Background The definition of psychological treatments and psychotherapy has various implications for communication within research and clinical care, as well as for legal issues — particularly in countries with psychotherapy acts. It can define what should be covered by public healthcare systems and who should be permitted to provide these services. Method We assembled a group of psychotherapists in Germany to develop an inclusive, scientific definition of psychotherapy. This definition should serve as an umbrella that is not limited to traditional treatment schools and is suitable for science, clinical care and legal acts. The group comprised people with different therapeutic backgrounds (e.g., CBT, psychodynamic and systemic therapy), experts from various disciplines (e.g., psychology, psychiatry and psychosomatic medicine), people focusing on different age groups (e.g., adults and youth), individuals with lived experience of psychotherapy and early career clinicians. Results A literature review led us to consider four aspects of a definition. What are the treatment means or 'tools'? (modality of treatment); how does the treatment work? (Proposed change mechanisms, assumptions about causal and evidence-based processes and concepts); who receives psychotherapy? (target group); and who provides psychotherapy? (Provider). Based on these aspects, we offer a definition of psychological therapy. Discussion Our suggested definition is not bound to specific treatment orientations, but is intended to encompass both traditional approaches and innovative developments. Our aim is to promote the evidence-based provision of psychological therapy within healthcare systems and legal frameworks.
Background Elevated paranoia levels have been found in discriminated, minoritized groups. Social-cognitive models of paranoia posit that experiences of discrimination strengthen negative core beliefs, which in turn foster clinical paranoia. In contrast, the healthy cultural mistrust hypothesis proposes that elevated paranoia in minoritized groups reflects an adaptive response to increased exploitation/discrimination. To explore whether elevated paranoia in discriminated groups can be fully understood within clinical models, we tested whether a history of discrimination amplifies the association between everyday-life stressors and subsequent state-paranoia and whether this moderation effect remains when controlling for established cognitive risk factors for paranoia (i.e., dysfunctional beliefs). Method A general population sample ( n = 108) answered a baseline self-report questionnaire of lifetime discrimination experiences (LDE) and core beliefs about oneself and others. Next, they reported state-paranoia, negative affect, and exclusion experiences in 2.5h intervals for seven days of ambulatory assessment. LDE and core-beliefs were tested as concurrent moderators for the associations between state-paranoia and putative triggers (negative-affect, exclusion) using multilevel regression. Results More LDE amplified the association between paranoia, negative affect, and exclusion experiences. When controlling for the moderation effects of negative beliefs, effect sizes for the LDE moderation were lower but largely remained significant. Conclusions Increased state-paranoia in the daily lives of people with discrimination experiences can be partially, but not fully, explained by clinical, cognitive risk factors. Consequently, healthy cultural mistrust can be considered an additional contributing factor to higher mistrust/paranoia in minoritized groups. Future in-depth research needs to disentangle mechanisms of emerging paranoia and adaptive mistrust in minoritized groups.
Background Research demonstrates that mental disorders are associated with specific dysfunctional expectations and a reduced ability to adjust them, even after expectation-violating experiences. The ViolEx (violated expectation) model offers a framework to explain why expectations persist or change, introducing the concept of cognitive immunization as a potential explanation for differences in information processes. Expectation-focused psychological interventions (EFPI) aim to promote expectation adaptation. Method This study examines the effectiveness of an online EFPI platform for individuals with mild depressive and/or anxiety symptoms. A total of 128 participants, screened with the PHQ-9 (scores 5-9) and/or BAI (scores 8-25), were randomly assigned to one of three groups. The EFPI group and the active control group (ACG) received a psychoeducational video about expectations and their influence on behavior. Over four weeks, the EFPI group completed behavioral experiments to test their personal expectations, while the ACG used only cognitive strategies to challenge personal expectations. A third group (control group; CG) received no intervention. Surveys were administered at baseline, four weeks, and eight weeks after the initial assessment. Results A significant reduction in cognitive immunization was observed over measurement timepoints, with a significant difference to the CG at the follow-up. Anxiety symptoms appear to moderate this effect, whereas EFPI did not influence depressive symptoms, nor did depressive symptoms moderate changes in cognitive immunization. Conclusion This study is the first to evaluate online EFPI for mild depression and/or anxiety symptoms, suggesting that EFPI may reduce cognitive immunization. Future studies should investigate therapist-delivered EFPI in clinical populations with more severe symptoms.
Background By identifying predictors of treatment failure that are susceptible to change (amenable), we can move towards studying ways to decrease the odds of treatment failure, e.g., by targeting these predictors before treatment, adapting interventions, accordingly, choosing more suitable treatments, or preparing patients better for psychotherapy. While treatment success, within anxiety and depressive disorders, has been studied extensively, it seems that treatment failure is overlooked, even while we know that about one third of the treatment population shows no benefit in treatment. Method In order to review the available body of knowledge concerning amenable patient-specific predictors for treatment failure, we conducted a literature search in PubMed, PsycInfo, Embase, and Medline, following the Prisma-ScR guidelines. Thirty articles met the inclusion criteria and are summarized in this review. Conclusions were drawn for scientific and clinical implications. Results Predictors of treatment failure that are replicated or are significant in multiple studies are low treatment expectancy, high neuroticism, low use of social support, low outcome expectancy, and low perceived social support. Treatment failure is hard to define, and very few studies are replicated. There are predictors that are studied in multiple articles, but they are measured with different instruments, or in very small or specific patient samples, therefore it is difficult to compare findings from different studies. Conclusions There are no predictors that stand out as overall strong amenable predictors of treatment failure. Possible predictors are high neuroticism, low treatment expectancies, and low use of social support. Future research should focus on replicating studies to confirm these predictors of treatment failure.
Background: Prolonged Grief Disorder (PGD) was included in the DSM-5-TR and ICD-11. The Traumatic Grief Inventory Self-Report Plus (TGI-SR+) is a self-report measure to assess PGD symptoms in accordance with both classification systems. It has been translated into various languages and validated across different contexts. Objective: Evaluating the psychometric properties of the Ukrainian TGI-SR+. Method: Participants were Ukrainian adults who had lost a loved one at least 6 months ago. One hundred ninety-eight participants completed the TGI-SR+ and measures assessing posttraumatic stress and depression. We examined the factor structure, internal consistency, convergent validity, and known-groups validity of the TGI-SR+. Moreover, rates of probable PGD caseness were calculated, and provisional cut-off scores were determined based on Receiver Operating Characteristic (ROC) analyses. Results: The one-factor model showed an acceptable fit for DSM-5-TR, but not for ICD-11 PGD symptoms. While some of the factor loadings were low for both criteria sets, the items demonstrated good internal consistency. Convergent validity was supported by strong associations between symptom levels of DSM-5-TR and ICD-11 PGD and posttraumatic stress and depression severity scores. Known-groups validity was partially supported by DSM-5-TR and ICD-11 PGD severity being related to both cause of death and kinship to the deceased. The provisional cut-off score for detecting both probable DSM-5-TR and ICD-11 PGD caseness, when summing all TGI-SR+ items, was >= 75. Conclusion: The psychometric properties of the Ukrainian TGI-SR+ were mixed. However, pending further research in different and larger samples of Ukrainian bereaved people, this instrument can be used to assess PGD severity in Ukrainians.
Background Mirror exposure represents a common component in treatment of body dysmorphic disorder (BDD). However, the benefits of repeated mirror exposure have not been investigated as a standalone intervention for BDD. This study aimed to examine the cognitive and affective response to mirror exposure in individuals with high and low levels of body dysmorphic symptoms. Method Fifty women participated in two guided full-body mirror exposures (approx. 32 minutes each). Participants were divided into two groups based on the severity of their BDD symptoms. Twenty-three participants reported elevated, not primarily weight related, body dysmorphic symptoms. Body satisfaction and affective responses were assessed before and after the exposure, affective responses were further assessed during the exposure. Post-event processing related to the experience was rated the day afterwards. Results Participants with body dysmorphic symptoms reported lower state body satisfaction and higher shame in both sessions, sadness was elevated in the first session only. State body satisfaction dropped from pre to post exposure but improved from the first to the second session. Negative affects did not decrease within but between the two sessions. Post-event processing after the first exposure predicted negative affect at the beginning of the second session. Conclusion The results support a positive effect of repeated mirror exposure across sessions, without improvement within the session. They point towards the detrimental role of mental post-processing.
Background A person’s ability to adapt to a given context is a critical determinant of mental health and psychopathology, which has been redefined by network approaches and Ecological Momentary Assessment (EMA). This study examined whether including adaptive processes in EMA enhances the informational value of idiographic network models. Method Forty-five university students participated in a multi-week EMA protocol assessing psychological dimensions using bipolar visual analogue scales ranging from maladaptive to adaptive. Participants were randomly assigned to two groups: one assessed only maladaptive processes; the other included both maladaptive and adaptive processes. Results Network analyses indicated higher density and connectivity in the adaptive–maladaptive group, as well as significantly reduced floor effects across all variables. Greater response dispersion was associated with more differentiated network structures. Motivation emerged as the most central node across conditions, highlighting its relevance as a transdiagnostic treatment target. Cognitive processing showed strong associations with other variables, underlining its clinical importance. Conclusion The findings suggest that incorporating adaptive dimensions into EMA facilitates a more comprehensive understanding of psychological functioning and improves the interpretability of idiographic models. The study represents an initial feasibility investigation and a basis for further investigations in clinical practice.
Background:Social Anxiety Disorder (SAD) is a prevalent mental disorder characterised by fear of negative evaluation. Although effective treatment approaches are available, access remains limited due to psychological and organisational barriers. Internet-based cognitive behavioural therapy (iCBT) has shown promising results and may facilitate an easy and more resource-efficient access to treatment. Method:We developed an app-based self-help intervention for SAD based on the Clark and Wells treatment program, implemented as an unguided smartphone application, which was evaluated in this quasi-experimental pre-post pilot study consisting of N = 33 patients with a primary diagnosis of SAD. Feasibility was assessed through usage parameters and qualitative feedback. Effectiveness was evaluated in regard to SAD and depression, using clinician-rated measures (LSAS, QIDS-C) at post-treatment (12 weeks) and self-report measures (SPIN, SCQ, BDI-FS) at midpoint and post-treatment. Additionally, moderating effects of usage parameters on symptom reduction were examined. Results:Clinician- and self-reported SAD symptoms were significantly reduced at post-measurement (within-group effect sizes LSAS: η2 = .54; SPIN: η2 = .47), with 52% of patients achieving a clinically significant improvement. Despite moderate overall adherence, the amount of conducted behavioural experiments moderated reduction in self-reported SAD symptom severity and SAD-related cognitions. Open feedback supported feasibility and acceptability of the app. Conclusion:In conclusion, findings provide preliminary support for feasibility, acceptability, and potential effectiveness of Mindable: Soziale Phobie. A randomised controlled trial will further evaluate the effectiveness and explore the impact of therapist guidance.
Background: The increasing popularity of mental-health information on social media platforms such as TikTok is raising concerns regarding misinformation. Previous research is limited to single disorders and videos in the English language only. Our objective was to investigate the quality of mental health information on German-language TikTok for a broader spectrum of disorders. Method: Thirty German-language TikTok-videos of each of the six most viewed hashtags on mental disorders (attention-deficit and hyperactivity disorder (ADHD), depression, autism, anxiety disorder, narcissism and post-traumatic stress disorder (PTSD)) were classified regarding authorship and rated either as "correct", "overgeneralized", "incorrect" or "subjective experience". The modified DISCERN (mDISCERN) and the Global Quality Scale (GQS) were used to rate reliability and quality of information for patients. Results: The 177 videos finally included in this study gathered a total of 94,348,220 views and 19.2% (n = 34) of the videos were rated as correct, 33.3% (n = 59) as incorrect, 18.1% (n = 32) as overgeneralized and 29.4% (n = 52) as personal experience. Chi-Square tests and Kruskal-Wallis tests showed significant relationships between either authorship or diagnosis and quality and reliability. Videos on PTSD and videos by expert authors showed the best and videos on narcissism and videos by laypeople the worst overall results. Conclusion: With around half of the analyzed videos supplying incorrect information, the quality of German-language TikTok mental health content is insufficient. Differences in the quality of content seem to be influenced by the topic and the authorship. Healthcare institutions and clinicians should be aware of this, educate patients accordingly, and could improve the quality of information by participating in online discourses.
Background: Despite efforts to integrate psychotherapy, the field remains fragmented into distinct theoretical orientations and practical approaches. Prejudices held by psychotherapists towards those from other theoretical orientations may hinder cooperation in research and clinical practice. This study examines stereotypes among psychotherapists from different theoretical orientations and practical approaches ('psychotherapy schools') towards their in-group and out-group colleagues. Method: The cross-sectional online study assessed socially shared evaluations of 'warmth' and 'competence' from the stereotype content model in a sample of 586 German psychotherapists (60.9% licensed; 39.1% in training) from different psychotherapy schools (34.5% psychoanalytic and psychodynamic psychotherapists, 19.8% psychodynamic psychotherapists, 28.7% cognitive behavioural therapists, and 17.1% systemic therapists). Linear mixed-effects models were used to examine differences in evaluations based on the rater's and the rated psychotherapy school.Results: The psychotherapists' assumed socially shared evaluations of 'warmth' and 'competence' varied depending on their psychotherapy school affiliation, with significantly higher evaluations assigned to their in-groups than to their out-groups. Conclusion: The results indicate in-group biases in the social perception of psychotherapists with different theoretical orientations, representing potential barriers to inter-group contact and collaboration. Addressing prejudices is key to strengthening integrative competence in both research and clinical practice.
Background:The network theory describes mental disorders as a network of interacting symptoms. While most research on the network theory is based on network analyses of symptom data, little is known about mental health professionals´ attitudes towards this theory. Clinical expertise could offer a valuable additional perspective on the validity of the theory and its applications to clinical practice. Method:Mental health professionals rated their agreement with propositions of the network theory regarding the phenomenology, aetiology, and treatment of mental disorders in an online survey. Further, the acceptability and appropriateness of possible applications were evaluated. We calculated descriptive statistics and examined associated factors with regression analyses. Results:The participating psychotherapists (n = 183), specialized physicians (n = 45), and clinical psychologists (n = 29, total n = 257) largely agreed with the network theory's propositions regarding the phenomenology of mental disorders and treatment effects. Appraisal of the network theory regarding the aetiology of mental disorders, regarding important treatment targets, and regarding acceptability and appropriateness of possible applications was mixed. A theoretical background in cognitive behavioural therapy and previous knowledge of the network theory were associated with a stronger agreement in most domains. Conclusions:The fundamental assumptions of the network approach seem to resonate with mental health professionals, while the consequences for the diagnosis and treatment of mental disorders were questioned. Our findings indicate that the general conceptualization of mental disorders as symptom networks seems to align with mental health professionals' perceptions but, at the same time, emphasizes the novelty and limited specificity of the theory's implications for clinical practice.
Background: Body dysmorphic disorder (BDD) is characterized by an excessive preoccupation with perceived appearance flaws, often accompanied by repetitive behaviors such as frequent mirror checking. It is further associated with severe occupational and social impairments, depression, and high levels of suicidality, including suicidal thoughts, suicide attempts and completed suicide. Given the high rates of depression and suicidality found in BDD, this study aimed to examine whether BDD symptoms may also be directly linked to suicidality, independent of depressive symptoms. Method: A mediation analysis was conducted to investigate the relationships between BDD symptoms, depression, and suicidality. Cross-sectional data were collected through an online self-test for BDD, assessing BDD symptoms, depression and suicidality. A total of 1,256 participants (aged 18-71; 72% female) met DSM-5 criteria for BDD (based on self-report). Results: Depressive symptoms partially mediated the relationship between BDD symptoms and suicidality. However, a direct association between BDD symptoms and suicidality was also observed, indicating that suicidality in individuals with BDD is not solely attributable to comorbid depressive symptoms. Conclusion: The findings underscore the need for thorough suicidality assessments in individuals with BDD, regardless of the presence of depressive symptoms. This further highlights the importance of targeted interventions to address suicidality in this population.
Background: Body checking (BC) is widespread among healthy populations and in individuals with eating disorders (EDs), body dysmorphic disorder (BDD), and illness anxiety disorder (IAD). Etiological models of these three disorders originate from research on obsessive-compulsive disorder and propose a short-term reduction of negative affect after BC. However, as empirical evidence shows a heterogenous pattern regarding the reduction of negative affect, the primary objective of this study was to test the etiological models in a cross-over laboratory experiment. Method: After induction of negative affect, N = 102 healthy females underwent a 10-min BC task, in which they were randomly assigned to perform ED-, BDD-, or IAD-related BC, and a 10-min control checking condition of checking the characteristics of two vases. Before and after each task, participants completed state questionnaires on affect and disorder-specific pathology. Results: The results revealed increased negative affect and disorder-specific pathology from before to after BC, but a reduction of these variables after the control checking condition. Conclusion: Thus, contrary to expectation, the theory explaining reduced negative affect in compulsive checking may not directly be applicable to ED-, BDD-, and IAD-related BC in healthy populations, thus providing evidence of the dysfunctionality of BC in the short term.
Context:Childhood trauma is more prevalent among individuals with substance use disorders compared to the general population, representing a significant public health concern. The presence of comorbid dissociative symptoms poses a significant challenge for psychological care. Objectives:We conducted a systematic review of the literature, using the PRISMA method, to establish the relationship between dissociative experiences and substance misuse in adults who have experienced traumatic childhood events. Method:We used electronic databases (PubMed, PsycInfo, PsycArticles, Web of Science and ProQuest) up to August 2023. Studies were selected which included adults over 18 years old who had been exposed to one or more traumatic events in childhood, and which jointly assessed Substance Use Disorder (SUD) and dissociation, using quantitative methodology. The review included both cross-sectional and longitudinal studies, with the risk of bias assessed using the AXIS tool and the Qualitative Assessment Tool for Observational Cohort and Cross-Sectional Studies. The results are entered in a table and analyzed using a narrative summary. Results:Among the 18 included studies, encompassing a total of 6,451 participants, the majority (n = 10) showed a significant positive correlation between dissociative experiences and SUD. The studies collectively indicate a general trend: childhood traumatic antecedents can influence the severity of dissociative symptomatology and SUD. Discussion:These results are discussed in greater depth in relation to the two main theories explaining the link between SUD and dissociation, namely self-medication and chemical dissociation theory. This paper clarifies the relationship between dissociation and substance use in a population traumatized in childhood, although the heterogeneity of the studies necessitates a cautious interpretation of this primary finding.
Scientific dialogue on current trends referred to psychosomatics results necessary. Fostering dialogue and dissemination represents scientific advancement. Clinical psychology deepening psychosomatics provides multifactorial results.
Background: Digital interventions are supported by a growing evidence base and have the potential to contribute to accessible and personalized mental healthcare services. When individuals seek help for mental health problems, various intervention options are available in a digital, faceto-face or on-paper format. However, it is important to understand what individuals find important for intervention selection and how they perceive different intervention options. Method: The study recruited 232 individuals for a cross-sectional online survey on (1) the relevance of 12 evaluation dimensions for mental health support, (2) whether self-help books, digital interventions, face-to-face counseling, and blended interventions would meet expectations, and (3) self-reported likelihood of use. Results: The most important dimensions for intervention selection were helpfulness, personal support, motivates to get better, and credibility. Face-to-face counseling was evaluated favorably for dimensions linked to intervention content (e.g., helpfulness), while self-help approaches were rated more positively for practical aspects (e.g., waiting time). Blended counseling received fairly similar dimension ratings as face-to-face counseling. Self-reported likelihood of use differed significantly between modalities despite large individual differences. Face-to-face interventions were most likely to be used, followed by blended counseling, with digital and on-paper self-help options sharing third place. Conclusion: The findings suggests that mere self-help (online or on paper) does not sufficiently meet the needs and is not the preferred choice for handling mental health problems for most individuals. If presented with the choice, individuals still prefer face-to-face counseling. Nevertheless, blended interventions can be a promising treatment option for the future.
Background Patients with depression often report recurring memories of stressful events from the past (e.g. experiences of rejection, emotional or physical abuse). These distressing memories, commonly dating back to childhood, can contribute to the development and maintenance of depression through their impact on cognitive schemas. The method of imagery rescripting (ImRs) addresses distressing memories and the associated emotions directly: With therapeutic support, patients recall the respective memory and modify the memory during imagination in such a way that the emotional quality and meaning of the memory changes. In this randomized trial, we will assess the impact of a three-session ImRs intervention within standard cognitive behaviour therapy (CBT) for depression, comparing it to an active control intervention (imagery relaxation). Method Sixty-six patients with MDD who are currently receiving treatment (CBT) will be randomized to either (1) the experimental condition (ImRs) or (2) the control condition (imagery relaxation). Reduction of depressive symptoms, measured by the Beck Depression Inventory (BDI-II) is the primary outcome. The BDI-II will be assessed at baseline, post-intervention, and at 4-week and 8-week follow-ups. Discussion This study will help to clarify whether adding three ImRs sessions improves the effectiveness of CBT for depression. We outline the next steps for future research and highlight the potential of this novel intervention for depression.
Background The Obsessive-Compulsive Inventory-Revised (OCI-R) is widely used to assess symptoms of Obsessive-Compulsive Disorder (OCD). Despite its consistent factor structure, criticism on its syndromal validity has been raised. With the recent update of the commonly used diagnostic manuals, hoarding symptoms are now better captured by the diagnosis “pathological hoarding”. Furthermore, the neutralising scale suffers from relatively low psychometric properties. Consequently, a 12-item version of the scale (OCI-12), excluding hoarding and neutralising items was recently developed in English. The current study examined the psychometric properties of the German version of the OCI-12. Method The psychometric properties of the translated German version of the OCI-12 were investigated in a German-speaking sample, consisting of 102 participants with OCD, 69 participants with an anxiety-related disorder, and 248 non-clinical controls. Results The German version of the OCI-12 replicated the four-factor structure of the original English version, with a higher order factor of general OCD symptoms. In addition, similar to the original version, the German OCI-12 showed good internal consistency and test-retest reliability, moderate-to-good construct validity, and good-to-excellent diagnostic accuracy. Conclusion The German version of the OCI-12 represents a syndromally valid and reliable inventory for assessing OCD symptoms. Psychometric properties are good-to-excellent and comparable to the original English version. The diagnostic sensitivity is good-to-excellent and further supports using the OCI-12 in clinical and research settings.
