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Despite the positive effects of including patients' preferences into therapy on psychotherapy outcomes, there are still few thoroughly validated assessment tools at hand. We translated the 18-item Cooper-Norcross Inventory of Preferences (C-NIP) into German and aimed at replicating its factor structure. Further, we investigated the reliability of the questionnaire and its convergence with trait measures. A heterogeneous sample of N = 969 participants took part in our online survey. Performing ESEM models, we found acceptable model fit for a four-factor structure similar to the original factor structure. Furthermore, we propose an alternative model following the adjustment of single items. The German C-NIP showed acceptable to good reliability, as well as small correlations with Big-Five personality traits, trait and attachment anxiety, locus of control, and temporal focus. However, we recommend further replication of the factor structure and further validation of the C-NIP.
Despite the positive effects of including patients’ preferences into therapy on psychotherapy outcomes, there are still few thoroughly validated assessment tools at hand. We translated the 18-item Cooper-Norcross Inventory of Preferences (C-NIP) into German and aimed at replicating its factor structure. Further, we investigated the reliability of the questionnaire and its convergence with trait measures. A heterogeneous sample of N = 969 participants took part in our online survey. Performing ESEM models, we found acceptable model fit for a four-factor structure similar to the original factor structure. Furthermore, we propose an alternative model following the adjustment of single items. The German C-NIP showed acceptable to good reliability, as well as small correlations with Big-Five personality traits, trait and attachment anxiety, locus of control, and temporal focus. However, we recommend further replication of the factor structure and further validation of the C-NIP.
Background:
Many authors regard counseling self-efficacy (CSE) as important in therapist development and training. The purpose of this study was to examine the factor structure, reliability, and validity of the German version of the Counselor Activity Self-Efficacy Scales-Revised (CASES-R).
Method:
The sample consisted of 670 German psychotherapy trainees, who completed an online survey. We examined the factor structure by applying exploratory and confirmatory factor analysis to the instrument as a whole.
Results:
A bifactor-exploratory structural equation modeling model with one general and five specific factors provided the best fit to the data. Omega hierarchical coefficients indicated optimal reliability for the general factor, acceptable reliability for the Action Skills-Revised (AS-R) factor, and insufficient estimates for the remaining factors. The CASES-R scales yielded significant correlations with related measures, but also with therapeutic orientations.
Conclusion:
We found support for the reliability and validity of the German CASES-R. However, the subdomains (except AS-R) should be interpreted with caution, and we do not recommend the CASES-R for comparisons between psychotherapeutic orientations.
Background:
Under the new psychotherapy law in Germany, standardized patients (SPs) are to become a standard component inpsychotherapy training, even though little is known about their authenticity.Objective:The present pilot study explored whether, followingan exhaustive two-day SP training, psychotherapy trainees can distinguish SPs from real patients.
Methods:
Twenty-eight psychotherapytrainees (M= 28.54 years of age,SD= 3.19) participated as blind raters. They evaluated six video-recorded therapy segments of trained SPsand real patients using the Authenticity of Patient Demonstrations Scale.
Results:
The authenticity scores of real patients and SPs did notdiffer (p= .43). The descriptive results indicated that the highest score of authenticity was given to an SP. Further, the real patients did notdiffer significantly from the SPs concerning perceived impairment (p= .33) and the likelihood of being a real patient (p= .52).
Conclusions:
The current results suggest that psychotherapy trainees were unable to distinguish the SPs from real patients. We therefore stronglyrecommend incorporating training SPs before application. Limitations and future research directions are discussed.
Public Significance Statement This study demonstrates that simulated patients (SPs) can authentically portray a depressive case. The results provide preliminary evidence of psychometrically sound properties of the rating scale that contributes to distinguishing between authentic and unauthentic SPs and may thus foster SPs' dissemination into evidence-based training. <br /> For training purposes, simulated patients (SPs), that is, healthy people portraying a disorder, are disseminating more into clinical psychology and psychotherapy. In the current study, we developed an observer-based rating instrument for the evaluation of SP authenticity-namely, it not being possible to distinguish them from real patients-so as to foster their use in evidence-based training. We applied a multistep inductive approach to develop the Authenticity of Patient Demonstrations (APD) scale. Ninety-seven independent psychotherapy trainees, 77.32% female, mean age of 31.49 (SD = 5.17) years, evaluated the authenticity of 2 independent SPs, each of whom portrayed a depressive patient. The APD demonstrated good internal consistency (Cronbach's alpha = .83) and a strong correlation (r = .82) with an established tool for assessing SP performance in medical contexts. The APD scale distinguished significantly between an authentic and unauthentic SP (d = 2.35). Preliminary evidence for the psychometric properties of the APD indicates that the APD could be a viable tool for recruiting, training, and evaluating the authenticity of SPs. Strengths, limitations, and future directions are also discussed in detail.
Background
Communicating a diagnosis is highly important, yet complex, especially in the context of cancer and mental disorders. The aim was to explore the communication style of an oncologist vs. psychotherapist in an online study.
Methods
Patients (N = 136: 65 cancer, 71 depression) were randomly assigned to watch a standardized video vignette with one of two communication styles (empathic vs. unempathic). Outcome measures of affectivity, information recall, communication skills, empathy and trust were applied.
Results
Regardless of diagnosis, empathic communication was associated with the perception of a significantly more empathic (p < 0.001, η2partial = 0.08) and trustworthy practitioner (p = 0.014, η2partial = 0.04) with better communication skills (p = 0.013, η2partial = 0.05). Cancer patients reported a larger decrease in positive affect (p < 0.001, η2partial = 0.15) and a larger increase in negative affect (p < 0.001, η2partial = 0.14) from pre- to post-video than depressive patients. Highly relevant information was recalled better in both groups (p < 0.001, d = 0.61–1.06).
Conclusions
The results highlight the importance of empathy while communicating both a diagnosis of cancer and a mental disorder. Further research should focus on the communication of a mental disorder in association with cancer.
While metacognitive interventions are gaining attention in the treatment of various mental disorders, a review of the literature showed that the term is often defined poorly and used for a variety of psychotherapeutic approaches that do not necessarily pursue the same goal. We give a summary of three metacognitive interventions which were developed within a sound theoretical framework-metacognitive therapy, metacognitive training, and metacognitively-oriented integrative psychotherapies-and discuss their similarities and distinctive features. We then offer an integrative operational definition of metacognitive interventions as goal-oriented treatments that target metacognitive content, which is characterized by the awareness and understanding of one's own thoughts and feelings as well as the thoughts and feelings of others. They aim to alleviate disorder-specific and individual symptoms by gaining more flexibility in cognitive processing.
Objective: Despite increasing research on psychotherapy preferences, the preferences of psychotherapy trainees are largely unknown. Moreover, differences in preferences between trainees and their patients could (a) hinder symptom improvement and therapy success for patients and (b) represent significant obstacles in the early career and development of future therapists. Method: We compared the preferences of n = 466 psychotherapy trainees to those of n = 969 laypersons using the Cooper-Norcross Inventory of Preferences. Moreover, we compared preferences between trainees in cognitive-behavioural therapy (CBT) and psychodynamic trainees. Results: We found significant differences between both samples in 13 of 18 items, and three of four subscales. Psychotherapy trainees preferred less therapist directiveness (d = 0.58), more emotional intensity (d = 0.74), as well as more focused challenge (d = 0.35) than laypeople. CBT trainees preferred more therapist directiveness (d = 2.00), less emotional intensity (d = 0.51), more present orientation (d = 0.76) and more focused challenge (d = 0.33) than trainees in psychodynamic/psychoanalytic therapy. Conclusion: Overall, the results underline the importance of implementing preference assessment and discussion during psychotherapy training. Moreover, therapists of different orientations seem to cover a large range of preferences for patients, in order to choose the right fit.
Purpose: The acquisition of skills is essential to the conceptualization of cognitive-behavioural therapy. Yet, what experiences are encountered and what skills actually learned during therapy, and whether patients and therapists have concurrent views hereof, remains poorly understood. Method: An explorative pilot study with semi-structured, corresponding interview guides was conducted. Pilot data from our outpatient unit were transcribed and content-analyzed following current guidelines. Results: The responses of 18 participants (patients and their psychotherapists) were assigned to six main categories. Educational and cognitive aspects were mentioned most frequently and consistently by both groups. Having learned Behavioural alternatives attained the second highest agreement between perspectives. Conclusions: Patients and therapists valued CBT as an opportunity to learn new skills, which is an important prerequisite also for the maintenance of therapeutic change. We discuss limitations to generalizability but also theoretical and therapy implications.
Hintergrund: Im Rahmen des reformierten Psychotherapeutengesetzes wird eine starkere Praxisorientierung in der klinisch-psychologischen Lehre und in der Prufung psychotherapeutischer Kompetenzen verankert. Hierbei sollen Studierende durch die Interaktion mit standardisierten Patient*innen (SP) therapeutische Kompetenzen erwerben und demonstrieren. Fragestellung: Das Ziel des vorliegenden Beitrags ist es, eine evidenzbasierte Umsetzung dieser neuen Lehr- und Prufungsformate zu unterstutzen, indem bisherige Forschungsbefunde zum Einsatz von SP dargestellt und Bereiche, in denen weitere Forschung notwendig ist, aufgezeigt werden. Ergebnisse: Empirische Befunde zeigen, dass SP psychische Storungen authentisch darstellen konnen. Voraussetzung dafur sind beispielsweise die Auswahl geeigneter SP, detaillierte Rollenanleitungen, spezifisches Training, Feedback und Nachschulungen. Auch wenn einige Forschungsfragen, wie zur vergleichenden Wirksamkeit des Einsatzes von SP, noch unbeantwortet sind, lassen sich praktische Implikationen fur SP-Programme in Lehre, Prufung und Forschung ableiten, die in einem Ablaufschema dargestellt werden. Schlussfolgerungen: Der Einsatz von SP bietet gro ss es Potenzial fur die klinisch-psychologische Lehre und Ausbildungsforschung. Um den Einsatz von SP an anderen Standorten zu unterstutzen, werden Beispielmaterialien (z.B. Rollenanleitung) in den elektronischen Supplementen (siehe www.karger.com/doi/10.1159/000509249 fur alle Supplemente) zum Artikel zur Verfugung gestellt.
Background: Although clinical supervision is considered to be a major component of the development and maintenance of psychotherapeutic competencies, and despite an increase in supervision research, the empirical evidence on the topic remains sparse.
Methods: Because most previous reviews lack methodological rigor, we aimed to review the status and quality of the empirical literature on clinical supervision, and to provide suggestions for future research. MEDLINE, PsycInfo and the Web of Science Core Collection were searched and the review was conducted according to current guidelines. From the review results, we derived suggestions for future research on clinical supervision.
Results: The systematic literature search identified 19 publications from 15 empirical studies. Taking into account the review results, the following suggestions for further research emerged: Supervision research would benefit from proper descriptions of how studies are conducted according to current guidelines, more methodologically rigorous empirical studies, the investigation of active supervision interventions, from taking diverse outcome domains into account, and from investigating supervision from a meta-theoretical perspective.
Conclusions: In all, the systematic review supported the notion that supervision research often lags behind psychotherapy research in general. Still, the results offer detailed starting points for further supervision research.
Assessments of psychotherapeutic competencies play a crucial role in research and training. However, research on the reliability and validity of such assessments is sparse. This study aimed to provide an overview of the current evidence and to provide an average interrater reliability (IRR) of psychotherapeutic competence ratings. A systematic review was conducted, and 20 studies reported in 32 publications were collected. These 20 studies were included in a narrative synthesis, and 20 coefficients were entered into the meta-analysis. Most primary studies referred to cognitive-behavioral therapies and the treatment of depression, used the Cognitive Therapy Scale, based ratings on videos, and trained the raters. Our meta-analysis revealed a pooled ICC of 0.82, but at the same time severe heterogeneity. The evidence map highlighted a variety of variables related to competence assessments. Further aspects influencing the reliability of competence ratings and regarding the considerable heterogeneity are discussed in detail throughout the manuscript.
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.
There is increasing interest in improving psychotherapy training using evidence-based supervision. One approach is live supervision (LS), in which the supervisor offers immediate feedback to the trainee (e.g., via microphone, text messages) during the session. This review summarizes the research on LS and its main results. The databases Web of Science Core Collection, PsycArticles, PsycBooks, PsycInfo, PSYNDEX, Psychology and Behavioral Sciences Collection, and PubMed were searched from inception to January 23, 2020 (including a backward search) and updated November 15, 2020. The inclusion criteria (i.e., main focus on LS, immediate feedback from a present supervisor, psychological setting) were met by k = 138 publications, including k = 8 randomized controlled trials (RCTs; N = 339). Two reviewers independently evaluated the RCTs' risk of bias using the revised Cochrane Risk-of-Bias Tool. Most publications had a family therapy background (59%), were categorized as nonempirical (55%), aimed primarily at describing or comparing specific LS methods (35%), and displayed positive views on LS (87%). Based on the RCTs, LS was superior to no-supervision in 78% of all comparisons, but only in 13% of the cases compared to a delayed supervision (DS) condition (i.e., regarding trainee skills, patient outcomes, or other variables). These results somewhat contradict the overall favorable views in the literature. However, the generalizability is limited due to a lack of high-quality studies and substantial heterogeneity in terms of LS methods, concepts, outcomes, and measurements. Ideas for more systematic research on LS regarding objectives and methods are proposed. <br /> Public Significance Statement This review summarizes research on live supervision (LS). LS is a form of supervision in psychotherapy training in which the supervisor observes the trainee's therapy session and provides immediate feedback. The review concludes that LS is probably as effective as delayed supervision (DS), although more high-quality research is needed.
Objective
Problem-drinking among university students is common and poses serious health-related risks. Therefore, identifying and addressing associated factors is important.
Participants and methods
A large cross-sectional online-survey with 12,914 university students from Berlin was conducted from November 2016 to August 2017. Relative-risk- and correlation-analysis was used to identify factors associated with problem-drinking and regular heavy-drinking. Independent t-tests compared impulsivity and personality traits, chi-square-tests compared drinking motives between risk- and non-risk-drinkers.
Results
Male gender, tobacco-smoking, illegal substance use, impulsivity and various sociodemographic and psychosocial variables were significantly related to problem/heavy-drinking. Extraversion was a risk, conscientiousness and agreeableness were protective factors. Drinking-motives did not differ significantly between risk- and non-risk-drinkers. Generally, the main drinking-motives were to feel elated, relax and social purposes.
Conclusion
The identified markers and related problem behaviors may serve as a tool to enhance the identification of student subgroups at risk for problem/heavy-drinking, and hence improve targeted health-intervention-programs.
Purpose: Although subjective knowledge about the prognosis of an advanced disease is extremely important for coping and treatment planning, the concept of prognostic awareness (PA) remains inconsistently defined. The aims of the scoping review were to synthesize a definition of PA from the most recent literature, describe preconditions, correlates and consequences, and suggest a conceptual model.
Methods: By using scoping review methodology, we searched the Web of Science and PubMed databases, and included publications, reviews, meta-analyses or guidelines on all physical diagnoses, as well as publications offering a conceptual or an operational definition of PA. The data were analyzed by means of content analysis techniques.
Results: Of the 24 included publications, 21 referred exclusively to cancer, one to patients with hip fractures and two to palliative care in general. The deduced definition of PA comprised the following facets: adequate estimation of chances for recovery, knowledge of limited time to live, adequate estimation of life expectancy, knowledge of therapy goals, and knowledge of the course of the disease. Further content analysis results were mapped graphically and in a detailed table.
Conclusion: There appears to be a lack of theoretical embedding of PA that in turn influences the methods used for empirical investigation. Drawing on a clear conceptual definition, longitudinal or experimental studies would be desirable.
This study examined the effectiveness of psychological interventions for severe health anxiety (SHA) regarding somatic symptoms (SS) and health anxiety (HA). The databases Web of Science, EBSCO, and CENTRAL were searched on May 15, 2019, May 16, 2019, and August 5, 2019, respectively. Eighteen randomized controlled trials (N = 2,050) met the inclusion criteria (i.e., hypochondriasis, illness anxiety disorder or somatic symptom disorder with elevated HA being assessed with validated interviews: use of standardized outcome measures). Two reviewers independently evaluated the studies' risk of bias using the Revised Cochrane Risk-of-Bias Tool for randomized trials (RoB-2) tool. Overall, psychological interventions were significantly more effective than waitlist, treatment-as-usual, or placebo post-treatment (g(SS) = 0.70, g(HA) = 1.11) and at follow-up (g(SS) = 0.33, g(HA)= 0.70). CBT outperformed other psychological interventions or pharmacotherapy for HA post- treatment (Hedge's g(HA) = 0.81). The number of sessions did not significantly predict the effect sizes. In sum, psychological interventions were effective for SHA, but the generalizability of the results for SS is limited, because only two high-quatity trials contributed to the comparison.
Background
Despite the prevalence of obsessive-compulsive disorder (OCD), its precise identification remains challenging. With the Zohar-Fineberg Obsessive-Compulsive Screen (ZF-OCS; 5 or 6 items), a brief instrument is widely available mainly in English. As there is a lack of empirical studies on the ZF-OCS, the aim of the present study was to translate the items into German and investigate the instrument in a nonclinical sample.
Methods
In two consecutive online surveys, n = 304 and n = 51 students participated. Besides the ZF-OCS, they answered established measures on OCD, depression, health anxiety, general anxiety and health-related well-being.
Results
Whereas internal consistency was low (α = .53–.72; ω = .55–.69), retest reliability (rt1,t2 = .89) at two weeks was high. As expected, we found high correlations with other OCD instruments (r > .61; convergent validity), and significantly weaker correlations with measures of depression (r = .39), health anxiety (r = .29), and health-related well-being (r = −.28, divergent validity). Nonetheless, the correlations with general anxiety were somewhere in between (r = .52).
Conclusions
Due to heterogeneous OCD subtypes, the ZF-OCS asks diverse questions which probably resulted in the present internal consistency. Nevertheless, the results on retest reliability and validity were promising. As for other OCD instruments, divergent validity regarding general anxiety seems problematic to establish. Even so, the ZF-OCS seems valuable for screening purposes, as it is short and easy to administer, and may facilitate initiating subsequent clinical assessment. Further studies should determine the instrument’s diagnostic accuracy.
Hintergrund: Dysfunktionale Überzeugungen und Bewertungen von Zwangsgedanken sind ausschlaggebend für die Entstehung und Aufrechterhaltung von Zwangsstörungen. Die reliable und valide Erfassung dieser Überzeugungen mithilfe von Screeningverfahren ist für die kognitiv-verhaltenstherapeutische Behandlung relevant. Fragestellung: Ziel der Arbeit war die Erstellung eines Scoping review bezüglich der aktuellen Screeninginstrumenten zur Erfassung der 6 von der Obsessive Compulsive Cognitions Working Group (OCCWG) vorgeschlagenen Domänen bei Zwangsstörungen. Die Verfahren wurden systematisch nach ihrer psychometrischen Güte bewertet und in ihren Eigenschaften verglichen. Material und Methoden: Die Literatursuche erfolgte in den Datenbanken Web of Science Core Collection, Google Scholar und PubMed. Eingeschlossen wurden deutsch- und englischsprachige Verfahren für Erwachsene (≥18 Jahre). Ergebnisse: Es konnten 56 Studien zur Überprüfung der psychometrischen Eigenschaften von 16 Fragebogen eingeschlossen werden. Die Fragebogen erfassten alle Domänen dysfunktionaler Überzeugungen. Außerdem lagen 4 domänenübergreifende Verfahren vor, und 9 der Fragebogen waren deutschsprachig. Die Mehrzahl der Screeningverfahren wies adäquate bis gute psychometrische Werte auf. Die methodische Qualität der Studien war heterogen; methodische und statistische Verfahren nahmen über die Jahre an Komplexität zu. Schlussfolgerung: Weiterer Forschungsbedarf besteht v. a. in der Untersuchung der Störungsspezifität und Änderungssensitivität von Screeningverfahren an klinischen Stichproben.
Background
Psychotherapy is highly effective and widely acknowledged for treating various mental disorders. Nevertheless, in terms of methods for teaching effective psychotherapeutic approaches and competencies, there has been a lack of investigation. Training and supervision are the main strategies for teaching therapist competencies, and standardized role-plays with simulated patients (i.e., trained individuals playing someone with a mental disorder) seem useful for evaluating training approaches. In medical education, this procedure is now internationally established. However, so far, little use has been made of standardized role-playing to evaluate training and supervision in the area of clinical psychology and psychotherapy.
Methods
In this study, standardized role-plays are used to evaluate methods for training and supervision. Central cognitive behavioral approaches for treating depression are taught in the training. The first experiment compares an active training approach (i.e., model learning) with a passive one (i.e., reading manual-based instructions). The second experiment compares a direct supervision technique (i.e., supervision based on video analysis) with an indirect one (i.e., supervision based on verbal reporting). In each experiment, 68 bachelor’s and master’s students of psychology will be randomly assigned to the experimental and control groups. Each student takes part in three role-plays (baseline, post and 3-month follow-up), which are all videotaped. Two independent raters assess therapist competencies in each role-play on the basis of a standardized competence scale.
Discussion
The research project aims to contribute to the development of specific training and supervision methods in order to improve psychotherapy training and patient care.