Konstanzer Modellprojekt für psychisch belastete Geflüchtete : Koordinierte psychotherapeutische Behandlung unter Einbezug von Gesundheitspat:innen (KOBEG)
2023-08-11, Bogatzki, Lea, Miredin, Julia, Millet, Sophie, Lipinski, Leonie, Molle, Madlen, Rockstroh, Brigitte, Mier, Daniela, Odenwald, Michael
Geflüchtete mit psychischen Störungen sind mit Zugangsbarrieren zum psychiatrisch-psychotherapeutische Versorgungssystem konfrontiert. Um diesen Barrieren zu begegnen, wurde im Landkreis Konstanz ein Modellprojekt zur Unterstützung der Gesundheitsversorgung und Integration psychisch belasteter Geflüchteter etabliert (Koordinierte psychotherapeutische Behandlung unter Einbezug von Gesundheitspat:innen; KOBEG) und in einer ersten 3‑jährigen Modellphase evaluiert. Über eine zentrale Koordinierungsstelle werden die Geflüchteten an lokale, niedergelassene Psychotherapeut:innen vermittelt. Sprach- und kultursensitiv geschulte Gesundheitspat:innen (Peers) betreuen und begleiten die Geflüchteten während ihrer Therapie. Die Inanspruchnahme des vermittelten Therapieangebots und Erfahrungen beteiligter Therapeut:innen dienen als Indikatoren für die Effektivität der patengestützten Therapievermittlung. Die Wirksamkeit der therapeutischen Maßnahmen und Begleitung durch Gesundheitspat:innen wurde anhand der psychischen Symptombelastung (Symptomchecklist-27) und Funktionsbeeinträchtigung (Work and Social Adjustment Scale) vor und nach durchschnittlich 10 Monaten Projektteilnahme evaluiert. Im Zentrum der Untersuchung stehen die Geflüchteten (Angebotsinanspruchnahme und psychische Belastung) sowie die Psychotherapeut:innen (berichtete Erfahrungen). Erste Ergebnisse belegen eine überdurchschnittlich hohe Belastung der Geflüchteten zum Zeitpunkt des Erstgesprächs, eine hohe Teilnahmequote und eine geringe Abbruchrate. Die Verlaufserhebung zeigt signifikante Verbesserungen hinsichtlich der psychischen Symptombelastung sowie Funktionsbeeinträchtigung. Die (qualitative) Befragung der Psychotherapeut:innen unterstreicht die Effektivität von KOBEG, 93 % der Therapeut:innen beabsichtigen im Rahmen des Projekts weiterhin mit Geflüchteten zu arbeiten.
NETfacts : An integrated intervention at the individual and collective level to treat communities affected by organized violence
2022-11, Robjant, Katy, Schmitt, Sabine, Carleial, Samuel, Elbert, Thomas, de Abreu, Liliana, Chibashimba, Amani, Hinkel, Harald, Hoeffler, Anke, Rukundo-Zeller, Anja C., Rockstroh, Brigitte, Koebach, Anke
War and crises affect mental health, social attitudes, and cultural norms, which can exacerbate the state of long-term insecurity. With decades of armed conflict, the Democratic Republic of Congo is one example, and violence has become normalized in civilian settings. In this study, we tested the effectiveness of the NETfacts health system, an integrated model of evidence-based individual trauma treatment (Narrative Exposure Therapy [NET]) and a trauma-informed community-based intervention (NETfacts). Alongside changes in mental health outcomes (posttraumatic stress disorder, depression, social disapproval, and shame) we also investigated change in attitudes, including rape myth acceptance, stigmatization of survivors of sexual violence, and skepticism about the reintegration of former combatants. To test whether the additional community intervention is superior to individual NET alone, we implemented a randomized controlled design with six villages and interviewed a sample of 1,066 community members. Our results demonstrate that the NETfacts health system in comparison with NET alone more effectively reduced rape myth acceptance and with it ongoing victimization and perpetration. Community members of the NETfacts group also presented with less stigmatizing attitudes against survivors of sexual violence. Skepticism about the reintegration of former combatants declined in both groups. NETfacts appears to have increased motivation to engage in individual treatment. Synergizing the healing effects of individual and collective trauma exposure, the NETfacts health system appears to be an effective and scalable approach to correct degrading or ignominious norms and restore functioning and mental health in postconflict communities.
Feedback-Related Brain Potentials Indicate the Influence of Craving on Decision-Making in Patients with Alcohol Use Disorder : An Experimental Study
2021, Sehrig, Sarah, Odenwald, Michael, Rockstroh, Brigitte
Introduction: Alcohol craving is a key symptom of alcohol use disorder (AUD) and a significant cause of poor treatment outcome and frequent relapse. Craving is supposed to impair executive functions by modulating reward salience and decision-making.
Objective: The present study sought to clarify this modulation by scrutinizing reward feedback processing in an experimental decision-making task, which was accomplished by AUD patients in 2 conditions, in the context of induced alcohol craving and in neutral context.
Methods: AUD inpatients (N = 40) accomplished the Balloon Analog Risk Task, while their EEG was monitored; counterbalanced across conditions, the tasks were preceded either by craving induction by means of imagery and olfactory alcohol cues, or by neutral cues. Decision choice and variability, and event-related potentials (ERPs) prior to (stimulus-preceding negativity [SPN]) and following (P2a) reward feedback upon decisions, and the outcome-related feedback-related negativity (FRN) were compared between conditions and between patients, who experienced high craving upon alcohol cues (N = 18) and those who did not (N = 22).
Results: Upon craving induction (vs. neutral condition), high-craving AUD patients showed less adjustment of decision choice to preceding reward experience and more variable decisions than low-craving AUD patients, together with accentuated reward-associated ERP (SPN and P2a), while outcome-related FRN was not modified by craving. Conclusions: Results support orientation to reward in AUD patients, particularly amplified upon experienced craving, which may interfere with (feedback-guided) decision-making even in alcohol-unrelated context. Craving-accentuated ERP indices suggest neuroadaptive changes of cognitive-motivational states upon chronic alcohol abuse. Together with altered reward-related expectancies, this has to be considered in intervention and relapse prevention.
“It is worth hanging in there” – Psychotherapeutic experiences shaping future motivation for outpatient psychotherapy with refugee clients in Germany
2023-07-12, Potter, Flurina, Zehb, Marlene, Dohrmann, Katalin, Müller-Bamouh, Veronika, Rockstroh, Brigitte, Crombach, Anselm
Background: A high prevalence of mental disorders in refugees contrasts with a low rate of treatment and limited access to health care services. In addition to pre-, peri- and post-migration stress, language, cultural barriers together with lack of information about cost reimbursement, and access to German (mental) health care institutions are discussed as barriers to use of available services. Such barriers together with insufficient experience of treating traumatized refugee clients may lower therapists’ motivation and facilities to accept refugee clients. A model project called “Fearless” trained, and supervised therapists, translators, and peer counsellors to reduce these barriers and increase therapists’ motivation and engagement in future treatment of refugees. Methods: From a total 14 therapists participating in the project N = 13 were available for semi-structured interviews. The interviews were scheduled during or after their outpatient psychotherapy of refugee clients and lasted one hour on average. Based on qualitative assessment strategies, open questions addressed the therapists’ experience of challenges, enrichments, and motivation throughout the therapy. Therapists’ responses were analyzed using content structuring qualitative content analysis. Results: Three major challenges modulated therapists’ future motivation for treating refugee clients: specific bureaucratic efforts (e.g., therapy application), organizational difficulties (e.g., scheduling appointments), and clients’ motivation (e.g., adherence, reliability). Still, most interviewed therapists ( n = 12) evaluated the therapy as enriching and expressed their motivation to accept refugee clients in the future ( n = 10). Conclusion: Results recommend the reduction of bureaucratic effort (e.g., regular health insurance cover for all refugees) and implementation of organizational support (e.g., peer counsellors) in support of therapists’ motivation for future treatment of refugee clients. Further structural support e.g., with organizing and financing professional translators and referring refugee clients to psychotherapists should be deployed nationwide. We recommend the training in, and supervision of, the treatment of refugee clients as helpful additional modules in psychotherapy training curricula to raise therapists’ motivation to work with refugee clients.
Oscillatory connectivity as a mechanism of auditory sensory gating and its disruption in schizophrenia
2022, Popov, Tzvetan G., Rockstroh, Brigitte, Miller, Gregory A.
Although innumerable studies using an auditory sensory gating paradigm have confirmed that individuals with schizophrenia (SZ) show less reduction in brain response to the second in a pair of clicks, this large literature has not yielded consensus on the circuit(s) responsible for gating nor for the gating difference in SZ. Clinically stable adult inpatients (N = 157) and matched community participants (N = 90) participated in a standard auditory sensory gating protocol. Responses to paired clicks were quantified as peak-to-peak amplitude from a response at approximately 50 ms to a response at approximately 100 ms in MEG-derived source waveforms. For bilateral sources in each of four regions near Heschl's gyrus, the gating ratio was computed as the response to the second stimulus divided by the response to the first stimulus. Spectrally resolved Granger causality quantified effective connectivity among regions manifested in alpha-band oscillatory coupling before and during stimulation. Poorer sensory gating localized to A1 in SZ than in controls confirmed previous results, here found in adjacent brain regions as well. Spontaneous, stimulus-independent effective connectivity within the hemisphere from angular gyrus to portions of the superior temporal gyrus was lower in SZ and correlated with gating ratio. Significant involvement of frontal and subcortical brain regions previously proposed as contributing to the auditory gating abnormality was not found. Findings point to endogenous connectivity evident in a sequence of activity from angular gyrus to portions of superior temporal gyrus as a mechanism contributing to normal and abnormal gating in SZ and potentially to sensory and cognitive symptoms.
Therapeutic success in relapse prevention in alcohol use disorder : the role of treatment motivation and drinking-related treatment goals
2021, Senn, Smeralda, Odenwald, Michael, Sehrig, Sarah, Haffke, Peter, Rockstroh, Brigitte, Pereyra-Kröll, Devi, Menning, Hans, Wieber, Frank, Volken, Thomas, Rösner, Susanne
Changing addictive behavior is a complex process with high demands on motivation. The Transtheoretical Model of Behavior Change provides a theoretical framework for explaining and predicting behavioral change, although its predictive value for addiction is somewhat inconsistent.
The aim of the present study is to extend the Transtheoretical Model of Behavior Change by investigating not only treatment motivation but also the predictive value of the type of drinking-related treatment goal. Additional predictors, such as substance-related and sociodemographic variables, are also included in analyses seeking to predict return to drinking during relapse prevention treatment for alcohol use disorder.
In this observational study, 99 inpatients from a treatment center for alcohol use disorder were recruited. Treatment motivation was assessed in accordance with the Transtheoretical Model of Behavior Change, drinking-related treatment goal through a self-report questionnaire, and substance-related and sociodemographic variables via the clinic information system. Associations between the potential predictors and covariates were explored using stepwise logistic regression.
During treatment, 42.6% of participants had at least one relapse. Scoring higher on the action dimension at admission (OR = 0.81, p = .04) and being employed (OR = 0.37, p = .02) were significant predictors of abstinence during treatment.
This study confirms that treatment motivation contributes to the prediction of treatment outcome, even when controlling for other variables. In future research, the underlying mechanisms of treatment motivation should be further explored.
Bei Risiken und Nebenwirkungen fragen Sie Ihre… Patientinnen und Patienten : Entwicklung und Validierung des Fragebogens zur Risikowahrnehmung von Antipsychotika (FRA)
2023-03-17, Büchele, Natascha, Mier, Daniela, Rockstroh, Brigitte, Viehl, Kathrin, Schiller, Sabine, Haupt, Magdalena, Weitbrecht, Maja, Gegenfurtner, Carolin, Volkland, Katharina, Odenwald, Michael
Theoretischer Hintergrund: Das Verständnis der Antipsychotika-Adhärenz ist lückenhaft, obwohl sie ein Grundpfeiler der Schizophrenie-Behandlung darstellt. Die spezifische Erfassung der Wahrnehmung von Risiken bei Einnahme sowie Absetzen von Antipsychotika könnte zur Erklärung der Adhärenz beitragen. Fragestellung: Explorative Studie zur Entwicklung und ersten Evaluierung des Fragebogens zur Risikowahrnehmung von Antipsychotika (FRA). Methode: Basierend auf theoretischen Überlegungen wurde ein Itempool für die Risikowahrnehmung des Absetzens und Einnehmens von Antipsychotika generiert. Eingeschlossen wurden ambulante und stationäre F2-Patient_innen. Stichprobe 1 ( N = 120) diente zur Itemselektion und explorativen Faktorenanalyse (faktorielle Validität). Anhand Online-Stichprobe 2 ( N = 39) wurde die diskriminante und konvergente Validität analysiert. Ergebnisse: Die explorative Faktorenanalyse ergab die theoretisch erwartete zweifaktorielle Struktur. Die Korrelationen des FRA zu Adhärenzmaßen und spezifischen Medikamentenfragebögen unterstützten die konvergente und diskriminante Validität. Schlussfolgerungen: Der FRA als Erhebungsinstrument der Wahrnehmung von Antipsychotika-Risiken könnte das Verständnis von Antipsychotika-Adhärenz und von Behandlungsansätzen verbessern. Prospektive konfirmatorische Studien müssen durchgeführt werden.
The impact of experiencing severe physical abuse in childhood on adolescent refugees' emotional distress and integration during the COVID-19 pandemic
2022, Potter, Flurina, Dohrmann, Katalin, Rockstroh, Brigitte, Schauer, Maggie, Crombach, Anselm
Background: Accumulating evidence highlights the importance of pre- and post- migration stressors on refugees’ mental health and integration. In addition to migration-associated stressors, experiences earlier in life such as physical abuse in childhood as well as current life stress as produced by the COVID-19-pandemic may impair mental health and successful integration – yet evidence on these further risks is still limited. The present study explicitly focused on the impact of severe physical abuse in childhood during the COVID-19 pandemic and evaluated the impact of these additional stressors on emotional distress and integration of refugees in Germany.
Methods: The sample included 80 refugees, 88.8% male, mean age 19.7 years. In a semi-structured interview, trained psychologists screened for emotional distress, using the Refugee Health Screener, and integration status, using the Integration Index. The experience of severe physical abuse in childhood was quantified as a yes/no response to the question: “Have you been hit so badly before the age of 15 that you had to go to hospital or needed medical attention?” Multiple hierarchical regression analyses further included gender, age, residence status, months since the start of the COVID-19 pandemic and length of stay in Germany to predict emotional distress and integration.
Results: Two regression analyses determined significant predictors of (1) emotional distress (adjusted R2 = 0.23): duration of being in the pandemic (ß = 0.38, p < 0.001) and severe physical abuse in childhood (ß = 0.31, p = 0.005), and significant predictors of (2) integration (adjusted R2 = 0.53): length of stay in Germany (ß = 0.62, p < 0.001), severe physical abuse in childhood (ß = 0.21, p = 0.019) and emotional distress (ß = −0.28, p = 0.002).
Conclusion: In addition to migration-associated stressors, severe physical abuse in childhood constitutes a pre-migration risk, which crucially affects the well-being, emotional distress and integration of refugees in Germany.
A combined therapy for limb apraxia and related anosognosia
2020-11-25, Buchmann, Ilka, Finkel, Lisa, Dangel, Mareike, Erz, Dorothee, Harscher, Kathi Maren, Kaupp-Merkle, Moritz, Liepert, Joachim, Rockstroh, Brigitte, Randerath, Jennifer
Left hemisphere stroke frequently leads to limb apraxia, a disorder that has been reported to impact independence in daily life and rehabilitation success. Nonetheless, there is a shortcoming in research and availability of applicable trainings. Further, to date, anosognosia for limb apraxia has largely been neglected. Therefore, we developed a Naturalistic Action Therapy that trains object selection and application with an errorless learning approach and which includes supported self-evaluation. The current study presents the results of two stroke patients participating in the training. The procedure entailed two baseline and one post-training sessions including standardized limb apraxia and anosognosia assessments as well as 18 naturalistic action tasks. The training consisted of 15 sessions during which 4-6 of the 18 naturalistic action tasks (e.g., pour water into a glass, make a phone call) were trained. Both patients showed improvement in trained and untrained tasks as well as in standardized apraxia and anosognosia assessments. Training effects appeared strongest for the trained items. The procedure is documented in detail and easy to administer and thus may have the potential to be applied by relatives. The results of this pilot-study are promising and suggest that the approach is suitable for further evaluation.