Maria Hagl

A Meta-Analysis of Interventions for Bereaved Children and Adolescents.

The main objective of this review was to provide a quantitative and methodologically sound evaluation of existing treatments for bereavement and grief reactions in children and adolescents. Two meta-analyses were conducted: 1 on controlled studies and 1 on uncontrolled studies. The 2 meta-analyses were based on a total of 27 treatment studies published before June 2006. Hedgess g and Cohens d were used as measures of effect size and a random-effects model was applied. Results yielded small to moderate effect sizes. Interventions for symptomatic or impaired participants tended to show larger effect sizes than interventions for bereaved children and adolescents without symptoms. Promising treatment models were music therapy and trauma/grief-focused school based brief psychotherapy.

Efficacy of an outpatient treatment for prolonged grief disorder: A randomized controlled clinical trial

BACKGROUND Abnormal forms of grief, currently referred to as complicated grief or prolonged grief disorder, have been discussed extensively in recent years. While the diagnostic criteria are still debated, there is no doubt that prolonged grief is disabling and may require treatment. To date, few interventions have demonstrated efficacy. METHODS We investigated whether outpatients suffering from prolonged grief disorder (PGD) benefit from a newly developed integrative cognitive behavioural therapy for prolonged grief (PG-CBT). A total of 51 patients were randomized into two groups, stratified by the type of death and their relationship to the deceased; 24 patients composed the treatment group and 27 patients composed the wait list control group (WG). Treatment consisted of 20-25 sessions. Main outcome was change in grief severity; secondary outcomes were reductions in general psychological distress and in comorbidity. RESULTS Patients on average had 2.5 comorbid diagnoses in addition to PGD. Between group effect sizes were large for the improvement of grief symptoms in treatment completers (Cohen׳s d=1.61) and in the intent-to-treat analysis (d=1.32). Comorbid depressive symptoms also improved in PG-CBT compared to WG. The completion rate was 79% in PG-CBT and 89% in WG. LIMITATIONS The major limitations of this study were a small sample size and that PG-CBT took longer than the waiting time. CONCLUSIONS PG-CBT was found to be effective with an acceptable dropout rate. Given the number of bereaved people who suffer from PGD, the results are of high clinical relevance.

Efficacy of an integrative CBT for prolonged grief disorder: A long-term follow-up

BACKGROUND While some intervention trials have demonstrated efficacy in treating prolonged grief disorder (PGD), data on long-term treatment effects are scarce. METHODS Fifty-one outpatients with clinically relevant prolonged grief symptoms, who had participated in a randomized controlled trial (RCT), were followed up, on average, 1.5 years after integrative cognitive behavioral therapy for PGD (PG-CBT). Initial assessment procedures were repeated, with PGD symptom severity as the main outcome and general mental health symptoms as secondary outcomes. As results in the immediate and delayed treatment groups (former wait list) were similar, the follow-up data were pooled. RESULTS Overall, 80% of the original ITT sample could be reached, that is 89% of the 37 treated participants, as well as 8 out of 14 participants who had dropped out of the RCT. The considerable short-term treatment success of PG-CBT was stable; pre to follow-up Cohen׳s d was large, with 1.24 in the ITT analysis and 2.22 for completers. The pre to post-improvement in overall mental health was maintained. LIMITATIONS Since the RCT wait list group had been treated after their waiting period as well, no controlled long-term outcomes are available. CONCLUSIONS PG-CBT proved to be effective in the longer run. In comparison to other RCTs on prolonged grief this is the largest sample followed up for this long.

The Efficacy, Safety and Applications of Medical Hypnosis: A Systematic Review of Meta-analyses

BACKGROUND The efficacy and safety of hypnotic techniques in somatic medicine, known as medical hypnosis, have not been supported to date by adequate scientific evidence. METHODS We systematically reviewed meta-analyses of randomized controlled trials (RCTs) of medical hypnosis. Relevant publications (January 2005 to June 2015) were sought in the Cochrane databases CDSR and DARE, and in PubMed. Meta-analyses involving at least 400 patients were included in the present analysis. Their methodological quality was assessed with AMSTAR (A Measurement Tool to Assess Systematic Reviews). An additional search was carried out in the CENTRAL and PubMed databases for RCTs of waking suggestion (therapeutic suggestion without formal trance induction) in somatic medicine. RESULTS Out of the 391 publications retrieved, five were reports of metaanalyses that met our inclusion criteria. One of these meta-analyses was of high methodological quality; three were of moderate quality, and one was of poor quality. Hypnosis was superior to controls with respect to the reduction of pain and emotional stress during medical interventions (34 RCTs, 2597 patients) as well as the reduction of irritable bowel symptoms (8 RCTs, 464 patients). Two meta-analyses revealed no differences between hypnosis and control treatment with respect to the side effects and safety of treatment. The effect size of hypnosis on emotional stress during medical interventions was low in one meta-analysis, moderate in one, and high in one. The effect size on pain during medical interventions was low. Five RCTs indicated that waking suggestion is effective in medical procedures. CONCLUSION Medical hypnosis is a safe and effective complementary technique for use in medical procedures and in the treatment of irritable bowel syndrome. Waking suggestions can be a component of effective doctor-patient communication in routine clinical situations.

Dialogical Exposure with Traumatically Bereaved Bosnian Women: Findings from a Controlled Trial

OBJECTIVE In this trial, we compared the relative efficacy of dialogical exposure group treatment using Gestalt empty-chair method with a supportive group in the treatment of symptoms stemming from traumatic loss in a post-war society. METHODS One-hundred and nineteen women whose husbands were either killed or registered as missing during the war in Bosnia and Herzegovina were quasi-randomized to seven sessions of group treatment with dialogical exposure or to an active control condition. RESULTS Both interventions resulted in significant improvement from baseline to post-treatment for both kinds of loss, in terms of post-traumatic symptoms, general mental health and grief reactions, with the exception of depression and traumatic grief in the control condition. Regarding mean effect sizes (Cohens d), pre-treatment to post-treatment improvements were moderate (d = 0.56) for the dialogical exposure group and small (d = 0.34) for the supportive group. Treatment gains were maintained at least until the 1-year follow-up. In controlled comparisons, dialogical exposure was superior concerning traumatic grief (Cohens d = 0.37) and post-traumatic avoidance (d = 0.73) at post-treatment. CONCLUSIONS Results show that short-term dialogical exposure group treatment was moderately effective in treating traumatically bereaved women. KEY PRACTITIONER MESSAGE Research attests to high levels of symptoms among post-war civil populations, in particular, when a loved one was killed, which can lead not only to trauma reactions but also to severe separation distress. Grieving the loss of a loved one is hampered if the death remains unconfirmed. Unconfirmed loss could be conceptualized as unfinished business in terms of Gestalt therapy, which offers empty-chair dialogue for resolving unfinished business and grief. Dialogical exposure therapy (DET) supports the client in gaining awareness of and expressing his or her inner dialogues concerning the traumatic event, using Gestalt empty-chair method. Short-term DET was effective in treating traumatically bereaved women but showed little additional effects in comparison with a supportive group treatment, so further research is warranted.

Electromyographic Investigation of Hypnotic Arm Levitation: Differences Between Voluntary Arm Elevation and Involuntary Arm Levitation

Abstract Thirty-three volunteers were randomly exposed to 3 conditions: hypnotic arm levitation, holding up the arm voluntarily without hypnosis, and imagined arm lifting without hypnosis. Trapezius, deltoid, extensor digitorum, flexor digitorum profundus, biceps brachii, and triceps brachii muscles were measured. Strain and muscle activity during lifting and holding up the right arm for 3 minutes were used as dependent variables. During hypnotic arm levitation, the total muscle activity was lower than during holding it up voluntarily (p < .01); the activity in the deltoid was 27% lower (p < .001). Without hypnosis, the muscle activity showed a positive correlation with strain. However, there was no such correlation in the hypnotic condition. Apparently, it is possible to reduce strain and to objectively measure muscle activity in an uplifted arm through hypnotic arm levitation.

Personality Styles of German-Speaking Psychotherapists Differ from a Norm, and Male Psychotherapists Differ from Their Female Colleagues

Variables pertaining to the person of the psychotherapist have been neglected in psychotherapy research for some time. Concerning personality in particular, however, research has mostly focused on its relation with the psychotherapist’s choice of method, or differences between the various major therapy approaches. That is, psychotherapists were compared to each other without specifying how exactly psychotherapists are in comparison to “ordinary people.” We wanted to know: Are there specific personality styles that distinguish psychotherapists from the norm? A sample of 1,027 psychotherapists from Germany, Austria, and Switzerland filled out the short version of the Personality Style and Disorder Inventory (PSDI-S) via online survey. The PSDI-S is a self-report questionnaire that assesses 14 personality styles, partly related to the non-pathological equivalents of classifiable personality disorders. The psychotherapists were compared to a normative sample of 3,392 people of different professions. The results could be divided into three groups: (1) Large differences in four personality styles that might contribute to relationship skills and may enable psychotherapists to put their own personal opinion aside, show empathy and appreciation, open themselves to the emotional experience of the patient, and provide a trusting relationship. (2) Moderate differences in seven personality styles that are equally indicative of the professional social skills of the psychotherapists, i.e., they were neither submissive nor passive, not excessively helpful, but also not too self-assertive. (3) Hardly any or no differences regarding a charming (histrionic) style, optimism, and conscientiousness. Gender-specific results revealed that male psychotherapists differed from their female colleagues, but they did so differently than men and women in the normative sample do. The main limitations were that we relied on self-report and did not statistically control for gender, age, and education, when comparing to the norm. As a conclusion, German-speaking psychotherapists show personality styles that we interpret as functional for psychotherapeutic practice but this needs corroboration from studies that use different methods and measures.

Stress and stress management in European crisis managers

Purpose – The purpose of this paper is to examine specific stressors and demands, perceived control, received support and stress management strategies of crisis managers (i.e. executives and supervisors of organizations involved in disaster response) in the context of large-scale missions. Design/methodology/approach – Totally, 31 semi-structured interviews with crisis managers were conducted in five European countries and analyzed with the qualitative text analysis method GABEK®. Findings – The sample reported high demands and various sources of stress, including event-specific stressors as well as group specific, occupational stressors such as responsibility for decision making, justification of failures or dealing with press and media. While possibilities for control were perceived as limited during large-scale missions, organizational and peer support played an important role in mitigating mission-related stress. Effective stress management strategies were reported as crucial to ensure successful crisis management, and a need for more comprehensive stress management trainings was emphasized. Originality/value – While stressors and coping strategies in first responders and emergency services personnel have been previously examined, corresponding research regarding the professional group of crisis management leaders remains scarce. Therefore, this study makes an important contribution by examining influential stressors within the work environment of crisis managers and by identifying starting points and requirements for stress management trainings and psychosocial support programs.

Persönlichkeitsstile von studentischen Teilnehmerinnen an Hypnoseexperimenten im Vergleich zu Hypnoseanwendern

Zweck: Bei einer Befragung zu Personlichkeitsstilen bei 203 deutschsprachigen Hypnoseanwendern (v.a. Psychotherapeuten, Arzte und Zahnarzte) hatten sich signifikante, jedoch nicht klinisch auffallige Abweichungen zur Normstichprobe gezeigt. Dabei war unklar, ob diese auf Selektionseffekten in der Stichprobe selbst beruhten, oder ob es sich dabei um berufliche Sozialisations- oder Selektionseffekte handelte. Weil zur Personlichkeit von Studierenden im Fachbereich Psychologie wenig bekannt ist, sollten Personlichkeitsstile bei einer Stichprobe von Studentinnen, die an Hypnoseexperimenten teilnahmen, erfasst werden, um diese im Anschluss mit denen der Hypnoseanwender zu vergleichen. Methoden: Die Personlichkeitsstile von 52 Studentinnen aus den Fachern Psychologie und Padagogik wurden mit dem Personlichkeits- Stil-und Storungs-Inventar (PSSI) erhoben. Das PSSI erfasst 14 verschiedene Personlichkeitsstile, zum Teil im Sinne von nicht-pathologischen Entsprechungen der in DSM-IV und ICD-10 beschriebenen Personlichkeitsstorungen. Ergebnisse und Schlussfolgerungen: Die durchschnittlichen Personlichkeitsprofile lagen bei beiden Gruppen im klinisch unauffalligen Bereich. Wahrend bei den Hypnoseanwendern jedoch relativ viele extreme Auspragungen gefunden wurden, und zwar vor allem im Sinne von unterdurchschnittlich ausgepragten Personlichkeitsstilen, zeigten die Studentinnen gemasigtere Profile und bewegten sich naher am Normdurchschnitt. Insgesamt glichen sich die Profile im Verlauf, bis auf einige Aus nahmen. So fiel auf, dass die Studentinnen relativ hilfsbereit-selbstlos waren, wahrend dieser Stil bei den Hypnoseanwendern signifikant unterdurchschnittlich ausgepragt war. Dies konnte durch berufliche Sozialisationsprozesse zu erklaren sein, wenngleich einige methodische Probleme in dieser Untersuchung die Interpretation erschweren.

The Role of Tactile Support in Arm Levitation

How many persons need tactile support à la Milton H. Erickson to achieve arm levitation during hypnosis? How do these differ from those who do not need it? Hypnotic arm levitation was suggested three times consecutively to 30 medium suggestible students. Sixteen succeeded without any tactile support; 7 needed it one or two times; 5 needed it every time; and 2 achieved no arm levitation at all. Participants without any tactile support went more quickly into deeper hypnosis, experienced more involuntariness, less effort, and had higher electrodermal activity. This greater physiological activity seems necessary for hypnotic arm levitation as a form of “attentive hypnosis” in contrast to “relaxation hypnosis.” A change in verbal suggestion from “imagine a helium balloon” to “leave levitation to your unconscious mind” revealed no differences. Several issues resulting from this exploratory arm levitation study are discussed. The idea of different proprioceptive-kinesthetic abilities is introduced and the profound need of co-creating an individual suggestion is emphasized.