Theoretical Derivation of a Telephone-Based Health Coaching Intervention for Promoting Physical Activity and Healthy Nutrition.

Present research regarding interventions to change behavior suffers from insufficient communication of their theoretical derivation. This insufficient communication is caused by the restrictions imposed by most of the relevant scientific journals. This impedes further intervention development. In this article, a telephone-based health coaching (TBHC) intervention is introduced using a format outside these restrictions. This intervention is seen as a combination of (1) the activities performed with the target persons, i.e., its core, and (2) measures to ensure the quality of the intervention. The theoretical derivation of the core is presented. The core is seen to consist of (1) the style of coach-patient interaction and (2) the contents of this interaction. The style of coach-patient interaction was derived from self-determination theory and was concretized using motivational interviewing techniques. The contents of the coach-patient interaction were derived from the health action process approach and were concretized using behavior-change techniques. The derivation led to (1) a set of 16 coaching tools referring to the different states in which a patient might be and containing state-specific recommendations for performing the coaching session, and (2) guidelines for selecting the appropriate coaching tool for each session. To ensure the quality of the intervention, a coach-training program before and supervision sessions during the TBHC were added.

A pragmatic randomised controlled trial referring to a Personalised Self-management SUPport Programme (P-SUP) for persons enrolled in a disease management programme for type 2 diabetes mellitus and/or for coronary heart disease.

BACKGROUND: Type 2 diabetes mellitus (T2DM) and coronary heart disease (CHD) are two chronic diseases that cause a tremendous burden. To reduce this burden, several programmes for optimising the care for these diseases have been developed. In Germany, so-called disease management programmes (DMPs), which combine components of Disease Management and the Chronic Care Model, are applied. These DMPs have proven effective. Nevertheless, there are opportunities for improvement. Current DMPs rarely address self-management of the disease, make no use of peer support, and provide no special assistance for persons with low health literacy and/or low patient activation. The study protocol presented here is for the evaluation of a programme that addresses these possible shortcomings and can be combined with current German DMPs for T2DM and CHD. This programme consists of four components: 1) Meetings of peer support groups 2) Personalised telephone-based health coaching for patients with low literacy and/or low patient activation 3) Personalised patient feedback 4) A browser-based web portal METHODS: Study participants will be adults enrolled in a DMP for T2DM and/or CHD and living in North Rhine-Westphalia, a state of the Federal Republic of Germany. Study participants will be recruited with the assistance of their general practitioners by the end of June 2021. Evaluation will be performed as a pragmatic randomised controlled trial with one intervention group and one waiting control group. The intervention group will receive the intervention for 18 months. During this time, the waiting control group will continue with usual care and the usual measures of their DMPs. After 18 months, the waiting control group will also receive a shortened intervention. The primary outcome is number of hospital days. In addition, the effects on self-reported health-state, physical activity, nutrition, and eight different psychological variables will be investigated. Differences between values at month 18 and at the beginning will be compared to judge the effectiveness of the intervention. DISCUSSION: If the intervention proves effective, it may be included into the DMPs for T2DM and CHD. TRIAL REGISTRATION: The study was registered in the German Clinical Trials Registry (Deutsches Register Klinischer Studien (DRKS)) in early 2019 under the number 00020592. This registry has been affiliated with the WHO Clinical Trials Network ( https://www.drks.de/drks_web/setLocale_EN.do ) since 2008. It is based on the WHO template, but contains some additional categories for which information has to be given ( https://www.drks.de/drks_web/navigate.do?navigationId=entryfields&messageDE=Beschreibung%20der%20Eingabefelder&messageEN=Description%20of%20entry%20fields ). A release and subsequent number assignment only take place when information for all categories has been given.

High Rejection Sensitivity in Patients With Somatoform Pain Disorder.

Objective: Rejection sensitivity (RS) is often associated with mental disorders but as yet has not been investigated in patients with somatoform pain disorder (SPD). The aim of the study was to explore the degree of RS in patients with SPD compared to healthy controls. In addition, we examined factors associated with RS and the moderator effect of SPD. Methods: A total of 65 patients with SPD (confirmed by Structured Clinical Interview, SCID-I) and 65 age- and gender-matched healthy controls participated. Rejection Sensitivity Questionnaire (RSQ), Patient Health Questionnaire (PHQ-9, PHQ-15), Relationship Scale (ReSQ), Essen Trauma Inventory (ETI) and the Childhood Trauma Questionnaire (CTQ) were applied. Multiple linear regression analysis was performed. Results: The level of RS was significantly higher in patients with SPD compared to healthy controls (M = 10.30, SD = 5.64; M = 6.13, SD = 2.50; p < 0.001; d = 0.95). Higher levels of depressive symptoms (p < 0.001), childhood adversities (p < 0.001) and the insecure attachment style (p = 0.007) were related to higher levels of RS. No significant moderation effect was detected. Conclusions: Patients with SPD are highly sensitive to social rejection. In addition, insecure attachment styles as well as depressive symptoms and childhood adversities are strongly associated with RS. Further studies are needed to figure out how RS is connected to SPD over lifetime.

Insular Cortical Thickness in Patients With Somatoform Pain Disorder: Are There Associations With Symptom Severity and Childhood Trauma?

BACKGROUND: Studies show significant alterations in insular cortical thickness in patients with somatoform pain disorder (SPD). Additionally, associations between childhood maltreatment and morphometric alterations in insular cortex have been observed. Since patients with SPD often report about adverse childhood experiences, we were interested in the interrelationship of exposure to childhood maltreatment and insular cortical thickness in patients with SPD. METHODS: Fifteen adult patients with SPD (ICD-10 F 45.40/41, DSM-Code 307.80) and thirteen healthy adult controls underwent T1-weighted MR brain imaging. In the voxel-based morphometry (VBM) analysis we compared whole brain cortical thickness between patients and controls using a Student's two-sampled t-test (p < .05). Then we performed a secondary analysis to detect differences in cortical thickness levels in the insular cortex between both groups. For further analysis of differences in insular cortical thickness we used gender, age, depressive symptoms [Patient Health Questionnaire (PHQ)-9], and whole brain cortical thickness as nuisance covariates. Subsequently we explored associations between insular cortical thickness, symptom severity (PHQ-15) and past experiences of childhood maltreatment (CTQ) in both groups. RESULTS: Patients showed reduced insular cortical thickness in a subregion of right Brodmann area (BA) 13 (anterior part of the insular cortex), whereas whole brain cortical thickness did not differ between groups. The between-group difference in the identified insular subregion of right BA 13 was not diminished by any of the covariates. This implies that the reduction in cortical thickness in the identified insular subregion might be due to a specific group effect. The effect sizes indicate that the group of patients experienced more childhood maltreatment than the control group. Nonetheless, significant correlations of insular cortical thickness with symptom severity and childhood maltreatment in the total collective could not be demonstrated for the group of patients. CONCLUSIONS: Our data suggest that alterations in the identified insular subregion of right BA 13 are associated with somatoform pain, independent of gender, age, or coincident depression levels. To identify significant associations of insular cortical thickness and experiences of childhood maltreatment in patients with SPD investigations within larger samples are highly recommended.

Insecure attachment style and cumulative traumatic life events in patients with somatoform pain disorder: A cross-sectional study.

OBJECTIVE: Current models assume somatoform pain disorder (SPD) to be the result of a complex interaction between bio- and psychosocial factors, but the etiology is still not well understood. This study aimed to investigate the distribution of attachment style and the frequency of traumatic life events, especially childhood adversities, in patients with SPD compared to healthy controls. METHODS: We compared 65 patients with SPD (confirmed by Structured Clinical Interview, SCID-I) to 65 age- and gender-matched healthy controls. The following questionnaires were employed: Relationship Scale Questionnaire (RSQ), Essen Trauma Inventory (ETI), Childhood Trauma Questionnaire (CTQ) and Patient Health Questionnaire (PHQ-15). A logistic regression analysis was used to identify the association between SPD and psychological factors. RESULTS: Insecure attachment was significantly more prevalent (60%) in patients with SPD compared to healthy subjects (14%; p<0.001). Overall, 70.4% of patients with SPD reported three or more traumatic events in their life, compared with healthy subjects who reported predominantly one (40%). Patients with SPD scored significantly higher in all CTQ subscales compared to the healthy controls. The factor most strongly related with SPD was the insecure attachment style (OR=11.20, 95% CI: 1.32-94.86). Other significant predictive factors were depression (OR=3.35, 95% CI: 1.84-6.11) and number of traumatic events (OR=2.04, 95% CI: 1.06-3.92). Insecure attachment, depression symptoms and the number of traumatic events explained 86.2% of the variance. CONCLUSIONS: The high predictive value of insecure attachment style and cumulative traumatic events emphasize their importance as risk factors of SPD.