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Donath C, Atzmüller L, Florack J, Engel C, Luttenberger K. [The Effect of Exercise Therapy on Adolescent Mental Health: A Systematic Review with Practical Example]. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2023; 52:94-108. [PMID: 38063057 DOI: 10.1024/1422-4917/a000960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
The Effect of Exercise Therapy on Adolescent Mental Health: A Systematic Review with Practical Example Abstract: The mental health of children and adolescents in Germany is currently highly burdened. Because of the psychotherapeutic care situation, easily accessible, less stigmatizing, and efficient offers are urgently needed. Exercise therapy would be one possibility. However, the effectiveness of such offers must first be proven. We conducted a systematic review concerning the effectiveness of exercise therapy on the mental health of children and adolescents which included studies since 2020 (subsequent to Hale et al., 2021). We analyzed a total of 17 intervention studies based on the PRISMA statement. The results show that exercise therapy interventions significantly affect certain populations: Attention and cognitive skills significantly improved in children and adolescents with ADHD; for depression, we found positive effects for affection. Some studies revealed significant effects across populations on the quality of life and sleep. In children and adolescents with autism or learning disabilities, we found positive effects on social behavior. Thus, according to the literature, exercise therapy is a recommendable therapy option for children and adolescents with mental health problems. As an illustration, we present a boulder intervention as a combined exercise intervention and psychotherapy along with its feasibility as a possible practical example.
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Affiliation(s)
- Carolin Donath
- Universitätsklinikum Erlangen, Klinik für Psychiatrie und Psychotherapie, Zentrum für Medizinische Versorgungsforschung, Friedrich-Alexander-Universität Erlangen-Nürnberg, Deutschland
| | - Lukas Atzmüller
- Universitätsklinikum Erlangen, Klinik für Psychiatrie und Psychotherapie, Zentrum für Medizinische Versorgungsforschung, Friedrich-Alexander-Universität Erlangen-Nürnberg, Deutschland
| | - Jakob Florack
- St. Joseph Krankenhaus, Klinik für seelische Gesundheit im Kindes- und Jugendalter, Berlin, Deutschland
- Vivantes Klinikum im Friedrichshain, Klinik für Kinder- und Jugendpsychiatrie, Psychotherapie und Psychosomatik, Berlin, Deutschland
| | - Caroline Engel
- Vivantes Klinikum im Friedrichshain, Klinik für Kinder- und Jugendpsychiatrie, Psychotherapie und Psychosomatik, Berlin, Deutschland
| | - Katharina Luttenberger
- Universitätsklinikum Erlangen, Klinik für Psychiatrie und Psychotherapie, Zentrum für Medizinische Versorgungsforschung, Friedrich-Alexander-Universität Erlangen-Nürnberg, Deutschland
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Kind L, Luttenberger K, Leßmann V, Dorscht L, Mühle C, Müller CP, Siegmann EM, Schneider S, Kornhuber J. New ways to cope with depression-study protocol for a randomized controlled mixed methods trial of bouldering psychotherapy (BPT) and mental model therapy (MMT). Trials 2023; 24:602. [PMID: 37736688 PMCID: PMC10514980 DOI: 10.1186/s13063-023-07629-x] [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] [Received: 02/06/2023] [Accepted: 09/07/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Due to the growing gap between the demand and supply of therapeutic services for people suffering from depression, with this study, we are investigating the effectiveness and factors of influence of new approaches in group treatments for depression. Two previous studies have already identified bouldering psychotherapy (BPT) as an effective option. It combines psychotherapeutic interventions with action- and body-oriented bouldering exercises. Mental model therapy (MMT) is a new cognitive-behavioral approach for treating depression. It focuses on identifying cognitive distortions, biases in decision making, and false assumptions and aims to correct and replace them with useful mental models. We aim to investigate the effectiveness of the interventions compared with a control group (CG) and to assess the factors of influence in a mixed methods approach. METHODS The study is being conducted as a randomized controlled intervention trial. Adult participants with unipolar depression are being randomized into three groups (BPT, MMT, or CG), and the first two groups are undergoing a 10-week treatment phase. CG follows their individual standard treatment as usual. A priori power analysis revealed that about 120 people should be included to capture a moderate effect. The primary outcome of the study is depression rated with the Montgomery and Asberg Depression Rating Scale (MADRS) before (t0), directly after (t1), and 12 months after the intervention phase (t2). Data are being collected via questionnaires, computer-assisted video interviews, and physical examinations. The primary hypotheses will be statistically analyzed by mixed model ANOVAs to compare the three groups over time. For secondary outcomes, further multivariate methods (e.g., mixed model ANOVAs and regression analyses) will be conducted. Qualitative data will be evaluated on the basis of the qualitative thematic analysis. DISCUSSION This study is investigating psychological and physical effects of BPT and MMT and its factors of influence on outpatients suffering from depression compared with a CG in a highly naturalistic design. The study could therefore provide insight into the modes of action of group therapy for depression and help to establish new short-term group treatments. Methodological limitations of the study might be the clinical heterogeneity of the sample and confounding effects due to simultaneous individual psychotherapy. TRIAL REGISTRATION ISRCTN, ISRCTN12347878. Registered 28 March 2022, https://www.isrctn.com/ISRCTN12347878 .
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Affiliation(s)
- Leona Kind
- Centre for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany.
| | - Katharina Luttenberger
- Centre for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Vivien Leßmann
- Centre for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Lisa Dorscht
- Centre for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Christiane Mühle
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Christian P Müller
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
- Centre for Drug Research, Universiti Sains Malaysia, 11800, Minden, Penang, Malaysia
- Institute of Psychopharmacology, Central Institute of Mental Health, Faculty of Medicine Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Eva-Maria Siegmann
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Sophia Schneider
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Schwabachanlage 6, 91054, Erlangen, Germany
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Luttenberger K, Donath C, Graessel E, Kornhuber J, Schlüter A, Dorscht L, Kind L. Treating depression in an outpatient setting: Predictors of patient response to bouldering psychotherapy, cognitive behavioural therapy or exercise alone. Clin Psychol Psychother 2023. [PMID: 37642328 DOI: 10.1002/cpp.2898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 06/20/2023] [Accepted: 08/01/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Bouldering psychotherapy (BPT) for depression has proven effective, but nothing is known about its potential predictors of response. This study should identify predictors of response to BPT, cognitive behavioural therapy (CBT) and an active control (home-based exercise programme; EP) using a literature-based model. METHODS In a multicentre randomised controlled trial, 233 outpatients were assigned to BPT, CBT or EP. Response (reduction of at least 46% on the Montgomery-Åsberg Depression Rating Scale [MADRS]) and remission (≤7 MADRS points) were defined as suggested by the literature. Predictors of response were identified twofold: (1) univariate analyses followed by logistic regression analyses in each group with all predictors yielding a univariate p-value <.20 and (2) a backward regression analysis with all potential predictors. Only variables that emerged as predictors in both types of analyses were interpreted. RESULTS There was a significantly greater proportion of responders (p = .035) in the BPT than in the EP. The chance of response in the BPT was higher for patients with a higher health-related quality of life. In the EP, response was higher for patients with lower interpersonal sensitivity, suffering from their first episode and living with a partner. CONCLUSIONS Response rates in BPT are similar to or even higher than in other outpatient psychotherapy group therapies. BPT and CBT are suitable for a wide range of patients, but patients with higher functionality could start with psychoeducation and exercise.
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Affiliation(s)
- Katharina Luttenberger
- Centre for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Carolin Donath
- Centre for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Elmar Graessel
- Centre for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Annika Schlüter
- Centre for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Lisa Dorscht
- Centre for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Leona Kind
- Centre for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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Luttenberger K, Najem C, Rosenbaum S, Sifri C, Kind L, Baggenstos B. A Climbing (Bouldering) Intervention to Increase the Psychological Well-Being of Adolescents in the Bekaa Valley in Lebanon-Study Protocol for a Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4289. [PMID: 36901303 PMCID: PMC10002189 DOI: 10.3390/ijerph20054289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/06/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
(1) Background: Adolescent refugees in Lebanon and Lebanese youth are both at high risk of suffering from reduced psychological well-being. Sport is an evidence-based strategy for improving mental and physical health, and climbing is a type of sport that may positively impact both. The aim of this study is to test the effect of a manualized, psychosocial group climbing intervention on the well-being, distress, self-efficacy, and social cohesion of adolescents in Lebanon. In addition, the mechanisms behind psychological changes will be investigated. (2) Methods: In this mixed-methods waitlist-controlled study, we are allocating a minimum of 160 participants to an intervention (IG) or a control group (CG). The primary outcome is overall mental well-being (WEMWBS) after the 8-week intervention. Secondary outcomes include distress symptoms (K-6 Distress Scale), self-efficacy (General Self-Efficacy Scale; GSE), and social cohesion. Potential mechanisms of change and implementation factors are being investigated through qualitative interviews with a subgroup of 40 IG participants. (3) Conclusions: The results may contribute to knowledge of sports interventions and their effects on psychological well-being and will provide insights regarding low-intensity interventions for supporting adolescent refugees and host populations in conflict-affected settings. The study was prospectively registered at the ISRCTN platform (current-controlled trials). ISRCTN13005983.
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Affiliation(s)
- Katharina Luttenberger
- Department Medical Psychology and Medical Sociology, Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Charbel Najem
- Spine, Head and Pain Research Unit Ghent, Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Ghent University, 9052 Ghent, Belgium
- Department of Physiotherapy, Faculty of Public Health, Antonine University, Baabda, Lebanon
| | - Simon Rosenbaum
- Discipline of Psychiatry and Mental Health, Faculty of Medicine and Health, UNSW, Sydney 2052, Australia
| | - Charles Sifri
- ClimbAID Lebanon, Branch of ClimbAID, 8048 Zurich, Switzerland
| | - Leona Kind
- Department Medical Psychology and Medical Sociology, Faculty of Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Beat Baggenstos
- ClimbAID Lebanon, Branch of ClimbAID, 8048 Zurich, Switzerland
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Wayne PM, Yeh GY, Mehta DH. The Uplifting Variety of Mind-Body Therapies for Treating Depression. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2022; 28:775-779. [PMID: 36154236 DOI: 10.1089/jicm.2022.0708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Bichler CS, Niedermeier M, Hüfner K, Gálffy M, Gostner JM, Nelles P, Schöttl SE, Sperner-Unterweger B, Kopp M. Climbing as an Add-On Treatment Option for Patients with Severe Anxiety Disorders and PTSD: Feasibility Analysis and First Results of a Randomized Controlled Longitudinal Clinical Pilot Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11622. [PMID: 36141895 PMCID: PMC9517148 DOI: 10.3390/ijerph191811622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/22/2022] [Accepted: 08/25/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Exercise has considerable effects on physical and psychological health. Anxiolytic effects of climbing exercise have been found in people suffering from depression. However, there are no studies on patients with severe anxiety disorders or post-traumatic stress disorder (PTSD) practicing climbing as add-on treatment. Additionally, many studies on physical therapy fail to use adequate active control groups. Therefore, this study aimed to investigate the feasibility of a four-week climbing exercise program for patients with anxiety disorders or PTSD in comparison to a standard exercise treatment and a social control group. METHODS Outpatients diagnosed with anxiety disorders or PTSD (F 40, F 41, F 43.1 according to ICD-10) were randomly assigned to (a) climbing exercise (n = 27), (b) Nordic walking exercise (n = 23), or (c) control condition (n = 23) providing the same amount of social contact for eight sessions of 90 minutes each. Psychological parameters (symptom severity, worry symptoms, self-efficacy, quality of life) and biological parameters were assessed at the beginning and at the end of the four-week program. Additionally, follow-up assessments were conducted three and six months after the program ended. RESULTS Sixty outpatients (75% female) aged 18-65 years with a longstanding history of a mental disorder (>10 years) and classified as treatment-resistant (95%) and with averaging 3.8 psychiatric comorbidities completed the pilot trial. After participation, symptoms of anxiety disorders were significantly reduced (p = 0.003), and health-related characteristics significantly improved (depression symptoms: p < 0.001, worry symptoms: p < 0.001, self-efficacy: p < 0.001, quality of life-physical health: p = 0.002, quality of life-psychological health: p = 0.006) in all groups. The feasibility of conducting climbing exercises for the patient groups could be demonstrated, and a general acceptance in the groups was recorded. No significant time-by-group interactions were found. At the completion of the program, psychological parameters improved, while biological parameters remained the same in all three groups. CONCLUSIONS Participation in the climbing group as well as in Nordic walking and social contact groups demonstrated beneficial results in patients with anxiety disorders and PTSD with severe mental burden. Nevertheless, climbing did not show any additional clinically relevant benefits compared to Nordic walking or social contact. Studies with larger sample sizes and qualitative insights are needed to further evaluate the possible benefits of climbing in this population.
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Affiliation(s)
- Carina S. Bichler
- Department of Sport Science, University of Innsbruck, Fuerstenweg 185, 6020 Innsbruck, Austria
| | - Martin Niedermeier
- Department of Sport Science, University of Innsbruck, Fuerstenweg 185, 6020 Innsbruck, Austria
| | - Katharina Hüfner
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Innsbruck Medical University, Anichstraße 35, 6020 Innsbruck, Austria
| | - Mátyás Gálffy
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Innsbruck Medical University, Anichstraße 35, 6020 Innsbruck, Austria
| | - Johanna M. Gostner
- Institute of Medical Biochemistry, Biocenter, Medical University of Innsbruck, Innrain 80-82, 6020 Innsbruck, Austria
| | - Philipp Nelles
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Innsbruck Medical University, Anichstraße 35, 6020 Innsbruck, Austria
| | - Stefanie E. Schöttl
- Department of Sport Science, University of Innsbruck, Fuerstenweg 185, 6020 Innsbruck, Austria
| | - Barbara Sperner-Unterweger
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Innsbruck Medical University, Anichstraße 35, 6020 Innsbruck, Austria
| | - Martin Kopp
- Department of Sport Science, University of Innsbruck, Fuerstenweg 185, 6020 Innsbruck, Austria
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Liu S, Gong X, Li H, Li Y. The Origin, Application and Mechanism of Therapeutic Climbing: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9696. [PMID: 35955052 PMCID: PMC9367706 DOI: 10.3390/ijerph19159696] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/02/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
As an innovative exercise therapy, therapeutic climbing (TC) has attracted more attention than ever before in recent years. In this review of the related studies on TC, the authors explore its origin and development; summarize its therapeutic effect in treating depression, low back pain and other diseases; and further analyze its underlying mechanism. According to the literature, TC was primarily applied in the field of orthopedics and then was gradually used in neurology, psychiatry and psychology. It provides a new means for the treatment of depression, lower back pain, multiple sclerosis and other diseases. There are two potential mechanisms: physiological and psychological. In the future, exercise effects, adverse effects and exercise prescriptions of TC should be explored with large samples and high-quality randomized controlled trials.
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Thaller L, Frühauf A, Heimbeck A, Voderholzer U, Kopp M. A Comparison of Acute Effects of Climbing Therapy with Nordic Walking for Inpatient Adults with Mental Health Disorder: A Clinical Pilot Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116767. [PMID: 35682348 PMCID: PMC9180369 DOI: 10.3390/ijerph19116767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/18/2022] [Accepted: 05/27/2022] [Indexed: 11/18/2022]
Abstract
As climbing therapy is increasingly used for mental health disorders, the present study aimed to compare acute effects of a therapeutic climbing intervention (CT) on affective responses, anxiety, and self-efficacy with those of Nordic walking (NW) and a sedentary control condition (SC) in an inpatient setting with persons with depression, anxiety, or obsessive−compulsive disorders. A total of 21 inpatients (32 ± 12.2 years) participated in a clinical trial in all interventions using an experimental within-subject design. Anxiety and self-efficacy were assessed preintervention (t0) and postintervention (t2) using the State-Trait Anxiety Inventory and the General Self-Efficacy Scale, and affective responses were additionally evaluated during (t1) and 180 min after the intervention (t3) using the Feeling Scale, Felt Arousal Scale, and Positive and Negative Affect Schedule. Statistical evaluation was performed with a 3 × 2 or 3 × 4 repeated measures ANOVA. Significant interaction effects were found for affective responses regarding positive affect, affective valence, and perceived activation (p < 0.015) favoring CT over NW and SC. For anxiety, a significant interaction effect was found (F(2.40) = 6.603; p = 0.003; η2 = 0.248), and also perceived self-efficacy increased significantly (F(2.40) = 6.046; p = 0.005; η2 = 0.232). Single CT sessions may enhance affective responses and self-efficacy and reduce anxiety in inpatients with mental health disorders to a higher extent than NW. CT as part of an inpatient therapy program may help to improve key affective mechanisms and should be further studied in comparison with other exercise interventions with comparable intensity.
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Affiliation(s)
- Lisa Thaller
- Department of Sports Science, University of Innsbruck, 6020 Innsbruck, Austria; (A.F.); (M.K.)
- Schoen Clinic Roseneck, 83209 Prien am Chiemsee, Germany; (A.H.); (U.V.)
- Correspondence: ; Tel.: +49-151-20702742
| | - Anika Frühauf
- Department of Sports Science, University of Innsbruck, 6020 Innsbruck, Austria; (A.F.); (M.K.)
| | - Alexander Heimbeck
- Schoen Clinic Roseneck, 83209 Prien am Chiemsee, Germany; (A.H.); (U.V.)
| | - Ulrich Voderholzer
- Schoen Clinic Roseneck, 83209 Prien am Chiemsee, Germany; (A.H.); (U.V.)
- Department of Psychiatry and Psychotherapy, University Hospital of Munich (LMU), 80336 Munich, Germany
| | - Martin Kopp
- Department of Sports Science, University of Innsbruck, 6020 Innsbruck, Austria; (A.F.); (M.K.)
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