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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.

Background This is the validation of the Operationalized Psychodynamic Diagnosis—Structure Questionnaire (OPD-SQ). Methods A clinical sample of 399 adults and a nonclinical general population sample of 50 healthy adults completed measures of depression, attachment, psychiatric symptomatology and distress. Internal consistency and concurrent validity were assessed. Test–retest and Reliable Change Index were also calculated, as was the ability of the OPD-SQ to distinguish between the clinical and general population groups. Results High internal consistencies were found; significant differences between clinical and nonclinical samples, and significant associations with psychiatric symptomatology, depression and psychological distress. Conclusion The Chilean OPD-SQ has good reliability, and discriminates between clinical and healthy samples.

Self-criticism has been identified as a core dimension of depressive experience. At the same time, the ability to regulate self-esteem and maintain a realistic and positive view of the self is an important aspect of personality functioning. Thus, the functional domain of self-criticism overlaps with both depression and personality dysfunction. The chapter will first provide an overview of commonalities and differences between self-criticism, depression, and personality dysfunction. Empirical studies are reviewed to shed light on the overlap as well as the unique aspects of the three constructs. A particular focus will be placed on the impact of personality dysfunction from a perspective of the Structural Integration Axis of the Operationalized Psychodynamic Diagnosis System (OPD-2), which highly overlaps with the levels of functioning from the DSM-5 Alternative Model of Personality Disorders. Secondly, we review clinical theory and empirical research on self-criticism as a predictor of psychotherapy outcome. The findings demonstrate that pronounced self-criticism has a meaningful impact on the treatment process and needs to be addressed specifically and adaptively for successful outcomes.

Recent developments in the dimensional assessment of personality functioning have made the implementation of latent measurement models increasingly attractive. In this study, we applied item response theory (IRT) to a well-established personality functioning instrument (the OPD Structure Questionnaire) to identify a unidimensional latent trait and to evaluate the feasibility of computer adaptive testing (CAT). We hypothesized that the use of IRT could reduce the test burden - compared to a fixed short form - while maintaining high precision over a wide range of the latent trait. The OPD-SQ was collected from 1235 patients in a psychosomatic clinic. IRT assumptions were fulfilled. A 9-factor model yielded sufficient fit and unidimensionality in exploratory factor analysis with bifactor rotation. Items were iteratively reduced, and a graded-response IRT model was fitted to the data. Simulations showed that a CAT with approximately 7 items was able to capture an OPD-SQ global severity score with an accuracy similar to that of a fixed 12-item short form. The final item bank and CAT yielded satisfactory content validity. Strong correlations with depression and anxiety replicated previous results on the OPD-SQ. We concluded that IRT applications could be useful to reduce the test burden of personality functioning instruments.

Zusammenfassung

Aim of this study is to evaluate the newly developed Questionnaire for the Assessment of Adverse and Protective Childhood Experiences (APC).Reliability, convergent as well as criterion validity were assessed in a sample of 128 patients in a hospital-setting.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.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.Erste Evaluation des neu entwickelten Fragebogens zur Erfassung Aversiver und Protektiver Kindheitserfahrungen (APK).In einer Stichprobe von 128 Patienten in stationärer oder teilstationärer Psychotherapie wurden die Reliabilität des APK sowie konvergente und Kriteriumsvalidität untersucht.Der APK zeigte in seinen Gesamtskalen und in den meisten Subskalen eine hohe bis sehr hohe interne Konsistenz, deutliche Hinweise auf konvergente Validität, sowie Zusammenhänge mit Depressivität und Bindungsunsicherheit. Insbesondere die Skala zu protektiven Kindheitserfahrungen klärte eigenständige Varianz in Bezug auf Validitätsaspekte auf.Mit dem APK liegt ein erweitertes Instrument zur Traumadiagnostik vor. Neben der Erfassung aversiver Kindheitserfahrungen hat die Möglichkeit des gleichzeitigen Erfassens protektiver Kindheitserfahrungen für Forschung wie Praxis eine besondere Bedeutung.

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.

Zusammenfassung

Der Person des Therapeuten kommt eine entscheidende Bedeutung innerhalb des psychotherapeutischen Behandlungsprozesses zu. Somit ruckt auch die Psychotherapieausbildung, als wichtiger Teil der Entwicklung einer therapeutischen Personlichkeit und Kompetenz, zunehmend in den Fokus der Psychotherapieforschung. Bisher ist jedoch wenig bekannt, welche personlichen und inhaltlichen Erwartungen und Wunsche Psychologen zu Beginn ihrer Therapieausbildung an dieselbe haben. Bisherige Untersuchungen beschrankten sich masgeblich auf quantitative Fragebogenerhebungen, was der Vielschichtigkeit der personlichen Erwartungen haufig nicht gerecht werden kann. Es wurden 24 Psychologen zu Beginn ihrer Ausbildung an einem Institut fur tiefenpsychologisch fundierte Psychotherapie (TfP, n = 12) und an einem Institut fur Verhaltenstherapie (VT, n = 12) in einem halbstandardisierten Einzelinterview zu ihren Erwartungen an die gerade begonnene Ausbildung befragt. Die wortlich transkribierten Interviews wurden uber eine qualitative Inhaltsanalyse nach Mayring als deduktive Erhebung mithilfe der Software MaxQDA ausgewertet. Eine zentrale Erwartung an die Ausbildung war die Durchfuhrung praktischer therapeutischer Ubungen in einem geschutzten Rahmen mit Fokus auf die Behandlungstechnik bei VT-Kandidaten und auf die Patient-Therapeut-Beziehung bei TfP-Kandidaten. Bezuglich der Vermittlung theoretischer Inhalte strebten TfP-Kandidaten Theoriearbeit an, berichteten aber Sorgen vor der Umsetzung in die Praxis, wohingegen VT-Kandidaten eine direkte Vermittlung storungs- und behandlungsrelevanten Wissens erwarteten. Die Kandidaten schatzten die Zugehorigkeit zu einem Ausbildungsjahrgang, wobei in der VT-Gruppe Befurchtungen von Erwartungsdruck und Konkurrenz ausgepragter erschienen. Gemeinsam waren beiden Gruppen die Betonung der zeitlichen und der finanziellen Belastungen, insbesondere in der Praktikumszeit, sowie die Bedeutung von Supervision, Selbsterfahrung und personlicher Weiterentwicklung im Rahmen der Ausbildung. Die Erwartungen und Wunsche bezuglich der Ausbildung werden vor dem Hintergrund einer curricularen Bestandsaufnahme beleuchtet und mogliche Konsequenzen fur die bedarfsgerechte Weiterentwicklung der Psychotherapieausbildung abgeleitet.

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.

Zusammenfassung

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.

Individualized case formulations play a pivotal role in the treatment of personality disorders (PDs). An integrative and practical way to think about PDs is provided by the Operationalized Psychodynamic Diagnosis (OPD) system, which has been applied, researched and taught to clinicians for more than two decades. The OPD system assesses maladaptive interpersonal patterns, internal motivational conflicts and levels of personality functioning, and integrates different theories from psychodynamic, interpersonal and developmental models. This chapter will describe background and rating procedure of the OPD system, provide an example to illustrate individualized case formulations according to the OPD, and will conclude with remarks about integrating OPD diagnosis in a variety of treatment models.

In this chapter we present the empirical support for a number of central psychodynamic concepts. We begin by providing an overview of the basic tenets of psychodynamic theory and then examine the empirical evidence for concepts related to each tenet. We focus on unconscious and subjective mental processes, defense mechanisms, transference, psychodynamic psychotherapy processes, and neuroscience evidence.

Background Insecure attachment patterns are related to the onset and development of chronic pain. However, it is less documented on how short- and long-term effects of pain therapy might differ with the attachment style in interaction with specific pain conditions. We therefore examined how two different groups of chronic pain patients differ in their treatment trajectories and in regard to attachment. Method N=85/76/67 (T1/T2/T3) patients with medically unexplained musculoskeletal pain (UMP group) were compared to n=89/76/56 patients with joint pain from osteoarthritis (OA group), using multilevel modeling. UMP patients received a multimodal pain program, and OA patients received surgery. Pain intensity before (T1) and after (T2) treatment and at a 6 months follow-up (T3) was assessed by using a visual analog scale of pain. Results Pain patients report a significant reduction in pain intensity upon the completion of the treatment compared to T1. Over the next 6 months, the pain intensity has further declined for patients with low attachment anxiety. In contrast, patients with highly anxious attachment report an increase in pain intensity. This main effect of anxious attachment on pain is significant when predicting changes both in acute treatment and during follow-up while controlling for group effect. In addition, there is also an interactive effect of group by avoidant attachment. In the UMP group, high scores in avoidant attachment were associated with the lower reduction in pain severity, while in the OA group, high scores in attachment avoidance were associated with a steeper reduction in pain severity. Conclusion The results indicate that insecurely attached patients with pain symptoms only benefit from a multimodal pain therapy in limited ways in regard to posttreatment trajectories. Maintaining positive results over a period of 6 months is a challenge, compared with securely attached patients. Significance The results of this study suggest the importance of direct and indirect mechanisms of attachment and its relevance for the management of pain experiences. Therefore, to include the individual attachment patterns in the treatment may be a promising way to enhance the treatment prospects.

Operationalized Psychodynamic Diagnosis - Structure Questionnaire (OPD-SQ) in Youth: First Results on Reliability and Validity The OPD structure axis questionnaire (OPD-SQ) demonstrated good empirical findings and usability in therapeutic work. Therefore, the aim of this study was to verify the OPD-SQ for an adolescent sample in order to further implement the questionnaire as an economic instrument in clinical childhood and adolescence psychiatry routine. The overall sample consisted of 180 adolescent inpatients (72.8 % female) and 152 pupils (57.9 % female). In order to test reliability, Cronbach's alpha and discriminatory power were assessed. To test validity, YSR11-18 data was collected for the overall sample, and further data (AIDA, LoPF Q12-18, SKID-II, WISC-IV) was collected for the inpatient-sample. Cronbach's alpha was satisfactory for overall OPD-SQ, and all dimensions and sub-dimensions. The differences in mean values between inpatients and pupils were as expected. When controlled for overall symptom severity, gender differences lost significance. Adolescents with one or more SCID-II diagnoses had significantly lower psychic structure. Both construct-related questionnaires (AIDA, LoPF Q12-18) correlated high with OPD-SQ, no correlations were found for psychic structure and intelligence. OPD-SQ proved to be well applicable for the use on adolescents and can be implemented as an economic instrument for the measure of psychic structure in clinical adolescent psychiatry routine.Zusammenfassung Ausgehend von den guten empirischen Befunden und der Einsetzbarkeit des OPD-Strukturfragebogens (OPD-SF) war es Ziel dieser Studie zu prüfen, ob der OPD-SF auch auf eine jugendliche Stichprobe valide anwendbar ist. Die Gesamtstichprobe (n = 332) besteht aus 180 stationären jugendlichen Patient/innen (72,8 % weiblich) und 152 Schüler/innen (57,9 % weiblich). Zur Reliabilitätsprüfung werden für die Skalen des OPD-SF und seiner Subdimensionen Cronbachs Alphas und Trennschärfeindizes berechnet. Zur Prüfung der Validität kam zusätzlich der YSR11-18R in der Gesamtstichprobe zum Einsatz. Für die klinische Stichprobe liegen weitere Daten (AIDA, LoPF Q12-18, SKID II, WISC-IV) vor, die neben Alter und Geschlecht in die Validierungsprüfungen einbezogen werden. Itemtrennschärfe sowie Cronbachs Alphas liegen sowohl beim Gesamtwert des OPD-SF sowie bei allen Dimensionen und Subdimension in einem zufriedenstellenden Bereich. Es zeigen sich deutliche Unterschiede zwischen Schul- und klinischer Stichprobe in erwarteten Richtungen. Die Geschlechtsdifferenzen verlieren ihre Signifikanz, wenn für den Gesamtbeschwerdedruck kontrolliert wird. Jugendliche, die mindestens eine SKID-II Diagnose erfüllen, zeigen deutlich höhere Werte im OPD-SF. Weiter ergeben sich hohe korrelative Zusammenhänge zwischen dem OPD-SF und den zwei konstruktnahen Fragebögen, zur Intelligenz zeigten sich keine Zusammenhänge. Reliabilitäts- und Validitätsprüfung konnten zeigen, dass der OPD-SF auch bei Jugendlichen ein ökonomisches und valides Instrument zur Diagnostik in der klinische Routine darstellt.

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.

OBJECTIVE The aim of this study was to investigate associations between patients' subjective agency, their observable in-session behavior, and the patient-therapist interaction during the early phase of psychotherapy. METHODS The sample included 52 depressed patients in psychodynamic psychotherapy. After Session 5, the patients' agency and the quality of the therapeutic alliance were assessed. Based on session recordings, two independent observers rated the patients' involvement, their interpersonal behavior, and the therapists' directiveness. RESULTS Higher agency was associated with stronger therapeutic alliances. Patients who indicated higher agency in their therapy participated more actively in the session and showed less hostile impact messages. Patients' agency was not related to therapists' directiveness. CONCLUSIONS Patients' sense of agency in psychotherapy was associated with more active involvement and affiliative interaction. The findings support the idea that patients need to feel capable of acting within and having an influence on their therapy to benefit from it.

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.

Zusammenfassung Fragestellung: Das schnelle Erfassen struktureller Defizite der Personlichkeit hat eine hohe Relevanz fur die Behandlungsplanung. Daher besteht ein Bedarf an Kurzversionen bestehender Instrumente wie des OPD-Strukturfragebogens (OPD-SF). Methode: Zur Entwicklung einer Kurzversion wurde die Originalstichprobe des OPD-SF in zwei Substichproben aufgeteilt.Nach inhaltlichen und psychometrischen Kriterien wurde eine vorlaufige Zwolf-Item-Version erstellt und in der zweiten Substichprobe und einer weiteren, unabhangigen Stichprobe uberpruft. Ergebnisse: Eine konfirmatorische Faktorenanalyse bestatigte die Struktur von drei miteinander korrelierenden Faktoren mit adaquaten Fit-Indices. Befunde der Langversion zur Validitat wurden repliziert. Dieselbe Faktorstruktur zeigte sich in einer unabhangigen Stichprobe aus einer psychosomatischen Klinik, ebenso weitere Hinweise auf Validitat. Diskussion: Mit dem OPD-SFK liegt eine Screeningversion des OPD-SF mit guten psychometrischen Eigenschaften zurUnte...

Depressionen sind haufige Erkrankungen in der psychosomatischen Medizin und Psychotherapie. Bisher existieren jedoch kaum kontrollierte Studien, die unterschiedliche Behandlungsintensitaten miteinander vergleichen. Insbesondere zur Wirksamkeit der tagesklinischen Psychotherapie ist bisher wenig bekannt. Die Pilotstudie setzte hier an und untersuchte zunachst die Machbarkeit einer randomisiert-kontrollierten Vergleichsstudie tagesklinischer und stationarer Psychotherapie in der klinischen Routine. Die vorliegende Arbeit erganzt diese ersten Befunde um die Patienteneinschatzung des Behandlungserfolges sowie um eine Katamnese 6 Monate nach Entlassung. Insgesamt wurden 44 depressive Patienten rekrutiert und zufallig einer tagesklinischen oder stationaren Psychotherapie uber 8 Wochen zugewiesen. Depressive Symptome und interpersonelle Probleme nahmen im Laufe der Behandlung ab, und zur Katamnese erneut angestiegene Werte blieben insgesamt unter dem Ausgangsniveau. In der Pilotstudie fanden sich keine Unterschiede zwischen der tagesklinischen und der stationaren Psychotherapie. Fur die Zukunft erscheint ein Vergleich von randomisierten mit praferierten Behandlungsverlaufen wichtig. Auch wenn die Daten zunachst in groseren Stichproben repliziert werden mussen, erscheinen die Ergebnisse der Pilotstichprobe vielversprechend fur die tagesklinische Therapie. Langfristiges Ziel bleibt ein besseres Verstandnis der differentiellen Wirksamkeit unterschiedlicher Behandlungsintensitaten fur verschiedene Patientengruppen.

Depression in borderline personality disorder (BPD) is hypothesized to be distinct in quality and severity. This paper provides a systematic review of depression quality, and a meta-analysis of depression severity in BPD patients compared to those with depressive disorders (DeDs) only. Based on a systematic literature search, 26 studies were identified for systematic review and 35 studies (3425 participants) were included for meta-analysis. The review focused on different forms of depressive symptoms, affective impairment, self-evaluation, and negative interpersonal experiences. The meta-analysis examined age, gender, presence of comorbid DeDs in BPD patients, and type of depression scale as moderators of effect sizes. Findings indicate that depression quality in BPD is characterized by higher anger/hostility and self-criticism. There was no significant difference in depression severity between BPD and DeD groups, and a high level of heterogeneity. Moderator analyses revealed lower depression severity in BPD patients without comorbid DeDs, but higher severity in BPD patients with comorbid DeDs compared to depressed controls. Our results suggest high variability in depression severity across BPD patients, point toward the consideration of comorbid DeDs, and lend partial support to a BPD-specific depression quality. We discuss difficulties in research on depression in BPD, and offer directions for future studies.

Soziale Probleme stellen einen wichtigen Faktor fur die Entwicklung seelischer Erkrankungen und deren Losung stellen einen zentralen Schritt fur das Gelingen des psychotherapeutischen Behandlungsprozesses dar. Seelische Belastungen ziehen umgekehrt haufig soziale Schwierigkeiten nach sich. Weder die Ausbildungsinhalte noch die beruflichen Rahmenbedingungen arztlicher oder psychologischer Psychotherapeuten sind darauf ausgerichtet, hinreichende Kompetenzen zu erwerben, um komplexen sozialen Problemen hochbelasteter Patienten angemessen begegnen zu konnen. Drei einander erganzende Strategien scheinen vor diesem Hintergrund von hoher Relevanz, um sozialen Krisen von betroffenen Patienten adaquat zu begegnen: 1) die Sensibilitat von Psychotherapeuten fur das Erkennen von und Kompetenzen in der Begleitung ernsthafter sozialer Krisen zu steigern, 2) die Zusammenarbeit mit der klinischen Sozialarbeit zu verbessern, und 3) sozialtherapeutische Konzepte in einen psychotherapeutischen Gesamtbehandlungsplan zu integrieren. Anhand des Vorgehens im Rahmen der integrierten Versorgung an einer Universitatsklinik soll modellhaft vorgestellt werden, wie sich diese Strategien in der therapeutische Praxis umsetzen lassen.

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.

So sehr sich unterschiedliche Verfahren zur Therapie struktureller ­Storungen der Personlichkeit in der Theorie unterscheiden – in der Praxis fuhren sie oft zu ganz ahnlichen Ergebnissen. Dieser Beitrag skizziert ein auf OPD-Struktur- und -Beziehungsachse basierendes ­Modell, um scheinbar widerspruchliche Forschungsbefunde ­integrieren zu konnen und Anhaltspunkte fur eine gelingende fokusorientierte Beziehungsgestaltung im klinischen Alltag zu erhalten.

Die Frage nach der Wirksamkeit psychodynamischer Behandlungsverfahren hat in berufspolitischen und wissenschaftlichen Debatten der letzten Jahre einen hohen Stellenwert eingenommen. In diese Zeit fallt eine Vielzahl weiterer Studienergebnisse mit neuen Effektivitatsnachweisen. Ziel des vorliegenden Beitrags ist es, einen uberblick uber aktuelle Ergebnisse der psychodynamischen Psychotherapieforschung zu geben, mit einem Schwerpunkt auf Metaanalysen und randomisierten Vergleichsstudien. Die Ergebnisse zeigen, dass es fur eine grose Anzahl von Storungsbildern mittlerweile Effektivitatsnachweise auf einer robusten Datengrundlage gibt. Die methodische Qualitat der aktuellen Studien ist gut; auch der Vergleich mit anderen Therapieverfahren braucht nicht gescheut zu werden. Gleichzeitig sind weitere Studien notwendig, sowohl in Bezug auf Storungsbilder als auch Praxisstudien zur Abbildung der Wirksamkeit in der Breite der Anwendung im Alltag.

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.

From year one of studying medicine an increase of psychological stress is found. The relationship between the occurrence of this stress and attachment patterns or structural personality functions remains unclear. The present study aimed at investigating whether a relationship between the enduring personality variables, attachment style and level of structural integration of the personality, and acute stress experience at the beginning of medical students' studies exists.In this study, all students in the first semester of medicine were invited to participate in a study to identify stress factors via questionnaire (MBI-SS, PSQ, PHQ-9, GAD-7) in the WS 2013/2014. Simultaneously, the predominant attachment style (RQ-2) and structural abilities (OPD-SFK) were evaluated.The study included 293 students (return: 91.3%). Securely attached students experienced significantly less stress than insecurely attached students (p=0.019). Students with a high level of structural integration showed significantly less stress burden (p0.001) and lower exhaustion- (p0.001) and cynicism values (p0.001), while showing a higher experience of self-efficacy (p0.001). The influence of attachment behavior on stress experience is mediated by the level of the structural integration of the personality.Significant correlations exist between attachment style and the level of structural integration of the personality, and burnout risk as well as stress burden. The level of structural integration of the personality mediates the relationship between the attachment-related "model of self" and stress experience, i. e. a positive "model of self" can have a stress-protective effect when good structural abilities are present. Practical implication: An insecure attachment style and a low level of structural integration may be associated with higher stress experience when transitioning to study. The results suggest that the enduring personality variable attachment style, mediated by the level of structural integration of the personality, leads to higher stress and burnout experience. Affected students could be supported by early preventive measures enabling the sustainable preparation for this transitional period. Longitudinal prospective studies are needed to explore if the assumption is applicable that pre-existing vulnerabilities in school are exacerbated at this transitional stage.

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).

Hintergrund Die therapeutische Beziehung ist ein zentraler Wirkfaktor in Psychotherapien, dessen Ausgestaltung zumindest z. T. mithilfe der Bindungstheorie erklart werden konnte. Allerdings fehlen bisher Untersuchungen zur Frage, in welchen Behandlungssituationen bei Patienten bindungsrelevante Bedurfnisse und damit u. U. problematische Bewaltigungsstrategien ausgelost werden.

Strukturmerkmale der Personlichkeit sind ein zentrales Element der Operationalisierten Psychodynamischen Diagnostik. Die Beurteilung ist bisher nur mit Hilfe klinischer Interviews reliabel und valide moglich, was die Moglichkeit des Einsatzes in klinischer Routine und Forschung einschrankt und die Patientenperspektive ausklammert. Daher wurde ein Fragebogen zur Strukturachse der OPD (OPD-SF) entwickelt und in mehreren groseren klinischen und nicht-klinischen Stichproben evaluiert (N=1 112). Die rational gewonnenen Skalen des OPD-SF zeigen eine gute interne Konsistenz. Unterschiede zwischen den Gruppen und innerhalb der klinischen Stichprobe entsprechen ebenso den Erwartungen (z. B. hohere Werte bei Vorliegen einer Personlichkeitsstorung), wie die Zusammenhange mit relevanten Personlichkeitsmerkmalen (Bindungssicherheit, Neurotizismus). Geschlechts- oder Alterseffekte fehlen bzw. sind gering ausgepragt. Der OPD-SF kann zum Einsatz im klinischen Alltag und in Forschungsprojekten genutzt werden.

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.Three samples (total N = 821) were used to evaluate the psychometric properties and factor structure of the questionnaire.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.The IDES is a psychometrically reliable questionnaire for the evaluation of process factors in inpatient and day-clinic psychotherapy settings.

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.

To test the possibility of predicting psychotherapy outcome by measures of cardiovascular adaptability to stress at the beginning of treatment we used a prospective, within-subject design with experimental induction of short-term stress. Cardiovascular data during induced stress (mental arithmetic, anger recall) and relaxation were assessed in 21 patients with a main diagnosis of depression at the beginning of their 12-week inpatient psychotherapy treatment. Lower change scores in blood pressure during induced stress at the beginning of therapy were significantly related to better treatment outcome, accounting for 41% of variance, even after controlling for several covariates. Furthermore, there was evidence for the impact of negative affect. Using cardiovascular stress testing as an additional area of information seems a feasible method of incorporating biological parameters in psychotherapy evaluation.

Attachment theory is a conceptual framework for emotional-motivational behaviour and stress regulation in social relationships. However, few experimental studies have investigated attachment-related autonomic stress responses in adults. In a sample of 50 healthy subjects, we investigated autonomic cardiovascular reactions and subjective stress-load to a newly developed, attachment-related short-term stressor (separation recall, SR). The overall magnitude of the cardiovascular response to SR was comparable to the well established mental arithmetic (MA) stress test. However, the SR induced higher levels of sadness and impaired diastolic blood pressure recovery, whereas MA was associated with higher levels of anger and greater heart rate increase. Recovery scores to the attachment-stressor but not the mental arithmetic were related to attachment avoidance as measured by self-report, especially when taking into account the content of the reported episodes of the SR. In sum, our newly developed attachment-related short-term stressor has proven good performance in a first study. Copyright © 2010 John Wiley & Sons, Ltd.

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.