An Internet-based program to enhance motivation to change in females with symptoms of an eating disorder: a randomized controlled trial.

BACKGROUND: Previous research has demonstrated an association between low motivation to change and an unfavorable treatment outcome in patients with an eating disorder. Consequently, various studies have examined the effects of motivational enhancement therapy (MET) on motivation to change and treatment outcome in eating disorders. In each of these studies, MET was administered in a face-to-face setting. However, because of its anonymity and ease of access, the internet provides several advantages as the format for such an intervention. Therefore, the current study investigated the effects of an internet-based program ('ESS-KIMO') to enhance motivation to change in eating disorders. METHOD: In total, 212 females were accepted for participation and assigned randomly to the intervention condition (n = 103) or waiting-list control condition (n = 109). The intervention consisted of six online MET sessions. Before and after the intervention or waiting period respectively, participants completed the Eating Disorder Examination Questionnaire (EDE-Q), the Stages of Change Questionnaire for Eating Disorders (SOCQ-ED), the Pros and Cons of Eating Disorders Scale (P-CED), the Self-Efficacy Scale (SES), and the Rosenberg Self-Esteem Scale (RSES). A total of 125 participants completed the assessment post-treatment. Completer analyses and intent-to-treat analyses were performed. RESULTS: Significant time × group interactions were found, indicating a stronger increase in motivational aspects and self-esteem, in addition to a stronger symptom reduction on some measures from pre- to post-treatment in the intervention group compared to the control group. CONCLUSIONS: Internet-based approaches can be considered as useful for enhancing motivation to change in eating disorders and for yielding initial symptomatic improvement.

[Pain therapy with children and adolescents severely disabled due to chronic pain: long-term outcome after inpatient pain therapy]. / Schmerztherapie bei Chronisch Schmerzkranken, Schwer Beeinträchtigten Kindern und Jugendlichen: Langzeiterfolge einer 3-Wöchigen Stationären Schmerztherapie.

BACKGROUND: A prospective study controlled for sex and age was conducted evaluating the success of a 3-week inpatient pain therapy after 3, 6 and 12 months for 200 children and adolescents severely disabled due to chronic pain. METHODS: The following validated German questionnaires were used: pain questionnaire (DSF-K/J/E), pain coping inventory (PPCI-R), anxiety questionnaire (AFS) and depression questionnaire (DIKJ). After an intention-to-treat analysis unifactorial und multifactorial variance analyses were conducted. A significance level of p<0.01 was used. RESULTS: Durable improvements were observed for average pain intensity, pain disability, days absent from school, depression and for passive and interaction-based pain coping strategies 3 months after finishing inpatient pain therapy. On the other hand general anxiety and school aversion were only reduced at 6 and 12 months, respectively. Girls reported more pain in general and during follow-up. Younger children relied in general more on others when dealing with their pain. CONCLUSION: An inpatient pain therapy can help children and adolescents severely disabled due to chronic pain not only in the short term but also in the long term.

[Pain perception of adolescents with chronic functional pain : adaptation and psychometric validation of the Pain Perception Scale (SES) by Geissner]. / Schmerzempfindung bei Jugendlichen mit chronischen funktionellen Schmerzen : Adaptation und psychometrische Uberprüfung der Schmerzempfindungsskala (SES) nach Geissner.

BACKGROUND: Pain perception is a central aspect of the multidimensional model of chronic pain. Up to now, validated measurement tools are lacking in the German language for measuring pain perception in adolescents. The aim of this study was to examine and adapt the well-established Pain Perception Scale for Adults by Geissner (SES) for use in adolescents with chronic pain to provide a measure for clinical diagnosis and evaluation of treatment effects. MATERIAL AND METHODS: Principal component, reliability and item analyses were conducted on a sample with 139 adolescents. To test validity, age and sex effects, correlations with pain-related constructs, differences between treatment groups (inpatients vs outpatients) and concordance between adolescents and their parents were analysed. RESULTS: Findings support a two-factor solution with one affective and one sensory factor; three additional sensory items were included in the final version. The scales show good internal consistency. Consistent with hypotheses, we found significant correlations with pain characteristics, emotional and cognitive variables as well as pain-related disability. Inpatients and outpatients show a significant difference in affective pain perception. Concordance between parents and adolescents was high. CONCLUSION: With this questionnaire there is now a validated German assessment tool to measure pain perception in adolescents with chronic pain (Pain Perception Scale for Adolescents, SES-J). Due to its practicability it is suitable for clinical application.

[Pain-related disability in adolescents suffering from chronic pain. Preliminary examination of the Pediatric Pain Disability Index (P-PDI)]. / Schmerzbezogene Beeinträchtigung bei Jugendlichen mit chronischen Schmerzen. Erste Uberprüfung des Pediatric Pain Disability Index (P-PDI).

BACKGROUND: Pain-related disability affects many children and adolescents suffering from chronic pain and may exert an impact on all areas of their lives. Reduction of pain-related disability is, therefore, a fundamental aim of treatment; however, no validated means exist to assess pain-related disability in children and adolescents. The aim of this study was to translate the Pediatric Pain Disability Index (P-PDI) of Varni into German and to investigate its psychometric qualities. METHODS: Principal component and item analyses were conducted on outpatient (n=163) and inpatient samples (n=167) of adolescents suffering from chronic pain. Changes in pain-related disability 3 months after starting treatment were analysed in an outpatient sample of 110 adolescents. Correlations between pain-related disability, emotional variables and school absence as well as concordance with parents' ratings were investigated. RESULTS: The P-PDI is a one-dimensional assessment tool with sufficient reliability. There were significant correlations between pain-related disability and pain intensity and school absence but not with pain duration, fear and depression. Parents and adolescents ratings correlated significantly, but 57% of parents underestimated the pain-related disability of their children. CONCLUSION: There is now a validated German version of the P-PDI to measure pain-related disability in adolescents suffering from chronic pain, which can be used in studies investigating treatment effectiveness.

[Pain-related coping strategies in children and adolescents with chronic pain. Validation of a German version of the Paediatric Pain Coping Inventory (PPCI revised)]. / Schmerzbezogene Copingstrategien von Kindern und Jugendlichen mit chronischen Schmerzen. Uberprüfung einer deutschen Fassung der Paediatric Pain Coping Inventory (PPCI-revised).

Validated intruments for measuring coping in children and adolescents with chronic pain are rare in Germany. Using a sample of 180 out-patient children with chronic pain, a main component analysis was performed as well as cross-validations with out-patient and in-patient treated children. The scales of the PPCI-R showed significant relationships to pain characteristics and emotional stress. Different alterations were found in the PPCI-R scales in children with migraine and those with tension-type headache. The PPCI revised is therefore a validated instrument for measuring coping an can be implemented e.g. in treatment studies for children suffering from chronic pain.

[Methodologic decisions in evaluation of psychotherapy]. / Methodische Entscheidungen in der Evaluation von Psychotherapie.

Psychotherapy research makes demands on evaluation studies in regard to content and methodology. These demands, however, are difficult to realize. The expense of a study results in a multidimensional matrix consisting of: the different sources of data, number and extent of the measures on theoretically derived assessment levels, the number of times measures are repeated, and the sample size. Decisions for research methods should be deduced explicitly from the goal of the evaluation study as well as from the goals of the evaluated therapy. Alternatives for the choice of operationalization, test designs, data evaluation and presentation will be reviewed and discussed.