Research on common and differential factors in the therapeutic process is impeded by the lack of instruments suitable for assessing common change mechanisms. This study presents the psychometric properties of a newly developed time-economic instrument (WIFA-k), which was designed to assess common factors of psychotherapy as designed by Grawe. Within a multi-center study comparing the efficacy of cognitive therapy and psychodynamic therapy in the treatment of social phobia, 6 raters assessed 25 randomly selected, videotaped therapy sessions of each treatment approach, and evaluated common factors using the Wifa-k. Interrater-reliability was found to be high for the items "resource activation", "motivational clarification" and "mastery" and low for the items "therapeutic relationship" and "problem activation". Ways to increase reliability and validity of the scale are discussed.
This is a welcome and valuable update on an important discipline by North American investigators.It covers the historical roots of psychoneuroendocrinology, the roles of peptide, adrenocortical, gonadal and thyroid hormones in both endocrine and psychiatric illness, laboratory testing in psychoneuroendocrinology, and stress and neuroendocrine function.Unfortunately, the attention given to the various areas is rather inconsistent, as is the quality of the different chapters.
Die Paruresis ist als Unterform der sozialen Phobie klassifiziert, bei der die Betroffenen über Ängste und Unfähigkeit klagen, auf öffentlichen Toiletten zu urinieren. Verfügbare Therapiemanuale sowie Fallstudien basieren hauptsächlich auf behavioralen Methoden wie Desensibilisierung, Entspannungsverfahren oder graduierter Exposition. Trotz nachgewiesener Effektivität der kognitiven Therapie der sozialen Phobie nehmen kognitive Interventionen bisher eher einen kleinen Stellenwert in der Behandlung ein. Am Beispiel einer Falldarstellung eines 19-jährigen Patienten mit Paruresis wird ein kognitiver Therapieansatz beschrieben, der sich in der Therapie der sozialen Phobie bereits bewährt hat. Konkrete kognitiv-verhaltenstherapeutische Interventionen werden aus dem kognitiven Modell nach Clark und Wells logisch abgeleitet. In 33 Therapiesitzungen konnten die Ziele des Patienten, die zu Beginn der Therapie aufgestellt wurden, erreicht werden. Die Falldarstellung zeigt, dass die Anwendung des kognitiven Modells der sozialen Phobie bei Paruresis erfolgreich sein kann. Die rein kognitive Vorgehensweise stellt eine Neuerung zu den bisher stark behavioral angelehnten Therapieansätzen dar. Weitere Forschung zur Entstehung, Aufrechterhaltung und Behandlung der Paruresis ist notwendig.
Background: Although body dysmorphic disorder (BDD) is frequently found in dermatological settings, it often remains unrecognised. The aims of the current study were to validate the Dysmorphic Concern Questionnaire (DCQ) as a screening instrument; and to estimate the frequency of dysmorphic concerns in a dermatological sample of female outpatients. Patients and Methods: Item characteristics and factor structure of the DCQ were analysed on the basis of data from an unselected sample of 156 dermatological outpatients. In addition, to investigate discriminative validity of the DCQ, 65 patients, including 22 patients with BDD, 21 patients with disfiguring dermatological conditions and 21 patients with non-disfiguring, mild dermatological conditions participated in the study. Diagnoses were based on the Body Dysmorphic Disorder Diagnostic Module. Additionally, the Yale-Brown Obsessive Compulsive Scale modified for BDD was applied, and the patients completed a depression questionnaire. Results: The factor structure and internal consistency of the DCQ were satisfactory. Significant correlations with depressive mood and obsessive-compulsive symptoms confirm its convergent validity. The DCQ revealed significant differences between BDD patients, patients with disfiguring disorders, and patients with non-disfiguring disorders, thus demonstrating a high discriminative validity. A cut-off value of ≧14 provided the best balance of sensitivity and specificity and resulted in correct classification of 84.6% of the patients. Of the unselected outpatients sample 9% achieved positive test results that indicate clinically significant dysmorphic concerns. Conclusion: The results confirm the validity of the DCQ as a sensitive and specific screening instrument that can be recommended as a routine assessment instrument in clinical practice.
Zusammenfassung. Theoretischer Hintergrund: Während die Hypochondrie eine relativ niedrige Prävalenz aufweist, gibt es Hinweise, dass hypochondrische Merkmale unterhalb der diagnostischen Schwelle deutlich häufiger vorliegen. Fragestellung: Wie häufig bestehen bei ambulanten Psychotherapiepatienten ausgeprägte hypochondrische Merkmale? Kann die hypochondrische Symptomatik durch bestehende somatische Krankheiten erklärt werden? Welche Risikofaktoren könnten bedeutsam sein? Methode: 85 Patienten einer psychotherapeutischen Ambulanz wurden hinsichtlich des Vorliegens hypochondrischer Merkmale, Krankheitserfahrungen und traumatischer Erfahrungen in der Kindheit untersucht. Ergebnisse: Je nach Cut-off-Kriterium zeigten sich bei 24–34% der Patienten ausgeprägte krankheitsbezogene Befürchtungen, die in geringem Umfang (6–10%) durch einen schlechteren Gesundheitsstatus erklärt werden konnten. Potenziell relevant für hypochondrische Symptome zeigte sich zudem die Anzahl verstorbener Familienangehöriger. Schlussfolgerung: Hypochondrische Merkmale sollten in der ambulanten psychotherapeutischen Versorgung eine größere Beachtung finden, da sie von den Patienten häufig berichtet werden.
Among the cultural conceptualizations of distress, susto is defined in the DSM-5 as "a cultural explanation of distress and misfortune in Latin America that refers to an illness attributed to a terrifying event that causes the soul to leave the body and leads to unhappiness and illness, as well as difficulties in performing key social functions" (American Psychiatric Association (APA) (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Washington, DC: APA, p. 836). Thus, susto represents a cultural explanation that encompasses the symptoms of various mental disorders and physical diseases. We analyzed the descriptions of susto from different scientific fields and related them to definitions of DSM-5 syndromes. Three syndromic subtypes of susto show a symptomatic overlap with depression, post-traumatic stress disorder (PTSD) and somatic disorder. However, linguistic metaphors describing symptoms and perceived causes that are specific for Latin American culture support the concept of susto as a specific idiom of distress (e.g., loss of soul, shadow or ajayu; sunken, closed or white eyes; jumping and screaming in the night; being thrown to the ground). In addition, if diagnostic criteria are met for mental disorders, then susto describes a perceived cause of psychopathological states (e.g., depressive disorder, PTSD, somatic disorder, panic disorder, generalized anxiety disorder). Future research with people who have experienced susto is needed to clarify whether susto precedes the onset of other mental disorders (perceived cause) or whether it is a way of designating distress (idiom of distress).
