Psychotherapie Psychosomatik Medizinische Psychologie最新文献

Background:   With the help of statements from contemporary witnesses, it shall be deduced, if and to what extent Psychiatry was experienced as a shelter for employees and patients in the state controlled society of the GDR and which effort of adaptation to the authoritarian regime was needed to organize protected and protective spaces, here called "niches".

Method:   74 guide-based interviews from subjects including former patients and different staff groups of the East german Psychiatry were analyzed qualitatively.

Results:   Many quotations show, that Psychiatry in the GDR was experienced as a "niche" for dissenting people and could offer a certain amount of protection for patients. On the other hand, the autonomy of the psychiatric care was often violated by political intrusions regarding individual treatments. Moreover, treatment autonomy was restricted by harsh shortages in supplies.

Conclusion:   Psychiatrists in the GDR could protect their patients through their actings and so Psychiatry could establish a "niche" for patients and employees. However, establishing such protected spaces required efforts in adaptation. In reverse, Psychiatry has also been politically instrumentalised - either directly through unjustified admissions and exit restrictions or indirectly by a stigmatization of dissenters and removing them from society.

Background: Burnout and procrastination are widespread phenomena among students. The role of personality structure has been little researched so far.

Objective of the study: The relationship between personality structure and study-related work disorders in psychology and medical students is examined, taking into account resources and demands.

Methods: As part of a cross-sectional study, data was collected online from 61 German colleges and universities. Personality structure variables (levels of personality functioning, OPD-SFK; attachment, ECR-RD 12; emotion regulation, ERQ), study-related work disorders (burnout, MBI-SS-d; procrastination; APSI-d) as well as resources (social support, F-SozU K-6; scope for decision-making in studies, self-developed scale) and demands (Corona pandemic, self-developed scale) were assessed. The research question was answered by means of a hierarchical regression analysis.

Results: From February 2020 to December 2021, 775 students (49.2% psychology students, 50.8% medical students; age M=24.1 years, SD=5.1 years; 82.3% female, 17.4% male, 0.3% diverse) participated in the survey. In the overall model, 30.4% of the variance in burnout exhaustion, 16.2% of the variance in burnout cynicism, 20.9% of the variance in burnout inefficiency and 30.1% of the variance in procrastination was explained (p<0.001). Levels of personality functioning showed significant negative correlations with all burnout variables as well as with procrastination (p<0.001). The emotion regulation strategy reappraisal was associated with lower burnout inefficiency and procrastination (p<0.001), and the emotion suppression strategy with lower burnout cynicism (p≤0.01). Scope for decision-making in studies was negatively associated with all burnout variables and procrastination (p<0.001), and social support was negatively associated with burnout inefficiency (p≤0.01). The general stress level during the Corona pandemic showed a positive association with burnout exhaustion (p≤0.001).

Conclusions: Personality structure (levels of personality functioning, emotion regulation) is significantly related to study-related burnout and procrastination. Training opportunities to promote emotion regulation skills could be very helpful for vulnerable student groups in dealing with burnout and procrastination.

With the introduction of medical psychology and medical sociology as examination subjects in the medical curriculum, as enacted by the year 1970 in Germany, medical faculties established professorships and departments for these disciplines. This raised the concern of how the two separate scientific cultures of the social and behavioural sciences and of medicine, rooted in basic sciences, could reconcile their teaching and research activities in a constructive way. It turned out that the quality and the thematic affinity of new research aligning with core medical interests were important preconditions of successful integration of the new disciplines. This paper exemplifies a respective success in case of a scientific development in medical sociology. Based on a theoretical model, a longstanding, internationally collaborating research program analysing social determinants of stress-related disorders resulted in a series of innovative insights. Furthermore, the paper illustrates close links between biographical luck and structural opportunities and constraints, and it emphasizes the important role of committed inter-disciplinary scientific collaboration.

The "Questionnaire of Thoughts and Feelings" (QTF) is being used as screening instrument as well as tool for treatment planning and treatment evaluation for patients with borderline personality disorder (BPD). The primary goal of this study was the validation of the dimensional structure of the short version with 14 items, QTF-14. Additionally, item characteristics, reliability and evidence of convergent validity were examined. A diagnostically homogenous sample of patients with BPD (N=3035) of a psychosomatic clinic was presented with several self-assessment inventories, including the QTF-14. The expected single-factor model of the structure of the FGG showed unacceptable model fit indices (CFI=0.751; TLI=0.706; RMSEA=0.115; SRMR=0.073). Exploratory factor analysis showed evidence of two or three specific factors. In a subsequent confirmatory factor analysis, a bifactor model with two specific factors proved to be preferable (CFI=0.956; TLI=0.936; RMSEA=0.054; SRMR=0.034). The internal consistency of the total scale as well as the suggested subscales "Relationship Difficulties and Emotional Dysregulation" and "Autoaggression" was acceptable to good (ω=.81-.84; α=.79-.85). Associations with similar scales were as expected. Good psychometric properties of the QTF-14 can be confirmed in this study. Using the suggested subscales could support treatment planning.

Objective: Since the reunification of Germany, a debate on the professional activities of GDR psychotherapists has rised up. This debate is partly conducted by the spirit of coming to terms with the past and partly by legitimizing therapeutic activities in the GDR. The aim of this work is to show in individual patterns the professional self-image of selected GDR psychotherapists. The study focused from a sociological perspective with the intention of differentiating this topic. In course of this, the range of political positioning of GDR psychotherapists will also be determined on a case-by-case basis and it will be shown how this was shaped in the often named "niche of psychotherapy".

Methods: Based on-biographical interviews, educational biographical trajectories of GDR psychotherapists were reconstructed. The interviews were analyzed using grounded theory in a circular process of material selection and theory development. According to the principle of maximum contrast (theoretical sampling), four women were selected for reconstruction from a sample of 39 interviews from the joint project Seelenarbeit im Sozialismus (Soul Work in Socialism) and analyzed using Teifel's (2005) coding guide based on educational theory.

Results: Within the four cases, extremely individual educational biographies emerge on the levels of the coding strategy (meaning/structure perspective and mode of action), each showing different characteristics with regard to their ability to adopt a reflexive stance and the adoption of professional agency. The cases also show different characteristics with regard to their different positions on the system of GDR.

Discussion: The results of the case reconstructions can be summarized in an overarching scheme. This shows that the role of each individual's educational access, their educational paths and their individual practice of action must be seen in relation to the influence of the political system and the ability to adopt a professional attitude. The psychotherapists of the GDR cannot be understood per se as a group acting subversively against the state.

Background: Although patients with psychotic disorders (PPS) are indicated for outpatient psychotherapy at any stage of their illness, they are rarely treated in this way. For this purpose, structural conditions, the experience of competence of therapists, as well as content-related aspects of training and further education of psychotherapists are analyzed.

Methods: Based on a qualitative preliminary study, an online survey was conducted among 487 psychological psychotherapists.

Results: Half of the respondents indicated a high willingness to treat PPS. In the acute phase of the disease only 20% are willing to do so. In the studies as well as in the theoretical part of the education and further education, there is hardly any preparation for a corresponding treatment. In contrast, practical experience in psychiatric clinics is considered very important. With regard to structural framework conditions, low hourly quotas and inflexible billing modalities are criticized. With regard to patients, in addition to sufficient motivation for treatment, low reliability, low cognitive ability, low insight into the illness, and frequent discontinuation of therapy are stated. Contrary to some prejudices, patients are characterized as "peaceful" in their interactions. The reduction of psychotic relapses, social integration and reduction of comorbid symptoms are mainly mentioned as achievable outcomes. The reduction of psychotic symptoms is rated less optimistically. Psychotherapists from psychiatric outpatient clinics (PIA) differ from other outpatient psychotherapists by better competence experience and correspondingly more frequent work with PPS, also in the acute stage.

Discussion: Although every second therapist does not feel well trained, the willingness to treat PPS seems to be higher than the pure supply figures suggest. There is potential for optimization in education and training as well as in networking with other professional groups/relatives. This could be responsible for the fact that in the acute psychotic stage there are fears of contact and competence concerns. Psychotherapists in PIAs, where there is closer networking with other professional groups for structural reasons, experience corresponding deficits to a lesser extent. With regard to other structural barriers, the question arises as to whether these represent disorder-specific or rather general problems in psychotherapy.

Objective: The scientific approval of hypnotherapy for certain mental disorders is still not confirmed. In a randomized-controlled study comparing the efficacy of hypnotherapy (HT) with cognitive behavioral therapy (CBT) for mild to moderate depressive episodes, a non-inferiority of HT compared to CBT could be found. The aim of this study was to examine depressive symptomatology in the long-term course three and a half years after end of the treatment.

Methods: A total of 152 randomized patients received outpatient individual psychotherapy with 16 to 20 sessions over a period of six months. All were invited to participate in a follow-up three and a half years after the end of treatment where depressive symptoms were assessed via self- and clinician-ratings. In the per-protocol (PP) analysis, only those with available data were included, but a comparison of characteristics was made with individuals without participation in the follow-up survey. An additional intention-to-treat (ITT) analysis was conducted with multiple imputed data for missing data.

Results: A total of 71 subjects (46.7%) participated in the follow-up. The noninferiority in the percentage symptom reduction assessed with the clinician-rating of HT compared with CBT was confirmed in the PP and the ITT sample. The symptom improvement in self- and clinician-rating by the end of therapy persisted during the follow-up. Response rates and remission rates for both self- and clinician-ratings are reported.

Conclusion: In this study, indications were found that HT was noninferior to CBT in the treatment of depression, even in the long term. Further studies should examine the efficacy of HT in larger multicenter samples and identify predictors of individual treatment success.

A particular feature of the demographic change is the growing proportion of elderly and very elderly people. In Western countries, this is largely due to improved medical care for age-associated diseases. There is still comparatively little knowledge about mental health disorders in old age, their age-typical clinical presentation and specific psychotherapeutic treatment.

For families of chronically ill children with a high level of psychosocial stress, it is necessary to involve child and adolescent psychiatric or psychosomatic specialists directly in the pediatric treatment process. For this purpose, a family consultation was set up in the Heidelberg University Pediatrics as part of a model project, which deals with these families in an interdisciplinary and systemic way. It shows that the implementation of the consultation works despite a high organizational effort and is regularly used. The first evaluation results confirm the already described high levels of psychosocial stress in the affected families. They indicate a positive assessment of the consultation and a desire for a permanent offer. First follow-up results indicate a significant decrease in treatment-related concerns, uncertainty and a reduction in treatment-related problems. The lack of a viable funding model poses a challenge for long-term implementation.