Psychische Flexibilität messen und im stationären Setting fördern

Background: The transdiagnostic Acceptance and Commitment Therapy (ACT) transsituatively follows the overriding goal of promoting psychological flexibility (PF) across various situations and settings. However, the common questionnaire-based operationalization of PF necessary for empirical research on ACT and PF are criticized. Furthermore, only a few studies investigating the effects of ACT on transdiagnostic samples and in inpatient settings exist so far and further studies are needed. Aim: In this thesis, (1) an alternative questionnaire for the assessment of PF is validated, (2) different questionnaires for PF are compared regarding treatment sensitivity and (3) effects of an inpatient ACT-based transdiagnostic treatment are examined. Method: The Open and Engaged State Questionnaire (OESQ) was validated based on data of the independent samples. The treatment sensitivity of the currently dominant PFquestionnaire was compared to three alternative questionnaires for PF based on data of three different samples. Finally, an observational study examined the effect of a transdiagnostic, ACT-based inpatient treatment using pre-to-post comparisons and weekly-process-measures from three independent sources. Results: The OESQ showed good psychometric properties and can be highlighted in terms of discriminatory and predictive validity compared to other PF-questionnaires. The currently dominant PF-questionnaire showed lower treatment-sensitivity then all three other alternative questionnaires. Finally, medium to high pre-to-post effect sizes in multiple variables and linear increases in weekly process mesaures in PF as a result of transdiagnostic inpatient ACT-treatment were observed. Conclusions: As explicitly mentioned in the literature, an alternative questionnaire for PF was developed and validated. The results regarding treatment sensitivity showed lacks in previous assessments of PF and the results seem to suggest that possible effects of ACT regarding its effects on PF may have been underestimated so far. Finally, the positive effects of ACT also appear to be evident in inpatient settings and for transdiagnostic samples

The psychological syndrome associated with Long-COVID: A study protocol

Introduction: Chronic post-viral syndromes, including Long-COVID, are characterized by a range of persistent symptoms that occur following a viral infection. Psychological symptoms are prevalent in Long-COVID patients and can have a significant impact on their quality of life. However, the specific patterns of psychological symptoms, their associations with physical symptoms, and the factors predicting their severity remain poorly understood. Aims: This study aims to explore and systematically assess psychological symptoms in Long-COVID, to identify syndrome clusters based on these symptoms, to examine their relationship with physical symptoms, and to investigate the influence of pandemic-related variables. Methods: Descriptive, cross-sectional study with data collected through an online questionnaire across several EU countries, from February 2020 to December 2022. Participants were recruited using public relations, the social media and information campaigns directed at the public and health professionals using snowball sampling. Results: The findings will allow to phenotype Long-COVID related psychological symptom clusters based on self-reports. facilitating improved assessment and treatment approaches. Conclusions: The results will provide important knowledge for the public health management of the public healh management of Long COVID. The findings will contribute to a better understanding of the psychological symptoms associated with Long-COVID and the development of specific treatment guidelines for psychological burden associated with Long-COVID, thereby supporting management strategies to combat the after-effects of the COVID-19 pandemic, enhancing their overall well-being and quality of life

Treatment sensitivity in the measurement of psychological flexibility

Psychological flexibility (PF) is a central construct in Acceptance and Commitment Therapy (ACT). Many studies have operationalized PF using the self-report Acceptance and Actions Questionnaire (AAQ-II). Information on the treatment sensitivity of self-report assessments of PF is lacking, however. We investigated differences in the treatment sensitivity of the AAQ-II compared to other measures of PF across various samples. Using three different clinical samples (N=164), we compared the pretreatment–posttreatment change scores of the AAQ-II to those of three alternative self-report questionnaires measuring PF in a within-subject design. Sensitivity to change was assessed with effect sizes and Reliable Change Index (RC). Without exception, effect sizes and rates of clinically significant change were larger in all three alternative questionnaires and across three populations compared to the standard formulation of the AAQ-II.The results of the present study show greater treatment sensitivity of three alternative questionnaires measuring PF compared to the AAQ-II. The results suggest that treatment effects concerning PF may have been underestimated depending on the wording and measure used. Implications for research on PF and ACT processes and outcomes are discussed

The psychological syndrome associated with Long-COVID: A study protocol

IntroductionChronic post-viral syndromes, including Long-COVID, are characterized by a range of persistent symptoms that occur following a viral infection. Psychological symptoms are prevalent in Long-COVID patients and can have a significant impact on their quality of life. However, the specific patterns of psychological symptoms, their associations with physical symptoms, and the factors predicting their severity remain poorly understood.AimsThis study aims to explore and systematically assess psychological symptoms in Long-COVID, to identify syndrome clusters based on these symptoms, to examine their relationship with physical symptoms, and to investigate the influence of pandemic-related variables.MethodsDescriptive, cross-sectional study with data collected through an online questionnaire across several EU countries, from February 2020 to December 2022. Participants were recruited using public relations, the social media and information campaigns directed at the public and health professionals using snowball sampling.ResultsThe findings will allow to phenotype Long-COVID related psychological symptom clusters based on self-reports. facilitating improved assessment and treatment approaches.ConclusionsThe results will provide important knowledge for the public health management of the public healh management of Long COVID. The findings will contribute to a better understanding of the psychological symptoms associated with Long-COVID and the development of specific treatment guidelines for psychological burden associated with Long-COVID, thereby supporting management strategies to combat the after-effects of the COVID-19 pandemic, enhancing their overall well-being and quality of life

The everyday lives of in- and outpatients when beginning therapy: The importance of values-consistent behavior

The manifestation of functional impairment in patients’ daily lives and interference with things they value is poorly understood. If values are compromised in patients, as theory suggests, social contexts (and the lack thereof) are especially important – though this is currently unexplored. We therefore examined whether daily values-consistent behavior was associated with the importance of a value and whether it involved social or non-social activity. Using Event Sampling Methodology, we examined daily values-consistent behavior in 57 transdiagnostic inpatients and 43 transdiagnostic outpatients at the beginning of treatment. Patients’ values-consistent behavior, its importance, and (social vs non-social) context was sampled six times per day during a one-week intensive longitudinal examination. Across both groups, the probability of subsequent values-consistent behavior increased if (1) it was judged as more important by the patient or (2) if it was embedded in a social context. The probability of reporting values-consistent behavior was higher for outpatients than inpatients. Clinicians are encouraged to examine the values of their patients more closely and to especially monitor important and/or social values. Incorporating these into clinical work might increase patients’ values-consistent behavior, which can play a role in reducing suffering

Akzeptanz- und Commitment-Therapie mit Therapieresistenten Störungen im stationären Setting: Eine Beobachtungsstudie

Hintergrund: Stationäre psychotherapeutische Behandlungen haben eine große Bedeutung im Versorgungsalltag. Ihre Bewährung bei schwergradigen und komorbiden Störungsbildern ist jedoch nur lückenhaft untersucht. Dies gilt besonders für die zunehmend angewendete Akzeptanz- und Commitment-Therapie (ACT). Fragestellung: In erster Linie soll die Wirksamkeit einer stationären störungsübergreifenden ACT-basierten Behandlung in erwähnten Stichproben untersucht werden. Ergänzend wird der zeitliche Verlauf der psychischen Flexibilität (PF), dem Kernkonzept der ACT, explorativ untersucht. Methode: Eine konsekutive Stichprobe von 47 Patientinnen und Patienten mit heterogenen und komorbiden Störungsbildern in stationärer Psychotherapie wurde im Rahmen einer explorativen Beobachtungsstudie mittels wöchentlicher Verlaufsmessungen sowie umfassender Prä-Post-Vergleiche untersucht. Ergebnisse: Die Effektstärken hinsichtlich allgemeiner Symptomreduktion, der Zunahme psychischer Flexibilität sowie weiterer ACT-spezifischer Fertigkeiten sind moderat bis hoch. Die Verlaufsmessungen weisen auf lineare Verbesserungen sowie hohe Übereinstimmungen zwischen Selbst- und Fremdrating hin. Schlussfolgerungen: Die Ergebnisse zeigen positive Effekte der ACT im stationären Setting bei einer diagnostisch heterogenen Stichprobe mit einem hohen Anteil komorbider Störungen. Background: Inpatient psychotherapeutic treatments are of great importance in everyday clinical care. However, research of specific inpatient treatments for severe and comorbid disorders is lacking. This is particularly true for acceptance and commitment therapy (ACT), which is increasingly used. Aim: The efficacy of an inpatient ACT-based treatment for transdiagnostic patients was investigated in the aforementioned sample. In addition, weekly process data on psychological flexibility, the core concept of ACT, were analyzed. Method: A consecutive sample of 47 patients with heterogeneous and comorbid disorders was investigated in an exploratory observational study using weekly progression measurements and pre-to-post comparisons. Results: The effect sizes regarding overall symptomatology, increase of psychological flexibility, and other ACT-specific processes were moderate to high. The process measures indicated linear improvements and high concurrence between self-report and clinical assessment. Conclusion: The results demonstrate the positive effects of an ACT-based inpatient therapy in a transdiagnostic sample with a high proportion of severe and comorbid disorders

Long COVID Classification: Findings from a Clustering Analysis in the Predi-COVID Cohort Study.

peer reviewedThe increasing number of people living with Long COVID requires the development of more personalized care; currently, limited treatment options and rehabilitation programs adapted to the variety of Long COVID presentations are available. Our objective was to design an easy-to-use Long COVID classification to help stratify people with Long COVID. Individual characteristics and a detailed set of 62 self-reported persisting symptoms together with quality of life indexes 12 months after initial COVID-19 infection were collected in a cohort of SARS-CoV-2 infected people in Luxembourg. A hierarchical ascendant classification (HAC) was used to identify clusters of people. We identified three patterns of Long COVID symptoms with a gradient in disease severity. Cluster-Mild encompassed almost 50% of the study population and was composed of participants with less severe initial infection, fewer comorbidities, and fewer persisting symptoms (mean = 2.9). Cluster-Moderate was characterized by a mean of 11 persisting symptoms and poor sleep and respiratory quality of life. Compared to the other clusters, Cluster-Severe was characterized by a higher proportion of women and smokers with a higher number of Long COVID symptoms, in particular vascular, urinary, and skin symptoms. Our study evidenced that Long COVID can be stratified into three subcategories in terms of severity. If replicated in other populations, this simple classification will help clinicians improve the care of people with Long COVID

"Choose change": design and methods of an acceptance and commitment therapy effectiveness trial for transdiagnostic treatment-resistant patients

Acceptance and Commitment Therapy (ACT) has been successfully established in hundreds of efficacy trials. It is less understood, however, how ACT works in real-world settings. Furthermore, little is known about how contextual variables such as treatment setting (inpatient vs. outpatient), social network and environment of the patient impact outcome.This paper describes the methods of the Choose Change study that compares transdiagnostic inpatients (n=85) and outpatients (n=85) with varying degrees of treatment experience and treatment success (i.e., no previous treatment vs. previous remission vs. treatment-resistant). Patients received ACT during an intensive treatment phase lasting approximately twelve treatment sessions, and were accompanied up to twelve months following intensive treatment. Main outcomes include symptoms, functioning, and well-being. Multiple levels of data are investigated, including treatment context, weekly assessments, a behavioral approach test, multiple follow-up phases, and ambulatory assessment using Event Sampling Methodology, to examine patients' daily context. We aim to investigate antecedents, consequences, and inherent processes that contribute to the maintenance or fluctuations of psychological disorders and the efficacy of ACT treatment. Furthermore, this study intends to increase understanding of how accurately participants can report on their own experiences, in order to expand our knowledge of how to probe for such information in the future. The results of Choose Change will provide basic clinical theory and clinical care with important and meaningful insights into the effectiveness of ACT, trans diagnostically, in in- and outpatients, and in a naturalistic setting. This study was retrospectively registered in the ISRCTN Registry (registration number ISRCTN11209732) on May 20th 2016

The motivations for the adoption of management innovation by local governments and its performance effects

This article analyses the economic, political and institutional antecedents and performance effects of the adoption of shared Senior Management Teams (SMTs) – a management innovation (MI) that occurs when a team of senior managers oversees two or more public organizations. Findings from statistical analysis of 201 English local governments and interviews with organizational leaders reveal that shared SMTs are adopted to develop organisational capacity in resource‐challenged, politically risk‐averse governments, and in response to coercive and mimetic institutional pressures. Importantly, sharing SMTs may reduce rather than enhance efficiency and effectiveness due to redundancy costs and the political transaction costs associated with diverting resources away from a high‐performing partner to support their lower‐performing counterpart

Assessing psychological flexibility: Validation of the open and engaged state questionnaire

Background: Despite increasing research on psychological flexibility (PF) and its importance to psychological health, only a few measures exist for assessing this construct, and they have shortcomings, particularly in construct validity.Methods: This study assessed the factor structure, construct validity, and predictive value of the Open and Engaged State Questionnaire (OESQ) on samples with panic disorder and/or agoraphobia (n=120), panic disorder with agoraphobia (n=46), and burnout (n=85).Results: The confirmatory factor analysis verified the expected one-dimensional structure and found good internal consistency in all three samples. Analysis of the construct validity revealed correlations to pathology, personality traits, and total functioning; it also revealed discrimination of PF from neuroticism when measured with the OESQ. Furthermore, we found that PF predicted outcomes of symptomatology.Conclusions: Considering the criticisms and suggestions for improvement in the literature on assessing PF, the OESQ proved to be a valuable operationalization of this construct. With better discriminant and incremental validity compared to other questionnaires as well as unique predictive value, the OESQ is important for future research on PF and acceptance and commitment therapy (ACT)