Emphatic Memories and Their Meaning in Societal and Legal Contexts: A Narrative Review and Position Paper.

BACKGROUND: Many past and ongoing conflicts in the world are associated with memories. The role of emphatic memories is however often neglected in conflict solving. Therefore, this narrative review gives a short introduction to the phenomenon of emphatic memories and implications for counteracting dysfunctional effects of emphatic memories. SUMMARY: Memory has two connotations. One is remembering and knowing (I can remember when I got married) and on the other is reminding and emphasizing memories (I remind my partner of our wedding day). Memories are less a report on the past but result of current emotions and motives. Emphatic memories serve for self-portrayal and distinction from others, self-exculpation, accusation of others, justification of claims. They are regularly reproachful, have an aggressive character, and are distorted and pseudologic. This is also true on a societal level, as memories are used for defining social groups, and by this for political purposes, in order to juxtapose one group against the other. If memories are revoked, they are regularly accompanied with the very emotions, which were associated with the past event. Corresponding behavior is motivated. Many people suffer from memories and associated emotions and dysfunctional behavior, as is well described in the context of post-traumatic stress disorders. Also, social groups can as a whole suffer from negative emotions because of memories, which may go back up to thousand years. To ensure that memories do not adversely affect individuals and social groups, they should best be forgotten, or at least rescripted, in a way that they are disentangled from negative emotions and motives. An important psychological process in this regard is wisdom and forgiveness, which must not be confused with understanding, justification, tolerating, or reconciliation. Wisdom and forgiveness allow persons to close the books, act self-determined, find freedom from external events, and end suffering because of the past. It is a rational and emotional act. KEY MESSAGES: Emphatic memories can cause that individuals and groups do not find peace and persistently provoke new conflicts. Internal and interactional peace can be found if memories are let alone and fade away. Forgiveness and wisdom describe avenues to let dysfunctional memories go.

[Spectrum of Complex Partial Performance Disorders in Patients with Mental Illnesses]. / Spektrum komplexer Teilleistungsstörungen bei Patienten mit psychischen Erkrankungen.

INTRODUCTION: Recent research highlights a high prevalence of minimal cerebral dysfunctions (MCD) in patients with mental disorders. Nonetheless, empirical understanding of minimal cerebral dysfunctions and diffuse neuropsychological impairments in adult patients remains limited. METHOD: In our study, we examined 399 patients with diverse common mental disorders on minimal cerebral dysfunctions. 329 patients were in psychosomatic rehabilitation, 40 in forensic psychiatry, and 30 in an addiction ward of a psychiatric hospital at the time of the study. Symptom patterns and anamnesis of MCD and sociodemographic characteristics of the patients were recorded using structured questionnaires. RESULTS: Overall, about 29% of all patients reported MCD symptoms. Patients with MCD reported greater problem burden in everyday coping (attention, arithmetic, memory, sensitivity to noise, orientation) and social interaction (outsider, excitability) than patients without partial performance disorders. CONCLUSIONS: Patients with mental illness reported a heterogeneous pattern of minimal cerebral dysfunctions. These frequent disorders should be recognized in diagnostics and treatment. Further studies should investigate therapeutic approaches for MCD according to Baltes' Selective Optimization and Compensation model.

Virtual Reality Mental Health Interventions in Geriatric Care for Functional or Well-being Enhancement - A Scoping Review.

PURPOSE: It has become common to use Virtual Reality (VR) for mental health interventions; however, its use in care of the elederly is limited, especially regarding mood and well-being. In this review, we summarize the results of current VR-based mental health interventions for this population. METHODS: Peer-reviewed journal articles on immersive VR mental health intervention in seniors, published until 2022, were included. RESULTS: There were 2697 results found in the database search, of which 40 articles met the inclusion criteria and were included in the final analysis. Most studies did not use an experimental design with randomized controlled trials and follow-up sessions. Function-oriented and entertainment-oriented intervention studies were categorized. VR-based geriatric mental interventions have grown rapidly since 2018, especially the number of interventions that promote wellbeing. The function-oriented intervention used active interactions with varied devices. Entertainment-oriented interaction was primarily passive, seldomly using hand controllers for moving activities. Generally, VR interventions improved the mental health of older adults. CONCLUSION: Geriatric rehabilitation can benefit from this innovative technology to maintain cognitive functions and to improve the well-being of seniors. They have potential for use in aging care and in retirement homes. Future VR intervention may also involve promoting social interaction to combat loneliness among seniors.

[Participation-oriented psychotherapy for patients with mental disorders who are able or unable to work : Results of a survey of practicing psychotherapists]. / Teilhabeorientierte Psychotherapie bei arbeitsfähigen und arbeitsunfähigen Patienten mit psychischen Erkrankungen : Ergebnisse einer Befragung niedergelassener Psychotherapeuten.

BACKGROUND: Treatment of (chronic) mental disorders must focus on both reducing symptoms and improving social and work participation by social medicine treatments and counselling. The objective of this study was to compare psychotherapy patients who are fit or unfit for work to describe similarities and differences regarding patient status and interventions. METHODS: Interviews were performed with 73 cognitive behavior therapists and 58 psychodynamic psychotherapists about 188 and 134 recent cases they had seen, respectively. The case reports referred to patients who were on average 42 years old (65% females). RESULTS: There were no differences between patients with no or short-term sick leave (up to 6 weeks, n = 156) and patients with longer sick leave (7 weeks or more, n = 140) with respect to basic characteristics of treatment (side effects, therapeutic alliance). Patients with a longer sick leave duration had more severe capacity and participation impairments and received more specific work participation-oriented treatments, whereas general saluto-therapeutic activities (sports-club, counselling, family-support) were similarly undertaken in patients with shorter or longer sick leave. DISCUSSION: Therapists chose intervention options according to indication: in patients with work participation problems, more work-related treatments are undertaken, whereas interventions for general mental health improvement are distributed independent of specific work participation problems.

Effects of talking about side effects versus not talking about side effects on the therapeutic alliance: A controlled clinical trial.

INTRODUCTION: Side effects of psychotherapy are common. Therapists and patients must recognize negative developments to take countermeasure. Therapists can be reluctant to talk about problems of their own treatment. The hypothesis could be that talking about side effects can impair the therapeutic relationship. METHODS: We examined whether a systematic monitoring and discussion of side effects has a negative effect on therapeutic alliance. Intervention group (IG) therapists and patients filled in the UE-PT scale (unwanted events in the view of patient and therapists scale) and discussed their mutual ratings (IG, n = 20). As unwanted events can be independent of therapy, but also be treatment-related side effects, the UE-PT-scale first asks for UE and then for their relation to the ongoing treatment. In the control group (CG, n = 16) treatment was done without any special side effect monitoring. Both groups filled in the Scale for Therapeutic Alliance (STA-R). RESULTS: IG-therapists reported various unwanted events in 100% and patients in 85% of cases: complexity of problems, burdensome or overdemanding therapy, problems with work, and symptom deterioration. Any side effect was reported in 90% by therapists and in 65% by patients. Most frequent side effects were demoralization and worsening of symptoms. IG therapists observed an improvement of global therapeutic alliance in STA-R (M = 3.08 to M = 3.31, p = 0.024, interaction effect in ANOVA with two groups and measurement repetition), and reduced patient fear (M = 1.21 to M = 0.91, p = 0.012). IG patients perceived improvement in bond (M = 3.45 to M = 3.70, p = 0.045). In the CG no comparable changes were seen (alliance M = 2.97 to M = 3.00; patient fear M = 1.20 to M = 1.36; patient-perceived bond M = 3.41 to M = 3.36). CONCLUSION: The initial hypothesis must be rejected. The results suggest that monitoring, and discussion of side effects can even improve the therapeutic alliance. Therapists must not be afraid that this will endanger the therapeutic process. The use of a standardized instrument like the UE-PT-scale seems helpful.

Prevalence and Correlates of Embitterment in a National Representative Sample.

INTRODUCTION: Embitterment may occur after stressful but normal life events, such as job loss, divorce, or unjust events. Embitterment is a normal affect, but it may become clinically relevant in case it becomes very strong and long-lasting, and impairs daily functioning. OBJECTIVE: Until now, no epidemiological data on the frequency of high embitterment in the general population have been available. METHODS: A national representative survey of 2,531 people was carried out in Germany in 2019. The participants gave ratings for their embitterment due to perceived events (Posttraumatic Embitterment Scale), their psychological capacity profile (Mini-ICF-APP-S), sick leave duration, and sociodemographics. RESULTS: About 11.7% of the investigated representative population report moderate embitterment, and another 3.8% high embitterment. Embitterment was only low correlated with other psychopathology, here work anxiety (r = 0.281**). There are no differences between embittered and nonembittered in respect to age, sex, household members, and professional distribution. Those with the highest embitterment have been unemployed more often and have lower income. At least 7.2% of those with high embitterment have a severe psychological capacity impairment and are in need of support by thirds to fulfill daily duties. In 55% of the 802 who reported a stressful event, injustice by an important person has been reported. Injustice by an institution (14%) or societal injustice (12%) was least often reported as a relevant stressful event. CONCLUSION: Physicians, therapists, and public health must be aware of embitterment as a specific mental health problem which occurs frequently and may become chronic with work and life participation problems.

[Similar wisdom strategies for different life problems]. / Ähnliche Weisheitsstrategien für unterschiedliche Lebensprobleme.

OBJECTIVE: Wisdom can be understood as the ability to solve unsolvable problems. Wise persons are better in coping with difficult life situations. Wise strategies help them to do so. The question is whether the same or different wisdom strategies make sense for different life problems. METHODS: A total of 416 persons (40.4 years old) read two situational vignettes, one about a work problem and one about a private problem. After each situational vignette, they were asked about their wisdom strategies regarding the respective situation. Wisdom strategies were measured by means of a self-rating wisdom scale. RESULTS: People agreed similarly with wisdom strategies for both situations. For both situations, participants agreed most strongly to use factual and procedural knowledge, perception and acceptance of emotions, value relativism and relativization of problems and aspirations. The order of the remaining eight wisdom strategies was the same for both situations. DISCUSSION AND CONCLUSION: People agreed similarly with wisdom strategies regardless of the situation type. Wisdom strategies seem to be meaningful across different life problems. This is of interest for the design of interventions to promote psychological resilience.

[Patienten mit komorbiden somatischen und psychischen Erkrankungen haben ähnliche Fähigkeitsbeeinträchtigen wie Patienten mit psychischen Erkrankungen]. / Patients with Somatic and Comorbid Mental Disorders have Similar Psychological Capacity Impairment Profiles like Patients with Mental Disorders.

OBJECTIVES: In patients with somatic illness and additional mental disorder, not only motor or sensory functions may be impaired, but also psychological capacities. These become more and more important for work ability in our modern working world. There are presently no data about the type and distribution of psychological capacity impairments in patients with comorbid somatic and mental disorders. These data are however important for estimation of diagnostic and therapy requirements. METHODS: 402 orthopedic, cardiological, and neurological patients with additional mental disorders were investigated with a structured clinical assessment for mental disorders (MINI) and psychological capacity impairments (Mini-ICF-APP). RESULTS: In all three somatic indications at least half of the comorbid patients had any clinically relevant psychological capacity impairment. Neurological patients (67%) and orthopedic patients (72%) were more often affected than cardiological patients (50.5%). Orthopedic patients are slightly more impaired in self-care; neurological and orthopedic patients are more impaired in mobility; and cardiological patients are less impaired in assertiveness. CONCLUSION: In comparison of all three somatic patient groups with mental disorders the number of psychological capacity impairments is similar. In contrast to patients with mental disorders only (i. e. those without somatic comorbidity), the psychological impairment quality in comorbid patients may be influenced by the somatic illness. The data from this study are important in order to estimate diagnostic and therapeutic needs, such as capacity training or compensation of psychological capacity impairments.

Childbirth fear, birth-related mindset and knowledge in non-pregnant women without birth experience.

BACKGROUND: Childbirth fear and interventions during childbirth might be related to the mindset and knowledge non-pregnant women have regarding childbirth. Non-pregnant women before their first birth experience may be particularly at risk for childbirth fear. METHODS: The present study examined the expressions and associations of birth-related mindset, knowledge, and fear among 316 young, non-pregnant women without birth experience. They participated in a cross-sectional online study and completed the Childbirth Fear Prior to Pregnancy, the Mindset and Birth Questionnaire, and a birth knowledge test. RESULTS: Most women (44%) had a natural mindset and low fear, 29% had a medical mindset and low fear, 8% natural mindset and higher fear, and 19% medical mindset and higher fear. There were no differences in knowledge between the four groups. Some gaps in knowledge appeared concerning signs of beginning birth, and non-medical approaches to pain relief. From women with natural mindset and low childbirth fear, a higher percentage (13%) has already watched a birth, as compared to the other groups. Natural mindset was associated with lower childbirth fear, whereas knowledge was independent from childbirth fear. Higher knowledge was low associated with natural mindset. Mindset and childbirth fear were independent from age and education degree. CONCLUSIONS: Gynecologists, midwifes and other health professionals may develop an awareness for birth as a natural event in their non-pregnant patients, and take birth-related fear into account in their counseling, with focus on women's self-efficacy and non-medical approaches to pain relief.

Students or medical professionals: whose knowledge improved after social-medicine training? Results from a quasi-experimental evaluation study.

PURPOSE: Rehabilitation professionals are faced with judging and describing the social-medicine status of their patients. Rehabilitation professionals must know the core concepts of acute unfitness for work, psychological capacities, and long-term work capacity. Acquiring and applying this knowledge, requires training. The research question is if and to what extent medical professionals and students' knowledge changes after social medicine training. METHODS: This quasi-experimental study was carried out in the real-life context of social medicine training. Psychology students (n = 42), physicians/psychotherapists (i.e. state-licensed health professionals) (n = 44) and medical assistant professionals (n = 29) were trained. Their social medicine knowledge was measured before and after training by a 10-min expert-approved and content valid knowledge questionnaire. Three free-text questions had to be answered on the essential aspects of present and prognostic work ability and psychological capacities. Answers were rated for correctness by two experts. Paired t tests and variance analysis have been calculated for group comparisons. RESULTS: All groups improved their social medicine knowledge from the pre- to the post-test. The students started with the lowest level of knowledge in the pre-test. After training, 69% of the physicians/psychotherapists and 56.8% of the medical assistant professionals, but only 7% of the students, obtained maximum scores for naming psychological capacities. CONCLUSIONS: Social medicine knowledge increased after a training course consisting of eight lessons. The increase was greater for medical assistant professionals and physicians/psychotherapists than for students. Social medicine training must be adjusted to the trainee groups' knowledge levels.

Embitterment as a Specific Mental Health Reaction during the Coronavirus Pandemic.

INTRODUCTION: Embitterment can occur as a reaction to perceived injustice. During the pandemic and restrictions in daily living due to infection risk management, a range of many smaller or severe injustices have occurred. OBJECTIVE: The aim of this study is to investigate what characterizes persons with high embitterment, mental illness, embitterment and mental illness, and those without embitterment or mental health problems. METHODS: We conducted an online survey including persons from the general population in November 2020 and December 2020, the phase during which a second lockdown took place, with closed shops, restaurants, cultural and activity sites. 3,208 participants (mean age 47 years) gave self-ratings on their present well-being, burdens experienced during the pandemic, embitterment, wisdom, and resilience. RESULTS: Embitterment occurred among 16% of the sample, which is a high rate in comparison with 4% during pre-pandemic times. Embitterment was weakly correlated with unspecific mental well-being. There were more persons with embitterment than those with embitterment and a mental health problem. Persons with embitterment reported less coronavirus-related anxiety than persons without embitterment. However, embittered persons reported more social and economic burdens and more frequent experiences of losses (job loss and canceling of medical treatments). Embittered persons perceive their own wisdom competencies on a similar level as persons with mental health problems or persons without mental health problems. CONCLUSION: Embitterment is a specific potentially alone-standing affective state, which is distinguishable from general mental health and coping capacities (here: wisdom). The economic and social consequences of pandemic management should be carefully recognized and prevented by policy.

Induction of false beliefs and false memories in laboratory studies-A systematic review.

Psychological interventions often use guided discovery and other techniques for diagnostic exploration and intervention planning. This way, memories may arise in the person, which may be true or false. False memories of earlier events can be harmful and result in real suffering, similar to actual traumatic memories. Based on cognitive psychological and psycho-traumatological findings, there is pronounced dissent in the academic disciplines regarding the conceptualization, relevance and research of false memories. This review contributes to the basic question of how often false beliefs and false memories may be induced within the frame of different interactional techniques. A systematic review has been conducted of 59 articles from (quasi-)experimental studies and two qualitative sources from 30 data bases. Three main methods of memory induction provide the basis for reporting: imagination inflation, false feedback, and memory implantation. Due to the conceptual and methodological diversity of the studies, the results appear to be heterogeneous. Free and guided imagery, as well as suggestive statements, could induce false beliefs or false memories in, on average, 20%-50% of the participants who underwent experimental manipulation concerning false past events. A false belief induction may occur after dream interpretation or hypnosis in more than 50% of participants. Personalized suggestion is more effective in inducing memory than the general plausibility of the suggested events. Further research questions are which therapeutic actions seem appropriate in cases of harmful false memories. This depends not only on whether there are veridical elements in the false memory but also on the quality and meaning of the memory for the person's life and ability to cope with burdens.

Evaluation of an internet-based intervention for service members of the German armed forces with deployment-related posttraumatic stress symptoms.

BACKGROUND: The present study was designed to evaluate the efficacy of a therapist-guided internet-based cognitive-behavioral therapy (iCBT) intervention for service members of the German Armed Forces with posttraumatic stress disorder (PTSD). The iCBT was adapted from Interapy, a trauma-focused evidence-based treatment based on prolonged exposure and cognitive restructuring. It lasted for 5 weeks and included 10 writing assignments (twice a week). The program included a reminder function if assignments were overdue, but no multimedia elements. Therapeutic written feedback was provided asynchronously within one working day. METHODS: Male active and former military service members were recruited from the German Armed Forces. Diagnoses were assessed with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and the Mini-International Neuropsychiatric Interview. Psychopathology was assessed at pre-treatment, post-treatment, and 3-month follow-up. Severity of PTSD was the primary outcome and anxiety was the secondary outcome. Participants were randomly allocated to a treatment group that received iCBT immediately or to a waitlist group that received iCBT after 6 weeks. Due to the overall small sample size (n = 37), the two groups were collapsed for the statistical analyses. Change during the intervention period was investigated using latent-change score models. RESULTS: Improvements in the CAPS-5 were small and not statistically significant. For anxiety, small significant improvements were observed from pre- to follow-up assessment. The dropout rate was 32.3%. CONCLUSIONS: The low treatment utilization and the high dropout rate are in line with previous findings on treatment of service members. The interpretation of the current null results for the efficacy of iCBT is limited due to the small sample size, however for military samples effect estimates were also smaller in other recent studies. Our results demonstrate the need to identify factors influencing treatment engagement and efficacy in veterans. TRIAL REGISTRATION: Australian Clinical Trials Registry ACTRN12616000956404.

Unwanted Effects within a Cognitive Behavioral Therapy Group in Comparison with a Recreational Group - a Cluster-Randomized Controlled Trial.

BACKGROUND: Group interventions can have negative effects for patients with anxiety disorders. Stimuli which provoke side effects may be the group setting, the content, or the interaction between the participants in the group. This study is the first to report negative effects from a cognitive behavioral group intervention, in comparison with an unspecific, recreational group for anxiety patients. SUBJECTS AND METHODS: 107 patients with work-related anxiety disorders were randomized to either a cognitive behavioral group therapy (work-coping group WG) or an unspecific group encounter aimed at increasing recreational activities (recreational group RG). Patients completed the Unwanted Events in Group Therapy Scale (UE-G scale). RESULTS: In the work-coping group, 41.9% of the patients reported at least one relevant side effect, as compared to 28.9% in the recreational group. These included an increase in the perception of anxiety and work-problems, feelings of exposure to criticism and the development of negative views on group therapy as such. CONCLUSIONS: This is the first randomized, controlled, therapy study in anxiety patients to systematically investigate side effects. Work-coping group interventions have, despite their useful main effects, specific negative effects, when compared with group encounters. Group psychotherapists or group moderators should be aware of the potential side effects in anxiety patients.

[Resilience: A Longitudinal Study of Children with Risk Factors]. / Resilienz: Längsschnittliche Betrachtung von Kindern mit Risikofaktoren.

Resilience: A Longitudinal Study of Children with Risk Factors This study examines the development of children who have grown up with severe early childhood stress. A distinction was made between resilient and maladapted child developments. On the one hand, the aim was to identify longitudinal protective factors that can contribute to the development of resilience. On the other hand, we cross-sectionally examined in which psychological areas resilience manifests itself. The sample consists of 343 children who were examined first in early childhood (M = 4 years) and then ten years later in adolescence. 24 % of the children belonged to the risk group of which 14 % showed a resilient and 9 % a maladapted development. An active temperament, higher intelligence, and more self-control in early childhood proved to be protective factors with medium effect sizes. The proportion of resilience was increased among migrants. Cross-sectionally we found differences with small and medium effect sizes in addictive behavior (alcohol, tobacco and drug use), internet dependency, overweight, and school grades.

Assessment of Capacity Impairment in Patients with Mental Disorders by Routine Clinical Assessment and by Structured Assessment with the Mini-ICF-APP.

BACKGROUND: Physicians and therapists are also consulted to give judgments on working ability. Ability to work cannot simply be derived from the patient's symptom status but from the illness-related capacity impairments in relation to the work demands. A structured assessment of capacity impairments has been evaluated and applied internationally: the Mini-ICF-APP Social Functioning Scale. It is currently unclear whether a free-text clinical report (i.e., usual clinical practice: clinical exploration according to clinical standards, but without a standardized documentation form, instead a text is written) and a structured capacity assessment correspond to the overall work ability judgment, i.e., the decision whether a patient is "fit for work" or "unfit for work." OBJECTIVES: This investigation assessed, for the first time, whether usual clinical judgment and the additional structured capacity rating support the work ability decision. METHODS: A total of 100 medical reports from patients in a psychotherapy hospital were excerpted for psychopathological symptoms and capacity disorders using a checklist. Additionally, a structured assessment of capacity disorders was documented on the Mini-ICF-APP rating for all patients. RESULTS: In the free-text clinical medical report, endurance, flexibility, and contacts to others were the things mainly reported as impaired. This was similar to the structured Mini-ICF-APP rating. However, other capacity impairments were also reported in the Mini-ICF-APP, i.e., adherence to rules and regulations, planning and structuring, assertiveness, and group integration. When the free-text clinical report and the structured Mini-ICF-APP rating were compared, there was a higher rate of stated impairments covering all capacity dimensions in the Mini-ICF-APP rating. CONCLUSIONS: The free-text report in the medical report shows the differences between patients who are fit for work and those who are not, and thus speak for the validity of work ability decisions. However, optimization is possible in terms of depth and differentiation of capacity impairment description by adhering to the standard set by the Mini-ICF-APP.

[Indication for Inpatient Psychosomatic Rehabilitation in Primary Care Patients with Chronic Mental Disorders and Participation Impairments]. / Indikation zur stationären medizinischen Rehabilitation bei Hausarztpatienten mit chronischen psychischen Erkrankungen und Teilhabebeeinträchtigungen.

BACKGROUND: Mental disorders often result in social and occupational participation restrictions, which may be an indication for an inpatient psychosomatic rehabilitation treatment. These patients are usually treated by general practitioners, who function as an important gate keeper in the pathway to rehabilitation treatment. The question is which patients receive an inpatient treatment, and which do not. METHOD: A prototypically representative sample of 307 patients with chronic mental disorders from 40 general practitioners were examined by a psychosomatic consultant. The investigation included the medical history, treatment status, illness status, capacity status and participation impairment. The psychosomatic consultant gave a recommendation whether an inpatient rehabilitation was indicated or not. RESULTS: 64% of the patients with chronic mental disorder had not received an inpatient rehabilitation in the past 5 years and there was no present indication. In 5.2% of cases an inpatient rehabilitation had been done before, but there was no indication for a renewal. In 27% there was no rehabilitation in the past five years but now seen indicated. In 3.6% there was an inpatient rehabilitation in the past and a renewed indication now. Patients who had already been in inpatient rehabilitation in the past 5 years were more severely ill and had more severe participation problems. Patients with present indication for rehabilitation had acute work-related problems. Capacity and participation impairment was an important factor to discriminate between patients with and without a present indication for an inpatient rehabilitation. In 13 out of 35 patients who got a recommendation for a new psychosomatic rehabilitation, this rehabilitation was initiated within 6 months after the consult. CONCLUSION: General practitioners play a central role in long-term treatment of mental disorders. Rehabilitation orientation, i. e. a participation-oriented treatment perspective, should be encouraged in the primary care setting.

Prevalence and Characteristics of Work Anxiety in Medical Rehabilitation Patients: A Cross-Sectional Observation Study.

OBJECTIVE: To investigate frequency, type, and characteristics of work anxieties in patients with somatic illness. DESIGN: Cross-sectional observation study. SETTING: Neurology, orthopedic, and cardiology rehabilitation clinics. PARTICIPANTS: Patients (N=1610; age, 18-65y) with work anxieties. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Patients who scored high on at least 2 of 9 items in the work-anxiety screening questionnaire and who reported impairment were investigated with a differential diagnostic interview on work anxieties and with the Mini-International Neuropsychiatric Interview on non-work-related common mental disorders. Patients also filled out a self-rating questionnaire on their subjective symptom load and sociodemographic data. RESULTS: Approximately 20% to 27% of the investigated inpatients in somatic rehabilitation (altogether n=393) received a work-anxiety diagnosis. Patients with orthopedic illness report highest work anxiety and have previous longest sick leave (20.6wk in the past 12mo). Patients with orthopedic illness suffer from work-related adjustment disorder with anxiety, social anxieties, and workplace phobias, whereas patients with cardiac illness are more often affected by hypochondriac anxieties. Anxieties of insufficiency and worrying occur equally in all indications. CONCLUSIONS: About a quarter of patients in somatic rehabilitation are in need of additional diagnostic attention owing to work anxieties. Differential diagnostic of work anxiety is needed for initiating adequate therapeutic action. Somatic rehabilitation physicians should be aware of work anxieties in their patients, especially in patients with orthopedic illness with previous long-term sick leave.

[Towards a Rehabilitation- and Participation-Oriented Psychotherapy]. / Perspektiven einer Teilhabeorientierten Psychotherapie in Anlehnung an Empfehlungen der Deutschen Gesellschaft für Rehabilitationswissenschaften (DGRW).

Mental disorders (such as recurrent mood disorders, personality disorders, or psychotic disorders) come along with enduring impairment in daily life activities. Therefore psychotherapeutic actions in inpatient or outpatient settings require a life-span and participation-oriented treatment perspective. Participation-oriented treatment aims at social and vocational integration in general life despite enduringly recurring or resting symptoms. According to the model of health problems offered by the International Classification of Functioning, Disability and Health, ICF (WHO, 2001), disability can be defined as context-dependent activity impairment due to illness. Disability is not the person̓s illness itself, but depends on the interaction of health status and contextual conditions. This context-dependent impairment shall be overcome with the help of treatment. In psychotherapy, the perspective of participation over the life-span has always been of great importance. However, it has until now hardly been mentioned explicitly.For practical handling of the ICF philosophy, its bio-psycho-social model of health problem-description is useful. Psychotherapists should gain knowledge on medical, vocational, and social rehabilitation treatment aims, institutions and the health care system. Psychotherapists may serve, similar to family physicians, as a case manager of illness processes. They do not only aim reducing mental illness symptoms, but focus on life-span management of the mental disorder. The aim is mainly to improve patients̓ daily life participation.