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Psychotherapieforschung im Kindes- und Jugendalter Vom 18.-19. März 2010 fand in Berlin die „3. Wissenschaftliche Tagung für Psychotherapieforschung im Kindes- und Jugendalter“ statt. Ziel dieser Tagung war es, die vielfältigen Entwicklungen der Forschung zu psychotherapeutischen Themenfeldern bei Kindern und Jugendlichen übersichtlich zu bündeln und gleichzeitig einen Austausch zwischen entsprechend engagierten wissenschaftlichen Arbeitsgruppen zu ermöglichen. Im vorliegenden Heft haben wir einige Beiträge der Tagung zusammengestellt, die in methodischer und inhaltlicher Hinsicht ein breites Spektrum abdecken.

Treatment integrity (the degree to which a treatment is implemented as planned) represents a key concept in school-based intervention and is considered to be a link between use and effectiveness of...

The present paper makes the case for systematic assessment and evaluation in clinical practice. The purpose of systematic evaluation is to enhance client care and to improve the basis for drawing inferences about treatment and therapeutic change. Requirements of a methodology for clinical practice are outlined that begin with the priority of clinical care and patient improvement. Assessment, design, and data evaluation strategies as well as the processes they reflect in the context of clinical work are outlined. Ongoing assessment of client progress over the course of treatment is emphasized as the central feature of systematic evaluation. Implications of assessment for setting goals, specifying means, and making decisions to augment patient care are also presented and illustrated. Further work required to develop a methodology of clinical practice, common objections to systematic evaluation in clinical work, and professional issues that affect adoption of systematic evaluation are also presented.

It is remarkably difficult for people with obesity to maintain a new lower weight following weight loss. The aim of the present study was to examine the immediate and longer-term effects of a new cognitive behavioural treatment that was explicitly designed to minimise this post-treatment weight regain. One hundred and fifty female participants with obesity were randomized to the new treatment, behaviour therapy (the leading alternative psychological treatment) or guided self-help (a minimal intervention). Both of the main treatments resulted in an average weight loss of about ten percent of initial weight whereas weight loss was more modest with guided self-help. The participants were subsequently followed-up for three years post-treatment. The great majority regained almost all the weight that they had lost with the new treatment being no better than the behavioural treatment in preventing weight regain. These findings lend further support to the notion that obesity is resistant to psychological methods of treatment, if anything other than a short-term perspective is taken. It is suggested that it is ethically questionable to claim that psychological treatments for obesity “work” in the absence of data on their longer-term effects.

Objectives. We used a simulation model to analyze whether the Healthy People 2010 goal of reducing smoking prevalence from the current 19.8% rate to 12% by 2010 could be accomplished by increasing quit attempts, increasing the use of treatments, or increasing the effectiveness of treatment. Methods. We expanded on previous versions of the tobacco control simulation model SimSmoke to assess the effects of an increase in quit attempts, treatment use, and treatment effectiveness to reduce smoking prevalence. In the model, we considered increases in each of these parameters individually and in combination. Results. Individually, 100% increases in quit attempts, treatment use, and treatment effectiveness reduced the projected 2020 prevalence to 13.9%, 16.7%, and 15.9%, respectively. With a combined 100% increase in all components, the goal of a 12% adult smoking prevalence could be reached by 2012. Conclusions. If we are to come close to reaching Healthy People 2010 goals in the foreseeable future, we must not only induce quit attempts but also increase treatment use and effectiveness. Simulation models provide a useful tool for evaluating the potential to reach public health targets.

Blatt, Zuroff, Hawley, and Auerbach (2010) assert that psychotherapy research has adopted the implicit but fundamental assumption that “patients at the start of treatment are more alike than differ...

This study evaluates the efficacy of the Children of Divorce Intervention Program (CODIP), a preventive intervention based on social support and coping skills, for 4th-6th grade urban children of divorce. Structure and content of the 14 group sessions were tailored to the developmental level and sociocultural make-up of the target sample. Pre-post comparisons of demographically matched groups of 57 CODIP participants, 38 non-program divorce controls and 93 children from non-divorced families revealed improvements on parent, child and group leader measures of adjustment. Limitations of the study and directions for future research are discussed.

PART I - GENERAL ISSUES PART II - COGNITIVE-BEHAVIOURAL THERAPY PART III - FAMILY INTERVENTIONS PART IV - OTHER FORMS OF TREATMENT PART V - EPILOGUE

SummaryA recent meta-analysis concluded that newer antidepressant drugs are equivalent to or no better than placebos, a conclusion at some variance with their commonly judged clinical effectiveness. The ‘disconnect’ between randomised controlled trials and clinical practice would benefit from dissection of contributing factors, and redressing limitations to current trial procedures.

In 1952, Hans Eysenck published “The Effects of Psychotherapy: An Evaluation” in which he concluded that the effect of psychotherapy is no greater than that of spontaneous remission. In the present paper, we tested this conclusion using Eysenck's original panel of “untreated” patients. A probit analysis of rates of improvement by time of assessed improvement was conducted on these data, and results were compared to a probit analysis conducted on a panel of patients who had received psychotherapy. Treatment was associated with significantly higher rates of improvement when compared to the effects of spontaneous remission. In fact, 50% of psychotherapy patients were estimated to improve after 8 weeks, whereas only 2% of untreated patient were estimated to improve in this time. Probit analysis showed that the 50% improvement rate for Eysenck's spontaneous remission group occurred at a much later time than the 50% improvement rate for psychotherapy. According to his % improvement estimates, psychotherapy acco...

The present article critically analyzes the current approach to treatment outcome research and the uncritical use of treatment packages. Comparing various combinations of treatments with groups of clients randomly assigned to these conditions has led to the neglect of individual differences between persons falling into broad diagnostic categories. The inconclusive results of such studies say little about the efficacy of a particular treatment for an individual client and are also not very useful in helping clinicians to decide which specific treatment to use for a given client. Although treatment packages may be attractive and at times helpful to clinicians, their simplistic use is antithetical to the original and unique approach of behavior therapy and no substitute for treatment individualization. Using the example of agoraphobic problems we show how a conceptual understanding of the processes involved in a given clinical problem and the development of an integrative paradigmatic behavioral model may guide the researcher/clinician toward more effective treatment planning. Conceptually derived treatments can be individualized more easily and therefore take better account of individual differences between clients suffering from a seemingly similar problem. Treatment outcome studies should specifically compare the efficacy of matching particular types and constellations of dysfunctional processes with different procedures which specifically target those dysfunctions.

The objective of the study was to examine the efficacy of EMDR treatment for children with post-traumatic stress disorder (PTSD) compared with untreated children in a waiting list control group (WLC) participating in a randomized controlled superiority trial (RCT). Thirty-three 6-16-year-old children with a DSM-IV diagnosis of PTSD were randomly assigned to eight weekly EMDR sessions or the WLC group. The Posttraumatic Stress Symptom Scale for Children (PTSS-C scale) was used in interviews with children to evaluate their symptoms and outcome. Post-treatment scores of the EMDR group were significantly lower than the WLC indicating improvement in total PTSS-C scores, PTSD-related symptom scale, and the subscales re-experiencing and avoidance among subjects in the EMDR group, while untreated children improved in PTSD-non-related symptom scale. The improvement in re-experiencing symptoms proved to be the most significant between-group difference over time. The results of the present exploratory study including a limited number of children with PTSD are encouraging and warrant further controlled studies of larger samples of children suffering from PTSD.

Udgivelsesdato: 2007-null The aim of the present study was firstly to describe the characteristics of alcoholic outpatients (A) suffering from co-morbid personality disorder (PD) of either the cluster B (A+PDB) or cluster C (A+PDC) type. Secondly, to investigate the effect of various kinds of treatment to be able to single out the most beneficial therapy. Thirdly, to identify the most beneficial treatment. The patients were offered the following outpatient treatments: cognitive behaviour therapy, family therapy and supportive consultations. The material consisted of 363 patients who started psychosocial treatment at the outpatient alcohol clinic at Odense University Hospital, Denmark. It was possible to re-interview 276 (76%) patients 1 year after onset of treatment. Of the 363 patients, 87% were alcohol-dependent (ICD-10) and 34% fulfilled the ICD-10-R criteria for PDs. The basic interviews focused on the seven main areas of the Addiction Severity Index. A+PDC had significantly more serious medical problems than A-PD, while the A+PDB group had significantly more employment, drug use and social problems than the A-PD. As for psychiatric status, A-PD had significantly different scores compared with A+PDB and A+PDC. A+PDB were younger and had a longer history of alcohol abuse than A-PD and A+PDC. After treatment there was no significance between the patients with and without PD concerning alcohol outcome and psychosocial outcome. The significance of co-morbid PD for the prognosis of alcohol abusers may be overestimated. Our results indicate that A+PD can be treated as successfully as other patients in an outpatient alcohol clinic can.

Hypnotherapy is claimed to be effective in treatment of psychosomatic disorders. A meta-analysis was conducted with 21 randomized, controlled clinical studies to evaluate efficacy of hypnosis in psychosomatic disorders. Studies compared patients exclusively treated with hypnotherapy to untreated controls. Studies providing adjunctive standard medical care in either treatment condition were also admitted. Hypnotherapy was categorized into classic (n = 9), mixed form (n = 5), and modern (n = 3). Results showed the weighted mean effect size for 21 studies was d(+) = .61 (p = .0000). ANOVA revealed significant differences between classic, mixed, and modern hypnosis. Regression of outcome on treatment dose failed to show a significant relationship. Numerical values for correlation between suggestibility and outcome were only reported in three studies (mean r = .31). The meta-analysis clearly indicates hypnotherapy is highly effective in treatment of psychosomatic disorders.

This pilot study evaluated the use of contingency management (CM) procedures in combination with cognitive-behavioral therapy (CBT) for smoking cessation in adolescents. Twenty-eight treatment-seeking adolescent smokers participated in a 1-month, school-based smoking cessation program and were randomly assigned to receive either CM with weekly CBT or CBT alone. In the CM+CBT group, biochemical verification of abstinence was obtained twice daily during the first 2 weeks, followed by daily appointments during the 3rd week and once every other day during the 4th week. Participants were monetarily reinforced for abstinence on an escalating magnitude schedule with a reset contingency. At the end of 1 week and 1 month of treatment, abstinence verified using quantitative urine cotinine levels was higher in participants in the CM+CBT group (1 week: 76.7%; 1 month: 53.0%) when compared with the CBT-alone group (1 week: 7.2%; 4 weeks: 0%). These preliminary results provide a strong initial signal supporting the utility of CM techniques for smoking cessation in adolescents and demonstrate the feasibility of implementing such a program in a school setting.

More than half of people with severe mental illness are lonely, the subjective state associated with social isolation and lack of desired relationships. Their loneliness is related to impaired ability to make and keep friends, lack of opportunities to participate in social activities, and stigma associated with mental illness that creates barriers between them and their communities. Treatment for people with severe mental illness often fails to include social network interventions that have the potential to decrease loneliness. Knowledge of social network interventions-their characteristics, effectiveness, and applicability for specific patients-can guide nurses' use of these treatment modalities.

Differential responsiveness to intervention programs suggests the inadequacy of a single treatment approach for all children with autism. One method for reducing outcome variability is to identify participant characteristics associated with different outcomes for a specific intervention. In this investigation, an analysis of archival data yielded 2 distinct behavioral profiles for responders and nonresponders to a widely used behavioral intervention, pivotal response training (PRT). In a prospective study, these profiles were used to select 6 children (3 predicted responders and 3 predicted nonresponders) who received PRT. Children with pretreatment responder profiles evidenced positive changes on a range of outcome variables. Children with pretreatment nonresponder profiles did not exhibit improvements. These results offer promise for the development of individualized treatment protocols for children with autism.

Numerous types of treatments for pathological gambling have been described, but two of the most common are Gamblers Anonymous (GA) and cognitive-behavioral therapy. This paper describes some outcome data associated with the two approaches. It also reviews evidence suggesting that a combined intervention may enhance therapy engagement and reduce relapse rates.

Es wird eine Übersicht über die Entwicklung der Wirksamkeitsforschung im Bereich der psychoanalytisch begründeten Verfahren für die Kinder- und Jugendlichenpsychotherapie im deutschsprachigen und internationalen Bereich gegeben. Im Vergleich zu anderen Psychotherapieverfahren im Bereich der Kinder- und Jugendlichenpsychotherapie wird festgestellt, dass bei der analytischen Kinder- und Jugendlichenpsychotherapie ein Rückstand in der empirischen Forschung besteht. Gleichwohl belegen die vorhandenen Studien die Wirksamkeit analytischer Kinder und Jugendlichenpsychotherapie. Auch bilden die vorliegenden Katamnesen die Behandlungsrealität unter Versorgungsbedingungen naturalistisch gut ab. Es wird eine Zuordnung und Bewertung der einzelnen Studien nach den vom Wissenschaftlichen Beirat nach § 11 PsychThG festgelegten Anwendungsbereichen und Mindestanforderungen vorgenommen. Neuere Studien, die eine Kombination von Wartekontrollgruppendesign und naturalistischer Feldabbildung darstellen, stellen die Wirksamkeit von analytischer Kinder- und Jugendlichenpsychotherapie unter Versorgungsbedingungen fest. Die störungsspezifischen Studien zu depressiven, Angst- und Verhaltensstörungen (Horn et al. 2005; Kronmüller et al. 2005 und Winkelmann et al. 2005a, b) belegen einzig und erstmalig, kontrolliert und naturalistisch die Wirksamkeit analytischer Kinder- und Jugendlichenpsychotherapie in der ambulanten Versorgung in Deutschland. Schlagwörter: Wirksamkeitsforschung - Katamnesen - kontrolliert-naturalistische Studien - Anwendungsbereiche und Mindestanforderungen nach Wissenschaftlichem Beirat nach § 11 PsychThG - psychoanalytisch begründete Verfahren bei Kindern und Jugendlichen An overview is given of the development of efficacy research in the field of psychoanalytically justified procedures for psychotherapy for children and adolescents in German-speaking countries and internationally. It is ascertained that there exists a shortfall in the empirical research on analytical psychotherapy for children and adolescents in comparison with other psychotherapy processes in the field of psychotherapy for children and adolescents. The available studies nevertheless give evidence for the efficacy of analytical psychotherapy for children and adolescents. The available catamneses also give a good naturalistic portrayal of the reality of treatment under delivery conditions. An allocation and evaluation of the individual studies in accordance with the application areas and minimum requirements set by the Wissenschaftliche Beirat (scientific advisory board) according to § 11 PsychThG (Psychotherapeutengesetz = law for psychotherapy). More recent studies, which present a combination of waiting control group design and naturalistic field portrayal, establish the efficacy of analytical psychotherapy for children and adolescents under supply conditions. The disorder-specific studies on depressive, anxiety and behavioural disorders (Horn et al. 2005, Kronmüller et al. 2005 and Winkelmann et al. 2005) give the first and only controlled and naturalistic evidence of the efficacy of analytical psychotherapy for children and adolescents in outpatient care in Germany. Key words: efficacy research - catamneses - controlled naturalistic studies - areas of pplication and minimum requirements according to the scientific advisory board in accordance with § 11 PsychThG - psychoanalytical procedures with children and adolescents

Data are reported on drug use among cocaine-dependent homeless persons who participated in a clinical trial that compared day treatment only (DT, n = 69) with day treatment plus abstinent-contingent housing and work (DT+, n = 72). Drug use was measured with multiple weekly urine toxicologies. Compared with DT participants, more DT+ participants established abstinence, maintained abstinence for longer durations, were marginally significantly more likely to lapse, and significantly less likely to relapse. Of all participants who established abstinence and then relapsed, DT+ participants relapsed later and were more likely to reestablish abstinence. These analyses yield information on the processes involved in the manner in which drug use changes as a result of abstinent-contingent housing and work.

The discovery or disclosure of an extramarital affair can have a devastating impact on partners, both individually and on the relationships. Research suggests that affairs occur relatively frequently in relationships and are a common presenting problem in couple therapy. However; despite their prevalence, there is little empirical treatment research in this area, and most therapists describe this problem as one of the more difficult to treat. In this study, we used a replicated case-study design to explore the efficacy of an integrative treatment designed to help couples recover from an affair. Six couples entered and completed treatment. The majority of these couples were less emotionally or maritally distressed at the end of treatment, and the injured partners reported greater forgiveness regarding the affair. Details of the intervention, suggested adaptations of the treatment, and areas for future research are discussed.

This study evaluated the efficacy of a low-cost, prize reinforcement contingency management (CM) intervention for reducing cocaine use.Community-based treatment centers.Cocaine-abusing out-patients (n = 120) were assigned randomly to one of three 12-week conditions: standard treatment, standard treatment plus CM with an expected maximum of $80 of reinforcement or standard treatment plus CM with an expected maximum of $240 of reinforcement.In the CM conditions, patients earned the opportunity to win prizes for submitting negative urine samples and completing goal-related activities.Drug use was measured at intake and throughout a 3-month treatment period.Patients in the $240 CM condition achieved more abstinence than patients in the standard condition. Patients who initiated treatment with positive urinalysis results were most responsive to the CM intervention, with the $240 CM condition engendering the best effects in this subgroup. In contrast, patients who initiated treatment with negative urinalysis results generally remained abstinent during treatment, regardless of treatment assignment. On average, patients in the two CM conditions earned $36 and $68 in prizes.This study suggests that prize reinforcement CM may be suitable for community-based settings, and beneficial effects may be magnitude-dependent in more severe patients.

Zur Geschichte, wissenschaftlichen Fundierung und Anerkennung einer psychotherapeutischen Methode. Erweiterte und überarbeitete Fassung eines Vortrags auf der Internationalen Arbeitstagung des Deutschen Arbeitskreises für Konzentrative Bewegungstherapie(DAKBT) am 14.11.2002 in Berlin.