[The OPD conflict questionnaire]. / Der OPD-Konfliktfragebogen.

The OPD conflict questionnaire Background: To date, no self-report measure is available to assess modes of coping with unconscious conflicts according to Operationalized Psychodynamic Diagnosis (OPD). The OPD conflict questionnaire (OPD-CQ) developed here thus intends to close this gap. METHODS: To select the items for the OPD-CQ, expert ratings and psychometric criteria based on a sample of 534 persons were combined. RESULTS: The OPD-CQ comprises 66 items with which active and passive modes of coping with six conflicts as well as defended perception of conflict and emotions can be assessed. Some of the scales had a rather low internal consistency. An investigation of the factor structure of the OPD-CQ scales revealed five factors that could be meaningfully interpreted. The OPD-CQ scales showed expected correlations with other clinically relevant instruments. In addition, we showed the incremental validity of the OPD-CQ scales regarding the prediction of psychological distress and life satisfaction above and beyond structural deficits. DISCUSSION: The results provide important clues toward developing and validating the OPDCQ. The first version presented here should be considered preliminary.

Tracking functional brain changes in patients with depression under psychodynamic psychotherapy using individualized stimuli.

OBJECTIVE: Neurobiological models of depression posit limbic hyperactivity that should normalize after successful treatment. For psychotherapy, though, brain changes in patients with depression show substantial variability. Two critical issues in relevant studies concern the use of unspecific stimulation experiments and relatively short treatment protocols. Therefore changes in brain reactions to individualized stimuli were studied in patients with depression after eight months of psychodynamic psychotherapy. METHODS: 18 unmedicated patients with recurrent major depressive disorder were confronted with individualized and clinically derived content in a functional MRI experiment before (T1) and after eight months (T2) of psychodynamic therapy. A control group of 17 healthy subjects was also tested twice without intervention. The experimental stimuli were sentences describing each participant's dysfunctional interpersonal relationship patterns derived from clinical interviews based on Operationalized Psychodynamic Diagnostics (OPD). RESULTS: At T1 patients showed enhanced activation compared to controls in several limbic and subcortical regions, including amygdala and basal ganglia, when confronted with OPD sentences. At T2 the differences in brain activity between patients and controls were no longer apparent. Concurrently, patients had improved significantly in depression scores. CONCLUSIONS: Using ecologically valid stimuli, this study supports the model of limbic hyperactivity in depression that normalizes after treatment. Without a control group of untreated patients measured twice, though, changes in patients' brain activity could also be attributed to other factors than psychodynamic therapy.

Operationalized psychodynamic diagnosis as an instrument to transfer psychodynamic constructs into neuroscience.

This theoretical article makes a contribution to the field of "psychoanalytically informed neuroscience". First, central characteristics of psychoanalysis and neuroscience are briefly described leading into three epistemic dichotomies. Neuroscience versus psychoanalysis display almost opposing methodological approaches (reduction vs. expansion), test quality emphases (reliability vs. validity) and meaning of results (correlation vs. explanation). The critical point is to reach an intermediate level: in neuroscience an adequate position integrating both aspects-objective and subjective-of dual-aspect monism, and in psychoanalysis the appropriate level for the scientific investigation of its central concepts. As a suggestion to reach that level in both fields the system of Operationalized Psychodynamic Diagnosis (OPD; OPD Task Force, 2008) is presented. Combining aspects of both fields areas, expansion and reduction as well as reliability and validity, OPD could be a fruitful tool to transfer psychodynamic constructs into neuroscience. The article closes with a short description of recent applications of OPD in neuroscience.

[Assessing risk exposure in families within the scope of early intervention: the Heidelberg Stress scale (HBS) and its quality criteria]. / Einschätzung der Risikobelastung in Familien im Rahmen von Frühen Hilfen: Die Heidelberger Belastungsskala (HBS) und ihre Gütekriterien.

The aim of the study presented is to introduce the newly developed instrument to assess stress, the Heidelberg Stress Scale (Heidelberger Belastungsskala--HBS), and to examine its psychometric characteristics. The HBS was developed for a low-threshold and multi-professional assessment of a family's stresses and resources after the birth of a child. The HBS can be used in the outreach work of family midwives, for instance, as well as in research. The validity of the HBS was tested in a sample of 284 psychosocially stressed families after the birth of their child; the inter-rater reliability was tested in a sample of 41 families that were also in stress. The HBS exhibits an excellent inter-rater reliability within a homogeneous professional group (psychology students). As relates to the construct validity, a strong positive connection between the HBS and Kindler's screening sheet was found; the HBS exhibits a negative correlation with maternal sensitivity and a positive correlation with maternal stress level. With a high level of stress in the HBS, the risk of taking the child into care is increased by 4.5 times; the sensitivity amounts to 63.6%. The quality criteria are satisfactory.

Individualized and clinically derived stimuli activate limbic structures in depression: an fMRI study.

OBJECTIVES: In the search for neurobiological correlates of depression, a major finding is hyperactivity in limbic-paralimbic regions. However, results so far have been inconsistent, and the stimuli used are often unspecific to depression. This study explored hemodynamic responses of the brain in patients with depression while processing individualized and clinically derived stimuli. METHODS: Eighteen unmedicated patients with recurrent major depressive disorder and 17 never-depressed control subjects took part in standardized clinical interviews from which individualized formulations of core interpersonal dysfunction were derived. In the patient group such formulations reflected core themes relating to the onset and maintenance of depression. In controls, formulations reflected a major source of distress. This material was thereafter presented to subjects during functional magnetic resonance imaging (fMRI) assessment. RESULTS: Increased hemodynamic responses in the anterior cingulate cortex, medial frontal gyrus, fusiform gyrus and occipital lobe were observed in both patients and controls when viewing individualized stimuli. Relative to control subjects, patients with depression showed increased hemodynamic responses in limbic-paralimbic and subcortical regions (e.g. amygdala and basal ganglia) but no signal decrease in prefrontal regions. CONCLUSIONS: This study provides the first evidence that individualized stimuli derived from standardized clinical interviewing can lead to hemodynamic responses in regions associated with self-referential and emotional processing in both groups and limbic-paralimbic and subcortical structures in individuals with depression. Although the regions with increased responses in patients have been previously reported, this study enhances the ecological value of fMRI findings by applying stimuli that are of personal relevance to each individual's depression.

[The use of OPD-based focused interventions in inpatient psychotherapy: effects on outcome and course of treatment]. / Fokusorientierte Interventionen mit der OPD in der stationären Psychotherapie: Effekte auf Ergebnis und Verlauf der Behandlung.

OBJECTIVES: The study explores the course and outcome of inpatient psychodynamic psychotherapy (N=200) with particular regard to interpersonal experiences and behaviour. Based on the implementation of a focus conference, the multi-professional team members formulated an interpersonal treatment focus and individualised helpful interpersonal attitude towards the patient (so-called therapeutic tuning). This focus formulation follows the systematic procedure provided by the Operationalised Psychodynamic Diagnostics System (OPD-2). METHODS: The study was initiated to evaluate the effectiveness of the so-called "tuning-treatment" compared to inpatient "treatment as usual". RESULTS: Compared to "treatment as usual", the tuning condition showed greater improvement (p>.001) in interpersonal functioning (GARF). Interpersonal problems (IIP) and symptoms (SCL-90-R) were slightly more improved than in the "treatment as usual" cases (p=.13 and. p=.09). CONCLUSIONS: An interpersonal treatment focus followed by focus-oriented interventions is a promising approach for inpatient psychodynamic psychotherapy. Generalisation of the empirical results is, however, limited due to problems of internal validity.

[About the state of counselling and therapy of parents with their infants in Germany--results of an expertise]. / Zur Lage der Beratung und Therapie von Eltern mit Säuglingen und Kleinkindern in Deutschland. Ergebnisse einer Expertise.

Topic of this study is the acquisition and documentation of all German services of early psychosocial interventions as well as the description of attributes of these care providers. On the basis of this attributes the quality of the offers is evaluated. The services provide counseling and therapy for parents with babies and toddlers. Their aim is to assess and treat disorders of behavior regulation in the context of dysfunctional parent-child-relationships. The expertise was initiated by the German Federal Centre for Health Education. It is based on data of 288 services in Germany. Different attributes of structural and process qualities are described and evaluated e.g. the institutional context, presented problems, training of specialists, kind of interventions. Number and attributes of the early interventions show great variation from region to region. The discrepancy between the number of services and the prevalence of early childhood regulation disorders is high. Due to the unresolved question of financing, parents often have to pay the treatment by themselves. On the basis of the results different implications for the improvement of structural quality are formulated. Relevant issues of research in psychosocial early childhood interventions are discussed.

El sistema Diagnóstico Psicodinámico Operacionalizado (OPD): Concepto, confiabilidad y validez / Operationalized Pshychodinamic Diagnosis (OPD): Concept, reliability and validity

This paper presents the system "Operationalized Psychodynamic Diagnosis (OPD), which has been applied in the German speaking countries very successfully during the last 10 years. The OPD is the operationalization of the psychodynamically oriented clinical assessment. The clinical material assessed during the initial interview with the patient is described in a way which is close to the level of observation. The classification system OPD serves as a clinically relevant and process oriented tool for psychotherapists. The multidimensional psychodynamically oriented approach is based on five axes. Axis I: Experience with the illness and treatment preconditions, axis II: habituated relationships of the patient, axis III: the intrapsychic conflicts of the patient; axis IV: The psychic structure of the patient, axis V: syndromatic, according to chapter V (F) of the ICD 10. The fifth axis is conzeptualized as a linking tool to ICD-10. Reliability studies on OPD show good to satisfying scores for interrater agreement for the research context. The results derived from the validity studies support the validity of the OPD system. There are also hints for improvements of multiple categories or items within each axis.

Este artículo presenta el sistema de "diagnóstico psicodinámico operacionalizado" (OPD), que en los últimos 10 años se ha difundido ampliamente en los países de habla germana. El OPD tiene como meta operacionalizar los constructos psicoanalíticos clínicamente probados. El material clínico presentado por el paciente en la primera entrevista puede ser estimado y clasificado en un nivel lo más cercano posible a lo directamente observable. Con la OPD se puede formular un diagnóstico psicodinámico clínicamente relevante y orientador para los psicoterapeutas. El diagnóstico psicodinámico multiaxial se basa en 5 ejes diferentes: eje 1: experiencia de enfermedad y prerrequisitos para el tratamiento, eje 2: relaciones interpersonales, eje 3: conflicto, eje 4: estructura, eje 5: diagnóstico sindromático (según el capítulo V (F) del CIE 10). El eje 5 de la OPD genera un punto de unión del instrumento con el modelo del CIE. Los estudios sobre confiabilidad muestran un nivel bueno a satisfactorio de confiabilidad en el contexto investigativo. Los resultados de los estudios sobre la validez evidencian un buen nivel de validez de cada eje. Los múltiples estudios con el OPD ofrecen guías para perfeccionar las categorías.

[New diagnostic alternatives for dysfunctional relationships: the relationship axis of the OPD-2]. / Neue Möglichkeiten der Diagnostik dysfunktionaler Beziehungen--die Bezeihungsachse der OPD-2.

As a part of the new version of Operationalized Psychodynamic Diagnosis (OPD-2), the relationship axis is introduced which was developed on the basis of research and clinical work with the OPD-1. It provides a procedure indicating dysfunctional relationship patterns. The new version is characterized by the following qualities: The relationship axis is based more consequently on the circumplex model of interpersonal behaviour. Therefore, it is suitable for a broader range of evaluation methods linked to this model. It also contains instructions on how to draw a summary of relationship dynamics. Thus the results of the diagnostic assessment can be summarized for clinical and practical purposes and used directly for therapeutic work. In addition, a simplified version of the rating procedure enables identification of the patient's significant problematic relationship themes and his or her personal resources.