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Importance: In the treatment of persistent depressive disorder (PDD), disorder-specific Cognitive Behavioral Analysis System of Psychotherapy (CBASP) has been shown to be superior to Supportive Psychotherapy (SP) in outpatients. It remains to clear which subgroups of patients benefit equally and differentially from both psychotherapies.Objective: To identify those patient-level baseline characteristics that predict a comparable treatment effectiveness of CBASP and SP and those that moderate the differential effectiveness of CBASP compared to SP.Design, setting and participants: In this analysis of a 48-week multicenter randomized clinical trial comparing CBASP to SP in adult antidepressant-free outpatients with early-onset PDD, we evaluated baseline variables from the following domains as potential predictors and moderators of treatment effectiveness: socio-demography, clinical status, psychosocial and global functioning, life quality, interpersonal problems, childhood trauma, treatment history, preference for psychotherapy, and treatment expectancy.Interventions: A 48-week treatment program with 32 sessions of either CBASP or SP.Main outcomes and measures: Depression severity measured by the 24-item Hamilton Rating Scale for Depression (HRSD-24) at week 48.Results: From N = 268 randomized outpatients, N = 209 completed the 48-week treatment program. CBASP completers had significantly lower post-treatment HRSD-24 scores than SP completers (meanCBASP=13.96, sdCBASP= 9.56; meanSP= 16.69, sdSP= 9.87; p = 0.04). A poor response to both therapies was predicted by higher baseline levels of clinician-rated depression, elevated suicidality, comorbid anxiety, lower social functioning, higher social inhibition, moderate-to-severe early emotional or sexual abuse, no preference for psychotherapy, and the history of at least one previous inpatient treatment. Moderator analyses revealed that patients with higher baseline levels of self-rated depression, comorbidity of at least one Axis-I disorder, self-reported moderate-to-severe early emotional or physical neglect, or at least one previous antidepressant treatment, had a significantly lower post-treatment depression severity with CBASP compared to SP (all p < 0.05).Conclusions and relevance: A complex multifactorial interaction between severe symptoms of depression, suicidality, and traumatic childhood experiences characterized by abuse, social inhibition, and anxiety may represent the basis of non-response to psychotherapy in patients with early onset PDD. Specific psychotherapy with CBASP might, however, be more effective and recommendable for a variety of particularly burdened patients compared to SP.

BACKGROUND Internet-based self-help interventions for individuals with depressive symptoms, in which the main component is often a web-based self-help program, have been shown to be efficacious in many controlled trials. However, there are also trials on self-help programs showing no significant effect when delivered in routine care, and some studies report high dropout and low adherence rates. Research suggests that these findings do not emerge primarily due to the specific content of a self-help program. It seems more important how a program is embedded in the context of human and automated support before and during the use of a self-help program. OBJECTIVE This study aims to better understand the effects of 4 supportive contextual factors on outcomes of and adherence to a web-based self-help program for depressive symptoms. In a factorial experiment, 2 of 4 supportive factors, for which there is evidence for their role on outcomes and adherence, are realized during the intervention—personal guidance and automated email reminders. The other 2 factors are realized before the intervention—a diagnostic interview and a preintervention module aimed at increasing the motivation to use the program with motivational interviewing techniques. METHODS The study is a full factorial randomized trial. Adults with mild to moderate depressive symptoms (Patient Health Questionnaire–9 score: 5-14) are recruited from the community through the internet and conventional media. All participants receive access to a web-based self-help program based on problem-solving therapy. They are randomized across 4 experimental factors, each reflecting the presence versus absence of a supportive factor (guidance, automated reminders, diagnostic interview, preintervention module) resulting in a 16-condition balanced factorial design. The primary outcome is depressive symptoms at 10 weeks post assessment. Secondary outcomes include adherence to the program, anxiety, stress, health-related quality of life, possible negative effects, and treatment satisfaction. Potential moderators and mediators (eg, treatment expectancy, problem-solving skills, working alliance with the study team) will also be investigated. RESULTS Ethical approval was received on January 20, 2020. The study was initiated in February 2020, and 240 participants have been enrolled in the study as of November 1, 2020. Recruitment for a total of 255 participants is ongoing. Data collection is expected to be completed by May 2021. CONCLUSIONS A better understanding of relevant supportive factors in the dissemination of web-based interventions is necessary to improve outcomes of and adherence to web-based self-help programs. This study may inform health care systems and guide decisions to optimize the implementation context of web-based self-help programs for depressive symptoms. CLINICALTRIAL ClinicalTrials.gov NCT04318236; https://clinicaltrials.gov/ct2/show/NCT04318236 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/21207

The existing therapeutic strategies of Tourette syndrome (TS) do not lead to sufficient improvement in a significant number of patients. Recently published studies show that paying attention to tics increases whereas directing attention away decreases tic frequency. The aim of the present case series in three patients with TS was to investigate the effect of attention training technique (ATT) on TS symptoms. ATT is a technique derived from metacognitive therapy that aims on training patients to consciously (re-)focus their attention away from themselves. Friedman's chi-square test indicated a trend regarding the reduction of tic frequency and tic severity and a significant reduction of positive metacognitions from pre-baseline to follow-up. Reliable Change Indices (RCIs) are given for each measure and patient. Given the small number of patients, further studies including randomized controlled trials appear warranted.

Introduction Numerous RCTs have demonstrated the effectiveness of internet-based self-management interventions (SMIs) in the treatment of depressive symptoms. These studíes often recruit outside routine clinical practice. For the present study, we investigated the feasibility, effectiveness and safety of an SMI (deprexis) in routine medical care using a non-interventional design. Methods A total of 104 patients with a depressive disorder (60.58% female, mean age 45.82 yrs) were recruited in 25 outpatient practices in Germany (mostly psychiatric practices, n = 16). They received 12 week access to the SMI in addition to their usual care (76.0% took concomitant antidepressant medication). Guidance could optionally be offered by the treating physician. The effectiveness of the intervention was assessed using the clinician-rated short version of the Montgomery Asberg-Depression Scale (svMADRS) and the Patient Health Questionnaire (PHQ-9), a self-rating for depressive symptoms. Outcomes were assessed at baseline as well as at weeks 3, 6, 9 and 12. Results Most patients reported using the intervention at least once (n = 87, 83.6%), among these users the mean number of sessions was 18.05 (SD = 11.33). Only a minority of patients received the guided version of the intervention (n = 7, 8.0%). The severity of depressive symptoms decreased significantly over the observation period from 29.72 (SD = 10.03) to 15.73 (SD = 9.74) for the svMADRS (Cohen's d = 1.42, 95% CI 0.08–2.76) and from 15.20 (SD = 5.03) to 8.77 (SD = 5.03) for the PHQ-9 (d = 1.29, 95% CI 0.60–1.97). Discussion The size of the pre-post effect on depressive symptoms observed in this study is comparable to the pre-post effect size reported in an RCT using the same intervention in patients suffering from depressive symptoms of the same severity. Limitations of this study include the lack of a control group and the fact that the recruitment rate was far lower than expected. Conclusion This non-interventional study conducted in outpatient practices confirms results from numerous RCTs. Taken together, these data show that deprexis can be used effectively and safely in the routine care of depressed outpatients., Highlights • Many RCTs demonstrate the efficacy of self-management interventions for depression. • Much less is known about their effectiveness in real-world clinical practice. • We studied the intervention deprexis in outpatient clinics (mostly psychiatrists). • In this observational study, deprexis was as effective as in RCTs. • This suggests it can be used effectively in real-world settings.

Trypanosomal and leishmanial infections claim tens of thousands of lives each year. The metabolism of these unicellular eukaryotic parasites differs from the human host and their enzymes thus constitute promising drug targets. Tryparedoxin (Tpx) from Trypanosoma brucei is the essential oxidoreductase in the parasite's hydroperoxide-clearance cascade. In vitro and in vivo functional assays show that a small, selective inhibitor efficiently inhibits Tpx. With X-ray crystallography, SAXS, analytical SEC, SEC-MALS, MD simulations, ITC, and NMR spectroscopy, we show how covalent binding of this monofunctional inhibitor leads to Tpx dimerization. Intra- and intermolecular inhibitor-inhibitor, protein-protein, and inhibitor-protein interactions stabilize the dimer. The behavior of this efficient antitrypanosomal molecule thus constitutes an exquisite example of chemically induced dimerization with a small, monovalent ligand that can be exploited for future drug design.

Background: Deficits in social cognition, referred to as preoperational thinking, are assumed to play a key role in the pathogenesis of persistent depression. The aim of this study was to explore the effect of preoperational thinking on the two-year course of depressive symptoms in a sample of persistently depressed, episodically depressed as well as healthy participants. Methods: We recruited 43 persistently depressed participants, 26 episodically depressed participants and 16 healthy control participants. Preoperational thinking was assessed at baseline with the Luebeck Questionnaire for Recording Preoperational Thinking. Over the period of two years, the course of depressive symptom severity was measured every three months using the Inventory of Depressive Symptomatology. Results: Using linear mixed model analysis we found a significant effect for the influence of preoperational thinking on the severity of depressive symptoms in the observation period. We found a non-significant statistical trend for an association of preoperational thinking with the change of depressive symptom severity. Conclusion: Our analyses suggest that a high degree of preoperational thinking is associated with a higher severity of depressive symptoms and possibly less symptom improvement. These findings support the notion that preoperational thinking is a relevant factor for the further course of depression and might indeed contribute to the maintenance of persistent depression.

This study tested the hypothesis that chronic depression (CD) is more similar to depression with multiple prior episodes (ME) than to depression with few prior episodes (FE). Data from participants (n = 1013) with mild to moderate depressive symptoms (Patient Health Questionnaire [PHQ-9] score 5 – 14) who took part in a randomized control trial of an internet intervention for depression (EVIDENT trial) were re-analyzed. The MINI-interview was conducted to diagnose CD (n = 376). If CD was not diagnosed, the self-reported number of depressive episodes was used to categorize participants as having episodic depression with up to five (FE, n = 422) or more than five (ME, n = 215) prior episodes. Over a three-year period, participants were assessed repeatedly regarding the course of depression (PHQ-9, QIDS), quality of life (SF-12) and therapeutic progress (FEP-2). At baseline, most scores were different between CD and FE but comparable between CD and ME. Time to remission did not differ between CD and ME but was longer in CD compared to FE. Results suggest that ME closely resembles CD and that CD differs from FE.

Smartphone-based devices are increasingly recognized to assess disease symptoms in daily life (e.g. ecological momentary assessment, EMA). Despite this development in digital psychiatry, clinical trials are mainly based on point assessments of psychopathology. This study investigated expectable increases in statistical power by intense assessment in randomized controlled trials (RCTs). A simulation study, based on three scenarios and several empirical data sets, estimated power gains of two- or fivefold pre-post-assessment. For each condition, data sets of various effect sizes were generated, and AN(C)OVAs were applied to the sample of interest (N = 50–N = 200). Power increases ranged from 6% to 92%, with higher gains in more underpowered scenarios and with higher number of repeated assessments. ANCOVA profited from a more precise estimation of the baseline covariate, resulting in additional gains in statistical power. Fivefold pre-post EMA resulted in highest absolute statistical power and clearly outperformed traditional questionnaire assessments. For example, ANCOVA of automatized PHQ-9 questionnaire data resulted in absolute power of 55 (for N = 200 and d = 0.3). Fivefold EMA, however, resulted in power of 88.9. Non-parametric and multi-level analyses resulted in comparable outcomes. Besides providing psychological treatment, digital mental health can help optimizing sensitivity in RCT-based research. Intense assessment appears advisable whenever psychopathology needs to be assessed with high precision at pre- and post-assessment (e.g. small sample sizes, small treatment effects, or when applying optimization problems like machine learning). First empiric studies are promising, but more evidence is needed. Simulations for various effects and a short guide for popular power software are provided for study planning., Highlights • This article estimated expectable gains in statistical power for intense pre-post-assessment • A simulation study based on several empirical data sets was performed • Simulations indicated that 5 EMA assessments can outperform standard questionnaire assessments • Intense pre-post-assessment widens the choice of assessment strategies for controlled trials • First empiric studies are promising, but more evidence is needed

Background Therapeutic alliance has been well established as a robust predictor of face-to-face psychotherapy outcomes. Although initial evidence positioned alliance as a relevant predictor of internet intervention success, some conceptual and methodological concerns were raised regarding the methods and instruments used to measure the alliance in internet interventions and its association with outcomes. Objective The aim of this study was to explore the alliance-outcome association in a guided internet intervention using a measure of alliance especially developed for and adapted to guided internet interventions, showing evidence of good psychometric properties. Methods A sample of 223 adult participants with moderate depression received an internet intervention (ie, Deprexis) and email support. They completed the Working Alliance Inventory for Guided Internet Intervention (WAI-I) and a measure of treatment satisfaction at treatment termination and measures of depression severity and well-being at termination and 3- and 9-month follow-ups. For data analysis, we used two-level hierarchical linear modeling that included two subscales of the WAI-I (ie, tasks and goals agreement with the program and bond with the supporting therapist) as predictors of the estimated values of the outcome variables at the end of follow-up and their rate of change during the follow-up period. The same models were also used controlling for the effect of patient satisfaction with treatment. Results We found significant effects of the tasks and goals subscale of the WAI-I on the estimated values of residual depressive symptoms (γ02=−1.74, standard error [SE]=0.40, 95% CI −2.52 to −0.96, t206=−4.37, P Conclusions The results of this study point out the importance of attuning internet interventions to patients’ expectations and preferences in order to enhance their agreement with the tasks and goals of the treatment. Thus, the results support the notion that responsiveness to a patient’s individual needs is crucial also in internet interventions. Nevertheless, these findings need to be replicated to establish if they can be generalized to different diagnostic groups, internet interventions, and supporting formats.

Background Persistent depressive disorder (PDD) is associated with high rates of comorbid psychiatric disorders, mostly anxiety disorders (ADs). Comorbid AD was found to be associated with poorer treatment outcome in PDD patients. The effect of comorbid AD on disorder-specific treatment for PDD (Cognitive Behavioral Analysis System of Psychotherapy [CBASP]) has not been studied yet. Methods We analyzed whether the presence of a comorbid AD was moderating the effectiveness of disorder-specific (CBASP) versus nonspecific psychotherapy (supportive therapy [SP]) on depressive symptoms (24-item Hamilton Rating Scale for Depression [HRSD-24]) in a sample of unmedicated early-onset PDD outpatients (N = 268). Secondary outcomes were response and remission of depressive symptoms and the extent of interpersonal problems (Inventory of Interpersonal Problems [IIP-64]). Results The superiority of CBASP over SP was significantly stronger in PDD patients with comorbid AD compared to patients without AD (in HRSD-24 and IIP-64). There was no significant moderation for remission or response of depressive symptoms. Discussion Our hypothesis of a moderating effect of comorbid AD was confirmed. The main limitation might be the exclusion criteria of our sample limiting the generalizability. The major strength is the systematic analysis of the effect of AD in treating early-onset PDD with high quality of psychotherapy in both arms of this trial. Conclusion Patients suffering from PDD comorbid with AD might experience greater benefit when they are treated with specific as opposed to unspecific therapy. Analyzing subgroups of patients with PDD seems worthwhile to improve treatment effectiveness even within disorder-specific treatment programms.

Background Internet-based self-management interventions are effective in the prevention and treatment of mental disorders; however, for those affected as well as treating clinicians and decision makers in the healthcare sector, it is difficult to identify safe and effective interventions. Aim Development of quality criteria for self-management interventions. Methods Based on a non-specific assessment matrix, a task force from two scientific societies formulated specific quality criteria for self-management interventions for mental disorders. Patients and other relevant stakeholders were involved in the process. Results A total of 8 key criteria with 17 subordinate points were developed. These must be met for the certification of an intervention. The criteria focus on therapeutic quality requirements, patient safety, data protection and security as well as proof of efficacy in at least one randomized study. A further five criteria are only descriptive and are not required for certification. Discussion These quality criteria serve as a starting point for the establishment of a certification process. This could help to make internet-based self-management interventions for mental disorders part of routine care in the German healthcare system.

Despite growing awareness of occasional adverse effects of psychological treatments, only a few instruments cover side effects and other unwanted effects of psychotherapy. For the present study, the Positive and Negative Effects of Psychotherapy Scale (PANEPS) was evaluated in a population of individuals with depression who had completed at least one course of face-to-face psychotherapy. A total of 135 individuals with a current or previous depressive episode as verified by a diagnostic interview filled out the online version of the PANEPS, which is designed to capture both positive and adverse events. Factor analysis yielded four dimensions: positive effects, side effects, malpractice, and unethical conduct. Internal consistency of the individual subscales was satisfactory to excellent (Cronbach's α: 0.72 and 0.92). Positive effects were reported by virtually all patients (95.6%). At the same time, approximately half of the sample noted at least one adverse event (52.6%). Among these, side effects (38.5%) and malpractice (26.7%) were significantly more prevalent than unethical conduct (8.1%). As expected, positive effects were negatively correlated with adverse events. Our results challenge the common clinical assumption that some degree of destabilization is necessary for symptom improvement. The survey was conducted anonymously, and the sample underwent diagnostic verification. The results indicate a need for improved treatment guidelines and mechanisms to monitor treatment.

Etwa ein Drittel aller depressiven Storungen nimmt einen chronischen Verlauf [1]. Chronische Depressionen gelten auch wegen der haufigen fruhen Traumatisierungen und Komorbiditaten als schwer behandelbar. Die Betroffenen haben vor dem Hintergrund langjahriger widriger Beziehungserfahrungen in Kindheit und Jugend oft Schwierigkeiten, vertrauensvolle und konstruktive Beziehungen aufzubauen. Das hat tiefgreifende Auswirkungen auf ihren Alltag und sollte in der Behandlung beachtet werden. In der spezifischen Psychotherapie chronischer Depression wird daher ein Fokus auf Interaktionsfertigkeiten und soziales Problemlosen gelegt. Das wichtigste Beispiel dafur ist das Cognitive Behavioral Analysis System of Psychotherapy (CBASP).

Background Persistent depressive disorder (PDD) is associated with high rates of comorbid personality disorders (PD). The association of comorbid PD and clinical characteristics has not been systematically studied in PDD. Results regarding effects on treatment outcome are heterogeneous. Methods We analyzed the association of comorbid personality disorders with clinical characteristics and outcome in a randomized controlled trial comparing the disorder-specific Cognitive Behavioral Analysis System of Psychotherapy (CBASP) with nonspecific supportive psychotherapy (SP) in patients with early-onset PDD. The main outcome measure was the Hamilton Rating Scale for Depression (HRSD-24). Further baseline measures were comorbid axis-I diagnoses (SCID-I), quality of life (QLDS), global functioning (GAF), interpersonal problems (IIP-64) and childhood maltreatment (CTQ). Results Out of the 268 patients, 103 (38.4%) met criteria for at least one PD. PD was associated with higher rates of axis I comorbidities (mainly anxiety disorders) and interpersonal problems (patients with PD were more vindictive, more self-sacrificing, less assertive and more inhibited socially than patients without PD). There was no significant main effect of PD on treatment outcome and no significant interaction between PD and treatment group. Limitations The main limitation was the exclusion of patients with certain personality disorders (antisocial, schizotypal, and borderline personality disorders). Furthermore, the study was underpowered to find interaction effects of small size. Conclusion Persistently depressed patients with and without comorbid PD primarily seemed to differ in the rate of axis I comorbidity and the severity of interpersonal problems. Treatment outcomes appear to be not significantly affected by the presence of PD.

BACKGROUND: Most individuals with depression do not receive adequate treatment. Internet interventions may help to bridge this gap. Research on attitudes toward Internet interventions might facilitate the dissemination of such interventions by identifying factors that help or hinder uptake and implementation, and by clarifying who is likely to benefit. This study examined whether attitudes toward Internet interventions moderate the effects of a depression-focused Internet intervention, and how attitudes change over the course of treatment among those who do or do not benefit. METHODS: We recruited 1,004 adults with mild-to-moderate depression symptoms and investigated how attitudes toward Internet interventions are associated with the efficacy of the program deprexis, and how attitudes in the intervention group change from pre to post over a 3 months intervention period, compared to a control group (care as usual). This study consists of a subgroup analysis of the randomized controlled EVIDENT trial. RESULTS: Positive initial attitudes toward Internet interventions were associated with greater efficacy (η2p = .014) independent of usage time, whereas a negative attitude (perceived lack of personal contact) was associated with reduced efficacy (η2p = .012). Users' attitudes changed during the trial, and both the magnitude and direction of attitude change were associated with the efficacy of the program over time (η2p = .030). CONCLUSIONS: Internet interventions may be the most beneficial for individuals with positive attitudes toward them. Informing potential users about evidence-based Internet interventions might instill positive attitudes and thereby optimize the benefits such interventions can provide. Assessing attitudes prior to treatment might help identify suitable users.

Im Dezember 2017 wurde eine Überarbeitung der bis dato geltenden BASEL III Richtlinien mit dem Titel „Basel III: Finalising post-crisis reforms” veröffentlicht, welche wesentliche Änderungen für die österreichischen Genossenschaftsbanken mit sich bringen. Dabei liegt der Fokus dieses Artikles speziell auf die Veränderung im Kreditrisiko Standardansatz für die Bemessung des Kreditrisikos. Anhand einer Simulation sollen mögliche Auswirkungen auf die Eigenmittelquote dargestellt und Handlungsmaßnahmen abgeleitet werden.

Background: Internet interventions are effective in treating depressive symptoms but few studies conducted a long-term follow-up. The aim of this study was to test the effectiveness of an internet intervention in increasing the remission rate over a twelve months period. Methods: A total of 1013 participants with mild to moderate depressive symptoms were randomized to either care as usual alone or a 12-week internet intervention (Deprexis) plus usual care. Self-rated depression severity (PHQ-9) was assessed regularly over twelve months. Results: Remission rates over time were significantly higher in the intervention group (Cox regression: hazard ratio [HR] 1.31; p = 0.009). The intervention was more effective in the subgroup not taking antidepressant medication (Cox regression: HR 1.88; p < 0.001). PHQ-change from baseline was greater in the intervention group (linear mixed model [LMM]: p < 0.001) with the between-group effect gradually decreasing from d = 0.36 at three months to d = 0.13 at twelve months (LMM: group by time interaction: p < 0.001). Conclusion: This internet intervention can contribute to achieving remission in people with mild to moderate depressive symptoms, especially if they are not on antidepressant medication (Trial Registration: NCT01636752). (C) 2017 Elsevier Ltd. All rights reserved.

Viral infections impose major stress on the host cell. In response, stress pathways can rapidly deploy defence mechanisms by shutting off the protein synthesis machinery and triggering the accumulation of mRNAs into stress granules to limit the use of energy and nutrients. Because this threatens viral gene expression, viruses need to evade these pathways to propagate. Human norovirus is responsible for gastroenteritis outbreaks worldwide. Here we examined how norovirus interacts with the eIF2α signaling axis controlling translation and stress granules. While norovirus infection represses host cell translation, our mechanistic analyses revealed that eIF2α signaling mediated by the stress kinase GCN2 is uncoupled from translational stalling. Moreover, infection results in a redistribution of the RNA-binding protein G3BP1 to replication complexes and remodelling of its interacting partners, allowing the avoidance from canonical stress granules. These results define novel strategies by which norovirus undergo efficient replication whilst avoiding the host stress response and manipulating the G3BP1 interactome., Author summary Viruses have evolved elegant strategies to evade host responses that restrict viral propagation by targeting the protein synthesis machinery and stress granules, which are membrane-less RNA granules with antiviral properties. Previous studies have unravelled how viruses, including norovirus the leading cause of gastroenteritis, regulate the activity of translation factors to affect the antiviral response. Furthermore, stress granules evasion strategies have been linked to targeting the scaffolding protein G3BP1. Here we dissect how murine norovirus, the main model for norovirus, evades the cellular stress responses. Our work challenges the dogma that translational control during infection is mainly mediated by eIF2α and demonstrate that norovirus evades this stress pathway. We further show that norovirus evades the stress granule response in a novel way by isolating and characterising the G3BP1 interactome for the first time in the context of a viral infection. We conclude that norovirus infection results in a redistribution of G3BP1 and its cellular partners to replication complexes, thereby preventing the assembly of stress granules. Overall, we define a novel evasion strategy by which norovirus escapes stress granule formation by rewiring the G3BP1 interactome.

We investigate the replenishment of 102 asset-backed securities (ABS) backed by more than 1.7 million small- and medium-sized enterprise loans. Based on our extensive data set from 2012 to 2017 obtained from the first and only loan-level central repository for ABS in Europe, we reveal that loans added to securitized loan portfolios after the transactions' closing perform worse than loans that are part of the initial portfolio. We additionally provide evidence that originators induce these performance differences since they exploit their information advantage by deliberately adding low-quality loans to securitized loan portfolios. This adverse behavior is mitigated by originators' reputation efforts, by increasing transparency in the ABS market, as for example per the European Central Bank's loan-level initiative, and most effectively by their interaction.

Objective To examine immediate and long-term effectiveness of an adjunctive Internet intervention for depression in a large sample of patients undergoing routine psychotherapy. Method The current study evaluated a subgroup of patients from the Evident trial, a randomized investigation of a 12-week minimally guided Internet intervention (Deprexis) for the treatment of mild to moderate depression. 340 adults (mean age = 43.3 years; 71.7 % female) of the original sample received routine outpatient psychotherapy during the trial period, resulting in a standard psychotherapy group (n = 174) and an augmented therapy group (n = 166). Outcomes were assessed at baseline, post-treatment and 6-month follow-up. Results Intention-to-treat analyses indicated that combined treatment led to a greater reduction in symptoms of depression (effect size d = 0.32; p = .002), improved therapeutic progress (d = 0.36; p = .003), and higher mental health-related quality of life (d = 0.34; p = .004). There was no intervention effect on physical health-related quality of life. The same pattern was found at 6-month follow-up, and adjunctive treatment also resulted in increased rates of clinical improvement. Treatment success was independent from therapeutic orientation of combined face-to-face therapy. Conclusion Results indicate that the adjunctive use of the investigated intervention can produce additional and lasting effects in routine outpatient psychotherapy for mild to moderate levels of depression. The study adds to the ongoing evidence on augmented effects of blended treatment. Future studies should investigate different types of blends in diverse populations by means of change-sensitive assessment strategies.

This review describes four cognitive approaches for the treatment of schizophrenia: cognitive-behavioral therapy for psychosis (CBTp), metacognitive therapy, metacognitive training, and metacognitive reflection insight therapy (MERIT). A central reference point of our review is a seminal paper by James Flavell, who introduced the term metacognition ("cognition about cognition"). In a way, every psychotherapeutic approach adopts a metacognitive perspective when therapists reflect with clients about their thoughts. Yet, the four approaches map onto different components of metacognition. CBTp conveys some "metacognitive knowledge" (eg, thoughts are not facts) but is mainly concerned with individual beliefs. Metacognitive therapy focuses on unhelpful metacognitive beliefs about thinking styles (eg, thought suppression). Metacognitive training brings distorted cognitive biases to the awareness of patients; a central goal is the reduction of overconfidence. MERIT focuses on larger senses of identity and highlights metacognitive knowledge about oneself and other persons. For CBTp and metacognitive training, meta-analytic evidence supports their efficacy; single studies speak for the effectiveness of MERIT and metacognitive therapy. .Esta revisión describe cuatro enfoques cognitivos para el tratamiento de la esquizofrenia: terapia cognitivo-conductual para la psicosis (TCCp), terapia metacognitiva (TMC), entrenamiento metacognitivo (EMC) y terapia metacognitiva de reflexión (TMCR). Un punto de referencia central es un artículo seminal de James Flavell, quien introdujo el término metacognición ("cognición acerca de la cognición"). En cierto modo, cada enfoque terapéutico adopta una perspectiva metacognitiva cuando los terapeutas reflexionan con los clientes acerca de sus pensamientos. Sin embargo, los cuatro enfoques se asignan a diferentes componentes de la metacognición. La TCCp transmite algún "conocimiento metacognitivo" (p. ej. Los pensamientos no son realidades), pero se ocupa principalmente de las creencias individuales. La TMC se centra en creencias metacognitivas inútiles acerca de los estilos de pensamiento (p. ej. Supresión del pensamiento). El EMC trae sesgos cognitivos distorsionados a la conciencia de los pacientes, siendo un objetivo central la reducción del exceso de confianza. La TMCR se enfoca en sentidos de identidad más amplios y destaca el conocimiento metacognitivo sobre uno mismo y otras personas. La evidencia metaanalítica respalda la eficacia de la TCCp y el EMC, y los estudios individuales la efectividad de la TMCR y la TMC.Cet article décrit quatre approches cognitives pour le traitement de la schizophrénie : les TCCp (Thérapie cognitivo-comportementale) pour la psychose, la TMC (thérapie métacognitive), l’EMC (entraînement métacognitif) et la MERIT (Metacognitive Reflection Insight Therapy). James Flavell est l’auteur de référence d’un article fondateur qui a introduit le terme de métacognition (« la connaissance de la connaissance »). D’une certaine façon, chaque approche thérapeutique adopte une perspective métacognitive lorsque le thérapeute réfléchit avec son patient sur ses pensées. Cependant les quatre approches représentent les différentes composantes de la métacognition. Les TCCp véhiculent une certaine « connaissance métacognitive » (par exemple les pensées ne sont pas des faits) mais sont principalement concernées par les croyances individuelles. La TMC s’intéresse aux croyances métacognitives inutiles sur les modes de pensée (par exemple, suppression de la pensée). L’EMC aide les patients à prendre conscience des distorsions cognitives ; l’objectif central est la diminution de la sur-confiance. La MERIT se concentre sur des facultés plus larges d’identité et met en valeur la connaissance métacognitive sur soi-même et sur les autres. Des méta-analyses sont en faveur de l’efficacité des TCCp et de l’EMC ; la MERIT et la TMC ont fait l’objet d’études isolées pour leur efficacité.

Inspired by neurobiological systems, Spiking Neural Networks (SNNs) are gaining an increasing interest in the field of bio-inspired machine learning. Neurons, as central processing and short-term memory units of biological neural systems, are thus at the forefront of cutting-edge research approaches. The realization of CMOS circuits replicating neuronal features, namely the integration of action potentials and firing according to the all-or-nothing law, imposes various challenges like large area and power consumption. The non-volatile storage of polarization states and accumulative switching behavior of nanoscale HfO2 - based Ferroelectric Field-Effect Transistors (FeFETs), promise to circumvent these issues. In this paper, we propose two FeFET-based neuronal circuits emulating the Integrate-and-Fire (IF) behavior of biological neurons on the basis of SPICE simulations. Additionally, modulating the depolarization of the FeFETs enables the replication of a biology-based concept known as membrane leakage. The presented capacitor-free implementation is crucial for the development of neuromorphic systems that allow more complex features at a given area and power constraint.

BACKGROUND Therapeutic alliance has been well established as a robust predictor of face-to-face psychotherapy outcomes. Although initial evidence positioned alliance as a relevant predictor of internet intervention success, some conceptual and methodological concerns were raised regarding the methods and instruments used to measure the alliance in internet interventions and its association with outcomes. OBJECTIVE The aim of this study was to explore the alliance-outcome association in a guided internet intervention using a measure of alliance especially developed for and adapted to guided internet interventions, showing evidence of good psychometric properties. METHODS A sample of 223 adult participants with moderate depression received an internet intervention (ie, Deprexis) and email support. They completed the Working Alliance Inventory for Guided Internet Intervention (WAI-I) and a measure of treatment satisfaction at treatment termination and measures of depression severity and well-being at termination and 3- and 9-month follow-ups. For data analysis, we used two-level hierarchical linear modeling that included two subscales of the WAI-I (ie, tasks and goals agreement with the program and bond with the supporting therapist) as predictors of the estimated values of the outcome variables at the end of follow-up and their rate of change during the follow-up period. The same models were also used controlling for the effect of patient satisfaction with treatment. RESULTS We found significant effects of the tasks and goals subscale of the WAI-I on the estimated values of residual depressive symptoms (γ02=−1.74, standard error [SE]=0.40, 95% CI −2.52 to −0.96, t206=−4.37, P02=3.10, SE=1.14, 95% CI 0.87-5.33, t198=2.72, P=.007) at the end of follow-up. A greater score in this subscale was related to lower levels of residual depressive symptoms and a higher level of well-being. However, there were no significant effects of the tasks and goals subscale on the rate of change in these variables during follow-up (depressive symptoms, P=.48; patient well-being, P=.26). The effects of the bond subscale were also nonsignificant when predicting the estimated values of depressive symptoms and well-being at the end of follow-up and the rate of change during that period (depressive symptoms, P=.08; patient well-being, P=.68). CONCLUSIONS The results of this study point out the importance of attuning internet interventions to patients’ expectations and preferences in order to enhance their agreement with the tasks and goals of the treatment. Thus, the results support the notion that responsiveness to a patient’s individual needs is crucial also in internet interventions. Nevertheless, these findings need to be replicated to establish if they can be generalized to different diagnostic groups, internet interventions, and supporting formats.

Background About one in five patients with depression experiences a chronic course. Despite the great burden associated with this disease, there is no current screening instrument for Persistent Depressive Disorder (PDD). In the present study, we examine a short screening test, the persistent depression screener (PDS), that we developed for DSM-5 PDD. The PDS is comprised of one question that is administered following an initial self-assessment for depression. Methods Ninety patients from an inpatient clinic/day clinic specialized in treating depression completed the PDS. They were also assessed using a structured clinical interview covering the DSM-5 criteria for PDD. Retest reliability was examined after two weeks (n = 69, 77%). Results In this sample, the prevalence of PDD was 64%. Sensitivity of the PDS was 85% with a positive predictive value of 80%. Specificity was 63%. Positive and negative likelihood ratios were 2.3 and .24, respectively. Agreement between the PDS results and the outcome of the clinical interview was moderate (Cohen’s Kappa κ = .48 ([95%-CI .28, .68], p

Only about half of those suffering from a depressive disorder seek treatment. Self-management interventions are one way to reduce this treatment gap. These interventions are mostly based on evidence-based techniques of cognitive behavioural therapy, which are taught by a computer program instead of a therapist. Numerous studies have shown the effectiveness of these interventions. However, these studies also raise a number of questions. These concern the efficacy both in the external rating and in the long-term course and the efficacy in severe depressive symptoms or in combination with antidepressant medication. Finally, the question arises as to the use of these interventions in patients in clinical practice and in people who are not particularly Internet-savvy. We addressed these questions in a large randomized study (EVIDENT study). This study investigated the efficacy of Intervention deprexis®. The results of this study are summarised in this overview and placed in the context of other interventions available in Germany.Nur etwa die Hälfte derjenigen, die an einer depressiven Störung leiden, sucht auch eine Behandlung auf. Selbstmanagement Interventionen sind eine Möglichkeit, diese Behandlungslücke zu reduzieren. Diese Interventionen basieren meist auf evidenzbasierten Techniken der Kognitiven Verhaltenstherapie, welche statt durch einen Therapeuten durch ein Computerprogramm vermittelt werden. Zahlreiche Studien belegen die Wirksamkeit dieser Interventionen. Diese Studien werfen allerdings auch eine Reihe an Fragen auf. Diese betreffen die Wirksamkeit sowohl im Fremdrating als auch im Langzeitverlauf und die Wirksamkeit bei schwerer depressiver Symptomatik oder in der Kombination mit antidepressiver Medikation. Schließlich stellt sich die Frage nach dem Einsatz dieser Interventionen bei Patienten in der klinischen Praxis und bei Menschen, die nicht besonders internetaffin sind. Diese Fragen haben wir im Rahmen einer großen randomisiertenStudie adressiert (EVIDENT-Studie). In dieser Studie wurde die Wirksamkeit Intervention deprexis® untersucht. Die Ergebnisse dieser Studie werden in dieser Übersicht zusammengefasst und in den Kontext anderer in Deutschland verfügbarer Interventionen gestellt.

Numerous self-management interventions have proven to be efficacious in the treatment of a number of mental disorders in randomized trials. However, these interventions have not yet reached clinical routine everywhere. Among other things, this is due to the fact that, in addition to the evidence-based interventions, other interventions are offered that have never been scientifically investigated, and in some cases, do not even rely on evidence-based methods of psychotherapy. The present quality criteria, developed by the two professional associations DGPs and DGPPN, are intended to help patients, practitioners and decision-makers in the health care sector to identify safe and efficacious interventions. The core quality criteria cover the following aspects: safety of patients and their data; ensuring therapeutic quality by using evidence-based psychotherapeutic methods and developing the intervention in liaison with licensed psychotherapists or medical specialists; the presence of proof of efficacy from at least one randomized trial; and transparency regarding key information, e. g., the cost of the intervention. We hope that these criteria can contribute to the inclusion of self-management interventions in the range of services covered by statutory health insurance companies.Zahlreiche Selbstmanagement Interventionen haben in randomisierten Studien ihre Wirksamkeit in der Behandlung von einer Reihe von psychischen Störungen gezeigt. Dennoch sind diese Interventionen gegenwärtig noch nicht überall in der klinischen Routine angekommen. Das liegt unter anderem daran, dass neben den evidenzbasierten Interventionen auch Interventionen angeboten werden, die nie wissenschaftlich untersucht worden sind und teilweise noch nicht einmal auf evidenzbasierten Psychotherapiemethoden beruhen. Die vorliegenden Qualitätskriterien der beiden Fachgesellschaften DGPs und DGPPN sollen Betroffenen, Behandlern und Entscheidern im Gesundheitswesen helfen, sichere und wirksame Interventionen zu identifizieren. Im Mittelpunkt der Qualitätskriterien stehen die Sicherheit der Patienten und ihrer Daten; die Sicherstellung der therapeutischen Qualität durch Rückgriff auf evidenzbasierte Psychotherapiemethoden und Begleitung der Entwicklung durch approbierte Psychotherapeuten oder Fachärzte; das Vorliegen eines Wirksamkeitsnachweises aus mindestens einer randomisierten Studie; und die Transparenz bezüglich zentraler Informationen, z. B. der Kosten der Intervention. Wir hoffen, dass diese Kriterien dazu beitragen können, dass Selbstmanagement Interventionen in den Leistungskatalog der Krankenkassen aufgenommen werden.

Psychotherapy as a field tends toward conservativism, and the rate of innovation and development of new evidence-based effective treatments has been slow. The paper explores important barriers to innovation like the dodo bird verdict and the habit of starting the development of therapeutic methods from techniques. The paper looks at the opportunities for translating basic science in psychology into psychotherapeutic techniques. Metacognitive therapy stands out from other psychotherapies by its development from basic science. The paper describes the development of the techniques detached mindfulness and attention training, how they were derived from basic science and tested for their suitability in the therapy of patients with anxiety disorders. By this process, metacognitive therapy may be an important model for the innovation process in psychotherapy.

Clinical trials are mainly based on single point assessments of psychopathology. At the same time, automatized repeated assessments based on short scales are an increasing practice to account for daily fluctuations in disease symptoms (e.g. ecological momentary assessment, or time series-based analyses). This study investigated the impact of Intense Pre-Post-Assessment (IPA) on statistical power in randomized controlled trials (RCTs).A simulation study, based on three scenarios and several empirical data sets, estimated the expected power gains of two- or fivefold pre-post-measurements of fluctuating disease symptoms. For each condition, patient data sets of various effect sizes were generated, and AN(C)OVAs were applied to the sample size of interest (N=50 – N=200).Power increases ranged from 6% to 92%, with higher gains in more underpowered scenarios. ANCOVA with baseline as covariate profited from a more precise estimation of the baseline covariate, resulting in additional gains in statistical power. Ecological momentary assessment-like data sources resulted in highest absolute statistical power and outperformed traditional point assessments if fivefold IPA was applied. For example, ANCOVA of automatized PHQ-9 questionnaire data resulted in absolute power of 55 (for N=200 and d=0.3). Fivefold IPA, however, resulted in power of 88.9 to detect a similar effect.IPA integrates short EMA-based assessments into RCT-based research designs. Sensitivity and efficiency of current RCTs could be improved by implementing a low number of automatized repeated assessments. Therefore, the merits of the suggested approach should be tested across various areas of clinical research (e.g. in neuroscience, or drug and psychotherapy research).

To date, only few studies have attempted to investigate non-ignorable dropout during Internet-based interventions by applying an NMAR model, which includes missing data indicators in its equations. Here, the Muthen-Roy model was used to investigate change and dropout patterns in a sample of patients with mild-to-moderate depression symptoms (

Poor transparency of asset-backed securities (ABS) exacerbated the latest subprime lending crisis. In response, the European Central Bank introduced the ABS loan-level reporting initiative, obliging originators to disclose quarterly loan-by-loan information. However, does this increase in transparency alleviate the agency problems inherent in securitization? To answer this question, we examine a novel dataset of 107 ABS pools that are backed by more than 2.8 million loans for small and medium-sized enterprises from the first securitization repository in Europe. The results show that the increase in transparency indeed has valuable effects for investors, inducing originators to improve pool performance and diversification for existing as well as newly issued ABS. These effects persist for a large set of control variables and a broad variety of robustness tests.

Objectives To compare treatment effect estimates obtained from a regression discontinuity (RD) design with results from an actual randomized controlled trial (RCT). Study Design and Setting Data from an RCT (EVIDENT), which studied the effect of an Internet intervention on depressive symptoms measured with the Patient Health Questionnaire (PHQ-9), were used to perform an RD analysis, in which treatment allocation was determined by a cutoff value at baseline (PHQ-9 = 10). A linear regression model was fitted to the data, selecting participants above the cutoff who had received the intervention ( n = 317) and control participants below the cutoff ( n = 187). Outcome was PHQ-9 sum score 12 weeks after baseline. Robustness of the effect estimate was studied; the estimate was compared with the RCT treatment effect. Results The final regression model showed a regression coefficient of −2.29 [95% confidence interval (CI): −3.72 to −.85] compared with a treatment effect found in the RCT of −1.57 (95% CI: −2.07 to −1.07). Conclusion Although the estimates obtained from two designs are not equal, their confidence intervals overlap, suggesting that an RD design can be a valid alternative for RCTs. This finding is particularly important for situations where an RCT may not be feasible or ethical as is often the case in clinical research settings.

Background Mental disorders are frequently not or only insufficiently treated. Internet-based interventions offer the potential of closing the existing gaps in the treatment of mental disorders; however, it is very difficult for patients and providers to choose from the numerous interventions available. Objective The aim of this study was to develop a set of quality criteria that can help patients and care providers to identify recommendable internet-based interventions. Methods A selective literature search was carried out and the existing evidence on internet-based interventions in the treatment of mental disorders was collated. A panel of experts then developed quality criteria based on existing models for the systematic assessment of telemedicine applications. Results Internet-based interventions are effective in the treatment of a broad range of mental disorders. The best evidence is available for depression and anxiety disorders. A set of criteria is proposed for the evaluation of available internet-based interventions using a checklist. These criteria have to be developed further with input from other stakeholders. Discussion When taking these quality criteria into account, evidence-based interventions available on the internet can make an important contribution to improvement of the care of patients with mental disorders.

A wide range of Internet interventions, mostly grounded in methods of cognitive behavioral therapy, have been developed and tested for several mental disorders. The evidence to date shows that these interventions are effective in reducing symptoms of depression. Metaanalyses report small-to-medium effect sizes when Internet interventions are delivered as stand-alone self-help interventions (d=0.25-0.36), and medium-to-large effect sizes when delivered as therapist-guided interventions (d=0.58-0.78), both compared with usual care. Only a minority of people suffering from depression receive adequate treatment, and Internet interventions might help bridge the large treatment gap. This review summarizes the current body of evidence and highlights pros and cons of Internet interventions. It also outlines how they could be implemented in mental health care systems and points out unresolved questions, as well as future directions, in this research field.Se ha desarrollado y probado una amplia gama de intervenciones por internet para diversos trastornos mentales y la mayor parte está basada en métodos de terapia cognitivo conductual. A la fecha la evidencia muestra que estas intervenciones son efectivas para reducir síntomas depresivos. Estudios de meta-análisis dan cuenta de efectos de pequeña a mediana cuantía cuando las intervenciones por internet son proporcionadas como intervenciones de auto-ayuda de forma autónoma (d=0,25-0,36), y efectos de mediana a gran cuantía cuando son proporcionadas como intervenciones guiadas por terapeutas (d=0,58-0,78), en ambos casos en comparación con el tratamiento habitual. Sólo una minoría de las personas que sufre una depresión recibe un tratamiento adecuado y las intervenciones por internet podrían ayu-dar a reducir la gran brecha terapéutica. En este campo de investigación la presente revisión resume el cuerpo actual de evidencia de las intervenciones por internet y destaca los pros y contras de ellas. También bosqueja cómo podrían ser implementadas estas intervenciones en los sistemas de atención de salud y señala tanto preguntas sin resolver como futuras orientaciones.Un large éventail de procédures Internet, dont la plupart sont fondées sur des méthodes de thérapie cognitivo-comportementale, ont été développées et testées pour plusieurs troubles mentaux. À ce jour, les données montrent que ces programmes sont efficaces pour réduire les symptômes dépressifs. Des métaanalyses rapportent que, comparées à un traitement classique, les procédures Internet délivrées en tant que programmes indépendants d'auto-assistance ont un effet de faible ampleur à moyenne ampleur (d = 0,25-0,36) et un effet de moyenne ampleur à forte ampleur lorsqu'il s'agit de programmes menés par un thérapeute (d = 0,58-0,78). Seule une minorité de personnes souffrant de dépression sont correctement traitées, et les procédures Internet peuvent aider à combler l'écart important (d'observance) du traitement. Cet article résume l'état actuel des connaissances et souligne les avantages et les inconvénients des procédures utilisant l'Internet. Il décrit aussi la façon dont elles pourraient être mises en oeuvre dans les systèmes de santé mentale et indique les questions non résolues, ainsi que les axes de recherche à venir dans ce domaine.

Eine leitliniengerechte stationare psychiatrisch-psychotherapeutische Behandlung ist ein wesentlicher Bestandteil der Versorgung von Patienten mit einer Zwangsstorung. Moglicherweise wird der Aufwand fur diese Psychotherapie im gegenwartigen Personalbudget nach Psychiatrie-Personalverordnung (Psych-PV) jedoch nicht ausreichend abgebildet. Das Ziel dieses Beitrages ist, die fur eine leitliniengerechte stationare psychiatrisch-psychotherapeutische Behandlung notwendigen Personalressourcen zu bestimmen und mit dem Personalbudget in der Psych-PV zu vergleichen. Auf Grundlage der S3-Leitlinienempfehlung zur Behandlung von Zwangsstorungen und einer Metaanalyse zur Behandlungsintensitat wurde ein normativer Wochenbehandlungsplan erstellt. Ausgehend davon wurden die fur diesen Behandlungsplan notwendigen Personalressourcen berechnet. Diese wurden mit dem in der Psych-PV in der Kategorie A1 (Regelbehandlung) vorgesehenen Personalbudget verglichen. Die Therapiezeit fur eine leitliniengerechte stationare psychiatrisch-psychotherapeutische Behandlung der Zwangsstorung betragt 23,5 h in der Woche. Das entspricht einem Personalbedarf von 20,9 h in der Woche. Dieser Personalbedarf ist in der Psych-PV nur zu 82,8 % (17,3 h) berucksichtigt. Die Deckung des Personalbedarfs im Bereich arztliche und psychologische Psychotherapie betragt sogar nur 38,3 % (183 min im Behandlungsplan vs. 70 min in der Psych-PV). Der vorliegende Beitrag macht deutlich, dass eine leitliniengerechte stationare, psychotherapeutische Behandlung einer Zwangsstorung im Psych-PV-Budget nicht ausreichend abgebildet ist. Die tatsachliche Lucke wird hier moglicherweise sogar unterschatzt.

Background Lack of adaptive and enhanced maladaptive coping with stress and negative emotions are implicated in many psychopathological disorders. We describe the development of a new scale to investigate the relative contribution of different coping styles to psychopathology in a large population sample. We hypothesized that the magnitude of the supposed positive correlation between maladaptive coping and psychopathology would be stronger than the supposed negative correlation between adaptive coping and psychopathology. We also examined whether distinct coping style patterns emerge for different psychopathological syndromes. Methods A total of 2200 individuals from the general population participated in an online survey. The Patient Health Questionnaire-9 (PHQ-9), the Obsessive-Compulsive Inventory revised (OCI-R) and the Paranoia Checklist were administered along with a novel instrument called Maladaptive and Adaptive Coping Styles (MAX) questionnaire. Participants were reassessed six months later. Results MAX consists of three dimensions representing adaptive coping, maladaptive coping and avoidance. Across all psychopathological syndromes, similar response patterns emerged. Maladaptive coping was more strongly related to psychopathology than adaptive coping both cross-sectionally and longitudinally. The overall number of coping styles adopted by an individual predicted greater psychopathology. Mediation analysis suggests that a mild positive relationship between adaptive and certain maladaptive styles (emotional suppression) partially accounts for the attenuated relationship between adaptive coping and depressive symptoms. Limitations Results should be replicated in a clinical population. Conclusions Results suggest that maladaptive and adaptive coping styles are not reciprocal. Reducing maladaptive coping seems to be more important for outcome than enhancing adaptive coping. The study supports transdiagnostic approaches advocating that maladaptive coping is a common factor across different psychopathologies.

eHealth programs have been found to be effective in treating many psychological conditions. Regarding Borderline Personality Disorder (BPD), few programs have been tested, nevertheless, results are promising. The therapeutic alliance is an important factor predicting treatment outcome in BPD. However, we do not know yet to what extent BPD patients form a therapeutic alliance with an eHealth tool and how this relationship differs from the relationship with their human therapist. This study aims to address this question using priovi, an interactive schema therapy-based eHealth tool for BPD. Semi-structured interviews were conducted to explore how patients perceived the therapeutic alliance with priovi and its differences compared to the alliance with their human therapist (N = 9). Interview data were analyzed following the procedures of qualitative content analysis. Additionally, the Working Alliance Inventory (WAI-SR) was administered in two versions (regarding the human therapist and priovi, N = 16) every three months during the treatment phase of one year. Results indicate that patients were able to form a good therapeutic relationship with priovi, but it differed from the relationship to their human therapist. Important categories were &ldquo, priovi is helpful, supportive and always there&rdquo, and &ldquo, priovi is less flexible&rdquo, WAI ratings for the task subscale were high in both relationships but significantly higher in WAItherapist compared to WAIpriovi in two measurements (nine-months measurement: t = 2.76, df = 15, p = 0.015, twelve-months measurement: t = 3.44, df = 15, p = 0.004). These results indicate that BPD patients can form a functioning alliance with an eHealth program and that eHealth programs may be especially useful for psychoeducation and cognitive exercises.

Background: Evidence on the long-term efficacy of psychotherapeutic approaches for chronic depression is scarce. Objective: To evaluate the effects of the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) compared to Supportive Psychotherapy (SP) 1 year and 2 years after treatment termination. Methods: In this study, we present 1- and 2-year follow-up assessments of a prospective, multicenter, evaluator-blinded, randomized clinical trial of outpatients with early-onset chronic major depression (n = 268). The initial treatment included 32 sessions of CBASP or SP over 48 weeks. The primary outcome was the rate of “well weeks” (Longitudinal Interval Follow-Up Evaluation; no/minimal symptoms) after 1 year and 2 years. The secondary outcomes were, among others, clinician- and self-rated depressive symptoms, response/remission rates, and quality of life. Results: Of the 268 randomized patients, 207 (77%) participated in the follow-up. In the intention-to-treat analysis, there was no statistically significant difference between CBASP and SP patients in experiencing well weeks (CBASP: mean [SD] of 48.6 [36.9] weeks; SP: 39.0 [34.8]; rate ratio 1.26, 95% CI 0.99–1.59, p = 0.057, d = 0.18) and in remission rates (CBASP: 1 year 40%, 2 years 40.2%; SP: 1 year 28.9%, 2 years 33%) in the 2 years after treatment. Statistically significant effects were found in favor of CBASP 1 year after treatment termination regarding the rate of well weeks, self-rated depressive symptoms, and depression-related quality of life. Conclusions: CBASP lost its superiority over SP at some point between the first and the second year. This suggests the necessity of maintenance treatment for early-onset chronically depressed patients remitted with CBASP during the acute therapy phase, as well as the sequential integration of other treatment strategies, including medication for those who did not reach remission.

The internet-based intervention Deprexis® has proven to be effective in improving overall depression severity. The current pragmatic randomized controlled trial included 1013 participants with mild to moderate symptomatology and aimed to identify the symptom-specific effects of the internet-based intervention Deprexis (intervention group) in comparison to care as usual (control group). All participants -in both conditions- were permitted to use any type of treatment. Of the nine considered symptoms (assessed with the Patient Health Questionnaire), seven showed larger improvements in the intervention condition relative to care as usual (effect sizes ranging from 0.15 to 0.31). No significant differences were found for the two other symptoms. In a next step, a network was estimated including treatment condition as well as changes in all nine symptoms. The resulting network suggests that four of the seven identified symptom-specific effects were direct, whereas the three other symptom-specific effects were indirect and could be explained by effects on other symptoms. Lastly, exploratory analyses showed that the intervention was more effective in improving overall depression severity for participants with higher scores on those four symptoms that were directly affected by the intervention; consequently, the network estimation techniques showed potential in precision psychiatry.

ZusammenfassungNur etwa die Hälfte derjenigen, die an einer depressiven Störung leiden, sucht auch eine Behandlung auf. Selbstmanagement Interventionen sind eine Möglichkeit, diese Behandlungslücke zu reduzieren. Diese Interventionen basieren meist auf evidenzbasierten Techniken der Kognitiven Verhaltenstherapie, welche statt durch einen Therapeuten durch ein Computerprogramm vermittelt werden. Zahlreiche Studien belegen die Wirksamkeit dieser Interventionen. Diese Studien werfen allerdings auch eine Reihe an Fragen auf. Diese betreffen die Wirksamkeit sowohl im Fremdrating als auch im Langzeitverlauf und die Wirksamkeit bei schwerer depressiver Symptomatik oder in der Kombination mit antidepressiver Medikation. Schließlich stellt sich die Frage nach dem Einsatz dieser Interventionen bei Patienten in der klinischen Praxis und bei Menschen, die nicht besonders internetaffin sind. Diese Fragen haben wir im Rahmen einer großen randomisiertenStudie adressiert (EVIDENT-Studie). In dieser Studie wurde die Wirksamkeit Intervention deprexis® untersucht. Die Ergebnisse dieser Studie werden in dieser Übersicht zusammengefasst und in den Kontext anderer in Deutschland verfügbarer Interventionen gestellt.