Johannes Mander

Stages of change, treatment outcome and therapeutic alliance in adult inpatients with chronic anorexia nervosa

BackgroundAnorexia nervosa (AN) is associated with high rates of chronicity and relapse risk is a considerable therapeutic challenge in the disorder. The aim of the present study was to investigate the association of stages of change and outcome with a focus on the relapse struggle in the maintenance stage in patients with predominantly chronic AN. Further, therapeutic alliance and stages of change associations were explored.MethodsAs an instrument measuring relapse struggle in the maintenance stage, we applied the short form of the University of Rhode Island Change Assessment-Short (URICA-S). We assessed stages of change in 39 patients with a predominantly chronic course of AN in early, middle, and late stages of inpatient psychotherapy. General symptom severity as assessed by the SCL-90-R and weight change were investigated as outcome measures.ResultsIn-line with earlier evidence, contemplation significantly predicted therapeutic alliance. Further, we demonstrated that relapse risk as operationalized by URICA-S maintenance is an important predictor of general psychopathology. BMI change was not predicted by stages of change.ConclusionsThe URICA-S maintenance scale might be applied to help identify patients at relapse risk. High URICA-S maintenance scores could be considered as one critical aspect of AN patients who might especially benefit from relapse-preventing aftercare programs.

Change mechanisms in psychotherapy: Multiperspective assessment and relation to outcome

Abstract The study aimed at constructing a reliable and valid post-session questionnaire measuring general change mechanisms of psychotherapy with correspondent versions for patient and therapist perspectives. Therefore, 253 inpatients in early, middle, and late stages of psychotherapy completed the newly developed Scale for the Multiperspective Assessment of General Change Mechanisms in Psychotherapy (SACiP) and diverse outcome measures. The psychometric qualities of the SACiP were excellent as shown by (a) exploratory factor analyses on patient and therapist ratings, (b) confirmatory factor analyses on later measuring times, and (c) high internal consistencies. Supporting construct validity, the SACiP predicted outcome, as shown by correlational analyses and mixed effects modeling. Patient evaluations of change mechanisms were better predictors of outcome than the corresponding therapist evaluations.

The Individual Therapy Process Questionnaire: Development and Validation of a Revised Measure to Evaluate General Change Mechanisms in Psychotherapy

There is a dearth of measures specifically designed to assess empirically validated mechanisms of therapeutic change. To fill in this research gap, the aim of the current study was to develop a measure that covers a large variety of empirically validated mechanisms of change with corresponding versions for the patient and therapist. To develop an instrument that is based on several important change process frameworks, we combined two established change mechanisms instruments: the Scale for the Multiperspective Assessment of General Change Mechanisms in Psychotherapy (SACiP) and the Scale of the Therapeutic Alliance-Revised (STA-R). In our study, 457 psychosomatic inpatients completed the SACiP and the STA-R and diverse outcome measures in early, middle and late stages of psychotherapy. Data analyses were conducted using factor analyses and multilevel modelling. The psychometric properties of the resulting Individual Therapy Process Questionnaire were generally good to excellent, as demonstrated by (a) exploratory factor analyses on both patient and therapist ratings, (b) CFA on later measuring times, (c) high internal consistencies and (d) significant outcome predictive effects. The parallel forms of the ITPQ deliver opportunities to compare the patient and therapist perspectives for a broader range of facets of change mechanisms than was hitherto possible. Consequently, the measure can be applied in future research to more specifically analyse different change mechanism profiles in session-to-session development and outcome prediction. Key Practitioner Message This article describes the development of an instrument that measures general mechanisms of change in psychotherapy from both the patient and therapist perspectives. Post-session item ratings from both the patient and therapist can be used as feedback to optimize therapeutic processes. We provide a detailed discussion of measures developed to evaluate therapeutic change mechanisms.

A meta‐analysis of the relation between therapeutic alliance and treatment outcome in eating disorders

The therapeutic alliance has demonstrated an association with favorable psychotherapeutic outcomes in the treatment of eating disorders (EDs). However, questions remain about the inter-relationships between early alliance, early symptom improvement, and treatment outcome. We conducted a meta-analysis on the relations among these constructs, and possible moderators of these relations, in psychosocial treatments for EDs. Twenty studies met inclusion criteria and supplied sufficient supplementary data. Results revealed small-to-moderate effect sizes, βs = 0.13 to 0.22 (p < .05), indicating that early symptom improvement was related to subsequent alliance quality and that alliance ratings also were related to subsequent symptom reduction. The relationship between early alliance and treatment outcome was partially accounted for by early symptom improvement. With regard to moderators, early alliance showed weaker associations with outcome in therapies with a strong behavioral component relative to nonbehavioral therapies. However, alliance showed stronger relations to outcome for younger (vs. older) patients, over and above the variance shared with early symptom improvement. In sum, early symptom reduction enhances therapeutic alliance and treatment outcome in EDs, but early alliance may require specific attention for younger patients and for those receiving nonbehaviorally oriented treatments.

Patients With Depression, Somatoform Disorders, and Eating Disorders on the Stages of Change: Validation of a Short Version of the URICA

The study aimed at constructing a time-efficient short version of the University of Rhode Island Change Assessment (URICA), and at exploring differences in the stages of change between patients with depression, somatoform disorders, and eating disorders across the course of therapy. The URICA and diverse outcome measures were administered to 253 patients in early-, middle-, and late stages of inpatient therapy. The factor structure of the short form of the URICA (URICA-S) was excellent as shown by (1) an exploratory factor analysis on a randomized one-half of the sample, (2) a confirmatory factor analysis on the other half of the sample, and (3) a stable factor structure over a 6-week interval. The resulting factors of the URICA-S were called precontemplation, contemplation, action, and maintenance. The internal consistencies of the URICA-S factors were sufficient to excellent. Supporting the criterion-related validity, the URICA-S predicted relevant outcome measures. Analyses of variance showed that the ratings on the action and the maintenance factors were differentially associated with outcome in patients with depression, somatoform disorders, and eating disorders. These findings implicate that a disorder-specific combination of action and relapse-prevention-oriented interventions might optimize outcome in inpatients with different psychiatric disorders.

Associations between Grawe's general mechanisms of change and Young's early maladaptive schemas in psychotherapy research: a comparative study of change processes.

Abstract Objective: The study aimed at analyzing associations between Grawes general mechanisms of change and Youngs early maladaptive schemas (EMS). Method: Therefore, 98 patients completed the Scale for the Multiperspective Assessment of General Change Mechanisms in Psychotherapy (SACiP), the Young Shema Questionnaire-Short Form Revised (YSQ S3R), and diverse outcome measures at the beginning and end of treatment. Results: Our results are important for clinical applications, as we demonstrated strong predictive effects of change mechanisms on schema domains using regression analyses and cross-lagged panel models. Conclusions: Resource activation experiences seem to be especially crucial in fostering alterations in EMS, as this change mechanism demonstrated significant associations with several schema domains. Future research should investigate these aspects in more detail using observer-based micro-process analyses.

Motivational Interviewing – Hintergründe, Methode, Möglichkeiten

Der Leser soll nach der Durcharbeitung des Artikels kennen: ▶ die Herkunft von Motivational Interviewing (MI) und seinen Bezug zum transtheoretischen Modell ▶ die Unterschiede zwischen MI und anderen motivationalen Ansätzen ▶ Indikationen und Anwendungsbereiche vonMI ▶ theoretische Hintergründe des MI ▶ Basisprinzipien im MI Der Leser soll nach der Durcharbeitung des Artikels übertragen und beginnend praktisch anwenden können: ▶ Einschätzen der Veränderungsbereitschaft eines Patienten ▶ Einsetzen der Basisprinzipien im ärztlichen Gespräch ▶ Übertragen der therapeutischen Grundhaltung und Einsatz des Basisverhaltens ▶ Einsatz von Techniken zum Hervorrufen von Change-Talk ▶ Anpassung der therapeutischen Strategie an die Veränderungsbereitschaft des Patienten

Effects of mindfulness exercises as stand-alone intervention on symptoms of anxiety and depression: Systematic review and meta-analysis

Mindfulness-based interventions (MBIs) are currently well established in psychotherapy with meta-analyses demonstrating their efficacy. In these multifaceted interventions, the concrete performance of mindfulness exercises is typically integrated in a larger therapeutic framework. Thus, it is unclear whether stand-alone mindfulness exercises (SAMs) without such a framework are beneficial, as well. Therefore, we conducted a systematic review and meta-analysis regarding the effects of SAMs on symptoms of anxiety and depression. Systematic searching of electronic databases resulted in 18 eligible studies (n = 1150) for meta-analyses. After exclusion of one outlier SAMs had small to medium effects on anxiety (SMD = 0.39; CI: 0.22, 0.56; PI: 0.07, 0.70; p < .001, I2 = 18.90%) and on depression (SMD = 0.41; CI: 0.19, 0.64; PI: -0.05, 0.88; p < .001; I2 = 33.43%), when compared with controls. Summary effect estimates decreased, but remained significant when corrected for potential publication bias. This is the first meta-analysis to show that the mere, regular performance of mindfulness exercises is beneficial, even without being integrated in larger therapeutic frameworks.

Theorie-Praxis-Netzwerke in verhaltenstherapeutischer Ausbildung: Schulung, Selbsterfahrung und Einsatz in der Therapie am Beispiel von Achtsamkeit

Hintergrund: Die Bausteine der theoretischen und praktischen verhaltenstherapeutischen Ausbildung finden selten direkt aufeinander bezogen statt. Die stärkere Vernetzung von Schulung, Übungsintervall und Einsatz in der Therapie von relevanten therapeutischen Interventionen ist wünschenswert. Am Beispiel einer Untersuchung von Achtsamkeitsinterventionen wurde im vorliegenden Manuskript der Versuch unternommen, dieses Thema zu adressieren. Methodik: 27 Ausbildungstherapeuten führten Achtsamkeits-Workshops mit Selbsterfahrungsintervallen durch. Darauf aufbauend wurden bei 36 Patienten standardisierte sitzungseinleitende Übungen mit Achtsamkeitselementen direkt in die Ausbildungstherapien integriert. Das Programm wurde auf Akzeptanz, Durchführbarkeit und Effektivität überprüft. Die Symptomreduktion (Beck Depression Inventory (BDI-II), Brief Symptom Inventory (BSI)) von Probatorik zur 15. Therapiesitzung wurde varianzanalytisch mit Patienten der Routineversorgung als Kontrollgruppe verglichen. Ergebnisse: In qualitativen Interviews zeigten sich positive Achtsamkeitserfahrungen. Generell waren Akzeptanz und Durchführbarkeit des Theorie-Praxis-Netzwerks hoch. Laut Aussagen der Ausbildungstherapeuten wurden hier sinnvolle Schnittstellen zwischen theoretischer und praktischer Ausbildung realisiert. Bezüglich der Symptomreduktion zeigten sich für Patienten der Achtsamkeitsgruppe und Routineversorgung ähnliche Effektstärken, hier bestanden keine signifikanten Unterschiede. Schlussfolgerung: Die Kombination aus Achtsamkeits-Workshops und darauf aufbauenden sitzungseinleitenden Übungen wurde als sinnvoll erlebt, zeigte allerdings keine stärkeren klinischen Effekte als die Routineversorgung. Zukünftige Forschung sollte Theorie-Praxis-Netzwerke in anderen Bereichen (z.B. Progressive Muskelrelaxation, Compassion) untersuchen. Zusätzlich zu positiven Durchführbarkeits- und Akzeptanzbefunden könnten dort auch klinisch relevante Effekte identifizierbar sein.

Development and psychometric validation of the ‘Parent Perspective University of Rhode Island Change Assessment-Short’ (PURICA-S) Questionnaire for the application in parents of children with overweight and obesity

Introduction High prevalence rates of childhood obesity urgently call for improved effectiveness of intervention programmes for affected children and their families. One promising attempt can be seen in tailoring interventions according to the motivational stages of parents as ‘agents of change’ for their children. Evidence from other behavioural contexts (eg, addiction) clearly shows the superiority of motivational-stage dependent tailored (behavioural) interventions. For the time-efficient assessment of motivational stages of change, this study aims to develop and psychometrically validate a ‘Parent Perspective Version’ of the existing University of Rhode Island Change Assessment-Short, an instrument assessing the motivational stages based on the theoretical fundamentals of the Transtheoretical Model of Psychotherapy. Methods and analysis In a multistep Delphi procedure, involving experts from the study context, the original items of the University of Rhode Island Change Assessment-Short Questionnaire will be transformed from the ‘self-perspective’ (‘I am having a problem’) to the parent perspective (‘my child is having a problem’). Following item adaptation, the new version of the questionnaire will be psychometrically validated in a cohort of N=300 parents with overweight or obese children. Parents will be recruited within a multicentre and multisite approach involving private paediatric practices, specialised outpatient clinics as well as inpatient and rehabilitation sites. Analyses will include confirmatory factor analyses, internal consistencies (reliability) as well as convergent and criterion validity. Convergent validity will be analysed using subscales of the HAKEMP-90 Questionnaire, an instrument which has been shown to differentiate between ‘state’ and ‘action’ orientation of individuals. Ethics and dissemination This study has been granted ethics committee approval by the University of Tuebingen (number 644/2014BO2). The results of this study will be released to the participating study centres and will be submitted to peer-reviewed journals and presented at international conferences. Trial registration number VfD_PURICA-S_15_003607.