Micha Strack

Measuring Psychotherapeutic Change with the Symptom Checklist SCL 90 R

Background: Despite a long tradition of discussions on the evaluation of psychotherapy, there is still a lack of agreement for measuring change after psychological treatment. In this paper we describe the concept of statistical and clinical significance of change. We use the Symptom Checklist 90 R as a commonly administered instrument to propose conventions and cutoff points for psychological symptoms and their change after therapy. Method: A German norm population and several psychotherapy samples have been aggregated to calculate cutoffs and confidence intervals (reliable change indices) for statistically and clinically significant changes after psychotherapy. Results: The cutoff point between a ‘functional’ and a ‘dysfunctional’ population was calculated as C = 0.57 (Global Severity Index, GSI). Patients above this score need a change of at least RCI = 0.43 (GSI difference) for a statististically significant change. Below this score the RCI = 0.16. The use of multiple clinical groups (e.g. inpatients and outpatients) for a more realistic determination of a ‘stepwise’ clinically significant change, as proposed by Tingey et al. in the USA, is not possible in the German samples collected so far. Initial SCL 90-R scores in these groups do not show enough differences to call a move from one group to the other a clinically significant change. Conclusion: In the German samples investigated the move from a ‘functional’ to a ‘dysfunctional’ population and vice versa has to be taken as the criterion for a clinically significant change up to now.

How Shared Preferences in Music Create Bonds Between People: Values as the Missing Link

How can shared music preferences create social bonds between people? A process model is developed in which music preferences as value-expressive attitudes create social bonds via conveyed value similarity. The musical bonding model links two research streams: (a) music preferences as indicators of similarity in value orientations and (b) similarity in value orientations leading to social attraction. Two laboratory experiments and one dyadic field study demonstrated that music can create interpersonal bonds between young people because music preferences can be cues for similar or dissimilar value orientations, with similarity in values then contributing to social attraction. One study tested and ruled out an alternative explanation (via personality similarity), illuminating the differential impact of perceived value similarity versus personality similarity on social attraction. Value similarity is the missing link in explaining the musical bonding phenomenon, which seems to hold for Western and non-Western samples and in experimental and natural settings.

Stereotypical Relationship patterns and psychopathology

Background: We explored the relationship between the consistency of relationship patterns and the severity of psychopathology. Method: Relationship patterns were assessed by means of Relationship Anecdote Paradigm interviews rated according to the Core Conflictual Relationship Theme (CCRT) method. The repetition of the same type of CCRT components across relationship narratives indicated stereotypical patterns. Results: Subjects treated in an inpatient setting (n = 25) told narratives with more consistent patterns than subjects in an outpatient setting (n = 32). Relationship episodes of normal adults (n = 23) were more flexible compared with the two clinical groups. Especially repetitions of the wish component were closely associated with the severity of psychopathology assessed by SCL-90R. Conclusions: The consistency of relationship patterns seems to be connected with the severity of psychopathology.

Positive impact of crisis resource management training on no-flow time and team member verbalisations during simulated cardiopulmonary resuscitation: a randomised controlled trial.

OBJECTIVES To evaluate the impact of video-based interactive crisis resource management (CRM) training on no-flow time (NFT) and on proportions of team member verbalisations (TMV) during simulated cardiopulmonary resuscitation (CPR). Further, to investigate the link between team leader verbalisation accuracy and NFT. METHODS The randomised controlled study was embedded in the obligatory advanced life support (ALS) course for final-year medical students. Students (176; 25.35±1.03 years, 63% female) were alphabetically assigned to 44 four-person teams that were then randomly (computer-generated) assigned to either CRM intervention (n=26), receiving interactive video-based CRM-training, or to control intervention (n=18), receiving an additional ALS-training. Primary outcomes were NFT and proportions of TMV, which were subdivided into eight categories: four team leader verbalisations (TLV) with different accuracy levels and four follower verbalisation categories (FV). Measurements were made of all groups administering simulated adult CPR. RESULTS NFT rates were significantly lower in the CRM-training group (31.4±6.1% vs. 36.3±6.6%, p=0.014). Proportions of all TLV categories were higher in the CRM-training group (p<0.001). Differences in FV were only found for one category (unsolicited information) (p=0.012). The highest correlation with NFT was found for high accuracy TLV (direct orders) (p=0.06). CONCLUSIONS The inclusion of CRM training in undergraduate medical education reduces NFT in simulated CPR and improves TLV proportions during simulated CPR. Further research will test how these results translate into clinical performance and patient outcome.

Randomized comparison of the i-gel™, the LMA Supreme™, and the Laryngeal Tube Suction-D using clinical and fibreoptic assessments in elective patients

BackgroundThe i-gel™, LMA-Supreme (LMA-S) and Laryngeal Tube Suction-D (LTS-D) are single-use supraglottic airway devices with an inbuilt drainage channel. We compared them with regard to their position in situ as well as to clinical performance data during elective surgery.MethodsProspective, randomized, comparative study of three groups of 40 elective surgical patients each. Speed of insertion and success rates, leak pressures (LP) at different cuff pressures, dynamic airway compliance, and signs of postoperative airway morbidity were recorded. Fibreoptic evaluation was used to determine the devices’ position in situ.ResultsLeak pressures were similar (i-gel™ 25.9, LMA-S 27.1, LTS-D 24.0 cmH2O; the latter two at 60 cmH2O cuff pressure) as were insertion times (i-gel™ 10, LMA-S 11, LTS-D 14 sec). LP of the LMA-S was higher than that of the LTS-D at lower cuff pressures (p <0.05). Insertion success rates differed significantly: i-gel™ 95%, LMA-S 95%, LTS-D 70% (p <0.05). The fibreoptically assessed position was more frequently suboptimal with the LTS-D but this was not associated with impaired ventilation. Dynamic airway compliance was highest with the i-gel™ and lowest with the LTS-D (p <0.05). Airway morbidity was more pronounced with the LTS-D (p <0.01).ConclusionAll devices were suitable for ventilating the patients’ lungs during elective surgery.Trial registrationGerman Clinical Trial Register DRKS00000760

The influence of interpersonal problems and symptom severity on the duration and outcome of short-term psychodynamic psychotherapy

This naturalistic outcome study investigated validity aspects of the Inventory of Interpersonal Problems (IIP [Horowitz, Strauß, & Kordy, 1995]). The sample consisted of 180 patients who received short-term psychodynamic psychotherapy for an average number of 7.8 sessions and an average duration of 3.4 months. Small changes in pre-post-measures imply that the IIP is not to be recommended as an instrument for outcome evaluation in short-term psychotherapy, due to the traitlike character of its items. However, we showed by path analyses that a higher score on the affiliative dimension of the interpersonal circumplex goes along with a better treatment outcome. The influence of the dominance dimension is gender specific: male patients (who generally showed more dismissive and introverted behavior in this sample) received, if dismissive and introverted, a longer introductory therapy, whereafter they - in cases of high symptom load - were often referred to long-term treatment. Dominant male patients and, in general, female patients with high symptom scores, were referred faster, after only a few sessions. Results are discussed under aspects of adaptive therapist behavior.

INFLUENCES OF PATIENTS’ AND THERAPISTS’ INTERPERSONAL PROBLEMS AND THERAPEUTIC ALLIANCE ON OUTCOME IN PSYCHOTHERAPY

Abstract The aim of this study was to investigate the importance of therapists’ and patients’ interpersonal problems as well as the impact of the therapeutic alliance on symptomatic outcome in psychotherapy. Of interest were direct effects of interpersonal problems, represented through the dimensions of affiliation and control, as well as possible interaction effects between patient and therapist variables on outcome. Further hypotheses referred to therapist differences in the predictive impact of the therapeutic alliance for outcome. Outcome ratings of 1,513 psychotherapy inpatients treated by 31 psychodynamically oriented individual psychotherapists were studied. Therapists’ and patients’ interpersonal dispositions were assessed with the Inventory of Interpersonal Problems, and patients answered standardized outcome measures before and after therapy and retrospectively evaluated the therapeutic alliance at discharge. The results indicate that dominant patients profited better from their therapy and that therapists’ interpersonal disposition did not have a direct influence on outcome. The influence of the therapeutic alliance on outcome varied among the therapists. The general positive effect of therapeutic alliance on outcome was stronger for less affiliative therapists. Limitations of the study and implications of the results are discussed.

Transfer of airway skills from manikin training to patient: success of ventilation with facemask or LMA-SupremeTM by medical students

During emergency care, the ability to ventilate the patients lungs is a crucial skill. Supraglottic airway devices have an established role in emergency care, and manikin trials have shown that placement is easy even for inexperienced users. However, there is current discussion as to what extent these results can be transferred to patients. We studied the transfer of skills learnt on a manikin to the clinical situation in novice medical students during their anaesthesia rotation. They were required to ventilate the lungs of a manikin using a facemask and then position a supraglottic airway device (LMA‐Supreme™) and ventilate the lungs. This process was then repeated on anaesthetised patients, with standard ventilator settings to assess adequacy of ventilation. Sixty‐three students participated in the manikin study. The success rate for ventilating the lungs was 100% for both devices, but the mean (SD) time to achieve successful ventilation was 27.8 (24.4) s with the facemask compared with 38.6 (22.0) s with the LMA‐Supreme (p = 0.008). Fifty‐one of the students progressed to the second part of the study. In anaesthetised patients, the success rate for ventilating the lungs was lower for the facemask, 27/41 (66%) compared with the LMA‐Supreme 37/41 (90%, p = 0.006). For 26 students who succeeded with both devices, the tidal volume was lower using the facemask, 431 (192) ml compared with the LMA‐Supreme 751 (221) ml (p = 0.001), but the time to successful ventilation did not differ, 60.0 (26.2) s vs 57.3 (26.6) s (p = 0.71). We conclude that the results obtained in manikin studies cannot be transferred directly to the clinical situation and that guidelines should take this into account. Based on our findings, a supraglottic airway device may be preferable to a facemask as the first choice for inexperienced emergency caregivers.

A controlled rapid-sequence induction technique for infants may reduce unsafe actions and stress

Background: Classic rapid‐sequence induction of anaesthesia (RSI‐classic) in infants and small children presents a time‐critical procedure, regularly associated with hypoxia. This results in high stress levels for the provider and may trigger unsafe actions. Hence, a controlled induction technique (RSI‐controlled) that involves gentle mask ventilation until full non‐depolarizing muscular blockade has become increasingly popular. Clinical observation suggests that RSI‐controlled may reduce the adverse effects noted above. We aimed to evaluate both techniques with respect to unsafe actions and stress.

An Inclusive Model of Group Coordination

The need for a cross-disciplinary inclusive model to analyse the coordination of human and non-human groups is based on observations that (1) group coordination is a fundamental and complex everyday phenomenon in both human and non-human primate groups that (2) largely impacts the functioning of these groups and (3) continues to be fragmentarily studied across disciplines. We formulate an overview of the basic group challenge (group task) of coordination and describe how the context of the group task regulates the group’s functions (effectiveness criteria) for achieving their task. We explain the basic entities that have to be coordinated and therefore analysed, illustrate the concept of coordination process mechanisms by which the entities can be coordinated, and finally argue that these mechanisms have finite characteristics of explicitness or implicitness and can and do occur before and after the core coordination process. We then go into further detail by showing how patterns emerge from the various coordination dynamics, and end with a discussion of how the various coordination levels at which coordination operates also need to be analysed with a separate IPO (input–process–outcome) ‘lens’ that revolves around the basic analytical model, ensuring that multiple perspectives as well as levels of dissolution (macro, meso, micro) are analysed. In our final section, we review the components of contemporary small group theory and integrate these components into our inclusive functions–entities–mechanisms–patterns (FEMPipo) model of human and non-human primate small group coordination.