Klinisch-psychologische Intervention im Internet

Background

Currently a multitude of Internet-based intervention (IBI) programs exist for various disorders. These programs generally have the potential to reach a wide spectrum of the low threshold population and encourage them to play a more active role in managing individual healthcare. How effective are disorder and problem-specific IBI programs? This review aims to give a systematic overview of controlled evaluation studies available to date and contrast them with the state of research in 2003 (Ott 2003).

Method

References were analyzed in three steps: 1. Research in pertinent international scientific databases using specified keywords (result: more than 1,000 publications since 2003). 2. Selection: exclusion of publications which did not contain empirical evidence of effectiveness (with control group design) (result: 89 studies published between 2003 and 2009 as opposed to 30 up to 2003). 3. Systemization: classification of the analyzed studies based on two dimensions (type of syndrome, function of intervention).

Results

In most of the studies on hand (91.0%) the effectiveness of IBI could be confirmed. Among the methods used cognitive behavioral methods (cognitive, behavioral therapy, CBT) were used almost exclusively. In nearly three quarters of all studies (71.9%), IBI procedures were used for treatment. The remaining studies were on prevention (19.1%) and rehabilitation (9.0%).

Conclusion

Evaluation studies of IBIs are now available, particularly for anxiety disorders, depression, posttraumatic stress disorder, eating disorders including adiposity, substance-related and behavioral medical disorders, psychological problems related to physical illnesses, compulsive gambling and burnout. For each type of disorder, exemplary programs are described. Subsequently the methodical limitations of several of the studies are pointed out.     

Kulturdynamisches Modell der bikulturellen Identit?t

In intercultural psychotherapeutic treatment, the psychological integration of different cultures within an individual has to be involved as an additional developmental dimension. Individual change during the process of migration considered as desirable adaptation has often been conceptualized in terms of a bicultural identity, which includes aspects of the culture of origin as well as aspects of the host culture. The theoretical foundation of the concept of bicultural identity, however, has remained insufficient. The culture-dynamic model presented here differentiates personal and social identity according to the identity concept proposed by Mead (Geist, Identit?t und Gesellschaft, 1988, Suhrkamp, Frankfurt a.?M.). Personal identity is essentially formed by an individual??s culture of origin, while influences of the host culture primarily affect the social identity. For healthy coping with the challenges associated with migration and adequate support of this process in intercultural psychotherapy, it can be assumed that a stabilization of personal identity is required to allow for a dynamization of social identity. Implications for identity constitution in second generation immigrants, in different stages of lifespan development and in the process of learning the language of the host culture are discussed.     

Complexity of culture: the role of identity and context in bicultural individuals' body ideals

Culture plays an important role in shaping body image, and people from different cultures have different beliefs about what constitutes the "ideal" body type. This study examines the relationship between culture and body ideals in Asian-American and Black-American women. Results from two studies show that subjective cultural identity and situational cultural cues had different relationships with body ideals. Among Asian-American women, identification with Asian culture was related to a thinner body ideal, but exposure to Asian cultural cues (relative to American cultural cues) was related to a thicker body ideal. Among Black-American women, identification with Black culture was related to a thicker body ideal, but exposure to Black cultural cues (relative to American cultural cues) was related to a thinner body ideal. These results have theoretical and practical implications for understanding how internal and external manifestations of culture can differentially influence body image.     

Comparative meta-analysis of behavioral interventions for insomnia and their efficacy in middle-aged adults and in older adults 55+ years of age.

Meta-analyses support the effectiveness of behavioral interventions for the treatment of insomnia, although few have systematically evaluated the relative efficacy of different treatment modalities or the relation of old age to sleep outcomes. In this meta-analysis of randomized controlled trials (k = 23), moderate to large effects of behavioral treatments on subjective sleep outcomes were found. Evaluation of the moderating effects of behavioral intervention type (i.e., cognitive-behavioral treatment, relaxation, behavioral only) revealed similar effects for the 3 treatment modalities. Both middle-aged adults and persons older than 55 years of age showed similar robust improvements in sleep quality, sleep latency, and wakening after sleep onset. A research agenda is recommended to examine the mechanisms of action of behavioral treatments on sleep with increased attention to the high prevalence of insomnia in older individuals.     

Validation of the reasons for living inventory in general and delinquent adolescent samples

Two studies are reported that discuss the validation of an adult suicide prediction questionnaire for use with adolescents. The Reasons for Living Inventory (RFL; Linehan, Goodstein, Nielsen, & Chiles, 1983) was slightly modified and administered to two samples of adolescents: one from a general high school population and one from a population of juvenile delinquents receiving psychological treatment in a correctional facility. As with adults, adolescents who reported more reasons for staying alive were less apt to report past or recent suicidal thoughts or behaviors. Evidence of convergent validity emerged via correlations of RFL subscales with depression, hopelessness, and other suicide inventories. Evidence of discriminant validity emerged in that correlations with social desirability were not large. Evidence of construct validity emerged in that the RFL subscales related to suicidal thoughts and behaviors over and above depression and hopelessness. Differences between general and delinquent adolescents' reasons for living are discussed.Special gratitude is due to the Indiana Department of Corrections and the Penn-Harris-Madison Public School System for their cooperation and assistance in data collection for this project.     

Operant hoarding: a new paradigm for the study of self-control.

In the first of four experiments, rats were exposed to a modified multiple continuous reinforcement-extinction schedule during 15-min daily sessions. In one condition (saves condition) with the cuelight on, a single lever press produced a food pellet, briefly extinguished the cuelight, and started a clock. Saves (additional lever presses with interresponse times less than 1 s) produced an additional food pellet, briefly extinguished the cuelight, and restarted the interresponse time clock. The cuelight was extinguished 1 s after the last lever press and remained off during a 10-s period of extinction, during which no food pellets were delivered. In the other condition (savings account condition), the contingencies were the same except that the cuelight was extinguished and was not reilluminated after the initial lever press, and the delivery of all food pellets in the reinforcement component was delayed until the onset of extinction. In both conditions, rats made saves, but mean saves (total saves divided by the number of reinforcement components) were slightly reduced in the savings account condition. In Experiment 2, using six equally spaced 15-min sessions per day on alternate days, saves were either followed immediately with food and brief cuelight offset (saves condition) or were not reinforced at all. Mean saves were much greater when saves were reinforced. In Experiment 3, during 5-min daily sessions, saves earned a single pellet (savings account condition) or a number of pellets equal to the ordinal number of the lever press (interest condition). Rats made fewer mean saves, with little change in the food rate, when saves earned interest. In Experiment 4, the rats earned all their food in the operant situation during 24 daily 5-min sessions, these separated by 55-min intersession intervals during which no food was available; otherwise, the conditions were the same as in Experiment 3. In Experiment 4, the shift to interest for saves led to an increase in mean daily mean saves (total daily mean saves divided by the number of daily sessions) as well as to an increase in the number of food pellets delivered in each session. The results are discussed in terms of self-control and behavioral economics.     

Functionalism and inverted spectra

Functionalism, a philosophical theory, has empirical consequences. Functionalism predicts that where systematic transformations of sensory input occur and are followed by behavioral accommodation in which normal function of the organism is restored such that the causes and effects of the subject's psychological states return to those of the period prior to the transformation, there will be a return of qualia or subjective experiences to those present prior to the transform. A transformation of this type that has long been of philosophical interest is the possibility of an inverted spectrum. Hilary Putnam argues that the physical possibilty of acquired spectrum inversion refutes functionalism. I argue, however, that in the absence of empirical results no a priori arguments against functionalism, such as Putnam's, can be cogent. I sketch an experimental situation which would produce acquired spectrum inversion. The mere existence of qualia inversion would constitute no refutation of functionalism; only its persistence after behavioral accommodation to the inversion would properly count against functionalism. The cumulative empirical evidence from experiments on image inversion suggests that the results of actual spectrum inversion would confirm rather than refute functionalism.     

BEHAVIORAL MANAGEMENT OF EXERCISE TRAINING IN VASCULAR HEADACHE PATIENTS: AN INVESTIGATION OF EXERCISE ADHERENCE AND HEADACHE ACTIVITY

A behavioral package was used to shape and maintain the adherence of 5 subjects with vascular headache to a program of aerobic exercise training. Repeated measures of exercise behavior were examined through the use of a bidirectional changing criterion design. Repeated measures of headache activity were also collected. Results demonstrated a functional relationship between the behavioral package and exercise adherence, because all 5 subjects showed exercise behavior that matched bidirectional changing exercise criteria. The results also indicated clinically significant collateral reductions in vascular headache activity in 4 subjects. Subjects whose aerobic fitness levels were not masked by vasoactive medication also showed measurable increases in aerobic fitness. The results are discussed in terms of the methodology used to demonstrate a functional relationship between the adherence package and exercise behavior and the possible mechanism(s) by which aerobic exercise activity might affect vascular headache activity.     

The Adolescent Activities Checklist: Reliability,standardization data,and factorial validity

This study was conducted to provide standardization data and information on the reliability and factorial validity of the recently developed Adolescent Activities Checklist (AAC). A total of 563 adolescents in grades 7 through 12 served as subjects. Significant main effects for gender, race, and grade were obtained in a multivariate analysis of variance. On the basis of this information, standardization data were established for these three variables. Further investigation indicated that the internal consistency of the AAC was high. In addition, results of a principal components analysis conducted on the frequencies of the Unpleasant and Pleasant Activities subscales revealed four and three factors, respectively. For unpleasant activities, the major dimensions were found to occur in three situations-namely, social interactions, family situations, and school situations. Stressful events also occurred as one of the four unpleasant activities dimensions. For pleasant activities, three dimensions appeared: heterosocial behavior, reinforcing interpersonal situations, and social reinforcement.