Recognizing oneself in the encounter with others: Meaningful moments in systemic therapy for social anxiety disorder in the eyes of patients and their therapists after the end of therapy.

OBJECTIVE: The objective of this study is to characterize and describe meaningful moments in the context of systemic psychotherapy, from the point of view of patients and their therapists, after the end of therapy. The therapy studied is a manualized, monitored systemic therapy for social anxiety disorder. METHOD: Semi-structured follow-up interviews were conducted separately with five patients and their therapists (N = 10). Methodological triangulation was used: Grounded theory was used to code the transcripts as described by Charmaz. Then the passages of the selected code "meaningful moment" were evaluated using thematic comparison, in line with Meuser & Nagel. FINDINGS: Three categories involving meaningful moments were identified: (1) meeting other patients in group therapy session, (2) therapeutic resource orientation and (3) recognizing oneself in a diagnosis or pattern of behaviour. These categories emerged as contexts related to the occurrence of meaningful moments from a subjective perspective. DISCUSSION: Meaningful moments seem to be consistently related to the therapist input and to specific interventions or settings, both from the perspective of the patients and the therapists. Two tandems each described a coincident moment. One central aspect of all 14 moments is that the patients and therapists described patients being able to acquire another outlook on themselves.

Comparing Cognitive Behavioral Therapy and Systemic Therapy for Social Anxiety Disorder: Randomized Controlled Pilot Trial (SOPHO-CBT/ST).

This randomized controlled trial (RCT) aimed to pilot the newly developed manualized and monitored systemic therapy (ST) for social anxiety disorder (SAD), as compared to manualized and monitored cognitive behavioral therapy (CBT). We conducted a prospective multicenter, assessor-blind pilot RCT on 38 outpatients (ICD F40.1; Structured Clinical Interview for DSM (SCID); Liebowitz Social Anxiety Scale, LSAS-SR >30). The primary outcome was level of social anxiety (LSAS-SR) at the end of treatment. A total of 252 persons were screened, and 38 patients were randomized and started therapy (CBT: 20 patients; ST: 18 patients; age: M = 36 years, SD = 14). Within-group, simple-effect intent-to-treat analyses (ITT) showed significant reduction in LSAS-SR (CBT:d = 1.04; ST:d = 1.67), while ITT mixed-design ANOVA demonstrated the advantage of ST (d = 0.81). Per-protocol analyses supported these results. Remission based on reliable change indices also demonstrated significant difference (LSAS-SR: 15% in CBT; 39% in ST;h: 0.550), supported by blind diagnosticians' ratings of those who completed therapy (SCID; 45% in CBT, 78% in ST,p = .083). No adverse events were reported. CBT and ST both reduced social anxiety, supporting patient improvement with the newly developed ST for SAD; this has yet to be verified in a subsequent confirmatory RCT.

Este ensayo controlado aleatorizado tuvo como finalidad probar la terapia sistémica (TS) estandarizada y monitoreada recientemente desarrollada para el trastorno de ansiedad social en comparación con la terapia cognitivo-conductual (TCC) estandarizada y monitoreada. Realizamos un ensayo controlado aleatorizado prospectivo, multicentro y con enmascaramiento para el evaluador en 38 pacientes ambulatorios (CIE F40.1; Entrevista Clínica Estructurada para los trastornos del DSM (SCID); Escala de Ansiedad Social de Liebowitz, LSAS-SR > 30). El resultado principal fue el nivel de ansiedad social (LSAS-SR) al final del tratamiento. Se evaluó a un total de 252 personas, 38 pacientes fueron aleatorizados y comenzaron la terapia (TCC: 20 pacientes; TS: 18 pacientes; edad: promedio= 36 años, desviación estándar = 14). Los análisis intragrupales, de efecto simple, con intención de tratar demostraron una reducción significativa del LSAS-SR (TCC: d = 1.04; TS: d = 1.67), mientras que el análisis de varianza de diseño mixto con intención de tratar demostró la ventaja de la TS (d = 0.81). Los análisis por protocolo respaldaron estos resultados. La remisión basada en los índices de cambio fiable también demostró una diferencia significativa (LSAS-SR: 15% en la TCC; 39% en la TS; h: 0.550), respaldada por diferencias casi significativas en las valoraciones con enmascaramiento para los evaluadores de aquellos que completaron la terapia (SCID; 45% en la TCC, 78% en la TS, p = 0.083). No se informaron efectos adversos. Tanto la TCC como la TS reducen la ansiedad social y respaldan la mejora de los pacientes con la terapia sistémica recientemente desarrollada para los trastornos de ansiedad social; esto aun debe verificarse en un ensayo controlado aleatorizado confirmatorio posterior.

Changing Me, Changing Us: Relationship Quality and Collective Efficacy as Major Outcomes in Systemic Couple Therapy.

We examine the sensitivity to change in the Evaluation of Social Systems (EVOS) scale, which assesses relationship quality and collective efficacy. In Study 1 we conducted a waitlist-control, short-term couple therapy RCT study (N = 43 couples) with five systemic therapy sessions treating communication and partnership problems; our intent was to provide high external validity. Construct validity of EVOS was assessed by comparison with additionally applied scales (Family Scales; Outcome Questionnaire, OQ-45.2). In Study 2, N = 332 individuals completed an experiment with high internal validity in order to verify sensitivity to change in three different social contexts. Results from Study 1 revealed a significant increase in relationship quality in the treatment group directly after treatment, as compared to the control group. Sensitivity to change was slightly better for EVOS than for other measures. While this positive change could not be fully sustained between posttreatment and a 4-week follow-up, EVOS score did not fall below baseline and pretreatment levels, supporting moderate-to-large sensitivity to change. Study 2 supported high sensitivity to change in EVOS for couple relations, family relations, and work-team relationships. Therefore, EVOS can be used as an outcome measure to monitor the process of systemic interventions focusing on relationship quality and collective efficacy. Due to its sensitivity to change, EVOS can provide evidence for treatment success with regard to relationship aspects.

The Experience in Personal Social Systems Questionnaire (EXIS.pers): Development and Psychometric Properties.

This study presents the theoretical background, development, and psychometric properties of the German and English versions of the Experience in Personal Social Systems Questionnaire (EXIS.pers). It assesses how the members of a personal social system experience their situation within that system. It is designed as a research tool for interventions in which only one member of the system participates (e.g., Family Constellation Seminars). The EXIS.pers was created to measure change on the individual level relating to one's own important personal social system. In Study 1, we used exploratory factor analysis (EFA) for latent variable identification of the original German EXIS.pers (n = 179). In Studies 2 and 3, we used confirmatory factor analysis (CFA) to examine the dimensionality of the German (n = 634) and English (n = 310) EXIS.pers. Internal consistencies and cross-cultural structural equivalence were assessed. EFA indicated that a four-factor model provided best fit for the German EXIS.pers. For both the German and English EXIS.pers, CFA provided the best fit for a five-factor bi-level model that included a general factor (Experience In Personal Social Systems) and four dimensions (Belonging, Autonomy, Accord, Confidence). Good internal consistencies, external associations, and cross-cultural structural equivalence were demonstrated. This study provides first evidence for the German and English EXIS.pers as an economical and reliable measure of an individual's experience within his or her personal social systems.

When Significant Others Suffer: German Validation of the Burden Assessment Scale (BAS).

There is a need of an economical, reliable, and valid instrument in the German-speaking countries to measure the burden of relatives who care for mentally ill persons. We translated the Burden Assessment Scale (BAS) and conducted a study investigating factor structure, psychometric quality and predictive validity. We used confirmative factor analyses (CFA, maximum-likelihood method) to examine the dimensionality of the German BAS in a sample of 215 relatives (72% women; M = 32 years, SD = 14, range: 18 to 77; 39% employed) of mentally ill persons (50% (ex-)partner or (best) friend; M = 32 years, SD = 13, range 8 to 64; main complaints were depression and/or anxiety). Cronbach's α determined the internal consistency. We examined predictive validity using regression analyses including the BAS and validated scales of social systems functioning (Experience In Social Systems Questionnaire, EXIS.pers, EXIS.org) and psychopathology (Brief Symptom Inventory, BSI). Variables that might have influenced the dependent variables (e.g. age, gender, education, employment and civil status) were controlled by their introduction in the first step, and the BAS in the second step of the regression analyses. A model with four correlated factors (Disrupted Activities, Personal Distress, Time Perspective, Guilt) showed the best fit. With respect to the number of items included, the internal consistency was very good. The modified German BAS predicted relatives' social systems functioning and psychopathology. The economical design makes the 19-item BAS promising for practice-oriented research, and for studies under time constraints. Strength, limitations and future directions are discussed.

An investigation of the mediating role of personality and family functioning in the association between attachment styles and eating disorder status.

BACKGROUND: This study examined relationships between attachment style, eating disorders (EDs), personality variables and family functioning. METHODS: In our study, 253 women (M = 25.72 years, SD = 8.73) were grouped into one of four categories either according to self-reported ED diagnosis or by exceeding cut-offs for a clinical diagnosis on the Eating Disorder Examination Questionnaire (EDE-Q) or Short Evaluation of Eating Disorders (SEED): anorexia nervosa (AN), bulimia nervosa (BN), other eating disorder (O-ED), no eating disorder (Non-ED). The ED group (AN, BN, O-ED) included 106 women (M = 24.74 years, SD = 7.71), and the Non-ED group 147 women (M = 26.42 years, SD = 9.37). Approximately half of the ED group had a comorbid disorder (59.4 %), while the majority of the Non-ED group had no psychological disorder (89.1 %). RESULTS: Participants with an ED were significantly more often insecurely attached (Adult Attachment Scale; AAS), emotionally unstable, less extraverted (Big-Five-Test of Personality; B5T) and showed less positive family functioning (Experiences in Personal Social Systems Questionnaire; EXIS.pers). Results showed partial mediation for attachment and EDs through neuroticism, extraversion and family functioning. DISCUSSION: The study found further evidence for elevated problems with attachment, personality, and family experiences in individuals with EDs, while suggesting mechanisms that may link these constructs. Implications for research and practice were discussed. CONCLUSION: This study supports findings that acknowledge the mediating role played by personality factors and family functioning in the relationship between attachment and EDs.

Comparing systemic therapy and cognitive behavioral therapy for social anxiety disorders: study protocol for a randomized controlled pilot trial.

BACKGROUND: Social anxiety disorders are among the most prevalent anxiety disorders in the general population. The efficacy of cognitive behavioral therapy (CBT) for social anxiety disorders is well demonstrated. However, only three studies point to the efficacy of systemic therapy (ST) in anxiety disorders, and only two of them especially focus on social anxiety disorders. These ST studies either do not use a good comparator but minimal supportive therapy, they do not use a multi-person ST but a combined therapy, or they do not especially focus on social anxiety disorders but mood and anxiety disorders in general. Though ST was approved as evidence based in Germany for a variety of disorders in 2008, evidence did not include anxiety disorders. This is the first pilot study that will investigate multi-person ST, integrating a broad range of systemic methods, specifically for social anxiety disorders and that will compare ST to the "gold standard" CBT. DESIGN: This article describes the rationale and protocol of a prospective, open, interventive, balanced, bi-centric, pilot randomized controlled trial (RCT). A total of 32 patients with a primary SCID diagnosis of social anxiety disorder will be randomized to either CBT or ST. Both treatments will be manualized. The primary outcome will include social anxiety symptoms at the end of therapy. Therapy will be restricted to no more than 26 hours (primary endpoint). Secondary outcomes will include psychological, social systems and interpersonal functioning, symptom adjustment, and caregiver burden, in addition to change measures, therapist variables and treatment adherence. At the secondary endpoints, 9 and 12 months after the beginning of therapy, we will again assess all outcomes. DISCUSSION: The study is expected to pilot test a RCT which will be the first to directly compare CBT and multi-person ST, integrating a broad range of systemic methods, for social anxiety disorders, and it will provide empirical evidence for the calculation of the number of patients needed for a confirmatory RCT. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02360033 ; date of registration: 21 January 2015.

Mid- and long-term effects of family constellation seminars in a general population sample: 8- and 12-month follow-up.

In a previous randomized controlled trial (RCT), short-term efficacy of family constellation seminars (FCSs) in a general population sample was demonstrated. In this article, we examined mid- and long-term stability of these effects. Participants were 104 adults (M = 47 years; SD = 9; 84% female) who were part of the intervention group in the original RCT (3-day FCS; 64 active participants and 40 observing participants). FCSs were carried out according to manuals. It was predicted that FCSs would improve psychological functioning (Outcome Questionnaire OQ-45.2) at 8- and 12-month follow-up. Additionally, we assessed the effects of FCSs on psychological distress, motivational incongruence, individuals' experience in their personal social systems, and overall goal attainment. Participants yielded significant improvement in psychological functioning (d = 0.41 at 8-month follow-up, p = .000; d = 0.40 at 12-month follow-up, p = .000). Results were confirmed for psychological distress, motivational incongruence, the participants' experience in their personal social systems, and overall goal attainment. No adverse events were reported. This study provides first evidence for the mid- and long-term efficacy of FCSs in a nonclinical population. The implications of the findings are discussed.

Improving experience in personal social systems through family constellation seminars: results of a randomized controlled trial.

This study examined the efficacy of family constellation seminars (FCSs) on individuals' experience in their personal social systems, especially the experience of belonging, autonomy, accord, and confidence. We conducted a single-blind, stratified and balanced, randomized controlled trial. Participants were 208 adults (M = 48 years, SD = 10, 79% women) who were randomly allocated either to the intervention group (3-day FCSs; 64 active participants, 40 observing participants) or to the wait-list group (64 active participants, 40 observing participants). Change was measured short-term (2-week and 4-month follow-up) using the Experience In Social Systems Questionnaire, personal domain (EXIS.pers). EXIS.pers is a new outcome measure being applied for the first time in evaluation research. In addition, we used interpersonal scales derived from established measures (Outcome Questionnaire, OQ-45; Tool for the Evaluation of the Psychotherapeutic Progress, FEP). The average person in the intervention group showed improved experience in personal social systems, as compared with approximately 73% of the wait-list group after 2 weeks (total score: Cohen's d = .61, p = .000) and 69% of the wait-list group after 4 months (total score: d = .53, p = .000). The results were confirmed in per-protocol analyses (n = 191) by the results of the EXIS.pers dimensions (Belonging, Autonomy, Accord, and Confidence) and the interpersonal scales derived from the OQ-45 and FEP. No adverse events were reported. This RCT provides first evidence that FCSs tend to positively influence participants' experience in their social systems.

Family constellation seminars improve psychological functioning in a general population sample: results of a randomized controlled trial.

The study examined the efficacy of nonrecurring family constellation seminars on psychological health. We conducted a monocentric, single-blind, stratified, and balanced randomized controlled trial (RCT). After choosing their roles for participating in a family constellation seminar as either active participant (AP) or observing participant (OP), 208 adults (M = 48 years, SD = 10; 79% women) from the general population were randomly allocated to the intervention group (IG; 3-day family constellation seminar; 64 AP, 40 OP) or a wait-list control group (WLG; 64 AP, 40 OP). It was predicted that family constellation seminars would improve psychological functioning (Outcome Questionnaire OQ-45.2) at 2-week and 4-month follow-ups. In addition, we assessed the impact of family constellation seminars on psychological distress and motivational incongruence. The IG showed significantly improved psychological functioning (d = 0.45 at 2-week follow-up, p = .003; d = 0.46 at 4-month follow-up, p = .003). Results were confirmed for psychological distress and motivational incongruence. No adverse events were reported. This RCT provides evidence for the efficacy of family constellation in a nonclinical population. The implications of the findings are discussed.