Zusammenfassung Extended-Reality-Technologien (XR; Virtual, Augmented und Mixed Reality) eröffnen neue Möglichkeiten für Psychotherapie und psychosomatische Versorgung. Ziel dieser Arbeit ist es, aktuelle Anwendungen und die Evidenzlage zu XR in der Psychotherapie und Psychosomatik in einer Übersicht darzustellen. Es wurde ein narrativer Review konzeptueller Arbeiten sowie Studien zu konkreten Anwendungsbereichen und Akzeptanz von XR in der klinischen Versorgung durchgeführt. Betrachtet werden psychosomatisch relevante Anwendungsfelder im Rahmen der psychotherapeutischen Richtlinienverfahren, bei der Entwicklung innovativer störungsspezifischer Interventionen sowie in ergänzenden Verfahren wie Achtsamkeit, Entspannung oder künstlerischen Therapien. Konzeptuell können der stark kontrollierte Charakter von XR, die intensive Darbietung und die Möglichkeit von Perspektivwechseln auch in andere Personen für den Einsatz von XR sprechen. Für viele Interventionen aus Richtlinienverfahren existieren bereits XR-Varianten, wobei die virtuelle Exposition bisher am besten untersucht ist. Innovative Entwicklungen zielen vor allem auf Perspektivwechsel und Embodiment anderer Personen oder Varianten des Selbst ab. Darüber hinaus finden sich vielfältige Einsatzmöglichkeiten in Entspannungsverfahren, Achtsamkeit, Aufmerksamkeitslenkung und künstlerischen Therapien. Bei grundsätzlich offener Haltung der Therapeut*innen wurden jedoch einige praktische Hürden einer breiten Implementierung in die Versorgung identifiziert. XR ist ein ergänzendes Medium, das neue Erfahrungsräume eröffnet. Für die psychosomatische Versorgung bietet es Potenzial, erfordert jedoch eine enge Einbettung in therapeutische Gesamtkonzepte. Hürden bestehen in technischem und personellem Aufwand, Datenschutz sowie fehlender Kostenerstattung. XR bietet ein breites Anwendungspotenzial in der psychosomatischen Medizin, doch bedarf es weiterer klinischer Studien, standardisierter Konzepte und tragfähiger Versorgungsstrukturen, um dieses Potenzial in der Praxis nutzbar zu machen.

Objective:Extended reality (XR; virtual, augmented, and mixed reality) opens up new opportunities for psychotherapy and psychosomatic care. The aim of this review is to summarize current applications and the state of evidence regarding XR in psychotherapy and psychosomatic medicine. Methods:A narrative review of conceptual papers as well as clinical and feasibility studies on the use of XR was conducted, focusing on psychosomatically relevant fields of application. These include evidence-based psychotherapy approaches, the development of innovative disorder-specific interventions, and complementary approaches such as mindfulness, relaxation, or arts-based therapies. Results:Conceptually, the highly controlled nature of XR, its immersive presentation, and the possibility of perspective-taking (including embodiment of other persons or self-representations) support its potential use. XR variants already exist for many established therapeutic techniques, with virtual exposure therapy being the most extensively studied. Recent innovations emphasize perspective-taking and embodiment, while additional applications are found in relaxation, mindfulness, attention training, and arts-based therapies. While therapists generally express openness toward XR, several practical barriers to broad implementation have been identified. Discussion:XR constitutes a complementary medium that enables novel experiential dimensions. It holds significant potential for psychosomatic care but requires careful integration into therapeutic frameworks. Key challenges include technical and personnel demands, data protection, and the current lack of reimbursement structures. Conclusion:XR offers broad potential for psychosomatic medicine. To translate this promise into routine practice, further clinical studies, standardized implementation concepts, and sustainable service structures are needed.

Heightened food-specific impulsivity, associated with prefrontal cortex hypoactivity, may impair outcomes following metabolic bariatric surgery (MBS). This pilot study examined the feasibility of transcranial direct current stimulation (tDCS) targeting the right dorsolateral prefrontal cortex (dlPFC) combined with an individualized food-specific inhibitory control training addressing behavioral impulsivity alongside psychosocial follow-up (FU) care to support early postoperative lifestyle adaptation. Within 18 months post-MBS, n = 19 patients were randomized to 6 sessions of verum or sham tDCS over the right dlPFC combined with inhibition training and psychosocial group sessions. Acceptability, feasibility, food-specific impulsivity and diverse secondary outcomes (e.g., quality of life) were assessed 4 weeks (t1) and 3 months (t2) post-tDCS through (BS-specific) interviews, validated questionnaires and blood samplings. Retention (67 – 80

Cognitive processes play a central role in the development, maintenance, and remission of mental disorders, like Binge Eating Disorder (BED). Cognitive trainings aim to alter those cognitive processes to achieve amelioration of psychopathology. Regardless, little is known about the underlying mechanisms that can explain effective treatment in BED. Therefore, we analyzed findings from a clinical randomized-controlled trial (RCT) (Giel, Schag et al., 2023) which used an individualized computer-based inhibitory control training programme enhanced by transcranial direct current stimulation (tDCS). At the beginning of the treatment, for each person the 20 highest-rated food stimuli concerning valence, appetite, liking and wanting out of 40 high-calorie food stimuli were selected. In total, 41 patients were included in the study, 39 of those completed the training. Overall, we identified a devaluation effect for food stimuli used in the training programme: after completion of the six training sessions a significant reduction of valence, appetite, liking, and wanting of food stimuli being used in the training were observed whereas this effect was absent of food stimuli not being used in the training programme. However, the individual devaluation effect did not predict the degree of binge eating frequency reduction. As predictor variables for effective treatment, we found specific dimensions of food valence at the baseline- or follow-up-measurement to be predictive for the binge eating frequency reduction. Lastly, we found a reduction of eating concerns as well as an increase in general well-being as a predictor for binge eating frequency reduction which might indicate a potential mechanism of the inhibitory control training. Future studies might focus additionally on emotion, affect and affect regulation to complete the multifaceted clinical picture of BED to target its underlying processes to achieve effective treatment with cognitive trainings.

Long COVID describes long-term health sequelae after a SARS-CoV-2 infection. Despite various theoretical approaches, the pathogenesis of long COVID is not yet fully understood and the diagnostic criteria are vague. This makes the development of targeted, cause-specific therapies challenging. In addition to the symptoms, many patients suffer from various psychosocial burdens and a significantly reduced quality of life. In order to address this, psychosomatic or psychotherapeutic interventions should be used in addition to symptom-oriented treatment. Within the PsyLoCo project, a psychotherapeutic treatment manual was developed that is tailored to the specific needs of long COVID patients. In four modules, it addresses (1) coping and distress management, (2) physical complaints and pain, (3) chronic fatigue and affective symptoms and (4) social and working life. The manual was tested for feasibility and effectiveness in a multicentre, randomized controlled pilot study. The contents of this treatment manual are presented below.

Feeding and eating disorders (FEDs) are a heterogeneous grouping of disorders at the mind-body interface, with typical onset from childhood into emerging adulthood. They occur along a spectrum of disordered eating and compensatory weight management behaviors, and from low to high body weight. Psychiatric comorbidities are the norm. In contrast to other major psychiatric disorders, first-line treatments for FEDs are mainly psychological and/or nutrition-focused, with medications playing a minor adjunctive role. Patients, carers and clinicians all have identified personalization of treatment as a priority. Yet, for all FEDs, the evidence base supporting this personalization is limited. Importantly, disordered eating and related behaviors can have serious physical consequences and may put the patient's life at risk. In these cases, immediate safety and risk management considerations may at least for a period need to be prioritized over other efforts at personalization of care. This paper systematically reviews several key domains that may be relevant to the characterization of the individual patient with a FED aimed at personalization of management. These domains include symptom profile, clinical subtypes, severity, clinical staging, physical complications and consequences, antecedent and concomitant psychiatric conditions, social functioning and quality of life, neurocognition, social cognition and emotion, dysfunctional cognitive schemata, personality traits, family history, early environmental exposures, recent environmental exposures, stigma, and protective factors. Where possible, validated assessment measures for use in clinical practice are identified. The limitations of the current evidence are pointed out, and possible directions for future research are highlighted. These also include novel and emerging approaches aimed at providing more fine-grained and sophisticated ways to personalize treatment of FEDs, such as those that utilize neurobiological markers. We additionally outline remote measurement technologies designed to delineate patients' illness and recovery trajectories and facilitate development of novel intervention approaches.

Anorexia nervosa (AN) is a mental disorder marked by a significantly low body weight. Differentially methylated CpG sites have been reported to be involved in body weight regulation. Methylation pattern may change during considerable weight gain by in-patient treatment. Consequently, we aimed to (1) replicate the hypomethylation at the NR1H3 gene locus (identified in our previous epigenome-wide association study) in independent study groups of 189 female patients with AN and 67 healthy-lean female controls, and (2) identify regions associated with large weight gain associated DNA methylation changes in three patients with AN through whole-genome bisulfite sequencing in CD14+ cells. In the replication study, no evidence was observed for hypomethylation at the investigated 15 CpG sites of the NR1H3 locus. Relying on two analysis tools (camel, metilene) to identify differentially methylated regions (DMRs), subtle methylation differences concordant between both tools were detected only when the usual threshold of camel was lowered. Then, eight regions were selected exemplarily for technical replication with deep bisulfite sequencing in the same three patients with AN. None of the regions could be confirmed. Summarising, we could not confirm hypomethylation at NR1H3 and could not detect methylation differences in patients with AN between admission and weight gain at discharge.

Long COVID beschreibt gesundheitliche Langzeitfolgen nach einer SARS-CoV-2-Infektion. Die Pathogenese von Long COVID ist trotz verschiedener theoretischer Ansätze noch nicht vollständig geklärt und die Diagnosekriterien unscharf. Dadurch ist die Entwicklung zielgerichteter, ursachenspezifischer Therapien herausfordernd. Viele Betroffene leiden neben den Symptomen an verschiedenen psychosozialen Belastungen und einer deutlich reduzierten Lebensqualität. Um dies zu adressieren, sollten neben einer symptomorientierten Behandlung psychosomatische bzw. psychotherapeutische Interventionen eingesetzt werden. Im PsyLoCo-Projekt wurde ein psychosomatisch-psychotherapeutisches Behandlungsmanual entwickelt, das auf die spezifischen Bedarfe von Long COVID-Patient*innen zugeschnitten ist. In vier Modulen wird darin auf (1) Coping und Distressmanagement, (2) Körperbeschwerden und Schmerzen, (3) Chronische Erschöpfung und affektive Symptome und das (4) Sozial- und Arbeitsleben eingegangen. In einer multizentrischen, randomisiert-kontrollierten Pilotstudie wurde das Manual auf Machbarkeit und Wirksamkeit untersucht. Die Inhalte dieses Behandlungsmanuals werden im Folgenden vorgestellt.

Research findings on the prevalence of eating disorders in elite sports are contradictory. Existing eating disorder models in the general population do not consider that elite sports require specific training schedules, body types, nutritional and eating behaviours, to improve athletic performance. Thus, an eating disorder model tailored to the specific demands of elite sport is important to detect eating disorders and prevent potential harm in athletes. Here, a theoretical model based on existing evidence and knowledge was developed. The model aims at specifying indicators that may determine whether athletes' eating behaviours are drifting to becoming disordered rather than serving their athletic performance. The model describes potential relationships between the key indicators weight sensitivity, performance pressure, body image, attitudes towards training, and fatigue. This model is a step towards improving psychological care for this vulnerable group and provides a basis for scientific proofing.

Essstörungen sind komplexe psychische Störungen, deren Prävalenz insbesondere seit der Corona-Pandemie weiter zunimmt. Die Binge-Eating-Störung wurde als Diagnose neu in das Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) und die International Statistical Classification of Diseases and Related Health Problems 11 (ICD-11) aufgenommen. Wir geben einen State-of-the-Art-Überblick zu diagnostischen Kriterien, Psychopathologie, Differenzialdiagnostik, Epidemiologie, Komorbiditäten, Entstehungs- und Aufrechterhaltungsfaktoren, Therapie und Versorgungssituation der Binge-Eating-Störung. Es wurde ein narratives Review erarbeitet. Die Binge-Eating-Störung ist durch wiederkehrende Essanfälle mit Kontrollverlust gekennzeichnet. Sie ist die häufigste Essstörung in der Allgemeinbevölkerung und häufig mit Übergewicht oder Adipositas vergesellschaftet. Neurobiologische Modelle sehen Veränderungen im Bereich der Emotionsregulation, Belohnungsverarbeitung und Impulskontrolle als ätiologische Beiträge zur Binge-Eating-Störung. Psychotherapie ist der Behandlungsansatz der ersten Wahl bei der Binge-Eating-Störung, die häufig unentdeckt und unversorgt bleibt. Ein Grund hierfür sind erlebte oder befürchtete Stigmatisierung, Scham und Schuldgefühle der Betroffenen. Da die Diagnose einer Binge-Eating-Störung die Therapiewahl und Prognose sowohl der Essstörung als auch einer potenziell komorbiden Adipositas beeinflusst, ist das aktive Abklären des Essverhaltens und einer möglichen Essstörung im Rahmen einer motivierenden Gesprächsführung essenziell.

BackgroundUnemployment is a risk factor for the development and perpetuation of psychological distress. Finding support for affected individuals can be particularly challenging, which causes a vicious cycle of psychological distress and unemployment. ObjectiveThe aim of this systematic review is to assess and summarize existing evidence regarding interventions that address both mental health and re-employment, emphasizing accessibility through community or social care structures. MethodsA systematic literature search using PubMed and EBSCOhost and an additional search using reference list screening were conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In order to identify interventions for the mental health and re-employment of individuals experiencing psychological distress and unemployment, an inclusion process according to the PICO (population, intervention, comparison, and outcome) scheme and the study design was applied. Title and abstract screening and full-text screening for eligibility were performed independently by 2 reviewers. Quality assessments using the Cochrane Risk of Bias Tools for randomized and nonrandomized trials were conducted by 2 independent reviewers. ResultsThe initial systematic search yielded 4442 results, and 15 articles were additionally identified via reference list screening. Eventually, 74 articles were subjected to a thorough evaluation process by 2 independent reviewers. The interrater reliability was determined to be good, with a Cohen κ score of 0.770. After a multistep extraction process, 17 studies remained for inclusion, with each focusing on the improvement of mental health, re-employment, or both outcomes. A heterogeneous pattern of results emerged, with most interventions showing improvement in either mental health or re-employment. Most studies were assessed as having a moderate (n=7) or high (n=9) risk of bias. ConclusionsThe results of the systematic research indicate that low-threshold services in close cooperation with institutions and exchange with other supportive stakeholders should be fostered. Derivable overarching themes and intervention content for integrative support measures can serve as guidelines for future interventions. Trial RegistrationPROSPERO CRD42022378490; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022378490