[Borderline personality disorder and non-suicidal self-injury: the role of mindfulness training in risk reduction].

INTRODUCTION: Due to patients diagnosed with borderline personality disorder (BPD) can engage risky behaviors, it is necessary to develop evidence based interventions in healthcare that can help to reduce the most pressing problems. BPD-specific cognitive therapy-based mindfulness training (MBCT) can be a solution to this challange. LITERATURE REVIEW: Non-suicidal self-injury (NSSI) is a significant predictor of subsequent suicide attempts and occurs in 80% of BPD patients. It is related to impulse- and emotion-dysregulation (cognitive-emotional model), as well as the deficit of mindfulness skills, which are also key difficulties in BPD (emotional cascade model, mindfulness deficit theory). The cognitive-emotional reactivity model of NSSI based on the reactivity model in recurrent depression, the four-function model and theories above. The model differs situational, cognitive, emotional, physiological, and behavioral factors that can trigger or maintain NSSI, and it also helps to determine intervention points. STUDY PROTOCOL: Our hypothesis is that the 8-week MBCT training is more effective in developing mindfulness skills, emotion- and impulse control, and in reducing self-harm also than waiting list or supportive therapy. Participants are BPD patients with NSSI, in a quasi-experimental repeated measure design, planned sample size is N=60 per group. Before the training there is a two-stage interview procedure, patients fill out a questionnaire survey and they have to sign a suicide prevention contract. The planned waiting time between the first interview and the start of the training is 8-12 weeks. The group sessions are based on the MBCT training protocol designed to reduce the risk of suicide, supplemented with BPD-specific elements (specific psychoeducation, loving-kindness meditation). DISCUSSION: Based on the effectiveness of small-sample research, our aim is to test the effectiveness of MBCT training among BPD patients based on the above protocol.

[The Barratt Impulsiveness Scale-Brief-8 in an Incarcerated Sample: Suicide Risk, Impulsivity and Mindfulness].

INTRODUCTION: Suicide attempts and their consequences have been the leading causes of death among prisoners. Meta-analyses suggest that the main risk factors are current suicidal ideation, the presence of a mental disorder, high perceived stress levels, previous suicidal attempts or self-harm, and institutional and criminogenic variables. Empirical evidence is consistent with the integrated motivational-volitional model of suicidality, which also emphasizes the role of impulsivity in suicidal behaviour. The main objectives of our research are: (a) factor analysis of the Barratt Impulsiveness Scale-Brief-8 (BIS-R-8); (b) examination of the mental health status of prisoners, and the suicidal risk factors in our sample; (c) modeling the effect of mindfulness skills on the main risk factors. METHODS: In our cross-sectional survey, we matched a sample of inmates to a convenience sample according to gender and age (N=378). Based on our hypotheses, we examined the factor structure and reliability of the BIS-R-8. An independent sample t-test was used for comparison, and a two-step linear regression and mediation modeling were used to examine the risk of suicide. RESULTS: Based on factor analysis, the BIS-R-8 can be used as a unidimensional scale. A two-factor structure with cognitive and behavioral impulsivity subscales has also been confirmed. However, the internal and external reliability of the one-factor structure proved to be better. Depression, hopelessness, perceived stress and impulsivity turned out to be of higher level in the prisoner sample; lower levels of coping skills, self-esteem, mindfulness skills and well-being were also confirmed. Depression and perceived stress level seems to be the main modifiable risk factors for suicidal thoughts in the total and prisoner's sample. Previous suicide attempts and non-suicidal self-harm are the main unmodifiable risk factors of suicidal thoughts. Low level of mindfulness skills directly and indirectly via perceived stress explains 50% of the heterogeneity in depression. DISCUSSION: In correctional institutions BIS-8-R can be a suitable screening tool for measuring impulsivity as a suicide risk factor. Mindfulness-based interventions seem promising for improving the mental health status of prisoners and reducing the risk of suicide.

A transdiagnostic model of low self-esteem: pathway analysis in a heterogeneous clinical sample.

BACKGROUND: Low self-esteem (LSE) has been associated with several psychiatric disorders, and is presumably influenced by transdiagnostic factors. Our study was based both on investigations of the relationship between depression and LSE (vulnerability, scar, reciprocal models) and on theories of cognitive factors contributing to the development and maintenance of LSE, such as Melanie Fennell's model, the catalyst model and the Self-Regulatory Executive Function model. AIMS: Based on the theories above, in our cross-sectional study we aimed at understanding more specifically the transdiagnostic factors that can maintain LSE in a heterogeneous clinical sample. METHOD: Six hundred and eleven out-patients were assessed by SCID-I and self-report questionnaires. The model was tested by structural equation modelling. RESULTS: Based on the fit indices, the hypothesis model did not fit the data; therefore, a modified transdiagnostic model was emerged. This model made a good fit to the data [χ2 (12, n=611)=76.471, p<.001; RMSEA=.080, CFI=.950, TLI=.913] with a strong explanatory power (adj R2=.636). Severe stressful life events and depressive symptoms lead to LSE indirectly. Self-blame, perfectionism, seeking love and hopelessness have been identified as mediating factors in the relationship between depressive symptoms and LSE. Although there was a significant correlation between state-anxiety and LSE, as well as LSE and rumination, these two factors did not fit into the model. CONCLUSIONS: The new transdiagnostic model of LSE has great potential in the treatment of various mental conditions and may serve as a guide to developing more focused and more effective therapeutic interventions.

[The role of socialisation in psychosexual development].

INTRODUCTION: In the recent research and interpretation of the genetical-biological and environmental-social factors shaping psychosexual development, in addition to scientific arguments, more and more ideological and political aspect have received unfortunate emphasis. OBJECTIVE: Since the literature investigating the development of gender identity and gender orientation has not only increased, but also polarized, it is timely to look at the scientific exchange of ideas and debates among the differing positions. METHOD: Exploring the significance of genetic, biological and social factors involved in the development of gender identity and gender orientation based on international literature data. RESULTS: Based on the current state of science it can be concluded that, in addition to the indisputably marked genetic-biological factors, education and social patterns, as well as the extremely complex environmental and media-related influence with its variable intensity and diverse emotional content also play a significant role in the psychosexual development. This is supported, among other observations, by the data indicating that homoerotic behavior is more common in people raised by same-sex couples. CONCLUSION: As psychosexual development is determined jointly by both genetic-biological and social factors (like education, media etc), belonging to a sexual minority group is not a choice, not the result of a personal decision. Therefore, any kind of discrimination in this regard is unacceptable. Further scientific studies are necessary to answer a large number of questions that still remain open.

[Suicide prevention contract: a possibility for reducing the risk of suicidality in outpatient psychoterapy care].

The prevention of suicide and self-harm are of particular importance in psychiatric practice handling ade - quate diagnostic procedures. Despite its decreasing tendency, suicide risk is still a serious problem facing our health care system. From the second half of the 20th century, verbal or written agreements that were intended to forestall sui - ci dal behavior became part of suicide prevention protocol. Today, we refer to them as "suicide prevention contracts" or "no-suicide contracts". Despite the fact that these agreements are becoming more and more common in medical care, there is still no general agreement among health care providers on the indication, form or other aspects of these con - tracts. However, contracting in these situations requires delicate discretion. At the outpatient psychotherapy service of the Clinical Psychology Department, Semmelweis University we have been using this tool in the last 20 years in the management of patients in suicidal crisis. In this article the establishment of contracts in clinical use and its indica - tions are described as well as some special issues like suicidality in adolescence. We also discuss the presumed positive effects of contracting, and demonstrate the use of no-suicide contracts in clinical practice by presenting selected cases.

[Focused Cognitive Therapy: A New Possibility for the Treatment of Depression].

In this literature review the new trends of cognitive behavioural therapy (CBT), namely behavioural activation and rumination-focused cognitive behavioural therapy are introduced as new methods for the treatment of major depression. Component-analytical studies of CBT showed that besides cognitive restructuring, behavioural components play an important role as active treatment factors. Behavioural activation and rumination-focused CBT emphasize these processes. The central idea of behavioural activation is that negative experiences in depression result in secondary avoidant behaviour. Clients participating in such therapy learn to recognize and change avoidant behaviour. Rumination-focused CBT target repetitive negative thoughts that are considered a transdiagnostic maladaptive phenomenon. These conceptual and methodological can contribute substantially to the effectiveness of CBT for major depression.

Gender differences in the relationship of childhood trauma and the course of illness in schizophrenia.

INTRODUCTION: Different types of childhood trauma have been repeatedly shown to contribute to psychotic symptoms. Gender differences in schizophrenia are well known. Some studies argue that trauma history means a significantly higher risk of psychosis for women than men. However, there is evidence of early adverse life events to be associated with higher stress-sensitivity in men. Little is known about the connection of specific type of trauma and specific psychotic symptoms as well as the course of illness with explicit regard to gender differences. METHODS: 102 men and women with schizophrenia spectrum disorder were tested using Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Scale for Assessing Positive Symptoms, Early Trauma Inventory-SR. RESULTS: Although, women had a later age at onset without regarding trauma history (d = 0.74), this difference became non-significant when introducing trauma variables. Patients reporting physical abuse had a significantly earlier age at onset, regardless of their sex (V = 0.13, F = 3.11, p = 0.03. Physical abuse predicted an earlier age at onset only in women (R2 = 0.23). History of general trauma predicted more frequent hospitalizations only in men (R2 = 0.55). CONCLUSIONS: Although women generally tend to have a more favorable course of illness including a later age at onset men, women with CPA seem to lose this "advantage". It is necessary to investigate the contribution of gender interacting with adverse life events in contribution to the phenomenology and etiology of schizophrenia.

[Low-intensity, evidence-based cognitive-behavioural therapy of a patient with Crohn's disease]. / Az alacsony intenzitású, bizonyítottan hatékony kognitív viselkedésterápia Crohn-betegségben.

Inflammatory bowel disease (Crohn's disease and colitis ulcerosa) is a chronic, long-term condition that causes chronic inflammation in the digestive tract, and shows an increasing incidence and prevalence worldwide. Changes in disease activity over time affect psychological distress which increases the risk of exacerbations. Beside somatic symptoms (such as abdominal pain, diarrhoea and weight loss), psychiatric comorbidity (in particular major depression, anxiety, social phobia) is common in patients with Crohn's disease. This case study illustrates the management and stabilization of a 21-year-old adult male patient with active Crohn's disease and with severe psychiatric comorbidity. The patient was diagnosed with avoidant personality disorder and dysruptive mood dysregulation disorder based on the results of psychodiagnostics (SCID-II structured clinical interview, MMPI personality inventory and disease-specific clinical questionnaires such as Beck Depression Inventory, Beck Hopelessness Scale, Social Cognition Questionnaire, Anger Expression Scale, Cognitive Emotion Regulation Questionnaire, Rosenberg Self-Esteem Scale). The main aim of psychotherapy is to increase the adherence to pharmacotherapy, to promote psychosocial functioning, to improve well-being and to enhance adaptive coping strategies. Low-intensity cognitive-behavioural psychotherapy was used which included psychoeducation, motivational interview, behavioural activation, patient diary, cognitive restructuring, problem-solving training, and family consulting. Twenty-five sessions were held weekly in outpatient form and 3 sessions of crisis intervention after the surgery at the hospital. The efficacy of the treatment was measured by self-reported questionnaires at baseline and at two follow-up sessions which corroborated a very significant decrease in the severity of depression, hopelessness, while emotional regulation and self-esteem became more adaptive. The remission of the above-mentioned psychiatric symptoms resulted in the improvement of the pharmacotherapy adherence and the quality of life. Low-intensity psychosocial interventions are proven to be an effective way of delivering evidence-based psychotherapy. Orv Hetil. 2018; 159(9): 363-369.

[Social anxiety and self-esteem: Hungarian validation of the "Brief Fear of Negative Evaluation Scale - Straightforward Items"]. / Szociális szorongás és önértékelés: a "Félelem a negatív megítéléstol" (FÉLNE) kérdoív hazai adaptációja.

INTRODUCTION: Although social anxiety disorder (SAD) is the third most frequent emotional disorder with 13-15% prevalence rate, it remains unrecognized very often. Social phobia is associated with low self-esteem, high self-criticism and fear of negative evaluation by others. It shows high comorbidity with depression, alcoholism, drug addiction and eating disorders. AIM: To adapt the widely used "Fear of Negative Evaluation" (FNE) social phobia questionnaire. METHOD: Anxiety and mood disorder patients (n = 255) completed the Fear of Negative Evaluation Scale (30, 12 and 8 item-versions) as well as social cognition, anxiety and self-esteem questionnaires. RESULTS: All the three versions of the FNE have strong internal validity (α>0.83) and moderate significant correlation with low self-esteem, negative social cognitions and anxiety. The short 8-item BFNE-S has the strongest disciminative value in differentiating patients with social phobia and with other emotional disorders. CONCLUSIONS: The Hungarian version of the BFNE-S is an effective tool for the quick recognition of social phobia. Orv Hetil. 2017; 158(22): 843-850.

[Recognition, care and prevention of suicidal behaviour in adults].

Suicide is a major public health problem everywhere in the world and in the WHO European Region suicide accounts for over 120,000 deaths per year. 1. Recognition and diagnosis: An underlying psychiatric disorder is present in up to 90% of people who completed suicide. Comorbidity with depression, anxiety, substance abuse and personality disorders is high. In order to achieve successful prevention of suicidality, adequate diagnostic procedures and appropriate treatment for the underlying disorder are essential. 2. Treatment and care: Acute intervention should start immediately in order to keep the patient alive. Existing evidence supports the efficacy of pharmacological treatment and cognitive behavioural therapy (including dialectical behavior therapy and problem-solving therapy) in preventing suicidal behaviour. Some other psychological treatments are promising, but the supporting evidence is currently insufficient. Studies show that antidepressant and mood stabilizer treatments decrease the risk for suicidality among responders in mood disorder patients. However, the risk of suicidal behaviour in depressed patients treated with antidepressants exists during the first 10-14 days of treatment, which requires careful monitoring. Short-term supplementary medication with anxiolytics and hypnotics in the case of anxiety and insomnia is recommended. Treatment with antidepressants of children and adolescents should only be given under supervision of a specialist. Long-term treatment with lithium has been shown to be very effective in preventing both suicide and attempted suicide in patients with unipolar and bipolar depression. Treatment with clozapine is effective in reducing suicidal behaviour in patients with schizophrenia. Other atypical antipsychotics are promising but more evidence is required. 3. Family and social support: The suicidal person should always be motivated to involve family in the treatment. Psychosocial treatment and support is recommended, as the majority of suicidal patients have problems with relationships, work, school and lack functioning social networks. 4. SAFETY: A secure home, public and hospital environment, without access to suicidal means is a necessary strategy in suicide prevention. Each treatment option, prescription of medication and discharge of the patient from hospital should be carefully evaluated against the involved risks. 5. Education of treatment team: Training of general practitioners is effective in the prevention of suicide. It improves treatment of depression and anxiety, quality of the provided care and attitudes towards suicide. Continuous training including discussions about ethical and legal issues is necessary for psychiatrists and other mental health professionals. Multidisciplinary treatment teams including psychiatrist and other professionals such as psychologist, social worker, and occupational therapist are always preferable, as integration of pharmacological, psychological and social rehabilitation is recommended especially for patients with chronic suicidality. 6. Public aspects: Not only the health care workers are responsible for suicide prevention. All members of our society (including community/political leaders as well as religious and civil organizations) have their own task with more or less competence and responsibility.

[Outcome of a one-year behavior therapy weight loss program]. / A viselkedésterápia eredményeinek vizsgálata az elhízás kezelésében egy év távlatában.

INTRODUCTION: Treatment of obesity has become one of the most challenging issues. AIM: The aims of the authors were to present the results of standard behavior therapy weight loss program combined with self-help and the results of one-year follow-up. METHOD: The 24-week program involved 41 participants of which 33 subjects participated in the follow-up. Anthropometric data were obtained and the participants were asked to fill questionnaires (the 21 items Three Factor Eating Questionnair Revised 21 items; Physical Exercise: Steps of change [Short Form]. RESULTS: 87.8% of participants achieved a minimum weight loss of 5% which is the rate expected in professional therapies for obesity. Significant changes in maladaptive eating pattern and an increase in the rate of regular exercise were observed. Significant association was found between the increase of cognitive restraint and the rate of weight loss during treatment. At one-year follow-up the majority of participants (75.8%) did keep their minimum weight loss of 5% and they showed significant change in eating pattern. CONCLUSIONS: The results suggest that standard behavior therapy extended with self-help elements may be a cost-effective treatment of obesity.

The relevance of traumatic life events in schizophrenia spectrum disorders.

The central goal of this manuscript was to review literature about the interconnections of traumatic life events and symptoms of schizophrenia spectrum of the last 15 years. First of all, the stress-diathesis model and the traumagenic neurodevelopmental model are shortly presented. Psychological effects of traumas and specific psychotic symptoms in connection with traumatic events are discussed. The course of the disease in patients affected by previous traumas and possible mediating factors are also addressed. Studies of both clinical and community samples are cited. It was also our aim to review literature about the neurobiological and neurocognitive processes in people affected by schizophrenia and/or traumatic life events. The role of prefrontal and medial temporal regions are explored with a special emphasis on contextual memory and hippocampal functioning. Finally, the possible effects of exploring traumatic life events on the treatment of schizophrenia are discussed.

[From life events to symptoms of anxiety and depression: the role of dysfunctional attitudes and coping]. / Az életeseményektol a depressziós és szorongásos panaszokig: a diszfunkcionális attitudök és a megküzdés szerepe a patogenezis folyamatában.

UNLABELLED: The aim of the present study was a systematic path-analytical investigation between the effects of life events, dysfunctional attitudes and coping strategies in relation with the exhibited depressive and anxiety symptoms in patients with mental disorders. METHODS: Self-report data of 234 patients from our outpatient psychotherapy unit were analyzed. Life events, dysfunctional attitudes, coping strategies as well as symptoms of anxiety and depression were assessed by self-administerd questionnaires. Statistical methods included structural equation modelling, which enables the estimation of the magnitude and strength of individual variables within an overarching casual model, thus yielding a complex view on the possible processes underlying the development of the clinical symptoms of anxiety and depression. RESULTS: Our findings indicate that both the number of negative life events and their subjectively experienced intensity contributed to the increase of dysfunctional attitudes. The presence of dysfunctional attitudes decreased the use of problem-focused coping strategies and increased the use of emotion-focused coping strategies. The use of problem-focused coping decreased symptom occurrence and emotion-focused coping strategies increased the frequency of symptoms of anxiety and depression. Our findings suggest that dysfunctional need for achievement and perfectionism directly increase the probability of depressive symptom manifestation. The attitude of external locus of control showed a significant relationship with anxiety symptoms through emotion-focused coping strategies and directly as well. CONCLUSION: Restructuring dysfunctional attitudes and developing problem-focused coping strategies are an important part of psychotherapeutic interventions aiming to decrease anxiety and depressive symptoms.

Cognitive emotion regulation strategies moderate the effect of parenting self-efficacy beliefs on parents' anxiety following their child's surgery.

OBJECTIVE: To explore the role of cognitive emotion regulation (CER) in the association between parenting self-efficacy (PSE) and state anxiety in parents of children undergoing surgery. METHOD: In a prospective design, parents of 114 children admitted to hospital for planned surgical interventions completed self-report questionnaires assessing PSE, CER, and state anxiety. Mediational and moderational analyses were conducted to test competing theoretical models regarding the role of CER in the relationship between PSE and parents' anxiety. RESULTS: The mediational model was rejected, whereas the findings supported a moderational model. The use of nonadaptive CER moderated the effect of PSE on parents' anxiety. Higher PSE only predicted lower postsurgery anxiety when low use of nonadaptive CER was present. CONCLUSIONS: Interacting cognitive factors contribute to parents' anxiety after a child's surgery. Both PSE and CER should be targeted in parent interventions promoting successful adjustments to surgery on children.

Proposal for a short version of the Beck Hopelessness Scale based on a national representative survey in Hungary.

In our study we assessed the frequency of reported hopelessness and suicide attempts in the national representative survey Hungarostudy 2002. The randomly selected sample consisted of 14,000 individuals over the age of 18. We created a short version of the widely used Beck Hopelessness Scale for screening purposes in suicide prevention. The short version of the BHS consists of four items and has high internal consistency (Cronbach's alpha = 0.85). Moreover, we conducted an investigation into psychological, somatic, sociological and socio-economic as well as cultural variables that show a positive or negative correlation with hopelessness and important predictors of suicide. The following psychological variables showing a positive correlation with hopelessness were identified: dysfunctional attitudes, exhaustion, psychological distress, hostility, lack of life goals and inability to cope emotionally. Sense of coherence, social support, perceived self-efficiency, subjective well-being and problem-solving coping showed a negative correlation with hopelessness. Concerning the relationship between hopelessness and suicide attempts, we found that participants who attempted suicide in the last year scored higher (mean = 4.86) than participants who attempted suicide more than 3 years ago (mean = 3.57). These results indicate that applying the short version of the BHS could be very useful in general practice and in psychiatric care.

[Coping with work-related stress in health care professionals -- strategies for the prevention of burnout and depression]. / A munkahelyi stresszel való megküzdés egészségügyi szakdolgozók körében -- lehetoségek a kiégés és depresszió megelozésének szolgálatában.

BACKGROUND: The prevalence of depression and burnout among health care professionals is high in Hungary. However, there is limited empirical data on disease prevention among these populations. AIMS: This study aims at evaluating the mediating role of coping mechanisms in preventing depression and burnout. METHODS: Cross-sectional survey among 1333 health care professionals. Participants completed self-administered questionnaires about their perception of work stress, burnout and depressive symptoms, as well as their preferred coping strategies. Analyses were performed using structural equation modelling. RESULTS: The prevalence of severe depression and lack of personal accomplishment was 5.6% and nearly 50%, respectively. Work stress predicted symptoms of burnout and depression both directly and indirectly through the mediation by coping strategies. Of the coping strategies, cognitive restructuring, which accentuates the realistic assessment of challenging situations, was found to reduce the probability of the development of burnout and depression symptoms. CONCLUSIONS: This study provides further data for the development of cognitive interventional strategies and highlights the significance of these strategies in the prevention of depression and burnout among Hungarian health care professionals.

[Posttraumatic stress symptoms, dysfunctional attitudes and ways of coping in a clinical sample of PTSD patients]. / Poszttraumás stressztünetek, diszfunkcionalis attitudök és megküzdési módok -- egy klinikai minta explorativ vizsgálata.

INTRODUCTION: In the present study specific characteristics of PTSD patients were explored in a clinical sample with particular regard to dysfunctional attitudes and coping strategies. The purpose was to draw attention to this rarely investigated but presumably prevalent psychiatric disorder in the Hungarian population. METHOD: Twenty-two PTSD patients' retrospective data was analyzed who presented at our clinic for outpatient psychotherapy treatment. Patients were assessed on depressive, anxiety, hopelessness, and posttraumatic stress symptoms, as well as dysfunctional attitudes and coping strategies. RESULTS: Thirty-two percent (n=7) of the sample is male and 68% (n=15) is female, the mean age is 34.77 years. Based on trauma type 40.9% (n=9) had a motor vehicle accident, 18.2% (n=4) lost a close relative, 18.2% (n=4) was a victim of sexual or physical assault. There is great variance in the duration since the trauma (2 months to 10 years). The results suggest that posttraumatic stress symptoms (PTSSs) are associated with the dysfunctional attitudes of need for achievement and external control, and with avoidant and conforming coping styles. Additionally, PTSSs were highly comorbid with depressive and anxiety symptoms. CONCLUSION: The results imply that PTSD patients in Hungary have similar characteristics as international findings indicate.

[Clinical picture and differential diagnosis of depression in old age]. / A depresszió klinikai képe és differenciáldiagnosztikája idoskorban.

Depression in old age is often underdiagnosed, although it is the leading mental health problem at this age. The significance of assessment and adequate treatment of depression among elderly patients cannot be overstated, since it significantly impairs the quality of life, increases morbidity and mortality in many of the chronic disease groups. In addition, it is a primary risk factor in completed suicide, which occurs up to three times more often among elderly than in other age groups. In our non-systematic (narrative) summary study, we briefly review the clinical picture and differential diagnosis of depression in elderly patients, as well as the main aspects of screening and treatment. The clinical characteristics and the pathology of the disease at this age raise a number of methodological questions that could be the subject of further empirical studies. Orv Hetil. 2023; 164(39): 1537-1543.

[Intensive cognitive behavioral group therapy for the treatment of panic disorder]. / Intenzív kognitív viselkedésterápiás csoport pánikbetegség kezelésére.

INTRODUCTION: Panic disorder is one of the most commonly occurring emotional disorder, showing increased prevalence rates since the COVID-19 pandemic. The ever-growing number of patients in need of treatment is a heavy burden on the healthcare system, which draws attention to the importance of low-intensity, short and effective psychological interventions in the treatment of mental disorders, especially in the field of primary care. According to international guidelines, the recommended evidence-based treatment of panic disorder is cognitive behavioral therapy, which is based on the cognitive model of panic disorder. According to the model, a panic attack develops in those who catastrophize the symptoms of the normal stress reaction, i.e., consider them a sign of a serious physical illness such as heart-attack and react to this with intense anxiety. OBJECTIVE: Based on Salkovskis and Clark (1986), we developed a 5 session, intensive cognitive behavioral group therapy protocol for panic patients. METHOD: Effectiveness of the short group therapy was assessed with questionnaires (Spielberger's State-Trait Anxiety Inventory, Beck Depression Inventory) and an additional subjective scale. Paired sample t-tests were conducted. RESULTS: Our results suggest that the intensity of anxiety and depressive symptoms (t(36) = 5.497, p<0.0001; Z = -4.871, p<0.0001) as well as the frequency of panic attacks (Z= -5.190, p<0.0001) decreased significantly after the 5 session group therapy. DISCUSSION AND CONCLUSION: Our clinical study provides further evidence by the effectiveness of low-intensity psychological interventions, offering an evidence-based protocol for professionals working in primary as well as mental health care. Orv Hetil. 2023; 164(42): 1665-1672.

The role of stigma and depression in the reduced adherence among young breast cancer patients in Hungary.

BACKGROUND: The main aim of our study was to investigate the role of depression, stigmatization, body shame and self-compassion in the adherence of young Hungarian breast cancer patients aged between 18 and 45 years. METHODS: In a cross-sectional online survey, data were collected from 99 young breast cancer patients (BC). Participants completed self-report questionnaires on socio-demographic and cancer-specific parameters as well as psychological factors (adherence: 12-item Medication Adherence Scale; depression: Hospital Anxiety and Depression Scale; stigmatization: Stigma Scale for Chronic Illnesses; body shame: Experience of Shame Scale; self-compassion: Self-Compassion Scale). We tested the predictors and mediators of adherence using hierarchical regression, mediation and moderation analysis among BC patients. RESULTS: We found that adherence was significantly associated with body shame and stigmatization in our BC sample. In addition, stigmatization alone was a significant predictor of lower adherence. Finally, in mediation models, where body shame was a mediator, we found a significant direct effect between stigma and adherence, in other words body shame had a significant mediating effect between these variables. According to our moderation analysis, self-compassion as a significant moderator acts as a protective factor in the linear relationship between stigma and lower adherence. CONCLUSIONS: Our results highlight the importance of stigma and body shame in the development of adherence in oncological care among young Hungarian BC patients aged between 18 and 45 years. Assessment of stigma, body shame, self-compassion, and the improvement of the availability of evidence-based psychological interventions may increase the adherence of young Hungarian BC patients, leading to more favourable rates of survival.