Maria Kleinstäuber

Efficacy of short-term psychotherapy for multiple medically unexplained physical symptoms: A meta-analysis

Multiple medically unexplained physical symptoms (MUPS) are considered to be difficult and costly to treat. The current meta-analysis therefore investigates the efficacy of short-term psychotherapy for MUPS. Based on a multiple-phase literature search, studies were selected according to a-priori defined inclusion criteria. The standardized mean gain was used as the effect size index. Separate data aggregation of between- and within-group contrasts was performed on the basis of a mixed effects model. Outcome variables were physical symptoms, disorder specific emotions, cognitions and behaviors, depressive symptoms, general psychopathology, functional impairment, and health care utilization. Based on 27 included studies, small between-group effect sizes (range: d(+)=0.06-d(+)=0.40) and small to large within-group effect sizes (range: d(+)=0.36-d(+)=0.80) were found for post-treatment and follow-up assessments for the different outcome variables. Significant moderator variables were identified as the type, mode, and setting of therapy, number of therapy sessions, profession of therapist, age and sex of patients, quality of diagnostic procedure, and the control of concomitant treatments. Implications of the results for clinical practice and future research are discussed.

Cognitive-Behavioral and Pharmacological Interventions for Premenstrual Syndrome or Premenstrual Dysphoric Disorder: A Meta-Analysis

The current meta-analysis investigates the efficacy of psychotherapeutic interventions and psychopharmacotherapy for premenstrual syndrome (PMS) and premenstrual dysphoric disorder. Based on a multiple-phase literature search, controlled trials were selected according to a priori defined inclusion criteria. Data were extracted on the basis of a standardized coding scheme. The standardized weighted mean difference (random effects model) was used as effect size index. Dependent on outcome, 22 included studies obtained small to medium effect sizes for cognitive-behavioral interventions (range: d+xa0=xa00.24–0.70) and for serotonergic antidepressants (range: d+xa0=xa00.29–0.58), at post-assessment. Follow-ups were performed only in studies of cognitive-behavioral interventions (range: d+xa0=xa00.46–0.74). There was no evidence of a publication bias. For both cognitive-behavioral interventions and serotonergic antidepressants, efficacy in treatment of PMS was found to not be satisfactory. Future research should possibly focus more on a combination of both approaches.

The Role of Fear-Avoidance Cognitions and Behaviors in Patients with Chronic Tinnitus

The current study investigated the role of fear-avoidance—a concept from chronic pain research—in chronic tinnitus. A self-report measure the “Tinnitus Fear-Avoidance Cognitions and Behaviors Scale (T-FAS)” was developed and validated. Furthermore, the role of fear-avoidance behavior as mediator of the relationship between anxiety sensitivity and tinnitus handicap was investigated. From a clinical setting, N = 373 patients with chronic tinnitus completed questionnaires assessing tinnitus handicap (Tinnitus Handicap Inventory), anxiety, depression (Hospital Anxiety and Depression Scale), anxiety sensitivity (Anxiety Sensitivity Index-3), personality factors (Big Five Inventory-10), and fear-avoidance. To analyze the psychometric properties, principal component analysis with parallel component extraction and correlational analyses were used. To examine a possible mediating effect, hierarchical regression analysis was applied. The principal component analysis resulted in a three-factor solution: Fear-avoidance Cognitions, Tinnitus-related Fear-Avoidance Behavior, and Ear-related Fear-Avoidance Behavior. Internal consistency was satisfactory for the total scale and all subscales. High correlations between tinnitus-related handicap scales, depressive and anxiety symptoms, and the T-FAS were found, whereas associations with personality factors were low. Moreover, results indicate a significant partial mediation of fear-avoidance behaviors in the relationship between anxiety sensitivity and the cognitive dimension of tinnitus handicap. Results show that fear-avoidance behavior plays an important role in tinnitus handicap. More attention should be paid to this concept in research and clinical practice of psychotherapy for chronic tinnitus.

Acceptance of Tinnitus: Validation of the Tinnitus Acceptance Questionnaire

The concept of acceptance has recently received growing attention within tinnitus research due to the fact that tinnitus acceptance is one of the major targets of psychotherapeutic treatments. Accordingly, acceptance-based treatments will most likely be increasingly offered to tinnitus patients and assessments of acceptance-related behaviours will thus be needed. The current study investigated the factorial structure of the Tinnitus Acceptance Questionnaire (TAQ) and the role of tinnitus acceptance as mediating link between sound perception (i.e. subjective loudness of tinnitus) and tinnitus distress. In total, 424 patients with chronic tinnitus completed the TAQ and validated measures of tinnitus distress, anxiety, and depression online. Confirmatory factor analysis provided support to a good fit of the data to the hypothesised bifactor model (root-mean-square-error of approximation = .065; Comparative Fit Index = .974; Tucker–Lewis Index = .958; standardised root mean square residual = .032). In addition, mediation analysis, using a non-parametric joint coefficient approach, revealed that tinnitus-specific acceptance partially mediated the relation between subjective tinnitus loudness and tinnitus distress (path ab = 5.96; 95% CI: 4.49, 7.69). In a multiple mediator model, tinnitus acceptance had a significantly stronger indirect effect than anxiety. The results confirm the factorial structure of the TAQ and suggest the importance of a general acceptance factor that contributes important unique variance beyond that of the first-order factors activity engagement and tinnitus suppression. Tinnitus acceptance as measured with the TAQ is proposed to be a key construct in tinnitus research and should be further implemented into treatment concepts to reduce tinnitus distress.

Memory bias for schema-related stimuli in individuals with bulimia nervosa

This study investigates whether individuals with bulimia nervosa (BN) have a memory bias in relation to explicit memory (cued and free recall vs. verbal and pictorial recognition tasks). Twenty-five participants diagnosed with BN and 27 normal controls (NC) were exposed to body-related, food-related, and neutral TV commercials, and then recall and recognition rates were assessed. Poorer recognition and recall of body-related stimuli was found for BN in comparison to NC, suggesting a memory bias. Results are discussed in relation to previous studies, along with suggestions as to how future studies can gain more insight into dysfunctions in information processing that can lead to the maintenance of eating disorders.

Are individuals with an eating disorder less sensitive to aesthetic flaws than healthy controls

OBJECTIVEnThis study aimed to investigate whether the positive evaluation of other peoples bodies is due to difficulties in the recognition of flaws in attractive features of others.nnnMETHODnThirty female individuals with an eating disorder (IEDs) and 30 normal controls (NCs) rated pictures of a womans face in relation to various manipulated facial features. Accuracy rates, discrepancy scores, and response times were assessed. Participants also answered questionnaires relating to social comparison, internalization of the slender ideal, and eating disorder symptoms.nnnRESULTSnNCs were significantly more accurate at detecting flaws and recognized the degree of manipulation better than IEDs. A MANCOVA including body-image-relevant variables was not statistically significant, but the drive to be thin (Eating Disorder Inventory-2) and the number of comorbid disorders were significant covariates. No significant associations were found between internalization of the slender ideal, tendency for social comparison, eating-disorder-relevant variables, and indicators of aesthetic sensitivity, for either IEDs or NCs. When both groups were combined, a significant correlation between drive for thinness and indicators of the ability to detect facial flaws was revealed.nnnCONCLUSIONnIEDs are less capable of recognizing flaws in the appearance of others, which appears to be moderated by the degree of drive for thinness and the degree of psychiatric comorbidity. Evaluating the appearance of others more positively in contrast to ones own appearance could lead to poor self-evaluation, thus reinforcing body dissatisfaction and contributing toward the maintenance of the disorder.

Facial discrimination in body dysmorphic, obsessive-compulsive and social anxiety disorders

Body dysmorphic disorder (BDD) is characterized by preoccupation with perceived flaws in ones own appearance. Several risk factors such as aesthetic perceptual sensitivity have been proposed to explain BDDs unique symptomatology. Although research on facial discrimination is limited so far, the few existing studies have produced mixed results. Thus, the purpose of this study was to further examine facial discrimination in BDD. We administered a facial discrimination paradigm, which allows to assess the ability to identify slight to strong facial changes (e.g., hair loss, acne) when presented with an original (unmodified) facial image, relative to a changed (modified) facial image. The experiment was administered in individuals with BDD, social anxiety disorder, obsessive-compulsive disorder, and mentally healthy controls (32 per group, respectively). Overall, groups did not differ with respect to their ability to correctly identify facial aberrations when presented with other peoples faces. Our findings do not support the hypothesis of enhanced general aesthetic perceptual sensitivity in individuals with (vs. without) BDD.

Was sollten Sie als Betroffener über das Selbsthilfetraining wissen

Kapitel 7 richtet sich an die Tinnitusbetroffenen und vermittelt ihnen konkrete Informationen zur Arbeit mit dem Selbsthilfetraining. Als wichtige Grundlage wird zu Beginn der Unterschied zwischen Tinnitusgerausch und Tinnitusbeeintrachtigung erortert. Anschliesend wird der Aufbau des Trainings vorgestellt. Es wird eine Ubersicht uber die einzelnen Module gegeben und erlautert, welche Materialien zur Verfugung stehen. Im dritten Abschnitt geht es ganz konkret um den personlichen Einstieg der Betroffenen in das Selbsthilfetraining. Mithilfe von Arbeitsblattern konnen die Leser uber ihre aktuelle Situation in Bezug auf den Tinnitus und ihre Erwartungen an das Selbsthilfetraining nachdenken, sie konnen ihre personlichen Trainingsziele festlegen und einen individuellen Trainingsplan erstellen. Schlieslich werden konkrete Hinweise fur die Trainingsdurchfuhrung gegeben: Wie lauft eine Trainingswoche ab und wie wird diese abgeschlossen, wie ist mit Ruckschlagen umzugehen, und was sollte beim Abschluss des gesamten Trainings beachtet werden.

Diagnostik: Wie wird ein Tinnitus untersucht und diagnostiziert?

Kapitel 4 beschaftigt sich mit der Frage, wie der Tinnitus und die Tinnitusbelastung untersucht werden konnen. Dabei wird im ersten Abschnitt ein genereller Uberblick uber die verschiedenen Schritte der Tinnitusdiagnostik gegeben – von der HNO-arztlichen Untersuchung bis hin zur psychologischen Diagnostik der Tinnitusbelastung. Im zweiten Abschnitt wird erklart, wie ein Audiogramm, das beim HNO-Arzt oder Akustiker erstellt wurde, zu lesen ist. Die psychologische Diagnostik wird im Detail im dritten Abschnitt vorgestellt. Dabei wird zuerst primar fur die fachlichen Leser beschrieben, wie eine psychologische Tinnitusanamnese stattfinden kann und welche Fragebogen zur Selbstbeurteilung der Tinnitusbelastung eingesetzt werden konnen. Im Anschluss daran finden Tinnitusbetroffene einen Selbsttest, anhand dessen sie fur sich einschatzen konnen, wie hoch ihre personliche Tinnitusbelastung ausgepragt ist. Basierend auf dem Ergebnis des Selbsttests werden Empfehlungen gegeben, ob und wie das vorliegende Selbsthilfetraining genutzt werden kann. Der letzte Abschnitt richtet sich erneut an die fachlichen Leser und soll Antworten auf die Frage geben, wann das vorliegende Selbsthilfetraining verwendet werden sollte und wann eher eine umfassende psychotherapeutische Behandlung indiziert ist.

Was versteht man unter einem „Tinnitus“?

Kapitel 2 gibt grundlegende Informationen zum Thema Tinnitus. Dazu werden zuerst drei Fallbeispiele vorgestellt, anhand derer unterschiedliche Krankheitsverlaufe deutlich werden. Im Anschluss wird nach einer grundlegenden Begriffsbestimmung und Definition dargestellt, wie Tinnitus klassifiziert werden kann. Hierbei werden beispielsweise die Unterscheidungen hinsichtlich Tinnitusdauer, Nachweisbarkeit des Tinnitus oder Schwere der Beeintrachtigung erlautert. In einem Therapeutenexkurs werden weitere Moglichkeiten der Differenzierung des Tinnitus nach dem Entstehungsort dargelegt, die Therapeuten als Hintergrundwissen fur die Vermittlung von Modellen zur Tinnitusentstehung an die Patienten hilfreich sein konnen. Der letzte Abschnitt des Kapitels geht darauf ein, wie haufig Tinnitus in der Bevolkerung vorkommt (Pravalenz), welche Verlaufe es hinsichtlich der Tinnitusbelastung gibt (Verlauf und Prognose) sowie welche weiteren korperlichen und psychischen Beeintrachtigungen mit dem Tinnitus einhergehen konnen (Komorbiditat).