Increasing the treatment motivation of patients with somatic symptom disorder: applying the URICA-S scale

Background: Therapeutic intervention programs for somatic symptom disorder (SSD) show only small-to-moderate effect sizes. These effects are partly explained by the motivational problems of SSD patients. Hence, fostering treatment motivation could increase treatment success. One central aspect in SSD patients might be damage to motivation because of symptomatic relapses. Consequently, the aim of the present study was to investigate associations between motivational relapse struggle and therapeutic outcome in SSD patients. Methods: We assessed 84 inpatients diagnosed with SSD in the early, middle and late stages of their inpatient treatment. The maintenance subscale of the University of Rhode Island Change Assessment-Short (URICA-S) was applied as a measure to assess motivational relapse struggle. Additionally, patients completed measures of treatment outcome that focus on clinical symptoms, stress levels and interpersonal functioning. Results: The results from multiple regression analyses indicate that higher URICA-S maintenance scores assessed in early stages of inpatient treatment were related to more negative treatment outcomes in SSD patients. Conclusions: SSD patients with ambivalent treatment motivation may fail in their struggle against relapse over the course of therapy. The URICA-S maintenance score assessed at therapy admission facilitated early identification of SSD patients who are at greater risk of relapse. Future studies should incorporate randomized controlled trials to investigate whether this subgroup could benefit from motivational interventions that address relapse

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

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

Zum Einfluss von Bindung und interpersonellen Problemen auf die therapeutische Beziehung und das Ergebnis

Der Fokus dieser Dissertation lag auf der Untersuchung von Therapeutenvariablen in der stationären Psychotherapie. Die Dissertation ist in vier separate empirische Studien aufgeteilt. In der ersten Studie wurde die Unterscheide zwischen Therapeuten in stationärer Therapie getestet. Die Ergebnisse zeigen, dass Therapeuteneffekte im stationären Setting zwar vorhanden sind, die Unterschiede zwischen Therapeuten hier aber geringer als im ambulanten Bereich ausfallen. Dagegen gab es große Unterschiede zwischen Therapeuten in der Beziehungsqualität, da einige Therapeuten bessere therapeutische Beziehungen zu ihren Patienten aufbauen als andere. Darauf aufbauend wendet sich die zweite Studie der Aufklärung von Therapeutenunterschieden zu. Dazu wurde getestet, ob interpersonelle Probleme von Therapeuten zur Aufklärung der Therapeutenunterschiede beitragen. Während höhere Dominanz von Patienten ein besseres Therapieergebnis vorhersagte, gab es keine Haupteffekte der interpersonellen Dimensionen der Therapeuten. Allerdings moderierte die Affiliation der Therapeuten den Einfluss der therapeutischen Beziehung auf den Therapieerfolg. In der dritten Studie wurde ein weiteres Konstrukt untersucht. Es wurde angenommen, dass die Bindungsrepräsentationen von Therapeuten relevante Einflussgrößen für Therapeutenverhalten darstellen und sowohl Therapiebeziehung als auch Ergebnis beeinflussen würden. Dieselbe Therapeutenstichprobe, die auch für Studie 2 untersucht wurde, wurde einer interview-basierten Bindungsdiagnostik mit dem Adult Attachment Interview unterzogen. Die Verteilung von sicherer und unsicherer Bindung ist mit einem Anteil von 60% sicher gebundenen Personen der Verteilung in der Normalbevölkerung ähnlich. Obwohl es keine signifikanten direkten Einflüsse der Bindungssicherheit im Sinne eines Haupteffekts gab, weisen Interaktionseffekte auf eine moderierenden Einfluss der Therapeutenbindung auf den Einfluss der Psychopathologie der Patienten hin. Höhere Bindungssicherheit von Therapeuten war besonders dann hilfreich für Beziehung und Therapieergebnis, wenn die Patienten stark beeinträchtigt zu Beginn der Therapie waren. In der vierten Studie wurde der Einfluss der Bindungsrepräsentationen von Therapeuten auf die Entwicklung der therapeutischen Beziehung über die Zeit betrachtet. Bindungsdimensionen der Therapeuten wurden in einem 3-Level Modell in Beziehung zu Beziehungsverläufen von Patienten über die Zeit gesetzt. Höhere Bindungssicherheit wies keinen Bezug zu den Beziehungsverläufen auf, aber ein höheres Ausmaß an Verstrickung ging mit niedrigerer Beziehungsqualität und einem leichten Anstieg am Ende der Therapie einher. Zusammenfassend zeigen die Ergebnisse der vier Studien, dass der Einzeltherapeut eine relevante Einflussgröße für den Erfolg von stationärer Psychotherapie darstellt. Interpersonelle Probleme und Bindungsrepräsentationen von Therapeuten waren zwar nicht direkt mit dem Therapieergebnis assoziiert, ihr moderierender Einfluss auf Patientenvariablen bestätigt aber trotzdem ihre Bedeutung

Intraindividual Dynamics Between Alliance and Symptom Severity in Long-Term Psychotherapy: Why Time Matters

Objective: The association between alliance and therapy outcome is one of the most investigated factors in psychotherapy research. However, even studies using advanced methods estimate effects over a specific time period (interval) between measurement occasions. Thus, it remains unknown how the magnitude and direction of effects depend on the considered time interval, resulting in limited comparability across studies. The current study examines the influence of time on the within-person relationship between alliance and symptom severity. Method: Alliance (WAI-SR) and symptom severity (SCL-K11) were assessed every fifth session in N = 650 patients receiving up to 100 weekly sessions (mode = 55; M = 41.03; SD = 27.23) of individual psychotherapy in a German outpatient clinic. Bivariate continuous-time (CT) structural equation modeling (SEM) was used to estimate within-person cross- and auto-effects. Results: Analysis revealed significant reciprocal within-person cross-effects with stronger relative effects of SCL-K11 on WAI-SR (a(21)) than vice versa (a(12)). CT analysis showed that both cross-lagged effects increased for longer time intervals with strongest effects for time intervals of about 40 sessions (a(21) = -.47; a(12) = -.19). Conclusions: Alliance and symptom severity showed a reciprocal relationship. Expanding current evidence, our analysis showed how the magnitude of these effects depends on the considered time interval. Applying CT-SEM on longitudinal data of the alliance outcome association complements current cross-lagged panel analysis and allows to compare results of studies which are based on different time intervals between measurement occasions. Methodological, theoretical, and clinical implications are discussed