EMG measured reaction time as a predictor of invalid symptom report in psychosomatic patients.

Background: Symptom validity tests (SVTs) and performance validity tests (PVTs) are important tools in sociomedical assessments, especially in the psychosomatic context where diagnoses mainly depend on clinical observation and self-report measures. This study examined the relationship between reaction times (RTs) and scores on the Structured Inventory of Malingered Symptomatology (SIMS). It was proposed that slower RTs and larger standard deviations of reaction times (RTSDs) would be observed in participants who scored above the SIMS cut-off (>16). Methods: Direct surface electromyography (EMG) was used to capture RTs during a computer-based RT test in 152 inpatients from a psychosomatic rehabilitation clinic in Germany. Correlation analyses and Mann-Whitney U were used to examine the relationship between RTs and SIMS scores and to assess the potential impact of covariates such as demographics, medical history, and vocational challenges on RTs. Therefore, dichotomized groups based on each potential covariate were compared. Results: Significantly longer RTs and larger RTSDs were found in participants who scored above the SIMS cut-off. Current treatment with psychopharmacological medication, diagnosis of depression, and age had no significant influence on the RT measures. However, work-related problems had a significant impact on RTSDs. Conclusion: There was a significant relationship between longer and more inconsistent RTs and indicators of exaggerated or feigned symptom report on the SIMS in psychosomatic rehabilitation inpatients. Findings from this study provide a basis for future research developing a new RT-based PVT.

Milieu-specific differences in symptom severity and treatment outcome in psychosomatic rehabilitation in Germany.

Introduction: Previous studies that focused on socioeconomic differences did not comprehensively explain existing inequalities in psychosomatic rehabilitation in Germany. We applied a social milieu approach, which additionally includes sociocultural factors such as lifestyles, attitudes and values, to investigate differences among patients in symptom severity, psychosocial impairment and improvement over the course of the intervention. Methods: As a model for social milieus, the empirical Sinus milieus were used. 2,000 patients of two psychosomatic rehabilitation clinics in Germany were included and their milieu was assessed with the Sinus milieu indicator for Germany 10/2018 questionnaire. BDI-II (N = 1,832) and HEALTH-49 (N = 1,829) questionnaires were used to measure depressiveness and psychosocial impairment at admission (T0) and discharge after 5 weeks of treatment (T1). Milieu differences in severity and improvement were analyzed by mixed-model ANOVAs. Results: Milieu distribution was not representative of the overall population of Germany. We found significant differences between patients from different milieus in both BDI-II and HEALTH-49 (p < 0.001). Patients from the Precarious Milieu had the highest burden of depressive symptoms in BDI-II and the highest impairment on all HEALTH-49 scales at T0 and T1. Over the course of rehabilitation, patients from all milieus improved significantly in all domains (p < 0.001). Significant interaction effects showed milieu-dependent differences in improvement for depressiveness on the BDI-II [F(9, 1822) = 2.50, p = 0.008] and for three HEALTH-49 scales, namely Psychological well-being [F(9, 1819) = 3.30, padj = 0.005], Interactional difficulties [F(9, 1819) = 2.74, padj = 0.036] and Activity and Participation [F(9, 1819) = 4.94, padj < 0.001], while post-hoc tests only revealed two significant group differences for the last scale. In all domains, patients from the Precarious Milieu retained higher symptoms and impairment at T1 than patients from better-off milieus had at T0. Discussion: Social milieu was associated with symptom severity, treatment access and outcome of psychosomatic rehabilitation patients. Milieu-specific sociocultural habits, psychosocial needs and therapeutic demands may help describe differences and should be considered in therapy planning and implementation, to improve equal access, quality and effectiveness of rehabilitation. Therefore, further research on milieu-specific differences and needs is necessary.

Training in psychosomatic medicine and psychotherapy for medical doctors in China: A field report.

Background: The high prevalence rates of mental disorders in China contrast a comparatively low care capacity from qualified trained medical doctors in the mental health field. The main objective of our cooperation project was to develop and implement advanced postgraduate training for medical doctors for their acquisition of knowledge, skills, and attitudes in the field of psychosomatic medicine and psychotherapy in China. Methods: Monitoring and evaluation as part of the advanced training in Beijing were conducted following the Kirkpatrick training approach using four levels of evaluation: reaction, learning, behavior and results. We performed a continuous course evaluation, assessed the respective learning goal attainment, conducted a pre-post evaluation of reasons and goals for participation in the training, and measured the treatment effects on the patient side. Results: The implementation of training standards in the field of psychosomatic medicine and psychotherapy for medical doctors and the transfer of didactic knowledge and skills for Chinese lecturers were achieved. A total of 142 mainly medical doctors attended the 2-year training. Ten medical doctors were trained as future teachers. All learning goals were reached. The content and didactics of the curriculum were rated with an overall grade of 1.23 (1 = very good to 5 = very bad). The highest rated elements were patient life interviews, orientation on clinical practice and communication skills training. The achievement of learning objectives for each block (depression, anxiety disorders, somatic symptom disorder, coping with physical diseases) was rated between 1 and 2 (1 = very well achieved to 5 = not achieved) for all items from participants' perspectives. On the patient side (n = 415), emotional distress decreased and quality of life and the doctor-patient alliance improved significantly. Discussion: Advanced training in psychosomatic medicine and psychotherapy was successfully implemented. The results of the evaluation show high participant satisfaction and the successful achievement of all learning objectives. A more detailed and extensive evaluation of the data, such as an analysis of the development of the participants as psychotherapists, is in preparation. The continuation of the training under Chinese guidance is guaranteed.

Psychometric properties of the job anxiety scale.

Background: Occupational stress and specifically job anxiety are crucial factors in determining health outcomes, job satisfaction as well as performance. In order to assess this phenomenon, the Job Anxiety Scale (JAS) is one of the instruments available. It consists of 70 items that are clustered in 14 subscales and five dimensions. This manuscript is a revised version of a retracted article that analyzed the properties of a short version of the JAS. Rather than shortening the scale, the authors of the JAS recommend to further assess the scale in its current state without modification of the factor structure. Hence, the aim of this paper is to assess the psychometric properties of the original JAS. Methods: The sample consists of 991 - mostly psychosomatic - patients from two different clinics. We applied methods of factor analysis and bivariate correlations to explore and test factor structure and the nomological net of related constructs. Results: The Job Anxiety Scale evinced satisfactory psychometric properties. We found very high internal consistency, and invariance across participant age. It displayed good discriminant validity and we found the expected pattern of convergent correlations. However, the model fit is not convincing. Conclusion: With the Job Anxiety Scale, researchers can assess job related worries in a reliable manner. The questionnaire is particularly useful in large-scale surveys, in therapy or work-related contexts. However, the scale could be modified in order to aim for a better fit and assess job related anxiety in a more efficient way.

Perceived professional development of Chinese psychotherapy trainees: a pilot study.

For more than 30 years counselling and psychotherapy services in China have progressed rapidly. Currently, various Chinese universities, hospitals, official mental health centres, and private mental health service organizations provide psychotherapy training programs. However, little is known about Chinese psychotherapy trainees and their development. This pilot study investigated the characteristics and perceived professional development of 20 Chinese trainees during and after an advanced training program for psychosomatic medicine and psychotherapy, which is a collaboration project between Peking Union Medical College Hospital and the Department of Psychosomatic Medicine and Psychotherapy from the University Medical Center Freiburg in Germany. Trainees completed questionnaires from the SPRISTAD (Society for Psychotherapy Research Interest Section on Therapist Training and Development) study at the beginning (T1), at the end (T2), and one year after finishing the program (T3). Seventeen of the twenty participants were clinicians. Trainees reported a prominent rise of Currently Experienced Growth throughout the training period, which nearly dropped to the baseline level after the training, although Retrospective Career Development showed a trend of an overall increase. Both 'experience in therapy with patients' and 'participation in courses or seminars' were the most important positively perceived sources of influence on trainees' development. This implies the importance of continuous psychotherapy training for the development of therapists during their career. Future research with a larger sample size should also assess trainees' development from the viewpoint of trainers, supervisors, and patients.

Work-related medical rehabilitation in patients with mental disorders: the protocol of a randomized controlled trial (WMR-P, DRKS00023175).

BACKGROUND: Various rehabilitation services and return-to-work programs have been developed in order to reduce sickness absence and increase sustainable return-to-work. To ensure that people with a high risk of not returning to work can participate in working life, the model of work-related medical rehabilitation was developed in Germany. The efficacy of these programs in patients with mental disorders has been tested in only a few trials with very specific intervention approaches. To date, there is no clear evidence of the effectiveness of work-related medical rehabilitation implemented in real-care practice. METHODS/DESIGN: Our randomized controlled trial will be conducted in six rehabilitation centers across Germany. Within 15 months, 1800 patients with mental disorders (300 per rehabilitation center) will be recruited and assigned one-to-one either to a work-related medical rehabilitation program or to a conventional psychosomatic rehabilitation program. Participants will be aged 18-60 years. The control group will receive a conventional psychosomatic rehabilitation program without additional work-related components. The intervention group will receive a work-related medical rehabilitation program that contains at least 11 h of work-related treatment modules. Follow-up data will be assessed at the end of the rehabilitation and 3 and 12 months after completing the rehabilitation program. The primary outcome is a stable return to work. Secondary outcomes cover several dimensions of health, functioning and coping strategies. Focus groups and individual interviews supplement our study with qualitative data. DISCUSSION: This study will determine the relative effectiveness of a complex and newly implemented work-related rehabilitation strategy for patients with mental disorders. TRIAL REGISTRATION: German Clinical Trials Register ( DRKS00023175 , September 29 2020).

[Rehabilitation Outcome and Therapeutic Alliance of Inpatients of Psychosomatic Rehabilitation with Pension Request]. / Psychosomatische Rehabilitation bei Patientinnen und Patienten mit Rentenüberlegungen: Reha-Erfolg und therapeutische Beziehung.

OBJECTIVE: Inpatients of psychosomatic rehabilitation with a latent or manifest desire for a pension are a risk group with regard to successful participation in rehabilitation and return to work. Reaching this group of patients, is both a legal requirement (rehabilitation before retirement), and important from an economic and health perspective. This study examines patients who are considering applying for a reduced earning capacity. The questions are whether these patients differ in socio-demographic variables and the success of rehabilitation from patients without pension considerations, and which patients benefitted from their rehabilitation despite pension considerations. Particular attention is paid to the therapeutic relationship. METHODS: Data are routinely collected from patients of 2 rehabilitation clinics who were undergoing inpatient psychosomatic treatment between October 2012 and February 2017 (n=8503). RESULTS: Inpatients with pension considerations were slightly older, more often incapacitated for work and more often receiving unemployment benefits. Both groups reported a significant reduction in symptoms over the course of the rehabilitation. Within the group considering retirement, patients who reported an improvement in symptoms reported a more positive relationship satisfaction. DISCUSSION/CONCLUSION: Patients who are thinking about retirement often have difficult socio-demographic and health-related conditions for successful rehabilitation. Despite these conditions, many report an improvement in psychosomatic symptoms and a positive therapeutic relationship.

Retraction Note: Psychometric properties of a short version of the Job Anxiety Scale.

This article has been retracted. Please see the Retraction Notice for more detail: https://doi.org/10.1186/s12874-020-01166-w .

Psychometric properties of a short version of the Job Anxiety Scale.

BACKGROUND: Occupational stress and specifically job anxiety are crucial factors in determining health outcomes, job satisfaction as well as performance. In order to assess this phenomenon, the Job Anxiety Scale is one of the instruments available. It consists of 70 items that are clustered in 14 subscales and five dimensions. The aim of this paper is to create a more efficient, short version of the Job Anxiety Scale, while retaining the five dimensions, and to assess its psychometric properties. METHODS: The sample consists of 991 - mostly psychosomatic - patients from two different clinics. We applied methods of factor analysis and bivariate correlations to explore and test factor structure and the nomological net of related constructs. RESULTS: After reducing the item pool via the construction of subsets and tests using ant-colony-optimization, a 15-item version of the Job Anxiety Scale evinced very good psychometric properties. We found very good model fit, high internal consistency, and invariance across participant age and sex. It displayed improved discriminant validity compared to the original scale, and we found the expected pattern of convergent correlations. CONCLUSIONS: With this short version of the Job Anxiety Scale, researchers can assess job related worries in a much more economic manner. The questionnaire is particularly useful in large-scale surveys and/or in samples that struggle with extensive assessments.

Validity and sensitivity to change of the Somatic Symptom Disorder-B Criteria Scale (SSD-12) in a clinical population.

OBJECTIVE: The SSD-12 is a brief self-report questionnaire to measure the psychological criteria of DSM-5 Somatic Symptom Disorder. This study examines its psychometric properties in a German inpatient sample from a psychosomatic rehabilitation setting, and provides evidence to its sensitivity to change. METHOD: Patients completed the SSD-12 and the Health49-subscale on somatoform complaints before and after receiving inpatient treatment. Therapists evaluated the psychological improvement of their patients at the end of treatment. Effect sizes (ES) and standardized response means (SRM) of pre- and post-SSD-12 mean changes were calculated for subgroups of patients who did or did not improve. RESULTS: SSD-12 scores at discharge were significantly lower compared to scores at admission for subgroups of patients who improved according to clinicians (t=2976, df=103, p=.004), and for patients who improved according to self-report (t=5.059, df=159, p<.001). Effect sizes of change in SSD-12 scores in the improved subgroups were ES=-0.19 and ES=-0.30, and standardized response means were SRM=-0.29 and SRM=-0.40, respectively. CONCLUSION: The SSD-12 shows sound psychometric properties and is useful and time-efficient for monitoring psychological burden associated with bothersome somatic symptoms. Its sensitivity to change over time could be documented.

[The Significance of Work Motivation for Rehabilitation Success]. / Die Bedeutung von Arbeitsmotivation für den Reha-Erfolg.

AIM OF THIS STUDY: Apart from the reduction of symptoms and the restoration of working ability, return to work is a long-term goal of medical rehabilitation. The aim of this study is to analyze the influence of work motivation on the outcome of rehabilitation. METHODS: The data basis consists of N=998 patients at the psychosomatic department of the Oberharz Rehabilitation Center as well as data from insurance accounts. Using multiple linear regression analysis the predictive power of work motivation on rehabilitation outcome as well as different facets of work motivation in their function as predictors are analyzed. RESULTS: Only minor statistical relations could be found between work motivation and rehabilitation success when also taking employment status of the previous year and subjective vocational disability into account. A small predictive power can be attributed to work motivation as a factor in rehabilitation success in the sense of a reduction of symptoms. Particular facets of work motivation are suitable to predict rehabilitation success. Patients with a work motivation risk profile differ from patients with a normal work motivation profile as regards their capacity to work in the year following rehabilitation treatment. CONCLUSION: Work motivation represents a relevant construct in rehabilitation success but is strongly influenced by individual factors. During rehabilitation, individual problems which influence work motivation should be taken into account more strongly.

[Testing the Psychometric Properties of the Helping Alliance Questionnaire (HAQ) in Different Health Care Settings]. / Psychometrische Überprüfung des Helping Alliance Questionnaire (HAQ) in unterschiedlichen Versorgungssettings.

Introduction The Helping Alliance Questionnaire developed by Luborsky was psychometricly examined for the first time and translated into German by Bassler et al. in the mid-1990s. It consists of 11 Items, which are summarized to the scales "relation to the therapist" and "satisfaction with therapeutic outcome". HAQ is now one of the most used instruments to measure therapeutic alliance. The goal of this study was to test the psychometric properties based on three large patient samples in different treatment settings. Material and methods Analyses were conducted based on 2 samples of patients in inpatient psychosomatic/psychotherapeutic rehabilitation (n=655, n=2494) and one sample in outpatient psychotherapy (n=1477). Exploratory factor analyses and for verification confirmatory factor analyses were applied. Furthermore reliability and validity analysis were conducted. Results The 2-factorial structure found in literature was replicated with an increasing stability at the end of treatment. Item 2 and 3 had inconsistent factor loadings at different points of measurement and study. Reliability and validity indices were satisfying to good. The fit of the model, on the other hand, was less satisfying and suggests a solution without Item 2 and 3. For reasons of content as well as for reasons of dissemination, it is pleaded for the maintenance of the existing item assignments in the HAQ for the present.

[Day-care vs. inpatient psychosomatic rehabilitation]. / Ganztägig ambulante- vs. stationäre psychosomatische Rehabilitation.

BACKGROUND AND OBJECTIVE: The present study compares patient characteristics and treatment outcome of 138 patients from a day-care psychosomatic rehabilitation and 540 patients from an inpatient psychosomatic rehabilitation. It was analyzed if patients differ in demographic-, clinical- and socio-medical characteristics, if there are different treatment effects between the 2 types of rehabilitations and if other patient characteristics can predict success of treatment. METHODS: Data was assessed twice (at intake and at discharge of rehabilitation) by self-reported surveys and external assessment of clinical discharge reports. Success of treatment was measured by changes in somatic and mental complaints, psychological well-being, work motivation, subjective forecast of employment, and externally estimated ability to work. RESULTS: RESULTS indicate that day-care patients were higher burdened than inpatients at intake. They showed more complaints, had a higher number of days of incapacity and a higher chance of work difficulties. Furthermore, the prevalence of a migration background was higher. Both kinds of rehabilitation were successful in reducing somatic and mental complaints and in increasing psychological well-being. The "Würzburger Screening", which measures the subjective forecast of employment and occupational stress, turned out to be the best predictor for success of treatment. CONCLUSION: Both day-care- and inpatient rehabilitation were mostly successful, even if day-care patients were more burdened at intake. Therefore day-care rehabilitation can be seen as a good alternative to inpatient rehabilitation.

[Relationship of sick leave before treatment to severity of symptoms and treatment outcome in in-patients with anxiety disorders]. / Zusammenhang der Arbeitsunfähigkeit vor Therapiebeginn mit Störungsgrad und Therapieerfolg bei stationären Angstpatienten.

The aim of this study is to explore whether or not being already on sick leave at admission to a psychosomatic clinic indicates a higher level of severity of symptoms in patients with anxiety disorders, and whether or not this has an impact on therapy outcome. We examined 194 in-patients at 8 psychosomatic clinics upon admission and discharge by interview and psychometric testing. Being on sick leave before admission proved to be an indicator for higher global symptom distress as well as a higher severity of anxiety symptoms. Treatment duration was longer for the sick leave group than for the patients that had not been on sick leave, but each group experienced the same degree of change in pre-and-post treatment symptoms. We conclude that sick leave before admission does give information about illness severity and need of treatment in patients with anxiety disorders.