Tobias Teismann

Psychodynamic Therapy and Cognitive-Behavioral Therapy in Social Anxiety Disorder: A Multicenter Randomized Controlled Trial

OBJECTIVE Various approaches to cognitive-behavioral therapy (CBT) have been shown to be effective for social anxiety disorder. For psychodynamic therapy, evidence for efficacy in this disorder is scant. The authors tested the efficacy of psychodynamic therapy and CBT in social anxiety disorder in a multicenter randomized controlled trial. METHOD In an outpatient setting, 495 patients with social anxiety disorder were randomly assigned to manual-guided CBT (N=209), manual-guided psychodynamic therapy (N=207), or a waiting list condition (N=79). Assessments were made at baseline and at end of treatment. Primary outcome measures were rates of remission and response, based on the Liebowitz Social Anxiety Scale applied by raters blind to group assignment. Several secondary measures were assessed as well. RESULTS Remission rates in the CBT, psychodynamic therapy, and waiting list groups were 36%, 26%, and 9%, respectively. Response rates were 60%, 52%, and 15%, respectively. CBT and psychodynamic therapy were significantly superior to waiting list for both remission and response. CBT was significantly superior to psychodynamic therapy for remission but not for response. Between-group effect sizes for remission and response were small. Secondary outcome measures showed significant differences in favor of CBT for measures of social phobia and interpersonal problems, but not for depression. CONCLUSIONS CBT and psychodynamic therapy were both efficacious in treating social anxiety disorder, but there were significant differences in favor of CBT. For CBT, the response rate was comparable to rates reported in Swedish and German studies in recent years. For psychodynamic therapy, the response rate was comparable to rates reported for pharmacotherapy and cognitive-behavioral group therapy.

Rumination as a predictor of relapse in mindfulness-based cognitive therapy for depression.

OBJECTIVES In mindfulness-based cognitive therapy (MBCT), it is proposed that training in mindfulness should reduce the tendency of formerly depressed patients to enter into ruminative thinking, thus reducing their risk of depressive relapse. However, data showing that rumination is associated with depressive relapse are lacking. METHOD In an uncontrolled study with 24 formerly depressed patients, rumination was assessed with the Ruminative Response Scale. To assess the occurrence of relapse or recurrence, the Structured Clinical Interview for DSM-IV was administered 12 months after the end of the MBCT. RESULTS Rumination significantly decreased during the MBCT course. Post-treatment levels of rumination predicted the risk of relapse of major depressive disorder in the 12-month follow-up period even after controlling for numbers of previous episodes and residual depressive symptoms. CONCLUSIONS The results provide preliminary evidence that rumination is important in the process of depressive relapse.

Psychotherapy for Social Anxiety Disorder: Long-Term Effectiveness of Resource-Oriented Cognitive-Behavioral Therapy and Cognitive Therapy in Social Anxiety Disorder

OBJECTIVE Resource-oriented cognitive-behavioral therapy (ROCBT) and cognitive therapy (CT) have been shown to be effective treatments for social anxiety disorder. However, so far few studies have examined the long-term effectiveness of these treatments. Thus, there is little information available about the durability of change in treated patients with social anxiety disorder. DESIGN This study examined the effectiveness of both treatments at 2-year and 10-year follow-up assessments. Patients who received ROCBT or CT were re-contacted after 2 (n = 51), and 10 years (n = 27), respectively, and completed a battery of self-report questionnaires. RESULTS Treatment gains were maintained over the 2-year follow-up on all measures. Furthermore, there was a significant improvement on 2 social anxiety measures between posttreatment and the 10-year follow-up. ROCBT and CT did not differ in overall effectiveness. CONCLUSION The results suggest that both treatments are effective and durable approaches in the treatment of social anxiety disorder.

Sitting Posture Makes a Difference—Embodiment Effects on Depressive Memory Bias

Basic research has shown that the motoric system (i.e., motor actions or stable postures) can strongly affect emotional processes. The present study sought to investigate the effects of sitting posture on the tendency of depressed individuals to recall a higher proportion of negative self-referent material. Thirty currently depressed inpatients either sat in a slumped (depressed) or in an upright (non-depressed) posture while imagining a visual scene of themselves in connection with positive or depression related words presented to them on a computer screen. An incidental recall test of these words was conducted after a distraction task. Results of a mixed ANOVA showed a significant posture x word type interaction, with upright-sitting patients showing unbiased recall of positive and negative words but slumped patients showing recall biased towards more negative words. The findings indicate that relatively minor changes in the motoric system can affect one of the best-documented cognitive biases in depression. Practical implications of the findings are discussed.

A randomized controlled trial on the effectiveness of a rumination-focused group treatment for residual depression

Abstract The maintenance of residual symptoms following acute treatment is common and is associated with poor long-term prognosis. This study investigates whether a cognitive-behavioral group treatment is effective in reducing residual depression by targeting depressive rumination. Participants (N=60) were randomly assigned to either the group treatment or a wait-list control condition. Treatment significantly improved depressed mood, rumination, perceived control over rumination and dysfunctional metacognitive beliefs compared with the wait condition. Treatment gains were maintained over the follow-up period of 1 year. Attrition was low and treatment satisfaction was high. Eight individuals suffered from a depressive relapse/recurrence in the year following treatment. The results indicate that cognitive-behavioral group therapy for depressive rumination is effective and well accepted by patients suffering from residual depression.

Ruminative Thinking as a Predictor of Perceived Postpartum Mother–Infant Bonding

Ruminative thinking has been identified as a vulnerability factor for the onset and maintenance of depression. Furthermore, depressed persons who are high in rumination report more difficulties in intimate relationships. It is still unclear, however, whether rumination is predictive of postpartum depressive symptoms as well as impairments in the mother–infant relationship. Possible associations were investigated in a short-term longitudinal study. Controlling for age, pre- and postnatal depressive symptoms, ruminative thinking during pregnancy was a significant predictor of mother-reported impairments in the mother–infant relationship. Yet, rumination was not predictive of postpartum depressive symptoms. The implications of these findings are discussed.

Rumination, Entrapment and Suicide Ideation: A Mediational Model.

Rumination has been shown to be positively associated with suicide ideation. Yet, only few studies have attempted to explain potential mediators of this association. Perceptions of entrapment are a core component of recent psychological models of suicidality and might mediate the relationship between rumination and suicide ideation. Possible mediator effects were investigated in an online sample (n = 142) and a clinical sample (n = 226) of adults receiving outpatient psychotherapy. Results demonstrated that perceptions of entrapment fully mediated the association between ruminative thinking and suicide ideation. However, the reverse relationship, where the association between entrapment and suicide ideation is mediated by ruminative thinking, was not supported. These findings suggest that the relationship between rumination and suicide ideation is explained by perceptions of entrapment. Theoretical and clinical implications are discussed. Copyright

Resting vagal tone is negatively associated with suicide ideation.

BACKGROUND The present study aimed at investigating whether resting vagally mediated heart rate variability (HRV) as a trait-like biomarker of cognitive inhibitory control capacity is related to suicide ideation in a sample without suicide attempt history. METHODS Thirty-seven healthy students participated voluntarily (18 to 34 years, M=24.5, SD=4.1; 73.0% female). Time and frequency measures of HRV were derived from an electrocardiogram that was recorded using Einthovens Triangle lead II. Participants filled in the Rasch-based Depression Screening and four questions concerning lifetime suicide ideation (SI). Bivariate Pearsons and partial (controlling for depression severity) correlation coefficients were calculated between SI and measures of vagally mediated HRV. RESULTS A significant correlation between the ln10-transformed high-frequency band of resting vagally mediated HRV and SI was found (r=-.33, p<.05). Correlations did not change substantially when controlling for depression. Mean heart rate as a time domain measure also significantly correlated with SI while controlling for depression (r=.36, p<.05). A trend correlation between SI and Root Mean Square of Successive Differences between interbeat intervals emerged. LIMITATIONS SI was assessed with a composite score of four items measuring SI. Future studies should consider using more comprehensive assessment instruments. CONCLUSIONS The relation between resting vagally mediated HRV and suicide ideation may be interpreted as indicating that reduced inhibitory cognitive control capacity may be a risk factor for suicidality. It may act already early in the suicidal process, before suicidal behavior develops and should be further investigated as potentially clinically important physiological predictor of suicidality.

Depressive Symptom Inventory Suicidality Subscale: Optimal Cut Points for Clinical and Non‐Clinical Samples

Suicide is a major cause of death in adulthood and specifically in patients suffering from mental illnesses. The Depressive Symptom Inventory Suicidality Subscale (DSI-SS) is widely used to detect and prevent suicidal ideation. The aim of the present study was to determine optimal cut points for the DSI-SS in different populations. We analysed the data of one population-based sample (n = 532), one outpatient sample (n = 180) and one inpatient sample (n = 244). Internal consistency, convergent validity and optimal cut points according to receiver operating characteristics were calculated. In all samples, we found excellent item-total correlations and internal consistencies for the DSI-SS. Zero-order correlations between the DSI-SS and theoretically related constructs showed positive correlation coefficients, ranging from 0.50 to 0.67. The DSI-SS differentiated well between patients with and without suicide attempts in the population-based sample, but less so in the inpatient sample and only marginally in the outpatient sample. A bootstrapping analysis showed some variability in the cut points that emerged as optimal, but there was no overlap between the different samples. The specific cut points that we identified may be used to improve the diagnostic utility of the DSI-SS and the chance to detect suicidal ideation. Copyright

Influence of violent video gaming on determinants of the acquired capability for suicide

The interpersonal theory of suicidal behavior proposes that fearlessness of death and physical pain insensitivity is a necessary requisite for self-inflicted lethal self-harm. Repeated experiences with painful and provocative events are supposed to cause an incremental increase in acquired capability. The present study examined whether playing a first-person shooter-game in contrast to a first-person racing game increases pain tolerance, a dimension of the acquired capability construct, and risk-taking behavior, a risk factor for developing acquired capability. N=81 male participants were randomly assigned to either play an action-shooter or a racing game before engaging in a game on risk-taking behavior and performing a cold pressor task (CPT). Participants exhibited higher pain tolerance after playing an action shooter game than after playing a racing game. Furthermore, playing an action shooter was generally associated with heightened risk-taking behavior. Group-differences were not attributable to the effects of the different types of games on self-reported mood and arousal. Overall these results indicate that action-shooter gaming alters pain tolerance and risk-taking behavior. Therefore, it may well be that long-term consumption of violent video games increases a persons capability to enact lethal self-harm.