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Many patients with major depressive disorder (MDD) remain untreated or do not respond to cognitive behavioral therapy (CBT). Physical exercise shows antidepressive effects and may serve as an effective augmentation treatment. However, research on combining exercise with CBT is sparse in MDD and underlying mechanisms of exercise are not well understood to date.120 outpatients with MDD were randomized to either a high intensity exercise group (HEX), a low intensity exercise group (LEX), or a waiting list control group (WL). After 12 weeks of exercise training or waiting period, all patients received a manualized CBT.Seventy-five patients with MDD completed both the exercise program/ waiting period and the CBT. While physical fitness improved in HEX after the exercise program, it did not change in LEX and WL. Depressive symptoms improved in all three groups from baseline to post-CBT and the group by time interaction was not significant. Regression analyses revealed that the amount of fitness improvement during exercise predicted the subsequent CBT response.The dropout rate was relatively high, preparatory CBT sessions during exercise / waiting period may have influenced depressive symptoms, and no patients with severe MDD were included.High intense physical exercise did not lead to a general enhancement of CBT outcome, but higher increases in physical fitness seem to improve symptom change during CBT. Our results suggest that the implementation of more individually tailored exercise programs could be a promising approach for future research and clinical practice.

Individual responses to behavioral treatment of anxiety disorders vary considerably, which requires a better understanding of underlying processes. In this study, we examined the violation and change of threat beliefs during exposure. From 8,484 standardized exposure records of 605 patients with different anxiety disorders, learning indicators were derived: expectancy violation as mismatch between threat expectancy before exposure and threat occurrence, expectancy change as difference between original and adjusted expectancy after exposure, and prediction-error learning rate as extent to which expectancy violation transferred into change. Throughout sessions, high threat expectancy but low occurrence and adjusted expectancy indicated successful violation and change of threat beliefs by exposure. Expectancy violation, change, and learning rate substantially varied between patients. Not expectancy violation itself, but higher learning rate and expectancy change predicted better treatment outcome. Successful exposure thus requires expectancy violation to induce actual expectancy change, supporting learning from prediction error as transdiagnostic mechanism underlying successful exposure therapy. Bundesministerium für Bildung und Forschung https://doi.org/10.13039/501100002347

Theoretischer Hintergrund: Eine wachsende Zahl von Forschungsarbeiten weist auf die Bedeutung der wahrgenommenen Zentralität eines traumatischen Ereignisses in der eigenen Lebensgeschichte für das Verständnis von Symptomen der Posttraumatischen Belastungsstörung (PTBS) hin. Zur Untersuchung dieser Beziehung exisitert bislang noch kein Messinstrument, das die Ereigniszentralität auf Deutsch erfasst. Fragestellung: Um die Forschung auf diesem Gebiet im deutschsprachigen Raum zu ermöglichen, wird die Centrality of Event Scale (CES; Berntsen & Rubin, 2006) in einer deutschen Übersetzung (CES-G) vorgestellt und hinsichtlich ihrer psychometrischen Eigenschaften untersucht. Methode: Zur psychometrischen Auswertung wurde die CES-G 322 Student_innen sowie 115 ambulanten Patient_innen mit ausgeprägter PTBS-Symptomatik vorgelegt. Ergebnisse: Die CES-G zeigt eine hervorragende interne Konsistenz, substanzielle Korrelationen mit Maßen von PTBS Symptomen, allgemeiner Psychopathologie, Depressivität und maladaptiven kognitiven Prozessen sowie eine kriterienbezogene Validität bezüglich PTBS Symptomen in einer klinischen Stichprobe. Schlussfolgerungen: Die deutsche Übersetzung der CES ist ein verlässliches und valides Messinstrument für Ereigniszentralität. Background: A growing body of research points to the importance of the perceived centrality of a traumatic event in one′s life story for understanding posttraumatic stress disorder (PTSD) symptoms. To date, no instrument measuring event centrality is available in German to examine this relationship. Objective: To enable research in the German-speaking countries on the Centrality of Event Scale (CES; Berntsen & Rubin, 2006), a German translation (CES-G) is introduced and examined for its psychometric properties. Methods: For the psychometric evaluation, the CES-G was presented to 322 undergraduates and 115 psychiatric outpatients with substantial PTSD symptomatology. Results: The CES-G shows excellent internal consistency, substantial correlations with measures of PTSD symptoms, psychopathology, depression, and maladaptive cognitive processes as well as criteria-related validity regarding PTSD symptoms in a clinical sample. Conclusions: The German translation of the CES is a reliable and valid measure for event centrality.

Background: Deficits in cognition like working memory (WM) are highly prevalent symptoms related to major depressive disorder (MDD). Neuroimaging studies have described frontoparietal abnormalities in patients with MDD as a basis for these deficits. Based on research in healthy adults, it is hypothesized that increased physical fitness might be a protective factor for these deficits in MDD. However, the relationship between physical fitness and WM-related neural activity and performance has not been tested in MDD, to date. Understanding these associations could inform the development of physical exercise interventions in MDD. Methods: Within a larger project, 111 (53female) MDD outpatients and 56 (34female) healthy controls performed an n-back task (0-, 1-, 2-, 3-back) during functional Magnetic Resonance Imaging. Physical fitness from a graded exercise test on a cycle ergometer was performed by 106 MDD patients. Results: Patients showed reduced performance particularly at high loads of the n-back WM task and prolonged reaction times at all n-back loads. A whole-brain interaction analysis of group by WM load revealed reduced neural activity in six frontoparietal clusters at medium and high WM loads in MDD patients compared to healthy controls. Analysis of covariance within the MDD sample showed that physical fitness was associated with neural activity in right and left superior parietal lobules. Externally defined Regions of Interest confirmed this analysis. Conclusions: Results indicate frontoparietal hypoactivity in MDD at high demands, arguing for decreased WM capacity. We demonstrate a parietal fitness correlate which could be used to guide future research on effects of exercise on cognitive functioning in MDD.

Jede psychotherapeutische Tatigkeit ist an eine Reihe von Gesetzen, Rechtsgrundlagen und Ordnungen gebunden. Es muss zwischen Berufsrecht und Sozialrecht unterschieden werden. Im Weiteren sind zusatzliche ubergeordnete rechtliche Rahmenbedingungen zu berucksichtigen. Hierzu gehoren die Aufklarungs- und Informationspflichten sowie die Pflicht zur Dokumentation, die im Burgerlichen Gesetzbuch (BGB, § 630 e,f) geregelt sind, sowie die Datenschutz-Grundverordnung im Bundesdatenschutzgesetz. Besonders wichtig bei der Berufsausubung ist die Beachtung von Regeln der Schweigepflicht (§ 203 im Strafgesetzbuch). Bedeutsam fur die psychotherapeutische Aus- und Weiterbildung sowie die psychotherapeutische Praxis sind das Psychotherapeutengesetz und die Approbationsordnung, die Heilberufe-Kammergesetze, die Berufsordnungen der Landerkammern und einige Sozialgesetzbucher. Der Beitrag stellt die aktuellen rechtlichen Rahmenbedingungen (Stand Juni 2021) in der Bundesrepublik Deutschland dar.

Prüfungsängste sind weit verbreitet und ziehen in der Mehrzahl der Fälle keine weitreichenden Beeinträchtigungen oder Belastungen nach sich. Manchmal sind Prüfungsängste jedoch so stark ausgeprägt und anhaltend vorhanden, dass sie im Rahmen einer psychotherapeutischen Behandlung thematisiert werden müssen – sei es als primäres Anliegen oder als zusätzliches Problem bei einem anderen Behandlungsanliegen. Die Neubearbeitung des Bandes stellt Informationen zur Symptomatik und Häufigkeit von Prüfungsangst bereit und berichtet den aktuellen Stand der Forschung zu Entstehungsbedingungen und Erklärungsmodellen. Weiterhin finden sich ausführliche Hinweise zur Diagnostik sowie vielfältige Anregungen zur praktischen Arbeit mit betroffenen Personen. Das therapeutische Vorgehen orientiert sich an verschiedenen möglichen Aspekten der Symptomatik und kann durch das modularisierte Vorgehen an die heterogenen Problembilder der betroffenen Personen angepasst werden. Alle Module sind der kognitiven Verhaltenstherapie zuzuordnen. Entsprechend finden sich neben verschiedenen Strategien zum Lernen, zum Zeitmanagement und zur Vorbereitung einer Prüfung auch kognitive Techniken zum Umgang mit hinderlichen Gedanken, Entspannungstechniken sowie das Verfahren der systematischen Desensibilisierung. Die Neuauflage des Bandes informiert über aktuelle Entwicklungen bei der Behandlung von Prüfungsängsten und geht hierbei auch auf neuere therapeutische Ansätze, z.B. imaginative und achtsamkeitsbasierte Interventionen, ein.

Individual responses to behavioral treatment of anxiety disorders vary considerably, calling for better understanding of underlying processes. This study examined the violation and change of threat beliefs during exposure. From 8484 standardized exposure records of 605 patients with different anxiety disorders, learning indicators were derived: Expectancy violation as mismatch between threat expectancy before exposure and threat occurrence, expectancy change as difference between original and adjusted expectancy after exposure, and prediction-error learning rate as extent to which expectancy violation transferred into change. Throughout sessions, high threat expectancy but low occurrence and adjusted expectancy indicated violation and change of threat beliefs by exposure. Expectancy violation, change, and learning rate substantially varied between patients. Not expectancy violation itself, but higher learning rate and expectancy change predicted better treatment outcome. Successful exposure thus requires expectancy violation to induce actual expectancy change, supporting learning from prediction error as transdiagnostic mechanism underlying successful exposure therapy.

ZusammenfassungEinleitung Sexuelle Funktionsstörungen gelten als häufig. Gleichzeitig fehlen epidemiologische Daten zur Behandlungsprävalenz sexueller Funktionsstörungen in der ambulanten Psychotherapie. Im Rahmen eines Projekts zur Koordination der Datenerhebung an den deutschen Hochschulambulanzen für Psychotherapie wird erstmals eine Schätzung für dieses Behandlungssegment möglich.Forschungsziele Das Ziel dieser Studie ist die Darstellung der festgestellten F52-Diagnosen an deutschen Hochschulambulanzen für Psychotherapie an psychologischen Instituten.Methoden 16 Hochschulambulanzen für Erwachsene übermittelten ausgewählte Daten zur Eingangsdiagnostik ihrer Patient_innen (N = 4 504; M Alter = 37.87; SD = 13.47; Altersbereich = 15 bis 86 Jahre; 65.3 % weiblich) aus dem Jahr 2016. In der hier vorgestellten Studie wird spezifisch die Häufigkeit der Vergabe von Diagnosen aus dem ICD-Kapitel F52 analysiert.Ergebnisse Insgesamt wurde in 32 Fällen (0.7 %) die Diagnose einer sexuellen Funktionsstörung vergeben, in acht Fällen (0.2 %) als Hauptdiagnose. In 31 Fällen (96.9 %) waren auch komorbide Störungen gegeben, hauptsächlich Angststörungen (34.4 %) und affektive Störungen (53.1 %). Unter den Hauptdiagnosen war der nichtorganische Vaginismus (n = 3) der häufigste Grund, eine psychotherapeutische Hochschulambulanz eines psychologischen Instituts aufzusuchen. Die Häufigkeit von F52-Diagnosen in den 16 Ambulanzen schwankte zwischen 0 % und 1.2 %, und acht der 16 Ambulanzen vergaben überhaupt keine F52-Diagnosen.Schlussfolgerung Die Werte in der vorliegenden Behandlungsstichprobe erscheinen vor dem Hintergrund der Prävalenzdaten aus Bevölkerungsstudien als auffällig niedrig. Hierfür können neben methodischen und studienspezifischen Gründen auch Aspekte der psychotherapeutischen Versorgung sowie Beurteilungsfehler bei der Diagnosevergabe verantwortlich sein.

Objective: Meta-analyses show that Acceptance and Commitment Therapy (ACT) is an efficacious treatment for a wide range of mental health problems. However, few studies have examined the effectivene...

Zusammenfassung. Theoretischer Hintergrund: Therapeutische Adhärenz ist eine zentrale Voraussetzung zur Sicherung der Validität von Psychotherapiestudien. Bisher existieren im deutschsprachigen Raum keine Skalen zur Erfassung der Adhärenz im Bereich der Akzeptanz- und Commitmenttherapie (ACT). Fragestellung: Ziel war es, Skalen zur Erfassung der Adhärenz von Therapeut_innen für ACT und der Kognitiven Verhaltenstherapie (KVT) zu entwickeln und deren Gütekriterien zu überprüfen. Methode: Die Validierung der Adhärenzskalen basierte auf n=38 ACT- und n=31 KVT-Gruppentherapiesitzungen zur Behandlung von depressiven und gemischten Störungsbildern. Die Adhärenz wurde durch zwei Rater_innen anhand von Audioaufzeichnungen bewertet. Ergebnisse: Sowohl für die ACT-Adhärenzskala (ICC=.96) als auch für die KVT-Adhärenzskala (ICC=.98) konnten hohe Interraterreliabilitäten erreicht werden. Die konvergente Validität konnte anhand einer negativen Korrelation zwischen den beiden Skalen sichergestellt werden ( r=-.95). Schlussfolgerungen: Beide Adhärenzskalen bieten eine erste Möglichkeit, um manualgetreues Therapeut_innenverhalten in ACT- und KVT-Gruppentherapien für Patient_innen mit gemischten Störungsbildern zu erfassen. Zudem geben die Ergebnisse einen Hinweis darauf, dass sich die beiden Methoden voneinander differenzieren lassen.

Objective Previous studies have found evidence of an attentional bias for trauma-related stimuli in posttraumatic stress disorder (PTSD) using eye-tracking (ET) technlogy. However, it is unclear whether findings for PTSD after traumatic events in adulthood can be transferred to PTSD after interpersonal trauma in childhood. The latter is often accompanied by more complex symptom features, including, for example, affective dysregulation and has not yet been studied using ET. The aim of this study was to explore which components of attention are biased in adult victims of childhood trauma with PTSD compared to those without PTSD. Method Female participants with (n = 27) or without (n = 27) PTSD who had experienced interpersonal violence in childhood or adolescence watched different trauma-related stimuli (Experiment 1: words, Experiment 2: facial expressions). We analyzed whether trauma-related stimuli were primarily detected (vigilance bias) and/or dwelled on longer (maintenance bias) compared to stimuli of other emotional qualities. Results For trauma-related words, there was evidence of a maintenance bias but not of a vigilance bias. For trauma-related facial expressions, there was no evidence of any bias. Conclusions At present, an attentional bias to trauma-related stimuli cannot be considered as robust in PTSD following trauma in childhood compared to that of PTSD following trauma in adulthood. The findings are discussed with respect to difficulties attributing effects specifically to PTSD in this highly comorbid though understudied population. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Zusammenfassung. Theoretischer Hintergrund: Das BDI-II ist ein Selbstbeurteilungsinstrument zur Erfassung des Schweregrads einer Depression. Es liegen kaum Analysen mit Modellen aus der Item-Response-Theorie (IRT) vor. Fragestellung: Wie hoch ist die Messgenauigkeit des BDI-II über die unterschiedlichen Ausprägungen des latenten Traits (Depressivität) hinweg und sind die Kategorien der Items jeweils aufsteigend geordnet? Methode: Anhand von sechs großen Datensätzen aus verschiedenen klinischen Bereichen wurden psychometrische Analysen mit dem Graded Response Model durchgeführt. Ergebnisse: In allen Stichproben fand sich eine hohe interne Konsistenz. Die Schwellenwerte waren mit Ausnahme von Item 6 („Bestrafungsgefühle“) geordnet. Gemäß Testinformationsfunktion misst das BDI-II im mittleren bis hohen Depressionsbereich sehr gut (Reliabilität > .90) und im unteren Bereich gut. Schlussfolgerung: Für das BDI-II ergibt sich eine hohe und relativ gleichbleibende Messpräzision über einen weiten Bereich des latenten Traits, weshalb es insbesondere im klinischen, aber auch im nicht klinisch relevanten Wertebereich zur Erhebung des Schweregrades einer Depression gut geeignet ist., publishedVersion

Common variation in the gene encoding the neuron-specific RNA splicing factor RNA Binding Fox-1 Homolog 1 (RBFOX1) has been identified as a risk factor for several psychiatric conditions, and rare genetic variants have been found causal for autism spectrum disorder (ASD). Here, we explored the genetic landscape of RBFOX1 more deeply, integrating evidence from existing and new human studies as well as studies in Rbfox1 knockout mice. Mining existing data from large-scale studies of human common genetic variants, we confirmed gene-based and genome-wide association of RBFOX1 with risk tolerance, major depressive disorder and schizophrenia. Data on six mental disorders revealed copy number losses and gains to be more frequent in ASD cases than in controls. Consistently, RBFOX1 expression appeared decreased in post-mortem frontal and temporal cortices of individuals with ASD and prefrontal cortex of individuals with schizophrenia. Brain-functional MRI studies demonstrated that carriers of a common RBFOX1 variant, rs6500744, displayed increased neural reactivity to emotional stimuli, reduced prefrontal processing during cognitive control, and enhanced fear expression after fear conditioning, going along with increased avoidance behaviour. Investigating Rbfox1 neuron-specific knockout mice allowed us to further specify the role of this gene in behaviour. The model was characterised by pronounced hyperactivity, stereotyped behaviour, impairments in fear acquisition and extinction, reduced social interest, and lack of aggression; it provides excellent construct and face validity as an animal model of ASD. In conclusion, convergent translational evidence shows that common variants in RBFOX1 are associated with a broad spectrum of psychiatric traits and disorders, while rare genetic variation seems to expose to early-onset neurodevelopmental psychiatric disorders with and without developmental delay like ASD, in particular. Studying the pleiotropic nature of RBFOX1 can profoundly enhance our understanding of mental disorder vulnerability.

About half of individuals seeking treatment for borderline personality disorder (BPD) present with co-occurring posttraumatic stress disorder (PTSD). However, therapies that have been proven efficacious for simultaneously treating the full spectrum of core symptoms in patients with a dual diagnosis of BPD + PTSD are lacking.This is a subgroup analysis from a randomized controlled trial (registration number DRKS00005578) which compared the efficacy of two treatment programs, dialectical behavior therapy for PTSD (DBT-PTSD) versus cognitive processing therapy (CPT). Specifically, the present analysis was carried out in 93 women with a dual diagnosis of BPD + PTSD (Diagnostic and Statistical Manual for Mental Disorders; DSM-5). Outcome evaluations included the Clinician-Administered PTSD Scale, the Borderline Symptom List, and validated scales assessing dissociation, depression, and global functioning. The primary analysis was based on the intent-to-treat population, using mixed models.Both PTSD and BPD symptoms significantly decreased in both treatment groups. For PTSD symptoms, pre-post effect sizes were d = 1.20, 95% confidence interval (CI): [0.80-1.58] in the DBT-PTSD group and d = 0.90, 95% CI: [0.57-1.22] in the CPT group; for BPD symptoms, they were d = 1.17, 95% CI: [0.77-1.55], and d = 0.50, 95% CI: [0.20-0.79], respectively. Between-group comparisons significantly favored DBT-PTSD for improvement in symptoms of PTSD, BPD, and dissociation. Between-group differences regarding depression and global functioning were not significant.Both DBT-PTSD and CPT emerged as promising treatment options for simultaneously addressing the full spectrum of core symptoms in patients diagnosed with BPD + PTSD. Differential efficacy was in favor of DBT-PTSD as participants randomized to the DBT-PTSD arm improved more with respect to both their BPD and PTSD symptoms. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Research about the relation between migration and mental health as well as factors influencing the mental health of migrants has been growing because challenges of migration can constitute a significant mental health burden. However, its divergent findings seem to reflect group-specific differences, e.g., regarding country of origin and receiving country. Almost no empirical studies about individual migrant groups in different receiving countries have been undertaken so far. The present population-based study explores symptoms of depression, anxiety, and somatization as well as quality of life in an Austrian and a German sample of ex-Soviet Jewish migrants. We mainly investigate the relationship of religiosity and perceived xenophobic and anti-Semitic discrimination to the psychological condition of the migrants. Standardized self-report scales, specifically the Beck-Depression-Inventory-II (BDI), State-Trait-Anxiety-Inventory (STAI), Brief Symptom Inventory (BSI), and WHO Quality of Life Questionnaire (WHOQOL-BREF), were used to measure mental health. Ex-Soviet Jewish migrants in Austria showed significantly more depression, anxiety, and somatic symptoms than those in Germany. Regression analyses support a protective effect of religiosity on mental health in the sample in Germany and an adverse effect of perceived discrimination in the sample in Austria. The present study reveals a less favorable situation for ex-Soviet Jewish migrants in Austria, in terms of income, residence status, and xenophobic attitudes in the local population, compared to the group in Germany. Furthermore, our data suggest that the receiving country matters for the mental health of this migrant group. However, further research is needed to support these conclusions.

Study Objectives Subjective reports of sleep impairments are common in individuals with posttraumatic stress disorder (PTSD), but objective assessments of sleep have yielded mixed results. Methods We investigated sleep via actigraphy and e-diary on 6 consecutive nights in a group of 117 women with PTSD after childhood abuse (CA; PTSD group), a group of 31 mentally healthy women with a history of CA (healthy trauma controls, HTC group) and a group of 36 nontraumatized mentally healthy women (healthy controls, HC group). Results The PTSD group reported lower sleep quality, more nights with nightmares, and shorter sleep duration than both HTC and HC. Actigraphic measures showed more and longer sleep interruptions in the PTSD group compared to HTC and HC, but no difference in sleep duration. While the PTSD group underestimated their sleep duration, both HTC and HC overestimated their sleep duration. HTC did not differ from HC regarding sleep impairments. Conclusions Sleep in women with PTSD after CA seems to be more fragmented but not shorter compared to sleep patterns of mentally healthy control subjects. The results suggest a stronger effect of PTSD psychopathology on sleep compared to the effect of trauma per se. Subset of Data from Clinical Trial Treating Psychosocial and Neural Consequences of Childhood Interpersonal Violence in Adults (RELEASE), https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00000000, German Clinical Trials registration number: DRKS00005578

ZUSAMMENFASSUNGDie Agoraphobie ist eine häufige Angsterkrankung und kann durch die kognitive Verhaltenstherapie (KVT) effizient behandelt werden. Für Patienten, die aufgrund einer schweren Symptomausprägung die eigene Wohnumgebung nicht selbstständig verlassen können, ist jedoch häufig die Aufnahme einer ambulanten Psychotherapie unmöglich. Das Pilotprojekt der „aufsuchenden Psychotherapie“ bietet deshalb in Berlin eine manualbasierte KVT an, die im häuslichen Bereich der Betroffenen beginnt. Den Schwerpunkt der Behandlung bildet eine 5-wöchige Intensivphase, in der durch eine Expositionstherapie die Mobilität der Patienten zeitnah wieder hegestellt und so die Fortsetzung der KVT im Rahmen der ambulanten Regelversorgung ermöglicht werden soll. Das speziell für diese Patientengruppe konzipierte Therapiemanual wird im Verlauf des Projekts kontinuierlich weiterentwickelt, um es möglichst optimal auf die Bedürfnisse der Patienten zu adaptieren und so eine größtmögliche Behandlungssicherheit herzustellen. Ziel des Projekts ist es, dass eine aufsuchende Komponente bedarfsgerecht als Teil der ambulanten KVT etabliert und finanziell adäquat durch die Kostenträger kompensiert wird.

Patients with anxiety disorders have a lower heart rate variability (HRV) than healthy controls. Low HRV is associated with cardiovascular disease and dysfunction of the autonomic nervous system (ANS). The aim of the present study was to investigate if HRV in patients with agoraphobia with or without panic disorder can be influenced by cognitive behavioral therapy (CBT). 73 patients with agoraphobia with or without panic disorder were included in the study. Heart rate (HR) and HRV were recorded at rest before and after CBT and during in-vivo exposure. No changes in HR and HRV were observed throughout therapy. During in-vivo exposure HRV increased significantly and HR exhibited a tendency to decrease. Despite clinical improvement of anxiety symptoms, ANS activity at rest did not seem to be influenced by CBT. However, during in-vivo exposure, HRV changed significantly, indicating a higher parasympathetic activity at the end of exposure.

Im Rahmen von Fokusgruppen werden allgemeine Erfahrungen auf Patientenund Therapeutenseite im transkulturellen Psychotherapiegeschehen sowie spezifisch die Bedeutsamkeit von Vorwissen von Therapeuten über die Kultur eines Patienten untersucht und mittels qualitativer Inhaltsanalyse ausgewertet. Hierbei wird deutlich, dass sehr hilfreich für das transkulturelle Therapiesetting allein die Anwendung der gängigen therapeutischen Basiskompetenzen zu sein scheint. Nutzen und Risiko von kulturellem Vorwissen werden kontrovers diskutiert.

Preclinical studies point to a pivotal role of the orexin 1 (OX1) receptor in arousal and fear learning and therefore suggest the HCRTR1 gene as a prime candidate in panic disorder (PD) with/without agoraphobia (AG), PD/AG treatment response, and PD/AG-related intermediate phenotypes. Here, a multilevel approach was applied to test the non-synonymous HCRTR1 C/T Ile408Val gene variant (rs2271933) for association with PD/AG in two independent case-control samples (total n = 613 cases, 1839 healthy subjects), as an outcome predictor of a six-weeks exposure-based cognitive behavioral therapy (CBT) in PD/AG patients (n = 189), as well as with respect to agoraphobic cognitions (ACQ) (n = 483 patients, n = 2382 healthy subjects), fMRI alerting network activation in healthy subjects (n = 94), and a behavioral avoidance task in PD/AG pre- and post-CBT (n = 271). The HCRTR1 rs2271933 T allele was associated with PD/AG in both samples independently, and in their meta-analysis (p = 4.2 × 10−7), particularly in the female subsample (p = 9.8 × 10−9). T allele carriers displayed a significantly poorer CBT outcome (e.g., Hamilton anxiety rating scale: p = 7.5 × 10−4). The T allele count was linked to higher ACQ sores in PD/AG and healthy subjects, decreased inferior frontal gyrus and increased locus coeruleus activation in the alerting network. Finally, the T allele count was associated with increased pre-CBT exposure avoidance and autonomic arousal as well as decreased post-CBT improvement. In sum, the present results provide converging evidence for an involvement of HCRTR1 gene variation in the etiology of PD/AG and PD/AG-related traits as well as treatment response to CBT, supporting future therapeutic approaches targeting the orexin-related arousal system.

Auf der Grundlage des Methodenpapiers des Wissenschaftlichen Beirats Psychotherapie wird erlautert, warum der Antrag der Arbeitsgemeinschaft Humanistische Psychotherapie (AGHPT) auf Anerkennung als wissenschaftliches Psychotherapieverfahren negativ beschieden wurde. Es werden wesentliche Eckpunkte des Methodenpapiers und deren Anwendung am Beispiel einiger empirischer Studien im Antrag auf Anerkennung der humanistischen Psychotherapie erklart. Zudem werden einige kritische Punkte zum Verfahrensbegriff in der Psychotherapie ausgefuhrt.

Background The need to optimize exposure treatments for anxiety disorders may be addressed by temporally intensified exposure sessions. Effects on symptom reduction and public health benefits should be examined across different anxiety disorders with comorbid conditions. Methods This multicenter randomized controlled trial compared two variants of prediction error-based exposure therapy (PeEx) in various anxiety disorders (both 12 sessions + 2 booster sessions, 100 min/session): temporally intensified exposure (PeEx-I) with exposure sessions condensed to 2 weeks (n = 358) and standard nonintensified exposure (PeEx-S) with weekly exposure sessions (n = 368). Primary outcomes were anxiety symptoms (pre, post, and 6-months follow-up). Secondary outcomes were global severity (across sessions), quality of life, disability days, and comorbid depression. Results Both treatments resulted in substantial improvements at post (PeEx-I: d\(_{within}\) = 1.50, PeEx-S: d\(_{within}\) = 1.78) and follow-up (PeEx-I: d\(_{within}\) = 2.34; PeEx-S: d\(_{within}\) = 2.03). Both groups showed formally equivalent symptom reduction at post and follow-up. However, time until response during treatment was 32% shorter in PeEx-I (median = 68 days) than PeEx-S (108 days; TR\(_{PeEx-I}\)-I = 0.68). Interestingly, drop-out rates were lower during intensified exposure. PeEx-I was also superior in reducing disability days and improving quality of life at follow-up without increasing relapse. Conclusions Both treatment variants focusing on the transdiagnostic exposure-based violation of threat beliefs were effective in reducing symptom severity and disability in severe anxiety disorders. Temporally intensified exposure resulted in faster treatment response with substantial public health benefits and lower drop-out during the exposure phase, without higher relapse. Clinicians can expect better or at least comparable outcomes when delivering exposure in a temporally intensified manner.

Theoretically, panic disorder and agoraphobia pathology can be conceptualized as a cascade of dynamically changing defensive responses to threat cues from inside the body. Guided by this trans-diagnostic model we tested the interaction between defensive activation and vagal control as a marker of prefrontal inhibition of subcortical defensive activation. We investigated ultra-short-term changes of vagally controlled high frequency heart rate variability (HRV) during a standardized threat challenge (entrapment) in n = 232 patients with panic disorder and agoraphobia, and its interaction with various indices of defensive activation. We found a strong inverse relationship between HRV and heart rate during threat, which was stronger at the beginning of exposure. Patients with a strong increase in heart rate showed a deactivation of prefrontal vagal control while patients showing less heart rate acceleration showed an increase in vagal control. Moreover, vagal control collapsed in case of imminent threat, i.e., when body symptoms increase and seem to get out of control. In these cases of defensive action patients either fled from the situation or experienced a panic attack. Active avoidance, panic attacks, and increased sympathetic arousal are associated with an inability to maintain vagal control over the heart suggesting that teaching such regulation strategies during exposure treatment might be helpful to keep prefrontal control, particularly during the transition zone from post-encounter to circa strike defense. Trial Registration Number: ISRCTN80046034. German Federal Ministry of Education and Research Universität Greifswald (1032)

Panic disorder (PD) has a lifetime prevalence of 2–4% and heritability estimates of 40%. The contributory genetic variants remain largely unknown, with few and inconsistent loci having been reported. The present report describes the largest genome-wide association study (GWAS) of PD to date comprising genome-wide genotype data of 2248 clinically well-characterized PD patients and 7992 ethnically matched controls. The samples originated from four European countries (Denmark, Estonia, Germany, and Sweden). Standard GWAS quality control procedures were conducted on each individual dataset, and imputation was performed using the 1000 Genomes Project reference panel. A meta-analysis was then performed using the Ricopili pipeline. No genome-wide significant locus was identified. Leave-one-out analyses generated highly significant polygenic risk scores (PRS) (explained variance of up to 2.6%). Linkage disequilibrium (LD) score regression analysis of the GWAS data showed that the estimated heritability for PD was 28.0–34.2%. After correction for multiple testing, a significant genetic correlation was found between PD and major depressive disorder, depressive symptoms, and neuroticism. A total of 255 single-nucleotide polymorphisms (SNPs) with p < 1 × 10−4 were followed up in an independent sample of 2408 PD patients and 228,470 controls from Denmark, Iceland and the Netherlands. In the combined analysis, SNP rs144783209 showed the strongest association with PD (pcomb = 3.10 × 10−7). Sign tests revealed a significant enrichment of SNPs with a discovery p-value of

Background Psychology is at the beginning of a cooperative revolution. Traditionally, psychological research has been conducted by individual labs, limiting its scope in clinical samples and promoting replication problems. Large-scale collaborations create new opportunities for highly powered studies in this resource-intensive research area. To present the current state of a Germany-wide platform for coordinating research across university outpatient clinics for psychotherapy. Method Since 1999, over 50 such clinics were created in Germany. They represent a unique infrastructure for research, training, and clinical care. In 2013, a steering committee initiated a nationwide research platform for systematic coordination of research in these clinics (German abbreviation “KODAP”). Its main goal is to aggregate and analyze longitudinal treatment data – including patient, therapist, and treatment characteristics – across all participating clinics. Results An initial survey (100% response rate) yielded recommendations for improved integration of data collection. Pilot data from 4,504 adult (16 clinics) and 568 child and adolescent patients (7 clinics) proved feasibility of data transfer and aggregation despite different data formats. Affective, neurotic, stress, and somatoform (adults) and anxiety and behavioral (children and adolescents) disorders were most frequent; comorbidity was high. Overcoming legal, methodological, and technical challenges, a common core assessment battery was developed, and data collection started in 2018. To date, 42 clinics have joined. Conclusions KODAP shows that research collaboration across university outpatient clinics is feasible. Fulfilling the need for stronger cumulative and cooperative research in Clinical Psychology will contribute to better knowledge about mental health, a core challenge to modern societies.

The Clinician-Administered PTSD Scale (CAPS) is a widely used diagnostic interview for posttraumatic stress disorder (PTSD). Following fundamental modifications in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ( DSM-5), the CAPS had to be revised. This study examined the psychometric properties (internal consistency, interrater reliability, convergent and discriminant validity, and structural validity) of the German version of the CAPS-5 in a trauma-exposed sample ( n = 223 with PTSD; n =51 without PTSD). The results demonstrated high internal consistency (αs = .65-.93) and high interrater reliability (ICCs = .81-.89). With regard to convergent and discriminant validity, we found high correlations between the CAPS severity score and both the Posttraumatic Diagnostic Scale sum score ( r = .87) and the Beck Depression Inventory total score ( r = .72). Regarding the underlying factor structure, the hybrid model demonstrated the best fit, followed by the anhedonia model. However, we encountered some nonpositive estimates for the correlations of the latent variables (factors) for both models. The model with the best fit without methodological problems was the externalizing behaviors model, but the results also supported the DSM-5 model. Overall, the results demonstrate that the German version of the CAPS-5 is a psychometrically sound measure.

While DNA methylation patterns have been studied for a role in the pathogenesis of anxiety disorders, the role of the enzymes establishing DNA methylation—DNA methyltransferases (DNMTs)—has yet to be investigated. In an effort to investigate DNMT genotype-specific effects on dimensional anxiety traits in addition to the categorical phenotype of panic disorder, 506 panic disorder patients and 3112 healthy participants were assessed for anxiety related cognition [Agoraphobic Cognitions Questionnaire (ACQ)], anxiety sensitivity [Anxiety Sensitivity Index (ASI)] as well as pathological worry [Penn State Worry Questionnaire (PSWQ)] and genotyped for five single nucleotide polymorphisms (SNPs) in the DNMT3A (rs11683424, rs1465764, rs1465825) and DNMT3B (rs2424932, rs4911259) genes, which have previously been found associated with clinical and trait-related phenotypes. There was no association with the categorical phenotype panic disorder. However, a significant association was discerned between DNMT3A rs1465764 and PSWQ scores in healthy participants, with the minor allele conveying a protective effect. In addition, a marginally significant association between questionnaire scores (PSWQ, ASI) in healthy participants and DNMT3B rs2424932 was detected, again with the minor allele conveying a protective effect. The present results suggest a possible minor role of DNMT3A and DNMT3B gene variation in conveying resilience towards anxiety disorders. As the observed associations indicated a protective effect of two SNPs particularly with pathological worry, future studies are proposed to explore these variants in generalized anxiety disorder rather than panic disorder.

Am Muster eines Ausbildungsinstituts im Verbund universitarer Ausbildungsinstitute fur Psychotherapie (unith) werden charakteristische Masnahmen zur Sicherung einer guten Qualitat der Ausbildung von Psychologischen Psychotherapeuten bzw. Kinder- und Jugentlichenpsychotherapeuten dargestellt. Dabei wird insbesondere auf die Auswahl von Teilnehmern, die Durchfuhrung der theoretischen und praktischen Ausbildung und die Selbsterfahrung eingegangen. Zudem wird dargestellt, wie eine hohe Qualitat bei der Durchfuhrung der Ausbildungstherapien durch Supervision und psychometrische Uberprufung der Behandlungsverlaufe erreicht wird. Abschliesend werden erste Befunde uber c.a. 4.500 in unith Instituten behandelte Patienten dargestellt.

Background and objectives Acceptance and Commitment Therapy (ACT) is a young psychotherapeutic approach. It expands traditional Cognitive Behavioral Therapy (CBT) especially by mindfulness and valued living. Available research findings indicate ACT to be generally efficacious compared to control conditions. Even though ACT is increasingly applied in clinical practice, only little research has been conducted in this field. Hence, to examine the effectiveness of ACT, the present study aims to compare treatment outcome of group ACT and group CBT+, which consists of CBT and Interpersonal Psychotherapy (IPT) sessions, within a naturalistic setting. Methods Sixty-seven inpatients of a German psychiatric department were assigned to either ACT or CBT+ condition and assessed with respect to symptom measure as well as ACT-specific outcomes. Results Both groups improved on measures of symptom severity as well as ACT-specific components. There were no significant between-group differences. Conclusion Results indicate that ACT appears to show comparable results as CBT+. Findings are discussed in terms of to what extend outcomes of ACT and CBT+ are distinct and which possibly influencing factors could be considered in future research and treatment.

Abstract. The primary aim of the current study was to examine the unique contribution of psychological need frustration and need satisfaction in the prediction of adults’ mental well-being and ill-being in a heterogeneous sample of adults ( N = 334; Mage = 43.33, SD = 32.26; 53% females). Prior to this, validity evidence was provided for the German version of the Basic Psychological Need Satisfaction and Frustration Scale (BPNSFS) based on Self-Determination Theory (SDT). The results of the validation analyses found the German BPNSFS to be a valid and reliable measurement. Further, structural equation modeling (SEM) showed that both need satisfaction and frustration yielded unique and opposing associations with well-being. Specifically, the dimension of psychological need frustration predicted adults’ ill-being. Future research should examine whether frustration of psychological needs is involved in the onset and maintenance of psychopathology (e.g., major depressive disorder).

Der moglichst objektive Nachweis der Wirksamkeit ist eine berufs- und sozialrechtlich begrundete Anforderung an die Behandlungen, die im Gesundheitssystem angeboten werden. Diese Forderung gilt auch fur psychotherapeutische Masnahmen. Im Artikel werden die methodischen Charakteristika verschiedener Arten von Untersuchungen zur Wirksamkeit vorgestellt und das Wesen und die Idee der Forderung nach einer evidenzbasierten Psychotherapie inklusive der Kriterien fur Therapieerfolg erlautert. Eine besondere Bedeutung haben dabei die randomisiert-kontrollierten Psychotherapiestudien, deren methodische Vor- und Nachteile sowie deren Rolle im Gesundheitswesen dargestellt und diskutiert werden. Weiterhin wird betont, dass fur eine gute Versorgung neben der Berucksichtigung externer Evidenz die klinische Expertise der Behandler fur die Umsetzung und die Adaptation auf den Einzelfall unerlasslich ist.

The use of d-cycloserine (DCS) to augment exposure based therapy for anxiety disorders has shown mixed, although overall positive effects. Aim of the present study was to examine post-exposure administration of DCS in patients with agoraphobia with or without panic disorder. 73 patients with agoraphobia (with or without panic disorder) were treated with 12 sessions of cognitive behavioral therapy (CBT) including 3 exposures. Following successful exposure patients were given double blind either placebo or 50 mg of DCS. Primary outcome criterion was change in the Panic and Agoraphobia Scale (PAS) between CBT session t1, t4 (+∼2 months), t10 (+∼3 months) und t11 (+∼4 months). During the course of CBT the patients' symptomatology decreased significantly as measured by primary and secondary outcome criteria, however, without an additional benefit for DCS treated patients. Exploratory sub-group analyses for severely ill patients and patients with high anxiety and strong habituation during exposure showed that DCS administration was associated with increased improvement during the 1-month follow-up period (t10 - t11) with medium to large effect sizes (range in effect size η2p from .06 to .25). Our study results are consistent with recent research on DCS, indicating a beneficial augmentative effect for sub-groups of anxiety patients. The lack of an overall DCS effect for the whole patient sample might be explained by a dual mechanism in fear conditioning and extinction with different cognitive processes being involved during exposure depending on the degree of anxiety experienced by the patient.

Victimized women are thought to have impairments in identifying risk and to have dysfunctional reactions to threatening situations, which increase the risk for revictimization. To investigate possible deficits in revictimized women, we used a method examining women's perceptions of an implicit facial cue of aggressiveness – the facial Width-to-Height Ratio (fWHR). We tested whether revictimized women show impairments in detecting aggressiveness in male faces by neglecting cues of fWHR and choosing a smaller preferred distance to men. Fifty-two revictimized PTSD patients and 52 healthy controls provided ratings of aggressiveness and attractiveness for 65 photographed men and chose their preferred distance towards 11 pictured men. Multiple regression analyses indicated that revictimized women do not show impairments in perceiving and reacting to cues of aggression accurately. Hierarchical linear models, however, indicated that revictimized women rated all men as less aggressive. Revictimized women with histories of intimate partner violence (IPV) rated men with larger fWHRs and higher values of actual aggression to be more attractive than did revictimized women without IPV histories. A reduced appraisal of threat signals as threatening and an attraction to wider-faced and more aggressive men might increase the risk for revictimization.

Zusammenfassung. Theoretischer Hintergrund: Im Jahr 2013 entstand die Initiative, Daten der universitären Psychotherapieambulanzen zusammenzuführen, um so eine deutschlandweite Forschungsdatenplattform zu schaffen. Der Forschungsverbund KODAP (Koordination der Datenerhebung und -auswertung an Forschungs-‍, Lehr- und Ausbildungsambulanzen für psychologische Psychotherapie) organisiert dieses komplexe Vorhaben. Fragestellung / Methode: In der vorliegenden Studie wird die technische und organisatorische Machbarkeit einer solchen Forschungskooperation im Hinblick auf die Übermittlung und Zusammenführung der Daten dargestellt. Gleichzeitig wird die im Jahr 2016 in den Ambulanzen behandelte Patient_innenpopulation beschrieben und es werden erste Vergleichsdaten zur Häufigkeit ICD-10-basierter Diagnosen in diesem Versorgungssegment generiert. Ergebnisse: Insgesamt stellten 16 Ambulanzen Daten von 4504 Patientinnen und Patienten (MAlter = 37.87; SD = 13.47; Range = 15 bis 86; 65.3 % weiblich) aus dem Jahr 2016 zur Verfügung. Trotz der unterschiedlichen Systeme und Formate, in denen Patient_innen- und therapiebezogene Forschungsdaten verwaltet werden, erwies sich die Übermittlung und Zusammenführung der Datensätze als machbar. Affektive Störungen (F3) und Neurotische, Belastungs- und Somatoforme Störungen (F4) machten den Großteil der vergebenen Diagnosen aus. Bei mehr als der Hälfte der Patient_innen lag mehr als eine Störungsdiagnose vor (M = 1.84; SD = 0.99; Range = 0 bis 7). Schlussfolgerungen: Diese Studie konnte zeigen, dass die Aufbereitung, Zusammenführung und Auswertung von Forschungsdaten über Ambulanzen hinweg möglich ist. Der Forderung nach einer stärkeren Ausrichtung der Psychologie in Richtung kumulativer und kooperativer Forschungsprojekte kommt das KODAP-Projekt in besonderem Maße nach.