMH operationalized by the Positive Mental Health Scale was equally distributed, and all psychosocial characteristics followed the gradient of educational level. In addition, the group with a high school diploma was particularly burdened. Structural equation modeling indicated that the associations between education and mental health were mediated by all psychosocial characteristics and daily hassles, apart from the delay of gratification. In the group with the lowest educational level the model fit indices for depressive symptoms and PMH were acceptable (χ2 = 10007.243 (627), CFI = 0.869, RMSEA = 0.04 (90% CI [0.04, 0.04], SRMR = 0.05; and χ2 = 12779.968 (741), CFI = 0.86, RMSEA = 0.05 (90% CI [0.05, 0.05], SRMR = 0.05), respectively). The effect size Pm refers to the proportion of the total effect that is mediated by one or more variables (“M”), and the effect size of all indirect effects in the model for depressive symptoms was Pm = .80 and for PMH it was Pm = .68. The results support our hypotheses that low education is associated with less psychosocial resources, which in turn serve together with daily hassles as pathways between education and depressive symptoms as well as PMH. Building on these findings, longitudinal studies are necessary to investigate causality. Keywords: Education, Depression, Positive mental health, Mediation analysis, Psychosocial resources, Sense of control, Resilience, Delay discounting, Cultural activities, Daily hassles

BACKGROUND:The present study conducted secondary analyses of a randomized controlled trial to examine the transgenerational relationship between cognitive-behavioral therapy for child Separation Anxiety Disorder (SepAD) and the mental health of parents. Symptoms of anxiety and depression were compared before and after child treatment between parents of children treated for SepAD and parents of healthy children, who did not receive any treatment. METHODS:One hundred and seven children aged 4-14 years with SepAD received one of two cognitive behavioral treatment programs for SepAD (TAFF; TrennungsAngstprogramm Für Familien; English: Separation Anxiety Family Therapy or CC; Coping Cat). Their parents (N = 189; 101 mothers and 88 fathers) were assessed at baseline and post-treatment for symptoms of separation anxiety, general anxiety, and depression. A comparison group of parents (N = 74; 42 mothers and 32 fathers) of 45 children without SepAD, who did not receive any treatment, were also assessed. RESULTS:Results indicated a significant interaction effect between group and time on mothers' depression and separation anxiety, indicating that maternal symptoms of depression and separation anxiety improved in the child treatment condition in comparison to mothers of healthy children. There was no significant improvement in parental pathology levels among fathers of children treated for SepAD. CONCLUSIONS:Treatment for child SepAD may have subsequent positive effects on mothers' own levels of separation anxiety and depression, though the mechanisms are yet unknown. Future studies are needed that test the transgenerational effect of child SepAD treatment on parental mental health as the primary research question.

Abstract. Introduction:. Fear of pain seems to be a key factor in the development and maintenance of chronic pain and pain-related disability. Interoceptive fear conditioning is assumed to constitute an important mechanism in the origins and maintenance of fear of pain. If conditioned stimuli such as internal bodily sensations are repeatedly paired with pain (unconditioned stimulus), they in turn elicit a conditioned fear response, including defence mobilization such as startle modulation and changes in heart rate and electrodermal activity. Research into emotional imagery suggests that defensive responses can also be elicited through imagery of fear scripts. Objectives:. We present 2 novel paradigms adapted from research on anxiety disorders, which allow to test, if perceived or imagined sensations locally proximal to the main pain location trigger heightened defence response mobilization in adolescents with chronic headaches and abdominal pain. Methods:. The provocation paradigm includes the anticipation and provocation of locally proximal and locally distal interoceptive sensations through disorder-specific muscle tensing tasks (tightening the neck or the abdominal muscles). The imagery paradigm includes 3 imagery scripts (standard neutral, standard fear, and disorder-specific). Startle probes are presented in both paradigms. Defence response mobilization is assessed using psychophysiological measures (startle response modulation, skin conductance level, and heart rate), as well as self-reported measures of fear. Perspective:. The paradigms will give insight into the defence response of adolescents with chronic pain, when confronted with or imagining interoceptive sensations. Results may inform the improvement of clinical interventions aimed to decrease fear of bodily sensations such as interoceptive exposure or interoceptive imagery exposure.

Graphical Abstract After decades of proclaimed therapeutic breakthroughs, neither neurobiology nor neuroscience has led to better long‐term outcomes for any of the major mental disorders. This contrasts with the long‐term efficacy of psychosocial interventions and points to the necessity to focus on sustained success, broaden our concept of mental health problems, and resist the temptations of marketing.

BACKGROUND:Difficulties in emotion regulation have been related to psychological and physiological stress responses such as lower mood and lower parasympathetic activation (HF-HRV) under resting condition, but evidence on the potential link to the hypothalamic-pituitary-adrenal (HPA) axis functioning and to physiological stress responses during a stress task is still scarce. The aim of the study was to investigate stress responses in young women when confronted to a daily stressor such as exposure to thin ideals and to understand the role of correlates of self-reported trait-like emotion regulation difficulties (ERD). METHODS:Heart rate variability (HRV) and salivary cortisol data were collected in a sample of 273 young women aged 18-35 with and without mental disorders during a vivid imagination of thin ideals (experimental condition) or landscapes (control condition). Changes in mood states were measured on a visual analogue scale (0-100). Correlates of trait-like ERD were self-reported using the Difficulties in Emotion Regulation Scale (DERS). RESULTS:Participants with higher ERD showed a stronger decline in self-reported mood after vivid imagination of thin ideals compared to participants with lower ERD in the experimental condition but also a stronger increase of positive mood with increasing ERD in the control condition. ERD were not related to baseline HF-HRV or baseline salivary cortisol levels nor to any physiological response during and after the imagination of thin ideals. DISCUSSION AND CONCLUSION:The results corroborate the role of ERD regarding the immediate psychological impact of daily stressors. Exposition to daily stressors in the laboratory results in discrepant psychological and physiological reactivity. Future studies should investigate under what conditions the complex interrelations between immediate and long-term ERD and biological activation are amenable to assessment in a laboratory setting. The additive effects of multiple exposition to stressors, such as thin ideals in daily life, also need to be addressed.

Estudios previos sobre orientaciones de valores tradicionales y modernos encontraron relaciones predictivas mediadas con trastornos mentales particulares. El objetivo de este estudio con muestras procedentes de tres países (Alemania, Rusia y China) es ampliar los resultados indicadores más amplios de salud mental (SM) y dos tipos de mediadores (apoyo social y resiliencia), de acuerdo a la teoría de los valores y la modernización/postmodernización. Se probó en los tres países un path-model con valores tradicionales prediciendo la SM mediada por el apoyo social y valores modernos prediciendo la SM mediada por la resiliencia. Como era de esperar, las orientaciones de valores eran en su mayor parte más fuertes en China, seguido por Rusia y Alemania. Modelos de ecuaciones estructurales apoyaron la hipótesis de la predicción de la SM mediada por las orientaciones de valores en general. La benevolencia de valores tradicionales predice el apoyo social, mientras que el valor autodirección moderna predice la resiliencia. Las orientaciones de valores constituyen una herramienta sensible para describir empíricamente las diferencias interculturales. Los resultados indican que las orientaciones de valores personales son predictores significativos de la SM. El análisis de los valores personales se muestra prometedor en la salud pública transcultural y cuestiones de modernización.

Thought-shape fusion (TSF) describes the experience of body-related cognitive distortions associated with eating disorder (ED) pathology. In the laboratory TSF has been activated by thoughts about fattening/forbidden foods and thin ideals. This study aims at validating a questionnaire to assess the trait susceptibility to TSF (i.e., body-related cognitive distortions) associated with the imagination of thin ideals, and developing an adapted version of the original TSF trait questionnaire, the Thought-Shape Fusion Body Questionnaire (TSF-B). Healthy control women (HC, n = 317) and women diagnosed with subthreshold and clinical EDs (n = 243) completed an online-questionnaire. The factor structure of the TSF-B questionnaire was examined using exploratory (EFA) and subsequent confirmatory factor analysis (CFA). EFA pointed to a two-factor solution, confirmed by CFA. Subscale 1 was named Imagination of thin ideals, containing five items referring to the imagination of female thin ideals. Subscale 2 was named Striving for own thin ideal, with seven items about pursuing/abandoning attempts to reach one’s own thin ideal. The total scale and both subscales showed good convergent validity, excellent reliability, and good ability to discriminate between individuals with subthreshold/clinical EDs and HCs. Results indicate that cognitive distortions are also related to the imagination of thin ideals, and are associated with ED pathology. With two subscales, the TSF-B trait questionnaire appropriately measures this construct. Future studies should clarify whether TSF-B is predictive for the development and course of EDs. Assessing cognitive distortions with the TSF-B questionnaire could improve understanding of EDs and stimulate the development of cognitively oriented interventions. Clinical Trial Registration Number: DRKS-ID: DRKS00005709.

Previous research indicates that body image disturbance is transmitted from mother to daughter via modeling of maternal body-related behaviors and attitudes (indirect transmission) and via maternal body-related feedback (direct transmission). So far, the transmission of body-related attentional biases, which according to cognitive-behavioral theories play a prominent role in the development and maintenance of eating disorders, has not been analyzed. The current eye-tracking study applied the concepts of direct and indirect transmission to body-related attentional biases by examining body-related viewing patterns on self- and other-pictures within mother-daughter dyads.Eye movements of N = 82 participants (n = 41 healthy female adolescents, mean age 15.82 years, SD = 1.80, and their mothers, mean age 47.78 years, SD = 4.52) were recorded while looking at whole-body pictures of themselves and a control peer. Based on fixations on self-defined attractive and unattractive body areas, visual attention bias scores were calculated for mothers and daughters, representing the pattern of body-related attention allocation. Based on mothers' fixations on their own daughter's and the adolescent peer's body, a second visual attention bias score was calculated, reflecting the mothers' viewing pattern on their own daughter.Analysis of variance revealed an attentional bias for self-defined unattractive body areas in adolescents. The girls' visual attention bias score correlated significantly with their mothers' bias score, indicating indirect transmission, and with their mothers' second bias score, indicating direct transmission. Moreover, the girls' bias score correlated significantly with negative body-related feedback from their mothers.Female adolescents show a deficit-oriented attentional bias for one's own and a peer's body. The correlated body-related attention patterns imply that attentional biases might be transmitted directly and indirectly from mothers to daughters. Results underline the potential relevance of maternal influences for the development of body image disturbance in girls and suggest specific family-based approaches for the prevention and treatment of eating disorders.

The objective of this study was to test a time-efficient screening instrument to assess clinically relevant and everyday-life (e.g.,economic,political,personal)anxieties.Furthermore,factors influencing these anxieties, correlations between clinical and everyday anxieties and, for the first time, anxiety during different stages of life were assessed in a representative sample of the general population (N= 2229).Around 30% of the respondents manifested at least one disorder-specific key symptom within one year (women > men), 8% reported severe anxiety symptoms.Two thirds of respondents reported minor everyday anxieties and 5% were strongly impaired, whereby persons with severe clinical symptoms were more frequently affected.A variety of potential influencing factors could be identified. These include,in addition to socioeconomic status, gender, general health, risk-taking and leisure behaviour, also some up to now little investigated possible protective factors,such as everyday-life mental activity. The observed effects are rather small, which, however, given the heterogeneity of the general population seems plausible. Although the correlative design of the study does not allow direct causal conclusions, it can, however, serve as a starting point for experimental intervention studies in the future. Together with time series from repeated representative surveys, we expect these data to provide a better understanding of the processes that underlie everyday-life and clinical anxieties.

BACKGROUND:Social rhythm refers to the regularity with which one engages in social activities throughout the week, and has established links with bipolar disorder, as well as some links with depression and anxiety. The aim of the present study is to examine social rhythm and its relationship to various aspects of health, including physical health, negative mental health, and positive mental health. METHOD:Questionnaire data were obtained from a large-scale multi-national sample of 8095 representative participants from the U.S., Russia, and Germany. RESULTS:Results indicated that social rhythm irregularity is related to increased reporting of health problems, depression, anxiety, and stress. In contrast, greater regularity is related to better overall health state, life satisfaction, and positive mental health. The effects are generally small in size, but hold even when controlling for gender, marital status, education, income, country, and social support. Further, social rhythm means differ across Russia, the U.S., and Germany. Relationships with mental health are present in all three countries, but differ in magnitude. CONCLUSIONS:Social rhythm irregularity is related to mental health in Russia, the U.S., and Germany.