Gastrointestinale Tumorpatienten leiden bei ihrer Akutaufnahme im Krankenhaus und in der sich anschließenden Chemotherapie unter somatischen, psychischen und sozialen Belastungen, die sie psychoonkologisch behandlungsbedürftig erscheinen lassen. Bei 60 % dieser Patienten wurde ein solcher Behandlungsbedarf festgestellt. Das Anliegen der Arbeit war es, neben der Ermittlung des psychoonkologischen Betreuungsbedarfs, die Teilnahmebereitschaft dieser Patienten an einer psychoonkologischen Intervention festzustellen und zwei unterschiedliche Therapieverfahren (kognitiv-verhaltenstherapeutisch ausgerichtete Gesprächstherapie und Entspannungstherapie in Form einer progressiven Muskelrelaxation) mit einer Kontrollgruppe (Darreichung von Informationsmaterial über das Krankheitsbild) zu vergleichen. Es konnte ein positiver Effekt der Intervention, besonders der Gesprächstherapie, auf die Reduktion der Angst und Depression bei hoch belasteten Tumorpatienten nachgewiesen werden. Der Betreuungsbedarf derjenigen Patienten, die nur Informationsmaterial über die bösartige Krankheit erhielten, veränderte sich dagegen in der Zeit ihrer Chemotherapie nicht. Verlaufsabhängig konnte gezeigt werden, dass die Veränderung des psychoonkologischen Betreuungsbedarfs bereits kurz nach der Intervention einsetzt. Es gab aber auch Patienten, die erst im Verlauf der Intervention während der Chemotherapie einen psychoonkologischen Betreuungsbedarf entwickelten, den sie zu Beginn der Untersuchung nicht hatten. Auch diese Patienten konnten durch die psychotherapeutischen Interventionsmaßnahmen erfolgreich behandelt werden. / Gastrointestinal cancer patients who are hospitalized and receiving chemotherapy suffer from somatic, psychological, and social stresses that can be counteracted with psycho-oncological treatment. In fact, 60% of this population has been found to be in need of such services. The aim of this study was to determine how many patients in need of these services would be willing to participate in a psychosocial intervention, and to compare the outcomes of groups receiving two different therapeutic approaches (cognitive behavioral talk therapy and relaxation therapy in the form of a progressive muscle relaxation) with those of a control group, who were simply given written materials about their illness that included information on relevant psychosocial issues. The interventions, especially the talk therapy, were observed to have a positive effect on alleviating depression and anxiety in highly burdened cancer patients. The patients who only received written information about their disease showed no changes in the degree to which they needed psycho-oncological support over the time they were receiving chemotherapy. While some patients experienced improvements soon after the interventions had begun, there were also cases of patients who hadn’t initially exhibited a need for psycho-oncological support but later came to develop this need over the course of undergoing chemotherapy. These patients were also successfully treated through the psychotherapeutic interventions.

Die jährliche Inzidenz von Krebserkrankungen liegt in Deutschland bei 450.000. Angst und Depression können zu jedem Zeitpunkt als Folge der Erkrankung selbst, aber auch der oft schwerwiegenden Behandlungen auftreten. In Studie 1 wurde der Frage nach der Wirksamkeit psychoonkologischer Interventionen im perioperativen Setting nachgegangen. 132 Patienten wurden anhand des kritischen Wertes von 12 in der HADS entweder in eine low-risk- oder eine high-risk-Gruppe eingeteilt. Innerhalb jeder Gruppe wurden diese in einen Arm mit Intervention und in einen Arm ohne Intervention randomisiert. Am Ende des stationären Aufenthaltes wurden Angst und Depression erneut erfasst. Es konnte eine Reduktion von Angst und Depression bei psychisch hoch belasteten Patienten bereits während des stationären Aufenthaltes durch psychoonkologische Intervention nachgewiesen werden. Studie 2 untersuchte die Frage nach der Wirksamkeit zwei verschiedener psychoonkologischer Interventionen. Dazu sollten die Effekte eines einmaligen Gespräches und einer einmaligen Entspannung vergleichend analysiert werden. Die Besonderheit dieser Studie liegt in der Erfassung sowohl subjektiver als auch objektiver Stressparameter. Die Einteilung in low-risk- und high-risk-Gruppe erfolgte analog zu Studie 1. In diese Studie konnten 45 Patientinnen eingeschlossen werden. Innerhalb der high-risk-Gruppe erfolgte die Randomisierung in die Interventionsarme. Beide Interventionen führten zu Reduktion von Angst und Depression. Das Gespräch zeigte sich bezüglich Depression wirksamer. Hinsichtlich subjektiv und objektiv gemessener Stressparameter ergab sich ein Vorteil für den Entspannungsarm. Die Resultate geben jedoch Hinweise darauf, dass bei über einem Drittel der Patientinnen eine einmalige Intervention nicht ausreichend ist. Die Ergebnisse beider Studien werden zusammengefasst und aus stresstheoretischer Sicht diskutiert. Daran schließen sich Empfehlungen für die Praxis und weitere notwendige Untersuchungen. / In Germany the annual incidence rate of cancer is 450,000. Anxiety and depression can occur at any time point as a consequence of the disease itself or as a result of severe therapies. In study 1 the efficacy of psycho-oncological interventions in a peri-surgical setting has been analysed. 132 patients beginning inpatient treatment at a hospital specializing in surgical oncology were either classified as ‘low-risk’ or ‘high-risk’, according to the HADS. Patients from both categories were then randomly placed in either an ‘intervention’ group or an ‘observation’ group. Anxiety and depression levels were measured again prior to the patients discharge from the department of surgical oncology. Thereby a reduction of anxiety and depression in patients with a severe psychological burden has been demonstrated, already during their inpatient stay. Study 2 explored the question if there are any differences in the efficacy of two psycho-oncological interventions. The effects of a single therapy session versus a non-recurring relaxation have been analysed in this present study. The distinctiveness of this study is the collection of subjective and objective stress parameters. The classification in high-risk or low-risk-group took place according to study 1. Both interventions lead to a reduction in anxiety and depression. An advantage concerning depression was found in the conversation arm. With regards to the subjectively and objectively measured stress parameters, an advantage in the relaxation arm has been observed. In cancer patients with a severe psychological burden, psycho-oncological interventions in an inpatient setting represent instrumental support as part of interdisciplinary care. Nonetheless, the results suggest that in more than one third of patients a non-recurring intervention is not sufficient. The findings of both studies are summarised and discussed from a stress-theoretical viewpoint, followed by recommendations on further necessary examinations.

Made available in DSpace on 2016-04-25T19:20:45Z (GMT). No. of bitstreams: 1 Maria Cristina Mariante Guarnieri.pdf: 1263043 bytes, checksum: 5a8109dd8162f2900b878d027f998959 (MD5) Previous issue date: 2006-12-12 / This thesis studies angst as a religious philosophical concept beside the importance of the religious thinker as a comprehension method for religion. Regarding this, it takes as object the religious thinkers Franz Rosenzweig, Sören A. Kierkegaard and the wise man Qohelet, of the Old Testament, whose reflections indicate the presence of angst. The hypothesis that guides this work is that, in these thinkers, this presence, due to the relationship with the transcendent, manifests itself as conceptual tension which produces knowledge. In view of this hypothesis, the intention is to discuss the possibility of building knowledge from religion itself. Angst, then, is the affection that, in these authors, indicates a tension between immanence and transcendence, realizing the human finitude and the infinite possibility, the absolute lack of meaning and the establishment of a multiplicity of meanings. It is a productive agony that serves as hard task in the search for knowledge. Giving priority to the subjectivity and the concreteness of the existence, the authors here worked make an effort to understand the human being, unique is his or her suffering. The angst as key for thinking about the human condition is born from the perception of its own aporia, discovery starting from the first inquiry about the meaning of life / Essa tese estuda a angústia como conceito filosófico religioso ao lado da importância do pensador religioso como método de compreensão da religião. Para isso, toma como objeto os pensadores religiosos Franz Rosenzweig, Sören A. Kierkegaard e o sábio Qohelet, do Antigo Testamento, cujas reflexões indicam a presença da angústia. A hipótese que norteia este trabalho é que, nesses pensadores, esta presença, devido à relação com o transcendente, manifesta-se como tensão conceitual produtora de conhecimento. Face a essa hipótese, a intenção é discutir a possibilidade de construção do conhecimento a partir da própria religião. A angústia, então, é o afeto que, nestes autores, indica uma tensão entre a imanência e transcendência, entre a constatação da finitude humana e a possibilidade infinita, entre a falta de sentido absoluta e a constatação da multiplicidade de sentidos. Uma agonia produtiva que serve de árdua tarefa na busca do conhecimento. Priorizando a subjetividade e a concretude da existência, os autores aqui trabalhados se esforçam para compreender o humano que é único em seu sofrimento. A angústia como chave de pensamento sobre a condição humana nasce da percepção da própria aporia, descoberta a partir da indagação primeira sobre o sentido da vida

Special Topics in Calamity Physics (2006) by Marisha Pessl and Das Blütenstaubzimmer (1997) by Zoё Jenny both feature strong female characters who go through difficult times because they experience genuine disillusionment with regard to their friends, the opposite sex, and, especially, their family. The focus of this thesis was to analyze if the authors depict their characters in such a way that one can see correlations between the emotional behavior of these characters and a phenomenon that is often referred to as adolescent angst. The theoretical foundation for defining adolescent angst and for understanding mechanisms that trigger adolescent angst was provided by Rapoport and Ismond’s internationally appraised DSM-IV Training Guide for Diagnosis of Childhood Disorders (1996) and Reinherz et al.’s ground-breaking study on „Depressive Disorders“ (2006). In my thesis, I was able to show that the depictions of difficult relationships between the protagonists and their parents and friends show characteristics of adolescent angst. Contrary to that, positive influences like reliable friends who are understanding and lend support, function as motivational forces which decrease the protagonists’ anxieties and frustration in both texts. The analysis of the final scenes showed that after all hardships, the protagonists do not give up hope and open themselves up to a once unimaginable future. Although Pessl and Jenny dismiss the concept of a clear didaxis in their texts, they nevertheless imply a motivational message; namely that adolescent angst can be conquered and overcome. I was able to demonstrate that the concept of adolescent angst serves as a catalyst for the development of the protagonists in both Special Topics in Calamity Physics and Das Blütenstaubzimmer . The bestseller status of both novels underlines that the authors’ decision to conclude these novels which are centered around adolescent angst with an open ending seems to cater to a modern young adult readership, especially within the context of pop culture.

Background: Although it is well established that chronic somatic diseases are significantly associated with a wide range of psychopathology, it remains unclear to what extent subjects with chronic somatic diseases are at increased risk of experiencing mental disorders. The present epidemiological study investigates age- and sex-adjusted 12-month prevalence rates of mental disorders in patients with cancer, and musculoskeletal, cardiovascular and respiratory tract diseases, based on comprehensive physicians’ diagnoses and compared with physically healthy probands. Methods: Prevalence rates were calculated from two large epidemiological surveys. These studies investigated inpatients and patients from the general population with cancer (n = 174) and musculoskeletal (n = 1,416), cardiovascular (n = 915) and respiratory tract diseases (n = 453) as well as healthy controls (n = 1,083). The prevalence rates were based on the Munich Composite International Diagnostic Interview, a standardized interview for the assessment of mental disorders. Results: Prevalence rates were very similar for inpatients (43.7%) and patients from the general population (42.2%). The adjusted odds ratios (OR) of patients with chronic somatic diseases were significantly elevated for mental disorders in comparison with healthy probands (OR: 2.2). Mood, anxiety and somatoform disorders were most frequent. The prevalence rates did not differ significantly between the somatic index diseases. The number of somatic diseases per patient had a higher association with mental disorders. Conclusions: There is a strong relationship between chronic somatic diseases and mental disorders. A future task is to improve the care of mental disorders in patients with chronic physical illness, specifically with multimorbid conditions.

Objective: To examine the association between separation anxiety disorder (SAD) and mental disorders in a community sample and to evaluate whether separation anxiety is specifically related to panic disorder with and without agoraphobia. Method: The data come from a 4-year, prospective longitudinal study of a representative cohort of adolescents and young adults aged 14–24 years at baseline in Munich, Germany. The present analyses are based on a subsample of the younger cohort that completed baseline and two follow-up investigations (n = 1,090). DSM-IV diagnoses were made using the Munich Composite International Diagnostic Interview. Cox regressions with time-dependent covariates were used to examine whether prior SAD is associated with an increased risk for subsequent mental disorders. Results: Participants meeting DSM-IV criteria for SAD were at an increased risk of developing subsequent panic disorder with agoraphobia (PDAG) (HR = 18.1, 95% CI = 5.6–58.7), specific phobia (HR = 2.7, 95% CI = 1.001–7.6), generalized anxiety disorder (HR = 9.4, 95% CI = 1.8–48.7), obsessive-compulsive disorder (HR = 10.7, 95% CI = 1.7–66.1), bipolar disorder (HR = 7.7, 95% CI = 2.8–20.8), pain disorder (HR = 3.5, 95% CI = 1.3–9.1), and alcohol dependence (HR = 4.7, 95% CI = 1.7–12.4). Increased hazard rates for PDAG (HR = 4.2, 95% CI = 1.4–12.1), bipolar disorder type II (HR = 8.1, 95% CI = 2.3–27.4), pain disorder (HR = 1.9, 95% CI = 1.01–3.5), and alcohol dependence (HR = 2.1, 95% CI = 1.1–4.) were also found for subjects fulfilling subthreshold SAD. Conclusions: Although revealing a strong association between SAD and PDAG, our results argue against a specific SAD-PDAG relationship. PDAG was neither a specific outcome nor a complete mediator variable of SAD.

We examined parental psychopathology and family environment in subthreshold and DSM-IV threshold conditions of social anxiety disorder (SAD) in a representative cohort sample of 1,395 adolescents. Offspring and parental psychopathology was assessed using the DIAX/ M-CIDI; recalled parental rearing and family functioning via questionnaire. Diagnostic interviews in parents were supplemented by family history reports from offspring. The cumulative lifetime incidence was 23.07% for symptomatic SAD, and 18.38 and 7.41% for subthreshold and threshold SAD, respectively. The specific parent-tooffspring association for SAD occurred for threshold SAD only. For subthreshold and threshold SAD similar associations were found with other parental anxiety disorders, depression and substance use disorders. Parental rearing behaviour, but not family functioning, was associated with offspring threshold SAD, and although less strong and less consistent, also with subthreshold SAD. Results suggest a continued graded relationship between familial risk factors and offspring SAD. Parental psychopathology and negative parental styles may be used defining high-risk groups to assign individuals with already subthreshold conditions of SAD to early intervention programs.

Accumulating evidence suggests that the magnetic resonance imaging (MRI) scanner can act as a stressor, eliciting subjective and neuroendocrine stress responses. Approaches to familiarize subjects with the scanner could help minimizing unintended effects on neural activation patterns of interest. Controlled studies on the effects of a scanner training are however missing. Using a comparative design, we analyzed within- and between session changes in subjective and neuroendocrine stress parameters in 63 healthy, scanner-naïve adults who participated in a two-day training protocol in an MRI, mock, or lab environment. A habituation task was used to assess within-session changes in subjective and neuroendocrine (cortisol) stress parameters; between-session changes were indicated by differences between days. MRI and mock, but not lab training were successful in reducing subjective distress towards the scanner. In contrast, cortisol reactivity towards the training environment generally increased during day 2, and the percentage of cortisol responders particularly rose in the mock and MRI groups. Within-session habituation of subjective arousal and anxiety was observed during both days and irrespective of training condition. Present findings demonstrate that training in a scanner environment successfully reduces subjective distress, but may also induce sensitization of endocrine stress levels during repeated scanning. Subjective distress can further be stabilized by acclimating subjects to the environment prior to the MRI assessment, including a short habituation phase into the assessment protocol. If replicated, present findings should be considered by researchers employing repeated measurement designs where subjects are exposed to a scanner more than once.

Im Rahmen einer Reanalyse von vier Erhebungen an jugendlichen und erwachsenen Probanden in den neuen und alten Bundesländern in den Jahren 1990 bis 1991/92 wurden Angaben zu Indikatoren für Depressivität, Angst/psychosomatische Beschwerden und Substanzgebrauch in Ost- und Westdeutschland verglichen. Zum Zeitpunkt der Untersuchungen gab es im Gegensatz zu der von einzelnen Autoren angeführten Erwartung keine eindeutigen Hinweise auf eine insgesamt erhöhte psychiatrische Morbidität in den neuen Bundesländern. Depressive Symptome und der Gebrauch von illegalen Drogen und Medikamenten sind durchgängig in den alten Bundesländern häufíger nachzuweisen als in den neuen Bundesländern. Allenfalls ergaben sich für die Stichproben Ost für einzelne depressionstypische sowie einzelne psychovegetative Symptome und für Alkoholgebrauch statistisch signifikant erhöhte Werte. Da keine Diagnosekriterien erhoben wurden, muβ die Aussagekraft der Daten dahingehend eingeschränkt werden, daβ lediglich Indikatoren für psychische Auffälligkeiten erhoben wurden.

Emotions are an integral part of the human experience and their interpretation can provide valuable but also misleading clues about oneself and other people’s state of mind. Negative emotional states can be perceived as uncomfortable and – when experienced chronically – can develop into anxiety and mood disorders. The more pervasive these disorders the more severely they affect and disable a person’s everyday functioning and often their sleep as well. According to Lang and colleagues (1998), emotions may be expressed verbally, behaviorally, and physiologically, i.e., emotions can be reported, observed, and objectively measured. Each measurement approach provides important, unique, and often conflicting information that can be used in the assessment and treatment evaluation of psychological disorders affecting the emotions. Autonomic measures have been used to indicate the physiological components of emotions, such as those along the worry-anxiety-fear-panic spectrum. Worry has been shown to suppress cardiac responses to imaginal feared material (see Borkovec, Alcaine, & Behar, 2004) and reduce autonomic variability (Hoehn-Saric, McLeod, Funderburk, & Kowalski, 2004; Hoehn-Saric, McLeod, & Zimmerli, 1989). Results for panic and anticipatory anxiety are less conclusive but theoretically these states should go along with increased autonomic arousal. Abnormal autonomic arousal might also be present during sleep as both panic disorder and worrying have been associated with sleeping difficulties. However, most empirical research has been confined to the laboratory where high internal validity is achieved at the cost of poor ecological validity. Thus, the purpose of this doctoral dissertation is to extend and validate laboratory findings on worry, anticipatory anxiety, and panic using ambulatory monitoring. Twenty-four hour monitoring not only can give valuable insights into a person’s daytime emotional experience but also allows observing how these emotions might affect their sleep in their natural environment. In the following chapter, the reader will be introduced to a conceptual framework that ties together worry, anxiety, fear, and panic, and related anxiety disorders (section 2.1), to autonomic arousal and electrodermal and cardiac arousal in particular (section 2.2), to sleep and its relation to autonomic arousal and anxiety disorders (section 2.3), and to ambulatory monitoring (section 2.4). After illustrating the aims of this thesis (chapter 3), chapters 4 to 6 present the results of three empirical studies conducted as part of this doctoral research. The first study deals solely with electrodermal monitoring and how it is affected by confounding variables in an ambulatory context (chapter 4). The next study then seeks to investigate the relationship between electrodermal arousal and anticipatory anxiety and panic in a sample of panic disorder patients and healthy controls. The last study focuses primarily on the effect of trait and state worry on subjective and objective sleep and electrodermal and cardiac arousal in a group of high and low worriers. Chapters 7 to 9 summarize and integrate the findings from these three empirical studies, discuss methodological limitations, and provide an outlook into future research.