Dirk Lehr - Academia.edu (original) (raw)

Papers by Dirk Lehr

Frontiers in Psychology, 2021

The aim of this study was to investigate employees’ self-reported creativity before and after vac... more The aim of this study was to investigate employees’ self-reported creativity before and after vacation and to examine the impact of recovery experiences (detachment, relaxation, mastery, meaning, autonomy, affiliation) on changes in creativity. The DRAMMA model of Newman et al. provides the theoretical background of our approach. Longitudinal data was assessed with four repeated measurements. The study encompassed data from 274 white-collar workers. Analyses showed that employees subjectively perceive their creativity to benefit not immediately after their vacation but 2 weeks later. Detachment was significantly related to lower creativity within persons, while mastery experiences explained differences in creativity between persons. This study provides a detailed picture of changes in creativity around vacations.

Introduction: The mental health burden for the general population due to the COVID-19 pandemic ha... more Introduction: The mental health burden for the general population due to the COVID-19 pandemic has been highlighted. Evidence on effective, easily accessible public health interventions to reduce worry, a major transdiagnostic riskfactor for, e.g., anxiety and depression, is scarce. Objective: In a pragmatic randomized controlled trial, we aimed to assess whether an internet cognitive-behavioral self-help intervention could reduce worry more than public mental health advice in the general population. Methods: Eligible internet users above the age of 18 were recruited from the German general population and randomly assigned, to either get.calm-move.on (GCMO), a 10-day unguided, internet-based self-help intervention, or mental health advice waiting group (MHA-W, receiving officially endorsed mental health recommendations). The primary outcome was level of worry, using the Penn State Worry Questionnaire (PSWQ), 2 weeks after randomization. Baseline assessment and 2-month and 6-month follow-ups were conducted. The trial was registered at the German Clinical Trials Registry (DRKS00021153). Results: Between April 7, 2020 and December 11, 2020, we randomly assigned 351 individuals to receive either GCMO (n = 175) or MHA-W (n = 176). Participants receiving GCMO (PSWQ = 46.6; change-10.3) reported significantly less worrying at post-intervention (F 1,219 = 12.9; p < 0.001; d = 0.38) than MHA-W controls (PSWQ = 51.6; change-5.1). Improvements were also seen on most secondary outcomes, including symptoms of anxiety and depression, general well-being, resiliency, and emotion regulation skills. Improvements made from baseline were stable until the 6-month follow-up. Conclusions: This internet-based selfhelp intervention providing cognitive-behavioral techniques to cope with the threatening pandemic situation is effective in reducing worry in the general population and should complement existing and potentially effective mental health recommendations.

eMovit is an iPhone application which facilitates the development and engagement in positive beha... more eMovit is an iPhone application which facilitates the development and engagement in positive behaviours ranking from physical activity to social or creative engagements. The application is based on the principles of Behavioural Activation. The project is targeted at the general population to test the feasibility, ie. willingness of users, of recruitment and data collection through the means of mobile applications, like eMovit. If the results of this study are positive, it would open new possibilities for research in the emerging world of mobile and web-based interventions.

BACKGROUND Although internet-based and mobile-based stress management interventions (iSMIs) may b... more BACKGROUND Although internet-based and mobile-based stress management interventions (iSMIs) may be a promising strategy to reach employees suffering from high chronic stress, it remains unknown whether participants with high symptom severity of depression or anxiety also benefit from iSMIs or should be excluded. OBJECTIVE This study aimed to evaluate the efficacy of iSMIs in subgroups with high symptom severity and to test whether baseline symptom severity moderates treatment outcome. METHODS Data from three randomized controlled trials (N=791) were pooled to identify effect modifiers and to evaluate efficacy in subgroups with different levels of initial symptom severity. The outcomes perceived stress (Perceived Stress Scale, PSS), depression severity (Center for Epidemiological Depression Scale, CES-D), and anxiety (Hospital Anxiety and Depression Scale, HADS) symptom severity were assessed at baseline, 7-week postassessment, and 6-month follow-up. Potential moderators were tested ...

Objective:Theassumptionthatlowbackpain(LBP)patientssufferfrom “disuse” as a consequence of high f... more Objective:Theassumptionthatlowbackpain(LBP)patientssufferfrom “disuse” as a consequence of high fear-avoidance beliefs is currently

Understanding mood changes of individuals with depressive disorders is crucial in order to guide ... more Understanding mood changes of individuals with depressive disorders is crucial in order to guide personalized therapeutic interventions. Based on diary data, in which clients of an online depression treatment report their activities as free text, we categorize these activities and predict the mood level of clients. We apply a bag-of-words text-mining approach for activity categorization and explore recurrent neuronal networks to support this task. Using the identified activities, we develop partial ordered logit models with varying levels of heterogeneity among clients to predict their mood. We estimate the parameters of these models by employing Markov Chain Monte Carlo techniques and compare the models regarding their predictive performance. Therefore, by combining text-mining and Bayesian estimation techniques, we apply a two-stage analysis approach in order to reveal relationships between various activity categories and the individual mood level. Our findings indicate that the m...

The analysis of diary data can increase insights into patients suffering from mental disorders an... more The analysis of diary data can increase insights into patients suffering from mental disorders and can help to personalize online interventions. We propose a two-step approach for such an analysis. We first categorize free text diary data into activity categories by applying a bag-of-words approach and explore recurrent neuronal networks to support this task. In a second step, we develop partial ordered logit models with varying levels of heterogeneity among clients to predict their mood. We estimate the parameters of these models by employing MCMC techniques and compare the models regarding their predictive performance. This two-step approach leads to an increased interpretability about the relationships between various activity categories and the individual mood level.

Background: Lost productivity due to insomnia in the working-population is a common and costly pr... more Background: Lost productivity due to insomnia in the working-population is a common and costly problem. This study aims to evaluate the cost-effectiveness, cost-utility and cost-benefit of an internet-based guided self-help intervention which aimed to improve recovery from work-related strain in teachers with sleeping problems and work-related rumination. Methods: School teachers (N = 128) with clinically significant insomnia symptoms and work-related rumination were randomized to guided internet-based guided self-help or a control-group, both with access to occupational care-as-usual. Economic data were collected at baseline and 6-month follow-up. We conducted a) a cost-effectiveness analysis with treatment response (Reliable Change [decline of 5.01 points] and Insomnia Severity Index < 8 at 6-month follow-up) as the outcome and b) a cost-benefit analysis and c) a cost-utility analyses with QALYS as outcome. Analyses were performed from both the societal (SP) and the employer’s ...

The European health psychologist, 2017

Background: Evidence for the impact of psychological Interventions in the treatment of subthresho... more Background: Evidence for the impact of psychological Interventions in the treatment of subthreshold depression (sD) and in the prevention of Major Depressive Disorder (MDD)is conflicting. The aim of the present research was to evaluate the effectiveness of a web-based guided self-help intervention in the treatment of sD and on the onset of MDD. Methods: In two randomized controlled trials, participants with sD were randomly allocated to a guided web-based intervention (n=202) and enhanced usual care (n=204) or to the same intervention with adherence-focused guidance (n=102) and a waitlist control condition (n=102). The primary outcome was time to onset of MDD in the intervention relative to the control group over a 12-month follow-up period using DSM-IV criteria and the reduction in depressive symptom severity as measured by blind diagnostic raters using the Quick Inventory of Depressive Symptomatology at post-treatment. Results: Cox regression analyses controlling for baseline depr...

Journal of Sleep Research, 2021

Sleep difficulties are widespread among international students. Internet-based interventions are ... more Sleep difficulties are widespread among international students. Internet-based interventions are suggested as a low-threshold treatment option but may require cultural adaptation among culturally diverse populations. The present pilot study investigated the effectiveness and acceptance of an internet-based intervention to improve sleep difficulties in international students. A total of 81 international students of 36 nationalities were randomly assigned to the intervention (n = 41) or waitlist control group (n = 40). The intervention group received immediate access to a culturally non-adapted unguided internet-based sleep intervention consisting of three modules based on sleep hygiene and cognitive techniques to reduce rumination. At baseline, 4 and 12 weeks after randomisation, insomnia severity, measured by the Insomnia Severity Index, and secondary outcomes (sleep quality, depression, anxiety, perceived stress, well-being, presenteeism, mental health literacy) were assessed. Data were analysed using linear multi-level analyses. Additionally, satisfaction and perceived cultural appropriateness of the intervention were evaluated by international students after 4 weeks, and compared with ratings of German students, who represent the original target group. Insomnia severity improved over time in the intervention group compared to the control group, revealing a significant estimated mean difference of -5.60 (Hedges' g = 0.84, p < 0.001) after 12 weeks. Satisfaction and perceived cultural appropriateness was high and comparable to that of German students. The present study shows that a culturally non-adapted internet-based sleep intervention can be a low-threshold treatment option to help meet the high demand for mental healthcare among international students. It thus indicates that cultural adaptation might not represent a precondition for providing effective internet-based sleep interventions to this target group.

BMC Psychology, 2021

Background Work-related stress shows steadily increasing prevalence rates and has tangible conseq... more Background Work-related stress shows steadily increasing prevalence rates and has tangible consequences for individual workers, their organizations, and society as a whole. One mechanism that may help offset the negative outcomes of work-related stress on employees’ well-being is recovery. Recovery refers to the experience of unwinding from one's job when not at work. However, employees who experience high levels of work-related stress and are thus particularly in need of recovery tend to struggle to switch-off. Due to the detrimental effects of this prolonged and sustained mental representation of job stressors, interventions promoting recovery may contribute to improvements in employees' mental health. Methods In this randomized, waitlist controlled trial, we will investigate the effectiveness of two 6-week online training programs (cognitive behavioral and mindfulness-based). The sample will include employees working at least part-time during regular work hours. Besides t...

Psychotherapy and Psychosomatics, 2020

Introduction: There is neither strong evidence on effective treatments for patients with chronic ... more Introduction: There is neither strong evidence on effective treatments for patients with chronic back pain (CBP) and depressive disorder nor sufficiently available mental health care offers. Objective: The aim is to assess the effectiveness of internet- and mobile-based interventions (IMI) as a scalable approach for treating depression in a routine care setting. Methods: This is an observer-masked, multicenter, pragmatic randomized controlled trial with a randomization ratio of 1:1.Patients with CBP and diagnosed depressive disorder (mild to moderate severity) were recruited from 82 orthopedic rehabilitation clinics across Germany. The intervention group (IG) received a guided depression IMI tailored to CBP next to treatment-as-usual (TAU; including medication), while the control group (CG) received TAU. The primary outcome was observer-masked clinician-rated Hamilton depression severity (9-week follow-up). The secondary outcomes were: further depression outcomes, pain-related outco...

BMC Public Health, 2020

Background While work-related rumination increases the risk of acute stressors developing into ch... more Background While work-related rumination increases the risk of acute stressors developing into chronic load reactions and adverse health, mental detachment has been suggested as a way to interrupt this chain. Despite the importance of mentally detaching from work during leisure time, workers seem to struggle to disengage and, instead, experience the constant mental representation of work-related stressors, regardless of their absence. Those who struggle with work-related rumination could benefit from an easy-access intervention that fosters mental detachment by promoting recreational activities. Especially during vacations, workers appear to naturally engage in sufficient recovery activities; however, this beneficial behaviour is not sustained. The smartphone app-based intervention “Holidaily” promotes recovery behaviour and, thus, mental detachment from work with the intension of extending the beneficial effects of workers’ vacations into their daily working life. Methods This rand...

Somnologie, 2020

ZusammenfassungDigital angebotene psychologische Interventionen gegen Schlafstörungen sind aktuel... more ZusammenfassungDigital angebotene psychologische Interventionen gegen Schlafstörungen sind aktuell ein sehr intensiv bearbeitetes Forschungsthema. In dieser Übersichtsarbeit werden Originalarbeiten und Metaanalysen zu diesem Thema zusammengefasst. Hierbei zeigt sich, dass die internetbasierte kognitive Verhaltenstherapie für Insomnie (KVT-I) bei Erwachsenen durchweg sehr effektiv ist mit allenfalls leicht geringeren Effektstärken als die gleiche Behandlung mit physischer Präsenz von Therapeuten und Patienten. Behandlungseffekte zeigen sich dabei auch für sekundäre Outcome-Parameter wie Depressivität, Angst, Fatigue und Lebensqualität. Hingegen lassen die Forschung zur Wirksamkeit der internetbasierten KVT‑I bei Erwachsenen mit komorbiden psychischen Störungen oder körperlichen Erkrankungen sowie die Forschung zur Frage, wieviel Therapeutenkontakt in die Behandlung integriert werden sollte, anscheinend noch keine abschließenden Antworten zu. In diesen Bereichen scheint weitere Forsch...

Frontiers in Psychology, 2021

The aim of this study was to investigate employees’ self-reported creativity before and after vac... more The aim of this study was to investigate employees’ self-reported creativity before and after vacation and to examine the impact of recovery experiences (detachment, relaxation, mastery, meaning, autonomy, affiliation) on changes in creativity. The DRAMMA model of Newman et al. provides the theoretical background of our approach. Longitudinal data was assessed with four repeated measurements. The study encompassed data from 274 white-collar workers. Analyses showed that employees subjectively perceive their creativity to benefit not immediately after their vacation but 2 weeks later. Detachment was significantly related to lower creativity within persons, while mastery experiences explained differences in creativity between persons. This study provides a detailed picture of changes in creativity around vacations.

Introduction: The mental health burden for the general population due to the COVID-19 pandemic ha... more Introduction: The mental health burden for the general population due to the COVID-19 pandemic has been highlighted. Evidence on effective, easily accessible public health interventions to reduce worry, a major transdiagnostic riskfactor for, e.g., anxiety and depression, is scarce. Objective: In a pragmatic randomized controlled trial, we aimed to assess whether an internet cognitive-behavioral self-help intervention could reduce worry more than public mental health advice in the general population. Methods: Eligible internet users above the age of 18 were recruited from the German general population and randomly assigned, to either get.calm-move.on (GCMO), a 10-day unguided, internet-based self-help intervention, or mental health advice waiting group (MHA-W, receiving officially endorsed mental health recommendations). The primary outcome was level of worry, using the Penn State Worry Questionnaire (PSWQ), 2 weeks after randomization. Baseline assessment and 2-month and 6-month follow-ups were conducted. The trial was registered at the German Clinical Trials Registry (DRKS00021153). Results: Between April 7, 2020 and December 11, 2020, we randomly assigned 351 individuals to receive either GCMO (n = 175) or MHA-W (n = 176). Participants receiving GCMO (PSWQ = 46.6; change-10.3) reported significantly less worrying at post-intervention (F 1,219 = 12.9; p < 0.001; d = 0.38) than MHA-W controls (PSWQ = 51.6; change-5.1). Improvements were also seen on most secondary outcomes, including symptoms of anxiety and depression, general well-being, resiliency, and emotion regulation skills. Improvements made from baseline were stable until the 6-month follow-up. Conclusions: This internet-based selfhelp intervention providing cognitive-behavioral techniques to cope with the threatening pandemic situation is effective in reducing worry in the general population and should complement existing and potentially effective mental health recommendations.

eMovit is an iPhone application which facilitates the development and engagement in positive beha... more eMovit is an iPhone application which facilitates the development and engagement in positive behaviours ranking from physical activity to social or creative engagements. The application is based on the principles of Behavioural Activation. The project is targeted at the general population to test the feasibility, ie. willingness of users, of recruitment and data collection through the means of mobile applications, like eMovit. If the results of this study are positive, it would open new possibilities for research in the emerging world of mobile and web-based interventions.

BACKGROUND Although internet-based and mobile-based stress management interventions (iSMIs) may b... more BACKGROUND Although internet-based and mobile-based stress management interventions (iSMIs) may be a promising strategy to reach employees suffering from high chronic stress, it remains unknown whether participants with high symptom severity of depression or anxiety also benefit from iSMIs or should be excluded. OBJECTIVE This study aimed to evaluate the efficacy of iSMIs in subgroups with high symptom severity and to test whether baseline symptom severity moderates treatment outcome. METHODS Data from three randomized controlled trials (N=791) were pooled to identify effect modifiers and to evaluate efficacy in subgroups with different levels of initial symptom severity. The outcomes perceived stress (Perceived Stress Scale, PSS), depression severity (Center for Epidemiological Depression Scale, CES-D), and anxiety (Hospital Anxiety and Depression Scale, HADS) symptom severity were assessed at baseline, 7-week postassessment, and 6-month follow-up. Potential moderators were tested ...

Objective:Theassumptionthatlowbackpain(LBP)patientssufferfrom “disuse” as a consequence of high f... more Objective:Theassumptionthatlowbackpain(LBP)patientssufferfrom “disuse” as a consequence of high fear-avoidance beliefs is currently

Understanding mood changes of individuals with depressive disorders is crucial in order to guide ... more Understanding mood changes of individuals with depressive disorders is crucial in order to guide personalized therapeutic interventions. Based on diary data, in which clients of an online depression treatment report their activities as free text, we categorize these activities and predict the mood level of clients. We apply a bag-of-words text-mining approach for activity categorization and explore recurrent neuronal networks to support this task. Using the identified activities, we develop partial ordered logit models with varying levels of heterogeneity among clients to predict their mood. We estimate the parameters of these models by employing Markov Chain Monte Carlo techniques and compare the models regarding their predictive performance. Therefore, by combining text-mining and Bayesian estimation techniques, we apply a two-stage analysis approach in order to reveal relationships between various activity categories and the individual mood level. Our findings indicate that the m...

The analysis of diary data can increase insights into patients suffering from mental disorders an... more The analysis of diary data can increase insights into patients suffering from mental disorders and can help to personalize online interventions. We propose a two-step approach for such an analysis. We first categorize free text diary data into activity categories by applying a bag-of-words approach and explore recurrent neuronal networks to support this task. In a second step, we develop partial ordered logit models with varying levels of heterogeneity among clients to predict their mood. We estimate the parameters of these models by employing MCMC techniques and compare the models regarding their predictive performance. This two-step approach leads to an increased interpretability about the relationships between various activity categories and the individual mood level.

Background: Lost productivity due to insomnia in the working-population is a common and costly pr... more Background: Lost productivity due to insomnia in the working-population is a common and costly problem. This study aims to evaluate the cost-effectiveness, cost-utility and cost-benefit of an internet-based guided self-help intervention which aimed to improve recovery from work-related strain in teachers with sleeping problems and work-related rumination. Methods: School teachers (N = 128) with clinically significant insomnia symptoms and work-related rumination were randomized to guided internet-based guided self-help or a control-group, both with access to occupational care-as-usual. Economic data were collected at baseline and 6-month follow-up. We conducted a) a cost-effectiveness analysis with treatment response (Reliable Change [decline of 5.01 points] and Insomnia Severity Index < 8 at 6-month follow-up) as the outcome and b) a cost-benefit analysis and c) a cost-utility analyses with QALYS as outcome. Analyses were performed from both the societal (SP) and the employer’s ...

The European health psychologist, 2017

Background: Evidence for the impact of psychological Interventions in the treatment of subthresho... more Background: Evidence for the impact of psychological Interventions in the treatment of subthreshold depression (sD) and in the prevention of Major Depressive Disorder (MDD)is conflicting. The aim of the present research was to evaluate the effectiveness of a web-based guided self-help intervention in the treatment of sD and on the onset of MDD. Methods: In two randomized controlled trials, participants with sD were randomly allocated to a guided web-based intervention (n=202) and enhanced usual care (n=204) or to the same intervention with adherence-focused guidance (n=102) and a waitlist control condition (n=102). The primary outcome was time to onset of MDD in the intervention relative to the control group over a 12-month follow-up period using DSM-IV criteria and the reduction in depressive symptom severity as measured by blind diagnostic raters using the Quick Inventory of Depressive Symptomatology at post-treatment. Results: Cox regression analyses controlling for baseline depr...

Journal of Sleep Research, 2021

Sleep difficulties are widespread among international students. Internet-based interventions are ... more Sleep difficulties are widespread among international students. Internet-based interventions are suggested as a low-threshold treatment option but may require cultural adaptation among culturally diverse populations. The present pilot study investigated the effectiveness and acceptance of an internet-based intervention to improve sleep difficulties in international students. A total of 81 international students of 36 nationalities were randomly assigned to the intervention (n = 41) or waitlist control group (n = 40). The intervention group received immediate access to a culturally non-adapted unguided internet-based sleep intervention consisting of three modules based on sleep hygiene and cognitive techniques to reduce rumination. At baseline, 4 and 12 weeks after randomisation, insomnia severity, measured by the Insomnia Severity Index, and secondary outcomes (sleep quality, depression, anxiety, perceived stress, well-being, presenteeism, mental health literacy) were assessed. Data were analysed using linear multi-level analyses. Additionally, satisfaction and perceived cultural appropriateness of the intervention were evaluated by international students after 4 weeks, and compared with ratings of German students, who represent the original target group. Insomnia severity improved over time in the intervention group compared to the control group, revealing a significant estimated mean difference of -5.60 (Hedges' g = 0.84, p < 0.001) after 12 weeks. Satisfaction and perceived cultural appropriateness was high and comparable to that of German students. The present study shows that a culturally non-adapted internet-based sleep intervention can be a low-threshold treatment option to help meet the high demand for mental healthcare among international students. It thus indicates that cultural adaptation might not represent a precondition for providing effective internet-based sleep interventions to this target group.

BMC Psychology, 2021

Background Work-related stress shows steadily increasing prevalence rates and has tangible conseq... more Background Work-related stress shows steadily increasing prevalence rates and has tangible consequences for individual workers, their organizations, and society as a whole. One mechanism that may help offset the negative outcomes of work-related stress on employees’ well-being is recovery. Recovery refers to the experience of unwinding from one's job when not at work. However, employees who experience high levels of work-related stress and are thus particularly in need of recovery tend to struggle to switch-off. Due to the detrimental effects of this prolonged and sustained mental representation of job stressors, interventions promoting recovery may contribute to improvements in employees' mental health. Methods In this randomized, waitlist controlled trial, we will investigate the effectiveness of two 6-week online training programs (cognitive behavioral and mindfulness-based). The sample will include employees working at least part-time during regular work hours. Besides t...

Psychotherapy and Psychosomatics, 2020

Introduction: There is neither strong evidence on effective treatments for patients with chronic ... more Introduction: There is neither strong evidence on effective treatments for patients with chronic back pain (CBP) and depressive disorder nor sufficiently available mental health care offers. Objective: The aim is to assess the effectiveness of internet- and mobile-based interventions (IMI) as a scalable approach for treating depression in a routine care setting. Methods: This is an observer-masked, multicenter, pragmatic randomized controlled trial with a randomization ratio of 1:1.Patients with CBP and diagnosed depressive disorder (mild to moderate severity) were recruited from 82 orthopedic rehabilitation clinics across Germany. The intervention group (IG) received a guided depression IMI tailored to CBP next to treatment-as-usual (TAU; including medication), while the control group (CG) received TAU. The primary outcome was observer-masked clinician-rated Hamilton depression severity (9-week follow-up). The secondary outcomes were: further depression outcomes, pain-related outco...

BMC Public Health, 2020

Background While work-related rumination increases the risk of acute stressors developing into ch... more Background While work-related rumination increases the risk of acute stressors developing into chronic load reactions and adverse health, mental detachment has been suggested as a way to interrupt this chain. Despite the importance of mentally detaching from work during leisure time, workers seem to struggle to disengage and, instead, experience the constant mental representation of work-related stressors, regardless of their absence. Those who struggle with work-related rumination could benefit from an easy-access intervention that fosters mental detachment by promoting recreational activities. Especially during vacations, workers appear to naturally engage in sufficient recovery activities; however, this beneficial behaviour is not sustained. The smartphone app-based intervention “Holidaily” promotes recovery behaviour and, thus, mental detachment from work with the intension of extending the beneficial effects of workers’ vacations into their daily working life. Methods This rand...

Somnologie, 2020

ZusammenfassungDigital angebotene psychologische Interventionen gegen Schlafstörungen sind aktuel... more ZusammenfassungDigital angebotene psychologische Interventionen gegen Schlafstörungen sind aktuell ein sehr intensiv bearbeitetes Forschungsthema. In dieser Übersichtsarbeit werden Originalarbeiten und Metaanalysen zu diesem Thema zusammengefasst. Hierbei zeigt sich, dass die internetbasierte kognitive Verhaltenstherapie für Insomnie (KVT-I) bei Erwachsenen durchweg sehr effektiv ist mit allenfalls leicht geringeren Effektstärken als die gleiche Behandlung mit physischer Präsenz von Therapeuten und Patienten. Behandlungseffekte zeigen sich dabei auch für sekundäre Outcome-Parameter wie Depressivität, Angst, Fatigue und Lebensqualität. Hingegen lassen die Forschung zur Wirksamkeit der internetbasierten KVT‑I bei Erwachsenen mit komorbiden psychischen Störungen oder körperlichen Erkrankungen sowie die Forschung zur Frage, wieviel Therapeutenkontakt in die Behandlung integriert werden sollte, anscheinend noch keine abschließenden Antworten zu. In diesen Bereichen scheint weitere Forsch...