Der „Affective Style Questionnaire (ASQ)”: Deutsche Adaption und Validitäten

Decoding emotions: Exploring the validity of sentiment analysis in psychotherapy

OBJECTIVE

Given the importance of emotions in psychotherapy, valid measures are essential for research and practice. As emotions are expressed at different levels, multimodal measurements are needed for a nuanced assessment. Natural Language Processing (NLP) could augment the measurement of emotions. The study explores the validity of sentiment analysis in psychotherapy transcripts.

METHOD

We used a transformer-based NLP algorithm to analyze sentiments in 85 transcripts from 35 patients. Construct and criterion validity were evaluated using self- and therapist reports and process and outcome measures via correlational, multitrait-multimethod, and multilevel analyses.

RESULTS

The results provide indications in support of the sentiments' validity. For example, sentiments were significantly related to self- and therapist reports of emotions in the same session. Sentiments correlated significantly with in-session processes (e.g., coping experiences), and an increase in positive sentiments throughout therapy predicted better outcomes after treatment termination.

DISCUSSION

Sentiment analysis could serve as a valid approach to assessing the emotional tone of psychotherapy sessions and may contribute to the multimodal measurement of emotions. Future research could combine sentiment analysis with automatic emotion recognition in facial expressions and vocal cues via the Nonverbal Behavior Analyzer (NOVA). Limitations (e.g., exploratory study with numerous tests) and opportunities are discussed.

The influence of the five-factor model of personality on performance in competitive sports: a review

Personality is considered to be a factor affecting athletic performance. However, inconsistency in the research results regarding size and even direction of the relationship. An evaluation of the evidence of the relationship between personality and athletic performance was conducted in order to summarize the evidence available. A systematic literature search was conducted in March 2023. Sport performance and the Big Five personality model were identified in our research. We used PubMed, Web of Science, Embase, Cochrane Library, Wang Fang (Chinese), Wei Pu (Chinese), and CNKI (Chinese) databases for the systematic literature search (Prospero registration number: CRD42022364000), screened 4,300 studies, and found 23 cross-sectional studies eligible for inclusion in this review. The results of this systematic analysis show that, besides neuroticism, openness, conscientiousness, extraversion, and agreeableness are all positively correlated with sports performance. Conscientiousness and extraversion are the two main personalities in team sports. Openness and agreeableness show different results in different sports, and it is not clear to which project they are beneficial. The value of personality as a possible predictor of athletic performance is generally positive. Therefore, professionals such as applied sports psychologists, coaching personnel, athletes, and sports administrators must comprehensively grasp the significance of personality's role in achieving success in major competitions. Considering these facts, sports practitioners should promote personality screening and personality development programs.

The Affect Intolerance Scale (AIS), German version: A validation study in a student and clinical sample of patients with trauma-related disorders

BACKGROUND AND OBJECTIVES

The Affect Intolerance Scale (AIS) assesses two core concepts of emotion regulation: appraisals of negative emotions as threatening and proneness to emotional avoidance. Maladaptive emotion regulation is associated with various psychopathologies. We translated and validated the AIS in a German student and clinical sample of patients with trauma-related disorders.

METHODS

340 patients, 161 with post-traumatic stress disorder and 179 with adjustment disorder, and 322 students were enrolled. We employed exploratory and confirmatory factor analyses in a cross-validation design to investigate construct validity, convergent and discriminant validity, and reliability.

RESULTS

We replicated the originally described two-factor structure in both samples. Cronbach's α was 0.947 in the student and 0.950 in the clinical sample. AIS subscales showed moderate to high correlations with convergent and low correlations with discriminant measures. AIS total scores were significantly larger in the clinical sample, controlled for gender and age.

LIMITATIONS

This study provides a unified cross-validation model in a clinical and a student sample at the cost of reduced sample sizes.

CONCLUSIONS

The AIS is a valid measure of affect intolerance with the discriminative ability to distinguish between patients with trauma-related disorders and students. Test redundancy within both sub-constructs of the AIS might lead to biased estimates but allows for increased test precision, rendering the AIS a tool suitable for individual treatment monitoring.

Personality Traits and Emotion Regulation Styles of Elite Beach Volleyball Dyads: Examination of Intra-Team Differences, Performance and Satisfaction Levels

The current study was designed to assess the personality traits and emotion regulation styles of elite beach volleyball players. Intra-team differences were examined with three primary objectives: (i) to create a personality profile of elite beach volleyball players, (ii) to examine the relationship of this profile in relation to performance and satisfaction levels, and (iii) to highlight the similarities in personalities of members of successful teams. A total of 82 elite beach volleyball players were asked to fill out the Big Five Inventory, the Personality Adjective Scale, and the Affective Style Questionnaire. In addition to these, the overall satisfaction and performance level of these athletes were measured. Results indicated a higher manifestation of warmth, liveliness, emotional stability and reasoning, along with lower levels of neuroticism in successful athletes. The players used a variety of emotional regulation styles and reported being moderately to highly satisfied with their team. A repeated-measures MANCOVA revealed no significant differences in personality traits between the team members. This study generates valuable insights into the personality of elite beach volleyball players and can be useful for coaches, sport psychologists, and academics for practical application and further scientific research.

Working Towards the Development and Implementation of Precision Mental Healthcare: An Example

Leonard Bickman’s (2020) Festschrift paper in the special issue “The Future of Children’s Mental Health Services” on improving mental health services is an impressive reflection of his career, highlighting his major insights and the development of mental health services research as a whole. Five major difficulties in this field’s current research and practice are attentively delineated: poor diagnostics, measurement problems, disadvantages of randomized controlled trials (RCTs), lack of feedback and personalized treatments. Dr. Bickman recommends possible solutions based on his extensive experience and empirical findings. We agree with his thoughts and illustrate how we, challenged with the same problems, have attempted to develop clinically informed research and evidence-based clinical practice. A comprehensive feedback system that deals with the aforementioned problems is briefly described. It includes pre-treatment recommendations for treatment strategies and an empirically informed dropout prediction based on a variety of data sources. In addition to treatment recommendations, continuous feedback as well as individualized treatment adaptation tools are provided during ongoing therapy. New projects are being implemented to further improve the system by including new data assessment strategies and sources, e.g., ecological momentary assessment (EMA) and automated video analysis.

For whom should psychotherapy focus on problem coping? A machine learning algorithm for treatment personalization

OBJECTIVE

We aimed to develop and test an algorithm for individual patient predictions of problem coping experiences (PCE) (i.e., patients' understanding and ability to deal with their problems) effects in cognitive-behavioral therapy. Method: In an outpatient sample with a variety of diagnoses (n=1010), we conducted Dynamic Structural Equation Modelling to estimate within-patient cross-lagged PCE effects on outcome during the first ten sessions. In a randomly selected training sample (2/3 of the cases), we tried different machine learning algorithms (i.e., ridge regression, LASSO, elastic net, and random forest) to predict PCE effects (i.e., the degree to which PCE was a time-lagged predictor of symptoms), using baseline demographic, diagnostic, and clinically-relevant patient features. Then, we validated the best algorithm on a test sample (1/3 of the cases).

RESULTS

The random forest algorithm performed best, explaining 14.7% of PCE effects variance in the training set. The results remained stable in the test set, explaining 15.4% of PCE effects variance.

CONCLUSIONS

The results show the suitability to perform individual predictions of process effects, based on patients' initial information. If the results are replicated, the algorithm might have the potential to be implemented in clinical practice by integrating it into monitoring and therapist feedback systems.

Why do patients go off track? Examining potential influencing factors for being at risk of psychotherapy treatment failure

BACKGROUND

Routine outcome monitoring can support clinicians to detect patients who deteriorate [not-on-track (NOT)] early in psychotherapy. Implemented Clinical Support Tools can direct clinicians' attention towards potential obstacles to a positive treatment outcome and provide suggestions for suitable interventions. However, few studies have compared NOT patients to patients showing expected progress [on-track (OT)] regarding such obstacles. This study aimed to identify domains that have predictive value for NOT trajectories and to compare OT and NOT patients regarding these domains and the items of the underlying scales.

METHODS

During treatment, 413 outpatients filled in the Hopkins-Symptom-Checklist-11 (depressive and anxious symptom distress) before every therapy session as a routine outcome measure. Further, the Assessment for Signal Clients, Affective Style Questionnaire, and Outcome Questionnaire-30 were applied every fifth session. These questionnaires measure the following domains, which were investigated as potential obstacles to treatment success: risk/suicidality, therapeutic alliance, motivation, social support and life events, as well as emotion regulation. Two groups (OT and NOT patients) were formed by defining a cut-off (failure boundary) as the 90% confidence interval (upper bound) of the respective patients' expected recovery curves. In order to differentiate group membership based on the respective problem areas, multilevel logistic regression analyses were performed. Further, OT and NOT patients were compared with regard to the domains' and items' cut-offs by performing Pearson chi-square tests and independent samples t-tests.

RESULTS

The life events and motivation scale as well as the risk/suicidality scale proved to be significant predictors of being not-on-track. NOT patients also crossed the cut-off significantly more often on the domains risk/suicidality, social support, and life events. For both OT and NOT patients, the emotion regulation domain's cut-off was most commonly exceeded.

CONCLUSION

Life events, motivation, and risk/suicidality seem to be directly linked to treatment failure and should be further investigated for the use in clinical support tools.

Factor structure and validity of the Affective Style Questionnaire

Previous studies in different countries have shown variability in the factor structures of the Affective Style Questionnaire, possibly due to differences in cultures, translation, or statistical approaches. We ran exploratory factor analysis with oblique rotation using data from 2806 university students in Southern California. A four-factor structure was found instead of the three-factor structure found in the original Affective Style Questionnaire studies in the Northeastern United States. Support for concurrent and convergent validity was found for the Concealing and Adjusting factors. The Tolerating and Holding factors comprised two items each, making it difficult to recommend them in future studies.

SREIS-D

Zusammenfassung. Emotionale Intelligenz (EI) ist ein zentraler Prädiktor psychischer Gesundheit. Im deutschsprachigen Raum lag bislang keine am Vier-Facetten-Modell der EI orientierte Selbstbeschreibungsskala vor, die an klinischen und nicht-klinischen Gruppen getestet wurde. Die Self-Rated Emotional Intelligence Scale (SREIS) ist mit 19 Items ein ökonomisch einsetzbares Instrument. Die Skala wurde ins Deutsche übertragen und psychometrisch überprüft. Außerdem wurde die SREIS erstmals an einer klinischen Population getestet. Auch werden erstmals differenzierte Ergebnisse zu den vier EI-Facetten vorgelegt. Die Ergebnisse bestätigen die Faktorenstruktur der englischen Originalskala. Die Reliabilität der Gesamtskala ist als gut einzustufen. Validität wird durch erwartungskonforme Korrelationen mit anderen EI-Maßen sowie klinischen Parametern belegt. Durch Diskriminationsfähigkeit zwischen klinischer Stichprobe und nicht-klinischer Kontrollgruppe zeigt die Skala zusätzlich klinische Relevanz. Skalare Messinvarianz zwischen beiden Gruppen liegt vor. Die SREIS-D ist ein ökonomisch einsetzbares Selbstberichtsmaß zur Erfassung von Facetten der EI im klinischen und subklinischen Bereich.

Acceptance-Based Emotion Regulation Reduces Subjective and Physiological Pain Responses

Acceptance-based regulation of pain, which focuses on the allowing of pain and pain related thoughts and emotions, was found to modulate pain. However, results so far are inconsistent regarding different pain modalities and indices. Moreover, studies so far often lack a suitable control condition, focus on behavioral pain measures rather than physiological correlates, and often use between-subject designs, which potentially impede the evaluation of the effectiveness of the strategies. Therefore, we investigated whether acceptance-based strategies can reduce subjective and physiological markers of acute pain in comparison to a control condition in a within-subject design. To this end, participants (N = 30) completed 24 trials comprising 10 s of heat pain stimulation. Each trial started with a cue instructing participants to welcome and experience pain (acceptance trials) or to react to the pain as it is without employing any regulation strategies (control trials). In addition to pain intensity and unpleasantness ratings, heart rate (HR) and skin conductance (SC) were recorded. Results showed significantly decreased pain intensity and unpleasantness ratings for acceptance compared to control trials. Additionally, HR was significantly lower during acceptance compared to control trials, whereas SC revealed no significant differences. These results demonstrate the effectiveness of acceptance-based strategies in reducing subjective and physiological pain responses relative to a control condition, even after short training. Therefore, the systematic investigation of acceptance in different pain modalities in healthy and chronic pain patients is warranted.

Sex-Specific Relationships Between Interoceptive Accuracy and Emotion Regulation

Over the last years, there has been a resurge in the interest to study the relationship between interoception and emotion. By now, it is well established that interoception contributes to the experience of emotions. However, it may also be possible that interoception contributes to the regulation of emotions. To test this possibility, we studied the relationship between interoception and emotion regulation in a sample of healthy individuals (n = 84). We used a similar heartbeat detection task and a similar self-report questionnaire for the assessment of interoceptive accuracy and emotion regulation as in previous studies. In contrast to previous studies, we differentiated between male and female individuals in our analyses and controlled our analyses for individual characteristics that may affect the relationship between interoceptive accuracy and emotion regulation. We found sex-differences in interoceptive accuracy and emotion regulation that amounted to a sex-specific relationship between interoceptive accuracy and emotion regulation: Whereas interoceptive accuracy was related to reappraisal but not to suppression in male individuals, interoceptive accuracy was unrelated to reappraisal and suppression in female individuals. These findings indicate that the relationship between interoception and emotion regulation is far more complex than has been suggested by previous findings. However, these findings nonetheless support the view that interoception is essential for both, the regulation and experience of emotions.

Affective Styles in Panic Disorder and Specific Phobia: Changes Through Cognitive Behavior Therapy and Prediction of Remission

Affective styles appear to be relevant to the development of psychopathology, especially anxiety disorders. The aim of the current study was to investigate changes in affective styles in patients with panic disorder and specific phobia, as a result of undergoing cognitive-behavioral therapy, and to identify a possible link between certain affective styles and remission. The sample consisted of outpatients (N = 101) suffering from panic disorder, specific phobia, or agoraphobia who completed the Affective Style Questionnaire (ASQ) before and after therapy, as well as at a 6-month follow-up assessment. Multivariate analyses of variance were conducted to test for changes due to therapy. Logistic regression analyses were calculated to test for the impact of affective styles on remission from anxiety disorders, and hierarchical regression analyses were calculated to examine the association between changes in affective styles and symptom reduction. Results indicated significant increases on the ASQ subscales adjusting and tolerating after therapy. Concealing did not decrease significantly after therapy. In addition, higher scores on adjusting significantly predicted remission from anxiety disorders. Finally, we found a significant association between increases on the adjusting scale and the reduction of anxiety symptoms.

Metta-based group meditation and individual cognitive behavioral therapy (MeCBT) for chronic depression: study protocol for a randomized controlled trial

BACKGROUND

Depression is a widespread disorder with severe impacts for individuals and society, especially in its chronic form. Current treatment approaches for persistent depression have focused primarily on reducing negative affect and have paid little attention to promoting positive affect. Previous studies have shown that metta meditation increases positive affect in chronically depressed patients. Results from previous trials provide evidence for the efficacy of a stand-alone metta meditation group treatment in combination with mindfulness-based approaches. Further research is needed to better understand the implementation of meditation practice into everyday life. Therefore, mindfulness and metta meditation in a group setting are combined with individual cognitive behavioral therapy (CBT) into a new, low-intensity, cost-effective treatment ("MeCBT") for chronic depression.

METHODS/DESIGN

In this single-center, randomized, observer-blinded, parallel-group clinical trial we will test the efficacy of MeCBT in reducing depression compared to a wait-list control condition. Forty-eight participants in a balanced design will be allocated randomly to a treatment group or a wait-list control group. Metta-based group meditation will be offered in eight weekly sessions and one additional half-day retreat. Subsequent individual CBT will be conducted in eight fortnightly sessions. Outcome measures will be assessed at four time points: before intervention (T0); after group meditation (T1); after individual CBT (T2); and, in the treated group only, at 6-month follow-up (T3). Changes in depressive symptoms (clinician rating), assessed with the Quick Inventory of Depressive Symptoms (QIDS-C) are the primary outcome. We expect a significant decline of depressive symptoms at T2 compared to the wait-list control group. Secondary outcome measures include self-rated depression, mindfulness, benevolence, rumination, emotion regulation, social connectedness, social functioning, as well as behavioral and cognitive avoidance. We will explore changes at T1 and T2 in all these secondary outcome variables.

DISCUSSION

To our knowledge this is the first study to combine a group program focusing on Metta meditation with state-of-the art individual CBT specifically tailored to chronic depression. Implications for further refinement and examination of the treatment program are discussed.

TRIAL REGISTRATION

ISRCTN, ISRCTN97264476. Registered 29 March 2018 (applied on 14 December 2017)-retrospectively registered.

Psychometrische Eigenschaften der deutschsprachigen Version des Interpersonal Emotion Regulation Questionnaire

Zusammenfassung. Prozessen der Emotionsregulation wird in den letzten Jahren im Rahmen psychologischer Forschung große Bedeutung beigemessen. Während im Kontext dieser Forschung mehrere Fragebogen zur Erhebung von intrapersonellen Emotionsregulationsprozessen entwickelt und validiert wurden, gibt es nur wenige Messinstrumente zur Erfassung von Emotionsregulation in interpersonellen Kontexten. In der vorliegenden Studie wurde deshalb eine deutschsprachige Version des Interpersonal Emotion Regulation Questionnaire (IERQ) von Hofmann, Carpenter und Curtiss (2016) entwickelt und in 2 Stichproben mit N = 206 und N = 729 Probanden im Hinblick auf ihre psychometrischen Eigenschaften untersucht. Faktorenanalytisch konnte die dimensionale Struktur des englischsprachigen IERQ mit 4 Faktoren bestätigt werden. Cronbachs α-Werte lagen für die 4 ermittelten Skalen zwischen .81 und .91, für die Retest-Reliabilitäten ergaben sich Werte zwischen .72 und .74. Hinsichtlich der Validität zeigten sich sehr ähnliche Zusammenhänge zu Maßen der intrapersonellen Emotionsregulation, wie sie mit der Originalversion ermittelt wurden. In Bezug zu anderen Konstrukten wie z. B. Depressivität wichen die hier erhobenen Korrelationen von der englischsprachigen Version ab. Weitere Analysen zur konvergenten und diskriminanten Validität bestätigten jedoch die Güte des Instrumentes, sodass bei der deutschen Version des IERQ von einem reliablen und validen Instrument zur Erfassung Interpersoneller Emotionsregulation auszugehen ist.

Akzeptanz- und Commiment-Therapie mit therapieresistenten Störungen im stationären Setting

Zusammenfassung. Hintergrund: Stationäre psychotherapeutische Behandlungen haben eine große Bedeutung im Versorgungsalltag. Ihre Bewährung bei schwergradigen und komorbiden Störungsbildern ist jedoch nur lückenhaft untersucht. Dies gilt besonders für die zunehmend angewendete Akzeptanz- und Commitment-Therapie (ACT). Fragestellung: In erster Linie soll die Wirksamkeit einer stationären störungsübergreifenden ACT-basierten Behandlung in erwähnten Stichproben untersucht werden. Ergänzend wird der zeitliche Verlauf der psychischen Flexibilität (PF), dem Kernkonzept der ACT, explorativ untersucht. Methode: Eine konsekutive Stichprobe von 47 Patientinnen und Patienten mit heterogenen und komorbiden Störungsbildern in stationärer Psychotherapie wurde im Rahmen einer explorativen Beobachtungsstudie mittels wöchentlicher Verlaufsmessungen sowie umfassender Prä-Post-Vergleiche untersucht. Ergebnisse: Die Effektstärken hinsichtlich allgemeiner Symptomreduktion, der Zunahme psychischer Flexibilität sowie weiterer ACT-spezifischer Fertigkeiten sind moderat bis hoch. Die Verlaufsmessungen weisen auf lineare Verbesserungen sowie hohe Übereinstimmungen zwischen Selbst- und Fremdrating hin. Schlussfolgerungen: Die Ergebnisse zeigen positive Effekte der ACT im stationären Setting bei einer diagnostisch heterogenen Stichprobe mit einem hohen Anteil komorbider Störungen.

Deficits in emotion regulation strategies among problematic and pathological gamblers in a sample of vocational school students

BACKGROUND AND AIMS

Deficits in emotion regulation (ER) are associated with mental disorders. To date, there are hardly any studies focusing on the role of ER strategies in the context of gambling behavior. The aim of this study was to investigate the association between specific ER strategies and pathological as well as problematic gambling in a proactively recruited sample.

METHODS

A large and unselected sample (n = 4,928) has been screened proactively and systematically in vocational schools. We assessed the Affective Style Questionnaire to measure ER strategies and the Stinchfield questionnaire for assessing problematic and pathological gambling. Associations were investigated with linear and multinomial logistic regression analyses.

RESULTS

The analyses showed a significant negative correlation between the subscales "Adjusting" and "Tolerating" and the Stinchfield sum score. Lower scores on these subscales were associated with a higher number of endorsed Stinchfield items. A lower score on the ER strategies "Adjusting" [conditional odds ratio (COR) = 0.95, confidence interval (CI) = 0.91-0.99] and "Tolerating" [COR = 0.95, CI = 0.92-99] led to a higher chance of being classified as a pathological gambler. In problematic gambling, on a subthreshold level, only "Tolerating" turned out to be significant [COR = 0.96, CI = 0.93-0.99].

DISCUSSION AND CONCLUSIONS

For the first time, deficits in specific ER strategies were identified as independent risk factors for problematic and pathological gambling in a large and proactively recruited sample. ER skills, especially acceptance-focused strategies, should be considered in prevention and psychotherapy.

Sex-Specific Associations Between Inter-Individual Differences in Heart Rate Variability and Inter-Individual Differences in Emotion Regulation

Neurobiological theories suggest that inter-individual differences in vagally mediated heart rate variability (vmHRV) have the potential to serve as a biomarker for inter-individual differences in emotion regulation that are due to inter-individual differences regarding the engagement of prefrontal and (para-)limbic brain regions during emotion processing. To test these theories, we investigated whether inter-individual differences in vmHRV would be associated with inter-individual differences in emotion regulation. We determined resting state vmHRV in a sample of 176 individuals that had also completed a short self-report measure of reappraisal and suppression use. Resting state vmHRV was derived from short-term (300 s) and ultra-short-term (120 s, 60 s) recordings of participants’ heart rate to determine the robustness of possible findings. Irrespective of recording length, we found that an increase in resting state vmHRV was associated with an increase in self-reported reappraisal but not suppression use. However, this association was only evident among male but not female participants, indicating a sex-specific association between inter-individual differences in resting state vmHRV and inter-individual differences in self-reported emotion regulation. These findings, which are consistent with previous ones, support theoretical claims that inter-individual differences in vmHRV serve as a biomarker for inter-individual differences in emotion regulation. Combing (ultra-)short-term measures of resting state vmHRV with short self-report measures of emotion regulation may, thus, be useful for researchers who have to investigate the neurobiological mechanisms of emotion regulation in a time- and resource-efficient manner.

Erfassung der Emotionsregulation bei Jugendlichen anhand des „Affective Style Questionnaire – Youth (ASQ-Y)“

Zusammenfassung. Zur Erfassung der 3 Emotionsregulationsstrategien Unterdrücken, Anpassen / Neubewerten und Akzeptieren wurde der Affective Style Questionnaire für Jugendliche (ASQ-Y) adaptiert und an einer entsprechenden Stichprobe (N = 1 092) validiert. Die Dimensionalität des englischen Originalfragebogens und der deutschen Version für Erwachsene konnte auch für Jugendliche bestätigt werden. Während der Analyse kam das ESEM-Verfahren (Exploratory Structural Equation Modeling) zum Einsatz, die Kennwerte bewegten sich im akzeptablen bis sehr guten Bereich. Der Comparative Fit Index (CFI) erreichte einen akzeptablen Wert von .938, ebenso der Tucker–Lewis Index (TLI) mit einem Wert von .911. Der Root Mean Square Error of Approximation (RMSEA) lag bei einem sehr guten Wert von .050, das Standardized Root Mean Square Residual (SRMR) erreichte einen guten Wert von .030. Die internen Konsistenzen der 3 Skalen (Unterdrücken: α = .77; Anpassen / Neubewerten: α = .76; Akzeptieren: α = .76) erreichten (vergleichbar mit dem englischen Original und der deutschen Erwachsenenstichprobe) zufriedenstellende Werte. Die Subskalen zeigten hypothesenkonforme diskriminante und konvergente Zusammenhänge mit etablierten Verfahren des Forschungsbereichs Emotionsregulation, was für die Konstruktvalidität spricht. Insgesamt ist der ASQ-Y als Messinstrument zur Erfassung von verschiedenen Emotionsregulationsstrategien bei Jugendlichen geeignet und ökonomisch in seiner Anwendung. Der ASQ-Y kann in der Allgemeinbevölkerung und in der Prävention eingesetzt werden. Nach entsprechender Validierung ist der Einsatz auch im klinischen Setting möglich.

Affective styles in mood and anxiety disorders - Clinical validation of the "Affective Style Questionnaire" (ASQ)

BACKGROUND

Emotion regulation plays a critical role in the development and maintenance of psychological disorders. Less is known about the association of affective styles and psychopathology. The 20-item "Affective Style Questionnaire" (ASQ) has been validated in nonclinical samples. The American and German validation studies resulted in a three-factor structure (concealing, adjusting, and tolerating). The present study aimed to investigate three aspects: (1) the validation of the ASQ within a clinical sample, (2) the examination of possible differences in affective styles between patients suffering from affective versus anxiety disorders, and (3) the association of affective styles and anxiety, depression, and stress symptoms.

METHODS

Overall 917 patients receiving cognitive-behavioral therapy at an outpatient clinic participated in this study, 550 participants were female. All data were collected before the beginning of treatment.

RESULTS

Confirmatory factor analyses revealed the same three-factor structure found in the previous Western samples (CFI = 0.90, RMSEA = 0.06): Concealing (α = 0.81), adjusting (α = 0.71), and tolerating (α = 0.70). Significantly lower scores in the ASQ subscale adjusting were found in patients suffering from affective disorders than patients suffering from anxiety disorders. The results of the regression analyses showed that the ASQ adjusting and concealing behavior seem to play a more important role than the ERQ reappraisal and suppression for depression, anxiety, and stress among clinical populations.

LIMITATIONS

A number of limitations must be taken into consideration while evaluating the present study. First and foremost, the clinical data were based on primary diagnoses. We did not ascertain comorbid diagnoses. This distinction may be important, since affective and anxiety disorders are often linked to each other. In addition, we only used data collected before the beginning of psychotherapeutic treatment and were therefore not able to analyze changes in affective styles during and after intervention. Furthermore, all data were based on self-reported information of patients. We did not implement either a therapeutic rating of affective styles or physiological measures, for instance arousal, which could have shown whether the used strategies successfully reduce negative emotions. Future research should address this question. Another limitation is the fact that we concentrated on the main categories of mental disorders and, therefore, did not subdivide patients with affective and anxiety disorders in terms of their concrete diagnoses. This is of special importance, because there might also be differences in affective styles within the main categories.

Loving Kindness Meditation zur Behandlung der chronischen Depression

Zusammenfassung. Theoretischer Hintergrund: Chronische Depressionen gehen mit einer langwierigen Belastung einher und verursachen hohe Krankheitskosten. Ein möglicher Ansatz zur Behandlung könnte die Loving Kindness Meditation (LKM) sein. Methode: In dieser Pilot-Studie wurde ein LKM-Gruppenprogramm eingesetzt und bezüglich der Effektivität untersucht. N = 2207 Fälle aus Wartelistendaten wurden stufenweise zu der LKM-Gruppe (n = 12) zugeordnet. Zwei Kontrollgruppen (n = 134 und n = 12) wurden gebildet, indem zunächst die Ein-und Ausschlusskriterien angewandt wurden und dann die verbliebene Stichprobe basierend auf der Kovariatenverteilung mittels Propensity Score Matching (PSM) angepasst wurde. Die Gruppen wurden anhand des OQ-30 verglichen. Ergebnisse: Im Prä-Post-Vergleich zeigten sich im OQ-30 signifikante Verbesserungen. Allerdings zeigte sich das so nicht in den symptomspezifischen Instrumenten (BDI-II und HAM-D). Im Vergleich zu der gesamten Wartelistenstichprobe (n = 134) ergaben sich signifikante Verbesserungen im OQ-30. Verglichen mit der PSM-Wartelistenkontrollgruppe zeigten sich marginal signifikante Unterschiede im OQ-30, signifikante Unterschiede konnten bezüglich der Depressionsitems des OQ-30 nachgewiesen werden. In der Interventionsgruppe ergaben sich mehr reliable Verbesserungen im OQ-30 als in den Wartelistenkontrollgruppen. Schlussfolgerung: Die Pilotstudie zeigte eine geringere Abbruchquote als Vorgängerpilotstudien und eine gute Prä-Post Effektstärke im OQ-30, sowie im Vergleich zu den beiden Wartelistekontrollgruppen. Allerdings zeigten sich keine konsistenten Prä-Post Effekte in den Depressionsskalen. Eine weitere umfangreichere Studie mit aktiver Kontrollgruppe wäre nötig, um das Programm hinsichtlich seiner Effektivität, bezüglich des Abbruchs sowie der Heterogenität der Effekte in den Depressionsskalen weiter untersuchen zu können.

Randomized controlled trial to evaluate the effects of personalized prediction and adaptation tools on treatment outcome in outpatient psychotherapy: study protocol

BACKGROUND

Psychotherapy is successful for the majority of patients, but not for every patient. Hence, further knowledge is needed on how treatments should be adapted for those who do not profit or deteriorate. In the last years prediction tools as well as feedback interventions were part of a trend to more personalized approaches in psychotherapy. Research on psychometric prediction and feedback into ongoing treatment has the potential to enhance treatment outcomes, especially for patients with an increased risk of treatment failure or drop-out.

METHODS/DESIGN

The research project investigates in a randomized controlled trial the effectiveness as well as moderating and mediating factors of psychometric feedback to therapists. In the intended study a total of 423 patients, who applied for a cognitive-behavioral therapy at the psychotherapy clinic of the University Trier and suffer from a depressive and/or an anxiety disorder (SCID interviews), will be included. The patients will be randomly assigned either to one therapist as well as to one of two intervention groups (CG, IG2). An additional intervention group (IG1) will be generated from an existing archival data set via propensity score matching. Patients of the control group (CG; n = 85) will be monitored concerning psychological impairment but therapists will not be provided with any feedback about the patients assessments. In both intervention groups (IG1: n = 169; IG2: n = 169) the therapists are provided with feedback about the patients self-evaluation in a computerized feedback portal. Therapists of the IG2 will additionally be provided with clinical support tools, which will be developed in this project, on the basis of existing systems. Therapists will also be provided with a personalized treatment recommendation based on similar patients (Nearest Neighbors) at the beginning of treatment. Besides the general effectiveness of feedback and the clinical support tools for negatively developing patients, further mediating and moderating variables on this feedback effect should be examined: treatment length, frequency of feedback use, therapist effects, therapist's experience, attitude towards feedback as well as congruence of therapist's and patient's evaluation concerning the progress. Additional procedures will be implemented to assess treatment adherence as well as the reliability of diagnosis and to include it into the analyses.

DISCUSSION

The current trial tests a comprehensive feedback system which combines precision mental health predictions with routine outcome monitoring and feedback tools in routine outpatient psychotherapy. It also adds to previous feedback research a stricter design by investigating another repeated measurement CG as well as a stricter control of treatment integrity. It also includes a structured clinical interview (SCID) and controls for comorbidity (within depression and anxiety). This study also investigates moderators (attitudes towards, use of the feedback system, diagnoses) and mediators (therapists' awareness of negative change and treatment length) in one study.

TRIAL REGISTRATION

Current Controlled Trials NCT03107845 . Registered 30 March 2017.

Factor Structure of the Affective Style Questionnaire in Flemish Adolescents

Emotion regulation plays an important role in both healthy and problematic adolescent psychological functioning. Emotion regulation tendencies can be assessed with the Affective Style Questionnaire (ASQ; Hofmann & Kashdan, 2010), but its validity in Dutch speaking adolescents has not been investigated so far. Two methods, namely traditional confirmatory factor analysis (CFA) and the recently developed exploratory structural equations modeling (ESEM), were compared to examine the dimensional structure of the ASQ in a Flemish adolescent sample (N = 1,601). Although, as expected, the ESEM-model fit the data better than the CFA-model, the fit indices indicated that both models did not have an acceptable fit. With a shortened version of the ASQ, model fit improved substantially, but only the ESEM solution provided a good fit. The ESEM results support the use of the adapted ASQ to effectively assess the affective styles of concealing, adjusting and tolerating in Dutch-speaking adolescents.

Effects of a 12-Week Mindfulness, Compassion, and Loving Kindness Program on Chronic Depression: A Pilot Within-Subjects Wait-List Controlled Trial

In this pilot study,N= 11 patients suffering from chronic depression were treated in a 12-week group program consisting of basic mindfulness exercises from Mindfulness-Based Cognitive Therapy and compassion exercises from Compassion Focused Therapy and Loving Kindness Meditation. In a 3-month waiting period prior to treatment, depression symptoms both in self-report and clinician rating did not change significantly. After treatment, depression severity was significantly reduced. After a 3-month follow-up, the symptoms further improved, with almost large effect sizes being observed in primary outcome measures.

Changes in emotion regulation styles reflected by a significant increase in acceptance and significant decrease in suppression of emotions were observed at follow-up. Rumination about oneself was also significantly reduced at follow-up. Compassionate love and mindfulness were increased at follow-up, no effects were found on the Self-Compassion Scale and the Rosenberg Self-Esteem Scale. Given further confirming studies for this approach, it might improve treatment options for patients suffering from chronic depression.

Loving-Kindness Meditation to Target Affect in Mood Disorders: A Proof-of-Concept Study

Conventional treatments for mood disorders primarily focus on reducing negative affect, but little on enhancing positive affect. Loving-kindness meditation (LKM) is a traditional meditation practice directly oriented toward enhancing unconditional and positive emotional states of kindness towards oneself and others. We report here two independent and uncontrolled studies carried out at different centers, one in Boston, USA (n = 10), and one in Frankfurt, Germany (n = 8), to examine the potential therapeutic utility of a brief LKM group intervention for symptoms of dysthymia and depression. Results at both centers suggest that LKM was associated with large-sized effects on self-reported symptoms of depression (d = 3.33 and 1.90), negative affect (d = 1.98 and 0.92), and positive affect (d = 1.63 and 0.94). Large effects were also found for clinician-reported changes in depression, rumination and specific positive emotions, and moderate effects for changes in adaptive emotion regulation strategies. The qualitative data analyses provide additional support for the potential clinical utility of the intervention. This proof-of-concept evaluation of LKM as a clinical strategy warrants further investigation.

Developmentally adapted cognitive processing therapy for adolescents and young adults with PTSD symptoms after physical and sexual abuse: study protocol for a randomized controlled trial

BACKGROUND

Although childhood sexual and/or physical abuse (CSA/CPA) is known to have severe psychopathological consequences, there is little evidence on psychotherapeutic interventions for adolescents and young adults suffering from post-traumatic stress disorder (PTSD). Equally sparse are data on moderators of treatment response on PTSD-related epigenetic changes, health care costs and loss of productivity, alterations in cognitive processing, and on how successful interventions affect all of these factors. Early treatment may prevent later (co)morbidity. In this paper, we present a study protocol for the evaluation of a newly developed psychotherapeutic manual for PTSD after CSA/CPA in adolescents and young adults - the Developmentally Adapted Cognitive Processing Therapy (D-CPT).

METHODS/DESIGN

In a multicenter randomized controlled trial (RCT) D-CPT is compared to treatment as usual (TAU). A sample of 90 adolescent outpatients aged 14 to 21 years will be randomized to one of these conditions. Four assessments will be carried out at baseline, at end of treatment, and 3 and 6 months after end of therapy. Each time, patients will be assessed via clinical interviews and a wide range of questionnaires. In addition to PTSD symptoms and comorbidities, we will evaluate moderators of treatment response, epigenetic profiles, direct and indirect costs of this disorder, and neurophysiological processing of threat cues in PTSD and their respective changes in the course of these two treatments (D-CPT and TAU).

DISCUSSION

The study will provide new insights in the understudied field of PTSD in adolescents and young adults. A newly developed intervention will be evaluated in this therapeutically underserved population. Results will provide data on treatment efficacy, direct and indirect treatment costs, as well as on associations of treatment outcome and PTSD intensity both to epigenetic profiles and to the neurobiological processing of threat cues. Besides, they will help to learn more about the psychopathology and possible new objective correlates of PTSD.

TRIAL REGISTRATION

Germanctr.de identifier: DRKS00004787.

Erfassung von Emotionsregulationsstrategien–eine Übersicht

Die vorliegende Übersicht stellt Verfahren zur Erfassung von Emotionsregulationsstrategien im Kindes-, Jugend- und Erwachsenenalter zusammen. Selbst- und Fremdbeurteilungsverfahren im Kindes- und Jugendalter sowie Fragebögen des Erwachsenenalters, für die eine validierte deutschsprachige Übersetzung vorliegt, werden betrachtet und hinsichtlich qualitativer Standards und psychometrischer Gütekriterien diskutiert. Es folgt die Darstellung der Methoden des Ecological Momentary Assessment, die es ermöglichen, emotionsregulierende Prozesse in der natürlichen Umwelt zu erfassen und Kontextfaktoren zu berücksichtigen. Der Beitrag schließt mit der Empfehlung, Emotionsregulationsstrategien multimethodal zu erfassen.