Advancing psychotherapy and evidence-based psychological interventions

Psychological models of mental disorders guide research into psychological and environmental factors that elicit and maintain mental disorders as well as interventions to reduce them. This paper addresses four areas. (1) Psychological models of mental disorders have become increasingly transdiagnostic, focusing on core cognitive endophenotypes of psychopathology from an integrative cognitive psychology perspective rather than offering explanations for unitary mental disorders. It is argued that psychological interventions for mental disorders will increasingly target specific cognitive dysfunctions rather than symptom-based mental disorders as a result. (2) Psychotherapy research still lacks a comprehensive conceptual framework that brings together the wide variety of findings, models and perspectives. Analysing the state-of-the-art in psychotherapy treatment research, “component analyses” aiming at an optimal identification of core ingredients and the mechanisms of change is highlighted as the core need towards improved efficacy and effectiveness of psychotherapy, and improved translation to routine care. (3) In order to provide more effective psychological interventions to children and adolescents, there is a need to develop new and/or improved psychotherapeutic interventions on the basis of developmental psychopathology research taking into account knowledge of mediators and moderators. Developmental neuroscience research might be instrumental to uncover associated aberrant brain processes in children and adolescents with mental health problems and to better examine mechanisms of their correction by means of psychotherapy and psychological interventions. (4) Psychotherapy research needs to broaden in terms of adoption of large-scale public health strategies and treatments that can be applied to more patients in a simpler and cost-effective way. Increased research on efficacy and moderators of Internet-based treatments and e-mental health tools (e.g. to support “real time” clinical decision-making to prevent treatment failure or relapse) might be one promising way forward.

Cortisol levels and history of depression in acute coronary syndrome patients

BACKGROUND: Depressed mood following an acute coronary syndrome (ACS) is a risk factor for future cardiac morbidity. Hypothalamic-pituitary-adrenal (HPA) axis dysregulation is associated with depression, and may be a process through which depressive symptoms influence later cardiac health. Additionally, a history of depression predicts depressive symptoms in the weeks following ACS. The purpose of this study was to determine whether a history of depression and/or current depression are associated with the HPA axis dysregulation following ACS. METHOD: A total of 152 cardiac patients completed a structured diagnostic interview, a standardized depression questionnaire and a cortisol profile over the day, 3 weeks after an ACS. Cortisol was analysed using: the cortisol awakening response (CAR), total cortisol output estimated using the area under the curve method, and the slope of cortisol decline over the day. RESULTS: Total cortisol output was positively associated with history of depression, after adjustment for age, gender, marital status, ethnicity, smoking status, body mass index (BMI), Global Registry of Acute Cardiac Events (GRACE) risk score, days in hospital, medication with statins and antiplatelet compounds, and current depression score. Men with clinically diagnosed depression after ACS showed a blunted CAR, but the CAR was not related to a history of depression. CONCLUSIONS: Patients with a history of depression showed increased total cortisol output, but this is unlikely to be responsible for associations between depression after ACS and later cardiac morbidity. However, the blunted CAR in patients with severe depression following ACS indicates that HPA dysregulation is present.

Higher emotional distress in female partners of cancer patients: prevalence and patient-partner interdependencies in a 3-year cohort

OBJECTIVE: Assessment and treatment of psychological distress in cancer patients was recognized as a major challenge. The role of spouses, caregivers, and significant others became of salient importance not only because of their supportive functions but also in respect to their own burden. The purpose of this study was to assess the amount of distress in a mixed sample of cancer patients and their partners and to explore the dyadic interdependence. METHODS: An initial sample of 154 dyads was recruited, and distress questionnaires (Hospital Anxiety and Depression Scale, Symptom Checklist 9-Item Short Version and 12-Item Short Form Health Survey) were assessed over four time points. Linear mixed models and actor-partner interdependence models were applied. RESULTS: A significant proportion of patients and their partners (up to 40%) reported high levels of anxiety, depression, psychological distress, and low quality of life over the course of the investigation. Mixed model analyses revealed that higher risks for clinical relevant anxiety and depression in couples exist for female patients and especially for female partners. Although psychological strain decreased over time, the risk for elevated distress in female partners remained. Modeling patient-partner interdependence over time stratified by patients' gender revealed specific effects: a moderate correlation between distress in patients and partners, and a transmission of distress from male patients to their female partners. CONCLUSIONS: Our findings provide empirical support for gender-specific transmission of distress in dyads coping with cancer. This should be considered as an important starting point for planning systemic psycho-oncological interventions and conceptualizing further research.

Patterns of psychological adaptation to divorce

Despite the increase in divorces after a long relationship, this trend remains a neglected research topic. The present contribution seeks to identify patterns of psychological adaptation to divorce after a long-term marriage. Data from a questionnaire study with 308 persons aged 45–65 years, who divorced after having been married for an average of 25 years, are presented. Exploratory latent profile analysis with various well-being outcomes revealed five groups: one with average adapted, one with resilients, and three small groups with seriously affected individuals. Discriminant variables between the groups were personality, time since separation, a new relationship, and financial situation. Age, gender, and length of marriage played a marginal role; satisfaction with the former marriage and initiator status were not relevant.

An exploratory study about the perception and justification of violence in Mixed Martial Arts and kickboxing athletes

THE INFLUENCE of combat sport practice on behaviour, attitude, personality and other factors was, and still remains, a research topic of great interest as well as conflicting points of view. Findings are as yet inconclusive since a direct or causal effect is difficult to establish and other factors external to the individual, such as the instructor’s coaching style, also need to be taken into consideration. Furthermore, the wide range of disciplines pertaining to the category combat sports differ from each other on a number of characteristics, such as the extent of physical contact or competition rules, and in fact, attempts have been made to distinguish between various sub-types (e.g. Trulson, 1986). A common distinction made is that between the traditional martial arts, which place emphasis on the art’s philosophy, its traditions and hierarchy (e.g. traditional karate, aikido) and the modern (or Western) combat sports (e.g. boxing, Mixed Martial Arts). An ongoing debate exists about the potential positive and/or negative influence of combat sport practice in comparison to other sport disciplines that do not include this element of fighting and direct aggression. On the one hand, combat sports have been presented by some researchers and sport practitioners as a means of promoting positive social and individual behavior, such as in Theeboom, De Knop and Wylleman’s (2008) evaluation of a martial arts Programme for socially disadvantaged youths in Belgium. Results revealed a positive effect of this project; however, it also highlighted the crucial role played by the instructors or leaders of such programmes. In another intervention using martial arts, Trulson (1986) reported a positive effect of a six month traditional martial art (Korean Tae Kwon Do) intervention with male juvenile delinquents including a reduction in aggressiveness and anxiety, thus confirming the positive influence of such an activity. Nevertheless, this effect was not observed in the other group participating in a modern Adaptation of this martial art led by the same instructor, where the philosophical aspect of this discipline was not emphasised. Moreover, an opposite effect was ascertained in this case where an increased tendency towards delinquency was reported. These results support the distinction between the various types of combat sports together with the way this sport is presented and taught by the instructor.

Search for charged Higgs bosons through the violation of lepton universality in t art events using collision data at sqrts=7 TeV with the AT experiment

In several extensions of the Standard Model, the top quark can decay into a bottom quark and a light charged Higgs boson H+, t -> bH(+), in addition to the Standard Model decay t -> bW. Since W bosons decay to the three lepton generations equally, while H+ may predominantly decay into tau nu, charged Higgs bosons can be searched for using the violation of lepton universality in top quark decays. The analysis in this paper is based on 4.6 fb(-1) of proton-proton collision data at root s = 7 TeV collected by the ATLAS experiment at the Large Hadron Collider. Signatures containing leptons (e or mu) and/or a hadronically decaying tau (tau(had)) are used. Event yield ratios between e+ tau(had) and e + mu, as well as between mu + tau(had) and mu + e, final states are measured in the data and compared to predictions from simulations. This ratio-based method reduces the impact of systematic uncertainties in the analysis. No significant deviation from the Standard Model predictions is observed. With the assumption that the branching fraction B(H+ -> tau nu) is 100%, upper limits in the range 3.2%-4.4% can be placed on the branching fraction B(t -> bH(+)) for charged Higgs boson masses m(H+) in the range 90-140GeV. After combination with results from a search for charged Higgs bosons in t (t) over bar decays using the tau(had) + jets final state, upper limits on B(t -> bH(+)) can be set in the range 0.8%-3.4%, for m(H+) in the range 90-160GeV.

Integrating fragmented evidence by network meta-analysis: relative effectiveness of psychological interventions for adults with post-traumatic stress disorder

BACKGROUND To summarize the available evidence on the effectiveness of psychological interventions for patients with post-traumatic stress disorder (PTSD). METHOD We searched bibliographic databases and reference lists of relevant systematic reviews and meta-analyses for randomized controlled trials that compared specific psychological interventions for adults with PTSD symptoms either head-to-head or against control interventions using non-specific intervention components, or against wait-list control. Two investigators independently extracted the data and assessed trial characteristics. RESULTS The analyses included 4190 patients in 66 trials. An initial network meta-analysis showed large effect sizes (ESs) for all specific psychological interventions (ESs between -1.10 and -1.37) and moderate effects of psychological interventions that were used to control for non-specific intervention effects (ESs -0.58 and -0.62). ES differences between various types of specific psychological interventions were absent to small (ES differences between 0.00 and 0.27). Considerable between-trial heterogeneity occurred (τ 2 = 0.30). Stratified analyses revealed that trials that adhered to DSM-III/IV criteria for PTSD were associated with larger ESs. However, considerable heterogeneity remained. Heterogeneity was reduced in trials with adequate concealment of allocation and in large-sized trials. We found evidence for small-study bias. CONCLUSIONS Our findings show that patients with a formal diagnosis of PTSD and those with subclinical PTSD symptoms benefit from different psychological interventions. We did not identify any intervention that was consistently superior to other specific psychological interventions. However, the robustness of evidence varies considerably between different psychological interventions for PTSD, with most robust evidence for cognitive behavioral and exposure therapies.

Self-esteem, coping styles, and quality of life in polish adolescents and young adults with unilateral cleft lip and palate.

Objectives : To evaluate self-esteem, coping styles, and health-related quality of life and their relationships in Polish adolescents and young adults with unilateral complete cleft lip and palate and related sex differences. Design and Participants : Self-report questionnaires measuring self-esteem (Multidimensional Self-Esteem Inventory), coping styles (Coping Inventory for Stressful Situations), and health-related quality of life (WHOQOL-BREF) were completed by 48 participants with cleft lip and palate (age, 16 to 23 years; 31 males, 17 females) and 48 controls without cleft lip and palate (age, 16 to 23 years; 28 males, 20 females) matched for age, place of residence, and socioeconomic status. Results : Regarding self-esteem, individuals with cleft lip and palate scored higher on body functioning (P < .01) and defensive self-enhancement (P < .05). Self-control showed an interaction effect: Females with cleft lip and palate scored higher than controls, but males did not differ between groups (P < .05). Males with cleft lip and palate scored lower than controls in personal power but higher in body functioning (P < .05); females showed no differences between groups. The groups did not differ with regard to coping styles or quality of life, but several correlations were found between self-esteem and coping styles, and quality of life (P < .01). Conclusions : Late adolescents and young adults with and without cleft lip and palate differed little in terms of psychological adjustment measures. The higher scores in defensive self-enhancement of individuals with cleft lip and palate suggest the need for instruments measuring social approval in psychosocial adjustment research involving this group.

Psychosocial aspects in cardiac rehabilitation: From theory to practice. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation of the European Society of Cardiology

A large body of empirical research shows that psychosocial risk factors (PSRFs) such as low socio-economic status, social isolation, stress, type-D personality, depression and anxiety increase the risk of incident coronary heart disease (CHD) and also contribute to poorer health-related quality of life (HRQoL) and prognosis in patients with established CHD. PSRFs may also act as barriers to lifestyle changes and treatment adherence and may moderate the effects of cardiac rehabilitation (CR). Furthermore, there appears to be a bidirectional interaction between PSRFs and the cardiovascular system. Stress, anxiety and depression affect the cardiovascular system through immune, neuroendocrine and behavioural pathways. In turn, CHD and its associated treatments may lead to distress in patients, including anxiety and depression. In clinical practice, PSRFs can be assessed with single-item screening questions, standardised questionnaires, or structured clinical interviews. Psychotherapy and medication can be considered to alleviate any PSRF-related symptoms and to enhance HRQoL, but the evidence for a definite beneficial effect on cardiac endpoints is inconclusive. A multimodal behavioural intervention, integrating counselling for PSRFs and coping with illness should be included within comprehensive CR. Patients with clinically significant symptoms of distress should be referred for psychological counselling or psychologically focused interventions and/or psychopharmacological treatment. To conclude, the success of CR may critically depend on the interdependence of the body and mind and this interaction needs to be reflected through the assessment and management of PSRFs in line with robust scientific evidence, by trained staff, integrated within the core CR team.

Patterns of Psychological Adaptation to Spousal Bereavement in Old Age

Background: While the negative effects of spousal bereavement on well-being are well documented in empirical research, the large individual differences in psychological adaptation are still not well understood. Objective: This contribution aims to identify patterns of psychological adaptation to spousal loss in old age and to shed light on the role of intra- and interpersonal resources and contextual factors as discriminant variables among these patterns. Methods: The data stem from a cross-sectional questionnaire study of 402 widowed individuals (228 women, 174 men) aged between 60 and 89 years (mean age 74.41 years), who lost their partner within the last 5 years, and 618 married individuals, who served as controls (312 women, 306 men; mean age 73.82 years). Results: The exploratory latent profile analysis of the well-being outcomes of depressive symptoms, hopelessness, loneliness, life satisfaction and subjective health revealed three different groups in the widowed sample: ‘resilients' (54% of the sample), ‘copers' (39%) and ‘vulnerables' (7%). The most important variables for group allocation were intrapersonal resources - psychological resilience and the Big Five personality traits - but also the quality of the former relationship and how the loss was experienced. Conclusion: Successful adaptation to spousal loss is primarily associated with high scores in psychological resilience and extraversion and low scores in neuroticism. Our results shed light on the variability in psychological adaptation and underline the important role of intrapersonal resources in facing spousal loss in old age.

University and school students' motivation for effortful thinking: Factor structure, reliability, and validity of the German Need for Cognition Scale

Need for cognition (NFC) reflects a relatively stable trait regarding the degree to which one enjoys and engages in cognitive endeavors. We examined whether the previously demonstrated one-dimensional structure of the German NFC Scale could be replicated in three samples of undergraduates and secondary school students. Moreover, we investigated the test-retest reliability of the German NFC Scale, which has not yet been tested. Further, we investigated whether the scale would be valid in a sample of secondary school students. Multigroup confirmatory factor analyses established the one-dimensional factor structure of the long form as well as the short form of the German NFC Scale for undergraduates (N = 559), students of academic track secondary schools (German Gymnasium; N = 555), and students of vocational track secondary schools (German Realschule; N = 486). The scale proved to have a high test-retest reliability in a university student sample (N = 43). For secondary school students, we again found a high test-retest reliability (N = 157), and also found the scale to be valid (N = 181).

Why does placement of persons with Alzheimer's disease into long-term care improve caregivers' well-being? Examination of psychological mediators.

Caregiving for individuals with Alzheimer's disease is associated with chronic stress and elevated symptoms of depression. Placement of the care receiver (CR) into a long-term care setting may be associated with improved caregiver well-being; however, the psychological mechanisms underlying this relationship are unclear. This study evaluated whether decreases in activity restriction and increases in personal mastery mediated placement-related reductions in caregiver depressive symptoms. In a 5-year longitudinal study of 126 spousal Alzheimer's disease caregivers, we used multilevel models to evaluate placement-related changes in depressive symptoms (short form of the Center for Epidemiologic Studies Depression scale), activity restriction (Activity Restriction Scale), and personal mastery (Pearlin Mastery Scale) in 44 caregivers who placed their spouses into long-term care relative to caregivers who never placed their CRs. The Monte Carlo method for assessing mediation was used to evaluate the significance of the indirect effect of activity restriction and personal mastery on postplacement changes in depressive symptoms. Placement of the CR was associated with significant reductions in depressive symptoms and activity restriction and was also associated with increased personal mastery. Lower activity restriction and higher personal mastery were associated with reduced depressive symptoms. Furthermore, both variables significantly mediated the effect of placement on depressive symptoms. Placement-related reductions in activity restriction and increases in personal mastery are important psychological factors that help explain postplacement reductions in depressive symptoms. The implications for clinical care provided to caregivers are discussed.

Trajectories of psychological adaptation to marital breakup after a long-term marriage

While the negative effects of divorce on well-being are well documented in research literature, the large individual differences in psychological adaptation over time are still not well understood. This is especially the case for marital breakup after long-term marriage, which is still a neglected research topic. Against this background, the aim of the present contribution is to shed light on the various trajectories of psychological adaptation to marital breakup after a long-term relationship. Data stem from a longitudinal survey study, which is part of the Swiss National Centre of Competence in Research ‘LIVES – Overcoming vulnerability: life course perspectives’ (funded by the Swiss National Science Foundation). Our analyses are based on results of an exploratory latent profile analysis performed at the first assessment in 2012 among 308 divorced participants aged 45 – 65 years, who divorced after an average of 25 years of marriage (Perrig-Chiello, Hutchison, & Morselli, 2014). Five different groups regarding psychological adaptation to marital breakup (i.e. life satisfaction, depression, hopelessness, subjective health, and mourning) were identified. They were composed of two larger groups of individuals that adapted quite well or very well (“average copers”, n=151 and “resilients”, n=90) and of three smaller groups with major difficulties to adjust to the new situation (“vulnerables”, n= 18; “malcontens”, n= 37 and “resigned ones”, n=12). Clusters differed statistically significant regarding personality variables, time since separation, current relationship status, and financial situation. In the present contribution, we want to investigate the course of adaptation of the five classes two years later by using latent transition analysis. Furthermore, we aim to examine which variables in terms of personality, relationship status, variables of the context of the separation and socio-demographic variables are crucial for change or stability in levels of adaptation in the different classes. The evaluation of the trajectories of adaptation to this critical life event and the identification of variables that enhance the adaptation over time is essential for developing more differentiated measures in counselling as well as intervention techniques in clinical and social services.