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Intervention study Dysfunctional expectations are an important disorder and problem-specific mechanism that can contribute to the development and maintenance of mental disorders. Placebo research studies suggest that expectations can influence the success of treatment. In addition, studies from psychotherapy research show that the violation and modification of expectations make a central contribution to the treatment effect. Accordingly, a focus on capturing and modifying expectations can optimize treatment. We want to investigate whether a single expectation-focused psychological intervention (EFPI) is more effective in reducing disability related to social conflicts compared to a single supportive psychological intervention.

The effectiveness of (psycho-)therapeutic interventions can be improved by using mobile intervention programs with chronic pain patients (Cavanagh et al., 2019; Irvine et al., 2015; Johnson, Levesque, Broderick, Bailey, & Kerns, 2017; Toelle, Utpadel-Fischler, Haas, & Priebe, 2019). For example, by helping patients to be more active in their daily lives (Alexander & Joshi, 2016). In particular patients with higher levels of disability may benefit from the use of health apps (Ross, Jamison, Nicholls, Perry, & Nolen, 2020). Although there are now over 160,000 health apps available (Lalloo et al., 2017), the uptake rate of most patients is low (Lin, Faust, Ebert, Krämer, & Baumeister, 2018). This is partly due to low acceptance and performance expectancy towards web-based interventions (Hennemann, Beutel, & Zwerenz, 2016). However, an educational video has been shown to increase acceptance toward Internet-based interventions of depressed patients (Ebert et al., 2015). The purpose of this study is twofold: 1. investigation of use, acceptance and expectations of health apps in chronic pain patients; 2. investigation if we can increase the acceptance with a short video.

Background The supportive use of mobile intervention programs (mHealth; e.g. medical smartphone apps) in the therapy of patients with chronic pain has a high potential to improve treatment outcomes (Chatzipavlou, Christoforidou, & Vlachopoulou, 2016; Kvedar, Fogel, Elenko, & Zohar, 2016; Zhao, Yoo, Lancey, & Varghese, 2019) and shows promising study results (Johnson, Levesque, Broderick, Bailey, & Kerns, 2017; Toelle, Utpadel-Fischler, Haas, & Priebe, 2019). However, health apps are only moderately accepted by health professionals (Hennemann, Beutel, & Zwerenz, 2017). One decisive factor for this is the subjectively low rating of the potential of health apps (Hennemann et al., 2017; Liu et al., 2015). One consequence is the reduced use of such apps in medical practice (Liu et al., 2015). Goal The aim of the present study is to determine the acceptance and performance expectancy of health professionals towards health apps. Furthermore, the study aims to determine whether the performance expectancy can be increased by a short educational video showing the results of studies on the effectiveness of health apps.

This research project aims to investigate the extent to which chronic primary pain can be prevented by meditating with a meditation app (7mind). We are particularly interested in how protective factors (optimism, positive affect and resilience) and risk factors (negative affect, catastrophizing, pain-related fear and avoidance) change with frequent meditation praxis guided by the app. As in terms of effective secondary prevention, psychological risk factors should be reduced in risk groups (Flink et al., 2020; Nicholas, Linton, Watson, & Main, 2011) and protective factors strengthened at the same time (Flink et al., 2020). One approach used in the treatment of chronic pain and stress is Mindfulness-Based Stress Reduction (MBSR), which has proven to be effective in clinical and non-clinical samples (Hilton et al., 2017; Khoury, Sharma, Rush, & Fournier, 2015; Querstret, Morison, Dickinson, Cropley, & John, 2020). Thereby, mindfulness and self-compassion are assumed to be the central mechanism for the effectiveness of mindfulness interventions (Khoury et al., 2015). Since the original format of the MBSR program is very time-consuming and therefore costly, it is not suitable for low-threshold secondary prevention. However, there are already a large number of apps that pick up elements of the MBSR program. Compared to traditional procedures or computer-based programs, apps offer the advantage that they can be used anytime and anywhere (Chittaro & Vianello, 2014). Although there is currently little research in this area, initial studies show that mindfulness apps can also achieve similar effects (Chittaro & Vianello, 2016; Howells, Ivtzan, & Eiroa-Orosa, 2016; Möltner, Leve, & Esch, 2018). Based on the current state of research, the question arises as to whether an effective secondary prevention of chronic primary pain can be achieved by means of a mindfulness app that focuses on reducing risk factors and promoting protective factors. To investigate this research question, a subclinical pain population is examined over a period of three months.

Based on the prominent Fear-Avoidance Model Graded in vivo Exposure was adapted to the treatment of chronic low back pain (CLBP) patients. Concerning the selection of patients and the evaluation of treatment effects adequate measurements e.g. for pain-related disability are crucial. First studies found positive effects for exposure therapy in CLBP. But, results of experimental studies questioned the generalization of exposure experiences. This dissertation was realized in the context of a randomized controlled trial evaluating the effectiveness of Graded in vivo Exposure in CLBP, which is described in study I. The dissertation deals with two main subjects. First, we developed a German version of the Quebec Back Pain Disability Scale (QBPDS) and analysed its psychometric properties in a sample of N = 180 CLBP sufferers. The German version approved to be reliable, valid and comparable to other national versions. The exploration of the underlying factor structure proposed a modification of the original six factors into a four-factor solution. Second, the generalization of exposure effects was investigated in N = 53 CLBP patients. While confronted to an unknown fear-eliciting movement in a novel context, participants of the exposure group showed less harm expectations compared to participants who received either cognitive behavioral therapy or no treatment at all. No group differences were found for pain expectations indicating a specific exposure effect which is the reduction of harm expectations as an aspect of fear avoidance. In conclusion, this dissertation provides a German version of the Quebec Back Pain Disability Scale, which demonstrated good psychometric qualities and is comparable to other international versions. Further, we demonstrated the successful generalization of exposure effects in CLBP giving evidence for the long term stability of this treatment., Basierend auf dem Fear-Avoidance Modell, welches die Chronifizierung von Rückenschmerzen beschreibt, wurde das Verfahren der Graduierten Exposition in vivo auf die Behandlung chronischer Rückenschmerzpatienten1 übertragen. Im Sinne des „tailored treatments“ richtet sich dieser spezifische Behandlungsansatz an eine Subgruppe chronischer Rückenschmerzpatienten. Sowohl zur Auswahl geeigneter Patienten als auch zur Überprüfung der Effektivität des neuen Therapieansatzes sind adäquate Messinstrumente u.a. zur Erfassung von „disability“ essentiell. Erste Hinweise auf die Effektivität von Graduierter Exposition in vivo bei chronischen Rückenschmerzpatienten liegen vor. Experimentelle Studien stellen jedoch die Generalisierung der Therapieeffekte auf andere Kontexte in Frage. Im Kontext einer randomisiert-kontrollierten Studie zur Überprüfung der Effektivität von Graduierter Exposition in vivo bei der Behandlung chronischer Rückenschmerzpatienten, deren Studiendesign und Intervention in Studie I beschrieben wurde, sollen in der vorliegenden Dissertation zwei Themenschwerpunkte bearbeitet werden. Erstens wurde an einer Stichprobe von N = 180 chronischen Rückenschmerzpatienten eine deutsche Version der weitverbreiteten Quebec Back Pain Disability Scale (QBPDS) entwickelt und auf deren Gütekriterien untersucht (Studie II). Die deutsche Version zeigte gute psychometrische Qualitäten und erwies sich als vergleichbar mit anderen nationalen Versionen der Skala. Die Überprüfung der Faktorstruktur ergab vier zugrunde liegende Faktoren, sodass eine Modifikation der Originalversion vorgeschlagen wurde. Durch die Entwicklung einer validen Version der QBPDS, liegt nun auch im deutschen Sprachraum ein Messinstrument vor, welches vor allem im Kontext von Graduierter Exposition in vivo eingesetzt werden kann. Zweitens wurde an einer Stichprobe von N = 53 chronischen Rückenschmerzpatienten untersucht, ob sich expositions-spezifische Lernerfahrungen auf einen anderen Kontext außerhalb der Therapie übertragen lassen (Studie III). Bei der Konfrontation mit einem neuen Bewegungsstimulus in einem unbekannten Kontext zeigte sich, dass die Schädlichkeitserwartungen bei Patienten, die eine Expositionsbehandlung erhielten, deutlich geringer ausfielen als bei Patienten der Vergleichsgruppen (Verhaltenstherapie, keine Therapie). In Bezug auf Schmerzerwartungen zeigten sich keine Gruppenunterschiede, was darauf hindeutet, dass ein spezifischer Effekt von Exposition in der Veränderung von Schädlichkeitsannahmen liegt. Die vorliegende Arbeit konnte eine valide und reliable deutsche Version der Quebec Back Pain Disability Scale entwickeln, welche die internationale Vergleichbarkeit von Studienergebnissen des RCTs ermöglicht. Weiterhin konnte gezeigt werden, dass expositions-spezifische Therapieerfahrungen, wie die Reduktion kognitiver Aspekte von Fear-Avoidance, generalisierbar sind und damit auch auf langfristig stabile Therapieeffekte durch Graduierte Exposition in vivo hinweisen.