Work involvement and work satisfaction of psychotherapists-A nationwide online survey among psychotherapeutic practitioners in Germany.

OBJECTIVE: The aim of this study was to explore psychotherapist characteristics associated with work involvement and work satisfaction among psychotherapists in Germany. METHOD: In total N = 1358 psychotherapeutic practitioners with different levels of training participated in our nationwide online survey, we assessed work involvement and its sub-concepts of healing involvement (HI), stressful involvement (SI) and work satisfaction (WS) using the Therapist Work Involvement Scale (TWIS) and combined HI and SI into practice patterns. RESULTS: In our study, the levels of HI and WS were high, whereas SI was low. The percentage of effective practice patterns was higher than in previous studies, whereas challenging practice patterns were lower. HI, SI and WS were associated with gender and age, indicating that male and younger participants showed more SI but less HI and WS. Psychodynamic therapists reported more SI and WS. The number of weekly therapy sessions was related to HI, SI and WS. Furthermore, HI was positively related to WS and negatively to SI, while SI and WS were negatively correlated. CONCLUSION: Our results indicated that therapist characteristics influenced their work involvement and work satisfaction. Therefore, therapist training and interventions should consider individualized approaches based on the relevant therapist characteristics to foster HI and WS while reducing SI. One could speculate whether the changes in psychotherapeutic training may have already contributed to improved practice patterns over the last decades.

Making chronic pain count: empirical support for the ICD-11 classification of chronic pain.

PURPOSE OF REVIEW: The purpose is to review the evidence that has been collected with regard to the new classification of chronic pain. In 2022, the World Health Assembly endorsed the 11 th revision of the International Classification of Diseases and Related Health Problems (ICD-11), and with it a new classification of chronic pain. RECENT FINDINGS: The evidence from the formative field testing indicated that the categories were clearly delineated and the coverage of chronic pain excellent (<3% in remainder categories). Official WHO field tests showed that the classification works well within the technical parameters WHO classifications must conform to and outperformed the ICD-10 diagnoses in all respects. International field tests, in which clinicians diagnosed consecutive patients in settings of medium and high resources, showed substantial interrater reliability (κ = 0.596 to κ = 0.783) for the diagnoses and the clinicians rated their clinical utility as very high. Studies using complete hospital records demonstrated that with the information they contain, retrospective coding of the new diagnoses is possible and provides much more meaningful information than the ICD-10 diagnoses. SUMMARY: The evidence supports the use of the new classification and highlights its informational gains - using it will contribute to making chronic pain count in many contexts.

Self-Perceived Problematic Use of Online Pornography Is Linked to Clinically Relevant Levels of Psychological Distress and Psychopathological Symptoms.

Online pornography is a widespread Internet application. As with other Internet applications, in some cases its use can become problematic. First indications point to a link between problematic use of online pornography and psychological distress and general functional impairment. However, to date, there are no standardized criteria for assessing problematic use of online pornography. In this study, we used the Online Pornography Disorder Questionnaire (OPDQ)-an instrument which adapted the official criteria for Internet Gaming Disorder to online pornography-to measure problematic use and investigated to what extent consumers with a self-perceived problematic use of online pornography differed from casual users with regard to their psychological distress. An online sample of German adult visitors to a popular casual dating site completed the OPDQ, the Brief Symptom Inventory (BSI), and provided information on their online pornography use (n = 1539; 72.6% male; 31.43 ± 11.96 years). T-scores for the BSI were calculated and independent t-tests were conducted to compare casual users with consumers with a self-perceived problematic use of online pornography. Of the users, 5.9% fulfilled the criteria for problematic use. This group consumed online pornography for longer amounts of time and showed higher levels of psychological distress (Hedges' g from 0.75 to 1.21). The T-scores of users with self-perceived problematic online pornography use reached clinically relevant levels on all subscales. Overall, the results of the study indicate that self-perceived problematic use of online pornography seems to be linked to severe psychological distress that may warrant clinical attention.

Cross-cultural adaption and psychometric investigation of the German version of the Evidence Based Practice Attitude Scale (EBPAS-36D).

BACKGROUND: The implementation of evidence-based practice (EBP) in mental health care confers many benefits to patients, and research into factors facilitating the implementation of EBP is needed. As an important factor affecting the implementation of EBP, service providers' attitudes toward EBP emerged. The Evidence-Based Practice Attitude Scale (EBPAS-36) is an instrument with good psychometric characteristics that measures positive and ambivalent attitudes toward EBP. However, a German version is missing. The present study therefore aims to provide a validated German translation of the EBPAS-36. METHODS: The scale was translated and back-translated as recommended by standard procedures. German psychotherapists were recruited to participate in an online survey. They provided demographic and professional information, completed the EBPAS-36, the Implementation Climate Scale (ICS) and the Intention Scale for Providers (ISP). Standard item and reliability analyses were conducted. Construct validity was evaluated with exploratory (EFA) and confirmatory factor analyses (CFA) in two subsamples (random split). Convergent validity was tested by predicting a high positive correlation of the EBPAS-36D with two scores of attitudes of the ISP and an interest in EBP score. It was tested whether the EBPAS-36D predicts the intention to use EBP. RESULTS: N = 599 psychotherapists participated in the study. The item analyses showed a mean item difficulty of pi = 0.64, a mean inter-item correlation of r = 0.18, and a mean item-total correlation of ritc = 0.40. The internal consistency was very good for the total scale (α = 0.89) and ranged from adequate to very good for the subscales (0.65-0.89), indicating high reliability. The original factor structure showed an acceptable model fit (RMSEA = 0.064 (90% CI = 0.059-0.068); SRMR = 0.0922; AIC = 1400.77), confirming the 12-factor structure of the EBPAS-36. However, a second-order factor structure derived by the EFA had an even better model fit (RMSEA = 0.057 (90% CI = 0.052-0.062); SRMR = 0.0822; AIC = 1274.56). When the EBPAS-36D was entered in a hierarchical regression model with the criterion Intention to use EBP, the EBPAS-36D contributed significantly to the prediction (Change in R2 = 0.28, p < 0.001) over and above gender, age and participants' report of ever having worked in a university context. CONCLUSIONS: The present study confirms good psychometric properties and validity of a German version of the EBPAS-36 in a sample of psychotherapists.

A psychometric approach to assessments of problematic use of online pornography and social networking sites based on the conceptualizations of internet gaming disorder.

BACKGROUND: The problematic use of online gaming, social networking sites (SNS) and online pornography (OP) is an evolving problem. Contrary to the problematic use of SNS and OP, Internet gaming disorder (IGD) was included in the new edition of the Diagnostic and statistical manual of mental disorders (DSM-5) as a condition for further study. The present study adapted the criteria for IGD to the problematic use of SNS and OP by modifying a validated questionnaire for IGD (Internet Gaming Disorder Questionnaire: IGDQ) and investigating the psychometric properties of the modified versions, SNSDQ and OPDQ. METHODS: Two online samples (SNS: n = 700, 25.6 ± 8.4 years, 76.4% female; OP: n = 700, 32.9 ± 12.6 years, 76.7% male) completed the SNSDQ/OPDQ, the Brief Symptom Inventory (BSI) and the short Internet Addiction Test (sIAT) and provided information on their SNS/OP use. Standard item and reliability analyses, exploratory and confirmatory factor analyses and correlations with the sIAT were calculated. Problematic and non-problematic users were compared. RESULTS: The internal consistencies were ωordinal = 0.89 (SNS) and ωordinal = 0.88 (OP). The exploratory factor analyses extracted one factor for both questionnaires. Confirmatory factor analyses confirmed the results. The SNSDQ/OPDQ scores correlated highly with the sIAT scores and moderately with SNS/OP usage time. Of the users, 3.4% (SNS) and 7.1% (OP) lay above the cutoff for problematic use. Problematic users had higher sIAT scores, used the applications for longer and experienced more psychological distress. CONCLUSION: Overall, the results of the study indicate that the adaption of the IGD criteria is a promising approach for measuring problematic SNS/OP use.

Development of an Instrument to Assess Parents' Excessive Web-Based Searches for Information Pertaining to Their Children's Health: The "Children's Health Internet Research, Parental Inventory" (CHIRPI).

BACKGROUND: People often search the internet to obtain health-related information not only for themselves but also for family members and, in particular, their children. However, for a minority of parents, such searches may become excessive and distressing. Little is known about excessive web-based searching by parents for information regarding their children's health. OBJECTIVE: This study aimed to develop and validate an instrument designed to assess parents' web-based health information searching behavior, the Children's Health Internet Research, Parental Inventory (CHIRPI). METHODS: A pilot survey was used to establish the instrument (21 items). CHIRPI was validated online in a second sample (372/384, 96.9% mothers; mean age 32.7 years, SD 5.8). Item analyses, an exploratory factor analysis (EFA), and correlations with parents' perception of their children's health-related vulnerability (Child Vulnerability Scale, CVS), parental health anxiety (modified short Health Anxiety Inventory, mSHAI), and parental cyberchondria (Cyberchondria Severity Scale, CSS-15) were calculated. A subset of participants (n=73) provided retest data after 4 weeks. CHIRPI scores (total scores and subscale scores) of parents with a chronically ill child and parents who perceived their child to be vulnerable (CVS+; CVS>10) were compared with 2×2 analyses of variances (ANOVAs) with the factors Child's Health Status (chronically ill vs healthy) and perceived vulnerability (CVS+ vs CVS-). RESULTS: CHIRPI's internal consistency was standardized alpha=.89. The EFA identified three subscales: Symptom Focus (standardized alpha=.87), Implementing Advice (standardized alpha=.74) and Distress (standardized alpha=.89). The retest reliability of CHIRPI was measured as rtt=0.78. CHIRPI correlated strongly with CSS-15 (r=0.66) and mSHAI (r=0.39). The ANOVAs comparing the CHIRPI total score and the subscale scores for parents having a chronically ill child and parents perceiving their child as vulnerable revealed the main effects for perceiving one's child as vulnerable but not for having a chronically ill child. No interactions were found. This pattern was observed for the CHIRPI total score (η2=0.053) and each subscale (Symptom Focus η2=0.012; Distress η2=0.113; and Implementing Advice η2=0.018). CONCLUSIONS: The psychometric properties of CHIRPI are excellent. Correlations with mSHAI and CSS-15 indicate its validity. CHIRPI appears to be differentially sensitive to excessive searches owing to parents perceiving their child's health to be vulnerable rather than to higher informational needs of parents with chronically ill children. Therefore, it may help to identify parents who search excessively for web-based health information. CHIRPI (and, in particular, the Distress subscale) seems to capture a pattern of factors related to anxious health-related cognitions, emotions, and behaviors of parents, which is also applied to their children.

Cancer patient utilisation of psychological care in Germany: The role of attitudes towards seeking help.

OBJECTIVE: Even if significantly distressed, many patients with cancer do not seek psychological help. There is growing evidence that attitudes are central barriers for help-seeking, and instruments to assess cancer patients' attitudes towards help-seeking are urgently needed. This study aimed to evaluate the German Attitudes towards Seeking Help after Cancer Scale (ASHCa-G) and investigated the relationship between patients' attitudes and psychological care utilisation. METHODS: The ASHCa-G was presented to 270 patients with cancer (age 63.0 ± 12.7 years, 44.8% women). Item analyses, principal component analysis and associations with age, social support, help-seeking intention and psychological care utilisation were calculated. A hierarchical logistic regression was performed to ascertain the leading role of attitudes in explaining psychological care utilisation. RESULTS: Principal component analysis supported a two-component solution, which showed good internal consistency for the positive attitudes (α = 0.80) and negative attitudes (α = 0.75) subscales. The associations with age, distress and help-seeking intention confirmed the validity of the ASHCa-G. Positive attitudes explained most variance of cancer patients' current psychological care utilisation. CONCLUSION: The ASHCa-G seems to be a reliable and valid questionnaire for assessing attitudes towards seeking psychological help among patients with cancer. Clinical practice might profit from identifying attitudinal barriers that hinder patients with cancer from seeking psychological help.

Assessment of grief-related rumination: validation of the German version of the Utrecht Grief Rumination Scale (UGRS).

BACKGROUND: Bereavement can result in severe mental health problems, including persistent, severe and disabling grief symptoms, termed complicated grief. Grief rumination (i.e., repetitive thought about the causes and consequences of the loss) is a malleable cognitive risk-factor in adjustment to bereavement. The Utrecht Grief Rumination Scale (UGRS) was recently developed to assess grief rumination. The present study aimed to develop and validate a German version of the UGRS. METHODS: An online survey including measures of demographic and loss-related variables, grief rumination (UGRS), depressive rumination (brooding and reflection), and symptoms of depression, anxiety, and complicated grief, was administered online among 159 persons (87% women) who had lost a first-degree relative in the past three years. UGRS item analyses, a confirmatory factor analysis and associations of grief rumination with brooding, reflection and symptom levels were performed. RESULTS: The internal consistency of the UGRS was good. The confirmatory factor analysis obtained a good fit for a model with five correlated grief rumination subscales. The UGRS contributed uniquely to the prediction of complicated grief symptoms even when controlling for symptoms of anxiety and depression, brooding, reflection, and demographic and loss-related variables. Discriminant validity of the UGRS was demonstrated by the fact that higher UGRS scores were found in participants with a higher likelihood of receiving a diagnosis of complicated grief (d > 1.60). CONCLUSION: The translated UGRS showed very good psychometric properties and the correlations with maladaptive ruminative styles and complicated grief symptoms demonstrated the clinical relevance of grief rumination. Limitations concerning generalisability of the results are discussed.

Pilot field testing of the chronic pain classification for ICD-11: the results of ecological coding.

BACKGROUND: A task force of the International Association for the Study of Pain (IASP) has developed a classification of chronic pain for the ICD-11 consisting of seven major categories. The objective was to test whether the proposed categories were exhaustive and mutually exclusive. In addition, the perceived utility of the diagnoses and the raters' subjective diagnostic certainty were to be assessed. METHODS: Five independent pain centers in three continents coded 507 consecutive patients. The raters received the definitions for the main diagnostic categories of the proposed classification and were asked to allocate diagnostic categories to each patient. In addition, they were asked to indicate how useful they judged the diagnosis to be from 0 (not at all) to 3 (completely) and how confident they were in their category allocation. RESULTS: The two largest groups of patients were coded as either chronic primary pain or chronic secondary musculoskeletal pain. Of the 507 patients coded, 3.0% had chronic pain not fitting any of the proposed categories (97% exhaustiveness), 20.1% received more than one diagnosis. After adjusting for double coding due to technical reasons, 2.0% of cases remained (98% uniqueness). The mean perceived utility was 1.9 ± 1.0, the mean diagnostic confidence was 2.0 ± 1.0. CONCLUSIONS: The categories proved exhaustive with few cases being classified as unspecified chronic pain, and they showed themselves to be mutually exclusive. The categories were regarded as useful with particularly high ratings for the newly introduced categories (chronic cancer-related pain among others). The confidence in allocating the diagnoses was good although no training regarding the ICD-11 categories had been possible at this stage of the development.

Examining differences in cognitive and affective theory of mind between persons with high and low extent of somatic symptoms: an experimental study.

BACKGROUND: Medically unexplained somatic symptoms are common, associated with disability and strongly related to depression and anxiety disorders. One interesting, but to date rarely tested, hypothesis is that deficits in both theory of mind (ToM) and emotional awareness may undergird the phenomenon of somatization. This study sought to investigate whether or not differences in ToM functioning and self-reported emotional awareness are associated with somatic symptoms in a sample from the general population. METHODS: The sample consisted of 50 healthy participants (37 females, 13 males) aged between 22 and 64 years (46.8 ± 11.7) of whom 29 reported a high extent of somatic symptoms (HSR), whereas 21 reported a low extent of somatic symptoms (LSR) based on the 30 highest and lowest percentiles of the Symptom List norms. The participants' affective and cognitive ToM were assessed with two experimental paradigms by experimenters who were blind to the participants' group membership. In addition, self-reports regarding emotional awareness, alexithymia, depressive and anxiety symptoms and current affect were collected. RESULTS: In the experimental tasks, HSR showed lower affective ToM than LSR but the groups did not differ in cognitive ToM. Although HSR reported lower emotional awareness than LSR in the self-report measure, this group difference vanished when we controlled for anxiety and depression. Depression, anxiety, emotional awareness and alexithymia were correlated positively. CONCLUSIONS: The data supported the hypothesis that deficits in affective ToM are related to somatic symptoms. Neither cognitive ToM nor self-reported emotional awareness were associated with somatic symptoms. Self-reported emotional awareness, alexithymia and symptoms of depression and anxiety shared a considerable amount of variance.

The Cyberchondria Severity Scale (CSS): German Validation and Development of a Short Form.

PURPOSE: 'Cyberchondria' describes a pattern of researching health information online motivated by distress or anxiety about health, which becomes excessive and in turn increases distress. The Cyberchondria Severity Scale (CSS) assesses this construct. The aims of the present study were to validate a German version of the CSS and to propose a short form. METHOD: The CSS was translated and posted online. Inclusion criteria were fulfilled by n = 500 participants (age 29.1 ± 10.4 years, 73.6 % women). Item analyses, an exploratory factor analysis and correlations with health anxiety, somatic symptoms, health-care utilization and depression were calculated. A brief version with 15 items was developed (CSS-15) and validated in a second sample (n = 292; age 24.2 ± 4.1 years, 76.4 % women). RESULTS: The internal consistency of the CSS was α = .93 and its split-half reliability α = .95. The mean item-total correlation was r itc = .51, the mean inter-item correlation r = .29 and the mean item difficulty p i = .36. The principal component analysis extracted five factors. The CSS score correlated highly with health anxiety and moderately with somatic symptoms and health-care utilization. The CSS-15 still had an internal consistency of α = .82 and the confirmatory factor analysis confirmed the five factors. The correlation coefficients with health-related measures were unaffected. CONCLUSION: The German version of the CSS possesses very good psychometric characteristics, which were preserved in a short version. The factorial structure was replicated. The correlations with health anxiety and depression for both scales underscore their validity and clinical relevance.

Restless Legs Syndrome: Psychiatric Comorbidities Are More Important Than Neuroticism.

Restless legs syndrome (RLS) is often associated with psychopathological symptoms. We compared psychiatric diagnoses, psychological complaints, sleep and personality traits in RLS patients and a control group The RLS patients also answered the IRLS, RLS-6, and QoL-RLS. The RLS patients showed more depressive disorders, psychopathological symptoms, and lower well-being than controls, but no differences in personality traits. The slightly, but not significantly, higher neuroticism found in RLS patients can be explained by the higher rates of depression among the patients. It is advisable to screen RLS patients for psychiatric comorbidities. The design using a matched control group without sleep disorders limits the conclusions that can be drawn regarding the frequency of psychiatric diagnoses and controls with sleep problems.

The Psychological Inflexibility in Pain Scale (PIPS) - validation, factor structure and comparison to the Chronic Pain Acceptance Questionnaire (CPAQ) and other validated measures in German chronic back pain patients.

BACKGROUND: Acceptance and Commitment Therapy (ACT) for pain offers an alternative to traditional Cognitive Behavioural Therapy (CBT) approaches. ACT focuses on the enhancement of 'psychological flexibility' that enables individuals to pursue their values and goals despite pain. To assess specific treatment effect or mediators and moderators of change, questionnaires measuring ACT constructs are needed. METHODS: The Psychological Inflexibility in Pain Scale (PIPS) was translated into German and completed by 182 participants with chronic back pain (70.3 % women, age 51.0 ± 10.5 years). Item analyses and a confirmatory factor analysis were computed as well as correlations with the Chronic Pain Acceptance Questionnaire (CPAQ), which measures related, but slightly different ACT-related constructs, and self-reported disability, pain intensity and further pain-related questionnaires. RESULTS: The confirmatory factor analysis reproduced the original structure with two subscales and a good fit. The internal consistencies of the subscales were Cronbach's α = .91 (Avoidance) and α = .26 (Fusion). Average item-whole correlations of the items with the respective subscales were r = .71 (Avoidance) and r = .20 (Fusion). The highest correlations were observed for Avoidance with the CPAQ (r = -.81), the Tampa Scale of Kinesiophobia (r = .58) and the Pain Catastrophizing Scale (r = .56) and for Fusion with the CPAQ subscale Pain willingness (r = -.55). The PIPS subscale Avoidance predicted pain-related disability even after controlling for catastrophizing and fear of movement. CONCLUSIONS: The PIPS subscale Avoidance may be a valuable instrument to assess treatment processes in future RCTs. The PIPS subscale Fusion seemed more problematic in the German sample with chronic back pain. More research on the comparison between PIPS and other questionnaires assessing psychological flexibility and the usefulness of the concept 'Fusion' for chronic pain are needed.

Clinicians diagnosing virtual patients with the classification algorithm for chronic pain in the ICD-11 (CAL-CP) achieve better diagnoses and prefer the algorithm to standard tools: An experimental validation study.

BACKGROUND: The ICD-11 classification of chronic pain comprises seven categories, each further subdivided. In total, it contains over 100 diagnoses each based on 5-7 criteria. To increase diagnostic reliability, the Classification Algorithm for Chronic Pain in the ICD-11 (CAL-CP) was developed. The current study aimed to evaluate the CAL-CP regarding the correctness of assigned diagnoses, utility and ease of use. METHODS: In an international online study, n = 195 clinicians each diagnosed 4 out of 8 fictitious patients. The clinicians interacted via chat with the virtual patients to collect information and view medical histories and examination findings. The patient cases differed in complexity: simple patients had one chronic pain diagnosis; complex cases had two. In a 2 × 2 repeated-measures design with the factors tool (algorithm/standard browser) and diagnostic complexity (simple/complex), clinicians used either the algorithm or the ICD-11 browser for their diagnoses. After each case, clinicians indicated the pain diagnoses and rated the diagnostic process. The correctness of the assigned diagnoses and the ratings of the algorithm's utility and ease of use were analysed. RESULTS: The use of the algorithm resulted in more correct diagnoses. This was true for chronic primary and secondary pain diagnoses. The clinicians preferred the algorithm over the ICD-11 browser, rating it easier to work with and more useful. Especially novice users benefited from the algorithm. CONCLUSIONS: The use of the algorithm increases the correctness of the diagnoses for chronic pain and is well accepted by clinicians. The CAL-CP's use should be considered in routine care and research contexts. SIGNIFICANCE STATEMENT: The ICD-11 has come into effect in January 2022. Clinicians and researchers will soon begin using the new classification of chronic pain. To facilitate clinicians training and diagnostic accuracy, a classification algorithm was developed. The paper investigates whether clinicians using the algorithm-as opposed to the generic tools provided by the WHO-reach more correct diagnoses when they diagnose standardized patients and how they rate the comparative utility of the diagnostic instruments available.

Patients' perspective on the chronic pain classification in the 11th revision of the International Classification of Diseases (ICD-11): results from an international web-based survey.

ABSTRACT: The 11th revision of the International Classification of Diseases and Related Health Problems (ICD-11) aims at improving the lives of persons with the lived experience of chronic pain by providing clearly defined and clinically useful diagnoses that can reduce stigma, facilitate communication, and improve access to pain management, among others. The aim of this study was to assess the perspective of people with chronic pain on these diagnoses. An international web-based survey was distributed among persons with the lived experience of chronic pain. After having seen an information video, participants rated the diagnoses on 8 endorsement scales (eg, diagnostic fit, stigma) that ranged from -5 to +5 with 0 representing the neutral point of no expected change. Overall ratings and differences between participants with chronic primary pain (CPP) and chronic secondary pain (CSP) were analyzed. N = 690 participants were included in the data analysis. The ratings on all endorsement scales were significantly higher than the neutral point of 0. The highest ratings were obtained for "openness" (2.95 ± 1.93) and "overall opinion" (1.87 ± 1.98). Participants with CPP and CSP did not differ in their ratings; however, those with CSP indicated an improved diagnostic fit of the new diagnoses, whereas participants with CPP rated the diagnostic fit of the new diagnoses similar to the fit of their current diagnoses. These results show that persons with the lived experience of chronic pain accept and endorse the new diagnoses. This endorsement is an important indicator of the diagnoses' clinical utility and can contribute to implementation and advocacy.

Endorsing a Biopsychosocial Perspective of Pain in Individuals With Chronic Pain: Development and Validation of a Scale.

OBJECTIVES: Patients' beliefs about pain play an important role in their readiness to engage with chronic pain self-management. The central aim of this study was to validate a self-report instrument to assess a specific set of pain beliefs, patients' endorsement of a biopsychosocial model of chronic pain Patients' Endorsement of a Biopsychosocial Model of Chronic Pain Scale (PEB). METHODS: Interdisciplinary experts in the field of pain were involved in creating an instrument, the PEB Scale, to operationalize patients' endorsement of a biopsychosocial pain model. A sample of 199 patients with chronic pain was recruited to evaluate the factorial structure (principal axis factoring), the internal consistency (Cronbach alpha), the convergent and discriminant validity (correlational analyses), incremental validity (multiple, hierarchical regression analyses), and construct validity (differential population analysis) of the instrument. RESULTS: The factor analysis resulted in a unidimensional, 11-item instrument that explained 51.2% of the total variance. Cronbach alpha (=0.92) indicated high internal consistency of the created set of pain-related beliefs. Regression analyses demonstrated that PEB is a strong predictor of patients' engagement with pain self-management ( P < 0.001) after controlling for demographic variables, anxiety, depression, and other pain-related beliefs. DISCUSSION: Our results show that the PEB Scale is a highly reliable self-report instrument that has the potential to predict patients' readiness to adopt pain self-management. Future research should focus on revalidating the scale to operationalize PEB. Moreover, the PEB Scale should be implemented in longitudinal study designs to investigate its ability to predict the transition from acute to chronic pain and patients' long-term pain management.

Differences between recreational gamers and Internet Gaming Disorder candidates in a sample of Animal Crossing: New Horizons players.

Throughout the last decade, research has considered players' gaming motives as risk and the perceived social support (PSS) as protective factors in the context of Internet Gaming Disorder (IGD). However, the literature is lacking diversity regarding the representation of female gamers as well as of casual and console-based games. The aim of this study was to assess IGD, gaming motives, and PSS comparing recreational gamers and IGD candidates in a sample of Animal Crossing: New Horizons players. A total of 2909 ACNH players (93.7% of them female gamers) took part in an online survey which collected demographic, gaming-related, motivational, and psychopathologic data. Using the cut-off of at least five positive answers to the IGDQ, potential IGD candidates were identified. ACNH players reported a high prevalence rate for IGD (10.3%). IGD candidates differed from recreational players regarding age, sex, and game-related, motivational, and psychopathological variables. A binary logistic regression model was computed to predict membership in the potential IGD group. Age, PSS, escapism and competition motives as well as psychopathology were significant predictors. To discuss IGD in the context of casual gaming, we consider demographic, motivational, and psychopathological player characteristics as well as game design and the COVID-19 pandemic. IGD research needs to broaden its focus concerning game types as well as gamer populations.

The invisible cost of pain management by the current International Classification of Diseases coding system: a study in a tertiary care inpatient setting.

ABSTRACT: The International Classification of Diseases ( ICD ) is applied worldwide for public health data collection among other use cases. However, the current version of the ICD ( ICD-10 ), to which the reimbursement system is linked in many countries, does not represent chronic pain properly. This study aims to compare the ICD-10 with the ICD-11 in hospitalized patients in terms of specificity, clinical utility, and reimbursement for pain management. The medical records of hospitalized patients consulted for pain management at Siriraj Hospital, Thailand, were reviewed, and all pain-related diagnoses were coded into ICD-10 and ICD-11 . The data of 397 patients showed unspecified pain was coded 78% in the ICD-10 and only 0.5% in the ICD-11 version. The difference gap in the proportion of unspecified pain between the 2 versions is wider than in the outpatient setting. The 3 most common codes for ICD-10 were other chronic pain, low back pain, and pain in limb. The 3 most common codes for ICD-11 were chronic cancer pain, chronic peripheral neuropathic pain, and chronic secondary musculoskeletal pain. As in many other countries, no pain-related ICD-10 codes were coded for routine reimbursement. The simulated reimbursement fee remained the same when adding 397 pain-related codings, even if the cost of pain management, such as cost of labor, existed. Compared with the ICD-10 version, the ICD-11 is more specific and makes pain diagnoses more visible. Thus, shifting from ICD-10 to ICD-11 has the potential to improve both the quality of care and the reimbursement for pain management.

Climate for evidence-based mental health care implementation in Germany: psychometric investigation of the Implementation Climate Scale (ICS).

Organizational implementation climate is an important construct in implementation research to describe to what extent implementation is expected, supported, and rewarded. Efforts in bridging the research-practice gap by implementing evidence-based practice (EBP) can benefit from consideration of implementation climate. The Implementation Climate Scale (ICS) is a psychometrically strong measure assessing employees' perceptions of the implementation climate. The present cross-sectional study aimed at providing a German translation and investigating its psychometric properties. The translation followed standard procedures for adapting psychometric instruments. German psychotherapists (N = 425) recruited online completed the ICS, the Evidence Based Practice Attitudes Scale (EBPAS-36D) and the Intention Scale for Providers (ISP). We conducted standard item and reliability analyses. Factorial validity was assessed by comparing an independent cluster model of Confirmatory Factorial Analysis (ICM-CFA), a Bifactor CFA, a Second-order CFA and an (Bifactor) Exploratory Structural Equation Model (ESEM). Measurement invariance was tested using multiple-group CFA and ESEM, convergent validity with correlation analysis between the ICS and the ISP subjective norms subscale (ISP-D-SN). The mean item difficulty was pi = .47, mean inter-item correlation r = .34, and mean item-total correlation ritc = .55. The total scale (ω = 0.91) and the subscales (ω = .79-.92) showed acceptable to high internal consistencies. The model fit indices were comparable and acceptable (Second-order CFA: RMSEA [90% CI] = .077 [.069; .085], SRMR = .078, CFI = .93). Multiple-group CFA and ESEM indicated scalar measurement invariance across gender and presence of a psychotherapy license. Psychotherapists in training reported higher educational support for EBP than licensed psychotherapists (T = 2.09, p = .037, d = 0.25). The expected high correlation between the ICS and the ISP-D-SN was found (r = .59, p < .001). Results for the German ICS confirm good psychometric properties including validity.

Chronic Pain in the ICD-11: New Diagnoses That Clinical Psychologists Should Know About.

Background: In the 10th revision of the International Classification of Diseases and Related Health Problems (ICD-10), chronic pain was not represented adequately. Pain was left undefined and not recognized as a biopsychosocial phenomenon. Instead, a flawed dualism between psychological and somatic factors was implied. Individual diagnoses were ill-defined and scattered randomly through different chapters. Many patients received diagnoses in remainder categories devoid of meaningful clinical information. Method: The International Association for the Study of Pain launched a Task Force to improve the diagnoses for the 11th revision of the ICD and this international expert team worked from 2013-2019 in cooperation with the WHO to develop a consensus based on available evidence and to improve the diagnoses. Results: A new chapter on chronic pain was created with a biopsychosocial definition of pain. Chronic pain was operationalized as pain that persists or recurs longer than three months and subdivided into seven categories: Chronic primary pain and six types of chronic secondary pain. All diagnoses were based on explicit operationalized criteria. Optional extension codes allow coding pain-related parameters and the presence of psychosocial aspects together with each pain diagnosis. Conclusion: First empirical studies demonstrated the integrity of the categories, the reliability, clinical utility, international applicability and superiority over the ICD-10. To improve reliability and ease of diagnosis, a classification algorithm is available. Clinical psychologists and other clinicians working with people with chronic pain should watch the national implementation strategies and advocate for multimodal and interdisciplinary treatments and adequate reimbursement for all providers involved.