How to Measure the Mental Health of Teachers? Psychometric Properties of the GHQ-12 in a Large Sample of German Teachers.

To improve the health status of teachers, there is a need for good and reliable instruments to continuously assess their mental health. The current study proposed the GHQ-12 questionnaire as an appropriate instrument for measuring the mental health of teachers. The GHQ-12 is a well-established screening instrument that has mostly been applied in non-teaching samples. In the current study, the psychometric properties of the questionnaire were analyzed using a large sample of German teachers (N = 3996). The data was collected yearly over an extended period of time (2012-2020). Results showed good to very good reliability, as well as high correspondence to burnout and life satisfaction scales. Principal axis factor analysis supported a two-factor structure: Factor 1 represents "depression/stress" and Factor 2 represents "loss of confidence". However, the mental health of the investigated teachers was worse than that of a representative sample in Germany. Consequently, this study highlighted the fact that the teaching profession is vulnerable to mental strain and underlined the importance of promoting prevention programs that could help to sustain and foster the mental health of teachers. In this context, the GHQ-12 could be proposed as a good and economic tool to assess and analyze mental health in German teachers. The presented norm could help practitioners and teachers to compare individual scores within a larger peer group

SOMATOFORM PAIN DISORDER – OVERVIEW

Somatoforme Schmerzen sind ein sowohl in der Primärals auch der fachsomatischen Versorgung häufiges Beschwerdebild. Neben somatisch nicht ausreichend zu erklärenden Schmerzen aller Lokalisationen treten häufig auch umschriebene Funktionsstörungen einzelner Organsysteme wie Schwindel, Herz- oder Verdauungsbeschwerden sowie Erschöpfungsbeschwerden auf. Gleichzeitig klagen viele Patienten über depressive oder Angstsymptome. Während psychodynamisch-interaktionelle Modelle eine frühe Beeinträchtigung der Körperbeziehung sowie eine ungenügende Affektdifferenzierung in den Vordergrund stellen, fokussieren kognitiv-behaviorale Modelle somatosensorische Amplifikationsprozesse. Die organische Ursachenüberzeugung der Patienten sowie die im Durchschnitt lange Anamnesedauer mit Enttäuschungen über die zahlreichen, meist unbefriedigenden Behandlungsversuchen bedingen nicht selten interaktionelle Schwierigkeiten in der Arzt-Patienten- Beziehung. Schulenübergreifende Handlungsempfehlungen betonen eine aktive Haltung des Therapeuten, Legitimation der Schmerzbeschwerden sowie Hilfe bei der Symptombewältigung. Psychodynamische Ansätze fokussieren zudem Affektdifferenzierung sowie die Bearbeitung von im Zusammenhang mit Schmerzerleben berichteten Beziehungsepisoden.Patients with severe and disabling pain and bodily distress which cannot be explained by underlying organic pathology are common in all levels of health care and are typically difficult to treat for physicians as well as for mental health specialists. Beside pain in different locations, not fully explained by specific somatic pathology, specific functional complaints such as dizziness, fatigue or vegetative disorders are common. A great proportion of patients with somatoform pain complain of comorbid depressive or anxiety disorder. Psychodynamic-interpersonal psychotherapy particularly emphasises interpersonal processes as well as disturbance of body awareness and self regulation already in childhood. Cognitive-behavioral models focus on the phenomenon of somatosensory amplification. The patients do have a strong believe in an underlying somatic illness, therefore seeking for further diagnostic and somatic therapy. This frequently leads to multiple but ineffective therapeutic attempts in the field of somatic medicine resulting in frustration of the patients and a difficult doctor-patient-relationship. General therapeutic recommendations include an active therapeutic approach with paying tribute for the patients’ suffering and giving support to cope with the pain. A specific psychodynamic approach furthermore focuses on improvement of affect differentiation and the interaction of somatoform pain and interpersonal relationships

The Longitudinal Effect of Vertigo and Dizziness Symptoms on Psychological Distress Symptom-Related Fears and Beliefs as Mediators

Despite the frequent observation that vertigo and dizziness (VD) disorders may trigger or exacerbate secondary psychiatric comorbidities, there is limited understanding of the mechanisms underlying this development. To address this gap, we investigated whether symptom-related fears and cognitions as indicated by questionnaire-based measures are mediators of the longitudinal effect of VD symptoms on anxiety and depression after 1 year. We analyzed data from a large study with patients of a treatment center specialized in vertigo (N = 210). Simple and multiple parallel mediation models strengthened our hypothesis that fear of bodily sensations and cognitions about these symptoms play a mediating role in the relationship between VD symptoms and psychopathology at follow-up after baseline scores of the outcome were controlled for. Results are discussed within a cognitive theory framework and point to the potential benefits of interventions that modify symptom-related beliefs and fears via cognitive psychotherapy in this therapeutically underserved population

Functional Relaxation and Guided Imagery as Complementary Therapy in Asthma: A Randomized Controlled Clinical Trial

Background: Asthma is a frequently disabling and almost invariably distressing disease that has a high overall prevalence. Although relaxation techniques and hypnotherapeutic interventions have proven their effectiveness in numerous trials, relaxation therapies are still not recommended in treatment guidelines due to a lack of methodological quality in many of the trials. Therefore, this study aims to investigate the efficacy of the brief relaxation technique of functional relaxation (FR) and guided imagery (GI) in adult asthmatics in a randomized controlled trial. Methods: 64 patients with extrinsic bronchial asthma were treated over a 4-week period and assessed at baseline, after treatment and after 4 months, for follow-up. 16 patients completed FR, 14 GI, 15 both FR and GI (FR/GI) and 13 received a placebo relaxation technique as the control intervention (CI). The forced expiratory volume in the first second (FEV 1) as well as the specific airway resistance (sR(aw)) were employed as primary outcome measures. Results: Participation in FR, GI and FR/GI led to increases in FEV 1 (% predicted) of 7.6 +/- 13.2, 3.3 +/- 9.8, and 8.3 +/- 21.0, respectively, as compared to -1.8 +/- 11.1 in the CI group at the end of the therapy. After follow-up, the increases in FEV 1 were 6.9 +/- 10.3 in the FR group, 4.4 +/- 7.3 in the GI and 4.5 +/- 8.1 in the FR/GI, compared to -2.8 +/- 9.2 in the CI. Improvements in sR(aw) (% predicted) were in keeping with the changes in FEV 1 in all groups. Conclusions: Our study confirms a positive effect of FR on respiratory parameters and suggests a clinically relevant long-term benefit from FR as a nonpharmacological and complementary therapy treatment option. Copyright (C) 2009 S. Karger AG, Base

Teacher self-efficacy and mental health: their intricate relation to professional resources and attitudes in an established manual-based psychological group program

Introduction: Teaching is considered a mentally challenging occupation. Teacher self-efficacy is a personal resource which buffers the experience of stress and may be important in maintaining mental health. The preventive intervention “Manual-Based Psychological Group Program for Teachers” (MBPGPT) was applied and evaluated state-wide to improve the mental health of teachers. This study aims to investigate the intricate relation between teacher self-efficacy and mental health and their changes in the course of the intervention. Method: Using a single-group pre-/post-design, the relation between teacher self-efficacy and mental health was investigated in 742 teachers. Pre- and post-changes in teacher self-efficacy and their interaction with mental health were examined in a subsample of 171 teachers, who met the conservative inclusion criteria. In ancillary analyses, correlations with underlying changes in work-related behavior and experience patterns were analyzed to better understand the intricate link between teacher self-efficacy and mental health. Results: Teacher self-efficacy showed a significant, moderate correlation with mental health. Self-efficacy was moderately higher after the intervention than before the intervention, but independent of changes in mental health. Teacher self-efficacy was related to work-related psychological resistance and positive emotions. An increase in teacher self-efficacy was accompanied by an improvement in life satisfaction and distancing ability. A decrease in teacher self-efficacy went hand in hand with reduced experience of social support. Discussion: This study confirmed teacher self-efficacy as an important, reliable resource and its correlation with psychological resistance. The absence of a control group limits what causal conclusions can be drawn from the study. Nevertheless, self-efficacy seems to be a worthwhile goal of preventive interventions for teachers and should be promoted due to its wide-ranging implications. Suggestions for further studies and interventions are made

Psychiatric comorbidity and psychosocial impairment among patients with vertigo and dizziness

Background: Vertigo and dizziness are often not fully explained by an organic illness, but instead are related to psychiatric disorders. This study aimed to evaluate psychiatric comorbidity and assess psychosocial impairment in a large sample of patients with a wide range of unselected organic and non-organic (ie, medically unexplained) vertigo/dizziness syndromes. Methods: This cross-sectional study involved a sample of 547 patients recruited from a specialised interdisciplinary treatment centre for vertigo/dizziness. Diagnostic evaluation included standardised neurological examinations, structured clinical interview for major mental disorders (SCID-I) and self-report questionnaires regarding dizziness, depression, anxiety, somatisation and quality of life. Results: Neurological diagnostic workup revealed organic and non-organic vertigo/dizziness in 80.8% and 19.2% of patients, respectively. In 48.8% of patients, SCID-I led to the diagnosis of a current psychiatric disorder, most frequently anxiety/phobic, somatoform and affective disorders. In the organic vertigo/dizziness group, 42.5% of patients, particularly those with vestibular paroxysmia or vestibular migraine, had a current psychiatric comorbidity. Patients with psychiatric comorbidity reported more vertigo-related handicaps, more depressive, anxiety and somatisation symptoms, and lower psychological quality of life compared with patients without psychiatric comorbidity. Conclusions: Almost half of patients with vertigo/dizziness suffer from a psychiatric comorbidity. These patients show more severe psychosocial impairment compared with patients without psychiatric disorders. The worst combination, in terms of vertigo-related handicaps, is having non-organic vertigo/dizziness and psychiatric comorbidity. This phenomenon should be considered when diagnosing and treating vertigo/dizziness in the early stages of the disease

Mentalizing in psychotherapeutic processes of patients with eating disorders

BackgroundImprovement in the capacity to mentalize (i.e., reflective functioning/RF) is considered both, an outcome variable as well as a possible change mechanism in psychotherapy. We explored variables related to (in-session) RF in patients with an eating disorder (ED) treated in a pilot study on a Mentalization-Based Treatment (MBT) - oriented day hospital program. The research questions were secondary and focused on the psychotherapeutic process: What average RF does the group of patients show in sessions and does it change over the course of a single session? Are differences found between sections in which ED symptomatology is discussed and those in which it is not? Does RF increase after MBT-type interventions?Methods1232 interaction segments from 77 therapy sessions of 19 patients with EDs were rated for RF by reliable raters using the In-Session RF Scale. Additionally, content (ED symptomatology yes/no) and certain MBT interventions were coded. Statistical analysis was performed by mixed models.ResultsPatients showed a rather low RF, which increased on average over the course of a session. If ED symptomatology was discussed, this was associated with significantly lower RF, while MBT-type interventions led to a significant increase in RF.ConclusionsResults suggest that in-session mentalizing can be stimulated by MBT-typical interventions. RF seems to be more impaired when disorder-specific issues are addressed. Further studies have to show if improving a patient´s ability to mentalize their own symptoms is related to better outcomes

A Randomized Controlled Trial on Functional Relaxation as an Adjunct to Psychoeducation for Stress

This randomized controlled trial investigated whether adding the psychodynamically based body-oriented psychotherapy “Functional Relaxation” (FR) to psychoeducation (PE) is more effective than PE alone to reduce stress and stress-associated complaints. Eighty-one participants with elevated stress-levels, ≥50 points on the global scale of the Perceived Stress Questionnaire (PSQ), received either 10 sessions of manualized FR + PE (n = 42) or two sessions of manualized PE alone (n = 39) in a group setting. Six FR trainers took part in this study. Stress-level (PSQ) was the primary outcome and secondary outcomes were depression (PHQ-9) and somatization (PHQ-15). Multilevel models for discontinuous change revealed that FR + PE was more helpful to reduce stress-levels than PE from pre-treatment to post-treatment (t0 → t1) as well as from pre-treatment to 6-month follow-up (t0 → t2) (both p < 0.05) with effect sizes (d) being medium for PE (dt0 → t1 = 0.57; dt0 → t2 = 0.67) and large for FR + PE (dt0 → t1 = 1.57; dt0 → t2 = 1.39). Moreover, FR + PE affected depression and somatization more positively than did PE from t0 to t1 as well as from t0 to t2 (all p < 0.05). Effect sizes for depression were small to medium for PE (dt0 → t1 = 0.52; dt0 → t2 = 0.37) and large for FR + PE (dt0 → t1 = 1.04; dt0 → t2 = 0.95). Effect sizes for somatization were small for PE (dt0 → t1 = 0.18; dt0 → t2 = 0.19) and medium to large for FR + PE (dt0 → t1 = 0.73; dt0 → t2 = 0.93). In summary, the combination of FR and PE was more effective than PE alone. The results of the present trial provide first evidence of FR as a potent component of stress interventions. Adding FR to such interventions might better help prevent clinically relevant disorders such as depression or somatization

Bullying girls - Changes after brief strategic family therapy: A randomized, prospective, controlled trial with one-year follow-up

Background: Many girls bully others. They are conspicuous because of their risk-taking behavior, increased anger, problematic interpersonal relationships and poor quality of life. Our aim was to determine the efficacy of brief strategic family therapy (BSFT) for bullying-related behavior, anger reduction, improvement of interpersonal relationships, and improvement of health-related quality of life in girls who bully, and to find out whether their expressive aggression correlates with their distinctive psychological features. Methods: 40 bullying girls were recruited from the general population: 20 were randomly selected for 3 months of BSFT. Follow-up took place 12 months after the therapy had ended. The results of treatment were examined using the Adolescents' Risk-taking Behavior Scale (ARBS), the State-Trait Anger Expression Inventory (STAXI), the Inventory of Interpersonal Problems (IIP-D), and the SF-36 Health Survey (SF-36). Results: In comparison with the control group (CG) (according to the intent-to-treat principle), bullying behavior in the BSFT group was reduced (BSFT-G from n = 20 to n = 6; CG from n = 20 to n = 18, p = 0.05) and statistically significant changes in all risk-taking behaviors (ARBS), on most STAXI, IIP-D, and SF-36 scales were observed after BSFT. The reduction in expressive aggression (Anger-Out scale of the STAXI) correlated with the reduction on several scales of the ARBS, IIP-D, and SF-36. Follow-up a year later showed relatively stable events. Conclusions: Our findings suggest that bullying girls suffer from psychological and social problems which may be reduced by the use of BSFT. Expressive aggression in girls appears to correlate with several types of risk-taking behavior and interpersonal problems, as well as with health-related quality of life. Copyright (c) 2006 S. Karger AG, Basel