Klinisch-psychologische Intervention im Internet

Background

Currently a multitude of Internet-based intervention (IBI) programs exist for various disorders. These programs generally have the potential to reach a wide spectrum of the low threshold population and encourage them to play a more active role in managing individual healthcare. How effective are disorder and problem-specific IBI programs? This review aims to give a systematic overview of controlled evaluation studies available to date and contrast them with the state of research in 2003 (Ott 2003).

Method

References were analyzed in three steps: 1. Research in pertinent international scientific databases using specified keywords (result: more than 1,000 publications since 2003). 2. Selection: exclusion of publications which did not contain empirical evidence of effectiveness (with control group design) (result: 89 studies published between 2003 and 2009 as opposed to 30 up to 2003). 3. Systemization: classification of the analyzed studies based on two dimensions (type of syndrome, function of intervention).

Results

In most of the studies on hand (91.0%) the effectiveness of IBI could be confirmed. Among the methods used cognitive behavioral methods (cognitive, behavioral therapy, CBT) were used almost exclusively. In nearly three quarters of all studies (71.9%), IBI procedures were used for treatment. The remaining studies were on prevention (19.1%) and rehabilitation (9.0%).

Conclusion

Evaluation studies of IBIs are now available, particularly for anxiety disorders, depression, posttraumatic stress disorder, eating disorders including adiposity, substance-related and behavioral medical disorders, psychological problems related to physical illnesses, compulsive gambling and burnout. For each type of disorder, exemplary programs are described. Subsequently the methodical limitations of several of the studies are pointed out.     

Kulturdynamisches Modell der bikulturellen Identit?t

In intercultural psychotherapeutic treatment, the psychological integration of different cultures within an individual has to be involved as an additional developmental dimension. Individual change during the process of migration considered as desirable adaptation has often been conceptualized in terms of a bicultural identity, which includes aspects of the culture of origin as well as aspects of the host culture. The theoretical foundation of the concept of bicultural identity, however, has remained insufficient. The culture-dynamic model presented here differentiates personal and social identity according to the identity concept proposed by Mead (Geist, Identit?t und Gesellschaft, 1988, Suhrkamp, Frankfurt a.?M.). Personal identity is essentially formed by an individual??s culture of origin, while influences of the host culture primarily affect the social identity. For healthy coping with the challenges associated with migration and adequate support of this process in intercultural psychotherapy, it can be assumed that a stabilization of personal identity is required to allow for a dynamization of social identity. Implications for identity constitution in second generation immigrants, in different stages of lifespan development and in the process of learning the language of the host culture are discussed.     

意外地点任务中不同测试问题及意图理解与执行功能的关系

旨在讨论意外地点任务中“知否问题”与“预测问题”可能存在的差异及两者与执行功能任务的关系,并初步探讨意图理解与执行功能间的关系。用意外地点任务、膝跳反射任务和两个执行功能的任务（DCCS和手部游戏）对59名3~5岁的儿童施测。结果显示：（1）儿童在意外地点任务的“知否问题”上的表现显著好于“预测问题”,儿童对“知否问题”和“预测问题”的回答可能反映了心理理论发展的不同阶段。（2）膝跳反射任务,DCCS任务与“知否问题”三者间有显著的相关,且其高相关在排除年龄及语言能力的影响后仍保持显著。“双表征区分结构”可能是三者间具有共同的成分。     

Interrelations between maternal smoking during pregnancy,birth weight and sociodemographic factors in the prediction of early cognitive abilities

Maternal prenatal smoking, birth weight and sociodemographic factors were investigated in relation to cognitive abilities of 1544 children (aged 3.5 years) participating in the Québec Longitudinal Study of Children's Development. The Peabody Picture Vocabulary Test (PPVT) was used to assess verbal ability, the Wechsler Preschool and Primary Scale of Intelligence‐Revised (WPPSI‐R) block design test to assess visuospatial ability, and the Visually Cued Recall (VCR) task to assess short‐term memory. Prenatal smoking was related to performance on the WPPSI‐R, the PPVT, and the VCR, although it did not independently predict any cognitive ability after maternal education was taken into account. Birth weight was a more robust predictor of all outcome measures and independently predicted VCR‐performance. Birth weight interacted significantly with family income and maternal education in predicting visuospatial ability, indicating a greater influence of birth weight under relatively poor socio‐economic conditions. Parenting and family functioning mediated associations between maternal education/family income and cognitive task performance under different birth weight conditions, although there were indications for stronger effects under relatively low birth weight. We conclude that investigations of moderating and mediating effects can provide insights into which children are most at risk of cognitive impairment and might benefit most from interventions. Copyright © 2006 John Wiley & Sons, Ltd.     

The effects of delay on neonatal retention of habituated head-turning

Recovery of neonatal head orientation following auditory habituation was used to examine the effects of intertrial delay. One of two words served as stimuli with criterion orienting and habituation established before the delay. Fifty-six full-term neonates were assigned randomly to one of four delay groups: 10 (control), 55, 100, or 145 s. The percentage of head-turns toward the sound source (with one turn per trial) for blocks of three trials served as the principal dependent variable. Recovery of localized head-turning increased as length of delay increased, with the 100- and 145-s groups showing greater recovery than the 10- and 55-s groups. Infants presented with control trials systematically turned away from the sound source following habituation. Selective sensory adaptation, spontaneous recovery, and short-term memory interpretations of these data are considered.     

Psychological reactivity to discrepant events: Support for the curvilinear hypothesis

80 male and 60 female infants were observed under 5 a priori judged levels of discrepancy to assess whether sustained attention was linearly or curvilinearly related to degree of discrepancy from an experimental standard. Following habituation, $\text{7}\text{1}\text{2}$-month-old infants were exposed to either the repetition of the standard, a minimal, first- or second-level moderate discrepancy, or a novel stimulus having no relation to the standard. The related stimuli, varying in elongation, were sphere, pear, club, and cylinder-shaped objects; the novel stimulus was a different colored, tooth-like object. 80 infants observed the sphere as the standard and the cylinder as the second-level moderate discrepancy; 60 infants were exposed to the reverse order with the cylinder as the standard. The use of different stimuli at each discrepancy level controlled for specific stimulus effects. Habituation and recovery of responding were observed in an operant paradigm. Lever pressing, fixation, and vocalization increased most to the second-level moderate stimuli and decreased most to the familiar and novel objects; fretting was highest to the redundant stimuli and lowest to the moderate objects. There were no stimulus main effects or interactions. The results support the hypothesis of a curvilinear relation between stimulus discrepancy and sustained attention, excitement, and preference.     

Rule selection versus rule execution in preschoolers: an error-detection approach.

In 2 experiments, an error-detection approach was used to determine whether 3-year-olds' perseverative errors on the postswitch phase of the Dimensional Change Card Sort (DCCS) are due to lack of response control or representational inflexibility. In Experiment 1, 3-, 4-, and 5-year-olds watched a puppet sort perseveratively on the postswitch phase and evaluated its responses. Most 4- and 5-year-olds detected the puppet's perseverative errors, whereas most 3-year-olds failed to do so despite detecting errors on a simpler card sort. Experiment 2 revealed that 3-year-olds who failed to correctly evaluate the puppet's behavior tended to fail their own DCCS. Results imply that perseveration on the DCCS cannot be attributed to difficulty inhibiting prepotent motor responses. Instead, changes in rule use between 3 and 5 years of age are interpreted in terms of the development of representational flexibility.     

Die therapeutische Beziehung

The therapeutic relationship is deserving of special consideration. Both knowledge of the widely varying aspects of proposals in terms of possible relationship regulation and acquisition of the different forms of therapeutic relationship management are crucial for therapeutic success. Impact factors are used in the psychotherapeutic process (resource activation, problem activation, problem identification and problem solving), which are predominantly used in rapid succession or even simultaneously. This is also true of the relationship proposals intended and deployed by the therapist, which can also be conceptualised on the basis of impact factors. It has been shown that a single relationship quality can have very different mechanisms of action (e.g. on problem updating and identification). Successful therapeutic relationship regulation is characterized by high flexibility on the part of the therapist, who is able to move between the poles of understanding/confirmation, guidance/support and leadership/control. A good therapeutic relationship in terms of effecting an improvement in the patient is characterized according to the therapist’s flexibility as regards what he/she can offer in the relationship, a flexibility which can no longer be squarely attributed to one therapy discipline alone. In order to take the significance of the therapeutic relationship into account, the training and specific skills required for this need to be taught during training and supervision. A prerequisite to this, in addition to a sound theoretical training in the relevant aspects of relationship regulation, is relationship regulation skills in terms of both concept and own practical experience.