Martin Eisemann

The development of a short form of the EMBU: Its appraisal with students in Greece, Guatemala, Hungary and Italy

Abstract Out of the necessity of having an abbreviated form of the EMBU, a measure of perceived parental rearing behaviour, a short form (s-EMBU) consisting of three scales (rejection, emotional warmth and protection) with, respectively, 7, 6 and 9 items (plus 1 unscaled item) was developed from the original 81-item version. The factorial and/or construct validity and reliability of this s-EMBU were examined among samples of 2373 students from Italy, Hungary, Guatemala and Greece. The data were presented for the four national groups separately. The 23-item s-EMBU is recommended as a reliable functional equivalent to the 81-item early EMBU. Attention was drawn to the need for further research to explain some of the observed cross-national differences in the correlations between parental rearing styles and personality.

Temperament and character during the course of unipolar depression among inpatients

Abstract Cloninger has developed a novel approach concerning relationships between psychopathological syndromes and personality by his biosocial theory. Increased levels of harm avoidance (HA) were consistently found in unipolar disorders. The present study was conducted to cross-validate, in part, previous findings that high harm avoidance (HA) persisted in the course of disorder and to explore the distinct role of character dimensions. One hundred and twenty-six inpatients with an unipolar depressive disorder and 126 healthy controls, strictly matched for age and gender have been included in the study. Our findings underline that higher harm avoidance among unipolar depressives compared to healthy controls persisted after treatment even if a significant reduction could be observed. Recurrent disorders and comorbidity with anxiety disorders seem to be related to a relatively immature character in terms of consistently lower scores for the character dimensions (e.g. self-directedness and cooperativeness) of the patients classified into these groups both at admission and at discharge compared with their healthy counterparts.

Pain as a symptom in depressive disorders: I. Relationship to diagnostic subgroup and depressive symptomatology.

Abstract The incidence of pain as a symptom in depressive disorders has been studied in a series of 161 depressed patients admitted to the Department of Psychiatry, Umeå University. 57% of the patients reported pain as a symptom. Female patients reported pain significantly more often than male patients and the patients with pain were found to be significantly older than those without. Despite the fact that patients with neurotic reactive depressions were significantly younger than the patients in the other diagnostic subgroups, they reported pain significantly more often than patients with other depressive disorders. Patients with pain were found to have significantly more muscular tension and more autonomic disturbances while no significant differences were found in items measuring sadness or inhibition‐retardation.

Art therapy improves experienced quality of life among women undergoing treatment for breast cancer: a randomized controlled study

Women with breast cancer are naturally exposed to strain related to diagnosis and treatment, and this influences their experienced quality of life (QoL). The present paper reports the effect, with regard to QoL aspects, of an art therapy intervention among 41 women undergoing radiotherapy treatment for breast cancer. The women were randomized to an intervention group with individual art therapy sessions for 1 h/week (n = 20), or to a control group (n = 21). The WHOQOL-BREF and EORTC Quality of Life Questionnaire-BR23, were used for QoL assessment, and administrated on three measurement occasions, before the start of radiotherapy and 2 and 6 months later. The results indicate an overall improvement in QoL aspects among women in the intervention group. A significant increase in total health, total QoL, physical health and psychological health was observed in the art therapy group. A significant positive difference within the art therapy group was also seen, concerning future perspectives, body image and systemic therapy side effects. The present study provides strong support for the use of art therapy to improve QoL for women undergoing radiotherapy treatment for breast cancer.

The clinical effectiveness of web-based cognitive behavioral therapy with face-to-face therapist support for depressed primary care patients: Randomized controlled trial

Background Most patients with mild to moderate depression receive treatment in primary care, but despite guideline recommendations, structured psychological interventions are infrequently delivered. Research supports the effectiveness of Internet-based treatment for depression; however, few trials have studied the effect of the MoodGYM program plus therapist support. The use of such interventions could improve the delivery of treatment in primary care. Objective To evaluate the effectiveness and acceptability of a guided Web-based intervention for mild to moderate depression, which could be suitable for implementation in general practice. Methods Participants (N=106) aged between 18 and 65 years were recruited from primary care and randomly allocated to a treatment condition comprising 6 weeks of therapist-assisted Web-based cognitive behavioral therapy (CBT), or to a 6-week delayed treatment condition. The intervention included the Norwegian version of the MoodGYM program, brief face-to-face support from a psychologist, and reminder emails. The primary outcome measure, depression symptoms, was measured by the Beck Depression Inventory-II (BDI-II). Secondary outcome measures included the Beck Anxiety Inventory (BAI), the Hospital Anxiety and Depression Scale (HADS), the Satisfaction with Life Scale (SWLS), and the EuroQol Group 5-Dimension Self-Report Questionnaire (EQ-5D). All outcomes were based on self-report and were assessed at baseline, postintervention, and at 6-month follow-up. Results Postintervention measures were completed by 37 (71%) and 47 (87%) of the 52 participants in the intervention and 54 participants in the delayed treatment group, respectively. Linear mixed-models analyses revealed a significant difference in time trends between the groups for the BDI-II, (P=.002), for HADS depression and anxiety subscales (P<.001 and P=.001, respectively), and for the SWLS (P<.001). No differential group effects were found for the BAI and the EQ-5D. In comparison to the control group, significantly more participants in the intervention group experienced recovery from depression as measured by the BDI-II. Of the 52 participants in the treatment program, 31 (60%) adhered to the program, and overall treatment satisfaction was high. The reduction of depression and anxiety symptoms was largely maintained at 6-month follow-up, and positive gains in life satisfaction were partly maintained. Conclusions The intervention combining MoodGYM and brief therapist support can be an effective treatment of depression in a sample of primary care patients. The intervention alleviates depressive symptoms and has a significant positive effect on anxiety symptoms and satisfaction with life. Moderate rates of nonadherence and predominately positive evaluations of the treatment also indicate the acceptability of the intervention. The intervention could potentially be used in a stepped-care approach, but remains to be tested in regular primary health care. Trial Registration Australian New Zealand Clinical Trials Registry: ACTRN12610000257066; http://apps.who.int/trialsearch/trial.aspx?trialid=ACTRN12610000257066 (Archived by WebCite at http://www.webcitation.org/6Ie3YhIZa).

Evaluating the effectiveness and efficacy of unguided internet-based self-help intervention for the prevention of depression: a randomized controlled trial

The Internet has the potential to increase the capacity and accessibility of mental health services. This study aimed to investigate whether an unguided Internet-based self-help intervention delivered without human support or guidance can reduce symptoms of depression in young people at risk of depression. The study also aimed to explore the usage of such sites in a real-life setting, to estimate the effects of the intervention for those who received a meaningful intervention dose and to evaluate user satisfaction. Young adults were recruited by means of a screening survey sent to all students at the University of Tromsø. Of those responding to the survey, 163 students (mean age 28.2 years) with elevated psychological distress were recruited to the trial and randomized to an Internet intervention condition or the waiting list control group. The Internet condition comprised a depression information website and a self-help Web application delivering automated cognitive behavioural therapy. The participants in the waiting list condition were free to access formal or informal help as usual. Two-thirds of the users who completed the trial initially reported an unmet need for help. The findings demonstrated that an unguided intervention was effective in reducing symptoms of depression and negative thoughts and in increasing depression literacy in young adults. Significant improvements were found at 2-month follow up. Internet-based interventions can be effective without tracking and thus constitute a minimal cost intervention for reaching a large number of people. User satisfaction among participants was high.

Early maladaptive schemas, temperament and character traits in clinically depressed and previously depressed subjects.

UNLABELLED The Young Schema Questionnaire (YSQ) and the Temperament and Character Inventory (TCI) have been suggested as vulnerability markers for depression. One- hundred forty clinically depressed subjects(CD), previously depressed subjects(PD) and never depressed (ND) controls completed the YSQ, the TCI and the Beck Depression Inventory. Results showed that CD and PD differed significantly on early maladaptive schemas, temperament and character traits compared with ND. In accordance with previous research, higher levels of harm avoidance and lower levels of self-directedness were found in CD and in recovered PD. Moreover, CD and PD showed substantial variability in the scores on the YSQ and the TCI when controlling for concurrent depression severity. In multiple regression analyses, YSQ domain scales of disconnection, impaired autonomy, restricted self-expression and impaired limits emerged as significant predictors of depression severity. Likewise, as concerns TCI higher order scales, high harm avoidance, low self-directedness and high persistence emerged as significant predictors of depression severity. Harm avoidance was positively related to several early maladaptive schemas (EMSs), whereas self-directedness was negatively related to a majority of the EMSs. Our findings indicate the presence of maladaptive personality characteristics in CD and PD. Longitudinal studies are needed to establish their causal role in relation to first-onset and recurrent depression. KEY PRACTITIONER MESSAGE *Early maladaptive schemas, high harm [correction made here after initial online publication] avoidance and low self-directedness may be a part of vulnerability to depression. *The finding of these personality characteristics in subjects recovered from depression indicates malfunctioning to some degree. *Addressing such characteristics in therapy should be considered in order to prevent and treat depression from its relapsing and recurring course.

Rückblick auf die Eltern: Der Fragebogen zum erinnerten elterlichen Erziehungsverhalten (FEE)

Zusammenfassung. Im Beitrag werden Ergebnisse der teststatistischen Uberprufung eines neuen Fragebogens zur ruckblickenden Erfassung des perzipierten elterlichen Erziehungsverhaltens an einer bevolkerungsreprasentativen Stichprobe (N = 2968) vorgestellt. Der Fragebogen zum erinnerten elterlichen Erziehungsverhalten (FEE), der konzeptionell auf den international in der klinischen Angst- und Depressionsforschung haufig verwendeten EMBU-Fragebogen zuruckgeht, erweist sich dabei als ein reliables und valides Forschungsinstrument. Der FEE gestattet es, Erinnerungen an das Erziehungsverhalten der Eltern (jeweils getrennt fur Vater und Mutter) bezuglich der faktorenanalytisch ermittelten Dimensionen “Ablehnung und Strafe”, “Emotionale Warme” sowie “Kontrolle und Uberbehutung” zu erfassen. In unserer Studie liesen sich daruber hinaus signifikante Zusammenhange zwischen dem erinnerten elterlichen Erziehungsverhalten auf der einen Seite und der Lebenszufriedenheit sowie interpersonalen Problemen auf der anderen Sei...

Effectiveness of cognitive behavioural therapy in primary health care: a review

BACKGROUND Depression and anxiety are highly prevalent disorders causing substantial impairment in daily life. Cognitive behavioural therapy (CBT) delivered face-to-face or as self-help has shown to be an effective treatment for these disorders. Such treatments may be suitable for delivery in primary health care. AIM The aim of the article was to review research on the effectiveness of CBT for depression and anxiety disorders delivered in primary care by primary care therapists. METHODS A literature search of quantitative studies of the effectiveness of CBT delivered in primary care was conducted on multiple electronic databases. A total of 17 studies were included in the review. RESULTS Eight studies of supported Internet- or computer-based CBT, six of which were randomized controlled trials (RCTs), indicate that this treatment is effective for mild to moderate depression and anxiety. Five studies suggest that this treatment may be more effective than usual care for mild to moderate but not for more severe symptoms. Results of four RCTs of brief therapies using written self-help material suggest that while such interventions are effective, no particular approach outperformed any other, including usual care. Five RCTs of CBT delivered face-to-face show that this treatment can be effective when delivered by therapists highly educated in the mental health field. However, many primary care therapists may find such interventions too time consuming. CONCLUSIONS CBT delivered in primary care, especially including computer- or Internet-based self-help programs, is potentially more effective than usual care and could be delivered effectively by primary care therapists.

Depressive mood and personality in terms of temperament and character among the normal population and depressive inpatients

Abstract Based on a recent report on the relatedness between depressed mood, as assessed by the Beck Depression Inventory (BDI), and personality according to Cloninger’s Temperament and Character Inventory (TCI), we attempted to replicate those findings in a sample of normal subjects (n=850) and depressive inpatients (n=353) taking into account age, gender and various aspects of depressive symptoms by means of BDI factors. ‘Harm Avoidance’ and ‘Self-Directedness’ were found closely related with depressive mood in both samples. Furthermore, ‘Exploratory Excitability’ (NS 1) was consistently related with depressive mood. However, the occurred age and gender effects onto the relations of depressive mood and personality characteristics were very weak (trends for ‘Reward Dependence’ and ‘Persistence’ at P=0.10 exclusively in the normal sample). Most of the variance in depressive mood could be explained by changes in ‘Harm Avoidance’ and ‘Self-Directedness’ independent on effects of age and gender. Possibly, the latter factors are slightly influencing these relations for ‘Reward Dependence’ and ‘Persistence’.