A European research agenda for somatic symptom disorders, bodily distress disorders, and functional disorders: Results of an estimate-talk-estimate delphi expert study

Background: Somatic Symptom Disorders (SSD), Bodily Distress Disorders (BDD) and functional disorders (FD) are associated with high medical and societal costs and pose a substantial challenge to the population and health policy of Europe. To meet this challenge, a specific research agenda is needed as one of the cornerstones of sustainable mental health research and health policy for SSD, BDD, and FD in Europe. Aim: To identify the main challenges and research priorities concerning SSD, BDD, and FD from a European perspective. Methods: Delphi study conducted from July 2016 until October 2017 in 3 rounds with 3 workshop meetings and 3 online surveys, involving 75 experts and 21 European countries. EURONET-SOMA and the European Association of Psychosomatic Medicine (EAPM) hosted the meetings. Results: Eight research priorities were identified: (1) Assessment of diagnostic profiles relevant to course and treatment outcome. (2) Development and evaluation of new, effective interventions. (3) Validation studies on questionnaires or semi-structured interviews that assess chronic medical conditions in this context. (4) Research into patients preferences for diagnosis and treatment. (5) Development of new methodologic designs to identify and explore mediators and moderators of clinical course and treatment outcomes (6). Translational research exploring how psychological and somatic symptoms develop from somatic conditions and biological and behavioral pathogenic factors. (7) Development of new, effective interventions to personalize treatment. (8) Implementation studies of treatment interventions in different settings, such as primary care, occupational care, general hospital and specialty mental health settings. The general public and policymakers will benefit from the development of new, effective, personalized interventions for SSD, BDD, and FD, that will be enhanced by translational research, as well as from the outcomes of research into patient involvement, GP-patient communication, consultation-liaison models and implementation. Conclusion: Funding for this research agenda, targeting these challenges in coordinated research networks such as EURONET-SOMA and EAPM, and systematically allocating resources by policymakers to this critical area in mental and physical well-being is urgently needed to improve efficacy and impact for diagnosis and treatment of SSD, BDD, and FD across Europe

Stress management interventions in the workplace improve stress reactivity: a randomised controlled trial

Objective To examine the long-term effects of a stress management intervention (SMI) based on the effort-reward imbalance (ERI) model, on psychological and biological reactions to work stress. Methods 174 lower or middle management employees (99% male) were randomly assigned to an intervention or a waiting control group. The programme comprised 24×45 min group sessions (2 full days followed by two 4×45 min sessions within the next 8 months) on individual work stress situations. The primary endpoint was perceived stress reactivity (Stress Reactivity Scale, SRS), while secondary endpoints were salivary cortisol and α-amylase, anxiety and depression, and ERI. Assessments were repeated in 154 participants 1 year later. Results SRS score decreased in both groups. A two-factor ANOVA with repeated measures showed a significant time×group effect (F=5.932; p=0.016) with the greater reduction in the intervention group. For SRS, the effect size (Cohen`s d) after 1 year was d=0.416 in the intervention and d=0.166 in the control group. α-Amylase as a measure of sympathetic nervous system activation, decreased more strongly in the intervention group (area under the daytime curve and daytime slope: time×group effect p=0.076 and p=0.075). No difference was observed for cortisol. For depression, anxiety and ERI, improvements were higher in the intervention group but did not reach statistical significance. Conclusions SMI based on work stress theory, is effective in reducing perceived stress reactivity and sympathetic activation in lower and middle management employees. Other mental health parameters and ERI show a tendency towards improvement. These beneficial effects are present 1 year later

Vom Sinn des Verfahrenskonzepts und der Verfahrensvielfalt. Und warum das Baukasten-System in der Psychotherapie nicht funktioniert

Fragestellung: In Deutschland sind die geltenden Psychotherapierichtlinien für die ambulanten Behandlungen verfahrensorientiert ausgerichtet und auch die psychotherapeutische Aus- und Weiterbildung erfolgt im deutschen Gesundheitssystem verfahrensbezogen. In letzter Zeit werden jedoch Stimmen laut, die sich gegen die Beibehaltung des Verfahrensbegriffs in der Psychotherapie aussprechen und damit auch die Richtlinien-Psychotherapie in Frage stellen. Ziel: Die vorgebrachten Argumente (z.B. die Heterogenität der Verfahren) sowie die vorgetragenen Alternativen (z.B. ein verfahrens-übergreifendes „integratives“ Störungs- und Therapiemodell nach dem Baukasten-Prinzip) werden kritisch diskutiert. Ergebnisse: Die vorgebrachten Argumente gegen das Konzept der Verfahren und die präsentierten Alternativen erweisen sich unter wissenschaftlichen und psychotherapeutischen Gesichtspunkten als wenig überzeugend. Zum einen wird gezeigt, dass Psychotherapie nach dem Baukasten-Prinzip anhand von störungsspezifischen Methoden oder Modulen „verfahrens-übergreifend“ weder gelernt noch gelehrt oder ausgeübt werden kann. Zum anderen gibt es für eine „allgemeine“ oder „integrative“ Psychotherapie bisher keinerlei Evidenz – im Unterschied zu den Richtlinien-Verfahren. Schlussfolgerungen: Das Konzept der Psychotherapie-Verfahren erweist sich als ein unverzichtbares Orientierungsprinzip sowohl für Therapeuten als auch für Patienten

Effectiveness and cost effectiveness of a stress management training for leaders of small and medium sized enterprises – study protocol for a randomized controlled-trial

Background: Leaders in small and medium-sized enterprises (SMEs) are exposed to increased stress as a result of a range of challenges. Moreover, they rarely have the opportunity to participate in stress management trainings. Therefore, KMU-GO (ger: Kleine and mittlere Unternehmen - Gesundheitsoffensive; en: small and medium-sized enterprises - health campaign) aims at conducting and evaluating such a stress management training. The focus of evaluation does not only lie on the effects on leaders participating but also on their employees. Methods: The study is planned as a 2 x 3 mixed design with two groups (intervention and waiting control group) as a between factor and point in time (at baseline, 6 and 12 months later) as a within factor. We aim at collecting data from N = 200 leaders. Based on the results of a preceding assessment, an already successfully implemented stress management training was adapted to SME needs and now serves as the framework of this intervention. The stress management training comprises one and a half days and is followed by two booster sessions (each 180 min) about 3 and 6 months after the training. The main focus of this intervention lies on specifying leaders stress reactivity while at the same time investigating its effects on employees' mental health. Further dependent variables are leaders' depression and anxiety scores, effort-reward imbalance, sick days and psychophysiological measures of heart rate variability, hair cortisol, and salivary alpha-amylase. Cost-effectiveness analyses will be conducted from a societal and employers' point of view. Discussion: Stress management is a highly relevant issue for leaders in SMEs. By providing an adequate occupational stress management training, we expect to improve leaders' and also employees' mental health, thereby preventing economic losses for SMEs and the national economy. However, collecting data from employees about the success of a stress management training of their leader is a highly sensitive topic. It requires a carefully planned proceeding ensuring for example a high degree of transparency, anonymity, and providing team incentives