Inanspruchnahme, Verlauf und Ergebnis ambulanter Psychotherapie

This paper summarizes the major results of the study ?Optimizing psychotherapy service provision via transparency and outcome orientation: evaluating outpatient psychotherapy“ (TRANS-OP). Between September 1998 and February 2000, all insured persons of a major German health insurance company (?Deutsche Krankenversicherung“) who requested reimbursement of outpatient psychotherapy were asked to participate in the study. Comprehensive data concerning structural, process and outcome criteria of outpatient psychotherapy were collected from 714 participants and from the majority of their psychotherapists during a 2-year observation period. Participants applied for the following treatments eligible for reimbursement in the German health insurance system: psychodynamically oriented psychotherapy (52%), cognitive behavioral therapy (31%), and psychoanalytic psychotherapy (17%). The amounts of sessions claimed for reimbursement were approved almost without exception. Participants in the three treatment modalities did not differ in socio-demographic characteristics, or in initial symptom severity as assessed by standardized measures. Even though courses of improvement of the symptoms varied, therapy outcome after 2 years was similar in the three forms of treatment. In addition, a cost offset was found, i.e. medical costs, especially for hospital days, substantially decreased during the course of psychotherapy. These findings support the effectiveness as well as the economic significance of outpatient psychotherapy across different treatment modalities in routine care. However, allocation of psychotherapeutic resources should be more considerate of individual patient needs and treatment outcome.     

The role of elaboration in the persistence of awareness for degraded objects

When a fragmented line-drawing of an object moves relative to a background of randomly oriented lines, the previously hidden object can be segregated from the background and consequently enters awareness. In this shape-from-motion paradigm, the percept of the object briefly persists after the motion stops, demonstrating the maintenance of a bound percept in awareness. This study investigated how the manipulation of object features that are crucial to recognition influences both the binding process and the maintenance of objects in awareness. Overall, we found that objects that took longer to recognize (i.e., objects missing their vertices) were nonetheless maintained in awareness for longer. We argue that this effect is mediated by additional elaborative processing that is required to bind these less recognizable forms, which generates stronger and more robust representations. These representations are then more easily maintained in awareness, suggesting an important role of elaborative mechanisms for conscious representations.     

Sleep in children improves memory performance on declarative but not procedural tasks

Sleep supports the consolidation of memory in adults. Childhood is a period hallmarked by huge demands of brain plasticity as well as great amounts of efficient sleep. Whether sleep supports memory consolidation in children as in adults is unclear. We compared effects of nocturnal sleep (versus daytime wakefulness) on consolidation of declarative (word-pair associates, two-dimensional [2D] object location), and procedural memories (finger sequence tapping) in 15 children (6-8 yr) and 15 adults. Beneficial effects of sleep on retention of declarative memories were comparable in children and adults. However, opposite to adults, children showed smaller improvement in finger-tapping skill across retention sleep than wakefulness, indicating that sleep-dependent procedural memory consolidation depends on developmental stage.     

Conscious and Preconscious Uses of Memory in Patients with Depressive and Somatoform Disorders

This study investigated whether conscious and preconscious memory features contribute to discrimination between depressive and somatoform disorders. Thirty-one participants fulfilling the diagnostic criteria for a somatoform disorder and 28 participants fulfilling the criteria for depression were examined within the framework of the process–dissociation paradigm using neutral, health-threatening, and general threatening words in a lexical decision task. Parameters of conscious memory, preconscious memory, and chance were used to compare memory features of both the groups. There was an inverse relationship between conscious and preconscious memory effects for health-threatening stimuli in the group of patients with somatoform disorders but not in the group of depressive patients. Patients with somatoform disorders showed a significantly lower level of conscious memory for health-threatening stimuli than depressive participants. Compared to depressive patients, a more dynamic relationship between decreased conscious and increased preconscious memory for health-related stimuli seems to be characteristic for patients with somatoform disorders.     

Toward a developmental psychology of Sehnsucht (life longings): the optimal (utopian) life

The topic of an optimal or utopian life has received much attention across the humanities and the arts but not in psychology. The German concept of Sehnsucht captures individual and collective thoughts and feelings about one's optimal or utopian life. Sehnsucht (life longings; LLs) is defined as an intense desire for alternative states and realizations of life. Presenting a first effort at capturing this phenomenon, the authors conceptualize LLs as composed of 6 interrelated core characteristics: (a) utopian conceptions of ideal development; (b) sense of incompleteness and imperfection of life; (c) conjoint time focus on the past, present, and future; (d) ambivalent (bittersweet) emotions; (e) reflection and evaluation of one's life; and (f) symbolic richness. Self-report data from 299 adults (19-81 years) support the postulated structure and support predictions regarding the functional role of Sehnsucht. Having LLs was evaluated as providing direction to development and helping to manage life's incompleteness. At the same time, the frequent and intense experience of LLs was associated with lower well-being. When LLs were perceived as controllable, however, this negative association disappeared.     

Multidisciplinary Engagement with Nanoethics Through Education—The Nanobio-RAISE Advanced Courses as a Case Study and Model

This paper presents and evaluates two advanced courses organised in Oxford as part of the European project Nanobio-RAISE and suggests using their format to encourage multidisciplinary engagement between nanoscientists and nanoethicists. Several nanoethicists have recently identified the need for ‘better’ ethics of emerging technologies, arguing that ethical reflection should become part and parcel of the research and development (R&D) process itself. Such new forms of ethical deliberation, it is argued, transcend traditional disciplinary boundaries and require the active engagement and involvement of both nanoethicists and nanoscientists with the broader issues surrounding technological developments. Whereas significant research efforts into multi- and interdisciplinary collaborations during R&D processes are now emerging, opportunities for encouraging multidisciplinary engagement through education have remained relatively underexplored. This paper argues that educational programmes could be a natural extension of ongoing collaborative research efforts ‘in the lab’ and analyses how the Nanobio-RAISE courses could be used as a model for course development. In addition to exploring how the elements that were conducive to multidisciplinary engagement in this course could be preserved in future courses, this paper suggests shifting the emphasis from public communication towards ethical deliberation. Further course work could thus build capacity among both nanoscientists and nanoethicists for doing ‘better’ nanoethics.     

Effects of received and mobilized support on recipients' and providers' self-efficacy beliefs: a 1-year follow-up study with patients receiving radical prostatectomy and their spouses

From a proactive agentic perspective, social support is not just seen as a protective cushion against environmental demands. Rather, support may facilitate an individual's self-regulation by enhancing perceived self-efficacy (i.e., enabling hypothesis). In the present study, patient-reported indicators of mobilized and received spousal support as predictors of their own and their spouses' self-efficacy beliefs were investigated within 1 year following radical prostatectomy. During this time frame, postoperative sequelae such as urinary incontinence and erectile dysfunctions are still likely to interfere with couples' everyday activities. Seventy-two patients receiving radical prostatectomy and their spouses participated. Patients' and spouses' self-efficacy beliefs and patients' received and mobilized spousal support were assessed prior to and 12 months following surgery. Additional patient-reported covariates at 1 year post-surgery were degree of bother by urinary incontinence, overall sexual satisfaction, and relationship satisfaction. Results indicated that patients' received spousal support was associated with higher levels of patients' self-efficacy only cross-sectionally, but not longitudinally. Support mobilized by the patient prior to and 1 year after surgery, however, positively predicted spouses' levels and changes in self-efficacy. Results, thus, did not fully confirm predictions by the enabling hypothesis of social support; rather, associated aspects, such as the degree of being mobilized as a provider of support or being needed, seem to enhance agency beliefs in spouses.     

Priming the ant or the grasshopper in people's mind: How regulatory mode affects inter‐temporal choices

The present study examined the influence of two regulatory mode concerns—a locomotion concern with movement from state to state and an assessment concern with making comparisons—on choices between immediate and delayed (from 2 to 6 weeks) money rewards. Regulatory mode orientation was induced by means of a priming procedure. We predicted that the choices in the assessment condition would be less impulsive and more far‐sighted than those in the locomotion condition. After taking into account the effects of amount of early reward, length of delay and increase in delayed reward—all of which were in the direction of previous studies—this regulatory mode prediction was supported. Our findings suggest that it might be possible to induce more far‐sighted (or economically rational) inter‐temporal choices by means of instructions that induce an assessment orientation independent of stable inter‐individual differences in discount rate. Copyright © 2009 John Wiley & Sons, Ltd.     

Go no-go performance under psychosocial stress: beneficial effects of implementation intentions

Acute stress has been found to have negative and implementation intentions (IIs) to have positive effects on cognitive performance. This study was the first to examine the effects of IIs on executive action control under acute psychosocial stress. Forty-two male subjects aged 21-39 years were randomly assigned to the Trier Social Stress Test (TSST) versus a rest condition. In addition, the instruction to the executive task (a go no-go task) was manipulated (IIs versus standard instruction). After the stress test, a dual-task procedure including a go no-go task was conducted. The TSST resulted in increases in cortisol response, heart rate and state anxiety compared to the rest condition. Acute stress significantly impaired go no-go performance, but only in the group without IIs. We conclude that under acute stress conditions executive functioning is reduced, but the use of IIs can be an effective strategy to overcome this negative effect.     

„ Den Alkoholiker“ gibt es nicht

Zusammenfassung:  Im Gegensatz zur lange vorherrschenden Konzentration auf die Behandlung des Entzugs und der Abh?ngigkeit, haben sich durch neuere Befunde Tendenzen entwickelt, die Therapie Alkoholabh?ngiger wieder st?rker auf die tats?chlichen individuellen Hintergründe auszurichten. Besonders hilfreich für eine verbesserte therapeutische Transparenz erwiesen sich die aktuellen Erkenntnisse neuro-biologischer Befunde. Damit erkl?ren sich viele bisher r?tselhafte Hintergründe einer Abh?ngigkeitsbildung und suchtbedingte Stereotype, speziell „Craving“ (massives Alkoholverlangen) und die krisenhaften Turbulenzen und Rückfallstendenzen auch nach l?ngerer Abstinenz. Die süchtige Umprogrammierung des mesolimbischen Belohnungssystems macht auch die rasche Reaktivierung des Abh?ngigkeits-prozesses bei neuerlichem Alkoholkonsum besser verst?ndlich. Da allerdings zu akzeptieren ist, dass die neurobiologischen Ver?nderungen keinesfalls die Ursache, sondern erst die Konsequenz einer süchtigen Umprogrammierung darstellen, muss sich die therapeutische Aufmerksamkeit wieder vermehrt auf die individuellen Hintergründe einer Suchtentwicklung fokussieren: Spezielles Interesse gilt hier schon seit l?ngerem den pathologischen Mustern der überanpassung und Selbstentwertung, die sich als Folge einer Dekompensation des Selbstwertregulationssystems entwickeln. Zahlreiche Befunde weisen darauf hin, dass gerade der Versuch, Selbstwertprobleme, permanente Verunsicherung und soziale ?ngste mit Alkohol zu „behandeln“, ein deutlich erh?htes Abh?ngigkeitsrisiko bewirkt. Daraus ergibt sich die Aufgabe einer zus?tzlichen therapeutischen Ver?nderung derartiger Hintergrundfaktoren, da andernfalls eine Alkoholrückf?lligkeit auf dem Boden dieser Muster programmiert w?re. Die somit gegebene Vielfalt individueller Entwicklungsfaktoren und Verlaufsbilder best?tigt auch eindrucksvoll die inzwischen weitgehend akzeptierte Not-wendigkeit einer syndrombezogenen und verlaufsorientierten Individualisierung der Langzeittherapie und damit eine Abkehr von kategorial orientierten, kollektiven Behandlungskonzepten.

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Summary:  In contrast to the long prevailing concentration towards the treatment of withdrawal symptoms and addiction, latest experiences and medical findings support tendencies towards individually designed treatment concepts, taking into consideration individual root causes. Recent consolidated findings in neurobiology have proved valuable for an improved therapeutic understanding since puzzling processes in the development of addiction, as well as the context and dynamic of addictive stereotypes, the phenomenon of craving and critical turbulences can now be explained. Furthermore, it is now better understood, why the mesolimbic gratification system reprogrammed with addictive features can provoke relapse and the recurrance of addictive behaviour immediately after reuptake of alcohol consumption. Since those neurobiological findings mentioned above have to be considered a consequence of addictive processes, the instances leading to the primary onset of addictive behaviour have to be brought into the therapeutical focus. Here, special emphasis has been placed on pathological behavioural patterns such as over-conformity and self-devaluation which might develop after decompensation of the self-concept regulation system. On-site findings in diverse fields of addiction research point towards an increased risk of self medication efforts as compensation efforts of self-worth problems, personal instability or social anxiety. As a result, any therapeutic intervention would intend to alter such background factors since they might be seen as elevated risk potential for relapse. The highly visible diversity of possible alternatives regarding developmental factors and aetiopathology impressively supports the widely accepted necessity for individually designed syndrome, as well as process-oriented, treatment concepts, thus abandoning categorically oriented universal approaches.