[Dialectical behavioral therapy for complex posttraumatic stress disorder (DBT-PTSD): an evidence-based disorder-specific treatment program]. / Dialektisch behaviorale Therapie für komplexe posttraumatische Belastungsstörung (DBT-PTBS): ein evidenzbasiertes störungsspezfisches Behandlungsprogramm.

Dialectical behavioral therapy for complex posttraumatic stress disorders (DBT-PTSD) is a modular treatment program that was developed at the Central Institute for Mental Health at the University of Heidelberg, Germany in 2005-2021. DBT-PTSD is designed to meet the needs of patients with complex PTSD related to sexual or physical trauma in childhood and adolescence. It is specifically designed for patients suffering from severe emotional dysregulation, persistent self-injury, chronic suicidal ideation, severe dissociative symptoms and a markedly negative self-concept with a high level of guilt, shame, self-loathing and interpersonal problems. To address these different core symptoms, DBT-PTSD combines evidence-based therapeutic strategies: principles, rules, and skills of DBT, trauma-specific cognitive and exposure-based techniques, imaginative interventions and procedures for behavioral change. The treatment program is designed to be carried out in an outpatient (45 weeks) or residential (12 weeks) setting. The results from two randomized controlled trials showed large effect sizes across very different symptom domains and a significant superiority of DBT-PTSD over Cognitive Processing Therapy (CPT). Based on these results, DBT-PTSD is currently a promising evidence-based treatment program for all features of a complex PTSD after sexual abuse in childhood and adolescence.

[Implementation and evaluation of a telephone hotline for professional mental health first aid during the COVID-19 pandemic in Germany]. / Implementierung und Evaluation einer Telefonhotline zur professionellen Ersthilfe bei psychischen Belastungen durch die COVID-19-Pandemie in Baden-Württemberg.

BACKGROUND: The COVID-19 pandemic represents a significant psychological burden for many people; however, especially during the first wave of the pandemic in Germany, little acute professional help was available for people in need. OBJECTIVE: In southern Germany, a telephone hotline for psychological first aid for COVID-19-related burdens was set up under the lead of the Baden-Wuerttemberg Ministry of Social Affairs and Integration, opened to the entire population and evaluated in April 2020. MATERIAL AND METHODS: In the period from 22 April to 24 July 2020, 753 volunteer psychotherapeutically trained counselors from different professional groups answered a total of 8096 calls. RESULTS: Depression symptoms (36%), anxiety symptoms (18%) and psychotic symptoms (19%) were most frequently reported. Every second call was related to a previous mental illness. During the counseling sessions, which lasted 25 min on average, a variety of psychological acute interventions were conducted. In the presence of unclear symptoms, psychotic symptoms or severe personality disorder symptoms, the counselors were able to help significantly less compared to the remaining calls in which other clearly defined symptoms were present. CONCLUSION: The results point to both the benefits and limitations of hotline services. The major benefits relate to the fast availability and effective professional help for people with clearly characterized symptoms. In the case of unclear or complex symptoms, immediate help by telephone seems to be possible only to a limited extent, but it could initiate access to further help offers. Overall, the results of this study provide a first indication that hotline services for psychological first aid are feasible under pandemic conditions.

Socio-economic consequences of mental distress: quantifying the impact of self-reported mental distress on the days of incapacity to work and medical costs in a two-year period: a longitudinal study in Germany.

BACKGROUND: Mental disorders are related to high individual suffering and significant socio-economic burdens. However, it remains unclear to what extent self-reported mental distress is related to individuals' days of incapacity to work and their medical costs. This study aims to investigate the impact of self-reported mental distress for specific and non-specific days of incapacity to work and specific and non-specific medical costs over a two-year span. METHOD: Within a longitudinal research design, 2287 study participants' mental distress was assessed using the Hospital Anxiety and Depression Scale (HADS). HADS scores were included as predictors in generalized linear models with a Tweedie distribution with log link function to predict participants' days of incapacity to work and medical costs retrieved from their health insurance routine data during the following two-year period. RESULTS: Current mental distress was found to be significantly related to the number of specific days absent from work and medical costs. Compared to participants classified as no cases by the HADS (2.6 days), severe case participants showed 27.3-times as many specific days of incapacity to work in the first year (72 days) and 10.3-times as many days in the second year (44 days), and resulted in 11.4-times more medical costs in the first year (2272 EUR) and 6.2-times more in the second year (1319 EUR). The relationship of mental distress to non-specific days of incapacity to work and non-specific medical costs was also significant, but mainly driven from specific absent days and specific medical costs. Our results also indicate that the prevalence of presenteeism is considerably high: 42% of individuals continued to go to work despite severe mental distress. CONCLUSIONS: Our results show that self-reported mental distress, assessed by the HADS, is highly related to the days of incapacity to work and medical costs in the two-year period. Reducing mental distress by improving preventive structures for at-risk populations and increasing access to evidence-based treatments for individuals with mental disorders might, therefore, pay for itself and could help to reduce public costs.

Psychometric properties of the German version of the fears of compassion scales.

The cultivation of compassion is associated with beneficial effects on physical and psychological health, satisfaction with life and social relationships. However, some individuals, especially those high in psychopathological symptoms or those with particular disorders such as borderline personality disorder (BPD) may demonstrate pronounced fears of engagement in compassionate experiences or behaviours. Furthermore, fears of compassion have been found to impede progress in psychotherapy. The 38-item fears of compassion scales (FCS) is a self-report questionnaire for measuring trait levels of fears of compassion (a) one receives from others (FCFO), (b) one feels towards others (FCTO) and (c) one feels for oneself (self-compassion; FSC). The FCS is an internationally used instrument of proven validity and reliability in both clinical and nonclinical samples. In the present study, a German translation of the FCS including its three subscales was provided, and the psychometric properties were examined in 430 participants from four different samples: (a) a sample from the general population; (b) a mixed sample of psychiatric residential and outpatients; (c) a clinical sample of residential and outpatients with a primary diagnosis of BPD and (d) a sample of healthy control participants. Internal consistencies were excellent for the German version of the FSC and acceptable to excellent for its subscales. Correlations with established measures of mental health demonstrate its validity. Additionally, the German FCS discriminates significantly between individuals from the general population and patients, thus supporting its specificity. The German FCS is suitable to detect potential obstacles in cultivating compassion in psychotherapeutic treatments and beyond.

Dissociation in victims of childhood abuse or neglect: a meta-analytic review.

Childhood abuse and neglect are associated with dissociative symptoms in adulthood. However, empirical studies show heterogeneous results depending on the type of childhood abuse or neglect and other maltreatment characteristics. In this meta-analysis, we systematically investigated the relationship between childhood interpersonal maltreatment and dissociation in 65 studies with 7352 abused or neglected individuals using the Dissociative Experience Scale (DES). We extracted DES-scores for abused and non-abused populations as well as information about type of abuse/neglect, age of onset, duration of abuse, and relationship to the perpetrator. Random-effects models were used for data synthesis, and meta-regression was used to predict DES-scores in abused populations from maltreatment characteristics. The results revealed higher dissociation in victims of childhood abuse and neglect compared with non-abused or neglected subsamples sharing relevant population features (MAbuse = 23.5, MNeglect = 18.8, MControl = 13.8) with highest scores for sexual and physical abuse. An earlier age of onset, a longer duration of abuse, and parental abuse significantly predicted higher dissociation scores. This meta-analysis underlines the importance of childhood abuse/neglect in the etiology of dissociation. The identified moderators may inform risk assessment and early intervention to prevent the development of dissociative symptoms.

Shame, self-disgust, and envy: An experimental study on negative emotional response in borderline personality disorder during the confrontation with the own face.

Background: A markedly negative self-image and pervasive shame proneness have consistently been associated with borderline personality disorder (BPD). The present experimental study investigated the intensity of negative emotional responses with a focus on shame in BPD compared to healthy control persons (HCs) during an experimental paradigm promoting self-awareness, self-reflection, and self-evaluation. Furthermore, the relationship between levels of state shame during the experiment and shame proneness in BPD compared to HCs was examined. Methods: A sample of 62 individuals with BPD and 47 HCs participated in the study. During the experimental paradigm, participants were presented with photos of (i) the own face, (ii) the face of a well-known person, and (iii) of an unknown person. They were asked to describe positive facets of these faces. Participants rated the intensity of negative emotions induced by the experimental task as well the pleasantness of the presented faces. Shame-proneness was assessed using the Test of the Self-Conscious Affect (TOSCA-3). Results: Individuals with BPD experienced significantly higher levels of negative emotions than HCs both before and during the experimental task. While HC participants responded to their own face particularly with an increase in shame compared to the other-referential condition, the BPD patients responded above all with a strong increase of disgust. Furthermore, the confrontation with an unknown or well-known face resulted in a strong increase of envy in BPD compared to HC. Individuals with BPD reported higher levels of shame-proneness than HCs. Higher levels of shame-proneness were related to higher levels of state shame during the experiment across all participants. Conclusion: Our study is the first experimental study on negative emotional responses and its relationship to shame proneness in BPD compared to HC using the own face as a cue promoting self-awareness, self-reflection, and self-evaluation. Our data confirm a prominent role of shame when describing positive features of the own face, but they emphasize also disgust and envy as distinct emotional experience characterizing individuals with BPD when being confronted with the self.

Predictors of Psychological Distress and Coronavirus Fears in the First Recovery Phase of the Coronavirus Disease 2019 Pandemic in Germany.

Objectives: While previous research has mainly focused on the impact of the first acute phase of the COVID-19 pandemic on mental health, little empirical knowledge exists about depression, anxiety, and somatic symptom levels and possible predictors of symptom levels in the pandemic's recovery phase. The present study aimed to analyze the mental burden of a convenience ample of the general German population during the first recovery phase of the pandemic and to identify significant predictors of symptom levels. Methods: Standardized measures of anxiety (GAD-2), depression (PHQ-2), somatic symptoms (PHQ-15), and health anxiety, as well as measures of COVID-19 fears and possible vulnerability factors, were administered through a national, cross-sectional online survey (n = 2160, mean age 42.7 years, 75% female), asking participants for their current symptom levels and their symptom levels prior to the COVID-19 pandemic. Results: Our findings show significantly elevated levels of depression, anxiety, somatic symptoms, and health anxiety in the recovery period compared to before the pandemic. The current prevalence rates based on self-reporting were 26.7% for depression, 24.5% for anxiety, and 29% for somatization. The strongest predictors of these symptom reports included domain-specific pre-existing symptom levels, neuroticism, biological COVID-19 risk factors, avoidance of illness information, and younger age. The most important predictors of COVID-19 fears were subjective COVID-19 risk perception, followed by pre-existing health anxiety, the number of biological COVID-19 risk factors, older age, neuroticism, avoidance of illness information and female gender. Discussion: These findings indicate the need for specific psychological programs to help individuals with enhanced psychological and biological vulnerability to cope better with the mental distress experienced during all phases of the ongoing COVID-19 crisis.

Effectiveness of a mindfulness- and skill-based health-promoting leadership intervention on supervisor and employee levels: A quasi-experimental multisite field study.

Acknowledging increasing demands for workforce health, new theoretical concepts of health-oriented leadership (HoL) have been introduced, emphasizing the supervisor's direct and explicit engagement in workplace health by focusing on their self- and staff-care. However, empirical evidence of the effectiveness of HoL interventions for supervisors and their staff is still scarce. We developed a mindfulness- and skill-based HoL intervention and investigated its effectiveness in a quasi-experimental multisite field study including supervisor and employee ratings from 12 German companies. A total of n = 117 supervisors and their employees (n = 744) completed assessments on mental distress and perceived HoL before and after the intervention as well as during the 3-month follow-up period. The intervention group was compared to a passive control cohort based on propensity score matching. Hierarchical linear models showed that the supervisors who had participated in the HoL intervention experienced a significantly larger decrease in mental distress and an increase in health-oriented self-care as well as staff-care than did their matched controls (g = 0.18-0.59). These results were confirmed by intent-to-treat analyses. The effect on supervisors' mental distress was mediated by an increase of their health-oriented self-care and moderated by the frequency of their mindfulness practice. No significant effects appeared between groups regarding outcomes at the employee level. Overall, these findings indicate how HoL can be effectively trained to increase supervisors' self- and staff-care and reduce their mental distress. Future research should explore additional moderator variables, linkages to established work stress models, and improvements of these interventions to increase their effectiveness for employees. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Psychometric properties of the German version of the Forms of Self-Criticizing/Attacking and Self-Reassuring Scale (FSCRS).

Self-criticism is significantly associated with a variety of mental health difficulties affecting vulnerability, presentation, progress, and recovery. In contrast, self-reassurance is associated with good mental health, psychological well-being, and beneficial physiological processes. The 22-item Forms of Self-Criticizing/Attacking and Self-Reassuring Scale (FSCRS) is an internationally used self-report questionnaire for measuring manifestation and changes in different types of self-criticism and self-reassurance. It has been shown to be a valid and reliable measure in clinical and nonclinical samples. In the present study, a German translation of the FSCRS and its 3 subscales (hated self, inadequate self, reassured self) was provided, and the factor structure and psychometric properties were examined in 415 participants from 4 different population samples: (a) a sample from the general population, (b) a sample of psychiatric residential and outpatients, (c) a clinical sample of residential and outpatients with a primary diagnosis of borderline personality disorder (BPD), and (d) a sample of healthy control participants. Results from confirmatory factor analysis favored a 3-factor solution of the German FSCRS. Furthermore, findings indicate that the German version of the FSCRS and its subscales had good to excellent internal consistencies. Convergent validity was good for all 3 subscales as shown by medium to large correlations with established measures of self-criticism, self-compassion, self-esteem, satisfaction with life, symptoms of depression and anxiety, and secure attachment styles. Additionally, the 3 FSCRS subscales discriminated significantly between the clinical and nonclinical samples, with the BPD sample demonstrating significantly higher levels than the other samples on the hated self subscale. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Health-Oriented Leadership and Mental Health From Supervisor and Employee Perspectives: A Multilevel and Multisource Approach.

The link between leadership and mental health at the workplace is well established by prior research. However, most of the studies have addressed this relationship from a single-source perspective. The aim of this study was to examine how supervisor and employee ratings of health-oriented leadership correspond to each other and which sources are predictive for employee mental health. We assessed data within 99 teams (headed by 99 supervisors) containing 713 employees in 11 different companies in Southern Germany. Supervisors and their staff completed questionnaires on the supervisors' health-oriented staff-care dimensions awareness, value of health and health behavior (Health-Oriented Leadership Scale, HoL) and current mental distress (Hospital Anxiety and Depression Scale, HADS). Hierarchical linear models revealed that supervisors' self-ratings were significantly related to their employees' ratings (at the team level) only on the health behavior dimension, but not on the health awareness and value of health dimensions. Also, supervisors rated themselves significantly higher on HoL compared to their employees. Employee ratings of HoL significantly predicted their own level of mental distress (direct within-level effect), whereas supervisor ratings of HoL did not predict employees' mental distress at the team level (direct cross-level effect). Supervisors' self-ratings of HoL did not influence the relationship between employee ratings of HoL and their mental distress on an individual level (cross-level interaction). These results highlight the complex relationship between multisource assessments of HoL and employee mental health, emphasizing the importance of subjective perception for mental health. Future studies should investigate under which conditions supervisor and employee ratings correspond to each other and are predictive for mental health at the workplace.

Dissociation in Psychiatric Disorders: A Meta-Analysis of Studies Using the Dissociative Experiences Scale.

OBJECTIVE: Dissociation is a complex, ubiquitous construct in psychopathology. Symptoms of dissociation are present in a variety of mental disorders and have been connected to higher burden of illness and poorer treatment response, and not only in disorders with high levels of dissociation. This meta-analysis offers a systematic and evidence-based study of the prevalence and distribution of dissociation, as assessed by the Dissociative Experiences Scale, within different categories of mental disorders, and it updates an earlier meta-analysis. METHOD: More than 1,900 original publications were screened, and 216 were included in the meta-analysis, comprising 15,219 individuals in 19 diagnostic categories. RESULTS: The largest mean dissociation scores were found in dissociative disorders (mean scores >35), followed by posttraumatic stress disorder, borderline personality disorder, and conversion disorder (mean scores >25). Somatic symptom disorder, substance-related and addictive disorders, feeding and eating disorders, schizophrenia, anxiety disorder, OCD, and most affective disorders also showed mean dissociation scores >15. Bipolar disorders yielded the lowest dissociation scores (mean score, 14.8). CONCLUSIONS: The findings underline the importance of careful psychopathological assessment of dissociative symptoms in the entire range of mental disorders.