Associations between coping and survival time of adult leukemia patients receiving allogeneic bone marrow transplantation: results of a prospective study.

BACKGROUND: To investigate associations between coping strategies and length of survival in a sample of 52 adult leukemia patients receiving allogeneic bone marrow transplantation (BMT). METHODS: 52 adult patients, diagnosed with acute (AML) and chronic myeloid leukemia (CML) admitted for allogeneic BMT to a university hospital BMT unit in preparation for a transplantation of genotypically matched HLA donor marrow, were interviewed immediately after informed consent and prior to preparatory treatment for transplantation. Semistructured interviews were conducted and recorded for analysis to assess coping styles and were evaluated by a new content analytic coping measure [Ulm Coping Manual (UCM)]. Patients were a random sample of all eligible patients on the BMT unit between May 1990 and May 1994. RESULTS: Complete audiotaped interviews were rated by blind raters, employing a newly developed content analysis for the identification of patients' coping strategies. Multivariate analysis using a Cox model revealed three pretransplant variables that demonstrated a statistically significant influence on 5-year survival: Stage of Disease at transplant (P < .012), Distraction (P < .007), and Fighting Spirit as coping modalities (P < .013). CONCLUSIONS: The results of this prospective study document the impact of certain psychological variables, notably coping style on survival with BMT. This suggests the necessity of utilizing psychosocial interventions to address stress and anxiety in patients awaiting transplantation in order to reduce anxieties and to employ more effective coping techniques to deal more appropriately with their situation and to enhance Fighting Spirit. The effects on survival of such psychosocial interventions need to be tested in a randomized controlled study.

[Psychotherapy research--how it should (not) be done. An expert reanalysis of comparative studies by Grawe et al. (1994)]. / Psychotherapieforschung--wie man es (nicht) machen sollte. Eine Experten/Innen-Reanalyse von Vergleichsstudien bei Grawe et al. (1994).

22 psychotherapy outcome studies used in the Bernese meta-analysis by Grawe, Donati and Bernauer (1994) for a treatment comparison between behavioural and psychoanalytic-psychodynamic treatment concepts were reanalysed by 12 expert psychotherapy researchers independent of each other. Three clinical criteria served as basic criteria for the assessment of the methodological quality of the 22 comparative studies: treatment dosage, therapists' competence or expertise, and an adequate realisation of the intended treatment concept. The expert ratings were then compared with an evaluation of an assessment of a research team from the University of Ulm and with the one from the Bernese research team. Contrary to the Bernese meta-analysis, both the experts and the Ulm research group conclude that only 5 or 8 of the 22 studies, respectively, could be accepted for a relatively fair comparison between the treatments under study. Out of the 5/8 studies, none could be considered fully suitable for a treatment comparison, at the most only moderately suitable. These remaining 5 or 8 studies, respectively, do not prove superiority of one treatment over the other. Hence, the "Dodo Bird Verdict" stands up under scrutiny.

[Group psychotherapy in psychiatry--results of a pilot study and perspectives]. / Gruppenpsychotherapie in der Psychiatrie--Ergebnisse einer Pilotstudie und Perspktiven.

This paper reports about first preliminary results of an investigation by DGPPN regarding group therapeutic work in psychiatric inpatient settings throughout the Federal Republic of Germany. The DGPPN sub-section "Group Therapy in Psychiatry" was set up by starting with this pilot study using a preliminary version of a questionnaire which is currently under revision for future investigations. This paper also deals with a brief historical survey of the origins of group work and group therapy in institutions. In regards to the installation of the new domain of a "Physician for Psychiatry and Psychotherapy" it is intended to theoretically consolidate group therapy in psychiatric facilities. The "Interpersonal Model" of Sullivan is being highlighted as a useful theory towards an integration of various theoretical perspectives such as biological, individual, interpersonal, and sociological ones. This integration is being stressed for education/ training and treatment aspects in psychiatry and psychotherapy as well.

[Results of research on therapeutic factors and treatment effectiveness of group therapy with adolescent patients]. / Forschungsergebnisse zu Wirkfaktoren und Effektivität von Gruppentherapien bei Jugendlichen.

Group therapy with adolescents suffers from a lack of empirical studies although this specific therapeutic setting has been described in clinical reports as particularly beneficial. This article provides a survey of available controlled outcome- and process-studies in group therapeutic settings with adolescents covering publications up to 1992. Future research topics in adolescent group therapy investigations are being discussed while comparing results and questions of group therapy research with adult clientels and their possible application to research with adolescents in groups.

Self-disclosure, feedback, and outcome in long-term inpatient psychotherapy groups.

Process and outcome measures were compared in two long-term psychotherapy groups. Measures of Self-Disclosure and Feedback were based on analysis of videotaped sessions by use of Bales's SYMLOG three-axial system. These measures were then combined to form a measure of Interpersonal Work. High Interpersonal Work scores, both in early sessions and throughout treatment, predicted better outcome for individual members at 18-month follow-up. Interpersonal Work scores in later group sessions were not related to outcome. Findings suggest that early sessions are a critical time for members to develop a working style in the group. Members who fail to do so have a less successful outcome even if their working styles improve in later sessions.

[Coping with bone marrow transplantation. A contribution to adaptive vs. maladaptive coping]. / Coping bei Knochenmarktransplantation. Ein Beitrag zur Frage des "geeigneten" vs. "ungeeigneten Copings".

The coping strategies of 36 adult leukemia patients admitted for bone marrow transplantation have been investigated systematically by trained raters using audio-taped material from semi-structured interviews. So-called long term survivors with a median survival time of 978 days after BMT displayed significantly lower passive-stoic acceptance and resignation than non-survivors who died within a median time of 229 days after BMT. These copings were of high prognostic value prior to all treatment regimes in strong correlation with a negative hematological prognosis and age. Non-survivors showed significantly higher passive-stoic acceptance and resignation coping. Form of leukemia and other sociodemographic variables or stress had neither a significant impact on coping intensity nor on coping quality. Consequences for further coping research and possible treatment interventions prior to or immediately after BMT are being discussed.

Intensive analysis of therapeutic factors and outcome in long-term inpatient groups.

Two long-term analytic inpatient groups comprised of severely disturbed neurotic and personality disordered patients were intensively investigated through process ratings and therapist and patient reports with regard to five therapeutic factors: cohesiveness, self-disclosure, feedback, interpersonal learning-output, and family re-enactment. The process variables were correlated with outcome assessments at 12 and 18 months following treatment. The study applied a single case (group) approach with replication to cross-validate the findings from one group to the next. Results demonstrated that all five therapeutic factors were meaningfully associated with clinical improvement. Although different treatment groups may generate unique psychological climates for producing change, the findings suggest that group cohesiveness is an important ingredient for effective group process to occur. The multimethod, multiperspective nature of this study lends considerable credence to the findings, despite the small sample size.

[Affects in dreams of children and adolescents]. / Affekte in Träumen von Kindern und Jugendlichen.

This study deals with the examination of manifest emotions in dreams as reported (written down) ba children and adolescents. The contents were examined from 407 dreams of children and adolescents regarding anxious and aggressive emotions. The emotions found by patient-children or patient adolescents, who had asked for psychotherapeutic help, were compared with those of inconspicuous children and adolescents of al school forms. Two areas of examination were of special interest: In which way do manifest dream emotions change with the beginning of puberty and in which way do social factors effect the manifestation of dream emotions? In this context especially the role of the gender issues is discussed.

Relatedness, group work, and outcome in long-term inpatient psychotherapy groups.

Process and outcome measures were compared in two long-term groups. The measure "Relatedness" reflected an individual's attachment to and comfort with the group, and "Group Work" indicated perception of the group as having a positive working climate. High Relatedness scores predicted better outcome at 18-month follow-up. Group Work scores were not related to outcome. Relatedness and Group Work scores were not correlated. Results replicate in a group psychotherapy population the importance, reported in individual therapy literature, of an early and sustained positive therapeutic alliance (Relatedness). However, a measure that is closely related to the concept of "working alliance" (Group Work) did not predict outcome.

[Therapeutic factors of inpatient analytic group psychotherapy]. / Wirkfaktoren in stationärer analytischer Gruppenpsychotherapie.

Several change mechanisms, their interrelationship, and their relation to outcome as well as to long-term follow-ups have been investigated in an inpatient group therapy. Eight of initially ten patients finished a long-term group in an inpatient setting for severe neurotics and personality disorders. Successful patients were able to change significant behavior characteristics, to develop a higher cohesiveness towards the group and especially to use aspects of family reenactment in order to change internalized significant object representations. The results indicate that important changes occur early during the treatment. The contributing change mechanisms and their interdependency are described and discussed in detail.

Verbal affective expression during group and individual psychotherapy. Towards a description of therapist- and setting-related variables.

The paper deals with a comparison between verbal affective interventions by the same psychoanalyst in different therapeutic settings, individual and group therapy. Since the same therapist is involved, an exploration of interactional aspects of his therapeutic style becomes possible, taking into consideration his theoretical allegiance and his hypotheses about the structure and development of the psychotherapeutic milieu. The conformation of therapist-group and therapist-individual dyads shows a high thematic concordance across both settings, particularly with regard to separation anxiety, but also to a significant degree in relation to other verbally expressed affects. However similar the correlations do appear, there remain certain differences in the affective interactions between group or individual patients and the therapist that are due to developmental aspects of the therapeutic relationship in either setting.

Psychoanalytic concepts of eating disorders: an empirical approach with a semantic differential (Ertel).

To study empirically some psychoanalytic assumptions concerning aspects of the oral character and manifestations of fixation and regression, 61 neurotic inpatients at a psychotherapeutic clinic were investigated using a semantic differential technique (Ertel). Each patient was judged by the differential technique on the basis of 12 object representations which, in respect to the psychoanalytic theory of development, are postulated to have connections with the oral stage. A connotative proximity in the semantic space was postulated for several 'oral connotations'. For these relevant connotations the theoretical assumptions were proved empirically. However, there were no statistical differences between several groups of patients (those with an oral fixation and those with later fixations). Furthermore single dimensions of the semantic differential technique used, in contrast to the three-dimensional analysis, allowed the differentiation of patients with oral fixations from the others simply by using object representations that ought to be relevant for the oral stage of psychosexual development.