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McDonald M, Linden M. Increasing the Therapeutic Dosage by Combining Cognitive Behavior Group Therapy With a Monitored Self-Help Group. J Cogn Psychother 2024; 38:203-210. [PMID: 38991744 DOI: 10.1891/jcp-2023-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
Objective: A problem in psychotherapy is the limited availability of psychotherapists. This can not only delay the start of therapy but also curtail the number of sessions and the therapeutic dosage. An option to extend the therapeutic dose without an increase in therapist time may be to combine group psychotherapy with a self-help group. The goal of the present study is to investigate how patients judge this treatment mode and to what degree the contents of a regular group treatment are pursued in a parallel self-help group.Method: Seventy-two psychosomatic inpatients participated in cognitive behavior group therapy and parallel self-help group, which was monitored by the therapist during the regular group therapy sessions. Patients in both groups filled in a questionnaire that asked for the content of the group session, how patients had experienced the interaction, and what they had taken from the group.Results: Patients reported that in the self-help group, they discussed similar topics as in the regular group therapy, like how to deal with anxiety or sadness, how to interact with other people, and how to cope with their mental disorder and problems at work, in the family, or with friends. Patients indicated that there was more relaxed chatting in the self-help group, whereas learning new behavior was reported more frequently for the regular group therapy.Conclusions: In the regular group therapy and the guided self-help group, similar topics were discussed, which suggests that a combination of both can extend the therapeutic process and increase the therapeutic dosage without costs for the therapist or the institution.
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Affiliation(s)
- Maria McDonald
- Research Group Psychosomatic Rehabilitation, Charité University Medicine Berlin, Berlin, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, Faculty of Medicine Carl Gustav Carus of the TU Dresden, Dresden, Germany
| | - Michael Linden
- Research Group Psychosomatic Rehabilitation, Charité University Medicine Berlin, Berlin, Germany
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2
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Wei B. The tendency of the schematic structure to maintain stability can be interpreted as mental inertia. Front Psychol 2023; 14:1243711. [PMID: 38022980 PMCID: PMC10646405 DOI: 10.3389/fpsyg.2023.1243711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
This paper incorporates schematic concepts related to mental inertia and provides an avenue for interpreting psychology using the principles of classical mechanics. Schemas find wide application in diverse fields, ranging from ergonomics to psychotherapy. Nonetheless, it is crucial to incorporate schemas themselves into a more unified and comprehensive theoretical framework. Drawing upon the free energy principle (FEP) and the second law of thermodynamics, it is evident that humans possess a natural inclination to construct and maintain consistent cognitive structures. This characteristic contributes to the stability of schemas within a defined range. The particular scope of the model is closely intertwined with its structure, leading to variations among individuals in diverse environments. The coherence of the schema within a defined range can be perceived as the magnitude of mental inertia. This psychological analogy emphasizes the importance of considering the influences exerted by the external environment and their effects on mental inertia when predicting the human mind and behavior.
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Affiliation(s)
- Berlyne Wei
- Psychology Department, School of Educational Science, Hunan Normal University, Changsha, China
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Plag J, Hoyer J. Die soziale Angststörung – ein Update. FORTSCHRITTE DER NEUROLOGIE · PSYCHIATRIE 2022; 90:471-487. [DOI: 10.1055/a-1803-8526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Es kann passieren, dass man sich vermeintlich peinlich oder insuffizient
verhält; kurzfristige Gefühle wie Scham oder Selbstzweifel
bleiben meist jedoch ohne Bedeutung. Kommt es aber zu überzogenen und
überdauernden Befürchtungen oder signifikantem
Vermeidungsverhalten, kann es sich um eine soziale Angststörung (SAS)
handeln. Der vorliegende Artikel bietet eine Übersicht über den
aktuellen Stand der Ätiologie, Diagnostik und Therapie der SAS.
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4
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Pittig A, Heinig I, Goerigk S, Thiel F, Hummel K, Scholl L, Deckert J, Pauli P, Domschke K, Lueken U, Fydrich T, Fehm L, Plag J, Ströhle A, Kircher T, Straube B, Rief W, Koelkebeck K, Arolt V, Dannlowski U, Margraf J, Totzeck C, Schneider S, Neudeck P, Craske MG, Hollandt M, Richter J, Hamm A, Wittchen HU. Efficacy of temporally intensified exposure for anxiety disorders: A multicenter randomized clinical trial. Depress Anxiety 2021; 38:1169-1181. [PMID: 34293223 DOI: 10.1002/da.23204] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/25/2021] [Accepted: 07/12/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The need to optimize exposure treatments for anxiety disorders may be addressed by temporally intensified exposure sessions. Effects on symptom reduction and public health benefits should be examined across different anxiety disorders with comorbid conditions. METHODS This multicenter randomized controlled trial compared two variants of prediction error-based exposure therapy (PeEx) in various anxiety disorders (both 12 sessions + 2 booster sessions, 100 min/session): temporally intensified exposure (PeEx-I) with exposure sessions condensed to 2 weeks (n = 358) and standard nonintensified exposure (PeEx-S) with weekly exposure sessions (n = 368). Primary outcomes were anxiety symptoms (pre, post, and 6-months follow-up). Secondary outcomes were global severity (across sessions), quality of life, disability days, and comorbid depression. RESULTS Both treatments resulted in substantial improvements at post (PeEx-I: dwithin = 1.50, PeEx-S: dwithin = 1.78) and follow-up (PeEx-I: dwithin = 2.34; PeEx-S: dwithin = 2.03). Both groups showed formally equivalent symptom reduction at post and follow-up. However, time until response during treatment was 32% shorter in PeEx-I (median = 68 days) than PeEx-S (108 days; TRPeEx-I = 0.68). Interestingly, drop-out rates were lower during intensified exposure. PeEx-I was also superior in reducing disability days and improving quality of life at follow-up without increasing relapse. CONCLUSIONS Both treatment variants focusing on the transdiagnostic exposure-based violation of threat beliefs were effective in reducing symptom severity and disability in severe anxiety disorders. Temporally intensified exposure resulted in faster treatment response with substantial public health benefits and lower drop-out during the exposure phase, without higher relapse. Clinicians can expect better or at least comparable outcomes when delivering exposure in a temporally intensified manner.
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Affiliation(s)
- Andre Pittig
- Department of Psychology (Biological Psychology Clinical Psychology, and Psychotherapy), Center of Mental Health, University of Würzburg, Würzburg, Germany.,Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Ingmar Heinig
- Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Stephan Goerigk
- Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilians University, Munich, Germany
| | - Freya Thiel
- Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Katrin Hummel
- Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Lucie Scholl
- Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Paul Pauli
- Department of Psychology (Biological Psychology Clinical Psychology, and Psychotherapy), Center of Mental Health, University of Würzburg, Würzburg, Germany
| | - Katharina Domschke
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany.,Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Basics in NeuroModulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ulrike Lueken
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center of Mental Health, University Hospital of Würzburg, Würzburg, Germany.,Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas Fydrich
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lydia Fehm
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jens Plag
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy & Center for Mind Brain and Behavior - CMBB, Philipps-University Marburg, Marburg, Germany
| | - Benjamin Straube
- Department of Psychiatry and Psychotherapy & Center for Mind Brain and Behavior - CMBB, Philipps-University Marburg, Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology & Center for Mind, Brain and Behavior - CMBB, Philipps-University of Marburg, Marburg, Germany
| | - Katja Koelkebeck
- Institute for Translational Psychiatry, University of Muenster, Muenster, Germany
| | - Volker Arolt
- Institute for Translational Psychiatry, University of Muenster, Muenster, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Muenster, Muenster, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Christina Totzeck
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Silvia Schneider
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Peter Neudeck
- Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Protect-AD Study Site Cologne, Cologne, Germany
| | - Michelle G Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
| | - Maike Hollandt
- Department of Psychology, Biological and Clinical Psychology, University of Greifswald, Greifswald, Germany
| | - Jan Richter
- Department of Psychology, Biological and Clinical Psychology, University of Greifswald, Greifswald, Germany
| | - Alfons Hamm
- Department of Psychology, Biological and Clinical Psychology, University of Greifswald, Greifswald, Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology & Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilians University, Munich, Germany
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5
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Hoyer J, Lueken U. [Psychotherapy of anxiety disorders: state of the art]. DER NERVENARZT 2021; 92:441-449. [PMID: 33575834 DOI: 10.1007/s00115-021-01069-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Alongside depression, anxiety disorders are the most frequent reason for consulting a psychotherapist. OBJECTIVE This article describes the recent progress in understanding basic learning processes in anxiety treatment, the resulting therapeutic procedures, the current state of knowledge on the efficacy of the various psychotherapeutic procedures and on the moderators of the success of treatment. MATERIAL AND METHODS The English and German language literature was reviewed and compiled, with an emphasis on the last 10 years. RESULTS Cognitive-behavioral therapy (CBT) achieves the best and broadest level of evidence across all anxiety disorders. Initial studies have also provided emerging evidence for the efficacy of manualized short-term psychodynamic treatment. The most discussed mechanism of action is that of inhibitory learning. Augmentation strategies and personalized treatment approaches are gaining in relevance. CONCLUSION Current models of inhibitory learning are rooted in basic research and foster a deeper understanding of the underlying neurobiological mechanisms. In order to optimize success of exposure treatment in vulnerable subgroups of patients, many procedural, device-based and pharmacological augmentation strategies are currently under investigation, whereby the latter are mostly still in the stage of (pre)clinical testing.
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Affiliation(s)
- J Hoyer
- Klinische Psychologie und Psychotherapie, TU Dresden, Hohe Str. 53, 01187, Dresden, Deutschland.
| | - U Lueken
- Institut für Psychologie, Humboldt-Universität zu Berlin, Berlin, Deutschland
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6
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Pittig A, Hoyer J, Noack R. Smart-Glass Guided Exposure for Anxiety Disorders: A Proof-of-Concept Study. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2020.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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7
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Hunger C, Hilzinger R, Klewinghaus L, Deusser L, Sander A, Mander J, Bents H, Ditzen B, Schweitzer J. Comparing Cognitive Behavioral Therapy and Systemic Therapy for Social Anxiety Disorder: Randomized Controlled Pilot Trial (SOPHO-CBT/ST). FAMILY PROCESS 2020; 59:1389-1406. [PMID: 31657011 DOI: 10.1111/famp.12492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This randomized controlled trial (RCT) aimed to pilot the newly developed manualized and monitored systemic therapy (ST) for social anxiety disorder (SAD), as compared to manualized and monitored cognitive behavioral therapy (CBT). We conducted a prospective multicenter, assessor-blind pilot RCT on 38 outpatients (ICD F40.1; Structured Clinical Interview for DSM (SCID); Liebowitz Social Anxiety Scale, LSAS-SR >30). The primary outcome was level of social anxiety (LSAS-SR) at the end of treatment. A total of 252 persons were screened, and 38 patients were randomized and started therapy (CBT: 20 patients; ST: 18 patients; age: M = 36 years, SD = 14). Within-group, simple-effect intent-to-treat analyses (ITT) showed significant reduction in LSAS-SR (CBT:d = 1.04; ST:d = 1.67), while ITT mixed-design ANOVA demonstrated the advantage of ST (d = 0.81). Per-protocol analyses supported these results. Remission based on reliable change indices also demonstrated significant difference (LSAS-SR: 15% in CBT; 39% in ST;h: 0.550), supported by blind diagnosticians' ratings of those who completed therapy (SCID; 45% in CBT, 78% in ST,p = .083). No adverse events were reported. CBT and ST both reduced social anxiety, supporting patient improvement with the newly developed ST for SAD; this has yet to be verified in a subsequent confirmatory RCT.
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Affiliation(s)
- Christina Hunger
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Rebecca Hilzinger
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Laura Klewinghaus
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Laura Deusser
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Anja Sander
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Johannes Mander
- Center for Psychological Psychotherapy, University of Heidelberg, Heidelberg, Germany
| | - Hinrich Bents
- Center for Psychological Psychotherapy, University of Heidelberg, Heidelberg, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Jochen Schweitzer
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
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8
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Hoyer J, Niermann H. Expositionsübungen und Verhaltensexperimente: Varianten des erfahrungsbasierten Lernens in der Verhaltenstherapie. VERHALTENSTHERAPIE 2020. [DOI: 10.1159/000511096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Expositionsübungen (Reizkonfrontationen) stellen die wichtigste Interventionskomponente bei Angststörungen dar; Verhaltensexperimente die wichtigste beobachtungsbezogene Disputationsmethode. Beides sind Beispiele erfahrungsorientierten Lernens in der Verhaltenstherapie. In der vorliegenden Übersichtsarbeit werden diese Vorgehensweisen definiert, in ihren Durchführungsvarianten dargestellt und hinsichtlich ihrer logischen Begründung sowie ihrer hypothetischen Wirkmechanismen verglichen. Dabei wird deutlich, dass beide Ansätze gemäß dem Prinzip der Erwartungs- bzw. Befürchtungswiderlegung (expectancy violation) erwartungs- bzw. einstellungskonträre Erfahrungen ermöglichen sollen. Der Schwerpunkt bei den Expositionsübungen liegt auf der Veränderung des emotionalen Erlebens und automatisierter Vermeidungsreaktionen in bestimmten Zielsituationen, bei den Verhaltensexperimenten liegt er auf der Veränderung von Einstellungen und Erwartungen. Ferner wird bei den Expositionsübungen der Erwerb emotionaler Kompetenzen (Furchttoleranz) angestrebt, was bei Verhaltensexperimenten zumindest nicht primär intendiert ist. Zwar zielt die Fallkonzeption bei Expositionen mehr auf die Veränderung problematischer Handlungen/Vermeidungsreaktionen und bei Verhaltensexperimenten mehr auf die Veränderung problematischer Kognitionen, beide Interventionsvarianten konvergieren aber grundsätzlich hinsichtlich des übenden Ansatzes, bei dem durch häufige Wiederholung im Alltag positive Kontrasterfahrungen stabil im Gedächtnis verankert werden sollen.
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Becker-Haimes EM, Byeon YV, Frank HE, Williams NJ, Kratz HE, Beidas RS. Identifying the organizational innovation-specific capacity needed for exposure therapy. Depress Anxiety 2020; 37:1007-1016. [PMID: 32390315 PMCID: PMC7822059 DOI: 10.1002/da.23035] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/15/2019] [Accepted: 04/20/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Current approaches to increasing the rates of clinician use of exposure therapy for anxiety disorders in community settings are limited. Research underscores the importance of addressing contextual variables to facilitate clinician use of evidence-based practices; however, no studies have identified the innovation-specific organizational capacity necessary to implement exposure therapy. Such work is critical to ensure that treatment-seeking individuals with anxiety receive effective care. METHODS We used a two-step process to identify the innovation-specific organizational capacity necessary to deliver exposure. First, 24 leaders of specialty anxiety clinics in the United States (50% female, mean [M]age = 47.7 years) completed a survey about the organizational innovation-specific capacity (e.g., policies and procedures) they employ to support their providers in delivering exposure therapy. Second, 19 community clinicians (79% female, M age = 42.9 years) reported on the extent to which these characteristics were present in their settings. RESULTS In Step 1, specialty clinic leaders unanimously endorsed six organizational characteristics as essential and five as important within the areas of organizational policies, supervisory support, and peer clinician support. These characteristics were present in more than 90% of specialty clinics. In Step 2, therapists in community clinics reported these characteristics were minimally present in their organizations. CONCLUSIONS Specialty clinic leaders exhibited consensus on the innovation-specific organizational capacity necessary to implement exposure therapy. Identified characteristics were largely absent from community clinics. Developing fiscal, policy, or organizational strategies that enhance the organizational capacity within community settings may improve the patients' access to effective treatment for anxiety disorders.
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Affiliation(s)
- Emily M. Becker-Haimes
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Young Vivian Byeon
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hannah E. Frank
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | | | - Hilary E. Kratz
- Department of Psychology, La Salle University, Philadelphia, Pennsylvania
| | - Rinad S. Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, Pennsylvania,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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10
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Treatment Manuals, Single-Subject Designs, and Evidence-Based Practice: A Clinical Behavior Analytic Perspective. PSYCHOLOGICAL RECORD 2020. [DOI: 10.1007/s40732-020-00394-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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11
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Noack R, Eckelt T, Scharoba J, Hoferichter E, Jacobi F, Weidner K, Hoyer J. Psychotherapeutische Fernbegleitung von Expositionstherapie bei Angststörungen mittels Smart Glass: Praktikabilitäts- und Akzeptanzevaluation. VERHALTENSTHERAPIE 2019. [DOI: 10.1159/000503871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<b><i>Hintergrund:</i></b> Trotz vielfach belegter Wirksamkeit expositionsbasierter Methoden bei Angststörungen werden diese in verhaltenstherapeutischen Praxen häufig nicht oder nicht vertieft genug umgesetzt. Planungs- und Zeitaufwand sind häufige Hinderungsgründe. In dieser Studie wurden Usability (Gebrauchstauglichkeit), User Experience (Nutzererleben) und Nutzerakzeptanz eines Systems zur Fernbegleitung von Expositionstherapie mittels Smart Glass evaluiert. <b><i>Methoden:</i></b> In einer standardisierten Laboruntersuchung bewerteten 39 Probanden mit Spinnenangst sowie 16 Therapeuten Usability, User Experience und Nutzerakzeptanz mittels etablierter Fragebögen. Vergleiche mit Normstichproben wurden vorgenommen und Adjective Rankings vergeben. <b><i>Ergebnisse:</i></b>92% der Probanden konnten sich selbstständig in das technische System einarbeiten und die Anweisungen des Therapeuten wahrnehmen und umsetzen. Die Usability wurde von den Probanden als “OK” bewertet. Bei der User Experience wurden bei konservativster Berechnung für die aufgabenbezogenen Faktoren Durchschaubarkeit, Effizienz und Steuerbarkeit “unterdurchschnittliche” und für die hedonischen Merkmale Stimulation und Originalität “gute” bis “exzellente” Bewertungen abgegeben. Die Nutzerakzeptanz war “durchschnittlich”. Die informiert rekrutierten Therapeuten zeigten in allen Variablen höhere Bewertungen. <b><i>Schlussfolgerungen:</i></b>Es besteht eine ausreichende Usability, eine in Bezug auf unterschiedliche Qualitäten heterogene User Experience und eine zufriedenstellende Akzeptanz. Insofern kann eine Expositionsfernbegleitung eine vielversprechende Alternative für die begleitete Exposition in vivo bieten. Verbesserungswürdige technische Probleme sowie medizinproduktebezogene und datenschutzrechtliche Fragen werden benannt.
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12
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Boettcher J, Weinbrecht A, Heinrich M, Renneberg B. Treatment of Social Anxiety Disorder and Avoidant Personality Disorder in Routine Care: A Naturalistic Study of Combined Individual and Group Therapy. VERHALTENSTHERAPIE 2019. [DOI: 10.1159/000497738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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13
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Boettcher J, Weinbrecht A, Heinrich M, Renneberg B. Die Behandlung der sozialen Angststörung und ängstlich-vermeidenden Persönlichkeitsstörung in der Versorgung: eine naturalistische Studie zu einer kombinierten Einzel- und Gruppentherapie. VERHALTENSTHERAPIE 2019. [DOI: 10.1159/000497620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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14
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Pittig A, Kotter R, Hoyer J. The Struggle of Behavioral Therapists With Exposure: Self-Reported Practicability, Negative Beliefs, and Therapist Distress About Exposure-Based Interventions. Behav Ther 2019; 50:353-366. [PMID: 30824251 DOI: 10.1016/j.beth.2018.07.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/05/2018] [Accepted: 07/09/2018] [Indexed: 01/30/2023]
Abstract
Exposure-based interventions are a core ingredient of evidence-based cognitive-behavioral treatment (CBT) for anxiety disorders, posttraumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD). However, previous research has documented that exposure is rarely utilized in routine care, highlighting an ongoing lack of dissemination. The present study examined barriers for the dissemination of exposure from the perspective of behavioral psychotherapists working in outpatient routine care (N = 684). A postal survey assessed three categories of barriers: (a) practicability of exposure-based intervention in an outpatient private practice setting, (b) negative beliefs about exposure, and (c) therapist distress related to the use of exposure. In addition, self-reported competence to conduct exposure for different anxiety disorders, PTSD, and OCD was assessed. High rates of agreement were found for single barriers within each of the three categories (e.g., unpredictable time management, risk of uncompensated absence of the patient, risk of decompensation of the patient, superficial effectiveness, or exposure being very strenuous for the therapist). Separately, average agreement to each category negatively correlated with self-reported utilization of exposure to a moderate degree (-.35 ≤ r ≤ -.27). In a multiple regression model, only average agreement to barriers of practicability and negative beliefs were significantly associated with utilization rates. Findings illustrate that a multilevel approach targeting individual, practical, and systemic barriers is necessary to optimize the dissemination of exposure-based interventions. Dissemination efforts may therefore benefit from incorporating strategies such as modifying negative beliefs, adaptive stress management for therapists, or increasing practicability of exposure-based interventions.
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Affiliation(s)
- Andre Pittig
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany.
| | - Roxana Kotter
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | - Jürgen Hoyer
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
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15
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Salzer S, Stefini A, Kronmüller KT, Leibing E, Leichsenring F, Henningsen P, Peseschkian H, Reich G, Rosner R, Ruhl U, Schopf Y, Steinert C, Vonderlin E, Steil R. Cognitive-Behavioral and Psychodynamic Therapy in Adolescents with Social Anxiety Disorder: A Multicenter Randomized Controlled Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2018; 87:223-233. [PMID: 29895001 DOI: 10.1159/000488990] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 04/03/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although social anxiety disorder (SAD) has an early onset and is frequently found in adolescence, evidence for psychotherapeutic treatments of SAD in adolescents is rather scarce. Within the Social Phobia Psychotherapy Research Network (SOPHO-NET), we examined the efficacy of cognitive-behavioral (CBT) and psychodynamic therapy (PDT) compared to a waiting list (WL) in these patients. METHODS In a multicenter randomized controlled superiority trial, 107 patients, aged 14-20 years, were randomized to CBT (n = 34), PDT (n = 34), or WL (n = 39). Assessments were made at baseline, at the end of treatment, and 6 and 12 months after termination. The Liebowitz Social Anxiety Scale for Children and Adolescents (LSAS-CA) applied by raters masked to the treatment condition was used as the primary outcome. As secondary outcomes, rates of response and remission and the Social Phobia Anxiety Inventory (SPAI) were used. RESULTS Both treatments were superior to WL in the LSAS-CA (CBT: p = 0.0112, d = 0.61, 95% CI 0.14-1.08; PDT: p = 0.0261, d = 0.53, 95% CI 0.06-1.00). At the end of treatment, response rates were 66, 54, and 20% for CBT, PDT, and WL. The corresponding remission rates were 47, 34, and 6%, respectively. CBT and PDT were significantly superior to WL regarding remission (CBT: p = 0.0009, h = 1.0; PDT: p = 0.0135, h = 0.74), response (CBT: p = 0.0004, h = 0.97; PDT: p = 0.0056, h = 0.72), and the SPAI (CBT: p = 0.0021, d = 0.75, 95% CI 0.27-1.22; PDT: p = 0.0060, d = 0.66, 95% CI 0.19-1.13). Treatment effects were stable at 6- and 12-month follow-ups. CONCLUSIONS These results are comparable to the large SOPHO-NET trial in adults (n = 495). Early treatments for social anxiety are needed in order to prevent chronic manifestation of SAD.
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Affiliation(s)
- Simone Salzer
- Clinic of Psychosomatic Medicine and Psychotherapy, Georg August University Göttingen, Göttingen, Germany.,International Psychoanalytic University (IPU) Berlin, Berlin, Germany
| | - Annette Stefini
- Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | | | - Eric Leibing
- Clinic of Psychosomatic Medicine and Psychotherapy, Georg August University Göttingen, Göttingen, Germany
| | - Falk Leichsenring
- Clinic of Psychosomatics and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany
| | | | - Günter Reich
- Clinic of Psychosomatic Medicine and Psychotherapy, Georg August University Göttingen, Göttingen, Germany
| | - Rita Rosner
- Katholische Universität Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Uwe Ruhl
- Department of Clinical Psychology and Psychotherapy, Georg August University Göttingen, Göttingen, Germany
| | - Yvonne Schopf
- Department of Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany
| | - Christiane Steinert
- Clinic of Psychosomatics and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - Eva Vonderlin
- Department of Psychology, University of Heidelberg, Heidelberg, Germany
| | - Regina Steil
- Department of Clinical Psychology and Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany
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16
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Neudeck P, Brahm CI, Hamm AO. Transdiagnostische expositionsbasierte Behandlung von Angststörungen. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2017. [DOI: 10.1026/1616-3443/a000446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Hintergrund: Neben störungsspezifischen Behandlungskonzepten werden in den letzten Jahren vermehrt transdiagnostische Behandlungsmanuale in der expositionsbasierten Behandlung von Ängsten und komorbiden Störungen eingesetzt. Die vorliegende narrative systematische Übersichtsarbeit beschreibt den Stand der Forschung zu transdiagnostischen Behandlungskonzepten in Hinsicht auf Angst- und komorbide Störungen. Methode: Die Literaturrecherche und die Datenanalyse wurden angelehnt an die PRISMA Guidelines vorgenommen. Die Ergebnisse von 17 Untersuchungen zu expositionsbasierten transdiagnostischen Behandlungskonzepten der letzten fünfzehn Jahre werden beschrieben. Ergebnisse: Die Resultate der referierten Studien zeigen, dass expositionsbasierte transdiagnostische Behandlungen die Symptome, sowohl der primären als auch der komorbiden Störungen, signifikant reduzieren. Expositionsbasierte transdiagnostische Konzepte sind effektiv zur Behandlungen von Angststörungen und komorbider Störungen. Sie stellen eine geeignete Alternative zu störungsspezifischen Behandlungen dar. Diskussion: Die Implikationen transdiagnostischer Konzepte für das praktische Vorgehen bei der individualisierten Diagnostik, der Vorbereitung und Durchführung von Expositionen werden erörtert. Schließlich werden Vorschläge für die Konzeptualisierung einer störungsübergreifenden Behandlung von Angststörungen, insbesondere solcher mit komorbider Symptomatik, vorgestellt.
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Affiliation(s)
| | | | - Alfons O. Hamm
- Institut für Psychologie, Ernst-Moritz-Arndt-Universität Greifswald
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17
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Pittig A, Neudeck P. Exposition. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2017. [DOI: 10.1026/1616-3443/a000448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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Pittig A, Hoyer J. Exposition aus Sicht niedergelassener Verhaltenstherapeutinnen und Verhaltenstherapeuten. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2017. [DOI: 10.1026/1616-3443/a000441] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Expositionsbasierte Interventionen gehören zu den wirksamsten Methoden bei der Behandlung von Angststörungen. Dennoch legen vergangene Studien nahe, dass Exposition in der verhaltenstherapeutischen Routinepraxis nur selten eingesetzt wird. Barrieren, die eine Anwendung verhindern, wurden bisher nicht systematisch erfasst. Fragestellung und Methode: Hauptziel dieser Studie war eine praxis-orientierte Erhebung systemischer Barrieren und Veränderungswünschen bei der Anwendung von Exposition aus Sicht ambulant tätiger Verhaltenstherapeutinnen und -therapeuten. Mittels postalischer Befragung wurden diese Barrieren sowie die Anwendungshäufigkeit von expositionsbasierten Interventionen erfasst (N = 684). Ergebnisse: Gemäß Selbstbericht wurde bei weniger als der Hälfte der Behandlungen von Angststörungen eine Form der Exposition eingesetzt (46.8 %), wobei die Anwendungshäufigkeit stark zwischen den Behandelnden variierte. Exposition wurde hauptsächlich in der eigenen Praxis, durchschnittlich für eine Dauer von einer Stunde und mit einer wöchentlichen bis zweiwöchentlichen Frequenz eingesetzt. Eine häufigere Anwendung war mit jüngerem Alter, weniger Berufsjahren und mehr expositionsspezifischen Aus- und Weiterbildungsstunden assoziiert. Systemische Barrieren bezogen sich besonders auf finanzielle Aspekte und das Aufwand-Vergütungsverhältnis, Unklarheiten bezüglich Versicherungs- und Abrechnungsaspekten, sowie das begrenzte Stundenkontingent. Schlussfolgerung: Exposition bei Angststörungen scheint nicht so häufig und intensiv eingesetzt zu werden, wie in aktuellen evidenzbasierten Leitlinien empfohlen wird. Diverse systemische Barrieren erschweren die Anwendung in der ambulanten Routineversorgung.
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Affiliation(s)
- Andre Pittig
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden
| | - Jürgen Hoyer
- Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden
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19
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Velten J, Margraf J, Benecke C, Berking M, In-Albon T, Tania Lincoln, Lutz W, Schlarb A, Schöttke H, Willutzki U, Jürgen Hoyer. Methodenpapier zur Koordination der Datenerhebung und -auswertung an Hochschul- und Ausbildungsambulanzen für Psychotherapie (KODAP). ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2017. [DOI: 10.1026/1616-3443/a000431] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Zusammenfassung. Die Forschung an psychotherapeutischen Hochschulambulanzen (HSA) leistet einen entscheidenden Beitrag zur Behandlung von Menschen mit psychischen Störungen und zur Weiterentwicklung und wissenschaftlichen Fundierung von Psychotherapie im Kindes-, Jugend- und Erwachsenenalter. Durch das im Jahr 2013 gestartete Projekt zur Koordination der Datenerhebung und -auswertung an Forschungs- und Ausbildungsambulanzen für Psychotherapie (KODAP) sollen unter der Trägerschaft des Verbundes universitärer Ausbildungsgänge für Psychotherapie unith.ev ab 2018 jährlich relevante Daten aus den teilnehmenden HSA aggregiert und gemeinsam ausgewertet werden. Im vorliegenden Beitrag beschreiben wir die mit dem Projekt im Zusammenhang stehenden rechtlichen, methodischen und durchführungstechnischen Herausforderungen sowie den derzeitigen Stand des Kooperationsprojektes, einschließlich einer für das Jahr 2017 geplanten Pilotstudie.
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Affiliation(s)
- Julia Velten
- Ruhr-Universität Bochum, Klinische Psychologie und Psychotherapie
| | - Jürgen Margraf
- Ruhr-Universität Bochum, Klinische Psychologie und Psychotherapie
| | - Cord Benecke
- Universität Kassel, Klinische Psychologie und Psychotherapie
| | - Matthias Berking
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Klinische Psychologie und Psychotherapie
| | - Tina In-Albon
- Universität Koblenz-Landau, Klinische Psychologie und Psychotherapie des Kindes- und Jugendalters
| | - Tania Lincoln
- Universität Hamburg, Klinische Psychologie und Psychotherapie
| | - Wolfgang Lutz
- Universität Trier, Klinische Psychologie und Psychotherapie
| | - Angelika Schlarb
- Universität Bielefeld, Klinische Psychologie und Psychotherapie des Kindes- und Jugendalters
| | | | - Ulrike Willutzki
- Universität Witten / Herdecke, Klinische Psychologie und Psychotherapie
| | - Jürgen Hoyer
- Technische Universität Dresden, Klinische Psychologie und Psychotherapie
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20
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Richter J, Pittig A, Hollandt M, Lueken U. Bridging the Gaps Between Basic Science and Cognitive-Behavioral Treatments for Anxiety Disorders in Routine Care. ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2017. [DOI: 10.1027/2151-2604/a000309] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. As a core component of cognitive-behavioral therapies (CBT), behavioral exposure is an effective treatment for anxiety disorders. Still, recent treatment studies demonstrate relatively high rates of treatment dropout, nonresponse, and relapse, indicating a substantial need for optimizing and personalizing existing treatment procedures. In the present article, we aim to address current challenges and future demands for translational research in CBT for the anxiety disorders, including (a) a better understanding of those mechanisms conferring behavioral change, (b) identifying important sources of individual variation that may act as moderators of treatment response, and (c) targeting practical barriers for dissemination of exposure therapy to routine care. Based on a recursive process model of psychotherapy research we will describe distinct steps to systematically translate basic and clinical research “from bench to bedside” to routine care, but also vice versa. Some of these aspects may stimulate the future roadmap for evidence-based psychotherapy research in order to better target the treatment of anxiety disorders as one core health challenge of our time.
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Affiliation(s)
- Jan Richter
- Department of Physiological and Clinical Psychology/Psychotherapy, University of Greifswald, Germany
| | - Andre Pittig
- Institute of Clinical Psychology and Psychotherapy, Department of Psychology, Technische Universität Dresden, Germany
| | - Maike Hollandt
- Department of Physiological and Clinical Psychology/Psychotherapy, University of Greifswald, Germany
| | - Ulrike Lueken
- Center of Mental Health, Department of Psychiatry, Psychosomatics, and Psychotherapy, University Hospital of Würzburg, Germany
- Department of Psychology, Humboldt University of Berlin, Germany
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