Early developments in general change mechanisms predict reliable improvement in addition to early symptom trajectories in cognitive behavioral therapy.

General change mechanisms (GCMs) have been shown to predict treatment outcome in cognitive behavioral therapy (CBT). Early changes in GCMs (early-change-GCMs) and in symptom severity were also linked to treatment outcome, but evidence is still limited. We investigated whether early-change-GCMs from patients' and therapists' perspectives in addition to early changes in symptom severity predict treatment outcome. Data from a university-based outpatient clinic was analyzed (N = 911 completers). Most treatments were provided by therapists in CBT training. Outcomes were symptom severity and life satisfaction. Continuous post-treatment scores and categories of reliable improvement (improved vs. not improved) were investigated. Some patient-rated early-change-GCMs and early changes in symptom severity proved to be predictors for continuous outcomes (p < .05) in symptom severity and life satisfaction. In addition, some patient-rated early-change-GCMs predicted reliable improvement in life satisfaction. By contrast, therapist-rated early-change-GCMs and early symptom severity change predicted reliable improvement in symptom severity. Early-change-GCMs explained between two and four percent additional variance in outcomes. Thus, it is important to consider early changes in GCMs in addition to early changes in symptom severity in routine monitoring.

Cognitive-Behavioral and Psychodynamic Therapy in Adolescents with Social Anxiety Disorder: A Multicenter Randomized Controlled Trial.

BACKGROUND: Although social anxiety disorder (SAD) has an early onset and is frequently found in adolescence, evidence for psychotherapeutic treatments of SAD in adolescents is rather scarce. Within the Social Phobia Psychotherapy Research Network (SOPHO-NET), we examined the efficacy of cognitive-behavioral (CBT) and psychodynamic therapy (PDT) compared to a waiting list (WL) in these patients. METHODS: In a multicenter randomized controlled superiority trial, 107 patients, aged 14-20 years, were randomized to CBT (n = 34), PDT (n = 34), or WL (n = 39). Assessments were made at baseline, at the end of treatment, and 6 and 12 months after termination. The Liebowitz Social Anxiety Scale for Children and Adolescents (LSAS-CA) applied by raters masked to the treatment condition was used as the primary outcome. As secondary outcomes, rates of response and remission and the Social Phobia Anxiety Inventory (SPAI) were used. RESULTS: Both treatments were superior to WL in the LSAS-CA (CBT: p = 0.0112, d = 0.61, 95% CI 0.14-1.08; PDT: p = 0.0261, d = 0.53, 95% CI 0.06-1.00). At the end of treatment, response rates were 66, 54, and 20% for CBT, PDT, and WL. The corresponding remission rates were 47, 34, and 6%, respectively. CBT and PDT were significantly superior to WL regarding remission (CBT: p = 0.0009, h = 1.0; PDT: p = 0.0135, h = 0.74), response (CBT: p = 0.0004, h = 0.97; PDT: p = 0.0056, h = 0.72), and the SPAI (CBT: p = 0.0021, d = 0.75, 95% CI 0.27-1.22; PDT: p = 0.0060, d = 0.66, 95% CI 0.19-1.13). Treatment effects were stable at 6- and 12-month follow-ups. CONCLUSIONS: These results are comparable to the large SOPHO-NET trial in adults (n = 495). Early treatments for social anxiety are needed in order to prevent chronic manifestation of SAD.

Health beliefs and over-the-counter product use.

BACKGROUND: Pharmacists are often consulted as medical advisors. Given this case, customers and pharmacists should interact in a trustful way (eg, in terms of responding to customer's needs or recommending a different drug). Consideration of the health beliefs of the customer could improve the interaction between pharmacists and their clients and have a positive impact on medical adherence. OBJECTIVE: To examine the health beliefs of pharmacy customers in Germany, the impact of those beliefs on over-the-counter (OTC) medication use, and associations with sociodemographic variables. METHODS: By means of literature review and methodical surveys, a standardized questionnaire was designed that contained 68 items concerning health beliefs, habits of OTC product use, decision criteria that customers used when purchasing drugs, and information about the sociodemographic background of the participants. Main outcome measures were reliability (Cronbach's alpha) and correlations. A random sample of 58 pharmacies in Saxony, Germany (10 questionnaires per pharmacy), invited their customers to take part in our study. RESULTS: One hundred twenty-three questionnaires (response rate 53.48%) were completed and returned to us. The outcome suggests that there is a strong association between health beliefs and frequency of use or the type of OTC drug (eg, illness attributions: p < 0.05; preventive lifestyle: p < 0.05). There were no significant associations between sociodemographic variables and chosen drugs. CONCLUSIONS: Health beliefs, in terms of the general attitude toward health and illness, illness attribution, prevention, and the attitude toward treatment strategies, influence the kind of remedy (conventional vs complementary medication) that consumers seek. These results may have implications for consultations in pharmacies or for product marketing.

Cognitive-Behavioral and Psychodynamic Therapy in Female Adolescents With Bulimia Nervosa: A Randomized Controlled Trial.

OBJECTIVE: The authors compared cognitive-behavioral therapy (CBT) and psychodynamic therapy (PDT) for the treatment of bulimia nervosa (BN) in female adolescents. METHOD: In this randomized controlled trial, 81 female adolescents with BN or partial BN according to the DSM-IV received a mean of 36.6 sessions of manualized disorder-oriented PDT or CBT. Trained psychologists blinded to treatment condition administered the outcome measures at baseline, during treatment, at the end of treatment, and 12 months after treatment. The primary outcome was the rate of remission, defined as a lack of DSM-IV diagnosis for BN or partial BN at the end of therapy. Several secondary outcome measures were evaluated. RESULTS: The remission rates for CBT and PDT were 33.3% and 31.0%, respectively, with no significant differences between them (odds ratio [OR] = 0.90, 95% CI = 0.35-2.28, p = .82). The within-group effect sizes were h = 1.22 for CBT and h = 1.18 for PDT. Significant improvements in all secondary outcome measures were found for both CBT (d = 0.51-0.82) and PDT (d = 0.24-1.10). The improvements remained stable at the 12-month follow-up in both groups. There were small between-group effect sizes for binge eating (d = 0.23) and purging (d = 0.26) in favor of CBT and for eating concern (d = -0.35) in favor of PDT. CONCLUSION: CBT and PDT were effective in promoting recovery from BN in female adolescents. The rates of remission for both therapies were similar to those in other studies evaluating CBT. This trial identified differences with small effects in binge eating, purging, and eating concern. Clinical trial registration information-Treating Bulimia Nervosa in Female Adolescents With Either Cognitive-Behavioral Therapy (CBT) or Psychodynamic Therapy (PDT). http://isrctn.com/; ISRCTN14806095.

Associations between waist circumference and depressive disorders.

BACKGROUND: Previous research has suggested that abdominal obesity and mental disorders are associated. This paper was initiated to investigate associations between unfavourable waist circumference (WC) and mental disorders in a representative sample of German adults. METHODS: 4181 individuals (aged 18-65 years) took part in a physical examination (including measurement of body weight and WC) and a structured psychological interview (M-CIDI) to evaluate mental disorders. RESULTS: An unfavourable WC (males: 26.9%; females: 31.3%) was highly prevalent. However, unfavourable WC and mental disorders were not associated, neither with regard to the prevalence of any mental disorder nor regarding in particular depressive disorders. Moreover, even middle-aged depressive women that have often been assumed to be at high risk of increased visceral fat did not show more unfavourable WCs than their non-depressed, female counterparts. LIMITATIONS: The main limitation is that the co-occurrence of mental disorders and obesity was recorded but not, if obesity was related to the onset of mental problems. CONCLUSION: From an epidemiologic perspective, it is not possible to prove associations between WC and mental disorders. Patients with unfavourable waist circumferences do not show a higher prevalence of depressive disorders.

[Cognitive-behavioral psychotherapy for adolescents with eating disorders]. / Kognitiv-behaviorale Psychotherapie bei Jugendlichen mit Essstörungen.

Anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) are grouped together under the term eating disorders. Due to its typical onset in adolescence, AN in particular represents a frequent disorder with often an unfavourable course in this age range (Steinhausen 2002). The mental, social and physical consequences are serious. Research has shown that cognitive-behavioral treatment (CBT) has good effectiveness in adult patients with AN, BN and BED and that it is superior to other treatments. However, there have been few studies on children and adolescents. The effectiveness in adolescence can thus be judged only when the results in adulthood are taken into account. At present, there is limited evidence for the effectiveness of CBT in adolescence.

Two dimensions of social anxiety disorder: a pilot study of the Questionnaire for Social Anxiety and Social Competence Deficits for Adolescents.

BACKGROUND: The Questionnaire for Social Anxiety and Social Competence Deficits for Adolescents (SASKO-J) was developed as an instrument for clinical diagnostics of social anxiety disorder in youths by measuring social anxiety and social deficits in two separate dimensions. The study provides an initial assessment of the scale's psychometric properties in a clinical sample. METHOD: The reliability and validity of the SASKO-J were assessed in a mixed clinical sample of 12- to 19-year-old German adolescents (N = 85; mean age 15.71 years; SD = 1.92; 62.4 % girls). In a second step, the diagnostic validity was evaluated in a clinical sample of 31 adolescent patients with social anxiety disorder (mean age 16.10 years; SD = 1.54; 74.2 % girls) and a sample of 115 German high school students (mean age 15.84 years; SD = 1.65; 60.9 % girls) via Receiver Operating Characteristic (ROC) analysis. RESULTS: The internal consistencies of the total scale and the subscales were good to excellent (0.80 ≤ α ≤ 0.96), and the results indicated a good convergent and divergent validity. The ROC analysis revealed a satisfying area under curve (AUC = 0.866), and a cutoff of 41.5 for the SASKO-J total score represented the best balance of sensitivity (0.806) and specificity (0.826). CONCLUSIONS: The results of this pilot study provide initial support for the clinical use of the SASKO-J in the diagnostic process. Future research should address the question of psychometric properties in a social anxiety disorder sample as well as the questionnaire's sensitivity for detecting change in symptoms during therapy.

Obesity and the risk for mental disorders in a representative German adult sample.

BACKGROUND: A systematic approach to examining associations among obesity and socio-demographic determinants, psychological problems, and mental disorders in epidemiological samples is missing. METHODS: Within the representative German Health Interview and Examination Survey and its Mental Health Supplement (GHS-MHS), 4181 subjects (age 18-65 years) took part in a physical examination (including measurement of body weight and height) and a standardized psychological interview (M-CIDI). Obesity (BMI > 30 kg/m(2)), somatic diseases, socio-economic variables, health-related quality of life (SF-36), and mental disorders (DSM-IV) were assessed. Data were analysed by logistic regression analyses. RESULTS: Prevalence of obesity was 18.5%. There was a strong association between obesity and somatic conditions, as well as to low socio-economic status (SES). No psychosocial disadvantages (e.g. regarding social relationships, impairment due to mental health problems, depressed feelings) for the obese individuals were found. With the exception of a higher prevalence of anxiety disorders in obese men (12.5 versus 8.5%, OR = 1.53, CI = 1.06-2.21, disappearing when controlled for number of somatic conditions), obese persons showed no elevated rates of mental disorders. DISCUSSION: Obesity is associated with a low SES and some somatic disadvantages but not with other social or emotional disadvantages that have been often assumed to be very prevalent in that group. From the population-based perspective, obesity per se seems not to be associated with a higher risk for suffering from mental disorders, whereas relations between specific aspects of obesity and specific types of psychopathology still need further study.

Drug use patterns in young German women and association with mental disorders.

BACKGROUND: There is a lack of data about drug use patterns in young women. Mental disorders may influence those drug use patterns. OBJECTIVE: To evaluate drug use patterns (prescribed drugs, self-medication) in general and in relation to the prevalence rates of mental disorders in young German women. METHODS: A total of 2064 women (18-24 y old), obtained in a random clustered sample, were asked about their actual and former medication use. Moreover, a structured psychological interview (Diagnostic Interview for Mental Disorders) was conducted with each woman to evaluate the prevalence of mental disorders (according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition). RESULTS: Oral contraceptives (55.9%), thyroid preparations (7.1%), respiratory system drugs (9.4%), and nervous system drugs (8%) were the most commonly used medications. Only 10% of the women with one or more mental disorders used psychotropic medication. As expected, women with mental disorders were significantly more likely to use antidepressants and psycholeptic agents (ie, sedatives/hypnotics, antipsychotics) than were women without any mental disorder. However, there were no significant differences in use of pain medication. CONCLUSIONS: The results of this study indicate an apparently inadequate supply of drugs acting on the nervous system for women with mental disorders in Germany. Further studies on different age and gender groups are needed. It is important to evaluate the prevalence of diseases and drug use at the same time so as to identify deficits in drug therapy and optimize prescription and self-medication use.