How Treatment Motivation Predicts Favorable Outcomes in Interdisciplinary Multimodal Pain Treatment Among Patients with Chronic Primary Pain.

As motivation for psychological treatment at intake has been shown to predict favorable outcomes after an inpatient stay, this study aimed to further characterize the different components of psychological treatment motivation that predict favorable treatment outcomes. 294 inpatients with chronic primary pain participating in an interdisciplinary multimodal pain treatment in a tertiary psychosomatic university clinic completed a battery of psychological questionnaires at intake and discharge. Treatment motivation was assessed at intake using the scales of the FPTM-23 questionnaire, while pain intensity, pain interference, anxiety, and depression were assessed both at intake and discharge. After treatment, pain intensity, pain interference, anxiety, and depression were significantly reduced. While higher levels on the FPTM-23 scale of suffering predicted smaller decreases in anxiety after treatment, higher scores on the scale of hope, i.e., lower levels of hopelessness, predicted lower levels of pain interference, anxiety, and depression after treatment. None of the scales of treatment motivation predicted pain intensity levels after treatment. Above and beyond providing symptom relief, reducing hopelessness and fostering hope regarding the treatment process and outcome might help clinicians treat patients with chronic primary pain more effectively.

Motive Satisfaction Among Patients with Chronic Primary Pain: A Replication.

We set out to replicate findings of significant (a) reductions in pain, psychological distress, and motivational incongruence (i.e., insufficient motive satisfaction) after interdisciplinary multimodal pain treatment and (b) associations between reductions in motivational incongruence (i.e., improved motive satisfaction) and decreases in psychological distress (Vincent et al., Journal of Clinical Psychology in Medical Settings 28:331-343, 2021). 475 Patients with chronic primary pain completed standardized self-reported questionnaires assessing motivational incongruence, psychological distress, pain intensity, and pain interference at intake and discharge from a tertiary psychosomatic university clinic. We used hierarchical linear models to analyze motivational incongruence's effects on psychological distress. We partially replicated Vincent et al.'s findings. Significant reductions in pain, psychological distress, and motivational incongruence after treatment were found. Reductions in motivational incongruence were associated with reductions in psychological distress. Similarly, a better motive satisfaction mediated the relationship between pain interference and psychological distress. Our findings show that reducing motivational incongruence may be a key component of treating chronic primary pain; we recommend to assess and target motivational incongruence to improve interdisciplinary multimodal pain treatment.

Is Home Treatment for Everyone? Characteristics of Patients Receiving Intensive Mental Health Care at Home.

We aimed at determining differential characteristics of patients treated by a home treatment (HT) team compared to patients treated on hospital wards. Of 412 consecutively admitted patients, 194 (47.1%) were at least partially treated at home, whereas 218 (52.9%) received inpatient treatment only during an episode of acute illness. A multivariate logistic regression model identified current employment to increase the odds of HT (p < 0.001). A primary diagnosis of anxiety or stress-related disorder (p < 0.001), other rare primary diagnoses such as personality disorders (p < 0.001), and more pronounced clinician-rated social problems (p = 0.041) decreased the odds of HT. Overall, it remained difficult to clearly specify suitability for HT based on available sociodemographic and clinical characteristics. This might indicate that responsible clinicians consider HT to be a viable alternative to hospital care and hence initiate HT for a relatively broad spectrum of patients.

Informed consent in psychotherapy: a survey on attitudes among psychotherapists in Switzerland.

BACKGROUND: The legal and ethical guidelines of psychological professional associations stipulate that informed consent by patients is an essential prerequisite for psychotherapy. Despite this awareness of the importance of informed consent, there is little empirical evidence on what psychotherapists' attitudes towards informed consent are and how informed consent is implemented in psychotherapeutic practice. METHODS: 155 psychotherapists in Switzerland completed an online survey assessing their attitudes regarding informed consent. RESULTS: Among the surveyed psychotherapists, there was a high consensus on important information that should be communicated to patients in the context of informed consent. Almost all psychotherapists rated confidentiality and its exemptions (95%) and self-determined decision-making (97%) as important. The importance to disclose information regarding fees and the empirical effectiveness of the provided treatment, were both seen as important by more than 80% of participants. The disclosure of personal information about the therapist was rated as important by 60%. Other aspects, which are not direct components of informed consent but rather overarching goals, were also evaluated rather homogeneously: self-determined decision making of the patient was rated as important by almost all of the surveyed psychotherapists (97%). The following components were also judged as important by a majority of the participants: promotion of hope (80%) and discussion of treatment goals (93%). Most psychotherapists described the implementation of informed consent as an ongoing process, rather than a one-time event during the first session of therapy. Therapists' age, postgraduate training, treated patient group, and setting influenced attitudes towards informed consent. CONCLUSIONS: The present study shows that informed consent is perceived by psychotherapists as both a challenge and a resource. The implementation of informed consent in psychotherapy requires further research from a clinical and ethical perspective.

Effects of patient-therapist interpersonal complementarity on alliance and outcome in cognitive-behavioral therapies for depression: Moving toward interpersonal responsiveness.

This study analyzed patient-therapist in-session interpersonal complementarity effects on the therapeutic alliance and depression severity during the initial and working phase of cognitive-behavioral therapy for depression. It also explored whether patients' interpersonal problems moderate those complementarity effects. We drew on a sample of 90 dyads derived from a randomized controlled trial of two cognitive-behavioral therapies for depression. Using an observer-based measure, we assessed patients' and therapists' interpersonal behavior in Sessions 1, 5, 9, and 13 and computed their complementarity regarding interpersonal affiliation (i.e., correspondence) and dominance (i.e., reciprocity). Patients completed measures of interpersonal problems at baseline and session-by-session measures of depression severity and quality of the therapeutic alliance. Response surface analyses based on polynomial regressions showed that patient-therapist complementarity in higher affiliative behaviors was associated with a stronger alliance. Interpersonal problems regarding agency moderated the complementarity effects of the dominance dimensions on depression severity. Overly dominant patients benefited more from a nonreciprocal relationship in the dominance dimension, whereas submissive patients benefited more from complementarity in that dimension. Furthermore, interpersonal problems of communion significantly moderated the effects of complementarity in affiliative behaviors on both the alliance and outcome. These results suggest the relevance of both interpersonal correspondence and reciprocity for the psychotherapy process, informing clinical practice in terms of interpersonal responsiveness. The moderation effects of interpersonal problems provide preliminary evidence, which should be replicated in future research, to determine relevant markers indicating for whom a complementary approach would be beneficial in cognitive therapy for depression. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Motive Satisfaction in Chronic Pain Patients: Does It Improve in Multidisciplinary Inpatient Treatment and, if so, Does It Matter?

According to consistency theory, insufficient motive satisfaction (motivational incongruence) is associated with psychological distress and mental disorders. High levels of distress and comorbid psychological disorders are common in patients with chronic pain. The aim of the present study was to investigate the role of motivational incongruence in chronic pain patients and the association of incongruence change with symptom improvement. Inpatients with chronic pain in multimodal interdisciplinary treatment (n = 177) completed questionnaires measuring motivational incongruence, psychological distress, pain intensity and pain interference at the beginning and end of a multimodal interdisciplinary inpatient treatment program at a tertiary psychosomatic university clinic. Results demonstrated that pain and motivational incongruence were significantly reduced at post-treatment, and reductions in incongruence were associated with reductions in psychological distress. In particular, better satisfaction of approach motives mediated the association between reduction of pain interference and psychological distress at post-treatment. Findings suggest that a reduction of motivational incongruence may be part of successful treatment of chronic pain.

Telemedicine for chronic pain treatment during the COVID-19 pandemic: Do pain intensity and anxiousness correlate with patient acceptance?

INTRODUCTION: Recent recommendations for the treatment of chronic pain patients during the coronavirus disease 2019 (COVID-19) pandemic suggest using telemedicine instead of in-person consultations. Knowing whether patients with chronic pain are receptive to the use of telemedicine during a pandemic might improve tailored care. OBJECTIVE: The aims of the present study were to assess patients' acceptance of telemedicine during the COVID-19 pandemic in Switzerland and to examine the correlation of acceptance with pain intensity and anxiousness. METHODS: An anonymous survey was conducted from March 31, 2020, to July 30, 2020, with 61 patients referred to the Pain Center at the Bern University Hospital Inselspital in Bern, Switzerland. Collected data were analyzed descriptively, and correlations were calculated between acceptance of telemedicine and mean levels of current pain, psychological distress, and fear of COVID-19. RESULTS: Our main finding was an average level of acceptance of telemedicine, with a mean of 6.25 on a scale from 0 (not at all) to 10 (completely), with substantial variability and range (SD = 3.56). The acceptance of telemedicine correlated negatively with current mean pain level (r = -0.44), worries (r = -0.42), and fear of COVID-19 (r = -0.4), as well as positively with the general condition (r = 0.46). CONCLUSIONS: Using telemedicine for chronic pain treatment during the COVID-19 crisis was accepted to a sufficient degree by a considerable proportion of patients. However, the higher the mean levels of pain and anxiousness, the lower the acceptance, indicating that these severely burdened patients may suffer most from treatment restrictions. For this subgroup, telemedicine might not suffice and in-person visits should be considered.

Home treatment for acute mental healthcare: randomised controlled trial.

BACKGROUND: Home treatment has been proposed as an alternative to acute in-patient care for mentally ill patients. However, there is only moderate evidence in support of home treatment. AIMS: To test whether and to what degree home treatment services would enable a reduction (substitution) of hospital use. METHOD: A total of 707 consecutively admitted adult patients with a broad spectrum of mental disorders (ICD-10: F2-F6, F8-F9, Z) experiencing crises that necessitated immediate admission to hospital, were randomly allocated to either a service model including a home treatment alternative to hospital care (experimental group) or a conventional service model that lacked a home treatment alternative to in-patient care (control group) (trial registration at ClinicalTrials.gov: NCT02322437). RESULTS: The mean number of hospital days per patient within 24 months after the index crisis necessitating hospital admission (primary outcome) was reduced by 30.4% (mean 41.3 v. 59.3, P<0.001) when a home treatment team was available (intention-to-treat analysis). Regarding secondary outcomes, average overall treatment duration (hospital days + home treatment days) per patient (mean 50.4 v. 59.3, P = 0.969) and mean number of hospital admissions per patient (mean 1.86 v. 1.93, P = 0.885) did not differ statistically significantly between the experimental and control groups within 24 months after the index crisis. There were no significant between-group differences regarding clinical and social outcomes (Health of the Nation Outcome Scales: mean 9.9 v. 9.7, P = 0.652) or patient satisfaction with care (Perception of Care questionnaire: mean 0.78 v. 0.80, P = 0.242). CONCLUSIONS: Home treatment services can reduce hospital use among severely ill patients in acute crises and seem to result in comparable clinical/social outcomes and patient satisfaction as standard in-patient care.

The Association of Therapeutic Alliance With Long-Term Outcome in a Guided Internet Intervention for Depression: Secondary Analysis From a Randomized Control Trial.

BACKGROUND: Therapeutic alliance has been well established as a robust predictor of face-to-face psychotherapy outcomes. Although initial evidence positioned alliance as a relevant predictor of internet intervention success, some conceptual and methodological concerns were raised regarding the methods and instruments used to measure the alliance in internet interventions and its association with outcomes. OBJECTIVE: The aim of this study was to explore the alliance-outcome association in a guided internet intervention using a measure of alliance especially developed for and adapted to guided internet interventions, showing evidence of good psychometric properties. METHODS: A sample of 223 adult participants with moderate depression received an internet intervention (ie, Deprexis) and email support. They completed the Working Alliance Inventory for Guided Internet Intervention (WAI-I) and a measure of treatment satisfaction at treatment termination and measures of depression severity and well-being at termination and 3- and 9-month follow-ups. For data analysis, we used two-level hierarchical linear modeling that included two subscales of the WAI-I (ie, tasks and goals agreement with the program and bond with the supporting therapist) as predictors of the estimated values of the outcome variables at the end of follow-up and their rate of change during the follow-up period. The same models were also used controlling for the effect of patient satisfaction with treatment. RESULTS: We found significant effects of the tasks and goals subscale of the WAI-I on the estimated values of residual depressive symptoms (γ02=-1.74, standard error [SE]=0.40, 95% CI -2.52 to -0.96, t206=-4.37, P<.001) and patient well-being (γ02=3.10, SE=1.14, 95% CI 0.87-5.33, t198=2.72, P=.007) at the end of follow-up. A greater score in this subscale was related to lower levels of residual depressive symptoms and a higher level of well-being. However, there were no significant effects of the tasks and goals subscale on the rate of change in these variables during follow-up (depressive symptoms, P=.48; patient well-being, P=.26). The effects of the bond subscale were also nonsignificant when predicting the estimated values of depressive symptoms and well-being at the end of follow-up and the rate of change during that period (depressive symptoms, P=.08; patient well-being, P=.68). CONCLUSIONS: The results of this study point out the importance of attuning internet interventions to patients' expectations and preferences in order to enhance their agreement with the tasks and goals of the treatment. Thus, the results support the notion that responsiveness to a patient's individual needs is crucial also in internet interventions. Nevertheless, these findings need to be replicated to establish if they can be generalized to different diagnostic groups, internet interventions, and supporting formats.

Quality of leadership and presenteeism in health professions education and research: a test of a recovery-based process model with cognitive irritation and impaired sleep as mediators.

Presenteeism (PRES) includes working while feeling ill and constrained in performance. Compared with absence from work, PRES generates significantly higher cost estimates. Health problems and PRES are related to leadership quality. Hence, research on corporate health management needs to explore why leadership problems (LP) correspond to more frequent PRES.This study tests recovery after work as an underlying process with cognitive irritation (COGIRR) and sleep problems (SP) as simultaneous mediators and explores three mediation pathways (path one: LP→COGIRR→PRES; path two: LP→SP→PRES; and path three: LP→COGIRR→SP→PRES). Out of 293 employees of a university's school of health professions in German-speaking Switzerland, 211 completed a questionnaire. LP and PRES were found to be positively related (r(211) = .22, p < .01). The tests of mediation yielded no significant results for path one and two, but the third mediation path LP→COGIRR→SP→PRES was positive and differed significantly from zero (B = 0.83, CI95 = 0.33 to 1.69). According to our results, a recovery-based mediation model fits the empirical self-report data best. These results suggest that occupational health interventions should improve leadership quality to promote recovery after work in order to increase health and productivity by reduced PRES.

The Working Alliance Inventory for guided Internet interventions (WAI-I).

OBJECTIVE: This study analyses the psychometric properties of the Working Alliance Inventory adapted for guided Internet interventions (WAI-I). METHODS: We drew on the data set from a multicenter trial that examined a guided Internet intervention (deprexis) for patients with mild to moderate depression. Two hundred twenty-three patients completed the WAI-I and the Patient Satisfaction Questionnaire (ZUF-8) at posttreatment, and the Attitudes toward Psychological Online-Interventions Questionnaire (APOI) at baseline. We ran confirmatory factor analyses (CFA) testing two- and three-factor solutions and calculated Cronbach's α, item-total correlations, and correlations of the WAI-I with APOI and ZUF-8. RESULTS: The results suggested a two-factor solution, with a very good model fit and evidence of factor independency, adequate internal consistency, and external validity for the complete scale and the sub-scales. CONCLUSIONS: The WAI-I showed as a reliable and valid instrument to capture alliance in guided Internet interventions, which might facilitate process-outcome research and treatment development efforts.

Using the Personalized Advantage Index for individual treatment allocation to cognitive behavioral therapy (CBT) or a CBT with integrated exposure and emotion-focused elements (CBT-EE).

Even though different psychotherapeutic interventions for depression have shown to be effective, patients suffering from depression vary substantially in their treatment response. The goal of this study was to answer the following research questions: (1) What are the most important predictors determining optimal treatment allocation to cognitive behavioral therapy (CBT) or CBT with integrated exposure and emotion-focused elements (CBT-EE)?, and (2) Would model-determined treatment allocation using this predictive information result in better treatment outcomes? Bayesian Model Averaging (BMA) was applied to the data of a randomized controlled trial comparing the efficacy of CBT and CBT-EE in depressive outpatients. Predictions were made for every patient for both treatment conditions and an optimal versus a suboptimal treatment was identified in each case. An index comparing the two estimates, the Personalized Advantage Index (PAI), was calculated. Different predictors were found for both conditions. A PAI of 1.35 BDI-II points for the two conditions was found and 46% of the sample was predicted to have a clinically meaningful advantage in one of the therapies. Although the utility of the PAI approach must be further confirmed in prospective research, the present study study promotes the identification of specific interventions favorable for specific patients.

Disentangling within- and between-patient effects of defensive functioning on psychotherapy outcome using mixed models.

Abstract There is a great need to identify predictors of treatment response, and the analysis of defense mechanisms is a promising approach. Defensive functioning may influence psychotherapy outcome in two ways: First, when it is generally higher or lower for some patients relative to others and second, as it shifts in individual patients over time. The present study examined both within- and between patient effects of defenses using hierarchical linear modeling. Forty-seven patients diagnosed with depression, anxiety, or adjustment disorders received 25 ± 3 sessions of integrative cognitive-behavioral therapy in a university outpatient clinic. The Defense Mechanism Rating Scale (DMRS) was used to assess defenses in the 1st, 8th, 16th, and 24th session and relate them to symptom severity of depression and anxiety. A higher number of adaptive defense mechanisms was associated with less severe depressive symptoms during treatment while a higher number of immature defenses was related to more severe depressive and anxiety symptoms. An increase in adaptive and a decrease in immature defenses over the course of treatment predicted symptom reduction of depression whereas a decrease in neurotic and immature defenses was associated with reductions in anxiety symptoms. Our results empirically support defensive functioning as a mechanism of change in psychotherapy.

[Guideline for the planning of personalized, interdisciplinary multimodal pain treatment]. / Wegleitung zur Planung einer personalisierten, interdisziplinären multimodalen Schmerztherapie.

Interdisciplinary multimodal pain therapy (IMPT) should be delivered in a personalized, mechanism- and goal-oriented manner on the basis of an individual case conception. To the authors' knowledge, a practical instrument for planning IMPT does not exist. The model and guideline presented here for treatment should help practitioners to optimize the planning of IMPT and execute it efficiently. Based on the relevant interference mechanisms, goals for change and treatment are set and possible interventions are proposed. This involves explicitly including the patient's existing resources.

[Assessment of complex posttraumatic stress disorder with the revised Trauma Symptom Inventory (TSI-2)]. / Erfassung der komplexen posttraumatischen Belastungsstörung mit dem revidierten Trauma Symptom Inventory (TSI-2).

BACKGROUND: This study tested whether it is possible to diagnose complex posttraumatic stress disorder (CPTSD) according to the beta version of ICD-11 by means of the Trauma Symptom Inventory 2 (TSI-2). Currently, there is no established measurement for this. METHODS: An algorithm for the TSI-2 was developed. This was tested in a sample of 100 psychiatric patients, who had experienced aversive and/or traumatic events. The frequency of CPTSD and differences regarding gender, age and traumatic events will be reported. RESULTS: On the basis of this TSI-2 algorithm, 5% of the sample were estimated to suffer from CPTSD. A trend towards more women being affected was observed, and younger patients were more affected than older ones. Traumatized individuals reported more mental health problems than non-traumatized ones. CONCLUSION: Tentatively, these results indicate that it may be possible to use a combination of certain scales of the TSI-2 to diagnose CPTSD in line with its current definition by the ICD-11.

[ICD-11 posttraumatic stress disorder (PTSD) in male prisoners]. / Die posttraumatische Belastungsstörung (PTBS) nach dem ICD-11 Kriterienvorschlag bei inhaftierten Männern.

THEORETICAL BACKGROUND: The eleventh version of the ICD, expected to be published in 2018, leads to changed criteria for post-traumatic stress disorder (PTSD) according to the online beta version. Such changes are likely to affect previously known features of PTSD, including the prevalence rate. Little is known about the prevalence of ICD-11 PTSD in imprisoned men. The present study examined this issue in this high-risk group for trauma disorders, as male prisoners are known to be more often affected by traumatic events compared to the general population. METHOD: In n = 49 men imprisoned in Switzerland, cross-sectional and standardized self-assessment procedures (ACE, Cidi list, IES-R) were used to record traumatic events and possible trauma symptoms. The frequency of ICD-11 PTSD was calculated using the diagnostic heuristic of Hyland et al. (2017), on the basis of which ICD-11 PTSD is estimated by means of the IES-R. RESULTS: Overall, 88 % of the detained men examined had been traumatized during childhood and / or life span; 78 % reported at least one event on the ACE, on average 1.5, with 25 % reporting four or more events. Emotional abuse was reported most frequently (51 %). Furthermore, 71 % reported at least one event on the Cidi list, on average 1.8, with 45 % reporting serious physical threat. The analysis of ICD-11 PTSD was carried out with n = 34 inmates after exclusion of those without a traumatic event and those who did not complete the IES-R, and ICD-11 PTSD was estimated at 26.5 %. CONCLUSION: The study shows that imprisoned men are likely to be a high risk group for the development of PTSD even according to the new ICD. Considering the high prevalence of traumatic events and the numerous negative consequences for mental as well as physical health, specific psychotherapeutic programs and a trauma-informed imprisonment are necessary.

Patient characteristics and the therapist as predictors of depressed patients' outcome expectation over time: A multilevel analysis.

Objective: Although there is an established link between patients' early positive outcome expectation for and their actual improvement from therapy, there is little research on patients' change in outcome expectation across therapy and both patient and therapist correlates of early outcome expectation level and change. The present study examined: (i) the overall trajectory of change in patients' outcome expectation through cognitive-behavioral therapy (CBT) for depression; (ii) patient characteristics as predictors of both initial outcome expectation and change in outcome expectation; and (iii) between-therapist effects in outcome expectation change. Method: Depressed patients (N = 143) received a brief course of CBT. Outcome expectation was measured at screening, pretreatment, session 7, and session 14. Results: Outcome expectation linearly increased from screening to session 14. When controlling for other patient characteristics at intake, having previous depressive episodes was negatively associated with initial outcome expectation and higher well-being was positively associated with initial outcome expectation. When controlling for early alliance and early symptom change, outcome expectation change was predicted by previous depressive episodes. Finally, therapist effects emerged in outcome expectation over time. Conclusions: Various depressed patients' characteristics predict initial outcome expectation level and change, with significant between-therapists' differences related to outcome expectation change.

A randomized-controlled trial of cognitive-behavioral therapy for depression with integrated techniques from emotion-focused and exposure therapies.

BACKGROUND: Emotional processing (EP) is hypothesized to be a key mechanism of change in psychotherapy that may enhance its long-term efficacy. To study the effects of fostering EP in psychotherapy for depression, this randomized-controlled clinical trial compares the efficacy and pattern of change of a cognitive-behavioral therapy that integrates emotion-focused techniques within an exposure framework (Exposure-Based Cognitive Therapy for depression; EBCT-R) to a standard cognitive-behavioral therapy (CBT). METHODS: One hundred and forty-nine depressed outpatients were randomized to a maximum of 22 sessions of manualized EBCT-R (N = 77) or CBT (N = 72). Primary outcomes were self-reported and clinician-rated depressive symptoms at posttreatment and 12-month follow-up. Secondary outcomes were self-esteem, interpersonal problems, and avoidance thoughts and behaviors. RESULTS: Depressive symptoms improved significantly over therapy in both treatments, with large within-group effect sizes for CBT (d = -1.95) and EBCT-R (d = -1.77). The pattern of depression change during treatment did not differ between treatments. Symptom relief lasted over 12 months and did not differ between EBCT-R and CBT. CONCLUSIONS: Results suggest that both treatments produced significant short- and long-term improvement in depression symptoms, but the integration of emotion-focused techniques within an exposure framework did not have added benefit. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01012856 Clinical or methodological significance of this article: This trial compares cognitive-behavioral therapy (CBT) with a similarly structured CBT that was designed to foster emotional processing by integrating emotion-focused techniques within an exposure framework. Results indicate that this form of assimilative integration did not improve outcomes at 12-month follow-up.

[Functional body disorders]. / Funktionelle Körperbeschwerden.

Functional body disorders Abstract. By definition, functional disorders cannot be conceptualized bio-morphologically at the organ level. They originate on the basis of dysregulated control processes and perceptional alterations at a superordinate level of the organism. Under excessive stress, any vegetatively regulated system might develop functional disorders. Hence they can also be observed in veterinary medicine. The «incongruence¼ between the organic findings and the symptoms reported represents a diagnostic challenge, which general practitioners, due to the high prevalence of functional disorders are confronted with on a daily basis. Therefore a comprehensible explanatory model is needed in order to build trust and to motivate the patient for treatment. The new S3 guidelines «functional disorders¼ provide constructive and pragmatic information for the adequate treatment of patients with functional disorders.

Interpersonal Sensitivity as a Mediator Between Cumulative Childhood Traumatic Events and Adult Sexual Disturbance.

Previous research has shown that cumulative childhood traumatic events are stronger predictors of sexual disturbances than childhood sexual abuse. Additional factors are likely to influence this relationship. Whereas socio-interpersonal factors such as interpersonal sensitivity have repeatedly been shown to be salutogenic in the aftermath of traumatic events, the specific underlying mechanisms are little understood. The aim of the present study was to examine the relationship between cumulative childhood traumatic events and adult sexual disturbances (i.e., the avoidance of sexual contacts, disruptive sexual behavior, poor sexual boundaries, decreased regulation of sexual impulses) and to investigate the role of interpersonal sensitivity as a potential mediator. The sample comprised 100 adult psychiatric in-patients. As expected, cumulative childhood traumatic events were found to be strong predictors of sexual disturbances, with interpersonal sensitivity partially mediating this relationship.