The avoidance of a decision is a phenomenon that has been studied in various forms and psychological disciplines. Nevertheless, previous studies often lacked the integration of situational as well as ...personal factors in predicting decision avoidance. Additionally, studies about conditions that affect different forms of decision avoidance are still lacking. Therefore, this study investigated how situational and personal factors influenced two different forms of decision avoidance: 1) the option of deferring choice to a later point in time (decision deferral) and 2) the option to refuse both alternatives (option refusal). Furthermore, this study aimed to analyze how the participants experienced their avoidance behavior. This served the purpose of capturing functional and dysfunctional avoidance out of a subjective perspective instead of providing predefined best options. A vignette study based on realistic decision-making scenarios within a student's daily life was conducted. In an online survey, N = 312 participants chose to decide, to defer choice, or to refuse options in the context of eight vignettes. Situational factors (time pressure, lack of information, and attractiveness of alternatives) were systematically varied. Additionally, the following personal factors were captured by questionnaires: indecisiveness, decision-making styles, and the need for cognitive closure. Further factors were captured, but not systematically varied: selection difficulty, importance of a decision, and similarity of alternatives. The individual satisfaction with decision-making behavior was evaluated as an indicator of subjective decision quality. The results showed that decision deferral was affected by situational factors (primarily due to time pressure), selection difficulty, and individual indecisiveness. The refusal of current alternatives was exclusively influenced by situational factors, mainly the manipulated attractiveness of the choice-set. The results emphasize the functionality of refusing unattractive options and help to distinguish adaptive and maladaptive coping forms in decision-making.
Aims
: Is there evidence for increased psychological distress and alterations in personality functioning in patients with Crohn’s disease (CD) and ulcerative colitis (UC) compared to healthy controls ...(HCs)?
Background
: In patients with CD and UC, perceived stress is closely associated with changes in disease activity. The stress response is influenced by psychological burden and personality functioning, but only little is known about these factors in inflammatory bowel diseases (IBD).
Study
: A total of 62 patients with an endoscopic ensured CD/UC without remission (
n
= 31 per group) and 31 HC were included. Patients with an active CD/UC and HC were individually matched (
n
= 93, 31 per group) for age, sex, education, and disease activity. Depression and anxiety were assessed to evaluate the effect of psychological burden (Patient Health Questionnaire-9/PHQ-9, Generalized Anxiety Disorder-7/GAD-7). Personality functioning was measured by validated questionnaires for psychodynamic structural characteristics, mentalization, and attachment (Operationalized Psychodynamic Diagnosis-Structure Questionnaire/OPD-SQ, Mentalization Questionnaire/MZQ, and Experiences in Close Relationships scale/ECR-RD 12).
Results
: Levels of depression and anxiety were higher in CD/UC patients than in HC with large effect sizes. Comparing personality functioning in CD/UC with HC, psychodynamic structural characteristics differed between CD/UC and HC with medium effect sizes, with structural differences occurring primarily in the domain of self-perception and regulation. Only minor differences were found regarding mentalization and attachment. CD and UC differed only with small effect sizes.
Conclusion
: Our data show that compared to HC, patients with CD/UC are characterized by a higher level of psychological burden and structural alterations in the domain of self.
Abstract
Background
Irritable bowel syndrome (IBS) appears to have a bidirectional interaction with both depressive and anxiety-related complaints. However, it remains unclear how exactly the ...psychological complaints, at the individual level, are related to somatic symptoms on a daily basis. This single case study investigates how somatic and psychological variables are temporally related in a patient with irritable bowel syndrome.
Case report
The patient was a woman in her mid-twenties with an IBS diagnosis. She reported frequent soft bowel movements (5–6 times per day), as well as flatulence and abdominal pain. She resembled a typical IBS patient; however, a marked feature of the patient was her high motivation for psychosomatic treatment as well as her willingness to try new strategies regarding the management of her symptoms. As an innovative approach this single case study used a longitudinal, observational, time series design. The patient answered questions regarding somatic and psychological variables daily over a period of twelve weeks with an online diary. The diary data was analysed using an autoregressive (VAR) modeling approach. Time series analyses showed that in most variables, strong same-day correlations between somatic (abdominal pain, daily impairment) and psychological time series (including coping strategies) were present. The day-lagged relationships indicated that higher values in abdominal pain on one day were predictive of higher values in the psychological variables on the following day (e.g. nervousness, tension, catastrophizing, hopelessness). The use of positive thinking as a coping strategy was helpful in reducing the pain on the following days.
Conclusion
In the presented case we found a high correlation between variables, with somatic symptoms temporally preceding psychological variables. In addition, for this patient, the use of positive thoughts as a coping strategy was helpful in reducing pain.
Objective
Irritable bowel syndrome (IBS) is a chronic disease leading to abdominal pain that is often related to psychological distress. The aim of the study was to investigate the temporal ...relationships between abdominal pain and psychological variables in patients with IBS.
Methods
This longitudinal diary study included eight patients from a waiting group, recruited in the frame of a pilot intervention study. During their waiting time of 3 months the patients answered questions daily regarding somatic and psychological variables using an online diary. All patients were considered and analyzed as single cases. The temporal dynamics between the time series of psycho-somatic variables were analyzed using a vector autoregressive (VAR) modeling approach.
Results
For all patients, positive same-day correlations between somatic and psychological time series were observed. The highest same-day correlations were found between somatic symptoms and pain-related discomfort (
r
= 0.40 to
r
= 0.94). Altogether,
n
= 26 significant lagged relationships were identified;
n
= 17 (65%) indicated that somatic values were predictive of psychological complaints on the following days.
N
= 9 (35%) lagged relationships indicated an opposite relationship in that psychological complaints were predictive of somatic symptoms. Three patients showed a significant positive same-day correlation between abdominal pain and use of a positive coping strategy. However, significant lagged relationships in two patients showed that for these patients the use of positive thinking as a coping strategy was unhelpful in reducing pain on the following days.
Conclusions
In patients with IBS abdominal symptoms appear to be closely related to psychological symptoms. For some patients, somatic complaints predict psychological complaints, in other patients the directionality is opposite. The impact of coping strategies on somatic symptoms varies among patients, therefore their role for a possible reduction of pain should be further explored. The results suggest the need of characterizing patientsindividually for effective health interventions. Individual time series analyses provide helpful tools for finding reasonable person-level moderators.
Objective:
Despite a wealth of treatment options for irritable bowel syndrome (IBS), data on the subjective experience of treatments in ongoing clinical practice are sparse. This follow-up study ...assessed the individual usage of treatment modalities by IBS patients over time and investigated the patients’ subjective experience of therapeutic impact.
Methods:
The study was conducted at the Specialty Clinic for Functional Gastrointestinal Disorders of the Heidelberg University Hospital. All patients who fulfilled the Rome III criteria for IBS and treated in our outpatient clinic between January 2012 and December 2016 were invited to the assessment. The primary outcome variables were individual usage of treatment modalities and the Patient Global Impression of Change (PGIC) with treatments.
Results:
Three hundred and sixty-six patients fulfilled the Rome III criteria for IBS and thus were eligible for this study. Two hundred and seven patients dropped out from the study. The study could include 159 patients (43.7 ± 17.1 years; 71.1% female). The mean time since the first visit to the clinic was 2.8 ± 1.3 years (median 3.0 years). The mean time of symptom duration was 14.1 ± 11.1 years (median 10 years). The average number of treatment attempts was 12, ranging from 2 to 39). With respect to the subjective experience of therapeutic impact, there were no significant differences in the PGIC scores among different treatments (
p
= 0.183). The rates of non-response rates (minimally improved, no change, or minimally worse) ranged from 63.0% to 83.9%. The PGIC score was correlated negatively with the mean number of treatment attempts (
r
= −0.316,
p
< 0.01). The mean number of treatment attempts was correlated negatively with quality of life (
r
= −0.262,
p
< 0.01).
Conclusion:
A multidisciplinary treatment approach of IBS is characterized by high rates of non-response and a high number of frustrating treatment attempts. The connection between the various treatment attempts and the frustrating subjective experience of therapeutic impact puts a substantial burden on IBS patients.
Somatic symptom disorder (SSD) is one of the most common reasons for consultations in primary care, in addition to simple acute infections. Questionnaire-based screening instruments to identify ...patients at high risk of SSD are thus of great clinical relevance. Although screening instruments are frequently used, it is currently unclear to what extent they are influenced by the concurrent presence of simple acute infections. Therefore, this study aimed to investigate how symptoms of simple acute infections affect the two established questionnaires as screening instruments for somatic symptom disorder in the primary care setting.
In our cross-sectional, multicenter design, a total of 1,000 patients in primary care practices were screened using the two most established SSD screening questionnaires, the 8-item Somatic Symptom Scale (SSS-8) and the 12-item Somatic Symptom Disorder-B Criteria Scale (SSD-12), followed by clinical assessment by the primary care physician.
A total of 140 patients with a simple acute infection (acute infection group, AIG) and 219 patients with chronic somatic symptoms (somatic symptom group, SSG) were included. The patients in the SSG showed higher total SSS-8 and SSD-12 scores than the patients in the AIG; however, the SSS-8 was more susceptible to changes triggered by symptoms of a simple acute infection than the SSD-12.
These results suggest that the SSD-12 is less susceptible to symptoms of a simple acute infection. Its total score and corresponding cutoff value provide a more specific and thus less susceptible screening tool for identifying SSD in primary care.
Zusammenfassung
Das subjektive Erleben im Verschwörungsglauben bietet durch seine aggressiven Fantasien und anschaulichen Motivwelten spannende Anhaltspunkte für ein psychodynamisches Verständnis. In ...diesem Artikel wird dargelegt, inwiefern die inneren Erlebniswelten im Verschwörungsglauben metaphorische Vorstellungen des Weltbildes und der innewohnenden Selbst- und Objektrepräsentanzen bieten könnten. Zusätzlich erfolgt eine Analyse der klassischen Motive im Verschwörungsglauben hinsichtlich ihrer möglichen psychodynamischen Funktion: (1) die Marionette und ihr Puppenspieler, (2) der „Erwachte“ vs. die „Schlafenden“, (3) „gegen den Strom“ vs. „Mainstream“, (4) „David gegen Goliath“, (5) apokalyptische Krisen und „Phönix aus der Asche“, (6) Grenz-Schutz vor „feindlichen Eindringlingen“ und (7) Selbstversorger und Selbstverwalter. Anhand der Motivwahl werden Hypothesen über die unterschiedlichen Ausgestaltungen der primären unbewussten Ängste, psychischen Funktionen und favorisierten Bewältigungsstile aufgestellt. Abschließend wird erörtert, inwiefern das Misstrauen im Verschwörungsglauben als vertrautes inneres Terrain letztlich vergangenes äußeres Terrain, welches auf dem biografischen und soziokulturellen Nährboden von Macht und Abhängigkeit in der Eltern-Kind-Beziehung und (familiären) Erfahrungen mit staatlicher Gewalt und Fürsorge fußt, widerspiegeln könnte.
Deficits in affective processing are associated with impairments in both mental and physical health. The role of affective processing in patients with functional somatic complaints such as irritable ...bowel syndrome (IBS) remains unclear. Most studies have focused on the capacity for emotional awareness and expression, but neglect other dimensions of affective processing. Therefore, this study aimed to systematically analyze differences in six different dimensions of affective processing between patients with IBS and healthy controls (HCs). Additionally, we exploratively investigated the impact of IBS symptom severity, psychological distress, and attachment styles on affective processing in IBS.
A controlled cross-sectional multi-center study was conducted. Overall, 127 patients with IBS were compared with 127 matched HCs using multivariate analysis of variances. Affective processing was operationalized in line with the affect cascade model on six specific dimensions: emotional experience, emotional awareness, affect tolerance, affect differentiation, affect regulation, and emotional communication. They were measured using two subscales of the Mentalizing Questionnaire (MZQ) and four subscales of the Operationalized Psychodynamic Diagnosis-Structure Questionnaire (OPD-SQ). Linear regression analysis was used to investigate the influence of IBS symptom severity (IBS-Severity Scoring System, IBS-SSS), depression (Patient Health Questionnaire, PHQ-9), anxiety (General Anxiety Disorder, GAD-7), and anxious and avoidant attachment styles (Experiences in Close Relationships Scale, ECR-RD12) on the different dimensions of affective processing in IBS.
Patients with IBS compared to HCs showed deficits in all six dimensions of affective processing. Deficits were largest for affect tolerance (
= 0.849) and lowest for emotional experience (
= 0.222) and emotional awareness (
= 0.420). Moderate effect sizes were found for affect differentiation (
= 0.773), emotional communication (
= 0.665), and affect regulation (
= 0.552). Moreover, explorative analyses indicated that affective processing in patients with IBS was significantly influenced by levels of anxiety and insecure attachment.
The results indicate a specific pattern of affective processing abilities in patients with IBS. The deficits in affective processing are more prominent in the area of understanding and tolerating difficult affective states than experiencing affective states. This opens interesting perspectives for the development of specific psychotherapeutic interventions.
DRKS00011685.
Objectives. Overlaps between different functional gastrointestinal disorders (FGIDs) are common. However, little is known about the impact of this overlap on patients’ health status. This study is ...aimed at analyzing the differences between patients with multiple as compared to one single FGID. Methods. A retrospective, cross-sectional study was conducted with patients presenting to a tertiary care FGID specialty clinic between 06/2012 and 01/2015 (n=294). They were characterized primarily according to their GI symptom severity (IBS-SSS) and secondarily to their physical as well as psychosocial symptom burden, quality of life, health care utilization, and work-related impairment. Differences between patients with >1 vs. 1 FGID were analyzed. Results. Of the 294 patients, 92.2% fulfilled the Rome III criteria for any FGID, and 48.0% had >1 FGIDs. FGID patients had a median age of 38 23.0 years; 72.0% were female. Median GI symptom severity (IBS-SSS) scores were 339 126 and 232 163 in patients with >1 and 1 FGID, respectively (p<.001). Furthermore, patients with >1 FGIDs had higher general somatic symptom severity, higher illness anxiety, lower quality of life, and more work-related impairment. Almost no differences were found regarding their somatic as well as mental comorbidities. Conclusions. Multiple FGIDs are associated with an increased risk for complicated courses of illness as reflected in higher GI and somatic symptom severity, as well as stronger psychosocial and diet- and work-related impairment. Stepped and interdisciplinary models of care including psychosocial expertise and dietary advice are needed, especially for patients with multiple FGIDs.
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