[Steadfast--effectiveness of a cognitive-behavioral self-management program for patients with somatoform vertigo and dizziness]. / Standfest? Erste Ergebnisse der Entwicklung eines kognitiv-verhaltenstherapeutischen Gruppenschulungsprogramms zur Behandlung des somatoformen Schwindels.

The aim of the study was to evaluate a psychotherapeutic intervention for somatoform vertigo regarding illness perception, severity and psychopathology.Patients underwent a waiting-list control group design (n=10 control group; n=14 intervention group with diagnostics at baseline, post-intervention, 3- and 12-month follow-up). Psychometric assessments comprised the Illness Perception Questionnaire, Vertigo Symptom and Handicap Questionnaire, Hospital Anxiety and Depression Scale, and Physical Health Questionnaire.The intervention group improved in personal control (p=0.046; d=0.46), and coherency (p=0.087; d=0.42). Illness beliefs in organic deteriorations could be corrected towards psychosomatic attributions.Steadfast decreased dysfunctional illness representations and increased patient empowerment.

Screening for distress in routine oncological care-a survey in 520 melanoma patients.

INTRODUCTION: Despite the increasing incidence of melanoma little is known about patients' emotional distress associated with this disease. Supplemented by the problem list (PL), the distress thermometer (DT) is a recommended screening instrument to measure psychosocial distress in cancer patients. Our objective was to explore the acceptance and the feasibility of the DT and PL as a concise screening tool in an ambulatory setting for routine care and to elucidate determinants of distress in melanoma patients with regard to sociodemographic and clinical variables. METHODS: Consecutive melanoma outpatients were asked to complete the DT with the PL prior to their scheduled consultation. Demographic and clinical data were obtained from the patients' charts. Clinical data included melanoma stage, time since diagnosis, previous treatment, current treatment, and other cancer disease. RESULTS: Out of 734 patients recruited into the study, 520 patients (71%) completed both the DT and the PL. Forty-seven percent met the ≥5 cut-off score for distress. Younger and employed patients reported higher distress than older and retired patients. A cut-off score of ≥5 was closely associated with self-reported emotional sources of distress, with practical problems, especially at work, family problems (dealing with the partner), and physical problems like pain, appearance, getting around, and nausea. Apart from higher distress under current systemic treatment, no associations were found between distress and clinical data. CONCLUSION: The DT together with the PL seems to be an economically reasonable screening tool to measure psychosocial distress in melanoma patients. In particular, younger melanoma patients who are currently employed are prone to experience distress at some point after diagnosis, but there appears to be almost no association between clinical data and the extent of distress. To characterize the impact of distress on disease outcome and quality of life in melanoma patients, further research is needed.

Implementing panic-focused psychodynamic psychotherapy into clinical practice.

OBJECTIVE: To determine the effectiveness of manualized panic-focused psychodynamic psychotherapy (PFPP) in routine care in Germany. METHOD: German psychoanalysts were trained according to the PFPP manual. Fifty-four consecutive outpatients with panic disorder (with or without agoraphobia) were randomly assigned in a 2:1 ratio to PFPP or cognitive-behavioural therapy (CBT) plus exposure therapy. Subjects (female 57.4%; mean age 36.2 years) had high rates of psychiatric (68.5%) and somatic (64.8%) comorbidity, and previous psychiatric treatments (57.4%). Assessments were performed pre- and posttreatment and at 6-month follow-up. The primary outcome measure was the Panic Disorder Severity Scale. RESULTS: Both treatments were highly effective. In patients randomized to PFPP, remission was achieved in 44.4% at termination and by 50% at follow-up (CBT 61.1% and 55.6%, respectively). No significant differences were found. Emotional awareness, a posited moderator of good outcome in psychotherapies, was significantly higher in the CBT group at baseline. It was found to be a strong moderator of treatment effectiveness in both treatments. After adjusting for initial Levels of Emotional Awareness Scale (LEAS) scores, effect sizes (ESs) for the primary outcome were Cohen d = 1.28, from pre- to posttreatment, and d = 1.03, from pretreatment to follow-up, for PFPP, and d = 1.81 and 1.28 for CBT, respectively. CONCLUSIONS: PFPP was implemented effectively into clinical practice by psychoanalysts in the community in a sample with severe mental illness with large ESs. Assessment of LEAS may facilitate the identification of patients suitable for short-term psychotherapy. ( CLINICAL TRIAL REGISTRATION NUMBER: German Clinical Trials Register, DRKS00000245; Universal Trial Number, U1111-1112-4245).

Objectif : Déterminer l'efficacité de la psychothérapie psychodynamique axée sur la panique (PPAP), pratiquée d'après un manuel, dans les soins courants en Allemagne. Méthode : Les psychanalystes allemands ont été formés en conformité avec le manuel de PPAP. Cinquante-quatre patients ambulatoires consécutifs souffrant de trouble panique (avec ou sans agoraphobie) ont été affectés au hasard dans un rapport de 2:1 à la PPAP ou la thérapie cognitivo-comportementale (TCC) en plus d'une thérapie d'exposition. Les sujets (femmes 57,4 %; âge moyen 36,2 ans) avaient des taux élevés de comorbidités psychiatriques (68,5 %) et somatiques (64,8 %), et de traitements psychiatriques précédents (57,4 %). Des évaluations ont été exécutées avant et après le traitement, et au suivi de 6 mois. La principale mesure des résultats était l'échelle de gravité du trouble panique. Résultats : Les deux traitements ont été très efficaces. Chez les patients affectés à la PPAP, la rémission a été atteinte chez 44,4 % des sujets au terme du traitement, et chez 50 % au suivi (TCC 61,1 % et 55,6 %, respectivement). Aucune différence significative n'a été observée. La conscience émotionnelle, un modérateur présumé de bons résultats en psychothérapie, était significativement plus élevée dans le groupe de la TCC au départ. Elle s'est révélée être un bon modérateur de l'efficacité du traitement dans les deux traitements. Après correction des scores initiaux à l'échelle des niveaux de conscience émotionnelle (LEAS), l'ampleur de l'effet (AE) des premiers résultats était d de Cohen = 1,28, d'avant à après traitement, et d = 1,03, d'avant le traitement au suivi, pour la PPAP, et d = 1,81 et 1,28 pour la TCC, respectivement. Conclusions : La PPAP a été mise en œuvre efficacement dans la pratique clinique par des psychanalystes de la communauté dans un échantillon souffrant de grave maladie mentale et présentant de larges AE. L'évaluation par la LEAS peut faciliter l'identification des patients à qui la psychothérapie à court terme convient. (Numéro d'enregistrement d'essai clinique : German Clinical Trials Register, DRKS00000245; Universal Trial Number, U1111­1112­4245).