[Psychotherapy motivation--factor analysis and validity of a modified version of the Psychotherapy Motivation Questionnaire (FPTM)]. / Faktorenstruktur und Validität einer veränderten Version des Fragebogens zur Messung von Psychotherapiemotivation (FPTM) im Vorfeld der psychotherapeutischen Behandlung.

Motivation for psychotherapy is seen as a major factor for the success of psychotherapy. Examination of this motivation process requires procedures which recognize motivation for psychotherapy prior to initiation of therapy. Therefore, we reformulated the Psychotherapy Motivation Questionnaire (FPTM). N = 383 patients were given the questionnaire before their first consultation in outpatient psychosomatic treatment. The factorial and criteria validity were tested. The factorial structure of the altered questionnaire is identical to the original version. Confirmative factor analysis affirms "initiative" and "knowledge" as two separate factors. Patients with somatoform disorders and "unexplained physical symptoms" as the reason for referral show less motivation than other patients. Patients with previous experience with psychotherapy show higher motivation. The Psychotherapy Motivation Questionnaire can be used in its adapted version before patients start psychotherapy. The increase in motivation depends on the disorder and the treatment phase. Information and the reason for referral are important variables in motivation.

Short-term psychotherapeutic interventions for somatizing patients in the general hospital: a randomized controlled study.

BACKGROUND: Treatment acceptance and motivation for psychotherapy of somatizing patients in the general hospital is low. METHODS: Patients (n = 91) fulfilling the criteria for somatization were randomized into an intervention group (n = 49) and a control group (n = 42). The patients in the intervention group attended 5 psychotherapeutic sessions based on the modified reattribution model. The patients in the control group received psychoeducational reading material. The primary outcomes were motivation for psychotherapy and contacting a psychotherapist after discharge. The secondary outcomes consisted of changes regarding somatoform symptoms, emotional distress and quality of life. RESULTS: Patients from the intervention group were significantly more motivated for psychotherapy (p = 0.001) than patients from the control group. At the 3-month follow-up, 42% of the patients from the intervention group had contacted a psychotherapist, compared to 20% of the patients from the control group (p = 0.045). At the 6-month follow-up, however, the ratio of patients having contacted a psychotherapist had changed to 44 and 29%, respectively, and was no longer significant. The intensity of somatoform symptoms and the anxiety symptoms decreased and mental functioning improved significantly over time for patients from both groups. CONCLUSIONS: Short-term psychotherapeutic interventions for somatizing patients in general hospitals have a moderately better effect on motivation for psychotherapy and contacting a psychotherapist than psychoeducational reading material alone. Future studies should attempt to prove the effectiveness of short-term psychoeducational interventions for somatizing patients in the general hospital.

Depressive coping is a predictor for emotional distress and poor quality of life in a German-Austrian sample of cardioverter-defibrillator implant recipients at 3 months and 1 year after implantation.

OBJECTIVE: The implantable cardioverter defibrillator (ICD) has been proven to prolong the lives of patients with life-threatening ventricular arrhythmia. However, implant recipients must cope with numerous challenges. We studied the effects of specific coping strategies and the adaptability of coping in ICD implant recipients. METHOD: This prospective study investigated the subjective well-being and objective disease course in 180 patients with life-threatening cardiac arrhythmias, who were recruited while awaiting implantation of a cardioverter defibrillator. Patients completed well-validated self-assessment questionnaires before implantation (T0), as well as 3 months (T1) and 1 year (T2) after implantation. In addition, cardiological findings were documented. RESULTS: Depressive coping (range Beta, -0.36 to -0.58) was found to be a stable highly-significant predictor for low emotional well-being and quality of life. Active problem-oriented coping showed small positive influence (range Beta, 0.10 to 0.19). Employing a broad range of coping strategies was predictive of less emotional distress and better quality of life. CONCLUSIONS: Depressive coping is a risk factor for emotional distress and poor quality of life after ICD implantation. Patients with this tendency should be identified early and offered supportive psychotherapy.

[Effectiveness of psychosocial interventions for emotional disorders by general practitioners. A systematic review]. / Was bewirken hausärztliche Interventionen bei Patienten mit psychischen Störungen? Eine systematische Literaturübersicht.

OBJECTIVES: The introduction of psychosomatic primary care provides for the first time the possibility for general practitioners to treat emotional and psychosomatic disorders and problems which in the past were often not recognized. METHODS: Using computer-based searches in data bases and journals we surveyed controlled studies in which general practitioners performed psychosocial interventions. The studies were assessed according to standardized procedures for systematic reviews. RESULTS: A total of 9 studies were found which took place between 1966 and 2003. The clinical effects attained were usually limited and of short duration. Studies with specific therapeutic approaches in specific disorders showed the best results. CONCLUSIONS: Psychosocial interventions by the general practitioner are effective, but there is need for improvement. Further conceptual development of structured psychosocial interventions which can be applied in the general practice for the most common emotional disorders is necessary. Considering the large number of patients with emotional disorders in primary care, these efforts will undoubtedly be worthwhile.

[Effects of psychotherapeutic interventions on length of stay in cardiology inpatients]. / Der Einfluss eines psychosomatischen Liaisondienstes auf die stationäre Verweildauer von Patienten in der Kardiologie.

OBJECTIVES: Mental comorbidities as recorded in the DRG system by the Patient Comorbidity and Complication Level (PCCL) cause extended length of stay in cardiology with resultant higher costs. Studies analyzing the influence of a psychiatric consultation and liaison service on the length of stay and the costs incurred thereby have generated inconsistent results. The present prospective study examines the effects of the psychotherapeutic liaison service on the length of stay. METHODS: In the course of 6 months, two cardiology wards were alternately provided traditional psychotherapeutic consultation and psychotherapeutic liaison service based on a Cross-Over-Design (A-B-A). Inclusion criteria for patients was the presence of one of the four most common cardiological diagnoses (ischemic heart diseases, heart valve defects, cardiomyopathies, arrhythmias). After the exclusion of patients with a length of less than five days, the random sampling comprised n = 317 patients. RESULTS: The study showed no direct correlation between the intensified care system of the liaison service and a reduction in the length of stay. The results obtained remained consistent even after controlling for age, sex, and case complexity. Recommendations for further investigations are discussed.

Psychosocial interventions for somatizing patients by the general practitioner: a randomized controlled trial.

OBJECTIVE: The objective of this study was to compare the effects of psychosocial interventions based on the modified reattribution model for somatizing patients in general practice (GP) with those of nonspecific psychosocial primary care (PPC) alone. METHODS: Forty-two GPs were randomized, 23 into the intervention group (IG), who were trained in reattribution techniques, and 19 into the control group (CG). One hundred twenty-seven patients were included. Primary outcome measures were somatoform symptoms and quality of life. RESULTS: Multilevel modeling revealed a reduction of physical symptoms (P = .007), an improvement in physical functioning (P = .0172), and a reduction of depression (P = .0211) and anxiety (P = .0388) in the IG compared with the CG at the 3-month follow-up. However, results no longer remained significant after controlling for baseline and covariate variables besides a reduction of physical symptoms at 6-month follow-up (P = .029). CONCLUSION: Compared with nonspecific PPC, the effects of reattribution techniques were small and limited to physical symptoms.

Differentiation of somatizing patients in primary care: why the effects of treatment are always moderate.

The heterogeneity of somatizing patients influences outcomes, especially in unselected samples in primary care. A cluster analysis was performed as secondary analysis on an existing data set of 127 somatizing patients included in a randomized controlled clinical trial. Anxiety and depression (HADS), number and intensity of physical symptoms (SOMS), physical and emotional functioning (short form of the SF-36 Health Survey), health beliefs (KKU-G), and psychological distress (General Health Questionnaire) were used for clustering. Outcome, treatment satisfaction, and diagnosis were calculated and compared for the clusters. We differentiated three groups from this analysis: one with elevated emotional and physical stress, one in which emotional stress dominated, and one with low emotional and physical stress. The three groups did not differ in diagnoses of somatoform disorders. The high-stress groups improved over time, whereas the depression and emotional-functioning scores in the low-stress group deteriorated. All patients were satisfied with the treatment provided. Deterioration in the scores of the low-stress group may be a result of a clinically valuable change process, in that patients who were initially in denial were able to open up and admit their problems. The increased satisfaction with treatment supports this interpretation. This so-called response shift must be taken into account in the planning of studies.

[Utilization of psychotherapy depending on treatment motivation during the diagnostic stage assessed in an outpatient clinic]. / Inanspruchnahme von Psychotherapie in Abhängigkeit von der Psychotherapiemotivation während der Indikationsstellung in einer Klinikambulanz.

OBJECTIVES: So far treatment motivation of patients who have not yet started psychotherapy has been widely neglected. The present study investigates treatment motivation in an outpatient clinic of a university hospital. METHOD: Treatment motivation (FPTM) and emotional distress (SCL-90-R) were assessed before and three weeks after the diagnostic interview. A six months follow-up focussed the utilisation of psychotherapy. 155 patients were included in the study. RESULTS: Patients who suffer from emotional distress before the interview were more likely to seek professional help. Three weeks after the interview hope, sufferance and initiative were related to seeking behaviour and taking up psychotherapy. The relationship between treatment motivation and health care seeking behaviour was not influenced by age, sex and symptom severity. CONCLUSIONS: Treatment motivation plays a decisive role in the utilisation of psychotherapy. Patient motivation for psychotherapy has to be strengthened in the decision making stage. Hope for amelioration is a crucial factor in the process of health care seeking behaviour.