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Background: Nonadherence to homework assignments is a frequent problem among patients with depression during cognitive-behavioral therapy (CBT). The present study investigated the effects of two additional treatment components of CBT: a placebo and SMS (short message service) reminders. These components aimed at improving homework compliance (the practicing of a daily relaxation exercise at home) during a four-week outpatient program. Subjects and Methods: Eighty-six patients diagnosed with major depressive disorder were randomly assigned to one of three groups: ‘Coping with Depression’ course (treatment as usual; TAU group), ‘Coping with Depression’ course with additional daily placebo treatment (PLA group), or ‘Coping with Depression’ course with additional daily SMS reminders (SMS group). The placebo (sunflower oil) was introduced as a natural medicine to mobilize the body’s natural healing powers. SMS messages were sent out once a day to remind the patients of their homework. Results: The placebo group showed better homework compliance than the two other groups with improved quantity and quality of relaxation exercises. The SMS group practiced more often than TAU but did not differ in homework quality (relaxation level) from TAU. All groups showed a significant reduction of depression symptoms at the end of the course with the most pronounced reduction in the PLA group. Conclusions: The results suggest that placebo treatment is more effective than SMS reminders to support relaxation training in patients with depression. Additionally, the placebo was associated with a larger reduction of depression symptoms., Mediterranean Journal of Clinical Psychology, Vol 10, No 3 (2022)

In der kognitiven Verhaltenstherapie (CBT) bei Depressionen kann die Hausaufgaben-Compliance eine der größten Herausforderungen darstellen. In fünf Studien wurde in dieser Dissertation die Wirksamkeit verschiedener Placebobehandlungen zur Verbesserung der Hausaufgaben-Compliance und zur Verringerung von Depressionssymptomen vor, während und nach der CBT untersucht. In Studie I verbesserte ein Placebo (wirkungsloses Mittel, mit der Suggestion PatientInnen zu helfen, sich auf ihre inneren Stärken zu konzentrieren und die natürlichen Heilkräfte ihres Körpers zu mobilisieren) die Quantität und Qualität der Hausaufgaben und verringerte die Depressionssymptome. In einer Folgestudie (Studie II) konnte gezeigt werden, dass die Placebo-Gruppe drei Monate nach der Therapie noch immer weniger Depressionssymptome zeigte und das Entspannungstraining häufiger nutzte als die Nicht-Placebo-Gruppe. In Studie III wurde die Wirksamkeit des Placebos mit der Wirksamkeit von SMS-Erinnerungen verglichen: Placebo-EmpfängerInnen praktizierten das Entspannungstraining häufiger und berichteten von einem höheren Entspannungsgrad nach dem Entspannungstraining im Vergleich zu den Empfängern von SMS-Erinnerungen. In Studie IV zeigten die Open-Label-Placebo-EmpfängerInnen eine stärkere Verringerung der Depressionssymptome im Vergleich zu Nicht-Placebo-EmpfängerInnen und eine verbesserte Quantität der Hausaufgaben, wobei die Qualität der Hausaufgaben nicht verbessert wurde. In Studie V reduzierte eine Placebo-Behandlung die Depressionssymptome und erhöhte das allgemeine Wohlbefinden bei Placebo-EmpfängerInnen im Vergleich zu Nicht-Placebo-EmpfängerInnen während der Wartezeit für CBT. Die Ergebnisse deuten darauf hin, dass Placebos verwendet werden können, um CBT-Effekte bei PatientInnen mit Depressionen zu verstärken und effektiver als SMS-Erinnerungen die Compliance bei therapeutischen Hausaufgaben unterstützen. Darüber hinaus zeigten sich langfristige Placeboeffekte, welche auch nach der Nachbesprechung vorhanden waren. In cognitive-behavioral therapy (CBT) for depression, homework compliance can be one of the biggest challenges. In five studies, this dissertation focused on placebo effects on homework compliance (with relaxation training) and depression symptoms before, during, and after CBT for adult outpatients with depression. The effectiveness of different adjunctive treatments (providing daily deceptive placebos, open-label placebos, and SMS reminders) to improve homework compliance and reduce depression symptoms was examined. Furthermore, long-term placebo effects on homework compliance and placebo effects on depression symptoms during the waiting period for CBT were investigated. In study I, a deceptive placebo (‘a natural medicine to help the patients focus on their inner strengths and mobilize their bodies’ natural healing powers’) improved homework quantity and quality and decreased depressive symptoms. In a follow-up study (study II), it was demonstrated that three months after the therapy, the placebo group still had a lower level of depression and used relaxation training more often than the no-placebo group. In study III, placebo recipients practiced relaxation training more often and reported a higher relaxation level compared to SMS reminder recipients. In study IV, the open-label placebo recipients showed a greater reduction in depression symptoms compared to no-placebo recipients and improved homework quantity but not homework quality. In study V, a deceptive placebo reduced depression symptoms and increased overall well-being during the waiting period for CBT. The results suggest that placebos can be used to leverage CBT effects in patients with depression and are more effective than SMS reminders to support therapeutic homework. Moreover, the effects of ‘deceptive placebos’ are present even after the debriefing. Arbeit an der Bibliothek noch nicht eingelangt - Daten nicht geprüft Abweichender Titel laut Übersetzung des Verfassers/der Verfasserin Dissertation Karl-Franzens-Universität Graz 2022

Introduction: A previous study revealed that patients with depression who received a combination of cognitive-behavioral therapy (CBT) and placebo treatment (CBT+placebo) showed greater symptom reduction than a CBT group without a placebo. Moreover, the CBT+placebo group practiced relaxation training more frequently. We conducted a 3-month follow-up assessment to investigate the temporal stability of the placebo effects. Methods: Eighty-two outpatients with a diagnosis of major depressive disorder who had participated in a 4-week CBT course (CBT: n = 40; CBT with daily placebo treatment: n = 42) returned to a 3-month follow-up assessment. The participants of the CBT+placebo group had been debriefed directly after the course. Results: Compared to the CBT group, the CBT+placebo group had lower scores on the Beck Depression Inventory-II (BDI-II) at follow-up and more participants were below the clinical cut-off score of the BDI-II. Additionally, the CBT+placebo group continued to practice relaxation more frequently. Discussion: This study demonstrates that placebo effects are not short-lived and continue to be present after the debriefing. Version of record

Zanimanje za kvaliteten test, ki meri čustveno inteligentnost je veliko. Namen pričujoče magistrske naloge je bil preveriti psihometrične značilnosti dveh novonastalih mer čustvene inteligentnosti kot sposobnosti, to sta Situacijski test razumevanja čustev (STEU) in Situacijski test uravnavanja čustev (STEM). Preverjali smo ustreznost parametrov nalog, zanesljivost testov, strukturo testov in konstruktno veljavnost testov. V ta namen smo izvedli preliminarno raziskavo, fokusno skupino in glavno raziskavo. V glavni raziskavi je sodelovalo 541 študentov (93,9 % žensk in 5,2 % moških) študijskih programov razredni pouk in predšolska vzgoja. Ob testih STEU in STEM smo uporabili še mero kristalizirane sposobnosti, alternativno mero prepoznavanja čustev, osebnostni vprašalnik, podatek o povprečni študijski oceni in za zagotavljanje triangulacije še oceno mentorja o čustveni sposobnosti študenta. Rezultati niso potrdili zanesljivosti in veljavnosti testov STEU in STEM. Problematični so bili predvsem koeficienti diskriminativnosti, zelo šibke korelacije, nizki koeficienti notranje skladnosti in neprimerna delitev strukture testov na več podlestvic. Po drugi strani pa so rezultati pokazali ustrezne indekse težavnosti nalog in nakazali povezanost s kristalizirano inteligentnostjo. Ugotovitve torej kažejo, da testa nista ustrezni meri razumevanja in uravnavanja čustev in da je za oblikovanje mere čustvene inteligentnosti kot sposobnosti potreben celosten in kompleksen pristop. The interest for a quality test which measures emotional intelligence is high. The aim of this master’s thesis was to examine the psychometric characteristics of two new measures of emotional intelligence as a mental ability namely, the Situational test of emotional understanding (STEU) and the Situational test of emotion management (STEM). Specifically, we examined the adequacy of item parameters, the test reliability, the test structure and the construct validity of the tests. For this purpose, we conducted a preliminary study, a focus group and the main study. 541 students (93,9 % females and 5,2 % males) from Elementary Education and Pre-school Education study programs participated in the main study. In addition to the STEU and the STEM test, we used a measure of crystallized ability, an alternative measure of emotion recognition, a personality questionnaire, grade point average and the mentors grading of emotional ability of students to provide triangulation. The results did not confirm the reliability and validity of the STEU and STEM tests. Problems arose with discrimination coefficients, very weak correlations, low coefficients of internal consistency and the inadequate test structure division into several subscales. However, the results showed appropriate indices of tasks difficulty and indicated a relationship with crystallized intelligence. Our finding therefore show that the two tests are not an appropriate measure of emotion understanding and management and that the creation of a measure for emotional intelligence as a mental ability requires a holistic and complex approach.