The Efficacy of Systemic Therapy for Internalizing and Other Disorders of Childhood and Adolescence: A Systematic Review of 38 Randomized Trials

Systemic therapy (ST) is one of the most widely applied psychotherapeutic approaches in the treatment of children and adolescents, yet few systematic reviews exist on the efficacy of ST with this age group. Parallel to a similar study on adults, a systematic review was performed to analyze the efficacy of ST in the treatment of children and adolescents. All randomized or matched controlled trials (RCT) evaluating ST in any setting with child and adolescent index patients were identified by database searches and cross‐references, as well as in existing meta‐analyses and reviews. Inclusion criteria were: index patient diagnosed with a DSM‐IV or ICD‐10 listed psychological disorder, or suffering from other clinically relevant conditions, and trial published by December 2011. Studies were analyzed according to their sample, research methodology, interventions applied, and results at end‐of‐treatment and at follow‐up. This article presents findings for internalizing and mixed disorders. Thirty‐eight trials were identified, with 33 showing ST to be efficacious for the treatment of internalizing disorders (including mood disorders, eating disorders, and psychological factors in somatic illness). There is some evidence for ST being also efficacious in mixed disorders, anxiety disorders, Asperger disorder, and in cases of child neglect. Results were stable across follow‐up periods of up to 5 years. Trials on the efficacy of ST for externalizing disorders are presented in a second article. There is a sound evidence base for the efficacy of ST as a treatment for internalizing disorders of child and adolescent patients.     

Impersonal Sex Orientation and Multitasking Influence the Effect of Sexual Media Content on Involvement With a Sexual Character

The aim of the present study was to investigate whether responses to sexual media content depend on personal and situational factors. Specifically, we studied the role of the personal factor impersonal sex orientation (IS) and the situational factor multitasking in the effect of sexual media content on involvement with the character, a concept that has received increasing attention as an explanation of sexual media effects. College-aged women who were low or high in IS watched a neutral scene or a sex scene. Half of the participants in the neutral and sex condition had to multitask (a tone detection task) while viewing the scene. In the sex condition, participants high in IS were more involved with the character than participants low in IS. Multitasking resulted in opposite patterns of involvement with the character in the sex condition: Participants high in IS became less involved with the character, whereas participants low in IS became more involved with the character.     

Improving Experience in Personal Social Systems through Family Constellation Seminars: Results of a Randomized Controlled Trial

This study examined the efficacy of family constellation seminars (FCSs) on individuals' experience in their personal social systems, especially the experience of belonging, autonomy, accord, and confidence. We conducted a single‐blind, stratified and balanced, randomized controlled trial. Participants were 208 adults (M = 48 years, SD = 10, 79% women) who were randomly allocated either to the intervention group (3‐day FCSs; 64 active participants, 40 observing participants) or to the wait‐list group (64 active participants, 40 observing participants). Change was measured short‐term (2‐week and 4‐month follow‐up) using the Experience In Social Systems Questionnaire, personal domain (EXIS.pers). EXIS.pers is a new outcome measure being applied for the first time in evaluation research. In addition, we used interpersonal scales derived from established measures (Outcome Questionnaire, OQ‐45; Tool for the Evaluation of the Psychotherapeutic Progress, FEP). The average person in the intervention group showed improved experience in personal social systems, as compared with approximately 73% of the wait‐list group after 2 weeks (total score: Cohen's d = .61, p = .000) and 69% of the wait‐list group after 4 months (total score: d = .53, p = .000). The results were confirmed in per‐protocol analyses (n = 191) by the results of the EXIS.pers dimensions (Belonging, Autonomy, Accord, and Confidence) and the interpersonal scales derived from the OQ‐45 and FEP. No adverse events were reported. This RCT provides first evidence that FCSs tend to positively influence participants' experience in their social systems.     

Heilung als Gemeinschaftsleistung

The concept of healing as a collective achievement starts from the premise that developing mental disorders is an unwanted and unconscious collective endeavor and that healing mental disorders equally requires a (conscious and planned) collective endeavor again. In practice this concept underlies various conjoint therapy approaches. The methods, indications and potential to be combined with individual therapies are briefly introduced and the training of skills needed to conduct conjoint therapy sessions and the financing of conjoint therapy sessions are discussed.     

Planning bridges the intention–behaviour gap: Age makes a difference and strategy use explains why

Objective: This study examines age-differential association patterns between intentions, planning and physical activity in young and middle-aged individuals. The effectiveness of planning to bridge the intention–behaviour gap is assumed to increase with advancing age. We explore the use of behaviour change strategies that include selection, optimisation and compensation (SOC) as underlying mechanisms for age differences. Methods: In N = 265 employees of a national railway company (aged 19–64 years), intentions, planning, SOC strategy use and physical activity were assessed at baseline (Time 1) and again 1 month later (Time 2). Hypotheses were tested in two different path models. Results: Age moderates the extent to which planning mediates the intention–behaviour relation due to an increasing strength of the planning–behaviour link. As a possible psychological mechanism for these age differences, we identified SOC strategy use as a mediator of the age by planning interaction effect on physical activity. Conclusion: These findings suggest differential mechanisms in behaviour regulation in young and middle-aged individuals.     

Limitations of distal effect anticipation when using tools

Modern technologies progressively create workplaces in which the execution of movements and the observation of their consequences are spatially separated. Challenging workplaces in which users act via technical equipment in a distant space include aviation, applied medical engineering and virtual reality. When using a tool, proprioceptive/tactile feedback from the moving hand (proximal action effect) and visual feedback from the moving effect point of the tool, such as the moving cursor on a display (the distal action effect) often do not correspond or are even in conflict. If proximal and distal feedback were equally important for controlling actions with tools, this discrepancy would be a constant source of interference. The human information processing system solves this problem by favoring the intended distal action effects while attenuating or ignoring proximal action effects. The study presents an overview of experiments aiming at the underlying motor and cognitive processes and the limitations of visual predominance in tool actions. The main findings are, that when transformations are in effect the awareness of one's own actions is quite low. This seems to be advantageous when using tools, as it allows for wide range of flexible sensorimotor adaptations and – may be more important – it evokes the feeling of being in control. Thus, the attenuation of perceiving one's own proximal action effects is an important precondition for using tools successfully. However, the ability to integrate discordant perception-action feedback has limits, especially, but not only, with complex transformations. When feature overlap between vision and proprioception is low, and when the existence of a transformation is obvious proximal action effects come to the fore and dominate action control in tool actions. In conclusion action–effect control plays an important role in understanding the constraints of the acquisition and application of tool transformations.     

Defensive self-esteem impacts attention, attitude strength, and self-affirmation processes

Individuals with defensive self-esteem score low on implicit measures of self-esteem (ISE) and high on explicit measures of self-esteem (ESE). Although there is some evidence about the consequences of defensive self-esteem, much of it is indirect and open to alternative explanations. Here, we offer direct and novel evidence regarding the implications of defensive self-esteem. Using a standard visual attention paradigm, Study 1 revealed that defensive self-esteem is associated with enhanced attention to defensiveness-related words. Building upon these results, Study 2 found that defensive self-esteem individuals reported particularly strong attitudes, across different operationalizations of attitude strength as well as different attitude objects. Study 3 examined the sensitivity of defensive self-esteem individuals to self-affirmation effects. The results revealed that self-affirmation was particularly effective for defensive self-esteem individuals in reducing actual-ideal self-discrepancies. Overall, the results provide novel and firm evidence that the combination of simultaneously low ISE and high ESE elicits defensiveness.     

Unglücklich machende Familienideale Ihre Dekonstruktion in der Psychotherapie

Der Artikel konstrastiert familiäre Lebensrealitäten und familiäre Idealvorstellungen miteinander. Für Patienten, bei denen beide weit auseinander klaffen, werden Anregungen für die Dekonstruktion selbstquälerischer Familienideale in der Psychotherapie entwickelt. Als potenziell unglücklich machend werden Familienideale beschrieben, nach denen Kinder (nur) eine Familie und Familien (nur) ein Heim brauchen; dass Familien gemeinsam verbrachte Zeit, Söhne ihre Väter und überhaupt Kinder heterosexuelle Eltern bräuchten; dass Eltern einander lieben und ihre Kinder bei sich behalten sollten; dass Kinder sich von ihren Eltern ablösen sollten. Als psychotherapeutisch nützlich werden aus Familiensoziologie und systemischer Psychotherapie die Ideen der Wahlverwandtschaft, der konsensentlasteten Diskurse und der systemischen Selbstbeobachtung empfohlen, ferner als therapeutische Techniken die zirkulären Fragen, speziell Verschlimmerungsfragen und die positive Umdeutung. Die Konstruktion neuer Rituale und die Nutzung von Netzwerkressourcen stehen am Ende der Untersuchung.     

Omission bias in vaccination decisions: Where’s the “omission”? Where’s the “bias”?

Several studies have reported that parents are often reluctant to vaccinate their own or other people’s children, even when the balance of health risks and benefits clearly favors vaccination. This reluctance has been interpreted as a manifestation of “omission bias”, a general tendency to prefer inactive to active options even when inaction leads to worse outcomes or greater risks. The research raises significant public health concerns as well as worries about human decision biases in general. In this paper we argue that existing research on vaccination decisions has not convincingly demonstrated any general reluctance to vaccinate nor has it made the case that such a tendency, if found, would constitute a bias. We identify several conceptual and methodological issues that, we argue, cloud interpretation of earlier studies. In a new questionnaire-based study (Experiment 1) we examined the vaccination decisions of undergraduate students (N=103) and non-student adults (N=192). In both groups a clear majority chose to vaccinate when disease and vaccination risks were balanced. Experiments 2 and 3 identify several problems associated with the measures used in earlier studies, and show how these problems could have led to the misleading appearance of majority anti-vaccination preferences. In our data, vaccination intentions appear to be less a function of generalized preferences for action or inaction than they are of the regret respondents expect to feel if vaccination or non-vaccination were to lead to a poor outcome. Regret-avoiding choices led some respondents to favor vaccination, others to oppose it. In two follow-up studies, few respondents mentioned action or inaction per se in explaining their choices. We conclude that there is no convincing evidence that a generalized “omission bias” plays any important role in vaccination decisions.