1
|
Amacher SA, Gross S, Becker C, Arpagaus A, Urben T, Gaab J, Emsden C, Tisljar K, Sutter R, Pargger H, Marsch S, Hunziker S. Misconceptions and do-not-resuscitate preferences of healthcare professionals commonly involved in cardiopulmonary resuscitations: A national survey. Resusc Plus 2024; 17:100575. [PMID: 38375442 PMCID: PMC10875294 DOI: 10.1016/j.resplu.2024.100575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/29/2024] [Accepted: 01/31/2024] [Indexed: 02/21/2024] Open
Abstract
Aims To assess the DNR preferences of critical care-, anesthesia- and emergency medicine practitioners, to identify factors influencing decision-making, and to raise awareness for misconceptions concerning CPR outcomes. Methods A nationwide multicenter survey was conducted in Switzerland confronting healthcare professionals with a case vignette of an adult patient with an out-of-hospital cardiac arrest (OHCA). The primary outcome was the rate of DNR Code Status vs. CPR Code Status when taking the perspective from a clinical case vignette of a 70-year-old patient. Secondary outcomes were participants' personal preferences for DNR and estimates of survival with good neurological outcome after in- and out-of-hospital cardiac arrest. Results Within 1803 healthcare professionals, DNR code status was preferred in 85% (n = 1532) in the personal perspective of the case vignette and 53.2% (n = 932) when making a decision for themselves. Main predictors for a DNR Code Status regarding the case vignette included preferences for DNR Code Status for themselves (n [%] 896 [58.5] vs. 87 [32.1]; adjusted odds ratio [OR] 2.97, 95% confidence interval [CI] 2.25-3.92; p < 0.001) and lower estimated OHCA survival (mean [±SD] 12.3% [±11.8] vs. 14.7%[±12.8]; adjusted OR 0.98, 95% CI 0.97-0.99; p = 0.001). Physicians chose a DNR order more often when compared to nurses and paramedics. Conclusions The estimation of outcomes following cardiac arrest and personal living conditions are pivotal factors influencing code status preferences in healthcare professionals. Healthcare professionals should be aware of cardiac arrest prognosis and potential implications of personal preferences when engaging in code status- and end-of-life discussions with patients and their relatives.
Collapse
Affiliation(s)
- Simon A. Amacher
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland
- Department of Emergency Medicine, University Hospital Basel, Basel, Switzerland
| | - Sebastian Gross
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Christoph Becker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Department of Emergency Medicine, University Hospital Basel, Basel, Switzerland
| | - Armon Arpagaus
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Tabita Urben
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland
| | - Christian Emsden
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland
- Post-Intensive Care Clinic, University Hospital Basel, Basel, Switzerland
| | - Kai Tisljar
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland
| | - Raoul Sutter
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
| | - Hans Pargger
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
| | - Stephan Marsch
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
| | - Sabina Hunziker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Post-Intensive Care Clinic, University Hospital Basel, Basel, Switzerland
- Medical Faculty, University of Basel, Basel, Switzerland
| |
Collapse
|
2
|
de Leeuw M, Laager M, Gaab J, Ruppen W, Schneider T. Boosting open-label placebo effects in acute induced pain in healthy adults (BOLPAP-study): study protocol of a randomized controlled trial. Front Med (Lausanne) 2024; 11:1238878. [PMID: 38420356 PMCID: PMC10900763 DOI: 10.3389/fmed.2024.1238878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 01/22/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Pain is a highly prevalent symptom in the hospital setting, but treatment options remain limited. Harnessing the placebo effect in an ethical manner could provide a new possibility to reduce pain in clinical practice. So called open-label placebos (OLP) have been shown to elicit significant effects in reducing acute pain. But, before implementation, more knowledge concerning the properties of OLPs is needed. This study aims to assess the duration of analgesic effects from OLP and to determine the possibility of boosting such effects. Methods and analysis This is the protocol of an ongoing (first patient enrolled in March 2023) single-site randomized trial investigating OLPs in two parts (i.e., substudies). In both parts, pain will be induced in healthy adults using an intradermal electrical stimulation model. Participants in Part 1 will have two study visits: An interventional visit with one OLP injection accompanied by an evidence-based treatment rationale and a control visit with no treatment. For Part 2, participants will be randomized into three groups: (1) A fixed-time "Booster" group including one single repetition of the OLP injection at a fixed time point, (2) an on-demand "Booster" group including one single repetition of the OLP injection on-demand, and (3) a control group who will receive just one OLP injection. Differences in pain ratings over time (using the Numeric Rating Scale) will be analyzed with several two-sample t-tests. The time point for a fixed-time "Booster" in Part 2 will be derived from Part 1 with additional statistical tools such as a broken-stick mixed-effect model. Discussion This study aims to further characterize the analgesic effects of OLPs. In doing so, it will provide valuable information needed for later implementation of OLPs in clinical practice, where they could play a role in multimodal analgesic concepts. Ethics and dissemination The "Ethikkommission Nordwest- und Zentralschweiz" (BASEC 2023-00296) approved the study protocol. Results of the analysis will be submitted for publication in a peer-reviewed journal. Clinical Trial Registration This study is registered at ClinicalTrials.gov (NCT05819476) and is listed in the Swiss National Registry at kofam.ch (SNCTP000005470).
Collapse
Affiliation(s)
- Matthijs de Leeuw
- Pain Unit, Clinic for Anesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Mirjam Laager
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Wilhelm Ruppen
- Pain Unit, Clinic for Anesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| | - Tobias Schneider
- Pain Unit, Clinic for Anesthesia, Intermediate Care, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
3
|
Kharko A, Buergler S, Bärkås A, Hägglund M, Gaab J, Fagerlund AJ, Locher C, Blease C. Open notes in psychotherapy: An exploratory mixed methods survey of psychotherapy students in Switzerland. Digit Health 2024; 10:20552076241242772. [PMID: 38559581 PMCID: PMC10981219 DOI: 10.1177/20552076241242772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/12/2024] [Indexed: 04/04/2024] Open
Abstract
Background In a growing number of countries, patients are offered access to their full online clinical records, including the narrative reports written by clinicians (the latter, referred to as "open notes"). Even in countries with mature patient online record access, access to psychotherapy notes is not mandatory. To date, no research has explored the views of psychotherapy trainees about open notes. Objective This study aimed to explore the opinions of psychotherapy trainees in Switzerland about patients' access to psychotherapists' free-text summaries. Methods We administered a web-based mixed methods survey to 201 psychotherapy trainees to explore their familiarity with and opinions about the impact on patients and psychotherapy practice of offering patients online access to their psychotherapy notes. Descriptive statistics were used to analyze the 42-item survey, and qualitative descriptive analysis was employed to examine written responses to four open-ended questions. Results Seventy-two (35.8%) trainees completed the survey. Quantitative results revealed mixed views about open notes. 75% agreed that, in general open notes were a good idea, and 94.1% agreed that education about open notes should be part of psychotherapy training. When considering impact on patients and psychotherapy, four themes emerged: (a) negative impact on therapy; (b) positive impact on therapy; (c) impact on patients; and (d) documentation. Students identified concerns related to increase in workload, harm to the psychotherapeutic relationship, and compromised quality of records. They also identified many potential benefits including better patient communication and informed consent processes. In describing impact on different therapy types, students believed that open notes might have differential impact depending on the psychotherapy approaches. Conclusions Sharing psychotherapy notes is not routine but is likely to expand. This mixed methods study provides timely insights into the views of psychotherapy trainees regarding the impact of open notes on patient care and psychotherapy practice.
Collapse
Affiliation(s)
- Anna Kharko
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Sarah Buergler
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Annika Bärkås
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Maria Hägglund
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | | | - Cosima Locher
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Basel, Switzerland
| | - Charlotte Blease
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Uppsala, Sweden
| |
Collapse
|
4
|
Gross S, Becker C, Beck K, Memma V, Gaab J, Schütz P, Leuppi JD, Schaefert R, Langewitz W, Trendelenburg M, Breidthardt T, Eckstein J, Osthoff M, Bassetti S, Hunziker S. Occurrence of sensitive topics during ward round: an ancillary analysis of the BEDSIDE-OUTSIDE trial. BMJ Open 2023; 13:e073584. [PMID: 37734895 PMCID: PMC10514661 DOI: 10.1136/bmjopen-2023-073584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/21/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE Discussing sensitive topics (eg, medical uncertainty, social issues, non-adherence) during ward rounds is challenging and may negatively impact patient satisfaction with the healthcare they are receiving. In the previous multicentre randomised BEDSIDE-OUTSIDE trial focusing on communication during ward rounds, we investigated the interplay between sensitive topics and low reported satisfaction with care. DESIGN Pre-planned secondary analysis of a randomised controlled trial. For this analysis data of the original trial was pooled across intervention groups. SETTING Three Swiss teaching hospitals. PARTICIPANTS Adult patients hospitalised for medical care. INTERVENTIONS We analysed predefined sensitive health topics and specific elements of communication from audiotapes recorded during ward rounds, for both patients dealing with and without sensitive topics. PRIMARY AND SECONDARY OUTCOME MEASURES The primary endpoint was overall patient satisfaction with care; measured on a Visual Analogue Scale from 0 to 100. Secondary endpoints included duration of ward rounds and further satisfaction outcomes. RESULTS Of the 919 included patients, 474 had at least one sensitive topic including medical uncertainty (n=251), psychiatric comorbidities (n=161), tumour diagnosis (n=137) and social issues (n=125). Compared with patients without sensitive topics, patients with sensitive topics reported lower satisfaction with care (mean (SD), 87.7 (±14.6) vs 90.2 (±12.1), adjusted difference -2.5 (95% CI -4.28 to -0.72), p=0.006. Among patients with sensitive topics, risk factors for low satisfaction included several parameters concerning patient-physician interaction such as disagreements during ward rounds (mean (SD), 14/212 (6.6%) vs 41/254 (16.1%), adjusted OR 2.78 (95% CI 1.47 to 5.27), p=0.002). CONCLUSIONS A large proportion of medical inpatients must deal with sensitive health topics. This is associated with lower satisfaction with care, particularly if the patient perceives the interaction with doctors during ward rounds as unsatisfactory. Educating physicians on specific communication techniques may help improve care for these patients. TRIAL REGISTRATION NUMBER NCT03210987.
Collapse
Affiliation(s)
- Sebastian Gross
- Department of Medical Communication / Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Christoph Becker
- Department of Medical Communication / Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Emergency Department, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Katharina Beck
- Department of Medical Communication / Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Valentina Memma
- Department of Medical Communication / Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Philipp Schütz
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Division of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Jörg D Leuppi
- Faculty of Medicine, University of Basel, Basel, Switzerland
- University Center of Internal Medicine, Kantonsspital Baselland, Liestal, Switzerland
| | - Rainer Schaefert
- Department of Medical Communication / Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Psychosomatics and Psychiatry, Bethesda Hospital, Basel, Switzerland
| | - Wolf Langewitz
- Department of Medical Communication / Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Marten Trendelenburg
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Tobias Breidthardt
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Jens Eckstein
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Michael Osthoff
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Stefano Bassetti
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Sabina Hunziker
- Department of Medical Communication / Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
5
|
Stumpp L, Jauch M, Sezer D, Gaab J, Greifeneder R. Effects of an open-label placebo intervention on reactions to social exclusion in healthy adults: a randomized controlled trial. Sci Rep 2023; 13:15369. [PMID: 37717121 PMCID: PMC10505215 DOI: 10.1038/s41598-023-42547-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 09/12/2023] [Indexed: 09/18/2023] Open
Abstract
Social exclusion, that is being left out by others, can have adverse consequences for individuals' psychological well-being. Even short-term experiences of social exclusion strongly threaten basic psychological needs and cause so-called social pain. Prior research suggests an overlap between the experience of social and physical pain that, amongst others, is reflected by the effectiveness of physical pain treatments in alleviating social pain. Drawing upon these prior findings, we here explore whether open-label placebos, which have previously been found to be effective in reducing physical pain, can alleviate social pain following social exclusion. Seventy-four healthy participants were randomly assigned to one of four conditions in a 2 × 2 between-subjects design: First, they either received an open-label placebo intervention or no treatment. Second, they either experienced inclusion or exclusion by their co-players in the interactive ball-tossing game Cyberball. We find that excluded participants in the open-label placebo condition experienced significantly less hurt feelings compared to those in the control condition (Cohen's d = 0.77). There was no effect of treatment for need threat. The findings suggest new possibilities to alleviate social pain, which is of particular interest in the context of preventing destructive and maladaptive behaviors in situations where functional coping strategies are unavailable.
Collapse
Affiliation(s)
| | - Melissa Jauch
- Division of Social Psychology, Faculty of Psychology, University of Basel, Basel, Switzerland.
| | - Dilan Sezer
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Rainer Greifeneder
- Division of Social Psychology, Faculty of Psychology, University of Basel, Basel, Switzerland
| |
Collapse
|
6
|
Buergler S, Sezer D, Busch A, Enzmann M, Bakis B, Locher C, Bagge N, Kirsch I, Carvalho C, Gaab J. A qualitative study of imaginary pills and open-label placebos in test anxiety. PLoS One 2023; 18:e0291004. [PMID: 37656757 PMCID: PMC10473493 DOI: 10.1371/journal.pone.0291004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/21/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND The efficacy of open-label placebos (OLPs) has been increasingly demonstrated and their use holds promise for applications compatible with basic ethical principles. Taking this concept one step further an imaginary pill (IP) intervention without the use of a physical pill was developed and tested in a randomized controlled trial (RCT). To explore participants' experiences and views, we conducted the first qualitative study in the field of IPs. METHODS A reflexive thematic analysis (RTA) of semi-structured interviews with test anxious students (N = 20) was nested in an RCT investigating an IP and OLP intervention. In addition, open-ended questions from the RCT were evaluated (N = 114) to corroborate the RTA and pill characteristics were included to more accurately capture the IP experience. RESULTS Four key themes were identified: (1) attitude towards the intervention, (2) applicability of the intervention, (3) experience of effects, and (4) characteristics of the imagination. The IP intervention was well-accepted, easily applicable, and various effects, pill characteristics and appearances were described. While many participants did not desire a physical pill, either due to the absence of the imagination component or aversion to pills, the approach was considered to be cognitively and time demanding, which in turn, however, encouraged the establishment of a therapeutic ritual that protected against the increase in test anxiety during the preparation phase. OLP findings were comparable, and especially the importance of a treatment rationale was stressed in both groups, counteracting an initial ambivalent attitude. The RTA findings were supported by the open-ended questions of the RCT. CONCLUSION IPs appear to be a well-accepted and easily applicable intervention producing a variety of beneficial effects. Thus, the IP approach might serve as an imaginary based alternative to OLPs warranting further investigations on its application to harness placebo effects without a physical pill.
Collapse
Affiliation(s)
- Sarah Buergler
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Dilan Sezer
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Alexander Busch
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Marlon Enzmann
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Berfin Bakis
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Cosima Locher
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Niels Bagge
- Institute for Emotion-Focused Therapy, Roskilde, Denmark
| | - Irving Kirsch
- Program in Placebo Studies, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States of America
| | - Claudia Carvalho
- Department of Clinical and Health Psychology, Instituto Superior de Psicologia Aplicada (ISPA), Lisbon, Portugal
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| |
Collapse
|
7
|
Jones EE, Reed M, Meyer AH, Gaab J, Ooi YP. Stress, mental health and sociocultural adjustment in third culture kids: exploring the mediating roles of resilience and family functioning. Front Psychol 2023; 14:1093046. [PMID: 37645063 PMCID: PMC10461105 DOI: 10.3389/fpsyg.2023.1093046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 06/30/2023] [Indexed: 08/31/2023] Open
Abstract
Introduction This cross-sectional study explores the contributions of personal and contextual factors in the adjustment process of a sample of internationally mobile children and adolescents having relocated to Switzerland. Based on evolutionary developmental theories and recommendations by Research Domain Criteria and The Hierarchical Taxonomy of Psychopathology theoretical frameworks, we hypothesized and tested a heuristic model of TCK adjustment, aiming to identify prevention and treatment targets tailored for our sampled population. Methods We assessed the relationships in the hypothesized models, particularly how perceived and acculturative stress influence TCK adjustment and whether the relationship between the predictors of TCK stress and the outcomes of TCK adjustment are mediated by resilience and family functioning. A total of 143 participants aged 7-17, having relocated internationally with their working parent(s), recruited in local and international schools in Switzerland, were included in this study. Data were collected using an online survey after we collected consent. We assessed factors of adjustment using validated questionnaires: perceived stress and acculturative stress and the potential mediating roles of family functioning and resilience. We measured the outcome of adjustment through mental health difficulties and sociocultural adjustment. We used path analysis to test the model. Results Results highlight the contributions of perceived stress and acculturative stress to TCK mental health and sociocultural adjustment. We also we found a mediation effect for resilience in the relationship between perceived stress and mental health. Family functioning was not a significant mediator in any relationship that we assessed. Discussion We discuss implications for future research, promoting TCK adjustment and preventative psychotherapeutic interventions.
Collapse
Affiliation(s)
| | | | | | - Jens Gaab
- University of Basel, Basel, Switzerland
| | - Yoon P. Ooi
- University of Basel, Basel, Switzerland
- Institute of Mental Health, Singapore, Singapore
| |
Collapse
|
8
|
Buergler S, Sezer D, Gaab J, Locher C. The roles of expectation, comparator, administration route, and population in open-label placebo effects: a network meta-analysis. Sci Rep 2023; 13:11827. [PMID: 37481686 PMCID: PMC10363169 DOI: 10.1038/s41598-023-39123-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/20/2023] [Indexed: 07/24/2023] Open
Abstract
Three meta-analyses have demonstrated the clinical potential of open-label placebos (OLPs). However, there is a need to synthesize the existing evidence through more complex analyses that would make it possible to answer questions beyond mere efficacy. Such analyses would serve to improve the understanding of why and under what circumstances OLPs work (e.g., depending on induced expectations or across different control groups). To answer these questions, we conducted the first network meta-analyses in the field of OLPs. Our analyses revealed that OLPs could be beneficial in comparison to no treatment in nonclinical (12 trials; 1015 participants) and clinical populations (25 trials; 2006 participants). Positive treatment expectations were found to be important for OLPs to work. Also, OLP effects can vary depending on the comparator used. While the kind of administration route had no substantial impact on the OLP effects, effects were found to be larger in clinical populations than in nonclinical populations. These results suggest that the expectation, comparator, administration route, and population should be considered when designing and interpreting OLP studies.
Collapse
Affiliation(s)
- Sarah Buergler
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland.
| | - Dilan Sezer
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Cosima Locher
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Faculty of Health, University of Plymouth, Plymouth, UK
| |
Collapse
|
9
|
Seaward H, Dieffenbacher S, Gaab J, Graf M, Elger B, Wangmo T. Stigma management during reintegration of older incarcerated adults with mental health issues: A qualitative analysis. Int J Law Psychiatry 2023; 89:101905. [PMID: 37329868 DOI: 10.1016/j.ijlp.2023.101905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/19/2023]
Abstract
INTRODUCTION The number of older prisoners with mental health issues released from prisons and forensic psychiatric institutions is rising. Their successful integration is important due to its implications for the public's safety and the individual's health and well-being. However, reintegration efforts are hampered due to the double stigma attached to 'mental illness' and 'incarceration history'. To alleviate the burden of such stigma, affected persons and their social networks employ stigma management strategies. This study sought to investigate the stigma management strategies of mental health professionals supporting older incarcerated adults with mental health issues in their reintegration process. METHODS Semi-structured interviews with 63 mental health professionals from Canada and Switzerland were carried out as part of the overall project. To address the reintegration topic, data from 18 interviews were used. Data analysis followed the thematic analysis approach. RESULTS Mental health professionals emphasized the double stigmatization of their patients which impaired their quest for housing. Lengthy searches for placement frequently resulted in patients' unnecessary long stays in forensic programs. Nevertheless, participants outlined that they were at times successful in finding appropriate housing for their patients due to the use of certain stigma management strategies. They stated that they, first, established initial contacts with outside institutions, second, educated them about stigmatizing labels and, third, provided ongoing collaboration with public institutions. DISCUSSION Incarcerated persons with mental health issues face double stigmatization that affects their reentry process. Our findings are interesting as they illustrate ways in which stigma can be reduced, and how the reentry process can be streamlined. Future research should include the perspectives of incarcerated adults with mental health issues to shed more light on the various options that they seek for successful reintegration after imprisonment.
Collapse
Affiliation(s)
- Helene Seaward
- University of Basel, Institute for Biomedical Ethics (IBMB), Bernoullistrasse 28, 4056 Basel, Switzerland.
| | - Sophie Dieffenbacher
- Psychiatric Hospital of the University of Basel, Division for Psychosomatics and Psychotherapy, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland.
| | - Jens Gaab
- University of Basel, Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, Missionsstrasse 62, 4055 Basel, Switzerland.
| | - Marc Graf
- Psychiatric Hospital of the University of Basel, Forensic Psychiatric Hospital, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland.
| | - Bernice Elger
- University of Basel, Institute for Biomedical Ethics (IBMB), Bernoullistrasse 28, 4056 Basel, Switzerland; University of Geneva, Center for legal medicine (CURML), Medical faculty, Rue Michel-Servet 1, 1211 Genève, Switzerland.
| | - Tenzin Wangmo
- University of Basel, Institute for Biomedical Ethics (IBMB), Bernoullistrasse 28, 4056 Basel, Switzerland.
| |
Collapse
|
10
|
Locher C, Petignat M, Wagner C, Hediger K, Roth B, Gaab J, Koechlin H. Animal-Assisted Psychotherapy for Pediatric Chronic Pain: Case Series of an Open Pilot Study to Test Initial Feasibility and Potential Efficacy. J Pain Res 2023; 16:1799-1811. [PMID: 37273273 PMCID: PMC10237188 DOI: 10.2147/jpr.s394270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 03/23/2023] [Indexed: 06/06/2023] Open
Abstract
Objective Chronic pain is a common complaint in children and adolescents, placing an enormous burden on individuals, their families, and the healthcare system. New innovative approaches for the treatment of pediatric chronic pain (PCP) are clearly warranted, as drop-out rates in intervention studies are high and it can be difficult to engage patients with PCP in therapy. Here, animal-assisted interventions (AAIs) might be promising, since there is preliminary evidence for the approach in adults with chronic pain, and AAIs are generally known to foster the therapeutic motivation of patients. To date, however, AAIs have not been examined in pediatric chronic pain. Methods The aim of this open pilot study was to examine the initial feasibility of recruitment and potential efficacy of an animal-assisted group psychotherapy (including horses, rabbits, chickens, goats, and a dog), providing case reports of three children with chronic pain. We applied a mixed-methods approach, including the conductance of semi-structured interviews and assessment of quantitative pre-post data with a focus on pain severity, avoidance behavior, pain acceptance, and ability to defocus from the pain. Results The three participating girls (age: 9-12 years) reported chronic pain in the head and abdomen. The process of recruitment turned out to be challenging. All three children reported reduced pain-related disability and pain-related distress, as well as an increased ability to accept pain and to defocus from the pain. The qualitative data revealed that patients and their parents had a positive attitude towards AAIs. Conclusion Our initial open pilot study is the first to investigate AAIs in the context of pediatric chronic pain. Notably, we had difficulties in the recruitment procedure, mostly due to the Covid-19 situation. Based on three case reports, we found some first indication that AAI approaches might be associated with symptom changes. Future randomized-control studies with larger sample sizes are clearly warranted. Clinicaltrialsgov Identifier NCT04171336.
Collapse
Affiliation(s)
- Cosima Locher
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Milena Petignat
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Cora Wagner
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Karin Hediger
- Division of Clinical Psychology and Animal-Assisted Interventions, Faculty of Psychology, University of Basel, Basel, Switzerland
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- Faculty of Psychology, Open University, Heerlen, the Netherlands
| | - Binia Roth
- Interdisciplinary Pain Consultation, Child and Adolescent Psychiatry of Basel-Landschaft, Binningen, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Helen Koechlin
- Department of Psychosomatics and Psychiatry, University Children’s Hospital Zurich, Zurich, Switzerland
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
11
|
Wagner C, Gaab J, Hediger K. The Importance of the Treatment Rationale for Pain in Animal-Assisted Interventions: A Randomized Controlled Trial in Healthy Participants. J Pain 2023:S1526-5900(23)00012-3. [PMID: 36641027 DOI: 10.1016/j.jpain.2023.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 12/12/2022] [Accepted: 01/04/2023] [Indexed: 01/13/2023]
Abstract
Animal-assisted interventions (AAIs) is a promising treatment approach for pain, but possible mechanisms still need to be elucidated. This study set out to investigate the analgesic effects of an animal provided with a treatment rationale in a randomized controlled trial employing a standardized experimental heat-pain paradigm. We randomly assigned 128 healthy participants to: dog treatment (DT), placebo treatment (PT), dog and placebo treatment (DPT), and no treatment (NT). Primary outcomes were heat-pain tolerance and the corresponding self-reported ratings of pain unpleasantness and intensity. Results revealed no differences in heat-pain tolerance between the conditions. However, participants in the DT condition experienced heat-pain as significantly less unpleasant at the limit of their tolerance compared to participants in the NT condition (estimate = -0.96, CI = -1.58 to 0.34, P = .010). Participants in the DT condition also showed lower ratings of pain intensity at the limit of their tolerance compared to participants in the NT condition (estimate = -0.44, CI = -0.89 to 0.02, P = .060). This study indicates that a dog has analgesic effects on pain perception when integrated into the treatment rationale. We assume that providing a treatment rationale regarding the animal is important in AAIs for pain. PERSPECTIVE: This study shows that the presence of an animal is not sufficient for animal-assisted interventions (AAIs) to have an analgesic effect on pain unless they are provided with a treatment rationale. This could imply that not only the animal but also contextual factors are important in AAIs. TRIAL REGISTRATION: Clinical Trials NCT04361968.
Collapse
Affiliation(s)
- Cora Wagner
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland.
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Karin Hediger
- Division of Clinical Psychology and Animal-Assisted Intervention, Faculty of Psychology, University of Basel, Basel, Switzerland; Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Allschwil, Switzerland; Faculty of Psychology, Open University, Heerlen, Netherlands; Clinic for Neurorehabilitation and Paraplegiology, REHAB Basel, Basel, Switzerland
| |
Collapse
|
12
|
Sezer D, Locher C, Gaab J. Deceptive and open-label placebo effects in experimentally induced guilt: a randomized controlled trial in healthy subjects. Sci Rep 2022; 12:21219. [PMID: 36481801 PMCID: PMC9731964 DOI: 10.1038/s41598-022-25446-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
Placebos are known to yield significant effects in many conditions. We examined deceptive and open-label placebo effects on guilt, which is important for self-regulation and a symptom of mental disorders. Following an experimental induction of guilt, healthy subjects were randomized to deceptive placebo (DP; n = 35), open-label placebo (OLP; n = 35), or no treatment (NT; n = 39). The primary outcome was guilt responses assessed in area under the curve (AUC). Secondary outcomes were shame, guilt, and affect. We hypothesized that DP and OLP would reduce guilt compared to NT. Guilt responses were higher in the NT group than in the placebo groups (estimate = 2.03, 95% CI = 0.24-3.82, d = 0.53), whereas AUC guilt did not differ significantly between the placebo groups (estimate = -0.38, 95% CI = -2.52-1.76, d = -0.09). Placebos are efficacious in reducing acute guilt responses, regardless of the placebo administration (i.e., open vs. deceptive). Furthermore, we observed narrative-specific effects with significant changes of guilt but not shame, pride, or affect. These results indicate not only that guilt is amenable to placebos but also that placebos can be administered in an ethical and potentially emotion-specific manner.
Collapse
Affiliation(s)
- Dilan Sezer
- grid.6612.30000 0004 1937 0642Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Missionsstrasse 62, 4055 Basel, Switzerland
| | - Cosima Locher
- grid.412004.30000 0004 0478 9977Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland ,grid.11201.330000 0001 2219 0747Faculty of Health, University of Plymouth, Plymouth, UK
| | - Jens Gaab
- grid.6612.30000 0004 1937 0642Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Missionsstrasse 62, 4055 Basel, Switzerland
| |
Collapse
|
13
|
Bäumer AV, Fürer L, Birkenberger C, Wyssen A, Steppan M, Zimmermann R, Gaab J, Kaess M, Schmeck K. The impact of outcome expectancy on therapy outcome in adolescents with borderline personality disorder. Borderline Personal Disord Emot Dysregul 2022; 9:30. [PMID: 36464739 PMCID: PMC9721041 DOI: 10.1186/s40479-022-00200-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/27/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Outcome expectancy has been found to be a significant predictor of psychotherapy outcome. However, given that severity, chronicity and comorbidity are moderators of outcome expectancy, it is important to provide evidence of whether the same holds true in clinical conditions marked by these attributes, such as in borderline personality disorder (BPD). The aim of the present study was to investigate the role of patients' outcome expectancy in adolescents undergoing early intervention for BPD using pre-post difference of psychosocial functioning as outcome. METHODS Forty-four adolescent BPD patients were treated with Dialectical Behavior Therapy for Adolescents (DBT-A) or Adolescent Identity Treatment (AIT). We investigated the effect of outcome expectancy on outcome with type of treatment as moderator. Based on the relevant literature, we assess the correlation between outcome expectancy and pretreatment symptomatology, namely BPD severity, personality functioning, childhood trauma and depression. RESULTS The results showed a significant effect of expectancy on outcome (stand. β = 0.30, p = 0.020) above autoregression. ANOVA analysis revealed no difference between the two treatments. Further, results indicate that pretreatment symptomatology, i.e., depression, childhood trauma and personality functioning dimensions self-direction and intimacy, are associated with early treatment expectancy. CONCLUSION Outcome expectancy as a common factor plays a key role in successful psychotherapy with adolescent BPD patients. Elevated pretreatment depression, childhood trauma and impairment in personality functioning dimensions self-direction and intimacy are risk factors associated with lower expectancy. Low outcome expectancy should be addressed in early psychotherapy to improve the therapeutical process.
Collapse
Affiliation(s)
- Anna-Valeska Bäumer
- Child and Adolescent Psychiatric Research Department, University Psychiatric Clinics, University of Basel, Wilhelm Klein-Strasse 27, CH-4056, Basel, Switzerland.
| | - Lukas Fürer
- Child and Adolescent Psychiatric Research Department, University Psychiatric Clinics, University of Basel, Wilhelm Klein-Strasse 27, CH-4056, Basel, Switzerland
| | - Carolin Birkenberger
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Andrea Wyssen
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Martin Steppan
- Child and Adolescent Psychiatric Research Department, University Psychiatric Clinics, University of Basel, Wilhelm Klein-Strasse 27, CH-4056, Basel, Switzerland
| | - Ronan Zimmermann
- Child and Adolescent Psychiatric Research Department, University Psychiatric Clinics, University of Basel, Wilhelm Klein-Strasse 27, CH-4056, Basel, Switzerland.,Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Klaus Schmeck
- Child and Adolescent Psychiatric Research Department, University Psychiatric Clinics, University of Basel, Wilhelm Klein-Strasse 27, CH-4056, Basel, Switzerland
| |
Collapse
|
14
|
Jones EM, Reed M, Gaab J, Ooi YP. Adjustment in third culture kids: A systematic review of literature. Front Psychol 2022; 13:939044. [PMID: 36518953 PMCID: PMC9743971 DOI: 10.3389/fpsyg.2022.939044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 09/20/2022] [Indexed: 08/31/2023] Open
Abstract
UNLABELLED Third Culture Kids (TCKs) are children of expatriates who live in a culture other than their country of nationality or their parent's country of nationality for a significant part of their childhood. Past research has indicated that adjustment is a key factor in the success of global mobility. However, current research in the area of TCK adjustment is lacking. This systematic review aims to present and summarize all available published scientific data on the adjustment of internationally mobile children and adolescents who relocate with their families. We aim to understand factors related to TCK adjustment, highlight lacking research areas, and define areas of interest for future research. The eligibility criteria for inclusion in the review were: traditional TCKs; aged 7-17 years; measures taken during the relocation; outcome variables of wellbeing, psychological adjustment or social adjustment, or socio-cultural adjustment or adjustment. An initial search across eight databases in December 2021 yielded 9,433 studies, which were included in COVIDENCE and reviewed independently by two researchers at each phase. We finally included 14 studies in this study, 10 of which presented quantitative data. Extracted quantitative and qualitative studies were abstracted, and the main findings are presented using a consistent grid of codes: an initial computerized lexical scan (Leximancer) of all included papers generated a preliminary list of topics and their frequencies. We refined these initial topics using the most prominent theories around the topics of TCK, adjustment, and the extracted theories from selected papers and created a codebook. Then we abstracted the quantitative data from the selected studies and organized the statistically significant findings according to the codes. Lastly, we abstracted and synthesized the findings from qualitative studies. Efforts were made to present the available data within a reading grid, which enhances the understanding of mechanisms specific to the sample population and also makes it apparent where more research is needed. Specifically, findings suggest a need for a more inclusive multi-trajectory adjustment model and a better definition of the ecological sample. The coding system for the extraction and analysis in this systematic review may be a guide for researchers planning future studies on TCK adjustment. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020151071, identifier: CRD42020151071.
Collapse
Affiliation(s)
- Emma Marchal Jones
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Marnie Reed
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Yoon Phaik Ooi
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore, Singapore
| |
Collapse
|
15
|
Gaab J. The reasons for its effectiveness, however, remain in dispute—A tribute to Irving Kirsch. Front Psychol 2022; 13:1037678. [DOI: 10.3389/fpsyg.2022.1037678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 10/24/2022] [Indexed: 11/15/2022] Open
Abstract
Irving Kirsch’s work spans over four decades and provided science and clinical practice with as much invaluable insights in the inner workings of treatments as it provided us and patients with their rights and our duties. Here, two early publications of Irving Kirsch on the topic of psychotherapy and its relation to placebo are revised and put into both a historical and contemporary context to pay tribute to the work of Irving Kirsch.
Collapse
|
16
|
Vincent A, Beck K, Thommen E, Widmer M, Becker C, Loretz N, Gross S, Mueller J, Amacher SA, Bohren C, Schaefert R, Gaab J, Marsch S, Emsden C, Tisljar K, Sutter R, Hunziker S. Post-intensive care syndrome in out-of-hospital cardiac arrest patients: A prospective observational cohort study. PLoS One 2022; 17:e0276011. [PMID: 36240252 PMCID: PMC9565684 DOI: 10.1371/journal.pone.0276011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 09/27/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Intensive care unit patients are at risk for post-intensive care syndrome (PICS), which includes psychological, physical and/or cognitive sequelae after their hospital stay. Our aim was to investigate PICS in adult patients with out-of-hospital cardiac arrest (OHCA). METHODS In this prospective observational cohort study, we assessed risks for PICS at 3 and 12-month follow-up within the following domains: a) physical impairment (EuroQol [EQ-5D-3L]), b) cognitive functioning (Cerebral Performance Category [CPC] score >1, modified Rankin Scale [mRS] >2) and c) psychological burden (Hospital Anxiety and Depression Scale [HADS], Impact of Event Scale-Revised [IES-R]). RESULTS At 3 months, 69/139 patients (50%) met the definition of PICS including 37% in the physical domain, 25% in the cognitive domain and 13% in the psychological domain. Intubation (OR 2.3, 95%CI 1.1 to 5,0 p = 0.03), sedatives (OR 3.4, 95%CI 1 to 11, p = 0.045), mRS at discharge (OR 4.3, 95%CI 1.70 to 11.01, p = 0.002), CPC at discharge (OR 3.3, 95%CI 1.4 to 7.6, p = 0.005) and post-discharge work loss (OR 13.4, 95%CI 1.7 to 107.5, p = 0.014) were significantly associated with PICS. At 12 months, 52/110 (47%) patients had PICS, which was associated with prolonged duration of rehabilitation, higher APACHE scores, and higher mRS and CPC scores at hospital discharge. CONCLUSIONS Nearly half of long-term OHCA survivors show PICS after 3 and 12 months. These high numbers call for more emphasis on appropriate screening and treatment in this patient population. Future studies should evaluate whether early identification of these patients enables preventive strategies and treatment options.
Collapse
Affiliation(s)
- Alessia Vincent
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse, Basel, Switzerland
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Missionsstrasse, Basel, Switzerland
| | - Katharina Beck
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse, Basel, Switzerland
| | - Emanuel Thommen
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse, Basel, Switzerland
| | - Madlaina Widmer
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse, Basel, Switzerland
| | - Christoph Becker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse, Basel, Switzerland
- Emergency Department, University Hospital Basel, Petersgraben, Basel, Switzerland
| | - Nina Loretz
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse, Basel, Switzerland
| | - Sebastian Gross
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse, Basel, Switzerland
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Missionsstrasse, Basel, Switzerland
| | - Jonas Mueller
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse, Basel, Switzerland
| | - Simon A. Amacher
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse, Basel, Switzerland
- Department of Intensive Care, University Hospital Basel, Petersgraben, Basel, Switzerland
| | - Chantal Bohren
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse, Basel, Switzerland
| | - Rainer Schaefert
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse, Basel, Switzerland
- Medical Faculty, University of Basel, Klingelbergstrasse, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Missionsstrasse, Basel, Switzerland
| | - Stephan Marsch
- Department of Intensive Care, University Hospital Basel, Petersgraben, Basel, Switzerland
- Medical Faculty, University of Basel, Klingelbergstrasse, Basel, Switzerland
| | - Christian Emsden
- Department of Intensive Care, University Hospital Basel, Petersgraben, Basel, Switzerland
| | - Kai Tisljar
- Department of Intensive Care, University Hospital Basel, Petersgraben, Basel, Switzerland
| | - Raoul Sutter
- Department of Intensive Care, University Hospital Basel, Petersgraben, Basel, Switzerland
- Medical Faculty, University of Basel, Klingelbergstrasse, Basel, Switzerland
| | - Sabina Hunziker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse, Basel, Switzerland
- Medical Faculty, University of Basel, Klingelbergstrasse, Basel, Switzerland
- * E-mail:
| |
Collapse
|
17
|
Stefanie N, Gaab J. The missing construct: Impathy. Front Psychol 2022; 13:726029. [DOI: 10.3389/fpsyg.2022.726029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/20/2022] [Indexed: 01/10/2023] Open
Abstract
This article is about impathy (introversive empathy), understood as the ability to share in and understand one’s own feelings, which is considered a critical psychological construct relevant for the recovery and maintenance of mental health. However, while the ability to empathize with oneself has received considerable attention from the clinical community, this has not been paralleled by the same scientific scrutiny, which was subject to the ability to empathize with others. Impathy has not yet been operationally defined and thus has remained relatively unexplored, both conceptually and empirically. This work describes an operational definition of impathy with four dimensions: Perceiving, Meta-Position, Accepting Attitude, and Understanding. Issues of differentiation from related constructs are discussed and avenues of clinical applicability are explored, suggesting that impathy exists as a distinct human capacity, which can be assessed and which has important clinical implications. The paper closes with future directions, including the assessment of impathy and possible research questions.
Collapse
|
18
|
Ooi YP, Reed M, Marchal-Jones E, Meyer AH, Gaab J. Sociocultural Adjustment and Well-being Among Third Culture Kids and Their Families: Protocol for a Longitudinal Study. JMIR Res Protoc 2022; 11:e30088. [PMID: 35776500 PMCID: PMC9288103 DOI: 10.2196/30088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 03/25/2022] [Accepted: 04/01/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Increasing globalization has led to more families with children being relocated each year, highlighting the importance of issues, such as adjustment and psychological well-being, in this population. These children, commonly known as third culture kids, often spend a significant part of their developmental years in countries and cultures foreign to them. OBJECTIVE Our longitudinal study aims to examine the roles of cognitive, psychological, sociocultural, and family factors in the longitudinal trajectories of the well-being and sociocultural adjustment of third culture kids and their families over time. METHODS This study adopts both quantitative and qualitative procedures. Data from both procedures will be collected at baseline and at a 1-year follow-up. We aim to recruit 150 to 200 participants between 7 and 17 years old and one of their primary caregivers. After providing informed consent, participants will complete an online survey. Outcome measures include validated questionnaires on well-being and sociocultural adjustment. Predictor measures include validated questionnaires on negative self-thoughts, emotion regulation, resilience, psychological attributes, self-esteem, stress, acculturative stress, cultural intelligence, couple satisfaction, and family functioning. A multiple regression model will be used to analyze quantitative data. In addition, 15 to 20 families who participate in the online survey will be randomly selected to take part in a family interview focusing on questions related to well-being, relocation experiences, cultural issues, and challenges. A concurrent triangulation mixed methods design will be used to analyze and interpret data from both quantitative and qualitative methods. RESULTS As of March 15, 2022, a total of 138 children and 126 parents have completed the baseline online survey. In addition, 44 children and 48 parents have completed the 1-year follow-up online survey. A total of 8 families have completed the baseline family interview, while 4 families have completed the 1-year follow-up interview. Data analyses, transcription of the interview, and preparation for publication are on-going. CONCLUSIONS Findings from this study would enable us to understand the adjustment processes, and risk and protective factors associated with the well-being and sociocultural adjustment of third culture kids and their families in Switzerland, which could have implications on the development of intervention programs for individuals and families to address acculturation and adjustment issues. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/30088.
Collapse
Affiliation(s)
- Yoon Phaik Ooi
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Basel, Switzerland
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - Marnie Reed
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Basel, Switzerland
| | - Emma Marchal-Jones
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Basel, Switzerland
| | - Andrea Hans Meyer
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Basel, Switzerland
| |
Collapse
|
19
|
Locher C, Buergler S, Heimgartner N, Koechlin H, Gerger H, Gaab J, Büchi S. Greater than the sum of the parts: a qualitative content analysis of what constitutes a good treatment in the inpatient setting. BMC Health Serv Res 2022; 22:565. [PMID: 35477407 PMCID: PMC9044573 DOI: 10.1186/s12913-022-07834-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 03/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background The evaluation of psychotherapy is guided by established concepts, such as efficacy and effectiveness, and acceptability. Although these concepts serve as valid proxies, little is known about corresponding criteria for those directly involved in this treatment. This study aimed to explore inpatients’ and health professionals’ definitions of a good treatment in the inpatient setting. Methods Fifteen semi-structured interviews were conducted in a private psychiatric clinic in Switzerland and structured by qualitative content analysis. Different subsamples of the inpatient setting (patients N = 5; psychiatrists N = 5; other health professionals N = 5) were interviewed. Results In total, 546 text passages were grouped in 10 superordinate categories and identified as relevant for the concept of a good treatment. Participants stressed patient-specific (i.e., new insights; basic attitudes), treatment-specific (i.e., therapy methods and expertise; treatment success; therapy setting), and relationship-based (i.e., communication and feedback; relationships within the clinical setting; overcoming challenges and hurdles) components that are indispensable for a good therapeutic process. Components that are related to the clinical inpatient setting (i.e., setting and organization of the clinic; code of conduct) were also highlighted. Conclusions Patients’ and health professionals’ definitions of what constitutes a good treatment entails a wide array of aspects. The clinical setting is seen to offer unique components that are emphasized to have a healing effect. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07834-5.
Collapse
Affiliation(s)
- Cosima Locher
- Clinic for Psychotherapy and Psychosomatics Hohenegg, Meilen, Switzerland. .,Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland. .,Faculty of Health, University of Plymouth, Plymouth, UK.
| | - Sarah Buergler
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Nadja Heimgartner
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Helen Koechlin
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland.,Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Zurich, Switzerland.,Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, USA
| | - Heike Gerger
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Stefan Büchi
- Clinic for Psychotherapy and Psychosomatics Hohenegg, Meilen, Switzerland
| |
Collapse
|
20
|
Wagner C, Gaab J, Locher C, Hediger K. Lack of Effects of the Presence of a Dog on Pain Perception in Healthy Participants-A Randomized Controlled Trial. Front Pain Res (Lausanne) 2022; 2:714469. [PMID: 35295505 PMCID: PMC8915708 DOI: 10.3389/fpain.2021.714469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
Animal-assisted interventions (AAIs) have been shown to be effective in the treatment of pain. Studies suggest that relationships with animals can have comparable qualities to relationships with humans and that this enables animals to provide social support. Further, the presence of an animal can strengthen the therapeutic alliance between patients and treatment providers. This suggests that the analgesic effects of AAI might be mediated by social support from an animal or by strengthening the alliance between the patient and the treatment provider. To test these assumptions, we examined the effects of the presence of a dog on experimentally induced pain in a pain assessment and a pain therapy context. Hundred thirty-two healthy participants were randomly assigned to the conditions “pain,” “pain + dog,” “pain + placebo,” or “pain + placebo + dog.” We collected baseline and posttreatment measurements of heat-pain tolerance and the heat-pain threshold and of the corresponding subjective ratings of heat-pain intensity and unpleasantness as well as of participants' perceptions of the study investigator. The primary outcome was heat-pain tolerance. The presence of the dog did not influence the primary outcome (“pain” vs. “pain + dog”: difference = 0.04, CI = −0.66 to 0.74, p = 0.905; “pain + placebo” vs. “pain + placebo + dog”: difference = 0.43, CI = −0.02 to 0.88, p = 0.059). Participants did also not perceive the study investigator to be more trustworthy in the presence of the dog (“pain” vs. “pain + dog”: difference = 0.10, CI = −0.67 to 0.87, p = 0.796; “pain + placebo” vs. “pain + placebo + dog”: difference = 0.11, CI = −0.43 to 0.64, p = 0.695). The results indicate that the mere presence of a dog does not contribute to pain reduction and that the analgesic effects of AAI that previous studies have found is not replicated in our study as AAI did not increase perceived social support and had no effect on the alliance between the participant and the treatment provider. We assume that the animal most likely needs to be an integrated and plausible part of the treatment rationale so that participants are able to form a treatment-response expectation toward AAI. Clinical Trial Registration: This study was preregistered as a clinical trial on www.clinicaltrials.gov (Identifier: NCT0389814).
Collapse
Affiliation(s)
- Cora Wagner
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Cosima Locher
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland.,School of Psychology, University of Plymouth, Plymouth, United Kingdom.,Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston Children's Hospital, Boston, MA, United States
| | - Karin Hediger
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland.,Clinic for Neurorehabilitation and Paraplegiology, REHAB Basel, Basel, Switzerland.,Human and Animal Health Unit, Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.,Faculty of Psychology, Open University, Heerlen, Netherlands
| |
Collapse
|
21
|
Wicht CA, Mouthon M, Chabwine JN, Gaab J, Spierer L. Experience with opioids does not modify the brain network involved in expectations of placebo analgesia. Eur J Neurosci 2022; 55:1840-1858. [PMID: 35266226 PMCID: PMC9311217 DOI: 10.1111/ejn.15645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/11/2022] [Accepted: 02/24/2022] [Indexed: 12/02/2022]
Abstract
Placebo analgesia (PA) is defined as a psychobiological phenomenon triggered by the information surrounding an analgesic drug instead of its inherent pharmacological properties. PA is hypothesized to be formed through either verbal suggestions or conditioning. The present study aims at disentangling the neural correlates of expectations effects with or without conditioning through prior experience using the model of PA. We addressed this question by recruiting two groups of individuals holding comparable verbally‐induced expectations regarding morphine analgesia but either (i) with or (ii) without prior experience with opioids. We then contrasted the two groups' neurocognitive response to acute heat‐pain induction following the injection of sham morphine using electroencephalography (EEG). Topographic ERP analyses of the N2 and P2 pain evoked potential components allowed to test the hypothesis that PA involves distinct neural networks when induced by expectations with or without prior experience. First, we confirmed that the two groups showed corresponding expectations of morphine analgesia (Hedges' gs < .4 positive control criteria, gs = .37 observed difference), and that our intervention induced a medium‐sized PA (Hedges' gav ≥ .5 positive control, gav = .6 observed PA). We then tested our hypothesis on the recruitment of different PA‐associated brain networks in individuals with versus without prior experience with opioids and found no evidence for a topographic N2 and P2 ERP components difference between the two groups. Our results thus suggest that in the presence of verbally‐induced expectations, modifications in the PA‐associated brain activity by conditioning are either absent or very small.
Collapse
Affiliation(s)
- Corentin A Wicht
- Neurology Unit, Medicine Section, Faculty of Science and Medicine, Fribourg, Switzerland
| | - Michael Mouthon
- Neurology Unit, Medicine Section, Faculty of Science and Medicine, Fribourg, Switzerland
| | - Joelle Nsimire Chabwine
- Neurology Unit, Medicine Section, Faculty of Science and Medicine, Fribourg, Switzerland.,Division of Neurorehabilitation, Fribourg Hospital, Fribourg, Switzerland
| | - Jens Gaab
- Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland
| | - Lucas Spierer
- Neurology Unit, Medicine Section, Faculty of Science and Medicine, Fribourg, Switzerland
| |
Collapse
|
22
|
Gross S, Beck K, Becker C, Gamp M, Mueller J, Loretz N, Amacher SA, Bohren C, Gaab J, Schuetz P, Mueller B, Fux CA, Leuppi JD, Schaefert R, Langewitz W, Trendelenburg M, Breidthardt T, Eckstein J, Osthoff M, Bassetti S, Hunziker S. Perception of physicians and nursing staff members regarding outside versus bedside ward rounds: ancillary analysis of the randomised BEDSIDE-OUTSIDE trial. Swiss Med Wkly 2022; 152:w30112. [PMID: 35072414 DOI: 10.4414/smw.2022.w30112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We recently compared the effects of bedside and outside the room ward rounds on patients' knowledge about their medical care. Here, we report preferences of medical and nursing staff members regarding outside versus bedside ward rounds. METHODS Within this ancillary project of a large multicentre randomised controlled trial, we prospectively conducted a survey of medical and nursing staff members participating in the weekly consultant ward rounds in the internal medicine division of three Swiss teaching hospitals between July 2017 and October 2019. Participants were asked about their preferences on outside versus bedside ward rounds. The primary endpoint was satisfaction of healthcare workers with the ward round measured with a visual analogue scale from 0 to 100. RESULTS Between July 2017 and October 2019, 919 patients were included in the trial, and we received 891 survey responses (nurses 15.6%, residents 26.8%, attending physicians 29.6%, consultants 7.8% and chief physicians 20.2%. In the overall analysis, mean (± standard deviation) satisfaction of healthcare workers was higher with outside the room than bedside ward rounds (78.03 ± 16.96 versus 68.25 ± 21.10 respectively; age-, gender- and centre-adjusted difference of -10.46, 95% confidence interval [CI] -12.73 to -8.19; p <0.001). Healthcare workers reported better time management, more discussion of sensitive topics and less discomfort when case presentations were conducted outside the room. A stratified subgroup analysis considering the profession, however, showed strong differences, with nurses being more satisfied with bedside rounds (69.20 ± 20.32 versus 65.32 ± 20.92, respectively; adjusted difference 4.35, 95% CI -1.79 to 10.51; p <0.001), whereas attending physicians showed higher satisfaction with outside the room rounds (82.63 ± 13.87 versus 66.59 ± 21.82; adjusted difference -16.51, 95% CI -20.29 to -12.72; p = 0.002). CONCLUSIONS While bedside ward rounds are considered more patient centred and are preferred by the nursing staff, physicians prefer outside the room presentation of patients during ward rounds because of the perceived better discussion of sensitive topics, better time management and less staff discomfort. Continuous training including medical communication techniques may help to increase satisfaction of physicians with bedside ward rounds. Trial registration: https://clinicaltrials.gov/ct2/show/NCT03210987.
Collapse
Affiliation(s)
- Sebastian Gross
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Switzerland
| | - Katharina Beck
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Switzerland
| | - Christoph Becker
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Switzerland.,Emergency Department, University Hospital Basel, Switzerland
| | - Martina Gamp
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Switzerland
| | - Jonas Mueller
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Switzerland
| | - Nina Loretz
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Switzerland
| | - Simon A Amacher
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Switzerland.,Intensive Care, University Hospital Basel, Switzerland
| | - Chantal Bohren
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland
| | - Philipp Schuetz
- Faculty of Medicine, University of Basel, Switzerland.,Division of Internal Medicine, Kantonsspital Aarau, Switzerland
| | - Beat Mueller
- Faculty of Medicine, University of Basel, Switzerland.,Division of Internal Medicine, Kantonsspital Aarau, Switzerland
| | - Christoph A Fux
- Faculty of Medicine, University of Basel, Switzerland.,Division of Internal Medicine, Kantonsspital Aarau, Switzerland
| | - Jörg D Leuppi
- Faculty of Medicine, University of Basel, Switzerland.,University Clinic of Medicine, Kantonsspital Baselland, Liestal, Switzerland
| | - Rainer Schaefert
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Switzerland.,Faculty of Medicine, University of Basel, Switzerland
| | - Wolf Langewitz
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Switzerland.,Faculty of Medicine, University of Basel, Switzerland
| | - Marten Trendelenburg
- Faculty of Medicine, University of Basel, Switzerland.,Division of Internal Medicine, University Hospital Basel, Switzerland
| | - Tobias Breidthardt
- Faculty of Medicine, University of Basel, Switzerland.,Division of Internal Medicine, University Hospital Basel, Switzerland
| | - Jens Eckstein
- Faculty of Medicine, University of Basel, Switzerland.,Division of Internal Medicine, University Hospital Basel, Switzerland
| | - Michael Osthoff
- Faculty of Medicine, University of Basel, Switzerland.,Division of Internal Medicine, University Hospital Basel, Switzerland
| | - Stefano Bassetti
- Faculty of Medicine, University of Basel, Switzerland.,Division of Internal Medicine, University Hospital Basel, Switzerland
| | - Sabina Hunziker
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Switzerland.,Faculty of Medicine, University of Basel, Switzerland
| |
Collapse
|
23
|
Vincent A, Urben T, Becker C, Beck K, Daetwyler C, Wilde M, Gaab J, Langewitz W, Hunziker S. Breaking bad news: A randomized controlled trial to test a novel interactive course for medical students using blended learning. Patient Educ Couns 2022; 105:105-113. [PMID: 33994021 DOI: 10.1016/j.pec.2021.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 04/07/2021] [Accepted: 05/03/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Breaking bad news (BBN) is challenging for physicians and patients and specific communication strategies aim to improve these situations. This study evaluates whether an E-learning assignment could improve medical students' accurate recognition of BBN communication techniques. METHODS This randomized controlled trial was conducted at the University of Basel. After a lecture on BBN, 4th year medical students were randomized to an intervention receiving an E-learning assignment on BBN or to a control group. Both groups then worked on an examination video and identified previously taught BBN elements shown in a physician-patient interaction. The number of correctly, misclassified and incorrectly identified BBN communication elements as well as missed opportunities were assessed in the examination video. RESULTS We included 160 medical students (55% female). The number of correctly identified BBN elements did not differ between control and intervention group (mean [SD] 3.51 [2.50] versus 3.72 [2.34], p = 0.58). However, the mean number of inappropriate BBN elements was significantly lower in the intervention than in the control group (2.33 [2.57] versus 3.33 [3.39], p = 0.037). CONCLUSIONS Use of an E-learning tool reduced inappropriate annotations regarding BBN communication techniques. PRACTICE IMPLICATIONS This E-learning might help to further advance communication skills in medical students.
Collapse
Affiliation(s)
- Alessia Vincent
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland; Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Tabita Urben
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Christoph Becker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland; Emergency Department, University Hospital Basel, Basel, Switzerland
| | - Katharina Beck
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | | | - Michael Wilde
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Wolf Langewitz
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Sabina Hunziker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland.
| |
Collapse
|
24
|
Sezer D, de Leeuw M, Netzer C, Dieterle M, Meyer A, Buergler S, Locher C, Ruppen W, Gaab J, Schneider T. Open-Label Placebo Treatment for Acute Postoperative Pain (OLP-POP Study): Study Protocol of a Randomized Controlled Trial. Front Med (Lausanne) 2021; 8:687398. [PMID: 34805194 PMCID: PMC8602681 DOI: 10.3389/fmed.2021.687398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 10/07/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Open-label placebos have been proposed as way of using long recognized analgesic placebo effects in an ethical manner. Recent evidence shows efficacy of open-label placebos for clinical conditions, but there is need for more research on open-label placebos in acute pain. In the treatment of acute postoperative pain, minimization of opioid related side effects remains one of the key challenges. Therefore, this study aims at investigating the potential of adding unconditioned open-label placebos to treatment as usual as a means of reducing opioid consumption and its related side effects in patients with acute postoperative pain. Methods and Analysis: This is the protocol of an ongoing single site randomized controlled trial. The first patient was enrolled in May 2020. In total, 70 patients suffering from acute postoperative pain following dorsal lumbar interbody fusion are randomized to either a treatment as usual group or an experimental intervention group. The treatment as usual group consists of participants receiving a patient-controlled morphine pump. On day 1 and 2 post-surgery, patients in the intervention group receive, in addition to treatment as usual, two open-label placebo injections per day along with an evidence-based treatment rationale explaining the mechanisms of placebos. The primary outcome is measured by means of self-administered morphine during day 1 and 2 post-surgery. Several other outcome measures including pain intensity and adverse events as well as potential predictors of placebo response are assessed. Analysis of covariance will be used to answer the primary research question and additional statistical techniques such as generalized linear mixed models will be applied to model the temporal course of morphine consumption. Discussion: This study will provide valuable insights into the efficacy of open-label placebos in acute pain and will potentially constitute an important step toward the implementation of open-label placebos in the clinical management of acute postoperative pain. In addition, it will shed light on a cost-efficient and patient-centered strategy to reduce opioid consumption and its related side effects, without any loss in pain management efficacy. Ethics and Dissemination: The "Ethikkommission Nordwest- und Zentralschweiz" (BASEC2020-00099) approved the study protocol. Results of the analysis will be submitted for publication in a peer-reviewed journal. Clinical Trial Registration: The study is registered at ClinicalTrials.gov (NCT04339023) and is listed in the Swiss national registry at kofam.ch (SNCTP000003720).
Collapse
Affiliation(s)
- Dilan Sezer
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Matthijs de Leeuw
- Pain Unit, Department of Anesthesiology, University Hospital of Basel, Basel, Switzerland
| | - Cordula Netzer
- Department of Spine Surgery, University Hospital of Basel, Basel, Switzerland
| | - Markus Dieterle
- Pain Unit, Department of Anesthesiology, University Hospital of Basel, Basel, Switzerland
| | - Andrea Meyer
- Division of Clinical Psychology and Epidemiology, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Sarah Buergler
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Cosima Locher
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland.,Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Wilhelm Ruppen
- Pain Unit, Department of Anesthesiology, University Hospital of Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Tobias Schneider
- Pain Unit, Department of Anesthesiology, University Hospital of Basel, Basel, Switzerland
| |
Collapse
|
25
|
Eberle K, Grosse Holtforth M, Inderbinen M, Gaab J, Nestoriuc Y, Trachsel M. Informed consent in psychotherapy: a survey on attitudes among psychotherapists in Switzerland. BMC Med Ethics 2021; 22:150. [PMID: 34772408 PMCID: PMC8588676 DOI: 10.1186/s12910-021-00718-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The legal and ethical guidelines of psychological professional associations stipulate that informed consent by patients is an essential prerequisite for psychotherapy. Despite this awareness of the importance of informed consent, there is little empirical evidence on what psychotherapists' attitudes towards informed consent are and how informed consent is implemented in psychotherapeutic practice. METHODS 155 psychotherapists in Switzerland completed an online survey assessing their attitudes regarding informed consent. RESULTS Among the surveyed psychotherapists, there was a high consensus on important information that should be communicated to patients in the context of informed consent. Almost all psychotherapists rated confidentiality and its exemptions (95%) and self-determined decision-making (97%) as important. The importance to disclose information regarding fees and the empirical effectiveness of the provided treatment, were both seen as important by more than 80% of participants. The disclosure of personal information about the therapist was rated as important by 60%. Other aspects, which are not direct components of informed consent but rather overarching goals, were also evaluated rather homogeneously: self-determined decision making of the patient was rated as important by almost all of the surveyed psychotherapists (97%). The following components were also judged as important by a majority of the participants: promotion of hope (80%) and discussion of treatment goals (93%). Most psychotherapists described the implementation of informed consent as an ongoing process, rather than a one-time event during the first session of therapy. Therapists' age, postgraduate training, treated patient group, and setting influenced attitudes towards informed consent. CONCLUSIONS The present study shows that informed consent is perceived by psychotherapists as both a challenge and a resource. The implementation of informed consent in psychotherapy requires further research from a clinical and ethical perspective.
Collapse
Affiliation(s)
- Klara Eberle
- Specialist Department for the Prevention of Eating Disorders, University Hospital Bern, Bern, Switzerland
| | - Martin Grosse Holtforth
- Department of Psychology, University of Bern, Bern, Switzerland.,Division of Psychosomatic Medicine, University Hospital Bern, Bern, Switzerland
| | - Marc Inderbinen
- Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Jens Gaab
- Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Yvonne Nestoriuc
- Helmut-Schmidt-University/University of the Federal Armed Forces Hamburg, Hamburg, Germany.,Systems Neuroscience, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Manuel Trachsel
- Institute of Biomedical Ethics and History of Medicine, University of Zurich (UZH), Zürich, Switzerland. .,Clinical Ethics Unit, University Hospital Basel (USB) and University Psychiatric Clinics (UPK), Basel, Switzerland.
| |
Collapse
|
26
|
Evers AWM, Colloca L, Blease C, Gaab J, Jensen KB, Atlas LY, Beedie CJ, Benedetti F, Bingel U, Büchel C, Bussemaker J, Colagiuri B, Crum AJ, Finniss DG, Geers AL, Howick J, Klinger R, Meeuwis SH, Meissner K, Napadow V, Petrie KJ, Rief W, Smeets I, Wager TD, Wanigasekera V, Vase L, Kelley JM, Kirsch I. What Should Clinicians Tell Patients about Placebo and Nocebo Effects? Practical Considerations Based on Expert Consensus. Psychother Psychosom 2021; 90:49-56. [PMID: 33075796 DOI: 10.1159/000510738] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/23/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Clinical and laboratory studies demonstrate that placebo and nocebo effects influence various symptoms and conditions after the administration of both inert and active treatments. OBJECTIVE There is an increasing need for up-to-date recommendations on how to inform patients about placebo and nocebo effects in clinical practice and train clinicians how to disclose this information. METHODS Based on previous clinical recommendations concerning placebo and nocebo effects, a 3-step, invitation-only Delphi study was conducted among an interdisciplinary group of internationally recognized experts. The study consisted of open- and closed-ended survey questions followed by a final expert meeting. The surveys were subdivided into 3 parts: (1) informing patients about placebo effects, (2) informing patients about nocebo effects, and (3) training clinicians how to communicate this information to the patients. RESULTS There was consensus that communicating general information about placebo and nocebo effects to patients (e.g., explaining their role in treatment) could be beneficial, but that such information needs to be adjusted to match the specific clinical context (e.g., condition and treatment). Experts also agreed that training clinicians to communicate about placebo and nocebo effects should be a regular and integrated part of medical education that makes use of multiple formats, including face-to-face and online modalities. CONCLUSIONS The current 3-step Delphi study provides consensus-based recommendations and practical considerations for disclosures about placebo and nocebo effects in clinical practice. Future research is needed on how to optimally tailor information to specific clinical conditions and patients' needs, and on developing standardized disclosure training modules for clinicians.
Collapse
Affiliation(s)
- Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands, .,Erasmus University Rotterdam & Delft University of Technology, Rotterdam/Delft, The Netherlands,
| | - Luana Colloca
- Departments of Pain Translational Symptoms Science and Anesthesiology, School of Nursing and Medicine, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Charlotte Blease
- General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jens Gaab
- Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Karin B Jensen
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Lauren Y Atlas
- National Center for Complementary and Integrative Health, National Institute of Mental Health, and National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, USA
| | - Chris J Beedie
- School of Psychology, University of Kent, Canterbury, United Kingdom
| | - Fabrizio Benedetti
- Physiology and Neuroscience, University of Turin Medical School, Turin, Italy
| | - Ulrike Bingel
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Christian Büchel
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jet Bussemaker
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Ben Colagiuri
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Alia J Crum
- Department of Psychology, Stanford University, Stanford, California, USA
| | | | - Andrew L Geers
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
| | - Jeremy Howick
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Regine Klinger
- Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefanie H Meeuwis
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Karin Meissner
- Division of Health Promotion, University of Applied Sciences, Coburg, Germany
| | - Vitaly Napadow
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, USA
| | - Keith J Petrie
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Ionica Smeets
- Science Communication and Society, Institute of Biology, Leiden University, Leiden, The Netherlands
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire, USA
| | | | - Lene Vase
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - John M Kelley
- Beth Israel Deaconess Medical Center, Harvard Medical School, Program in Placebo Studies, Boston, Massachusetts, USA
| | - Irving Kirsch
- Beth Israel Deaconess Medical Center, Harvard Medical School, Program in Placebo Studies, Boston, Massachusetts, USA
| | | |
Collapse
|
27
|
Evers AWM, Colloca L, Blease C, Gaab J, Jensen KB, Atlas LY, Beedie CJ, Benedetti F, Bingel U, Büchel C, Bussemaker J, Colagiuri B, Crum AJ, Finniss DG, Geers AL, Howick J, Klinger R, Meeuwis SH, Meissner K, Napadow V, Petrie KJ, Rief W, Smeets I, Wager TD, Wanigasekera V, Vase L, Kelley JM, Kirsch I. "Consensus on Placebo and Nocebo Effects Connects Science with Practice:" Reply to "Questioning the Consensus on Placebo and Nocebo Effects". Psychother Psychosom 2021; 90:213-214. [PMID: 33631769 DOI: 10.1159/000514435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 12/23/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands, .,Erasmus University Rotterdam & Delft University of Technology, Rotterdam/Delft, The Netherlands,
| | - Luana Colloca
- Departments of Pain Translational Symptoms Science and Anesthesiology, School of Nursing and Medicine, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Charlotte Blease
- General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jens Gaab
- Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Karin B Jensen
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Lauren Y Atlas
- National Center for Complementary and Integrative Health, National Institute of Mental Health, and National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland, USA
| | - Chris J Beedie
- School of Psychology, University of Kent, Canterbury, United Kingdom
| | - Fabrizio Benedetti
- Physiology and Neuroscience, University of Turin Medical School, Turin, Italy
| | - Ulrike Bingel
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Christian Büchel
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jet Bussemaker
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Ben Colagiuri
- School of Psychology, University of Sydney, Sydney, New South Wales, Australia
| | - Alia J Crum
- Department of Psychology, Stanford University, Stanford, California, USA
| | | | - Andrew L Geers
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
| | - Jeremy Howick
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Regine Klinger
- Center for Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefanie Helena Meeuwis
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Karin Meissner
- Division of Health Promotion, University of Applied Sciences, Coburg, Germany
| | - Vitaly Napadow
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, USA
| | - Keith J Petrie
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | - Ionica Smeets
- Science Communication and Society, Institute of Biology, Leiden University, Leiden, The Netherlands
| | - Tor D Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire, USA
| | | | - Lene Vase
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - John M Kelley
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Irving Kirsch
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | |
Collapse
|
28
|
Werner CP, Birkhaeuer J, Locher C, Gerger H, Heimgartner N, Colagiuri B, Gaab J. Price information influences the subjective experience of wine: A framed field experiment. Food Qual Prefer 2021. [DOI: 10.1016/j.foodqual.2021.104223] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
29
|
Abstract
OBJECTIVES To analyse participants' concepts about the open-label placebo (OLP) effect; to explore their views about the discussion points that are applied in conventional OLP trials and to examine their experiences of taking part in an OLP trial. DESIGN A qualitative study using thematic analysis of semistructured interviews that were nested within a randomised controlled trial investigating experimental OLP analgesia (registered at ClinicalTrials.gov: NCT02578420). PARTICIPANTS 30 healthy adults who took part in the randomised controlled trial. RESULTS Participants mostly conceptualised placebo as something that is inert and requires deception in order to be effective. Interviewees used a broad definition of placebos, going beyond a conventional notion of sugar pills. In contrast to the conventional OLP rationale, participants seldom emphasised classical conditioning as a mechanism of placebo effects, stressing a variety of other well-established components through which placebos might be therapeutic, whereas the conventional OLP disclosures state that 'a positive attitude helps but is not necessary', participants in our study applied other attitudes, such as 'it's worth a try'. When asked about their experiences during the trial, the majority emphasised that the concept of OLP was completely novel to them. Participants were rather sceptical about the efficacy of the intervention. CONCLUSION Integrating lay perspectives into the scientific rationale of OLP treatments might enhance the plausibility and credibility of the rationale in ethical treatments. TRIAL REGISTRATION NUMBER NCT02578420.
Collapse
Affiliation(s)
- Cosima Locher
- Department of Consultation-Liaison Psychiatry and Psychosomatics, University Hospital Zurich, Zurich, Switzerland
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Sarah Buergler
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Antje Frey Nascimento
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Linda Kost
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Charlotte Blease
- General Medicine and Primary Care, Harvard Medical School, Boston, Massachusetts, USA
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| |
Collapse
|
30
|
Vincent A, Beck K, Becker C, Zumbrunn S, Ramin-Wright M, Urben T, Quinto A, Schaefert R, Meinlschmidt G, Gaab J, Reinhardt T, Bassetti S, Schuetz P, Hunziker S. Psychological burden in patients with COVID-19 and their relatives 90 days after hospitalization: A prospective observational cohort study. J Psychosom Res 2021; 147:110526. [PMID: 34051515 PMCID: PMC8132501 DOI: 10.1016/j.jpsychores.2021.110526] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/17/2021] [Accepted: 05/17/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVE COVID-19 causes psychological distress for patients and their relatives at short term. However, little research addressed the longer-term psychological outcomes in this population. Therefore, we aimed to prospectively assess clinically relevant psychological distress in hospitalized patients with COVID-19 and their relatives 90 days after hospital discharge. METHODS This exploratory, prospective, observational cohort study included consecutive adult patients hospitalized in two Swiss tertiary-care hospitals between March and June 2020 for confirmed COVID-19 and their relatives. The primary outcome was psychological distress defined as clinically relevant symptoms of anxiety and/or depression measured with the Hospital Anxiety and Depression Scale (HADS) 90 days after discharge. RESULTS Clinically relevant psychological distress 90 days after hospital discharge was present in 23/108 patients (21.3%) and 22/120 relatives (18.3%). For patients, risk and protective factors associated with clinically relevant psychological distress included sociodemographic, illness-related, psychosocial, and hospital-related factors. A model including these factors showed good discrimination, with an area under the receiver-operating characteristic curve (AUC) of 0.84. For relatives, relevant risk factors were illness-related, psychosocial, and hospital-related factors. Resilience was negatively associated with anxiety and depression in both patients and relatives and regarding PTSD in relatives only. CONCLUSION COVID-19 is linked to clinically relevant psychological distress in a subgroup of patients and their relatives 90 days after hospitalization. If confirmed in an independent and larger patient cohort, knowledge about these potential risk and protective factors might help to develop preventive strategies.
Collapse
Affiliation(s)
- Alessia Vincent
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland,Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland
| | - Katharina Beck
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Christoph Becker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland,Emergency Department, University Hospital Basel, Basel, Switzerland
| | - Samuel Zumbrunn
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Maja Ramin-Wright
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Tabita Urben
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Adrian Quinto
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Rainer Schaefert
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland,Department for Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland,Medical Faculty of the University of Basel, Basel, Switzerland
| | - Gunther Meinlschmidt
- Department for Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland,Medical Faculty of the University of Basel, Basel, Switzerland,Division of Clinical Psychology and Cognitive Behavioural Therapy, International Psychoanalytic University, Berlin, Germany,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland
| | - Thomas Reinhardt
- Human Resources & Leadership Development, University Hospital Basel, Basel, Switzerland
| | - Stefano Bassetti
- Medical Faculty of the University of Basel, Basel, Switzerland,Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Philipp Schuetz
- Medical Faculty of the University of Basel, Basel, Switzerland,Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Sabina Hunziker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland; Department for Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland.
| |
Collapse
|
31
|
Heimgartner N, Meier S, Grolimund S, Ponti S, Arpagaus S, Kappeler F, Gaab J. Randomized controlled evaluation of the psychophysiological effects of social support stress management in healthy women. PLoS One 2021; 16:e0252568. [PMID: 34086752 PMCID: PMC8177426 DOI: 10.1371/journal.pone.0252568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/17/2021] [Indexed: 11/19/2022] Open
Abstract
Considering the high and increasing prevalence of stress, approaches to mitigate stress-related biological processes become a matter of public health. Since supportive social interactions contribute substantially to mental and physical health, we set out to develop a social support stress management intervention and examined its effects on psychophysiological stress responses as well as self-reported stress in healthy women. In a parallel-group randomized controlled trial, registered in the DSRK (DRKS00017427), 53 healthy women were randomly assigned to a social support stress management or a waitlist control condition. All participants underwent a standardized psychosocial stress test where physiological and emotional stress responses were assessed by repeated measurements of cortisol, heart rate, heart rate variability and state anxiety. Also, all participants completed self-report questionnaires of perceived stress and social support at pre-intervention, post-intervention and follow-up four weeks later. Participants in the social support stress management showed a significantly attenuated integrated state anxiety response in comparison to those in the control condition, but conditions did not differ in any of the assessed physiological stress responses. The intervention significantly reduced perceived stress in comparison to the control condition, but perceived stress levels returned to baseline at follow-up. Our results indicated that the intervention had no effect on physiological responses to acute psychosocial stress, even though anxiety responses to stress were attenuated. However, the social support stress management intervention had a significant, albeit transient impact on perceived stress.
Collapse
Affiliation(s)
- Nadja Heimgartner
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
- * E-mail:
| | - Sibylle Meier
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Stefanie Grolimund
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Svetlana Ponti
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Silvana Arpagaus
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Flurina Kappeler
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| |
Collapse
|
32
|
Inderbinen M, Schaefer K, Schneeberger A, Gaab J, Garcia Nuñez D. Relationship of Internalized Transnegativity and Protective Factors With Depression, Anxiety, Non-suicidal Self-Injury and Suicidal Tendency in Trans Populations: A Systematic Review. Front Psychiatry 2021; 12:636513. [PMID: 34093262 PMCID: PMC8172993 DOI: 10.3389/fpsyt.2021.636513] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 04/08/2021] [Indexed: 11/24/2022] Open
Abstract
Discrimination heavily impacts the lives of trans populations and causes adverse mental health outcomes. As stated by the Gender Minority Stress Model self-stigmatization could play an important role in this process. The aim of this systematic review is to investigate whether there is a positive association between self-stigmatization and mental health and to identify mediation factors. Studies which quantitatively investigated the association between internalized transnegativity and selected mental health outcomes (depression, anxiety, non-suicidal self-injury, suicidal tendency) in self-identified trans populations were included. Comprehensive search of 5 large databases in June 2020 and the following screening and selection procedure, performed by two researchers separately, identified 14 studies which met criteria. The relationship to be studied was reported with correlation and/or mediation analysis of cross-sectional data. IT was directly positively associated with depression, anxiety and suicidal tendency in most of the reviewed studies. Data indicates links between self-stigmatization and other general mental health stressors such as rumination and thwarted belongingness. Community connectedness showed to be the strongest protective factor for mental health impairments. These results should be considered in transition counseling. More research is needed to better understand the underlying mechanisms of the GMSM and to address unsolved operationalization and measurement issues.
Collapse
Affiliation(s)
- Marc Inderbinen
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Kristin Schaefer
- Department of Plastic, Reconstructive and Aesthetic Surgery and Hand Surgery, Basel University Hospital, Basel, Switzerland
| | | | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - David Garcia Nuñez
- Center for Gender Variance, Basel University Hospital, University of Basel, Basel, Switzerland
| |
Collapse
|
33
|
Blease C, Kharko A, Annoni M, Gaab J, Locher C. Machine Learning in Clinical Psychology and Psychotherapy Education: A Mixed Methods Pilot Survey of Postgraduate Students at a Swiss University. Front Public Health 2021; 9:623088. [PMID: 33898374 PMCID: PMC8064116 DOI: 10.3389/fpubh.2021.623088] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background: There is increasing use of psychotherapy apps in mental health care. Objective: This mixed methods pilot study aimed to explore postgraduate clinical psychology students' familiarity and formal exposure to topics related to artificial intelligence and machine learning (AI/ML) during their studies. Methods: In April-June 2020, we conducted a mixed-methods online survey using a convenience sample of 120 clinical psychology students enrolled in a two-year Masters' program at a Swiss University. Results: In total 37 students responded (response rate: 37/120, 31%). Among respondents, 73% (n = 27) intended to enter a mental health profession, and 97% reported that they had heard of the term "machine learning." Students estimated 0.52% of their program would be spent on AI/ML education. Around half (46%) reported that they intended to learn about AI/ML as it pertained to mental health care. On 5-point Likert scale, students "moderately agreed" (median = 4) that AI/M should be part of clinical psychology/psychotherapy education. Qualitative analysis of students' comments resulted in four major themes on the impact of AI/ML on mental healthcare: (1) Changes in the quality and understanding of psychotherapy care; (2) Impact on patient-therapist interactions; (3) Impact on the psychotherapy profession; (4) Data management and ethical issues. Conclusions: This pilot study found that postgraduate clinical psychology students held a wide range of opinions but had limited formal education on how AI/ML-enabled tools might impact psychotherapy. The survey raises questions about how curricula could be enhanced to educate clinical psychology/psychotherapy trainees about the scope of AI/ML in mental healthcare.
Collapse
Affiliation(s)
- Charlotte Blease
- General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Anna Kharko
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Marco Annoni
- Interdepartmental Center for Research Ethics and Integrity CNR, Rome, Italy.,Fondazione Umberto Veronesi, Milan, Italy
| | - Jens Gaab
- Department of Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland
| | - Cosima Locher
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom.,Department of Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland.,Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
34
|
Koechlin H, Kossowsky J, Lam TL, Barthel J, Gaab J, Berde CB, Schwarzer G, Linde K, Meissner K, Locher C. Nonpharmacological Interventions for Pediatric Migraine: A Network Meta-analysis. Pediatrics 2021; 147:peds.2019-4107. [PMID: 33688031 DOI: 10.1542/peds.2019-4107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Migraine is a common neurologic disorder in children and adolescents. However, a comparison of multiple nonpharmacological treatments is lacking. OBJECTIVE To examine whether nonpharmacological treatments are more effective than waiting list and whether there are differences between interventions regarding efficacy. DATA SOURCES Systematic review and network meta-analysis of studies in Medline, Cochrane, Embase, and PsycINFO published through August 5, 2019. STUDY SELECTION Randomized controlled trials of nonpharmacological treatments in children and adolescents diagnosed with episodic migraine. DATA EXTRACTION Effect sizes, calculated as standardized mean differences (SMDs) for the primary outcome efficacy, were assessed in a random-effects model. RESULTS Twelve studies (N = 576) were included. When interventions were classified into groups on the basis of similarity of treatment components, self-administered treatments, biofeedback, relaxation, psychological treatments, and psychological placebos were significantly more effective than waiting list with effect sizes ranging between SMD = 1.14 (95% confidence interval, 0.09 to 2.19) for long-term psychological placebos to SMD = 1.44 (95% confidence interval, 0.26 to 2.62) for short-term self-administered treatments. However, when all interventions were examined individually (ie, 1 node per intervention), none were significantly more effective compared with waiting list, mainly because of lack of statistical power. LIMITATIONS Because of our focus on pediatric migraine, only a small number of studies could be included. CONCLUSIONS Our findings reveal that components of nonpharmacological interventions are effective in treating pediatric migraine. Some effects have to be interpreted carefully because they are based on small studies. Future researchers should identify factors associated with individual responses in large, multicentered studies.
Collapse
Affiliation(s)
- Helen Koechlin
- Division of Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland.,Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts.,Contributed equally as co-first authors
| | - Joe Kossowsky
- Division of Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland.,Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts.,Contributed equally as co-first authors
| | - Thanh Lan Lam
- Institute of Medical Psychology, LMU Munich, Munich, Germany
| | | | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland
| | - Charles B Berde
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Guido Schwarzer
- Institute of Medical Biometry and Statistics, University of Freiburg, Breisgau, Germany
| | - Klaus Linde
- Institute of General Practice and Health Services Research, School of Medicine, Technical University Munich, Munich, Germany
| | - Karin Meissner
- Institute of Medical Psychology, LMU Munich, Munich, Germany.,Division of Integrative Health Promotion, Coburg University of Applied Sciences, Coburg, Germany
| | - Cosima Locher
- Division of Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland; .,Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts.,Faculty of Health, University of Plymouth, Plymouth, United Kingdom; and.,Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
35
|
Gerger H, Werner CP, Gaab J, Cuijpers P. Comparative efficacy and acceptability of expressive writing treatments compared with psychotherapy, other writing treatments, and waiting list control for adult trauma survivors: a systematic review and network meta-analysis. Psychol Med 2021; 52:1-13. [PMID: 33634766 PMCID: PMC9772920 DOI: 10.1017/s0033291721000143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 11/23/2020] [Accepted: 01/12/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Expressive writing about a traumatic event is promising in treating posttraumatic stress disorder (PTSD) symptoms in adult trauma survivors. To date, the comparative efficacy and acceptability of this approach is uncertain. Therefore, we aimed to examine the comparative efficacy and acceptability of expressive writing treatments. METHODS We included 44 RCTs with 7724 participants contributing 54 direct comparisons between expressive writing (EW), enhanced writing (i.e. including additional therapist contact or individualized writing assignments; EW+), PTSD psychotherapies (PT), neutral writing (NW), and waiting-list control (WL). RESULTS EW, EW+, PT, and NW were statistically significantly more efficacious than WL at the longest available follow-up, with SMDs (95% CI) of -0.78 (-1.10 to -0.46) for PT, -0.81 (-1.02 to -0.61) for EW+ , -0.43 (-0.65 to -0.21) for EW, and -0.37 (-0.61 to -0.14) for NW. We found small to moderate differences between the active treatments. At baseline mean PTSD severity was significantly lower in EW+ compared with WL. We found considerable heterogeneity and inconsistency and we found elevated risk of bias in at least one of the bias dimensions in all studies. When EW+-WL comparisons were excluded from the analyses EW+ was no longer superior compared with EW. CONCLUSIONS The summarized evidence confirms that writing treatments may contribute to improving PTSD symptoms in medium to long-term. Methodological issues in the available evidence hamper definite conclusions regarding the comparative efficacy and acceptability of writing treatments. Adequately sized comparative randomized controlled trials preferably including all four active treatment approaches, reporting long-term data, and including researchers with balanced preferences are needed.
Collapse
Affiliation(s)
- Heike Gerger
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Christoph Patrick Werner
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, Australia
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| |
Collapse
|
36
|
Busmann M, Meyer AH, Wrege J, Lang UE, Gaab J, Walter M, Euler S. Vulnerable narcissism as beneficial factor for the therapeutic alliance in borderline personality disorder. Clin Psychol Psychother 2021; 28:1222-1229. [PMID: 33619789 DOI: 10.1002/cpp.2570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 01/23/2021] [Accepted: 01/24/2021] [Indexed: 01/13/2023]
Abstract
Evidence suggests that narcissism and borderline personality disorder are associated with each other. This naturalistic study investigated the predictive value of grandiose and vulnerable narcissism on the development of the therapeutic alliance in short-term psychodynamic treatment across 12 weeks. The sample consisted of 99 patients with borderline personality disorder. Narcissism was assessed with the Pathological Narcissism Inventory at treatment onset. The therapeutic alliance was rated with the Scale to Assess Therapeutic Relationships by both patient and therapist at four time points during treatment. Results showed a significant predictive value of vulnerable narcissism on the therapeutic alliance, revealing a more beneficial progression for patients with higher vulnerable narcissism. Grandiose narcissism had no predictive value on the therapeutic alliance. The study strengthens the clinical utility of the concept of vulnerable narcissism towards the evaluation of treatment processes in borderline personality disorder.
Collapse
Affiliation(s)
- Mareike Busmann
- Psychiatric University Hospital Basel, Centre of Psychosomatics and Psychotherapy, Basel, Switzerland
| | - Andrea H Meyer
- Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Johannes Wrege
- Psychiatric University Hospital Basel, Centre of Psychosomatics and Psychotherapy, Basel, Switzerland
| | - Undine E Lang
- Psychiatric University Hospital Basel, Centre of Psychosomatics and Psychotherapy, Basel, Switzerland
| | - Jens Gaab
- Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Marc Walter
- Psychiatric University Hospital Basel, Centre of Psychosomatics and Psychotherapy, Basel, Switzerland
| | - Sebastian Euler
- Department of Consultation Psychiatry and Psychosomatics, University Hospital Zürich, Zürich, Switzerland
| |
Collapse
|
37
|
Favaretto M, De Clercq E, Gaab J, Elger BS. First do no harm: An exploration of researchers' ethics of conduct in Big Data behavioral studies. PLoS One 2020; 15:e0241865. [PMID: 33152039 PMCID: PMC7644008 DOI: 10.1371/journal.pone.0241865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/21/2020] [Indexed: 11/24/2022] Open
Abstract
Research ethics has traditionally been guided by well-established documents such as the Belmont Report and the Declaration of Helsinki. At the same time, the introduction of Big Data methods, that is having a great impact in behavioral research, is raising complex ethical issues that make protection of research participants an increasingly difficult challenge. By conducting 39 semi-structured interviews with academic scholars in both Switzerland and United States, our research aims at exploring the code of ethics and research practices of academic scholars involved in Big Data studies in the fields of psychology and sociology to understand if the principles set by the Belmont Report are still considered relevant in Big Data research. Our study shows how scholars generally find traditional principles to be a suitable guide to perform ethical data research but, at the same time, they recognized and elaborated on the challenges embedded in their practical application. In addition, due to the growing introduction of new actors in scholarly research, such as data holders and owners, it was also questioned whether responsibility to protect research participants should fall solely on investigators. In order to appropriately address ethics issues in Big Data research projects, education in ethics, exchange and dialogue between research teams and scholars from different disciplines should be enhanced. In addition, models of consultancy and shared responsibility between investigators, data owners and review boards should be implemented in order to ensure better protection of research participants.
Collapse
Affiliation(s)
| | - Eva De Clercq
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | | |
Collapse
|
38
|
Kunnel John R, Xavier B, Waldmeier A, Meyer AH, Gaab J. The governmental ranking of class and the academic performance of Indian adolescents. PLoS One 2020; 15:e0241483. [PMID: 33137108 PMCID: PMC7605817 DOI: 10.1371/journal.pone.0241483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 10/15/2020] [Indexed: 11/21/2022] Open
Abstract
Social and economic factors are commonly examined as contextual variables that
predict academic achievement, apart from the educational environment. In India,
a major segment of the socioeconomic status of students comprises the
governmental stratification of population into three broad classes, viz.,
scheduled castes/tribes (SC-ST), other backward classes (OBC) and general class
(GC). In this study, we examined the association of these governmental classes
with the academic performance of Indian adolescents who enjoy the same school
environment. Psychological measures of self-esteem and life satisfaction as well
as demographic variables such as gender, age and family income were also
examined as covariates. The study was conducted on a convenient sample of 858
students of X and XI grades. Based on multilevel regression models, the
relationship between governmental classes and academic performance was
significantly positive, wherein higher level of class predicted better academic
performance. The study highlighted that students from the same school
environment performed differently based on their social status and that this
difference was not a function of their family income, thus pointing to potential
role of non-economic aspects of the governmental stratification including caste
affiliation. The findings indicate the need for further examining as well as
planning to improve the aspects of students’ social status that impact academic
performance.
Collapse
Affiliation(s)
- Roshin Kunnel John
- Division of Clinical Psychology and Psychotherapy, Department of
Psychology, University of Basel, Basel, Switzerland
- * E-mail:
| | - Boby Xavier
- Division of Clinical Psychology and Psychotherapy, Department of
Psychology, University of Basel, Basel, Switzerland
| | - Anja Waldmeier
- Division of Clinical Psychology and Psychotherapy, Department of
Psychology, University of Basel, Basel, Switzerland
| | - Andrea Hans Meyer
- Division of Developmental and Personality Psychology, Department of
Psychology, University of Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Department of
Psychology, University of Basel, Basel, Switzerland
| |
Collapse
|
39
|
Locher C, Kossowsky J, Koechlin H, Lam TL, Barthel J, Berde CB, Gaab J, Schwarzer G, Linde K, Meissner K. Efficacy, Safety, and Acceptability of Pharmacologic Treatments for Pediatric Migraine Prophylaxis: A Systematic Review and Network Meta-analysis. JAMA Pediatr 2020; 174:341-349. [PMID: 32040139 PMCID: PMC7042942 DOI: 10.1001/jamapediatrics.2019.5856] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
IMPORTANCE Migraine is one of the most common neurologic disorders in children and adolescents. However, a quantitative comparison of multiple preventive pharmacologic treatments in the pediatric population is lacking. OBJECTIVE To examine whether prophylactic pharmacologic treatments are more effective than placebo and whether there are differences between drugs regarding efficacy, safety, and acceptability. DATA SOURCES Systematic review and network meta-analysis of studies in MEDLINE, Cochrane, Embase, and PsycINFO published through July 2, 2018. STUDY SELECTION Randomized clinical trials of prophylactic pharmacologic treatments in children and adolescents diagnosed as having episodic migraine were included. Abstract, title, and full-text screening were conducted independently by 4 reviewers. DATA EXTRACTION AND SYNTHESIS Data extraction was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis network meta-analysis guidelines. Quality was assessed with the Cochrane Risk of Bias tool. Effect sizes, calculated as standardized mean differences for primary outcomes and risk ratios for discontinuation rates, were assessed in a random-effects model. MAIN OUTCOMES AND MEASURES Primary outcomes were efficacy (ie, migraine frequency, number of migraine days, number of headache days, headache frequency, or headache index), safety (ie, treatment discontinuation owing to adverse events), and acceptability (ie, treatment discontinuation for any reason). RESULTS Twenty-three studies (2217 patients) were eligible for inclusion. Prophylactic pharmacologic treatments included antiepileptics, antidepressants, calcium channel blockers, antihypertensive agents, and food supplements. In the short term (<5 months), propranolol (standard mean difference, 0.60; 95% CI, 0.03-1.17) and topiramate (standard mean difference, 0.59; 95% CI, 0.03-1.15) were significantly more effective than placebo. However, the 95% prediction intervals for these medications contained the null effect. No significant long-term effects for migraine prophylaxis relative to placebo were found for any intervention. CONCLUSIONS AND RELEVANCE Prophylactic pharmacologic treatments have little evidence supporting efficacy in pediatric migraine. Future research could (1) identify factors associated with individual responses to pharmacologic prophylaxis, (2) analyze fluctuations of migraine attack frequency over time and determine the most clinically relevant length of probable prophylactic treatment, and (3) identify nonpharmacologic targets for migraine prophylaxis.
Collapse
Affiliation(s)
- Cosima Locher
- School of Psychology, University of Plymouth, Plymouth, England,Division of Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland,Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joe Kossowsky
- Division of Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland,Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Helen Koechlin
- Division of Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland,Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Thanh Lan Lam
- Institute of Medical Psychology, Medical Faculty, LMU Munich, Munich, Germany
| | - Johannes Barthel
- Institute of Medical Psychology, Medical Faculty, LMU Munich, Munich, Germany
| | - Charles B Berde
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland
| | | | - Klaus Linde
- School of Medicine, Institute of General Practice and Health Services Research, Technical University Munich, Munich, Germany
| | - Karin Meissner
- Institute of Medical Psychology, Medical Faculty, LMU Munich, Munich, Germany,Division of Integrative Health Promotion, Coburg University of Applied Sciences, Coburg, Germany
| |
Collapse
|
40
|
Abstract
INTRODUCTION Recent evidence suggests that for certain clinical conditions, placebos can improve clinical outcomes even without deception. These so-called open-label placebos (OLPs) bear the advantage of a significant lower risk of adverse events and comply with ethical principles. Although premenstrual syndrome (PMS) seems to be considerably susceptible to placebo effects, no study has examined open-OLP responses on PMS. METHODS AND ANALYSIS To test the efficacy of OLPs in women suffering from PMS, a clinical randomised controlled trial including two OLP study groups (with and without treatment rationale) was designed to investigate on the effect on PMS. PMS symptoms are monitored on a daily basis via a symptom diary, adverse events are monitored intermittently. The study started in spring 2018 and patients will be included until a maximum of 150 participants are randomised. Besides the primary outcome PMS symptom intensity and interference, an array of further variables is assessed. Multilevel modelling will be used for data analyses. ETHICS AND DISSEMINATION Ethics approval was obtained from the Ethics Committee Northwest and Central Switzerland. Results of the main analysis and of secondary analyses will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBERS: (1) ClinicalTrials.gov (NCT03547661); (2) Swiss national registration (SNCTP000002809).
Collapse
Affiliation(s)
- Antje Frey Nascimento
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Basel, Switzerland
| | - Irving Kirsch
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Joe Kossowsky
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Basel, Switzerland
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrea Meyer
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Cosima Locher
- Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Basel, Switzerland
- School of Psychology, University of Plymouth, Plymouth, UK
| |
Collapse
|
41
|
Blease CR, Arnott T, Kelley JM, Proctor G, Kube T, Gaab J, Locher C. Attitudes About Informed Consent: An Exploratory Qualitative Analysis of UK Psychotherapy Trainees. Front Psychiatry 2020; 11:183. [PMID: 32231601 PMCID: PMC7083167 DOI: 10.3389/fpsyt.2020.00183] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 02/25/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Ethical informed consent to psychotherapy has recently been the subject of in-depth analysis among healthcare ethicists. Objective: This study aimed to explore counseling and psychotherapy students' views and understanding about informed consent to psychological treatments. Methods: Two focus groups were conducted with a total of 10 students enrolled in a Masters course in counseling and psychotherapy at a British university. Questions concerned participants' understanding of informed consent including judgments about client capacity; the kinds of information that should be disclosed; how consent might be obtained; and their experiences of informed consent, both as a client and as a therapist. Focus groups were audio-recorded, transcribed, and analyzed using qualitative content analysis. Coding was conducted independently by three authors. Results: Comments were classified into three main themes: (1) the reasons and justifications for informed consent; (2) informed consent processes; and (3) the hidden ethics curriculum. Some trainees expressed significant doubts about the importance of informed consent. However, participants also identified the need to establish the clients' voluntariness and their right to be informed about confidentiality issues. In general, the format and processes pertaining to informed consent raised considerable questions and uncertainties. Participants were unsure about rules surrounding client capacity; expressed misgivings about describing treatment techniques; and strikingly, most trainees were skeptical about the clinical relevance of the evidence-base in psychotherapy. Finally, trainees' experiences as clients within obligatory psychotherapy sessions were suggestive of a "hidden ethics curriculum"-referring to the unintended transmission of norms and practices within training that undermine the explicit guidance expressed in formal professional ethics codes. Some students felt coerced into therapy, and some reported not undergoing informed consent processes. Reflecting on work placements, trainees expressed mixed views, with some unclear about who was responsible for informed consent. Conclusions: This qualitative study presents timely information on psychotherapy students' views about informed consent to psychotherapy. Major gaps in students' ethical, conceptual, and procedural knowledge were identified, and comments suggested the influence of a hidden curriculum in shaping norms of practice. Implications: This exploratory study raises important questions about the preparedness of psychotherapy students to fulfill their ethical obligations.
Collapse
Affiliation(s)
- Charlotte R Blease
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.,School of Psychology, University College Dublin, Dublin, Ireland
| | - Tim Arnott
- School of Healthcare, University of Leeds, Leeds, United Kingdom
| | - John M Kelley
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.,Department of Psychology, Endicott College, Beverly, MA, United States
| | - Gillian Proctor
- School of Healthcare, University of Leeds, Leeds, United Kingdom
| | - Tobias Kube
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.,Pain and Psychotherapy Lab, University of Koblenz and Landau, Landau, Germany
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Cosima Locher
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland.,School of Psychology, University of Plymouth, Plymouth, United Kingdom
| |
Collapse
|
42
|
Gerger H, Nascimento AF, Locher C, Gaab J, Trachsel M. What are the Key Characteristics of a 'Good' Psychotherapy? Calling for Ethical Patient Involvement. Front Psychiatry 2020; 11:406. [PMID: 32581856 PMCID: PMC7292227 DOI: 10.3389/fpsyt.2020.00406] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 04/21/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The evidence-based practice movement clearly defines the relevant components of a good treatment. In the present article, we elaborate on how the active involvement of patients within psychotherapy can and should be increased in order to respect ethical considerations. Our arguments complement the requirements of evidence-based practice, and are independent of the actual psychotherapeutic treatment approach being used. METHOD Theoretical and ethical analysis. RESULTS In order to respect patient autonomy, psychotherapy needs to be transparent and honest when it comes to disclosing the relevant factors for promoting therapeutic change. It has been argued that ethical informed consent needs to include empirically supported patient information. In this paper we go one step further: we outline that fully respecting ethical considerations in psychotherapeutic treatment necessarily calls for acknowledging and strengthening the active role of patients in the course of psychotherapy. Accordingly, patients need not only to be informed openly and transparently about the planned treatment, the treatment rationale, and the expected prognosis of improvement in the course of psychotherapy, but they also need to be actively involved in the decision-making process and during the entire process of psychotherapeutic treatment. CONCLUSIONS Our arguments support the tendency that can be observed in health care in recent years towards more active patient involvement across different health-care domains, but also in clinical research. This article offers an ethical perspective on the question what defines a 'good psychotherapy', which, hopefully, will help to leave behind some of the ongoing psychotherapy debates and move the field forward.
Collapse
Affiliation(s)
- Heike Gerger
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland.,Department of General Practice, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Antje Frey Nascimento
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Cosima Locher
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland.,School of Psychology, University of Plymouth, Plymouth, United Kingdom.,Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Manuel Trachsel
- Faculty of Medicine, Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland.,Clinical Ethics Unit, University Hospital of Basel, Basel, Switzerland
| |
Collapse
|
43
|
Markert C, Gomm C, Ehlert U, Gaab J, Nater UM. Effects of cognitive-behavioral stress management training in individuals with functional somatic symptoms - an exploratory randomized controlled trial. Stress 2019; 22:696-706. [PMID: 31198076 DOI: 10.1080/10253890.2019.1625329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Stress is discussed as a risk factor in the manifestation and maintenance of functional somatic (FS) symptoms. However, there is a lack of evidence regarding the effects of cognitive-behavioral stress management training (CBSM) on FS symptoms and the (potentially mediating) role of the neuroendocrine system. This study aims to examine stress-related psychological and neuroendocrine changes after receiving a brief CBSM in individuals with FS symptoms. Forty-three participants of both sexes, who reported at least one current FS symptom, were analyzed (treatment group (TG) n = 21, waitlist control group (WCG) n = 22) using mixed models. Number of symptoms, psychological stress, and salivary cortisol levels were assessed at pretreatment, posttreatment, and 6 months later. Mixed model analyses did not reveal significant differences between the TG and the WCG regarding number of FS symptoms (p > 0.05), psychological stress measures (p > 0.05) or the cortisol awakening response (CAR) (p > 0.05). The TG presented lower diurnal cortisol levels at pretreatment, posttreatment and 6 months later (p < 0.05). We did not find significant beneficial effects that were specific to CBSM. Further research should be undertaken to investigate the effects of CBSM on real life stress or laboratory stressors in subjects with FS symptoms. Moreover, learning cognitive restructuring and establishing new coping strategies into everyday life might require more time. This study is a first step in filling the gap in understanding the influences of CBSM as a brief intervention on psychological and biological aspects of stress in participants with FS symptoms and will hopefully inform larger trials of CBSM for FS symptoms.
Collapse
Affiliation(s)
| | - Claudia Gomm
- Department of Psychology, University of Zurich , Zurich , Switzerland
| | - Ulrike Ehlert
- Department of Psychology, University of Zurich , Zurich , Switzerland
| | - Jens Gaab
- Department of Psychology, University of Basel , Basel , Switzerland
| | - Urs M Nater
- Department of Psychology, University of Vienna , Vienna , Austria
| |
Collapse
|
44
|
Abstract
Psychotherapy and placebo have a long history, and both have been shown to have significant and clinically meaningful effects. In the last 100 years and up to today, psychotherapy has been subject to an enduring and often heated debate about its mechanisms and its possible relationship to placebos and their effects. However, there is little awareness of the placebo effects' counterpart-nocebo effects (from Latin "I will harm")-in the context of psychotherapy. Embedded in the controversy of whether psychotherapy and placebo share some unwanted proximity in terms of effects and mechanisms, the question arises which role nocebo effects may play in relation to psychotherapy. By using two examples, this article analyzes and discusses two different kinds of possible associations between psychotherapy and nocebo effects. We close with possibilities of how to prevent the occurrence of nocebo effects in psychotherapy, including some specific recommendations for clinical practice.
Collapse
Affiliation(s)
- Cosima Locher
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
- School of Psychology, University of Plymounth, Plymouth, United Kingdom
| | - Helen Koechlin
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Heike Gerger
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| |
Collapse
|
45
|
Gaab J, Bürgin D, Locher C, Werner C, Urech S, Bratschi C, Garcia LB, Hauke M, Bitter S, Bohny M, Bentz D. Endogenous cortisol and conditioned placebo effects on pain - A randomized trial. J Psychosom Res 2019; 123:109739. [PMID: 31376878 DOI: 10.1016/j.jpsychores.2019.109739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/07/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Abstract
Placebo effects can be induced by learning and conditioning processes, which in turn are influenced and modulated by glucocorticoids. Accordingly, previous research has shown that intervention-related associative learning can be modulated through exogenous as well as endogenous glucocorticoids. Thus, the aim of this study was to elucidate whether placebo effects induced by conditioning is modulated by daily fluctuations of endogenous cortisol levels in healthy male and female subjects. Overall 77 participants underwent a two-phased placebo conditioning paradigm for pain analgesia. Subjects were randomized in two groups, which underwent placebo preconditioning either in the morning (08:00-10:00, i.e. with high endogenous cortisol levels) or in the afternoon (16:00-18:00, i.e. with low endogenous cortisol levels). Placebo effects were assessed two days later at noontime (12:00-13:00), with possible differences between groups as an indicator of glucocorticoid modulation on the placebo learning. Results indicated a significant conditioned placebo-induced analgesia, resulting in a placebo effect of small to medium size. Cortisol levels on conditioning day significantly differed between groups and cortisol levels were similar during assessment of placebo effects. Groups did not differ in their mean reduction in pain sensation, thus the placebo effect was not affected by differences in cortisol levels during the conditioning of placebo effects. The present study does not indicate a moderation of placebo conditioning by endogenous glucocorticoid levels.
Collapse
Affiliation(s)
- Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland.
| | - David Bürgin
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland
| | - Cosima Locher
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland
| | - Christoph Werner
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland
| | - Stefanie Urech
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland
| | - Christine Bratschi
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland
| | - Lorena Bartolomé Garcia
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland
| | - Milena Hauke
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland
| | - Salome Bitter
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland
| | - Marc Bohny
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland
| | - Dorothée Bentz
- Division of Cognitive Neuroscience, Faculty of Psychology, University of Basel, Switzerland; Psychiatric University Clinics, University of Basel, Switzerland
| |
Collapse
|
46
|
Abstract
Placebos are usually employed deceptively in clinical trials in order to control for non-specific effects. However, since placebos themselves have been found to cause clinically relevant changes and in some cases are indistinguishable from the verum they are tested against, this theoretically inert, but practically effective intervention has become a scientific discipline in its own right. In this review, it is argued that placebos are generic and genuine biopsychosocial interventions and as such are highly interesting candidates for a psychoneuroendocrinological perspective. Yet, despite a considerable conceptual proximity between explanatory models of placebos and their effects with psychoneuroendocrine models and findings, placebos have thus far not been subject to systematic psychoneuroendocrine examination. Consequently, it would be highly interesting and informative to make placebos the target of psychoneuroendocrine scrutiny.
Collapse
Affiliation(s)
- Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland.
| |
Collapse
|
47
|
Kunnel John R, Xavier B, Waldmeier A, Meyer A, Gaab J. Psychometric Evaluation of the BFI-10 and the NEO-FFI-3 in Indian Adolescents. Front Psychol 2019; 10:1057. [PMID: 31143151 PMCID: PMC6520757 DOI: 10.3389/fpsyg.2019.01057] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 04/24/2019] [Indexed: 11/13/2022] Open
Abstract
The Five-Factor Model (FFM) is one of the most commonly examined constructs of personality across cultures in recent times. However, there is a lacuna of evidence for the suitability of FFM measures for Indian adolescent school students below the age of 17 years. We carried out two independent studies for the psychometric evaluation of the measures BFI-10 and NEO-FFI-3 on Indian adolescent school students. Both studies examined two socio-culturally distinct linguistic groups of secondary and senior secondary school students with a total sample of N = 1117 students. There was very limited support for a five-factor solution in both cases. Model fit was poor when applying FFM measures to our samples, whether applying confirmatory factor analysis or exploratory structural equation models. The results provide evidence against using adult personality measures with adolescents without separate psychometric validation and applying the Western age norms to Indian students without considering that the process of personality consolidation during adolescence may not be identical across cultures.
Collapse
Affiliation(s)
- Roshin Kunnel John
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Boby Xavier
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Anja Waldmeier
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Andrea Meyer
- Division of Clinical Psychology and Epidemiology, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| |
Collapse
|
48
|
Abstract
The use of second languages is ubiquitous in modern societies. Despite many benefits, there is also evidence for this to cause or exacerbate stress (e.g. in the form of foreign language anxiety). The aim of the present study was to examine to which extent speaking a second language increases acute psychobiological stress in a social context. A total of N = 63 healthy Swiss males were randomly allocated to one of two conditions: completing the Trier Social Stress Test (TSST) in Swiss German (their first language) vs. standard German (perceived as a second language). Repeated measures of self-reported stress, anxiety, salivary cortisol, and heart rate were obtained. Participants speaking standard German showed significantly larger cortisol increases in response to the TSST when compared to those speaking Swiss German (F(1, 61) = 5.53, p = .022, eta2 = .083). The two groups did not differ in terms of self-reported stress and anxiety, nor in their heart rate response (all p > .216). This study provides initial evidence that speaking a second language in social contexts increases the cortisol stress response. Future research should explore the short- and long-term effects this may have in populations frequently using second languages (e.g. learners of a second language, migrants).
Collapse
Affiliation(s)
- Susanne Fischer
- a Clinical Psychology and Psychotherapy , Institute of Psychology, University of Zurich , Zurich , Switzerland
| | - Corinne M Spoerri
- a Clinical Psychology and Psychotherapy , Institute of Psychology, University of Zurich , Zurich , Switzerland
| | - Andrea Gmuer
- a Clinical Psychology and Psychotherapy , Institute of Psychology, University of Zurich , Zurich , Switzerland
| | - Manuela Wingeier
- a Clinical Psychology and Psychotherapy , Institute of Psychology, University of Zurich , Zurich , Switzerland
| | - Urs M Nater
- b Clinical Psychology, Department of Psychology , University of Vienna , Vienna , Austria
| | - Jens Gaab
- c Clinical Psychology and Psychotherapy, Department of Psychology , University of Basel , Basel , Switzerland
| | - Ulrike Ehlert
- a Clinical Psychology and Psychotherapy , Institute of Psychology, University of Zurich , Zurich , Switzerland
| | - Beate Ditzen
- d Heidelberg University, University Hospital, Institute of Medical Psychology , Heidelberg , Germany
| |
Collapse
|
49
|
Busmann M, Wrege J, Meyer AH, Ritzler F, Schmidlin M, Lang UE, Gaab J, Walter M, Euler S. Alternative Model of Personality Disorders (DSM-5) Predicts Dropout in Inpatient Psychotherapy for Patients With Personality Disorder. Front Psychol 2019; 10:952. [PMID: 31114528 PMCID: PMC6502965 DOI: 10.3389/fpsyg.2019.00952] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 04/10/2019] [Indexed: 11/13/2022] Open
Abstract
Objective Criterion A serves as the fundamental diagnostic criterion of the Alternative Model of Personality Disorders in section III of the Diagnostic and Statistical Manual 5. Consisting of a self- and an interpersonal dimension, it defines the construct of personality functioning as a general and dimensional factor of personality disorders. This study aimed to explore criterion A along with well-established treatment dropout predictors, e.g., sociodemographic factors, personality disorder diagnosis, symptom severity, and the therapeutic alliance. Methods The sample consisted of 132 patients diagnosed with personality disorder in a psychotherapeutic inpatient treatment. Cox proportional hazard regression models and a lasso model were applied. Results 28% of the sample prematurely discontinued treatment. The risk for dropout was 2.3 times higher for patients with high impairments in self-functioning as assessed with criterion A. Moreover, a positive therapist-rated therapeutic alliance was associated with a lower dropout risk. Conclusion The study suggests criterion A is a useful clinical indicator by identifying patients with personality disorder with a higher risk for dropout. An individualized therapeutic approach for such patients might be required.
Collapse
Affiliation(s)
- Mareike Busmann
- Department of Psychosomatics and Psychotherapy, Psychiatric University Hospital Basel, University of Basel, Basel, Switzerland
| | - Johannes Wrege
- Department of Psychosomatics and Psychotherapy, Psychiatric University Hospital Basel, University of Basel, Basel, Switzerland
| | - Andrea H Meyer
- Department of Psychology, University of Basel, Basel, Switzerland
| | - Franziska Ritzler
- Department of Psychosomatics and Psychotherapy, Psychiatric University Hospital Basel, University of Basel, Basel, Switzerland
| | - Moira Schmidlin
- Department of Psychosomatics and Psychotherapy, Psychiatric University Hospital Basel, University of Basel, Basel, Switzerland
| | - Undine E Lang
- Department of Psychosomatics and Psychotherapy, Psychiatric University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jens Gaab
- Department of Psychology, University of Basel, Basel, Switzerland
| | - Marc Walter
- Department of Psychosomatics and Psychotherapy, Psychiatric University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sebastian Euler
- Department of Psychosomatics and Psychotherapy, Psychiatric University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Consultation Psychiatry and Psychosomatics, University Hospital Zürich, Zurich, Switzerland
| |
Collapse
|
50
|
Denzinger A, Bingisser MB, Ehrbar V, Huggenberger HJ, Urech C, Woessmer B, Gaab J, Roth B, Rochlitz C, Alder J. Web-based counseling for families with parental cancer: Baseline findings and lessons learned. J Psychosoc Oncol 2019; 37:599-615. [PMID: 31010412 DOI: 10.1080/07347332.2019.1602576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: This is the first study in Switzerland to report on psychological adjustment in children of a parent with cancer using a web-based intervention during cancer therapy. Design/Sample: Twenty-two families participated in this randomized controlled web-based intervention program. Methods: Quality of life and emotional-behavioral well-being of children were examined using child self-reports, and parent proxy-reports. Furthermore, family communication and satisfaction and feedback on the web-based program were assessed. Findings: Children's first stage adjustment to parental cancer did not show detrimental patterns. The "lesson learned" in this setting emphasizes the challenge to reach families in need. The web-based program was appreciated as an additional source of information and support in this mostly highly functioning population. Conclusion: While feasibility was shown, it remains unclear how to contact families with lower psychosocial functioning.
Collapse
Affiliation(s)
- Anna Denzinger
- Department of Obstetrics and Gynaecology, University Hospital Basel , Basel , Switzerland
| | | | - Verena Ehrbar
- Department of Obstetrics and Gynaecology, University Hospital Basel , Basel , Switzerland
| | - Harriet J Huggenberger
- Department of Obstetrics and Gynaecology, University Hospital Basel , Basel , Switzerland
| | - Corinne Urech
- Department of Obstetrics and Gynaecology, University Hospital Basel , Basel , Switzerland
| | - Brigitta Woessmer
- Division of Psychosomatic, Department of Internal Medicine, University Hospital Basel , Basel , Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel , Basel , Switzerland
| | - Binia Roth
- Child and Adolescent Psychiatry of Baselland , Bruderholz , Switzerland
| | | | - Judith Alder
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel , Basel , Switzerland
| |
Collapse
|