Stefan M . Schulz | University Trier, Germany (original) (raw)

Papers by Stefan M . Schulz

Social cognitive and affective neuroscience, Jan 18, 2014

Anxiety disorder patients were repeatedly found to overestimate the association between disorder-... more Anxiety disorder patients were repeatedly found to overestimate the association between disorder-relevant stimuli and aversive outcomes despite random contingencies. Such an illusory correlation (IC) might play an important role in the return of fear after extinction learning; yet, little is known about how this cognitive bias emerges in the brain. In a functional magnetic resonance imaging study, 18 female patients with spider phobia and 18 healthy controls were exposed to pictures of spiders, mushrooms and puppies followed randomly by either a painful electrical shock or nothing. In advance, both patients and healthy controls expected more shocks after spider pictures. Importantly, only patients with spider phobia continued to overestimate this association after the experiment. The strength of this IC was predicted by increased outcome aversiveness ratings and primary sensory motor cortex activity in response to the shock after spider pictures. Moreover, increased activation of th...

Cortex; a journal devoted to the study of the nervous system and behavior, 2015

Contextual fear conditioning takes place if the occurrence of threat cannot be predicted by speci... more Contextual fear conditioning takes place if the occurrence of threat cannot be predicted by specific cues. As a consequence the context becomes the best predictor of the threat and later induces anxiety (sustained fear response). Previous studies suggest that both the amygdala and the hippocampus are crucial for contextual fear conditioning. First, we wanted to further elucidate the neuronal correlates of long-lasting contextual threat within a highly ecologically setting created in virtual reality (VR). Second, we wanted to distinguish between initial and sustained components of the anxiety response to a threatening situation. Twenty-four participants were guided through two virtual offices for 30s each. They received unpredictable electric stimuli (unconditioned stimulus, US) in one office (anxiety context, CXT+), but never in the second office (safety context, CXT-). Successful contextual fear conditioning was indexed by higher anxiety and enhanced US-expectancy ratings for CXT+ ...

Abstract: Research has shown that individuals with generalized anxiety disorder (GAD) have rigid ... more Abstract: Research has shown that individuals with generalized anxiety disorder (GAD) have rigid autonomic nervous systems, evidenced by low heart rate variability (HRV) and cardiac vagal tone. Cognitive behavioral therapy (CBT) is established as an effective method for ...

Behaviour Research and Therapy, 2008

The cognitive model of social anxiety predicts that negative self-focused cognitions increase anx... more The cognitive model of social anxiety predicts that negative self-focused cognitions increase anxiety when anticipating social threat. To test this prediction, 36 individuals were asked to anticipate and perform a public-speaking task. During anticipation, negative self-focused cognitions or relaxation were experimentally induced while self-reported anxiety, autonomic arousal (heart rate, heart rate variability, skin conductance level), and acoustic eye-blink startle response were assessed. As predicted, negative self-focused cognitions mediated the effects of trait social anxiety on self-reported anxiety and heart rate variability during negative anticipation. Furthermore, trait social anxiety predicted increased startle amplitudes. These findings support a central assumption of the cognitive model of social anxiety.

American Heart Journal, 2007

The main purpose of ICDs is to abort sudden death by delivering therapy at the moment of tachycar... more The main purpose of ICDs is to abort sudden death by delivering therapy at the moment of tachycardia. Shocks accomplish this goal but are painful. Alternatively antitachycardia pacing is painless and if deemed safe may be reasonable substitute. Multiple trials show a high efficacy rate by ATP (78-94%) for treating VTs below 200 bpm. ATP has had less efficacy for faster VTs (41-79%) and have higher probability of accelerating tachycardia (5-55%). The PainFREE trials address these issues. The first pilot study PainFREE Rx applied standardized VT detection and ATP regimen to 220 patients with 1100 spontaneous episodes of VT. ATP success for slow VT success was 92% and fast VT > 188 bpm raw success rate was 89%. None of these trials randomize shock versus ATP so comparative safety data was missing. Thus, the PainFREE Rx II trial was designed to make direct safety comparison between shock and ATP therapies for fast VT > 188 bpm. It included 634 patients with either ischemic or nonischemic cardiomyopathy followed for 1 year yielding 1760 episodes of slow VT, fast VT plus VF. The results of the PainFREE Rx II trial showed that a single regimen of ATP, burst pace 8 pulses at 88% VT cycle length could safely terminate 77% of fast VT and 90% of slow VT. Consequently, shocks were reduced by 70% compared to the shock group. Furthermore, ATP was proven safe because there was no increase in sudden death, syncope or even arrhythmia acceleration compared to shock. The quality of life of the ATP group was found to be superior to the shock group validating ATP's intent. Secondary yet important findings also included the fact that by programming the ICD to wait for 18 beats in PainFREE Rx II before treating an episode reduced markedly the number of episodes treated when compared to 12 beat detection as done in PainFREE Rx I. Since syncope occurred in only 1% of episodes, the authors suggested that a longer wait for ICD detection needs to be evaluated.

Based on a review of models and empirical findings a working model is proposed, suggesting that s... more Based on a review of models and empirical findings a working model is proposed, suggesting that self-related negative cognitions and biased processing of external social threat-cues are mediators of social anxiety. Hypotheses derived from this model were tested in three experiments. The first experiment examined whether levels of trait social anxiousness predicted fearful responding to external social threat-cues (angry vs. neutral and happy facial expressions) during social evaluation. Higher trait social anxiousness predisposes to an inward focus on one's fear reaction to social threat. Using this strategy was expected to enhance fearful responding to angry facial expressions. A strategy of identifying with angry faces was expected to counteract fearful responding, but was expected to fail more often with increasing levels of trait social anxiousness. To examine these hypotheses, affective modulation of the startle eye-blink was assessed in fortyfour undergraduate students. This measure served as a probe into the activation of brain structures involved in the automatic evaluation of environmental threat-cues. Trait and state anxiety as well as explicit emotional responding to the stimuli were assessed with questionnaires and ratings. Processing angry faces potentiated startle amplitudes as expected. Low arousal induced by the stimuli was a probable reason, why startle potentiation to happy faces emerged instead of attenuation. Trait social anxiousness and the cognitive strategies did not influence these effects. Yet, increased trait social anxiousness predicted decreased startle latency, indicating motor hyperresponsivity, which is part of the clinical representation of social anxiety disorder (SAD). Processing facial expressions and identifying with them disrupted this association. Previous studies support that similar strategies may enhance treatment of SAD. Individuals with SAD were expected to respond with increased arousal to external social threatcues. Therefore, the second experiment examined whether nine individuals with SAD showed attentional (prepulse inhibition, PPI) or affective startle modulation to angry as compared to neutral and happy facial expressions. Corrugator supercilii activity was assessed as a behavioral indicator for effects of facial expressions. The remaining setup resembled the first experiment.

Respiratory sinus arrhythmia (RSA) is related to cardiac vagal outflow and the respiratory patter... more Respiratory sinus arrhythmia (RSA) is related to cardiac vagal outflow and the respiratory pattern. Prior infant studies have not systematically examined respiration rate and tidal volume influences on infant RSA or the extent to which infants’ breathing is too fast to extract a valid RSA. We therefore monitored cardiac activity, respiration, and physical activity in 23 six-month old infants during a standardized laboratory stressor protocol. On average, 12.6 % (range 0–58.2%) of analyzed breaths were too short for RSA extraction. Higher respiration rate was associated with lower RSA amplitude in most infants, and lower tidal volume was associated with lower RSA amplitude in some infants. RSA amplitude corrected for respiration rate and tidal volume influences showed theoretically expected strong reductions during stress, whereas performance of uncorrected RSA was less consistent. We conclude that stress-induced changes of peak-valley RSA and effects of variations in breathing patte...

The present study investigated the phenomenon of sudden gains in 107 participants with social pho... more The present study investigated the phenomenon of sudden gains in 107 participants with social phobia (social anxiety disorder) who received either cognitive–behavioral group therapy or exposure group therapy without explicit cognitive interventions, which primarily used public speaking situations as exposure tasks. Twenty-two out of 967 session-to-session intervals met criteria for sudden gains, which most frequently occurred in Session 5. Individuals with sudden gains showed similar improvements in the 2 treatment groups. Although cognitive–behavioral therapy was associated with more cognitive changes than exposure therapy, cognitive changes did not precede sudden gains. In general, the results of this study question the clinical significance of sudden gains in social phobia treatment.

Mental Health, Religion & Culture

ABSTRACT A core issue in obsessive-compulsive disorder (OCD) is the fear of losing control. Relig... more ABSTRACT A core issue in obsessive-compulsive disorder (OCD) is the fear of losing control. Religion may help individuals with OCD to maintain their self-esteem despite the challenge of coping with the unpredictability of life. Data of N = 200 OCD outpatients were assessed via questionnaires at five government hospitals in Lahore, Pakistan. As predicted, high OCD significantly correlated with low self-esteem (r = −.20), and high religiosity was associated with high self-esteem (r = .18). Against the hypothesis, mediation analyses did not reveal an indirect effect of OCD on self-esteem via religiosity (b = −.02, p > .01), and OCD was associated with lowered religiosity (r = −.20). Sample characteristics indicate that most study-participants suffered from very low financial and social support. This struggle may have eroded confidence in the power of religion, which may undermine its potentially healing effects and therefore contribute to OCD and the associated issue of low self-esteem.

Social cognitive and affective neuroscience, Apr 21, 2016

Negative emotions such as anxiety enhance pain perception. However, certain threat characteristic... more Negative emotions such as anxiety enhance pain perception. However, certain threat characteristics are discussed to have different or even divergent effects on pain (hypoalgesia vs hyperalgesia). In order to investigate the neurobiological basis of different threats, we compared the impact of conditioned threat (CT) vs instructed threat (IT) on pain using fMRI. In two groups, participants underwent either Pavlovian threat conditioning or an instructed threat procedure. Afterwards, in an identical test phase participants watched the same visual cues from the previous phase indicating potential threat or safety, and received painful thermal stimulation. In the test phase, pain ratings were increased in both groups under threat. Group comparisons show elevated responses in amygdala and hippocampus for pain under threat in the CT group, and higher activation of the mid-cingulate gyrus (MCC) in the IT group. Psychophysiological interaction analyses in CT demonstrated elevated connectivit...

European Neuropsychopharmacology, 2016

Facilitated processing of interoceptive and exteroceptive information in the salience network is ... more Facilitated processing of interoceptive and exteroceptive information in the salience network is suggested to promote the development of anxiety and anxiety disorders. Here, it was investigated whether the adenosine 2 A receptor gene (ADORA2A) 1976T/C (rs5751876) variant - previously associated with anxiety disorders and anxiety-related phenotypes as well as general attentional efficiency -was involved in the regulation of this network. In detail, fMRI recordings of 65 healthy participants (female=35) were analyzed regarding ADORA2A genotype effects on brain connectivity related to (1) interoceptive processing in terms of functional connectivity resting-state fMRI, and (2) exteroceptive processing using dynamic causal modeling in task-based fMRI. In a subsample, cardiac interoceptive accuracy was furthermore measured via the Mental Tracking Task. ADORA2A genotype was found to modulate a fronto-insular network at rest (interoceptive processing) and while performing an executive control task (exteroceptive processing). Across both modalities, the ADORA2A TT risk genotype was associated with increased connectivity between the insula and the prefrontal cortex. The strength in connectivity correlated with interoceptive accuracy. It is concluded that alterations in fronto-insular connectivity are modulated by both the adenosinergic system and interoceptive accuracy. Thus, fronto-insular connectivity in synopsis with ADORA2A genotypic information could serve as combined biomarkers for personalized treatment approaches in anxiety disorders targeting exteroceptive and interoceptive dysfunction.

Behaviour Research and Therapy, 2014

Behavior Research Methods, 2009

Obtaining noninvasive measures of autonomic regu lation is of great interest to researchers in bi... more Obtaining noninvasive measures of autonomic regu lation is of great interest to researchers in biological psychology and internal medicine. In this context, res piratory sinus arrhythmia (RSA), or highfrequency heartrate variability, has frequently been used to esti mate vagal outflow to the heart (Berntson et al., 1997; Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysi ology, 1996). Studies that used pharmacological block ade have clearly demonstrated a dependency of RSA on levels of parasympathetic activity (

It remains uncertain whether generalized anxiety disorder (GAD) and major depressive disorder (MD... more It remains uncertain whether generalized anxiety disorder (GAD) and major depressive disorder (MDD) represent two separate diagnostic entities. The goal of this study was to examine whether comorbid MDD distinguishes individuals with GAD on a psychophysiological level during an experimentally-induced worrying procedure. Participants included 39 individuals with GAD, 14 of whom met criteria for MDD. During the experimental procedure, participants were asked to worry or relax after an initial baseline phase while measuring their heart rate, high frequency heart rate variability (HF-HRV), skin conductance level, and subjective level of anxiety. The two groups did not differ in their subjective anxiety, heart rate response, and skin conductance levels. However, participants with comorbid MDD had greater HF-HRV values throughout the experiment than did those without MDD. At baseline, HF-HRV was significantly correlated with a self-report measure of depression. These results suggest that individuals with comorbid GAD and MDD can be distinguished based on HF-HRV from individuals with GAD but without MDD. These results support the distinction between GAD and MDD.

Journal of Cranio-Maxillofacial Surgery

GMS German Medical Science, 2021

Background: The study aimed to assess the mental well-being of healthcare professionals at a Germ... more Background: The study aimed to assess the mental well-being of healthcare professionals at a German department of anesthesiology and critical care with a specialized ICU for treatment of COVID-19 patients during the first two peaks of the 2020 pandemic, and identifying risk and protective factors. Methods: A single-center longitudinal, online-based survey was conducted in healthcare workers from a department of anesthesiology and critical care in Bavaria, the most affected federal state in Germany at the time of assessment. Validated scores for depression, anxiety, somatic disorders, burnout, resilience, and self-management were used and complemented by questions about perceived COVID-19-related stressors. In parallel, patient characteristics in the ICU were collected. Results: 24 and 23 critically ill COVID-19 patients were treated during both observation periods in April/May and November/December 2020, respectively. 87.5% and 78.2% of patients had moderate to severe acute respirat...

AIMS Anxiety, depression, and reduced quality of life (QoL) are common in patients with implantab... more AIMS Anxiety, depression, and reduced quality of life (QoL) are common in patients with implantable cardioverter-defibrillators (ICDs). Treatment options are limited and insufficiently defined. We evaluated the efficacy of a web-based intervention (WBI) vs. usual care (UC) for improving psychosocial well-being in ICD patients with elevated psychosocial distress. METHODS AND RESULTS This multicentre, randomized controlled trial (RCT) enrolled 118 ICD patients with increased anxiety or depression [≥6 points on either subscale of the Hospital Anxiety and Depression Scale (HADS)] or reduced QoL [≤16 points on the Satisfaction with Life Scale (SWLS)] from seven German sites (mean age 58.8 ± 11.3 years, 22% women). The primary outcome was a composite assessing change in heart-focused fear, depression, and mental QoL 6 weeks after randomization to WBI or UC, stratified for age, gender, and indication for ICD placement. Web-based intervention consisted of 6 weeks' access to a structured...

Psychophysiology

Infant autonomic reactivity to stress is a potential predictor of later life health complications... more Infant autonomic reactivity to stress is a potential predictor of later life health complications, but research has not sufficiently examined sympathetic activity, controlled for effects of physical activity and respiration, or studied associations among autonomic adjustments, cardiac activity, and affect in infants. We studied 278 infants during the repeated Still-Face Paradigm, a standardized stressor, while monitoring cardiac activity (ECG) and respiratory pattern (respiratory inductance plethysmography). Video ratings of physical activity and affect were also performed. Respiratory sinus arrhythmia (RSA) and T-wave amplitude (TWA) served as noninvasive indicators of cardiac parasympathetic and sympathetic activity, respectively. Responses were compared between infants who completed two still-face exposures and those who terminated after one exposure due to visible distress. Findings, controlled for physical activity, showed robust reductions in respiration-adjusted RSA and TWA, with more tonic attenuation of TWA. Infants completing only one still-face trial showed more pronounced autonomic changes and less recovery from stress. They also showed elevated minute ventilation, suggesting hyperventilation. Both reductions in adjusted RSA and TWA contributed equally to heart rate changes and were associated with higher negative and lower positive affect. These associations were more robust in the group of distressed infants unable to complete both still-face trials. Thus, cardiac sympathetic activation and parasympathetic withdrawal are part of the infant stress response, beyond associated physical activity and respiration changes. Their association with cardiac chronotropy and affect increases as infants' distress level increases. This excess reactivity to social stress should be examined as a predictor of future cardiovascular disease.