Basic counseling skills in psychology and teaching: validation of a short version of the counselor activity self-efficacy scales

BACKGROUND

Counseling self-efficacy is a relevant measure to examine trainees' beliefs about their counseling skills. This study aimed to validate three scales of the revised German version of the Counselor Activity Self-Efficacy Scales (CASES-R) measuring basic counseling skills. To ascertain the scales' sensitivity to change, counseling self-efficacy was assessed before and after specific training.

METHOD

The sample comprised 163 university students enrolled either in psychology or education. Students were examined before and after participating in training focusing on basic counseling skills. We applied confirmatory factor analysis and tested internal consistency, convergent validity, and criterion validity.

RESULTS

Confirmatory factor analysis supported the three-factor structure of the CASES-R scales for basic counseling skills. The scales provided acceptable to good internal consistency (α = 0.77 - 0.87). Significant relations with general self-efficacy (r =.23, p <.01) provided first indication for convergent validity. We also found a significant correlation of the CASES-R with positive affect (r =.22), and significant correlations of some subscales with empathetic concern (r =.16 -.21) and mastery goal orientation (r =.16), overall supporting criterion validity. The CASES-R scales proved to be sensitive to change, as participants' scores were higher after (M = 6.18, SD = 1.05) than before (M = 5.37, SD = 1.16) counseling training (F(1, 309) = 42.27, p <.001).

CONCLUSION

We found support for the proposed factor structure and reliability of the German version of the three CASES-R scales, indicating its suitability for use in basic counseling settings. Future research should further examine the scales' validity.

Modeling in psychotherapy training: A randomized controlled proof-of-concept trial

OBJECTIVE

Despite the importance of modeling for learning, it has only so far been investigated in a few controlled studies in psychotherapy training. We, therefore, investigated, across several study outcomes, whether modeling outperformed a control group.

METHOD

Sixty-nine trainees (i.e., psychology students; mean age 25.58 years, 81.2% women and 81.2% Caucasian) were randomly assigned to the intervention group (IG, manual reading plus modeling) or control group (CG, manual reading). After manual reading, IG participants watched a video of a skillfully conducted therapy session, whereas CG participants watched an unspecific tutorial (e.g., solving a Rubik's Cube). Trainees then demonstrated cognitive behavioral interventions in videotaped role-plays with (SPs). Psychotherapeutic competences and counseling skills were rated by two independent raters, on the Cognitive Therapy Scale (CTS) and the Clinical Communication Skills Scale-Short Form (CCSS-S). In addition, raters, trainees, and SPs assessed empathy (Empathy Scale [ES]) and alliance (Helping Alliance Questionnaire [HAQ]).

RESULTS

Multilevel modeling revealed Significant Time × Group Effects, that is, psychotherapy competences (CTS, β = .26, p = .026) and counseling skills (CCSS-S, β = .31, p = .004) to increase more pre-post in the IG than in the CG (rater perspective). The same applied to the alliance (HAQ) from the external rater and SP perspectives. Trainees evaluated the alliance as improving in both groups from pre to post training (main effect).

CONCLUSIONS

The results provide initial support for modeling as important for fostering psychotherapy skills. Future studies should focus on more complex training and real patient encounters. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Differences in psychotherapy preferences between psychotherapy trainees and laypeople

Despite increasing research on psychotherapy preferences, the preferences of psychotherapy trainees are largely unknown. Moreover, differences in preferences between trainees and their patients could (a) hinder symptom improvement and therapy success for patients and (b) represent significant obstacles in the early career and development of future therapists.

We compared the preferences of n = 466 psychotherapy trainees to those of n = 969 laypersons using the Cooper-Norcross Inventory of Preferences. Moreover, we compared preferences between trainees in cognitive-behavioural therapy (CBT) and psychodynamic trainees.

We found significant differences between both samples in 13 of 18 items, and three of four subscales. Psychotherapy trainees preferred less therapist directiveness (d = 0.58), more emotional intensity (d = 0.74), as well as more focused challenge (d = 0.35) than laypeople. CBT trainees preferred more therapist directiveness (d = 2.00), less emotional intensity (d = 0.51), more present orientation (d = 0.76) and more focused challenge (d = 0.33) than trainees in psychodynamic/psychoanalytic therapy.

Overall, the results underline the importance of implementing preference assessment and discussion during psychotherapy training. Moreover, therapists of different orientations seem to cover a large range of preferences for patients, in order to choose the right fit.

Problem drinking among university students in Berlin

OBJECTIVE

Problem-drinking among university students is common and poses serious health-related risks. Therefore, identifying and addressing associated factors is important.

PARTICIPANTS AND METHODS

A large cross-sectional online-survey with 12,914 university students from Berlin was conducted from November 2016 to August 2017. Relative-risk- and correlation-analysis was used to identify factors associated with problem-drinking and regular heavy-drinking. Independent t-tests compared impulsivity and personality traits, chi-square-tests compared drinking motives between risk- and non-risk-drinkers.

RESULTS

Male gender, tobacco-smoking, illegal substance use, impulsivity and various sociodemographic and psychosocial variables were significantly related to problem/heavy-drinking. Extraversion was a risk, conscientiousness and agreeableness were protective factors. Drinking-motives did not differ significantly between risk- and non-risk-drinkers. Generally, the main drinking-motives were to feel elated, relax and social purposes.

CONCLUSION

The identified markers and related problem behaviors may serve as a tool to enhance the identification of student subgroups at risk for problem/heavy-drinking, and hence improve targeted health-intervention-programs.

Assessing Patient Preferences: Examination of the German Cooper-Norcross Inventory of Preferences

Despite the positive effects of including patients’ preferences into therapy on psychotherapy outcomes, there are still few thoroughly validated assessment tools at hand. We translated the 18-item Cooper-Norcross Inventory of Preferences (C-NIP) into German and aimed at replicating its factor structure. Further, we investigated the reliability of the questionnaire and its convergence with trait measures. A heterogeneous sample of N = 969 participants took part in our online survey. Performing ESEM models, we found acceptable model fit for a four-factor structure similar to the original factor structure. Furthermore, we propose an alternative model following the adjustment of single items. The German C-NIP showed acceptable to good reliability, as well as small correlations with Big-Five personality traits, trait and attachment anxiety, locus of control, and temporal focus. However, we recommend further replication of the factor structure and further validation of the C-NIP.

Assessment of Counseling Self-Efficacy: Validation of the German Counselor Activity Self-Efficacy Scales-Revised

Background: Many authors regard counseling self-efficacy (CSE) as important in therapist development and training. The purpose of this study was to examine the factor structure, reliability, and validity of the German version of the Counselor Activity Self-Efficacy Scales-Revised (CASES-R). Method: The sample consisted of 670 German psychotherapy trainees, who completed an online survey. We examined the factor structure by applying exploratory and confirmatory factor analysis to the instrument as a whole. Results: A bifactor-exploratory structural equation modeling model with one general and five specific factors provided the best fit to the data. Omega hierarchical coefficients indicated optimal reliability for the general factor, acceptable reliability for the Action Skills-Revised (AS-R) factor, and insufficient estimates for the remaining factors. The CASES-R scales yielded significant correlations with related measures, but also with therapeutic orientations. Conclusion: We found support for the reliability and validity of the German CASES-R. However, the subdomains (except AS-R) should be interpreted with caution, and we do not recommend the CASES-R for comparisons between psychotherapeutic orientations.

The concise measurement of clinical communication skills: Validation of a short scale

OBJECTIVE

There is a lack of brief rating scales for the reliable assessment of psychotherapeutic skills, which do not require intensive rater training and/or a high level of expertise. Thus, the objective is to validate a 14-item version of the Clinical Communication Skills Scale (CCSS-S).

METHODS

Using a sample of N = 690 video-based ratings of role-plays with simulated patients, we calculated a confirmatory factor analysis and an exploratory structural equation modeling (ESEM), assessed convergent validities, determined inter-rater reliabilities and compared these with those who were either psychology students, advanced psychotherapy trainees, or experts.

RESULTS

Correlations with other competence rating scales were high (rs > 0.86-0.89). The intraclass correlations ranged between moderate and good [ICC_(2,2) = 0.65-0.80], with student raters yielding the lowest scores. The one-factor model only marginally replicated the data, but the internal consistencies were excellent (α = 0.91-95). The ESEM yielded a two-factor solution (Collaboration and Structuring and Exploration Skills).

CONCLUSION

The CCSS-S is a brief and valid rating scale that reliably assesses basic communication skills, which is particularly useful for psychotherapy training using standardized role-plays. To ensure good inter-rater reliabilities, it is still advisable to employ raters with at least some clinical experience. Future studies should further investigate the one- or two-factor structure of the instrument.

Communicating the diagnosis of cancer or depression: Results of a randomized controlled online study using video vignettes

Background

Communicating a diagnosis is highly important, yet complex, especially in the context of cancer and mental disorders. The aim was to explore the communication style of an oncologist vs. psychotherapist in an online study.

Methods

Patients (N = 136: 65 cancer, 71 depression) were randomly assigned to watch a standardized video vignette with one of two communication styles (empathic vs. unempathic). Outcome measures of affectivity, information recall, communication skills, empathy and trust were applied.

Results

Regardless of diagnosis, empathic communication was associated with the perception of a significantly more empathic (p < 0.001, ηpartial2 = 0.08) and trustworthy practitioner (p = 0.014, ηpartial2 = 0.04) with better communication skills (p = 0.013, ηpartial2 = 0.05). Cancer patients reported a larger decrease in positive affect (p < 0.001, ηpartial2 = 0.15) and a larger increase in negative affect (p < 0.001, ηpartial2 = 0.14) from pre‐ to post‐video than depressive patients. Highly relevant information was recalled better in both groups (p < 0.001, d = 0.61–1.06).

Conclusions

The results highlight the importance of empathy while communicating both a diagnosis of cancer and a mental disorder. Further research should focus on the communication of a mental disorder in association with cancer.

Recognizing obsessive-compulsive disorder: how suitable is the German Zohar-Fineberg obsessive-compulsive screen?

BACKGROUND

Despite the prevalence of obsessive-compulsive disorder (OCD), its precise identification remains challenging. With the Zohar-Fineberg Obsessive-Compulsive Screen (ZF-OCS; 5 or 6 items), a brief instrument is widely available mainly in English. As there is a lack of empirical studies on the ZF-OCS, the aim of the present study was to translate the items into German and investigate the instrument in a nonclinical sample.

METHODS

In two consecutive online surveys, n = 304 and n = 51 students participated. Besides the ZF-OCS, they answered established measures on OCD, depression, health anxiety, general anxiety and health-related well-being.

RESULTS

Whereas internal consistency was low (α = .53-.72; ω = .55-.69), retest reliability (r_t1,t2 = .89) at two weeks was high. As expected, we found high correlations with other OCD instruments (r > .61; convergent validity), and significantly weaker correlations with measures of depression (r = .39), health anxiety (r = .29), and health-related well-being (r = -.28, divergent validity). Nonetheless, the correlations with general anxiety were somewhere in between (r = .52).

CONCLUSIONS

Due to heterogeneous OCD subtypes, the ZF-OCS asks diverse questions which probably resulted in the present internal consistency. Nevertheless, the results on retest reliability and validity were promising. As for other OCD instruments, divergent validity regarding general anxiety seems problematic to establish. Even so, the ZF-OCS seems valuable for screening purposes, as it is short and easy to administer, and may facilitate initiating subsequent clinical assessment. Further studies should determine the instrument's diagnostic accuracy.

Management of COVID-19 ICU-survivors in primary care: - a narrative review

Many survivors of critical illness suffer from long-lasting physical, cognitive, and mental health sequelae. The number of affected patients is expected to markedly increase due to the COVID-19 pandemic. Many ICU survivors receive long-term care from a primary care physician. Hence, awareness and appropriate management of these sequelae is crucial. An interdisciplinary authorship team participated in a narrative literature review to identify key issues in managing COVID-19 ICU-survivors in primary care. The aim of this perspective paper is to synthesize important literature to understand and manage sequelae of critical illness due to COVID-19 in the primary care setting.

Development of a Scale for Assessing Basic Psychotherapeutic Skills

Abstract. Background: Well-established scales for the observation-based assessment of psychotherapy competence encompass multiple domains, require extensive rater training, and are rather cost-intensive. Objective: To develop a comprehensive but easy-to-administer instrument for the observation-based assessment of basic communication and counseling skills in both real and simulated patient encounters, the Clinical Communication Skills Scale (CCSS). Methods: We investigated the content validity and applicability of this scale. We then presented videos of simulated therapy sessions conducted by a competent vs. noncompetent therapist online to N = 209 laypersons and psychology students. Results: Results suggested a one-factorial solution. Internal consistency was excellent ( α = .94). For most aspects, convergent validity with established scales was moderate to high. The CCSS effectively differentiated between both levels of skill. Conclusions: The CCSS appears to be a feasible, reliable, and valid instrument. Nonetheless, its psychometric criteria should be investigated further in clinical samples, with licensed therapists, and in other languages.

Ist der Einsatz simulierter Patient_innen zum Erwerb psychotherapeutischer Fertigkeiten praktikabel?

Zusammenfassung. Theoretischer Hintergrund: Da der Kompetenzerwerb in der Psychotherapieausbildung maßgeblich durch Üben und systematisches Feedback bestimmt wird, wurde eine Online-Lehrveranstaltung entwickelt, in der erfahrungsbasiertes Lernen mit Simulationspatient_innen (SP) und strukturiertes Feedback kombiniert wurden. Fragestellung: Ziel der Studie war die qualitative und quantitative Evaluation der Lehrveranstaltung. Methode: Zunächst wurden halbstandardisierte Interviews mit Seminarteilnehmer_innen, SP und der Supervisorin durchgeführt und inhaltsanalytisch ausgewertet. Außerdem wurden die Gesprächsführungsfertigkeiten der Student_innen (aus Sicht einer Supervisorin) und die therapeutische Selbstwirksamkeit (Selbstbeurteilung) im Seminarverlauf erhoben. Ergebnisse: Zwischen N = 13 und 15 Masterstudent_innen der Klinischen Psychologie, die beiden SP und die Supervisorin nahmen an Begleitstudie und Interviews teil. Die Student_innen schätzten v. a. den Praxisbezug des Seminars, wünschten sich mehr Interaktionen mit SP und noch häufigeres Feedback. Das Onlineformat wurde als Übergangslösung wahrgenommen. Gesprächsführungsfertigkeiten und therapeutische Selbstwirksamkeit nahmen signifikant zu. Schlussfolgerungen: Erfahrungsbasiertes Lernen kann mit SP und Feedback praktikabel umgesetzt werden, allerdings sollten Präsenzrollenspiele zumindest ergänzend angeboten werden.

Prognostic Awareness in Advanced Disease: A Review Update and Concept Analysis

Purpose

Although subjective knowledge about the prognosis of an advanced disease is extremely important for coping and treatment planning, the concept of prognostic awareness (PA) remains inconsistently defined. The aims of the scoping review were to synthesize a definition of PA from the most recent literature, describe preconditions, correlates and consequences, and suggest a conceptual model.

Methods

By using scoping review methodology, we searched the Web of Science and PubMed databases, and included publications, reviews, meta-analyses or guidelines on all physical diagnoses, as well as publications offering a conceptual or an operational definition of PA. The data were analyzed by means of content analysis techniques.

Results

Of the 24 included publications, 21 referred exclusively to cancer, one to patients with hip fractures and two to palliative care in general. The deduced definition of PA comprised the following facets: adequate estimation of chances for recovery, knowledge of limited time to live, adequate estimation of life expectancy, knowledge of therapy goals, and knowledge of the course of the disease. Further content analysis results were mapped graphically and in a detailed table.

Conclusion

There appears to be a lack of theoretical embedding of PA that in turn influences the methods used for empirical investigation. Drawing on a clear conceptual definition, longitudinal or experimental studies would be desirable.

Standardized Patients in Clinical Psychology: From Research to Practice

Background: Within the pending reform of the German law of psychotherapy training, education in clinical psychology and the examination of psychotherapeutic competencies are established as more practice oriented. Students will acquire and demonstrate therapeutic skills through interactions with standardized patients (SPs). The aim of the current paper is to enhance evidence-based implementation of these new methods of education and examination by presenting the current evidence regarding the use of SPs and by pointing out areas for further research. Results: Results of recent studies demonstrate that SPs are able to present mental disorders authentically. Prerequisites are, among others, the selection of suitable SPs, detailed role scripts, specific training, feedback, and corrective training. Although some research questions, including the comparative effectiveness of SPs, remain unanswered, practice implications for using SPs in education, examination, and research can be drawn. These implications are illustrated schematically. Conclusions: The use of SPs has large potential for education in clinical psychology and for research on psychotherapy training. With a view to encouraging the widespread use of SPs, we provide exemplary materials (e.g., role script) within the online supplements (for all online suppl. material, see www.karger.com/doi/10.1159/000510049).

Die Validierung der Dimensional Obsessive-Compulsive Scale (DOCS) an einer deutschsprachigen Stichprobe

<b><i>Hintergrund:</i></b> PatientInnen mit Zwangsstörungen werden in klinischer Forschung und Praxis häufig nicht erkannt oder fehldiagnostiziert, wodurch es zu verzögerten und unzureichenden Behandlungen kommt. Ein Aspekt, der maßgeblich dazu beiträgt, sind unter anderem unzureichende Screening- und Diagnostikinstrumente, da bestehende Fragebögen zur Erfassung von Zwangsstörungen zu einem großen Teil Limitationen hinsichtlich ihrer psychometrischen Qualitäten und ihrer Aktualität unterliegen. Mit der Dimensional Obsessive-Compulsive Scale (DOCS) steht im englischsprachigen Raum seit mehreren Jahren bereits ein vielversprechendes Instrument zur Erfassung von Zwangsstörungen zur Verfügung. <b><i>Patienten und Methoden:</i></b> Ziel der vorliegenden Arbeit war es, erstmalig die Faktorstruktur sowie die psychometrischen Eigenschaften der deutschsprachigen DOCS-Version zu überprüfen. Hierzu wurden 177 PatientInnen (107 mit Zwangsstörung, 30 mit Angststörungen und 40 mit Depression) sowie eine nicht-klinische Kontrollgruppe mit 223 Probanden untersucht. <b><i>Ergebnisse:</i></b> Die vierfaktorielle Originalstruktur der DOCS konnte in explorativen und konfirmatorischen Faktoranalysen repliziert werden. Interne Konsistenzen und die zeitliche Stabilität der DOCS fielen akzeptabel bis sehr gut aus. Die Konstruktvalidität der DOCS-Gesamtskala fiel zufriedenstellend bis gut aus. Die Kriteriumsvaliditäten fielen bedingt zufriedenstellend aus. Die diagnostische Genauigkeit der DOCS fiel befriedigend aus. <b><i>Schlussfolgerung:</i></b> Die deutsche Version der DOCS ist ein robustes, reliables und erstmals validiertes Instrument zur dimensionalen Beschreibung des Schweregrads von Zwangsstörungen.

Einsatz standardisierter Patienten im Psychologiestudium: Von der Forschung in die Praxis

<b><i>Hintergrund:</i></b> Im Rahmen des reformierten Psychotherapeutengesetzes wird eine stärkere Praxisorientierung in der klinisch-psychologischen Lehre und in der Prüfung psychotherapeutischer Kompetenzen verankert. Hierbei sollen Studierende durch die Interaktion mit standardisierten Patient*innen (SP) therapeutische Kompetenzen erwerben und demonstrieren. <b><i>Fragestellung:</i></b> Das Ziel des vorliegenden Beitrags ist es, eine evidenzbasierte Umsetzung dieser neuen Lehr- und Prüfungsformate zu unterstützen, indem bisherige Forschungsbefunde zum Einsatz von SP dargestellt und Bereiche, in denen weitere Forschung notwendig ist, aufgezeigt werden. <b><i>Ergebnisse:</i></b> Empirische Befunde zeigen, dass SP psychische Störungen authentisch darstellen können. Voraussetzung dafür sind beispielsweise die Auswahl geeigneter SP, detaillierte Rollenanleitungen, spezifisches Training, Feedback und Nachschulungen. Auch wenn einige Forschungsfragen, wie zur vergleichenden Wirksamkeit des Einsatzes von SP, noch unbeantwortet sind, lassen sich praktische Implikationen für SP-Programme in Lehre, Prüfung und Forschung ableiten, die in einem Ablaufschema dargestellt werden. <b><i>Schlussfolgerungen:</i></b> Der Einsatz von SP bietet großes Potenzial für die klinisch-psychologische Lehre und Ausbildungsforschung. Um den Einsatz von SP an anderen Standorten zu unterstützen, werden Beispielmaterialien (z.B. Rollenanleitung) in den elektronischen Supplementen (siehe www.karger.com/doi/10.1159/000509249 für alle Supplemente) zum Artikel zur Verfügung gestellt.

Perspectives of patients with multiple myeloma on accepting their prognosis-A qualitative interview study

OBJECTIVE

Prognostic awareness is essential for making treatment decisions in malignant diseases. Being confronted with a poor prognosis, however, can affect patients' mental health. Therefore, it is important to study coping in the context of malignant diseases. Acceptance is an adaptive coping strategy associated with less psychological distress. This study sought to explore the facilitators and barriers for prognostic acceptance in a sample in which both hope and uncertainty regarding prognosis are pronounced: multiple myeloma patients.

METHODS

In a German university hospital, 20 multiple myeloma patients participated in semistructured interviews. Following thematic content analysis by Kuckartz, the interview transcripts were coded for facilitators and barriers for prognostic acceptance. Additionally, patients completed questionnaires on prognostic awareness and sociodemographic characteristics.

RESULTS

Patients described the following facilitators for prognostic acceptance: social support, positive thinking, focusing on the Here and Now, proactive confrontation, having little to no symptoms, and being there for others. The indicated barriers were distressing physical symptoms and restricted functioning, social distress, and additional distress from other areas of life.

CONCLUSIONS

Patients reported a variety of factors-related to the social realm, symptom burden, and specific attitudes-that help or hinder them in accepting their prognosis. Oncologists and psycho-oncologists may support prognostic acceptance by encouraging patients to both actively deal with realistic information as well as enjoy pleasant and meaningful moments in the present during which the disease and its prognosis recedes into the background.

Local and Nonlocal Electron Dynamics of Au/Fe/MgO(001) Heterostructures Analyzed by Time-Resolved Two-Photon Photoemission Spectroscopy

Employing femtosecond laser pulses in front and back side pumping of Au/Fe/MgO(001) combined with detection in two-photon photoelectron emission spectroscopy, we analyze local relaxation dynamics of excited electrons in buried Fe, injection into Au across the Fe-Au interface, and electron transport across the Au layer at 0.6 to 2.0 eV above the Fermi energy. By analysis as a function of Au film thickness we obtain the electron lifetimes of bulk Au and Fe and distinguish the relaxation in the heterostructure's constituents. We also show that the excited electrons propagate through Au in a superdiffusive regime and conclude further that electron injection across the epitaxial interface proceeds ballistically by electron wave packet propagation.

Can Psychotherapy Trainees Distinguish Standardized Patients From Real Patients?

Abstract. Background: Under the new psychotherapy law in Germany, standardized patients (SPs) are to become a standard component in psychotherapy training, even though little is known about their authenticity. Objective: The present pilot study explored whether, following an exhaustive two-day SP training, psychotherapy trainees can distinguish SPs from real patients. Methods: Twenty-eight psychotherapy trainees ( M = 28.54 years of age, SD = 3.19) participated as blind raters. They evaluated six video-recorded therapy segments of trained SPs and real patients using the Authenticity of Patient Demonstrations Scale. Results: The authenticity scores of real patients and SPs did not differ ( p = .43). The descriptive results indicated that the highest score of authenticity was given to an SP. Further, the real patients did not differ significantly from the SPs concerning perceived impairment ( p = .33) and the likelihood of being a real patient ( p = .52). Conclusions: The current results suggest that psychotherapy trainees were unable to distinguish the SPs from real patients. We therefore strongly recommend incorporating training SPs before application. Limitations and future research directions are discussed.

Screening dysfunktionaler Überzeugungen bei Zwangsstörungen

Hintergrund

Dysfunktionale Überzeugungen und Bewertungen von Zwangsgedanken sind ausschlaggebend für die Entstehung und Aufrechterhaltung von Zwangsstörungen. Die reliable und valide Erfassung dieser Überzeugungen mithilfe von Screeningverfahren ist für die kognitiv-verhaltenstherapeutische Behandlung relevant.

Fragestellung

Ziel der Arbeit war die Erstellung eines Scoping review bezüglich der aktuellen Screeninginstrumenten zur Erfassung der 6 von der Obsessive Compulsive Cognitions Working Group (OCCWG) vorgeschlagenen Domänen bei Zwangsstörungen. Die Verfahren wurden systematisch nach ihrer psychometrischen Güte bewertet und in ihren Eigenschaften verglichen.

Material und Methoden

Die Literatursuche erfolgte in den Datenbanken Web of Science Core Collection, Google Scholar und PubMed. Eingeschlossen wurden deutsch- und englischsprachige Verfahren für Erwachsene (≥18 Jahre).

Ergebnisse

Es konnten 56 Studien zur Überprüfung der psychometrischen Eigenschaften von 16 Fragebogen eingeschlossen werden. Die Fragebogen erfassten alle Domänen dysfunktionaler Überzeugungen. Außerdem lagen 4 domänenübergreifende Verfahren vor, und 9 der Fragebogen waren deutschsprachig. Die Mehrzahl der Screeningverfahren wies adäquate bis gute psychometrische Werte auf. Die methodische Qualität der Studien war heterogen; methodische und statistische Verfahren nahmen über die Jahre an Komplexität zu.

Schlussfolgerung

Weiterer Forschungsbedarf besteht v. a. in der Untersuchung der Störungsspezifität und Änderungssensitivität von Screeningverfahren an klinischen Stichproben.

Psychological Interventions for Health Anxiety and Somatic Symptoms

Abstract. This study examined the effectiveness of psychological interventions for severe health anxiety (SHA) regarding somatic symptoms (SS) and health anxiety (HA). The databases Web of Science, EBSCO, and CENTRAL were searched on May 15, 2019, May 16, 2019, and August 5, 2019, respectively. Eighteen randomized controlled trials ( N = 2,050) met the inclusion criteria (i.e., hypochondriasis, illness anxiety disorder or somatic symptom disorder with elevated HA being assessed with validated interviews; use of standardized outcome measures). Two reviewers independently evaluated the studies’ risk of bias using the Revised Cochrane Risk-of-Bias Tool for randomized trials (RoB-2) tool. Overall, psychological interventions were significantly more effective than waitlist, treatment-as-usual, or placebo post-treatment ( gSS = 0.70, gHA = 1.11) and at follow-up ( gSS = 0.33, gHA = 0.70). CBT outperformed other psychological interventions or pharmacotherapy for HA post-treatment (Hedge’s  gHA = 0.81). The number of sessions did not significantly predict the effect sizes. In sum, psychological interventions were effective for SHA, but the generalizability of the results for SS is limited, because only two high-quality trials contributed to the comparisons.

Krankheitsängste bei Psychologiestudierenden

Zusammenfassung. Theoretischer Hintergrund: Als Medical Students’ Disease wird die Angst von Medizinstudierenden bezeichnet, unter Krankheiten zu leiden, mit denen sie sich im Studium auseinandersetzen. Fragestellung: Es wurde untersucht, ob ähnliche Phänomene vorübergehender Krankheitsängste auch bei Psychologiestudierenden existieren. Methode: Mittels etablierter Illness-Attitude-Scales (IAS) und einer eigens entwickelten Ergänzung wurden Ängste vor somatischen und psychischen Erkrankungen erhoben. Ergebnisse: Krankheitsängste bei Psychologiestudierenden waren nicht stärker ausgeprägt als bei Studierenden anderer Fachrichtungen. Ängste vor körperlichen Erkrankungen waren häufiger als Ängste vor psychischen Störungen, die keiner signifikanten zeitlichen Veränderung unterlagen. Schlussfolgerung: Die Beschäftigung mit psychischen Störungen geht nicht zwangsläufig mit einem Anstieg von Ängsten vor psychischen Erkrankungen unter Psychologiestudierenden einher. Erhöhte Belastungswerte bei allen Studierenden legen nahe, dass das Studium selbst eine Herausforderung darstellt, für deren Bewältigung Unterstützung angeboten werden kann.

Standardized patients in psychotherapy training and clinical supervision: study protocol for a randomized controlled trial

Background

Psychotherapy is highly effective and widely acknowledged for treating various mental disorders. Nevertheless, in terms of methods for teaching effective psychotherapeutic approaches and competencies, there has been a lack of investigation. Training and supervision are the main strategies for teaching therapist competencies, and standardized role-plays with simulated patients (i.e., trained individuals playing someone with a mental disorder) seem useful for evaluating training approaches. In medical education, this procedure is now internationally established. However, so far, little use has been made of standardized role-playing to evaluate training and supervision in the area of clinical psychology and psychotherapy.

Methods

In this study, standardized role-plays are used to evaluate methods for training and supervision. Central cognitive behavioral approaches for treating depression are taught in the training. The first experiment compares an active training approach (i.e., model learning) with a passive one (i.e., reading manual-based instructions). The second experiment compares a direct supervision technique (i.e., supervision based on video analysis) with an indirect one (i.e., supervision based on verbal reporting). In each experiment, 68 bachelor’s and master’s students of psychology will be randomly assigned to the experimental and control groups. Each student takes part in three role-plays (baseline, post and 3-month follow-up), which are all videotaped. Two independent raters assess therapist competencies in each role-play on the basis of a standardized competence scale.

Discussion

The research project aims to contribute to the development of specific training and supervision methods in order to improve psychotherapy training and patient care.

Trial registration

ISRCTN Registry, ISRCTN19173895. Registered on 10 December 2019.

The heterogeneous course of OCD - A scoping review on the variety of definitions

Although effective treatments exist, obsessive-compulsive disorder (OCD) is, according to the views of patients and experts, still associated with chronicity, a term with no clear and consistent definition. To improve patient care and to foster research, a clear distinction between the various concepts of chronicity cited in the literature is crucial. The aim was thus to explicate central concepts related to courses and trajectories in OCD based on an explorative, scoping search of the existing literature. Our review revealed a considerable lack in content validity, as the concepts were operationalized inconsistently. Concepts related to symptom improvement were (complete) recovery, partial/full remission and partial/full response. Terms used in relation with symptom stability or worsening were chronic/continuous, intermittent and episodic course, waxing and waning, relapse, recurrence, deterioration and treatment-refractoriness. All concepts are explained and visualized as a result of the review. Further, based on authors' remarks, we present recommendations on how to enhance care for chronic OCD patients, namely training psychotherapists to apply CBT as intended, managing patient beliefs about disease and treatment, and adapting psychotherapy to OCD subtypes. Finally, we then propose a literature-based definition of treatment-refractory OCD.

Research priorities set by people with OCD and OCD researchers: Do the commonalities outweigh the differences?

Objective

In contrast to research agendas being predominantly set by scientists or funders, a collaborative approach was used to spot future goals for research on obsessive‐compulsive disorder.

Methods

First, we conducted a meta‐review and then compared the results of two online surveys with OCD professionals and patients on research priorities. The literature search was performed in three comprehensive databases, and ten research goals were extracted. Sixty‐four patients and eight professionals responded to open questions on their five most important goals. Then, they ranked the ten aims extracted from the literature on a 6‐point Likert scale.

Results

For patients and professionals, research on treatment gains that persist long‐term was most important. Concerning the top five goals listed in an open format, for patients, development and maintenance of the disease was as important as psychotherapy and its efficacy. In contrast, for professionals, the efficacy and the optimization of psychotherapy were the far most important research goals.

Conclusions

We proposed one possibility to involve patients in OCD research, and the multitude of answers presents a wealth of research ideas.

Practice Implications

Since consistent research involvement may contribute to its clinical impact, researchers are now invited to translate our findings into empirical studies.

Erfolgreiche Supervision in der Psychotherapieausbildung

Zusammenfassung. Theoretischer Hintergrund: Supervision fand als Forschungsgegenstand in der Kognitiven Verhaltenstherapie vergleichsweise wenig Beachtung. Fragestellung: Ziel der explorativen Studie war es, Voraussetzungen und Auswirkungen erfolgreicher Supervision zu erheben. Methode: Elf Supervisor_innen und zehn Supervisand_innen des Weiterbildungsstudiengangs Psychologische Psychotherapie (Verhaltenstherapie) wurden mittels halbstrukturierter Leitfadeninterviews befragt. Die Auswertung erfolgte anhand der qualitativen Inhaltsanalyse nach Mayring. Ergebnisse: Es wurden Personenmerkmale (z. B. Kritikfähigkeit, Offenheit, Strukturiertheit), eine tragfähige Supervisionsbeziehung (z. B. vertrauensvolle Atmosphäre) sowie Methoden (z. B. Videoanalyse) als Voraussetzungen für erfolgreiche Supervision beschrieben. Diese dienen vor allem der Förderung psychotherapeutischer Kompetenzen. Schlussfolgerung: Erfolgreiche Supervision ist strukturiert und interpersonell effektiv gestaltet. Vermutlich spielen Merkmale der Supervisand_innen (z. B. Kritikfähigkeit) eine bedeutsamere Rolle als bisher angenommen. Theoretische Annahmen stützend wurden die Auswirkungen vorwiegend in der Förderung psychotherapeutischer Kompetenzen gesehen.

Warum nehmen Verhaltenstherapeut_innen an Fortbildungen teil?

Zusammenfassung. Theoretischer Hintergrund: Um psychotherapeutische Kompetenzen zu erhalten, kommt Fortbildungen eine zentrale Rolle zu. Fragestellung: Ziel war es, Verhaltenstherapeut_innen zu Motivatoren und Barrieren bezüglich der Teilnahme an Fortbildungen und zu Einstellungen zu evidenzbasierter Praxis zu befragen. Methode: In die Befragung einbezogen wurden N = 48 Teilnehmer_innen eines zweitägigen Workshops zu aktuellen Ansätzen der Traumatherapie. Fortbildungsmotivation, Teilnahmebarrieren und Einstellungen zu evidenzbasierter Praxis wurden in Zusammenhang mit der aktuellen Fortbildungsteilnahme geprüft. Ergebnisse: Der Wunsch nach beruflicher Verbesserung und persönliches Interesse motivierten am häufigsten, soziale Anreize und beruflicher Aufstieg waren weniger relevant. Die Vereinbarkeit von Fortbildungen mit der Arbeitstätigkeit und Fortbildungskosten waren häufige Barrieren. Schlussfolgerungen: Die Ergebnisse liefern Hinweise zur Diskussion des Konzepts der evidenzbasierten Psychotherapie und zur Dissemination wissenschaftlicher Ergebnisse in die Praxis.

Empirical research in clinical supervision: a systematic review and suggestions for future studies

BACKGROUND

Although clinical supervision is considered to be a major component of the development and maintenance of psychotherapeutic competencies, and despite an increase in supervision research, the empirical evidence on the topic remains sparse.

METHODS

Because most previous reviews lack methodological rigor, we aimed to review the status and quality of the empirical literature on clinical supervision, and to provide suggestions for future research. MEDLINE, PsycInfo and the Web of Science Core Collection were searched and the review was conducted according to current guidelines. From the review results, we derived suggestions for future research on clinical supervision.

RESULTS

The systematic literature search identified 19 publications from 15 empirical studies. Taking into account the review results, the following suggestions for further research emerged: Supervision research would benefit from proper descriptions of how studies are conducted according to current guidelines, more methodologically rigorous empirical studies, the investigation of active supervision interventions, from taking diverse outcome domains into account, and from investigating supervision from a meta-theoretical perspective.

CONCLUSIONS

In all, the systematic review supported the notion that supervision research often lags behind psychotherapy research in general. Still, the results offer detailed starting points for further supervision research.

TRIAL REGISTRATION

PROSPERO; CRD42017072606 , registered on June 20, 2017.

The assessment of cognitive-behavioral therapy skills in patients diagnosed with health anxiety: Development and pilot study on an observer-based rating scale

Cognitive-behavioral therapy is a highly effective treatment of health anxiety, but it remains unclear through which mechanisms treatment effects prevail. Some evidence suggests that patients acquire skills-understood as techniques helping them reach therapy goals-through psychotherapy. In the current study, an observer-based rating scale for the skills assessment of patients with health anxiety (SAPH) was developed and validated in a pilot study. Based on 177 videotapes, four independent raters evaluated the frequency of skills acquired during cognitive and exposure therapy among 66 patients diagnosed with health anxiety with the SAPH. Predictive validity was evaluated by the Yale-Brown Obsessive-Compulsive Scale for Hypochondriasis. The SAPH demonstrated good interrater reliability (ICC_(1,2)  = .88, p < .001, 95% CI [.81, .92]) and internal consistency (α = .94). Although patient skills did not significantly increase during three sessions, they significantly predicted a reduction in health anxiety symptoms at the end of treatment (R²  = .35). Patients' skills are highly important within the treatment of health anxiety. By providing external ratings of patients' skills with good psychometric properties, our pilot data suggest that the SAPH may complement current tools for the assessment of skills, specifically in targeting health anxiety.

Effectiveness of metacognitive interventions for mental disorders in adults-A systematic review and meta-analysis (METACOG)

We evaluated the effectiveness and acceptability of metacognitive interventions for mental disorders. We searched electronic databases and included randomized and nonrandomized controlled trials comparing metacognitive interventions with other treatments in adults with mental disorders. Primary effectiveness and acceptability outcomes were symptom severity and dropout, respectively. We performed random-effects meta-analyses. We identified Metacognitive Training (MCTrain), Metacognitive Therapy (MCTherap), and Metacognition Reflection and Insight Therapy (MERIT). We included 49 trials with 2,609 patients. In patients with schizophrenia, MCTrain was more effective than a psychological treatment (cognitive remediation, SMD = -0.39). It bordered significance when compared with standard or other psychological treatments. In a post hoc analysis, across all studies, the pooled effect was significant (SMD = -0.31). MCTrain was more effective than standard treatment in patients with obsessive-compulsive disorder (SMD = -0.40). MCTherap was more effective than a waitlist in patients with depression (SMD = -2.80), posttraumatic stress disorder (SMD = -2.36), and psychological treatments (cognitive-behavioural) in patients with anxiety (SMD = -0.46). In patients with depression, MCTherap was not superior to psychological treatment (cognitive-behavioural). For MERIT, the database was too small to allow solid conclusions. Acceptability of metacognitive interventions among patients was high on average. Methodological quality was mostly unclear or moderate. Metacognitive interventions are likely to be effective in alleviating symptom severity in mental disorders. Although their add-on value against existing psychological interventions awaits to be established, potential advantages are their low threshold and economy.

Standardized Patients in Clinical Psychology and Psychotherapy: a Scoping Review of Barriers and Facilitators for Implementation

OBJECTIVES

The use of simulated and standardized patients (SP) is widely accepted in the medical field and, from there, is beginning to disseminate into clinical psychology and psychotherapy. The purpose of this study was therefore to systematically review barriers and facilitators that should be considered in the implementation of SP interventions specific to clinical psychology and psychotherapy.

METHODS

Following current guidelines, a scoping review was conducted. The literature search focused on the MEDLINE, PsycINFO and Web of Science databases, including Dissertation Abstracts International. After screening for titles and abstracts, full texts were screened independently and in duplicate according to our inclusion criteria. For data extraction, a pre-defined form was piloted and used. Units of meaning with respect to barriers and facilitators were extracted and categorized inductively using content-analysis techniques. From the results, a matrix of interconnections and a network graph were compiled.

RESULTS

The 41 included publications were mainly in the fields of psychiatry and mental health nursing, as well as in training and education. The detailed category system contrasts four supercategories, i.e., which organizational and economic aspects to consider, which persons to include as eligible SPs, how to develop adequate scenarios, and how to authentically and consistently portray mental health patients.

CONCLUSIONS

Publications focused especially on the interrelation between authenticity and consistency of portrayals, on how to evoke empathy in learners, and on economic and training aspects. A variety of recommendations for implementing SP programs, from planning to training, monitoring, and debriefing, is provided, for example, ethical screening of and ongoing support for SPs.

Do mental health patients learn what their cognitive-behaviour therapists think they do? A short report on qualitative interviews comparing perspectives

Purpose: The acquisition of skills is essential to the conceptualization of cognitive-behavioural therapy. Yet, what experiences are encountered and what skills actually learned during therapy, and whether patients and therapists have concurrent views hereof, remains poorly understood.

Method: An explorative pilot study with semi-structured, corresponding interview guides was conducted. Pilot data from our outpatient unit were transcribed and content-analyzed following current guidelines.

Results: The responses of 18 participants (patients and their psychotherapists) were assigned to six main categories. Educational and cognitive aspects were mentioned most frequently and consistently by both groups. Having learned Behavioural alternatives attained the second highest agreement between perspectives.

Conclusions: Patients and therapists valued CBT as an opportunity to learn new skills, which is an important prerequisite also for the maintenance of therapeutic change. We discuss limitations to generalizability but also theoretical and therapy implications.

Effectiveness of metacognitive interventions for mental disorders in adults: a systematic review protocol (METACOG)

INTRODUCTION

Whereas the efficacy of cognitive-behavioural therapy has been demonstrated for a variety of mental disorders, there is still need for improvement, especially regarding less prevalent or more severe disorders. Recently, metacognitive interventions have been developed and are now available for a variety of diagnoses. Still, a systematic review investigating the effectiveness of different metacognitive interventions for various mental disorders is missing.

METHODS AND ANALYSIS

Randomised controlled trials (RCTs), cross-over and cluster RCTs and non-randomised controlled trials on metacognitive interventions (ie, metacognitive therapy, metacognitive training, others) in adults with any mental disorder will be included. As comparators, another psychological or pharmacological treatment, a combined psychological and pharmacological treatment, treatment as usual or no active treatment are eligible. Outcomes refer to efficacy and acceptability of metacognitive interventions.

ETHICS AND DISSEMINATION

In light of the popularity of metacognitive interventions, the systematic review will provide researchers, clinicians and patients with substantial information on the intervention's effectiveness across different mental disorders. Results will be published in peer-reviewed journals and disseminated through a patient workshop.

Supervision in der Verhaltenstherapie

Zusammenfassung. Theoretischer Hintergrund: Supervision spielt eine zentrale Rolle zum Wissens- und Kompetenzerwerb sowie in der Qualitätssicherung. Fragestellung: Ziel war es, den aktuellen Forschungsstand zur Supervision im Rahmen der kognitiven Verhaltenstherapie abzubilden, um daraus Schlussfolgerungen für die zukünftige Forschung abzuleiten. Methode: Zur Evidenzsynthese wurde ein Scoping Review durchgeführt, das die Darstellung zentraler Konzepte, aktueller Evidenz und möglicher Forschungsbedarfe ermöglichte. Neben einer systematischen Literaturrecherche wurden Vorwärts- und Rückwärtssuchstrategien eingesetzt. Ergebnisse: Eingeschlossen wurden zwölf Publikationen basierend auf zehn empirischen Studien. Alle Studien beschrieben Ausbildungssettings, aber nur wenige untersuchten übende Interventionen (z. B. Rollenspiele). Häufig wurden Effekte subjektiv erfasst, die methodische Qualität der Begleitstudien variierte. Schlussfolgerungen: Notwendig sind weitere methodisch hochwertige Studien, experimentell orientiert oder in der klinischen Praxis, die die Supervisionsforschung bereichern können.

Conceptual decomposition of complex health care interventions for evidence synthesis: a literature review

RATIONALE, AIMS AND OBJECTIVES

The clarity of pivotal concepts is an important prerequisite for the development, evaluation and exchange of scientific ideas. The term 'complex intervention' is increasingly used in the health care literature, although it often remains unclear what is actually meant by this concept. Therefore, our aim was to analyse the literature regarding definitions of the terms 'complex intervention' and 'components' of such interventions.

METHOD

To identify the methodological publications, systematic and snowballing techniques were combined for the literature search. Relevant units of meaning were extracted from 68 included publications. Afterwards, we deduced categories and related frequencies by inductive and quantitative content analysis techniques.

RESULTS

Several types of complexity were distinguished in the literature. Most authors viewed complex interventions as multicomponent interventions that are characterized by interactions between the components themselves, with the context or as systemic interventions. Components of complex interventions were described in the publications as having the potential to causally influence outcomes, thus being essential for achieving an effect. Other definitions and inconsistencies among the definitions are highlighted and discussed.

CONCLUSIONS

From our synthesis, we derived definitions of the central health care-related concepts 'complex intervention' and 'components' of an intervention. Although we found numerous diverse definitions, they could be reduced to a defined number of core characteristics. These characteristics may facilitate communication regarding complex interventions and enable the deduction of methodological approaches for evidence synthesis.

A comparison of the emotional and behavioral problems of children of patients with cancer or a mental disorder and their association with parental quality of life

OBJECTIVE

To compare the emotional and behavioral problems of children of patients suffering from cancer or a mental disorder and their association with parental quality of life.

METHODS

A total of 223 children from 136 families and their 160 parents were investigated from multiple perspectives in a cross-sectional study. The consistency of different adjustment reports between family members was examined. Through mixed models, the differences between parental HRQoL and the children's symptomatology were studied with regard to the type of parental illness. The prediction of children's adjustment through parental HRQoL was further examined. Additionally, gender and age of the children were considered.

RESULTS

Half of the children exhibited psychosocial problems. Gender and age differences were independent of the type of parental disease. In families with parental cancer, the reports of children's adjustment were more consistent between family members than in families where a parental mental disorder was present. We found differences in HRQoL between families with mentally ill parents and those with parental cancer patients. Specifically, the healthy partners of mentally ill parents showed worse HRQoL compared with healthy partners of cancer patients. Healthy parents' reduced HRQoL was associated with worse adjustment in their children, regardless of the type of parental illness, but this result was not found for ill parents.

CONCLUSION

Family members confronted with parental cancer or mental disorders are more burdened compared with those from the "normal" population, independently of the type of disease. Our results indicate that the type of a parental disease has no direct effect on children's adjustment. However, there are disease-specific effects on parental HRQoL, which are associated with children's adjustment.