Cognitive-Behavioral Psychotherapy with and within Groups – A Treatment Program for Depressed Inpatients Background: Extensive research of cognitive behavioral therapy shows that it is an effective treatment for unipolar major depression. As the setting (e.g. inpatient vs. outpatient treatment) can influence therapeutic outcome, it is argued that modifications on treatment programs should take such settings into account. The modified treatment programs should then be evaluated within these settings. Based on these arguments, a group psychotherapy program was set up combining disorder-specific components (increasing pleasant activities and modification of dysfunctional thoughts) with a group psychotherapy approach that is more open regarding individual treatment goals. Method: The treatment program was evaluated within a naturalistic single group design. Patients who were hospitalized for unipolar major depression and took part on a therapy group were assessed pre- and post-therapy and at a 6-months follow- up. Results: 71 inpatients participated in 9 therapy groups and completed the program. Only a small number of patients (13.3%) dropped out before the end of treatment, which was interpreted as a high acceptance. The pre-post changes in degree of depressiveness (BDI, HAMD) and the 6-month follow-up results were similar to those of other controlled studies. Discussion: The advantages and disadvantages of a group psychotherapy approach are discussed, together with the limitations of the study.

The Typus melancholicus personality type (TMP) is characterised by orderliness, conscientiousness and interpersonal dependence. Several standardised instruments have been developed for the assessment of the Typus melancholicus personality. To date there has been no systematic comparison of these instruments and in particular it has been unclear whether TMP represents a single trait or a personality trait constellation. The aim of this study was the comparison of four TMP questionnaires and the investigation of the dimensionality of the personality as revealed by these questionnaires. The factorial validity of four TMP questionnaires was examined based on a sample of n = 264 psychiatric inpatients and normal controls. In a factor analysis of the items of the TMP questionnaires, four dimensions could be differentiated: Dependence, Intolerance of Ambiguity, Norm-Orientation, and Perfectionism. Psychometric evaluation showed good values for the individual items and the new TMP scales. The four subscales had a differential correlation profile in relation to the dimensions of the five-factor model of personality. The TMP scales could distinguish a group of depressed patients from a group of normal controls. The results show that TMP personality is not a single trait but consists of four related but separate traits. These can be clearly distinguished from those of the five-factor model of personality. The analysis of the TM concept therefore also represents a theoretical perspective for the integration of the personality characteristics which are relevant for depression. Based on this analysis, we constructed a multidimensional TMP inventory which forms the basis for the investigation of the effect of TM personality on clinical outcome and on psychotherapeutic treatment.

Zusammenfassung: Aus unterschiedlichen theoretischen Perspektiven ist die Bedeutung der Emotionen Scham und Schuld für die Entstehung psychischer Störungen kontrovers diskutiert worden. Bislang wurden die unterstellten Zusammenhänge empirisch noch nicht zufrieden stellend untersucht, da derzeit wenige gut evaluierte Erhebungsinstrumente zur Erfassung und Differenzierung von Scham und Schuld vorliegen. Aufgrund dieses Mangels soll in der vorliegenden Arbeit die deutsche Version des “Test of Self-Conscious Affects” (TOSCA) vorgestellt und hinsichtlich der Gütekriterien evaluiert werden. Der TOSCA erfasst typische affektive, kognitive und verhaltensbezogene Aspekte, die mit einer Neigung, mit Schuld bzw. Scham zu reagieren, assoziiert sind. Darüber hinaus werden Stolz sowie emotionsrelevante Attributionsmuster erfasst. Ergebnisse aus Studien mit einer klinischen Stichprobe stationärer psychiatrischer Patienten (N = 127) und einer nicht-klinischen studentischen Stichprobe (N = 194) weisen auf hohe interne Konsistenzen und Retest-Reliabilitäten der Subskalen hin. Die empirische Differenzierbarkeit beider Emotionen bestätigt sich durch das Muster der Skaleninterkorrelation; Hinweise auf die klinische Bedeutung von Scham gegenüber Schuld ergeben sich aus den Zusammenhängen mit störungsrelevanten Persönlichkeitseigenschaften.

Personality traits are significant factors in the development and course of depression. Apart from the classical five-factor model of personality, other personality constellations, such as Tellenbach’s Typus melancholicus, have been described in association with depressive disorder. Several instruments have been developed to assess the Typus melancholicus personality (TMP). A systematic comparison of these instruments has not been done to date. The goal of this study was the comparison of four questionnaires used in assessing TMP. Four TMP questionnaires were compared and their relationship to the five-factor model of personality was examined among 264 psychiatric patients and normal controls. It was found that the TMP type represents a trait distinct from those of the five-factor model. TMP inventories had only moderate concurrent validity. The single TMP scales focus on different aspects of the TMP, despite their common core. Both the five-factor personality traits and the TMP scales were able to differentiate a group of depressed patients from control groups. The results show that TMP is not one trait but a personality trait constellation. This leads to the conclusion that a number of dimensions must be taken into consideration in the construction of a TMP inventory. This multidimensionality contributes to the refinement of the TMP concept and differentiates its therapeutic implications.

Shame and guilt feelings play a pivotal role in the aetiology and maintenance of a number of psychological disorders as well as in the development and regulation of moral behaviour. Despite intensive theoretical treatments of this topic, there have been few empirical studies to date, chiefly because of the lack of appropriate measuring instruments. The purpose of this study was the psychometric evaluation of the German version of the Test of Self-Conscious Affect for Children and Adolescents (TOSCA-C/A). The psychometric properties of this instrument were evaluated using a non-clinical sample of N = 505 children and adolescents aged between 8 and 18 years and a clinical sample of N = 50 children and adolescents. The individual scales proved reliable. There were many indications of the validity of the scales. We conclude that the German version of the TOSCA-C/A is the basis for the further investigation of self-conscious affects such as guilt and shame in children and adolescents.