Affective and cognitive Theory of Mind in patients with alcohol use disorder: Associations with symptoms of depression, anxiety, and somatization.

INTRODUCTION: Theory of Mind (ToM) is the ability to ascribe thoughts (cognitive ToM) and feelings (affective ToM) to others. Ample evidence exists for impairments of affective and cognitive ToM in individuals with alcohol use disorder (AUD); however, evidence regarding changes of these impairments during AUD treatment and their possible relationship to comorbid symptoms is ambiguous. The current study analyzed changes in ToM during treatment and tested associations with comorbid symptoms of depression, anxiety, somatization, and social functioning. METHODS: We analyzed data from 175 individuals with AUD. The study assessed ToM and comorbid symptoms of depression, anxiety, somatization, and social functioning at the time of admission and at the time of discharge from an approximately 60 days long abstinence-oriented inpatient treatment. We assessed affective and cognitive ToM using the Movie for the Assessment of Social Cognition, a measure with high ecological validity. RESULTS: All symptoms, total and cognitive ToM improved following treatment; however, affective ToM did not improve. Moreover, cognitive ToM at the beginning of treatment was associated with improved symptoms of depression and somatization, while affective ToM was not. CONCLUSIONS: Our study shows improvements in total and cognitive ToM as well as symptoms of depression, anxiety, somatization, and social functioning following long-term treatment. Furthermore, cognitive ToM was related to improvements in comorbid symptoms. This finding suggests that ToM may be an important treatment target in patients with AUD.

Psychopathology and Theory of Mind in patients with personality disorders.

OBJECTIVE: People with mental disorders frequently suffer from deficits in the ability to infer other's mental states (Theory of Mind; ToM). Individuals with borderline personality disorder (BPD) show ToM deficits characterized by exceeding ToM (over-attributions of mental states). The present study analyzed associations between ToM, BPD severity, and depression severity in patients with BPD and other personality disorders. METHOD: We analyzed ToM abilities in 128 patients with BPD and 82 patients with 'mixed and other personality disorders' (MOPD). MOPD are diagnosed if symptoms of multiple personality disorders are present without any set of symptoms being dominant enough to allow a specific diagnosis. We used the movies for the assessment of social cognition (MASC) to measure ToM abilities, the Patient Health Questionnaire (PHQ-9) to assess severity of depression and the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) to assess the severity of BPD symptoms. RESULTS: Both symptoms of BPD and depression were associated with exceeding ToM in separate regressions. Using a stepwise regression, only the association of depression severity with exceeding ToM was reliable. Patients with BPD and MOPD did not differ in exceeding ToM. Age was most reliably associated with ToM. CONCLUSION: The results imply that exceeding ToM is associated with general psychopathology instead of BPD-symptoms in specific. Patients with MOPD show deficits similar to BPD patients.

Dialectical behaviour therapy for posttraumatic stress disorder (DBT-PTSD): transportability to everyday clinical care in a residential mental health centre.

Background: Dialectical Behaviour Therapy for Posttraumatic Stress Disorder (DBT-PTSD) is a phase-based treatment for PTSD. The DBT-PTSD treatment programme's efficacy has not been tested during standard operation, outside of laboratory outcome studies.Objective: The present pilot study investigated the transportability of the DBT-PTSD treatment to a real word clinical setting in a residential mental health centre.Methods: The DBT-PTSD treatment was compared to a treatment as usual (TAU) condition in a non-randomized study. Overall, 156 patients from a residential mental health centre were included. Propensity score matching was used to match participants in the two treatment arms based on baseline characteristics. Primary and secondary outcomes (PTSD and other symptoms) were assessed at the time of admission and at the time of discharge.Results: The DBT-PTSD treatment outperformed the TAU condition in the improvement of all primary outcomes, as indicated by a significant time and group interaction. There were notable differences in the effect sizes between the unmatched and matched sample as well as between the available and the intent-to-treat (ITT) data analyses. The effect sizes in the ITT data analyses were much lower. Both treatment groups showed similar improvements in secondary outcomes.Conclusions: This study provides initial evidence for the transportability of the DBT-PTSD treatment to a naturalistic clinical care setting, but with considerably lower effect sizes than in previously published laboratory RCTs. The higher efficacy of DBT-PTSD compared to TAU may largely depend on patient's adherence to treatment.

The objective of the present study was to investigate the transportability of the DBT-PTSD programme to a real word clinical setting in a residential mental health centre.The DBT-PTSD treatment outperformed the TAU condition in the reduction of trauma-related symptoms, dissociative symptoms and DSO related but with lower effect sizes compared to previously published RCTs.The study results indicate the influence of treatment adherence on estimates of treatment effects and stress the necessity to routinely monitor the symptoms of patients who are at high risk of dropout or deterioration.

How Individual and Situational Factors Influence Measures of Affective and Cognitive Theory of Mind in Psychiatric Inpatients.

Mental disorders are associated with difficulties to correctly infer the mental states of other's (theory of mind; ToM). These inferences either relate to affective states of others (affective ToM) or to their thoughts, intentions, or beliefs (cognitive ToM) and can be associated with mental disorder. The current study explores the influence of individual and situational effects on the measurement of ToM abilities within two clinical samples, to increase generalizability. We analyzed data from 229 in-patients; 103 patients treated for alcohol use disorder and 126 patients treated for a personality disorder. ToM was assessed with the Movie for the Assessment of Social Cognition (MASC). We analyzed changes in test performance over the course of the test using a logistic linear mixed effects model. Performance on the cognitive ToM items decreased over time, while performance on the affective ToM items increased over time. This difference was more pronounced among older individuals. The results show important moderators of ToM performance that might help to resolve inconsistencies in the current literature about ToM abilities in different clinical or age groups.

Psychological Distress During the COVID-19 Pandemic in Patients With Mental or Physical Diseases.

The coronavirus disease 2019 (COVID-2019) and the consequences of the pandemic on individuals' social, economic, and public lives are assumed to have major implications for the mental health of the general population but also for patients already diagnosed with psychological disorders. The aim of the present study was to investigate the psychological distress during the COVID-19 pandemic in patients with psychological disorders or physical health conditions in inpatient mental and physical treatment programs. A total 2710 patients completed COVID-19 related questions concerning their psychological distress and financial burden during the pandemic. Patients with psychological disorders reported the highest level of psychological distress and financial burden compared to patients with physical health conditions. Furthermore, most patients with psychological disorders attributed their individual psychological distress to the COVID-19 pandemic. In comparison to patients with physical health conditions, patients with psychological disorders are more strongly impacted by the COVID-19 pandemic and have an additional need for psychological/psychotherapeutic treatment due to the COVID-19 crisis. The findings stress the importance of continuous psychosocial support and availability of psychosocial support services for patients with psychological disorders during the pandemic.

Gender effects on outcomes of psychosomatic rehabilitation are reduced.

OBJECTIVE: The study examined whether psychiatric/psychosomatic rehabilitation continues to have a better course of treatment for women than men. METHODS: We compared the course of global symptom severity, health-related quality of life and functioning between admission and discharge in patients (848 men, 1412 women) at an Austrian psychiatric/psychosomatic rehabilitation clinic. RESULTS: Gender-specific differences in the course of treatment were all too small to be clinically relevant. The differences were smallest in the middle-aged cohort. However, at the time of admission, women reported a slightly higher symptom burden. CONCLUSION: Overall, the results show a gender-fair effectiveness of the rehabilitation. The new findings could be explained by changes in living conditions, gender roles, or better treatment methods.

Relationship between psychological stress and metabolism in morbidly obese individuals.

BACKGROUND: Despite evidence for a bidirectional relationship between obesity and stress-related mental disorders, the general relationship between psychological stress and metabolism is still controversial. Only few studies have addressed this relationship in morbidly obese individuals. METHODS: The present study investigated the relationship between psychological distress, health-related quality of life (HRQL), eating behavior, negative emotions and body mass index (BMI), body composition and biomedical parameters of metabolism in an adult sample of 123 (94 females) morbidly obese individuals. RESULTS: No significant relationship was found between psychological distress and BMI, body composition or any of the parameters of metabolism; however, there was a strong and robust association between HRQL in the physical domain and BMI, body composition and several biomedical parameters of sugar and fat metabolism. The results also showed an interesting dissociation in the relationship between BMI and HRQL in the physical and psychology domains. Only little evidence was found for a relationship between eating behavior (e.g. restraint) or negative emotions (e.g. anger) and BMI, body composition and parameters of metabolism. There was, however, a significant gender difference in restraint eating. Other commonly reported gender differences in BMI, body composition, fat metabolism and liver values were also observed in this sample of morbidly obese individuals. CONCLUSION: Results from the present study highlight the relationship between HRQL in the physical domain and metabolism. Implications of these findings for weight loss treatment are discussed, emphasizing HRQL as an important treatment goal and the need for long-term psychological monitoring.

Psychopharmacological treatment of patients with borderline personality disorder: comparing data from routine clinical care with recommended guidelines.

Objectives: Borderline personality disorder (BPD) is a life-threatening mental disorder. Guideline recommendations for pharmacological treatment of patients with BPD vary widely. The objective of the present study was to investigate pharmacotherapy of BPD patients in a routine clinical care setting. Methods: Data on the pharmacological treatment of 110 patients (90% female) with BPD (F- 60.3), treated in an inpatient psychiatric-psychosomatic clinic in Austria were assessed. Results: Results show that clinicians frequently prescribe psychotropic medications to patients with BPD, in many cases multiple medications. The most commonly prescribed substance groups were antipsychotics, mood stabilisers and antidepressants. The most commonly prescribed individual drugs were Quetiapine, Lamotrigine and Setraline. There was no significant difference in the different types or overall number of medications prescribed to BPD patients with vs. without comorbid diagnoses. Pharmacotherapy was not related to comorbidity. Conclusions: The present study shows that in routine clinical care settings psychotropic medications are frequently prescribed to patients with BPD, very often resulting in polypharmacy. A positive association between the number of medications and the effectiveness of the inpatient treatment program, as well as the absence of a relationship between number of medications and comorbidity contradicts the often suggested iatrogenic effect of polypharmacy. Key points Guidelines for pharmacotherapy of borderline personality disorders lack consensus Yet, clinicians frequently prescribe psychotropic medications to BPD patients Types/number of medications prescribed to patients with vs. without comorbidities are similar Larger treatment effects are observed for patients with greater numbers of medications Further knowledge is needed about how and why clinicians prescribe medications.

[Meta-analysis of evaluation results of psychiatric-psychosomatic rehabilitation in Austria]. / Meta-Analyse der Evaluationsergebnisse psychiatrischer-psychosomatischer Rehabilitation in Österreich.

OBJECTIVE: Since previous meta-analyses of psychiatric-psychosomatic rehabilitation only rarely included studies from Austrian rehabilitation clinics a systematic review with meta-analysis of previously available evaluation results from Austrian rehabilitation clinics should be conducted. METHODS: A systematic literature search in several data bases (Psyndex, PsycInfo, MEDLINE, Pubmed) and additional manual search was conducted. Evaluation results from the most commonly used assessment instruments (SCL-90/BSI, BDI, WHOQOL-BREF, GAF) were extracted from the studies included and subsequently a meta-analysis was calculated with the extracted data (pre-post comparison). RESULTS: 12 publications with 9 studies from 6 different Austrian rehabilitation clinics could be included in the meta-analysis, with a total of 9329 patients. Results show a significant improvement from pre- to post assessment in the medium effect size range, with a Hedges' g of 0.53 (95%-confidence interval [0.45;0.60]) for improvement in global symptom severity, a Hedges' g of 0.59 (95%-confidence interval [0.54;0.63]) for improvement in subjective quality of life and a Hedges' g of 1.00 (95%-confidence interval [0.83;1.18]) for improvement in global functioning. The effects are robust and there is no evidence for distortion or publication bias. CONCLUSIONS: On average medium effect sizes have been previously achieved with psychiatric-psychosomatic rehabilitation in Austrian rehabilitation clinics. This is comparable with the previous results of rehabilitation clinics in Germany. However, since only one controlled study is available thus far it can not be ruled out that the effects in comparison to no rehabilitation might turn out smaller. Thus, in the future increasingly controlled studies should be conducted and the quality of conducted studies should be improved.

[Relevance of type of diagnosis and occupational status for the results of psychiatric rehabilitation]. / Relevanz von Erkrankungsart und beruflichem Status für die Ergebnisse psychiatrischer Rehabilitation.

OBJECTIVE: The specific effectiveness of psychiatric rehabilitation has been confirmed in numerous studies. Of particular interest is to what extend different results can be observed regarding the occupational status and type of mental illness of patients. Unemployment at the start of treatment is generally deemed to be a disadvantage for treatment outcome. Weaker treatment effects have also been reported for some types of mental illnesses, such as pain- und somatoform disorders. METHODS: Results from the evaluation of a sample of 2260 patients form the psychiatric rehabilitation clinic Gars am Kamp were analyzed, with regard to the occupational status and type of mental illness of patients. Changes in general symptom severity, quality of life and functioning were assessed. RESULTS: Regarding the occupational status, overall unemployed patients suffered from higher degrees of global symptom severity and the lower levels of global quality of life compared to employed and retired patients. However, improvements in the course of rehabilitative treatment could be observed regardless of the occupational status of patients. Regarding the type of mental illness, overall patients with burnout (Z73.0) reported the lowest levels of global symptom severity and highest degree of global quality of life. In comparison patients with somatoform disorders (F45) showed the lowest degree of global quality of life. However, positive treatment effects regarding general symptom severity and health related quality of life could be observed regardless of the type of mental illness (diagnosis) of patients. In respect to the improvement of global functioning small differences in absolute treatment effects were detected depending on the type of diagnosis of patients. However, relative treatment effects in respect to global functioning were comparable for all types of diagnosis. CONCLUSIONS: Improvements in the course of rehabilitative treatment regarding general symptom severity, quality of life and global functioning can be obtained independent of occupational status and type of mental illness of patients.

Developmental Trends in Flexibility and Automaticity of Social Cognition.

Age-related changes in flexibility and automaticity of reasoning about social situations were investigated. Children (N = 101; age range = 7;8-17;7) were presented with the flexibility and automaticity of social cognition (FASC), a new measure of social cognition in which cartoon vignettes of social situations are presented and participants explain what is happening and why. Scenarios vary on whether the scenario is socially ambiguous and whether or not language is used. Flexibility is determined by the number of unique, plausible explanations, and automaticity is indicated by speed of response. Overall, both flexibility and automaticity increased significantly with age. Language and social ambiguity influenced performance. Future work should investigate differences in FASC in older populations and clinical groups.

[Changes and differences of heart rate variability of patients in a psychiatric rehabilitation clinic]. / Veränderungen und Unterschiede in der Herzratenvariabilität (HRV) von Patienten einer psychiatrischen Rehabilitationsklinik.

BACKGROUND: A reduced heart rate variability (HRV) has been associated with various different pathological physical and psychological conditions and illnesses. The present study is focused on investigating HRV in respect to psychological disorders (depressive disorders anxiety disorders, Burn-out-Syndrome). METHODS: The results from an investigation with patients from a psychiatric Rehabilitation clinic following a six week in-patient treatment are presented. RESULTS: The results show relevant changes in HRV in the course of the rehabilitative treatment for patients with depressive disorders, anxiety disorders or Burn-out-Syndrome. Simultaneously changes in HRV were linked with improvements in patient's psychological symptoms. Changes in HRV (i. e. an increase of relevant HRV-parameters) were accompanied by a reduction of psychological strain as well as psychological and physical health problems, which typically occur in Burnout-Syndrome. Furthermore, changes in relevant HRV-parameters were predictive of changes in psychological symptoms (depression, anxiety, phobia, Burnout symptoms). CONCLUSIONS: The present study did show, that in respect to the investigation of the relationship between HRV and subjective data, primarily those HRV-parameters are important (in terms of significant results) which are based on parasympathetic activity. These results are interesting in the context of theories, which view vagal mediated HRV as positively connected with self-regulation, adaptability and positive interpersonal interaction of individuals.

Training children's theory-of-mind: A meta-analysis of controlled studies.

BACKGROUND: Theory-of-mind (ToM) refers to knowledge and awareness of mental states in oneself and others. Various training programs have been developed to improve ToM in children. OBJECTIVES: In the present study, we conducted a quantitative review of ToM training programs that have been tested in controlled studies. DATA SOURCES: A literature search was conducted using PubMed, PsycInfo, the Cochrane Library, and manual searches. REVIEW METHODS: We identified 32 papers with 45 studies or experiments that included 1529 children with an average age of 63 months (SD=28.7). RESULTS: ToM training procedures were more effective than control procedures and their aggregate effect size was moderately strong (Hedges' g=0.75, CI=0.60-0.89, p<.001). Moderator analyses revealed that although ToM training programs were generally effective, ToM skill-related outcomes increased with length of training sessions and were significantly higher in active control studies. CONCLUSION: ToM training procedures can effectively enhance ToM in children.

Children's emotion understanding: A meta-analysis of training studies.

BACKGROUND: In the course of development, children show increased insight and understanding of emotions-both of their own emotions and those of others. However, little is known about the efficacy of training programs aimed at improving children's understanding of emotion. OBJECTIVES: To conduct an effect size analysis of trainings aimed at three aspects of emotion understanding: external aspects (i.e., the recognition of emotional expressions, understanding external causes of emotion, understanding the influence of reminders on present emotions); mental aspects (i.e., understanding desire-based emotions, understanding belief-based emotions, understanding hidden emotions); and reflective aspects (i.e., understanding the regulation of an emotion, understanding mixed emotions, understanding moral emotions). DATA SOURCES: A literature search was conducted using PubMed, PsycInfo, the Cochrane Library, and manual searches. REVIEW METHODS: The search identified 19 studies or experiments including a total of 749 children with an average age of 86 months (S.D.=30.71) from seven different countries. RESULTS: Emotion understanding training procedures are effective for improving external (Hedge's g = 0.62), mental (Hedge's g = 0.31), and reflective (Hedge's g = 0.64) aspects of emotion understanding. These effect sizes were robust and generally unrelated to the number and lengths of training sessions, length of the training period, year of publication, and sample type. However, training setting and social setting moderated the effect of emotion understanding training on the understanding of external aspects of emotion. For the length of training session and social setting, we observed significant moderator effects of training on reflective aspects of emotion. CONCLUSION: Emotion understanding training may be a promising tool for both preventive intervention and the psychotherapeutic process. However, more well-controlled studies are needed.

Intrusive thoughts and young children's knowledge about thinking following a natural disaster.

BACKGROUND: Hurricane Katrina devastated the Mississippi Gulf Coast in August 2005. Intrusive re-experiencing is a common posttraumatic stress symptom. However, young children with limited introspection skills might have difficulties identifying their intrusive thoughts. METHOD: A sample of 165 5- to 9-year-old children were surveyed about their unwanted intrusive thoughts and their knowledge about thinking, 10 months following the hurricane. RESULTS: Results replicate and extend the findings from a previous study (Sprung, 2008). Although there was no difference in the overall occurrence of intrusive thoughts, there was a striking difference between hurricane-exposed and control children in their contents. Children's knowledge about thinking was linked to their ability to report on their negative intrusive thoughts, even taking language ability into account. CONCLUSION: There is a shift toward negative content following hurricane exposure compared with non-hurricane-exposed children and knowledge about thinking is linked to the reporting of such intrusive thoughts. Implications for current research on autobiographical memory and for interventions following potentially traumatic events are discussed.

Clinically Relevant Measures of Children's Theory of Mind and Knowledge about Thinking: Non-Standard and Advanced Measures.

Measures of Theory of Mind (ToM) in clinical disorders and conditions are reviewed, focusing on non-standard and advanced measures. Relevant studies linking these measures to social problems and cognitive symptoms are reviewed. The multifaceted nature of ToM is stressed and clinically relevant aspects of ToM are suggested. Strategies to select relevant measures for clinical research and practice are presented and examples are discussed in more detail. It is recommended to consider specific aspects of ToM in relation to specific clinical conditions and symptoms. Relationships between ToM and other cognitive deficits, and implications for clinical practice and intervention are also discussed.

Unwanted intrusive thoughts and cognitive functioning in kindergarten and young elementary school-age children following Hurricane Katrina.

Seven months after Hurricane Katrina, 183 five- to eight-year-old children were surveyed about their own intrusive thoughts and tested on their level of cognitive functioning (knowledge about the mind and the mind's operations). Basic developmental research suggests that children who lack sufficient knowledge about the mind should have difficulties answering questions about intrusive thoughts. Hurricane-affected children reported relatively more intrusive thoughts with negative content than nonaffected children reported. An association between children's level of understanding of the mind and their ability to report on their own intrusive thoughts supports this hypothesis. Results point to a funneling of intrusive thoughts toward negative content following a traumatic event and highlight the importance of considering children's level of understanding of the mind when investigating intrusive thoughts in young children.

Want that is understood well before say that, think that, and false belief: a test of de Villiers's linguistic determinism on German-speaking children.

Two experiments with 79 monolingual German speaking children between 2.5 and 4.5 years showed a consistent developmental gap between children's memory/inference of what someone wanted and what someone wrongly said or thought. For instance, when John is still playing and mother says, "John should be going to bed," more than 70% answered correctly that mother wanted John to go to bed. However, when mother said, "John is going to bed," about 70% answered wrongly that she thought/said that he was still playing. Correct answers emerged with the mastery of the false-belief task. In German, want sentences (about something to happen) obligatorily take the same grammatical that complement as say or think sentences. Therefore, the observed gap constrains de Villier's (1995) linguistic determinism, which claims that acquisition of the necessary grammatical structures for talking about the mind drives children's ability to think about the mind.