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BACKGROUND: Patients with depersonalization disorder (DPD) typically complain about emotional detachment. Previous studies found reduced autonomic responsiveness to emotional stimuli for DPD patients as compared to patients with anxiety disorders. We aimed to investigate autonomic responsiveness to emotional auditory stimuli of DPD patients as compared to patient controls. Furthermore, we examined the modulatory effect of mindful breathing on these responses as well as on depersonalization intensity. METHODS: 22 DPD patients and 15 patient controls balanced for severity of depression and anxiety, age, sex and education, were compared regarding 1) electrodermal and heart rate data during a resting period, and 2) autonomic responses and cognitive appraisal of standardized acoustic affective stimuli in two conditions (normal listening and mindful breathing). RESULTS: DPD patients rated the emotional sounds as significantly more neutral as compared to patient controls and standardized norm ratings. At the same time, however, they responded more strongly to acoustic emotional stimuli and their electrodermal response pattern was more modulated by valence and arousal as compared to patient controls. Mindful breathing reduced severity of depersonalization in DPD patients and increased the arousal modulation of electrodermal responses in the whole sample. Finally, DPD patients showed an increased electrodermal lability in the rest period as compared to patient controls. CONCLUSIONS: These findings demonstrated that the cognitive evaluation of emotional sounds in DPD patients is disconnected from their autonomic responses to those emotional stimuli. The increased electrodermal lability in DPD may reflect increased introversion and cognitive control of emotional impulses. The findings have important psychotherapeutic implications.

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OBJECTIVE: The German Version of the Emotion Regulation Questionnaire (ERQ) has recently been published. The questionnaire investigates two common emotion regulation strategies (10 items) on two scales (suppression, reappraisal). Major aims of the study were to assess the reliability and factor structure of the ERQ, to determine population based norms and to investigate relations of suppression and reappraisal to anxiety, depression and demographic characteristics. METHODS: In a representative community study (N=2524) we assessed emotion regulation strategies, anxiety, depression (Hospital Anxiety and Depression Scale), and demographic variables. The mean age of the participants was 49.4 (SD 18.2) years. 55.5% were female. The age-groups were represented in comparable proportions. The representativeness of the sample was ensured by drawings of ADM (Arbeitskreis Deutscher Marktforscher) samples und by comparison with the data of German Federal Statistical Office. RESULTS: Confirmatory factor analysis could not fully confirm the original factor structure, we kept the original scaling, except a modification regarding item 8. Internal consistencies were acceptable for the original and the modified version: reappraisal (Cronbach's alpha = 0.82) and suppression (alpha = 0.76). Norms are presented as percentile scores for age groups and gender. Reappraisal correlated negative with anxiety and depression, whereas we could find a positive relationship of suppression with anxiety and depression. In a linear regression model suppression was predicted by depression, a lower level of education, male gender, and lower income. CONCLUSIONS: The ERQ is a short instrument to assess emotion regulation strategies economically, e.g. in larger community based studies. We could demonstrate sufficient psychometric properties of the German version of the ERQ: reliability, factor structure and indicators for construct validity. Because of the cross sectional character of our study it remains unclear whether reappraisal is protective and suppression is unfavourable regarding mental health or whether life circumstances and psychic symptoms lead to a suppression of emotions.

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BACKGROUND: Psychodynamic psychotherapy is frequently applied in the treatment of social phobia. Nevertheless, there has been a lack of studies on the transfer of manualized treatments to routine psychodynamic practice. Our study is the first one to examine the effects of additional training in a manualized Short Term Psychodynamic Psychotherapy (STPP) procedure on outcome in routine psychotherapy for social phobia. This study is an extension to a large multi-site RCT (N = 512) comparing the efficacy of STPP to Cognitive-Behavioral Therapy (CBT) of Social Phobia. METHODS/DESIGN: The manualized treatment is designed for a time limited approach with 25 individual sessions of STPP over 6 months. Private practitioners will be randomized to training in manualized STPP vs. treatment as usual without a specific training (control condition). We plan to enrol a total of 105 patients (84 completers). Assessments will be conducted before treatment starts, after 8 and 15 weeks, after 25 treatment sessions, at the end of treatment, 6 months and 12 months after termination of treatment. The primary outcome measure is the Liebowitz Social Anxiety Scale. Remission from social phobia is defined scoring with 30 or less points on this scale. DISCUSSION: We will investigate how the treatment can be transferred from a controlled trial into the less structured setting of routine clinical care. This question represents Phase IV of psychotherapy research. It combines the benefits of randomized controlled and naturalistic research. The study is genuinely designed to promote faster and more widespread dissemination of effective interventions. It will answer the questions whether manualized STPP can be implemented into routine outpatient care, whether the new methods improve treatment courses and outcomes and whether treatment effects reached in routine psychotherapeutic treatments are comparable to those of the controlled, strictly manualized treatment of the main study. TRIAL REGISTRATION: German Clinical Trials Register (DRKS) DRKS00000570.

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