Sömnsvårigheter inklusive insomni är ett utbrett problem för stora delar av befolkningen. Personer med insomni tenderar att oroa sig över sin sömn och har dysfunktionella antaganden kring sömnbristens konsekvenser. Studiens huvudsakliga syfte var att undersöka om skillnader i utfall mellan två behandlingsmetoder för insomni kunde tillräknas en exponeringseffekt. Studiens hypoteser var: 1a) Patienter som deltar i sömnrestriktion kommer få en större reducering av oro över sin sömn. 1b) Det finns ett samband mellan hög följsamhet till behandlingsmetoden och minskad oro över sömnen. 2) En kraftigare exponering medför lägre följsamhet till behandlingsmetoden. 3) Det finns ett samband mellan minskad oro över sömnen och minskade insomnisymptom. Data användes där 185 deltagare randomiserats till någon av KBT-behandlingarna för insomni sömnkomprimering (n=93) och sömnrestriktion (n=92). Oron hade minskat för studiedeltagarna fem veckor efter behandlingsstart men inga signifikanta skillnader påträffades mellan grupperna. Ett signifikant samband observerades mellan minskning av insomnisymptom och oro över sömnbrist. Slutsatser från uppsatsen är det redan etablerade sambandet mellan oro och insomni bekräftas. Studien kunde inte bekräfta hypotesen att exponering leder till minskad oro. Vidare forskning rekommenderas för att avgöra hur exponering kan användas för patienter med insomni för att möjliggöra effektivare behandlingsmetoder. / Sleep impairments including insomnia is a widespread problem affecting a large quantity of the population. Insomnia patients tend to worry about their sleep and having dysfunctional beliefs about sleep deficit consequences. The main purpose of this study was to examine if differences in results between two treatment methods could be attributed to effects of exposure. The hypotheses in the study were: 1a) Patients who participate in sleep restriction will have a greater reduction of sleep-related worry. 1b) There is a correlation between high compliance to the treatment methods and reduced sleep-related worry. 2) A greater exposure induces lower compliance to the treatment methods. 3a) There is a correlation between reduction of sleep-related worry and reduction of insomnia symptoms. Data consisted of 185 participants who was randomised into the CBT-treatments for insomnia sleep compression (n=93) or sleep restriction (n=92). A hypothesis was that sleep restriction implicate more exposure than sleep compression. Worry had decreased among participants after five weeks of treatment but no significant differences occurred between the groups. A significant correlation occurred between reduction of insomnia symptoms and reduction of worries regarding sleep deficit. Conclusions is that the already established correlation between worry and insomnia is confirmed. This study failed to confirm that exposure leads to reduced worry. Further research is advised to determine how exposure can be used for insomnia patients to enable more efficient treatment methods. / ClinicalTrials.gov Identifier: NCT02743338, CompRest - a Comparison Between Sleep Compression and Sleep Restriction for Treating Insomnia

La globalisation et les crises économiques successives, les pressions de la concurrence et les exigences des clients contraignent les entreprises pour survivre à initier des changements et à réviser leurs promesses et perspectives de rétributions, parfois de manière brutale. Les frontières organisationnelles se délitent, des relations atypiques et triangulaires se développent, les collectifs de travail sont fragilisés, les valeurs interpellées. L’équivocité des situations initie des processus de sensemaking. Les schémas mentaux traditionnels de la relation d’emploi basés sur la confiance, la stabilité et la fidélité sont bousculés. A la sécurité d’emploi à long terme et la carrière interne se substitue la notion d’employabilité et de flexisécurité. Les employés essaient de percevoir et d’interpréter ce qui survient dans les organisations. Les « contract makers » viennent alors préciser et expliquer les changements dans les promesses et obligations du contrat psychologique entre l’employé et l’organisation. En cas d’échec, ce sont les « contract influencers » comme les syndicats qui viennent donner un sens qui n’est pas forcément celui attendu par le management… Les plans de restructuration avec réduction d’effectif se multiplient engendrant des processus de rupture et de violation du contrat psychologique et un climat social dégradé. Les processus de cession de site, l’absence de perspectives à long terme engendrent de l’incertitude et de l’inquiétude chez les salariés, des contrats psychologiques de transition sans garantie émergent et lorsque la situation perdure ces derniers sont susceptibles d’engendrer des comportements hostiles et déviants qui peuvent conduire à un contrat psychologique de défiance.La présente thèse étudie le processus de formation et d’évolution du contrat psychologique sous le prisme du sensemaking du personnel d’une entreprise agro-alimentaire de Dijon. Un cadre d’analyse contextualiste basé sur une méthode mixte quantitative et qualitative nous permet de suivre les processus de formation, d’évolution de rupture et de reconstruction du contrat psychologique et de comprendre comme les acteurs organisationnels construisent la réalité. / Globalization and economic crises, as well as the pressures of competition and customer demands, are forcing companies, in order to survive, to initiate changes and revise their promises and payment prospects, sometimes in a brutal way. Organizational boundaries are disintegrating, atypical or triangular relationships are developing, staffs feel weakened, and values are ?. The ambiguity of these situations initiates the processes of sensemaking. Traditional expectations based on trust, stability and fidelity are shaken up. Job security and long-term internal careers are being replaced by the concepts of employability and flexisecurity. Employees try to understand and to detect what is happening in organizations. « Contract makers » then come a long side to explain and to detail changes in the promises and obligations of the psychological contract between the employee and the organization. When this process fails, it is the « contract influencers » such as unions who give meaning, but is not necessarily the one the management expected... Restructuring plans which include downsizing lead to the increasing number of processes of rupture and violation of the psychological contract and down-grading in the social climate. The process of selling the site and, the lack of long-term prospects create uncertainty and anxiety among employees. Transitional psychological contracts with no guarantee conditions emerge and when this situation persists it is likely to generate hostile and deviant behaviors that can lead to distrust psychological contract.This thesis examines the process of forming and developing the psychological contracts through the prism of sensemaking, employees of a food company in Dijon. An analytical framework based on a contextualist quantitative and qualitative mixed method allows us to follow the process of establishing and developing rupture and reconstruction of psychological contracts, as well as to understand how people concerned in the organization construct reality.

Hintergrund. Exzessives Sorgen ist durch anhaltende, sich wiederholende negative Gedanken gekennzeichnet, die als aufdringlich und unkontrollierbar empfunden werden. Chronisches Sorgen kann zu einer schwer beeinträchtigenden mentalen Aktivität werden und es wird angenommen, dass es zur Entstehung, Aufrechterhaltung und Verschlechterung einer Reihe von somatischen Gesundheitsproblemen und psychischen Störungen beiträgt. Theoretische Modelle und empirische Befunde deuten darauf hin, dass exzessives Sorgen mit einer gestörten Bottom-up-Salienzverarbeitung, einer unzureichenden Top-down-Aufmerksamkeitssteuerung, Defiziten in der Emotionsregulation und abnormalen selbstreferenziellen mentalen Funktionen verbunden sind. Neuroimaging-Studien zu exzessivem Sorgen zeigen Veränderungen funktioneller Aktivierung und Konnektivität in limbischen und paralimbischen Hirnstrukturen, welche die Reaktivität auf emotionale Stimuli unterstützen, in präfrontalen Strukturen, die in Top-down-Prozesse involviert sind, welche der Aufmerksamkeitssteuerung und Emotionsregulation zugrunde liegen, und in medialen kortikalen Mittellinienstrukturen, die an selbstreferenziellen mentalen Aktivitäten beteiligt sind. Im Hinblick auf das Vorhandensein, die genaue Lokalisation der beteiligten Hirnareale und die Richtung der Effekte präsentieren diese Studien jedoch weitgehend heterogene Ergebnisse. Die hohe Variabilität der Befunde erschwert es, ein kohärentes Verständnis der neurobiologischen Mechanismen exzessiven Sorgens zu erlangen. Um dieses Verständnis zu erweitern und künftige Richtungen für die weitere Forschung auf diesem Gebiet aufzuzeigen, verfolgte die vorliegende Dissertationsschrift drei Ziele: (i) die emotionsbezogene, aufgabenbasierte fMRT-Literatur zu exzessivem Sorgen auf quantitative, datengesteuerte Weise zusammenzufassen, um konsistente funktionelle Störungen über Studien hinweg zu identifizieren; (ii) zu bestimmen, mit welchen psychologischen Prozessen die identifizierten Hirnregionen assoziiert sind, und in welchen funktionellen Hirnnetzwerken sie wirken; und (iii) Anomalien in der grundlegenden Hirnorganisation zu untersuchen, die mit exzessivem Sorgen assoziiert sind. Methoden. Eine State-of-the-Art koordinatenbasierte Meta-Analyse wurde unter Anwendung des Activation Likelihood Estimation (ALE) Algorithmus durchgeführt, um die Übereinstimmung zwischen 16 Neuroimaging-Experimenten zu bestimmen, die Veränderungen in der funktionellen Aktivität des Gehirns während der Verarbeitung emotionaler Inhalte zwischen Personen mit hoher und normaler Sorgenneigung berichten. Die identifizierten Regionen wurden mithilfe von Metadaten der funktionellen Magnetresonanztomographie (fMRT) hinsichtlich ihrer psychologischen Funktionen charakterisiert (Verhaltens-Charakterisierung). Zusätzlich wurde meta-analytic-connectivity modeling (MACM) verwendet, um ihre globalen funktionellen Konnektivitätsmuster zu bestimmen und so zugehörige Gehirnnetzwerke zu identifizieren. Schließlich wurde fMRT im Ruhezustand (resting-state) verwendet, um die funktionellen Konnektivitätsmuster zwischen 21 Personen mit hoher und 21 Personen mit normaler Sorgenneigung ohne einer aufgabenbezogenen Gehirnaktivierung zu vergleichen. Dispositionelle Sorgen wurden mit dem Penn State Worry Questionnaire als verlässliches Selbstauskunftsmaß für schwere Sorgen erhoben. Saatregion-basierte Analysen mit den meta-analytisch abgeleiteten Hirnregionen als Saatregionen und eine datengesteuerte Multi-Voxel-Pattern-Analyse (MVPA) wurden durchgeführt, um funktionelle Konnektivitätsunterschiede zwischen den beiden Gruppen zu detektieren. Darüber hinaus wurden gruppenüber-greifende Korrelationen zwischen dem aktuellen Sorgenausmaß (State-Sorgen) und den funktionellen Konnektivitätsmustern der Saat-Regionen sowie den aus der MVPA abgeleiteten Komponenten-Werten analysiert. Ergebnisse. Die Meta-Analyse ergab konvergente Anomalien bei Individuen mit hoher im Vergleich mit normaler Sorgenneigung, hauptsächlich in einem linkshemisphärischen Cluster, welcher Teile des mittleren frontalen Gyrus, des inferioren frontalen Gyrus und der anterioren Insula umfasst. Die Verhaltens-Charakterisierung zeigte, dass der identifizierte Cluster mit der Sprachverarbeitung und dem Gedächtnis assoziiert ist. Darüber hinaus ergaben die meta-analytischen Konnektivitätskartierungen starke funktionelle Verbindungen zwischen den beobachteten konvergenten Regionen und frontalen, temporalen und parietalen Hirnregionen, die sich mit Teilen von zwei verhaltensrelevanten Hirnnetzwerken überschneiden, nämlich dem Salienznetzwerk (SN) und dem Default-Netzwerk (DN). Die resting-state funktionellen Konnektivitätsanalysen zeigten keine Unterschiede zwischen Individuen mit hoher und normaler Sorgenneigung und auch keine Korrelationen zwischen den resting-state funktionellen Konnektivitätsmustern und State-Sorgen, weder mit dem auf Saatregionen basierenden Ansatz noch mit dem MVPA-Ansatz. Schlussfolgerungen. Die Ergebnisse dieser Dissertationsschrift deuten darauf hin, dass exzessives Sorgen mit einer gestörten Funktion in Hirnarealen zusammenhängt, die mit bottom-up und top-down Aufmerksamkeitssteuerung sowie Emotionserzeugung und Emotionsregulation in Verbindung gebracht werden. Die Verhaltensanalyse deckte Assoziationen zwischen dem identifizierten Cluster und der Sprachverarbeitung auf, die mit dem übermäßigen inneren Sprechen bei zu Sorgen neigenden Personen zusammenhängen könnten. Diese Assoziation ist bisher eher unbeachtet geblieben und sollte weiter erforscht werden. Darüber hinaus stellen die identifizierten Hirnregionen Schlüsselknoten in interagierenden neuronalen Netzwerken dar, die endogen und exogen orientierte Kognition unterstützen und das dynamische Zusammenspiel zwischen diesen Prozessen steuern. Ihre veränderte netzwerkübergreifende Dynamik könnte die Ursache für die Unfähigkeit von zu schweren Sorgen neigen-den Personen sein, sich von intern orientierten Kognitionen zu lösen, wenn adaptives Reagieren einen externen Fokus der Aufmerksamkeit erfordern würde. Die Nullergebnisse der Ruhezustandsanalysen könnten auf das Studiendesign zurückzuführen sein oder durch Charakteristika des Sorgens selbst verursacht werden, werden aber nicht als Beleg dafür interpretiert, dass Anomalien in der intrinsischen Konnektivität des Gehirns in Verbindung mit exzessivem Sorgen nicht vorhanden sind. Die Ergebnisse dieser Arbeit können zukünftige Forschungen anleiten, die z.B. untersuchen könnten, ob und wie sich die dynamischen zeitlichen Interaktionen innerhalb und zwischen den hier identifizierten Netzwerken in Abhängigkeit vom Schweregrad des Sorgens unterscheiden. Die ALE-Ergebnisse liefern eine A-priori-Auswahl von Hirnregionen für solche Studien. Ein besseres Verständnis der Veränderungen in den Gehirnnetzwerken, die exzessivem Sorgen zugrunde liegen, und der psychologischen Funktionen, die dadurch beeinträchtigt werden, wird Ansatzpunkte für die Verbesserung therapeutischer Interventionen liefern.:Contents TABLES VIII FIGURES IX ABBREVIATIONS X ABSTRACT 1 1 THEORETICAL BACKGROUND 6 1.1 WORRY 6 1.1.1 DEFINITION, NATURE AND FUNCTION OF WORRY 6 1.1.2 THE WORRY CONTINUUM – NORMAL VERSUS MALADAPTIVE WORRY 7 1.1.3 THE DELETERIOUS EFFECTS OF EXCESSIVE WORRY 8 1.1.4 THEORETICAL MODELS OF EXCESSIVE WORRY 11 1.2 FUNCTIONAL BRAIN NETWORKS AND EXCESSIVE WORRY 18 1.2.1 A SYSTEMS NEUROSCIENCE VIEW OF EXCESSIVE WORRY 18 1.2.2 EMPIRICAL EVIDENCE: FMRI STUDIES ON EXCESSIVE WORRY 20 1.3 RESEARCH QUESTION 32 2 STUDY I: A QUANTITATIVE META-ANALYSIS OF FMRI STUDIES INVESTIGATING EMOTIONAL PROCESSING IN EXCESSIVE WORRIERS: APPLICATION OF ACTIVATION LIKELIHOOD ESTIMATION ANALYSIS 35 2.1 ABSTRACT 36 2.2 INTRODUCTION 37 2.3 METHODS 40 2.3.1 LITERATURE SEARCH AND STUDY SELECTION 40 2.3.2 ACTIVATION LIKELIHOOD ESTIMATION 46 2.3.3 META-ANALYTIC CONNECTIVITY MODELING 47 2.3.4 ANALYSIS OF BEHAVIORAL DOMAIN PROFILES 47 2.4 RESULTS 48 2.4.1 SIGNIFICANT ALE CLUSTERS 48 2.4.2 FUNCTIONAL CONNECTIVITY OF THE DERIVED ALE-CLUSTER – MACM-ANALYSIS 51 2.4.3 FUNCTIONAL CHARACTERIZATION OF THE DERIVED ALE-CLUSTER – BEHAVIORAL ANALYSIS 54 2.5 DISCUSSION 55 2.6 CONCLUSION 59 2.7 SUPPLEMENTARY MATERIAL STUDY I: LISTING OF ALE CLUSTERS SIGNIFICANT AT P < 0.001 UNCORRECTED, CLUSTER SIZE > 100MM3 60 3 STUDY II: HIGH AND LOW WORRIERS DO NOT DIFFER IN UNSTIMULATED RESTING-STATE BRAIN CONNECTIVITY 61 3.1 ABSTRACT 62 3.2 INTRODUCTION 63 3.3 MATERIALS AND METHODS 65 3.3.1 PARTICIPANTS AND PROCEDURE 65 3.3.2 FMRI DATA ACQUISITION 66 3.3.3 SELF-REPORT ASSESSMENTS AND STATE WORRY ASSESSMENT 66 3.3.4 STATISTICAL ANALYSES 67 3.4 RESULTS 69 3.4.1 SELF-REPORT MEASURES 69 3.4.2 FMRI RESULTS 72 3.5 DISCUSSION 72 3.6 CONCLUSION 75 3.7 SUPPLEMENTARY MATERIAL STUDY II: STATE WORRY ASSESSMENT 75 4 GENERAL DISCUSSION 76 4.1 CONVERGENT ABERRANT FUNCTION IN THE MFG-IFG-INSULA-CLUSTER 76 4.2 META-ANALYTIC FUNCTIONAL CHARACTERIZATION AND CONNECTIVITY MAPPING OF THE MFG-IFG-INSULA CLUSTER 82 4.3 NO RESTING-STATE FUNCTIONAL CONNECTIVITY DIFFERENCES BETWEEN HW AND LW 84 4.4 STRENGTHS AND LIMITATIONS 87 4.5 FUTURE DIRECTIONS 90 4.6 CONCLUSION 91 REFERENCES 92 APPENDIX: DECLARATION OF HONOUR / EIGENSTÄNDIGKEITSERKLÄRUNG 131 / Background. Excessive worry is characterized by persistent, repetitive negative thoughts that are perceived as intrusive and uncontrollable. Chronic worrying can become a severely debilitating mental activity and is thought to contribute to the development, maintenance and deterioration of a range of somatic health problems and mental disorders. Theoretical accounts and empirical findings suggest that excessive worry is associated with impaired bottom-up salience-processing, insufficient top-down attentional control, deficits in emotion regulation and abnormal self-referential mental functions. Neuroimaging studies of excessive worry indicate functional activation and connectivity alterations in limbic and paralimbic brain structures that support reactivity to emotional stimuli, in prefrontal structures implicated in top-down processes underlying attentional control and emotion regulation, and in cortical midline structures involved in self-referential mental activity. However, with regard to the presence, the exact localization of the brain areas involved and the directionality of the effects, these studies have presented largely heterogenous results. The high variability of findings makes it difficult to achieve a coherent understanding of the neurobiological mechanisms of excessive worry. To extend this understanding and provide future directions for continued research in this area, the aim of this thesis was threefold: (i) to synthesize the emotional task-based fMRI literature on excessive worry in a quantitative, data-driven manner for the purpose of identifying consistent functional perturbations across studies; (ii) to determine the psychological processes with which the identified brain regions are associated and the functional brain networks in which they operate; and (iii) to examine abnormalities in basic brain organization associated with excessive worry. Methods. A state-of-the-art coordinate-based meta-analysis was conducted applying the activation likelihood estimation (ALE) algorithm to determine concordance among 16 neuroimaging experiments reporting alterations in brain functional activity during emotional processing between individuals experiencing high versus normal levels of worry. The identified regions were behaviorally characterized using functional magnetic resonance imaging (fMRI) metadata. Additionally, meta-analytic-connectivity modeling (MACM) was used to determine their global functional connectivity (FC) patterns and thus identify related brain networks. Finally, resting-state fMRI was used to compare FC patterns between 21 high and 21 low worriers in the absence of task-related brain activation. Dispositional worry was assessed using the Penn State Worry Questionnaire as a reliable self-report measure of severe worry. Seed-based analyses with the meta-analytically derived brain regions as seeds and a data-driven multi-voxel pattern analysis (MVPA) were performed to detect FC differences between the two groups. In addition, cross-group correlations between state worry levels and the FC patterns of the seed regions as well as the MVPA-derived component scores were analyzed. Results. The meta-analysis revealed convergent aberrations in high compared to normal worriers mainly in a left-hemispheric cluster comprising parts of the middle frontal gyrus, inferior frontal gyrus and anterior insula. Behavioral characterization indicated the identified cluster to be associated with language processing and memory. Furthermore, meta-analytic connectivity mapping yielded strong functional connections between the observed convergent regions and frontal, temporal, and parietal brain regions that overlap with parts of two behaviorally relevant brain networks, specifically the salience network (SN) and the default network (DN). The resting-state FC (rsFC) analyses revealed no differences between high and normal worriers and also no correlations between rsFC patterns and state worry, neither using the seed-based nor the MVPA approach. Conclusions. The results of this thesis indicate that excessive worry is related to disturbed functioning in brain areas that have been related to bottom-up and top-down attentional control as well as emotion generation and regulation. Behavioral analysis uncovered associations between the identified cluster and language processing that might be related to the exaggerated inner speech processes in worry prone individuals. This association has so far remained rather unnoticed and requires further exploration. Moreover, the identified brain regions constitute key nodes within interacting neural networks that support internally and externally oriented cognition and control the dynamic interplay among these processes. Their altered cross-network dynamics may underlie the inability of worry-prone individuals to disengage from internally oriented cognitions when adaptive responding would require an external focus of attention. The null-findings of the resting-state analyses might be due to the study design or caused by characteristics of worry itself, but are not interpreted as evidence that abnormalities in the brain's intrinsic connectivity associated with excessive worrying are absent. The results of this thesis may guide future research that could, for example, investigate whether and how the dynamic temporal interactions within and between the networks identified here differ depending on the severity of worry. The ALE results provide an a priori selection of brain regions for such studies. Increasing our understanding of the aberrations in brain networks that underlie excessive worry and the psychological functions that are impaired as a result will provide targets for improving therapeutic interventions.:Contents TABLES VIII FIGURES IX ABBREVIATIONS X ABSTRACT 1 1 THEORETICAL BACKGROUND 6 1.1 WORRY 6 1.1.1 DEFINITION, NATURE AND FUNCTION OF WORRY 6 1.1.2 THE WORRY CONTINUUM – NORMAL VERSUS MALADAPTIVE WORRY 7 1.1.3 THE DELETERIOUS EFFECTS OF EXCESSIVE WORRY 8 1.1.4 THEORETICAL MODELS OF EXCESSIVE WORRY 11 1.2 FUNCTIONAL BRAIN NETWORKS AND EXCESSIVE WORRY 18 1.2.1 A SYSTEMS NEUROSCIENCE VIEW OF EXCESSIVE WORRY 18 1.2.2 EMPIRICAL EVIDENCE: FMRI STUDIES ON EXCESSIVE WORRY 20 1.3 RESEARCH QUESTION 32 2 STUDY I: A QUANTITATIVE META-ANALYSIS OF FMRI STUDIES INVESTIGATING EMOTIONAL PROCESSING IN EXCESSIVE WORRIERS: APPLICATION OF ACTIVATION LIKELIHOOD ESTIMATION ANALYSIS 35 2.1 ABSTRACT 36 2.2 INTRODUCTION 37 2.3 METHODS 40 2.3.1 LITERATURE SEARCH AND STUDY SELECTION 40 2.3.2 ACTIVATION LIKELIHOOD ESTIMATION 46 2.3.3 META-ANALYTIC CONNECTIVITY MODELING 47 2.3.4 ANALYSIS OF BEHAVIORAL DOMAIN PROFILES 47 2.4 RESULTS 48 2.4.1 SIGNIFICANT ALE CLUSTERS 48 2.4.2 FUNCTIONAL CONNECTIVITY OF THE DERIVED ALE-CLUSTER – MACM-ANALYSIS 51 2.4.3 FUNCTIONAL CHARACTERIZATION OF THE DERIVED ALE-CLUSTER – BEHAVIORAL ANALYSIS 54 2.5 DISCUSSION 55 2.6 CONCLUSION 59 2.7 SUPPLEMENTARY MATERIAL STUDY I: LISTING OF ALE CLUSTERS SIGNIFICANT AT P < 0.001 UNCORRECTED, CLUSTER SIZE > 100MM3 60 3 STUDY II: HIGH AND LOW WORRIERS DO NOT DIFFER IN UNSTIMULATED RESTING-STATE BRAIN CONNECTIVITY 61 3.1 ABSTRACT 62 3.2 INTRODUCTION 63 3.3 MATERIALS AND METHODS 65 3.3.1 PARTICIPANTS AND PROCEDURE 65 3.3.2 FMRI DATA ACQUISITION 66 3.3.3 SELF-REPORT ASSESSMENTS AND STATE WORRY ASSESSMENT 66 3.3.4 STATISTICAL ANALYSES 67 3.4 RESULTS 69 3.4.1 SELF-REPORT MEASURES 69 3.4.2 FMRI RESULTS 72 3.5 DISCUSSION 72 3.6 CONCLUSION 75 3.7 SUPPLEMENTARY MATERIAL STUDY II: STATE WORRY ASSESSMENT 75 4 GENERAL DISCUSSION 76 4.1 CONVERGENT ABERRANT FUNCTION IN THE MFG-IFG-INSULA-CLUSTER 76 4.2 META-ANALYTIC FUNCTIONAL CHARACTERIZATION AND CONNECTIVITY MAPPING OF THE MFG-IFG-INSULA CLUSTER 82 4.3 NO RESTING-STATE FUNCTIONAL CONNECTIVITY DIFFERENCES BETWEEN HW AND LW 84 4.4 STRENGTHS AND LIMITATIONS 87 4.5 FUTURE DIRECTIONS 90 4.6 CONCLUSION 91 REFERENCES 92 APPENDIX: DECLARATION OF HONOUR / EIGENSTÄNDIGKEITSERKLÄRUNG 131

Background: Worry exposure (WE) is a core element of cognitive-behavioral treatment for generalized anxiety disorder (GAD). Its efficacy as a stand-alone treatment method (without further cognitive-behavioral therapy interventions) has never been tested.We aimed to examine whether WE alone is as efficacious as the empirically supported stand-alone treatment for GAD, applied relaxation (AR). Methods: In a randomized controlled study, 73 outpatients meeting DSM-IV criteria for GAD as primary diagnosis were allocated to either WE or AR or a waiting list control group; in a 2nd randomization procedure the waiting list subjects were reallocated to WE or AR. The treatment was manualized (15 sessions with WE or AR), included 6-month and 1-year follow-ups, as well as last observation carried forward and completer analyses, and was controlled for allegiance effects.The Hamilton Anxiety Rating Scale and the State-Trait Anxiety Scale were used as primary outcome measures. Self-report scales of anxiety, worrying and depression including negative metacognition about worrying and thought suppression served as secondary outcome measures. Results: The dropout rate was moderate. The pre-/posttreatment effects were high for the Hamilton Anxiety Rating Scale (standardized mean difference >1) and for the State-Trait Anxiety Inventory (standardized mean difference >0.87). The proportion of patients reaching high end state functioning was 48% (WE) and 56% (AR). WE and AR did not differ with regard to dropout rate or treatment effects. The treatment effects were stable at 6 month and 1 year follow-up. Conclusion: This is the first study to show that a stand-alone exposure in sensu technique – WE – is efficacious in the treatment of GAD. Both AR and WE seem to represent effective principles of change in GAD. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Syftet med studien var att genom en statistisk analys och ur ett riskkommunikationsperspektiv undersöka informationens roll för riskuppfattning och upplevelse av oro kring pågående dödligt våld (PDV) hos studenter vid lärosäten i Sverige. I studien innefattar informationens roll beteenden kopplade till informationssökning, information som trygghetsskapande faktor och informationsbehov. I studien genomfördes en enkätundersökning som 120 studenter vid ett lärosäte besvarade. Genom en statistisk analys analyserades studiens forskningsfrågor utifrån aspekter kring informationskonsumtion, riskuppfattning, tillit och oro för att undersöka informationens roll. Studiens teoretiska ramverk bestod av teorier och begrepp från riskkommunikationsforskning (riskuppfattning) samt teorier och begrepp relaterade till informationskonsumtion (informationsundvikande, uncertainty reduction theory och risk information seeking and processing model). Resultatet i studien visade att de studenter som är oroliga och som söker information kring PDV är de studenter som i störst utsträckning anser sig ha kunskap om ämnet, däremot fanns det inte ett enskilt samband mellan ökad oro och att söka information. Individer som förväntas besitta kunskap om PDV, söker i större utsträckning mer information om ämnet. Studenterna i studien har inte fått information kring PDV från sitt lärosäte, men vill generellt få mer information och tror att information kan göra dem tryggare. Studenterna känner generellt tillit till lärosätet, trots att de inte fått någon information om PDV. De som känner tillit till lärosätet skulle vilja söka information om PDV hos dem, medan de som inte känner tillit söker mer information på egen hand. Vidare uppmuntras forskning där det undersöks vilken roll andras förväntan på individens kunskaper om risker spelar för individens informationskonsumtion. / The purpose of this study was to investigate the role of information for the risk perception and worry regarding ongoing deadly violence (ODV) that students at Swedish schools experience. The role of information regards behaviours in relation to information seeking, information need and information as a way to reduce worry. In the study, a web survey was conducted in which 120 students at a Swedish school participated. Through a statistical analysis, the research questions were analysed from aspects regarding information consumption, risk perception, trust and worry to investigate the role information plays. The theoretical framework for this study consisted of theories and concepts from the risk communication research field (such as risk perception), but it also consisted of theories and concepts related to information consumption (such as information avoidance, uncertainty reduction theory, and risk information seeking and processing model). The result of this study indicated that students who worry and seek information about ODV believe that they possess knowledge about the subject. However, no correlation between a higher level of worry and increased information seeking was shown. The individuals that feel a greater responsibility to have knowledge about ODV seek more information. The students in this study have not been given information about ODV from their school, but generally want to get more information and believe that information could make them less worried. Those who trust the school would seek information about ODV from the school, while the ones that do not trust the school tend to seek more information by themselves. Furthermore, we encourage further research that aim to investigate which role the expectations of others regarding expected knowledge play for the level of knowledge that individuals possess about risks and their information consumption.

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is a popular measure of psychosocial functioning and psychopathology in the assessment of individuals in a variety of settings. However, the method of construction employed with the MMPI more than 60 years ago with psychiatric patients challenges the applicability of the scales for determining the psychosocial functioning of individuals from different settings. The restandardisation conducted in 1987 made no effort to eradicate the item overlap that was a result of the criterion keying method with contrasted groups. Although restandardized and updated with more contemporary language and content, the original psychiatric constructs were retained in order to maintain continuity with its predecessor. The aims of this investigation were to develop a new structure for the MMPI-2 constructed at the item-level, empirically derived and which specifically represents the dimensions that are relevant and appropriate in evaluating the psychosocial functioning of personal injury claimants. This task included comparisons with a comparable scale-level analysis and developing optimal scoring strategies where items in components and facets are allocated weightings based upon their strength of association. Study 1 was conducted using a sample of 2989 personal injury claimants assessed in Australia and the United States of America. The final sample of 3230, included 241 normal individuals, was utilized to develop a scale-level structure from 79 standard MMPI-2 scales and subscales. A nine-component solution consisting of General Maladjustment /Emotional Distress, Asocial Beliefs, Social Vulnerability, Somatic Complaints, Psychological Disturbance, Impulsive Expression, Antisocial Practices, Stereotypic Fears and Family Difficulties was derived using principal component analysis. However, intercorrelation between components in the structure signaled the need to develop a structure that would eradicate problems that were perpetuated by item overlap. The second study was conducted with a set of best practice procedures with the same clinical sample of 2989 personal injury claimants as Study 1. Forty-one components were derived through principal component analysis. Through the application of a set of criteria, a 35-component solution was retained. The pattern coefficients from the allocation of items to components determined the weightings to be applied to each item. Further analysis of the 35 components derived a substructure of 37 facets. The 35 components included only 442 of the 567 items, with the reliability coefficients of the first 25 components that ranged between .5 and .97, and the remaining 10 components that ranged from .29 to .49. The latter unreliable components were not included in the final Structural Summary, leaving 25 components (400 items) and their 33 facets for interpretation. Hence, in demonstrating the utility of the newly-derived structure, only 25 components and their 33 facets were interpreted. The 25 components were grouped conceptually into six domains. In the emotional domain were Psychological Distress (PsyDist), Anger, Fears, Psychotic Symptoms (PsyS), Paranoia (Par), Irritability (Irrit), Elation (Elat), Fear of the Dark (FD), and Financial Worry (FinWo). Somatic Complaints (SomC), Sexual Concerns (SexCon), and Gastrointestinal Problems (GasP) made up the measures in the physiological domain. In the behavioural domain were Cognitive Difficulties (CogDiff), Stimulus-Seeking (StimuS), Discipline (Dis), and Delinquency (Del) whilst the interpersonal domain was formed by Social Withdrawal (SoW), Negative Interpersonal Attitude (NIA), Timidity (Tim), Lie, Dissatisfaction with Self (DWS) and Family Relationship Difficulties (FReD). Alcoholism (Alco) was the only measure in the substance abuse domain, and the gender domain was comprised of Masculinity (Mas) and Femininity (Fem). The third study established preliminary normative means and standard deviations using a small opportunistic Australian university student sample (N = 219). No substantial gender differences were found but gender norms were maintained to facilitate comparisons with the traditional MMPI-2 approach. Comparisons of frequency of 'true' item response between the Australian university student sample and the U.S. restandardisation sample found relatively little differences and permitted evaluation of between sample differences on components and facets. The utility of the structure was demonstrated with the illustration of two clinical case examples, and a comparison was made with the standard MMPI-2 scales and subscales. The Structural Summary for the MMPI-2 demonstrated discriminative measures of psychosocial functioning that were a result of no item overlap, and the ability to attend to the different levels of intensity of self-report items because of differential weightings.

No description available.