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- psychotherapy (11)
- psychotherapy training (7)
- therapist competence (6)
- clinical supervision (5)
- hypochondriasis (5)
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- Psychotherapy research (4)
- Simulated patients (4)
- Standardized patients (4)
- Systematic review (4)
Objectives: The use of simulated and standardized patients (SP) is widely accepted in the medical field and, from there, is beginning to disseminate into clinical psychology and psychotherapy. The purpose of this study was therefore to systematically review barriers and facilitators that should be considered in the implementation of SP interventions specific to clinical psychology and psychotherapy. Methods: Following current guidelines, a scoping review was conducted. The literature search focused on the MEDLINE,PsycINFO and Web of Science databases, including Dissertation Abstracts International. After screening for titles and abstracts,full texts were screened independently and in duplicate according to our inclusion criteria. For data extraction, a pre-defined form was piloted and used. Units of meaning with respect to barriers and facilitators were extracted and categorized inductively using content-analysis techniques. From the results, a matrix of interconnections and a network graph were compiled. Results: The 41 included publications were mainly in the fields of psychiatry and mental health nursing, as well as in training and education. The detailed category system contrasts four supercategories, i.e., which organizational and economic aspects to consider, which persons to include as eligible SPs, how to develop adequate scenarios, and how to authentically and consistently portray mental health patients.Conclusions: Publications focused especially on the interrelation between authenticity and consistency of portrayals, on how to evoke empathy in learners, and on economic and training aspects. A variety of recommendations for implementing SP programs,from planning to training, monitoring, and debriefing, is provided, for example, ethical screening of and ongoing support for SPs.
Theoretischer Hintergrund:Supervision spielt eine zentrale Rolle zum Wissens- und Kompetenzerwerb sowie in der Qualitätssicherung.
Fragestellung:Ziel war es, den aktuellen Forschungsstand zur Supervision im Rahmen der kognitiven Verhaltenstherapie abzubilden, um daraus Schlussfolgerungen für die zukünftige Forschung abzuleiten.
Methode:Zur Evidenzsynthese wurde ein Scoping Review durchgeführt, das die Darstellung zentraler Konzepte, aktueller Evidenz und möglicher Forschungsbedarfe ermöglichte. Neben einer systematischen Literaturrecherche wurden Vorwärts- und Rückwärtssuchstrategien eingesetzt.
Ergebnisse:Eingeschlossen wurden zwölf Publikationen basierend auf zehn empirischen Studien. Alle Studien beschrieben Ausbildungssettings, aber nur wenige untersuchten übende Interventionen (z. B. Rollenspiele). Häufig wurden Effekte subjektiv erfasst, die methodische Qualität der Begleitstudien variierte.
Schlussfolgerungen:Notwendig sind weitere methodisch hochwertige Studien, experimentell orientiert oder in der klinischen Praxis, die die Supervisionsforschung bereichern können.
Clinical supervision is regarded as one of the most important components of psychotherapy training. In clinical practice, it has been found that the implementation of clinical supervision varies substantially and often differs from the recommendations made in the literature. The objective of the current study was to investigate the frequency of topics (e.g. ethical issues) and techniques (e.g. role play) in the clinical supervision of psychotherapy trainees in Germany. To this end, we considered supervisions in cognitive behavioural therapy (CBT) and psychodynamic therapy (PT). A total of 791 psychotherapy trainees (533 CBT and 242 PT) were asked via the internet to provide information about their current supervision sessions. We found that clinical supervision in psychotherapy training addressed topics that are central for the effective treatment of supervised patients (i.e. therapeutic interventions, therapeutic alliance, maintaining factors, and therapeutic goals). However, the most frequently used intervention in clinical supervision in psychotherapy training was case discussion. Rarely were techniques used that allowed the supervisor to give the supervisee feedback based on the supervisee's demonstrated competencies. For example, 46% of the supervisors never used audiotapes or videotapes in the supervision. Differences between CBT and PT were rather small. Current practice regarding the techniques used in clinical supervision for psychotherapy trainees contradicts recommendations for active and feedback-oriented clinical supervision. Thus the potential of clinical supervision might not be fully used in clinical practice.
Previous studies found high prevalence rates of personality disorders (PDs) in patients with hypochondriasis; however, assessment was often based only on questionnaires. In the current study, a sample of 68 patients with hypochondriasis was compared to 31 patients with panic disorder and to 94 healthy controls. Participants were investigated with the Structured Clinical Interview for DSM-IV Personality Disorders questionnaire (SCID-II questionnaire) and the SCID-II interview. Based on the cut-off scores of the SCID-II questionnaire, we found a prevalence rate of 45.6% for PD in patients with hypochondriasis. In comparison to healthy controls, patients with hypochondriasis showed characteristics of paranoid, borderline, avoid ant, and-dependent PDs in the dimensional assessment significantly more often. However, no significant differences were found between the clinical samples. Based on the SCID-II interview, only 2.9% of the patients with hypochondriasis fulfilled the criteria for a PD. These results suggest that PDs are not a specific characteristic of hypochondriasis.
The illness-related evaluation of bodily symptoms is considered to be an important maintaining factor in somatoform disorders. However, little is known about context variables that could influence this evaluation process. In the current study, participants completed three versions of the Health Norms Sorting Task (HNST) and evaluated bodily symptoms in different contexts (i.e., different evaluation perspectives and time frames of evaluation). Additionally, the three HNST versions were presented in different orders. Bodily symptoms were evaluated more often as a sign of illness when a specific time frame (i.e., one week) was given. However, this context effect was only large when participants had previously evaluated symptoms existing without a concrete duration. Thus, previously completed symptom evaluations appear to represent an important frame of reference in terms of a cue that makes specific context variables salient. The results further suggested that these cueing effects might be less relevant for participants with elevated somatic symptom reports.
Theoretischer Hintergrund:Supervision spielt eine zentrale Rolle zum Wissens- und Kompetenzerwerb sowie in der Qualitätssicherung.
Fragestellung:Ziel war es, den aktuellen Forschungsstand zur Supervision im Rahmen der kognitiven Verhaltenstherapie abzubilden, um daraus Schlussfolgerungen für die zukünftige Forschung abzuleiten.
Methode:Zur Evidenzsynthese wurde ein Scoping Review durchgeführt, das die Darstellung zentraler Konzepte, aktueller Evidenz und möglicher Forschungsbedarfe ermöglichte. Neben einer systematischen Literaturrecherche wurden Vorwärts- und Rückwärtssuchstrategien eingesetzt.
Ergebnisse:Eingeschlossen wurden zwölf Publikationen basierend auf zehn empirischen Studien. Alle Studien beschrieben Ausbildungssettings, aber nur wenige untersuchten übende Interventionen (z. B. Rollenspiele). Häufig wurden Effekte subjektiv erfasst, die methodische Qualität der Begleitstudien variierte.
Schlussfolgerungen:Notwendig sind weitere methodisch hochwertige Studien, experimentell orientiert oder in der klinischen Praxis, die die Supervisionsforschung bereichern können.
Theoretischer Hintergrund: Einflüsse von therapeutenorientiertem Kompetenz-Feedback in der Psychotherapieausbildung wurden bislang wenig untersucht.
Fragestellung: Wie gehen Ausbildungstherapeuten mit Feedback um? Welchen Einfluss hat ein regelmäßiges Kompetenz-Feedback auf die Qualität psychotherapeutischer Behandlungen (insbesondere Therapiesitzungen, therapeutische Beziehung, Person des Therapeuten, Supervision)?
Methode: Elf Therapeuten wurden mithilfe eines halbstrukturierten Interviewleitfadens befragt. Die Auswertung erfolgte mittels qualitativer Inhaltsanalyse nach Mayring (2015).
Ergebnisse: Das auf Basis der Interviews erstellte Kategoriensystem umfasste die Kategorien „Erwartungen an das Feedback“, „Wahrnehmung des Feedbacks“, „Verarbeitung von und Umgang mit Feedback“, „Folgen, Auswirkungen und Veränderungen durch Feedback“ sowie „Verbesserungswünsche“.
Schlussfolgerungen: Therapeuten streben eine Umsetzung des Feedbacks an, welches sich auf die Behandlung, die Supervision, die eigene Person und die therapeutische Beziehung auswirkt.
Theoretischer Hintergrund: Einflüsse von therapeutenorientiertem Kompetenz-Feedback in der Psychotherapieausbildung wurden bislang wenig untersucht.
Fragestellung: Wie gehen Ausbildungstherapeuten mit Feedback um? Welchen Einfluss hat ein regelmäßiges Kompetenz-Feedback auf die Qualität psychotherapeutischer Behandlungen (insbesondere Therapiesitzungen, therapeutische Beziehung, Person des Therapeuten, Supervision)?
Methode: Elf Therapeuten wurden mithilfe eines halbstrukturierten Interviewleitfadens befragt. Die Auswertung erfolgte mittels qualitativer Inhaltsanalyse nach Mayring (2015).
Ergebnisse: Das auf Basis der Interviews erstellte Kategoriensystem umfasste die Kategorien „Erwartungen an das Feedback“, „Wahrnehmung des Feedbacks“, „Verarbeitung von und Umgang mit Feedback“, „Folgen, Auswirkungen und Veränderungen durch Feedback“ sowie „Verbesserungswünsche“.
Schlussfolgerungen: Therapeuten streben eine Umsetzung des Feedbacks an, welches sich auf die Behandlung, die Supervision, die eigene Person und die therapeutische Beziehung auswirkt.
Objective: Cognitive-behavioral therapy (CBT) has been shown to be effective in treating hypochondriasis. However, there are doubts regarding the long-term effectiveness of CBT for hypochondriasis, in particular for follow-up periods longer than 1 year. The aim of the present study was to evaluate the long-term effectiveness of cognitive therapy (CT) and exposure therapy (ET) for the treatment of hypochondriasis. Method: Seventy-five patients with a diagnosis of hypochondriasis who were previously treated with CT or ET were contacted 3 years after treatment. Fifty (67%) patients participated and were interviewed by an independent and blinded diagnostician using standardized interviews. Results: We found further improvements after therapy in primary outcome measures (d = .37), general functioning (d = .38), and reduced doctor visits (d = .30) during the naturalistic follow-up period. At the 3-year follow-up, 72% of the patients no longer fulfilled the diagnosis of hypochondriasis. Based on the main outcome measure, we found response rates of 76% and remission rates of 68%. At follow-up, only 4% of patients were taking antidepressant medication. Additional psychological treatment was utilized by 18% of the patients during the follow-up period (only 8% because of health anxiety). We found no overall differences between CT and ET. Only a trend for a greater deterioration rate in CT (13%) in comparison to ET (0%) was found. Conclusions: Our results suggest that 2/3 of the patients with hypochondriasis were remitted in the long term. Thus, remission rates after CBT were twice as high as in untreated samples.
ObjectivePsychotherapy for hypochondriasis has greatly improved over the last decades and cognitive-behavioral treatments are most promising. However, research on predictors of treatment outcome for hypochondriasis is rare. Possible predictors of treatment outcome in cognitive therapy (CT) and exposure therapy (ET) for hypochondriasis were investigated. MethodCharacteristics and behaviors of 75 patients were considered as possible predictors: sociodemographic variables (sex, age, and cohabitation); psychopathology (pretreatment hypochondriacal symptoms, comorbid mental disorders, and levels of depression, anxiety, and somatic symptoms); and patient in-session interpersonal behavior. ResultsSeverity of pretreatment hypochondriacal symptoms, comorbid mental disorders, and patient in-session interpersonal behavior were significant predictors in multiple hierarchical regression analyses. Interactions between the predictors and the treatment (CT or ET) were not found. ConclusionsIn-session interpersonal behavior is an important predictor of outcome. Furthermore, there are no specific contraindications to treating hypochondriasis with CT or ET.
Changes in Free Symptom Attributions in Hypochondriasis after Cognitive Therapy and Exposure Therapy
(2016)
Treatment delivery factors (i.e., therapist adherence, therapist competence, and therapeutic alliance) are considered to be important for cognitive behavioral therapy (CBT) for panic disorder and agoraphobia (PD/AG). In the current study, four independent raters conducted process evaluations based on 168 two-hour videotapes of 84 patients with PD/AG treated with exposure-based CBT. Two raters evaluated patients’ interpersonal behavior in Session 1. Two raters evaluated treatment delivery factors in Session 6, in which therapists provided the rationale for conducting exposure exercises. At the 6-month follow-up, therapists’ adherence (r = 0.54) and therapeutic alliance (r = 0.31) were significant predictors of changes in agoraphobic avoidance behavior; therapist competence was not associated with treatment outcomes. Patients’ interpersonal behavior in Session 1 was a significant predictor of the therapeutic alliance in Session 6 (r = 0.17). The findings demonstrate that treatment delivery factors, particularly therapist adherence, are relevant to the long-term success of CBT for PD/AG.
Changes in free symptom attributions in hypochondriasis after cognitive therapy and exposure therapy
(2016)
Background: Cognitive-behavioural therapy can change dysfunctional symptom attributions in patients with hypochondriasis. Past research has used forced-choice answer formats, such as questionnaires, to assess these misattributions; however, with this approach, idiosyncratic attributions cannot be assessed. Free associations are an important complement to existing approaches that assess symptom attributions. Aims: With this study, we contribute to the current literature by using an open-response instrument to investigate changes in freely associated attributions after exposure therapy (ET) and cognitive therapy (CT) compared with a wait list (WL). Method: The current study is a re-examination of a formerly published randomized controlled trial (Weck, Neng, Richtberg, Jakob and Stangier, 2015) that investigated the effectiveness of CT and ET. Seventy-three patients with hypochondriasis were randomly assigned to CT, ET or a WL, and completed a 12-week treatment (or waiting period). Before and after the treatment or waiting period, patients completed an Attribution task in which they had to spontaneously attribute nine common bodily sensations to possible causes in an open-response format. Results: Compared with the WL, both CT and ET reduced the frequency of somatic attributions regarding severe diseases (CT: Hedges's g = 1.12; ET: Hedges's g = 1.03) and increased the frequency of normalizing attributions (CT: Hedges's g = 1.17; ET: Hedges's g = 1.24). Only CT changed the attributions regarding moderate diseases (Hedges's g = 0.69). Changes in somatic attributions regarding mild diseases and psychological attributions were not observed. Conclusions: Both CT and ET are effective for treating freely associated misattributions in patients with hypochondriasis. This study supplements research that used a forced-choice assessment.