Heribert Sattel

Background: Dissociative disorders frequently co-occur with post-traumatic stress disorder (PTSD), yet many individuals lack adequate treatment. Existing interventions often prioritise reducing arousal over promoting safety and self-soothing, tending to neglect the bodily experience. Aims: This randomised clinical within-person pilot study examined the effects of the nest position, a physiotherapeutic intervention designed to enhance safety and self-soothing, on patients with dissociative disorders and healthy controls (German Clinical Trials Register No.: DRKS00030669). Method: Eighteen patients with dissociative disorders and 18 healthy controls alternated between the nest position and a neutral supine position across two rounds of a measurement session. The order of the experimental conditions (nest position or supine only) was randomised for each participant. We assessed self-reported distress and comfort (Subjective Units of Distress and Comfort) and autonomic nervous system activity during three baseline phases and imagination of stressful and comforting situations. Results: Both patients and healthy controls experienced lower distress and greater comfort in the nest position. Heart rate and sympathetic tone decreased, particularly in the healthy controls. There were no significant changes in parasympathetic tone in both groups. Linear mixed models revealed a significant effect of the nest position on distress, comfort and sympathetic tone. Conclusions: The nest position is a potentially promising additional intervention for highly dissociative patients. Our findings help to better understand the importance of self-soothing and safety in these individuals and to address the research gap in physiotherapy within in-patient mental health care.

Objective: Somatic complaints are frequently named by emerging adults in many countries, but psychological factors contributing to the high level of these often medically unexplained symptoms have received little attention. This study examines the influence of shared risk factors on somatic complaints in a culturally diverse sample.Methods and measures: In a cross-cultural survey study of 2,113 emerging adults (mean age = 22.0 yrs.; SD = 2.04) from seven countries (France, Germany, Turkey, Greece, Peru, Pakistan, and Poland) personality variables, parental rearing styles, coping abilities as well as identity-related stress were assessed. In a second step we successively entered these variables in hierarchical linear mixed models, controlling for country and gender effects and their respective interaction, in order to determine their impact on the level of somatic complaints across countries.Results: All these dimensions varied extensively between all countries, with females reporting higher levels of somatic complaints than men in several countries. Despite this variation, our findings demonstrate a general and stable influence of neuroticism, openness, parental rearing styles, coping abilities and identity-related stress on somatic complaints across countries.Conclusion: Findings support the use of a general intervention model that includes appropriate coping strategies for emotion regulation, but also encourages support seeking for age-specific problems in dealing with identity stress during the transition to adulthood. In addition, this intervention model should be adjusted for a specific culture and gender.

The aim of the present work was the development and validation of a short form of the Experiences in Close Relationship Scale (ECR) in German. Three studies were conducted. In study 1, the best items for the short form were selected from the item pool of the original version based on ant colony optimization (ACO), a recently developed probabilistic approach. Data from three samples collected at a university, an online portal, and a psychosomatic clinic with a total of 1470 participants were analyzed. A 10-item solution resulted, measuring avoidance and anxiety with five items each. This solution showed a good model fit and acceptable reliability in all three samples. The two new short scales were independent of each other. In study 2, the 10-item solution was validated by correlating the new short scales with external criteria. Data from previous studies that included student, community, and clinical samples were reanalyzed. Both short scales showed expected correlations with measures of romantic relationships, personality, psychopathology, and childhood trauma, indicating convergent and discriminant validity. The significant correlations were moderate to strong. In study 3, the selected ten items alone and several content-related scales were presented online to 277 participants, most of them students. The good results in terms of model fit, reliability, and validity observed in studies 1 and 2 could be replicated here. The new short form, called ECR-G-10, allows the measurement of attachment avoidance and anxiety in an economic way in research and clinical practice.

Objective: The heterogeneous conceptualizations and classifications of persistent and troublesome physical symptoms impede their adequate clinical management. Functional somatic disorder (FSD) is a recently suggested interface concept that is etiologically neutral and allows for dysfunctional psychobehavioral characteristics as well as somatic comorbidity. However, its prevalence and impact are not yet known. Methods: We analyzed 2379 participants (mean age = 48.3 years, 52.5% female) from a representative German community survey using operationalized FSD criteria. These criteria defined FSD types based on somatic symptom count, type, and severity assessed by the Bodily Distress Syndrome Checklist. In addition, the associations of those types with health concerns, comorbidity, psychological distress, and self-rated health were determined. Results: There were four clearly demarcated groups with no relevant bothering symptoms, with one or with few bothering symptoms from one organ system, and with multiple bothering symptoms from at least two organ systems. Psychological distress, health concerns, and comorbidity steadily increased, and self-rated health decreased according to the number and severity of symptoms. Somatic symptom burden, health concerns, and comorbidity independently predicted self-rated health, with no interaction effect between the latter two. Conclusions: Our data support an FSD concept with two severity grades according to persistent and troublesome symptoms in one versus more organ systems. The delimitation of subtypes with psychobehavioral characteristics and/or with somatic comorbidity seems useful, while still allowing the demarcation of a group of participants with high symptom burden but without those additional characteristics.

People suffering from chronic dissociation often experience stress and detachment during self-perception. We tested 18 people with dissociative disorders not otherwise specified (DDNOS; compared with a matched sample of 18 healthy controls) undergoing a stress-inducing facial mirror confrontation paradigm, and measured acute dissociation and frontal electroencephalography (measured with a four-channel system) per experimental condition (e.g. confrontation with negative cognition). Linear mixed models indicated a significant group×time×condition effect, with DDNOS group depicting less electroencephalography power than healthy controls at the beginning of mirror confrontation combined with negative and positive cognition. This discrepancy – most prominent in the negative condition – diminished in the second minute. Correlational analyses depicted a positive association between initial electroencephalography power and acute dissociation in the DDNOS group. These preliminary findings may indicate altered neural processing in DDNOS, but require further investigation with more precise electroencephalography measures.

Despite the growing relevance and applicability of elements based on and derived from the embodied mind paradigm, body psychotherapy (BPT) appears not to be a well-established treatment option. This might be due to a lack of proof for its efficacy. We searched electronic databases (Pubmed MEDLINE, PsycInfo, and PSYNDEX) for randomized controlled trials (RCTs) examining predefined BPT interventions. A total of 2,180 references were screened, of which 113 studies were scrutinized in detail and 18 RCTs finally included. The observed effect size (ES) demonstrated medium effects of BPT on primary outcomes psychopathology and psychological distress. In case of significant statistical heterogeneity, exploratory subgroup analyses revealed diagnosis and the degree of control group activity as noteworthy moderators. For secondary outcomes, evidence was scarce, and an improvement could be demonstrated only for coping abilities. The identified evidence indicates that BPT is beneficial for a wide spectrum of psychic suffering. There is a strong need for high-quality studies with bigger samples and for well-defined diagnostic entities to underpin its effectiveness.

Thousands of refugees who have entered Europe experienced threatening conditions, potentially leading to post traumatic stress disorder (PTSD), which has to be detected and treated early to avoid chronic manifestation, especially in children. We aimed to evaluate and test suitable screening tools to detect PTSD in children. Syrian refugee children aged 4–14 years were examined using the PTSD-semi-structured interview, the Kinder-DIPS, and the Child Behavior Checklist (CBCL). The latter was evaluated as a potential screening tool for PTSD using (i) the CBCL-PTSD subscale and (ii) an alternative subscale consisting of a psychometrically guided selection of items with an appropriate correlation to PTSD and a sufficient prevalence (presence in more than 20% of the cases with PTSD). For both tools we calculated sensitivity, specificity, and a receiver operating characteristic (ROC) curve. Depending on the sum score of the items, the 20-item CBCL-PTSD subscale as used in previous studies yielded a maximal sensitivity of 85% and specificity of 76%. The psychometrically guided item selection resulted in a sensitivity of 85% and a specificity of 83%. The areas under the ROC curves were the same for both tools (0.9). Both subscales may be suitable as screening instrument for PTSD in refugee children, as they reveal a high sensitivity and specificity.

We tested the efficacy of an integrative psychotherapeutic group treatment (IPGT) in reducing vertigo/dizziness-related impairment along with depression, anxiety, and somatization by conducting a randomized controlled superiority trial comparing IPGT to self-help groups moderated by a clinical psychologist (SHG). Adult patients with functional vertigo and dizziness symptoms were randomly allocated to either the IPGT or SHG as active control group. Outcomes were assessed at baseline (t0), after treatment lasting 16 weeks (t1), and 12 months after treatment (t2). A total of 81 patients were assigned to IPGT and 78 patients were assigned to SHG. Vertigo-related impairment was reduced in both conditions (IPGT: t0–t1: d = 1.10, t0–t2: d = 1.06; SHG: t0–t1: d = 0.86, t0–t2: d = 1.29), showing the efficiency of both IPGT and SHG. Clinically relevant improvements were also obtained for depression in both groups. Linear mixed model analyses revealed no differences between groups for all outcomes (effect of group for the primary outcome: b = −1.15, SE = 2.13, t = −0.54, p = 0.59). Attrition rates were higher in SHG (52.6%) than in IPGT (28.4%). Both conditions improved primary and secondary outcomes while IPGT was better accepted by patients than SHG. Trial registration: ClinicalTrials.gov, Identifier: NCT02320851.

Feedback is regarded a key element in teaching communication skills. However, specific aspects of feedback have not been systematically investigated in this context. Therefore, the aim of this study was to investigate the effectiveness of communication skills training (CST) integrating specific, structured and behavioral feedback. We condensed best practice recommendations for feedback in a CST for undergraduate medical students and compared the effect of specific, structured and behavior-orientated feedback (intervention group CST-behav) to general, experience-orientated feedback (CST- exp. as our control group) in a randomized controlled trial (RCT). We investigated changes on communication skills evaluated by independent raters, and evaluated by standardized patients (SP). To do that, every student was video-recorded in a pre and post assessment. Sixty-six undergraduate medical students participated voluntarily in our study. Randomization did not result in equally skilled groups at baseline, so valid inter-group comparisons were not possible. Therefore, we analyzed the results of 34 students of our intervention group (CST-behav). Five out of seven domains in communication skills as evaluated by independent raters improved significantly, and there was a significant change in the global evaluation by SP. Although we were unable to make between-group comparisons, the results of the within group pre-post evaluation suggest that specific feedback helps improve communication skills.