The impact of the COVID-19 pandemic restrictions on the health care utilization of cancer patients.

BACKGROUND: COVID-19 has impacted both society and medical care. While Germany entered the first lockdown in spring 2020, the PIKKO study (Patient information, communication and competence empowerment in oncology) was still active. The intervention modules, patient navigator (PN), services of the Saarland Cancer Society (SCS), psycho-social counseling and different courses, and online knowledge database (ODB) continued to be offered, but in an adapted form. It was the aim of this supplementary survey to identify the restrictions and burdens of the pandemic containment strategies on the PIKKO patients and thus on the PIKKO study itself. Furthermore, this work shows how the PIKKO modules were used during the lockdown. METHODS: All patients in the PIKKO intervention group (IG) were invited to complete a questionnaire, n = 503. Furthermore, utilization of the SCS and log files of the ODB were analyzed. For socio-demographic data and contacts with the PN, data from the regular PIKKO surveys were used. In addition to descriptive statistics, chi²-tests, F-tests and linear regression analyses were performed. RESULTS: 356 patients participated in this supplemental survey. 37.6% reported restrictions. "Restrictions on accompanying persons", "ban on visits to the wards" and "protective mouth-nose-mask" were reported as the greatest burdens. 39.0% expressed fears that the restrictions would have an impact on the course of their disease. Linear regression analyses showed differences in feelings of burden among age groups (more among < 60-year-olds), gender (more among women), children in the household (more with children), and preexisting financial stress (more with financial worries). In April 2020, there was more patient contact with PNs by phone, more SCS psycho-social counseling by phone, adapted SCS course offering, but with significantly fewer participants, and high activity on the ODB. CONCLUSION: Cancer patients in the IG reported restrictions from the pandemic containment strategies and feared an impact on their recovery. However, whether a burden is perceived as heavy depends more on gender, age, or pre-existing burdens than on whether the lockdown affects PIKKO or not. The utilization of counseling, courses or the ODB despite lockdown shows the need for such services, especially in times of crisis. TRIAL REGISTRATION: This study was retrospectively registered in the German Clinical Trial Register under DRKS00016703 (21 Feb 2019, retrospectively registered). https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016703 .

Patient information, communication and competence empowerment in oncology: Results and learnings from the PIKKO study.

PURPOSE: Many concepts for accompanying and supporting cancer patients exist and have been studied over time. One of them was PIKKO (a German acronym for "Patient information, communication and competence empowerment in oncology"), which combined a patient navigator, socio-legal and psychological counseling (with psychooncologists), courses dealing with various supportive aspects, and a knowledge database with validated and easy-to-understand disease-related information. The aim was to increase the patients' health-related quality of life (HRQoL), self-efficacy as well as health literacy and to reduce psychological complaints such as depression and anxiety. METHODS: To this purpose, an intervention group was given full access to the modules in addition to treatment as usual, while a control group received only treatment as usual. Over twelve months, each group was surveyed up to five times. Measurements were taken using the SF12, PHQ-9, GAD, GSE, and HLS-EU-Q47. RESULTS: No significant differences were found in scores on the mentioned metrics. However, each module was used many times and rated positively by the patients. Further analyses showed a tendency higher score in health literacy with higher intensity of use of the database and higher score in mental HRQoL with higher intensity of use of counseling. CONCLUSION: The study was affected by several limitations. A lack of randomization, difficulties in recruiting the control group, a heterogeneous sample, and the COVID-19 lockdown influenced the results. Nevertheless, the results show that the PIKKO support was appreciated by the patients and the lack of measurable effects was rather due to the mentioned limitations than to the PIKKO intervention. TRIAL REGISTRATION: This study was retrospectively registered in the German Clinical Trial Register under DRKS00016703 (21.02.2019, retrospectively registered). https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016703.

[Psychometric Properties of the Qualiskope-A for Measuring Patient Satisfaction with Outpatient Medical Treatment: Use in Oncology and Transferability to Inpatient Care]. / Psychometrische Eigenschaften des Qualiskope-A zur Messung der Patientenzufriedenheit mit der ambulant-ärztlichen Behandlung: Einsatz in der Onkologie und Übertragbarkeit auf die stationäre Versorgung.

AIM: The Qualiskope-A is a German-language PREM (Patient Reported Experience Measure) which, with the help of 27 items allocated to four scales, enables measurement of patient satisfaction with outpatient medical treatment along four dimensions of patient satisfaction. This study examined whether the questionnaire delivers reliable results in an oncological population and whether its application can be extended to inpatient care. METHOD: Required data was collected as part of the PIKKO study. Initially, descriptive statistics and internal consistency (Cronbach's alpha) of the PREM's scales were analyzed. In addition, a sub-sample that assessed the same doctor at two consecutive measurement time points was observed with regard to test-retest reliability (Spearman correlation (rs) between both measurement time points). The measurement model of the Qualiskope-A was then examined using confirmatory factor analysis. To test the transferability to inpatient care, measurement invariance with regard to outpatients and inpatients was computed. RESULTS: A total of 476 patients was included in the study. Every score of the Qualiskope-A showed a left-skewed distribution in the sample and revealed pronounced ceiling effects. Cronbach's alpha coefficients were consistently>0,8. Within the test-retest group (n=197), a strong correlation (rs>0,5) was observed between the measurement time points. The fit indices calculated using confirmatory factor analysis showed a good model fit (CFI=0,958; RMSEA=0,026; SRMR=0,040; every factor loadings>0,6). The fit indices, calculated as part of the investigation of measurement invariance, consistently met the defined threshold values. CONCLUSION: The Qualiscope-A shows good reliability in the examined oncological sample. It can be used in both outpatient and inpatient settings (no indications of non-invariance were found). Due to pronounced ceiling effects, however, the item scaling should be revised.

[Measurement Invariance and Validity of the Short Form of the Bielefeld Partnership Expectations Questionnaire (BPEQ12)]. / Messinvarianz und Validität der Kurzform des Bielefelder Fragebogens zu Partnerschaftserwartungen (BFPE12).

The short form of the Bielefeld Partnership Expectations Questionnaire (BPEQ12) measures three partner-related attachment scales: fear of rejection, readiness for self-disclosure and conscious need for care. In addition to factor structure and reliability, the present study examined measurement invariance and validity using a non-clinical and a clinical sample of college students (N=208). Besides the BFPE12, the following Questionnaires were assessed: Short Form of Experiences in Close Relationships - Revised (ECR-RD8), Outcome Questionnaire (OQ-30), revised Beck Depression Inventory (BDI-II), Social Phobia Inventory (SPIN), and Test Anxiety Inventory (TAI-G). The factor structure is tested using confirmatory factor analysis (CFA), the internal consistency of the scales is quantified using McDonald's ω, the measurement invariance is investigated with two-group structural equation models, and the validity is examined using correlation and regression analyses. In both samples, the factor structure was confirmed (CFI>0.93; TLI>0.93; RMSEA<0.08; SRMR<0.08) and the reliability of all three scales was acceptable (ω>.7) - with the exception of need for care in the non-clinical group. We found configurational, metric and scalar measurement invariance regarding to the assignment in the clinical and non-clinical sample. In terms of convergent validity, fear of rejection and conscious need for care were associated with attachment-related anxiety (r=0.771 and r=0.539, p<0.001) and low readiness for self-disclosure was correlated with attachment-related avoidance (measured with ECR-RD8, r=- 0.704, p<0.001). Overall, the present study supports the factor structure, measurement invariance, reliability, and validity of the BPEQ12 in clinical and non-clinical samples.

Continual rehabilitation motivation of patients with postparalytic facial nerve syndrome.

PURPOSE: To evaluate the continued rehabilitation motivation in patients with postparalytic facial synkinesis (PFS). METHODS: In this single-center cross-sectional survey, the multidimensional patient questionnaire for assessment of rehabilitation motivation (PAREMO-20) was used to assess the rehabilitation motivation. Associations Sunnybrook and Stennert index grading, Facial Clinimetric Evaluation (FaCE) survey, general quality of life (SF-36), Liebowitz Social Anxiety Scale (LSAS), Patient Health Questionnaire (PHQ)-9, technology commitment and affinity, and interest in further therapy were analyzed. RESULTS: 69 adults with PFS (73% women; median age: 54 years) answered the survey. In comparison to prior treatment forms, there was a significant higher future interest in computer-based home facial training (p < 0.0001). For PAREMO Psychological burden subscore, SF36 Emotional role was the highest negative correlative factor (p < 0.0001). For PAREMO Physical burden subscore, SF-36 General health was the highest negative correlative factor (p = 0.018). Working (p = 0.033) and permanent relationship (p = 0.029) were the only independent factors correlated to PAREMO Social Support Subscore. Higher positive impacts of technology affinity was inversely correlated to PAREMO Knowledge subscore (p = 0.017). Lower SF-36 Role physical subscore p = 0.045) and a lower SF-36 General health (p = 0.013) were correlated to a higher PAREMO Skepticism subscore. CONCLUSIONS: Patients with PFS seem to have a high facial motor and non-motor psychosocial impairment even after several facial therapies. Rehabilitation-related motivation increases with both, higher facial motor and non-motor dysfunction. Social and emotional dysfunction are drivers to be interested in innovative digital therapy forms.

[A Short Version of the Body Experience Questionnaire (FBeK): Results of Clinical and Non-Clinical Samples]. / Eine Kurzversion des Fragebogens zur Beurteilung des eigenen Körpers (FBeK): Ergebnisse aus klinischen und bevölkerungsrepräsentativen Stichproben.

OBJECTIVES: The aim of this study was the development and evaluation of a short (9-item) version of the body experience questionnaire (FBeK-9). METHOD: Based upon a representative survey from 1996, a 15-item version of the FBeK was constructed which was then evaluated in another representative sample (n=2510) as well as three clinical groups, namely patients with depressive disorders (n=106), patients with eating disorders (N=107), and patients suffering from pain (N=90). Depressive and anxiety symptoms and pain disability (PHQ-9, PHQ-4, PDI) were also assessed. Item selection and the determination of the factor structure were performed using exploratory and confirmatory factor analysis and led to the development of the FBeK-9. The final three subscales were tested for invariance related to sex, age and disorder. In addition, convergent validity was assessed and norms were provided. RESULTS: Models of confirmatory factor analyses revealed acceptable fit indices ((CFI) =0.982,(ω ) =0.020) in all samples. The subscales "uncertainty/impaired sensation","attractiveness/self-confidence" and "accentuation of the body/sensitivity" indicated acceptable reliability (ω=0.707) and correlated with depressive and anxiety symptoms and pain in an expected manner. We also could show differences between the normative sample and the clinical groups. Measurement invariance was shown for age and sex. CONCLUSIONS: It can be concluded that the 9-item version of the body experience questionnaire also provides a reliable, valid and economically efficient measure that can be used in studies of body experience in non-clinical and clinical samples. In the future, more validity studies should be performed.

[Convergence of Scales to Measure Social Anxiety: An IRT Linking Approach]. / Konvergenz von Skalen zur Erfassung sozialer Ängste: Ein IRT-Linking Ansatz.

OBJECTIVE: The Liebowitz Social Anxiety Scale (LSAS) and the Social Phobia Inventory (SPIN) are established measures in the investigation of social anxiety. Furthermore, the subscale Interpersonal Sensitivity of the Brief Symptom Inventory (BSI-53) is frequently used to screen social anxiety. All three scales claim to capture the same construct, which raises the question of the convergence of these scales. To make research findings comparable by a cross-questionnaire factor (common factor), an item response theory (IRT) linking approach is used in the present study. METHODS: 64 German-speaking psychiatric patients and 295 healthy subjects completed the three questionnaires. Different IRT models, including Graded Response Models (GRM), were constructed, and their model fit compared. Regression analyses were performed based on the best-fit model. The common factor was predicted from the questionnaire total values. RESULTS: The relationship between the different scales was best explained by a bifactor GRM with one common factor and three domain-specific factors (RMSEA=0.036, CFI=0.977, WRMR=1.061). Based on the results of the regression analyses, three equations were derived for the transformation of questionnaire's total values. CONCLUSION: The IRT linking approach allows the derivation of a general factor of social anxiety, taking into account commonalities and differences between the instruments used. This has advantages for both research and practice. A replication of this study as well as the implementation of further instruments are recommended to verify the validity of this approach and to generalize the results.

Is there an elephant in the room? A study of convergences and divergences of adult attachment measures commonly used in clinical studies.

Objective: In view of the persisting conceptual confusion related to the convergence of attachment measures, we investigated several common measures within a clinical and a non-clinical sample, tested the convergence/divergence of different measures, and tried to find a dimensional model. Method: 175 patients with panic disorder/agoraphobia and 143 matched non-clinical individuals completed seven self-report attachment measures/ clinical self-reports and were interviewed by applying the Adult Attachment Interview (AAI), the Adult Attachment Rating (AAR) and the Adult Attachment Projective (AAP). Results: The categorical and most dimensional attachment measures differentiated between the samples. The convergence of the categorical measures was low, whereas we found moderate to high correlations between similar scales in the dimensional self-report measures. Expectedly, the convergence of dimensional and categorical attachment measures was low. In a factorial (exploratory as well as confirmatory) model, four independent dimensions were extracted reflecting self-rated attachment anxiety and avoidance, the categories of the AAI and those of the AAP, indicating significant differences between the measures. Discussion: Measures of adult attachment are only partially convergent, underlining the need for clarification of which aspect of attachment is actually being assessed in individual clinical investigations. The question remains whether the different measures are in fact related to one construct.

Cross-Correlation- and Entropy-Based Measures of Movement Synchrony: Non-Convergence of Measures Leads to Different Associations with Depressive Symptoms.

BACKGROUND: Several algorithms have been proposed to quantify synchronization. However, little is known about their convergent and predictive validity. METHODS: The sample included 30 persons who completed a manualized interview focusing on psychosomatic symptoms. The intensity of body motions was measured using motion-energy analysis. We computed several measures of movement synchrony based on the time series of the interviewer and participant: mutual information, windowed cross-recurrence analysis, cross-correlation, rMEA, SUSY, SUCO, WCLC-PP and WCLR-PP. Depressive symptoms were assessed with the Patient Health Questionnaire (PHQ9). RESULTS: According to the explorative factor analyses, all the variants of cross-correlation and all the measures of SUSY, SUCO and rMEA-WCC led to similar synchrony measures and could be assigned to the same factor. All the mutual-information measures, rMEA-WCLC, WCLC-PP-F, WCLC-PP-R2, WCLR-PP-F, and WinCRQA-DET loaded on the second factor. Depressive symptoms correlated negatively with WCLC-PP-F and WCLR-PP-F and positively with rMEA-WCC, SUCO-ES-CO, and MI-Z. CONCLUSION: More standardization efforts are needed because different synchrony measures have little convergent validity, which can lead to contradictory conclusions concerning associations between depressive symptoms and movement synchrony using the same dataset.

Movement Synchrony and Facial Synchrony as Diagnostic Features of Depression: A Pilot Study.

ABSTRACT: The pilot study investigated with a matched-subjects design whether nonverbal synchrony is a diagnostic feature for depression and whether it mediates between depression and postsession ratings of the interviewer behavior. The sample includes n = 15 patients with major depression and n = 15 healthy controls (aged 20-30 years, 40% female). We conducted structured diagnostic interviews for somatic complaints to standardize the recording setting, issue, and course of conversation. Body movements and facial expressions were coded automatically frame by frame using computer vision methods. Ratings of the interviewers' professional behavior and positive affect were assessed using questionnaires. Patients with depression showed less movement synchrony and less synchronous positive facial expressions. Only synchronous positive expressions mediated between depression and less perceived positive affect. We conclude that the applied methodology is well suited to examine nonverbal processes under naturalistic but widely standardized conditions and that depression affects the nonverbal communication in medical conversations.

Depression Severity Is Related to Less Gross Body Movement: A Motion Energy Analysis.

Psychomotor retardation is a well-known clinical phenomenon in depressed patients that can be measured in various ways. This study aimed to investigate objectively measured gross body movement (GBM) during a semi-structured clinical interview in patients with a depressive disorder and its relation with depression severity. A total of 41 patients with a diagnosis of depressive disorder were assessed both with a clinician-rated interview (Hamilton Depression Rating Scale) and a self-rating questionnaire (Beck Depression Inventory-II) for depression severity. Motion energy analysis (MEA) was applied on videos of additional semi-structured clinical interviews. We considered (partial) correlations between patients' GBM and depression scales. There was a significant, moderate negative correlation between both measures for depression severity (total scores) and GBM during the diagnostic interview. However, there was no significant correlation between the respective items assessing motor symptoms in the clinician-rated and the patient-rated depression severity scale and GBM. Findings imply that neither clinician ratings nor self-ratings of psychomotor symptoms in depressed patients are correlated with objectively measured GBM. MEA thus offers a unique insight into the embodied symptoms of depression that are not available via patients' self-ratings or clinician ratings.

Movement and Emotional Facial Expressions during the Adult Attachment Interview: Interaction Effects of Attachment and Anxiety Disorder.

INTRODUCTION: Adult attachment is commonly associated with emotion regulation. Less is known about the nonverbal embodiment of adult attachment. OBJECTIVE: We hypothesized that dismissing attachment is related to less movement and fewer facial expressions of emotions, whereas preoccupied attachment is associated with more negative emotional facial expressions. Moreover, the interaction of attachment and the presence of an anxiety disorder (AD) was explored. METHODS: The sample included 95 individuals, 21 with AD without comorbidity, 21 with AD and comorbid major depression (AD-CD), and 53 healthy controls. We analyzed nonverbal behavior during a part of the Adult Attachment Interview (AAI) asking about the family and parental figures. The movements of the interviewees were captured via Motion Energy Analysis. Facial expressions were coded according to the Facial Action Coding System using the OpenFace software. We compared individuals with secure, dismissing, and preoccupied states of mind (assessed with the AAI) with regard to the frequency and complexity of movements and the frequency of the facial expressions such as happy, sad, and contemptuous. RESULTS: As expected, dismissingly attached individuals moved less often and with lower complexity than securely attached. For emotional facial expressions, a main effect of the disorder group and interaction effects of attachment by disorder were found. In the AD-CD group, dismissingly attached patients showed comparatively fewer happy facial expressions than securely attached individuals. CONCLUSIONS: Reduced movement specifically seems to be related to dismissing attachment when interviewees talk about significant parental figures. Facial expressions of emotions related to attachment occurred when maladaptive emotion regulation strategies were intensified by a psychological disorder.

[Brief Scale to assess Social Support in Chronic Diseases (SUCE-4)]. / Kurzfragebogen zur Sozialen Unterstützung bei chronischen Erkrankungen (SUCE-4).

AIM OF THE STUDY: Social support is an important resource for coping with serious chronic diseases such as cancer. The available questionnaires for the measurement of social support are usually extensive. So far, available short versions do not completely aim at situation-specific requirements of the social environment of chronically ill patients. Therefore, a short form of a measure of perceived social support was developed consisting of only 4 items: the SUCE-4. METHODS: A sample of cancer patients (N=424) was examined at 2 time points. The factor structure was evaluated using exploratory and confirmatory factor analysis (CFA) and reliability and validity were examined. RESULTS: The expected factor structure was confirmed (for CFA: RMSEA=0.028). The short questionnaire revealed a good internal consistency (Cronbach's α>0.86). In terms of the first indications of validity, significant and expected correlations with psychological quality of life, self-efficacy expectations, depression and anxiety were found at both time points. CONCLUSION: The SUCE-4 is an economical, reliable and valid instrument for the assessment of perceived social support in the context of severe chronic diseases such as cancer.

[Long-Term Patterns of Depressive Symptomload and their Predictors in Hospitalised Patients Undergoing Psychodynamic Psychotherapy: Findings of the STOP-D Study]. / Langzeitverläufe depressiver Symptomlast und deren Prädiktoren bei stationärer, tiefenpsychologisch fundierter Psychotherapie: Befunde der STOP-D-Studie.

OBJECTIVE: Depression is one of the most common mental disorders. While the general effectiveness of in- and outpatient psychotherapy is proven, different long-term patterns in treatment of symptoms of depression have been described. The aim of the present study was to show different patterns of benefit in the context of inpatient psychodynamic psychotherapy of depressive disorders and to detect predictors of different types of response that help to identify possible non-responders and adjust treatments accordingly. METHODS: Data of the naturalistic multicentre intervention study were collected in 15 German psychosomatic hospital units employing a predominantly psychodynamic approach to treatment. The sample includes n=432 patients (women: age 25-45 years) with typical symptoms of depression. The patterns of outcome were identified using a latent state model with a method factor and a latent class analysis; potential course predictors were analysed using regression analysis. RESULTS: Three long-term patterns of outcome were identified: patients with significant treatment benefit, whose symptom decline was stable even in a 6-month catamnesis (Responders: 76.9%), patients without a significant symptom decrease during treatment and in the follow-up survey (Non-responders: 18.8%), as well as patients with a significant symptom decrease but showing an increase of symptoms in the catamnesis (Backsliders: 4.4%). The severity of baseline depressive symptom load was determined as a predictor for the pattern of Backsliders. Non-responders differed from responders in having had psychosomatic pre-treatments more frequently. DISCUSSION: In the case of backsliders, further studies should, for instance, verify whether relapses can be explained by the patient's symptoms, treatment, or social environment. In the case of non-response due to numerous unsuccessful pre-treatments, the question arises whether psychosomatic treatment offers the right setting for these patients or how therapy settings should be modified. CONCLUSION: Long-term patterns reported in the literature were partially confirmed. There are indications of an influence of the initial symptom-load severity on the outcome of treatment. It is important to consider how treatment settings can be modified accordingly.

Differential effects of adult attachment in cognitive-behavioural and psychodynamic therapy in social anxiety disorder: A comparison between a self-rating and an observer rating.

Different measures of attachment are usually weakly correlated. In a subsample of an RCT comparing short-term cognitive-behavioural therapy (CBT) and psychodynamic therapy (PDT), we examined the association between attachment and outcome using two attachment measures. The sample comprises 148 patients with social anxiety disorder who were treated in the SOPHO-NET trial. Pretreatment attachment was assessed using the Adult Attachment Prototype Rating (AAPR) and the Bielefeld Questionnaire of Client Expectations (BQCE). Regression models were used to predict the therapeutic alliance (HAQ) at session 8, the Liebowitz Social Anxiety Scale (LSAS) at the end of therapy and a 6-month follow-up. Attachment groups (secure, avoidant, and ambivalent) classified with the AAPR and the BQCE were not significantly correlated (Cohen's κ = 0.08). Only the BQCE was associated with the HAQ indicating avoidantly attached patients showing lower HAQ scores than securely attached (Cohen's d = 0.722). Regarding the AAPR, we found an interaction effect of treatment and attachment related to the post-treatment LSAS scores. Post hoc tests revealed that securely attached patients in CBT had lower scores than securely attached in PDT (d = 0.922) and, on a trend level, avoidantly attached in CBT (d = 0.782). We conclude that attachment-outcome associations are affected by the applied measure. The identified differential effects suggest that psychotherapists should adapt the interventions on the attachment of their patients.

Patient information, communication and competence empowerment in oncology (PIKKO) - evaluation of a supportive care intervention for overall oncological patients. Study protocol of a non-randomized controlled trial.

BACKGROUND: Cancer patients have to undergo a difficult medical therapy and are also confronted with various psychological, social and economic problems. Support is available from many providers, but patients often gain no access to it. Accordingly, there is a need for a single point of contact that can provide advice, information and assistance. In the state of Saarland, Germany, a supportive new consulting and information path (PIKKO) for all types of cancer is currently evaluated by the German Cancer Society, the Cancer Society of the Saarland, three statutory health insurances and the Jena University Hospital. PIKKO is designed to improve quality of life, self-efficacy, health literacy and patient satisfaction and to reduce psychological distress, related health care costs and the days of inability to work. This methodical work presents the process and analysis planning of this evaluation. METHODS: The study population includes all cancer types, both new and existing diseases. PIKKO (with patient navigator, oncological knowledge database, specialized oncological counseling) is evaluated within a controlled, non-randomized, comparative, multicenter, longitudinal design. In addition to patient surveys, data from statutory health insurances and utilization data from the web database are collected, and interviews with patient navigators and doctors are carried out. Patients are assigned to a control (usual care) or an intervention group (u. c. + PIKKO). Primary outcome is the health related quality of life (SF-12) six months after baseline. Secondary outcomes are self-efficacy (GSE), psychological distress such as depression (PHQ-9) or anxiety (GAD-7), health literacy (HLS-EU-Q47) and patient satisfaction in health care (Qualiskope-A). Furthermore, the time course of direct costs of medical care (e.g. work disability days) and usage data of the intervention modules are analyzed. Among other statistical procedures, we use t-tests, univariate tests and growth curve models. DISCUSSION: If PIKKO proves to be effective, recommendations can be made to health organizations, which should lead to the concept being rolled out throughout Germany and included into oncological guidelines. We expect PIKKO to be a useful addition to usual cancer care, helping to improve the quality of life of cancer patients and reduce healthcare costs. TRIAL REGISTRATION: This study was retrospectively registered in the German Clinical Trial Register under DRKS00016703 (21.02.2019, the reason for the delay was the prioritization of the study management in the first year to establish the new approach into practice). https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016703.

Patterns of early change in interpersonal problems and their relationship to nonverbal synchrony and multidimensional outcome.

Early change is an increasing area of investigation in psychotherapy research. In this study, we analyzed patterns of early change in interpersonal problems and their relationship to nonverbal synchrony and multiple outcome measures for the first time. We used growth mixture modeling to identify different latent classes of early change in interpersonal problems with 212 patients who underwent cognitive-behavioral treatment including interpersonal and emotion-focused elements. Furthermore, videotaped sessions were analyzed using motion energy analysis, providing values for the calculation of nonverbal synchrony to predict early change in interpersonal problems. The relationship between early change patterns and symptoms as well as overall change in interpersonal problems was also investigated. Three latent subgroups were identified: 1 class with slow improvement (n = 145), 1 class with fast improvement (n = 12), and 1 early deterioration class (n = 55). Lower levels of early nonverbal synchrony were significantly related to fast improvement in interpersonal change patterns. Furthermore, such patterns predicted treatment outcome in symptoms and interpersonal problems. The results suggest that nonverbal synchrony is associated with early change patterns in interpersonal problems, which are also predictive of treatment outcome. Limitations of the applied methods as well as possible applications in routine care are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Associations between movement synchrony and outcome in patients with social anxiety disorder: Evidence for treatment specific effects.

Background: Studies with heterogeneous samples in naturalistic treatment settings suggest that movement synchrony (MS) between therapists and patients correlates with therapeutic success. In this study, we examined a homogeneous sample of patients with social anxiety disorder and investigated whether MS in sessions 3 and 8 would be associated with therapy outcome and therapeutic alliance, and whether these associations depend on the therapeutic approach. Methods: The patients (N = 267) were treated with either manual-guided cognitive behavior therapy (CBT), manual-guided psychodynamic therapy (PDT), or naturalistic CBT. The Helping Alliance Questionnaire (HAQ), the Inventory of Interpersonal Problems (IIP) and the Beck-Depression-Inventory (BDI) were used as measures. Body motions were coded with motion energy analysis. MS was quantified using time series analysis methods. Results: MS was observed more frequently in both CBT conditions than in PDT. In both CBT groups, more synchrony was predictive of lower IIP scores at the end of therapy. If the patient lead synchrony more often than the therapist, higher IIP and BDI scores were observed at the end of treatment. PDT showed the largest effect size for the synchrony-alliance-association. Conclusion: Movement synchrony and therapeutic success are associated. The effect of therapeutic approach and leading/following are relevant for this association.

Quantification of nonverbal synchrony using linear time series analysis methods: Lack of convergent validity and evidence for facets of synchrony.

Nonverbal synchrony describes coordination of the nonverbal behavior of two interacting partners. Additionally, it seems to be important in human interactions, such as during psychotherapy. Currently, there are several options for the automated determination of synchrony based on linear time series analysis methods (TSAMs). However, investigations into whether the different methods measure the same construct have been missing. In this study, N = 84 patient-therapist dyads were videotaped during psychotherapy sessions. Motion energy analysis was used to assess body movements. We applied seven different TSAMs and recorded multiple output scores (average synchrony, maximum synchrony, and frequency of synchrony; in total, N = 16 scores). Convergent validity was examined using correlations of the output scores and exploratory factor analysis. Additionally, two criterion-based validations were conducted: investigations of concordant validity with a more generalized nonlinear method, and of the predictive validity of the synchrony scores for improvement in interpersonal problems at the end of therapy. We found that the synchrony measures only partially correlated with each other. The factor analysis did not support a common-factor model. A three-factor model with a second-order synchrony variable showed the best fit for eight of the selected synchrony scores. Only some synchrony scores were able to predict improvement at the end of therapy. We concluded that the considered TSAMs do not measure the same synchrony construct, but different facets of synchrony: the strength of synchrony of the total interaction, the strength of synchrony during synchronization intervals, and the frequency of synchrony.

[Development of a Short Version of the Bielefeld Partnership Expectations Questionnaire (BFPE)]. / Entwicklung einer Kurzversion des Bielefelder Fragebogens zu Partnerschaftserwartungen (BFPE-12).

The Bielefeld Partnership Expectations Questionnaire (BFPE) is a self-rating instrument of partner related attachment. Besides the assessment of the dimensions fear of rejection, readiness for self-disclosure, and conscious need for care, individuals can be classified according to 5 different attachment patterns. Using data from a representative German survey (N=1768), an explorative factor analysis revealed a short version comprising 12 items. Confirmatory factor analysis using two datasets (N=1768 and N=801) supported the 3-factor-structure (RMSEA<0.08, CFI>0.93). Subscales of the short version were highly correlated with the corresponding scales of the long version (r=0,799-0,914). Furthermore, the classifications of 5 attachment patterns strongly converged (κ=0,659). The short version can be recommended as a substitute of the long version in clinical and non-clinical studies.