Status der psychosomatischen Forschung im deutschsprachigen Bereich

Psychosomatic medicine aims at exploring the relationships between biological, psychological and social factors in onset, maintenance and treatment of psychosomatic disorders. The present article describes current topics and methodological approaches in the field of psychosomatic research. A bibliometric analysis of two German journals in 2009 and 2010 was conducted, yielding 43 articles dealing with different aspects of psychosomatic medicine: chronic illness, somatoform disorders and pain, trauma-related disorders, borderline personality disorder and attention deficit hyperactivity disorder. The results show that psychosomatic research covers a variety of topics with different research designs. However, there is still a paucity of controlled studies in the field.     

An Integrative Approach to Somatoform Disorders Combining Interpersonal and Cognitive-behavioral Theory and Techniques

Data regarding the treatment of somatoform disorders suggest that the gains associated with current psychopharmacologic or psychotherapeutic treatments are modest at best. There have been a few moderately effective treatments for selected functional somatic syndromes, but patients who present with multi-system symptoms meeting criteria for the DSM-IV somatoform disorders are notoriously unresponsive to treatment. Experts in the field have advocated several approaches, including interpersonally oriented and cognitive-behavioral therapies, and have emphasized the importance of the provision of reassurance within the doctor-patient relationship. While each individual approach has merit, none is likely to be maximally efficacious as a stand-alone treatment. In this article we describe the theoretical underpinnings and technical aspects of a treatment for somatizing patients that integrates these three elements.     

Family therapy and psychopathology: developments in research and approaches to treatment

The impact of family approaches in understanding and treating psychopathology is reviewed for the following disorders: schizophrenia, mood disorders, anxiety disorders, psychoactive substance use disorders, eating disorders, and conduct disorders in children. Family-oriented interventions are concluded to be useful in treating disorders when applied flexibly and multi-dimensionally and when used in conjunction with psychopharmacological or other valid individual treatment approaches.     

Genes, brain, and behavior: Bridging disciplines

With excitement surrounding the publication of the human genome, scientists have set out to uncover the functions of specific genes. This special issue on Genes, Brain, and Behavior attempts to present research strategies that connect major avenues of genetic research across disciplines. For example, anatomical information provided by brain imaging can serve as a convenient link between anatomical abnormalities seen in knockout/transgenic mouse models and abnormal patterns of brain activity seen in certain patient populations. Identifying genetic risk factors for disorders with carefully designed cognitive assays is another strategy that has gained increasing attention. These approaches are being combined with behavioral studies of mouse models of gene function. Alone, each of these approaches provides limited information on gene function in complex human behavior, but together, they are forming bridges between animal models and human psychiatric disorders.     

Psychotherapy integration in the treatment of personality disorders: a commentary

Whereas research on the treatment of personality disorders over the past several decades has focused primarily on comparing the efficacy of various treatment packages associated with different theoretical models, there is increasing evidence that the field would benefit from focusing more attention on developing integrative treatments that are both informed by research and capable of scientific verification. The articles assembled for this special section each propose a different approach to integrative treatment for personality disorders. In this commentary, we outline a number of reasons for making such a shift to more integrative treatments, consider some of the potential challenges to integration, and discuss the different approaches to integration illustrated in these articles. We highlight some of the difficult tradeoffs that must be made in developing an integrative approach and discuss similarities and differences in the response to such challenges by the contributors to this special section. Finally, we point to several areas for future research that we believe will contribute to the development of increasingly effective treatments for individuals with personality disorders.     

Emerging Trauma Therapies: Critical Analysis and Discussion of Three Novel Approaches

Trauma-related disorders and treatment have gained increasing attention in the last 3 decades, spurring the development of novel treatment approaches. Many of these are incorporated into clinical practice despite lacking a solid evidence base or unbiased analyses to facilitate interpretation of existing information. Although treatments might draw on elements from validated therapies, questions regarding the incremental efficacy of new approaches persist. Three novel therapies that might warrant further examination include energy psychology, yoga, and brainspotting. The emergence of novel, trauma-related therapies is examined, and the history, theory, practice, and evidence base of these 3 specific therapies are outlined. Directions for future work are discussed. Expositions such as this might serve as a helpful resource for clinicians seeking discernment regarding treatment for posttraumatic stress disorder.     

Genes, language development, and language disorders

Genetic factors are important contributors to language and learning disorders, and discovery of the underlying genes can help delineate the basic neurological pathways that are involved. This information, in turn, can help define disorders and their perceptual and processing deficits. Initial molecular genetic studies of dyslexia, for example, appear to converge on defects in neuronal and axonal migration. Further study of individuals with abnormalities of these genes may lead to the recognition of characteristic cognitive deficits attributable to the neurological dysfunction. Such abnormalities may affect other disorders as well, and studies of co-morbidity of dyslexia with attention deficit disorder and speech sound disorder are helping to define the scope of these genes and show the etiological and cognitive commonalities between these conditions. The genetic contributions to specific language impairment (SLI) are not as well defined at this time, but similar molecular approaches are being applied to identify genes that influence SLI and comorbid disorders. While there is co-morbidity of SLI with dyslexia, it appears that most of the common genetic effects may be with the language characteristics of autism spectrum disorders rather than with dyslexia and related disorders. Identification of these genes and their neurological and cognitive effects should lay out a functional network of interacting genes and pathways that subserve language development. Understanding these processes can form the basis for refined procedures for diagnosis and treatment.     

Attention Processes in Children with Movement Difficulties, Reading Difficulties or Both

Reading difficulties (RD) and movement difficulties (MD) co-occur more often in clinical populations than expected for independent disorders. In this study, we investigated the pattern of association between attentional processes, RD and MD in a population of 9 year old school children. Children were screened to identify index groups with RD, MD or both, plus a control group. These groups were then tested on a battery of cognitive attention assessments (TEA-Ch). Results confirmed that the occurrence of RD and MD was greater than would be predicted for independent disorders. Additionally, children with MD, whether or not combined with RD, had poor performance on all attention measures when compared with typically developing children. Children with RD only, were no poorer on measures of attention than typical children. The results are discussed with respect to approaches proposed to account for the co-occurrence of disorders.     

Cognitive-Behavioral Therapy: Nature and Relation to Non-Cognitive Behavioral Therapy

Since the introduction of Beck’s cognitive theory of emotional disorders, and their treatment with psychotherapy, cognitive-behavioral approaches have become the most extensively researched psychological treatment for a wide variety of disorders. Despite this, the relative contribution of cognitive to behavioral approaches to treatment are poorly understood and the mechanistic role of cognitive change in therapy is widely debated. We critically review this literature, focusing on the mechanistic role of cognitive change across cognitive and behavioral therapies for depressive and anxiety disorders.     

Development and Preliminary Evaluation of a Positive Emotion Regulation Augmentation Module for Anxiety and Depression

Research has shown that positive emotions are important to optimal health, functioning, and well-being, and contribute to resilience against psychological dysfunction. Many clinical disorders, particularly anxiety and mood disorders, are associated with deficits in positive emotion that may contribute to disorder severity and prevent full recovery, and these deficits have received insufficient attention in treatment. The present study represents a preliminary evaluation of the feasibility and utility of adding a novel brief intervention module for enhancing positive emotion in anxiety and depressive disorders to existing evidence-based treatment. This intervention was evaluated in nine patients with a range of principal anxiety disorders who had previously completed an initial course of cognitive-behavioral treatment, utilizing a multiple baseline experimental-across-participants design. Results indicated that the intervention was effective in improving positive emotion regulation skills for five of nine participants. The intervention was also associated with further improvements in anxiety and depressive symptoms, positive and negative emotion, functioning, quality of life, and well-being. Participants reported high acceptability and satisfaction with the study intervention. Future research is needed to confirm the validity of these findings and evaluate the generalizability of these effects across patients and settings.     

Les troubles du comportement chez l'enfant et l'adolescent : vers une cohérence des pratiques pluridisciplinaires

Many professionals are involved with the children who present behaviour disorders. One question is “How to develop a medical and psychological care project which involves the child, the family and the school”. In order to respond to that question, four papers with different theoretical approaches will follow in this issue of Pratiques Psychologiques. They present: 1) the different nosological status of behaviour disorders; 2) an example of an analytic work with children and their relatives; 3) a behavioural intervention at school; 4) the problems of treatment access and possibilities of new responses.     

Research on adherence, behavior change, and mental health: a workshop overview.

The National Institute of Mental Health sponsored a research workshop in 1999 to examine the potential of various theoretical approaches for enhancing adherence and behavior change, with special attention to mental disorders as mediators and outcomes. Complementary, multiple levels of analysis--including individual, small-group, community, and cultural perspectives--were considered. Working groups identified problems and gaps in knowledge that if addressed would transform adherence and behavior change from overlooked or nuisance variables to critical variables in research on mental and medical disorders.     

Correctional treatment for co-occurring disorders: results of a national survey

The significant expansion of correctional populations in the last decade, coupled with the gradual erosion of community treatment infrastructure and health insurance, have brought greater attention to the needs of offenders who have co-occurring mental health and substance use disorders. Individuals with co-occurring disorders frequently cycle through acute care facilities in the community and increasingly are placed in jails or prisons. Approximately 16% of inmates in correctional facilities have major mental health disorders (Bureau of Justice Statistics, 1999), and a large majority of these inmates have co-occurring substance use disorders. Few studies have examined the effectiveness of correctional treatment for co-occurring disorders, and there is little information available regarding clinical and programmatic approaches used with this population. The current study provides findings from a comprehensive national survey of co-occurring disorder treatment programs in correctional settings. A total of 20 co-occurring disorder treatment programs from 13 state correctional systems were identified and surveyed. Many of the programs featured modified therapeutic communities, but there was significant diversity in the duration of treatment and type of services provided. Several unique structural and clinical modifications to treatment have been developed in these settings. Implementation of co-occurring disorder treatment programs has led to enhanced collaboration with prison health services and community supervision and treatment agencies, and greater use of interdisciplinary staff to provide outreach and case management services. Research is now being conducted to examine outcomes in several of these correctional treatment programs.     

Causes or Cures: What makes us think of attention issues as disorders?

Are attention issues disorders or not? Philosophers of medicine have tried to address this question by looking for properties that distinguish disorders from non-disorders. Such properties include deviation of a statistical norm, a loss of function or experienced suffering. However, attempts at such conceptual analysis have not led to a consensus on the necessary and sufficient conditions for the application of the concept of disorder. Recently, philosophers have proposed an experimental approach to investigate in which circumstances people think a specific concept is applicable. Here we present a quantitative vignette study investigating whether disorder attribution depends on the perceived cause and the perceived type of treatment for an attention problem. The results of our study indicate that the attribution of a disorder decreased when the attention problem was understood as caused by bullying (social environmental cause) or by an accident (non-social environmental cause) rather than a genetic cause. When prescribed a pill, attention problems were considered a disorder to a larger extent than when the child was prescribed an environmental treatment. Our study also suggests that whereas successful environmental treatments will not necessarily decrease the disorder attribution, successful pharmacological treatments will decrease the likelihood that a person is thought to still suffer from a disorder after receiving the treatment.     

Neuropathological determinants of acquired attention disorders in traumatic brain injury

Attentional disorders are frequently mentioned neuropsychological sequalae following traumatic brain injury (TBI). However, little is known about the recovery of attention, or the determinants of variability of attentional functioning following TBI. The present study was undertaken to examine (1) the extent to which attentional disorders are present among patients at various chronicity stages following TBI, (2) differences in performance on a number of measures of attention as a function of different clinical-neuropathological syndromes. A sample of 70 TBI subjects were rated according to different clinical-neuropathological syndromes and neuropsychologically evaluated. The results suggest that TBI patients of different chronicity stages, with significantly different lengths of coma, did not significantly differ in terms of the type or severity of attentional disorders. However, when the same patients were classified according to clinical-neuropathological syndromes, significant differences in the severity and type of attentional disorders were evident. The findings were interpreted to suggest that typical indices of severity of TBI do not correlate with the severity and type of attentional disorders and that qualitative aspects of the subjects' pathology may be more important in determining the nature of the attentional disorders.