Self-Practice of Stabilizing and Guided Imagery Techniques for Traumatized Refugees via Digital Audio Files: Qualitative Study.

BACKGROUND: Refugees have an increased risk of developing mental health problems. There are insufficient psychosocial care structures to meet the resulting need for support. Stabilizing and guided imagery techniques have shown promising results in increasing traumatized refugees' emotional stabilization. If delivered via audio files, the techniques can be practiced autonomously and independent of time, space, and human resources or stable treatment settings. OBJECTIVE: This study aimed to evaluate the self-practice of stabilizing and guided imagery techniques via digital audio files for traumatized refugees living in a reception and registration center in Germany. METHODS: From May 2018 to February 2019, 42 traumatized refugees participated in our study. At T1, patients received digital audio files in English, French, Arabic, Farsi, Turkish, or Serbian for self-practice. Nine days later, at T2, a face-to-face interview was conducted. Two months after T2, a follow-up interview took place via telephone. RESULTS: At T2, about half of the patients reported the daily practice of stabilizing and guided imagery techniques. At follow-up, the average frequency of practice was once weekly or more for those experiencing worse symptoms. No technical difficulties were reported. According to T2 and follow-up statements, the techniques helped the patients dealing with arousal, concentration, sleep, mood, thoughts, empowerment, and tension. The guided imagery technique "The Inner Safe Place" was the most popular. Self-practice was impeded by postmigratory distress factors, like overcrowded accommodations. CONCLUSIONS: The results show that self-practice of stabilizing and guided imagery techniques via digital audio files was helpful to and well accepted by the assessed refugees. Even though postmigratory distress factors hampered self-practice, "The Inner Safe Place" technique was particularly well received. Overall, the self-practiced audio-based stabilizing and guided imagery techniques showed promising results among the highly vulnerable group of newly arrived traumatized refugees.

Secondary Traumatization, Psychological Stress, and Resilience in Psychosocial Emergency Care Personnel.

Volunteers active in psychosocial emergency care offer psychological first aid to survivors of accidents and trauma, their relatives, eye witnesses, bystanders, and other first responders. So far, there are no studies that investigate the secondary and primary traumatization of this group of first responders. We included N = 75 volunteers, who filled out questionnaires to assess their secondary (QST/FST) and primary traumatization (PDS), and levels of comorbid psychological stress (PHQ-9, GAD-7, SF-12). We investigated factors of resilience by measuring attachment behavior (ECR-RD, RQ-2), level of personality functioning (OPD-SFK), sense of coherence (SOC-29), social support (F-SozU), and mindfulness (MAAS). The volunteers' levels of secondary and primary traumatization were below cut-off scores. Their levels of comorbid psychological stress were comparable to representative norm samples. Additionally, the volunteers presented high levels of resilience. Gender (ß = 0.26; p < 0.05), case discussions (ß = -0.37; p < 0.05), and social support (ß = 0.45; p < 0.01) were revealed to be predictors of secondary traumatization, while mindfulness turned out to be a predictor of primary traumatization (ß = -0.34; p = 0.008). However, we cannot rule out that the low prevalence of traumatization and comorbid psychological stress in our study sample might not be explained by a positive response bias.

Stabilizing Techniques and Guided Imagery for Traumatized Male Refugees in a German State Registration and Reception Center: A Qualitative Study on a Psychotherapeutic Group Intervention.

Refugees have an increased risk of developing mental health problems. Due to the unstable setting in refugee state registration and reception centers, recommended trauma-focused treatment approaches are often not applicable. For this purpose, we devised a suitable therapeutic approach to treat traumatized refugees in a German state registration and reception center: Group therapy, focusing on stabilizing techniques and guided imagery according to Reddemann (2017). From May 2017 to April 2018, we conducted semi-structured interviews with n = 30 traumatized refugees to assess their experiences with the stabilizing techniques and guided imagery in group sessions and self-practice. Participants mainly reported that they had more pleasant feelings, felt increasingly relaxed, and could better handle recurrent thoughts. Additionally, the participants noticed that their psychosocial functioning had improved. The main difficulties that participants encountered were feeling stressed, having difficulties staying focused, or concentrating on the techniques. During self-practice, the participants found it most challenging that they did not have any verbal guidance, were often distracted by the surroundings in the accommodation, and had recurrent thoughts about post-migratory stressors, such as insecurity concerning the future or the application for asylum. Our results show that stabilizing techniques and guided imagery according to Reddemann (2017) are a suitable approach to treat traumatized refugees living in volatile conditions.

A Comparison of Stress Perception in International and Local First Semester Medical Students Using Psychometric, Psychophysiological, and Humoral Methods.

(1) Medical doctors and medical students show increased psychological stress levels. International medical students seem to be particularly vulnerable. (2) We compared different methods of assessing stress levels in international and local first year medical students. First, study participants completed questionnaires related to stress, depression, empathy, and self-efficacy (MBI, PSQ, PHQ-9, JSPE-S, and GSE) at three separate points in time (T1 to T3). Second, their heart rate variabilities (HRVs) were recorded in an oral examination, a seminar, and in a relaxing situation. Third, hair samples were collected at the beginning and at the end of the semester to assess the cortisol concentration. (3) Included were 20 international and 20 local first semester medical students. At T1, we found considerable differences between international and local students in the JSPE-S; at T2 in the MBI factor "professional efficacy", the PHQ-9, and in the JSPE-S; and at T3 in the MBI factors "cynicism" and "professional efficacy", the PHQ-9, and in the JSPE-S. International and local students also differed concerning their HRVs during relaxation. Over the course of the semester, international students showed changes in the MBI factors "emotional exhaustion" and "professional efficacy", the PHQ-9, and the GSE. Local students showed changes in the GSE. No effects were found for students' hair cortisol concentrations. (4) All participants showed low levels of stress. However, while international students experienced their stress levels to decrease over the course of the semester, local students found their stress levels to increase.

[Teaching about chronic pain in psychosomatics courses - an overview of the situation in Germany and the Tübingen Model]. / Schmerzmedizin in der psychosomatischen Lehre ­ Deutschland-Übersicht und Tübinger Modell.

Teaching about chronic pain in psychosomatics courses - an overview of the situation in Germany and the Tübingen Model Objectives: When dealing with chronic pain patients it is crucial to take a bio-psycho-social approach. However, it is unclear how this approach is currently being taught to medical students, and how they judge its role and importance. METHODS: We carried out a qualitative study (questionnaire) asking (1) German psychosomatic departments about pain-related teaching and (2) medical undergraduates about pain-relevant issues. RESULTS: Bio-psycho-social facts are well represented within psychosomatics courses but only theoretically tested. There is still much room for improvement through cross-linking with other disciplines. In Tübingen, "psychosocial factors" and the "empathic doctor-patient relationship" play a significantly higher role when teaching psychosomatic courses than somatic ones. There were no significant differences regarding the role of an "integrative recording of medical history" or how the importance of any of the three topics was rated. CONCLUSIONS: Chronic pain is well represented in psychosomatic courses in Germany, though exams could be more practical. The establishment of interdisciplinary approaches beyond the teaching of core psychosomatic content could be expanded and especially used more frequently when adapting curricula to competence-based standards.

Healthy ageing at work- Efficacy of group interventions on the mental health of nurses aged 45 and older: Results of a randomised, controlled trial.

OBJECTIVE: This multicentre, randomised controlled trial (RCT) aimed to evaluate the efficacy of a small-group intervention promoting successful ageing at work in older nurses (aged ≥45). METHOD: A sample of 115 nurses aged ≥45 from 4 trial sites in Germany were randomly assigned to either the intervention group (IG), that received a small-group intervention of seven weekly sessions of 120 min with a booster session after six weeks or to a wait-list control condition (WLC). Outcomes were measured via validated self-report questionnaires at baseline (T1) and at post-treatment (T2). Primary outcomes were mental health-related well-being and mental health-related quality of life (QOL). The secondary outcomes included mental health-related and work-related measures. RESULTS: The intention to treat (ITT) analysis showed significant positive effects of the intervention on mental health. A significant small effect (d = 0.3) in favour of the IG was found for psychological health-related quality of life. Positive small effects (d = 0.24 to d = 0.31) were also found for work related mental strain. CONCLUSIONS: Our small-group intervention based on a theory of successful ageing for nurses aged ≥45 was found to be effective with regard to improvements of psychological health related quality of life and other mental health-related outcomes. Thus, our study shows that the ageing workforce can be reached through specifically designed preventive interventions. The components of our intervention could be easily adapted to the belongings of other professions. Our results suggest that these components should be evaluated in various settings outside the healthcare sector.

Depression profile in cancer patients and patients without a chronic somatic disease.

BACKGROUND: To investigate whether depressed oncology patients show a specific depressive symptom profile, we compared depression symptoms in depressed cancer patients (CANCER-DEP) and depressed patients without a chronic somatic disease (NONCANCER-DEP). METHODS: Of a total of 2493 outpatients from a comprehensive cancer center and a center for psychosocial medicine, 1054 (42.3%) met the DSM-5 criteria for depression, measured with the Patient Health Questionnaire 9. Based on the Patient Health Questionnaire 9 scores, differences in severity of each of the 9 individual DSM-5 depression symptoms between CANCER-DEP (n = 542) and NONCANCER-DEP (n = 512) were examined. Non-depressed cancer patients (CANCER-NONDEP; n = 1216) served as a comparison group for somatic symptoms independent of depression in cancer. To control for depression severity, group comparisons were performed separately for patients with major depression and any depressive disorders. RESULTS: Depressed cancer patients reported significantly lower levels of the cognitive-emotional depression symptoms "worthlessness" and "suicidal thoughts" than NONCANCER-DEP. Only 1 out of 5 somatic depression symptoms ("changes in appetite") was more pronounced in CANCER-DEP than in NONCANCER-DEP. Confirming previous research, somatic depression symptoms occurred more frequently in CANCER-DEP than in CANCER-NONDEP. CONCLUSIONS: The lower level of cognitive-emotional symptoms in CANCER-DEP than in NONCANCER-DEP is discussed in relation to different psychosocial phenomena. Our results indicate that somatic depression symptoms are similarly pronounced in CANCER-DEP and NONCANCER-DEP, and that CANCER-DEP show greater somatic depression symptoms than CANCER-NONDEP. The presence of high levels of somatic symptoms should alert clinicians to investigate for a potential comorbid depression in cancer patients.

[Normative-empirical determination of personnel requirements in psychosomatic medicine and psychotherapy]. / Normativ-empirische Bestimmung des Personalbedarfs in der Psychosomatischen Medizin und Psychotherapie.

OBJECTIVES: There is a high degree of misallocated medical care for patients with somatoform disorders and patients with concomitant mental diseases. This complex of problems could be reduced remarkably by integrating psychosomatic departments into hospitals with maximum medical care. Admitting a few big psychosomatic specialist clinics into the calculation basis decreased the Day-Mix Index (DMI). The massive reduction of the calculated costs per day leads to a gap in funding resulting in a loss of the necessary personnel requirements - at least in university psychosomatic departments. The objective of this article is therefore to empirically verify the reference numbers of personnel resources calculated on the basis of the new German lump-sum reimbursement system in psychiatry and psychosomatics (PEPP). METHODS: The minute values of the reference numbers of Heuft (1999) are contrasted with the minute values of the PEPP reimbursement system in the years 2013 and 2014, as calculated by the Institute for Payment Systems in Hospitals (InEK). RESULTS: The minute values derived from the PEPP data show a remarkable convergence with the minute values of Heuft's reference numbers (1999). CONCLUSIONS: A pure pricing system like the PEPP reimbursement system as designed so far threatens empirically verifiable and qualified personnel requirements of psychosomatic departments. In order to ensure the necessary therapy dosage and display it in minute values according to the valid OPS procedure codes, the minimum limit of the reference numbers is mandatory to maintain the substance of psychosomatic care. Based on the present calculation, a base rate of at least 285 e has to be politically demanded. Future developments in personnel costs have to be refinanced at 100 %.

[Day-clinic and Inpatient Psychotherapy of Depression (DIP-D)--Secondary Outcomes and Follow-up Results of a Randomized-Controlled Pilot Trial]. / Tagesklinische und stationäre Psychotherapie der Depression (DIP-D)--Sekundäre Erfolgsmaße und Katamneseergebnis einer randomisiert-kontrollierten Pilotstudie.

Depressions are frequent disorders in psychosomatic medicine and psychotherapy. However, there are only few controlled studies comparing different levels of care for depressed patients. Especially the efficacy of day-clinic psychotherapy for depression remains understudied. The pilot study aims to close this gap by examining the feasibility of a randomized-controlled trial comparing day-clinic and inpatient psychotherapy for depression in a routine hospital setting. The current paper adds the secondary outcome measures on patient self-reported symptoms and interpersonal problems. In addition, findings of a 6-month follow-up are analyzed. Overall, 44 patients were recruited and randomly allocated to either day clinic or inpatient psychotherapy for 8 weeks. Depressive symptoms and interpersonal problems decreased during treatment, and follow-up scores stayed below intake scores. There were no differences between the treatment groups in this pilot study. For the future, it is desirable to compare randomized patients with those patients who received their preferred treatment option. Although the findings need to be replicated in larger samples, they appear promising for day-clinic psychotherapy. The better understanding of differential effectiveness of different levels of care of patient subgroups remains an important goal.

The effect of using standardized patients or peer role play on ratings of undergraduate communication training: a randomized controlled trial.

OBJECTIVES: Considering the expense of standardized patients (SP) for training communication skills and the convenience of peer role playing (RP) there is a surprising lack of studies directly comparing the two methods. METHODS: Fifth year medical students (N=103) were assigned to three groups receiving a training in counseling parents of sick children with RP (N=34) or SP (N=35) or to a control group (CG, N=34). We assessed self-efficacy, as well as objective performance in parent-physician communication using questionnaires and the Calgary-Cambridge-Observation-Guide Checklist in a six-station OSCE, respectively. RESULTS: The training led to an increase in self-efficacy ratings and in the post-intervention OSCE score after RP (p<.021 and p<.001 respectively) and SP-training (p<.007 and p<.006 respectively) compared to controls. Surprisingly, this benefit was higher after RP than after SP-training (p<.021) due to significantly higher performance in the domain understanding of parents'perspective (p<.001). CONCLUSION: Both RP and SP are valuable tools for training specific communication skills. RP offer a methodological advantage in fostering empathy for patient perspectives. PRACTICE IMPLICATIONS: Both peer-role-play and standardized patients hold specific benefits for communication training. Peer-role-play seems to foster a more empathic approach towards patients' concerns justifying its prominent role in medical curricula.

Peer role-play and standardised patients in communication training: a comparative study on the student perspective on acceptability, realism, and perceived effect.

BACKGROUND: To assess the student perspective on acceptability, realism, and perceived effect of communication training with peer role play (RP) and standardised patients (SP). METHODS: 69 prefinal year students from a large German medical faculty were randomly assigned to one of two groups receiving communication training with RP (N = 34) or SP (N = 35) in the course of their paediatric rotation. In both groups, training addressed major medical and communication problems encountered in the exploration and counselling of parents of sick children. Acceptability and realism of the training as well as perceived effects and applicability for future parent-physician encounters were assessed using six-point Likert scales. RESULTS: Both forms of training were highly accepted (RP 5.32 +/- .41, SP 5.51 +/- .44, n.s.; 6 = very good, 1 = very poor) and perceived to be highly realistic (RP 5.60 +/- .38, SP 5.53 +/- .36, n.s.; 6 = highly realistic, 1 = unrealistic). Regarding perceived effects, participation was seen to be significantly more worthwhile in the SP group (RP 5.17 +/- .37, SP 5.50 +/- .43; p < .003; 6 = totally agree, 1 = don't agree at all). Both training methods were perceived as useful for training communication skills (RP 5.01 +/- .68, SP 5.34 +/- .47; 6 = totally agree; 1 = don't agree at all) and were considered to be moderately applicable for future parent-physician encounters (RP 4.29 +/- 1.08, SP 5.00 +/- .89; 6 = well prepared, 1 = unprepared), with usefulness and applicability both being rated higher in the SP group (p < .032 and p < .009). CONCLUSIONS: RP and SP represent comparably valuable tools for the training of specific communication skills from the student perspective. Both provide highly realistic training scenarios and warrant inclusion in medical curricula. Given the expense of SP, deciding which method to employ should be carefully weighed up. From the perspective of the students in our study, SP were seen as a more useful and more applicable tool than RP. We discuss the potential of RP to foster a greater empathic appreciation of the patient perspective.

[Working as a clinician-scientist in psychosomatic medicine: status, skills and research productivity]. / Der klinische Forscher in der psychosomatischen Medizin: Status, Kompetenzen und Leistungen.

OBJECTIVE: Even though there is a high need of clinical research for the medical and psychotherapeutic practice in Germany, the interest in clinical research seems to be decreasing. The aim of this study was to assess the circumstances under which clinical research in psychosocial medicine is performed and to identify opportunities for improvement. METHODS: n = 53 residents of the departments for Psychosomatic Medicine of the University Hospitals of Heidelberg and Tübingen and of the Technical University of Munich were asked about their research activities, their subjective research skills, and their productivity in clinical psychosocial research. In addition, objective research knowledge was investigated using a multiple-choice test. RESULTS: Both, subjective research skills and objective research knowledge were relatively low. The percentage of correct answers in the multiple choice test was 33 %. Subjective problems were predominately stated regarding "biostatistics" and "study design". In terms of research productivity, 33 % of residents had published as first authors of an original journal article, and 12 % had submitted a successful grant proposal. DISCUSSION: Altogether, there is a high need of training in the field of clinical psychosomatic research. We are presenting a training model that is adapted to the conditions of young clinicians and that addresses both general clinical research and specific psychosocial clinical research.

[Role playing as an essential element of simulation procedures in medicine]. / Rollenspiel als wesentliches Element bei Simulationsverfahren in der Medizin.

Role playing is an important element of virtually all simulation-based procedures. An improved understanding for methodological aspects facilitates its goal-oriented use in education and training, research and examinations. In the present paper we describe how different forms of role play are used in different simulation-based procedures. We describe a plausibility study from skills labs demonstrating that the introduction of role-playing can increase perceived realism. Finally we derive practical suggestions for the conduction of role plays in medical simulation.

[Medical education in the field of psychosomatic medicine and psychotherapy at the German universities in 2006]. / Der Unterricht im Fach "Psychosomatische Medizin und Psychotherapie" an den Hochschulen der Bundesrepublik Deutschland nach Anderung der Approbationsordnung für Arzte.

BACKGROUND: The new licensing regulations for physicians introduced in 2002 place core competencies in the field of Psychosomatic Medicine and Psychotherapy at the centre of medical training and have been considered to constitute a favourable opportunity for psychosocial faculties. To date, no data have been published concerning the consequences of these new regulations. METHODS: All 34 chairs of Psychosomatic Medicine and Psychotherapy currently held by professors were surveyed by means of a written questionnaire at the beginning of the year 2006, regarding the present teaching situation and changes occurring through the introduction of the new regulations, as well as particular problem areas and respective solutions and suggestions. RESULTS: The rate of return for the questionnaires was 100 %. The consequences of the new regulations were rated predominantly positively. From a content point of view, classes continue to be more heavily weighted in cognitive areas and less so in areas of clinical practice; demands for an emphasis on affective learning objectives hence appear to have not been adequately met thus far. The newly established course formats (cross-sectional areas, obligatory optional courses, tutorials) also appear to have been employed to a rather limited degree. In addition to a lack of resources, the co-ordination with other specialist areas as well as the adequate assessment of teaching content poses a particular problem. DISCUSSION: The field of Psychosomatic Medicine and Psychotherapy constitutes an important engine for the didactic and content-related advancement of the medical curriculum in Germany. Nevertheless, the opportunities which the new licensing regulations for physicians offer to psychosocial faculties have not yet been entirely made use of. Surveyed individuals consider nationwide agreement concerning learning objectives, an exchange of experiences regarding the efficient and creative use of available resources and the development of suitable assessment methodologies, to be tasks to be urgently undertaken.

[Communication and interaction in psychosomatic education: use of standardized patients]. / Kommunikations- und Interaktionstraining im psychosomatischen Praktikum: Einsatz von standardisierten Patienten.

An amendment to the German medical curriculum in April 2002 will place communication and social skills at the centre of medical training. In addition to providing cognitive knowledge, psychosomatic courses offer the opportunity to integrate affective learning, with a focus on communication and interaction processes. In winter term 2001/2002 a training with standardised patients was implemented and evaluated as part of the psychosomatic internship of the Department of General Internal and Psychosomatic Medicine at the Medical Hospital of the University of Heidelberg. Quantitative and qualitative results showed that training with standardised patients is well accepted and that acceptance is independent of student gender, career choice, or interests. These training units are easy to integrate into psychosomatic practical courses. The results discussed here will focus on the role and importance of various elements of medical training.