[Work-Anxieties and their Treatment in Medical Rehabilitation - Hand Tools for Capacity Training and Psychotherapy]. / Arbeitsängste und ihre Behandlung in der medizinischen Rehabilitation ­ Handwerkszeug für Fähigkeitentrainings und Psychotherapie.

Work-anxieties are often going along with workplace problems and long-term sick leave. Psychopathologically, different qualities of work anxiety can be distinguished: worrying, phobic anxiety, health-related anxiety, anxiety of insufficiency. An evaluation of a work-anxiety treatment showed that confronting patients with the topic work during medical rehabilitation leads to a better course. In work-oriented capacity trainings or behavior therapy groups, coping with everyday phenomena at work may be trained (self-presentation, social rules, work organization and problem solving, coping with chronic illness and impairment conditions). Active coping and communication (explaining impairment to the supervisor and occupational physician for making problem solving possible) are helpful. In some cases, correction of expectations must be done, and normalizing everyday work problems (conflicts and achievement requirements are normal at work, work does not make happy all the time).

[Side Effects of Occupational Group Therapy]. / Nebenwirkungen von Ergotherapiegruppen.

Background: Occupational therapy is an important co-therapy in psychiatric therapy. It is a common belief that no risks are associated with occupational therapy. Negative effects caused by group therapy, especially occupational therapy, have not been in the focus of research yet. In this study we want to illustrate possible types and intensities of group side effects through occupational therapy. Patients and Methods: Patients of an inpatient rehabilitation facility filled out the Adverse Treatment Reaction Group Checklist. The checklist contains 47 items divided in six dimensions: group size, content, group participants, group outcome and global. The self-rating used a 5-point likert scale (0 = not at all; 4 = very much, extremely stressful) and gives information about types and intensities of the side effects. Results: 88.9 % of 45 patients reported negative effects of occupational group therapy. 28.9 % of the patients rated the side effect as at least severe. Discussion: Occupational therapy is associated with side effects as every other group therapy. Possible side effects caused by group therapy should be considered while planning and implementing occupational therapy.

Self-reported workplace perception as indicators of work anxieties.

BACKGROUND: Work anxiety is a potentially disabling mental health problem, which can cause (long-term) sickness absence. In many cases patients do not openly report their anxieties and tend to give externalizing explanations of inner problems. Therefore people with work anxiety may perceive their workplace more negatively than those without such anxiety. AIMS: To investigate the relation between subjective work description and work anxiety. METHODS: Work anxiety was investigated with a standardized interview in a sample of employed psychosomatic rehabilitation inpatients suffering from common mental disorders. We assessed their subjective perception and evaluation of workplace conditions with the 'Short Questionnaire for Job Analysis' (KFZA) and compared their results with those from a sample of employees in the general population. RESULTS: There were 148 inpatient participants and 8015 general population controls. Patients with work anxiety described their workplace significantly more negatively than patients without work anxiety and employees in the general population, with no differences in workplace descriptions between psychosomatic patients without work anxiety and the general population sample. The type of complaint about work conditions was related to the specific type of work anxiety. CONCLUSIONS: Reports about workplace burdens can be indicative of work anxiety and should prompt further in-depth assessments. The content of complaints about work conditions may point to the type of underlying work anxiety.

[Undesired treatment effects in behavior group therapy: Frequency and spectrum]. / Unerwünschte Therapiewirkungen bei verhaltenstherapeutischer Gruppentherapie : Häufigkeit und Spektrum.

BACKGROUND: Psychotherapy not only has positive but also negative effects, which is especially true for group psychotherapy due to psychodynamic and interactional processes. METHODS: Using the UE-G questionnaire 71 patients who participated in cognitive behavioral group psychotherapy reported on negative experiences in the context of the group therapy. The answers were then validated in a qualitative interview. RESULTS: Of the patients 98.6% reported about at least one negative experience and 43.7% about severe or extremely severe negative experiences. Most prominent was the induction of hopelessness and demoralization by what patients saw and heard from other patients in the group. CONCLUSION: Burdensome and therefore undesired treatment effects are regularly seen in group psychotherapy, because of treatment or patient related factors. In any case they must be taken into account during treatment, in the training of group psychotherapists and in quality control.

[Patient education in heart failure improves disease-related knowledge and behavior during cardiac rehabilitation]. / Patientenschulung bei Herzinsuffizienz verbessert krankheitsbezogenes Wissen und Verhalten während kardiologischer Rehabilitation.

INTRODUCTION: Heart failure is one of the most common und costly chronic diseases. Patient education is an important part of heart failure therapy. Rehabilitation aims to improve self-management abilities and the course of the disease. A structured heart failure education program was established to create knowledge about the disease and to implement a disease friendly behavior. The effectiveness was tested in a randomized controlled design. METHODS: Patients were cluster randomized -assigned to an intervention group or a control group at the beginning of a rehabilitation. Both received a rehabilitation specifically geared to heart-failure-patients. The intervention group received additionally the education program, the control group a single lecture on the disease. At the end of rehabilitation and 6 months later the knowledge and integrity of the recommended self-tests have been checked. In addition the disease severity and pharmacotherapy were determined. RESULTS: Both groups showed improvements in disease status. Participants of the education program had a sustained higher knowledge, were better adjusted to medication after 6 months and documented their self-tests more frequently. DISCUSSION: Regardless to the education intervention an improvement of the disease status occurs during cardiac rehabilitation. The effective single components are still unclear. The evaluated education program leads specifically to an improved disease-related knowledge and improved self-management skills. Due to these results it seems useful to include cardiac rehabilitation in heart failure disease-management programs - a specific heart failure education program should be integrated.

The significance of job-anxiety in a working population.

BACKGROUND: Job-anxiety, as distinguished from trait-anxiety, is associated with long-term sickness absence. The prevalence of job-anxiety within a working population is not known. Identifying individuals who would benefit from intervention might be useful. AIMS: To investigate job-anxiety in employees not undergoing treatment for mental health illness, firstly by assessing the level of job-anxiety and work-related avoidance tendencies in a working sample, and secondly by testing whether job-anxiety is distinguishable from trait-anxiety. METHODS: Cross-sectional survey of a convenience sample obtained through personal contact distribution. Employees from different professional settings completed an anonymous questionnaire and provided information on their employment status. The State-Trait-Anxiety Inventory (STAI-T) was used to measure trait-anxiety and the Job-Anxiety-Scale (JAS) was used to assess job (state) anxiety. RESULTS: There was a 69% response rate (240 responses); 188 responses were available for analysis of whom 62% were women. There were no employees with high trait-anxiety. Ten employees (5%) reported increased job-anxiety and of these nine employees reported high 'tendencies of avoidance and workplace absence'. Avoidance was most often accompanied by the comorbid job-anxieties 'job-related social anxiety', 'fear of changes at work' and 'fears of existence', 'anticipatory' and 'conditioned' job-anxiety and 'panic symptoms'. CONCLUSIONS: In this sample, self-reported job-anxiety appeared as a specific type of anxiety as opposed to trait-anxiety. In the workplace job-anxiety can present as job-avoidance and sickness absence and should be distinguished from trait-anxiety. In practice, employers and occupational health practitioners should be aware of those employees prone to sickness absence.

[Medical rehabilitation by general practitioners in patients with chronic mental disorders]. / Rehabilitationsbedarf bei Hausarztpatienten mit psychischen Störungen.

BACKGROUND: Rehabilitation medicine is the medical specialty for the prevention, diagnosis and treatment of chronic disorders. This is especially relevant in mental disorders. Treatment of chronic disorders requires a complex and multidisciplinary long-term-treatment which is regularly done by general practitioners. However, concepts for rehabilitation-medicine in outpatient settings are until now by and large insufficient. METHODS: 40 general practitioners were asked to give an estimate on how many patients with chronic psychological disorders were among their patients.Next, 1 451 patients between 18 and 60 years filled in the WHO-5 wellbeing-rating, the IMET scale on participation disorders, the Burvill scale on multimorbidity and answered questions on their mental and work status. RESULTS: The general practitioners estimated that on average 41,9% (SD=18,2; Range 15-90%) were suffering from chronic mental disorders. 46,5% of the patients said that they suffered from mental problems, 38,3% had mental problems longer than 6 months, i. e., chronic, and in 26,9% even persistent. 29,7% of the patients suffered from chronic mental problems with relevant participation disorders. CONCLUSION: Patients with chronic mental disorders and participation problems are frequent in general practice. Rehabilitation medicine is an important part the daily activities of general practitioners, including diagnosis, treatment, treatment coordination, and sociomedical interventions like sick leave certificates, or initiating inpatient rehabilitation. General practitioners should get more scientific attention when concepts of rehabilitation are discussed.

[Socio-medical aspects of mental disorders: mental disorders in the German medical health care system and socio-medical therapeutic interventions]. / Sozialmedizinische Aspekte bei psychischen Erkrankungen : Psychische Erkrankungen im medizinischen Versorgungssystem und therapeutische Maßnahmen.

In the first article social medicine was defined. In this second article the health care system and special socio-medical treatments for the individual are described. The role of social medicine is to describe and optimize the health care system. The legal basis for the structure of the health care system is the Social Law. The individual encounter between therapists and patients is also regulated by law. This includes a contract of personal service. Liability of therapists is therefore restricted to correct treatment, which must be documented, and not depending on outcome. Therapists must cooperate with each other. There are special socio-medical treatments for individuals. This includes sickness certificates, enforced treatment, guardianship, support by counselling services, socio-medical support by physicians and psychotherapists in private practice, care and assessment in rehabilitation centres, and measures for reintegration into working life.

[Socio-medical aspects of mental disorders : Definition, epidemiology, context and assessment of capacity]. / Sozialmedizinische Aspekte bei psychischen Erkrankungen : Definition, Epidemiologie, Kontextbedingungen und Leistungsbeurteilung.

Social medicine is an interdisciplinary field of medicine which analyses and describes the interactions between illness, individual, society, and organisational structures of the health care system, including prevention, treatment and rehabilitation. Part of social medicine is epidemiology, including analytic epidemiology. The goal is to monitor the prevalence and spectrum of illnesses in the general population or subpopulations and to study possible risks of illness. The question is which environmental or contextual factors influence the prevalence and course of illnesses. Another area of social medicine is to evaluate patients and decide who needs social support. Important topics are inability to work, need for early retirement and pension, or disability. In this context it is important to make a distinction between functions, capacities, context and participation. There is a second paper on social medicine which covers modes of care and treatment in social medicine.

[Cardiac rehabilitation with a structured education programme for patients with chronic heart failure--illness-related knowledge, mental wellbeing and acceptance in participants]. / Kardiologische Rehabilitation mit strukturierter Schulung bei Herzinsuffizienz--Akzeptanz bei Patienten und Veränderungen in Krankheitswissen und Wohlbefinden.

BACKGROUND: Chronic heart failure is a severe disease with increasing importance and difficult prognosis. Patient education is an essential component of medical rehabilitation, which is aimed at increasing self-management abilities and reducing mental symptom load in these patients. A newly developed patient education programme for heart failure was implemented as part of a three-week cardiac rehabilitation programme. The present study dealt with patients' acceptance of this programme, changes in disease-related knowledge, perceived health- and illness-related quality of life, and mental symptoms over the treatment course. METHOD: During inpatient cardiac rehabilitation, 64 patients (79.7% male) participated in this competence-focused programme for patients with chronic heart failure. Before, directly after and 6 months after participation in the programme, they filled in self-rating questionnaires on their mental wellbeing (HADS anxiety and depression), quality of life (SF-36, KCCQ), and a test of their knowledge on heart-related disease behavior. Additionally they were given an evaluation-questionnaire of the programme. RESULTS: Evaluation of the programme given by the patients was very good. Knowledge and perceived quality of life had increased significantly at the end and 6 months after rehabilitation. Mental symptoms of anxiety and depressivity were reduced directly and also 6 months after rehabilitation. CONCLUSION: Over the course of a multidimensional cardiac rehabilitation programme focusing on training of disease-directed competences, patients felt better and were better informed. However, special attention needs to be given to possible deterioration effects education programmes can have in patients with increased trait-anxiety or hypochondriac tendencies.

[Workplace-related anxiety, workplace phobia and disorders of participation]. / Arbeitsplatzängste und Arbeitsplatzphobie und ihre Auswirkungen auf die berufliche Partizipation.

Work is an important domain of life. It is therefore clear that problems at the workplace and mental disorders will have negative interactions. Job-related anxieties are of special importance as any workplace causes or intensifies anxiety by its very nature. A common final pathway of mental disorders in general and workplace-related anxieties in particular is workplace phobia. Similarly to agoraphobia, it is characterised by panic when approaching or even thinking of the stimulus, in this case the workplace. Workplace phobia has serious negative consequences for the further course of illness. It impairs the ability to work, and can lead to sick leave and early retirement. It requires special therapeutic interventions. This paper describes workplace-related anxieties and workplace phobia and gives a conceptual framework for their understanding.

[Occupational and social participation disorders in patients in office-practice medical care]. / Berufliche und soziale Partizipationsstörungen bei Patienten in der vertragsärztlichen Versorgung.

BACKGROUND: Primary care physicians play a crucial role in the assessment of restrictions in of participation, i. e. especially sick leave. In this study we investigated to which degree patients in primary care suffer from disorders of participation and how this is related to problems at the workplace and sick leave. METHOD: A total of 382 patients, aged 18-65, were investigated in primary care office practices. Self-reported disorders of participation were measured with the IMET, together with sociodemographic and work-related information. RESULTS: 27,4% of 299 patients who were at present working reported to have problems at the workplace. 19% were at present on sick leave. These patients did significantly more often report mobbing at the workplace. No differences were found with respect to quantitative or qualitative overtaxation or with respect to context variables. Restrictions in of participation were strongest related to the workplace but were also reported for the domain of family or social activities. Patients on sick leave also showed more impairment in these private areas than patients at work. The treating physicians saw psychosocial problems as a primary cause for disorders of participation at the workplace. CONCLUSION: Chronic illness does impair occupational as well as general social participation, and such patients are frequently seen in primary care. Physicians in primary health care therefore play an important role in the treatment of restrictions in of participation and especially in early intervention.

[Workplace related anxiety and phobia]. / Arbeitsplatzbezogene Angste und Arbeitsplatzphobie.

Work is an important aspect of life. Problems at the workplace must therefore have negative consequences on the mental status and mental problems will interfere with the working place. The relation between anxiety and the workplace is especially important because the workplace causes anxiety due to its very nature. A common final pathway of mental disorders in general, and work related anxieties in particular, are workplace phobias, with panic when approaching or even thinking of the workplace. This is a serious complication with negative consequences for the further course of illness. It makes special therapeutic intervention necessary. This paper describes the phenomenon of workplace related anxieties and phobia and provides a conceptual framework for their understanding.