Making Sense of Spiritual, Metaphysical, and Eschatological Elements in Delusions: A Qualitative Study Using Interpretative Phenomenological Analysis.

BACKGROUND: Spiritual, metaphysical, or eschatological elements in delusions (SMEDs) are frequent and often subjectively regarded as profound transformational experiences, similar to mystical experiences. This study aimed (1) to explore how SMEDs are experienced and in which aspects they are similar to mystical experiences and (2) to investigate how individuals make sense of SMED. METHODS: Seven participants were interviewed, and their expressions were analyzed using interpretative phenomenological analysis. RESULTS: We found that SMEDs were similar to mystical experiences with regard to alterations in perception of space, time, and unity. Furthermore, SMEDs were accompanied by a sense of enlightenment that however remained ineffable. SMEDs were interpreted from different viewpoints, i.e., as a source of ontological insight, as a mental health issue, as an inspiration for a new orientation in the world, and, for some participants, as an example of the limits of knowledge. Making sense of SMED appeared to follow a lively internal dialogue in which various, sometimes contradictory positions were reflected upon. Participants usually struggled to align the ostensible ontological significance of SMED to the dominating illness explanation. CONCLUSION: SMEDs have similarities to mystical experiences, but integrating SMED into one's own life is challenging. We propose a philosophical, non-pathological interpretation of SMED derived from a novel perspective on mystical experience which may also have some therapeutic utility.

[Effectiveness and Cost-Effectiveness of Individual Placement and Support (Ips) in Germany - A Controlled Trials with Individuals with Psychosis]. / Effektivität und Kosteneffizienz von Individual Placement and Support (IPS) in Deutschland ­ eine Vergleichsstudie bei Menschen mit Psychosen.

OBJECTIVE: To establish the effectiveness of Individual Placement and Support (IPS) to integrate people with mental illness into the general labor market, controlled comparisons with usual rehabilitative practice in terms of employment rates and cost-effectiveness are needed. METHODS: 20 IPS participants with psychoses (primarily schizophrenia spectrum disorders) were compared with 20 controls who were offered usual rehabilitative practices in adjacent counties (rehabilitation as usual, RAU) over 18 months. RESULTS: IPS was significantly superior to RAU on all job-related criteria with moderate to high effect sizes, with no differences in absenteeism, hospital days, or dropout rates. IPS was significantly superior to RAU on cost-effectiveness. CONCLUSION: This study provides evidence that IPS is an effective and cost-efficient addition to existing vocational rehabilitation services for people with psychoses.

[Psychological Distress during the Corona Shutdown: Associations between Behavioral Adaption and Psychological Distress in Individuals with Preexisting Psychiatric Conditions and Healthy Controls]. / Die Auswirkungen des Corona-Shutdowns im März/April 2020: Der Zusammenhang zwischen Alltagsverhalten und psychischer Belastung bei psychisch Vorerkrankten und Gesunden.

OBJECTIVE: Current research suggests that individuals with preexisting psychiatric conditions experienced particularly high levels of psychological distress during the various 'shutdown' measures to contain Covid-19. In order to gain a better insight into the demands for psychiatric care in times of crisis, this study compared levels of psychological distress in individuals with preexisting psychiatric conditions with healthy controls and further examined associations of daily routines with psychological distress. METHOD: Out of 99 participants of an online survey, 44 individuals reported prior mental health-related inpatient treatment. Patients were asked about their levels of psychological distress and adaptation of lifestyle and activities of daily living. RESULTS: Individuals with a psychiatric history were significantly more psychologically distressed (p < 0.001; d = 1.68) and displayed significantly less behavioral adaptation than healthy controls (p = 0.012; d = -0.52) in response to the changed circumstances. The difference in behavioral adaptation accounted for 21 % of the difference in psychological distress. CONCLUSIONS: In times of crisis, individuals with a psychiatric history require ongoing support from mental health services, in particular those supporting every-day lifestyle in order to better cope with the consequences of a drastically changed environment.

What Makes Soteria Work? On the Effect of a Therapeutic Milieu on Self-Disturbances in the Schizophrenia Syndrome.

Soteria represents an alternative approach to the treatment of acute psychosis providing a community-based social milieu, personal relationships ("being-with"), and meaningful shared activities ("doing-with") along with minimal neuroleptic medication. In this review article, we analyze Soteria's potential to adapt to and restore self-disturbances, a central element of phenomenological conceptions of the schizophrenia syndrome. Based on typical difficulties of psychotic patients in responding adequately to situational demands, in relating to others, and in utilizing skills, we analyze how the architectural and social context, being-with, and doing-with take account of self-disturbances. The central elements of the Soteria approach all appear to carry the potential to adjust to self-disturbances and even offer opportunities for their relief. We suggest that it is precisely this property of the Soteria paradigm that induces sustained relaxation in patients, allowing for symptom relief, thereby specifying a central claim of "affect-logic" to explain the antipsychotic effect of Soteria.

[From Technical Terminology to Prejudicial Plattitudes - A Cognitive Analysis of Jargon in Psychiatric Institutions]. / Vom psychiatrischen Fachbegriff zur schädlichen Plattitüde ­ Eine kognitionspsychologische Analyse.

Within psychiatric institutions it is common to label psychiatric patients with a broad array of technical terms from different domains. However, through their nonreflective usage technical terms gradually become "fuzzy" in content, enriched with normative evaluations and finally reificated as "real" entities. This evolvement of meaning may foster a schematic and biased understanding of mental patients, threaten the validity of psychiatric diagnoses and negatively influence the therapeutic process. Becoming familiar with the underlying cognitive mechanisms, frequent supervision and the provision of context factors that permit the development of a close therapeutic alliance can help to alleviate these potential dangers to efficient psychiatric therapy.

Type and timing of adverse childhood experiences differentially affect severity of PTSD, dissociative and depressive symptoms in adult inpatients.

BACKGROUND: A dose-dependent effect of Adverse Childhood Experiences (ACE) on the course and severity of psychiatric disorders has been frequently reported. Recent evidence indicates additional impact of type and timing of distinct ACE on symptom severity experienced in adulthood, in support of stress-sensitive periods in (brain) development. The present study seeks to clarify the impact of ACE on symptoms that are often comorbid across various diagnostic groups: symptoms of posttraumatic stress disorder (PTSD), shutdown dissociation and depression. A key aim was to determine and compare the importance of dose-dependent versus type and timing specific prediction of ACE on symptom levels. METHODS: Exposure to ten types of maltreatment up to age 18 were retrospectively assessed in N = 129 psychiatric inpatients using the Maltreatment and Abuse Chronology of Exposure (MACE). Symptoms of PTSD, shutdown dissociation, and depression were related to type and timing of ACE. The predictive power of peak types and timings was compared to that of global MACE measures of duration, multiplicity and overall severity. RESULTS: A dose-dependent effect (MACE duration, multiplicity and overall severity) on severity of all symptoms confirmed earlier findings. Conditioned random forest regression verified that PTSD symptoms were best predicted by overall ACE severity, whereas type and timing specific effects showed stronger prediction for symptoms of dissociation and depression. In particular, physical neglect at age 5 and emotional neglect at ages 4-5 were related to increased symptoms of dissociation, whereas the emotional neglect at age 8-9 enhanced symptoms of depression. CONCLUSION: In support of the sensitive period of exposure model, present results indicate augmented vulnerability by type x timing of ACE, in particular emphasizing pre-school (age 4-5) and pre-adolescent (8-9) periods as sensitive for the impact of physical and emotional neglect. PTSD, the most severe stress-related disorder, varies with the amount of adverse experiences irrespective of age of experience. Considering type and timing of ACE improves understanding of vulnerability, and should inform diagnostics of psychopathology like PTSD, dissociation and depression in adult psychiatric patients.

A brief intervention to improve exercising in patients with schizophrenia: a controlled pilot study with mental contrasting and implementation intentions (MCII).

BACKGROUND: Regular exercise can have positive effects on both the physical and mental health of individuals with schizophrenia. However, deficits in cognition, perception, affect, and volition make it especially difficult for people with schizophrenia to plan and follow through with their exercising intentions, as indicated by poor attendance and high drop-out rates in prior studies. Mental Contrasting and Implementation Intentions (MCII) is a well-established strategy to support the enactment of intended actions. This pilot study tests whether MCII helps people with schizophrenia in highly structured or autonomy-focused clinical hospital settings to translate their exercising intentions into action. METHODS: Thirty-six inpatients (eleven women) with a mean age of 30.89 years (SD = 11.41) diagnosed with schizophrenia spectrum disorders from specialized highly structured or autonomy-focused wards were randomly assigned to two intervention groups. In the equal contact goal intention control condition, patients read an informative text about physical activity; they then set and wrote down the goal to attend jogging sessions. In the MCII experimental condition, patients read the same informative text and then worked through the MCII strategy. We hypothesized that MCII would increase attendance and persistence relative to the control condition over the course of four weeks and this will be especially be the case when applied in an autonomy-focused setting compared to when applied in a highly structured setting. RESULTS: When applied in autonomy-focused settings, MCII increased attendance and persistence in jogging group sessions relative to the control condition. In the highly structured setting, no differences between conditions were found, most likely due to a ceiling effect. These results remained even when adjusting for group differences in the pre-intervention scores for the control variables depression (BDI), physical activity (IPAQ), weight (BMI), age, and education. Whereas commitment and physical activity apart from the jogging sessions remained stable over the course of the treatment, depression and negative symptoms were reduced. There were no differences in pre-post treatment changes between intervention groups. CONCLUSIONS: The intervention in the present study provides initial support for the hypothesis that MCII helps patients to translate their exercising intentions into real-life behavior even in autonomously-focused settings without social control. TRIAL REGISTRATION: ClinicalTrials.gov ID; URL: NCT01547026 Registered 3 March 2012.

From theory to clinical practice: a phenomenologically inspired intervention for patients with schizophrenia.

BACKGROUND: Phenomenological conceptualizations of schizophrenia regard the fundamental transformation of self-experience as the central feature of the schizophrenic state of mind. Recently, self-disorders as subtle, trait-like, merely subjective alterations of self-experience have received vast empirical attention. However, the question of how to address self-disorders psychotherapeutically has remained neglected. METHODS: From phenomenologically inspired analyses of self-disorders we derive a therapeutic intervention that focuses on the following: (1) verbalizing diffuse changes in self-experiences and (2) conceptualizing these self-experiences in terms of aggravating and relieving factors in order to stimulate coping and derive targeted therapeutic interventions. RESULTS: The clinical implementation is illustrated by two case studies. The feasibility of our approach is preliminarily supported by an exploratory study. CONCLUSIONS: This intervention seems promising in assisting patients to develop an embodied and enacted understanding of self-disorders.

[News from the Soteria--a phenomenologically inspired approach to the rehabilitation of social and daily living skills]. / Aktuelles aus der Soteria--Die Förderung lebenspraktischer und sozialer Fertigkeiten von Menschen mit Schizophrenien aus phänomenologischer Sicht.

Soteria is an alternative approach to the treatment of schizophrenia that focuses on human interaction ("being-with") within a residential community and the cautious use of neuroleptic medication. Despite forty years of promising clinical and empirical evidence, the need for facilities based on the Soteria paradigm is still largely grounded on humanitarian and "moral" reasons. In addition to this, we will try to demonstrate that Soteria might also prove to be a promising approach based on scientific reasons immanent to the disorder. From a phenomenological informed conception of schizophrenia we will explicate clinical implications, specifically the need for a holistic treatment in real life settings, and demonstrate how these conclusions can most adequately be implemented within Soteria.