Steffen Moritz

University of Hamburg, Hamburg, Hamburg, Germany

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Publications (269)722.22 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background and Objectives Semantic network models suggest that individuals with obsessive-compulsive disorder (OCD) process words with multiple meanings (e.g., “knife”) more likely in an OC-related (i.e., “weapon”) than in a neutral way (i.e., “cutlery”). Initial evidence was found in an online study. The aim of the current study was to investigate semantic networks in a clinical sample and particularly to identify whether changes in semantic networks following the add-on intervention association splitting (AS) exceeded changes expected through cognitive behavioral therapy (CBT) alone. Methods An association task was presented to 36 healthy controls and 70 OCD patients over a period of eight weeks with OCD patients receiving CBT and an add-on intervention (randomized allocation to either AS or a computerized cognitive training). Participants were asked to generate up to five associations to standardized (OC-relevant, negative, neutral) and individual cue words. Associations were rated with regard to OC-relevance and valence. Results Analyses revealed that OCD participants produced a) significantly more OC-relevant associations and b) more negative associations than controls for cue words. In the OCD sample, the OC-relevance and valence of associations changed after therapy for personal cue words. This effect was associated with AS at statistical trend level. Limitations No clinical control group was recruited; no inter-rater reliability was assessed for the association task. Conclusions Some evidence for biased associative networks in OCD was found. Associations of individually chosen cue words proved to be modifiable by therapy.
    Journal of Behavior Therapy and Experimental Psychiatry 12/2014; · 2.23 Impact Factor
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    ABSTRACT: An experimental design was used to test whether self-reported, psychophysiological and symptomatic stress-responses increase as a function of the underlying vulnerability to psychosis as proposed by vulnerability-stress-models.Methods Stress-responses of participants with psychotic disorders (PSY, n=35) were compared to those of participants with attenuated positive symptoms (AS, n=29), first-degree relatives of persons with psychotic disorders (REL, n=26), healthy controls (HC, n=28) and controls with depression (DEP, n=30). Using a repeated measures design, participants were assigned to a noise-stressor, a social-stressor and a no stress-condition in random order. Stress-responses were assessed via self-report, salivary cortisol levels, heart rate and skin conductance levels. State-paranoia and depression were assessed with clinical scales.ResultsPSY reported to be significantly more stressed than HC, AS and REL across all conditions which went along with increased heart rate and decreased overall cortisol release. In contrast, AS showed elevated levels of cortisol. PSY showed a stronger response of self-reported stress to the noise-compared to the no stress-condition than HC, but no stronger response than the other samples. Furthermore, the stressors did not trigger stronger psychophysiological responses or symptom-increases in PSY.LimitationsThe stressors were brief and not individualized and did not have an effect on cortisol.Conclusions The findings support the notion that subjective stress-responsiveness increases with vulnerability, but not the assumption that symptoms arise directly as a function of stress and vulnerability. Also, the generally high levels of arousal seem to be more relevant to psychosis than the responsiveness to specific stressors.
    Journal of Behavior Therapy and Experimental Psychiatry 11/2014; · 2.23 Impact Factor
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    ABSTRACT: Competitive Memory Training (COMET) is a cognitive intervention that aims to change the maladaptive cognitive-emotional networks underlying obsessive-compulsive disorder (OCD). COMET has not been previously tried as a self-help intervention. The present study tested the preliminary feasibility, acceptability, and effectiveness of COMET for OCD implemented as a self-help intervention. Sixty-five participants with OCD recruited through online OCD self-help fora completed an online baseline assessment including measures of OCD symptoms, self-esteem, and depression. Participants were randomly assigned to either COMET or a wait-list control group. All participants were approached 4 weeks later to complete an online post-assessment. There was no evidence for a greater decline of OCD symptoms or depression under COMET. When analyses were limited to only those participants who reported reading the entire manual at least once, self-esteem was higher at post-assessment in the COMET group. Although 78.1% of patients in the COMET group rated it as appropriate for self-administration, only 56.5% performed COMET exercises regularly and 26.4% read the entire manual at least once. The feasibility and effectiveness of COMET as a self-help internet intervention for OCD was not supported in this study. Further work is needed to better understand if modifications to our implementation of COMET may yield improved outcomes.
    Cognitive Behaviour Therapy. 11/2014;
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    ABSTRACT: Background: Obsessive-compulsive disorder (OCD) is a very disabling condition with a chronic course, if left untreated. Though cognitive behavioral treatment (CBT) with or without selective serotonin reuptake inhibitors (SSRI) is the method of choice, up to one third of individuals with obsessive-compulsive disorder (OCD) do not respond to treatment in terms of at least 35% improvement of symptoms. Mindfulness based cognitive therapy (MBCT) is an 8-week group program that could help OCD patients with no or only partial response to CBT to reduce OC symptoms and develop a helpful attitude towards obsessions and compulsive urges. Methods/design: This study is a prospective, bicentric, assessor-blinded, randomized, actively-controlled clinical trial. 128 patients with primary diagnosis of OCD according to DSM-IV and no or only partial response to CBT will be recruited from in- and outpatient services as well as online forums and the media. Patients will be randomized to either an MBCT intervention group or to a psycho-educative coaching group (OCD-EP) as an active control condition. All participants will undergo eight weekly sessions with a length of 120 minutes each of a structured group program. We hypothesize that MBCT will be superior to OCD-EP in reducing obsessive-compulsive symptoms as measured by the Yale-Brown-Obsessive-Compulsive Scale (Y-BOCS) following the intervention and at 6- and 12-months-follow-up. Secondary outcome measures include depressive symptoms, quality of life, metacognitive beliefs, self-compassion, mindful awareness and approach-avoidance tendencies as measured by an approach avoidance task. Discussion:The results of this study will elucidate the benefits of MBCT for OCD patients who did not sufficiently benefit from CBT. To our knowledge, this is the first randomized controlled study assessing the effects of MBCT on symptom severity and associated parameters in OCD.Trial registrationGerman Clinical Trials Register DRKS00004525. Registered 19 March 2013.
    BMC Psychiatry 11/2014; 14(1):314. · 2.23 Impact Factor
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    ABSTRACT: Although antipsychotic medication has been the most widely used and efficacious treatment in ameliorating the symptoms of psychosis, there has been a growing realization that pharmacological treatment has limitations. A significant minority of individuals continue to show ‘treatment resistant’ symptoms and significant relapse risk, while others show symptom reduction without the corresponding improvement in social and role functioning. Psychotherapy, in combination with medication, can help with symptom reduction, as well as improve functioning and quality of life. In the current paper, we will focus briefly on two modalities of psychotherapy which have shown to improve symptomatology and functioning in individuals with psychosis - Cognitive Behaviour Therapy for psychosis (CBTp), and Metacognitive Training (MCT). Both treatment approaches focus on increasing the individuals understanding of the psychological mechanisms associated with delusions and hallucinations, and helping them develop strategies to improve reality testing and belief evaluation. We aim to provide an overview of both treatments, examining not only the theoretical mechanisms and efficacy of each approach, but also the common therapeutic components they share.
    Clinical Schizophrenia & Related Psychoses 11/2014;
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    ABSTRACT: Objective Depression is the most prevalent psychiatric disorder in persons with epilepsy (PWEs). Despite its major impact on quality of life and risk of suicide, most PWEs are not treated for depression. A current challenge in mental health care is how to close this treatment gap and increase access to psychological services. Psychological online interventions (POIs) have shown efficacy in improving depression among individuals without neurologic disorders. This pilot study aimed to assess the feasibility and efficacy of a psychological online intervention for depression (Deprexis) in PWEs who have symptoms of depression.Methods Participants with self-reported epilepsy and subjective complaints of depressive symptoms were randomized to an intervention condition (Deprexis) or to a waiting list control (WLC) condition. After 9 weeks, participants were invited to complete an online reassessment.ResultsRelative to the waiting list group, program users experienced a significant symptom decline on the Beck Depression Inventory - I (BDI-I, primary outcome) with a moderate effect size in the complete observations analysis and a small effect size in the intention-to-treat analysis. Furthermore, there was a significant improvement with a moderate effect size on the “energy/fatigue” subscale of the Quality of Life In Epilepsy Inventory - 31 (QOLIE-31).SignificanceThe results of this trial suggest that POIs may be a feasible and beneficial tool for PWEs who have comorbid depressive symptoms.
    Epilepsia 11/2014; · 3.96 Impact Factor
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    ABSTRACT: Approximately 50%–75% of all patients do not take their antipsychotic medication as prescribed. The current study examined reasons why patients continue versus discontinue antipsychotic medication. We were particularly interested to which extent positive attitudes towards psychotic symptoms foster medication nonadherence. An anonymous online questionnaire was set up to decrease response biases. After a strict selection process, 91 participants with schizophrenia spectrum disorders were retained for the final analyses. On average, 6.2 different reasons for nonadherence were reported. Side-effects (71.4%), sudden subjective symptom improvement (52.4%), forgetfulness (33.3%) and poor communication between therapist and patient (25.6%) emerged as the most frequent reasons for drug discontinuation. Approximately one fourth of all participants (27.3%) reported at least one positive aspect of psychosis as a reason for nonadherence. In contrast, patients reported on average 3.5 different reasons for adherence (e.g., want to live a normal life (74.6%), fear of psychotic symptoms (49.3%)). The belief that paranoia represents a survival strategy (subscale derived from the Beliefs about Paranoia Scale) was significantly associated with nonadherence. Patients' attitudes toward medication and the individual illness model need to be carefully considered when prescribing medication. In particular, for patients who likely discontinue psychopharmacological treatment, complementary or alternative psychological treatment should be sought in view of a largely increased relapse rate in case of sudden drug discontinuation.
    European Neuropsychopharmacology. 11/2014;
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    ABSTRACT: Persistent psychotic symptoms represent a major challenge for psychiatric care. Basic research has shown that psychotic symptoms are associated with cognitive biases. Metacognitive training (MCT) aims at helping patients to become aware of these biases and to improve problem-solving. Fifty-two participants fulfilling diagnostic criteria of schizophrenia or schizoaffective disorders and persistent delusions and stabilized antipsychotic medication were enrolled in this study. Following baseline assessment patients were randomized either to treatment as usual (TAU) conditions or TAU+MCT. The intervention consisted of eight weekly 1-hour sessions (maximum: 8hours). Participants were assessed at 8weeks and 6-months later by blind assessors. Participants were assessed with the Psychotic Symptoms Rating Scales (PSYRATS) and the positive subscale of the PANSS. Between-group differences in post- and pre-test values were significant at a medium effect size in favor of the MCT for the PSYRATS delusion scale and the positive scale of the PANSS both at post and follow-up. The results of this study indicate that MCT training has a surplus antipsychotic effect for patients suffering from schizophrenia-related disorders who demonstrate only a partial response to antipsychotic treatment and that the effect of the intervention persists for at least 6months after the intervention.
    European Psychiatry 10/2014; 29:275-281. · 3.29 Impact Factor
  • Wim Veling, Steffen Moritz, Mark van der Gaag
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    ABSTRACT: In recent years, virtual reality (VR) research on psychotic disorders has been initiated. Several studies showed that VR can elicit paranoid thoughts about virtual characters (avatars), both in patients with psychotic disorders and healthy individuals. Real life symptoms and VR experiences were correlated, lending further support to its validity. Neurocognitive deficits and difficulties in social behavior were found in schizophrenia patients, not only in abstract tasks but also using naturalistic virtual environments that are more relevant to daily life, such as a city or encounters with avatars. VR treatments are conceivable for most dimensions of psychotic disorders. There is a small but expanding literature on interventions for delusions, hallucinations, neurocognition, social cognition, and social skills; preliminary results are promising. VR applications for assessment and treatment of psychotic disorders are in their infancy, but appear to have a great potential for increasing our understanding of psychosis and expanding the therapeutic toolbox.
    Schizophrenia Bulletin 09/2014; · 8.80 Impact Factor
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    ABSTRACT: Difficulties in emotion regulation (ER) are present in psychotic disorders, but their precise nature is not yet fully understood and it is unclear which difficulties are unique to psychosis compared with other disorders. This study investigated whether ER difficulties in psychosis are more prominent for the ability to modify emotions or for the ability to tolerate and accept them. Furthermore, it investigated whether ER difficulties occur for sadness, anxiety, anger and shame likewise.ER skills were assessed in participants with psychotic disorders (n = 37), participants with depression (n = 30) and healthy controls (n = 28) using the Emotion Regulation Skill Questionnaire that asks participants to rate the intensity of different emotions over the past week and the skills employed to handle each of them.Compared with healthy controls, participants with psychosis showed reduced skills related to awareness, understanding and acceptance of potentially distressing emotions, but not in the ability to modify them. These differences remained significant after controlling for depression. Participants with psychosis showed reduced ER skills in regard to all of the assessed emotions compared with the healthy controls, despite the fact that they only reported sadness as being significantly more intense. The participants with depression showed a similar pattern of ER skills to the psychosis sample, although with a tendency towards even more pronounced difficulties.It is concluded that psychosis is characterized by difficulties in using specific ER skills related to awareness, understanding and acceptance to regulate anger, shame, anxiety and sadness. These difficulties are not unique to psychosis but nevertheless present a promising treatment target. Copyright © 2014 John Wiley & Sons, Ltd.Key Practitioner MessageThe participants with psychosis found it more difficult to be aware of their emotions, to understand them and to accept them than the healthy control group. However, they reported equal skills when it came to actively modifying emotions.The difficulties in emotion regulation reported by the participants with psychosis were comparable with those reported by the participants with depression, and they occurred for all types of negative emotions likewise.The difficulties in using specific ER skills related to awareness, understanding and acceptance are a promising target for psychological treatment of psychosis.Interventions that are aimed specifically at increasing these skills need to be further developed.
    Clinical Psychology & Psychotherapy 09/2014; · 2.59 Impact Factor
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    ABSTRACT: Cognitive interventions increasingly complement psychopharmacological treatment to enhance symptomatic and functional outcome in schizophrenia. Metacognitive training (MCT) is targeted at cognitive biases involved in the pathogenesis of delusions.
    JAMA Psychiatry 08/2014; · 12.01 Impact Factor
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    ABSTRACT: Introduction. The aims of this study were to identify whether responses to paranoid thoughts distinguish patients with psychotic disorders from people in the population who have paranoid thoughts occasionally and to identify factors that are associated with and might explain the different ways of responding. Methods. Paranoid thoughts were assessed in patients diagnosed with a psychotic disorder (n = 32) and a population control sample (n = 34) with the Paranoia Checklist. Responses to paranoid thoughts were assessed with the Reactions to Paranoid Thoughts Scale (RePT) and social support, self-efficacy and cognitive insight were assessed as potential correlates of the responses to paranoid thoughts. Results. The patients showed significantly more depressed, physical and devaluating responses to paranoid thoughts and employed less normalising responses than the controls. The differences in normalising responses were explained by perceived social integration, whereas the differences in depressive responses were explained by the overall levels of depression and partly explained by externality and social integration. Conclusions. Maladaptive responses to paranoid thoughts could be relevant to the pathogenesis and maintenance of persecutory delusions. Interventions aimed at reducing paranoia could benefit from targeting dysfunctional responses to paranoid thoughts and by placing a stronger emphasis on treating depression and improving social integration.
    Cognitive Neuropsychiatry 07/2014; · 1.68 Impact Factor
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    ABSTRACT: Obsessions are traditionally defined as bothersome and repetitive thoughts that the patient is unable to resist. Preliminary evidence suggests that in a subgroup of patients with obsessive-compulsive disorder (OCD), obsessions are experienced as partially perceptual. The present study explored the frequency of perceptually laden obsessions and their relationship with illness insight and depression. Twenty-six patients with OCD were administered the newly developed Sensory Properties of Obsessions Questionnaire. Participants were asked to endorse on a 5-point Likert scale whether their obsessions were associated with perceptual features. Participants showed moderate symptom severity. A total of 73% affirmed that their obsessions contained perceptual features. The predominant perceptual channels were visual, tactile, and somatic (i.e., bodily sensations). The extent of perceptual aspects associated with obsessions was strongly correlated with lack of insight (Yale-Brown Obsessive-Compulsive Scale item 11) but not depression severity. The present study suggests that obsessive thoughts are frequently accompanied by perceptual sensations, which concurs with models assuming a continuum between hallucinations and intrusions. Apparently, the more "real" or authentic the obsessive thought is experienced, the less the afflicted person is able to dismiss its content as fully irrational or absurd.
    The Journal of nervous and mental disease. 06/2014;
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    ABSTRACT: Previous research on trichotillomania (TTM) has demonstrated an emotion regulation function of hair pulling behavior. One condition that can impede the regulation of emotions is alexithymia. The present study aimed to explore the relationship between the degree of alexithymia and the severity of hair pulling behavior in individuals with TTM. Multiple strategies were used to recruit a sample of 105 participants via the internet. All participants were diagnosed with TTM by an experienced clinician via a subsequent phone-interview. Multiple linear regression analysis was performed to test the potential predictive value of the different facets of alexithymia (20-item Toronto Alexithymia Scale) on the severity of TTM (Massachusetts General Hospital Hair-Pulling Scale). Both the difficulty in identifying feelings (DIF) facet of alexithymia (p = 0.045) and depression (p = 0.049) were significant predictors of the severity of TTM. In conclusion, alexithymia seems to play a role in hair pulling behavior in individuals with TTM. However, the significant association was small in terms of the overall variance explained, thus warranting further research. If replicated in prospective studies, then these results indicate that therapeutic approaches aimed at supporting patients in recognizing and differentiating feelings might be useful for the treatment of TTM.
    Psychiatry Research 05/2014; accepted 2014-03-24. · 2.68 Impact Factor
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    ABSTRACT: Symptom severity and neuropsychological deficits negatively influence functional outcomes in patients with schizophrenia. Recent research implicates specific types of biased thinking styles (e.g. jumping-to-conclusions) in the pathogenesis of schizophrenia. This is the first study to test the impact of jumping-to-conclusions on functional outcome in schizophrenia. The aim of the study was to investigate the association of psychopathology, neuropsychology and JTC with subjective quality of life, vocational outcome and housing status in schizophrenia. Analyses were carried out both cross-sectionally at baseline, and longitudinally over the course of symptomatic improvement in the immediate aftermath of a psychotic exacerbation. Seventy-nine patients with schizophrenia were included in the study. Data concerning the variables of interest were collected at baseline, after one month, and after six months. Positive symptomatology was the most significant predictor of subjective and vocational outcome and changes across time. Verbal memory deficits were associated with functional status cross-sectionally, whereas general cognitive capacity significantly predicted functional changes over time. Improvement of the jumping-to-conclusions bias positively affected vocational outcome. Though limited, the observed effect of this bias on real-world functioning highlights the possible usefulness of interventions aimed at improving (meta)cognitive deficits in schizophrenia.
    Psychiatry research. 05/2014;
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    ABSTRACT: Theoretical models postulate an important role of attributional style (AS) in the formation and maintenance of persecutory delusions and other positive symptoms of schizophrenia. However, current research has gathered conflicting findings. In a cross-sectional design, patients with persistent positive symptoms of schizophrenia (n = 258) and healthy controls (n = 51) completed a revised version of the Internal, Personal and Situational Attributions Questionnaire (IPSAQ-R) and assessments of psychopathology. In comparison to controls, neither patients with schizophrenia in general nor patients with persecutory delusions (n = 142) in particular presented an externalizing and personalizing AS. Rather, both groups showed a "self-blaming" AS and attributed negative events more toward themselves. Persecutory delusions were independently predicted by a personalizing bias for negative events (beta = 0.197, P = .001) and by depression (beta = 0.152, P = .013), but only 5% of the variance in persecutory delusions could be explained. Cluster analysis of IPSAQ-R scores identified a "personalizing" (n = 70) and a "self-blaming" subgroup (n = 188), with the former showing slightly more pronounced persecutory delusions (P = .021). Results indicate that patients with schizophrenia and patients with persecutory delusions both mostly blamed themselves for negative events. Nevertheless, still a subgroup of patients could be identified who presented a more pronounced personalizing bias and more severe persecutory delusions. Thus, AS in patients with schizophrenia might be less stable but more determined by individual and situational characteristics that need further elucidation.
    Schizophrenia Bulletin 04/2014; · 8.80 Impact Factor
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    ABSTRACT: Weight and shape concerns are core aspects of eating disorders and can have an intrusive and obsessive character. Such thoughts play an important role in the development and maintenance of eating disorders and seem to be a result of dysfunctional cognitive networks. Association Splitting, a novel intervention for obsessive-compulsive disorders, targets such dysfunctional networks. To adapt Association Splitting for the reduction of weight- and shape-related cognitions in students with high weight and shape concerns. Thirteen students with high weight and shape concerns were recruited and ten completed assessments before and after using the Association Splitting approach. Self-reported weight and shape concerns, eating behaviours and obsessive thinking were assessed. Changes between the two time points were analysed. After using Association Splitting, participants reported lower weight and shape concerns, reduced drive for thinness and body dissatisfaction and lower levels of eating disorder-related behaviours. The technique was perceived as helpful by 70 % of the participants. Association Splitting is a feasible approach to reducing weight and shape concerns and might be a useful addition to the treatment or prevention of eating disorders.
    Eating and weight disorders: EWD 03/2014; · 0.53 Impact Factor
  • Schizophrenia Bulletin 02/2014; in press. · 8.80 Impact Factor
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    ABSTRACT: We found evidence that the usual developmental trends in children's spontaneous false memories were eliminated using novel stimuli containing obvious themes. That is, children created more false memories than adults when scenes needed to be remembered. In Experiment 1, 7- and 8-year-olds had higher false memory rates than adults when using visual scenes. Experiment 2 showed that gist cuing could not account for this effect. In Experiment 3, children and adults received visual scenes and story contexts in which these scenes were embedded. For both types of stimuli, we found that children had the highest false memory rates. Our results indicate that the underlying theme of these scenes is easily identified, resulting in our developmental false memory trend.
    Journal of Experimental Child Psychology 01/2014; 121C:28-41. · 3.12 Impact Factor
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    Jan Philipp Klein, Steffen Moritz
    Frontiers in Psychiatry 01/2014; 5:77.

Publication Stats

4k Citations
722.22 Total Impact Points


  • 1998–2014
    • University of Hamburg
      • • Department of Psychiatry and Psychotherapy
      • • Department of Psychosomatic Medicine and Psychotherapy
      Hamburg, Hamburg, Germany
  • 1997–2014
    • University Medical Center Hamburg - Eppendorf
      • • Department of Psychiatry and Psychotherapy
      • • Department of Psychosomatic Medicine and Psychotherapy
      Hamburg, Hamburg, Germany
  • 2013
    • Charité Universitätsmedizin Berlin
      • Department of Psychiatry and Psychotherapy
      Berlin, Land Berlin, Germany
  • 2010–2013
    • Universität Heidelberg
      • Department of Geriatric Psychiatry
      Heidelberg, Baden-Wuerttemberg, Germany
  • 2009–2013
    • Medical University of Warsaw
      • Katedra i Klinika Psychiatryczna
      Warsaw, Masovian Voivodeship, Poland
    • Evangelisches Krankenhaus Alsterdorf
      Hamburg, Hamburg, Germany
  • 2011
    • Universitätsklinikum Freiburg
      • Department of Psychiatry and Psychotherapy
      Freiburg, Lower Saxony, Germany
  • 2008–2010
    • Philipps-Universität Marburg
      • Fachbereich Psychologie
      Marburg an der Lahn, Hesse, Germany
  • 2007
    • Simon Fraser University
      Burnaby, British Columbia, Canada
  • 2002
    • University of British Columbia - Vancouver
      • Department of Psychology
      Vancouver, British Columbia, Canada
  • 2000
    • University of Freiburg
      Freiburg, Baden-Württemberg, Germany