Professorships/ Sections

Working groups

Research areas

Projects

Immunoregulatory approaches to promote stress resilience

Funding

DFG, intramural funding

It is the major aim of this preclinical project, to promote resilience against stress-related somatic and affective pathologies in male and female mice by repeated subcutaneous (s.c.), intranasal (i.n.) or intragastric (i.g.) administrations of heat-inactivated preparations of immunoregulatory "old friends from mud and soil", including Mycobacterium vaccae NCTC 11659, M. vaccae ATCC 15483typestrain and M. aurum DSM 33539, and to understand the underlying mechanisms.

Background: Epidemiological data provide strong evidence for a steady rise in the incidence of many stress-associated psychosomatic disorders in developed countries since the 1950s.(1-10) Although the underlying mechanism is not clear, decreased immunoregulation, resulting from decreased numbers of regulatory T cells (Tregs),(11, 12) is likely to play a role. Furthermore, as less people in rural compared with urban areas suffer from stress-associated somatic and mental disorders,(13-19) it is likely that a reduced exposure, especially during early life,(20) to microorganisms with which mammals co-evolved (=Old Friends), at least in part accounts for immunoregulatory deficits, increased stress-induced inflammation and disease prevalence in modern industrialized urban areas.

Main findings: Consistent with what is proposed by the “Old Friends” hypothesis, we and others have shown that repeated s.c. administrations with a heat-killed preparation of M. vaccae NCTC 11659, an abundant saprophytic “Old Friend” from mud with immunoregulatory properties, is effective in: i) stabilizing the gut microbiome,(21, 22) ii) increasing the percentage of Tregs in mesenteric lymph node cells,(21) iii) preventing stress-induced colitis and proinflammatory cytokine secretion from freshly isolated mesenteric lymph node cells stimulated with anti-CD3 antibody ex vivo,(21) iv) preventing stress-induced aggravation of dextran sulfate sodium (DSS)-induced colitis,(21) v) preventing stress-induced exaggeration of anxiety,(21) vi) preventing stress-induced microglial priming and neuroinflammation,(23-26) vii) ameliorating features of age‑associated microglia activation in the amygdala and hippocampus,(27) viii) preventing negative outcomes of sleep deprivation,(28) and ix) enhancing fear extinction.(29). In extension of these findings and in support of using “Old Friends” not only to prevent but also to treat stress-associated disorders, we recently showed that M. vaccae NCTC 11659 also ameliorates stress-induced anxiety when administered repeatedly via the s.c. route during chronic psychosocial stressor exposure, i.e., after the first psychosocial traumatization has occurred.(30) Own studies further confirm the stress protective effects of M. vaccae NCTC 11659 even when administered via the non-invasive i.n.(30) or i.g.(31) route, respectively. In detail, male mice administered i.g. with M. vaccae NCTC 11659 are protected against: 1) the stress-induced increase in splenic TLR2+ and TLR4+ polymorphonuclear myeloid-derived suppressor cells (PMN-MDSCs) and TLR4+ monocytes/mononuclear (MO)-MDSCs; 2) the increase in functional splenic in vitro glucocorticoid (GC) resistance typically seen following psychosocial stress in combination with significant wounding (=physical trauma); as well as 3) the stress-induced increase in basal and LPS-induced splenic in vitro cell viability.(31)

In a recent study we further showed that the negative behavioral, immunological and physiological consequences of early life stress (ELA) induced by the maternal separation (MS) paradigm in both sexes, although relatively mild, are to a great extent prevented by subsequent s.c. M. vaccae NCTC 11659 administrations.(32) In extension, own data further show that the catabolic bone turnover and osteoporotic bone phenotype induced by ELA in female sex only was prevented by repeated s.c. administrations of M. vaccae NCTC 11659 (Schimmele et al., under review).

Importantly, the stress-protective effects of M. vaccae NCTC 11659 are not specific for this strain but transferable also to M. vaccae ATCC 15483T.(33) In support for the latter, also repeated i.g. administrations of female mice with M. vaccae ATCC 15483T prior to mating protected the male offspring of these females (i.e. intergenerational effects) from developing enhanced LPS-induced ex vivo cell viability of isolated splenocytes, increased delta cell viability (LPS-stimulated minus basal conditions) of isolated and ex vivo stimulated splenocytes in the absence of CORT as well as functional splenic ex vivo GC resistance as a consequence of CSC exposure during adulthood (Schiele et al., in preparation). As also repeated i.g. administrations of a heat-inactivated preparation of M. aurum DSM 33539 have profound stabilizing effects on the composition of the intestinal microbiome and were protective against the aggravating effects of stress on subsequent DSS colitis (Langgartner et al., under review), the stress protective effects reported for M. vaccae NCTC 11659 and M. vaccae ATCC 15483T seem to generalizable also to other nontuberculous mycobacteria (NTM) species.

Main collaborators: Prof. Dr. Christopher Lowry (University of Colorado, Boulder, USA), Prof. Dr. David Slattery (Goethe University Frankfurt), Prof. Dr. Steffen Stenger (Ulm University Medical Center, Ulm, Germany).

1. Bach JF (2002): The effect of infections on susceptibility to autoimmune and allergic diseases. N Engl J Med. 347:911-920.

2. Woolcock A, Peat J (1997): Evidence for the increase in asthma worldwide. Ciba Found Symp. 206:122-134.

3. Williams H (1992): Is the prevalence of atopic dermatitis increasing? Clin Exp Dermatol. 17:385-391.

4. Upton MN, McConnachie A, McSharry C, Hart CL, Smith GD, Gillis CR, et al. (2000): Intergenerational 20 year trends in the prevalence of asthma and hay fever in adults: the Midspan family study surveys of parents and offspring. BMJ. 321:88-92.

5. Rosati G, Aiello I, Mannu L, Pirastru M, Agnetti V, Sau G, et al. (1988): Incidence of multiple sclerosis in the town of Sassari, Sardinia, 1965 to 1985: evidence for increasing occurrence of the disease. Neurology. 38:384-388.

6. Poser S, Stickel B, Krtsch U, Burckhardt D, Nordman B (1989): Increasing Incidence of Multiple Sclerosis in South Lower Saxony, Germany. Neuroepidemiology. 8:207-213.

7. Group EAS (2000): Variation and trends in incidence of childhood diabetes in Europe. The Lancet. 355:873-876.

8. Farrokhyar F, Swarbrick E, Irvine E (2001): A critical review of epidemiological studies in inflammatory bowel disease. Scand J Gastroenterol. 36:2-15.

9. Smith K (2014): Mental health: A world of depression. Nature. 515:180-181.

10. Ng SC, Shi HY, Hamidi N, Underwood FE, Tang W, Benchimol EI, et al. (2018): Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet. 390:2769-2778.

11. Li Y, Xiao B, Qiu W, Yang L, Hu B, Tian X, et al. (2010): Altered expression of CD4(+)CD25(+) regulatory T cells and its 5-HT(1a) receptor in patients with major depression disorder. J Affect Disord. 124:68-75.

12. Sommershof A, Aichinger H, Engler H, Adenauer H, Catani C, Boneberg EM, et al. (2009): Substantial reduction of naive and regulatory T cells following traumatic stress. Brain Behavior and Immunity. 23:1117-1124.

13. Riedler J, Braun-Fahrländer C, Eder W, Schreuer M, Waser M, Maisch S, et al. (2001): Exposure to farming in early life and development of asthma and allergy: a cross-sectional survey. The Lancet. 358:1129-1133.

14. Braun-Fahrländer C, Riedler J, Herz U, Eder W, Waser M, Grize L, et al. (2002): Environmental Exposure to Endotoxin and Its Relation to Asthma in School-Age Children. N Engl J Med. 347:869-877.

15. Ege MJ, Mayer M, Normand A-C, Genuneit J, Cookson WOCM, Braun-Fahrländer C, et al. (2011): Exposure to Environmental Microorganisms and Childhood Asthma. N Engl J Med. 364:701-709.

16. Peen J, Schoevers RA, Beekman AT, Dekker J (2010): The current status of urban-rural differences in psychiatric disorders. Acta Psychiatr Scand. 121:84-93.

17. Rook GA (2013): Regulation of the immune system by biodiversity from the natural environment: an ecosystem service essential to health. Proc Natl Acad Sci U S A. 110:18360-18367.

18. Vassos E, Agerbo E, Mors O, Pedersen CB (2016): Urban–rural differences in incidence rates of psychiatric disorders in Denmark. The British Journal of Psychiatry. 208:435-440.

19. Pedersen C, Mortensen P (2001): Evidence of a dose-response relationship between urbanicity during upbringing and schizophrenia risk. Arch Gen Psychiatry. 58:1039-1046.

20. Lynch SV, Boushey HA (2016): The microbiome and development of allergic disease. Curr Opin Allergy Clin Immunol. 16:165-171.

21. Reber SO, Siebler PH, Donner NC, Morton JT, Smith DG, Kopelman JM, et al. (2016): Immunization with a heat-killed preparation of the environmental bacterium Mycobacterium vaccae promotes stress resilience in mice. Proc Natl Acad Sci U S A. 113:E3130-3139.

22. Foxx CL, Heinze JD, Gonzalez A, Vargas F, Baratta MV, Elsayed AI, et al. (2020): Effects of Immunization With the Soil-Derived Bacterium Mycobacterium vaccae on Stress Coping Behaviors and Cognitive Performance in a "Two Hit" Stressor Model. Frontiers in physiology. 11:524833.

23. Frank MG, Fonken LK, Watkins LR, Maier SF, Lowry CA (2018): Could Probiotics Be Used to Mitigate Neuroinflammation? ACS Chemical Neuroscience.

24. Frank MG, Fonken LK, Dolzani SD, Annis JL, Siebler PH, Schmidt D, et al. (2018): Immunization with Mycobacterium vaccae induces an anti-inflammatory milieu in the CNS: Attenuation of stress-induced microglial priming, alarmins and anxiety-like behavior. Brain, Behavior, and Immunity. 73:352-363.

25. Fonken LK, Frank MG, Gaudet AD, Maier SF (2018): Stress and aging act through common mechanisms to elicit neuroinflammatory priming. Brain, Behavior, and Immunity. 73:133-148.

26. Fonken LK, Frank MG, D'Angelo HM, Heinze JD, Watkins LR, Lowry CA, et al. (2018): Mycobacterium vaccae immunization protects aged rats from surgery-elicited neuroinflammation and cognitive dysfunction. Neurobiol Aging. 71:105-114.

27. Sanchez K, Darling JS, Kakkar R, Wu SL, Zentay A, Lowry CA, et al. (2022): Mycobacterium vaccae immunization in rats ameliorates features of age-associated microglia activation in the amygdala and hippocampus. Sci Rep. 12:2165.

28. Bowers SJ, Lambert S, He S, Lowry CA, Fleshner M, Wright KP, Jr., et al. (2020): Immunization with a heat-killed bacterium, Mycobacterium vaccae NCTC 11659, prevents the development of cortical hyperarousal and a PTSD-like sleep phenotype after sleep disruption and acute stress in mice. Sleep.

29. Hassell JE, Jr., Fox JH, Arnold MR, Siebler PH, Lieb MW, Schmidt D, et al. (2019): Treatment with a heat-killed preparation of Mycobacterium vaccae after fear conditioning enhances fear extinction in the fear-potentiated startle paradigm. Brain Behav Immun.

30. Amoroso M, Böttcher A, Lowry CA, Langgartner D, Reber SO (2020): Subcutaneous Mycobacterium vaccae promotes resilience in a mouse model of chronic psychosocial stress when administered prior to or during psychosocial stress. Brain Behav Immun. 87:309-317.

31. Langgartner D, Amoroso M, Kempter E, Kustermann M, Scheurer J, Lowry CA, et al. (2023): Mycobacterium vaccae protects against glucocorticoid resistance resulting from combined physical and psychosocial trauma in mice. Brain, Behavior, and Immunity. 109:221-234.

32. Mazzari G, Lowry CA, Langgartner D, Reber SO (2023): Subcutaneous Mycobacterium vaccae ameliorates the effects of early life adversity alone or in combination with chronic stress during adulthood in male and female mice. Neurobiology of Stress.100568.

33. Loupy KM, Cler KE, Marquart BM, Yifru TW, D'Angelo HM, Arnold MR, et al. (2021): Comparing the effects of two different strains of Mycobacterium vaccae, M. vaccae NCTC 11659 and M. vaccae ATCC 15483, on stress-resilient behaviors and lipid-immune signaling in rats. Brain, Behavior, and Immunity.

Prävention Psychosozialer Risiken bei Algorithmischen Management – PRisAM

Project description

"3for1 - Three paths, one goal" is a research project on the effectiveness of an intervention to support unemployed job centre customers with mental health problems in their job search and recovery. The intervention has three components, namely (i) psychological consultation hours directly at the job centre, (ii) supported employment in the form of job coaching during the job search and at the new workplace, and (iii) support from peer guides, i.e. guidance and support from people with personal experience of mental illness and unemployment. The effectiveness of this intervention is primarily tested by comparing the rate of employment 12 months after project entry between the comparison group initially included in the project (job centre clients without intervention) and the intervention group subsequently included in the project (job centre clients who participated in the intervention for a maximum period of 12 months). The project is being run by the Ulm Job Centre in cooperation with four other job centres in Baden-Württemberg and one Bavarian job centre as well as the universities of Ulm and Tübingen.

Project management

Prof Dr Jörn von Wietersheim, Ulm University Hospital, Department of Psychosomatic Medicine and Psychotherapy
Prof Dr Harald Gündel, Ulm University Hospital, Department of Psychosomatic Medicine and Psychotherapy
Prof Dr Nicolas Rüsch, Ulm University Hospital, Department of Psychiatry and Psychotherapy II of Ulm University, Section of Public Mental Health

Project partners

Job Centre Ulm
Job Centre Alb-Donau
Job Centre Neu-Ulm
Job Centre City of Heilbronn
Tübingen district job centre
Reutlingen district job centre

Project coordination

Running time:

11/2021 - 10/2026

Financing:

Federal Ministry of Labour and Social Affairs; part of the federal programme "Innovative ways to participate in working life - rehapro"

Funding amount: €4.45 million

Stress-induced bone defects

Funding

DFG, intramural funding

It is the main aim of this project to investigate in preclinical and clinical studies the cellular, molecular and microbiome-related mechanisms underlying the sex-specific effects of chronic psychosocial stress during early life (=early life adversity, ELA), adulthood (CAS) and a combination of both (ELA&CAS) on bone homeostasis and regeneration. Note, with respect to ELA we study the effects of stressors occurring during the prenatal and postnatal phase on both male and female offspring and their mothers.

Background: Chronic psychosocial stress during adulthood(1, 2) as well as early life adversity (ELA)(3-7) are acknowledged risk factors for several psychosomatic disorders, including posttraumatic stress disorder (PTSD) and major depression (MD). Both diseases display a high prevalence in western countries, are strongly comorbid with various somatic pathologies(8, 9) and have been associated with osteoporosis and increased bone fracture risk in a number of studies.(8-12). However, while there is strong evidence for an increased risk for low bone mass and fragility fractures in depressed patients being mediated by increased glucocorticoid (GC) concentrations,(13, 14) findings in PTSD patients are less consistent. For example, multivariable analyses controlling for depression in PTSD subjects failed to demonstrate a link between PTSD and osteoporosis,(15) whereas earlier studies stated a significant association between these conditions.(12) Furthermore, PTSD may influence long-bone growth: children subjected to repeated mental traumatization during childhood were of a significantly shorter stature.(16) In summary, these clinical studies implicate different effects of stress-induced depression and PTSD on bone turnover.

Main findings: In contrast to mouse models for depression, employing the chronic subordinate colony housing (CSC) paradigm as an acknowledged model for social stress-associated PTSD in male mice(17, 18) we showed that mental traumatization in adolescent mice negatively impacts cartilage-to-bone transition during endochondral ossification in the epiphyseal growth plate, the main site of longitudinal growth of the long bones, while appositional bone growth seems to be undisturbed.(19) In detail, CSC mice show reduced tibia and femur lengths, mineral deposition at the growth plate and Runt-related transcription factor 2 (Runx2) expression in hypertrophic chondrocytes in the growth plate, while growth plate and trabecular thickness as well as bone mineral density (BMD) were increased in CSC compared to single-housed control (SHC) mice.(19) An enhanced tyrosine hydroxylase (TH) expression, which is the rate limiting enzyme in catecholamine (CA) synthesis,(20) in bone marrow (BM) cells located at the growth plates of CSC mice suggests that local CA signalling is involved in the negative CSC effects on bone metabolism.(19) Of note in this context, norepinephrine (NE) release by sympathetic nerve fibers during chronic variable stress signals bone marrow niche cells to decrease CXCL12 levels through the β3-adrenoreceptor, resulting in increased hematopoietic stem cell proliferation and release of neutrophils and inflammatory monocytes.(21) In a follow up study we extended these findings by revealing that CSC mice undergoing standardized femur fracture show a delayed bone healing, again accompanied by a compromised cartilage-to-bone transition. Furthermore, CSC mice were characterized by a misbalanced inflammatory response in the fracture hematoma.(22) The latter was indicated by increased numbers of TH expressing neutrophils, and both delayed fracture healing and hematoma invasion of TH expressing neutrophils were prevented in CSC mice by injection with an unspecific β-adrenoceptor blocker prior to fracture surgery.(22) In a recent study(23) we provide evidence supporting the conclusion that while impaired mental health and stress in general promotes BM myelopoiesis, TH expression and, consequently, the capacity to produce/ secrete CAs is specifically facilitated in neutrophils. Neutrophil-derived CAs locally in the BM activate α (in vitro data)/β2 (in vitro and in vivo data)-ARs and dopaminergic receptors (DRs, in vitro data) on chondrocytes and, consequently, compromise their transdifferentiation into osteoblasts and, thus, bone metabolism. Neutrophil-derived CAs in an autocrine manner further promote their own BM emigration and, in case of a fracture, facilitate their own immigration into the fracture hematoma, likely in a paracrine manner by increasing CXCL1 release from hematoma mast cells and macrophages which are two main CXCL1 producing cell types.(24) In the fracture hematoma, neutrophil-derived CAs again activate α/β2-ARs and DRs on chondrocytes and, consequently, compromise their transdifferentiation into osteoblasts and, thus, adequate bone repair. According to our clinical data,(23) indicating an increased TH expression in fracture hematomas of patients with an increased mental stress load, which is further accompanied by a compromised fracture healing and/or increased pain sensitivity, our preclinical data seem to be of high translational value, suggesting strategies to block immigration of TH positive myeloid cells/ neutrophils into the fracture hematoma or their local release of CAs to represent promising future strategies to facilitate fracture healing in patients who are at risk for psychosomatic disorders.

Main collaborators: Prof. Dr. Melanie Haffner-Luntzer & Prof. Dr. Anita Ignatius (Ulm University, Ulm, Germany), Prof. Dr. Florian Gebhard & Prof. Dr. Konrad Schütze (Ulm University Medical Center, Ulm, Germany).

References:

1. Yehuda R, Seckl J (2011): Minireview: Stress-related psychiatric disorders with low cortisol levels: a metabolic hypothesis. Endocrinology. 152:4496-4503.

2. Gold PW, Goodwin FK, Chrousos GP (1988): Clinical and biochemical manifestations of depression. Relation to the neurobiology of stress (1). The New England journal of medicine. 319:348-353.

3. Kuzminskaite E, Vinkers CH, Elzinga BM, Wardenaar KJ, Giltay EJ, Penninx BWJH (2020): Childhood Trauma and Dysregulation of Multiple Biological Stress Systems in Adulthood: Results from the Netherlands Study of Depression and Anxiety. Psychoneuroendocrinology.104835.

4. Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. (2019): REPRINT OF: Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults: The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 56:774-786.

5. Hughes K, Bellis MA, Hardcastle KA, Sethi D, Butchart A, Mikton C, et al. (2017): The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. The Lancet Public Health. 2:e356-e366.

6. Maercker A, Augsburger M (2019): Die posttraumatische Belastungsstörung. Traumafolgestörungen: Springer, pp 13-45.

7. Steil R, Rosner R (2009): Posttraumatische Belastungsstörung bei Kindern und Jugendlichen. In: Maercker A, editor. Posttraumatische Belastungsstörungen. Berlin, Heidelberg: Springer Berlin Heidelberg, pp 321-343.

8. Gebara MA, Shea ML, Lipsey KL, Teitelbaum SL, Civitelli R, Muller DJ, et al. (2014): Depression, antidepressants, and bone health in older adults: a systematic review. J Am Geriatr Soc. 62:1434-1441.

9. Glaesmer H, Kaiser M, Braehler E, Freyberger HJ, Kuwert P (2012): Posttraumatic stress disorder and its comorbidity with depression and somatisation in the elderly - a German community-based study. Aging Ment Health. 16:403-412.

10. Calarge CA, Butcher BD, Burns TL, Coryell WH, Schlechte JA, Zemel BS (2014): Major depressive disorder and bone mass in adolescents and young adults. J Bone Miner Res. 29:2230-2237.

11. Zong Y, Tang Y, Xue Y, Ding H, Li Z, He D, et al. (2016): Depression is associated with increased incidence of osteoporotic thoracolumbar fracture in postmenopausal women: a prospective study. Eur Spine J. 25:3418-3423.

12. Glaesmer H, Brahler E, Gundel H, Riedel-Heller SG (2011): The association of traumatic experiences and posttraumatic stress disorder with physical morbidity in old age: a German population-based study. Psychosom Med. 73:401-406.

13. Cizza G, Ravn P, Chrousos GP, Gold PW (2001): Depression: a major, unrecognized risk factor for osteoporosis? Trends Endocrinol Metab. 12:198-203.

14. Cizza G, Primma S, Coyle M, Gourgiotis L, Csako G (2010): Depression and Osteoporosis: A Research Synthesis with Meta-Analysis. Horm Metab Res. 42:467-482.

15. Tsai J, Shen J (2017): Exploring the Link Between Posttraumatic Stress Disorder and inflammation-Related Medical Conditions: An Epidemiological Examination. Psychiatr Q.

16. Batty GD, Shipley MJ, Gunnell D, Huxley R, Kivimaki M, Woodward M, et al. (2009): Height, wealth, and health: an overview with new data from three longitudinal studies. Econ Hum Biol. 7:137-152.

17. Reber SO, Langgartner D, Foertsch S, Postolache TT, Brenner LA, Guendel H, et al. (2016): Chronic subordinate colony housing paradigm: A mouse model for mechanisms of PTSD vulnerability, targeted prevention, and treatment—2016 Curt Richter Award Paper. Psychoneuroendocrinology. 74:221-230.

18. Reber S, Birkeneder L, Veenema A, Obermeier F, Falk W, Straub R, et al. (2007): Adrenal insufficiency and colonic inflammation after a novel chronic psycho-social stress paradigm in mice: implications and mechanisms. Endocrinology. 148:670-682.

19. Foertsch S, Haffner-Luntzer M, Kroner J, Gross F, Kaiser K, Erber M, et al. (2017): Chronic psychosocial stress disturbs long-bone growth in adolescent mice. Dis Model Mech. 10:1399-1409.

20. Molinoff PB, Axelrod J (1971): Biochemistry of catecholamines. Annu Rev Biochem. 40:465-500.

21. Heidt T, Sager HB, Courties G, Dutta P, Iwamoto Y, Zaltsman A, et al. (2014): Chronic variable stress activates hematopoietic stem cells. Nature medicine. 20:754.

22. Haffner-Luntzer M, Foertsch S, Fischer V, Prystaz K, Tschaffon M, Mödinger Y, et al. (2019): Chronic psychosocial stress compromises the immune response and endochondral ossification during bone fracture healing via β-AR signaling. Proceedings of the National Academy of Sciences.201819218.

23. Tschaffon-Müller MEA, Kempter E, Steppe L, Kupfer S, Kuhn MR, Gebhard F, et al. (2023): Neutrophil-derived catecholamines mediate negative stress effects on bone. Nat Commun. 14:3262.

24. De Filippo K, Dudeck A, Hasenberg M, Nye E, van Rooijen N, Hartmann K, et al. (2013): Mast cell and macrophage chemokines CXCL1/CXCL2 control the early stage of neutrophil recruitment during tissue inflammation. Blood. 121:4930-4937.

Stress-induced glucocorticoid resistance

Funding

DFG, intramural funding

It is the major aim of this preclinical project to investigate and understand the mechanisms underlying the development of splenic ex vivo glucocorticoid (GC) resistance in male mice as consequence of psychosocial stress associated with physical trauma, as for instance severe bite wounds or planned surgery.

Background: Chronic psychosocial stress is a major burden of modern life and poses an acknowledged risk factor for many somatic and psychiatric disorders, which are often associated with chronic low-grade inflammation.(1-8) Many clinical and preclinical studies(6, 9-14) support the hypothesis that stress-associated inflammation is promoted at least in part via development of glucocorticoid (GC) resistance, defined as a state of reduced sensitivity to the anti-inflammatory action of GCs, in certain immune cell subpopulations(6, 11) amongst which myeloid CD11b+ cells seem to play a critical role.(12, 13, 15) Noteworthy, over-shooting local and/ or systemic inflammatory responses(16-22) as well as development of GC resistance(23-25) further promote posttraumatic complications (e.g., septic shock), for patients on intensive care.

Therefore, a history of chronic/traumatic psychosocial stress and the subsequent development of GC resistance is a plausible scenario in vulnerable subgroups of physical trauma patients on intensive care. Of note, MDSCs represent immature myeloid cells, are generated in the bone marrow and able to suppress T cell proliferation via generation of nitric oxide (NO) and reactive oxygen species, as well as via depletion of arginine and down-regulation of the T cell receptor complex ζ chain, and have been first described in tumor patients and tumor-bearing mice.(26-28) As MDSCs are also induced during bacterial infections,(29, 30) they seem to provide a cellular link between activation of innate immunity and concomitant suppression of adaptive immunity.

Main findings: In a series of preclinical experiments employing the chronic subordinate colony housing (CSC) paradigm as an acknowledged model for social stress-associated posttraumatic stress disorder (PTSD) in male mice(31, 32) we could show that particularly CD11b+Ly6G+Ly6C+ polymorphonuclear (PMN)-myeloid-derived suppressor cells (MDSCs) play a critical role in psychosocial stress-induced splenic ex vivo functional GC resistance.(33-36) In detail, we showed that CSC accompanied by significant wounding and, thus, a combination of psychosocial and physical trauma, i) enhanced basal and LPS-induced ex vivo cell viability of isolated BM cells, ii) increased the percentage of toll-like receptor (TLR)2-expressing bone marrow (BM) and spleen CD11b+Ly6G+Ly6C- neutrophils, PMN-MDSCs and CD11b+Ly6G-Ly6C+ monocytes/MO-MDSCs, iii) increased the percentage of TLR4-expressing spleen PMN-MDSCs and monocytes/ mononuclear (MO)-MDSCs, iv) enhanced basal and LPS-induced ex vivo cell viability of isolated PMN-MDSC-enriched PBMCs and splenocytes, as well as ex vivo migration activity of neutrophil/PMN-MDSC-enriched WBCs, v) induced ex vivo GC resistance in LPS-stimulated Ly6G+ splenocytes but not Ly6G-depleted total splenocytes or PMN-MDSC-enriched PBMCs, vi) rendered stress-induced Ly6G+ splenocytes to increase cell viability upon LPS stimulation exclusively via the NF-κB pathway.(37) These results support the hypothesis that stress-induced PMN-MDSCs get primed(37) and activated locally in the bone marrow (BM) as determined by toll-like receptor (TLR)2 and TH, but not TLR4, upregulation and increased basal and lipopolysaccharide (LPS)-induced ex vivo cell viability.(33) These primed and activated PMN-MDSCs emigrate into the peripheral circulation and subsequently, if psychosocial stress is accompanied by significant bite wounding, accumulate in the spleen(33). In the spleen, PMN-MDSCs upregulate TLR4 expression, which in concert with PMN-MDSCs-derived catecholamines as a consequence of increased TH expression promotes NF-κB hyperactivation upon LPS-stimulation, thereby exceeding the anti-inflammatory capacities of GCs and resulting in GC resistance.(33) Upregulation of myeloid-derived catecholamines as a consequence of TH upregulation has been shown to promote NF-κB signaling and to augment the acute inflammatory response to acute lung injury.(38, 39).

Main collaborators: Prof. Dr. Jan Tuckermann & Prof. Dr. Maja Vujić Spasić (Ulm University, Ulm, Germany), Prof. Dr. Steffen Stenger (Ulm University Medical Center, Ulm, Germany).

References:

1. Rohleder N (2014): Stimulation of systemic low-grade inflammation by psychosocial stress. Psychosom Med. 76:181-189.

2. Rohleder N, Marin TJ, Ma R, Miller GE (2009): Biologic cost of caring for a cancer patient: dysregulation of pro- and anti-inflammatory signaling pathways. J Clin Oncol. 27:2909-2915.

3. Langgartner D, Lowry CA, Reber SO (2019): Old Friends, immunoregulation, and stress resilience. Pflügers Archiv - European Journal of Physiology.1-33.

4. Langgartner D, Fuchsl AM, Uschold-Schmidt N, Slattery DA, Reber SO (2015): Chronic subordinate colony housing paradigm: a mouse model to characterize the consequences of insufficient glucocorticoid signaling. Frontiers in psychiatry. 6:18.

5. Michopoulos V, Powers A, Gillespie CF, Ressler KJ, Jovanovic T (2017): Inflammation in Fear- and Anxiety-Based Disorders: PTSD, GAD, and Beyond. Neuropsychopharmacology. 42:254-270.

6. Miller AH, Raison CL (2016): The role of inflammation in depression: from evolutionary imperative to modern treatment target. Nat Rev Immunol. 16:22-34.

7. Gould TD, Georgiou P, Brenner LA, Brundin L, Can A, Courtet P, et al. (2017): Animal models to improve our understanding and treatment of suicidal behavior. Translational psychiatry. 7:e1092.

8. Schultebraucks K, Qian M, Abu-Amara D, Dean K, Laska E, Siegel C, et al. (2021): Pre-deployment risk factors for PTSD in active-duty personnel deployed to Afghanistan: a machine-learning approach for analyzing multivariate predictors. Mol Psychiatry. 26:5011-5022.

9. Bellingrath S, Rohleder N, Kudielka BM (2013): Effort-reward-imbalance in healthy teachers is associated with higher LPS-stimulated production and lower glucocorticoid sensitivity of interleukin-6 in vitro. Biol Psychol. 92:403-409.

10. Raison CL, Capuron L, Miller AH (2006): Cytokines sing the blues: inflammation and the pathogenesis of depression. Trends Immunol. 27:24-31.

11. Raison CL, Miller AH (2003): When not enough is too much: the role of insufficient glucocorticoid signaling in the pathophysiology of stress-related disorders. Am J Psychiatry. 160:1554-1565.

12. Stark JL, Avitsur R, Padgett DA, Campbell KA, Beck FM, Sheridan JF (2001): Social stress induces glucocorticoid resistance in macrophages. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology. 280:R1799-R1805.

13. Avitsur R, Stark JL, Dhabhar FS, Padgett DA, Sheridan JF (2002): Social disruption-induced glucocorticoid resistance: kinetics and site specificity. J Neuroimmunol. 124:54-61.

14. Engler H, Engler A, Bailey MT, Sheridan JF (2005): Tissue-specific alterations in the glucocorticoid sensitivity of immune cells following repeated social defeat in mice. J Neuroimmunol. 163:110-119.

15. Engler H, Bailey MT, Engler A, Sheridan JF (2004): Effects of repeated social stress on leukocyte distribution in bone marrow, peripheral blood and spleen. J Neuroimmunol. 148:106-115.

16. Perl M, Hohmann C, Denk S, Kellermann P, Lu D, Braumuller S, et al. (2012): Role of activated neutrophils in chest trauma-induced septic acute lung injury. Shock. 38:98-106.

17. Seitz DH, Niesler U, Palmer A, Sulger M, Braumuller ST, Perl M, et al. (2010): Blunt chest trauma induces mediator-dependent monocyte migration to the lung. Crit Care Med. 38:1852-1859.

18. Knoferl MW, Liener UC, Seitz DH, Perl M, Bruckner UB, Kinzl L, et al. (2003): Cardiopulmonary, histological, and inflammatory alterations after lung contusion in a novel mouse model of blunt chest trauma. Shock. 19:519-525.

19. Perl M, Gebhard F, Knoferl MW, Bachem M, Gross HJ, Kinzl L, et al. (2003): The pattern of preformed cytokines in tissues frequently affected by blunt trauma. Shock. 19:299-304.

20. Heckbert SR, Vedder NB, Hoffman W, Winn RK, Hudson LD, Jurkovich GJ, et al. (1998): Outcome after hemorrhagic shock in trauma patients. J Trauma. 45:545-549.

21. Kauvar DS, Wade CE (2005): The epidemiology and modern management of traumatic hemorrhage: US and international perspectives. Crit Care. 9 Suppl 5:S1-9.

22. Angele MK, Schneider CP, Chaudry IH (2008): Bench-to-bedside review: latest results in hemorrhagic shock. Crit Care. 12:218.

23. Rothwell PM, Udwadia ZF, Lawler PG (1991): Cortisol response to corticotropin and survival in septic shock. Lancet. 337:582-583.

24. Annane D, Sebille V, Troche G, Raphael JC, Gajdos P, Bellissant E (2000): A 3-level prognostic classification in septic shock based on cortisol levels and cortisol response to corticotropin. JAMA. 283:1038-1045.

25. Molijn GJ, Spek JJ, van Uffelen JC, de Jong FH, Brinkmann AO, Bruining HA, et al. (1995): Differential adaptation of glucocorticoid sensitivity of peripheral blood mononuclear leukocytes in patients with sepsis or septic shock. J Clin Endocrinol Metab. 80:1799-1803.

26. Peranzoni E, Zilio S, Marigo I, Dolcetti L, Zanovello P, Mandruzzato S, et al. (2010): Myeloid-derived suppressor cell heterogeneity and subset definition. Current opinion in immunology. 22:238-244.

27. Gabrilovich DI, Nagaraj S (2009): Myeloid-derived suppressor cells as regulators of the immune system. Nature reviews immunology. 9:162-174.

28. Nagaraj S, Schrum AG, Cho HI, Celis E, Gabrilovich DI (2010): Mechanism of T cell tolerance induced by myeloid-derived suppressor cells. J Immunol. 184:3106-3116.

29. Delano MJ, Scumpia PO, Weinstein JS, Coco D, Nagaraj S, Kelly-Scumpia KM, et al. (2007): MyD88-dependent expansion of an immature GR-1(+)CD11b(+) population induces T cell suppression and Th2 polarization in sepsis. J Exp Med. 204:1463-1474.

30. Delano MJ, Thayer T, Gabrilovich S, Kelly-Scumpia KM, Winfield RD, Scumpia PO, et al. (2011): Sepsis induces early alterations in innate immunity that impact mortality to secondary infection. J Immunol. 186:195-202.

31. Reber SO, Langgartner D, Foertsch S, Postolache TT, Brenner LA, Guendel H, et al. (2016): Chronic subordinate colony housing paradigm: A mouse model for mechanisms of PTSD vulnerability, targeted prevention, and treatment—2016 Curt Richter Award Paper. Psychoneuroendocrinology. 74:221-230.

32. Reber S, Birkeneder L, Veenema A, Obermeier F, Falk W, Straub R, et al. (2007): Adrenal insufficiency and colonic inflammation after a novel chronic psycho-social stress paradigm in mice: implications and mechanisms. Endocrinology. 148:670-682.

33. Kempter E, Amoroso M, Kupfer S, Lupu L, Kustermann M, Scheurer J, et al. (2023): The PMN-MDSC – A key player in glucocorticoid resistance following combined physical and psychosocial trauma. Brain, Behavior, and Immunity. 108:148-161.

34. Foertsch S, Reber SO (2020): The role of physical trauma in social stress-induced immune activation. Neurosci Biobehav Rev. 113:169-178.

35. Foertsch S, Langgartner D, Reber SO (2020): Abdominal surgery prior to chronic psychosocial stress promotes spleen cell (re)activity and glucocorticoid resistance. Scientific Reports. 10:6917.

36. Foertsch S, Füchsl AM, Faller SD, Hölzer H, Langgartner D, Messmann J, et al. (2017): Splenic glucocorticoid resistance following psychosocial stress requires physical injury. Scientific Reports. 7:15730.

37. Hanke ML, Powell ND, Stiner LM, Bailey MT, Sheridan JF (2012): Beta adrenergic blockade decreases the immunomodulatory effects of social disruption stress. Brain, Behavior, and Immunity. 26:1150-1159.

38. Flierl MA, Rittirsch D, Nadeau BA, Sarma JV, Day DE, Lentsch AB, et al. (2009): Upregulation of Phagocyte-Derived Catecholamines Augments the Acute Inflammatory Response. PLoS ONE. 4:e4414.

39. Flierl MA, Rittirsch D, Nadeau BA, Chen AJ, Sarma JV, Zetoune FS, et al. (2007): Phagocyte-derived catecholamines enhance acute inflammatory injury. Nature. 449:721-725.

Understanding the mechanisms underlying the increased prevalence of mental and physical stress-associated disorders in urban vs. rural areas

Funding

DFG, intramural funding

It is the main aim of this clinical project to investigate the cellular, molecular and microbiome-related mechanisms underlying the increased prevalence of stress-associated mental as well as physical disorders in individuals raised in an urban (URBANs) versus rural (RURALs) environment.

Background: Urbanization is on the rise,(1) and stress-associated somatic and mental disorders are more prevalent in urban vs. rural areas.(2-4) Many of these disorders are accompanied by an over-reactive immune system and chronic low-grade inflammation,(5, 6) and prospective human and mechanistic animal studies strengthen the idea that an exaggerated immune (re)activity plays a causal role in their pathogenesis.(5, 7-9) Deficits in immunoregulation are thought to be in part dependent on reduced exposure, especially during early life,(10, 11) to microorganisms with which mammals co-evolved.(12) These “Old Friends” needed to be tolerated, as they were either part of host physiology (human microbiota), harmless but inevitably contaminating air, food and water (environmental microbiota), or causing severe tissue damage when attacked by the host immune system (helminthic parasites).(12) However, contact with these microorganisms that play a crucial role in setting up regulatory immune pathways is slowly but progressively diminishing in high-income countries, particularly in the concrete landscapes of urban areas.(11, 13) Noteworthy, the decline in biodiversity is currently facilitated to unprecedented levels due to dramatic changes in global climate, excessive levels of environmental pollution as well as recent COVID-19-related restrictions. Besides the declining availability of health promoting green space rich in biodiversity,(14, 15) another critical factor contributing to the diminishing contact with “Old Friends”, particularly in urban areas, seems to be the lack of regular contact with animals.(16-19) Supporting this hypothesis, dog ownership has been shown to increase microbial diversity and relative abundances of dog-associated bacterial taxa across multiple locations within the home.(20, 21)

Main findings: In a recent study (Urban vs. Rural Stress Study, URSS) we demonstrated that systemic immune activation in response to a standardized laboratory social stressor, namely the Trier Social Stress Test (TSST), is increased and prolonged in healthy male URBANs raised in the absence of daily contact with pets, relative to healthy male RURALs raised in the presence of farm animals, even though the inflammatory stress response triggering HPA axis and SNS activation were more pronounced in the latter.(22) In detail, in response to the TSST, URBANs raised in the absence of pets showed a more pronounced increase in the number of peripheral blood mononuclear cells (PBMCs) and plasma interleukin (IL)-6 concentrations compared with RURALs raised in the presence of farm animals. Moreover, ex vivo cultured PBMCs from URBANs raised in the presence of pets secreted more IL-6 in response to the T cell-specific mitogen concanavalin A (ConA) than respective PBMCs from RURALs raised in the presence of farm animals. In turn, anti-inflammatory IL-10 secretion was suppressed following TSST in URBANs raised in the absence of pets, suggesting immunoregulatory deficits in urban participants following social stress. Importantly, URBANs reporting absolutely no pet contact differed in their salivary microbiome composition from all other URBANs and RURALs reporting regular or at least occasional contact to farm animals or pets belonging to others households, and displayed a significantly higher TSST-induced immune activation compared to URBANs reporting at least occasional contact to pets belonging to others,(23) suggesting that the complete absence of any pet contact plays a critical role in mediating the negative consequences of urban upbringing. The other way round, having a pet may mitigate some of the decreases in exposures to diverse microbial environments and the associated immunoregulatory deficits in those living in modern urban environments and, therefore, represent a primary prevention strategy for chronic low-grade inflammation and development of any kind of stress-associated disorder linked to an (over)activated immune system. In line with this hypothesis we showed in a follow-up study (Effects of Pets on Social Stress, EPSS) that adult healthy male URBANs raised in the absence (noPETs) vs. presence (PETs) of household pets were characterized by deficits in their immunoregulatory and intestinal barrier function, which under basal conditions did not translate into a chronic low-grade inflammatory state.(24) This was different under acute psychosocial stress conditions. Exposure to the TSST resulted in a facilitated mobilization of particularly neutrophil granulocytes in noPETs vs. PETs, accompanied by an enhanced pro- and compromised anti-inflammatory systemic stress response.(24) Together, the presence of pets during urban upbringing seems to reduce the risk for developing stress-associated disorders later in life (i.e., primary prevention) by facilitating immunoregulatory and barrier functions, in turn preventing an overshooting immune activation in response to acute stressors and chronic low-grade inflammation in response to repeated/chronic stressors.

Main collaborators: Prof. Dr. Christopher Lowry (University of Colorado, Boulder, USA), Prof. Dr. Harald Gündel, Dr. Katja Weimer, Dr. Marc Jarczok, Prof. Dr. Hans Kestler, Dr. Alexander Groß, Prof. Dr. Markus Huber-Lang (Ulm University or Ulm University Medical Center, Ulm, Germany), Prof. Dr, Andreas Meyer-Lindenberg, Prof. Dr. Heike Tost (Central Institute of Mental Health, Mannheim, Germany), Prof. Nicolas Rohleder (Friedrich-Alexander-Universität, Erlangen, Germany), Prof. Dr. Graham Rook (University College London (UCL), London, United Kingdom)

References:

1. United Nations DoEaSA, Population Division. World Urbanization Prospects: The 2014 Revision, Highlights (ST/ESA/SER.A/352). 2014.

2. Peen J, Schoevers RA, Beekman AT, Dekker J. The current status of urban-rural differences in psychiatric disorders. Acta Psychiatr Scand 2010; 121:84-93.

3. Riedler J, Braun-Fahrländer C, Eder W, Schreuer M, Waser M, Maisch S, et al. Exposure to farming in early life and development of asthma and allergy: a cross-sectional survey. The Lancet 2001; 358:1129-33.

4. Langgartner D, Lowry CA, Reber SO. Old Friends, immunoregulation, and stress resilience. Pflügers Archiv - European Journal of Physiology 2019:1-33.

5. Pace TW, Mletzko TC, Alagbe O, Musselman DL, Nemeroff CB, Miller AH, et al. Increased stress-induced inflammatory responses in male patients with major depression and increased early life stress. Am J Psychiatry 2006; 163:1630-3.

6. Gola H, Engler H, Sommershof A, Adenauer H, Kolassa S, Schedlowski M, et al. Posttraumatic stress disorder is associated with an enhanced spontaneous production of pro-inflammatory cytokines by peripheral blood mononuclear cells. BMC Psychiatry 2013; 13:40.

7. Hodes GE, Pfau ML, Leboeuf M, Golden SA, Christoffel DJ, Bregman D, et al. Individual differences in the peripheral immune system promote resilience versus susceptibility to social stress. Proc Natl Acad Sci U S A 2014; 111:16136-41.

8. Kivimaki M, Shipley MJ, Batty GD, Hamer M, Akbaraly TN, Kumari M, et al. Long-term inflammation increases risk of common mental disorder: a cohort study. Mol Psychiatry 2014; 19:149-50.

9. Rohleder N. Stimulation of systemic low-grade inflammation by psychosocial stress. Psychosom Med 2014; 76:181-9.

10. Rook GA, Lowry CA, Raison CL. Microbial 'Old Friends', immunoregulation and stress resilience. Evolution, medicine, and public health 2013; 2013:46-64.

11. Rook GA, Raison CL, Lowry CA. Childhood microbial experience, immunoregulation, inflammation and adult susceptibility to psychosocial stressors and depression in rich and poor countries. Evolution, medicine, and public health 2013; 2013:14-7.

12. Rook GA. Regulation of the immune system by biodiversity from the natural environment: an ecosystem service essential to health. Proc Natl Acad Sci U S A 2013; 110:18360-7.

13. Martínez I, Stegen James C, Maldonado-Gómez Maria X, Eren AM, Siba Peter M, Greenhill Andrew R, et al. The gut microbiota of rural Papua New Guineans: composition, diversity patterns, and ecological processes. Cell Reports 2015; 11:527-38.

14. Engemann K, Pedersen CB, Arge L, Tsirogiannis C, Mortensen PB, Svenning J-C. Residential green space in childhood is associated with lower risk of psychiatric disorders from adolescence into adulthood. Proceedings of the National Academy of Sciences 2019:201807504.

15. Yang B-Y, Zeng X-W, Markevych I, Bloom MS, Heinrich J, Knibbs LD, et al. Association Between Greenness Surrounding Schools and Kindergartens and Attention-Deficit/Hyperactivity Disorder in Children in China. JAMA Network Open 2019; 2:e1917862-e.

16. Stein MM, Hrusch CL, Gozdz J, Igartua C, Pivniouk V, Murray SE, et al. Innate immunity and asthma risk in amish and hutterite farm children. N Engl J Med 2016; 375:411-21.

17. Fall T, Lundholm C, Ortqvist AK, Fall K, Fang F, Hedhammar A, et al. Early exposure to dogs and farm animals and the risk of childhood asthma. JAMA Pediatr 2015; 169:e153219.

18. Mubanga M, Byberg L, Nowak C, Egenvall A, Magnusson PK, Ingelsson E, et al. Dog ownership and the risk of cardiovascular disease and death - a nationwide cohort study. Sci Rep 2017; 7:15821.

19. Okabe H, Hashimoto K, Yamada M, Ono T, Yaginuma K, Kume Y, et al. Associations between fetal or infancy pet exposure and food allergies: The Japan Environment and Children’s Study. PLoS ONE 2023; 18:e0282725.

20. Dunn RR, Fierer N, Henley JB, Leff JW, Menninger HL. Home life: factors structuring the bacterial diversity found within and between homes. PLoS ONE 2013; 8:e64133.

21. Mäki JM, Kirjavainen PV, Täubel M, Piippo-Savolainen E, Backman K, Hyvärinen A, et al. Associations between dog keeping and indoor dust microbiota. Sci Rep 2021; 11:5341.

22. Böbel TS, Hackl SB, Langgartner D, Jarczok MN, Rohleder N, Rook GA, et al. Less immune activation following social stress in rural vs. urban participants raised with regular or no animal contact, respectively. Proc Natl Acad Sci U S A 2018; 115:5259-64.

23. Langgartner D, Zambrano CA, Heinze JD, Stamper CE, Böbel TS, Hackl SB, et al. Association of the Salivary Microbiome With Animal Contact During Early Life and Stress-Induced Immune Activation in Healthy Participants. Frontiers in Psychiatry 2020; 11.

24. Langgartner D, Weimer K, Brunner-Weisser J, Winkler R, Mannes M, Huber-Lang M, et al. PAWsitive impact: How pet contact during urban childhood ameliorates adult inflammatory stress responses. under review.

3for1 - Three ways to one goal

3for1 - Three ways-one goal

Project description

Project management

Prof Dr Jörn von Wietersheim, Ulm University Hospital, Department of Psychosomatic Medicine and Psychotherapy
Prof Dr Harald Gündel, Ulm University Hospital, Department of Psychosomatic Medicine and Psychotherapy
Prof Dr Nicolas Rüsch, Ulm University Hospital, Department of Psychiatry and Psychotherapy II of Ulm University, Section of Public Mental Health

Project partners

Job Centre Ulm
Job Centre Alb-Donau
Job Centre Neu-Ulm
Job Centre City of Heilbronn
Tübingen district job centre
Reutlingen district job centre

Homepage

www.projekt-3for1.de

Project coordination

Running time:

11/2021 - 10/2026

Financing:

Federal Ministry of Labour and Social Affairs; part of the federal programme "Innovative ways to participate in working life - rehapro"

Funding amount: €4.45 million

BEAT-Covid

BEAT-Covid (Breathing against Coronavirus Disease): Breathing-assisted anti-inflammatory reflex stimulation to reduce systemic inflammation in Covid-19 disease

Project description

Suddenly highly elevated pro-inflammatory cytokines such as interleukin-6 (IL-6) and C-reactive protein (CRP) have been observed in patients with coronavirus disease 2019 (COVID-19) and are associated with worse clinical outcomes (Madjid et al., 2020), also known as cytokine release syndrome (CRS) or cytokine storm. The vagus nerve is centrally involved in the regulation of the systemic immune response via the cholinergic anti-inflammatory reflex (Pavlov & Tracey, 2017) and is associated with mortality in the long term (Jarczok et al. 2021). A study of hospitalised COVID-19 positive soldiers showed that vagal activity decreases, as measured by heart rate variability (HRV) parameters, immediately before the sharp increase in CRP. Consequently, an increase in vagal activity could have a reducing effect on the increase in inflammatory parameters and thus have a positive influence on the course of the disease.

In addition to electrical vagus stimulators or medication, vagus activity can also be reliably stimulated using a specific breathing technique with a reduced frequency and prolonged exhalation phase (slow-paced breathing) (Lehrer & Gevirtz, 2014; Schwerdtfeger et al., 2020). The direct effect on vagal activity can be visualised immediately by measuring heart rate variability. The effect of this breathing technique on inflammatory markers is unknown. The advantage of the breathing technique over drug or electrical stimulation lies in its broad and immediate applicability.

Aim of the study

The aim of the study is to determine whether high-dose (3 times a day for 20 minutes) breath-supported reflex stimulation leads to a reduction in systemic inflammation levels in hospitalised Covid-19 patients and can alleviate the symptoms of COVID-19 in the further course of the disease.

Literature

Jarczok, M.N., Koenig, J. & Thayer, J.F. Lower values of a novel index of vagal neuroimmunomodulation are associated to higher all-cause mortality in two large general population samples with 18 year follow up. Sci Rep 11, 2554 (2021). doi.org/10.1038/s41598-021-82168-6

Lehrer, P. M., & Gevirtz, R. (2014). Heart rate variability biofeedback: how and why does it work? Frontiers in Psychology, 5(JUL), 1-9. doi.org/10.3389/fpsyg.2014.00756

Madjid, M., Safavi-Naeini, P., Solomon, S. D., & Vardeny, O. (2020). Potential Effects of Coronaviruses on the Cardiovascular System: A Review. JAMA Cardiology, 10, 1-10. doi.org/10.1001/jamacardio.2020.1286

Pavlov, V. A., & Tracey, K. J. (2017). Neural regulation of immunity: molecular mechanisms and clinical translation. Nature Neuroscience, 20(2), 156-166. doi.org/10.1038/nn.4477

Schwerdtfeger, A. R., Schwarz, G., Pfurtscheller, K., Thayer, J. F., Jarczok, M. N., & Pfurtscheller, G. (2020). Heart rate variability (HRV): From brain death to resonance breathing at 6 breaths per minute. Clinical Neurophysiology, 131(3), 676-693. doi.org/10.1016/j.clinph.2019.11.013

Study management

Start of study

02/2021

Co-operation:

with the infection ward M1C of the University Hospital, Ulm

Registration:

The study is registered in the German Register of Clinical Studies under the ID DRKS00023971.

ENHANCE

Improving the effectiveness of trauma-focused cognitive behavioural therapy and trauma-focused psychodynamic therapy for post-traumatic stress disorder in adults associated with childhood violence and abuse

Project description

People who experienced violence or abuse as children or adolescents often still have psychological problems in adulthood. Post-traumatic stress disorder (PTSD) is a common secondary illness. PTSD is a mental illness that can lead to severe stress and serious problems in many areas of life.

ENHANCE is an interdisciplinary, multicentre randomised controlled psychotherapy study. The aim of the study is to improve and compare the effectiveness of trauma-focused cognitive behavioural therapy (STAIR Narrative Therapy, SNT) and trauma-focused psychodynamic therapy (TF-PDT) in PTSD-GMK. After a detailed and comprehensive diagnosis, the study patients with PTSD-GMK are randomly assigned to one of the two forms of therapy, trauma-focused cognitive behavioural therapy (STAIR Narrative Therapy, SNT) or trauma-focused psychodynamic therapy (TF-PDT), or to a 6-month waiting control group. In both therapy groups, the study patients receive 24 hours of short-term outpatient psychotherapy. Once during therapy (10th session), after the end of therapy, 6 and 12 months after the end of therapy, PTSD symptom severity will be assessed again. Further questions are investigated in sub-studies B1-B4. In sub-study B1, tape-recorded therapy sessions are used to examine the extent to which the therapists have implemented the therapy concept appropriately. In addition, the influence of certain factors (e.g. type and duration of traumatisation) on the therapy outcome will be investigated. In sub-project B2, neurobiological changes and their influence on the therapy outcome are investigated. The aim of the functional and structural magnetic resonance imaging study B3 is to investigate the neuronal correlates underlying and predicting short- and long-term psychotherapeutic changes in this patient group. In a further sub-project (B4), health economic analyses will be carried out.

Further information can be found on the cross-centre homepage:
https://www.uni-giessen.de/enhance-traumatherapie

Study centre

The study centre is the Justus Liebig University Giessen, Clinic for Psychotherapy and Psychosomatics, Prof. Dr. Falk Leichsenring. In addition to Giessen and Ulm, the psychosomatic university clinics and universities in Berlin, Mainz and Dresden are also involved. The study is funded by the BMBF.

Co-operations

In Ulm, the study is being conducted in close co-operation between the Clinic for Psychosomatic Medicine and Psychotherapy and the Institute of Psychology, Department of Clinical & Biological Psychology. Patients are recruited and treated for the study in both institutions.

Study management Ulm

Prof Dr Iris-Tatjana Kolassa

Head of the Department of Clinical &
Biological Psychology
University of Ulm

Downloads

Project flyer (PDF)

egePan

Development, testing and implementation of regionally adaptive care structures and processes for evidence-led pandemic management coordinated by university medicine"

Project description

The "egePan" network is establishing a national pandemic management system to be able to recognise and treat COVID-19 patients even faster and better in future, prevent infections and be prepared for future pandemics. The aim is to monitor local outbreaks and assess them in the context of the overall German and European situation. The network brings together and analyses action plans, diagnostic and treatment strategies of the university hospitals and develops and evaluates concepts.

The overarching objectives are to ensure adequate resource management within the regions and to safeguard the healthcare system's ability to act in the face of rising infection rates and growing numbers of patients requiring hospitalisation. Maintaining or restoring the ability to work and the physical and mental health of medical staff is a key prerequisite for successfully coping with the Covid-19 pandemic and possible future pandemics. The EVIPan project therefore aims to safeguard the health of medical staff during the pandemic. The VOICE sub-project, a collaboration between the university hospitals in Ulm, Erlangen, Bonn, Cologne and Dresden, has recently completed the fourth web-based survey wave on mental stress, work stress, health and personal resources of medical staff.

Project management Ulm site

FEEL test

Facially Expressed Emotion Labelling Test (FEEL test)

Project description

The FEEL test (short for Facially Expressed Emotion Labelling) was developed in the Medical Psychology Section of the Clinic for Psychosomatic Medicine and Psychotherapy at Ulm University Hospital in order to recognise the ability of emotional facial expressions (Kessler, Bayerl, Deighton & Traue, 2002).

The emotions shown are based on the so-called basic emotions according to Paul Ekman (joy, sadness, disgust, fear, surprise, anger). Basic emotions are shown to the test subjects on a desktop and are to be recognised with a mouse click; the recognition rate and reaction time are of relevance here. It is possible to implement different image data sets in the FEEL test.

If you are interested in using the FEEL test empirically, please contact steffen.walter@uni-ulm.de.

Selected literature

Lazaro E, Amayra I, Lopez-Paz JF, Martinez O, Perez M, Berrocoso S, et al. Instrument for Assessing the Ability to Identify Emotional Facial Expressions in Healthy Children and in Children With ADHD: The FEEL Test. Journal of attention disorders. 2019 Apr;23(6):563-9
Crönlein T, Langguth B, Eichhammer P, Busch V. Impaired recognition of facially expressed emotions in different groups of patients with sleep disorders. PLoS ONE. 2016;11(4):1-9;
Rukavina S, Gruss S, Hoffmann H, Tan J-W, Walter S, Traue HC. Affective computing and the impact of gender and age. PLoS ONE. 2016;11(3);
Kliegl KM, Limbrecht-Ecklundt K, Dürr L, Traue HC, Huckauf A. The complex duration perception of emotional faces: effects of face direction. Frontiers in Psychology [Internet]. 2015;6:262. Available from: https://www.frontiersin.org/article/10.3389/fpsyg.2015.00262
Jongen S, Axmacher N, Kremers NAW, Hoffmann H, Limbrecht-Ecklundt K, Traue HC, et al. An investigation of facial emotion recognition impairments in alexithymia and its neural correlates. Behavioural brain research. 2014 Sep;271:129-39
Hoffmann H, Traue HC, Bachmayr F, Kessler H. Perceived realism of dynamic facial expressions of emotion: Optimal durations for the presentation of emotional onsets and offsets. Cognition and Emotion [Internet]. 2010 Dec 1;24(8):1369-76. Available from: https://doi.org/10.1080/02699930903417855
Braun M, Traue HC, Frisch S, Deighton RM, Kessler H. Emotion recognition in stroke patients with left and right hemispheric lesion: results with a new instrument-the FEEL Test. Brain and cognition. 2005 Jul;58(2):193-201;
Kessler H, Bayerl P, Deighton RM, Traue HC. Facially Expressed Emotion Labelling (FEEL): PC-based test for emotion recognition. [Facially Expressed Emotion Labelling (FEEL): A computer-based test for emotion recognition.] Behaviour Therapy & Behavioural Medicine. 2002;23(3):297-306.

Project coordination

feelBack

Networked, digital, patient-related feedback in psycho-oncology

Project description

Cancer is associated with a variety of stresses and strains. According to the National Cancer Plan, all cancer patients and their relatives should receive needs-based, psycho-oncological care. Regular screening for psychosocial stress across all relevant treatment sectors is prescribed to determine individual care needs. So far, actual implementation has fallen short of these goals.
The feelBack project aims to establish digital stress screening instead of the paper questionnaires used to date. In addition to structuring the survey processes more effectively, this also makes it possible to avoid data loss and could contribute to increasing the screening rate (e.g. by making it available as an app on mobile devices). In the future, digitalisation processes in this area could sustainably improve sectoral networking in psycho-oncological care, e.g. through targeted, patient-determined data transfer between treatment centres. Finally, research areas and centre certifications could benefit from the greater availability of structured data.
As part of a randomised controlled pilot study, the feasibility and acceptance of a digital stress screening was examined in direct comparison to the standard paper questionnaire. In addition, the survey was used to determine the respondents' interest in and acceptance of a cross-sectoral data exchange of screening results. From May to November 2020, 60 people seeking advice at the outpatient psychosocial cancer counselling centre in Ulm were included in the survey. Since August 2021, the survey has been expanded to include a further 90 inpatients treated at Ulm University Hospital (Internal Medicine I). The digital application is based on the feelBack app developed as part of the project, which contains the validated and internationally recognised Distress Thermometer*.
Work on the feelBack project will continue via a cost-neutral extension. The aim is to publish the extended results. In addition, the challenges with regard to the desired interfaces will be addressed so that cross-sectoral summarisation of data can be implemented in real care. In addition, further optimisations in the area of user-friendliness and systematisation of the feelBack app will be undertaken.

* NCCN 1.2005 Distress Management Guideline. National Comprehensive Cancer Network.

Publications

Schobel, J., Volz, M., Hörner, K., Kuhn, P., Jobst, F., Schwab, J. D., Ikonomi, N., Werle, S. D., Fürstberger, A., Hoenig, K., Kestler, H. A. (2021). Supporting Medical Staff from Psycho-Oncology with Smart Mobile Devices: Insights into the Development Process and First Results. MDPI International Journal of Environmental Research and Public Health, 18, 5092. https:// doi.org/10.3390/ijerph18105092

Internal stakeholders

CCCU - Comprehensive Cancer Centre Ulm, Dr Peter Kuhn, Head of Clinical Cancer Registry

Franz Jobst, Head of Strategic IT Development, Ulm University Hospital

Centre for Information and Communication (ZIK), Department of University Medicine Ulm

External participants

Biberach Health Department, Dr Monika Spannenkrebs, Head of Department

AOK - The health insurance company Ulm-Biberach

Project management

Prof Dr Hans Kestler,
Head of the Institute for Medical Systems Biology,
University of Ulm

Study management

Runtime

11/2018 - 12/2022

FRIAA

Early intervention in the workplace for employees with mental health issues

Project description

The Early Intervention in the Workplace (friaa) project is funded by the Federal Ministry of Education and Research (BMBF, funding code: BMBF-01GX1902A) and will be realised over a period of 4 years.

A total of 8 co-operation partners throughout Germany are involved in the friaa project, with the project being coordinated at the Ulm site. The aim of friaa is to develop and manualise a modularised work-related psychotherapeutic intervention as a first step.

The aim of the intervention is to reach employees with psychological stress as early as possible in order to provide them with work-related psychotherapy. One aim of work-related psychotherapy is, if possible, to ensure that they remain in employment or to facilitate their return to work. In addition to the extraordinarily early intervention, a special feature is the networking of prevention, acute care and rehabilitation for the care of mentally ill employees.

The intervention is being carried out at five locations (Berlin/Teltow, Düsseldorf, Erlangen, Hildesheim and Ulm). The intervention will be publicised via various regional networks, such as chambers of industry and commerce and company doctors. A total of almost 520 people from small, medium-sized and large companies from as many different sectors as possible are to be recruited to take part in the intervention. The Institute of Medical Biometry and Informatics at Heidelberg University Hospital will act as a co-operation partner to ensure compliance with the highest standards of clinical studies. In addition to the clinical evaluation of the intervention, a health economic evaluation of the intervention will be carried out by the Department of Psychiatry and Psychotherapy II (Günzburg/Ulm), as well as a formative evaluation by the Federal Institute for Occupational Safety and Health (BAuA, Berlin).

Co-operation partner

Clinic for Psychiatry and Psychotherapy II, Günzburg
Institute for Occupational, Social and Environmental Medicine at the University of Düsseldorf
Department of Psychosomatics and Behavioural Therapy, Seehof Rehabilitation Centre and Psychosomatic Rehabilitation Research Group at Charité - Universitätsmedizin Berlin
Federal Institute for Occupational Safety and Health, Berlin
Institute of Psychology at the University of Hildesheim
Institute for Medical Biometry and Informatics at the University of Heidelberg
Psychosomatic and Psychotherapeutic Department of the University Hospital Erlangen

Project management Ulm

Runtime

2020 - 2024

learn more

HelpingParentsMinds

Co-Design eines mentalisierungsbasierten Smartphonespiel-Prototypen für belastete Eltern

This page in English

HypRa

Promoting the quality of life of tumour patients through hypnosystemic resource activation - a short-term programme to strengthen their own resources

Project description

Oncological patients (N = 60) were randomly assigned to one of two treatment arms
HTI (Hypnosystemic Interventions) vs CBI (Cognitive-Behavioural Interventions), each with three individual sessions or a waiting group. The participants in the HTI group learnt how to use individual inner mental images to activate resources via self-hypnosis, while the participants in the CBI group learnt supportive methods for mindfulness and self-care via psychoeducation. During the waiting period, the patients in the waiting group were cared for as usual (CAU). Changes in dealing with stress and anxiety were evaluated at three measurement points using standardised questionnaires. The extent of psychosocial stress and the ability to cope with stress were analysed using linear regression models with mixed effects at several levels, including diagnosis and duration of illness. The initial results indicate that the short-term programme makes an effective contribution to the psychosomatic support of tumour patients and can be integrated into medical oncological therapy at a low threshold. The catamnestic data is currently being analysed. A workshop report entitled "What can we achieve in three sessions?" was published in the journal Suggestions 2019. A publication in an international journal for psychosomatics and a manualisation are in preparation.

Aim of the study

In order to improve the quality of life of tumour patients and strengthen their individual ability to cope with the disease, a short-term psycho-oncological programme was developed and evaluated to provide support during outpatient medical therapy in the day clinic.

Study management

Runtime

2017 - 2021

in co-operation with

the CCCU,
of the Clinic for Internal Medicine III and the
Clinic for Gynaecology and Obstetrics
at Ulm University Hospital

Partial funding:
German Society for Hypnosis and Hypnotherapy e.V

(Intercultural) emotional experience and interoception through art therapy

Project description

In this study, a new art therapy intervention, "Figurative focussing - body maps of feelings", will be investigated. This art-therapeutic body image work provides insights into the connections between emotional experience and physical reactions. It is an effective method of linking physical well-being with emotional feelings.
The concept of interoception analysed in the study describes the ability to perceive, interpret, integrate and regulate internal body signals and their processing. It is strongly linked to aspects of physical and mental health. There are correlations with different health-related variables (e.g. stress), emotions and various mental illnesses.

The study is intended to be a first step in investigating the change in interoceptive abilities and the experience of emotions through the art therapy intervention "Figurative Focusing - Body Maps of Emotions". Furthermore, emotional and possibly neurological processes are to be analysed in order to improve the treatment of mental illnesses with the help of art therapy measures.

In the further course of the project, this study is to be expanded interculturally and carried out in Vietnam in order to explore differences and similarities.

Co-operation partner

Faculty of Psychology, University of Social Sciences and Humanities in Ho Chi Minh City, under the direction of Le Thi Mai Lien, Ph.D. (Applied Psychology Research Group)
Department of Clinical and Health Psychology, University of Ulm under the direction of Prof. Dr Dr Olga Pollatos
IKT Institute for Art and Therapy Munich under the direction of Alexandra Danner-Weinberger

Poster on the study

Poster_Pilot_Vu_Stiftung2.pdf (PDF)

Project management

Promotion

Prof. hc. Dr hc. Rudolf Kurz Foundation

IPS-PILOT

IPS Pilot

Project description

Since January 2023, the multicentre research project IPS-Pilot has been conducted under the direction of Prof. Harald Gündel, Department of Psychosomatic Medicine and Psychotherapy. The project is dedicated to integrated psychosocial support for staff, patients and relatives in intensive care units (IPS-Pilot for short). At the Ulm site, the intervention is taking place in cooperation with the Department of Anaesthesiology and Intensive Care Medicine (Prof. Bettina Jungwirth).
The project consortium is made up of three sites; in addition to Ulm, these are the Medical Clinic with a focus on psychosomatics at Charité Berlin (Prof. Rose) and the Department of Psychosomatic Medicine and Psychotherapy (Prof. Junne) at Magdeburg University Hospital. The Institute for Social Medicine and Health Systems Research at the Medical Faculty of the University of Magdeburg (Prof Apfelbacher) is providing methodological support for the project.

In the IPS pilot project, we are working with healthcare professionals, relatives and patients to develop integrated psychosocial care (central intervention components: Psychological psychotherapist as a team member of an intensive care unit, supervisions, health circles). To this end, findings on needs, expected benefits and necessary framework conditions for implementation are first collected in a structured manner from all those affected. The specific intervention concept is then developed using creative and team-orientated methods with all stakeholders. This development is based on theories about the promotion of resources and the effectiveness of an employee-friendly psychosocial safety climate. The subsequent feasibility study will be conducted as a circumscribed scientific pilot study (RCT) on 8 intensive care units. The central endpoints are the psychosocial safety climate, well-being and intention to change, as assessed by healthcare professionals. In the course of this pilot study, it will be assessed whether a later, larger, so-called effectiveness study would also be accepted by those affected and is realistically feasible. Qualitative interviews and field notes will be used to gain further insights into the strengths and weaknesses of our approach.

Consortium partners

Prof. Dr Matthias Rose - Charité - Universitätsmedizin Berlin, Medical Clinic specialising in Psychosomatics
Prof Dr Florian Junne - University Medicine Magdeburg, University Clinic for Psychosomatic Medicine and Psychotherapy
Prof Dr Christian Apfelbacher - Institute for Social Medicine and Health Systems Research, Faculty of Medicine, Otto von Guericke University Magdeburg

Study management

Runtime

01.01.2023 - 31.12.2025

Funding through:

LOUISA

Learning model for multidimensional quantitative motion analysis

Project description

Musculoskeletal disorders are one of the main risks of illness in the workplace and often result in chronic pain, which significantly restricts the quality of life of those affected and can even lead to incapacity for work. These illnesses accounted for 21.8 per cent of sick leave and caused the most absences from work with 326.9 days of incapacity to work per 100 insured persons. Due to this prevalence, these forms of illness place a considerable burden not only on the individual's medical history but also on the healthcare solidarity systems. According to the Federal Statistical Office, the costs caused by musculoskeletal and connective tissue disorders (M00-M99) totalled around EUR 34.2 billion in Germany in 2015. The most important causes include back disorders (M54), disc damage (M51), shoulder lesions (M75) and internal damage to the knee joint (M23). According to the WHO, the most common cause of back pain is lack of exercise and persistent one-sided physical strain or incorrect loading.

In line with the ecosystem concept, diseases of the musculoskeletal system have an influence

on the individual and their quality of life as well as their opportunity for biographical self-realisation.
on the individual as an employee, their employment history and the opportunity to identify with their gainful employment and experience social esteem.
the individual company and its planning security.
to the healthcare provider and their options for evaluating the individual illness or therapy measure.
Health insurance and its ability to assess the risk of the disease occurring.
the solidarity-based health insurance system and its ability to distribute healthcare resources fairly.
Medical research and its ability to conduct prevention research and therapy evaluation using valid and anonymised large data sets.

All participants in this ecosystem have a major interest in ensuring that musculoskeletal disorders do not occur. However, due to mutual transparency and trust deficits, there is no common approach that enables collective action in this complex socio-economic process.

The LOUISA joint project is tackling this problem, researching, developing and validating a learning model for multidimensional quantitative movement analysis. Innovations are

a quantitative movement score that is accepted as an intersubjectively understandable and practicable measure by all participants in the ecosystem.
the recognition and prediction of risk factors through intuitive 2D camera movement self-analysis corresponding to the human senses and automatic muscle tone and pain recognition that can be expanded by the user in a self-determined manner.
a defined adaptation process for future innovative sensor channels.

The advantages

In line with the concept of prevention, LOUISA enables people to engage in uncomplicated and low-threshold medical prevention with regard to musculoskeletal disorders directly at the workplace (see Section 20 SGB V Primary prevention and health promotion). LOUISA creates trust and acceptance among all those involved in the ecosystem through a combination of effectiveness and transparency. LOUISA supports companies, organisations and health insurance companies as part of occupational health management (see § 20b SGB V Workplace Health Promotion). LOUISA can also be used in medicine or physiotherapy as a validated measurement method using pre- and post-test procedures. The comparability of the determined movement score significantly supports the selection of suitable therapeutic measures or methods by the doctor or therapist. LOUISA can also be used to monitor the course of therapy.

Success of the project

The project is successful,

if we can make a statement about the accuracy of the individual sensor channels in recognising and predicting risk factors.
if we can make a statement about the effort and performance of the defined adaptation process for future innovative sensor channels.

if the model can be applied safely, practicably and confidently in the defined ecosystem (employees, employers, healthcare providers, health insurers, reinsurers). Possible ethical, legal and social implications have been researched and validated. Nothing stands in the way of certification within the framework of workplace health promotion (BGF) in accordance with § 20b SGB V (German Social Security Code, Book V) and reimbursement by health insurance companies

Partner

Frank Weber, AIMO GmbH
Welf Löwe, Department of Computer Science and Media Technology, Linnaeus University, Sweden
Wulf Loh, International Centre for Ethics in the Sciences and Humanities, University of Tübingen

The goal

An individual's well-being is inextricably linked to their physical health. LOUISA's aim is to motivate people in the workplace to actively maintain, improve and safeguard their health and quality of life.

Topics addressed

The LOUISA joint project addresses the topic of "Healthy living - prevention through technical companions" in the "KMU Innovativ: Mensch-Technik-Interaktion" funding programme, in particular "motivating people to exercise or generally healthy behaviour through appealing visualisation and comparability".^{^[1]}

LOUISA as a learning model with a dynamic adaptation process is a technology for prevention. It combines human-technology interaction (smartphone with a mobile 2D camera scan, pain and muscle tone measurement, feedback and therapy suggestions) with machine learning and biosensor technology. The technology learns from and with people without constantly monitoring them. LOUISA is easily accessible, user-friendly, motivates intuitive use, strengthens patient autonomy and personal responsibility for health and thus places people, their quality of life and work biographical potential at the centre.

Project coordination

Runtime

08/2020 - 07/2023

Promotion

VDI/ VDE - BMBF

MaGnet

Ist ambulante Mentalisierungsbasierte Therapie (MBT) effektiver im Vergleich zu einer Bona- Fide-Therapie mit Richtlinienpsychotherapie (BFT) in Deutschland für Patienten mit einer Borderline Persönlichkeitsstörung?

This page in English

Projektbeschreibung

Die Borderline Persönlichkeitsstörung (BPS) ist eine schwere psychische Störung, die mit hohen Belastungen verbunden ist. Obwohl in den letzten Jahren eine Reihe vielversprechender Therapien entwickelt wurden, besteht eine hohe Notwendigkeit, die Versorgungssituation dieser Patientengruppe weiter zu verbessern. Die MaGnet-Studie untersucht die Wirksamkeit von Mentalisierungsbasierter Therapie (MBT) bei Patienten mit BPS im Vergleich zur besten aktuell verfügbaren Richtlinienpsychotherapie
(„Bona Fide Treatment“, BFT) in ambulanter Behandlung. In die Studie
werden männliche und weibliche Patienten mit der Finanzierung Deutsche Forschungsgemeinschaft (DFG).

Diagnose BPS eingeschlossen, die zwischen 18-65 Jahre alt sind und selbstverletzendes Verhalten oder Suizidversuche in den letzten zwei Jahren aufweisen, wobei das letzte Ereignis nicht länger als sechs Monate zurückliegt.
In fünf Rekrutierungszentren in Deutschland werden N=544 BPS Patienten auf die Einschlusskriterien untersucht und beim Vorliegen der Kriterien und
einem informierten Einverständnis in einen der beiden Therapiearme
randomisiert. Die Behandlung mit MBT ist auf12 Monate angelegt, BFT kann länger oder kürzer sein. Die Intent-to-treat Stichprobe ist auf 304
Patienten berechnet. Der primäre Endpunkt nach 12 Monaten Follow-Up und erfasst die Anzahl an Krisenereignissen in Bezug auf suizidales und
selbstverletzendes Verhalten. Sekundäre Zielkriterien, die untersucht werden, sind Kosteneffektivität, Schwereder BPS- und anderer psychiatrischer Symptome, allgemeines und interpersonales Funktionsniveau, Lebensqualität, Veränderung der Medikation und
Therapieabbruch. Ziel der Studie ist die experimentelle Testung der
Effektivität der MBT als eine innovative BPS-spezifische und
kosteneffektive Behandlungsmethode.

Bei Interesse oder Fragen zur Teilnahme melden Sie sich gerne über die
Studien-Emailadresse: Magnet.Studie@uniklinik-ulm.de

Projektkoordination /-leitung

Prof. Dr. Jana Volkert
Prof. Dr. Harald Gündel

Mitarbeiter

M.Sc. Psych. Ellen Wolff

Finanzierung

Deutsche Forschungsgemeinschaft (DFG)

Projekt Homepage

Laufzeit

2023 - 2028

Flyer für interessierte Patient*innen

Flyer_Patienten_Magnet.pdf (PDF)

Flyer für interessierte Therapeut*innen

Flyer_Therapeuten_Magnet.pdf (PDF)

Multimodal automated pain detection

Project description

The objective assessment of subjectively experienced multidimensional pain is a problem that has not yet been adequately solved(https://www.youtube.com/watch?v=JuWHpMR2a9Y). Especially in clinical pain measurement, verbal methods (pain scales, questionnaires) and visual analogue scales are common, but these are not very reliable and valid in mentally impaired people. Expressive expressions of pain and/or psychobiological parameters can offer a solution. Such coding systems exist, but they involve a great deal of effort or have not been sufficiently evaluated in terms of test theory. Test subjects are exposed to painful stimuli under controlled conditions and mimic and psychobiological parameters are recorded(http://www.iikt.ovgu.de/BioVid.html). Based on psychobiological, video-based (facial expressions, gestures) and prosodic data, pain-relevant characteristics are to be identified and an automatic system developed with which pain can be measured qualitatively and quantitatively(https://www.jove.com/t/59057?language=German).

Partner

Eberhard Barth, Clinic for Anaesthesiology and Intensive Care Medicine, Ulm University Hospital
Ayoub Al-Hamadi & Philipp Werner, IIKT, University of Magdeburg
Oliver Wilhelm and Mattis Geiger, Differential Psychology and Psychological Diagnostics, University of Ulm
Adriano Andrade, Biomedical Engineering Laboratory (BioLab), Federal University of Uberlandia, Brazil
Friedhelm Schwenker, Institute for Neuroinformatics, University of Ulm
Magrit-Ann Geibel, Oral and Maxillofacial Surgery, Ulm University Hospital

Project coordination

Runtime

2012 - 2020

PartnerCare

PartnerCARE

Psycho-oncological online training for partners of people with cancer

Project description

Cancer is not only a great burden for the patient themselves, but also for their relatives. The partner, who is the patient's most important resource, is particularly affected. Cancer confronts the partner with a multitude of new tasks and far-reaching adjustments. This demanding support service and their own everyday tasks mean that many partners feel overwhelmed and report psychological problems. However, the existing support services for relatives of cancer patients are rarely utilised by the partners.

As part of this research project, an online psycho-oncological intervention for partners of cancer patients is being developed and its effectiveness tested. The online intervention is based on elements of cognitive behavioural therapy and specific psycho-oncology content. It consists of six weekly lessons, four optional additional lessons and a refresher lesson. Each lesson is accompanied by feedback from a therapist. The partner also has the option of using an SMS coach.

The aim of the intervention is to reduce psychological stress, such as depression and anxiety, as well as to improve the partner's quality of life. Because it is independent of time and place, an online intervention is particularly suitable for partners of cancer patients who have a busy schedule. In addition, the online intervention lowers the threshold of utilisation for stressed partners who make less use of conventional face-to-face therapies (e.g. male partners).

Feasibility and acceptance check

A randomised controlled feasibility study was conducted from 04/2019 to 07/2020 to investigate the feasibility and acceptance of the PartnerCARE online training. 60 partners were randomly assigned to the training group (direct access to PartnerCARE) and the waiting list group (access to PartnerCARE after a 4-month waiting period). Online questionnaires were completed at three time points (baseline (T0), 2 months (T1) and 4 months (T2) after randomisation). The study showed good feasibility and high acceptance of the training (73.3% completed the training, positive individual feedback from participants). In addition, there were initial promising trends with regard to the effectiveness of the training. Detailed information on this can be found in the publications Bodschwinna et al. (2022a) and Bodschwinna et al. (2022b).

Further development of the PartnerCARE online training programme (term: 11/20-10/21)

The findings of the pilot study will be used to improve the content of the PartnerCARE training programme and make it more attractive and interactive for participants. To this end, whiteboard videos will be created and exemplary dialogue situations between partner and patient will be filmed and incorporated into the online training.

Planned effectiveness study of PartnerCARE 2.0

The PartnerCARE online training course has undergone a feasibility and acceptance test and was subsequently optimised in the further development phase to PartnerCARE 2.0. There are now plans to investigate the effectiveness of PartnerCARE in a randomised controlled effectiveness study.

PartnerCARE is a cooperation project between the Clinic for Psychosomatic Medicine and Psychotherapy (Ulm University Hospital), the Comprehensive Cancer Centre Ulm and the Psychosocial Cancer Counselling Centre Ulm with the Department of Clinical Psychology and Psychotherapy (Ulm University).

Publications

Bodschwinna D., Lorenz I., Bauereiss N., et al. PartnerCARE-a psycho-oncological online intervention for partners of patients with cancer: study protocol for a randomised controlled feasibility trial. BMJ Open 2020;10:e035599. doi: 10.1136/bmjopen-2019-035599 https://bmjopen.bmj.com/content/10/10/e035599

Helmut Wölte Prize 2021 for the PartnerCARE online training programme

M.Sc. Daniela Bodschwinna has been awarded the Helmut Wölte Prize 2021 for the PartnerCARE project. https://helmut-woelte-stiftung.de/

PartnerCARE is a psycho-oncological online training programme for partners of cancer patients. The project is a collaboration between the Department of Psychosomatic Medicine and Psychotherapy at Ulm University Hospital and the Department of Clinical Psychology at Ulm University with the Comprehensive Cancer Centre Ulm (CCCU) under the direction of Dr Klaus Hönig and Prof Dr Harald Baumeister. The innovative online training programme provides partners of people with cancer with a low-threshold and flexible offer of psychosocial support. The results of the project will help to close the gap in psychosocial care for relatives of cancer patients in the long term.

The PartnerCARE online training programme has undergone a feasibility and acceptance test and is currently in the further development phase. In the coming year, the effectiveness of PartnerCARE is to be investigated in a randomised controlled effectiveness study.

Study Director University Clinic for Psychosomatic Medicine and Psychotherapy Ulm

Runtime

2017 - ongoing

Promotion of the sub-project

This sub-project is funded by the Baden-Württemberg Cancer Association.

Study Director University of Ulm, Department of Clinical Psychology and Psychotherapy

Prof Dr Harald Baumeister

Note: Recruitment for the pilot study has now been completed
, so PartnerCARE
is not currently available

PULS study

PULS

Project description

Officers in the police service are exposed to extraordinary mental stress due to their socially important duties such as hazard prevention, protection and law enforcement. This demands a high degree of resilience and personal skills that need to be maintained and strengthened.

For this reason, the Ulm Police Headquarters, Ulm University Hospital and the Deutsche Traumastiftung e.V. (German Trauma Foundation ) have collaborated on a research project to develop ways of preventing trauma-related stress in the police service. Our common goal is to define preventative measures that enable police officers to deal with incisive and stressful experiences during their police service in a healthy manner. Maintaining the ability to work while minimising absences, especially during periods of high workload, is the common long-term goal, for which this research project to record the current situation is the first building block.

Literature:

https://www.baden-wuerttemberg.de/de/service/presse/pressemitteilung/pid/ergebnisse-zur-puls-studie-veroeffentlicht-1

Press:

https://www.uniklinik-ulm.de/aktuelles/detailansicht/leuchtturmprojekt-ergebnisse-zur-studie-der-polizei-und-der-universitaetsklinik-ulm-zu-leistung-und-staerke-puls-veroeffentlicht.html

https://www.regio-tv.de/mediathek/video/studie-zu-psychischer-belastung-von-polizeibeamten/

https://www.regio-tv.de/mediathek/video/schwere-situationen-im-polizeiberuf-besser-ueberstehen-eine-studie-der-uniklinik-und-der-polizei-soll-helfen/

Project management

Running time:

12/2020 - 03/2023

Registration:

DRKS00013288

PsyLoCo

Psychosocial needs of patients with Long COVID

Project description

Many patients with long/post COVID continue to suffer from symptoms weeks or months after their illness. To date, there is little scientific knowledge about long/post COVID and how those affected can be helped in the best possible way.

The project, funded by the Federal Ministry of Education and Research (funding code: 01EP2107A), aims to develop the scientific knowledge available to date on the late symptoms of COVID-19 and to use this to improve care for those affected.

Contact: long.covid@uniklinik-ulm.de

PsyLoCo comprises a total of four sub-projects:

1. analysis of existing cohort data
The study is based on data from two groups of people who have already been studied. The data contains information on COVID-19 in general and Long-COVID in particular. The Corona Cohort Stuttgart Study (CoKoS) was launched in spring 2020, while the DigiHero cohort in Halle (Saale) was initiated in January 2021 as a digital "multi-purpose platform". The two population-based COVID cohorts are analysed and evaluated in a targeted manner. A special focus is on the occurrence of long-COVID symptoms.

2. writing a review
A detailed and systematic search is carried out in various scientific databases. The results of the research are summarised in a review. This should provide an overview of the symptoms suffered by those affected and the extent to which they differ from other population groups.

3. interview study
The individual complaints associated with long/post COVID are recorded in dialogue with those affected and members of a patient council. In addition to the symptoms, the personal burdens are also enquired about. A particular focus here is on the psychosocial needs of those affected as well as support options for dealing with the disease. This process is supplemented by a series of interviews conducted with patients. The data obtained in this way provides the basis for a psychotherapeutic therapy manual that is specifically designed for long-term/post-COVID treatment.

4. therapy study
The centrepiece of the project is the development of a therapy manual that is geared towards the individual psychosocial needs of those affected by long/post COVID. The aim is to improve outpatient care and rehabilitation. The treatment is designed as a 12-hour short-term therapy programme. One session per week takes place in an individual setting.

The content covers a total of 4 areas (modules):
- Coping strategies and distress management
- Dealing with persistent physical complaints and pain symptoms
- Treatment of affective symptoms and chronic fatigue
- Long-term/post-COVID in the areas of social and working life

Co-operations

Dr Christine Allwang, Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, TU Munich
Prof. Dr Florian Junne, University Clinic for Psychosomatic Medicine and Psychotherapy, Magdeburg University Hospital
Prof. Dr Rafael Mikolajczyk, Institute of Medical Epidemiology, Biometry and Informatics, Faculty of Medicine, Martin Luther University Halle-Wittenberg
Prof. Dr rer. nat. Katrin Giel, Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen
Prof. Dr rer. nat. Peter Martus, Institute for Clinical Epidemiology and Applied Biometry, University Hospital Tübingen
Prof. Dr Claas Lahmann, Department of Psychosomatic Medicine and Psychotherapy, Freiburg University Medical Centre

Project management Ulm site

Start:

01.01.2022

SEEGEN

Research network: "Mental health in the hospital workplace" SEEGEN

Project description

Health, the development and progression of illnesses are determined by very different factors. The professional environment in particular shapes a large number of these factors, both in a positive sense, such as the opportunity to experience recognition, to be creative and productive, to establish social contacts and to use them as a resource for coping with stressful situations. But also in a negative sense, for example when the modern, condensed world of work consisting of diverse demands creates feelings of excessive demands or alienation. However, especially in the diverse working areas of hospitals and clinics, which have undergone enormous change in recent decades, particularly in terms of working conditions, for example due to cost-cutting measures, there is a lack of systematic occupational health management that can favourably influence the various factors at different levels.

Target:

The aim of this two-stage collaborative project is to develop a complex intervention based on behavioural and behavioural prevention measures, test its effectiveness and put it into practice.

Procedure:

In Phase I (2 years), the following five intervention modules (sub-projects 1.A-E) will be developed individually, evaluated differently depending on the format and study situation, and strategies for their subsequent implementation will be tested:

Sub-project 1.A: Sensitisation of senior managers (chief physicians and nursing area managers) for occupational health management in the clinic, sub-project located at the Heinrich Heine University Düsseldorf - Centre for Health and Society (CHS) - Institute for Occupational, Social and Environmental Medicine, project management: PD. Dr A. Müller

Sub-project 1.B Ways out of dilemmas that cause illness - dilemma competence for middle managers in the healthcare sector. Sub-project located at the University Hospital of Heidelberg University, Centre for Psychosocial Medicine (ZPM), Institute for Medical Psychology, project management: Prof. Dr J. Schweitzer-Rothers

Sub-project 1.C Strengthening the relationship-preventive and interprofessional leadership skills of middle managers to reduce the psychological stress of their employees in hospital; sub-project located at the Medical University Hospital Tübingen, Department of Psychosomatic Medicine and Psychotherapy, project management: Dr F. Junne

Life-stage-specific interventions in middle and old age:

Sub-project 1.D Improving the compatibility of work and family in hospitals to reduce the psychological stress of those affected and teams, sub-project located at the University Hospital of the University of Ulm, Department of Child and Adolescent Psychiatry and Department of Psychosomatic Medicine and Psychotherapy, project management: Dr Eva Rothermund

Sub-project 1.E Healthy ageing in the nursing profession (GAP) - development and evaluation of an intervention module to promote successful ageing in the profession. Sub-project located at the University Hospital of the Ruprecht-Karls-University Heidelberg, Clinic for General Internal Medicine. Project management: Dr I. Maatouk

Sub-project 2: In Phase II (years 3+4), the participatory implementation of the above-mentioned components into a complex intervention is being carried out at three hospital sites. Their effectiveness in terms of well-being will be evaluated in a cluster-randomised study. The results will be used to produce manuals for future implementation and for discussion at health policy level. Project management Prof Dr Harald Gündel

Sub-project 3: A cross-phase I and II business management sub-project supports the change in the hospitals and develops key figures (e.g. employer attractiveness, productivity) in order to measure the success of behavioural and behavioural prevention measures in terms relevant to decision-makers. Based at Heinrich Heine University Düsseldorf, Chair of Business Administration, in particular Organisation and Human Resources. Project management Prof. Dr Stefan Süß

Project coordination

Runtime

09/2017 - 09/2021

learn more

Network partners

University Hospital Ulm, Heinrich Heine University Düsseldorf, University Hospital Heidelberg, University Hospital Tübingen

STOP-DM

What psychotherapy do men need: Effects of inpatient depth-psychologically orientated psychotherapy for depressive disorders in men

Project description

The aim of the study is to analyse the effectiveness of inpatient depth psychology-based psychotherapy and individual therapy components in patients with depression. In particular, the differential effectiveness depending on gender will be analysed. It is assumed that men benefit differently from the psychotherapeutic programmes than women. The data will be collected in at least 10 clinics using questionnaires; the surveys will take place at the beginning and end of inpatient treatment and at a catamnesis point 6 months after treatment. In addition, patients will keep a diary during their inpatient treatment in which they will document the individual therapy modules, their duration and their effectiveness. A total of 300 patients are to be included in the study, at least 30 of them from the Psychosomatic Clinic at Ulm University Hospital. Men and women are to be included in a ratio of 2:1.

In the Ulm clinic, the study design was expanded and all patients with depression were approached and recruited for participation, including patients who were treated in a day clinic or in a behavioural therapy setting. A total of 85 patients have been included so far.

The study is partially funded by the Heigl Foundation. The study centre is the Clinic for Psychosomatic Medicine and Psychotherapy at Düsseldorf University Hospital, project leader Prof. M. Franz, MD.

Study management Ulm

SUSTAIN

Specialised post-inpatient outpatient follow-up treatment via video conferencing for sustained stabilisation in anorexia nervosa (SUSTAIN) - a randomised controlled trial

Project description

Anorexia Nervosa (AN) is characterised by severe underweight and high mortality and morbidity rates. Inpatient psychotherapy is successful in terms of initial weight gain, but many patients suffer recurrent relapses shortly after discharge, which are associated with an unfavourable prognosis and frequent chronification of AN.

As part of a multicentre, prospective randomised controlled study, outpatient follow-up treatment is to be investigated in patients with AN following day-clinic or inpatient psychotherapy. The aim is to compare the effectiveness of 20 sessions over 8 months of a new cognitive-behavioural outpatient psychotherapy called SUSTAIN, which is specifically aimed at patients with AN following (partial) inpatient treatment, with conventional outpatient follow-up treatment (optimised treatment as usual, TAU-O). The experimental group receives SUSTAIN psychotherapy mainly in the form of video calls to ensure continuity of treatment by specialised treatment centres. The main target criterion of the study is the difference in weight (BMI) between enrolment in the study (T0) and the end of treatment (T2). Other important questions relate to the change in eating disorder pathology, general psychopathology, weight rehabilitation, the relapse rate and the long-term course of BMI. The cost-effectiveness of the new treatment will also be analysed. In an additional question, biomarkers in the blood (methylation and gene expression) of the patients will also be analysed.

The study centre is the Clinic for Psychosomatic Medicine and Psychotherapy at the University Hospital of Tübingen, with Prof. Dr Katrin Giel as project leader. Other participating centres are the Psychosomatic University Clinics in Berlin (Charite), Bochum, Essen, Freiburg, Hanover, Heidelberg, Freiburg and the Roseneck Clinic in Prien/Chiemsee. The study is funded by the BMBF.

Study management Ulm

Runtime

11/2020 - 03/2024

VAST

VAST study (vagus-stimulating breathing technique in patients with psychosomatic illnesses)

Project description

The VAST study (vagus-stimulating breathing technique in patients with psychosomatic illnesses) is dedicated to an important basic topic: we know from many years of research that the various psychosomatic illnesses are usually accompanied by measurably reduced activity in parts of the autonomic nervous system. The vagus nerve in particular, which as the 10th cranial nerve regulates large parts of physical functions such as the heartbeat or blood pressure, is affected here.

However, the vagus nerve may also play a key role in the regulation of emotions, as it transmits these physical states to our brain, to which a significant part of the development of emotions can be attributed.

Our main aim in this study is to find out whether the additional use of a vagus-stimulating breathing technique leads to an improved ability to regulate emotions.

We are looking for patients with a recommendation for inpatient or daypatient treatment at the Clinic for Psychosomatic Medicine who are willing to learn this technique and can use it independently. Our professional study team will accompany you on a weekly basis during the application phase.

You will receive an expense allowance totalling €80 for full participation.

Our commitment to your psychosomatic health is at the centre of our work. If you have any questions or are interested in our study, please do not hesitate to contact us.

Email: vast.studie@uniklinik-ulm.de

Study number: 0173 / 349 02 63

Aim of the study

The main aim of this study is to find out whether the additional use of a vagus-stimulating breathing technique leads to an improved ability to regulate emotions.

Literature

Study management

Start of study

11/2023

Co-operation:

Registration:

VERIKOM

Edit "Responsible artificial intelligence in..." on page "VERIKOM

Project description

In the planned project, we want to investigate how doctors and patients react to different AI-mediated communication formats in realistic eHealth scenarios in order to filter out which formats can actually be used responsibly and for the benefit of patients in doctor-patient interaction.

We will design interaction sequences for doctor-patient communication that contain varying degrees of AI (using a Wizard of Oz design) and compare these with real social communication in a doctor-patient interaction. The interaction sequences describe different diagnostic situations and treatment planning under standard conditions, but also under aggravating circumstances (e.g. serious diagnosis, anxiety reaction or expression of suicidal thoughts by the patient). The reaction of the practitioner and the patient will be documented on several levels (self-report, standardised survey using psychobiological measures and video coding) and the different sequences will be compared.

From the findings, we plan to derive recommendations for the use of AI-based techniques in the healthcare sector that take into account the psychological aspects of patients in particularly sensitive situations.

Partner

Beate Ditzen, Johannes Ehrenthal and Julia Mahal, Institute of Medical Psychology, Heidelberg University Hospital

Project coordination

Runtime

10/2020 - 09/2023

Promotion

Baden-Württemberg Foundation

VOICE

Project description

The current situation of the COVID-19 pandemic is unknown to all of us and is associated with various types of stress, especially for employees in the healthcare sector: Overcrowding of intensive care beds due to COVID-19 patients, vacancies in entire wards and surgeries, uncertainty about the course of the pandemic, fears for one's own health, stress due to the difficult work-life balance and many more.

Various studies show that during epidemics such as SARS or MERS, employees in the healthcare professions are under particular strain and are also extremely vulnerable in terms of their mental health. At the same time, however, many of them also have structural, social and very personal resources from which they draw strength and support.

Our multidisciplinary working group from the university hospitals in Erlangen, Bonn and Ulm has developed an online survey in order to record the current stress and resources during the Covid-19 pandemic in a broad sample and thus be able to offer targeted help to affected colleagues during and after the crisis as quickly as possible.

Study objective

The aim of the study is to identify specific stresses and anxieties in the context of the COVID-19 crisis (e.g. fear of infection, stress due to changes in tasks, etc.) as well as sources of personal resilience in the structural, social and spiritual areas and, if necessary, to record any resulting stress symptoms such as sleep disorders, but also indications of traumatisation, depression, anxiety disorders and their severity. At the same time, working conditions and aspects of work-life balance and resources are to be surveyed. The data will be used to identify possible correlations between stress/resources and mental health/quality of life as well as possible differences between genders/specialisms/settings. We also want to analyse typical courses of coping processes.

To this end, data from two survey waves (spring and late autumn 2020) will be analysed and a third survey wave is planned. At T1 > 8000 participants took part in the survey, at T2 > 6000 participants. Further qualitative interviews are also planned.

Study management

Prof. Yesim Erim (spokesperson) and Dr.rer.medic. Dipl. Psych. Dipl. Theol. Eva Morawa, Psychosomatic and Psychotherapeutic Department, University Hospital Erlangen

Prof. Dr med Dipl.-Psych. Franziska Geiser, Clinic and Polyclinic for Psychosomatic Medicine and Psychotherapy and Prof. Dr med Lukas Radbruch, Clinic for Palliative Medicine, University Hospital Bonn

PD Dr Petra Beschoner and PD Dr bio.hum. Lucia Jerg-Bretzke, Clinic for Psychosomatic Medicine and Psychotherapy, Ulm University Hospital

Study programme

Since mid-April 2020, data has been collected online in anonymised form. The data collected does not allow any conclusions to be drawn about the respective individuals; the longitudinal data is collated using an anonymous code.
A positive ethics vote and approval from the data protection officer have been obtained.

To date, over 5000 employees in the healthcare sector have completed the questionnaire online.

Cooperation partners

Prof Dr Christian Albus, Clinic and Polyclinic for Psychosomatics and Psychotherapy, University Hospital Cologne
Prof Dr Kerstin Weidner, Clinic and Polyclinic for Psychotherapy and Psychosomatics, University Hospital Carl Gustav Carus Dresden
Prof Dr Christoph Herrmann-Lingen, Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Göttingen
Prof. Dr Hans Drexler, Institute and Polyclinic for Occupational, Social and Environmental Medicine, Department of Occupational Medicine, University of Erlangen-Nuremberg,
Prof Eberhard Hauschildt, Institute for Practical Theology, University of Bonn
Prof. Dr Thomas Kühlein, Institute of General Medicine, University Hospital Erlangen Clinic Forchheim - Franconian Switzerland
Prof Dr Christian Maihöfner, Neurological Clinic, Fürth Hospital
Dr Irmgard Pfaffinger, Professional Association of Specialists in Psychosomatic Medicine and Psychotherapy e.V.
Prof Dr Ceren Acartürk, Koc University Istanbul, Turkey

Background to the study

Scientific studies show that epidemics and pandemics, such as the H1N1 pandemic in 2009, lead to an increase in mental stress among medical staff (Matsuishi 2012, Maunder 2006). Initial data on mental stress among healthcare workers during the SARS-CoV-2 outbreak and the associated coronavirus disease 2019 (COVID-19) in China point in the same direction and report enormous mental stress, including sleep disorders, depression, anxiety disorders (Huang 2020) and post-traumatic stress disorder (Liu 2020, Sun 2020). With regard to predictive factors for high levels of stress, Brooks et al. (2018) identified working conditions such as the type of job, whether there is contact with infected people, measures to prepare employees for the situation (Brooks 2018). Social isolation or social support and loss of control were other specific factors associated with increased psychological stress (Brooks 2018). Medical staff working in areas with a high risk of infection during the SARS epidemic in 2003 were significantly more likely to show symptoms of post-traumatic stress disorder than staff in less risky areas (Wu 2009).

The COVID-19 pandemic is now also posing major challenges for Europe. Due to the rapid increase in infections, far-reaching changes had to be made to work processes in hospitals (emergency operation). The number of COVID-19 patients in hospitals is rising, as is the number of cases requiring intensive care and the number of deaths from COVID-19. This places high demands on healthcare staff. In order to be able to deal with the resulting mental stress and crises both preventively and therapeutically during and after the crisis, a well-founded assessment of the specific stress and prevalence is needed in order to derive targeted offers of help.

Study management Ulm

Team

Runtime

2020 - 2021

Latest news

Current publications (WHO listing)

WHEEL QUEST

Study on the psychosocial care situation of paraplegic patients in southern Germany

Project description

Background: While psychotherapeutic care for patients with spinal cord injury plays an important role in the acute inpatient setting, it is unfortunately often unclear what happens after the important step of discharge from initial rehabilitation for psychologically distressed patients with this condition. For patients with other clinical pictures, such as patients with mental disabilities or underlying oncological diseases, care studies have already been carried out to look at special needs and approaches to facilitating access to psychotherapeutic care. Patients with spinal cord injuries have been underrepresented in the literature on mental health - we want to change that!

Research question: Which subgroup of psychotherapists already has experience in treating patients with spinal cord injury? What are the possible obstacles and concerns regarding the treatment of spinal cord injured patients? What starting points can be found for improving access to psychotherapy?

Method: Using a 5- to 10-minute online questionnaire, the WHEEL QUEST, the survey of practising psychological and medical psychotherapists in Bavaria and Baden-Württemberg is planned. The therapists will be recruited via the e-mail addresses listed as freely accessible by the KV Bayern and Baden-Württemberg, as well as by publicising the study via the distribution lists of the Bavarian Chamber of Psychotherapists and professional associations, via which a direct link to the questionnaire will be sent. The survey period extends from December 2020 to the end of January 2021.

Collaboration

Anika Börsig, cand.med.

Study management

Project management

Publikationen 2025

D. Langgartner, K. Weimer, J. Brunner-Weisser, R. Winkler, M. Mannes, M. Huber-Lang, J.-D. Sterrett, C. A. Lowry, N. Rohleder, B. Bajrami, A. H. Luippold, A. Groß, H. A. Kestler, H. Tost, A. Meyer-Lindenberg, H. Gündel, M. N. Jarczok, S. O. Reber. How pet contact ameliorates adult inflammatory stress responses in individuals raised in an urban environment. Brain, Behavior, and Immunity 127, 217-228. https://doi.org/10.1016/j.bbi.2025.03.013

Publications 2024

S. Kern, L. Jerg-Bretzke, P. Beschoner. Psychotherapeutische Interventionen zu Burnout – Ein Umbrella-Review und Impulse für die Therapie (2024). Bundesgesundheitsblatt 67:1279-1287. https://doi.org/10.1007/s00103-024-03961-y

A. Toussaint, A. Weigel, B. Löwe, J. Blanch, K. Bogaerts, B. Boye, C. Burton, F. Cosci, P. Engelmann, P. Fink, S. Fischer, S. Frisch, L. Frostholm, L. K. Gormsen, M. Greco, K. Hansen Kallesoe, T. olde Hartman, T. Hechler, S. Hennemann, P. Henningsen, K. Hüfner, P. Hüsing, J. Ronel, R. von Känel, C. A. Kenedi, F. Köteles, S. Kohlmann, W. J. Kop, N. Lehnen, J. Levenson, B. Löwe, K. Maehder, A. Martin, C. Pieh, V. Pitron, C. U. Rask, W. Rief, M. , J. Rosmalen, J. Rymaszewska, M. Sainio, S. Salzmann, R. Schaefert, S. Selinheimo, M. Shedden-Mora, J. Stone, L. Tak, A. Toussaint, N. Uhlenbusch, O. Van den Bergh, L. de Vroege, A. Weigel, U. Werneke, M. Witthöft (2024). The overlooked burden of persistent physical symptoms: a call for action in European healthcare. The Lancet Regional Health - Europe 48, 2025:101140. https://doi.org/10.1016/j.lanepe.2024.101140.

L.W. Desmond, E.M. Holbrook, C.T.O. Wright, C.A. Zambrano, C.E. Stamper, A.D. Bohr, M.G. Frank, B.K. Podell, J.A. Moreno, A.S. MacDonald, S.O. Reber, R. Hernández-Pando, C.A. Lowry (2024). Effects of Mycobacterium vaccae NCTC 11659 and lipopolysaccharide challenge on polarization of murine BV-2 microglial cells. International Journal of Molecular Sciences 25: 474.
https://doi.org/10.3390/ijms25010474

M. Haffner-Luntzer, S.O. Reber, M. Huber-Lang, A. Ignatius (2024). Regeneration at the interface of mental and physical health after trauma. Current Opinion in Biomedical Engineering 31: 100545.
https://doi.org/10.1016/j.cobme.2024.100545

J. Schiele, G. Mazzari, A. Struck, Y. Bailer, D. Langgartner*, S.O. Reber* (2024). Chronic sensory contact with subordinated conspecifics promotes splenic glucocorticoid resistance in experimentally wounded C57BL/6N male mice. Nature Scientific Reports 14: 10867.
https://doi.org/10.1038/s41598-024-61581-7

T. Vega-Vásquez, D. Langgartner, J.Y. Wang, S.O. Reber, M. Picard, C. Basualto-Alarcón (2024). Mitochondrial morphology in the mouse adrenal cortex: influence of chronic psychosocial stress.
Psychoneuroendocrinology 160: 106683. https://doi.org/10.1016/j.psyneuen.2023.106683

Publications 2023

E. M. Balint, V. Daniele, D. Langgartner, S. O. Reber, E. Rothermund, H. Gündel, J. Von Wietersheim, T. Buckley, M. N. Jarczok (2023). Heart rate variability predicts outcome of short-term psychotherapy at the workplace. Psychophysiology 60: 16. https://www.doi.org/10.1111/psyp.14150

E. M. Holbrook, C. A. Zambrano, C. T. O. Wright, E. M. Dubé, J. R. Stewart, W. J. Sanders, M. G. Frank, A. S. MacDonald, S. O. Reber and C. A. Lowry (2023). Mycobacterium vaccae NCTC 11659, a Soil-Derived Bacterium with Stress Resilience Properties, Modulates the Proinflammatory Effects of LPS in Macrophages. International Journal of Molecular Sciences 24: 5176.
https://doi.org/10.3390/ijms24065176

E. Kempter, M. Amoroso, S. Kupfer, L. Lupu, M. Kustermann, J. Scheurer, B. Baumann, T. Wirth, H. Gündel, R. H. Straub, G. Strauß, M. Huber-Lang, D. Langgartner and S. O. Reber (2023). The PMN-MDSC – A key player in glucocorticoid resistance following combined physical and psychosocial trauma. Brain, Behavior, and Immunity 108: 148-161.
https://doi.org/10.1016/j.bbi.2022.11.011

D. Langgartner*, M. Amoroso*, E. Kempter, M. Kustermann, J. Scheurer, C. A. Lowry, G. Strauß, S. O. Reber (2023). Mycobacterium vaccae protects against glucocorticoid resistance resulting from combined physical and psychosocial trauma in mice. Brain, Behavior, and Immunity 109: 221-234. https://doi.org/10.1016/j.bbi.2023.01.018

D. Langgartner*, M. Koenen*, S. Kupfer, L. Glogger, L. Kurz, L. G. Perez-Rivas, M. Theodoropoulou, M. Noll-Hussong, S. Vettorazzi, J. Tuckermann*, S. O. Reber* (2023). Intact GR dimerization is critical for restraining plasma ACTH levels during chronic psychosocial stress. Neurobiology of Stress 24: 100541. https://www.doi.org/10.1016/j.ynstr.2023.100541

D. Langgartner, R. Winkler, J. Brunner-Weisser, N. Rohleder, M. N. Jarczok, H. Gündel, K. Weimer and S. O. Reber (2023). COVID-19 vaccination exacerbates ex vivo IL-6 release from isolated PBMCs. Nature Scientific Reports 13: 9496.
https://www.doi.org/10.1038/s41598-023-35731-2

G. Mazzari, C. A. Lowry, D. Langgartner, S. O. Reber (2023). Subcutaneous Mycobacterium vaccae ameliorates the effects of early life adversity alone or in combination with chronic stress during adulthood in male and female mice. Neurobiology of Stress 9, 26: 100568.
https://doi.org/10.1016/j.ynstr.2023.100568

J. C. Reiners, L. Leopold, V. Hallebach, D. Sinske, P. Meier, M. Amoroso, D. Langgartner, S. O. Reber, B. Knöll (2023). Acute stress modulates the outcome of traumatic brain injury-associated gene expression and behavioral responses. FASEB Journal 37: e23218.
https://doi.org/10.1096/fj.202301035R

M.E.A. Tschaffon-Müller*, E. Kempter*, L. Steppe, S. Kupfer, M.R. Kuhn, F. Gebhard, C. Pankratz, M. Kalbitz, K. Schütze, H. Gündel, N. Kaleck, G. Strauß, J. Vacher, H. Ichinose, K. Weimer, A. Ignatius, M. Haffner-Luntzer*, S.O. Reber* (2023). Neutrophil-derived catecholamines mediate negative stress effects on bone. Nature Communications 14: 3262.
https://doi.org/10.1038/s41467-023-38616-0

Publications 2022

A. Zeeck, S. Taubner, T. C. Gablonski, I. Lau, S. Zipfel, W. Herzog, B. Wild, H. C. Friederich, G. Resmark, K. Giel, M. Teufel, M. Burgmer, A. Dinkel, S. Herpertz, B. Loewe, S. Tagay, J. von Wietersheim, M. De Zwaan, M. Zettl, A. F. Meier and A. Hartmann (2022). In-Session-Reflective-Functioning in Anorexia Nervosa: An Analysis of Psychotherapeutic Sessions of the ANTOP Study. Frontiers in Psychiatry. 13:12. https://www.doi.org/10.3389/fpsyt.2022.814441

K. Wolfling, A. Zeeck, B. te Wildt, G. Resmark, E. Morawa, A. Kersting, J. von Wietersheim and A. Muller (2022). Behavioral Addictions in Psychosomatic Care. Psychotherapie Psychosomatik Medizinische Psychologie. 72: 139-147. https://www.doi.org/10.1055/a-1647-3280

F. Winter, M. N. Jarczok, M. Warth, S. Hembd-Peuse, B. Ditzen and C. Aguilar-Raab (2022). A new way to measure partner burden in depression: Construction, validation, and sensitivity to change of the partner burden in depression questionnaire. Journal of Marital and Family Therapy. 48: 1111-1127. https://www.doi.org/10.1111/jmft.12584

P. Werner, D. Lopez-Martinez, S. Walter, A. Al-Hamadi, S. Gruss and R. W. Picard (2022). Automatic Recognition Methods Supporting Pain Assessment: A Survey. Ieee Transactions on Affective Computing. 13: 530-552. https://www.doi.org/10.1109/taffc.2019.2946774

K. Weimer, C. Buschhart, E. K. Broelz, P. Enck and B. Horing (2022). Bibliometric Properties of Placebo Literature From the JIPS Database: A Descriptive Study. Frontiers in Psychiatry. 13: 13. https://www.doi.org/10.3389/fpsyt.2022.853953

K. Weimer (2022). Schaefer M, Hellmann-Regen J, Enge S. Effects of Open-Label Placebos on State Anxiety and Glucocorticoid Stress Responses. Brain Sci. 2021 Apr 16;11(4):508. doi: 10.3390/brainsci11040508. Complementary Medicine Research. 29: 96-97

F. Stuber, T. Seifried-Dubon, E. Tsarouha, Z. R. Azad, R. Erschens, I. Armbruster, S. Schnalzer, N. Mulfinger, A. Muller, P. Angerer, M. Helass, I. Maatouk, C. Nikendei, S. Ruhle, B. Puschner, H. Gundel, M. A. Rieger, S. Zipfel and F. Junne (2022). Feasibility, psychological outcomes and practical use of a stress-preventive leadership intervention in the workplace hospital: the results of a mixed-method phase-II study. Bmj Open. 12:12. https://www.doi.org/10.1136/bmjopen-2021-049951

M. Stiawa, M. Peters, N. Mulfinger, S. Krumm, B. Worringer, I. Maatouk, J. Kullenberg, F. Junne, M. Genrich, H. Gundel and B. Puschner (2022). "Stress Occurs Every Day" - Reasons for Work-Related Burden in Hospitals and Coping of Staff. A Qualitative Study. Psychiatrische Praxis. 49: 128-137. https://www.doi.org/10.1055/a-1477-6000

C. Schug, F. Geiser, N. Hiebel, P. Beschoner, L. Jerg-Bretzke, C. Albus, K. Weidner, E. Morawa and Y. Erim (2022). Sick Leave and Intention to Quit the Job among Nursing Staff in German Hospitals during the COVID-19 Pandemic. International Journal of Environmental Research and Public Health. 19: 15. https://www.doi.org/10.3390/ijerph19041947

C. Schug, Y. Erim, F. Geiser, N. Hiebel, P. Beschoner, L. Jerg-Bretzke, C. Albus, K. Weidner, S. Steudte-Schmiedgen, A. Borho, M. Lieb and E. Morawa (2022). Vaccination willingness against COVID-19 among healthcare workers in Germany Results from a University Medicine Network survey between November 2020 and January 2021. Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz. 65: 74-85. https://www.doi.org/10.1007/s00103-021-03418-6

J. Schmuck, N. Hiebel, M. Kriegsmann-Rabe, J. Schneider, J. K. Matthias, Y. Erim, E. Morawa, L. Jerg-Bretzke, P. Beschoner, C. Albus, K. Weidner, L. Radbruch, E. Hauschildt and F. Geiser (2022). Individual Stress Burden and Mental Health in Health Care Workers during the COVID-19 Pandemic: Moderating and Mediating Effects of Resilience. Int J Environ Res Public Health. 19. https://www.doi.org/10.3390/ijerph19116545

J. Schmuck, N. Hiebel, M. Kriegsmann-Rabe, J. Schneider, J. K. Matthias, Y. Erim, E. Morawa, L. Jerg-Bretzke, P. Beschoner, C. Albus, K. Weidner, L. Radbruch, E. Hauschildt and F. Geiser (2022). Individual Stress Burden and Mental Health in Health Care Workers during the COVID-19 Pandemic: Moderating and Mediating Effects of Resilience. International Journal of Environmental Research and Public Health. 19: 15.https://www.doi.org/10.3390/ijerph19116545

J. Schmuck, N. Hiebel, M. Kriegsmann-Rabe, J. Schneider, J. K. Matthias, Y. Erim, E. Morawa, L. Jerg-Bretzke, P. Beschoner, C. Albus, K. Weidner, L. Radbruch, E. Hauschildt and F. Geiser (2022). Individual Stress Burden and Mental Health in Health Care Workers during the COVID-19 Pandemic: Moderating and Mediating Effects of Resilience. International Journal of Environmental Research and Public Health. 19: 15. https://www.doi.org/10.3390/ijerph19116545

C. Schillings, G. Karanassios, N. Schulte, D. Schultchen and O. Pollatos (2022). The Effects of a 3-Week Heartbeat Perception Training on Interoceptive Abilities. Frontiers in Neuroscience. 16: 12. https://www.doi.org/10.3389/fnins.2022.838055

C. Schillings, M. N. Jarczok, K. Weimer and H. O. Guendel (2022). TRAJECTORIES OF STRESS MINDSET MEASURES IN PSYCHOSOMATIC PATIENTS AND ITS ASSOCIATION WITH HEART RATE VARIABILITY - RESULTS FROM THE MEPP STUDY. Psychosomatic Medicine. 84: A18-A18

S. K. Rupp, K. Weimer, M. Goebel-Stengel, P. Enck, S. Zipfel and A. Stengel (2022). Is the Pandemic Wearing Us Out? A Cross-Sectional Study of the Prevalence of Fatigue in Adult Twins without Previous SARS-CoV-2 Infection. Journal of Clinical Medicine. 11: 13. https://www.doi.org/10.3390/jcm11237067

S. K. Rupp, K. Weimer, M. Goebel-Stengel, P. Enck, S. Zipfel and A. Stengel (2022). Genetics, shared environment, or individual experience? A cross-sectional study of the health status following SARS-CoV-2 infection in monozygotic and dizygotic twins. Frontiers in Psychiatry. 13: 10. https://www.doi.org/10.3389/fpsyt.2022.1048676

E. Rothermund, T. Possnecker, A. Antes, R. Kilian, F. Kessemeier, J. von Wietersheim, D. Mayer, M. A. Rieger, H. Gundel, M. Holzer, E. M. Balint and K. Mortl (2022). Conceptual Framework of a Psychotherapeutic Consultation in the Workplace: A Qualitative Study. International Journal of Environmental Research and Public Health. 19: 30. https://www.doi.org/10.3390/ijerph192214894

C. M. M. Queiroz, G. M. da Silva, S. Walter, L. B. Peres, L. M. D. Luiz, S. C. Costa, K. C. de Faria, A. A. Pereira, M. F. Vieira, A. M. Cabral and A. D. Andrade (2022). Single channel approach for filtering electroencephalographic signals strongly contaminated with facial electromyography. Frontiers in Computational Neuroscience. 16: 23. https://www.doi.org/10.3389/fncom.2022.822987

T. Possnecker, M. Baxendale, S. Braun, E. Schwarz, M. Holzer, P. Angerer, H. Gundel, E. Balint and E. Rothermund (2022). Occupational physicians dealing with mental health: between employee and company interests: a qualitative study. Bmc Psychology. 10: 13. https://www.doi.org/10.1186/s40359-022-01012-2

M. Michaelis, M. A. Rieger, S. Burgess, V. Tows, F. I. Abma, U. Bultmann, B. C. Amick and E. Rothermund (2022). Evaluation of measurement properties of the German Work Role Functioning Questionnaire. Bmc Public Health. 22: 9. https://www.doi.org/10.1186/s12889-022-13893-4

T. Maier, M. Rappel, D. S. Rhee, S. Brill, J. Maderner, F. Pijahn, H. Gundel, P. Radermacher, B. Friemert, H. P. Becker and C. Waller (2022). Mental but no bio-physiological long-term habituation to repeated social stress: A study on soldiers and the influence of mission abroad. Frontiers in Psychiatry. 13: 16. https://www.doi.org/10.3389/fpsyt.2022.1011181

M. Lieb, A. Wunsch, K. Schieber, C. Bergelt, H. Faller, F. Geiser, U. Goerling, K. Honig, B. Hornemann, I. Maatouk, A. Niecke, B. Stein, M. Teufel, M. Wickert, A. Buttner-Teleaga, Y. Erim and J. Weis (2022). Return to work after cancer: Improved mental health in working cancer survivors. Psycho-Oncology. 31: 893-901. https://www.doi.org/10.1002/pon.5877

J. Lehmann, E. Schwarz, M. Gast, S. Gritzka, M. Diebig, R. Erschens, C. Schropel, F. Junne, P. Angerer and H. Gundel (2022). Introduction of a stress management training for leaders of small and medium sized enterprises. Safety and Health at Work. 13: S100-S101

M.R. Kuhn*, M. Haffner-Luntzer*, E. Kempter, S.O. Reber, H. Ichinose, J. Vacher, A. Ignatius and M.E.A. Tschaffon-Mueller (2022). Myeloid cell-derived catecholamines influence bone turnover and regeneration in mice. Frontiers in Endocrinology 13: 14. https://www.doi.org/10.3389/fendo.2022.997745

F. Koehler-Dauner, E. Roder, M. Gulde, I. Mayer, J. M. Fegert, U. Ziegenhain and C. Waller (2022). Maternal Sensitivity Modulates Child's Parasympathetic Mode and Buffers Sympathetic Activity in a Free Play Situation. Frontiers in Psychology. 13: 11. https://www.doi.org/10.3389/fpsyg.2022.868848

J. Kersten, A. Wolf, L. Hoyo, E. Hull, M. Tadic, S. Andress, S. d'Almeida, D. Scharnbeck, E. Roder, P. Beschoner, W. Rottbauer and D. Buckert (2022). Symptom burden correlates to impairment of diffusion capacity and exercise intolerance in long COVID patients. Scientific Reports. 12: 9. https://www.doi.org/10.1038/s41598-022-12839-5

A. Karabatsiakis, K. de Punder, C. Doyen-Waldecker, L. Ramo-Fernandez, S. Krause, A. M. Gumpp, A. M. Bach, J. M. Fegert, I. T. Kolassa, H. Gundel, U. Ziegenhain and A. Buchheim (2022). Reactivity of the Oxytocinergic and Neuroendocrine System Following the Adult Attachment Projective Picture System in Men of Recent Fatherhood: Results from an Exploratory Pilot Study with a Cross-Sectional Design. Brain Sciences. 12: 12. https://www.doi.org/10.3390/brainsci12101314

M. N. Jarczok, K. Weimer, C. Braun, D. P. Williams, J. F. Thayer, H. O. Gundel and E. M. Balint (2022). Heart rate variability in the prediction of mortality: A systematic review and meta-analysis of healthy and patient populations. Neuroscience and Biobehavioral Reviews. 143: 21. https://www.doi.org/10.1016/j.neubiorev.2022.104907

M. N. Jarczok, V. Goldberg, J. Kocks, S. Tuerkmen, J. Harbich, J. F. Thayer, H. O. Guendel, E. M. Balint and K. Weimer (2022). COMPARING THE TRIGEMINOCARDIAL REFLEX RESPONSES TO THE COLD FACE TEST IN A CLINICAL AND A NONCLINICAL SAMPLE. Psychosomatic Medicine. 84: A37-A37

M. Hitzler, A. Behnke, H. Gundel, U. Ziegenhain, H. Kindler, I. T. Kolassa and J. Zimmermann (2022). Sources of social support for postpartum women with a history of childhood maltreatment: Consequences for perceived stress and general mental health in the first year after birth. Child Abuse & Neglect. 134: 14. https://www.doi.org/10.1016/j.chiabu.2022.105911

M. Hitzler, A. M. Bach, F. Kohler-Dauner, H. Gundel and I. T. Kolassa (2022). Long-Term Consequences of Childhood Maltreatment Among Postpartum Women-Prevalence of Psychosocial Risk Factors for Child Welfare: An Independent Replication Study. Frontiers in Psychiatry. 13: 11. https://www.doi.org/10.3389/fpsyt.2022.836077

W. Herzog, B. Wild, K. E. Giel, F. Junne, H. C. Friederich, G. Resmark, M. Teufel, D. Schellberg, M. De Zwaan, A. Dinkel, S. Herpertz, M. Burgmer, B. Lowe, A. Zeeck, J. Von Wietersheim, S. Tagay, C. Schade-Brittinger, H. Schauenburg, U. Schmidt and S. Zipfel (2022). Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in female outpatients with anorexia nervosa (ANTOP study): 5-year follow-up of a randomised controlled trial in Germany. Lancet Psychiatry. 9: 280-290. https://www.doi.org/10.1016/s2215-0366(22)00028-1

K. Herrmann, R. Kaluscha, A. Liebert, J. Spohrs, H. Gundel and J. von Wietersheim (2022). First onset of treatment of patients with eating disorders and treatment course: Results of data from a German health insurance company. European Eating Disorders Review. 30: 787-796. https://www.doi.org/10.1002/erv.2922

M. Helass, A. Greinacher, S. Gotz, A. Muller, H. Gundel, F. Junne, C. Nikendei and I. Maatouk (2022). Age stereotypes towards younger and older colleagues in registered nurses and supervisors in a university hospital: A generic qualitative study. Journal of Advanced Nursing. 78: 471-485. https://www.doi.org/10.1111/jan.15021

H. Hebestreit, C. Zeidler, C. Schippers, M. de Zwaan, J. Deckert, P. Heuschmann, C. Krauth, M. Bullinger, A. Berger, M. Berneburg, L. Brandstetter, A. Deibele, J. Dieris-Hirche, H. Graessner, H. Gundel, S. Herpertz, G. Heuft, A. M. Lapstich, T. Lucke, T. Maisch, C. Mundlos, A. Petermann-Meyer, S. Muller, S. Ott, L. Pfister, J. Quitmann, M. Romanos, F. Rutsch, K. Schaubert, K. Schubert, J. B. Schulz, S. Schweiger, O. Tuscher, K. Ungethum, T. O. F. Wagner, K. Haas and Z.-D. W. Grp (2022). Dual guidance structure for evaluation of patients with unclear diagnosis in centers for rare diseases (ZSE-DUO): study protocol for a controlled multi-center cohort study. Orphanet Journal of Rare Diseases. 17: 12. https://www.doi.org/10.1186/s13023-022-02176-1

J. Hannemann, A. Abdalrahman, Y. Erim, E. Morawa, L. Jerg-Bretzke, P. Beschoner, F. Geiser, N. Hiebel, K. Weidner, S. Steudte-Schmiedgen and C. Albus (2022). The impact of the COVID-19 pandemic on the mental health of medical staff considering the interplay of pandemic burden and psychosocial resources -A rapid systematic review. Plos One. 17: 33. https://www.doi.org/10.1371/journal.pone.0264290

A. Greinacher, M. Helass, C. Nikendei, A. Muller, N. Mulfinger, H. Gundel and I. Maatouk (2022). The impact of personality on intention to leave the nursing profession: A structural equation model. Journal of Clinical Nursing. 31: 1570-1579. https://www.doi.org/10.1111/jocn.16010

C. Gotzl, T. Staiger, M. Stiawa, P. Beschoner, H. Gundel, T. Becker, R. Kilian and S. Krumm (2022). Fatherhood and Depression: Dealing with Depression in the Family from the Fathers' Perspective - A Qualitative Study. Psychiatrische Praxis. 49: 411-418. https://www.doi.org/10.1055/a-1667-9363

M. Genrich, P. Angerer, B. Worringer, H. Gundel, F. Kroner and A. Muller (2022). Managers' Action-Guiding Mental Models towards Mental Health-Related Organizational Interventions-A Systematic Review of Qualitative Studies. International Journal of Environmental Research and Public Health. 19: 33. https://www.doi.org/10.3390/ijerph191912610

O. C. G. Gelo and E. Mergenthaler (2022). Therapeutic cycles model Computer-assisted text analysis in psychotherapy research. Psychotherapeut. 67: 143-149. https://www.doi.org/10.1007/s00278-022-00577-y

M. Gast, J. Lehmann, E. Schwarz, C. Hirning, M. Hoelzer, H. Guendel and E. M. Balint (2022). A Single-Day Training for Managers Reduces Cognitive Stigma Regarding Mental Health Problems: A Randomized Trial. International Journal of Environmental Research and Public Health. 19: 12. https://www.doi.org/10.3390/ijerph19074139

M. Gantner, M. N. Jarzcok, J. Schneider, S. Brandner, H. Gundel and J. von Wietersheim (2022). Psychotherapeutic Consultation Services in the Workplace: A Longitudinal Analysis of Treatments and Sick Leave Using Health Insurance Data. Frontiers in Psychiatry. 13: 13. https://www.doi.org/10.3389/fpsyt.2022.838823

S. Frisch, S. Walter, V. Rebhann, S. Gruss, K. J. Bar, R. Smith, R. Lane and H. Gundel (2022). Unconscious negative emotional Memories increase the Pain Discomfort - an experimental Study. Zeitschrift Fur Psychosomatische Medizin Und Psychotherapie. 68: 159-160

S. Frisch, S. Walter, V. Rebhann, S. Gruss, K. J. Bar, H. Gundel, R. D. Lane and R. Smith (2022). SUPPRESSED NEGATIVE EMOTIONAL MEMORIES INCREASE PAIN UNPLEASANTNESS IN FEMALE ADULTS - AN EXPERIMENTAL STUDY. Psychosomatic Medicine. 84: A38-A39

U. Friebe-Hoffmann, L. Dietrich, K. Honig, T. W. P. Friedl, D. Grab, K. Lato and W. Paulus (2022). Emotional Impact of DEGUM II/ III based Second Trimester Screening on expectant Fathers. Geburtshilfe Und Frauenheilkunde. 82: E70-E70. https://www.doi.org/10.1055/s-0042-1756812

R. Erschens, T. Seifried-Dubon, F. Stuber, M. A. Rieger, S. Zipfel, C. Nikendei, M. Genrich, P. Angerer, I. Maatouk, H. Gundel, E. Rothermund, M. Peters and F. Junne (2022). The association of perceived leadership style and subjective well-being of employees in a tertiary hospital in Germany. Plos One. 17: 20. https://www.doi.org/10.1371/journal.pone.0278597

N. Denoix, O. McCook, A. Scheuerle, T. Kapapa, A. Hoffmann, H. Guendel, C. Waller, C. Szabo, P. Radermacher and T. Merz (2022). Brain Histology and Immunohistochemistry After Resuscitation From Hemorrhagic Shock in Swine With Pre-Existing Atherosclerosis and Sodium Thiosulfate (Na2S2O3) Treatment. Frontiers in Medicine. 9: 10. https://www.doi.org/10.3389/fmed.2022.925433

A. Buchheim, U. Ziegenhain, H. Kindler, C. Waller, H. Guendel, A. Karabatsiakis and J. Fegert (2022). Identifying Risk and Resilience Factors in the Intergenerational Cycle of Maltreatment: Results From the TRANS-GEN Study Investigating the Effects of Maternal Attachment and Social Support on Child Attachment and Cardiovascular Stress Physiology. Frontiers in Human Neuroscience. 16: 22. https://www.doi.org/10.3389/fnhum.2022.890262

C. Bosle, H. Brenner, J. E. Fischer, M. N. Jarczok, B. Schottker, L. Perna, K. Hoffmann and R. M. Herr (2022). The association between supportive social ties and autonomic nervous system function-differences between family ties and friendship ties in a cohort of older adults. European Journal of Ageing. 19: 263-276. https://www.doi.org/10.1007/s10433-021-00638-2

P. Borusiak, Y. Mazheika, S. Bauer, E. Haberlandt, I. Krois, C. Fricke, L. Simon, P. Beschoner, L. Jerg-Bretzke, F. Geiser, N. Hiebel, K. Weidner, C. Albus, E. Morawa and Y. Erim (2022). The impact of the COVID-19 pandemic on pediatric developmental services: a cross-sectional study on overall burden and mental health status. Archives of Public Health. 80: 13. https://www.doi.org/10.1186/s13690-022-00876-5

M. Born, J. Kullenberg, A. Drews, U. Bossmann, J. Zwack, H. Gundel and J. Schweitzer (2022). The effects of a dilemma management training program on mental health: a prospective study with mid-level executives in hospitals. Leadership in Health Services. 35: 537-558. https://www.doi.org/10.1108/lhs-03-2022-0024

D. Bodschwinna, G. Weissflog, H. Doehner, D. Niederwieser, A. Mehnert-Theuerkauf, H. Guendel, J. Ernst, U. Goerling and K. Hoenig (2022). Couples Coping With Hematological Cancer: Support Within and Outside the Couple - Findings From a Qualitative Analysis of Dyadic Interviews. Frontiers in Psychology. 13: 10. https://www.doi.org/10.3389/fpsyg.2022.855638

D. Bodschwinna, I. Lorenz, N. Bauereiss, H. Gundel, H. Baumeister and K. Honig (2022). A psycho-oncological online intervention supporting partners of patients with cancer (PartnerCARE): Results from a randomized controlled feasibility trial. Psycho-Oncology. 31: 1230-1242. https://www.doi.org/10.1002/pon.5917

D. Bodschwinna, H. Baumeister and K. Honig (2022). Online intervention for partners (PartnerCARE) Overview of a randomized controlled feasibility study. Onkologie. 28: 923-930. https://www.doi.org/10.1007/s00761-022-01224-6

P. Beschoner, L. Jerg-Bretzke, M. Braun, C. Schonfeldt-Lecuona, E. Rottler, A. Bruck, L. Steiner, M. J. Kempf and J. von Wietersheim (2022). Mobbing Among Hospital Physicians. Gesundheitswesen. 84: 1094-1100. https://www.doi.org/10.1055/a-1581-7896

P. Beschoner, M. N. Jarczok, M. Kempf, K. Weimer, F. Geiser, N. Hiebel, Y. Erim, E. Morawa, S. Steudte-Schmiedgen, C. Albus and L. Jerg-Bretzke (2022). egePan-VOICE study on the psychosocial burden of the Covid-19 pandemic among medical technical assistants. Zeitschrift Fur Psychosomatische Medizin Und Psychotherapie. 68: 250-268

P. Beschoner (2022). Disclosure of One's Own Crisis Experiences by Psychiatric Professionals - Contra. Psychiatrische Praxis. 49: 294-295. https://www.doi.org/10.1055/a-1738-7211

E. M. Balint, D. M. Langgartner, S. O. Reber, E. Rothermund, H. Guendel, J. von Wietersheim, T. Buckley and M. N. Jarczok (2022). CIRCADIAN PROFILES OF HEART RATE VARIABILITY AND CORTISOL IN PATIENTS OF A PSYCHOTHERAPEUTIC CONSULTATION IN THE WORKPLACE. Psychosomatic Medicine. 84: A18-A18

E. M. Balint, B. Gruner, S. Haase, M. Kaw-Geppert, J. F. Thayer, H. Gundel and M. N. Jarczok (2022). A randomized clinical trial to stimulate the cholinergic anti-inflammatory pathway in patients with moderate COVID-19-pneumonia using a slow-paced breathing technique. Frontiers in Immunology. 13: 11. https://www.doi.org/10.3389/fimmu.2022.928979

E. M. Balint, P. Angerer, H. Guendel, B. Marten-Mittag and M. N. Jarczok (2022). Stress Management Intervention for Leaders Increases Nighttime SDANN: Results from a Randomized Controlled Trial. International Journal of Environmental Research and Public Health. 19: 12. https://www.doi.org/10.3390/ijerph19073841

E. Balint, C. Braun, F. Kessemeier, C. Hirning, T. Buckley, H. Guendel and M. Jarczok (2022). Improving individual biopsychosocial knowledge using a 24-h heart rate variability color spectrograph. Journal of Psychosomatic Research. 157: 1. https://www.doi.org/10.1016/j.jpsychores.2022.110821

C. Aguilar-Reab, F. Winter, M. N. Jarczok, B. Ditzen and M. Werth (2022). Feeling low and unhappy together? An actor-partner-interdependence model uncovering the linkage between different operationalizations of relationship quality and depression in different-sex couples. Plos One. 17: 17. https://www.doi.org/10.1371/journal.pone.0274756

Publications 2021

Humer, E., Sattel, H., Gündel, H., Henningsen, P., Kruse, J., Schneider, G., . . . Probst, T. (2021). Stress, depression, and the therapeutic alliance as mediators on the outcome of brief psychodynamic-interpersonal psychotherapy for multisomatoform disorder. Psychotherapy Research, 1-10. [DOI:10.1080/10503307.2021.1882711]

Jarczok, M. N., Buckley, T., Guendel, H., Boeckelmann, I., Mauss, D., Thayer, J. F., & Balint, E. M. (2021). 24 h-Heart Rate Variability as a Communication Tool for a Personalized Psychosomatic Consultation in Occupational Health. Frontiers in Neuroscience, 15, 31.

Jarczok, M.N., Koenig, J. & Thayer, J.F. Lower values of a novel index of Vagal-Neuroimmunomodulation are associated to higher all-cause mortality in two large general population samples with 18 year follow up. Sci Rep 11, 2554 (2021). [DOI]

Lehmann, J.A.M., Schwarz, E., Rahmani Azad, Z., Gritzka, S., Seifried-Dübon, T., Diebig, M., Gast, M., Kilian, R. Nater, U., Jarczok, M., Kessemeier, F., Braun, S., Balint, E., Rothermund, E., Junne, F., Angerer, P., Gündel, H.Effectiveness and cost effectiveness of a stress management training for leaders of small and medium sized enterprises – study protocol for a randomized controlled-trial. BMC Public Health 21, 468 (2021). [DOI 10.1186/s12889-021-10398-4]

Leichsenring F., Steinert C., Beutel M.E., Feix, L., Gündel, H. et al. Trauma-focused psychodynamic therapy and STAIR Narrative Therapy of post-traumatic stress disorder related to childhood maltreatment: trial protocol of a multicentre randomised controlled trial assessing psychological, neurobiological and health economic outcomes (ENHANCE)BMJ Open 2020;10:e040123. [DOI 10.1136/bmjopen-2020-040123]

Mauss, D., & Jarczok, M. N. (2021). The streamlined allostatic load index is associated with perceived stress in life – findings from the MIDUS study. Stress, 1-9. [DOI:10.1080/10253890.2020.1869935]

Michaelis, M., Burgess, S., Junne, F., Rothermund, E., Gündel, H., Zipfel, S., Wolf, M., & Rieger, M. A. (2021). Mental Health Applications for Primary and Secondary Prevention of Common Mental Disorders: Attitudes of German Employees. Frontiers in Psychiatry, 12, 555. [DOI:10.3389/fpsyt.2021.508622]

Morawa, E., Schug, C., Geiser, F., Beschoner, P., Jerg-Bretzke, L., Albus, C., Weidner, K., Hiebel, N., Borho A., Erim, Y. (2021). Psychosocial burden and working conditions during the COVID-19 pandemic in Germany: The VOICE survey among 3678 health care workers in hospitals. Journal of Psychosomatic Research 144: 110415. [DOI 10.1016/j.jpsychores.2021.110415]

Publications 2020

Balint, E. M., Braun, S., Kessemeier, F., Gündel, H., Buckley, T., Jarczok, M. (2020). Das Spektogramm individueller 24h-EKG-Aufzeichnungen als Spiegel psychosomatischer Zusammenhänge im Arzt-Patienten-Gespräch: Eine Pilotstudie an Führungskräften auf Basis der Herzratenvariabilität. Deutscher Kongress für Psychosomatische Medizin und Psychotherapie, 20.

Beschoner P., Sosic-Vasic Z., Jerg-Bretzke L. (2020). Heimweh - eine systematische Übersicht zu Prävalenz und Folgen eines Phänomens von aktueller Relevanz. Psychiatrische Praxis Psychiatrische Praxis 2020; 47(07): 352-360. [DOI: 10.1055/a-1182-2433]

Beschoner, P., von Wietersheim, J., Jarczok, M. N., Braun, M., Schönfeldt-Lecuona, C., Jerg-Bretzke, L., & Steiner, L. (2020). Changes in Working Conditions and Mental Health Among Intensive Care Physicians Across a Decade. Frontiers in Psychiatry, 11, 145.[PubMed] [DOI: 10.1007/s00115-019-0739-x]

Bodschwinna, D., Lorenz, I., Bauereiss, N., Gündel, H., Baumeister, H., & Hoenig, K. (2020). PartnerCARE—a psycho-oncological online intervention for partners of patients with cancer: study protocol for a randomised controlled feasibility trial. BMJ Open, 10(10), e035599. [DOI:10.1136/bmjopen-2019-035599]

Datzmann, T., Hoffmann, A., McCook, O., Merz, T., Wachter, U., Preuss, J., Vettorazzi, S., Calzia, E., Gröger, M., Kohn, F., Schmid, A., Denoix, N., Radermacher, P., Wepler, M. (2020). "Effects of sodium thiosulfate (Na2S2O3) during resuscitation from hemorrhagic shock in swine with preexisting atherosclerosis". Pharmacological Research 151, 104536. [PubMed] [DOI: 10.1016/j.phrs.2019.104536]

Denoix, N., McCook, O., Ecker, S., Wang, R., Waller, C., Radermacher, P., Merz, T. (2020). "The Interaction of the Endogenous Hydrogen Sulfide and Oxytocin Systems in Fluid Regulation and the Cardiovascular System" antioxidants 9:748. [PubMed] [DOI: 10.3390/antiox9080748]

Denoix, N., McCook, O., Scheuerle, A., Kapapa, T., Hoffmann, A., Gündel, G., Waller, C., Radermacher, P., Merz, T. (2020). "Brain histology and immunohistochemistry after resuscitation from hemorrhagic shock in swine with pre-existing atherosclerosis: Effects of sodium thiosulfate (Na2S2O3)" Frontiers in Pharmacology under review

Denoix, N., Merz, T., Unmuth, S., Hoffmann, A., Nespoli, E., Scheuerle, A., Huber-Lang, M., Gündel, H., Waller, C., Radermacher, P., McCook, O. (2020). "Cerebral Immunohistochemical Characterization of the H2S and the Oxytocin Systems in a Porcine Model of Acute Subdural Hematoma" Frontiers in Neurology 11:649. [PubMed] [DOI: 10.3389/fneur.2020.00649]

Gäbel, C., Rittner, S., Stoffel, M., Jarczok, M. N., Aguilar-Raab, C., Ditzen, B., & Warth, M. (2019). Die MUSED-Studie: Musiktherapie bei Depressionen. Musiktherapeutische Umschau, 40(3), 278-280. [DOI:10.13109/muum.2019.40.3.278]

Gumpp, A. M., Boeck, C., Behnke, A., Bach, A. M., Ramo-Fernández, L., Welz, T., Gündel, H., Kolassa, I., Karabatsiakis, A. (2020). Childhood maltreatment is associated with changes in mitochondrial bioenergetics in maternal, but not in neonatal immune cells. Proceedings of the National Academy of Sciences, 117(40), 24778. [DOI:10.1073/pnas.2005885117]

Jarczok, M.N., Buckley, T., Balint, E.M. Commentary on “Heart Rate Variability and Risk of All-Cause Death and Cardiovascular Events in Patients With Cardiovascular Disease: A Meta-Analysis of Cohort Studies.” Biological Research For Nursing. 2020;22(3):418-420. [DOI:10.1177/1099800420909420

Jerg-Bretzke, L., Karremann, M., Beschoner, P., de Gregorio, N., Janni, W., Ebner, F., Rottler E., Walter S., de Gregorio, A. (2020). „Zur Vereinbarkeit von Beruf und Familie bei Beschäftigten einer Universitätsfrauenklinik “–Auswertung einer systematischen Berufsgruppen-übergreifenden Befragung. Zeitschrift für Geburtshilfe und Neonatologie. [PubMed] [DOI: 10.1055/a-1200-3070]

Jerg-Bretzke, L., Limbrecht-Ecklundt, K., Walter, S., Spohrs, J., Beschoner, P. (2020). Correlations of the “Work–Family Conflict” With Occupational Stress—A Cross-Sectional Study Among University Employees. Frontiers in Psychiatry, 11, 134. [PubMed] [DOI: 10.3389/fpsyt.2020.00134]

Kempf M., Jerg-Bretzke L., Jarczok M.N., Beschoner P. (2020). Maladaptive Schemata und berufliche Gratifikationskrisen bei ÄrztInnen und PsychotherapeutInnen – ein systematischer Literaturüberblick. Der Psychotherapeut. [DOI 10.1007/s00278-020-00468-0]

Kessemeier, F., Gündel, H., Von Wietersheim, J., Hölzer, M., Rothermund, E. (2020). Seelische Gesundheit und berufliche Teilhabe: Die Bedeutung psychosomatischer Rehabilitation im Versorgungssystem. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie, 68 (2), 1–15. [DOI:10.1024/1661-4747/a000412]

Kilian R, Müller-Stierlin A, Söhner F, Beschoner P., Gündel H., Staiger T, Stiawa M, Becker T, Frasch K, Panzhirsch M, Schmauß M, Krumm S (2020). Masculinity norms and occupationale role in men treated for depression. PLoS ONE 15(5): e0233764. [PubMed] [DOI: 10.1371/journal.pone.0233764]

Langgartner, D., Zambrano, C.A., Heinze, J.D., Stampr, C.E., Böbel, T.S., Hackl, S.B., Jarczok, M.N., Rohleder, N., Rook, G.A., Gündel, H., Waller, C., Lowry, C.A., Reber, S.O. Association of the Salivary Microbiome With Animal Contact During Early Life and Stress-Induced Immune Activation in Healthy Participants. Front Psychiatry. 2020 May 7;11:353. [PubMed] [DOI: 10.3389/fpsyt.2020.00353]

McCook, O., Scheuerle, A., Denoix, N., Kapapa, T., Radermacher, P., Merz, T. (2020). "Localization of the hydrogen sulfide and oxytocin systems at the depth of the sulci in a porcine model of acute subdural hematoma" Invited review: Neural Regeneration Research under Review.

Merz, T., Denoix, N., Huber-Lang, M., Singer, M., Radermacher, P., McCook, O. (2020). "Microcirculation versus Mitochondria -What to target?" Frontiers In Medicine 7, 416. [PubMed] [DOI:10.3389/fmed.2020.00416]

Merz,T., Denoix, N., Wepler, M., Gässler, H., Messerer, D., Hartmann, C., Datzmann, T., Radermacher, P., McCook, O. (2020). "H2S in acute lung injury: A therapeutic dead end(?)" Intensive Care Medicine Experimental in press.

Merz, T., Denoix, N., Wigger, D., Waller, C., Wepler, M., Vettorazzi, S., Tuckermann, J., Radermacher, P., Mccook, O. (2020). "The Role of Glucocorticoid Receptor and Oxytocin Receptor in the Septic Heart in a Clinically Relevant, Resuscitated Porcine Model With Underlying Atherosclerosis" Frontiers in Endocrinology (Lausanne) 11:299. [DOI: 10.3389/fendo.2020.00299]

Mulfinger, N., Lampl, J., Dinkel, A., Weidner, K., Beutel, M. E., Jarczok, M. N., Hildenbrand G., Kruse J.,Seifried-Dübon T., Junne F., Beschoner P., Gündel H. (2020). Psychische Belastungen durch Epidemien bei Beschäftigten im Gesundheitswesen und Implikationen für die Bewältigung der Corona-Krise: eine Literaturübersicht. Zeitschrift für Psychosomatische Medizin und Psychotherapie, 66(3), 220-242 [PubMed]

Roder, E., Koehler-Dauner, F., Krause, S., Prinz, J., Rottler, E., Alkon, A., Kolassa, I., Gündel, H., Fegert, J. M., Ziegenhain, U., Waller, C. (2020). Maternal separation and contact to a stranger more than reunion affect the autonomic nervous system in the mother-child dyad: ANS measurements during Strange Situation Procedure in mother-child dyad. International Journal of Psychophysiology, 147, 26-34. [DOI:https://doi.org/10.1016/j.ijpsycho.2019.08.015]

Schmalenberger, K.M., Eisenlohr-Moul, T.A., Jarczok, M.N., Eckstein, M., Schneider, E., Brenner, I.G., Duffy, K., Schweizer, S., Kiesner, J., Thayer, J.F., Ditzen, B. Menstrual Cycle Changes in Vagally-Mediated Heart Rate Variability are Associated with Progesterone: Evidence from Two Within-Person Studies. J Clin Med. 2020 Feb 25;9(3):617. [PubMed] [DOI: 10.3390/jcm9030617]

Schwerdtfeger, A.R., Schwarz, G., Pfurtscheller, K., Thayer, J.F., Jarczok, M.N., Pfurtscheller, G. Heart rate variability (HRV): From brain death to resonance breathing at 6 breaths per minute. Clin Neurophysiol. 2020 Mar;131(3):676-693. [PubMed] [DOI: 10.1016/j.clinph.2019.11.013]

Seifried-Dübon, T., Stuber, F., Schnalzer, S., Rieger, M. A., Tsarouha, E., Angerer, P., Gündel, H., Contributors of the SEEGEN Consortium, & Junne, F. (2020). Gesundheitsförderliche Führung am Arbeitsplatz Krankenhaus. Public Health Forum, 28(2), 135-138. [DOI:https://doi.org/10.1515/pubhef-2020-0020]

Spohrs, J., Fischer, A. S., Hönig, K., Gündel, H., & Wietersheim, J. V. (2020). Empathie in der ärztlichen Gesprächsführung ist lernbar! : Psychosomatik -- Autoren: J. Spohrs, A.-S. Fischer, K. Hönig, H. Gündel, J. von Wietersheim. MMW Fortschritte der Medizin, 162(17), 40–43. [PubMed] [DOI:https://doi.org/10.1007/s15006-020-3201-x]

Staiger T, Stiawa M, Mueller-Stierlin AS, Kilian R, Beschoner P., Gündel H., Becker T, Frasch K, Panzirsch M, Schmauß M, Krumm S (2020). Masculinity and Help-Seeking among Men with Depression: a Qualitative Study. Frontiers in Psychiatry

Staiger, T., Stiawa, M., Mueller-Stierlin, A. S., Kilian, R., Beschoner, P., Gündel, H., ... & Krumm, S. (2020). Depression und Männlichkeit: Krankheitstheorien und Bewältigung–Eine biografisch-narrative Studie. Psychiatrische Praxis, 47(02), 65-70. [PubMed] [DOI: 10.1055/a-1043-8126]

Stiawa, M., Müller-Stierlin, A., Staiger, T., Kilian R., Becker T, Gündel H., Beschoner P., Grinschgl A, Frasch K, Schmauß M, Panzirsch M, Mayer L, Sittenberger E, Krumm S (2020). Mental health professionals view about the impact of male gender for the treatment of men with depression - a qualitative study. BMC Psychiatry 20, 276 (2020). [PubMed] [DOI: 10.1186/s12888-020-02686-x]

Stiawa, M., Müller-Stierlin, A., Staiger, T., Kilian, R., Becker, T., Götzl, C., Gündel H., Beschoner P., Grinschgl A., Frasch K., Schmauß M. (2020). Männer mit depressiven Erkrankungen in der stationären Behandlung: Bedarf und Behandlungsziele aus Sicht psychiatrischer Fachkräfte. Psychiatrische Praxis. DOI: 10.1055/a-1149-5429

Stuber, F., Seifried-Dübon, T., Rieger, M. A., Gündel, H., Ruhle, S., Zipfel, S., & Junne, F. (2020). The effectiveness of health-oriented leadership interventions for the improvement of mental health of employees in the health care sector: a systematic review. International Archives of Occupational and Environmental Health. [DOI:10.1007/s00420-020-01583-w]

Viviani, R., Dommes, L., Bosch, J., Steffens, M., Paul, A., Schneider, K. L., Stingl JC, Beschoner, P. (2020). Signals of anticipation of reward and of mean reward rates in the human brain. Scientific Reports, 10(1), 1-16. [PubMed] [DOI: 10.1038/s41598-020-61257-y]

Walter, S., Gruss, S., Frisch, S., Liter, J., Jerg-Bretzke, L., Zujalovic, B. and Barth, E. (2020) “What About Automated Pain Recognition for Routine Clinical Use?” A Survey of Physicians and Nursing Staff on Expectations, Requirements, and Acceptance. Front. Med. 7: 566278. [DOI:10.3389/fmed.2020.566278]

Warth, M., Stoffel, M., Winter, F., Jarczok, M. N., Aguilar-Raab, C., & Ditzen, B. (2020). Instructed Partnership Appreciation in Depression: Effects on Mood, Momentary Relationship Satisfaction, and Psychobiological Arousal. Frontiers in psychiatry, 11, 701. [PubMed][DOI:10.3389/fpsyt.2020.00701]

Wigger, D. C., Gröger, N., Lesse, A., Krause, S., Merz, T., Gündel, H., Braun, K., McCook, O., Radermacher, P., Bock, J., Waller, C. (2020). Maternal Separation Induces Long-Term Alterations in the Cardiac Oxytocin Receptor and Cystathionine γ-Lyase Expression in Mice. Oxidative Medicine and Cellular Longevity, 2020, 4309605. [DOI:10.1155/2020/4309605]

Worringer, B., Genrich, M., Müller, A., Gündel, H., Contributors of the SEEGEN Consortium; Angerer, P. Hospital Medical and Nursing Managers’ Perspective on the Mental Stressors of Employees. Int. J. Environ. Res. Public Health 2020, 17, 5041. [DOI:https://doi.org/10.3390/ijerph17145041]

C.T. Wohnhaas, R. Schmid, M. Rolser, E. Kaaru, D. Langgartner, K. Rieber, B. Strobel, C. Eisele, F. Wiech, I. Jakob, F. Gantner, I. Herichova, R. Vinisko, W.O. Böcher, S. Visvanathan, F. Shen, M. Panzenbeck, E. Raymond, S.O. Reber, D. Delić, P. Baum (2020). Fecal MicroRNAs Show Promise as Noninvasive Crohn’s Disease Biomarkers. Crohn's & Colitis 360: 2.
https://www.doi.org/10.1093/crocol/otaa003

D. Langgartner*, C.A. Zambrano*, J.D. Heinze, C.E. Stamper, T.S. Böbel, S.B. Hackl, M.N. Jarczok, N. Rohleder, G.A. Rook, H. Gündel, C. Waller, C.A. Lowry, S.O. Reber(2020). Association of the Salivary Microbiome With Animal Contact During Early Life and Stress-Induced Immune Activation in Healthy Participants. Frontiers in Psychiatry 11.
https://www.doi.org/10.3389/fpsyt.2020.00353

D. Langgartner, J. Marks, T.C. Nguyen, S.O. Reber (2020). Changes in adrenal functioning induced by chronic psychosocial stress in male mice: a time course study.
Psychoneuroendocrinology 122: 104880. https://doi.org/10.1016/j.psyneuen.2020.104880

D. Langgartner, C.A. Lowry, S.O. Reber (2020). „Old Friends“, Immunregulation und Stressresilienz - Teil 2 Mechanismen. Nervenheilkunde 39: 55-66.
https://www.doi.org/10.1055/a-1037-2032

D. Langgartner, C.A. Lowry, S.O. Reber (2020). „Old Friends“, Immunregulation und Stressresilienz. Teil 1: Theoretische Grundlagen, Nervenheilkunde 39: 47-54.
https://www.doi.org/10.1055/a-1037-0710

S. Foertsch, S.O. Reber (2020). The role of physical trauma in social stress-induced immune activation. Neuroscience & Biobehavioral Reviews 13: 169-178.
https://www.doi.org/10.1016/j.neubiorev.2020.02.025

S. Foertsch, D. Langgartner, S.O. Reber (2020). Abdominal surgery prior to chronic psychosocial stress promotes spleen cell (re)activity and glucocorticoid resistance. Scientific Reports 10: 6917.
https://www.doi.org/10.1038/s41598-020-63419-4

M. Amoroso*, E. Kempter*, D. Langgartner, P. Gross, S.O. Reber (2020). Inducing a stressed phenotype in healthy recipient mice by adoptively transferring CD4+ lymphocytes from mice undergoing chronic psychosocial stress. Psychoneuroendocrinology 122: 104898.
https://doi.org/10.1016/j.psyneuen.2020.104898

M. Amoroso, A. Böttcher, C.A. Lowry, D. Langgartner*, S.O. Reber* (2020). Subcutaneous Mycobacterium vaccae promotes resilience in a mouse model of chronic psychosocial stress when administered prior to or during psychosocial stress. Brain, Behavior, and Immunity 87:309-317. https://www.doi.org/10.1016/j.bbi.2019.12.018

2021

2020

Montano, D., & Gündel, H. (2020). The ethical significance of prevention. Psychotherapy and the world of work. In F. Steger & J. Brunner (Eds.), Ethics in psychotherapeutic practice: integrative - case-orientated - value-plural (pp. 202-213). Kohlhammer.

2019

Gündel, H. (2019). Schizoidie and connecting lines to alexithymia and pensée opératoire. In G. Dammann & O. F. Kernberg (Eds.), Schizoidie und schizoide Persönlichkeitsstörung: Psychodynamik - Diagnostik - Psychotherapie (pp. 220-230). Kohlhammer.

Rothermund, E., Gulde, M., Mulfinger, N., Jerg-Bretzke, L., Gündel, H., & Ziegenhain, U. (2019). Reconciling family and career in the hospital workplace. In P. Angerer, H. Gündel, S. Brandenburg, S. Letzel, A. Nienhaus, & D. Nowak (Eds.), Working in the healthcare sector: Psychosocial working conditions - employee health - quality of patient care (pp. 330-335). ecomed Medizin.

2018

Gündel, H. (2018). Workplace health promotion. In E. Brähler & W. Herzog (Eds.), Sozialpsychosomatik: Das vergessene Soziale in der psychosomatischen Medizin (pp. 114-128). Schattauer.

Noll-Hussong, M., Gündel, H., Lahmann, C., & Henningsen, P. (2018). Somatoform disorders. In G. Schiepek (Ed.), Neurobiology of psychotherapy (pp. 509-522). Schattauer.

2017

Buchheim, A., George, C., Gündel, H., & Viviani, R. (2017). Editorial: Neuroscience of Human Attachment. In A. Buchheim, C. George, H. Gündel, & R. Viviani (Eds.), Frontiers in Human Neuroscience (Vol. 11, p. 136). Frontiers Media.[DOI:https://doi.org/10.3389/978-2-88945-221-7]

Elbing, U., Oster, J. (2017). Art therapy research in the field of tension between object appropriateness and proof of effectiveness. In Spreti, F. and Steger, F. (Eds.) KunstTherapie: Künstlerisches Handeln - Wirkung - Handwerk Schattauer: Stuttgart 411-418.

2016

Rothermund, E., & Gündel, H. (2016). Early detection and early intervention for mental and psychosomatic illnesses in employees. In M. Rieger, S. Hildenbrand, T. Nesseler, & D. Nowak (Eds.), Prevention and health promotion at the interface between curative medicine and occupational medicine (pp. 219-233).

Master's and doctoral theses

Our offer

We are always looking for motivated and interested students who are interested in writing a doctoral or master's thesis in the field of psychosomatics as part of their studies in medicine, clinical psychology and psychotherapy, neuroscience or biology.

You can find an overview of the various subject areas of our research sections and working groups on the research pages of our website.

If you are interested in working in one of our projects or research groups, please contact the named project leaders by email.

Please send a short letter of motivation (.pdf or .docx) with your email, stating why you are interested in certain topics/research methods, when and for how long you would like to be involved in a research project and whether you would be prepared to take a semester off for this. In addition, we would be pleased to receive your CV and, if applicable, a list of publications so that we can get to know you better. References are not required at this stage.

Due to the large number of enquiries, we are only able to accept some of the applications. However, we endeavour to answer all applications personally. However, if you have not received a reply within four weeks, please assume that we are unable to offer you a suitable project at this time.

We look forward to receiving your application!

Current projects we are looking for

There arecurrentlyno projects for which doctoral or master's students are being sought.

Research topics with contact persons

Psychotherapy process research(Prof. Dr Jana Volkert)
Molecular psychosomatics(Prof. Dr rer. nat. Stefan Reber)
Automated pain recognition(Prof. Dr Steffen Walter)
Emotions & pain experience(Dr Stephan Frisch)
Translational research(Dr Katja Weimer)
Psycho-oncology and consultative psychosomatics(Dr Klaus Hönig)

Ulm University Medicine offers you interdisciplinary, cutting-edge university medicine that combines patient care, research and teaching.

Better medicine through research Ulm University Hospital stands for cutting-edge research focussing on various specialist areas.

Find clinical studies

Professorships/ Sections

Working groups

Research areas

Projects

Prof. Dr. rer. nat. Stefan Reber

Dr. Svenja Schlachter

M.Sc. Miriam Mehler

Prof. Dr. rer. nat. Stefan Reber

Prof. Dr. rer. nat. Stefan Reber

Prof. Dr. rer. nat. Stefan Reber

Dr. Svenja Schlachter

M.Sc. Miriam Mehler

em. Prof. Dr. phil. Jörn von Wietersheim

Prof. Dr. med. Harald Gündel

Downloads

Prof. Dr. Lucia Jerg-Bretzke

Dr. Klaus Hönig

PD Dr. med. Eva Rothermund-Nassir

Prof. Dr. med. Harald Gündel

Dr. Klaus Hönig

Dr. rer. nat. Daniela Bodschwinna

Poster on the study

Alexandra Danner-Weinberger

Thu Vu

Prof. Dr. med. Harald Gündel

Prof. Dr. med. Harald Gündel

Dr. Klaus Hönig

M.Sc. Psych. Sophie Nickel

Flyer für interessierte Patient*innen