Steffen Moritz

Publications of Steffen Moritz

• "Don't give me that look" - Overconfidence in false mental state perception in schizophrenia.

  Authors: Ulf Köther, Ruth Veckenstedt, Francesca Vitzthum, Daniela Roesch-Ely, Ute Pfueller, Florian Scheu, Steffen Moritz

  Psychiatry research. 04/2012;

  Dysfunctions in social cognition are implicated in the pathogenesis of schizophrenia and have been extensively replicated over the years. For memory research, the administration of cognitive tasksDysfunctions in social cognition are implicated in the pathogenesis of schizophrenia and have been extensively replicated over the years. For memory research, the administration of cognitive tasks with metacognitive aspects like confidence ratings has deepened our insight into how impairments contribute to symptoms of the disorder. A total of 76 patients with schizophrenia or schizoaffective disorder and a sample of 30 healthy participants were tested with the Reading the Mind in the Eyes test (Eyes-test). The Eyes-test was complemented with a rating scale requesting response confidence and was administered along with paradigms tapping neuropsychological parameters and cognitive insight. Schizophrenia patients showed impaired abilities on mental state perception. In addition, they committed more high-confidence errors and at the same time made fewer high-confidence correct responses. Impairments were most pronounced in patients with formal thought disorder. The patients displayed a decreased metacognitive awareness for their deficits. The results suggest that adding confidence ratings to the investigation of social cognition promises to advance our understanding of social cognition in schizophrenia. Patients not only show severe impairments in social cognition, but are overconfident in their judgments and lack cognitive insight into their deficits. The results highlight the need for metacognitive therapeutic approaches for the treatment of this population.

• The effect of practice on the recall of salient information in obsessive-compulsive disorder.

  Authors: Lena Jelinek, Liz Rietschel, Michael Kellner, Christoph Muhtz, Steffen Moritz

  Psychiatry research. 03/2012;

  Deficits in memory and cognitive inhibition have been proposed as underlying mechanisms of obsessive-compulsive disorder (OCD). To test this hypothesis an emotional variant of the retrieval inducedDeficits in memory and cognitive inhibition have been proposed as underlying mechanisms of obsessive-compulsive disorder (OCD). To test this hypothesis an emotional variant of the retrieval induced forgetting (RIF) paradigm was constructed which investigates whether repeated retrieval of previously learned material (Rp+) leads to enhanced forgetting of related but nonretrieved material (Rp-) in comparison to unrelated material (NRp). This paradigm (using of OCD-relevant, neutral and negative material) was presented to 21 participants with OCD and 22 healthy controls. To compare personally relevant stimuli across groups, salience ratings of the material were included. RIF was not reduced in OCD per se. Tentative evidence was found for a weakened RIF effect for personally salient OCD-relevant material in OCD patients in comparison to healthy controls.

• Beyond the Usual Suspects: Positive Attitudes Towards Positive Symptoms Is Associated With Medication Noncompliance in Psychosis.

  Authors: Steffen Moritz, Jerome Favrod, Christina Andreou, Anthony P Morrison, Francesca Bohn, Ruth Veckenstedt, Peter Tonn, Anne Karow

  Schizophrenia bulletin. 02/2012;

  Antipsychotic medication represents the treatment of choice in psychosis according to clinical guidelines. Nevertheless, studies show that half to almost three-quarter of all patients discontinueAntipsychotic medication represents the treatment of choice in psychosis according to clinical guidelines. Nevertheless, studies show that half to almost three-quarter of all patients discontinue medication with antipsychotics after some time, a fact which is traditionally ascribed to side-effects, mistrust against the clinician and poor illness insight. The present study investigated whether positive attitudes toward psychotic symptoms (ie, gain from illness) represent a further factor for medication noncompliance. An anonymous online survey was set up in order to prevent conservative response biases that likely emerge in a clinical setting. Following an iterative selection process, data from a total of 113 patients with a likely diagnosis of schizophrenia and a history of antipsychotic treatment were retained for the final analyses (80%). While side-effect profile and mistrust emerged as the most frequent reasons for drug discontinuation, 28% of the sample reported gain from illness (eg, missing voices, feeling of power) as a motive for noncompliance. At least every fourth patient reported the following reasons: stigma (31%), mistrust against the physician/therapist (31%), and rejection of medication in general (28%). Approximately every fifth patient had discontinued antipsychotic treatment because of forgetfulness. On average, patients provided 4 different explanations for noncompliance. Ambivalence toward symptoms and treatment should thoroughly be considered when planning treatment in psychosis. While antipsychotic medication represents the evidence-based cornerstone of the current treatment in schizophrenia, further research is needed on nonpharmacological interventions for noncompliant patients who are willing to undergo intervention but refuse pharmacotherapy.

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• [Formula: see text] Effects of Obsessive-Compulsive Symptoms on Neuropsychological Test Performance: Complicating an Already Complicated Story.

  Authors: Steffen Moritz, Birgit Hottenrott, Lena Jelinek, Amanda M Brooks, Armin Scheurich

  The Clinical neuropsychologist. 12/2011; 26(1):31-44.

  Theoretical models of obsessive-compulsive disorder (OCD) implicate neurocognitive dysfunction, particularly deficits in nonverbal memory and executive functioning, in the pathogenesis of theTheoretical models of obsessive-compulsive disorder (OCD) implicate neurocognitive dysfunction, particularly deficits in nonverbal memory and executive functioning, in the pathogenesis of the disorder. The opposite hypothesis (poor performance in neuropsychological test as an epiphenomenon of OCD symptoms) has rarely been contemplated although checking behavior, obsessional doubt, lack of motivation, and slowness as well as preoccupation with touching objects may result in secondary test impairment and mimic manifestations of neural dysfunction. A total of 60 patients with OCD and 30 healthy controls were tested with a multi-functional neuropsychological battery. At the end of the testing participants were asked about their effort and the severity of OCD symptoms during task execution. Up to one fourth of the OCD patients affirmed OCD-related worries and motivational problems during task execution. Poor motivation and checking were significantly associated with enhanced objective performance deficits. Whereas the present study does not negate a role of neurocognitive deficits in the formation of OCD, in our view the reverse relationship should be contemplated as well. We advise researchers to pay closer attention to possible confounds that may mediate the relationship between OCD and neurocognition. Limitations of the study are discussed.

• Veridical and false memory for scenic material in posttraumatic stress disorder.

  Authors: Marit Hauschildt, Maarten J V Peters, Lena Jelinek, Steffen Moritz

  Consciousness and cognition. 12/2011; 21(1):80-9.

  The question whether memory aberrations in posttraumatic stress disorder (PTSD) also manifest as an increased production of false memories is important for both theoretical and practical reasons, butThe question whether memory aberrations in posttraumatic stress disorder (PTSD) also manifest as an increased production of false memories is important for both theoretical and practical reasons, but is yet unsolved. Therefore, for the present study we investigated veridical and false recognition in PTSD with a new scenic variant of the Deese-Roediger-McDermott (DRM) paradigm, which was administered to traumatized individuals with PTSD (n=32), traumatized individuals without PTSD (n=30), and non-traumatized controls (n=30). The PTSD group neither produced higher rates of false memories nor expressed more confidence in errors, but did show inferior memory sensitivity. Whereas depressive symptoms did not correlate with veridical nor false recognition, state dissociation was positively associated with false memories.

• Elucidating the black box from stress to paranoia.

  Authors: Steffen Moritz, Pia Burnette, Sabine Sperber, Ulf Köther, Marion Hagemann-Goebel, Maike Hartmann, Tania M Lincoln

  Schizophrenia bulletin. 11/2011; 37(6):1311-7.

  Sensitivity to stress has long been implicated in the pathogenesis of schizophrenia. It remains unclear, however, which exact mechanisms underlie the progression from vulnerability to psychoticSensitivity to stress has long been implicated in the pathogenesis of schizophrenia. It remains unclear, however, which exact mechanisms underlie the progression from vulnerability to psychotic breakdown. For the present study, we hypothesized that the induction of stress would aggravate cognitive biases in schizophrenia. A total of 20 acute and remitted schizophrenia patients and 15 healthy controls were tested with parallel versions of cognitive biases paradigms under 2 laboratory conditions: stress (loud noise, 75 dB) vs no-stress. In the course of both conditions, participants had to fill out a questionnaire that assessed depressive, obsessive-compulsive, and paranoid symptoms. For the patients with acute psychotic symptoms, paranoid but not other psychiatric symptoms were elevated under stress in comparison with no-stress. In contrast, stress somewhat diminished subclinical paranoid symptoms in healthy participants. Jumping to conclusions was evident in schizophrenia under both conditions but significantly more pronounced when stress was applied first in the acute group. A tendency emerged in both acute and remitted patients to attribute events to other people under stress which was not seen in healthy subjects. The present study may serve as a starting point for further research investigating how stress translates vulnerability into acute paranoia and to pinpoint cognitive risk factors that can be modified by treatment.

• Changes in cortisol secretion during antidepressive treatment and cognitive improvement in patients with major depression: A longitudinal study.

  Authors: Kim Hinkelmann, Steffen Moritz, Johannes Botzenhardt, Christoph Muhtz, Klaus Wiedemann, Michael Kellner, Christian Otte

  Psychoneuroendocrinology. 09/2011;

  OBJECTIVES: We have previously reported that cognitive deficits are cross-sectionally associated with elevated cortisol in depressed patients. Here, we longitudinally examined if changes in cortisolOBJECTIVES: We have previously reported that cognitive deficits are cross-sectionally associated with elevated cortisol in depressed patients. Here, we longitudinally examined if changes in cortisol secretion during treatment are associated with improvement of cognition. METHODS: Cognitive function and salivary cortisol levels were longitudinally examined in 52 patients with major depression before and after 3 weeks of standardized selective serotonin reuptake inhibitor (SSRI) and an add-on treatment modulating the mineralocorticoid receptor and compared to a healthy control group (n=50) matched for age, gender and years of education. RESULTS: Across add-on treatment groups, SSRI treatment reduced salivary cortisol in patients to levels of healthy controls (time×group interaction p=.05). In patients, reduction of cortisol significantly correlated with improvement in depressive symptoms (r=.52, p<.01), speed of information processing (r=.50, p<.01), and cognitive set-shifting (r=.34, p=.03). Improved depressive symptoms were only associated with improved attention and working memory. CONCLUSIONS: Improvement of some cognitive domains during SSRI treatment was associated with decreasing cortisol secretion and was only to a lesser extent associated with improved depressive symptoms.

• Do it yourself? Self-help and online therapy for people with obsessive-compulsive disorder.

  Authors: Steffen Moritz, Charlotte E Wittekind, Marit Hauschildt, Kiara R Timpano

  Current opinion in psychiatry. 09/2011; 24(6):541-8.

  In spite of advances in the understanding and treatment of obsessive-compulsive disorder (OCD), for most patients some symptoms persist even after therapeutic intervention. Another large subgroupIn spite of advances in the understanding and treatment of obsessive-compulsive disorder (OCD), for most patients some symptoms persist even after therapeutic intervention. Another large subgroup does not seek treatment at all, particularly due to shame or fear of stigma. The treatment gap in OCD is large and self-help is increasingly seen as a low-threshold form of intervention for individuals with minor symptoms or who are currently treatment-reluctant. Our review summarizes the expanding but still small literature on self-help and Internet interventions for OCD and provides advice on how to conduct (Internet) studies on self-help. Strategies to deal with methodological problems that notoriously plague Internet research are discussed. Despite methodological limitations inherent in most studies considered for the current review, as well as the unreplicated nature of some of the more recent findings, self-help tools hold some promise. In particular, self-help interventions that are rooted in evidence-based concepts may be helpful as an add-on to standard interventions and as (initial) therapeutic strategies for those who are presently reluctant to participate in face-to-face treatment. The current review identifies self-help, which is based on evidence-based concepts, as a promising clinical tool for the treatment of OCD. The current literature suggests that self-help can be a facilitator and aid to standard face-to-face interventions, rather than a rival.

• Heart rate variability in response to affective scenes in posttraumatic stress disorder.

  Authors: Marit Hauschildt, Maarten J V Peters, Steffen Moritz, Lena Jelinek

  Biological psychology. 08/2011; 88(2-3):215-22.

  Posttraumatic stress disorder (PTSD) is characterized by psychophysiological abnormalities, such as an altered baseline heart rate and either hyper- or hyporeactivity to a wide range of stimuli,Posttraumatic stress disorder (PTSD) is characterized by psychophysiological abnormalities, such as an altered baseline heart rate and either hyper- or hyporeactivity to a wide range of stimuli, implying dysfunctional arousal regulation. Heart rate variability (HRV) has been established as an important marker of arousal regulatory ability. The aim of the present study was to examine HRV in PTSD under different affective conditions and to explore the role of potential moderating factors. To meet this purpose, videos of varying emotional valence were presented to trauma-exposed participants with PTSD (n=26), trauma-exposed participants without PTSD (n=26), as well as non-trauma-exposed controls (n=18) while HRV was recorded. The PTSD group showed lower HRV than non-trauma-exposed controls at baseline (corrected for age) and throughout different affective conditions implying decreased parasympathetic activity and an inflexible response regulation. There was a negative relationship between HRV and self-report of both depression and state dissociation.

• Are patients with obsessive-compulsive disorder generally more doubtful? Doubt is warranted!

  Authors: Steffen Moritz, Liz Rietschel, Lena Jelinek, Karl-Heinz T Bäuml

  Psychiatry research. 08/2011; 189(2):265-9.

  A number of neuropsychological models implicate disinhibition and a lack of response confidence in the pathogenesis of obsessive-compulsive disorder (OCD). To provide a fair test of the inhibitionA number of neuropsychological models implicate disinhibition and a lack of response confidence in the pathogenesis of obsessive-compulsive disorder (OCD). To provide a fair test of the inhibition and confidence account, a variant of the directed forgetting (DF) paradigm with OCD-related and unrelated conditions was administered in 30 OCD patients and 20 healthy controls. First, 16 words were presented which the participant was subsequently instructed to forget. Then, 16 words were presented that should be memorized. After a short interval, patients were shown the to-be-forgotten and the to-be-remembered items along with new items in random order. The subjects were instructed to recollect both the to-be-remembered and the to-be-forgotten items. The subject was asked to grade responses according to confidence. In accordance with prior findings from our group, patients did not differ from controls on overall recollection, response confidence, and the recollection of to-be-forgotten (allegedly inhibited) information. Our study cannot refute the claim that disinhibition plays a role in OCD in view of the vast array of paradigms tapping different aspects of inhibition. Still, we deem a psychological understanding more fruitful that looks at dysfunctional coping strategies and false beliefs as mechanisms for the persistence and pervasiveness of obsessive thoughts.

• Further evidence for the efficacy of association splitting as a self-help technique for reducing obsessive thoughts.

  Authors: Steffen Moritz, Lena Jelinek

  Depression and anxiety. 06/2011; 28(7):574-81.

  Despite improved treatment options, many people with obsessive-compulsive disorder (OCD) do not seek or even actively avoid therapy due to shame or fear of stigmatization. Self-help treatment isDespite improved treatment options, many people with obsessive-compulsive disorder (OCD) do not seek or even actively avoid therapy due to shame or fear of stigmatization. Self-help treatment is increasingly acknowledged as a means to "treat the untreated" and to motivate patients for face-to-face psychotherapy. Our group has gathered preliminary evidence for the efficacy of a novel self-help approach entitled association splitting (AS) aimed at the reduction of obsessions. For this study, a total of 46 participants with a likely diagnosis of OCD were randomly allocated to either AS or a waitlist control (WL). Treatment consisted of the self-study of a manual sent via e-mail. At baseline and four weeks later symptoms were assessed online using the self-report version of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Obsessive-Compulsive Inventory-Revised (OCI-R), and the Beck Depression Inventory (BDI). A total of 74% of the initial sample took part in the re-assessment. Results were in accordance with prior uncontrolled data indicating that AS is a feasible approach leading to a symptom decline of approximately 25% on the Y-BOCS. The technique also exerted a positive effect on depression (BDI) and the OCI-R subscale obsessive thoughts. The study confirms the feasibility and efficacy of AS for a subgroup of patients with OCD. Ongoing studies explore whether short-term effects are maintained over time and whether therapist-guided therapy may enhance the efficacy of AS.

• A randomized controlled trial of a novel self-help technique for impulse control disorders: a study on nail-biting.

  Authors: Steffen Moritz, Andras Treszl, Michael Rufer

  Behavior modification. 06/2011; 35(5):468-85.

  Nail-biting is currently classified as an impulse control disorder not otherwise specified. Although seldom targeted as a primary symptom, nail-biting is often associated with somatic complicationsNail-biting is currently classified as an impulse control disorder not otherwise specified. Although seldom targeted as a primary symptom, nail-biting is often associated with somatic complications and decreased quality of life. The present study assessed the effectiveness of an innovative self-help technique, titled decoupling (DC). DC aims at attenuating pathological nail-biting by performing motor sequences that decouple and rearrange the behavioral elements involved in the habit. A total of 72 participants with excessive nail-biting were recruited via specialized self-help forums and were randomized to either DC or progressive muscle relaxation (PMR) groups after baseline assessment. Four weeks later, participants underwent a similar assessment as before and were asked to rate the effectiveness of the intervention. The primary outcome parameter was the Massachusetts General Hospital Scale (MGH) adapted. Relative to the PMR group, the DC group showed significant progress in withstanding the urge to bite their nails. Furthermore, they appraised the appearance of their nails as considerably less compromised at the end of the treatment relative to participants undergoing PMR. At statistical trend level, the DC group showed a significantly greater decline on the adapted MGH relative to PMR. Despite methodological limitations, the present study asserts that the effectiveness of DC, previously shown for trichotillomania, extends to nail-biting.

• Larger than life: overestimation of object size is moderated by personal relevance in obsessive-compulsive disorder.

  Authors: Steffen Moritz, Georg W Alpers, Lisa Schilling, Lena Jelinek, Amanda Brooks, Bastian Willenborg, Matthias Nagel

  Journal of behavior therapy and experimental psychiatry. 05/2011; 42(4):481-7.

  Along with other cognitive biases overestimation of threat (OET) has been implicated in the pathogenesis of obsessive-compulsive disorder (OCD). The present study investigated whether OET would notAlong with other cognitive biases overestimation of threat (OET) has been implicated in the pathogenesis of obsessive-compulsive disorder (OCD). The present study investigated whether OET would not only manifest in cognitive distortions but, also in overestimations of the object size of disorder-related visual objects. A total of 65 participants with OCD and 55 healthy controls who were recruited via OCD online forums underwent an incidental learning paradigm consisting of two blocks. In Block 1, participants were asked to rate the valence and the personal relevance for individual OCD concerns of 40 pictures which varied in size. Differences in size, however, were not explicitly communicated to the participants. Stimuli were selected from four categories: 1. neutral, 2. fear-related but OCD-unrelated, 3. washing (OCD-related), and 4. checking (OCD-related). In Block 2, participants were asked to recollect the original size of each stimulus (depicted as a small thumbnail) on a seven point scale. Whereas few group differences emerged for pre-defined OCD items, OCD-relevant items (individual judgments) were judged as significantly larger by patients with OCD relative to controls. The opposite pattern emerged for neutral items. The sample was recruited via online forums and had probable but not externally validated diagnoses of OCD. No psychiatric control group was recruited. The present study indicates that OET may extend to neuropsychological tasks. Further research is needed to pinpoint whether OET occurs at the level of encoding suggesting a perceptual bias and/or occurs at the level of retrieval suggesting a memory bias.

• Differences and similarities between obsessive and ruminative thoughts in obsessive-compulsive and depressed patients: a comparative study.

  Authors: Karina Wahl, Sabine Schönfeld, Johanna Hissbach, Sebastian Küsel, Bartosz Zurowski, Steffen Moritz, Fritz Hohagen, Andreas Kordon

  Journal of behavior therapy and experimental psychiatry. 03/2011; 42(4):454-61.

  Repetitive, intrusive cognitive phenomena are central both to obsessive-compulsive patients - typically as obsessive thoughts - and to depressed patients - typically as ruminative thoughts. TheRepetitive, intrusive cognitive phenomena are central both to obsessive-compulsive patients - typically as obsessive thoughts - and to depressed patients - typically as ruminative thoughts. The objective of the present study is to compare obsessive and ruminative thoughts in non-depressed obsessive-compulsive and depressed patients. Thirty-four patients diagnosed with obsessive-compulsive disorder and 34 patients diagnosed with major depression disorder were asked to identify both a personally relevant obsessive and a personally relevant ruminative thought and to subsequently evaluate these thoughts on a modified version of the Cognitive Intrusions Questionnaire (CIQ) developed by Freeston, Ladouceur, Thibodeau, and Gagnon (1991). The CIQ assesses general descriptors, emotional reactions, appraisal and coping strategies on a nine-point Likert scale. A mixed-model ANOVA demonstrated that obsessive and ruminative thoughts are distinct cognitive processes, clearly distinguishable in form, appraisal and temporal orientation across disorders. In obsessive-compulsive patients, ruminative thoughts were more common and more emotionally distressing than predicted. In depressed patients, obsessive thoughts occurred infrequently and were not associated with high negative emotions. Clarifying similarities and differences between ruminative and obsessive thoughts and understanding their interaction might ultimately help to expand on the role of cognitive vulnerability factors in obsessive-compulsive and major depression disorder.

• Psychotic-like cognitive biases in borderline personality disorder.

  Authors: Steffen Moritz, Lisa Schilling, Katja Wingenfeld, Ulf Köther, Charlotte Wittekind, Kirsten Terfehr, Carsten Spitzer

  Journal of behavior therapy and experimental psychiatry. 03/2011; 42(3):349-54.

  Whereas a large body of research has linked borderline personality disorder (BPD) with affective rather than psychotic disorders, BPD patients frequently display psychotic and psychosis-proneWhereas a large body of research has linked borderline personality disorder (BPD) with affective rather than psychotic disorders, BPD patients frequently display psychotic and psychosis-prone symptoms, respectively. The present study investigated whether cognitive biases implicated in the pathogenesis of psychotic symptoms, especially delusions, are also evident in BPD. A total of 20 patients diagnosed with BPD and 20 healthy controls were administered tasks measuring neuropsychological deficits (psychomotor speed, executive functioning) and cognitive biases (e.g., one-sided reasoning, jumping to conclusions, problems with intentionalizing). Whereas BPD patients performed similar to controls on standard neuropsychological tests, they showed markedly increased scores on four out of five subscales of the Cognitive Biases Questionnaire for Psychosis (CBQp) and displayed a one-sided attributional style on the revised Internal, Personal and Situational Attributions Questionnaire (IPSAQ-R) with a marked tendency to attribute events to themselves. The study awaits replication with larger samples, but we tentatively suggest that the investigation of psychosis-related cognitive biases may prove useful for the understanding and treatment of BPD.

• Knock, and it will be opened to you? An evaluation of meridian-tapping in obsessive-compulsive disorder (OCD).

  Authors: Steffen Moritz, Stefany Carrillo Aravena, Sascha R Guczka, Lisa Schilling, Christiane Eichenberg, Gabriele Raubart, Andreas Seebeck, Lena Jelinek

  Journal of behavior therapy and experimental psychiatry. 03/2011; 42(1):81-8.

  Meridian-tapping (MT) is a body-oriented therapeutic technique which among other psychological problems targets anxiety disorders. Despite bold claims by some of its advocates that it brings lastingMeridian-tapping (MT) is a body-oriented therapeutic technique which among other psychological problems targets anxiety disorders. Despite bold claims by some of its advocates that it brings lasting success in the vast majority of patients with anxiety disorders, solid empirical evidence for its effectiveness is scarce and its theoretical foundations are refuted by many scientists. The present study tested the effectiveness of a published MT self-help approach for obsessive-compulsive disorder (OCD). Following a baseline assessment over the internet including standard outcome measures for OCD (Y-BOCS, OCI-R) and depression (BDI-SF), 70 participants with OCD were randomly allocated to MT or to progressive muscle relaxation (PMR). Four weeks after the dispatch of the self-help manuals (including video demonstrations of the technique), participants were requested to take part in a post assessment. Whereas subjects found MT more helpful than PMR in retrospect (39% versus 19%) and would continue to use it in the future (72% versus 48%) there was no evidence for a stronger decline of OCD symptoms under MT on any of the psychometric measures. Moreover, Y-BOCS scores did not significantly change across time for both interventions. The present study does not support bold claims about the effectiveness of MT as a stand-alone technique. Cognitive-behavioral therapy remains the treatment of choice for OCD. While self-help MT may enhance the well-being of a subgroup of participants, its potential for OCD appears to be small. Exaggerated success claims on the effectiveness of MT in conjunction with degrading appraisals of conventional psychotherapy as made by some of its leading figures may in our view foster fatalism in patients not experiencing major symptom relief by MT.

• Movement decoupling: A self-help intervention for the treatment of trichotillomania.

  Authors: Steffen Moritz, Michael Rufer

  Journal of behavior therapy and experimental psychiatry. 03/2011; 42(1):74-80.

  Trichotillomania (TTM) is classified as an impulse control disorder characterized by the recurrent urge to pull out one's own hair resulting in noticeable hair loss. Cognitive-behavioral therapy,Trichotillomania (TTM) is classified as an impulse control disorder characterized by the recurrent urge to pull out one's own hair resulting in noticeable hair loss. Cognitive-behavioral therapy, involving habit reversal training, currently represents the treatment of choice. The present study assessed the feasibility and effectiveness of a novel self-help technique, entitled decoupling (DC). DC aims at attenuating TTM by performing movements that decouple the behavioral elements involved in hair pulling. A total of 42 subjects with TTM were recruited via self-help forums for TTM and were randomized either to DC or progressive muscle relaxation (PMR). After four weeks, participants were asked to fill out the same questionnaires as before and rate the effectiveness of the intervention. The completion rate was high and the reliability of the assessments at least satisfactory. The DC group showed a significantly greater decline on the Massachusetts General Hospital - Hair-Pulling Scale, which served as the primary outcome, relative to PMR indicating a medium to strong effect size. Declines on scales tapping depression and obsessive-compulsive disorder were comparable between the two groups. Despite some methodological limitations and the need for replication including follow-up and expert ratings, the present study suggests that DC may prove beneficial to a substantial number of individuals affected with TTM.

• What happened to the voices? A fine-grained analysis of how hallucinations and delusions change under psychiatric treatment.

  Authors: Sophia D Schneider, Lena Jelinek, Tania M Lincoln, Steffen Moritz

  Psychiatry research. 01/2011; 188(1):13-7.

  The Psychiatric Symptom Rating Scales (PSYRATS) have demonstrated their usefulness for the dimensional assessment of hallucinations and delusions. However, there is no evaluated German version of theThe Psychiatric Symptom Rating Scales (PSYRATS) have demonstrated their usefulness for the dimensional assessment of hallucinations and delusions. However, there is no evaluated German version of the PSYRATS to date. Also, in spite of theoretical conceptions about "detaching" effects of antipsychotics, there are few consolidated findings about how core symptomatic aspects of schizophrenia change during antipsychotic treatment. The present study aimed to fill this gap. A total of 40 schizophrenic voice-hearers were interviewed three times during the course of six months using a newly developed German version of the PSYRATS with very good psychometric properties. At the same time, psychopathology was assessed with the Positive and Negative Syndrome Scale (PANSS). In the longitudinal course, a general symptomatic decrease became apparent only for auditory hallucinations but not for delusions. Specifically, the loudness of the hallucinated voices as well as the associated distress decreased early, while other aspects of the hallucinations took more time to fade. In this study, the PSYRATS proved to be a valuable tool for measuring the change of specific symptom dimensions. However, our results only partially supported the notion of a general detachment from symptoms due to psychiatric treatment.

• Incorrigibility, jumping to conclusions, and decision threshold in schizophrenia.

  Authors: Ruth Veckenstedt, Sarah Randjbar, Francesca Vitzthum, Birgit Hottenrott, Todd S Woodward, Steffen Moritz

  Cognitive neuropsychiatry. 01/2011; 16(2):174-92.

  Previous studies confirmed a bias against disconfirmatory evidence (BADE) for both delusional and delusion-neutral events in paranoid schizophrenia. In the present study, we examined a potentialPrevious studies confirmed a bias against disconfirmatory evidence (BADE) for both delusional and delusion-neutral events in paranoid schizophrenia. In the present study, we examined a potential relationship between the BADE and delusional ideation. Fifty-five patients with schizophrenia (32 with current delusions), 20 patients with obsessive-compulsive disorder and 30 healthy participants were presented written scenarios composed of three successive sentences which increasingly disambiguated the situation. Participants were asked to rate interpretations presented along with the sentences. After each new sentence, participants could adjust their judgements in view of the new information. One interpretation ("true") did not seem to fit the first statement but became increasingly plausible, whereas "lure" interpretations appeared very likely initially but were eventually incorrect. Patients were given the option to decide for one of the statements. Patients with schizophrenia, irrespective of delusion severity, attenuated their ratings significantly less for lure interpretations in face of disconfirmatory evidence (BADE) compared to both control groups. We found no impairment regarding the integration of confirmatory evidence. Patients with schizophrenia made more incorrect decisions after the first sentence indicating jumping to conclusions relative to healthy controls. Participants with schizophrenia showed a lowered decision threshold compared to the controls. The findings lend further evidence to the claim that patients with schizophrenia are hastier and rather inflexible in their decision making. This response pattern may represent a trait-like vulnerability factor for the emergence of delusional incorrigibility, a hallmark symptom of schizophrenia.

• Intergenerational transmission of biased information processing in posttraumatic stress disorder (PTSD) following displacement after World War II.

  Authors: Charlotte E Wittekind, Lena Jelinek, Michael Kellner, Steffen Moritz, Christoph Muhtz

  Journal of anxiety disorders. 12/2010; 24(8):953-7.

  An attentional bias for trauma-related stimuli has been demonstrated in individuals with posttraumatic stress disorder (PTSD). However, few studies have investigated how biological relatives ofAn attentional bias for trauma-related stimuli has been demonstrated in individuals with posttraumatic stress disorder (PTSD). However, few studies have investigated how biological relatives of individuals with PTSD process trauma-relevant information. To investigate whether parental PTSD is associated with an attentional bias for trauma-related stimuli in adult offspring, we compared performance of individuals displaced after World War II with (n=22) and without PTSD (n=24) to a non-displaced healthy control group (n=11) and their respective offspring as to their processing of trauma-related stimuli in an emotional Stroop task. Evidence for biased information processing was neither found in individuals with PTSD nor their offspring. Possible explanations for the findings and implications for future studies are discussed.