Almut Zeeck - Academia.edu (original) (raw)

Papers by Almut Zeeck

Frontiers in Psychiatry, Oct 10, 2019

European Eating Disorders Review, Jun 5, 2019

European Eating Disorders Review, Mar 20, 2022

OBJECTIVE Previous diffusion tensor imaging studies reported a reduced fractional anisotropy in t... more OBJECTIVE Previous diffusion tensor imaging studies reported a reduced fractional anisotropy in the body of the corpus callosum in patients with anorexia nervosa patients, which may indicate impaired white matter integrity in interhemispheric connections. The aim of the current study was to investigate whether structural connectivity is affected in patients with anorexia nervosa. METHOD To this end, we compared the number of streamlines (a model of the white matter fibre tracts) and the total volume filled by these streamlines in different subsections of the corpus callosum in 33 women with and 33 without anorexia nervosa as well as in 20 recovered individuals. RESULTS The volume of streamlines in the anterior and mid-anterior subsection of the corpus callosum was reduced in women with, but not in those who had recovered from anorexia nervosa. No differences in number of streamlines was detected in the corpus callosum between patients with anorexia nervosa, healthy controls and recovered patients. CONCLUSIONS Alterations of the corpus callosum have been repeatedly reported in anorexia nervosa. Since the recovered group did not differ from the healthy control group, the reported alterations in acute patients appear to represent a state and not a trait marker.

Psychoanalytic Psychotherapy, 2018

Traumatic experiences during childhood have been shown to be associated with a higher risk for de... more Traumatic experiences during childhood have been shown to be associated with a higher risk for depressive disorders, more severe symptoms, higher rates of comorbidity, and poorer response to therapy. This study aims to further investigate these links in a clinical sample, focusing especially on therapeutic outcome. Data were collected in a large naturalistic study on inpatient and day hospital treatment of depression at the beginning, the end and after treatment, with this article being a secondary data analysis. Occurrence of childhood trauma, depressive and other symptoms and therapeutic results were compared using robust MANOVA, multiple regression, mixed ANO-VA, and Spearman's correlation. Results provide support for a relationship between childhood trauma and depressive and general symptom severity, the age of onset of depression and the occurrence of personality disorders and somatic diagnoses. There was a significant reduction of depressive symptomatology after therapy. Patients with childhood trauma did not differ significantly from controls in their response to treatment. Clinicians should take the high probability of childhood trauma in depressive patients and the consequent risk of more severe symptoms into account when taking a history and consider adjusting treatment, even if the present data showed that patients generally benefitted from therapy.

Psychopathology, 2017

Pathological forms of exercising are a topic of debate in terms of classification, etiology, and ... more Pathological forms of exercising are a topic of debate in terms of classification, etiology, and treatment. Validated instruments are a precondition for research in this field. The aim of this study was to validate the German version of the Commitment to Exercise Scale (CES-de). A confirmatory factor analysis was conducted using data from a large community sample (n = 571). In a second study, 100 eating disordered patients, 107 elite athletes and 100 individuals engaged in leisure time sporting activities were compared to assess discriminant validity and psychological correlates. A 1-factor solution showed the best fit to the data. The CES-de differentiated between the eating disordered group and individuals engaged in leisure time sporting activities, but not between those with an eating disorder and competitive athletes. The total score was significantly correlated with drive for thinness, perfectionism, and overall psychopathology. The CES-de can be considered a valid instrument for measuring problematic behavioral and attitudinal aspects of the commitment to exercise. The use of the CES-de total score is recommended. However, a more specific instrument should be used for athletes. A limitation of the study is that the samples were not stratified by age and gender.

Frontiers in Psychiatry, Aug 7, 2020

Objective: To date, there is only a limited number of studies evaluating the implementation and e... more Objective: To date, there is only a limited number of studies evaluating the implementation and effects of treatment guidelines. Therefore, this study aimed to determine how many patients diagnosed with a major depression were treated in compliance with the German treatment guideline after hospital treatment, and whether a deviation from the guideline resulted in a less favorable development. Methods: Five hundred two patients, which originally participated in the INDDEP-study, were included. Data were collected at admission and discharge from eight different psychosomatic (psychotherapeutic) hospitals in Germany as well as 3 months and 1 year after hospital treatment. Data on depressive symptomatology were assessed by QIDS-C (clinical interviews). By phone interviews, the clinical course and the outpatient treatments were assessed. Statistical analyses compared patients who were treated in compliance with the German treatment guideline with those who were not. Results: Seventy-nine point one percent of the outpatient treatments complied with the treatment guideline. Eleven point eight percent of the patients were treated with medication only, 60.2% with psychotherapy only, and 28.0% with a combination. There was no difference in the clinical outcome (depression) with regard to guideline compliance. Cases in which deviation from the guideline occurred (20.9%) were younger and had a less severe depressive symptomatology at admission and after hospital treatment. Conclusion: After treatment in a psychosomatic hospital or day hospital, the majority of patients with a depressive disorder received adjacent treatment in accordance with the German guideline and with a clear focus on psychotherapy. Deviations from the guideline did not result in a less favorable course of the illness.

Journal of eating disorders, Jul 7, 2020

Background: Unhealthy attitudes towards sport and problematic exercise behavior in eating disorde... more Background: Unhealthy attitudes towards sport and problematic exercise behavior in eating disorders (ED) are common and associated with poorer treatment outcome and higher relapse rates. There is a need to develop and empirically test interventions that could complement standard treatment. The study aimed to assess the efficacy of the Freiburg sport therapy program for eating disorders (FSTP). Methods: Outpatients with ED were randomized either to a 3 month sport therapy program (sport therapy group: STG) or a waiting list control group (CG). Patients were assessed when starting the program and at the end of the intervention. The intervention group (STG) was followed up after 6 month. Main outcome criterion was a reduction in unhealthy exercise (Commitment to Exercise Scale, CES). Secondary outcomes encompassed eating pathology (Eating Disorder Examination, EDE), different dimensions of unhealthy exercise (Compulsive Exercise Test, CET subscales) and exercise quantity (accelerometer). Results: Recruitment was challenging. Fifteen patients were randomized to the STG and 11 were randomized to the CG condition. There was no statistically significant difference between groups according to the main outcome criterion. However, the STG showed a significantly stronger reduction in avoidance and rule driven behavior (CET subscale) when compared to the CG. Improvements (STG) were maintained at follow up. Conclusions: There was no statistically significant difference in the reduction of unhealthy attitudes towards sport and problematic exercise behavior between the intervention and the group, as measured with the Commitment to Exercise Scale. Further findings may point to the effectiveness of the program, but have to be interpreted with caution and verified in further studies. A major limitation is the small sample size.

Psychiatry Research-neuroimaging, Sep 1, 2018

Zeitschrift Fur Psychosomatische Medizin Und Psychotherapie, Jul 1, 2006

Zusammenfassung Fragestellung: Es handelt sich um einen explorativen Vergleich stationarer und ta... more Zusammenfassung Fragestellung: Es handelt sich um einen explorativen Vergleich stationarer und tagesklinischer Behandlung von Patientinnen mit Anorexia Nervosa. Methode: 13 konsekutiv aufgenommene Tagesklinikpatientinnen (Anorexia Nervosa; ICD-10, DSM-IV) werden mit 13 stationar behandelten Patientinnen parallelisiert (Variablen: Alter bei Beginn der Erkrankung, Alter bei Aufnahme, Minimalgewicht, Krankheitsdauer, Geschlecht, Aufnahmegewicht, restriktiver oder bulimischer Subtyp). Die Behandlungsergebnisse bei Entlassung werden anhand definierter Outcome-Kriterien sowie anhand der Veranderungen auf der Symptom-Check-Liste (SCL-90-R) und des Eating-Disorder-Inventory (EDI-2) verglichen. Ergebnisse: Nach stationarer Behandlung zeigen signifikant mehr Patientinnen ein gutes Behandlungsergebnis. Auch die Hohe der Effektstarken weist auf eine Uberlegenheit stationarer Behandlung hin. Diskussion: In der initialen Phase der Therapie deutlich untergewichtiger anorektischer Patientinnen ist vermutlich das struktur...

International Journal of Eating Disorders, Sep 1, 2018

Objective: Reduced grey (GM) and white matter (WM) volumes and increased cerebrospinal fluid (CSF... more Objective: Reduced grey (GM) and white matter (WM) volumes and increased cerebrospinal fluid (CSF) have been frequently reported in anorexia nervosa (AN), but studies focusing on cortical thickness (CT) are scarce and findings inconsistent. We conducted the first study in AN that analyzed both parameters in the same study to gain novel and comprehensive insight. Method: Voxel-based morphometry (VBM) analysis was performed on T1-weighted magnetic resonance images from 34 predominantly adult women with acute AN, 24 REC participants, and 41 healthy controls (HC). Global brain segment volumes (GM, WM, and CSF), regional GM volume, and cortical thickness measures were obtained from the same study sample. We further focused on recovery by including a REC group. Results: The GM and WM volumes were decreased, and correspondingly, the CSF volume increased in the AN in comparison to the HC and REC groups. No significant volume differences between the REC and HC groups could be observed. AN patients showed reduced regional GM volumes in the right hippocampus and the left middle and right inferior frontal gyrus. Cortical thinning occurred in the AN group, which was particularly robust in fronto-parietal areas. The REC and HC groups failed to show any regional GM or cortical thickness differences. Discussion: AN is accompanied by severe loss of brain volume and cortical thickness as assessed by complementary investigation tools. However, these changes seem to be largely reversible, which should be encouraging for therapists and patients. The underlying neurobiological mechanisms remain unclear and should be assessed in further studies.

Frontiers in Psychiatry, Apr 6, 2023

J (2023) Typical disease courses of patients with unipolar depressive disorder after in-patient t... more J (2023) Typical disease courses of patients with unipolar depressive disorder after in-patient treatments-results of a cluster analysis of the INDDEP project.

Psychotherapy and Psychosomatics, Nov 8, 2019

Technological progress offers the chance to incorporate health interventions into everyday life, ... more Technological progress offers the chance to incorporate health interventions into everyday life, for example, on smartphones, which may be beneficial for people with mental illness. However, there is a large gap between what is technically feasible and what is known about effects on everyday life. For example, exercise is known to reduce depression symptoms in general, but specific influences of exercise interventions on everyday life mood, a core issue of depression, have yet to be studied. Therefore, we equipped 15 participants with depression with smartphone diaries for 3 days both before and after a 10-week exercise intervention. The participants answered 83.6% of all queries. Significant cross-level interaction effects in multilevel analyses revealed that people who engaged less in exercise at the start of the intervention showed greater improvements in everyday life mood (valence: b = 5.8; calmness: b = 5.3). Our results may serve as a tiny kick-off paving the way for evidence-based physical activity interventions on smartphones.

Psychiatry Research: Neuroimaging, Mar 1, 2018

Jacob et al. (2011) previously reported on intimate picture stimuli for emotion research in femal... more Jacob et al. (2011) previously reported on intimate picture stimuli for emotion research in females in Psychiatry Research. Difficulties to engage in intimate relations constitute problems of many mental disorders, and intimacy must be differentiated from pure sex drive. Functional neuroimaging is an important tool to understand the pathophysiology of psychiatric disorders. We now studied cerebral activation in response to intimate stimuli in 35 healthy women. Comparison stimuli were taken from the International Affective Picture System. Neuroimaging revealed increased activation in bilateral occipitotemporal, parietal and anterior cingulate cortices extending to the orbitofrontal area. These data reflect cognitive, emotional and motivational compounds congruent with previous neuroimaging data of attachment and long term romantic relationships. Lateral prefrontal, posterior insular regions and the fusiform face area were more active during control images. Our data present a solid basis for use in psychiatric samples.

PLOS ONE, Nov 16, 2018

Muscle dysmorphia (MD) is a condition that is characterized by body image disturbance, a drive fo... more Muscle dysmorphia (MD) is a condition that is characterized by body image disturbance, a drive for muscularity and excessive exercising. It leads to considerable functional impairment. Most previous studies focused on male samples. The study aimed to validate a German version of the Muscle Dysmorphic Disorder Inventory (MDDI) in order to make the instrument available in German speaking countries. We further aimed to explore for gender differences in the MDDI factors (measurement invariance) and to assess the relationship between MD and positive dimensions of body experience as well as exercise dependence. 394 participants (53% females, mean age 24.3 years) took part in an internet-based survey. The three-factor structure of the English version of the MDDI was replicated, independent of gender (multi group CFA; Base model TLI = .961; CFI = .970). Cronbach´s alpha was .81-.84 for the subscales and .75 for the MDDI total score. MD was associated with exercise dependence and negatively correlated with dimensions of positive body experience, which can be considered relevant for satisfying relationships and a positive sense of self: e.g. body contact and sexual fulfillment. Men and women showed differences in two subscales of the MDDI (appearance intolerance, drive for size). Testing for measurement invariance resulted in weak invariance: Equivalent factor structure for men and women, but significantly different loadings and coefficients. No statistically significant difference in the MDDI total score was found. The findings suggest good psychometric properties of the German version of the MDDI. Future studies should address the question of cutoff scores and norms for different samples as well as a possible overlap between MD and eating disorder psychopathology in women.

Frontiers in Psychiatry, Mar 12, 2020

Aim of the study was to identify patient variables that predict specific patterns of symptom cour... more Aim of the study was to identify patient variables that predict specific patterns of symptom course during and after hospital treatment for major depressive disorder (MDD). In a sample of 518 patients, four pairs of clinically relevant patterns of symptom change were contrasted. The time points of measurement were admission, discharge, 3 and 12 month after discharge. CATREG was used to identify the best sets of predictors from 28 variables. A greater reduction in self-criticism during hospital treatment was the strongest predictor of rapid and sustained improvement. Traumatic childhood experiences and lower abilities for communication with others predicted a transient relapse after discharge, while a co-morbid personality disorder and higher level of anxiety differentiated between those with a persistent relapse and those with only a transient relapse in depressive symptoms following discharge. Overall, patients with less severe depression at admission, better abilities in self-perception, and less self-criticism (baseline and/or greater reduction during treatment) showed a better outcome after 1 year. There is limited generalizability to other countries and treatment settings. Data on personality functioning were not available for all patients and findings are correlational in nature. However, findings are in support of a psychotherapeutic focus on a reduction of self-criticism in MDD. Patient with traumatization, a co-morbid personality disorder and lower abilities to communicate their emotional needs should get specific attention and support after discharge from hospital treatment.

Zeitschrift Fur Psychosomatische Medizin Und Psychotherapie, Dec 3, 2019

Objectives: Remission rates after treatment for bulimia nervosa can be considered insufficient. T... more Objectives: Remission rates after treatment for bulimia nervosa can be considered insufficient. The study aimed to explore the perspective of expert psychotherapists on possible reasons for non-response and recommendations for an optimized treatment. Methods: Experts filled in a questionnaire that comprised questions about possible reasons for low remission rates as well as ratings of interventions suggested for different treatment phases and subgroups of patients. Results: 56 experienced therapists could be included in the survey. Ambivalence of patients, insufficient training of therapists and heterogeneity of the patient group were most often rated as possible reasons for insufficient outcomes. For optimized treatment, therapists recommended a combination of cognitive-behavioral and psychodynamic techniques, depending on treatment phase and patient characteristics. Conclusions: Further research should examine, if a more specific training of therapists, a more integrative approach and flexible adaptations of interventions to patients' characteristics are effective strategies to improve outcome.

Hintergrund: Viele Patientinnen mit Essstörungen zeigen einen dysfunktionalen Umgang mit körperli... more Hintergrund: Viele Patientinnen mit Essstörungen zeigen einen dysfunktionalen Umgang mit körperlicher und sportlicher Aktivität. Dieser wird unter anderem als aufrechterhaltender Faktor für eine Essstörungspathologie diskutiert. Bislang existieren kaum Programme, die auf eine[for full text, please go to the a.m. URL]

Objective: This naturalistic study aimed to identify criteria which are of relevance for making a... more Objective: This naturalistic study aimed to identify criteria which are of relevance for making a decision as to whether inpatient or day hospital treatment is indicated.

Psychotherapy and Psychosomatics, Dec 17, 2018

sible occurrence of an aversive unconditioned stimulus (UCS), the CS becomes a threat-predicting ... more sible occurrence of an aversive unconditioned stimulus (UCS), the CS becomes a threat-predicting CS+ (threat condition; online suppl. 1/2; see www.karger.com/doi/10.1159/000495367 for all online suppl. material). We hypothesize that pathological fear/threat appraisal in AN results in a hyperresponsive FN [9]. In women who recovered from AN (RE), persistent changes in the FN would indicate an endophenotype or “scar” from the disorder. We studied 31 AN, 32 controls (HC), and 23 well-recovered women without psychotropic medication. In the supplements, we provide details of the sample (online suppl. 3), measurements, analyses, and results (online suppl. 4–10). During the instructed fear paradigm, fMRI (online suppl. 7) and galvanic skin conductance response (GSR; online suppl. 5), a common measure of a fear reaction, were recorded in two separate runs. After each run, participants indicated whether they perceived a UCS and rated their UCS expectancy. Hormonal parameters were also obtained (cortisol, oxytocin; online suppl. 6). Apart from substantially higher eating disorder pathology, the AN group showed increased trait anxiety ratings (online suppl. 3). All participants were aware of the stimulus contingencies. In comparison to HC, AN lacked a differential blood oxygen level-dependent response towards the threat (CS+) condition in large parts of the FN (1,785 voxels) covering the ACC, dACC/dmPFC, dorsolateral PFC, AI, and inferior frontal gyrus (Fig. 1a, b; online suppl. Table 2). Superior and inferior parietal lobe function were unaltered in AN (Fig. 1a; online suppl. 8). RE did not differ from HC. Furthermore, beta estimates of the voxels with the largest group difference (AN < HC) indicate that the activation pattern in RE largely recovers (online suppl. 9; Fig. 1a). Across groups, higher trait anxiety scores were related to less neural activity in the dACC/ dmPFC (online suppl. 10). Additional analyses correcting for depressiveness, total brain volume, and age confirmed the aforementioned results (online suppl. 9). UCS expectancy significantly declined from run 1 to run 2 and no significant group difference emerged (online suppl. 4). The GSR showed two significant interactions, namely group × phase and group × condition × run (online suppl. 5), indicating a blunting physiological threat reaction in the AN group. The RE group showed results similar to HC. A significant reduction in threat-induced FN activity in AN contradicts the hypothesis of a generally hyperreactive FN [2, 9]. Rather, basic processing (e.g., fear expression and appraisal) and regulation of externally induced fear is hampered in the state of AN. These data contrast with the results of a hyperreactive FN in AN when confronted with disorder-specific stimuli (e.g., food images) [2, 3]. Importantly, the superior and inferior parietal lobe responses were not different in AN, so that the basic stimulus perception and discrimination seems to be intact. The absence of a threat-related increase in dACC/dmPFC activation is important, as this structure plays a crucial role in conscious fear appraisal [6]. Insufficient fear appraisal can lead to diDear Editor, Individuals with anorexia nervosa (AN) persistently restrict food intake due to intense fear of weight gain and/or body image disturbances. Merely looking at food images can already elicit psychophysiological fear and avoidance responses [1], which are reflected in an activation of the so-called fear network (FN) [2, 3]. This observation has been interpreted as “fear of food” and could have its origin in an anxious-avoidant personality that predisposes the development of AN [2]. Therefore, abnormal fear processing is thought to play a key role in AN pathophysiology [2]. In contrast, a persistent restriction of food intake can reduce anxiety [4]. The FN comprises the amygdala and hippocampus as well as anterior insular (AI), anterior cingulate (ACC), and prefrontal cortices (PFC) [5]. The dorsal ACC (dACC) and its transition into the dorsomedial PFC (dmPFC) are involved in conscious emotional appraisal [6] and may play a pivotal role in the reported negative appraisal of food stimuli in AN [7]. A hyperreactive dACC/dmPFC and other areas of the FN are observable in generalized anxiety disorder and specific phobias [6]. A current AN model [8] suggests that a high baseline anxiety level in patients fosters fear of food intake and food avoidance. Accordingly, the importance of studying neurobiological correlates of fear learning in AN has been emphasized [2, 9]. We studied neurobiological fear correlates using an instructed fear fMRI paradigm that triggers anticipatory anxiety. By verbally linking an initially neutral conditioned stimulus (CS) with the posReceived: February 22, 2018 Accepted after revision: November 11, 2018 Published online: December 17, 2018