Search

To assess the current status of psychodynamic therapy (PDT) as an empirically supported treatment (EST), we carried out a pre‐registered systematic umbrella review addressing the evidence for PDT in common mental disorders in adults, based on an updated model for ESTs. Following this model, we focused on meta‐analyses of randomized controlled trials (RCTs) published in the past two years to assess efficacy. In addition, we reviewed the evidence on effectiveness, cost‐effectiveness and mechanisms of change. Meta‐analyses were evaluated by at least two raters using the proposed updated criteria, i.e. effect sizes, risk of bias, inconsistency, indirectness, imprecision, publication bias, treatment fidelity, and their quality as well as that of primary studies. To assess the quality of evidence we applied the GRADE system. A systematic search identified recent meta‐analyses on the efficacy of PDT in depressive, anxiety, personality and somatic symptom disorders. High quality evidence in depressive and somatic symptom disorders and moderate quality evidence in anxiety and personality disorders showed that PDT is superior to (inactive and active) control conditions in reducing target symptoms with clinically meaningful effect sizes. Moderate quality evidence suggests that PDT is as efficacious as other active therapies in these disorders. The benefits of PDT outweigh its costs and harms. Furthermore, evidence was found for long‐term effects, improving functioning, effectiveness, cost‐effectiveness and mechanisms of change in the aforementioned disorders. Some limitations in specific research areas exist, such as risk of bias and imprecision, which are, however, comparable to those of other evidence‐based psychotherapies. Thus, according to the updated EST model, PDT proved to be an empirically‐supported treatment for common mental disorders. Of the three options for recommendation provided by the updated model (i.e., “very strong”, “strong” or “weak”), the new EST criteria suggest that a strong recommendation for treating the aforementioned mental disorders with PDT is the most appropriate option. In conclusion, PDT represents an evidence‐based psychotherapy. This is clinically important since no single therapeutic approach fits all psychiatric patients, as shown by the limited success rates across all evidence‐based treatments.

In Germany, cognitive-behavioral therapy, psychodynamic therapy, and systemic therapy are scientifically and legally approved as suitable procedures for treating mental disorders. While all methods have provided empirical evidence of their effectiveness in adults according to defined criteria of the "Scientific Advisory Board for Psychotherapy" (in German: "Wissenschaftlicher Beirat Psychotherapie"), i. e., the official board which decides upon the formal scientific approval of psychotherapeutic approaches in Germany, an evaluation is lacking for the psychodynamic methods in children and adolescents. Against this background, we evaluated the available empirical data for psychodynamic therapy in children and adolescents based on the methods paper of the "Scientific Advisory Board for Psychotherapy" (2019; version 2.9). Published reviews served as the basis for identifying relevant studies, supplemented by a systematic literature search. We identified 91 potentially relevant studies but could not consider the majority of these due to formal exclusion criteria (mainly not disorder-specific, no control group). Up to 26 of the remaining studies provide evidence of efficacy as defined by the "Scientific Advisory Board for Psychotherapy". These cover 10 of the 18 areas of application as defined by the "Scientific Advisory Board for Psychotherapy". According to our evaluation, the reviewed studies provide empirical evidence for the three most relevant areas of application (i. e., affective disorders; anxiety disorders and obsessive-compulsive disorders; hyperkinetic disorders and conduct disorders). Thus, the available evidence supports the suitability of psychodynamic therapy as a method for the treatment of children and adolescents.

Mental disorders represent a worldwide public health concern. Psychotherapies and pharmacotherapies are recommended as first line treatments. However, evidence has emerged that their efficacy may be overestimated, due to a variety of shortcomings in clinical trials (e.g., publication bias, weak control conditions such as waiting list). We performed an umbrella review of recent meta‐analyses of randomized controlled trials (RCTs) of psychotherapies and pharmacotherapies for the main mental disorders in adults. We selected meta‐analyses that formally assessed risk of bias or quality of studies, excluded weak comparators, and used effect sizes for target symptoms as primary outcome. We searched PubMed and PsycINFO and individual records of the Cochrane Library for meta‐analyses published between January 2014 and March 2021 comparing psychotherapies or pharmacotherapies with placebo or treatment‐as‐usual (TAU), or psychotherapies vs. pharmacotherapies head‐to‐head, or the combination of psychotherapy with pharmacotherapy to either monotherapy. One hundred and two meta‐analyses, encompassing 3,782 RCTs and 650,514 patients, were included, covering depressive disorders, anxiety disorders, post‐traumatic stress disorder, obsessive‐compulsive disorder, somatoform disorders, eating disorders, attention‐deficit/hyperactivity disorder, substance use disorders, insomnia, schizophrenia spectrum disorders, and bipolar disorder. Across disorders and treatments, the majority of effect sizes for target symptoms were small. A random effect meta‐analytic evaluation of the effect sizes reported by the largest meta‐analyses per disorder yielded a standardized mean difference (SMD) of 0.34 (95% CI: 0.26‐0.42) for psychotherapies and 0.36 (95% CI: 0.32‐0.41) for pharmacotherapies compared with placebo or TAU. The SMD for head‐to‐head comparisons of psychotherapies vs. pharmacotherapies was 0.11 (95% CI: –0.05 to 0.26). The SMD for the combined treatment compared with either monotherapy was 0.31 (95% CI: 0.19‐0.44). Risk of bias was often high. After more than half a century of research, thousands of RCTs and millions of invested funds, the effect sizes of psychotherapies and pharmacotherapies for mental disorders are limited, suggesting a ceiling effect for treatment research as presently conducted. A paradigm shift in research seems to be required to achieve further progress.

In Germany, cognitive-behavioral therapy, psychodynamic therapy, and systemic therapy are scientifically and legally approved as suitable procedures for treating mental disorders. While all methods have provided empirical evidence of their effectiveness in adults according to defined criteria of the "Scientific Advisory Board for Psychotherapy" (in German: "Wissenschaftlicher Beirat Psychotherapie"), i. e., the official board which decides upon the formal scientific approval of psychotherapeutic approaches in Germany, an evaluation is lacking for the psychodynamic methods in children and adolescents. Against this background, we evaluated the available empirical data for psychodynamic therapy in children and adolescents based on the methods paper of the "Scientific Advisory Board for Psychotherapy" (2019; version 2.9). Published reviews served as the basis for identifying relevant studies, supplemented by a systematic literature search. We identified 91 potentially relevant studies but could not consider the majority of these due to formal exclusion criteria (mainly not disorder-specific, no control group). Up to 26 of the remaining studies provide evidence of efficacy as defined by the "Scientific Advisory Board for Psychotherapy". These cover 10 of the 18 areas of application as defined by the "Scientific Advisory Board for Psychotherapy". According to our evaluation, the reviewed studies provide empirical evidence for the three most relevant areas of application (i. e., affective disorders; anxiety disorders and obsessive-compulsive disorders; hyperkinetic disorders and conduct disorders). Thus, the available evidence supports the suitability of psychodynamic therapy as a method for the treatment of children and adolescents.Zusammenfassung In Deutschland sind Verhaltenstherapie, psychoanalytisch begründete Verfahren und systemische Therapie wissenschaftlich und sozialrechtlich als geeignete Verfahren zur Behandlung von psychischen Störungen anerkannt. Während alle Verfahren den empirischen Nachweis ihrer Wirksamkeit bei Erwachsenen gemäß definierter Kriterien des „Wissenschaftlichen Beirats Psychotherapie“ als dem offiziellen Gremium, das über die formale wissenschaftliche Anerkennung von psychotherapeutischen Verfahren in Deutschland entscheidet, erbracht haben, fehlt ein entsprechender Nachweis bei Kindern und Jugendlichen für die psychoanalytisch begründeten Verfahren. Vor diesem Hintergrund wurde die empirische Datenlage für psychoanalytisch begründete Verfahren bei Kindern und Jugendlichen auf der Grundlage des Methodenpapiers des „Wissenschaftlichen Beirats Psychotherapie“ (2019; Version 2.9) evaluiert. Als Grundlage zur Identifikation relevanter Studien dienten veröffentlichte Übersichtsarbeiten, die durch eine systematische Literaturrecherche ergänzt wurden. Insgesamt wurden 91 potenziell relevante Studien überprüft, von denen der Großteil jedoch aufgrund formaler Ausschlusskriterien (v. a. nicht störungsspezifisch, keine Kontrollgruppe) nicht weiter berücksichtigt werden konnte. Von den verbliebenen Studien konnten bis zu 26 als Wirksamkeitsnachweise im Sinne des Wissenschaftlichen Beirats Psychotherapie klassifiziert werden. Diese verteilen sich auf 10 der 18 vom Wissenschaftlichen Beirat Psychotherapie definierten Anwendungsbereiche. Gemäß der vorliegenden Evaluation liefert die vorhandene empirische Studienlage hinreichend Evidenz für die drei versorgungsrelevantesten Anwendungsbereiche (Affektive Störungen; Angststörungen und Zwangsstörungen; Hyperkinetische Störungen und Störungen des Sozialverhaltens und der Emotionen) und belegt damit zugleich die Eignung psychoanalytisch begründeter Verfahren für die Behandlung von Kindern und Jugendlichen.

Background: Mentalization processes seem to be of high relevance for social learning and seem important in all psychotherapies. The exact role of mentalization processes in psychotherapy is still unknown. The aim of the present systematic review is to investigate whether mentalization is related to the therapeutic outcome and, if so, whether it has a moderating, mediative, or predictive function. Method: A systematic review with an electronic database search was conducted. A total of 2567 records were identified, and 10 studies were included in the final synthesis. Results: Psychotherapy research is still in an initial phase of examining and understanding the impact of mentalization on psychotherapy outcome. The small number of studies and the executed study designs and statistical analyses indicate the possible role that mentalization has in psychotherapy. Conclusion: Generally, strongly elaborated study designs are needed to identify the role of mentalization in psychotherapy. Mentalization seems to be differently represented in differential treatment approaches. Nevertheless, it should be noted that the patient’s mentalizing capacity seems to be relevant to the psychotherapy process. Psychotherapies should be adapted to this.

AimsThe aim of this study was to reanalyse the data from Cuijpers et al.'s (2018) meta-analysis, to examine Eysenck's claim that psychotherapy is not effective. Cuijpers et al., after correcting for bias, concluded that the effect of psychotherapy for depression was small (standardised mean difference, SMD, between 0.20 and 0.30), providing evidence that psychotherapy is not as effective as generally accepted.MethodsThe data for this study were the effect sizes included in Cuijpers et al. (2018). We removed outliers from the data set of effects, corrected for publication bias and segregated psychotherapy from other interventions. In our study, we considered wait-list (WL) controls as the most appropriate estimate of the natural history of depression without intervention.ResultsThe SMD for all interventions and for psychotherapy compared to WL controls was approximately 0.70, a value consistent with past estimates of the effectiveness of psychotherapy. Psychotherapy was also more effective than care-as-usual (SMD = 0.31) and other control groups (SMD = 0.43).ConclusionsThe re-analysis reveals that psychotherapy for adult patients diagnosed with depression is effective.

ispartof: LANCET PSYCHIATRY vol:8 issue:2 pages:96-97 ispartof: location:England status: published

Objective: Background regarding a recent debate between Cuijpers et al. (2019a, b) and the authors (Munder et al. 2019) about the efficacy of psychotherapy for depression is given. Method: A main reason for the discrepancy in Cuijpers et al.'s and our conclusions is discussed. Results: In our view the discrepancy is due, among other things, to a blurred distinction between questions of relative and absolute efficacy of psychotherapy. Although the efficacy of psychotherapy vis-à-vis alternative treatments may be ambiguous, there can be little doubt about the benefits of psychotherapy relative to no treatment. Conclusion: We do not think that raising fundamental concerns about the value of psychotherapy is a service to the field. We argue that moving the field forward requires a focus on how psychotherapy works and how the access to psychotherapy can be increased. ispartof: ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE vol:65 issue:2 pages:178-182 ispartof: location:Germany status: published

ispartof: PSYCHOLOGICAL MEDICINE vol:49 issue:5 pages:876-878 ispartof: location:England status: published

Trotz stetig wachsender Evidenz fur psychodynamische Therapie i. Allg. wird der empirische Status psychodynamischer Langzeittherapie weiterhin kontrovers diskutiert. Lange Zeit fehlten uberzeugende Wirksamkeitsstudien zu psychodynamischer Langzeittherapie. Die vorliegende Arbeit gibt einen Uberblick uber die vorhandenen systematischen Reviews zur Evidenz fur psychodynamische Langzeittherapie. Die Befunde sprechen dafur, dass psychodynamische Langzeittherapie bei verschiedenen und insbesondere bei komplexeren Storungen grose sowie uberdauernde Effekte erzielen kann, die nach dem Behandlungsende haufig noch weiterzunehmen. Im Vergleich zu kurzeren oder weniger intensiven Psychotherapieverfahren erweist sich psychodynamische Langzeittherapie in den meisten Ergebnisdimensionen als signifikant uberlegen. Erste Wirtschaftlichkeitsstudien geben Hinweise, dass psychodynamische Langzeittherapie langfristig auch kosteneffizient sein kann. Im Vergleich von randomisierten kontrollierten Studien und Beobachtungsstudien zeigen sich keine signifikanten Unterschiede bezuglich der ermittelten Behandlungsergebnisse. Allerdings werden die vorliegenden Wirksamkeitsnachweise fur psychodynamische Langzeittherapie von Vertretern anderer therapeutischer Orientierungen und Forschungstraditionen immer wieder infrage gestellt. Die geauserte Kritik wurde wiederholt beantwortet und konnte als zum grosten Teil unberechtigt zuruckgewiesen werden. Nichtsdestotrotz sind weitere Studien dringend notwendig, um die Evidenzbasis fur psychodynamische Langzeittherapie zu erweitern und differenziertere Aussagen bezuglich der Wirksamkeit von spezifischen Formen psychodynamischer Langzeittherapie bei spezifischen psychischen Storungen im Vergleich zu spezifischen Behandlungsalternativen zu ermoglichen.

BackgroundPersonality disorder is a severe health issue. However, the epidemiology of personality disorders is insufficiently described and surveys report very heterogeneous rates.AimsWe aimed to conduct a meta-analysis on the prevalence of personality disorders in adult populations and examine potential moderators that affect heterogeneity.MethodWe searched PsycINFO, PSYNDEX and Medline for studies that used standardised diagnostics (DSM-IV/-5, ICD-10) to report prevalence rates of personality disorders in community populations in Western countries. Prevalence rates were extracted and aggregated by random-effects models. Meta-regression and sensitivity analyses were performed and publication bias was assessed.ResultsThe final sample comprised ten studies, with a total of 113 998 individuals. Prevalence rates were fairly high for any personality disorder (12.16%; 95% CI, 8.01–17.02%) and similarly high for DSM Clusters A, B and C, between 5.53 (95% CI, 3.20–8.43%) and 7.23% (95% CI, 2.37–14.42%). Prevalence was highest for obsessive–compulsive personality disorder (4.32%; 95% CI, 2.16–7.16%) and lowest for dependent personality disorder (0.78%; 95% CI, 0.37–1.32%). A low prevalence was significantly associated with expert-rated assessment (versus self-rated) and reporting of descriptive statistics for antisocial personality disorder.ConclusionsEpidemiological studies on personality disorders in community samples are rare, whereas prevalence rates are fairly high and vary substantially depending on samples and methods. Future studies investigating the epidemiology of personality disorders based on the DSM-5 and ICD-11 and models of personality functioning and traits are needed, and efficient treatment should be a priority for healthcare systems to reduce disease burden.Declaration of interestNone.

With more than 100 non-inferiority or equivalence trials published per year in many areasof research (Piaggio et al., 2012), statistical and methodological issues involved in these trialsbecome increasingly important. A recent article by Rief and Hofmann (2018) suggests, however,that some of these issues are not sufficiently clear. For this reason, central issues will bediscussed here and some misunderstandings will be addressed.

Einleitung: Die Qualitat von Psychotherapiestudien wird immer wieder als moglicher Einflussfaktor auf das ermittelte Behandlungsergebnis diskutiert. Da sich in einer aktuellen Metaanalyse zur Wirksamkeit von stationarer Psychotherapie im deutschsprachigen Raum hochst uneinheitliche Behandlungseffekte zeigten, soll uberpruft werden, inwiefern die Heterogenitat der ermittelten Behandlungseffekte mit der Studienqualitat zusammenhangt. Material und Methoden: Die Qualitat der 103 eingeschlossenen Studien wurde anhand von 19 Kriterien zur allgemeinen Studienqualitat sowie zur internen und externen Validitat beurteilt. Der Zusammenhang zwischen Studienqualitat und Behandlungseffekt (Effektstarke Hedges’ g im Global Severity Index der Symptomcheckliste (SCL GSI) sowie einem Gesamtmas uber diverse Ergebnisparameter) wurde mittels univariater Korrelationsanalysen sowie Metaregression gepruft. Ergebnisse: Insgesamt zeigt sich eine hohe Varianz der Studienqualitat sowohl zwischen den eingeschlossenen Arbeiten als auch zwischen den verschiedenen Qualitatskriterien. Im Durchschnitt kann die Qualitat der eingeschlossenen Studien als mittelmasig beurteilt werden. Zwischen den meisten Qualitatskriterien und dem Behandlungseffekt liegen keine signifikanten Zusammenhange vor. Tendenziell zeigen hoherwertige Studien hohere Behandlungseffekte. Diskussion: Die Operationalisierung einzelner Qualitatsaspekte erscheint noch optimierbar, da einige Kriterien fast nie, andere hingegen immer erfullt wurden. Da sich je nach Kriterium sowohl positive als auch negative Zusammenhange mit den Behandlungseffekten zeigen, kann die Studienqualitat keinesfalls als einheitliches Konstrukt betrachtet werden. Die Bildung eines Qualitats-Gesamtscores erscheint wenig sinnvoll. Schlussfolgerung: In Hinblick auf die hier uberprufte Metaanalyse zur Wirksamkeit psychotherapeutischer Krankenhausbehandlung ist trotz der Berucksichtigung einiger qualitativ weniger hochwertiger Studien keine Uberschatzung der aggregierten Behandlungsergebnisse anzunehmen.

Spontaneity has been defined as an adaptive response to varying situational conditions. In this regard, it may be considered as a major contributor to well-being and mental health which could play an essential role within the context of psychotherapy. Despite its potential importance empirical research on spontaneity has been lacking until recently. As a remedy, the present paper introduces the German translation of the Revised Spontaneity Assessment Inventory (SAI-R; Kipper and Shemer, Group Psychother Psychodrama Sociom, 59(3):127–136, 2006) as a qualified self-report measure of spontaneity.

Background: With regard to cluster B personality disorders, most psychotherapeutic treatments focus on borderline personality disorder. Evidence-based treatments for patients with other cluster B personality disorders are not yet available. Psychoanalytic-interactional therapy (PIT) represents a transdiagnostic treatment for severe personality disorders. PIT has been applied in clinical practice for many years and has proven effective in open studies. In a randomized controlled trial, we compared manual-guided PIT to nonmanualized pychodynamic therapy by experts in personality disorders (E-PDT) in patients with cluster B personality disorders. Methods: In an inpatient setting, patients with cluster B personality disorders were randomly assigned to manual-guided PIT (n = 64) or nonmanualized E-PDT (n = 58). In addition, a quasi-experimental control condition was used (n = 46) including both patients receiving treatment as usual and patients waiting for treatment. Primary outcomes were level of personality organization and overall psychological distress. As secondary outcomes, depression, anxiety and interpersonal problems were examined. Results: No significant improvements were found in the control patients. Both PIT and E-PDT achieved significant improvements in all outcome measures and were superior to the control condition. No differences were found between PIT and E-PDT in any outcome measure at the end of treatment. The type of cluster B personality disorder had no impact on the results. Conclusions: In an inpatient setting, both PIT and E-PDT proved to be superior to a control condition in cluster B personality disorders. In a head-to-head comparison, both treatments appeared to be equally effective. Further research on the treatment of cluster B personality disorders is required.

OBJECTIVE Several studies document the effectiveness of psychotherapeutic hospital treatment in German speaking countries, although results show a considerable heterogeneity. METHODS Based on data from a comprehensive meta-analysis, we investigated the impact of potential study-level predictors on average treatment duration and average symptom severity at discharge using meta-regression. RESULTS Selected predictors explain 55 and 78 percent of between-study variance of mean treatment duration and mean symptom severity at discharge, respectively. Samples of younger patients, samples including more patients with personality disorders, samples treated in specialist centers and samples from older investigations showed longer average treatment durations. Studies in patient populations with less severe symptoms at intake and a lower proportion of personality disorders showed lower impairment at discharge. We found a statistically significant positive association between severity of symptoms at discharge and treatment duration. CONCLUSION Regarding the higher symptom load at discharge in patients with higher impairment at intake and personality disorders, treatment concepts for these groups require improvement, for example through flexible treatment durations.

Psychometric instruments are commonly applied in psychotherapeutic research and care for the baseline assessment of symptoms, the planning of therapeutic interventions, the assessment of the longitudinal course of symptoms and outcomes of therapeutic interventions as well as quality management of care. Psychometric properties as well as economic aspects should be considered in the selection of specific instruments. It is assumed that users of psychometric instruments face a great variety of instruments and related information. For that reason, it seems challenging to absorb the current knowledge and to integrate it into clinical practice and research. Thus, it is likely that well-known, established and easily accessible instruments are commonly used, while new developed instruments might not be disseminated in research and healthcare.Based on available international review models, the working group "Psychometrics and Psychodiagnostics" of the German College of Psychosomatic Medicine (DKPM) has developed and tested a review model specifically tailored for psychotherapeutic research and care.The different steps of development, as well as the final review model based on the consensus of the working group are presented. The review model contains 6 generic terms (reliability, validity, objectivity, reference groups and aspects of application) with 21 different criteria to be assessed with 0-3 asterisks (*). The criteria are clearly operationalized and the practical use of the review model is explained and discussed.With the review model for the assessment of psychometric instruments a well-defined evaluation system is made available for research and clinical practice which has been developed by an expert group. The review model facilitates systematic, transparent and comparative evaluation of psychometric instruments along clearly defined criteria. It also supports the selection of psychometric instruments in research and care. Next, the working group aims at disseminating and implementing the review model as well asthe application and publication of reviews for different psychometric instruments based on the review model.

Objective: Psychodynamically based brief psychotherapy is frequently used in clinical practice for a range of common mental disorders in children and adolescents. To our knowledge, there have been no meta-analyses to evaluate the effectiveness of these therapies. Method: After a broad search, we meta-analyzed controlled outcome studies of short-term psychodynamic psychotherapies (STPP, 40 or fewer sessions). We also performed sensitivity analyses and evaluated the risk of bias in this body of studies. Results: We found 11 studies with a total of 655 patients covering a broad range of conditions including depression, anxiety disorders, anorexia nervosa, and borderline personality disorder. STPP did not separate from what were mostly robust treatment comparators, but there were some subgroup differences. Robust (g ¼ 1.07, 95% CI ¼ 0.80–1.34) within group effect sizes were observed suggesting the treatment may be effective. These effects increased in follow up compared to post treatment (overall, g ¼ 0.24, 95% CI ¼ 0.00–0.48), suggesting a tendency toward increased gains. Heterogeneity was high across most analyses, suggesting that these data need be interpreted with caution. Conclusion: This review suggests that STPP may be effective in children and adolescents across a range of common mental disorders. J. Am. Acad. Child Adolesc. Psychiatry, 2013;52(8):863–875. Key Words: anxiety, child, depression, psychodynamic, psychotherapy

Summary The efficacy of psychodynamic therapy: a controversy There is growing evidence from randomized controlled trials supporting the efficacy of psychodynamic psychotherapy (PDT) in specific mental disorders. Yet the evidence for the efficacy of psychodynamic psychotherapy has not gone unchallenged. Several responses have addressed these concerns, showing that most of the criticism was not justified. Nevertheless, the evidence for psychodynamic psychotherapy continues to be frequently ignored, criticized or presented in a distorted way. A recent controversy published in the Nervenarzt may serve as an illustrative example, which is discussed here more in detail. This example shows that some authors are not interested in a truly scientific discussion, but rather try to discredit a rival method of psychotherapy and its scientific representatives for political reasons.

The efficacy of psychodynamic therapy (PDT) is well established1 ,2 and has been acknowledged by independent review committees.3 ,4 Stefan Hofmann, however, again questioned the empirical status of PDT.4 When confronted with evidence refuting his claims,4 Hofmann ignored the data and repeated his critique in this journal.5 We again address Hofmann’s claims. Hofmann criticised PDT as a ‘poorly defined concept’, claiming that all therapies including cognitive–behavioural therapy (CBT) would meet its definition.5 However, there is evidence that PDT and CBT can be significantly differentiated by blind raters (eg, references # 26, 27, 40, 42, 46, 64, 67, 70, 81 in Leichsenring et al 1)—also showing adequate treatment integrity in contrast to Hofmann's claims. …

Based on the German original questionnaire of the "Hamburger modules for measuring generic aspects of psycho-social health in the therapeutic practice" (HEALTH-49) a Turkish speaking version (T-HEALTH-49) was cross-cultural sensitively developed. The psychometric properties have been analysed by means of a clinical sample of Turkish speaking patients (N=311). The questionnaire proves to be practical, the dimensional structure and the relatively independence of the modules have been confirmed by factor analysis. The single scales are characterised by satisfactory to high reliability and satisfactory validity. The T-HEALTH-49 considers adequately psychosocial aspects in diagnostic, therapy planning and quality assurance. The questionnaire can be downloaded for free (www.hamburger-module.de).

Background: Treatment integrity is defined as the extent to which a treatment is carried out as intended. It includes several interrelated components (e.g. therapy adherence, therapist competence and therapy differentiation). Treatment integrity is regarded to play an essential role in psychotherapy outcome research. Objective: This article discusses (1) conceptual aspects, (2) empirical results and (3) methodological problems of research on treatment integrity. Results: (1) Therapy integrity refers to different aspects of experimental validity. It is usually discussed with regard to internal validity. Maybe even more important, however, treatment integrity also refers to construct validity. Treatment integrity is also related to external validity and validity of statistical conclusions. (2) Results for the relationship between treatment integrity (adherence to a treatment model and competent delivery of techniques) and outcome are heterogeneous and suggest that the relationship between outcome and treatment integrity is not yet clear. Even in studies which found a relationship between treatment integrity and outcome, the proportion of variance explained by intended techniques was between 10% and 30%. Thus, the majority of variance was not explained by intended techniques. (3) Methodological problems may contribute to the lack of consistent results. As most results come from randomized controlled efficacy studies, the ranges of data for both outcome and adherence/competence may be restricted by the selection of patients and therapists, as well as by training of therapists, manualization and monitoring of treatment. These factors attenuate the association between treatment integrity and outcome. Other factors that may contribute to the inconsistent results are unreliability of measures, instability of adherence and competence during the process of psychotherapy or nonlinear relationships between treatment integrity and outcome. Conclusions: Further studies are required that address the relationship between adherence, competence and outcome, especially for those methods of psychotherapy that were shown to be effective in a particular disorder. Factors that moderate or mediate the relationship between outcome and therapy integrity should be included. Due to their high level of standardization, randomized controlled efficacy studies seem to be only of limited use to study the relationship between treatment integrity and outcome. The recent shift from a single-disorder focus of the traditional manualized interventions to transdiagnostic, modular and component-based interventions may lead to a change in the conceptualization of treatment integrity. It allows for a more flexible use of interventions while maintaining treatment integrity. This shift may both enhance the external validity of studies using manualized treatments and lead to more consistent results regarding the relationship between treatment integrity and outcome.

BackgroundDose–effect relationship data suggest that short-term psychotherapy is insufficient for many patients with chronic distress or personality disorders (complex mental disorders).AimsTo examine the comparative efficacy of long-term psychodynamic psychotherapy (LTPP) in complex mental disorders.MethodWe conducted a meta-analysis of controlled trials of LTPP fulfilling the following inclusion criteria: therapy lasting for at least a year or 50 sessions; active comparison conditions; prospective design; reliable and valid outcome measures; treatments terminated. Ten studies with 971 patients were included.ResultsBetween-group effect sizes in favour of LTPP compared with less intensive (lower dose) forms of psychotherapy ranged between 0.44 and 0.68.ConclusionsResults suggest that LTPP is superior to less intensive forms of psychotherapy in complex mental disorders. Further research on long-term psychotherapy is needed, not only for psychodynamic psychotherapy, but also for other therapies.

Background: The Health of the Nation Outcome Scales (HoNOS) is a clinician-rated instrument for the differentiated measurement of severity in patients with mental disorder. Item 8 of the instrument, assessing ‘Other mental and behavioral problems’, is particularly relevant for patients with affective disorders, anxiety disorders, and eating and personality disorders. However, some studies have shown that the scale possesses unsatisfactory psychometric properties. The objective of the present study was therefore to validate the psychometric properties of a more specified version of the HoNOS-D item 8. Methods: The instrument’s reliability and validity were tested using a large, representative, clinical sample of patients with mental disorders (study 1: n = 1,918 and n = 1,357). Additional tests of reliability and criterion validity were performed using a further clinical sample of patients with mental disorders (study 2: N = 55). Results: The extended version of the HoNOS provides a differentiated picture of additional problem areas for the patient. Although inter-rater reliability indicates a need for more detailed instructions, the problem areas of item 8 proved on the whole to be suitable for measuring the extent and severity of mental problems that are present in addition to the primary problem. Conclusion: In order to make the extended assessment of the HoNOS useful for clinical routine practice, a supplemental glossary is needed.

The Health of the Nation Outcome Scales (HoNOS) is an internationally-established clinician-rating instrument for the differential assessment of the severity of patients with mental disorders. The aim of this study was to examine the validity of the German version of the HoNOS (HoNOS-D). Evaluation of validity, including factor validity, convergent and discriminant validity and sensitivity to change, was conducted on a large, virtually representative, clinical sample of patients with mental disorders in inpatient psychotherapy (Study 1, N = 3169). Additional assessment of criterion-based validity was completed using another clinical sample of patients with mental disorders (Study 2, N = 55). Although factor validity of the HoNOS-D and its total score could not be confirmed as expected, the majority of single items of the HoNOS-D proved to be valid in terms of convergent validity, criterion-based validity and sensitivity to change. Hence, single items, rather than the total score of the HoNOS-D, can be recommended for obtaining a picture of the impairment of patients with mental disorders in the clinical setting.

OBJECTIVE: Quality of life is a major criterion of the outcome of psychotherapeutic interventions. The concept of quality of life emphasizes patient self-ratings. However, they can be burdensome or inappropriate in some cases. Therefore we have compared self-ratings and clinician-ratings of quality of life. METHODS: Self- and clinician-ratings of the SF-8 (1-week recall version) were measured from consecutive samples of 1 812 inpatients from eleven psychotherapeutic clinics at admission and at discharge six weeks later. A physical summary score (PSS) and a mental summary score (MSS) were calculated. Pearson product-moment correlations were used. RESULTS: Self- and clinician-ratings of the PSS correlate r=0.48 at admission and r=0.58 at discharge, of the MSS r=0.46 and r=0.51, respectively. Concerning single items we find the highest correlation for item 4 (bodily pain: r=0.53 and r=0.55), the lowest for item 6 (social functioning: r=0.26 and r=0.30). Change scores of the PSS correlate r=0.20, of the MSS r=0.32. Correlations differ between diagnostic groups: Correlations are low for patients with either schizophrenia (F2), depressive episode (F32) or personality disorder (F60-62), comparatively higher for patients with dysthymia. Comparing correlations across the 11 clinics reveals substantial differences, for the MSS ranging from r=0.38 to r=0.58 at admission and r=0.27 to r=0.68 at discharge. CONCLUSION: Patient self-ratings of quality of life as a psychotherapeutic outcome measure using the SF-8 Health Survey could not be substituted by clinician-ratings, they should be used as complements.

Zusammenfassung Fragestellung: Der {!HEALTH}-Fragebogen, der in seiner Ursprungsversion 79 Items umfasst, soll der multidimensionalen Erfassung generischer Aspekte von psychosozialer Gesundheit dienen. Methode: Auf der Grundlage umfangreicher klinischer und gesunder Stichproben (n = 1.548 Patienten aus stationarer psychosomatischer Rehabilitation, n = 5.630 Patienten aus der primararztlichen Versorgung) wurde er verkurzt und einer umfassenden psychometrischen Uberprufung unterzogen. Ergebnisse: Der verkurzte Fragebogen umfasst 49 Items (»{!HEALTH-49}«), die sechs eigenstandigen Modulen mit insgesamt neun Skalen zugeordnet sind (Somatoforme Beschwerden, Depressivitat, Phobische Angste, Psychisches Wohlbefinden, Interaktionelle Schwierigkeiten, Selbstwirksamkeit, Aktivitat und Partizipation, Soziale Unterstutzung und Soziale Beeintrachtigung). Er erweist sich als praktikables Instrument. Die dimensionale Struktur und die relative Eigenstandigkeit der entwickelten Module lassen sich faktorenanalytisch gut be...

It is widely accepted that the quality of a study may affect its results. A possible influence of the studies' quality on the heterogeneity of the treatment effects will therefore be examined on the basis of studies being included in a recent meta-analysis on inpatient psychotherapy in German speaking countries.The quality of the 103 included studies was assessed by means of 19 criteria addressing general study quality as well as internal and external validity. We examined the relation between study quality and treatment outcome (quantified by effect size Hedges' g either for the Global Severity Index of the Symptom Checklist (SCL GSI) or for an overall outcome calculated across various measures) with univariate correlation analyses as well as metaregression.Study quality varies considerably between the included studies but also between the different quality criteria. On average, the included studies show a medium quality. Most quality criteria do not correlate significantly with the treatment effects. Studies of higher quality tend to show higher treatment effects.The operationalization of single quality items is still worthy of discussion since some criteria are hardly ever while others are always fulfilled. The study quality does not appear to be a homogenous concept, but there are positive as well as negative correlations between single criteria and treatment outcome. Accordingly, the calculation of a total quality score does not seem feasible.Regarding the present meta-analysis on the effectiveness of psychotherapeutic hospital treatment, a systematic overestimation due to the inclusion of some studies with lower quality is not to be assumed.

A sound base of evidence for different kinds of psychotherapy is a fundamental prerequisite for adequate access to treatment. The present article addresses the question of what kind of evidence is required to demonstrate that a specific method of psychotherapy works. Referring to recent conceptualisations of the logical structure of scientific theories, the authors argue that randomised controlled trials (RCTs) and effectiveness studies refer to different domains of intended applications. In RCTs the efficacy of a treatment under controlled experimental conditions is tested, whereas in effectiveness studies the outcome of a treatment under the conditions of clinical practice is examined. Accounting for the different domains of intended applications has several important implications. These implications refer to methodological questions of research (e.g. internal and external validity, study design type), but also the possibility of transferring results from experimental to field settings, and the criteria for evaluating the evidence-base of treatments. They also address the important question of the degree to which the presently available forms of psychotherapy can be regarded as evidence-based. The considerations presented in this article primarily refer to psychotherapy; however, they are also relevant to the evidence-based treatment approach in general.

PURPOSE: Psychosocial factors affect the onset and course of several, particularly chronic diseases, thus being important components of rehabilitative interventions. As a prerequisite for an adequate consideration of psychosocial aspects in diagnostic assessment, therapy evaluation, and quality assurance of medical care, appropriate assessment tools are needed. To date, there are only few instruments, allowing a comprehensive, generic, and economical evaluation of psychosocial health aspects. The present paper hence introduces a new self-report questionnaire for the multidimensional assessment of psychosocial health aspects in various, particularly chronic diseases. MATERIALS AND METHODS: The HEALTH questionnaire consists of 79 items, which are assigned to seven discrete modules. As part of a nationwide clinical-epidemiological study in primary care (DETECT) n=5.630 patients completed the questionnaire. Psychometric analyses were conducted to examine the feasibility, dimensional structure, reliability, and validity of the HEALTH modules. Clinical information from treating physicians and patients were used for validation. RESULTS: The HEALTH questionnaire proves to be well accepted and feasible under routine conditions. Factor analyses confirm the intended dimensional configuration and the relative independence of modules. The HEALTH scales reveal high reliability, preliminary evidence of their construct and differential validity are demonstrated. CONCLUSIONS: The new HEALTH questionnaire allows for the time-economic and comprehensive assessment of generic aspects of psychosocial health, and is highly suitable for use in clinical practice. Its modular construction allows a flexible adaptation to the clinical context. For the examination of more differentiated research questions, more specific supplementary modules should be adopted.

Objective: Although it is widely accepted that the quality of a study may affect its results, there is no agreed specific standard for assessing the quality of psychotherapy outcome studies. This study aims to review the existing variety of relevant quality assessment criteria. Method: We identified relevant quality measures based on a systematic literature search. To determine the specific relevance of the available quality criteria, we consulted experts in the field of psychotherapy outcome research. Results: Nineteen different measures providing 185 different quality criteria were included. Four measures specifically focused psychotherapy studies, none of these were designed for studies without a control group. Experts did judge 20% of the items as “absolutely indispensable.” Conclusions: Quality criteria that are exclusively related to the context of psychotherapy research are rare. Further research is required to examine the empirical relation between specific quality criteria and study results.

Several studies document the effectiveness of psychotherapeutic hospital treatment in German speaking countries, although results show a considerable heterogeneity.Based on data from a comprehensive meta-analysis, we investigated the impact of potential study-level predictors on average treatment duration and average symptom severity at discharge using meta-regression.Selected predictors explain 55 and 78 percent of between-study variance of mean treatment duration and mean symptom severity at discharge, respectively. Samples of younger patients, samples including more patients with personality disorders, samples treated in specialist centers and samples from older investigations showed longer average treatment durations. Studies in patient populations with less severe symptoms at intake and a lower proportion of personality disorders showed lower impairment at discharge. We found a statistically significant positive association between severity of symptoms at discharge and treatment duration.Regarding the higher symptom load at discharge in patients with higher impairment at intake and personality disorders, treatment concepts for these groups require improvement, for example through flexible treatment durations.

Psychometric instruments are commonly applied in psychotherapeutic research and care for the baseline assessment of symptoms, the planning of therapeutic interventions, the assessment of the longitudinal course of symptoms and outcomes of therapeutic interventions as well as quality management of care. Psychometric properties as well as economic aspects should be considered in the selection of specific instruments. It is assumed that users of psychometric instruments face a great variety of instruments and related information. For that reason, it seems challenging to absorb the current knowledge and to integrate it into clinical practice and research. Thus, it is likely that well-known, established and easily accessible instruments are commonly used, while new developed instruments might not be disseminated in research and healthcare.Based on available international review models, the working group "Psychometrics and Psychodiagnostics" of the German College of Psychosomatic Medicine (DKPM) has developed and tested a review model specifically tailored for psychotherapeutic research and care.The different steps of development, as well as the final review model based on the consensus of the working group are presented. The review model contains 6 generic terms (reliability, validity, objectivity, reference groups and aspects of application) with 21 different criteria to be assessed with 0-3 asterisks (*). The criteria are clearly operationalized and the practical use of the review model is explained and discussed.With the review model for the assessment of psychometric instruments a well-defined evaluation system is made available for research and clinical practice which has been developed by an expert group. The review model facilitates systematic, transparent and comparative evaluation of psychometric instruments along clearly defined criteria. It also supports the selection of psychometric instruments in research and care. Next, the working group aims at disseminating and implementing the review model as well as the application and publication of reviews for different psychometric instruments based on the review model.

Zusammenfassung. Da soziale Ängste bei stationär behandlungsbedürftigen Psychotherapiepatienten allgemein weit verbreitet sind, bestand das Ziel der vorliegenden Untersuchung in der psychometrischen Überprüfung der Social Phobia Scale (SPS) und der Social Interaction Anxiety Scale (SIAS) im stationären Setting. Untersucht wurde eine Stichprobe von 823 stationären Psychotherapiepatienten (190 mit sozialer Phobie, 129 mit sonstigen Angststörungen, 504 mit anderen klinischen Störungen). Die beiden Skalen erweisen sich angesichts hoher interner Konsistenz und Stabilität als reliabel. Korrelationen mit anderen Beschwerde-Fragebögen belegen eine gute konvergente, aber mangelnde diskriminante Validität. SPS und SIAS unterscheiden zwar zwischen den untersuchten Störungsgruppen, ihre Klassifikationsleistung im Einzelfall ist jedoch unbefriedigend und sinkt zudem mit zunehmender Komorbidität. Der Nutzen der beiden Skalen zur Bearbeitung differenzieller diagnostischer Fragestellungen im stationären Kontext erscheint damit begrenzt.

Hintergrund In der psychodynamischen Theorie gilt Einsicht als einer der wesentlichen kurativen Faktoren. Im Gegensatz dazu stehen maladaptive Uberzeugungen, die pathogen wirken konnen. Zielsetzung der Studie war es, die Entwicklung von Einsicht und pathogenen Uberzeugungen in Relation zu den therapeutischen Interventionen am Fall einer 25-jahrigen Patientin mit einer depressiven Storung zu untersuchen.

Um die Wirksamkeit der psychodynamischen Kurztherapie („short-term psychodynamic psychotherapy“, STPP) bei spezifischen psychischen Storungen zu uberprufen, fuhrten wir eine aktuelle Metaanalyse durch. Dieses ist von besonderer Bedeutung, da bisherige Metaanalysen widerspruchliche Ergebnisse erbracht hatten, und da die Wirksamkeit psychoanalytischer und psychoanalytisch orientierter Psychotherapie nach wie vor kontrovers diskutiert wird. Mithilfe computergestutzter Suche wurden Studien zur STPP, die zwischen Januar 1970 und Oktober 2004 publiziert wurden, identifiziert. Untersuchungen zur interpersonellen Therapie (IPT) wurden ausdrucklich ausgeschlossen, und es wurden strenge Einschlusskriterien zugrunde gelegt, die von 17 Studien erfullt wurden. Wir berechneten Effektgrosen separat fur Zielprobleme, allgemeine psychische Symptome und soziales Funktionieren. Um die Stabilitat des Therapie-Outcomes zu bestimmen, wurden die Effektgrosen fur das Therapieende und fur die Follow-up-Untersuchungen getrennt berechnet. Die Effektgrosen von STPP verglichen wir mit denen von Wartelistenkontrollpatienten, „treatment as usual“ (TAU) und anderen Formen von Psychotherapie. Psychodynamische Kurztherapie erbrachte signifikante und grose Pra-post-Effekte, die stabil waren und tendenziell im Follow-up noch zunahmen. Die Effektgrosen von STPP uberschritten signifikant die von Wartelistenkontrollpatienten und von TAU. Dagegen wurden keine Unterschiede zwischen STPP und anderen Formen von Psychotherapie gefunden. Psychodynamische Kurztherapie erwies sich als wirksame Behandlung fur verschiedene psychische Storungen. Weitere Studien bei spezifischen psychischen Storungen sind erforderlich, die auch eine Untersuchung der Wirkfaktoren und der Ubertragbarkeit in die Praxis einschliesen sollten.

Objectives At the Tiefenbrunn hospital, patients suffering from severe psychiatric and psychosomatic disorders are treated. The treatment concept is psychodynamically oriented. Psychopharmacological treatments are included if necessary. This article reports the results of the treatment of a sample of patients with schizophrenic and other psychotic disorders (ICD-10: F20-F25). Methods An unselected sample of N = 33 patients was studied upon admission and before discharge with a set of routinely administered standardized instruments. Results According to the data, all of these patients were severely disturbed: Upon admission to the clinic, they showed high pathological values in the Beeintrachtigungs- Schwere-Score (degree of impairment score; Schepank 1995), the Symptom Checklist SCL-90-R (Franke 1995), the Inventory of Interpersonal Problems (Horowitz et al. 1994), as well as a high degree of comorbid disorders. A comparison of the data at admission and at discharge shows that these patients improved significantly and substantially concerning symptoms, interpersonal problems, contentedness with life and individually formulated target problems. Discussion The results of the present study are discussed with regard to both the treatment of psychotic patients and the results of other studies.

Under the label of social phobia a complex of ailments was introduced into the syndromal diagnostic classification system of ICD-10 and DSM-IV, which is characterized by fear of embarrassing and humiliating experiences in relation to other persons. According to our experiences, however, social phobias and other problems in interpersonal relations are not yet paid the clinical attention that these problems deserve, when the severity of impairments subjects affected by social phobias suffer from is taken into account. There is a considerable lack of research of the psychodynamic aspects of social phobia as well. For this reason, we studied the frequency and extent of social anxieties in a sample of patients requiring psychiatric-psychotherapeutic inpatient treatment suffering from social anxieties (N = 930). This sample was compared to another sample of patients without social anxieties. We applied standardized diagnostic and psychometric instruments in order to collect information about anamnestic and social data as well as data about symptom severity, interpersonal impairments and comorbid disorders. The results do not only show the high frequency of social anxieties (45 %), but also the severe impairments in various domains of personal functioning of patients suffering from social anxieties compared to the patients without severe social anxieties. According to our clinical experiences and to the results presented here, the construct of social phobia as it is currently used in the psychiatric classification systems is an syndromal additive description that falls short of a form of suffering that is characterized by the facts that it is interwoven with the complete social existence of an affected person. For this reason, the term social phobia should be replaced by the more appropriate term of social anxiety.