1
|
Scholten S, Rubel JA, Glombiewski JA, Milde C. What time-varying network models based on functional analysis tell us about the course of a patient's problem. Psychother Res 2024:1-19. [PMID: 38588679 DOI: 10.1080/10503307.2024.2328304] [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: 04/20/2023] [Accepted: 03/05/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Relations among psychological variables are assumed to be complex and to vary over time. Personalized networks can model multivariate complex interactions. The development of time-varying networks allows to model the variation of parameters over time. Objectives: We aimed to determine the value of time-varying networks for clinical practice. Methods: We applied time-varying mixed graphical models (TV-MGM) and time-varying vector autoregressive models (TV-VAR) to intensive longitudinal data of nine participants with depressive symptoms (n = 6) or anxiety (n = 3). Results: Most of the participants showed temporal changes in network topology within the assessment period of 30 days. Time-varying networks of participants with small, medium, and large time variability in edge parameters clearly show the different temporal evolvements of dynamic interactions between variables. The case example indicates clinical utility but also limitations to the application of time-varying networks in clinical practice. Conclusion: Time-varying network models provide a data-driven and exploratory approach that could complement current diagnostic standards by reflecting interacting, often mutually reinforcing processes of mental health problems and by accounting for variation over time. They can be used to generate hypotheses for further confirmatory and clinical testing.
Collapse
Affiliation(s)
- Saskia Scholten
- RPTU Kaiserslautern-Landau, Pain and Psychotherapy Research Lab, Landau, Germany
| | - Julian A Rubel
- Psychotherapy Research Lab, Osnabrueck University, Osnabrueck, Germany
| | - Julia A Glombiewski
- RPTU Kaiserslautern-Landau, Pain and Psychotherapy Research Lab, Landau, Germany
| | - Christopher Milde
- RPTU Kaiserslautern-Landau, Pain and Psychotherapy Research Lab, Landau, Germany
| |
Collapse
|
2
|
Spaeth AM, Koenig S, Everaert J, Glombiewski JA, Kube T. Are depressive symptoms linked to a reduced pupillary response to novel positive information?-An eye tracking proof-of-concept study. Front Psychol 2024; 15:1253045. [PMID: 38464618 PMCID: PMC10920252 DOI: 10.3389/fpsyg.2024.1253045] [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: 07/05/2023] [Accepted: 01/31/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction Depressive symptoms have been linked to difficulties in revising established negative beliefs in response to novel positive information. Recent predictive processing accounts have suggested that this bias in belief updating may be related to a blunted processing of positive prediction errors at the neural level. In this proof-of-concept study, pupil dilation in response to unexpected positive emotional information was examined as a psychophysiological marker of an attenuated processing of positive prediction errors associated with depressive symptoms. Methods Participants (N = 34) completed a modified version of the emotional Bias Against Disconfirmatory Evidence (BADE) task in which scenarios initially suggest negative interpretations that are later either confirmed or disconfirmed by additional information. Pupil dilation in response to the confirmatory and disconfirmatory information was recorded. Results Behavioral results showed that depressive symptoms were related to difficulties in revising negative interpretations despite disconfirmatory positive information. The eye tracking results pointed to a reduced pupil response to unexpected positive information among people with elevated depressive symptoms. Discussion Altogether, the present study demonstrates that the adapted emotional BADE task can be appropriate for examining psychophysiological aspects such as changes in pupil size along with behavioral responses. Furthermore, the results suggest that depression may be characterized by deviations in both behavioral (i.e., reduced updating of negative beliefs) and psychophysiological (i.e., decreased pupil dilation) responses to unexpected positive information. Future work should focus on a larger sample including clinically depressed patients to further explore these findings.
Collapse
Affiliation(s)
- Alexandra M. Spaeth
- Department of Psychology, University of Kaiserslautern-Landau, Landau, Germany
| | - Stephan Koenig
- Department of Psychology, University of Kaiserslautern-Landau, Landau, Germany
| | - Jonas Everaert
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, Netherlands
- Research Group of Quantitative Psychology and Individual Differences, KU Leuven, Leuven, Belgium
| | | | - Tobias Kube
- Department of Psychology, University of Kaiserslautern-Landau, Landau, Germany
| |
Collapse
|
3
|
Milde C, Brinskelle LS, Glombiewski JA. Does Active Inference Provide a Comprehensive Theory of Placebo Analgesia? Biol Psychiatry Cogn Neurosci Neuroimaging 2024; 9:10-20. [PMID: 37678710 DOI: 10.1016/j.bpsc.2023.08.007] [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: 05/22/2023] [Revised: 08/21/2023] [Accepted: 08/28/2023] [Indexed: 09/09/2023]
Abstract
Placebo interventions generate mismatches between expected pain and sensory signals from which pain states are inferred. Because we lack direct access to bodily states, we can only infer whether nociceptive activity indicates tissue damage or results from noise in sensory channels. Predictive processing models propose to make optimal inferences using prior knowledge given noisy sensory data. However, these models do not provide a satisfactory explanation of how pain relief expectations are translated into physiological manifestations of placebo responses. Furthermore, they do not account for individual differences in the ability to endogenously regulate nociceptive activity in predicting placebo analgesia. The brain not only passively integrates prior pain expectations with nociceptive activity to infer pain states (perceptual inference) but also initiates various types of actions to ensure that sensory data are consistent with prior pain expectations (active inference). We argue that depending on whether the brain interprets conflicting sensory data (prediction errors) as a signal to learn from or noise to be attenuated, the brain initiates opposing types of action to facilitate learning from sensory data or, conversely, to enhance the biasing influence of prior pain expectations on pain perception. Furthermore, we discuss the role of stress, anxiety, and unpredictability of pain in influencing the weighting of prior pain expectations and sensory data and how they relate to the individual ability to regulate nociceptive activity (endogenous pain modulation). Finally, we provide suggestions for future studies to test the implications of the active inference model of placebo analgesia.
Collapse
Affiliation(s)
- Christopher Milde
- Department of Psychology, Rheinland-Pfälzische Technische Universität Kaiserslautern-Landau, Landau, Germany.
| | - Laura S Brinskelle
- Department of Psychology, Rheinland-Pfälzische Technische Universität Kaiserslautern-Landau, Landau, Germany
| | - Julia A Glombiewski
- Department of Psychology, Rheinland-Pfälzische Technische Universität Kaiserslautern-Landau, Landau, Germany
| |
Collapse
|
4
|
Riecke J, Rief W, Lemmer G, Glombiewski JA. Sustainability of cognitive behavioural interventions for chronic back pain: A long-term follow-up. Eur J Pain 2024; 28:83-94. [PMID: 37470301 DOI: 10.1002/ejp.2160] [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: 05/11/2022] [Revised: 02/17/2023] [Accepted: 07/05/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND There is a significant research gap with respect to the long-term sustainability of psychological treatment effects in chronic pain patients. This study aimed to investigate long-term treatment effects of two psychological treatments: cognitive behavioural therapy (CBT) as a broad-spectrum approach and exposure as a specific intervention for fear-avoidant pain patients. METHODS Patients with chronic low back pain were randomized to CBT or exposure in vivo. Long-term follow-up (LTFU) data were available for 64 patients up to 8 years after treatment, with a response rate of 73%. The primary outcomes were pain-related disability and pain intensity and secondary outcomes were emotional distress, psychological flexibility, catastrophizing and pain-related fear. The data analysis was performed with longitudinal multilevel modelling. RESULTS Multilevel analyses showed improvements in all primary outcomes as well as all secondary outcomes from pre-treatment to LTFU for both treatments. The mean proportion of cases meeting reliable and clinical improved criteria in all primary outcome was 36% (range: 22%-46%) in the exposure group and 50% (range: 33%-60%) in the CBT group. Dropout analyses revealed significantly higher deterioration rates over time. Pre-treatment to LTFU effect sizes of the primary outcomes ranged from 0.54 to 1.59. CONCLUSIONS Our results indicate that the effects of psychological treatments might be stable over several years. Treatment gains for exposure as a stand-alone treatment seem to be of shorter duration than a general CBT intervention. Thus, psychological treatments might offer a promising and sustainable long-term perspective for patients with chronic back pain. SIGNIFICANCE The long-term stability of treatment effects is a highly neglected issue despite its inherent importance in the context of chronic pain. This study is the first to investigate treatment effects of cognitive behavioural therapy and in vivo exposure in chronic back pain sufferers up to 8 years after treatment. The findings contribute to an understanding of the sustainability of psychological cognitive behavioural therapy-based intervention effects.
Collapse
Affiliation(s)
- Jenny Riecke
- Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Gunnar Lemmer
- Department of Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | | |
Collapse
|
5
|
Kube T, Riecke J, Heider J, Glombiewski JA, Rief W, Barsky AJ. Same same, but different: effects of likelihood framing on concerns about a medical disease in patients with somatoform disorders, major depression, and healthy people. Psychol Med 2023; 53:7729-7734. [PMID: 37309182 DOI: 10.1017/s0033291723001654] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Research has shown that patients with somatoform disorders (SFD) have difficulty using medical reassurance (i.e. normal results from diagnostic testing) to revise concerns about being seriously ill. In this brief report, we investigated whether deficits in adequately interpreting the likelihood of a medical disease may contribute to this difficulty, and whether patients' concerns are altered by different likelihood framings. METHODS Patients with SFD (N = 60), patients with major depression (N = 32), and healthy volunteers (N = 37) were presented with varying likelihoods for the presence of a serious medical disease and were asked how concerned they are about it. The likelihood itself was varied, as was the format in which it was presented (i.e. negative framing focusing on the presence of a disease v. positive framing emphasizing its absence; use of natural frequencies v. percentages). RESULTS Patients with SFD reported significantly more concern than depressed patients and healthy people in response to low likelihoods (i.e. 1: 100 000 to 1:10), while the groups were similarly concerned for likelihoods ⩾1:5. Across samples, the same mathematical likelihood caused significantly different levels of concern depending on how it was framed, with the lowest degree of concern for a positive framing approach and higher concern for natural frequencies (e.g. 1:100) than for percentages (e.g. 1%). CONCLUSIONS The results suggest a specific deficit of patients with SFD in interpreting low likelihoods for the presence of a medical disease. Positive framing approaches and the use of percentages rather than natural frequencies can lower the degree of concern.
Collapse
Affiliation(s)
- Tobias Kube
- Harvard Medical School, Program in Placebo Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, 02115, Boston, MA, USA
- RPTU Kaiserslautern-Landau, Department of Clinical Psychology and Psychotherapy, Ostbahnstr. 10, 76829 Landau, Germany
| | - Jenny Riecke
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Gutenbergstr. 18, 35032 Marburg, Germany
| | - Jens Heider
- RPTU Kaiserslautern-Landau, Department of Clinical Psychology and Psychotherapy, Ostbahnstr. 10, 76829 Landau, Germany
- Schön Clinic Roseneck, Am Roseneck 6, 83209 Prien am Chiemsee, Germany
| | - Julia A Glombiewski
- RPTU Kaiserslautern-Landau, Department of Clinical Psychology and Psychotherapy, Ostbahnstr. 10, 76829 Landau, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Gutenbergstr. 18, 35032 Marburg, Germany
| | - Arthur J Barsky
- Harvard Medical School, Program in Placebo Studies, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, 02115, Boston, MA, USA
- Brigham and Women's Hospital, Department of Psychiatry, 75 Francis Street, Boston, MA 02115, USA
| |
Collapse
|
6
|
Milde C, Glombiewski JA, Wilhelm M, Schemer L. Psychological factors predict higher odds and impairment of post-COVID symptoms: A prospective study. Psychosom Med 2023:00006842-990000000-00124. [PMID: 37199433 DOI: 10.1097/psy.0000000000001214] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
OBJECTIVE The causes of the long-term persistence of symptoms after a SARS-CoV-2 infection (i.e., post-COVID syndrome) remain elusive. Although previous research identified demographic and medical risk factors for the development of post-COVID, the present prospective study is the first to investigate the role of psychological factors. METHODS The interview and survey data of PCR positive participants (n = 137, 70.8% female) were assessed in the acute, subacute (3 months after symptom onset) and chronic phases (6 months after symptom onset) of COVID. RESULTS After controlling for medical (BMI, disease score) and demographic factors (gender, age), psychosomatic symptom burden (measured by the SSD-12) predicted higher odds and magnitude of COVID-related symptom impairment in the post-COVID phases. Fear of COVID related health consequences (measured by the FCV-19 scale) also predicted higher odds of reporting any COVID symptoms in the subacute and chronic phase, while it only predicted higher magnitude of COVID-related symptom impairment in the subacute phase. In subsequent exploratory analyses, we found that other psychological factors were associated with an overall increase (i.e., chronic stress and depression) or decrease (i.e., trait positive affect) in the odds and magnitude of COVID-related symptom impairment. CONCLUSIONS We conclude that psychological factors can fuel or temper the experience in post-COVID syndrome, opening new possibilities for psychological interventions.Registration: The study protocol was preregistered in the open science framework (https://osf.io/k9j7t).
Collapse
Affiliation(s)
- Christopher Milde
- RPTU Kaiserslautern-Landau, Pain and Psychotherapy Research Lab, Germany
| | | | - Marcel Wilhelm
- University of Marburg, Department of Psychology, Germany
| | - Lea Schemer
- RPTU Kaiserslautern-Landau, Pain and Psychotherapy Research Lab, Germany
| |
Collapse
|
7
|
Markert C, Storz F, Golder S, Rechmann J, Rubel JA, Lalk C, Vogt R, Glombiewski JA, Braun D, Pané-Farré CA, Michael T, Mattheus HK, Dominick N, Wölfling K, Lutz W, Schaffrath J, Stangier U, Kananian S, Strüwing D, Klingelhöfer D, Valbert F, Neumann A, Walter B, Stark R. On the current psychotherapeutic situation for persons with pornography use disorder in Germany. J Behav Addict 2023. [PMID: 37141047 DOI: 10.1556/2006.2023.00011] [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: 08/19/2022] [Revised: 11/08/2022] [Accepted: 03/10/2023] [Indexed: 05/05/2023] Open
Abstract
Background and aims For the first time, the ICD-11 provides the diagnosis compulsive sexual behavior disorder (CSBD) that can be assigned for pornography use disorder (PUD). This study aimed to estimate the prevalence of PUD and associated consequences in Germany, to identify the psychotherapy demand among likely PUD (lPUD) cases and the treatment supply in different psychotherapeutic settings, to survey psychotherapists' level of expertise regarding PUD, and to identify predictors for psychotherapy demand. Methods Four studies were conducted: 1. Online study in the general population (n = 2070; m = 48.9%, f = 50.8%, d = 0.2%), 2. Survey among practicing psychotherapists (n = 983), 3. Survey of psychotherapists in psychotherapeutic outpatient clinics (n = 185), 4. Interviews with psychotherapeutic inpatient clinics (n = 28). Results The estimated prevalence of lPUD in the online study was 4.7% and men were 6.3 times more often affected than women. Compared to individuals without PUD, individuals with lPUD more often indicated negative consequences in performance-related areas. Among lPUD cases, 51.2% of men and 64.3% of women were interested in a specialized PUD treatment. Psychotherapists reported 1.2%-2.9% of lPUD cases among their patients. 43.2%-61.5% of psychotherapists stated to be poorly informed about PUD. Only 7% of psychotherapeutic inpatient clinics provided specific treatments to patients with PUD. While, among other factors, negative consequences attributed to lPUD were predictive for psychotherapy demand, weekly pornography consumption, subjective well-being, and religious attachment were not. Discussion and conclusions Although PUD occurs quite often in Germany, availability of mental health care services for PUD is poor. Specific PUD treatments are urgently needed.
Collapse
Affiliation(s)
- Charlotte Markert
- 1Department of Psychotherapy and Systems Neuroscience, Justus Liebig University of Giessen, Germany
- 2Bender Institute of Neuroimaging, Justus Liebig University of Giessen, Germany
- 3Center of Mind, Brain and Behavior, Universities of Marburg and Giessen, Germany
| | - Florian Storz
- 1Department of Psychotherapy and Systems Neuroscience, Justus Liebig University of Giessen, Germany
| | - Sarah Golder
- 1Department of Psychotherapy and Systems Neuroscience, Justus Liebig University of Giessen, Germany
| | - Johanna Rechmann
- 1Department of Psychotherapy and Systems Neuroscience, Justus Liebig University of Giessen, Germany
| | - Julian A Rubel
- 4Clinical Psychology and Psychotherapy, University of Osnabrück, Germany
| | - Christopher Lalk
- 4Clinical Psychology and Psychotherapy, University of Osnabrück, Germany
| | - Rabea Vogt
- 5Department of Clinical Psychology and Psychotherapy, University Koblenz-Landau, Germany
| | - Julia A Glombiewski
- 5Department of Clinical Psychology and Psychotherapy, University Koblenz-Landau, Germany
| | - David Braun
- 6Department of Clinical Psychology, Experimental Psychopathology and Psychotherapy, Philipps University of Marburg, Germany
| | - Christiane A Pané-Farré
- 6Department of Clinical Psychology, Experimental Psychopathology and Psychotherapy, Philipps University of Marburg, Germany
| | - Tanja Michael
- 7Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Germany
| | - Hannah K Mattheus
- 7Division of Clinical Psychology and Psychotherapy, Department of Psychology, Saarland University, Germany
| | - Nanne Dominick
- 8Outpatient Clinic for Behavioral Addictions, Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Klaus Wölfling
- 8Outpatient Clinic for Behavioral Addictions, Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Germany
| | - Wolfgang Lutz
- 9Clinical Psychology and Psychotherapy, University of Trier, Germany
| | - Jana Schaffrath
- 9Clinical Psychology and Psychotherapy, University of Trier, Germany
| | - Ulrich Stangier
- 10Clinical Psychology and Psychotherapy, Goethe University, Frankfurt, Germany
| | - Schahryar Kananian
- 10Clinical Psychology and Psychotherapy, Goethe University, Frankfurt, Germany
| | - Dirk Strüwing
- 11Aus-und Weiterbildungseinrichtung für klinische Verhaltenstherapie (AWKV), Kassel, Germany
| | - Doerthe Klingelhöfer
- 11Aus-und Weiterbildungseinrichtung für klinische Verhaltenstherapie (AWKV), Kassel, Germany
| | - Frederik Valbert
- 12Institute for Healthcare Management and Research, University Duisburg-Essen, Essen, Germany
| | - Anja Neumann
- 12Institute for Healthcare Management and Research, University Duisburg-Essen, Essen, Germany
| | - Bertram Walter
- 1Department of Psychotherapy and Systems Neuroscience, Justus Liebig University of Giessen, Germany
- 3Center of Mind, Brain and Behavior, Universities of Marburg and Giessen, Germany
| | - Rudolf Stark
- 1Department of Psychotherapy and Systems Neuroscience, Justus Liebig University of Giessen, Germany
- 2Bender Institute of Neuroimaging, Justus Liebig University of Giessen, Germany
- 3Center of Mind, Brain and Behavior, Universities of Marburg and Giessen, Germany
| |
Collapse
|
8
|
Schemer L, Hess CW, Van Orden AR, Birnie KA, Harrison LE, Glombiewski JA, Simons LE. Enhancing Exposure Treatment for Youths With Chronic Pain: Co-design and Qualitative Approach. J Particip Med 2023; 15:e41292. [PMID: 36892929 PMCID: PMC10037174 DOI: 10.2196/41292] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/19/2022] [Accepted: 01/23/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Increasing the access to and improving the impact of pain treatments is of utmost importance, especially among youths with chronic pain. The engagement of patients as research partners (in contrast to research participants) provides valuable expertise to collaboratively improve treatment delivery. OBJECTIVE This study looked at a multidisciplinary exposure treatment for youths with chronic pain through the lens of patients and caregivers with the aim to explore and validate treatment change processes, prioritize and develop ideas for improvement, and identify particularly helpful treatment elements. METHODS Qualitative exit interviews were conducted with patients and caregivers at their discharge from 2 clinical trials (ClinicalTrials.gov NCT01974791 and NCT03699007). Six independent co-design meetings were held with patients and caregivers as research partners to establish a consensus within and between groups. The results were validated in a wrap-up meeting. RESULTS Patients and caregivers described that exposure treatment helped them better process pain-related emotions, feel empowered, and improve their relationship with each other. The research partners developed and agreed upon 12 ideas for improvement. Major recommendations include that pain exposure treatment should be disseminated more not only among patients and caregivers but also among primary care providers and the general public to facilitate an early referral for treatment. Exposure treatment should allow flexibility in terms of duration, frequency, and delivery mode. The research partners prioritized 13 helpful treatment elements. Most of the research partners agreed that future exposure treatments should continue to empower patients to choose meaningful exposure activities, break long-term goals into smaller steps, and discuss realistic expectations at discharge. CONCLUSIONS The results of this study have the potential to contribute to the refinement of pain treatments more broadly. At their core, they suggest that pain treatments should be disseminated more, flexible, and transparent.
Collapse
Affiliation(s)
- Lea Schemer
- Department of Clinical Psychology and Psychotherapy, University of Kaiserslautern-Landau, Landau, Germany
| | - Courtney W Hess
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Amanda R Van Orden
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Kathryn A Birnie
- Department of Anesthesiology, Perioperative, and Pain Medicine, Department of Community Health Sciences, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Lauren E Harrison
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Julia A Glombiewski
- Department of Clinical Psychology and Psychotherapy, University of Kaiserslautern-Landau, Landau, Germany
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| |
Collapse
|
9
|
Henrich D, Glombiewski JA, Scholten S. Systematic review of training in cognitive-behavioral therapy: Summarizing effects, costs and techniques. Clin Psychol Rev 2023; 101:102266. [PMID: 36963208 DOI: 10.1016/j.cpr.2023.102266] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/09/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023]
Abstract
With the steadily growing importance of psychotherapeutic care, there is also an increasing need for high-quality training. We analyze the literature published between 2009 and 2022 on the effectiveness of training in cognitive behavioral therapy. The review addresses current gaps in the literature by focusing on the description of specific training components and their associated costs, as well as examining therapist-level predictors of training effectiveness. Our findings confirm the effect of additional supervision on both therapist competence and patient outcomes. Instructor-led training and self-guided web-based training seem to moderately increase competence, especially when targeting specific and highly structured treatments or skills. The level of prior training and experience of a therapist appears to predict the strength of training-related gains in competence. Few studies analyzed the differential effect of certain elements of training (e.g., the amount of active learning strategies) and training costs were generally not reported. Future studies should replicate or expand the existing evidence on active ingredients and therapist-level predictors of training effectiveness. Costs should be systematically reported to enhance the comparability of different training strategies.
Collapse
Affiliation(s)
- Dominik Henrich
- Department of Clinical Psychology and Psychotherapy, RPTU Kaiserslautern-Landau, Germany.
| | - Julia A Glombiewski
- Department of Clinical Psychology and Psychotherapy, RPTU Kaiserslautern-Landau, Germany
| | - Saskia Scholten
- Department of Clinical Psychology and Psychotherapy, RPTU Kaiserslautern-Landau, Germany
| |
Collapse
|
10
|
Kube T, Riecke J, Heider J, Ballou SK, Glombiewski JA, Rief W, Barsky AJ. How the integration of normal medical test results can be improved in patients with somatoform disorders-An experimental study. Health Psychol 2023; 42:103-112. [PMID: 36548078 DOI: 10.1037/hea0001243] [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: 12/24/2022]
Abstract
BACKGROUND We examined whether the difficulties of patients with somatoform disorders (SFDs) in integrating medical reassurance can be altered by preventing patients from devaluing reassuring information through defensive cognitive strategies. METHOD Patients with SFD (n = 60), patients with major depression (n = 32), and healthy volunteers (n = 37) watched a videotaped doctor's report, which provided medical reassurance for gastroenterological complaints. Subsequently, participants were asked about their perception of the report. In the SFD sample, patients' appraisal of the reassuring was experimentally modulated: In one condition, doubts about the validity of the doctor's diagnostic assessment were triggered; in another condition, the devaluation of medical reassurance was blocked through underscoring the validity of the doctor's diagnostic assessment; and a control condition received no manipulation. RESULTS As evident on all outcome variables, patients with SFD had more difficulty integrating medical reassurance than depressed and healthy people. Within the SFD sample, participants from the experimental condition blocking the devaluation of medical reassurance rated the likelihood of an undetected serious disease to be significantly lower than the other two conditions. They also reported less emotional concern and a lower desire to seek the opinion of another doctor. CONCLUSIONS By comparing patients with SFD to both a healthy and a clinical control group, the current study suggests that the difficulty in processing reassuring medical information is a specific psychopathological feature of SFD. Furthermore, our results suggest that the integration of medical reassurance can be improved by preventing patients from devaluing reassuring information through dismissive cognitive strategies. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
Affiliation(s)
| | - Jenny Riecke
- Department of Clinical Psychology and Psychotherapy
| | | | | | | | | | | |
Collapse
|
11
|
Abstract
OBJECTIVE Placebos being prescribed with full honesty and disclosure (i.e., open-label placebo [OLP]) have been shown to reduce symptom burden in a variety of conditions. With regard to allergic rhinitis, previous research provided inconclusive evidence for the effects of OLP, possibly related to a separate focus on either symptom severity or symptom frequency. Overcoming this limitation of previous research, the present study aimed to examine the effects of OLP on both the severity and frequency of allergic symptoms. METHODS In a randomized-controlled trial, patients with allergic rhinitis ( N = 74) were randomized to OLP or treatment as usual (TAU). Because of the COVID-19 pandemic, OLP was administered remotely in a virtual clinical encounter. Participants took placebo tablets for 14 days. The primary outcomes were the severity and frequency of allergic symptoms. The secondary end point was allergy-related impairment. RESULTS OLP did not significantly improve symptom severity over TAU ( F (1,71) = 3.280, p = .074, η2 = 0.044) but did reduce symptom frequency ( F (1,71) = 7.272, p = .009, η2 = 0.093) and allergy-related impairment more than TAU ( F (1,71) = 6.445, p = .013, η2 = 0.083), reflecting medium to large effects. The use of other antiallergic medication did not influence the results. CONCLUSIONS Although OLP was able to lower the frequency of allergic symptoms and allergy-related impairment substantially, its effects on symptom severity were weaker. The remote provision of OLP suggests that physical contact between patients and providers might not be necessary for OLP to work.
Collapse
Affiliation(s)
- Tobias Kube
- From the Pain and Psychotherapy Research Lab (Kube, Glombiewski), University of Koblenz-Landau, Landau, Germany; Program in Placebo Studies, Beth Israel Deaconess Medical Center (Kube, Kirsch), Harvard Medical School, Boston, Massachusetts; Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology (Witthöft, Bräscher), Johannes Gutenberg University of Mainz, Mainz, Germany
| | | | | | | | | |
Collapse
|
12
|
Kube T, Körfer K, Riecke J, Glombiewski JA. How expectancy violations facilitate learning to cope with pain - An experimental approach. J Psychosom Res 2022; 157:110807. [PMID: 35390722 DOI: 10.1016/j.jpsychores.2022.110807] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 03/21/2022] [Accepted: 03/28/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Expectations of painful sensations constitute a core feature of chronic pain. An important clinical question is whether such expectations are revised when disconfirming experiences are made (e.g., less pain than expected). This study examined how people adjust their pain expectations when the experience of decreasing pain is expected vs. unexpected. METHODS In a novel randomized between-subjects design, a subclinical sample of people who frequently experience pain was provided with painful thermal stimulations. Unbeknownst to participants, the temperature applied was decreased from trial to trial. Based on the experimental instructions provided, this experience of decreasing pain was expected in one condition (expectation-confirmation; n = 34), whereas it was unexpected in another (expectation-disconfirmation; n = 39). RESULTS Perceived pain intensity was lower in the expectation-confirmation condition than in the expectation-disconfirmation condition (p = .014, ηp2 = 0.083). The expectation-confirmation condition also showed a greater adjustment of their pain expectations than the expectation-disconfirmation condition (p = .046, ηp2 = 0.047). Across groups, large expectation violations (i.e., less pain than expected) were associated with increases in pain tolerance and the ability to cope with pain at a one-week follow-up. CONCLUSIONS In terms of assimilation, perceived pain intensity was shaped in the direction of pain expectations. The greater adjustment of expectations in the expectation-confirming condition is consistent with a confirmation bias in pain perception. Though participants who experienced large discrepancies between expected and experienced pain were hesitant to adjust their pain expectations immediately, expectation violations increased their ability to cope with pain one week later, suggesting some beneficial longer-term effects of expectation violations.
Collapse
Affiliation(s)
- Tobias Kube
- Pain and Psychotherapy Research Lab, University of Koblenz-, Landau, Germany.
| | - Karoline Körfer
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Germany
| | - Jenny Riecke
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Germany
| | - Julia A Glombiewski
- Pain and Psychotherapy Research Lab, University of Koblenz-, Landau, Germany
| |
Collapse
|
13
|
Friehs T, Rief W, Glombiewski JA, Haas J, Kube T. Deceptive and non-deceptive placebos to reduce sadness: A five-armed experimental study. Journal of Affective Disorders Reports 2022. [DOI: 10.1016/j.jadr.2022.100349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
|
14
|
Lischetzke T, Schemer L, Glombiewski JA, In-Albon T, Karbach J, Könen T. Negative Emotion Differentiation Attenuates the Within-Person Indirect Effect of Daily Stress on Nightly Sleep Quality Through Calmness. Front Psychol 2021; 12:684117. [PMID: 34456798 PMCID: PMC8385208 DOI: 10.3389/fpsyg.2021.684117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/13/2021] [Indexed: 11/17/2022] Open
Abstract
The ability to differentiate between negative emotional states [negative emotion differentiation (NED)] has been conceptualized as a trait that facilitates effective emotion regulation and buffers stress reactivity. In the present research, we investigated the role of NED in within-person processes of daily affect regulation and coping during times of stress (the first COVID-19-related pandemic lockdown in April 2020). Using intensive longitudinal data, we analyzed whether daily stress had an indirect effect on sleep quality through calmness in the evening, and we tested whether NED moderated this within-person indirect effect by buffering the link between daily stress and calmness in the evening. A non-representative community sample (n = 313, 15–82 years old) participated in a 21-day ambulatory assessment with twice-daily surveys. The results of multilevel mediation models showed that higher daily stress was related to within-day change in calmness from morning to evening, resulting in less calmness in the evening within persons. Less calmness in the evening, in turn, was related to poorer nightly sleep quality within persons. As expected, higher NED predicted a less negative within-person link between daily stress and calmness in the evening, thereby attenuating the indirect effect of daily stress on nightly sleep quality through calmness. This effect held when we controlled for mean negative emotions and depression. The results provide support for a diathesis-stress model of NED, and hence, for NED as a protective factor that helps to explain why some individuals remain more resilient during times of stress than others.
Collapse
Affiliation(s)
- Tanja Lischetzke
- Department of Psychology, University of Koblenz-Landau, Landau, Germany
| | - Lea Schemer
- Department of Psychology, University of Koblenz-Landau, Landau, Germany
| | | | - Tina In-Albon
- Department of Psychology, University of Koblenz-Landau, Landau, Germany
| | - Julia Karbach
- Department of Psychology, University of Koblenz-Landau, Landau, Germany
| | - Tanja Könen
- Department of Psychology, University of Koblenz-Landau, Landau, Germany
| |
Collapse
|
15
|
Kube T, Hofmann VE, Glombiewski JA, Kirsch I. Correction: Providing open-label placebos remotely-A randomized controlled trial in allergic rhinitis. PLoS One 2021; 16:e0252850. [PMID: 34077482 PMCID: PMC8171944 DOI: 10.1371/journal.pone.0252850] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0248367.].
Collapse
|
16
|
Scholten S, Lischetzke T, Glombiewski JA. Integrating theory-based and data-driven methods to case conceptualization: A functional analysis approach with ecological momentary assessment. Psychother Res 2021; 32:65-77. [PMID: 33877958 DOI: 10.1080/10503307.2021.1916639] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Objective Ecological momentary assessment (EMA) and network analysis are promising empirical developments for psychotherapy research and practice, but they lack a therapeutic rationale that could guide case conceptualization and treatment planning. We developed an assessment strategy that aims to assess functional analysis with EMA. Method: The assessment strategy was applied to a series of three N-of-1 assessments in a proof-of-concept study. After selecting a personalized set of items, EMA was implemented with three measurement time points per day for a period of 30 days. The participants evaluated feasibility and acceptance. Practicing psychotherapists discussed clinical implications in a focus group. Results: The implementation of the assessment strategy seemed feasible and accepted; participants did not report any side effects. Principal component and network analyses indicated interpretable components (e.g., participant 1: hopelessness, procrastination, coping, avoidance). The focus group pointed out potentials (e.g., efficient profit of the waiting time, empowering patients) and challenges (e.g., prioritize and interpret all the information). Conclusion: The presented assessment strategy may enhance the scientific quality of case conceptualization empowering therapists' decision-making regarding treatment planning. At the same time, it is a concrete demonstration of the challenges that need to be addressed in future research.
Collapse
Affiliation(s)
- S Scholten
- Pain and Psychotherapy Research Lab, Universität Koblenz-Landau, Landau in der Pfalz, Germany
| | - T Lischetzke
- Pain and Psychotherapy Research Lab, Universität Koblenz-Landau, Landau in der Pfalz, Germany
| | - J A Glombiewski
- Pain and Psychotherapy Research Lab, Universität Koblenz-Landau, Landau in der Pfalz, Germany
| |
Collapse
|
17
|
Kube T, Hofmann VE, Glombiewski JA, Kirsch I. Providing open-label placebos remotely-A randomized controlled trial in allergic rhinitis. PLoS One 2021; 16:e0248367. [PMID: 33705475 PMCID: PMC7951912 DOI: 10.1371/journal.pone.0248367] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/23/2021] [Indexed: 12/12/2022] Open
Abstract
Background Placebos can reduce physical symptoms even when provided with full honesty and disclosure. Yet, the precise mechanisms underlying the effects of “open-label placebos” (OLPs) have remained subject of debate. Furthermore, it is unclear whether OLPs are similarly effective when provided remotely, as is sometimes required e.g. in the current COVID-19 pandemic. Methods In a randomized-controlled trial, we examined the effects of OLP plus treatment as usual (TAU) compared to TAU alone on symptom reduction in people with allergic rhinitis (N = 54) over the course of two weeks. Due to the COVID-19 pandemic, OLP was provided remotely (i.e. sent via postal service). To investigate the potential influence of the clinical encounter on the effects of OLP, we manipulated the perception of the virtual clinical encounter, both with respect to verbal and nonverbal factors (augmented vs. limited encounter). Results The results of the manipulation check confirmed that the augmented clinical encounter was evaluated more positively than the limited encounter, in terms of perceived warmth of the provider. Participants from all treatment groups showed significant symptom reduction from baseline to two weeks later, but OLP had no incremental effect over TAU. Participants benefitted more from OLP when they did not take any other medication against allergic symptoms than when taking medication on demand. When controlling for baseline symptoms, a significant treatment by encounter interaction was found, pointing to greater symptom improvement in the OLP group when the encounter was augmented, whereas the control group improved more when the encounter was limited. Discussion The study demonstrates that providing OLP and enhancing the encounter remotely is possible, but their effectiveness might be lower in comparison to previous studies relying on physical patient-provider interaction. The study raises questions for future research about the potential and challenges of remote placebo studies and virtual clinical encounters. The study has been registered as a clinical trial at ISRCTN (record number: 39018).
Collapse
Affiliation(s)
- Tobias Kube
- Pain and Psychotherapy Research Lab, University of Koblenz-Landau, Landau, Germany
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | - Verena E. Hofmann
- Pain and Psychotherapy Research Lab, University of Koblenz-Landau, Landau, Germany
| | - Julia A. Glombiewski
- Pain and Psychotherapy Research Lab, University of Koblenz-Landau, Landau, Germany
| | - Irving Kirsch
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| |
Collapse
|
18
|
Hansmeier J, Haberkamp A, Glombiewski JA, Exner C. Metacognitive Change During Exposure and Metacognitive Therapy in Obsessive-Compulsive Disorder. Front Psychiatry 2021; 12:722782. [PMID: 34539468 PMCID: PMC8446266 DOI: 10.3389/fpsyt.2021.722782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/11/2021] [Indexed: 11/23/2022] Open
Abstract
Metacognitive therapy (MCT) has been shown to be a promising treatment approach for obsessive-compulsive disorder (OCD). The changeability of metacognitions by (metacognitive) treatment and its relevance to treatment outcome is, however, still unclear. The current study investigates, (1) if treatment with MCT or exposure and response prevention (ERP) in a randomized-controlled pilot trial (n = 24 patients with OCD) changes OCD-specific metacognitions of thought fusion beliefs, beliefs about rituals and stop signals, and (2) if these changes are relevant for the treatment outcome in terms of patient- and therapist-rated OCD symptoms. ANOVA with pretest, posttest and follow-up scores could show that all three metacognitions significantly decreased during both treatments. Regarding thought fusion beliefs, a significant interaction effect indicated a higher decrease after MCT than ERP treatment. In hierarchical regression analyses, changes in stop signals from pre- to post-treatment significantly predicted patient-rating OCD symptoms at post-treatment and follow-up at 3 months after treatment. These changes were even predictive of post-treatment outcome after controlling for general metacognitions and dysfunctional cognitive beliefs. These findings support the assumption that metacognitions can change during both treatments and that changes in stop signals might be relevant for the treatment outcome on the symptom level in OCD.
Collapse
Affiliation(s)
- Jana Hansmeier
- Department of Psychology, University of Leipzig, Leipzig, Germany
| | - Anke Haberkamp
- Department of Psychology, University of Marburg, Marburg, Germany
| | | | - Cornelia Exner
- Department of Psychology, University of Leipzig, Leipzig, Germany
| |
Collapse
|
19
|
Hansmeier J, Haberkamp A, Glombiewski JA, Exner C. The Behavior Avoidance Test: Association With Symptom Severity and Treatment Outcome in Obsessive-Compulsive Disorder. Front Psychiatry 2021; 12:781972. [PMID: 35756727 PMCID: PMC9231550 DOI: 10.3389/fpsyt.2021.781972] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/30/2021] [Indexed: 11/29/2022] Open
Abstract
Behavior therapy of obsessive-compulsive disorder (OCD) aims to reduce avoidance, rituals, and discomfort in OCD-relevant situations. The Behavioral Avoidance Test (BAT) measures these behavior-related outcomes in individually challenging OCD-related situations. The association of the BAT with OCD severity measures and its relevance for treatment outcome is, however, still unclear. The current study investigates with a retrospective analysis of a subsample of a pilot study, (1) if reactions on the BAT are related to OCD severity measures in an OCD sample (n = 28), (2) if treatment with two variants of cognitive-behavior therapy (exposure and response prevention vs. metacognitive therapy) changes the BAT scores and (3) if these changes as well as pretreatment BAT avoidance are relevant for OCD treatment outcome as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Participants rated avoidance, ritual, and discomfort in three individually challenging OCD-related situations before and after therapy. For one of these situations, BAT dimensions were rated by the therapist and an independent rater in addition to the patients' ratings. Correlational analyses found significant correlations between BAT discomfort and OCD severity measures like the Y-BOCS. A repeated measures ANOVA with pre- and posttest scores showed that all three BAT dimensions significantly decreased during both treatments. Hierarchical regression analyses (controlling for Y-BOCS pretest scores) revealed that changes in BAT discomfort as well as pretreatment BAT avoidance scores predicted the Y-BOCS posttest score. These findings suggest that the BAT is a distinct measure of behavior-related outcomes partly being relevant for OCD treatment outcome.
Collapse
Affiliation(s)
- Jana Hansmeier
- Department of Psychology, University of Leipzig, Leipzig, Germany
| | - Anke Haberkamp
- Department of Psychology, University of Marburg, Marburg, Germany
| | - Julia A Glombiewski
- Department of Psychology, University of Koblenz-Landau, Koblenz-Landau, Germany
| | - Cornelia Exner
- Department of Psychology, University of Leipzig, Leipzig, Germany
| |
Collapse
|
20
|
Körfer K, Schemer L, Kube T, Glombiewski JA. An Experimental Analogue Study on the "Dose-Response Relationship" of Different Therapeutic Instructions for Pain Exposures: The More, The Better? J Pain Res 2020; 13:3181-3193. [PMID: 33293855 PMCID: PMC7719044 DOI: 10.2147/jpr.s265709] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 08/20/2020] [Indexed: 01/05/2023] Open
Abstract
Objective Novel suggestions derived from the inhibitory learning model on how to optimize exposure therapy have been debated with enthusiasm in the last few years, particularly with respect to the focus on expectancy violations. However, little is known about how this new approach directly compares to the traditional habituation rationale of exposure therapy. In the present study, we examined these two competing therapeutic instructions among healthy female participants in an experimental heat pain paradigm. Design and Methods Participants (N= 116) received a therapeutic instruction derived from either a habituation-based approach or the inhibitory learning model (expectation violation). Participants were repeatedly exposed to painful thermal stimulations until a predefined exposure goal was reached. Results The expectation violation instruction led to faster goal attainment and higher response rates than the habituation instruction. Both instructions led to increased pain tolerance in the short and long term (one-week follow-up). Conclusion Our results suggest that exposure treatments using an expectation violation instruction are especially time-effective. Although the findings from this analogue design cannot be directly generalized to populations with clinically relevant levels of chronic pain, they do point to some important theoretical and clinical implications for the treatment of pain.
Collapse
Affiliation(s)
- Karoline Körfer
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Lea Schemer
- Department of Clinical Psychology and Psychotherapy, University of Koblenz - Landau, Landau, Germany
| | - Tobias Kube
- Department of Clinical Psychology and Psychotherapy, University of Koblenz - Landau, Landau, Germany
| | - Julia A Glombiewski
- Department of Clinical Psychology and Psychotherapy, University of Koblenz - Landau, Landau, Germany
| |
Collapse
|
21
|
Schemer L, Rief W, Glombiewski JA. <p>Treatment Expectations Towards Different Pain Management Approaches: Two Perspectives</p>. J Pain Res 2020; 13:1725-1736. [PMID: 32753946 PMCID: PMC7358092 DOI: 10.2147/jpr.s247177] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/23/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Accumulating evidence suggests an association between patient expectations and treatment success across various types of pain treatments. Expectations among treatment caregivers, however, are often neglected. Despite international treatment guidelines, only a small minority of chronic pain patients undergo psychological interventions. Therefore, our aim was to explore expectations among treatment receivers and caregivers especially concerning their attitudes towards psychological pain treatments. Methods Two hundred ten (potential) treatment receivers (n=85 individuals suffering from chronic low back pain (CLBP); n=125 healthy controls) and 237 caregivers (n=75 physicians; n=64 psychotherapists; n=98 physiotherapists) provided ratings of expected treatment success for standardized vignettes describing patients suffering from CLBP and undergoing a pharmacological, psychological, or multimodal pain management program. Results Individuals suffering from CLBP generally had lower treatment expectations than healthy controls. Both psychotherapists and physicians had higher treatment expectations from their own individual treatment approach. All participants expected the multimodal approach to be most effective. The psychological approach was expected to be more effective than the pharmacological approach – except for the physicians, who expected both treatment approaches to be equally effective. Conclusion There is an urgent need to clarify, under which circumstances and how patient expectations can be altered among individuals suffering from CLBP. Our results appear to encourage the implementation of multimodal and psychological pain management approaches across various settings. We invite clinicians to reflect whether their own expectations are in line with the recommendations in international treatment guidelines.
Collapse
Affiliation(s)
- Lea Schemer
- Department of Clinical Psychology and Psychotherapy, University Koblenz - Landau, Landau76829, Germany
- Correspondence: Lea Schemer Department of Clinical Psychology and Psychotherapy, University Koblenz – Landau, Ostbahnstraße 10, Landau76829, GermanyTel +49 6341 280-35627 Email
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg35032, Germany
| | - Julia A Glombiewski
- Department of Clinical Psychology and Psychotherapy, University Koblenz - Landau, Landau76829, Germany
| |
Collapse
|
22
|
Riecke J, Rief W, Vlaeyen JW, Glombiewski JA. Generalizability of harm and pain expectations after exposure in chronic low back pain patients. Eur J Pain 2020; 24:1495-1504. [DOI: 10.1002/ejp.1604] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/10/2020] [Accepted: 05/15/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Jenny Riecke
- Department of Clinical Psychology and Psychotherapy Philipps‐University Marburg Marburg Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy Philipps‐University Marburg Marburg Germany
| | - Johan W.S. Vlaeyen
- KU Leuven Health Psychology Research GroupLeuven Belgium
- Department of Experimental Health Psychology Maastricht University Maastricht Netherlands
| | | |
Collapse
|
23
|
Abstract
Exposure therapy is an economical and promising psychological method for the treatment of chronic back pain, although little research has been done and its evidence needs further clarification. Exposure therapy has so far been little used in practice, which is partly due to the few published studies on this topic and partly to the uncertainty of the practitioners as to whether exposure therapy can be carried out without risk. Exposure therapy can be classified as a "tailored treatment" approach, in which patients with certain profiles (here: increased fear of movement) receive specific treatments. In this review article, the theoretical principles of exposure therapy are presented. Subsequently, possibilities for the identification of those patients suitable for exposure treatment are explained. The practical procedure is presented using a case study. The four randomized controlled trials available to date are described in detail and discussed.
Collapse
Affiliation(s)
- J A Glombiewski
- Klinische Psychologie und Psychotherapie, Fachbereich Psychologie, Universität Koblenz-Landau, Ostbahnstr. 10, 76829, Landau, Deutschland.
| |
Collapse
|
24
|
Schemer L, Vlaeyen JW, Doerr JM, Skoluda N, Nater UM, Rief W, Glombiewski JA. Treatment processes during exposure and cognitive-behavioral therapy for chronic back pain: A single-case experimental design with multiple baselines. Behav Res Ther 2018; 108:58-67. [DOI: 10.1016/j.brat.2018.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 06/21/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022]
|
25
|
Kube T, Rief W, Gollwitzer M, Glombiewski JA. Introducing an EXperimental Paradigm to investigate Expectation Change (EXPEC). J Behav Ther Exp Psychiatry 2018; 59:92-99. [PMID: 29253640 DOI: 10.1016/j.jbtep.2017.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 07/24/2017] [Revised: 11/13/2017] [Accepted: 12/11/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND AND OBJECTIVES Dysfunctional expectations are considered to be core features of various mental disorders. Clinical observations suggest that people suffering from mental disorders such as major depression tend to maintain dysfunctional expectations despite expectation-disconfirming evidence. Surprisingly, this clinically relevant phenomenon has not yet sufficiently been investigated in empirical studies. Therefore, we developed an experimental paradigm to investigate expectation change vs. maintenance, and the first step to test its validity is to apply it in healthy individuals. METHODS After conducting two pilot studies (n = 28; n = 37), the present study systematically examined whether it is possible to change healthy individuals' (n = 102) task-specific and generalized performance expectations through expectation-disconfirming experiences. Using a standardized instruction, we initially induced non-positive expectations regarding participants' ability to successfully work on an unknown test. Then, participants received standardized performance feedback that either confirmed or disconfirmed their expectations before assessing participants' expectations again after completing the Test for the Measure of Emotional Intelligence. RESULTS Results indicate that expectation-disconfirming feedback led to a significant change of both task-specific and generalized performance expectations. There was no expectation change in the expectation-confirming condition. LIMITATIONS As the present study examined expectation change among healthy individuals, the next step is to apply this paradigm in a clinical sample and to examine whether expectation change is less likely among people suffering from depression or other mental disorders characterized by dysfunctional expectations. CONCLUSIONS Focusing more rigorously on expectation maintenance among people with mental disorders could enable therapists to develop expectation-focused interventions aiming at enhancing expectation change.
Collapse
Affiliation(s)
- Tobias Kube
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany.
| | - Winfried Rief
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany
| | - Mario Gollwitzer
- Philipps-University of Marburg, Department of Psychological Methodology and Social Psychology, Gutenbergstraße 18, D-35032 Marburg, Germany
| | - Julia A Glombiewski
- Philipps-University of Marburg, Department of Clinical Psychology and Psychotherapy, Gutenbergstraße 18, D-35032 Marburg, Germany
| |
Collapse
|
26
|
Kube T, D'Astolfo L, Glombiewski JA, Doering BK, Rief W. Focusing on situation-specific expectations in major depression as basis for behavioural experiments - Development of the Depressive Expectations Scale. Psychol Psychother 2017; 90:336-352. [PMID: 27935247 DOI: 10.1111/papt.12114] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 04/15/2016] [Revised: 11/07/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Dysfunctional expectations are considered to be core features of various mental disorders. The aim of the study was to develop the Depressive Expectations Scale (DES) as a depression-specific measure for the assessment of dysfunctional expectations. Whereas previous research primarily focused on general cognitions and attitudes, the DES assesses 25 future-directed expectations (originally 75 items) which are situation-specific and falsifiable. DESIGN AND METHODS To evaluate the psychometric properties of the DES, the scale was completed by 175 participants with and without severe depressive symptoms in an online survey. Participants additionally completed the Patient Health Questionnaire modules for depression (PHQ-9) and anxiety (GAD-7). People experiencing depressive symptoms were informed about the study with the help of self-help organizations. RESULTS Reliability analyses indicated excellent internal consistency of the scale. An exploratory factor analyses revealed four factors: social rejection, social support, mood regulation, and ability to perform. The DES sum score strongly correlated with the severity of depressive symptoms. The DES sum score also significantly correlated with symptoms of generalized anxiety. CONCLUSION The DES was shown to have excellent reliability; validity analyses were promising. As the DES items are situation-specific and falsifiable, they can be tested by the individual using behavioural experiments and may therefore facilitate cognitive restructuring. Thus, a structured assessment of patients' expectation with help of the DES can provide a basis for interventions within cognitive-behavioural treatment of depression. PRACTITIONER POINTS Assessing situation-specific expectations in patients experiencing depressive symptoms can provide a basis for the conduction of behavioural experiments to test patients' expectations. For the use of behavioural experiments, therapists should choose those dysfunctional expectations which a patient strongly agrees on. To modify patients' expectations, they should be exposed to situations where the discrepancy between patients' expectations and actual situational outcomes can be maximized. The Depressive Expectations Scale can be completed repeatedly to monitor a patient's progress within cognitive-behavioural treatment.
Collapse
Affiliation(s)
- Tobias Kube
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Germany
| | - Lisa D'Astolfo
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Germany
| | - Julia A Glombiewski
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Germany
| | - Bettina K Doering
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Germany
| |
Collapse
|
27
|
Kube T, Rief W, Glombiewski JA. On the Maintenance of Expectations in Major Depression - Investigating a Neglected Phenomenon. Front Psychol 2017; 8:9. [PMID: 28149287 PMCID: PMC5241292 DOI: 10.3389/fpsyg.2017.00009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 09/23/2016] [Accepted: 01/03/2017] [Indexed: 11/17/2022] Open
Abstract
In this perspective paper, we suggest that among patients suffering from major depressive disorder (MDD), dysfunctional expectations are maintained despite experiences that are contrary to these expectations. Surprisingly, this persistence of expectations in MDD has not yet been addressed by empirical studies. We argue that it is worthwhile to investigate this phenomenon with the aim of improving the treatment of MDD, and we provide a theoretical framework for understanding it. It is hypothesized that the persistence of expectations is primarily due to a process called immunization. That is, people experiencing depressive symptoms may cognitively reappraise the contradictory experience such that expectations do not need to be changed. There may be two mechanisms underlying this immunization: (1) the experience in the expectation-violating situation is considered to be an exception; or (2) the credibility of the information gained from the experience is called into question. Moreover, the maintenance of expectations may be particularly persistent if a person’s expectations reflect his or her self-concept, as self-concept has been shown to be associated with future expectations. To empirically examine the hypothesized maintenance of expectations in MDD, we propose an experimental approach which could provide important implications for the treatment of MDD within cognitive behavioral therapy. We suggest that psychological interventions such as behavioral experiments should more rigorously focus on patients’ appraisal of expectation-violating experiences in order to prevent immunization processes. Therapists should continuously examine whether patients’ expectations were modified and should address the reasons for the maintenance of expectations.
Collapse
Affiliation(s)
- Tobias Kube
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg Marburg, Germany
| | - Julia A Glombiewski
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg Marburg, Germany
| |
Collapse
|
28
|
Riecke J, Holzapfel S, Rief W, Lachnit H, Glombiewski JA. Cross-cultural adaption of the German Quebec Back Pain Disability Scale: an exposure-specific measurement for back pain patients. J Pain Res 2016; 9:9-15. [PMID: 26811693 PMCID: PMC4714739 DOI: 10.2147/jpr.s92615] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [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] [Indexed: 11/29/2022] Open
Abstract
Study design Cross-cultural translation and psychometric testing. Objective The purpose of the present study was to examine reliability and validity of a cross-cultural adaption of the German Quebec Back Pain Disability Scale (QBPDS) in a context of a randomized controlled trial evaluating the effectiveness of graded in vivo exposure in chronic low back pain patients. Background The QBPDS is one of the most widely used disease-specific disability questionnaires. In particular, for cognitive behavioral treatments with a clear focus on behavioral aspects such as graded in vivo exposure, the QBPDS provides an ascertained strategy with a sound conceptual basis and excellent quality criteria. Nevertheless, there is conflicting evidence concerning factor structure and a German adaption is missing. Methods The cross-cultural adaption followed international guidelines. Psychometric testing was performed using data from 180 participants with chronic low back pain. The psychometric analyses included internal consistency, convergent, and divergent validity. Exploratory factor analysis was used to determine the underlying factor structure. Results The QBPDS showed strong psychometric properties, with high internal consistency for the full scale (α=0.94) and good convergent and divergent validity. The factor analysis revealed a four-factor solution (bending, ambulation, brief effortful movements, and long-lasting postures). Conclusion The translation and cross-cultural adaption of the QBPDS into German was successful. The German version proved to be a valid and reliable instrument and is well suited for use in the context of an exposure-based psychological treatment.
Collapse
Affiliation(s)
- Jenny Riecke
- Department for Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Sebastian Holzapfel
- Department for Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Winfried Rief
- Department for Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| | - Harald Lachnit
- Department for Associative Learning, University of Marburg, Marburg, Germany
| | - Julia A Glombiewski
- Department for Clinical Psychology and Psychotherapy, University of Marburg, Marburg, Germany
| |
Collapse
|
29
|
Auer CJ, Glombiewski JA, Doering BK, Winkler A, Laferton JAC, Broadbent E, Rief W. Patients’ Expectations Predict Surgery Outcomes: A Meta-Analysis. Int J Behav Med 2015. [DOI: 10.1007/s12529-015-9500-4] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
30
|
Barke A, Riecke J, Rief W, Glombiewski JA. The Psychological Inflexibility in Pain Scale (PIPS) - validation, factor structure and comparison to the Chronic Pain Acceptance Questionnaire (CPAQ) and other validated measures in German chronic back pain patients. BMC Musculoskelet Disord 2015; 16:171. [PMID: 26215038 PMCID: PMC4517641 DOI: 10.1186/s12891-015-0641-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 07/21/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Acceptance and Commitment Therapy (ACT) for pain offers an alternative to traditional Cognitive Behavioural Therapy (CBT) approaches. ACT focuses on the enhancement of 'psychological flexibility' that enables individuals to pursue their values and goals despite pain. To assess specific treatment effect or mediators and moderators of change, questionnaires measuring ACT constructs are needed. METHODS The Psychological Inflexibility in Pain Scale (PIPS) was translated into German and completed by 182 participants with chronic back pain (70.3 % women, age 51.0 ± 10.5 years). Item analyses and a confirmatory factor analysis were computed as well as correlations with the Chronic Pain Acceptance Questionnaire (CPAQ), which measures related, but slightly different ACT-related constructs, and self-reported disability, pain intensity and further pain-related questionnaires. RESULTS The confirmatory factor analysis reproduced the original structure with two subscales and a good fit. The internal consistencies of the subscales were Cronbach's α = .91 (Avoidance) and α = .26 (Fusion). Average item-whole correlations of the items with the respective subscales were r = .71 (Avoidance) and r = .20 (Fusion). The highest correlations were observed for Avoidance with the CPAQ (r = -.81), the Tampa Scale of Kinesiophobia (r = .58) and the Pain Catastrophizing Scale (r = .56) and for Fusion with the CPAQ subscale Pain willingness (r = -.55). The PIPS subscale Avoidance predicted pain-related disability even after controlling for catastrophizing and fear of movement. CONCLUSIONS The PIPS subscale Avoidance may be a valuable instrument to assess treatment processes in future RCTs. The PIPS subscale Fusion seemed more problematic in the German sample with chronic back pain. More research on the comparison between PIPS and other questionnaires assessing psychological flexibility and the usefulness of the concept 'Fusion' for chronic pain are needed.
Collapse
Affiliation(s)
- Antonia Barke
- Klinische Psychologie und Psychotherapie, Philipps-Universität Marburg, Gutenbergstraße 18, 35037, Marburg, Germany.
| | - Jenny Riecke
- Klinische Psychologie und Psychotherapie, Philipps-Universität Marburg, Gutenbergstraße 18, 35037, Marburg, Germany.
| | - Winfried Rief
- Klinische Psychologie und Psychotherapie, Philipps-Universität Marburg, Gutenbergstraße 18, 35037, Marburg, Germany.
| | - Julia A Glombiewski
- Klinische Psychologie und Psychotherapie, Philipps-Universität Marburg, Gutenbergstraße 18, 35037, Marburg, Germany.
| |
Collapse
|
31
|
Hansmeier J, Glombiewski JA, Rief W, Exner C. Differential memory effects for encoding and retrieving disorder-relevant contents in relation to checking. J Behav Ther Exp Psychiatry 2015; 46:99-106. [PMID: 25302658 DOI: 10.1016/j.jbtep.2014.09.006] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 09/15/2014] [Accepted: 09/16/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Obsessive-compulsive (OC) checkers have been shown to be impaired in memory. However, when encoding OC-related material, OC checkers exhibit superior recall. This study aims to investigate emotion-related memory performance in relation to checking using newly developed OC-specific material. Additionally, metacognitive characteristics such as cognitive confidence were considered. METHOD In a sample of 63 participants (including 26 participants with obsessive-compulsive disorder), immediate and delayed recall for neutral stories and for OC-specific stories containing checking- and washing-related content were assessed. Regression analyses were applied to investigate the relationship to checking symptoms. The influence of metacognitive characteristics on recall was also examined. RESULTS Higher checking was related to significantly better memory performance for a checking-related story as compared to two neutral stories. However, higher checking was also related to higher rates of forgetting of the OC-specific material over the delay period. Rates of forgetting in relation to checking were mediated by cognitive confidence. Diagnostic status was not predictive of any outcome variables. LIMITATIONS The use of typical and not idiosyncratic verbal material may limit the ecological validity of these findings. CONCLUSIONS In relation to high checking, different disorder-related cognitive and affective processes seem to interfere with memory encoding and retrieval at different stages. Metacognitive therapy methods might address these processes and thereby lead to a reduction of both cognitive impairment and OC symptoms.
Collapse
Affiliation(s)
- J Hansmeier
- Department of Clinical Psychology, University of Marburg, Marburg, Germany.
| | - J A Glombiewski
- Department of Clinical Psychology, University of Marburg, Marburg, Germany
| | - W Rief
- Department of Clinical Psychology, University of Marburg, Marburg, Germany
| | - C Exner
- Department of Clinical Psychology, University of Leipzig, Leipzig, Germany
| |
Collapse
|
32
|
|
33
|
Winkler A, Dörsing B, Rief W, Shen Y, Glombiewski JA. Treatment of internet addiction: A meta-analysis. Clin Psychol Rev 2013; 33:317-29. [DOI: 10.1016/j.cpr.2012.12.005] [Citation(s) in RCA: 165] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 11/17/2012] [Accepted: 12/27/2012] [Indexed: 01/12/2023]
|
34
|
Abstract
Background Adherence to medication is low in specific populations who need chronic medication. However, adherence to medication is also of interest in a more general fashion, independent of specific populations or side effects of particular drugs. If clinicians and researchers expect patients to show close to full adherence, it is relevant to know how likely the achievement of this goal is. Population based rates can provide an estimate of efforts needed to achieve near complete adherence in patient populations. The objective of the study was to collect normative data for medication nonadherence in the general population. Methods and Findings We assessed 2,512 persons (a representative sample of German population). Adherence was measured by Rief Adherence Index. We also assessed current medication intake and side effects. We found that at least 33% of Germans repeatedly fail to follow their doctor's recommendations regarding pharmacological treatments and only 25% of Germans describe themselves as fully adherent. Nonadherence to medication occurs more often in younger patients with higher socioeconomic status taking short-term medications than in older patients with chronic conditions. Experience with medication side effects was the most prominent predictor of nonadherence. Conclusions The major strengths of our study are a representative sample and a novel approach to assess adherence. Nonadherece seems to be commonplace in the general population. Therefore adherence cannot be expected per se but needs special efforts on behalf of prescribers and public health initiatives. Nonadherence to medication should not only be considered as a drug-specific behaviour problem, but as a behaviour pattern that is independent of the prescribed medication.
Collapse
Affiliation(s)
- Julia A Glombiewski
- University of Marburg, Department of Clinical Psychology and Psychotherapy, Marburg, Germany.
| | | | | | | | | |
Collapse
|
35
|
Rief W, Glombiewski JA. The hidden effects of blinded, placebo-controlled randomized trials: an experimental investigation. Pain 2012; 153:2473-2477. [PMID: 23084328 DOI: 10.1016/j.pain.2012.09.007] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 09/18/2012] [Indexed: 12/19/2022]
Abstract
The knowledge of having only a 50% chance of receiving an active drug can result in reduced efficacy in blinded randomized clinical trials (RCTs) compared to clinical practice (reduced external validity). Moreover, minor onset sensations associated with the drug (but not with an inert placebo) can further challenge the attribution of group differences to drug-specific efficacy (internal validity). We used a randomized experimental study with inert placebos (inert substance) vs active placebos (inducing minor sensations), and different instructions about group allocation (probability of receiving drug: 0%, 50%, 100%). One hundred forty-four healthy volunteers were informed that a new application method for a well-known painkiller would be tested. Pain thresholds were assessed before and after receiving nasal spray. Half of the nasal sprays were inert placebos (sesame oil), while the other half were active placebos inducing prickling nasal sensations (sesame oil with 0.014% capsaicin). The major outcome was pain threshold after placebo application. A substantial expectation effect was found for the inert placebo condition, with participants who believed they had received an active drug reporting the highest pain thresholds. Active placebos show substantial differences to passive placebos in the 50% chance group. Therefore, patient expectations are significantly different in placebo-controlled clinical trials (50% chance) vs clinical practice (100% chance). Moreover, minor drug onset sensations can challenge internal validity. Effect sizes for these mechanisms are medium, and can substantially compete with specific drug effects. For clinical trials, new study designs are needed that better control for these effects.
Collapse
Affiliation(s)
- Winfried Rief
- Department of Clinical Psychology, University of Marburg, Marburg, Germany
| | | |
Collapse
|
36
|
Rief W, Barsky AJ, Glombiewski JA, Nestoriuc Y, Glaesmer H, Braehler E. Assessing general side effects in clinical trials: reference data from the general population. Pharmacoepidemiol Drug Saf 2010; 20:405-15. [DOI: 10.1002/pds.2067] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 08/27/2010] [Accepted: 09/20/2010] [Indexed: 11/10/2022]
|
37
|
Glombiewski JA, Sawyer AT, Gutermann J, Koenig K, Rief W, Hofmann SG. Psychological treatments for fibromyalgia: a meta-analysis. Pain 2010; 151:280-295. [PMID: 20727679 DOI: 10.1016/j.pain.2010.06.011] [Citation(s) in RCA: 198] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Revised: 04/06/2010] [Accepted: 06/11/2010] [Indexed: 11/28/2022]
Abstract
The aims of the present analysis were to investigate the short- and long-term efficacies and treatment moderators of psychological interventions for fibromyalgia. A literature search using PubMed, PsychINFO, the Cochrane Library, and manual searches identified 23 eligible studies including 30 psychological treatment conditions and 1396 patients. Meta-analytic integration resulted in a significant but small effect size for short-term pain reduction (Hedges's g=0.37, 95% confidence interval (CI): 0.27-0.48) and a small-to-medium effect size for long-term pain reduction over an average follow-up phase of 7.4 months (Hedges's g=0.47, 95% CI: 0.3-0.65) for any psychological intervention. Psychological treatments also proved effective in reducing sleep problems (Hedges's g=0.46, 95% CI: 0.28-0.64), depression (Hedges's g=0.33, 95% CI: 0.20-0.45), functional status (Hedges's g=0.42, 95% CI: 0.25-0.58), and catastrophizing (Hedges's g=0.33, 95% CI: 0.17-0.49). These effects remained stable at follow-up. Moderator analyses revealed cognitive-behavioral treatment to be significantly better than other psychological treatments in short-term pain reduction (Hedges's g=0.60, 95% CI: 0.46-0.76). Higher treatment dose was associated with better outcome. Publication-bias analyses demonstrated that the effect sizes were robust. The results suggest that the effects of psychological treatments for fibromyalgia are relatively small but robust and comparable to those reported for other pain and drug treatments used for this disorder. Cognitive-behavioral therapy was associated with the greatest effect sizes.
Collapse
Affiliation(s)
- Julia A Glombiewski
- Department of Psychology, Boston University, Boston, MA, USA University of Marburg, Department of Clinical Psychology and Psychotherapy, Marburg, Germany
| | | | | | | | | | | |
Collapse
|
38
|
Trapp K, Glombiewski JA, Hartwich-Tersek J, Rief W. [Desire for early retirement and therapy of chronic back pain: relevance of social medical variables for outpatient psychotherapeutic treatment]. Schmerz 2009; 23:166-72. [PMID: 19052779 DOI: 10.1007/s00482-008-0744-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study investigated the influence of patients' desire for early retirement on the success of an outpatient cognitive behavioural treatment (CBT) in patients with chronic back pain. Previous studies have shown that the desire for early retirement and social compensation had a negative influence on therapy outcome, e.g. pain intensity and pain disability. This study was conducted to reassess whether these results can be replicated in an outpatient CBT setting. METHOD Questionnaires assessing pain-related variables were issued to a total of 116 patients at the beginning, at the end of treatment and 6 months after termination of therapy. RESULTS Overall, the treatment showed significant positive results in the variables assessed. In contrast to other studies, patients with a desire for early retirement also showed improvement during treatment. The success of treatment proved to be stable after termination of therapy. CONCLUSION CBT in an outpatient setting seems to be an effective treatment for patients with chronic back pain and even patients with a desire for early retirement benefit from treatment.
Collapse
Affiliation(s)
- K Trapp
- FB Psychologie - AG Klinische Psychologie und Psychotherapie, Philipps-Universität Marburg, Gutenbergstr. 18, 35032, Marburg, Deutschland.
| | | | | | | |
Collapse
|