Zukunftsperspektiven sexualforensischer Psychotherapie

There is a controversial discussion on to what extent sexual forensic psychotherapy has a positive influence on the legal probation of sexually delinquent people. From this the question arises on how treatment with a perspective for success could be structured. This article assumes that such a perspective can only succeed through close cooperation between science and psychotherapeutic practice. Through the analysis of a methodologically elaborate study, considerations on the motivation and the influence of empirically ascertained risk factors are developed and each placed in relation to scientific and therapeutic practice. In this way various problems are tackled, which range from insufficiently described interventions via too little therapeutic flexibility up to limitations in the scientific evaluation. Finally, possible barriers for the development of such a perspective are discussed and the connection to the so-called risk-need-responsivity (RNR) model is explored.     

Wie können Langzeittherapien mit kürzeren Behandlungen verglichen werden?

Long-term psychotherapy is not recommended in the current guidelines, which are based on the criteria of evidence-based medicine, as there is a lack of confirmation for long-term psychotherapy by efficacy studies. Using the example of psychoanalytic long-term psychotherapy this article describes six dilemmas which impede the realization of efficacy studies for long-term psychotherapy. Finally, basic elements of a study design are proposed, which are considered as being adequate to compare (psychoanalytic) long-term psychotherapy with shorter treatment forms in terms of outcome and cost-effectiveness. The anxiety and personality disorders (APD) study is briefly described as an example of a study realizing the proposed design.     

Operationalisierte Basisdokumentation von Gruppenpsychotherapien

It can be assumed that group psychotherapy will play an increasingly more important role for both inpatient and outpatient basic care not only due to health economic considerations. This means that new methods of documentation, quality management and optimization of group-specific therapy processes and results have to be developed. The present system for operationalized basic documentation of group psychotherapy (OBG) is not only meant to be a starting point for research on dynamics and efficacy of group psychotherapy but could also serve as an instrument for standardized documentation of clinical progress, quality assurance and, in combination with the accompanying manual, as an aid for education and further training for psychotherapists. The contents of the documentation system are based on the current state of scientific research and, as far as possible, were implemented irrespective of specific psychotherapeutic approaches referring to particular schools of thought. Particular consideration was given to the practice guidelines for group psychotherapy of the American Group Psychotherapy Association (AGPA) published in 2007. The system structure is based on a model of anatomy and physiology of a group according to Burlingame et al., which ascertains patterns and processes within groups. In addition to general thematic and methodological aspects, several items on group dynamics are included, such as distribution of roles, formation of subgroups, development of group norms, conflict management, interpersonal feedback, self-disclosure, cohesion and other so-called therapeutic factors. Clinical testing in different settings is currently being carried out. Results and further developmental possibilities of the OBG system will be reported soon.     

Aktueller Stand der Gruppenpsychotherapieforschung

In view of an increasing importance of group therapies and the intention in healthcare politics to support group treatment, it seems appropriate to provide a review of the current research efforts in this field. In this review, several research traditions are described with a clear focus on the effectiveness of group treatment. Both systematic narrative reviews and recent meta-analyses clearly demonstrate that group treatment of various disorders is equally as effective as individual psychotherapy. Besides outcome research there are other developments in the field, such as the improvement of manualized and focused group therapies even outside cognitive behavioral concepts. Studies related to feedback in groups, specific patient characteristics (especially alexithymia and attachment) as well as the construction of new measures seem to be characteristic for group research during recent years. There is still a need for research related to group dynamics and process aspects of small groups as well as the group leaders and their behavior. In total, research on group psychotherapy has clearly progressed, which justifies the support of this treatment setting.     

The predictive capacity of self-reported motivation vs. early observed motivational language in cognitive behavioural therapy for generalized anxiety disorder

ABSTRACT

Client motivation to change is often considered a key factor in psychotherapy. To date, research on this client construct has largely relied on self-report, which is prone to response bias and ceiling effects. Moreover, self-reported motivation has been inconsistently related to treatment outcome. Early observed client in-session language may be a more valid measure of initial motivation and thus a promising predictor of outcome. The predictive ability of motivational factors has been examined in addiction treatment but has been limited in other populations. Addressing this lack, the present study investigated 85 clients undergoing cognitive behavioural therapy (CBT) alone and CBT infused with motivational interviewing (MI-CBT) for severe generalized anxiety disorder. There were two aims: (1) to compare the predictive capacity of motivational language vs. two self-report measures of motivation on worry reduction and (2) to examine the influence of treatment condition on motivational language. Findings indicated that motivational language explained up to 35% of outcome variance, event 1-year post-treatment. Self-reported motivation did not predict treatment outcome. Moreover, MI-CBT was associated with a significant decrease in the most detrimental type of motivational language compared to CBT alone. These findings support the importance of attending to in-session motivational language in CBT and learning to respond to these markers using motivational interviewing.     

The effect of reward on orienting and reorienting in exogenous cuing

It is thought that reward-induced motivation influences perceptual, attentional, and cognitive control processes to facilitate behavioral performance. In this study, we investigated the effect of reward-induced motivation on exogenous attention orienting and inhibition of return (IOR). Attention was captured by peripheral onset cues that were nonpredictive for the target location. Participants performed a target discrimination task at short (170 ms) and long (960 ms) cue–target stimulus onset asynchronies. Reward-induced motivation was manipulated by exposing participants to low- and high-reward blocks. Typical cue facilitation effects on initial orienting were observed for both the low- and high-reward conditions. However, IOR was found only for the high-reward condition. This indicates that reward-induced motivation has a clear effect on reorienting and inhibitory processes following the initial capture of attention, but not on initial exogenous orienting that is considered to be exclusively automatic and stimulus-driven. We suggest that initial orienting is completely data-driven, not affected by top-down motivational processes, while reorienting and the accompanying IOR effect involve motivational top-down processes. To support this, we showed that reward-induced motivational processes and top-down control processes co-act in order to improve behavioral performance: High-reward-induced motivation caused an increase in top-down cognitive control, as signified by posterror slowing. Moreover, we show that personality trait propensity to reward-driven behavior (BAS-Drive scale) was related to reward-triggered behavioral changes in top-down reorienting, but not to changes in automatic orienting.     

Boredom at work: towards a dynamic spillover model of need satisfaction,work motivation,and work-related boredom

Boredom occurs regularly at work and can have negative consequences. This study aimed to increase insight in the antecedents and processes underlying the development of work-related boredom by (a) examining whether work-related need satisfaction and the quality-of-work motivation mediate the associations between the work characteristics defined in the Job Characteristics Model and work-related boredom, (b) investigating if this motivational process operates both on an “enduring,” between-person level and a daily within-person level, and (c) examining if and how daily experiences of work-related boredom spill over to the next day. Data among employees were collected in a cross-sectional study (N = 115) and a 5-day daily diary study (N = 90). Study 1 results showed that need satisfaction and quality-of-work motivation mediated the association between work characteristics and work-related boredom. This motivational process was also found on a day-to-day basis in Study 2. This study further revealed that work-related boredom spills over to the next day through its associations with increased negative work attitudes and decreased intrinsic motivation. These findings provide insight in the process by which momentary experiences of boredom at work may develop into a more enduring experience of work-related boredom.     

Why are attitude–behaviour inconsistencies uncomfortable? Using motivational theories to explore individual differences in dissonance arousal and motivation to compensate

Using cognitive dissonance theories and self-determination theory, we explored the role of individual differences in global and contextual motivational orientations on dissonance arousal processes following spontaneous attitude–behaviour inconsistencies (ABIs). Study 1 (N = 382) showed that individual differences in global motivation relate to the frequency of ABIs and dissonance arousal across important life domains. Studies 2 (N = 282) and 3 (N = 202) showed that individual differences in contextual motivation toward the environment predict the relative frequency of ABIs and the quantity and quality of proximal motivation to compensate for ABIs in that context. Autonomous motivation was associated with a tendency to compensate for ABIs to both reduce dissonance and restore self-integrity. Controlled motivation disposed individuals to reduce dissonance to protect ego-invested self-structures, and to be indifferent to non self-threatening ABIs. Amotivation left people indifferent to ABIs. Individual differences in motivational orientations could explain why ABIs are uncomfortable and motivate people to compensate differently when they face ABIs.     

Leader autonomy support in the workplace: A meta-analytic review

Leader autonomy support (LAS) refers to a cluster of supervisory behaviors that are theorized to facilitate self-determined motivation in employees, potentially enabling well-being and performance. We report the results of a meta-analysis of perceived LAS in work settings, drawing from a database of 754 correlations across 72 studies (83 unique samples, N?=?32,870). Results showed LAS correlated strongly and positively with autonomous work motivation, and was unrelated to controlled work motivation. Correlations became increasingly positive with the more internalized forms of work motivation described by self-determination theory. LAS was positively associated with basic needs, well-being, and positive work behaviors, and was negatively associated with distress. Correlations were not moderated by the source of LAS, country of the sample, publication status, or the operationalization of autonomy support. In addition, a meta-analytic path analysis supported motivational processes that underlie LAS and its consequences in workplaces. Overall, our findings lend support for autonomy support as a leadership approach that is consistent with self-determination and optimal functioning in work settings.     

Prefrontal Cortex,Emotion, and Approach/Withdrawal Motivation

This article provides a selective review of the literature and current theories regarding the role of prefrontal cortex, along with some other critical brain regions, in emotion and motivation. Seemingly contradictory findings have often appeared in this literature. Research attempting to resolve these contradictions has been the basis of new areas of growth and has led to more sophisticated understandings of emotional and motivational processes as well as neural networks associated with these processes. Progress has, in part, depended on methodological advances that allow for increased resolution in brain imaging. A number of issues are currently in play, among them the role of prefrontal cortex in emotional or motivational processes. This debate fosters research that will likely lead to further refinement of conceptualizations of emotion, motivation, and the neural processes associated with them.     

The effect of embodied emotive states on cognitive categorization

Research has uncovered that positive affect broadens cognitive categorization. The motivational dimensional model, however, posits that positive affect is not a unitary construct with only one cognitive consequence. Instead, this model puts forth that there are different positive affects varying in approach motivational intensity. According to this model, only positive affects lower in motivational intensity should broaden cognitive processes, whereas positive affects higher in motivational intensity should narrow cognitive processes. Consistent with these predictions, high approach positive affect has been shown to narrow attention, whereas low approach positive affect has been shown to broaden it (Gable & Harmon-Jones, 2008). High approach positive affect, therefore, might narrow categorization. Two experiments investigated this possibility by having participants respond to cognitive categorization tasks in 3 body postures designed to elicit different levels of approach motivation: reclining backward, which should evoke low approach motivation; sitting upright, which should evoke moderate approach motivation; and leaning forward, which should evoke high approach motivation. Participants smiled while in each posture in order to experience positive affect. Experiment 1 provided initial support for the idea that high approach positive affect narrows categorization and low approach positive affect broadens categorization. Experiment 2 replicated these findings with improved smiling instructions. These results extend previous work by showing that the motivational model's predictions hold for basic attentional processes as well as higher level cognitive processes such as categorization.     

Beziehung und Exposition

In the treatment of anxiety disorders both psychodynamic and behavioral therapeutic methods have proved successful. Linking the two methods in one treatment is usually avoided by therapists, although there is evidence for using such an approach. There is a lack of a regulatory framework for the integration of the various procedures. Taking anxiety treatment as an example, a contribution to such a regulatory framework is developed: the use of exposure (as a cognitive behavioral element) and the examination of the transference aspect of the therapeutic relationship by the therapist (as a psychodynamic element) are systematically placed in relation to each other, whereby the understanding of the therapeutic process is deepened.     

For which side the bell tolls: The laterality of approach-avoidance associative networks

The two hemispheres of the brain appear to play different roles in emotion and/or motivation. A great deal of previous research has examined the valence hypothesis (left hemisphere = positive; right = negative), but an increasing body of work has supported the motivational hypothesis (left hemisphere = approach; right = avoidance) as an alternative. The present investigation (N = 117) sought to provide novel support for the latter perspective. Left versus right hemispheres were briefly activated by neutral lateralized auditory primes. Subsequently, participants categorized approach versus avoidance words as quickly and accurately as possible. Performance in the task revealed that approach-related thoughts were more accessible following left-hemispheric activation, whereas avoidance-related thoughts were more accessible following right-hemispheric activation. The present results are the first to examine such lateralized differences in accessible motivational thoughts, which may underlie more “downstream” manifestations of approach and avoidance motivation such as judgments, decision making, and behavior.     

Vom Vermeiden und Versinken

Impulsivity and lack of dopamine make ADHD patients a high risk group for addiction. In addition the social climate in the family is often impaired by disorder related behaviour. This leads to low compliance phenomena in adolescent patients, especially concerning conversational psychotherapy – a problem becoming severe when avoidance behaviour is obvious and makes acquiring an addiction even more likely. The following multi-modal approach is defined by three realms of intervention. The (adoptive) mother was made familiar with the principals of New Authority by Omer [10]. A combination of Vigilant Care and Non-Voilent-Resistance helped the mother to regain her natural authority and to have a means against physical attacks of her son. The tension in the family also relaxed and the boy started to trust the therapists more and more. He was treated using Motivational Interviewing (Miller and Rollnick) [6] to develop a motivation for coping with his disorder and getting to know its controllable aspects. MI was also used when the less problematic avoidance behaviour (immersing into electronics) was replaced by more problematic health patterns like heavy smoking. In the third realm of intervention both, mother and child, were made familiar with the SPACE attitude by Omer [9], to not support anxiety but resist the manipulative or destructive behavioural aspects of the disorder. All these interventions were embedded in a tight network of diverse professionals and strengthened by psychosocial support mechanisms.     

Warum nachhaltige therapeutische Veränderungen im Gehirn Zeit brauchen

Successful psychotherapy requires structural and functional changes in limbic brain centers; however, these differ in manner, effectiveness and dynamics. One primary factor is the therapeutic alliance, i.?e. the mutual trust between patient and therapist. This factor reduces the level of stress hormones via release of the “bonding hormone” oxytocin and increases the production of serotonin and endogenous opioids. As a consequence, a rapid improvement of the mental emotional state of the patient often occurs; however, this is not accompanied by the deeper and longer lasting neuronal changes necessary to treat severe mental illnesses. This occurs only when dysfunctional habits of feeling, thinking and acting residing primarily in the basal ganglia (striatopallidum and nucleus accumbens) and amygdala are reorganized. Rather than being an explicit cognitive process this represents an implicit procedural process, which after an extensive search for resources requires a sufficient length of time and frequent rehearsal of more adaptive emotional attitudes and patterns of behavior. Apparently, this is promoted by the generation of new nerve cells from neural stem cells induced by oxytocin and neurotrophins, such as brain-derived neurotrophic factor (BDNF), taking place in the hippocampus and the basal ganglia. All these facts are in favor of a long-term psychotherapy at least in cases of severe mental diseases.     

On motivational influences,moving beyond valence,and integrating dimensional and discrete views of emotion

ABSTRACT

The field of cognition and emotion has grown considerably over the past 30 years, with an increased emphasis on the relationships between emotional and motivational components and how they contribute to basic perceptual, cognitive, and neural processes. For instance, research has revealed that emotion often influences these processes via emotion’s relationship with motivational dimensions, as when positive emotions low versus high in approach motivational intensity have different influences on attentional and other cognitive processes. Research has also revealed that motivational direction (approach vs. withdrawal) and affective valence (positive vs. negative) are not as closely related as once was theorised; that is, positive affect is not inevitably associated with approach motivation and negative affect is not inevitably associated with withdrawal motivation. These and other lines of research with anger have suggested that the field needs to move beyond a focus on affective valence and it needs to consider an integration of dimensional and discrete models of emotion. The article also includes some suggestions for improving methods of measuring and inducing emotions and some recommendations for future researchers.     

When does self-reported prosocial motivation predict helping? The moderating role of implicit prosocial motivation

In three studies, we tested a motivational model to predict different types of helping from an interactionist, dual-system perspective. We argued that helping behavior is determined by the interplay of two distinct motivational systems: the explicit (i.e., conscious) and the implicit (i.e., unconscious). In line with previous research we expected that explicit prosocial motivation relates to helping, and additionally proposed that depending on the type of helping this relationship is moderated by implicit prosocial motivation: For planned helping, explicit prosocial motivation is a sufficient predictor, regardless of implicit prosocial motivation. For spontaneous helping, on the other hand, the effect of explicit prosocial motivation is moderated by implicit prosocial motivation, and only predictive when also implicit prosocial motivation is high. Study 1 (207 Dutch participants, M _age  = 51.7 years; 51.7 % female) with self-reported willingness to help as dependent variable confirmed that planned helping was determined by explicit prosocial motivation, whereas its effect on spontaneous helping was moderated by implicit prosocial motivation. Study 2 (193 U.S. participants, M _age  = 35.2 years; 64.2 % female) with real-life measures of planned help confirmed the hypothesized main effect of explicit prosocial motivation. Study 3 (73 Dutch participants, M _age  = 20.8 years; 68.5 % female) with a real-life measure of spontaneous helping confirmed the moderating role of implicit prosocial motivation, as the effect of explicit prosocial motivation on helping was only significant for individuals with high implicit prosocial motivation. We argue that considering implicit prosocial motivation provides an overlooked avenue for a more systematic investigation of helping.     

A Cyclical Model of Motivational Constructs in Web-Based Courses

The current study investigates antecedents and outcomes of motivation to learn across nine Web-based courses. The results supported a cyclical model of motivational processes across courses in a training curriculum. Trainees' course expectations had a positive effect on motivation to learn, motivation to learn had a positive effect on trainee reactions, and trainee reactions predicted expectations for subsequent courses in the curriculum. In addition, motivation to learn decreased across the nine courses such that the average level of motivation was 0.30 points lower (on a 5-point scale) for the ninth than the first course. Agreeableness predicted changes in motivation to learn such that motivation decreased at a steeper rate for highly agreeable trainees across courses. The results suggest that there is a dynamic interplay among motivational constructs over time, and motivation should be examined from a systems perspective to understand carryover effects across training courses.     

Die Behandlung paraphiler Störungen mit GnRH-Agonisten unter besonderer Berücksichtigung ethischer und rechtlicher Aspekte

Current guidelines recommend the use of antiandrogenic medication in addition to psychotherapeutic procedures in the treatment of patients and sexual offenders with severe paraphilic disorders and a high to very high risk of committing severe sexual offences. This article provides an overview about the current state of research concerning the effectiveness and possible side effects of antiandrogens and discusses the legal and ethical basis of using antiandrogens in the therapy of paraphilic disorders with a focus on gonadotropin-releasing hormone (GnRH) agonists. Meanwhile, a great deal of empirical evidence exists with respect to the effectiveness of GnRH agonists for lowering paraphilic sexual fantasies and behaviors; however, GnRH agonist treatment also still has a risk of mild to severe undesired side effects, e.?g. hypertension, hyperlipidemia, liver damage, bone demineralization and depression. Nevertheless, in German forensic psychiatric institutions a not insignificant proportion of patients are treated with antiandrogens and furthermore, in the last few years treatment with GnRH agonists has become more important. In Germany, GnRH agonists can only be used on a voluntary basis; however, in some European countries and North American states legal statutes for compulsory treatment also exist. This is clearly contrary to the recommendations of current international guidelines. In light of the fact that GnRH agonist treatment could violate basic human rights, the need for an ethically sound approach is even more important in the decision for therapy with GnRH agonists. This article provides some proposals for a treatment approach that is in line with current ethical and legal requirements.