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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.
Theoretischer Hintergrund: Als Medical Students’ Disease wird die Angst von Medizinstudierenden bezeichnet, unter Krankheiten zu leiden, mit denen sie sich im Studium auseinandersetzen. Fragestellung: Es wurde untersucht, ob ähnliche Phänomene vorübergehender Krankheitsängste auch bei Psychologiestudierenden existieren. Methode: Mittels etablierter Illness-Attitude-Scales (IAS) und einer eigens entwickelten Ergänzung wurden Ängste vor somatischen und psychischen Erkrankungen erhoben. Ergebnisse: Krankheitsängste bei Psychologiestudierenden waren nicht stärker ausgeprägt als bei Studierenden anderer Fachrichtungen. Ängste vor körperlichen Erkrankungen waren häufiger als Ängste vor psychischen Störungen, die keiner signifikanten zeitlichen Veränderung unterlagen. Schlussfolgerung: Die Beschäftigung mit psychischen Störungen geht nicht zwangsläufig mit einem Anstieg von Ängsten vor psychischen Erkrankungen unter Psychologiestudierenden einher. Erhöhte Belastungswerte bei allen Studierenden legen nahe, dass das Studium selbst eine Herausforderung darstellt, für deren Bewältigung Unterstützung angeboten werden kann. the same level of fear regarding health anxiety as students of other disciplines. Their anxiety about suffering from physical illnesses was also greater than their anxiety about suffering from mental disorders. Conclusion: Studying mental disorders does not necessarily result in an increase of related health anxiety. However, university studies seem to be a burdensome period of life in their own right, for which coping support can be provided.
Objective:
Therapist competence is considered essential for the success of psychotherapy. Feedback is an intervention which has the potential to improve therapist competence. The present study investigated whether competence feedback leads to an improvement of therapist competence and patient outcome.
Method:
Sixty-seven master-level clinical trainees were randomly assigned to either a competence feedback group (CFG) or a control group (CG). Patients with a diagnosis of major depression (N = 114) were randomly assigned to CFG or CG. Treatment included 20 individual sessions of cognitive behavioral therapy (CBT). In CFG, therapists received, parallel to the treatment, five competence feedbacks, based on videotaped therapy sessions. Independent raters assessed therapist competence with the Cognitive Therapy Scale (CTS) and provided the competence feedback. Patient outcome was evaluated with the Beck Depression Inventory-II (BDI-II) and therapeutic alliance (Helping Alliance Questionnaire [HAQ]) from both therapist's (HAQ-T) and patient's (HAQ-P) perspective were evaluated after each of the 20 sessions.
Results:
(a) Therapist competence (CTS) increased significantly more for CFG than CG. (b) Depression (BDI-II) decreased significantly across sessions for both groups, but without evidence for a group-differential benefit for the CFG. (c) Therapeutic alliance (HAQ-T/P) increased significantly across sessions for both groups from both perspectives, but without group differences. (d) There is a positive effect of BDI-II on CTS at the beginning and a negative effect of CTS on BDI-II at the end of therapy.
Conclusion:
Competence feedback improves therapists' independently rated competence, but there is no evidence that competence feedback in CBT leads to better outcome.
What is the public health significance of this article? This study suggests the substantial value of systematic competence feedback for improving therapist competence in the psychotherapy of depression. No significant effect of competence feedback on the reduction of reported depressive symptoms was found.