[Assessing common factors in psychotherapy: psychometric properties of a new time-economic instrument (WIFA-k)]. / WIFA-k: Ein neues Messinstrument zur zeitökonomischen Erfassung allgemeiner Wirkfaktoren nach Grawe.

Research on common and differential factors in the therapeutic process is impeded by the lack of instruments suitable for assessing common change mechanisms. This study presents the psychometric properties of a newly developed time-economic instrument (WIFA-k), which was designed to assess common factors of psychotherapy as designed by Grawe. Within a multi-center study comparing the efficacy of cognitive therapy and psychodynamic therapy in the treatment of social phobia, 6 raters assessed 25 randomly selected, videotaped therapy sessions of each treatment approach, and evaluated common factors using the Wifa-k. Interrater-reliability was found to be high for the items "resource activation", "motivational clarification" and "mastery" and low for the items "therapeutic relationship" and "problem activation". Ways to increase reliability and validity of the scale are discussed.

Assessing therapeutic competence in cognitive therapy for social phobia: psychometric properties of the cognitive therapy competence scale for social phobia (CTCS-SP).

BACKGROUND: There has been considerable acknowledgement in treatment outcome research that, although the assessment of treatment integrity is essential in many respects, it requires great effort as well as resources and is therefore often neglected. AIMS: In order to fill this gap, the Cognitive Therapy Competence Scale for Social Phobia (CTCS-SP) was developed, based on the Cognitive Therapy Scale, to measure therapist competence in delivering cognitive therapy for social phobia. The aim of the present study was to investigate interrater reliability, internal consistency and retest reliability of the scale. METHOD: Raters evaluated therapist competence from 161 videotaped sessions (98 patients) selected from 234 cognitive treatments within a multi-centre study. RESULTS: Interrater-reliability was found to be high for the overall score (ICC = .81) and moderate for individual items (ICC = .62-.92). Internal consistency and retest reliability were also found to be high (Cronbach's alpha = .89; (ICCretest = .86). CONCLUSIONS: The results indicate that the CTCS-SP is highly reliable. As even individual items yield satisfactory reliability, the scale can be used in various fields of research, including the measurement of changes in skill acquisition and the impact of competence on outcome criteria.

ADC changes in schizophrenia: a diffusion-weighted imaging study.

Studies using diffusion tensor imaging (DTI) have shown multifocal reduction in anisotropy of white matter fibre tracts in schizophrenia, and a few of these also suggest changes in apparent diffusion coefficient (ADC). In this study, we assessed ADC in 18 patients with schizophrenia and 18 healthy controls using a voxel-based approach. We did not find evidence of statistically significant changes in ADC in either direction at P < 0.05 (FDR corrected) using different smoothing filter sizes; only at an uncorrected threshold of P < 0.001 did we find an increase in a small right prefrontal area close to our previous FA finding. Our findings therefore do not support ADC changes to be a marker of white matter or grey matter abnormalities in schizophrenia. Changes in other parameters like fractional anisotropy (FA) might be a more sensitive indicator of white matter pathology in this disorder.

[SOPHO-NET - a research network on psychotherapy for social phobia]. / SOPHO-NET - Forschungsverbund zur Psychotherapie der Sozialen Phobie.

This paper presents the Social Phobia Psychotherapy Research Network (SOPHO-NET). SOPHO-NET is among the five research networks on psychotherapy funded by "Bundesministerium für Bildung und Forschung". The research program encompasses a coordinated group of studies of social phobia. In the central project (Study A), a multi-center randomized controlled trial, refined models of manualized cognitive-behavioral therapy (CBT) and manualized short-term psychodynamic psychotherapy (STPP) are compared in the treatment of social phobia. A sample of n=512 outpatients will be randomized to either CBT, STPP or wait list. For quality assurance and treatment integrity, a specific project has been established (Project Q). Study A is complemented by four interrelated projects focusing on attachment style (Study B1), cost-effectiveness (Study B2), polymorphisms in the serotonin transporter gene (Study C1) and on structural and functional deviations of hippocampus and amygdala (Study C2). Thus, the SOPHO-NET program allows for a highly interdisciplinary research of psychotherapy in social phobia.

White matter abnormalities and brain activation in schizophrenia: a combined DTI and fMRI study.

Diffusion tensor imaging (DTI) studies of schizophrenia have revealed white matter abnormalities in several areas of the brain. The functional impact on either psychopathology or cognition remains, however, poorly understood. Here we analysed both functional MRI (during a working memory task) and DTI data sets in 18 patients with schizophrenia and 18 controls. Firstly, DTI analyses revealed reductions of fractional anisotropy (FA) in the right medial temporal lobe adjacent to the right parahippocampal gyrus, likely to contain fibres of the inferior cingulum bundle, and in the right frontal lobe. Secondly, functional MRI revealed prefrontal, superior parietal and occipital relative hypoactivation in patients with the main effect of task. This was accounted for by reduced prefrontal activation during the encoding phase of the task, but not during maintenance or retrieval phases. Thirdly, we found a direct correlation in patients between the frontal FA reduction (but not medial temporal reductions) and fMRI activation in regions in the prefrontal and occipital cortex. Our study combining fMRI and DTI thus demonstrates altered structure-function relationships in schizophrenia. It highlights a potential relationship between anatomical changes in a frontal-temporal anatomical circuit and functional alterations in the prefrontal cortex.

Temporal changes in neural activation during practice of information retrieval from short-term memory: an fMRI study.

Several findings indicate that practice in working memory tasks leads to signal decreases in task-relevant regions. However, the precise dynamics underlying these signal decreases and how they are correlated with improvements in behavioral performance are still matters of debate. We used functional magnetic resonance imaging (fMRI) to assess the cerebral correlates of the practice-related transition from controlled to automatic processing for the retrieval of information maintained in working memory storage. Exponential signal decreases and increases were modeled as covariates of interest. In addition, a bivariate regression analysis on the change in BOLD signal for two a priori hypothesized prefrontal regions (VLPFC, DLPFC) and the change in behavioral performance was conducted to examine the relationship between practice-related changes in cerebral activation and performance. We found exponential practice-related signal decreases mainly in the right superior frontal gyrus/DLPFC (BA 8/9/46), the middle frontal gyrus bilaterally (BA 10/11), the left precentral gyrus (BA 4/6) and the dorsal part of the right anterior cingulate cortex (BA 32). An exponential signal increase was detectable in the posterior cingulate cortex adjacent to the corpus callosum. In addition, there was a correlation between the practice-related change in BOLD signal in the DLPFC (BA 8/9) and the practice-related change in behavioral performance. These results suggest that the transition from controlled to automatic working memory processing is associated with exponential signal decreases in task-relevant regions. The temporal changes in brain activation patterns could be attributed to enhanced efficiency of information processing as a result of cognitive practice.

Common factors of cognitive therapy and interpersonal psychotherapy in the treatment of social phobia.

The comparison of active ingredients across different psychotherapeutic approaches is impeded by the specificity of the theoretical concepts explaining change mechanisms. This study aims to shed light on effective components of the therapeutic process in a trial comparing cognitive therapy (CT) and interpersonal psychotherapy (IPT) in the treatment of social anxiety disorder (SAD). Sixty-two outpatients with SAD were included in the study. Patients and therapists rated common efficacy factors after each session according to the generic model developed by Grawe (2004). Results show significant differences between treatment conditions on several therapist-rated subscales. Therapist ratings revealed a significantly greater focus on behavioral coping strategies in CT as compared with IPT. In addition, CT therapists also reported greater use of resource activation and motivational clarification. No differences were found with regard to problem activation or the therapeutic relationship. Therapeutic outcome was predicted by resource activation and problem activation. Implications of the findings for research and practice are discussed.