A Suicide Attempt Multicomponent Intervention Treatment (SAMIT Program): study protocol for a multicentric randomised controlled trial.

BACKGROUND: Suicide has become a first-order public health concern, especially following the negative impact of COVID-19 on the mental health of the general population. Few studies have analysed the effects of early psychotherapeutic interventions on subjects who have attempted suicide, and even fewer have focused on those hospitalized in non-psychiatric units after a Medically Serious Suicide Attempt (MSSA). The main aim of this study is to describe the protocol designed to evaluate the effectiveness of individual psychological treatment for patients hospitalized after an MSSA. The secondary objectives of the study are: (1) to evaluate the impact on quality of life and other psychosocial variables of patients with a recent MSSA who receive early psychological intervention; (2) to analyse the biological, psychological, and clinical impact of early psychotherapeutic treatment on subjects hospitalized after an MSSA. METHODS: A longitudinal randomised controlled trial will be conducted with patients over 16 years of age admitted to two general hospitals. The case intervention group will enrol for 8-sessions of individual psychotherapy, Suicide Attempts Multi-component Intervention Treatment (SAMIT), combining Dialectical Behaviour Therapy (DBT), Mentalization-Based Therapy (MBT), and Narrative approaches, while the control group will receive a treatment-as-usual intervention (TAU). Longitudinal assessment will be conducted at baseline (before treatment), post-treatment, and 3, 6, and 12 months after. The main outcome variable will be re-attempting suicide during follow-up. DISCUSSION: Some psychotherapeutic interventions, usually implemented in outpatient, have proven to be effective in preventing suicidal behaviours. The combination of some of these may be a powerful treatment for preventing future SA in patients hospitalised after an MSSA, which is the most severely suicidal subgroup. Moreover, assessment of the biological, clinical and psychometric impact of this new intervention on patients during the first year after the attempt may help understand some of the multi-level factors associated with the effectiveness of psychotherapeutic interventions in MSSAs. The prevalence of high suicide rates requires the design of effective psychological interventions for their prevention, and also in order to design new pharmacological and psychological treatments. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT06238414. Date of registration: 1st February 2024, final update is protocol version 3.0, 19th March 2024.

Narrative therapy and family therapy in genetic counseling: A scoping review.

Genetic counseling facilitates psychological and social adaptation in clients and families. Two psychotherapeutic approaches, narrative and family therapy foster client adaptation to adverse situations and may enhance the genetic counseling process. This scoping review aimed to describe the applications of narrative therapy and family therapy in genetic counseling, and to document the actual and perceived value of these approaches in a genetic counseling setting. Nine original research articles and six commentary articles met the study inclusion criteria. Original articles reported on positive client attitudes when these approaches were applied to hereditary cancer and Huntington disease settings. Five studies applied either approach in group sessions, where safety was key to positive outcomes, including sharing lived experiences and coping strategies. Balanced utilization of structured and open elements in group sessions maximized a sense of control, while also allowing for opportunity to self-disclose. Narrative therapy interventions were time efficient and were reported to foster connection with others and shape a new adaptive narrative centered around strengths. Family therapy approaches, based on experiential family therapy, the intersystem model, object relations family therapy, and the social ecology model, required a greater time commitment, but promoted disclosure of complex feelings and diffused tension. Family therapy genogram tools were feasible in practice, easy to implement, and effective at identifying communication barriers. Commentary articles highlighted the alignment of both approaches with genetic counseling goals and their potential value in practice. Utilization of psychotherapeutic approaches can improve counselors' ability to shape sessions, enhance insight and optimize efficacy, and flexibility in moving between models can maximize impact. This review highlights the paucity of studies investigating the efficacy of these psychotherapeutic approaches in the genetic counseling context and the need for more outcomes-based research on the utilization of narrative or family therapy in genetic counseling practice.

[Psychotherapeutic approaches to crises]. / Psychotherapeutischer Umgang mit Krisen.

BACKGROUND: Psychotherapeutic interventions play a crucial role in alleviating psychological distress and promoting resilience during personal and global crises. OBJECTIVE: What general principles are relevant for psychotherapeutic crisis interventions in acute psychiatry? What contributes to an in-depth understanding of individual reactions to the course of crises? When do global crises translate into personal crises? How can global crises be integrated into the psychotherapeutic process? MATERIAL AND METHODS: Selected results from the scientific literature on psychiatric psychotherapeutic crisis interventions in acute psychiatry are reviewed and summarized. RESULTS: Although the evidence for specific crisis intervention strategies in acute psychiatry is limited, general principles for psychotherapeutic crisis interventions can be derived. CONCLUSION: Understanding early relational experiences based on psychodynamic or learning theory processes influences the application of further crisis intervention techniques and their impact on affected individuals.

[Rationale, models, and impact of workplace-based psychotherapeutic services]. / Rationale, Modelle und Wirkung arbeitsplatznaher psychotherapeutischer Angebote.

Mental illnesses and behavioral disorders are very common among the working population, affecting up to a third of employees each year, and are associated with great suffering, the risk of chronicity, and the loss of employment. Economically, mental illnesses cause high costs. In order to mitigate these consequences and increase the chances of recovery, rapid diagnosis, early and appropriate treatment where necessary, and-over and above the usual psychotherapy approach-attention to the work-related causes are of crucial importance.Psychotherapeutic Consultation at the Workplace (PT-A) attempts to meet these requirements. It offers psychotherapeutic help at short notice and close to the workplace for employees suffering from mental stress; provides (depending on the problem) counseling, diagnostics, prevention, and short-term or bridging therapy; and supports reintegration after a longer period of mental illness. It is helpful to cooperate closely with the company medical service, which consults the PT­A, refers employees to it, provides information on the company situation, and can support reintegration if necessary. Funding is often provided by the company but can also be provided by health insurance companies in integrated care models.This article begins by describing the history and principles of PT­A and the role of work stress in the development of psychological and psychosomatic disorders. The implementation of PT­A is then outlined using two examples. Finally, the current study "Early Intervention at the Workplace" ("Frühe Intervention am Arbeitsplatz" [friaa]), to which several articles in this special issue refer, is briefly presented.

Psychotherapeutic nursing as Advanced Clinical Practice for the promotion of mental health in Spain.

OBJECTIVE: To contribute to the recognition of psychotherapeutic nursing (PTN) as a regulated advanced clinical practice (ACP) in Spain, as is the case in other countries. BACKGROUND: Nurses are continually evolving to improve overall health outcomes. PTN has become a reality, with several authors describing it as an ACP. In Spain, psychotherapy is not officially regulated, which has led to a significant number of psychiatric nurses adopting an important ACP in this area without recognition. SOURCES OF EVIDENCE: Evidence confirms that PTN possesses the attributes necessary to be considered an ACP. Nurses, like psychotherapists, independently address the complex needs of individuals and families within the context of therapeutic relationships, and there is a pressing need to advance formal processes of regulation and certification. DISCUSSION: PTN has evolved at different rates depending on local initiatives, policies and various professional interests. In Spain, it is crucial to evaluate its outcomes, recognise it as an ACP and develop training plans for its regulation and accreditation. CONCLUSIONS: Mental health nurses in Spain have a strong interest in PTN being recognised as an ACP. To this end, they should join forces with other partners, scientific associations and international bodies such as the International Council of Nurses (ICN) to make PTN an internationally recognised ACP. IMPLICATIONS FOR NURSING PRACTICE: Psychotherapeutic nurses could contribute to improving mental health outcomes, client satisfaction and health system efficiency, and their formal recognition is an opportunity to enhance their professional identity, competence and autonomy. IMPLICATIONS FOR NURSING POLICY: Nursing policy needs to be reoriented towards strengthening psychotherapy as an ACP. Synergies and alliances between international nursing associations and the ICN can promote its development and implementation, while research, education and leadership are essential to achieving official regulation and accreditation.

Effects on long-term survival of psychosocial group intervention in early-stage breast cancer: follow-up of a randomized controlled trial.

BACKGROUND: The promise of prolonged survival after psychosocial interventions has long been studied, but not convincingly demonstrated. This study aims to investigate whether a psychosocial group intervention improved long-term survival in women with early-stage breast cancer and investigate differences in baseline characteristics and survival between study participants and non-participants. METHODS: A total of 201 patients were randomized to two six-hour psychoeducation sessions and eight weekly sessions of group psychotherapy or care as usual. Additionally, 151 eligible patients declined to participate. Eligible patients were diagnosed and treated at Herlev Hospital, Denmark, and followed for vital status up to 18 years after their primary surgical treatment. Cox's proportional hazard regressions were used to estimate hazard ratios (HRs) for survival. RESULTS: The intervention did not significantly improve survival in the intervention group compared with the control group (HR, 0.68; 95% confidence interval (CI), 0.41-1.14). Participants and non-participants differed significantly in age, cancer stage, adjuvant chemotherapy, and crude survival. When adjusted, no significant survival difference between participants and non-participants remained (HR, 0.77; 95% CI, 0.53-1.11). CONCLUSIONS: We could not show improved long-term survival after the psychosocial intervention. Participants survived longer than nonparticipants, but clinical and demographic characteristics, rather than study participation, seem accountable for this difference.

Employees' preferences on organisational aspects of psychotherapeutic consultation at work by occupational area, company size, requirement levels and supervisor function - a cross-sectional study in Germany.

BACKGROUND: Common mental disorders affect a significant proportion of the population worldwide at any given time. Psychotherapeutic consultation at work offers employees with mental distress short-term and low-threshold access to psychotherapeutic treatment. However, this offer is only accepted by one to two percent of the employees to whom it is offered. Taking into account employees ' preferences regarding organisational aspects might increase the use of psychotherapeutic consultation at work. This study therefore aimed to identify preferences on organisational aspects of psychotherapeutic consultation at work among employees of diverse occupational areas, company sizes, supervisor functions and job requirement levels. METHODS: A total of 755 employees were recruited via advertisements on social media (Instagram, Facebook and LinkedIn). Participants rated on a 5-point Likert scale their agreement to different implementation options of psychotherapeutic consultation at work: type (in-person/video/telephone), location (on/outside company premises), time (within/outside working hours), scope (diagnostic/diagnostic + treatment) and purpose (private/occupational). Additionally, the maximum accepted distance to the location of consultation was assessed. Various analyses of variances (ANOVA) were conducted to determine differences in agreement to implementation options within each organisational aspect and to analyse differences between occupational areas, company sizes, requirement levels and between employees with and without supervisor function. RESULTS: Participants indicated a preference for in-person psychotherapeutic consultation that takes places outside company premises and outside working hours. Furthermore, they preferred offers including diagnostic and treatment sessions compared to offers including diagnostic sessions only. Even though participants agreed that consultation should be offered for all purposes, agreement for occupational issues was stronger than for private issues. For some implementation options, the level of agreement varied according to occupational field, company size, supervisor function and level of requirement. However, these differences did not affect the key findings mentioned above. CONCLUSION: Those findings give practical indications on the organisational design of psychotherapeutic consultation at work. The results suggest that in-person consultation outside company premises and working hours combining diagnostic and treatment sessions will be accepted by employees regardless of their occupational area, company size, supervisor function and requirement level.

LoveYourBrain Mindset: Feasibility, Acceptability, Usability, and Effectiveness of an Online Yoga, Mindfulness, and Psychoeducation Intervention for People with Traumatic Brain Injury.

OBJECTIVE: Despite the benefits of yoga, mindfulness, and psychoeducation after traumatic brain injury (TBI), no online programming exists. This study investigated the feasibility, acceptability, usability, and effectiveness of the LoveYourBrain Mindset online program for people with TBI. RESEARCH DESIGN: Pre-post, retrospective intervention. METHODS: LoveYourBrain Mindset is a six-week online yoga, mindfulness, and psychoeducation program with weekly interactive Zoom classes and prerecorded mindfulness tools. Two interactive class types (45-minute group discussion, 75-minute group discussion and gentle yoga) are offered to enhance accessibility. People were eligible if they experienced TBI, were a caregiver, or clinician; ≥15 years old; and capable of gentle exercise and group discussion. We analyzed attendance, program ratings, mindfulness tools utilization, and pre/post-intervention differences in QOL, resilience, emotional/behavioral dysregulation, cognition, and positive affect/well-being. RESULTS: Overall, 1539 individuals signed up for LoveYourBrain Mindset with 1093 (71.02%) participating in one/more classes. The mean program rating was 9.09 (SD=1.28). Majority (62.99%) used the mindfulness tools each week. Multiple linear regression models controlling for age, TBI severity, and gender indicated significant improvements in QOL, resilience, emotional/behavioral dysregulation, cognition, and positive affect/well-being (p<0.001). CONCLUSION: LoveYourBrain Mindset is feasible, acceptable, usable, and may improve outcomes among people with TBI.

Synchronous Web-Based Psychotherapy for Mental Disorders From a Health Quality Perspective: Scoping Review.

BACKGROUND: The COVID-19 pandemic necessitated rapid changes to health care delivery, including a shift from in-person to digitally delivered psychotherapy. While these changes helped ensure timely psychotherapy provision, many concerns exist, including clinical, cultural, practical, privacy, and security issues. OBJECTIVE: This scoping review systematically mapped existing peer-reviewed research on synchronous, therapist-delivered web-based psychotherapy for individuals with a diagnosed mental illness. Data were analyzed through the lens of the Alberta Quality Matrix for Health (AQMH) to assess to what degree this literature addresses key indicators of health care quality. This analysis aided in the identification and organization of knowledge gaps with regard to web-based psychotherapies, highlighting potential disparities between previously prioritized dimensions of care and those requiring further attention. METHODS: This review adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. We included peer-reviewed primary research studies in the English language investigating synchronous, therapist-delivered remote psychotherapy delivered to adults (aged 18 years and older) with a Diagnostic and Statistical Manual of Mental Disorders or International Statistical Classification of Diseases diagnosed mental illness. All other citations were excluded. Relevant studies were identified through MEDLINE, APA PsycINFO, Embase (OVID), Web of Science: Core Collection (Clarivate), Cochrane Library (Wiley), and Scopus (Elsevier) databases. Databases were searched on March 18, 2021. For every publication that was taken into consideration, the data were charted independently by 2 reviewers, and in the event of a discrepancy, the principal investigator validated the choice of either extractor. Results were thematically described according to the 6 AQMH dimensions: acceptability, accessibility, appropriateness, effectiveness, efficiency, and safety. RESULTS: From 13,209 publications, 48 articles were included, largely from North American studies. Most studies measured treatment effectiveness (n=48, 100%) and acceptability (n=29, 60%) health quality dimensions. Over 80% (40/48) of studies investigated either a cognitive or exposure intervention for either posttraumatic stress disorder or a mood or anxiety disorder, generally indicating comparable results to in-person therapy. Safety (n=5, 10%) was measured in fewer studies, while treatment accessibility, appropriateness, and efficiency were not explicitly measured in any study, although these dimensions were mentioned as a future direction, hypothesis, or potential outcome. CONCLUSIONS: In relation to web-based therapist-delivered psychotherapies for those with a diagnosed mental illness, important aspects of health care quality (accessibility, appropriateness, efficiency, and safety) have received little scientific examination, underscoring a need to address these gaps. There are also significant issues related to the generalizability of this literature, including the underrepresentation of many geographic regions, cultures, populations, clinical contexts, and psychotherapy modalities. Qualitative research in underrepresented populations and settings may uncover important patient and contextual factors important for the future implementation of quality web-based psychotherapy.

[Joint crisis plans in mental health hospitals-Real practice in an association of psychiatric hospitals]. / Behandlungsvereinbarungen in der Psychiatrie ­ reale Praxis in einem Verbund psychiatrischer Kliniken.

BACKGROUND: Joint crisis plans (JCPs) are offered in many psychiatric hospitals, but patients only rarely make use of them. OBJECTIVE: To assess the rates of JCPs among inpatients of mental health hospitals and to analyze the clinical characteristics of patients who make use of a JCP. MATERIAL AND METHODS: We carried out a retrospective analysis of routine data from the statistical database/basis documentation of the LVR hospital association, which consists of nine psychiatric hospitals. The basis documentation is consistent in the nine hospitals. All admissions between 2016 and 2020 were considered. We recorded the existence of a JCP, age, gender and main diagnosis at release, as well as previous hospital stays, detention under the Mental Health Act of the Federal State of NRW and experiences with compulsory measures (seclusion/restraint) in the previous 24 months before index admission. RESULTS: Out of a total of 117,662 inpatients 467 (0.4%) had completed a JCP. Patients with JCP were more likely to be diagnosed with schizophrenia, bipolar disorder, or emotionally unstable personality disorder. Patients with a JCP had more previous inpatient stays and they had more frequently experienced detentions and compulsory measures. However, 50% of the patients with a JCP had other diagnoses and the vast majority of them had experienced no detention or compulsory measure in the 24 months preceding the first documentation of a JCP. CONCLUSIONS: Overall, the use of JCPs is limited. The targeted group of patients with severe mental illness and previous experience with involuntary placements and compulsory measures make use of the offer of a JCP but so do other patients as well. Additional qualitative analyses are required in order to analyze the content and objectives of JCPs in more detail.

[Questionnaire on Treatment Satisfaction in Inpatient Child and Adolescent Psychiatry (FBZ-KJP) - Results of a Swiss Pilot Study]. / Fragebogen zur Behandlungszufriedenheit in der stationären Kinder- und Jugendpsychiatrie (FBZ-KJP).

Questionnaire on Treatment Satisfaction in Inpatient Child and Adolescent Psychiatry (FBZ-KJP) - Results of a Swiss Pilot Study Abstract: Objectives: Patient satisfaction is an established indicator for medical interventions. Existing questionnaires for the assessment of patient satisfaction in child and adolescent psychiatry are too global to target quality improvement in child and adolescent psychiatric hospitals. The assessment of patient satisfaction in child and adolescent psychiatry is very challenging because specific demands (development status, role of parents in treatment) have been taken into account. Therefore, an expert team leaded by the Swiss Society of Child and Adolescent Psychiatry developed a targeted instrument to assess patient satisfaction in both language regions (i. e., German and French). Methods: The article reviews the development of a new child and adolescent psychiatric questionnaire for the assessment of patient satisfaction as well as the findings of a survey conducted in a representative sample of 174 patients and 145 parents in six hospitals. Results: The internal consistency (Cronbach's α = .93) is excellent. The questionnaire has high levels of both convergence and face validity, and the correlation with the Client Satisfaction Questionnaire (CSQ-8) is ρ = .80 (patient-report) and .83 (parent-report). Furthermore, this questionnaire reveals the relative strengths and weaknesses of individual hospitals. The correlation between patient and parent assessment is, as expected, moderate (ρ = .29, for the total score and ρ = .39 for the CSQ-8). Conclusions: The Patient Satisfaction Questionnaire can be recommended to professionals as a standard for collecting data on client satisfaction within child and adolescent psychiatry.

[Photographing to advance, the use of photography in psychotherapy]. / Photographier pour avancer, l'utilisation de la photographie en psychothérapie.

The practice of the clinical psychologist in child psychiatry can be a perilous task. His balance, as precarious as it may be, lies in listening to and observing the patient, but also in the use of precious tools of which therapeutic mediations are a part. They allow to experiment a sensory-motor anchorage and bring a multidimensional vision necessary to the comprehension of the subject and his suffering. By creating an intermediary space between the I and the You, the outside and the inside, they determine a place where the psychotherapeutic work can take place.

Psychologic Impacts on Diabetic Neuropathic Pain.

PURPOSE OF REVIEW: Many Americans cope with painful diabetic neuropathy (DN) as a sequela of high rates of diabetes mellitus in the US population. Appropriate management of this complex, debilitating chronic pain condition requires thorough evaluation through a biopsychosocial framework. This review aims to synthesize findings from original research studies and analyze the psychological factors that influence the experience of, and treatments for, DN pain. RECENT FINDINGS: Existing clinical literature suggests a wide breadth of psychological factors impacting DN pain. One research study detailed the demographic characteristics of DN patients most likely to have significant anxiety or depressive symptoms, and have emotional distress adversely impacting their response to therapies. A retrospective study demonstrated a correlation between patients' mindfulness-based stress reduction and improvement in DN pain severity. In addtion, a small-scale, randomized controlled pilot study supported cognitive-behavioral therapy as a superior intervention to conventional medical treatments in reducing DN patients' pain severity and pain interference, even when not accompanied by significant improvement in depressive symptoms. This review of investigations into psychological factors implicated in DN pain suggests that diagnosable mental health conditions as well as discrete, adverse thinking processes both exert significant influences on DN pain. This review further brings attention to the beneficial impact that psychotherapeutic modalities can have on DN pain.

Comparability of Patients in Trials of eHealth and Face-to-Face Psychotherapeutic Interventions for Depression: Meta-synthesis.

BACKGROUND: Depressive disorders (DDs) are a public health problem. Face-to-face psychotherapeutic interventions are a first-line option for their treatment in adults. There is a growing interest in eHealth interventions to maximize accessibility for effective treatments. Thus, the number of randomized controlled trials (RCTs) of eHealth psychotherapeutic interventions has increased, and these interventions are being offered to patients. However, it is unknown whether patients with DDs differ in internet-based and face-to-face intervention trials. This information is essential to gain knowledge about eHealth trials' external validity. OBJECTIVE: We aimed to compare the baseline characteristics of patients with DDs included in the RCTs of eHealth and face-to-face psychotherapeutic interventions with a cognitive component. METHODS: In this meta-epidemiological study, we searched 5 databases between 1990 and November 2017 (MEDLINE, Embase, PsycINFO, Google Scholar, and the database of Cuijpers et al). We included RCTs of psychotherapeutic interventions with a cognitive component (eg, cognitive therapy, cognitive behavioral therapy [CBT], or interpersonal therapy) delivered face-to-face or via the internet to adults with DDs. Each included study had a matching study for predefined criteria to allow a valid comparison of characteristics and was classified as a face-to-face (CBT) or eHealth (internet CBT) intervention trial. Two authors selected the studies, extracted data, and resolved disagreements by discussion. We tested whether predefined baseline characteristics differed in face-to-face and internet-based trials using a mixed-effects model and testing for differences with z tests (statistical significance set at .05). For continuous outcomes, we also estimated the difference in means between subgroups with 95% CI. RESULTS: We included 58 RCTs (29 matching pairs) with 3846 participants (female: n=2803, 72.9%) and mean ages ranging from 20-74 years. White participants were the most frequent (from 63.6% to 100%). Other socioeconomic characteristics were poorly described. The participants presented DDs of different severity measured with heterogeneous instruments. Internet CBT trials had a longer depression duration at baseline (7.19 years higher, CI 95% 2.53-11.84; 10.0 vs 2.8 years; P=.002), but the proportion of patients with previous depression treatment was lower (24.8% vs 42%; P=.04). Subgroup analyses found no evidence of differences for the remaining baseline characteristics: age, gender, education, living area, depression severity, history of depression, actual antidepressant medication, actual physical comorbidity, actual mental comorbidity, study dropout, quality of life, having children, family status, and employment. We could not compare proficiency with computers due to the insufficient number of studies. CONCLUSIONS: The baseline characteristics of patients with DDs included in the RCTs of eHealth and face-to-face psychotherapeutic interventions are generally similar. However, patients in eHealth trials had a longer duration of depression, and a lower proportion had received previous depression treatment, which might indicate that eHealth trials attract patients who postpone earlier treatment attempts. TRIAL REGISTRATION: PROSPERO CRD42019085880; https://tinyurl.com/4xufwcyr.

Can you see what I see? A comparison of client and observer perspectives of the alliance and group cohesion in CBT.

Both therapeutic alliance and group cohesion have been identified as "demonstrably effective" relationship elements in therapy. However, the overwhelming majority of process-outcome research has relied on clients as raters of the therapeutic relationship. A lack of convergence between client, therapist, and observer perspectives has raised questions regarding how best to measure relationships in therapy. Interest in observational measures has grown, as they may offer more objective and reliable measurements of process. This study compared the predictive validity of client and observer ratings of the alliance (Agreement and Bond) and group cohesion in the context of group cognitive behaviour therapy (CBT) for anxiety disorders. Results showed that client and observer ratings of process were not significantly correlated, and regarding the alliance, only client-rated Agreement predicted client-rated treatment gains. In contrast, both client and observer-ratings of group cohesion were found to uniquely contribute to treatment outcomes. If replicated, the findings from the present study suggest that (1) while client ratings of alliance consistently predict client-rated outcomes, the predictive validity of observer measures has yet to be established, and (2) both clients and observers provide meaningful and distinct information about group cohesion in therapy.

[Presentation of an innovative interdisciplinary and cross-sector therapeutic concept for pain patients as part of a regional selective contract]. / Vorstellung eines innovativen interdisziplinären, sektoren-übergreifenden und gestuften Behandlungskonzepts für Schmerzpatient*innen im Rahmen eines regionalen Selektivvertrages nach §140a SGB V.

BACKGROUND: A graded therapeutic concept for the treatment of chronic pain patients in Germany is only available to a limited extent. Following the onset of coronavirus disease (COVID-19), care for these patients has become even worse. AIM: To develop and establish a cross-sector therapeutic concept for chronic pain patients as part of a selective contract. METHODS: Embedded in existing therapeutic procedures, we define seven clinical pathways (CPs) into which patients are directed, after an interdisciplinary assessment according to refined criteria. ORGANIZATION: In CP I, patients remain in standard therapy. In CP II, patients have the opportunity to participate in an additional inter-profession education program. In CP III, patients get a specialized outpatient treatment. CP IV is a partial inpatient treatment, where multiple inpatient attendance days are replaced by tele-medical treatment, via a rehabilitation app. CP V and VI are inpatient treatments over 8 and 15 days each. If patients need further psychotherapeutic support after an inpatient treatment, they can be treated by clinical psychotherapists for another six months in CP VII. EVALUATION: The evaluation takes place 3, 6 and 12 months after initial assessment and includes the German Pain Questionnaire with different psychometric tests.

Prevalence of Mental Disorders in a German Kidney Transplant Population: Results of a KTx360°-Substudy.

In patients after kidney transplantation (KTx) an increased rate of affective and anxiety disorders has been observed. Repeatedly, a relationship between mental health issues and increased morbidity and mortality in KTx recipients has been reported. However, information on the prevalence of mental disorders in KTx patients is scarce. As part of the structured multimodal follow-up program (KTx360°), mental disorders were examined in 726 patients after KTx through structured diagnostic interviews using the Mini-DIPS Open Access. Overall, 27.5% had a current and 49.2% a lifetime mental disorder. Only 14.5% with a current mental disorder reported to be in treatment. Affected patients were younger, more often female, reported more symptoms of anxiety and depression and less perceived social support. While comparable to the rate in general population samples, the prevalence of mental disorders should attract attention. The low treatment rate requires an improved identification of afflicted patients and provision of specialist treatment.ISRCTN registry, https://doi.org/10.1186/ISRCTN29416382 , date of registry: 03.05.2017.

Therapeutic relationship and professional burnout in psychotherapists: A structural equation model approach.

Previous studies on the therapists' burnout have focused on individual and environmental risk factors. This study aimed to analyse whether variables reflecting therapeutic relationship-the therapist experience of relational depth and quality of the therapeutic relationship-can be related to psychotherapist burnout. Four alternative path models were examined. A total of 101 humanistic-experiential psychotherapists, aged between 29 and 86 years, participated in the research. The Relational Depth Frequency Scale, the Scale to Assess the Therapeutic Relationship, the Psychological Well-Being Scale and the Link Burnout Questionnaire were applied to the research. The results showed that relational depth and therapeutic quality correlated negatively with psychotherapist burnout. Relational depth is the main predictor of psychological well-being and psychotherapist burnout through its effect on therapeutic quality. The experiences of relational depth, primarily of person-centred therapists, have positive psychological potential in predicting lower professional burnout.

Which, who and when? Therapeutic processes in group cognitive behaviour therapy for anxiety disorders.

The evidence for the effect of therapeutic alliance in group cognitive behaviour therapy (CBT) for anxiety disorders is unclear. Identifying whether the alliance-outcome relationship depends on (1) which components are assessed, (2) who is measuring the alliance and (3) when the alliance is measured will help to clarify the role of the client-therapist relationship in therapy. The present study explored the effects of alliance component (agreement vs. bond), rater perspective (client vs. therapist) and timing (early vs. late therapy) on the alliance-outcome relationship. Individuals with an anxiety disorder enrolled into transdiagnostic group CBT were studied, with n = 78 at early therapy and n = 57 at late therapy. Results showed that greater client-rated agreement significantly predicted improved post-treatment outcomes throughout the course of therapy, while stronger client-rated bond in late therapy predicted reduced treatment gains. In contrast, therapist perceptions of agreement and bond were not associated with post-treatment outcomes at any point in therapy. Client-reported group cohesion also was not associated with additional variance in outcome after accounting for client-rated alliance. Overall, the findings highlight the importance of prioritizing the client's perception of the client-therapist relationship in CBT for anxiety disorders, as well as distinguishing the effects of component, rater and timing in future process-outcome studies.

Relational depth from the perspective of the psychotherapy dyad: Psychometric properties of the Relational Depth Frequency Scale.

Objective: The Relational Depth Frequency Scale (RDFS) is a 6-item measure to assess the impact of relational depth experiences on psychotherapeutic outcomes. To date, the RDFS has only been validated in online samples of clinical and non-clinical individuals. This study aimed to examine the psychometric properties of the RDFS in clinical dyads of clients and psychotherapists.Method: A total of 86 psychotherapy dyads-86 psychotherapists (18 male, 68 female, mean age = 44.34) and 86 clients (17 male, 69 female, mean age = 34.22)-completed the RDFS, and the Scale to Assess the Psychotherapeutic Relationship (STAR), mid-psychotherapy.Results: CFA showed acceptable fit statistics for a one-factor model. The partial measurement invariance across both partners of the psychotherapeutic dyad was positively verified. The RDFS had good internal consistency for psychotherapists and clients (α = .90 and .81, respectively). Actor-partner interdependence model confirmed moderate to high levels of convergent validity against the STAR. Relational depth in both partners was predicted by their own perceptions of the quality of the psychotherapeutic relationship. Psychotherapist frequency of relational depth was also related to client perceptions of the psychotherapeutic relationship.Conclusion: The RDFS is a promising tool measuring relational depth both from psychotherapist and client perspectives.