Search

In the psychotherapeutic treatment of social phobia, the hand movement behaviour exhibited during the interaction provides information about the success of the therapy. In particular, the degree of mutual somatosensory stimulation of the hands (hands moving on each other, as a unit, apart) appears to be relevant regarding the patient's mental state. To test this hypothesis, the present study investigates hand coordination in the course of psychotherapy in patients with and without symptom improvement and in the corresponding therapeutic dyads. Forty-two videos of patient–therapist dyads consisting of 21 patients (n = 11 non-improved; n = 10 improved; according to Liebowitz Social Anxiety Scale self assessment) from the Social Phobia Research Network project were investigated in early psychotherapy sessions and in pre-last sessions. Hand movements of four randomised video sequences per dyad were analysed with NEUROGES®-ELAN. Patients with non-improved symptoms displayed shorter act apart coordination and more act on each other coordination than patients with improved symptoms. Patients displayed more act apart and act on each other and less act as a unit coordination than therapists. In therapeutic dyads, act on each other coordination in early sessions, as well as short act apart coordination, was significantly related to non-improvement. Patients with non-improved symptoms are characterised by more hand coordination associated with a high degree of somatosensory stimulation serving self-regulation (act on each other), as well as short complex gestural expressions (act apart). Thus, hand coordination constitutes a progression and outcome parameter informing on somatosensory stimulation.

Zusammenfassung Fragestellung (Teil-)stationäre Psychotherapie ist in Deutschland gut implementiert. Um Wirksamkeitsfaktoren und Effekte besser zu verstehen, sind Effektivitätsstudien notwendig. Diese naturalistische Studie untersucht die Effektivität stationärer und teilstationärer Psychotherapie sowie patientenzentrierte und störungsbezogene Einflussfaktoren auf individuelle Symptomverbesserungen. Methoden Analysiert werden Patient*innen einer psychosomatisch-psychotherapeutischen Universitätsklinik, die in den Jahren 2015 bis 2019 behandelt wurden und das BSI-18 entweder bei Aufnahme und Entlassung (N=1366) oder bei Aufnahme und Dreimonatskatamnese (N=497) ausfüllten. Ergebnisse Die Verbesserungen in der globalen Symptomschwere zeigen moderate Effektstärken. Deskriptiv sind diese größer bei teilstationärer als bei stationärer Behandlung–besonders im Follow-up-Vergleich (direkt nach Entlassung: dstationär=0.401, dteilstationär=0,482; drei Monate nach Entlassung: dstationär=0,403, dteilstationär=0,807). Die teilstationären unterscheiden sich signifikant von den stationären Patient*innen – gering in Alter, Beschäftigungsstatus, Arbeitsfähigkeit und initialen Symptombelastungen, moderat in der Anzahl psychischer Komorbiditäten und stark in ihren Hauptdiagnosen. Soziodemographische Faktoren zeigen keinen, die initiale Symptomschwere einen moderaten positiven und die Anzahl psychischer Komorbiditäten einen komplexen Einfluss auf die Symptomverbesserungen. Diskussion Allgemein bestätigt diese Studie die Wirksamkeit (teil-)stationärer psychosomatischer Therapie. Die Relevanz teilstationärer Angebote wird vor dem Hintergrund von Kosteneffizienz und guter Integration in den Alltag betont, unter Beachtung individueller Behandlungsindikationen.

Hands are, compared to other body parts, the body parts that display the most gestural movements during an interaction and their movement is sensitive to reveal anxiety states. However, psychotherapy research focuses on movement synchrony of different body parts to be an indicator of improved symptoms. The present study investigates symptoms in social anxiety disorder and considers both, individual and simultaneous hand movements. 56 video recordings of 28 patient-therapist dyads with patients with social anxiety at the beginning and in the end of psychotherapy were analyzed. Two independent blind certified raters analyzed the hand movement behavior using the NEUROGES

Fidgeting may be a motor sign reflecting self-regulation processes in patients with social anxiety disorder (SAD) and depressive patients. Since SAD co-occurs with comorbid depression, the question arises whether fidgeting is a disorder-unspecific phenomenon or a specific and therefore diagnostically relevant sign of depression. 33 SAD patients with (n = 12) and without (n = 21) depression from the Social Phobia Psychotherapy Research Network project were compared regarding their nonverbal behavior. Four video sequences of a psychotherapy session with each patient were analyzed using a standardized system for the analysis of nonverbal behavior by two independent, certified, blind raters. SAD patients with comorbid depression exhibited significantly more (number/minute) irregular movements, but fewer (number/minute) repetitive movements than SAD patients without depression. Irregular movements, which reflect less structured motor behavior, are associated with comorbid depression in SAD. In contrast, in SAD without depression, more structured repetitive movements were prominent. Thus, irregular movements represent a diagnostically relevant behavior for comorbid depression among SAD patients.

(Partial) inpatient psychotherapy is well implemented in Germany. To better understand efficacy factors and effects, efficacy studies are necessary. This naturalistic study investigates the effectiveness of inpatient and day clinic psychotherapy as well as patient-and disorder-related factors influencing individual symptom improvements.Patients at a psychosomatic-psychotherapeutic university hospital treated from 2015 to 2019 who completed the BSI-18 either at admission and discharge (n=1366) or at admission and three-month catamnesis (n=497) were included in the analysis.Improvements in global symptom severity showed moderate effect sizes. Descriptively, these were larger for day clinic patients than for those receiving treatment as inpatients-especially in the follow-up comparison (immediately after discharge: dinpatient=0.401, dday clinic=0.482; three months after discharge: dinpatient=0.403, dday clinical=0.807). Day hospitalized patients differed significantly from inpatients-slightly in age, employment status, ability to work and initial symptom burden, moderately in the number of mental comorbidities and strongly in their main diagnoses. Socio-demographic factors showed no positive influence on symptom improvement, initial symptom severity a moderate positive influence and the number of mental comorbidities a complex influence.In general, this study confirms the effectiveness of (partial) inpatient psychosomatic therapy. The relevance of day clinic offers is emphasised in the context of cost efficiency and good integration into everyday life, but under consideration of individual treatment indications.FRAGESTELLUNG: (Teil-)stationäre Psychotherapie ist in Deutschland gut implementiert. Um Wirksamkeitsfaktoren und Effekte besser zu verstehen, sind Effektivitätsstudien notwendig. Diese naturalistische Studie untersucht die Effektivität stationärer und teilstationärer Psychotherapie sowie patientenzentrierte und störungsbezogene Einflussfaktoren auf individuelle Symptomverbesserungen.Analysiert werden Patient*innen einer psychosomatisch-psychotherapeutischen Universitätsklinik, die in den Jahren 2015 bis 2019 behandelt wurden und das BSI-18 entweder bei Aufnahme und Entlassung (N=1366) oder bei Aufnahme und Dreimonatskatamnese (N=497) ausfüllten.Die Verbesserungen in der globalen Symptomschwere zeigen moderate Effektstärken. Deskriptiv sind diese größer bei teilstationärer als bei stationärer Behandlung–besonders im Follow-up-Vergleich (direkt nach Entlassung: dstationär=0.401, dteilstationär=0,482; drei Monate nach Entlassung: dstationär=0,403, dteilstationär=0,807). Die teilstationären unterscheiden sich signifikant von den stationären Patient*innen – gering in Alter, Beschäftigungsstatus, Arbeitsfähigkeit und initialen Symptombelastungen, moderat in der Anzahl psychischer Komorbiditäten und stark in ihren Hauptdiagnosen. Soziodemographische Faktoren zeigen keinen, die initiale Symptomschwere einen moderaten positiven und die Anzahl psychischer Komorbiditäten einen komplexen Einfluss auf die Symptomverbesserungen.Allgemein bestätigt diese Studie die Wirksamkeit (teil-)stationärer psychosomatischer Therapie. Die Relevanz teilstationärer Angebote wird vor dem Hintergrund von Kosteneffizienz und guter Integration in den Alltag betont, unter Beachtung individueller Behandlungsindikationen.

In order to understand the psychopathology of the social anxiety disorder (SAD) at the neuroendocrine level, standardized experimental studies on endocrine and physiological markers are necessary, especially since empirical data are still ambiguous. Hence, differences in both, the autonomic nervous system (ANS) and the endocrine stress responses (ACTH, salivary and plasma cortisol) were investigated in a particularly homogenous sample after a standardized stressor (Trier Social Stress Test). The sample consisted of n = 35 patients with SAD, age, and gender matched to n = 35 healthy controls (HC). In terms of the heart rate, the response pattern was comparable in both groups. Concerning ACTH, no significant group differences in the response pattern nor in the total output (AUCG) were exhibited. Significant differences were noticeable only in the plasma cortisol response pattern with less total output (AUCG) in patients suggesting a blunted response. The salivary cortisol response indicated comparable patterns between groups. However, the patients’ total output (AUCG) was significantly smaller relative to the controls. In sum, evidence for a hypo-responsiveness of the HPA-axis in SAD by means of blood cortisol was observed, with no differences in ACTH between the two groups. This reduced reactivity of the HPA-axis might be associated with an inability to elicit an adequate hormone release, possibly accompanied by an enhanced perception of the stress stimulus. This might be explained by an adaptation of the adrenocortical system due to prolonged repeated stress exposure such as social evaluation.

Objective The study represents a conceptual replication of the study by Eng et al. (2001) in a sample of adult patients diagnosed with social anxiety disorder as primary diagnosis. Methods Two different attachment questionnaires (Bielefeld Questionnaire of Client Expectations (BQCE) and Experiences in Close Relationships (ECR-RD)) were applied to examine whether the effect of attachment on depression (measured by the BDI) is mediated by social anxiety (measured by the LSAS) in a cross-sectional study. Results The data confirms such a mediation. The effect of attachment measured with the BQCE on depression was completely mediated, whereas the effect of both scales of the ECR-RD (attachment related avoidance and anxiety) on depression was only partially mediated by social anxiety disorder. Conclusion The study supports the association of attachment, social anxiety, and depressive symptoms and the need to consider different perspectives on attachment.

Dass korperliche Misshandlung und emotionale Vernachlassigung in der Kindheit lebenslang das Risiko fur psychische und funktionelle Storungen erhohen, ist seit langerer Zeit wissenschaftlich gut belegt. Zusatzlich wurde in den letzten Jahren eine erhohte Vulnerabilitat fur das Auftreten haufiger korperlicher Erkrankungen (Herz-Kreislauf-Erkrankungen, Typ-2-Diabetes, Hepatitiden, Chronisch obstruktive Lungenerkrankung (COPD), immunologische Erkrankungen und Schmerzerkrankungen, Pharynx- und Lungenkarzinom) und daruber hinaus eine eingeschrankte Lebenserwartung gesichert. Es wird ein Uberblick uber die diesbezugliche Studienlage sowie die neurobiologischen und entwicklungspsychologischen Mechanismen gegeben, welche diese Langzeitfolgen vermitteln. Ergebnisse zu familiaren Risikokonstellationen zeigen Ansatzpunkte fur eine gezielte Pravention, deren Wirksamkeit in Modellprojekten gut belegt ist. Nur durch deren Etablierung durften die enormen gesundheitsbezogenen wie volkswirtschaftlichen Folgekosten (Arbeitsunfahigkeitsgage, Fruhberentungen) kunftig begrenzt werden konnen.

Disgust affects interpersonal relationships and regulates hygienic, sexual and distance behaviour. Its intensity in the interpersonal context depends on the character of the relationship. Strangers normally evoke more disgust than intimates (known as the source effect). General disgust sensitivity is increased in various mental diseases. It is unclear how disgust in the interpersonal context is affected and whether the source effect is preserved. 460 inpatients with mental disorders and 463 healthy subjects answered a newly developed Questionnaire (DIRQ) that covers disgust in the interpersonal context on content categories (hygiene, physical proximity, sexuality) and on source categories (self, partner, parent, stranger). Mental disorders were diagnosed with structured interviews. Healthy controls exhibited a pronounced source effect, with strangers evoking more disgust than intimates. In patients, this source effect was reduced (Cohen’s d = 0.3), especially for sexual disgust, while general disgust sensitivity was increased (d = 0.5). High disgust in patients was best predicted by a history of sexual abuse and by the presence of post-traumatic stress disorder. In conclusion, mentally impaired patients show increased and trauma-associated disgust sensitivity. Their downregulation of sexual disgust in intimate relationships is hindered, which may have a boundary protective function but might also fuel difficulties engaging in relationships or intimacy.

Objectives Within a randomized controlled trial contrasting the outcome of manualized cognitive-behavioral (CBT) and short term psychodynamic therapy (PDT) compared to a waiting list condition (the SOPHO-Net trial), we set out to test whether self-reported attachment characteristics change during the treatments and if these changes differ between treatments. Research design and methods 495 patients from the SOPHO-Net trial (54.5% female, mean age 35.2 years) who were randomized to either CBT, PDT or waiting list (WL) completed the partner-related revised Experiences in Close Relationships Questionnaire (ECR-R) before and after treatment and at 6 and 12 months follow-up. The Liebowitz Social Anxiety Scale (LSAS) was administered at pre-treatment, post-treatment, and at 6-month and 1-year follow-up. ECR-R scores were first compared to a representative healthy sample (n = 2508) in order to demonstrate that the clinical sample differed significantly from the non-clinical sample with respect to attachment anxiety and avoidance. Results LSAS scores correlated significantly with both ECR-R subscales. Post-therapy, patients treated with CBT revealed significant changes in attachment anxiety and avoidance whereas patients treated with PDT showed no significant changes. Changes between post-treatment and the two follow-ups were significant in both conditions, with minimal (insignificant) differences between treatments at the 12- month follow-up. Conclusions The current study supports recent reviews of mostly naturalistic studies indicating changes in attachment as a result of psychotherapy. Although there were differences between conditions at the end of treatment, these largely disappeared during the follow-up period which is line with the other results of the SOPHO-NET trial. Trial registration Controlled-trials.com ISRCTN53517394

Analytische Psychotherapieverfahren gehoren traditionell zu den in der klinischen Versorgung am haufigsten angewandten ­Psychotherapieverfahren. Naturalistische Studien zeigten eine gute Wirksamkeit, auch bei chronifizierten Angststorungen. So wirkte es fast wie eine narzisstische Krankung, als die symptomorientierten kognitiv-behavioralen Ansatze in den 1990er-Jahren in kontrollierten Studien eine hohe Effektstarke nachweisen konnten. Diese ­Herausforderung durch die Wirksamkeitsforschung war heilsam.

This study investigated whether partner-related attachment characteristics differentially predict premature treatment termination as well as posttreatment and 1-year follow-up outcome in patients with social anxiety disorder treated with a manualized cognitive-behavioral therapy (CBT) or short-term psychodynamic therapy (PDT) in the SOPHO-NET (Social Phobia Psychotherapy Network) trial. Participants were 412 patients with social anxiety disorder (57% female) with a mean age of 35.4 years (SD = 12.1) who were randomized to either CBT or PDT. Partner-related attachment characteristics were measured using the revised Experiences in Close Relationships Questionnaire (ECR-R) at pretreatment. The Liebowitz Social Anxiety Scale was administered at pretreatment, posttreatment, and a 1-year follow-up. To address our research questions, linear regression models were applied. Furthermore, we compared CBT versus PDT patients within ECR-R quartiles. Treatment dropout did not differ between CBT and PDT and was not predicted by pretreatment attachment. In both treatment conditions, there was a trend for higher attachment anxiety to be associated with a more limited reduction in symptoms if controlling for pretreatment Liebowitz Social Anxiety Scale scores. Exploratory analyses showed that patients assigned to the highest quartile of the ECR-R-Avoidance distribution showed more benefit within the CBT condition posttreatment and at follow-up than the PDT condition. Our findings suggest that it may be useful to assess attachment characteristics in patients with social anxiety disorder before psychotherapeutic treatment. Patients characterized by very high pretreatment attachment avoidance (ECR-R-Avoidance >3.87) may specifically benefit more from CBT than from PDT. However, replication studies are needed that also should investigate nonlinear effects of pretreatment attachment. (PsycINFO Database Record

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.

ObjectiveVarious approaches to cognitive-behavioral therapy (CBT) have been shown to be effective for social anxiety disorder. For psychodynamic therapy, evidence for efficacy in this disorder is scant. The authors tested the efficacy of psychodynamic therapy and CBT in social anxiety disorder in a multicenter randomized controlled trial.MethodIn an outpatient setting, 495 patients with social anxiety disorder were randomly assigned to manual-guided CBT (N=209), manual-guided psychodynamic therapy (N=207), or a waiting list condition (N=79). Assessments were made at baseline and at end of treatment. Primary outcome measures were rates of remission and response, based on the Liebowitz Social Anxiety Scale applied by raters blind to group assignment. Several secondary measures were assessed as well.ResultsRemission rates in the CBT, psychodynamic therapy, and waiting list groups were 36%, 26%, and 9%, respectively. Response rates were 60%, 52%, and 15%, respectively. CBT and psychodynamic therapy were signi...

The perception of disgust is a powerful but yet puzzling emotion, aiming at the prevention of potential microbial pathogens and being directly linked to olfactory processing in its neurophysiological pathways via the anterior insular cortex. In sample of healthy participants with a natural variation in olfactory function, we investigated the relation between olfactory sensitivity and disgust perception. A total of 123 healthy individuals were surveyed with a disgust sensitivity questionnaire. Olfactory threshold was assessed in all participants using the Sniffin' Sticks. Additionally, tactile 2-point discrimination threshold was tested in a subgroup of the participants as a controlling factor for the specificity of the relationship between olfactory sensitivity and disgust. Only in men, a significant relation between disgust ratings and olfactory threshold was observed. Men with high olfactory sensitivity reported as high levels of disgust as female participants, while men with low olfactory sensitivity reported significantly lower disgust than women. There was no such relation for tactile sensitivity. Investigating sensory subscales of the disgust questionnaire, olfactory sensitivity was related to olfactory and tactile, but not to visual disgust ratings. In conclusion, there is a specific relation between the level of disgust and olfactory sensitivity in men, who generally present lower values of disgust than women. When disgust ratings are low, there seems to be an additional merit in the ability to perceive subtle olfactory stimuli. Thus high olfactory sensitivity may facilitate the perception of potential pathogenic threats and contribute to the evolutionary function of disgust as disease avoidance mechanism.

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.

In the last decade strong empirical evidence from several long-term studies supports the conclusion that physical and sexual abuse as well as emotional deprivation in childhood make people significantly more vulnerable to mental and functional disorders across their lifetime. Additionally, an increased vulnerability to several somatic disorders (cardiovascular disorders, type-2-diabetes, hepatitis, chronic obstructive pulmonary disease (COPD), immunological and pain disorders, pharynx and lung cancer) was demonstrated - most of them with a reduced life expectancy. A review of the current research will be presented that outlines the underlying developmental neurobiological and psychological mechanisms mediating these long-term effects. There is now sufficient evidence about familial risk constellations that demonstrates the well-documented impact of specific prevention strategies by several model projects. Only by establishing these strategies, future enormous health-related burdens and high economic costs (unfitness to work, early retirement) can presumably be limited.

The goal of the present investigation was to examine effects of a cognitive-behavioral group intervention for pregnant women with subclinically elevated stress, anxiety and/or depression on perceived stress and salivary cortisol levels. Expectant mothers were recruited in gynaecologist practices. They participated in a screening, a standardized diagnostic interview (Munich-Composite Diagnostic Interview, M-CIDI), and were randomly assigned to an intervention (N = 21) and treatment as usual control group (N = 40). The intervention consisted of a manualized cognitive-behavioral group program for expectant mothers with subclinically elevated stress, depression, and/or anxiety symptoms. Stress questionnaire (prenatal distress (PDQ), perceived stress (PSS)) as well as diurnal salivary cortisol assessment took place at T1 (antenatal, preintervention), at T2 (antenatal, post-intervention) and T3 (3-month postpartum). Subjects that participated in the intervention exhibited a significant post-treatment change in morning cortisol (cortisol awakening response, CAR) in contrast to control subjects, F(8,51) = 2.300, p = 0.047. Intervention participants showed a smaller CAR subsequent to the intervention, displaying a lessened stress reaction. This effect was not observed in the control group. In contrast, we failed in discovering a significant difference between the research groups regarding the cortisol area under curve parameter (AUC) and the applied subjective stress questionnaires. Evaluation results were thus heterogeneous. Nevertheless, intervention effects on the CAR are promising. Our results suggest that a cognitive-behavioral intervention might lead to an improvement in the biological stress response of pregnant women with subclinically elevated stress, anxiety, or depressive symptoms.

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...

Diabet. Med. 28, 168–174 (2011) Abstract Aims To characterize bio-psycho-social factors, particularly mental disorders and self-harm behaviour, associated with the development of diabetic foot ulcers. Methods Two groups of diabetic patients with and without foot ulcers (n = 47 in each group) with similar sex, age and diabetes duration were assessed for mental disorders using the Composite International Diagnostic Interview. Self-harm behaviour, quality of life, depressive symptoms and self-compassion were rated using different standard questionnaires. Results Patients from the ulcer group visited their practitioners and/or psychotherapists less frequently in the last 12 months than patients in the control group 0 vs. 13%; P = 0.026). The ulcer group patients had a history of increased alcohol consumption (43 vs. 19%; P = 0.025), lower levels of education (8 vs. 10 grades; P = 0.014) and income (1190 vs. 1535€/month; P = 0.039). Additionally, they were less likely to be diagnosed with anxiety disorders (11 vs. 32%; P = 0.022). No significant differences in glycated haemoglobin, body mass index, smoking and direct self-harm behaviour were identified. Conclusions Patients with foot ulcers tend to exhibit lower health-conscious behaviour, particularly higher lifetime alcohol consumption, lower utilization of medical services and less general anxiety. Practitioners should be aware of these behaviours, since early detection of diabetes patients at psycho-social risk and consecutive psychological intervention may be an effective preventive strategy in avoiding the development of foot ulcers.

The sense of olfaction is often reported to have a special relationship with emotional processing. Memories triggered by olfactory cues often have a very emotional load. On the other hand, basic negative or positive emotional states should be sufficient to cover the most significant functions of the olfactory system including ingestion, hazard avoidance, and social communication. Thus, we investigated whether different basic emotions can be evoked in healthy people through the sense of olfaction. We asked 119 participants which odor evokes one of the six basic emotions (happiness, disgust, anger, anxiety, sadness, and surprise); another 97 participants were asked about pictures evoking those emotions. The results showed that almost every participant could name an olfactory elicitor for happiness or disgust. Olfactory elicitors of anxiety were reported less frequently, but they were still reported by three-quarters of the participants. However, for sadness and anger only about half of the participants reported an olfactory elicitor, whereas significantly more named a visual cue. Olfactory emotion elicitors were mainly related to the classes of culture, plants, and food, and visual emotion elicitors were largely related to humans. This data supports the hypothesis that in the vast majority of people, few differentiated emotions can be elicited through the olfactory channel. These emotions are happiness, disgust, and anxiety.

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...

New diagnostic concept of adjustment disorders in psychosomatic outpatients – Symptom severity, willingness to change, psychotherapy motivation Objectives: Adjustment disorders (AD) represent a frequently diagnosed type of disorder for which scientific interest has been limited because of insufficient diagnostic criteria. This study presents a concept comprising cognitive, behavioural, and emotional criteria (ADNM) which investigates differences in symptom severity, willingness to change, and motivation for psychotherapy in subjects with adjustment disorders. Method: 331 outpatients were examined with a number of tools (ADNM, SCL-90-R, FPTM-23, FEVER). The ADNM is evaluated on the basis of theoretical assumptions and divides the sample into subjects with elevated and normal scores. Results: The sample comprised patients with elevated scores (61 %) and normal scores (39 %). Subjects with AD scored higher on depression, anxiety, and impulsivity (p < 0.001) as well as exhibiting elevated scores on the SCL-90-R (p < 0.001), for contemplation/action (p = 0.003 | p < 0.001), and for psychotherapy motivation (p < 0.001). Conclusion: The ADNM identifies patients experiencing stress. Further longitudinal studies should examine whether patients more frequently enter psychotherapy or not.

Objective Type-D personality—negative affectivity and social inhibition—are related to poor prognosis in cardiovascular diseases. At present, little is known about type-D personality and its stability before and after cardiac surgery. Methods One hundred twenty-six patients recommended for coronary bypass and/or valve surgery were examined at pre-surgery and 6 months post-surgery to investigate the stability of type-D (14-item Type-D Scale) and its relationship to anxiety, depression (Hospital Anxiety and Depression Scale) and quality of life (Short Form 12). Results Preoperatively, 26% were assessed to have type-D, while only 11% fulfilled type-D criteria both pre- and post-surgery. Patients were assessed and identified as belonging to one of the four type-D groups: Stable type-D (11%), non-type-D (61%), type-D pre (15%), and type-D post (13%). In comparison to the stable non-type D group, the stable type-D reported more symptoms of anxiety, depression, lower physical quality of life post-surgery, and lower mental quality of life both pre- and post-surgery. When compared to the population at large, stable type-D had more symptoms of depression pre-surgery, and more anxiety as well as lower physical and mental quality of life pre- and post-surgery. Conclusion Type-D diagnosis changed in nearly 60% of the cases post-surgery. Only those patients with stable type-D exhibited a relationship to emotional distress, such as anxiety and depression and reduced quality of life. Additional research on the critical cut-off scores and stability of type-D as it relates to critical life events would likely enhance our ability to more effectively diagnose and treat patients who are at high risk for insufficient coping.

The purpose of this study was to assess olfactory function and olfactory bulb volume in patients with acute major depression in comparison to a normal population. Twenty-one patients diagnosed with acute major depressive disorder and 21 healthy controls matched by age, sex and smoking behavior participated in this study. Olfactory function was assessed in a lateralized fashion using measures of odor threshold, discrimination and identification. Olfactory bulb volumes were calculated by manual segmentation of acquired T2-weighted coronal slices according to a standardized protocol. Patients with acute major depressive disorder showed significantly lower olfactory sensitivity and smaller olfactory bulb volumes. Additionally, a significant negative correlation between olfactory bulb volume and depression scores was detected. Their results provide the first evidence, to our knowledge, of decreased olfactory bulb volume in patients with acute major depression. These results might be related to reduced neurogenesis in major depression that could be reflected also at the level of the olfactory bulb.

This study examined whether a short-term psychosomatic intervention during pregnancy had effects on characteristics of labour and delivery as well as on the long-term course of anxiety, depression and physical complaints in pregnant in-patient women.All gynaecological and obstetric inpatients of a university hospital, who had either exhibited complications during their pregnancy or were considered high-risk pregnancies, were examined. Symptoms of anxiety and depression (HADS) and physical symptoms (GBB) were assessed by standardised questionnaires. Women with elevated scores on either the HADS or the GBB were randomly assigned to either a treatment group, which had received a psychosomatic intervention or an untreated control group. Of the n = 238 women who were assessed during their stay in our hospital, n = 135 were included in the follow-up 1-year later.More than one-third of the participants (38.7%) had elevated scores of anxiety, depression and/or physical symptoms. The psychosomatic intervention had a significant effect on anxiety scores (p = 0.006), but not on depression scores, physical complaints and characteristics of labour and delivery.Findings suggest that a short-term psychosomatic intervention can have a positive long-term effect on anxiety symptoms. Future studies are needed to show whether the reduction of anxiety symptoms in turn can lead to a reduction of postnatal complications and lower rates of disturbed mother-child interactions.

The aim of the study was to record patients’ symptoms of anxiety, depression and post-traumatic stress, as well as their subjective experience of illness, with different forms of radiotherapy and for different indications. The question is to be answered of whether more invasive techniques such as stereotactic radiotherapy involve greater stress or whether the psychological stress instead tends to be caused by the underlying disorder itself. Questionnaires were given to 240 patients after conventional radiotherapy for a malignant underlying disorder, to 80 with a benign disorder, and to 67 patients following stereotactic radiotherapy. The German version of the Hospital Anxiety and Depression Scale (HADS-D) was used to measure anxiety and depression; the Post-Traumatic Symptom Scale (PTSS-10) was used to measure symptoms related to post-traumatic stress disorder (PTSD), and there were questions about patients’ subjective experience of radiotherapy. 28% of all patients scored in the pathologic or borderline anxiety range; 26% were in the pathologic or borderline depression range. 22% of patients were above the diagnostic cutoff for the PTSS-10. No differences were evident between the three groups in terms of anxiety and stress-related symptoms. Women were significantly (p = 0.001) more severely affected by symptoms of PTSD and anxiety than men. No gender differences could be proven in terms of depression. In the HADS-D, patients with a benign underlying disorder had significantly (p < 0.05) lower depression values than the two other groups studied. Patients who had undergone stereotactic radiotherapy did not demonstrate higher values for anxiety, depression or PTS symptoms than patients treated with conventional radiotherapy. From the results submitted here it cannot be assumed that this form of treatment leads to an increased incidence of traumatic stress or even post-traumatic stress disorder (PTSD). All in all, it is the type of underlying disorder (malignant/benign), which affects the extent of psychological stress experienced by patients following radiotherapy.

Introduction Anecdotal reports from patients with smell loss provided the basic motivation for the present study on sexual dysfunction among patients with olfactory dysfunction. The aim of the present study was to investigate the sexual appetite and the subject's depression in regard to olfactory function. Methods Eighty-six patients referred to our smell and taste clinic with olfactory dysfunction were investigated. Olfactory function was assessed by means of the “Sniffin' Sticks” test battery consisting of tests for odor threshold (T), odor discrimination (D), and odor identification (I). Their results were summed up to a composite score, the so-called “TDI score.” All participants completed a questionnaire including the Beck Depression Inventory (BDI) and 11 questions for evaluation of the sexual appetite in regard to the time before the onset of olfactory dysfunction and since the olfactory dysfunction. The points received for the latter questions were summed up to the so called Sexual Appetite Index (SAI). Results Olfactory testing revealed that 38 patients were functionally anosmic, 39 patients were hyposmic, and nine patients were normosmic. The average BDI score was 11.0 ± 8.4 points. Evaluation of the SAI questionnaire revealed a significant decrease ( P = 0.003) of the score from 22.7 ± 4.5 points from the time before to 21.4 ± 4.9 points since the onset of olfactory loss. No significant correlation was found between olfactory function and the SAI since the onset of olfactory dysfunction. However, the BDI score correlated negatively with the SAI since the onset of olfactory dysfunction ( r 85 = −0.36; P = 0.001). Conclusion The present study does not confirm the hypothesis that loss of olfactory function directly impacts on sexual appetite. It seems that depression caused by olfactory loss is the main cause for the self-reported decrease in sexual appetite as the onset of olfactory dysfunction. Gudziol V, Wolff-Stephan S, Aschenbrenner K, Joraschky P, and Hummel T. Depression resulting from olfactory dysfunction is associated with reduced sexual appetite—A cross-sectional cohort study. J Sex Med 2009;6:1924–1929.

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.