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2017 (9)

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Dissertation
Interoceptive Fear Conditioning and Generalization in a Sample of Healthy Subjects and Panic Disorder Patients
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Year: 2017 Publisher: Leuven KU Leuven. Faculteit Psychologie en Pedagogische Wetenschappen

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Interoceptive fear conditioning and generalization have all been proposed to play a part in the development of panic disorder (PD). Interoceptive fear conditioning with respiratory stimuli has been studied in healthy participants, but not in patients with PD. Furthermore, interoceptive fear conditioning and generalization with respiratory stimuli in a between-subject paired/unpaired paradigm have never been combined in one study. This study aims to investigate whether healthy participants (N = 40) and PD patients (N = 15) can learn fear to an interoceptive stimulus, whether this fear generalizes to similar stimuli, and whether it influences interoceptive accuracy. An inspiratory breathing impairment (inspiratory load of 15 cmH2O/l/s) serves as the interoceptive conditioned stimulus, along with a total inspiratory blocking (occlusion) as the unconditioned stimulus (US) in a between-subject paired/unpaired conditioning paradigm. Generalization is tested with four inspiratory loads surrounding the CS (GSs: 5-10-20-25 cmH2O/l/s). Measures include PD relevant questionnaires, startle blink EMG responses, skin conductance responses, electrocardiographic activity, respiration, and US expectancy. Respiratory stimulus perception was assessed with self-report scales. This study successfully established interoceptive fear conditioning with respiratory stimuli in the CS-US paired condition. Moreover, our findings show a trend for the unpaired group (decreased US expectancy in acquisition) that could point to safety learning. Our results did not support generalization to GSs close to the CS after fear conditioning. Interoceptive accuracy appeared to decrease after fear acquisition in the paired condition, however this was a non-significant trend. All participants did show signs of habituation to the respiratory loads. Due to the small sample size in the patient group, the current sample lacks the statistical power to draw conclusions and therefore, additional data collection is needed.

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Dissertation
Validatie van de Smith Mindfulness State Questionnaire
Authors: --- --- ---
Year: 2017 Publisher: Leuven KU Leuven. Faculteit Psychologie en Pedagogische Wetenschappen

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De voornaamste doelstellingen van deze masterproef waren het vertalen en valideren van de “Smith Mindfulness State Questionnaire” (SMSQ; Smith, 2014), een relaxatievragenlijst met 43 items die 17 “mindfulness states” beoogt te meten. Deze “mindfulness states” beschrijven subjectieve ervaringen die samengaan met relaxatie en kunnen gegroepeerd worden in “premindful relaxation”, “core mindfulness” en “mindful engagement and transcendence”. De vertaling werd uitgevoerd door drie perfect tweetalige psychologen en bestond uit een procedure die gebruik maakte van cross-vertaling. Na de vertaling werd een pilootstudie (n = 15) uitgevoerd om mogelijke fouten en/of onduidelijkheden bij de instructie na te gaan. De uiteindelijke vragenlijst vroeg de participanten om terug te denken aan de meest effectieve en belonende relaxatieactiviteit uit de voorbije twee weken en vervolgens op een 4-likert schaal aan te duiden in welke mate hun ervaring paste bij de vragen. De Nederlandstalige SMSQ werd afgenomen bij 269 eerstejaarsstudenten uit de richting psychologie. Aan de hand van de Shapiro-Wilk test werd aangetoond dat de data scheef verdeeld waren. Vervolgens werden met Mplus vijf exploratieve factoranalyses uitgevoerd gaande van een één tot een vijf factoren oplossing met oblieke rotatie (oblimin). Vanwege de scheve verdeling werd gebruik gemaakt van het WLSMV schattingsalgoritme. Op basis van deze analyses en rekening houdend met de interpreteerbaarheid van de factoren, werd gekozen voor een oplossing met vijf factoren. Deze vijf factoren werden vervolgens gereduceerd tot vier schalen, met name slaap (n = 4), fysieke en mentale relaxatie (n = 13), transcendentie en positieve emotie (n = 16) en acceptatie en flow (n = 5). De vier schalen vertoonden ondanks de verschillen met de voorgestelde factorstructuur van Smith een goede betrouwbaarheid met Cronbach’s alfa coëfficiënten tussen .78 en .92. Met uitzondering van de schaal slaap, vertoonden de gemiddelde scores van de schalen bovendien matige tot hoge correlaties met de gemiddelde score van de “fysical tension” schaal van de Relaxation Inventory, wat een teken is van een goede convergente validiteit. De gevonden verschillen tussen de schalen en de factorstructuur van Smith (2014) kunnen samenhangen met de aard van “mindfulness states”, welke afhankelijk zijn van de relaxatieactiviteit die beoefend wordt. Ondanks de verschillen tussen de schalen uit dit onderzoek en de originele factorenstructuur van Smith waren we in staat om vier valide en betrouwbare schalen af te leiden van de SMSQ. Verder onderzoek dat in staat is om de factorstructuur te vergelijken tussen twee populaties of tussen data die reeds bestaan uit onderzoek met vorige versies van de SMSQ is nodig om de validiteit van de Nederlandstalige SMSQ verder aan te tonen.

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Dissertation
Effects of transcutaneous vagal nerve stimulation on the extinction of conditioned heart rate and vagal tone.
Authors: --- ---
Year: 2017 Publisher: Leuven KU Leuven. Faculteit Psychologie en Pedagogische Wetenschappen

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Extinction training through exposure to a feared stimulus, is a key component to the treatment of fear-related problems. However, sometimes a successfully extinguished fear response can return. Stimulation of the vagus nerve (VNS) has been suggested to promote the extinction process in rats (Pena et al., 2013) and a study in humans found that transcutaneous VNS (tVNS) accelerates extinction (Burger et al., 2015). The objective of this study was to investigate effects of fear conditioning, extinction and retention on physiological measures, such as heart rate and heart rate variability (HRV), and to investigate the effects of transcutaneous vagus nerve stimulation (tVNS) on the extinction and retention of conditioned heart rate and cardiac vagal tone. HRV is a measure of the extent in which cardiac activity adapts to changes in the environment, a marker of self-regulatory flexibility. Healthy participants (N = 60) participated in the 3 day experiment: day 1, acquisition (24 trials); day 2, extinction (40 trials); day 3, retention of extinction (12 trials). Geometrical figures served as CSs and were presented for 30 s per trial. During acquisition, the CS+ was reinforced with one or two painful electrical shocks in 75 % of presentations. The tVNS group received vagus nerve stimulation when presented with each CS during extinction training, while the control group received sham stimulation. During acquisition and retention of extinction, both groups received sham stimulation. Heart rate, skin conductance, startle blink EMG and continuous US-expectancy ratings were measured throughout the experiment. However only heart rate measures will be discussed in this dissertation. For the discussion of these other measures you are referred to the master’s thesis of Lisse Cools and Lise Thijs (Van Diest, I., Cools, L. & Thijs, L., 2016). Results suggest that heart rate can be conditioned to the CS+ during fear acquisition, and that these conditioned changes can be extinguished through extinction training. HRV was not conditioned during fear acquisition in this experimental paradigm, however extinction training does appear to have a conditioning effect on HRV. There were no different extinction curves found for the tVNS and control group. The present study offers a new perspective on the effect of fear conditioning on heart rate and HRV. Our findings suggest that tVNS does not promote fear extinction or retention of extinction in physiological measures.

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Dissertation
Respiratory Hypoalgesia: How Slow Deep Breathing Influences Pain Over Time
Authors: --- ---
Year: 2017 Publisher: Leuven KU Leuven. Faculteit Psychologie en Pedagogische Wetenschappen

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Many studies have already addressed the effects of slow deep breathing (SDB) on pain and blood pressure (BP), but the underlying mechanism is still unclear. No studies however looked at the gradual effect of SDB over time. The aim of this study was to investigate the evolution of pain and systolic blood pressure (BP) over the trial during instructed SDB. Forty-one participants performed three trials of SDB, each trial lasting ten minutes. In each SDB trial, participants received 30 electrocutaneous stimuli, with an individually tailored intensity rated as 'moderate pain' at the start of the study. Participants had to rate their perceived pain caused by each stimulus on a numeric scale and beat-to-beat blood pressure was continuously recorded. A Repeated Measures ANOVA with two within subject factors, number of trial (1, 2, 3) and time within trial (minutes 1-10), was applied to the pain ratings and the systolic blood pressure data. As expected, BP decreased over time during SDB, but this effect became less strong through repeated trials. Unexpectedly, also an increase in pain over time was observed during SDB. The increase in pain can potentially be explained by the decrease in BP, which possibly influenced the pain via the central branch of the baroreflex system. Alternative explanations for the increase in pain over time during SDB may involve (1) a decreasing effect over time of distraction from pain during instructed SDB, or, (2) central sensitization. The present findings suggest that to maximize a potential pain-reducing effect of SDB, SDB should be applied only for a short time (e.g. 1 minute).

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Dissertation
The placebo-effect of transcutaneous vagal nerve stimulation (tVNS) during Cognitive Behavioral treatment (CBT) of panic disorder using a single case AB-design
Authors: --- --- ---
Year: 2017 Publisher: Leuven KU Leuven. Faculteit Psychologie en Pedagogische Wetenschappen

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Summary Nele Vanoutrive, The placebo-effect of transcutaneous vagal nerve stimulation (tVNS) during Cognitive Behavioral treatment (CBT) of panic disorder using a single case AB-design. Master’s thesis submitted for the degree of Master of Science in Psychology Examenperiode: September 2017 Promotor: Prof. Dr. Ilse Van Diest Copromotor: Dr. Nathalie Claes Literature suggests the possible added value of vagal nerve stimulation combined with exposure therapy to obtain extinction of fear. Stimulating the vagal nerve would cause an increase in memory consolidation and may also have an anxiolytic effect due to its influences on brain areas responsible for these two processes. Researchers have developed a non-invasive variant of this vagal nerve stimulation (tVNS) by using a transcutaneous stimulation device. With the use of this tVNS, we expected the occurrence of a placebo effect for a clinical population with panic disorder, due to the possible presence of great expectations on its effectiveness. This has led to our main research question whether the effects of transcutaneous vagal nerve stimulation during cognitive behavioral treatment of a panic disorder could be attributed to a placebo-effect rather than the effect of the stimulation itself. The aim of this master thesis was to set up the whole experimental protocol for a repeated single case study that will run for a longer period. This paper will discuss only one single case and also aims to discuss the feasibility of the study. In the long-term, we aim to compare groups of panic disorder patients with or without sham transcutaneous vagal nerve stimulation to assess a potential placebo effect of wearing the tVNS device during their cognitive-behavioral treatment (CBT). Eventually, also a verum tVNS condition will be run to assess whether stimulating the vagus during exposure therapy can enhance the outcome of CBT . Using the NEMOS transcutaneous vagal nerve stimulator in an ineffective way during the CBT sessions, we hypothesized that for this panic patient, her general well-being, avoidance and/or anticipation behavior, and the occurrence and intensity of the present panic complaints would improve. These three aspects were measured using an online diary which the patient had to fill in daily. Our results show an ineffectiveness of the used treatment protocol combined with the sham tVNS for the described panic patient. The patient did not show improvements in general well-being, avoidance and anticipation behavior and occurrence and intensity of the panic complaints. However, due to the use of one single case, reliable conclusions on the effectiveness are difficult to make because of the inability of disentangling the effects of the sham tVNS and CBT for this patient. The patient’s therapy was still running after our cut-off of the treatment period in this study.

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Dissertation
Food for Thought: Do Saturated Fatty Acids Enhance Executive Control via the Vagus Nerve?
Authors: --- --- ---
Year: 2017 Publisher: Leuven KU Leuven. Faculteit Psychologie en Pedagogische Wetenschappen

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A healthy diet consists of a balance between three primary macronutrients: carbohydrates, protein and fats. These may influence executive control, an important brain function for success and well-being in daily life. However, little is known about the mechanism whereby nutrients affect the brain. Previous research has shown that nutrients activate receptors in the gut via digestive hormones activating afferent fibers of the vagus nerve that signal to brain areas such as the prefrontal cortex (important for executive control). We proposed that fatty acids with chain lengths longer than 12 carbons affect the vagus nerve through release of cholecystokinin, thereby differentially affecting executive control and heart rate variability (HRV), a measure of efferent vagal activation. It was expected that long chain fatty acids C12 (lauric acid) and C16 (palmitic acid) improve performance on executive control tasks and elevate heart rate variability compared to control conditions saline and C10 (capric acid). To investigate this hypothesis, a randomized, within-subject double-blind, placebo-controlled experiment was conducted. Participants completed four sessions and received a different solution each session (saline, C10, C12 and C16). Solutions were administered intragastrically before participants completed executive control tasks, including an immediate word recall task, the Trail Making Test, the Forward Digit Span Task and a delayed word recognition task. Heart rate variability was measured before and after nutrient manipulation. Since previous research shows that fatty acids can have an attenuating effect on induced negative emotion, we controlled for mood effects in this study. Participants filled out several mood and satiety questionnaires including the Positive and Negative Affect Scale (PANAS), Visual Analogue Scale (VAS), and Self-Assessment Manikin (SAM). Preliminary results of 20 participants did not show a significant effect of the administered long chain fatty acids on executive control. However, for the mood and satiety ratings, some significant effects were found. Valence scores tended to be higher post-infusion compared to pre-infusion in all conditions. A similar result was found for feelings of control in all conditions except for C10. Also nausea and fullness scores increased significantly post-infusionw. This study was innovative in two ways. Firstly, this study contributes to existing literature by investigating the effects of isolated nutrients on executive control. Secondly, fatty acids were directly infused in the stomach, thereby bypassing taste and expectation effects. This study contributes to a better understanding of mechanisms involved in gut-brain interactions, such as the effects of nutrients on executive control. Since executive control is correlated with success in several life areas such as social relationships and job performance, it is of crucial importance to better understand which manipulations might influence this cognitive function.

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Dissertation
Symptom perception processes in functional somatic syndromes
Authors: --- --- --- --- --- et al.
Year: 2017 Publisher: Leuven KU Leuven. Faculteit Psychologie en Pedagogische Wetenschappen

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Dissertation
FOOD FOR THOUGHT: DO SATURATED FATTY ACIDS ENHANCE EXECUTIVE CONTROL VIA THE VAGUS NERVE? The Effects of Intragastrically Infused Saturated Fatty Acids on Executive Control in Healthy Young Adults: Preliminary Results.
Authors: --- --- ---
Year: 2017 Publisher: Leuven KU Leuven. Faculteit Psychologie en Pedagogische Wetenschappen

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A healthy diet consists of a balance between three primary macronutrients: carbohydrates, protein and fats. These may influence executive control, an important brain function for success and well-being in daily life. However, little is known about the mechanism whereby nutrients affect the brain. Previous research has shown that nutrients activate receptors in the gut via digestive hormones activating afferent fibers of the vagus nerve that signal to brain areas such as the prefrontal cortex (important for executive control). We proposed that fatty acids with chain lengths longer than 12 carbons affect the vagus nerve through release of cholecystokinin, thereby differentially affecting executive control and heart rate variability (HRV), a measure of efferent vagal activation. It was expected that long chain fatty acids C12 (lauric acid) and C16 (palmitic acid) improve performance on executive control tasks and elevate HRV compared to control conditions saline and C10 (capric acid). To investigate this hypothesis, a randomized, within-subject, double-blind, placebo-controlled experiment was conducted. Participants completed four sessions and received a different solution each session (saline, C10, C12, and C16). Solutions were administered intragastrically before participants completed executive control tasks, including an immediate word recall task, the Trail Making Test, the Forward Digit Span Task, and a delayed word recognition task. HRV was assumed to measure efferent vagal activity and was measured before and after the nutrient manipulations. Since previous research showed that fatty acids have an attenuating effect on induced negative emotion, we controlled for mood effects in this study. Participants filled out several mood and satiety questionnaires, including the Positive and Negative Affect Scale, Visual Analogue Scale, and Self-Assessment Manikin. Preliminary results of 20 participants did not show a significant effect of the administered long chain fatty acids on executive control performance. However, for the mood and satiety ratings, some significant effects were found. Valence scores tended to be higher post-infusion compared to pre-infusion in all conditions. A similar result was found for feelings of control in all conditions except for C10. Also nausea and fullness scores increased significantly post-infusion. This study was innovative in two ways. Firstly, this study contributes to existing literature by investigating the effects of isolated nutrients on executive control. Secondly, fatty acids were directly infused in the stomach, thereby bypassing taste and expectation effects. This study contributes to a better understanding of mechanisms involved in gut-brain interactions, such as the effects of nutrients on executive control. Since executive control is correlated with success in several life areas such as social relationships and job performance, it is of crucial importance to better understand which manipulations might influence this cognitive funtion.

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Dissertation
Respiratory gating of pain: A linear mixed model to disentangle the effect of slow deep breathing on pain perception

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If you were in pain for a reason, would you change your breathing to relieve from it, or would you use any breathing techniques to ease the feeling of pain? To make this more clear, can any sort of controlled breathing such as slow deep breathing or breath-holding can change the feeling of pain? The use of controlled breathing techniques is as old as Yoga, going back 2000 years ago. Breathing techniques are used in mindfulness, meditation, and for relaxation commonly by people. Alongside its use in healthy people, breathing practices are a common therapeutic technique to manage symptoms in conditions such as anxiety, high blood pressure, and pain. In controlling pain, slow deep breathing techniques particularly used for patients with pain or during labour. Despite the widespread use of these techniques, their efficacy and mechanisms of action have received little attention. This is still unclear how much these techniques can attenuate pain and through which psychological or physiological mechanisms they work. However, we believe psychologically attention manipulation, distraction, or changing the expectancy of people play an important role in the analgesic effect of these techniques. In addition, physiologically evidence tells us that slow deep breathing practice can effectively change the blood pressure fluctuation, regulate the heartbeats, and influence the autonomic nervous system effectively. The autonomic nervous system controls the conditions inside the body. We know that if we get pain during slow deep breathing comparing to normal breathing, in most of the times we feel less pain. However, we still don’t know if we continue our practice of slow deep breathing, the pain feeling continues to decline. Another important question is, when doing slow deep breathing exercise, do we need to emphasize on the breathing-in part or breathing-out part. These are the two questions that we tried to answer in this current research. Our findings show that no matter how long we are going to do the breathing practice, the pain feeling stays the same. Surprisingly, even at the beginning, it starts to increase a bit. So longer slow breathing doesn’t mean less pain again. However, this does not conflict with another possible benefit of such techniques for longer use of them. We also found that pain fluctuates during one respiration cycle, but this fluctuation is very small and also swing faster than the breathing cycle. We need to do more experiments to understand how the nature and quality of the pain changes by slow deep breathing.

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