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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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objective: Telephone emergency services (TES) play an important role in suicide prevention across different health care systems around the world. However, little is known about the telephone counselors who often volunteer to provide free and confidential help for people in emotional crises. The current study aims to examine the interpersonal values of volunteer counselor trainees and further investigates their personality traits, life satisfaction and expectations regarding their future counseling style. Method: For the current study, 261 counselor trainees were recruited within the German nationwide organization TelefonSeelsorge at the beginning of their paraprofessional training. Interpersonal values were described according to the interpersonal circumplex (IPC) model with the structural summary method. Results: Compared to a matched nonclinical reference group, trainee counselors reported significantly higher interpersonal values for the scales Harmony (LM) and Helpful Influence (NO). A cluster analysis revealed 3 distinct groups of trainees, which can be described as predominantly submissive-altruistic, helpful-influential, and friendly-harmonious. The 3 groups further differed in the Big Five personality traits Extraversion, Neuroticism and Agreeableness, as well as in self-reported mentalization, attachment anxiety, and avoidance, but not in life satisfaction. Furthermore, the groups differed with regard to their expected future counseling style. Conclusion: The results contribute to an understanding of interpersonal goals and motives of volunteer counselor trainees in TES. [ABSTRACT FROM AUTHOR]

The influence of patients' interpersonal traits in interaction with experienced individual cohesion (i.e., each patient's feeling of belonging to the group) was investigated in a sample of 327 inpatients with mixed diagnoses. High cohesion and an increase in cohesion emerged as predictive for symptom improvement in a multilevel regression model. This influence was moderated by the affiliation dimension: In dismissive patients, an increase of cohesion over the course of treatment was helpful; in affiliative patients, symptom improvement was correlated with a slight decrease of cohesion. The findings highlight the therapeutic importance of group therapy and point to the differential influence of individually experienced group cohesion. [ABSTRACT FROM AUTHOR]

Objective: The association between alliance and therapy outcome is one of the most investigated factors in psychotherapy research. However, even studies using advanced methods estimate effects over a specific time period (interval) between measurement occasions. Thus, it remains unknown how the magnitude and direction of effects depend on the considered time interval, resulting in limited comparability across studies. The current study examines the influence of time on the within-person relationship between alliance and symptom severity. Method: Alliance (WAI-SR) and symptom severity (SCL-K11) were assessed every fifth session in N = 650 patients receiving up to 100 weekly sessions (mode = 55; M = 41.03; SD = 27.23) of individual psychotherapy in a German outpatient clinic. Bivariate continuous-time (CT) structural equation modeling (SEM) was used to estimate within-person cross- and auto-effects. Results: Analysis revealed significant reciprocal within-person cross-effects with stronger relative effects of SCL-K11 on WAI-SR (a21) than vice versa (a12). CT analysis showed that both cross-lagged effects increased for longer time intervals with strongest effects for time intervals of about 40 sessions (a21 = -.47; a12 = --.19). Conclusions: Alliance and symptom severity showed a reciprocal relationship. Expanding current evidence, our analysis showed how the magnitude of these effects depends on the considered time interval. Applying CT-SEM on longitudinal data of the alliance outcome association complements current crosslagged panel analysis and allows to compare results of studies which are based on different time intervals between measurement occasions. Methodological, theoretical, and clinical implications are discussed. [ABSTRACT FROM AUTHOR]

Introduction: While ample data demonstrate the effectiveness of inpatient psychosomatic treatment, clinical observation and empirical evidence demonstrate that not all patients benefit equally from established therapeutic methods. Especially patients with a comorbid personality disorder often show reduced therapeutic success compared to other patient groups. Due to the heterogeneous and categorical personality assessment, previous studies indicated no uniform direction of this influence. This complicates the derivation of therapeutic recommendations for mental disorders with comorbid personality pathology., Methods: Analyzing n = 2094 patients from German university hospitals enrolled in the prospective "MEPP" study, we tested the dynamic interaction between dimensionally assessed personality functioning and psychopathology of anxiety and depression., Results: Longitudinal structural equation modelling replicated the finding that the severity of symptoms at admission predicts symptom improvement within the same symptom domain. In addition, we here report a significant coupling parameter between the baseline level of personality function and the change in general psychopathology - and vice versa., Discussion and Conclusion: These results imply that personality pathology at admission hinders the therapeutic improvement in anxiety and depression, and that improvement of personality pathology is hindered by general psychopathology. Furthermore, the covariance between both domains supports the assumption that personality functioning and general psychopathology cannot be clearly distinguished and adversely influence each other. A dimensional assessment of the personality pathology is therefore recommendable for psychotherapy research and targeted therapeutic treatment., Competing Interests: Declaration of competing interest Christoph Herrmann-Lingen reports financial support was provided by Hogrefe Publishing. Christoph Herrmann-Lingen reports financial support was provided by Novartis AG. All authors, except for Stephan Doering, are working at one of the German university departments of psychosomatic medicine and psychotherapy. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Die Autorinnen und Autoren geben an, dass kein Interessenskonflikt besteht.

Introduction: Germany is one of the few countries with a medical specialty of psychosomatic medicine and psychotherapy and many treatment resources of this kind., Objective: This observational study describes the psychosomatic treatment programs as well as a large sample of day-hospital and inpatients in great detail using structured diagnostic interviews., Methods: Mental disorders were diagnosed according to ICD-10 and DSM-IV by means of Mini-DIPS and SCID-II. In addition to the case records, a modified version of the CSSRI was employed to collect demographic data and service use. The PHQ-D was used to assess depression, anxiety, and somatization., Results: 2,094 patients from 19 departments participated in the study after giving informed consent. The sample consisted of a high proportion of "complex patients" with high comorbidity of mental and somatic diseases, severe psychopathology, and considerable social and occupational dysfunction including more than 50 days of sick leave per year in half of the sample. The most frequent diagnoses were depression, somatoform and anxiety disorders, eating disorders, personality disorders, and somato-psychic conditions., Conclusions: Inpatient and day-hospital treatment in German university departments of psychosomatic medicine and psychotherapy is an intensive multimodal treatment for complex patients with high comorbidity and social as well as occupational dysfunction., (© 2022 The Author(s). Published by S. Karger AG, Basel.)

Objective: This study examined the reciprocal effects between therapeutic agency, working alliance, and symptoms during psychotherapy. We aimed to predict symptom improvement by previous changes in either agency or alliance. In addition, we examined whether alliance development was predicted by previous changes in agency., Method: A sample of 386 patients in psychodynamic outpatient psychotherapy answered the Therapeutic Agency Inventory (TAI), the Working Alliance Inventory-SR (WAI-SR), and the Symptom Checklist-K11 (SCL-K11) after Sessions 1, 5, 10, 15, and 20. Dynamic panel models were estimated using structural equation modeling. Associations were tested while controlling for autoregressive effects and differentiating within-person changes over time from between-person differences., Results: Increases in agency predicted subsequent symptom improvement. Similarly, increases in alliance predicted subsequent symptom improvement. For agency and alliance, we found a more complex pattern with varying reciprocal effects over time., Conclusions: Findings show evidence for agency and alliance as curative change factors in psychodynamic psychotherapy. The study supports the importance of both agency and alliance and further suggests that both mechanisms may need to be balanced in successful psychotherapies. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective: Aim of this study is to evaluate the newly developed Questionnaire for the Assessment of Adverse and Protective Childhood Experiences (APC)., Methods: Reliability, convergent as well as criterion validity were assessed in a sample of 128 patients in a hospital-setting., Results: The APC showed high to very high reliability for the two main scales and for most of its subscales, convergent validity, and was related to depression and attachment insecurity. The scale for the assessment of protective childhood experiences explained incremental variance regarding validity., Conclusion: The APC is an enhanced instrument for the assessment of adverse childhood experiences. Especially the simultaneous assessment of protective childhood experiences can be of particular importance for research and practice., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

This article reports about a new treatment setting, the Psychotherapeutic Evening Clinic at the University Hospital Heidelberg. The treatment intensity is ranked between intensive, full-day inpatient and day-clinic programs in hospitals and less frequent outpatient psychotherapy according to the Germany Psychotherapy Guideline. Patients attend the Evening Clinic on 3 evenings per week for 3 hours each. During this time, they receive group therapy, individual therapy, mindfulness exercises and psychotherapeutic ward rounds. The first experiences with the new setting are positive, a specific advantage is the possibility to include daily hassles and everyday stressors as well as patients' strengths and resources into the treatment. Therapeutic challenges are the potential of overburdening patients with an already high impairment. On the structural and political level it will be important to ensure funding for the new treatment setting., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objectives: The Inpatient and Day-Clinic Experience Scale (IDES) was developed to assess common factors in a multimodal psychotherapy setting from the patients' perspective. The questionnaire measures different aspects of therapeutic relationships, a positive self-view and a critical attitude towards therapy., Methods: Three samples (total N = 821) were used to evaluate the psychometric properties and factor structure of the questionnaire., Results: Confirmatory analyses show a good model fit and support the proposed structure with 25 items and seven scales. In addition, reliability indices were stable throughout multiple assessments over time. Concerning validity, early IDES process measures were moderately associated with symptomatic improvement., Conclusions: The IDES is a psychometrically reliable questionnaire for the evaluation of process factors in inpatient and day-clinic psychotherapy settings.

Objectives: The goal of the present research was the examination of overlap between 2 research traditions on interpersonal personality traits in major depression. We hypothesized that Blatt's (2004) dimensions of depressive experiences around the dimensions of relatedness (i.e., dependency) and self-definition (i.e., self-criticism) are associated with specific interpersonal problems according to the interpersonal circumplex model (Leary, 1957). In addition, we examined correlations of interpersonal characteristics with depression severity., Method: Analyses were conducted on 283 patients with major depressive disorder combined from 2 samples. Of the patients, 151 participated in a randomized controlled trial in the United States, and 132 patients were recruited in an inpatient unit in Germany. Patients completed measures of symptomatic distress, interpersonal problems, and depressive experiences., Results: Dependency was associated with more interpersonal problems related to low dominance and high affiliation, while self-criticism was associated with more interpersonal problems related to low affiliation. These associations were independent of depression severity. Self-criticism showed high overlap with cognitive symptoms of depression., Conclusion: The findings support the interpersonal nature of Blatt's dimensions of depressive experiences. Self-criticism is associated with being too distant or cold toward others as well as greater depression severity, but is not related to the dimension of dominance., (© 2014 Wiley Periodicals, Inc.)

As an addition to the ongoing discussion concerning the magnitude of therapist effects on outcome in psychotherapy, we investigated therapist variability in a large inpatient psychotherapy sample. We included global symptomatic outcome (Global Severity Index of the Symptom Checklist-90 Revised [SCL-90-R]; German version, Franke, 1995) and alliance (Helping Alliance Questionnaire; German version, Bassler, Potratz & Krauthauser, 1995) ratings of 2554 inpatients who were treated by 50 psychotherapists. Multilevel regression analyses (HLM; Raudenbush, Bryk, Cheong, & Congdon, 2004) were used for analyses. Overall, therapists accounted for a much greater variability on alliance (33%) than on outcome (3%). Therapists were differentially effective with regard to their patients' symptom severity at the beginning of treatment, and therapists differed in the degree that a positive alliance was associated with therapeutic outcome. The relatively small therapist effect on outcome is attributed to compensatory mechanisms in the specific context of inpatient therapy.