Bernhard Strauss

Adult attachment and social support interact to reduce psychological but not cortisol responses to stress

OBJECTIVE Adult attachment has been suggested to mediate the effect of social support on stress protection. The purpose of this study was to investigate the effects of adult attachment and social support on psychological and endocrine responses to psychosocial stress. METHODS Sixty-three healthy men who were married or cohabiting were randomly assigned to receive either instructed social support from their partner or no social support before being exposed to a standardized psychosocial stressor (Trier Social Stress Test). Attachment was determined using the Experiences in Close Relationships-Revised questionnaire. State anxiety, mood, and salivary cortisol levels were repeatedly assessed before and after stress. RESULTS Secure attachment was associated with stronger decreases in state anxiety levels following stress exposure. More importantly, the combination of social support and secure attachment exhibited the lowest anxiety levels after stress (interaction effect). Social support alone reduced cortisol responses to stress, whereas secure attachment did not influence cortisol concentrations. CONCLUSION This first study on the interaction of adult attachment and social support in terms of psychological and endocrine stress responses concurs with previous studies suggesting an important protective role of attachment for psychological stress responsiveness. However, attachment did not directly moderate cortisol responses to acute stress.

Psychodynamic Therapy and Cognitive-Behavioral Therapy in Social Anxiety Disorder: A Multicenter Randomized Controlled Trial

OBJECTIVE Various approaches to cognitive-behavioral therapy (CBT) have been shown to be effective for social anxiety disorder. For psychodynamic therapy, evidence for efficacy in this disorder is scant. The authors tested the efficacy of psychodynamic therapy and CBT in social anxiety disorder in a multicenter randomized controlled trial. METHOD In an outpatient setting, 495 patients with social anxiety disorder were randomly assigned to manual-guided CBT (N=209), manual-guided psychodynamic therapy (N=207), or a waiting list condition (N=79). Assessments were made at baseline and at end of treatment. Primary outcome measures were rates of remission and response, based on the Liebowitz Social Anxiety Scale applied by raters blind to group assignment. Several secondary measures were assessed as well. RESULTS Remission rates in the CBT, psychodynamic therapy, and waiting list groups were 36%, 26%, and 9%, respectively. Response rates were 60%, 52%, and 15%, respectively. CBT and psychodynamic therapy were significantly superior to waiting list for both remission and response. CBT was significantly superior to psychodynamic therapy for remission but not for response. Between-group effect sizes for remission and response were small. Secondary outcome measures showed significant differences in favor of CBT for measures of social phobia and interpersonal problems, but not for depression. CONCLUSIONS CBT and psychodynamic therapy were both efficacious in treating social anxiety disorder, but there were significant differences in favor of CBT. For CBT, the response rate was comparable to rates reported in Swedish and German studies in recent years. For psychodynamic therapy, the response rate was comparable to rates reported for pharmacotherapy and cognitive-behavioral group therapy.

Attachment and coping with chronic disease

BACKGROUND In this clinical study, attachment theory was applied to research in the field of coping with chronic disease. The approach was to integrate concepts of coping within a framework of attachment theory. It was hypothesised that attachment concepts have an influence on coping strategies, and that they may predict the subjective emotional and physical health status during the course of medical treatment. METHOD One hundred fifty patients were investigated with an adult attachment interview (AAPR coding system) and a coping interview (Bernese Coping Modes). Self-reported coping modes, social support, the subjective health status and quality of life were also assessed by self-report measures at two or more sampling points of measurement. Three subsamples of patients, suffering from (a) breast cancer, (b) chronic leg ulcers and (c) alopecia, were studied in order to include a broad range of subjective impairment caused by a disease. RESULTS Findings indicate a moderate statistical effect of attachment patterns on coping strategies when controlling the influence of confounding variables. Insecure attachment was related to less flexible coping. Coping strategies also differed between the different types of insecure attachment; however, there were differences depending on the perspective of the coping behaviour (self- vs. observer ratings) as well. From the observer perspective, ambivalently attached individuals showed more negative emotional coping while avoidantly attached individuals showed more diverting strategies. In the self-report, ambivalently attached patients revealed hyperactivating tendencies in their coping behaviour while avoidantly attached individuals revealed deactivating tendencies. CONCLUSION As a conclusion, two levels of coping should be differentiated. One level strongly corresponds with affect regulation, in particular the regulation of attachment-related emotions and concerns, while the other level shows a stronger tendency to outwardly oriented coping. A more secure attachment might be considered to be an important inner resource in the emotional adaptation to chronic diseases.

Group interventions for patients with cancer and HIV disease. Part I: Effects on psychosocial and functional outcomes at different phases of illness

Abstract Group interventions for individuals facing cancer or HIV disease have drawn considerable attention among researchers and clinicians over the past 20 years. There is growing evidence that group services may be helpful, but which interventions are most effective for participants at which phases in the trajectory of disease has been less clear. Moreover, professionals working in different intervention settings (e.g., primary prevention vs. clinical care) and different disease sites (cancer vs. HIV disease) often have little awareness of relevant advances in other fields. Efforts to integrate findings in the literature may accelerate research and advance the standard of clinical care. The current article, the first in a series of four special reports, critically evaluates the efficacy of group interventions led by professional or trained facilitators for individuals confronted by cancer or HIV, across the spectrum of illness from elevated risk through advanced disease. We examine psychosocial and functional outcomes for different interventions directed toward different patient subgroups, trace common themes, highlight limitations, and offer recommendations for further research.

Efficacy of hypnosis in adults undergoing surgery or medical procedures: A meta-analysis of randomized controlled trials

This meta-analysis investigates the efficacy of hypnosis in adults undergoing surgical or medical procedures compared to standard care alone or an attention control. Through a comprehensive literature search N=34 eligible randomized controlled trials (RCTs) were included, comprising a total of 2597 patients. Random effects meta-analyses revealed positive treatment effects on emotional distress (g=0.53, CI 95% [0.37; 0.69]), pain (g=0.44, CI 95% [0.26; 0.61]), medication consumption (g=0.38, CI 95% [0.20; 0.56]), physiological parameters (g=0.10, CI 95% [0.02; 0.18]), recovery (g=0.25, CI 95% [0.04; 0.46]), and surgical procedure time (g=0.25, CI 95% [0.12; 0.38]). In conclusion, benefits of hypnosis on various surgically relevant outcomes were demonstrated. However, the internal validity of RCTs seems limited and further high methodological quality RCTs are needed to strengthen the promising evidence of hypnosis for adults undergoing surgery or medical procedures.

Brain activation during anticipatory anxiety in social anxiety disorder

Exaggerated anticipatory anxiety during expectation of performance-related situations is an important feature of the psychopathology of social anxiety disorder (SAD). The neural basis of anticipatory anxiety in SAD has not been investigated in controlled studies. The current study used functional magnetic resonance imaging (fMRI) to investigate the neural correlates during the anticipation of public and evaluated speaking vs a control condition in 17 SAD patients and 17 healthy control subjects. FMRI results show increased activation of the insula and decreased activation of the ventral striatum in SAD patients, compared to control subjects during anticipation of a speech vs the control condition. In addition, an activation of the amygdala in SAD patients during the first half of the anticipation phase in the speech condition was observed. Finally, the amount of anticipatory anxiety of SAD patients was negatively correlated to the activation of the ventral striatum. This suggests an association between incentive function, motivation and anticipatory anxiety when SAD patients expect a performance situation.

Physical and mental health in patients and spouses after intensive care of severe sepsis: a dyadic perspective on long-term sequelae testing the Actor-Partner Interdependence Model.

Objective:To examine the physical and mental long-term consequences of intensive care treatment for severe sepsis in patients and their spouses under consideration of a dyadic perspective using the Actor–Partner Interdependence Model. Design:Prospective study. Setting:Patients and spouses who had requested advice from the German Sepsis Aid’s National Helpline were invited to participate. Subjects:We included 55 patients who survived severe sepsis and their spouses an average of 55 months after ICU discharge. Measurements and Main Results:The Hospital Anxiety and Depression Scale, the Short Form-12 Health Survey, the Posttraumatic Stress Scale-10, and the Giessen Subjective Complaints List-24 were used. The Actor–Partner Interdependence Model was tested using multilevel modeling with the actor effect representing the impact of a person’s posttraumatic stress symptoms on his or her own mental health-related quality of life and the partner effect characterized by the impact of a person’s posttraumatic stress symptoms on his or her partner’s mental health-related quality of life. A significant proportion of patients and spouses (26%–42%) showed clinically relevant scores of anxiety and depression; approximately two thirds of both, patients and spouses, reported posttraumatic stress symptoms defined as clinically relevant. Compared with normative samples, patients reported greater anxiety, poorer mental and physical health-related quality of life, and greater exhaustion; spouses had an impaired mental health-related quality of life and increased anxiety. Testing the Actor–Partner Interdependence Model revealed that posttraumatic stress symptoms were related to patients’ (&bgr; = −0.71, 95% confidence interval −0.88 to −0.54) and spouses’ (&bgr; = −0.62, 95% confidence interval −0.79 to −0.46) own mental health-related quality of life. Posttraumatic stress symptoms further influenced the mental health-related quality of life of the respective other (&bgr; = −0.18, 95% confidence interval −0.35 to −0.003 for patients; &bgr; = −0.15, 95% confidence interval −0.32 to 0.02 for spouses). Conclusions:Interventions to treat posttraumatic stress symptoms after critical illness to improve mental health-related quality of life should not only include patients, but also consider spouses.

Subjective physical complaints and hypochondriacal features from an attachment theoretical perspective

The main goal of the present study was to examine the association between physical complaints, hypochondriacal features and attachment characteristics in a representative German general population sample. A total of 1997 German adults, 883 males and 1114 females, completed the Revised Adult Attachment Scale (RAAS), the short form of the Giessen Subjective Complaints List (GSCL) to investigate gender-related bodily complaints and the Whiteley Index for assessing hypochondriacal concerns. Item response theoretical methods, i.e. mixed Rasch analysis, were used in order to identify the best model for the attachment items. Findings suggested that five latent classes yielded the best model fit. The findings provided evidence that attachment styles displayed different profiles of subjective physical complaints. The highest amount of physical symptoms and hypochondriacal features was identified in anxiously attached individuals with two subsets displaying functionally different subjective symptoms. Secure attachment was, in contrast, not related to a higher amount of specific symptoms. Results are discussed in terms of a developmental approach to symptom experience and somatization.

Using the CORE-R battery in group psychotherapy.

This article applies and illustrates the American Group Psychotherapy Association (AGPA) revised CORE battery to daily practice. The CORE can assist practitioners in periodically or continuously monitoring outcome and process factors to determine patient status (e.g., improved, deteriorated, or no change), and ruptures in the therapeutic relationships. The CORE-R provides group therapists with a tool kit of measures for assessing the effectiveness of their groups and includes three classes of measures: selection, process, and outcome. We provide a summary of each class of measures along with specific instruments.

Associations among attachment characteristics, patients’ assessment of therapeutic factors, and treatment outcome following inpatient psychodynamic group psychotherapy

Abstract Within a multisite study, including 289 inpatients from six different hospitals who underwent interpersonal-psychodynamic group psychotherapy, associations among attachment characteristics, therapeutic factors, and treatment outcome were investigated. Attachment characteristics were assessed with an interview-based measure (Adult Attachment Prototype Rating [AAPR]) as well as an attachment self-report (Bielefeld Questionnaire of Client Expectations [BQCE]). Therapeutic factors were measured retrospectively with the Düsseldorf Therapeutic Factors Questionnaire and treated as an individual- as well as a hospital-specific characteristic. On an individual level, only the group climate factor independently predicted treatment outcome (i.e., Symptom Checklist-90-R Global Severity Index and Inventory of Interpersonal Problems mean). If simultaneously but separately included into a path model, analyses revealed independent significant effects of AAPR-Security and BQCE-Security on group climate. If modeled as a latent variable (common attachment security), a substantially higher proportion of group climate variance could be explained. Further analyses revealed interactions between particular therapeutic factors and attachment characteristics, indicating a particular importance of these therapeutic factors for different attachment categories.