Chronisches Ersch?pfungssyndrom

The treatment of chronic fatigue syndrome (CFS) may pose a challenge as controversial concepts of its aetiology are discussed. Psychotherapy and graded exercise therapy have been suggested for the treatment of CFS. The aim of the present literature review is to summarize the evidence for these treatments based on two meta-analyses and more recently published randomized controlled trials. There is robust evidence for the efficacy of cognitive-behavioural therapy for CFS, showing moderate effects especially on fatigue severity and physical functioning at post-treatment and at short to medium term follow-up. Other psychological treatments have mainly been tested as control conditions and not as bona fide psychotherapy; however, single trials suggest benefits of non-directive counselling and psycho-education. To further improve treatment results and their maintenance, relapse prevention strategies are important and a stronger empirical foundation of long-term effects is needed.     

The role of top-down knowledge about environmental context in egocentric distance judgments

Judgments of egocentric distances in well-lit natural environments can differ substantially in indoor versus outdoor contexts. Visual cues (e.g., linear perspective, texture gradients) no doubt play a strong role in context-dependent judgments when cues are abundant. Here we investigated a possible top-down influence on distance judgments that might play a unique role under conditions of perceptual uncertainty: assumptions or knowledge that one is indoors or outdoors. We presented targets in a large outdoor field and in an indoor classroom. To control visual distance and depth cues between the environments, we restricted the field of view by using a 14-deg aperture. Evidence of context effects depended on the response mode: Blindfolded-walking responses were systematically shorter indoors than outdoors, whereas verbal and size gesture judgments showed no context effects. These results suggest that top-down knowledge about the environmental context does not strongly influence visually perceived egocentric distance. However, this knowledge can operate as an output-level bias, such that blindfolded-walking responses are shorter when observers’ top-down knowledge indicates that they are indoors and when the size of the room is uncertain.

     

Eine Schlafstörung kommt selten allein

In the clinical routine insomnia disorders are often merely seen as symptoms of the underlying disease and are therefore not considered relevant enough for diagnostic clarification and initiation of specific treatment. The following article intends to give an overview of the differential diagnosis of nonorganic insomnia and underlines the importance of cognitive behavioral therapy in this context, which is substantiated by two case studies.     

The futility of explicit knowledge of a sequence of tasks

In an experiment that combined the task-shifting methodology with a serial reaction-time task, three groups of participants had to shift among a set of four tasks that were arranged in regular sequences of length eight. Two groups of participants were given explicit knowledge about the sequence of tasks. To ensure that the knowledge of the sequence was referred to in each trial, one group was asked to verbalise the forthcoming task (verbalisation group), whereas the other group had to detect trials that deviated from the learned sequence (detection group). Participants of a control group were given no information about the sequence of tasks. In addition, for all experimental groups in half of the blocks of trials external precues were presented which indicated the forthcoming task. The control group exhibited substantial task-shifting costs that were greatly reduced by the presentation of precues. Participants of the explicit-knowledge groups showed no indication that explicit knowledge resulted in advance preparation of the forthcoming task. In addition, the effect of the precues depended on the secondary task that had to be performed on the basis of explicit knowledge. Whereas for the detection group precues reduced shift costs to the same degree as for the control group, the verbalisation group showed no precueing benefits at all.     

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.     

Psychotherapeuten und Internet

Background

Communication is part and parcel of every interaction. This raises the question of the role of modern media in mental health care. The aim of this explorative study was to investigate the use of modern media in the clinical practice.

Material and methodology

In an Internet survey 234 psychotherapists from Nordrhein-Westfalen (NRW) were surveyed about the extent to which they integrate new media in the practice and their opinion about this integration. For this purpose a questionnaire was developed based on the questionnaire of Wangberg et al. (2007).

Results

Most of the psychotherapists already use e-mails as well as mobile communication to contact their patients. The main reason for choosing this modern way of communication is the possibility to simplify the management of formal issues. Psychotherapists were indifferent about the idea of web-based counseling.

Conclusion

Forms of digital media are used as an addition to conventional ways of therapeutic communication but face-to-face interaction cannot be replaced completely which is also indicated by the fact that professionals still highly value personal contact.     

Sexualit?t in Zeiten des Internet

The Internet shows several more or less specific characteristics, in particular accessibility, anonymity, affordability, worldwide connectivity and interactivity. These characteristics hold chances as well as risks for the development of sexuality and sexual relationships. Rarely stressed and investigated are the possible positive effects, such as easier sexual contacts especially for individuals with social deficits, for sexual minorities (e.g. gay, lesbian, transgender, sadomasochists or fetishists), reducing sexual prejudices and stereotypes, better partner matching and easy access to reliable information and counseling platforms about sexual issues. The psychotherapist more often encounters the problematic effects of Internet pornography and cybersex, such as avoiding real life (offline) sexual and non-sexual social contacts, the stress on relationships (e.g. through cyber infidelity), intensifying fantasies and impulses that are harmful to oneself or others up to criminal behavior (e.g. use and circulation of child pornography). Describing a case history this review discusses the role of the Internet in the development of sexual addictive or compulsive symptomatology, including treatment options. Only a differentiated analysis of the chances and risks can counterbalance the increasing tendencies to demonize and pathologize the use of the Internet for sexual purposes.     

Therapiekonzeption für traumatisierte Patienten mit schweren Persönlichkeitsstörungen

Comorbidity between severe personality disorder and posttraumatic stress disorder is a frequent clinical problem. Severe personality disorders are characterized by an impaired regulation of emotions, a low mentalization capacity and deficits in personality integration. For severe personality disorders and posttraumatic stress disorder, a variety of evidence-based treatment approaches of psychodynamic and cognitive-behavioral origin are available. However, a closer inspection of these treatment concepts shows that they do not sufficiently take the respective comorbid condition into account. No single concept is able to cover all problem areas presented by patients with this comorbidity. Therefore, an attempt is made to present an integrative psychodynamically oriented therapy concept for traumatized patients with personality disorders which contains elements from psychodynamic, cognitive-behavioral and other concepts. The phase structure of the concept clarifies the sequence hierarchy of the therapeutic interventions. The content of the five phases are: (1) safety, holding and strengthening of coping capacities, (2) emotion regulation and self-care, (3) mentalization and development of stable representations, (4) gentle trauma processing and (5) conflict-oriented psychotherapy and treatment of maladaptive relationship patterns.