Injustice and Embitterment: Crucial Stressors in Psychosomatic Patients.

OBJECTIVE: "Disorders specifically associated with stress" are receiving increasing attention in clinical practice, research, and modern classification systems of mental disorders. This includes not only reactions to "extremely threatening or horrific events" as it is characteristic for "post-traumatic stress disorders" but also a variety of day-to-day experiences. Examples are experiences of injustice, humiliation, or breach of trust which can have dire psychological consequences such as feelings of embitterment, a strong and crippling emotion. This study investigated the frequency of feelings of injustice and concomitant embitterment across different areas of daily life of psychosomatic patients. METHODS: In an observational archival study, 200 inpatients of a department of behavioral medicine filled in the "Differential Life Burden Scale, DLB-Scale" and the "Post-Traumatic Embitterment Scale, PTED-Scale" which asks for experiences of injustice and embitterment. RESULTS: More than half of all patients (58.5%) reported about very or extremely unjust and unfair life events and 51.5% additionally about feelings of embitterment. This was primarily associated with complaints about problems in the family and the workplace and was accompanied by an impairment of well-being. CONCLUSIONS: The findings indicate that experiences of injustice and embitterment are frequently seen in psychosomatic inpatients and should get special attention.

Promoting stigma coping and empowerment in patients with schizophrenia and depression: results of a cluster-RCT.

There is a need for interventions supporting patients with mental health conditions in coping with stigma and discrimination. A psycho-educational group therapy module to promote stigma coping and empowerment (STEM) was developed and tested for efficacy in patients with schizophrenia or depression. 30 clinical centers participated in a cluster-randomized clinical trial, representing a broad spectrum of mental health care settings: in-patient (acute treatment, rehabilitation), out-patient, and day-hospitals. As randomized, patients in the intervention group clusters/centers received an illness-specific eight sessions standard psychoeducational group therapy plus three specific sessions on stigma coping and empowerment ('STEM'). In the control group clusters the same standard psychoeducational group therapy was extended to 11 sessions followed by one booster session in both conditions. In total, N = 462 patients were included in the analysis (N = 117 with schizophrenia spectrum disorders, ICD-10 F2x; N = 345 with depression, ICD-10 F31.3-F31.5, F32-F34, and F43.2). Clinical and stigma-related measures were assessed before and directly after treatment, as well as after 6 weeks, 6 months, and 12 months (M12). Primary outcome was improvement in quality of life (QoL) assessed with the WHO-QOL-BREF between pre-assessment and M12 analyzed by mixed models and adjusted for pre-treatment differences. Overall, QoL and secondary outcome measures (symptoms, functioning, compliance, internalized stigma, self-esteem, empowerment) improved significantly, but there was no significant difference between intervention and control group. The short STEM module has proven its practicability as an add-on in different settings in routine mental health care. The overall increase in empowerment in both, schizophrenia and depression, indicates patients' treatment benefit. However, factors contributing to improvement need to be explored.The study has been registered in the following trial registers. ClinicalTrials.gov: https://register.clinicaltrials.gov/ Registration number: NCT01655368. DRKS: https://www.drks.de/drks_web/ Registration number: DRKS00004217.

[Wisdom Attitudes and Coping In Life of Psychosomatic Patients]. / Weisheitseinstellungen und Lebensbewältigung bei psychosomatischen Patienten.

BACKGROUND: Wisdom is a capacity, which is needed in coping with difficult problems in life. It can be understood as a special type of problem solving skill. It is getting growing recognition in psychology in general, and in psychotherapy and clinical practice in particular. Goal of the present study is to assess wisdom competencies and their correlates in psychosomatic patients, using for the first time the 12-WD-scale. METHOD: The 12-WD-Scale covers 12 wisdom dimensions. As part of their routine intake assessment, 202 unselected inpatients of a department of psychosomatic medicine filled in the 12-WD-scale together with the differential life burden scale, the global belief in a just world scale and the posttraumatic embitterment scale. Additional patient and clinical data could be taken from the routine data. RESULTS: Wisdom scores showed a normal distribution. The mean was in the positive range (4.50, SD=0.71). A factor analysis showed three factors (sobriety, serenity, modesty), explaining 53.7% of the total variance. There were positive correlations of the wisdom score with life satisfaction and age, negative correlations with beliefs in justice and embitterment, but not with formal education. DISCUSSION: The results of the 12-WD-Scale show that psychosomatic patients appreciate wisdom attitudes and that this is associated with better coping in life. Wisdom competencies are an interesting field in psychotherapy when patients are burdened by difficult situations in life. The 12-WD-scale can provide helpful information in this regard.

Treatment of posttraumatic embitterment disorder with cognitive behaviour therapy based on wisdom psychology and hedonia strategies.

BACKGROUND: Posttraumatic embitterment disorder (PTED) is a reaction to unjust or humiliating life events, including embitterment and impairment of mood, somatoform complaints, reduction in drive, withdrawal from social contacts, and even suicide and murder suicide. Patients have been shown to be nonresponders to many treatments. This paper gives an outline of cognitive behaviour therapy based on wisdom psychology and reports first data on treatment effects. METHOD: In a first pilot study on psychotherapy for PTED, a cohort of 25 PTED inpatients was treated with routine multidimensional cognitive behaviour therapy. A second consecutive cohort of 28 patients was treated with PTED-specific cognitive behaviour therapy, which is based on wisdom psychology (wisdom psychotherapy) and another 29 patients with cognitive behaviour therapy based on wisdom psychology together with additional hedonia strategies (wisdom and hedonia psychotherapy). Treatment integrity was measured with special modules of the Behaviour Therapy Competency Checklist. The outcomes were measured in all 3 groups with the SCL-90 and a global clinical rating of patients and therapists on treatment outcome. RESULTS: There were significant and clinically meaningful reductions in the SCL score after wisdom therapy, as compared to routine treatment. In clinical ratings by therapists and patients, both specific treatments were judged as more effective than treatment as usual. Additional hedonia strategies did not lead to better treatment effects. CONCLUSIONS: The results of this pilot study suggest that wisdom psychology offers an approach to treat PTED and justify further randomized controlled outcome studies.

The Post-Traumatic Embitterment Disorder Self-Rating Scale (PTED Scale).

The present study introduces the Post-Traumatic Embitterment Disorder Self-Rating Scale (PTED Scale), which asks for prolonged and disabling embitterment reactions in the aftermath of negative life events. The PTED Scale was administered to four independent samples of patients and normals. Internal consistency and test-retest reliability were high. Factor analysis indicated a two-factor solution, accounting for 55.25% of the total variance. The PTED Scale discriminated significantly between patients who had been classified according to clinical judgement as suffering from pathological embitterment. Correlations with related instruments demonstrated good convergent validity. Data obtained from a non-clinical sample indicated a prevalence of clinically relevant embitterment in the general population of about 2.5%. The PTED Scale is a reliable and valid measure for embitterment as an emotional reaction to a negative life event. Furthermore, results demonstrate that reactive embitterment in connection to a negative life event is a prevalent phenomenon among clinical and non-clinical populations.

[Adverse effects, side effects and medical malpractice in psychotherapy]. / Unerwünschte Effekte, Nebenwirkungen und Behandlungsfehler in der Psychotherapie.

There is ample proof for the efficacy of psychotherapy but no systematic research on unwanted effects. Cases of malpractice represent a special problem as they always result from a therapist's inadequate behaviour. Furthermore, it is especially difficult in psychotherapy to distinguish between negative life events, unavoidable and undesirable developments of the disease, side effects of psychotherapy and positive treatment effects. In psychotherapy unwanted effects (UEs) can occur in the context of diagnostic problems, selection of the wrong treatment focus, technically inadequate interventions, sensitization processes, or inadequate development of a therapeutic alliance. Examples and case vignettes will be presented for these types of UEs and conclusions will be drawn as to how UE management can be improved.