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In the psychotherapeutic treatment of social phobia, the hand movement behaviour exhibited during the interaction provides information about the success of the therapy. In particular, the degree of mutual somatosensory stimulation of the hands (hands moving on each other, as a unit, apart) appears to be relevant regarding the patient's mental state. To test this hypothesis, the present study investigates hand coordination in the course of psychotherapy in patients with and without symptom improvement and in the corresponding therapeutic dyads. Forty‐two videos of patient–therapist dyads consisting of 21 patients (n = 11 non‐improved; n = 10 improved; according to Liebowitz Social Anxiety Scale self‐assessment) from the Social Phobia Research Network project were investigated in early psychotherapy sessions and in pre‐last sessions. Hand movements of four randomised video sequences per dyad were analysed with NEUROGES®‐ELAN. Patients with non‐improved symptoms displayed shorter act apart coordination and more act on each other coordination than patients with improved symptoms. Patients displayed more act apart and act on each other and less act as a unit coordination than therapists. In therapeutic dyads, act on each other coordination in early sessions, as well as short act apart coordination, was significantly related to non‐improvement. Patients with non‐improved symptoms are characterised by more hand coordination associated with a high degree of somatosensory stimulation serving self‐regulation (act on each other), as well as short complex gestural expressions (act apart). Thus, hand coordination constitutes a progression and outcome parameter informing on somatosensory stimulation. [ABSTRACT FROM AUTHOR]

There are many postulates of a relation between quality of attachment with theory of mind and language functions (e.g., de Rosnay & Hughes, 2006). The current study examined in longitudinal design how different patterns of attachment are associated with usage of internal state language at ages 17, 23, 30 and 36 months. Transcripts of mother-child play situations were coded for eleven categories of internal state language: positive emotion, negative emotion, valence reversal, physiology, ability, volition, obligation, moral, cognition, emotion-modulatory particles and cognitive-contrast particles. Repeated-measures ANOVAs revealed that securely attached children exhibit more frequent utterances of positive emotion, valence reversal, physiology, ability, cognition, emotion-modulatory, and cognitive-contrast particles at relatively earlier times. Negative emotion terms were more frequently uttered by avoidant-insecure children at 30 months and by disorganized children at 36 months. (Contains 4 tables and 1 footnote.)

Hands are, compared to other body parts, the body parts that display the most gestural movements during an interaction and their movement is sensitive to reveal anxiety states. However, psychotherapy research focuses on movement synchrony of different body parts to be an indicator of improved symptoms. The present study investigates symptoms in social anxiety disorder and considers both, individual and simultaneous hand movements. 56 video recordings of 28 patient-therapist dyads with patients with social anxiety at the beginning and in the end of psychotherapy were analyzed. Two independent blind certified raters analyzed the hand movement behavior using the NEUROGES® analysis system for nonverbal behavior concerning individual movement units and the simultaneous overlaps between the patients' and therapists' movement units. Simultaneous overlap change negatively correlated with symptoms (LSAS week eight-measurement, r = −.52; and week 15-measurement, r = −.52; BDI pre-measurement, r = −.54). The patients' right hand movement at the end of the psychotherapy correlated significantly with therapeutic alliance (HAQ post-measurement; r =.55). Hand movement behavior analysis should be considered in psychotherapy research in combination with movement synchrony as a measurement parameter related to therapeutic process and outcome. Enriching previous findings, this study indicates that simultaneous movement change is related to symptoms and therefore a process-sensitive parameter in psychotherapy. [ABSTRACT FROM AUTHOR]

AbstractResearch shows the significance of death attitudes for the mental health of somatically ill people, but findings that focus on multidimensionality in processing death are scarce. Patients with Chronic Obstructive Pulmonary Disease (COPD) report shortness of breath, pain and anxiety about suffocation and high mental distress. Utilizing a mixed-methods approach from 64 hospitalized COPD patients, we examined how they cope with mortality. We conducted a narrative interview with two questions. Patients completed the Multidimensional Orientation Toward Dying and Death Inventory (MODDI-F). Findings reveal a spectrum of death-related narratives, with most patients reporting at least 3 different attitudes. The sample showed below average scores in the Rejection of One’s Own Death and Dying subscale of the MODDI-F. Assessing death attitudes using two simple questions proved highly applicable in this population and may serve as a potential approach to engage patients in discussions about existential matters, as suggested in the literature. [ABSTRACT FROM AUTHOR]

Abstract Background Psychodynamic psychotherapy is frequently applied in the treatment of social phobia. Nevertheless, there has been a lack of studies on the transfer of manualized treatments to routine psychodynamic practice. Our study is the first one to examine the effects of additional training in a manualized Short Term Psychodynamic Psychotherapy (STPP) procedure on outcome in routine psychotherapy for social phobia. This study is an extension to a large multi-site RCT (N = 512) comparing the efficacy of STPP to Cognitive-Behavioral Therapy (CBT) of Social Phobia. Methods/Design The manualized treatment is designed for a time limited approach with 25 individual sessions of STPP over 6 months. Private practitioners will be randomized to training in manualized STPP vs. treatment as usual without a specific training (control condition). We plan to enrol a total of 105 patients (84 completers). Assessments will be conducted before treatment starts, after 8 and 15 weeks, after 25 treatment sessions, at the end of treatment, 6 months and 12 months after termination of treatment. The primary outcome measure is the Liebowitz Social Anxiety Scale. Remission from social phobia is defined scoring with 30 or less points on this scale. Discussion We will investigate how the treatment can be transferred from a controlled trial into the less structured setting of routine clinical care. This question represents Phase IV of psychotherapy research. It combines the benefits of randomized controlled and naturalistic research. The study is genuinely designed to promote faster and more widespread dissemination of effective interventions. It will answer the questions whether manualized STPP can be implemented into routine outpatient care, whether the new methods improve treatment courses and outcomes and whether treatment effects reached in routine psychotherapeutic treatments are comparable to those of the controlled, strictly manualized treatment of the main study. Trial Registration German Clinical Trials Register (DRKS) DRKS00000570

Abstract Background Ethnic diversity in schools increases due to globalization. Thus, the children's social-emotional competence development must be considered in the context of a multi-ethnic classroom. Methods In this study, the social-emotional competence of 65 Asian-American and Latin-American children was observed at the beginning and the end of their kindergarten year. Results Initially, significant differences existed among these ethnic groups in respect to moral reasoning. Furthermore, the male children showed more dysregulated aggression but the female children implemented more moral reasoning than their male counterparts. These ethnic specificities did not disappear over the course of the year. In addition, a significant change in avoidance strategies as well as expressed emotions in the narrative took place over the course of one year. Conclusion Ethnic specificity in social-emotional competence does exist independent of gender at the beginning as well as at the end of the kindergarten year in a multi-ethnic kindergarten classroom.

Objectives: Within a randomized controlled trial contrasting the outcome of manualized cognitive-behavioral (CBT) and short term psychodynamic therapy (PDT) compared to a waiting list condition (the SOPHO-Net trial), we set out to test whether self-reported attachment characteristics change during the treatments and if these changes differ between treatments. Research design and methods: 495 patients from the SOPHO-Net trial (54.5% female, mean age 35.2 years) who were randomized to either CBT, PDT or waiting list (WL) completed the partner-related revised Experiences in Close Relationships Questionnaire (ECR-R) before and after treatment and at 6 and 12 months follow-up. The Liebowitz Social Anxiety Scale (LSAS) was administered at pre-treatment, post-treatment, and at 6-month and 1-year follow-up. ECR-R scores were first compared to a representative healthy sample (n = 2508) in order to demonstrate that the clinical sample differed significantly from the non-clinical sample with respect to attachment anxiety and avoidance. Results: LSAS scores correlated significantly with both ECR-R subscales. Post-therapy, patients treated with CBT revealed significant changes in attachment anxiety and avoidance whereas patients treated with PDT showed no significant changes. Changes between post-treatment and the two follow-ups were significant in both conditions, with minimal (insignificant) differences between treatments at the 12- month follow-up. Conclusions: The current study supports recent reviews of mostly naturalistic studies indicating changes in attachment as a result of psychotherapy. Although there were differences between conditions at the end of treatment, these largely disappeared during the follow-up period which is line with the other results of the SOPHO-NET trial. Trial registration: Controlled-trials.com [ABSTRACT FROM AUTHOR]

The perception of disgust is a powerful but yet puzzling emotion, aiming at the prevention of potential microbial pathogens and being directly linked to olfactory processing in its neurophysiological pathways via the anterior insular cortex. In sample of healthy participants with a natural variation in olfactory function, we investigated the relation between olfactory sensitivity and disgust perception. A total of 123 healthy individuals were surveyed with a disgust sensitivity questionnaire. Olfactory threshold was assessed in all participants using the Sniffin' Sticks. Additionally, tactile 2-point discrimination threshold was tested in a subgroup of the participants as a controlling factor for the specificity of the relationship between olfactory sensitivity and disgust. Only in men, a significant relation between disgust ratings and olfactory threshold was observed. Men with high olfactory sensitivity reported as high levels of disgust as female participants, while men with low olfactory sensitivity reported significantly lower disgust than women. There was no such relation for tactile sensitivity. Investigating sensory subscales of the disgust questionnaire, olfactory sensitivity was related to olfactory and tactile, but not to visual disgust ratings. In conclusion, there is a specific relation between the level of disgust and olfactory sensitivity in men, who generally present lower values of disgust than women. When disgust ratings are low, there seems to be an additional merit in the ability to perceive subtle olfactory stimuli. Thus high olfactory sensitivity may facilitate the perception of potential pathogenic threats and contribute to the evolutionary function of disgust as disease avoidance mechanism. [ABSTRACT FROM AUTHOR]

Background: Despite growing evidence for manualized psychodynamic treatments, there is a lack of studies on their transfer to routine practice. This is the first study to examine the effects of an additional training in manualized Short Term Psychodynamic Psychotherapy (STPP) on the outcome in routine psychotherapy for social anxiety disorder (SAD). The study is an extension to a large RCT comparing STPP to Cognitive-Behavioral Therapy of SAD. Methods: The manualized treatment was designed for a time limited approach with 25 individual sessions of STPP over 6 months. Private practitioners were randomized to training in manualized STPP (mSTPP) vs. treatment as usual without a specific training (tauSTPP). A total of 109 patients were enrolled (105 started treatment; 75 completed at least 20 treatment sessions). Assessments were conducted pre-treatment, after 8 and 15 weeks, after 25 treatment sessions, at the end of treatment, 6 and 12 months after termination of treatment. Remission as primary outcome was defined by the Liebowitz-Social-Anxiety-Scale (LSAS) score ≤30. Secondary outcomes were response (at least 31% reduction in LSAS), treatment duration and number of sessions, changes in social anxiety (LSAS, SPAI), depression (BDI), clinical global impression (CGI), and quality of life (EQ-5D). Results: Remission rates of mSTPP (9%) resp. tauSTPP (16%) and also response rates of 33% resp. 28% were comparable between the two treatment approaches as well as treatment duration and number of sessions. Most of the within-group differences (baseline to 25 sessions) indicated moderate to large improvements in both treatments; within-group differences from baseline to 12 months follow-up (LSAS, SPAI, BDI, CGI) were large ranging from d = -0.605 to d = -2.937. Benefits of mSTPP were limited to single outcomes. Conclusions: Findings are discussed with regard to implementation and dissemination of empirically validated treatments in psychodynamic training and practice. SAD patients with a high comorbidity of personality disorders and a long treatment history may need longer treatments. [ABSTRACT FROM AUTHOR]

Objectives: Little is known about patient characteristics as predictors for outcome in manualized short term psychodynamic psychotherapy (PDT). No study has addressed which patient variables predict outcome of PDT for social anxiety disorder. Research Design and Methods: In the largest multicenter trial on psychotherapy of social anxiety (SA) to date comparing cognitive therapy, PDT and wait list condition N = 230 patients were assigned to receive PDT, of which N = 166 completed treatment. Treatment outcome was assessed based on diverse parameters such as endstate functioning, remission, response, and drop-out. The relationship between patient characteristics (demographic variables, mental co-morbidity, personality, interpersonal problems) and outcome was analysed using logistic and linear regressions. Results: Pre-treatment SA predicted up to 39 percent of variance of outcome. Only few additional baseline characteristics predicted better treatment outcome (namely, lower comorbidity and interpersonal problems) with a limited proportion of incremental variance (5.5 to 10 percent), while, e.g., shame, self-esteem or harm avoidance did not. Conclusions: We argue that the central importance of pre-treatment symptom severity for predicting outcomes should advocate alternative treatment strategies (e.g. longer treatments, combination of psychotherapy and medication) in those who are most disturbed. Given the relatively small amount of variance explained by the other patient characteristics, process variables and patient-therapist interaction should additionally be taken into account in future research. Trial Registration: Controlled-trials.com/ [ABSTRACT FROM AUTHOR]

Background: Childhood maltreatment is associated with the development and maintenance of mental disorders. The purpose of this naturalistic study was (a) to identify different patterns of childhood maltreatment, (b) to examine how these patterns are linked to the severity of mental disorders and (c) whether they are predictive of treatment outcome. Methods: 742 adult patients of a university hospital for psychotherapy and psychosomatics were assessed at intake and discharge by standardized questionnaires assessing depression (Beck Depression Inventory, BDI) and general mental distress (Symptom Check List-90-R, SCL-90-R). Traumatic childhood experience (using the Childhood Trauma Questionnaire, CTQ) and ICD-10 diagnoses were assessed at intake. Results: The patients could be allocated to three different patterns of early childhood trauma experience: mild traumatization, multiple traumatization without sexual abuse and multiple traumatization with sexual abuse. The three patterns showed highly significant differences in BDI, General Severity Index (GSI) and in the number of comorbidity at intake. For both BDI and GSI a general decrease in depression and general mental distress from intake to discharge could be shown. The three patterns differed in BDI and GSI at intake and discharge, indicating lowest values for mild traumatization and highest values for multiple traumatization with sexual abuse. Patients with multiple traumatization with sexual abuse showed the least favourable outcome. Conclusion: The results provide evidence that the severity of childhood traumatization is linked to the severity of mental disorders and also to the treatment outcome in inpatient psychotherapy. In the study, three different patterns of childhood traumatization (mild traumatization, multiple traumatization without sexual abuse, multiple traumatization with sexual abuse) showed differences in the severity of mental disorder and in the course of treatment within the same therapy setting. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective: Relatively few studies have examined the long-term outcome of psycho therapy in social anxiety disorder. The authors previously reported findings o f a clinical trial comparing cognitive behavioral therapy (CBT), psychodynamic therapy, and a wait-list control. The purpose of the present study was to follow the participants' status over the ensuing 24 months. Method: Outpatients with social anxiety disorder who were treated with CBT (N=209) or psychodynamic therapy (N=207) in the previous trial were assessed 6, 12, and 24 months after the end o f therapy. Primary outcome measures were rates of remission and response. Results: For both CBT and psychodynamic therapy, response rates were approximately 70% by th e 2-year follow -u p. Remission rates were nearly 40% for both treatment conditions. Rates of response and remission were stable or tended to increase for both treatments over the 24-month follow up period, and no significant differences were found between the treatment conditions after 6 months. Conclusions: CBT and psychodynamic therapy were efficacious in treating social anxiety disorder, in both the short- and long-term, when patients showed continuous improvement. Although in the short term, intention-to-treat analyses yielded some statistically significant but small differences in favor of CBT in several outcome measures, no differences in outcome were found in the long-term. [ABSTRACT FROM AUTHOR]

Background: Patients with Panic Disorder (PD) direct their attention towards potential threat, followed by panic attacks, and increased sweat production. Onés own anxiety sweat odor influences the attentional focus, and discrimination of threat or non-threat. Since olfactory projection areas overlap with neuronal areas of a panic-specific fear network, the present study investigated the neuronal processing of odors in general and of stress-related sweat odors in particular in patients with PD. Methods: A sample of 13 patients with PD with/ without agoraphobia and 13 age- and gender-matched healthy controls underwent an fMRI investigation during olfactory stimulation with their stress-related sweat odors (TSST, ergometry) as well as artificial odors (peach, artificial sweat) as non-fearful non-body odors. Principal Findings: The two groups did not differ with respect to their olfactory identification ability. Independent of the kind of odor, the patients with PD showed activations in fronto-cortical areas in contrast to the healthy controls who showed activations in olfaction-related areas such as the amygdalae and the hippocampus. For artificial odors, the patients with PD showed a decreased neuronal activation of the thalamus, the posterior cingulate cortex and the anterior cingulate cortex. Under the presentation of sweat odor caused by ergometric exercise, the patients with PD showed an increased activation in the superior temporal gyrus, the supramarginal gyrus, and the cingulate cortex which was positively correlated with the severity of the psychopathology. For the sweat odor from the anxiety condition, the patients with PD showed an increased activation in the gyrus frontalis inferior, which was positively correlated with the severity of the psychopathology. Conclusions: The results suggest altered neuronal processing of olfactory stimuli in PD. Both artificial odors and stress-related body odors activate specific parts of a fear-network which is associated with an increased severity of the psychopathology. [ABSTRACT FROM AUTHOR]

Disgust causes specific reaction patterns, observable in mimic responses and body reactions. Most research on disgust deals with visual stimuli. However, pictures may cause another disgust experience than sounds, odors, or tactile stimuli. Therefore, disgust experience evoked by four different sensory channels was compared. A total of 119 participants received 3 different disgusting and one control stimulus, each presented through the visual, auditory, tactile, and olfactory channel. Ratings of evoked disgust as well as responses of the autonomic nervous system (heart rate, skin conductance level, systolic blood pressure) were recorded and the effect of stimulus labeling and of repeated presentation was analyzed. Ratings suggested that disgust could be evoked through all senses; they were highest for visual stimuli. However, autonomic reaction toward disgusting stimuli differed according to the channel of presentation. In contrast to the other, olfactory disgust stimuli provoked a strong decrease of systolic blood pressure. Additionally, labeling enhanced disgust ratings and autonomic reaction for olfactory and tactile, but not for visual and auditory stimuli. Repeated presentation indicated that participant's disgust rating diminishes to all but olfactory disgust stimuli. Taken together we argue that the sensory channel through which a disgust reaction is evoked matters. [ABSTRACT FROM AUTHOR]

Background: In industrialized countries, about 5% to 15% of all adults have a pathologically severe fear of dental treatment, and some 3% avoid going to the dentist altogether. The affected persons may, in turn, suffer from severe dental diseases and their psychosocial effects. Many people with dental phobia have other mental disorders as well. These facts motivated us to study the prevalence of fear of dental treatment in a group of patients being treated by our psychosomatic service. Method: 212 patients of our psychosomatic service and 95 healthy controls were studied with the Hierarchical Anxiety Questionnaire (HAQ) to determine the intensity of their fear of dental treatment. Mental disorders were diagnosed with structured clinical interviews according to DSM-IV. Results: Nearly one patient in three (30.5%, n = 64) suffered from pathologically severe fear of dental treatment; 24 of them (38.5%) had avoided visiting a dentist for longer than one year. Only 4 (4.2%) of the healthy controls were greatly afraid of dental treatment. Certain types of mental disorder were especially highly associated with fear of dental treatment: in particular, anxiety disorders (relative risk [RR] 7.44, 95% confidence interval [CI] 2.68-20.70) and depressive disorders (RR 4.92, 95% CI 1.73-14.05). Patients with post-traumatic stress disorder were affected most commonly: 34 (42%) of these patients were greatly afraid of dental treatment (RR 9.97, 95% CI 3.69-26.90). 75 of the 134 study participants who were afraid of dental treatment (56%) had cancelled a dental appointment, or failed to appear for a scheduled appointment, because of their fears. Conclusion: Fear of dental treatment commonly accompanies certain types of mental disorder. Patients at high risk should be asked about such fears so that the problem can be recognized early and appropriately treated. [ABSTRACT FROM AUTHOR]