Benefits and challenges in practice-oriented psychotherapy research in Germany: the TK and the QS-PSY-BAY projects of quality assurance in outpatient psychotherapy.

OBJECTIVE: Two patient-focused long-term research projects performed in the German outpatient psychotherapy system are focused on in this article. The TK (Techniker Krankenkasse) project is the first study to evaluate a quality assurance and feedback system with regard to its practical feasibility in German routine care. The other study ("Quality Assurance in Outpatient Psychotherapy in Bavaria"; QS-PSY-BAY) was designed to test a new approach for quality assurance in outpatient psychotherapy using electronic documentation of patient characteristics and outcome parameters. In addition this project provides the opportunity to analyze data on health-related costs for the patients undergoing outpatient psychotherapy. METHOD: Both projects and their results indicating high effect sizes are briefly described. RESULTS: From the perspectives of the research teams, advisory boards and other stakeholders, the experiences with these projects are discussed focusing on obstacles, challenges, difficulties, and benefits in developing and implementing the studies. The triangle collaboration of therapists, researchers, and health insurance companies/health service institutions turned out to be fruitful in both studies. CONCLUSIONS: Despite some controversies between the partners the experiences indicate the importance of practiced-research collaborations to provide relevant information about the delivery of outpatient psychotherapy in the health system.

Differentiating cerebral ischemia from functional neurological symptom disorder: a psychosomatic perspective.

BACKGROUND: The differential diagnosis of pseudo-neurological symptoms often represents a clinical challenge. The Diagnostic and Statistical Manual of Mental Disorders, DSM-5, made an attempt to improve diagnostic criteria of conversion disorder (functional neurological symptom disorder). Incongruences of the neurological examination, i.e. positive neurological signs, indicate a new approach--whereas psychological factors are not necessary anymore. As the DSM-5 will influence the International Classification of Diseases, ICD-11, this is of importance. In the case presented, a history of psychological distress and adverse childhood experiences coexisted with a true neurological disorder. We discuss the relevance of an interdisciplinary assessment and of operationalized diagnostic criteria. CASE PRESENTATION: A 32-year-old man presented twice with neurological symptoms without obvious pathological organic findings. A conversion disorder was considered early on at the second admission by the neurology team. Sticking to ICD-10, this diagnosis was not supported by a specialist for psychosomatic medicine, due to missing hints of concurrent psychological distress in temporal association with neurological symptoms. Further investigations then revealed a deep vein thrombosis (though D-dimers had been negative), which had probably resulted in a crossed embolus. CONCLUSION: The absence of a clear proof of biological dysfunction underlying neurological symptoms should not lead automatically to the diagnosis of a conversion disorder. In contrast, at least in more complex patients, the work-up should include repeated psychological and neurological assessments in close collaboration. According to ICD-10 positive signs of concurrent psychological distress are required, while DSM-5 emphasizes an incongruity between neurological symptoms and neurophysiological patterns of dysfunction. In the case presented, an extensive medical work-up was initially negative, and neither positive psychological nor positive neurological criteria could be identified. We conclude, that, even in times of more sophisticated operationalization of diagnostic criteria, the interdisciplinary assessment has to be based on an individual evaluation of all neurological and psychosocial findings. Prospective studies of inter-rater reliability and validity of psychological factors and positive neurological signs are needed, as evidence for both is limited. With respect to ICD-11, we suggest that positive neurological as well as psychological signs for functional neurological symptom disorder should be considered to increase diagnostic certainty.

The pairwise approximate spatiotemporal symmetry algorithm: A method for segmenting time series pairs.

Methods that measure the association between two intensively measured time series are of interest to researchers studying the symmetry of behaviors during social interaction. Such methods have historically focused on aggregating the amount of symmetry across all measurement occasions. However, it is rarely expected that symmetry is present at all measurement occasions. The current method, the pairwise approximate spatiotemporal symmetry (PASS) algorithm, is an approach that may be used to determine which measurement occasions in pairwise time series are indicative of symmetry and which are not. This process thus divides time series into symmetric and nonsymmetric segments. The PASS algorithm is demonstrated here on representative simulated data and naturalistic psychotherapy data. Results suggest that the PASS algorithm has the potential to extract meaningful symmetry segments from human signals. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Unresolved trauma in fibromyalgia: A cross-sectional study.

This study examined the prevalence of unresolved attachment-related trauma and its association with physical and psychological health status in 34 patients with fibromyalgia. Unresolved trauma was assessed with the Adult Attachment Interview. In addition, participants completed self-report measures of childhood trauma, fibromyalgia-related health status and depression. Of the sample, 50 per cent was classified as unresolved on the Adult Attachment Interview. Neither interview-based ratings of unresolved trauma nor self-reported childhood sexual or physical abuse were associated with health outcomes. Only for self-reported emotional abuse, a positive correlation with depression emerged. The implications of the findings are discussed.

Treatment selection in private practice psychodynamic psychotherapy: a naturalistic prospective longditudinal study.

In this naturalistic prospective longitudinal study, the authors evaluated the treatment selection decisions of 24 psychotherapists in private practice over a 12-month period. A comparison of the treatment selection criteria for patients who were accepted for treatment and for those who were not yielded 3 results: (a) Motivation was the outstanding factor determining whether a patient was accepted for treatment; (b) selection of short-term or long-term psychotherapy depended on the therapists' emotional response to the patient; and (c) psychiatric diagnosis and symptom severity contributed relatively little to treatment selection. These findings suggest that treatment selection in private practice psychodynamic psychotherapy is based on specific aspects of the therapist-patient relationship rather than on patient characteristics related to symptom severity or psychiatric diagnosis.