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A huge number of clinical studies and meta-analyses have shown that psychotherapy is effective on average. However, not every patient profits from psychotherapy and some patients even deteriorate in treatment. Due to this result and the restricted generalization of clinical studies to clinical practice, a more patient-focused research strategy has emerged. The question whether a particular treatment works for an individual case is the focus of this paradigm. The use of repeated assessments and the feedback of this information to therapists is a major ingredient of patient-focused research. Improving patient outcomes and reducing dropout rates by the use of psychometric feedback seems to be a promising path. Therapists seem to differ in the degree to which they make use of and profit from such feedback systems. This dissertation aims to better understand therapist differences in the context of patient-focused research and the impact of therapists on psychotherapy. Three different studies are included, which focus on different aspects within the field:
Study I (Chapter 5) investigated how therapists use psychometric feedback in their work with patients and how much therapists differ in their usage. Data from 72 therapists treating 648 patients were analyzed. It could be shown that therapists used the psychometric feedback for most of their patients. Substantial variance in the use of feedback (between 27% and 52%) was attributable to therapists. Therapists were more likely to use feedback when they reported being satisfied with the graphical information they received. The results therefore indicated that not only patient characteristics or treatment progress affected the use of feedback.
Study II (Chapter 6) picked up on the idea of analyzing systematic differences in therapists and applied it to the criterion of premature treatment termination (dropout). To answer the question whether therapist effects occur in terms of patients’ dropout rates, data from 707 patients treated by 66 therapists were investigated. It was shown that approximately six percent of variance in dropout rates could be attributed to therapists, even when initial impairment was controlled for. Other predictors of dropout were initial impairment, sex, education, personality styles, and treatment expectations.
Study III (Chapter 7) extends the dissertation by investigating the impact of a transfer from one therapist to another within ongoing treatments. Data from 124 patients who agreed to and experienced a transfer during their treatment were analyzed. A significant drop in patient-rated as well as therapist-rated alliance levels could be observed after a transfer. On average, there seemed to be no difficulties establishing a good therapeutic alliance with the new therapist, although differences between patients were observed. There was no increase in symptom severity due to therapy transfer. Various predictors of alliance and symptom development after transfer were investigated. Impacts on clinical practice were discussed.
Results of the three studies are discussed and general conclusions are drawn. Implications for future research as well as their utility for clinical practice and decision-making are presented.
Dysfunctional eating behavior is a major risk factor for developing all sorts of eating disorders. Food craving is a concept that may help to understand better why and how these and other eating disorders become chronic conditions through non homeastatically-driven mechanisms. As obesity affects people worldwide, cultural differences must be acknowledged to apply proper therapeutic strategies. In this work, we adapted the Food Craving Inventory (FCI) to the German population. We performed a factor analysis of an adaptation of the original FCI in a sample of 326 men and women. We could replicate the factor structure of the FCI on a German population.rnThe factor extraction procedure produced a factor solution that reproduces the fourfactors described in the original inventory, the FCI. Our instrument presents high internal consistency, as well as a significant correlation with measures of convergent and discriminant validity. The FCI-Deutsch (FCI-DE) is a valid instrument to assess craving for particular foods in Germany, and it could, therefore, prove useful in the clinical and research practice in the field of obesity and eating behaviors.
In mehreren aktuellen Studien wurde bei Kindern und Erwachsenen ein Zusammenhang zwischen der Diagnose einer Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) und dem Vorliegen eines erhöhten Gewichtsstatus bzw. Übergewicht und Adipositas nachgewiesen. Übergewicht und Adipositas entwickeln sich aufgrund einer mittel- bzw. langfristigen positiven Energiebilanz (Energieaufnahme > Energieverbrauch). Da ADHS zumeist mit vermehrter Bewegung bzw. Hyperaktivität einhergeht, welche sich steigernd auf den Energieverbrauch auswirkt, sollte sich eine positive Energiebilanz im Falle einer ADHS überwiegend durch eine erhöhte Energieaufnahme erklären lassen. In der vorliegenden Untersuchung wurde das Ess- und Ernährungsverhalten von 30 Jungen ohne sowie 47 Jungen mit einer ADHS nach DSM-IV im Alter von 8 bis 14 Jahren mittels verschiedener Methoden untersucht. Die Makrostruktur des Essverhaltens der Probanden im Alltag wurde mittels eines Ernährungstagebuches erfasst. Es zeigten sich v.a. eine geringere berichtete Energieaufnahme bei den adoleszenten Probanden mit ADHS, jedoch keine weiteren Unterschiede in der so erfassten Makrostruktur des Essverhaltens zwischen den Gruppen. Allerdings stellte sich ein erhöhter Gewichtsstatus auch als bedeutsamer Prädiktor einer Unterschätzung der konsumierten Nahrung heraus. Mittels Fragebogen wurde u.a. erfasst, wie problematisch und belastend die Mahlzeiten von den Eltern der Jungen erlebt werden. Ess- und Ernährungsprobleme stellten sich dabei als Teilaspekte der psychischen Gesamtauffälligkeit der Kinder heraus, während Eltern von Kinder mit ADHS sich im Vergleich dadurch als stressbelasteter erlebten. Letztlich wurde die Mikrostruktur des Essverhaltens der Probanden während einer Testmahlzeit im Labor untersucht. Die Jungen mit einer ADHS zeigten dabei v.a. eine größere Bissengröße sowie eine kürzere Essdauer. Die Befunde werden abschließend im Rahmen eines Modells zu impulsivem Essverhalten diskutiert.