Rudolf J. Knickenberg

Vocational training integrated into inpatient psychosomatic rehabilitation--short and long-term results from a controlled study.

Purpose. The aim of this study was to determine the impact of a vocational training programme on short- and long-term results after psychosomatic rehabilitation. Method. 1,590 inpatients were screened for vocational integration. A high-risk group of 266 patients was randomly assigned to the vocational training programme plus psychosomatic treatment; treatment- as- usual served as a control condition. An occupational training was conducted at local companies, closely integrated into psychosomatic treatment. Vocational attitudes and adjustment were studied at intake, discharge, three, 12 and 24 month follow-ups. Results. More than half of the study participants were unemployment and/or long-term work-disabled harbouring strong negative attitudes toward return to work. Forty-six percent of the intervention group declined from participation, but complied with follow-up investigation. At discharge, participants of the vocational training programme had become more optimistic regarding resuming work. One year following discharge, participants of the training programme reported less absence from work. After 24 months, vocational adjustment had improved considerably among programme participants, and declined among controls and refusers. Conclusion. An intensive vocational training programme is effective in promoting positive attitudes to work, reducing work disability and promoting return-to-work. However, a randomized design may be not optimal; evaluation necessitates long-term follow-up.

Psychodynamic Focal Group Treatment for Psychosomatic Inpatients–with an Emphasis on Work-Related Conflicts

Abstract Conflicts arising from the work setting have remained a neglected issue in psychotherapy. To address this, the present study investigated the effectiveness of a manualized focal group treatment for psychotherapeutic inpatients suffering from vocational strains and conflicts and identified predictors of outcome. Cohorts of patients were assigned either to a treatment (N = 144) or control condition (N = 135). The group therapy intervention was found to be highly accepted by participants who were also more optimistic about returning to work and more favorable in their evaluations of treatment than patients in the treatment–as–usual condition. Group climate was found to be a predictor of favorable outcome. The findings suggest that a group therapy intervention with a strong emphasis on motivations and attitudes about work may be particularly suitable to deal with vocational conflicts and strains.

Evaluation of an internet-based aftercare program to improve vocational reintegration after inpatient medical rehabilitation: study protocol for a cluster-randomized controlled trial

BackgroundMental disorders are the main reasons for rising proportions of premature pension in most high-income countries. Although inpatient medical rehabilitation has increasingly targeted work-related stress, there is still a lack of studies on the transfer of work-specific interventions into work contexts. Therefore, we plan to evaluate an online aftercare program aiming to improve vocational reintegration after medical rehabilitation.MethodsVocationally strained patients (n = 800) aged between 18 and 59 years with private internet access are recruited in psychosomatic, orthopedic and cardiovascular rehabilitation clinics in Germany. During inpatient rehabilitation, participants in stress management group training are cluster-randomized to the intervention or control group. The intervention group (n = 400) is offered an internet-based aftercare with weekly writing tasks and therapeutic feedback, a patient forum, a self-test and relaxation exercises. The control group (n = 400) obtains regular e-mail reminders with links to publicly accessible information about stress management and coping. Assessments are conducted at the beginning of inpatient rehabilitation, the end of inpatient rehabilitation, the end of aftercare, and 9 months later. The primary outcome is a risk score for premature pension, measured by a screening questionnaire at follow-up. Secondary outcome measures include level of vocational stress, physical and mental health, and work capacity at follow-up.DiscussionWe expect the intervention group to stabilize the improvements achieved during inpatient rehabilitation concerning stress management and coping, resulting in an improved vocational reintegration. The study protocol demonstrates the features of internet-based aftercare in rehabilitation.Trial registrationInternational Standard Randomised Controlled Trial Number Register (ISRCTN:ISRCTN33957202)

Does a cognitive-training programme improve the performance of middle-aged employees undergoing in-patient psychosomatic treatment?

Purpose. With the ever-increasing average life expectancy and rising age of retirement, cognitive and work capacities in advanced age take on great importance. Cognitive impairments, however, increase with age. The effect of cognitive-training programmes on people with mild cognitive impairment has not been verified in any systematic investigations. Method. This study presents a cognitive-training programme designed for middle-aged employees that was implemented and evaluated at the Psychosomatic Clinic Bad Neustadt/Saale in an AB study design (A: no intervention; B: intervention). Results. Memory performance of the intervention group (n = 33) improved significantly between intake and discharge, compared with that of the control group (n = 40), as did self-ratings of memory and work-related attitudes. Conclusions. A cognitive-training programme is useful and effective in patients with mild cognitive impairment. Future studies should investigate how older or more severely impaired patients benefit from such a programme.

Online Self-Help as an Add-On to Inpatient Psychotherapy: Efficacy of a New Blended Treatment Approach

Background: Depression is one of the most frequent and costly mental disorders. While there is increasing evidence for the efficacy of online self-help to improve depression or prevent relapse, there is little evidence in blended care settings, especially combined with inpatient face-to-face psychotherapy. Therefore, we evaluated whether an evidence-based online self-help program improves the efficacy of inpatient psychotherapy. Methods: A total of 229 depressed patients were randomly allocated either to an online self-help program (intervention group [IG]; Deprexis) or an active control group (CG; weekly online information on depression) in addition to inpatient psychodynamic psychotherapy. Both groups had access to their respective experimental intervention for 12 weeks, regardless of inpatient treatment duration. Reduction of depressive symptoms, as measured with the Beck Depression Inventory-II, was the primary outcome at the end of the intervention (T2). Results: Depressive symptoms were statistically significantly lower in the IG compared to the active CG at T2 with a moderate between-group effect size of d = 0.44. The same applied to anxiety (d = 0.33), quality of life (d = 0.34), and self-esteem (d = 0.38) at discharge from inpatient treatment (T1). No statistically significant differences were found regarding dysfunctional attitudes (d = 0.14) and work ability (d = 0.08) at T1. Conclusions: This is the first evidence for blended treatment combining online self-help with inpatient psychotherapy. The study opens new and promising avenues for increasing the efficacy of inpatient psychotherapy. Future studies should determine how integration of online self-help into the therapeutic process can be developed further.

Evaluation of a video-based Internet intervention as preparation for inpatient psychosomatic rehabilitation: study protocol for a randomized controlled trial

BackgroundPatients’ treatment expectations are a key factor in psychotherapy. Several studies have linked higher expectations to better treatment success. Therefore, we want to evaluate the impact of a targeted video-based intervention on patients’ expectations and the treatment success of inpatient rehabilitation.Methods/designAll patients who will be referred to inpatient psychosomatic rehabilitation in three clinics will receive a study flyer with information about how to log in to the study platform together with the usual clinic information leaflet. Patients will receive the study information and informed consent upon login and will be randomized into the intervention or the control group. The intervention group (n = 394) will get access to our virtual online clinic, containing several videos about inpatient rehabilitation, until their admission to inpatient rehabilitation. The control group (n = 394) will receive no special treatment preparation. Questionnaires will be given at study inclusion (T0), two weeks before admission to (T1), and at the end of (T2) inpatient rehabilitation. The primary outcome is the outcome expectancy measured with the Credibility Expectancy Questionnaire at T1. Secondary outcomes include treatment motivation, mental health, work ability, depression, anxiety, and satisfaction with and usage of the Internet platform.DiscussionWe expect the intervention group to benefit from the additional preparation concerning their outcome expectancy. If successful, this approach could be used in the future to enhance the efficacy of inpatient rehabilitation.Trial registrationClinicalTrials.gov: NCT02532881. Registered on 25 August 2015.

Berufsbezogene Einstellungen, Ressourcen und Risikomerkmale im Therapieverlauf:

Zusammenfassung. Hintergrund. Das Fehlen standardisierter Messverfahren ist hinderlich fur die psychotherapeutische Diagnostik und Bearbeitung berufsbezogener Belastungen und Konflikte. Der AVEM (Arbeitsbezogenes Verhaltens- und Erlebensmuster) erfasst Selbstbeschreibungen berufsbezogener Einstellungen, Bewaltigungsressourcen und Risikomerkmale differenziert und okonomisch, wurde allerdings an nicht- klinischen Stichproben (Lehrerinnen, Fuhrungskrafte) entwickelt. Fragestellung: Uberprufung der Eignung des AVEM fur psychisch und psychosomatisch Kranke. Methode: 644 Patientinnen und Patienten wurden bei Aufnahme zur stationaren psychosomatischen Rehabilitation, Entlassung und 3-Monatskatamnese (N = 329) untersucht. Ergebnisse: Faktorenstruktur und Reliabilitat wurden repliziert. Korrelationen mit weiteren Selbstbeschreibungsverfahren ergaben Validitatshinweise. Selbsteinschatzungen berufsbezogener Ressourcen veranderten sich wahrend der Therapie in Richtung auf die Normstichprobe. Schlussfolgerungen: Es ha...

[Cognitive training in rehabilitation: a program to treat mild cognitive impairment].

ZusammenfassungIm Rahmen eines Forschungsprojekts wurde ein verhaltenstherapeutisch orientiertes Trainingsprogramm zur Verbesserung der kognitiven Leistungsfähigkeit älterer Arbeitnehmer entwickelt und evaluiert. Ziel des Trainings war es, die kognitiven, affektiven und verhaltensbezogenen Bedingungen kognitiver Leistungseinbußen im Beruf zu analysieren. Das Training fokussierte auf zwei Themenschwerpunkte: erstens Erschließen neuer Arbeitsaufgaben, zweitens Zeitmangel und Termindruck. Insgesamt 316 Patienten der Psychosomatischen Klinik Bad Neustadt im Alter zwischen 50 und 59 Jahren nahmen an der Studie teil. Diejenigen mit objektivierbaren kognitiven Beeinträchtigungen wurden in der Interventionsphase dem Training, in der Kontrollphase der Kontrollgruppe zugewiesen. Die kognitiv auffälligen Patienten wurden vor der Entlassung erneut neuropsychologisch untersucht. Die Ergebnisse zeigten, dass sich die objektive und subjektive Gedächtnisleistung der Trainingsteilnehmer im Vergleich zur Kontrollgruppe signifikant verbesserte. Zum Zeitpunkt der Katamnese gaben 84% der Teilnehmer an, die im Training erworbenen Strategien in ihrem beruflichen Alltag einsetzen zu können.AbstractAs part of a research project, a behavior therapy-oriented cognitive training program, designed to improve the cognitive ability of middle-aged employees (50 to 59 years), was implemented and evaluated. The goal of the training program was to analyze the cognitive, affective and behavior-related conditions of memory deficits in the workplace. The training focused on two topics: (1) development of new job tasks, (2) lack of time and deadline constraints. A total of 316 patients in the psychosomatic clinic of Bad Neustadt participated in the study. Those who showed cognitive impairments took part in the cognitive training program during the intervention phase. During the control phase, patients with cognitive impairments received no additional intervention. The neuropsychological screening was repeated with patients with cognitive impairments at discharge. The findings show that the objective and subjective memory performance of the participants improved significantly compared to that of the control group. At the 1-year follow-up, 84% of the participants reported that they could use the training strategies in their job.As part of a research project, a behavior therapy-oriented cognitive training program, designed to improve the cognitive ability of middle-aged employees (50 to 59 years), was implemented and evaluated. The goal of the training program was to analyze the cognitive, affective and behavior-related conditions of memory deficits in the workplace. The training focused on two topics: (1) development of new job tasks, (2) lack of time and deadline constraints. A total of 316 patients in the psychosomatic clinic of Bad Neustadt participated in the study. Those who showed cognitive impairments took part in the cognitive training program during the intervention phase. During the control phase, patients with cognitive impairments received no additional intervention. The neuropsychological screening was repeated with patients with cognitive impairments at discharge. The findings show that the objective and subjective memory performance of the participants improved significantly compared to that of the control group. At the 1-year follow-up, 84% of the participants reported that they could use the training strategies in their job.

Gedächtnismanagementtraining in der Rehabilitation (KTR)@@@Cognitive training in rehabilitation: Programm zur Behandlung leichter kognitiver Beeinträchtigungen@@@A program to treat mild cognitive impairment

ZusammenfassungIm Rahmen eines Forschungsprojekts wurde ein verhaltenstherapeutisch orientiertes Trainingsprogramm zur Verbesserung der kognitiven Leistungsfähigkeit älterer Arbeitnehmer entwickelt und evaluiert. Ziel des Trainings war es, die kognitiven, affektiven und verhaltensbezogenen Bedingungen kognitiver Leistungseinbußen im Beruf zu analysieren. Das Training fokussierte auf zwei Themenschwerpunkte: erstens Erschließen neuer Arbeitsaufgaben, zweitens Zeitmangel und Termindruck. Insgesamt 316 Patienten der Psychosomatischen Klinik Bad Neustadt im Alter zwischen 50 und 59 Jahren nahmen an der Studie teil. Diejenigen mit objektivierbaren kognitiven Beeinträchtigungen wurden in der Interventionsphase dem Training, in der Kontrollphase der Kontrollgruppe zugewiesen. Die kognitiv auffälligen Patienten wurden vor der Entlassung erneut neuropsychologisch untersucht. Die Ergebnisse zeigten, dass sich die objektive und subjektive Gedächtnisleistung der Trainingsteilnehmer im Vergleich zur Kontrollgruppe signifikant verbesserte. Zum Zeitpunkt der Katamnese gaben 84% der Teilnehmer an, die im Training erworbenen Strategien in ihrem beruflichen Alltag einsetzen zu können.AbstractAs part of a research project, a behavior therapy-oriented cognitive training program, designed to improve the cognitive ability of middle-aged employees (50 to 59 years), was implemented and evaluated. The goal of the training program was to analyze the cognitive, affective and behavior-related conditions of memory deficits in the workplace. The training focused on two topics: (1) development of new job tasks, (2) lack of time and deadline constraints. A total of 316 patients in the psychosomatic clinic of Bad Neustadt participated in the study. Those who showed cognitive impairments took part in the cognitive training program during the intervention phase. During the control phase, patients with cognitive impairments received no additional intervention. The neuropsychological screening was repeated with patients with cognitive impairments at discharge. The findings show that the objective and subjective memory performance of the participants improved significantly compared to that of the control group. At the 1-year follow-up, 84% of the participants reported that they could use the training strategies in their job.As part of a research project, a behavior therapy-oriented cognitive training program, designed to improve the cognitive ability of middle-aged employees (50 to 59 years), was implemented and evaluated. The goal of the training program was to analyze the cognitive, affective and behavior-related conditions of memory deficits in the workplace. The training focused on two topics: (1) development of new job tasks, (2) lack of time and deadline constraints. A total of 316 patients in the psychosomatic clinic of Bad Neustadt participated in the study. Those who showed cognitive impairments took part in the cognitive training program during the intervention phase. During the control phase, patients with cognitive impairments received no additional intervention. The neuropsychological screening was repeated with patients with cognitive impairments at discharge. The findings show that the objective and subjective memory performance of the participants improved significantly compared to that of the control group. At the 1-year follow-up, 84% of the participants reported that they could use the training strategies in their job.

Gedächtnismanagementtraining in der Rehabilitation (KTR)

ZusammenfassungIm Rahmen eines Forschungsprojekts wurde ein verhaltenstherapeutisch orientiertes Trainingsprogramm zur Verbesserung der kognitiven Leistungsfähigkeit älterer Arbeitnehmer entwickelt und evaluiert. Ziel des Trainings war es, die kognitiven, affektiven und verhaltensbezogenen Bedingungen kognitiver Leistungseinbußen im Beruf zu analysieren. Das Training fokussierte auf zwei Themenschwerpunkte: erstens Erschließen neuer Arbeitsaufgaben, zweitens Zeitmangel und Termindruck. Insgesamt 316 Patienten der Psychosomatischen Klinik Bad Neustadt im Alter zwischen 50 und 59 Jahren nahmen an der Studie teil. Diejenigen mit objektivierbaren kognitiven Beeinträchtigungen wurden in der Interventionsphase dem Training, in der Kontrollphase der Kontrollgruppe zugewiesen. Die kognitiv auffälligen Patienten wurden vor der Entlassung erneut neuropsychologisch untersucht. Die Ergebnisse zeigten, dass sich die objektive und subjektive Gedächtnisleistung der Trainingsteilnehmer im Vergleich zur Kontrollgruppe signifikant verbesserte. Zum Zeitpunkt der Katamnese gaben 84% der Teilnehmer an, die im Training erworbenen Strategien in ihrem beruflichen Alltag einsetzen zu können.AbstractAs part of a research project, a behavior therapy-oriented cognitive training program, designed to improve the cognitive ability of middle-aged employees (50 to 59 years), was implemented and evaluated. The goal of the training program was to analyze the cognitive, affective and behavior-related conditions of memory deficits in the workplace. The training focused on two topics: (1) development of new job tasks, (2) lack of time and deadline constraints. A total of 316 patients in the psychosomatic clinic of Bad Neustadt participated in the study. Those who showed cognitive impairments took part in the cognitive training program during the intervention phase. During the control phase, patients with cognitive impairments received no additional intervention. The neuropsychological screening was repeated with patients with cognitive impairments at discharge. The findings show that the objective and subjective memory performance of the participants improved significantly compared to that of the control group. At the 1-year follow-up, 84% of the participants reported that they could use the training strategies in their job.As part of a research project, a behavior therapy-oriented cognitive training program, designed to improve the cognitive ability of middle-aged employees (50 to 59 years), was implemented and evaluated. The goal of the training program was to analyze the cognitive, affective and behavior-related conditions of memory deficits in the workplace. The training focused on two topics: (1) development of new job tasks, (2) lack of time and deadline constraints. A total of 316 patients in the psychosomatic clinic of Bad Neustadt participated in the study. Those who showed cognitive impairments took part in the cognitive training program during the intervention phase. During the control phase, patients with cognitive impairments received no additional intervention. The neuropsychological screening was repeated with patients with cognitive impairments at discharge. The findings show that the objective and subjective memory performance of the participants improved significantly compared to that of the control group. At the 1-year follow-up, 84% of the participants reported that they could use the training strategies in their job.