"Never meant to break your heart" Adult attachment and cardiovascular regulatory capacity

Although theoretically and clinically important, research on attachment-related cardiovascular function in adults has just started to unfold over the last decade, and methods and results differ substantially. A central shortcoming of previous studies concerns attachment theory itself: There are several pathways on when and how the attachment system may influence stress physiology, and these interactions have been largely neglected. One area of particular significance is the dynamic conceptualization of insecure attachment strategies as defensive processes. This dissertation aims at testing a possible approach to address these issues. As many of the existing studies use self-report data for the assessment of attachment, we first translated and validated the Experiences in Close Relationships - Revised questionnaire (ECR-R) in two large samples. The German version performed well with regard to reliability and validity, and was therefore used in all other studies. The second study describes the rationale and validation of a newly developed, attachment-related short-term stressor, the separation recall (SR) task. The SR was compared to an achievement-oriented stressor, and correlated with attachment style. Both stressors elicited cardiovascular and emotional reactions, but patterns differed between the tasks. Blood pressure down-regulation after the SR but not the other stressor was related to attachment avoidance. The third study deals with factors leading to the activation of attachment-related defensive processes. It probes whether there is a lower threshold of personal significance of attachment-related memory content which triggers attachment-related defensive functioning as measured by psychophysiological response. Differences in personal significance of the reported separation experience moderated the influence of attachment avoidance on heart rate reactivity. The fourth study concentrates on whether psychological distress in general, and life-stress more specifically, are able to distract and change the impact of attachment defensive functioning on psychophysiological stress reaction; in other words, it explores the upper boundaries and vulnerability of insecure attachment strategies. Results indicate that especially life-stress may moderate the impact of attachment avoidance on the reactivity of high-frequency heart rate variability. The overall findings are discussed with regard to their impact on psychosomatic medicine and health psychology

Experience-Based Competency Training in Child and Adolescent Psychotherapy

Background: Compared to adult psychotherapy training, there is little knowledge about the use of standardized actor-patients (SPs) for the development of professional competencies for younger patient populations. Objective: We assessed the effectiveness of two university-based training programs for diagnostic as well as intervention skills in child and adolescent psychotherapy. Methods: Psychology students took part in two courses on the development of diagnostic competencies (NÂ =Â 59) and on intervention skills (NÂ =Â 51). We applied active and experience-based learning strategies, including exercises on self-awareness, mindfulness, peer role-play, and the use of SPs. Competence gain as well as a general evaluation of the seminars were assessed by self-report. Results: For both seminars, self-reported competence increased significantly with a large effect. The retrospective evaluation of learning success and acceptance ratings of the didactic formats were high. Conclusions: Experience-based trainings that include SPs are a feasible option for child and adolescent psychotherapy. The findings are discussed from a conceptual as well as a practical perspective.Hintergrund: Im Vergleich zur Psychotherapieausbildung für Erwachsene fehlt es an Wissen über den Einsatz von standardisierten Schauspielpatient_innen (SP) für die Entwicklung professioneller Kompetenzen für jüngere Patient_innenpopulationen. Fragestellung: Wir untersuchten die Effektivität zweier universitärer Trainings zu diagnostischen und interventionellen Fertigkeiten in der Kinder- und Jugendlichenpsychotherapie. Methoden: Psychologiestudierende nahmen an zwei Kursen zur Entwicklung diagnostischer Kompetenzen (N = 59) und Interventionsfertigkeiten (N = 51) teil. Wir setzten aktive, erfahrungsbasierte Lernstrategien ein, darunter Übungen zur Selbstwahrnehmung, Achtsamkeit, Peer-Rollenspiele und Schauspielpatient_innen. Subjektiver Kompetenzgewinn wurde im Fragebogen sowie durch eine allgemeine Bewertung des Seminars erfasst. Ergebnisse: In beiden Seminaren stieg das subjektive Kompetenzerleben signifikant mit einem großen Effekt an. Retrospektive Bewertung des Lernerfolgs und Akzeptanz der didaktischen Formate waren hoch. Schlussfolgerungen: Erfahrungsbasierte Trainings unter Einbeziehung von SPs für die Kinder- und Jugendlichenpsychotherapie sind machbar. Die Ergebnisse werden unter konzeptuellen und anwendungsbezogenen Aspekten diskutiert

Study protocol - efficacy of an attachment-based working alliance in the multimodal pain treatment

Background: The concept of attachment is relevant for the onset and development of chronic pain. Insecure attachment styles negatively affect therapeutic outcome. Insecurely attached patients seem to be less able to sustain positive effects of a multimodal treatment program. However, it has never been tested before if an attachment-oriented approach can improve treatment results of insecurely attached patients in a multimodal outpatient setting. To test this assumption, we compare the short- and long-term outcomes for pain patients who will receive multidisciplinary, attachment-oriented treatment with the outcomes for patients in a control group, who will receive the multidisciplinary state-of-the-art treatment. Methods: Two patient groups (baseline, attachment intervention) are assessed before treatment, after treatment, and at a 6 month follow-up. The study is conducted in a block design: After data collection of the first block (controls) and before as well as during data collection for the second block (treatment group), the health care personnel of the outpatient pain clinic receives training on attachment theory and its use in the therapeutic context. Pain intensity as measured with visual analogue scales and physical functioning will serve as the primary outcome measures. Discussion: The design of our study allows for a continuous exchange of experienced team members, which may help bring about concrete attachment related guidelines for the enhancement of therapeutic outcome. This would be the first attempt at an attachment-oriented improvement of multimodal pain programs. Conclusion: An attachment-based approach may be a promising way to enhance long-term treatment outcomes for insecurely attached pain patients. Trial registration: DRKS00008715 (registered on the 3rd of June 2015)

Structural impairment and conflict load as vulnerability factors for burnout – A cross-sectional study from the German working population

IntroductionIndividual vulnerability and resilience factors are increasingly studied in burnout research. This is especially true for clinical variables that translate directly into intervention programs from a psychodynamic perspective. For example, few studies have examined the relationship between structural impairment and the individual spectrum of motivational conflicts according to the Operationalized Psychodynamic Diagnosis system (OPD) in relation to burnout. To substantiate previous findings, we hypothesized that structural impairment as well as motivational conflicts are related to burnout, but that structural impairment explained additional variance and mediated a possible relationship between conflicts and burnout.MethodThe present cross-sectional study was carried out on a sample of the German working population (N = 545). Questionnaires were used to measure structural impairment (OPD-SQS), the conflict-modes along with the category K0 (OPD-CQ), as well as burnout (BOSS-I/-II).ResultsStructural impairment, a number of conflict modes, and burnout were significantly associated. Moreover, structural impairment explained additional variance in burnout. The requirements for the conflict-specific mediation models were given for 9 of the 12 OPD conflict modes. In these models the impact of the conflict modes on burnout was mediated by structural impairment.DiscussionThe current study broadens the comprehension of the relations between structural impairment, the conflict modes and burnout. In addition it higlights the role of structural impairment in predicting burnout risk and possible prevention approaches

Effectiveness of an Attachment-Informed Working Alliance in Interdisciplinary Pain Therapy

Attachment theory provides a useful framework for understanding individual differences inpain patients, especially with insecure attachment shown to be more prevalent in chronic pain patients compared to the general population. Nevertheless, there is little evidence of attachment-informed treatment approaches for this population. The present study compares outcomes from two different attachment-informed treatment modalities for clinicians, with outcomes from treatment as usual (TAU). In both intervention groups (IG1 and IG2), clinicians received bi-monthly training sessions on attachment. Additionally, clinicians in IG1 had access to the attachment diagnostics of their patients. All treatments lasted for four weeks and included a 6-month follow up. A total of 374 chronic pain patients were recruited to participate in this study (TAU = 159/IG1 = 163/IG2 = 52). Analyses were carried out using multilevel modeling with pain intensity as the outcome variable. Additionally, working alliance was tested as a mediator of treatment efficacy. The study was registered under the trial number DRKS00008715 on the German Clinical Trials Register (DRKS). Findings show that while IG2 was efficient in enhancing treatment outcomes, IG1 did not outperform TAU. In IG2, working alliance was a mediator of outcome. Results of the present study indicate that attachment-informed treatment of chronic pain can enhance existing interdisciplinary pain therapies; however, caveats are discussed.Fil: Pfeifer, Ann Christin. Ruprecht Karls Universitat Heidelberg.; AlemaniaFil: Meredith, Pamela. University of Queensland; AustraliaFil: Schröder Pfeifer, Paul. Ruprecht Karls Universitat Heidelberg.; AlemaniaFil: Gómez Penedo, Juan Martín. Universidad de Buenos Aires. Facultad de Psicología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Ehrenthal, Johannes. Ruprecht Karls Universitat Heidelberg.; AlemaniaFil: Schroeter, Corinna. Ruprecht Karls Universitat Heidelberg.; AlemaniaFil: Neubauer, Eva. Ruprecht Karls Universitat Heidelberg.; AlemaniaFil: Schiltenwolf, Marcus. Ruprecht Karls Universitat Heidelberg.; Alemani

Measuring personality functioning with the 12-item version of the OPD-Structure Questionnaire (OPD-SQS): reliability, factor structure, validity, and measurement invariance in the general population

BackgroundThe assessment of personality functioning is at the core of current dimensional models of personality disorders. A variety of measures from different clinical and research traditions aim to assess basic psychological capacities regarding the self and others. While some instruments have shown reliability and validity in clinical or other selected samples, much less is known about their performance in the general population.MethodsIn three samples representative of the German adult population with a total of 7,256 participants, levels of personality functioning were measured with the short 12-item version of the Operationalized Psychodynamic Diagnosis – Structure Questionnaire (OPD-SQS). We addressed questions of factor structure, reliability, validity, factorial invariance, and provide norm values.ResultsConfirmatory factor analysis indicated a satisfactory to good model fit. OPD-SQS models were mostly unaffected by variables such as gender, age, or measurement time. As expected, personality functioning was associated with general psychopathology as well as indices of occupational functioning.ConclusionThe OPD-SQS is a viable measure to assess personality functioning in the general population

Day clinic and inpatient psychotherapy of depression (DIP-D): qualitative results from a randomized controlled study

Objective: Depressive disorders are among the most common psychiatric disorders. For severely depressed patients, day clinic and inpatient settings represent important treatment options. However, little is known about patients’ perceptions of the different levels of care. This study aimed to obtain an in-depth analysis of depressive patients’ experiences of day clinic and inpatient treatment in a combined clinical setting. Methods. Following a randomized controlled trial comparing day clinic and inpatient psychotherapy for depression (Dinger et al. in Psychother Psychosom 83:194–195, 2014), a sample of depressive patients (n = 35) was invited to participate in a semi-structured interview during an early follow up 4 weeks after discharge. A qualitative analysis of interview transcripts was performed following the principles of constructivist thematic analysis. Results: Following analysis, 1355 single codes were identified from which five main categories and 26 themes were derived for both groups. In regard to patient group integration and skill transfer to everyday life, distinct differences could be observed between the day clinic and inpatient group. Conclusion: While adjustment to therapeutic setting and patient group integration seem to be facilitated by inpatient treatment, the day clinical setting appears to promote treatment integration into patients’ everyday contexts, aiding treatment-related skill transfer to everyday life as well as alleviating discharge from clinic treatment. Further studies on depressive subject groups in day clinic and inpatient treatment should investigate aspects of group cohesion and treatment integration in relation to therapeutic outcome

Evaluation of the short form of "Experience in Close Relationships" (Revised, German Version "ECR-RD12") - A tool to measure adult attachment in primary care

Attachment theory helps us to understand patients' health behavior. Attachment styles might explain patient differences in coping behavior, self-treatment, or patient-provider relationships. In primary care time constrains are relevant. A short instrument may facilitate screening and assessment in daily medical practice. The aim of this study was to evaluate a 12-item short version of the Experience in Close Relationships-revised (ECR-R-D) to be used in primary care settings. We included 249 patients from ten general practices in central Germany into a cross-sectional study. Exploratory factor analysis was performed to evaluate the factor structure of the ECR-items. Cronbach's alpha was used to assess internal consistency. The results related to the short form of the ECR are in line with those of the German full-length version of the measure (ECR-RD 36). Internal consistencies were in an adequate range. The ECR short form can be recommended as a screening measure of attachment styles in primary care