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…

Classification characteristics of the Patient Health Questionnaire-15 for screening somatoform disorders in a primary care setting

Abstract Background This study examines how effectively the Patient Health Questionnaire-15 (PHQ-15), a self-administered screening instrument, recognizes somatoform symptoms and somatoform disorders in a German primary care setting. Methods A selected sample of 308 patients (mean age 47.2 years, 71.4% women) from two regular primary care practices was screened with the PHQ-15 and additionally examined with structured interviews. Their primary care physicians rated symptoms reported in the interview as either “medically explained” or “medically unexplained.” Results Seventy-six percent of the symptoms were judged as medically unexplained. The PHQ-15 correlated significantly with the total n…

A meta-analysis of nonrandomized effectiveness studies on outpatient cognitive behavioral therapy for adult anxiety disorders

Abstract Objective The primary aim of this study was to assess the overall effectiveness of individual and group outpatient cognitive behavioral therapy (CBT) for adults with a primary anxiety disorder in routine clinical practice. Method We conducted a random effects meta-analysis of 71 nonrandomized effectiveness studies on outpatient individual and group CBT for adult anxiety disorders. Standardized mean gain effect sizes pre- to posttreatment, and posttreatment to follow-up are reported for disorder-specific symptoms, depression, and general anxiety. The mean dropout from CBT is reported. Results Outpatient CBT was effective in reducing disorder-specific symptoms in completer ( d  = 0.9…

Emotion Elicitation: A Comparison of Pictures and Films

Abstract Pictures and film clips are widely used and accepted stimuli to elicit emotions. Based on theoretical arguments it is often assumed that the emotional effects of films exceed those of pictures, but to date this assumption has not been investigated directly. The aim of the present study was to compare pictures and films in terms of their capacity to induce emotions verified by means of explicit measures. Stimuli were (a) single pictures presented for 6 s, (b) a set of three consecutive pictures with emotionally congruent contents presented for 2 s each, (c) short film clips with a duration of 6 s. A total of 144 participants rated their emotion and arousal states following stimulus …

Influence of Personality Disorders on Therapy Outcome in Somatoform Disorders at 2-Year Follow-up

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…

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…

Clinical Profiles of Premenstrual Experiences Among Women Having Premenstrual Syndrome (PMS): Affective Changes Predominate and Relate to Social and Occupational Functioning.

Our objective for this study was to examine symptom severity among women suffering from premenstrual syndrome as well as associations between symptom severity and impairment. In a one-cycle prospective study, various premenstrual symptoms of 91 women were assessed. Tension and irritability were the most severe symptoms. Headache, irritability, self-deprecating thoughts, and depressed mood were the symptoms that were subjectively rated as the most burdensome. Significant correlations were found between the mean premenstrual severity and functional impairment. The severity of premenstrual affective symptoms was related to social impairment. The severity of psychological symptoms was correlate…

What Predicts Outcome, Response, and Drop-out in CBT of Depressive Adults? A Naturalistic Study

Background: The efficacy of CBT for unipolar depressive disorders is well established, yet not all patients improve or tolerate treatment. Aims: To identify factors associated with symptomatic outcome, response, and drop-out in depressive patients under naturalistic CBT. Method: 193 patients with major depression or dysthymia were tested. Sociodemographic and clinical variables were entered as predictors in hierarchical regression analyses. Results: A higher degree of pretreatment depression, early improvement, and completion of therapy were identified as predictors for symptomatic change and response. Drop-out was predicted by concurrent personality disorder, less positive outcome expectan…

Der Cognitive Emotion Regulation Questionnaire (CERQ)

Zusammenfassung. Theoretischer Hintergrund: Der Cognitive Emotion Regulation Questionnaire (CERQ; Garnefski, Kraaij & Spinhoven, 2001 ) erfasst neun Dimensionen kognitiver Emotionsregulation. Fragestellung: Es wurde eine deutsche Adaption des CERQ entwickelt und hinsichtlich Reliabilität, Dimensionalität und Zusammenhängen mit Depressivität und Angstsensitivität getestet. Methode: Die Studie wurde als postalische Fragebogenstudie durchgeführt. Von den zufällig ausgewählt und angeschriebenen 3000 Personen, sendeten 423 den Fragebogen zurück, die finale Stichprobe umfasste N = 414. Angstsensitivität und Depressivität wurden mit dem ASI-3 und dem PHQ-9 erfasst. Ergebnisse: Das 9-Faktorenm…

Cognitive behavior therapy for functional gastrointestinal disorders: is group treatment effective?

Objective:The intention of this study was to evaluate therapy outcome of a cognitive-behavioral group treatment program for functional gastrointestinal disorders. As a particular characteristic, gastrointestinal symptoms were investigated independently from diagnostic categories on a dimensional basis, considering the persistence of symptoms as well as the aspect of severity.Methods:A total of 64 subjects participated in the 10-week treatment program, and 49 completed the study. Subjects underwent four assessments (baseline, pre-, post-treatment, 12-month follow-up), each comprising several self-rated questionnaires on gastrointestinal, somatoform, depressive, hypochondriacal and anxious sy…

Implicit Affect after Mental Imagery: Introduction of a Novel Measure and Relations to Depressive Symptoms in a Non-Clinical Sample

Mental imagery can critically influence our emotional state. In contrast to commonly used explicit measures, implicit measures are promising for objectively assessing automatic emotional processes beyond deliberate control. In two studies with non-clinical samples, we tested the Affect Misattribution Procedure (AMP) to measure implicit affect induced by mental imagery. In a first study (N = 145), the implicit measure showed that mental imagery elicits significantly stronger negative affect than verbally processed stimuli (F(1, 144) = 3.94, p≤.05, η2p = 03). In Study 2 (N = 71), we refined the implicit measure and found that mental images can induce implicit affective reactions at least as …

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…

Hypochondriasis, Somatoform Disorders, and Anxiety Disorders

The question of whether hypochondriasis (HYP) should be considered a somatoform disorder (SFD) or classified as an anxiety disorder (ANX) has recently been raised. To empirically provide information on this issue, we compared patients with HYP (n = 65) with those with other SFDs (n = 94) and those with ANX (n = 224) regarding sociodemographic and biographical variables, general psychopathology, and naturalistic cognitive-behavioral therapy treatment effects. Compared with SFD, patients with HYP were younger and had fewer comorbid affective disorders and less impaired life domains, suggesting a closer connection between HYP and ANX. Regarding cognitive-behavioral therapy treatment effects, a…

Defining response and remission in psychotherapy research: A comparison of the RCI and the method of percent improvement

There is no consensus as to how to define response and remission for mental disorder treatments. The Reliable Change Index (RCI) is most commonly used in psychotherapy research, whereas psychopharmacologists prefer to calculate percentage of improvement (PI). We compared both methods using the Beck Depression Inventory in 395 depressive outpatients. The overall pre-post effect size was d=1.18. The PI-50 (≥ 50% improvement from baseline) resulted in outcome estimates higher than the RCI: 66.3% vs. 59.2% for response and 50.6% vs. 45.8% for remission. We demonstrate that the PI approach is independent of arbitrarily chosen reliabilities and reference populations. Furthermore, it takes differe…

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 …

Modul 1: Behandlungsmotivation

Wie bereits in vorherigen Kapiteln erwahnt, weisen Patienten mit medizinisch unerklarten Korperbeschwerden z. T. eine eher skeptische Haltung gegenuber Psychotherapie auf. In diesem ersten Modul des einzeltherapeutischen Behandlungskonzepts stehen deshalb daher verschiedene Strategien im Vordergrund, die dem Patienten das Therapiekonzept transparent machen sollen. Dazu gehort, dass mit dem Patienten zunachst die Therapieinhalte kurz umrissen werden. Damit der Patient sich validiert fuhlt, ist es zudem sinnvoll, seine Vorstellungen zu den Ursachen seiner Beschwerden zu explorieren. Die Klarung und Formulierung von Therapiezielen hilft dem Patienten, seine Therapieerwartungen realistisch zu r…

Efficacy of short-term psychotherapy for multiple medically unexplained physical symptoms: a meta-analysis.

Multiple medically unexplained physical symptoms (MUPS) are considered to be difficult and costly to treat. The current meta-analysis therefore investigates the efficacy of short-term psychotherapy for MUPS. Based on a multiple-phase literature search, studies were selected according to a-priori defined inclusion criteria. The standardized mean gain was used as the effect size index. Separate data aggregation of between- and within-group contrasts was performed on the basis of a mixed effects model. Outcome variables were physical symptoms, disorder specific emotions, cognitions and behaviors, depressive symptoms, general psychopathology, functional impairment, and health care utilization. …

Does sound stimulation have additive effects on cognitive-behavioral treatment of chronic tinnitus?

Psychological and physiological habituation are major goals in the treatment of patients suffering from chronic tinnitus. This study evaluates whether sound stimulation provided by use of low level white noise generators (NG) enhances the effects of cognitive-behavioral treatment (CBT). 124 outpatients with tinnitus of >6 months received manualized group treatment and were randomly assigned to the NG/no NG conditions. Those with moderate tinnitus-related distress obtained four sessions focusing on education, while severely distressed subjects were treated according to a full 10-session CBT program. Outcome was assessed at post-treatment and at 6- and 18-month follow-up. No additive effects …

Drop-out and treatment outcome of outpatient cognitive-behavioral therapy for anorexia nervosa and bulimia nervosa.

In the present study, drop-out-analyses were carried out for a manual-based cognitive–behavioral therapy for 104 females with anorexia nervosa (AN) and bulimia nervosa (BN), in the service setting of a university outpatient clinic (naturalistic setting). A total of 22.9% of patients with AN terminated therapy prematurely (drop-outs), compared to 40.6% of patients with BN. Group differences between drop-outs and completers show that the group of drop-outs with BN had higher values in the depression score at the start of therapy and was almost two times more likely to have a comorbid disorder (odds ratio 1.69), whereas drop-outs with AN had higher values in the outcome-scale drive for thinnes…

Rasch scalability of the somatosensory amplification scale: a mixture distribution approach.

Abstract Objective Somatosensory amplification refers to a person's tendency to experience somatic sensations as inappropriately intense and involves hypervigilance concerning bodily sensations. We applied the Somatosensory Amplification Scale (SSAS) in an Internet sample of young adults (N = 3031) to test whether the SSAS is Rasch scalable. Methods We applied mixture distribution extensions of the partial credit and rating scale models to identify possible subgroups that use the response set of the SSAS in different ways. Results A partial credit model, with two latent classes, showed a superior fit to all other models. Still, one of the SSAS items had to be removed because it showed sever…

Ergebnisse der Evaluation des Einzeltherapiekonzepts

In diesem Kapitel werden die ersten Ergebnisse zur Wirksamkeit des in Kap. 5 bis 12 dargestellten kognitiv-verhaltenstherapeutischen Behandlungskonzepts vorgestellt. Die Befunde basieren auf einer Stichprobe von Patienten mit multiplen unerklarten Korperbeschwerden, die in der Poliklinischen Institutsambulanz fur Psychotherapie der Johannes Gutenberg-Universitat Mainz entsprechend dem beschriebenen manualisierten Vorgehen behandelt wurden. Neben den klassischen Ergebnismasen zur Intensitat der Korperbeschwerden werden Veranderungen auch in anderen Patientenmerkmalen berichtet – wie z. B. hypochondrischen Einstellungen, korperbezogenen dysfunktionalen Kognitionen, Krankheitsverhalten, allgem…

Tinnitus-Related Distress and the Personality Characteristic Resilience

It has been suggested that personality traits may be prognostic for the severity of suffering from tinnitus. Resilience as measured with the Wagnild and Young resilience scale represents a positive personality characteristic that promotes adaptation to adverse life conditions including chronic health conditions. Aim of the study was to explore the relation between resilience and tinnitus severity. In a cross-sectional study with a self-report questionnaire, information on tinnitus-related distress and subjective tinnitus loudness was recorded together with the personality characteristic resilience and emotional health, a measure generated from depression, anxiety, and somatic symptom severi…

When tinnitus loudness and annoyance are discrepant: audiological characteristics and psychological profile.

This study evaluates sociodemographic and clinical characteristics of patients reporting discrepant levels of tinnitus loudness and annoyance. 4958 subjects recruited from a national tinnitus association completed a comprehensive screening questionnaire including Klockhoff and Lindblom’s loudness grading system and the psychometric Mini-TQ (Tinnitus Questionnaire). There was a moderate correlation of 0.45 between loudness and annoyance. Of the subjects reporting very loud tinnitus, about one third had only mild or moderate annoyance scores. They were not different from those with high annoyance regarding age, gender and tinnitus duration, but annoyance was increased when subjects had additi…

Kognitive Emotionsregulation und Psychopathologie: Erste teststatistische Untersuchung des deutschen Cognitive Emotion Regulation Questionnaire (CERQ) in einer klinischen Stichprobe

Zusammenfassung. Ein besseres Verständnis der Rolle von Prozessen und Stilen der Emotionsregulation (ER) im Kontext psychischer Störungen erscheint essentiell, um psychische Störungsmodelle und Behandlungskonzepte zu optimieren. Diese Studie überprüfte den Cognitive Emotion Regulation Questionnaire (CERQ) in einer klinischen Stichprobe von ambulanten Psychotherapiepatienten (N = 156) hinsichtlich seiner teststatistischen Güte sowie im Hinblick auf Zusammenhänge mit Psychopathologie. Der CERQ wies eine gute Reliabilität (.70 ≤ α ≤ .84) sowie faktorielle Validität auf. Im Vergleich zu einer Bevölkerungsstichprobe berichtete die klinische Stichprobe höhere Ausprägungen in dysfunktionalen und …

Internet-based guided self-help versus group cognitive behavioral therapy for chronic tinnitus : a randomized controlled trial

<b><i>Background:</i></b> The aim of this randomized controlled trial was to investigate the effects of conventional face-to-face group cognitive behavioral therapy (GCBT) and an Internet-delivered guided self-help treatment (Internet-based CBT, ICBT) on tinnitus distress. <b><i>Methods:</i></b> A total of 128 adults with at least mild levels of chronic tinnitus distress were randomly assigned to GCBT (n = 43), ICBT (n = 41), or a web-based discussion forum (DF) that served as a control condition (n = 44). Standardized self-report measures [the Tinnitus Handicap Inventory (THI), Mini-Tinnitus Questionnaire (Mini-TQ), Hospital Anxiety and Depre…

The working alliance in a randomized controlled trial comparing Internet-based self-help and face-to-face cognitive behavior therapy for chronic tinnitus

Objective This study (ID: NCT01205906) compared the impact of the working alliance between the therapist and the client on treatment outcome in a group and an Internet-based cognitive behavior therapy (GCBT vs. ICBT) for chronic tinnitus. Methods The Working Alliance Inventory — Short Revised (WAI-SR, scale range: 1–5) was administered to 26 GCBT and 38 ICBT participants after treatment weeks 2, 5, and 9, and the Tinnitus Handicap Inventory (THI) before and after the treatment. Results High alliance ratings were found in both ICBT (WAI-SR total scores at week 9: M = 3.59, SD = 0.72) and GCBT (WAI-SR total scores at week 9: M = 4.20, SD = 0.49), but significantly higher ratings occurred in G…

Längerfristige Effekte einer essstörungsspezifischen KVT im naturalistischen Setting

In naturalistischen Studien konnte die Wirksamkeit der KVT bei Essstorungen aufgezeigt werden. Es fehlen Studien mit langerfristigen Effekten im Praxissetting. Insgesamt wurden n=99 Frauen mit der DSM-IV Hauptdiagnose einer Essstorung untersucht. Von 53,5% (n=53) lagen Daten mit langerfristiger Dauer vor. Als Messinstrumente wurden EDE-Q, BDI und BSI herangezogen, welche zu Beginn, am Ende sowie mind. 18 Monate nach Behandlungsende eingesetzt wurden. Die Pra-/Post-Effektstarken blieben im Langzeitverlauf stabil. Auch der Anteil der Responder blieb durchschnittlich gleich hoch (63,6%), wobei 25% den Responder-Status verloren und 22,7% im Langzeitverlauf eine Spontanremission zeigten. Die dur…

Factors Influencing Tinnitus Loudness and Annoyance

Objective To evaluate the 2 major components of tinnitus severity, loudness and annoyance, and their degree of dependence on characteristics of tinnitus manifestation, history, and etiology. Design Cross-sectional survey performed during the first months of 2004. Setting Nonclinical population. Participants A total of 4995 members of the German Tinnitus League. Main Outcome Measures Comprehensive screening questionnaire, including the Klockhoff and Lindblom loudness grading system and the miniversion of the Tinnitus Questionnaire. Results A moderate correlation of 0.45 was found between tinnitus loudness and annoyance. Both factors were generally higher in men, those older than 50 years, th…

Why DSM-III was right to introduce the concept of somatoform disorders.

From the Psychological Institute, University of Mainz; and the Psychological Institute, University of Marburg, Marburg, Germany. Address correspondence and reprint requests to Dr. Hiller, Psychological Institute, University of Mainz, Staudingerweg 9, D-55099 Mainz, Germany; hiller@mail.uni-mainz.de (e-mail). Copyright 2005 The Academy of Psychosomatic Medicine. An interesting debate about the adequacy of the somatoform disorders as a diagnostic and clinical concept has begun. The debate is stimulated by the announcement of APA’s preparation of DSM-V, which is likely to follow DSM-IV as the world’s most influential classification system for defining the terminology and diagnostic definitions…

Cognitive Behavioral Therapy Versus Sertraline in Patients With Depression and Poorly Controlled Diabetes: The Diabetes and Depression (DAD) Study

OBJECTIVE This study compared the long-term efficacy of a diabetes-specific cognitive behavioral group therapy (CBT) with sertraline in patients with diabetes and depression who initially responded to short-term depression treatment. RESEARCH DESIGN AND METHODS A randomized controlled single-blind trial was conducted in 70 secondary care centers across Germany comparing 12 weeks of CBT with sertraline in 251 patients with type 1 or 2 diabetes (mean HbA1c 9.3%, 78 mmol/mol) and major depression (Structured Clinical Interview for DSM-IV [SCID]). After 12 weeks, treatment responders (≥50% reduction Hamilton Depression Rating Scale [HAMD-17]) were included in the 1-year study phase where CBT p…

Kognitiv-verhaltenstherapeutisches Einzeltherapiekonzept für Patienten mit unerklärten Körperbeschwerden: Grundlagen und Eingangsphase

Das vorliegende Therapiemanual ist modulartig gegliedert. Da die Wirksamkeit des Therapiekonzepts unter Einhaltung der Modulabfolge bzw. des strukturierten Vorgehens nachgewiesen werden konnte (► Kap. 6), empfehlen wir Ihnen, sich moglichst an der vorgeschlagenen Reihenfolge der Therapiebausteine zu orientieren. Das Manual umfasst insgesamt sieben Module (◘ Tab. 4.1), die sich auf 20 Einzeltherapiesitzungen aufgliedern.

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…

The Role of Dysfunctional Cognitions in Patients With Chronic Tinnitus

OBJECTIVES The present study investigates the role of dysfunctional cognitions in patients with chronic tinnitus. To explore different dimensions of tinnitus-related thoughts, a 22-item self-report measure, the "Tinnitus Cognitions Scale" (T-Cog), is presented. Furthermore, dysfunctional cognitions are examined as a possible mediator of the relation between tinnitus distress and depression. DESIGN The present study analyzes the cross-sectional data of 373 patients with chronic tinnitus. Parallel analysis and principal axis factoring are used to identify the factor structure of the T-Cog. Assumed mediating effects are tested using the asymptotic and resampling procedure. RESULTS Factor analy…

Vorschläge zur Evaluation regulärer Psychotherapien an Hochschulambulanzen im Sinne der Phase-IV-Therapieforschung

Zusammenfassung. Durch den Aufbau psychotherapeutischer Hochschulambulanzen an Universitätsinstituten ist in den letzten Jahren ein enormes Potenzial für die naturalistische Phase-IV-Therapieforschung entstanden. Viele Ambulanzen haben ein System zur kontinuierlichen Evaluation der Behandlungen eingeführt. Das methodische Vorgehen dabei ist jedoch heterogen und erscheint mehr von den lokalen Möglichkeiten als von übergeordneten wissenschaftlichen Überlegungen bestimmt. Dies betrifft die Organisation der Datenerhebung, die Definition des „Produkts Psychotherapie” sowie die Auswertung und Präsentation der Daten. Ein Vergleich zwischen den Ambulanzen und die Zusammenführung von Datensätzen zu…

Course and prediction of somatoform disorder and medically unexplained symptoms in primary care

Abstract Theory/objective Somatoform disorder (SFD) is associated with considerable psychosocial impairment. However, only a few studies have dealt with the course of this clinical subgroup. Therefore, the objective was to identify predictors for the various courses of SFD and medically unexplained symptoms (MUS). Method We screened 620 consecutive patients in primary care using the Patient Health Questionnaire (PHQ-15). Afterwards, 308 patients were studied in more detail using a diagnostic interview and a set of questionnaires. One year later, we were able to interview 277 participants a second time. Result After 1 year, 48.8% of the respondents had a remitted SFD. The following variables…

Psychological Approaches to Origins and Treatments of Somatoform Disorders

Medically unexplained symptoms are the defining feature of somatoform disorders (SFD) as currently included in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and the International Classification of Diseases, Tenth Edition. Cognitive, behavioral, biological, and social variables are important to our understanding of SFD. Research in the past decade has highlighted the central role of (a) prolonged attention allocation to bodily sensations, (b) the dysfunctional role of catastrophizing symptoms as signs of severe illness, (c) neuroendocrine alterations, and (d) the influence of illness behavior (e.g., the avoidance of physical activity) on the maintenance and chronici…

Baseline Patient Characteristics Predicting Outcome and Attrition in Cognitive Therapy for Social Phobia: Results from a Large Multicentre Trial

We examined the role of baseline patient characteristics as predictors of outcome (end-state functioning, response and remission) and attrition for cognitive therapy (CT) in social anxiety disorder (SAD). Beyond socio-demographic and clinical variables such as symptom severity and comorbidity status, previously neglected patient characteristics (e.g., personality, self-esteem, shame, interpersonal problems and attachment style) were analysed. Method Data came from the CT arm of a multicentre RCT with n = 244 patients having DSM-IV SAD. CT was conducted according to the manual by Clark and Wells. Severity of SAD was assessed at baseline and end of treatment with the Liebowitz Social Anxiety …

Predictors of the application of exposure in vivo in the treatment of agoraphobia in an outpatient clinic: An exploratory approach.

AbstractObjective: Although exposure in vivo is considered to be the most effective therapy component in the treatment of agoraphobia (AG), there is a remarkable lack of its application in psychotherapeutic routine care. We examined the severity of anxiety, psychological distress/comorbidity, therapeutic process/alliance, and sociodemographic status as potential predictors of in vivo exposure. Method: We applied correlational analyses and logistic regression analyses in a sample of N = 92 patients (main diagnosis AG) in an outpatient setting. Results: Logistic regression analyses did not yield any significant single predictors, whereas a combination of a subset of predictors significantly p…

Ein exemplarischer Therapieverlauf

Mithilfe eines Fallbeispiels soll dem Therapeuten verdeutlicht werden, wie die Anwendung des in diesem Manual beschriebenen Einzeltherapiekonzepts in der Praxis aussehen kann. Es werden zunachst Informationen uber die Symptomatik, Krankheitsanamnese und lebensgeschichtliche Entwicklung eines Patienten mit multiplen, chronischen unerklarten Korperbeschwerden vermittelt. Danach wird exemplarisch eine Verhaltensanalyse zum vorliegenden Patientenbeispiel beschrieben. Abschliesend werden die Therapieziele abgeleitet und der Therapieverlauf bzw. das Therapieergebnis geschildert. Elemente dieser Falldarstellung konnen auch als Orientierung fur die Erstellung eines Berichts zum Therapieantrag bei e…

The role of mental imagery in depression : negative mental imagery induces strong implicit and explicit affect in depression

Mental imagery, seeing with the mind's eyes, can induce stronger positive as well as negative affect compared to verbal processing. Given this emotion-amplifying effect, it appears likely that mental images play an important role in affective disorders. According to the subcomponents model of depression, depressed mood is maintained by both negative imagery (which amplifies negative mood) and less efficient positive imagery processes. Empirical research on the link between mental imagery and affect in clinical depression, however, is still sparse. This study aimed at testing the role of mental imagery in depression, using a modified version of the affect misattribution procedure (AMP) and t…

The DSM-IV nosology of chronic pain: a comparison of pain disorder and multiple somatization syndrome.

This study evaluates the classification of pain from the perspective of the DSM-IV system. Of 60 in-patients with long-standing and disabling pain syndromes, 29 with pain disorder (PD) and 31 with pain as part of a multiple somatization syndrome (MSS) were compared before and after a structured cognitive-behavioral treatment. It was hypothesized that MSS patients show more psychological distress, are more severely disabled, and respond less to the treatment. Both groups were similar with respect to sociodemographic status, history of pain symptomatology and comorbidity with DSM-IV mental disorders. The results show that MSS patients had higher levels of affective and sensoric pain sensation…

Preference for attractiveness and thinness in a partner: Influence of internalization of the thin ideal and shape/weight dissatisfaction in heterosexual women, heterosexual men, lesbians, and gay men

This study assesses whether characteristics of one's own body image influences preferences of attractiveness in a partner. The role of gender and sexual orientation is also considered. Heterosexual women (n=67), lesbian women (n=73), heterosexual men (n=61) and gay men (n=82) participated in an internet survey assessing attitudes towards the body and preferences of attractiveness in a partner. Men in particular were found to prefer attractive partners, regardless of sexual orientation. Weight/shape dissatisfaction was found to be a negative predictor for heterosexual men and women. For gay men, preferences were better explained by internalization and weight/shape dissatisfaction. No such as…

Pharmacological interventions for somatoform disorders in adults, a Cochrane systematic review

Kognitiv-verhaltenstherapeutisches Einzeltherapiekonzept für Patienten mit unerklärten Körperbeschwerden: Therapeutische Phase

Zu Beginn der Stunde ist es empfehlenswert, dem Patienten einen Schnellhefter fur seine Therapieunterlagen zur Verfugung zu stellen. Im Anschluss wird ein grober Uberblick uber Inhalte und Ablauf der Therapie gegeben. Der Patient erhalt ► Arbeitsblatt 1.1 (Inhalte der Behandlung). Der Therapeut erlautert kurz die einzelnen Stichworte.

Häufigkeit und prädiktiver Wert von Early Response in naturalistischen Psychotherapien

Zusammenfassung. Theoretischer Hintergrund: Verschiedene randomisiert-kontrollierte Studien konnten die Bedeutung frühzeitiger Therapieerfolge für das Therapieergebnis nachweisen. Entsprechende Erkenntnisse unter Routinebedingungen sind bislang selten. Fragestellung: Diese Studie untersucht Häufigkeit, prädiktiven Wert sowie Patientenmerkmale eines frühen Ansprechens auf die Therapie („Early Response“) in einer verhaltenstherapeutischen Hochschulambulanz. Methode: Wir klassifizierten anhand prozentualer Wertereduktion 1109 Patienten verschiedener Störungsgruppen hinsichtlich ihrer psychischen Belastung als Early Responder beziehungsweise Early Nonresponder. Ergebnisse: 48,2 % der Patienten…

Modul 2: Stress und Stressbewältigung (Teil 1)

Aufgrund der haufig eher biomedizinisch gepragten Vorstellungen des Patienten zu den Ursachen seiner Korperbeschwerden bietet sich nach dem Aufbau ausreichender Therapiemotivation der Einstieg mit dem Thema »Stressbewaltigung« an. Viele Patienten erleben den Begriff »Stress« wenig bedrohlich und stigmatisierend. Aus der Alltagssprache sind viele Patienten mit dem Thema »Stress« vertraut. Eine einfuhrende Psychoedukation uber »Stress« erlaubt es, in die Behandlung auf einer biologisch-medizinischen Ebene einzusteigen, die in der Regel naher an den Erklarungen des Patienten fur seine Beschwerden steht. Aufgrund der nach aktuellem wissenschaftlichem Stand zentralen Bedeutsamkeit von Stresserle…

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…

Exkurs-Modul: Kommunikation im Alltag und mit dem Arzt

Schwierigkeiten in der Kommunikation in verschiedenen Lebensbereichen stellen bei einer Subgruppe von Patienten mit somatoformen Beschwerden ein wichtiges Problem dar. Sie konnen u. a. in der Beziehung zu Angehorigen, zu Freunden, zum (Ehe-)Partner oder zum Arzt auftreten. Diese Kommunikationsprobleme konnen mit der Entwicklung negativer Emotionen wie z. B. Frustration, Arger oder Enttauschung beim Patienten sowie seinem Umfeld einhergehen, die wiederum zur Aufrechterhaltung der korperlichen und begleitenden Beschwerden beitragen konnen. Es ist wissenschaftlich bewiesen, dass storungsubergreifend 40 % der Varianz im Therapieerfolg durch extratherapeutische Faktoren, einschlieslich der sozia…

Wenn Therapien vorzeitig scheitern

Zusammenfassung. Theoretischer Hintergrund: Zu Abbrüchen ambulanter Psychotherapien fehlen gesicherte Erkenntnisse über Häufigkeit, Auftretensmerkmale und Risikofaktoren. Fragestellung: Diese Studie untersucht soziodemografische und klinische Merkmale von Abbrechern im Routinebetrieb einer verhaltenstherapeutischen Hochschulambulanz. Methode: Wir klassifizierten 1391 konsekutive Patienten als Completer sowie qualitätsrelevante und qualitätsneutrale Abbrecher. Ergebnisse: Die Gesamtabbruchrate lag bei 24,6% und 14,1% der Abbrüche waren qualitätsrelevant. 56,1% erfolgten innerhalb der ersten 20 Sitzungen. Häufigster Grund war mit 28,1% eine unzureichende Veränderungsmotivation. Am häufigsten…

Causal symptom attributions in somatoform disorder and chronic pain.

Abstract Objective Somatoform disorders (SFD) are defined by symptoms that lack medical explanation. This study examined the type and pattern of patients' causal attributions using a new semistructured interview technique Methods The Causal Attributions Interview allows to assess and weigh 15 common explanations of physical symptoms. Attributions given by 79 patients with SFD were compared with those obtained from 187 chronic pain patients. Results The test–retest reliabilities of the interview-elicited attributions were satisfactory to good. SFD patients attributed most of their symptoms to mental/emotional problems (46.9%) and somatic disease (41.1%), while the pain sample preferred physi…

Strategien und Instrumente der Veränderungsmessung

Der Erfassung von Veränderungen kommt in der Klinischen Psychologie wie Psychiatrie eine wichtige Funktion zu, speziell der Erfassung therapieinduzierter Veränderungen. Dies betrifft sowohl die Psychotherapie als auch Psychopharmakotherapie. Speziell im Zusammenhang mit einer therapie-begleitenden Diagnostik ist dies von großer Bedeutung. In der klinischen Praxis spiegelt sich dies jedoch nur bedingt wider. Im Beitrag wird ein Überblick gegeben zu den verschiedenen Möglichkeiten der Erfassung und Bewertung von Veränderungen mittels psychometrischer Verfahren. Darüber hinaus werden Kriterien aufgezeigt, die derartige Instrumente erfüllen müssen. Der Schwerpunkt des Artikels liegt auf einer …

Does tinnitus distress depend on age of onset?

Objectives: Tinnitus is the perception of a sound in the absence of any physical source of it. About 5–15% of the population report hearing such a tinnitus and about 1–2% suffer from their tinnitus leading to anxiety, sleep disorders or depression. It is currently not completely understood why some people feel distressed by their tinnitus, while others don’t. Several studiesindicate that the amount of tinnitus distress is associated with many factors including comorbid anxiety, comorbid depression, personality, the psychosocial situation, the amount of the related hearing loss and the loudness of the tinnitus.Furthermore, theoretical considerations suggest an impact of the age at tinnitus o…

A multidimensional approach to the reporting of somatic symptoms: The Somatic Symptom Questionnaire Five (SSQ-5G)

Study protocol of the Diabetes and Depression Study (DAD): a multi-center randomized controlled trial to compare the efficacy of a diabetes-specific cognitive behavioral group therapy versus sertraline in patients with major depression and poorly controlled diabetes mellitus

Background Depression is common in diabetes and associated with hyperglycemia, diabetes related complications and mortality. No single intervention has been identified that consistently leads to simultaneous improvement of depression and glycemic control. Our aim is to analyze the efficacy of a diabetes-specific cognitive behavioral group therapy (CBT) compared to sertraline (SER) in adults with depression and poorly controlled diabetes. Methods/Design This study is a multi-center parallel arm randomized controlled trial currently in its data analysis phase. We included 251 patients in 70 secondary care centers across Germany. Key inclusion criteria were: type 1 or 2 diabetes, major depress…

Memory bias for schema-related stimuli in individuals with bulimia nervosa

This study investigates whether individuals with bulimia nervosa (BN) have a memory bias in relation to explicit memory (cued and free recall vs. verbal and pictorial recognition tasks). Twenty-five participants diagnosed with BN and 27 normal controls (NC) were exposed to body-related, food-related, and neutral TV commercials, and then recall and recognition rates were assessed. Poorer recognition and recall of body-related stimuli was found for BN in comparison to NC, suggesting a memory bias. Results are discussed in relation to previous studies, along with suggestions as to how future studies can gain more insight into dysfunctions in information processing that can lead to the maintena…

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…

Überprüfung der zeitlichen Stabilität medizinisch nicht erklärter Beschwerden und somatoformer Störungen vor dem Hintergrund unterschiedlicher Diagnosekonzepte

OBJECTIVE: The aim of this study was to determine and to compare the stability of medically unexplained symptoms and somatoform disorders within the context of different diagnostic concepts (SSI4/6, DSM-IV, DSM-V). METHOD: In a 2-stage follow-up study, 620 consecutive patients were first of all screened using the PHQ-15 questionnaire. In the second stage, 308 selected persons were then interviewed in detail. 12 months later, 89,9% of participants could be interviewed again. RESULTS: Medically unexplained symptoms and somatoform disorders showed weak stability coefficients. In regard to Complex Somatic Symptom Disorder (DSM-V), the prevalence rates were smaller than expected. Within a year, …

Modul 5: Krankheitsverhalten

Nach dem funktionalen Modell somatoformer Storungen spielt Krankheitsverhalten vor allem bei der Aufrechterhaltung von Korperbeschwerden eine wichtige Rolle. Krankheitsverhaltensweisen konnen bei somatoformen Patienten extrem vielfaltig und subtil sein. Zugleich sind somatoforme Patienten hinsichtlich ihres Krankheitsverhaltens sehr heterogen – nicht zwangslaufig mussen alle bekannten dysfunktionalen Verhaltensweisen bei allen Patienten vorhanden sein. In den vier Sitzungen des funften Moduls legen wir den Schwerpunkt auf diejenigen Krankheitsverhaltensweisen, die am haufigsten bei somatoformen Patienten nachgewiesen sind. Die vier Sitzungen fokussieren auf Vermeidungs- und Schonungsverhalt…

Modul 4: Bewertungsprozesse

Nach dem funktionalen Modell somatoformer Storungen spielen Bewertungen und Gedanken der Patienten zu ihren korperlichen Beschwerden eine zentrale Rolle in der Entwicklung und Aufrechterhaltung der Symptome. In der Regel benotigt die Arbeit an Kognitionen viel Zeit und ist mit 5 Sitzungen im vorliegenden Modul eher knapp bemessen. Mithilfe eines Verhaltensexperiments und Strategien des geleiteten Entdeckens werden die Patienten zunachst mit der Rolle von Gedanken bez. ihrer Korperbeschwerden vertraut gemacht und in das ABC-Schema eingefuhrt. In der zweiten Sitzung des Moduls ist die Exploration der individuellen, wenig hilfreichen Gedanken des Patienten vordergrundig. In der dritten und vie…

Pharmacological interventions for somatoform disorders in adults

BACKGROUND: Somatoform disorders are characterised by chronic, medically unexplained physical symptoms (MUPS). Although different medications are part of treatment routines for people with somatoform disorders in clinics and private practices, there exists no systematic review or meta-analysis on the efficacy and tolerability of these medications. We aimed to synthesise to improve optimal treatment decisions.OBJECTIVES: To assess the effects of pharmacological interventions for somatoform disorders (specifically somatisation disorder, undifferentiated somatoform disorder, somatoform autonomic dysfunction, and pain disorder) in adults.SEARCH METHODS: We searched the Cochrane Depression, Anxi…

Modul 6: Stress und Stressbewältigung (Teil 2)

Das Thema Stress und Stressbewaltigung wurde bereits im sechsten Kapitel behandelt und wird nun im Therapieverlauf wieder aufgegriffen. Im zweiten Teil der Stressbewaltigung steht die Rolle von Gedanken im Zusammenhang mit Stresserleben im Vordergrund. Dementsprechend wird der Patient uber Strategien des geleiteten Entdeckens in der ersten Sitzung dieses Moduls in die Rolle von der Bewertung des Stressors und eigener Kapazitat zur Stressbewaltigung eingefuhrt. Verschiedene Formen des Umgangs mit Stress werden abgeleitet und individuelle Stressoren in der zweiten Sitzung exploriert. Die dritte Sitzung des sechsten Moduls widmet sich ubergeordneten kognitiven Schemata, die Stresserleben verst…

Störungstheorien, Modelle und Konzepte unerklärter Körperbeschwerden und somatoformer Störungen

Im Folgenden werden die wichtigsten derzeit bekannten Ansatze zur Erklarung der Entstehung und Aufrechterhaltung somatoformer Beschwerden und Storungen skizziert. Die Kenntnis zentraler Entstehungsmechanismen erscheint hierbei nicht nur aus theoretischer Perspektive interessant, sondern stellt eine zentrale Voraussetzung dar, in der therapeutischen Arbeit mit Patienten sukzessive differenzierte (z. B. kognitionspsychologisch und psychobiologisch fundierte) Modelle als Alternativen zu einem meist monokausalen organischen Krankheitsmodell erarbeiten und vermitteln zu konnen.

Evaluation von Psychotherapien aus der Perspektive von Qualitätssicherung und Qualitätsmanagement

Dieser Beitrag befasst sich mit methodischen Fragen, die sich aus den Prämissen des Qualitätsmanagements (QM) für die Evaluation von Psychotherapien unter Routinebedingungen ergeben. Am Beispiel der Poliklinischen Institutsambulanz der Universität Mainz wird aufgezeigt, welche Anforderungen an den Datenerhebungsprozess zu stellen sind und nach welchen Kennwerten die Therapieergebnisse bewertet werden können. Es werden Qualitätskriterien für Datenqualität und Erfolgsmaße vorgeschlagen. Die Ergebnisqualität sollte sowohl mit Hilfe von Mittelwertsveränderungen (und dazugehörigen Effektstärken) als auch durch Response- und Remissionsanalysen (Beurteilung des individuellen Ansprechens auf die T…

Toward empirically based criteria for the classification of somatoform disorders

Abstract There is a major need for an empirical evaluation of classification criteria for somatoform disorders. The present study analyzes psychometric properties of the existing criteria for somatization disorder. The full sample consisted of 324 patients seeking help because of “psychosomatic problems.” Data from a subsample of carefully diagnosed patients with somatization syndrome (n=76) and a clinical comparison group (n=32) permitted the analysis of the discriminative power of items. Twenty-one somatic symptoms adopted from DSM-IV and ICD-10 criteria did not exhibit the necessary psychometric characteristics (item probability, item-total correlation, etc.). Thirty-two somatic symptoms…

Merkmale und prädiktiver Wert von früher Verschlechterung in der ambulanten Psychotherapie

Zusammenfassung. Theoretischer Hintergrund: Trotz des anhaltenden Forschungsinteresses an frühen Therapieerfolgen (Early Response), wurden frühe Verschlechterungen in bisherigen Untersuchungen eher vernachlässigt. Fragestellung: Diese Studie untersucht Merkmale und prädiktive Qualität einer frühen Verschlechterung für das Behandlungsergebnis in einer verhaltenstherapeutischen Hochschulambulanz. Methode: 1983 Patienten wurden anhand des Reliable Change Indexes (RCI) auf das Vorliegen einer frühen Verschlechterung der psychischen Belastung überprüft. Ergebnisse: Es fanden sich nur wenige charakteristische Merkmale einer frühen Verschlechterung (z. B. höhere Anzahl psychischer Störungen). Sic…

Benchmarking of cognitive-behavioral therapy for depression in efficacy and effectiveness studies--how do exclusion criteria affect treatment outcome?

Abstract Objective: Little is known about how exclusion criteria applied in randomized controlled trials (RCTs) affect the transfer of psychotherapy outcome research to naturalistic settings. This study evaluated the effects of naturalistic depression therapies and benchmarked them with published RCTs. Method: Commonly used exclusion criteria were applied to n=338 depressive patients receiving cognitive-behavioral therapy. Outcomes of the resulting subsample eligible for RCTs were compared to those reported in RCTs. Results: Treatment outcomes of the total sample (d=1.16) and the subsample eligible for RCTs (d=1.15) were highly similar. Therapy outcome was worse than in high-quality RCTs (d…

Differentiating hypochondriasis from panic disorder

Hypochondriasis and panic disorder are both characterized by prevalent health anxieties and illness beliefs. Therefore, the question as to whether they represent distinct nosological entities has been raised. This study examines how clinical characteristics can be used to differentiate both disorders, taking the possibility of mixed symptomatologies (comorbidity) into account. We compared 46 patients with hypochondriasis, 45 with panic disorder, and 21 with comorbid hypochondriasis plus panic disorder. While panic patients had more comorbidity with agoraphobia, hypochondriasis was more closely associated with somatization. Patients with panic disorder were less pathological than hypochondri…

Modul 3: Aufmerksamkeit

Aufmerksamkeitsprozesse spielen in der Entstehung und Aufrechterhaltung somatoformer Beschwerden eine zentrale Rolle. Mithilfe von Verhaltensexperimenten und Metaphern werden dem Patienten im Rahmen der ersten beiden Sitzungen dieses Moduls die Funktion unseres Aufmerksamkeitssystems und die Wirkweise von Aufmerksamkeitslenkung und deren Einfluss auf korperliche Wahrnehmungen verdeutlicht. Geleitetes Entdecken spielt in diesen Sitzungen eine besonders wichtige Rolle. Das Modul wird mit einer dritten Sitzung zur Erarbeitung von individuellen Ablenkungsstrategien abgerundet. In diesem Kontext bietet es sich an, besonders ressourcenorientiert zu arbeiten und das Konzept von »Genuss und Genusss…

High utilizers of medical care

Abstract Objective Patients with somatoform disorders (SFD) are likely to overutilize healthcare services. This study investigates (a) whether extraordinarily high medical costs can be predicted from patient characteristics or psychopathology, and (b) whether high-utilizing patients respond differently to cognitive–behavioral treatment. Methods We compared 42 SFD high utilizers with 53 SFD average utilizers and 29 patients suffering from other than SFD mental disorders. High utilization was defined by healthcare expenditures of ≥€2500 during the past 2 years. Costs were computed from medical and billing records of health insurance companies. Somatization distress, hypochondriasis, depressio…

The affective response to health-related information and its relationship to health anxiety: An ambulatory approach

Affective reactions to health-related information play a central role in health anxiety. Therefore, using ambulatory assessment, we analysed the time course of negative affect in a control group (CG, n = 60) which only rated their negative affect and an experimental group (EG, n = 97) which also rated the presence of somatic symptoms (e.g., back pain). By means of mixed regression models, we observed a decline of negative affect following the symptom self-ratings in the EG and a stable affect in the CG. The decline of negative affect was not moderated by the degree of health anxiety. Our findings might indicate that evaluating one's health status leads to a general reduction of negative aff…

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…

Modul 7: Störungsmodell

Zunachst mag es ungewohnlich erscheinen, dass ein kognitiv-verhaltenstherapeutisches Behandlungskonzept mit einem Storungsmodell abgeschlossen und nicht eingefuhrt wird. Insbesondere fur Patienten, die zu Beginn der Behandlung stark ausgepragte somatomedizinische Annahmen zu ihren Korperbeschwerden aufweisen, kann es uberfordernd sein, wenn Sie mit einem biopsychosozialen Behandlungsmodell konfrontiert werden. Die Module des vorliegenden Behandlungsansatzes sind so aufgebaut, dass sie immer mit psychoedukativen Abschnitten eingeleitet werden, sodass dem Patienten das Storungsmodell uber den Therapieverlauf Schritt fur Schritt vermittelt wird. Das zusammenfassende Storungsmodell in der letzt…

A controlled treatment study of somatoform disorders including analysis of healthcare utilization and cost-effectiveness.

Abstract Objective: The purpose of this prospective study was to evaluate the effects of cognitive-behavioral treatment (CBT) on mental health status and healthcare utilization in patients with somatoform disorders (SFD) of a specialized tertiary care center. Methods: According to DSM-IV interviews, 54 patients had somatization disorder (SD), 51 abridged somatization syndrome (SSI-8) and 67 other defined SFD. A clinical non-SFD comparison group consisted of 123 patients. Treatment effects were controlled against the waiting list. Cost calculations for the 2-year periods before and after treatment were based on medical and billing records from health insurance companies. Results: The SFD pat…

Tactile perceptual processes and their relationship to medically unexplained symptoms and health anxiety

Abstract Objective The Somatic Signal Detection Task (SSDT; Lloyd, Manson, Brown and Poliakoff, 2008) is an innovative paradigm to study perceptual processes related to physical symptoms. It allows examining touch illusions as a laboratory analog of medically unexplained symptoms (MUS) according to the cognitive model of MUS proposed by Brown (2004). The present study compared psychopathologic measures of MUS and health anxiety with SSDT parameters. Furthermore, we aimed to define a reliable measurement of tactile perception threshold. Methods 67 participants of a student population reported whether they detected tactile stimuli at their fingertip which were presented in half of the test tr…

Therapieansätze für unerklärte Körperbeschwerden und somatoforme Störungen

Bis Patienten mit medizinisch unerklarten Korperbeschwerden eine psychotherapeutische Behandlung aufsuchen, haben sie in der Regel bereits eine lange Behandlungsvorgeschichte hinter sich, die haufig von widerspruchlichen Informationen zu Diagnostik und Interventionsansatzen gepragt ist. Es ist deshalb nicht verwunderlich, dass Patienten mit somatoformen Storungen im ersten Kontakt mit einem Psychotherapeuten haufig sehr verunsichert sind. Damit die psychotherapeutischen Therapeuten und Arzte die Patienten angemessen beraten konnen, ist ein fundiertes Wissen uber psychologische wie auch psychopharmakologische Behandlungsansatze und ihre Wirksamkeit von groser Bedeutung. Orientiert am aktuell…

Beliefs and attitudes among Swedish workers regarding the risk of hearing loss

The aim of this study was to develop an abridged version of the Tinnitus Questionnaire (TQ) to be used as a quick tool for the assessment of tinnitus-related psychological distress. Data from 351 inpatients and 122 outpatients with chronic tinnitus were used to analyse item statistics and psychometric properties. Twelve items with an optimal combination of high item-total correlations, reliability and sensitivity in assessing changes were selected for the Mini-TQ. Correlation with the full TQ was >0.90, and test-retest reliability was 0.89. Validity was confirmed by associations with general psychological symptom patterns. Treatment effects indicated by the Mini-TQ were slightly greater tha…

The prevalence of medically unexplained symptoms in primary care.

Objective There is only a small number of studies dealing with the prevalence of medically unexplained symptoms and somatoform disorder in German primary care practices. Therefore, we aimed to study the prevalence of medically unexplained symptoms and the prevalences and comorbidities of somatoform and other mental disorders. Method In the initial stage of a two-stage prevalence study, 620 consecutive patients were first screened with a PHQ-15 questionnaire. In the second stage, 308 selected persons were then interviewed in detail. Results Medically unexplained symptoms made up two-thirds of all reported symptoms with women, younger persons, and non-native speakers having the highest rates.…

Predictors of improved eating behaviour following body image therapy: A pilot study

Cognitive processes seem to play a vital role in eating disorders and body image. The current study, therefore, examines the impact and change of dysfunctional cognitions during a body image group therapy, which included 41 patients with an eating disorder. Dysfunctional cognitions were assessed with the 'Eating Disorder Cognition Questionnaire' both before and after treatment. Eating disorder psychopathology was also assessed. Results indicate a significant reduction of dysfunctional cognitions relating to 'body and self-esteem', 'dietary restraint', 'eating and loss of control', as well as 'internalisation and social comparison'. Furthermore, the changes in dysfunctional cognitions were a…

The relations between social anxiety and social intelligence: A latent variable analysis

Social anxiety has been associated with biases in cognitive processing and deficits in social performances. Yet, it remains unclear if these variations may be partly attributable to deficits in fundamental social abilities: for example, social intelligence (SI). Using the Magdeburg Test of Social Intelligence (MTSI) as an objective and performance based SI measure, we examined the relationship between social anxiety and SI in a general population sample (N=110) using Structural Equation Modeling. Dimensions of social anxiety as postulated by Clark and Wells (1995) and facets of SI (social understanding, social memory, and social perception), were negatively correlated. Use of safety-behavio…

Emotional interference and attentional processing in premenstrual syndrome

Abstract Background and objectives Premenstrual syndrome (PMS) is characterized by menstrual cycle-related affective, behavioral, and/or somatic symptoms. By applying the emotional Stroop task (EST) the current study examined if changes in processing emotional information, which have been demonstrated in affective disorders, are also present in PMS. Methods Via online screening, telephone interviews, and daily records over two months 55 women for the PMS group (on the basis of the specific inclusion criteria and a prospectively confirmed PMS) and 55 ‘non-PMS’ controls were recruited. All participants completed three emotional Stroop tasks (EST) with neutral and negative word, picture, and f…

Therapeutenbegleitete und patientengeleitete Exposition bei Panikstörung mit Agoraphobie

Zusammenfassung. Theoretischer Hintergrund: Die Exposition gilt als hoch wirksames Therapieelement in der Behandlung der Panikstörung mit Agoraphobie. Es ist jedoch weitgehend unklar, wie häufig und mit welchen Effekten verschiedene Modalitäten der Exposition (therapeutenbegleitet vs. patientengeleitet) in der Routineversorgung durchgeführt werden. Fragestellung: Es sollen Häufigkeit und Wirksamkeit der verschiedenen Durchführungsmodalitäten von Exposition in der Routinebehandlung der Panikstörung mit Agoraphobie untersucht werden. Methode: Bei N = 93 konsekutiven Patienten einer Hochschulambulanz mit der Hauptdiagnose Panikstörung mit Agoraphobie wurden Prä-Post-Veränderungen der Angstsym…

Human Sleep EEG under the Influence of Pulsed Radio Frequency Electromagnetic Fields

Former exploratory investigations of sleep alterations due to global system for mobile communications (GSM) signals have shown a hypnotic and REM-suppressive effect under field exposure. This effect was observed in a first study using a power flux density of 0.5 W/m<sup>2</sup>, and the same trend occurred in a second study with a power flux density of 0.2 W/m<sup>2</sup>. For the present study, we applied a submaximal power flux density of 50 W/m<sup>2</sup>. To investigate putative effects of radio frequency electromagnetic fields (EMFs) of cellular GSM phones on human sleep EEG pattern, all-night polysomnographies of 20 healthy male subjects both with …

Kausalattributionen von körperlichen Beschwerden bei somatoformen Störungen

Zusammenfassung. Es wird angenommen, dass Patienten mit somatoformen Störungen überwiegend organmedizinisch-biologische Ursachen für ihre Beschwerden verantwortlich machen - und dass diese Attributionen an der Aufrechterhaltung der Störung beteiligt sind. Bislang wurden die Kausalattributionen nur selten und überwiegend mit Bestätigungsmethoden an somatoformen Störungen untersucht. Ziele der Studie waren die Identifikation der spontanen Ursachenzuschreibungen und der Prädiktoren des Attributionsstils bei Patienten mit somatoformen Störungen - sowie die Überprüfung der Auswirkung der Kausalattributionen auf den Therapieverlauf. Insgesamt wurden 79 Patienten einer psychosomatischen Klinik mi…

Therapeutischer Misserfolg in der ambulanten Psychotherapie

Theoretischer Hintergrund: Zum Thema therapeutischer Misserfolg in der Psychotherapie fehlen methodisch gut vergleichbare Studien, sodass Forschungsbedarf besteht. Fragestellung: Ziele der vorliegenden Arbeit sind eine Replikation der Studie zur Häufigkeit therapeutischen Misserfolgs von Jacobi, Uhmann und Hoyer (2011) sowie die Erweiterung der Definition therapeutischen Misserfolgs. Methode: Wir analysierten die Daten von 1866 konsekutiven Patienten hinsichtlich Non-Response, Verschlechterung, auffälligen und hoch-symptomatischen Therapieabschlusswerten. Als Messinstrumente kamen der BSI, BDI und der GAF zum Einsatz. Ergebnisse: Verschlechterungen (i. S. einer Untermenge therapeutischen M…

Assessment of somatoform disorders: a review of strategies and instruments.

We provide an overview of methods and instruments developed for the assessment of somatoform disorders. Four diagnostic purposes have been identified: (i) classification according to a diagnostic system; (ii) screening for probable cases; (iii) dimensional measurement of syndrome severity; and (iv) assessment of associated clinical features. Existing instruments designed for each of these strategies are described, including specifications of their psychometric properties, particular features, advantages and disadvantages. A conclusion of this review is that the currently existing ‘family of assessment instruments’ in the field of somatoform disorders should be used to improve the comparabil…

Searching for a Gastrointestinal Subgroup Within the Somatoform Disorders

The authors examined whether patients suffering from functional gastrointestinal symptoms constitute a separate group within the broader concept of the somatoform disorders. The authors compared 103 patients with a severe gastrointestinal syndrome, 220 patients with a somatization syndrome according to DSM-IV, and 250 clinical control subjects with nonsomatoform mental disorders. The gastrointestinal group showed more catastrophizing thinking, complained more about autonomic sensations, felt bodily weaker, was less tolerant towards bodily discomfort, had developed more hypochondriacal fears and behaviors, was more depressed, and was more severely disabled in different areas of psychosocial …

Hypochondriasis and somatization: two distinct aspects of somatoform disorders?

We investigated boundaries and overlap between somatization and hypochondriasis on different levels of psychopathology: (1) comorbidity between hypochondriasis and somatization on the level of diagnoses in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994): (2) comorbidity with other mental disorders; (3) differences in clinical characteristics: and (4) overlap on the level of psychometric measures. The sample consisted of 120 psycho somatic inpatients. Somatoform, hypochondriacal, and depressive symptomatology, cognitions about body and health, and further aspects of general symptomatology were investigated. Diagnoses …

Evaluation des Einzeltherapiekonzepts

In diesem Kapitel werden die ersten Ergebnisse zur Wirksamkeit des in ► Kap. 4 und 5 dargestellten kognitiv-verhaltenstherapeutischen Behandlungskonzepts vorgestellt. Die Befunde basieren auf einer Stichprobe von Patienten mit multiplen unerklarten Korperbeschwerden, die in der Poliklinischen Institutsambulanz fur Psychotherapie der Johannes Gutenberg-Universitat Mainz entsprechend dem beschriebenen manualisierten Vorgehen behandelt wurden.

The predictive value of early response in patients with depressive disorders

Several randomized controlled trials have identified early response to psychotherapy as a predictor for later treatment outcome among patients with depressive disorders. However, supporting evidence under routine conditions is rare. This study evaluated the predictive value of early improvement for final outcomes in psychotherapy among depressive patients in the naturalistic setting of a German university outpatient clinic.We used the method of percent symptom reduction to classify 639 patients with major depression or dysthymic disorder who underwent an average of 40.0 sessions (SD = 16.3) of naturalistic cognitive-behavioral therapy (CBT) as having either an early response or an early non…

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…

Evidence-Based Assessment (EBA) in Psychiatrie, Klinischer Psychologie und Psychotherapie

Zusammenfassung. In der klinischen Praxis gewinnen evidenzbasierte Behandlungsleitlinien zunehmend an Bedeutung. Innerhalb dieser finden sich jedoch nur unbefriedigende Informationen zur Diagnostik, speziell im Hinblick auf eine therapie-begleitende Diagnostik. Der Erfolg einer Therapie, ob Psycho- und/oder Pharmakotherapie, hängt jedoch von der Verzahnung von Therapie und Diagnostik ab, um z.B. den Therapieverlauf und -erfolg zu bewerten und bei Bedarf die therapeutische Strategie zu ändern. Der Ansatz des Evidence-Based Assessment (EBA) bietet hier ein hilfreiches Rahmenmodell und konkrete Vorschläge sowie Kriterien zur Realisierung dieser Verzahnung. Im Beitrag soll EBA vorgestellt sowi…

Response und Remission in der Psychotherapieforschung

Treatment effects of psychotherapy are usually studied using analysis of mean differences, tests of significance and effect size measures. These strategies, however, do not answer the question of how large the proportion of patients is who responded to treatment or who even reached remission. This article compares 2 competing methods of response and remission analysis: The Reliable Change Index (RCI) according to Jacobson et al. and the method of percent symptom reduction (PSR). We applied both methods using a sample of 338 patients with DSM-IV major depressive disorder. A pre-post treatment effect of Cohen's d=1,16 (intention-to-treat) resulted for the Beck Depression Inventory (BDI), corr…

The impact of exposure to images of ideally thin models in TV commercials on eating behavior: an experimental study with women diagnosed with bulimia nervosa.

This study investigates whether eating behavior in women with diagnosed bulimia nervosa is influenced by prior exposure to images of ideally thin models. Twenty-six participants diagnosed with bulimia nervosa (BN) and 30 normal controls (NC) were exposed to body-related and neutral TV commercials; then food that typically triggers binge eating was provided, and the amount of food eaten was measured. No significant difference for food intake between NC and BN could be found, but food intake for BN was predicted by the degree of thoughts related to eating behaviors during exposure to the thin ideal. No impact of general body image or eating pathology on food intake could be found. The results…

Health anxiety – An indicator of higher interoceptive sensitivity?

Abstract Background and objectives According to cognitive-behavioral models, health anxiety arises from the misattribution of normal bodily sensations as signs of a severe illness. Consequently, higher levels of interoceptive accuracy might be critically involved in the development of health anxiety. Methods To test this central assumption of cognitive behavioral models of health anxiety, we assessed interoceptive accuracy in a sample of college students ( N  = 100). Two interoceptive tasks (detection of one's own heartbeat using the Schandry paradigm and detection of nonspecific skin conductance fluctuations, NSCFs) were used. Results We found no indication for a positive association betwe…

Hypochondriasis and health anxiety in the German population

Epidemiologic studies on hypochondriasis are very rare and have not been included in large North American community surveys until now. In order to gain information on the prevalence as well as the socio-demographic characteristics of hypochondriasis, the following community study was carried out. Analyses are based on an assessment of 1575 subjects selected by socio-demographic representation criteria for the German community. All subjects completed the Illness Attitude Scales (IAS) and responded to several additional questions on sociodemographics and diagnostic criteria pertaining to Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) hypochondriasis. The IAS is…

The role of fear-avoidance cognitions and behaviors in patients with chronic tinnitus.

The current study investigated the role of fear-avoidance-a concept from chronic pain research-in chronic tinnitus. A self-report measure the "Tinnitus Fear-Avoidance Cognitions and Behaviors Scale (T-FAS)" was developed and validated. Furthermore, the role of fear-avoidance behavior as mediator of the relationship between anxiety sensitivity and tinnitus handicap was investigated. From a clinical setting, N = 373 patients with chronic tinnitus completed questionnaires assessing tinnitus handicap (Tinnitus Handicap Inventory), anxiety, depression (Hospital Anxiety and Depression Scale), anxiety sensitivity (Anxiety Sensitivity Index-3), personality factors (Big Five Inventory-10), and fear-…

Alternating Chain Magnetism in Catena-μ-Oxo-Hemiporphyrazinatoiron(IV), The First μ-Oxo Linear Chain Complex Of Iron

Abstract X-ray studies, Mossbauer, and magnetism show FeOHp to be an antiferromagneticaly coupled alternating chain with J = -133 cm−1, g = 2.3 and an alternation parameter of 0.4.

Unerklärte Körperbeschwerden und somatoforme Störungen

Medizinisch unerklarte Korperbeschwerden, somatoforme Storungen, funktionelle somatische Syndrome … Das Fachgebiet zu korperlichen Symptomen, fur die kein organischer Befund nachweisbar ist, hat eine – zum Teil verwirrende – Vielfalt an Fachbegriffen hervorgebracht. Die Klarung und Abgrenzung dieser Begrifflichkeiten und diagnostischen Konzepte ist eine notwendige Voraussetzung, um das zugrunde liegende Problem des Patienten verstehen und einen erfolgversprechenden Therapieplan erstellen zu konnen. Dazu stellen die ersten drei Abschnitte des ersten Kapitels eine Hilfe dar: Zunachst wird mithilfe von zwei Fallbeispielen ein Einblick in die Vielseitigkeit unerklarter Korpersymptome und beglei…

Die Evaluation von Therapieeffekten bei sozialen Angststörungen in einer Hochschulambulanz mit verhaltenstherapeutischem Schwerpunkt

Hintergrund: Verhaltenstherapie hat sich bei sozialen Angststörungen in zahlreichen randomisiert-kontrollierten Studien als wirksam erwiesen. Entsprechende Nachweise unter Routinebedingungen sind bislang selten. Fragestellung: Welche Effektstärken, Response- und Remissionsraten können unter Routinebedingungen in einer verhaltenstherapeutisch orientierten Hochschulambulanz bei sozialen Angststörungen erreicht werden? Methode: Es wurden insgesamt 247 Patienten mit sozialer Angststörung zu Therapiebeginn, -ende sowie nach 6 und 12 Monaten untersucht. Ergebnisse: Es ergeben sich signifikante Unterschiede zwischen Prä- und Postmesszeitpunkt. Die Effektstärke der Completer erreichte d = 1.04 und…

Zertifizierung eines Studiengangs für Psychotherapie nach DIN EN ISO 9001

Zertifizierung einer Psychotherapeutischen Hochschulambulanz nach DIN EN ISO 9001

Methodological aspects of clinical trials in tinnitus: a proposal for an international standard

Abstract: Chronic tinnitus is a common condition with a high burden of disease. While many different treatments are used in clinical practice, the evidence for the efficacy of these treatments is low and the variance of treatment response between individuals is high. This is most likely due to the great heterogeneity of tinnitus with respect to clinical features as well as underlying pathophysiological mechanisms. There is a clear need to find effective treatment options in tinnitus, however, clinical trials differ substantially with respect to methodological quality and design. Consequently, the conclusions that can be derived from these studies are limited and jeopardize comparison betwee…

Effect of comorbid anxiety, depressive, and personality disorders on treatment outcome of somatoform disorders

Comorbid mental disorders of DSM-IV axis I and axis II have repeatedly been found to be a negative predictor for the treatment of axis I disorders, although recent contrary findings exist. Little is known about the effect of comorbidity on the therapy outcome of somatoform disorders. We compared three types of comorbidity, (1) personality disorders (PDs), (2) major depression (MDD) and anxiety (ANX) disorders, and (3) PDS and MDD and ANX, with regard to their relevance for the treatment outcome of somatoform disorders. One hundred twenty-six inpatients were assessed at least 4 weeks before admission to treatment, upon admission, and again at discharge. Somatoform, hypochondriacal, and depre…

Self-compassion as an emotion regulation strategy in major depressive disorder

Cognitive reappraisal and acceptance are two presumably adaptive emotion regulation strategies in depression. More recently, self-compassion has been discussed as another potentially effective strategy for coping with depression. In the present study, we compared the effectiveness of self-compassion with a waiting condition, reappraisal, and acceptance in a clinically depressed sample, and tested the hypothesis that the intensity of depressed mood would moderate the differential efficacy of these strategies. In an experimental design, we induced depressed mood at four points in time in 48 participants meeting criteria for major depressive disorder. After each mood induction, participants we…

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…

Who is looking at me? The cone of gaze widens in social phobia

Gaze direction is an important cue that regulates social interactions and facilitates joint attention. Although humans are very accurate in determining gaze directions in general, they have a surprisingly liberal criterion for the presence of mutual gaze. Using an established psychophysical task that required observers to adjust the eyes of a virtual head to the margins of the area of mutual gaze, we examined whether the resulting cone of gaze is altered in people with social phobia. It turned out that during presence of a second virtual person, the gaze cone's width was specifically enlarged in patients with social phobia as compared to healthy controls. The size of this effect was correla…

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 …

Don't change a winning horse

IntroductionThere is surprising excitement about the adequacy andfuture of the somatoform disorders (SFDs) as a circum-scribed diagnostic group [1–4]. Some authors wish to takethe forthcoming fifth revision of the Diagnostic andStatistical Manual (DSM) as a welcome occasion to removean unloved diagnostic term. However, eliminating the SFDswould devaluate the progress of research and clinicalpractice made during the past 25 years. It would lead toinsecurity and confusion in an interdisciplinary field whereclear terminology and common understanding is of highvalue. This contribution attempts to summarize some of themajor reasons why DSM-V should continue with the SFDs.Some suggestions will be…

hs-CRP Predicts Improvement in Depression in Patients With Type 1 Diabetes and Major Depression Undergoing Depression Treatment: Results From the Diabetes and Depression (DAD) Study

hs-CRP is elevated in depression (1), but evidence on decreases of hs-CRP during depression treatment or the role of hs-CRP in the prediction of response to depression treatment is still controversial (2,3). To date, no study has examined this association in patients with diabetes. As elevated hs-CRP increases the risk of diabetes complications in diabetes (4), we aimed to explore hs-CRP in patients with diabetes and major depression undergoing depression treatment based on the data of the Diabetes and Depression (DAD) study (5). Participants were randomized to 12 weeks (short-term phase) of diabetes-specific group cognitive behavioral therapy or sertraline treatment and followed up for 15 …