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Introduction: Clinical psychologists in Austria shouldered a large part of the massive increase in demand for mental health services caused by the COVID-19 pandemic. This study aimed to find out how the pandemic affected their work and to gather information on how best to support the profession in the event of a crisis., Methods: N = 172 Austrian clinical psychologists participated in a cross-sectional online survey between 11 April 2022 and 31 May 2022, including both closed and open-ended questions about their work. Open-ended questions were analyzed using qualitative content analysis. A mixed-methods analysis was conducted to test correlations between the categories derived from the qualitative analysis and professional variables., Results: The analyses revealed that clinical psychologists, especially those with more years of experience, perceived an increased need for clinical psychological treatment, especially for children and adolescents, a lack of coverage for clinical psychological treatment by health insurance, a change to remote treatment formats, and a number of burdens associated with complying with COVID-19 measures., Discussion: Clinical psychologists reported an urgent need to increase resources in both outpatient and inpatient settings and to promote health insurance coverage. To support the clinical psychology profession in providing high-quality work in times of crisis, there is a need to facilitate more opportunities for team and peer exchange, as well as financial support in the event of loss of income., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Santillan-Ramos, Humer, Schaffler, Pieh, Probst, Felnhofer, Kothgassner, Netzer and Jesser.)

Background: While most studies assessing psychotherapy efficacy are randomized-controlled trials conducted in research institutions or short clinical treatments, the understanding of psychotherapy effectiveness under regular, clinically representative conditions, particularly in outpatient practice, remains limited. Representative data examining the effectiveness of psychotherapy under real-world conditions in Austria is lacking., Aims and Methods: This paper introduces a naturalistic observational combined process- and outcome study, implementing a dual-perspective approach through standardised pre- and post-treatment questionnaires and evaluating changes in the therapeutic alliance after each session. Further, semi-structured qualitative interviews aim to illuminate the personal experiences of patients and therapists. The primary objective of the presented study is to discern whether symptoms markedly decrease following therapy. A significant secondary goal is to trace the therapeutic alliance's evolution from both patient and therapist viewpoints, emphasising the alliance-outcome association and gender dynamics within the pairs. This paper discusses the project's feasibility after three years and shares key insights., Discussion: Recruitment for this study has posed substantial challenges due to psychotherapists' concerns regarding data protection, extensive documentation, and philosophical reservations about the study design. Consequently, we recruited fewer participants than initially planned. Despite these hurdles, qualitative data collection has shown notable success. Given psychotherapists' busy schedules and reluctance to participate, more potent external incentives or a legal obligation may be necessary to encourage participation in future studies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Schaffler, Jesser, Humer, Haider, Pieh, Probst and Schigl.)

Introduction: Although adherence to immunosuppressive medication is the key factor for long-term graft survival today, 20-70% of transplant recipients are non-adherent to their immunosuppressive medication., Objective: A prospective, randomized, controlled single-center feasibility study was designed to evaluate the impact of a step guided multicomponent interprofessional intervention program for patients after kidney or liver transplantation on adherence to their immunosuppressive medication in daily clinical practice., Materials and Methods: The intervention consisted of group therapy and daily training as well as individual sessions in a step guided approach. The primary endpoint of the study was adherence to immunosuppression as assessed with the "Basel Assessment of Adherence to Immunosuppressive Medications Scale" (BAASIS). The coefficient of variation (CV%) of Tacrolimus (TAC) through levels and the level of personality functioning was a secondary endpoint. We conducted six monthly follow-up visits., Results: Forty-one age- and sex-matched patients [19 females, 58.5 ( SD = 10.56) years old, 22 kidney- and 19 liver transplantation] were randomized to the intervention- ( N = 21) or control-group ( N = 20). No differences between intervention- and control groups were found in the primary endpoint adherence and CV% of TAC. However, in further exploratory analyses, we observed that individuals with higher impairments in personality functioning showed higher CV% of TAC in the controls. The intervention might compensate personality-related susceptibility to poor adherence as evident in CV% of TAC., Discussion: The results of the feasibility study showed that this intervention program was highly accepted in the clinical setting. The Intervention group could compensate higher CV% of TAC after liver or kidney transplantation in individuals with lower levels of personality functioning and non-adherence., Clinical Trial Registration: ClinicalTrials.gov, identifier NCT04207125., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling editor declared a past co-authorship with the author JW-S., (Copyright © 2023 Wagner-Skacel, Fink, Kahn, Dalkner, Jauk, Bengesser, Mairinger, Schüssler, Pieh, Stadlbauer, Kirsch, Zitta, Rosenkranz, Fickert and Schemmer.)

Introduction: The impact of the Coronavirus disease (COVID-19) pandemic and the associated governmental restrictions on mental health have been reported in different countries. This cross-sectional study evaluated mental health during the COVID-19 pandemic in Austria and the association with sociodemographic factors (i.e., age, sex, education, income, employment status, partnership status, and migration background)., Methods: A representative sample ( N = 1,031) of the Austrian general population was surveyed online end of April 2022. Indicators of mental health were depression (PHQ-9), anxiety (GAD-7), insomnia (ISI), alcohol abuse (CAGE), eating disorders (SCOFF), and stress (PSS-10)., Results: 1,031 participants completed the online survey (50.3% women; mean age: 45.6 ± 17.23 years). Cut-offs for clinically relevant depression were exceeded by 28%. 16% scored above the cut-off for clinically relevant anxiety symptoms, 15% for clinical insomnia, 18% for alcohol abuse, 26% for eating disorders, and 65% for moderate to high stress. Comparisons with another cross-sectional representative Austrian sample recruited during the first weeks of the COVID-19 pandemic in Austria (April 2020) revealed increases in depression (from 21 to 28%) but no significant changes in anxiety, insomnia, and moderate to high stress. Multivariable logistic regression showed the strongest associations of mental health indicators with age, income, and sex. Increasing age and income were associated with lower odds of mental health symptoms. Being female compared to male increased the odds of depressive symptoms while decreasing the odds of alcohol abuse., Discussion: The COVID-19 crisis seems particularly stressful for younger adults (<35 years) and people with low income (<€2,000 net household income per month). Policymakers need to consider the high social and economic costs of lockdowns and think of optimal intervention methods for mental disorders among young and low-income individuals., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Humer, Schaffler, Jesser, Probst and Pieh.)

Studies report that psychotherapists overestimate their own performance (self-assessment bias). This study aimed to examine if the self-assessment bias in psychotherapists differs between therapeutic orientations and/or between social comparison groups. Psychotherapists gave subjective estimations of their professional performance (0-100 scale from poorest to best performance) compared to two social comparison groups ("all psychotherapists" vs. "psychotherapists with the same therapeutic approach"). They further rated the proportion of their patients recovering, improving, not changing, or deteriorating. In total, N  = 229 Austrian psychotherapists ( n  = 39 psychodynamic, n  = 121 humanistic, n  = 48 systemic, n  = 21 behavioral) participated in the online survey. Psychotherapists rated their own performance on average at M  = 79.11 relative to "all psychotherapists" vs. at M  = 77.76 relative to "psychotherapists with the same therapeutic approach" ( p  < 0.05). This was not significantly different between therapeutic orientations. A significant interaction between social comparison group and therapeutic orientation ( p  < 0.05) revealed a drop of self-assessement bias in social comparison group "same approach" vs. "all psychotherapists" in psychodynamic and humanistic therapists ( p  < 0.05). Psychotherapists overestimated the proportion of patients recovering ( M  = 44.76%), improving ( M  = 43.73%) and underestimated the proportion of patients not changing ( M  = 9.86%) and deteriorating ( M  = 1.64%), with no differences between orientations. The self-assessment bias did not differ between therapeutic orientations, but the social comparison group appears to be an important variable. A major drawback is that results have not been connected to patient-reported outcome or objectively rated performance parameters., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Probst, Humer, Jesser and Pieh.)

The COVID-19 pandemic has had unprecedented effects on our daily lives. This study aimed to assess the quality of life (QoL) (WHOQOL-Bref physical, social, and environmental domains) at two time points during the COVID-19 pandemic with lockdown restrictions according to gender, age, and urbanization level. Qualtrics ® recruited representative Austrian population samples in April 2020 (t1; N = 1,005) and December 2020/January 2021 (t2; N = 1,505). ANOVAs and the Bonferroni-corrected post-hoc tests were conducted to investigate differences between April and December 2020 and to compare with pre-pandemic data. Although the quality of life (physical, social, and environmental domains) changed from pre-pandemic (mean scores 80, 77, and 81, respectively) to April 2020 (mean scores 72, 65, and 75, all p -values < 0.001), there were no significant changes between April and December (mean scores 75, 65, and 75). Living location (urban vs. rural), gender, and age showed an effect on the quality of life. All domains of quality of life have decreased since the onset of the pandemic, and this decline has been maintained over the course of the first year of the pandemic. Creative measures should be implemented to assist people in improving one or more areas of quality of life, within the lockdown restrictions to improve the overall wellbeing of the population., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Dale, Budimir, Probst, Humer and Pieh.)

The aim of this study was to investigate the impact of different coping styles on situational coping in everyday life situations and gender differences. An ecological momentary assessment study with the mobile health app TrackYourStress was conducted with 113 participants. The coping styles Positive Thinking , Active Stress Coping , Social Support , Support in Faith , and Alcohol and Cigarette Consumption of the Stress and Coping Inventory were measured at baseline. Situational coping was assessed by the question "How well can you cope with your momentary stress level" over 4 weeks. Multilevel models were conducted to test the effects of the coping styles on situational coping. Additionally, gender differences were evaluated. Positive Thinking ( p  = 0.03) and Active Stress Coping ( p  = 0.04) had significant positive impacts on situational coping in the total sample. For women, Social Support had a significant positive effect on situational coping ( p  = 0.046). For men, Active Stress Coping had a significant positive effect on situational coping ( p  = 0.001). Women had higher scores on the SCI scale Social Support than men ( p  = 0.007). These results suggest that different coping styles could be more effective in daily life for women than for men. Taking this into account, interventions tailored to users' coping styles might lead to better coping outcomes than generalized interventions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 O’Rourke, Vogel, John, Pryss, Schobel, Haug, Haug, Pieh, Nater, Feneberg, Reichert and Probst.)

The novel coronavirus disease (COVID-19) has repeatedly been reported to impair mental health. This longitudinal study evaluated mental health at the emergence of the COVID-19 pandemic (t1) and 6 months later (t2) in Austria. Indicators of mental health were depression (PHQ-9), anxiety (GAD-7), sleep quality (ISI), perceived stress (PSS-10), as well as quality of life (WHO-QOL BREF) and well-being (WHO-5). In total, N = 437 individuals participated in both surveys (52.9% women). The number of participants with clinically relevant depressive, anxiety, or insomnia symptoms did not differ statistically significantly between t1 and t2 ( p ≥ 0.48). The prevalence of moderate or severe (clinically relevant) (1) depressive symptoms changed from 18.3% to 19.7% ( p = 0.48), (2) anxiety symptoms from 16.5 to 15.6% ( p = 0.67), and insomnia from 14.6 to 15.6% ( p = 0.69) from t1 to t2. Bonferroni-corrected t -tests showed that the stress level (PSS-10) decreased, and well-being (WHO-5) increased. However, effect sizes do not seem to be clinically relevant (Cohen's d < 0.2). Results suggest that detrimental health consequences of the COVID-19 pandemic persisted several months after its outbreak and the end of the lockdown measures, respectively. Regarding well-being and stress, there is a slight trend toward improvement., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Pieh, Budimir, Humer and Probst.)

This study investigated stress-level, degree of job-related anxiety, and fear of coronavirus disease (COVID-19) infection in psychotherapists in the early weeks of the COVID-19 lockdown in Austria. One thousand five hundred and forty-seven psychotherapists participated in an online survey, assessing stress [Perceived Stress Scale-10 (PSS-10)], work-related worries and fears of existence [Job Anxiety Scale (JAS)], fear of COVID-19 infection during face-to-face psychotherapy, and adherence to five protective measures against COVID-19 infection during face-to-face psychotherapy. Stress-levels were higher than in a representative sample ( p < 0.001). When psychotherapy was the sole income, stress-level ( p = 0.020) and job anxiety ( p < 0.001) were higher. Experiences with teletherapy, the psychotherapy format used during COVID-19, as well as reductions in number of patients treated during COVID-19, had no effect on stress-level or job anxiety. Psychotherapists still conducting face-to-face psychotherapy during COVID-19 reported less fear of infection compared to those conducting no face-to-face psychotherapy ( p < 0.001), whereby the fear of infection was further reduced when they were more able to adhere to protective measures against COVID-19 ( p < 0.01). Mental hygiene is important for psychotherapists to manage stress and job-related anxiety during COVID-19, especially in those whose income relies on psychotherapy., (Copyright © 2020 Probst, Humer, Stippl and Pieh.)

Purpose: Pain and depression have been shown to have a bidirectional interaction. Although several outcome studies have been conducted, it is still unclear if and how depression influences pain outcome. The current study aims to further clarify this relationship by comparing the predicting value of an interview- and a questionnaire-based assessment of depression., Patients and Methods: This retrospective study analyzed data of N = 496 chronic pain patients who received a multimodal pain management program. Multilevel models were performed with depression as predictor, pain measures as dependent variables, and the respective pain score at baseline as covariate. Depression was measured at baseline with (1) a semi-structured psychiatric interview corresponding to the ICD-10 and (2) the Center for Epidemiologic Studies Depression Scale (CES-D). Pain outcomes were pain intensity assessed with the Numeric Rating Scale (NRS), pain disability measured with the pain disability index (PDI), and affective as well as sensory pain perception assessed with the Pain Perception Scale (PPS-A/PPS-S)., Results: At post-treatment, pain intensity (NRS) was higher in patients with depression. This result emerged for interview- (ICD-10) and questionnaire- (CES-D) based depression. These results were significant after correction for multiple testing as well. Moreover, affective pain perception (PSS-A) at post-treatment was higher in patients with depression. Again, this result emerged for interview- (ICD-10) and questionnaire- (CES-D) based depression but it was not significant anymore after correction for multiple testing. Furthermore, pain disability (PDI) was higher at post-treatment in patients with depression according to the CES-D than in those without CES-D depression and this difference in the PDI did not emerge for interview-based depression. Yet, this difference on the PDI between the CES-D depression group and the CES-D no depression group was not significant anymore after correction for multiple testing., Conclusion: The hypothesis that how depression is assessed - interview-based corresponding to the ICD-10 or with the CES-D - contributes to the association between depression and pain treatment outcome could not be confirmed. Future research should use more than one interview and questionnaire to assess depression, since our results are limited to the clinical ICD-10 interview and the CES-D.

Associations between suicidal ideation and skill use were investigated during in-patient dialectical behavior therapy (DBT) for borderline personality disorder (BPD). Participants were N = 44 patients with BPD undergoing a 5-week in-patient DBT program in a psychiatric clinic. They filled in a diary card each treatment day resulting in 1,334 skill use ratings and 1,364 suicidal ideation ratings. Treatment days were categorized as days with successful skill use (using skills and perceiving them as effective), days with no skill use, days with unsuccessful skill use (using skills but perceiving them as ineffective). Multilevel models were performed to account for the nested data structure. The results showed that suicidal ideation improved more for patients who applied skills successfully more often during treatment ( p < 0.05). Moreover, suicidal ideation was lower on treatment days with successful skill use compared to treatment days with no skill use and compared to treatment days with unsuccessful skill use ( p < 0.05). When treatment days with no skill use were compared to treatment days with unsuccessful skill use, suicidal ideation was higher on treatment days with unsuccessful skill use ( p < 0.05). To conclude, using skills successfully on as many treatment days as possible is associated with lower suicidal ideation.

This randomized controlled trial investigated whether adding the psychodynamically based body-oriented psychotherapy "Functional Relaxation" (FR) to psychoeducation (PE) is more effective than PE alone to reduce stress and stress-associated complaints. Eighty-one participants with elevated stress-levels, ≥50 points on the global scale of the Perceived Stress Questionnaire (PSQ), received either 10 sessions of manualized FR + PE ( n = 42) or two sessions of manualized PE alone ( n = 39) in a group setting. Six FR trainers took part in this study. Stress-level (PSQ) was the primary outcome and secondary outcomes were depression (PHQ-9) and somatization (PHQ-15). Multilevel models for discontinuous change revealed that FR + PE was more helpful to reduce stress-levels than PE from pre-treatment to post-treatment (t0 → t1) as well as from pre-treatment to 6-month follow-up (t0 → t2) (both p < 0.05) with effect sizes ( d ) being medium for PE ( d t0 → t1 = 0.57; d t0 → t2 = 0.67) and large for FR + PE ( d t0 → t1 = 1.57; d t0 → t2 = 1.39). Moreover, FR + PE affected depression and somatization more positively than did PE from t0 to t1 as well as from t0 to t2 (all p < 0.05). Effect sizes for depression were small to medium for PE ( d t0 → t1 = 0.52; d t0 → t2 = 0.37) and large for FR + PE ( d t0 → t1 = 1.04; d t0 → t2 = 0.95). Effect sizes for somatization were small for PE ( d t0 → t1 = 0.18; d t0 → t2 = 0.19) and medium to large for FR + PE ( d t0 → t1 = 0.73; d t0 → t2 = 0.93). In summary, the combination of FR and PE was more effective than PE alone. The results of the present trial provide first evidence of FR as a potent component of stress interventions. Adding FR to such interventions might better help prevent clinically relevant disorders such as depression or somatization.