Generalisierte Angststörung ressourcen- und problemorientiert behandeln - deutsche Adaption des Manuals Mastery your Anxiety and Worry (MAW)

Problemstellung: Patienten mit (komorbider) generalisierter Angststörung (GAS) werden oftmals als ausschließlich depressive Patienten fehlinterpretiert. Da GAS-Patienten relativ gut auf die medikamentöse Depressions- Behandlung ansprechen, wird diese Fehlinterpretation in der Praxis oftmals nicht erkannt. Für die Psychotherapie kann sich die nicht erkannte GAS-Problematik jedoch ungünstig auswirken, so dass die Patienten ein suboptimales psychotherapeutisches Angebot erhalten (wie beispielsweise suboptimale Psychoedukation, Verstärkung der Nervosität durch den schnellen Aufbau „angenehmer“ Tätigkeiten). GAS-spezifische Aspekte, wie das Erkennen von Sorgenketten werden dadurch von Therapeuten oftmals übersehen oder falsch interpretiert (z. B. Fehlinterpretation der Sorgenketten als „ressourcenorientierte“ Ziele oder „positive“ Reframings). Ziele des Workshops: Einführung in die deutsche Adaption des Manuals Mastery your Anxiety and Worry (MAW) nach Zinbarg, Craske & Barlow (2006) mittels Therapiemanual und Videobeispielen GAS-spezifische Interventionen wie GAS-Psychoedukation, Sorgentagebuch oder Imagery exposure kennen Ressourcen- und problemorientierte Fallkonzeption im Rahmen der generalisierten Angststörung kennen Individualisierung im Rahmen des MAW-Manuals

Worry activation impairs intelligence test performace only under ego depletion

Detrimental effects of anxiety on cognitive performance have been explained by the activation of worry, detracting attention away from the task at hand. However, recent research has shown that anxiety is only related to performance when self-control capacity is low (i.e., ego depletion). The aim of the present work has been to extend these findings by showing that activation of worry will interfere with cognitive performance more strongly when self-control capacity is momentarily depleted compared to intact. After manipulations of self-control capacity and worry activation, 70 undergraduates completed a standardized intelligence test. As expected, activation of worry was associated with lower performance when self-control capacity was depleted, but had no effect when self-control capacity was intact. The findings implicate that worry may play a causal role in the anxiety–performance relationship, but only when its regulation by self-control is momentarily hindered.

Predicting perceived vulnerability for breast cancer among women with an average breast cancer risk

OBJECTIVES: The purpose of the present study was to investigate predictors of perceived vulnerability for breast cancer in women with an average risk for breast cancer. On the basis of empirical findings that suggested which variables might be associated with perceived vulnerability for breast cancer, we investigated whether knowledge of breast cancer risk factors, cancer worry, intrusions about breast cancer, optimism about not getting cancer and perceived health status have a predictive value for perceived breast cancer vulnerability. DESIGN: In a 3-step approach, we recruited 292 women from the general public in Germany who had neither a family history of breast cancer nor breast cancer themselves. After receiving an initial informational letter about study objectives, the women were interviewed by telephone and then asked to fill in a self-administered questionnaire. METHODS: We used structural equation modelling and hypothesized that each of the included variables has a direct influence on perceived vulnerability for breast cancer. RESULTS: We found a valid model with acceptable fit indices. Optimism about not getting cancer, intrusions about breast cancer and women's perceived health status explained 32% of the variance of perceived vulnerability for breast cancer. Cancer worry and knowledge about breast cancer did not influence perceived vulnerability for breast cancer. CONCLUSION: Perceived vulnerability for breast cancer is associated with health-related variables more than with knowledge about breast cancer risk factors.

Predictors of oral health quality of life in older adults

There is limited information regarding oral health status and other predictors of oral health-related quality of life. An association between oral health status and perceived oral health-related quality of life (OHQOL) might help clinicians motivate patients to prevent oral diseases and improve the outcome of some dental public health programs. This study evaluated the relationship between older persons' OHQOL and their functional dentition, caries, periodontal status, chronic diseases, and some demographic characteristics. A group of 733 low-income elders (mean age 72.7 [SD = 4.71, 55.6% women, 55.1% members of ethnic minority groups in the U.S. and Canada) enrolled in the TEETH clinical trial were interviewed and examined as part of their fifth annual visit for the trial. OHQOL was measured by the Geriatric Oral Health Assessment Index (GOHAI); oral health and occlusal status by clinical exams and the Eichner Index; and demographics via interviews. Elders who completed the four-year assessment had an average of 21.5 teeth (SD = 6.9), with 8.5 occluding pairs (SD = 4.6), and 32% with occlusal contacts in all four occluding zones. Stepwise multiple regressions were conducted to predict total GOHAI and its subscores (Physical, Social, and Worry). Functional dentition was a less significant predictor than ethnicity and being foreign-born. These variables, together with gender, years since immigrating, number of carious roots, and periodontal status, could predict 32% of the variance in total GOHAI, 24% in Physical, 27% in Social, and 21% in the Worry subscales. These findings suggest that functional dentition and caries influence older adults' OHQOL, but that ethnicity and immigrant status play a larger role.

The effects of catecholamine depletion on the neural response to fearful faces in remitted depression

Recent evidence suggests that increased psychophysiological response to negatively valenced emotional stimuli found in major depressive disorder (MDD) may be associated with reduced catecholaminergic neurotransmission. Fourteen unmedicated, remitted subjects with MDD (RMDD) and 13 healthy control subjects underwent catecholamine depletion with oral α-methyl-para-tyrosine (AMPT) in a randomized, placebo-controlled, double-blind crossover trial. Subjects were exposed to fearful (FF) and neutral faces (NF) during a scan with [15O]H2O positron emission tomography to assess the brain-catecholamine interaction in brain regions previously associated with emotional face processing. Treatment with AMPT resulted in significantly increased, normalized cerebral blood flow (CBF) in the left inferior temporal gyrus (ITG) and significantly decreased CBF in the right cerebellum across conditions and groups. In RMDD, flow in the left posterior cingulate cortex (PCC) increased significantly in the FF compared to the NF condition after AMPT, but remained unchanged after placebo, whereas healthy controls showed a significant increase under placebo and a significant decrease under AMPT in this brain region. In the left dorsolateral prefrontal cortex (DLPFC), flow decreased significantly in the FF compared to the NF condition under AMPT, and increased significantly under placebo in RMDD, whereas healthy controls showed no significant differences. Differences between AMPT and placebo of within-session changes in worry-symptoms were positively correlated with the corresponding changes in CBF in the right subgenual prefrontal cortex in RMDD. In conclusion, this study provided evidence for a catecholamine-related modulation of the neural responses to FF expressions in the left PCC and the left DLPFC in subjects with RMDD that might constitute a persistent, trait-like abnormality in MDD.

Psychotische Störungen im DSM-5

This article provides an overview of the main changes in the chapter "Schizophrenia Spectrum and Other Psychotic Disorders" from DSM-IV-TR to DSM-5, which, once again, does not make allowance for potential characteristics of children and adolescents. Changes in the main text include abandoning the classical subtypes of Schizophrenia as well as of the special significance of Schneider's first-rank symptoms, resulting in the general requirement of two key features (one having to be a positive symptom) in the definition of Schizophrenia and the allowance for bizarre contents in Delusional Disorders. Further introduced are the diagnosis of a delusional obsessive-compulsive/body dysmorphic disorder exclusively as Obsessive-Compulsive Disorder, the specification of affective episodes in Schizoaffective Disorder, and the formulation of a distinct subchapter "Catatonia" for the assessment of catatonic features in the context of several disorders. In Section III (Emerging Measures and Models) there is a recommendation for a dimensional description of psychoses. A likely source of confusion lies in the double introduction of an "Attenuated Psychosis Syndrome." On the one hand, a vague description is provided among "Other Specified Schizophrenia Spectrum and Other Psychotic Disorders" in the main text; on the other hand, there is a precise definition in Section III as a "Condition for Further Study." There is some cause to worry that this vague introduction of the attenuated psychosis syndrome in the main text might indeed open the floodgates to an overdiagnosis of subthreshold psychotic symptoms and their early pharmacological treatment.

Entwicklung der Fünf-Item-Kurzskala STAI-SKD zur Messung von Zustandsangst

Das State-Trait-Angstinventar (STAI) ist eines der am häufigsten eingesetzten Erhebungsinstrumente im Bereich der Angstdiagnostik. Die STAI-Skala zur Erfassung von Zustandsangst umfasst 20 Items. Unter bestimmten Erhebungsbedingungen erweist es sich als relativ schwierig, eine große Menge an Items zu bearbeiten oder aber es steht nicht ausreichend Testzeit zur Verfügung. Daher war es das Ziel der vorliegenden Studie, eine Kurzform der State-Version des STAI zu entwickeln. An einer Stichprobe von N = 65 Studierenden wurde aufgrund inhaltlicher und statistischer Kriterien eine Kurzform der State-Version des STAI, das STAI-SKD, mit fünf Items generiert. Eine konfirmatorische Faktorenanalyse an einer zweiten Stichprobe von N = 191 Studierenden zeigte, dass das STAI-SKD die Angstkomponenten Emotionality und Worry abbildet. Die Beziehungen des STAI-SKD zu positivem und negativem Affekt sowie dessen Veränderungssensitivität fielen in einer dritten Stichprobe (N = 80 Studierende) erwartungsgemäß aus. Die neue Kurzform der State-Version des STAI erlaubt eine ökonomische Erfassung der Zustandsangst.

Role of self-control strength in the relation between anxiety and cognitive performance

In the present work, we examine the role of self-control resources within the relationship between anxiety and cognitive test performance. We argue that self-control is required for keeping attention away from anxiety-related worries, which would otherwise distract a person from performing on the test. In Study 1 (N = 67) and Study 2 (N = 96), we found that state anxiety was negatively related to performance of verbal learning and mental arithmetic if participants' self-control resources were depleted, but it was unrelated if participants' self-control was intact. In Study 3 (N = 99), the worry component of trait test anxiety was more strongly related to perceived distraction by worries while performing an arithmetic task for participants with depleted self-control resources than for nondepleted participants. Furthermore, distraction by worries showed to be responsible for suboptimal performance. The findings may help to clarify the anxiety-performance relationship and offer a novel approach for counteracting performance decrements associated with test anxiety.

Experimenting and modeling: sharp distinctions, integration or just a mess?

At first sight, experimenting and modeling form two distinct modes of scientific inquiry. This spurs philosophical debates about how the distinction should be drawn (e.g. Morgan 2005, Winsberg 2009, Parker 2009). But much scientific practice casts serious doubts on the idea that the distinction makes much sense. There are two worries. First, the practices of modeling and experimenting are often intertwined in intricate ways because much modeling involves experimenting, and the interpretation of many experiments relies upon models. Second, there are borderline cases that seem to blur the distinction between experiment and model (if there is any). My talk tries to defend the philosophical project of distinguishing models from experiment and to advance the related philosophical debate. I begin with providing a minimalist framework of conceptualizing experimenting and modeling and their mutual relationships. The methods are conceptualized as different types of activities that are characterized by a primary goal, respectively. The minimalist framwork, which should be uncontroversial, suffices to accommodate the first worry. I address the second worry by suggesting several ways how to conceptualize the distinction in a more flexible way. I make a concrete suggestion of how the distinction may be drawn. I use examples from the history of science to argue my case. The talk concentrates and models and experiments, but I will comment on simulations too.

A Single-blinded, Randomized Clinical Trial of How to Implement an Evidence-based Treatment for Generalized Anxiety Disorder [IMPLEMENT] — Effects of Three Different Strategies of Implementation

BACKGROUND: Despite long-standing calls to disseminate evidence-based treatments for generalized anxiety (GAD), modest progress has been made in the study of how such treatments should be implemented. The primary objective of this study was to test three competing strategies on how to implement a cognitive behavioral treatment (CBT) for out-patients with GAD (i.e., comparison of one compensation vs. two capitalization models). METHODS: For our three-arm, single-blinded, randomized controlled trial (implementation of CBT for GAD [IMPLEMENT]), we recruited adults with GAD using advertisements in high-circulation newspapers to participate in a 14-session cognitive behavioral treatment (Mastery of your Anxiety and Worry, MAW-packet). We randomly assigned eligible patients using a full randomization procedure (1:1:1) to three different conditions of implementation: adherence priming (compensation model), which had a systematized focus on patients' individual GAD symptoms and how to compensate for these symptoms within the MAW-packet, and resource priming and supportive resource priming (capitalization model), which had systematized focuses on patients' strengths and abilities and how these strengths can be capitalized within the same packet. In the intention-to-treat population an outcome composite of primary and secondary symptoms-related self-report questionnaires was analyzed based on a hierarchical linear growth model from intake to 6-month follow-up assessment. This trial is registered at ClinicalTrials.gov (identifier: NCT02039193) and is closed to new participants. FINDINGS: From June 2012 to Nov. 2014, from 411 participants that were screened, 57 eligible participants were recruited and randomly assigned to three conditions. Forty-nine patients (86%) provided outcome data at post-assessment (14% dropout rate). All three conditions showed a highly significant reduction of symptoms over time. However, compared with the adherence priming condition, both resource priming conditions indicated faster symptom reduction. The observer ratings of a sub-sample of recorded videos (n = 100) showed that the therapists in the resource priming conditions conducted more strength-oriented interventions in comparison with the adherence priming condition. No patients died or attempted suicide. INTERPRETATION: To our knowledge, this is the first trial that focuses on capitalization and compensation models during the implementation of one prescriptive treatment packet for GAD. We have shown that GAD related symptoms were significantly faster reduced by the resource priming conditions, although the limitations of our study included a well-educated population. If replicated, our results suggest that therapists who implement a mental health treatment for GAD might profit from a systematized focus on capitalization models. FUNDING: Swiss Science National Foundation (SNSF-Nr. PZ00P1_136937/1) awarded to CF. KEYWORDS: Cognitive behavioral therapy; Evidence-based treatment; Implementation strategies; Randomized controlled trial