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This article summarizes four studies of process and outcome research on family outreach therapy (ATF) with multi-problem families (MPF). We examined the relationship between different "patterns of of collaboration" and outcome variables in the treatment of MPF. Furthermore, we examined the relationship between childhood adversity factors and protective factors for the development of child psychiatric symptoms, and evaluated catamnesis data (follow-up 3 years). The paper summarizes four naturalistic studies of pre and post values and follow-up data in children aged 4-18 years, participating in an integrative, structural family therapy with (X = 115 sessions in 28.8 months, SD = 19.2). The data n = 1,031 show large effect sizes (ES) (d) (thirteen parameters, mean = 1.04, range 0.34 - 2.18). The outcome values correlate most strongly with the pattern "Improving Alliance", i. e. the improvement of the working alliance in the pre-post comparison (d = 0.64). Empirical studies on childhood adversity and protective factors showed significantly higher stress factors and significantly fewer protective factors in children from MPF compared to the non-clinical sample (95.7 % of children from MPF had a psychopathological diagnosis). The follow-up data showed stable treatment effects (three years of follow-up).The empirical research on the treatment of MPF requires further empirical studies in the sense of the treatment aptitude research on the question "what works for whom?".Zusammenfassung Dieser Artikel fasst vier empirische Studien der Prozess- und Ergebnisforschung zur Aufsuchenden Familientherapie (ATF) mit Multiproblem-Familien (MPF) zusammen. Wir untersuchten den Zusammenhang zwischen unterschiedlichen Mustern „pattern of collaboration“ (Zusammenarbeit der Familien mit denTherapeuten) und Outcomevariablen in der Behandlung der MPF. DesWeiteren erfassten wir Daten über den Zusammenhang von Kindheitsbelastungsfaktoren und Protektivfaktoren für die Entwicklung kinderpsychiatrischer Symptome und werteten Katamnesedaten (follow-up 3 Jahre) aus. Die Publikation fasst vier naturalistische Studien der Vorher- und Nachhermesswerte und Follow-up Daten bei Kindern im Alter von 4-18 Jahren zusammen, die an einer integrativen, strukturellen Familientherapie mit (X = 115 Sitzungen in 28,8Monaten, SD = 19,2). Die Daten n = 1.031 zeigen große Effektstärken (ES) (d) (dreizehn Parameter, Mittelwert = 1,04, Bereich 0,34-2,18). Die Outcome- Werte korrelieren am stärksten mit dem Muster „Improving Alliance“, das heißt der Verbesserung des Arbeitsbündnisses im Prä-Post-Vergleich (d = 0,64). Die empirische Untersuchung zu Belastungs- und Protektivfaktoren, zeigten signifikant höhere Belastungsfaktoren und signifikant weniger Protektivfaktoren von Kindern aus MPF im Vergleich zur nichtklinischen Stichprobe (95,7 % der Kinder aus MPF hatten eine psycho-pathologische Diagnose). Die Katamnesedaten weisen stabile Behandlungseffekte (drei Jahre Follow-up) nach. Die empirische Forschung zur Behandlung von MPF erfordert weitere empirische Studien im Sinne der „treatment aptitude“-Forschung, um die Frage „what works for whom?“ besser beantworten zu können.

OBJECTIVE: Home-based treatment of families with low socio-economic status and multiple psychosocial problems (multi-problem families, MPFs) is gaining importance in clinical social epidemiology and health services research. The sustainability of the treatment is of special importance in order to breach transgenerational effects. METHODS: We examined outcome, effect size, and clinical significance of home-based treatment for 84 multi-problem families in a naturalistic setting. 48 of the families were available for a follow-up after 3 years. The baseline characteristics of these family systems included low collaboration, an increased family adversity index, minors with high rates of child psychiatric disorders, a high prevalence of comorbidity, low relational family functioning, and adolescents who refused any form of treatment or had unilaterally terminated different forms of treatment before. The home-based family therapy consisted of one or two face-to-face counseling sessions per week over an average of 28.8 months (SD = 19.2). The symptoms and competence of the adolescents, the caregivers, and the family structure were assessed with 13 variables. RESULTS: All variables showed significant improvement rates (pre- vs. post- treatment) with medium to high effect sizes (mean of Cohen’s d = 1.04, range = .34 – 2.18). All variables showed a sustained or even further improvement at follow-up. CONCLUSION: This study provides evidence of statistically (p), practically (d), and clinically (RCI) significant changes in symptom and competence-related variables among adolescents and caregivers in MPFs with sustainable long-term effects in the 3-year follow-up period.

Eine inzwischen sehr umfassende Tradition in der Psychotherapieforschung und zahlreiche Meta-Analysen beschaftigen sich mit der Frage, welche Wirkfaktoren die Wirkung von Psychotherapie ausmachen. Etwas technischer formuliert: Welche Faktoren erklaren wieviel Prozent der Outcome-Varianz? Unterschiedliche Autoren klassifizieren die in einzelnen Studien identifizierten Faktoren durchaus unterschiedlich (s. z.B. Wampold et al. 2018; Wampold 2015; Duncan et al. 2010). Einer Darstellung von Lambert (2013) folgend lassen sich ca. 30% der Outcome-Varianz auf allgemeine (d.h. technikunabhangige) Faktoren wie die therapeutische Beziehung, die Ubereinstimmung zwischen Therapeut und Klient hinsichtlich Zielen und Vorgehensweisen, Einsicht und Problemverstandnis des Klienten oder Erwartungseffekte zuruckfuhren. 20% sollten auf Therapeuteneffekte zuruckgehen (gelingt es ihm z.B., die Zusammenarbeit, die Selbstwirksamkeit oder die Veranderungsmotivation des Klienten zu fordern?), 40% auf extratherapeutische Faktoren (z.B. das soziale Umfeld des Klienten) und nur 10% auf Behandlungstechniken.

CONTEXT: Families with high rates of childhood adversities (CAs) (Multi-problem-families-MPF) have an increasing importance in public health-policy. OBJECTIVE: The present study addresses the relationship between risk- and protective factors and the severity and treatment-outcome of mental disorders. SETTING: Family-therapeutic home-based treatment for MPF. We examined a clinical sample (N = 1031) of children between the age of 4 to 17, and a non-clinical sample of 148 children. We hypothesized that of all children of the clinical group have a predominance of risk factors and a higher number of psychopathological symptoms. Furthermore, we hypothesized that children with a predominance of protective factors benefit stronger from psychotherapy. MAIN RESULTS: In the clinical sample, most children met the criteria of a psychopathological diagnosis (95.7%, as compared to 21.6% in the non-clinical sample) and showed significant higher rates of childhood adversities and significant less protective factors as compared to the non-clinical sample. The clinical group showed a significant reduction of psychopathological symptoms and benefitted equally well from treatment. The number of risk factors was a significant predictor for a child from the non-clinical sample to meet the criteria of a psychopathological diagnosis, while the number of protective factors significantly predicted the absence thereof. CONCLUSION: Children and adolescents with high scores of CAs show significant associations with child psychiatric symptoms (d = 0.35; including all ICD-diagnosis such as e.g. Asperger-Syndrome, ADHD etc. with a higher rate of genetic etiology). Early life stressors however do not trigger an irreversible fate, as psychotherapy with young people with high numbers of risk factors does help to reduce psychopathological symptoms significantly (range of 5 outcome parameters: d = 0.31 – 0.72).

Families with a low socioeconomic status play an increasingly significant role in health services, research and social policy. The present outcome research study is a pre/post naturalistic study of home-based therapeutic work with multi-problem families (MPF), as conducted by Therapeutisch Ambulante Familenbetreung, an integrative family therapy with a structure-related, mentalization-based, psychoanalytic orientation. With a mean treatment duration of 75.7 weeks, 379 families showed significant psychological improvement on 10 scales concerning patient-therapist collaboration, treatment expectancy and psycho-social outcome measures with a medium to large effect size for all parameters (range: .35-1.49). About two-thirds of the sample improved by two SD on individually set treatment goals, further supporting the clinical significance of the therapeutic effect of home-based family treatment. Improvements in goal-directed collaboration and treatment expectancy are shown to be related to clinical improvement. Structural family therapy interventions for families with multiple problems thus benefit from individually setting goals and improving their self-efficacy and problem-solving by means of improved treatment expectancy.

Objective: Apart from increased somatic morbidity, extreme obesity causes grave psychosocial and psychopathological problems. We examined a sample of 50 extremely adipose women (BMI < 40kg/m2) from 2000 to 2003 to find out whether surgical reduction of stomach volume leads to lasting change in Body Mass Index (BMI), psychosocial symptoms, and health related quality of life. We found that positive changes in BMI reduction, psychosocial symptoms, and health related quality of life could be expected three years after gastric banding ( Int. J Psychiatry Med 2005;35:109–122). During the following three years, we continued to observe these patients to determine long-term effects. Method: Fifty adipose women who had taken part in the first study from 2004 to 2006 were surveyed. Annual primary outcome measures were BMI, self-reported changes on the scales of the Three-Factor Eating Questionnaire (TFEQ), Hospital Anxiety and Depression Scale (HADS-D), and Health Survey (SF-36). Results: At the 6-year mark, significant changes in BMI ( p < 0.01), significantly increased employment (0.012) and the existence of a partnership ( p < 0.01), plus significant changes on all three scales of the TFEQ ( p < 0.01), on both scales of the HADS-D (anxiety: p < 0.05; depression: p < 0.011), and all scales of the SF-36 Health Survey (all p < 0.01) were observed. Conclusions: The positive changes in BMI reduction, i.e., increased employment and subjects living in a partnership, improvement in eating behavior, reduction in anxiety and depressive symptoms, and improvement in health related quality of life were also confirmed as remaining stable over a 3-year observation period, i.e., for a total of six years.

Background: All therapists direct their attention in some manner during psychotherapy. A special form of directing attention, ‘mindfulness’, is recommended. This study aimed to examine whether, and to what extent, promoting mindfulness in psychotherapists in training (PiT) influences the treatment results of their patients. Methods: The therapeutic course and treatment results of 124 inpatients, who were treated for 9 weeks by 18 PiTs, were compared. The PiTs were randomly assigned to 1 of 2 groups: (i) those practicing Zen meditation (MED; n = 9 or (ii) control group, which did not perform meditation (noMED; n = 9). The results of treatment (according to the intent-to-treat principle) were examined using the Session Questionnaire for General and Differen-tial Individual Psychotherapy (STEP), the Questionnaire of Changes in Experience and Behavior (VEV) and the Symptom Checklist (SCL-90-R). Results: Compared to the noMED group (n = 61), the patients of PiTs from the MED group (n = 63) had significantly higher evaluations (according to the intent-to-treat principle) for individual therapy on 2 STEP scales, clarification and problem-solving perspectives. Their evaluations were also significantly higher for the entire therapeutic result on the VEV. Furthermore, the MED group showed greater symptom reduction than the noMED group on the Global Severity Index and 8 SCL-90-R scales, including Somatization, Insecurity in Social Contact, Obsessiveness, Anxiety, Anger/Hostility, Phobic Anxiety, Paranoid Thinking and Psychoticism. Conclusions: This study indicates that promoting mindfulness in PiTs could positively influence the therapeutic course and treatment results in their patients.

BackgroundOverworking is one of the most frequent stressors. The purpose of this study was to determine the effectiveness of behavioural/psycho-educational group training in men who are chronically stressed from overworking.MethodOf 72 male subjects, 36 were randomly assigned to training for 8 weeks and another 36 formed the control group, which received a placebo intervention. Primary outcome measures were systolic blood pressure, salivary cortisol concentration upon awakening, and self-reported changes on the scales of the Trier Inventory for the Assessment of Chronic Stress (TICS), the State-Trait Anger Expression Inventory (STAXI) and the 36-item Short Form Health Survey (SF-36).ResultsA significant reduction in mean values was observed in daily systolic blood pressure and salivary cortisol concentration on all the TICS and most of the STAXI and SF-36 scales.ConclusionsBehavioural/psycho-educational group training appears to be effective in the treatment of men suffering from chronic stress due to overworking.

Suicide attempts by adolescents continue to be a major public health problem. The purpose of this study was to examine the difference in the family functioning and sociopsychopathological risk factor relationship between female bulimic adolescents with suicidal ideation only, and those who attempted suicide. A group of 211 patients were observed for 12 months. Data from 63 subjects (SUG [suicide group], age 17.2 +/- 1.3 years) who had attempted suicide were then compared with 148 (control group, age 18.1 +/- 1.5 years) who had expressed suicidal ideation but did not follow through. Those in the suicide attempt group had been exposed more frequently to physical/sexual violence in childhood. As adults they either lived alone or were dissatisfied with their partnership. The frequency of borderline personality disorders and depressive disorders in this group was significant. Psychosomatic symptoms, disturbed coenesthesia, substance abuse, social impairment and interference with their perception of their own life circumstances, as well as their job performance, often preceded the suicide attempt. Nine genuine risk factors that occurred significantly more often in the SUG were calculated out of all the stress factors using stepwise logistic regression: 'as a child I was even hit with a stick or whip', 'I had no set orientation in life', 'I had a feeling of loneliness despite family and friends', 'I could not relax', 'incapable of dealing with the public', 'I do not like to be touched', 'parents have psychiatric disorders', 'misuse of stimulants', and 'as a child I felt lonely' (odds ratio, 10.56-1.90). Adverse family experiences and multiple sociopsychopathological factors may increase the risk of suicide in female bulimic adolescents. Language: en

Psychosomatic rehabilitation and the concluding social-medical assessment constitute a particular challenge. The aim of this study was to examine whether inpatient psychosomatic rehabilitation in the context of an integrated treatment concept, conducted in Turkish and German, is effective in the rehabilitation of Turkish migrant laborers, and what concluding socio-medical assessment results from this treatment. 195 Turkish patients--44 male and 151 female--received inpatient psychosomatic treatment for approximately 40 days. Sociodemographic, psychiatric and social-medical data were recorded, as well as Symptom Checklist (SCL-90-R) testing upon admission and discharge. A predominant number of patients were laborers, with a low level of primary education, who were afflicted with psychosocial problems and dissatisfaction with their workplace and who first came into psychosomatic treatment many years following the onset of their illness. Many of them had a clearly defined desire to retire. At the end of their admission, a significant improvement in almost all the scales of the SCL-R-90 was ascertained on the one hand, but on the other, adequate socio-medical results were hardly observed. The symptoms' improvement would confirm that the combination of service offerings in Turkish and German proved themselves. A portion of the patients (approx. 40 %) were classified subsequent to treatment as capable of working for 6 hours or more. Nevertheless, approximately approx. 75 % still sought to retire. Timely psychosomatic treatment could counteract chronification of the illness and the establishment of a steadfast desire to enter retirement, and consequently represent an improvement in the prognosis. Likewise, consistent psychosomatic training of physicians, as well as systematic prophylactic measures with the migrant laborers, should be considered.

Borderline personality disorder is a common and severe psychiatric illness. The goal of this study was to determine whether topiramate can influence patients' borderline psychopathology, health-related quality of life, and interpersonal problems. Women meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Structured Clinical Interview II criteria for borderline personality disorder were randomly assigned in a 1:1 ratio to topiramate titrated from 25 to 200 mg/d (n = 28) or placebo (n = 28) for 10 weeks. Primary outcome measures were changes on the Symptom-Checklist, on the SF-36 Health Survey, and on the Inventory of Interpersonal Problems. Body weight and additional side effects were assessed weekly. According to the intent-to-treat principle, significant changes (all P < 0.001) on the somatization, interpersonal sensitivity, anxiety, hostility, phobic anxiety, and Global Severity Index scales of the Symptom Checklist were observed in the topiramate-treated subjects after 10 weeks (no significant changes on the obsessive-compulsive, depression, paranoid ideation, and psychoticism scales). In the SF-36 Health Survey, significant differences were observed on all 8 scales (all P < 0.01 or P < 0.001). In the Inventory of Interpersonal Problems, significant differences (all P < 0.001) were found in the scales for overly autocratic, overly competitive, overly introverted, and overly expressive (no significant differences in the scales for overly cold, overly subassertive/subservient, overly exploitable/compliant, and overly nurturant/friendly). Weight loss was additionally observed (p < 0.001). Topiramate appears to be a safe and effective agent in the treatment in women with borderline personality disorder. Additional weight loss can be expected.

Background: Asthma is a serious medical problem in pregnancy and is often associated with stress, anger and poor quality of life.The aim of this study was to determine the efficacy of progressive muscle relaxation (PMR) on change in blood pressure, lung parameters, heart rate, anger and health-related quality of life in pregnant women with bronchial asthma. Methods: We treated a sample of 64 pregnant women with bronchial asthma from the local population in an 8-week randomized, prospective, controlled trial. Thirty-two were selected for PMR, and 32 received a placebo intervention. The systolic blood pressure, forced expiratory volume in the first second, peak expiratory flow and heart rate were tested, and the State-Trait Anger Expression Inventory and Health Survey (SF-36) were employed. Results: According to the intend-to-treat principle, a significant reduction in systolic blood pressure and a significant increase in both forced expiratory volume in the first second and peak expiratory flow were observed after PMR. The heart rate showed a significant increase in the coefficient of variation, root mean square of successive differences and high frequency ranges, in addition to a significant reduction in low and middle frequency ranges. A significant reduction on three of five State-Trait Anger Expression Inventory scales, and a significant increase on seven of eight SF-36 scales were observed. Conclusions: PMR appears to be an effective method to improve blood pressure, lung parameters and heart rate, and to decrease anger levels, thus enhancing health-related quality of life in pregnant women with bronchial asthma.

Whether the treatment results in inpatient psychotherapy are significantly influenced by the patient's motivation is a subject of discussion. The goal of this study was to assess whether the primary motivation for therapy in depressive women influences the results of psychotherapeutic treatment. In a prospective study, the monitored results from 64 female inpatients (32 who were highly motivated to enter therapy, and 32 who were minimally motivated) were compared to each other. The period of observation was six weeks. As instruments of assessment, the Fragebogen zur Therapiemotivation (FMP) (Questonnaire on Motivation for Entering Therapy) and the Beck Depression Inventory (BDI) were aministered upon admission; after the fourth and sixth weeks of therapy, the Veranderungsfragebogen des Erlebens und Verhaltens (VEV) (Questionnaire of Changes in Experience and Behavior) was administered as well. All patients who had applied for a pension were found in the group of less motivated patients and consolidated into a subgroup. The analysis was carried out according to the intent-to-treat principle. The variance analysis for the repeat measurements showed significant differences on all the FMP scales and on the BDI (all P< 0.001). The measurements with VEV likewise resulted in a significant difference (P< 0.01). The subgroup of "pension patients" showed significantly less change in all three of the above measurements. Patients with depressive symptomology who essentially are relatively highly motivated for therapy could profit significantly more from inpatient psychosomatic treatment than those who are less motivated. Establishing and developing motivation prior to inpatient hospitalization could possibly contribute to more efficient and cost-effective clinical treatment. Where legal proceedings pertaining to a pension are pending, relatively less motivated patients fare significantly worse not only in their motivational development for therapy, but also in their final treatment results. It should be noted, however, that the relatively small random sample, the restricted blinding, which was only partially possible, could have led to possible distortions.

Social phobia is an anxiety disorder characterized by extreme fear and phobic avoidance of social and performance situations and by a relatively poor health-related quality of life. The goal of this study was to compare the efficacy of mirtazapine versus placebo in the treatment of patients with social phobia. In 2004, we conducted a randomized, double-blind, placebo-controlled study of mirtazapine in 66 female subjects from the general population meeting the criteria for social phobia. The subjects were randomly assigned in a 1:1 manner to mirtazapine (n = 33) or placebo (n = 33). The treatment lasted 10 weeks. Seven patients dropped out. Primary outcome measures were self-reported changes on the Social Phobia Inventory, Liebowitz Social Anxiety Scale, and Health Survey (SF-36). In comparison with the placebo group and according to the intent-to-treat principle, significant differences on the Social Phobia Inventory and Liebowitz Social Anxiety Scale scales (all P < 0.001), as well as on most (5 from 8) scales of SF-36 (all P < 0.001), were observed in the mirtazapine-treated subjects. All patients tolerated mirtazapine relatively well. Mirtazapine appears to be an effective agent in the treatment of social phobia in women and in the improvement of their health-related quality of life.

Objective The aim of this study was to examine whether bioenergetic exercises (BE) significantly influence the inpatient psychotherapeutic treatment results for Turkish immigrants with chronic somatoform disorders. Method In a 6-week randomized, prospective, controlled trial, we treated a sample of 128 Turkish patients: 64 were randomly assigned to BE and 64 participated in gymnastic exercises in lieu of BE. The Symptom Checklist (SCL-90-R) and State-Trait Anger Expression Inventory (STAXI) were employed. Results According to the intent-to-treat principle, the bioenergetic analysis group achieved significantly better treatment results on most of the SCL-90-R and STAXI scales. Conclusions BE appears to improve symptoms of somatization, social insecurity, depressiveness, anxiety, and hostility in the inpatient therapy of subjects with chronic somatoform disorders. Reduction of the anger level and reduction in directing anger inwards, with a simultaneous increase of spontaneous outward emotional expression, could be expected.

Objective: The aim of this study is to examine the efficacy of progressive muscle relaxation (PMR) on change in blood pressure, lung parameters and heart rate in female adolescent asthmatics. Method: In a prospective, randomized, double-blind, controlled study, adolescent female asthmatics (n=31) were tested to find out how the systolic blood pressure (SBP), forced expiratory volume in the first second (FEV1), peak expiratory flow (PEF) and heart rate change after PMR. The control group (CG; n=30) received a placebo intervention. Results: A significant reduction in SBP and a significant increase in the FEV1 and PEF were observed after PMR. The heart rate showed a significant increase in the coefficient of variation (CV), root-mean-square of successive differences (RMSSD) and at the high frequency (HF) range, in addition to a significant reduction at the low and middle frequency (LF and MF, respectively) ranges. Conclusion: PMR appears to be effective in improvement of blood pressure, lung parameter and heart rate in adolescent female asthmatics. D 2005 Elsevier Inc. All rights reserved.