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OBJECTIVE: To determine the treatment effect of psychodynamic therapy for adolescents in comparison to normative developmental progression in two groups without treatment: healthy adolescents and adolescents with juvenile diabetes. RESEARCH DESIGN AND METHODS: In a 3-wave longitudinal study, n = 531 adolescents (n = 303 treated adolescents, n = 119 healthy, n = 109 with diabetes) and their parents filled out psychopathology questionnaires (Youth Self-Report [YSR] and Child Behaviour Checklist [CBCL]). Growth curve modeling (GCM) was used to examine within-person change in psychopathology while controlling for stable between-person differences. RESULTS: GCM analyses revealed significant within-person reductions in patients' YSR and CBCL (d = 1.02-1.99) at the end of treatment. When accounted for the control groups' developmental progression (d = .14-.94), patients' within-person change remained significantly higher (d = .48-.82). In all three groups, parents rated the severity of psychopathology significantly lower, and within-person change significantly higher than the adolescents him/herself. CONCLUSIONS: Psychodynamic therapy led to a significant symptom reduction in treated adolescents and was superior to development-related symptom changes occurring in the two control groups. Hence, clinically relevant symptoms in adolescents do not "grow out", but require psychotherapeutic treatment. Differences between adolescents and their parents in the evaluation of symptom severity and change require attention in psychotherapy treatment and research.

Zusammenfassung Hintergrund Menschen mit der Diagnose einer posttraumatischen Belastungsstörung (PTBS) sind oftmals mit sehr langen Wartezeiten zwischen Diagnose und Beginn einer leitliniengerechten traumafokussierten Behandlung konfrontiert. Um dieser Versorgungslücke zu begegnen, wurde eine Gruppenbehandlung mit 9 Sitzungen konzipiert, die den Fokus auf Stabilisierung und Selbstregulation legt, um entweder eine Traumabearbeitung in einer nachfolgenden Einzeltherapie zu erleichtern oder aber für Menschen mit komplexer PTBS eine zusätzliche Hilfe bei der Behandlung entsprechender Symptome zu ermöglichen. Methodik In einer Machbarkeitsstudie mit 5 Patientinnen mit der Diagnose einer PTBS nach DSM-IV wurden die Stimmung vor und nach jeder Sitzung sowie allgemeine und traumaspezifische Symptome vor und nach der Behandlung erfasst. Nach Behandlungsende und in einer Zweimonatskatamnese wurden Daten zu Verlauf und Akzeptanz erhoben. Ergebnisse Die Stimmung der Patientinnen hob sich im Verlauf der jeweiligen Sitzungen. Ebenso nahmen die Häufigkeit des selbstberichteten Übens und Anwendens der Übungen zu. Die Methode wurde insgesamt als sehr positiv eingeschätzt. Deskriptiv nahmen die Fähigkeit zur Selbstberuhigung ebenso wie strukturelle Fähigkeiten der Persönlichkeitsfunktion zu sowie Traumasymptomatik, Depressivität, Ängstlichkeit und interpersonelle Probleme ab. Diskussion Die Daten geben erste Hinweise auf die Machbarkeit und Akzeptanz einer Gruppenintervention zu Stabilisierung und Selbstregulation bei Frauen mit Traumafolgestörungen. Die Gruppenintervention hat das Potenzial, in der ambulanten Versorgung die Wartezeit auf eine traumafokussierte Einzeltherapie sinnvoll zu nutzen.

In Deutschland stellt die psychosomatische Rehabilitation neben der akutmedizinischen Versorgung eine feste Saule im Gesundheitswesen dar. Im Sinne einer gestaffelten Versorgung und begrenzter stationarer Behandlungszeiten sollen die Behandlungseffekte in ambulanten Nachsorgeangeboten in Gruppenformaten stabilisiert werden. Ungeachtet der weiten Verbreitung sind diese Nachsorgeangebote wenig beforscht. In einer naturalistischen Studie mit einem Pra-post-Design ohne Kontrollgruppe wurden insgesamt 261 Patienten in 23 psychosomatischen Nachsorgegruppen untersucht. Neben soziodemografischen Daten wurde die symptomatische Belastung zu insgesamt 3 Messzeitpunkten mithilfe des Klinisch-Psychologischen Diagnosesystem 38 (KPD-38) untersucht. Weiterhin wurde die Stichprobe hinsichtlich der Patienten, die die Masnahme komplett durchlaufen haben, und der Patienten, die die Masnahme vorzeitig beendeten, verglichen. In der Gesamtgruppe nahm die Symptomatik im Laufe der Gruppenbehandlung insgesamt signifikant und mit kleinen bis mittleren Effekten ab. Patienten mit regularem Abschluss der Masnahme profitierten am meisten im Gegensatz zu denen, die diese vorzeitig beendeten. Die Ergebnisse der Studie sind fur die Anwendung der ambulanten gruppenpsychotherapeutischen Nachsorge vielversprechend, jedoch sind weitere Studien zu Wirksamkeit und Pradiktoren der Veranderung notig.

Das gesprochene Wort ist in der Richtlinienpsychotherapie das zentrale Vehikel therapeutischen Handelns – ganz besonders in Situationen, in denen kein Standardschema das Vorgehen bestimmt, wenn es z. B. um Verstehen, Aushandeln, Mustererkennen oder das Bearbeiten von Brüchen der therapeutischen Arbeitsbeziehung geht. Am Beispiel psychodynamischer Interventionen soll gezeigt werden, wie praxisorientierte Kompetenzentwicklung mithilfe innovativer Lehr- und Lernformate erleichtert werden kann.

Knowledge on etiological and risk factors of genito-pelvic pain/penetration disorder, formerly classified as dyspareunia and vaginismus, is limited. The Operationalized Psychodynamic Diagnosis (OPD) system offers a valuable basis for developmental considerations, and has not yet been used to research sexual pain difficulties in women. We conducted an exploratory pilot study of psychodynamic motivational conflicts and level of personality functioning as defined by the OPD system by means of an anonymous online survey among 24 women who had been diagnosed with dyspareunia or vaginismus. We matched them with 24 healthy controls and compared groups using paired-samples t-tests and Wilcoxon tests. Effect sizes were calculated using Pearson's r. Large effect sizes were found for mean or median differences of several OPD Structure Questionnaire (OPD-SQ) scales (self-reflection, p = 0.002/r = 0.59; affect differentiation, p = 0.007/r = 0.53; self-perception, p = 0.002/r = 0.58; impulse control, p = 0.007/r = 0.53; self-worth regulation, p = 0.008/r = 0.52; self-regulation, p = 0.004/r = 0.56; experiencing affect, p = 0.009/r = 0.53; bodily self, p = 0.008/r = 0.54; OPD-SQ total score, p = 0.007/r = 0.52; internal communication, p = 0.001/r = 0.63) and OPD Conflict Questionnaire (OPD-CQ) scales (guilt conflict active, p = 0.004/r = 0.60; Oedipal conflict passive, p = 0.009/r = 0.51; individuation versus dependency conflict active, p = 0.01/r = 0.52; guilt conflict passive, p < 0.001/r = 0.70; self-worth conflict passive, p = 0.001/r = 0.70; passive mode, p < 0.001/r = 0.68). The problems with personality functioning and more pronounced types of conflicts participants displayed suggest proneness for self-invalidation, internalization and restricted self-perception.

Objective We aimed to investigate change in self-esteem through intensive group treatment for personality dysfunction, by exploring: (a) the relationship between patients' experience of therapeutic alliance and improvement in self-esteem during treatment, including patients' quality of object-relations (QOR) as a possible moderator; and (b) the association between improvement in self-esteem during treatment, and depressive symptoms 9 months later. Method Eighty patients with personality dysfunction, consecutively enrolled in a group-oriented treatment program, were assessed at pretreatment, posttreatment, and 9 months follow-up. Results Especially for patients with lower QOR, alliance predicted self-esteem change during treatment. In addition, change in self-esteem during treatment predicted follow-up depression severity, even when controlling for within-treatment symptom change. Conclusions Patients with impoverished inner relational representations may benefit more from a secure alliance in terms of improving their self-esteem. Change in self-esteem may also be important in preventing relapse of depressive symptoms in people with personality dysfunction.

Nicht zuletzt vor dem Hintergrund des Entwurfs einer Reform der Psychotherapieausbildung steht die Lehrbarkeit psychodynamischer Kompetenzen im besonderen Fokus der Aufmerksamkeit. Spezifische didaktische Ansatze konnen helfen, psychoanalytisch begrundete Interventionsstrategien erfahrbar und damit auf eine Weise zuganglich zu machen, die die klassische Trias von Literaturstudium, Selbsterfahrung und Supervision erganzt. In der vorliegenden Arbeit werden zunachst Hintergrunde fur die Bedeutsamkeit erfahrungsbasierten Lernens beschrieben, bevor exemplarisch zwei universitare Seminarformate dargestellt und mit Daten zum subjektiven Kompetenzzuwachs der teilnehmenden Studierenden unterlegt werden. Zum Abschluss werden Voraussetzungen, Moglichkeiten und Grenzen dieser Form der erfahrungsbasierten Lehre psychodynamischer Interventionen diskutiert.

Traumafolgestörungen werden oftmals als stressassoziierte seelische Erkrankungen verstanden. Neben den psychischen Symptomen bietet die Stressforschung wichtige Einblicke in biopsychologische Veränderungen der Traumafolgestörungen, die über das hinausgehen, was von Patientinnen und Patienten berichtet werden kann. Der Beitrag stellt Stressmodelle und zentrale Forschungsbefunde vor und diskutiert Fragen der Reversibilität veränderter Stressachsenregulation.

This study examines emotional experience in major depressive disorder (MDD) with and without comorbid borderline personality disorder (BPD). It investigates if depression severity or personality functioning mediates group differences and which aspects of emotional experience change during psychotherapy. The emotional experience of MDD-BPD patients (n = 44) was compared to MDD-only patients (n = 35) before and after multimodal short-term psychotherapy. Emotions were classified based on valence and an active/passive polarity. MDD-BPD patients exhibited more active-negative emotions. This group difference was mediated by the level of personality functioning, but not by depression severity. Although passive-negative emotions decreased and positive emotions increased during therapy, there was no significant change in active-negative emotions. The two patient groups did not significantly differ in the change of emotional experience. Lower levels of personality functioning in depressed patients with BPD are associated with a broader spectrum of negative emotions, specifically more active-negative emotions.

Objective: Deficits in affective processing are associated with impairments in both mental and physical health. The role of affective processing in patients with functional somatic complaints such as irritable bowel syndrome (IBS) remains unclear. Most studies have focused on the capacity for emotional awareness and expression, but neglect other dimensions of affective processing. Therefore, this study aimed to systematically analyze differences in six different dimensions of affective processing between patients with IBS and healthy controls (HCs). Additionally, we exploratively investigated the impact of IBS symptom severity, psychological distress, and attachment styles on affective processing in IBS.Methods: A controlled cross-sectional multi-center study was conducted. Overall, 127 patients with IBS were compared with 127 matched HCs using multivariate analysis of variances. Affective processing was operationalized in line with the affect cascade model on six specific dimensions: emotional experience, emotional awareness, affect tolerance, affect differentiation, affect regulation, and emotional communication. They were measured using two subscales of the Mentalizing Questionnaire (MZQ) and four subscales of the Operationalized Psychodynamic Diagnosis–Structure Questionnaire (OPD-SQ). Linear regression analysis was used to investigate the influence of IBS symptom severity (IBS-Severity Scoring System, IBS-SSS), depression (Patient Health Questionnaire, PHQ-9), anxiety (General Anxiety Disorder, GAD-7), and anxious and avoidant attachment styles (Experiences in Close Relationships Scale, ECR-RD12) on the different dimensions of affective processing in IBS.Results: Patients with IBS compared to HCs showed deficits in all six dimensions of affective processing. Deficits were largest for affect tolerance (d = 0.849) and lowest for emotional experience (d = 0.222) and emotional awareness (d = 0.420). Moderate effect sizes were found for affect differentiation (d = 0.773), emotional communication (d = 0.665), and affect regulation (d = 0.552). Moreover, explorative analyses indicated that affective processing in patients with IBS was significantly influenced by levels of anxiety and insecure attachment.Conclusion: The results indicate a specific pattern of affective processing abilities in patients with IBS. The deficits in affective processing are more prominent in the area of understanding and tolerating difficult affective states than experiencing affective states. This opens interesting perspectives for the development of specific psychotherapeutic interventions.Clinical Trial Registration: DRKS00011685.

Background The broad range of adverse health outcomes following child maltreatment (child maltreatment) underscores the need to investigate shared trajectories that contribute to associated physical and mental health problems. Previous research focused on different mechanisms, such as emotion regulation or attachment. In the present study, we propose personality functioning, comprising self- and interpersonal regulation and perception, to mediate between child maltreatment and mental and physical health. Methods In a German representative sample (N = 2,508), we assessed remembered child maltreatment, levels of personality functioning, and different health outcomes in adulthood, namely somatic symptoms, general mental distress, and body dysmorphic concern. We conducted path analyses to investigate mediation effects in the total sample as well as in female and male subsamples. Results Child maltreatment significantly predicted the assessed health outcomes and showed significant associations with lower levels of personality functioning. Personality functioning partially mediated all health outcomes assessed by significant indirect effects and lowered direct effects of child maltreatment on health outcomes. An exploratory analysis of different facets of personality functioning revealed a pronounced impact of identity perception and self-reflective capacities in mediating between child maltreatment and physical and mental health. Comparable results were found in female and male participants. Limitations Major limitations of the study are the reliance on cross-sectional data and the use of a screening measure to assess experienced child maltreatment. Conclusion Personality functioning may represent a transdiagnostic link to different somatic and psychological symptoms in the aftermath of child maltreatment.

Improvement in life satisfaction is hard to achieve for any patient with personality psychopathology, and possibly even moreso for those who feel hopeless at the start of treatment. The present research investigated the potential influence of hopelessness in the treatment of patients with personality dysfunction, using data from patients who completed an intensive group therapy program designed to reduce symptom distress and support optimal psychosocial functioning (N = 80). In the present study, we sought to examine whether hopelessness would moderate (i.e., strengthen or weaken) relations between compatibility ratings and life satisfaction outcome. Hopelessness had a significant moderating effect on the relationship between compatibility and outcome, suggesting that, for patients who entered treatment feeling more hopeless, higher appraisals of fit within the group facilitated better gains in life satisfaction. If replicated, the findings underlie the importance of focusing on increasing hope and perceived group affiliation in the treatment of personality dysfunction.

Objectives: Therapeutic agency is defined as a patient’s intentional influence over the process of psychotherapeutic change. However, there is a lack of conceptually sound self-report measures with...

In this study, we explored whether attachment insecurity moderates the effects of adverse childhood experiences on stress-reactivity in the context of Borderline Personality Disorder (BPD). Participants were 113 women (39 with BPD, 15 with some BPD criteria present, 59 without any BPD symptoms) who participated in the Trier Social Stress Test. Saliva samples were collected before and after the stressor, and assayed for alpha-amylase and cortisol. Adverse childhood experiences were measured using the Childhood Trauma Questionnaire, and Attachment by the Experiences in Close Relationships-Revised questionnaire. Results revealed that attachment avoidance, and a combination of more adverse childhood experiences and attachment insecurity (anxiety and avoidance) resulted in higher salivary alpha-amylase (sAA) levels as well as differences in reactivity to the stressor. Interactions between attachment anxiety and adverse childhood experiences were related to blunted cortisol reactivity. The results suggest that the influence of adverse childhood experiences on stress-regulation in BPD may be moderated by attachment-related regulatory processes.

Objective The study represents a conceptual replication of the study by Eng et al. (2001) in a sample of adult patients diagnosed with social anxiety disorder as primary diagnosis. Methods Two different attachment questionnaires (Bielefeld Questionnaire of Client Expectations (BQCE) and Experiences in Close Relationships (ECR-RD)) were applied to examine whether the effect of attachment on depression (measured by the BDI) is mediated by social anxiety (measured by the LSAS) in a cross-sectional study. Results The data confirms such a mediation. The effect of attachment measured with the BQCE on depression was completely mediated, whereas the effect of both scales of the ECR-RD (attachment related avoidance and anxiety) on depression was only partially mediated by social anxiety disorder. Conclusion The study supports the association of attachment, social anxiety, and depressive symptoms and the need to consider different perspectives on attachment.

Reduced social impairment and improved life satisfaction are important objectives in group treatment for patients with personality dysfunction. Knowledge regarding patient characteristics and group treatment processes that contribute to these outcomes, however, remains limited. Dispositional connectedness, the valuing of interpersonal connections, may be an important patient factor that influences patients' experience of group treatment in ways that facilitate therapeutic benefits. The present study investigated the roles of dispositional connectedness and group engagement in contributing to improvement in social functioning and life satisfaction through integrative group treatment for personality dysfunction. Seventy-nine patients who completed an integrative group treatment programme were assessed for dispositional connectedness at baseline and social functioning and life satisfaction at pretreatment and posttreatment; each also provided ratings of group engagement during treatment. Regression analyses using bootstrap confidence intervals found significant indirect effects for dispositional connectedness regarding improvement in both social functioning and life satisfaction, through the mediating effect of group engagement. Thus, patients who entered treatment with tendencies towards interpersonal connectedness perceived a higher level of engagement in the group environment. Group engagement in turn contributed to greater improvement in social functioning and to greater improvement in life satisfaction following treatment. The findings indicate dispositional connectedness as a salient characteristic in selecting patients for group treatment and highlight the role of an engaged interpersonal climate in facilitating improvement in social functioning and life satisfaction.

In Section III of DSM-5, the Level of Personality Functioning Scale (LPFS), a component of the DSM-5 Alternative Model for Personality Disorders (AMPD), offers a dimensional approach to the assessment of personality pathology. Similar to the psychoanalytic concept of personality organization developed by Kernberg ( 1984 ), personality disorders are assessed not only by categorical diagnoses, but also by measuring impairment of personality functioning. In this study we empirically investigate the convergence between two instruments examining personality functioning, the Structured Clinical Interview for the DSM-5 Alternative Model for Personality Disorders Module I (SCID-AMPD) and the Structured Interview of Personality Organization (STIPO). For this goal, correlations between both the overall scores of the two instruments as well as between the corresponding domain scale scores were examined. In addition, the relationship between interview ratings and clinical criteria quantifying the severity of the disorder (suicide attempts, frequency of psychiatric hospitalization, ICD-10 diagnoses) were analyzed. Based on videotaped assessments of 30 psychotherapeutic in- and outpatients with both instruments, significant correlations between overall scores and domain scales of the two interviews were found. Moreover, the ratings from both interviews showed high correlations with criteria of clinical severity.

Einleitung: Ab dem ersten Studienjahr kommt es im Medizinstudium zu einer Zunahme von psychischen Belastungen. Unklar bleibt, wie das Auftreten dieser Belastungen mit dem Bindungsmuster oder mit strukturellen Funktionen der Personlichkeit in Verbindung steht. Ziel dieser Studie war es, zu eruieren, ob ein Zusammenhang zwischen den uberdauernden Personlichkeitsvariablen Bindungsstil und Strukturniveau mit dem akuten Stresserleben zu Studienbeginn besteht. Material & Methoden: Im Rahmen dieser Studie wurden im WS 2013/2014 alle Studierenden des ersten Semesters Humanmedizin eingeladen, an einer Fragebogenuntersuchung zur Identifizierung von Belastungsfaktoren teilzunehmen (MBI-SS, PSQ, PHQ-9, GAD-7). Gleichzeitig wurde der vorherrschende Bindungsstil ermittelt (RQ-2) und eine Beurteilung der strukturellen Kompetenzen vorgenommen (OPD-SFK). Ergebnisse: Es nahmen 293 Studierende teil (Rucklauf: 91,3%). Sicher gebundene Studierende erlebten signifikant weniger Stress als unsicher gebundene Studierende (p=0,019). Studierende mit hohem Strukturniveau zeigten sich signifikant weniger stressbelastet (p Diskussion: Es bestehen signifikante Korrelationen zwischen Bindungsstil und Strukturniveau mit dem Burnoutrisiko sowie der Stressbelastung. Das Strukturniveau der Personlichkeit mediiert den Zusammenhang zwischen dem bindungsbezogenen „Modell des Selbst“ und Stresserleben, d. h. ein positives „Modell des Selbst“ kann eine stressprotektive Wirkung haben, wenn gute strukturelle Fahigkeiten vorhanden sind. Fazit fur die Praxis: Ein unsicherer Bindungsstil und ein niedrigeres Strukturniveau konnten mit einem hoheren Stresserleben im Rahmen der Schwellensituation des Studienbeginns einhergehen. Die Ergebnisse legen nahe, dass die uberdauernde Personlichkeitsvariable Bindungsstil, vermittelt uber die Personlichkeitsstruktur, zu einem hoheren Stresserleben fuhrt. Betroffene konnten fruhzeitig Praventionsmasnahmen wahrnehmen, um eine nachhaltige Vorbereitung auf diese Schwellensituation zu ermoglichen. Longitudinal-prospektive Studien sind notwendig, um zu erforschen, ob die Vermutung, dass eine in der Schulzeit vorbestehende Vulnerabilitat erst in der Schwellensituation zur Exazerbation der psychischen Belastungen fuhrt, zutreffend ist.

Aims Psychosocial variables influence chronic diseases, such as type 2 diabetes mellitus. While there is evidence for a negative impact of depression, much less is known about stable, personality oriented factors. Aim of the study was to assess the impact of depression and personality functioning on glucose regulation in patients with type 2 diabetes. Methods Seventy-five adult individuals with a first diagnosis of type 2 diabetes were consecutively recruited in an outpatient medical practice. Plasma glucose (HbA1c) was measured at initial contact, and after three and six months of a standardized disease management program. Depression was assessed by self-report (Patient Health Questionnaire, PHQ-D), levels of personality functioning with the screening version of the Operationalized Psychodynamic Diagnosis structure questionnaire (OPD-SQS). Results Using mixed regression models, OPD-SQS scores were associated with lower baseline levels of HbA1c, but a less steep decline over time. PHQ-D scores were neither associated with intercept nor with slopes of HbA1c. Conclusions In type 2 diabetes, levels of personality functioning but not depression predicted decline in plasma glucose during the first six months of a standardized disease management program. Personality functioning may be especially important in chronic diseases that demand a high level of compliance and lifestyle change.

Interpersonal characteristics contribute to therapists' ability to form helpful working alliances with their patients. But how are attachment styles and interpersonal motives distributed among therapist trainees? This study examines attachment styles and interpersonal motives of therapist trainees by comparing them with matched reference samples from representative surveys. A total sample of 285 trainees, who were enrolled in either cognitive-behavioral or psychodynamic therapy training programs, was recruited via their training institutes. Participants answered questionnaires on attachment (Experiences in Close Relationships-Revised, 36-item version, and Experiences in Close Relationships-Revised, 8-item version) and interpersonal motives (Circumplex Scales of Interpersonal Values). Compared with 2 matched nonclinical reference samples from representative surveys, therapist trainees reported lower scores on attachment-related avoidance and higher scores on harmonious interpersonal motives. Therapist trainees are characterized by a wish for warm proximity with others and feel comfortable in close relationships. (PsycINFO Database Record

An increased understanding of repetitive dysfunctional patterns and their relationship to an individual's life history is regarded as a key mechanism of change in insight-oriented therapies. At the same time, empirical research on the insight-outcome relationship is rare, and its generalizability is restricted by the use of a wide range of definitions and methods among studies. The authors conducted a meta-analysis to systematically examine the association between patient insight and psychotherapy outcome across a range of treatment modalities.Insight was defined as patients' understanding of associations between past and present experiences, typical relationship patterns, and the relation between interpersonal challenges, emotional experience, and psychological symptoms. From 13,849 initially identified abstracts, the authors extracted 23 independent effect sizes. A random-effects meta-analysis was performed to assess the magnitude of the insight-outcome relationship. Risk of publication bias was assessed with funnel plot inspections, Egger's regression test, and Duval and Tweedie's trim-and-fill procedure as sensitivity analyses.A significant, moderate correlation (r=0.31) was observed between insight and treatment outcome. Sensitivity analyses demonstrated the robustness of the results.The findings support the importance of insight for psychotherapy outcome. Insight may be a relevant mechanism of change across different treatment modalities.

OBJECTIVES Limited empirical attention has been devoted to individualized treatment objectives in intensive group therapy for personality dysfunction. This study investigated patients' ratings of distress associated with individual therapy goals - referred to as target object severity - in an intensive Evening Treatment Programme for patients with personality dysfunction. DESIGN Change in target objective severity was examined in a sample of 81 patients who completed treatment in an intensive, integrative group therapy programme. METHODS Correlation and regression analyses were used to examine associations between change in target object severity and patients' pre-treatment diagnosis, symptom distress, and treatment outcome expectancy, and between change in target objective severity and patients' ratings of group therapy process (group climate, therapeutic alliance, group cohesion). The relationship between change in target objective severity and longer-range life satisfaction was also examined in a subsample of patients who rated life satisfaction at follow-up. RESULTS While change in target objective severity was not significantly related to pre-treatment variables, significant associations were found with several aspects of group therapy process. Patients' experience of a highly engaged group climate was uniquely associated with improvement in target object severity. Such improvement was significantly related to longer-term life satisfaction after controlling for general symptom change. CONCLUSION The working atmosphere in group therapy contributes to patients' progress regarding individual treatment targets, and such progress is an important factor in later satisfaction. Attention to individualized treatment targets deserves further clinical and research attention in the context of integrative group therapy for personality dysfunction. PRACTITIONER POINTS This study found that patients attending an integrative group treatment programme for personality dysfunction experienced significant improvement in severity of distress related to individual treatment objectives. Improvement in severity of distress related to individual treatment objectives was uniquely associated with patients' experience of an engaged, collaborative working atmosphere. Improvement in individual target objective severity was associated with patients' ratings of overall life satisfaction, rated an average of 9 months following termination, after controlling for change in general symptom severity.

Objective Periodontal disease is associated with a wide range of psychosocial risk-factors. Disease-related tooth-loss has been associated with an increase in depressive symptoms in cross-sectional studies. However, while depression is a known risk-factor for the outcome of chronic diseases, it remains unclear if tooth loss can also predict depressive symptoms over the course of treatment. Aim of the current pilot study was to test, to what extend the number of teeth predict depressive symptoms several years later. Methods Tooth status of 310 patients with chronic and aggressive periodontitis was evaluated at the beginning of a specialized, university based outpatient treatment. We assessed depressive symptoms with the Patient Heath Questionnaire (PHQ) on average 13 years later. Regression analyses were used to relate initial number of teeth to self-reported depression scores. Results Fewer teeth at the beginning of the treatment were related to higher scores of depressive symptoms, even when controlling for several covariates. Conclusions Tooth loss is a potential risk-factor for the development of depression in periodontal disease. Further longitudinal studies that control for initial depressive symptoms are needed to identify disease mechanisms.

Reduced self-esteem is a core symptom of depression, but few studies have investigated within-treatment change of self-esteem as a predictor of long-term outcome in depression. This study investigated change in self-esteem during 8 weeks of multimodal, psychodynamically oriented psychotherapy for 40 depressed patients and tested whether it would predict outcome 6 months after termination. Data was drawn from a randomized clinical pilot trial on day-clinic versus inpatient psychotherapy for depression. Findings supported the association between change in self-esteem and follow-up depression severity, even when controlling for within-treatment symptom change. Change in self-esteem was not related to overall symptoms and interpersonal problems at follow-up. Thus, change in self-esteem may be an important variable in preventing relapse for depression. Key Practitioner Message Self-esteem is related to depressive symptoms and interpersonal problems. Improvement of self-esteem during psychotherapy correlates with improvements of symptoms and interpersonal problems. Change of self-esteem during psychotherapy predicts depressive symptoms 6 months after termination of therapy. When treating depressed patients, psychotherapists should work towards an improvement of self-esteem in order to prevent relapse.

Maternal depression poses a risk for the developing mother-infant relationship. Similarly, maternal insecure attachment styles may limit the ability to adequately connect with the newborn during the postpartum period. The aim of this study was to investigate the effect of maternal depression and insecure attachment (insecure and dual/disorganized) on maternal bonding in a sample of n = 34 women with depression according to DSM-IV and n = 59 healthy women. Maternal depression was assessed 3 to 4 months postpartum with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), bonding with the Postpartum Bonding Questionnaire, and maternal attachment style with the Attachment Style Interview. Women with current and lifetime depression as well as women with dual/disorganized attachment style reported lower bonding. Explorative analysis revealed that depression partially mediated the link between dual/disorganized attachment style and bonding with a medium-sized mediation effect. The combination of maternal depression and dual/disorganized attachment style may pose a special risk constellation for the developing mother-infant bond that should be addressed in prevention and early intervention programs.

Background: The concept of attachment is relevant for the onset and development of chronic pain. Insecure attachment styles negatively affect therapeutic outcome. Insecurely attached patients seem to be less able to sustain positive effects of a multimodal treatment program. However, it has never been tested before if an attachment-oriented approach can improve treatment results of insecurely attached patients in a multimodal outpatient setting. To test this assumption, we compare the short- and long-term outcomes for pain patients who will receive multidisciplinary, attachment-oriented treatment with the outcomes for patients in a control group, who will receive the multidisciplinary state-of-the-art treatment. Methods: Two patient groups (baseline, attachment intervention) are assessed before treatment, after treatment, and at a 6 month follow-up. The study is conducted in a block design: After data collection of the first block (controls) and before as well as during data collection for the second block (treatment group), the health care personnel of the outpatient pain clinic receives training on attachment theory and its use in the therapeutic context. Pain intensity as measured with visual analogue scales and physical functioning will serve as the primary outcome measures. Discussion: The design of our study allows for a continuous exchange of experienced team members, which may help bring about concrete attachment related guidelines for the enhancement of therapeutic outcome. This would be the first attempt at an attachment-oriented improvement of multimodal pain programs. Conclusion: An attachment-based approach may be a promising way to enhance long-term treatment outcomes for insecurely attached pain patients. Trial registration: DRKS00008715 (registered on the 3rd of June 2015).

The quality of depression in borderline personality disorder (BPD) was reported to differ from that in patients with major depressive disorder (MDD) only. However, little is known about affect dynamics in "borderline-depression." The authors assessed affective instability and reactivity in 20 MDD patients with BPD and in 21 MDD patients without BPD by Ambulatory Assessment. Participants reported on current affect, daily events, and attribution of affective states to events five times per day over a 7-day period. The results do not indicate higher affective instability in MDD patients with BPD comorbidity. Depressed patients with BPD reported less subjectively perceived affective reactivity, while observed associations between events and affect were not different between groups, except for one finding: In depressed patients with BPD, overall mood was lower after being alone. These findings suggest impaired attribution of mood changes and less tolerance of being alone as specific for depression in BPD.

Attachment theory helps us to understand patients´ health behavior. Attachment styles might explain patient differences in coping behavior, self-treatment, or patient-provider relationships. In primary care time constrains are relevant. A short instrument may facilitate screening and assessment in daily medical practice. The aim of this study was to evaluate a 12-item short version of the Experience in Close Relationships-revised (ECR-R-D) to be used in primary care settings. We included 249 patients from ten general practices in central Germany into a cross-sectional study. Exploratory factor analysis was performed to evaluate the factor structure of the ECR-items. Cronbach's alpha was used to assess internal consistency. The results related to the short form of the ECR are in line with those of the German full-length version of the measure (ECR-RD 36). Internal consistencies were in an adequate range. The ECR short form can be recommended as a screening measure of attachment styles in primary care.

Objectives. Despite its clinical importance and relevance for health care policy, the pathways between depression and stress regulation remain poorly understood. The objective of our study was to compare cardiovascular and autonomic responses to brief psychosocial stress in a group of severely depressed subjects without heart disease and a non-depressed controlgroup. Methods.We recorded cardiovascular and autonomic reactions to two different stress tasks including anger recall and mental arithmetic in a sample of 25 severely depressed and 25 non-depressed subjects. Aggregated data were compared with repeated-measures MANOVA. We used contrasts to evaluate different response patterns concerning cardiovascular and autonomic reactivity vs. recovery. Results. Depressed subjects showed overall reduced high-frequency heart rate variability and an altered cardiovascular adaptability concerning heart rate, blood pressure, cardiac output, and, on a trend level, peripheral resistance. With few exceptions, we found no differences between reactivity vs. recovery response patterns. Conclusions. Our results provide further evidence for altered cardiovascular reactivity and impaired cardiac autonomic functioning in depression. Further research is needed on psychophysiological response to either more disease-oriented or more personality-oriented stressors.

The psychoanalytically informed construct of 'defence mechanisms' is of central importance for the understanding of the dynamics of inner conflicts and the onset of neurotic symptoms. Objective and valid assessment of 'defence' is difficult. There are a number of observer rating instruments but only few self-report questionnaires. The German version of the 'Defence Style Questionnaire - DSQ 40' (Andrews, Singh, & Bond, 1993) was examined with regard to its factorial and content validity, and its sensitivity to change during inpatient psychotherapy. One hundred and fifty-five patients with mixed diagnoses were administered the DSQ 40 and the SCL-90-R before and after 3 months of inpatient psychotherapy. Diagnoses were mostly affective and anxiety disorders as well as eating disorders, and there was a high comorbidity of personality disorders. After deletion of some items due to insufficient pairwise item-intercorrelation or false classification to a defence mechanism by experienced clinicians, we found three stable factors of defence (maladaptive, intermediate-neurotic and adaptive) consistent with the previous research. After 3 months of therapy, a decrease in maladaptive mechanisms and an increase in adaptive patterns were found, while neurotic mechanisms did not change on average. Our shortened version of the DSQ 40 was shown to be a valid instrument for the assessment of defence mechanisms and change in these mechanisms after psychotherapy. Our design did not permit an assessment of whether or not the change in defence mechanisms was due to the therapeutic treatment.