Veränderungsprozesse während Psychotherapie

Obgleich Psychotherapie hilft (Lambert & Ogles, 2004), ist noch immer wenig über die dabei ablaufenden Veränderungsprozesse bekannt (Orlinsky et al., 2004). Um diese trotz ihrer Einzigartigkeit und Dynamik zu erkunden, wurden basierend auf dem theoretischen Rahmen der Synergetik (Haken, 2009b) mittels des Therapietagebuchsystems SNS (Haken & Schiepek, 2006) 114 hochfrequent aufgezeichnete Therapieprozessverläufe von Patienten einer psychosomatischen Klinik hinsichtlich Instabilität (I), Ordnungsübergänge (O) und Ordnungsausmaß untersucht. Dabei zeigte sich, dass sich 3 Verlaufskategorien unterscheiden lassen: Verläufe ohne O und I, mit O aber ohne I und mit O und I, welche zunehmend mit größerer Problemstärke assoziiert sind. Darüber hinaus lassen sich die Verläufe hinsichtlich ihrer Instabilitäten clustern, wodurch Behandlungs(miss)erfolg erklärbar ist. Instabilität zeigt sich somit als Chance oder als Risiko.Psychotherapy works (Lambert & Ogles, 2004), but little is known about the underlying process of change (Orlinsky et al., 2004). Methods derived from synergetic theory (Haken, 2009b) were thus used to investigate in retrospect the course and development of therapy in 114 cases of a psychosomatic in-patient clinic for which nearly daily assess-ments of outcome had been obtained (utilizing a modified version of the SNS diary sys-tem by Haken and Schiepek [2006]). Analyses targeted instabilities (I), phase shifts (P), and changes in order in these psychotherapy processes. Three different courses of psychotherapy could be identified: (1) therapies lacking both P and I; (2) therapies with P but without I; and (3) therapies with both P and I. Across these three types of therapy courses problem severity increased. Furthermore, therapy courses could be clustered by type of instability with respect to global outcome, demonstrating that instabilities both pose a chance and a risk in psychotherapy processes

Stress during transition from home to public childcare

Four saliva probes were collected per day from 104 children (10 to 35 months old) transitioning from home (T0) to childcare across a four-month period (until T3), resulting in over one thousand cortisol values. Latent Profile Analysis classified three profiles within a regular spectrum of children’s cortisol rhythms and described a fourth hypocortisol stress profile. Further Latent Transition Analysis revealed that profiles frequently changed across the transition but stabilized at T3. Most importantly, regular profiles across transition most likely occurred with high AQS scores of mother-child and care provider–child attachment. A machine learning procedure (XGBoost) featured predictors for stress profiles at T3 (when the child ought to be adjusted and stress profiles should be rare) referring to characteristics of the children (e.g., gender, number of siblings, peer contact before entry), the mothers (their worries), the care providers (their work experience, engagement, attachment) and the groups in the childcare centers (e.g., size, age differences, illness frequency). As a result, experience with siblings and peers before entry facilitated the transition. However, most conditions not linearly affecting children’s cortisol revealed even opposite effects when analyzed at different times. For example, smaller group size and large age-differences at T1 helped the child to stabilize a Regular profile, perhaps due to better control over the situation and greater support from the older children in the group. At T3, however, Regular profiles were associated with larger group size and smaller age-differences which might be helpful for establishing close peer relationships to buffer stress

Infants' stress responses and protest behaviors at childcare entry and the role of care providers.

During the transition from home to childcare, 70 15-month-old infants were videotaped, and their negative emotions were rated. Infants' attachments to mothers were assessed prior to child care entry and to care providers five months later using the Strange Situation Procedure (SSP). Infant heart rate was monitored at home, during adaptation to childcare (mothers present), and during subsequent separations. Respiratory sinus arrhythmia (RSA) was computed from the beat-to-beat measures of heart rate to reflect vagal tone, which is reduced during chronic states of stress, and was collected upon Arrival, during in-group Play, and when in the Group more generally. All infants responded to childcare entry with low RSA levels indicating stress. However, during adaptation with the mother present, RSA was higher for securely attached infants. On the first separation day, 35.3% of the infants fussed and cried extensively. These intense protests predicted later secure attachments to care providers, which adaptively helped to reduce stress, especially in infants who protested extensively, as if summoning their mothers back. Because extensive protest suggests limited regulatory capacities, infants risk overburdening the stress system when left unsupported

"Spontaneous" late recovery from stuttering: Dimensions of reported techniques and causal attributions

Purpose: (1) To survey the employed techniques and the reasons/occasions which adults who had recovered from stuttering after age 11 without previous treatment reported as causal to overcome stuttering, (2) to investigate whether the techniques and causal attributions can be reduced to coherent (inherently consistent) dimensions, and (3) whether these dimensions reflect common therapy components.Methods: 124 recovered persons from 8 countries responded by SurveyMonkey or paper-and-pencil to rating scale questions about 49 possible techniques and 15 causal attributions.Results: A Principal Component Analysis of 110 questionnaires identified 6 components (dimensions) for self-assisted techniques (Speech Restructuring; Relaxed/Monitored Speech; Elocution; Stage Performance; Sought Speech Demands; Reassurance; 63.7% variance explained), and 3 components of perceived causal attributions of recovery (Life Change, Attitude Change, Social Support; 58.0% variance explained).Discussion: Two components for self-assisted techniques (Speech Restructuring; Elocution) reflect treatment methods. Another component (Relaxed/Monitored Speech) consists mainly of items that reflect a common, non-professional understanding of effective management of stuttering. The components of the various perceived reasons for recovery reflect differing implicit theories of causes for recovery from stuttering. These theories are considered susceptible to various biases. This identification of components of reported techniques and of causal attributions is novel compared to previous studies who just list techniques and attributions.Conclusion: The identified dimensions of self-assisted techniques and causal attributions to reduce stuttering as extracted from self-reports of a large, international sample of recovered formerly stuttering adults may guide the application of behavioral stuttering therapies.</p

“Spontaneous” late recovery from stuttering: Dimensions of reported techniques and causal attributions

Purpose: (1) To survey the employed techniques and the reasons/occasions which adults who had recovered from stuttering after age 11 without previous treatment reported as causal to overcome stuttering, (2) to investigate whether the techniques and causal attributions can be reduced to coherent (inherently consistent) dimensions, and (3) whether these dimensions reflect common therapy components. Methods: 124 recovered persons from 8 countries responded by SurveyMonkey or paper-and-pencil to rating scale questions about 49 possible techniques and 15 causal attributions. Results: A Principal Component Analysis of 110 questionnaires identified 6 components (dimensions) for self-assisted techniques (Speech Restructuring; Relaxed/Monitored Speech; Elocution; Stage Performance; Sought Speech Demands; Reassurance; 63.7% variance explained), and 3 components of perceived causal attributions of recovery (Life Change, Attitude Change, Social Support; 58.0% variance explained). Discussion: Two components for self-assisted techniques (Speech Restructuring; Elocution) reflect treatment methods. Another component (Relaxed/Monitored Speech) consists mainly of items that reflect a common, non-professional understanding of effective management of stuttering. The components of the various perceived reasons for recovery reflect differing implicit theories of causes for recovery from stuttering. These theories are considered susceptible to various biases. This identification of components of reported techniques and of causal attributions is novel compared to previous studies who just list techniques and attributions. Conclusion: The identified dimensions of self-assisted techniques and causal attributions to reduce stuttering as extracted from self-reports of a large, international sample of recovered formerly stuttering adults may guide the application of behavioral stuttering therapies

Antioxidants Protect Keratinocytes against M. ulcerans Mycolactone Cytotoxicity

BACKGROUND: Mycobacterium ulcerans is the causative agent of necrotizing skin ulcerations in distinctive geographical areas. M. ulcerans produces a macrolide toxin, mycolactone, which has been identified as an important virulence factor in ulcer formation. Mycolactone is cytotoxic to fibroblasts and adipocytes in vitro and has modulating activity on immune cell functions. The effect of mycolactone on keratinocytes has not been reported previously and the mechanism of mycolactone toxicity is presently unknown. Many other macrolide substances have cytotoxic and immunosuppressive activities and mediate some of their effects via production of reactive oxygen species (ROS). We have studied the effect of mycolactone in vitro on human keratinocytes--key cells in wound healing--and tested the hypothesis that the cytotoxic effect of mycolactone is mediated by ROS. METHODOLOGY/PRINCIPAL FINDINGS: The effect of mycolactone on primary skin keratinocyte growth and cell numbers was investigated in serum free growth medium in the presence of different antioxidants. A concentration and time dependent reduction in keratinocyte cell numbers was observed after exposure to mycolactone. Several different antioxidants inhibited this effect partly. The ROS inhibiting substance deferoxamine, which acts via chelation of Fe(2+), completely prevented mycolactone mediated cytotoxicity. CONCLUSIONS/SIGNIFICANCE: This study demonstrates that mycolactone mediated cytotoxicity can be inhibited by deferoxamine, suggesting a role of iron and ROS in mycolactone induced cytotoxicity of keratinocytes. The data provide a basis for the understanding of Buruli ulcer pathology and the development of improved therapies for this disease