Background and Aims
Existing evidence suggests that text message interventions can help people to reduce their alcohol consumption. However, studies with alcohol‐dependent patients are lacking. In ...this study a 1‐year automatic mobile phone‐based short messaging service (SMS) intervention on alcohol consumption in patients after alcohol detoxification in hospital was compared with treatment as usual.
Design
Multi‐center, randomized, controlled, two parallel‐group, observer‐blinded trial.
Setting and Participants
Primary and secondary care: four hospitals and community (1 million residents, 7600 km2 area in Germany). A total of 462 patients with alcohol dependence (ICD‐10) were included during inpatient detoxification treatment. Patients were randomly assigned (1 : 1) to an SMS intervention and treatment as usual (SMS + TAU; n = 230; mean age: 45.4 years; 22.6% women) or TAU alone (n = 232 mean age: 44.5 years; 22.8% women). Planned, automated messages were sent to patients over 1 year to record assistance needs. A ‘yes’ or missing response triggered a telephone call from a hospital therapist. Outcome was assessed by an independent survey center.
Measurements
The primary end‐point was a three‐category alcohol consumption measure covering months 10–12 after discharge: abstinence, non‐heavy drinking, heavy drinking men > 60 g/day; women > 40 g/day equal to World Health Organization (WHO) criteria: high risk and very high risk, mean consumption. Secondary end‐points were number of abstinent days over 12 months and frequency of abstinence.
Results
The arms differed primarily in the heavy drinking category (intervention group 22.2%, TAU‐only group 32.3%) in months 9–12. This is reflected by an odds ratio (OR) = 1.68, 95% confidence interval (CI) = 1.11–2.54, P = 0.015 for heavy drinking versus non‐heavy drinking/abstinence. No difference between treatments was found with respect to any drinking versus abstinence (OR = 1.13). These results were confirmed by models adjusting for randomization strata.
Conclusions
In Germany, a 12‐month mobile phone short messaging service‐based intervention enhanced the reduction in heavy drinking for 1 year in routine care among adults with alcohol dependence discharged from inpatient alcohol detoxification.
•Alexithymia, chronic stress and declarative memory performance were measured.•Alexithymia predicted impaired declarative memory performance.•Perceived chronic stress predicted immediate, but not ...delayed recall.•Alexithymia was strongly associated with perceived chronic stress.•Chronic stress mediated the relation of alexithymia with immediate recall.
Previous evidence showed associations of alexithymia with altered declarative memory performance. However, these findings were not fully consistent and the underlying mechanism remains unclear. Alexithymic subjects may be at specific risk for chronic psychosocial stress, which in turn represents a predictor for poorer memory performance. We investigated independent and interaction effects of alexithymia and chronic perceived stress on declarative memory performance. Data were used from two independent general-population samples from the Study of Health in Pomerania (SHIP). In sample 1 (N = 1981), the Auditory Verbal Learning Test, the Toronto Alexithymia Scale (TAS-20) and the Screening Scale for Chronic Stress (SSCS) were applied. In sample 2 (N = 3799), the word list of the Nuremburg Age Inventory and TAS-20 were administered to replicate findings. Alexithymia was significantly associated with poorer immediate and delayed word recall. Chronic stress negatively predicted immediate, but not delayed recall. Alexithymia and particularly “Difficulties Identifying Feelings” showed significant associations with chronic perceived stress. Our findings provide clear evidence for an association of alexithymia with impaired declarative memory performance for words. The strong association of alexithymia with perceived chronic stress could contribute to explain the association of alexithymia with stress-related disorders.
ABSTRACTUp to now, it has remained unclear whether displacement itself is the pathogenetic factor for the impairment of mental health in uprooted individuals or whether the effect is mediated by the ...amount of traumatic events experienced during forced displacement and/or by the development of posttraumatic stress disorder (PTSD). A total of 1657 participants were included in this population-based study, who were then administered with the Patient Health Questionnaire, a modified trauma list of the PTSD module of the Munich Composite International Diagnostic Interview, and the Posttraumatic Diagnostic Scale. Displacement was associated with increased rates of traumatic events. The displaced participants were significantly more affected by somatoform symptoms and PTSD than the nondisplaced population. It was not displacement itself but the amount of trauma experienced during displacement that predicts current somatization in the population-based sample. The results highlight the necessity for prevention and treatment of posttraumatic conditions in displaced individuals and underpin the importance to understand somatization as one condition of the posttraumatic symptoms spectrum in the elderly.
Abstract Objectives As a personality trait, alexithymia is assumed to present a longstanding risk factor for emotional dysregulation that also affects the autonomic nervous system. Therefore, we ...hypothesize that alexithymia is associated with hypertension and carotid atherosclerosis in the general population. Methods A total of 1168 subjects (age <65 years) from the Study of Health in Pomerania (SHIP) were eligible for complete case analyses. Alexithymia was assessed with the 20-item Toronto-Alexithymia-Scale (TAS-20). An extensive interview and physical examination were performed. Extracranial carotid arteries were examined bilaterally with B-mode ultrasonography. Regression models were adjusted for sociodemographic factors and classical risk factors for cardiovascular diseases and mental distress. Results In the adjusted logistic regression models, alexithymia was significantly associated with hypertension (OR=1.60; 95% CI=1.14–2.25) and with atherosclerotic plaques (OR=1.70; 95% CI=1.14–2.54). Hypertension changed the effect of alexithymia on atherosclerosis only marginally (OR=1.76 to 1.70). Conclusion Alexithymia may represent a relevant and independent risk factor for hypertension and carotid atherosclerosis at the population level. None of the putative confounders mediated a relevant proportion of the risk. Prospective studies are needed to confirm this association.
Objective: Previous research has indicated that dissociation might be a negative predictor of treatment outcome in cognitive behavioural therapy for patients with obsessive-compulsive and anxiety ...disorders. Using a naturalistic design it was hypothesized that higher levels of dissociation predict poorer outcome in inpatients with affective, anxiety and somatoform disorders participating in a brief psychodynamic psychotherapy.
Method: A total of 133 patients completed the Symptom Check List (SCL-90), the German short version of the Dissociative Experiences Scale and the Inventory of Interpersonal Problems at the beginning and the end of treatment. The Global Severity Index (GSI) of the SCL-90 was chosen as outcome criterion.
Results: A total of 62.4% of study participants were classified as treatment responders, that is, they showed a statistically significant change of their GSI scores. Controlling for general psychopathology, the non-responders had significantly higher baseline dissociation scores than the responders. In a logistic regression analysis with non-response as a dependent variable, a comorbid personality disorder, low baseline psychopathology and high dissociation levels emerged as relevant predictors, but interpersonal problems and other comorbid disorders did not.
Conclusions: Dissociation has a negative impact on treatment outcome. It is suggested that dissociative subjects dissociate as a response to negative emotions arising in psychotherapy leading to a less favourable outcome. Additionally, dissociative patients may have an insecure attachment pattern negatively affecting the therapeutic relationship. Thus, dissociation may directly and indirectly influence the treatment process and outcome.
Alexithymia and Outcome in Psychotherapy Grabe, Hans Joergen; Frommer, Jörg; Ankerhold, Annegret ...
Psychotherapy and psychosomatics,
01/2008, Letnik:
77, Številka:
3
Journal Article
Recenzirano
Background: About 25% of all patients seeking psychotherapeutic treatment are considered to be alexithymic. Alexithymia has been assumed to be negatively associated with therapeutic outcome. On the ...other hand, it is unclear to which extent alexithymia itself may be modified by psychotherapeutic interventions. Methods: From 414 consecutively admitted inpatients, 297 were followed up after 4 weeks (t1) and after 8–12 weeks (t2) upon discharge. Patients were treated with psychodynamic group therapy in a naturalistic setting. The Toronto Alexithymia Scale (TAS-20) and the Symptom Checklist-90 were administered. Results: Twenty-seven percent of the patients were alexithymic (TAS-20 ≧61) at baseline. Multivariate models with repeated measurements indicated significant changes in Global Severity Index of the Symptom Checklist-90 in both alexithymic and nonalexithymic subjects. However, alexithymic subjects had significantly higher Global Severity Index scores than nonalexithymic subjects at t0, t1 and t2 (p < 0.001). The TAS-20 scores demonstrated a high relative stability in the total sample. However, in the alexithymic group, the TAS-20 scores changed considerably from baseline to discharge 66.3 (SD = 4.7) to 55.9 (SD = 9.9); t = 8.69; d.f. = 79; p < 0.001. Conclusion: The inpatient treatment program including psychodynamic group therapy significantly reduced psychopathological distress and alexithymic features in alexithymic patients. Still, these patients suffered from higher psychopathological distress at discharge than nonalexithymics. Therefore, alexithymic features may negatively affect the long-term outcome.
Zusammenfassung
Supervision ist ein unverzichtbarer Bestandteil der Aus‑, Fort- und Weiterbildung und der klinischen Praxis. Qualifikationsmerkmale der Supervisoren sowie die Erfordernisse zu deren ...Ausbildung wurden bisher nicht ausreichend definiert. In diesem Beitrag werden die vorliegenden Vorschläge von Qualifikationskriterien für Supervisoren vorgestellt und diskutiert. Zusätzlich werden einige Trainings- und Ausbildungskonzepte vorgestellt. Hieraus werden Vorschläge für einen spezifizierten Kompetenzerwerb und für die Zertifizierung von Supervisoren abgeleitet.
Childhood abuse and neglect are associated with worse physical and mental health outcomes. There is some evidence, that the CTS is a brief and valid screening tool. To support the application of the ...CTS for categorical diagnostics cut-offs will be identified and validated.
Based on two large-scale population studies suitable cut-off-scores for the different dimensions of childhood abuse and neglect were identified due to comparable case identification rates in the CTS compared with the Childhood Trauma Questionnaire. The cut-off-scores were validated with respect to depression as an external criterion.
Suitable cut-off-scores were identified for all subscales in both samples. The cases and non-cases according to the cut-off-scores differed significantly regarding the severity of depressive symptoms and the prevalence of depression. Good to very good sensitivity and specificity of the CTS-items and the related subscales of the CTQ are shown, except for the dimension "physical neglect".
With the help of the cut-off-scores it is possible to use the CTS for categorical diagnostics, especially in large-scale studies with two-step diagnostic approaches.
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