Blinde Flecken? Der Einfluss von Stigma auf die psychotherapeutische Versorgung von Menschen mit Schizophrenie

Schlier, Björn; Lincoln, Tania M.

doi:10.1159/000450694

Cited by 29 publications

(21 citation statements)

References 39 publications

(24 reference statements)

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“…Furthermore, due to the existing structural, organizational, and financial barriers, the implementation of professional care, including psychotherapeutic and psychosocial interventions during hospitalization and aftercare, has been reported as insufficient ( 25 , 26 ). Concerning organizational barriers, it has been noted that only about 1% of patients with SSDs received psychotherapy in Germany ( 27 – 29 ). On a structural level, national psychotherapy guidelines only covered accessory and residual symptoms, however, not direct symptoms of SSDs ( 25 , 29 ).…”

Section: Introductionmentioning

confidence: 99%

“…Concerning organizational barriers, it has been noted that only about 1% of patients with SSDs received psychotherapy in Germany ( 27 – 29 ). On a structural level, national psychotherapy guidelines only covered accessory and residual symptoms, however, not direct symptoms of SSDs ( 25 , 29 ). Moreover, insurance companies denied psychotherapy requests for SSDs more frequently in comparison to other mental disorders ( 25 ).…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, through comprehensive efforts of multi-stakeholder treatment options could be partially increased (outpatient psychotherapy up to 3%) by facilitating state-of-the-art care, anti-stigma efforts, and training of evidence-based psychotherapy for SSD to overcome multiple barriers ( 29 ). Despite these changes, there still remains a huge gap in treatment options, therapy manuals, and well-trained psychotherapists in CBT for SSDs in both in- and outpatient settings ( 31 , 32 ).…”

Section: Introductionmentioning

confidence: 99%

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Mindfulness-Based Interventions for In-Patients With Schizophrenia Spectrum Disorders—A Qualitative Approach

et al. 2020

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In recent years, mindfulness-based interventions (MBI) have gained clinical relevance in the treatment of patients with schizophrenia spectrum disorders (SSDs). High symptom burden, long durations of hospitalization and high rehospitalization rates demonstrate the severity and cost-intensity of these disorders. MBIs have shown promising treatment outcomes in a small number of trials, primarily taking place in English-speaking countries. The current study aims to explore mechanisms and processes as well as adverse effects of MBIs on in-patients with SSDs in a German university hospital setting. A qualitative design based on inductive thematic analysis accompanied by quantitative assessments was chosen. A semi-structured interview guide was developed by psychiatrists and psychologists to assess patient experiences, perceptions, thoughts, and feelings during and after taking part in a MBI. Twenty-seven interviews were conducted between September 2017 and October 2018 with in-patients who are diagnosed with schizophrenia or schizoaffective disorder. Rater-based questionnaires, such as the Positive and Negative Syndrome Scale (PANSS), Montgomery Asberg Depression Rating Scale (MADRS), and Psychotic Symptom Rating Scales-Auditory Hallucination (PSYRATS-AH) were administered at baseline to collect clinical outcomes. Qualitative analysis revealed two domains: content and function. In the first domain related to content with the core elements "detachment and rumination", "presence and getting lost", "nonjudgment and judgment", and effects with "emotions", "cognition", and "symptom changes". A second domain related to function was extracted, including the relevance of perception of context and transfer to everyday life. Overall, improvements concerning cognition, distress, and psychopathology were detected, while no adverse effects, such as increased psychotic symptoms, were revealed. As the first study of its kind, mechanisms, processes, and the safety of MBIs were explored and confirmed in a sample of German in-patients with SSDs. The results of this qualitative study are in line

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mindfulness-Based Interventions for In-Patients With Schizophrenia Spectrum Disorders—A Qualitative Approach

et al. 2020

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“…For example, despite the NICE guideline recommendation to offer CBT to all patients with psychosis, only a minority of eligible patients with psychosis are being offered CBT in the UK (Prytys, Garety, Jolley, Onwumere, & Craig, 2011). In Germany, studies indicate that only a minority of psychosis patients have access to evidence-based psychotherapy (Schlier & Lincoln, 2016). To our knowledge, this serious implementation problem of evidence-based interventions is not restricted to Germany and the UK.…”

Section: Final Conclusionmentioning

confidence: 98%

An Overview of the Evidence for Psychological Interventions for Psychosis: Results From Meta-Analyses

Lincoln

Pedersen

2019

CPE

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There are numerous psychological approaches to psychosis that differ in focus, specificity and formats. These include psychodynamic, humanistic, cognitive-behavioural and third-wave-approaches, psychoeducation, various types of training-based approaches and family interventions. We briefly describe the main aims and focus of each of these approaches, followed by a review of their evidence-base in regard to improvement in symptoms, relapse and functioning. We conducted a systematic search for meta-analyses dating to 2017 for each of the approaches reviewed. Where numerous meta-analyses for an approach were available, we selected the most recent, comprehensive and methodologically sound ones. We found convincing short- and long-term evidence for cognitive behavioural approaches if the main aim is to reduce symptom distress. Evidence is also strong for psychoeducative family interventions that include skills training if the main aim is to reduce relapse and rehospitalisation. Acceptance and commitment therapy, mindfulness-based approaches, meta-cognitive and social skills training, as well as systemic family interventions, were also found to be efficacious, depending on the outcome of interest, but meta-analyses for these approaches were based on a comparatively lower number of outcome studies and a narrower selection of outcome measures. We found no convincing evidence for psychodynamic approaches, humanistic approaches or patient-directed psychoeducation (without including the family). An array of evidence-based psychological therapies is available for psychotic disorders from which clinicians and patients can choose, guided by the strength of the evidence and depending on the outcome area focused on. Increased effort is needed in terms of dissemination and implementation of these therapies into clinical practice. Meta-analyses show convincing evidence for CBT if the main target is psychotic symptoms. Meta-analyses show convincing evidence for family interventions if the main target is relapse. Effects are promising for ACT, mindfulness-based and systemic approaches, but more research is needed. The array of effective approaches allows clinicians and patients to select the most appropriate one. Meta-analyses show convincing evidence for CBT if the main target is psychotic symptoms. Meta-analyses show convincing evidence for family interventions if the main target is relapse. Effects are promising for ACT, mindfulness-based and systemic approaches, but more research is needed. The array of effective approaches allows clinicians and patients to select the most appropriate one.

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“…AVHs in the context of psychotic disorders are generally treated with antipsychotic medication as a first line of treatment (and in many cases the only line). 15 Clinical drug trials typically report small to moderate effects for psychotic symptoms in general and reanalyses of these trials indicate that these effects can be generalised to AVH. 16 Nevertheless, about one-third of the patients who take antipsychotics continue to have AVH.…”

Section: Introductionmentioning

confidence: 99%

RELATE—a randomised controlled feasibility trial of a Relating Therapy module for distressing auditory verbal hallucinations: a study protocol

et al. 2021

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IntroductionAuditory verbal hallucinations (AVHs) are associated with distress and reduced functioning. Research suggests that distress is associated with the voice hearer’s responding to AVH in a passive and subordinate manner. A novel approach focuses on relating to AVH and teaches assertive responses to AVH using experiential role-plays. A small pilot study found a large effect of this approach on AVH distress but an independent multicentre study is required to ascertain effectiveness across different settings. We aim to estimate the expected effect for a subsequent trial to demonstrate that adding a module of Relating Therapy (RT) to treatment as usual (TAU) is superior to TAU alone in reducing AVH distress. We also test the feasibility of patient recruitment, therapist training, and therapy monitoring in different psychological and psychiatric outpatient facilities in Germany.Methods and analysisWe will recruit 75 patients diagnosed with a schizophrenia spectrum disorder and persistent distressing AVH across four sites. Patients will be randomised to receive either 16 sessions of RT plus TAU or TAU alone within a 5-month period. Randomisation will be stratified by sites. Single-blind assessments will take place at baseline, at 5 months (T1) and at 9 months (T2). The primary outcome is the distress factor score of the AVH subscale of the Psychotic Symptoms Rating Scale at T2 adjusted for the baseline value. Secondary outcomes are change in depressive symptoms, quality of life, time spent in structured activities as well as negative relating to voices and to other people.Ethics and disseminationThe trial has received ethical approval from the German Psychological Society Ethics Committee. The trial results will be disseminated through conference presentations, peer-reviewed publications and social media.Trial registration numberClinicalTrials.gov Registry (NCT04578314).

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Blinde Flecken? Der Einfluss von Stigma auf die psychotherapeutische Versorgung von Menschen mit Schizophrenie

Cited by 29 publications

References 39 publications

Mindfulness-Based Interventions for In-Patients With Schizophrenia Spectrum Disorders—A Qualitative Approach

Mindfulness-Based Interventions for In-Patients With Schizophrenia Spectrum Disorders—A Qualitative Approach

An Overview of the Evidence for Psychological Interventions for Psychosis: Results From Meta-Analyses

RELATE—a randomised controlled feasibility trial of a Relating Therapy module for distressing auditory verbal hallucinations: a study protocol

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