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As motivation for psychological treatment at intake has been shown to predict favorable outcomes after an inpatient stay, this study aimed to further characterize the different components of psychological treatment motivation that predict favorable treatment outcomes. 294 inpatients with chronic primary pain participating in an interdisciplinary multimodal pain treatment in a tertiary psychosomatic university clinic completed a battery of psychological questionnaires at intake and discharge. Treatment motivation was assessed at intake using the scales of the FPTM-23 questionnaire, while pain intensity, pain interference, anxiety, and depression were assessed both at intake and discharge. After treatment, pain intensity, pain interference, anxiety, and depression were significantly reduced. While higher levels on the FPTM-23 scale of suffering predicted smaller decreases in anxiety after treatment, higher scores on the scale of hope, i.e., lower levels of hopelessness, predicted lower levels of pain interference, anxiety, and depression after treatment. None of the scales of treatment motivation predicted pain intensity levels after treatment. Above and beyond providing symptom relief, reducing hopelessness and fostering hope regarding the treatment process and outcome might help clinicians treat patients with chronic primary pain more effectively.

Long-term consequences of aversive childhood experiences: effects on the incidence of psychiatric illnesses Abstract. Early childhood stress experiences through physical, psychological and sexual abuse as well as emotional or physical neglect often lead to permanent changes in the psychological well-being. Clinically, this is shown among other things in an increased incidence of various psychiatric disorders. This narrative survey aims to summarize the current status of existing studies on early childhood stress experiences and related psychiatric consequences. Scientific publications from the online libraries PubMed, PsycINFO and GoogleScholar served as the database. The search was conducted under the keywords Adversive Childhood Events (ACE), Adverse Childhood, Childhood Trauma, Psychiatric Disorders, Health Consequences as well as their German translations. The search resulted in 46 studies to be considered.

Aversive childhood stress and its implications für expert reports using the example of chronic pain Abstract. Insurance-medical questions regarding the consequences of severe aversive childhood stress arise in the context of psychiatric and psychosomatic expert reports. In psychiatric expert reports, the insurance-medical weighting of disorders of thinking, feeling and behaviour is in the foreground. In psychosomatic expert reports the assessment of limited performance with regard to functional body symptoms are considered to be most important. The majority of expert reports in the psychosomatic field concern people with chronic pain disorders. Pain disorders can develop insidiously over the years or be triggered by accidents. For expert reports of chronic pain conditions, guidelines have been developed by the corresponding specialist bodies in Switzerland. These have been available in German and French since 2019 (www.sappm.ch). The following overview focuses on expert reports of chronic pain disorders and is based on the Swiss guidelines mentioned above. The demanding nature of writing such expert reports is also recognized by specialists in other European countries.

Statt sich an Therapieschulen auszurichten, sollte auch bei der Behandlung chronischer Schmerzen schon in der Aus- und Weiterbildung von Psychotherapeut*innen eine auf allgemeinen Veränderungsmechanismen basierende Weiterbildung treten. Geeignete Vorschläge für mögliche störungsübergreifende Veränderungsmechanismen der kognitiv-verhaltenstherapeutisch ausgerichteten Psychotherapie finden sich bei Hayes und Hofmann (2018). Vorschläge für Veränderungsmechanismen und Interventionen in der Schmerzpsychotherapie jenseits des KVT-Ursprungs machen Lumley und Schubiner (2019). Die Liste der Veränderungsmechanismen und dazugehöriger Interventionen sollte nach aktuellem Wissensstand ständig erweitert werden. Schmerzpsychotherapie nach heutigen Standards ist letztlich Teil einer interdisziplinären multimodalen Schmerztherapie (IMST), die gemäß dem biopsychosozialen Krankheitsmodell stets eine interprofessionelle Zusammenarbeit erfordert., Instead of orienting oneself towards therapy schools, psychotherapy training based on general change mechanisms should also be introduced for the treatment of chronic pain. Suggestions for possible change mechanisms of cognitive-behaviorally (CBT)-based psychotherapy can be found in Hayes and Hofmann (2018). Proposals for change mechanisms and interventions in pain psychotherapy beyond the origin of CBT have been made by Lumley and Schubiner (2019). The list of mechanisms of change and related interventions should be continuously expanded according to current knowledge. Pain psychotherapy according to today’s standards is ultimately part of an interdisciplinary multimodal pain therapy (IMST), which according to the biopsychosocial disease model always requires interprofessional cooperation.

OBJECTIVES: This study aimed to analyze the associations among depressive/anxiety and pain symptoms in patients diagnosed with chronic pain. METHODS: Four hundred and fifty-four inpatients who were consecutively admitted in a multimodal 3-weeks treatment in a tertiary psychosomatic university clinic completed 25 items from the Brief Pain Inventory and the Hospital Anxiety and Depression Scale at baseline and after treatment termination. Associations among symptoms were explored by network analyses using the graphical least absolute shrinkage and selection operator to estimate their partial correlations, while Extended Bayesian Information Criterion was used to select the best network solution for the data. We explored symptoms' centrality and expected influence within the network as well as the minimum spanning tree for the network. RESULTS: Besides expected associations within depressive/anxiety and pain symptoms, the estimated network showed several local associations between depressive and pain interference symptoms. The lacks of being cheerful and of laughing are two of the depressive symptoms that showed the greatest associations with pain interference and a strong centrality within the network. Sleep problems were both associated with anxiety/depressive symptoms and pain intensity symptoms. Although at post-treatment, most of the symptoms showed a significant decrease, the strength of the associations between the symptoms within the network were significantly higher than at baseline. DISCUSSION: The results support focusing psychosocial interventions in chronic pain treatment not only on reducing pain, anxiety and sleep symptoms but also on enhancing positive affect. Future research is needed to replicate these findings using repeated within-person measures designs.

BACKGROUND Internet-based cognitive behavioral treatment (iCBT-I) for insomnia comprising different sleep-related cognitive and behavioral interventional components has shown some promise. However, it is not known which components are necessary for a good treatment outcome. METHOD People suffering from insomnia (N = 104) without any other comorbid psychiatric disorders were randomized (2:2:1) to two guided internet-based self-help interventions for insomnia [multi-component cognitive behavioral self-help intervention (MCT); sleep restriction intervention for insomnia (SRT)], and care as usual [CAU]. In all three conditions, additional care or treatment was allowed. The primary outcome was insomnia severity measured with the insomnia severity index (ISI) at eight weeks. Furthermore, the two active conditions were compared regarding sleep efficacy from daily diary data over the eight weeks, and other measures from the daily protocols. Secondary outcomes included sleep quality, depressive symptoms, dysfunctional beliefs, and quality of life at post-treatment (eight weeks) and follow-up (six months after randomization). RESULTS Both conditions were more effective than CAU at post-treatment, with medium to large between-group effect sizes on the primary outcome (ISI; MCT: Cohen's d = -1.15; SRT: d = -0.68) and small to medium between-group effect sizes for secondary outcomes. Treatment gains were maintained at six-month follow-up. Active conditions did not differ from each other on all measures from pre to post, except for dysfunctional beliefs about sleep, and sleep protocol data throughout the intervention. Participants in MCT were significantly more satisfied with the intervention than participants in SRT. CONCLUSIONS Results of the present study indicate that CAU + MCT and CAU + SRT are both effective compared to CAU. There were no statistical differences regarding efficacy between the two active conditions, but participants in MCT reported to be more satisfied with the intervention.