[Perspectives and Opportunities for Psychotherapeutic Interventions in Inpatient Psychiatric Treatment Delivered by Nurses]. / Perspektiven und Chancen für pflegerisch-psychotherapeutische Interventionen in der stationären psychiatrischen Behandlung.

BACKGROUND: Psychotherapy is an essential part of treating people with mental illness. However, the implementation of psychotherapeutic interventions in the field of inpatient psychiatric treatment remains well behind demand. At the same time, the use of psychotherapeutic interventions by other professional groups - such as social workers and nursing - is not a common practice in Germany. OBJECTIVE: What can we learn from the international research with regard to nursing for Germany in view of the insufficient supply of psychotherapeutic care. METHOD: Based on a literature analysis, the German situation of care is related to international developments and a German training curriculum is presented. RESULT: A look at the international literature shows that in other countries especially trained nurses perform psychotherapeutic Interventions. In addition, there are effective training curricula whose transferability to Germany appears to be possible after appropriate adjustments.An 18 months lasting training program for nurses is presented. In addition to disorder-specific competences, this curriculum also provides psychotherapeutic interventions with a general approach. CONCLUSION: Collaborative care in the collaboration of different health professionals has been repeatedly and stably proven to be effective and helpful in treating people with various mental disorders. In order to better meet the growing need for psychotherapeutic interventions in the population in the sense of a stepped care model, trained nurses need to be more involved in the provision of psychotherapeutic services.

[Low-intensity Psychiatric Expert Monitoring and Counseling of Unemployed: Presentation of the Gütersloh Pilot Project]. / Gesundheitscoach ­ Niedrigschwellige Begleitung von psychisch belasteten Arbeitslosengeld II Empfängern: Darstellung des Gütersloher Pilotprojekts.

OBJECTIVE: Psychological problems are highly prevalent in unemployed people and can lead to impairments in several areas of life. Programs to support and assist those affected, especially the long-term unemployed, are scarce. Reservations by those affected present an additional barrier with respect to health care utilisation. The authors designed a collaborative care cooperation project between a local job center and a psychiatric clinic with the aims of counselling unemployed people with psychological distress as well as offering continuing psychosocial care if required. METHOD: This paper presents the methodological design, clinical procedure as well as a preliminary evaluation of the pilot phase. RESULTS: Within the first 12 months of the pilot phase, 57 long-term unemployed were enrolled in the project. Subjective psychological distress in the sample was comparable with other studies reporting high rates of psychological problems in the unemployed. The psychosocial intervention was well accepted not only by the unemployed but also by case managers and led to high re-assignment rates (n=37) to complementary services within the psychosocial health care system. CONCLUSION: Unemployment and psychological distress should be addressed together within collaborative care projects that can positively affect the negative interaction between unemployment and psychological distress. Low-intensity psychological interventions are well suited to address barriers that hinder health care utilization and to offer person-centered, psychological assistance.

[Low-Intensity Cognitive Behavioral Therapy (LI-CBT) - An Introduction in Concepts and Framework]. / Low-Intensity Cognitive Behavioral Therapy (LI-CBT) ­ Eine Einführung in Konzepte und Rahmenbedingungen.

Low-intensity cognitive behavioural therapy (LI-CBT) depicts interventions that aim at increasing access to evidence-based psychological therapies. This is achieved by (1) reducing the amount of time in which the practitioner is in contact with individual patients, (2) using practitioners that have been specifically trained to deliver low intensity interventions and without any prior formal health professional qualifications and (3) use of interventions with varying intensity. Stepped care and collaborative care constitute the organizational frame to deliver low-intensity interventions. Whereas large-scale research and health service projects abroad are focussing on LI-CBT, research in German is lagging far behind. Particularly in the light of the growing demands and utilization of mental health care as well as governmental claims to develop and evaluate new forms of providing mental health services, LI-CBT represents a promising approach.

["Nicht von schlechten Eltern - NischE": A Family Orientated Collaborative Care Approach to Support Children in Families with Mentally Ill Parents]. / Nicht von schlechten Eltern ­ NischE: Ein Brückenkonzept familienorientierter Versorgung von Kindern mit psychisch oder suchtbelasteten Eltern.

"Nicht von schlechten Eltern - NischE": A Family Orientated Collaborative Care Approach to Support Children in Families with Mentally Ill Parents The present work describes the setting- and multi-professional offer "NischE" in Gütersloh, a systemic approach for the care of children and their mentally ill parents. Children of mentally ill parents are a special risk group for developing their own mental illness. The aim of the collaborative care model between child and adolescent psychiatry, youth services and adult psychiatry is to enable affected families in terms of family-focused practice a low threshold access to different services. For this purpose, two positions have been created to advise the affected families and support access to the help system in the sense of a systemic case management in a project. The article describes the background and the need for the development of the offer, the current scientific knowledge base on the subject and illustrates the procedure using a case study from practice.

Written threat: Electrophysiological evidence for an attention bias to affective words in social anxiety disorder.

Social anxiety disorder (SAD) is associated with heightened sensitivity to threat cues, typically represented by emotional facial expressions. To examine if this bias can be transferred to a general hypersensitivity or whether it is specific to disorder relevant cues, we investigated electrophysiological correlates of emotional word processing (alpha activity and event-related potentials) in 20 healthy participants and 20 participants with SAD. The experimental task was a silent reading of neutral, positive, physically threatening and socially threatening words (the latter were abusive swear words) while responding to a randomly presented dot. Subsequently, all participants were asked to recall as many words as possible during an unexpected recall test. Participants with SAD showed blunted sensory processing followed by a rapid processing of emotional words during early stages (early posterior negativity - EPN). At later stages, all participants showed enhanced processing of negative (physically and socially threatening) compared to neutral and positive words (N400). Moreover, at later processing stages alpha activity was increased specifically for negative words in participants with SAD but not in healthy controls. Recall of emotional words for all subjects was best for socially threatening words, followed by negative and positive words irrespective of social anxiety. The present findings indicate that SAD is associated with abnormalities in emotional word processing characterised by early hypervigilance to emotional cues followed by cognitive avoidance at later processing stages. Most importantly, the specificity of these attentional biases seems to change as a function of time with a general emotional bias at early and a more specific bias at later processing stages.

This person is saying bad things about you: The influence of physically and socially threatening context information on the processing of inherently neutral faces.

Recent studies have shown that the perceptual processing of human faces is affected by context information, such as previous experiences and information about the person represented by the face. The present study investigated the impact of verbally presented information about the person that varied with respect to affect (neutral, physically threatening, socially threatening) and reference (self-referred, other-referred) on the processing of faces with an inherently neutral expression. Stimuli were presented in a randomized presentation paradigm. Event-related potential (ERP) analysis demonstrated a modulation of the evoked potentials by reference at the EPN (early posterior negativity) and LPP (late positive potential) stage and an enhancing effect of affective valence on the LPP (700-1000 ms) with socially threatening context information leading to the most pronounced LPP amplitudes. We also found an interaction between reference and valence with self-related neutral context information leading to more pronounced LPP than other related neutral context information. Our results indicate an impact of self-reference on early, presumably automatic processing stages and also a strong impact of valence on later stages. Using a randomized presentation paradigm, this study confirms that context information affects the visual processing of faces, ruling out possible confounding factors such as facial configuration or conditional learning effects.

Dissociation as a mediator of the relationship between childhood trauma and nonsuicidal self-injury in females: a path analytic approach.

New theoretical models of nonsuicidal self-injury (NSSI) postulate that symptoms subsequent to childhood maltreatment rather than childhood maltreatment itself may lead to engagement in NSSI. However, little is known concerning which specific syndromes serve as underlying mechanisms. In this study we sought to examine the mediating effects of dissociative, posttraumatic, and depressive symptoms, 3 often comorbid syndromes following childhood trauma. In addition, we aimed to assess differences between women with and without NSSI. A sample of 87 female inpatients with a history of childhood abuse and neglect was divided into 2 subgroups (NSSI: n = 42, no NSSI: n = 45). The assessment included measures of NSSI characteristics; adverse childhood experiences; and posttraumatic, dissociative, and depressive symptoms. The NSSI group reported significantly more cases of childhood maltreatment and higher levels of current dissociative, posttraumatic, and depressive symptoms than patients without NSSI. The results of a path analysis showed that only dissociation mediated the relationship between a history of child maltreatment and NSSI when all 3 psychopathological variables were included in the model. The findings point toward a strong and rather specific association between dissociative experiences and NSSI and therefore have important implications for clinical practice.

Differences in trauma history and psychopathology between PTSD patients with and without co-occurring dissociative disorders.

BACKGROUND: The interplay between different types of potentially traumatizing events, posttraumatic symptoms, and the pathogenesis of PTSD or major dissociative disorders (DD) has been extensively studied during the last decade. However, the phenomenology and nosological classification of posttraumatic disorders is currently under debate. The current study was conducted to investigate differences between PTSD patients with and without co-occurring major DD with regard to general psychopathology, trauma history, and trauma-specific symptoms. METHODS: Twenty-four inpatients were administered the Clinician-Administered PTSD Scale for DSM-IV (CAPS) and the Mini-Structured Clinical Interview for DSM-IV Dissociative Disorders (MINI-SKID-D) to assess DD and PTSD. Additionally, participants completed questionnaires to assess general psychopathology and health status. RESULTS: Symptom profiles and axis I comorbidity were similar in all patients. Traumatic experiences did not differ between the two groups, with both reporting high levels of childhood trauma. Only trauma-specific avoidance behavior and dissociative symptoms differed between groups. CONCLUSION: Results support the view that PTSD and DD are affiliated disorders that could be classified within the same diagnostic category. Our results accord with a typological model of dissociation in which profound forms of dissociation are specific to DD and are accompanied with higher levels of trauma-specific avoidance in DD patients.

Cortical reactions to verbal abuse: event-related brain potentials reflecting the processing of socially threatening words.

Human information processing is sensitive to aversive stimuli, in particular to negative cues that indicate a threat to physical integrity. We investigated the extent to which these findings can be transferred to stimuli that are associated with a social rather than a physical threat. Event-related potentials were recorded during silent reading of neutral, positive, physically threatening, and socially threatening words, whereby socially threatening words were represented by swear words. We found facilitated processing of positive and physically threatening words in contrast to both neutral and socially threatening words at a first potential that emerged at about 120 ms after stimulus onset. At a semantic processing stage reflected by the N400, processing of all classes of affective words, including socially threatening words, differed from neutral words. We conclude that socially threatening words as well as neutral words capture more attentional resources than positive and physically threatening words at early stages. However, social threatening words are processed in a manner similar to other emotional words and different from neutral words at higher levels.