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Objectives: Deficits in emotion regulation (ER) have been shown to be associated with binge-eating disorder (BED). To further clarify the causal nature of this association, we tested whether systematically enhancing ER skills would reduce symptoms of BED. Methods: We randomly allocated N = 101 individuals meeting the criteria for BED to a transdiagnostic ER skills training or to a waitlist control condition (WLC). Primary outcome was the reduction in binges during the treatmentvs.-waiting period as assessed with the Eating Disorder Examination (EDE) interview. Results: Mixed-model ANOVAs indicated that the average pre-to-post decrease in binges assessed with the EDE was significantly greater in the ER skills training condition than in the WLC (d = 0.66). These effects were stable over the 6-month follow-up period (d = 0.72). Remission rates at post/follow-up were 34.4/45.0% in the skills training and 7.5/20.0% in the WLC. Additionally, we found a greater reduction in general eating disorder psychopathology, of food consumption in a bogus taste test and of depression in the ER skills training condition. Moreover, the greater reduction in binge-eating episodes in the training condition was (partially) mediated by a greater increase in ER skills. Conclusions: The findings provide further support for the assumed importance of deficits in ER as a maintaining factor and, hence, as a target in the treatment of BED. As ER skills trainings have been shown to also reduce other kinds of psychopathology, they might be considered a promising transdiagnostic add-on component to disorder-specific interventions. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the efficacy of an internet-based treatment for Genito-Pelvic Pain/Penetration Disorder (GPPPD) which adversely affects women's sexuality and is associated with reduced well-being and mental health comorbidities. Method: Two-hundred women with GPPPD (no penetrative intercourse ≥6 months) were randomly allocated to the intervention group (IG) or a waitlist control group (WCG). The intervention included eight modules and one booster session and was delivered through an eHealth platform. Participants were supported by an eCoach regarding treatment adherence. The primary outcome was intercourse penetration behavior. Online assessments were scheduled at baseline (T1), after Session 8/12 weeks (T2), and 6 months (T3) after randomization. Intention-to-treat analyses were reported. Results: Significantly more participants (31.00%, n = 31/100) in the IG were able to have sexual intercourse at T2 compared to those in the WCG, 13.00%, n = 13/100; χ2(1) = 9.44, p <.01. At T3, still more participants in the IG had sexual intercourse (29%) compared to those in the WCG (20%) but the groups no longer differed significantly, χ2(1) = 2.19, p =.19. Genital pain, painful and noncoital penetration behavior, and negative penetration-related cognitions significantly improved with medium to large effects at T2 (d = 0.66−1.25) and small to large effects at T3 (d = 0.23−1.32), whereas fear of sexuality, overall sexual functioning, trait anxiety, and well-being improved with small to medium effects (T2: d = 0.20−0.49, T3: d = 0.23−0.46) in the IG compared to the WCG. On average, participants completed 79% of the intervention. Conclusion: Internet-based treatment has been shown to be effective for GPPPD symptoms and could therefore be a promising treatment modality. What is the public health significance of this article?: This study suggests that internet-based treatment can be an acceptable and effective approach to enable intercourse penetration behavior and reduce associated symptoms of Genito-Pelvic Pain/Penetration Disorder in comparison to a waitlist condition. Internet-based treatment might be recommended for women preferring self-help and who cannot and will not access face-to-face therapy due to structural and attitudinal barriers. [ABSTRACT FROM AUTHOR]

Background: Given their ubiquity and technological facilities, smartphone-based interventions (SBIs) hold potential to support the cost-effective dissemination of evidence-based treatments for depression. As technologically enriched, blended approach–avoidance modification trainings (AAMTs) have recently been shown effective for symptom reduction in various mental health problems, we developed a blended SBI combining group-based psychoeducation and 14 days of app training utilizing principles from AAMT to reduce depressive symptoms. Methods: In this pilot trial, N = 16 individuals with heightened depression scores were randomized to either an intervention group using the mentalis Phoenix app or a wait list control condition. As outcomes, we descriptively explored usability of the app, engagement with the intervention, and possible reductions of depressive symptoms. Results: Data analyses suggest that the SBI tested in this pilot trial possesses high usability, is frequently engaged with, and reduces depressive symptoms in participants in the intervention group when compared to wait list controls. Conclusions: This pilot study provides preliminary evidence that an SBI utilizing AAMT can reduce depressive symptoms. Future studies should replicate these findings using larger samples and disentangle possible mechanisms of change. Trial registration: DRKS-ID: DRKS00021613 (retrospectively registered). [ABSTRACT FROM AUTHOR]

Deficits in general emotion regulation skills have been shown to be associated with various mental disorders. Thus, general affect-regulation training has been proposed as promising transdiagnostic approach to the treatment of psychopathology. In the present study, we aimed to evaluate the efficacy of a general affect-regulation as a stand-alone, group-based treatment for depression. For this purpose, we randomly assigned 218 individuals who met criteria for major depressive disorder (MDD) to the Affect Regulation Training (ART), to a waitlist control condition (WLC), or to a condition controlling for common factors (CFC). The primary outcome was the course of depressive symptom severity as assessed with the Hamilton Rating Scale for Depression and the Beck Depression Inventory. Multi-level analyses indicated that participation in ART was associated with a greater reduction of depressive symptom severity than was participation in WLC (d = 0.56), whereas the slight superiority of ART over CFC (d = 0.25) was not statistically significant. Mediation analyses indicated that changes in emotion regulation skills mediated the differences between ART/CFC and WLC. Thus, the findings provide evidence for enhancing emotion regulation skills as a common mechanism of change in psychological treatments for depression. The study was registered with ClinicalTrials.gov (NCT01330485) and was supported by grants from the German Research Association (DFG; BE 4510/3-1; HI 456/6-2). Future research should compare the (cost-) efficacy of ART with that of disorder-specific interventions. [ABSTRACT FROM AUTHOR]

Background: Problematic drinking is common among college students and associated with various somatic and mental health problems. Given significant evidence for the efficacy of smartphone-based interventions and the frequent use of smartphones among college students, it can be assumed that such interventions have great potential to facilitate access to evidence-based interventions for students suffering from problematic drinking. Thus, we developed a brief intervention that combined a counseling session with an app that utilizes approach-avoidance modification training to reduce alcohol consumption. Methods: To test the feasibility and explore the potential efficacy of the intervention, we conducted a before-after single-arm study with N = 11 participants reportedly engaging in problematic drinking, who were instructed to practice with the app for 14 days. Feasibility was assessed with the System Usability Scale (SUS). Outcomes included the reduction of self-reported problematic drinking behavior, dysfunctional attitudes about alcohol, and craving, as well as implicit associations between alcohol and self during the training period. Additionally, self-reported problematic drinking behavior was assessed at a 4-week follow-up. Results: On average, participants rated app usability on the SUS (possible range: 0 to 100) with M = 84.32 (SD = 6.53). With regard to efficacy, participants reported a significant reduction of problematic drinking behavior (dpre vs. post = 0.91) which was sustained at follow-up (dfollow-up vs. baseline = 1.07). Additionally, participants reported a significant reduction of dysfunctional attitudes about alcohol (dpre vs. post = 1.48). Results revealed no significant changes in craving nor in implicit associations regarding alcohol. Conclusions: Findings from this feasibility study provide preliminary evidence that smartphone-based interventions might help reduce problematic drinking in college students. Further research needs to replicate these findings with larger samples in randomized controlled trials. Trial registration: DRKS00014675 (retrospectively registered). [ABSTRACT FROM AUTHOR]

Hintergrund: Schwierigkeiten, Geschlechtsverkehr zu haben trotz bestehenden Wunsches, stellen für Frauen mit Genito-Pelviner Schmerz-Penetrationsstörung (GPSPS) eine große Belastung dar. Die Verfügbarkeit spezifischer Therapieangebote für sexuelle Funktionsstörungen bei Frauen ist begrenzt und existierende Therapiemöglichkeiten werden oftmals aus Schamgefühlen nicht in Anspruch genommen. Internetbasierte Behandlungsansätze können einen niedrigschwelligen, anonymen, zeit- und ortsunabhängigen spezialisierten Therapiezugang ermöglichen. Bislang liegt noch kein wissenschaftlich evaluiertes Programm für die Behandlung von GPSPS vor. Das Ziel der vorliegenden Arbeit ist es deshalb, den Therapieleitfaden eines neu entwickelten internetbasierten, begleiteten Behandlungsprogramms für GPSPS (Paivina-Care) vorzustellen sowie exemplarisch die Akzeptanz und Zufriedenheit und den subjektiven Nutzen anhand eines Fallberichtes darzustellen. Methodik: Das Rational und der Therapieleitfaden des Behandlungsprogramms werden vorgestellt. Die Falldarstellung nach der Case Reporting (CARE)-Leitlinie präsentiert eine Patientin mit erfolgreichem Behandlungsverlauf sowie qualitative und quantitative Erfolgsmaße. Ergebnisse: Die Kasuistik zeigt, dass das kognitiv-verhaltenstherapeutische Programm basierend auf Schmerz- und Sexualtherapie unter Einbezug des Partners die GPSPS bei der vorgestellten Patientin erfolgreich behandeln konnte und mit hoher Therapiezufriedenheit Schmerzen und sexualitätsbezogene Ängste und negative Kognitionen reduzieren sowie Geschlechtsverkehr ermöglichen konnte. Derzeit erfolgt eine randomisiert-kontrollierte Wirksamkeitsuntersuchung an 200 Frauen mit GPSPS. Schlussfolgerung: Das internetbasierte Behandlungsprogramm bietet Frauen mit GPSPS eine flexible Behandlungsmöglichkeit, die sie anonym, zeit- und ortsunabhängig nutzen können. [ABSTRACT FROM AUTHOR]

Introduction Difficulties with vaginal penetration can severely affect a woman's desire to have sexual intercourse, her sexual and general well-being, or her partnership. However, treatment opportunities for vaginismus are scarce. Aim To evaluate the efficacy of an internet-based guided self-help intervention for vaginismus in a randomized controlled pilot trial. Methods Seventy-seven women with vaginismus (primary inclusion criterion = no intercourse ≥ 6 months) were randomly assigned to an intervention group (IG) and a waitlist control group (WCG). The intervention consisted of 10 sessions involving psychoeducation, relaxation exercises, sensate focus, and gradual exposure with dilators. Participants received written feedback on completed sessions from an eCoach. Main Outcome Measures The primary outcome was successful sexual intercourse. Secondary outcomes were non-intercourse penetration, fear of coitus, sexual functioning, and dyadic coping. Self-reported assessments were scheduled at baseline, 10 weeks, and 6 months. Results More participants (10 of 40, 34.48%) in the IG had intercourse compared with those in the WCG (6 of 37, 20.69%) at least once at 10 weeks or 6 months (odds ratio = 2.02). The difference was not significant (χ 2 1 = 1.38, P = .38), but in the IG, there was a significant increase in intercourse penetration from baseline to 6 months (d = 0.65). No such increase was found in the WCG (d = 0.21). There were significant between-group effects concerning non-intercourse penetration (self-insertion of a finger or dilator or insertion by the partner) in favor of the IG. Fear of coitus and dyadic coping significantly decreased in the IG. Overall satisfaction with the training was high. Conclusion This randomized controlled trial showed promising effects of an internet-based intervention by increasing participants' ability to have intercourse and non-intercourse penetration while experiencing high treatment satisfaction. The WCG also showed improvement, although participants had vaginismus for an average duration of 6 years. Internet-based interventions could be a treatment modality to complement other methods in stepped care for vaginal penetration difficulties. [ABSTRACT FROM AUTHOR]

Background: Childhood trauma increases the risks of both depression and dysfunctional emotion regulation, which is a factor that has been strongly linked to depression. Because of these demonstrated relationships, it can be hypothesized that dysfunctional emotion regulation is a mediator of the association between childhood trauma and depression.Methods: To test this hypothesis, we assessed the indirect effect of emotion regulation (Emotion Regulation Skills Questionnaire) on the relationship between childhood trauma (Childhood Trauma Questionnaire) and depression severity (24-item Hamilton Rating Scale for Depression) as well as depression lifetime persistency (i.e., lifetime percentage spent in major depressive episodes; assessed via SCID and Life Chart Interviews) in 269 patients with major depressive disorder (MDD).Results: Bootstrapping-enhanced mediation analyses indicated that deficits in general emotion regulation mediated the association of childhood trauma to both depression severity and depression lifetime persistency. Further exploratory analyses indicated that specific emotion regulation skills (such as the ability to mindfully observe, accept, and tolerate undesired emotions or the willingness to voluntarily confront situations that prompt negative emotions in order to attain personally relevant goals) significantly mediated the association between childhood trauma and depression severity. Willingness to confront was a mediator for both depression outcomes (depression severity and lifetime persistency).Limitations: The employed mediation analyses are cross-sectional in nature, which limits any firm conclusions regarding causality.Conclusions: The findings support the assumption that a sophisticated emotion regulation may help prevent the onset or unfavorable course of depression in individuals who have experienced childhood trauma. [ABSTRACT FROM AUTHOR]

Abstract: Deficits in emotion regulation have been identified as an important risk and maintaining factor for depression. The aim of this study was to examine the long-term effects of emotion regulation on symptoms of depression. Moreover, we investigated which specific emotion regulation skills were associated with subsequent symptoms of depression. Participants were 116 individuals (78% women, average age 35.2 years) who registered for an online-based assessment of depression and its risk-factors and reported at least some symptoms of depression. Successful application of emotion regulation skills and depressive symptom severity were assessed twice over a 5-year period. We utilized cross-lagged panel analyses to assess whether successful skills application would be negatively associated with subsequent depressive symptom severity. Cross-lagged panel analyses identified successful skills application as a significant predictor for depressive symptom severity even when controlling for the effects of initial symptoms of depression. A comparison of the effect sizes for different emotion regulation skills on subsequent depressive symptoms suggests that most of the skills included have similar predictive value. These findings provide preliminary evidence for the hypotheses that deficits in emotion regulation may contribute to the development of depression and that interventions systematically enhancing adaptive emotion regulation skills may help prevent and treat depressive symptoms. [Copyright &y& Elsevier]

Im Mai 2013 ist die fünfte Auflage des Diagnostischen und Statistischen Manuals Psychischer Störungen (DSM-5) der American Psychiatric Association erschienen. Um die Vor- und Nachteile des DSM-5 beurteilen und gegebenenfalls in Forschung und Praxis angemessen berücksichtigen zu können, sollten Wissenschaftler und Praktiker gleichermaßen über die Änderungen gegenüber dem DSM-IV informiert sein. In diesem Beitrag werden die wesentlichen Unterschiede zwischen dem DSM-IV und DSM-5 beschrieben. Zentrale Unterschiede in dem Gesamtsystem ergeben sich durch die Aufgabe des multiaxialen Systems und die Neuanordnung der Störungen. Wesentliche Veränderungen auf Störungsebene enthalten die Einführung Schwerer und Leichter Neurokognitiver Störungen, die Aufhebung von Trauerreaktionen als Ausschlusskriterium für Major Depression und die Aufnahme von Agoraphobie als eigenständige Diagnose. Als neue Störungskategorien wurden beispielsweise die «Binge-Eating»-Störung, die Prämenstruelle Dysphorische Störung, die Disruptive Stimmungsdysregulationsstörung, Zwanghaftes Horten, Dermatillomanie und Koffeinentzug eingeführt. Ausgeschlossen wurden unter anderem die Störung mit Sexueller Aversion und die Undifferenzierte Somatoforme Störung. Letztlich wurden bei fast allen Störungen die Informationen zur Störungsbeschreibung aktualisiert und/oder die diagnostischen Kriterien geringfügig modifiziert. Bei der Bewertung der vorgenommenen Veränderungen muss berücksichtigt werden, dass das DSM verschiedenen, teilweise konträren Zielstellungen dient. Eine kontroverse Bewertung der Neuauflage ist daher zu erwarten. [ABSTRACT FROM AUTHOR]

Objective: No recent meta-analysis has examined the effects of cognitive-behavioural therapy (CBT) for adult depression. We decided to conduct such an updated meta-analysis. Methods: Studies were identified through systematic searches in bibliographical databases (PubMed, PsyclNFO, Embase, and the Cochrane library). We included studies examining the effects of CBT, compared with control groups, other psychotherapies, and pharmacotherapy. Results: A total of 115 studies met inclusion criteria. The mean effect size (ES) of 94 comparisons from 75 studies of CBT and control groups was Hedges g = 0.71 (95% CI 0.62 to 0.79), which corresponds with a number needed to treat of 2.6. However, this may be an overestimation of the true ES as we found strong indications for publication bias (ES after adjustment for bias was g = 0.53), and because the ES of higher-quality studies was significantly lower (g = 0.53) than for lower-quality studies (g = 0.90). The difference between high- and low-quality studies remained significant after adjustment for other study characteristics in a multivariate meta-regression analysis. We did not find any indication that CBT was more or less effective than other psychotherapies or pharmacotherapy. Combined treatment was significantly more effective than pharmacotherapy alone (g = 0.49). Conclusions: There is no doubt that CBT is an effective treatment for adult depression, although the effects may have been overestimated until now. CBT is also the most studied psychotherapy for depression, and thus has the greatest weight of evidence. However, other treatments approach its overall efficacy. [ABSTRACT FROM AUTHOR]

Background: Deficits in emotion regulation skills are possible factors maintaining major depressive disorder (MDD). Therefore, the aim of the study was to test whether integrating a systematic emotion regulation training (ERT) enhances the efficacy of routine inpatient cognitive behavioral therapy (CBT) for MDD. Methods: In a prospective randomized controlled trial, 432 inpatients meeting criteria for MDD were assigned to receive either routine CBT or CBT enriched with an intense emotion regulation skills training (CBT-ERT). Results: Participants in the CBT-ERT condition demonstrated a significantly greater reduction in depression (response rates - CBT: 75.5%, CBT-ERT: 84.9%; remission rates - CBT: 51.1%, CBT-ERT: 65.1%). Moreover, CBT-ERT participants demonstrated a significantly greater reduction of negative affect, as well as a greater increase of well-being and emotion regulation skills particularly relevant for mental health. Conclusions: Integrating strategies that target emotion regulation skills improves the efficacy of CBT for MDD. Copyright © 2013 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract: Background and objectives: In order to clarify mechanisms underlying the association between emotion regulation and psychopathology, we tested whether the ability to modify negative emotions mediates the associations of other emotion-regulation skills with psychopathological symptoms in two studies. Methods: The first study included 151 college students; the second included 121 psychiatric inpatients. Bootstrapping-enhanced mediation analyses were utilized to assess associations between self-reports of emotion-regulation skills and psychopathology, as well as potential mediation effects. Results: In both samples, the ability to modify emotions completely mediated the association between symptoms and skills for most skills, but not for the skill of accepting/tolerating negative emotions. Limitations: Major limitations include the use of a cross-sectional design as well as exclusive use of self-report data. Conclusions: The ability to modify negative emotions may be the common pathway by which many emotion-regulation skills exert their influence on mental health; however, the skill of accepting/tolerating negative emotions may be beneficial to mental health regardless of whether or not it facilitates modification of emotions. [Copyright &y& Elsevier]

Objective: As emotion regulation is widely considered to be a primary motive in the misuse of alcohol, our aim in the study was to investigate whether deficits in adaptive emotion-regulation skills maintain alcohol dependence (AD). Method: A prospective study investigated whether emotion-regulation skills were associated with AD and whether these skills predicted alcohol use during and after treatment for AD. Participants were 116 individuals treated for AD with cognitive-behavioral therapy. Emotion regulation and severity of AD symptoms were assessed by self-report. Alcohol use during treatment was assessed by Breathalyzer and urine analysis for ethyl glucuronide; alcohol use during the 3-month follow-up interval was assessed by self-report. Results: Pretreatment emotion-regulation skills predicted alcohol use during treatment, and posttreatment emotion-regulation skills predicted alcohol use at follow-up, even when controlling for other predictors potentially related to emotion regulation. Among a broad range of specific emotion-regulation skills, the ability to tolerate negative emotions was the only skill that negatively predicted subsequent alcohol consumption when controlling for the other skills. Individuals in the AD sample reported significantly larger deficits in emotion-regulation skills than did those in a nonclinical control sample but significantly less than did those in a sample of individuals exclusively meeting criteria for major depressive disorder. Conclusions: Enhancement of general emotion-regulation skills, especially the ability to tolerate negative emotions, appears to be an important target in the treatment of AD. [ABSTRACT FROM AUTHOR]

Police officers are routinely exposed to situations that elicit intense negative emotions; thus, officers have a particularly strong need for effective methods of regulating such emotions. The main purpose of this study was to investigate whether a manualized emotion-regulation training (Integrative Training of Emotional Competencies; iTEC; Berking, 2010a) can improve the emotion-regulation skills of police officers. First, self-reports of 9 emotion-regulation skills were assessed in a sample of officers (N= 31) and compared to those of a matched community-based control group. Then, the effects of the training on the emotion-regulation skills of officers were evaluated in a time-staggered design with a waitlist control condition. Results indicate that, compared to controls, officers have difficulties in accepting and tolerating negative emotions, supporting themselves in distressing situations, and confronting emotionally challenging situations. The training significantly enhanced successful skill application, especially some skills with which officers reported difficulty applying. These findings suggest that a focus on emotion-regulation skills may be an important component for programs aimed at preventing mental-health problems in police officers. [ABSTRACT FROM AUTHOR]

Abstract: Background: Reducing symptoms of depression is an important target in the treatment of borderline personality disorder (BPD). Although current treatments for BPD are effective in reducing depression, the average post-treatment level of depression remains high. Aim: To test whether experiential avoidance (EA) impedes the reduction of depression during treatment for BPD. Method: EA and depression were assessed in 81 clients at baseline and 4-month intervals during 1 year of therapy. Simple correlations, hierarchical linear modeling, and latent difference score models were used to investigate the association between self-reports of EA and both self-reports and observer-based ratings of depression. Results: EA was positively associated with greater severity of depression at all points of assessment, and changes in EA were positively associated with changes in depression. Moreover, EA significantly predicted less subsequent reduction in depression whereas no such effect was found for depression on subsequent EA. Conclusion: The findings are consistent with the hypothesis that EA impedes the reduction of depression in the treatment of BPD and should thus be considered an important treatment target. [Copyright &y& Elsevier]

Abstract: Background: Deficits in emotion-regulation skills have been shown to be integral to the development and maintenance of a wide range of mental disorders. Aim: To evaluate the importance of these skills as a treatment target in psychotherapeutic interventions. Method: Nine specific emotion-regulation skills were assessed in a sample of 289 inpatients before and after cognitive-behavioural treatment. Self-reports of success in pretreatment skills application were first compared to those of 246 non-clinical controls. Pretreatment skills application and change in skills application during therapy were then related to a variety of outcome measures. Finally, the effects of integrating a brief training of general emotion-regulation skills into the CBT-based treatment were evaluated in a controlled trial. Results: Uni- and multivariate analyses identified the skills of acceptance, tolerance, and active modification of negative emotions as particularly important for current mental health and treatment outcome. Replacing parts of the standard CBT treatment with the emotion-regulation training enhanced the effects of the CBT treatment on skills application and on other measures of mental health. Conclusion: Incorporating interventions that directly target general emotion-regulation skills may improve the effectiveness of psychotherapeutic interventions. [Copyright &y& Elsevier]

Deficits in emotion-regulation skills have widely been shown to be associated with poor emotional adjustment. However, it is still unclear whether these deficits are a cause or a consequence of poor adjustment. The purpose of the present research was to clarify the reciprocal effects between these 2 concepts. In 2 studies (Ns = 446 and 635), self-reports of emotion regulation and emotional adjustment were assessed twice with a 2-week interval. Cross-lagged regression analyses demonstrated that self- reports of emotion regulation predicted subsequent adjustment, over and above the effects of previous adjustment, whereas emotional adjustment did not predict subsequent emotion regulation. Thus, a focus on emotion-regulation skills may be important in the prevention and treatment of affect-related mental health problems. [ABSTRACT FROM AUTHOR]

Abstract: Forgiveness is often assumed to be adaptive for psychological adjustment following interpersonal transgressions. Three hundred and forty seven individuals who had experienced a recent interpersonal transgression were surveyed on four occasions over the course of six weeks. Forgiveness was assessed with scales measuring interpersonal avoidance and revenge motivation and psychological adjustment was assessed with scales measuring depression and rumination. Latent growth curve analyses showed that intraindividual changes in forgiveness were positively correlated with changes in adjustment. Latent difference score analyses indicated that adjustment predicted subsequent change in forgiveness, but that forgiveness did not predict subsequent change in adjustment. The results suggest that adjustment facilitates forgiveness, but not that forgiveness facilitates adjustment. [Copyright &y& Elsevier]

Treatment goals are either proposed by a patient or deduced from the case formulation of the therapist. To optimize goal-finding procedures in psychotherapy, therapists need an empirical point of reference to estimate the degree of goal attainment that can be expected for a specific treatment goal. To establish such an empirical basis, treatment goal categories of the primary treatment goals of 2,770 inpatients undergoing cognitive–behavioral therapy were categorized by the Bern Inventory of Treatment Goals. The levels of goal attainment were then compared with respect to 48 different goal categories. The results indicate that goal attainment differs according to treatment goal categories, even if confounding characteristics of the patient are controlled for. [ABSTRACT FROM AUTHOR]

According to consistency theory, incongruence between individual perceptions and goals reduces well-being and increases the risk for the development and further maintenance of psychopathological disorders. Successful psychotherapy should therefore reduce the level of incongruence and therapy outcome should be associated with the reduction of incongruence. To test these hypotheses the level of incongruence was assessed in a sample of 62 inpatients undergoing cognitive-behavioural therapy (CBT) before and after treatment using the Incongruence Questionnaire. Pre–post differences were then correlated with other outcome measures and factor analysis was used to assess the underlying dimensionality of all outcome measures. The level of congruence was reduced substantially by inpatient CBT, changes were positively related to other measures of psychotherapy outcome and incongruence loaded strongly on only one of two emerging factors. Incongruence can be seen as an independent construct. It seems advisable to assess level of incongruence at the beginning of each psychotherapy for effective planning of treatment and at the end of therapy for a comprehensive outcome measurement. The reduction of high levels of incongruence must be seen as an important higher level goal in psychotherapy. Further research has to clarify under what conditions the reduction of incongruence is especially important and what methods are most effective to do so. Copyright © 2003 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Introduction: Limited research exists on intervention efficacy for comorbid subclinical anxiety and depressive disorders, despite their common co-occurrence. Internet- and mobile-based interventions (IMIs) are promising to reach individuals facing subclinical symptoms. Objective: This study aimed to evaluate the efficacy of a transdiagnostic and self-tailored IMI in reducing subclinical anxiety and depressive symptom severity with either individualized (IG-IMI) or automated (AG-IMI) guidance compared to a waitlist control group with care-as-usual access (WLC). Methods: Participants included 566 adults with subclinical anxiety (GAD-7 ≥ 5) and/or depressive (CES-D ≥16) symptoms, who did not meet criteria for a full-syndrome depressive or anxiety disorder. In a three-arm randomized clinical trial, participants were randomized to a cognitive behavioral 7-session IMI plus booster session with IG-IMI (n = 186) or AG-IMI (n = 189) or WLC (n = 191). Primary outcomes included observer-rated anxiety (HAM-A) and depressive (QIDS) symptom severity 8 weeks after randomization assessed by blinded raters via telephone. Follow-up outcomes at 6 and 12 months are reported. Results: Symptom severity was significantly lower with small to medium effects in IG-IMI (anxiety: d = 0.45, depression: d = 0.43) and AG-IMI (anxiety: d = 0.31, depression: d = 0.32) compared to WLC. No significant differences emerged between guidance formats in primary outcomes. There was a significant effect in HAM-A after 6 months favoring AG-IMI. On average, participants completed 85.38% of IG-IMI and 77.38% of AG-IMI. Conclusions: A transdiagnostic, self-tailored IMI can reduce subclinical anxiety and depressive symptom severity, but 12-month long-term effects were absent. Automated guidance holds promise for enhancing the scalability of IMIs in broad prevention initiatives. [ABSTRACT FROM AUTHOR]

Objectives: Bouldering has shown promising results in the treatment of various health problems. In previous research, bouldering psychotherapy (BPT) was shown to be superior to a waitlist control group and to physical exercise with regard to reducing symptoms of depression. The primary aim of this study was to compare group BPT with group cognitive behavioural psychotherapy (CBT) to test the hypothesis that BPT would be equally as effective as CBT. Design: We conducted a randomized, controlled, assessor‐blinded non‐inferiority trial in which 156 outpatients meeting the criteria of a depressive episode according to the Diagnostic and Statistical Manual of Mental Disorders (DSM‐IV) were randomly assigned to one of the two intervention groups (CBT: N = 77, BPT: N = 79). Methods: Intervention groups were manualized and treated for 10 weeks with a maximum of 11 participants and two therapists. The primary outcome was depressive symptom severity assessed with the Montgomery–Åsberg Depression Rating Scale (MADRS) and the Patient Health questionnaire (PHQ‐9) at the beginning and end of the treatment phase as well as one year after the end of treatment. Result: In both groups, depressive symptoms improved significantly by an average of one severity level, moving from moderate to mild depressive symptoms after therapy (MADRS difference scores: BPT −8.06, 95% CI [−10.85, −5.27], p <.001; CBT −5.99, 95% CI [−8.55, −3.44], p <.001). The non‐inferiority of BPT in comparison with CBT was established on the basis of the lower bound of the 95% confidence interval falling above all of the predefined margins. BPT was found to be effective in both the short (d = 0.89) and long term (d = 1.15). Conclusion: Group BPT was found to be equally as effective as group CBT. Positive effects were maintained until at least 12 months after the end of therapy. Thus, BPT is a promising approach for broadening the therapeutic field of therapies for depression. Practitioner points: Physical activity is effective in the treatment of depression and current guidelines explicitly recommend it as a complementary method for the treatment of depression. Nevertheless, body‐related interventions are still underrepresented in current treatments for depression.Bouldering psychotherapy (BPT) combines physical activity with psychotherapeutic content. Its concept relies on proven effective factors from CBT such as exposure training, problem solving and practicing new functional behaviours and is thus an enrichment and implementation of CBT methods on the bouldering wall.The positive effect of group bouldering psychotherapy (BPT) in reducing depressive symptoms in outpatients with depression is not inferior to the effect of group cognitive behavioural therapy (CBT).Additionally the 10‐weeks BPT‐programme significantly improved symptoms of anxiety and interpersonal sensitivity as well as health‐related quality of life, coping, body image, self‐efficacy, and global self‐esteem. [ABSTRACT FROM AUTHOR]

Background: Blended psychotherapy (bPT) is a treatment that integrates internet- and mobile-based interventions into out-/inpatient psychotherapy. It can enrich the therapy by using online-based treatment modules as therapeutic extension that patients use time- and location-independently between face-to-face sessions. It could potentially improve the efficacy of psychotherapy and increase the number of treated persons through saved therapist time. The case report aims to facilitate the understanding of the blended treatment components. Case Report: A 4-month short-time depression treatment with six face-to-face therapy sessions, six online lessons, and app ratings of a 48-year-old female patient is presented based on the CARE guidelines and quantitative and qualitative measures (treatment documentation). Depressive symptoms were clinically significantly reduced (PHQ-9, 0–27: T0 = 17; T1 = 7) from a moderately severe to a subclinical-mild degree, and no diagnostic criteria were met in the 12-month follow-up diagnostic interview. The patient showed a maximum treatment satisfaction (ZUF-8, 8–32: T1 = 32) and adherence and rated the therapeutic working alliance (WAI, 12–60: T1 = 57) highly positive. Conclusion: bPT reduced depressive symptoms for this patient. Strengths of the treatment were the facilitated use of the internet-based elements with a full-time job and the individualization within the face-to-face sessions through the therapist. Treatment success was limited by the predetermined six sessions, which hindered addressing all topics and conducting relapse prevention. [ABSTRACT FROM AUTHOR]

New developments in machine learning-based analysis of speech can be hypothesized to facilitate the long-term monitoring of major depressive disorder (MDD) during and after treatment. To test this hypothesis, we collected 550 speech samples from telephone-based clinical interviews with 267 individuals in routine care. With this data, we trained and evaluated a machine learning system to identify the absence/presence of a MDD diagnosis (as assessed with the Structured Clinical Interview for DSM-IV) from paralinguistic speech characteristics. Our system classified diagnostic status of MDD with an accuracy of 66% (sensitivity: 70%, specificity: 62%). Permutation tests indicated that the machine learning system classified MDD significantly better than chance. However, deriving diagnoses from cut-off scores of common depression scales was superior to the machine learning system with an accuracy of 73% for the Hamilton Rating Scale for Depression (HRSD), 74% for the Quick Inventory of Depressive Symptomatology–Clinician version (QIDS-C), and 73% for the depression module of the Patient Health Questionnaire (PHQ-9). Moreover, training a machine learning system that incorporated both speech analysis and depression scales resulted in accuracies between 73 and 76%. Thus, while findings of the present study demonstrate that automated speech analysis shows the potential of identifying patterns of depressed speech, it does not substantially improve the validity of classifications from common depression scales. In conclusion, speech analysis may not yet be able to replace common depression scales in clinical practice, since it cannot yet provide the necessary accuracy in depression detection. This trial is registered with DRKS00023670. [ABSTRACT FROM AUTHOR]

Perceived stress, a global health problem associated with various mental disorders, is assumed to be influenced by dysfunctional beliefs. It can be hypothesized that these beliefs can be modified with the help of approach‐avoidance modification trainings (AAMTs). In the present study (conducted 2020–2022), we aimed to clarify whether the efficacy of AAMTs can be enhanced by utilizing the expression of emotions to move AAMT stimuli. For this purpose, we tested the feasibility and acceptability of a new AAMT paradigm in which the expression of disgust is used to move stress‐increasing beliefs away from oneself and the expression of positive emotions is used to move stress‐reducing beliefs towards oneself (AAMT‐DP). Additionally, we explored the therapeutic potential of the AAMT‐DP intervention by comparing it to an inactive control condition and to a conventional AAMT in which stimuli are moved by swipe movements (n = 10 in each condition). The primary outcome was perceived stress 1 week after the training as assessed with the Perceived Stress Scale. Findings indicate sufficient feasibility and acceptability of the intervention and that the decrease in perceived stress in the AAMT‐DP condition was greater than in the inactive control condition (g = 0.72 [0.10, 1.72]) and than in the swipe control condition (g = 0.64 [0.01, 1.41]). In sum, findings provide preliminary evidence for the feasibility, acceptability, and the therapeutic potential of the AAMT‐DP intervention. [ABSTRACT FROM AUTHOR]

Background: Emotion regulation (ER) is associated with posttraumatic stress symptoms (PTSS). However, most findings are from cross-sectional studies and are hence unable to clarify whether deficits in ER longitudinally contribute to the worsening and maintenance of PTSS. In addition, no studies consider the process of how ER affects PTSS. To further clarify causal pathways, we tested prospective associations between ER and subsequent PTSS by gender in individuals who had experienced traumatic events.Methods: We used data from an online survey of 1,794 Japanese participants aged 18-83 years who had experienced at least one traumatic event. They completed the Emotion Regulation Skills Questionnaire at baseline, as well as the PTSD Checklist for DSM-5 at baseline and four months later.Results: Multi-group structural equation modeling by gender revealed that participants' ER predicted their PTSS four months later, even after controlling for symptoms at baseline. The findings indicate that identifying undesired emotions and then dealing with them decreases subsequent PTSS. ER had a greater effect on later PTSS in males than in females.Limitations: The use of an online survey and the exclusive use of self-report instruments might limit the generalizability of our results and the validity of the assessment.Conclusions: Deficits in ER likely contribute to worsening and maintenance of PTSS. The process of identifying and subsequently dealing with emotions may be important for the clinical suppression of PTSS. [ABSTRACT FROM AUTHOR]

Hintergrund: Blended Psychotherapy (bPT) ist ein Behandlungskonzept zur Integration von Internet-/Mobil-basierten Interventionen in die ambulante/stationäre Psychotherapie. Es kann den Therapieprozess bereichern, indem Online-basierte Behandlungselemente als verlängerter therapeutischer Arm genutzt und zwischen den Therapiesitzungen von PatientInnen zeit- und ortsunabhängig bearbeitet werden. Dadurch könnten die Effektivität von Psychotherapie potenziell verbessert oder mehr Therapieplätze durch die eingesparte Therapeutenzeit angeboten werden. Der Fallbericht soll ein Verständnis der Verzahnung der Behandlungselemente ermöglichen. Fallbericht: Die viermonatige Kurzzeit-Depressionsbehandlung einer 48-jährigen Patientin mit sechs Face-to-Face-Therapiesitzungen, sechs Online-Lektionen und App-Ratings wird nach den CARE-Richtlinien und auf Basis quantitativer und qualitativer Daten (Behandlungsdokumentation) dargestellt. Die depressive Sympto-matik reduzierte sich im Behandlungsverlauf klinisch signifikant (Patient Health Questionnaire [PHQ-9], 0–27: T0 = 17; T1 = 7) von einer mittel-schwergradigen zu einer subklinisch-milden Ausprägung und erfüllte im 12-Monats-Diagnostikinterview keine klinischen Diagnosekriterien. Die Patientin zeigte eine maximale Behandlungszufriedenheit (Fragebogen zur Patientenzufriedenheit [ZUF-8], 8–32: T1 = 32) sowie Adhärenz und bewertete die therapeutische Bezie-hung sehr positiv (Working Alliance Inventory [WAI], 12–60: T1 = 57). Schlussfolgerung: bPT war bei dieser Patientin ge-eignet, um depressive Symptome zu reduzieren. Stärken der Behandlung waren die gute Integrierbarkeit der Online-Behandlung in die Berufstätigkeit der Patientin und die Individualisierung in den Therapiegesprächen durch die Therapeutin. Die Vorgabe von sechs Therapiesitzungen schränkte den Behandlungserfolg insofern ein, dass nicht alle Behandlungsthemen therapeutisch bearbeitet und keine Rezidiv-prophylaxe durchgeführt werden konnten. [ABSTRACT FROM AUTHOR]

Abstract: Aims: The present study addresses potential problems with treatment transition by investigating the use of aftercare treatments by inpatients after alcohol withdrawal treatment without immediate transition to rehabilitation. Methods: We analyzed the control group of the SmartAssistEntz project. Therefor, 181 individuals were interviewed three and six weeks, as well as three and six months after their withdrawal treatment, assessing information regarding the use and evaluation of different aftercare treatments. Results: Over the course of the study, more than half of the participants reported using at least one aftercare treatment. Mostly and most continuously used were drug counseling offers (20-35 % of the participants). Rehabilitation treatments were reported by 8-14 % of the participants six weeks after withdrawal treatment, and by 27-33 % six months thereafter. The treatments were mostly considered to be "helpful", whereby self-help groups performed worst. The reason for the lack of aftercare was mostly waiting time (12-22 % of the cases). The use of rehabilitation treatment during the first three months after withdrawal treatment was associated with a reduced risk of relapse. Conclusions: Particularly drug counseling offers seem to be a low-threshold and subjectively helpful measure following inpatient withdrawal treatment. At the same time, regarding abstinence, the visit of rehabilitation treatments seems to be decisive. Thus, their use should be promoted more intensely. [ABSTRACT FROM AUTHOR]

Background: Stress levels and thus the risk of developing related physical and mental health conditions are rising worldwide. Dysfunctional beliefs contribute to the development of stress. Potentially, such beliefs can be modified with approach-avoidance modification trainings (AAMT). As previous research indicates that effects of AAMTs are small, there is a need for innovative ways of increasing the efficacy of these interventions. For this purpose, we aim to evaluate the feasibility of the intervention and study design and explore the efficacy of an innovative emotion-based AAMT version (eAAMT) that uses the display of emotions to move stress-inducing beliefs away from and draw stress-reducing beliefs towards oneself. Methods: We will conduct a parallel randomized controlled pilot study at the Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany. Individuals with elevated stress levels will be randomized to one of eight study conditions (n = 10 per condition) — one of six variants of the eAAMT, an active control intervention (swipe-based AAMT), or an inactive control condition. Participants in the intervention groups will engage in four sessions of 20–30 min (e)AAMT training on consecutive days. Participants in the inactive control condition will complete the assessments via an online tool. Non-blinded assessments will be taken directly before and after the training and 1 week after training completion. The primary outcome will be perceived stress. Secondary outcomes will be dysfunctional beliefs, symptoms of depression, emotion regulation skills, and physiological stress measures. We will compute effect sizes and conduct mixed ANOVAs to explore differences in change in outcomes between the eAAMT and control conditions. Discussion: The study will provide valuable information to improve the intervention and study design. Moreover, if shown to be effective, the approach can be used as an automated smartphone-based intervention. Future research needs to identify target groups benefitting from this intervention utilized either as stand-alone treatment or an add-on intervention that is combined with other evidence-based treatments. Trial registration: The trial has been registered in the German Clinical Trials Register (Deutsches Register Klinischer Studien; DRKS00023007; September 7, 2020). [ABSTRACT FROM AUTHOR]

Introduction. Pregnancy is a unique time in a woman's life that can be both exciting and challenging. It is also a period that can be associated with significant stress, anxiety, and depression, which can have negative consequences for both the mother and the baby. Mindfulness interventions are known to be a well-suited treatment and prevention method for psychiatric symptoms in pregnancy, and web-based applications have been explored. We here present an up-to-date systematic review and meta-analysis of randomized–controlled trials to investigate the effect of digital-based mindfulness interventions on depressive, anxiety, and stress symptoms during pregnancy. Methods. The systematic literature search and data extraction was performed by two independent raters. It resulted in 13 eligible studies overall comprising 1373 participants. We conducted random-effects meta-analyses for depressive, anxiety, and stress symptoms after completion of a digital mindfulness intervention (compared to a control group). Results. Digital mindfulness intervention methods were significantly able to reduce depression (g = −0.47, 95% CI [−0.9; −0.09]) and anxiety symptoms (g = −0.41, 95% CI [−0.77; −0.05]), but not stress symptoms. These effects were moderated by the attrition rate (βDepression = 0.025, pDepression < 0.01; βAnxiety = 0.022, pAnxiety < 0.01; βStress = 0.022, pStress < 0.01). Primiparity also had a significant influence on the intervention effect regarding depression symptoms (β = 0.033, p = 0.024). Conclusions. Digital mindfulness interventions are a promising method to reduce mental health symptoms in pregnant women. We identified certain parameters moderating this effect, for example, primiparity and the attrition rate. [ABSTRACT FROM AUTHOR]

Background and aims: Internet Use Disorders (IUDs) are emerging as a societal challenge. Evidencebased treatment options are scarce. Digital health interventions may be promising to deliver psychological treatment to individuals with IUDs directly in their online setting. The aim of this study was to evaluate the efficacy of a digital health intervention for IUDs compared to a waitlist control group (WCG). Methods: In a two-armed randomized controlled trial, N 5 130 individuals showing IUDs (Internet Addiction Test; IAT =49) were randomly allocated to the intervention group (IG; n 5 65) or WCG (n 5 65). The intervention consisted of 7 sessions based on cognitive behavioral therapy. The primary outcome was IUD symptom severity measured via the IAT at post treatment 7 weeks after randomization. Secondary outcomes included IUD symptoms (Compulsive Internet Use Scale; CIUS), quality of life, depressive and anxiety symptoms, and other psychosocial variables associated with IUDs. Results: Participants were on average 28.45 years old (SD 5 10.59) and 50% identified as women, 49% as men, and 1% as non-binary. The IG (n 5 65) showed significantly less IUD symptom severity (IAT) (d 5 0.54, 95% CI 0.19-0.89) and symptoms (d 5 0.57, 95% CI 0.22-0.92) than the WCG (n 5 65) at post-treatment. Study attrition was 20%. Effects on all other secondary outcomes were not significant. On average, participants completed 67.5% of the intervention. Discussion and Conclusions: A digital health intervention could be a promising first step to reduce IUD symptom severity. [ABSTRACT FROM AUTHOR]

Emotion regulation has become an important topic in mental health and psychotherapy research. Skills supposingly relevant for adaptive responses towards emotions include the abilities to be consciously aware of emotions, identify and correctly label emotions, understand what has caused and maintains one’s present emotions, modify the intensity or duration of one's emotions, accept and tolerate undesired emotions, confront situations likely to cue negative emotions, and provide effective self-support when working to cope with challenging emotions. To economically assess these abilities, a self-report measure has been developed in German and validated in various studies. To facilitate the use of the measure in English speaking countries, we have developed and validated an English version of the Emotion Regulation Skills Questionnaire (ERSQ) in a student sample (n = 263) and a sample of individual clinical sample (n = 35). Findings from this study provide significant evidence for the reliability and validity of the ERSQ. Thus, the measure can be used to assess a broad range of important emotion regulation skills in an economic way. [ABSTRACT FROM AUTHOR]

Background: Mental disorders (MDs) are one of the leading causes for workforce sickness absence and disability worldwide. The burden, costs and challenges are enormous for the individuals concerned, employers and society at large. Although most MDs are characterised by a high risk of relapse after treatment or by chronic courses, interventions that link medical-psychotherapeutic approaches with work-directed components to facilitate a sustainable return to work (RTW) are rare. This protocol describes the design of a study to evaluate the (cost-)effectiveness and implementation process of a multimodal, clinical and work-directed intervention, called RTW-PIA, aimed at employees with MDs to achieve sustainable RTW in Germany. Methods: The study consists of an effectiveness, a health-economic and a process evaluation, designed as a two-armed, multicentre, randomised controlled trial, conducted in German psychiatric outpatient clinics. Sick-listed employees with MDs will receive either the 18-month RTW-PIA treatment in conjunction with care as usual, or care as usual only. RTW-PIA consists of a face-to-face individual RTW support, RTW aftercare group meetings, and web-based aftercare. Assessments will be conducted at baseline and 6, 12, 18 and 24 months after completion of baseline survey. The primary outcome is the employees´ achievement of sustainable RTW, defined as reporting less than six weeks of working days missed out due to sickness absence within 12 months after first RTW. Secondary outcomes include health-related quality of life, mental functioning, RTW self-efficacy, overall job satisfaction, severity of mental illness and work ability. The health-economic evaluation will be conducted from a societal and public health care perspective, as well as from the employer's perspective in a cost–benefit analysis. The design will be supplemented by a qualitative effect evaluation using pre- and post-interviews, and a multimethod process evaluation examining various predefined key process indicators from different stakeholder perspectives. Discussion: By applying a comprehensive, multimethodological evaluation design, this study captures various facets of RTW-PIA. In case of promising results for sustainable RTW, RTW-PIA may be integrated into standard care within German psychiatric outpatient clinics. Trial registration: The study was prospectively registered with the German Clinical Trials Register (DRKS00026232, 1 September 2021). [ABSTRACT FROM AUTHOR]

Background: Self-compassion has recently been discussed as an effective affect regulation strategy for reducing negative affective states. The primary aim of the current study was to compare the efficacy of self-compassion to the more established strategies of acceptance and reappraisal.Methods: For this purpose, we induced depressed mood in formerly, currently and never depressed individuals (n=30 each) at four different time-points. Participants were instructed to regulate their emotions after each mood induction by either waiting, employing self-compassion, accepting their emotions or reappraising the situation. Level of depressed mood was assessed before and after each mood induction and regulation phase.Results: Across groups, decreases in depressed mood were greater in the self-compassion compared to the waiting and acceptance conditions. In recovered and never depressed participants, self-compassion was also more effective than reappraisal.Limitations: Our results rely solely on self-report data.Conclusions: Our finding that self-compassion is superior to acceptance and equally or more effective than reappraisal encourages future research on how self-compassion interventions can be used to enhance the efficacy and stability of current depression treatments. [ABSTRACT FROM AUTHOR]

Introduction Although cognitive behavior therapy (CBT) is the best evidenced psychological treatment for medically unexplained symptoms (MUS), effect sizes are rather moderate. Empirically evidenced deficits in emotion processing in patients with MUS make a CBT enriched with an emotion regulation training (ENCERT) a promising approach to increase treatment effects. Methods and design This protocol describes the development and implementation of a multicenter, randomized, active-controlled study with blinded outcome assessors to compare the efficacy of ENCERT with a conventional CBT for MUS. Individuals presenting with ≥ 3 disabling, chronic MUS and fulfilling other predefined inclusion criteria are randomized to 20 sessions either of ENCERT or conventional CBT. Power calculations are based on the severity index of the Screening of Somatoform Disorders-7T and obtained an optimal sample size of N = 244. Questionnaires on symptom severity, symptom-related psychological features, and emotion regulation skills are administered at baseline, end of therapy, and 6-months follow-up. An every-session monitoring of therapy progress, and regular patients'/therapists' ratings of quality of therapy, working alliance, outcome expectations, and adverse events are conducted. Primary statistical analysis shall verify the hypothesis of ENCERT being more efficacious than conventional CBT regarding symptom severity. Discussion Enriching CBT with transdiagnostic therapeutic strategies addressing emotion regulation is a promising and new approach to target not only somatic symptom coping but also symptom-associated problems and comorbid mental disorders. The current trial will not only allow examining the efficacy of ENCERT but also important variables and mechanisms of the process of therapy. Trial registration: NCT01908855 [ABSTRACT FROM AUTHOR]

Whereas self-criticism has been proposed as an important risk factor for major depressive disorder (MDD), self-compassion has been suggested as a resilience factor that protects against the development and maintenance of depressive episodes. This study aimed to test the hypothesis that frequent self-criticism and low habitual self-compassion are related to concurrent depression and to vulnerability to depression by comparing groups of currently, remitted and never depressed individuals. As expected, both currently and remitted depressed individuals reported higher levels of self-criticism and lower self-compassion than never depressed controls. Individual differences in self-criticism and self-compassion were related to depression status above and beyond additional potential correlates of MDD (i.e., perfectionistic beliefs and cognitions, rumination and overall adaptive emotion regulation). The findings provide support for the idea that increased self-criticism and decreased self-compassion place certain individuals at increased risk for experiencing depression repeatedly or chronically over the course of their lives. [ABSTRACT FROM AUTHOR]

Background: Problematic alcohol consumption is associated with a high disease burden for affected individuals and has a detrimental impact on companies and society due to direct and indirect health costs. This protocol describes a study design to evaluate the (cost)-effectiveness of a guided and unguided Internet-based self-help intervention for employees called "GET.ON Clever weniger trinken" (be smart - drink less) compared to a waiting list control group.Methods: In a three-arm randomized controlled trial, 528 German adults who are currently members of the workforce will be recruited by occupational health departments of major health insurance companies. Employees aged 18 and older displaying problematic drinking patterns (>21/14 drinks per week and an AUDIT score > 8/6 for men/women) will be randomly assigned to one of three following study conditions: 1. unguided web-based self-help for problematic drinking, 2. adherence-focused guided self-help, and 3. waiting list control. Self-report data will be collected at baseline (T1), 6 weeks (T2), and 6 months (T3) after randomization. The primary outcome will be the reduction of alcohol standard units during the 7 days prior to T2, using the Timeline Followback method. Cost-effectiveness analyses to determine direct and indirect costs will be conducted from the perspectives of employers and the society. Data will be analyzed on an intention-to-treat basis and per protocol.Discussion: There is a need to identify effective low-threshold solutions to improve ill-health and reduce the negative economic consequences due to problematic alcohol drinking in workforces. If the proposed web-based intervention proves both to be efficacious and cost-effective, it may be a useful tool to increase utilization rates of interventions for problematic drinking in occupational settings.Trial Registration: German Register of Clinical Studies (DRKS): DRKS00006105 , date of registration: 2014-07-07. [ABSTRACT FROM AUTHOR]

Background: Depression and comorbid chronic back pain (CBP) lead to high personal and economic burden. Internet- and mobile-based interventions (IMI) might be a cost-effective adjunct to established interventions.Methods: A health economic evaluation was embedded into an observer-blinded, multicenter RCT (societal and health care perspective). We randomly assigned participants (≥18 years) with CBP and diagnosed depression from 82 orthopedic clinics across Germany to intervention (IG + treatment as usual [TAU]) or TAU control group (CG). The IG received a guided IMI. Primary outcomes were depression response and quality-adjusted life years (QALYs) at 6-months follow-up. Multiple imputation was used to address missing data. Incremental cost-effectiveness/cost-utility ratios (ICER/ICUR) and the probability of being cost-effective at different willingness-to-pay thresholds were calculated. Statistical uncertainty was estimated using bootstrapping techniques (N = 10,000).Results: Between October 2015 and July 2017 210 participants were randomly assigned to IG (n = 105) and CG (n = 105). Depression response did not differ significantly between groups. QALYs were significantly higher in the IG compared to the CG. Taking the societal perspective and assuming a commonly used willingness-to-pay of €34,000/QALY, the intervention's likelihood of being cost-effective was 64%.Limitations: The main limitation is that the study was powered to detect clinical but not health economic differences between groups.Conclusion: The IMI is considered cost-effective (vs. CG) for individuals with depression and CBP (societal perspective). These results are promising when considering the high individual and economic burden of this patient group. Further research is needed to adequately inform political decision makers before implementation into routine care. [ABSTRACT FROM AUTHOR]

Objectives: Impulsivity is related to a higher risk of relapse in alcohol use disorders. However, besides drinking behavior, other recovery outcomes like physical and mental health‐related quality of life are at least as important. The present study aimed to fill a research gap regarding the association of different impulsivity facets with health‐related quality of life and well‐being in alcohol use disorder. Methods: Individuals with a primary alcohol use disorder diagnosis (n = 167) were interviewed with standardized self‐report measures at the progressed stage of their withdrawal treatment and 6 weeks thereafter. Multiple regression models were calculated to examine the association of impulsivity, craving, and drinking patterns with health‐related quality of life and well‐being 6 weeks after withdrawal treatment, as well as the predictive role of impulsivity assessed during withdrawal for these two outcomes. Results: Craving was associated with health‐related quality of life and well‐being 6 weeks after withdrawal. Likewise, non‐planning and attentional impulsivity were associated with well‐being 6 weeks after withdrawal. Motor impulsivity during withdrawal treatment predicted health‐related quality of life 6 weeks thereafter. Conclusion: Impulsivity seems to be negatively related to health‐related quality of life and well‐being in the first weeks after alcohol withdrawal treatment, probably to a higher extent than drinking patterns, but differentiating between its facets seems to be important. These findings emphasize the importance of treatment approaches aiming at reduced impulsivity in the early recovery process. [ABSTRACT FROM AUTHOR]

Affective reactions to health-related information play a central role in health anxiety. Therefore, using ambulatory assessment, we analysed the time course of negative affect in a control group (CG,n= 60) which only rated their negative affect and an experimental group (EG,n= 97) which also rated the presence of somatic symptoms (e.g., back pain). By means of mixed regression models, we observed a decline of negative affect following the symptom self-ratings in the EG and a stable affect in the CG. The decline of negative affect was not moderated by the degree of health anxiety. Our findings might indicate that evaluating one's health status leads to a general reduction of negative affect in healthy individuals. The results of the study are in line with a bidirectional symptom perception model and underline the crucial role of affect regulation in the processing of health-related information. [ABSTRACT FROM PUBLISHER]

There is evidence that craving mediates the relationship between Impulsive Personality Traits (IPTs) and relapse during the treatment of an Alcohol Use Disorder (AUD). To provide tailored interventions, a deeper understanding of the relation between IPTs and craving, namely mediating processes, is important. Based on previous literature, we proposed that lower emotion regulation competencies mediate the relation between attentional as well as non-planning IPTs and craving. To investigate these interrelations, we used data from the baseline assessment (n = 320) of the SmartAssistEntz project (pre-registered in the German Clinical Trials Register [DRKS00017700]). Inpatients with a primary AUD diagnosis were interviewed using standardized self-report measures (IPTs: BIS-15, emotion regulation competencies: ERSQ, craving: OCDS-G short version) during their withdrawal treatment. Indirect effects were calculated using the SPSS macro PROCESS v3.5. Attentional as well as non-planning, but not motor, IPTs were associated with craving. Emotion regulation competencies mediated the relationship between attentional as well as non-planning IPTs and craving. Given their mediating role in the present study, it is interesting to investigate if addressing emotion regulation competencies can mitigate the negative influences of attentional and non-planning IPTs. The direct effect of attentional IPTs implicates alternate mediating processes, which should also be investigated in future research. [ABSTRACT FROM AUTHOR]

Aims: To perform an economic evaluation of guided and unguided internet-based interventions to reduce problematic alcohol consumption in employees compared with a waiting-list control condition (WLC) with unrestricted access to treatment-as-usual. Design: A cost-effectiveness analysis (CEA) and cost-utility analysis (CUA) from a societal and a cost-benefit analysis from the employer's perspective with a 6-month time horizon. Setting: Open recruitment in the German working population. Participants: Employees (178 males, 256 females, mean age 47 years) consuming at least 14 (women) or 21 (men) standard units of alcohol (SUAs) per week and scoring = 8 (men) or 6 (women) on the Alcohol Use Disorders Identification Test. Measurements: On-line questionnaires administered to assess SUAs and assess quality of life (AQoL-8D) and resource use. Outcome measure was responder (= 14/= 21 SUAs) for the CEA and quality-adjusted life years (QALYs) for the CUA. Net benefit regression was used to estimate cost-effectiveness for each study arm. Bootstrapping and sensitivity analyses were performed to account for uncertainty. Interventions: Five weekly modules including personalized normative feedback, motivational interviewing, goal setting, problem-solving and emotion regulation, provided with adherence-focused guidance [n = 142; responders: n = 73 (51.4%); QALYs = 0.364, standard error (SE) = 0.006] or without guidance [n = 146; n = 66 (45.2%); 0.359, 0.007]. Controls were on a waiting-list [n = 144; n = 38 (26.4%); 0.342, 0.007]. Findings: From a societal perspective, the guided intervention had a probability of 55% (54%) of being the most efficient strategy at a willingness-to-pay (WTP) of €0 per responder (QALY) gained, compared with the unguided intervention and the control condition. At a WTP of €20 000 per QALY gained, the probability was 78%. From an employer's perspective, the guided intervention had a higher probability of a positive return on investment (81%) compared with the unguided intervention (58%). Conclusion: A guided internet-based intervention to reduce problematic alcohol consumption in employees appears to be both cost-beneficial and cost-effective. [ABSTRACT FROM AUTHOR]

Background: To examine whether a simple Visual Analogue Mood Scale (VAMS) is able to predict time to relapse over 5.5-years. Methodology/Principal Findings: 187 remitted recurrently depressed out-patients were interviewed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and the 17-item Hamilton Depression rating scale (HAM-D) to verify remission status (HAM-D <10). All patients rated their current mood with the help of a Visual Analogue Mood Scale (VAMS) at baseline and at a follow-up assessment three months later. Relapse over 5.5-years was assessed by the SCID-I. Cox regression revealed that both the VAMS at baseline and three months later significantly predicted time to relapse over 5.5-years. Baseline VAMS even predicted time to relapse when the number of previous depressive episodes and HAM-D scores were controlled for. The baseline VAMS explained 6.3% of variance in time to relapse, comparable to the HAM-D interview. Conclusions/Significance: Sad mood after remission appears to play a pivotal role in the course of depression. Since a simple VAMS predicted time to relapse, the VAMS might be an easy and time-effective way to monitor mood and risk of early relapse, and offers possibilities for daily monitoring using e-mail and SMS. Trial Registration: International Standard Randomized Controlled Trial Register Identifier: ISRCTN68246470. [ABSTRACT FROM AUTHOR]

Strong cravings for unhealthy foods and implicit tendencies to approach them threaten the physical and mental health of vulnerable populations. Yet, implicit measures of food approach tendencies have methodological limitations, as existing approach-avoidance tasks (AAT) are often unreliable and require specialized hardware. We propose a novel method to measure approach biases: on a touchscreen, participants slide their hand either toward a food item (and away from control images) or away from it (and toward control images) in separate blocks. Adequate attention to the stimuli is ensured by the coupling of stimulus category to the required response. We found that this touchscreen-variant of the AAT yielded reliable bias scores when approach and avoidance were defined as movements relative to the stimulus rather than to the body. Compared to control images, we found an approach bias for low-calorie foods but not for high-calorie foods. This bias additionally varied on a food-by-food basis depending on the participant's desire to eat individual food items. Correlations with state and trait cravings were inconclusive. Future research needs to address the order effects that were found, in which participants avoiding foods in the first block showed larger biases than participants approaching food in the first block, likely due to insufficient opportunity to practice the task. Our findings highlight the need for approach bias retraining paradigms to use personalized stimulus sets. The task can enrich the methodological repertoire of research on eating disorders, obesity and cognitive bias modification. [ABSTRACT FROM AUTHOR]

Summary: Sleep disturbances and insomnia are common in college students, and reduce their quality of life and academic performance. The aim of this meta‐analysis was to evaluate the efficacy of psychological interventions aimed at improving sleep in college students. A meta‐analysis was conducted with 10 randomized controlled trials with passive control conditions (N = 2,408). The overall mean effect size (Hedges' g) of all sleep‐related outcomes within each trial was moderate to large (g = 0.61; 95% confidence interval: 0.41−0.81; numbers‐needed‐to‐treat = 3). Effect sizes for global measures of sleep disturbances were g = 0.79; 95% confidence interval: 0.52−1.06; and for sleep‐onset latency g = 0.65; 95% confidence interval: 0.36−0.94. The follow‐up analyses revealed an effect size of g = 0.56; 95% confidence interval: 0.45−0.66 for the combined sleep‐related outcomes based on three studies. No significant covariates were identified. These results should be interpreted cautiously due to an overall substantial risk of bias, and in particular with regard to blinding of participants and personnel. Nevertheless, they provide evidence that psychological interventions for improving sleep are efficacious among college students. Further research should explore long‐term effects and potential moderators of treatment efficacy in college students. [ABSTRACT FROM AUTHOR]

Introduction: Persistent medically unexplained symptoms (MUS) are a major burden for health care. Cognitive behaviour therapy (CBT) is efficacious for patients with MUS, with small to medium effects. The current study investigates whether therapy outcomes of a CBT for MUS patients can be improved by complementing it with emotion regulation training.Methods: In a multicentre trial 255 patients with at least three persisting MUS were randomised to 20 sessions of either conventional CBT (n = 128) or CBT complemented with emotion regulation training (ENCERT; n = 127). Somatic symptom severity and secondary outcomes were assessed at pre-treatment, therapy session 8, end of therapy, and 6-month follow-up.Results: Linear mixed-effect models revealed medium to large effects in both study arms for almost all outcomes at the end of therapy and 6-month follow-up. ENCERT and CBT did not differ in their effect on the primary outcome (d = 0.20, 95% CI: -0.04 to 0.44). Significant time × group cross-level interactions suggested ENCERT to be of more benefit than conventional CBT for a few secondary outcomes. Moderator analyses revealed higher effects of ENCERT in patients with co-morbid mental disorders.Discussion/conclusions: Current findings are based on a representative sample. Results demonstrate that both CBT and ENCERT can achieve strong effects on primary and secondary outcomes in MUS patients. Our results do not indicate that adding a training in emotion regulation skills generally improves the effect of CBT across all patients with MUS. Large effect sizes of both treatments and potential specific benefits of ENCERT for patients with co-morbid mental disorders are discussed. [ABSTRACT FROM AUTHOR]

Retrospective and experimental data demonstrate the importance of emotion regulation (ER) in the maintenance of binge episodes in binge eating disorder (BED). The current study tested whether mood and ER prospectively influence binge episodes in individuals with BED via ecological momentary assessment (EMA). Individuals with BED (n = 79) completed two weeks of EMA. Each sampling point consisted of a series of questions pertaining to participants' mood, ER, and eating behaviour. Successful application of adaptive ER strategies predicted subsequent abstinence, while rumination predicted subsequent binge episodes. However, neither successful application of adaptive ER, nor maladaptive ER, moderated the association between negative mood and probability of binge episodes. This naturalistic study emphasizes the importance of promoting the successful application of adaptive ER skills and cessation of rumination in treatment interventions designed to decrease the occurrence of binge episodes in BED. [ABSTRACT FROM AUTHOR]