Why are some cases not on track? An item analysis of the assessment for signal cases (ASC) during inpatient psychotherapy

Within the Routine Outcome Monitoring System “OQ‐Analyst”, the questionnaire “Assessment for Signal Cases” (ASC) supports therapists in detecting potential reasons for not‐on‐track trajectories. Factor analysis and a machine learning algorithm (Lasso with 10‐fold cross‐validation) were applied and potential predictors of not‐on‐track classifications were tested using logistic multilevel modelling methods. The factor analysis revealed a shortened (30‐item) version of the ASC with good internal consistency (α = 0.72 – 0.89) and excellent predictive value (AUC = 0.98; +PV = 0.95; ‐PV = 0.94). Item‐level analyses showed that interpersonal problems captured by specific ASC items (not feeling able to speak about problems with family members; feeling rejected or betrayed) are the most important predictors of not‐on‐track trajectories

Resisting the mantle of the monstrous feminine : women's construction and experience of premenstrual embodiment

The female reproductive body is positioned as abject, as other, as site of defciency and disease, the epitome of the ‘monstrous feminine.’ Premenstrual change in emotion, behavior or embodied sensation is positioned as a sign of madness within, necessitating restraint and control on the part of the women experiencing it (Ussher 2006). Breakdown in this control through manifestation of ‘symptoms’ is diagnosed as PMS (Premenstrual Syndrome) or PMDD (Premenstrual Dysphoric Disorder), a pathology deserving of ‘treatment.’ In this chapter, we adopt a feminist material-discursive theoretical framework to examine the role of premenstrual embodiment in relation to women’s adoption of the subject position of monstrous feminine, drawing on interviews we have conducted with women who self-diagnose as ‘PMS sufferers.’ We theorize women’s self-positioning as subjectifcation, wherein women take up cultural discourse associated with idealized femininity and the reproductive body, resulting in self-objectifcation, distress, and self-condemnation. However, women can resist negative cultural constructions of premenstrual embodiment and the subsequent self-policing. We describe the impact of women-centered psychological therapy which increases awareness of embodied change, and leads to greater acceptance of the premenstrual body and greater self-care, which serves to reduce premenstrual distress

Factors Associated with Sexual Health and Well-Being in Older Adulthood

Purpose of review: To provide an update of recent studies on factors associated with sexual well being in older people with a special focus on sexual activity, satisfaction and function. Recent findings: Most recent studies confirmed the relationship between mental health status, especially negative affect and depressive symptoms, and sexual health in older adulthood. However, when this relationship is investigated more deeply, it seems that in fact positive psychological well being (positive affect and quality of life) accounts for sexual activity rather than the lack of depressive symptoms. Moreover, recent studies provided more insight into the relationship between marital characteristics, religion, cognitive functioning and sleeping difficulties and different dimensions of sexual health in older adulthood. Summary: In summary, there is substantial previous research revealing associations between various psychosocial, health-related and demographic variables and sexual health in older adulthood. Most considered variables are, for example, age, sex, general physical and mental health. For future research, it is important to consider that relationships between specific variables and sexual health in higher age are usually more complex than they are expected to be and factors differ between different dimensions of sexual health. Communication about sexuality between health-care providers and older patients still implies a lot of barriers and lack of knowledge. Therefore, the provision of communication training for health-care providers to older people in which knowledge is gained about correlates of sexual health in older adulthood should be implemented

A Confirmatory Factor Analytic Validation of the Tinnitus Handicap Inventory

Objective: Because the postulated three-factor structure of the internationally widely used Tinnitus Handicap Inventory (THI) has not been confirmed yet by a confirmatory factor analytic approach this was the central aim of the current study. Methods: From a clinical setting, N = 373 patients with chronic tinnitus completed the THI and further questionnaires assessing tinnitus-related and psychological variables. In order to analyze the psychometric properties of the THI, confirmatory factor analysis (CFA) and correlational analyses were conducted. Results: CFA provided a statistically significant support for a better fit of the data to the hypothesized three-factor structure (RMSEA = .049, WRMR = 1.062, CFI = .965, TLI = .961) than to a general factor model (RMSEA = .062, WRMR = 1.258, CFI = .942, TLI = .937). The calculation of Cronbach\u27s alpha as indicator of internal consistency revealed satisfactory values (.80–.91) with the exception of the catastrophic subscale (.65). High positive correlations of the THI and its subscales with other measures of tinnitus distress, anxiety, and depression, high negative correlations with tinnitus acceptance, moderate positive correlations with anxiety sensitivity, sleeping difficulties, tinnitus loudness, and small correlations with the Big Five personality dimensions confirmed construct validity. Conclusion: Results show that the THI is a highly reliable and valid measure of tinnitus-related handicap. In contrast to results of previous exploratory analyses the current findings speak for a three-factor in contrast to a unifactorial structure. Future research is needed to replicate this result in different tinnitus populations

Internet-Delivered Cognitive-Behavior Therapy for Tinnitus: A Randomized Controlled Trial

Objectives: Tinnitus has a substantially negative impact on quality of life in up to 5% of the general population. Internet-based cognitive-behavioral treatment (iCBT) has been shown to be effective in a few trials. The aim of our study was to investigate iCBT for tinnitus by using a randomized controlled trial. Methods: Patients with severe tinnitus-related distress were randomly assigned to therapist-guided iCBT (n = 62) or to a moderated online discussion forum (n = 62). Standardized self-report measures for tinnitus-related distress (Tinnitus Handicap Inventory, Mini-Tinnitus Questionnaire) and associated symptoms (tinnitus acceptance, anxiety, depression, and insomnia) were assessed at pretreatment and posttreatment, 6-month-, and 1-year follow-up. Clinical significance was assessed with the Reliable Change Index. Results: Multivariate analyses of variance revealed significant main effects for time, group, and interaction in favor of the iCBT group. With regard to tinnitus-related distress, the significant univariate interaction effects (time by group) were supported by large effect sizes (Tinnitus Handicap Inventory: g = 0.83, 95% confidence interval = 0.47–1.20; Mini-Tinnitus Questionnaire: g = 1.08, 95% confidence interval = 0.71–1.64). For the secondary outcomes, significant interactions with small to medium effect sizes were found. Within-group effects for the iCBT, from pretreatment to follow-up, were substantial in regard to tinnitus-related distress (1.38 ≤ d ≤ 1.81) and small to large for secondary outcomes (0.39 ≤ d ≤ 1.04). Conclusions: Using a randomized controlled trial design, we replicated prior findings regarding positive effects of Internet-delivered CBT on tinnitus-related distress and associated symptoms. Implementing iCBT for tinnitus into regular health care will be an important next step to increase access to treatment for patients with tinnitus

When People Change, and Its Relation to Specific Therapy Techniques and Common Factors [Wenn sich Menschen ändern –Veränderungsprozesse in der Psychotherapie und ihre Beziehung zu spezifischen Therapietechniken und allgemeinen Wirkfaktoren].

Erkenntnisse diverser Studien legen nahe, dass Placebo-Kontrollgruppen mehr von Psychotherapie profitieren als Kontrollgruppen ohne jegliche Behandlung, jedoch weniger als Patienten, die eine theoriegeleitete Behandlung erhalten. Die vorliegende Auswertung der Befunde vergleichender Ergebnisstudien - zum einen solche, die Ergebnisse von Patienten, die von auszubildenden/paraprofessionellen versus professionellen Therapeuten behandelt wurden, gegenüberstellen und zum anderen solche, die eine Symptomverbesserung in der Anfangsphase der Behandlung (‚early response‘ bzw. frühe Therapie-Response) in einem beträchtlichen Anteil der Stichprobe zeigen - legt nahe, dass den allgemeinen Wirkfaktoren von Psychotherapie bedeutende Effekte zukommen. Das Phänomen der frühen Therapie-Response stellt dabei eine Herausforderung dar, sowohl für das Verständnis der Effekte spezifischer psychotherapeutischer Ansätze als auch der ursächlichen Effekte spezifischer therapeutischer Techniken in der Behandlung bestimmter Erkrankungen. Die Behandlungsergebnisse sind dabei am ehesten als komplexes Zusammenspiel allgemeiner Wirkfaktoren, wie z.B. der Erwartung des Patienten hinsichtlich einer erfolgreichen Behandlung oder der therapeutischen Beziehung, sowie spezifischer Interventionen zu verstehen

Aspects of Mental Health Care in the Gynecological Setting

Psychological disorders are commonly associated with gynecological conditions, but are frequently undetected and untreated, and may influence the presentation and treatment outcomes of the physical condition. A literature search was conducted in order to provide a narrative review of psychological aspects of menopause, premenstrual syndrome, premenstrual dysphoric disorder, chronic pelvic pain, incontinence and polycystic ovarian syndrome. All the conditions that have been addressed in this review can be associated with an increased risk of psychological symptoms and disorders. Anxiety and depression are common and are associated with significant morbidity. Gynecological conditions, by their nature, are likely to be accompanied by impairments in social, occupational and personal functioning. Greater emphasis should be placed on the mental health aspects of gynecological conditions

Nocebo-Hypothesis Cognitive Behavioral Therapy (NH-CBT) for Persons with Functional Neurological Symptoms (Motor Type): Design and Implementation of a Randomized Active-Controlled Trial

Introduction: Functional Neurological Symptom Disorders (FNSD) are associated with high levels of disability and immense direct and indirect health costs. An innovative interdisciplinary rehabilitation approach for individuals with functional neurological symptoms of motor type–Nocebo-Hypothesis Cognitive Behavioral Therapy (NH-CBT)—combines CBT and movement retraining with video feedback embedded in a comprehensive explanatory model of the etiology of FNSD. Methods: This protocol describes the development and implementation of a phase II, parallel group, randomized controlled trial with blinded outcome assessors to compare the efficacy of NH-CBT with an active control condition (supportive counseling and movement retraining). Individuals meeting diagnostic criteria of an FNSD or psychogenic movement disorder will be randomly assigned to one of the 8-week interventions. Self-report scales of motor and other physical symptoms, symptom-related psychological variables, and assessor ratings of participants\u27 mobility will be administered at baseline, and at 8- and 16-week follow-up. Adverse events will be monitored across all sessions and therapeutic alliance will be measured at the end of therapy. The primary statistical analysis will test the hypothesis that NH-CBT is more effective than the control intervention at the 8-week follow-up. Discussion: The therapeutic strategies of NH-CBT are theory-driven by assumptions of the predictive coding model of the etiology of FNSD. Strengths and limitations of this trial will be discussed