Infra-Low Frequency Neurofeedback in the Treatment of Patients With Chronic Eating Disorder and Comorbid Post-Traumatic Stress Disorder.

The treatment of patients suffering from an eating disorder and a comorbid post-traumatic stress disorder is challenging and often leads to poor outcomes. In a randomized control trial, we evaluated to what extent adding Infra-Low Frequency (ILF) neurofeedback could improve symptom reduction within an established inpatient treatment program. In a randomized two-group design, patients suffering from an eating disorder (anorexia nervosa, bulimia nervosa, or binge eating disorder) and comorbid post-traumatic stress disorder (N = 36) were examined while attending an inpatient treatment program in a clinic for psychosomatic disorders. The intervention group received ILF neurofeedback in addition to regular therapy, while the control group received "media-supported relaxation" as a placebo intervention. At the beginning and at the end of their treatment, all participants completed the Eating Disorder Examination-Questionnaire (EDE-Q) as a measure of eating disorder psychopathology and the Impact of Event Scale-Revised (IES-R) in order to assess symptoms of post-traumatic stress. Changes in EDE-Q and IES-R scores over time served as primary outcomes as well as an increase in body mass index in underweight patients. Secondary outcomes were the perceived benefit of the received intervention, global assessment of psychological treatment success, and complications in the course of treatment. Statistical evaluation was carried out with repeated measurement analysis of variance for the primary outcomes and with t-tests and Fisher's exact test for the secondary outcomes. Our results indicate better treatment outcomes in the ILF neurofeedback group with regard to trauma-associated avoidance as well as with regard to restraint eating and increase in body weight. Furthermore, patients who had received ILF neurofeedback rated the intervention they received and, in tendency, their overall treatment more positively and they experienced fewer complications in the course of treatment. ILF neurofeedback is very well accepted by patients and seems to provide a relevant additional benefit in some aspects of symptom reduction. Findings confirm the feasibility of embedding this treatment approach in an inpatient setting and support the case for a larger study for greater statistical power. Clinical Trial Registration: "Infra-Low Frequency Neurofeedback training in the treatment of patients with eating disorder and comorbid post-traumatic stress disorder"; German Clinical Trials Registry (https://www.drks.de; Identifier: DRKS00027826).

Ascertaining minimal clinically meaningful changes in symptoms of depression rated by the 15-item Centre for Epidemiologic Studies Depression Scale.

RATIONALE, AIMS AND OBJECTIVES: In clinical practise and in clinical studies on depression it is important to estimate whether changes in symptomatology measured by self-rating instruments are, in fact, clinically relevant. Therefore, the aim of the study was to estimate the clinical relevance of changes on the 15-item version of the Centre for Epidemiologic Studies Depression Scale (CES-D-15) based on the concept of the minimal clinically important difference (MCID). METHODS: Data was acquired from 4781 patients with depression symptoms from a German psychosomatic hospital who have been assessed using the CES-D-15 before and after treatment. Threshold values representing the MCID were estimated on the basis of mean change scores and sensitivity/specificity analyses. Patients' global impression of change, clinical (therapists') global impression of change and change in impairment severity were used as external anchor criteria. RESULTS: On average, the MCID was represented by a reduction of approximately 11 points in the CES-D-15, irrespective of age, gender, type of treatment and first or secondary diagnosis. However, higher baseline scores in the CES-D-15 required larger changes of raw values to represent a clinically important difference. CONCLUSIONS: Anchor-based values are suggested here as an estimation of the clinical relevance of changes in the CES-D-15. Thus, instead of relying solely on effect sizes, the evaluation of treatment outcomes should be supplemented by reporting the percentage of patients who have reached the MCID. Further examinations to verify our results in other patient populations and with other types of anchor criteria will be needed.

[Anchor-based ascertaining of meaningful changes in depressive symptoms using the example of the German short form of the CES-D]. / Ankerbasierte Ermittlung klinisch relevanter Veränderung depressiver Symptomatik am Beispiel der Kurzform der CES-D.

BACKGROUND AND OBJECTIVES: Depression is frequently measured on the 15 item version of the Center for Epidemiological Studies Depression Scale (CES-D-15). Up to now, there are no data based estimates for minimal clinically important differences (MCID) in depression scales. METHODS: Data on 5241 subjects with depressive symptoms from a German psychosomatic hospital were used. The changes in the CES-D-15 from admission to discharge were compared to the clinically global impression of change (CGIC), i. e., the therapists' perception. Categories of "slightly improved" and "much improved" were used as indicators of a clinically important difference. The relation between these ratings and the CES-D-15 was explored using mean change scores and sensitivity/specificity analyses. RESULTS: On average, a reduction of approximately nine points or 30 percent in the CES-D-15 or an individual effect size of 0.9 represented a minimal clinically important difference. A consistent relationship between the changes in the CES-D-15 and the CGIC was demonstrated irrespective of age, gender, education level, type of treatment, or first diagnosis. However, higher baseline scores in CES-D-15 required larger changes of raw values to represent a clinically important difference. CONCLUSIONS: Our results show anchor-based values for change in CES-D-15 that best represent a minimal clinically important difference. Reporting the percentage of patients who have reached the MCID improves the evaluation of therapeutical processes. The estimated MCID could also be used as an indicator for relevant changes in clinical practice. A further examination in other patient populations will be needed.

[Psychometric analysis of the Turkish speaking version of the "Hamburg Modules for the Assessment of Psychosocial Health" (T-HEALTH-49)]. / Psychometrische Überprüfung der türkischsprachigen Version der "Hamburger Module zur Erfassung allgemeiner Aspekte psychosozialer Gesundheit" (T-HEALTH-49).

Based on the German original questionnaire of the "Hamburger modules for measuring generic aspects of psycho-social health in the therapeutic practice" (HEALTH-49) a Turkish speaking version (T-HEALTH-49) was cross-cultural sensitively developed. The psychometric properties have been analysed by means of a clinical sample of Turkish speaking patients (N=311). The questionnaire proves to be practical, the dimensional structure and the relatively independence of the modules have been confirmed by factor analysis. The single scales are characterised by satisfactory to high reliability and satisfactory validity. The T-HEALTH-49 considers adequately psychosocial aspects in diagnostic, therapy planning and quality assurance. The questionnaire can be downloaded for free (www.hamburger-module.de).