Emotional-associative learning processes such as fear conditioning and extinction are highly relevant to not only the development and maintenance of anxiety disorders (ADs), but also to their treatment. Extinction, as the laboratory analogue to behavioral exposure, is assumed a core process underlying the treatment of ADs. Although exposure-based treatments are highly effective for the average patient suffering from an AD, there remains a gap in treatment efficacy with over one third of patients failing to achieve clinically significant symptom relief. There is ergo a pressing need for intensified research regarding the underlying neural mechanisms of aberrant emotional-associative learning processes and the neurobiological moderators of treatment (non-)response in ADs. The current thesis focuses on different applications of the fundamental principles of fear conditioning and extinction by using two example cases of ADs from two different multicenter trials. First, we targeted alterations in fear acquisition, extinction, and its recall as a function of psychopathology in panic disorder (PD) patients compared to healthy subjects using fMRI. Second, exposure-based therapy and pre-treatment patient characteristics exerting a moderating influence on this essential learning process later on (i.e. treatment outcome) were examined using multimodal functional and structural neuroimaging in spider phobia. We observed aberrations in emotional-associative learning processes in PD patients compared to healthy subjects indicated by an accelerated fear acquisition and an attenuated extinction recall. Furthermore, pre-treatment differences related to defensive, regulatory, attentional, and perceptual processes may exert a moderating influence on treatment outcome to behavioral exposure in spider phobia. Although the current results need further replication, on an integrative meta level, results point to a hyperactive defensive network system and deficient emotion regulation processes (including extinction processes) and top-down control in ADs. This speaks in favor of transdiagnostic deficits in important functional domains in ADs. Deficits in transdiagnostic domains such as emotion regulation processes could be targeted by enhancing extinction learning or by means of promising tools like neurofeedback. The detection of pre-treatment clinical response moderators, for instance via machine learning frameworks, may help in supporting clinical decision making on individually tailored treatment approaches or, respectively, to avoid ineffective treatment and its related financial costs. In the long run, the identification of neurobiological markers which are capable of detecting non-responders a priori represents an ultimate goal.

Epigenetic mechanisms have been proposed to mediate fear extinction in animal models. Here, MAOA methylation was analyzed via direct sequencing of sodium bisulfite-treated DNA extracted from blood cells before and after a 2-week exposure therapy in a sample of n = 28 female patients with acrophobia as well as in n = 28 matched healthy female controls. Clinical response was measured using the Acrophobia Questionnaire and the Attitude Towards Heights Questionnaire. The functional relevance of altered MAOA methylation was investigated by luciferase-based reporter gene assays. MAOA methylation was found to be significantly decreased in patients with acrophobia compared with healthy controls. Furthermore, MAOA methylation levels were shown to significantly increase after treatment and correlate with treatment response as reflected by decreasing Acrophobia Questionnaire/Attitude Towards Heights Questionnaire scores. Functional analyses revealed decreased reporter gene activity in presence of methylated compared with unmethylated pCpGfree_MAOA reporter gene vector constructs. The present proof-of-concept psychotherapy-epigenetic study for the first time suggests functional MAOA methylation changes as a potential epigenetic correlate of treatment response in acrophobia and fosters further investigation into the notion of epigenetic mechanisms underlying fear extinction.

Presence is often considered the most important quale describing the subjective feeling of being in a computer-generated and/or computer-mediated virtual environment. The identification and separation of orthogonal presence components, i.e., the place illusion and the plausibility illusion, has been an accepted theoretical model describing Virtual Reality (VR) experiences for some time. This perspective article challenges this presence-oriented VR theory. First, we argue that a place illusion cannot be the major construct to describe the much wider scope of virtual, augmented, and mixed reality (VR, AR, MR: or XR for short). Second, we argue that there is no plausibility illusion but merely plausibility, and we derive the place illusion caused by the congruent and plausible generation of spatial cues and similarly for all the current model’s so-defined illusions. Finally, we propose congruence and plausibility to become the central essential conditions in a novel theoretical model describing XR experiences and effects.

In dieser Dissertation untersuchten wir die neuronalen Korrelate des Training-Effektes einer auditorischen P300 Gehirn-Computer Schnittstelle mittels fMRI Analyse in einem prä-post Design mit zehn gesunden Testpersonen. Wir wiesen in drei Trainings-sitzungen einen Trainingseffekt in der EEG-Analyse der P300 Welle nach und fanden entsprechende Kontraste in einer prä-post Analyse von fMRI Daten, wobei in allen fünf Sitzungen das gleiche Paradigma verwendet wurde. In der fMRI Analyse fanden wir fol-gende Ergebnisse: in einem Target-/ Nichttarget Kontrast zeigte sich verstärkte Aktivie-rung in Generatorregionen der P300 Welle (temporale und inferiore frontale Regionen) und interessanterweise auch in motorassoziierten Arealen, was höhere kognitiver Pro-zesse wie Aufmerksamkeitslenkung und Arbeitsspeicher widerspiegeln könnte. Der Kon-trast des Trainingseffektes zeigte nach dem Training einen stärkeren Rebound Effekt im Sinne einer verstärkten Aktivierung in Generatorregionen der P300 Welle, was eine ver-besserte Erkennung und Prozessierung von Target-Stimuli reflektieren könnte. Eine Ab-nahme von Aktivierung in frontalen Arealen in diesem Kontrast könnte durch effizientere Abläufe kognitiver Prozesse und des Arbeitsgedächtnis erklärt werden.

Reading skills are among the most important basic skills in society. However, not all readers are able to adequately understand texts or decode individual words. Findings from the Progress in International Reading Literacy Study (PIRLS; German: IGLU) show that about one fifth of fourth graders can only establish coherence at the local level, and in some cases they only have a rudimentary understanding of the text they read (Bremerich-Vos et al., 2017). In addition, these reading deficits persist and have a negative impact on academic and professional success (Jimerson, 1999). Therefore, identifying the causes of these deficits and creating opportunities for interventions at an early stage is an important research objective. The aim of this dissertation was to examine the relationship between the aspects of reading fluency and their influence on reading comprehension. Despite the increasing scientific interest in reading fluency in recent years, a research gap still exists in the relationship between word recognition accuracy and both speed and the relevance of prosodic patterns for reading comprehension. Study 1 investigated whether German fourth graders (N = 826) were required to reach a certain word-recognition accuracy threshold before their word-recognition speed improved. In addition, a sub-sample (n = 170) with a pre-/posttest design was examined to assess the extent that the existing word-recognition accuracy can influence the effects of a syllable-based reading intervention on word-recognition accuracy and word-recognition speed. Results showed that word-recognition speed improved after children achieved a word-recognition accuracy of 71%. A positive intervention effect was also found on word-recognition accuracy for children who were below the 71% threshold before the intervention, whereas the intervention effect on word-recognition speed was positive for all children. However, a positive effect on reading comprehension was only found for children who were above the 71% threshold before the intervention. Study 2 investigated the relationship between word-recognition accuracy threshold and word-recognition speed shown in the first study in a longitudinal design with German students (N = 1,095). Word-recognition accuracy and speed were assessed from the end of Grade 1 to 4, whereas reading comprehension was assessed from the end of Grade 2 to 4. The results showed that the developmental trajectories of word recognition speed and reading comprehension were steeper in children who reached the word-recognition accuracy threshold by the end of the first grade than in children who later reached or had not reached this threshold. In Study 3, recurrence analysis (RQA) was used to extract prosodic patterns from reading recordings of struggling and skilled readers in the second (n = 67) and fourth grade (n = 69) and was used for the classification into struggling and skilled readers. In addition, the classification based on the prosodic patterns from the recurrence quantification analysis was compared with the classification of prosodic features from the manual transcription of the reading recordings. The results showed that second-grade struggling readers have lengthier pauses within or between words and take more time between pauses on average, whereas fourth-grade struggling readers spend more time between recurring stresses and have multiple diverse patterns in pitch and more recurring accents. Although the recurrence analysis had a good goodness of fit and provided additional information about the relationship of prosody with reading comprehension, the model using prosodic features from transcription had a better fit. In summary, the three studies in this dissertation provide four important insights into reading fluency in German. First, a threshold in word-recognition accuracy must be achieved before word-recognition speed improves. Second, the earlier this accuracy level is reached, the greater the gain in word-recognition speed and reading comprehension. Third, the intervention effects of a primary school reading intervention are influenced by the accuracy level. Fourth, although incorrect pauses within or between words play an important role in identifying and describing struggling readers in second grade, the importance of prosodic patterns increases in fourth grade.