Roland Vauth | University of Basel, University Hospital (original) (raw)
Papers by Roland Vauth
Reproduktionsmedizin, 1999
Zusammenfassung Angesichts großer Erfolge in der medikamentösen Behandlung der erektilen Dysfun... more Zusammenfassung Angesichts großer Erfolge in der medikamentösen Behandlung der erektilen Dysfunktion haben psychotherapeutische Interventionen in letzter Zeit wenig Aufmerksamkeit erhalten. Doch ist bei Erektionsstörungen als psycho-physisches Gesamtgeschehen auch die Kenntnis psychologischer Faktoren für eine erfolgreiche Behandlung nötig. Die vorliegende Arbeit stellt grundlegende ätiologische Konzepte psychogener Erektionsstörungen vor, erläutert die psychologische Diagnostik und die gängigen Modelle für Sexualberatung und Sexualtherapie. Schließlich
Psychotherapie in der Psychiatrie, 1997
Zeitschrift für ärztliche Fortbildung
In this paper, our experience with training courses for quality circle moderators is reported. Ba... more In this paper, our experience with training courses for quality circle moderators is reported. Basic principles of the peer review method in general and the specific model of the topic-oriented quality circle approach in the ambulatory care in Sudbaden is described. Peer review in quality circle groups demands specific participants' skills. Thus, training courses for quality circle leaders have been set up to prepare moderators for their task. Attention is given to the goals and contents of training courses for physicians. Key elements are the supervisory role of the moderator and specific tasks in handling the group dicussions. Evaluation questionnaires after the courses showed that the participants (n = 41) judged the programme very positively.
The role of sildenafil in the treatment of erectile dysfunction is discussed. Especially in prima... more The role of sildenafil in the treatment of erectile dysfunction is discussed. Especially in primary care there is a necessity to weigh the individual cost-benefit-ratio. Functional analysis of erectile dysfunction, exclusion of psychiatric and organic comorbidity, identification of sexual deviance and couple counseling about the advantages and disadvantages of sildenafil prescription are the core prerequisites of sildenafil application in primary care. The counseling model of PLIS-SIT is proposed as a guideline for counseling process. Current approaches of education for general practitioners are reviewed and the integration in a recently developed training for management of psychiatry and psychosomatic illness in general medical settings is proposed. Finally open questions for research and quality management are discussed.
The Journal of nervous and mental disease, 2014
Lack of insight is a major target in the treatment of schizophrenia. However, insight may have un... more Lack of insight is a major target in the treatment of schizophrenia. However, insight may have undesirable effects on self-concept and motivation that can hinder recovery. This study aimed to examine the link between insight, self-stigma, and demoralization as predictors of symptoms and functioning. Insight, self-stigma, depressive and psychotic symptoms, and functioning were assessed among 133 outpatients with schizophrenia at baseline and 12 months later. The data were analyzed by hierarchical multiple linear regressions. More insight at baseline and an increase in self-stigma over 12 months predicted more demoralization at follow-up. Insight at baseline was not associated with any outcome variable, but self-stigma at baseline was related to poorer functioning and more positive symptoms at follow-up. More demoralization at baseline predicted poorer functioning 12 months later. Demoralization did not mediate the relationship between self-stigma at baseline and functioning after 1 y...
Schizophrenia bulletin, 2005
Cognitive dysfunctions and negative symptoms are "rate-limiting factors" for community ... more Cognitive dysfunctions and negative symptoms are "rate-limiting factors" for community outcome and response to psychosocial intervention in people with schizophrenia. Therefore, two cognitive-behavioral group therapies were developed-computer-assisted cognitive strategy training (CAST) and training of self-management skills for negative symptoms (TSSN)-to target these barriers to rehabilitation readiness. One hundred thirty-eight DSM-IV schizophrenia inpatients on a rehabilitation ward were randomly assigned to CAST plus vocational rehabilitation, TSSN plus vocational rehabilitation, or vocational rehabilitation alone. CAST included computer-based training in coping strategies focusing on deficits in attention, verbal memory, and planning. TSSN focused on social withdrawal/social anhedonia, lack of drive/volition, and affect flattening using techniques such as time scheduling, mastery, and pleasure techniques. Treatment outcome was assessed at intake and at discharge after...
Psychiatry research, Jan 30, 2004
Research on barriers to treatment and rehabilitation readiness in people with schizophrenia, espe... more Research on barriers to treatment and rehabilitation readiness in people with schizophrenia, especially focusing on risk factors of poor outcome in social and vocational functioning, has focused on the role of social cognition and neurocognition. Others have hypothesized that social cognition (i.e., encoding and understanding of social cues guided by social schemas or scripts) may be one mediator between basic neurocognition and functional outcome. Our study analyzes data from 133 DSM-IV schizophrenic inpatients on a rehabilitation ward using structural equation modeling (SEM) to test whether social cognition has a stronger and more direct influence on vocational functioning than nonsocial cognition. The results supported the hypothesized model; that is, 25% of work-related social skills could be explained by social cognition and nonsocial cognition. The direct impact of nonsocial cognition on vocational functioning was smaller than the impact of social cognition on work-related soc...
Der Nervenarzt, 2000
A critical review of current approaches and principles of cognitive remediation strategies in reh... more A critical review of current approaches and principles of cognitive remediation strategies in rehabilitation of schizophrenia is given. Selection of cognitive functions targeted in compensatory training programs could be based on results of neuropsychological predictor research on social and vocational functioning in community and neuropsychological rate limiting factors in rehabilitation. Methodological flaws in data base, missing of task analysis of more complex skills like social perception, social skills and interpersonal problem solving and the lack of evaluation of training generalization on work performance are discussed. Finally the cognitive remediation program developed in the Department of General Psychiatry and Psychotherapy/University of Freiburg, Germany is proposed. The components focused on training in attention, memory, and executive function (decision making, planning). Compensatory strategy building, and computer-mediated automatization are integrated in a group s...
Regulating Emotions, 2008
The different social factors and underlying neurobiological mechanisms that may influence and com... more The different social factors and underlying neurobiological mechanisms that may influence and compromise an effective regulation of emotion have a direct relevance for many clinical fields of application. Severe mental disorders such as schizophrenia, for example, are typically ...
Qualitätszirkel erfolgreich gestalten, 1998
Psychiatry Research, 2004
Understanding the factors that impede and promote adherence by people with schizophrenia to neuro... more Understanding the factors that impede and promote adherence by people with schizophrenia to neuroleptic medication is important for treatment planning and relapse prevention. A total of 184 DSM-IV schizophrenia inpatients were examined with the Rating of Medication Influences (ROMI) scale within a context of inpatient vocational rehabilitation. Confirmatory factor analysis was used to evaluate the underlying dimensions of compliance behavior. The three-dimensional model of Weiden and his associates was confirmed by this study; specific factors included influence of others, medication affinity, and prevention. Additional analyses examined cognitive variables, symptoms, and course variables as predictors of individual factors. Verbal memory and cognitive flexibility were found to be associated with influence of others. Possible consequences for designing compliance enhancing therapeutic interventions are discussed.
Psychiatrische Praxis, 2007
Assessing attachment style in people with schizophrenia may be important to identify a risk facto... more Assessing attachment style in people with schizophrenia may be important to identify a risk factor in building a strong therapeutic relationship and so indirectly to understand the development of mal-compliance as one of the major obstacles in the treatment of schizophrenia. The present study analysed the psychometric properties of the German version of the Psychosis Attachment Measure (PAM), which assesses avoidant and anxious attachment style. A sample of 127 patients suffering from chronic schizophrenia or schizoaffective disorder participated in this study. In testing discriminant validity, we assessed psychopathology, depression, therapeutic relationship and service engagement. Internal consistency, test-retest reliability and factor structure were analysed. The German version of PAM exhibited acceptable to good internal and test-retest reliabilities and the two-factor structure of the English version could be replicated. Avoidant attachment style was related to higher levels of positive symptoms and to a poorer therapeutic relationship. In the context of external validation, a regression analysis revealed that a poor therapeutic relationship correlated with avoidant attachment style, independent of anxious attachment style and depressive symptoms. Anxious attachment was associated with higher treatment adherence. Both insecure attachment styles (avoidant and anxious) were found to be correlated with higher levels of depression, but only attachment anxiety had an independent predictive value for self-reported depression in regression analysis. The German version of PAM displayed satisfactory psychometric properties and seems to be a reliable measure for assessing attachment style in individuals with schizophrenia. Validation of PAM led to the finding that only the avoidant attachment style might be a risk factor when building a strong therapeutic relationship in schizophrenia. In future studies, other factors influencing therapeutic relationship should be taken into account. Anxious attachment style may be a risk factor for depression, but it also has an enhancing effect on treatment adherence.
Journal of Mental Health, Oct 1, 2008
ABSTRACT Background: The stigma of mental illness has been shown to be a barrier to recovery in s... more ABSTRACT Background: The stigma of mental illness has been shown to be a barrier to recovery in schizophrenia. Aims: The present study aimed to examine the influence of perceived stigma on self-efficacy and the coping styles of secrecy and withdrawal over and above selected sociodemographic and clinical variables and psychopathology. Method: Outpatients diagnosed with schizophrenia (N = 127) filled in measures of perceived stigma, secrecy and withdrawal as coping modi, positive and negative symptom severity, self-efficacy, depression and insight into psychosis. Results: Perceived stigma accounted for a significant amount of variance in secrecy and withdrawal, as well as low self-efficacy, over and above the amount of variance explained by positive and negative symptomatology, depression, insight, age and gender. Conclusion: Our findings demonstrate the negative influence of stigma perceived by persons with schizophrenia on self-efficacy and coping. Clinicians should offer guidance in functional coping with perceived stigma in order to reduce the effect of stigma on patients' lives.
Der Nervenarzt, Dec 1, 2006
Psychiatry Research, Feb 28, 2007
The concept of internalized stigma or self-stigma is central to the understanding of the psycholo... more The concept of internalized stigma or self-stigma is central to the understanding of the psychological harm caused by stigma. In this study, we aim to demonstrate how the evaluative dimension of self-concept (self-efficacy and empowerment) mediates the psychological effects of self-stigmatizing and coping with stigma. As important examples of psychological effects, depression and quality of life were focussed on. In 172 outpatients with DSM-IV schizophrenia, measures of self-stigma and devaluation, coping with stigma, self-efficacy, empowerment, quality of life and depression were assessed. It was hypothesized that withdrawal and secrecy as important coping strategies yielded to higher levels of anticipatory anxiety of future stigmatizing. Higher levels of perceived discrimination and devaluation were hypothesised to undermine self-efficacy and illness-related empowerment. Lowering of empowerment was supposed to enhance depression and reduce quality of life. This hypothesis was tested by Structural Equation Modeling as a method of data analysis. The results supported the hypothesized model; i.e., 46% of depression and 58% of quality of life reduction could be explained by eroded empowerment. Moreover, 51% of the empowerment reduction was explained by reduction in self-efficacy at a more general level by dysfunctional coping and higher levels of anticipated stigma. Taken together, our data suggest an avoidant coping style as a risk factor for anticipatory stigma, which erodes self-efficacy and empowerment. These data have implications for cognitive behavioral approaches, which should focus on anticipated stigma to improve recovery in schizophrenia.
Journal of Clinical Psychology, Feb 13, 2012
The Journal of Nervous and Mental Disease, 2012
Attitudes toward medication are important predictors of medication adherence in schizophrenia. Ho... more Attitudes toward medication are important predictors of medication adherence in schizophrenia. However, monitoring their strength and influence in clinical settings is challenged by the absence of assessments separating them from adherence and subjective response and distinguishing between attitudes toward pharmacotherapy in general and antipsychotic medications. This study examined the applicability of the Beliefs about Medication Questionnaire (BMQ) in outpatients with schizophrenia (N = 131). Confirmatory factor analysis (CFA) could not support the original four-factor structure. A subsequent exploratory factor analysis revealed the factors Antipsychotics Necessity, Antipsychotics Concern, and Pharmacotherapy Distrust were supported by an acceptable fit of a completing CFA. These subscales have satisfactory internal reliability, test-retest reliability, and local fit indices. Modest correlations with insight and illness perception indicate construct validity. Criterion validity was supported by a significantly higher medication adherence of accepting patients compared with skeptical patients. The BMQ is a psychometrically sound and valid measure of attitudes toward medication in outpatients with schizophrenia.
Reproduktionsmedizin, 1999
Zusammenfassung Angesichts großer Erfolge in der medikamentösen Behandlung der erektilen Dysfun... more Zusammenfassung Angesichts großer Erfolge in der medikamentösen Behandlung der erektilen Dysfunktion haben psychotherapeutische Interventionen in letzter Zeit wenig Aufmerksamkeit erhalten. Doch ist bei Erektionsstörungen als psycho-physisches Gesamtgeschehen auch die Kenntnis psychologischer Faktoren für eine erfolgreiche Behandlung nötig. Die vorliegende Arbeit stellt grundlegende ätiologische Konzepte psychogener Erektionsstörungen vor, erläutert die psychologische Diagnostik und die gängigen Modelle für Sexualberatung und Sexualtherapie. Schließlich
Psychotherapie in der Psychiatrie, 1997
Zeitschrift für ärztliche Fortbildung
In this paper, our experience with training courses for quality circle moderators is reported. Ba... more In this paper, our experience with training courses for quality circle moderators is reported. Basic principles of the peer review method in general and the specific model of the topic-oriented quality circle approach in the ambulatory care in Sudbaden is described. Peer review in quality circle groups demands specific participants' skills. Thus, training courses for quality circle leaders have been set up to prepare moderators for their task. Attention is given to the goals and contents of training courses for physicians. Key elements are the supervisory role of the moderator and specific tasks in handling the group dicussions. Evaluation questionnaires after the courses showed that the participants (n = 41) judged the programme very positively.
The role of sildenafil in the treatment of erectile dysfunction is discussed. Especially in prima... more The role of sildenafil in the treatment of erectile dysfunction is discussed. Especially in primary care there is a necessity to weigh the individual cost-benefit-ratio. Functional analysis of erectile dysfunction, exclusion of psychiatric and organic comorbidity, identification of sexual deviance and couple counseling about the advantages and disadvantages of sildenafil prescription are the core prerequisites of sildenafil application in primary care. The counseling model of PLIS-SIT is proposed as a guideline for counseling process. Current approaches of education for general practitioners are reviewed and the integration in a recently developed training for management of psychiatry and psychosomatic illness in general medical settings is proposed. Finally open questions for research and quality management are discussed.
The Journal of nervous and mental disease, 2014
Lack of insight is a major target in the treatment of schizophrenia. However, insight may have un... more Lack of insight is a major target in the treatment of schizophrenia. However, insight may have undesirable effects on self-concept and motivation that can hinder recovery. This study aimed to examine the link between insight, self-stigma, and demoralization as predictors of symptoms and functioning. Insight, self-stigma, depressive and psychotic symptoms, and functioning were assessed among 133 outpatients with schizophrenia at baseline and 12 months later. The data were analyzed by hierarchical multiple linear regressions. More insight at baseline and an increase in self-stigma over 12 months predicted more demoralization at follow-up. Insight at baseline was not associated with any outcome variable, but self-stigma at baseline was related to poorer functioning and more positive symptoms at follow-up. More demoralization at baseline predicted poorer functioning 12 months later. Demoralization did not mediate the relationship between self-stigma at baseline and functioning after 1 y...
Schizophrenia bulletin, 2005
Cognitive dysfunctions and negative symptoms are "rate-limiting factors" for community ... more Cognitive dysfunctions and negative symptoms are "rate-limiting factors" for community outcome and response to psychosocial intervention in people with schizophrenia. Therefore, two cognitive-behavioral group therapies were developed-computer-assisted cognitive strategy training (CAST) and training of self-management skills for negative symptoms (TSSN)-to target these barriers to rehabilitation readiness. One hundred thirty-eight DSM-IV schizophrenia inpatients on a rehabilitation ward were randomly assigned to CAST plus vocational rehabilitation, TSSN plus vocational rehabilitation, or vocational rehabilitation alone. CAST included computer-based training in coping strategies focusing on deficits in attention, verbal memory, and planning. TSSN focused on social withdrawal/social anhedonia, lack of drive/volition, and affect flattening using techniques such as time scheduling, mastery, and pleasure techniques. Treatment outcome was assessed at intake and at discharge after...
Psychiatry research, Jan 30, 2004
Research on barriers to treatment and rehabilitation readiness in people with schizophrenia, espe... more Research on barriers to treatment and rehabilitation readiness in people with schizophrenia, especially focusing on risk factors of poor outcome in social and vocational functioning, has focused on the role of social cognition and neurocognition. Others have hypothesized that social cognition (i.e., encoding and understanding of social cues guided by social schemas or scripts) may be one mediator between basic neurocognition and functional outcome. Our study analyzes data from 133 DSM-IV schizophrenic inpatients on a rehabilitation ward using structural equation modeling (SEM) to test whether social cognition has a stronger and more direct influence on vocational functioning than nonsocial cognition. The results supported the hypothesized model; that is, 25% of work-related social skills could be explained by social cognition and nonsocial cognition. The direct impact of nonsocial cognition on vocational functioning was smaller than the impact of social cognition on work-related soc...
Der Nervenarzt, 2000
A critical review of current approaches and principles of cognitive remediation strategies in reh... more A critical review of current approaches and principles of cognitive remediation strategies in rehabilitation of schizophrenia is given. Selection of cognitive functions targeted in compensatory training programs could be based on results of neuropsychological predictor research on social and vocational functioning in community and neuropsychological rate limiting factors in rehabilitation. Methodological flaws in data base, missing of task analysis of more complex skills like social perception, social skills and interpersonal problem solving and the lack of evaluation of training generalization on work performance are discussed. Finally the cognitive remediation program developed in the Department of General Psychiatry and Psychotherapy/University of Freiburg, Germany is proposed. The components focused on training in attention, memory, and executive function (decision making, planning). Compensatory strategy building, and computer-mediated automatization are integrated in a group s...
Regulating Emotions, 2008
The different social factors and underlying neurobiological mechanisms that may influence and com... more The different social factors and underlying neurobiological mechanisms that may influence and compromise an effective regulation of emotion have a direct relevance for many clinical fields of application. Severe mental disorders such as schizophrenia, for example, are typically ...
Qualitätszirkel erfolgreich gestalten, 1998
Psychiatry Research, 2004
Understanding the factors that impede and promote adherence by people with schizophrenia to neuro... more Understanding the factors that impede and promote adherence by people with schizophrenia to neuroleptic medication is important for treatment planning and relapse prevention. A total of 184 DSM-IV schizophrenia inpatients were examined with the Rating of Medication Influences (ROMI) scale within a context of inpatient vocational rehabilitation. Confirmatory factor analysis was used to evaluate the underlying dimensions of compliance behavior. The three-dimensional model of Weiden and his associates was confirmed by this study; specific factors included influence of others, medication affinity, and prevention. Additional analyses examined cognitive variables, symptoms, and course variables as predictors of individual factors. Verbal memory and cognitive flexibility were found to be associated with influence of others. Possible consequences for designing compliance enhancing therapeutic interventions are discussed.
Psychiatrische Praxis, 2007
Assessing attachment style in people with schizophrenia may be important to identify a risk facto... more Assessing attachment style in people with schizophrenia may be important to identify a risk factor in building a strong therapeutic relationship and so indirectly to understand the development of mal-compliance as one of the major obstacles in the treatment of schizophrenia. The present study analysed the psychometric properties of the German version of the Psychosis Attachment Measure (PAM), which assesses avoidant and anxious attachment style. A sample of 127 patients suffering from chronic schizophrenia or schizoaffective disorder participated in this study. In testing discriminant validity, we assessed psychopathology, depression, therapeutic relationship and service engagement. Internal consistency, test-retest reliability and factor structure were analysed. The German version of PAM exhibited acceptable to good internal and test-retest reliabilities and the two-factor structure of the English version could be replicated. Avoidant attachment style was related to higher levels of positive symptoms and to a poorer therapeutic relationship. In the context of external validation, a regression analysis revealed that a poor therapeutic relationship correlated with avoidant attachment style, independent of anxious attachment style and depressive symptoms. Anxious attachment was associated with higher treatment adherence. Both insecure attachment styles (avoidant and anxious) were found to be correlated with higher levels of depression, but only attachment anxiety had an independent predictive value for self-reported depression in regression analysis. The German version of PAM displayed satisfactory psychometric properties and seems to be a reliable measure for assessing attachment style in individuals with schizophrenia. Validation of PAM led to the finding that only the avoidant attachment style might be a risk factor when building a strong therapeutic relationship in schizophrenia. In future studies, other factors influencing therapeutic relationship should be taken into account. Anxious attachment style may be a risk factor for depression, but it also has an enhancing effect on treatment adherence.
Journal of Mental Health, Oct 1, 2008
ABSTRACT Background: The stigma of mental illness has been shown to be a barrier to recovery in s... more ABSTRACT Background: The stigma of mental illness has been shown to be a barrier to recovery in schizophrenia. Aims: The present study aimed to examine the influence of perceived stigma on self-efficacy and the coping styles of secrecy and withdrawal over and above selected sociodemographic and clinical variables and psychopathology. Method: Outpatients diagnosed with schizophrenia (N = 127) filled in measures of perceived stigma, secrecy and withdrawal as coping modi, positive and negative symptom severity, self-efficacy, depression and insight into psychosis. Results: Perceived stigma accounted for a significant amount of variance in secrecy and withdrawal, as well as low self-efficacy, over and above the amount of variance explained by positive and negative symptomatology, depression, insight, age and gender. Conclusion: Our findings demonstrate the negative influence of stigma perceived by persons with schizophrenia on self-efficacy and coping. Clinicians should offer guidance in functional coping with perceived stigma in order to reduce the effect of stigma on patients' lives.
Der Nervenarzt, Dec 1, 2006
Psychiatry Research, Feb 28, 2007
The concept of internalized stigma or self-stigma is central to the understanding of the psycholo... more The concept of internalized stigma or self-stigma is central to the understanding of the psychological harm caused by stigma. In this study, we aim to demonstrate how the evaluative dimension of self-concept (self-efficacy and empowerment) mediates the psychological effects of self-stigmatizing and coping with stigma. As important examples of psychological effects, depression and quality of life were focussed on. In 172 outpatients with DSM-IV schizophrenia, measures of self-stigma and devaluation, coping with stigma, self-efficacy, empowerment, quality of life and depression were assessed. It was hypothesized that withdrawal and secrecy as important coping strategies yielded to higher levels of anticipatory anxiety of future stigmatizing. Higher levels of perceived discrimination and devaluation were hypothesised to undermine self-efficacy and illness-related empowerment. Lowering of empowerment was supposed to enhance depression and reduce quality of life. This hypothesis was tested by Structural Equation Modeling as a method of data analysis. The results supported the hypothesized model; i.e., 46% of depression and 58% of quality of life reduction could be explained by eroded empowerment. Moreover, 51% of the empowerment reduction was explained by reduction in self-efficacy at a more general level by dysfunctional coping and higher levels of anticipated stigma. Taken together, our data suggest an avoidant coping style as a risk factor for anticipatory stigma, which erodes self-efficacy and empowerment. These data have implications for cognitive behavioral approaches, which should focus on anticipated stigma to improve recovery in schizophrenia.
Journal of Clinical Psychology, Feb 13, 2012
The Journal of Nervous and Mental Disease, 2012
Attitudes toward medication are important predictors of medication adherence in schizophrenia. Ho... more Attitudes toward medication are important predictors of medication adherence in schizophrenia. However, monitoring their strength and influence in clinical settings is challenged by the absence of assessments separating them from adherence and subjective response and distinguishing between attitudes toward pharmacotherapy in general and antipsychotic medications. This study examined the applicability of the Beliefs about Medication Questionnaire (BMQ) in outpatients with schizophrenia (N = 131). Confirmatory factor analysis (CFA) could not support the original four-factor structure. A subsequent exploratory factor analysis revealed the factors Antipsychotics Necessity, Antipsychotics Concern, and Pharmacotherapy Distrust were supported by an acceptable fit of a completing CFA. These subscales have satisfactory internal reliability, test-retest reliability, and local fit indices. Modest correlations with insight and illness perception indicate construct validity. Criterion validity was supported by a significantly higher medication adherence of accepting patients compared with skeptical patients. The BMQ is a psychometrically sound and valid measure of attitudes toward medication in outpatients with schizophrenia.