Miriam Kampa

Background and aims: Problematic usage of the internet (PUI) refers to maladaptive patterns of specific online activities such as gaming, social networking, online shopping, or pornography use. Building on theoretical frameworks such as the I-PACE model and the incentive-sensitization theory, the present multicenter study ( N = 1,015) examined automatic approach and avoidance tendencies toward internet-related cues. Methods: Using an explicit Approach-Avoidance Task (AAT), reaction times to addiction-related and neutral stimuli were assessed and related to symptom severity, cue reactivity, and outcome expectancies. Results: Across all user groups (non-problematic, risky, pathological), participants displayed relative approach tendencies toward internet-related stimuli, with pathological users showing the strongest differentiation between addiction-related and neutral cues. Associations between approach tendencies and both cue reactivity and gratification were best described as linear, with higher cue reactivity and greater experienced gratification being associated with stronger approach tendencies. For symptom severity, curve estimation analyses provided evidence for significant, albeit weak, quadratic associations, suggesting that at high symptom severity approach as well as avoidance tendencies may occur. Discussion and Conclusions: Overall, these findings indicate that approach tendencies toward internet-related cues increase gradually with reward experiences and cue-reactivity, while at higher levels of symptom severity approach or avoidance responses may be observed suggesting that motivational responses remain heterogeneous. From a clinical perspective, approach–avoidance tendencies may serve as behavioral markers relevant to the development and maintenance of PUI and may help inform individualized prevention and intervention strategies targeting cognitive-motivational processes underlying problematic internet use.

Background and Aims: Most men consume pornography, with a small but significant percentage losing control over their use. Since ICD-11, problematic pornography use can be diagnosed as “compulsive sexual behavior disorder.” Debate persists on whether problematic pornography use is an impulse-control disorder or a behavioral addiction. Mechanisms of learning and memory play a central role in addictive disorders but are presumably less relevant for impulse control disorders. Methods: One hundred thirty-nine heterosexual male users of pornography and gaming participated in our study which was part of a multi-center research project on internet use disorders in Germany. We focus on a subsample of fifty-eight non-problematic ( n = 35) and problematic pornography users ( n = 23, labeled pathological). FMRI data were collected during appetitive conditioning, extinction and recall. Pornographic, game, and money images served as unconditioned stimuli, geometric shapes as conditioned stimuli (CS). Results: During appetitive conditioning pathological pornography users showed a generally stronger response in ventral striatum to all CSs, whereas altered activations in extinction and recall were specific to the porn-associated CS. Greater activations in the dorsal anterior cingulate cortex during extinction and in the medial orbitofrontal cortex during recall suggest persistence of appetitive memory for pornography in pathological users, supported by valence ratings and skin conductance responses (SCR). Sensitization to the monetary cue also emerged in SCR. Discussion and Conclusions: Based on these new neurobiological findings, which are consistent with current addiction theories about stimulus-specific altered reward sensitivity and appetitive memory, we argue that problematic pornography use should be considered a behavioral addiction.

Exposure-based therapy is effective in treating anxiety, but a return of fear in the form of relapse is common. Exposure is based on the extinction of Pavlovian fear conditioning. Both animal and human studies point to increased arousal during immediate compared to delayed extinction (>+24 h), which presumably impairs extinction learning and increases the subsequent return of fear. Impaired extinction learning under arousal might interfere with psychotherapeutic interventions. The aim of the present study was to investigate whether arousal before extinction differs between extinction groups and whether arousal before extinction predicts the return of fear in a later (retention) test. As a highlight, both the time between fear acquisition and extinction (immediate vs. delayed) and the time between extinction and test (early vs. late test) were systematically varied. We performed follow-up analyses on data from 103 young, healthy participants to test the above hypotheses. Subjective arousal ratings and physiological arousal measures of sympathetic and hypothalamic pituitary adrenal axis activation (tonic skin conductance and salivary cortisol) were collected. Increased pre-extinction arousal in the immediate extinction group was only confirmed for subjective arousal. In linear regression analyses, none of the arousal measures predicted a significant return of fear in the different experimental groups. Only when we aggregated across the two test groups, tonic skin conductance at the onset of extinction predicted the return of fear in skin conductance responses. The overall results provide little evidence that pre-extinction arousal affects subsequent extinction learning and memory. In terms of clinical relevance, there is no clear evidence that exposure could be improved by reducing subjective or physiological arousal.

Background and purpose: Many studies have shown that exposure to life events can have a negative impact on mental health. Life events like the death of a spouse or the birth of a child pose a challenge and require temporal or permanent adjustments. Meta‐analyses on brain stress responses found bilateral anterior insula activation in response to acute stress. Fear conditioning is assumed a crucial mechanism for the development of anxiety disorders associated with increased activation in the bilateral amygdala. Empirical evidence is lacking regarding the relationship of exposure to recent life events and past childhood adversity with neural processing during fear conditioning.Methods: In the present study, we analyzed data from 103 young, healthy participants. Multiple linear regressions were performed on functional magnetic resonance imaging activation during fear conditioning with the Life Events Scale for Students and the Childhood Trauma questionnaire included as covariates in two separate models.Results: We found a positive relationship between the number of life events in the last year and left amygdala activation to the conditioned stimulus. A second finding was a positive relationship between childhood adversity and right anterior insula response to the unconditioned stimulus.Conclusions: Many studies have shown increased amygdala activity after stressful life events. In addition, the anterior insula is activated during acute stress. The present study points to stressor‐induced increased salience processing during fear conditioning. We suggest that this could be a potential mechanism for resilience versus mental illness.

Anxiety disorders are effectively treated with exposure therapy based on the extinction of Pavlovian fear conditioning. Animal research indicates that both the timing of extinction and test are important factors to reduce the return of fear. However, empirical evidence in humans is incomplete and inconsistent. In this neuroimaging study, we, therefore, tested 103 young, healthy participants in a 2-factorial between-subjects design with the factors extinction group (immediate, delayed) and test group (+1 day and +7 days). Immediate extinction led to greater retention of fear memory at the beginning of extinction training indicated by increased skin conductance responses. A return of fear was observed in both extinction groups, with a trend toward a greater return of fear in immediate extinction. The return of fear was generally higher in groups with an early test. Neuroimaging results show successful cross-group fear acquisition and retention, as well as activation of the left nucleus accumbens during extinction training. Importantly, the delayed extinction group showed a larger bilateral nucleus accumbens activation during test. This nucleus accumbens finding is discussed in terms of salience, contingency, relief, and prediction error processing. It may imply that the delayed extinction group benefits more from the test as a new learning opportunity.

Background: Repeated or chronic stress is considered a major source of disease, in terms of both somatic and mental illnesses. The prevention of stress-related disease by interventions for relaxation has thus increased societal relevance. In this randomized controlled non-inferiority trial, we will compare a newly developed virtual reality (VR) environment for relaxation to an active control group applying a freely chosen relaxation method. To test if our VR environment supports relaxation in a situation of acute stress, a standardized stress induction protocol will precede the relaxation phase. Methods: One hundred healthy participants will be recruited from the University of Siegen and randomly assigned to the VR or the active control group that will be free to choose their own relaxation strategy. The multi-sensory VR includes visual, acoustic, and haptic features to induce a strong feeling of presence. The laboratory testing will comprise a baseline measurement, a stress induction, a relaxation intervention, and a recovery measurement. The primary outcomes are self-reported stress and relaxation measured with a visual analog scale (VAS) at pre- and post-baseline, at the start, middle, and end of the stress induction, at pre- and post-relaxation, at pre- and post-recovery, and in the evening of testing. Secondary outcomes are the physiological parameters, namely heart rate and heart rate variability, tonic skin conductance level as well as the number of non-specific skin conductance responses, systolic and diastolic blood pressure and respiratory rate recorded during the four experimental phases as well as state mood, and state rumination assessed at four time points (pre- and post-stress, post-relaxation, and in the evening of testing). Finally, post-event processing will be assessed after relaxation and in the evening of testing. Repeated measures ANOVAs will be performed to test for statistical effects of group, time, and group × time interaction. Discussion: The newly developed, multi-sensory VR offers an intervention for relaxation without prior training. Its immersive character might increase efficacy compared to other relaxation methods, especially in situations of acute stress. Future directions could be the development of a mobile version of the VR to enhance accessibility for users. To achieve a transfer of training effects to real life, VR components should successively be eliminated until relaxation is practiced without guidance by the VR. Trial registration: ISRCTN Registry ISRCTN11162338. Retrospectively registered on January 22, 2021

* Background: Repeated or chronic stress is considered a major source of disease, in terms of both somatic and mental illness. The prevention of stress-related disease by interventions for relaxation has thus increasing societal relevance. In this randomized controlled trial, we will compare a newly developed virtual reality (VR) environment for relaxation to an active control group applying a freely chosen relaxation method. To directly test if our VR environment supports relaxation in a situation of acute stress, a standardized stress induction protocol will precede the relaxation phase.* Methods: One hundred healthy participants will be recruited from the University of Siegen and randomly assigned to the VR or the free relaxation group. The multi-sensory VR includes visual, acoustic, and haptic features to induce a strong feeling of presence. The laboratory testing will comprise a baseline measurement, a stress induction, the relaxation intervention, and a recovery measurement. The primary outcomes are self-reported stress and relaxation measured with a visual analogue scale (VAS) at pre and post baseline, at start, middle, and end of the stress induction, at pre and post relaxation, at pre and post recovery, and in the evening of testing. Secondary outcomes are the physiological parameters recorded during the four experimental phases as well as, state mood, and state rumination assessed at four time points (pre and post stress, post relaxation and in the evening of testing). Finally, post event processing will be assessed after relaxation and in the evening of testing. General linear models with repeated measures will be performed to test for statistical effects of group, time and group x time interaction.* Discussion: The newly developed, multi-sensory VR offers an intervention for relaxation without prior training. Its immersive character might increase efficacy compared to other relaxation methods, especially in situations of acute stress. Future directions could be the development of a mobile version of the VR to enhance accessibility for users. To achieve a transfer of training effects to real life, VR components should successively be eliminated until relaxation is practiced without guidance by the VR.* Trial registration: Registered with ISRCTN registry (Trial ID: ISRCTN11162338) on January 22nd 2021.