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

Modification of 40X13 steel at high-intensity nitrogen ion implantation

This paper presents the results of the formation of deep modified layers in 40X13 steel using a high-intensity repetitively pulsed nitrogen ion beam with a current density up to 0.25 A/cm2. An arc generator with a hot cathode provided the DC nitrogen plasma flow. A plasma immersion approach was used for high-frequency, short-pulse very intense nitrogen ion beam formation. A grid hemisphere with radii of 7.5 cm was immersed in the plasma. Negative bias pulses with an amplitude of 1.2 kV, a pulse duration of 4 µs, and a pulse repetition rate of 105 pulses per second were applied to the grid. The substrates were implanted at the temperature of 500 °C and various processing times ranging from 20 to 120 minutes with 1.2 keV nitrogen ions using a very-high current density up to 0.25 A/cm2 ion beams. The work explores the surface morphology, elemental composition, and mechanical properties of deep-layer modified 40X13 steel after low ion energy, very-high-intensity nitrogen ion beam implantation

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

The ANTOP study: focal psychodynamic psychotherapy, cognitive-behavioural therapy, and treatment-as-usual in outpatients with anorexia nervosa - a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Anorexia nervosa is a serious eating disorder leading to high morbidity and mortality as a result of both malnutrition and suicide. The seriousness of the disorder requires extensive knowledge of effective treatment options. However, evidence for treatment efficacy in this area is remarkably weak. A recent Cochrane review states that there is an urgent need for large, well-designed treatment studies for patients with anorexia nervosa. The aim of this particular multi-centre study is to evaluate the efficacy of two standardized outpatient treatments for patients with anorexia nervosa: focal psychodynamic (FPT) and cognitive behavioural therapy (CBT). Each therapeutic approach is compared to a "treatment-as-usual" control group.</p> <p>Methods/Design</p> <p>237 patients meeting eligibility criteria are randomly and evenly assigned to the three groups – two intervention groups (CBT and FPT) and one control group. The treatment period for each intervention group is 10 months, consisting of 40 sessions respectively. Body weight, eating disorder related symptoms, and variables of therapeutic alliance are measured during the course of treatment. Psychotherapy sessions are audiotaped for adherence monitoring. The treatment in the control group, both the dosage and type of therapy, is not regulated in the study protocol, but rather reflects the current practice of established outpatient care. The primary outcome measure is the body mass index (BMI) at the end of the treatment (10 months after randomization).</p> <p>Discussion</p> <p>The study design surmounts the disadvantages of previous studies in that it provides a randomized controlled design, a large sample size, adequate inclusion criteria, an adequate treatment protocol, and a clear separation of the treatment conditions in order to avoid contamination. Nevertheless, the study has to deal with difficulties specific to the psychopathology of anorexia nervosa. The treatment protocol allows for dealing with the typically occurring medical complications without dropping patients from the protocol. However, because patients are difficult to recruit and often ambivalent about treatment, a drop-out rate of 30% is assumed for sample size calculation. Due to the ethical problem of denying active treatment to patients with anorexia nervosa, the control group is defined as "treatment-as-usual".</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN72809357</p

Diagnostic psychodynamique opérationnalisé (OPD) - un nouveau système diagnostique pour la psychothérapie

Bei der „Operationalisierten Psychodynamischen Diagnostik - OPD“ handelt es sich um ein diagnostisches System zur Anwendung in der psychotherapeutischen Praxis, Lehre und Forschung. Es wurde seit etwa 1992 in einer Arbeitsgruppe von überwiegend psychodynamisch, teilweise auch verhaltenstherapeutisch orientierten Klinikern und Forschern entwickelt und wird im deutschsprachigen Raum breit rezipiert. Die vorliegende Arbeit beschreibt Entstehungsgeschichte, theoretischen Hintergrund und Struktur des Systems sowie den aktuellen Stand der Anwendung in Klinik, Lehre und Forschung.Schlüsselwörter: Psychodynamische Diagnostik, Psychotherapieforschung, psychotherapeutische AusbildungThe system of “Operationalized Psychodynamic Diagnostics - OPD ” was developed for application in psychotherapeutic practice, teaching and research. The system was created since the beginning of the nineties by a working group of mostly psychodynamically, partly also cognitive-behaviorally oriented clinicians and researchers and is intensely discussed in german speaking countries. This paper describes the process of the development of the system, its historical background and the actual state of its use in the clinical field, in psychotherapeutic training, and in research.Keywords: Psychodynamic diagnosis, psychotherapy research, psychotherapeutic trainingLe “diagnostic psychodynamique opérationnalisé” (OPD) constitue un système pouvant être appliqué au niveau de la pratique psychothérapeutique comme à ceux de l’enseignement et de la recherche. Il a été élaboré vers 1992 par un groupe de travail réunissant des cliniciens et des chercheurs appartenant au courant psychodynamique, avec quelques thérapeutes du comportement. Il s’agissait de définir des catégories diagnostiques multiaxiales, applicables dans le domaine de la psychothérapie, en vue de compléter les diagnostics psychiatriques considérés comme insuffisants (DSM IV et ICD 10, ch. 5), et de saisir des caractéristiques pertinentes au niveau de ’action. Le système doit en outre permettre de collecter des données fiables au niveau de la recherche. Finalement, il fallait pouvoir présenter des diagnostics psychodynamiques sous une forme adéquate d’un point de vue didactique et améliorer la communication sur ce plan.Le système se fonde sur cinq axes. Axe 1: aspects globaux concernant la manière dont le client vit les troubles et les conditions du traitement (ex.: degré de gravité, compliance, motivation, théorie subjective de la maladie). Axe 2: permet de décrire les schémas relationnels dysfonctionnels qui se sont établis, ce qui peut être important pour focaliser l’approche clinique. L’axe 3 inclut sept dimensions en rapport avec des conflits inconscients de longue durée (ex,: autonomie-dépendance). L’axe 4 regroupe les capacités et déficits enregistrés au niveau de la structure de la personnalité (perception de soi, auto-régulation, communication etc.). Le cinquième axe est réservé au diagnostic d’un syndrome selon l’ICD 10, y compris une manière modifiée de diagnostiquer les troubles psychosomatiques.Depuis sa publication en 1996 l’OPD a fait l’objet de nombreuses publications dans les pays de langue allemande. Des séminaires de formation ont lieu à intervalles réguliers; les auteurs recevront volontiers critiques, échos et propositions permettant de le développer plus avant. De premières études ont montré qu’il est pratique et que sa fiabilité est convenable. Actuellement, de nombreux projets de recherche s’intéressant à la psychothérapie et à la psychosomatique l’utilisent déjà. Leurs résultats doivent contribuer à son développement futur. Une version anglaise va être publiée très prochainement.De plus, en Allemagne un large groupe de pédopsychiatres a commencé en 1997 à préparer une version adaptée et élargie de l’OPD, destinée au travail avec des enfants et adolescents.Le présent article décrit la manière dont le système a été élaboré, son arrière-plan théorique et sa structure; il fournit aussi des indications quant à l’état actuel de son application dans les domaines clinique, enseignement et recherche

Was ist psychotherapeutische Kompetenz?

Das Thema therapeutische Kompetenz ist sehr komplex. Kompetenz umfasst u. a. schulen- und ausbildungsbezogene als auch kulturelle Aspekte, die jedoch oft wenig reflektiert werden. Wir möchten deshalb einmal direkt die zwei in unserem Sprachraum verbreiteten kulturellen Räume gegenüberstellen – in Form eines Dialogs. Orientiert haben wir uns an dem allgemeinen Kompetenzkriterien, wie sie die American Psychological Association 1 vorschlägt