Burkhard Brosig

Alexithymic Characteristics and Patient-Therapist Interaction: A Video Analysis of Facial Affect Display

Alexithymia as a disorder of affect regulation entails a patient’s reduced ability to process emotional information. The purpose of this study was to evaluate the impact of alexithymia [as measured by the Toronto Alexithymia Scale (TAS)-26, German version] on affective correlates in a dyadic therapeutic interaction (as recorded by the Emotional Facial Action Coding System). Interviews with 12 in-patients with various psychosomatic disorders (anxiety, depression, somatisation) were videotaped and evaluated for facial affect display. The corresponding emotional reactions of the therapists (split screen) were recorded separately. Patients with high alexithymia scores (TAS-26 total score) tended to display less aggressive affects than those with low scores. The therapists’ predominant emotional reaction to alexithymic patients was contempt. Our findings underscore the deep-rooted nature of alexithymia as a disorder of affect regulation. Since facial affects play a major role in the regulation of emotional interaction, this disorder may evoke negative reactions of potential caregivers.

Atopic Eczema Prevention Programs – a New Therapeutic Concept for Secondary Prevention

Patient education for atopic eczema patients are programs for prevention or relapse prevention. A combination of dermatological education and psychological behavior training has proved effective. Recent studies with long follow-up periods and randomized controlled study designs show the positive aspects of patient education programs. The main aim is not the reduction of symptoms, but the improvement of coping behavior, of subjective impairment, and of life quality are central aspects of the patient program. In the meantime, the atopic eczema prevention program has been standardized, and a certification of the instructors has been established. Different studies and the contents of the patient prevention programs are presented.

Psychosomatic Aspects of Pruritus

Pruritus is an uncomfortable sensation that induces craving for scratching. This overview shows some aspects of the recent research on itch and its etiology. Although pruritus is often correlated with a somatic disease, psychogenic pruritus and psychosocial factors can play an important role in the etiology. Itch is probably a specific sensation. It is generally accepted that there are specific and discrete pathways for pain and itch, which are described as ‘itch-units’ in slowly conducting C-fibers. Itch is mostly neuropeptide-induced and recent data suggest that it is limited to their mast-cell activating effect. The close connection between epidermal nerve fibers and brain is pointed out by some newer studies in brain research. An activation of the anterior cingulate cortex, supplementary motor area, premotor area and inferior parietal lobe by itch was seen, which was different from pain-induced activation. Measurement of itch is mostly evaluated by a visual analogue scale. The Itching Cognition Questionnaire assesses coping cognitions related to itching. Psychological factors showed a comorbidity of itch with depression and anxiety, a decrease of life quality and mentally inducible pruritus. Pruritus sine materia is an autologous somatoform disorder.

Psychosomatische Dermatologie in Deutschland*: Eine Umfrage an 69 Hautkliniken

ZusammenfassungHintergrund und Fragestellung. Eine Umfrage zur Situation und Entwicklung der psychosomatischen Dermatologie in deutschen Hautkliniken sollte die Ist-Situation 10 Jahre nach einer ähnlichen Studie erheben. Patienten/Methodik. Es wurden 170 Hautkliniken mittels eines Fragebogens angeschrieben. 76 wurden zurückgeschickt, 69 hiervon (40,6%) konnten ausgewertet werden. Die Fragebögen wurden überwiegend von dermatologischen Chefärzten (38/69=55,1%) beantwortet. Ergebnisse. Fast 85% der Hautkliniken geben an, dass psychosomatische Aspekte in der Therapie berücksichtigt werden. Eine psychotherapeutische Zusatzqualifikation haben 5,1% der Hautärzte in den Kliniken. Die Verbesserung der Krankheitsbewältigung sollte wesentliches Ziel der psychosomatischen Intervention sein. Die Bedeutung psychischer Faktoren wurde insgesamt im Vergleich zur Studie vor 10 Jahren bei fast allen Dermatosen deutlich höher angegeben. Schlussfolgerungen. Psychosomatische Aspekte scheinen nach den Angaben der Umfrage inzwischen zu einem obligaten Bestandteil dermatologischer Versorgung in den Hautkliniken geworden zu sein. Die Häufigkeit einzelner Störungen wird jedoch im Vergleich zu Studienergebnissen aus der Literatur immer noch unterschätzt.AbstractBackground and Objective. A questionnaire study of German dermatological clinics was designed to show the situation and development of psychosomatic dermatology 10 years after a similar study. Patients/Methods. A questionnaire was sent to 170 dermatological clinics. 76 were send back; 69 of them (40.6%) were evaluable. The questionnaires were mostly answered by the heads of the dermatological clinics (38/69=55,1%). Results. Nearly 85% of the dermatological clinics answered that they take psychosomatic aspects into consideration in the therapy. 5,1% of the dermatologists working in clinics have additional psychotherapeutic certification. The improvement of coping behaviour seems to be the main goal of psychosomatic interventions. The importance of psychic factors increased in the last 10 years in comparison to a former study in regard to most of the dermatological diseases. Conclusions. Psychosomatic aspects seem to be an obligatory part of inpatient dermatological therapy. The frequency of some diseases was underestimated in comparison with results from literature.

Psyche and skin: What's new?

U Gieler,†* J Kupfer,‡ V Niemeier,† B Brosig† † Department of Psychosomatic Dermatology, Clinic for Psychosomatic Medicine and Psychotherapy, Justus-Liebig-University Gießen, Ludwigstraße 76, D 35392 Gießen, Germany, ‡ Institute of Medical Psychology, Justus-Liebig-University Gießen, Ludwigstraße 76, D 35392 Gießen, Germany. * Corresponding author, tel. +49 641 99 45650; fax +49 641 99 45659; E-mail: uwe.gieler@psycho.med.uni-giessen.de

Sense of Coherence among Psoriatics as a Predictor of Symptom-Free Time Following Dermatological Inpatient Therapy

Objective: In the present study, we investigated the health-protective resources of psoriatics, operationalized via their sense of coherence. Our objective was to determine whether the strength of these resources has an influence on the duration until relapse. Patients and Methods: 72 patients were examined three times (before, immediately after, and 15–18 months after treatment). Along with the Psoriasis Area Severity Index score and determination of the subjective estimation of severity, patients were asked to answer questionnaires relating to how they were dealing with their illness as well as to lifequality, sense of coherence (SOC), and critical life events. Results: Personal estimation of severity of condition and PASI values at the commencement of therapy highly correlated. At follow-up after balneophototherapy, subjective severity of condition had almost returned to the initial value. 76.7% of the patients experienced relapse within the first 6 months following therapy. The level of the score for manageability correlates with the length of time until the first relapse. Patients with low SOC suffered their first relapse 3.5 months after therapy, while patients with high SOC underwent first relapse after 10 months on average. Conclusion: The data suggest that the SOC could play a protective role in respect of the tendency towards relapse among psoriatics.

Vitiligo – Coping Behavior

Thirty-three inpatients with vitiligo were compared at the Tomesa Klinik (Bad Salzschlirf, Germany) to a healthy control group using the Beck Depression Inventory, Interaction Anxiety Questionnaire (German version: Interaktions-Angst-Fragebogen, Becker), and the Questionnaire on Health Locus on Control Scales (in the German version: Fragebogen zu Kontrollüberzeugungen von Krankheit und Gesundheit – KKG – by Lohaus und Schmitt). The groups were matched for age, sex and social situation. 27.3% of patients attributed their vitiligo to emotional stress. The patients were not characterized by elevated depression values, but the depression scores tended to increase with the duration of illness. Com-pared to the control group, the patients had higher scores in some specific areas of anxiety. This could be reduced by early improvement in coping strategies by means of psychotherapeutic measures. Compared to the control group, the vitiligo patients considered the locus of control to be more external. When a large percentage of the body surface was affected, the patients had in-creased scores indicating fatalistic Health Locus of Control.

Long-term outcomes of short-term and long-term psychosomatic inpatient treatment and their predictors

OBJECTIVES The Clinic for Psychosomatic Medicine and Psychotherapy at the University Giessen, Germany, offers short-term (STT) and long-term inpatient therapy (LTT). METHODS In a prospective, 3-year follow-up study, we examined therapeutic indication, short- and long-term results, outcome predictors, and the utilization of aftercare for both settings. RESULTS STT patients were more frequently acutely ill, suffered from stronger symptomatic manifestations, and were more frequently employed. LTT patients had a greater rate of chronic psychosomatic disorders, personality disorders and somatic comorbidity. In both settings, distress strongly declined during inpatient therapy and remained stable for 3 years. Negative predictors of outcome were infantile object relation patterns and interpersonal problems. We found no differences between STT and LTT patients in terms of the utilization of aftercare. CONCLUSION Duration of psychosomatic inpatient treatment should be differentiated according to the chronicity and nature of the disorder.

Urticaria and the Recall of a Sexual Trauma

Presented is the case of a 34-year-old woman with acute urticaria. The lesions of this psychodermatologic condition appeared in a process of remembering a traumatic event in her childhood. At the age of 12, she was sexually abused by her grandmother’s husband, a memory, she had repressed. First attempts to split off the emotional content of this trauma failed, and, in a process of resomatization, itching and urticaria wheals occurred. Finally, she could not longer deny her past and started a 6-week short-term psychotherapy. In a catharsis, some crucial aspects of the sexual assault were worked through and the skin symptoms disappeared. A follow-up 2 years later confirmed that the skin disease did not reappear. The marital tensions between the patient and her husband, however, culminated in a temporal separation. The process of this psychodynamic treatment is discussed using psychosomatic concepts such as the ‘skin-ego’ and the ‘stimulus barrier’.

The Skin Satisfaction Questionnaire – an Instrument to Assess Attitudes toward the Skin in Healthy Persons and Patients

Introduction: The purpose of this study was to construct a questionnaire on skin satisfaction (SSQ = HautZuf) suitable to assess satisfaction and attitudes toward one’s skin, to be used with dermatology and other patients as well as with healthy subjects. In this sense, the SSQ expands the existing spectrum of dermatological-psychosomatic/psychological questionnaires, which primarily address issues like coping with disease, quality of life, stigmatization and disease-specific problems, and includes underlying deep-psychological aspects such as the role of the skin in regulating closeness and distance. Patients and Methods: The a priori scales contained 69 items and were constructed on the basis of theoretical considerations about feelings of shame and disgust, closeness and distance, sexuality, affection and the skin-self. An experts’ rating of the contents and a pilot phase in which laymen tested comprehensibility of the items preceded development of the questionnaire. After this, 185 subjects from three groups were recruited (group 1: secondary school certification students in adult education programs, n = 54; group 2: patients in the psychosomatic outpatient clinic, n = 67; group 3: medical students in their first semester, n = 64). After exclusion of items with frequently missing data (>5%) and extremely skewed distribution, 50 items entered the factor analysis which was computed on complete data sets of 167 subjects. Results: Scree test suggested a 5-factor solution which explained 38.3% of the variance. Finally, an item pool of 32 items crystallized, which were assigned to the following 5 areas: partnership touching, shame, family touching, disgust and self-touching. All scales showed good internal consistency and reliability (Cronbach’s alpha: 0.74–0.80; split-half reliability: 0.72–0.81). Intercorrelations between scales were low except for the touching scales. Correlations with the Giessen Test (GT), a German personality questionnaire, were comprehensible but rather low, indicating that the SSQ asks for a specific spectrum of psychological characteristics. Conclusion: The SSQ is a useful test instrument which assesses a broad range of parameters on specific psychosocial aspects of skin perception, skin satisfaction and attitudes toward the skin, suitable for healthy persons as well as (skin) patients.