What time-varying network models based on functional analysis tell us about the course of a patient's problem.

Background: Relations among psychological variables are assumed to be complex and to vary over time. Personalized networks can model multivariate complex interactions. The development of time-varying networks allows to model the variation of parameters over time. Objectives: We aimed to determine the value of time-varying networks for clinical practice. Methods: We applied time-varying mixed graphical models (TV-MGM) and time-varying vector autoregressive models (TV-VAR) to intensive longitudinal data of nine participants with depressive symptoms (n = 6) or anxiety (n = 3). Results: Most of the participants showed temporal changes in network topology within the assessment period of 30 days. Time-varying networks of participants with small, medium, and large time variability in edge parameters clearly show the different temporal evolvements of dynamic interactions between variables. The case example indicates clinical utility but also limitations to the application of time-varying networks in clinical practice. Conclusion: Time-varying network models provide a data-driven and exploratory approach that could complement current diagnostic standards by reflecting interacting, often mutually reinforcing processes of mental health problems and by accounting for variation over time. They can be used to generate hypotheses for further confirmatory and clinical testing.

Leveraging Single-Case Experimental Designs to Promote Personalized Psychological Treatment: Step-by-Step Implementation Protocol with Stakeholder Involvement of an Outpatient Clinic for Personalized Psychotherapy.

Our objective is to implement a single-case experimental design (SCED) infrastructure in combination with experience-sampling methods (ESM) into the standard diagnostic procedure of a German outpatient research and training clinic. Building on the idea of routine outcome monitoring, the SCED infrastructure introduces intensive longitudinal data collection, individual effectiveness measures, and the opportunity for systematic manipulation to push personalization efforts further. It aims to empower psychotherapists and patients to evaluate their own treatment (idiographic perspective) and to enable researchers to analyze open questions of personalized psychotherapy (nomothetic perspective). Organized around the principles of agile research, we plan to develop, implement, and evaluate the SCED infrastructure in six successive studies with continuous stakeholder involvement: In the project development phase, the business model for the SCED infrastructure is developed that describes its vision in consideration of the context (Study 1). Also, the infrastructure's prototype is specified, encompassing the SCED procedure, ESM protocol, and ESM survey (Study 2 and 3). During the optimization phase, feasibility and acceptability are tested and the infrastructure is adapted accordingly (Study 4). The evaluation phase includes a pilot implementation study to assess implementation outcomes (Study 5), followed by actual implementation using a within-institution A-B design (Study 6). The sustainability phase involves continuous monitoring and improvement. We discuss to what extent the generated data could be used to address current questions of personalized psychotherapy research. Anticipated barriers and limitations during the implementation processes are outlined.

Temporal Stability of Sexual Excitation and Sexual Inhibition in Women.

The dual control model of sexual response proposes two factors, sexual excitation (SE) and sexual inhibition (SI), that aim to predict sexual behavior and response. While SE and SI are described as stable traits that influence sexuality-related outcomes such as sexual function or sexual risk taking, only a few studies have presented data on the stability of these factors. The aim of this study was to evaluate the temporal stability of SE and SI, and to investigate whether changes in sexual function or partnership status influence SE and SI in a longitudinal sample of women. To address these research questions, the Sexual Excitation/Sexual Inhibition Inventory for Women (SESII-W) was administered five times over the course of 4 years. The SESII-W includes two main scales of SE and SI which consist of five (Arousability, Partner characteristics, Sexual power dynamics, Smell, and Setting) and three subscales (Concerns about sexual function, Arousal contingency, Relationship importance), respectively. Data from 553 women (Mage = 31.38 years, SD = 10.25, range = 18-67) who participated in at least two assessment points were included in this study. Bivariate correlations between baseline and the fifth follow-up assessment indicated a high temporal stability of SE and SI in women (.47 < r < .71). A series of generalized linear models were conducted to investigate the impact of time, changes in sexual function, partnership status, and changes in partnership status on SE and SI. Partner characteristics (SE) that showed small increases over time. Across different subscales, improvements in sexual function were associated with higher SE and lower SI. Changes in partnership status and partnership status itself were predictors of one SE- and three SI-related scales. This study suggests a relatively high temporal stability of SE and SI in women and supports the dual control model's assertion that both factors are stable individual traits. Certain life events such as a new partnership or sexual difficulties may, however, impact time stability of both factors.

Correction to: Temporal Stability of Sexual Excitation and Sexual Inhibition in Women.

The authors would like to issue a correction for a statement made in the conclusion section of the paper entitled "Temporal stability of sexual excitation and sexual inhibition in women". As one might expect and as rightly stated throughout the paper, our study suggests that improvements in sexual function might increase sexual excitation and decrease sexual inhibition in women, not the other way around.

Lifestyle choices and mental health: a longitudinal survey with German and Chinese students.

BACKGROUND: A healthy lifestyle can be beneficial for one's mental health. Thus, identifying healthy lifestyle choices that promote psychological well-being and reduce mental problems is useful to prevent mental disorders. The aim of this longitudinal study was to evaluate the predictive values of a broad range of lifestyle choices for positive mental health (PMH) and mental health problems (MHP) in German and Chinese students. METHOD: Data were assessed at baseline and at 1-year follow-up. Samples included 2991 German (Mage = 21.69, SD = 4.07) and 12,405 Chinese (Mage = 20.59, SD = 1.58) university students. Lifestyle choices were body mass index, frequency of physical and mental activities, frequency of alcohol consumption, smoking, vegetarian diet, and social rhythm irregularity. PMH and MHP were measured with the Positive Mental Health Scale and a 21-item version of the Depression Anxiety and Stress Scale. The predictive values of lifestyle choices for PMH and MHP at baseline and follow-up were assessed with single-group and multi-group path analyses. RESULTS: Better mental health (higher PMH and fewer MHP) at baseline was predicted by a lower body mass index, a higher frequency of physical and mental activities, non-smoking, a non-vegetarian diet, and a more regular social rhythm. When controlling for baseline mental health, age, and gender, physical activity was a positive predictor of PMH, smoking was a positive predictor of MHP, and a more irregular social rhythm was a positive predictor of PMH and a negative predictor of MHP at follow-up. The good fit of a multi-group model indicated that most lifestyle choices predict mental health comparably across samples. Some country-specific effects emerged: frequency of alcohol consumption, for example, predicted better mental health in German and poorer mental health in Chinese students. CONCLUSIONS: Our findings underline the importance of healthy lifestyle choices for improved psychological well-being and fewer mental health difficulties. Effects of lifestyle on mental health are comparable in German and Chinese students. Some healthy lifestyle choices (i.e., more frequent physical activity, non-smoking, regular social rhythm) are related to improvements in mental health over a 1-year period.

[Complains about Psychotherapy and their Impact on Patients]. / Beschwerden über Psychotherapie und ihre Auswirkungen auf Patienten und Patientinnen.

Unprofessional psychotherapy damages its otherwise good standing. For that reason, a public discussion about malpractice and unethical psychotherapist behavior is oftentimes missing even though addressing the topic openly could illustrate its rarity and promote a professional handling of psychotherapeutic misconduct. In the presented study, qualitative content analysis was conducted to analyze malpractice claims that were sent to the Psychotherapeutic Chamber of North Rhine-Westphalia (Germany) in 2011 and 2012. All letters were anonymized and the processing of the claims was completed. In total, 149 relevant malpractice claims and 124 statements about consequences of malpractice behaviors were identified. Most malpractice claims were related to the category "violation of therapeutic basic variables" (40.3%), followed by "violation of general conditions" (16.8%) and "financial abuse" (12.1%). In consequence, 28.2% of the patients described a "deterioration of their symptoms". These results shed light on the variation of existing malpractice claims and their consequences for patients indicating the need for awareness-raising actions for therapists and patients.

[Definition and Decision-Making in the Determination and Detection of Side Effects of Psychotherapy]. / Definition und Entscheidungsschritte in der Bestimmung und Erfassung von Nebenwirkungen von Psychotherapie.

There is no generally accepted definition of side effects, which causes problems in research and clinical practice. Not even the distinction between main and side effects is always clear. Several judgments are needed in the assessment of side effects. First, it must be decided where to look for unwanted events. Events are defined by the temporal contingency with the treatment. Second, it must be made a judgement whether it is an unwanted or wanted event. Everything is unwanted, which would be problematic, if it would be possible to do without it. Thirdly, a causal relationship with the treatment must be made plausible. Fourthly, a decision must be made that the treatment has been adequate and not malpractice or other unethical behavior. Side effects can be defined as unwanted consequences of correct treatment. The relevance of side effects is depending on severity and duration.

[Unwanted Side Effects in Children and Youth Psychotherapy - Introduction and Recommendations]. / Unerwünschte Nebenwirkungen in der Kinder- und Jugendlichenpsychotherapie ­ Eine Einführung und Empfehlungen.

Psychotherapy in children and adolescents is effective, but unwanted effects can occur. Until now, psychotherapy research has neglected this important topic, although children and youths are in need of special protection. Unwanted effects caused by therapy are not systematically investigated and a corresponding conceptualization is missing. The aim of this article is to investigate whether the current classifications of unwanted effects of psychotherapy in adults are applicable to children and adolescents and to identify distinctive features. Furthermore, the adaptation of the Inventory for the Assessment of Negative Effects of Psychotherapy for children and adolescents (Children-INEP) is presented. Finally, steps for the information and prevention of unwanted, and negative effects of psychotherapy in children and adolescents are pointed out.

Sexual Excitation and Sexual Inhibition as Predictors of Sexual Function in Women: A Cross-Sectional and Longitudinal Study.

To date, no longitudinal studies have evaluated the predictive value of the two factors of the dual control model-sexual excitation (SE) and sexual inhibition (SI)-for future sexual function. The aims of the present study were to investigate the associations between SE/SI and sexual function and estimate their predictive value for future sexual function in a sample of women. Overall, 2,214 women participated in a web-based survey that assessed SE, SI, and sexual function as well as symptoms of depression. The one- and two-year follow-up surveys included 396 and 382 participants, respectively. Correlational analyses and hierarchical regression analyses were conducted to analyze the relationships between predictor and outcome variables. Four factors of SE (Arousability, Partner Characteristics, Sexual Power Dynamics, and Setting) and two factors of SI (Concerns about Sexual Function and Arousal Contingency), as well as symptoms of depression and partnership status, were significant predictors of concurrent and future sexual function. Several subscales of SE and SI contributed to the prediction of future sexual function above and beyond prior sexual function levels. Our study provides the first supportive evidence for the assumptions of the dual control model that propensities for low SE and high SI influence future sexual function.

Unprotected Intercourse and One-Night Stands: Impact of Sexual Excitation, Sexual Inhibition, and Atypical Sexual Arousal Patterns on Risky Sexual Behaviors in Women.

INTRODUCTION: Associations among sexual excitation, sexual inhibition, atypical sexual arousal patterns, and risky sexual behaviors have been reported in studies involving men and women. To date, longitudinal studies have not evaluated the predictive value of these propensities for future sexual behaviors in women. AIM: To investigate associations among sexual excitation, sexual inhibition, atypical sexual arousal patterns, and potentially risky sexual behaviors in women. METHODS: Overall, 2,214 women (mean age = 30.65 years, standard deviation = 9.91 years) participated in a baseline Web-based survey. The 1- and 2-year follow-up surveys included 396 and 382 participants, respectively. Correlational analyses and multiple linear regression analyses were conducted to analyze the relations between predictor and outcome variables. MAIN OUTCOME MEASURES: Number of partners, number of one-time sexual encounters, and number of partners with whom no condoms were used during the 12-month periods before each of the three data assessment points. RESULTS: All five lower-order factors of sexual excitation showed positive correlations and all three lower-order factors of sexual inhibition showed negative correlations with outcomes at baseline and follow-up. Atypical sexual arousal patterns, the tendency to become aroused in unusual sexual situations, and the importance of relationship factors, such as trust, for sexual arousal were the strongest predictors for sexual behaviors at baseline. These variables also predicted the number of sexual partners and the number of one-night stands at follow-up. CONCLUSION: The findings suggest that increased sexual arousal when experiencing negative mood might be a risk factor for potentially health-threatening sexual decisions and support the assumptions of the dual control model that sexual excitation is positively and sexual inhibition is negatively predictive of risky sexual behavior in women.