Physical exercise through mountain hiking in high-risk suicide patients. A randomized crossover trial.

OBJECTIVE: The following crossover pilot study attempts to prove the effects of endurance training through mountain hiking in high-risk suicide patients. METHOD: Participants (n = 20) having attempted suicide at least once and clinically diagnosed with hopelessness were randomly distributed among two groups. Group 1 (n = 10) began with a 9-week hiking phase followed by a 9-week control phase. Group 2 (n = 10) worked vice versa. Assessments included the Beck Hopelessness Scale (BHS), Beck Depression Inventory (BDI), Beck Scale of Suicide Ideation (BSI), and maximum physical endurance. RESULTS: Ten participants of Group 1 and seven participants of Group 2 completed the study. A comparison between conditions showed that, in the hiking phase, there was a significant decrease in hopelessness (P < 0.0001, d = -1.4) and depression (P < 0.0001, d = -1.38), and a significant increase in physical endurance (P < 0.0001, d = 1.0), but no significant effect for suicide ideation (P = 0.25, d = -0.29). However, within the hiking phase, there was a significant decrease in suicide ideation (P = 0.005, d = -0.79). CONCLUSION: The results suggest that a group experience of regular monitored mountain hiking, organized as an add-on therapy to usual care, is associated with an improvement of hopelessness, depression, and suicide ideation in patients suffering from high-level suicide risk.

Coordination dynamics of circulatory and respiratory rhythms during psychomotor drive reduction.

A 0.15-Hz rhythm band in cutaneous blood oscillations in awake human subjects was studied in cardiovascular-respiratory time series of five subjects relaxing naïvely or practicing hypnoid relaxation (autogenic training, or AT). Time series analysis used nonlinear algorithms, time-frequency distribution (TFD), postevent scan (PES) method, and linear fast Fourier transform (FFT) algorithm. This 0.15-Hz rhythm band caused phase synchronization with respiration at 1:2, 1:1, and 2:1 integer number (n/m) ratios for extended periods. During wave epochs, the 0.15-Hz rhythm band was amplified, causing the 0.15-Hz rhythm band to also appear in interbeat intervals and arterial blood pressure fluctuations. If phase synchronization of the 0.15-Hz rhythm band with respiration was established at a 1:1 integer number ratio, it was maintained and resulted in consensualization of all cardiovascular-respiratory oscillations at this frequency. Simultaneous cardiovascular and respiratory oscillations at about 0.1 Hz did not affect the appearance of the 0.15-Hz rhythm band in the photoplethysmography (PPG) signal. Recent evidence suggests the emergence of the 0.15-Hz rhythm band and n/m phase synchronization to result from nonequilibrium phase transitions operational in the network of lower brainstem neurons and associated parasympathetic neuronal effectors. These findings corroborate our notion of the 0.15-Hz rhythm band as a marker of the trophotropic mode of operation.

[Segments of the recovery story of a patient with anorexia nervosa from the viewpoint of self-organization theory]. / Ausschnitte aus der Genesungsgeschichte einer Patientin mit Anorexia nervosa aus Sicht der Selbstorganisationstheorie.

In order to examine the dynamics of anorectic processes we interviewed a 16-year-old girl which had recently recovered from her illness. She portrayed her experiences for a time span of 22 months from the beginning of her self-starvation until the date of the interview. After clustering all informations into variables she rated the degree of these variables for 11 important events during the time of her recovery. Synergies between cognition, emotion and behaviour during recovery are displayed. Activated feedback dynamics (positive, negative, and mixed feedback-loops) give rise of the interpretation of recovery from anorexia nervosa as a dynamic, self-organizing system. Nonlinear dynamics are salient in psychological change even if we are adopting a qualitative view on the phenomena.

[Is systemic psychotherapy research possible?]. / Ist eine systemische Psychotherapieforschung möglich?

With the growing importance of systemic therapies the interest in quality evaluation, at the one hand, and in a deeper understanding of therapy processes, at the other, becomes more and more important. Therefore the question is raising how to do psychotherapy research for systemic therapies in an adequate manner. Some possibilities will be discussed. As we will see, the existing field of process research offers a lot of theoretical conceptualizations and methodological tools for the understanding of dynamical patterns in psychotherapy. An example for the single case microanalysis of client-therapist-interaction in a solution-oriented brief therapy illustrates one of several different ways in system-oriented psychotherapy research.

[Research in county and district psychiatric hospitals]. / Forschung in psychiatrischen Landes- und Bezirkskrankenhäusern.

Scientific research in psychiatric county-hospitals could substantially contribute to the further development of the psychosocial practice. Although the hospitals in principle are open to scientific activities, a genuin integration of research into these institutiones has not yet come about. The study then goes on to discuss perspectives for research, methodological issues and advances organizational proposals regarding the overcoming of these obstacles.

[Patterns of Change--Transitions between "States of Mind" in a solution oriented brief therapy]. / Psychotherapie als Veränderung von Ubergangsmustern zwischen "States of Mind" - Einzelfallanalyse einer systemisch-ressourcenorientierten Kurzzeittherapie -

The concept of "states of mind" (configurational analysis by M. J. Horowitz) allows for a comprehensive phenomenological description of psychotherapy processes. The method is exemplified by a single case analysis of a 13-session solution oriented therapy. Some of the representative state-transitions and state-cycles are described. Additionally, the states-of-mind-approach is integrated into concepts of self-organization and pattern transitions in complex dynamic systems. States of mind can be defined as attractors of closely interconnected physiological, mental, and social processes. In this sense, psychotherapy would lead to changes in attractor constellations which represent important aspects of personality.

[With problem of applying modern systems theories in clinical practice]. / Das Problem der Nutzung moderner Systemtheorien in der klinischen Praxis.

In this paper the tension between "practice" and "theory" is reflected concerning modern system theories and psychosocial practice. Focusing the limits of predictability and manageability these theories contrast with practitioners need for easy-to-use advices for acting. Reframing the well-known dilemma of the discrepancy between theory and practice the usefulness of the difference between theory and practice is accentuated. Others reflected these topic in more fundamental or philosophical way (cf. Krohn & Küppers 1990; Schiepek 1991; Schiepek, Fricke & Kaimer 1992; Willke 1989). In a more "pragmatic turn" attention is drawn to some methods of orientation and intervention in complex systems. System game and system competence are new ways in training and evaluating the management of complex systems.

[Analysis of the activity and effectiveness of lay persons as therapists in a psychiatric rehabilitation project]. / Tätigkeitsanalyse und Effektivität von Laien als Therapeuten in einem psychiatrischen Rehabilitationsprojekt.

A wealth of research indicates equal or even superior psychotherapeutic effects of lay-persons in comparison to professional therapists. Detailed analysis of process and effects however is needed. Results of the first period (4 months) of a longer controlled psychiatric therapy and rehabilitation project are presented. One out of four groups was run by psychiatrically unexperienced lay therapists. Objective behavior and subjective experiences as well of therapists as of patients were assessed by means of continuous observation, rating- and attitude-scales, sociographical methods and interviews. Results confirm the therapeutic change-potential of lay-persons and give interesting findings on the therapeutic process itselves.

[Static to sequential plan analysis]. / Von der statischen zur Sequentiellen Plananalyse.

The method of Plan Analysis helps for a better understanding of the interactional engagement of the client within the client-therapist relationship. In spite of this interactional conceptualization of the method, plan analysis produces only a statical diagnosis of interpersonal intentions and plans. In order to realize a dynamical analysis of the client-therapist relationship, the method has to be modified. The steps of this modification will be explained. The result is an idiographic, discovery oriented strategy, called "Sequential Plan Analysis" (SPA), which can be used to do single case analysis of psychotherapy processes. SPA produces sequential patterns of interactional plans (nominal data) as well as quantitative time series.