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Panagiotides NG, Zimprich F, Machold K, Schlager O, Müller M, Ertl S, Löffler-Stastka H, Koppensteiner R, Wadowski PP. A Case of Autoimmune Small Fiber Neuropathy as Possible Post COVID Sequelae. Int J Environ Res Public Health 2023; 20:4918. [PMID: 36981826 PMCID: PMC10049708 DOI: 10.3390/ijerph20064918] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/06/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023] [Imported: 08/24/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is reported to induce and augment autoimmune processes. Moreover, postinfectious effects of coronavirus disease 2019 (COVID-19) are still poorly understood and often resemble symptoms of the acute infection phase. A patient with swollen extremities was presented to the Department of Angiology at the Medical University of Vienna with complaints of muscle and joint pain, paresthesia, and arterial hypertension with intense headache. Prior to these complaints, she had been suffering from various symptoms since November 2020, following a SARS-CoV-2 infection in the same month. These included recurrent sore throat, heartburn, dizziness, and headache. Paresthesia and muscle and joint pain started in temporal relation to a human papillomavirus (HPV) vaccination. Since the patient was suffering from severe pain, intensive pain management was performed. Skin and nerve biopsies revealed autoimmune small fiber neuropathy. The patient's condition could be related to COVID-19, as her first symptoms began in temporal relation to the SARS-CoV-2 infection. Furthermore, in the disease course, antinuclear (ANA) and anti-Ro antibodies, as well as anti-cyclic citrullinated peptide (anti-CCP) antibodies, could be detected. Together with the symptoms of xerophthalmia and pharyngeal dryness, primary Sjögren's syndrome was diagnosed. In conclusion, though biopsy results could not distinguish a cause of the disease, SARS-CoV-2 infection can be discussed as a likely trigger for the patient's autoimmune reactions.
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Affiliation(s)
- Noel G. Panagiotides
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (N.G.P.); (O.S.); (M.M.); (S.E.); (R.K.)
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria
| | - Fritz Zimprich
- Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Klaus Machold
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria;
| | - Oliver Schlager
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (N.G.P.); (O.S.); (M.M.); (S.E.); (R.K.)
| | - Markus Müller
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (N.G.P.); (O.S.); (M.M.); (S.E.); (R.K.)
| | - Sebastian Ertl
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (N.G.P.); (O.S.); (M.M.); (S.E.); (R.K.)
- Division of Internal Medicine II, Klinikum Wels-Grieskirchen, 4600 Wels-Grieskirchen, Austria
| | | | - Renate Koppensteiner
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (N.G.P.); (O.S.); (M.M.); (S.E.); (R.K.)
| | - Patricia P. Wadowski
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria; (N.G.P.); (O.S.); (M.M.); (S.E.); (R.K.)
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Löffler-Stastka H, Pietrzak-Franger M. COVID-19 survivors: Multi-disciplinary efforts in psychiatry and medical humanities for long-term realignment. World J Psychiatry 2022; 12:995-998. [PMID: 36051597 PMCID: PMC9331443 DOI: 10.5498/wjp.v12.i7.995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/14/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] [Imported: 08/24/2023] Open
Abstract
The coronavirus disease 2019 pandemic represents an enduring transformation in health care and education with the advancement of smart universities, telehealth, adaptive research protocols, personalized medicine, and self-controlled or artificial intelligence-controlled learning. These changes, of course, also cover mental health and long-term realignment of coronavirus disease 2019 survivors. Fatigue or anxiety, as the most prominent psychiatric “long coronavirus disease 2019” symptoms, need a theory-based and empirically-sound procedure that would help us grasp the complexity of the condition in research and treatment. Considering the systemic character of the condition, such strategies have to take the whole individual and their sociocultural context into consideration. Still, at the moment, attempts to build an integrative framework for providing meaning and understanding for the patients of how to cope with anxiety when they are confronted with empirically reduced parameters (e.g., severe acute respiratory syndrome coronavirus type 2) or biomarkers (e.g., the FK506 binding protein 5) are rare. In this context, multidisciplinary efforts are necessary. We therefore join in a plea for an establishment of ‘translational medical humanities’ that would allow a more straightforward intervention of humanities (e.g., the importance of the therapist variable, continuity, the social environment, etc) into the disciplinary, medial, political, and popular cultural debates around health, health-care provision, research (e.g., computer scientists for simulation studies), and wellbeing.
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Steinmair D, Löffler-Stastka H. Personalized treatment - which interaction ingredients should be focused to capture the unconscious. World J Clin Cases 2022; 10:2053-2062. [PMID: 35321177 PMCID: PMC8895185 DOI: 10.12998/wjcc.v10.i7.2053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 12/14/2021] [Accepted: 02/13/2022] [Indexed: 02/06/2023] Open
Abstract
A recent meta-analysis revealed that mental health and baseline psychological impairment affect the quality of life and outcomes in different chronic conditions. Implementing mental health care in physical care services is still insufficient. Thus, interdisciplinary communication across treatment providers is essential. The standardized language provided by the diagnostic statistical manual favors a clear conceptualization. However, this approach might not focus on the individual, as thinking in categories might impede recognizing the continuum from healthy to diseased. Psychoanalytic theory is concerned with an individual’s unconscious conflictual wishes and motivations, manifested through enactments like psychic symptoms or (maladaptive) behavior with long-term consequences if not considered. Such modifiable internal and external factors often are inadequately treated. However, together with the physical chronic condition constraints, these factors determine degrees of freedom for a self-determined existence. The effect of therapeutic interventions, and especially therapy adherence, relies on a solid therapeutic relationship. Outcome and process research still investigates the mechanism of change in psychotherapeutic treatments with psychanalysis’s focus on attachment problems. This article examines existing knowledge about the mechanism of change in psychoanalysis under the consideration of current trends emerging from psychotherapy research. A clinical example is discussed. Additionally, further directions for research are given. The theoretical frame in psychoanalytic therapies is the affect-cognitive interface. Subliminal affect-perception is enabled via awareness of subjective meanings in oneself and the other; shaping this awareness is the main intervention point. The interactional ingredients, the patient’s inherent bioenvironmental history meeting the clinician, are relevant variables. Several intrinsic, subliminal parameters relevant for changing behavior are observed. Therapeutic interventions aim at supporting the internalization of the superego’s functions and at making this ability available in moments of self-reflection. By supporting mentalization abilities, a better understanding of oneself and higher self-regulation (including emotional regulation) can lead to better judgments (application of formal logic and abstract thinking). Thus, this facilitates enduring behavior change with presumably positive effects on mental and physical health.
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Affiliation(s)
- Dagmar Steinmair
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Wien 1090, Österreich, Austria
| | - Henriette Löffler-Stastka
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Wien 1090, Österreich, Austria
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Steinmair D, Zervos K, Wong G, Löffler-Stastka H. Importance of communication in medical practice and medical education: An emphasis on empathy and attitudes and their possible influences. World J Psychiatry 2022; 12:323-337. [PMID: 35317334 PMCID: PMC8900587 DOI: 10.5498/wjp.v12.i2.323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/30/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Healthcare professionals need to be prepared to promote healthy lifestyles and care for patients. By focusing on what students should be able to perform one day as clinicians, we can bridge the gap between mere theoretical knowledge and its practical application. Gender aspects in clinical medicine also have to be considered when speaking of personalized medicine and learning curricula.
AIM To determine sets of intellectual, personal, social, and emotional abilities that comprise core qualifications in medicine for performing well in anamnesis-taking, in order to identify training needs.
METHODS An analysis of training clinicians’ conceptions with respect to optimal medical history taking was performed. The chosen study design also aimed to assess gender effects. Structured interviews with supervising clinicians were carried out in a descriptive study at the Medical University of Vienna. Results were analyzed by conducting a qualitative computer-assisted content analysis of the interviews. Inductive category formation was applied. The main questions posed to the supervisors dealt with (1) Observed competencies of students in medical history taking; and (2) The supervisor’s own conceptions of "ideal medical history taking".
RESULTS A total of 33 training clinicians (n = 33), engaged in supervising medical students according to the MedUni Vienna’s curriculum standards, agreed to be enrolled in the study and met inclusion criteria. The qualitative content analysis revealed the following themes relevant to taking an anamnesis: (1) Knowledge; (2) Soft skills (relationship-building abilities, trust, and attitude); (3) Methodical skills (structuring, precision, and completeness of information gathering); and (4) Environmental/contextual factors (language barrier, time pressure, interruptions). Overall, health care professionals consider empathy and attitude as critical features concerning the quality of medical history taking. When looking at physicians’ theoretical conceptions, more general practitioners and psychiatrists mentioned attitude and empathy in the context of "ideal medical history taking", with a higher percentage of females. With respect to observations of students’ history taking, a positive impact from attitude and empathy was mainly described by male health care professionals, whereas no predominance of specialty was found. Representatives of general medicine and internal medicine, when observing medical students, more often emphasized a negative impact on history taking when students lacked attitude or showed non-empathetic behavior; no gender-specific difference was detected for this finding.
CONCLUSION The analysis reveals that for clinicians engaged in medical student education, only a combination of skills, including adequate knowledge and methodical implementations, is supposed to guarantee acceptable performance. This study’s findings support the importance of concepts like relationship building, attitude, and empathy. However, there may be contextual factors in play as well, and transference of theoretical concepts into the clinical setting might prove challenging.
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Affiliation(s)
- Dagmar Steinmair
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna 1090, Austria
- Karl Landsteiner University of Health Sciences, Krems 3500, Austria
- Department of Ophtalmology, University Hospital St. Pölten, St. Pölten 3100, Austria
| | - Katharina Zervos
- Department of Internal Medicine I, KRH Klinikum Robert-Koch-Gehrden, Gehrden 30989, Germany
| | - Guoruey Wong
- Faculty of Medicine, University of Montréal, Montréal 2900, Québec, Canada
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Altmann P, Ivkic D, Ponleitner M, Leutmezer F, Willinger U, Schmoeger M, Berger T, Bsteh G, Löffler-Stastka H. Individual Perception of Telehealth: Validation of a German Translation of the Telemedicine Perception Questionnaire and a Derived Short Version. Int J Environ Res Public Health 2022; 19:ijerph19020902. [PMID: 35055724 PMCID: PMC8775421 DOI: 10.3390/ijerph19020902] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/28/2021] [Accepted: 01/12/2022] [Indexed: 02/07/2023]
Abstract
Telehealth is a growing domain with particular relevance for remote patient monitoring. With respect to the biopsychosocial model of health, it is important to evaluate perception and satisfaction with new methods in telehealth as part of an integrative approach. The Telemedicine Perception Questionnaire (TMPQ) is a 17-item questionnaire measuring patients' perception of and satisfaction with telecare. We translated this survey into German and determined its validity and reliability in 32 adolescents and adults. Furthermore, we derived a short version of the TMPQ, named Patient and Physician Satisfaction with Monitoring (PPSM), which is a 5-item questionnaire that can be administered to both patients and physicians. Validity and reliability were tested in 32 patients and 32 physicians. Crohnbach's α for the translated TMPQ was 0.76, and the German version yielded high validity (intraclass correlation coefficient (ICC) 0.995). We tested the PPSM in both patients and physicians and found acceptable values for Crohnbach's α (0.72 and 0.78) with excellent validity (ICC 0.965). We therefore concluded from this small study that both German versions of the TMPQ and PPSM can be used to investigate the acceptance of telehealth applications.
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Affiliation(s)
- Patrick Altmann
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (P.A.); (D.I.); (M.P.); (F.L.); (U.W.); (M.S.); (T.B.)
| | - Dominik Ivkic
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (P.A.); (D.I.); (M.P.); (F.L.); (U.W.); (M.S.); (T.B.)
| | - Markus Ponleitner
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (P.A.); (D.I.); (M.P.); (F.L.); (U.W.); (M.S.); (T.B.)
| | - Fritz Leutmezer
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (P.A.); (D.I.); (M.P.); (F.L.); (U.W.); (M.S.); (T.B.)
| | - Ulrike Willinger
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (P.A.); (D.I.); (M.P.); (F.L.); (U.W.); (M.S.); (T.B.)
| | - Michaela Schmoeger
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (P.A.); (D.I.); (M.P.); (F.L.); (U.W.); (M.S.); (T.B.)
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (P.A.); (D.I.); (M.P.); (F.L.); (U.W.); (M.S.); (T.B.)
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (P.A.); (D.I.); (M.P.); (F.L.); (U.W.); (M.S.); (T.B.)
- Correspondence: ; Tel.: +43-1-40400-31450
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Gergov V, Milic B, Löffler-Stastka H, Ulberg R, Vousoura E, Poulsen S. Psychological Interventions for Young People With Psychotic Disorders: A Systematic Review. Front Psychiatry 2022; 13:859042. [PMID: 35401253 PMCID: PMC8987205 DOI: 10.3389/fpsyt.2022.859042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/24/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Psychotic disorders are commonly accompanied by intense psychological burden, and psychological interventions are usually needed in order to reduce the symptoms and help in maintaining or improving the level of psychological and social functioning after the onset of psychosis. The evidence-base for treating young people at risk for psychosis and adults with psychotic disorders is accumulating. Yet, pervasive systematic literature reviews that would include patients from the full age range being the most essential period for the risk of developing a psychotic disorder, a wide range of psychological interventions, and various types of clinical trials, have been lacking. The aim of this systematic review is to fill the gap by presenting the current research evidence from clinical trials on the effectiveness of psychological interventions for treating young people (12-30) with psychotic disorders. METHODS A systematic search was conducted in PubMed and PsycINFO followed by a 3-step screening process based on the PICOS strategy. Risk of bias of the included studies was assessed by the Mixed Methods Appraisal Tool (MMAT). Extracted data from the included studies is reported using a narrative synthesis. RESULTS Of the 1,449 publications screened, 40 from 25 studies were included in the review. Of these, 10 studies reported results from cognitive or behavioral therapy, nine from cognitive remediation therapy (CRT), and six from other types of therapies (i.e., integrative interventions combining psychoeducation and family/group interventions). All but one study found the target interventions to be effective, but the results mostly did not differ significantly from the control conditions in reducing symptoms and improving functioning, preventing relapses and hospitalization, or improving psychological or family variables. The most consistent findings were from CRT, showing more improvement in cognitive functioning compared to control conditions while not being superior in reducing symptom severity. Integrative interventions might be effective in treating young people suffering from psychotic disorders. CONCLUSION There is some evidence that psychological interventions are effective for young people with psychotic disorders. However, with regard to symptom severity, psychotherapy does not outperform control conditions, and the results do not strongly favor any specific type of treatment. SYSTEMATIC REVIEW REGISTRATION [https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020166756], identifier [CRD42020166756].
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Affiliation(s)
- Vera Gergov
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- *Correspondence: Vera Gergov,
| | - Branka Milic
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | | | - Randi Ulberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - Eleni Vousoura
- Department of Psychiatry, University of Athens, Athens, Greece
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Heinonen E, Orlinsky DE, Willutzki U, Rønnestad MH, Schröder T, Messina I, Löffler-Stastka H, Hartmann A. Psychotherapist Trainees' Quality of Life: Patterns and Correlates. Front Psychol 2022; 13:864691. [PMID: 35401345 PMCID: PMC8988184 DOI: 10.3389/fpsyg.2022.864691] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 02/21/2022] [Indexed: 02/05/2023] Open
Abstract
While psychotherapists are trained to improve their clients' quality of life, little work has examined the quality of life experienced by psychotherapist trainees themselves. Yet their life satisfactions and stresses would plausibly affect both their ability to learn new skills and conduct psychotherapy. Therefore, in the Society for Psychotherapy Research Interest Section on Psychotherapist Development and Training study, we investigated the patterns of self-reported life quality and their correlates in a multinational sample of 1,214 psychotherapist trainees. A comprehensive questionnaire was used at the outset of trainings to assess trainees' professional background, current life situation, personal characteristics, family background, and social and national origin. The findings indicated 54.3% of trainees' lives could be characterized as fortunate or happy (i.e., experiencing great life satisfaction and not much stress), whereas 14.3% could be characterized as clearly distressed or troubled (i.e., experiencing great life stress and not much satisfaction). The strongest correlates of high life stress, a contributor to poor life quality, were economic insecurity, self-protectiveness, and attachment-related anxiety in relationships, and economic or psychological hardship in childhood. In turn, greater wellbeing was most strongly associated with a warm and open interpersonal style, being married, having sufficient economic means, and material and emotional security in childhood. While the results indicate the majority of therapists experience a relatively good quality of life, the findings also suggest potential targets for increasing trainees' life quality when it may be deficient, such as those on a societal level (e.g., availability of low-cost student loans), training program level (e.g., promoting supportive supervision, positive between-trainee relationships and group collaboration), and individual level (e.g., personal therapy and learning self-care), in order to promote effective learning and therapy practice.
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Affiliation(s)
- Erkki Heinonen
- Department of Psychology, University of Oslo, Oslo, Norway
- Finnish Institute for Health and Welfare, Helsinki, Finland
- *Correspondence: Erkki Heinonen,
| | - David E. Orlinsky
- Department of Comparative Human Development, University of Chicago, Chicago, IL, United States
| | - Ulrike Willutzki
- Department of Psychology and Psychotherapy, University of Witten/Herdecke, Witten, Germany
| | | | - Thomas Schröder
- Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, United Kingdom
| | | | | | - Armin Hartmann
- Department of Psychosomatic Medicine and Psychotherapy, Faculty of Medicine, Medical Center – University of Freiburg, Freiburg im Breisgau, Germany
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Pietrabissa G, Schmidt SJ, Loeffler-Stastka H, Ulberg R. Editorial: Individualized Psychotherapy Treatment of Young People With Mental Disorders. Front Psychol 2022; 13:838296. [PMID: 35401374 PMCID: PMC8983955 DOI: 10.3389/fpsyg.2022.838296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/22/2022] [Indexed: 02/05/2023] Open
Affiliation(s)
- Giada Pietrabissa
- Department of Psychology, Catholic University of Milan, Milan, Italy
- IRCCS Istituto Auxologico Italiano, Milan, Italy
- *Correspondence: Giada Pietrabissa
| | - Stefanie Julia Schmidt
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | | | - Randi Ulberg
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Löffler-Stastka H, Dietrich D, Sauter T, Fittner M, Steinmair D. Simulating the mind and applications – a theory-based chance for understanding psychic transformations in somatic symptom disorders. World J Meta-Anal 2021; 9:474-487. [DOI: 10.13105/wjma.v9.i6.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/15/2021] [Accepted: 12/24/2021] [Indexed: 02/06/2023] Open
Abstract
With the new category of somatic symptom disorder/bodily distress disorder in ICD-11, research into pathogenetic and therapeutic pathways is stimulated. By turning away from the definition of somatoform disorders as “the lack of something physical explaining everything”, this new classification might offer a way to put the focus on the individual patient’s psychodynamic balance and conflicts and their condensation in the symptom. Modelling and simulation have a long history in science to gain insight also into complex phenomena. Considering the evolution of precision medicine many different parameters are meanwhile operationalised and ready for consequent process research. Calculation models have to fit to the complexity of this disorder category. In an interdisciplinary discourse between computer and medical/psychoanalytic scientists a multilayer, fine grained calculation model is elaborated. Starting from a clinical case history, within iterative discussion, by acknowledging the demand for interdisciplinary synergy and cooperation in science, psychoanalytic theory served as the basis for computer-scientific information technique. A parallelisation with the Mealy model helped to establish a meaningful calculation possibility for further process research. How psychic transformations can be understood properly in order to provide meaningful treatments, the respective training, and to conduct appropriate process- and outcome-research is established in simulating the mind and applications.
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Affiliation(s)
| | | | - Thilo Sauter
- Institute of Computer Technology, TU Wien, Vienna 1040, Austria
- Center for Integrated Sensor Systems, Danube University Krems, Wiener Neustadt 2700, Austria
| | - Martin Fittner
- Institute of Computer Technology, TU Wien, Vienna 1040, Austria
| | - Dagmar Steinmair
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Vienna 1090, Austria
- University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten 3100, Austria
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Steinmair D, Wong G, Frantal S, Rohm C, Löffler-Stastka H. Affect regulation in psychoanalytic treatments of patients with a borderline personality disorder–psychoanalysis and psychodynamic psychotherapy–a comparison. World J Psychiatry 2021; 11:1328-1345. [PMID: 35070781 PMCID: PMC8717030 DOI: 10.5498/wjp.v11.i12.1328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 07/19/2021] [Accepted: 11/21/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A recent meta-analysis has confirmed that the effects of psychotherapy on patients with borderline personality disorders (BPD) are still insufficiently understood. Evidence of differences between different types of therapies has been questioned.
AIM To study repetitive interaction patterns in patients with BPD undergoing either psychoanalysis or psychodynamic therapy.
METHODS Psychoanalysis (PSA) or psychodynamic psychotherapy (PDT) was administered to 10 patients each, the two groups were matched. Therapy regimens were applied according to care as usual/manualized including quality control and supervision as usual. Randomization to one of the groups was done after baseline assessment. During classical PSA (n = 10) and PDT (n = 10), semiannually, recordings (audio or video) of five consecutive therapy sessions were taken over three years for an ex-post analysis. The patients' characteristics, such as affect parameters [Affect regulation and experience Q-sort (AREQ)], quality of object relations (quality of object relations scale) and personality traits [Shedler-Westen Assessment Procedure (SWAP-200)] were analyzed retrospectively by independent raters. Therapeutic action (psychotherapy process Q-sort) and affective (re)actions of the patients (AREQ) were then analyzed in relation to changes found in the patients' characteristics.
RESULTS During the first year of therapy (PSA: n = 10; PDT: n = 9), the therapeutic method PSA was associated with significant improvements in the variable "SWAP Borderline", while in PDT change was not significantly different to baseline (PSA: P = 0.04; PDT: P = 0.33). Long-term results and follow up was available for seven participants in PSA and for five in PDT after three years; change in SWAP borderline for the whole sample was not significant at this time point when confronting to baseline (P = 0.545). However, differences between PSA and PDT were significant when analyzing the “mean change” in the SWAP Borderline variable after one year of therapy (P = 0.024): PSA led to slightly increased BPD symptoms, while PDT to a decrease; for the long run, variance of observed change was higher in PSA than in PDT (SDPSA ± 9.29 vs SDPDT ± 7.94). Our assumption that transference interpretations, closely followed by affective changes in the patient, could be useful modes of interaction was reproducible in our findings, especially when looking at the descriptive findings in the long-term data. The analysis of repetitive interaction structures demonstrated a very specific "time-lag" between therapeutic intervention and a corresponding increase in positive affect in successful therapy cases.
CONCLUSION Exploring the change processes in the patients' characteristics and linking these changes to specific treatment strategies is of clinical importance when starting treatment and for its long-term progress.
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Affiliation(s)
- Dagmar Steinmair
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Wien 1090, Austria
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, Krems 3500, Austria,
- Department of Ophtalmology, University Hospital St. Pölten, St. Pölten 3100, Austria
| | - Guoruey Wong
- Faculté de Médecine, Université de Montréal, Montréal H3C 3J7, Québec, Canada
| | - Sophie Frantal
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Wien 1090, Austria
| | - Christine Rohm
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Wien 1090, Austria
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Tretter F, Loeffler-Stastka H. How does the 'environment' come to the person? The 'ecology of the person' and addiction. World J Psychiatry 2021; 11:915-936. [PMID: 34888165 PMCID: PMC8613760 DOI: 10.5498/wjp.v11.i11.915] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/30/2021] [Accepted: 09/02/2021] [Indexed: 02/06/2023] [Imported: 08/24/2023] Open
Abstract
Currently, psychiatry lacks a field that can be called "theoretical psychiatry", which uses theoretical concepts and explanatory models: The main stream of research is to collect data of all kinds in the hope that the computational Big Data approach will shed a bright light on the black box of mental disorders. Accordingly, the biology-based Research Domain Criteria of the National Institute of Mental Health have been established. However, as philosophical analyses of concepts and methods have shown, several epistemological gaps stand in the way of a consistent multilevel understanding of mental disorders. Also, the implicit ontological problems in the biological reduction of the psychosocial level and in the integration of so-called hard and soft disciplines are mostly left out. As a consequence, a non-reductive psychological theory of mental disorders is sought that also integrates correlating biological and sociological issues. In this context, one example of promising nonreductive psychiatric research is the option of systems/network psychopathology. The possibilities for integrating different psychological perspectives are highlighted for the field of addiction research and treatment, where pragmatic behaviorist approaches dominate over the theory-based practice of psychoanalysis. In comparing the theoretical constructs of these two approaches, the relevance of the concept of "(social) environment" as the wealth of influential sociocultural factors is discussed at levels superior to the interpersonal micro-level, namely the organizational meso- and societal macro level, which is not sufficiently considered in current biopsychiatry. On this basis of argumentation, the usefulness of grounding and framing psychiatry through the field of ecological sciences, especially human ecology, is demonstrated. Finally, to this end, an outline of an ecological model of mental health and illness is presented.
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Affiliation(s)
- Felix Tretter
- Bertalanffy Center for the Study of Systems Science, Vienna 1040, Austria
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12
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Löffler-Stastka H, Steinmair D. Future of processing and facilitating change and learning. World J Psychiatry 2021; 11:507-516. [PMID: 34631456 PMCID: PMC8474993 DOI: 10.5498/wjp.v11.i9.507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/24/2021] [Accepted: 08/02/2021] [Indexed: 02/06/2023] Open
Abstract
The field of the sciences of the mind is evolving fast. With the diversification of knowledge and accumulation of data, often lacking integration and reproducibility, questions arise. The role of critical thinking and research is evident. As the science of the unconscious, psychoanalysis provides a method and theory to understand human minds and mentalities, helping the patient know his mind and transform action into reflection. Mental activities, including social skills, develop in the social context, depending on the social environment’s demands and resources put onto the individual. Encoding emotional signals, markers of meaning for the individual, is ontogenetically necessary and has influences on memory encoding. Beyond theoretical understanding, implicit relational knowledge is actualized in the therapeutic setting. With a strong focus on experiencing emotional reconsolidation of memories, previous relationships’ repercussions are enriched with broadening viewpoints in the analytic environment. The long-term effects of psychotherapeutic treatments have been examined. A sufficient explanation of the specific factors contributing to success or an answer when an impact is lacking is still under investigation. When investigating subliminal and implicit mechanisms leading to memory reconsolidation and the formation of functional object relations and interaction patterns, the focus is set on affective interplay and processing prior/during and after social interactions. The present paper discusses which parameters might contribute to the reshaping of memories and the linkage of memory with the emotional load of experience. Providing insights into such dynamic mental phenomena could enhance process research by investigating moment by moment interactions in psychoanalysis, treatment, and learning processes. Due to the research subject’s complexity, different research methods and integration of associated research fields are required.
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Affiliation(s)
| | - Dagmar Steinmair
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna 1090, Austria
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13
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Steinmair D, Fink B, Horvath E, Matuszak-Luss K, Löffler-Stastka H. Mentalisierungsfähigkeit und Empathie in der Psychiatrie – eine Sozialisationsfrage? psychopraxis neuropraxis 2021. [PMCID: PMC8325535 DOI: 10.1007/s00739-021-00738-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] [Imported: 08/24/2023]
Abstract
ZusammenfassungBerufliche Sozialisation entwickelt sich im Kontext der Persönlichkeitsentwicklung und vorhandener Bedingungen unterschiedlich. Das Aufrechterhalten der Mentalisierungsfähigkeit im beruflichen Alltag und vor allem in herausfordernden Situationen ist keine Selbstverständlichkeit, sondern abhängig von Umgebungsbedingungen. Die Übernahme von Verantwortung für die gewählte berufliche Tätigkeit erfordert eine Auseinandersetzung mit dem jeweils spezifischen Anforderungsprofil; es stellen sich Lern- und Entwicklungsaufgaben. Die Integration der beruflichen Identität im Rahmen förderlicher Umgebungsbedingungen bedeutet, sich als Teil dieser Gruppe(n) zu erleben. Aus gruppenpsychoanalytischer Sicht stellt die Identifikation mit einer Gruppe eine Verinnerlichung eines „guten Objekts“ dar, einer Gruppenrepräsentanz, welche in herausfordernden Situationen zugänglich ist. Dies kann die Mentalisierungsfähigkeit verbessern.
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Affiliation(s)
- D. Steinmair
- Klinik für Psychoanalyse und Psychotherapie, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090 Wien, Österreich
- Klinische Abteilung für Augenheilkunde und Orbitachirurgie, Universitätsklinikum St. Pölten, Karl Landsteiner Privatuniversität für Gesundheitswissenschaften, St. Pölten, Österreich
| | - B. Fink
- Sektion Psychotherapie/AG Ambulante Psychotherapie, Österreichische Gesellschaft für Psychiatrie, Psychotherapie und Psychosomatik,
Wien
, Österreich
- Ordination, Auhofstraße 70/4, 1130 Wien, Österreich
| | - E. Horvath
- Sektion Psychotherapie/AG Ambulante Psychotherapie, Österreichische Gesellschaft für Psychiatrie, Psychotherapie und Psychosomatik,
Wien
, Österreich
- Ordination, Tellgasse 14/12, 1150 Wien, Österreich
| | - K. Matuszak-Luss
- Sektion Psychotherapie/AG Ambulante Psychotherapie, Österreichische Gesellschaft für Psychiatrie, Psychotherapie und Psychosomatik,
Wien
, Österreich
- Ordination für Psychiatrie, psychotherapeutische Medizin und Neurologie, Seckendorfstraße 6/1/6, 1140 Wien, Österreich
| | - H. Löffler-Stastka
- Klinik für Psychoanalyse und Psychotherapie, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090 Wien, Österreich
- Sektion Psychotherapie/AG Ambulante Psychotherapie, Österreichische Gesellschaft für Psychiatrie, Psychotherapie und Psychosomatik,
Wien
, Österreich
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14
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Vousoura E, Gergov V, Tulbure BT, Camilleri N, Saliba A, Garcia-Lopez L, Podina IR, Prevendar T, Löffler-Stastka H, Chiarenza GA, Debbané M, Markovska-Simoska S, Milic B, Torres S, Ulberg R, Poulsen S. Predictors and moderators of outcome of psychotherapeutic interventions for mental disorders in adolescents and young adults: protocol for systematic reviews. Syst Rev 2021; 10:239. [PMID: 34462006 PMCID: PMC8404358 DOI: 10.1186/s13643-021-01788-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 08/02/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Adolescence and young adulthood is a risk period for the emergence of mental disorders. There is strong evidence that psychotherapeutic interventions are effective for most mental disorders. However, very little is known about which of the different psychotherapeutic treatment modalities are effective for whom. This large systematic review aims to address this critical gap within the literature on non-specific predictors and moderators of the outcomes of psychotherapeutic interventions among adolescents and young adults with mental disorders. METHODS The protocol is being reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) Statement. PubMed and PsycINFO databases will be searched for randomized controlled and quasi-experimental/naturalistic clinical trials. Risk of bias of all included studies will be assessed by the Mixed Methods Appraisal Tool. The quality of predictor and moderator variables will be also assessed. A narrative synthesis will be conducted for all included studies. DISCUSSION This systematic review will strengthen the evidence base on effective mental health interventions for young people, being the first to explore predictors and moderators of outcome of psychotherapeutic interventions for a wide range of mental disorders in young people. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020166756 .
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Affiliation(s)
- Eleni Vousoura
- Department of Psychology, American College of Greece - Deree, 6 Gravias Street GR-153 42 Aghia Paraskevi, Athens, Greece.
- First Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, Eginition Hospital, 74 Vas. Sofias Ave, 11528, Athens, Greece.
| | - Vera Gergov
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Nigel Camilleri
- Mental Health Services, Attard, Malta
- University of Malta, Msida, Malta
| | - Andrea Saliba
- Mental Health Services, Attard, Malta
- University of Malta, Msida, Malta
| | | | - Ioana R Podina
- Laboratory of Cognitive Clinical Sciences, Department of Psychology, University of Bucharest, Bucharest, Romania
| | | | | | | | - Martin Debbané
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | | | | | - Sandra Torres
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Randi Ulberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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15
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Pap G, Lackinger F, Kamp G, Löffler-Stastka H. Analysis of a dream series by the Dream Coding System developed by Ulrich Moser. Res Psychother 2021; 24:538. [PMID: 34568107 PMCID: PMC8451208 DOI: 10.4081/ripppo.2021.538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 07/27/2021] [Indexed: 02/07/2023]
Abstract
This paper serves psychotherapeutic process research and shows the process of change in a psychodynamic, individual psychological psychotherapy by means of a theory-based content analysis of the dreams reported in this therapy. The analysis of the patient's dreams is carried out according to the dream coding method by Ulrich Moser and Vera Hortig (2019). The guiding question is about changes in positioning and interactions of the dream elements, how can they be determined and how (within the framework of the underlying dream generation theory) the influence of these changes on the patient's ability to regulate affect can be assessed. Dream coding according to Moser and Hortig uses only the manifest dream and can be regarded as a research tool that rests, among other things, on psychoanalytic concepts, while at the same time taking into account more recent findings in dream and affect research. Its focus is on the coding of the present dream experience and the transformation of dream elements both within individual dreams and in the course of an entire dream series. It allows, without knowledge of the biographical anamnesis and without using psychoanalytic interpretation methods, to recognize changes in the dream structure and the affect regulation produced by it. The coding system thus also offers the possibility of making comparisons regarding the therapeutic changes achieved and thus (at least potentially) the effectiveness of different treatment methods (cf. Leuzinger-Bohleber, 2008, p. 7 f.). The coding of several dreams, i.e. the manifest dream content as a dream series highlighted the patient's inner psychic change process: while the safety principle dominated the beginning, involvement increased and the use of the elements was more flexible and the interactions more mixed, to approach the initial dream again towards the end of the dream series. The coding indicates that the patient was able to increase her self-efficacy due to better containment of the emergent (dysfunctional) affects. This coding procedure serves as a promising empirical process assessment for carrying out single case studies.
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Affiliation(s)
| | - Fritz Lackinger
- Vienna Psychoanalytic Academy, Alpen-Adria University, Klagenfurt
| | - Gerhard Kamp
- ULG Psychotherapy Research, Postgraduate Unit, Medical University of Vienna
| | - Henriette Löffler-Stastka
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, and Postgraduate Program of Psychotherapy Research, Postgraduate Unit, Teaching Center, Vienna, Austria
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, and Postgraduate Program of Psychotherapy Research, Postgraduate Unit, Teaching Center, Währinger Gürtel 18-20 A-1090 Vienna, Austria. +43.1.40400.30700.
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16
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Richter F, Steinmair D, Löffler-Stastka H. Construct Validity of the Mentalization Scale (MentS) Within a Mixed Psychiatric Sample. Front Psychol 2021; 12:608214. [PMID: 34149501 PMCID: PMC8210847 DOI: 10.3389/fpsyg.2021.608214] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 04/26/2021] [Indexed: 02/05/2023] Open
Abstract
Introduction: The concept of mentalizing is nowadays widely used in research as well as in clinical practice. Despite its popularity, the development of an economic assessment is still challenging. The Mentalization Scale appears to be a promising measurement with good psychometric properties but lacking convergent validity with the Reflective Functioning Scale. Objective: This study aims to test the construct validity of the Mentalization Scale through correlations with the gold standard, the Reflective Functioning Scale, within a clinical sample. Furthermore, it was of interest to replicate its internal consistency. Methods: Twenty-six inpatients of an acute psychiatric ward in Vienna were given the Mentalization Scale (MentS). They were interviewed with the Brief Reflective Function Interview, which was coded with the Reflective Functioning Scale. Correlations and internal consistency were calculated. Results: Concerning the primary aim of this study, the validity was satisfactory for the MentS whole-scale mentalizing as well as for the subscales self- and other-oriented mentalizing. Internal consistency was lower to the findings of the developer and close to the 0.70 threshold. Conclusion: Our findings could foster the psychometric properties of the MentS. Furthermore, the MentS seems to be a promising measurement tool for detecting different dimensions of reflective functioning. Limitations and further research are discussed.
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Affiliation(s)
- Felix Richter
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Dagmar Steinmair
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Karl Landsteiner University of Health Sciences, Krems, Austria
- Department of Ophthalmology, Oculoplastics and Orbital Surgery, Karl Landsteiner University of Health Sciences, Sankt Pölten, Austria
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17
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Messina I, Loffler-Stastka H. Psychotherapists' perception of their clinical skills and in-session feelings in live therapy versus online therapy during the COVID-19 pandemic: a pilot study. Res Psychother 2021; 24:514. [PMID: 33937115 PMCID: PMC8082529 DOI: 10.4081/ripppo.2021.514] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/05/2021] [Indexed: 02/07/2023]
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, many psychotherapists who were used to seeing their patients in face-toface setting adapted to providing therapies online. In the present pilot study, we investigated therapist current experiences of online therapy compared to live therapy. Twenty-nine therapists completed Clinical Skills, Difficulties in Practice, and in-sessions feelings of Flow, Boredom and Anxiety of the Trainee Current Progress Report, giving a score for each item in two different conditions: Live Therapy and Online Therapy. Compared to Live Therapy, in Online Therapy therapists reported significantly less Clinical Skills, whereas Difficulties in Practice did not differ in the considered conditions. With regard to in-sessions feeling, therapists reported significantly lower scores of Boring and higher scores of Flow in Live Therapy compared to Online Therapy, whereas Anxiety did not differed in the considered conditions.
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Affiliation(s)
| | - Henriette Loffler-Stastka
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Vienna, Austria
- Department of Psychoanalysis and Psychotherapy, Medical University Vienna, Waringer Gurtel 18-20, A-1090 Vienna, Austria. +43.(0)1.40400.30700.
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18
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Pietrabissa G, Volpi C, Bottacchi M, Bertuzzi V, Guerrini Usubini A, Löffler-Stastka H, Prevendar T, Rapelli G, Cattivelli R, Castelnuovo G, Molinari E, Sartorio A. The Impact of Social Isolation during the COVID-19 Pandemic on Physical and Mental Health: The Lived Experience of Adolescents with Obesity and Their Caregivers. Int J Environ Res Public Health 2021; 18:3026. [PMID: 33804231 PMCID: PMC7999166 DOI: 10.3390/ijerph18063026] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/07/2021] [Accepted: 03/11/2021] [Indexed: 02/07/2023]
Abstract
Adolescence is a complex developmental phase, made more complex by obesity and the social isolation imposed by the COVID-19 pandemic. The literature related to the impact of social isolation on obesity self-management in adolescents is scant and inconsistent. This paper describes the phenomenon from the perspectives of a sample of adolescents with obesity enrolled in an inpatients' multidisciplinary rehabilitation program for weight-loss and their caregivers, and its impact on different life domains. Individual semi-structured ad hoc interviews were conducted with 10 adolescent-caregiver dyads, and narratives were qualitatively investigated using an interpretative phenomenology approach to data. Twenty participants took part in the study. The major themes that emerged from this study fall into five basic categories: (1) COVID-19 as an opportunity to reconsider what makes a good life; (2) Persistence in life; (3) Empowering relationship; (4) Daily routine in quarantine; (5) Lives on hold. Understandings drawn from this study may assist health care professionals in providing holistic support, and guidance to adolescents with weight-related issues and their caregivers who experience social isolation during the COVID-19 pandemic.
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Affiliation(s)
- Giada Pietrabissa
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, 20145, Milan, Italy; (G.P.); (C.V.); (M.B.); (A.G.U.); (G.R.); (R.C.); (G.C.); (E.M.)
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy;
| | - Clarissa Volpi
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, 20145, Milan, Italy; (G.P.); (C.V.); (M.B.); (A.G.U.); (G.R.); (R.C.); (G.C.); (E.M.)
| | - Michela Bottacchi
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, 20145, Milan, Italy; (G.P.); (C.V.); (M.B.); (A.G.U.); (G.R.); (R.C.); (G.C.); (E.M.)
| | - Vanessa Bertuzzi
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy;
| | - Anna Guerrini Usubini
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, 20145, Milan, Italy; (G.P.); (C.V.); (M.B.); (A.G.U.); (G.R.); (R.C.); (G.C.); (E.M.)
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy;
| | | | - Tamara Prevendar
- Psychology Study Programme, Sigmund Freud University Vienna—Ljubljana Branch, 1000 Ljubljana, Slovenia;
| | - Giada Rapelli
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, 20145, Milan, Italy; (G.P.); (C.V.); (M.B.); (A.G.U.); (G.R.); (R.C.); (G.C.); (E.M.)
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy;
| | - Roberto Cattivelli
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, 20145, Milan, Italy; (G.P.); (C.V.); (M.B.); (A.G.U.); (G.R.); (R.C.); (G.C.); (E.M.)
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy;
| | - Gianluca Castelnuovo
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, 20145, Milan, Italy; (G.P.); (C.V.); (M.B.); (A.G.U.); (G.R.); (R.C.); (G.C.); (E.M.)
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy;
| | - Enrico Molinari
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, 20145, Milan, Italy; (G.P.); (C.V.); (M.B.); (A.G.U.); (G.R.); (R.C.); (G.C.); (E.M.)
- Department of Psychology, Catholic University of Milan, 20123 Milan, Italy;
| | - Alessandro Sartorio
- Istituto Auxologico Italiano IRCCS, Experimental Laboratory for Auxo-Endocrinological Research, 28824 Piancavallo (VB), Italy;
- Istituto Auxologico Italiano IRCCS, Division of Auxology, 28824 Piancavallo (VB), Italy
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Dzirlo L, Richter F, Steinmair D, Löffler-Stastka H. Reflective Functioning in Patients with Irritable Bowel Syndrome, Non-Affective Psychosis and Affective Disorders-Differences and Similarities. Int J Environ Res Public Health 2021; 18:ijerph18052780. [PMID: 33803368 PMCID: PMC7967285 DOI: 10.3390/ijerph18052780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 02/07/2023]
Abstract
Irritable bowel syndrome (IBS), as part of the functional somatic syndromes, is frequent in the general population. Medical care and morbidity costs are high, and so is the psychological and somatic strain. The etiopathogenesis of IBS is still poorly understood; it is assumed to be multifactorial and to include biopsychosocial factors. Links between the intestine, psyche, nervous system (e.g., via the hypothalamic-pituitary-adrenal axis (HPA-Axis/neurotransmitters) and with the microbiome, the immune system have lately been investigated. Factors such as personality traits, mentalization, and early attachment strategies (deactivating and hyperactivating) have been suggested to influence IBS with relevance for treatment regimens. At this time, data on reflective functioning (RF) is lacking. Within a cross-sectional, we examined the mentalizing capacity of a clinical sample (n = 90) consisting of patients with IBS (n = 30), affective disorders (AD; n = 28), and non-affective psychosis (NAP; n = 32). The reflective functioning scale was used based on the brief reflective function interview (BRFI). The results revealed severe impairment in patients with IBS concerning their mentalizing ability, which was comparable to patients with affective disorders. Patients with non-affective-psychosis showed the lowest mentalizing ability. Thus, psychotherapeutic treatment with a focus on mentalization could be a promising approach.
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Affiliation(s)
- Larisa Dzirlo
- Department of Internal Medicine and Psychosomatics, Krankenhaus der Barmherzigen Schwestern, 1060 Vienna, Austria;
| | - Felix Richter
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, 1090 Vienna, Austria; (F.R.); (D.S.)
| | - Dagmar Steinmair
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, 1090 Vienna, Austria; (F.R.); (D.S.)
- Karl Landsteiner University of Health Sciences, 3500 Krems, Austria
| | - Henriette Löffler-Stastka
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, 1090 Vienna, Austria; (F.R.); (D.S.)
- Correspondence: ; Tel.: +43-(0)1-40400-30700
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20
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Milic B, Feller C, Schneider M, Debbané M, Loeffler-Stastka H. Social cognition in individuals with 22q11.2 deletion syndrome and its link with psychopathology and social outcomes: a review. BMC Psychiatry 2021; 21:130. [PMID: 33676445 PMCID: PMC7936464 DOI: 10.1186/s12888-020-02975-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 11/18/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The 22q11.2 deletion syndrome (22q11DS) is a genetic syndrome that results in a highly variable profile of affected individuals of which impairments in the social domain and increased psychopathology are the most prominent. Notably, 25-30% of affected individuals eventually develop schizophrenia/psychosis, predisposing persons with the syndrome to increased risk for this disorder. Because social cognition is considered to underlie social behavior and to be related to psychopathology, this systematic review investigated social cognition in individuals with 22q11DS and examined reported links across its domains with psychopathology and social outcomes. This can provide the basis for a closer understanding of the path from risk to disorder and will inform on the specific domains that can be targeted with preventive intervention strategies. METHOD Systematic literature review of studies that reported the links between social cognitive domains and psychopathology and/or social outcomes in individuals with 22q11DS. Electronic databases searched were PubMed and PsycINFO. RESULTS Defined eligibility criteria identified a total of ten studies to be included in the present review. Selected studies investigated links between two domains of social cognition (emotion processing and theory of mind (ToM)) and psychopathology and/or social outcomes. With respect to the links to psychopathology, two aspects of social cognition were related primarily to negative symptoms. Results regarding the associations to positive and emotional symptoms (anxiety/depression) are limited and require further investigation. Even though both aspects of social cognition were associated with social outcomes, several studies also found no links between these two domains. Both reports invite for an additional examination of reported results and specific considerations regarding chosen constructs. CONCLUSION Although equivocal, results of the present review provide sufficient evidence that social cognition is a useful domain for the closer elucidation of clinical outcomes and social difficulties in this population. At the same time, longitudinal studies and consideration of other variables are also necessary for a timely understanding of affected persons in this respect.
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Affiliation(s)
- Branka Milic
- Clinic for Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria.
| | - Clémence Feller
- Clinical Psychology Unit for Intellectual and Developmental Disabilities, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Maude Schneider
- Clinical Psychology Unit for Intellectual and Developmental Disabilities, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Martin Debbané
- Developmental Clinical Psychology Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
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Abstract
Given the tight interconnections proposed between brain and psyche, psychoanalysis was conceptualized as an interdisciplinary theory right from the beginning. The diversification of knowledge performed by different science and technology fields, concerned with the same matter (explaining mind and brain and connecting them), makes this interdisciplinarity even more visible and evident. This challenges the integrative potential lying in psychoanalytic meta-theory.
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Affiliation(s)
- Dagmar Steinmair
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Karl Landsteiner Private University for Health Sciences, Krems an der Donau, Austria
| | - Henriette Löffler-Stastka
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
- *Correspondence: Henriette Löffler-Stastka,
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Löffler-Stastka H, Bednar K, Pleschberger I, Prevendar T, Pietrabissa G. How to Include Patients' Perspectives in the Study of the Mind: A Review of Studies on Depression. Front Psychol 2021; 12:651423. [PMID: 33912114 PMCID: PMC8072288 DOI: 10.3389/fpsyg.2021.651423] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 03/04/2021] [Indexed: 02/05/2023] Open
Abstract
Depression has been widely studied by researchers from different fields, but its causes, and mechanism of action are still not clear. A difficulty emerges from the shifting from objective diagnosis or analysis to exploration of subjective feelings and experiences that influence the individuals' expression, communication and coping in facing depression. The integration of the experiential dimension of the first-person in studies on depression-and related methodological recommendations-are needed to improve the validity and generalizability of research findings. It will allow the development of timely and effective actions of care. Starting from providing a summary of the literature on theoretical assumptions and considerations for the study of the mind, with particular attention to the experiential dimension of patients with depression (aim #1 and #2), this contribution is aimed to provide practical suggestions for the design of research able to incorporate first- and third-person accounts (aim #3). It is also aimed to review qualified phenomenological methods for the acquisition and interpretation of experiential data in patients with depression (aim #4). Recognizing the first-person perspective in the study of depression is a major step toward a better understanding and treatment of this disorder. Theoretical constructs and technique suggestions that result from this review offer a valid starting point for the inclusion of the experiential dimension to common third-person research in the study of the mind.
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Affiliation(s)
- Henriette Löffler-Stastka
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
- *Correspondence: Henriette Löffler-Stastka
| | - Kathrin Bednar
- Vienna University of Economics and Business, Vienna, Austria
| | | | - Tamara Prevendar
- Sigmund Freud University Vienna - Ljubljana Branch, Ljubljana, Slovenia
| | - Giada Pietrabissa
- Department of Psychology, Catholic University of Milan, Milan, Italy
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Milan, Italy
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Abstract
The psychological strain of many psychiatric disorders arises from difficulties encountered in social interactions. Social withdrawal is often the first symptom of neuropsychiatric disorders. The authors explore the various options for training social cognition skills. Social cognition was assessed using the Movie for the Assessment of Social Cognition (MASC). After completion of mentalization-based therapy (MBT) training, MASC scores improved significantly in health care providers (p = .006, r = .57). Mentalizing (operationalized with reflective functioning [RF]) was assessed in the MBT group (Group A) and compared with RF in a control group (Group B). RF was significantly higher in Group A (RF = 4.35, SD = 1.19) than in Group B (RF = 3.43, SD = 1.70) (p = .0385; Cohen's d = 0.65). MBT might be a promising intervention in social cognition training. Mentalizing skills might be associated with attitude.
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Affiliation(s)
- Dagmar Steinmair
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Richard Horn
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Department of Psychiatry, Klinik Favoriten, Vienna, Austria
| | - Felix Richter
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Guoruey Wong
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Faculté de Médecine, Université de Montréal, Montreal, Canada
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Ertl S, Steinmair D, Löffler-Stastka H. Encouraging communication and cooperation in e-learning: solving and creating new interdisciplinary case histories. GMS J Med Educ 2021; 38:Doc62. [PMID: 33824898 PMCID: PMC7994877 DOI: 10.3205/zma001458] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 01/08/2021] [Accepted: 01/20/2021] [Indexed: 02/07/2023]
Abstract
Background: An increasing number of patients to treat combined with a rapidly growing amount of knowledge to integrate, is challenging for future doctors. To take the medical history and diagnose effectively, to send the patient to an expert, to create a relevant expert to expert communication, to discuss with the patient, the time needed for a decision, should be as short as possible. Investigating medical students' cognitive processes while solving a patient's case leads to the conclusion that educators should help and facilitate these reasoning and communication processes. Developments in information technology offer a large variety of tools for educators. Method: Practicing repeated memory retrieval in clinically relevant virtual settings leads to more durable storage of theoretical knowledge, especially when applying the theoretical knowledge to meaningful cases. The cases in the present e-learning tool are only solvable when knowledge is coherent, communicated and well-organized, as they demand combination of different interdisciplinary knowledge-fields. Thus, by practicing in the virtual environment, prospective memory (i.e. the ability to remember to do something in the future) is changed and the intention and attention in learning processes is shaped and adapted to the core requirements of clinical practice. Conclusion: Case-based learning can be a promising approach to teach students how to investigate and ask for important information. This paper focuses on undergraduate education and provides an outlook on possible concepts that can be used in different health care sectors.
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Affiliation(s)
- Sebastian Ertl
- Med. Universität Wien, Universitätsklinik für Psychoanalyse und Psychotherapie, Vienna, Austria
- Med. Universität Wien, Teaching Center/Postgraduate Unit, Vienna, Austria
| | - Dagmar Steinmair
- Med. Universität Wien, Universitätsklinik für Psychoanalyse und Psychotherapie, Vienna, Austria
| | - Henriette Löffler-Stastka
- Med. Universität Wien, Universitätsklinik für Psychoanalyse und Psychotherapie, Vienna, Austria
- Med. Universität Wien, Teaching Center/Postgraduate Unit, Vienna, Austria
- *To whom correspondence should be addressed: Henriette Löffler-Stastka, Med. Universität Wien, Universitätsklinik für Psychoanalyse und Psychotherapie, Währinger Gürtel 18-20, A-1090 Vienna, Austria, E-mail:
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Hempel L, Kienle R, Kiessling C, Löffler-Stastka H, Philipp S, Rockenbauch K, Schnabel KP, Zimmermann A. Special issue on teaching social and communicative competences - status quo. GMS J Med Educ 2021; 38:zma001468. [PMID: 33824884 PMCID: PMC7994875 DOI: 10.3205/zma001468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 02/15/2021] [Accepted: 02/15/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Linn Hempel
- Brandenburg Medical School Theodor Fontane, Department of Curriculum and Teaching Affairs, Neuruppin, Germany
- *To whom correspondence should be addressed: Linn Hempel, Brandenburg Medical School Theodor Fontane, Department of Curriculum and Teaching Affairs, Fehrbelliner Str. 38, D-16816 Neuruppin, Germany, E-mail:
| | - Rolf Kienle
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Office of the Vice Dean for Teaching and Learning, Berlin, Germany
| | - Claudia Kiessling
- Universität Witten/Herdecke, Fakultät für Gesundheit, Lehrstuhl für die Ausbildung personaler und interpersonaler Kompetenzen im Gesundheitswesen, Witten, Germany
| | - Henriette Löffler-Stastka
- Medical University of Vienna, Department of Psychoanalysis and Psychotherapy and Teaching Center/Unit for Postgraduate Programs, Vienna, Austria
| | - Swetlana Philipp
- University of Jena, Institute of Psychosocial Medicine, Psychotherapy and Psychooncology, Jena University Hospital, Jena, Germany
| | - Katrin Rockenbauch
- University of Leipzig, Prorectorate for education and international affairs, Project: "Teaching Practice in Transfer plus" , Leipzig, Germany
| | - Kai P. Schnabel
- University of Bern, Institute for Medical Education, Bern, Switzerland
| | - Anja Zimmermann
- University of Leipzig, Medical Faculty, Skills- und Simulation Centre LernKlinik Leipzig, Leipzig, Germany
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Thajer A, Sommersguter-Reichmann M, Löffler-Stastka H. Implementing a Clinical Research Department to Support Pediatric Studies: A SWOT Analysis. Int J Environ Res Public Health 2020; 17:ijerph17176211. [PMID: 32867050 PMCID: PMC7504077 DOI: 10.3390/ijerph17176211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/11/2020] [Accepted: 08/22/2020] [Indexed: 02/07/2023]
Abstract
The safety, tolerability, pharmacokinetics and efficacy of most drugs used in pediatrics have not been studied in different age groups and are administered "off-label use". Clinical pediatric drug trials require specific and stringent compliance with laws, regulations, guidelines, and patient/parent/public involvement, which in turn increases resource use and makes support useful from a medical, qualitative, economic, and system perspective. We examined the strengths, weaknesses, opportunities and threats of implementing a Research Department for the Support of Pediatric Studies (RDPS) in Vienna. We used the SWOT ("strengths", "weaknesses", "opportunities", and "threats") analysis to collect comprehensive data and facts on the internal strengths, weaknesses (company analysis), and external opportunities and threats (environmental analysis). The company analysis revealed a productivity gain, due to a highly specialized team and standardized processes. The environmental analysis outlined a considerable 360-degree potential for a qualitative and quantitative medical- and social-scientific expansion of the service portfolio. The establishment of a RDPS leads to the centralization of pediatric studies by bundling tasks and concentration of specialist knowledge, which enables the exploitation of synergies, the standardization of processes, the promotion of professionalism, flexibility, innovations and the reduction of inefficiencies in the form of duplication of tasks. RDPS offers tailored advice and support for different types of pediatric studies.
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Affiliation(s)
- Alexandra Thajer
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria;
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Seitz T, Ucsnik L, Kottmel A, Bitzer J, Teleky B, Löffler-Stastka H. Let us integrate sexual health-do psychiatrists integrate sexual health in patient management? Arch Womens Ment Health 2020; 23:527-534. [PMID: 31897606 PMCID: PMC7368870 DOI: 10.1007/s00737-019-01016-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 12/18/2019] [Indexed: 02/07/2023]
Abstract
The high prevalence of sexual dysfunction and the importance of sexual health issues in general stress the need for a physician to integrate sexual health issues in patient management. In this study, we evaluate the frequency of psychiatrists addressing sexual health issues as well as their attitude towards sexual health. Plus, we want to evaluate the multi-professional network for patient treatment that is needed by physicians for collaboration with other medical specialists and health care professionals. At total 100 psychiatrists (age range 30-60 years), participating at the annual meeting of the Austrian Society of Psychiatry, Psychotherapy, and Psychosomatics, were invited to self-assess their caring for patients' sexual health issues and answer a self-report questionnaire. The return rate was 74%. A third of the participating psychiatrists and psychotherapists stated to address sexual health in patients in daily routine. Twenty-five percent of the physicians suspected sexual health problems in 60-100% of their patients but did not ask the patients about this topic. Mentioned reasons why patients would not actively address sexual problems were rated by the survey participants "a different problem was more important", "lack of time", and "embarrassment". Only few of the participating psychiatrists stated to offer a consultation in sexual health to the patients, none to offer sexual therapy. A mentioned reason was "lack of competence regarding sexual health". Twelve percent referred the patients with sexual issues to a physician with another medical specialization, especially to experts in gynaecology and obstetrics, to experts in urology, or to andrologists. However, a need for a network in the field of sexual medicine was stated and an unawareness of a sexual health care network: where to refer the patients in need. Our data showed an increased need in the routine treatment and management of sexual health care in psychiatrists and psychotherapists. Plus, the data stresses the need for professional sexual medicine qualification and for extended cooperation between different medical fields and health care professionals in order to integrate sexual health topics professionally in daily routine.
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Affiliation(s)
- Tamara Seitz
- Department of Infectious Diseases and Tropical Medicine, SMZ SÜD, Vienna, Austria
| | - Lucia Ucsnik
- Department of Visceral Surgery, University Clinic of Surgery, Medical University Vienna, Vienna, Austria
| | - Andrea Kottmel
- Private Practice for Gynecology and Sexual Medicine, Vienna, Austria
| | | | - Bela Teleky
- Department of Visceral Surgery, University Clinic of Surgery, Medical University Vienna, Vienna, Austria
| | - Henriette Löffler-Stastka
- University Clinic of Psychoanalysis and Psychotherapy, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
- Austrian Society of Psychiatry, Psychotherapy and Psychosomatics, Section Psychotherapy, Vienna, Austria.
- Postgraduate Unit, Teaching Center, Medical University Vienna, Vienna, Austria.
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Neidhart E, Löffler-Stastka H. Case studies in psychotherapy training using Austria as an example. World J Clin Cases 2020; 8:2787-2801. [PMID: 32742989 PMCID: PMC7360703 DOI: 10.12998/wjcc.v8.i13.2787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/15/2020] [Accepted: 06/30/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Case studies (CS) are relevant for the development of theoretical and practical competencies in psychotherapy. Despite rapid progress in the development of methods and principles for establishing CS in the last three decades, research into the aims of CS, especially in training, or how CS are to be conducted is rare.
AIM To elucidate the form and methodology of CS, the objectives of CS used in training institutions (TI), and if/how TIs handle therapist allegiance. Also, this preliminary investigation will suggest avenues for further research and attempt to establish certain guidelines.
METHODS In order to counteract researcher bias and enlarge the question-pool, a focus group was established. The recorded and transcribed text was analyzed with Mayring’s method of qualitative content analysis, and the generated categories were formulated as questions. The resulting questionnaire with both qualitative and quantitative queries was sent out (after pre-testing) to all 39 Austrian TIs that provide professional psychotherapy training. The answers and text passages received were then also categorized with qualitative content analysis. Data analysis was discussed by a peer group consisting of three psychotherapists trained in differing schools of psychotherapeutic methods.
RESULTS 94% of Austrian institutes use CS as part of their psychotherapeutic training. Understanding of the term “case study” is inconsistent and has a wide variety of interpretations. CS serve mainly: (1) For observation of training/progress in therapeutic practice and knowledge/acquisition of the theory specific to each psychotherapeutic school; (2) To improve (self-)reflection capabilities; and (3) To expand theoretical knowledge. Most of the CS written are not accessible for students nor for the research community. More than two thirds of the CS take only the position of the author into account (the client’s position is not described). 15.5 % of the TIs do not consider researcher or therapist allegiance at all.
CONCLUSION A more precise formulation of the term case study is needed in psychotherapeutic training. The training therapists play a key function, as they exemplify and teach how to deal with distorting factors. General guidelines as to how to conduct CS in training institutions would provide more direction to students, increase scientific rigor, and enhance synergistic effects.
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Affiliation(s)
- Ela Neidhart
- Department of Psychoanalysis and Psychotherapy, and Teaching Center – Postgraduate Unit, Medical University of Vienna/General Hospital of Vienna, Vienna 1090, Austria
| | - Henriette Löffler-Stastka
- Department of Psychoanalysis and Psychotherapy, and Teaching Center – Postgraduate Unit, Medical University of Vienna/General Hospital of Vienna, Vienna 1090, Austria
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Löffler-Stastka H, Wong G. Learning and competence development via clinical cases – what elements should be investigated to best train good medical doctors? World J Meta-Anal 2020; 8:178-189. [DOI: 10.13105/wjma.v8.i3.178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/15/2020] [Accepted: 06/19/2020] [Indexed: 02/06/2023] Open
Abstract
In European higher education, application of information technology, concentration on the learning-processes, consistent implementation, transfer learning, case-based learning, autonomous learning has been extensively studied in the last decade. Educational sciences based on neuroscientific findings use brain-based learning and teaching, including integrated thematic instructions and emotion-theory. Elements essential to this strategy, such as theory and methods for learning, competencies, attitudes, social reality, and a metadiscourse are described herein. Research on learning tends to focus on declarative knowledge, associative learning with conditional stimuli, and procedural knowledge with polythematic/crosslinking thinking. Research on competencies: In research on competencies (e.g., for clinical reasoning, decision-making), intuitive and analytical components are studied. As repeated presentation and exercising of clinical cases is crucial for an efficient learning process, the implementation of interactive scenarios including affectively involving didactics is considered. For competence-development observational methods, questionnaires/item sets or factors have to be targeted and empirically validated. Attitudes and social reality: Clinical decision-making, identification processes and attitudes (“Hidden curriculum”), as well as secondary socialization processes (integration of social norms, values, preparation of role-acquisition, occupational role) are studied via process research, conceptual research, and observational methods. With respect to social reality research, conscious and unconscious bargaining processes have to be taken into account. Methodology: Neuroscience – memory, neuronal, molecular biology, and computer science (Neurocircuits) are integrated into observational process research (e.g., affective-cognitive interface, identification processes) and conceptual research is added and studied on the meta-level, including discussion of research paradigms. This discussion provides ongoing feedback to projects in a hermeneutic circle.
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Affiliation(s)
- Henriette Löffler-Stastka
- Department of Psychoanalysis and Psychotherapy, and Postgraduate Unit, Teaching Center, Medical University of Vienna, Vienna 1090, Austria
| | - Guoruey Wong
- Faculté de Médecine, Université de Montréal, Montréal H3T 1J4, Quebec, Canada
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Keckeis J, Schäfer M, Akkaya-Kalayci T, Löffler-Stastka H. Guaranteed Equal Opportunities? The Access to Nursing Training in Central Europe for People with a Turkish Migration Background. Int J Environ Res Public Health 2020; 17:ijerph17124503. [PMID: 32585898 PMCID: PMC7345274 DOI: 10.3390/ijerph17124503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 02/07/2023]
Abstract
This paper examines the reason for the small percentage of professional nurses with a Turkish migration background and investigates possibilities to increase this low amount. Our society grows older, and the number of chronic diseases increases. Furthermore, nursing professionals tend to migrate, and the retirement of the baby boomer generation will also create a lack of professional nurses in Vorarlberg, Austria. People with a Turkish migration background, who are the second largest group without Austrian citizenship in Austria, could be an important resource for the upcoming lack of qualified nurses. The nursing profession could be a secure career opportunity for these people, and therefore it is of great importance to make access to professional nursing training easier for people with a Turkish migration background. This paper describes the effects of migration on society, institutions and individuals and gives an overview of concepts related to how to deal with this situation. This qualitative study investigates the access to nursing training for people with a Turkish migration background from three different points of view-those of experts, students and nurses with a Turkish migration background, and people with a Turkish migration background who have to pass a university entrance qualification-in the form of guided interviews. The results will illustrate structural and social barriers due to complex social dynamics and also highlight possibilities to reduce those barriers. Based on the results, prospects for professional nursing are deduced on the macro, meso and micro levels, which should generate an increasing number of nurses with a Turkish migration background.
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Neidhart E, Löffler-stastka H. Fallstudien in der psychotherapeutischen Ausbildung: Der Fall als Quelle der wissenschaftlichen Erkenntnis? Psychotherapie Forum 2020; 24:3-8. [DOI: 10.1007/s00729-020-00137-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ZusammenfassungFallstudien werden in der psychotherapeutischen Ausbildung als didaktisches Werkzeug eingesetzt, um das schulenspezifische theoretische Wissen in seiner empirischen Anwendung in der Arbeit mit den KlientInnen/PatientInnen abzubilden. Klinische Einzelfallstudien wiesen in der Vergangenheit zahlreiche Verzerrungsfaktoren auf. Seit den ersten Fallstudien von Freud zeigte sich eine rasche Entwicklung vom Narrativ zur wissenschaftlichen Arbeit. Unterschiedliche Forschungsdesigns ermöglichen die Nutzung der klinischen Einzelfallstudie als Beitrag zum Erkenntnisgewinn über die komplexen Vorgänge in einem psychotherapeutischen Behandlungsprozess.Bereits in der Ausbildung zur Psychotherapeutin/zum Psychotherapeuten können die Grundlagen für die Zusammenführung von Praxis und Forschung vermittelt werden indem Leitlinien für die Erstellung von Fallstudien etabliert werden, die den Anforderungen der praxisorientierten Psychotherapieforschung entsprechen. Die Empfehlungen werden hier beispielhaft angeführt.
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Steinmair D, Richter F, Löffler-Stastka H. Relationship between Mentalizing and Working Conditions in Health Care. Int J Environ Res Public Health 2020; 17:ijerph17072420. [PMID: 32252375 PMCID: PMC7178150 DOI: 10.3390/ijerph17072420] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/28/2020] [Accepted: 03/31/2020] [Indexed: 02/07/2023]
Abstract
Mentalizing describes the human ability to comprehend one's own and others' mental states and is seen as one of the core competencies of psychotherapists. Current research has emphasized the importance of both early dyadic attachment as well as broader sociocultural environmental input on the development of mentalizing. This study investigates whether mentalizing skills, operationalized via reflective functioning (RF), might be influenced by training and working conditions. This study was a matched case-control comparison, cross-sectional study. RF was assessed in a total of 10 psychotherapy trainees working in private practice at the beginning (group A; n = 5) and end (group B; n = 5) of their psychotherapy training (training association: Gestalt Therapy, Institute of Integrative Gestalttherapy Vienna) and in a total of 40 health professionals (institution: General Hospital Vienna-Social Medical Center South, Vienna, Department of Psychiatry, acute psychiatric ward) at the beginning of (group C; n = 20) and without (group D; n = 20) mentalization based therapy training. The participants differed from each other regarding their training, but participants of the same institution were matched. RF scores were significantly higher in group A and B than in group C and D (A,C: p = 0.0065, Odds Ratio (OR): 0.0294; A,D: p = 0.0019, OR: 0.0132; B,C: p = 0.0065, OR: 0.0294, B,D: p = 0.0019, OR: 0.0132). RF scores were not significantly different among groups A and group B (A,B: p > 0.9999) or between groups C and D (C,D: p = 0.6050). The current study suggests that mentalizing skills might be rather slow to improve by training, but that they might be influenced by the context.
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Affiliation(s)
- Dagmar Steinmair
- Karl Landsteiner University of Health Sciences, University Hospital St. Pölten, Dunant-Platz 1, 3100 St. Pölten, Austria;
| | - Felix Richter
- Department of Psychoanalysis und Psychotherapy, and Teaching Center/Postgraduate Unit, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria;
| | - Henriette Löffler-Stastka
- Department of Psychoanalysis und Psychotherapy, and Teaching Center/Postgraduate Unit, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria;
- Correspondence:
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Löffler-Stastka H. [Psychotherapy in psychiatry via digital media? Against]. Nervenarzt 2020; 91:259-260. [PMID: 31440770 DOI: 10.1007/s00115-019-00786-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Henriette Löffler-Stastka
- Klinik für Psychoanalyse und Psychotherapie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
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Wadowski PP, Giurgea GA, Schlager O, Luf A, Gremmel T, Hobl EL, Unterhumer S, Löffler-Stastka H, Koppensteiner R. Acute Limb Ischemia after Intake of the Phenylethylamine Derivate NBOMe. Int J Environ Res Public Health 2019; 16:ijerph16245071. [PMID: 31842318 PMCID: PMC6950699 DOI: 10.3390/ijerph16245071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/08/2019] [Accepted: 12/09/2019] [Indexed: 02/07/2023]
Abstract
Objective: N-(2-methoxy) benzyl-phenethylamine (NBOMe) derivatives have a high affinity to the serotonin receptor 2A and emerged as new psychedelic agents. We report the case of a 30-year-old man admitted to the hospital because of acute ischemia of the left arm with clinical symptoms of pallor, pulselessness, paresthesia, and a motoric deficit. The patient had a history of schizophrenia and drug abuse and disclosed during the hospital stay the sublingual intake of a substance bought as 25I-NBOMe the night before the ischemic event. Methods: Routine clinical diagnostics including among others color-coded duplex sonography and computed tomography angiography (CTA) were performed. The remainder of the drugs was analyzed using high performance liquid chromatography. Results: Initial color-coded duplex sonography of the upper left limb showed pathological flow profiles of the axillary, brachial, ulnar, and radial artery with a reduced diameter of the ulnar (0.9 mm) and radial (1.1 mm) artery. In consequence, peripheral vasospasm, distal arterial thrombosis, or arterial embolization was anticipated. As therapeutic measures, the patient immediately received intravenous systemic vasodilators (alprostadil) and therapeutic anticoagulation with low molecular weight heparin. Instant symptom improvement was observed within the first day after therapy initiation. The subsequently performed CTA of the heart and left arm showed no signs of thrombotic material. Treatment was continued for five days and the patient was released thereafter having completely normalized perfusion in his left arm. Outpatient treatment was continued with calcium-channel blockers, as the patient had also displayed arterial hypertension. Drug analysis retrieved a composition of the isomers 25I-NBOMe, 25C-NBOMe, and 25H-NBOMe as well as traces of pentylon. Conclusion: NBOMe ingestion implicates the risk of peripheral vasospasms with severe, limb-threatening ischemia.
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Affiliation(s)
- Patricia P. Wadowski
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, A-1090 Vienna, Austria; (P.P.W.); (G.-A.G.); (O.S.); (T.G.)
| | - Georgiana-Aura Giurgea
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, A-1090 Vienna, Austria; (P.P.W.); (G.-A.G.); (O.S.); (T.G.)
| | - Oliver Schlager
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, A-1090 Vienna, Austria; (P.P.W.); (G.-A.G.); (O.S.); (T.G.)
| | - Anton Luf
- Department of Laboratory Medicine, Medical University of Vienna, A-1090 Vienna, Austria;
| | - Thomas Gremmel
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, A-1090 Vienna, Austria; (P.P.W.); (G.-A.G.); (O.S.); (T.G.)
| | - Eva-Luise Hobl
- Department of Clinical Pharmacology, Medical University of Vienna, A-1090 Vienna, Austria;
| | - Sylvia Unterhumer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, A-1090 Vienna, Austria;
| | - Henriette Löffler-Stastka
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, A-1090 Vienna, Austria;
| | - Renate Koppensteiner
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, A-1090 Vienna, Austria; (P.P.W.); (G.-A.G.); (O.S.); (T.G.)
- Correspondence: ; Tel.: +43-1-40400-46710
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Datz F, Wong G, Löffler-Stastka H. Interpretation and Working through Contemptuous Facial Micro-Expressions Benefits the Patient-Therapist Relationship. Int J Environ Res Public Health 2019; 16:ijerph16244901. [PMID: 31817282 PMCID: PMC6950517 DOI: 10.3390/ijerph16244901] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 11/27/2019] [Accepted: 11/28/2019] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The significance of psychotherapeutic micro-processes, such as nonverbal facial expressions and relationship quality, is widely known, yet hitherto has not been investigated satisfactorily. In this exploratory study, we aim to examine the occurrence of micro-processes during psychotherapeutic treatment sessions, specifically facial micro-expressions, in order to shed light on their impact on psychotherapeutic interactions and patient-clinician relationships. METHODS In analyzing 22 video recordings of psychiatric interviews in a routine/acute psychiatric care unit of Vienna General Hospital, we were able to investigate clinicians' and patients' facial micro-expressions in conjunction with verbal interactions and types. To this end, we employed the Emotion Facial Action Coding System (EmFACS)-assessing the action units and microexpressions-and the Psychodynamic Intervention List (PIL). Also, the Working Alliance Inventory (WAI), assessed after each session by both patients and clinicians, provided information on the subjective quality of the clinician-patient relationship. RESULTS We found that interpretative/confrontative interventions are associated with displays of contempt from both therapists and patients. Interestingly, displays of contempt also correlated with higher WAI scores. We propose that these seemingly contradictory results may be a consequence of the complexity of affects and the interplay of primary and secondary emotions with intervention type. CONCLUSION Interpretation, confrontation, and working through contemptuous microexpressions are major elements to the adequate control major pathoplastic elements. Affect-cognitive interplay is an important mediator in the working alliance.
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Affiliation(s)
- Felicitas Datz
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, A-1090 Vienna, Austria;
| | - Guoruey Wong
- Faculté de Médecine, Université de Montréal, Montréal, QC H3T 1J4, Canada;
| | - Henriette Löffler-Stastka
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, A-1090 Vienna, Austria;
- Teaching Center, Medical University of Vienna, A-1090 Vienna, Austria
- Correspondence:
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Turk B, Ertl S, Wong G, Wadowski PP, Löffler-Stastka H. Does case-based blended-learning expedite the transfer of declarative knowledge to procedural knowledge in practice? BMC Med Educ 2019; 19:447. [PMID: 31796049 PMCID: PMC6889574 DOI: 10.1186/s12909-019-1884-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 11/20/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Case-Based Learning (CBL) has seen widespread implementation in undergraduate education since the early 1920s. Ample data has shown CBL to be an enjoyable and motivational didactic tool, and effective in assisting the expansion of declarative and procedural knowledge in academia. Although a plethora of studies apply multiple choice questions (MCQs) in their investigation, few studies measure CBL or case-based blended learning (CBBL)-mediated changes in students' procedural knowledge in practice or employ comparison or control groups in isolating causal relationships. METHODS Utilizing the flexibilities of an e-learning platform, a CBBL framework consisting of a) anonymized patient cases, b) case-related textbook material and online e-CBL modules, and c) simulated patient (SP) contact seminars, was developed and implemented in multiple medical fields for undergraduate medical education. Additionally, other fields saw a solo implementation of e-CBL in the same format. E- cases were constructed according to the criteria of Bloom's taxonomy. In this study, Objective Structured Clinical Examination (OSCE) results from 1886 medical students were analyzed in total, stratified into the following groups: medical students in 2013 (n = 619) before CBBL implementation, and after CBBL implementation in 2015 (n = 624) and 2016 (n = 643). RESULTS A significant improvement (adjusted p = .002) of the mean OSCE score by 1.02 points was seen between 2013 and 2015 (min = 0, max = 25). CONCLUSION E-Case-Based Learning is an effective tool in improving performance outcomes and may provide a sustainable learning platform for many fields of medicine in future.
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Affiliation(s)
- Bela Turk
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Kennedy Krieger Institute, Johns Hopkins University, Baltimore, USA
| | - Sebastian Ertl
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Guoruey Wong
- Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada
| | - Patricia P Wadowski
- Department of Internal Medicine II, Division of Angiology, Medical University of Vienna, Vienna, Austria
| | - Henriette Löffler-Stastka
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
- Teaching Center, Medical University of Vienna, Vienna, Austria.
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Tretter F, Löffler-Stastka H. Medical knowledge integration and "systems medicine": Needs, ambitions, limitations and options. Med Hypotheses 2019; 133:109386. [PMID: 31541780 DOI: 10.1016/j.mehy.2019.109386] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/22/2019] [Accepted: 08/29/2019] [Indexed: 02/07/2023]
Abstract
Medicine today is an extremely heterogeneous field of knowledge, based on clinical observations and action knowledge and on data from the biological, behavioral and social sciences. We hypothesize at first that medicine suffers from a disciplinary hyper-diversity compared to the level of conceptual interdisciplinary integration. With the claim to "understand" and cure diseases, currently with the label "Systems Medicine" new forms of molecular medicine promise a general new bottom-up directed precise, personalized, predictive, preventive, translational, participatory, etc. medicine. Our second hypothesis rejects this claim because of conceptual, methodological and theoretical weaknesses. In contrary, this is our third hypothesis; we suggest that top-down organismic systems medicine, related to general system theory, opens better options for an integrative scientific understanding of processes of health and disease.
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Affiliation(s)
- Felix Tretter
- Bertalanffy Center for the Study of Systems Science, Vienna, Austria
| | - Henriette Löffler-Stastka
- Dept. of Psychanalysis and Psychotherapy, and Postgraduate Unit, Medical University Vienna, Austria.
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Wadowski PP, Litschauer B, Seitz T, Ertl S, Löffler-Stastka H. Case-based blended eLearning scenarios-adequate for competence development or more? Neuropsychiatr 2019; 33:207-211. [PMID: 31696411 PMCID: PMC6901430 DOI: 10.1007/s40211-019-00322-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 10/03/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Learning, competence development and scientific thinking in medicine need several strategies to facilitate new diagnostic and therapeutic ways. The optimal collaboration between creative thinking and biomedical informatics provides innovation for the individual patient and for a medical school or society. Utilizing the flexibilities of an e‑learning platform, a case based blended learning (CBBL) framework consisting of A) case based textbook material, B) online e‑CBL with question driven learning scenarios and C) simulated patient (SP) contact seminars was developed and implemented in multiple medical fields. Real-life clinical cases were anonymized and transferred into an interactive and an interdisciplinary eLearning platform. METHODS As an example of the offered clinical teaching-case collection, an example of a psychiatric case for the disease "posttraumatic stress disorder (PTSD)" is presented: a 30-year-old man with a history of insomnia with difficulties in falling asleep and sleeping through, nightmares, nervousness and psychomotor restlessness. The students are challenged to identify possible differential diagnoses and further get to know the patient's personal history (loss of relatives due to war, torture and flight from home country). Further, the students are guided through the principles of fear conditioning including translational aspects like neurotransmitter signaling of PTSD pathomechanism (translational and research aspects like dopamine transporter gene polymorphism, long term potentiation and synaptic signaling). RESULTS/CONCLUSION The case presentation comprises different learning aspects: First, declarative knowledge has to be acquired and collected in basic medical sciences, knowledge that is in fact available and can be accessed on the conscious and preconscious level in long-term memory. Second, associative learning leads to the formation of neuronal connections and is an important way of learning and discovering, founded in neural associations. Third, polythematic-crosslinking thinking is needed as ability to link information in a meaningful way. These steps are a typical intellectual ability of gifted learners and researchers that combine previously seemingly unrelated areas to each other and drive innovation.
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Affiliation(s)
- Patricia Pia Wadowski
- Department of Internal Medicine II, Division of Angiology, Medical University of Vienna, Vienna, Austria
| | - Brigitte Litschauer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Tamara Seitz
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Sebastian Ertl
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Henriette Löffler-Stastka
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Löffler-Stastka H, Gelo O, Pleschberger I, Hartmann A, Orlinsky DE, Rønnestad MH, Willutzki U. [Psychotherapy training in Austria: Baseline and socio-demographic background data from a SPRISTAD ( Society of Psychotherapy Research Interest Section on Therapist Training and Development)-Pilotstudy]. Z Psychosom Med Psychother 2019; 65:341-352. [PMID: 31801441 DOI: 10.13109/zptm.2019.65.4.341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objectives: Description of the qualifications of psychotherapy-training candidates in Austria at the beginning of their training. Methods: Psychotherapists in training in Austria were interviewed at the beginning of their training concerning their socio-demographic background and prior education. These background data were collected using the Trainee Background Information Form (TBIF), which was designed by the Society for Psychotherapy Research Interest Section on Therapist Training and Development (SPRISTAD). Results: The group of 197 psychotherapy trainees from Austria consists largely of women, of persons with high school education and with a satisfactory, financially secure life situation. One-third of them show a "second career" pattern, which is in line with the predominantly part-time training programs in Austria. A high percentage of the candidates have previous professional experience in the psychosocial field. Conclusions: As this is a pilot study, results can be seen as a starting point for further research in psychotherapy training and competence development. In discussing the findings, both national conditions and opportunities for future interdisciplinary research are considered.
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Affiliation(s)
- Henriette Löffler-Stastka
- Klinik für Psychoanalyse und Psychotherapie Medizinische Universität Wien Währinger Gürtel 18-20 A-1090 Wien Österreich Medizinische Universität Wien
| | - Omar Gelo
- University of Lecce Italien University of Lecce
| | - Ingrid Pleschberger
- Klinik für Psychoanalyse und Psychotherapie Medizinische Universität Wien Währinger Gürtel 18-20 A-1090 Wien Österreich Medizinische Universität Wien
| | - Armin Hartmann
- Klinik für Psychosomatische Medizin und Psychotherapie Zentrum für Psychische Erkrankungen Universitätsklinikum Freiburg Deutschland Uniklinik Freiburg - Klinik für Psychosomatische Medizin und Psychotherapie
| | | | | | - Ulrike Willutzki
- Universität Witten/Herdecke Deutschland Universität Witten/Herdecke
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Parth K, Wolf I, Löffler-Stastka H. Capturing the Unconscious-The "Psychoanalytic Core Competency Q-Sort". An Innovative Tool Investigating Psychodynamic Therapeutic Skills. Int J Environ Res Public Health 2019; 16:ijerph16234700. [PMID: 31779100 PMCID: PMC6926890 DOI: 10.3390/ijerph16234700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 11/21/2019] [Accepted: 11/22/2019] [Indexed: 02/07/2023]
Abstract
The Psychoanalytic Core Competency Q-Sort (PCC Q-Sort) is a newly developed empirical research tool that allows for the description and illustration of the ways psychodynamically-oriented psychotherapists work. It provides a simple, straightforward rating procedure utilizing a well-established q-sort method. The present pilot study describes the psychoanalytic core competency items and discusses the development procedure of the instrument as well as statistical analysis of ratings from psychoanalytic sessions, including inter-rater reliability as well as preliminary findings on possible construct validity. Additionally, a factor analysis was performed. Values were assessed by applying the PCC Q-Sort to 30 audio recordings of psychoanalytic sessions. The results of the present study indicate that the PCC Q-Sort is a reliable process research instrument that allows for a detailed investigation of psychotherapy processes in psychodynamic psychotherapies and change processes.
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Affiliation(s)
- Karoline Parth
- Department of Psychoanalysis and Psychotherapy, Medical University, A-1090 Vienna, Austria;
| | - Isabelle Wolf
- University Program for Psychotherapy Research, Postgraduate Unit, Medical University, A-1090 Vienna, Austria;
| | - Henriette Löffler-Stastka
- Department of Psychoanalysis and Psychotherapy, Medical University, A-1090 Vienna, Austria;
- University Program for Psychotherapy Research, Postgraduate Unit, Medical University, A-1090 Vienna, Austria;
- Correspondence: ; Tel.: +43-1-40400-30700
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Tretter F, Löffler-Stastka H. The Human Ecological Perspective and Biopsychosocial Medicine. Int J Environ Res Public Health 2019; 16:ijerph16214230. [PMID: 31683637 PMCID: PMC6862005 DOI: 10.3390/ijerph16214230] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/27/2019] [Accepted: 10/29/2019] [Indexed: 02/07/2023]
Abstract
With regard to philosophical anthropology, a human ecological framework for the human-environment relationship as an "ecology of the person" is outlined, which focuses on the term "relationship" and aims to be scientifically sound. It also provides theoretical orientations for multiprofessional clinical work. For this purpose, a multi-dimensional basic grid for the characterization of the individual human being is proposed. The necessity and meaningfulness of a differentiation and systematization of the terms "environment", and above all "relationship", are demonstrated, and practical examples and links to similar framework models are given.
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Affiliation(s)
- Felix Tretter
- German Society for Human Ecology, A-1040 Wien, Austria.
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Rumpold T, Lütgendorf-Caucig C, Löffler-Stastka H, Roider-Schur S, Pötter R, Kirchheiner K. Attitude Towards End of Life Communication of Austrian Medical Students. J Cancer Educ 2019; 34:743-748. [PMID: 29687186 DOI: 10.1007/s13187-018-1366-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Medical students have to acquire theoretical knowledge, practical skills, and a personal attitude to meet the emerging needs of palliative care. The present study aimed to assess the personal attitude of Austrian medical students towards end of life communication (EOLC), as key part of palliative care. This cross-sectional, mono-institutional assessment invited all medical students at the Medical University of Vienna in 2015. The assessment was conducted web-based via questionnaire about attitudes towards EOLC. Additional socio-demographic and medical education-related parameters were collected. Overall, 743 medical students participated in the present report. Differences regarding the agreement or disagreement to several statements concerning the satisfaction of working with chronically ill patients, palliative care, and health care costs, as well as the extent of information about palliative disease, were found for age, gender, and academic years. The overall attitude towards EOLC in the present sample can be regarded as quite balanced. Nevertheless, a considerable number of medical students are still reluctant to inform patients about their incurable disease. Reservations towards palliative care as part of the health care system seem to exist. The influence of the curriculum as well as practical experiences seems to be important but needs further investigation.
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Affiliation(s)
- Tamara Rumpold
- Department of Radiation Oncology, Comprehensive Cancer Center Medical University of Vienna, Waehringer Straße 18-20, 1090, Vienna, Austria
| | | | - Henriette Löffler-Stastka
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Straße 18-20, 1090, Vienna, Austria
| | - Sophie Roider-Schur
- Division of Palliative Care, Department of Internal Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Waehringer Straße 18-20, 1090, Vienna, Austria
| | - Richard Pötter
- Department of Radiation Oncology, Comprehensive Cancer Center Medical University of Vienna, Waehringer Straße 18-20, 1090, Vienna, Austria
| | - Kathrin Kirchheiner
- Department of Radiation Oncology, Comprehensive Cancer Center Medical University of Vienna, Waehringer Straße 18-20, 1090, Vienna, Austria
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Löffler-Stastka H, Sell C, Zimmermann J, Huber D, Klug G. Is countertransference a valid source of clinical information? Investigating emotional responses to audiotaped psychotherapy sessions. Bull Menninger Clin 2019; 83:353-375. [PMID: 31180236 DOI: 10.1521/bumc_2019_83_02] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The study aimed to test whether countertransference reactions contain valid information about the patient. The authors examined whether a significant part of the variance in emotional, cognitive, and motivational responses to recorded therapy sessions is attributable to the patient. Six student raters listened to 605 audiotaped sessions of 81 patients with major depression treated by 19 therapists and indicated their reactions using a modified version of the Countertransference Questionnaire. The relative amount of variance in countertransference reactions due to differences between patients, ranging from 2% to 16%, was significant for most of the countertransference dimensions. Reactions were influenced by type of treatment and severity of depression but not by comorbid personality disorder or interpersonal problems. The relative amount of variance due to differences between raters was large, averaging at 23%. The authors conclude that-albeit having a relatively low "signal-to-noise ratio"in raters without psychotherapy training-countertransference reactions contain valid clinical information.
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Affiliation(s)
| | | | | | - Dorothea Huber
- International Psychoanalytic University Berlin, Berlin, Germany
| | - Guenther Klug
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Technische Universität München, Germany
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Seitz T, Stastka K, Schiffinger M, Rui Turk B, Löffler-Stastka H. Interprofessional care improves health-related well-being and reduces medical costs for chronic pain patients. Bull Menninger Clin 2019; 83:105-127. [PMID: 30840490 DOI: 10.1521/bumc_2019_83_01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study evaluated whether patients with somatic symptom disorder, expressing chronic pain that could not be attributed to a medical condition, would benefit from an 8-week inpatient residence at a psychiatric ward. In the 1-year follow-up after termination the authors examined the extent to which the integrated treatment decreased patient costs. A total of 106 patients participated in the follow-up and reported a significant improvement in their general health (Cohen's d = 1.5-2.21), a decrease in impairment due to pain (d = 2.24), and a decrease in symptom severity (d = 1.29). They took fewer medications and sick days, reported fewer hospital stays and medical examinations, and consulted and changed physicians and outpatient clinics less often (d = 0.55-1.1). The average cost per patient was cut in half, down to € 80,000/$96,000 per year. From a clinical standpoint, group analysis that focused on aggression was the most effective intervention.
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Affiliation(s)
- Tamara Seitz
- Medical University of Vienna, Department of Psychoanalysis and Psychotherapy, and Teaching Center/Postgraduate Unit/Health Care Management and Psychotherapy Research, Vienna, Austria
- SMZ Süd Hospital of Vienna, Department of Infectious Diseases and Tropical Medicine, Vienna, Austria
| | - Kurt Stastka
- SMZ Süd Hospital of Vienna, Department of Psychiatry, Vienna, Austria
| | | | - Bela Rui Turk
- Kennedy Krieger Institute, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Henriette Löffler-Stastka
- Medical University of Vienna, Department of Psychoanalysis and Psychotherapy, and Teaching Center/Postgraduate Unit/Health Care Management and Psychotherapy Research, Vienna, Austria
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Seitz T, Raschauer B, Längle AS, Löffler-Stastka H. Competency in medical history taking-the training physicians' view. Wien Klin Wochenschr 2019; 131:17-22. [PMID: 30569233 PMCID: PMC6342885 DOI: 10.1007/s00508-018-1431-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 12/06/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Because effective communication skills are crucial for every physician, this study evaluated students' competence to take a sufficient medical history. This ability was measured via reports from the students' supervising and training physicians. METHODS A total of 24 physicians from several different departments were interviewed' and a stratification of medical specialties was performed due to the current supply-relevant number of medical doctors in the country. A qualitative content analysis was then performed. RESULTS The analysis revealed the students' lack of expertise and ability to take a structured and complete medical history. Additionally, the lack of students' engagement was criticized by the training physicians. An insufficiency of student supervision was also shown as only half of the departments have a fixed supervisor for the students during the internship. CONCLUSION The data showed the need for a refinement of the training of communicative skills at university and the practical training at hospitals.
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Affiliation(s)
- Tamara Seitz
- Social-Medical Center South, Vienna, Austria
- Dept. of Psychoanalysis and Psychotherapy, Medical University Vienna, Währingerstraße 18-20, 1090, Vienna, Austria
| | | | - Angelika S Längle
- Dept. of Psychoanalysis and Psychotherapy, Medical University Vienna, Währingerstraße 18-20, 1090, Vienna, Austria
- Postgraduate Unit/Teaching Center, Medical University Vienna, Vienna, Austria
| | - Henriette Löffler-Stastka
- Dept. of Psychoanalysis and Psychotherapy, Medical University Vienna, Währingerstraße 18-20, 1090, Vienna, Austria.
- Postgraduate Unit/Teaching Center, Medical University Vienna, Vienna, Austria.
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Finger-Ossinger M, Löffler-Stastka H. Self-reflectivity: a moment of professionalization in psychotherapy training. Res Psychother 2018; 21:316. [PMID: 32913766 PMCID: PMC7451385 DOI: 10.4081/ripppo.2018.316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 08/27/2018] [Indexed: 02/07/2023]
Abstract
The required basic skills of European psychotherapists were published by the European Association of Psychotherapy in 2013. One of these abilities is self-reflection. To mentalize oneself, to reflect on what circumstances and experiences in the past and present have led to the present desires, thoughts and convictions is an essential prerequisite for professional work in the psychosocial field. With the help of the thematic analysis a data set of 41 self-reflection reports of students is analysed at the end of the training. Since the training should be evaluated and if necessary optimized, it should be examined which elements of the online preparation course make the selfreflection ability visible. The analysis of the students' texts gives a clear indication of existing self-reflection skills. It was surprising that for some students, besides the great importance of self-awareness lessons, affective integration into the blended learning program was an essential impulse for self-reflection.
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Affiliation(s)
| | - Henriette Löffler-Stastka
- Clinic for Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
- Clinic for Psychoanalysis and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria. +43.0.1.40400.30700.
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Seitz T, Längle AS, Seidman C, Löffler-Stastka H. Does medical students' personality have an impact on their intention to show empathic behavior? Arch Womens Ment Health 2018; 21:611-618. [PMID: 29623465 PMCID: PMC6245122 DOI: 10.1007/s00737-018-0837-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 03/21/2018] [Indexed: 02/07/2023]
Abstract
Several studies have demonstrated a correlation between specific personal traits and empathy. However, it is not clear if persons with certain personality traits lack the intent to show empathic behavior or if other factors independent of their intent are affecting their empathic behavior. To answer this question, we asked 132 medical students to fill out questionnaires evaluating the General Intention to Show Empathic Behavior (GISEB) and the five personality traits measured by NEO Five-Factor Inventory (NEO-FFI). Additionally, we evaluated the influence of other factors, such as age, gender, curricular progress (second versus fourth year), and preferred specialization after graduation. We performed a Pearson's correlation and a regression analysis. Results indicate that the five personality traits and gender have little influence on the General Intention (GISEB), only extraversion (r = .221, 95% CI [.013-.394], p = .027), and agreeableness (r = .229, 95% CI [.021-.428], p = .022) correlated with the intention. The only predictor for General Intention (GISEB) was curricular progress (β = - .27, p < .05), showing a decrease of General Intention to Show Empathic Behavior from second to fourth year of university (U = 1203.5, p = .002). A further finding indicates that gender and personality influence the students' wish of specialization after graduation: Agreeableness (F(12, 53) = 2.376, p = .016) impacted the preferred specialization. Our study demonstrated that medical students' personality might not notably impact the intention to show empathic behavior. Further research is needed to investigate moderating effects.
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Affiliation(s)
- Tamara Seitz
- Department of Infectious Diseases and Tropical Medicine, SMZ Süd Wien, Vienna, Austria
| | - Angelika S Längle
- Department of Psychoanalysis und Psychotherapy, and Teaching Center/Postgraduate Unit, Medical University of Vienna, Währingerstraße 18-20, 1090, Vienna, Austria
| | | | - Henriette Löffler-Stastka
- Department of Psychoanalysis und Psychotherapy, and Teaching Center/Postgraduate Unit, Medical University of Vienna, Währingerstraße 18-20, 1090, Vienna, Austria.
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Himmelbauer M, Seitz T, Seidman C, Löffler-Stastka H. Standardized patients in psychiatry - the best way to learn clinical skills? BMC Med Educ 2018; 18:72. [PMID: 29625572 PMCID: PMC5889557 DOI: 10.1186/s12909-018-1184-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 03/27/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Standardized patients (SP) have been successfully utilized in medical education to train students' communication skills. At the Medical University of Vienna communication training with SPs in psychiatry is a mandatory part of the curriculum. In the training, the SP plays the role of four different patients suffering from depression/suicidal tendencies, somatoform disorder, anxiety disorder, or borderline disorder while the student attempts to gather the patient's medical history. Both the instructor and SP then give the student constructive feedback afterwards. METHOD The aim of the study was to evaluate the quality of the SP's roleplay and feedback, using a self-created questionnaire. Additionally, we wanted to gauge the differences between the students' and teachers' evaluations of the SP's role playing performance and feedback. RESULTS The questionnaire was completed by 529 students and 29 teachers who attended the training. Overall, both students and teachers evaluated the SPs' performance and feedback very well. In comparison to the responses given by the teachers, more students reported that the "SP overacted" while fewer students believed that the "SP could be a real patient". The feedback given by the SP was evaluated similarly by students and teachers, suggesting that students are able to recognize the quality of constructive feedback. Furthermore, the SP's quality of roleplaying was evaluated as the poorest while playing the psychiatric disorder "depression/suicidal tendencies." CONCLUSIONS Our study showed that students and teachers appreciate SPs' competence of role play and of giving feedback. However, further studies should be performed to figure out why both students and teachers alike evaluated the played psychiatric disorder "depression/suicidal tendencies" to be the worst.
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Affiliation(s)
- Monika Himmelbauer
- 0000 0000 9259 8492grid.22937.3dTeaching Center, Medical University of Vienna, Vienna, Austria
| | - Tamara Seitz
- Department of Infectious Diseases and Tropical Medicine, SMZ Süd, Kundratstraße 10, 1100 Wien, Austria
| | - Charles Seidman
- 0000000419368729grid.21729.3fColumbia University, New York, USA
| | - Henriette Löffler-Stastka
- 0000 0000 9259 8492grid.22937.3dDepartment of Psychoanalysis and Psychotherapy, and Teaching Center/Postgraduate Unit, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
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Schmidsberger F, Löffler-Stastka H. Empathy is proprioceptive: the bodily fundament of empathy - a philosophical contribution to medical education. BMC Med Educ 2018; 18:69. [PMID: 29622015 PMCID: PMC5887217 DOI: 10.1186/s12909-018-1161-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 03/15/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The current philosophical debate on empathy entails accounts of theory of mind and simulation as well as a phenomenological opposition. The first focuses on a detached observation of others from a 3rd person perspective and formulates the common claim that there is no direct access to the mental and emotional life of others, only simulation or analogy can grant access to the emotions and behaviour of others. The philosophical respectively phenomenological account of Fuchs instead opposes by focusing personal interaction within a 1st or 2nd person perspective claiming that the emotions of others are experienceable through bodily expression and bodily resonance. Fuchs offers an account of embodied affectivity that emphasizes the role of the (subjective) body for emotion and empathy. By experiencing the bodily expressed emotions of a vis-à-vis with and through the own body empathy and social understanding are bodily grounded. Following this core thesis Fuchs differentiates a primary, bodily empathy and an extended empathy that focuses on putting myself in the shoes of others (perspective taking). DISCUSSION By comparison of different forms of social understanding as discussed in the phenomenological tradition - like contagion, sharing and empathy - it can be shown that extended empathy has an egocentric character. By putting myself in the shoes of others I miss a person's otherness that transcends my capacity of imagination respectively the personal frame of my experience. Further Fuchs' disregards that a bodily based empathy is co-structured by higher level form of understanding like contextual biographic knowledge. CONCLUSION The philosophical discussion offers fertile impulses for Medical Education (ME) and the training of empathic communication skills. The account of Fuchs highlights the role of bodily perception (proprioception) as a resource of understanding others. Thus proprioceptive skills of a physician can support the empathic understanding of the physician. The objection against the egocentric trait of perspective taking admonishes not to generalize the own perspective as decisive for empathy and to adopt an attitude that remains open to the otherness of a patient and its experiences.
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Affiliation(s)
- Florian Schmidsberger
- 0000 0001 2286 1424grid.10420.37Institute for Philosophy, and University Program for Psychotherapeutic Propedeutics, Postgraduate Center, University of Vienna, Vienna, AT Austria
| | - Henriette Löffler-Stastka
- Department for Psychoanalysis and Psychotherapy, University Program for Psychotherapy Research, Teaching Center, Medical University of Vienna, Postgraduate Center, University Vienna, Währingerstraße 18-20, 1090 Vienna, Austria
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Ludwig B, Turk B, Seitz T, Klaus I, Löffler-Stastka H. The search for attitude-a hidden curriculum assessment from a central European perspective. Wien Klin Wochenschr 2018; 130:134-140. [PMID: 29356896 PMCID: PMC5816099 DOI: 10.1007/s00508-018-1312-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 01/03/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Little is known about the development of the hidden curriculum in the medical education system. It refers to a conglomeration of implicit beliefs, attitudes and forms of conduct that are unwittingly transmitted from one generation of teaching physicians to the next. How can we describe this process, what are the potential positive or negative impacts, and last but not least, how can we measure it? METHODS Students of the Medical University of Vienna complete their clinical rotations in Vienna and in other accredited, mostly central European hospitals. They were subsequently invited to evaluate their rotations in an online questionnaire regarding dimensions, such as professionalism, teaching, integration and appreciation. RESULTS In total, 133 students participated in this pilot study and the average response rate was 10.1%, similar to evaluations conducted prior to that. Although the evaluation results on average were positive, several experiences of deprecation and less professional conduct were present in each evaluated rotation. Giving the students the opportunity to reflect upon their experiences could be seen as an intervention and investigation at the same time. CONCLUSIONS This survey serves as a precursor to a qualitative interview-based study, accompanying the implementation of case-based learning designed by collaborating residents and medical students. The findings of this pilot-study support the necessity of fostering a reflective capacity in the education of medical students, enabling them to speak up and live up to the expected professionalism despite shortcomings within the hidden curriculum.
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Affiliation(s)
- Birgit Ludwig
- Dept. for Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Bela Turk
- Kennedy Krieger Institute, Johns Hopkins Medical Institutions, Baltimore, USA
| | | | | | - Henriette Löffler-Stastka
- Dept. for Psychoanalysis and Psychotherapy, and Teaching Center, Postgraduate Unit, Medical University Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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