Ferdinand Mitterlehner

Promoting mindfulness in psychotherapists in training influences the treatment results of their patients: a randomized, double-blind, controlled study.

Background: All therapists direct their attention in some manner during psychotherapy. A special form of directing attention, ‘mindfulness’, is recommended. This study aimed to examine whether, and to what extent, promoting mindfulness in psychotherapists in training (PiT) influences the treatment results of their patients. Methods: The therapeutic course and treatment results of 124 inpatients, who were treated for 9 weeks by 18 PiTs, were compared. The PiTs were randomly assigned to 1 of 2 groups: (i) those practicing Zen meditation (MED; n = 9 or (ii) control group, which did not perform meditation (noMED; n = 9). The results of treatment (according to the intent-to-treat principle) were examined using the Session Questionnaire for General and Differen-tial Individual Psychotherapy (STEP), the Questionnaire of Changes in Experience and Behavior (VEV) and the Symptom Checklist (SCL-90-R). Results: Compared to the noMED group (n = 61), the patients of PiTs from the MED group (n = 63) had significantly higher evaluations (according to the intent-to-treat principle) for individual therapy on 2 STEP scales, clarification and problem-solving perspectives. Their evaluations were also significantly higher for the entire therapeutic result on the VEV. Furthermore, the MED group showed greater symptom reduction than the noMED group on the Global Severity Index and 8 SCL-90-R scales, including Somatization, Insecurity in Social Contact, Obsessiveness, Anxiety, Anger/Hostility, Phobic Anxiety, Paranoid Thinking and Psychoticism. Conclusions: This study indicates that promoting mindfulness in PiTs could positively influence the therapeutic course and treatment results in their patients.

Topiramate in treatment of patients with chronic low back pain: a randomized, double-blind, placebo-controlled study.

ObjectiveChronic low back pain (CLBP) is a widespread ailment. The aim of this study was to assess the efficacy of topiramate in the treatment of CLBP and the changes in anger status and processing, body weight, subjective pain-related disability and health-related quality of life during the course of treatment. MethodsWe conducted a 10-week, randomized, double-blind, placebo-controlled study of topiramate in 96 (36 women) patients with CLBP. The subjects were randomly assigned to topiramate (n=48) or placebo (n=48). Primary outcome measures were changes on the McGill Pain Questionnaire, State-Trait Anger Expression Inventory, Oswestry Low Back Pain Disability Questionnaire and SF-36 Health Survey scales, and in body weight. ResultsIn comparison with the placebo group (according to the intent-to-treat principle), significant changes on the pain rating index of McGill Pain Questionnaire (Ps<0.001), State-Trait Anger Expression Inventory Scales (all Ps<0.001), Oswestry Low Back Pain Disability Questionnaire (P<0.001), and SF-36 Health Survey scales (all P<0.001, except on the role-emotional scale) were observed after 10 weeks in the patients treated with topiramate. Weight loss was also observed and was significantly more pronounced in the group treated with topiramate than in those treated with placebo (P<0.001). Most patients tolerated topiramate relatively well but 2 patients dropped out because of side effects. DiscussionTopiramate seems to be a relatively safe and effective agent in the treatment of CLBP. Significantly positive changes in pain sensitivity, anger status and processing, subjective disability, health-related quality of life, and loss of weight were observed.

Mirtazapine treatment of social phobia in women: a randomized, double-blind, placebo-controlled study.

Abstract: Social phobia is an anxiety disorder characterized by extreme fear and phobic avoidance of social and performance situations and by a relatively poor health-related quality of life. The goal of this study was to compare the efficacy of mirtazapine versus placebo in the treatment of patients with social phobia. In 2004, we conducted a randomized, double-blind, placebo-controlled study of mirtazapine in 66 female subjects from the general population meeting the criteria for social phobia. The subjects were randomly assigned in a 1:1 manner to mirtazapine (n = 33) or placebo (n = 33). The treatment lasted 10 weeks. Seven patients dropped out. Primary outcome measures were self-reported changes on the Social Phobia Inventory, Liebowitz Social Anxiety Scale, and Health Survey (SF-36). In comparison with the placebo group and according to the intent-to-treat principle, significant differences on the Social Phobia Inventory and Liebowitz Social Anxiety Scale scales (all P < 0.001), as well as on most (5 from 8) scales of SF-36 (all P < 0.001), were observed in the mirtazapine-treated subjects. All patients tolerated mirtazapine relatively well. Mirtazapine appears to be an effective agent in the treatment of social phobia in women and in the improvement of their health-related quality of life.

The Occurrence of Posttraumatic Stress Disorder in Patients Following Intensive Care Treatment: A Cross-Sectional Study in a Random Sample

Posttraumatic stress disorder (PTSD) can now be applied to patients who have just had intensive care treatment. The authors tested whether the reliability of the diagnosis depends on the measuring instrument used and whether the occurrence of PTSD is related to the presence of preexisting psychic disorders or to a worsening of the patients’ general condition. The authors examined 41 former patients of an intensive care unit (ICU) with the Posttraumatic Scale (PTSS-10) and, afterward, with the Structured Clinical Interview (SCID). Screening with PTSS-10 showed that 17.07% of the patients met the recommended threshold for probable diagnosis of PTSD of 35 or more points. With SCID, PTSD could be confirmed in 9.76% of the cases. Patients with a prior psychiatric disease showed more frequent (P< .02) occurrences of PTSD. The severity of their Acute Physiology and Chronic Health Evaluation System II (Apache II) scores had no significant influence. PTSS-10 can be used for a preliminary diagnostic orientation. With the PTSD module of the SCID, a structured diagnostic tool is available. Almost twice as many PTSD cases were diagnosed among the subjects with the PTSS-10 as with SCID. Post-ICU PTSD occurred more frequently among patients with prior psychiatric diseases; however, it was not dependent on exacerbation of the patient’s Apache II scores.

Bullying Girls - Changes after Brief Strategic Family Therapy: A Randomized, Prospective, Controlled Trial with One-Year Follow-Up

Background: Many girls bully others. They are conspicuous because of their risk-taking behavior, increased anger, problematic interpersonal relationships and poor quality of life. Our aim was to determine the efficacy of brief strategic family therapy (BSFT) for bullying-related behavior, anger reduction, improvement of interpersonal relationships, and improvement of health-related quality of life in girls who bully, and to find out whether their expressive aggression correlates with their distinctive psychological features. Methods: 40 bullying girls were recruited from the general population: 20 were randomly selected for 3 months of BSFT. Follow-up took place 12 months after the therapy had ended. The results of treatment were examined using the Adolescents’ Risk-taking Behavior Scale (ARBS), the State-Trait Anger Expression Inventory (STAXI), the Inventory of Interpersonal Problems (IIP-D), and the SF-36 Health Survey (SF-36). Results: In comparison with the control group (CG) (according to the intent-to-treat principle), bullying behavior in the BSFT group was reduced (BSFT-G from n = 20 to n = 6; CG from n = 20 to n = 18, p = 0.05) and statistically significant changes in all risk-taking behaviors (ARBS), on most STAXI, IIP-D, and SF-36 scales were observed after BSFT. The reduction in expressive aggression (Anger-Out scale of the STAXI) correlated with the reduction on several scales of the ARBS, IIP-D, and SF-36. Follow-up a year later showed relatively stable events. Conclusions: Our findings suggest that bullying girls suffer from psychological and social problems which may be reduced by the use of BSFT. Expressive aggression in girls appears to correlate with several types of risk-taking behavior and interpersonal problems, as well as with health-related quality of life.

Zur psychopathologischen und psychosozialen Charakteristik von Patienten, die häufig ihre Psychotherapeuten wechseln

SummaryThis study was performed on a clinic group of patients (n = 1000, 83.9% responder) to test characteristics of persons who switched psychotherapists on three or more occasions (n = 74). Compared with the group of minor variation, these patients had higher rates of psychosomatic symptoms, lower systemic operativeness, a dissatisfying sexuality, tended towards alcohol and pharmaceutical abuse, and had significantly higher exposure in infancy to violence and sexual abuse (all p < 0.01 after Bonferroni correction). Psychosocial factors including early experience in forming relationships in addition to current factors appear to play a decisive role in a persons dropout liability as well as the attitude to therapy.ZusammenfassungIn der vorliegenden Querschnittstudie an einer klinischen Stichprobe (n = 1000; Responderquote, 83,9 %) wurden die Merkmale von Patienten untersucht, die dreimal oder häufiger ihre Psychotherapeuten gewechselt haben (n = 74). Diese Personen zeigten im Vergleich zur Gruppe ohne häufigen Therapeutenwechsel u. a. signifikant mehr psychosomatische Symptome, eine unbefriedigende Lebensgestaltung und Sexualität, mangelnde Leistungsfähigkeit, neigten mehr zum Konsum von Alkohol und Medikamenten und waren in ihrer Kindheit signifikant mehr Gewalt und Missbrauch ausgesetzt (p jeweils <0,01 nach Bonferroni-Korrektur). Psychosoziale Faktoren, sowohl die frühen Beziehungserfahrungen als auch die aktuellen Faktoren, scheinen entscheidend für das Risikoverhalten zu sein und die Einstellung zur medizinischen Handlung zu beeinflussen.

Anger, Interpersonal Relationships, and Health-Related Quality of Life in Bullying Boys Who Are Treated With Outpatient Family Therapy: A Randomized, Prospective, Controlled Trial With 1 Year of Follow-up

Objective. Ten to 30% of students engage in bullying behavior. Bullies stand out on account of increased anger, poor interpersonal relationships, and poor quality of life. Our aim was to determine the effectiveness of outpatient family psychotherapy as a monotherapy for anger reduction and improvement of behavior and interpersonal relationships and of health-related quality of life in male youths with bullying behavior. Methods. Twenty-two boys with bullying behavior took part in a family therapy program for 6 months. The control group was also composed of 22 youths and took part in a placebo intervention program. Every 2 weeks, results were checked with the Adolescents Risky-Behavior Scale (ARBS), the State-Trait Anger Expression Inventory (STAXI), the Inventory of Interpersonal Problems (IIP-D), and the SF-36 Health Survey (SF-36). Follow-up testing took place 12 months after treatment. Results. In comparison with the control group (according to the intention-to-treat principle), bullying behavior was reduced (family therapy group: from n = 22 to n = 6; control group: from n = 22 to n = 20). Significant changes on all ARBS scales and on the STAXI scales State-Anger, Trait-Anger, Anger-Out, and Anger-Control were observed after 6 months. In the IIP-D, significant differences were found on the scales for overly autocratic, overly competitive, overly introverted, overly expressive, and exploitable/compliant. In the SF-36, significant differences were observed in general health perceptions, vitality, social functioning, role-emotional, and mental health. The reduction in expression of anger correlated with a reduction in several scales of the ARBS, IIP-D, and SF-36. Follow-up after 1 year showed relatively stable, lasting treatment effects. Conclusion. The results of this study show that outpatient family therapy seems to be an effective method of reducing anger and improving interpersonal relationships and health-related quality of life in male youths with bullying behavior.

Aggressive female youth benefit from outpatient family therapy: A randomized, prospective, controlled trial

Abstract Background : Treatments for aggression are based on the underlying causes and may combine pharmacological and environmental or psychotherapeutic measures. The aim of this study was to determine the effectiveness of family psychotherapy as a monotherapy for anger in female youth.

Chronic fatigue and indicators of long-term employment disability in psychosomatic inpatients

ZusammenfassungDas Hauptziel dieser Studie war, Indikatoren der Langzeitarbeitsunfähigkeit bei chronischer Müdigkeit zu ermitteln. Zu diesem Zweck wurde eine Querschnittuntersuchung einer randomisierten Stichprobe (n=1000, Responderquote 83,9%) aus Patienten einer Psychosomatischen Fachklinik durchgeführt. In 51,1% der Fälle (n=429) wurde eine zum Erhebungszeitpunkt als stark erlebte andauernde Erschöpfung gefunden. Sie stand ohne nachvollziehbare Relation zu tatsächlich vollbrachten Anstrengungen. 159 (37,1%) Patienten dieser Gruppe waren arbeitsunfähig. Sie bildeten die Hauptzielgruppe dieser Untersuchung. Signifikant (P jeweils<0,01) mehr Patienten der Zielgruppe arbeiteten stundenweise, waren überproportional lange arbeitsunfähig (50,9% aller Arbeitsunfähigen mehr als 6 Monate im letzten Jahr) und fühlten sich durch Konflikte mit den Vorgesetzten und/oder Kollegen belastet. Sie klagten häufiger über körperliche Beschwerden, wiesen jedoch keine signifikant häufigere Komorbidität mit psychischen Störungen auf. Subjektiv fühlten sich jedoch nicht die arbeitsfähigen Patienten mit chronischer Müdigkeit mehr belastet, sondern diejenigen, die geringeren Belastungen ausgesetzt waren. Diese hatten im Vergleich zu den Patienten, die arbeitsfähig waren, eine stärkere Fixierung auf somatische Beschwerden, keine adäquate Wahrnehmung von körperlichen und psychischen Empfindungen sowie Schwierigkeiten mit anderen Menschen und mit einer geregelten Tätigkeit zurechtzukommen (P jeweils <0,01). Eine zukünftige prospektive Untersuchung dieser Indiktoren könnte zur Formulierung von Prädiktorvariablen führen, die bei chronischer Müdigkeit Langzeitarbeitsunfähigkeit voraussagen, deren Berücksichtigung zu einer rechtzeitigen sozialmedizinischen Einschätzung und Behandlung beitragen könnte.SummaryThe major goal of this study was to determine indictors of long-term disability for psychosomatic inpatients with chronic fatigue syndrome. To this end, a cross-sectional study was performed with a random sample of patients (n=1000, response rate: 83.9%) at a psychosomatic inpatient clinic. 51.1% of the patients (n=429) reported intensely persistent exhaustion that had no logical relation to actual exertion. 159 (37.1%) patients in this group were disabled from working and these comprised the main target group of this study. Significantly more patients in the target group worked part time, were disabled for a disproportionately long period of time (50.9% of all were disabled for more than 6 months in the previous year), and felt stressed because of conflicts with their superiors and/or colleagues (in each case, P<0.01). While more frequent psychological comorbidity was not found, they reported physical complaints more often. It was not the patients fit for work who felt more burdened with chronic fatigue, but rather the employment-disabled, who were actually exposed to fewer demands. These patients had, in comparison with those fit to work, a stronger fixation on somatic complaints, inadequate perception of physical and psychic sensations, difficulties getting along with other people and in coping with a regular job (in each case, P<0.01). Prospective examination of these indicators could help detect predictor variables for long-term disability in chronic fatigue. Such predictors could contribute to timely social-medical assessment and treatment.

In-patient psychiatric-psychotherapeutic treatment of mothers with a generalized anxiety disorder: Does the co-admission of their children influence the treatment results? A prospective, controlled study

SummaryINTRODUCTION: Whether women who are admitted together with their children achieve inpatient psychotherapeutic treatment results that differ significantly from the results for women who are admitted alone is a subject of controversy. We compared both groups in a prospective, randomized, controlled study. METHODS: The monitored results of 29 female patients diagnosed with generalized anxiety disorder, 15 of whom were admitted with accompanying children and 14 without, were compared (response rate, 95.3%). The period of observation amounted to six weeks. The System Checklist (SCL-90-R) and the Questionnaire of Changes in Experience and Behavior (VEV) were used as instruments of assessment. RESULTS: With respect to co-morbidity and socio-demographic data, both groups were initially comparable. During the course of six-week treatment, no statistically significant differences between the results for mothers with and mothers without accompanying children were measured in any of the tests we used, namely, the VEV (difference, 0.3; 95% CI [–5.4, 6.1]; p = 0.66) and the SCL-90-R, which includes the Global Severity Index (difference, 4.0; 95% CI [–1.4, 9.4]; p = 0.15), and the Anxiety Scale (difference, 0.5; 95% CI [–2.0, 1.0]; p = 0.63). CONCLUSION: The results indicate that mothers with generalized anxiety disorder who were accompanied by their children during inpatient psychotherapeutic treatment achieved treatment results that were just as good as those.of mothers with the same diagnosis who were admitted without children.