TY - THES A1 - Muschalla, Beate T1 - Workplace-related anxieties and workplace phobia : a concept of domain-specific mental disorders T1 - Arbeitsplatzbezogene Ängste und Arbeitsplatzphobie : Konzeptualisierung einer lebensbereichsspezifischen psychischen Erkrankung N2 - Background: Anxiety in the workplace is a special problem as workplaces are especially prone to provoke anxiety: There are social hierarchies, rivalries between colleagues, sanctioning through superiors, danger of accidents, failure, and worries of job security. Workplace phobia is a phobic anxiety reaction with symptoms of panic occurring when thinking of or approaching the workplace, and with clear tendency of avoidance. Objectives: What characterizes workplace-related anxieties and workplace phobia as domain-specific mental disorders in contrast to conventional anxiety disorders? Method: 230 patients from an inpatient psychosomatic rehabilitation center were interviewed with the (semi-)structured Mini-Work-Anxiety-Interview and the Mini International Neuropsychiatric Interview, concerning workplace-related anxieties and conventional mental disorders. Additionally, the patients filled in the self-rating questionnaires Job-Anxiety-Scale (JAS) and the Symptom Checklist (SCL-90-R)measuring job-related and general psychosomatic symptom load. Results: Workplace-related anxieties occurred together with conventional anxiety disorders in 35% of the patients, but also alone in others (23%). Workplace phobia could be found in 17% of the interviewed, any diagnosis of workplace-related anxiety was stated in 58%. Workplace phobic patients had significantly higher scores in job-anxiety than patients without workplace phobia. Patients with workplace phobia were significantly longer on sick leave in the past 12 months (23,5 weeks) than patients without workplace phobia (13,4 weeks). Different qualities of workplace-related anxieties lead with different frequencies to work participation disorders. Conclusion: Workplace phobia cannot be described by only assessing the general level of psychosomatic symptom load and conventional mental disorders. Workplace-related anxieties and workplace phobia have an own clinical value which is mainly defined by specific workplace-related symptom load and work-participation disorders. They require special therapeutic attention and treatment instead of a “sick leave” certification by the general health physician. Workplace phobia should be named with a proper diagnosis according to ICD-10 chapter V, F 40.8: “workplace phobia”. N2 - Hintergrund: Angst am Arbeitsplatz ist ein spezielles Phänomen, da Arbeitsplätze ihrer Natur nach angstauslösende Charakteristika aufweisen: Vorgesetzte die sanktionieren, Rangkämpfe mit Kollegen, reale Unfallgefahren, Scheitern und Leistungsversagen, Unklarheit um plötzliche Veränderungen, Arbeitsplatzunsicherheit. Arbeitsplatzphobie ist eine phobische Angstreaktion mit Panikerleben beim Gedanken an oder bei Annäherung an den Arbeitsplatz. Fragestellung: Was charakterisiert arbeitsplatzbezogene Ängste und Arbeitsplatzphobie als lebensbereichsspezifische Angsterkrankungen in Abgrenzung zu klassischen Angsterkrankungen? Methode: 230 Patienten einer stationären psychosomatischen Rehabilitation wurden im halbstrukturierten Interview (Mini-Arbeits-Angst-Interview, Mini International Neuropsychiatric Interview) hinsichtlich arbeitsplatzbezogener Ängste und klassischer psychischer Erkrankungen befragt. Selbsteinschätzungsurteile wurden hinsichtlich des Schweregrads der arbeitsbezogenen (Job-Angst-Skala, JAS) und allgemeinen psychosomatischen (Symptom-Checkliste, SCL-90-R) Symptombelastung erhoben. Ergebnisse: 58% der befragten Patienten litten an mindestens einer arbeitsplatzbezogenen Angstvariante. Arbeitsplatzbezogene Ängste kamen bei 35% der Befragten zusammen mit einer klassischen Angsterkrankung vor, bei 23% jedoch als allein stehende Angsterkrankung. 17% der Befragten erfüllten die Kriterien einer Arbeitsplatzphobie. Arbeitsplatzphobie-Patienten hatten signifikant höhere Job-Angst-Werte als Patienten ohne Arbeitsplatzphobie, und sie waren signifikant länger arbeitsunfähig in den letzten 12 Monaten (23,5 Wochen versus 13,4 Wochen). Schlussfolgerung: Arbeitsplatzbezogene Ängste und Arbeitsplatzphobie haben eine spezielle klinische Wertigkeit, die sich anhand arbeitsbezogener Partizipationsstörungen und spezifischer arbeitsbezogener Symptombelastung beschreiben lässt. Arbeitsplatzphobie erfordert besondere therapeutische Herangehensweisen anstelle von angsterhaltender da Vermeidungsverhalten fördernder „Krankschreibung“. Arbeitsplatzphobie sollte als Diagnose benannt werden entsprechend ICD-10 Kapitel V, F 40.8: “Arbeitsplatzphobie”. KW - Arbeitsplatzphobie KW - Angsterkrankung KW - Arbeitsplatz KW - Arbeitsunfähigkeit KW - Partizipationsstörung KW - workplace phobia KW - anxiety disorder KW - workplace KW - sick leave KW - participation disorder Y1 - 2008 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus-20048 ER - TY - JOUR A1 - Muschalla, Beate A1 - Heldmann, Madleen A1 - Fay, Doris T1 - The significance of job-anxiety in a working population JF - Occupational medicine N2 - Background Job-anxiety, as distinguished from trait-anxiety, is associated with long-term sickness absence. The prevalence of job-anxiety within a working population is not known. Identifying individuals who would benefit from intervention might be useful. Aims To investigate job-anxiety in employees not undergoing treatment for mental health illness, firstly by assessing the level of job-anxiety and work-related avoidance tendencies in a working sample, and secondly by testing whether job-anxiety is distinguishable from trait-anxiety. Methods Cross-sectional survey of a convenience sample obtained through personal contact distribution. Employees from different professional settings completed an anonymous questionnaire and provided information on their employment status. The State-Trait-Anxiety Inventory (STAI-T) was used to measure trait-anxiety and the Job-Anxiety-Scale (JAS) was used to assess job (state) anxiety. Results There was a 69% response rate (240 responses); 188 responses were available for analysis of whom 62% were women. There were no employees with high trait-anxiety. Ten employees (5%) reported increased job-anxiety and of these nine employees reported high 'tendencies of avoidance and workplace absence'. Avoidance was most often accompanied by the comorbid job-anxieties 'job-related social anxiety', 'fear of changes at work' and 'fears of existence', 'anticipatory' and 'conditioned' job-anxiety and 'panic symptoms'. Conclusions In this sample, self-reported job-anxiety appeared as a specific type of anxiety as opposed to trait-anxiety. In the workplace job-anxiety can present as job-avoidance and sickness absence and should be distinguished from trait-anxiety. In practice, employers and occupational health practitioners should be aware of those employees prone to sickness absence. KW - Job-anxiety KW - occupational health KW - sickness absence KW - trait-anxiety KW - workplace Y1 - 2013 U6 - https://doi.org/10.1093/occmed/kqt072 SN - 0962-7480 VL - 63 IS - 6 SP - 415 EP - 421 PB - Oxford Univ. Press CY - Oxford ER - TY - JOUR A1 - Muschalla, Beate A1 - Kessler, U. A1 - Schwantes, U. A1 - Linden, M. T1 - Rehabilitationsbedarf bei Hausarztpatienten mit psychischen Störungen JF - Die Rehabilitation : Zeitschrift für Praxis und Forschung in der Rehabilitation N2 - Hintergrund: Rehabilitationsmedizin ist nach § 2 und § 26 SGB IX die medizinische Spezialdisziplin zur Vorbeugung, Diagnostik und Behandlung chronischer Erkrankungen. Dies betrifft in besonderem Maße psychische Erkrankungen. Die Behandlung chronischer Erkrankungen erfordert in der Regel eine komplexe und multimodale Langzeitbetreuung, bei der niedergelassenen Ärzten eine zentrale Rolle zukommt. Allerdings gibt es bislang nur wenig ausgearbeitete Konzepte zu den rehabilitationsmedizinischen Aufgaben niedergelassener Ärzte und den ihnen zur Verfügung stehenden diesbezüglichen Behandlungsoptionen. Methoden: Zur Klärung der Frage, welche Rolle rehamedizinische Aspekte in der Hausarztpraxis haben, wurden im ersten Schritt 40 niedergelassene Ärzte zum geschätzten Anteil chronisch psychisch kranker Patienten in ihrer Praxis befragt. Im zweiten Schritt wurden 1 451 Patienten im Alter von 18 bis 60 Jahren mittels des WHO-5-Screenings zum psychischen Wohlbefinden, dem IMET-Fragebogen zu Teilhabestörungen, der Burvillskala zur Multimorbidität und Fragen zum psychischen Erkrankungsstatus und Arbeitsstatus untersucht. Ergebnisse:Im Durchschnitt schätzten die Hausärzte den Anteil ihrer Patienten mit psychischen Erkrankungen auf 41,9% (SD=18,2; Range 15-90%).Von den Patienten gaben 46,5% an, unter psychischen Beschwerden zu leiden. 38,3% der Patienten sagten, dass die Probleme bereits seit 6 Monaten oder länger bestehen (chronisch), und 26,9% erklärten, dass sie die Beschwerden in den letzten 6 Monaten durchgängig erlebt haben (persistierend). Insgesamt litten 29,7% der 18- bis 60-jährigen Hausarztpatienten unter chronischen psychischen Beschwerden mit zusätzlich relevanten Teilhabestörungen. Schlussfolgerungen: Patienten mit chronischen psychischen Problemen und Teilhabestörungen sind in Praxen niedergelassener Ärzte häufig anzutreffen. Niedergelassene Ärzte und insbesondere Hausärzte sind demnach zu einem wesentlichen Teil ihrer Tätigkeit als Rehabilitationsmediziner anzusehen. In ihren Händen liegt die Diagnostik, Behandlung, Koordinierung und Langzeitführung der chronisch Kranken, wie auch die sozialmedizinische Betreuung, von der Feststellung einer Arbeitsunfähigkeit bis hin zur Einleitung stationärer Rehamaßnahmen. Die Bedeutung der niedergelassenen Ärzte im Rehaprozess verdient organisatorisch wie wissenschaftlich mehr Aufmerksamkeit. KW - chronic illness KW - rehabilitation episodes KW - primary care KW - participation disorders Y1 - 2013 U6 - https://doi.org/10.1055/s-0032-1327587 SN - 0034-3536 SN - 1439-1309 VL - 52 IS - 4 SP - 252 EP - 257 PB - Thieme CY - Stuttgart ER - TY - JOUR A1 - Linden, Michael A1 - Muschalla, Beate A1 - Hansmeier, Thomas A1 - Sandner, Gabriele T1 - Reduction of sickness absence by an occupational health care management program focusing on self-efficacy and self-management JF - Work : a journal of prevention, assessment & rehabilitation N2 - BACKGROUND: The aim of occupational health care management programs (OHMP) is to improve the health status of employees, increase work ability and reduce absence time. This includes better coping abilities, work-related self-efficacy and self-management which are important abilities that should be trained within OHMPs. OBJECTIVES: To study the effectiveness of an OHMP including special interventions to enhance self-efficacy and self-management. PARTICIPANTS: Employees from the German Federal Pension Agency. METHODS: Effects of an OHMP on sickness absence was studied by comparing an intervention group (N = 159) and two control groups (N = 450). A core feature of the OHMP were group sessions with all members of working teams, focussing on self-efficacy and self management of the individual participant as well as the team as a group (focus groups). Participants in the OHMP were asked for their subjective evaluation of the focus groups. Rates of sickness absence were taken from the routine data of the employer. RESULTS: Participants of the OHMP indicated that they had learned better ways of coping and communication and that they had generated intentions to make changes in their working situation. The rate of sickness absence in the intervention group decreased from 9.26% in the year before the OHMP to 7.93% in the year after the program, while there was in the same time an increase of 7.9% and 10.7% in the two control groups. CONCLUSIONS: The data suggest that OHMP with focus on self-efficacy and self management of individuals and teams are helpful in reducing work absenteeism. KW - Focus group KW - team training KW - prevention KW - health status KW - sickness absence Y1 - 2014 U6 - https://doi.org/10.3233/WOR-131616 SN - 1051-9815 SN - 1875-9270 VL - 47 IS - 4 SP - 485 EP - 489 PB - IOS Press CY - Amsterdam ER - TY - JOUR A1 - Muschalla, Beate T1 - Capacity-oriented behavior therapy in mental disorders JF - Verhaltenstherapie N2 - Capacity-Oriented Behavior Therapy in Mental Disorders Mental disorders come along with the impairment of activities and capacities of daily live. Behavior therapy often uses capacity trainings for improving compensatory behavior, beside symptom reduction as such. This article gives an overview on how behavior therapy techniques can be used to improve compensatory behavior in different capacity domains that were conceptually derived from the International Classification of Functioning, Disability and Health (ICF) and which are often impaired in mental disorders. KW - Capacities KW - Capacity disorders KW - Mental disorders KW - ICF KW - Behavior therapy Y1 - 2014 U6 - https://doi.org/10.1159/000358737 SN - 1016-6262 SN - 1423-0402 VL - 24 IS - 1 SP - 48 EP - 55 PB - Karger CY - Basel ER - TY - JOUR A1 - Muschalla, Beate T1 - Work-related anxieties in research and practice JF - Zeitschrift für Arbeits- und Organisationspsychologie : german journal of work and organizational psychology N2 - Workplaces contain by their very nature different anxiety-provoking characteristics. When workplace-related anxieties manifest, absenteeism, long-term-sick leave, and even disability pension can be the consequences. In medical-vocational rehabilitation about 30-60 % of the patients suffer from workplace-related anxieties that are often a barrier for return to work. Even in mentally healthy employees, 5 % said that they were prone to ask for a sick leave certificate due to workplace-related anxieties. Future research should focus on workplace-related anxieties not only in rehabilitation, but more earlier, i. e. in the workplace. The concept of workplace-related anxieties offers ideas which can be useful in mental-health-oriented work analysis, employee-workplace-fit, and job design. KW - workplace KW - anxiety KW - sick leave KW - mental health-oriented work analysis Y1 - 2014 U6 - https://doi.org/10.1026/0932-4089/a000166 SN - 0932-4089 SN - 2190-6270 VL - 58 IS - 4 SP - 206 EP - 214 PB - Hogrefe CY - Göttingen ER - TY - JOUR A1 - Muschalla, Beate A1 - Linden, Michael T1 - Workplace phobia, workplace problems, and work ability among primary care patients with chronic mental disorders JF - Journal of the American Board of Family Medicine N2 - Purpose: Work-related anxieties are frequent and have a negative effect on the occupational performance of patients and absence due to sickness. Most important is workplace phobia, that is, panic when approaching or even thinking of the workplace. This study is the first to estimate the prevalence of workplace phobia among primary care patients suffering from chronic mental disorders and to describe which illness-related or workplace-specific context factors are associated with workplace phobia. Methods: A convenience sample of 288 primary care patients with chronic mental disorders (70% women) seen by 40 primary care clinicians in Germany were assessed using a standardized diagnostic interview about mental disorders and workplace problems. Workplace phobia was assessed by the Workplace Phobia Scale and a structured Diagnostic and Statical Manual of Mental Disorders-based diagnostic interview. In addition, capacity and participation restrictions, illness severity, and sick leave were assessed. Results: Workplace phobia was found in 10% of patients with chronic mental disorders, that is, approximately about 3% of all general practice patients. Patients with workplace phobia had longer durations of sick leave than patients without workplace phobia and were impaired to a higher degree in work-relevant capacities. They also had a higher degree of restrictions in participation in other areas of life. Conclusions: Workplace phobia seems to be a frequent problem in primary care. It may behoove primary care clinicians to consider workplace-related anxiety, including phobia, particularly when patients ask for a work excuse for nonspecific somatic complaints. KW - Anxiety KW - Mental Health KW - Sick Leave KW - Workplace Y1 - 2014 U6 - https://doi.org/10.3122/jabfm.2014.04.130308 SN - 1557-2625 SN - 1558-7118 VL - 27 IS - 4 SP - 486 EP - 494 PB - American Board of Family Medicine CY - Lexington ER - TY - JOUR A1 - Muschalla, Beate T1 - Different work capacity impairments in patients with different work-anxieties JF - International archives of occupational and environmental health N2 - Purpose Persons with work-anxieties are especially endangered for work capacity impairment and sick leave. Work capacity impairment is not directly due to symptoms but due to illness-related capacity disorders. Work capacity impairments can be described on different dimensions (e.g., social interaction, decision making and judgment, endurance, mobility). Understanding the type of work capacity impairment is important for reintegration interventions. This is the first study to investigate work capacity impairment in risk patients with different work-anxieties. Results Patients with different work-anxieties were impaired in different capacity dimensions: Work-related social anxiety went along with clinically relevant impairment in capacity of assertiveness (M = 2.40), anxiety of insufficiency went along with impaired capacity of endurance (M = 2.20), and work-related generalized worrying was accompanied by impairment in the capacity for decision making (M = 1.82). Specific capacity impairment dimensions were related to sick leave duration, while a global work ability prognosis was not. Conclusions The capacity approach is useful to describe work impairment more precisely and beyond symptoms. On this basis, reintegration-focusing interventions such as capacity training (e.g., social interaction training) or work adjustment (e.g., reducing exposure with interactional work tasks) can be initiated. KW - Work ability KW - Work-anxiety KW - Sick leave KW - Impairment KW - Mental disorders KW - ICF Y1 - 2016 U6 - https://doi.org/10.1007/s00420-015-1099-x SN - 0340-0131 SN - 1432-1246 VL - 89 SP - 609 EP - 619 PB - Springer CY - New York ER - TY - JOUR A1 - Muschalla, Beate A1 - Fay, Doris A1 - Seemann, Anne T1 - Asking for work adjustments or initiating behavioural changes - what study on the reactions towards colleagues with a personality disorder JF - Fundamenta informaticae N2 - People with mental disorders, especially personality disorders, often face low acceptance at work. This is particularly problematic when returning to work after sick leave, because it impedes reintegration into the former workplace. This study explores colleagues’ reactions towards a problematic worker dependent on the returning person’s reintegration strategy: The returning person undertaking changes in their behaviour is compared with the person requesting adjustments of the workplace. In an experimental study, 188 employed persons read one of four vignettes that described a return-to-work-situation of a problematic co-worker. Across all vignettes, the co-worker was depicted as having previously caused problems in the work team. In the first vignette, the co-worker did not change anything (control condition) when she returned to work; in the second, she asked for workplace adjustments; in the third vignette she initiated efforts to change her own behaviour; and the fourth vignette combined both workplace adjustments and behavioural change. Study participants were asked for their reactions towards the problematic co-worker. Vignettes that included a behavioural change evoked more positive reactions towards the co-worker than vignettes without any behavioural change. Asking for workplace adjustments alone did not yield more positive reactions compared to not initiating any change. When preparing employees with interactional problems for their return to work, it is not effective to only instruct them on their statutory entitlement for workplace adjustments. Instead, it is advisable to encourage them to proactively strive for behaviour changes. KW - Workplace KW - personality disorders KW - mental health KW - sick leave KW - acceptance KW - social distance Y1 - 2016 U6 - https://doi.org/10.1080/13548506.2015.1109671 SN - 1354-8506 SN - 1465-3966 VL - 21 SP - 856 EP - 862 PB - IOS Press CY - Abingdon ER - TY - JOUR A1 - Flöge, B. A1 - Fay, Doris A1 - Jöbges, M. A1 - Linden, M. A1 - Muschalla, Beate T1 - Side Effects of Occupational Group Therapy JF - Fortschritte der Neurologie, Psychiatrie N2 - Background: Occupational therapy is an important co-therapy in psychiatric therapy. It is a common belief that no risks are associated with occupational therapy. Negative effects caused by group therapy, especially occupational therapy, have not been in the focus of research yet. In this study we want to illustrate possible types and intensities of group side effects through occupational therapy. Patients and Methods: Patients of an inpatient rehabilitation facility filled out the Adverse Treatment Reaction Group Checklist. The checklist contains 47 items divided in six dimensions: group size, content, group participants, group outcome and global. The self-rating used a 5-point likert scale (0 = not at all; 4 = verymuch, extremely stressful) and gives information about types and intensities of the side effects. Results: 88.9 % of 45 patients reported negative effects of occupational group therapy. 28.9 % of the patients rated the side effect as at least severe. Discussion: Occupational therapy is associated with side effects as every other group therapy. Possible side effects caused by group therapy should be considered while planning and implementing occupational therapy. KW - side effects KW - occupational therapy KW - group therapy Y1 - 2016 U6 - https://doi.org/10.1055/s-0042-119026 SN - 0720-4299 SN - 1439-3522 VL - 84 SP - 729 EP - 732 PB - Thieme CY - Stuttgart ER -