Jochen Schweitzer

If Every Fifth Physician Is Affected by Burnout, What About the Other Four? Resilience Strategies of Experienced Physicians

Purpose To identify health-promoting strategies employed by experienced physicians in order to define prototypical resilience processes and key aspects of resilience-fostering preventive actions. Method From January 2010 to March 2011, the authors conducted 200 semistructured interviews with physicians of different ages, disciplines, and hierarchical status from across Germany. The interview transcripts were analyzed according to the Content Analysis method. Results Analysis revealed 30 subcodes in three dimensions: (1) job-related gratifications derived from treatment interactions, (2) practices, such as leisure-time activities, self-demarcation, limitation of working hours, and continuous professional development, and (3) attitudes, such as acceptance of professional and personal boundaries, a focus on positive aspects of work, and personal reflexivity. Conclusions The reported strategies and attitudes helped to develop mental, physical, and social resource pools that fostered effective decision making. Successful coping, in turn, encouraged the maintenance of resilience-promoting abilities. In relation to Conservation of Resources Theory, physician resilience emerged as the ability to invest personal resources in a way that initiates positive resource spirals in spite of stressful working conditions. Enriching traditional stress management approaches with the dynamic of positive as well as negative resource spirals would thus appear to be a promising approach.

The Efficacy of Systemic Therapy for Childhood and Adolescent Externalizing Disorders: A Systematic Review of 47 RCT

Systemic (family) therapy is a widely used psychotherapy approach. However, most systematic efficacy reviews have focused solely on family-based treatment rather than on the theoretic orientation systemic therapy. We systematically review trials on the efficacy of systemic therapy for the treatment of childhood and adolescent externalizing disorders. All randomized (or matched) controlled trials (RCT) evaluating systemic/systems-oriented therapy in various forms (family, individual, group, multi-family group therapy) with child or adolescent index patients (0-17xa0years) suffering from mental disorders were identified by data base searches and cross-references. Inclusion criteria were as follows: index patient diagnosed with a DSM- or ICD-listed mental disorder, and trial published in any language up to the end of 2011. The RCTs were analyzed for their research methodology, interventions applied, and results (postintervention; follow-up). A total of 47 trials from the United States, Europe, and China, published in English, German, and Mandarin, were identified. A total of 42 of them showed systemic therapy to be efficacious for the treatment of attention deficit hyperactivity disorders, conduct disorders, and substance use disorders. Results were stable across follow-up periods of up to 14xa0years. There is a sound evidence base for the efficacy of systemic therapy for children and adolescents (and their families) diagnosed with externalizing disorders.

Family constellation seminars improve psychological functioning in a general population sample: results of a randomized controlled trial.

The study examined the efficacy of nonrecurring family constellation seminars on psychological health. We conducted a monocentric, single-blind, stratified, and balanced randomized controlled trial (RCT). After choosing their roles for participating in a family constellation seminar as either active participant (AP) or observing participant (OP), 208 adults (M = 48 years, SD = 10; 79% women) from the general population were randomly allocated to the intervention group (IG; 3-day family constellation seminar; 64 AP, 40 OP) or a wait-list control group (WLG; 64 AP, 40 OP). It was predicted that family constellation seminars would improve psychological functioning (Outcome Questionnaire OQ-45.2) at 2-week and 4-month follow-ups. In addition, we assessed the impact of family constellation seminars on psychological distress and motivational incongruence. The IG showed significantly improved psychological functioning (d = 0.45 at 2-week follow-up, p = .003; d = 0.46 at 4-month follow-up, p = .003). Results were confirmed for psychological distress and motivational incongruence. No adverse events were reported. This RCT provides evidence for the efficacy of family constellation in a nonclinical population. The implications of the findings are discussed.

Improving Experience in Personal Social Systems through Family Constellation Seminars: Results of a Randomized Controlled Trial

This study examined the efficacy of family constellation seminars (FCSs) on individuals experience in their personal social systems, especially the experience of belonging, autonomy, accord, and confidence. We conducted a single-blind, stratified and balanced, randomized controlled trial. Participants were 208 adults (M = 48 years, SD = 10, 79% women) who were randomly allocated either to the intervention group (3-day FCSs; 64 active participants, 40 observing participants) or to the wait-list group (64 active participants, 40 observing participants). Change was measured short-term (2-week and 4-month follow-up) using the Experience In Social Systems Questionnaire, personal domain (EXIS.pers). EXIS.pers is a new outcome measure being applied for the first time in evaluation research. In addition, we used interpersonal scales derived from established measures (Outcome Questionnaire, OQ-45; Tool for the Evaluation of the Psychotherapeutic Progress, FEP). The average person in the intervention group showed improved experience in personal social systems, as compared with approximately 73% of the wait-list group after 2 weeks (total score: Cohens d = .61, p = .000) and 69% of the wait-list group after 4 months (total score: d = .53, p = .000). The results were confirmed in per-protocol analyses (n = 191) by the results of the EXIS.pers dimensions (Belonging, Autonomy, Accord, and Confidence) and the interpersonal scales derived from the OQ-45 and FEP. No adverse events were reported. This RCT provides first evidence that FCSs tend to positively influence participants experience in their social systems.

The Experience in Personal Social Systems Questionnaire (EXIS.pers): development and psychometric properties

This study presents the theoretical background, development, and psychometric properties of the German and English versions of the Experience in Personal Social Systems Questionnaire (EXIS.pers). It assesses how the members of a personal social system experience their situation within that system. It is designed as a research tool for interventions in which only one member of the system participates (e.g., Family Constellation Seminars). The EXIS.pers was created to measure change on the individual level relating to ones own important personal social system. In Study 1, we used exploratory factor analysis (EFA) for latent variable identification of the original German EXIS.pers (nxa0=xa0179). In Studies 2 and 3, we used confirmatory factor analysis (CFA) to examine the dimensionality of the German (nxa0=xa0634) and English (nxa0=xa0310) EXIS.pers. Internal consistencies and cross-cultural structural equivalence were assessed. EFA indicated that a four-factor model provided best fit for the German EXIS.pers. For both the German and English EXIS.pers, CFA provided the best fit for a five-factor bi-level model that included a general factor (Experience In Personal Social Systems) and four dimensions (Belonging, Autonomy, Accord, Confidence). Good internal consistencies, external associations, and cross-cultural structural equivalence were demonstrated. This study provides first evidence for the German and English EXIS.pers as an economical and reliable measure of an individuals experience within his or her personal social systems.

An investigation of the mediating role of personality and family functioning in the association between attachment styles and eating disorder status

BackgroundThis study examined relationships between attachment style, eating disorders (EDs), personality variables and family functioning.MethodsIn our study, 253 women (Mu2009=u200925.72xa0years, SDu2009=u20098.73) were grouped into one of four categories either according to self-reported ED diagnosis or by exceeding cut-offs for a clinical diagnosis on the Eating Disorder Examination Questionnaire (EDE-Q) or Short Evaluation of Eating Disorders (SEED): anorexia nervosa (AN), bulimia nervosa (BN), other eating disorder (O-ED), no eating disorder (Non-ED). The ED group (AN, BN, O-ED) included 106 women (Mu2009=u200924.74xa0years, SDu2009=u20097.71), and the Non-ED group 147 women (Mu2009=u200926.42xa0years, SDu2009=u20099.37). Approximately half of the ED group had a comorbid disorder (59.4xa0%), while the majority of the Non-ED group had no psychological disorder (89.1xa0%).ResultsParticipants with an ED were significantly more often insecurely attached (Adult Attachment Scale; AAS), emotionally unstable, less extraverted (Big-Five-Test of Personality; B5T) and showed less positive family functioning (Experiences in Personal Social Systems Questionnaire; EXIS.pers). Results showed partial mediation for attachment and EDs through neuroticism, extraversion and family functioning.DiscussionThe study found further evidence for elevated problems with attachment, personality, and family experiences in individuals with EDs, while suggesting mechanisms that may link these constructs. Implications for research and practice were discussed.ConclusionThis study supports findings that acknowledge the mediating role played by personality factors and family functioning in the relationship between attachment and EDs.

Mid‐ and Long‐Term Effects of Family Constellation Seminars in a General Population Sample: 8‐ and 12‐Month Follow‐Up

In a previous randomized controlled trial (RCT), short-term efficacy of family constellation seminars (FCSs) in a general population sample was demonstrated. In this article, we examined mid- and long-term stability of these effects. Participants were 104 adults (Mxa0=xa047xa0years; SDxa0=xa09; 84% female) who were part of the intervention group in the original RCT (3-day FCS; 64 active participants and 40 observing participants). FCSs were carried out according to manuals. It was predicted that FCSs would improve psychological functioning (Outcome Questionnaire OQ-45.2) at 8- and 12-month follow-up. Additionally, we assessed the effects of FCSs on psychological distress, motivational incongruence, individuals experience in their personal social systems, and overall goal attainment. Participants yielded significant improvement in psychological functioning (dxa0=xa00.41 at 8-month follow-up, pxa0=xa0.000; dxa0=xa00.40 at 12-month follow-up, pxa0=xa0.000). Results were confirmed for psychological distress, motivational incongruence, the participants experience in their personal social systems, and overall goal attainment. No adverse events were reported. This study provides first evidence for the mid- and long-term efficacy of FCSs in a nonclinical population. The implications of the findings are discussed.

Comparing systemic therapy and cognitive behavioral therapy for social anxiety disorders: study protocol for a randomized controlled pilot trial

BackgroundSocial anxiety disorders are among the most prevalent anxiety disorders in the general population. The efficacy of cognitive behavioral therapy (CBT) for social anxiety disorders is well demonstrated. However, only three studies point to the efficacy of systemic therapy (ST) in anxiety disorders, and only two of them especially focus on social anxiety disorders. These ST studies either do not use a good comparator but minimal supportive therapy, they do not use axa0multi-person ST but a combined therapy, or they do not especially focus on social anxiety disorders but mood and anxiety disorders in general. Though ST was approved as evidence based in Germany for a variety of disorders in 2008, evidence did not include anxiety disorders. This is the first pilot study that will investigatexa0multi-person ST, integrating a broad range of systemic methods, specifically for social anxiety disorders and that will compare ST to the gold standard CBT.DesignThis article describes the rationale and protocol of a prospective, open, interventive, balanced, bi-centric, pilot randomized controlled trial (RCT). A total of 32 patients with a primary SCID diagnosis of social anxiety disorder will be randomized to either CBT or ST. Both treatments will be manualized.The primary outcome will include social anxiety symptoms at the end of therapy. Therapy will be restricted to no more than 26xa0hours (primary endpoint). Secondary outcomesxa0will include psychological, social systems and interpersonal functioning, symptom adjustment, and caregiver burden, in addition to change measures, therapist variables and treatment adherence. At the secondary endpoints, 9 and 12xa0months after the beginning of therapy, we will again assess all outcomes.DiscussionThe study is expected to pilot test a RCT which will be the first to directly compare CBT and multi-person ST, integrating a broad range of systemic methods, for social anxiety disorders, and it will provide empirical evidence for the calculation of the number of patients needed for a confirmatory RCT.Trial registrationClinicalTrials.gov: NCT02360033; date of registration: 21 January 2015.

Changing Me, Changing Us: Relationship Quality and Collective Efficacy as Major Outcomes in Systemic Couple Therapy

We examine the sensitivity to change in the Evaluation of Social Systems (EVOS) scale, which assesses relationship quality and collective efficacy. In Study 1 we conducted a waitlist-control, short-term couple therapy RCT study (Nxa0=xa043 couples) with five systemic therapy sessions treating communication and partnership problems; our intent was to provide high external validity. Construct validity of EVOS was assessed by comparison with additionally applied scales (Family Scales; Outcome Questionnaire, OQ-45.2). In Study 2, Nxa0=xa0332 individuals completed an experiment with high internal validity in order to verify sensitivity to change in three different social contexts. Results from Study 1 revealed a significant increase in relationship quality in the treatment group directly after treatment, as compared to the control group. Sensitivity to change was slightly better for EVOS than for other measures. While this positive change could not be fully sustained between posttreatment and a 4-week follow-up, EVOS score did not fall below baseline and pretreatment levels, supporting moderate-to-large sensitivity to change. Study 2 supported high sensitivity to change in EVOS for couple relations, family relations, and work-team relationships. Therefore, EVOS can be used as an outcome measure to monitor the process of systemic interventions focusing on relationship quality and collective efficacy. Due to its sensitivity to change, EVOS can provide evidence for treatment success with regard to relationship aspects.

When Significant Others Suffer: German Validation of the Burden Assessment Scale (BAS)

There is a need of an economical, reliable, and valid instrument in the German-speaking countries to measure the burden of relatives who care for mentally ill persons. We translated the Burden Assessment Scale (BAS) and conducted a study investigating factor structure, psychometric quality and predictive validity. We used confirmative factor analyses (CFA, maximum-likelihood method) to examine the dimensionality of the German BAS in a sample of 215 relatives (72% women; M = 32 years, SD = 14, range: 18 to 77; 39% employed) of mentally ill persons (50% (ex-)partner or (best) friend; M = 32 years, SD = 13, range 8 to 64; main complaints were depression and/or anxiety). Cronbach’s α determined the internal consistency. We examined predictive validity using regression analyses including the BAS and validated scales of social systems functioning (Experience In Social Systems Questionnaire, EXIS.pers, EXIS.org) and psychopathology (Brief Symptom Inventory, BSI). Variables that might have influenced the dependent variables (e.g. age, gender, education, employment and civil status) were controlled by their introduction in the first step, and the BAS in the second step of the regression analyses. A model with four correlated factors (Disrupted Activities, Personal Distress, Time Perspective, Guilt) showed the best fit. With respect to the number of items included, the internal consistency was very good. The modified German BAS predicted relatives’ social systems functioning and psychopathology. The economical design makes the 19-item BAS promising for practice-oriented research, and for studies under time constraints. Strength, limitations and future directions are discussed.