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.     

Prospective memory and pediatric traumatic brain injury: effects of cognitive demand.

This study investigated the effects of pediatric traumatic brain injury (TBI) on prospective memory. Fourteen children and 14 adolescents with TBI were compared with 25 and 23 noninjured children and adolescents, respectively. Based on a prefrontal model, the cognitive demand on the ongoing component of a prospective-memory task was manipulated. Overall, those with TBI had poorer prospective-memory performance than their noninjured peers. Performance was worse in a high cognitive-demand condition than a low, and younger children performed worse than adolescents. Decreases in performance from the low- to high-demand conditions were not significantly different between the two children's groups but were between the two adolescents' groups. Furthermore, the age and injury effects were reflected in the performances on executive function tests: the Self-ordered Pointing Task (SOPT), and the Stroop Color Word Interference Test. The Tower of London (TOL), which did not produce age or injury effects, was nevertheless found to be an important predictor of performance on the high-demand task in those with TBI. Although previous research has demonstrated impaired prospective memory performance in children with TBI, this study attempted to explain why this might occur, specifically that the prefrontal regions might be implicated.     

Using cue words to investigate the distribution of autobiographical memories in childhood

The cue-word technique is frequently used with adults to examine the distribution of autobiographical memories across the life span. Such studies demonstrate childhood amnesia: a paucity of memories of events from the first 3(1/2) years of life, and a gradually increasing number of memories from age 3 to age 7. The pattern is remarkable in light of findings of autobiographical competence among children in the period of life eventually obscured by this amnesia. In the present study, we modified the cue-word task for use with school-age children. Seven- to 10-year-olds successfully generated and dated memories of past events. Girls provided more complete narratives than boys. Across the sample, the resulting distribution of memories was better fit by an exponential than by a power function, implying that early memories may not consolidate and instead remain vulnerable to interference. Implications for explanations of childhood amnesia are discussed.     

Cognitive control under stress: how stress affects strategies of task-set reconfiguration

This study investigated the effect of stress on cognitive control in task shifting. Subjects shifted between two tasks in an explicit cuing paradigm. Shift costs (i.e., performance decrements on task shifts relative to task repetitions) were measured for a long and a short cue-stimulus interval (CSI). Stress was varied by administering low-stress and high-stress IQ scales to two groups of subjects. In the low-stress group, shift costs were reduced with an increased CSI, a result that typically indicates anticipatory and shift-specific task-set reconfiguration. In the high-stress group, however, shift costs were independent of the CSI. This result is consistent with the idea that stress induces a change in the reconfiguration strategy, possibly to adapt to depleted resources.     

Overgeneral memory and suppression of trauma memories in post-traumatic stress disorder

The study investigated the relationship between the suppression of trauma memories and overgeneral memory in 42 assault survivors with and without PTSD. Overgeneral memory (OGM) was assessed with a standard autobiographical memory test (AMT). Participants completed two further AMTs under the instructions to either suppress or not suppress assault memories, in counterbalanced order. Participants with PTSD retrieved fewer and more general memories when following the suppression instruction than participants without PTSD, but not under the control instruction. OGM correlated with PTSD symptom severity, and measures of cognitive avoidance. The results are discussed with reference to current theories of overgeneral memory and its possible relationship with PTSD.     

Virtual reality for the psychophysiological assessment of phobic fear: responses during virtual tunnel driving

An overall assessment of phobic fear requires not only a verbal self-report of fear but also an assessment of behavioral and physiological responses. Virtual reality can be used to simulate realistic (phobic) situations and therefore should be useful for inducing emotions in a controlled, standardized way. Verbal and physiological fear reactions were examined in 15 highly tunnel-fearful and 15 matched control participants in 3 virtual driving scenarios: an open environment, a partially open tunnel (gallery), and a closed tunnel. Highly tunnel-fearful participants were characterized by elevated fear responses specifically during tunnel drives as reflected in verbal fear ratings, heart rate reactions, and startle responses. Heart rate and fear ratings differentiated highly tunnel-fearful from control participants with an accuracy of 88% and 93%, respectively. Results indicate that virtual environments are valuable tools for the assessment of fear reactions and should be used in future experimental research.     

Pianists duet better when they play with themselves: on the possible role of action simulation in synchronization

Ensemble musicians play in synchrony despite expressively motivated irregularities in timing. We hypothesized that synchrony is achieved by each performer internally simulating the concurrent actions of other ensemble members, relying initially on how they would perform in their stead. Hence, musicians should be better at synchronizing with recordings of their own earlier performances than with others' recordings. We required pianists to record one part from each of several piano duets, and later to play the complementary part in synchrony with their own or others' recordings. The pianists were also asked to identify their own recordings. The pianists were better at synchronizing with their own than with others' performances, and they were able to recognize their own recordings. Furthermore, synchronization accuracy and recognition were correlated: Pianists who were relatively accurate at synchronizing with their own performances were also good at recognizing them. Thus, action simulation may underlie both synchronization and self-recognition.     

Nice wor_ if you can get the wor_: subliminal semantic and form priming in fragment completion

Two experiments investigated subliminal semantic and form priming in a word-completion task. Visual gap-words with a dominant and a subordinate solution were preceded by form-related or by semantically related words, which were briefly presented and sandwich-masked. Priming of the subordinate solution was assessed in Experiment 1, relative to a neutral condition. Both solutions were primed in Experiment 2. In the absence of conscious prime recognition, both semantic and form primes reliably increased the probability with which the primed solution was given. With our variant of fragment-completion, response priming can be ruled out as explanation. Moreover, effects were already present at first presentation, excluding an interpretation in terms of partial awareness due to massive repetition. The data demonstrate automatic activation at both form and semantic levels in the absence of conscious awareness.     

Excessive computer game playing: evidence for addiction and aggression?

Computer games have become an ever-increasing part of many adolescents' day-to-day lives. Coupled with this phenomenon, reports of excessive gaming (computer game playing) denominated as "computer/video game addiction" have been discussed in the popular press as well as in recent scientific research. The aim of the present study was the investigation of the addictive potential of gaming as well as the relationship between excessive gaming and aggressive attitudes and behavior. A sample comprising of 7069 gamers answered two questionnaires online. Data revealed that 11.9% of participants (840 gamers) fulfilled diagnostic criteria of addiction concerning their gaming behavior, while there is only weak evidence for the assumption that aggressive behavior is interrelated with excessive gaming in general. Results of this study contribute to the assumption that also playing games without monetary reward meets criteria of addiction. Hence, an addictive potential of gaming should be taken into consideration regarding prevention and intervention.     

Happiness theories of the good life

The paper starts with a presentation of the pure happiness theory, i.e. the idea that the quality of a person’s life is dependent on one thing only, viz. how happy that person is. To find out whether this type of theory is plausible or not, I examine the standard arguments for and against this theory, including Nozick’s experience machine argument. I then investigate how the theory can be modified in order to avoid the most serious objections. I first examine different types of epistemic modifications of the theory (e.g. the idea that a person’s happiness is more valuable for her if it is based on a correct perception of her own life), and then turn to a number of modifications which all make the value of a person’s happiness depend on whether the evaluative standard on which her happiness is based satisfies certain requirements. In connection with this, I present and defend my own modified version of the happiness theory.