Expectation Of Harm Research Articles

Imagery rescripting and extinction: Effects on US expectancy, US revaluation, and the generalization of fear reduction

Exposure therapy consists of exposing patients to their fears and thereby diminishing their harm expectancies (i.e., extinction or expectancy learning). Although effective for many anxiety patients, its long-term success depends on the generalization of these harm expectancies to other stimuli. However, research shows that this generalization of extinction is limited. Besides decreasing harm expectancies, fear reduction may also be achieved by changing the meaning of an aversive memory representation (US revaluation). Imagery rescripting (ImRs) may be more successful in generalizing fear reduction because it allegedly works through US revaluation. The current experiment aimed to test working mechanisms for ImRs and extinction (revaluation and expectancy learning, respectively), and to examine generalization of fear reduction. In a fear conditioning paradigm, 113 healthy participants watched an aversive film clip that was used as the US. The manipulation consisted of imagining a script with a positive ending to the film clip (ImRs-only), extinction (extinction-only), or both (ImRs + extinction). Results showed enhanced US revaluation in ImRs + extinction. US expectancy decreased more strongly in the extinction conditions. Generalization of fear reduction was found in all conditions. Our results suggest different working mechanisms for ImRs and exposure. Future research should replicate this in (sub)clinical samples.

When ‘fear factors’ motivate people to adopt electric vehicles in India: An empirical investigation of the protection motivation theory

Climatic extremes have caused immense harm around the world. Its harm in terms of the proportion of people and regions affected continues to increase every single day. Due to people's psychological distance from such climatic threats, active initiatives are not undertaken for mitigation of its source. Rather, localized short-term solutions are marking a new status-quo. This study examines if fear can be used as a motivator to nudge people away from the psychological distance and motivate them to adopt electric vehicles (EVs). While subsidies and tax rebates are popularly adopted means to boost demand and supply of EVs, monetary incentives are costly to sustain for developing nations, amidst their diverse priorities. Instead, use of motivators like ‘fear’ is cheap, yet not much explored. Using the protection motivation theory, the study interviews 1112 Indian individuals, to examine if fear can nudge EV adoption. Using structural equation modeling and mediation analysis, the study finds that the expectation of personal harm from climatic threats can nudge one to actively mitigate the source of threat. Various aspects of threat and the associated coping processes that need to be triggered sequentially to nudge the formation of a pro-environmental intention to adopt EVs are also outlined.

Effects Of Health Promotion Through Animation Video In Reducing Anxiety Among Hypertension Patients: A Literature Review

Introduction: Anxiety is a state of unease or apprehension that arises from the expectation of potential harm, frequently without a clear or identifiable cause. An individual undergoing anxiety might induce a rise in blood pressure. Anxiety exacerbates hypertension by causing vasoconstriction, resulting in elevated blood pressure. Regarding the correlation between anxiety and hypertension, it is crucial to address anxiety in individuals with hypertension. There are multiple methods available to address this anxiety, including both pharmaceutical and non-pharmacological approaches. Material and Methods: This study is a review of existing literature. The researchers aimed to locate scholarly literature about the use of animated movies as a means of alleviating anxiety in individuals diagnosed with hypertension. Articles about the specified theme were chosen from 2018 to 2023 using electronic databases such as Science Direct, PubMed, and Google Scholar and open knowledge maps during the article search. The researchers employed the PRISMA methodology to analyze the literature review studies. Results: 174 articles were chosen using the keywords Health Promotion, Animation Video, Anxiety, and Hypertension. The research underwent a comprehensive review encompassing its aims, samples, methods, and results. Based on the literature review findings, there needs to be more participants or samples that align with the focus of this study. Researchers did not discover any instances of anxiousness in individuals with hypertension through the examination of samples. However, researchers conducted studies on various topics, including the impact of using animated videos to promote health in reducing anxiety among postpartum patients, preoperative anxiety in children, and hypertension. These findings are presented in Table 1. Nevertheless, scholars might engage in discussions regarding the impacts of animated videos. The researchers selected and evaluated only ten publications despite their lack of relevance to the research area of this literature review. Conclusion: Out of the 10 articles examined, many employed animated videos as interventions. However, researchers did not discover any studies specifically focused on investigating the impact of using animated videos for health promotion in reducing anxiety among hypertensive patients. The researchers discovered an independent subject. Consequently, researching this topic can contribute innovatively to future investigations.

Exposure bij de angstbehandeling in de mondzorgpraktijk

For dental anxiety, cognitive behavioral therapy is the treatment of choice and exposure therapy is a major part of this treatment program. This article describes the underlying working mechanism of exposure therapy. Exposure should be directed toward the patient's harm expectancies. Moreover, the patient needs to be ensured that their harm expectation will not be violated, despite being challenged to the maximum. In addition, it is important that patients perform exposure exercises in as many different contexts as possible and to ensure a lot of repetition. Combining different fear-inducing stimuli during exposure sessions is also recommended. Currently, the inhibition model is the best explanatory working mechanism model and this article contrasts the new inhibition model with the older habituation model, that is still often used in clinical practice. The most important clinical implications of the inhibition model are described and illustrated with practical examples.

Home e-cigarette rules and youth's vulnerability to initiate and sustain e-cigarette use

Existing studies of the impact of home rules on youth's vulnerability to e-cigarette use were based on cross-sectional data, youth or parent reports alone, as well as youth's perceptions and susceptibility. This study capitalizes on the restricted-use data of the Population Assessment of Tobacco and Health (PATH) Study to examine the longitudinal association between home rules for e-cigarette use and youth's vulnerability including initiation of use and regular use two years later. Secondary analysis was conducted on 1203 parent-youth pairs who participated in both Wave 4 (2016–2018) and Wave 5 (2018–2019) assessment of the PATH Study and while the youth were age 12–16 at Wave 4. Linear and logistic regressions were performed to examine the associations between having a strict home rule for e-cigarette use at Wave 4 and the youth's outcomes including perceived social norms, expectancies, susceptibility, initiation of use, and regular use of e-cigarettes at Wave 5, controlling for parent and youth factors. The results show that having a strict home rule for e-cigarette use was associated with youth's heightened level of perceived injunctive norms (β = 0.22, p < 0.01), higher expectancy of harmfulness (β = 0.28, p < 0.01) and lower odds for regular e-cigarette use (OR = 0.36, p < 0.05). In conclusion, the findings of this study support the potential protective effects of implementing a strict home rule for e-cigarette use. Future intervention efforts may promote parents' awareness of the potential protective effects of a strict home e-cigarette rule on youth's normative belief, harm expectancy, and behavior of e-cigarette use.

Factors that influence the connection between engineering self-efficacy and growth within academic, social and spiritual life habits

First year engineering students begin their degree with pre-conceived notions of how the year will go, with respect to their academics, in addition to their social and spiritual lives. This thereby gives way to a loss of self-efficacy, associated with both engineering itself and their own self-concept led by that initial disconnection. Thus, it is important to understand what factors influence the connections between engineering self-efficacy and their academic, social, and spiritual life-habits. Life habits can be defined as any set of factors encouraging the growth of an individual, affecting an individual’s life, ranging from learning strategies to self-perception of oneself and everything in between. Previous research has explored the stressors specific to students in first year engineering and how this affects students’ wellbeing overall [1] - although not specific to the motivational belief that is self-efficacy and the effect it has on their entire life. Using an inductive thematic analysis [2] on responses written by students who completed a series of self-reflections after participating in Mental Wellness and Engineering Attributes seminars offered in their first year Engineering courses, this research explores the factors that influence the connection between self-efficacy and an individual’s personal growth as described through life habits. The five themes that were found were social/spiritual wellness in terms of a support system, a fixed academic mindset with an “all or nothing” behavior, the inability to cope with transitioning and adapting out of their previous institutions, harmful expectations, and the importance of finding a balance in their everyday lives. Given these findings, the connection between self-efficacy and life habits is prevalent both negatively and positively for first year engineering students. The results suggest that individuals in their first year of engineering are caught off guard by the difficulty of the program, leading to a loss of self-efficacy and the development of new negative learning strategies - until they discover how to succeed in engineering.

Effects of nocebo and drusebo in determining statin-induced muscle symptoms

Statins represent an important class of cardiovascular drugs for the prevention of atherogenic complications. However, despite the effectiveness of statins, non-adherence and discontinuation of therapy with these drugs is a problem worldwide. Reasons for not using statins in patients at high CV risk include statin-associated muscle symptoms (SAMS), which are not usually associated with significant elevations of serum creatine kinase. SAMS are the most common side effects of statins: 3–5% in RCTs, 15–20% in observational studies, and 60% in patient surveys. This range is possibly due to misinterpretation of symptoms, as well as patients’ expectation of harm from statin treatment (“statin fear”). The article highlights the problem of studying the role of nocebo and drusebo effects for SAMS, presents differences in definitions and methods of detection. The concept of the drucebo effect was proposed by the International Lipid Expert Group (ILEP, 2018) as a harm to the patient, unrelated to the pharmacological action of the drug (negative effect of the drucebo). The results of studies and meta-analyses evaluating the effects of nocebo and drusebo for SAMS are presented, in which no difference was found in the frequency and severity of muscle symptoms between statin and placebo; the nocebo rate was 90% of the statin effect, and the contribution of the drusebo effect to SAMS and statin discontinuation ranged from 38 to 78%. Also presented are current international guidelines and principles of patient management aimed at preventing discontinuation of statin use in connection with SAMS.

Politicizing self-advocacy: Disabled students navigating ableist expectations in postsecondary education

The student self-advocacy literature commonly claims that although self-advocacy is a vital skill that disabled students require to succeed in postsecondary education, many of these students experience a significant ‘skills-deficit’ in this area. This paper seeks to intervene in this literature by proposing opportunities to ‘politicize’ self-advocacy and move away from its individual, deficit-focused approach. To do so, the paper reports findings from a qualitative study at a research-intensive Canadian university. Interviews with 11 disabled students revealed a perception that there is an institutionally endorsed ‘right way’ to self-advocate that included expectations to: (1) register for formal accommodations; (2) embody visible/physical disability; (3) perform less disabled; and (4) make others comfortable. Rooted in ableism, these harmful expectations adopt misconceptions of disability as predictable and visible, and burden students with demands that they make their self-advocacy convenient for those to whom they are self-advocating. As a form of resistance to these ableist expectations, students described their own ‘better way’ of negotiating self-advocacy and disability on campus. This ‘better way’ offers opportunities for ‘politicizing’ self-advocacy by recognizing ableism and the harms of the self-advocacy model, affirming disabled student knowledge and community, and enacting their visions for institutional change. Vital to this politicization is a move away from staff and nondisabled-led initiatives like self-advocacy training to address a perceived skills-deficit in individual students. Politicizing self-advocacy moves instead towards disabled students as full partners in conducting research and informing student services and staff training based on their collective lived expertise and strategic practices.

Grief and mourning in Covid-19 pandemic and delayed business as a new concept.

The measures, restrictions, and death-related rituals in the COVID-19 pandemic have affected the mourning-related routines of individuals. Moreover, mourning processes have been affected by the restriction of death-related cultural rituals, funeral ceremonies performed only by the officials, and the prohibition of visiting graves. This study aims to investigate the experiences of individuals who lost their loved ones in Turkey during the COVID-19 pandemic. For that purpose, the phenomenological method is employed in the design of the study. Individual interviews were conducted with nine participants who lost their relatives during the COVID-19 pandemic. Data were collected through semi-structured interview forms prepared by the researchers. The study participants described the various factors contributing to the grief and mourning process in the COVID-19 pandemic. These factors were categorized into three following main categories: grief and mourning responses of the individuals lost loved ones, including cognitive, emotional, and behavioral responses; risk factors including the expectation of harm, unfinished business, and restriction of death-related religious-cultural rituals; and protective factors including relative support (i.e., family, spouse, friend, partner), tele-support (i.e., mobile phone, internet, social media), positive coping strategies (cognitive, behavioral, and religious-spiritual), and delayed business. The “delayed business” concept was also addressed within protective factors and explained in general terms. Finally, the findings were discussed considering the literature and presented some theoretical and practical implications.

NLA scientific statement on statin intolerance: a new definition and key considerations for ASCVD risk reduction in the statin intolerant patient

Although statins are generally well tolerated, statin intolerance is reported in 5-30% of patients and contributes to reduced statin adherence and persistence, as well as higher risk for adverse cardiovascular outcomes. This Scientific Statement from the National Lipid Association was developed to provide an updated definition of statin intolerance and to inform clinicians and researchers about its identification and management. Statin intolerance is defined as one or more adverse effects associated with statin therapy which resolves or improves with dose reduction or discontinuation and can be classified as a complete inability to tolerate any dose of a statin or partial intolerance with inability to tolerate the dose necessary to achieve the patient-specific therapeutic objective. To classify a patient as having statin intolerance, a minimum of two statins should have been attempted, including at least one at the lowest approved daily dosage. This Statement acknowledges the importance of identifying modifiable risk factors for statin intolerance and recognizes the possibility of a “nocebo” effect (patient expectation of harm resulting in perceived side effects). To identify a tolerable statin regimen it is recommended that clinicians consider using several different strategies (e.g., different statin, dose, and/or dosing frequency). Non-statin therapy may be required for patients who cannot reach therapeutic objectives with lifestyle and maximal tolerated statin therapy. If so, therapies with outcomes data from randomized trials showing reduced cardiovascular events are favored. In high and very high risk patients who are statin intolerant, clinicians should consider initiating non-statin therapy while additional attempts are made to identify a tolerable statin in order to limit the time of exposure to elevated levels of atherogenic lipoproteins.

Magazines as contradictory spaces for alcohol messaging: a mixed method content and thematic analysis of UK women’s magazine representations of alcohol and its consumption

Background Women’s magazines provide a space in which gendered norms around alcohol-related practice are (re)-produced. They act as important points of reference for women to draw upon in their own understandings of alcohol use within their identity making. Studying the alcohol-related messages women’s magazines disseminate is therefore an important line of inquiry. Methods An analysis of textual and visual alcohol depictions, including alcohol advertising, in 70 editions of 20 printed magazines targeted at and read by women, published between August 2020 and January 2021, was conducted using quantitative content and qualitative thematic analysis. Results Women’s magazines have the potential to disseminate public health messages about the physical and mental health impacts of alcohol use, alcohol’s role in gender inequalities and the risk of harm from alcohol use by men. However, they do so in ways that reproduce harmful gender norms and expectations, and overlook the structural causes of alcohol-related harms. Associations between alcohol use and violence against women were simplified, in ways that ignored the root causes, produced victim-blaming narratives and deflected responsibility from the perpetrator to the effects of alcohol. Narratives around drinking and sobriety were underpinned by concerns over appearance, which reinforced social expectations of the ideal feminine body. Health narratives were in conflict with the presence of pro-alcohol messages such as consumption suggestions and alcohol advertising, which promoted alcohol use as a normalised aspect of women’s day to day lives. Conclusions Women receive a number of mixed and contradictory messages on alcohol use through their magazine readership, which places limits on magazines as educational sources of public health messaging.

The effects of a specialized staff training on trauma-sensitivity in professionals working with patients with a psychotic disorder: A pilot study

ABSTRACT Background Studies show that the trauma-sensitivity of professionals working with patients with psychosis is insufficient. As a result, trauma-related problems remain undetected and untreated, which may impede recovery in this group. This study explored the effects of a specialised staff training on six trauma-sensitivity factors (i.e. knowledge, credibility, expected burden, harm expectancy, diagnostic competency and organizational support), self-reported trauma-sensitive behaviour and objective indicators of trauma-sensitive behaviour in medical files. Method Professionals (N = 56) rated the six trauma-sensitivity factors and their own trauma-sensitive behaviour at pre-training, post-training and at 6- and 12-months follow-up. Changes in indicators of trauma-sensitive behaviours were assessed by a review of medical files (N = 97). Results The specialized training increased knowledge, crediblity and experienced diagnostic compentence. The training decreased burden and harm expectancies, and enhanced self-reported trauma-sensitive behaviour. However, this positive change could not be objectified by indicators of trauma-sensitive behaviour in medical files. Discussion These findings support the notion that specialised training has a positive effect on increasing trauma-sensitivity and decreasing burden and harm expectancies, but not necessarily on observable trauma-sensitive behaviour. In addition to training staff, structural implementation and organisational support are argued to be essential to attain actual behaviour change.

Expectancy violation during exposure therapy: A pilot randomized controlled trial

Despite empirical support for the efficacy of exposure-based therapy for anxiety-related disorders, many individuals do not respond to this intervention or else experience a return of fear after treatment. Inhibitory learning theory has informed novel approaches to exposure therapy delivery that aim to improve both short- and long-term outcomes. One exposure optimization strategy is to maximize expectancy violation (i.e., the difference between expected and actual outcomes), which is thought to strengthen inhibitory (i.e., non-threat) associations and enhance long-term fear extinction. In practice, exposure therapy is traditionally preceded by cognitive restructuring to lessen the magnitude of harm expectancies. Yet this technique may restrict the discrepancy between expected and actual outcomes, thus reducing the potency of exposure and limiting the durability of treatment gains. The present study examined the effects of manipulating the timing of cognitive techniques during exposure-based therapy by randomly assigning 45 participants with spider phobia to one of three conditions: (a) cognitive restructuring before exposure (CR-EXP; n = 15), (b) exposure before cognitive restructuring (EXP-CR; n = 15), and (c) stress management control (SM; n = 15). Although both CR-EXP and EXP-CR were more effective than SM, there were no significant differences between CR-EXP and EXP-CR on measures of fear, avoidance, spider-related cognitions, or change in harm expectancy. Clinical implications, study limitations, and future directions are discussed.

Social Buffering as a Tool for Improving Rodent Welfare.

The presence of a conspecific can be calming to some species of animal during stress, a phenomenon known as social buffering. For rodents, social buffering can reduce the perception of and reaction to aversive experiences. With a companion, animals may be less frightened in conditioned fear paradigms, experience faster wound healing, show reduced corticosterone responses to novelty, and become more resilient to everyday stressors like cage-cleaning. Social buffering works in diverse ways across species and life stages. For example, social buffering may rely on specific bonds and interactions between individuals, whereas in other cases, the mere presence of conspecific cues may reduce isolation stress. Social buffering has diverse practical applications for enhancing rodent wellbeing (some of which can be immediately applied, while others need further development via welfare-oriented research). Appropriate social housing will generally increase rodents' abilities to cope with challenges, with affiliative cage mates being the most effective buffers. Thus, when rodents are scheduled to experience distressing research procedures, ensuring that their home lives supply high degrees of affiliative, low stress social contact can be an effective refinement. Furthermore, social buffering research illustrates the stress of acute isolation: stressors experienced outside the cage may thus be less impactful if a companion is present. If a companion cannot be provided for subjects exposed to out-of-cage stressors, odors from unstressed animals can help ameliorate stress, as can proxies such as pieces of synthetic fur. Finally, in cases involving conditioned fear (the learned expectation of harm), newly providing social contact during exposure to negative conditioned stimuli (CS) can modify the CS such that for research rodents repeatedly exposed to aversive stimuli, adding conspecific contact can reduce their conditioned fear. Ultimately, these benefits of social buffering should inspire the use of creative techniques to reduce the impact of stressful procedures on laboratory rodents, so enhancing their welfare.

Pain as a threat—psychological and phenomenological aspects

Introduction: Pain is a multidimensional experience of injury or threat of future damage, with sensory, cognitive, motivational and emotional aspects. The essence of the pain experience depends on the meaning that the individual gives to pain in a particular situation. Aim: The aim of the article is to analyze and structure the concept of pain as a threat, covering its psychological and phenomenological aspects Materials and Methods: A review and critical analysis of relevant literature have been conducted. Results: It has been established that a predisposing factor for maintaining acute pain and turning it into a chronic one is the expectation (threat) of future harm. The emotional components of the threat of pain (fear and anxiety), as well as the cognitive ones (overvigilance and catastrophizing), have been studied. The assessments of the situation during pain and of the pain-coping resources are the main cognitive mediators that determine the outcome. The perception of pain as a threat provokes fear, anxiety, experiences of insecurity, helplessness, and maladaptive behaviors. Pain-avoiding behavior is in the basis of the stress-diathesis in the manifestation of chronic pain and it predicts future disability. Conclusion: Pain is a threat to the physical and the psychosocial functioning. The assessment of the emotional, cognitive and situational aspects related to pain should be a part of the multidisciplinary approaches to pain management. Manipulating these factors is key to reducing the risk of pain becoming chronic. The application of effective behavioral and cognitive techniques, aimed at increasing the resources for coping with and controlling pain enables patients to continue to function normally in spite of the pain.

Competitive gossip: the impact of domain, resource value, resource scarcity and coalitions.

Those with better reputations often obtain more resources than those with poorer reputations. Consequently, gossip might be an evolved strategy to compete for valuable and scarce material and social resources. Influenced by models of non-human primate competition, we test the hypotheses that gossip: (i) targets aspects of reputation relevant to the domain in which the competition is occurring, (ii) increases when contested resources are more valuable, and (iii) increases when resources are scarcer. We then test hypotheses derived from informational warfare theory, which proposes that coalitions strategically collect, analyse and disseminate gossip. Specifically, we test whether: (iv) coalitions deter negative gossip, and (v) whether they increase expectations of reputational harm to competitors. Using experimental methods in a Mechanical Turk sample (n = 600), and survey and ego network analysis methods in a sample of California sorority women (n = 74), we found that gossip content is specific to the context of the competition; that more valuable and scarcer resources cause gossip, particularly negative gossip, to intensify; and that allies deter negative gossip and increase expectations of reputational harm to an adversary. These results support social competition theories of gossip. This article is part of the theme issue 'The language of cooperation: reputation and honest signalling'.

The affluenza epidemic: consequences of parent-child value congruence in a material world

PurposeThe purpose of this research is to offer a theoretical explanation for the perpetuation of materialistic values among adolescents. In a recent survey by the Pew Research Center (2019), adolescents in America say that having a lot of money is more important to them in their future than getting married or having children. This research answers the call for a theoretical explanation for the perpetuation of materialistic values among adolescents. Using person–environment fit (P-E fit) theory, this study argues that it is not the content of the values, but rather the fit between a person’s value priorities and the values prevailing in the environment which is crucial to well-being.Design/methodology/approachA national online panel was used to collect cross-sectional survey data from 278 families (adolescents aged 13–18 and their parents).FindingsFindings indicate that adolescents in congruent value households express significantly greater life satisfaction and less depressed mood than adolescents in conflict value households. In fact, materialistic adolescents living in materialistic households expressed the greatest life satisfaction, a finding which contrasts with the current claims that materialism uniformly causes anxiety and depressed mood.Research limitations/implicationsTo the best of the authors’ knowledge, this study is the first to test person–environment fit theory in the context of the family and to offer this theory as a viable explanation of affluenza among America’s youth. The results of this study support the P-E fit theory and suggest that materialism is not universally associated with negative well-being, but rather that adolescents’ well-being is a function of the congruency of an adolescent’s values to his/her family environment.Social implicationsWhile materialistic socialization within the family does enhance the well-being of adolescents temporarily, it may also set adolescents up for a lifetime of harmful expectations from the pursuit money. A consistent pattern of overconsumption as a reward to adolescents may later produce materialistic adults who suffer from financial difficulties and mental health disorders. Disproportionate consumption further leads to environmental pollution.Originality/valueNo study to date has examined the impact of value congruence in the household (parent-child), as it pertains to the development of materialism in adolescents and its effects on adolescents’ well-being. This study suggests that highly materialistic adolescents can experience happiness from the pursuit of consumption. This offers insight into how a value deemed as detrimental as materialism continues to permeate in our society.

M230. VIRTUAL REALITY FOR IMPROVING SOCIAL ACTIVITIES AND PARTICIPATION (VR-SOAP): DEVELOPMENT OF A NEW TREATMENT FOR YOUNG PEOPLE WITH PSYCHOSIS

BackgroundYoung people with a psychotic disorder have the same social goals as their healthy peers, but their social networks are smaller, they participate less often in leisure activities and are less successful in work and education. Current treatments have only moderate effects on social functioning. Virtual Reality (VR) has a great potential to improve the social functioning of young people with psychosis. With VR, individuals can practice with simulations of difficult social situations in a safe and personalized way. Therefore, we aimed to develop and investigate feasibility of a novel VR treatment (VR-SOAP) for improving social contacts, leisure activities and social participation of young people with a psychotic disorder.MethodsAs a first step, a literature search of causes of impaired social functioning was conducted. Underlying relationships and mechanisms of the causes were identified. The causes of impaired social functioning were translated into concepts for the VR modules. The concepts were translated into requirements for the VR modules. Subsequently, the software and the treatment manual were developed in an iterative process with a team of experiential experts, psychosis therapists, researchers, VR experts and software engineers. The final prototype will be tested in a small pilot study with three therapists and six patients. In order to determine the feasibility and acceptability of the treatment and to evaluate and improve the treatment protocol using input from therapists and patients.ResultsSeveral determinants of impaired social functioning were identified: negative symptoms, impaired social cognition, paranoid ideations, social anxiety, low self-esteem, self-stigma and poor communication skills. These causes are multifaceted, but at the same time interrelated and overlapping. VR-SOAP was designed as five modules that address these causes, four optional modules (1–4) and one fixed module (5). The treatment is personalized and takes the specific individual contributing causes into account. Patient and therapist select two out of four optional modules. In module 1 (Negative symptoms) patients will focus on increasing their motivation and pleasure in dealing with amotivation and anhedonia. In module 2 (Social cognition) patients will practice with recognizing facial emotions and interpreting social situations. Module 3 (Paranoid ideations) consists of exposure exercises and behavioural experiments testing harm expectancies. In module 4 (Self-esteem and self-stigma) patients will focus on positive aspects of the self and challenge self-criticism. All patients will end with module 5 (Communication and Interaction skills), in which experiences, knowledge and skills from other modules are integrated and applied in role-plays. Currently, the pilot feasibility study is ongoing. Preliminary results will be presented.DiscussionVR-SOAP is a promising new intervention for enhancing the social functioning of young adults with psychosis. VR is very useful for practising new social behaviour. It enables patients to practice with real-world social situations in a safe and gradual way. In the coming years, a single-blind randomized controlled trial will be conducted to test the effect of VR-SOAP on social contacts, leisure activities and social participation.

Nocebo and lessebo effects.

The power of placebos is commonly associated with the placebo effect. In contrast, detrimental effects related to the use of a placebo are little studied and less well recognized. This chapter covers the nocebo and lessebo effects defined, respectively, as expectation of harm in the form of adverse events in a placebo arm and reduction of therapeutic benefit due to the uncertainty of being allocated to placebo. The lessebo effect is a more recent concept and has been described only in depression, schizophrenia and Parkinson's disease. The nocebo response was evaluated in many neurological diseases, including epilepsy, multiple sclerosis, Parkinson's disease, Alzheimer's disease, restless leg syndrome, among others. Meta-analyses of randomized controlled trials in these conditions reveal a significant variability of the magnitude of the nocebo response and that factors related to study design, study participants or neurological disease can be associated with a nocebo response, although with the opposing findings across conditions. The knowledge about neurobiological mechanisms of the nocebo effect is poor for neurological diseases, and most of the information has been generated in pain. Functional neuroimaging suggests the existence of a distinct network for the anticipation and the experience of a hyperalgesia nocebo response. Different types of neurotransmitters have been involved, including cholecystokinin, dopamine and opioids. Recognizing the potential impact of nocebo and lessebo effects, mitigating strategies are in development with application to clinical research and clinical practice, such as a contextualized informed consent process, alternative study designs and enhancement of patient-physician communication.

A Situational Context Training for Socially Anxious Children

The processing of facial expressions is biased in social anxiety (SA). We tested whether a brief situational context training in the school setting might be helpful in changing biased facial processing and reducing relevant symptoms in children with SA. A final sample of 118 children aged 8 to 13 years with high vs. low SA were randomly assigned to a training group or a control group without intervention. During the training, the children were exposed to images depicting negative facial expressions with masked and later unmasked backgrounds, in order to demonstrate that negative expressions can also occur in emotion-irrelevant contexts (e.g., during onion cutting). Especially for socially anxious children, the intervention effectively reduced harmful expectations during the presentation of images showing negative facial expressions. Moreover, socially anxious children having undertaken the training were able to perform a subjectively more challenging social evaluation task in front of the class.