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Andreas Maercker

Publications and source records attributed to Andreas Maercker.

At least 19 recordsLinked to original sources
PubMed2006

Does the quality of the working alliance predict treatment outcome in online psychotherapy for traumatized patients?

BACKGROUND: The provision of online counseling and online therapy is steadily increasing. The results of a number of controlled trials investigating the efficacy of online approaches indicate that some of these new treatment alternatives might indeed be effective. Yet, little is known about how the therapeutic relationship (or working alliance) evolves over the Internet and whether it influences treatment outcome as it does in traditional face-to-face therapy. The working alliance has been defined as the extent to which a patient and a therapist work collaboratively and purposefully and connect emotionally. OBJECTIVE: The aim of the study was to investigate the quality and predictive relevance of the therapeutic alliance for patients receiving a short-term, Internet-based, cognitive-behavioral therapy program for posttraumatic stress reactions. METHODS: After rigorous screening for exclusion criteria of high dissociative tendencies, risk of psychosis, and suicidal tendencies, 48 patients, who had experienced a traumatic event in the past, were included in the online treatment study. The short form of the Working Alliance Inventory (WAI-S) was administered at the fourth treatment session. The relevance of the therapeutic relationship for treatment outcome was assessed in terms of residual gain from pretreatment assessment to the end of treatment. The revised Impact of Event Scale (IES-R) and the depression and anxiety subscales of the Brief Symptom Inventory (BSI) were used to assess treatment outcome. RESULTS: A total of 48 participants were included in the analysis. Overall, high alliance scores were found. In contrast to previous studies of conventional face-to-face therapy, there was only a low to modest association (.13 to .33) between the quality of the therapeutic relationship and treatment outcome. CONCLUSION: High alliance scores indicate that it was possible to establish a stable and positive therapeutic relationship online. However, the therapeutic relationship was found to be a less relevant predictor of the therapy outcome than in face-to-face approaches. We discuss whether this finding can be attributed to methodological reasons such as the restricted range of alliance ratings obtained or the time of administration of the WAI-S, or whether the therapeutic relationship might be less relevant to the treatment outcome of online therapy approaches.

Cognitive Behavioral Therapy↗
PubMed2006

Cardiovascular correlates of motor vehicle accident related posttraumatic stress disorder and its successful treatment.

Persons with posttraumatic stress disorder (PTSD) have been shown to display elevated baseline cardiovascular activity and a heightened physiological reactivity to trauma-related stimuli. Study 1 examined differences in baseline heart rate (HR) and HR reactivity in 68 survivors of motor vehicle accidents (MVAs) and healthy controls without MVA. MVA survivors with PTSD (n=26), subsyndromal PTSD (n=22), traumatized controls without PTSD (non-PTSD with MVA, n=20) and healthy controls without MVA (HC, n=27) underwent measurement of HR during baseline and exposure to a neutral, positive, negative, and trauma-related picture. PTSD patients showed elevated baseline HR and increased HR reactivity only during exposure to the trauma-related picture. Study 2 investigated whether the elevated physiological responses observed in Study 1 normalized after cognitive behavioral therapy (CBT). We conducted a randomized, controlled treatment trial comparing CBT (n=17) to a Wait-list condition (WLC, n=18). Results showed a greater decrease in HR reactivity for CBT than for WLC. The change in HR reactivity was associated with clinical improvement.

Accidents, Traffic↗
PubMed2006

Comparison of two diagnostic systems for Complicated Grief.

BACKGROUND: To date, there are mainly two diagnostic systems that have been proposed for the diagnosis of Complicated Grief [Horowitz, M.J., Siegel, B., Holen, A., Bonanno, G.A., Milbrath, C., Stinson, C.H., 1997. Diagnostic criteria for complicated grief disorder. American Journal of Psychiatry 154, 904-910; Prigerson, H.G., Shear, M.K., Jacobs, S.C., Reynolds, C.F., Maciejewski, P.K., Davidson, J.R., Rosenheck, R., Pilkonis, P.A., Wortman, C.B., Williams, J.B., Widiger, T.A., Frank, E., Kupfer, D.J., Zisook, S., 1999. Consensus criteria for traumatic grief: a preliminary empirical test. British Journal of Psychiatry 174, 67-73]. There is also no data about prevalence rates of Complicated Grief in a representative sample. The purpose of this study was to compare the diagnostic systems with regard to prevalence, conditional probabilities, and agreement. METHODS: In a sample of elderly persons, features of bereavement, diagnoses of Complicated Grief and related symptoms were assessed. Agreement between the diagnostic systems was determined by kappa statistics. RESULTS: 18.9% of the sample had experienced a major bereavement, in average 15 years before measurement. The prevalence rates were 4.2% (Horowitz et al.) and 0.9% (Prigerson et al.). The agreement was poor (kappa=.13), i.e. the minority of cases received both diagnoses. The conditional probabilities of developing CG after experiencing a major bereavement were 22.2% (Horowitz et al.) and 4.6% (Prigerson et al.). LIMITATIONS: The findings are constrained to an elderly, urban population. Screening instruments, no clinical interviews, were used to assess psychopathology. CONCLUSIONS: The Horowitz et al. criteria set is more inclusive and less strict than the Prigerson et al. criteria set. The importance of functional impairment and the number of symptoms needed account for this difference. Further research should integrate diagnostic systems in order to achieve international standardization of diagnostic criteria for Complicated Grief.

Adaptation, Psychological↗
PubMed2006

Dresden PTSD treatment study: randomized controlled trial of motor vehicle accident survivors.

BACKGROUND: We translated, modified, and extended a cognitive behavioral treatment (CBT) protocol by Blanchard and Hickling (2003) for the purpose of treating survivors of MVA with full or subsyndromal posttraumatic stress disorder (PTSD) whose native language is German. The treatment manual included some additional elements, e. g. cognitive procedures, imaginal reliving, and facilitating of posttraumatic growth. The current study was conducted in order to test the efficacy of the modified manual by administering randomized controlled trial in which a CBT was compared to a wait-list control condition. METHODS: Forty-two motor vehicle accident survivors with chronic or severe subsyndromal posttraumatic stress disorder (PTSD) completed the treatment trial with two or three detailed assessments (pre, post, and 3-month follow-up). RESULTS: CAPS-scores showed significantly greater improvement in the CBT condition as compared to the wait list condition (group x time interaction effect size d = 1.61). Intent-to-treat analysis supported the outcome (d = 1.34). Categorical diagnostic data indicated clinical recovery of 67% (post-treatment) and 76% (3 months FU) in the treatment group. Additionally, patients of the CBT condition showed significantly greater reductions in co-morbid major depression than the control condition. At follow-up the improvements were stable in the active treatment condition. CONCLUSION: The degree of improvement in our treatment group was comparable to that in previously reported treatment trials of PTSD with cognitive behavioral therapy. TRIAL REGISTRATION: ISRCTN66456536.

Accidents, Traffic↗
PubMed2006

Posttraumatic growth in clinical psychology - a critical review and introduction of a two component model.

Positive psychological or personal changes in the aftermath of trauma, defined as the result of the struggle with highly stressful events, have recently elicited heightened attention by trauma researchers. This article aims at summarizing the most important theoretical models and conceptualizations of posttraumatic growth (PTG) and addresses the issue of the adaptive significance of this phenomenon. It further renders a thorough empirical review of the relationship between PTG and psychological adjustment. European findings are specifically incorporated. As a conclusion, a two component cognitive model of PTG will be proposed that may explain the contradicting empirical findings in regard to the relationship between mental health and PTG. The Janus-Face model of PTG [Maercker, A. and Zoellner, T. (2004). The Janus face of self-perceived growth: Toward a two-component model of posttraumatic growth. Psychological Inquiry, 15, 41-48.] incorporates a constructive and an illusory aspect. On this basis, findings regarding relevant cognitive factors as predictors of PTG are summarized and evaluated. The article ends with a discussion of fruitful future research directions and how PTG can add a new perspective into trauma therapy.

Adaptation, Psychological↗
PubMed2006

Regional brain electrical activity in posttraumatic stress disorder after motor vehicle accident.

This study examined whether patients with posttraumatic stress disorder (PTSD) related to motor vehicle accidents (MVAs) would show an abnormal pattern of electroencephalographic (EEG) alpha asymmetries, which has been proposed for particular types of anxiety. Patients with PTSD (n = 22) or subsyndromal PTSD (n = 21), traumatized controls without PTSD (non-PTSD with MVA; n = 21), and healthy controls without MVA (n = 23) underwent measurement of EEG activity during baseline and exposure to a neutral, a positive, a negative, and an accident-related picture. Differences in brain asymmetry between groups were observed only during exposure to trauma-related material. PTSD and subsyndromal PTSD patients showed a pattern of enhanced right anterior and posterior activation, whereas non-PTSD with MVA participants showed the opposite pattern. Furthermore, posterior asymmetry in nontraumatized healthy controls varied with gender, with female participants showing a pattern of higher right posterior activation. The results support the hypothesis that symptomatic MVA survivors are characterized by a pattern of right hemisphere activation that is associated with anxious arousal and symptoms of PTSD during processing of trauma-specific information.

Accidents, Traffic↗
PubMed2006

Neural correlates of posttraumatic growth after severe motor vehicle accidents.

Frontal brain asymmetry has been associated with emotion- and motivation-related constructs. The authors examined the relationship between frontal brain asymmetry and subjective perception of posttraumatic growth (PTG) after severe motor vehicle accidents (MVAs). Eighty-two survivors of MVAs completed self-report measures of PTG, trait and state affect, and diagnostic interviews assessing clinical status, and underwent measurement of resting electroencephalographic activity. As predicted, increased relative left frontal activation was significantly related to PTG, even when statistically controlling for dispositional positive affect. The authors assume that approach-related motivational tendencies associated with higher relative left frontal brain activity may be involved in the process and outcome of PTG.

Accidents, Traffic↗
PubMed2006

Internet-based cognitive-behavioral therapy for complicated grief: a randomized controlled trial.

The present study investigates the efficacy of an Internet-based cognitive-behavioral therapy program for bereaved people suffering complicated grief. The program combines established methods of psychotherapy with new technology--therapists and patients communicated exclusively by e-mail. Bereaved individuals diagnosed with complicated grief (n = 55) were randomly assigned to either the treatment group or a waiting list control condition. The 5-week intervention consisted of three modules: (1) exposure to bereavement cues; (2) cognitive reappraisal; and (3) integration and restoration. The Impact of Event Scale (IES), a failure to adapt scale, and the depression and anxiety subscales of the Brief Symptom Inventory (BSI) were used to assess treatment outcomes. Participants in the treatment group (n = 26) improved significantly relative to participants in the waiting condition on symptoms of intrusion, avoidance, maladaptive behavior, and general psychopathology, and showed a large treatment effect. Follow-up results show that this improvement was maintained after 3 months.

Adaptation, Psychological↗
PubMed2006

Trauma and posttraumatic reactions in German development aid workers: prevalences and relationship to social acknowledgement.

BACKGROUND: While on duty abroad developmental aid workers (DAWs) are at risk of being traumatised. We investigated the prevalence of traumatic events, posttraumatic stress disorder (PTSD) and subsyndromal PTSD as well as associations with duty features and the psychological variable of social acknowledgement as victim or survivor. METHOD: A total of 312 developmental aid workers from the governmental German Development Service (DED) were surveyed by use of a trauma list, demographic questionnaire, the Posttraumatic Diagnostic Scale (PDS) and the Social Acknowledgement Questionnaire (SAQ). In addition, participants answered an open question concerning the amelioration of the DED's care provision. RESULTS: Some 47% of the surveyed DAWs had experienced and 7% of them had witnessed traumatic events while on duty abroad. A total of 16% developed either full or partial PTSD with the highest conditional PTSD probability after rape (33%) and life-threats (23%). Experience of traumatic events was correlated to duration of duties and number of duties, while PTSD symptomatology was associated with self-perceived general disapproval as a trauma victim. CONCLUSIONS: DAWs on duty in foreign countries experience more traumatic events compared with other German representative population samples. PTSD prevalences are also higher than those of German population samples. The association between rejection as a victim of trauma and PTSD severity indicates a possible starting-point for the development of PTSD prevention specific to this profession. Implications of the study are discussed with regard to participants' suggestions on how to handle traumatic experiences while on duty abroad.

Adult↗
PubMed2006

Feelings of revenge, retaliation motive, and posttraumatic stress reactions in crime victims.

Individuals with posttraumatic stress disorder (PTSD) are often said to experience strong feelings of revenge. However, there is a need for confirmatory empirical studies. Therefore, in a study of 174 victims of violent crimes, the relation between feelings of revenge and posttraumatic stress reactions was investigated. Feelings of revenge were correlated with intrusion and hyperarousal but not with avoidance. Feelings of revenge explained incremental variance of intrusion and hyperarousal when the variance explained by victimological variables was controlled. The retaliation motive implied in feelings of revenge did not account for the relation between feelings of revenge and posttraumatic stress reactions. However, the relation was moderated by the time since victimization. Therefore, feelings of revenge must presumably be regarded as a maladaptive coping reaction to experienced injustice, but not in the first period after victimization.

Adaptation, Psychological↗
PubMed2005

Meta-analytic review of event-related potential studies in post-traumatic stress disorder.

In recent years there has been an accumulation of studies that have utilized the measurement of event-related potentials (ERP) to examine the neuroelectric correlates of hypothesized alterations in information processing in persons with post-traumatic stress disorder (PTSD). The objective of this meta-analysis was to summarize the findings of ERP PTSD research, including studies that have examined P50 auditory sensory gating, augmenting-reducing P200, and P300 in target detection oddball tasks. The results suggest that persons with PTSD exhibit alterations in the amplitude and latency of ERP within these paradigms that support the hypothesis that changes in information processing can accompany PTSD. The results were also consistent with recent cognitive neuropsychological findings in PTSD research.

Brain↗
PubMed2005

Complicated grief as a stress response disorder: evaluating diagnostic criteria in a German sample.

BACKGROUND: Complicated grief has been described as a diagnosis candidate for DSM-V. On the basis of the stress response theory, Horowitz et al. [Am J Psychiatry 154 (1997) 904-10] characterized complicated grief as a combination of sustained intrusion, avoidance, and maladaptation symptoms following the loss of a close person. This study aimed at evaluating diagnostic criteria based on the stress response model of complicated grief. METHODS: We administered a symptom list derived from Horowitz et al.'s operationalization to a sample of bereaved persons and evaluated the psychometric properties of the symptom criteria and symptom category subscales. Using this symptom list and other self-report measures of psychopathology and normal grief reactions, we examined a German sample consisting of 75 participants who had lost either siblings, children, parents, or spouses, on average, 5.4 years prior to the study. RESULTS: Analyses confirmed the classification of symptoms into intrusion, avoidance, and failure-to-adapt categories with only minimal reordering (two symptom criteria). The symptom category subscales showed favourable psychometric characteristics, receiver operating characteristic (ROC) analyses indicated high diagnostic accuracy of the symptom criteria, and predictive validation revealed a meaningful correlational pattern to standard measures of divergent psychopathology and normal grief reactions. CONCLUSIONS: The application of a stress response operationalization of complicated grief is supported.

Adaptation, Psychological↗
PubMed2005

Longitudinal course of posttraumatic stress disorder and posttraumatic stress disorder symptoms in a community sample of adolescents and young adults.

OBJECTIVE: Few studies have focused on the natural course of posttraumatic stress disorder (PTSD) and its determinants in samples of the general population. The authors examined determinants of remission and chronicity of PTSD and associations with other disorders in a prospective community sample. METHOD: The data were drawn from a prospective, longitudinal epidemiological study of adolescents and young adults (age 14-24 years) in Munich, Germany (N=2,548). The course of PTSD from baseline to follow-up 34-50 months later was studied in 125 respondents with DSM-IV PTSD or subthreshold PTSD at baseline. RESULTS: Although 52% of the PTSD cases remitted during the follow-up period, 48% showed no significant remission of PTSD symptoms. Respondents with a chronic course were more likely to experience new traumatic event(s) during follow-up (odds ratio=5.21, 95% confidence interval [CI]=1.95-13.92), to have higher rates of avoidant symptoms at baseline (odds ratio=10.16, 95% CI=1.73-59.51), and to report more help seeking (odds ratio=5.50, 95% CI=1.04-29.05), compared to respondents with remission. Rates of incident somatoform disorder (odds ratio=4.24, 95% CI=1.60-11.19) and other anxiety disorders (odds ratio=4.07, 95% CI=1.15-14.37) were also significantly associated with a chronic course. CONCLUSIONS: PTSD is often a persistent and chronic disorder. Specific symptom clusters--especially avoidant symptoms--might be associated with the course of PTSD. In addition, the occurrence of new traumatic events differentiates PTSD cases with a chronic course from those with remission.

Adolescent↗
PubMed2004

[Psychotherapy with the elderly in outpatient settings: are elderly patients the easier ones?].

Elderly patient's preconditions for outpatient psychotherapy are compared with regard to symptom levels, psychological and bodily functioning, and interpersonal problems with groups of younger patients. Based on the Age and Disorder-Specific Model of Psychotherapy (ADS-MP) we predicted that the group of older patients exhibits more favorable preconditions for psychotherapy as well as a shorter duration of treatments than younger groups. A total of 169 outpatients from an university clinic were divided into four groups and compared. Rates of mental disorders did not differ between the groups for all frequent disorders. The group of elderly patients did not show a difference in symptom levels although their psychological functioning was better than in the comparison groups. Two of eight interpersonal problems showed more favorable initial values for the elderly. The number of necessary therapy hours up to the treatment conclusion was significantly smaller in the older group (on average 21 hours) than with young to middle-aged patients groups. The results point to the fact that the psychological preconditions for psychotherapy in old age are good and indicate promising directions for the development of age-appropriate interventions.

Adolescent↗
PubMed2004

Social acknowledgment as a victim or survivor: a scale to measure a recovery factor of PTSD.

The development and validation of a new measure of social acknowledgment as a victim or survivor is presented, whose items were derived from previous research on social recovery factors of post-traumatic stress disorder. The Social Acknowledgment Questionnaire (SAQ) was administered to nontreatment seeking traumatized persons--178 former political prisoners in East Germany and 151 recently traumatized interpersonal crime victims. Principal components analysis yielded three factors--Recognition as victim, General disapproval, and Family disapproval. The factors showed high internal consistency and good test-retest reliability; correlated moderately to strong with measures of PTSD severity, social support, and reluctance to talk about the trauma. In comparison to a conventional measure of social support, the SAQ predicted comparably better between persons with high- and low-PTSD severity.

Adult↗
PubMed2004

Do trials of perpetrators retraumatize crime victims?

Attendance at trials of perpetrators could be retraumatizing for crime victims suffering from posttraumatic stress disorder. To investigate this hypothesis, two studies were conducted in which retraumatization was defined as a significant increase in posttraumatic stress reactions. A cross-sectional study of 137 victims of rape and nonsexual assault revealed that trial variables do virtually not predict posttraumatic stress reactionsat a time several years after trial. A longitudinal study of 31 victims of rape and nonsexual assault revealed intraindividual stability of posttraumatic stress reactions for the time interval from a few weeks before the trial to a few weeks after the trial; in addition, interindividual stability was high. The results of both studies do not support the retraumatization hypothesis, which should therefore be used with caution.

Adult↗
PubMed2004

Age of traumatisation as a predictor of post-traumatic stress disorder or major depression in young women.

BACKGROUND: Findings in developmental psychopathology suggest that traumatisation in childhood may increase the risk of both post-traumatic stress disorder (PTSD) and major depressive disorder, whereas traumatisation in adolescence is more likely to lead to elevated PTSD risk. AIMS: To estimate the impact of traumatisation in childhood or adolescence in a community sample. METHOD: A representative sample of 1966 young women from Dresden aged 18-45 years were interviewed for occurrence of traumatic events and the onset of PTSD and major depression. The sample was subdivided into a childhood trauma group (trauma up to age 12 years) and an adolescent trauma group (trauma from age 13 years). RESULTS: A quarter of all participants reported traumatic events meeting the DSM AI criterion. In the childhood group conditional risks for PTSD and major depressive disorder were 17.0% and 23.3%, respectively, compared with risks of 13.3% and 6.5%, respectively, in the adolescent group. In 29% of those with PTSD, major depression was also present. CONCLUSIONS: The risk of developing major depressive disorder after traumatisation in childhood is approximately equal to the risk of developing PTSD. After age 13 years, the risk of PTSD is greater than the risk of major depression after traumatisation.

Adolescent↗