Lena Krämer

Correlates of reduced exercise behaviour in depression: The role of motivational and volitional deficits

Objective: The study aimed at uncovering the correlates of reduced exercise in depressive patients. On the basis of the Health Action Process Approach (Schwarzer, 2011), we hypothesised that reduced exercise in depressive patients can be explained by motivational deficits and volitional deficits. Design: A longitudinal sample of 56 clinically depressive outpatients was compared to a sample of 56 parallelised non-depressive controls. Main outcome measures: Self-reported intention, exercise, and motivational and volitional HAPA variables were measured with self-report questionnaires at baseline and four-week follow-up. Results: Depressive patients showed a motivational deficit: they had significantly reduced intentions to exercise compared to non-depressive participants, and they suffered from reduced self-efficacy and increased negative outcome expectations. No differences were found with regard to positive outcome expectations. Depressive patients also showed a volitional deficit: depressive high-intenders were less capable of transforming their intention into action than non-depressive high-intenders. They produced less action plans, had less maintenance self-efficacy and were more easily distracted by barriers. Conclusion: The lower level of exercise among depressive patients is partly due to motivational, partly to volitional deficits. Interventions should be stage-matched and should focus on pessimistic beliefs (negative outcome expectations, self-efficacy) and planning deficits in depression.

Non-traumatic subdural hematoma secondary to septic brain embolism: A rare cause of unexpected death in a drug addict suffering from undiagnosed bacterial endocarditis

Acute subdural hematomas are mostly due to blunt traumatization of the head. In rare instances, subdural bleeding occurs without evidence of a previous trauma following spontaneous hemorrhage, e.g. from a ruptured aneurysm or an intracerebral hematoma perforating the brain surface and the arachnoid. The paper presents the morphological, microbiological and toxicological findings in a 38-year-old drug addict who was found by his partner in a dazed state. When brought to a hospital, he underwent trepanation to empty a right-sided subdural hematoma, but he died already 4h after admission. Autopsy revealed previously undiagnosed infective endocarditis of the aortic valve as well as multiple infarctions of brain, spleen and kidneys obviously caused by septic emboli. The subdural hematoma originated from a subcortical brain hemorrhage which had perforated into the subdural space. Microbiological investigation of the polypous vegetations adhering to the aortic valve revealed colonization by Streptococcus mitis and Klebsiella oxytoca. According to the toxicological analysis, no psychotropic substances had contributed to the lethal outcome. The case reported underlines that all deaths of drug addicts should be subjected to complete forensic autopsy, as apart from intoxications also natural and traumatic causes of death have to be taken into consideration.

Handlungsplanung, Barrieren und Barrierenmanagement

Neben der Festigung der Motivation sollte das Ziel jeder Reha-Masnahme darin bestehen, Patienten in ihren Fahigkeiten zur Umsetzung ihrer Motivation zu unterstutzen. In diesem Kapitel wird eine Reihe an Masnahmen vorgestellt, die veranschaulichen, wie Patienten auf ihrem Weg von der Absicht zur Umsetzung unterstutzt werden konnen. Im Fokus stehen dabei Masnahmen zur Handlungsplanung (was mochte ich tun? wo? wann? wie? mit wem?), Antizipation von Barrieren (welche Situationen konnen vom Handlungsplan abhalten?) und zum Barrierenmanagement (wie kann mit Barrieren umgegangen werden?). Zusatzlich werden Masnahmen zur Steigerung von Selbstbeobachtung, -bewertung und -belohnung sowie Strategien zum Umgang mit Misserfolg vorgestellt.

Effectiveness and acceptance of a web-based depression intervention during waiting time for outpatient psychotherapy: study protocol for a randomized controlled trial

BackgroundDue to limited resources, waiting periods for psychotherapy are often long and burdening for those in need of treatment and the health care system. In order to bridge the gap between initial contact and the beginning of psychotherapy, web-based interventions can be applied. The implementation of a web-based depression intervention during waiting periods has the potential to reduce depressive symptoms and enhance well-being in depressive individuals waiting for psychotherapy.MethodsIn a two-arm randomized controlled trial, effectiveness and acceptance of a guided web-based intervention for depressive individuals on a waitlist for psychotherapy are evaluated. Participants are recruited in several German outpatient clinics. All those contacting the outpatient clinics with the wish to enter psychotherapy receive study information and a depression screening. Those adults (age ≥ 18) with depressive symptoms above cut-off (CES-D scale > 22) and internet access are randomized to either intervention condition (treatment as usual and immediate access to the web-based intervention) or waiting control condition (treatment as usual and delayed access to the web-based intervention). At three points of assessment (baseline, post-treatment, 3-months-follow-up) depressive symptoms and secondary outcomes, such as quality of life, attitudes towards psychotherapy and web-based interventions and adverse events are assessed. Additionally, participants’ acceptance of the web-based intervention is evaluated, using measures of intervention adherence and satisfaction.DiscussionThis study investigates a relevant setting for the implementation of web-based interventions, potentially improving the provision of psychological health care. The results of this study contribute to the evaluation of innovative and resource-preserving health care models for outpatient psychological treatment.Trial registrationThis trial has been registered on 13 February 2017 in the German clinical trials register (DRKS); registration number DRKS00010282.

Niedrigintensive Interventionen zur Reduktion depressiver Symptome vor Beginn einer ambulanten Psychotherapie

Psychotherapeutic resources are limited, leading to prolonged waiting periods prior to outpatient psychotherapy. Low-intensity interventions have the potential to bridge such treatment gaps. This systematic review aims to identify interventions targeting depressive symptoms implemented prior to outpatient psychotherapy, and to assess their effectiveness and acceptance. 22 studies were identified. Interventions were classified as active waiting, self-help, guided self-help, brief single-strand interventions, and low-intensity psychotherapy. Evidence of intervention effectiveness is limited; intervention acceptance varies between interventions. The resulting classification illustrates a range of innovative interventions which can be implemented into routine care depending on existing resources and preferences. Different models for the provision of low-intensity interventions are discussed.

A Web-Based Acceptance-Facilitating Intervention for Identifying Patients’ Acceptance, Uptake, and Adherence of Internet- and Mobile-Based Pain Interventions: Randomized Controlled Trial

Background Internet- and mobile-based interventions are effective for the treatment of chronic pain. However, little is known about patients’ willingness to engage with these types of interventions and how the uptake of such interventions can be improved. Objective The aim of this study was to identify people’s acceptance, uptake, and adherence (primary outcomes) with regard to an internet- and mobile-based intervention for chronic pain and the influence of an information video as an acceptance-facilitating intervention (AFI). Methods In this randomized controlled trial with a parallel design, we invited 489 individuals with chronic pain to participate in a Web-based survey assessing the acceptance of internet- and mobile-based interventions with the offer to receive an unguided internet- and mobile-based intervention for chronic pain after completion. Two versions of the Web-based survey (with and without AFI) were randomly sent to two groups: one with AFI (n=245) and one without AFI (n=244). Participants who completed the Web-based survey with or without AFI entered the intervention group or the control group, respectively. In the survey, the individuals’ acceptance of pain interventions, measured with a 4-item scale (sum score ranging from 4 to 20), predictors of acceptance, sociodemographic and pain-related variables, and physical and emotional functioning were assessed. Uptake rates (log in to the intervention) and adherence (number of completed modules) to the intervention was assessed 4 months after intervention access. To examine which factors influence acceptance, uptake rate, and adherence in the internet- and mobile-based interventions, we conducted additional exploratory subgroup analyses. Results In total, 57 (intervention group) and 58 (control group) participants in each group completed the survey and were included in the analyses. The groups did not differ with regard to acceptance, uptake rate, or adherence (P=.64, P=.56, P=.75, respectively). Most participants reported moderate (68/115, 59.1%) to high (36/115, 31.3%) acceptance, with 9.6% (11/115) showing low acceptance (intervention group: mean 13.91, SD 3.47; control group: mean 13.61, SD 3.50). Further, 67% (38/57, intervention group) and 62% (36/58, control group) had logged into the intervention. In both groups, an average of 1.04 (SD 1.51) and 1.14 (SD 1.90) modules were completed, respectively. Conclusions The informational video was not effective with regard to acceptance, uptake rate, or adherence. Despite the high acceptance, the uptake rate was only moderate and adherence was remarkably low. This study shows that acceptance can be much higher in a sample participating in an internet- and mobile-based intervention efficacy trial than in the target population in routine health care settings. Thus, future research should focus not only on acceptance and uptake facilitating interventions but also on ways to influence adherence. Further research should be conducted within routine health care settings with more representative samples of the target population. Trial Registration German Clinical Trial Registration DRKS00006183; http://www.drks.de/drks_web/navigate.do ?navigationId=trial.HTML&TRIAL_ID=DRKS00006183 (Archived by WebCite at http://www.webcitation.org/70ebHDhne)

Chronische körperliche Krankheit und Krankheitsbewältigung

Chronische korperliche Erkrankungen bilden eine Gruppe von Krankheiten mit unterschiedlicher Atiologie, Pathogenese, Symptomatik und Prognose. Den Krankheitsbildern ist gemeinsam, dass sie langfristig bestehen und eine vollstandige Heilung in der Regel nicht erreicht werden kann. Die Rehabilitation soll dabei unterstutzen, die chronische korperliche Erkrankung und die damit einhergehenden Belastungen zu bewaltigen, sowie dadurch moglichst weitgehend und selbstandig am gewohnten Leben in Familie, Beruf und Gesellschaft teilhaben zu konnen. Das Kapitel gibt zunachst einen Uberblick uber die Belastungen, die im Rahmen von chronischen Erkrankungen auftreten konnen und beschreibt mogliche Belastungsfolgen. Im Anschluss werden verschiedene Arten der Krankheitsbewaltigung beschrieben. Der Einfluss der Krankheitsbewaltigung auf Belastungen und Belastungsfolgen wird diskutiert. Aus den theoretischen Ausfuhrungen leiten sich praktische Implikationen fur die psychologische Versorgung ab.

Psycho-social distress in patients with chronic somatic diseases

Abstract. Research activities of the Department of Rehabilitation Psychology and Psychotherapy, University of Freiburg, mainly focus on psycho-social distress of patients with chronic somatic diseases. Examples of current or recent research projects are: 1. Meta-analysis on quality of life and health care costs in patients with somatic diseases and comorbid mental disorders: Preliminary results indicate a substantial negative effect of comorbid mental disorders on somatic and psychosocial aspects as well as health care costs. 2. Communication in cancer care from the patients’ perspective: Breast cancer patients who were more satisfied with the received information at baseline showed better psychological adjustment after three and six months. 3. Patients’ experiences as empowerment. German version of the website DIPEx with the modules diabetes and chronic pain: it is a free multimedia website with a database of patients’ experiences of their illnesses, linked with evidence-based information on these diseas...