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Veliko Tarnovo Hall - Marinela

General Mental Health

Philipp Herzog, Pavlina Petkova, Carolina Marín, Samet Baş / Regina Steil (chair) Speaker

Chair: Regina Steil

16:00 From explanation to prediction – Identifying predictors of treatment non-response in
           patients suffering from posttraumatic stress disorder in routine clinical care
Philipp Herzog, Philipps-University of Marburg; Ulrich Voderholzer, Schoen Clinic Roseneck; Matthias Feldmann, Winfried Rief, Eva-Lotta Brakemeier, Philipps-University of Marburg

16:15 Mindfulness techniques for Post-traumatic stress disorder
          Petkova, P., Tsoneva, N., Dimmitrova, S., Sofia University, Bulgaria

16:30 Application of positive psychology protocol in victims of M-11 terrorist attacks in
            Madrid (Spain):A pilot study
CAROLINA MARÍN, GONZALO HERVÁS, MARIA CRESPO, M.MAR GÓMEZ-GUTIÉRREZ, MANUEL J. RODRÍGUEZ-ABUIN, CARMELO VÁZQUEZ, COMPLUTENSE UNIVERSITY - MADRID

16:45 Spouse Support and General Health In the Context of Marital Satisfaction
             In Grieving Couples: An Actor–Partner Interdependence 
Mediation Model
           Samet Baş, Duygu Güngör Culha, Dokuz Eylul University

17:00 Discussion

Abstracts:

1) From explanation to prediction – Identifying predictors of treatment non-response in patients suffering from posttraumatic stress disorder in routine clinical care
Philipp Herzog, Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany; Ulrich Voderholzer, Schoen Clinic Roseneck, Prien, Germany; Matthias Feldmann, Winfried Rief, Eva-Lotta Brakemeier, Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany

Introduction: Posttraumatic Stress Disorder (PTSD) is a severe and often chronic mental disorder in people, who were exposed to a potential traumatic, life-threatening event. Patients suffering from PTSD can be treated in an outpatient, day clinic or inpatient setting. Meta-analyses and systematic reviews support the efficacy of psychotherapy in different settings, especially individual trauma-focused cognitive-behavioral therapy. Although there is a huge amount of studies investigating the efficacy of psychotherapy in patients suffering from PTSD, little is known about individual treatment course raising questions about why some patients are responding to treatment while others do not. Data indicates that non-response-rates and dropout-rates of trauma-focused cognitive-behavioral therapy are despite its general efficacy relatively high. The results of studies aiming at identifying predictors of treatment outcome are inconsistent. These findings suggest that there is a need of studies identifying patients at-risk non-responding. Hence, the purpose of the current study is to examine valid and reliable predictors determining treatment non-response in patients suffering from PTSD.

Method:In a naturalistic longitudinal design, 1850 patients suffering from PTSD and being treated in five inpatient psychosomatic clinics between 2013 and 2017 were examined. Sociodemographic, clinical and treatment-specific variables were assessed at intake. Treatment outcome was assessed at intake and discharge by symptom-specific self-questionnaires and self-questionnaires measuring general psychopathology and quality of life. Due to the large dataset and the high amount of possible predictors and interactions, we propose to use modern machine learning approaches to select the most important variables for prediction. Recently, several authors argue for a combination of machine-learning techniques to decrease the variance of algorithms used and thus make results more comparable. We follow this argument using different methods (e.g., Random Forest algorithm, Bayesian Additive Regression Trees, Elastic Net Regularization) as a basis and modify them for the purpose of this study. Results: First results can be presented in summer 2018. The analyses are assumed to end up in a set of valid and reliable predictors of treatment non-response in patients suffering from PTSD.

Discussion:Results will be discussed within the context of current literature.  

Conclusion: Findings of this study can offer to some extent an opportunity to gain insight into the omnipresent question in current psychotherapy research: “What works for whom?”. The examination of predictors of treatment outcome allows the identification of patients at risk faring worse during the course of treatment. It is of high clinical relevance to identify groups of patients currently not benefiting from inpatient routine care in order to develop and provide personalized treatments for these groups to improve treatment outcome.

 

2) Mindfulness techniques for Post-traumatic stress disorder
    Petkova, P., Tsoneva, N., Dimmitrova, S., Sofia University, Bulgaria

         One of the key features of Post-traumatic stress disorder (PTSD) is the formation of complex dysfunctional beliefs which are a compilation of the dysfunctional beliefs of the individual before the traumatic situation and the ones triggered by it. Emotions like guilt and shame become the connecting point for complex dysfunctional beliefs which aggravate the social disability of the individual.

         In our practice we use mindfulness techniques together with cognitive-behavioral therapy in individual as well as group sessions. For initial assessment we use the projective test “Doors”. The client chooses a picture of a door behind which ‘stands’ his trauma from the past and tells about his memory. The door serves to bring more cognitive and emotional details about the trauma that might otherwise not be accessible consciously. The second stage is using the technique “vipassana” to teach the client to observe the dynamics of his emotions and how they influence his perceptions, beliefs, his behavior and bodily sensations. Cognitive restructuring is also applied to help reconsider the losses for the individual as gains in personality development. Specially chosen musical pieces are used to balance the emotions evoked by the traumatic situations. Coloring of mandalas is recommended as a way of seeing the trauma as a part of the puzzle of life. At the end of therapy, the client chooses a second door which symbolizes his future. He then projects his goals and life meaning onto it.

         The use of mindfulness techniques together with projective tests, musical and drawing methods enhance the effectiveness of CBT in Post-traumatic stress disorder.

3) Application of positive psychology protocol in victims of M-11 terrorist attacks in Madrid (Spain):A pilot study

CAROLINA MARÍN, GONZALO HERVÁS, MARIA CRESPO, M.MAR GÓMEZ-GUTIÉRREZ, MANUEL J. RODRÍGUEZ-ABUIN, CARMELO VÁZQUEZ, COMPLUTENSE UNIVERSITY - MADRID

 

INTRODUCTION: Fourteen years after the terrorist attacks of March 11th, 2004 in Madrid (Spain), victims demand new actions focused on solving current psychological needs. Once Post Traumatic Stress Disorder (PTSD) and other comorbid disorders have been treated, Positive Psychology might be a good approach to work on some aspect more related to this stage of the recovery in order to improve their well-being. Preliminary data gathered from M-11 victims showed that traumatic symptomatology and well-being can coexist in some people and suggests that well-being can be a target for psychological intervention In order to work on positive variables and increase well-being, a structured protocol stemmed from Positive Psychology was developed. Their specific objectives were: (a) increase the frequency, intensity and range of positive emotions; (b) develop key areas of well-being as relatedness, self-acceptance, life meaning, among others; and (c) promote perception of benefits and the development of a positive identity.

 

METHOD: The protocol was applied to 15 victims of M-11 terrorist attacks that had previously underwent psychological treatment for their symptoms and showed low PTSD symptoms with low well-being. Application was carried out in groups by trained therapist along 10 weekly session of 90 minutes in 2017. Well-being (Pemberton index), positive and negative Affect (PANAS),savoring and dampening (RPA), posttraumatic growth (PTG), and enjoyment orientation (EOS) were assessed in pretreatment, posttreatment and 3-moths follow-up. Nonparametric statistical methods were used.

 

RESULTS: Results showed a significant increase on well-being, positive affect, enjoyment orientation, as well as a significant decrease of negative affect from pre- to follow-up.Posttraumatic growth did not show any significant change.

 

DISCUSSION: Due to the important implications of having chronic low well-being levels, there appears to be a need of promote well-being in victims of terrorist attacks. This study presents a new approach to achieve this aim that offers promising results. Nevertheless, because of the small simple size and the lack of control group and long-term follow ups results should be taken cautiously. This is only a start point to fit the protocol for further and methodologically sound studies.

 

CONCLUSIONS: This study offers a new approach in psychological treatment for victims of terrorism; this approach goes beyond symptoms and pursuits higher levels of life satisfaction and well-being. Anyway, it would be a second level intervention that would be helpful once trauma related symptoms have been properly treated through a trauma-focused treatment. Furthermore, this kind of protocols would be further applied to other trauma victims.

4) Spouse Support and General Health In the Context of Marital Satisfaction In Grieving Couples: An Actor–Partner Interdependence Mediation Model Samet Baş, Psychology Department of Dokuz Eylul University, İzmir, Turkey;
Duygu Güngör Culha, Department of Psychology of Dokuz Eylul University, İzmir, Turkey

Introduction:
It is known that bereaved individuals may experience mental or physical health problems after the death of a loved one.Despite the fact that men and women give different reactions to the loss, in the context of marriage, partner’s health conditions are mutually influencing each other.
Method:
In this study using dyadic analysis we examined whether marital satisfaction is an effective mediator in the relationship between spouse support and general health among grieving couples (N=296). The data obtained from couples who has a significant loss experience tested using the actor-partner interdependence model and path analysis.
Results:
The model revealed that actor effects between spouse support and general heath mediated by marital satisfaction. The higher spouse support was significantly associated with higher marital satisfaction, and marital satisfaction was significantly associated with better general health for grieving couples. However, the partner effects showed different associations for men and women. While women’s perceived spouse support had asignificant effect on men’s marital satisfaction, perceived spouse support of men was not significantly associated withwomen’s marital satisfaction. Moreover, there was no significant partner effect in the relationship between marital satisfaction and general health.
Conclusion:
Such findings provide an important perspective on interactive nature of men and women during marriage and the role of actor-partner interdependence model. Recommendations for further researches and dyadic methods will be discussed.