0000000000053843
AUTHOR
Falk Leichsenring
Reliability, validity and responsiveness of the EQ-5D in assessing and valuing health status in patients with social phobia
Abstract Objective The aim of the study was to analyse the psychometric properties of the EQ-5D in patients with social phobia. Methods We used a sample of 445 patients with social phobia with five measurement points over a 30 month period. The discriminative ability of the EQ-5D was analysed by comparing the patients’ responses with the general population and between different disease severity levels. For test-retest reliability we assessed the level of agreement in patients’ responses over time, when there was no change in the Liebowitz Social Anxiety Scale (LSAS). Construct validity was analysed by identifying correlations of the EQ-5D with more specific instruments. For responsiveness w…
The costs of social anxiety disorder: The role of symptom severity and comorbidities
Abstract Background Social anxiety disorder (SAD) is associated with low direct costs compared to other anxiety disorders while indirect costs tend to be high. Mental comorbidities have been identified to increase costs, but the role of symptom severity is still vague. The objective of this study was to determine the costs of SAD, and to explore the impact of symptoms and comorbidities on direct and indirect costs. Methods Baseline data, collected within the SOPHO-NET multi-centre treatment study ( N =495), were used. Costs were calculated based on health care utilization and lost productivity. Symptom severity was measured with the Liebowitz-Social-Anxiety-Scale; comorbidities were include…
Short-term cost-effectiveness of psychodynamic therapy and cognitive-behavioral therapy in social anxiety disorder: Results from the SOPHO-NET trial
Abstract Background To investigate the short-term cost-effectiveness of cognitive-behavioral therapy (CBT) and psychodynamic therapy (PDT) compared to waiting list (WL). Methods The analysis was conducted alongside the SOPHO-NET multi-center efficacy trial. Patients were randomly assigned to CBT ( n =209), PDT ( n =207), or WL ( n =79). Resource use was assessed prior and during treatment to determine direct and absenteeism costs. Unadjusted incremental cost-effectiveness ratios (ICERs) were calculated based on remission and response rates. To visualize statistical uncertainty, cost-effectiveness acceptability curves (CEACs) were constructed based on adjusted net-benefit regression. Differe…
The role of shame and guilt in social anxiety disorder
Abstract Research suggests that shame and guilt may play a role in anxiety disorders. For social anxiety disorder (SAD), however, only a few studies investigated patients with the primary diagnosis of SAD. Thus, further research on shame and guilt in SAD is required. A secondary analysis of Data from the SOPHO-NET multicenter treatment study was performed. In a large sample of N = 495 patients with the primary diagnosis of SAD the relationship between shame and guilt with symptoms of social anxiety, depression, and interpersonal problems was examined by means of correlation analysis and additionally, a hierarchical linear regression analysis. To assess SAD, the German version of the Structu…
Typical symptom change patterns and their predictors in patients with social anxiety disorder: A latent class analysis
Abstract Objectives The use of trajectories and analysis of change patterns is a promising way toward better differentiation of subgroups in psychotherapy studies. Research on change patterns in social anxiety disorder (SAD) are still rare, although SAD is one of the most common mental disorders. In a secondary analysis of data from the SOPHO-NET-trial (ISRCTN53517394) this study aimed to investigate change patterns and their predictors in a sample of SAD patients. Methods Patients with SAD (N = 357) were randomly assigned to cognitive-behavioral or psychodynamic therapy. The Liebowitz Social Anxiety Scale (LSAS) was assessed at 1st session (pre), 8th session, 15th session and at the end of…
Interindividual Differences in Treatment Effects based on Structural Equation Models with Latent Variables: An EffectLiteR Tutorial
The investigation of interindividual differences in the effects of a treatment is challenging, because many constructs-of-interest in psychological research such as depression or anxiety are latent variables and modeling heterogeneity in treatment effects requires interactions and potentially nonlinear relationships. In this paper, we present a tutorial of the EffectLiteR approach (Mayer, Dietzfelbinger, Rosseel, & Steyer, 2016) that allows for estimating individual treatment effects based on latent variable models. We describe step by step how to apply the approach using the EffectLiteR software package with data from the multicenter randomized controlled trial of the Social Phobia…
Cognitive-behavioral therapy and psychodynamic psychotherapy: techniques, efficacy, and indications.
In this article, we provide an overview of the techniques and efficacy of the two most commonly used psychotherapeutic treatments of psychiatric disorders in adults: cognitive-behavioral and psychodynamic therapy. Psychotherapeutic techniques, major indications, and empirical evidence will be presented. The focus will be on empirically supported models of treatment.Cognitive-behavioral therapy and psychodynamic psychotherapy are the most frequently applied methods of psychotherapy in clinical practice.To give an up-to-date description of cognitive-behavioral therapy and psychodynamic psychotherapy and to review empirical evidence for efficacy in specific mental disorders.Systematic reviews …
The Social Phobia Psychotherapy Research Network
This paper presents the Social Phobia Psychotherapy Research Network. The research program encompasses a coordinated group of studies adopting a standard protocol and an agreed-on set of standardized measures for the assessment and treatment of social phobia (SP). In the central project (study A), a multicenter randomized controlled trial, refined models of manualized cognitive-behavioral therapy and manualized short-term psychodynamic psychotherapy are compared in the treatment of SP. A sample of 512 outpatients will be randomized to either cognitive-behavioral therapy, short-term psychodynamic psychotherapy or waiting list. Assessments will be made at baseline, at the end of treatment and…
Developing a prototype for short-term psychodynamic (supportive-expressive) therapy: An empirical study with the psychotherapy process Q-set.
AbstractObjective: A Psychotherapy Process Q-set (PQS) prototype characteristic of short-term psychodynamic therapy (STPP) does not yet exist. Method: Experts in supportive-expressive (SE) therapy used the 100-Item PQS questionnaire to rate an ideal short-term SE therapy. Results: Agreement between raters was high (Cronbach's alpha = 0.94). The prototype for SE therapy showed a significant correlation with the psychoanalytic prototype, but with 28% of variance explained, the majority of variance of the former was not explained by the latter or vice versa. Furthermore, the SE prototype showed significant correlations with the cognitive-behavioral prototype and the prototype of interpersonal …
Optimal Cut Points for Remission and Response for the German Version of the Social Phobia Anxiety Inventory (SPAI).
The German version of the Social Phobia and Anxiety Inventory (SPAI-G) is a validated measure for the detection of social anxiety disorder (SAD). The aim of the present study was to develop optimal cut points (OC) for remission and response to treatment for the SPAI-G.We used Receiver Operating Characteristic methods and bootstrapping to analyse the data of 359 patients after psychotherapeutic treatment. OCs where defined as the cut points with the highest sensitivity and specificity after bootstrapping.For remission, an OC of 2.79 was found, and for response, a change in score from pre- to posttreatment by 11% yielded best results.The OC we identified for remissionmay be used to improve th…
Excess costs of social anxiety disorder in Germany
Abstract Background Social anxiety disorder is one of the most frequent mental disorders. It is often associated with mental comorbidities and causes a high economic burden. The aim of our analysis was to estimate the excess costs of patients with social anxiety disorder compared to persons without anxiety disorder in Germany. Methods Excess costs of social anxiety disorder were determined by comparing two data sets. Patient data came from the SOPHO-NET study A1 (n=495), whereas data of persons without anxiety disorder originated from a representative phone survey (n=3213) of the general German population. Missing data were handled by “Multiple Imputation by Chained Equations”. Both data se…
Changes of attachment characteristics during psychotherapy of patients with social anxiety disorder : results from the SOPHO-Net trial
Objectives Within a randomized controlled trial contrasting the outcome of manualized cognitive-behavioral (CBT) and short term psychodynamic therapy (PDT) compared to a waiting list condition (the SOPHO-Net trial), we set out to test whether self-reported attachment characteristics change during the treatments and if these changes differ between treatments. Research design and methods 495 patients from the SOPHO-Net trial (54.5% female, mean age 35.2 years) who were randomized to either CBT, PDT or waiting list (WL) completed the partner-related revised Experiences in Close Relationships Questionnaire (ECR-R) before and after treatment and at 6 and 12 months follow-up. The Liebowitz Social…
SOPHO-NET – Forschungsverbund zur Psychotherapie der Sozialen Phobie
This paper presents the Social Phobia Psychotherapy Research Network (SOPHO-NET). SOPHO-NET is among the five research networks on psychotherapy funded by "Bundesministerium fur Bildung und Forschung". The research program encompasses a coordinated group of studies of social phobia. In the central project (Study A), a multi-center randomized controlled trial, refined models of manualized cognitive-behavioral therapy (CBT) and manualized short-term psychodynamic psychotherapy (STPP) are compared in the treatment of social phobia. A sample of n=512 outpatients will be randomized to either CBT, STPP or wait list. For quality assurance and treatment integrity, a specific project has been establ…
Vom Sinn des Verfahrenskonzepts und der Verfahrensvielfalt – und warum das Baukasten-System in der Psychotherapie nicht funktioniert
Why the concept of distinct psychotherapeutic approaches is indispensable - and why the tool box concept of psychotherapy cannot work Background: In Germany, the official psychotherapy guidelines are oriented towards the model of distinct psychotherapeutic approaches. Within the German health care system this also applies to the training in psychotherapy. Some critics, however, are presently pleading in favour of abolishing the model of distinct psychotherapeutic approaches, which also implies to abolish the concept of the so called "Richtlinienverfahren" in Germany - approaches of psychotherapy which proved to be efficacious and whose costs are reimbursed by the insurance companies. Object…
Long-term cost-effectiveness of cognitive behavioral therapy versus psychodynamic therapy in social anxiety disorder.
Background To determine the cost-effectiveness of cognitive behavioral therapy (CBT) versus psychodynamic therapy (PDT) in the treatment of social anxiety disorder after a follow-up of 30 months from a societal perspective. Methods This analysis was conducted alongside the multicenter SOPHO-NET trial; adults with a primary diagnosis of social anxiety disorder received CBT (n = 209) or PDT (n = 207). Data on health care utilization and productivity loss were collected at baseline, after 6 months (posttreatment), and three further follow-ups to calculate direct and indirect costs. Anxiety-free days (AFDs) calculated based on remission and response were used as measure of effect. The increment…
Liebowitz Social Anxiety Scale (LSAS): Optimal cut points for remission and response in a German sample
The Liebowitz Social Anxiety Scale (LSAS) is the most frequently used instrument to assess social anxiety disorder (SAD) in clinical research and practice. Both a self-reported (LSAS-SR) and a clinician-administered (LSAS-CA) version are available. The aim of the present study was to define optimal cut-off (OC) scores for remission and response to treatment for the LSAS in a German sample. Data of N = 311 patients with SAD were used who had completed psychotherapeutic treatment within a multicentre randomized controlled trial. Diagnosis of SAD and reduction in symptom severity according to the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th editi…