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Background: Childhood maltreatment is associated with the development and maintenance of mental disorders. The purpose of this naturalistic study was (a) to identify different patterns of childhood maltreatment, (b) to examine how these patterns are linked to the severity of mental disorders and (c) whether they are predictive of treatment outcome. Methods: 742 adult patients of a university hospital for psychotherapy and psychosomatics were assessed at intake and discharge by standardized questionnaires assessing depression (Beck Depression Inventory, BDI) and general mental distress (Symptom Check List-90-R, SCL-90-R). Traumatic childhood experience (using the Childhood Trauma Questionnaire, CTQ) and ICD-10 diagnoses were assessed at intake. Results: The patients could be allocated to three different patterns of early childhood trauma experience: mild traumatization, multiple traumatization without sexual abuse and multiple traumatization with sexual abuse. The three patterns showed highly significant differences in BDI, General Severity Index (GSI) and in the number of comorbidity at intake. For both BDI and GSI a general decrease in depression and general mental distress from intake to discharge could be shown. The three patterns differed in BDI and GSI at intake and discharge, indicating lowest values for mild traumatization and highest values for multiple traumatization with sexual abuse. Patients with multiple traumatization with sexual abuse showed the least favourable outcome. Conclusion: The results provide evidence that the severity of childhood traumatization is linked to the severity of mental disorders and also to the treatment outcome in inpatient psychotherapy. In the study, three different patterns of childhood traumatization (mild traumatization, multiple traumatization without sexual abuse, multiple traumatization with sexual abuse) showed differences in the severity of mental disorder and in the course of treatment within the same therapy setting.

Zusammenfassung Fragestellung: Untersucht wurde, ob sich das Selbstkonzept von Patienten mit sozialer Angststorung signifikant von dem der Allgemeinbevolkerung unterscheidet, inwiefern es sich durch Psychotherapie verandert und welcher Zusammenhang zwischen den Veranderungen von Selbstkonzept und sozialer Angst besteht. Methode: Bei N = 86 Patienten mit sozialer Angststorung wurde das Selbstkonzept mit den Frankfurter-Selbstkonzeptskalen (FSKN; Deusinger 1986) untersucht. Die Patienten wurden mit manualisierter kognitiver (CT) oder psychodynamischer (PDT) Kurzzeittherapie behandelt. Die Kernsymptomatik wurde mit der Liebowitz-Soziale-Angst-Skala (Stangier u.Heidenreich 2004) sowie dem Soziale-Phobie-und-Angst-Inventar (Fydrich 2002) vor und nach Therapie erfasst. Ergebnisse: Die Patienten wiesen auf allen Skalen der FSKN ein signifikant negativeres Selbstkonzept auf als die Normpopulation (alle p0.001). Ihr Selbstkonzept verbesserte sich signifikant durch die Kurzzeittherapie (alle p0.01), wobei sich kein...

Background Despite growing evidence for manualized psychodynamic treatments, there is a lack of studies on their transfer to routine practice. This is the first study to examine the effects of an additional training in manualized Short Term Psychodynamic Psychotherapy (STPP) on the outcome in routine psychotherapy for social anxiety disorder (SAD). The study is an extension to a large RCT comparing STPP to Cognitive-Behavioral Therapy of SAD. Methods The manualized treatment was designed for a time limited approach with 25 individual sessions of STPP over 6 months. Private practitioners were randomized to training in manualized STPP (mSTPP) vs. treatment as usual without a specific training (tauSTPP). A total of 109 patients were enrolled (105 started treatment; 75 completed at least 20 treatment sessions). Assessments were conducted pre-treatment, after 8 and 15 weeks, after 25 treatment sessions, at the end of treatment, 6 and 12 months after termination of treatment. Remission as primary outcome was defined by the Liebowitz-Social-Anxiety-Scale (LSAS) score ≤30. Secondary outcomes were response (at least 31% reduction in LSAS), treatment duration and number of sessions, changes in social anxiety (LSAS, SPAI), depression (BDI), clinical global impression (CGI), and quality of life (EQ-5D). Results Remission rates of mSTPP (9%) resp. tauSTPP (16%) and also response rates of 33% resp. 28% were comparable between the two treatment approaches as well as treatment duration and number of sessions. Most of the within-group differences (baseline to 25 sessions) indicated moderate to large improvements in both treatments; within-group differences from baseline to 12 months follow-up (LSAS, SPAI, BDI, CGI) were large ranging from d = −0.605 to d = −2.937. Benefits of mSTPP were limited to single outcomes. Conclusions Findings are discussed with regard to implementation and dissemination of empirically validated treatments in psychodynamic training and practice. SAD patients with a high comorbidity of personality disorders and a long treatment history may need longer treatments. Trial registration German Clinical Trials Register (DRKS) DRKS00000570, registered 03. March 2011.

BACKGROUND: Different types of childhood maltreatment, like emotional abuse, emotional neglect, physical abuse, physical neglect and sexual abuse are interrelated because of their co-occurrence. Different patterns of childhood abuse and neglect are associated with the degree of severity of mental disorders in adulthood. The purpose of this study was (a) to identify different patterns of childhood maltreatment in a representative German community sample, (b) to replicate the patterns of childhood neglect and abuse recently found in a clinical German sample, (c) to examine whether participants reporting exposure to specific patterns of child maltreatment would report different levels of psychological distress, and (d) to compare the results of the typological approach and the results of a cumulative risk model based on our data set. METHODS: In a cross-sectional survey conducted in 2010, a representative random sample of 2504 German participants aged between 14 and 92 years completed the Childhood Trauma Questionnaire (CTQ). General anxiety and depression were assessed by standardized questionnaires (GAD-2, PHQ-2). Cluster analysis was conducted with the CTQ-subscales to identify different patterns of childhood maltreatment. RESULTS: Three different patterns of childhood abuse and neglect could be identified by cluster analysis. Cluster one showed low values on all CTQ-scales. Cluster two showed high values in emotional and physical neglect. Only cluster three showed high values in physical and sexual abuse. The three patterns of childhood maltreatment showed different degrees of depression (PHQ-2) and anxiety (GAD-2). Cluster one showed lowest levels of psychological distress, cluster three showed highest levels of mental distress. CONCLUSION: The results show that different types of childhood maltreatment are interrelated and can be grouped into specific patterns of childhood abuse and neglect, which are associated with differing severity of psychological distress in adulthood. The results correspond to those recently found in a German clinical sample and support a typological approach in the research of maltreatment. While cumulative risk models focus on the number of maltreatment types, the typological approach takes the number as well as the severity of the maltreatment types into account. Thus, specific patterns of maltreatment can be examined with regard to specific long-term psychological consequences. Language: en

Zusammenfassung Fragestellung: Die Studie untersuchte die Beziehungen zwischen Lebenssinn und Traumabewaltigung und die Zusammenhange zwischen posttraumatischem Wachstum und psychischem Befinden. Methode: Inhaltliche und strukturelle Aspekte der individuellen Sinnkonstruktionen von 62 Patientinnen mit posttraumatischer Belastungsstorung wurden qualitativ erfasst. Auserdem wurden Fragebogen zu Sinnerleben (LRI-r-d; MLQ), PTBS-Symptomatik (IES-R), Depressivitat (BDI-II), gesundheitsbezogener Lebensqualitat (EQ-5D), Lebenszufriedenheit (SWLS) und posttraumatischem Wachstum (PPR-d) eingesetzt. Ergebnisse: Ein starkeres Ausmas an subjektivem Sinnerleben und eine hohere Tragfahigkeit des individuellen Sinnsystems gingen mit einem besseren psychischen Befinden und einem starkeren Ausmas an posttraumatischemWachstum einher.PosttraumatischesWachstum war ebenfalls positiv mit einem besseren Befinden assoziiert. Diskussion: Patientinnen mit einem tragfahigen Sinnsystem konnen ihre traumatischen Erfahrungen besser be...

Zusammenfassung Fragestellung: Die Studie untersuchte einerseits Unterschiede in den individuellen Sinnkonstruktionen von Psychotherapeuten und Psychotherapiepatienten und andererseits Zusammenhange zwischen Lebenssinn und seelischer Gesundheit. Methode: Inhaltliche und strukturelle Aspekte der individuellen Sinnkonstruktionen von 41 Psychotherapeuten und 77 Psychotherapiepatienten wurden qualitativ erfasst. Auserdem wurden Fragebogen zu Sinnerleben (LRI-r-d),Koharenzerleben (SOC-9L), Selbstwert (RSES) Lebenszufriedenheit (SWLS), Selbstwirksamkeitserwartung (SWK) und Depressivitat (BDI) eingesetzt. Ergebnisse: Zuganglichkeit, Differenziertheit und Koharenz der individuellen Sinnsysteme von Psychotherapeuten waren hoher ausgepragt als bei Psychotherapiepatienten. In der Gruppe der Patienten korrelierten tragfahigere Sinnkonstruktionen positiv mit dem subjektiven Erleben von Sinn. Zusammenhange zwischen Lebenssinn und Faktoren der seelischen Gesundheit konnten grostenteils nachgewiesen werden. Diskussion: P...

Zusammenfassung Fragestellung: Die Studie untersuchte, (1) wie hoch die Symptombelastung von Sozialphobikern im Vergleich zu Patienten ohne Sozialphobie bei Aufnahme, Entlassung und ein Jahr nach der Therapie ist und (2) ob das Vorliegen einer Sozialphobie einen Einfluss auf den Therapieverlauf hat. Methode: 613 Patienten einer psychosomatischen Universitatsklinik machten Angaben zu Symptombelastung (GSI, KOPS), korperlicher Symptomatik, psychischer und sozialer Beeintrachtigung (KOPS) und Depressivitat (BDI). Die Diagnose Sozialphobie wurde durch ein standardisiertes diagnostisches Interview gestellt. Ergebnisse: Eine Sozialphobie lag bei 25% der Patienten vor. Die Komorbiditat war bei Sozialphobikern signifikant hoher als bei anderen Patienten (4.18 vs. 2.41 Diagnosen). Sozialphobiker wiesen bei Aufnahme signifikant hohere Symptombelastungen und korperliche, psychische und soziale Beeintrachtigungen auf und waren depressiver. Das Vorliegen einer Sozialphobie beeinflusste den Therapieverlauf. Obwohl sich...

This paper presents the Social Phobia Psychotherapy Research Network (SOPHO-NET). SOPHO-NET is among the five research networks on psychotherapy funded by "Bundesministerium fur Bildung und Forschung". The research program encompasses a coordinated group of studies of social phobia. In the central project (Study A), a multi-center randomized controlled trial, refined models of manualized cognitive-behavioral therapy (CBT) and manualized short-term psychodynamic psychotherapy (STPP) are compared in the treatment of social phobia. A sample of n=512 outpatients will be randomized to either CBT, STPP or wait list. For quality assurance and treatment integrity, a specific project has been established (Project Q). Study A is complemented by four interrelated projects focusing on attachment style (Study B1), cost-effectiveness (Study B2), polymorphisms in the serotonin transporter gene (Study C1) and on structural and functional deviations of hippocampus and amygdala (Study C2). Thus, the SOPHO-NET program allows for a highly interdisciplinary research of psychotherapy in social phobia.

We assessed victims’ status and its relation to self-perceived “social acknowledgment as a victim or survivor” ( Maercker & Müller, 2004 ) in a sample of Chechen refugees living in camps in Ingushetia. A total of 61 Chechen refugees were surveyed using a war-related trauma checklist, the Impact of Event Scale-Revised, and the Disclosure of Trauma Questionnaire. Rates of potentially traumatic events and posttraumatic stress disorder (PTSD) appeared to be very high in this sample: 100% reported one or more potentially traumatic events and over 75% were estimated to have PTSD. As expected, social acknowledgment as a victim or survivor was negatively related to PTSD symptoms. We discuss the possible causal direction of this finding. Our cross-sectional study provides further evidence that social acknowledgment should be regarded as a protective or resource factor in the aftermath of trauma.

This paper presents the Social Phobia Psychotherapy Research Network. The research program encompasses a coordinated group of studies adopting a standard protocol and an agreed-on set of standardized measures for the assessment and treatment of social phobia (SP). In the central project (study A), a multicenter randomized controlled trial, refined models of manualized cognitive-behavioral therapy and manualized short-term psychodynamic psychotherapy are compared in the treatment of SP. A sample of 512 outpatients will be randomized to either cognitive-behavioral therapy, short-term psychodynamic psychotherapy or waiting list. Assessments will be made at baseline, at the end of treatment and 6 and 12 months after the end of treatment. For quality assurance and treatment integrity, a specific project using highly elaborated measures has been established (project Q). Study A is complemented by 4 interrelated add-on projects focusing on attachment style (study B1), on cost-effectiveness (study B2), on variation in the serotonin transporter gene in SP (study C1) and on structural and functional deviations of the hippocampus and amygdala (study C2). Thus, the Social Phobia Psychotherapy Research Network program enables a highly interdisciplinary research into SP. The unique sample size achieved by the multicenter approach allows for studies of subgroups (e.g. comorbid disorders, isolated vs. generalized SP), of responders and nonresponders of each treatment approach, for generalization of results and for a sufficient power to detect differences between treatments. Psychological and biological parameters will be related to treatment outcome, and variables for differential treatment indication will be gained. Thus, the results provided by the network may have an important impact on the treatment of SP and on the development of treatment guidelines for SP.

This article introduces a new qualitative–quantitative approach to assess meaning of life. The participants described their sources of meaning and how they were interconnected. Four quantitative measures for (1) the accessibility of meaning-related knowledge, the degree of (2) differentiation and (3) elaboration of personal meaning systems, and (4) their coherence were calculated. The sample consisted of 59 theology and science students. The study tested (a) whether the structural properties of personal meaning systems predicted health and well-being, and (b) reflected different degrees of expertise in constructing meaning. Differentiation, elaboration, and coherence measures correlated with health and well-being and predicted life satisfaction. Theology students presented more differentiated, elaborated, and coherent personal meaning systems than science students. Both results indicate that assessing structural properties of personal meaning systems can be a promising new approach to measure meaning of life.

To determine whether the self-concept of patients with Social Anxiety Disorder deviates significantly from that found in the normative sample, to what extent it changes through psychotherapeutic short-term interventions and how such changes in self-concept relate to changes in the level of social anxiety.The self-concept of N = 86 patients with Social Anxiety Disorder was assessed using the Frankfurter-Selbstkonzeptskalen (FSKN; Deusinger 1986). Patients were treated with a manualized cognitive (CT) or psychodynamic (PDT) short-term intervention. The level of social anxiety was assessed pre-therapy and post-therapy via the Liebowitz Social Anxiety Scale (StangierHeidenreich 2004) and the Social Phobia and Anxiety Scale (Fydrich 2002).Patients with Social Anxiety Disorder exhibited a significantly more negative self-concept than the norm (all ps0.001). Their self-concept improved significantly in all facets following psychotherapeutic short-term intervention (all ps0.01). No significant difference was found between cognitive and psychodynamic therapy. Improvements in self-concept correlate with reductions in social anxiety.The results confirm the relevance of self-concept in Social Anxiety Disorder and its susceptibility to short-term-therapy.

Epstein's “Constructive Thinking Inventory” (CTI) was developed to measure the construct of experiential intelligence, which is based on his cognitive-experiential self-theory. Inventory items were generated by sampling naturally occurring automatic cognitions. Using principal component analysis, the findings showed a global factor of coping ability as well as six main factors: Emotional Coping, Behavioral Coping, Categorical Thinking, Personal Superstitious Thinking, Esoteric Thinking, and Naive Optimism. We tested the replicability of this factor structure and the amount of statistical independence (nonredundancy) between these factors in an initial study of German students (Study 1, N = 439) and in a second study of patients with chronic skin disorders (Study 2, N = 187). Factor congruence with the original (American) data was determined using a formula proposed by Schneewind and Cattell (1970) . Our findings show satisfactory factor congruence and statistical independence for Emotional Coping and Esoteric Thinking in both studies, while full replicability or independence could not be found in both for the other factors. Implications for the use and further development of the CTI are discussed.

The Dresden Body Image Questionnaire (DKB-35) measures 5 dimensions of body image: vitality, self-acceptance, self-aggrandisement, physical closeness, and sexual fulfilment. This article presents data on the reliability and validity of the DKB-35. The sample consisted of 560 pa-tients with psychosomatic disorders. To analyse the factor structure, a confirmatory factor analysis was conducted. To examine the convergent validity, correlations between the DKB-35 scales and the Frankfurt Body Concept Scales (FKKS, [1]), the Narcissism Personality Inventory (NPI, [2]) and the self-esteem subscale of the Frankfurt Self-Concept Scales (FSKN, [3]) were computed. The 5 scales of the DKB-35 showed excellent reliability. Between the 5 DKB-35 scales and the corresponding scales of the FKKS, the NPI, and the FSKN, moderate correlations were found. The results confirm the reliability and validity of the DKB-35. Possible fields of applications and further developments are discussed.

The Dresden Body Image Questionnaire (DKB-35) measures 5 dimensions of body image: vitality, self-acceptance, self-aggrandisement, physical closeness, and sexual fulfilment. This article presents data on the reliability and validity of the DKB-35. The sample consisted of 560 pa-tients with psychosomatic disorders. To analyse the factor structure, a confirmatory factor analysis was conducted. To examine the convergent validity, correlations between the DKB-35 scales and the Frankfurt Body Concept Scales (FKKS, [1]), the Narcissism Personality Inventory (NPI, [2]) and the self-esteem subscale of the Frankfurt Self-Concept Scales (FSKN, [3]) were computed. The 5 scales of the DKB-35 showed excellent reliability. Between the 5 DKB-35 scales and the corresponding scales of the FKKS, the NPI, and the FSKN, moderate correlations were found. The results confirm the reliability and validity of the DKB-35. Possible fields of applications and further developments are discussed.

Objective The aim of the study was to analyse the psychometric properties of the EQ-5D in patients with social phobia. Methods We used a sample of 445 patients with social phobia with five measurement points over a 30 month period. The discriminative ability of the EQ-5D was analysed by comparing the patients’ responses with the general population and between different disease severity levels. For test-retest reliability we assessed the level of agreement in patients’ responses over time, when there was no change in the Liebowitz Social Anxiety Scale (LSAS). Construct validity was analysed by identifying correlations of the EQ-5D with more specific instruments. For responsiveness we compared the means of EQ VAS/EQ-5D index anchored on improved (deteriorated) health status and computed effect sizes as well as a receiver operating characteristic (ROC) curve. Results Compared to the general population, patients with social phobia reported more problems in the dimensions “usual activities”, “pain/discomfort”, and “anxiety/depression” and less problems in “mobility” and “self-care”. The EQ-5D was able to distinguish between different disease severity levels. The test-retest reliability was moderate (intraclass correlation coefficient > 0.6). Correlations between the EQ-5D and other instruments were mostly small except for correlations with Beck Depression Inventory. The EQ-5D index seemed to be more responsive than the EQ VAS, but with only medium effect sizes (0.5

This study investigated the relationship between meaning in life and coping with trauma, and correlations between posttraumatic growth and mental health.The content and structure of the personal meaning systems of 62 patients suffering from posttraumatic stress disorder (PTSD) were assessed qualitatively. In addition, the participants completed questionnaires measuring meaning in life (LRI-r-d; MLQ), PTSD symptoms (IES-R), depression (BDI-II), health-related quality of life (EQ-5D), satisfaction with life (SWLS) and posttraumatic growth (PPR-r).A stronger sense of meaning in life and a more elaborately structured personal meaning system correlated with a better mental health and more posttraumatic growth. Posttraumatic growth was also associated with mental health.Patients with coherent personal meaning systems are more successful in coping with traumatic life events. They also reported more posttraumatic growth.

Background Psychodynamic psychotherapy is frequently applied in the treatment of social phobia. Nevertheless, there has been a lack of studies on the transfer of manualized treatments to routine psychodynamic practice. Our study is the first one to examine the effects of additional training in a manualized Short Term Psychodynamic Psychotherapy (STPP) procedure on outcome in routine psychotherapy for social phobia. This study is an extension to a large multi-site RCT (N = 512) comparing the efficacy of STPP to Cognitive-Behavioral Therapy (CBT) of Social Phobia. Methods/Design The manualized treatment is designed for a time limited approach with 25 individual sessions of STPP over 6 months. Private practitioners will be randomized to training in manualized STPP vs. treatment as usual without a specific training (control condition). We plan to enrol a total of 105 patients (84 completers). Assessments will be conducted before treatment starts, after 8 and 15 weeks, after 25 treatment sessions, at the end of treatment, 6 months and 12 months after termination of treatment. The primary outcome measure is the Liebowitz Social Anxiety Scale. Remission from social phobia is defined scoring with 30 or less points on this scale. Discussion We will investigate how the treatment can be transferred from a controlled trial into the less structured setting of routine clinical care. This question represents Phase IV of psychotherapy research. It combines the benefits of randomized controlled and naturalistic research. The study is genuinely designed to promote faster and more widespread dissemination of effective interventions. It will answer the questions whether manualized STPP can be implemented into routine outpatient care, whether the new methods improve treatment courses and outcomes and whether treatment effects reached in routine psychotherapeutic treatments are comparable to those of the controlled, strictly manualized treatment of the main study. Trial Registration German Clinical Trials Register (DRKS) DRKS00000570

This study investigated differences in the personal meaning systems of psychotherapists and psychotherapy patients as well as correlations between meaning in life and mental health.We qualitatively assessed the content and structure of the personal meaning systems of 41 psychotherapists and 77 psychotherapy patients. In addition, the participants completed questionnaires measuring meaning in life (LRI-r-d), sense of coherence (SOC-9L), self-esteem (RSES), satisfaction with life (SWLS), self-efficacy (SWK), and depression (BDI).The personal meaning systems of psychotherapists were more complex and coherent compared to psychotherapy patients. In the group of psychotherapy patients, a more elaborate structure of the personal meaning system correlated with the subjective sense of meaning. We were able to confirm correlations between meaning in life and mental health for most of the instances.Psychotherapists had more elaborate and coherent meaning systems than psychotherapy patients. Especially for psychotherapy patients elaborate and coherent meaning systems turned out to be important for mental health.

This paper presents the Social Phobia Psychotherapy Research Network (SOPHO-NET). SOPHO-NET is among the five research networks on psychotherapy funded by "Bundesministerium für Bildung und Forschung". The research program encompasses a coordinated group of studies of social phobia. In the central project (Study A), a multi-center randomized controlled trial, refined models of manualized cognitive-behavioral therapy (CBT) and manualized short-term psychodynamic psychotherapy (STPP) are compared in the treatment of social phobia. A sample of n=512 outpatients will be randomized to either CBT, STPP or wait list. For quality assurance and treatment integrity, a specific project has been established (Project Q). Study A is complemented by four interrelated projects focusing on attachment style (Study B1), cost-effectiveness (Study B2), polymorphisms in the serotonin transporter gene (Study C1) and on structural and functional deviations of hippocampus and amygdala (Study C2). Thus, the SOPHO-NET program allows for a highly interdisciplinary research of psychotherapy in social phobia.

Depressive Storungen sind in der psychosomatischen Akutversorgung eine haufige Erkrankung. Der Anteil der Patienten, die an einer Depression oder einer klinisch relevanten Auspragung der Depressivitat leiden, liegt in der untersuchten Stichprobe bei 67%. Auf der Basis des Merkmals Depressivitat wurden clusteranalytisch funf Verlaufstypen identifiziert: Patienten mit masig ausgepragter, kontinuierlich abnehmender Depressivitat (Cluster 1, n = 80, 41.2%), Patienten mit hoher Depressivitat und kontinuierlicher, stabiler Verbesserung (Cluster 2, n = 41, 21.1%), Patienten mit hoher, stabiler Depressivitat (Cluster 3, n = 32, 16.5%), Patienten mit masiger Depressivitat und instabiler Verbesserung (Cluster 4, n = 28, 14.4%) sowie Patienten mit starken Schwankungen in der Depressivitat (Cluster 5, n = 13, 6.7%). Die Analyse von Pra- (Komorbiditat, seelische Gesundheit, relevante Problembereiche) und Post-Differenzen (Zielerreichung und Problemverbesserungen am Ende der Therapie und ein Jahr spater) zeigte, dass Patienten in Cluster 1 sich deutlich von den anderen Gruppen unterschieden. Sie waren weniger belastet (Depressivitat, Komorbiditat) und seelisch gesunder. Ihr Therapieerfolg (Zielerreichung und Problemreduktion) war groser. Die erzielten Therapieergebnisse blieben im Katamnesezeitraum nicht in allen Patientengruppen stabil. Ein groser Teil der Patienten (Cluster 1 und Cluster 3, n = 121) konnte das erzielte Therapieergebnis halten, in zwei Gruppen (Cluster 4 und Cluster 5, n = 41) kam es allerdings im Vergleich zum Therapiebeginn zu einem deutlichen Anstieg der Depressivitat. Die Ursachen dafur sind moglicherweise negative Therapieeff ekte (Cluster 5) und Ruckfalle und soziale Probleme im Katamnesezeitraum (Cluster 4). Offen bleibt, was die unterschiedlichen Verlaufe von Cluster 2 und Cluster 3 erklaren kann. Beide Gruppen wiesen zu Beginn der Therapie gleich hohe Depressionswerte auf und unterschieden sich in der weiteren Entwicklung deutlich.

Die Soziale Phobie kann nach Willutzki (2005) als intrapersonell formuliertes interpersonelles Problem aufgefasst werden, wobei die Storung mit dem gesamten Spektrum interpersoneller Probleme verbunden ist. In einer naturalistischen Studie an 103 Fallen einer psychosomatischen Universitatsklinik wurde untersucht, ob sich Sozialphobiker (SP, n=60) und Agoraphobiker (AP, n=43) (a) im Muster interpersoneller Probleme unterscheiden u. (b) wie sich diese Muster im Therapieverlauf verandern. Die Diagnosestellung erfolgte standardisiert mittels DIA-X. Erfasst wurden interpersonale Probleme (IIP) u. allgemeine Storungsmase (BDI, KOPS, SCL–90R). Die Ergebnisse zeigen, dass zu Therapiebeginn deutliche storungsspezifische Unterschiede im Muster interpersoneller Probleme bestehen. Patienten mit SP weisen signifikant hohere Werte auf den Skalen zu streitsuchtig, zu abweisend, zu introvertiert, zu selbstunsicher und zu ausnutzbar auf als jene mit AP. Im Therapieverlauf zeigt sich bei SP eine deutliche Reduktion der interpersonalen Probleme in den Bereichen zu abweisend, zu introvertiert, zu selbstunsicher u. zu ausnutzbar, welche als funktional einzuschatzen ist. Im Gegensatz dazu bleibt das Muster interpersonaler Probleme bei AP weitgehend stabil mit signifikant geringeren Werten in den Skalen zu aufdringlich u. zu introvertiert. Die Zusammenhange zur Problembelastung sind masig bis hoch. Die Stabilitat dieser Befunde wird vor dem Hintergrund erster katamnestischer Ergebnisse diskutiert.

Depressive Storungen sind in der psychosomatischen Akutversorgung eine haufige Erkrankung. 67% der untersuchten Patienten (N=194) litten an einer klinisch relevanten Auspragung der Depressivitat. Auf der Basis der Depressionswerte bei Aufnahme, Entlassung, ein Jahr nach Entlassung und der Differenzwerte von Aufnahme-Entlassung und Entlassung-Katamnese wurden clusteranalytisch funf Verlaufstypen identifiziert: Cluster 1 (n=80, 41.2%) masig ausgepragte, kontinuierlich abnehmende Depressivitat, Cluster 2 (n=41, 21.1%) hohe Depressivitat und kontinuierliche, stabile Verbesserung, Cluster 3 (n=32, 16.5%) hohe, stabile Depressivitat, Cluster 4 (n=28, 14.4%) masige Depressivitat und instabile Verbesserung, Cluster 5 (n=13, 6.7%) starke Schwankungen in der Depressivitat. Die Therapieergebnisse blieben im Katamnesezeitraum nicht in allen Gruppen stabil. Ein groser Teil der Patienten (Cluster 1 und Cluster 3, n=121) konnte das erzielte Therapieergebnis halten, in zwei Gruppen (Cluster 4 und Cluster 5, n=41) kam es allerdings im Vergleich zum Therapiebeginn zu einem deutlichen Anstieg der Depressivitat. Ursachen dafur sind moglicherweise negative Therapieeffekte (Cluster 5) und Ruckfalle und soziale Probleme im Katamnesezeitraum (Cluster 4). Offen bleibt, was die unterschiedlichen Verlaufe von Cluster 2 und Cluster 3 erklart. Beide Gruppen wiesen zu Beginn der Therapie gleich hohe Depressionswerte auf und unterschieden sich in der weiteren Entwicklung deutlich.