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Jaffé ME, Loew SB, Meyer AH, Lieb R, Dechent F, Lang UE, Huber CG, Moeller J. Just Not Enough: Utilization of Outpatient Psychotherapy Provided by Clinical Psychologists for Patients With Psychosis and Bipolar Disorder in Switzerland. Health Serv Insights 2024; 17:11786329241229950. [PMID: 38348355 PMCID: PMC10860477 DOI: 10.1177/11786329241229950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/16/2024] [Indexed: 02/15/2024] Open
Abstract
Treatment guidelines state that evidence-based psychotherapy is effective for people with psychosis and bipolar disorder and should be offered during every phase of the treatment process. However, research has indicated a lack of outpatient psychotherapeutic services for this patient group, for example, in the United States or Germany. We extend this finding by presenting survey data from Switzerland. We surveyed 112 inpatients with a diagnosis of a schizophrenia spectrum disorder or bipolar disorder and assessed outpatient treatment over the 5 years prior to their index hospitalization by using retrospective self-reports. The survey focused on psychotherapy provided by clinical psychologists. Results indicate that only 23.2% of participants retrospectively reported having utilized any outpatient psychotherapy within the reporting period and only 8% of participants reported having received a number of outpatient sessions that reaches recommended levels of psychotherapy. Exploratory analyses did not detect a significant association between self-reported utilization of outpatient psychotherapy sessions and most demographic, psychiatric, and psychological attributes, but patients with a bipolar disorder diagnosis (vs schizophrenia spectrum diagnosis) reported having utilized outpatient treatment more often. These findings are preliminary. When replicated they highlight the need for increased access to outpatient psychotherapy and better alignment between guideline recommendations and outpatient supply.
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Affiliation(s)
- Mariela E Jaffé
- University Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland
| | - Sou Bouy Loew
- University Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Andrea H Meyer
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Roselind Lieb
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Frieder Dechent
- University Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland
| | - Undine E Lang
- University Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland
| | - Christian G Huber
- University Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland
| | - Julian Moeller
- University Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
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Braun-Koch K, Rief W, Teige-Mocigemba S. Changing attitudes towards psychotherapy via social observations: are similarities more important than discrepancies? BMC Psychol 2022; 10:286. [PMID: 36461123 PMCID: PMC9719139 DOI: 10.1186/s40359-022-00952-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 10/12/2022] [Accepted: 10/19/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES Therapy expectations and attitudes towards psychotherapy contribute substantially to the outcome, process and duration of psychotherapy. The a priori use of role model videos seems to be promising for changing expectations and attitudes towards psychotherapy. In contrast, underlying mechanisms, like identifying with the role model, have been sparsely investigated in studies so far. For instance, the effects of similarities and differences between the role model and the observer are not clear yet. METHODS A total of 158 persons were recruited and randomly assigned to four groups. In one of three experimental groups, participants watched an expectation-optimised video with patients giving information about their mostly positive therapy outcomes (positive model). Two further experimental groups saw the same video, but either received instructions to focus on similarities (similarity group) or on differences (discrepancy group) between the patients and themselves. A further control group watched a video with patients who gave information about their symptoms. As the primary outcome variable, we assessed attitudes towards psychotherapy using the Questionnaire on Attitudes towards Psychotherapy (QAPT). It was filled in before and after watching the video and after a two-week follow-up period. RESULTS Contrary to the hypotheses, the discrepancy group and the experimental group without further intervention (positive model) showed significant improvements in their attitudes towards psychotherapy after watching the video, while such an effect was not found in the similarity group or control group. CONCLUSION Focusing on similarities between patient examples and the observer does not support a change in therapy expectations or attitudes through observation, while a positive video model without instructions, or with the instruction to focus on differences does. Attentional interference and depth of cognitive evaluation are discussed as possible reasons. TRIAL REGISTRATION Ethical approval (2018-19k) was obtained from the ethics committee of the Psychological Department, University of Marburg, and the trial was registered at Aspredicted.org (#22,205; 16.04.2019).
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Affiliation(s)
- Kristina Braun-Koch
- grid.10253.350000 0004 1936 9756Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Gutenbergstraße 18, 35032 Marburg, Germany
| | - Winfried Rief
- grid.10253.350000 0004 1936 9756Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Gutenbergstraße 18, 35032 Marburg, Germany
| | - Sarah Teige-Mocigemba
- grid.10253.350000 0004 1936 9756Department of Personality and Diagnostics, Psychological Diagnostics, Philipps-University, Marburg, Gutenbergstraße 18, 35032 Marburg, Germany
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Braun-Koch K, Rief W. Maintenance vs. Change of Negative Therapy Expectation: An Experimental Investigation Using Video Samples. Front Psychiatry 2022; 13:836227. [PMID: 35444567 PMCID: PMC9013760 DOI: 10.3389/fpsyt.2022.836227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/25/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Therapy expectations contribute substantially to the outcome of psychotherapy. In contrast, psychotherapy expectations are rarely addressed and systematically optimised in studies on psychotherapy. MATERIALS AND METHODS A total of 142 mostly healthy participants with critical attitudes towards psychotherapy were randomised into two groups: (1) a control group that watched a video with patients who gave information about their symptoms or (2) an experimental group that watched an expectation-optimised video with the same patients giving additional information about their mostly positive therapy outcomes. The primary outcome was the Milwaukee Psychotherapy Expectation Questionnaire (MPEQ), which was filled in before and after watching the video. RESULTS Both groups showed a significant improvement of their process expectations and attitudes towards psychotherapy after watching the video. Participants in the experimental group changed their therapy outcome expectation while there was no change in the control group [F(1,140) = 9.72, p = 0.002, η2 = 0.065]. CONCLUSION A video intervention with patients presenting their positive therapy experiences improves therapy expectations in persons with critical attitudes. Expectation-optimised videos could be used for prevention programmes and when starting therapy. TRIAL REGISTRATION Trial was registered at clinicaltrials.gov (NCT03594903) on November 2018.
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Affiliation(s)
- Kristina Braun-Koch
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
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Brandl EJ, Dietrich N, Mell N, Winkler JG, Gutwinski S, Bretz HJ, Schouler-Ocak M. Attitudes towards psychopharmacology and psychotherapy in psychiatric patients with and without migration background. BMC Psychiatry 2020; 20:176. [PMID: 32303265 PMCID: PMC7164188 DOI: 10.1186/s12888-020-02585-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 04/05/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Sociodemographic factors, attitude towards treatment and acculturation may be important factors influencing the decision of immigrants to seek and maintain psychiatric treatment. A better understanding of these factors may significantly improve treatment adherence and outcome in these patients. Therefore, we investigated factors associated the attitude towards psychotherapy and medication in a sample of psychiatric outpatients with and without migration background. METHODS N = 381 patients in a psychiatric outpatient unit offering specialized treatment for migrants were included in this study. Attitude towards psychotherapy was assessed using the Questionnaire on Attitudes Toward Psychotherapeutic Treatment, attitude towards medication with the Drug Attitude Inventory-10. Acculturation, symptom load and sociodemographic variables were assessed in a general questionnaire. Statistical analyses included analyses of covariance and hierarchical regression. RESULTS Patients of Turkish and Eastern European origin reported a significantly more positive attitude towards medication than patients without migration background. When controlling for sociodemographic and clinical variables, we did not observe any significant differences in attitude towards psychotherapy. Acculturation neither influenced the attitude towards psychotherapy nor towards medication. CONCLUSION Our study indicates that sociodemographic and clinical factors may be more relevant for patients´ attitudes towards treatment than acculturation. Considering these factors in psychiatric treatment of patients with migration background may improve treatment outcome and adherence.
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Affiliation(s)
- Eva J. Brandl
- grid.6363.00000 0001 2218 4662Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Mitte, Berlin, Germany Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.488294.bPsychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Nora Dietrich
- grid.6363.00000 0001 2218 4662Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Mitte, Berlin, Germany Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.488294.bPsychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Nicoleta Mell
- grid.6363.00000 0001 2218 4662Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Mitte, Berlin, Germany Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.488294.bPsychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Johanna G. Winkler
- grid.6363.00000 0001 2218 4662Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Mitte, Berlin, Germany Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.488294.bPsychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Stefan Gutwinski
- grid.6363.00000 0001 2218 4662Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Mitte, Berlin, Germany Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.488294.bPsychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - H. Joachim Bretz
- grid.6363.00000 0001 2218 4662Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Mitte, Berlin, Germany Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.488294.bPsychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
| | - Meryam Schouler-Ocak
- grid.6363.00000 0001 2218 4662Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Mitte, Berlin, Germany Charité Universitätsmedizin Berlin, Berlin, Germany ,grid.488294.bPsychiatrische Universitätsklinik der Charité im St. Hedwig Krankenhaus, Große Hamburger Str. 5-11, 10115 Berlin, Germany
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Yeo SU, Park JI, Jang JM, Kang NI, Cui Y, Kim MG, Kim HM, Jung AJ, Chung YC. Acceptance rate of long-acting injection after short information: a survey in patients with first- and multiple-episode psychoses and their caregivers. Early Interv Psychiatry 2017; 11:509-516. [PMID: 26256465 DOI: 10.1111/eip.12262] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 07/12/2015] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to investigate the acceptance rates of long-acting injection (LAI) in patients with first- and multiple-episode psychoses before and after providing concise information about LAI to the patients and their caregivers. Additionally, predictors of choosing LAI and the reasons for reluctance to accept LAI were also evaluated. METHODS The survey included the questionnaire about participants' demographic characteristics, prior knowledge about LAI, attitude towards the importance of medication or psychotherapy and acceptance for LAI - treatment. The acceptance rate for LAI was re-evaluated after providing short information about current LAI or to the hypothetical questions like if there are a 3-ms lasting injection or the cost of injection is cheap. RESULT This study included 161 patients and 113 caregivers who completed a cross-sectional survey. Following exposure to LAI information, acceptance rates for this method of treatment did not change in all groups. However, acceptance rates increased significantly when asked if the cost of LAI was cheaper than the current oral medication and the effect of LAI lasted for 3 months. Significant predictors of acceptance of LAI in patients with first-episode psychosis were prior knowledge about LAI, attitudes towards the importance of medication and discomfort due to medication side-effects. CONCLUSION The present study demonstrated that a substantial portion of patients with first- and multiple-episode psychoses and their caregivers prefer LAI over their current oral medication. The acceptance of LAI was not increased by providing succinct information concerning this method of treatment.
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Affiliation(s)
- Seong-Uk Yeo
- Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Korea
| | - Jong-Il Park
- Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Korea
| | - Jin-Mahn Jang
- Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Korea
| | - Nam-In Kang
- Maeumsarang Hospital, In-san Medical Foundation, Wanju, Korea
| | - Yin Cui
- Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Korea.,Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Min-Gul Kim
- Clinical Pharmacology Unit, Chonbuk National University Hospital and Research Institute of Clinical Medicine, Jeonju, Korea
| | - Hyun-Min Kim
- Maeumsarang Hospital, In-san Medical Foundation, Wanju, Korea
| | - Ae-Ja Jung
- Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Korea
| | - Young-Chul Chung
- Department of Psychiatry, Chonbuk National University Medical School, Jeonju, Korea.,Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
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Schulz W, Shin MA, Schmid-Ott G. [Attitudes towards psychotherapy in South Korea and Germany : A cross-cultural comparative study]. DER NERVENARZT 2016; 89:51-57. [PMID: 27909737 DOI: 10.1007/s00115-016-0252-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Due to the relatively recent introduction of psychotherapy in South Korea and against the background of collectivist and Confucian values, it has been suggested that South Koreans harbor more negative attitudes towards psychotherapy compared to Germans and that the social acceptance of psychotherapy is lower. METHODS We compared the attitudes of 99 women from South Korea with 98 German women using the questionnaire on attitudes towards psychotherapeutic treatment (FEP). For the study of the South Korean women we translated the questionnaire into the Korean language. RESULTS The results of the psychometric analysis suggest that the Korean version of the FEP is of acceptable quality. South Korean women reported a significantly more negative attitude towards psychotherapy compared to German women. Furthermore, South Korean women anticipated a more skeptical social attitude towards psychotherapy compared to Germans. CONCLUSION The presented results suggest the relevance of cultural imprinting in psychotherapy. They are discussed with respect to culture-specific self-concepts, concepts of disease and healing expectations and the increase of individualistic values in the Korean society.
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Affiliation(s)
- W Schulz
- Institut für Psychologie, Technische Universität Braunschweig, Humboldtstr. 33, 38106, Braunschweig, Deutschland.
| | - M A Shin
- Institut für Psychologie, Technische Universität Braunschweig, Humboldtstr. 33, 38106, Braunschweig, Deutschland
| | - G Schmid-Ott
- Abteilung Psychosomatik, Berolina Klinik, Löhne bei Bad Oeynhausen, Deutschland
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Ditte D, Schulz W, Ernst G, Schmid-Ott G. Attitudes towards complementary and alternative medicine among medical and psychology students. PSYCHOL HEALTH MED 2011; 16:225-37. [PMID: 21154015 DOI: 10.1080/13548506.2010.532559] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The use of complementary and alternative medicine (CAM) is increasing in Europe as well as in the USA, but CAM courses are infrequently integrated into medical curricula. In Europe, but also especially in the USA and in Canada, the attitudes of medical students and health science professionals in various disciplines towards CAM have been the subject of investigation. Most studies report positive attitudes. The main aim of this study was to compare the attitudes towards CAM of medical and psychology students in Germany. An additional set of questions concerned how CAM utilisation and emotional and physical condition affect CAM-related attitudes. Two hundred thirty-three medical students and 55 psychology students were questioned concerning their attitudes towards CAM using the Questionnaire on Attitudes Towards Complementary Medical Treatment (QACAM). Both medical students and psychology students were sceptical about the diagnostic and the therapeutic proficiency of doctors and practitioners of CAM. Students' attitudes towards CAM correlated neither with their experiences as CAM patients nor with their emotional and physical condition. It can be assumed that German medical and psychology students will be reluctant to use or recommend CAM in their professional careers. Further studies should examine more closely the correlation between attitudes towards CAM and the students' worldview as well as their existing knowledge of the effectiveness of CAM.
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Affiliation(s)
- Darja Ditte
- Department of Clinical Psychology, Institute of Psychology, Technical University at Braunschweig, Humboldtstr. 33, Braunschweig, Germany
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Zwerenz R, Barthel Y, Leuzinger-Bohleber M, Gieler U, Rudolf G, Schwarz R, Vogel J, Beutel ME. [Attitudes of medical students towards psychotherapeutic treatment and training]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2007; 53:258-72. [PMID: 17883933 DOI: 10.13109/zptm.2007.53.3.258] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Against the background of insufficient medical care for patients with psychiatric and psychosomatic disorders it is important to ascertain the interests and attitudes of medical students towards mental disorders, psychotherapeutic treatment and training. METHODS Medical students (N = 366) in their clinical training were given half-standardized questionnaires about their attitudes towards psychotherapeutic treatments, their career plans, psychosocial distress and sociodemographic characteristics. RESULTS There was an overall high interest in psychological distress of patients and in psychotherapeutic treatment methods. Contrary to these findings, however, only few medical students were willing to specialize in psychosomatic medicine, psychiatry or psychotherapy. Psychosomatic and psychotherapeutic career choices were more frequent in women as well as in students who had experienced psychological distress themselves, and who had undergone psychotherapy, and who were less oriented toward economic success and careers. CONCLUSIONS Medical students regarded psychological characteristics as generally interesting and important for medical care, but rarely considered specializing in these medical fields after graduation. Potential remedies (e.g., improved teaching of psychosocial competences and psychotherapeutic knowledge, career counselling) are discussed.
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Affiliation(s)
- Rüdiger Zwerenz
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie der Johannes Gutenberg-Universität Mainz.
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Ditte D, Schulz W, Schmid-Ott G. Einstellung gegenüber der Psychotherapie in der russischen Bevölkerung und in der Bevölkerung mit einem russischen/sowjetischen kulturellen Hintergrund in Deutschland. DER NERVENARZT 2006; 77:64-72. [PMID: 15776258 DOI: 10.1007/s00115-005-1889-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND We assumed that persons with a Russian/Soviet cultural background have a more skeptical attitude towards psychotherapy than persons with a German background because of the poor distribution of psychotherapy and the knowledge about this kind of treatment in Russia. METHODS We compared the views of Russian probands (n=40), Russian migrants living in Germany (n=65) and German probands (n=70) with the "Questionnaire on Attitudes towards Psychotherapeutic Treatment" (QAPT). For the study of the Russian probands we translated the questionnaire into the Russian language. RESULTS The psychometric examination predominantly suggests the quality of the Russian version of the QAPT. Russian probands showed a more skeptical attitude towards psychotherapy compared to the German probands. The migrants had a tendentially more negative attitude than the Germans and a more positive attitude than the Russians. However, we could not determine any differences concerning the anticipated social acceptance regarding participation in psychotherapy. DISCUSSION The results suggest the relevance of culture-specific factors in psychotherapy and an increased need for information of persons with a Russian/Soviet cultural background about psychotherapy.
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Affiliation(s)
- D Ditte
- Institut für Psychologie, Technische Universität Braunschweig
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Schmid-Ott G, Hofste N, Niederauer HH, Lamprecht F, Künsebeck HW. Illness Severity and Coping in Psoriasis Patients: A 1-Year Follow-up. ACTA ACUST UNITED AC 2004. [DOI: 10.1159/000083095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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