Associations between therapists' verbal techniques and patient-rated therapeutic alliance, insight, and problem solving.

OBJECTIVE: To investigate associations between common factors (alliance, insight, problem solving) and therapists' techniques. We expected a positive association between (1) supportive techniques and the alliance, (2) interpretative techniques and insight, and (3) a stronger association between interpretative techniques and insight for patients with more severe baseline symptoms. Other associations were analyzed in an exploratory way. METHOD: Sixty sessions from 15 adult female patients diagnosed with personality disorder were analyzed using the Psychodynamic Interventions List (verbal techniques, observer-rated transcripts), and the Session Questionnaire for General and Differential Individual Psychotherapy (common factors, patient-rated after each session). Multilevel modeling was applied. RESULTS: A greater use of supportive techniques was related to a higher therapeutic alliance (b = .28, 95% CI: .01-.55, p = .042). Neither the positive association between interpretative techniques and insight nor the moderating effect of baseline symptom severity could be confirmed. Exploratory analyses revealed associations between problem-solving and different verbal techniques. CONCLUSION: Therapists' use of supportive techniques seems to influence the therapeutic alliance positively in patients with personality disorders. The effect of interpretative techniques might depend on other factors like patient characteristics. In general, there seem to be differential and specific associations between different therapists' verbal techniques and common factors.

[The Relationship between Personality Structure, Burnout and Procrastination in Psychology and Medical Students, Taking into Account Social Support and Scope for Decision-Making in Studies]. / Der Zusammenhang von Persönlichkeitsstruktur, Burnout und Prokrastination bei Psychologie- und Medizinstudierenden unter Einbeziehung von sozialer Unterstützung und Entscheidungsspielraum im Studium.

BACKGROUND: Burnout and procrastination are widespread phenomena among students. The role of personality structure has been little researched so far. OBJECTIVE OF THE STUDY: The relationship between personality structure and study-related work disorders in psychology and medical students is examined, taking into account resources and demands. METHODS: As part of a cross-sectional study, data was collected online from 61 German colleges and universities. Personality structure variables (levels of personality functioning, OPD-SFK; attachment, ECR-RD 12; emotion regulation, ERQ), study-related work disorders (burnout, MBI-SS-d; procrastination; APSI-d) as well as resources (social support, F-SozU K-6; scope for decision-making in studies, self-developed scale) and demands (Corona pandemic, self-developed scale) were assessed. The research question was answered by means of a hierarchical regression analysis. RESULTS: From February 2020 to December 2021, 775 students (49.2% psychology students, 50.8% medical students; age M=24.1 years, SD=5.1 years; 82.3% female, 17.4% male, 0.3% diverse) participated in the survey. In the overall model, 30.4% of the variance in burnout exhaustion, 16.2% of the variance in burnout cynicism, 20.9% of the variance in burnout inefficiency and 30.1% of the variance in procrastination was explained (p<0.001). Levels of personality functioning showed significant negative correlations with all burnout variables as well as with procrastination (p<0.001). The emotion regulation strategy reappraisal was associated with lower burnout inefficiency and procrastination (p<0.001), and the emotion suppression strategy with lower burnout cynicism (p≤0.01). Scope for decision-making in studies was negatively associated with all burnout variables and procrastination (p<0.001), and social support was negatively associated with burnout inefficiency (p≤0.01). The general stress level during the Corona pandemic showed a positive association with burnout exhaustion (p≤0.001). CONCLUSIONS: Personality structure (levels of personality functioning, emotion regulation) is significantly related to study-related burnout and procrastination. Training opportunities to promote emotion regulation skills could be very helpful for vulnerable student groups in dealing with burnout and procrastination.

Prospective psychotherapists' bias and accuracy in assessing their own facilitative interpersonal skills.

We aimed to investigate prospective psychotherapists' bias in assessing their own facilitative interpersonal skills (FIS) and predictors of high self-assessments. In this cross-sectional observational study, we examined 132 psychology students and trainee psychotherapists. Therapists' demographic variables and self-concepts were assessed through self-report questionnaires, and their therapeutic skills were assessed with the German version of the "FIS" task. A truth-and-bias model approach was applied in three different hierarchical linear models to test self-assessment bias of FIS, and to identify factors associated with overly positive self-assessments of therapeutic skills. Significantly higher self-assessments of skills were found in comparison to observer ratings for overall FIS and for the FIS dimensions hope, emotional expression, warmth, acceptance, and understanding, empathy, alliance bond capacity, and rupture-repair responsiveness. Despite this discrepancy, there was a significant congruence between self- and observer ratings. A greater self-assessed ego-strength and attractiveness were associated with self-assessments of skills that were higher than the observer-rated average. Age, gender, experience, and other self-concept variables showed no significant association with self-assessments. This present study demonstrates self-assessment bias in prospective therapists. However, when participants rated their own FIS to be high, observers also tended to rate participants' skills higher. Especially therapists who generally feel more confident and attractive tend to estimate themselves positively. Supervisors and trainees should be aware of the ubiquity of self-assessment bias. Future research is necessary to test the effect of self-assessment bias on patient outcomes and process variables. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Factors influencing the duration of untreated illness among patients with anorexia nervosa: A multicenter and multi-informant study.

INTRODUCTION: The duration of untreated illness (DUI), that is, the interval between the onset of anorexia nervosa (AN) symptoms and start of specialized treatments, has a strong influence on the prognosis. OBJECTIVE: To quantify modifiable predictors of the DUI and to derive recommendations for secondary prevention strategies. METHODS: Within a multicenter, multi-informant study, DUI was assessed in interviews with patients undergoing first specialized AN treatment. Modifiable factors were assessed perspectives of AN-patients, their relatives, and primary care practitioners [PCPs]) with the FABIANA-checklist (Facilitators and barriers in anorexia nervosa treatment initiation). The effect of FABIANA-items on the DUI for each perspective was calculated using Cox Regression (control variables: age, eating disorder pathology, health care status, migration background, body mass index [BMI]). RESULTS: We included data from N = 125 female patients with AN (72 adults, 53 adolescents, Mage = 19.2 years, SD = 4.2, MBMI = 15.7 kg/m2 , SD = 1.9), N = 89 relatives (81.8% female, 18.2% male, Mage = 46.0 years, SD = 11.0) and N = 40 PCPs (Mage = 49.7 years, SD = 9.0). Average DUI was 12.0 months. Watching or reading articles about the successful treatment of other individuals with AN (patients' perspective) and regular appointments with a PCP (PCPs' perspective) were related to a shorter DUI (HR = 0.145, p = .046/ HR = 0.395, p = .018). Patients whose relatives rated that PCPs trivialized patients' difficulties had a longer DUI (HR = -0.147, p = .037). PCPs and relatives rated PCPs' competence higher than patients did. DISCUSSION: It is recommended (a) to incorporate treatment success stories in prevention strategies, (b) to inform PCPs about potential benefits of regular appointments during the transition to specialized care, and (c) to train PCPs in dealing with patients' complaints. PUBLIC SIGNIFICANCE: Many individuals with AN seek treatment very late. Our study shows that a promising approach to facilitate earlier AN treatment is to inform patients about successful treatments of affected peers, to foster regular appointments with a PCP and, to motivate these PCPs to take individuals' with AN difficulties seriously. Thus, our study provides important suggestions for interventions that aim to improve early treatment in AN.

Who are the skilled therapists? Associations between personal characteristics and interpersonal skills of future psychotherapists.

OBJECTIVE: Facilitative interpersonal skills (FIS) are a promising variable to explain the so-called therapist effect. We aimed to investigate associations between observer-rated interpersonal skills and self-reported personal characteristics of future therapists. METHOD: In this cross-sectional observational study, psychology students and trainee therapists completed self-report personality and sociodemographic questionnaires as well as the FIS Performance Task (German version, observer-rated). Mixed multilevel model analysis was conducted with FIS total mean score (mean value of 312 individual ratings [13 video-clips, 8 FIS-items, 3 raters]) as dependent variable, therapist ID and FIS clip ID as random effects and 15 therapist variables as fixed effects. RESULTS: In the present sample consisting of 177 participants (age: M = 29.8 years (SD = 7.3), [18,59]; 79.1% female, 20.9% male) greater therapists' experience level, male gender and lower levels of alexithymia were predictive for higher FIS score when statistically controlling for other therapist variables in the model. Age, self-reported childhood maltreatment, attachment style, emotion regulation and self-concept variables turned out to be unrelated. CONCLUSION: The results can inform psychotherapy training programs. They specifically support the importance of addressing therapists' potential difficulties in recognizing and verbalizing emotions. This is in line with theoretical literature on alliance ruptures and premises of the Alliance-focused training.

Burnout and job satisfaction among physicians working in urologic departments who immigrated to Germany, taking into account the income structure of their country of origin.

BACKGROUND: Studies are available on physician burnout and job satisfaction (JS) in relation to the specific income structure of the country of residence. However, no studies exist that investigate burnout of immigrated physicians taking into account the income structure of their country of origin (IS-COO) as well as duration of immigration. OBJECTIVE: To determine the influence of IS-COO on JS, income satisfaction, and critical burnout thresholds in the domains of emotional exhaustion (EE), depersonalization (DP) and reduction in personal accomplishment (RPA) among urologists with a migrant background working at German hospitals. METHODS: A questionnaire (Survey-Monkey®/101-items) was conducted among urologists of German hospitals with a migrant background. The online questionnaire was open for study participation from 1 August to 31 October 2020. The study included all physicians with a migration background who were born in a country other than Germany and were currently employed in a German department of urology. Physician burnout (Maslach-Burnout-Inventory) and JS were assessed using validated instruments. The influence of IS-COO and different covariates on the designated endpoints was tested using multivariate-models. RESULTS: 96 urologists with a median stay in Germany of 7 years participated and were stratified according to low (LIC/41.7%), middle (MIC/36.5%) and high (HIC/21.9%) income based on IS-COO. No significant influence of IS-COO on critical thresholds in each burnout domain could be found. Of urologists from LIC, MIC and HIC, 42%, 59% and 57%, respectively, showed rather or extreme JS (p = .446). There was also no significant difference between groups in income satisfaction (p = .838). However, in multivariate-models, duration of stay in Germany (≥7 vs. <7 years) had significant effects on DP (OR: 0.28, p = .038) and RPA (OR: 0.09, p = .014), but not on EE and JS. CONCLUSION: IS-COO has no impact on burnout and JS among urologists who immigrated to Germany. Similarly, income satisfaction in the country of residence is not influenced by IS-COO.

Job Satisfaction and Intentions to Leave of Foreign-National Urologists Working at German Hospitals: Results of the Cross-Sectional EUTAKD Study.

BACKGROUND: Studies exist that identify factors associated with higher professional satisfaction among clinicians. However, there are no reliable findings for clinicians with a migration background as to whether there is a correlation between particular dimensions of professional satisfaction and the desire to leave their current specialty or country of employment. For the first time, these data were collected within a questionnaire-based study from urological clinicians with a migration background (UCMBs) working in Germany. MATERIAL AND METHODS: A SurveyMonkey® with 101 items relating to characterizing features of the study participants and questions about job satisfaction (n = 39) was opened for UCMBs between August and October 2020. The influence of different dimensions of job satisfaction on the desire to quit the urological specialty/leave Germany was analyzed (group A: neither want to leave urology nor Germany; group B: can at least imagine leaving the urological profession and/or Germany). RESULTS: Eighty-one UCMBs were distributed almost equally in groups A (50.6%) and B (49.4%). Occupational satisfaction was higher in several respects in group A. Three dimensions that differed significantly with regard to occupational satisfaction were used to create an aggregate score ranging from 3 to 15 points as follows: (1) relationship to superiors (p = 0.014), (2) career opportunities in the clinic (p < 0.001), and (3) opportunities for the further development of surgical skills (p = 0.006). For each point value of this aggregate score, the UCMB's desire to quit urology or leave Germany (or at least uncertainty about this question) decreased by a relative value of 34.6% (odds ratio: 0.654, 95% confidence interval: 0.496-0.861, p = 0.002). CONCLUSIONS: Various dimensions of job satisfaction have been identified, the improvement of which could contribute to the long-term retention of UCMBs at German urological clinics.

The development and psychometric evaluation of FABIANA-checklist: a scale to assess factors influencing treatment initiation in anorexia nervosa.

BACKGROUND: A long duration of untreated illness (DUI) is an unfavorable prognostic factor in anorexia nervosa (AN) and is associated with chronic illness progression. Although previous preventive measures aimed at reducing DUI and thus improving short- and long-term treatment outcomes have been partially successful, a better understanding of the factors involved in the sensitive phase prior to treatment initiation is needed. To date, there is no validated instrument available to assess these factors specifically for patients with AN. The FABIANA-project (Facilitators and barriers in anorexia nervosa treatment initiation) aims at identifying predictors of the DUI in order to target preventive measures better in the future. As part of this project, the FABIANA-checklist was developed, based on a multi-informant perspective and a multimodal bottom-up approach. The present study focusses on the process of item generation, item selection and psychometric validation of the checklist. METHODS: Based upon a previous qualitative study, an initial set of 73 items was generated for the most frequently mentioned facilitators and barriers of treatment initiation in AN. After a process of consensual rating and cognitive pre-testing, the resulting 25-item version of the FABIANA-checklist was provided to a sample of female patients (N = 75), aged ≥ 14 years with AN that underwent their first psychotherapeutic treatment in the last 12 months. After item analysis, dimensionality of the final version of the FABIANA-checklist was tested by Principal Component Analysis (PCA). We evaluated construct validity assuming correlations with related constructs, such as perceived social support (F-SozU), support in the health care system (PACIC-5A), illness perception and coping (BIPQ). RESULTS: We included 54 adult and 21 adolescent patients with AN, aged on average 21.4 years. Average BMI was 15.5 kg/m2, age of onset was 19.2 years and average DUI was 2.25 years. After item analysis, 7 items were excluded. The PCA of the 18-item-FABIANA-checklist yielded six components explaining 62.64% of the total variance. Overall internal consistency was acceptable (Cronbach's α = .76) and construct validity was satisfactory for 14 out of 18 items. Two consistent components emerged: "primary care perceived as supportive and competent" (23.33%) and "emotional and practical support from relatives" (9.98%). With regard to the other components, the heterogeneity of the items led to unsatisfactory internal consistency, single item loading and in part ambiguous interpretability. CONCLUSIONS: The FABIANA-checklist is a valid instrument to assess factors involved in the process of treatment initiation of patients with AN. Psychometrics and dimensionality testing suggests that experienced emotional and practical support from the primary health care system and close relatives are main components. The results indicate that a differentiated assessment at item level is appropriate. In order to quantify the relative importance of the factors and to derive recommendations on early-intervention approaches, the predictive effect of the FABIANA-items on the DUI will be determined in a subsequent study which will further include the perspective of relatives and primary caregivers. Trial registration Clinical Trials.gov Identifier: NCT03713541: https://clinicaltrials.gov/ct2/show/NCT03713541 .

Early treatment contributes to a more favorable illness course and an improved prognosis in patients with anorexia nervosa (AN). The current study presents the development of the FABIANA checklist, which aims to assess factors which influence duration of untreated illness. The FABIANA checklist was developed on the basis of interviews with patients, their relatives and primary care practitioners. It provides data from the first use of the checklist in a German sample of 75 patients with AN. The results of our study suggest that the FABIANA-checklist is a valid instrument to assess factors involved in the process of treatment initiation. Emotional and practical support from the primary health care system and close relatives were the most consistent components. A follow-up study will investigate the relationship between the FABIANA-items and the DUI in order to guide the conception of effective secondary prevention measures.

["Achieving closeness in video treatment despite distance"]. / "In Videobehandlungen trotz Distanz Nähe schaffen": Wie erlebten Psychotherapeuten die Durchführung von Videobehandlungen in Zeiten von COVID-19?

Background: As a result of the contact ban issued at the beginning of the coronavirus disease 2019 (COVID-19) outbreak in March 2020, psychotherapists provided significantly more video-based therapy (VBT) and most of them provided it the first time. To date, there is little research on how therapists experienced VBT during the pandemic and no studies are available that look at possible procedure-specific features. Objective: The aim was to analyze what subjective experiences therapists of different guideline procedures had with the implementation of VBT in times of the COVID 19 pandemic and what advantages and disadvantages they experienced. Methods: This was a mixed methods study with a cross-sectional online survey. In addition to quantitative data, seven open-ended questions were used to collect therapists' subjective experiences with conducting VBT and analyzed using qualitative content analysis. The identified categories were subjected to a frequency analysis. Data from 174 medical or psychological psychotherapists were included in the analysis. Results: Particularly frequently mentioned advantages were flexibility of location and time, continuity of contact during pandemic periods and avoidance of risk of infection. The most commonly cited disadvantage was the lack of sensory input, facial expressions, gestures, eye contact, and nonverbal communication. The VBT was well-accepted by most, but not all, patients. Technical problems made the implementation difficult. Conclusion: For many therapists VBT remained a stopgap solution that was not designed to last; however, VBT could help to solve known care problems (e.g., underprovision in rural areas) beyond the pandemic period. The results of the study make an important contribution to weighing up the opportunities and risks of VBT for psychotherapeutic care and for keeping an eye on possible dangers and difficulties.

[Online psychotherapy in times of coronavirus disease 2019]. / Onlinepsychotherapie in Zeiten der Corona-Pandemie: Querschnittsbefragung deutscher Psychotherapeuten.

Theoretical background: As a reaction to the coronavirus diseases 2019 (COVID-19) pandemic, in individual settings psychotherapy could be conducted online to an unlimited extent in Germany. The attitudes and experiences of psychotherapists with respect to online therapy (OT) have so far been generally poorly studied and particularly with a view to the situation during the pandemic. Objective: The aim of the study was to examine 1) the frequency of utilization of OT during the first lockdown, 2) the satisfaction with OT versus face-to-face therapy and 3) the technology acceptance experience overall and with respect to the guideline procedures. Material and methods: German psychotherapists licensed and in training, cognitive-behavioral (CB 45.6%), analytic (AP 14%), depth-psychological (DP 34.5%), systemic (SYS 5.8%), were invited to participate in an online survey on demographic and therapeutic data, use of OT, satisfaction with OT vs. face-to-face therapy (Zufriedenheitsfragebogen für Therapeuten, ZUF-THERA) and technology acceptance (Unified Theory of Acceptance and Use of Technology 2 Questionnaire, UTAUT). Results: The 174 participating psychotherapists (mean age = 44.73 years, SD ±â€¯12.79; female 81.6%) reported that the average proportion of OT in the total therapeutic activity during the lockdown was 43.09%, with significant differences between guideline procedures (DP, CB > AP). The satisfaction with OT proved to be significantly lower than with face-to-face therapy and did not differ between the procedures. Prior experience with OT was reported by 23.6% of therapists overall and was higher among those working systemically compared to CB or AP therapists. Therapists working in CB experienced more enjoyment with OT than those working in DP and AP as well as perceived a stronger social influence (e.g. through colleagues) in the use of OT than therapists working in DP. Conclusion: The frequency of use of OT soared during the first lockdown (March-May 2020, 43% in comparison to the former limit covered by health insurances of 20%). In principle, therapists were highly satisfied with OT but significantly lower than with face-to-face therapy. Further studies analyzing the reasons for this in detail are urgently recommended.

[Relationship between non-medical reading and burnout as well as professional satisfaction among urologists with migrant background: results of the EUTAKD survey study conducted at German hospitals]. / Zusammenhang zwischen dem Lesen nicht-medizinischer Bücher mit Burnout und beruflicher Zufriedenheit bei Urologen mit Migrationshintergrund ­ Ergebnisse einer Fragebogenstudie an deutschen Kliniken.

BACKGROUND: There are no study results on the private and professional satisfaction and the burnout risk of urologists with a migrant background at German hospitals to date. Non-medical reading has been described to have an influence on lower burnout rates among physicians of different specialties. MATERIAL AND METHODS: A SurveyMonkey questionnaire with 101 items on criteria characterising the study participant, questions on private and professional satisfaction and the complete Maslach Burnout Inventory was opened to urologists with a migrant background at German clinics between August and October 2020. The impact of non-medical reading on professional satisfaction and burnout was comparatively assessed (group A: ≤1 book/12 months versus group B: ≥2 books/12 months). RESULTS: Eighty-one study participants were included. They were almost equally distributed into groups A (49.4%) and B (50.6%). In several items on personal and professional satisfaction, there was a significantly higher satisfaction in group B. In the burnout dimensions of emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA), a high risk of burnout was present in 27.9%, 35.3% and 73.5% of the study participants. A group comparison revealed significant advantages for Group B in the PA dimension in both the sum score (p=0.001) and the categorical comparison (p=0.002). Study participants in Group B also had a significantly lower DP dimension sum score compared with Group A (p=0.047). The group variable was independently associated with a combined score of EE and DP on the one hand (OR 0.316; p=0.031) and the PA dimension on the other (OR 0.170; p=0.024). CONCLUSIONS: Reading non-medical books was associated with higher professional satisfaction and a lower burnout risk among urologists with a migrant background at German hospitals.

[How Should Yoga in Anorexia Nervosa Treatment be Applied? A Qualitative Pilot Study on Yoga Strategies Perceived to be Beneficial from Patients' Perspective]. / Wie sollte Yoga in der Therapie der Anorexia nervosa ausgeführt werden? Eine qualitative Pilotstudie zu hilfreich erlebten Yoga-Strategien aus Sicht von Patientinnen.

An altered interoception is a central correlate of anorexia nervosa (AN) and addressing this issue offers a promising approach in the treatment of AN. First results have shown the effectiveness of yoga as a body-focused intervention in the treatment of AN. However, to date there is a lack of empirical evidence regarding the question how yoga strategies and yoga elements (postures, relaxation, breath, meditation) should be applied. Against this background, we conducted a qualitative pilot study with n=6 female patients with AN undergoing treatment in a specialist unit supporting re-insertion subsequent to a preceding inpatient AN treatment. Study participants received a weekly one-hour hatha-yoga intervention over at least 12 weeks. After the yoga intervention, semi-structured interviews (1/2 to 1 hour) were conducted to assess the experiences of the study participants during the yoga intervention. The data were analyzed using Grounded Theory. At the upper level of analysis, four categories were differentiated: information regarding 1) study participants' symptoms, 2) aspects of the setting experienced to be beneficial, 3) yoga strategies perceived to be beneficial and 4) perceived consequences of yoga strategies. With regard to the yoga strategies perceived to be beneficial, analyses revealed 4 subcategories: features of 1) postures and movements, 2) breath and meditation exercises, 3) relaxation exercises and 4) general information about the setting. The results give first indications regarding the conceptualization of yoga in the treatment of AN and potential mechanisms. Further qualitative and quantitative studies are needed, e.g., with regard to effectiveness, contraindications, mediators or moderators to better evaluate the potential of yoga in the treatment of AN.

[Functions of language in psychotherapy: A qualitative study of psychotherapists' subjective theories of the "talking cure"]. / Funktionen der Sprache in der Psychotherapie: Eine qualitative Studie zu subjektiven Theorien der "talking cure" von Psychotherapeut*innen.

Functions of language in psychotherapy: A qualitative study of psychotherapists' subjective theories of the "talking cure" Objectives: Psychotherapy is traditionally considered as a "talking cure". The specific functions of verbal activity, however, are disputed. The present study aims at identifying central therapeutic functions of verbal activity. Methods: In qualitative interviews n = 23 psychotherapists with psychodynamic (n = 12) or behavioral (n = 11) background were interviewed regarding their theories of the "talking cure." Based on Consensual Qualitative Research (CQR) a category system of therapeutic functions of verbal activity was constructed. Results: The participants described a wide range of relational, experiential, and behavioral functions of verbal activity in psychotherapy. Psychodynamic therapists emphasized relational and experiential functions of verbal activity, while behavioral therapists emphasized behavioral functions. Conclusions: The findings imply that verbal activity fulfills diverse functions in therapeutic contexts. This suggests a basic verbal materiality of many therapeutic techniques and common factors that needs to be specified in subsequent research.

Facilitators and barriers in anorexia nervosa treatment initiation: a qualitative study on the perspectives of patients, carers and professionals.

BACKGROUND: An early psychotherapeutic treatment of anorexia nervosa (AN) is crucial for a good prognosis. In order to improve treatment initiation, knowledge about facilitators and barriers to treatment is needed. OBJECTIVE: Against this background, we aimed to identify facilitators and barriers from the perspectives of patients, carers and professionals using a qualitative approach. METHOD: To this end, semi-structured interviews were conducted in triads of female patients with AN aged 14 years and older at the beginning of their first psychotherapeutic treatment, their carers, and referring health care professionals. A modified Grounded Theory approach was used for analysis. RESULTS: In total, 22 interviews were conducted (n = 6 adults, n = 4 adolescents, 4 full triads). The duration of untreated AN ranged between 30 days and 25.85 years (M = 3.06 ± 8.01 years). A wide spectrum of facilitators and barriers within the patient, the social environment, the health care system and the society were identified. Most prominent factors were 'recognizing and addressing' by close others, 'waiting times and availability' and 'recommendations and referrals' by health care professionals. 'Positive role models for treatment' were perceived as a specific facilitative social influence. Facilitators were more frequently mentioned than barriers and most of the factors seem to hold potential for modifiability. CONCLUSION: Overall, the findings suggest that early intervention approaches for AN should not only address patients and the health care system, but may also involve carers and successfully treated former patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03713541 .

[Psychotherapy Trainees' Experience of Alliance-Focused Training as a Part of Psychotherapy Training - A Qualitative Analysis]. / Wie erlebten Ausbildungskandidaten das allianzfokussierte Training im Rahmen der Psychotherapieausbildung? ­ Eine qualitative Studie.

Interpersonal competencies of therapists in dealing with alliance ruptures is related to therapeutic success. Therefore, it is of particular importance to learn and to train these competencies. A method which was developed specially for this purpose is the Alliance-Focused Training (AFT). Seven psychotherapy trainees participated in the AFT. In semi-structured interviews pre- and post-AFT, they were asked about their expectations from and experiences with the training. The transcriptions of the interviews were analyzed using the Consensual Qualitative Research (CQR) method. Before the AFT, participants showed ambivalent attitudes and fears mainly towards self-revelation. After the training, they mainly described personal development and progress in learning to deal with alliance ruptures. Video recordings of therapy sessions, role plays and training of metacommunikation skills were experienced as being helpful and practice related. The results indicate that the AFT has a great potential for improving competencies of psychotherapists.

Sensitivity to change and minimal clinically important difference of the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7).

BACKGROUND: Effective treatment requires regular follow-up and monitoring of symptoms. We investigated sensitivity to change and minimal clinically important difference of the Generalized Anxiety Disorder Scale (GAD-7). METHODS: This study included all participants from a multisite trial of chronic depression. Baseline and follow-up (12 and 48 weeks) data were used to assess treatment response. Effect sizes (ES) and standardized response means (SRM) of pre- and post-GAD-7 mean changes were calculated for subgroups of patients, who did or did not improve according to ratings in the Hamilton Rating Scale for Depression (HRSD-24). RESULTS: N = 261 patients were included in the analyses. In the subgroup of patients who improved according to HRSD-24, GAD-7 scores were significantly lower after 12 weeks (t = -6.31, df = 120, p < .001; ES = -0.51, SRM = -0.57), and 48 weeks of treatment (t = -12.68, df = 141, p < .001; ES = -1.0, SRM = -1.7), when compared to admission. In the group who worsened, GAD-7 scores were significantly higher after 12 weeks (t = 2.96, df = 41, p = .005; ES = 0.30, SRM = 0.46), and increased after 48 weeks (t = 1.99, df = 21, p = .059; ES = 0.37, SRM = 0.43), when compared to baseline. The unchanged group showed no significant difference between baseline and follow-up. MCID was estimated 4 points on the GAD-7 total score. LIMITATIONS: Confirmation of these findings and further investigation of the GAD-7 in populations and trials focusing on anxiety-specific treatment is highly recommended. CONCLUSIONS: Results show that the GAD-7 is sensitive to detect change in psychopathology over the course of treatment.

[Maintaining a Strong Therapeutic Alliance: Initial Experiences with the Alliance-Focused Training (AFT) in Germany]. / Umgang mit Spannungen und Krisen in der therapeutischen Beziehung: Erste Erfahrungen mit einem handlungsorientierten Ausbildungs- und Supervisionskonzept.

AIMS: Alliance Focused Training (AFT) 1 aims at enhancing therapists' competences in resolving ruptures in the therapeutic alliance using video recordings and role-plays. This pilot study funded by the Heigl Foundation aimed at presenting initial results and clinical experiences with AFT in Germany, and to prepare a subsequent RCT. METHODS: 7 trainee therapists participated. Therapies of 15 patients with depressive disorder were analyzed. RESULTS AND CONCLUSION: Trainees experienced AFT as very helpful for their professional development and for dealing with alliance ruptures. The therapeutic competence significantly improved both in self and in observer ratings. The results indicate that AFT is a promising approach to improve psychotherapy training, emphasizing the relevance of the planned proof of concept RCT.

Facilitators and barriers in anorexia nervosa treatment initiation (FABIANA): study protocol for a mixed-methods and multicentre study.

BACKGROUND: Anorexia nervosa is a serious disorder, which often takes a chronic course. Early treatment leads to a significantly better prognosis and prevents chronicity. However, existing evidence on facilitators and barriers in anorexia nervosa treatment initiation is scarce. AIMS: Against this background, the FABIANA study (ClinicalTrials.gov Identifier: NCT03713541) aims to (a) identify potentially modifiable facilitators and barriers from the perspectives of adolescent and adult patients with anorexia nervosa, carers and physicians, (b) develop and test an instrument for the combined assessment of multiple key facilitators and barriers, and (c) quantify the effect of potentially modifiable versus non-modifiable key facilitators and barriers on the duration of untreated illness (DUI) in patients with anorexia nervosa. METHOD: FABIANA is an observational, mixed-method-study divided into three consecutive substudies each corresponding to one of the study aims. All three substudies will include female patients with anorexia nervosa aged 14 years and older at the beginning of their first psychotherapeutic anorexia nervosa treatment. The qualitative substudy I and the quantitative substudy III will additionally include carers and involved physicians. The recruitment will take place at 20 cooperating study centres throughout Germany, which provide in-patient or out-patient anorexia nervosa specialist care. The DUI will be calculated based on the month of illness onset as determined in validated interviews on lifetime anorexia nervosa symptoms and the therapist-reported date of treatment initiation. CONCLUSIONS: Strengths and limitations of the retrospective assessment of the DUI will be discussed. The findings of the FABIANA study will contribute to the development of evidence-based early-intervention approaches and the prevention of a chronic course of illness. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03713541. DECLARATION OF INTEREST: None.

Facilitative interpersonal skills performance test: Psychometric analysis of a German language version.

OBJECTIVE: This study aimed at a psychometric analysis of the Facilitative Interpersonal Skills (FIS) performance test, a test of therapist relational skills that has repeatedly been found to predict psychotherapy outcome. We investigated the reliability, unidimensionality, and convergent validity of a German language version and psychometrics relevant for repeated and short assessments. METHOD: Thirty-nine trainee therapists took the FIS performance test and responded to self-report scales. RESULTS: Inter-rater agreement and internal consistency were high. The findings suggest that the FIS is a unidimensional scale. Correlations between the FIS and self-reported social skills, interpersonal problems, and working involvement were absent to low. FIS performance was independent from specific video stimuli and there was no indication of temporal effects. CONCLUSIONS: The findings suggest that the FIS is robust and ready to be used in repeated assessments and in short form. Further conceptual clarification of the FIS is needed.

Focusing on Patients' Existing Resources and Strengths in Cognitive-Behavioral Therapy and Psychodynamic Therapy: A Systematic Review and Meta-Analysis.

Objectives: Integrating a stronger focus on patients' existing strengths in traditional psychotherapy approaches is suggested by recent developments in psychological science, positive psychology, and psychotherapy research. However, the empirical status of treatments focusing on patients' existing strengths is unclear. The aim of this study was to conduct a systematic review (PROSPERO registration CRD42017054362) of studies on adaptations of traditional treatment approaches (e. g., cognitive-behavior therapy or psychodynamic therapy) explicitly focused on using patients' existing resources and strengths (hereafter, resource-focused treatments; RFT). Methods: Extensive systematic literature search yielded k = 11 treatment comparisons from 10 studies contrasting RFTs with either an alternative psychotherapeutic approach or wait list. Effect sizes controlling for pre-treatment differences (gPPWC) and standard Hedges's g effect sizes (gPOWC) were aggregated with random-effects methods Results: Across 8 direct comparisons, RFTs were superior to other psychotherapeutic approaches, as indicated by small to moderate (gPPWC = -0.349, 95 % CI -0.576, -0.122, p = .003, I2 = 46.50 %) and small effect sizes (gPOWC = -0.190, 95 % CI -0.355, -0.025, p = .024, I2 = 0.00 %) in favor of RFTs. Sensitivity analyses corroborated results. Many included studies were characterized by limited sample size, risk of bias or researcher allegiance. Conclusions: This meta-analysis showed preliminary evidence for the benefits of RFTs and suggests an intensification of further research efforts. The evidence was most convincing for hypnotherapeutic-systemic interventions as an add-on for cognitive-behavioral therapy.