Lorena Brenner | Charité – Universitätsmedizin Berlin | Germany
Rahel Bachem | Germany
Prof. Volker Köllner | Rehazentrum Seehof der Deutschen Rentenversicherung Bund | Germany
According to the bio-psycho-social illness concept, chronic illness manifest not only in disorder-specific symptoms but have further consequences such as illness-related capacity restrictions and disability (Linden, 2017).
The 11th revision to the International Classification of Diseases (WHO, 2018) includes a new chapter of stress-related disorders and presents two distinct sibling conditions: Posttraumatic Stress Disorder (PTSD) and complex PTSD (cPTSD). They are associated with different levels of functional impairment.
The current study therefore has the aim to supply information on PTSD and cPTSD specific differences in work-related impairment.
Participants were 662 patients (mean age 50.99 +/- 8.99 years; 70.1 % female) of a Psychosomatic Rehabilitation Clinic. Self-reported screening instruments including the Mini-ICF-APP-S, SCL-90-R, IES-R and the SkPTBS (Dorr et al., 2016) were administered to participants at the beginning of their inpatient psychotherapy.
A multivariate analysis of variance showed that the groups differed significantly regarding the strength of impairment at the Mini-ICF-APP-S dimensions (Pillai trace: V = .179, F(26,1228) = 4.647, p < .001, partial η² = .090). Significant Bonferroni-corrected differences emerged between the cPTSD group and the PTSD group (p < .001) as well as the cPTSD group and the no-PTSD group (p = < .001) among all dimensions. No significant differences were found between the PTSD group and the no-PTSD.
Patients with cPTSD reported stronger impairment in all capacity dimensions of the Mini ICF-APP-S than patients with PTSD or patients with no-PTSD. This confirms the theoretical construct of cPTSD and supports the need for an independent cPTSD diagnosis and own rehabilitation strategies for these group of patients.
1. Dorr, F., Firus, C., Kramer, R., & Bengel, J. (2016). Entwicklung und Prüfung eines Screenings zur komplexen Posttraumatischen Belastungsstörung (SkPTBS). Psychother Psych Med, 66(11), 441-448. doi:10.1055/s-0042-109403
2. Linden, M. (2017). Definition and assessment of disability in mental disorders under the perspective of the International Classification of Functioning, Disability and Health (ICF). Behavioral Sciences & the Law, 35(2), 124-134.
3. WHO. (2018). The ICD-11 classification of mental and behavioral disorders: Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization.
Differential effects of humiliation and injustice in patients in psychosomatic rehabilitation
Prof. Michael Linden | Charité Universitätsmedizin Berlin | Germany
N. Noack | Charité - Universitätsmedizin Berlin | Germany
Franziska Kessemeier | Zentrum für Klinische Psychologie und Rehabilitation (ZKPR), Universität Bremen | Germany
Dr. Axel Kobelt | Deutsche Rentenversicherung Braunschweig-Hannover | Germany
Prof. Markus Bassler | Deutsche Rentenversicherung | Germany
It has been shown that injustice and humiliation are the most frequent and burdensome negative life events, as reported by patients in psychosomatic rehabilitation (Bülau et al 2016). They both can result in embitterment reactions and can lead to strong negative emotions, including shame, feelings of inferiority, and helplessness, anger, vindictive feelings, and even aggressive rumination and acting out. This can severely impair the affected person, but also her or his environment.
The research question is whether there are differences between injustice and humiliation in regard to the type and severity of consequences.
In an ICF-oriented semi-structured interview, 102 inpatients from a department of behavioural medicine were asked about burdens in life. Additionally, patients filled in the “ICD-10 Symptom Rating”, the “ICF AT 50-Psych”, the “Beck Depression Inventory” and the “HEALTH-49”.
The experience of humiliation was rated as strong or very strong by 70.6% of the patients, which is the most frequent burden. It is followed by persistent stress (59.9%), and the experience of injustice in 56.8% of patients. Comparisons between patients who complained about injustice alone, humiliation alone, injustice and humiliation combined, and neither injustice or humiliation show that humiliation and injustice similarly and significantly impair psychological well-being. If both are combined negative reactions are augmented.
Humiliation and injustice are the most frequent and important negative life events in psychosomatic patients. They need proper recognition and treatment in psychosomatic rehabilitation care.
1. Bülau, N. I., Kessemeier, F., Petermann, F., M. Bassler & Kobelt, A. (2016). Evaluation von Kontextfaktoren in der psychosomatischen Rehabilitation. Rehabilitation, 55, 381-387
Outcome of psychosomatic rehabilitation in Germany - Overview of 30 years of rehabilitation / health services research
Dr. Rüdiger Nübling | Gesellschaft für Qualität im Gesundheitswesen (GfQG) | Germany
Prof. Holger Schulz | Universitätsklinikum Hamburg-Eppendorf | Germany
Dr. Jürgen Schmidt | Gesellschaft für Qualität im Gesundheitswesen (GfQG) | Germany
Prof. Markus Bassler | Rehazentrum Oberharz der Deutschen Rentenversicherung Braunschweig - Hannover | Germany
Psychosomatic rehabilitation has been an integral part of the treatment offer for mentally and psychosomatically ill people in Germany for about 50 years. In 2016, 16% of all rehabilitation treatments of the pension insurances were carried out for people with mental illness, which corresponds to about 150,000 treatments. There are also about as many treatments financed by statutory and private health insurances. The number of annual treatments is still increasing.
The aim is to give an overview over outcome research in psychosomatic rehabilitation in Germany
For about 30 years, evaluation research has developed for this area. A meta-analysis carried out at the year 2004 (MESTA study, Steffanowski et al, 2007) comes up with 67 mostly naturalistic studies involving more than 25,000 patients. Since 2004, a considerable number of further and large studies have been added, so that the data situation has been continuously expanded.
In the MESTA study, mean effect sizes were found at the end of treatment of d = 1.05 and in 1-year follow-up of d = 0.67. When considering disorder-specific patient groups (e.g., diagnosis depression) with disorder-specific assessment instruments (e.g., depression score), the effect sizes were d = 1.3 and d = 1.0, respectively. The return on investment (ROI) was 2-4.5. Although a systematic meta-analysis of recent studies is still outstanding, it can be assumed that psychosomatic rehabilitation is highly effective and also efficient.
The lecture discusses methodological foundations for rehabilitation and health services research as well as the results of the MESTA study in the context of current studies.
1. Steffanowski, A., Löschmann, C., Schmidt, J., Wittmann, W. W. & Nübling, R. (2007). Metaanalyse der Effekte psychosomatischer Rehabilitation. Bern, Huber.
Relation between occupation-related coping strategies and need for cognition in rehabilitation
Ursula Melicherova | Charité Universitätsmedizin Berlin
Aniko Steiger | Technische Universität Chemnitz | Germany
Prof. Alexander Strobel | Technische Universität Dresden
Prof. Jürgen Hoyer | Technische Universität Dresden
Prof. Anja Strobel | Technische Universität Chemnitz, Professur für Persönlichkeitspsychologie und Diagnostik
Prof. Volker Köllner | Rehazentrum Seehof der Deutschen Rentenversicherung Bund | Germany
Psychosomatic rehabilitation focuses on maintenance of occupation-related skills and enhancement of social participation in individuals with chronic mental disorders. By using diagnostic tools such as Occupation Stress and Coping Inventory (AVEM) ineffective occupation-related attitudes can be identified more effectively. One of the main aspects of therapy is the focus on utilisation and activation of personal resources and skills of individuals. Among others, need for cognition (NFC) is linked to personality traits such as conscientiousness and extraversion as well as an active, problem-focused coping style.
This study aims at examining the relation between occupation-related attitudes measured by AVEM and need for cognition assessed by ACES (work in progress) in psychosomatic rehabilitation.
ACES and AVEM were administered as part of a larger study to 178 patients (122 females, 56 males; mean age=51,83, SD=8,5) of psychosomatic rehabilitation clinic.
Significant positive correlations were found between cognitive motivation a subscale of ACES, and active problem-solving (r=.623, p<.001) and contentment (r=.497, p<.001), both subscales of AVEM. Volitional self-regulation, subscale of ACES, also positively correlated with both active problem-solving (r=.572, p<.001) and contentment (r=.543, p<.001). Inner resignation (AVEM) correlated negatively with both cognitive motivation (r=-.480, p<.001) and volitional self-regulation (r=-.488, p<.001).
This broadens the earlier findings on the relation of NFC with other protective personality traits. Further research is needed to examine the underlying mechanisms.
1. Köllner, V., Gündel, H. Hildenbrand G (2018). Psychosomatische Rehabilitation-Unterschiede zur Krankenhausbehandlung und Differentialindikation. Ärztliche Psychotherapie, 13,6-15.
2. Strobel, A., Anacker, K., & Strobel, A. (2017). Cognitive Engagement Mediates the Relationship between Positive Life Events and Positive Emotionality. Frontiers in psychology, 8, 1861. doi:10.3389/fpsyg.2017.01861
3. Maas, H., Spinath, FM.(2012).Personality and coping with professional demands: A behavioral genetics analysis.Journal of Occupational Health Psychology, 17, 376-385.doi: 10.1037/a0027641
Resilience and return to work in psychosomatic rehabilitation: Results of a prospective observation study with a 12-month follow-up
Dr. Scott Stock Gissendanner | Berolina Klinik GbmH & Co. KG | Germany
Prof. Gerhard Schmid-Ott | Berolina Klinik GmbH & Co. KG | Germany
Prof. Wolfgang Schulz | Technische Universität Braunschweig
Resilience refers to the capacities and resources an individual uses to overcome personal crises and sickness and to adapt to chronic stressors . No study has investigated its variability and predictive value for return-to-work outcomes in rehabilitation treatment.
This study measures changes in resilience scores among patients in five-week psychosomatic rehabilitation. It measures correlations between resilience and other socio-psychological predictors of rehabilitation outcomes and assesses the predictive value of these factors for employment one year after discharge.
Method: In a sample of 401 patients, resilience was measured at the beginning and end of treatment and at 12 months post discharge. The response rate at 12 months was 73.6%. We employed the German version of the Wagnild and Young's Relience Scale [2,3]. Other measures include the Hannover Self-Regulation Inventory (HSRI) to measure ego strength and the Subjective Prognosis of Employability scale.
The sample demonstrated a very low level of resilience in comparison to representative samples of the German population. There was a highly significant increase in average resilience over the course of rehabilitation. At 12 months, women showed a further increase whereas resilience among men did not change. At follow-up, 72.8% of patients were employed. Return to work is predicted significantly by resilience at treatment start and by resilience at end of treatment.
Resilience is a trait that changes during rehabilitative treatment and should be given more attention in psychosomatic rehabilitation and research. In psychotherapy involving conflicts and problems, therapists should integrate work-related factors.
1. Wagnild G, Young H. Development and psychometric evaluation of the Resilience Scale. J Nurs Measurement 1993; 1 (2):165-178.
2. Schumacher J, Leppert K, Gunzelmann Z, Strauß B, Brähler E. Die Resilienzskala – Ein Fragebogen zur Erfassung der psychischen Widerstandsfähigkeit als Personmerkmal. Z Klin Psychol Psychiat Psychother 2005; 53: 16-39.