Rolf Verres

Psychological consultation before living kidney donation: finding out and handling problem cases

Background. Since 1996, a team of medical psychologists, nephrologists, and urologists at Heidelberg University Hospital has developed a family-oriented consultation procedure for donors, recipients, and family members before living kidney transplantation. Qualitative content analyses of these consultations and their follow-up histories are presented, with particular focus on “problem cases.” Methods. Sixty-seven consultation interviews were explored by rating family interaction, consultee-consultant interaction, decision-making process, and intervention strategies in problem cases. Subsequently, 33 catamnestic interviews 1 year or more after living donation were explored by qualitative content analysis for donor and recipient quality of life, quality of relationships, and health status. Results. Generally, donors show themselves to be eager; recipients appear more reluctant. Expectations focus on spontaneity and a “normal life.” Fears are usually expressed not about oneself but about the partner involved. Types of confrontation with possible complications are anxious avoidance, active consideration, and optimistic fatalism. Past family experiences of medical traumata may influence content and level of anxiety. Problem cases are characterized by unilaterally dependent close relationships, unrealistic expectations, anxious avoidance of problem confrontation, and negative experiences with the medical system. At follow-up, the majority are in good medical and psychological health. Few donors and recipients are suffering from disappointed expectations or unexpected treatment side effects. Conclusions. The Heidelberg consultation setting has proven useful for allowing open discussion about critical issues. In problem cases, prescribing a moratorium instead of rejecting donation helps to relax consultation anxiety. Psychological support after transplantation seems to be indicated for a minority with typical first-year problems.

Resilience in infertile couples acts as a protective factor against infertility-specific distress and impaired quality of life

ObjectiveOur hypothesis was that resilience (=psychosocial stress-resistance) reduces infertility-specific distress and maintains quality of life of infertile couples.MethodsQuestionnaire data of WHO Quality of Life assessment (WHOQOL; domains: ‘physical’, ‘psychological’, ‘social relationships’ and ‘environment’), Fertility Problem Inventory (FPI; scales: ‘social concern’, ‘sexual concern’, ‘relationship concern’, ‘rejection of childfree lifestyle’ and ‘need for parenthood’), Resilience Scale (RS), as well as sociographic and medical data were available for 199 infertile couples.ResultsAge, medical diagnosis and ‘intensity of desire for a child’ had no influence on quality of life. High scores on ‘suffering from childlessness’ went along with less satisfaction on ‘physical’ and ‘psychological’ domains for the women only. For both partners, high scores on ‘suffering from childlessness’ went along with higher scores on all FPI scales. High resilience was associated with high scores on all WHOQOL domains for both partners, also with low scores on all FPI scales except for ‘need for parenthood’ for the women and with a low score only on ’relationship concern’ for the men.ConclusionsFor infertile couples, resilience can be considered as an unspecific protective factor against infertility-specific distress and impaired quality of life. When offering counselling to involuntarily childless couples, awareness should be raised for resilience as a couple’s resource and a “generic” factor of coping.

Monochord sounds and progressive muscle relaxation reduce anxiety and improve relaxation during chemotherapy: A pilot EEG study

BACKGROUND Chemotherapy is the most distressing form of cancer treatment in oncology, but listening to music can be an adjuvant during chemotherapy. Monochord (MC) sounds are used in music therapy for the alleviation of pain, enhanced body perception, and relaxation. This study investigated the relaxation effect of MC sounds for patients during chemotherapy compared with progressive muscle relaxation (PMR), an established relaxation technique. METHODOLOGY/PRINCIPAL FINDINGS Two randomized groups of patients were observed during chemotherapy. One group listened to recorded MC sounds (n=20) and the other group listened to recorded PMR (n=20). Each session was investigated pre and post using Spielbergers State Anxiety Inventory (SAI) and a questionnaire about the patients physical and psychological states. Further, for the first and the last session, multivariate electroencephalogram (EEG) signals were recorded. Patients in both MC and PMR groups showed significant improvement in their physical and psychological states and in state anxiety. The EEG data showed that the MC and the PMR groups were associated with an increase of posterior theta (3.5-7.5 Hz) and a decrease of midfrontal beta-2 band (20-29.5 Hz) activity during the end phase of relaxation treatment. Further, the MC group was associated with decreased alpha band (8-12 Hz) activity in comparison with PMR group. CONCLUSIONS This study shows that both listening to recorded MC sounds and practising PMR have a useful and comparable effect on gynaecologic oncological patients during chemotherapy, with partially overlapping but also notably divergent neural correlates. Future research should establish the systematic use of MC in oncological contexts.

A 10-year follow-up study of psychosocial factors affecting couples after infertility treatment

BACKGROUND Little is known about the long-term course taken in life by couples who had undergone medically assisted reproduction (MAR). The aim of this study was to find out in a large sample whether, in comparison with parents, involuntarily childless couples have a different subjective perception of overall and specific quality of life over a period of >10 years. METHODS Between 1994 and 1997, 564 couples participated in the initial Heidelberg Fertility Consultation Service study of psychosocial aspects of infertility. In March 2008, a follow-up questionnaire was sent to all of these couples. Both partners were asked about the current status of their desire for a child and their satisfaction with life, their self-esteem, partnership, sexuality and career, as well as their current attitude towards the MAR they had undergone and experience of the process. RESULTS The final sample consisted of 148 couples and 60 women (response rate: 41% of the women and 31% of the men contacted). Fifty-nine percent of the women had at least one genetically related child, 11% had a foster or adopted child and 30% remained childless. Comparisons of psychological variables between parents and childless couples were done for the 148 couples only. Post-MAR parents indicated significantly higher self-esteem than childless couples (P < 0.01) and were more inclined to go through the infertility treatment again than childless couples (P < 0.001 for women, P < 0.05 for men). Positive aspects of infertility were seen more often by childless couples than by parents (P < 0.001). Childless women reported more occupational satisfaction than mothers (P < 0.01), while no such difference was identified in the male partners. Concerning overall life satisfaction, satisfaction with friendships and the partnership, and sexual satisfaction there were no statistically significant differences between childless women/men and mothers/fathers. CONCLUSIONS Overall, our 10-year follow-up survey indicated good psychological adjustment both in childless couples and in post-MAR parents. A decline of sexual satisfaction in childless couples (often reported in the literature) was not observed in this large sample. Quality of life in the long-term can safely be said to be high, both in the definitively childless couples and the post-MAR parents. These findings should be integrated into the information and counselling for would-be parents prior to infertility treatment. A major limitation of this study is that the majority of women and men from the initial study did not respond in our follow-up study.

Therapeutic Effects of Ritual Ayahuasca Use in the Treatment of Substance Dependence—Qualitative Results

Abstract This qualitative empirical study explores the ritual use of ayahuasca in the treatment of addictions. Ayahuasca is an Amazonian psychedelic plant compound created from an admixture of the vine Banisteriopsis caapi and the bush Psychotria viridis. The study included interviews with 13 therapists who apply ayahuasca professionally in the treatment of addictions (four indigenous healers and nine Western mental health professionals with university degrees), two expert researchers, and 14 individuals who had undergone ayahuasca-assisted therapy for addictions in diverse contexts in South America. The study provides empirically based hypotheses on therapeutic mechanisms of ayahuasca in substance dependence treatment. Findings indicate that ayahuasca can serve as a valuable therapeutic tool that, in carefully structured settings, can catalyze neurobiological and psychological processes that support recovery from substance dependencies and the prevention of relapse. Treatment outcomes, however, can be influenced by a number of variables that are explained in this study. In addition, issues related to ritual transfer and strategies for minimizing undesired side-effects are discussed.

The Effect of Nasopharyngoscopic Biofeedback in Patients With Cleft Palate and Velopharyngeal Dysfunction

Objective To evaluate the immediate, long-term, and carry-over effects of nasopharyngoscopic biofeedback therapy in patients with cleft palate who exhibit velopharyngeal dysfunction (VPD). Design Pre- versus posttreatment and follow-up comparisons. Setting Cleft palate center of the Heidelberg University Hospital, Heidelberg, Germany. Subjects Eleven patients with VPD who had received conventional speech therapy without showing significant improvement. Interventions A four-stage feedback procedure. The patients watched and evaluated their velopharyngeal (VP) valving during speech by an endoscopic image displayed on a video monitor. Two feedback sessions took place for every target sound. Main Outcome Measures Mean occurrence of VP closure during speech sound production on different linguistic levels. Patients’ self-perception was assessed by a questionnaire and speech diary. Results Significant improvement and stability of VP closure was noted. Mean occurrence of VP closure was 5% before therapy, 91% after two biofeedback sessions, and 86% in the follow-up after 6 months. Velopharyngeal dysfunction associated with compensatory articulation proved to be equally well trained as VPD on sounds with good articulatory placement. No significant difference was observed in the degree of improvement between phoneme-specific VPD and generalized VPD. The transfer to the level of words and sentences was successful and showed significant stability. The stability of VP closure for vowels was less than the stability for fricatives and stop sounds. Patients gained improved auditory and kinesthetic self-perception of their articulation. Conclusions Nasopharyngoscopic biofeedback therapy proves to be a quick and effective method to change VPD. It shows stable results and carry-over effects.

Chronifizierungsprävention primärer Kopfschmerzen bei Kindern und Jugendlichen

Zusammenfassung. Primare Kopfschmerzen sind nach dem derzeitigen Forschungsstand als sowohl angeborene wie auch erlernte Funktionsstorung des zentralen und vegetativen Nervensystems zu betrachten. Kinder, die eine Veranlagung fur eine derartige Funktionsstorung mitbringen, reagieren auf vielfaltige Ausloser und Belastungen mit Kopfschmerzen. Sie haben die Aufgabe, eine Lebensform zu finden, die es ihnen unter Nutzung ihrer individuellen Ressourcen ermoglicht, mit moglichst wenig Kopfschmerzen zu leben. Es wird ein losungsorientiertes Therapiekonzept vorgestellt, das theoriegeleitet entwickelt wurde, das heist sich auf den derzeitigen atiopathogenetischen Kenntnisstand bezieht. Das Gruppentherapieprogramm wurde in einem Pra-post-follow-up-Design mit extern rekrutierter Vergleichsgruppe evaluiert. Erste Ergebnisse der Studie1Gefordert im Forschungsschwerpunkt “Multidimensionalitat des chronifizierenden Schmerzes” der Medizinischen Fakultat der Universitat Heidelberg. werden berichtet.

Musiktherapie bei chronischen Kopfschmerzen

ZusammenfassungFragestellung. Ausgehend von einem systemtheoretisch begründeten Verständnis chronischer Kopfschmerzen wird ein musiktherapeutischer Gruppenansatz für Patienten mit chronischen Kopfschmerzen vorgestellt. Anhand der Wirkungsweise klanggeleiteter Trancezustände wird das multimodale Behandlungskonzept musiktherapeutischer Kopfschmerzgruppen begründet und evaluiert. Dabei handelt es sich um ein kurztherapeutisches Vorgehen mit einem Umfang von 8 Gruppensitzungen mit jeweils einem Einzelgespräch vor und nach der Gruppenbehandlung. Methodik. Vier Kopfschmerzgruppen mit insgesamt 34 Teilnehmern wurden in einer kontrollierten Therapiestudie untersucht. Mit Hilfe verschiedener Selbstbeschreibungs-Fragebögen (DS, BL, HCB-S, FLZ, FEX), Schmerztagebücher und Kopfschmerzkalender wurden unmittelbar vor und nach der Gruppentherapie Daten zum Befinden, zur Lebensqualität, Schmerzverarbeitung, Expressivität und zum Schmerzerleben erhoben. 3 und 6–12 Monate später wurden katamnestische Daten zum Transfer und zur subjektiven Kopfschmerzbesserung erhoben sowie 6–12 Monate nach der Behandlung nochmals ein Kopfschmerzkalender zur Erhebung der Intensität und Dauer der Kopfschmerzen eingesetzt. Die Teilnehmer wurden außerdem nach der Behandlung zu Wirkungen und Therapieprozess interviewt. In einer Einzelfallbeschreibung werden die psychosoziale Anamnese, Therapieverlauf und -effekte exemplarisch dargestellt. Ergebnisse. Durch die Einzelfallbeschreibung wird deutlich, dass die Erfahrung von (partiellem) Kontrollverlust bzw. Reduzierung der Affektkontrolle während der Klangtrance therapeutisch bedeutsame, wirksame Erfahrungen und kreative Lösungsprozesse anstößt, die erst langfristig schmerzmildernde Wirkung entfalten. Im Prä-Post-Vergleich (mit Hilfe des Wilcoxon-Tests) der Mittelwerte ergaben sich wenige statistisch bedeutsame Therapieeffekte. Im Vergleich zu einer kleinen Kontrollgruppe reduzierten sich nach der Gruppentherapie die Schmerztage und Depressivität tendenziell, während das Copingverhalten “Suche nach sozialer Unterstützung” tendenziell zunahm. Als langfristiger Therapieeffekt zeigte sich, dass sich bei den Teilnehmern der Therapiegruppen 6–12 Monate nach der Behandlung die Kopfschmerztage signifikant reduziert haben und die Schmerzkontrolle signifikant gestiegen ist. Schlussfolgerung. Im Einklang mit zahlreichen psychologischen Evaluationsstudien liefert die Studie Hinweise auf die eher langfristige Wirkung musiktherapeutischer Maßnahmen bei Patienten mit chronischen Kopfschmerzen. Musiktherapeutische Ansätze ergänzen medizinische Behandlungsformen, indem sie Eigeninitiative wecken und zu einer adaptiven Schmerzbewältigung beitragen.AbstractProblem. This paper presents a new approach to music therapeutic treatments. We developed a short time treatment ( 8 group sessions) for patients suffering from chronic headaches. The multimodal concept of this headache treatment and particularly the effect of a sound trance on headache patients are explained and evaluated in this paper. Methods. An evaluation study was done with 34 patients, who belonged to four therapy groups. In order to evaluate this treatment the patients were interviewed and had to fill out several self-rating scales about pain and some psychological variables (e. g. depression) before, directly after and 6–12 months after the treatment. This treatment group (n=26) was compared to a small waiting group (n=9). A case study elucidated the psycho-social anamnesis, and the process and outcome of the music therapy. Results. The case study shows that the sound trance caused a loss of the affect control or at least reduced it. This experience enabled the patients to develop creative solutions, which resulted in a pain relief 6–12 month later. The comparison of the statistic means directly before and after the treatment did not reveal many therapeutic effects. Yet, 6–12 months later many patients reported less days at which they suffered from headaches; and they also significantly improved their ability of pain control. Conclusion. The results indicate that music therapy groups are more successful than a waiting group. The studys results agree with numerous other psychological evaluation studies and shows once more that music therapists working with patients suffering from chronic headaches are able to achieve successful results particularly long-dated. Thus, creative therapeutic approaches supplement the medical treatment, as they help the patients to develop an adaptive way of coping their pain. Yet, it will need further research to confirm the benefit of music therapy for patients suffering from chronic pain.

New Steps in Musical Meaning – the Metaphoric Process as an Organizing Principle

Cognitive metaphor theory provides music psychology and music therapy with some principles for an explanation of musical experience. This is described as personal meaning generation on different levels of information processing. The listeners or players actively merge internal and external contexts with their inframusical, acoustical perceptions. We introduce the concept of “musical scenes” as a characterisation of such contexts in music playing and listening, Here metaphor theory is demonstrated as an empirically based approach that gives insight into some meaning generation processes. Examples are given from interviews with music therapy clients. Finally some ideas on the development of music therapy theory are presented.

Primäre Kopfschmerzen im Kindes- und Jugendalter

ZusammenfassungFragestellung:Bei Erkrankungen und Störungen im Kindes- und Jugendalter ist die Familie in vielfältiger und komplexer Weise (etwa bei der Entstehung, Aufrechterhaltung und Genesung) involviert. Die vorliegende Pilotstudie stellt einen Zusammenhang zwischen familiären Variablen und den Therapieeffekten einer psychologischen Gruppen- und Familienbehandlung bei pädiatrischen Kopfschmerzen dar. Methode:Exemplarisch wird über eine Teilstichprobe von 12 Probanden mit ausgeglichenem Geschlechterverhältnis im Alter von 9–15 Jahren berichtet. Die Probanden wurden nach IHS-Kriterien diagnostiziert. Erfasst wurde die globale Symptombelastung mittels einer numerischen Ratingskala (NRS) zum Therapiebeginn und 9 Monate nach Beendigung der Therapie (Gruppenhypnotherapie kombiniert mit systemischer Familienberatung). Zu den oben angegebenen Zeitpunkten wurden mittels einer qualitativen Forschungsstrategie auch familiäre Beziehungsmuster, die kritisch mit den Kopfschmerzen assoziiert sind, erhoben. Ergebnisse:Es fand sich ein Zusammenhang zwischen der Veränderung der globalen Symptombelastung und der Veränderung familiärer Beziehungsmuster. Es fanden sich bei Probanden, die ihre globale Symptombelastung als unverändert eingeschätzt haben, kritische familiäre Beziehungsmuster, die ebenfalls als unverändert eingeschätzt wurden, und bei Probanden, die ihre globale Symptombelastung als positiv verändert eingeschätzt haben, nach der Therapie Beziehungsmuster, die als positiv verändert eingeschätzt wurden. Schlussfolgerungen:Die Ergebnisse liefern einen empirischen Hinweis darauf, wann die Einbeziehung der Familie in die Behandlung pädiatrischer Kopfschmerzen indiziert erscheint: in Fällen, in denen festgefahrene kopfschmerzbezogene familiäre Beziehungsmuster eine Veränderung der Symptomatik erschweren.AbstractIntroduction:Family interaction patterns are often involved in diseases and disorders in childhood and adolescence in complex ways (e.g in their development, maintenance and cure). The present study deals with the role of family factors in success in a pediatric headache therapy consisting of group hypnotherapy and systemic family consultation. Methods:A sample of 12 outpatients, aged 9–15 years and balanced in sex, is investigated. Patients were diagnosed by IHS-criteria. Global symptom strain was measured by numeric rating scale (NRS) at pre-appointment and at 9-months follow-up appoinment. Also family interaction patterns associated with the occurence of headache symptoms were measured by content analysis. Results:We found an association between changes in two independetly assessed variables: global symptom strain and family interaction patterns. (1) When patients assessed global symptom strain as unchanged, family interaction patterns associated with headache were also assessed as unchanged by observers; (2) when patients assessed their global symptom strain as positively changed, family interaction pattern associated with hheadache were also asessed aspositively changed by observers. Conclusion:These data provide empirical evidence about when to include family in treatment of pediatric headache: when rigid family interaction patterns associated with headache complicate a symptom change.