Effectiveness of behavioral activation and mindfulness in increasing reward sensitivity and reducing depressive symptoms - A randomized controlled trial.

Reward insensitivity is a potential key mechanism regarding the maintenance of depression. However, there is a lack of research examining and comparing the effectiveness of different psychological interventions in modifying reward insensitivity. This four-arm randomized controlled trial (RCT) investigated a two-week online intervention. After screening for eligibility, a total of 336 participants were randomized, and 224 participated per-protocol. Participants were assigned to either a) behavioral activation, b) mindfulness and gratitude, c) a combination of both, or d) a waitlist control condition. They received videos and implemented daily exercises. Reward sensitivity and depressive symptoms served as primary outcomes. Behavioral activation and mindfulness significantly improved depressive symptoms and reward sensitivity. However, the effects of behavioral activation were not superior. The combination treatment versus the waiting group was insignificant regarding reward insensitivity. Explorative analyses revealed that all intervention groups reduced anhedonia substantially. Our findings imply that brief online interventions with behavioral activation and mindfulness-based approaches can impact reward insensitivity, while effects for a combination were less clear. Nonetheless, our results do not allow us to infer the differential effectiveness of the interventions. There is a clear need for treatments better targeting maintaining factors of depression, such as reward insensitivity. Clinical trial registration number: NCT05402150.

Effects of Neurexan ® in an experimental acute stress setting--An explorative double-blind study in healthy volunteers.

AIMS: The objective of this study was to assess the efficacy profile of Nx4 (Neurexan ®) in an acute experimental stress setting. An acute stress reaction is a biopsychological condition arising in response to an event that is individually regarded as emotionally stressful. Medications can mitigate stress perception and stress reactions, but may also have side effects. MATERIALS AND METHODS: Sixty-four healthy male and female volunteers participated in this prospective two-arm two-site study following an explorative randomized placebo-controlled double-blind study design. Participants took six tablets of either Nx4 or placebo during a time period of 2.5h before exposure to an acute psychological stressor (Trier Social Stress Test), and were subsequently monitored for 1.5h. Subjective stress ratings as well as cardiovascular and neuroendocrine parameters were analyzed before and after stress exposure. KEY FINDINGS: All changes in primary and secondary efficacy parameters corresponded well with the experimental acute stress setting. Nx4 did not affect subjective stress ratings but significantly diminished stress-induced increases in salivary cortisol and plasma adrenaline. Nx4 was as safe as placebo and very well tolerated. SIGNIFICANCE: The results suggest an attenuated neuroendocrine stress response in healthy volunteers induced by Nx4. However, further investigations are needed to confirm these observations as well as to better understand why some parameters were affected while others were not. Future investigations should be extended to chronically stressed individuals with a greater disposition to experience stress in everyday life. ClinicalTrials.gov Identifier: NCT01703819.

[F45.41: chronic pain disorder with somatic and psychological factors : a coding aid]. / F45.41 Chronische Schmerzstörung mit somatischen und psychischen Faktoren : Eine Kodierhilfe.

In 2009, the German version of ICD-10 (ICD-10 GM version 2009) introduced the diagnosis of "chronic pain disorder with somatic and psychological factors", because current ICD-10 diagnoses did not address the biopsychosocial character of chronic pain adequately. For most patients, a dichotomous classification into psychologically versus biomedically caused pain is inappropriate and does not reflect current knowledge on pain. The new code F45.41 addresses the relevance of psychological factors for chronic pain persistence and chronic pain treatment, even in those conditions with a clear biomedical cause at the beginning. This guideline describes how to use this new diagnosis, which boundaries have to be considered, and how comorbid and associated conditions can be classified. The distinction of this new diagnosis from other pain-associated diagnoses and recommendations for the coding of comorbid conditions are presented. The differentiation of everyday pain symptoms from pain disorders is outlined. Finally, contextual factors of the classification process, as well as problems in integrating this new diagnosis into diagnosis-related group (DRG) systems of financial reimbursement are discussed.

[Personal responsibility for health. An interdisciplinary discussion on obesity as an example]. / Verantwortung für die eigene Gesundheit. Eine interdisziplinäre Diskussion am Beispiel der Adipositas.

Considering obesity as an example, the present study has developed an ethical, legal and psychological understanding of personal responsibility, which aims at enabling and activating health promoting behaviour. Enhancing individual capabilities and modifying social and political factors that have an effect on individual behaviour are highlighted as a promising, appropriate and ethically sound strategy of prevention.

[Desire for early retirement and therapy of chronic back pain: relevance of social medical variables for outpatient psychotherapeutic treatment]. / Rentenbegehren und Therapie chronischer Rückenschmerzen: Die Relevanz sozialmedizinischer Variablen bei ambulanter psychotherapeutischer Behandlung.

BACKGROUND: This study investigated the influence of patients' desire for early retirement on the success of an outpatient cognitive behavioural treatment (CBT) in patients with chronic back pain. Previous studies have shown that the desire for early retirement and social compensation had a negative influence on therapy outcome, e.g. pain intensity and pain disability. This study was conducted to reassess whether these results can be replicated in an outpatient CBT setting. METHOD: Questionnaires assessing pain-related variables were issued to a total of 116 patients at the beginning, at the end of treatment and 6 months after termination of therapy. RESULTS: Overall, the treatment showed significant positive results in the variables assessed. In contrast to other studies, patients with a desire for early retirement also showed improvement during treatment. The success of treatment proved to be stable after termination of therapy. CONCLUSION: CBT in an outpatient setting seems to be an effective treatment for patients with chronic back pain and even patients with a desire for early retirement benefit from treatment.