[Learning from Mistakes? - A Randomized Controlled Trial on the Acquisition of Knowledge about Clinical Communication Skills Using Positive vs. Mixed Therapy Models]. / Aus Fehlern wird man klug? ­ Eine randomisierte kontrollierte Studie zum Erwerb von Gesprächsführungswissen anhand positiver vs. gemischter Therapiemodelle.

OBJECTIVE: This study compares two types of therapeutic model videos: an ideal model and a model that shows mistakes. The idea is that the conscious perception of mistakes is more likely to help build a comprehensive understanding of clinical communication skills than an ideal model. METHODS: A total of n1=111 psychology students and n2=57 people from the general population were randomly assigned to one of two training conditions as part of an online study. While one group watched a short but competent conversation of a behavioral therapist in their training with a positive model video, the other group watched a mixed model video in their training that showed a therapist with mediocre competence. In both training videos, the positive or negative behavior was marked with written explanations. Before and after the training, the participants rated the competencies of a therapist in another interview situation using standardized scales. These competence ratings were compared with those of two clinical experts and thus provided an indicator of the participants' conceptual knowledge of competent interviewing. RESULTS: A series of ANCOVA models showed that the group that saw the mixed model video deviated significantly less from the experts after training than the group that saw the positive model video (ηp2=0.03-0.10). However, the group that watched the positive (vs. mixed) model video deviated more strongly from the expert judgments on two of three competence scales after the training than before (dPre-Post=0.78-0.82). DISCUSSION: Overall, the hypothesis that mixed models are advantageous was confirmed. The unexpected results in the group with the positive model video could be explained by the fact that they set an unrealistically high anchor to which the later behavior is compared. CONCLUSION: Mixed models may offer some advantage over positive models in imparting knowledge about professional communication, especially when the model videos contain behaviorally relevant explanations.

What characterizes helpful personal practice in psychotherapy training? Results of an online survey.

BACKGROUND: Personal practice (PP) is often considered as a central component in psychotherapy training aiming to promote personal and therapeutic competences. However, its implementation varies considerably in practice. AIMS: The purpose of this exploratory study was to examine the current practice of PP regarding the frequency/occurrence and perceived usefulness/impairment of topics, techniques and effects, as well as its helpful characteristics in psychotherapy training. METHOD: 407 German psychotherapy trainees (214 cognitive behavioural therapy; 178 psychodynamic therapy) were surveyed online as to their current practice of PP. RESULTS: For trainees, personal and therapeutic related topics were discussed. Reflection techniques and self-experiential practice were among the most frequently reported strategies, while the fostering of personal and interpersonal competences was among the effects with the strongest occurrence. However, negative PP effects were recorded as well. Differences in PP practice emerged between therapeutic orientations. CONCLUSIONS: As certain techniques which are central to PP (e.g. self-experience) were also rarely or not used, and negative effects reported, its potential might not be fully utilized.

Differences in psychotherapy preferences between psychotherapy trainees and laypeople.

Despite increasing research on psychotherapy preferences, the preferences of psychotherapy trainees are largely unknown. Moreover, differences in preferences between trainees and their patients could (a) hinder symptom improvement and therapy success for patients and (b) represent significant obstacles in the early career and development of future therapists.We compared the preferences of n = 466 psychotherapy trainees to those of n = 969 laypersons using the Cooper-Norcross Inventory of Preferences. Moreover, we compared preferences between trainees in cognitive-behavioural therapy (CBT) and psychodynamic trainees.We found significant differences between both samples in 13 of 18 items, and three of four subscales. Psychotherapy trainees preferred less therapist directiveness (d = 0.58), more emotional intensity (d = 0.74), as well as more focused challenge (d = 0.35) than laypeople. CBT trainees preferred more therapist directiveness (d = 2.00), less emotional intensity (d = 0.51), more present orientation (d = 0.76) and more focused challenge (d = 0.33) than trainees in psychodynamic/psychoanalytic therapy.Overall, the results underline the importance of implementing preference assessment and discussion during psychotherapy training. Moreover, therapists of different orientations seem to cover a large range of preferences for patients, in order to choose the right fit.

Group cohesion in group-based personal practice.

BACKGROUND: Personal practice (PP) is an integral component of many psychotherapy training programmes. It aims to promote personal and professional growth and is often conducted in a group format (g-PP). Group cohesion is one of the most researched mechanisms in group psychotherapy, but has rarely been studied in the context of g-PP. AIMS AND METHOD: This exploratory study examines the associations between cohesion, satisfaction with g-PP, its impact on personal and professional development, and theoretical orientation in a sample of n = 329 German psychotherapy trainees. Cohesion was assessed with the group questionnaire (GQ-D; Positive Bonding, Positive Working, Negative Relationship). RESULTS: Overall, participants reported high levels of all outcome variables. Positive Bonding was the strongest predictor of satisfaction with g-PP (ß = 0.46, p<.001). While trainees in cognitive behaviour therapy reported significantly better cohesion scores (d≥0.31), trainees in psychodynamic therapy reported significantly higher satisfaction with g-PP and its impact on their developments (d≥0.30). CONCLUSIONS: Group cohesion appears to be an important factor in g-PP that should be actively promoted by group leaders. However, longitudinal study designs are needed to better understand the emergence of cohesion in g-PP as well as potential moderating factors.

Perspectives of patients with multiple myeloma on accepting their prognosis-A qualitative interview study.

OBJECTIVE: Prognostic awareness is essential for making treatment decisions in malignant diseases. Being confronted with a poor prognosis, however, can affect patients' mental health. Therefore, it is important to study coping in the context of malignant diseases. Acceptance is an adaptive coping strategy associated with less psychological distress. This study sought to explore the facilitators and barriers for prognostic acceptance in a sample in which both hope and uncertainty regarding prognosis are pronounced: multiple myeloma patients. METHODS: In a German university hospital, 20 multiple myeloma patients participated in semistructured interviews. Following thematic content analysis by Kuckartz, the interview transcripts were coded for facilitators and barriers for prognostic acceptance. Additionally, patients completed questionnaires on prognostic awareness and sociodemographic characteristics. RESULTS: Patients described the following facilitators for prognostic acceptance: social support, positive thinking, focusing on the Here and Now, proactive confrontation, having little to no symptoms, and being there for others. The indicated barriers were distressing physical symptoms and restricted functioning, social distress, and additional distress from other areas of life. CONCLUSIONS: Patients reported a variety of factors-related to the social realm, symptom burden, and specific attitudes-that help or hinder them in accepting their prognosis. Oncologists and psycho-oncologists may support prognostic acceptance by encouraging patients to both actively deal with realistic information as well as enjoy pleasant and meaningful moments in the present during which the disease and its prognosis recedes into the background.

Recognizing obsessive-compulsive disorder: how suitable is the German Zohar-Fineberg obsessive-compulsive screen?

BACKGROUND: Despite the prevalence of obsessive-compulsive disorder (OCD), its precise identification remains challenging. With the Zohar-Fineberg Obsessive-Compulsive Screen (ZF-OCS; 5 or 6 items), a brief instrument is widely available mainly in English. As there is a lack of empirical studies on the ZF-OCS, the aim of the present study was to translate the items into German and investigate the instrument in a nonclinical sample. METHODS: In two consecutive online surveys, n = 304 and n = 51 students participated. Besides the ZF-OCS, they answered established measures on OCD, depression, health anxiety, general anxiety and health-related well-being. RESULTS: Whereas internal consistency was low (α = .53-.72; ω = .55-.69), retest reliability (rt1,t2 = .89) at two weeks was high. As expected, we found high correlations with other OCD instruments (r > .61; convergent validity), and significantly weaker correlations with measures of depression (r = .39), health anxiety (r = .29), and health-related well-being (r = -.28, divergent validity). Nonetheless, the correlations with general anxiety were somewhere in between (r = .52). CONCLUSIONS: Due to heterogeneous OCD subtypes, the ZF-OCS asks diverse questions which probably resulted in the present internal consistency. Nevertheless, the results on retest reliability and validity were promising. As for other OCD instruments, divergent validity regarding general anxiety seems problematic to establish. Even so, the ZF-OCS seems valuable for screening purposes, as it is short and easy to administer, and may facilitate initiating subsequent clinical assessment. Further studies should determine the instrument's diagnostic accuracy.

Research priorities set by people with OCD and OCD researchers: Do the commonalities outweigh the differences?

OBJECTIVE: In contrast to research agendas being predominantly set by scientists or funders, a collaborative approach was used to spot future goals for research on obsessive-compulsive disorder. METHODS: First, we conducted a meta-review and then compared the results of two online surveys with OCD professionals and patients on research priorities. The literature search was performed in three comprehensive databases, and ten research goals were extracted. Sixty-four patients and eight professionals responded to open questions on their five most important goals. Then, they ranked the ten aims extracted from the literature on a 6-point Likert scale. RESULTS: For patients and professionals, research on treatment gains that persist long-term was most important. Concerning the top five goals listed in an open format, for patients, development and maintenance of the disease was as important as psychotherapy and its efficacy. In contrast, for professionals, the efficacy and the optimization of psychotherapy were the far most important research goals. CONCLUSIONS: We proposed one possibility to involve patients in OCD research, and the multitude of answers presents a wealth of research ideas. PRACTICE IMPLICATIONS: Since consistent research involvement may contribute to its clinical impact, researchers are now invited to translate our findings into empirical studies.

The assessment of cognitive-behavioral therapy skills in patients diagnosed with health anxiety: Development and pilot study on an observer-based rating scale.

Cognitive-behavioral therapy is a highly effective treatment of health anxiety, but it remains unclear through which mechanisms treatment effects prevail. Some evidence suggests that patients acquire skills-understood as techniques helping them reach therapy goals-through psychotherapy. In the current study, an observer-based rating scale for the skills assessment of patients with health anxiety (SAPH) was developed and validated in a pilot study. Based on 177 videotapes, four independent raters evaluated the frequency of skills acquired during cognitive and exposure therapy among 66 patients diagnosed with health anxiety with the SAPH. Predictive validity was evaluated by the Yale-Brown Obsessive-Compulsive Scale for Hypochondriasis. The SAPH demonstrated good interrater reliability (ICC(1,2)  = .88, p < .001, 95% CI [.81, .92]) and internal consistency (α = .94). Although patient skills did not significantly increase during three sessions, they significantly predicted a reduction in health anxiety symptoms at the end of treatment (R2  = .35). Patients' skills are highly important within the treatment of health anxiety. By providing external ratings of patients' skills with good psychometric properties, our pilot data suggest that the SAPH may complement current tools for the assessment of skills, specifically in targeting health anxiety.

Strengthening competence of therapists-in-training in the treatment of health anxiety (hypochondriasis): Validation of the Assessment of Core CBT Skills (ACCS).

Although the observation and assessment of psychotherapeutic competences are central to training, supervision, patient care, quality control, and life-long practice, structured instruments are used only occasionally. In the current study, an observation-based tool for the Assessment of Core CBT Skills (ACCS) was translated into German and adapted, and its psychometric properties were pilot evaluated. Competence of therapists-in-training was assessed in a random sample of n = 30 videos on cognitive behavioural therapy including patients diagnosed with hypochondriasis. Two of three raters independently assessed the competences demonstrated in the entire, active treatment sessions (n = 60). In our sample, internal consistency was excellent, and interrater reliability was good. Convergent validity (Cognitive Therapy Scale) and discriminant validity (Helping Alliance Questionnaire) were within the expected ranges. The ACCS total score did not significantly predict the reduction of symptoms of hypochondriasis, and a one-factorial structure of the instrument was found. By providing multiple opportunities for feedback, self-reflection, and supervision, the ACCS may complement current tools for the assessment of psychotherapeutic competences and importantly support competence-based training and supervision.

Effectiveness of metacognitive interventions for mental disorders in adults-A systematic review and meta-analysis (METACOG).

We evaluated the effectiveness and acceptability of metacognitive interventions for mental disorders. We searched electronic databases and included randomized and nonrandomized controlled trials comparing metacognitive interventions with other treatments in adults with mental disorders. Primary effectiveness and acceptability outcomes were symptom severity and dropout, respectively. We performed random-effects meta-analyses. We identified Metacognitive Training (MCTrain), Metacognitive Therapy (MCTherap), and Metacognition Reflection and Insight Therapy (MERIT). We included 49 trials with 2,609 patients. In patients with schizophrenia, MCTrain was more effective than a psychological treatment (cognitive remediation, SMD = -0.39). It bordered significance when compared with standard or other psychological treatments. In a post hoc analysis, across all studies, the pooled effect was significant (SMD = -0.31). MCTrain was more effective than standard treatment in patients with obsessive-compulsive disorder (SMD = -0.40). MCTherap was more effective than a waitlist in patients with depression (SMD = -2.80), posttraumatic stress disorder (SMD = -2.36), and psychological treatments (cognitive-behavioural) in patients with anxiety (SMD = -0.46). In patients with depression, MCTherap was not superior to psychological treatment (cognitive-behavioural). For MERIT, the database was too small to allow solid conclusions. Acceptability of metacognitive interventions among patients was high on average. Methodological quality was mostly unclear or moderate. Metacognitive interventions are likely to be effective in alleviating symptom severity in mental disorders. Although their add-on value against existing psychological interventions awaits to be established, potential advantages are their low threshold and economy.

Standardized Patients in Clinical Psychology and Psychotherapy: a Scoping Review of Barriers and Facilitators for Implementation.

OBJECTIVES: The use of simulated and standardized patients (SP) is widely accepted in the medical field and, from there, is beginning to disseminate into clinical psychology and psychotherapy. The purpose of this study was therefore to systematically review barriers and facilitators that should be considered in the implementation of SP interventions specific to clinical psychology and psychotherapy. METHODS: Following current guidelines, a scoping review was conducted. The literature search focused on the MEDLINE, PsycINFO and Web of Science databases, including Dissertation Abstracts International. After screening for titles and abstracts, full texts were screened independently and in duplicate according to our inclusion criteria. For data extraction, a pre-defined form was piloted and used. Units of meaning with respect to barriers and facilitators were extracted and categorized inductively using content-analysis techniques. From the results, a matrix of interconnections and a network graph were compiled. RESULTS: The 41 included publications were mainly in the fields of psychiatry and mental health nursing, as well as in training and education. The detailed category system contrasts four supercategories, i.e., which organizational and economic aspects to consider, which persons to include as eligible SPs, how to develop adequate scenarios, and how to authentically and consistently portray mental health patients. CONCLUSIONS: Publications focused especially on the interrelation between authenticity and consistency of portrayals, on how to evoke empathy in learners, and on economic and training aspects. A variety of recommendations for implementing SP programs, from planning to training, monitoring, and debriefing, is provided, for example, ethical screening of and ongoing support for SPs.

Children of cancer patients: prevalence and predictors of emotional and behavioral problems.

BACKGROUND: Children of patients with cancer are at increased risk for developing emotional and behavioral problems. This study explored the prevalence and predictors of emotional and behavioral problems in Children of cancer patients in a multisite research project. METHODS: A cross-sectional sample of N = 235 families was recruited simultaneously in 5 university medical centers. The participants, including parents (N = 402) and children (N = 324; ages 11-21 years) completed standardized questionnaires. Emotional and behavioral problems in children were measured by the Strengths and Difficulties Questionnaire (SDQ). On the basis of previous research and using a mixed-model approach, child-, parent-, family- and cancer-related variables were examined in addition to socioeconomic status as potential predictors. Descriptive statistics and a multiple random coefficient model were used in the analyses. RESULTS: Compared to norms, Children of cancer patients show increased mean levels of emotional and behavioral symptoms. The best predictor of emotional and behavioral problems from the perspectives of the child, the healthy parent, and the ill parent was general family dysfunction. Although family dysfunction was identified as the main predictor, the analysis revealed that the main part of variance was related to the individual child's level. CONCLUSIONS: The results indicate that screening for child mental health problems and family dysfunction in oncological and psychosocial treatment units can identify the families most in need of psychosocial support. Psychological services need to be both family-oriented and child-centered and focus on family dysfunction to prevent mental health problems in children.

Effects of different husbandry systems and attitudes of cattle farmers on the behavior and welfare of cattle in Germany.

This study examines the relationship between the attitude of cattle farmers toward their animals and the occurrence of behavioral and health problems in cattle. Various factors, including animal behavior, husbandry conditions and the frequency of diseases, are taken into account. The results of an online survey of 1,242 German cattle farmers indicated that a range of factors, including the husbandry system, the number of cattle, grazing practices and the human-animal relationship, can influence the occurrence of abnormal behavior in cattle, such as tongue play, mutual sucking, horse-like sitting and standing up as well as diseases, especially musculoskeletal disorders. Additionally, the study identified two distinct types of basic attitudes among livestock farmers toward cattle: emotional and utilitarian attitudes. A robust foundation between the attitude of the livestock owner and the husbandry conditions can therefore facilitate the welfare of cattle in terms of freedom from pain, disease and psychological suffering, as well as the expression of normal behavior. This, in turn, can reduce the occurrence of abnormal behavior.

Exposure therapy tailored to inhibitory learning principles in a naturalistic setting: an open pilot trial in obsessive-compulsive outpatient care.

Inhibitory learning (IL) theory offers promising therapeutic strategies. However, more evidence is needed, especially regarding OCD treatment in routine care. The present pilot study investigated the positive and negative effects of IL-focused cognitive-behavioral therapy (CBT) in a university outpatient setting. A total of N = 21 patients (57.14% male, mean age 31.14, SD = 12.39 years) passed through manualized therapy delivered by licensed psychotherapists. Between the first and 20th IL-focused CBT session, obsessive-compulsive symptoms (Obsessive Compulsive Inventory-Revised, d = 3.71), obsessive beliefs (Obsessive-Beliefs Questionnaire, d = 1.17), depressive symptoms (Beck Depression Inventory, d = 3.49), and overall psychological distress (Global Severity Index, d = 3.40) decreased significantly (all ps < 0.01). However, individual patients reported some negative effects of therapy. The results underline the value of thorough investigations of novel therapeutic interventions in naturalistic settings.

Basic counseling skills in psychology and teaching: validation of a short version of the counselor activity self-efficacy scales.

BACKGROUND: Counseling self-efficacy is a relevant measure to examine trainees' beliefs about their counseling skills. This study aimed to validate three scales of the revised German version of the Counselor Activity Self-Efficacy Scales (CASES-R) measuring basic counseling skills. To ascertain the scales' sensitivity to change, counseling self-efficacy was assessed before and after specific training. METHOD: The sample comprised 163 university students enrolled either in psychology or education. Students were examined before and after participating in training focusing on basic counseling skills. We applied confirmatory factor analysis and tested internal consistency, convergent validity, and criterion validity. RESULTS: Confirmatory factor analysis supported the three-factor structure of the CASES-R scales for basic counseling skills. The scales provided acceptable to good internal consistency (α = 0.77 - 0.87). Significant relations with general self-efficacy (r =.23, p <.01) provided first indication for convergent validity. We also found a significant correlation of the CASES-R with positive affect (r =.22), and significant correlations of some subscales with empathetic concern (r =.16 -.21) and mastery goal orientation (r =.16), overall supporting criterion validity. The CASES-R scales proved to be sensitive to change, as participants' scores were higher after (M = 6.18, SD = 1.05) than before (M = 5.37, SD = 1.16) counseling training (F(1, 309) = 42.27, p <.001). CONCLUSION: We found support for the proposed factor structure and reliability of the German version of the three CASES-R scales, indicating its suitability for use in basic counseling settings. Future research should further examine the scales' validity.

[Parenthood and cancer: dyadic analysis of psychological distress and -health-related quality of life of cancer parents with minor children]. / Elternschaft und Krebserkrankung: Dyadische Analyse von psychosozialer Belastung und gesundheitsbezogener Lebensqualität von krebskranken Eltern minderjähriger Kinder.

The purpose of this study was the analysis of psychological distress and health-related quality of life (HRQoL) of parents with minor children during curative resp. palliative treatment.Cross-sectional design with a sample of N=89 parent dyads. Dyadic analysis of demographic, illness and family variables via mixed linear models.Patients and healthy partners indicated psychological distress on different subscales. Intradyadic correlations were small-moderate. Most important predictors of psychological distress and HRQoL were treatment stadium, gender, family functioning, and employment status.Dependent on demographic variables, psychooncological support was evident mainly for parents in palliative care and for families with dysfunctional functioning.

Parental palliative cancer: psychosocial adjustment and health-related quality of life in adolescents participating in a German family counselling service.

BACKGROUND: Parental palliative disease is a family affair, however adolescent's well-being and coping are still rarely considered. The objectives of this paper were a) to identify differences in psychosocial adjustment and health-related quality of life (HRQoL) among adolescents and young adults with parents suffering from palliative cancer or cancers in other disease stages, b) to relate psychosocial adjustment and health-related quality of life to adolescent coping, and c) to explore significant mediator and predictor variables. METHODS: Cross-sectional data were derived from a multi-site research study of families before child-centered counselling. N=86 adolescents and young adults were included, their mean age 13.78 years (sd 2.45), 56% being female. Performed analyses included ANCOVA, multiple linear regression, and mediation analysis. RESULTS: Adolescents with parents suffering from palliative cancers reported significantly less total psychosocial problems, and better overall HRQoL. There were no significant group differences regarding coping frequency and efficacy. Our set of coping items significantly mediated the effect of parental disease stage on psychosocial problems and HRQoL. Further, parental disease status and general family functioning predicted psychosocial problems (R2adj =.390) and HRQoL (R2adj =.239) best. CONCLUSION: The study indicates distress among adolescents throughout the entire parental disease process. Our analysis suggests that counselling services could offer supportive interventions which focus particularly on adolescent coping as well as family functioning.

[Parental cancer--parents ways of coping, family functioning, and psychosocial adjustment of dependent children]. / Kinder krebskranker Eltern - elterliches Coping, familiäres Funktionsniveau und psychosoziale Anpassung der Kinder.

Children exposed to parental cancer have an increased risk of mental health problems. However, the parental illness itself and its features do not predict children's psychological adjustment. Parent- and family-related factors are more predictive for children's well-being and the incidence of psychopathological symptoms, respectively. This study focuses on parental ways of coping with illness from both, the ill and healthy parent's perspective, and the relationship with family functioning and children's adjustment. Results show a significant impact of parental coping styles on children's health-related quality of life and psychopathological symptoms and, furthermore, that this relationship is mediated by aspects of family functioning. This study support the importance of family systems approaches. Implications for further studies and practical issues are discussed.

Perception of stress in cats by German cat owners and influencing factors regarding veterinary care.

OBJECTIVES: Visiting the veterinarian is generally perceived as a stressful situation for cats. Previous studies have shown that the perception of stress may influence cats' healthcare. In order to minimise stress in cats during the veterinary consultation, feline-friendly handling has gained importance and is increasingly being used. The aim of this study was to find out whether cats experience stress during a visit to the veterinarian (and, if so, to what extent), and which factors influence the perception of stress and whether feline-friendly handling techniques have an impact. METHODS: An online survey was conducted among German cat owners. In total, 889 questionnaires were evaluated. The results were analysed with binary logistic regression and a χ² test. A principal component analysis was used to detect the main influencing factors on the perception of stress. RESULTS: Most of the cats (88.7%, n = 732/825) were perceived as stressed during a veterinary consultation, while only about half of the owners (50.8%, n = 419/824) stated that they felt stressed themselves. The cat owners (n = 819) who perceived visiting the veterinarian as a stressful situation also described their cat as stressed significantly more often compared with owners who did not feel stressed (χ² = 101.113, P <0.001). The probability that owners experienced stress themselves was significantly increased if they perceived their cat to be stressed too (odds ratio 0.073, 95% confidence interval 0.016-0.328). One factor that influenced whether an owner was stressed was the stress behaviour of their cat (P <0.001). Furthermore a feline-friendly demeanour by the veterinarian led to less stress in the owners (P <0.001). CONCLUSIONS AND RELEVANCE: The owner's stress influences the perception of their cat's stress. By adhering to feline-friendly handling guidelines, veterinarians can reduce owner stress associated with veterinary visits, thereby promoting optimal veterinary care and health for their feline patients.