Gaby Bleichhardt

Emotional modulation of pain: A clinical perspective.

a Department of Psychosomatic Medicine and Psychotherapy, University of Heidelberg, Central Institute of Mental Health, Mannheim, Germany b Department of Cognitive and Clinical Neuroscience, University of Heidelberg, Central Institute of Mental Health, Mannheim, Germany c Department of Clinical Psychology, Johannes-Gutenberg-University, Mainz, Germany d Institute of Physiology und Pathophysiology, Johannes-Gutenberg-University, Mainz, Germany

Prolonged Grief Disorder, Depression, and Posttraumatic Stress Disorder Among Bereaved Kosovar Civilian War Survivors: a Preliminary Investigation

Background: This study aimed at examining diagnostic concordance between Prolonged Grief Disorder (PGD), Major Depressive Disorder (MDD), and Posttraumatic Stress Disorder (PTSD) among bereaved war survivors who had lost relatives due to war-related violence. Method: We investigated the rates of PGD and its association with PTSD and MDD among 60 bereaved people who had lost first-degree relatives due to war-related violence seven years ago and had also experienced other war-related events. Results: The results indicated that 38.3% of the sample fulfilled the criteria for PGD, 55.0% for PTSD, and 38.3% for MDD. Thirty per cent of the participants without PTSD and 21.6% of those without MDD met criteria for PGD. Women were more likely to have PGD than men. The immediate threat to life was significantly associated with an elevated risk for PTSD and MDD, but not PGD. Conclusion: The findings suggest that many cases of PGD would be missed by an exclusive focus on PTSD among bereaved war survivors.

Hypochondriasis and health anxiety in the German population

Epidemiologic studies on hypochondriasis are very rare and have not been included in large North American community surveys until now. In order to gain information on the prevalence as well as the socio-demographic characteristics of hypochondriasis, the following community study was carried out. Analyses are based on an assessment of 1575 subjects selected by socio-demographic representation criteria for the German community. All subjects completed the Illness Attitude Scales (IAS) and responded to several additional questions on sociodemographics and diagnostic criteria pertaining to Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) hypochondriasis. The IAS is internationally one of the best-established self-rating questionnaires for the assessment of hypochondriasis and health anxiety. Results reveal a 0.4% point prevalence rate of DSM-IV hypochondriasis. In contrast to that, 6% of the German population suffers from severe health anxiety. There are small positive effects for female gender, higher age and lower school education on health anxiety. Subjects with high health anxiety report a much lower health-related quality of life and a higher risk for a type of psychotherapeutic or psychiatric treatment. These results support the development of less restrictive criteria for hypochondriasis and place emphasis on the clinical and socio-economic relevance of health anxiety.

Screening for hypochondriasis with the Illness Attitude Scales.

The Illness Attitude Scales (IAS; Kellner, 1986, 1987) may prove highly useful for the screening of hypochondriasis. We expected the IAS subscales to be equally as effective as the 7-item short version of the Whiteley Index (Whiteley–7; Fink et al., 1999), which has previously been shown to be useful in screening for somatoform disorders. We investigated participants of a German population (n = 1,575) and 61 patients with the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM–IV]; American Psychiatric Association, 1994) diagnosis of hypochondriasis. The Bodily Preoccupations (BP) subscale showed high sensitivity (.92) and specificity (.90) as well as demonstrating convergent and discriminant validity. We found evidence for the superiority of the BP subscale over the Whiteley–7 in the screening of hypochondriasis.

The Factor Structure of the Illness Attitude Scales in A German Population

BackgroundThe illness attitudes scales (IAS) were developed to identify different dimensions of hypochondrical attitudes, fears, beliefs, and abnormal illness behavior (Kellner 1986). Although there are several studies which focus on the scale structure of the IAS, the factor structure has not yet been made quite clear.PurposeTherefore, the aim of this study was to investigate the factor structure of the IAS on a large representative sample.MethodParticipants (N = 1,575) comparable with the general German population regarding sex, age, and education level completed the IAS. For the data analyses, a principal components analyses with subsequent oblique rotations was used.ResultsThe minimum average partial method suggested a three-factor solution. The three factors were named (1) health anxiety, (2) health behavior, and (3) health habits. Internal consistency (Cronbach’s alpha) for the three scales were (1) α = 0.88, (2) α = 0.75, and (3) α = 0.56.ConclusionThe results support previous findings, namely that the IAS factor structure appears to be less complex than originally suggested by the author. For a sample of the general German population, a three-factor solution fit best. Further items should be added to improve the internal consistency, especially for the third scale (health habits).

Gruppentherapie für somatoforme Störungen – Behandlungsleitfaden, Akzeptanz und Prozessqualität

Group Therapy for Somatoform Disorders: Treatment Guidelines, Acceptance, and Process Quality Background: Patients with multiple and chronified somatoform symptoms are difficult to treat in psychotherapeutic settings. Therefore a group intervention has been developed. The acceptability and parts of the process quality are analyzed. Patients and Method: 107 patients with somatization syndrome (at least 8 physical symptoms) were treated in an inpatient setting with an integrative behavioral-cognitive approach. They received an additional standardized group therapy (‘Soma group’) to modify attributions and to develop coping strategies for the symptoms. After each of the 8 group therapy sessions, evaluation questionnaires were filled out. These process data were correlated with baseline data on symptomatology, psychotherapy motivation and outcome data of the 1-year follow-up. Results: The group intervention was highly accepted. More than 90% of patients stayed in therapy and filled out the questionnaires. While the ratings for the first session are medium, from the 2nd session forward ratings are very positive (above 4 on a 1–5 scale) and continuously improve. The initial number of somatoform symptoms only has a small influence on treatment satisfaction. Motivation for psychotherapy at the beginning has no substantial impact, indicating that patients without psychotherapy motivation can develop satisfaction with the treatment as well. Process data on treatment satisfaction are associated with general treatment satisfaction and symptom reduction 1 year later. Discussion: The group intervention seems to be an economic and highly accepted way to develop motivation for psychological treatments in somatoform disorders.

Evaluation von Psychotherapien aus der Perspektive von Qualitätssicherung und Qualitätsmanagement

Dieser Beitrag befasst sich mit methodischen Fragen, die sich aus den Pramissen des Qualitatsmanagements (QM) fur die Evaluation von Psychotherapien unter Routinebedingungen ergeben. Am Beispiel der Poliklinischen Institutsambulanz der Universitat Mainz wird aufgezeigt, welche Anforderungen an den Datenerhebungsprozess zu stellen sind und nach welchen Kennwerten die Therapieergebnisse bewertet werden konnen. Es werden Qualitatskriterien fur Datenqualitat und Erfolgsmase vorgeschlagen. Die Ergebnisqualitat sollte sowohl mit Hilfe von Mittelwertsveranderungen (und dazugehorigen Effektstarken) als auch durch Response- und Remissionsanalysen (Beurteilung des individuellen Ansprechens auf die Therapie) gemessen werden. Entsprechend des Vorgehens in kontrollierten Therapiestudien wird vorgeschlagen, zwischen Intention-to-Treat- und Completer-Analysen zu unterscheiden. Hierfur sind Kriterien erforderlich, nach denen Therapieabschlusse als Abbruch oder regulare Beendigung klassifiziert werden konnen. Anhand eines...

Specificity and Modifiability of Cognitive Biases in Hypochondriasis.

OBJECTIVE According to cognitive-behavioral models of hypochondriasis (HYP), biased attentional and memory processes related to health threat stimuli are crucial for the development and maintenance of severe health anxiety. Little is known about the specificity, temporal stability, and modifiability of these biases via psychotherapy. METHOD In an emotional Stroop and subsequent recognition task, the authors compared attention and memory processes for health-related words (illnesses, bodily complaints, and panic-related words) in patients with HYP (n = 32), other somatoform disorders (SFD; n = 27), and panic disorder (PD; n = 25). A control group consisted of 31 healthy participants (CG). All patients were reexamined after 4 months of cognitive-behavioral therapy (CBT). RESULTS Patients with HYP showed a significant attentional bias toward all 3 target word categories. Evidence for a specific bias was found only for the PD group. General recognition performance for health threat and neutral words was best in the HYP group. After therapy, attentional bias had clearly decreased in the HYP and SFD patients. CONCLUSIONS Patients with HYP can be characterized by attentional bias and more elaborate verbal processing. These irregularities tend to disappear after psychotherapy.

Hypochondriasis, somatoform disorders, and anxiety disorders: sociodemographic variables, general psychopathology, and naturalistic treatment effects.

Abstract The question of whether hypochondriasis (HYP) should be considered a somatoform disorder (SFD) or classified as an anxiety disorder (ANX) has recently been raised. To empirically provide information on this issue, we compared patients with HYP (n = 65) with those with other SFDs (n = 94) and those with ANX (n = 224) regarding sociodemographic and biographical variables, general psychopathology, and naturalistic cognitive-behavioral therapy treatment effects. Compared with SFD, patients with HYP were younger and had fewer comorbid affective disorders and less impaired life domains, suggesting a closer connection between HYP and ANX. Regarding cognitive-behavioral therapy treatment effects, all diagnostic groups showed comparable significant improvement (d = 0.44–0.64). According to level of anxiety, the SFD sample had significantly lower pretreatment scores than did the ANX and the HYP samples. The results suggest that patients with HYP have an interim position between SFD and ANX, with slightly closer connections to ANX.

Erweiterung der kognitiven Verhaltenstherapie um Emotionsregulationstraining bei Patienten mit multiplen somatoformen Symptomen: Ergebnisse einer kontrollierten Pilotstudie

Hintergrund: Kognitive Verhaltenstherapie (KVT) ist bei Patienten mit multiplen somatoformen Symptomen (MSS) erwiesenermaßen wirksam, bisher jedoch nur mit moderaten Effekten. Da sich bei diesen Patienten Hinweise für ein Emotionswahrnehmungsdefizit und Regulationsdefizit finden, wurde an der Universität Marburg ein Behandlungsmanual für Patienten mit MSS entwickelt, das KVT-Elemente und ein spezielles Emotionsregulationstraining verbindet. In diesem soll der Umgang mit Emotionen durch Strategien der bewertungsfreien Wahrnehmung, Akzeptanz und Achtsamkeit gefördert werden. Ziel der vorliegenden Studie war, die Durchführbarkeit des Behandlungsprogramms ENCERT (Enriching CBT with Emotion Regulation Training) zu testen sowie die Veränderungen über die Zeit unter ENCERT mit denen einer klassischen KVT zu vergleichen. Patienten und Methoden: 20 ENCERT-Patienten und 22 KVT-Patienten (mit ≥3 somatoformen Symptomen, seit ≥6 Monaten) nahmen im Rahmen einer nicht randomisierten Gruppenvergleichsstudie an 20 wöchentlichen Einzeltherapiesitzungen im ambulanten Setting teil. Zu Therapiebeginn und -ende wurden relevante Daten erhoben. Die primären Outcomemaße waren das Screening für somatoforme Störungen (SOMS-7T), der Fragebogen zur Selbsteinschätzung emotionaler Kompetenzen (SEK-27) und visuelle Analogskalen (VAS) zur Einschätzung der Symptomintensität und zur empfundenen Beeinträchtigung. Ergebnisse: Beide Gruppen verbesserten sich im Therapieverlauf signifikant bezüglich der Beeinträchtigungsintensität (ENCERT d = 0,70; KVT d = 0,46) und Beschwerdeanzahl (ENCERT d = 0,72; KVT d = 0,50). Gruppenunterschiede zu Therapieende zeigten sich nicht: Unter Berücksichtigung klinisch relevanter Baselinevariablen zeigte sich zu Therapieende ein Hinweis auf einen signifikanten Unterschied in der Beeinträchtigungsintensität (ANCOVA: F (1,37) = 4,058, p = 0,051; ENCERT überlegen). ENCERT-Patienten verbesserten sich zudem signifikant auf stündlich erhobenen visuellen Analogskalen (Beschwerdeintensität d = 0,59; Beeinträchtigung durch Beschwerden d = 1,25) und in ihren Emotionsregulationskompetenzen (d = 1,14). Schlussfolgerung: Patienten mit MSS verbesserten sich während ENCERT und KVT, mit tendenziell höheren Effektstärken für ENCERT, jedoch auch höheren Ausgangswerten in Depressivität und Angst. Gruppenunterschiede zeigten sich nicht, möglicherweise aufgrund geringer Power. Diese Ergebnisse ermutigen zur Durchführung einer größeren randomisierten und kontrollierten Multicenterstudie.