Publications by authors named "Harald Gündel"

107 Publications

Mental Health Applications for Primary and Secondary Prevention of Common Mental Disorders: Attitudes of German Employees.

Front Psychiatry 2021 4;12:508622. Epub 2021 May 4.

Institute of Occupational and Social Medicine and Health Services Research, University Hospital Tübingen, Tübingen, Germany.

Web-based and mobile mental health applications for the prevention and treatment of common mental disorders (CMDs) are on the rise. Under certain circumstances they have proved to be effective for a range of conditions (e.g., depression). There is not sufficient evidence regarding the benefits and barriers especially for mobile phone apps and for programs in the field of primary prevention. Studies on the acceptance of potential users of mental health apps yielded mixed outcomes. In a large survey we investigated the attitudes of employees toward mental health apps and various traditional mental health services. Our main research question in this contribution focuses on the acceptance of apps compared to other measures and the moderating influence of individual characteristics. The standardized survey was completed by members of an online access panel with different job types. A set of 33 self-developed items, including three questions on e-health, captured the perceived relevance of prevention at the (A) occupational, (B) individual, and (C) societal level. On the basis of an exploratory factor analysis, mean scores for mapping seven (sub-)dimensions were constructed and compared using the Wilcoxon test. The influence of potential predictors was analyzed in linear regression models. The data of 610 respondents were analyzed (response rate 75%). Support from mental health applications was rated significantly less important compared to all other dimensions at the levels (A) to (C). Respondents were more likely to use mental health apps if they felt literate with electronic devices, perceived a high relevance of work-related demands as causal factors for CMDs, stated they would be ashamed of having a CMD, and would be willing to begin psychotherapy if recommended. The results confirm the critical attitudes of potential mental health app users found in other studies. Since users with a negative attitude toward e-health might have a higher risk for dropout and non-adherence as well as lower intervention effects, well-designed educational strategies should be carried out beforehand.
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http://dx.doi.org/10.3389/fpsyt.2021.508622DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8130826PMC
May 2021

["Stress Occurs Every Day" - Reasons for Work-Related Burden in Hospitals and Coping of Staff. A Qualitative Study].

Psychiatr Prax 2021 May 20. Epub 2021 May 20.

Klinik für Psychiatrie und Psychotherapie II der Universität Ulm.

Objective: Workplace exposures are considered to be high in hospital staff. Workplace interventions might be an appropriate way to reduce workplace exposures. Therefore, views of hospital staff on reasons and implications of workplace exposures were assessed and consequences for workplace interventions were considered.

Methods: Six focus groups and seven semi-structured interviews were conducted with 34 members of hospital staff in total. Qualitative Content Analysis was performed.

Results: Stress occurs due to a lack of personnel, high workload, missing common-rooms for breaks and lunch, missing communication, a lack of clarity in work processes, team conflicts and a lack of appreciation. Social support, work breaks, reduction of working hours, physical activity and empowerment were mentioned as factors leading to stress reduction.

Conclusion: Possible stress reduction by means of problem-related coping and emotional coping depending on hospital structure and culture.
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http://dx.doi.org/10.1055/a-1477-6000DOI Listing
May 2021

Structural Equation Modeling of a Global Stress Index in Healthy Soldiers.

J Clin Med 2021 Apr 20;10(8). Epub 2021 Apr 20.

Clinic for Psychosomatics and Psychotherapeutic Medicine, Ulm University Medical Center, 89081 Ulm, Germany.

Accumulation of stress is a prognostic trigger for cardiovascular disease. Classical scores for cardiovascular risk estimation typically do not consider psychosocial stress. The aim of this study was to develop a global stress index (GSI) from healthy participants by combining individual measures of acute and chronic stress from childhood to adult life. One-hundred and ninety-two female and male soldiers completed the Perceived Stress Scale (PSS4), Trier Inventory for Chronic Stress (TICS), Hospital Anxiety and Depression Scale (HADS), Childhood Trauma Questionnaire (CTQ), Posttraumatic Diagnostic Scale Checklist (PDS), and the Deployment Risk and Resilience Inventory (DRRI-2). The underlying structure for the GSI was examined through structural equation modeling. The final hierarchical multilevel model revealed fair fit by taking modification indices into account. The highest order had a g-factor called the GSI. On a second level the latent variables stress, HADS and CTQ were directly loading on the GSI. A third level with the six CTQ subscales was implemented. On the lowest hierarchical level all manifest variables and the DRRI-2/PDS sum scores were located. The presented GSI serves as a valuable and individual stress profile for soldiers and could potentially complement classical cardiovascular risk factors.
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http://dx.doi.org/10.3390/jcm10081799DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8074902PMC
April 2021

Stress, depression, and the therapeutic alliance as mediators on the outcome of brief psychodynamic-interpersonal psychotherapy for multisomatoform disorder.

Psychother Res 2021 Feb 8:1-10. Epub 2021 Feb 8.

Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems, Austria.

Objective: The aim of this study was to identify and explore mediators of psychodynamic-interpersonal psychotherapy (PIT) on treatment outcome in multisomatoform disorders (MSD).

Methods: Data from 164 patients with MSD who took part in a randomized control trial of PIT (= 88) vs. enhanced medical care (EMC; = 76) were re-analyzed. A parallel mediation analysis was performed to investigate whether the beneficial effect of PIT vs. EMC on physical quality of life (physical component summary (PCS) of the SF-36 Health Survey) nine months post-treatment is mediated by post-treatment scores of stress, depression, and therapeutic alliance. The potential mediators were operationalized with the Helping Alliance Questionnaire (HAQ; therapeutic alliance), the Patient Health Questionnaire (PHQ)-stress module (perceived stress) and the PHQ-depression module (PHQ-9; depression).

Results: Stress partially mediated the effect of PIT vs. EMC on the follow-up outcome. PIT (as compared to EMC) led to lower post-treatment stress-levels, which in turn led to higher physical quality of life at follow-up. Neither depression nor the alliance had a mediating effect.

Conclusions: Stress mediated the outcome of PIT for MSD. Future studies are needed to extend the scope of research regarding which specific psychotherapeutic mechanisms of change are beneficial in PIT treatment of MSD patients.
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http://dx.doi.org/10.1080/10503307.2021.1882711DOI Listing
February 2021

Dyadic coping and social support: Various types of support in hematooncological patients and their spouses-Associations with psychological distress.

Psychooncology 2021 Jan 20. Epub 2021 Jan 20.

Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Ulm, Ulm, Germany.

Objective: Patients and spouses use various support strategies to deal with cancer and its associated burden. Support can be perceived within the dyad [perceived dyadic coping (PDC)] or from others [perceived social support (PSS)]. The present study investigates the association of PDC and PSS with depression and anxiety symptoms experienced by hematooncological dyads.

Methods: A total of 330 hematooncological dyads participated in the study. Dyadic Coping Inventory (DCI) including perceived stress communication and four PDC strategies (supportive, negative, delegated, common), ENRICHED Social Support Instrument (ESSI) and Patient Health Questionnaire-4 (PHQ-4) are used for assessment. To take nonindependence of patient's and spouse's variables into account, data are analyzed with the Actor-partner-interdependence model (APIM).

Results: Hematological cancer patients and their spouses reported a similar level of depression and anxiety symptoms. Perceived negative dyadic coping (DC) was adversely related with both patient's and spouse's outcomes (all p < 0.01) and perceived positive DC was adversely related with depression symptoms in both and anxiety symptoms in spouses (all p < 0.05). More PSS was associated with less depression and anxiety symptoms in both (all p < 0.05), and spouse's PSS (b = -0.04, p < 0.05) was significantly associated with patient's depression symptoms.

Conclusions: This study highlights the association between perceived negative DC, perceived positive DC and PSS with depression and anxiety symptoms. Focus should be on enhancement of PSS especially in spouses, as they experience a comparable amount of psychosocial distress and have considerable impact on the patient's wellbeing.
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http://dx.doi.org/10.1002/pon.5631DOI Listing
January 2021

Trauma-focused psychodynamic therapy and STAIR Narrative Therapy of post-traumatic stress disorder related to childhood maltreatment: trial protocol of a multicentre randomised controlled trial assessing psychological, neurobiological and health economic outcomes (ENHANCE).

BMJ Open 2020 12 17;10(12):e040123. Epub 2020 Dec 17.

Institute of Clincal Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.

Introduction: Success rates of psychotherapy in post-traumatic stress disorder related to childhood maltreatment (PTSD-CM) are limited.

Methods And Analysis: Observer-blind multicentre randomised clinical trial (A-1) of 4-year duration comparing enhanced methods of STAIR Narrative Therapy (SNT) and of trauma-focused psychodynamic therapy (TF-PDT) each of up to 24 sessions with each other and a minimal attention waiting list in PTSD-CM. Primary outcome is severity of PTSD (Clinician-Administered PTSD Scale for DSM-5 total) assessed by masked raters. For SNT and TF-PDT, both superiority and non-inferiority will be tested. Intention-to-treat analysis (primary) and per-protocol analysis (secondary). Assessments at baseline, after 10 sessions, post-therapy/waiting period and at 6 and 12 months of follow-up. Adult patients of all sexes between 18 and 65 years with PTSD-CM will be included. Continuing stable medication is permitted. To be excluded: psychotic disorders, risk of suicide, ongoing abuse, acute substance related disorder, borderline personality disorder, dissociative identity disorder, organic mental disorder, severe medical conditions and concurrent psychotherapy. To be assessed for eligibility: n=600 patients, to be e randomly allocated to the study conditions: n=328. Data management, randomisation and monitoring will be performed by an independent European Clinical Research Infrastructure Network (ECRIN)-certified data coordinating centre for clinical trials (KKS Marburg). Report of AEs to a data monitoring and safety board. Complementing study A-1, four inter-related add-on projects, including subsamples of the treatment study A-1, will examine (1) treatment integrity (adherence and competence) and moderators and mediators of outcome (B-1); (2) biological parameters (B-2, eg, DNA damage, reactive oxygen species and telomere shortening); (3) structural and functional neural changes by neuroimaging (B-3) and (4) cost-effectiveness of the treatments (B-4, costs and utilities).

Ethics And Dissemination: Approval by the institutional review board of the University of Giessen (AZ 168/19). Following the Consolidated Standards of Reporting Trials statement for non-pharmacological trials, results will be reported in peer-reviewed scientific journals and disseminated to patient organisations and media.

Trial Registration Number: DRKS 00021142.
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http://dx.doi.org/10.1136/bmjopen-2020-040123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7747578PMC
December 2020

Masculinity and Help-Seeking Among Men With Depression: A Qualitative Study.

Front Psychiatry 2020 24;11:599039. Epub 2020 Nov 24.

Department of Psychiatry II, University of Ulm and District Hospital Günzburg, Ulm, Germany.

Many studies indicate that men are more reluctant to seek help for mental health problems than women. Traditional ideas of masculinity are often seen as a cause of this phenomenon. However, little is known about the diversity of experiences during the processes of help-seeking and service use among men with depression who have already utilized mental health services. This study aims to explore men's experiences and attitudes toward depression, help-seeking, and service use in order to develop gender-sensitive services. Narrative-biographical interviews were conducted with men treated for depression ( = 12). Interview topics included individual experience with depression, help-seeking behavior, and mental health service use. Transcripts were analyzed using qualitative content analysis. Before seeking treatment, men's help-seeking behavior was negatively affected by internalized masculine norms. However, findings indicate a change of attitudes toward depression after mental health service use. Men with depression emphasized a salutogenic perspective toward mental health problems and critically reflected on masculine norms. The positive function of men-only groups were described as key for successful service use. Men with depression reported experiences toward help-seeking and service use on four different levels: (i) attitudes toward depression, (ii) perception of societal views on depression, (iii) experiences within the family context and (iv) experiences with mental health services. Interventions to reduce the stigma of being "unmanly" and to improve men's capacity to cope with being unable to work should be developed. Peer-led men-only groups may increase participants' self-esteem and assist in disclosing weaknesses. In the context of GPs' mediating role, training for health professionals concerning the impact of masculine norms on mental health is recommended.
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http://dx.doi.org/10.3389/fpsyt.2020.599039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7732518PMC
November 2020

Harmonized definition of occupational burnout: A systematic review, semantic analysis, and Delphi consensus in 29 countries.

Scand J Work Environ Health 2021 Mar 1;47(2):95-107. Epub 2020 Dec 1.

Unisanté, Department of occupational and environmental health, Route de la Corniche, 2, 1066 Epalinges-Lausanne, Switzerland.

Objective A consensual definition of occupational burnout is currently lacking. We aimed to harmonize the definition of occupational burnout as a health outcome in medical research and reach a consensus on this definition within the Network on the Coordination and Harmonisation of European Occupational Cohorts (OMEGA-NET). Methods First, we performed a systematic review in MEDLINE, PsycINFO and Embase (January 1990 to August 2018) and a semantic analysis of the available definitions. We used the definitions of burnout and burnout-related concepts from the Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT) to formulate a consistent harmonized definition of the concept. Second, we sought to obtain the Delphi consensus on the proposed definition. Results We identified 88 unique definitions of burnout and assigned each of them to 1 of the 11 original definitions. The semantic analysis yielded a first proposal, further reformulated according to SNOMED-CT and the panelists` comments as follows: "In a worker, occupational burnout or occupational physical AND emotional exhaustion state is an exhaustion due to prolonged exposure to work-related problems". A panel of 50 experts (researchers and healthcare professionals with an interest for occupational burnout) reached consensus on this proposal at the second round of the Delphi, with 82% of experts agreeing on it. Conclusion This study resulted in a harmonized definition of occupational burnout approved by experts from 29 countries within OMEGA-NET. Future research should address the reproducibility of the Delphi consensus in a larger panel of experts, representing more countries, and examine the practicability of the definition.
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http://dx.doi.org/10.5271/sjweh.3935DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114565PMC
March 2021

PartnerCARE-a psycho-oncological online intervention for partners of patients with cancer: study protocol for a randomised controlled feasibility trial.

BMJ Open 2020 10 5;10(10):e035599. Epub 2020 Oct 5.

Department of Psychosomatic Medicine and Psychotherapy, University Ulm Medical Center, Ulm, Germany.

Introduction: Cancer burdens not only the patient but also the partner to a comparable extent. Partners of patients with cancer are highly involved in the caring process and therefore often experience distress and report a low quality of life. Interventions for supporting partners are scarce. Existing ones are rarely used by partners because they are often time-consuming per se and offer only limited flexibility with regard to schedule and location. The online intervention PartnerCARE has been developed on the basis of caregiver needs and consists of six consecutive sessions and four optional sessions, which are all guided by an e-coach. The study aims to evaluate feasibility and acceptance of the online intervention PartnerCARE and the related trial process. In addition, first insights of the putative efficacy of PartnerCARE should be gained.

Methods And Analysis: A two-arm parallel-group randomised controlled trial will be conducted to compare the PartnerCARE online intervention with a waitlist control group. The study aims to recruit in total n=60 partners of patients with any type of cancer across different access paths (eg, university medical centres, support groups, social media). Congruent with feasibility study objectives, the primary outcome comprises recruitment process, study procedure, acceptance and satisfaction with the intervention (Client Satisfaction Questionnaire adapted to Internet-based interventions), possible negative effects (Inventory of Negative Effects in Psychotherapy) and dropout rates. Secondary outcomes include quality of life, distress, depression, anxiety, caregiver burden, fear of progression, social support, self-efficacy, coping and loneliness. Online measurements will be performed by self-assessment at three time points (baseline/pre-randomisation, 2 months and 4 months after randomisation). Data analyses will be based on intention-to-treat principle.

Ethics And Dissemination: Ethics approval has been granted by the Ethics Committee of the University of Ulm (No 390/18). Results from this study will be disseminated to relevant healthcare communities, in peer-reviewed journals and at scientific and clinical conferences.

Trial Registration Number: DRKS00017019.
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http://dx.doi.org/10.1136/bmjopen-2019-035599DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7537440PMC
October 2020

The effectiveness of health-oriented leadership interventions for the improvement of mental health of employees in the health care sector: a systematic review.

Int Arch Occup Environ Health 2021 Feb 4;94(2):203-220. Epub 2020 Oct 4.

Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.

Purpose: An increasing prevalence of work-related stress and employees' mental health impairments in the health care sector calls for preventive actions. A significant factor in the workplace that is thought to influence employees' mental health is leadership behavior. Hence, effective leadership interventions to foster employees' (leaders' and staff members') mental health might be an important measure to address this pressing issue.

Methods: We conducted a systematic review according to the PRISMA statement (Liberati et al. 2009) and systematically searched the following databases: PubMed (PMC), Web of Science, PsycINFO (EBSCOhost), EconLit (EBSCOhost), and Business Source Premier (EBSCOhost). In addition, we performed a hand search of the reference lists of relevant articles. We included studies investigating leadership interventions in the health care sector that aimed to maintain/foster employees' mental health.

Results: The systematic search produced 11,221 initial search hits in relevant databases. After the screening process and additional literature search, seven studies were deemed eligible according to the inclusion criteria. All studies showed at least a moderate global validity and four of the included studies showed statistically significant improvements of mental health as a result of the leadership interventions.

Conclusions: Based on the findings, leadership interventions with reflective and interactive parts in group settings at several seminar days seem to be the most promising strategy to address mental health in health care employees. As the available evidence is limited, efforts to design and scientifically evaluate such interventions should be extended.
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http://dx.doi.org/10.1007/s00420-020-01583-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532985PMC
February 2021

Childhood maltreatment is associated with changes in mitochondrial bioenergetics in maternal, but not in neonatal immune cells.

Proc Natl Acad Sci U S A 2020 10 1;117(40):24778-24784. Epub 2020 Oct 1.

Clinical & Biological Psychology, Institute of Psychology and Education, Ulm University, 89081 Ulm, Germany.

Childhood maltreatment (CM) comprises experiences of abuse and neglect during childhood. CM causes psychological as well as biological alterations in affected individuals. In humans, it is hardly explored whether these CM consequences can be transmitted directly on a biological level to the next generation. Here, we investigated the associations between maternal CM and mitochondrial bioenergetics (mitochondrial respiration and intracellular mitochondrial density) in immune cells of mothers and compared them with those of their newborns. In = 102 healthy mother-newborn dyads, maternal peripheral blood mononuclear cells and neonatal umbilical cord blood mononuclear cells were collected and cryopreserved shortly after parturition to measure mitochondrial respiration and intracellular mitochondrial density with high-resolution respirometry and spectrophotometric analyses, respectively. Maternal CM was assessed with the Maternal and neonatal mitochondrial bioenergetics were quantitatively comparable and positively correlated. Female newborns showed higher mitochondrial respiration compared to male newborns. Maternal CM load was significantly and positively associated with mitochondrial respiration and density in mothers, but not with mitochondrial respiration in newborns. Although maternal and neonatal mitochondrial bioenergetics were positively correlated, maternal CM only had a small effect on mitochondrial density in newborns, which was not significant in this study after adjustment for multiple comparisons. The biological relevance of our finding and its consequences for child development need further investigation in future larger studies. This study reports data on mitochondrial bioenergetics of healthy mother-newborn dyads with varying degrees of CM.
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http://dx.doi.org/10.1073/pnas.2005885117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7547248PMC
October 2020

Nachruf auf Horst Kächele.

Authors:
Harald Gündel

Z Psychosom Med Psychother 2020 Sep;66(3):306-307

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http://dx.doi.org/10.13109/zptm.2020.66.3.306DOI Listing
September 2020

[Psychological stress caused by epidemics among health care workers and implications for coping with the corona crisis: a literature review].

Z Psychosom Med Psychother 2020 Sep;66(3):220-242

Klinik für Psychosomatische Medizin und Psychotherapie Universitätsklinikum Ulm Albert-Einstein-Allee 23 89081 Ulm Deutschland Klinik für Psychosomatische Medizin und Psychotherapie.

COVID-19 has significantly changed the working and living conditions within a short period. Despite the milder course of the disease in comparison to other countries, employees in the German health care system are particularly affected by the massive impact of the disease on their professional and private lives. From a scientific point of view, summarized empirical evidence made during other epidemics and at the beginning of the COVID-19-pandemic is largely missing. Narrative review article, literature search on PubMed database. A total of 56 studies were included, 35 of them on the SARS epidemic and seven on COVID-19; included studies reported overall increased stress levels, anxiety and PTSD symptoms due to health care work during various epidemics. Direct contact with patients, quarantine experiences and perceived health risks were further stress factors in epidemics. Participation in intervention studies enabled better management of epidemic-related situations. Healthcare workers are exposed to high workloads because of epidemics, which can have a variety of adverse effects. Recommendations are made for dealing with periods of high exposure during the COVID-19-pandemic.
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http://dx.doi.org/10.13109/zptm.2020.66.3.220DOI Listing
September 2020

Cerebral Immunohistochemical Characterization of the HS and the Oxytocin Systems in a Porcine Model of Acute Subdural Hematoma.

Front Neurol 2020 7;11:649. Epub 2020 Jul 7.

Institute for Anesthesiological Pathophysiology and Process Engineering, Ulm University Medical Center, Ulm, Germany.

The hydrogen sulfide (HS) and the oxytocin/oxytocin receptor (OT/OTR) systems interact in trauma and are implicated in vascular protection and regulation of fluid homeostasis. Acute brain injury is associated with pressure-induced edema formation, blood brain barrier disruption, and neuro-inflammation. The similarities in brain anatomy: size, gyrencephalic organization, skull structure, may render the pig a highly relevant model for translational medicine. Cerebral biomarkers for pigs for pathophysiological changes and neuro-inflammation are limited. The current study aims to characterize the localization of OT/OTR and the endogenous HS producing enzymes together with relevant neuro-inflammatory markers on available porcine brain tissue from an acute subdural hematoma (ASDH) model. In a recent pilot study, anesthetized pigs underwent ASDH by injection of 20 mL of autologous blood above the left parietal cortex and were resuscitated with neuro-intensive care measures. After 54 h of intensive care, the animals were sacrificed, the brain was removed and analyzed via immunohistochemistry. The endogenous HS producing enzymes cystathionine-ɤ-lyase (CSE) and cystathionine-β-synthase (CBS), the OTR, and OT were localized in neurons, vasculature and parenchyma at the base of sulci, where pressure-induced injury leads to maximal stress in the gyrencephalic brain. The pathophysiological changes in response to brain injury in humans and pigs, we show here, are comparable. We additionally identified modulators of brain injury to further characterize the pathophysiology of ASDH and which may indicate future therapeutic approaches.
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http://dx.doi.org/10.3389/fneur.2020.00649DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7358568PMC
July 2020

Hospital Medical and Nursing Managers' Perspective on the Mental Stressors of Employees.

Int J Environ Res Public Health 2020 07 13;17(14). Epub 2020 Jul 13.

Institute for Occupational, Social, and Environmental Medicine, Centre for Health and Society, Medical Faculty, Düsseldorf University, 40225 Düsseldorf, Germany.

Working conditions in hospitals are characterized by occupational stressors, which lead to potentially harmful psychosocial stress reactions for medical and nursing staff. Representative surveys showed that almost every second hospital physician or nurse is affected by burnout and that there is a strong association between leadership behavior and employee health. Workplace health promotion programs can only be successful and sustainable if managers support them. However, it is still unclear whether hospital managers are aware of the working conditions and perceive them as an influence on the health of their employees. Therefore, the aim of this qualitative study was to explore the hospital medical and nursing managers' perspective on the mental stress of their employees. Semi-standardized interviews with 37 chief physicians (CP), senior physicians (SP) and senior nurses (SN) in total were carried out in one German hospital. The interviews were content-analyzed based on the guideline for the mental risk assessment of the 'Gemeinsame Deutsche Arbeitsschutzstrategie' (GDA). Most reported work characteristics related to work organization, work task, and social factors. Staff shortage could be identified as an underlying stressor for several other burdens. Social support by managers and among colleagues was mentioned as main resource. The findings indicate that managers strive to reduce the burden on their staff, especially through their personal support. Nevertheless, it seemed that managers need additional resources to counteract stressors.
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http://dx.doi.org/10.3390/ijerph17145041DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7400443PMC
July 2020

[Men with Depression and Inpatient Mental Health Treatment: Professionals' Perspectives on Treatment Needs and Aims].

Psychiatr Prax 2021 Jan 15;48(1):19-24. Epub 2020 Jun 15.

Klinik für Psychiatrie und Psychotherapie II der Universität Ulm, Bezirkskrankenhaus Günzburg.

Objective: To meet mental health needs in men with depression, gender sensitive services are needed and recommended. Therefore, mental health professionals' views on care needs among men with depression that should be met by gender-sensitive services were assessed and consequences for inpatient treatment are considered.

Methods: Semi-structured interviews were conducted with 33 mental health professionals focusing on men's specific needs in depression treatment against the background of male gender role expectations. Qualitative Content Analysis was performed using MAXqda-Software.

Results: Men with depression benefit from individual talk with staff and structured activity during treatment. Men-only groups are assessed as enabling critical reflection of aspects of masculinity. Physical activities and handicraft enable men to examine their performance level. Services focusing on men's specific needs are assessed as helpful but largely inexistent.

Conclusion: Expectations of social gender roles and their implications for mental health treatment should be considered in both mental health professional training and mental health treatment.
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http://dx.doi.org/10.1055/a-1149-5429DOI Listing
January 2021

[Men with Depression and Inpatient Mental Health Treatment: Professionals' Perspectives on Treatment Needs and Aims].

Psychiatr Prax 2021 Jan 15;48(1):19-24. Epub 2020 Jun 15.

Klinik für Psychiatrie und Psychotherapie II der Universität Ulm, Bezirkskrankenhaus Günzburg.

Objective: To meet mental health needs in men with depression, gender sensitive services are needed and recommended. Therefore, mental health professionals' views on care needs among men with depression that should be met by gender-sensitive services were assessed and consequences for inpatient treatment are considered.

Methods: Semi-structured interviews were conducted with 33 mental health professionals focusing on men's specific needs in depression treatment against the background of male gender role expectations. Qualitative Content Analysis was performed using MAXqda-Software.

Results: Men with depression benefit from individual talk with staff and structured activity during treatment. Men-only groups are assessed as enabling critical reflection of aspects of masculinity. Physical activities and handicraft enable men to examine their performance level. Services focusing on men's specific needs are assessed as helpful but largely inexistent.

Conclusion: Expectations of social gender roles and their implications for mental health treatment should be considered in both mental health professional training and mental health treatment.
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http://dx.doi.org/10.1055/a-1149-5429DOI Listing
January 2021

Association of the Salivary Microbiome With Animal Contact During Early Life and Stress-Induced Immune Activation in Healthy Participants.

Front Psychiatry 2020 7;11:353. Epub 2020 May 7.

Laboratory for Molecular Psychosomatics, Department of Psychosomatic Medicine and Psychotherapy, University of Ulm, Ulm, Germany.

The prevalence of stress-associated somatic and psychiatric disorders is increased in environments offering a narrow relative to a wide range of microbial exposure. Moreover, different animal and human studies suggest that an overreactive immune system not only accompanies stress-associated disorders, but might even be causally involved in their pathogenesis. In support of this hypothesis, we recently showed that urban upbringing in the absence of daily contact with pets, compared to rural upbringing in the presence of daily contact with farm animals, is associated with a more pronounced immune activation following acute psychosocial stressor exposure induced by the Trier Social Stress Test (TSST). Here we employed 16S rRNA gene sequencing to test whether this difference in TSST-induced immune activation between urban upbringing in the absence of daily contact with pets ( = 20) compared with rural upbringing in the presence of daily contact with farm animals ( = 20) is associated with differences in the composition of the salivary microbiome. Although we did not detect any differences in alpha or beta diversity measures of the salivary microbiome between the two experimental groups, statistical analysis revealed that the salivary microbial beta diversity was significantly higher in participants with absolutely no animal contact ( = 5, urban participants) until the age of 15 compared to all other participants ( = 35) reporting either daily contact with farm animals ( = 20, rural participants) or occasional pet contact ( = 15, urban participants). Interestingly, when comparing these urban participants with absolutely no pet contact to the remaining urban participants with occasional pet contact, the former also displayed a significantly higher immune, but not hypothalamic-pituitary-adrenal (HPA) axis or sympathetic nervous system (SNS) activation, following TSST exposure. In summary, we conclude that only urban upbringing with absolutely no animal contact had long-lasting effects on the composition of the salivary microbiome and potentiates the negative consequences of urban upbringing on stress-induced immune activation.
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http://dx.doi.org/10.3389/fpsyt.2020.00353DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223923PMC
May 2020

Masculinity norms and occupational role orientations in men treated for depression.

PLoS One 2020 26;15(5):e0233764. Epub 2020 May 26.

Department of Psychiatry and Psychotherapy II, Bezirkskrankenhaus Günzburg, Ulm University, Günzburg, Germany.

Purpose: A traditional male role orientation is considered to increase the risk of depression and preventing men from disclosing symptoms of mental illness and seeking professional help. Less is known about the variance of masculinity orientations in men already treated for depression and their role in the treatment process. In this study, patterns of masculinity norms and work role orientations will be identified among men treated for depression. Associations of these patterns with depressive symptoms, stigma and delay in professional help-seeking will be investigated.

Methods: In a cross-sectional study, male role orientations (MRNS), work-related attitudes (AVEM), symptoms of mental disorders (PHQ), and attitudes related to stigma of mental illness (DSS) were assessed by standardized methods in a sample of 250 men treated for depression in general medical, psychiatric and psychotherapeutic services. Data were analyzed by means of latent profile analysis (LPA), by multinomial and linear regression models, and by path analysis.

Results: The results of LPA revealed three latent classes of men treated for depression. Men assigned to class one reported a less traditional male role orientation, low professional ambitions and low coping capacities; men assigned to class two reported a traditional masculinity orientation, high professional ambitions but low coping capacities; men assigned to class three reported less traditional masculinity tended orientations, medium professional ambitions and high coping capacities. Men assigned to classes one and two to have more stigmatizing attitudes, longer periods of untreated illness and more severe symptoms of mental disorders, in comparison to men assigned to class three.

Conclusions: Overall, this study reveals that traditional masculinity norms and work-role orientations in men treated for depression are associated with a worse mental health status. Our study results also suggest that a slackening of traditional masculinity norms is associated with improved psychological well-being if it does not coincide with a complete distancing from professional ambitions and a lack of ability to cope with professional stress.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0233764PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7250462PMC
August 2020

Maternal Separation Induces Long-Term Alterations in the Cardiac Oxytocin Receptor and Cystathionine -Lyase Expression in Mice.

Oxid Med Cell Longev 2020 24;2020:4309605. Epub 2020 Jan 24.

Department of Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, Germany.

We recently showed that blunt chest trauma reduced the expression of the myocardial oxytocin receptor (Oxtr), which was further aggravated by genetic deletion of the HS-producing enzyme cystathionine -lyase (CSE). Exogenous HS supplementation restored myocardial Oxtr expression under these conditions. Early life stress (ELS) is a risk factor for cardiovascular disease by affecting vascular and heart structures. Therefore, we tested the hypotheses that (i) ELS affects cardiac Oxtr and CSE expressions and (ii) Oxtr and CSE expression patterns depend on the duration of stress exposure. Thus, two stress paradigms were compared: long- and short-term separation stress (LTSS and STSS, respectively). Cardiac Oxtr expression was differentially affected by the two stress paradigms with a significant reduction after LTSS and a significant increase after STSS. CSE expression, which was significantly reduced in knockout hearts, was downregulated and directly related to Oxtr expression in LTSS hearts ( = 0.657, = 0.012). In contrast, CSE expression was not related to Oxtr upregulation in STSS. Plasma Oxt levels were not affected by either ELS paradigm. The coincidence of LTSS-induced reduction of cardiac Oxtr and reduced CSE expression may suggest a novel pathophysiological link between early life adversities and increased risk for the development of cardiovascular disorders in adulthood.
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http://dx.doi.org/10.1155/2020/4309605DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7007946PMC
September 2020

[Men and Depression: Illness Theories and Coping - A Biographical Narrative Study].

Psychiatr Prax 2020 Mar 17;47(2):65-70. Epub 2020 Jan 17.

Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, BKH Günzburg.

Objective: In order to develop gender-sensitive services, there is a need to better understand coping among men with depression. The study aims to analyze the meaning of gender- and work-related roles for illness theories and coping among men with depression.

Methods: Based on a latent class analysis of three types of masculinities, biographical interviews were conducted with men with depression (n = 12). Transcripts were analyzed using a hermeneutic-reconstructive approach that includes subjective constructions of meaning related to (1) illness theories, (2) coping and (3) help-seeking behavior.

Results: Whereas most interviewees reported the role of family-related career orientation as a cause of depression, results differ in terms of coping. While participants partly distanced themselves from external expectations, some tried to keep up their employability. Others perceived their depression as a chance as well as an opportunity to change harmful attitudes.

Conclusion: Psychiatric services might consider different priorities referring to work and life and their impact on coping with depression among men.
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http://dx.doi.org/10.1055/a-1043-8126DOI Listing
March 2020

Cluster-randomised trial evaluating a complex intervention to improve mental health and well-being of employees working in hospital - a protocol for the SEEGEN trial.

BMC Public Health 2019 Dec 17;19(1):1694. Epub 2019 Dec 17.

Institute of Occupational and Social Medicine, Heinrich-Heine-University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany.

Background: Health care employees in Germany and worldwide are exposed to a variety of stressors. However, most of the hospitals in Germany lack a systematic workplace health management. Thus, this study aims at the evaluation of the effects of a behavioural as well as organisational (´complex´) intervention on the mental health and well-being of hospital staff.

Methods: Mental health in the hospital workplace (SEElische GEsundheit am Arbeitsplatz KrankeNhaus - SEEGEN) is an unblinded, multi-centred cluster-randomised open trial with two groups (intervention group (IG) and waitlist control group (CG)). Study participants in the intervention clusters will receive the complex intervention; study participants in the waitlist control clusters will receive the complex intervention after the last follow-up measurement. The intervention consists of five behavioural and organisational intervention modules that are specifically tailored to hospital employees at different hierarchical and functional levels. Hospital staff may select one specific module according to their position and specific needs or interests. Towards the end of the intervention roundtable discussions with representatives from all professional groups will be held to facilitate organisational change. Primary outcome is the change in emotional and cognitive strain in the working environment, from baseline (T0) to 6 month-follow up (T1), between IG and CG. In addition, employees who do not participate in the modules are included in the trial by answering shorter questionnaires (cluster participants). Furthermore, using mixed methods, a process evaluation will identify uptake of the intervention, and mediators and moderators of the effect.

Discussion: There seems to be growing psychological strain on people working in the health care sector worldwide. This study will examine whether investing directly in the hospital staff and their interpersonal relationship may lead to measurable benefits in subjective well-being at the workplace and improved economic performance indicators of the hospital. In case of a positive outcome, health promotion strategies looking at behavioural as well as organisational components within the hospital may gain additional importance, especially in regard of the growing financial pressure within the health sector.

Trial Registration Drks: The SEEGEN study is registered at the German Clinical Trial Register (DRKS) under the DRKS-ID DRKS00017249. Registered 08 October 2019, URL. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017249.
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http://dx.doi.org/10.1186/s12889-019-7909-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6918673PMC
December 2019

Psychische Erkrankungen im Arbeitskontext – eine Verortung im Versorgungssystem.

Psychother Psychosom Med Psychol 2019 Dec 4;69(12):505-516. Epub 2019 Dec 4.

Work and mental health are closely interrelated. Sick leave rates due to mental illness have constantly been rising for years. Thus, not only companies but also the society as a whole have become more and more aware of the relevance of this topic.At first, various work stress models are outlined in this article. This is followed by an overview of how to classify work-related mental disorders in the ICD and DSM systems. Burnout is explained with regard to terminology, origin and adequate use in clinical practice. Furthermore, the ILO (International Labour Organization) classification of work-related mental disorders is presented. Possible intervention models for the prevention and therapy of work-related mental health problems are discussed. In addition, the most essential components of work-related psychotherapy are pointed out. Finally, corresponding guidelines are put into an international context.
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http://dx.doi.org/10.1055/a-1021-8209DOI Listing
December 2019

Reduced caregiving quality measured during the strange situation procedure increases child's autonomic nervous system stress response.

Child Adolesc Psychiatry Ment Health 2019 31;13:41. Epub 2019 Oct 31.

2Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Ulm, Ulm, Germany.

Background: Dysfunctional maternal behavior has been shown to lead to disturbances in infant's regulatory capacities and alterations in vagal reactivity. We aim to investigate the autonomic nervous system (ANS) response of the child during the strange situation procedure (SSP) in relation to the quality of maternal behavior.

Methods: Twelve month after birth, 163 mother-child-dyads were investigated during the SSP. Heart rate (HR) and both, the parasympathetic branch (PNS) via the respiratory sinus arrhythmia (RSA) and the sympathetic branch (SNS) via the left ventricular ejection time (LVET) of the ANS were continuously determined during the SSP using electrocardiogram (ECG) and impedance cardiogram (ICG) measures. Maternal behavior was assessed by using the AMBIANCE measure.

Results: The ANS response in infants of mothers with disruptive behavior compared to infants of non-disruptive mothers was significantly altered during the SSP: HR increased especially when infants of disruptive mothers were alone with the stranger (F (1, 161) = 4.15, p = .04) with a significant vagal withdrawal when being in contact with the stranger despite of presence of the mother (F (1, 161) = 5.11, p = .03) and a significant increase in vagal tone during final reunion (F (1, 161) = 3.76, p = .05). HR increase was mainly based on a decrease in LVET (F (1, 161) = 4.08, p = .05) with a maximum infant's HR when the stranger came into the room instead of the mother.

Conclusion: Both, SNS and PNS branches of the child are significantly altered in terms of an ANS imbalance, especially during contract to a stranger, in relation to dysfunctional maternal behavior. Our findings suggest the importance of supporting high quality caregiving that enables the infant to adapt adequately to stressful interpersonal situations which is likely to promote later health.
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http://dx.doi.org/10.1186/s13034-019-0302-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6824052PMC
October 2019

Maternal separation and contact to a stranger more than reunion affect the autonomic nervous system in the mother-child dyad: ANS measurements during Strange Situation Procedure in mother-child dyad.

Int J Psychophysiol 2020 01 24;147:26-34. Epub 2019 Oct 24.

Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Ulm, Germany; Department of Psychosomatic Medicine and Psychotherapy, Paracelsus Medical University, Nuremberg General Hospital, Germany.

Background: The autonomic nervous system (ANS) processes underlying attachment-related mother-child interactions are not well understood. We aimed to describe and compare the responsivity of the ANS for mothers and their infants during the different phases of the Strange Situation Procedure (SSP).

Methods: Continuous measurements of the sympathetic (SNS) and parasympathetic (PNS) branches of the ANS were obtained simultaneously in 91 mothers and their infants (range 10-15 months). Heart rate (HR), respiratory sinus arrhythmia (RSA), pre-ejection period (PEP) and left ventricular ejection time (LVET), were calculated for the baseline period (e1) and seven subsequent episodes (e2-e8) of the SSP.

Results: The largest difference between the mother and infant was during e7, when the stranger went into the room where the infant was while the mother waited outside the room. Mothers showed reduced SNS-activity or stress reduction while the child showed PNS withdrawal or increased stress response. Additionally, LVET was found to be a marker for SNS changes in the one-year-old infant during SSP.

Conclusion: Mothers and infants showed different stress-related ANS responses during e7. Since this study showed that simultaneous measurement of ANS responses in mother-child dyads during the SSP is feasible, future studies can assess both mother and child stress responses in different contexts. The measure of LVET may be a valid SNS-reactivity measure in the one-year-olds. Since the separation episode e7 led to the strongest ANS responses, future studies might assess stress responses in more normative circumstances, such as child care programs.
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http://dx.doi.org/10.1016/j.ijpsycho.2019.08.015DOI Listing
January 2020

[Effort, Success and Failure while Seeking for Outpatient Psychotherapy - Results of a Prospective Study].

Gesundheitswesen 2021 Jan 21;83(1):40-46. Epub 2019 Oct 21.

Klinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm, Ulm.

Objective: Patients and general practitioners often report on difficulties in finding a psychotherapist. In this prospective study, we investigate how much effort patients have to invest and how long it takes until they get an appointment with a psychotherapist.

Methods: 69 patients who were recommended to have psychotherapy were followed-up by telephone calls during 3 months. They were asked what they did to find a therapist and what the answers of the therapists were.

Results: Patients made on average 9.3 (SD 11.8) telephone calls to therapists (range 1-50). After three months, 57.7% of the patients had found a therapist or were on a waiting list. 15.3% were still seeking, 6.8% had quit seeking. 20.3% had not even started seeking.

Conclusions: The results show that much effort is needed to find a psychotherapist, but also that the majority of the patients do find one. Reasons for quitting the search for a therapist might be ambivalence on the part of the patients, but also the marked barriers in the health system.
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http://dx.doi.org/10.1055/a-1005-6958DOI Listing
January 2021

Investigating the Role of Stress-Preventive Leadership in the Workplace Hospital: The Cross-Sectional Determination of Relational Quality by Transformational Leadership.

Front Psychiatry 2019 3;10:622. Epub 2019 Sep 3.

Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, Tübingen, Germany.

A good relationship quality between leaders and staff members promotes mental health and prevents stress. To improve the relationship quality, it is important to identify variables which determine relationship quality at the workplace. Therefore, this study aims to identify specific leadership characteristics which support the development of a positive relationship between hospital leaders and staff members. A cross-sectional study design was applied. A total number of 1,137 leaders ( = 315) and staff members ( = 822) of different professions (physicians, nursing staff, therapeutic professionals, administration staff, IT staff, clinical services, office assistants, scientists, others) working at a tertiary hospital in Germany assessed transformational leadership style as a staff-oriented leadership style and leader-member relationship quality by self-report questionnaires [integrative leadership questionnaire (FIF), leader-member exchange (LMX-7) questionnaire]. The data were statistically analyzed by mean comparisons and a multiple linear regression analysis. Leaders rated their own transformational leadership style (M = 3.98, SD = 0.43) systematically higher than staff members assessed their leader (M = 2.86, SD = 1.04). Evaluation of relationship quality showed similar results: leaders evaluated their relationship quality to one exemplary staff member higher (M = 4.06, SD = 0.41) than staff members rated their relationship quality to their direct leader (M = 3.15, SD = 0.97). From the staff members' perspective, four sub-dimensions of transformational leadership, that is, "individuality focus," "being a role model," "fostering innovations," and "providing a vision" showed large effect sizes in the regression analysis of relationship quality ( = 0.79, (14,690) = 189.26, < 0.001, = 1.94). The results of our study are in line with previous investigations in other working contexts and point to a profession-independent association as the professional group of participants did not contribute to the variance explanation of the regression analysis. The exploration of potential determinants of relationship quality at work can, for example, support the development of leadership training programs with a focus on transformational leadership style. This might be an opportunity to foster high relationship quality between leaders and staff members and consequently might represent one strategy to prevent stress in the health care sector.
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http://dx.doi.org/10.3389/fpsyt.2019.00622DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6735266PMC
September 2019

INPART - a psycho-oncological intervention for partners of patients with haemato-oncological disease - study protocol.

BMC Cancer 2019 Sep 5;19(1):885. Epub 2019 Sep 5.

Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.

Background: Suffering from cancer confronts both the patient and their partner with a number of psychosocial challenges in various aspects of their life. These challenges may differentially impact on quality of life, coping ability and compliance to treatment. This especially holds true for haemato-oncological diseases. To date, psychological interventions have predominantly been developed for oncological patients however specific interventions for partners of haemato-oncological patients are rare. In this study we aim to conduct a psycho-oncological group-intervention for partners of patients with haemato-oncological diseases. The aim of the intervention is to significantly reduce symptoms of depression and anxiety in the partners and the patient, as well as enhancing dyadic coping.

Methods: The design of the INPART-study is an unblinded, randomised controlled trial with 2 treatment conditions (experimental and control) and assessments at baseline, 3 and 6 months. It will be conducted at three study centres: the university medical centre's in Leipzig, Hannover and Ulm. The outcome criteria will be a reduction in depressive and anxiety symptoms as well as an improvement of dyadic coping.

Discussion: This trial shall provide information regarding the efficiency of a psycho-oncological intervention for partners of patients with haemato-oncological diseases and give references to the possible outcome in terms of dyadic coping and the reduction of mental strain. The study was supported by a grant from the German José Carreras Leukaemia Foundation.

Trial Registration: ISRCTN16085028 ; 20/03/2019.
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http://dx.doi.org/10.1186/s12885-019-6094-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6729088PMC
September 2019

Vom Sinn des Verfahrenskonzepts und der Verfahrensvielfalt – und warum das Baukasten-System in der Psychotherapie nicht funktioniert.

Z Psychosom Med Psychother 2019 Dec 22;65(4):321-340. Epub 2019 Jul 22.

Universität Gießen Klinik für Psychosomatik und Psychotherapie Ludwigstraße 76 D-35392 Gießen Deutschland Universität Gießen, Klinik für Psychosomatik und Psychotherapie.

: In Germany, the official psychotherapy guidelines are oriented towards the model of distinct psychotherapeutic approaches. Within the German health care system this also applies to the training in psychotherapy. Some critics, however, are presently pleading in favour of abolishing the model of distinct psychotherapeutic approaches, which also implies to abolish the concept of the so called "Richtlinienverfahren" in Germany - approaches of psychotherapy which proved to be efficacious and whose costs are reimbursed by the insurance companies. : The arguments put forward such as the heterogeneity of the approaches as well as the proposed alternatives, for example, an "integrative" model of both mental disorders and psychotherapeutic treatment are critically discussed. : Both the arguments and proposed alternatives are found to be not convincing, neither from a scientific nor from a psychotherapeutic perspective. From a scientific perspective, there is no evidence for efficacy of a "general" or "integrative" model of psychotherapy - which is in contrast to the Richtlinienverfahren for which evidence for efficacy exists. From a psychotherapeutic perspective psychotherapy cannot be taught, learnt and applied by use of tools or modules without a theoretical orientation. : The concept of distinct psychotherapeutic approaches proves to be an in dispensable principal for orientation in psychotherapy, for both therapists and patients.
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http://dx.doi.org/10.13109/zptm.2019.65.4.oa1DOI Listing
December 2019