Systemische Therapie bei Störungen des Erwachsenenalters

Background

Systemic therapy is a scientifically acknowledged form of psychotherapy in the US and many European countries, but not yet in Germany.

Method

All randomized (or parallelized) controlled trials (RCT) evaluating systemic couples/family/individual therapy with adult index patients published in English, German or Spanish up to the end of 2004 were identified via data base searches and cross-references in other meta-analyses and reviews. A meta-analysis of the identified RCT was performed.

Results

28 RCT (43 publications) evaluating systemic therapy with adult index patients suffering from clinical disorders (ICD-10) were identified. Systemic therapy is efficacious with regard to substance disorders, mental/social factors interacting with somatic disorders, schizophrenia, depression and eating disorders. The results are stable across follow-up periods of up to 5 years.

Conclusion

According to the criteria of the German Scientific Advisory Board Psychotherapy (Wissenschaftlicher Beirat Psychotherapie) there seems to be good evidence for the efficacy of systemic therapy in at least four fields of application of adult psychotherapy.     

Memories of real-life decisions

Three studies investigated decision makers' memory representations of choice alternatives in most important real-life decisions. In Study 1, each participant recalled the most important decision that she or he had ever made and rated to what degree a number of characteristics could describe the decisions. In Study 2, the participants were asked to think about an important decision that they had made during the last 7-10 days. In Study 3, the memory representations of decisions of a group of action-oriented participants were compared with those of a group of state-oriented participants (Kuhl, 1983). Characteristics related to standard decision theory, like consequences, values, and likelihood, had high ratings of applicability as well as affect/feeling. When testing the applicability of a circumplex model, the fuzzy-trace theory of memory, and differences between state- and action-oriented decision makers, we found (1) that there was no support for the circumplex model of emotions. Instead, an important decision problem was characterised by both positive and negative affect/emotion and thus, a bipolar mapping was found inadequate; (2) that a comparison of abstract and concrete aspects showed that the abstract characteristics scored higher, thereby supporting the fuzzy-trace theory; and (3) that the prediction that action-oriented participants would score higher than state-oriented participants on the characteristic of activity was not supported. However, state-oriented decision makers rated passivity higher than action-oriented decision makers for the important decision of leaving a partner. State-oriented decision makers used perceptual/cognitive scenario representations to a greater extent than action-oriented participants. Finally, it was stressed that in the development of decision theories it is essential to find theoretical representations as close as possible to how decision makers themselves represent the decisions. The method used in this contribution is focused on the role of memory in decision making and gives further insights into how important real-life decisions are represented by different decision makers.     

“Just another pretty face”: A multidimensional scaling approach to face attractiveness and variability

Findings on both attractiveness and memory for faces suggest that people should perceive more similarity among attractive than among unattractive faces. A multidimensional scaling approach was used to test this hypothesis in two studies. In Study 1, we derived a psychological face space from similarity ratings of attractive and unattractive Caucasian female faces. In Study 2, we derived a face space for attractive and unattractive male faces of Caucasians and non-Caucasians. Both studies confirm that attractive faces are indeed more tightly clustered than unattractive faces in people’s psychological face spaces. These studies provide direct and original support for theoretical assumptions previously made in the face space and face memory literatures.     

Mathematical skill in individuals with Williams syndrome: evidence from a standardized mathematics battery

Williams syndrome (WS) is a developmental disorder associated with relatively spared verbal skills and severe visuospatial deficits. It has also been reported that individuals with WS are impaired at mathematics. We examined mathematical skills in persons with WS using the second edition of the Test of Early Mathematical Ability (TEMA-2), which measures a wide range of skills. We administered the TEMA-2 to 14 individuals with WS and 14 children matched individually for mental-age on the matrices subtest of the Kaufman Brief Intelligence Test. There were no differences between groups on the overall scores on the TEMA-2. However, an item-by-item analysis revealed group differences. Participants with WS performed more poorly than controls when reporting which of two numbers was closest to a target number, a task thought to utilize a mental number line subserved by the parietal lobe, consistent with previous evidence showing parietal abnormalities in people with WS. In contrast, people with WS performed better than the control group at reading numbers, suggesting that verbal math skills may be comparatively strong in WS. These findings add to evidence that components of mathematical knowledge may be differentially damaged in developmental disorders.     

A Comparison of Suicide Note Writers with Suicides Who Did Not Leave Notes

There is disagreement in the suicide literature on the value of suicide notes as a data source, particularly regarding the extent to which suicide decedents who write notes differ from those who do not. Using 10 years of suicide cases from Summit County, Ohio, these two groups were compared on 40 variables including sociodemographic characteristics, reported affect before death, precipitating events, physical and mental health status and care, and method of suicide. The only differences found were that note writers were more likely to have lived alone and had made prior suicide threats. These findings suggest that for research purposes, suicide cases with and without notes are essentially similar.     

Building Models for the Relationship Between Attitudes Toward Suicide and Suicidal Behavior: Based on Data from General Population Surveys in Sweden,Norway, and Russia

Our aim was to build a model delineating the relationship between attitudes toward suicide and suicidal behavior and to assess equivalence by applying the model on data from different countries. Representative samples from the general population were approached in Sweden, Norway, and Russia with the Attitudes Toward Suicide (ATTS) questionnaire. Data on experience of suicidal behavior among significant others and self‐reported suicidal expressions were also collected. Structural equation modeling resulted in gender and country specific models where experience of suicidal behavior among significant others and self‐reported suicidal expressions earlier in life predicted attitudes, and attitudes predicted current suicidal expressions. The models included the attitude factors acceptance of suicide, condemnation, and preventability; age and level of education were also incorporated. The different models reveal possible ways to better understand gender and culture‐specific paths between attitudes and suicidal behaviors, and their relevance in a suicide prevention context is considered.     

A Review of “Suicidal Intent” Within the Existing Suicide Literature

The results of a systematic literature review that investigated suicide intent are presented. Of the 44 relevant articles identified, 17 investigated the relationships between various suicide risk factors and suicide intent and 25 publications investigated the relationships between suicide intent and various suicide outcomes. Despite recent advancements in the definition and nomological validity of suicide intent, a high degree of variability in the empirical measurement and analysis of suicide intent was found. Such variability limits future research related to measuring suicidal risk and outcomes, reporting suicide intent, or the meaningful comparison of diagnostic approaches or treatments across multiple studies.