De Psycho-lo No. 58 by ALEP

De Psycholo DI EENZEG ZEITUNG DEI EN ECK EWECH HUET! No. 58

INHALTSVERZEECHNES Virwuert

Presentatioun vum neien Comité 2021/2022

Berichte iwwert eis Aktiviteiten

Visite im Syrdall Schlass

Ancienstreffen

Themeberäich Psychologie am Fokus

Emmer der Nues no Eating Disorders and Media Key Connections and Direction of Interest

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Efficacy and Perceived Effectiveness of Deep Breathing, Guided Imagery, and Progressive Muscle Relaxation in a General Psychiatric Sample Imagery Rescripting: The Value of an Added Positive Emotion Component

Kräizwuerträtsel

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Virwuert Léif Lieserinnen a Lieser, Et ass erëm esou wäit fir eis 58. Editioun vum Psycholo, mat villen neien Themen, Berichter an interessant Artikelen! Fir d’éischt presentéieren mir iech déi néi Comitésmemberen 2021/2022, dono hunn mir fir iech zwee Resuméen. Eng Kéier een Resuméen iwwer d‘ Ancienstreffen an eng Kéier een iwwert Visitt am Syrdall Schlass. Uschléissend hu mir iech ee Artikel virbereet, deen sech op d’Thema olfaktoresch Wahrnehmung an d'Sprechwuert "eng Persoun net richen kennen!" baséiert. Dann hunn mir nach eng interessant Hausaarbecht fir iech, déi op den Zesummenhang tëscht den Medien an Iessstéierungen ageet. Dono kritt dir nach ee klengen Abléck an zwou Masteraarbechten iwwert d’Themen „Efficacy and Perceived Effectiveness of Deep Breathing, Guided Imagery, and Progressive Muscle Relaxation in a General Psychiatric Sample” an „Imagery Rescripting: The Value of an Added Positive Emotion Component“ Ofschléissend fannt dir nach ee Kräizwuerträtsel, den dir onbedéngt probéieren sollt, well mir verlousen un den Gewënner een Springerbuch! Mir hoffen, dass dir iech bëssen inspiréiere kennt a vill Spaass beim Liesen hutt! Mir wënschen all eise Memberen eng schéi Vakanz a bléift gesond.

Claire Gend ChefRedactrice

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ALEPComité 20212022 Kim VASILIJEVIC

Vorstandsposten: Präsidentin Studiert an der Universität: Universität Luxemburg (Bachelor) So könnte ich mir gut vorstellen später zu arbeiten: Forschung Dieses PsychologenVorurteil kann ich nicht mehr hören: "Wieso gehst du zum Psychologen, bist du etwa verrückt?" "Psychologie ist keine anerkannte Wissenschaft!" Wenn ich nochmal Ersti wäre, würde ich... mir weniger Stress machen. Der eigene Weg ergibt sich im Laufe der Zeit.

Louis THILL Vorstandsposten: VicePresident, EventManagement Studiert an der Universität: TU Dresden (Master) So könnte ich mir gut vorstellen später zu arbeiten: Forschung im Bereich der biologischen Psychologie oder der kognitiven Neurowissenschaften und gleichzeitig Psychotherapie Dieses PsychologenVorurteil kann ich nicht mehr hören: Wenn ich nochmal Ersti wäre, würde ich... früher anfangen, mich nicht mehr mit anderen über ihre Lernzeiten während des Semesters und Lerninhalte vor der Klausur zu unterhalten

Leila MUHOVIC Vorstandsposten: Sekretärin Studiert an der Universität: Universität Luxemburg (Bachelor) So könnte ich mir gut vorstellen später zu arbeiten: Kriminalpsychologin Dieses PsychologenVorurteil kann ich nicht mehr hören: "Kannst du meine Gedanken lesen?" Wenn ich nochmal Ersti wäre, würde ich... viel mehr vom Studentenleben profitieren, da dies wegen der Pandemie nicht möglich gewesen ist

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Thierry Aumer Vorstandsposten: Trésorier & EventManagement Studiert an der Universität: Universität Luxemburg (Bachelor) SportManagement Bachelor Absolvent: Deutsche Sporthochschule Köln. So könnte ich mir gut vorstellen später zu arbeiten: Selbstständiger Psychologe & Unternehmer Dieses PsychologenVorurteil kann ich nicht mehr hören: “Ahh du wirst Psychologe, dann muss ich jetzt aufpassen wie ich mich benehme.” Wenn ich nochmal Ersti wäre, würde ich... viel früher so viel wie möglich versuchen praktische Erfahrungen zu sammeln und mir erlauben mehr zu wagen und somit meinen Weg zu finden und zu leben. Claire GEND Vorstandsposten: ChefRedactrice Psycholo Studiert an der Universität: Universität Luxemburg (Bachelor) So könnte ich mir gut vorstellen später zu arbeiten: Im Bereich der klinischen Psychologie Dieses PsychologenVorurteil kann ich nicht mehr hören: "Dann kannst du ja jetzt in meinen Kopf hinein schauen" Wenn ich nochmal Ersti wäre, würde ich... mich weniger stressen und mehr das Studentenleben genießen.

Tony WERNECKE Vorstandsposten: Webmaster, Responsable Social Media Studiert an der Universität: Université Libre de Bruxelles (Bachelor) So könnte ich mir gut vorstellen später zu arbeiten: als Psychotherapeut oder auch als Polizeipsychologe zu arbeiten Dieses PsychologenVorurteil kann ich nicht mehr hören: Wir hätten selbst einen Knacks. Wenn ich nochmal Ersti wäre, würde ich... weniger Unterrichtsstoff auf “später” verschieben.

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De Psycholo No. 58 2021/22 Marie CASTEL Vorstandsposten: Responsable Social Media Studiert an der Universität: Université Libre de Bruxelles (Master) So könnte ich mir gut vorstellen später zu arbeiten: Gesundheits Psychologin Dieses PsychologenVorurteil kann ich nicht mehr hören: « Was ist meine Diagnose? » Wenn ich nochmal Ersti wäre, würde ich... Mich von Anfang an mehr im Psychologischen Bereich betätigen

Melissa AMAREL DA SILVA Vorstandsposten: EventManagement, Projektleiter Letz Mind Studiert an der Universität: Université Libre de Bruxelles (Master) So könnte ich mir gut vorstellen später zu arbeiten: Familientherapie Schulpsychologie Dieses PsychologenVorurteil kann ich nicht mehr hören: „Dann muss ich ja jetzt aufpassen, was ich sage“ Wenn ich nochmal Ersti wäre, würde ich... mir weniger Stress machen und mehr vom Studentenleben genießen

Mandy MARQUES Vorstandsposten: EventManagement, Prokektleiterin Letz Mind Studiert an der Universität: Université Libre de Bruxelles (Master en sciences psychologiques, à finalité Psychologie clinique et Psychopathologie) So könnte ich mir gut vorstellen später zu arbeiten: Als Psychologin für Kinder & Jugendliche oder im forensischen Bereich (z.B. Polizei, Gefängnis, soziojuristisches Umfeld, usw.) Dieses PsychologenVorurteil kann ich nicht mehr hören: “Was studierst du?” “Psychologie” “Uh dann analysierst du mich jetzt gerade bestimmt! ” Wenn ich nochmal Ersti wäre, würde ich... würde ich mit mehr Ruhe an das Studium rangehen und weniger auf andere Menschen hören.

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Joanna KRUPP Vorstandsposten: ViceMember Representative EFPSA (European Federation of Psychology Student Associations) Studiert an der Universität: Universität Luxemburg (Bachelor) So könnte ich mir gut vorstellen später zu arbeiten: Yogatherapie/ Coaching oder Ähnliches würde ich sehr gerne zum Beispiel für Kinder und Jugendliche anbieten Dieses PsychologenVorurteil kann ich nicht mehr hören: Jetzt analysierst du mich bestimmt gerade und kannst mich durchschauen. Wenn ich nochmal Ersti wäre, würde ich... auf jeden Fall anfangen Kaffee zu trinken

Charlie DUSKE Vorstandsposten: Member Representative EFPSA (European Federation of Psychology Student Associations) Studiert an der Universität: Universität Luxemburg (Master) So könnte ich mir gut vorstellen später zu arbeiten: Psychotherapeutin Dieses PsychologenVorurteil kann ich nicht mehr hören: dass wir alle Gedankenlesen können und dass wir genauso im Privatleben sind wie im Beruf Wenn ich nochmal Ersti wäre, würde ich... weniger Angst vor dem Versagen haben und mehr das Studentenleben genießen

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Berichter iwwert eis Aktivitéiten

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ALEP Visite im Syrdall Schlass 2. Juli 2021 Wie ist das Zentrum aufgebaut? Das Centre Hospitalier NeuroPsychiatrique (CHNP) besteht aus drei Teilen: De Park (für geistig behinderte Menschen), Pontalize (für ältere Menschen) und Rehaklinik (für Suchterkrankte). Das sich im Syrdall Schlass befindende Centre thérapeutique Manternach ist Teil der Rehaklinik mit der einzigen stationären Drogentherapie in ganz Luxemburg mit einer Aufnahmekapazität von 25 Leuten und genauso großer Warteliste. Dies hat zu Folge, dass man erst ein Zulassungsdatum erhält, wenn ein anderer Patient z.B. innerhalb von zwei Monaten seine Therapie beendet hat und wenn man regelmäßig bei d’alternativ Berodungsstell meldet, dass man noch auf der Warteliste stehen möchte, sowie einen körperlichenEntzug hinter sich hat. Dadurch, dass die Warteliste so lang ist und es ca. 2000 Risikokonsumenten gibt,wird auch empfohlen sich bei anderen Organisationen wie z.B. Service Impuls oder Quai57 zu melden. Nach einem Aufenthalt im Syrdall Schlass besteht auch noch die Möglichkeit in ein betreutes Wohnen zur Nachsorge untergebracht zu werden. Zielgruppe? Erwachsene Drogenkonsumenten, einschließlich Paaren und Eltern von Kindern zwischen 0 und 12 Jahren. Für letztere gibt es jederzeit drei Plätze, damit Eltern und Kinder nicht getrennt sind (MutterKindProjekt). Wenn eine Mutter während der Schwangerschaft (Drogen) konsumiert hat, kommt das Kind nach der Entbindung für einen „Entzug“ zunächst in die Kinderklinik, darf aber direkt danach wieder zur Mutter ins Syrdall Schlass. Hier werden alle Arten von Abhängigkeiten behandelt, wobei Kokain, Heroin und Mischungen heute sehr beliebt sind. Momentan befinden sich vor allem Männer in Behandlung, wobei die Frauenquote aber auch zu steigen beginnt. Man muss für die Aufnahme in Luxemburg ansässig sein oder

eine luxemburgische Identifikationsnummer besitzen. Wer agiert im Zentrum? Das multidisziplinäre Team des Zentrums besteht aus 25 Mitarbeitern, darunter PsychologInnen, MedizinerInnen, KrankenpflegerInnen, SozialarbeiterInnen, SekretärInnen, Personal für die Arbeitsateliers, ErgotherapeutInnen, SporttherapeutInnen, PsychomotorikerInnen, MusiktherapeutInnen und einem/r PsychiaterIn, der/die drei Mal die Woche kommt. Syrdall Schlass arbeitet aber auch eng mit Abrigado zusammen, die sogenannte „Fixerstuff“, in welcher Menschen mit Abhängigkeit in einer sicheren, sauberen und ruhigen Umgebung legal konsumieren dürfen. Therapien werden mittlerweile auf Deutsch und Französisch, aber auch Portugiesisch angeboten. Wie sieht der Alltag eines Patienten aus? Jeder Patient hat am Anfang vier Bezugspersonen: Eine Pflegeperson, eine/n TherapeutIn, eine/n SozialarbeiterIn und einen Buddy (Patient der schon länger im Zentrum ist). Das Programm besteht aus einer vierstündigen Arbeitstherapie am Morgen (z.B. Garten, Tierbereich, Schreinerei, Küche, Ergotherapie, Fitness und Freizeitaktivitäten) und Sport sowie Individual und Gruppentherapie am Nachmittag. Einmal die Woche wird besprochen in welchen Gruppen man sich in der kommenden Woche befinden wird. Die Gruppentherapien bestehen zum einen aus „groupes de parole“, in denen freie Themenwahl herrscht, aber auch aus themenspezifischen Gruppen (z.B. Umgang mit Gefühlen, Rückfallprävention, MutterKind, Aufbau von Selbstbewusstsein und wirksamkeit).

11 De Psycholo No. 58 2021/22 Wie sieht das Therapieangebot aus? Nach einer Anamnese verläuft die Ersttherapie in drei Phasen: Zunächst soll vier Wochen lang an der MOTIVATION des Patienten gearbeitet werden, indem der Kontakt nach draußen isoliert wird (keine Telefongespräche oder Besuch außer von den eigenen Kindern). Somit soll verhindert werden, dass man in alte Gewohnheiten zurückverfällt. Dann wird ein multidisziplinärer therapeutischer PLAN ausgearbeitet, der individuell an den Patienten angepasst wird. Hierbei wird u.a. festgemacht wie der Patient seinen Alltag am besten füllen kann, welche Ziele in der Therapie erreicht werden möchten und welchen Beruf er ausüben kann, um ggf. Schulden zu begleichen. Hierbei wird v.a. systemisch und kognitivbehavioral (z.B. acceptancecommitment therapy) gearbeitet. Alle paar Wochen wird über die Zielerreichung reflektiert und neue Ziele werden festgesetzt. In der LETZTEN Phase der Therapie wird eine Arbeit und Wohnung mit dem Patienten gesucht, wo u.a. ein betreutes Wohnen angeboten wird, bei dem ErzieherInnen regelmäßig Supervision leisten (z.B. mit Drogenscreenings). Es ist noch bis zu drei Monate nach der Therapie möglich,Nachgespräche mit einem Psychologen der Einrichtung zu haben. Es ist zudem möglich, eine mehrmonatige Behandlung im Ausland zu absolvieren, doch fehlt es oft an einer Nachbetreuung, wenn die Betroffenen nicht zur Reintegration nach Syrdall Schlass kommen, sondern in ihr altes dysfunktionales Leben zurückkehren. Welche Überkreuzungen mit anderen Störungsbildern gibt es? Man soll sich als PsychologIn bewusst sein, dass man mit viel Leid konfrontiert wird. Bei etwa 80 % der Patienten kann davon ausgegangen werden, dass die PTBS durch Erfahrungen mit sexueller Gewalt verursacht wird (laut Aussage der Expertin). Im Falle einer Doppeldiagnose sollte daher geprüft werden, ob die Sucht die Hauptdiagnose oder ein Symptom einer anderen Störung ist. Trotz einer Suchttherapie werden 70% der Patienten rückfällig, weil sie zu ihren alten

De Psycholo No. 58 2021/2212 Gewohnheiten und Bekanntschaften zurückkehren, für die sie sich oft schämen. Es ist daher die Aufgabe der Psychologen, die Menschen zu motivieren, wieder am Programm teilzunehmen, damit sie lernen, dass ein Rückfall nicht ausgeschlossen ist. Ziel ist es, einen möglichst stabilen Zustand aufrechtzuerhalten und eine Tagesstruktur aufzubauen, weshalb am Ende der Therapie gemeinsam mit dem Patienten ein Notfallkoffer erstellt wird, um einen Rückfall zu verhindern. Dieser Fall besteht aus allen möglichen "Gründen", warum man nicht rückfällig werden will (z. B. Fotos von wichtigen Bezugspersonen oder ein Foto von sich selbst, wie man im schlechten Zustand aussah). Manchmal ist es nach einer Stabilisierung erforderlich, psychotische Fälle an das CHNP zu überweisen, wo die Patienten eine angepasste Therapie erhalten können (aber auch bei Borderline oder Angststörungen). Darüber hinaus sind kognitive Probleme oft eine Folge des Drogenkonsums. In diesem Fall führen die Neuropsychologen der CHNP Reha diagnostische Tests durch (z. B. ADHS/ Intelligenz oder Konzentrationstests), damit eine gezieltere Behandlung durchgeführt werden kann. Wer bezahlt die Therapie? Da die Patienten motiviert werden müssen, Hilfe in Anspruch zu nehmen, und in der Regel kein Geld zur Verfügung haben, übernehmen die CNS, aber auch das Gesundheitsministerium oder andere Vereinigungen (Suchtverband, Anonym Glécksspiller, Jugendan Drogen Hëllef) einen Teil der Kosten. Es ist jedoch noch nicht geklärt, wer für "ältere" Patienten und Mütter mit Kindern zahlt. Welche Fälle sind der Expertin am meisten in Erinnerung geblieben? Eine Patientin mit einer BorderlineDiagnose wurde sieben Monate lang im Syrdall Schlass behandelt, entlassen und kehrte dann ein Jahr später mit einer Psychose und einem Kind zurück. Nach einer langen Behandlung wurde sie zu einer vorbildlichen Patientin, die

13 De Psycholo No. 58 2021/22 enorme Kompetenzen erworben hat und gerne zur Gruppentherapie gerufen wird, um über ihre Veränderung zu sprechen. Negativ in Erinnerung geblieben ist die Aufnahme eines Paares mit einem zwei Monate alten Kind in Syrdall Schlass, bei dem der Vater die Behandlung nach zehn Monaten abbrach und die Mutter bald darauf das Gleiche tat. Das Kind wurde zurückgelassen und musste in ein Kinderheim gebracht werden. Wie reagieren Kinder, dass sie eine Weile mit ihren Eltern im Syrdall Schlass leben müssen? Einige Kinder sind damit einverstanden, mit ihren Eltern in Syrdall Schlass zu leben, andere nicht. Im letzteren Fall wird dem Kind in angemessener Weise erklärt, dass der Elternteil krank ist und daher die Hilfe anderer Erwachsener benötigt, um zu genesen. Kinder merken oft, wenn es ihren Eltern wieder schlechter geht und sind dann enttäuscht, was die Eltern in der Regel dazu motiviert, die Behandlung fortzusetzen. ____________________________________ Kim Vasiljevic Universität Luxemburg kim.vasiljevic@alep.lu

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Ancienstreffen Wéi all Joer nees geplangt, huet d’ALEP den 18. September am da Vinci an der Staat een Ancienstreffe lancéiert, bei dem al an néi Comitésmemberen sech getraff hunn. Sou konnte fréier Memberen héiere wéi et der ALEP geet a vun hire néie Projeten héieren an néi Memberen erfuere wéi d’ALEP fréier ausgesinn huet a wéi se iwwerhaapt gegrënnt gouf. Esou hunn néier och gesinn, wat fir Beruffer eemoleg Memberen elo hunn a wat d'ALEP hinne bruecht huet.

Virum Treffe gouf et awer nach een Teambonding vum bestoendem Comité am Bella Napoli an der Staat fir déi geschwënn oftrieden Memberen ze verabschiden an déi néi ze begréissen.

____________________________________ Kim Vasiljevic Universität Luxemburg kim.vasiljevic@alep.lu

De Psycholo No. 58 2021/22

Themenberäich Psychologie am Fokus

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Emmer der Nues no

Eng Persoun net richen kennen! Bei dësem Saatz denkt een un éischter Linn wuel net un eng Anosmie, mee un d’Spréchwuert, datt een eng Persoun net ausstoen kann. Mee firwat soen mir dat iwwerhaapt? Gett et tatsächlech en Zesummenhang tescht eisem Gerochssënn an tëschemënschlechen Situatiounen? Oder ass et awer just e Spréchwuert ouni groussen Hannergrond? An der Reegel begéint een déi sougenannt olfaktoresch Wahrnehmung, dei dem Gerochssënn zouzeuerdnen ass, net oder just ganz kuerz am PsychologieBachelor. D’ass och villes iwwert de Gerochssënn an seng Bedeitung nach net sou richteg gewosst. Dat leit dorun, datt d’olfaktoresch Wahrnehmung laang vernoléissegt ginn ass (Cantone et al., 2017). Dësen Fait ass engersäits op d’Iwwerzeegung zréckféieren, datt de Gerochssënn beim Mënsch verkëmmert soll sinn (McGann, 2017) an anerersäits dorop, datt dat Visuellt am Zentrum vun eiser Opmierksamkeet steet (Köster, 2009). An den leschten Joren hunn sech Fuerscher an Fuerscherinnen awer méi mam Gerochssënn an der olfaktorescher Wahrnehmung beschäftegt. Besonnesch den Afloss op Tëschemënschleches stoung dobäi am Fokus (Stevenson, 2009). Och an der klinescher Praxis spillt d’olfaktoresch Wahrnehmung an Tëschenzäit eng Roll. Zum Beispill ass fonnt ginn, datt sech bei Patienten an Patientinnen mat Parkinson beanträchtegt Richfertegkeeten, schonn befiert sech Parkinson iwwerhaapt klinesch bemierkbar mëscht, weisen an datt olfaktoresch Tester och bei der Differentialdiagnostik hëllefen (Herting et al., 2008; Katzenschlager & Lees, 2004). Fir ze verstoen, wei de Gerochssënn eng Roll bei eisem Erliewen an Verhalen spillen kann, muss een sech mat de biologeschen Grondlagen auserneesetzen. Den nächsten Ofschnëtt soll en graffen Iwwerbléck iwwert des vermëttelen.

Allgemeng gehéiert de Gerochssënn zu den chemeschen Sënner an ass domat een vun deenen eelsten Sënner (Cantone et al., 2017). Dobäi huelen mir Moleküller aus der Loft iwwer eis Nueslächer op, déi sech dann un speziell Rezeptormoleküller vun bipolaren Nervenzellen am Riechepithel (Birbaumer & Schmidt, 2010) bannen. Dobäi ginn dann déi ursprénglech chemesch Signaler an Aktiounspotenzialer ëmgewandelt, die sech dann iwwer d’Axonen vun dësen Nervenzellen weider ausbreeden (Birbaumer & Schmidt, 2010). No dem Riechepithel vereenegen sech des Axonen ze Bündelen, déi een dann als Fila Olfactoria bezeechent (Birbaumer & Schmidt, 2010). Di éischt Statioun am Gehier vun dësen ass de Bulbus olfactorius, deen relativ weit vir am Kapp leit (Birbaumer & Schmidt, 2010). Als Deel vum Paläokortex gëtt de Bulbus olfactorius och als primären olfaktoreschen Kortex bezeechent (Albrecht & Wiesmann, 2006). Heibäi kennt et zu enger wichteger Etapp an der Veraarbechtung vun olfaktoreschen Signaler an zwar weist sech am Bulbus olfactorius eng héisch Konvergenz (Albrecht & Wiesmann, 2006). Duerch dësen Iwwergang vu villen Neuronen op eng däitlech méi kleng Unzuel un Mitralzellen gëtt eis Sensitivitéit fir méi geréng Konzentratiounen vun Duftstoffen erhéicht (Albrecht & Wiesmann, 2006). No dem primären olfaktoreschen Kortex gëtt et och e sekundären mat direktem Input an en tertiären olfaktoreschen Kortex mat indirektem Input aus dem Bulbus olfactorius (Albrecht & Wiesmann, 2006). Des héisch Konnektiviteit ass och eng vun de Grondlagen, firwat een dovun ausgeet, datt de Gerochssënn vläicht awer eng méi grouss Roll spillen kéint, wei een laang gemengt huet. Beispiller fir Hierregiounen, dei Input aus dem Bulbus olfactorius kréien sinn de

De Psycholo No. 58 2021/22 piriforme Kortex an d’Amygdala (Albrecht & Wiesmann, 2006). Besonnesch bei der Amygdala dierft bei där eng oder anerer Persoun lo eppes afalen: Emotiounen! D’Amygdala spillt eng zentral Roll bei der Veraarbechtung vun emotionalen Stimuli an dem Erliewen vun Emotiounen, besonnesch der Fuerscht (engl. Fear; Koscik & Tranel, 2011). Op indirektem Wee erhalen awer zum Beispill och den Hippocampus, den Orbitofrontalen Kortex (OFC), den Thalamus, Deeler vum Hypothalamus sou wei och d’Insula Input aus dem Bulbus olfactorius (Albrecht & Wiesmann, 2006). De Gerochssënn steet folglech am Zesummenhang mat villen Hierregiounen, déi bei zentralen psychologeschen Systemer wei bei den Emotiounen [z.B. Amygdala (Davis, 1997)] oder dem Gedächtnis [z.B. Hippocampus (Squire, 1992)] eng wichteg Roll spillen. Dëst ass een vun den Haaptargumenter, déi fir eng wichteg Roll vun der olfaktorescher Wahrnehmung beim Erliewen an Verhalen spillen. Ausgoend vun empireschen Studien huet Stevenson (2009) dobäi dräi zentral Beräicher identifizéiert, bei deenen d’olfaktoresch Wahrnehmung vu Bedeitung ass: d’Opnam vun Nahrung, d’Vermeidung vu Geforen an der Ëmwelt an sozial Kognitiounen. Besonnesch fir de leschte Beräich huet sech d’Fuerschung an den leschten Joren méi interesséiert. Empiresch Studien hunn gewisen, datt de Mënsch scheinbar dozou an der Lag ass, sozial Informatiounen aus dem Kierpergeroch vun engem Géigeniwwer ze gewannen (de Groot & Smeets, 2017). Dozou sollen d’biologesch Geschlecht, den Alter an awer och den gesondheetlechen an emotionalen Zoustand vum Géigeniwwer zielen (Stevenson, 2009). Besonnesch interessant ass dobäi och, datt Emotiounen wei Freet (engl. happiness) oder Fuerscht (engl. fear) am Sënn vun der Emotional Contagion Theory (Hatfield, Cacioppo & Rapson, 1993) iwwer de Kierpergeroch vun enger Persoun op eng Aner iwwerdroen kennen ginn (de Groot & Smeets, 2017).

16 Nieft Kierpergerech kennen awer och net sozial Gerech wei e Feschgeroch oder Menthe en Afloss hunn. Bei netsozialen Gerech ass en Afloss op d’Stëmmung (Smeets & Dijksterhuis, 2014) an op Emotiounen (Glass, Lingg & Heuberger, 2014; VernetMaury, AlaouiIsmaïli, Dittmar, Delhomme & Chanel, 1999) fonnt ginn. Bei Leschterem kann et souguer zu enger entspriechender Reaktioun vum autonomen Nervesystem kommen (Glass et al., 2014; VernetMaury et al., 1999). Dobäi sinn awer interindividuell Ënnerscheeder fonnt ginn, déi op ënnerschiddlech Lernerfahrungen zréckgefouert konnten ginn (Robin, Alaoui Ismaïli, Dittmar & VernetMaury, 1999). Als leschten Input vun dësem Artikel soll en omnipresent Konstrukt ervirgehuewen ginn an zwar d’Vertrauen tescht Mënschen. D’interpersonal Vertrauen huet eng besonnesch Roll an eisem alldeeglechen Liewen an beaflosst besonnesch eis affektiv Reaktiounen an Situatiounen, wou mir vun aneren Mënschen ofhänken (Rusbult, Kumashiro, Coolsen & Kirchner, 2004). Dobäi fërdert et ënner anerem och kooperatiivt Verhalen (Balliet & Van Lange, 2013). Allgemeng erméiglecht eis d’Vertrauen an d’Intentiounen vun enger anerer Persoun et, Ongewessheit an sozialen Situatiounen ze erdroen (Kassebaum, 2004). Trotz der héijer Bedeitung vun interpersonalem Vertrauen ass biswell awer nach éischter wéineg iwwer d‘biologesch Grondlagen bekannt (Kosfeld, Heinrichs, Zak, Fischbacher & Fehr, 2005). Betruecht een awer d’Evidenzlagen zur olfaktorescher Wahrnehmung an dem interpersonalen Vertrauen, sou loossen sech Argumenter fannen, déi fir en Zesummenhang tëscht dësen Béiden schwätzen. Engersäits weisen sech Iwwerlappungen an de biswell bekannten neurobiologeschen Grondlagen. Zum Beispill kritt d’Amygdala direkten Input aus dem Bulbus olfactorius (Albrecht & Wiesmann, 2006) an weist Aktivéierungen bei der

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Präsentatioun vun aversiven Gerech (Zald & Pardo, 1997), weist awer gläichzäiteg och en Zesummenhang tëscht enger Aktivitéitsreduktioun an interpersonalem Vertrauen (Baumgartner, Heinrichs, Vonlanthen, Fischbacher & Fehr, 2008). Eng mat der Amygdala verknëppt ass dobäi och d’Insula (Stein, Simmons, Feinstein & Paulus, 2007), déi vu Bedeitung bei der Veraarbechtung vun olfaktoreschen Informatiounen (Mazzola et al., 2017) an gläichzäiteg Aversioun kodéiert an domat eng Warnfunktioun virun engem potenziellen Trustee erfëllt (Aimone, Houser & Weber, 2014). Läsiounsstudien konnten dobäi och weisen, datt Patienten an Patientinnen mat enger Läsioun vun der Amygdala oder der Insula anormal héisch Vertrauensverhalen weisen (Belfi, Koscik & Tranel, 2015; Koscik & Tranel, 2011). Nieft dësen bestinn awer weider Iwwerlappungen an aneren Hierregiounen wie dem Gyrus Cinguli, dem OFC oder dem Hypothalamus. Anerersäits ass fonnt ginn, datt Kierpergerech, déi an enger Angscht/Stresssituatioun gewonne goufen, ze engem erhéichten Angscht/ Stresserlierwen féieren kennen, wat an enger Studie erklären konnt, firwat Menschen engem virtuellen Charakter manner Vertrauen geschenkt hunn (Quintana, Nolet, Baus & Bouchard, 2019). Des Weideren gouf fonnt, datt och netsozialnetemotional Gerech en Afloss op d‘interpersonal Vertrauen kennen hunn. Dobäi hiewen stimuléirend Gerech wei Menthe scheinbar Differenzen tëscht Persounen ervir, wärend berouegend Gerech wéi Lavendel des zu Gonschten vun engem gemeinsamen Zil an den Hannergrond sollen stellen (Sellaro, Hommel, Rossi Paccani & Colzato, 2015). En éischter kontraintuitiven Befonnt war, datt en onangeneemen Kierpergeroch kooperatiivt Verhalen fërderen kann, sous condition datt déi vertrauensschenkend Persoun dervun iwwerzeegt war, datt déi aner Persoun näischt fir hiren schlechten Kierpergeroch konnt (Camps, Stouten, Tuteleers & van Son, 2014). Dëse Befonnt weist exemplaresch, datt Gerech beim Mënsch keen Release Effekt

(Stimulus féiert ëmmer onweigerlech ze enger bestëmmter Reaktioun) hunn, mee en Priming Effekt auswierken, also e bestëmmt Verhalen méi warscheinlech maachen. Dobäi ass de Mënsch dozou fäeg, dëst Verhalen ze ënnerdrécken an anescht ze handelen. Letztendlech déiten net nëmmen d’Wierkungen vu Gerech op Vertrauen op en Zesummenhang tëscht der olfaktorescher Wahrnehmung an interpersonalem Vertrauen hin, mee och datt en Zesummenhang tëscht de Richfertegkeeten an der Empathie vu Mënschen, déi bei interpersonalem Vertrauen eng Roll spillt, fonnt gouf (Spinella, 2002). kéint awer och d’gläichzäiteg Virleien vun anormalen Richfertegkeeten an anormalem Vertrauensverhalen bei psychiatreschen Stéierungen wéi der Autismus Spektrum Stéierung en Indice fir en Zesummenhang sënn (Maurer, Chambon, BourgeoisGironde, Leboyer & Zalla, 2018; Schecklmann et al., 2013; Tonacci et al., 2017; Yang et al., 2017). Summa Summarum léisst sech also soen, datt et Evidenzen gëtt, déi op eng méi héisch Bedeitung vum Gerochssenn an der olfaktorescher Wahrnehmung fir eis Erliewen an Verhalen wei laang geduecht hiweisen. Besonnesch bei Tëschemënschlechem an sozialen Kognitiounen schéinen se eng Roll ze spillen. Dobäi muss een sech awer bewosst sënn, datt d’Evidenzlag net immens breet ass an et weider Fuerschung brauch, fir d’Ergebnisser ofzesécheren, an déi genau Bedeitung vun der olffaktorescher Wahrnehmung rauszefannen. Och eng méi grouss Standardiséierung an MetaAnalysen wieren wënschenswäert. Trotzdeem schéint et sou ze sinn, datt Gerech an eis Richfertegkeeten bei der Steierung vum Annährungs an Vermeidungsverhalen souwéi dem Vertrauen tëscht Mënschen eng Roll ze spillen schéinen. Insgesamt besteet also Grond zur Annam, datt d’Sprechwieder „ëmmer der Nues no“ an „een net richen

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___________________________________

Louis Thill TU Dresden louis.thill@alep.lu

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Eating Disorders and Media Key Connections and Direction of Interest

Eating Disorders Eating Disorders (ED) belong to one of the most common group of disorders in modern ‘western’ societies, especially when considering Anorexia Nervosa, which is one of the most common eating disorders with a lifetime prevalence of almost 9% (Smink, van Hoeken, & Hoek, 2012; Galmiche et al., 2019). Overall, women tend to be more susceptible to developing an eating disorder with a male lifetime prevalence of 2.2%, although it is important to note that this too may be rising (Harrison & Hefner, 2009). Eating disorders frequently have a difficult prognosis; they are often referred to as being chronic and hard to treat (Miller, 2010); this is further supported by meta analytical results which suggest a relapse rate of up to 30% in inpatient eating disorder clinics (Keel & Brown, 2010). These statistics allow for considerable concern and demonstrate the severity and importance of eating disorders and their treatment. These developments alongside the inarguable severity of eating disorders highlight the importance of finding possible links between the rise of eating disorders and current developments that might affect said rise in frequency. The Rise of Contemporary Interactive Media General media usage has experienced a noticeable increase over the last decades as well, especially among younger generations (Jacobsen & Forste, 2011). Media, such as TVshows and movies offer considerable ground for representations that may or may not influence the selfperception of those consuming content through them (Wilcox & Laird, 2000). More specifically, studies have repeatedly suggested that representations of overly slender women led to perception and

selfesteem issues among women. This trend is further amplified by results from a study by Greenberg and colleagues which found that 30% of American female TVcharacters are portrayed as being underweight which is drastically different when compared to the 5% underweight individuals in real life (Greenberg et al., 2003). However, other media has gained considerable reach over the last couple of years as well. Of the many forms of social media, the platform Instagram is regarded as the social media platform when it comes to appearancefocused activities and subsequent body image concerns (Cohen, NewtonJohn, & Slater, 2017). The Thin Ideal Societal changes have gone hand in hand with changes in media usage and its content. Over the last decades, body ideals seem to have changed considerably. This is reflected by the current ‘thinidealization’ (Harrison & Hefner, 2009), which refers to the societal belief that women who are slender, have a feminine physique and little body fat are more ‘beautiful’ than those who do not fit this ideal. This idealization is further polarized by the general associations made with being either thin or fat. There are two dire problems that the thin ideal brings with it; that women who are socially categorized as ‘fat’ are often shamed (Barron & Hollingsworth, 1989), and that physical ‘beauty’ is equated to a measure of success and worth. This is further shown by how ‘fat’ women are portrayed through media; specifically, Fouts and Burggraf (2000) found that within a study regarding

2133 21 6 6 characters in American television shows, women who were fat were generally depicted as funny, less attractive, were more likely to be insulted, and were more likely to express selfdeprecating sentiments towards themselves (Fouts & Burggraf, 2000). This is significant, as it transmits the message that women who are fat are less worthy of praise and success than those who are not. Additionally, it can be argued that internalizing the thinideal in essence means accepting that certain aspects of one’s physical appearance denote one’s worth. This can have serious negative effects on people, their selfesteem, and thus wellbeing (Vartanian & Dey, 2013). However, the nature of how the thinideal and dissatisfaction or other indicators of selfworth are related is still in the process of being investigated. For example, a study by Vartanian and Dey (2013) suggests that internalizing the thin ideal may play a mediating role in self concept clarity and body dissatisfaction. It is also suggested that selfobjectification can be counteracted through interventions, and that this may change over time (Kroon Van Diest & Perez, 2013), which is very positive as it goes to show that these factors are not necessarily stable within people. Pro Eating Disorder Sites and Social Countering The ‘thin ideal’ shapes general societal expectations and ideals and it also shapes the content that can be found on social platforms. Amongst other things, social media provides users the opportunity to discuss mental health. Within the early 2000’s, sites aimed specifically at discussing and glorifying anorexia nervosa and bulimia nervosa became popular (Harrison & Hefner, 2009). This content also found its way onto modern social media platforms, and is frequently referred to as proana and promia sites or content. Research regarding this content has been undertaken on many platforms: most notably Youtube, Tumblr, Instagram, and Facebook (Branley & Covey, 2017). These media enable their users to create, comment,

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dentify strongly with the group; seeing the disorder as a large part of their own identity (Bates, 2015; Oksanen et al., 2015). As it is the nature of the internet, about anything can be found, and for every movement there is a countermovement. This is also true for the proana and promia content. Content that is referred to as pro recovery content takes all kinds of forms such as sites, forums, channels, accounts, speaks out disapproval of the proana and mia content, highlighting that it does not promote health, and offering alternate reactions to suffering from an eating disorder (Chancellor, Mitra, & De Choudhury, 2016). Prorecovery content provides users and creators with an opportunity to share their stories, struggles, support one another and promote awareness regarding eating disorders (Schott & Langan, 2015; Oksanen et al.,2015; Chancellor, Mitra & Choudhury, 2016). With rising awareness of possibly negative and unrealistic standards and their effects comes positive resistance. This resistance takes many forms but one found on social media is the ‘Body Positivity Movement’. This movement refers to the conscious appreciation of bodies that do not necessarily fit the thinideal. Its aim is to increase awareness of the unrealistic nature of the thinideal, to promote selflove and acceptance, and to increase selfesteem (Lazuka et al., 2020). Although the effects of this movement have not been studied extensively, some research suggests that body positive content may act as a buffer for the exposure to thinidealization via social media (Halliwell, 2013; Andrew, Tiggemann & Clark, 2015). This may be interpreted as being a way through which the possible negative effects which social media bring with them can be counteracted by other effect of social media. An increasing number of consumers use their platforms to talk about and share their own struggles, especially regarding eating

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disorders. In other words, this open communication via social media platforms may have a positive effect on disordered eating behavior; irrespective of an exposure to thinidealizing content. The existence of this content can be interpreted as reflecting the interactive nature of the social media it appears upon. This is an example of the positive opportunities that media bring contemporarily. Being able to express oneself and inspire others for better or worse is a possibility that these media bring with them. Effects on the Consumer Many researchers have dedicated their efforts to understanding the dynamics between modern media, societal ideals and eating disorders. As of now, there is general consensus about a connection between exposures to standardadhering media content and disordered eating. Meta analytical results have consistently linked these constructs; however, the mechanisms through which this connection may exist remain unclear. Hawkins and colleagues (2004) argue that idealized media content may lead to disordered eating behaviors by decreasing body satisfaction, mood states and self esteem. Other research suggests that these effects are moderated through social comparison which is implicitly encouraged on social media platforms (Carrotte, Vella, & Lim, 2015). In addition to these direct and indirect effects, certain vulnerability factors have been identified. Depression, low self esteem, and perfectionism all may act as risk factors in the connection between media content and disordered eating (Perfloff, 2014), as can be seen in Perfloff’s “Transactional Model of Social Media and Body Image Concerns”.

initially expect, as the dynamic seems to be much more complex and interactive. Many variables are expected to have an influence on this development and interaction, with both risk factors and protective factors playing important roles. Summarizing thoughts As has become evident in this paper, there is convincing research suggesting a rather strong connection between social media use and eating disorders. However, there is evidence of positive associations, for example the body positivity movement but also the effects of using social media as a platform for open and honest communication. Despite the lack of research on positive effects, or perhaps because of this lack, social media should not be conclusively seen as a cause of modernday eating disorders as the connections seem to be complex and interactive to an extent that makes proposing an understanding of it seem hopeful at best as of now. Further research is needed in order to investigate this interesting and contemporarily relevant topic. References Andrew, R., Tiggemann, M., & Clark, L. (2015). The protective role of body appreciation against mediainduced body dissatisfaction. Body Image, 15, 98104. https://doi.org/ 10.1016/j.bodyim.2015.07.005 Branley, D. B., & Covey, J. (2017). Proana versus pro recovery: A content analytic comparison of social media users’ communication about eating disorders on Twitter and Tumblr. Frontiers in psychology, 8, 1356. Barron,

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social

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Aylin Yildiz & Charlie Duske Universität Luxemburg aylin.yildiz.001@student.lu charlotte.duske.001@student.uni.lu

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Efficacy and Perceived Effectiveness of Deep Breathing, Guided Imagery, and Progressive Muscle Relaxation in a General Psychiatric Sample Introduction Although stress is seen as adaptive, it can have significant negative consequences when environmental demands consistently and persistently exceed one’s personal resources. Several studies indicate that excessive and chronic stress may play a significant role in the aetiology and maintenance of symptoms in OCD (Adams et al., 2018), substance use disorders and eating disorders (Brewerton, 2014), anxiety and depression (Amutio & Smith, 2007; Morrison & O’Conner, 2005), schizophrenia (Walker et al., 2008), and posttraumatic stress disorder (Ehlers & Clark, 2000). Stress can additionally increase the risk for tissue damage and several physical conditions such as chronic pain, metabolic syndrome, cardiovascular disease, obesity, certain cancers, and neurodegeneration (Slavich & Irwin, 2014). Interestingly, inflammatory components of the immune system that link stress with anxiety and depression may also enable stress to promote physical diseases (Slavich & Irwin, 2014). The implications of this discovery suggest that stress may be associated with both mental and physical health conditions through common underlying pathways. To reduce the risk of developing and worsening psychopathology as well as physical diseases, it appears critical to target the stress response. According to cardiologist Herbert Benson (1983), stress can be counteracted by eliciting the relaxation response (RR). The RR refers to a physiological state marked by a decrease in oxygen consumption, heart rate, respiratory rate, and blood pressure, in turn increasing a sense of wellbeing. The RR is a state that can be elicited by mindbody interventions, i.e., interventions that focus on the relationship between mind and body, and their effect on physical and mental health (Wahebh et al. 2008). Many mindbody interventions

increase relaxation and thus appear to be useful for health conditions with stress as aa contributing factor. Noteworthily, mind–body interventions are often implemented because they have a low physical and emotional risk, cost relatively little, and encourage an active role in treatment. Mindbody interventions encompass, for instance, relaxation techniques, including deep breathing, guided imagery, and progressive muscle relaxation. Deep breathing (DB), also known as diaphragmatic breathing, is a technique rooted in the idea that integrating mind and body produces a state of relaxation (Consolo et al., 2008). The relaxation technique requires individuals to contract their diaphragm through slow inhalations and exhalations, creating a shift from shallow to deep breathing. A quantitative systematic review by Hopper and colleagues (2019) demonstrated the effectiveness of DB in reducing physiological and psychological measures of stress: DB improved biomarkers of respiratory rate and salivary cortisol levels, systolic and diastolic blood pressure, and scores on the stress subscale of the Depression Anxiety Stress Scales21 (DASS 21). Positive effects of DB have also been demonstrated in a multitude of population groups, including presurgical patients (Pardede et al., 2020), patients with diabetes mellitus (Warsono, 2020), hypertensive and prehypertensive individuals (Yau & Loke, 2021), undergraduate nursing students (Ariga, 2019), and healthy adults (Ma et al., 2017). Guided imagery (GI) is a relaxation technique that uses the imagination to create positive mindbody responses (Rossman, 2000). During GI, individuals follow instructions, either delivered by a practitioner or via audiorecording, that guide them in

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imagining pleasant, positive, and safe mental images. Mental images are sensory perceptual experiences that take the form of visual pictures, sounds, smells, tastes or bodily sensations, or a combination of two or more senses (Forunier et al., 2008). For instance, participants could imagine a mental image of a beach and focus on the sound of waves crashing, the smell of salty air, and the feeling of sand between their toes. A growing empirical literature supports the use of GI for managing anxiety, depression, and/or stress in various groups: patients with type 2 diabetes mellitus (Susanti & Ristyawati, 2021), chronic renal failure patients (Biradar & Patil, 2021), patients on hemodialysis (Beizaeeet al., 2018), adult patients and children at pre or postsurgery (Felix et al., 2018; Singh, 2021; Vagnoli et al., 2019), cancer patients undergoing chemotherapy (Mahdizadeh et al., 2019), ICU patients (Hadjibalassi et al., 2018), patients with mood disorders (Apostolo & Kolcaba, 2009), mental health professionals (Kiley et al., 2018), pregnant adolescents (Flynn et al., 2016), and firstyear nursing students (Maghaminejad et al., 2020). Progressive muscle relaxation (PMR) is a dynamic relaxation technique developed by Edmund Jacobson in the 1920s. PMR requires individuals to actively contract different muscle groups to create tension and then to progressively release that tension, repeating the routine until a sense of complete relaxation ensues (Zargarzadeh & Shirazi, 2014). PMR has been shown to be effective in reducing stress, anxiety, and depression, which has been linked to decreases in cortisol levels, blood pressure, heart rate, and muscle tension, when performed regularly (Yildirim & Fadiloglu, 2006). Progressive muscle relaxation has been extensively investigated in numerous samples, including pregnant women (Rajeswari et al., 2020), COVID19 patients (Özlü et al., 2021), dialysis patients (Yildirim & Fadiloglu, 2006), hospitalized patients with leprosy (Ramasamy et al., 2018), cancer patients (Pelekasis et al., 2016), patients undergoing hysterectomy

(Essa et al., 2017), patients with pulmonary arterial hypertension (Yunping et al., 2015), burn patients (Harorani et al., 2020), dental patients (Park et al., 2018), patients with fibromyalgia (Yoo et al., 2021), and veterinary students (Allison et al., 2020). Some studies further investigated relaxation techniques and compared either single or combined effects of various techniques with one another. For instance, Moore and colleagues (2021) investigated combined effects of DP, GI, PMR, mindfulness, physical exercise, aromatherapy, and yoga, but results did not reveal significant changes in test anxiety among nursing students. Another study by Shahriari and colleagues (2017) compared DB, GI, and PMR in elderlies diagnosed with breast or prostate cancer. Results revealed significant improvement in quality of life following a 45min session of either DB, GI, or PMR indicating equal effectiveness. Keptner and colleagues (2020) compared a 5min session of DB, PMR, and two sensory based interventions against each other on anxiety in undergraduate students. All interventions significantly decreased anxiety. Nasiri and colleagues (2018) investigated combined effects of GI and PMR on stress, anxiety, and depression in pregnant women compared to a control group. Results revealed that six sessions of GI and PMR significantly decreased stress, anxiety, and depression. Previous literature has demonstrated good evidence to support the usefulness and effectiveness of DB, GI, and PMR. However, these relaxation techniques have not yet been investigated sidebyside in a study to evaluate their relative effectiveness to reduce stress. Even though relaxation techniques are effective in reducing stress, it remains unclear which technique is the most clinically efficacious one. Moreover, outcome measures oftentimes cover stress, depression, or anxiety, whereas the most direct outcome of interest, i.e., relaxation state, is oftentimes overlooked. Not only are

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measures of relaxation lacking, but it also appears that relaxation techniques have surprisingly almost never been investigated in a psychiatric sample. Furthermore, the literature review suggests that perception of effectiveness has not yet been explored either. Thus, there appears to be a critical need to better distinguish the most effective techniques for increasing relaxation, especially in a psychiatric sample, and to explore patients’ perception of effectiveness. The present study aimed to examine DB, GI, and PMR in a headtohead comparison and investigate whether they differ in clinical efficacy. Based on previous literature, it was hypothesized that DB, GI, and PMR would significantly increase relaxation and reduce stress, but there would be no differences in clinical efficacy, measured by stress and relaxation change scores. Furthermore, the present study is the first study to explore differences in perception of effectiveness of DB, GI, and PMR. Discussion: The present study sought to better understand differential effects of relaxation techniques by comparing three commonly used techniques, namely deep breathing (DB), guided imagery (GI), and progressive muscle relaxation (PMR). First, we aimed to compare the efficacy of DB, GI, and PMR. For this purpose, we analysed differences on change in stress and relaxation scores between DB, GI, and PMR using data of completers, and then extended the analysis by using the total sample (i.e., participants who either completed one, two or all three sessions). Furthermore, we investigated differences between DB, GI, and PMR on reducing stress and increasing relaxation from baseline to followup. Based on previous literature, it was hypothesized that DB, GI, and PMR would not significantly differ from each other on change scores, nor in reducing stress and increasing relaxation across time points. Second, we explored patients’ perception of effectiveness. As there was no previous literature on perceived

effectiveness, we aimed to examine whether differences existed between DB, GI, and PMR in how effectively they were perceived by participants. In accordance with our first hypothesis, DB, GI, and PMR did not significantly differ in their stress change scores. Moreover, an additional analysis showed that every relaxation technique significantly lowered stress from baseline to followup, suggesting equal efficacy between techniques in reducing stress. Even though relaxation techniques were not compared to a control group, previous literature on effectiveness of relaxation techniques allows these findings to support and extend the existing literature, showing that DB, GI, and PMR can help to regulate stress and increase well being. Furthermore, our results extend previous work demonstrating that not only do DB, GI, and PMR alleviate stress in students (Allison et al., 2020; Ariga, 2019; Maghaminejad et al., 2020), healthy adults (Ma et al., 2017), surgery patients (Felix et al., 2018; Pardede et al., 2020; Singh, 2021; Vagnoli et al., 2019), cancer patients (Mahdizadeh et al., 2019; Pelekasis et al., 2016) and other physically ill patients (Biradar & Patil, 2021; Susanti & Ristyawati, 2021; Yunping et al., 2015), but they also reduced stress in a generic psychiatric patient sample. Contrary to our first hypothesis, DB, GI, and PMR differed in their ability to increase relaxation. Whereas relaxation scores of DB and PMR significantly increased from baseline to followup, relaxation scores of GI did not significantly increase from baseline to follow up. Surprisingly, DB, GI, and PMR did not all significantly increase relaxation from baseline to followup, even though they did not differ in relaxation chance scores. The present study was one of the first to investigate efficacy of DB, GI, and PMR with regard to a relaxation outcome. The unexpected finding that GI did not significantly increase relaxation from baseline

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to followup may suggest that stress reduction does not necessarily equal an increase in relaxation. A first possible explanation for GI to significantly reduce stress but not significantly increase relaxation may be that the sample used in this study was too small, causing loss of statistical power. A second explanation may be that there is a flaw in the reasoning that stress reduction equals relaxation increase. Measuring stress is standardised and various physiological and psychological measures of stress exist. However, measures of relaxation are not as standardised and widely used, possibly making it a default practice to use measures of stress for an outcome of interest, that is relaxation. The present study is one of very few to use relaxation as an outcome measure in investigating relaxation techniques, indicating that previous literature left a comprehensive picture of relaxation techniques incomplete. It is unexpected that the most direct outcome of interest, that is relaxation, is oftentimes being overlooked in similar studies. Our findings emphasize the need for future studies to further investigate relaxation techniques, including measures of relaxation to create a comprehensive body of research. The present study is one of only a few that tested the efficacy of DB, GI, and PMR in a headtohead comparison, whereas most studies have often investigated the combined effects of DB, GI, and PMR. For example, in a study by Moore and colleagues (2021), DP, GI, PMR, mindfulness, physical exercise, aromatherapy, and yoga were used concurrently. Even though combining multiple relaxation techniques can create synergistic effects and considerably increase wellbeing compared to any one single technique, such studies cannot investigate differential effects. The present study is also the first to compare DB, GI, and PMR against each other in a general psychiatric population. Previous studies have focusednonpsychiatric populations such as elderly oncology patients, pregnant women, prostate and breast cancer patients, surgery patients, and students

(Keptner et al., 2020; Nasiri et al., 2018; Shahriari et al., 2017; Felix et al., 2018; Pardede et al., 2020; Singh, 2021; Vagnoli et al., 2019; Allison et al., 2020; Ariga, 2019; Maghaminejad et al., 2020). Furthermore, the present study revealed that relaxation techniques can already be effective after a single 15min practice. DB, GI, and PMR decreased stress from baseline to followup after only one session of 15 mins. Similarly, DB and PMR increased relaxation from baseline to followup after only one session of 15 mins. Previous studies have shown the effectiveness of PMR in sessions of 10 to 30 minutes performed over several weeks (Zargarzadeh & Shirazi, 2014), with the shortest practice session being 15 minutes in a single PMR session (Keptner et al., 2021). Similar to PMR sessions, DB has previously been studied in 15min sessions repeated over several weeks (e.g., 20 sessions of 15 mins; Ma et al., 2017) and guided imagery in a single 20 single session or in a 10min session repeated over several times (Felix et al., 2018; Vagnoli et al., 2019). Hence, mind–body interventions such as relaxation techniques should not only be implemented because they have a low physical and emotional risk, cost relatively little, and encourage an active role in treatment, but also because they are quickly increase wellbeing and are time efficient. The present study is also the first one to investigate perceived effectiveness of relaxation techniques, i.e., specifically in a sample of psychiatric patients. Differences in perceived effectiveness between DB, GI, and PMR could not be detected. It is possible that statistically significant differences could not be detected because of several reasons. First, the sample was too small and there was not enough statistical power. Second, there was no control condition and thus information on perceived effectiveness might have been lost in the analyses. Third, perceived effectiveness in the present study was

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assessed based on a 1item Likert scale, which might not be a valid measure of perceived effectiveness or lack sensitivity. Perception of effectiveness could be a crucial factor in how relaxation techniques reduce stress and increase relaxation. Future studies should explore perceived effectiveness in bigger samples and use more sensitive measured of perception. These novel findings must be considered in the context of a number of limitations. First, the present study had a very small sample size due to limited group therapy entry in accordance with COVID19 restrictions. Therefore, the study should be replicated with a bigger sample to gain more insight into efficacy and perceived effectiveness of DB, GI, and PMR. Second, our study focused on only three techniques. Future studies should also include other relaxation techniques, such as mindfulness, autogenic training, and aromatherapy, in a headtohead comparison. Third, our study goes one step further by including both stress and relaxation measures, however future studies could further investigate relaxation techniques using psychological and physiological measures of stress and relaxation. Fourth, we compared DB, GI, and PMR against each other, without using a control group and findings should thus be interpreted carefully. Future studies may need to include a control condition when assessing relaxation techniques sidebyside in an experiment. In conclusion, adding to our general understanding of relaxation techniques, our findings highlight that (1) DB and PMR both increased relaxation from baseline to follow up, whereas GI did not, and (2) all relaxation techniques decreased stress from baseline to followup. However, relaxation techniques did not differ in relaxation or stress change scores. Moreover, interventions did not differ in patients’ perception of effectiveness. Noteworthily, results should be considered carefully as there was a sample size and no control condition. In sum, the present study adds to the current body of research on relaxation techniques as a mindbody

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Robine Mediavilla Maastricht University medi.robi@gmail.com

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Imagery Rescripting: The Value of an Added Positive Emotion Component Introduction: Most people experience a traumatic event during their lifetime (James et al., 2016). The Diagnostic and Statistical Manual of Mental Disorders describes a traumatic event as the “exposure to actual or threatened death, serious injury, or sexual violence” (5th ed.; DSM5; American Psychiatric Association [APA], 2013, pp. 271). Traumatic events can be experienced through direct personal exposure, direct observation, and indirect exposure through a family member or a close friend. Additionally, the DSM5 definition of trauma includes repeated or extreme work related exposure to aversive details or consequences of a traumatic event, as seen in military mortuary workers and forensic child abuse investigators (APA, 2013). Exposure to a traumatic event causes a clinically significant number of people to develop psychological and physiological symptoms, including those of Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD; James et al., 2016). Noteworthily, the estimated lifetime prevalence rates of ASD and PTSD range between 5 and 12% worldwide (Atwoli et al., 2015), with ASD increasing the likelihood of developing PTSD up to 36% (Bryant et al., 2012). The hallmark symptom of ASD and PTSD is the presence of intrusions. The DSM5 defines intrusions as repeated, involuntarily triggered reexperiencing of a traumatic event (APA, 2013). Intrusions can manifest as one or several of the following reexperiencing symptoms: intrusive memories, nightmares, flashbacks, physical reexperiencing, and intense psychological distress at reminders of trauma. Intrusions typically include relatively brief, vivid sensory impressions (e.g., visual images) and/or negative responses, both psychological and physiological, associated with the traumatic event (APA, 2013). Intrusions are oftentimes marked by a sense of nowness, i.e., as if (a part of) the traumatic

event is happening again right now rather than being a memory of the past (Ehlers et al., 2004). For instance, Reemtsma (1997) who was kidnapped and held hostage in a cellar for a month described his intrusive memories as being back in the cellar. Intrusions that are easily triggered, vivid and marked by a sense of nowness can be experienced as extremely distressing (Ehlers et al., 2004). Interestingly, individuals commonly experience intrusions in the initial weeks after a traumatic event and eventually recover as they successfully assimilate and process their trauma memories (Rachman, 2001). However, intrusions persist and become psychopathological when an individual processes the traumatic event in a manner that induces a sense of serious and current threat. The cognitive model of PTSD by Ehlers and Clark (2000) proposes that a sense of threat results from two key processes. The first process is the individual appraisal style of the traumatic event. Unlike individuals who recover, those who develop PTSD and continue to have intrusions seem unable to interpret the trauma as a time limited event that has no global negative consequences for the future. They have developed idiosyncratic negative appraisals of the traumatic event, leading to a sense of threat that can be external (e.g., “the world is a dangerous place”) or commonly internal (e.g., “I attract disaster”, “I am a bad person”). Another factor additionally contributing to this sense of threat is the second key process that relates to the nature of the trauma memory, i.e., how the traumatic event was cognitively encoded. If poorly elaborated and contextualised, trauma memories carry distorted meanings, can be easily triggered,

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and produce a strong sense of nowness. Once activated by these two reciprocating processes, this sense of current and serious threat is followed and subsequently heightened by intrusions, fear, and other negative emotions such anger, guilt, shame, and sadness. To reduce perceived threat and psychological distress, individuals frequently use coping strategies (e.g., safety behaviours, thought suppression, avoidance) that provide relief in the shortterm. However, these strategies prevent changes in the appraisal style and nature of trauma memories, thereby maintaining, and reinforcing intrusions, as shown in Figure 1. Figure 1 Maintenance of Intrusions in PTSD

Note. Adapted from “A Cognitive Model of Posttraumatic Stress Disorder,” by A. Ehlers and D. M. Clark, 2000, Behaviour Research and Therapy, 38(4), p. 321 (https:// doi.org/10.1016/s00057967(99)001230). Copyright 2000 by Elsevier Science Ltd.

One of the therapeutic methods used to treat intrusions is called imagery rescripting (ImRs). ImRs describes a set of imagery techniques that aims to reprocess the negative meanings encapsulated in trauma memories (Arntz, 2012). In this process, the therapist instructs the client to recall the peak emotionally distressing moment of the trauma memory, i.e., the “hot spot”. During this recall, the patient should imagine the memory as vividly as possible, using the five senses to create clear, powerful, and detailed images in the mind. The patient should additionally

y describe the scene in the present tense, as if it is happening right now. Then, the therapist assists the client in rescripting the recalled memory: the client changes the unfolding of events in the trauma memory by imagining a more desirable outcome. Rescripting can lead to different scenarios and may include imagining an alternative ending to the traumatic event, bringing a trusted adultfigure into the scene to protect the victim, or punishing the perpetrator (Stopa, 2011). For instance, a rape victim might rescript her trauma memory in a way that portrays her as successfully defending herself against the assailant. In severe cases of trauma, where the client is unable to imagine any good outcome, the therapist rescripts the memory while the client imagines it (Arntz, 2012). Whether used in combination with other treatments (e.g., CBT) or as a standalone treatment, ImRs is increasingly recognized as a helpful therapeutic technique. ImRs can significantly reduce intrusions, the perceived sense of threat and negative nonfear emotions such as anger, guilt, and shame (Arntz, 2012; Arntz et al., 2007; Hagenaars & Arntz, 2012; Morina et al., 2017; Siegesleitner et al., 2019). Although the underlying mechanisms of ImRs remain largely unknown, two mechanisms, in line with Ehlers and Clark’s cognitive model of PTSD (2000), could be involved. First, ImRs appears to modify an individual’s negative appraisals and significantly alter underlying belief structures (Hackmann, 2011). Addressing problematic appraisals and distressing cognitions of guilt, selfblame, anger, and powerlessness seems to facilitate reprocessing the trauma as timelimited and without global negative consequences for the future (Morina, et al., 2017). Second, ImRs helps to update trauma memories, i.e., to place them in a wider context of previous and subsequent knowledge (Stopa, 2011). Individuals learn to use this contextual

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information to explain the unfolding of the traumatic event, rather than pinning the event to a negative feature of the self (e.g., “I attract disaster”). Thus, directly challenging trauma memories and their engrained negative, distorted meanings appears to be a powerful means to adequately reprocess the trauma. The efficacy and working mechanisms of ImRs aiming to reduce intrusions have been systematically studied using the trauma film paradigm (TFP; James et al., 2016). Short film clips depicting traumatic events (e.g., road accidents, interpersonal violence) are shown to participants within the TFP and have been confirmed to induce shortlived intrusions and negative affect. However, this experimental model eliciting analogue traumarelated reactions has not yet been used to assess positive emotions as a possible working mechanism in ImRs. From a theoretical perspective, the broaden andbuild theory suggests that positive emotions like joy, interest, contentment, and love could have an additive effect within ImRs. In fact, the broadenandbuild theory proposes that positive emotions broaden one’s awareness and thoughtandaction repertoires by encouraging novel, varied and exploratory thoughts and actions, as seen in Figure 2 (Fredrickson, 2004). Over time, these broadened repertoires help to build durable biopsychosocial resources (Garland et al., 2010). For instance, interest about a land area becomes navigational knowledge and a pleasant encounter with a stranger becomes a nurturing friendship. Biopsychosocial resources accumulate over time and subsequently improve the individual’s overall wellbeing. An upward spiral eventually develops because an improved wellbeing generates more positive emotions that in turn further increase well being(Frederickson, 2001). Actively incorporating positive emotions in ImRs may therefore improve recovery from an (analogue) trauma by building new resources and increasing wellbeing.

Figure 2 The BroadenandBuild Model

Note. Adapted

from

“Positive

Emotions”,

Using the TFP, the present study aimed to test experimentally whether adding a positive emotion component to ImRs improved treatment effects in terms of intrusions and affect, compared to the standard ImRs procedure. On grounds of the broadenand build theory, it was hypothesized that ImRs with a positive emotion component (ImRs+) would significantly decrease intrusion frequency, sense of nowness, and distress, increase positive affect, and reduce negative affect compared to ImRs without a positive emotion component (ImRs). With the additional aim to replicate and extend previous findings, it was hypothesized that ImRs+ and ImRs would outperform a no intervention control (NIC) in terms of intrusions and affect. Discussion: The present study investigated differential effects of two variants of imagery rescripting (ImRs), with a positive emotion component (ImRs+) versus without a positive emotion component (ImRs), compared to a no intervention control (NIC) using the trauma film paradigm (TFP). First, we aimed to replicate and extend previous findings on ImRs compared to NIC. It was hypothesized

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that ImRs+ and ImRs would outperform NIC in intrusion frequency, sense of nowness, and distress as well as positive and negative affect. Second, we explored differential effects of the ImRs variants. In ImRs+, participants were encouraged to imagine a joyful activity in addition to the standard ImRs protocol, whereas participants in ImRs were asked to describe a typical day in their life as a control for the additional imagery in ImRs+. If positive emotions are pivotal in increasing resilience against trauma, then ImRs+ should produce more effects on frequency and severity of intrusions, and affect ratings compared to ImRs. It was thus hypothesized that ImRs+ would significantly decrease intrusion frequency and severity, increase positive affect, and reduce negative affect compared to ImRs. Contrary to our hypothesis, conditions did not differ with respect to intrusion frequency and sense of nowness. However, findings showed significant differences between groups in intrusion distress. In fact, participants in ImRs+ showed significantly less distress compared to NIC. However, we could not fully replicate previous results regarding the effects of a standard ImRs protocol compared to NIC (Siegesleitner et al., 2019), given the lack of significant effects of ImRs+ and ImRs compared to NIC on both intrusion frequency and sense of nowness. Additionally, no differential effects of ImRs+ compared to ImRs emerged. The unexpected finding that ImRs+ and ImRs did not significantly differ from NIC on intrusion frequency may indicate a general limitation of the TFP used in this study, namely a floor effect of intrusions. A first possible explanation for the floor effect might be rapid spontaneous recovery of analogue traumarelated intrusions. When evaluating the effect of different ImRs interventions on experimentally induced intrusions, it appears that intrusions decline quickly even in no intervention control groups (e.g., James et al., 2015; Siegesleitner et al., 2019). As a matter et al., 2019). As a matter of fact, examining

the reported frequency of intrusions on a day by day basis indicated that most intrusions occurred before the intervention took place. Within only one day after the intervention, participants in each condition reported, on average, no or only two intrusions, indicating that experimentally induced intrusions declined quickly. In other studies that did report significant effects (e.g., Kunze and colleagues, 2019), ImRs took place on the same day as the exposure to the TFP. Such a floor effect might explain why we could not detect potential effects of ImRs variants on intrusion frequency when compared to NIC. Thus, the results emphasize the need to further improve the TFP for future studies, and to replicate the current study with interventions taking place on day 1. A second possible explanation for floor effects of intrusion frequency but also intrusion severity might be that 14.7% of participants in ImRs+ and 3% in ImRs did not reported any intrusions at all, compared to 0% in NIC. When questioned during follow up, some participants explained that they did not have any intrusions because they regularly watched horror movies or crime documentaries. However, there were no differences between conditions in negative emotions elicited by the trauma film (see 4.2) and intrusion VAS 30 minutes after watching the movie (see 4.1), leaving confounding effects due to insensitivity rather unlikely. Other participants suggested that the movie was old (i.e., from 1975), making it more difficult to imagine being a bystander in the scene or relate to the abused teenagers. Here again, there were no differences between conditions in being distressed while watching the movie (see 4.1), leaving confounding effects due to insensitivity rather unlikely. Future studies may however want to exclude participants who watch horror movies or crime documentaries and use a compilation of reallife clips, depicting, for instance, road traffic accidents, as seen in

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Hagenaars and Arntz (2012). A third reason that might contribute to the failure to replicate previous findings and detect any differential effects of ImRs+ compared to ImRs is the nature of the interventions. ImRs interventions were guided through prerecorded audio intructions to enhance standardization, but this may have reduced the effects of ImRs due to feeling impersonal. Some participants had difficulties when they had to imagine a joyful activity after rescripting the most distressing scene of trauma film, because the transition felt unnatural and sometimes inadequate. Although prerecorded instructions prepared the transition from ImRs to the positive imagery task, the presence of a therapist could have smoothened the transition and better assisted participants in the overall ImRs protocol. In addition, participants knew that they were observed and voicerecorded during ImRs, possibly inducing feelings of unease that caused participants to rush through the task or not rescript the scene in a way that they had actually wanted or needed to do due to social desirability. Moreover, non specific therapeutic effects of NIC could have caused a floor effect. It is not clear to what extent participants used imagery while they listened to an audiotape about trees. Imagining trees or forests could have had a calming effect and induce a sense of peace and comfort. Future studies may use a more neutral and controllable task that would be performed in NIC. Contrary to our hypothesis, we did not find any significant differences between ImRs+ and ImRs compared to NIC on positive and negative affect. In addition, findings failed to show differential effects of ImRs+ compared to ImRs on negative affect. Nevertheless, results showed significant mean differences within ImRs+ on positive affect, with participants reporting significantly higher positive affect at followup, compared to pre intervention. Interestingly, participants in ImRs+ seem to have continued to build positive emotions after the intervention, intervention, to the extent that they

experienced significantly higher positive affect at follow up compared to pre intervention. Compared to ImRs+, ImRs and NIC did not increase positive affect from pre intervention to followup. It is thus conceivable that a positive imagery task induces positive emotions that then continue to increase, in line with the upward spiral of positive emotions described by the broaden andbuild theory. Future studies could use larger samples and longer followup periods to investigate groups differences between ImRs+, ImRs and NIC on positive and negative affect as well as intrusions. The following limitations should be considered when interpreting the present findings. First, we did not assess whether participants used personal coping strategies during the break after the aversive film, which could at least partly have influenced the results. Second, the manipulation check confirmed significant decrease of positive emotions and increase of negative emotions. However, we did not examine what negative emotions were specifically elicited. For instance, disgust was described by Arntz (2012), to be one of the emotions that are not easy to treat with ImRs. Since the trauma film Salo is known to induce high levels of disgust, we might have overlooked effects of ImRs when computing overall negative affect scores instead of looking at different negative affect dimensions. Lastly, even though the experimenter monitored adherence to the instructions during the interventions and used additional prompts to clarify instructions, no formal manipulation check was conducted. In conclusion, adding to our general understanding of ImRs, our findings highlight that (a) ImRs+, ImRs and NIC all decreased intrusion frequency and distress, (b) only ImRs+ produced a stronger decrease in intrusion distress than NIC, and (c) ImRs+ showed significantly higher positive affect at followup compared to preintervention. Previous results on differential effects of ImRs

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compared to NIC on intrusions and affect ratings could thus only be partly replicated in the present study. Moreover, no differences between ImRs+ and ImRs were evident, except for positive affect. The latter may suggest that positive emotions may build personal resources and increase wellbeing within ImRs, in line with the broadenandbuild theory. Noteworthily, results should be considered in light of an analogue experimental design that seems to be limited in its ability to investigate effects on intrusion. frequency and severity due to possible floor effects. In sum, the present study adds to the current body of research on ImRs as a treatment method for intrusions. Despite the limitation of the TFP as used in the present study, the promising effects of ImRs+ strongly encourage that future studies further investigate the role of positive emotions within ImRs and focus on longterm effects of positive affect.

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