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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.

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.

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

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).

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.

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 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.

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.

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.

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.

Background Impairments in sexual functioning and sexual satisfaction are very common in women who have experienced childhood sexual abuse (CSA). A growing body of literature suggests a high prevalence of sexual distress in patients with post-traumatic stress disorder (PTSD). However, the influence of sexual trauma exposure per se and the influence of PTSD symptoms on impairments in sexual functioning remain unclear. Aim The aim of this study was to investigate the influence of sexual trauma exposure and PTSD on sexual functioning and sexual satisfaction by comparing 3 groups of women. Methods Women with PTSD after CSA (N = 32), women with a history of CSA and/or physical abuse but without PTSD (trauma controls [TC]; N = 32), and healthy women (N = 32) were compared with regards to self-reported sexual functioning and sexual satisfaction. Trauma exposure was assessed with the Childhood Trauma Questionnaire, and PTSD was assessed with the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Outcomes Sexual functioning was assessed with the Sexual Experience and Behavior Questionnaire, and sexual satisfaction was assessed with the questionnaire Resources in Sexuality and Relationship. Results PTSD patients had significantly lower sexual functioning in some aspects of sexual experience (sexual aversion, sexual pain, and sexual satisfaction) but did not significantly differ in sexual arousal and orgasm from the other 2 groups. TC and healthy women did not significantly differ from each other on the measures of sexual functioning or sexual satisfaction. Clinical Translation Results suggest that the development of PTSD has a greater impact on sexual functioning than does the experience of a traumatic event. This emphasizes the importance to address possible sexual distress and sexual satisfaction in women with PTSD by administering specific diagnostic instruments and by integrating specific interventions targeting sexual problems into a trauma-specific treatment. Conclusions The study is the first comparing PTSD patients and TC with healthy women with regards to sexual functioning. Limitations are selection and size of the samples, the assessment of sexual functioning by self-report measures only, and lack of consideration of other potentially relevant factors influencing sexuality. The findings suggest that the experience of sexual abuse does not necessarily lead to sexual impairment, whereas comparably low levels of sexual functioning seem to be prominent in PTSD patients after CSA. Further research is needed on how to improve treatment for this patient group.

Background For the next edition of the International Statistical Classification of Diseases (ICD-11) it is proposed to include prolonged grief disorder as a new diagnosis. The diagnosis describes persistent intensive and disabling grief reactions to bereavement (WHO, 2016b). The aim of the present survey was to determine the extent to which the diagnosis is accepted by practitioners in the healthcare and psychosocial field. Methods A total of 2088 German-speaking professionals in the fields of psychotherapy, psychology, counselling, medicine and palliative care completed the online survey. Results 42.4% of the participants felt that the advantages of including the diagnosis outweigh the disadvantages, 32.9% came to the conclusion that there are more disadvantages. The remaining 24.7% stated that advantages and disadvantages are balanced. The proposed classification as separate diagnosis was supported by 24.8%, while 60.0% preferred alternatives (e.g. as subtype of adjustment disorder). Furthermore, a time criterion of at least 12 months was voted for considerably more frequently (49.2%) than the proposed 6 months (11.3%). Objections were predominantly expressed with regard to pathologization of normal grief and to the difficulty of adequate crosscultural application of the diagnosis. Limitations Results are limited to predominantly German health-care professionals. The items did not undergo psychometric analyses. Conclusions The disagreement about the diagnosis found in specialist literature is also reflected in the responses by the participants. The present results provide stimulation for future questions and validation studies carried out as part of the ICD revision.

Although the assessment of therapeutic competence in psychotherapy research is essential for examining its possible associations with treatment outcomes, it is often neglected due to high costs and a lack of valid instruments. This study aimed to develop two therapeutic competence scales that assess disorder-specific and treatment-specific therapeutic competence, and to examine these scales' psychometric properties along with those of the already established Cognitive Therapy Scale (CTS) in a posttraumatic stress disorder (PTSD) sample. Using an inductive procedure, two rating scales for assessing disorder-specific and treatment-specific competence were constructed. The psychometric properties of these scales and those of the CTS were assessed in a sample of 30 videotaped sessions of eight patients from a multicenter study in which PTSD related to child abuse was treated using cognitive processing therapy. Two raters assessed therapeutic competence in 30 videotaped psychotherapy sessions. Interrater reliability, internal consistency, and content validity were determined. The scales (all items and total scores) demonstrated good to excellent interrater reliability, intraclass correlation coefficients (ICCs) = .67 to .97, and internal consistency, Cronbach's α = .73 to .92. The PTSD experts' ratings confirmed good internal validity. We found statistically significant associations with therapeutic adherence, r = .62 to .85; p < .001; and therapeutic alliance, r = .47, p < .001. These preliminary data imply that the two newly developed competence scales and the CTS can be reliably used to assess different types of therapeutic competence in PTSD samples and may be useful as possible predictors of treatment outcomes.

Results regarding the association between global self-esteem and sexual behavior suggest the importance of a domain-specific construct—so-called sexual self-esteem (SSE). Prior studies suggested that SSE is malleable and found a negative impact of sexual abuse on SSE. In the present study, the German translation of the Sexual Self-Esteem Inventory-Short Form (SSEI-SF) by Zeanah and Schwarz (1996) was validated via an online survey with 557 women and then investigated in a clinical sample of women suffering from PTSD following sexual and physical abuse compared with healthy controls (n = 130). We examined differences in SSE depending on the type of abuse. Confirmatory factor analysis revealed adequate model fit, with acceptable-to-excellent reliability (α = .78–.94) and sound convergent and discriminant validity. As expected, SSEI-SF scores were significantly lower in the clinical sample than those in the healthy control group. Within the clinical sample, there were no significant differences in SSE between clients who had experienced sexual abuse and those who had experienced physical abuse, but a history of sexual abuse was significantly linked to lower SSE and SSE was related to both sexual behavior and sexual satisfaction. In conclusion, our study supports the validity and applicability of the German version of the SSEI-SF. Results regarding the differences in SSE between survivors of abuse and healthy controls contribute to the further understanding of female sexuality and have implications for treatment.

Major depressive disorder and the anxiety disorders are highly prevalent, disabling and moderately heritable. Depression and anxiety are also highly comorbid and have a strong genetic correlation (rg ≈ 1). Cognitive behavioural therapy is a leading evidence-based treatment but has variable outcomes. Currently, there are no strong predictors of outcome. Therapygenetics research aims to identify genetic predictors of prognosis following therapy. We performed genome-wide association meta-analyses of symptoms following cognitive behavioural therapy in adults with anxiety disorders (n = 972), adults with major depressive disorder (n = 832) and children with anxiety disorders (n = 920; meta-analysis n = 2724). We estimated the variance in therapy outcomes that could be explained by common genetic variants (h2SNP) and polygenic scoring was used to examine genetic associations between therapy outcomes and psychopathology, personality and learning. No single nucleotide polymorphisms were strongly associated with treatment outcomes. No significant estimate of h2SNP could be obtained, suggesting the heritability of therapy outcome is smaller than our analysis was powered to detect. Polygenic scoring failed to detect genetic overlap between therapy outcome and psychopathology, personality or learning. This study is the largest therapygenetics study to date. Results are consistent with previous, similarly powered genome-wide association studies of complex traits.

The availability of large-scale datasets and sophisticated machine learning tools enables developing models that predict treatment outcomes for individual patients. However, few studies used routinely available sociodemographic and clinical data for this task, and many previous investigations used highly selected samples. This study aimed to investigate cognitive behavioral therapy (CBT) outcomes in a large, naturalistic and longitudinal dataset. Routine data from a university-based outpatient center with n = 2.147 patients was analyzed. Only baseline data including sociodemographics, symptom measures and functional impairment ratings was used for prediction. Different competing classification and regression models were compared to each other; the best models were then applied to previously unseen validation data. Applied on the validation set, the best performing classification model for remission achieved a balanced accuracy of 59% (p 0.001) and the best performing regression model for dimensional change achieved r = 0.27 (p 0.001). Age, sex, functional impairment, symptom severity, and axis II comorbidity were among the most important features. Predictor performances significantly exceeded chance level but were far from clinical utility. Neither applying more sophisticated approaches nor restricting the sample to homogeneous subgroups resulted in considerable performance gains. Adding hypotheses-based, more specific clinical constructs and deep (e.g. neurobiological) to digital phenotypes may increase prediction performance.

Posttraumatic stress disorder (PTSD) after childhood abuse (CA) is often related to severe co-occurring psychopathology, such as symptoms of borderline personality disorder (BPD). The ICD-11 has included Complex PTSD as a new diagnosis, which is defined by PTSD symptoms plus disturbances in emotion regulation, self-concept, and interpersonal relationships. Unfortunately, the empirical database on psychosocial treatments for survivors of CA is quite limited. Furthermore, the few existing studies often have either excluded subjects with self-harm behaviour and suicidal ideation — which is common behaviour in subjects suffering from Complex PTSD. Thus, researchers are still trying to identify efficacious treatment programmes for this group of patients. We have designed DBT-PTSD to meet the specific needs of patients with Complex PTSD. The treatment programme is based on the rules and principles of dialectical behavioural therapy (DBT), and adds interventions derived from cognitive behavioural therapy, acceptance and commitment therapy and compassion-focused therapy. DBT-PTSD can be provided as a comprehensive residential programme or as an outpatient programme. The effects of the residential programme were evaluated in a randomised controlled trial. Data revealed significant reduction of posttraumatic symptoms, with large between-group effect sizes when compared to a treatment-as-usual wait list condition (Cohen’s d = 1.5). The first aim of this project on hand is to evaluate the efficacy of the outpatient DBT-PTSD programme. The second aim is to identify the major therapeutic variables mediating treatment efficacy. The third aim is to study neural mechanisms and treatment sensitivity of two frequent sequelae of PTSD after CA: intrusions and dissociation. To address these questions, we include female patients who experienced CA and who fulfil DSM-5 criteria for PTSD plus borderline features, including criteria for severe emotion dysregulation. The study is funded by the German Federal Ministry of Education and Research, and started in 2014. Participants are randomised to outpatient psychotherapy with either DBT-PTSD or Cognitive Processing Therapy. Formal power analysis revealed a minimum of 180 patients to be recruited. The primary outcome is the change on the Clinician-Administered PTSD Scale for DSM-5. The expected results will be a major step forward in establishing empirically supported psychological treatments for survivors of CA suffering from Complex PTSD. German Clinical Trials Register: registration number DRKS00005578 , date of registration 19 December 2013.

Zusammenfassung. Theoretischer Hintergrund: Die Anzahl universitärer psychotherapeutischer Ambulanzen für Kinder und Jugendliche an psychologischen Instituten ist in nur wenigen Jahren deutlich angestiegen. Diese erfreuliche Entwicklung ist potentiell für die Versorgung von Kindern und Jugendlichen mit psychischen Störungen, die praxisnahe Lehre im Psychologiestudium, die qualifizierte Psychotherapieausbildung und die klinisch-psychologische Forschung äußerst relevant. Der Wissensstand bezüglich Diagnostik, Ätiologie und psychotherapeutischer Behandlung von psychischen Störungen im Kindes- und Jugendalter steht für viele Störungsbilder deutlich hinter dem umfangreichen Forschungs- und Wissensstand psychischer Störungen des Erwachsenenalters. Vor diesem Hintergrund ist die Initiative, Daten der universitären Psychotherapieambulanzen für Kinder und Jugendliche zusammenzuführen, ein wesentlicher Schritt, um der Altersgruppe der Kinder und Jugendlichen gleich gut begründete und evaluierte Behandlungsansätze zukommen zu lassen. KODAP – die Koordination der Datenerhebung und -auswertung an Forschungs-‍, Lehr- und Ausbildungsambulanzen für psychologische Psychotherapie – übernimmt dabei die Koordination dieses komplexen Vorhabens sowohl für den Kinder- und Jugend- als auch den Erwachsenenbereich. Fragestellung / Methode: Es werden die soziodemographischen und klinischen Daten der im Jahr 2016 behandelten Patient_innen, deren Eltern und jeweiligen Therapeut_innen von sieben Ambulanzen beschrieben. Hierzu werden die deskriptiven Angaben zu Diagnosehäufigkeiten, Altersstruktur, Anzahl komorbider Störungen der Patient_innen und eine soziodemographische Beschreibung der Therapeut_innen und Eltern vorgestellt und diskutiert. Ergebnisse: Für das Jahr 2016 stehen Daten von 568 Kindern und Jugendlichen zwischen 3 und 20 Jahren (Malter = 11.89, SD = 3.68; 46.6 % weiblich) zur Verfügung. Die häufigsten Diagnosen stellten die Angststörungen (F40, F41, F93) mit 317 Diagnosen (35.30 %), gefolgt von den hyperkinetischen Störungen und den Störungen des Sozialverhaltens (F90, F91, F92) mit 195 Diagnosen (21.71 %) dar. Bei 45.6 % der Patient_innen wurde mehr als eine Störungsdiagnose festgestellt. Des Weiteren lagen die Daten von 257 Müttern bzw. 228 Vätern und 126 Therapeut_innen, davon 83.1 % weiblich, vor. Schlussfolgerungen: Die Studie zeigt die Machbarkeit der Zusammenführung und Aufbereitung der Daten aus universitären Psychotherapieambulanzen für Kinder und Jugendliche. Zudem geben die Pilotdaten einen ersten Einblick in diese Inanspruchnahmepopulation. Schlüsselwörter:Hochschulambulanzen für Kinder und Jugendliche, Versorgungsforschung, Psychotherapieforschung, Background: In recent years, the number of university outpatient psychotherapy clinics for children and adolescents in Germany has substantially increased. This is of potential importance not only for the health care of young people affected by mental disorders but also for teaching and mental health research. Knowledge about certain disorders in children and adolescents, predictors of treatment success, and treatment trajectories is still in its early stages. Objective: Therefore, in 2013 an initiative was launched to aggregate data from university outpatient psychotherapy clinics for children and adolescents in order to create a German-wide research data platform. KODAP short for the coordination of data collection and evaluation at research and training outpatient clinics for psychotherapy - is responsible for the coordination of this complex project for children/adolescents and adults. Method: The patient population treated in seven university outpatient psychotherapy clinics for children and adolescents in 2016 is described. Descriptive data on the diagnoses as well as on the age, frequency of comorbid disorders of the patient population, their parents, and their therapists are presented. Results: For the year 2016, data of 568 children and adolescents between 3 and 20 years of age (M = 11.89, SD = 3.68; 46.6% female) were available. The most frequent diagnoses were anxiety disorders (F40, F41, F93; n = 317, 35.30%) followed by attention-deficit hyperactivity disorders and conduct disorders (F90, F91, F92; n = 195, 21.71 %). In 45.6% of the patients, there was at least one additional comorbid diagnosis. The data of 257 mothers, 228 fathers, and 126 therapists, of these 83.1 % female, are described. Conclusion: The present study indicates the feasibility of consolidating and evaluating research data across university outpatient psychotherapy clinics for children and adolescents. This KODAP pilot study provides the first description of this patient population.

Background The association between maternal depression and adverse emotional and behavioral outcomes in children is well established. One associated factor might be altered affect recognition which may be transmitted transgenerationally. Individuals with history of depression show biased recognition of sadness. Our aim was to investigate parallels in maternal and children's affect recognition with remitted depressed mothers. Methods 60 Mother–child dyads completed an affect recognition morphing task. We examined two groups of remitted depressed mothers, with and without history of physical or sexual abuse, and a group of healthy mothers without history of physical or sexual abuse. Children were between 5 and 12 years old. Results Across groups, mothers identified happy faces fastest. Mothers with remitted depression showed a higher accuracy and response bias for sadness. We found corresponding results in their children. Maternal and children's bias and accuracy for sadness were positively correlated. Effects of remitted depression were found independent of maternal history of physical or sexual abuse. Limitations Our sample size was relatively small and further longitudinal research is needed to investigate how maternal and children's affect recognition are associated with behavioral and emotional outcomes in the long term. Conclusions Our data suggest a negative processing bias in mothers with remitted depression which might represent both the perpetuation of and vulnerability to depression. Children of remitted depressed mothers appear to be exposed to this processing bias outside acute depressive episodes. This may promote the development of a corresponding processing bias in the children and could make children of depressed mothers more vulnerable to depressive disorders themselves.

BACKGROUND: The association between maternal depression and adverse outcomes in children is well established. Similar links have been found for maternal childhood abuse. One proposed pathway of risk transmission is reduced maternal emotional availability. Our aim was to investigate whether sensitive parenting is impaired in mothers with depression in remission, and whether among these mothers childhood abuse has an additional impact. METHODS: The mother-child interaction of 188 dyads was assessed during a play situation using the Emotional Availability Scales, which measure the overall affective quality of the interaction: maternal sensitivity, structuring, nonhostility, and nonintrusiveness. Mothers with depression in remission were compared to healthy mothers. Children were between 5 and 12 years old. Group differences and impact of additional childhood abuse were analyzed by one-factorial analyses of covariance and planned contrasts. RESULTS: Mothers with depression in remission showed less emotional availability during mother-child interaction compared to healthy control mothers. Specifically, they were less sensitive and, at trend-level, less structuring and more hostile. Among these mothers, we found an additional effect of severe maternal childhood abuse on maternal sensitivity: Mothers with depression in remission and a history of severe childhood abuse were less sensitive than remitted mothers without childhood abuse. CONCLUSIONS: Our data suggest that depression impacts on maternal emotional availability during remission, which might represent a trait characteristic of depression. Mothers with depression in remission and additional severe childhood abuse were particularly affected. These findings may contribute to the understanding of children's vulnerability to develop a depressive disorder themselves. Language: en

Exposure therapy is considered an effective treatment strategy for phobic anxiety, however, it is rarely applied in clinical practice. The under-usage might be due to various factors of which heightened stress levels not only in patients but also in therapists are presumed to be of particular relevance. The present study aimed to investigate whether different forms of exposure might lead to varying physiological and psychological stress responses in therapists and phobic patients. 25 patients with specific phobia underwent individual cognitive behavioural therapy, performed by 25 psychotherapist trainees, applying exposure sessions in graduated form or the flooding technique. Patients and therapists provided subjective evaluations of stress and five saliva samples for analysis of salivary cortisol and alpha-amylase either during two graduated exposure sessions or during one flooding session, while a regular therapy session served as control condition. Therapists displayed heightened salivary alpha-amylase release during exposure of the flooding, but not the graduated, type. Patients showed elevated salivary cortisol during flooding exposure numerically, however, not on a statistically significant level. Therapists reported more pronounced subjective stress during flooding compared to graduated exposure. Elevated stress levels should be addressed in clinical training in order to improve application of exposure in routine practice.

Background: Patients suffering from panic disorder and agoraphobia are significantly impaired in daily life due to anxiety about getting into a situation due to apprehension about experiencing a panic attack, especially if escape may be difficult. Dysfunctional beliefs and behavior can be changed with cognitive behavioral therapy; however, the neurobiological effects of such an intervention on the anticipation and observation of agoraphobia-specific stimuli are unknown. Methods: We compared changes in neural activation by measuring the blood oxygen level-dependent signal of 51 patients and 51 healthy controls between scans before and those after treatment (group by time interaction) during anticipation and observation of agoraphobia-specific compared to neutral pictures using 3-T fMRI. Results: A significant group by time interaction was observed in the ventral striatum during anticipation and in the right amygdala during observation of agoraphobia-specific pictures; the patients displayed a decrease in ventral striatal activation during anticipation from pre- to posttreatment scans, which correlated with clinical improvement measured with the Mobility Inventory. During observation, the patients displayed decreased activation in the amygdala. These activational changes were not observed in the matched healthy controls. Conclusions: For the first time, neural effects of cognitive behavioral therapy were shown in patients suffering from panic disorder and agoraphobia using disorder-specific stimuli. The decrease in activation in the ventral striatum indicates that cognitive behavioral therapy modifies anticipatory anxiety and may ameliorate abnormally heightened salience attribution to expected threatening stimuli. The decreased amygdala activation in response to agoraphobia-specific stimuli indicates that cognitive behavioral therapy can alter the basal processing of agoraphobia-specific stimuli in a core region of the fear network.

Die z. T. schwierigen Arbeits- und Ausbildungsbedingungen von Psychotherapeutinnen und Psychotherapeuten in Ausbildung (PiA) finden zunehmend Eingang in den wissenschaftlichen und den gesellschaftlichen Diskurs. Der zur Arbeits- und Ausbildungssituation von PiA komplementare Fokus auf Beanspruchungserleben und -folgen wird bisher jedoch kaum thematisiert. Die bundesweite Studie (n = 464) enthalt Informationen zu zentralen personen- und arbeitsbedingten Risikofaktoren und Ressourcen. Zudem bietet sie Vergleiche bezuglich verschiedener Berufsgruppen mit hoher psychosozialer Beanspruchung und mit der Ausbildungssituation 2009. Die Studie zeigt, dass die Ausbildungsfinanzierungssituation eine Herausforderung darstellt. Psychotherapeutinnen und Psychotherapeuten in Ausbildung weisen zudem signifikant hohere Stresswerte als andere Berufsgruppen auf. Sie haben vergleichsweise geringere Werte in der Widerstandsfahigkeit bei zugleich hohem Arbeitsengagement. Nur wenige PiA zeigen gesundheitsforderliche berufliche Verhaltens- und Erlebensmuster. Die Ergebnisse implizieren die Uberprufung der Ausbildungsbedingungen. Interventionsmoglichkeiten werden aufgezeigt.

In der Zeitschrift Psychotherapeut wurden in den letzten Jahren immer wieder Themen der Psychotherapieausbildung abgehandelt, insbesondere im Kontext der Diskussion um eine Reform der Ausbildung in Deutschland. Diese Reform scheint nun auf den Weg gebracht zu sein. Neben einer historischen Skizze der Diskussionen um die Ausbildung in den letzten Jahren und einem Vorschlag, zentrale Kompetenzbereiche von Psychotherapeuten zu definieren, fasst der Beitrag aktuelle Trends in der Ausbildungsforschung zusammen, die innerhalb der Psychotherapieforschung an Bedeutung zu gewinnen scheinen.

Personlichkeitsstorungen sind charakterisiert durch lang andauernde und stabile Veranderungen des Denkens, Erlebens sowie Handelns und stellen eine besondere Herausforderung fur die psychotherapeutische Arbeit dar. Basierend auf der aktuellen Fachliteratur und angelehnt an die S2-Leitlinie „Personlichkeitsstorungen“ werden im vorliegenden Beitrag Strategien der kognitiven Verhaltenstherapie zur Behandlung von Patienten mit Personlichkeitsstorungen dargestellt. Die therapeutische Haltung sowie ein spezifisches und validierendes Krankheitskonzept sind wichtige Voraussetzungen in der kognitiven Verhaltenstherapie der Personlichkeitsstorungen. Obwohl nur fur drei Personlichkeitsstorungen manualisierte Behandlungsansatze empirisch untersucht wurden, existieren fur alle weiteren Personlichkeitsstorungen Therapieansatze, die vorwiegend auf kognitiv-verhaltenstherapeutischen Storungsmodellen basieren. Die hilfreiche Kategorisierung der Behandlungsansatze erfolgt dem Grad der Ich-Syntonie der Personlichkeitsstorung entsprechend. Dabei konnen Patienten mit hoher Ich-Dystonie der Personlichkeitsstorung und hohem Leidensdruck, die wegen ihrer Personlichkeitsstorung eine Behandlung aufsuchen, und Patienten, die wegen einer anderen psychischen Storung eine Behandlung aufsuchen und zusatzlich eine Personlichkeitsstorung mit einem hohen Grad an Ich-Syntonie aufweisen, unterschieden werden. Weiterhin gibt es Patienten, deren Merkmale der Personlichkeitsstorung zu Problemen in der Lebensbewaltigung fuhren, die die Symptomstorung (Achse-I-Storung) verstarken. Aufgrund der Chronizitat und der Rigiditat vieler Merkmale bei Personlichkeitsstorungen sollte als realistisches Ziel primar die Veranderung der zentralen leidbringenden Symptomatik angestrebt werden. Primar geht es darum, den Patienten in die Lage zu versetzen – vor dem Hintergrund seiner besonderen Personlichkeit – Belastungen und Beeintrachtigungen in der Lebensfuhrung sowie in interpersonellen Interaktionen zu vermeiden, um dadurch eigene Lebensziele – unter Beachtung der Motive und Ziele anderer – umsetzen zu konnen. Ein breites Spektrum an theoretischen Ansatzen und Interventionstechniken kann zur erfolgreichen Behandlung von Patienten mit Personlichkeitsstorungen eingesetzt werden. Hierbei stehen kognitive Methoden zur Modifikation dysfunktionaler Schemata und verhaltenstherapeutische Methoden zur Veranderung dysfunktionaler Verhaltensweisen im Vordergrund.

Hintergrund: In der Kognitiven Verhaltenstherapie (KVT) der Panikstörung mit Agoraphobie (PD/AG) werden häufig Körperübungen zur Symptomprovokation (interozeptive Exposition) eingesetzt, jedoch liegen kaum systematische, empirische Untersuchungen zu Wirkung und Wirkweise dieser Übungen vor. Ziel der vorliegenden Studie war die Charakterisierung individueller Reaktionen auf interozeptive Übungen sowie die mit der Wiederholung der Übungen verbundenen Veränderungen dieser Reaktionen. Patienten und Methoden: Selbstberichtdaten zu ausgelösten Körpersymptomen sowie Symptom- und Angststärken von 301 Patienten mit PD/AG, die verschiedene interozeptive Übungen durchführten, wurden ausgewertet. Die Durchführung der interozeptiven Exposition erfolgte im Rahmen einer manualisierten KVT des Psychotherapieverbundes «Panik-Netz». Ergebnisse: Interozeptive Exposition löste Körpersymptome und damit verbunden Angst aus. Am häufigsten wurden vestibuläre, respiratorische und kardiovaskuläre Symptome ausgelöst. Die stärkste Symptomausprägung verbunden mit der stärksten Angst erzeugten die Übungen «Drehen», «Hyperventilieren» und «Strohhalmatmung». Übungswiederholung bewirkte eine Reduktion der Symptom- und Angststärken, insbesondere die Übungen «Drehen», «Strohhalmatmung» und «Hyperventilieren». Diskussion und Schlussfolgerungen: Interozeptive Exposition ist gut geeignet zur Auslösung von Körpersymptomen und zur Reduktion der damit verbundenen Symptom- und Angststärke, insbesondere über die Übungen «Drehen», «Hyperventilieren» und «Strohhalmatmung». Zur größeren Angst- und Symptomstärkenreduktion empfiehlt sich eine hohe Wiederholungsrate. Die Relevanz respiratorischer, vestibulärer und kardiovaskulärer Symptome für den Behandlungserfolg sollte weiterführend untersucht werden. Background: Although interoceptive exposure is a frequent component of cognitive-behavioral therapies (CBT) in panic disorder with agoraphobia, there is a lack of evidence investigating the effect of this treatment component and its underlying mechanisms of change. The present study aimed at characterizing individual responses to interoceptive exposure and response changes after repeated exposure. Patients and Methods: Under the national research initiative ‘Panic Net’, self-report data were analyzed including bodily symptoms, symptom intensity and experienced anxiety during interoceptive exposure of 301 PD/AG patients who participated in a manualized CBT trial. Results: Interoceptive exposure induced bodily symptoms and anxiety. Respiratory, vestibular and cardiovascular symptoms were most frequently reported. Spinning, breathing through a straw and hyperventilation produced most intense symptom reports and anxiety ratings. Repeating the interoceptive exposure reliably reduced reported symptom intensity and anxiety ratings particularly after spinning, breathing through a straw and hyperventilation. Discussion and Conclusions: In PD/AG patients, interoceptive exposure induces bodily symptoms and reduces reported symptom intensity and anxiety, particularly through spinning, hyperventilation and breathing through a straw. Repeated rehearsal is encouraged given that larger reduction of anxiety and symptom reports were associated with more training. Further research is needed to assess the relevance of respiratory, vestibular and cardiovascular symptoms for CBT treatment.

Background: The psychological strain of migrants has been increasingly discussed in recent years. A special emphasis should be put on adolescents of second-generation immigrants, as they account for one third of the immigrant population in Germany. Objective: What is the degree of behavioral and emotional problems among Turkish migrant and German adolescents? Do perceived discrimination and acculturative stress have an impact on behavioral and emotional problems? Method: N1 = 522 and N2 = 91 adolescents (age = 14 - 17 years) were assessed regarding behavioral and emotional problems (Studies 1 and 2), acculturative stress, and perceived discrimination (Study 2). Results: In both studies, internalizing problems were reported significantly more often by girls than by boys. This finding was also observed for the Turkish group in the interview mode of Study 2. Perceived discrimination mediated the correlation between acculturative stress and behavioral and emotional problems. Conclusion: In the form of perceived discrimination, the cultural background of adolescents in Germany has an indirect impact on their mental health.___Theoretischer Hintergrund: Das psychische Belastungsniveau von Migranten wird seit einigen Jahren verstärkt diskutiert. Jugendliche der zweiten Einwanderergeneration sollten besondere Berücksichtigung finden, da sie bereits ein Drittel aller Personen dieser Altersgruppe in Deutschland darstellen. Fragestellung: Wie hoch ist die psychische Belastung von türkischen und deutschen Jugendlichen? Welchen Einfluss haben hierbei Akkulturationsstress und Diskriminierungswahrnehmung? Methode: N1 = 522 bzw. N2 = 91 Jugendliche (14 - 17 Jahre) wurden zu psychischer Belastung (Studie 1 & 2), Akkulturationsstress und Diskriminierungswahrnehmung (Studie 2) untersucht. Ergebnisse: Mädchen berichteten signifikant häufiger internalisierende Probleme als Jungen, im Interviewmodus galt dies für türkische Jugendliche insgesamt. Diskriminierungswahrnehmung wirkte als Mediatorvariable zwischen psychischer Gesundheit und Akkulturationsstress. Schlussfolgerungen: Der kulturelle Hintergrund von Jugendlichen in Deutschland hat in Form wahrgenommener Diskriminierung indirekt einen Einfluss auf deren psychische Gesundheit.

Patient satisfaction with psychiatric treatment has emerged as an important factor with respect to the quality of health care.Patient satisfaction using the Zurich Satisfaction Questionnaire (ZUF-8) as well as symptom severity (measured with the Hamilton Depression Scale [HRSD], Brief Psychiatric Rating Scale and Clinical Global Impression Scale) was assessed at admission and discharge of inpatient treatment in patients with a major depressive episode (MDD, N = 217) and schizophrenia (N = 75). Differences between the two diagnostic groups (using T-tests) and correlations of patient satisfaction with different social and treatment variables were calculated (Pearson product-moment correlation).The mean score of patient satisfaction was 26.8 points (ZUF-8; range 8-32 points), without differences between MDD and schizophrenia (t = 0.45, p = 0.78). Patients with MDD and personality disorder showed lower satisfaction than patients with MDD without personality disorder (t = 2.31, p = 0.03). Patient satisfaction correlated negatively with severity of depressive symptoms at discharge (HRSD: r = - 0.38; p0.01) and number of comorbidities (r = - 0.42; p0.01) in MDD. Number of prescribed drugs correlated negatively with patient satisfaction in both groups (depression: r = - 0.28, p = 0.02; schizophrenia: r = - 0.24; p = 0.03).Patient satisfaction was high without differences between MDD and schizophrenia. Severity of disease and comorbidites in MDD and number of prescribed drugs in both groups were related with reduced patient satisfaction.

Background: The assessment of therapeutic adherence is essential for accurately interpreting treatment outcomes in psychotherapy research. However, such assessments are often neglected. Aims: To fill this gap, we aimed to develop and test a scale that assessed therapeutic adherence to Cognitive Processing Therapy – Cognitive Only (CPT), which was adapted for a treatment study targeting patients with post-traumatic stress disorder and co-occurring borderline personality symptoms. Method: Two independent, trained raters assessed 30 randomly selected treatment sessions involving seven therapists and eight patients who were treated in a multicentre randomized controlled trial. Results: The inter-rater reliability for all items and the total score yielded good to excellent results (intraclass correlation coefficient [ICC] = 0.70 to 1.00). Cronbach's α was .56 for the adherence scale. Regarding content validity, three experts confirmed the relevance and appropriateness of each item. Conclusion: The adherence rating scale for the adapted version of CPT is a reliable instrument that can be helpful for interpreting treatment effects, analysing possible relationships between therapeutic adherence and treatment outcomes and teaching therapeutic skills.

Societal cost-of-illness in a German sample of patients with borderline personality disorder (BPD) was calculated for 12 months prior to an outpatient Dialectical Behavior Therapy (DBT) program, during a year of DBT in routine outpatient care and during a follow-up year. We retrospectively assessed resource consumption and productivity loss by means of a structured interview. Direct costs were calculated as opportunity costs and indirect costs were calculated according to the Human Capital Approach. All costs were expressed in Euros for the year 2010. Total mean annual BPD-related societal cost-of-illness was €28026 (SD = €33081) during pre-treatment, €18758 (SD = €19450) during the DBT treatment year for the 47 DBT treatment completers, and €14750 (SD = €18592) during the follow-up year for the 33 patients who participated in the final assessment. Cost savings were mainly due to marked reductions in inpatient treatment costs, while indirect costs barely decreased. In conclusion, our findings provide evidence that the treatment of BPD patients with an outpatient DBT program is associated with substantial overall cost savings. Already during the DBT treatment year, these savings clearly exceed the additional treatment costs of DBT and are further extended during the follow-up year. Correspondingly, outpatient DBT has the potential to be a cost-effective treatment for BPD patients. Efforts promoting its implementation in routine care should be undertaken.

Shame has been described as a central emotion in narcissistic personality disorder (NPD). However, there is a dearth of empirical data on shame in NPD. Patients with NPD (N=28), non-clinical controls (N=34) and individuals with borderline personality disorder (BPD, N=31) completed self-report measures of state shame, shame-proneness, and guilt-proneness. Furthermore, the Implicit Association Test (IAT) was included as a measure of implicit shame, assessing implicit shame-self associations relative to anxiety-self associations. Participants with NPD reported higher levels of explicit shame than non-clinical controls, but lower levels than patients with BPD. Levels of guilt-proneness did not differ among the three study groups. The implicit shame-self associations (relative to anxiety-self associations) were significantly stronger among patients with NPD compared to nonclinical controls and BPD patients. Our findings indicate that shame is a prominent feature of NPD. Implications for diagnosis and treatment are discussed.

BackgroundPanic disorder with agoraphobia is characterized by panic attacks and anxiety in situations where escape might be difficult. However, neuroimaging studies specifically focusing on agoraphobia are rare. Here we used functional magnetic resonance imaging (fMRI) with disorder-specific stimuli to investigate the neural substrates of agoraphobia.MethodWe compared the neural activations of 72 patients suffering from panic disorder with agoraphobia with 72 matched healthy control subjects in a 3-T fMRI study. To isolate agoraphobia-specific alterations we tested the effects of the anticipation and perception of an agoraphobia-specific stimulus set. During fMRI, 48 agoraphobia-specific and 48 neutral pictures were randomly presented with and without anticipatory stimulus indicating the content of the subsequent pictures (Westphal paradigm).ResultsDuring the anticipation of agoraphobia-specific pictures, stronger activations were found in the bilateral ventral striatum and left insula in patients compared with controls. There were no group differences during the perception phase of agoraphobia-specific pictures.ConclusionsThis study revealed stronger region-specific activations in patients suffering from panic disorder with agoraphobia in anticipation of agoraphobia-specific stimuli. Patients seem to process these stimuli more intensively based on individual salience. Hyperactivation of the ventral striatum and insula when anticipating agoraphobia-specific situations might be a central neurofunctional correlate of agoraphobia. Knowledge about the neural correlates of anticipatory and perceptual processes regarding agoraphobic situations will help to optimize and evaluate treatments, such as exposure therapy, in patients with panic disorder and agoraphobia.