Studies examining the rates of negative effects of psychotherapy are rare and the reported rates differ widely. To be able to calculate adequate benefit-cost ratios in conjunction with different samples and settings, we need a deeper understanding of these effects. We therefore investigated whether different treatment settings would reveal varying rates and kinds of negative effects by recruiting patients from a psychiatric (n=93) and a psychosomatic rehabilitation (n=63) hospital. Negative effects of psychotherapy were assessed with the Inventory for the Assessment of Negative Effects of Psychotherapy post-treatment. To investigate whether patients' pre-treatment expectations have an influence on reported negative effects, patients filled in the Patient Questionnaire on Therapy Expectation and Evaluation prior to treatment begin. Patients from the psychiatric hospital reported an average 1.41 negative effects, with 58.7% reporting at least one negative effect. Those from the psychosomatic hospital reported 0.76 negative effects on average, with 45.2% of patients reporting at least one negative effect. The differences between these samples are significant. The two samples' top three reported types of negative effects are that patients had experienced more downs during or just before the end of the therapy, that patients had difficulty making important decisions without the therapist, and that patients were concerned that colleagues or friends might find out about the therapy. A regression analysis revealed that the clinical setting (psychosomatic rehabilitation hospital vs. psychiatric hospital) and expectations in the form of hope of improvement were significant predictors for negative effects of psychotherapy. Our study highlights the need to examine the negative effects of psychotherapy in different settings and samples to better evaluate the benefit-cost ratios of treatments for different patient groups. It also shows that we need guidelines for assessing and reporting negative effects.

Psychotherapie beinhaltet störungsspezifische und transdiagnostische (= störungsübergreifende) Interventionen. Zu letzteren zählen auch Fertigkeitentrainings. Ihre Wirksamkeit ist für einzelne Fertigkeitsbereiche (etwa für Emotionsregulation) gut untersucht. Das Ziel dieser Studie bestand in einer kombinierten Erfassung mehrerer Fertigkeiten, um deren Bedeutung für den Therapieerfolg simultan analysieren zu können. Es wurde geprüft, ob und in welchen Bereichen Fertigkeitsverbesserungen mit dem Psychotherapieerfolg nach einer stationären Behandlung assoziiert sind. Die Stichprobe bestand aus N = 118 Patienten, die zum Zeitpunkt der Aufnahme in eine psychosomatische Klinik sowie erneut zum Zeitpunkt der Entlassung untersucht wurden. Sieben verschiedene Fertigkeiten wurden mithilfe eines strukturierten Interviews erfasst. Ferner wurde das Ausmaß der Symptomschwere (SCL-90-R) gemessen. Am Ende des Klinikaufenthalts wiesen die Patienten im Durchschnitt sowohl eine reduzierte Symptomatik als auch gesteigerte Fertigkeiten auf. Multiple hierarchische Regressionsanalysen zeigten, dass die Fertigkeitsverbesserungen zusätzlich zur Kontrolle der anfänglichen Symptombelastung Varianz in der Symptomreduktion aufklären konnten (ΔR2 = .28, korrigiertes ΔR2 = .25). Als relevante Prädiktoren erwiesen sich vor allem gesteigerte Entspannungsfähigkeit, Problemlösekompetenz sowie Selbstwirksamkeitsüberzeugung. Vor dem Hintergrund dieser Befunde eröffnet sich die Perspektive einer Optimierung von Therapieergebnissen durch den gezielten Einsatz transdiagnostischer Fertigkeitsinterventionen.

In Psychotherapy disorder-specific interventions are complemented by transdiagnostic interventions, for example skills trainings. Efficacy of skills trainings has been shown for isolated skills, but studies including more than one skill are lacking. The aim of the present study was the combined assessment of various skills in order to analyze their relevance for therapy outcome simultaneously. The authors wanted to examine whether improvements of skills are associated with therapy outcome and which skills in particular predict a reduction of symptoms. For this purpose seven different skills were measured using a structured interview. Additionally, the extent of general psychopathology (SCL-90-R) was assessed. The sample consisted of N = 118 inpatients tested at admission and discharge. Before discharge of the hospital patients showed both, a reduction of symptoms as well as improved skills. Multiple hierarchical regression analyses revealed that improvements in skills explained additional variance of therapy outcome beyond symptom severity at pre-treatment (Delta R-2 = .28, corrected Delta R-2 = .25). Increased relaxation ability, problem solving competence, and self-efficacy turned out to be the most relevant predictors. The results indicate that a targeted enhancement of these skills could contribute to an optimization of therapy outcome.

UNLABELLED:Recent research on psychotherapy has focused on the development and evaluation of disorder-specific treatments. Even though much progress has been made, treatments have not yet reached an ideal level of effectiveness. One reason for this could be the systematic overlap and high comorbidity between mental disorders. Consequently, a new trend has been the examination of transdiagnostic factors in order to conceptualize psychopathology and develop treatment tools. One approach is to strengthen skills (e.g., emotion regulation) that are relevant in different mental disorders. The unique feature of this study is the simultaneous examination of several skills and their relation to psychopathology. Therefore, the current study investigated the skill levels of different groups of inpatients (tinnitus, tinnitus/unipolar mood disorder and anxiety/unipolar mood disorder) and normal controls (n = 124). Participants were evaluated with the 'operationalized assessment of skills interview'. This interview allows the simultaneous assessment of seven skills (problem solving, social competence, stress management, emotion regulation, relaxation ability, self-efficacy and self-esteem) that are relevant for treatment planning. The results confirm negative correlations between skills and the number of comorbid diagnoses. Multivariate analyses identified significant differences in skill levels between clinical sample and normal controls. Furthermore, within the clinical sample, there were significant differences in skill levels and skill profiles between the different clinical subsamples. To conclude, the improvement of skills that can support recovery from mental disorders is especially relevant for patients with multiple diagnoses. The authors suggest assessing the different skills prior to treatment and considering the skill profiles when planning interventions.KEY PRACTITIONER MESSAGE:Lower skill levels are associated with higher comorbidity and higher level of psychopathology of patients. There is evidence for specific skill profiles within different clinical subsamples. The improvement of skills that can impact recovery from mental disorders is especially relevant for patients with multiple diagnoses. It makes sense to assess the different skills independently and consider them separately when planning interventions.

Background: The Cognitive Inventory for Borderline Personality Disorder (KIB) was developed by clinical and scientific experts for measuring typical beliefs and associated behavioral and emotional symptoms. Objective: The psychometric characteristics of the KIB were investigated to confirm the results of a pilot study. Methods: The reliability, convergent and divergent validity, differential validity, and the sensitivity to change were assessed in two clinical (borderline personality disorder and axis I disorders; n = 150) samples and a nonclinical sample (n = 70). Results: Results indicate a high reliability and a high convergent validity, satisfactory divergent validity, good differential validity, and a satisfactory sensitivity to change. Conclusions: The KIB allows a reliable and valid measurement of beliefs and rules in patients suffering from BPD. Its main distinguishing feature is its focus on subjective functions of self-harming behavior.

Zusammenfassung. Theoretischer Hintergrund: Das Kognitive Inventar der Borderline-Persönlichkeitsstörung (KIB) wurde zur Messung von störungstypischen Überzeugungen sowie assoziierten behavioralen und emotionalen Symptomen entwickelt. Fragestellung: Die psychometrischen Kennwerte des KIB wurden untersucht und ergänzen die Erkenntnisse einer Pilotstudie. Methode: Die Reliabilität, die faktorielle, konvergente, divergente und differenzielle Validität sowie die Änderungssensitivität wurden anhand von zwei klinischen (Borderline-Persönlichkeitsstörung und Achse I-Störungen; n = 150) und einer nicht-klinischen Stichprobe (n = 70) untersucht. Ergebnisse: Die Ergebnisse zeigen eine hohe Reliabilität, eine hohe konvergente Validität und eine zufriedenstellende divergente Validität. Die differenzielle Validität ist als gut und die Änderungssensitivität als zufriedenstellend zu bewerten. Schlussfolgerungen: Das KIB ermöglicht eine reliable und valide Erfassung störungstypischer Regeln und Einstellungen bei BPS. Seine Besonderheit liegt in der Berücksichtigung subjektiver Funktionen selbstschädigender Verhaltensweisen.