@article{NeuederAndreattaPauli2019,
  author    = {Neueder, Dorothea and Andreatta, Marta and Pauli, Paul},
  title     = {Contextual fear conditioning and fear generalization in individuals with panic attacks},
  series = {Frontiers in Behavioral Neuroscience},
  volume    = {13},
  journal   = {Frontiers in Behavioral Neuroscience},
  doi       = {10.3389/fnbeh.2019.00152},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-201318},
  pages     = {152},
  year      = {2019},
  abstract  = {Context conditioning is characterized by unpredictable threat and its generalization may constitute risk factors for panic disorder (PD). Therefore, we examined differences between individuals with panic attacks (PA; N = 21) and healthy controls (HC, N = 22) in contextual learning and context generalization using a virtual reality (VR) paradigm. Successful context conditioning was indicated in both groups by higher arousal, anxiety and contingency ratings, and increased startle responses and skin conductance levels (SCLs) in an anxiety context (CTX+) where an aversive unconditioned stimulus (US) occurred unpredictably vs. a safety context (CTX-). PA compared to HC exhibited increased differential responding to CTX+ vs. CTX- and overgeneralization of contextual anxiety on an evaluative verbal level, but not on a physiological level. We conclude that increased contextual conditioning and contextual generalization may constitute risk factors for PD or agoraphobia contributing to the characteristic avoidance of anxiety contexts and withdrawal to safety contexts and that evaluative cognitive process may play a major role.},
  language  = {en}
}
@article{ShibanDiemerMuelleretal.2017,
  author    = {Shiban, Youssef and Diemer, Julia and M{\"u}ller, Jana and Br{\"u}tting-Schick, Johanna and Pauli, Paul and M{\"u}hlberger, Andreas},
  title     = {Diaphragmatic breathing during virtual reality exposure therapy for aviophobia: functional coping strategy or avoidance behavior? A pilot study},
  series = {BMC Psychiatry},
  volume    = {17},
  journal   = {BMC Psychiatry},
  doi       = {10.1186/s12888-016-1181-2},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-181007},
  pages     = {10},
  year      = {2017},
  abstract  = {Background: Although there is solid evidence for the efficacy of in vivo and virtual reality (VR) exposure therapy for a specific phobia, there is a significant debate over whether techniques promoting distraction or relaxation have impairing or enhancing effects on treatment outcome. In the present pilot study, we investigated the effect of diaphragmatic breathing (DB) as a relaxation technique during VR exposure treatment. Method: Twenty-nine patients with aviophobia were randomly assigned to VR exposure treatment either with or without diaphragmatic breathing (six cycles per minute). Subjective fear ratings, heart rate and skin conductance were assessed as indicators of fear during both the exposure and the test session one week later. Results: The group that experienced VR exposure combined with diaphragmatic breathing showed a higher tendency to effectively overcome the fear of flying. Psychophysiological measures of fear decreased and self-efficacy increased in both groups with no significant difference between the groups. Conclusions: Our findings indicate that diaphragmatic breathing during VR exposure does not interfere with the treatment outcome and may even enhance treatment effects of VR exposure therapy for aviophobic patients.},
  language  = {en}
}
@article{ZieglerEhlisWeberetal.2021,
  author    = {Ziegler, Georg C. and Ehlis, Ann-Christine and Weber, Heike and Vitale, Maria Rosaria and Z{\"o}ller, Johanna E. M. and Ku, Hsing-Ping and Schiele, Miriam A. and K{\"u}rbitz, Laura I. and Romanos, Marcel and Pauli, Paul and Kalisch, Raffael and Zwanzger, Peter and Domschke, Katharina and Fallgatter, Andreas J. and Reif, Andreas and Lesch, Klaus-Peter},
  title     = {A Common CDH13 Variant is Associated with Low Agreeableness and Neural Responses to Working Memory Tasks in ADHD},
  series = {Genes},
  volume    = {12},
  journal   = {Genes},
  number    = {9},
  issn      = {2073-4425},
  doi       = {10.3390/genes12091356},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-245220},
  year      = {2021},
  abstract  = {The cell—cell signaling gene CDH13 is associated with a wide spectrum of neuropsychiatric disorders, including attention-deficit/hyperactivity disorder (ADHD), autism, and major depression. CDH13 regulates axonal outgrowth and synapse formation, substantiating its relevance for neurodevelopmental processes. Several studies support the influence of CDH13 on personality traits, behavior, and executive functions. However, evidence for functional effects of common gene variation in the CDH13 gene in humans is sparse. Therefore, we tested for association of a functional intronic CDH13 SNP rs2199430 with ADHD in a sample of 998 adult patients and 884 healthy controls. The Big Five personality traits were assessed by the NEO-PI-R questionnaire. Assuming that altered neural correlates of working memory and cognitive response inhibition show genotype-dependent alterations, task performance and electroencephalographic event-related potentials were measured by n-back and continuous performance (Go/NoGo) tasks. The rs2199430 genotype was not associated with adult ADHD on the categorical diagnosis level. However, rs2199430 was significantly associated with agreeableness, with minor G allele homozygotes scoring lower than A allele carriers. Whereas task performance was not affected by genotype, a significant heterosis effect limited to the ADHD group was identified for the n-back task. Heterozygotes (AG) exhibited significantly higher N200 amplitudes during both the 1-back and 2-back condition in the central electrode position Cz. Consequently, the common genetic variation of CDH13 is associated with personality traits and impacts neural processing during working memory tasks. Thus, CDH13 might contribute to symptomatic core dysfunctions of social and cognitive impairment in ADHD.},
  language  = {en}
}
@article{KaethnerEidelHaegeetal.2022,
  author    = {K{\"a}thner, Ivo and Eidel, Matthias and H{\"a}ge, Anne-Sophie and Gram, Annika and Pauli, Paul},
  title     = {Observing physicians acting with different levels of empathy modulates later assessed pain tolerance},
  series = {British Journal of Health Psychology},
  volume    = {27},
  journal   = {British Journal of Health Psychology},
  number    = {2},
  doi       = {10.1111/bjhp.12553},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-258368},
  pages     = {434-448},
  year      = {2022},
  abstract  = {Objectives The patient-physician relationship is essential for treatment success. Previous studies demonstrated that physicians who behave empathic in their interaction with patients have a positive effect on health outcomes. In this study, we investigated if the mere perception of physicians as empathic/not empathic modulates pain despite an emotionally neutral interaction with the patients. Methods N = 60 women took part in an experimental study that simulated a clinical interaction. In the paradigm, each participant watched two immersive 360° videos via a head-mounted display from a patient's perspective. The physicians in the videos behaved either empathic or not empathic towards a third person. Importantly, these physicians remained emotionally neutral in the subsequent virtual interaction with the participants. Finally, participants received a controlled, painful pressure stimulus within the narratives of the videos. Results The physicians in the high compared with the low empathy videos were rated as more empathic and more likable, indicating successful experimental manipulation. In spite of later neutral behaviour of physicians, this short observation of physicians' behaviour towards a third person was sufficient to modulate pain tolerance of the participants. Conclusions The finding of this study that the mere observation of physicians' behaviour towards a third person modulates pain, despite a neutral direct interaction with the participants, has important clinical implications. Further, the proposed paradigm enables investigating aspects of patient-physician communication that are difficult to examine in a clinical setting.},
  language  = {en}
}
@article{GenheimerAndreattaAsanetal.2017,
  author    = {Genheimer, Hannah and Andreatta, Marta and Asan, Esther and Pauli, Paul},
  title     = {Reinstatement of contextual conditioned anxiety in virtual reality and the effects of transcutaneous vagus nerve stimulation in humans},
  series = {Scientific Reports},
  volume    = {7},
  journal   = {Scientific Reports},
  number    = {17886},
  doi       = {10.1038/s41598-017-18183-3},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-169892},
  year      = {2017},
  abstract  = {Since exposure therapy for anxiety disorders incorporates extinction of contextual anxiety, relapses may be due to reinstatement processes. Animal research demonstrated more stable extinction memory and less anxiety relapse due to vagus nerve stimulation (VNS). We report a valid human three-day context conditioning, extinction and return of anxiety protocol, which we used to examine effects of transcutaneous VNS (tVNS). Seventy-five healthy participants received electric stimuli (unconditioned stimuli, US) during acquisition (Day1) when guided through one virtual office (anxiety context, CTX+) but never in another (safety context, CTX-). During extinction (Day2), participants received tVNS, sham, or no stimulation and revisited both contexts without US delivery. On Day3, participants received three USs for reinstatement followed by a test phase. Successful acquisition, i.e. startle potentiation, lower valence, higher arousal, anxiety and contingency ratings in CTX+ versus CTX-, the disappearance of these effects during extinction, and successful reinstatement indicate validity of this paradigm. Interestingly, we found generalized reinstatement in startle responses and differential reinstatement in valence ratings. Altogether, our protocol serves as valid conditioning paradigm. Reinstatement effects indicate different anxiety networks underlying physiological versus verbal responses. However, tVNS did neither affect extinction nor reinstatement, which asks for validation and improvement of the stimulation protocol.},
  language  = {en}
}
@article{SchieleReinhardReifetal.2016,
  author    = {Schiele, Miriam A. and Reinhard, Julia and Reif, Andreas and Domschke, Katharina and Romanos, Marcel and Deckert, J{\"u}rgen and Pauli, Paul},
  title     = {Developmental aspects of fear: Comparing the acquisition and generalization of conditioned fear in children and adults},
  series = {Developmental Psychobiology},
  volume    = {58},
  journal   = {Developmental Psychobiology},
  number    = {4},
  doi       = {10.1002/dev.21393},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-189488},
  pages     = {471-481},
  year      = {2016},
  abstract  = {Most research on human fear conditioning and its generalization has focused on adults whereas only little is known about these processes in children. Direct comparisons between child and adult populations are needed to determine developmental risk markers of fear and anxiety. We compared 267 children and 285 adults in a differential fear conditioning paradigm and generalization test. Skin conductance responses (SCR) and ratings of valence and arousal were obtained to indicate fear learning. Both groups displayed robust and similar differential conditioning on subjective and physiological levels. However, children showed heightened fear generalization compared to adults as indexed by higher arousal ratings and SCR to the generalization stimuli. Results indicate overgeneralization of conditioned fear as a developmental correlate of fear learning. The developmental change from a shallow to a steeper generalization gradient is likely related to the maturation of brain structures that modulate efficient discrimination between danger and (ambiguous) safety cues.},
  language  = {en}
}
@article{MadeiraGromerLatoschiketal.2021,
  author    = {Madeira, Octavia and Gromer, Daniel and Latoschik, Marc Erich and Pauli, Paul},
  title     = {Effects of Acrophobic Fear and Trait Anxiety on Human Behavior in a Virtual Elevated Plus-Maze},
  series = {Frontiers in Virtual Reality},
  volume    = {2},
  journal   = {Frontiers in Virtual Reality},
  doi       = {10.3389/frvir.2021.635048},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-258709},
  year      = {2021},
  abstract  = {The Elevated Plus-Maze (EPM) is a well-established apparatus to measure anxiety in rodents, i.e., animals exhibiting an increased relative time spent in the closed vs. the open arms are considered anxious. To examine whether such anxiety-modulated behaviors are conserved in humans, we re-translated this paradigm to a human setting using virtual reality in a Cave Automatic Virtual Environment (CAVE) system. In two studies, we examined whether the EPM exploration behavior of humans is modulated by their trait anxiety and also assessed the individuals' levels of acrophobia (fear of height), claustrophobia (fear of confined spaces), sensation seeking, and the reported anxiety when on the maze. First, we constructed an exact virtual copy of the animal EPM adjusted to human proportions. In analogy to animal EPM studies, participants (N = 30) freely explored the EPM for 5 min. In the second study (N = 61), we redesigned the EPM to make it more human-adapted and to differentiate influences of trait anxiety and acrophobia by introducing various floor textures and lower walls of closed arms to the height of standard handrails. In the first experiment, hierarchical regression analyses of exploration behavior revealed the expected association between open arm avoidance and Trait Anxiety, an even stronger association with acrophobic fear. In the second study, results revealed that acrophobia was associated with avoidance of open arms with mesh-floor texture, whereas for trait anxiety, claustrophobia, and sensation seeking, no effect was detected. Also, subjects' fear rating was moderated by all psychometrics but trait anxiety. In sum, both studies consistently indicate that humans show no general open arm avoidance analogous to rodents and that human EPM behavior is modulated strongest by acrophobic fear, whereas trait anxiety plays a subordinate role. Thus, we conclude that the criteria for cross-species validity are met insufficiently in this case. Despite the exploratory nature, our studies provide in-depth insights into human exploration behavior on the virtual EPM.},
  language  = {en}
}
@article{BraunEvdokimovFranketal.2022,
  author    = {Braun, Alexandra and Evdokimov, Dimitar and Frank, Johanna and Pauli, Paul and Wabel, Thomas and {\"U}{\c{c}}eyler, Nurcan and Sommer, Claudia},
  title     = {Relevance of Religiosity for Coping Strategies and Disability in Patients with Fibromyalgia Syndrome},
  series = {Journal of Religion and Health},
  volume    = {61},
  journal   = {Journal of Religion and Health},
  number    = {1},
  issn      = {1573-6571},
  doi       = {10.1007/s10943-020-01177-3},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-269135},
  pages     = {524-539},
  year      = {2022},
  abstract  = {Coping strategies are essential for the outcome of chronic pain. This study evaluated religiosity in a cohort of patients with fibromyalgia syndrome (FMS), its effect on pain and other symptoms, on coping and FMS-related disability. A total of 102 FMS patients were recruited who filled in questionnaires, a subgroup of 42 patients participated in a face-to-face interview, and data were evaluated by correlation and regression analyses. Few patients were traditionally religious, but the majority believed in a higher existence and described their spirituality as "transcendence conviction". The coping strategy "praying-hoping" and the ASP dimension "religious orientation" (r = 0.5, P < 0.05) showed a significant relationship independent of the grade of religiosity (P < 0.05). A high grade of belief in a higher existence was negatively associated with the choice of ignoring as coping strategy (r = - 0.4, P < 0.05). Mood and affect-related variables had the highest impact on disability (b = 0.5, P < 0.05). In this cohort, the grade of religiosity played a role in the choice of coping strategies, but had no effects on health and mood outcome.},
  language  = {en}
}
@article{KuhnScharfenortSchuemannetal.2016,
  author    = {Kuhn, Manuel and Scharfenort, Robert and Sch{\"u}mann, Dirk and Schiele, Miriam A. and M{\"u}nsterk{\"o}tter, Anna L. and Deckert, J{\"u}rgen and Domschke, Katharina and Haaker, Jan and Kalisch, Raffael and Pauli, Paul and Reif, Andreas and Romanos, Marcel and Zwanzger, Peter and Lonsdorf, Tina B.},
  title     = {Mismatch or allostatic load? Timing of life adversity differentially shapes gray matter volume and anxious temperament},
  series = {Social Cognitive and Affective Neuroscience},
  volume    = {11},
  journal   = {Social Cognitive and Affective Neuroscience},
  number    = {4},
  doi       = {10.1093/scan/nsv137},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-189645},
  pages     = {537-547},
  year      = {2016},
  abstract  = {Traditionally, adversity was defined as the accumulation of environmental events (allostatic load). Recently however, a mismatch between the early and the later (adult) environment (mismatch) has been hypothesized to be critical for disease development, a hypothesis that has not yet been tested explicitly in humans. We explored the impact of timing of life adversity (childhood and past year) on anxiety and depression levels (N = 833) and brain morphology (N = 129). Both remote (childhood) and proximal (recent) adversities were differentially mirrored in morphometric changes in areas critically involved in emotional processing (i.e. amygdala/hippocampus, dorsal anterior cingulate cortex, respectively). The effect of adversity on affect acted in an additive way with no evidence for interactions (mismatch). Structural equation modeling demonstrated a direct effect of adversity on morphometric estimates and anxiety/depression without evidence of brain morphology functioning as a mediator. Our results highlight that adversity manifests as pronounced changes in brain morphometric and affective temperament even though these seem to represent distinct mechanistic pathways. A major goal of future studies should be to define critical time periods for the impact of adversity and strategies for intervening to prevent or reverse the effects of adverse childhood life experiences.},
  language  = {en}
}
@article{HeinGamerGalletal.2021,
  author    = {Hein, Grit and Gamer, Matthias and Gall, Dominik and Gr{\"u}ndahl, Marthe and Domschke, Katharina and Andreatta, Marta and Wieser, Matthias J. and Pauli, Paul},
  title     = {Social cognitive factors outweigh negative emotionality in predicting COVID-19 related safety behaviors},
  series = {Preventive Medicine Reports},
  volume    = {24},
  journal   = {Preventive Medicine Reports},
  doi       = {10.1016/j.pmedr.2021.101559},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-265008},
  year      = {2021},
  abstract  = {Emotion-motivation models propose that behaviors, including health behaviors, should be predicted by the same variables that also predict negative affect since emotional reactions should induce a motivation to avoid threatening situations. In contrast, social cognitive models propose that safety behaviors are predicted by a different set of variables that mainly reflect cognitive and socio-structural aspects. Here, we directly tested these opposing hypotheses in young adults (N = 4134) in the context of COVID-19-related safety behaviors to prevent infections. In each participant, we collected measures of negative affect as well as cognitive and socio-structural variables during the lockdown in the first infection wave in Germany. We found a negative effect of the pandemic on emotional responses. However, this was not the main predictor for young adults' willingness to comply with COVID-19-related safety measures. Instead, individual differences in compliance were mainly predicted by cognitive and socio-structural variables. These results were confirmed in an independent data set. This study shows that individuals scoring high on negative affect during the pandemic are not necessarily more likely to comply with safety regulations. Instead, political measures should focus on cognitive interventions and the societal relevance of the health issue. These findings provide important insights into the basis of health-related concerns and feelings as well as behavioral adaptations.},
  language  = {en}
}