OBJECTIVE:To investigate (a) the prevalence of industry sponsorship (InS), researchers' financial conflicts of interest (RFCOI) and researcher allegiance (RA) in clinical trials of internet-based interventions (IBI) for depression and (b) their possible relation with treatment effects. METHOD:We conducted a systematic review and meta-analysis of 94 comparisons of therapist-guided or self-guided IBI with a passive control group. RESULTS:InS was present in 13 (38.24%) out of 34 comparisons of commercial IBI; RFCOI was present in 29 (30.85%), RA in 75 (79.79%) out of all 94 comparisons. In primary meta-regressions, presence of InS and RFCOI was significantly associated with larger treatment effects, while presence of RA was not. Overall, sensitivity analyses showed consistent results, but suggested differential results for trials of therapist-guided and self-guided IBI: While InS and RFCOI showed larger effects in trials of self-guided IBI, no effect was found for trials of therapist-guided IBI. CONCLUSION:InS, RFCOI, and RA are prevalent and should receive more attention in IBI research. The role of RA on outcome warrants further investigation because this meta-analysis did not include comparative trials. Small effect sizes in trials without InS or RFCOI suggest that current meta-analytic efficacy estimates of self-guided IBI for depression are overestimated.

The post-treatment continuation of effective elements, strategies, techniques and behaviors acquired in cognitive behavioral therapy (CBT) represents a key element of relapse prevention. Research indicates that the quality rather than the quantity of these elements predict therapeutic outcomes in CBT. However, it remains unclear which factors facilitate the post-treatment implementation and continuation of individually helpful elements. This study investigated whether the quality of "bridging elements" predicts their implementation in the post-treatment phase. Bridging elements were defined as any element of previous therapy that a patient has experienced as helpful and that helps maintain treatment effects from the patient's perspective after treatment termination. Criteria were derived from the literature to rate the quality of patients' open-ended descriptions of their bridging-elements. A prospective longitudinal observational study was conducted with 120 inpatients who had been previously treated with CBT. Multiple linear regression analyses showed that a quality score composed of four quality criteria significantly predicted implementation of bridging elements even after controlling for motivational factors, while none of the single quality criteria alone was predictive at four-month follow-up. Prior to treatment termination individually helpful bridging elements should be identified to foster enduring change. Specific attention should be paid to defining high-quality bridging skills, which should be specific, time-limited, independent from others, action-oriented, measurable, and frequently applicable.

Theoretischer Hintergrund: Die kognitive Verhaltenstherapie stellt das evidenzbasierte First-Line-Treatment zur Behandlung der Körperdysmorphen Störung (KDS) dar, gleichwohl bleiben Remissionsrate und Behandlungsefolge verbesserungswürdig. Wissen über antizipierte, störungsspezifische Herausforderungen und therapeutische Beziehungsgestaltung findet sich in Einzelstudien oder auf Manualebene wieder, obwohl diese gleichzeitig zentrale Stellschrauben für Behandlungserfolge sind. Fragestellungen: Was stellen störungsspezifische Herausforderungen in der KDS-Behandlung dar? Wie ist die therapeutische Beziehung bei Vorliegen einer KDS zu gestalten? Methode: In der qualitativ-explorativen Studie wurden mit sechs KDS-erfahrenen Psychotherapeut*innen (fünf weiblich, Alter: 42,66 Jahre, SD = 7,60; Anzahl behandelter KDS-Patient*innen: 3–300) semistrukturierte Expert*inneninterviews durchgeführt, die mittels qualitativer Inhaltsanalyse nach Mayring [Qualitative Inhaltsanalyse. Grundlagen und Techniken. Weinheim; 2015] mit deduktiver (abgeleitet aus Forschungsergebnissen sowie Behandlungsmanualen) und induktiver Kategorienbildung ausgewertet wurden. Ergebnisse: Als störungsspezifische Herausforderungen wurden zwölf Kategorien identifiziert, z.B. mangelnde Störungseinsicht oder eine geringe Behandlungsadhärenz. Bei der Gestaltung der therapeutischen Beziehung resultierten zehn Kategorien, wie z.B. die Vermeidung von Beschämung oder Geduld beim Aufbau. Schlussfolgerungen: Einige der Kategorien im Bereich der Herausforderungen (z.B. Suizidalität) und der Beziehungsgestaltung sind eher störungsübergreifend statt -spezifisch. Gleichwohl ist auf diese in der KDS-Behandlung und Supervision besonderes zu achten, da sie mit zur Fallkomplexität und entsprechenden Behandlungsimplikationen beitragen.

Theoretical Background: Cognitive-behavioural therapy is the evidence-based first-line treatment for body dysmorphic disorder (BDD), but remission rates and treatment outcomes still need improvement. Knowledge about anticipated, disorder-specific challenges and therapeutic alliance is found in individual studies or at the manual level, although these are at the same time central adjusting screws for treatment success. Research Questions: What are the disorder-specific challenges in the treatment of BDD? How should the therapeutic alliance be structured? Method: In the qualitative-explorative study, semi-structured expert interviews were conducted with six psychotherapists with experience of BDD (five female, age: 42.66 years, SD = 7.60; number of BDD patients treated: 3-300), which were analysed using qualitative content analysis according to Mayring [Qualitative Inhaltsanalyse. Grundlagen und Techniken. Weinheim; 2015] with deductive (derived from research results and treatment manuals) and inductive category formation. Results: Twelve categories were identified as disorder-specific challenges, e.g., lack of/low insight or low treatment adherence. In shaping the therapeutic relationship, ten categories such as avoiding shaming or patience in building resulted. Conclusions: Some of the categories in the area of challenges (e.g., suicidality) and therapeutic alliance are rather transdiagnostic/cross-disorder than -specific. Similarly, these need special attention in BDD treatment and supervision as they contribute to case complexity and corresponding treatment implications.

In western countries, men are increasingly using cosmetic surgery. However, despite this trend, there remains a dearth of information on the prevalence, acceptance, and motivations behind men's use of cosmetic surgery. Furthermore, the potential association between men's use of cosmetic surgery and in particular male-specific cosmetic surgery procedures such as head hair transplant or penis enlargement and traditional masculinity ideologies (TMI) has not been investigated so far. For this purpose, a cross-sectional anonymous online survey was conducted among 241 self-identifying men aged 18 years or older from the German-speaking part of Europe. Participants responded to questions about cosmetic surgery use and experiences, and completed the Conformity to Masculine Norms Inventory-Short Form (CMNI-SF) and the Male Role Norms Inventory-Short Form (MRNI-SF) questionnaires to assess conformity with and endorsement of TMI. Of the 241 men investigated, 47 (19.5%) had undergone cosmetic surgery. The most common types of cosmetic surgeries reported were wrinkle treatment, eyelid correction, and head-hair transplant. Penis enlargement procedures were reported by three (6.4%) of the 47 men who had undergone cosmetic surgery. The main reasons for undergoing surgery were to feel better (72.3%) and look better (55.3%), while to increase sexual success (17.0%) and to increase manliness (14.9%) were also reported. Logistic regression models showed that higher conformity to TMI (CMNI-SF) was associated with higher odds of having undergone cosmetic surgery. The results highlight the overall increase in men's cosmetic surgery use and its specific characteristics. The significant positive association between conformity to TMI and men's use of cosmetic surgery suggests that men increasingly use cosmetic surgery as a means to assert power, success, dominance, and sexual success.

IMPORTANCE Variables such as severe symptoms, comorbidity, and sociodemographic characteristics (eg, low educational attainment or unemployment) are associated with a poorer prognosis in adults treated for depressive symptoms. The exclusion of patients with a poor prognosis from RCTs is negatively associated with the generalizability of research findings. OBJECTIVE To compare the prognostic risk factors (PRFs) in patient samples of RCTs of face-to-face therapy (FTF) and internet-based therapy (IBT) for depression. DATA SOURCES PsycINFO, Cochrane CENTRAL, and reference lists of published meta-analyses were searched from January 1, 2000, to December 31, 2021. STUDY SELECTION RCTs that compared FTF (individual or group therapy) and IBT ( guided or self-guided interventions) against a control (waitlist or treatment as usual) in adults with symptoms of depression were included. DATA EXTRACTION AND SYNTHESIS Datawere extracted by 2 independent observers. The Cochrane revised risk-of-bias tool was used to assess the risk of bias. The study was preregistered with OSF Registries and followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. MAIN OUTCOMES AND MEASURES The primary outcomewas the standardized mean difference (Hedges g effect size) in depressive symptoms at treatment termination (assessed with standard patient self-report questionnaires), with a positive standardized mean difference indicating larger improvements in the intervention compared with those in the control group. Meta-regression analyses were adjusted for the type of control group. Three preregistered and 2 exploratory sensitivity analyses were conducted. A prognostic risk index (PROG) was created that calculated the sum of 12 predefined individual indicators, with scores ranging from 0 to 12 and higher scores indicating that a sample comprised patients with poorer prognoses. RESULTS This systematic review and meta-regression analysis identified 105 eligible RCTs that comprised 18 363 patients. In total, 48 studies (46%) examined FTF, and 57 studies (54%) examined IBT. The PROG was significantly higher in the RCTs of FTF than in the RCTs of IBT (FTF: mean [SD], 3.55 [1.75]; median [IQR], 3.5 [2.0-4.5]; IBT: mean [SD], 2.27 [1.66]; median [IQR], 2.0 [1.0-3.5]; z = -3.68, P <.001; Hedges g = 0.75; 95% CI, 0.36-1.15). A random-effects meta-regression analysis found no association of the PROG with the effect size. Sensitivity analyses with outliers excluded and accounting for risk of bias or small-study effects yielded mixed results on the association between the PROG and effect size. CONCLUSIONS AND RELEVANCE The findings of this systematic review and meta-regression analysis suggest that samples of RCTs of FTF vs IBT differ with regard to PRFs. These findings have implications for the generalizability of the current evidence on IBT for depression. More RCTs of internet-based interventions with clinically representative samples are needed, and the reporting of PRFs must be improved.

Body dysmorphic disorder (BDD) is defined as the obsessive idea that some aspect of one’s own body or appearance is severely flawed or ugly, which leads to excessive avoidance/safety-seeking behavior or mental acts, and therefore to an increase in psychosocial impairment. Cognitive behavioral therapy (CBT) is recommended as one of the first-line treatments for BDD. This chapter introduces the main components of CBT for BDD, including exposure and response prevention and the reconstruction of thoughts, and discusses the case study of Anastacia. Anastacia’s BDD involves her losing her hair and specific rituals of brushing and counting her hair for several hours per day. In the case study, the main components of CBT and elements of acceptance and commitment therapy are illustrated.

Introduction: Internet-based self-help interventions have shown to be effective in the treatment of depression. Several meta-analyses indicated that human contact has a crucial impact on adherence and outcome. While most research focused on the role of guidance during interventions, a review by Andersson and Johansson (2012) suggested that contact before the intervention too may play an important role. Objective: We investigated the impact of the degree of contact in internet-based interventions (IBIs) for depression on outcome in adults suffering from elevated symptoms of depression. Methods: We conducted a preregistered meta-analysis (www.osf.io/4mzyd) and included trials comparing IBIs for depression against control conditions (treatment as usual [TAU] or waiting list [WL]) in patients with symptoms of unipolar depression searching the databases PsycINFO and Cochrane's Central Register of Controlled Trials (CENTRAL) limited to entries from EMBASE and PubMed. Following Andersson and Johansson (2012), contact before an intervention was defined as having had a diagnostic interview before the IBI, and contact during intervention was defined as having received guidance during the IBI. IBIs were grouped as providing (0) no contact, (1) contact before the IBI, (2) contact during the IBI, or (3) contact both before and during the IBI. The primary outcome was standardized mean difference (SMD) of the IBI and control in depressive symptoms at treatment termination. Secondary outcomes were study dropout and adherence to the IBI. Results: We included 56 eligible trials that randomized 13,335 patients to 75 internet-based intervention conditions and control groups (TAU in 23 trials, WL in 33 trials). In total, 44 trials (78.57 %) were judged to show some concerns or a high risk of bias. Overall heterogeneity was high regarding the primary outcome (I2s < 66 %) and even higher for secondary outcomes (I2s < 91 %). Degree of contact was a robust predictor of outcome and adherence in all pre-registered and exploratory analyses. We found the effect of the IBI to increase with higher degree of contact. However, in pair-wise contrasts, only IBIs offering both contact before and during the intervention (SMD = 0.573, 95 % CI: 0.437, 0.709) significantly outperformed interventions offering no contact (SMD = 0.224, 95 % CI: 0.090, 0.340). Conclusions: The results suggest that contact before and during an intervention increases the effects of IBIs. The combination of contact before and during the intervention seems to a pivotal role regarding adherence as well as treatment outcome for patients suffering from depression.

BackgroundInnovative moments (IMs), defined as moments in psychotherapy when patients' problematic patterns change toward more elaborated and adaptive patterns, have been shown to be associated with a clinical change in patients with depression. Thus, far IMs have been studied in face-to-face settings but not in telephone-based cognitive-behavioral therapy (t-CBT). This study investigates whether IMs occur in t-CBT and examines the association between IMs and symptom improvement, and reconceptualization and symptom improvement. MethodsThe therapy transcripts of n = 10 patients with mild to moderate depression (range: 7-11 sessions, in total 94 sessions) undergoing t-CBT were qualitatively and quantitatively analyzed. Symptom severity (Patient Health Questionnaire-9) and IMs (levels and proportions) were assessed for each therapy session. Hierarchical linear models were used to test the prediction models. ResultsThe rating of IMs was shown to be feasible and reliable using the Innovative Moments Coding System (IMCS) (84.04% agreement in words coded), which is indicative of the applicability of the concept of IMs in t-CBT. Only reconceptualization IMs were shown to have a predictive value for treatment success (R-2 = 0.05, p = 0.01). DiscussionThe results should be interpreted with caution due to the exploratory nature of this study. Due to the telephone setting, it was necessary to adapt the IMCS. Nonetheless, the extent of IMs identified in the low-intensity t-CBT investigated was comparable to IMs in face-to-face therapy. Further studies are needed to clarify the association between IMs and treatment success as a change process, especially for low-intensity treatments.

This systematic review and meta-regression analysis compares the prognostic risk factors in patient samples reported in 105 randomized clinical trials of face-to-face and internet-based psychotherapy for treating depression.

Background: Although E-mental health (EMH) interventions have been shown to be effective in the treatment of mental health problems and empirical knowledge regarding EMH acceptance for different occupations in health care is established, little is known regarding EMH and psychotherapists-in-training. This seems particularly relevant as psychotherapists-in-training will shape the future health care system since they are as being the next generation of psychotherapists. With social distancing measures in place, COVID-19 has led to an increased demand for EMH, which is broadening the way psychological treatments are delivered. Objective: The present study aims to assess the acceptance of EMH and its determinants among psychotherapists-in-training of different EMH modalities and to retrospectively compare current acceptance with pre-COVID-19 times. Methods: Altogether, 29 training institutions in Switzerland and 232 training institutions in Germany were contacted, resulting in a sample of N = 216 psychotherapists-in-training (88.4 % female) who filled out the self-administered web-based questionnaire in summer 2020. The acceptance of EMH was assessed considering several different modalities (e.g., videoconference, guided self-help programs) as well as further possible predictors of EMH acceptance based on the Unified Theory of Acceptance and Use of Technology. Acceptance scores were categorized as low, moderate or high based on prior research and predicted using multiple regression. Results: Acceptance of EMH was moderate (M = 3.40, SD = 1.11) and increased significantly (t(215) = 12.03, p < .01; d = 0.88) compared to pre-COVID-19 (M = 2.67, SD = 1.11); however, acceptance varied significantly between modalities (F(2.6, 561.7) = 62.93, p < .01, partial eta(2) = 0.23), with videoconferencing being the most accepted and unguided programs the least. Stepwise regression including three of 14 variables (R-2 = 0.55, F(14, 201) = 17.68, p < .001) identified performance expectancy, social influence and concerns about the therapeutic alliance as significant determinants of EMH acceptance. Discussion: Acceptance by psychotherapists-in-training was moderate and in line with prior research and comparable with other clinicians' acceptance scores. Performance expectancy, social influence and concerns about the therapeutic alliance were predictive of EMH acceptance, indicating their significance in the implementation of EMH in health care. Conclusion: These findings underline the importance of the aforementioned determinants of EMH acceptance and the need for further studies investigating EMH acceptance in order to derive adequate educational programs and to facilitate dissemination among psychotherapists-in-training.

INTRODUCTION:Treatment as usual (TAU) is the most frequently used control group in randomized trials of psychotherapy for depression. Concerns have been raised that the heterogeneity of treatments in TAU leads to biased estimates of psychotherapy efficacy and to an unclear difference between TAU and control groups like waiting list (WL).OBJECTIVE:We investigated the impact of control group intensity (i.e., amount and degree to which elements of common depression treatments are provided) on the effects of face-to-face and internet-based psychotherapy for depression.METHODS:We conducted a preregistered meta-analysis (www.osf.io/4mzyd). We included trials comparing psychotherapy with TAU or WL in patients with symptoms of unipolar depression. Six indicators were used to assess control group intensity.PRIMARY OUTCOME:Standardized mean difference (SMD) of psychotherapy and control in depressive symptoms at treatment termination.RESULTS:We included 89 trials randomizing 14,474 patients to 113 psychotherapy conditions and 89 control groups (TAU in 42 trials, WL in 47 trials). Control group intensity predicted trial results in preregistered (one-sided ps < 0.042) and exploratory analyses. Psychotherapy effects were significantly smaller (one-sided p = 0.002) in trials with higher intensity TAU (SMD = 0.324, CI 0.209 to 0.439) than in trials with lower intensity TAU (SMD = 0.628, CI 0.455 to 0.801). Psychotherapy effects against lower intensity TAU did not differ from effects against WL (two-sided p = 0.663).CONCLUSIONS:Our results suggest that variation in TAU intensity impacts the outcome of trials. More scrutiny in the design of control groups for clinical trials is recommended.

Zusammenfassung. Erste Befunde indizieren, dass Patientinnen und Patienten mit stark ausgeprägter depressionsbezogener Selbstwirksamkeitserwartung bessere Behandlungsergebnisse erzielen und ein geringeres Rückfallrisiko aufweisen. Bisher existieren jedoch nur englischsprachige validierte Instrumente zur Erfassung des Konstrukts. In der vorliegenden Studie erfolgte eine psychometrische Überprüfung der deutschsprachigen Adaptation (DSW-Skala) der Self-efficacy for Managing Depression Scale ( Bush et al., 2001 ) anhand von N = 377 primärärztlichen Patientinnen und Patienten mit depressiver Symptomatik, die zu Behandlungsbeginn sowie nach 3, 6 und 12 Monaten untersucht wurden. Die Ergebnisse belegten eine gute interne Konsistenz der Skala (Cronbachs α ≥ .85) und akzeptable Retest-Reliabilität ( rtt = .63). Die Responsivität der Skala sowie eine vergleichbare Messstruktur über alle Messzeitpunkte hinweg wurden nachgewiesen. Multiple Regressionsanalysen belegten die Vorhersagekraft der DSW-Skala bezüglich der depressiven Symptomatik über 6 Monate. Die Ergebnisse zeigen, dass die DSW-Skala gängige psychometrische Standards erfüllt, sodass die Skala als zeitökonomisches und reliables Messinstrument in der Praxis und Forschung eingesetzt werden kann.

There are indications that perceived self-efficacy in the management and prevention of depression mediates health outcomes and depressive relapse. To date, however, validated measurements for this construct exist only in English. This study validates the German adaptation (DSW Scale) of the original English Self-efficacy for Managing Depression scale (Bush et al., 2001). The analysis is based on N = 377 primary-care patients with depressive symptoms who completed the DSW Scale at baseline and at 3, 6, and 12 months. The internal consistency was good at all assessments (Cronbach's a alpha >= .85). The retest reliability assessed between baseline and 3 months was satisfactory (r(tt) = .63). The responsiveness of the scale was confirmed by a two-factorial ANOVA with repeated measurement. The longitudinal measurement invariance confirmed the comparable structure of the data at each assessment. The construct validity of the scale was demonstrated by high correlations with related constructs. Predictive validity assessed by multiple regression analyses showed that the scale significantly predicted depressive symptoms at 6 months. The results demonstrate that the German DSW Scale meets common psychometric standards and presents a time-efficient and reliable measurement for use in clinic and research.

Cognitive behavioral therapy is an effective treatment for body dysmorphic disorder (BDD), but many patients do not receive appropriate treatment due to several treatment barriers and psychosocial care structures. Low-threshold interventions, including those from the field of e-mental health, could improve access to psychotherapy. In addition to internet-administered therapy, telephone-administered therapy may reduce treatment barriers, especially during the COVID-19 pandemic. This article presents four case reports of the same treatment (12 weeks of telephone-administered cognitive behavioral therapy accompanied by a workbook) applied to patients with body dysmorphic disorder during the summer of 2020. Three patients who completed the treatment had clinically relevant reductions in body dysmorphic and depressive symptoms and improved insight. One patient did not complete the telephone-administered therapy because her symptoms worsened, and she needed a more intensive form of treatment. These findings encourage future studies on the efficacy and effectiveness of telephone-administered treatment for BDD and its role in stepped-care models.

Background: Body dysmorphic disorder (BDD) is a mental disorder that is associated with pronounced shame, a high burden of disease, and functional impairments. Cog-nitive behavioral therapy (CBT) has been found the most effective treatment for BDD. However, due to several treatment barriers, most individuals with BDD do not re-ceive adequate psychotherapeutic treatment, which is why low-threshold treatment options (e.g., E-Mental Health) could play an important role to fill this gap. Prior international studies have demonstrated the effective-ness of E-Mental Health interventions for BDD. Material and Methods: This article provides an overview of the lit-erature regarding the implementation and effectiveness of E-Mental Health interventions for BDD and introduces the German version of BDD-NET, a manualized, internet-administered cognitive-behavioral program for BDD. Re-sults: BDD-NET consists of eight online modules delivered over 12 weeks. Further, the online platform provides the possibility to contact the therapist. In the current German version, all materials were translated from the original, and adaptations were made with regard to cultural as-pects. Conclusions: BDD-NET could constitute an impor-tant component in specific care options for BDD. To date, evaluation of the German version is still pending. Special characteristics of the online setting as well as clinical im-plications (e.g., insight as a potential treatment target) are presented. Conditions and structural factors for prospec-tive dissemination are discussed.(C) 2021 The Author(s). Published by S. Karger AG, Basel

Background Body dysmorphic disorder (BDD), defined as the obsessive idea that some aspect of one’s own body or appearance is severely flawed/deformed, is relatively common in the general population and has been shown to have strong associations with mood and anxiety disorders and substance abuse disorders. Furthermore, a previous study on symptoms of BDD among people in the military showed that muscles are an important area of preoccupation. Hence, this study aimed to 1. assess the prevalence of BDD symptoms in Swiss military recruits, 2. specify the areas of preoccupation, and 3. analyze associated features (depression and alcohol/drug abuse). Method A total of 126 Swiss male military recruits (age: M = 20.12, SD = 1.09, range: 18–24) were examined using self-report measurements to assess symptoms of BDD, depression, alcohol/drug abuse. Results The results showed that symptoms of BDD were relatively common (9.5% reached the cutoff value for probable BDD, 84% reported some symptoms), with the muscles as the most common area of preoccupation. A positive correlation (r = .38, p < .001) between depressive symptoms and symptoms of BDD was found, thus no correlation between alcohol/drug abuse and symptoms of BDD. Conclusion The results indicate a need to develop and implement measures for prevention (e.g. raising awareness among the military) and intervention in this specific population.

Stepped Care (gestufte Behandlung) bietet einen passenden Rahmen, um evidenzbasierte Behandlungsempfehlungen bei Depression umzusetzen und dabei bestehende Defizite in der Versorgung zu reduzieren. Dadurch können niedrigschwellige Interventionen innerhalb eines adäquaten klinischen Rahmens durchgeführt werden. Im Beitrag werden Kernmerkmale, Evidenzlage und mögliche Weiterentwicklungen zu Stepped Care vorgestellt.

Background: Treatment as usual (TAU) is the most frequently used control group in randomised trials of psychotherapy for depression and meta-analyses that summarise these trials. Concerns have been raised over imprecise and biased efficacy estimates because of substantial variability in the treatments provided in TAU. We set out to investigate the impact of the control group intensity (i.e., quantitative and qualitative aspects of treatments in control groups) on results of trials of psychotherapy for depression and confounding due to systematic differences in this intensity in trials of face-to-face (F2F) and internet-based (INT) psychotherapy.Methods: We conducted a pre-registered systematic review and meta-analysis. We searched PsycINFO for systematic reviews of psychotherapy for depression from Jan 1, 2015 to Jan 3, 2020 and retrieved all references of trials included in these systematic reviews. We searched Cochrane’s Central Register of Controlled Trials and PsycINFO for randomised trials from Jan 1, 2018 to Jan 3, 2020. We included trials that compared (individual or group) F2F or (self-guided or guided) INT with TAU or waiting list (WL) in the acute treatment of patients with symptoms of unipolar depression. We excluded trials published before 2000. All information was extracted by two independent researchers. Six dichotomous indicators were used to create a score that expressed the intensity of TAU and WL. Primary outcome: Standardised mean differences (SMD) of treatment and control groups in depressive symptoms at treatment termination. SMDs were extracted from trial reports. A protocol was pre-registered with the Center for Open Science (www.osf.io/4mzyd).Findings: We included 89 eligible trials that randomised 14,474 patients to 113 eligible psychotherapy arms (8,284 patients) and 89 control arms (6,190 patients). TAU was used as control group in 42 trials (47.19%) and WL in 47 trials (52.81%). F2F was investigated in 37 trials (42.05%) and INT in 51 trials (57.95%). Intensity of control groups did not differ between F2F trials (M = 0.86, SD = 1.42) and INT trials (M = 0.39, SD = 0.63, p = .255). Intensity of control group was a significant predictor of trial results in the main analysis (one-sided p = .042), in pre-registered sensitivity analyses, and in all further exploratory analyses. Heterogeneity estimates were high (I2 = 69.30% to 95.37%). The final analysis found psychotherapy effects to be SMD = -0.287 (95% confidence interval [CI] -0.483 to -0.091, one-sided p = .002, I2 = 76.13%) smaller in 24 trials with higher intensity TAU compared to 16 trials with lower intensity TAU. Interpretation: Our findings suggest that the variability of treatments in TAU influences the results of trials on psychotherapy for depression and is likely to introduce imprecision into meta-analyses of these trials. Source of funding: None

Hintergrund: Die Körperdysmorphe Störung (KDS) ist eine schwerwiegende psychische Störung, die mit starker Scham sowie Leidensdruck und Funktionseinschränkungen einhergeht. Kognitive Verhaltenstherapie stellt die aktuell wirksamste evidenzbasierte Behandlungsmethode dar. Aufgrund zahlreicher Behandlungsbarrieren kommen KDS-Betroffene jedoch selten in der psychotherapeutischen Behandlung an, weshalb niedrigschwelligen Behandlungsmethoden (z.B. aus dem Bereich E-Mental-Health) eine wichtige Rolle zukommen könnten. Erste internationale Studien weisen auf die Wirksamkeit von E-Mental-Health-Angeboten bei KDS hin. Material und Methoden: Dieser Beitrag gibt eine Übersicht zur bisherigen Umsetzung und Evidenz von E-Mental-Health-Angeboten für KDS und stellt die ins Deutsche übersetzte Version des BDD-NET-Programms, eines internetbasierten, manuali­sierten, therapeutenbegleiteten Interventionsprogramms, für die KDS vor, welches aus dem Englischen für den deutschen Sprachraum übersetzt und adaptiert wurde. Ergebnisse: BDD-NET umfasst acht Module, die binnen einer 12-wöchigen Behandlung online bearbeitet werden. Die Online-Plattform bietet für die Patienten die Möglichkeit, mit dem BDD-NET-Therapeuten mittels persönlicher Nachrichten zu kommunizieren. Sämtliche Materialien wurden aus dem Englischen übersetzt und vor allem in kultureller Hinsicht adaptiert. Schlussfolgerungen: BDD-NET könnte ein wichtiger Baustein in der Versorgung von KDS-Betroffenen sein. Die Evaluation steht für den deutschen Sprachraum noch aus. Auf Besonderheiten des Settings (z.B. Störungseinsicht als möglicher Behandlungsfokus) sowie praktische Implikationen wird eingegangen. Zudem werden Voraussetzungen und Rahmenbedingungen für eine perspektivische Dissemination diskutiert.