Suche nach der Ursache des chronischen Erschöpfungssyndroms: Eine Geschichte mit Fortsetzung

Zusammenfassung: Die Ursache des chronischen Erschöpfungssyndroms ist Gegenstand einer durchaus engagierten Debatte zwischen Wissenschaft, Behandlern, betroffenen Patienten und Selbsthilfegruppen, deren Form und Intensität nicht nur durch die Inhalte der bisherigen Forschungsergebnisse, sondern auch durch die dadurch erhoffte Legitimisierung bzw. befürchtete Delegitimisierung dieses Syndroms und der damit verbundenen Leiden sowie Beeinträchtigungen zu erklären ist. Anhand historischer und aktueller Beispiele somatischer Erklärungsmodelle von chronischen Erschöpfungszuständen sollen die Mechanismen dieser Abläufe beschrieben und erläutert werde

Chronisches Erschöpfungssyndrom: Evidenzbasierte Psychotherapie bei chronischer organisch unklarer Erschöpfung

Zusammenfassung: Chronische Erschöpfungszustände ohne bzw. ohne adäquate somatische Ursache sind für Betroffene sowie für Behandler ein Problem, da mit dem Fehlen einer eindeutigen nosologischen Zuordnung und eines eindeutigen Ätiologiemodells auch die Behandlungsoptionen nicht immer direkt auf der Hand liegen bzw. Gegenstand von Kontroversen sind (s.Gaab, in diesem Heft). Zur Behandlung des chronischen Erschöpfungssyndroms ("chronic fatigue syndrome", CFS) werden verschiedene psychotherapeutische Ansätze neben graduierter Aktivierung vorgeschlagen. Ziel des vorliegenden Beitrags ist es, den aktuellen Stand der Evidenzbasierung von Psychotherapie bei CFS auf Basis vorliegender Metaanalysen und neuerer randomisierter kontrollierter Studien darzustellen. Robuste Evidenz zeigt sich für die kognitive Verhaltenstherapie (KVT) mit im Durchschnitt moderater Wirksamkeit im Hinblick auf die Schwere der Erschöpfungssymptomatik und die körperliche Funktionseinschränkung nach Therapieabschluss sowie in kurz- bis mittelfristigen Katamnesen. Klinisch relevante Verbesserungen sind bei 40-50% der so behandelten Personen zu beobachten. Andere Psychotherapieverfahren wurden bislang selten evaluiert - vielversprechende Ergebnisse weisen jedoch Einzelstudien zu Gesprächspsychotherapie und Psychoedukation auf. Insgesamt besteht die Notwendigkeit, in der Therapie Konzepte zur Rückfallprophylaxe stärker zu berücksichtigen und die Nachhaltigkeit der therapeutisch erzielten Verbesserungen empirisch abzusicher

Post-Traumatic Stress Disorder Outcome Research: Why Moderators Should not be Neglected

Several psychotherapeutic treatments have been developed over the years for treating the symptoms of post-traumatic stress disorder (PTSD). But it remains still unclear which components of the complex treatment packages are necessary and most beneficial for PTSD symptom improvement. In PTSD outcome research, the randomized controlled trial (RCT) design has been applied in order to address this issue. However, meta-analyses repeatedly reported considerable variation between results from individual RCTs (i.e. between-study heterogeneity). Attempts to explain such heterogeneity led to the identification of relevant moderators of treatment effects in PTSD RCTs. This study presents meta-analytic findings, which show that factors, which are not part of the treatment (such as the investigators’ preferences for a particular treatment or the complexity of the patients’ clinical problems), impact on outcome in PTSD RCTs. We show that considering extra-therapeutic moderators in meta-analyses on PTSD RCTs may impact the conclusions and recommendations that may be deduced. The summarized findings confirm the notion that no PTSD treatment consistently outperforms the others and strengthen the position that even non-trauma-focused treatments may be beneficial PTSD treatments

Deceptive and open-label placebo effects in experimentally induced guilt: a randomized controlled trial in healthy subjects

Placebos are known to yield significant effects in many conditions. We examined deceptive and open-label placebo effects on guilt, which is important for self-regulation and a symptom of mental disorders. Following an experimental induction of guilt, healthy subjects were randomized to deceptive placebo (DP; n = 35), open-label placebo (OLP; n = 35), or no treatment (NT; n = 39). The primary outcome was guilt responses assessed in area under the curve (AUC). Secondary outcomes were shame, guilt, and affect. We hypothesized that DP and OLP would reduce guilt compared to NT. Guilt responses were higher in the NT group than in the placebo groups (estimate = 2.03, 95% CI = 0.24–3.82, d = 0.53), whereas AUC guilt did not differ significantly between the placebo groups (estimate = −0.38, 95% CI = −2.52–1.76, d = −0.09). Placebos are efficacious in reducing acute guilt responses, regardless of the placebo administration (i.e., open vs. deceptive). Furthermore, we observed narrative-specific effects with significant changes of guilt but not shame, pride, or affect. These results indicate not only that guilt is amenable to placebos but also that placebos can be administered in an ethical and potentially emotion-specific manner

Lack of effects of the presence of a dog on pain perception in healthy participants - a randomized controlled trial

Animal-assisted interventions (AAIs) have been shown to be effective in the treatment of pain. Studies suggest that relationships with animals can have comparable qualities to relationships with humans and that this enables animals to provide social support. Further, the presence of an animal can strengthen the therapeutic alliance between patients and treatment providers. This suggests that the analgesic effects of AAI might be mediated by social support from an animal or by strengthening the alliance between the patient and the treatment provider. To test these assumptions, we examined the effects of the presence of a dog on experimentally induced pain in a pain assessment and a pain therapy context. Hundred thirty-two healthy participants were randomly assigned to the conditions "pain," "pain + dog," "pain + placebo," or "pain + placebo + dog." We collected baseline and posttreatment measurements of heat-pain tolerance and the heat-pain threshold and of the corresponding subjective ratings of heat-pain intensity and unpleasantness as well as of participants' perceptions of the study investigator. The primary outcome was heat-pain tolerance. The presence of the dog did not influence the primary outcome ("pain" vs. "pain + dog": difference = 0.04, CI = -0.66 to 0.74, p = 0.905; "pain + placebo" vs. "pain + placebo + dog": difference = 0.43, CI = -0.02 to 0.88, p = 0.059). Participants did also not perceive the study investigator to be more trustworthy in the presence of the dog ("pain" vs. "pain + dog": difference = 0.10, CI = -0.67 to 0.87, p = 0.796; "pain + placebo" vs. "pain + placebo + dog": difference = 0.11, CI = -0.43 to 0.64, p = 0.695). The results indicate that the mere presence of a dog does not contribute to pain reduction and that the analgesic effects of AAI that previous studies have found is not replicated in our study as AAI did not increase perceived social support and had no effect on the alliance between the participant and the treatment provider. We assume that the animal most likely needs to be an integrated and plausible part of the treatment rationale so that participants are able to form a treatment-response expectation toward AAI

The roles of expectation, comparator, administration route, and population in open-label placebo effects: A network meta-analysis.

Three meta-analyses have demonstrated the clinical potential of open-label placebos (OLPs). However, there is a need to synthesize the existing evidence through more complex analyses that would make it possible to answer questions beyond mere efficacy. Such analyses would serve to improve the understanding of why and under what circumstances OLPs work (e.g., depending on induced expectations or across different control groups). To answer these questions, we conducted the first network meta-analyses in the field of OLPs. Our analyses revealed that OLPs could be beneficial in comparison to no treatment in nonclinical (12 trials; 1015 participants) and clinical populations (25 trials; 2006 participants). Positive treatment expectations were found to be important for OLPs to work. Also, OLP effects can vary depending on the comparator used. While the kind of administration route had no substantial impact on the OLP effects, effects were found to be larger in clinical populations than in nonclinical populations. These results suggest that the expectation, comparator, administration route, and population should be considered when designing and interpreting OLP studies

Adjustment in third culture kids: A systematic review of literature

Third Culture Kids (TCKs) are children of expatriates who live in a culture other than their country of nationality or their parent's country of nationality for a significant part of their childhood. Past research has indicated that adjustment is a key factor in the success of global mobility. However, current research in the area of TCK adjustment is lacking. This systematic review aims to present and summarize all available published scientific data on the adjustment of internationally mobile children and adolescents who relocate with their families. We aim to understand factors related to TCK adjustment, highlight lacking research areas, and define areas of interest for future research. The eligibility criteria for inclusion in the review were: traditional TCKs; aged 7-17 years; measures taken during the relocation; outcome variables of wellbeing, psychological adjustment or social adjustment, or socio-cultural adjustment or adjustment. An initial search across eight databases in December 2021 yielded 9,433 studies, which were included in COVIDENCE and reviewed independently by two researchers at each phase. We finally included 14 studies in this study, 10 of which presented quantitative data. Extracted quantitative and qualitative studies were abstracted, and the main findings are presented using a consistent grid of codes: an initial computerized lexical scan (Leximancer) of all included papers generated a preliminary list of topics and their frequencies. We refined these initial topics using the most prominent theories around the topics of TCK, adjustment, and the extracted theories from selected papers and created a codebook. Then we abstracted the quantitative data from the selected studies and organized the statistically significant findings according to the codes. Lastly, we abstracted and synthesized the findings from qualitative studies. Efforts were made to present the available data within a reading grid, which enhances the understanding of mechanisms specific to the sample population and also makes it apparent where more research is needed. Specifically, findings suggest a need for a more inclusive multi-trajectory adjustment model and a better definition of the ecological sample. The coding system for the extraction and analysis in this systematic review may be a guide for researchers planning future studies on TCK adjustment

Psychotherapy: A World of Meanings

Despite a wealth of findings that psychotherapy is an effective psychological intervention, the principal mechanisms of psychotherapy change are still in debate. It has been suggested that all forms of psychotherapy provide a context which enables clients to transform the meaning of their experiences and symptoms in such a way as to help clients feel better, and function more adaptively. However, psychotherapy is not the only health care intervention that has been associated with “meaning”: the reason why placebo has effects has also been proposed to be a “meaning response.” Thus, it has been argued that the meaning of treatments has a central impact on beneficial (and by extension, negative) health-related responses. In light of the strong empirical support of a contextual understanding of psychotherapy and its effects, the aim of this conceptual analysis is to examine the role of meaning and its transformation in psychotherapy—in general—and within three different, commonly used psychotherapy modalities