Marion Jakob

Cognitive therapy versus exposure therapy for hypochondriasis (health anxiety): A randomized controlled trial.

OBJECTIVE Cognitive-behavioral therapy has proven to be highly effective in the treatment of hypochondriasis and health anxiety. However, little is known about which therapeutic interventions are most promising. The aim of the present study was to compare the efficacy of cognitive therapy (CT) with exposure therapy (ET). METHOD Eighty-four patients with a diagnosis of hypochondriasis were randomly allocated to CT, ET, or a waiting list (WL) control group. The primary outcome measure was a standardized interview that evaluated hypochondriacal cognitions as well as behaviors conducted by independent diagnosticians. Several self-report questionnaires were evaluated as secondary outcome measures. Treatment success was evaluated at posttreatment and at 1-year follow-up. RESULTS Both CT (Hedgess g = 1.01-1.11) and ET (Hedgess g = 1.21-1.24) demonstrated their efficacy in comparison with the WL in the primary outcome measure. Moreover, a significant reduction in depressive symptoms and bodily complaints was found in the secondary outcome measures for both treatments in comparison with the WL, but anxiety symptoms were only significantly reduced by ET. In a direct comparison, no significant differences were found between CT and ET in the primary or the secondary outcome measures. Regarding safety behaviors, we found a significantly larger improvement with ET than with CT in the completer analyses. CONCLUSIONS The results suggest high efficacy of CT as well as ET in the treatment of hypochondriasis. Cognitive interventions were not a necessary condition for the change of dysfunctional cognitions. These findings are relevant to the conceptualization and psychotherapeutic treatment of hypochondriasis and health anxiety.

Cognitive intervention response is related to habitual physical activity in older adults

Background and aims: This study analysed the associations between physical activity and the effects of cognitive training on perceived cognitive functioning and life satisfaction in older adults. Methods: A sample of 114 intervention group participants (65–89 yrs) received weekly group sessions of cognitive stimulation for two months. This sample was stratified into groups according to habitual physical activity (PA) and matched with 45 controls. Participants completed the Memory Complaint Questionnaire (MAC-Q), Nuremberg Self-Rating List (NSL) and Alzheimer Disease Assessment Scale — Cognitive Subscale (ADAS-Cog) at three time-points (baseline, 2 months, and 6-month follow-up). Results: At baseline, groups did not differ in absolute MAC-Q, NSL or ADAS-Cog scores. NSL difference scores (follow-up score minus baseline NSL score) of the three cognitive intervention groups (>6.95h MVPA/wk; 3.64–6.95h MVPA/wk; <3.64h MVPA/wk) and controls were −3.8±7.3, −2.5±11.0, +0.3±12.0 and +0.1±9.1 over 2 months, and −4.2±7.6, −4.0±14.0, −1.8±7.7 and +0.5±9.7 over 6 months, respectively. MAC-Q difference scores were −1.1±2.9, −1.1±3.4, −0.3±3.9 and +0.3±2.7 over 2 months, and −1.5±3.2, −0.8±2.9, −0.3±2.9 and +0.3±2.2 over 6 months. The groups significantly (p<0.05) differed on NSL and MAC-Q difference scores. Specifically, the more active groups differed from controls, and in some cases from the least active group. Groups did not differ on ADAS-Cog difference scores. Conclusions: Our findings indicate a relation between amount of physical activity and the effects of a cognitive stimulation intervention on perceived cognitive functioning and life satisfaction. Physically more active persons may gain more benefit from cognitive stimulation than the physically less active.

Live-Supervision: Vom Einwegspiegel zur videobasierten Online-Supervision

Live-Supervision ermöglicht dem Supervisor, Einblicke in eine laufende Therapiesitzung zu erhalten und in diese beratend einzugreifen. Die direkte Rückmeldung des Supervisors an den Supervisanden stellt dabei ein wichtiges Unterscheidungsmerkmal zu nachträglichen Supervisionsformen dar. In den letzten 60 Jahren wurden verschiedene Formen der Live-Supervision entwickelt, die im Rahmen dieser Arbeit in Hinblick auf ihre Praktikabilität, Akzeptanz und Effektivität diskutiert werden. Aufgrund der vielen Vorteile von videobasierter Live-Supervision («bug-in-the-eye», BITE) wird in dem aktuellen Beitrag ein besonderes Augenmerk auf diese neueste Entwicklung der Live-Supervision gelegt. Während einer BITE-Supervisionssitzung verfolgt der Supervisor die Therapie online über eine Videokamera und hat die Möglichkeit, über einen Monitor direkte Hinweise an den Therapeuten zu geben. Bei diesem Supervisionsformat ist es dem Supervisor möglich, die Supervision andernorts via Internet durchzuführen. In der vorliegenden Arbeit werden konkrete Hinweise für die Durchführung einer BITE-Supervisionssitzung gegeben. Zudem werden auf der Basis von 25 BITE-Sitzungen erste Ergebnisse einer Studie zur Akzeptanz dieses Verfahrens berichtet. Hierbei zeigte sich, dass die Akzeptanz von BITE-Supervision bei Therapeuten, Supervisoren und Patienten sehr hoch ist und diese als nützlich und hilfreich eingeschätzt wird. Abschließend wird diskutiert, auf welche Weise BITE-Supervision in die Psychotherapieausbildung integriert werden könnte.

Therapist competence and therapeutic alliance are important in the treatment of health anxiety (hypochondriasis)

The role of treatment delivery factors (i.e., therapist adherence, therapist competence, and therapeutic alliance) is rarely investigated in psychotherapeutic treatment for health anxiety. This study aimed to investigate the role of the assessment perspective for the evaluation of treatment delivery factors and their relevance for treatment outcome. Therapist adherence, therapist competence, and therapeutic alliance were evaluated by independent raters, therapists, patients, and supervisors in 68 treatments. Patients with severe health anxiety (hypochondriasis) were treated with cognitive therapy or exposure therapy. Treatment outcome was assessed with a standardized interview by independent diagnosticians. A multitrait-multimethod analysis revealed a large effect for the assessment perspective of therapist adherence, therapist competence, and therapeutic alliance. The rater perspective was the most important for the prediction of treatment outcome. Therapeutic alliance and therapist competence accounted for 6% of the variance of treatment outcome while therapist adherence was not associated with treatment outcome. Therapist competence was only indirectly associated with treatment outcome, mediated by therapeutic alliance. Both therapeutic alliance and therapist competence demonstrated to be important treatment delivery factors in psychotherapy for health anxiety. A stronger consideration of those processes during psychotherapy for health anxiety might be able to improve psychotherapy outcome.

The Effects of Bug-in-the-Eye Supervision on Therapeutic Alliance and Therapist Competence in Cognitive-Behavioural Therapy: A Randomized Controlled Trial.

Live supervision enables a supervisor to have direct insight into the psychotherapeutic process and allows him or her to provide immediate feedback to the trainee. Therefore, live supervision might be superior to traditional supervisory formats that only allow for the provision of delayed feedback. When considering the different live supervision formats, bug-in-the-eye (BITE) supervision is particularly promising because of its improved and less invasive procedure. The current study compared the efficacy of BITE supervision with that of delayed video-based (DVB) supervision. In the present study, 23 therapists were randomly assigned to either the BITE supervision or DVB supervision groups. The participants were psychotherapy trainees who treated 42 patients (19 under BITE supervision and 23 under DVB supervision) over 25 sessions of cognitive-behavioural therapy. Two independent raters blind to the treatment conditions evaluated therapeutic alliance and therapist competence based on 195 videotapes. Therapeutic alliance was significantly stronger among the treatments conducted under BITE supervision than those conducted under DVB supervision. Moreover, a higher level of therapeutic competence was found in the BITE condition than in the DVB condition. However, no differences between supervision conditions were found when the results were controlled for the level of therapeutic alliance and therapist competence demonstrated in the first session. No differences were observed between the supervision conditions with respect to patient outcomes. There is evidence that BITE supervision is able to improve therapeutic alliance and therapist competence. However, these findings should be interpreted with caution because possible pre-treatment differences between therapists might explain the superiority of BITE supervision. Copyright

Assessment of patient interpersonal behavior: Development and validation of a rating scale

Abstract Objective: Patient in-session interpersonal behavior, as part of the therapeutic alliance, is an important aspect of the psychotherapy process and impacts treatment outcome. In the present study, the development and validation of a rating scale of patient in-session interpersonal behavior is described. Method: A 10-item rating scale, the Assessment Form of Patient Interpersonal Behavior (AFPIB), was developed using an inductive procedure. The AFPIB was then validated in a sample of patients with hypochondriasis (N = 30), by having two independent raters assess patients’ interpersonal behaviors shown in videotaped psychotherapy sessions (N = 60). Results: The AFPIB demonstrated good reliability and validity. Conclusions: Thus, the AFPIB seems to be a promising rating scale for the assessment of patient interpersonal behavior shown in psychotherapy sessions.

Internet-Based Treatments - Experiences from Sweden

Worldwide, Gerhard Andersson is one of the most influential researchers working on internet-based psychological treatments. Moreover, he is also one of the leading researchers in the field of psychologically oriented tinnitus research. He is full professor of clinical psychology at Linkoping University and affiliated professor at the Karolinska Institute in Stockholm at the Department of Clinical Neuroscience, Section Psychiatry. Professor Andersson has been highly productive, having produced more the 300 scientific papers. During his whole career he has worked part-time with patients. Apart from his own research and clinical work, Professor Andersson has editorial responsibilities for several journals including Cognitive Behaviour Therapy, Plos One, BMC Psychiatry, and Scandinavian Journal of Psychology. The interview was conducted by Professor Thomas Berger.

Nondisclosure during psychotherapy supervision: Validation of the German version of the Supervisory Questionnaire (SQ)

Abstract Nondisclosure is considered to be a central obstacle to effective psychotherapy supervision. The aim of the current study was the validation of the German version of the Supervisory Questionnaire (SQ; Yourman & Farber, 1996), a short measure for the assessment of supervisee nondisclosure. The investigation was based on a sample of 589 supervisees. Confirmatory factor analyses suggested a two-factor model of the SQ which included one factor describing nondisclosure regarding the patient (α=.74) and another describing nondisclosure regarding the supervisor (α=.71). The SQ demonstrated satisfactory convergent and discriminant validity. Additionally assessed supervisee characteristics accounted for 16% of the variance in nondisclosure. These results provide general support for the reliability and validity of the SQ in a large sample of supervisees.

Patient Characteristics and Patient Behavior as Predictors of Outcome in Cognitive Therapy and Exposure Therapy for Hypochondriasis.

OBJECTIVE Psychotherapy for hypochondriasis has greatly improved over the last decades and cognitive-behavioral treatments are most promising. However, research on predictors of treatment outcome for hypochondriasis is rare. Possible predictors of treatment outcome in cognitive therapy (CT) and exposure therapy (ET) for hypochondriasis were investigated. METHOD Characteristics and behaviors of 75 patients were considered as possible predictors: sociodemographic variables (sex, age, and cohabitation); psychopathology (pretreatment hypochondriacal symptoms, comorbid mental disorders, and levels of depression, anxiety, and somatic symptoms); and patient in-session interpersonal behavior. RESULTS Severity of pretreatment hypochondriacal symptoms, comorbid mental disorders, and patient in-session interpersonal behavior were significant predictors in multiple hierarchical regression analyses. Interactions between the predictors and the treatment (CT or ET) were not found. CONCLUSIONS In-session interpersonal behavior is an important predictor of outcome. Furthermore, there are no specific contraindications to treating hypochondriasis with CT or ET.

Inhalte: Demenz betrifft uns alle

Frau Umtrieb ist 65 Jahre alt und lebt gemeinsam mit ihrem Ehemann und ihren Kindern uber dem Restaurant, das die Familie seit uber 30 Jahren betreibt. Fruher war Frau Umtrieb sehr aktiv, hatte einen grosen Freundeskreis und viel Freude an der Arbeit im Restaurant. Seit einiger Zeit zieht sie sich immer mehr aus der Arbeit zuruck, auch Kontakte scheut sie. Sie sagt, sie sei zu alt fur so etwas und es mache ihr auch keinen Spas mehr. Ihre Familie bemerkt schon seit einiger Zeit, dass es ihr immer schwerer fallt, sich zu konzentrieren. In Gesprachen verliert sie haufig den Faden oder findet die richtigen Worter nicht. Sie vergisst kurz zuruckliegende Ereignisse und findet Sachen nicht mehr. Oft wirft sie ihren Kindern vor, sie hatten ihre Sachen falsch eingeordnet. Sie selbst raumt standig um, tragt Dinge hin und her. Einmal hat sie nach dem Einkaufen den Ruckweg nicht mehr gefunden. Frau Umtrieb bestreitet ihre zunehmenden Probleme und spielt sie herunter. Der Hausarzt schopft Verdacht und uberweist sie zu einem Facharzt fur Psychiatrie und Neurologie. Dieser diagnostiziert bei Frau Umtrieb eine masige kognitive Beeintrachtigung im Rahmen einer Alzheimer-Demenz.