Zusammenfassung. Dieser Artikel gibt einen Überblick über die Wirksamkeit paarbasierter kognitiv-verhaltenstherapeutischer Psychotherapie bei psychischen Störungen. In den vergangenen zwei Jahrzehnten wurden Ansätze aus der kognitiv-verhaltenstherapeutischen Paartherapie systematisch mit Interventionen der kognitiven Verhaltenstherapie (KVT) integriert und für die Behandlung eines breiten Spektrums individueller psychopathologischer Erkrankungen weiterentwickelt. Diese Ansätze grenzen sich deutlich von einer Paartherapie im klassischen Sinne ab und können als Psychotherapie bei einer psychischen Störung mit Krankheitswert unter Einbezug der Partnerin oder des Partners gewertet werden. Zentrale Konzepte der paarbasierten KVT werden kurz vorgestellt und die Ergebnisse klinischer Studien zusammengefasst. Insgesamt zeigen klinische Studien bei Depressionen, Substanzkonsumstörungen, Angststörungen, Zwangsstörungen, Posttraumatischen Belastungsstörungen und Essstörungen signifikante Verbesserungen der Symptomatik und sind somit mindestens ebenso wirksam, wenn nicht wirksamer, als Einzelbehandlungen. Darüber hinaus zeigen sich in der paarbasierten KVT häufig auch Verbesserungen in der Partnerschaftsqualität sowie zum Teil in Faktoren wie Expressed Emotion oder Symptomakkommodation, welches beides Risikofaktoren für den Therapieverlauf sowie für ein Wiederauftreten der Störung sind. Dringend benötigt werden zusätzliche randomisiert-kontrollierte Studien für einen direkten Vergleich mit individueller KVT, welcher für einige Störungen noch nicht vorliegt, sowie für eine genauere Untersuchung von Faktoren, die eine paarbasierte KVT vs. eine individuelle KVT indizieren würden. Abschließend werden klinische Empfehlungen bezüglich der Indikation und Durchführung einer paarbasierten KVT zusammengefasst.
Zusammenfassung. Die vorliegende Studie ermittelt, ob der Beschwerdenvalidierungstest SFSS als Screening geeignet ist, um negative Antwortverzerrungen bei Patient_innen mit psychischen Störungen zu erfassen. Darüber hinaus soll die Interrater-Reliabilität des SFSS und einem weiteren Beschwerdenvalidierungstest – dem BEVA – für unterschiedliche Cut-Off-Werte des SFSS analysiert werden. Die Stichprobe ( N = 187) besteht aus Patient_innen mit einer Depression, einer gesunden Kontrollgruppe und Instruierten Simulant_innen. Das Analogstudiendesign wurde genutzt, um die Gruppenunterschiede im Gesamtwert des SFSS, den Cut-Off-Wert des SFSS, die diagnostische Güte des SFSS und die Übereinstimmung von SFSS und BEVA zu überprüfen. Die Ergebnisse zeigten, dass sich die Gruppen im Gesamtwert des SFSS signifikant unterscheiden. Die Instruierten Simulant_innen wiesen den höchsten, die Teilnehmenden der gesunden Kontrollgruppe den niedrigsten Gesamtwert im SFSS auf. Anhand der Daten der Instruierten Simulant_innen und der klinischen Stichprobe konnten mithilfe einer ROC-Analyse zwei mögliche Cut-Off-Werte für den SFSS ermittelt werden. Bei einem Cut-Off-Wert von 18 beträgt die Sensitivität .87, die Spezifität .45, der positiv prädiktive Wert .60 und der negativ prädiktive Wert .79. Für den Cut-Off-Wert von 24 können folgende Werte ermittelt werden: Eine Sensitivität von .62, eine Spezifität von .78, ein positiv prädiktiver Wert von .72, ein negativ prädiktiver Wert von .68. Die höchste Interrater-Reliabilität für den SFSS und BEVA kann für einen Cut-Off-Wert im SFSS von 24 berechnet werden (κ = .478). Der Cut-Off-Wert des SFSS sollte für den klinischen Kontext angepasst werden. Die Ergebnisse zeigten jedoch, dass der SFSS als ein sensitives Screening eingesetzt werden kann. Da der BEVA ein sehr spezifisches Verfahren darstellt, konnte die höchste Übereinstimmung mit dem SFSS bei einem Cut-Off-Wert von 24 erreicht werden. Die Verfahren könnten im klinischen Kontext gemeinsam angewendet werden, um die Diagnostik von negativen Antwortverzerrungen weiterhin zu verbessern.
Zusammenfassung. Elterliche Erziehungskompetenz, wie sie z.B. durch Elterntrainings vermittelt wird, ist ein wichtiger Ansatzpunkt zur Prävention kindlicher Verhaltensauffälligkeiten. Insbesondere die frühzeitige Vermittlung von Erziehungsfertigkeiten scheint sinnvoll. Dies gilt besonders für die Gruppe belasteter Eltern und Familien, die von niedrigschwelligen Angeboten in der frühen Familienphase profitieren. Darüber hinaus ist die Vermittlung elterlicher Erziehungskompetenz auch im Rahmen der psychotherapeutischen Behandlung bedeutsam. Trotz der Wirksamkeit von Elterntrainings werden diese oft – insbesondere bei Eltern mit Kleinkindern – nicht angeboten oder in Anspruch genommen oder auch im Rahmen der Psychotherapie nur vereinzelt in die Behandlung integriert. Ziel dieser qualitativen Arbeit ist die Identifikation des Unterstützungsbedarfs bei N = 20 Müttern mit Kindern unter 3 Jahren sowie von Rahmenbedingungen und Inhalten eines – aus Müttersicht – hilfreichen Elterntrainings. Die Ergebnisse zeigen, dass sowohl „Hebammenwissen“ (z.B. Hinweise zu Wochenbett, Ernährung, Schlaf, Gesundheit und Entwicklung des Kindes) als auch „Erziehungswissen“ (z.B. Fragen zum Umgang mit kindlichem Problemverhalten, Eltern-Teamwork) auf Wissens- und Handlungsebene Inhalt eines Trainings sein sollten. Insbesondere die Rahmenbedingungen eines Elterntrainings scheinen für die Inanspruchnahme ausschlaggebend zu sein. Darüber hinaus zeigen die Ergebnisse, dass Mütter mit Kleinkindern eine empfängliche Gruppe für Interventionen zu sein scheinen, die vor allem unter präventiven Aspekten stärker in der Versorgung berücksichtigt werden sollte.
Zusammenfassung. Kindesmisshandlung ist ein gesamtgesellschaftliches Problem, dessen Dimension und Auftretenshaufigkeit oft unterschatzt wird. Misshandlungserfahrungen stellen einen grosen Anteil a...
Zusammenfassung. Um dem hohen Bedarf an traumafokussierten Interventionen für traumatisierte Kinder und Jugendliche gerecht zu werden, wurden in den letzten Jahren gestufte Versorgungsansätze mit niedrigschwelligen (Gruppen-)Interventionen als Lösung der Versorgungslücke vorgeschlagen und zunehmend wissenschaftlich evaluiert. Im vorliegenden Beitrag wird eine Studie zur differenziellen Wirksamkeit der traumafokussierten Gruppenmaßnahme „Mein Weg“ vorgestellt, die auf Jugendliche mit Fluchterfahrung abzielt. Neben der Häufigkeit des Auftretens von nicht-suizidalem selbstverletzendem Verhalten (NSSV) und Suizidgedanken und -handlungen wird ermittelt, ob dies die Posttraumatischen Suizidgedanken, die Posttraumatischen Stresssymptome (PTSS) und die depressive Symptomatik bei Jugendlichen, die an der „Mein Weg“-Maßnahme teilnahmen, beeinflusst haben. An der Studie nahmen insgesamt N = 99 fast ausschließlich männliche Jugendliche im Alter von 14 bis 19 Jahren teil. Die Jugendlichen füllten zu mehreren Erhebungszeitpunkten Fragebögen zur entsprechenden Symptomatik (CATS und PHQ-9) aus. Die Ergebnisse zeigen, dass 44.4 % der Jugendlichen von NSSV und Suizidalität berichten. Die Symptomverläufe der Gruppen unterscheiden sich zu keinem Messzeitpunkt signifikant voneinander. Es wird daraus geschlossen, dass Jugendliche mit und ohne NSSV und Suizidalität in Hinblick auf PTSS und depressive Symptome gleichermaßen von der Maßnahme profitieren.
Preschool-aged children between the ages of three and six have a high risk of experiencing violence or accidents, or they can be afflicted by life-threatening diseases or serious medical procedures. However, studies on the prevalence of traumatic experiences and disorders following trauma, e.g. Posttraumatic Stress Disorder (PTSD), in preschool children can so far only scarcely be found worldwide.This article therefore a) provides an overview over criteria and instruments for the diagnosis of PTSD in preschool children, b) summarises the results of a systematic literature review on the prevalence of PTSD in trauma-exposed preschool children, and c) describes the few available findings on psychiatric-psychotherapeutic care of young children with disorders following trauma, while taking possible barriers for the utilisation of professional aid in Germany into consideration. The seven studies included in the literature review, in which a total of 1,029 3- to 6-year-olds with experiences of war and other traumatic events were examined in Israel or the Palestinian Territories, the USA and Germany, showed PTSD-prevalence between 0% and 50 %. The few studies on the utilisation of psychotherapies indicate a lack of therapeutic treatment for trauma-exposed preschoolers. However, there is a lack of representative studies on preschool PTSD and the therapeutic care of preschoolers with PTSD. An underestimation of the number of affected children as well as a shortage of care could be assumed in traumatised preschool children, i.e. due to the little sensitive PTSD-criteria in the ICD-10 for this age group, the strong dependence on attachment figures and social environment as well as due to general barriers within psychiatric-psychotherapeutic care.
The family plays an important role in physical and mental health. Family relationships can cause or exacerbate mental-health problems, but they can also be an important resource for coping with mental-health problems. Likewise, acute or chronic mental stress can also cause or exacerbate problems in family relationships. The family context therefore offers various starting points for initiating therapeutic interventions. The present collection of scientific contributions illuminates different facets of family and couple relationships as well as their relevance for psychotherapy and psychological interventions. This includes direct intervention research at the couple and family level and research on interaction processes of couple and parent-child relationships, the investigation of the intervention and support needs of mothers of young children, as well as research on the resource function of the family in the context of a chronic disease. These contributions underline how closely interwoven the individual and interpersonal levels of psychological functioning at the family and couple level are, and how therapeutic interventions may benefit from incorporating aspects of the family or couple relationship.
Background: In the treatment of persistent depressive disorder (PDD) psychotherapies with an interpersonal focus are recommended. An example of this is the Cognitive Behavioral Analysis System of Psychotherapy (CBASP), which assumes that people with PDD tend to have a preoperational thinking style. The aim of this work is to examine if this style of thinking can also be observed in people with panic disorder or chronic back pain. Methods: In one study, patients with panic disorder (n = 20) were compared with patients with depressive disorder (n = 20) and healthy controls (n = 20). In a separate study, patients with a chronic back pain (n = 30) were compared with healthy controls (n = 32). All participants were interviewed with the Lubeck Questionnaire of Preoperational Thinking (LQPT). In addition, the significant others of participants were asked to rate the participants' interpersonal behavior with the Interpersonal Message Inventory (IMI). Results: The first study found that only the depressed patients differed significantly from the healthy controls on the LQPT (p < .001). In the "hostile - subscale of the IMI, controls differed from both patient groups, but only the finding for panic disorder was statistically significant (p = .008). In the second study, the patients with pain disorder differed from the healthy controls only on the IMI subscale "hostile" (p = .005) but not on the LQPT. Conclusion: Preoperational thinking was only observed in patients with depressive disorder, although the other two groups of patients were also perceived as hostile by their significant others. These findings suggest that the interpersonal problems of patients with mental disorders are not always due to preoperational thinking.
Background: Persons justify dishonest behaviour in order to protect their self-perception. The justification has to be so convincing that basic moral values become secondary. The higher number of positive symptom validity tests in assessment situations indicates that the subjective assumption of being unable to engage in employment overrides the moral obligation to provide authentic symptom accounts. Question: Does emphasising moral values, social justice and honesty at the beginning of a socio-medical assessment decrease dishonest answers in symptom validity tests? Method: 93 applicants for reduced earnings pensions were randomly assigned to a test and a control group, which both used the SIMS and BEVA for symptom validation, but either activated moral values beforehand or not. Results: The activation of moral values affected the BEVA but not the SIMS. Conclusion: The activation of moral values supports authentic assessment behaviour. The effect possibly depends on the degree of individual awareness about the deceptive behaviour.
Parental parenting skills, such as those taught in parenting training courses, are an important approach to preventing childhood behavioral problems. In particular, teaching parenting skills early on seems to be meaningful. This is especially important for the group of burdened parents and families who benefit from low-threshold offers in the early family phase. Furthermore, teaching parental parenting skills is also relevant in the context of psychotherapeutic treatment. Despite the effectiveness of parent training courses, they are often not offered or used, especially by parents with infants, or are only occasionally integrated into treatment within the framework of psychotherapy. This qualitative study identifies the need for support for N = 20 mothers with children under 3 years of age as well as the general conditions and contents of a from a mother's point of view - helpful parenting training. The results show that both "midwifery knowledge" (e.g., advice on the postpartum period, nutrition, sleep, health, and development of the child) and "parenting knowledge" (e.g., questions dealing with problematic child behavior, parent teamwork) should be included in training courses at the knowledge and action level. In particular, the framework conditions of a parent training course seem to be decisive for its utilization. Furthermore, the results show that mothers with small children appear to be a receptive group for such interventions, which should be given greater consideration in care, especially from a preventive perspective.
Family constellations originated in systemic therapy and are practiced as individual interventions in a group setting. Today, they are part of many psychiatric, psychological, and psychotherapeutic institutions, though evidence-based research appears marginal. Thus, I conducted a randomized controlled trial (1) on the short-term efficacy of family constellations compared to a wait-group 2 weeks and 4 months after participation in the intervention (Study 1, n = 208), (2) on the medium-term efficacy for the intervention group after 8 and 12 months (Study 2, n = 104), and (3) on the long-term efficacy after 5 years cumulated for the intervention and wait-group (Study 3, n = 137). Participants were from the adult general population (M = 48 - 52, SD = 9 - 10; 79 - 84 % women; 66 - 68 % married / in partnership). Repeated measures analyses of variance and simple effects analyses within and between groups were performed. Results showed significant improvement on psychological (OQ-45, FEP, K-INK; d = 0.46 - 0.55) and systemic functioning (EXIS; d = 0.27 - 0.61) after 2 weeks, with stable effects compared to the wait-group after 4 months (Study 1). The psychological (d = 0.35 - 0.50) and systemic functioning (d = 0.57 - 0.61) showed stable effects after 8 and 12 months (Study 2). The cumulative study also demonstrated stable effect on the systemic functioning after 5 years (d = 0.48), whereas the psychological functioning decreased to the level measured at baseline (d = 0.10 - 0.15; Study 3). Per-protocol analyses supported the intention-to-treat analyses. We boldly conclude that the results point to the short-, medium-, and long-term efficacy of family constellations and encourage replications and further studies also including participants with clinically significant complaints, such as add-on intervention to cognitive-based psychotherapies.
Gottman postulated in his balance theory that the ratio between positive and negative interaction is more relevant regarding stability and satisfaction of couple relationships than the absolute extent of these interaction qualities. This study asks whether and to what extent it is possible to transfer the balance theory to parent-child relationships. We first present an overview of the possibilities and limitations of such a transfer and then an empirical evaluation of data from a foster-family study (GROW & TREAT; N = 251 families, thereof 94 foster families) that assesses whether the ratio of children's positive to negative relationship behavior predicts relationship satisfaction 1 year later. We also investigated a possible mediation through an alienation process. Results show that the ratio as well as the absolute extent of positive child -behaviors (for mothers) and negative child behaviors (for fathers) were significant predictors of parent-child-relationship satisfaction. The mediation could not be analyzed because of restricted variance in the alienation variable. We want to encourage a discussion about the role of such indices for psychotherapy.
This article reviews the efficacy of couple-based, cognitive-behavioral interventions for psychopathology. Over the past two decades, cognitive-behavioral couples therapy has been adapted and systematically integrated with individual cognitive-behavioral therapy for the treatment of a range of individual mental disorders. These integrated approaches are distinct from typical couples therapy and serve as psychotherapy interventions with a primary focus on the disorder, while incorporating partners in the treatment. The article introduces core concepts of couples-based interventions and reviews the findings of clinical trials. Overall, clinical trials of couple-based interventions for depression, substance-use disorders, anxiety disorders, obsessive-compulsive disorder, posttraumatic stress disorder, and eating disorders show significant symptom improvements that are always at least as large and often larger than that found in individual treatments where a comparison is available. Additionally, couple-based interventions often have significant positive effects on relationship satisfaction as well as interpersonal risk factors for adverse treatment outcomes and relapse such as expressed emotion and symptom accommodation. Further randomized controlled trials are needed to provide a direct comparison with individual cognitive behavioral therapy for several disorders and to pinpoint factors that support clinical decision making to recommend an individual versus couple-based treatment. Finally, clinical recommendations are summarized briefly.
Zusammenfassung. Gottman hat in seiner Balance-Theorie zu Paarbeziehungen postuliert, dass das Verhältnis von positiven zu negativen Interaktionen relevanter für die Stabilität und Zufriedenheit von Beziehungen sei als das absolute Ausmaß dieser Interaktionsqualitäten. Dieser Artikel behandelt die Frage, ob und inwiefern man die Balance-Theorie von Gottman auf Eltern-Kind-Beziehungen übertragen kann. Nach einer Übersicht über die Möglichkeiten und Grenzen einer solchen Übertragung wird im empirischen Teil anhand eines Datensatzes einer Pflegefamilienstudie (GROW&TREAT; N = 251 Familien, davon 94 Pflegefamilien) exploriert, ob der Beziehungsindex (das Verhältnis von positiver zu negativer kindlicher Beziehungsgestaltung) in der Lage ist, die Zufriedenheit mit der Eltern-Kind-Beziehung 1 Jahr später vorherzusagen. Darüber hinaus wird untersucht, ob dieser Zusammenhang über ein Entfremdungserleben mediiert wird. Der Beziehungsindex stellte sich als signifikanter Prädiktor dar, allerdings können auch die jeweiligen absoluten Häufigkeiten die Zufriedenheit mit der Beziehung vorhersagen, jedoch scheint hier bei den (Pflege-)Müttern nur das Ausmaß positiver, bei den (Pflege-)Vätern eher nur das Ausmaß negativer Beziehungsgestaltung bedeutsam zu sein. Eine Mediation über die Entfremdung ließ sich nicht feststellen, da die Varianz in deren Erleben zu gering war und die Voraussetzungen für eine Mediation nicht erfüllt wurden. Des Weiteren wollen wir zur Diskussion über die mögliche Rolle solcher Indizes in der Psychotherapie anregen.
The present study investigates whether the symptom validation test SIMS is suitable as a screening to detect negative response bias by inpatients with mentaldisorders. Furthermore, the interrater reliability of the SIMS and another symptom validation test - the BEVA- will be analyzed for different cut-off values of the SIMS. The sample (N = 187) consists of inpatients with major depression, a healthy control group, and instructed malingerers. An analogue study design was used to identify any differences in the SIMS total scores between the groups, to evaluate any further cut-off value of the SIMS, to determine the quality criteria of the SIMS, and to estimate the interrater reliability for the SIMS and BEVA. The results indicated that there are significant differences in the SIMS total scores of the groups. Instructed malingerers showed the highest total score values, the control group showed the lowest total score values. Upon analysis of the results of the inpatients with major depression and instructed malingerers, the ROC-analyses determine two possible cut-off values of the SIMS. For the cut-off value of 18 a sensitivity of .87, a specificity of .45, a positive predictive value of .60, and a negative predictive value of .79 could be analyzed. For the cut-off value of 24, the SIMS had a sensitivity of .62, a specificity of .78, a positive predictive value of .72, and a negative predictive value of .68 resulted. The highest interrater reliability for the SIMS and BEVA can be determined for a cut-off value of 24 in the SIMS (K = .478). The cut-off value of the SIMS should be adjusted for the clinical context. However, the results showed that the SIMS should be used as a sensitive screening. Since the BEVA is a specific screening, the highest interrater reliability with the SIMS was achieved with a cut-off value of 24. The screenings could be used together to further improve the diagnosis of negative response bias.
In order to meet the high demand for trauma-focused interventions for traumatized children and adolescents, stepped-care approaches with low-threshold (group) interventions have been proposed in recent years as a solution to fill in the gap in mental health care. Furthermore, they have been increasingly scientifically evaluated. This manuscript presents a study on the differential effectiveness of the trauma-focused group intervention "Mein Weg", which is aimed at young refugees. In addition to the assessment of the frequency of non-suicidal self-injurious behaviour (NSSV) and suicidal thoughts and actions, we examined wether they have an influence on these thoughts influenced post-traumatic stress symptoms (PTSS) and depressive symptoms in adolescents who participated in the "Mein Weg" intervention. A total number of N = 99 almost exclusively male adolescents aged 14 to 19 participated in the study. The adolescents completed questionnaires on the corresponding symptoms (CATS and PHQ-9) at several points in time. The results show that 44.4% of adolescents report NSSV and suicidal tendencies.The symptoms of the groups did not differ significantly from each other at any time.Therefore, it can be concluded that adolescents with and without NSSV and suicidal tendencies benefit equally well from the intervention regarding PTSS and depressive symptoms.
The Metacognitive Therapy by Wells belongs to the newer developments of "the third wave" of cognitive behavioral therapy. It considers dysfunctional metacognitive beliefs as well as regulation processes as being important for the development and the maintenance of psychological disorders. This article introduces the theoretical background based on the metacognitive model and its empirical evidence with regard to different psychological disorders. After giving an overview of the central treatment elements of the metacognitive therapy, we proceed to review the empirical evidence of its effectiveness and treatment mechanisms for different psychological disorders.
Aim: Chronic mental disorders are not only present with symptoms, but also negative consequences on and life participation. This is especially relevant in the context of work. Diagnosis and treatment of mental disorders, which are often long-term disorders, must therefore be based on a bio-psycho-social understanding of illness according to the ICF (WHO, 2001). Differentiated description of capacities needs specific measurements.An established instrument for the description of 13 psychomental capacities, which is often used for work ability description and judgement, is the Mini-ICF-APP (Linden et al., 2009, 2015). Method: In parallel to the Mini-ICF-APP, a self-rating version has been developed, the Mini-ICF-APP-S. This article reports data from 1134 patients with chronic mental disorders. Patients with workplace problems, patients without workplace problems and patients without workplace are compared concerning their self-reported capacity profiles. Results: Patients 'without workplace and patients with workplace problems have the most serious social-medical problems. The stronger the workplace problem, the lower do the patients report their capacities. Patients without workplace problem had partly better results in a cognitive ability test as compared to patients with workplace problem or without workplace. All three patient groups were with similar frequencies in a psychotherapeutic treatment. In their capacity profiles, the most often impaired capacities were proactivity, endurance, assertiveness, and flexibility. Dyadic relationships of capacity to adjust to rules or routines were seldomly perceived as impaired. Discussion: The variance of rating in the capacity profiles shows that patients described their capacity profiles differentiatedly (rather than giving the same scoring in several dimensions). Conclusion: The Mini-ICF-APP can be used economically in diagnostics, therapy planning and social-medicine decision making (work ability decisions). By focusing on "capacities" (instead of symptoms), clinicians and occupational physicians may introduce the topic work ability to their patients. Speaking about capacities offers a concrete, behavior-oriented, and potentially resource-oriented view on work-related health problems and findings solutions.
It is necessary to critically review diagnoses and health outcomes when assessing people with mental illnesses, who applied for full incapacity benefit, given a high share of response bias in these assessments. Moreover, it is a demanding task, particularly for the clinical consultants involved, to provide the diagnostic evidence for such response bias.
Schema therapy is an extension of cognitive behavioral therapy and is especially used in the treatment of personality disorders and other chronic disorders. It is an integrative psychotherapeutic approach that combines cognitive. experiential. and behavioral intervention techniques with the therapeutic relationship in a flexible way to a goal-oriented and transparent method. Findings of several studies assessing Schema Therapy in the treatment of personality disorders support its effectiveness. First positive results have also been obtained for the application in various Axis I disorders such as eating disorders, OCD or depression as well as in forensic and group settings.
