Internetbasierte Vorbereitung auf eine station?re psychosomatisch-psychotherapeutische Behandlung

Background

Encouraged by promising results of online aftercare programs, this study adapted the concept of internet-based minimal interventions in order to use the time between referral and actual admission to inpatient treatment. The online intervention includes information about the hospital and the treatment and sections which aim to enhance motivation, provide support and allow contact.

Methods

A comprehensive cohort study was conducted with 379 participants in the randomized subcohort. Primary endpoint was the speed of change of the physical, mental and social impairment and of the psychological well-being in the first 2 weeks of inpatient treatment as well as the rates of reliable change 2 weeks after admission.

Results

Both the control and intervention group of the randomized subcohort showed statistically significant improvements in health status. No significant difference in the rate of change was found. The degree of achieved improvement in the physical impairment was equal to the expected intervention effect. A difference in the rates of change was found for the psychological well-being: the intervention group showed 19% more reliable improvements.

Conclusions

The study design and the contents of the intervention were accepted by the patients. The internet-based intervention can help to prepare for treatment and to shorten the settling-in period.     

F?rderung der Gesundheit und der psychosozialen Selbstwirksamkeit bei Langzeitarbeitslosen

Background

The development of appropriate preventive measures aimed at the promotion of psychosocial capabilities and health behavior is based on the recognition that unemployment is associated with many physical, psychological and social problems.

Objective

A group program ??promotion of health and psychosocial self-efficacy in long-term unemployed?? was developed and investigated with respect to the effectiveness by a study group at the Clinic for Psychosomatic Medicine of the University of Rostock. The study was part of a project funded by the European Social Fund (ESF).

Methods

During the period from October 2009 to April 2010 the group program was implemented in 5 different groups and the sample included a total of 35 persons. To examine the effectiveness of the program the participants had to complete standardized questionnaires at the beginning and at the end of the program. Information as to what extent the unemployed suffer from mental stress was collected via the brief symptom inventory (BSI; Franke 2000). The questionnaire on resources and self-management skills (FERUS; Jack 2007) was applied to analyze the capabilities and the self-management skills of the participants.

Results

The unemployed subjects reported lower levels of aggressiveness and paranoid thinking (distrust) after their participation in the program. Regarding the self-management skills the participants improved their coping skills, self-instructions skills and also felt more hopeful with regard to their current environment and the future.

Conclusions

A systematic support of unemployed people regarding coping with the psychosocial problems associated with unemployment seemed to be important. The use of low structured group programs is a good possibility to implement them in different contexts with relatively few resources.     

Nachsorge nach station?rer Psychotherapie f��r Essst?rungen

Background

Despite high relapse rates there is a lack of feasible, effective and efficient interventions to provide aftercare support to patients who complete treatment for an eating disorder. A program based on the short message service (SMS) and text messaging has been developed in order to provide such additional support to patients who undergo inpatient treatment for an eating disorder.

Materials and methods

A total of 165 patients with bulimia nervosa or an eating disorder not otherwise specified were randomly assigned either to the intervention group (n?=?82) with access to the text messaging intervention for 4 months following discharge from hospital or to the control group (n?=?83). The efficacy of the intervention was determined via the three eating disorder related subscales of the Eating Disorder Inventory (EDI-2) at 4 and 8 months follow-up and via the frequency of self-reported binge eating and compensatory behaviors (vomiting and abuse of laxatives) in the Short Evaluation of Eating Disorders (SEED) at 8 months follow-up.

Results

Participants in the intervention group reported significantly lower impairment on the EDI scales drive for thinness and body dissatisfaction both at 4 and 8 months follow-up. They also reported significantly fewer episodes of binge eating and vomiting. No differences were found for the EDI subscale bulimia and for the frequency of the use of laxatives.

Conclusion

The intervention based on text messaging proved efficacious in the aftercare treatment of patients with eating disorders. Chances and limitations concerning its use in the clinical routine as part of a stepped care model are discussed.     

Erfassung der sozialen Ungleichheit in empirischen Untersuchungen

Background

The interrelationship between social inequality and health problems is well known. This paper evaluates how current empirical studies in the context of social psychiatry, psychosomatics and medical sociology respond to this issue in terms of taking characteristics of socio-economic status (SES) into account.

Material and methods

All empirical studies published in the German journals Psychotherapie, Psychosomatik und Medizinische Psychologie and Psychiatrische Praxis in 2005 and 2006 were evaluated regarding the use of characteristics of SES.

Results

Of the 113 studies examined, 70 (62%) covered characteristics of the SES. The majority included characteristics of both formal and professional education, but often in only few categories. Some studies used a combination of formal and professional education. Half of the studies included categories of occupational status or gainful employment, also often in few categories and 11% of studies included net family income. Three studies formed an index of social class using the categories lower class, middle class and upper class.

Conclusion

Determination of characteristics of SES can be improved both quantitatively and qualitatively. Comparability of population studies can be improved by an increased orientation on demographic standards.     

Ressourcenaktivierung bei Patienten

Background

Starting from Klaus Grawe’s draft of a general psychotherapy, the patient’s resources and resource-activating interventions have received increasing attention in empirical research.

Objective

The effectiveness of standardized writing instructions for the activation of patients’ resources before participating in internet chat aftercare groups for psychosomatic patients was examined.

Method

In a randomized controlled trial writing instruction for the activation of patients’ resources was given in 52 out of 102 internet chat aftercare sessions. The effects of this minimal intervention on the patients’ activity and the number of positive emotion words expressed during the chat session were examined. Additionally, the effects on patients’ self-esteem, attachment, orientation, control and well-being after the group sessions were assessed.

Results

Patients reported higher levels of self-esteem, orientation, control and well-being after chat sessions with a resource-activating intervention. No differences between intervention and control groups were detected on the text-based variables activity and number of positive emotion words.

Conclusions

Standardized minimal interventions for the activation of patients’ resources seem to be promising for enhancing the effectiveness of therapeutic Internet chat groups.     

Kreuzvalidierung der Kurzform des Kindheitsfragebogens

Objectives

Existing questionnaires about parent-child relationships usually assess love and control only. The childhood questionnaire (CQ) offers a more differentiating alternative.

Methods

In a sample of approximately 1,400 patients and more than 500 controls the CQ was reduced from 22 to 11 scales and the number of items of each scale was shortened to 5.

Results

The shortened scales of the CQ also showed good reliability and item characteristics, as well as plausible intercorrelations.

Conclusion

By the use of 66 out of the former 128 items, the shortened version of the CQ assesses three further important dimensions in the parent-child relationship of adults towards their parents in childhood besides love and control: punishment, ambition and role reversal. Beside this, parental separation, divorce and job status as well as various parameters of the socio-economic status (e.g. educational, occupational and financial) of the parents can be assessed.     

Zur Gefährlichkeit ehemaliger Patienten des Maßregelvollzugs (§ 63 StGB)

Background

The prediction of dangerousness in mentally ill offenders – and here mainly the issue of safety – is still of primary interest for forensic experts and also the public. The effectiveness of treatment and therefore of the whole German forensic system is generally measured by recidivism rates of this clientele.

Methods

The Essen prospective Multi-Centre Prognosis Study began in 1997, and 23 forensic hospitals in Germany took part. Data of 321 subjects were collected with a follow-up of up to 10 years (mean 7.5 years). This article presents topical recidivism rates.

Results

Currently the general recidivism rate is 31.5% and for severe reoffences 10.3% which is relatively low in comparison to other recent studies.

Conclusions

The rate of general recidivism of forensic patients in Germany has been reduced in the last years while the rate of severe reoffence was constant. In order to reduce the number of reoffences further studies should analyze the forensic aftercare.     

Symptomattributionsstile bei Hypochondrie

Background

Somatic symptom attributions are of central importance in cognitive-behavioral models of the development, maintenance and treatment of hypochondriasis. However, the mode of symptom attribution has rarely been systematically investigated in these patients. Is a somatic mode of symptom attribution indeed specific for hypochondriasis and furthermore, how strongly is it associated with “doctor shopping”, a typical behavioral consequence of hypochondriasis?

Patients and methods

In this study 88 hypochondriacal, 52 depressive and 52 healthy persons were asked to complete the symptom interpretations questionnaire and several standardized symptom questionnaires. They also took part in two structured clinical interviews for the diagnosis of hypochondriasis and various other psychological disorders according to DSM-IV.

Results

Somatic symptom attributions were associated specifically with hypochondriasis, while normalizing attributions characterized persons with low health anxiety. When examined as predictors in multiple regression models, in particular somatic attributions and the total of somatoform complaints predicted the intensity of health anxiety (R ²?=?0.69) and “doctor shopping” (R ²?=?0.48).

Conclusion

In the cognitive-behavioral treatment of hypochondriasis, patients should be encouraged to test normalizing explanations as alternatives to habitual somatic attributions of somatic disturbances.     

Schizophrene Patienten der forensischen Psychiatrie im Vergleich zu schizophrenen Patienten der Allgemeinpsychiatrie

Background

The number of schizophrenic patients admitted to forensic hospitals according to section 63 of the German Criminal Code has increased continuously over the past years. Some researchers assume that these forensic patients form a group of patients with very complex mental disorders, a number of risk factors and insufficient pretreatment in general psychiatry. This study aimed to identify differences regarding the history of treatment of forensic and general psychiatric patients diagnosed with schizophrenia.

Method

The matched samples included 72 male patients from forensic wards and 72 male patients from general psychiatric institutions diagnosed with schizophrenia. The history of psychiatric treatment was reconstructed by interviewing the patients as well as outpatient psychiatrists and patients’ legal custodians and by analyzing patient medical records.

Results

In contrast to the general psychiatric patients, prior to admission forensic patients were less integrated into psychiatric care and showed a lower rate of treatment compliance. They also showed a higher rate of previous compulsory treatment because of aggressive behavior towards other persons as well as higher rates of treatment difficulties and violent behavior during previous inpatient treatment. Furthermore, forensic patients had a higher number of previous criminal convictions and had been convicted more often for violent offences. With regard to other relevant risk factors (e.g. comorbid substance abuse disorder, age, education, conduct disorder, antisocial personality disorder, previous exposure to violent and abusive behavior) the two patient groups were, however, comparable.

Conclusions

Regarding schizophrenic patients with comorbid substance abuse disorders, previous violent delinquency and violent behavior during previous inpatient treatment, an intensive outpatient aftercare should be arranged before they are discharged from general psychiatric institutions.     

Nonresponse in Employee Attitude Surveys: A Group-Level Analysis

Purpose

Given the common practice of using employee attitude surveys as a group-level intervention, this study used a group-level approach to examine the relationship between group satisfaction and group nonresponse.

Design/Methodology/Approach

Samples from four large organizations enabled job satisfaction scores to be aggregated to the work group level and correlated with group-level response rates. Additional regression analysis was conducted to control for a number of confounding variables at the group level.

Findings

Aggregate job satisfaction showed significant associations with group-level response rates across each of the samples examined. Work groups with higher aggregate job satisfaction had significantly higher response rates. Regression analyses showed that, in addition to job satisfaction, work group size, heterogeneity in tenure, and heterogeneity in gender composition all had significant effects on response rates.

Implications

Social influence processes may operate at the group level to increase homogeneity of job-relevant attitudes and similarity in survey response behavior. Future research should be designed to investigate the effects of group-level variables on nonresponse.

Originality/Value

The current study adds to the literature by demonstrating that work group variables may play an important role in explaining nonresponse in employee attitude surveys. Because the processes underlying survey response are likely to be different at different levels of analysis, the investigation of nonresponse as a group-level phenomenon creates new opportunities for research and practice.     

Wenn ja,wie lange? – Dauer antiandrogener Behandlung von Sexualstraftätern mit paraphilen Störungen

Background

Since 2010 a total of 15 individually justified, therapeutically accompanied treatment-free intervals from antiandrogenic treatment (ADT) have been carried out in the Forensic Therapeutic Outpatient (FTA) department in Berlin.

Material and methods

This article describes the conditions under which a responsible and legally justifiable cessation of ADT can be carried out.

Results

In all 15 of the investigated stable, forensically rehabilitated patients who had been on long-term psychotherapeutic treatment, no criminally prognostic or clinically relevant destabilization has so far occurred, which would have necessitated cessation of the treatment-free interval with resumption of the antiandrogenic depot medication.

Conclusion

The short-term experiences from the clinical aftercare practice have so far shown that in a strictly structered aftercare setting with continuous clinical monitoring, it is possible to withdraw even long-standing antiandrogenic medication. This is important not least to attest the argumentation for a removal of supervision of conduct in case destabilization does occur. Further long-term longitudinal investigations will be the subject of later publications.

     

Bindungsrelevante Situationen in der Psychotherapie

Background

The therapeutic relationship is a central factor for psychotherapy, which may be at least partially explained by attachment theory. However, research concerning the conditions under which attachment-related needs are activated in treatment followed by possibly dysfunctional coping strategies is rare.

Patients and methods

Semi-structured interviews on attachment-related situations in psychotherapies were conducted with 36 inpatients and then rated with regard to content.

Results

Triggers for attachment-related needs in therapies were interpersonal conflict and loss, beginning and end of therapy, symptom burden, specific interventions, addressing the therapeutic relationship and change of setting from outpatient to inpatient treatment. This was related to themes of desire for help and support, experience of rejection, self-disclosure and desire for understanding.

Conclusions

The attachment system is activated in therapies similar to other interpersonal situations. The results may help to become more sensitive to attachment-related situations and needs.     

Effectiveness of Consensus Information in Advertising: The Moderating Roles of Situational Factors and Individual Differences

Purpose

This study aims to investigate the influence of both individual consumer differences and the purchase decision context on the effectiveness of consensus information in advertising.

Design/Methodology/Approach

Three experiments explore the effectiveness of consensus information. In Experiment 1, gender serves as a moderator. Experiment 2 contains an examination of the susceptibility to interpersonal influence (SII) and purchase decision context as two potential moderators. Finally, Experiment 3 instead explores the need for cognitive closure (NFC) but again includes the purchase decision context as the two possible moderators.

Findings

In Experiment 1, female participants, but not male participants, generate higher purchase intentions for ads with consensus cues as opposed to those without them. With Experiment 2, this study demonstrates that the effectiveness of consensus cues increases for a group (vs. personal) purchase decision, but only for people with high susceptibility to individual influence. In Experiment 3, the effectiveness of consensus cues is relatively greater for a group (vs. personal) purchase decisions, but only for consumers with a high NFC.

Implications

Understanding what moderates the effectiveness of consensus information in advertising has the potential to help practitioners apply consensus information more effectively to improve their advertising returns.

Originality/Value

This study provides initial evidence about the impact of consensus information in advertising on purchase intentions, which is contingent on the situational context and individual differences.     

Patienten- und Elternzufriedenheit bei intensiver,klinikvernetzter Zu-Hause-Behandlung

Background

Due to the increasing importance of effective, patient-oriented treatment options for mentally ill children and adolescents, new alternatives to established inpatient and outpatient care in child and adolescent psychiatry have to be found. Intensive cross-sectoral treatment settings may be an alternative but have not yet been evaluated or implemented in routine care.

Aim

The objective of this randomized study was to compare and assess satisfaction with a new model of care within the underlying BeZuHG (“behandelt zu Hause gesund werden”, treated at home become healthy) study with regular inpatient care (TAU). Patients in BeZuHG received early discharge from inpatient care followed by 3 months of intensive home treatment enhanced by clinical elements.

Material and methods

Youths and parents were asked to fill in a patient satisfaction questionnaire (BesT) at completion of treatment. Participants in the study were evaluated between April 2012 and January 2013.

Results

Neither BeZuHG nor inpatient care was clearly superior. Youths in the control group stated a higher satisfaction with the overall treatment than youths in the BeZuHG group (p?=?0.031), while youths in the BeZuHG group named a significantly higher satisfaction with the home treatment component than with the inpatient component of treatment (p?=?0.007).

Conclusion

Patient satisfaction could be shown for inpatient and BeZuHG treatment at discharge. Data may change at follow-up. A long-term follow-up should be implemented to confirm these results or to allow other conclusions.     

Psychotherapeutische Behandlung von depressiven Kindern und Jugendlichen

Background

Depression is a psychiatric disorder with debilitating symptoms (e.g. suicidal behavior) with a high prevalence rate even in children and adolescents and the disorder shows a chronic course in many cases. According to psychiatric guidelines, cognitive behavioral therapy and interpersonal therapy are the psychotherapeutic methods of choice.

Aim

This article gives an overview of the current studies on cognitive behavioral and interpersonal group therapy programs for the treatment of depression in children and adolescents as well as a short illustration of the most prevalent therapy programs.

Material and methods

A literature research (PsycInfo, Psyndex, Pubmed) revealed 280 hits. After a review of all titles and abstracts 25 studies were included in this study.

Results

Efficacy studies mainly exist for cognitive behavioral group therapy programs (effect sizes ranged from 0.02 to 1.34) from English-speaking countries. There are only a few German programs available. With respect to interpersonal group therapies there are only few articles published in English and to the best of our knowledge none in German.

Conclusion

There is a great need for further studies that investigate the efficacy of group therapies for the treatment of depression in children and adolescents especially in German-speaking countries.     

Erfahrungsorientiertes Lernen in der Psychotherapie

Background

Based on principles of experiential learning, psychophysical exposure (PPE) on a tightrope course offers a promising intervention in the treatment of patients with mental disorders. A PPE program conducted on a hospital tightrope course is presented as an adjunct in inpatient psychotherapy.

Methods

The acceptance and effectiveness of the PPE were evaluated in a prospective controlled naturalistic study. A total of 155 patients, who were exposed at least once during their inpatient therapy, were compared with 92 control patients, who did not participate in the tightrope course. The main outcome criteria were self-reported depressive symptoms, state anxiety, locus of control, self-efficacy, and trait anxiety.

Results

The PPE was highly accepted by the participants. Patients who attended the tightrope courses showed greater improvement in the outcome criteria than patients who received inpatient treatment as usual. Particularly better effects were found on the personality variables.

Conclusions

Psychophysical exposure can successfully and effectively be integrated into a psychosomatic inpatient treatment program. Methodological limitations of the study, especially threats to internal validity, are discussed.     

Youth’s Negative Self-Statements as Related to Social Self-Efficacy Among Differing Relationships

Background

Cognitive variables are often neglected in child and adolescent populations despite their roles in the development and maintenance of psychopathology. Furthermore, the importance of examining these variables contextually is underestimated.

Objective

The present study aimed to examine the relationship between two theoretically related cognitive variables in a contextually relevant fashion by proposing several models demonstrating the association between negative self-statements and social self-efficacy holistically and among differing relationships (i.e., peers, adults, strangers) using Structural Equation Modeling (SEM) techniques.

Method

As part of a larger study, 126 participants (ages from 11 to 14 years) were recruited for participation from the middle school grades. Participants’ parents were contacted for informed consent, and subsequently, participants were asked to fill out a set of measures in assembly format.

Results

Results indicated that the structural model was well-fitted to the data. Specifically, the frequency of negative self-statements was found to indicate the amount of social self-efficacy present with more negative self-statements being associated with less social self-efficacy. Further, when examined among differing relationships via path analysis, the frequency of negative self-statements was found to be indicative of the social self-self efficacy with peers and adults, but not with strangers.

Conclusions

These findings provide useful information concerning cognitive trends, which are likely relevant for the enhancement of treatment processes in children and adolescents. Implications and recommendations are discussed.     

Ungedeckte psychotherapeutische Bedarfe bei Stimulanzienkonsumenten

Background

Despite changes in the regulations concerning outpatient psychotherapy in Germany, relatively few patients with substance use disorders receive this type of treatment.

Objectives

The results of a recent study among stimulant users are taken as an example to illustrate the psychotherapeutic needs of patients with substance use disorders.

Materials and methods

A total of 392 individuals with active use of amphetamine and/or methamphetamine were included using a broad range of recruitment strategies. In a mixed methods approach, qualitative as well as quantitative data were gathered regarding the history of substance use, the motives for use, and traumatic experiences during childhood.

Results

Psychological distress was a frequent motive even at the initiation of stimulant use. About two thirds of the participants (65.1?%) reported at least one form of childhood trauma (sexual, physical or emotional abuse, emotional or physical neglect).

Conclusion

The findings suggest a high need for psychotherapy among patients with substance use disorders. It seems important to further improve the information as well as the training of psychotherapists to work with these clients.     

Trauma und sexuelle Störungen

Background

Sexual disorders are common among patients with traumatic childhood experiences, especially when they were exposed to sexual abuse. Despite the fact that trauma-associated sexual disorders imply serious consequences for the persons concerned, to date the topic has not found much consideration in the research and clinical contexts.

Material and methods

This study investigated the prevalence and relationships of sexual disorders and experiences of sexual abuse in 189 patients (81?% women, 19?% men) with complex posttraumatic stress disorder. All participants completed the Interview zur Diagnostik der komplexen posttraumatischen Belastungsstörung (I-kPTBS, interview on diagnostics of complex posttraumatic stress disorder) and the traumatic antecedents questionnaire (TAQ).

Results

At least one sexual disorder was found in 77.2?% of the participants. In both sexes hyposexual disorders were more common than hypersexual disorders. Women showed more hyposexual disorders than men and men showed more hypersexual disorders than women. Of the participants 50.8?% reported experiences of sexual abuse and women were more often affected than men. The presence of hyposexual disorders was clearly associated with the existence of experiences of child sexual abuse.

Conclusion

There is a need for research on and effective treatment concepts for trauma-associated sexual disorders. The development of new therapeutic approaches should be realized in interdisciplinary cooperation.     

Steigerung des ?empowerment“ bei Angeh?rigen von schizophren Erkrankten

Objective

Enhancing empowerment is one of the aims of psychoeducational family interventions but it has never been examined in psychoeducational groups for relatives led by professionals. This study investigated the knowledge gain and the increase of empowerment of psychoeducational group programs for relatives in a naturalistic setting.

Methods

A total of 54 relatives of persons with schizophrenia or schizoaffective disorders took part in a psychoeducational group program of 8 sessions. A short questionnaire was used to assess the empowerment before and after the group programs. Knowledge gain was measured with the knowledge of illness about schizophrenia questionnaire (WFB).

Results

Among the participants of the psychoeducational groups the level of empowerment was significantly enhanced and the knowledge was significantly increased (p?<?0.01). The improvement of empowerment was independent of the knowledge gain and did not correlate with gender, age, education or group attendance.

Conclusions

Psychoeducational groups for family members not only reduce the rehospitalization rates of the ill relatives but also have additional positive effects on the family members themselves: better knowledge of the illness and enhanced empowerment. The findings emphasize the importance of psychoeducational groups for the relatives of persons with schizophrenia.