Dominique Schwartze

Screening riskanten Essverhaltens bei 12-jährigen Mädchen und Jungen: psychometrischer Vergleich der deutschsprachigen Versionen von SCOFF und EAT-26

To detect eating disorders and risky eating behaviour at an early stage, screening tests should be economic, i. e. as short as possible but at the same time they should fulfil the psychometric quality criteria. We compared the German version of the Eating Attitudes Test (EAT-26D, which comprises 26 items) and the German version of the SCOFF test (which contains only 5 Yes-no questions) in a community sample of 425 12-year-old girls and 382 boys from Thuringia, Germany. Although the EAT-26D reached higher psychometric properties, the SCOFF has been proved as a useful screening tool with a test-retest reliability of r (tt)=0.73 and a maximum accuracy of 82% (area under the ROC curve). With the EAT-26D (20 point cut-off) as a reference the sensitivity of the SCOFF was 79%, specificity 74%, positive predictive value 25%, and the negative predictive value, which is more relevant for screenings, was 97%. The criterion validity reached r=0.53.

Efficacy of group psychotherapy for social anxiety disorder: A meta-analysis of randomized-controlled trials.

Group psychotherapy for social anxiety disorder (SAD) is an established treatment supported by findings from primary studies and earlier meta-analyses. However, a comprehensive summary of the recent evidence is still pending. This meta-analysis investigates the efficacy of group psychotherapy for adult patients with SAD. A literature search identified 36 randomized-controlled trials examining 2171 patients. Available studies used mainly cognitive-behavioral group therapies (CBGT); therefore, quantitative analyses were done for CBGT. Medium to large positive effects emerged for wait list-controlled trials for specific symptomatology: g=0.84, 95% CI [0.72; 0.97] and general psychopathology: g=0.62, 95% CI [0.36; 0.89]. Group psychotherapy was also superior to common factor control conditions in alleviating symptoms of SAD, but not in improving general psychopathology. No differences appeared for direct comparisons of group psychotherapy and individual psychotherapy or pharmacotherapy. Hence, group psychotherapy for SAD is an efficacious treatment, equivalent to other treatment formats.

Primary prevention of eating-related problems in the real world

AimAs known from meta-analyses, prevention programs for eating disorders yield significant effects under ideal conditions. However, it is still unclear how these programs can be more widely disseminated. Since 2004 in Thuringia, Germany, several programs for preadolescent girls and boys (aged 10 to 15 years) covering a wide geographical range have been developed in order to prevent eating-related problems.Subjects and MethodsOver 3,500 pupils and more than 100 schools participated in the internal evaluation following the three-step standard of the Society of Prevention Research (SPR). To examine the program efficacy (step 1) and effectiveness (step 2), we conducted pre-post design studies with control groups. In order to describe the implementation process and the program dissemination (step 3), the Health Promoting School Approach (HEPS) was applied.ResultsGirls (6th grade) showed significant improvements in eating attitudes and self esteem about their bodies, whereas boys only improved their knowledge about eating and physical activity. The evaluations of the programs for 7th and 8th graders are still pending. On the HEPS checklist, our health promotion concept fulfilled 64 points out of a maximum of 74, which indicates a high intervention quality.ConclusionBroad dissemination of prevention programs requires methodological compromises and organizational flexibility. Quality assurance should be considered to be as important as the optimal level of evidence, which depends on the needs of all stakeholders and could not be derived from the standards for clinical studies. Furthermore, health promotion needs political support that is independent of legislative periods and the turnover of institutional staff.

Efficacy of group psychotherapy for posttraumatic stress disorder: Systematic review and meta-analysis of randomized controlled trials

Abstract Objective: The present meta-analysis evaluates the efficacy of group psychotherapy for post-traumatic stress disorder (PTSD) in adults directly compared to no treatment or active treatments examined in randomized controlled trials (RCTs). Method: Electronic databases were searched for eligible studies. Effects on PTSD symptoms, depression, and anxiety were extracted. Between- and within-group effect sizes (Hedges’ g) were calculated using a random-effects model. Data were adjusted to account for dependencies among observations in groups. Results: Twenty RCTs were included comprising 2244 individuals. Results showed significant effects of group psychotherapy in reducing symptoms of PTSD compared to no-treatment control groups (k = 13; g = 0.70; 95% CI: 0.41; 0.99). No significant differences in efficacy were found between group psychotherapy and other active treatments (k = 8; g = 0.13; 95% CI: −0.16; 0.42). Moderator analyses confirmed gender and trauma type as important moderators of within-treatment effects for PTSD. Conclusions: Group treatments are associated with improvements in symptoms of PTSD. Particularly, the efficacy of exposure-based cognitive-behavioral group therapy (group CBT) is empirically well demonstrated. Still little is known about the effects of group treatment approaches other than CBT and the comparative efficacy to alternative treatments such as individual therapy or pharmacotherapy. Clinical or Methodological Significance of this Article: This review provides an empirical base for group therapy as a viable treatment alternative for future PTSD practice guidelines. Although less is known about its comparative efficacy to alternative PTSD treatments such as individual therapy or pharmacotherapy, sufficient evidence exists to recommend group therapy (particularly exposure-based group CBT) for those who might not be able to access alternative treatments. Trauma type and gender proved to be important moderators of group treatment outcome. The results further indicate that the evidence base of recommendations for group therapy in current international treatment guidelines needs to be updated.

Efficacy of group psychotherapy for panic disorder: Meta-analysis of randomized, controlled trials.

Among psychological treatments for panic disorder (PD) with or without agoraphobia, group therapy is an established and cost-effective treatment. The typical review assessing the effects of psychological treatments for PD merges findings from both individual and group formats. What is absent from the literature is a meta-analysis that separately summarizes the efficacy of group treatments. The present meta-analysis addresses this gap by estimating the efficacy of group psychotherapy for PD in adults using randomized, controlled trials (RCTs). More specifically, studies that directly compared the effects of group psychotherapy with control groups or alternative treatments were included. We identified 15 RCTs that yielded 19 comparisons with 864 patients. In most studies, group therapy was based on a cognitive–behavioral approach. Outcomes assessing panic, agoraphobia, depression, and general anxiety symptoms were extracted and between-groups effect sizes (Hedges’ g) calculated using a random-effects model. Results showed large effects for group therapy reducing symptoms of panic and agoraphobia when compared with no-treatment control groups (k = 9; g = 1.08; 95% confidence interval [CI] [0.82, 1.34]; p < .001). However, no significant differences were found when group therapy was compared with alternative treatments (k = 6; g = 0.18; 95% CI [−0.14, 0.49]; p = .264). This review adds support for group psychotherapy (primarily cognitive–behavioral therapy, CBT) being one of several treatment options for PD. Results are discussed with respect to the positive effects of group therapy and the limits of group therapy when compared with alternative treatments such as individual therapy or pharmacotherapy.

Essstörungen wirksam vorbeugen mit den Schulprogrammen „PriMa“ und „Torera“ für Jugendliche in Klasse 6 und 7

The aim of this study was to assess the effects of 2 German school-based primary prevention programmes for (pre)adolescents, aged 11-13 years, with 9 manual-guided lessons. 92 (PriMa, n=1,553 girls) and 22 (Torera, n=256 boys, 277 girls) Thuringian secondary schools participated in controlled trials with pre-post assessment. Girls and students at risk showed significant improvements of conspicuous eating behaviour and body self-esteem with small to medium effect sizes. Implementation costs were € 2.50 per student.

Recommendations to enhance constructivist-based learning in Interprofessional Education using video-based self-assessment.

Introduction: Interprofessional collaboration is crucial to the optimization of patient care. Aim: This paper aims to provide recommendations for implementing an innovative constructivist educational concept with the core element of video-based self-assessment. Methodology: A course for students in medicine, physiotherapy, and nursing was developed through interprofessional, cross-institutional collaboration. The course consisted of drawing on prior knowledge about the work done by each professional group in regard to a specific clinical scenario and an interprofessional treatment situation, filming a role play of this treatment situation, and a structured self-assessment of the role play. We evaluated the preparation and implementation of the three courses conducted thus far. Concrete recommendations for implementation were made based on evaluation sheets (students), open discussions (tutors, instructors, institutions) and recorded meeting minutes (project managers, project participants). Results: Basic recommendations for implementation include: selecting appropriate criteria for self-assessment and a simulated situation that offers members of each professional group an equal opportunity to act in the role play. In terms of administrative implementation we recommend early coordination among the professions and educational institutions regarding the target groups, scheduling and attendance policy to ensure participant recruitment across all professions. Procedural planning should include developing teaching materials, such as the case vignette and treatment scenario, and providing technical equipment that can be operated intuitively in order to ensure efficient recording. Conclusion: These recommendations serve as an aid for implementing an innovative constructivist educational concept with video-based self-assessment at its core.

Publikationsbias – Kontrollieren versus Vorbeugen

Sie überlegen, ein neues Antidepressivum, Reboxetin, bei einem ihrer Patienten einzusetzen. Um den Nutzen der neuen Therapie zu bewerten, durchsuchen Sie die Forschungsliteratur nach relevanten Wirksamkeitsstudien. Aus den veröffentlichten Untersuchungen resultiert ein Nutzennachweis für Reboxetin. Sie entscheiden sich für den Einsatz des Medikaments und begehen damit unter Umständen einen folgenschweren Fehler. Eine Untersuchung des Instituts für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG) hat gezeigt, dass die Daten von über zwei Drittel der Patienten, die mit Reboxetin behandelt wurden, unveröffentlicht geblieben sind. Bei Auswertung aller Daten konnte der Nutzen des Medikaments nicht bestätigt werden [1]. Dieser bekannte Fall demonstriert die seit Jahren gängige selektive Publikationspraxis. Studien mit positiven oder statistisch signifikanten Ergebnissen, die auf die Wirksamkeit einer Intervention verweisen, werden mit einer höheren Wahrscheinlichkeit veröffentlicht als Studien mit negativen oder statistisch nicht signifikanten Ergebnissen [2–4]. Folglich werden die positiven Wirkungen einer Intervention häufiger überschätzt, da die Informationen über fehlende oder negative Auswirkungen nicht in ausreichendem Maß, z.B. für systematische Übersichtsarbeiten, zur Verfügung stehen. Die so entstehende Verzerrung der Datenlage wird als Publikationsbias bezeichnet. Ein ähnlicher Effekt resultiert, wenn positive Studienergebnisse mehrfach, unter Angabe verschiedener Autoren, veröffentlicht werden. Oftmals können diese Studien nicht als Duplikate identifiziert werden und gehen damit mehrfach als Bewertungsgrundlage ein. Dies wird als multipler Publikationsbias bezeichnet [5]. Dabei geht das selektive Publizieren nicht nur von den Autoren aus. Häufig werden Studien mit unerwünschten Ergebnissen auch von den Herausgebern oder Gutachtern einer Zeitschrift abgelehnt oder vom Sponsor der Studie nicht zur Veröffentlichung freigegeben [6].