Uwe Berger

The impact of attachment organization on potential countertransference reactions

Abstract This study sought to further examine correlations between attachment characteristics and the quality of the therapeutic relationship and interactions. Responses of medical students and therapists to the presentation of selected segments from adult attachment interviews (AAIs) were investigated. The AAIs of 3 patients were prototypically assigned to an autonomous, a dismissing, and an enmeshed–preoccupied attachment organization. Those parts of the attachment interviews comprising descriptions of the patients’ mother and father were tape-recorded in a standardized manner and presented according to a procedure used by Horowitz, Rosenberg, and Kalehzan (1992). The responses to the interview segments were assessed using the Impact Message Inventory, a well-being scale, and a countertransference questionnaire. In addition, the individuals described their own attachment styles using the Relationship Questionnaire. Results confirmed the hypothesis that the narratives of patients with different attachment organizations release specific responses in terms of interpersonal and countertransference reactions as well as listeners’ well-being. The medical students did not differ largely from the therapists. A systematic influence of listeners’ attachment style on their countertransference reactions could not be found. The results are discussed with respect to future investigations, focusing on the influence of attachment organization on the quality of the therapeutic relationship.

Screening riskanten Essverhaltens bei 12-jährigen Mädchen und Jungen: psychometrischer Vergleich der deutschsprachigen Versionen von SCOFF und EAT-26

To detect eating disorders and risky eating behaviour at an early stage, screening tests should be economic, i. e. as short as possible but at the same time they should fulfil the psychometric quality criteria. We compared the German version of the Eating Attitudes Test (EAT-26D, which comprises 26 items) and the German version of the SCOFF test (which contains only 5 Yes-no questions) in a community sample of 425 12-year-old girls and 382 boys from Thuringia, Germany. Although the EAT-26D reached higher psychometric properties, the SCOFF has been proved as a useful screening tool with a test-retest reliability of r (tt)=0.73 and a maximum accuracy of 82% (area under the ROC curve). With the EAT-26D (20 point cut-off) as a reference the sensitivity of the SCOFF was 79%, specificity 74%, positive predictive value 25%, and the negative predictive value, which is more relevant for screenings, was 97%. The criterion validity reached r=0.53.

Screening disordered eating in a representative sample of the German population: Usefulness and psychometric properties of the German SCOFF questionnaire

The prevention of eating disorders and the identification of high-risk individuals are essential for the public health sector. There is need for sensitive and specific screening instruments of disordered eating that can be applied in universal samples as an initial step into disease prevention. The SCOFF is a screening instrument for disordered eating, frequently used in international and cross-cultural contexts to detect individuals at risk. The objective of this research is to evaluate whether the SCOFF can be used as a screening tool for disordered eating in universal samples. This is the first study which examined the psychometric properties of the German version of the SCOFF in a general population sample. A representative sample (N=2527) of the German population, aged 14-95years, was recruited. Psychometric properties were determined including reliability, concurrent and construct validity, and factor structure. The prevalence of disordered eating was assessed. The prevalence of disordered eating in the general population was 10%. Using the established cutoff point of ≥2, values for diagnostic accuracy were 26% (sensitivity), 97% (specificity), 80% (positive predictive value), and 74% (negative predictive value). Factorial analyses revealed an excellent model fit of a unidimensional model. Due to its low sensitivity and a high percentage of false negatives, there are limitations in using the German version of the SCOFF in general population samples with wide age ranges.

Long-term effectiveness of a school-based primary prevention program for anorexia nervosa: A 7-to 8-year follow-up.

PURPOSE This is the first study to evaluate the long-term effectiveness of a school-based prevention program in Germany. The aim is to determine the long-term effects of the primary prevention program PriMa (Primary prevention of anorexia nervosa in preadolescent girls) on disordered eating and body self-esteem from childhood to young adulthood. METHODS PriMa was conducted and successfully evaluated in a quasi-experimental pre-post design with a control group from 2007 to 2008 consisting of 11-13year old girls (N=1508) from Thuringian schools in Germany. Seven to eight years after the intervention, the same cohort (mean age 19.8years) was invited to complete an online survey. Disordered eating (EAT-26), body self-esteem (FBeK) and BMI were assessed via self-report. The response rate at seven-to-eight-year follow-up was very low (7%). Data of N=100 girls were analyzed. RESULTS Concerning changes in disordered eating, results revealed no significant long-term effect of PriMa seven to eight years after the intervention. During this time, disordered eating remained stable without a significant increase or decrease. Regarding changes in body self-esteem, group courses differed significantly from each other. The results revealed a significant main effect of group, indicating significant differences in changes of body self-esteem between the intervention and the control group. Following the analysis of these changes of body self-esteem over time, it was found that the intervention group revealed an increase of body self-esteem after program participation and remained stable over time. By contrast, the control group revealed a decrease of body self-esteem over time. CONCLUSIONS Long-term intervention effects of PriMa could be found for body self-esteem but not for disordered eating. The findings suggest that PriMa prevented a decrease of body self-esteem from childhood to young adulthood. For a broader dissemination it is necessary to implement prevention programs consistently in school settings. In order to maintain the prevention effects, it would be interesting to investigate the effects of booster sessions which refresh the programs content on a regular basis. Furthermore, the results of this study revealed the implementation difficulties of primary prevention programs especially concerning the retention of the sample size.

Psychometric properties of a short version of the Eating Attitudes Test (EAT-8) in a German representative sample

PURPOSE Disordered eating is common for all ages and sexes in the general population. However, only some individuals are known to develop clinically relevant eating disorders. There is a critical need of efficient, reliable and valid screening instruments to measure disordered eating for the general population. The Eating Attitudes Test was shortened into an 8-item-version to screen individuals at high risk of developing clinical eating disorders in a general population sample. METHODS Psychometric properties (Cronbachs α, construct and concurrent validity and factor structure), cutoff scores (with sensitivity, specificity, positive and negative predictive value) and norms were determined in a representative sample of the German population (N=2527). Factorial validity was investigated using item response modeling. RESULTS Results confirmed reliability and validity of the questionnaire. Internal consistency and convergent validity were good. Analysis revealed different cutoff points for male and female participants. Values for sensitivity and specificity were satisfying and the positive predictive value was higher compared to other short screening instruments for disordered eating. Factorial analysis revealed a one-factor solution with an excellent model fit. The elimination of one item was discussed. Gender- and age-specific norms are reported. CONCLUSIONS Overall results indicated that the EAT-8 is an efficient instrument suitable for screening purposes in large general population samples.

Deutschsprachige Präventionsprogramme für Essstörungen – Ein systematisches Review

In the past years a considerable amount of primary and secondary prevention programs for eating disorders was developed in German speaking countries. However, up to now there has been no systematic review of contents and evaluation studies. The main objective of the present systematic review is to identify and outline German prevention programs for eating disorders. This should facilitate the selection of appropriate and effective interventions for medical experts, other professionals and teachers. A systematic literature research was conducted and 22 German-language primary and secondary prevention programs were identified. Half of them were evaluated. The programs were conducted either in school, on the internet or in a group setting. The findings show that throughout almost all programs a reduction in weight and shape concerns and drive for thinness as well as an increase of (body) self-esteem could be observed in either the total sample or the high-risk sample. However, programs were inconsistently effective in reducing disordered eating behavior in the target population. All studies were effective in reducing at least one risk factor. Overall, higher effect sizes were found for secondary prevention programs than for primary prevention programs. Lastly, limitations of the studies and suggestions for future prevention efforts are discussed.

Deutschsprachige Kurzskalen zur Erfassung auffälligen Essverhaltens

The development of brief instruments is an important area in the clinical and psychological assessment in the past years. Brief instruments reveal many advantages due to their efficiency and shortness for the users. However, the psychometric standards of development and validation were often neglected during the construction of short forms. The current overview presents 6 brief instruments for the assessment of disordered eating and eating disorders in German: Eating Attitudes Test 8 (EAT-8), Eating Disorder Examination-Questionnaire 8 (EDE-Q8) and the child version (ChEDE-Q8), ICD-10-Symptom-Rating subscale eating disorders (ISR-E), SCOFF questionnaire, and Short Evaluation of Eating Disorders (SEED). Furthermore, recent validation studies were summarized. Users should be aware about the fact that every brief instrument is validated for specific purpose and population. Therefore, aim of the present overview is to help the reader choosing the appropriate brief instrument for the intended purpose and population.