Behavioral activation for depression in groups embedded in psychosomatic rehabilitation inpatient treatment: a quasi-randomized controlled study.

Background: Behavioral activation (BA) and cognitive-behavioral therapy (CBT) have shown to be efficacious treatment methods for depression. Previous studies focused mostly on the outpatient treatment either in group or individual setting. The present study aimed at comparing the efficacy of group treatment BA vs. CBT, when embedded in inpatient psychosomatic rehabilitation treatment. Methods: 375 inpatients were randomly assigned to either BA (N = 174) or CBT (N = 201). We used established scales for depression such as the Beck Depression Inventory II (BDI-II, self-rating), the Quick Inventory of Depressive Symptomatology (QIDS; expert rating) and the Behavioral Activation for Depression Scale (BADS) to assess changes over the course of the treatment and at follow-up (4 to 6 months). In addition, we measured disability-related functioning with the Mini-ICF-APP, a rating scale built in reference to the International Classification of Functioning, Disability and Health (ICF). Multilevel models with repeated measures were conducted to examine the differences between groups in relation to change over time with patients' random effects. Results: Both group formats showed substantial reduction in depressive symptoms at the end of treatment (d= 0.83 BA vs. d= 1.08 CBT; BDI-II) and at follow-up after 4 to 6 months (d = 0.97 BA vs. d = 1.33 CBT, BDI-II; and d = 1.17 BA vs. d = 1.09 CBT, QIDS). There were no significant differences between treatment approaches. At least 50% symptom reduction was achieved by 53.7% and 54.2% in BA vs. CBT respectively. Reported activation levels increased from pre- to posttreatment (d = 0.76 BA vs. d = 0.70CBT), while showing loss of increment between the end of the treatment until follow up in both formats (d = 0.28 BA vs. d = 0.29 CBT). Discussion: Both modalities led to significant improvement of symptomatology and functioning at the end of the treatment and at follow-up, thus for the first time demonstrating the practicability of BA in rehabilitation clinics. Considering its lower requirements regarding cognitive abilities and its easier implementation, BA proved to be a good alternative to other psychotherapeutic treatments.

Originalbeiträge (Originals). Psychotherapeutic inpatient depression treatment in open versus closed group format.

OBJECTIVE: Controversy exists about the comparative efficacy of different group formats, e. g., open versus closed. Most of the findings come from outpatient, closed group research. In practice, the open format is more widely used. This monocentric study aims to compare the efficacy as well as group cohesion during inpatient group psychotherapy for depression delivered in an open versus closed format. METHODS: 291 depressed inpatients (ageM= 55.7, SD = 11) of a psychosomatic-rehabilitation clinic were consecutively assigned to either open (n = 117) or closed (n = 174) cognitive-behavioral groups, further subdivided into groups based on length of the stay. Using multilevel models, we examined depression and group cohesion concerning changes in patients' random effects over time. RESULTS: Both group formats showed a reduction in symptomatology (d = 1.8). A significant group format x time interaction in favor of the closed format was found regarding group cohesion. CONCLUSION: While group cohesion improved in the closed format only, we did not find any significant difference between group formats regarding their efficacy. Further research should focus on randomized controlled trials comparing both formats directly.

Attention deficits and depressive symptoms improve differentially after rehabilitation of post-COVID condition - A prospective cohort study.

BACKGROUND: Depressive and cognitive symptoms like fatigue, loss of energy or sleep disorders characterise the post-COVID condition. Post-COVID psychosomatic rehabilitation should focus on both symptom groups. The current prospective cohort study addresses the change in these symptoms in the context of a psychosomatic rehabilitation. METHOD: N = 80 patients with post-COVID symptoms underwent psychological testing on admission and discharge: PHQ-9 questionnaire for depression, TAP - test battery for the attention test with the sub-tests working memory, sustained attention, divided attention and alertness. Sample characteristics, including health-related and work-related parameters, the general symptom load and the course of symptoms during the five weeks of rehabilitation were evaluated. RESULTS: On admission, the PHQ-9 indicated the presence of depressive symptoms in post-COVID patients (PHQ-9 = 15.15 ± 5.11). Over the course of rehabilitation, the depressive symptoms decreased to a sub-clinical level (PHQ-9 = 8.80 ± 4.61), suggesting a strong effect of post-COVID inpatient rehabilitation (Cohen's d = 1.57). At the same time, post-COVID patients showed clinically relevant impairments in attention and working memory that persisted throughout the rehabilitation period despite multimodal post-COVID treatment. CONCLUSION: Over the course of post-COVID rehabilitation, depressive symptoms appear to be significantly reduced. With regard to cognitive impairment, a comparable effect within the short period of 5 weeks is not evident. Our results suggest the need for specific treatment of persistent neuropsychological deficits following post-COVID rehabilitation.

Milieu-specific differences in symptom severity and treatment outcome in psychosomatic rehabilitation in Germany.

Introduction: Previous studies that focused on socioeconomic differences did not comprehensively explain existing inequalities in psychosomatic rehabilitation in Germany. We applied a social milieu approach, which additionally includes sociocultural factors such as lifestyles, attitudes and values, to investigate differences among patients in symptom severity, psychosocial impairment and improvement over the course of the intervention. Methods: As a model for social milieus, the empirical Sinus milieus were used. 2,000 patients of two psychosomatic rehabilitation clinics in Germany were included and their milieu was assessed with the Sinus milieu indicator for Germany 10/2018 questionnaire. BDI-II (N = 1,832) and HEALTH-49 (N = 1,829) questionnaires were used to measure depressiveness and psychosocial impairment at admission (T0) and discharge after 5 weeks of treatment (T1). Milieu differences in severity and improvement were analyzed by mixed-model ANOVAs. Results: Milieu distribution was not representative of the overall population of Germany. We found significant differences between patients from different milieus in both BDI-II and HEALTH-49 (p < 0.001). Patients from the Precarious Milieu had the highest burden of depressive symptoms in BDI-II and the highest impairment on all HEALTH-49 scales at T0 and T1. Over the course of rehabilitation, patients from all milieus improved significantly in all domains (p < 0.001). Significant interaction effects showed milieu-dependent differences in improvement for depressiveness on the BDI-II [F(9, 1822) = 2.50, p = 0.008] and for three HEALTH-49 scales, namely Psychological well-being [F(9, 1819) = 3.30, padj = 0.005], Interactional difficulties [F(9, 1819) = 2.74, padj = 0.036] and Activity and Participation [F(9, 1819) = 4.94, padj < 0.001], while post-hoc tests only revealed two significant group differences for the last scale. In all domains, patients from the Precarious Milieu retained higher symptoms and impairment at T1 than patients from better-off milieus had at T0. Discussion: Social milieu was associated with symptom severity, treatment access and outcome of psychosomatic rehabilitation patients. Milieu-specific sociocultural habits, psychosocial needs and therapeutic demands may help describe differences and should be considered in therapy planning and implementation, to improve equal access, quality and effectiveness of rehabilitation. Therefore, further research on milieu-specific differences and needs is necessary.

S2k-Guideline SARS-CoV-2, COVID-19 and (early) rehabilitation - a consensus-based guideline for Germany.

The consensus-based guideline "SARS-CoV-2, COVID-19 and (early) rehabilitation" for Germany has two sections: In the first part, the guideline addresses infection protection-related procedures during the COVID-19 pandemic. In the second part, it provides practice recommendations for rehabilitation after COVID-19. The specific recommendations for rehabilitation after COVID-19 as issued by 13 German medical societies and two patient-representative organizations are presented together with general background information for their development.

S2k-Leitlinie SARS-CoV-2, COVID-19 und (Früh-) Rehabilitation ­ eine Kurzfassung mit allen Empfehlungen im Überblick.

The consensus-based SARS-CoV-2, COVID-19, and Rehabilitation Practice Guideline provides recommendations that take both infection prevention and the pursuit of therapeutic goals in rehabilitation settings during the coronavirus pandemic into account. The Practice Guideline provides guidance how to prevent SARS-CoV-2 infections in rehabilitation settings in a first part. The guideline's second part addresses rehabilitation for patients affected by COVID-19 starting with interventions on intensive care units, during early rehabilitation, post-acute rehabilitation, in outpatient and community rehabilitation settings, as well as long-term care, e. g. for COVID-19 survivors with Long- or Post-COVID.The updated second version of the Practice Guideline (dating from 01.11.2021) is a consensus-based guideline developed by a representative panel of healthcare professionals from 15 medical societies covering various rehabilitation disciplines, infectious diseases, hospital hygiene, and epidemiology. The abbreviated version provides an overview of all recommendations given.

[Not Only Multimodal, but also Interdisciplinary: A Concept for Interdisciplinary Cooperation in the Rehabilitation of Post-COVID Syndrome]. / Nicht nur multimodal, sondern auch interdisziplinär: Ein Konzept für fächerübergreifende Zusammenarbeit in der Rehabilitation des Post-COVID-Syndroms.

Currently (March 2022), more than 17 million people in Germany have been infected with the SARS-CoV-2 virus. It is expected that 5-10% of those infected will develop a clinically relevant post-COVID syndrome. The most common symptoms are fatigue, dyspnoea and cognitive impairment. A causal therapy is currently not available, but there is increasing evidence that a multimodal treatment approach with psychotherapeutic elements is promising. Post-COVID is thus a current challenge for the health care system and especially for rehabilitation. This article describes a dual internal psychosomatic rehabilitation concept. The core elements are a behavioural therapy-oriented, disorder-specific psychotherapy group as well as exercise therapy that is adapted to the individual's capacity and slowly builds up. The goals are support in coping with the illness and an improvement in performance. Interventions based on ACT and the Avoidance Endurance Concept are used. In addition, respiratory therapy, cognitive training as well as nutritional and social counselling are offered on an indicative basis. The internal medicine team provides the patients with the security of being able to engage in the physical training programme. Experience so far shows that the concept is well accepted by the patients and that the intended treatment goals can be achieved.

Responsivity and relation to depressive symptoms of occupational behavior and experience patterns.

Introduction: Work stress is a frequent factor in the development of depression. However, not only workplace environment, but also personal attitudes may affect stress experience. The aim of this study was to investigate the change sensitivity of occupational attitudes in psychosomatic inpatients and assess the relationship of changes to depressive symptom reduction. Methods: The data set encompassed N = 1708 inpatients from two German psychosomatic rehabilitation clinics at admission and discharge. Responsivity of AVEM measures was evaluated by Bonferroni-corrected t-tests and Cohen's dz effect sizes for paired samples. The relation of occupational behavior and experience patterns and depressive symptoms as assessed by the BDI-II questionnaire was calculated by Pearson correlation analysis of pre-post differential values. Results: Changes in work attitudes were found on eight out of eleven AVEM subscales (Padj ≤ 0.001, Cohen's dz = -0.45 to 0.43) and all AVEM coping styles. Most patients (57.4%) were classified to have a Burnout occupational coping style at admission. Changes following rehabilitation were most frequently observed from Burnout to Sparing coping styles (8.3%). Small to moderate associations between changes in occupational attitudes and depressive symptom reduction were found for all subscales (r = -0.39 to 0.25) except work ambition, and for occupational coping styles Burnout (r = 0.19), Sparing (r = -0.18) and Healthy (r = -0.10), but not Ambitious. Discussion: The data support responsivity of occupational behavior and experience patterns within a psychosomatic rehabilitation setting. Correlations with depressive symptom reduction suggest that occupational attitudes are related but separate treatment targets.

Using machine learning to investigate earning capacity in patients undergoing psychosomatic rehabilitation-A retrospective health data analysis.

Psychiatric disorders increasingly contribute to disability and early retirement. This study was conducted to investigate whether machine learning can contribute to a better understanding and assessment of such a reduced earning capacity. It analyzed whether impaired earning capacity is reflected in missing treatment effects, and which interventions drive treatment effects during psychosomatic rehabilitation. Analyses were based on routine clinical data encompassing demographics, diagnoses, psychological questionnaires before, and after treatment, interventions, and an interdisciplinary assessment of earning capacity for N = 1,054 patients undergoing psychosomatic rehabilitation in 2019. Classification of patients by changes in self-reported mental health and interventions predictive of changes were analyzed by gradient boosted model. Clustering results revealed three major groups, one of which was comprised almost exclusively of patients with full earning capacity, one of patients with reduced or lost earning capacity and a third group with mixed assessments. Classification results (Kappa = 0.22) indicated that patients experienced modestly divergent changes over the course of rehabilitation. Relative variable influence in the best model was highest for changes in psychological wellbeing (HEALTH-49). Regression analysis identified intervention A620 (physical exercise therapy with psychological goal setting) as most influential variable predicting changes in psychological wellbeing with a model fit of R 2 = 0.05 (SD = 0.007). Results suggest that disability due to psychiatric disorders does associate with distinct demographic and clinical characteristics but may be less clear-cut in a subgroup of patients. Trajectories of treatment response show moderately divergent paths between patient groups. Moreover, results support both physical exercise therapy as efficient intervention in reducing disability-associated impairments and the complementarity of a multimodal treatment plan.

Fächerübergreifende psychokardiologische Rehabilitation: vom Modellprojekt zur Blaupause des dualen Rehabilitationskonzeptes ­ von Erfahrungswerten zu wissenschaftlichen Daten.

The development and course of heart disease can be decisively influenced by psychological comorbidities (especially depression, anxiety disorder or post-traumatic stress disorder). An acute or chronic cardiological disease can in turn trigger or exacerbate mental disorders. These relationships are of considerable importance for cardiac rehabilitation, since psychological comorbidities often limit activity and participation more than organic heart disease. In monodisciplinary rehabilitation procedures (cardiological or psychosomatic), however, in the case of comorbidity, one clinical picture cannot be adequately treated and assessed by socio-medical experts. Interdisciplinary rehabilitation concepts are required here.In the first part of this article, the development and implementation of an interdisciplinary psychocardiological rehabilitation concept from the model phase to the establishment and expansion to other disciplines as well as the first research results are described. After initial positive evaluation data and good acceptance by the rehabilitants, the German Pension Insurance (DRV) is expanding the concept to other specialist areas under the name "dual rehabilitation" in order to promote interdisciplinary cooperation in the case of psychological and somatic comorbidity.In the second part of the work, the concept and first data from the controlled EvaPK study (Evaluation of the effectiveness of psychocardiological rehabilitation) funded by the DRV Bund are presented. These show that the comorbid patients are particularly stressed in terms of activity and participation (recorded in the Mini-ICF-APP-S) and that psychocardiological rehabilitation is also effective in this highly stressed group. However, the evaluations of the catamnesis and the cardiac function parameters are still missing.Both the pilot study and the first data from the EvaPK study show that psychocardiological rehabilitation meets the needs of comorbid patients and is well accepted by them. However, successful psychocardiological rehabilitation according to the concept presented here requires higher personnel costs and intensive, equal cooperation. Further research on this is necessary.

[Rehabilitation with coronavirus disease with SARS-CoV-2 (COVID-19)]. / Rehabilitation bei Coronavirus-Erkrankung mit SARS-CoV-2 (COVID-19).

The Coronavirus disease with SARS-CoV-2 viral infection (COVID-19) and its diverse courses of disease from mild to critical illness frequently is not only an acute disease, but will - in a proportion of those affected - lead to organ structure and body function deficits that still exist or become apparent after the acute stage of disease. When clinically relevant symptoms or functional deficits (impairments) are documented more than four weeks after COVID-19 onset, the syndrome is called "Long-COVID", from 12 weeks after onset onwards "Post-COVID".In such cases and when everyday life functioning and return to work are affected by persisting deficits specialized rehabilitation treatment is indicated. An individual medical, frequently multi-professional diagnostic evaluation is mandatory in that situation: For adequate treatment, it is important to identify and objectify the individually underlying health conditions based on knowledge about the diverse potential consequences of COVID-19, to assess type and severity of functional consequences (impairments, activity limitations, and restrictions of participation) of Long-/Post-COVID individually, and then to decide on the treatment necessities and plans. With regard to rehabilitation, need and decision for either pulmonary, neurological, cardiac, or psychosomatic rehabilitation depends on the individual medical presentation.

[Rehabilitation with coronavirus disease with SARS-CoV-2 (COVID-19)]. / Rehabilitation bei Coronavirus-Erkrankung mit SARS-CoV-2 (COVID-19).

The Coronavirus disease with SARS-CoV-2 viral infection (COVID-19) and its diverse courses of disease from mild to critical illness frequently is not only an acute disease, but will - in a proportion of those affected - lead to organ structure and body function deficits that still exist or become apparent after the acute stage of disease. When clinically relevant symptoms or functional deficits (impairments) are documented more than four weeks after COVID-19 onset, the syndrome is called "Long-COVID", from 12 weeks after onset onwards "Post-COVID".In such cases and when everyday life functioning or return to work are affected by persisting deficits specialized rehabilitation treatment is indicated. An individual medical, frequently multi-professional diagnostic evaluation is mandatory in that situation: For adequate treatment, it is important to identify and objectify the individually underlying health conditions based on knowledge about the diverse potential consequences of COVID-19, to assess type and severity of functional consequences (impairments, activity limitations, and restrictions of participation) of Long-/Post-COVID individually, and then to decide on the treatment necessities and plans. With regard to rehabilitation, need and decision for either pulmonary, neurological, cardiac, or psychosomatic rehabilitation depends on the individual medical presentation.

Relevance of the post-COVID syndrome within rehabilitation (PoCoRe): study protocol of a multi-centre study with different specialisations.

BACKGROUND: In Patients suffering from post-COVID syndrome, in addition to physical limitations, cognitive limitations, fatigue, dyspnea as well as depression and anxiety disorders may also be present. Up to now (as of May 2022), approx. 514 million people worldwide have been infected with SARS-CoV-2, in Germany this affects approx. 25 million. In Germany, 2.5 million people could potentially be affected by post-COVID syndrome. Post-COVID is thus a highly relevant public health issue. So far, there is no specific causal therapy for the post-COVID syndrome, but with multimodal symptom-oriented rehabilitation, the course can be favourably influenced. However, there is no study yet that focuses on patients in different rehabilitation indications and compares the focal symptomatology and coping strategies as well as the patients' benefit per indication. METHODS/DESIGN: As first objective, pulmonal, cardiac, neurological, cognitive or/and psychological functional impairments in rehabilitation patients after COVID-19 disease will be described. The second objective is the differentiated review of the specific rehabilitation measures, in the short term and in the longer term for the purpose of future prognoses and optimisation of therapeutic interventions. This prospective, non-randomised, controlled longitudinal study, plus multi-group comparisons will take place in seven rehabilitation clinics of different specialisations: cardiological rehab, pneumological rehab, neurological rehab, psychosomatic rehab. Within 12 months, 1000 cases across all participating centres will be included. Somatic and psychological testing will be conducted at three measurement points: Admission (t0), discharge (t1), 6-montas Catamnesis (t2). The patients receive the usual care according to the respective rehabilitation priorities, adapted to the special challenges of post-COVID symptoms. Patients of the post-COVID outpatient clinic without rehabilitation will be used as a control group. DISCUSSION: This study will precisely assess the extent to which subclinical neurological or/and psychological impairments are present in post-COVID-19 rehabilitation and the results will help, developing, providing and evaluating appropriate treatment concepts. This may also have relevant implications for the improvement of physical ability and quality of life in post-COVID-19 patients and increase the probability of return to work. Trial registration Z-2022-1749-8, registered 03. February 2022, https://studienanmeldung.zks-regensburg.de.

[Anxiety Disorders in Rehabilitation]. / Angsterkrankungen in der Rehabilitation.

Anxiety disorders are among the most common and socio-medically relevant mental illnesses. Correct diagnosis and initiation of appropriate therapy are of the utmost importance for patients' prognosis and for ensuring their social and occupational participation. This article therefore aims to provide an overview of new developments in the field of anxiety disorders relevant to rehabilitation.Within the framework of the changes in ICD-11, anxiety disorders now receive an independent chapter with a focus appropriate to their frequency and relevance. Further innovations concern the revised S3 guideline (2020) with the increasing consideration of digital therapy options, such as virtual reality exposure therapy (VER) as well as Internet-supported therapy methods as part of the therapy recommendations. Systemic therapy is also considered for the first time. However, the evidence for both procedures is significantly lower than for behavioral therapy, psychodynamic therapy, or pharmacotherapy. Online interventions are therefore not recommended as the sole therapy.Important for the practice in rehabilitation is the knowledge of the core symptoms of each of the above mentioned diagnoses as well as the diagnostic possibilities taking into account especially the correlations and interactions with physical diseases.Both psychotherapy and psychopharmacotherapy are available for treatment. In the field of psychotherapy, cognitive behavioral therapy (CBT) is the therapy of first choice due to the broadest base of evidence. In consideration of comorbid somatic diseases, attention must be paid to possible contraindications for antidepressants. Psychosomatic rehabilitation is an important resource in the overall treatment spectrum, especially if chronification or a threat to participation is foreseeable, in order to give the affected person confidence and motivation for further successful treatment of the anxiety disorder in an intensified treatment setting, in addition to teaching anxiety management strategies and socio-medical clarification. An important task of somatic rehabilitation is to recognize comorbid anxiety disorders and to provide the affected persons with an appropriate explanatory model of their complaints and to be able to initiate targeted treatment.

Heart-Focused Anxiety Affects Behavioral Cardiac Risk Factors and Quality of Life: A Follow-Up Study Using a Psycho-Cardiological Rehabilitation Concept.

Background: Heart-focused anxiety (HFA) raises the risk for adverse outcomes in patients with heart disease. Despite this great importance, it is rarely assessed in clinical practice. Three dimensions are commonly defined in the context of HFA: heart-related fear, avoidance, and attention. The impact of these aspects on cardiac risk factors is essentially unclear. In this study, we investigated the relationship between HFA and behavioral cardiac risk factors as well as health-related quality of life (HRQoL), which represent important treatment outcomes of inpatient psycho-cardiological rehabilitation. Methods: A prospective observational design was used to examine 238 rehabilitation inpatients with comorbidity of cardiac disease and psychiatric disorder. We assessed HFA using the Cardiac Anxiety Questionnaire (CAQ), HRQoL using the SF-12 Health Survey, exercise capacity using the 6-minute walk test, and smoking behavior, respectively at admission (t0) and discharge (t1). Physical activity was assessed at t0 and in a follow-up survey 6 months after discharge (t2) using the International Physical Activity Questionnaire (IPAQ). Multiple regression models were used to analyze the predictive value of HFA for the outcome variables at t0, t1, and t2, adjusted for socio-demographic factors and depression. Predictive values for changes over time were evaluated by the regressor variable approach. Results: Exercise capacity and physical activity were negatively predicted by baseline heart-related avoidance, both cross-sectionally and prospectively. Avoidance at t1 also negatively predicted long-term changes over time in physical activity at t2. Total HFA and the subcomponent avoidance negatively predicted physical HRQoL both cross-sectionally and prospectively. Mental HRQoL was cross-sectionally predicted by heart-focused attention at t0, and prospectively predicted by total HFA and by avoidance. Regarding changes in the course of rehabilitation, baseline avoidance negatively predicted improvement in physical HRQoL during rehabilitation. Concerning smoking behavior, no associations with HFA were found. Conclusions: HFA is a relevant inhibiting factor for the achievement of therapy goals in psycho-cardiological rehabilitation such as health behavior and HRQoL. Heart-related avoidance in particular, has a negative impact on exercise capacity, physical activity, and self-reported physical health. Its prospective negative predictive value for physical activity and physical health underlines the relevance of HFA for psycho-cardiological interventions.

[Pilot study examining a profession-oriented rehabilitation concept for nursing professions]. / Pilotstudie zur Evaluation einer medizinisch-beruflich orientierten Rehabilitation für Pflegekräfte.

Pilot study examining a profession-oriented rehabilitation concept for nursing professions Objectives: Nursing professions are associated with high levels of psychological distress, high numbers of absent days and premature retirement. To achieve higher return-to-work rates, psychosomatic rehabilitation is expected to offer treatments tailored to workplace demands. This pilot study is the first to examine the effects of a new workplace-oriented medical rehabilitation program for nursing professions. Methods: A total of N = 145 depressed patients in nursing occupations (86.9 % female; 50.9 ± 7.34 years) took part in a workplace-oriented rehabilitation program for nursing professions. At admission they were compared to N = 147 depressed patients (63.27 % female; 49.36 ± 7.58 years) in non-nursing professions regarding patterns of work-related experience and behaviour (AVEM) using a MANOVA with follow-up ANOVAs for individual subscales. Changes in work-related attitudes among the nursing professions following completion of the intervention were assessed using a MANOVA followed by repeated measures ANOVAs. The effect of the workplace- oriented intervention on depressiveness (BDI-II) was compared to a treatment program for depression using a mixed model after taking potentially confounding variables into account. Results: At entry, depressed patients in nursing professions scored significantly higher on AVEM scale willingness to work to exhaustion and lower on AVEM scale distancing ability compared to depressed patients in other professions. Following completion of the workplace-oriented intervention program for nursing professions, participants showed a significant reduction on AVEM scales subjective importance of work, willingness to work to exhaustion, and striving for perfection. Increasing scores were observed on the distancing ability and life satisfaction scales. Depression scores had significantly improved at discharge in both participants of the work-oriented intervention and the disorder-specific intervention for depressive disorders, whereas neither group differences nor interaction effects were found. Conclusions: The work-oriented intervention for nursing professions successfully induced changes in maladaptive work-related attitudes. Improvements in depressiveness did not significantly differ from an intervention targeting depression specifically.

First results from post-COVID inpatient rehabilitation.

Background: COVID-19 is associated with various symptoms and psychological involvement in the long term. In view of the multifactorial triggering and maintenance of the post-COVID syndrome, a multimodal therapy with somatomedical and psychotherapeutic content is expedient. This paper compares the psychological stress of post-COVID patients and their course in rehabilitation to psychosomatic and psychocardiological patients. Method: Observational study with control-groups and clinical, standardized examination: psychological testing (BDI-II, HELATH-49), 6-MWT as somatic parameter, two measurement points (admission, discharge). Sample characteristics, including work related parameters, the general symptom-load and the course of symptoms during rehabilitation are evaluated. Results: At admission in all measures post-COVID patients were significantly affected, but less pronounced than psychosomatic or psychocardiological patients (BDI-II post-COVID = 19.29 ± 9.03, BDI-II psychosomatic = 28.93 ± 12.66, BDI-II psychocardiology = 24.47 ± 10.02). During rehabilitation, in all complaint domains and sub-groups, symptom severity was significantly reduced (effect sizes ranging from d = .34 to d = 1.22). Medium positive effects were seen on self-efficacy (d = .69) and large effects on activity and participation (d = 1.06) in post-COVID patients. In the 6-MWT, the walking distance improved by an average of 76.43 ± 63.58 meters (d = 1.22). Not a single patient deteriorated in walking distance, which would have been a possible sign of post exercise malaise (PEM). Conclusion: Post-COVID patients have a slighter psychological burden as psychocardiological or psychosomatic patients. Although rehabilitation is not curative, post-COVID patients benefit significantly from the interventions and there were no signs of PEM.

Cognitive Motivation as a Resource for Affective Adjustment and Mental Health.

Background: Depressive symptoms compromise cognitive and self-regulating capacities. Overcoming associated deficits (e.g., attentional bias) demands cognitive effort and motivation. Previous studies on healthy individuals have found cognitive motivation to positively relate to self-regulation and negatively to depressive symptoms. A test of these associations in a clinical sample is lacking. Methods: We assessed cognitive motivation, self-regulation and depressive symptoms by means of well-validated questionnaires in N = 1,060 psychosomatic rehabilitation in-patients before and after treatment. Data were split and analyzed in two steps: We tested previously reported cross-sectional and longitudinal associations of all variables as well as their longitudinal changes in a first sample. Afterward, findings and derived hypotheses were replicated and tested in a second sample. Results: Analyses of both samples confirmed earlier reports on positive associations between cognitive motivation and self-regulation, and negative associations of both with depressive symptoms. While the change in all variables was predicted by their baseline scores, higher baseline cognitive motivation was found to predict stronger improvements in self-regulation, and lower baseline depression scores to predict smaller changes in cognitive motivation and self-regulation. In addition, the change in cognitive motivation partially mediated the association between the changes in depressive symptoms and self-regulation. Conclusion: Based on a large longitudinal data set, the present study expands previous findings and suggests a resource allocation model in which decreasing depressive symptoms lead to a release of capacities benefitting self-regulation directly, and indirectly via cognitive motivation.

Examining Working Memory Performance in Adult Psychosomatic Inpatients.

BACKGROUND: There is cumulating evidence that working memory (WM) processing is impaired in individuals suffering from a psychosomatic and a psychological disorder. However, it is unclear how repetitive negative thinking (RNT), depressive symptoms, and patient characteristics (i.e., age and incapability to work) contribute to WM impairments. The present study examines how these factors affect WM performance in highly distressed adult psychosomatic inpatients. METHODS: Seventy-six inpatients (M age = 52.7, SD = 8.4) from a psychosomatic rehabilitation clinic performed a two-block WM updating task, with accuracy and reaction time as indicators of WM functioning. RESULTS: Multivariate mixed effect model results show that accuracy and reaction time significantly decreased from WM Block 1 to WM Block 2. Higher levels of RNT, more severe depressive symptoms and higher age were associated with worse WM accuracy in Block 1. None of these variables were significantly associated with WM reaction time (in Block 1). CONCLUSION: From a clinical perspective, the results suggest that screening for the presence of high RNT levels, severe depressive symptoms or higher age may help to identify patients with impaired WM functioning and to intervene on these important patient characteristics early in the rehabilitation process.