Psychotherapie Psychosomatik Medizinische Psychologie最新文献

Following a SARS-CoV-2 infection, around 10% of patients develop post-COVID symptoms, with fatigue being one of the most common symptoms. This leads to a considerable reduction in quality of life and a high level of absenteeism from work. In the chronification of pain, dysfunctional patterns in the sense of the avoidance/endurance concept are relevant and clinical experience with PCS patients shows that these could also play a role here.The explorative observational study tests the assumption that maladaptive fear-avoidance reactions or endurance reactions have a significant influence on the maintenance of post-COVID fatigue symptoms.In N=97 patients with post-COVID fatigue symptoms from a rehabilitation facility, fatigue (FSMC), avoidance-endurance behaviour (AEQ) and psychological and work-related variables were recorded using self-report questionnaires, and a 6-minute walking test was also carried out.The following distribution pattern emerged: 2/3 distress perseveration, 1/3 avoidance and no adequate copers. The anxiety-avoidance response pattern was able to explain significant variance in the expression of fatigue (F (3, 88)=17,072, p<0,001; R²=0,368). The avoidance of physical activity is associated with an increased number of sick days.The results support the assumption that maladaptive response patterns contribute to the chronification of post-COVID symptoms. In view of this chronified sample, this speaks in favour of the importance of these constructs. Screening could be used to filter these out in advance and implement more targeted, individually tailored therapies.

Recognizing and adequately dealing with problems in the therapeutic relationship are considered key competencies of psychotherapists. Therefore, a concept for the inclusion of an external observation procedure for the assessment and classification of alliance ruptures in the new German licensing program was tested.In a 7-hour seminar, students were able to learn how to use the Rupture Resolution Rating System (3RS) and central repair strategies for alliance ruptures. A questionnaire regarding possible positive effects of the 3RS and a seminar evaluation form were applied. In addition, video ratings were carried out with the 3RS on the basis of a role-playing exercise in order to record changes in the students' abilities to deal with alliance ruptures.N=35 students took part in the 3RS seminar. The use of the 3RS was considered helpful by students to better recognize problems in the therapeutic alliance (74% agreement) and to be able to deal with them adequately in the future (91% agreement). n=8 students took part in the role-play exercise, of which 3 (37.5%) achieved an improvement in the effectiveness of their repair strategies. The other participants showed no change (n=2, 25%) or a decrease in the effectiveness of repair (n=3, 37.5%).Beyond the research context, applying the 3RS can be useful for teaching central aspects of therapeutic alliance in therapist training. In addition, it offers the potential to demonstrate individual change, although a more standardized basis of assessment is required.

The evidence on the association between lifetime traumatic events (LTE) and the occurrence of cognitive changes and dementia is heterogeneous and often based on studies in high-risk populations. Using data from a German population-based study, this study examines whether there is a connection between LTE and experiences of abuse (CA) and neglect (CN) in childhood with mild Neurocognitive Disorder (miNCD) in old age.889 participants were included in the analysis. The trauma list of the PTSD module of the Structured Clinical Interview for DSM-IV (SKID-I) and the Childhood Trauma Screener (CTS) were used to record LTE. miNCD was diagnosed using a neurocognitive test battery according to DSM-5 criteria. Binary logistic regression analyses were used to examine the extent to which the presence LTE is related to the presence of miNCD.In the sample 31.0% reported at least one LTE, 30.3% reported CN and 13.2% reported CA. 19.1% met the criteria for miNCD. Four models were tested, including age, gender and educational level as possible confounding variables. Model 1 examined whether LTE (yes/no) was associated with miNCD in old age. Model 2 tested whether the number of LTE was related to miNCD. Model 3 tested whether CN was related to miNCD, and model 4 tested whether CA was related to miNCD. None of the models showed a significant effect of the investigated variables on the occurrence of miNCD.International studies show indications of a correlation between TLE, CN, CA and miNCD, but there is a lack of corresponding studies in Germany. Despite methodological strengths (standardized recording of all variables, population-based study), our analysis found no correlations. Maybe study requirements led to a positive selection of healthy older people. Nevertheless, LTE, CA and CN were not underrepresented. The results contradict those in high-risk populations, but are consistent with more recent population-based studies that find no associations.In the wider population, the investigated link does not appear to be as clearly demonstrable as in populations with high traumatic burden, such as veterans, which seems reassuring news given that LTE are risk factors for numerous comorbidities that could then play a role in the development of the cognitive changes.

The psychotherapy guidelines of the Federal Joint Committee (GBA) are oriented towards the model of distinct psychotherapeutic approaches. The consequences of these guidelines for therapeutic practice and training have been controversially discussed for some time. The present study investigated the attitude of licensed psychotherapists in Germany towards distinct psychotherapeutic approaches.Data were collected using an online survey of n=507 licensed psychotherapists. The participants were asked about their therapeutic orientation, the use of techniques compliant or non-compliant with their own approach, and their opinion on therapeutic approaches in practice and clinical training.The majority of therapists described their orientation as integrative, with assimilative integration being the most common. Techniques that are non-compliant with the therapist's own approach were considered relevant for everyday practice. The majority of respondents were able to identify well with their own approach and described that having distinct therapeutic approaches was helpful for everyday practice. The majority of behavioral therapists were in favor of transtheoretical clinical training, whereas the majority of psychoanalytic therapists rejected it.According to GBA, a combination of different psychotherapeutic approaches is prohibited, but this contradicts the current practice. Although the model of distinct therapeutic approaches offers an important frame of reference for practitioners, it can also be perceived as restrictive if it is interpreted too rigidly.The perspective of practitioners should be given greater weight in the scientific discourse on psychotherapeutic approaches.

Social support is a key factor in mental health. Obstetric wards can promote social support by providing family rooms. Family rooms are not yet universally accessible. Studies on their influence on the maternal psyche are also lacking. The present study examines the mental health of women with and without accommodation in a family room on an obstetric ward.113 patients filled in standardized scales on anxiety, depression, psychological well-being and post-traumatic stress symptoms 1-3 days postpartum. In addition, obstetric data of birth mode, pregnancy and birth complications were collected. Recruitment during strict pandemic visiting restrictions made it possible to compare women in the family room (constant presence of the partner) and women without a family room (without any visits).In the overall sample, anxiety (22.6%) and lack of psychological well-being (33.6%) were particularly evident. The two groups did not differ in terms of mental health, but women with birth complications and an unplanned birth mode in the family room had significantly lower anxiety scores than women without a family room.Women with birth complications exhibited higher post-traumatic stress symptoms overall. Additionally, women in the family room were significantly more often primipara, they more often had an unplanned birth mode and they differed in the frequency of their birth complications.This study provides first evidence for a psychoprotective influence of family rooms on anxiety in patients with previous complications and unplanned birth modes. A discussion on promoting family rooms, especially for patients with peripartal complications, appears necessary. Further studies on the effectiveness of family rooms are required.

Background: Rehab satisfaction and treatment success are firmly anchored in the German Pension Insurance's quality assurance program as quality criteria for medical rehab. In the field of psychosomatic rehab, there are hardly any studies in which the relative importance of treatment- and hotel-related characteristics for the prediction of these criteria has been investigated.

Methods: In a secondary analysis, anonymous survey data from 25 psychosomatic rehab clinics/specialist departments were analyzed. The sample comprises around 50,000 inpatient rehabilitants from 2018-2022. The surveys were conducted using a largely standardized questionnaire for the purpose of internal quality assurance. The extent to which the two outcome criteria can be predicted from 14 predictors (assessments of partial performance areas) and from a heuristic model with three blocks of variables (KV=control variables, RB=rehabilitation treatment, HL=hotel services) was examined using regression analysis.

Results: All 14 predictors correlate significantly with both criteria and can explain a total of around 67% (rehab satisfaction) resp. 40% (treatment success). In stepwise regressions, the predictors "psychotherapeutic care" and "preparing for the time after rehab" contribute most to the prediction of the criteria. Hierarchical regressions show that the incremental share of the RB block in the prediction of both criteria, i. e. the share that can be attributed with certainty to the rehab treatment variables, is many times greater than that of the hotel services.

Discussion: The hierarchical regression analyses support earlier findings that characteristics of the actual rehab care (e. g. good psychotherapeutic support) play a much greater role for the rehabilitants with regard to both outcome criteria than hotel -related features. There is much to suggest that these findings are also valid for inpatient psychosomatic acute care.

This study exploratively investigated a possible relationship between suicidal/self-injurious behavior and the change in self-reported eating disorder symptoms as well as emotional dysregulation and interpersonal difficulties during eating disorder-specific treatment. For this purpose, the symptom index of the Eating Disorder Inventory-2 (EDI-SI) and the scale for the assessment of impulsivity and emotional dysregulation of borderline personality disorder (IES-27) with its subscales suicidal and self-injurious behavior (SVV/SEV), emotional dysregulation (EmotDys) and interpersonal difficulties (BezSchw) were collected from 167 female patients at a psychosomatic clinic. The participants were divided into four groups depending on the occurrence of SVV/SEV before the start and/or end of treatment. A one-way multivariate analysis of variance (MANOVA) with repeated measures showed an interaction of time and SVV/SEV group with regard to EDI-SI, EmotDys and BezSchw. The effect sizes of the pre-post comparison of the EDI-SI were very different in the groups divided according to the occurrence of SVV/SEV (0.27

Few studies compare differences between open and closed therapy groups. Different characteristics of both formats, which have been theoretically and practically substantiated to date, are presumably responsible for different therapeutically relevant effects. The present analysis documents and analyzes therapists' experiences with both open and closed group formats and provides information relevant to the selection of group format. To this end, psychologists and sport therapists in a department for behavioral orthopedic rehabilitation were asked in open, guided interviews about their experiences during a changeover from closed to open groups. Their responses were analyzed using qualitative content analysis. Characteristics of open and closed groups identified in the literature were largely confirmed, but differences not yet identified in the literature were also discovered. These relate to everyday therapeutic practice and therapist motivation. Additionally, similarities and differences between sport and psychotherapy groups are highlighted. In sum, closed groups are characterized by high group cohesion and deeper relationships in the course of therapy. Closed group sessions can build on each other and are structured. Open groups have a consistent level of energy and stronger dynamics over time and offer a wide range of contact opportunities. Different patient roles in group therapy must be kept in mind in both formats. Both group forms have characteristics that can be used for different therapeutic goals and indications and are therefore justified in a therapeutic context. These empirical findings suggest that therapists can strategically choose a specific group form for the support of specific types of patients or for reaching specific therapy goals.

Global change affects both individual life situations and social coexistence in a variety of ways. However, the effects of social events on mental illness and psychotherapy are only recorded and included in psychotherapy research in individual areas. The aim of this study is to explore current problems and concerns of patients in Germany on the basis of practical experience reports, to collect possible social causes and to bundle considerations for therapeutic treatment. To this end, psychotherapists (n=10) and psychotherapy patients (n=12) were interviewed in qualitative interviews and these were analyzed using grounded theory. After evaluating the collected perspectives, five main effects of current social events and the consequences of globalization were identified. From the perspectives of psychotherapists and patients, these include increasing anxiety about the future, decreasing social inclusion, increased questions about goals and identity as a concern for psychotherapy, increased psychological stress as a result of political divide and an increased demand for diversity-sensitive psychotherapy. In addition to expanding the scope of action, therapeutic approaches primarily include providing contact, guidance, orientation, emotional support and bonding experiences. The inclusion of knowledge from psychotherapists and patients as well as findings from social science can be helpful for identifying current problems and developing new therapeutic approaches or bundling, linking, and effectively using existing ones.