Background: The high prevalence of mental disorders related to posttraumatic stress among Syrian refugees is often in contrast with their low utilization ofmental health care in the host countries. Mental health self-stigma, i.e., internalized stigma of having a mental disorder, could prevent individuals from seeking mental health care. Therefore, we aimed to provide evidence on different aspects of mental health self-stigmatization among adult Syrian refugees with posttraumatic stress symptoms residing in Germany. Moreover, we investigated associations with sociodemographic and psychopathological variables in order to identify those at higher risk of self-stigmatization. Material and Methods: Overall, 133 participants with mild to moderate posttraumatic stress symptoms were recruited in the metropolitan areas of Leipzig, Dresden and Halle, Germany, using a multimodal approach. Mental health self-stigma was assessed using the Self-Stigma of Mental Illness Scale – Short Form (SSMIS-SF), consisting of four subscales (Stereotype awareness, Stereotype agreement, Application to self, Harm to self-esteem), each scoring from 5 (low) to 45 (high) points. Linear regression analysis was used to test associations of sociodemographic and psychopathological variables with self-stigma subscales. Results: On average, self-stigma ratings ranged from 16.5 (SD = 6.6) points on Application to self to 28.3 (SD = 7.5) points on Stereotype awareness. Results showed higher scores on Application to self for individuals who were younger (t =2.65, p=0.009) and single (F = 5.70, p = 0.004). Regression analyses yielded statistically significant associations between having multiple comorbidities and a higher Application to self stigma ( = 0.18, p = 0.044), controlling for sociodemographic covariates. Discussion: Mental health self-stigma was increased among Syrian refugees in Germany. Correlates of increased self-stigma could inform efforts to improve access to mental health care among Syrian refugees with mental ill-health. Longitudinal studies following an intersectional approach by concurrently examining multiple forms of public and internalized stigma could provide helpful insights for developing tailored stigma reduction efforts in this context.

Background: Cannabis is the third most consumed drug worldwide. Thus, healthcare providers should be able to identify users who are in need for an intervention. This study aims to explore the relationship of acute, chronic, and early exposure (AE, CE, and EE) to cannabis with cognitive and behavioral harms (CBH), as a first step toward defining risky cannabis use criteria. Methods: Adults living in Spain who used cannabis at least once during the last year answered an online survey about cannabis use and health-related harms. Cannabis use was assessed in five dimensions: quantity on use days during the last 30 days (AE), frequency of use in the last month (AE), years of regular use (YRCU) (CE), age of first use (AOf) (EE), and age of onset of regular use (AOr) (EE). CBH indicators included validated instruments and custom-made items. Pearson correlations were calculated for continuous variables, and Student’s t-tests for independent samples were calculated for categorical variables. Effect sizes were calculated for each of the five dimensions of use (Cohen’s d or r Pearson correlation) and harm outcome. Classification and Regression Trees (CART) analyses were performed for those dependent variables (harms) significantly associated with at least two dimensions of cannabis use patterns. Lastly, logistic binary analyses were conducted for each harm outcome. Results: The mean age of participants was 26.2 years old [standard deviation (SD) 8.5]. Out of 2,124 respondents, 1,606 (75.6%) reported at least one harm outcome (mean 1.8 and SD 1.5). In our sample, using cannabis on 3 out of 4 days was associated with an 8-fold probability of scoring 4+ on the Severity Dependence Scale (OR 8.33, 95% CI 4.91–14.16, p < 0.001), which is indicative of a cannabis use disorder. Also, a start of regular cannabis use before the age of 25 combined with using cannabis at least once per month was associated with a higher probability of risky alcohol use (OR 1.33, 95% CI 1.12–1.57, p = 0.001). Besides, a start of regular cannabis use before the age of 18 combined with a period of regular use of at least 7.5 years was associated with a higher probability of reporting a motor vehicle accident (OR 1.81, 95% CI 1.41–2.32, p < 0.0001). Results were ambiguous regarding the role that age of first use and milligrams of THC per day of use might play regarding cannabis-related harms. Conclusions: The relationship among AE, CE, and EE with CBH indicators is a complex phenomenon that deserves further studies. The pattern of cannabis use should be carefully and widely evaluated—(not just including frequency but also other dimensions of pattern of use)—in research (preferably in longitudinal studies) to assess cannabis-related harms.

As humans we are not stuck in an everlasting present. Instead, we can project ourselves into both our personal past and future. Remembering the past and simulating the future are strongly interrelated processes. They are both supported by largely the same brain regions including the rostral and ventral medial prefrontal cortex (mPFC) but also the hippocampus, the posterior cingulate cortex (PCC), as well as other regions in the parietal and temporal cortices. Interestingly, this core network for episodic simulation and episodic memory partially overlaps with a brain network for evaluation and value-based decision making. This is particularly the case for the mPFC. This part of the brain has been associated both with a large number of different cognitive functions ranging from the representation of memory schemas and self-referential processing to the representation of value and affect. As a consequence, a unifying account of mPFC functioning has remained elusive. The present thesis investigates the unique contribution of the mPFC to episodic simulation by highlighting its role in the representation of memory schemas and value. In a first functional MRI and pre-registered behavioral replication study, we demonstrate that the mPFC encodes representations of known people as well as of known locations from participants’ everyday life. We demonstrate that merely imagined encounters with liked vs. disliked people at these locations can change our attitude toward the locations. The magnitude of this simulation-induced attitude change was predicted by activation in the mPFC during the simulations. Specifically, locations simulated with liked people exhibited significantly larger increases in liking than those simulated with disliked people. In a second behavioral study, we examined the mechanisms of simulation-based learning more closely. To this end, participants also simulated encounters with neutral people at neutral locations. Using repeated behavioral assessments of participants’ memory representations, we reveal that simulations cause an integration of memory representations for jointly simulated people and locations. Moreover, compared to the neutral baseline condition we demonstrate a transfer of positive valence from liked and of negative valence from disliked people to their paired locations. We also provide evidence that simulations induce an affective experience that aligns with the valence of the person and that this experience can account for the observed attitude change toward the location. In a final fMRI study, we examine the structure of memory representations encoded in the mPFC. Specifically, we provide evidence for the hypothesis that the mPFC encodes schematic representations of our social and physical environment. We demonstrate that representations of individual exemplars of these environments (i.e., individual people and locations) are closely intertwined with a representation of their value. In sum, our findings show that we can learn from imagined experience much as we learn from actual past experience and that the mPFC plays a key role in simulation-based learning. The mPFC encodes information about our environment in value-weighted schematic representations. These representations can account for the overlap of mnemonic and evaluative functions in the mPFC and might play a key role in simulation-based learning. Our results are in line with a view that our memories of the past serve us in ways that are oriented toward the future. Our ability to simulate potential scenarios allows us to anticipate the future consequences of our choices and thereby fosters farsighted decision making. Thus, our findings help to better characterize the functional role of the mPFC in episodic future simulation and valuation.

In dieser Masterarbeit wurde der Frage nachgegangen, wie sich der Ikonizitätsgrad von Bildsymbolen, d.h. die wahrgenommene Ähnlichkeit eines Bildsymbols mit seiner realen Referenz, auf das Symbolverständnis von Kindern im Alter von 4 bis 5 Jahren auswirkt. Konkret wurden drei Ikonizitätsgrade (niedrig, mittel, hoch) und ihre Auswirkungen auf das Erreichen repräsentationaler Einsicht, d.h. der Erkenntnis, dass ein Symbol für etwas anderes als sich selbst steht, untersucht. Diese Frage wurde mit Hilfe eines einfaktoriellen, dreistufigen Between-Subject-Experimentaldesigns untersucht. Als Versuchsaufbau diente eine adaptierte Suchaufgabe, die auf der Arbeit von Judy S. DeLoache basiert. Darüber hinaus wurde der Frage nachgegangen, wie das Erreichen repräsentationaler Einsicht mit anderen kognitiven Fähigkeiten zusammenhängt. Die Ergebnisse zeigten, dass Kinder Schwierigkeiten haben, abstrakte Bildsymbole mit niedrigem Ikonizitätsgrad zu erfassen. Darüber hinaus konnte ein Zusammenhang zwischen dem Erreichen repräsentationaler Einsicht und der medialen Zeichenkompetenz sowie der Fähigkeit zur Metaphernbildung nachgewiesen werden. / This Master’s thesis investigated the question of how the degree of iconicity of picture symbols, i.e. the perceived similarity of a picture symbol with its real reference, affects the symbol understanding of children aged 4 to 5 years. Specifically, three levels of iconicity (low, medium, high) and their effects on the achievement of representational insight, i.e. the recognition that a symbol stands for something other than itself, were investigated. This was investigated with the help of a one-factorial, three-level between-subjects experimental design. The design of the experiment was an adapted object retrieval task based on the work of Judy S. DeLoache. In addition, the question of how the achievement of representational insight is related to other cognitive abilities was investigated. The results showed that children have difficulties in grasping abstract picture symbols with a low degree of iconicity. Furthermore, representational insight was found to be related to media sign literacy and the ability to form metaphors.

Background: Substance use disorders (SUDs) are a great burden on adolescent patients and treatment of these patients is often not successful. One reason for this difficulty is the high rate of co-occurring disorders. One disorder that frequently accompanies SUDs in adolescence is a Post-Traumatic Stress Disorder (PTSD). In studies it has often been reported that a large number of patients fulfill diagnostic criteria for both disorders at the same time. Several explanations for this co-occurrence exist: i) A common etiological factor (genetic predisposition, similar neurobiological pathways) might underlie the development of both disorders. ii) Various lifestyle factors that go hand-in-hand with an adolescent SUD (risky sexual behavior, violent dark markets) might expose patients to circumstances that increase the rate of encountered traumatic experiences (TEs) and therefore PTSD. iii) The self-medication hypothesis, where it is posited that adolescents use drugs to medicate their PTSD symptoms, often in a very specific manner, such that particular substances are used to reduce explicit symptoms. One aim explored in this thesis is the relationship between SUD, TEs, and PTSD with regard to differences in SUD severity, patterns of substance use, the role of self-medication and the effects of SUD-specific treatment on PTSD symptomatology. Methods: Five studies are presented in chapters 2 to 6 of this thesis. Chapter 2 contains a study in which the Drug Use Disorder Identification Test (DUDIT) was evaluated for use in a psychiatric adolescent patient population. This was the first study in which the DUDIT in relation to DSM-5 criteria was evaluated, in order to try to establish cut-off scores for the presence of a SUD in adolescents. In chapter 3 an evaluation is presented of the differences in SUD severity between adolescents with a SUD (‘noTE’ group), adolescents with a SUD and a history of TE but not PTSD (‘TE’ group) and adolescents with SUD and co-occurring PTSD (‘PTSD’ group). In the study presented in chapter 4 an investigation of the differences in substance use patterns between the three groups was undertaken, along with an evaluation of the associations between PTSD symptoms and use of specific substances. In chapter 5, the role coping motives play in the relationship between substance and PTSD symptoms was established. Finally, in chapter 6 the results of a pragmatic clinical trial are presented, in which the effects of a group-based treatment manual (the DELTA program) on SUD symptoms, substance use frequency and PTSD symptoms are assessed. Results: Across all included studies in this dissertation, an instrument for the assessment of SUD in adolescents was evaluated. This was used with other instruments, to establish a link between adolescent SUD and increased rates of PTSD and substance use. Furthermore, the connection between SUD and PTSD in adolescence seems to be related to a self-medication motive. Additionally we established a treatment program that reduced SUD symptoms but failed to influence the PTSD symptoms, which indicates treatment specific to one disorder is unlikely to support reductions in the co-occurring disorder. More specifically, the results presented in chapter 2 showed that the DUDIT has excellent discriminant validity and is a valid tool for the assessment of SUD severity in a clinical adolescent population. In chapter 3, it was shown that the prevalence of TEs and PTSD in adolescents with SUD is higher than in the general adolescent population. Furthermore, the PTSD group showed a significantly higher level of SUD severity than the other two groups. In contrast to our expectations, the TE group did not differ significantly with regard to SUD severity from the noTE group. In addition, SUD severity correlated positively with the number of PTSD symptoms in each symptom cluster. The study presented in chapter 4 showed that past-month substance use frequency was nearly the same across groups and across substances, with only the use of methylenedioxymethamphetamine (MDMA) being significantly more frequent and more prominent in the PTSD group compared to the other two. Participants in the PTSD group also reported a significantly earlier age of first substance use compared to participants in the other two groups. Moreover, in this study it was shown that the presence of the avoidance symptom cluster of PTSD was related to a more frequent past-month MDMA use. The findings presented in chapter 5, confirmed the pattern detected for past-month substance use in chapter 4. The PTSD group showed a more frequent MDMA use over the past-year compared to the other two groups. Additionally, the PTSD group reported using substances more frequently for coping reasons, and the frequency of coping use motives was positively correlated with the frequency of past-year MDMA use. In this study, evidence was provided that the relationship between group membership (noTE, TE, PTSD) and MDMA use frequency is in part mediated by the relationship both variables have with coping use motives. In chapter 6 medium-sized but non-significant reductions were shown in SUD symptoms and substance use frequency as a result of the DELTA intervention. Additionally, there was no indication that the treatment program resulted in changes in PTSD symptomatology. Discussion: Several important conclusion can be derived from the studies presented in this thesis. First, a co-occurring PTSD is more prevalent in SUD patients than in the general adolescent population and is associated with higher SUD severity. Second, patients with co-occurring PTSD and SUD are distinguished from SUD patients without PTSD through their increased use of MDMA. Third, the relationship between PTSD and MDMA use is partially mediated by a coping motive, supporting the self-medication hypothesis. Finally, the treatment of co-occurring PTSD and SUD seems to require therapeutic interventions specific for each disorder. The result that PTSD symptoms are not reduced after SUD-specific treatment can be interpreted as support for the self-medication hypothesis as well, in the sense that the treatment of the consequence (SUD) does not affect the preceding factor (PTSD). However, while the above interpretation is consistent with the data presented in this thesis on substance use itself, the associated data on the occurrence of SUDs indicates, that more factors than just self-medication are relevant for the development of a SUD. Furthermore, the results of this thesis do not imply that substance use motivated by self-medication motives is harmless or even beneficial, since there was no way of assessing if self-reported, coping-motivated substance use is successful in reducing symptoms or acute psychopathology. Consequently, in future projects focus should be on developing longitudinal research designs, in order to assess if and how PTSD symptoms develop over time with regard to substance use and how substance use trajectories develop in relation to PTSD symptomatology.

Objectives: Quality of life (QoL) has been the focus of increasing interest in oncology. QoL assessment instruments implicitly assume that each QoL domain has the same meaning for each patient. The objective of this study was to analyze the importance of and the satisfaction with QoL domains and to analyze the relationship between the two. Methods: A sample of 308 breast cancer survivors was examined twice with a three-month time interval. The women completed the two QoL questionnaires Questions of Life Satisfaction (FLZ-M), which measures participants’ satisfaction with eight QoL domains and the subjective importance of those domains to them, and the EORTC QLQ-C30. A sample of 1,143 women from the general population served as controls. Results: Compared with the general population sample, the patients were less satisfied with their health andmore satisfied with all other QoL domains. The subjective importance of health was lower in the patients’ sample (Effect size: d = 0.38). Satisfaction with health and importance of health were slightly positively correlated (r between 0.05 and 0.08). The effect of QoL domain importance on general QoL was small (beta between −0.05 and 0.11), and interaction effects between domain importance and satisfaction on the prediction of global QoL were negligible. Conclusion: In addition to satisfaction with QoL dimensions, the subjective importance of these dimensions is relevant for psychooncological research and treatment. Health is not the only relevant QoL domain in breast cancer survivors, other domains such as finances also deserve health care providers’ attention.

Der nachstehende Beitrag thematisiert das Phänomen Schulabsentismus unter besonderer Berücksichtigung des angstbedingten Meidungsverhaltens und der schulischen Selbstwirksamkeit von Schüler_innen. Zum Gegenstand gemacht werden somit individuelle Risikolagen, die in Bezug auf Schule desintegrative Wirkungen freizusetzen vermögen. Das Ziel dieses Beitrages ist es, anhand einer quantitativen Untersuchung an niedersächsischen Schulen mögliche Einflüsse schulbezogener Ängste und der schulischen Selbstwirksamkeitserwartung auf Schulversäumnisse zu ermitteln. / This article deals with the phenomenon of school absenteeism, with a special focus on school refusal behavior and the self-efficacy of students. Risk factors may lead to avoidance and end up in disintegrative processes. For this reason, this quantitative study investigates potential influences on school absenteeism, addressing the hypothesis that anxiety in school and lower self-efficacy may lead to school-attendance problems. To this end, we interviewed students at schools in Lower Saxony.

This paper interrogates the phenomenon of boredom at work by considering Ernst Jünger’s potential contribution. We contend that Jünger offers an important yet overlooked alternative to the dominant perspectives of boredom in Management and Organization Studies (MOS), which are largely composed of ‘simple’ psychological diagnoses and managerial prescriptions. Such studies largely understand boredom as a localised experience at work which can be overcome by targeted managerial prescriptions, techniques and interventions. In contrast we show how Jünger understands boredom from a ‘profound’ perspective as a central feature of modernity. This is premised on Jünger’s broader critique of the bourgeois values that define 20th and 21st century managerial work and organization. Jünger’s cultural-historical perspective is therefore aligned to the discrete field of Boredom Studies. By addressing how Jünger understands ‘work’ as the defining feature of the modern age, his critique situates the phenomenon of boredom at work within the broader social, institutional and cultural order of the 21st Century. While Jünger does not set out to provide a theory of boredom as such, we reconstruct such a theory through an exegesis of his writing on ‘work’ and ‘danger’. This reveals boredom and danger as phenomenologically intertwined concepts, which is an understanding of boredom that has not been considered in MOS or Boredom Studies. It is through this, we argue, that Jünger’s conception of work holds the potential for a powerful critique and understanding of boredom at work under the contemporary regime of neoliberal managerialism.

The present study examines the joint roles of leadership and stressors for presenteeism of scientific staff. Leaders may have an impact on employees’ health, both directly through interpersonal interactions and by shaping their working conditions. In the field of science, this impact could be special because of the mentoring relationships between the employees (e.g., PhD students) and their supervisors (e.g., professors). Based on the job demands-resources framework (JD-R), we hypothesized that the pressure to be present at the workplace induced by supervisors (supervisorial pressure) is directly related to employees’ presenteeism as well as indirectly via perceptions of time pressure. The conservation of resources theory (COR) states that resource loss resulting from having to deal with job demands weakens the resource pool and therefore the capacity to deal with other job demands. Thus, we hypothesized that accumulation of work moderates the relationship between supervisorial pressure and time pressure, such that the relationship is stronger when accumulation of work is high compared to if accumulation of work is low. Cross-sectional data were obtained from 212 PhD students and postdocs of 30 scientific institutions in Germany. Analysis was performed using the SPSS macro PROCESS (Hayes, 2013). Supervisorial pressure was directly associated with higher presenteeism of employees and indirectly through increased time pressure. Moreover, supervisorial pressure and accumulation of work interacted to predict time pressure, but in an unexpected way. The positive relationship between supervisorial pressure and time pressure is stronger when accumulation is low compared to if accumulation of work is high. It seems possible that job stressors do not accumulate but substitute each other. Threshold models might explain the findings. Moreover, specific patterns of interacting job demands for scientific staff should be considered in absence management.

A core construct in the lifespan theory of socioemotional selectivity, future time perspective (FTP) refers to individuals’ perceptions of their remaining time in life. Its adaptation to the work context, occupational future time perspective (OFTP), entails workers’ perceptions of remaining time and opportunities in their careers. Over the past decade, several quantitative studies have investigated antecedents and consequences of general FTP and OFTP in the work context (i.e., FTP at work). We systematically review and critically discuss this literature on general FTP (k = 17 studies) and OFTP (k = 16 studies) and highlight implications for future research and practice. Results of our systematic review show that, in addition to its strong negative relationship with age, FTP at work is also associated with other individual (e.g., personality traits) and contextual variables (e.g., job characteristics). Moreover, FTP at work has been shown to mediate and moderate relationships of individual and contextual antecedents with occupational well-being, as well as motivational and behavioral outcomes. As a whole, findings suggest that FTP at work is an important variable in the field of work and aging, and that future research should improve the ways in which FTP at work is measured and results on FTP at work are reported.