Does adult attachment mediate the relationship between primary emotion traits and eating disorder symptoms?

Objectives

Primary emotion traits and attachment patterns, have been linked to various mental disorders. This study aims to shed more light on the less studied relationship with eating disorder (ED) symptoms.

Methods

A total of 921 non-clinical subjects (69.9% females) were assessed for primary emotions traits (B-ANPS-GL), attachment insecurity (ECR-RD8), and eating disorder pathology (EDE-Q8). A theoretically derived model was evaluated by means of a path analysis with attachment anxiety as assumed mediator variable.

Results

Global problematic eating behavior showed negative correlations with the positive emotions PLAY, CARE, and LUST (r = -0.10 to -0.24), positive correlations with the negative primary emotions ANGER, FEAR, and SADNESS (r = 0.12-0.27), as well as with attachment anxiety (r = 0.22, all p < 0.01). Path analyses revealed direct effects between eating behavior pathology with LUST (β = -0.07 to -0.15) and FEAR (β = 0.12-0.19; all p < 0.05). The association of SADNESS and Weight (β = 0.05) and Shape Concern (β = 0.06, p < 0.001) was fully mediated by attachment anxiety. Overall, the path model explained 17% of the variance for attachment anxiety and 6% of the Restraint, 13% for Eating, 10% for Weight and 14% for Shape Concern Subscales.

Discussion

The findings shed light on the multifactorial relationship between affective traits, attachment security, and eating disorder pathology. In line with previous research, the results emphasize the role of attachment and affective functioning in ED symptoms.

The effectiveness of a standardized tobacco cessation program on psychophysiological parameters in patients with addiction undergoing long-term rehabilitation: a quasi-experimental pilot study

BACKGROUND

Although there is a very high comorbidity between tobacco dependence and other addictive disorders, there are only few studies examining the implementation and outcomes of a tobacco cessation program in patients with addictive diseases. Therefore, the aim of this study is to investigate to what extent a standardized tobacco cessation program leads to improvements regarding psychological/physical parameters in patients with addiction undergoing therapy and whether there is a reduction in tobacco consumption.

METHODS

The study took place in a therapeutic community specialized in addiction therapy. A total sample of 56 participants were non-randomly assigned to an intervention group (IG; n = 31) and a treatment as usual group (TAUG; n = 25). The IG participated in a 6-week tobacco cessation program, while the TAUG received no additional treatment. Both groups were assessed for changes in primary outcomes (tobacco dependence, smoked cigarettes per day (CPD), and general substance-related craving) and secondary outcomes (heart rate variability (HRV): root mean square of successive differences, self-efficacy, and comorbid psychiatric symptoms) at two measurement time points (pre- and post-treatment/6 weeks).

RESULTS

We observed significant improvements in self-efficacy (F(1,53) = 5.86; p < .05; ηp2 = .11) and decreased CPD in the IG (β = 1.16, ρ < .05), while no significant changes were observed in the TAUG. No significant interaction effects were observed in psychiatric symptoms, general substance-related craving, and HRV.

CONCLUSIONS

The results highlight the potential benefit of an additional tobacco cessation program as part of a general addiction treatment. Although no improvements in the physiological domain were observed, there were significant improvements regarding self-efficacy and CPD in the IG compared to the TAUG. Randomized controlled trials on larger samples would be an important next step.

TRIAL REGISTRATION

ISRCTN15684371.

Originalbeiträge (Originals). Primäremotionen und Bindung bei psychischer Störung

Primaryemotions and attachment in mental disorder Objectives: There is increasing evidence for associations between primary emotions and attachment with mental illness. This study illuminates the mediation relationship of these psychodynamic constructs in relation to psychiatric disorders.

METHODS

921 subjects (69.9 % female) were examined, who completed the questionnaires Brief Affective Neuroscience Personality Scales including a LUST Scale, Experiences in Close Relationships - Revised 8, and ICD-10 Symptom Rating online. A path analysis was conducted to evaluate the mediation effects of attachment anxiety.

RESULTS

A disease-specific pattern of direct associations between primary emotions, attachment anxiety, and psychological impairment emerged (all p < .01). Attachment exerted mediating effects primarily for SADNESS (p < .01), and to a lesser extent for LUST and CARE (p > .01).The model provided variance resolution ranging from7%(eating disorders) to 47%(depression).

CONCLUSION

The results demonstrate the relevance of affective explanations regarding the development of psychological symptoms, as well as therapeutic implications.

Is there an affective neuroscience of spirituality? The development and validation of the OCEANic feelings scale

Background

Oceanic feelings represent a phenomenological structure of affective sensations that characteristically involve feelings of self-dissolution and feelings of unity and transcendence. This study presents the preliminary version of a self-report instrument to measure individual dispositions toward oceanic feelings in order to enable further research within the concept of primary emotions postulated by Jaak Panksepp.

Methods

A first version of the questionnaire was applied to a total sample of 926 German-speaking adults of the general population. After performing item analysis and principal component analysis (PCA) in a first study (N = 300), the questionnaire was shortened. In a second study (N = 626), confirmatory factor analysis (CFA) was conducted and emerged scales were related to the already established instruments for the assessment of primary emotions (BANPS-GL) and Big Five personality traits (BFI-44).

Results

The OCEANic scale exhibited reliabilities ranging from Cronbach's α = 0.82 (positive) to α = 0.88 (negative) and plausible correlations with behavioral traits related to the seven affective neurobiological systems (ANGER, FEAR, CARE, SEEK, PLAY, SADNESS, and LUST) as well as with personality factors measured by the Big Five Inventory. For CFA, a bifactorial model with an overall factor demonstrated good fit: RMSEA = 0.00 (90% CI:0.00, 0.03); TLI = 1.00; CFI = 1.00; NFI = 0.99.

Discussion

The OCEANic scale enables the operationalization of oceanic feelings comprising two subscales and one total scale. The results indicate good reliability and acceptable factorial validity. Establishment and further validation of the OCEANic scale within future research will be needed to fully understand the role of oceanic feelings within the human affective life, especially the personality trait of spirituality.

Anxious and depressive symptoms mediate the influence of sleep quality on suicidality in young adults

This study investigated how sleep quality affects the global severity of psychiatric symptoms, including suicidality, in young adults. Poor sleep quality has a significant impact on mental health and should therefore be given special attention in suicidal treatment. 1,214 participants (914 females; age: M = 25.81, SD = 6.35) completed the Brief Symptom Inventory (BSI-18), the Scale for Suicidal Experience and Behavior (SSEV), and the Pittsburgh Sleep Quality Index (PSQI) via an online survey. Correlation statistics and path analysis were conducted for data evaluation. Thereby, anxiety and depression but not somatization mediated the relationship between sleep quality and suicidality. Our findings confirm the putative link between diminished sleep quality and increased suicidality and may lead to an early detection of suicidal behavior.

The Influence of Vitamin D Status on Cognitive Ability in Patients with Bipolar Disorder and Healthy Controls

Recent evidence on the association between vitamin D and cognition in mentally healthy individuals is inconsistent. Furthermore, the link between vitamin D and cognitive ability in individuals with bipolar disorder has not been studied yet. Thus, we aimed to investigate the association between 25-hydroxyvitamin D (25(OH)D), 24,25 dihydroxyvitamin D (24,25(OH)2D, the vitamin D metabolite ratio (VMR) and cognition in a cohort of euthymic patients with bipolar disorder. Vitamin D metabolites were measured simultaneously by liquid-chromatography tandem mass-spectrometry in serum samples from 86 outpatients with bipolar disorder and 93 healthy controls. Neither the inactive precursor 25(OH)D, nor the primary vitamin D catabolite 24,25(OH)2D, or the vitamin D metabolite ratio were significantly associated with the domains "attention", "memory", or "executive function" in individuals with bipolar disorder and healthy controls. Further, no vitamin D deficiency effect or interaction group × vitamin D deficiency was found in the cognitive domain scores. In summary, the present study does not support vitamin D metabolism as a modulating factor of cognitive function in euthymic BD patients. Considering the current study's cross-sectional design, future research should expand these results in a longitudinal setting and include additional aspects of mental health, such as manic or depressive symptoms, long-term illness course and psychopharmacological treatment.

On the trail of Sisyphus - addiction as an existential neurosis?

In Greek mythology, Sisyphus, king of the Corinthians, dared to deceive the gods and was condemned to roll a boulder to the top of a mountain for all eternity. Shortly before reaching the summit, however, the boulder rolled back down into the valley, and the arduous task had to begin anew. Many of the contents of this classic myth are reminiscent of the therapeutic approach to addictive disorders. In addiction therapy, too, it is often a long and rocky road that ends with a relapse. The therapeutic effort was not entirely in vain, but one often begins to doubt its usefulness. In terms of Sisyphus and a Bio-Psycho-Social Model (BPSM) of health and disease, addiction can be located at the end of a downward spiral. By extension of the BPSM, can addictive disease be considered an expression of existential neurosis? The results of our own research speak in favor of this and show a clearly reduced experience of sense and meaning, but also diminished feelings of hope and forgiveness in addiction patients. However, positive correlations between various parameters of existential well-being and mental health or more appropriate stress coping are also found for the addiction group. These results are supported by neuronal correlates and are mirrored in the general population. Based on this, the consideration of existential issues in addiction therapy can be discussed. Finally, the use of art therapy and work training are proposed as examples of a meaning based therapeutic intervention in dealing with people with addictive diseases.

Psychophysiological stress response after a 6-week Mindful Self-Compassion training in psychiatric rehabilitation inpatients: a randomized post-test only study

Objectives

Mindfulness-based interventions (including self-compassion interventions) are effective in improving stress management at psychological and physical levels. Mindful Self-Compassion (MSC) is a newly developed program particularly aimed at increasing self-compassion. The main objective of this study was to determine whether the psychophysiological stress response during a social-evaluative speaking task differs in inpatients participating in the MSC or the Progressive Muscle Relaxation (PMR) program at the end of their 6-week psychiatric rehabilitation stay (i.e., post-test only design).

Method

Data from 50 inpatients (25 MSC, 25 PMR, 35 female) aged 19 to 76 years (M = 47.22, SD = 12.44) were analyzed in terms of psychophysiological stress response. For this purpose, heart rate variability, heart rate, and blood pressure were assessed together with several psychometric variables: positive and negative affect (PANAS), subjective stress perception (Visual Analog Scale), self-compassion (Self-Compassion Scale), cognitive reappraisal and suppression (Emotion Regulation Questionnaire), psychological distress (Brief Symptom Inventory-18), and appraisal and rumination (selected items).

Results

After correction for alpha inflation no differences in the psychophysiological stress response and psychometric parameters between the MSC and PMR group were found.

Discussion

In general, our results indicate that MSC is not superior to PMR training. However, more research with clinical randomized controlled trials investigating larger samples are needed to further affirm these initial findings.

The German version of the brief affective neuroscience personality scales including a LUST scale (BANPS-GL)

Objectives

This study presents the German version of the Brief Affective Neuroscience Personality Scales (BANPS), which includes an additional subscale for the dimension LUST. The BANPS represents a shortened version of the Affective Neuroscience Personality Scales (ANPS), a self-report instrument to assess individual dispositions toward primary emotional systems as proposed by Jaak Panksepp.

Methods

In a large sample (N = 926), the reliability and various facets of validity of the German translation of the BANPS were examined together with the newly included LUST scale. The BANPS-GL was related to the Big Five Inventory (BFI) and Sexual Sensation Seeking Scale (SSSS) and analyzed via confirmatory factor analysis (CFA).

Results

Overall, the BANPS-GL exhibited reliabilities ranging from McDonald's ω = 0.70 (CARE) to α = 0.86 (SADNESS) and plausible correlations with external criteria. For CFA a correlated 7-factor model demonstrated good fit [TLI = 0.95; RMSEA = 0.04 (90% CI: 0.04, 0.05); SRMR = 0.06]. A similar fit was demonstrated for a 2-higher-factor model [TLI = 0.93; RMSEA = 0.05 (90% CI: 0.05, 0.06); SRMR = 0.07].

Conclusion

In broad agreement with the results of the original English version, the BANPS-GL showed good reliability and acceptable factorial validity, and overall improved the psychometric properties of the original long form. Finally, the inclusion of the dimension LUST allows for a complete coverage of the primary emotion dispositions as originally conceptualized by Panksepp.

Effects of Metabolic Syndrome and Sex on Stress Coping Strategies in Individuals with Depressive Disorder

Metabolic syndrome (MetS) is related to depression and contributes to reduced life expectancy in individuals with mental disorders. Stress coping strategies are important factors in the development and maintenance of depressive disorders and have been related to metabolic disturbances. The aim of this study was to determine whether there is a difference in the use of positive (re- and devaluation, distraction, and control) and negative stress coping strategies in relation to patients' MetS. A sample of 363 individuals (n female = 204, n male = 159) with a diagnosis of depression was measured with the Stress Coping Style Questionnaire and the Beck Depression Inventory. In addition, we collected data on MetS (waist circumference, triglycerides, high-density lipoprotein, fasting glucose/diabetes, blood pressure/hypertonia) according to the International Diabetes Federation. A 2 × 2 design including Mets (with vs. without) and sex (female vs. male) was performed to test for differences in stress coping strategies. Individuals with depression and MetS scored higher on distraction strategies than depressed individuals without MetS (p < 0.01, corrected with false discovery rate). In addition, we found sex differences in stress coping strategies indicating that women with depression scored higher on distraction strategies (p < 0.001, FDR corrected), as well as negative strategies (p < 0.001, FDR corrected), than men. No significant interaction between MetS and sex was found regarding the higher value of stress coping strategies. Findings suggest that individuals with depression and MetS used distraction strategies to a higher amount to cope with stress, which could be stress eating in some cases, than those without MetS. Women with depressive disorders had higher values than men on other coping strategies in our sample of individuals with depression. A better understanding of MetS and sex-specific differences in stress coping strategies might help to plan more effective preventive strategies and personalized treatment options for depression.

Effect of Yoga involvement on mental health in times of crisis: A cross-sectional study

Background

Yoga involvement can be understood as a degree of immersion in the philosophical/spiritual teachings of Yoga. Previous research has shown a positive association between Yoga involvement and mental health. This study further investigates the effect of Yoga involvement on several parameters of psychological well-being and distress amidst a global crisis precipitated by the COVID-19 pandemic.

Methods

A total sample of 246 participants (216 females; 118 Yoga versus 128 age-matched Pilates practitioners) were included in the study. Via an online-survey the following questionnaires were completed: the WHO-Five Well-Being Index, the Multidimensional Inventory for Religious/Spiritual Well-Being short version, the Leipzig Short Scale of Sense of Coherence, the Brief Symptom Inventory and the Yoga Immersion Scale which was adapted for the control group to Pilates Immersion Scale.

Results

When controlling for occupation and psychiatric disorder, involvement in general was higher for Yoga practitioners than for Pilates controls. Furthermore, Yoga practice was associated with increased religious/spiritual well-being and decreased sense of coherence, but neither with psychological well-being nor with psychological distress. Involvement, in general, positively predicted psychological well-being, religious/spiritual well-being and sense of coherence, but there was no connection with psychological distress. Lastly, involvement mediated the positive relationship between Yoga practice and religious/spiritual well-being and suppressed the negative effect of Yoga practice on sense of coherence.

Conclusion

Our findings suggest that involvement in a certain relaxation practice has a positive impact and might be a key component in understanding Yoga's influence on mental health. Further randomized controlled research, including clinical groups, is necessary to explain how involvement changes and how it effects well-being more specifically.

The Swedish version of the multidimensional inventory for religious/spiritual well-being – Part II: Development of a four-field typology

Background

In the field of mental health, religiosity and spirituality have gained particular attention in recent decades. However, only a few studies to date have investigated the effects of different types of religiosity and spirituality. In association with the recent introduction of a Swedish version of the multidimensional inventory of religious/spiritual well-being (MI-RSWB-S), the present study aimed to identify possible types of Religious/Spiritual Well-Being by using cluster analyses and to examine the extracted groups for differences in the sense of coherence (SOC), the Big Five personality factors, and central aspects of religiosity. Additionally, the study design was intended to further contribute to the validation of the MI-RSWB-S.

Methods

Based on a convenience sample of Swedish students (N = 1,011), initially obtained for the development of the MI-RSWB-S, the study included the MI-RSWB-S, the 13-items sense of coherence scale, the 10-item personality inventory, and the centrality of religiosity scale. For the statistical analysis, cluster analyses and one-way analyses of variance (ANOVAs) were conducted.

Results

The cluster analyses yielded the following four groups: Religiosity and spirituality high (n = 124), religiously oriented (n = 200), spiritually oriented (n = 149), and religiosity and spirituality low (n = 538). The groups differed in most aspects of well-being, in the personality dimensions agreeableness and openness to experience, as well as in central aspects of religiosity. In contrast, no differences were found for SOC, extraversion, conscientiousness, and emotional instability.

Conclusion

Our results suggest that different types of religious/spiritual well-being are associated with mental health and personality dimensions in substantially different ways, thus offering an interesting potential for future research.

The relationship between religious/spiritual well-being, psychiatric symptoms and addictive behaviors among young adults during the COVID-19-pandemic

Background

It is becoming increasingly apparent that the COVID-19 pandemic not only poses risks to physical health, but that it also might lead to a global mental health crisis, making the exploration of protective factors for mental well-being highly relevant. The present study seeks to investigate religious/spiritual well-being (RSWB) as a potential protective factor with regard to psychiatric symptom burden and addictive behavior.

Materials and Methods

The data was collected by conducting an online survey in the interim period between two national lockdowns with young adults (N = 306; age: 18-35) in Austria. The primary study variables were assessed through the Brief Symptom Inventory 18 (BSI-18; psychiatric symptom load), the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST; addictive behavior/addiction risk) and the Multidimensional Inventory for Religious/Spiritual Well-Being short version (MI-RSWB 12), with its sub-dimensions Hope (HO), Forgiveness (FO), General Religiosity (GR), and Connectedness (CO).

Results

We observed HO and FO as substantial negative predictors of psychiatric symptom burden. With regard to addictive behavior, HO in particular but also GR seem to have a protective function. Furthermore, we found positive connections between CO, psychiatric symptom burden, and addictive behavior.

Conclusion

In line with our assumptions, HO, FO and to a minor extent GR were confirmed as negative predictors regarding psychiatric symptom burden or addictive behavior in young adults, coping with the psychological threat of COVID-19 pandemic. These dimensions might be further considered as potential resources in clinical treatment. However, the positive prediction of mental illness parameters by increased feelings of CO could also be interpreted as an expression of exhaustion and alienation from the real world.

Effects of metabolic syndrome and obesity on suicidality in individuals with bipolar disorder

BACKGROUND

The prevalence of metabolic syndrome and overweight/obesity is increased in bipolar disorder (BD) compared to the general population and is related to suicidality. The aim of this study was to examine the association between both the rate of suicidal ideation and suicide attempts and metabolic variables in individuals with BD.

METHODS

Anthropometric measures, socio-demographic data, suicide history and serum lipid levels were measured in 215 individuals with BD. Individuals were divided into normal weight, overweight and obese according to their body mass index (BMI), and metabolic syndrome was assessed using "The International Diabetes Federation"-criteria.

RESULTS

Of the 215 individuals studied, 80.9% reported suicidal ideation, 35.3% reported at least one suicide attempt and 30.7% were diagnosed with metabolic syndrome. Both metabolic syndrome and BMI were not related to suicide attempts. However, individuals with normal weight had more suicidal ideation than overweight individuals, while obese individuals did not differ from either group. Furthermore, there was no association between suicide attempts or suicidal ideation and serum lipid levels.

LIMITATIONS

The cross-sectional design of the study, a non-standardized questionnaire for suicidality, and not controlling the medication intake are limiting factors.

CONCLUSION

Contrary to expectations, a difference was found in the BMI categories and suicidal ideation, but not suicide attempts. Serum lipid levels were found to be unsuitable as possible biomarkers for suicidality in individuals with BD. Special attention should be paid to suicidal ideation and BMI rather than metabolic syndrome or lipid values when treating suicidal individuals with BD.

The Swedish Version of the Multidimensional Inventory for Religious/Spiritual Well-Being: First Results From Swedish Students

Background: Studies investigating the relationship between religiosity/spirituality and mental health have suggested both positive and negative associations, highlighting the importance of multifaceted assessment of these rather broad constructs. The present study aims at contributing to this field of research by providing a validated Swedish version of the Multidimensional Inventory for Religious/Spiritual Well-Being (MI-RSWB-S) and further examining how this instrument relates to Big Five personality factors, Sense of Coherence (SOC), and religiosity.

Methods: Data were collected from a total of 1,011 Swedish students (747 females; age range 18–40) via completion of an online survey, including a new Swedish Version of the MI-RSWB-S, the Ten Item Personality Inventory (TIPI), the Sense of Coherence Scale (SOC-13), and the Centrality of Religiosity Scale (CRS-5).

Results: Results revealed adequate estimates of internal consistency and substantial evidence for the postulated six-dimensional structure. However, confirmatory factor analysis yielded poor fit indices, resulting in the development and validation of a revised measure of Religious/Spiritual Well-Being (RSWB), comprising the subscales General Religiosity and Connectedness. Most of the MI-RSWB-S dimensions were positively correlated with the personality domains Extraversion, Openness to Experience, Conscientiousness, and Agreeableness and negatively related to Neuroticism. SOC was positively linked to Hope Immanent, Forgiveness, Hope Transcendent, and Experiences of Sense of Meaning, whereas CRS exhibited positive correlations with all MI-RSWB-S subscales except Hope Transcendent.

Conclusion: The findings of the current study support the validity and reliability of the Swedish adoption of the MI-RSWB and confirm previously reported associations with the Big Five personality traits, SOC, and CRS. More in general, our results underline the putative substantial link between RSWB dimensions and mental health. Further research especially in clinical surroundings as well as by employing more representative samples is now warranted.

Attachment and Therapeutic Alliance in Substance Use Disorders: Initial Findings for Treatment in the Therapeutic Community

Background: There is convincing evidence that individuals suffering from Substance Use Disorder (SUD) often present insecure attachment patterns. In contrast, a strong therapeutic alliance in treatment of SUD has been found to lead to a more positive treatment outcome. However, insecure attachment has been observed to be linked with weaker therapeutic alliance strength. The primary aim of this explorative study was to gain initial insights regarding the influence of attachment and personality characteristics on therapeutic alliance and therapy motivation in SUD patients undergoing treatment at a therapeutic community. Furthermore, SUD patients were compared to healthy controls regarding attachment, personality and mood pathology. Methods: A total sample of 68 participants, 34 inpatients in SUD treatment and 34 age-gender and education adjusted controls, were investigated. Both groups filled in the Adult Attachment Scale (AAS), the Inventory of Personality Organization (IPO-16), and the Brief Symptom Inventory (BSI-18) questionnaires. Additionally, SUD patients filled in the Working Alliance Inventory (WAI-SR) and the adapted German version of the University of Rhode Island Change Assessment scale (FEVER). Results: In line with our assumptions, SUD patients exhibited a decreased amount of attachment security (AAS) which was related to higher personality (IPO-16) and mood pathology (BSI-18). Furthermore, correlational analysis revealed the WAI-SR dimension Bond being positively associated with more secure attachment. A strong task alliance was linked to the Action stage of change (FEVER) and decreased mood but not personality pathology. Conclusion: Our findings confirm the putative negative effect of attachment and personality pathology on therapy motivation and therapeutic alliance in addiction therapy as well as more specifically in therapeutic community treatment. Future research in enhanced samples might focus more on the long-term effects of the interaction of attachment, personality and therapeutic alliance variables.

Attachment Styles, Personality Organization, and Substance Use as Predictors of Emotion Regulation Strategies "Suppression" and "Reappraisal" in Young Adults

BACKGROUND

As evidenced by current literature, there is a crucial link between emotion regulation, attachment, personality patterns, and substance abuse. However, knowledge regarding the exact interactions of these specific parameters in terms of substance abuse development is still sparse. Therefore, this study is aimed to shed light on how two specific emotion regulation strategies ("Reappraisal" and "Suppression") might be influenced by the relationship between attachment, structural deficits in personality organization, and addictive behaviors.

METHOD

A total sample of 299 non-clinical young adults (Age: M = 22; SD = 3.81; 74.2% females) filled in the Emotion Regulation Questionnaire (ERQ) together with the Adult Attachment Scale (AAS), the Personality Organization Inventory (IPO-16), and the Alcohol, Smoking and Substance Involvement Screening (ASSIST) by means of an online survey.

RESULTS

As suggested by hierarchical regression analysis, attachment specifically predicted differences in Emotion Regulation (ER), whereby the AAS subscales "Close" ness (β = -0.38, p < 0.01) and "Depend" ence (β = -0.18, p < 0.01) were negatively associated with increased use of maladaptive strategies of expressional suppression of emotion, and "Depend" (β = 0.26, p < 0.01) was positively associated with increased use of adaptive strategies of cognitive reappraisal.

DISCUSSION

In line with our assumptions, we observed a more secure attachment system to be predictive for an increased use of adequate emotion regulation strategies. The findings support the suggestion that a focus on underlying attachment-related processes in a psychotherapeutic setting might be a promising way to promote adaptive self-regulation of emotions.

Influence of Spiritual Dimensions on Suicide Risk: The Role of Regional Differences

The field of suicide prevention has been enriched by research on the association between spirituality and suicide. Many authors have suggested focusing on the various dimensions of religiosity in order to better understand the association between religion and suicidal risk, but it is unclear whether the relationship between spirituality and suicidality differs between countries with different cultures, life values, and sociohistorical experiences. To explore this, the aim of this multicenter study was to investigate the possible relationship between suicide and spirituality in Italy and Austria. In the two countries, two different groups of subjects participated: psychiatric patients and university students. The patients were evaluated with the Mini International Neuropsychiatric Interview. In addition, the following measures were used: a sociodemographic questionnaire, the Columbia-Suicide Severity Rating Scale-B, the Symptom-Checklist-90-Standard, and the Multidimensional Inventory for Religious/Spiritual Well-Being. Our results confirmed the multifactorial nature of the relation between suicide risk and the various religious/spiritual dimensions, including religious/spiritual well-being and hope immanent. However, regional differences moderated this relationship in both the clinical and nonclinical samples.

Suicide and Personality Traits: A Multicenter Study of Austrian and Italian Psychiatric Patients and Students

OBJECTIVE

The aim of this multicenter study was to investigate the differences in personality traits, particularly Neuroticism, in three clinical samples and three student samples in Austria and Italy and their impact on suicide.

METHODS

In total, 1,043 people (410 psychiatric inpatients and 633 university students) were tested in three regions of Europe: central Italy, northeast Italy, and eastern Austria. Psychiatric diagnoses were evaluated using the Mini-International Neuropsychiatric Interview, and the following instruments were used: Sociodemographic Questionnaire, Columbia-Suicide Severity Rating Scale-B, Symptom-Checklist-90-Standard, and Big Five Inventory.

RESULTS

The study found that the intensity of Suicidal Ideation was associated with the personality traits of Neuroticism, Anxiety, and Extraversion but also with Depression.

CONCLUSIONS

In conclusion, without the presence of Depression symptoms, neuroticism was a protective factor against Suicidal Ideation, whereas neuroticism when comorbid with Depression symptoms increased suicide risk in psychiatric patients. In all three regions, the clinical samples had higher scores for Neuroticism and for Depression symptoms than the student sample and consequently higher scores for Suicide. Furthermore, we demonstrated an interaction between gender and culture on personality traits, supporting the hypothesis that the distribution of self-reported personality traits is organized geographically.

A Bifactor Model of Personality Organization

The aim of this study was to explore the viability of a bifactor model for the Inventory of Personality Organization (IPO), which is a self-report measure of personality functioning based on Kernberg's model of personality organization. A heterogeneous, predominantly clinical sample (N = 616) completed the German 83-item version of the IPO. Confirmatory and Exploratory Factor Analyses were applied to explore the factor structure of the IPO. We were able to establish a bifactor model with a general factor of personality functioning and three specific factors (Aggression, Reality Testing, Moral Values), which represent additional dimensions of personality organization. Virtually all items showed substantial positive loadings on the general factor, explaining roughly 66% of the common variance. Furthermore, we found support for convergent and discriminant validity of general and specific factors with regard to interview-based assessments of personality disorders and personality organization. The results lend support to a bifactor approach to Kernberg's model of personality organization. We also present a 30-item brief form of the IPO that efficiently implements the bifactor approach and may be further validated in future studies.

The Role of Attachment in Poly-Drug Use Disorder: An Overview of the Literature, Recent Findings and Clinical Implications

Background: Substance use disorders (SUDs) represent a worldwide epidemic with extensive costs to the individual and to society. Occasionally described as an attachment disorder, they have been linked to various impairments in self-regulation and social functioning. However, while there have been significant advances in the development and validation of treatment strategies for SUD in recent years, the components of these treatment approaches have yet to be fully explored. The characteristics of polydrug use disorder (PUD) especially need to be addressed in more detail, as this diagnosis is highly common in individuals seeking treatment, while simultaneously being associated with poor treatment success. Aim and Scope: This review aims at further exploring the relevance of attachment in PUD and its treatment. To this end, this review provides a concise summary of relevant theories on the development and treatment of SUD in general, including related parameters of attachment, emotion regulation, and neuroscience. Furthermore, several studies focused specifically on PUD are described in more detail. These studies explored the connections between attachment, personality structure, primary and higher emotions (including spirituality), as well as structural and functional neural parameters in inpatients with PUD as well as in healthy controls. Most notably, the described studies highlight that insecure attachment and impairments in personality structure are present in inpatients with PUD. In addition, these characteristics are paralleled by extensive impairments in white matter integrity, especially in tracts connected to facets of emotion regulation. Conclusions: Based on our findings, we emphasize conceptualization of PUD as an Attachment Disorder, on a behavioral as well as on a neural level. Furthermore, we point out the importance of an integrated bio-psycho-social approach in this research area. Consequently, future studies might more closely focus on the influence of attachment-based interventions on emotion regulation abilities as well as a potentially related neuroplasticity. Neuroplastic changes, which are still rather unexplored, might represent important parameters for the assessment of treatment outcomes especially in long-term SUD treatment.

Spiritual well-being and coping in scleroderma, lupus erythematosus, and melanoma

BACKGROUND AND OBJECTIVES

Religious/spiritual (R-S) well-being is associated with greater vitality and lower depression scores. In this study, we investigated strategies for coping with disease and the role of religiosity/spirituality with respect to improving subjective well-being.

PATIENTS AND METHODS

One hundred and forty-nine patients (107 women), 44 of whom with systemic sclerosis (SSc), 48 with lupus erythematosus (LE), and 57 with stage I or II malignant melanoma (MM) were surveyed using a self-designed questionnaire, which addressed subjective well-being and disease-related circumstances, as well as the Multidimensional Inventory for Religious/Spiritual Well-Being (MI-RSWB).

RESULTS

At the time of diagnosis, disease burden is greater in LE patients than in patients with SSc and MM. Only after several years are SSc and LE patients able to accept their disease. Compared with healthy individuals, the overall score of R-S well-being is significantly lower in LE patients. In LE, photosensitivity and joint pain are inversely correlated with the ability to forgive. SSc patients with facial lesions and pulmonary involvement show greater religiosity. MM patients display significantly higher values for transcendental hope.

CONCLUSION

Talks about the disease and psychological support are the most important needs of patients with SSc, LE, and MM. At present, programs aimed at improving R-S coping skills do not seem to play a significant role, but could be an important resource that should be addressed in the future.

Increased attachment security is related to early therapy drop-out in substance use disorders

OBJECTIVES

Previous research work suggests a positive association between secure attachment and increased therapy adherence (TA) in different patient groups. However, there is still a strong need for research focusing on the influence of attachment on TA in substance use disorder (SUD) treatment. Hence, this study attempts to investigate the predictive value of different attachment patterns concerning TA in SUD inpatients.

RESULTS

122 (34 female) SUD inpatients completed the Attachment Style Questionnaire (ASQ) during the entry phase of therapeutic community treatment. After 6 weeks, subjects who remained in therapy (n = 47) completed the ASQ for a second time. In line with the literature, agglomerative Cluster Analysis suggested a two-cluster solution (Cluster I: increased secure attachment pattern; Cluster II: increased insecure attachment pattern). Notably, inpatients in Cluster I were more likely to drop out of treatment within the first 6 weeks (p < .001). Furthermore, subjects showed less "Confidence in Self and Others" (p < .05) after 6 weeks of treatment. Our findings indicate a negative predictive value of increased attachment security for TA in SUD inpatients. This finding probably mirrors a more realistic kind of self-assessment. More generally, the importance of considering attachment styles in SUD treatment is underlined.

White matter integrity in polydrug users in relation to attachment and personality: a controlled diffusion tensor imaging study

The relationship between substance use disorders (SUD) and brain deficits has been studied extensively. However, there is still a lack of research focusing on the structural neural connectivity in long-term polydrug use disorder (PUD). Since a deficiency in white matter integrity has been reported as being related to various parameters of increased psychopathology, it might be considered an aggravating factor in the treatment of SUD. In this study we compared two groups of PUD inpatients (abstinent: n = 18, in maintenance treatment: n = 15) to healthy controls (n = 16) with respect to neural connectivity in white matter, and their relation to behavioral parameters of personality factors/organization and attachment styles. Diffusion Tensor Imaging was used to investigate white matter structure. Compared with healthy controls, the PUD patients showed reduced fractional anisotropy (FA) and increased radial diffusivity (RD) mainly in the superior fasciculus longitudinalis and the superior corona radiata. These findings suggest diminished neural connectivity as a result of myelin pathology in PUD patients. In line with our assumptions, we observed FA in the biggest cluster as negatively correlated with anxious attachment (r = 0.36, p < 0.05), personality dysfunctioning (r = -0.41; p < 0.01) as well positively correlated with personality factors Openness (r = 0.34; p < 0.05) and Agreeableness (r = 0.28; p < 0.05). Correspondingly these findings were inversely mirrored by RD. Further research employing enhanced samples and addressing longitudinally neuronal plastic effects of SUD treatment in relation to changes in personality and attachment is recommended.

Addiction as an Attachment Disorder: White Matter Impairment Is Linked to Increased Negative Affective States in Poly-Drug Use

Substance use disorders (SUD) have been shown to be linked to various neuronal and behavioral impairments. In this study, we investigate whether there is a connection between the integrity of white matter (WM) and attachment styles as well as different affective states including spirituality in a group of patients diagnosed for poly-drug use disorder (PUD) in comparison to non-clinical controls. A total sample of 59 right-handed men, comprising the groups of patients with PUD (n = 19), recreational drug-using individuals (RUC; n = 20) as well as non-drug using controls were recruited (NUC; n = 20). For the behavioral assessment, we applied the Adult Attachment-Scale, the Affective Neuroscience Personality-Scale (short version) and the Multidimensional Inventory for Religious/Spiritual Well-Being. Diffusion Tensor Imaging was used to investigate differences in WM neural connectivity. Analyses revealed decreased Fractional Anisotropy and decreased Mean Diffusivity in PUD patients as compared to RUC and NUC. No differences were found between RUC and NUC. Additional ROI analyses suggested that WM impairment in the superior longitudinal fasciculus (SLF) and the superior corona radiata (SCR) was linked to more insecure attachment as well as to more negative affectivity. No substantial correlation was observed with spirituality. These findings are mainly limited by the cross-sectional design of the study. However, our preliminary results support the idea of addiction as an attachment disorder, both at neuronal and behavioral levels. Further research might be focused on the changes of insecure attachment patterns in SUD treatment and their correlation with changes in the brain.

Spirituelles Wohlbefinden und Coping bei Sklerodermie, Lupus erythematodes und malignem Melanom

HINTERGRUND UND ZIELE

Religiös-spirituelles Wohlbefinden ist verbunden mit höherer Vitalität und verminderter Depressionsneigung. In unserer Studie untersuchten wir die Strategien zur Krankheitsbewältigung und die Rolle von Religiosität-Spiritualität (R-S) zur Verbesserung des subjektiven Wohlbefindens.

PATIENTEN UND METHODIK

149 Patienten (107 Frauen), 44 mit systemischer Sklerodermie (SKL), 48 mit Lupus erythematodes (LE) und 57 mit malignem Melanom (MM), Stadium I-II, wurden mittels eines selbstentwickelten Fragebogens zum subjektiven Wohlbefinden, zu den mit der Erkrankung einhergehenden Umständen sowie mit dem Multidimensionalen Inventar (MI-RSB) zu R-S befragt.

ERGEBNISSE

LE-Patienten sind zum Zeitpunkt der Diagnosestellung stärker belastet als SKL- und MM-Patienten. SKL- und LE-Patienten können erst nach Jahren die Erkrankung akzeptieren. Der Gesamtscore des religiös-spirituellen Befindens liegt bei LE-Patienten signifikant unter dem Wert der Normalbevölkerung. Fotosensitivität und Gelenksschmerzen sind bei LE-Patienten negativ assoziiert mit der Fähigkeit Vergeben zu können. SKL-Patienten mit Gesichtsveränderungen und Lungenbeteiligung zeigen höhere allgemeine Religiosität. MM-Patienten haben höhere Werte für transzendente Hoffnung.

SCHLUSSFOLGERUNGEN

Vorträge über die Krankheit und psychologische Betreuung sind die wichtigsten Bedürfnisse von Patienten mit SKL, LE und MM an ihre Betreuer. Religiös-spirituelle Angebote zur Krankheitsverarbeitung scheinen derzeit eine untergeordnete Rolle zu spielen, könnten aber eine wichtige Ressource sein, der man in Zukunft mehr Aufmerksamkeit schenken sollte.

EEG neurofeedback effects in the treatment of adolescent anorexia nervosa

A pre-post design including 22 females was used to evaluate the effectiveness of neurofeedback in the treatment of adolescent anorexia nervosa. Resting EEG measures and a psychological test-battery assessing eating behavior traits, clinical symptoms, emotionality, and mood were obtained. While both the experimental (n = 10) and control group (n = 12) received their usual maintenance treatment, the experimental group received 10 sessions of individual alpha frequency training over a period of 5 weeks as additional treatment. Significant training effects were shown in eating behavior traits, emotion regulation, and in relative theta power in the eyes closed condition. Although the results are limited due to the small sample size, these are the first empirical data demonstrating the benefits of neurofeedback as a treatment adjunct in individuals with anorexia nervosa.

[Neurofeedback in the Treatment of Anorexia Nervosa: a Case Report]

Anorexia nervosa has been related to alterations in brain activity in terms of hyperactive EEG patterns. This case report illustrates the principles and results of a five-week neurofeedback treatment in a 29-year-old woman suffering from anorexia nervosa. A neurofeedback protocol to enhance alpha activity (8 - 12 Hz) was developed and conducted additionally to the standardized treatment for eating disorders in training sessions twice a week. Pre- and post-test measurements included resting state EEG measurements and a psychological test battery. The results show improvements from pre- to post-test in eating disorder psychopathology including psychological wellbeing, emotional competence, and eating behavior traits. In addition, a decrease in theta power (4 - 7 Hz), a well-known trait marker of anorexia nervosa, was measured. However, our data should be interpreted with caution because this is a single case study. Nevertheless, this report documents the practicability and method of neurofeedback as treatment adjunct in eating disorders from the clinical perspective. Although the use of neurofeedback in the treatment of anorexia nervosa is recommended in literature, empirical studies are still lacking. Randomized controlled trials to evaluate short- and long-term effects of neurofeedback are needed.

Vulnerable Dark Triad Personality Facets Are Associated with Religious Fundamentalist Tendencies

BACKGROUND

This study explores the possibility that religious fundamentalism (RF) may be linked to deficits in personality structure, which is in contrast to the general assumption that religiosity and spirituality are positively related to mature personality development.

SAMPLING AND METHODS

To test this hypothesis, 327 (232 female) college students completed the Multidimensional Inventory for Religious/Spiritual Well-Being together with the Innsbrucker Religious Fundamentalism Scale. In addition, the 'vulnerable dark triad' of personality ('vulnerable narcissism', subscale of the Pathological Narcissism Inventory; 'secondary psychopathy', subscale of Levenson's Self-Report Psychopathy Scale; 'borderline personality', of the Borderline Personality Inventory) was assessed.

RESULTS

In general, the relation between spirituality and healthy personality functioning was confirmed. In addition to greatly overlapping with 'general religiosity' (p < 0.001), RF was also relevantly predicted by narcissistic ('hiding the self') and borderline ('primitive defenses') personality facets (p < 0.05 for both).

CONCLUSIONS

Based on these preliminary data, we conclude that specific structural deficits in personality might lead to more rigorous variants of religious/spiritual beliefs such as RF. Further research in clinical surroundings as well as in religious extremist groups is recommended.

Insecure Attachment Styles and Increased Borderline Personality Organization in Substance Use Disorders

BACKGROUND

Previous research has linked insecure attachment styles and borderline personality organization to substance use disorder (SUD). However, it still remains unclear whether those impairments apply to different kinds of SUDs to the same extent. Therefore, in this study we sought to investigate potential differences regarding attachment deficits and borderline personality organization in two different SUD inpatient groups and furthermore in comparison to healthy controls.

SAMPLING AND METHODS

A total of 66 (24 female) inpatients diagnosed with alcohol use disorder (AUD), 57 (10 female) inpatients diagnosed with polydrug use disorder (PUD), and 114 (51 female) healthy controls completed the Borderline Personality Inventory and the Attachment Style Questionnaire.

RESULTS

Compared to healthy controls, AUD and PUD inpatients showed significant deficits in all attachment parameters (p < 0.01) as well as a significantly increased amount of borderline personality organization (p < 0.01). No differences between AUD and PUD inpatients were observed (p > 0.05).

CONCLUSIONS

Our results indicate that the drug(s) of choice cannot be regarded as an indicator for the extent of attachment deficits or personality pathology. These initial findings are mainly limited by the rather small sample size as well as just a single point of measurement. Future research might also consider further covariates such as comorbidity or psychotropic medication.

The Janus face of schizotypy: enhanced spiritual connection or existential despair?

It has been asserted that schizotypy has a negative relationship with subjective well-being. By employing a multidimensional measure of spiritual well being with 400 British College students we report a more complex relationship. The Multidimensional Inventory for Religious/Spiritual Well-Being and Schizotypal Personality Questionnaire-Brief Version were used and analysis made use of Canonical Correlational Analysis. Results suggested that two distinct relationships emerged between schizotypy and spirituality. First, a positive association between cognitive/perceptual features of schizotypy and spiritual connectedness emerged. Second a more global negative relationship between feelings of spiritual isolation and despair was found for all aspects of schizotypy. These findings challenge the previous literature based on one-dimensional subjective well being measures which have found only a negative relationship. However, the positive association between connectedness and cognitive-perceptual aspects of schizotypy raises import questions about the possible benefit of certain types of schizotypal experience.

[Religious/spiritual well-being in mentally ill persons III: first results of a body-centered awareness meditation for in-patient rehabilitation]

OBJECTIVE

In recent years, positive effects of religiosity and spirituality on mental health can be found as well documented in the literature. However, very few studies have examined the effects of a spiritually based therapeutic intervention among psychiatric patients.

METHOD

For this reason, in this pilot study we examined the effectiveness of a morning body-centered meditation in comparison to a conventional morning walk in regards to subjective well-being and stress coping styles in 44 (26 females) randomly assigned psychiatric in-patients (according to ICD 10). The patients' amount of subjective well-being as well as their coping ability was assessed at the beginning and at the end of a 6 weeks therapy.

RESULTS

Thereby we found a significant increase in Religious/Spiritual Well-Being, Awareness and more adequate Coping strategies. This was paralleled by a decrease of psychiatric symptoms. Overall the general assumption of a positive association between spirituality and mental health was affirmed. However, we did not find any differences between the two treatment methods (meditation vs. morning walk).

CONCLUSIONS

Both interventions showed the same positive efficacy. Based on these initial results, possibilities and boundaries for the integration of religious/spiritual issues into the treatment of psychiatric patients are discussed.

Religious/Spiritual Well-being, personality and mental health: a review of results and conceptual issues

The current paper provides background to the development of the Multidimensional Inventory for Religious/Spiritual Well-being and then summarises findings derived from its use with other measures of health and personality. There is substantial evidence for religiosity/spirituality being positively related to a variety of indicators of mental health, including subjective well-being and personality dimensions. Furthermore, religiosity/spirituality can play an important role in the process of recovering from mental illness as well as providing a protective function against addictive or suicidal behaviours. However, further research is needed to examine the mechanisms through which religiosity/spirituality have an impact on health-related conditions.

Dimensions of religious/spiritual well-being and the dark triad of personality

BACKGROUND

In general, religious/spiritual dimensions are found to be negatively correlated with all kinds of psychiatric disorders such as depression, suicidal ideation and substance abuse. Contrary to these findings, the goal of this study was to investigate the relationship between dimensions of religious/spiritual well-being (RSWB) and less favorable aspects of personality - the so-called 'dark triad' of personality traits, i.e. narcissism, machiavellianism and psychopathy - together with general deficits in personality structure.

SAMPLING AND METHODS

A total of 312 college students (220 females) completed the Multidimensional Inventory for RSWB, the revised Narcissistic Personality Inventory, the Machiavellianism Inventory and the Levenson Self-Report Psychopathy Scale along with the 16-item Inventory of Personality Organization.

RESULTS

RSWB was confirmed to be negatively correlated with these negative aspects of personality, in particular with subclinical psychopathy. More specifically, there were several notable overlaps; narcissism, for instance, was found to be significantly positively associated with some RSWB subdimensions such as 'hope' or 'connectedness'.

CONCLUSIONS

First deductions can be made from these data concerning an ambivalent role of spirituality in impaired personality structure. These associations might be further investigated especially in psychiatric patients diagnosed with personality disorders in order to describe potential psychopathological facets of religion and spirituality more adequately.

[Religious/spiritual well-being in mentally ill persons II: the development of a short scale and comparison scores for clinical psychiatric groups and healthy controls]

OBJECTIVE

The Multidimensional Inventory for Religious/Spiritual Well-Being (MI-RSWB) was successfully applied in several clinical as well as non-clinical studies. However, the original version of the scale often showed to be as too comprehensive especially for clinical surroundings. There for the aim of this study is to develop a short version of the scale comprising 12 items.

METHOD

Based on a sample representative of the Austrian general population (N = 1,500), a first MI-RSWB short version is developed by means of factor- and reliability analysis. Furthermore the new short version of the scale is initially validated through several indicators of mental illness.

RESULTS

The MI-RSWB short version shows convincing psychometric properties. The total scale as well as the sub scales exhibit at least a sufficient internal consistency. A significant negative association with several indicators of psychiatric illness is also confirmed for the short version of the scale.

CONCLUSIONS

The MI-RWSB 12 scale is especially recommended for further research focusing on the clinical relevance of religiosity and spirituality.

Soul darkness? Dimensions of religious/ spiritual well-being among mood-disordered inpatients compared to healthy controls

BACKGROUND

Religiosity and spirituality have been found to be substantially associated with a variety of mental health and illness parameters. However, relevant empirical evidence is sparse, and more research is needed in order to further understand what role religiosity/spirituality plays in the development, progression and healing process of a psychiatric disease. Thus, the purpose of this study was to find out more information about the religious/spiritual needs of anxious/depressive inpatients.

SAMPLING AND METHODS

A total sample of 200 well-characterized anxious/depressive inpatients was investigated. Results were compared to those from an adjusted group of healthy individuals (n = 200). A newly developed Multidimensional Inventory for Religious/Spiritual Well-Being was applied to both groups, together with established psychiatric measures (e.g. Beck Depression Inventory).

RESULTS

Of the dimensions measured, Hope and Forgiveness turned out to be the strongest negative correlates of anxious/depressive symptoms (p < 0.001). Moreover, a lower degree of Hope (p < 0.001) and Experiences of Sense and Meaning (p < 0.01) was found in the patient group compared to healthy controls. In accordance with the literature, religiosity was confirmed to be a substantial suicidal buffer (p < 0.01).

CONCLUSIONS

Our results account for a more comprehensive psychiatric evaluation, emphasizing in particular the role that religiosity/spirituality plays in overall well-being. Furthermore, religious/spiritual well-being might be considered an important resource to explore, in particular for affective mentally disordered patients.

MI-RSB 48

Zusammenfassung. In interdisziplinärer Zusammenarbeit wurde ein mehrdimensionales Messinstrument zu Religiosität und Spiritualität (MI-RSB 48) im Erleben von körperlicher und psychischer Gesundheit und Krankheit entwickelt, um das Konstrukt zum religiös-spirituellen Befinden zu erfassen. Im Deutungsrahmen des bio-psycho-sozio-spirituellen Modells kann nach einer Darstellung des Hintergrunds des Forschungsanliegens bzw. der Phasen der Testentwicklung eine vorläufige Endversion des Fragebogens präsentiert werden. Das Inventar wurde an einer Stichprobe von 200 Studierenden erprobt und an einer Stichprobe entsprechend der österreichischen Allgemeinbevölkerung validiert (N = 263). Ausgehend von der Fragestellung zum Zusammenhang von Religiosität, Spiritualität und psychischer Gesundheit werden die Ergebnisse der Befragung zum religiös-spirituellen Befinden im Kontext anderer Konzepte zum Wohlbefinden im bio-psycho-sozialen Raum dargestellt. Einbezogen werden der Kohärenzsinn im salutogenetischen Ansatz nach A. Antonovsky bzw. das Ausmaß an subjektiver Zufriedenheit mit der Befriedigung von Mangel- und Wachstumsbedürfnissen im Sinne A. H. Maslows.