Wie wirkt sich mehrmaliges Kompetenz-Feedback auf psychotherapeutische Behandlungen aus?
Zusammenfassung. Theoretischer Hintergrund: Einflüsse von therapeutenorientiertem Kompetenz-Feedback in der Psychotherapieausbildung wurden bislang wenig untersucht. Fragestellung: Wie gehen Ausbildungstherapeuten mit Feedback um? Welchen Einfluss hat ein regelmäßiges Kompetenz-Feedback auf die Qualität psychotherapeutischer Behandlungen (insbesondere Therapiesitzungen, therapeutische Beziehung, Person des Therapeuten, Supervision)? Methode: Elf Therapeuten wurden mithilfe eines halbstrukturierten Interviewleitfadens befragt. Die Auswertung erfolgte mittels qualitativer Inhaltsanalyse nach Mayring (2015) . Ergebnisse: Das auf Basis der Interviews erstellte Kategoriensystem umfasste die Kat…
Group cohesion in group-based personal practice
AbstractBackgroundPersonal practice (PP) is an integral component of many psychotherapy training programmes. It aims to promote personal and professional growth and is often conducted in a group format (g-PP). Group cohesion is one of the most researched mechanisms in group psychotherapy, but has rarely been studied in the context of g-PP.Aims and methodThis exploratory study examines the associations between cohesion, satisfaction with g-PP, its impact on personal and professional development, and theoretical orientation in a sample of n = 329 German psychotherapy trainees. Cohesion was assessed with the group questionnaire (GQ-D; Positive Bonding, Positive Working, Negative Relationship).…
Patients' and therapists' experiences of general change mechanisms during bug-in-the-eye and delayed video-based supervised cognitive-behavioral therapy. A randomized controlled trial.
Objective This secondary analysis of a randomized controlled trial investigated whether bug-in-the-eye (BITE) supervision (live computer-based supervision during a psychotherapy session) affects the manner in which patients and therapists experience general change mechanisms (GCMs) during cognitive-behavioral therapy (CBT). Method A total of 23 therapists were randomized either to the BITE condition or the control condition (delayed video-based [DVB] supervision). After each session, both patients (BITE: n = 19; DVB: n = 23) and therapists (BITE: n = 11; DVB: n = 12) completed the Helping Alliance Questionnaire (HAQ) and the Bernese Post Session Report (BPSR). The HAQ total score and the 3 …
Screening for Hypochondriasis With the Illness Attitude Scales
The Illness Attitude Scales (IAS; Kellner, 1986, 1987) may prove highly useful for the screening of hypochondriasis. We expected the IAS subscales to be equally as effective as the 7-item short version of the Whiteley Index (Whiteley-7; Fink et al., 1999), which has previously been shown to be useful in screening for somatoform disorders. We investigated participants of a German population (n = 1,575) and 61 patients with the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV]; American Psychiatric Association, 1994) diagnosis of hypochondriasis. The Bodily Preoccupations (BP) subscale showed high sensitivity (.92) and specificity (.90) as well as demonstrating convergen…
Stellen Erfahrungen mit Krankheiten einen spezifischen Risikofaktor für Krankheitsängste dar?
Zusammenfassung. Theoretischer Hintergrund: Kognitive Modelle zu Hypochondrie und Krankheitsängsten beschreiben vergangene Erfahrungen mit Krankheiten als einen Risikofaktor für deren Entstehung. Diese Sichtweise wird durch mehrere empirische Untersuchungen gestützt, die jedoch nicht die allgemeine Ängstlichkeit der Personen hinreichend berücksichtigten. Fragestellung: Da Krankheitsängste hoch mit Ängstlichkeit assoziiert sind, stellt sich die Frage, ob frühere Erfahrungen mit Krankheiten einen spezifischen Risikofaktor für die Entstehung von Krankheitsängsten darstellen oder lediglich die allgemeine Ängstlichkeit bedingen. Methode: 260 Personen der Allgemeinbevölkerung wurden mittels Frag…
Evaluation des Behandlungsprogramms
Der beschriebene Behandlungsansatz wurde im Rahmen des Schwerpunktes zur Behandlung von Krankheitsangsten an der Johannes-Gutenberg-Universitat Mainz evaluiert. Diese Evaluation bezieht sich auf den kombinierten Ansatz aus Gruppen- und Einzeltherapie. Hierbei zeigten sich bei den Patienten mit Hypochondrie deutliche Verbesserungen hinsichtlich der Krankheitsangste und der dysfunktionalen krankheitsbezogenen Kognitionen. Zudem reduzierte sich hypochondrisches Sicherheitsverhalten bedeutsam. Rund drei Viertel der Patienten konnen zu Therapieabschluss als Responder eingeordnet werden.
The Effects of Bug-in-the-Eye Supervision on Therapeutic Alliance and Therapist Competence in Cognitive-Behavioural Therapy: A Randomized Controlled Trial.
Live supervision enables a supervisor to have direct insight into the psychotherapeutic process and allows him or her to provide immediate feedback to the trainee. Therefore, live supervision might be superior to traditional supervisory formats that only allow for the provision of delayed feedback. When considering the different live supervision formats, bug-in-the-eye (BITE) supervision is particularly promising because of its improved and less invasive procedure. The current study compared the efficacy of BITE supervision with that of delayed video-based (DVB) supervision. In the present study, 23 therapists were randomly assigned to either the BITE supervision or DVB supervision groups. …
The Multidimensional Inventory of Hypochondriacal Traits
Severe health anxiety constitutes a disabling and costly clinical condition. The Multidimensional Inventory of Hypochondriacal Traits (MIHT) represents an innovative instrument that was developed according to cognitive-behavioral, cognitive-perceptual, interpersonal, and trait models of hypochondriasis. We aimed at evaluating the psychometric properties of the MIHT in a sample of patients with the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) diagnosis of hypochondriasis. Using confirmatory factor analysis (CFA), the postulated four-factor structure of the MIHT was found in a first CFA in patients with hypochondriasis ( n = 178) and in a second CFA based on a mixed sample…
Implicit affective evaluation bias in hypochondriasis: findings from the Affect Misattribution Procedure.
Cognitive theories of hypochondriasis (HYP) suggest that catastrophic misinterpretations of benign body sensations are a core feature for the maintenance of the disorder. There is tentative support from an analog sample that the interpretation of illness-related information also involves an implicit affective component. This is the first study to examine this negative affective evaluation bias implicitly in patients with HYP. An adapted version of the Affect Misattribution Procedure (AMP) with illness, symptom and neutral primes was used in 80 patients with HYP, and compared to 83 patients with an anxiety disorder (AD), as well as 90 healthy controls (CG). The HYP group showed significantly…
Optimizing Exposure Therapy for Pathological Health Anxiety: Considerations From the Inhibitory Learning Approach
Abstract Exposure therapy has demonstrated its efficacy in the treatment of pathological health anxiety—however, psychotherapy research reveals that many patients do not show a clinically significant change. Therefore, improvements are necessary to optimize psychotherapy for pathological health anxiety. Most treatment rationales refer to habituation during exposure as the central mechanism of change. However, there is evidence that extinction learning is mediated by inhibitory learning processes. Targeting these processes may help to improve treatment outcomes in pathological health anxiety. The aim of this review was to adapt, from the inhibitory learning approach and empirical findings, t…
Context Effects in the Evaluation of Bodily Symptoms: Comparing Three Versions of the Health Norms Sorting Task
The illness-related evaluation of bodily symptoms is considered to be an important maintaining factor in somatoform disorders. However, little is known about context variables that could influence this evaluation process. In the current study, participants completed three versions of the Health Norms Sorting Task (HNST) and evaluated bodily symptoms in different contexts (i.e., different evaluation perspectives and time frames of evaluation). Additionally, the three HNST versions were presented in different orders. Bodily symptoms were evaluated more often as a sign of illness when a specific time frame (i.e., one week) was given. However, this context effect was only large when participan…
Mögliche Komplikationen und häufige Fragen
In ▶ Kap. 6 wird auf mogliche Komplikationen bei der Behandlung der Hypochondrie und auf haufige Fragen in Zusammenhang mit der Behandlung eingegangen. Hierbei werden insbesondere Hinweise zum schwierigen Umgang mit der Ruckversicherung gegeben. Es wird ein gekurztes Behandlungsprogamm fur Patienten mit moderat ausgepragten hypochondrischen Angsten vorgeschlagen und ein vereinfachtes Storungsmodell vorgestellt. Zudem wird auf die Behandlung von Krankheitsangsten bei vorliegenden Krankheiten eingegangen. Abschliesend werden Hinweise zur weiterfuhrenden Literatur gegeben.
Therapist competence and therapeutic alliance are important in the treatment of health anxiety (hypochondriasis)
The role of treatment delivery factors (i.e., therapist adherence, therapist competence, and therapeutic alliance) is rarely investigated in psychotherapeutic treatment for health anxiety. This study aimed to investigate the role of the assessment perspective for the evaluation of treatment delivery factors and their relevance for treatment outcome. Therapist adherence, therapist competence, and therapeutic alliance were evaluated by independent raters, therapists, patients, and supervisors in 68 treatments. Patients with severe health anxiety (hypochondriasis) were treated with cognitive therapy or exposure therapy. Treatment outcome was assessed with a standardized interview by independen…
The role of therapist and patient in-session behavior for treatment outcome in exposure-based cognitive behavioral therapy for panic disorder with agoraphobia.
Objective There is a very limited amount of research on the relationship between therapist and patient in-session behavior and treatment outcome in cognitive behavioral therapy (CBT) for panic disorder with agoraphobia (PD/AG). Additionally, the findings tend to be inconclusive. This study investigates the association between therapist competence, adherence, patient interpersonal behavior, and therapeutic alliance and outcome in a low-control CBT setting by using comprehensive measures. Methods Twenty-six patients with PD/AG received 12 sessions of exposure-based CBT. With regard to the outcome, treatments were classified either as problematic or nonproblematic by means of distinct criteria…
Thinking about anxiety moderates the relationship between implicit and explicit anxiety measures
Abstract Explicit measures (e.g., questionnaires) assess introspectively accessible self-descriptions and evaluations. In contrast, implicit measures (e.g., the Implicit Association Test) assess the self-concept indirectly, usually by means of performance measures such as reaction-time tasks. Correlations between implicit and explicit measures of personality dispositions tend to be low. The current study ( N = 82) tested the hypothesis that thinking about anxiety-arousing (vs. extraversion-arousing) situations moderates the relationship between implicit and explicit anxiety measures. Results supported this prediction: While no association between implicit and explicit anxiety measures was …
Kognitiv-behaviorale Therapieansätze und ihre Wirksamkeit
In diesem Kapitel werden verschiedene kognitiv-behaviorale Therapieansatze ausfuhrlich dargestellt. Hierzu gehoren die Explanatory Therapy von Kellner, die kognitiv-edukative Behandlung von Basky et al., die kognitiv-behaviorale Behandlung der Krankheitsangst nach Warwick und Salkovskis, die kognitiv-behaviorale Therapie fur somatoforme Storungen nach Rief & Hiller und der integrativ kognitiv-behaviorale Ansatz bei intensiven Krankheitssorgen nach Furer et al. Der Bezug dieser Behandlungsansatze zum vorliegenden Behandlungsmanual wird dargestellt. Zudem wird auf eine neuere Entwicklung, der Mindfulness-based Cognitive Therapy, eingegangen. Abschliesend wird auf empirische Befunde zur Wirksa…
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 o…
Exposure therapy changes dysfunctional evaluations of somatic symptoms in patients with hypochondriasis (health anxiety). A randomized controlled trial
Dysfunctional evaluations of somatic symptoms are considered a central factor in maintaining hypochondriasis. The aim of the current study was to investigate whether exposure therapy (ET) without cognitive restructuring is sufficient to change dysfunctional evaluations of somatic symptoms. The current study was based on a randomized controlled trial and compared patients with hypochondriasis (N=73) receiving ET or cognitive therapy (CT) to a wait list (WL) control group. In both the ET and CT groups, dysfunctional symptom evaluations changed significantly compared with the WL group. No differences between the ET and CT groups emerged. The relationship between the treatment condition (active…
Assessment of counseling self-efficacy : validation of the German Counselor Activity Self-Efficacy Scales-Revised
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. ve…
Changes in negative implicit evaluations in patients of hypochondriasis after treatment with cognitive therapy or exposure therapy
Abstract Background and Objectives Previous studies using modified versions of the Affect Misattribution Procedure (AMP; Payne, Cheng, Govorun, & Stewart, 2005) have revealed that there is an implicit negative evaluation bias of illness-related information in patients with hypochondriasis (HYP), which might be a maintaining feature of HYP. However, there is no evidence on whether this bias might be targeted successfully by effective treatments, such as exposure therapy (ET) or cognitive therapy (CT). This is the first study to examine the change in negative implicit evaluations in a randomized controlled trial, including individual CT and ET, compared to a wait-list control group for HYP. M…
Topics and techniques in clinical supervision in psychotherapy training
AbstractClinical supervision is regarded as one of the most important components of psychotherapy training. In clinical practice, it has been found that the implementation of clinical supervision varies substantially and often differs from the recommendations made in the literature. The objective of the current study was to investigate the frequency of topics (e.g. ethical issues) and techniques (e.g. role play) in the clinical supervision of psychotherapy trainees in Germany. To this end, we considered supervisions in cognitive behavioural therapy (CBT) and psychodynamic therapy (PT). A total of 791 psychotherapy trainees (533 CBT and 242 PT) were asked via the internet to provide informat…
Assessing therapist development: Reliability and validity of the Supervisee Levels Questionnaire (SLQ-R).
BACKGROUND Therapist development is a crucial target for clinical training in order to ensure high-quality psychotherapy. A major challenge in examining therapeutic development is the assessment of developmental processes. The Supervisee Levels Questionnaire (SLQ-R) was analyzed in this study to examine its validity, reliability, and underlying dimensional structure. METHOD Seven hundred and sixty therapists participated in an online survey concerning their current psychotherapy training. The factor structure as well as the validity of the SLQ-R were investigated using exploratory and confirmatory factor analysis. RESULTS In line with the results of the exploratory factor analyses, a Bifact…
Grundlagen zum Störungsbild
Hauptmerkmal der Hypochondrie ist die Angst oder Uberzeugung, an einer schweren korperlichen Erkrankung zu leiden, ohne dass eine derartige Befurchtung durch einen medizinischen Befund gestutzt wird. Haufig befurchtete Krankheiten sind Krebs, Erkrankungen des Herzkreislaufsystems, Aids und neurologische Erkrankungen, wie beispielsweise Multiple Sklerose oder Demenzerkrankungen. Die Belastung durch diese Sorgen und angste ist in ihrem Ausmas recht unterschiedlich und reicht von leichten Beeintrachtigungen bis hin zur Arbeitsunfahigkeit, massiven depressiven Zustanden und stationaren Klinikaufenthalten. Als Ausloser dieser angste gelten korperliche Empfindungen, Veranderungen oder Auffalligke…
Health Behavior in Hypochondriasis
The relationship between health behavior and hypochondriasis has not yet been sufficiently examined, as previous studies investigated only individual dimensions of health behavior. In the present study, we extend current literature by examining multiple dimensions of health behavior. One hundred twenty-six participants, consisting of 40 participants with a primary diagnosis of hypochondriasis, 41 participants with a primary diagnosis of anxiety disorder, and 45 healthy controls, completed a multidimensional questionnaire for the assessment of health behavior and other measures for the evaluation of general psychopathology, illness anxiety, depression, and general anxiety. Patients with hypo…
Manualisierte Gruppen- und Einzeltherapie
Die Behandlung in Therapiegruppen bietet gegenuber der Einzelbehandlung eine Reihe von Vorteilen: Die meisten Patienten kennen bis zum Therapiebeginn niemanden, der unter der gleichen psychischen Storung leidet und wissen allenfalls aus der Literatur, dass sie mit ihrem Problem nicht die Einzigen sind. Deshalb ist es fur viele eine sehr hilfreiche Erfahrung, andere Betroffene kennen zu lernen. Dieser auch als Universalitat des Leidens (Yalom & Leszcz, 2005) bezeichnete Aspekt ist ein zentraler Vorteil einer Gruppentherapie. Es gibt weitere Vorzuge der Gruppe: Die Teilnehmer konnen sich Anregungen und Ruckmeldung geben und lernen auch vom Verhalten der Mitpatienten. Positive Erfahrungen eine…
Competence feedback improves CBT competence in trainee therapists: A randomized controlled pilot study.
The development and improvement of therapeutic competencies are central aims in psychotherapy training; however, little is known about which training interventions are suitable for the improvement of competencies.In the current pilot study, the efficacy of feedback regarding therapeutic competencies was investigated in cognitive behavioural therapy (CBT). Totally 19 trainee therapists and 19 patients were allocated randomly to a competence feedback group (CFG) or control group (CG). Two experienced clinicians and feedback providers who were blind to the treatment conditions independently evaluated therapeutic competencies on the Cognitive Therapy Scale at five treatment times (i.e., at Sess…
Entwicklung und Validierung von Instrumenten zur Überprüfung der therapeutischen Adhärenz und Kompetenz bei der Behandlung der Panikstörung
Zusammenfassung. Theoretischer Hintergrund: Die Güte der Expositionsvorbereitung wird als wichtiger Faktor für die erfolgreiche Behandlung der Panikstörung mit Agoraphobie gesehen. Jedoch fehlt es an geeigneten Instrumenten, um dies zu untersuchen. Fragestellung: Ziel der Studie ist die Konstruktion und Validierung von Skalen zur Erfassung der Adhärenz und Kompetenz bei der Vorbereitung der Exposition. Methode: Vier Experten wurden zur Inhaltsvalidierung herangezogen. Die weitere Überprüfung der Reliabilität und Validität erfolgte auf der Basis von 84 psychotherapeutischen Behandlungen von Patienten mit Panikstörung und Agoraphobie. Ergebnisse: Die Adhärenz- und Kompetenzskala wiesen eine …
Evaluation of Treatment Integrity: The Treatment Specificity Index
Objective To differentiate between treatments in a randomized controlled trial (RCT), therapies need to display not only high purity but also high specificity. The aim of this study was to demonstrate the benefits of calculating a treatment specificity index for the evaluation of treatment differentiation. Method Based on an RCT of relapse prevention in depression, comparing a cognitive with a psychoeducational treatment, the specificity and the purity index were calculated. Results As indicated by the specificity index, both conditions differed in their levels of implemented specific and common interventions. A significant relationship was found between symptom change before a therapy sess…
Effectiveness of cognitive-behavioral group therapy for patients with hypochondriasis (health anxiety)
Cognitive behavioral therapy (CBT) has been shown to be highly effective in the treatment of health anxiety. However, little is known about the effectiveness of group CBT in the treatment of health anxiety. The current study is the largest study that has investigated the effectiveness of combined individual and group CBT for patients with the diagnosis of hypochondriasis (N=80). Therapy outcomes were evaluated by several questionnaires. Patients showed a large improvement on these primary outcome measures both post-treatment (Cohen's d=0.82-1.08) and at a 12-month follow-up (Cohen's d=1.09-1.41). Measures of general psychopathology and somatic symptoms showed significant improvements, with …