[Direct Costs of Social Phobia in Adolescents and Cost-Effectiveness of Psychotherapy]. / Direkte Kosten sozialer Angststörung bei Jugendlichen und Kosteneffektivität der Psychotherapie.

OBJECTIVES: Social anxiety disorder is one of the most prevalent mental disorders and often manifests in youth or adolescence. Our aim was to determine direct costs of adolescents with social anxiety disorder and the cost-effectiveness of cognitive-behavioral therapy (CBT) and psychodynamic therapy (PDT) compared to waiting list (WL). METHODS: Baseline data (n = 103) of a randomized controlled trial was used to determine direct costs. Cost-effectiveness of CBT and PDT compared to WL was analyzed using quality-adjusted life years (QALYs) based on the EQ-5D index as measure of health effects. RESULTS: Total six-month direct costs were 809 € (SE 508 €). Especially costs of outpatient physician treatment (325 €; SE 301 €) and psychiatric hospital stays (377 €; SE 258 €) were high. The incremental cost-effectiveness ratio (ICER) of CBT compared to WL was 18,824 €/QALY, with a probability of 63 % for the ICER being below 50,000 €/QALY. PDT did not prove to be cost-effective. CONCLUSIONS: Direct costs were mainly caused by psychiatric hospital stays and outpatient physician treatments. CBT is likely to be cost-effective compared to WL, whereas PDT is unlikely to be cost-effective.

Cognitive-Behavioral and Psychodynamic Therapy in Adolescents with Social Anxiety Disorder: A Multicenter Randomized Controlled Trial.

BACKGROUND: Although social anxiety disorder (SAD) has an early onset and is frequently found in adolescence, evidence for psychotherapeutic treatments of SAD in adolescents is rather scarce. Within the Social Phobia Psychotherapy Research Network (SOPHO-NET), we examined the efficacy of cognitive-behavioral (CBT) and psychodynamic therapy (PDT) compared to a waiting list (WL) in these patients. METHODS: In a multicenter randomized controlled superiority trial, 107 patients, aged 14-20 years, were randomized to CBT (n = 34), PDT (n = 34), or WL (n = 39). Assessments were made at baseline, at the end of treatment, and 6 and 12 months after termination. The Liebowitz Social Anxiety Scale for Children and Adolescents (LSAS-CA) applied by raters masked to the treatment condition was used as the primary outcome. As secondary outcomes, rates of response and remission and the Social Phobia Anxiety Inventory (SPAI) were used. RESULTS: Both treatments were superior to WL in the LSAS-CA (CBT: p = 0.0112, d = 0.61, 95% CI 0.14-1.08; PDT: p = 0.0261, d = 0.53, 95% CI 0.06-1.00). At the end of treatment, response rates were 66, 54, and 20% for CBT, PDT, and WL. The corresponding remission rates were 47, 34, and 6%, respectively. CBT and PDT were significantly superior to WL regarding remission (CBT: p = 0.0009, h = 1.0; PDT: p = 0.0135, h = 0.74), response (CBT: p = 0.0004, h = 0.97; PDT: p = 0.0056, h = 0.72), and the SPAI (CBT: p = 0.0021, d = 0.75, 95% CI 0.27-1.22; PDT: p = 0.0060, d = 0.66, 95% CI 0.19-1.13). Treatment effects were stable at 6- and 12-month follow-ups. CONCLUSIONS: These results are comparable to the large SOPHO-NET trial in adults (n = 495). Early treatments for social anxiety are needed in order to prevent chronic manifestation of SAD.

Cognitive-Behavioral and Psychodynamic Therapy in Female Adolescents With Bulimia Nervosa: A Randomized Controlled Trial.

OBJECTIVE: The authors compared cognitive-behavioral therapy (CBT) and psychodynamic therapy (PDT) for the treatment of bulimia nervosa (BN) in female adolescents. METHOD: In this randomized controlled trial, 81 female adolescents with BN or partial BN according to the DSM-IV received a mean of 36.6 sessions of manualized disorder-oriented PDT or CBT. Trained psychologists blinded to treatment condition administered the outcome measures at baseline, during treatment, at the end of treatment, and 12 months after treatment. The primary outcome was the rate of remission, defined as a lack of DSM-IV diagnosis for BN or partial BN at the end of therapy. Several secondary outcome measures were evaluated. RESULTS: The remission rates for CBT and PDT were 33.3% and 31.0%, respectively, with no significant differences between them (odds ratio [OR] = 0.90, 95% CI = 0.35-2.28, p = .82). The within-group effect sizes were h = 1.22 for CBT and h = 1.18 for PDT. Significant improvements in all secondary outcome measures were found for both CBT (d = 0.51-0.82) and PDT (d = 0.24-1.10). The improvements remained stable at the 12-month follow-up in both groups. There were small between-group effect sizes for binge eating (d = 0.23) and purging (d = 0.26) in favor of CBT and for eating concern (d = -0.35) in favor of PDT. CONCLUSION: CBT and PDT were effective in promoting recovery from BN in female adolescents. The rates of remission for both therapies were similar to those in other studies evaluating CBT. This trial identified differences with small effects in binge eating, purging, and eating concern. Clinical trial registration information-Treating Bulimia Nervosa in Female Adolescents With Either Cognitive-Behavioral Therapy (CBT) or Psychodynamic Therapy (PDT). http://isrctn.com/; ISRCTN14806095.

The assessment of skin picking in adolescence: psychometric properties of the Skin Picking Scale-Revised (German version).

BACKGROUND: Skin picking disorder has received growing attention since the release of DSM-5, yet there are no evidence-based assessment instruments for adolescent samples. AIM: The present study examines the psychometric properties of the Skin Picking Scale-Revised (SPS-R, German version) in adolescents. METHODS: A total of 76 adolescents (96% female) completed the SPS-R, the Clinical Psychological Diagnostic System (KPD-38), and a questionnaire assessing demographics and clinical characteristics online. RESULTS: The SPS-R had high internal consistency (α = 0.89) and significant small-to-medium correlations with reduced competence skills, psychological impairment, general life satisfaction, social support, and social problems on the KPD-38. Similar to prior findings for adults, an exploratory factor analysis suggested a two-factor model for the SPS-R in adolescents. Group comparisons failed to show significant differences on SPS-R scores between participants with and without dermatological conditions. CONCLUSIONS: The current results suggest that the SPS-R can be useful in adolescent samples as a reliable and valid instrument for the assessment of skin picking severity. Future research investigating scale validity and factor structure in a clinical sample of adolescent skin pickers is warranted.

[Interrater-reliability of the OPD-CA, the axes conflict and structure]. / Interrater-reliabilität der OPD-KJ-Achsen Konflikt und Struktur.

The reliability of the meanwhile widely used Operationalized Psychodynamic Diagnostics in childhood and adolescence (OPD-CA) is only rarely examined. By means of audiovisual recordings of OPD-CA-interviews with 39 adolescents in the context of a randomized-controlled psychotherapy study for the treatment female adolescents with bulimia nervosa and atypical bulimia nervosa the reliability of the axis conflict and the axis structure were examined. This was carried out by the calculation of Intraklassen-correlations of three raters. The rater agreements ranged from good to excellent, except for impulse control in the axis structure, where the results were satisfactory. The relevance of the results for clinical practice is discussed.

Attachment styles and outcome of psychoanalytic psychotherapy for children and adolescents.

BACKGROUND: Until now few studies have proven that an attachment style can be changed in the course of psychotherapy and that the attachment style has an impact on the therapy outcome. In particular, there is a lack of studies about these relationships in long-term psychoanalytic psychotherapy with children and adolescents. SAMPLING AND METHODS: Seventy-one children with mental disorders receiving long-term outpatient psychodynamic psychotherapy were assessed 4 times using the Heidelberg Attachment Style Rating for Children and Adolescents. The measurements were conducted at the beginning of treatment, at the 25th treatment session, at the end of treatment and 1 year after the completion of treatment. RESULTS: The results showed a significant change in attachment style during treatment. The proportion of children and adolescents with a secure attachment style increased from 23% to 63%. There was no significant difference in the attachment style between patients with good and poor treatment outcome, but a significant relationship between secure attachment and the number of treatment sessions could be demonstrated. CONCLUSIONS: A reorientation towards a secure main attachment style over the course of psychotherapy is possible. However, attachment style seems to be not a moderator but a mediator for the outcome of psychoanalytic psychotherapy in children and adolescents.

[Attachment style and outcome in short-term psychodynamic psychotherapy for children and adolescents]. / Bindungsstil und Therapieerfolg in der psychodynamischen Kurzzeittherapie bei Kindern und Jugendlichen.

In several studies, the association between attachment style and psychotherapy outcome has been shown for adults. The aim of the present study was to examine the association between attachment style and outcome of short-term psychodynamic psychotherapy for children and adolescents. 71 children and adolescents with a mental disorder receiving out-patient short-term psychodynamic psychotherapy were studied. Attachment style was assessed with the Heidelberg Attachment Style Rating for Children and Adolescents (HASR-CA). Therapy outcome was measured using the Severity of Impairment Score for Children and Adolescents (SIS-CA). It could be shown that good outcome in therapy is significantly more frequently associated with a secure attachment style than with an insecure attachment style. No significant changes in attachment security were observed during treatment. Thus, attachment style is a good predictor of a successful short-term psychodynamic psychotherapy for children and adolescents and therefore is an important criterion for the differential indication for psychodynamic therapies.

[Assessment of shame and guilt validation of the test of self-conscious affect for children and adolescents (TOSCA-C/A)]. / Zur Erfassung von Schuld und Scham bei Kindern und Jugendlichen Validierung der deutschen Fassung des Tests of Self-Conscious Affect for Children and Adolescents (TOSCA-C/A)

Shame and guilt feelings play a pivotal role in the aetiology and maintenance of a number of psychological disorders as well as in the development and regulation of moral behaviour. Despite intensive theoretical treatments of this topic, there have been few empirical studies to date, chiefly because of the lack of appropriate measuring instruments. The purpose of this study was the psychometric evaluation of the German version of the Test of Self-Conscious Affect for Children and Adolescents (TOSCA-C/A). The psychometric properties of this instrument were evaluated using a non-clinical sample of N = 505 children and adolescents aged between 8 and 18 years and a clinical sample of N = 50 children and adolescents. The individual scales proved reliable. There were many indications of the validity of the scales. We conclude that the German version of the TOSCA-C/A is the basis for the further investigation of self-conscious affects such as guilt and shame in children and adolescents.

[Efficacy of psychodynamic short-term psychotherapy for children and adolescents with anxiety disorders]. / Zur Wirksamkeit psychodynamischer Kurzzeit- psychotherapie bei Kindern und Jugendlichen mit Angststörungen.

Anxiety disorders can be regarded as one of the most prevalent disorders in children and adolescents. Although psychodynamic psychotherapies are frequently carried out in this field, the evaluation of its efficacy for anxiety disorders is still deficient. Therefore the aim of the study was to evaluate psychodynamic short-term psychotherapy (PSTP) comprising 25 therapy sessions for children and adolescents with anxiety disorders. In a controlled trial PSTP was compared to a waiting list control condition. 26 children and adolescents with anxiety disorders were included in the study. Treatment outcome was measured by the Impairment-Score for Children and Adolescents (IS-CA). Moreover, the Child Behavior Checklist (CBCL) and the Psychic and Social-Communicative Findings Sheet for Children and Adolescents (PSCFS-CA) were administered at the beginning and end of the treatment. The statistical and clinical significance of changes in these measures was evaluated. A significant advantage of the treatment group compared to the waiting control group for the IS-CA was shown. For the IS-CA total score, an effect size of 1.6 was found. Whereas 62% of the patients in the treatment group showed clinically significant and reliable improvement at the end of therapy, this was the case for only 8% of the subjects in the waiting list condition. Effect sizes comparable to the IS-CA were found for the PSCFS-CA. In the CBCL significant improvement could be shown for the treatment and control group. The findings support the evidence that psychodynamic short-term psychotherapy (PSTP) is an effective treatment for children and adolescents with anxiety disorders. However, some of the studied children and adolescents seem to be in need of more intensive treatment.

[Efficacy of psychodynamic short-term psychotherapy for children and adolescents with depression]. / Zur Wirksamkeit psychodynamischer Kurzzeit- psychotherapie bei Kindern und Jugendlichen mit Depressionen.

Depression is highly prevalent in children and adolescents. Psychodynamic therapies are only insufficiently evaluated in this field although many children and adolescents suffering from depression are treated using this approach. Therefore, the aim of our study was to evaluate the efficacy of psychodynamic short-term psychotherapy (PSTP) for the treatment of depression in children and adolescents. In a waiting-list controlled study, 20 children and adolescents fulfilling diagnosis of major depression or dysthymia were included. The treatment group received 25 sessions of psychodynamic psychotherapy. Main outcome criterion was the Impairment-Score for Children and Adolescents (IS-CA) as well as the Psychic and Social-Communicative Findings Sheet for Children and Adolescents (PSCFS-CA) and the Child Behavior Checklist (CBCL), which were assessed at the beginning and the end of treatment. The statistical and clinical significance of changes in these measures were evaluated. There was a significant advantage of the treatment group compared to the waiting group for the IS-CA. The effect size of the IS-CA total score was 1,3. In contrast to the treatment group, where 20% of the children showed clinically significant and reliable improvement, no subject in the waiting-list control group met this criterion. Comparable results were found for the PSCFS-CA and for the internalising score assessed with the CBCL. The results show that psychodynamic short-term psychotherapy (PSTP) is an effective treatment for depressed children and adolescents. Still, some of the children surely require more intensive treatment.

[Efficacy of psychodynamic short-term psychotherapy for children and adolescents with behavioral disorders]. / Zur Wirksamkeit psychodynamischer Kurzzeit- psychotherapie bei Kindern und Jugendlichen mit Verhaltensstörungen.

Behavioral disorders represent one of the most frequent mental disorders in children and adolescents. Even though psychodynamic psychotherapies are often used to treat behavioral disorders, to date, its efficacy has rarely been empirically evaluated. The aim of the study therefore was to evaluate psychodynamic short-term psychotherapy (PSTP) for children and adolescents with behavioral disorders. By means of a waiting-list controlled study, 26 children and adolescents fulfilling diagnosis of behavioral disorders were examined. The treatment group received 25 sessions of psychodynamic psychotherapy. Primary criterion of outcome was the Impairment-Score for Children and Adolescents (IS-CA). Furthermore, the Child Behavior Checklist (CBCL) and the Psychic and Social-Communicative Findings Sheet for Children and Adolescents (PSCFS-CA) were administered at the beginning and end of the treatment. The statistical as well as the clinical significance of changes during treatment were analysed. It could be shown, that the treatment group improved significantly more in the Impairment-Score for children and adolescents (IS-CA) compared to the waiting group. The effect size of the IS-CA total score was 0,6. 31% of the children in the treatment group improved clinically significantly or according to the criterion of Reliable Change, whereas that was the case only for 8 % of the subject in the waiting list condition. A significant advantage was found for the therapy group in the PSCFS-CA. Effect sizes were between 0.8 and 1.4. In the CBCL significant improvement could be shown for the treatment and control group however only with small effects. These results substantiate that psychodynamic short-term psychotherapy (PSTP) is an effective intervention for children and adolescents with behavioral disorders. However, the findings also show that some of the children and adolescents are in need of a more intensive or long-term treatment.