Efficacy of group therapy to reduce mental distress in women with non-metastatic breast cancer: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: Group treatments have proven to be effective for many mental disorders and showed beneficial effects in patients with medical illness. Aim of this systematic review and meta-analysis is to summarize the efficacy of group therapy for women with non-metastatic breast cancer. METHODS: We included studies comparing group therapy for women with non-metastatic breast cancer to non-active control groups, active control conditions, and individual psychotherapy. The primary outcome was mental distress, secondary outcomes were quality of life, coping, existential outcomes, fatigue, pain, and side effects. A comprehensive search was conducted in Medline, Web of Science, CENTRAL, PsycINFO, and DARE complemented by a manual search. Random-effects meta-analyses were run separately for different types of control groups. RESULTS: Thirty-seven studies (5902 patients) were included. Small effects on mental distress in favor of group treatment were found (non-active control groups: n = 19, g = 0.42, 95% CI [0.29; 0.56], I2  = 61.6%; active control conditions: n = 6, g = 0.20, 95% CI [0.06; 0.35], I2  = 0%). Cognitive-behavioral therapy (CBT) and third wave CBT group approaches proved to be most effective. Group treatments also showed beneficial effects on secondary outcomes, with most profound evidence on quality of life and coping. CONCLUSIONS: Results suggest that group interventions have the potential to reduce mental distress in women facing breast cancer. In the light of the considerable heterogeneity of most study effects, there is a need for more rigorous studies to strengthen the promising evidence and for trials examining the impact of patient and intervention characteristics on outcomes. REGISTRATION: PROSPERO international prospective register of systematic reviews, CRD42020184357.

[Communication with seriously ill patients - more than just breaking bad news]. / Kommunikation mit schwerstkranken Patienten ­ mehr als nur Breaking Bad News.

Communication with seriously ill patients - more than just breaking bad news Abstract. In the context of palliative care, specific communication strategies and techniques are needed to adequately meet the special challenges of the palliative care situation. Successful communication is characterized by criteria of patient-centeredness and can positively influence important parameters of patients, caregivers, and clinicians. These parameters include informed and shared decision making, a trustful relationship with the treatment team, improved knowledge and understanding of prognosis, improved treatment adherence and coping with difficult treatment decisions, and increased patient satisfaction and quality of life of patients and caregivers. Communication skills can be learned and reinforced in communication courses. The COMSKIL training program, which was developed for various professional groups in medical oncology care, defines five central components of a professional conversation (communication goals, communication strategies, communication techniques, process tasks, and cognitive assessments) and addresses basic skills as well as communicative challenges in the context of specific conversation occasions.

[Death Wishes in Patients with Advanced Cancer: An Explorative Analysis of Psychotherapeutic Treatment Transcripts]. / Todeswünsche bei Patientinnen und Patienten mit fortgeschrittener Krebserkrankung: Eine explorative Analyse psychotherapeutischer Gespräche.

Todeswünsche bei Patienten mit einer fortgeschrittenen Krebserkrankung sind bereits seit längerem Gegenstand der psychoonkologischen Forschung. Auch wenn es inzwischen einige Ansätze gibt, die sich mit der Konzeptualisierung und Beschreibung von Todeswünschen befassen, fehlt es bislang an einem in der klinischen Praxis gut anwendbaren Konzept und dazugehörigen Erhebungsinstrumenten. Ziel der Studie ist deshalb die phänomenologische Beschreibung von Todeswünschen bei Patienten mit fortgeschrittenem Krebs. Dafür wurden N=228 transkribierte Psychotherapiegespräche von 76 Patienten im Rahmen der randomisiert-kontrollierten Psychotherapiestudie Managing Cancer and Living Meaningfully (CALM) hinsichtlich des Themas Todeswunsch explorativ analysiert. Von den untersuchten 76 Patienten berichteten 16 (21%) explizit von Todeswünschen. Mithilfe ihrer Beschreibungen konnten zwei Dimensionen identifiziert werden: (1) Gründe für Todeswünsche mit sieben Unterkategorien (Vermeidung von Schmerz und Leid, Kontrolle und Selbstbestimmung erhalten, körperlicher Abbau und Begrenzungen im Alltag, Angst vor Siechtum, Leben nicht mehr lebenswert, Gefühl der Lebensvollendung und alles getan zu haben, fehlende Zukunftsperspektiven) sowie (2) der Grad des mit dem Todeswunsch verbundenen Handlungsdrucks. Die Ergebnisse stimmen mit existierenden Theorien zu Todeswünschen bei Patienten mit einer fortgeschrittenen Krebserkrankung größtenteils überein. Als zusammengehörige Dimensionen des Phänomens Todeswunsch wurden sie jedoch bisher noch nicht beschrieben. Vor allem für die klinische Praxis scheint dies sehr sinnvoll zu sein, da die Gründe in der Therapie größtenteils bearbeitbar sein dürften und der Grad des Handlungsdrucks Aufschluss über die Notwendigkeit einer Intervention geben kann.Death wishes in patients with advanced cancer is a research topic of high interest in psycho-oncologic research. Despite existing concepts describing death wishes, there is a lack of clinically applicable concepts and appropriate instruments. The objective of this study was the phenomenological description of death wishes in patients with advanced cancer. For this purpose, we qualitatively explored N=228 transcribed psychotherapeutic treatment sessions of 76 patients derived from an RCT evaluating the efficacy of Managing Cancer and Living Meaningfully (CALM) psychotherapeutic intervention. Sixteen out of the 76 patients explicitly reported death wishes (21%). Two dimensions were identified: (1) reasons for a death wish with seven subcategories (avoidance of pain and suffering, maintaining control and self-determination, physical deterioration and limitations in everyday life, fear of infirmity, life not longer worth living, feeling of life completion and having done everything, lack of future perspectives) and (2) the degree of pressure to act associated with the death wish. These results are consistent with existing theories regarding death wishes in patients with advanced cancer. However, they have not yet been described as interrelated dimensions of the phenomenon of the death wish.

Psychometric Evaluation of the German Version of the Demoralization Scale-II and the Association Between Demoralization, Sociodemographic, Disease- and Treatment-Related Factors in Patients With Cancer.

Objective: To test the psychometric properties, internal consistency, dimensional structure, and convergent validity of the German version of the Demoralization Scale-II (DS-II), and to examine the association between demoralization, sociodemographic, disease- and treatment-related variables in patients with cancer. Methods: We recruited adult patients with cancer at a Psychosocial Counseling Center and at oncological wards. Participants completed the 16-item DS-II, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Screener-2 (GAD-2), Distress Thermometer (DT), and Body Image Scale (BIS). We analyzed internal consistency of the DS-II using Cronbach's Alpha (α). We tested the dimensional structure of the DS-II with Confirmatory Factor Analyses (CFA). Convergent validity was expressed through correlation coefficients with established measures of psychological distress. The associations between demoralization, sociodemographic, disease- and treatment-related variables were examined with ANOVAs. Results: Out of 942 eligible patients, 620 participated. The average DS-II total score was M = 5.78, SD = 6.34, the Meaning and Purpose subscale M = 2.20, SD = 3.20, and the Distress and Coping Ability subscale M = 3.58, SD = 3.45. Internal consistency ranged from high to excellent with α = 0.93 for the DS-II total scale, α = 0.90 for the Meaning and Purpose subscale, and α = 0.87 for the Distress and Coping Ability subscale. The one-factor and the two-factor model yielded similar model fits, with CFI and TLI ranging between 0.910 and 0.933, SRMR < 0.05. The DS-II correlated significantly with depression (PHQ-9: r = 0.69), anxiety (GAD-2: r = 0.72), mental distress (DT: r = 0.36), and body image disturbance (BIS: r = 0.58). High levels of demoralization were reported by patients aged between 18 and 49 years (M = 7.77, SD = 6.26), patients who were divorced/separated (M = 7.64, SD = 7.29), lung cancer patients (M = 9.29, SD = 8.20), and those receiving no radiotherapy (M = 7.46, SD = 6.60). Conclusion: The DS-II has very good psychometric properties and can be recommended as a reliable tool for assessing demoralization in patients with cancer. The results support the implementation of a screening for demoralization in specific risk groups due to significantly increased demoralization scores.

Norm Values and Psychometric Properties of the 24-Item Demoralization Scale (DS-I) in a Representative Sample of the German General Population.

Purpose: The Demoralization scale (DS-I) is a validated and frequently used instrument to assess existential distress in patients with cancer and other severe medical illness. The purpose of this study was to provide normative values derived from a representative German general population sample and to analyze the correlational structure of the DS-I. Methods: A representative sample of the adult German general population completed the DS-I (24 Items), the Emotion Thermometers (ET) measuring distress, anxiety, depression, anger, need for help, and the Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-fatigue). Results: The sample consists of N = 2,407 adults (mean age = 49.8; range = 18-94 years), 55.7% women). The percentages of participants above the DS-I cutoff (≥30) was 13.5%. The mean scores of the DS-I dimensions were as follows: (1) loss of meaning and purpose: M = 2.78 SD = 4.49; (2) disheartenment: M = 3.19 SD = 4.03; (3) dysphoria M = 4.51 SD = 3.20; (4) sense of failure: M = 6.24 SD = 3.40; and for the DS-I total score: M = 16.72 SD = 12.74. Women reported significantly higher levels of demoralization than men, with effect sizes between d = 0.09 (Loss of Meaning) and d = 0.21 (Dysphoria). Age was not associated with demoralization in our sample. DS-I reliability was excellent (α = 0.94) and DS-I subscales were interrelated (r between 0.31 and 0.87) and significantly correlated with ET, especially depression, anxiety, and need for help and fatigue (r between 0.14 and 0.69). Conclusions: In order to use the DS-I as a screening tool in clinical practice and research the normative values are essential for comparing the symptom burden of groups of patients within the health care system to the general population. Age and sex differences between groups of patients can be accounted for using the presented normative scores of the DS-I.

Efficacy of Hypnosis in Adults Undergoing Surgical Procedures: A meta-analytic update.

In this meta-analysis we updated a review from 2013 investigating the evidence on the efficacy of hypnosis in adults undergoing surgical procedures compared to standard care alone or an attention control. A comprehensive literature search using Medline, CENTRAL, Web of Science, PsycINFO, ProQuest Dissertations and Theses database, and manual searches were conducted to identify randomized controlled trials. In this update, N = 23 eligible studies were added to the existing study pool, resulting in N = 50 studies with 4269 patients. Random effects meta-analyses revealed positive treatment effects on mental distress (g = 0.55, 95% CI [0.39; 0.70], NNT = 3.32), pain (g = 0.37, 95% CI [0.25; 0.50], NNT = 4.78), medication consumption (g = 0.46, 95% CI [0.23; 0.68], NNT = 3.95), recovery (g = 0.26, 95% CI [0.09; 0.42], NNT = 6.91), and surgical procedure time (g = 0.23, 95% CI [0.14; 0.33], NNT = 7.6). No effects were found for physiological parameters (g = 0.13, 95% CI [-0.06; 0.33], NNT = 13.26). 95% prediction intervals included the null effect for all outcomes except for procedure time. In conclusion, although positive effects of hypnosis could be shown, overall generalizability is limited due to high heterogeneity of the study results that could not be explained by characteristics of patients, interventions, or study methods.

The role of attachment avoidance: A longitudinal mediation model predicting existential distress in patients with advanced cancer.

OBJECTIVE: Although a protective effect of reliable interpersonal relationships on existential distress has been established, evidence remains inconclusive for attachment insecurity as an underlying factor of persistent psychological distress. We tested a longitudinal model hypothesizing attachment avoidance as a mediator of high demoralization and anxiety over time. METHODS: We studied 206 patients with advanced cancer (mean age = 59.6, 61% female) participating in an intervention trial. Patients completed self-report measures for demoralization, anxiety, perceived relatedness, attachment insecurity, and death anxiety. Our mediated path model included perceived relatedness and death anxiety at baseline as predictors, attachment avoidance at baseline as mediator, and demoralization and anxiety at 6-month follow-up (N = 125) as outcomes. RESULTS: Attachment avoidance partially mediated the relationship between death anxiety and demoralization (ß = 0.07, 95% CI 0.02-0.12) and anxiety (ß = 0.05, 95% CI 0.001-0.10). Findings for perceived relatedness were less conclusive. Its indirect effects through attachment avoidance were significant for both outcomes (demoralization: ß = -0.07, 95% CI -0.13 to -0.02, anxiety: ß = -0.05, 95% CI -0.11 to -0.003). CONCLUSIONS: Due to its trait-like quality, attachment avoidance may play a less central role in explaining the course of existential distress over time than previous research indicated. Addressing change-sensitive relational concerns in psychosocial interventions may be more effective to alleviate existential distress.

Testing the Treatment Integrity of the Managing Cancer and Living Meaningfully Psychotherapeutic Intervention for Patients With Advanced Cancer.

INTRODUCTION: The Managing Cancer and Living Meaningfully (CALM) therapy for patients with advanced cancer was tested against a supportive psycho-oncological counseling intervention (SPI) in a randomized controlled trial (RCT). We investigated whether CALM was delivered as intended (therapists' adherence); whether CALM therapists with less experience in psycho-oncological care show higher adherence scores; and whether potential overlapping treatment elements between CALM and SPI can be identified (treatment differentiation). METHODS: Two trained and blinded raters assessed on 19 items four subscales of the Treatment Integrity Scale covering treatment domains of CALM (SC: Symptom Management and Communication with Health Care Providers; CSR: Changes in Self and Relationship with Others; SMP: Spiritual Well-being and Sense of Meaning and Purpose; FHM: Preparing for the Future, Sustaining Hope and Facing Mortality). A random sample of 150 audio recordings (75 CALM, 75 SPI) were rated on a three-point Likert scale with 1 = "adherent to some extent," 2 = "adherent to a sufficient extent," 3 = "very adherent." RESULTS: All 19 treatment elements were applied, but in various frequencies. CALM therapists most frequently explored symptoms and/or relationship to health care providers (SC_1: n_applied = 62; 83%) and allowed expression of sadness and anxiety about the progression of disease (FHM_2: n_applied = 62; 83%). The exploration of CALM treatment element SC_1 was most frequently implemented in a satisfactory or excellent manner (n_sufficient or very adherent = 34; 45%), whereas the treatment element SMP_4: Therapist promotes acknowledgment that some life goals may no longer be achievable (n_sufficient or very adherent = 0; 0%) was not implemented in a satisfactory manner. In terms of treatment differentiation, no treatment elements could be identified which were applied significantly more often by CALM therapists than by SPI therapists. CONCLUSION: Results verify the application of CALM treatment domains. However, CALM therapists' adherence scores indicated manual deviations. Furthermore, raters were not able to significantly distinguish CALM from SPI, implying that overlapping treatment elements were delivered to patients.

Efficacy of the Managing Cancer and Living Meaningfully (CALM) individual psychotherapy for patients with advanced cancer: A single-blind randomized controlled trial.

OBJECTIVE: We aimed to determine whether the Managing Cancer and Living Meaningfully (CALM) therapy is superior to a non-manualized supportive psycho-oncological counselling intervention (SPI). METHODS: Adult patients with advanced cancer and ≥9 points on the PHQ-9 and/or ≥5 points on the DT were randomized to CALM or SPI. We hypothesized that CALM patients would report significantly less depression (primary outcome) on the BDI-II and the PHQ-9 6 months after baseline compared to SPI patients. RESULTS: From 329 eligible patients, 206 participated (61.2% female; age: M = 57.9 [SD = 11.7]; 84.5% UICC IV stage). Of them, 99 were assigned to CALM and 107 to SPI. Intention-to-treat analyses revealed significantly less depressive symptoms at 6 months than at baseline (P < .001 for BDI-II and PHQ-9), but participants in the CALM and SPI group did not differ in depression severity (BDI-II: P = .62, PHQ-9: P = .998). Group differences on secondary outcomes were statistically not significant either. CONCLUSIONS: CALM therapy was associated with reduction in depressive symptoms over time but this improvement was not statistically significant different than that obtained within SPI group.

Spiritual well-being mediates the association between attachment insecurity and psychological distress in advanced cancer patients.

PURPOSE: The diagnosis of a terminal disease bears existential challenges, which activate the attachment system. Attachment insecurity, as well as existential resources, such as spiritual well-being, influences patients' extent of psychological distress. Knowledge about the interrelation of these constructs is limited. Based on current research, we assume spiritual well-being to mediate the association of attachment insecurity and psychological distress. METHODS: We obtained data from the baseline measurement of a randomized controlled trial in advanced cancer patients. Patients were sampled from the University Medical Centers of Hamburg and Leipzig, Germany. Main outcome measures included the Patient Health Questionnaire (PHQ-9), the Death and Dying Distress Scale (DADDS), the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp), and the Experience in Close Relationships Scale (ECR-M16) for assessing attachment insecurity. We tested the mediation hypothesis with two regression analyses using bootstrapping procedure. RESULTS: A total of 190 patients were included. Spiritual well-being mediated the association of attachment insecurity and depression (R2 = 11%), as well as death anxiety (R2 = 15%), in fearful-avoidant attached patients. Neither dismissingly nor preoccupied attached patients differ in terms of spiritual well-being and psychological distress in comparison with secure attached patients. CONCLUSION: Spiritual well-being plays a relevant role in advanced cancer patient's mental health through mediating the association of attachment and psychological distress. Developing a better understanding of the interdependency of the constructs of spiritual well-being and attachment can help to develop individually tailored advanced cancer care programs and psychotherapeutic interventions. TRIAL REGISTRATION: NCT02051660.

[Psychosocial Care For Patients With Amyotrophic Lateral Sclerosis: A Narrative Review]. / Psychosoziale Versorgung bei Patienten mit Amyotropher Lateralsklerose: Ein narrativer Review.

This narrative review gives a broad summary of the psychosocial strain in patients with amyotrophic lateral sclerosis (ALS) and psychotherapeutic interventions addressing these issues. ALS is a fatal, rapidly progressing neurodegenerative disease, which leads to weakness and atrophy in almost all muscles of the body, resulting in impairment and finally inability in all domains of daily life including mobility, food intake, respiration or communication. In addition to these mainly motor impairments, most patients are also affected by severe cognitive-emotional and behavioral alterations and deficits which may lead to additional distress. Due to the severe symptomatology and poor diagnosis, ALS can lead to significant psychosocial strain including heightened levels of depressive and anxious symptomatology, hopelessness and even the wish for hastened death. A large body of research demonstrates the strong effect of psychosocial aspects on quality of life (QoL) in ALS patients. Nevertheless, research on psychotherapeutic interventions for patients with ALS is very sparse to date. Besides the general lack of interventions and the methodological limitations in testing their efficacy, few of these therapeutic concepts incorporate the palliative character and the specific symptomatology of the disease such as impaired communication or problems with emotion control. Further research on psychosocial interventions in this patient group is therefore urgently needed. Future research could aim to adapt therapy programs that already have been proven to be effective in other populations with advanced diseases. Such research should also test the applicability of the therapy models using alternative communication including computer with a voice synthesizer or brain-computer-interfaces.

[A group intervention to promote work ability in patients with head and neck cancer]. / Eine Gruppenintervention zur Förderung der Arbeitsfähigkeit für Patienten mit Kopf-Hals-Tumoren.

INTRODUCTION: Despite high distress the majority of head and neck cancer patients does not use any psycho-oncological counselling or psychotherapeutic support. Additionally, patients with head and neck cancer have an increased risk of not returning to work compared to other cancer patients. Therefore, we have developed a group intervention program which aims at improving work ability in patients with head and neck cancer as well as their quality of life, self-efficacy and psychological well-being. MATERIAL AND METHODS: In a randomized controlled trial head and neck cancer patients either receive a group intervention or socio-legal counselling. Male head and neck cancer patients with elevated levels of psychological and work-related distress are included. The group intervention consists of eight sessions. Groups are led by both a psychotherapist and a former head and neck cancer patient (peer). Feasibility and acceptability of the group intervention were tested by means of a pilot group. Each session was evaluated by pilot group participants. Semi-structured interviews were used to assess relevance of content and practicability. RESULTS: 113 patients were personally addressed, of which four patients participated in the pilot group. Patients reported that the intervention fit very well with their daily life and expressed satisfaction with it. Three patients emphasized the importance of the peer. DISCUSSION: The presence of the peer as identification figure seems to be of crucial importance. To increase recruitment numbers inclusion criteria will be modified and participation costs will be reduced.

[Assessment of Couples' Communication in Patients with Advanced Cancer: Validation of a German Version of the Couple Communication Scale (CCS)]. / Die Erfassung der Paarkommunikation bei Patienten mit einer fortgeschrittenen Krebserkrankung: Validierung einer deutschen Version der Couple Communication Scale (CCS).

BACKGROUND: There are only a few valid instruments measuring couples' communication in patients with cancer for German speaking countries. The Couple Communication Scale (CCS) represents an established instrument to assess couples' communication. However, there is no evidence regarding the psychometric properties of the German version of the CCS until now and the assumed one factor structure of the CCS was not verified for patients with advanced cancer yet. METHOD: The CCS was validated as a part of the study "Managing cancer and living meaningfully" (CALM) on N=136 patients with advanced cancer (≥18 years, UICC-state III/IV). The psychometric properties of the scale were calculated (factor reliability, item reliability, average variance extracted [DEV]) and a confirmatory factor analysis was conducted (Maximum Likelihood Estimation). The concurrent validity was tested against symptoms of anxiety (GAD-7), depression (BDI-II) and attachment insecurity (ECR-M16). RESULTS: In the confirmatory factor analysis, the one factor structure showed a low, but acceptable model fit and explained on average 49% of every item's variance (DEV). The CCS has an excellent internal consistency (Cronbachs α=0,91) and was negatively associated with attachment insecurity (ECR-M16: anxiety: r=- 0,55, p<0,01; avoidance: r=- 0,42, p<0,01) as well as with anxiety (GAD-7: r=- 0,20, p<0,05) and depression (BDI-II: r=- 0,27, p<0,01). CONCLUSION: The CCS is a reliable and valid instrument measuring couples' communication in patients with advanced cancer.

Perceived doctor-patient relationship and its association with demoralization in patients with advanced cancer.

BACKGROUND: Advanced diseases pose a great burden on patients and go hand in hand with existential concerns. Demoralization is considered as a syndrome of existential distress with a perceived inability to cope with loss of meaning in life and feelings of helplessness and hopelessness. Professional health care providers play an important role in providing support for patients and unfavorable conversational styles in their relationship can increase patient's distress. In this study, we examine the association between the patient's perceived relationship to health care providers and demoralization. METHODS: We used baseline data of a randomized control trial intervention study for advanced cancer patients (UICC-Stage ≥ III; PHQ ≥ 9 and/or Distress-Thermometer ≥5). We used a subscale of the QUAL-EC-P for assessing doctor-patient relationship, Beck Depression Inventory-II for depressive symptoms, a modified version of the MSAS as physiological symptom checklist, and the Demoralization Scale to assess demoralization. A hierarchical regression analysis was calculated. RESULTS: In our sample of 187 patients with stage III or IV cancer (62% women), demoralization was present in 53.4% (16% moderate demoralization; 37.4% high demoralization) of the patients. Relationship to health care provider was an independent predictor (ß = -.33, t(186) = -6.70, P < .001) of demoralization. CONCLUSIONS: Our findings underline the importance of the physician-patient relationship in the context of coping with existential challenges in advanced cancer patients. Trainings on how to communicate and build a sustainable relationship with patients and their specific needs may increase the buffering effect of social support by the physicians on patient's existential distress.

[Psychooncological Care: A Challenge]. / Psychoonkologische Versorgung: eine Herausforderung.

Cancer patients and their relatives suffer from multiple psychological and social problems associated with the illness itself and its treatment. The major challenge for an excellent psychooncological support is the further development and nationwide implementation of effective, patient-centered, quality assured, and affordable concepts of treatment and care.

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 Anxiety Scale (LSAS) was administered at pre-treatment, post-treatment, and at 6-month and 1-year follow-up. ECR-R scores were first compared to a representative healthy sample (n = 2508) in order to demonstrate that the clinical sample differed significantly from the non-clinical sample with respect to attachment anxiety and avoidance. RESULTS: LSAS scores correlated significantly with both ECR-R subscales. Post-therapy, patients treated with CBT revealed significant changes in attachment anxiety and avoidance whereas patients treated with PDT showed no significant changes. Changes between post-treatment and the two follow-ups were significant in both conditions, with minimal (insignificant) differences between treatments at the 12- month follow-up. CONCLUSIONS: The current study supports recent reviews of mostly naturalistic studies indicating changes in attachment as a result of psychotherapy. Although there were differences between conditions at the end of treatment, these largely disappeared during the follow-up period which is line with the other results of the SOPHO-NET trial. TRIAL REGISTRATION: Controlled-trials.com ISRCTN53517394.

Early detection of psychosis: helpful or stigmatizing experience? A qualitative study.

AIM: Despite the large scientific debate concerning potential stigmatizing effects of identifying an individual as being in an at-risk mental state (ARMS) for psychosis, studies investigating this topic from the subjective perspective of patients are rare. This study assesses whether ARMS individuals experience stigmatization and to what extent being informed about the ARMS is experienced as helpful or harmful. METHODS: Eleven ARMS individuals, currently participating in the follow-up assessments of the prospective Basel Früherkennung von Psychosen (FePsy; English: Early Detection of Psychosis) study, were interviewed in detail using a semistructured qualitative interview developed for this purpose. Data were analysed using Interpretative Phenomenological Analysis. RESULTS: Most individuals experiencing first symptoms reported sensing that there was 'something wrong with them' and felt in need of help. They were relieved that a specific term was assigned to their symptoms. The support received from the early detection centre was generally experienced as helpful. Many patients reported stigmatization and discrimination that appeared to be the result of altered behaviour and social withdrawal due to the prepsychotic symptoms they experienced prior to contact with the early detection clinic. CONCLUSIONS: The results suggest that early detection services help individuals cope with symptoms and potential stigmatization rather than enhancing or causing the latter. More emphasis should be put on the subjective experiences of those concerned when debating the advantages and disadvantages of early detection with regard to stigma. There was no evidence for increased perceived stigma and discrimination as a result of receiving information about the ARMS.

Efficacy of non-pharmacological interventions for procedural pain relief in adults undergoing burn wound care: A systematic review and meta-analysis of randomized controlled trials.

The aim of the present meta-analysis was to investigate the efficacy of non-pharmacological interventions for procedural pain relief in adults undergoing burn wound care compared to standard care alone or an attention control. Through a comprehensive literature search in various electronic databases 21 eligible randomized controlled trials (RCTs) were included, comprising a total of 660 patients. Random effects meta-analyses revealed significant positive treatment effects on pain outcomes, Hedges' g=0.58, 95% CI [0.33; 0.84]. Heterogeneity of study effects was substantial, I2=72%. Effects were significantly larger for comparisons against treatment as usual (TAU), g=0.69, CI 95% [0.40; 0.98] than for comparisons against attention control groups, g=0.21 [-0.11; 0.54], p<0.001. Distraction interventions, particularly those using virtual reality, and hypnosis revealed the largest effects on pain relief. Non-pharmacological interventions further resulted in a significant small, homogeneous effect on anxiety reduction, g=0.36 [0.20; 0.52]. In summary, benefits of non-pharmacological interventions on procedural pain relief and reduction of mental distress were demonstrated. Results have been proven to be free of publication bias. However, further high quality trials are needed to strengthen the promising evidence.

Insecure attachment predicts depression and death anxiety in advanced cancer patients.

ABSTRACTObjective:The prevalence of depression as well as adjustment and anxiety disorders is high in advanced cancer patients, and research exploring intraindividual factors leading to high psychological distress is underrepresented. Cancer patients' feelings about security and trust in their healthcare providers have a significant influence on how they deal with their disease. The perception of social support is affected by patients' attachment styles and influences their reactions to feelings of dependency and loss of control. We therefore aimed to explore attachment and its association with psychological distress in patients with advanced cancer. METHOD: We obtained data from the baseline measurements of a randomized controlled trial in advanced cancer patients. Patients were sampled from the university medical centers of Hamburg and Leipzig, Germany. The main outcome measures included the Patient Health Questionnaire, the Death and Dying Distress Scale, the Memorial Symptom Assessment Scale, and the Experience in Close Relationships Scale for assessing attachment insecurity. RESULTS: A total of 162 patients were included. We found that 64% of patients were insecurely attached (fearful-avoidant 31%, dismissing 17%, and preoccupied 16%). A dismissing attachment style was associated with more physical symptoms but did not predict psychological distress. A fearful-avoidant attachment style significantly predicted higher death anxiety and depression, whereas preoccupied attachment predicted higher death anxiety only. Overall, insecure attachment contributed to the prediction of depression (10%) and death anxiety (14%). SIGNIFICANCE OF RESULTS: The concept of attachment plays a relevant role in advanced cancer patients' mental health. Healthcare providers can benefit from knowledge of advanced cancer patients' attachment styles and how they relate to specific mental distress. Developing a better understanding of patients' reactions to feelings of dependency and distressing emotions can help us to develop individually tailored advanced cancer care programs and psychotherapeutic interventions.

Non-pharmacological interventions for reducing mental distress in patients undergoing dental procedures: Systematic review and meta-analysis.

OBJECTIVES: This meta-analysis investigates the efficacy of non-pharmacological interventions in adults undergoing dental procedures under regional or general anesthesia compared to standard care alone or an attention control group on the reduction of mental distress, pain, and analgesic use. DATA SOURCES: To identify relevant papers a comprehensive literature search was carried out in MEDLINE, CENTRAL, Web of Science, and PsycINFO (last search August 2017). Additionally, lists of references of relevant articles and previous reviews were checked. ProQuest Dissertations and Theses Full Text Database was screened to identify any unpublished material. STUDY SELECTION: A total of 29 eligible randomized controlled trials were included, comprising a total of 2.886 patients. Included trials investigated the effects of hypnosis, enhanced information, relaxation, music, or cognitive-behavioral approaches including distraction. RESULTS: Random effects meta-analyses revealed significant positive treatment effects on the reduction of mental distress (g = 0.58, CI 95% [0.39; 0.76]). Effects on pain relief (g = 0.00, CI 95% [-0.28; 0.28]) and the reduction of analgesic use (g = 0.26, CI 95% [-0.22; 0.73]) were not significant. Because effects on mental distress were substantially heterogeneous, subgroup analyses were run yielding significantly larger effects for studies with low risk of bias compared to studies with high or unclear risk of selection and attrition bias. No significant differences appeared between various types of non-pharmacological interventions. CONCLUSIONS: In summary, benefits of non-pharmacological interventions on reducing mental distress were demonstrated with largest effects being shown for hypnosis. However, further high quality trials are needed to strengthen the promising evidence. CLINICAL SIGNIFICANCE: This systematic review and meta-analysis indicated that non-pharmacological interventions may be beneficial for reducing mental distress in patients undergoing dental procedures and could thus be considered as valuable adjunct to standard care.