To evaluate psychological treatments for adolescent binge‐eating disorder (BED), reliable information on therapeutic process factors is needed. This study examines therapist adherence and therapeutic ...alliance and their associations in cognitive‐behavioural therapy (CBT) for adolescents with BED. In a randomised‐controlled efficacy trial, adherence and alliance were objectively determined based on 247 audio‐taped CBT sessions from a sample of N = 64 adolescents with BED. Variability of adherence and alliance, explained by treatment module, patient, and therapist were examined using multilevel modeling. Although adherence and alliance were excellent and unaffected by treatment module and therapist, there was significant between‐patient variability for both concepts. Adherence was negatively associated with patient's treatment expectation. Alliance was negatively associated with the number of loss of control eating episodes and positively associated with adherence. Excellent adherence supported the internal validity of CBT for adolescent BED. Associations between process factors and patient characteristics demand adequate supervision in CBT.
Objective
Internet‐based guided self‐help (GSH‐I) is an efficacious treatment for adults with binge‐eating disorder (BED) and overweight or obesity. Although broadly accessible, high dropout from ...GSH‐I has been reported. However, little is known about the factors explaining dropout from GSH‐I, including patients' adherence to treatment.
Method
Within a randomized trial on the treatment of BED, adherence to 4‐month GSH‐I was objectively assessed in N = 89 patients with BED and overweight or obesity. Objective adherence and subjective treatment evaluation were evaluated as predictors of dropout from GSH‐I, defined as having accessed 5 or less of 11 modules. Cutoffs with optimal sensitivity and specificity were derived using Receiver Operating Characteristics curves analysis, and baseline sociodemographic and clinical correlates were determined.
Results
According to our definition, n = 22 (24.7%) patients were defined as dropouts. Results of the full logistic regression model accounted for 72% of the variance in dropout and all objective adherence parameters (i.e., number of messages exchanged, days with a completed food diary, and days spent per module), but not patients' subjective GSH‐I evaluation significantly predicted dropout. Specifically, not completing the food diary in week 7 had maximized sensitivity and specificity in predicting dropout. Patients' body mass index was positively associated with the number of messages exchanged between patients and coaches. No other associations between baseline variables and objective adherence were found.
Discussion
Patients at risk for dropout from GSH‐I can be reliably identified via monitoring of objective adherence and may be provided with additional interventions to prevent dropout.
Background: Individuals with obesity face weight-related discrimination in many life domains, including workplace bullying, especially in female employees with obesity. However, associations between ...experiences of workplace bullying and psychological health impairments considering weight status and sex remain unclear. Methods: Within a representative population-based sample of N = 1290 employees, self-reported experiences of workplace bullying were examined for variations by weight status and sex. Using path analyses, sex-specific mediation effects of workplace bullying on associations between weight status and work-related psychological health impairments (burnout symptoms, quality of life) were tested. Results: Employees with obesity experienced more workplace bullying than those with normal weight. Workplace bullying was positively associated with psychological health impairments and partially mediated the associations between higher weight status and elevated burnout symptoms and lower quality of life in women, but not in men. Conclusions: The result that more experiences of workplace bullying were, compared with weight status, more strongly associated with work-related psychological health impairments in women, but not in men, uniquely extends evidence on sex-specific effects within weight-related discrimination. Continued efforts by researchers, employers, and policy makers are needed to reduce weight-related discrimination in work settings, eventually increasing employees’ health and job productivity.
During the transition to parenthood, a complex network of relationships unfolds between father, mother and the child. Expectant parents begin bonding with their unborn child, with this antenatal ...process supposedly being predictive for later postnatal attachment and child mental health. At the same time, couples may experience a change in partnership quality. While the majority of previous studies focused on associations between psychopathology, partnership quality and attachment from the perspective of mothers, the changes in partnership quality and attachment from the perspective of fathers has gained far less attention.
Data were derived from the
aternal
nxiety and it's
elation to
nfants' Development (MARI) study.
= 109 expectant fathers were recruited during mid-pregnancy (22 to 26 week of gestation). Lifetime anxiety and depressive disorders (DSM-IV) were assessed with a standardized diagnostic interview (CIDI). Paternal partnership characteristics and father-to-child attachments were assessed using standardized questionnaires at the second trimester, 10 days after delivery and 4 months after delivery in
= 76 fathers. Analyses were based on bivariate, robust and multivariate regression analyses.
Fathers did not report an overall decrease in partnership quality during the peripartum period. However, fathers with comorbid anxiety and depressive disorders reported lower partnership satisfaction at postpartum, as compared to unaffected fathers. Fathers with pure depressive disorders reported lower intensity of antenatal attachment. Paternal antenatal partnership quality was positively associated with antenatal father-to-child attachment. Furthermore, antenatal father-to-child attachment, as well as ante- and postnatal partnership quality in fathers, were positively related to postnatal father-to-child attachment.
Antenatal father-to-child-attachment and paternal partnership quality appear to be promising targets for the prevention of postnatal attachment problems in fathers. The associations between partnership quality and attachment to the child further support an interpersonal approach in perinatal research, treatment and intervention, and may also feed into awareness programs that encourage expectant fathers to actively engage in relationships as early as during pregnancy-both with the mother and the unborn child.
Introduction: Individuals suffering from overweight or obesity frequently experience weight-based stigmatization. The widespread belief that weight is a matter of personal will and self-control ...results in various weight-based stereotypes (e.g., laziness, lack of self-discipline, or neglect). Objective: Based on the modified version of the Weight Bias Internalization Scale (WBIS-M), a short form for the economic assessment of weight bias internalization in the general population was compiled and validated. Methods: A three-item short form (WBIS-3) was derived based on data from a representative sample of the German population (n = 1,092). This new short form was validated in a second representative population sample (n = 2,513). Item characteristics and internal consistency were obtained. Measurement invariance was tested. Construct validity was established via the correlation with theoretically related constructs (depression, anxiety, eating behavior, discrimination, weight status). To establish scale validity, all analyses were performed for the whole sample as well as for the subsample of individuals with overweight. Age- and gender-specific population norms were provided. Results: The WBIS-3 exhibited excellent psychometric properties. Internal consistency was α = 0.92. Strong measurement invariance was confirmed regarding age, gender, discrimination, and weight status in both the whole sample as well as the overweight subsample. Conclusions: The WBIS-3 constitutes a valid and economical tool for the assessment of weight bias internalization in epidemiological contexts. Measurement invariance allows for an unbiased comparison of means, correlation coefficients, and path coefficients within structural equation modeling across groups.
Die Binge-Eating-Störung (BES) wird als die häufigste Essstörung bei Erwachsenen und Jugendlichen beschrieben und weist eine hohe Relevanz für die individuelle und öffentliche Gesundheit auf, vor ...allem basierend auf ihren vielfältigen medizinischen und psychologischen Begleiterscheinungen und dem erheblichen klinischen Leiden der Betroffenen. Die Entwicklung und systematische Evaluierung therapeutischer Ansätze für Betroffene mit BES war und ist somit dringend geboten und liefert heute ein differenziertes Bild der Möglichkeiten und Grenzen psychotherapeutischen Agierens zur Behandlung der BES. Die Behandlungsoption mit der größten Evidenzbasierung bei der BES stellt die Kognitive Verhaltenstherapie (KVT) in ihrem klassischen psychotherapeutischen Modus, also von Angesicht zu Angesicht dar. Um relevante patientenbezogene und organisatorische Barrieren zu umgehen, werden die Prinzipien der KVT außerdem in Form von strukturierter Selbsthilfe (sSH) umgesetzt, deren spezifische Wirksamkeit bei BES ebenfalls meta-analytisch bestätigt wurde. Bei der Konzeption und Weiterentwicklung der Wirksamkeit von psychotherapeutischen Behandlungsansätzen bei BES sind zentrale Prozessaspekte herausgestellt worden, deren Ausprägung und Zustandekommen eine Rolle beim Erwirken erwünschter psychotherapeutischer Ergebnisse spielen. Die in dieser Dissertation betrachteten sogenannten „Prozessfaktoren“ umfassen die therapeutische Allianz, also die emotionale und kooperative Bindung zwischen Therapeut und Patient, einschließlich ihrer Übereinstimmung bezüglich Aufgaben und Zielen der Therapie sowie die therapeutische Adhärenz, also der Grad der Übereinstimmung zwischen Therapiemanual und tatsächlichem therapeutischen Vorgehen. Im Kontext der beschriebenen Vorbefunde konnte Studie 1 erstmalig zeigen, dass die therapeutische Adhärenz und Allianz in der altersangepassten KVT bei Jugendlichen mit BES standardisiert, objektiv, reliabel und mit guten psychometrischen Gütekriterien erfasst werden können sowie dass beide Parameter in der untersuchten Behandlung hohe Ausprägungen aufwiesen. Hypothesenkonform zeigten sich keine Assoziationen beider Parameter mit Therapeuten- oder Behandlungsmerkmalen, während verringerte Adhärenz mit höheren Erwartungen der jugendlichen Patienten an den Erfolg der Therapie und erhöhte Allianz mit einer geringeren Symptomschwere zu Beginn der Therapie verbunden waren.
Bezogen auf die Umsetzung kognitiv-verhaltenstherapeutischer Inhalte in Form von sSH, ergibt sich anhand der theoretischen Vorüberlegungen die besondere Relevanz von möglichst vollständiger Partizipation der Patienten in derartigen Therapie-Programmen. Studie 2 liefert, basierend auf Daten einer randomisiert-kontrollierten Studie zur Wirksamkeit von Internetbasierter sSH ein detailliertes Bild der Partizipation innerhalb der Internetbasierten sSH und belegt im Mittel die programmtreue Durchführung der Patienten, aber auch eine mit Vorbefunden vergleichbar hohe Dropout-Rate von knapp 25% der Patienten. Im Vergleich zu Patienten, deren Adhärenzwerte andeuten, dass sie sich an die empfohlenen Durchführungsmodalitäten gehalten haben (z.B. an allen Tagen das Ernährungstagebuch geführt haben), weisen jene Patienten ein höheres Dropout-Risiko auf, die das Ernährungstagebuch an weniger Tagen vollständig ausgefüllt, weniger Nachrichten mit ihrem Therapeuten ausgetauscht und länger für die Bearbeitung einzelner Module benötigt haben. Dabei zeigte sich nicht nur ein großer prädiktiver Effekt von 72% im Gesamtmodell, sondern auch eine besonders hohe Sensitivität und Spezifität für die Prädiktion von Dropout in Bezug auf das unvollständige Ausfüllen des Ernährungstagebuches in Therapiewoche 7, womit dieser Adhärenzparameter zu diesem Zeitpunkt den optimalsten Prädiktor für späteren Dropout in der vorliegenden Studie darstellte. Während nur der BMI einen signifikanten Zusammenhang zur Anzahl der ausgetauschten Nachrichten aufwies, war kein weiteres Patientenmerkmal (zu Beginn der Therapie) mit den beobachteten Adhärenzparametern bzw. Dropout assoziiert. Im Zusammenhang mit dem großen prädiktiven Wert der Adhärenzparameter in der vorliegenden Studie zeigt dieses Ergebnis zudem, dass objektiv erhobene Adhärenzparameter bei der Vorhersage von Dropout gegenüber Patientenmerkmalen zu bevorzugen sind. Vor dem Hintergrund, dass Adhärenz in Internet- oder App-basierten sSH-Programmen automatisch und objektiv erfasst werden kann, könnte deren automatische Überwachung bei der Entwicklung und Durchführung derartiger Programme dabei helfen, Patienten mit abnehmender Adhärenz und einem assoziierten Risiko für späteres Ausscheiden aus der Therapie zu identifizieren.
Das klinische Erscheinungsbild der BES ist neben der Essstörungssymptomatik in besonderem Maße von komorbid auftretenden Beeinträchtigungen geprägt, welche in erster Linie Übergewicht (BMI ≥ 25 kg/m²) und Adipositas (BMI ≥ 30 kg/m²) aber auch psychische Störungen wie Angst-, affektive und Substanzkonsumstörungen umfassen. Betroffene der BES berichten neben diesen Komorbiditäten weiterhin psychosoziale und interpersonelle Probleme sowie Einschränkungen der Lebensqualität. Vor allem Betroffene mit komorbid auftretendem Übergewicht bzw. Adipositas leiden zusätzlich unter den medizinischen und psychologischen Korrelaten des Übergewichts sowie unter den verschiedenen Formen gewichtsbezogener Stigmatisierung, mit denen sie in zentralen Lebensbereichen konfrontiert sind (z.B. am Arbeitsplatz, im Gesundheits- und Bildungswesen). Eine stetig wachsende Zahl an wissenschaftlichen Studien belegt wiederum die negativen medizinischen und psychologischen Korrelate von Erfahrungen mit gewichtsbezogener Stigmatisierung, die sich zu den primären Gesundheitseinschränkungen des Übergewichts hinzuaddieren. Basierend auf Daten einer großangelegten, bevölkerungsrepräsentativen Befragung in der deutschen Bevölkerung konnte Studie 3 zeigen, dass Menschen mit Adipositas im Vergleich mit Normalgewichtigen mehr Mobbingerfahrungen berichten. Ein erhöhtes Körpergewicht war nur bei Frauen mit arbeitsplatzbezogenen Gesundheitseinschränkungen (stärkeren Burnout-Symptomen, verringerter Lebensqualität) verbunden. Zusätzlich erwiesen sich Mobbingerfahrungen am Arbeitsplatz, nur bei Frauen und nicht bei Männern, als partieller Mediator für den Zusammenhang von erhöhtem Körpergewicht und arbeitsplatzbezogenen Gesundheitseinschränkungen. Somit legen die Ergebnisse nahe, dass sich, besonders bei Frauen mit Adipositas, verschiedene diskriminierte Merkmale (also weibliches Geschlecht und erhöhtes Körpergewicht) aufsummieren, wodurch sich vor allem in dieser Bevölkerungsgruppe ein entsprechender Handlungsbedarf zur Reduktion der Diskriminierung ergibt, um letztlich die psychosozialen arbeitsbezogenen Belastungen sowie entsprechende medizinische und psychologische Gesundheitsbeeinträchtigungen für Arbeitnehmer und damit verbundene Produktivitätsverluste für Unternehmen abzumildern.:Inhaltsverzeichnis
Abbildungs- und Tabellenverzeichnis
Abkürzungen
1 Theoretischer Hintergrund
1.1 Die Binge-Eating-Störung
1.1.1 Definition, Epidemiologie und Komorbidität
1.1.2 Therapie der Binge-Eating-Störung
1.1.2.1 Therapeutische Ansätze und Evidenz
1.1.2.2 Psychotherapeutische Prozessfaktoren
1.2 Übergewicht und Adipositas
1.2.1 Definition, Epidemiologie und Komorbidität
1.2.2 Gewichtsbezogene Stigmatisierung am Arbeitsplatz
1.2.2.1 Auftreten gewichtsbezogener Stigmatisierung
1.2.2.2 Korrelate gewichtsbezogener Stigmatisierung
2 Ableitung der Forschungsfragen
2.1 Studie 1
2.2 Studie 2
2.3 Studie 3
3 Publikationsmanuskripte
3.1 Therapist adherence and therapeutic alliance in individual cognitive-behavioral therapy for adolescent binge-eating disorder
3.2 Adherence as a predictor of dropout in Internet-based guided self-help for adults with binge-eating disorder and overweight or obesity
3.3 Sex-specific mediation effects of workplace bullying on associations between employees' weight status and psychological health impairments
4 Zusammenfassung
5 Referenzen
Anlagen
To evaluate psychological treatments for adolescent binge-eating disorder (BED), reliable information on therapeutic process factors is needed. This study examines therapist adherence and therapeutic ...alliance and their associations in cognitive-behavioural therapy (CBT) for adolescents with BED. In a randomised-controlled efficacy trial, adherence and alliance were objectively determined based on 247 audio-taped CBT sessions from a sample of N = 64 adolescents with BED. Variability of adherence and alliance, explained by treatment module, patient, and therapist were examined using multilevel modeling. Although adherence and alliance were excellent and unaffected by treatment module and therapist, there was significant between-patient variability for both concepts. Adherence was negatively associated with patient's treatment expectation. Alliance was negatively associated with the number of loss of control eating episodes and positively associated with adherence. Excellent adherence supported the internal validity of CBT for adolescent BED. Associations between process factors and patient characteristics demand adequate supervision in CBT.
Background & Aims Chronic HDV infection is an inflammatory liver disease and liver transplantation (LTX) remains the only curative treatment option for most patients. The hepatitis D virus (HDV) uses ...HBsAg as its surface protein, however, it is controversial to what extend HDV may be detected independently of HBsAg in blood and liver after LTX. The aims of this study were to investigate kinetics of HDV RNA and HBsAg early after LTX, to apply the data to a mathematical model and to study long-term persistence of HDV after LTX. Methods We retrospectively analyzed 26 patients with chronic hepatitis delta who underwent LTX between 1994 and 2009. Blood samples were obtained every 1–3 days during the first 14 days after LTX. Data were applied to a mathematical model to study viral kinetics. Available liver biopsy samples were stained for HBV and HDV viral antigens and tested for HBV DNA/cccDNA. Results HBsAg and HDV RNA became negative after a median of 5 days (range 1–13) and 4 days (range 1–10), respectively. Early HDV RNA and HBsAg decline paralleled almost exactly in all patients; however the mathematical model showed a high variability of virion death. HDAg stained positive in transplanted livers in six patients in the absence of liver HBV DNA/cccDNA, serum-HBsAg, and HDV RNA for up to 19 months after LTX. Conclusions HDV RNA and HBsAg decline follow almost identical kinetic patterns within the first days after LTX. Nevertheless, intrahepatic latency of HDAg has to be considered when exploring novel concepts to withdraw HBIG.
Introduction: Individuals suffering from overweight or obesity frequently experience weightbased stigmatization. The widespread belief that weight is a matter of personal will and selfcontrol results ...in various weight-based stereotypes (e.g., laziness, lack of self-discipline, or
neglect). Objective: Based on the modified version of the Weight Bias Internalization Scale
(WBIS-M), a short form for the economic assessment of weight bias internalization in the general population was compiled and validated. Methods: A three-item short form (WBIS-3) was
derived based on data from a representative sample of the German population (n = 1,092).
This new short form was validated in a second representative population sample (n = 2,513).
Item characteristics and internal consistency were obtained. Measurement invariance was
tested. Construct validity was established via the correlation with theoretically related constructs (depression, anxiety, eating behavior, discrimination, weight status). To establish scale
validity, all analyses were performed for the whole sample as well as for the subsample of individuals with overweight. Age- and gender-specific population norms were provided. Results: The WBIS-3 exhibited excellent psychometric properties. Internal consistency was α =
0.92. Strong measurement invariance was confirmed regarding age, gender, discrimination,
and weight status in both the whole sample as well as the overweight subsample. Conclusions: The WBIS-3 constitutes a valid and economical tool for the assessment of weight bias
internalization in epidemiological contexts. Measurement invariance allows for an unbiased
comparison of means, correlation coefficients, and path coefficients within structural equation modeling across groups
PDF
