Project

Special Interest Group E-Health, German Psychological Society, Clinical Psychology Section

Goal: The E-Health interest group consists of clinical psychologists who, within the framework of their scientific and practical activities, deal with issues of digitisation in clinical psychology and psychotherapy.

E-Health: Technology-based and IT-supported psychological interventions for health promotion, prevention and therapy of mental disorders and physical diseases

The use of new media for diagnosis, health promotion and treatment of mental disorders and physical diseases represents an innovative way of further improving the quality of care in our health system. Research on Internet- and mobile-based interventions (IMIs), virtual realities and artificial-intelligent systems has been one of the most productive areas of research within psychotherapy research over the last decade. E-health approaches are being discussed as promising technology-based solutions for the expansion and optimization of health care services both at various stages of health promotion and treatment (education, prevention, diagnostics, treatment and relapse prevention) and in various counselling and treatment settings (outpatient, (partially) inpatient, BGM). IMIs refer to a heterogeneous field of measures ranging from therapeutically accompanied or unaccompanied self-help interventions, to interlinked online/offline offers ("blended therapy") and synchronous online-based intervention, e.g. via video conferencing. In addition to IMIs, the possibility of using virtual reality and artificial-intelligent systems will significantly change the (digitalised) healthcare of the future. There is now a very comprehensive evidence base on the effectiveness and cost-effectiveness of technology and IT-based intervention approaches in relation to a wide range of mental health problems and disorders, health behaviour and physical illnesses. Of particular importance here is not only the question of whether e-health offers are effective, but also why. In addition, the investigation of relevant subgroups with specific risk profiles and special treatment requirements is of great importance. An important milestone for the implementation of these digital interventions in our health care system will be to establish technical and organizational, as well as data protection, professional and social legal frameworks and quality criteria in order to ensure sufficient treatment safety. In the area of technology development, however, it is also necessary to address and critically question social and ethical aspects of the digitalization of our health care.

The aim of the interest group is

Networking and communication among members of the group with a research and/or practical focus on e-health.
To systematize the broad and heterogeneous field of psychological e-health interventions for the prevention and treatment of mental disorders and physical illnesses and for the improvement of health behaviour.
Dissemination of the group's comprehensive expertise in this field, e.g. within the framework of satellite symposia at congresses of neighbouring and complementary subjects, by issuing statements and participating in task forces, committees, etc. Supporting the translation of research results into care practice and in health care institutions as well as into education and training.
Establishment as a central contact for stakeholders (ministries, service providers, service providers, professional associations, patient representatives, etc.) in the field of digitisation in the health care system; representation of the department's interests in cooperation with other departments and societies.

Acquisition of new specialist group members through active dissemination of the comprehensive activities and the associated increased visibility of the specialist group and its activities.
Creation of a platform for the necessary interdisciplinary exchange with complementary specialist areas (e.g. computer science, media design, medicine, law, business administration and economics, public health and health care research, etc.)
Promotion of the development of quality criteria for research, intervention safety, indication and implementation of e-health interventions.

Founding members in alphabetical order: Harald Baumeister, Matthias Berking, David Ebert, Severin Hennemann, Gitta Jacob, Corinna Jacobi, Christine Knaevelsrud, Lena Krämer, Jiaxi Lin, Andreas Maercker, Andreas Mühlberger, Thomas Probst, Lasse Sander, Rüdiger Zwerenz.

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Claudia Mueller-Weinitschke
added a research item
Introduction Behavioural activation is a highly effective treatment for depression. However, there is considerable heterogeneity of interventions grouped under the term ‘behavioural activation’. A main reason for the heterogeneity is the lack of a unified theory in the intervention development: few of the established intervention manuals give a theoretical rationale for their intervention techniques. For the first time, this study will examine the effectiveness of a theory-based behavioural activation intervention ( InterAKTIV ) based on the Health Action Process Approach. The intervention is implemented online to ensure broad dissemination and standardisation. Methods and analysis In a two-arm randomised controlled trial, the effectiveness of a guided web-based behavioural activation intervention for people with depression will be evaluated. Participants are recruited via the print and online media of a large German healthcare insurance company. Individuals (age 18–65), who meet criteria for major depressive episode in a clinical interview and no exclusion criteria are eligible for inclusion. A target sample of 128 participants is randomly allocated to either the intervention group (immediate access to InterAKTIV ) or treatment as usual (access after follow-up assessment). The primary outcome of depressive symptom severity (Quick Inventory of Depressive Symptomatology Clinician Rating) and secondary outcomes, including behavioural activation, physical activity and motivational and volitional outcomes are assessed at baseline, post treatment and 6-month follow-up. Data will be analysed on an intention-to-treat basis with additional per-protocol analyses. Ethics and dissemination This trial is approved by the ethics committee of the Albert-Ludwigs-University of Freiburg (no.: 20-1045). All participants are required to submit their informed consent online before study inclusion. The results will be submitted for publication in a peer-reviewed journal and presented at conferences. Trial registration number This trial was registered in the German Clinical Trials Register (DRKS): DRKS00024349 (date of registration: 29 January 2021).
Lasse B. Sander
added a research item
The high global prevalence of depression, together with the recent acceleration of remote care owing to the COVID-19 pandemic, has prompted increased interest in the efficacy of digital interventions for the treatment of depression. We provide a summary of the latest evidence base for digital interventions in the treatment of depression based on the largest study sample to date. A systematic literature search identified 83 studies (N = 15,530) that randomly allocated participants to a digital intervention for depression versus an active or inactive control condition. Overall heterogeneity was very high (I2 = 84%). Using a random-effects multilevel metaregression model, we found a significant medium overall effect size of digital interventions compared with all control conditions (g = .52). Subgroup analyses revealed significant differences between interventions and different control conditions (WLC: g = .70; attention: g = .36; TAU: g = .31), significantly higher effect sizes in interventions that involved human therapeutic guidance (g = .63) compared with self-help interventions (g = .34), and significantly lower effect sizes for effectiveness trials (g = .30) compared with efficacy trials (g = .59). We found no significant difference in outcomes between smartphone-based apps and computer- and Internet-based interventions and no significant difference between human-guided digital interventions and face-to-face psychotherapy for depression, although the number of studies in both comparisons was low. Findings from the current meta-analysis provide evidence for the efficacy and effectiveness of digital interventions for the treatment of depression for a variety of populations. However, reported effect sizes may be exaggerated because of publication bias, and compliance with digital interventions outside of highly controlled settings remains a significant challenge. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
David Daniel Ebert
added 43 research items
Background: Frequent Cannabis use has been linked to a variety of negative mental, physical, and social consequences. We assessed the effects of digital prevention and treatment interventions on Cannabis use reduction in comparison with control conditions. Methods: Systematic review with two separate meta-analyses. Thirty randomized controlled trials met the inclusion criteria for the review, and 21 were included in the meta-analyses. Primary outcome was self-reported Cannabis use at post-treatment and follow-up. Hedges's g was calculated for all comparisons with non-active control. Risk of bias was examined with the Cochrane risk-of-bias tool. Results: The systematic review included 10 prevention interventions targeting 8138 participants (aged 12 to 20) and 20 treatment interventions targeting 5195 Cannabis users (aged 16 to 40). The meta-analyses showed significantly reduced Cannabis use at post-treatment in the prevention interventions (6 studies, N = 2564, g = 0.33; 95% CI 0.13 to 0.54, p = 0.001) and in the treatment interventions (17 comparisons, N = 3813, g = 0.12; 95% CI 0.02 to 0.22, p = 0.02) as compared with controls. The effects of prevention interventions were maintained at follow-ups of up to 12 months (5 comparisons, N = 2445, g = 0.22; 95% CI 0.12 to 0.33, p < 0.001) but were no longer statistically significant for treatment interventions. Conclusions: Digital prevention and treatment interventions showed small, significant reduction effects on Cannabis use in diverse target populations at post-treatment compared to controls. For prevention interventions, the post-treatment effects were maintained at follow-up up to 12 months later.
Introduction The college years are a peak period for the onset of common mental disorders. Poor mental health is associated with low academic attainment, physical, interpersonal and cognitive impairments. Universities can use online approaches to screen students for mental disorders and treat those in need. The present study aims to assess the effectiveness of a guided web-based transdiagnostic individually tailored intervention to treat students with symptoms of depression and/or anxiety. Methods and analysis The present study is a randomised controlled trial. Participants are Dutch college students (≥18 years) with mild to moderate depression and/or anxiety symptoms. The intervention is a guided web-based transdiagnostic individually tailored intervention that targets symptoms of depression and/or anxiety. The intervention consists of seven online sessions with a duration ranging from 4 to 7 weeks depending on individual progress. A booster session is administered 4 weeks after the completion of the seventh session. Primary outcome measures are the Patient Health Questionnaire for depression and the Generalised Anxiety Disorder 7-item scale for anxiety. These scales are administered at screening, post-treatment and follow-up assessments (6 and 12 months post-randomisation). E thics and dissemination The Medical Ethics Committee of the Vrije Universiteit Medical Centre has approved the protocol (registration number 2016.583, A2017.362andA2018.421). Results of the trial will be published in a peer-reviewed journal. Trial registration number NTR6797; Pre-results.
Chronic illnesses cause considerable burden in quality of life, often leading to physical, psychological and social dysfunctioning of the sufferers and their family. There is a growing need for flexible provision of home-based psychological services to increase reach even for traditionally underserved chronic illness sufferer populations. Digital interventions can fulfill this role and provide a range of psychological services to improve functioning. Despite the potential of digital interventions, concerns remain regarding users’ engagement, as low engagement is associated with low adherence rates, high attrition, and sub-optimal exposure to the intervention. Human-computer interaction (e.g., theoretical models of persuasive system design, gamification, tailoring and supportive accountability) and user characteristics (e.g., gender, age, computer literacy) are the main identified culprits contributing to engagement and adherence difficulties. To date there have not been any clear and concise recommendations for improved utilization and engagement in digital interventions. This paper provides an overview of user engagement factors, and proposes research informed recommendations for engagement and adherence planning in digital intervention development. The recommendations were derived from the literature and consensualized by expert members of the European Federation of Psychology Associations', Psychology and Health Standing Committee and e-Health Task Force. These recommendations serve as a starting point for researchers and clinicians interested in the digitalized health field and promotes effective planning for engagement when developing digital interventions with the potential to maximize adherence and optimal exposure in the treatment of chronic health conditions.
Raphael Schuster
added a research item
Background Sample size planning (SSP) is vital for efficient studies that yield reliable outcomes. Hence, guidelines, therefore, emphasize the importance of SSP. The present study investigates the practice of SSP in current trials for depression. Methods Seventy-eight RCTs published between 2013 and 2017 were examined. Impact of study design (e.g. number of randomized conditions) and study context (e.g. funding) on sample size was analyzed using multiple regression. Results Overall, sample size during pre-registration, during SSP, and in published articles was highly correlated (r’s≥0.887). Simultaneously, only 7–18% of explained variance related to study design (p=.055-.155). This proportion increased to 30–42% by adding study context (p=.002-.005). The median sample size was N=106, with higher numbers for Internet interventions (N=181; p=.021) compared to face-to-face therapy. 59% of studies included SSP, with 28% providing basic determinants and 8–10% providing information for comprehensible SSP. Expected effect sizes exhibited a sharp peak at d=0.5. Depending on the definition, 10.2%–20.4% implemented intense assessment to improve statistical power. Conclusions Findings suggest that investigators achieve their determined sample size and pre-registration rates are increasing. During study planning, however, study context appears more important than study design. Study context, therefore, needs to be emphasized in the present discussion, as it can help understand the relatively stable trial numbers of the past decades. Acknowledging this situation, indications exist that digital psychiatry (e.g. Internet interventions, or intense assessment) can help to mitigate the challenge of underpowered studies. The article includes a short guide for efficient study planning.
Sarah Paganini
added a research item
Die Kombination aus einer hohen Krankheitsbelastung, hohen Kosten sowie einer unzureichenden Versorgung von Personen mit (chronischen) Schmerzen stellt eine große Herausforderung für das Gesundheitssystem dar. Internet- und mobile-basierte Interventionen (IMI) bieten eine Chance, Barrieren in der Versorgung zu überwinden. Da die Bereitstellung von IMI unabhängig von Ort und Zeit erfolgen kann, können sie insbesondere für Personen, die aufgrund von Schmerzen mobilitätseingeschränkt sind, vorteilhaft sein. Der vorliegende Beitrag soll eine Einführung in den Gegenstandsbereich von IMI geben und aktuelle Erkenntnisse zur Wirksamkeit und Kosteneffektivität von IMI bei chronischen Schmerzen beschreiben. Darüber hinaus werden methodische Stärken, Schwächen und die Generalisierbarkeit der Ergebnisse diskutiert sowie Schlussfolgerungen für eine Implementierung von IMI in die Regelversorgung gezogen.
Lasse B. Sander
added a research item
b> 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 outcomes, health-related quality of life, and work capacity. Biostatistician blinded analyses using regression models were conducted by intention-to-treat and per protocol analysis. Results: Between October 2015 and July 2017, we randomly assigned 210 participants (IG, n = 105; CG, n = 105), mostly with only a mild pain intensity but substantial pain disability. No statistically significant difference in depression severity between IG and CG was observed at the 9-week follow-up (β = –0.19, 95% CI –0.43 to 0.05). Explorative secondary depression (4/9) and pain-related (4/6) outcomes were in part significant ( p < 0.05). Health-related quality of life was significantly higher in the IG. No differences were found in work capacity. Conclusion: The results indicate that an IMI for patients with CBP and depression in a routine care setting has limited impact on depression. Benefits in pain and health-related outcomes suggest that an IMI might still be a useful measure to improve routine care.
Ina Beintner
added a research item
Background: Adherence reflects the extent to which individuals experience or engage with the content of online interventions and poses a major challenge. Neglecting to examine and report adherence and its relation to outcomes can compromise the interpretation of research findings. Objective: The aim of this systematic review is to analyze how adherence is accounted for in publications and to propose standards for measuring and reporting adherence to online interventions. Methods: We performed a systematic review of randomized controlled trials on online interventions for the prevention and treatment of common mental disorders (depression, anxiety disorders, substance related disorders, and eating disorders) published between January 2006 and May 2018 and indexed in Medline and Web of Science. We included primary publications on manualized online treatments (more than 1 session and successive access to content) and examined how adherence was reported in these publications. Results: We identified 216 publications that met our inclusion criteria. Adherence was addressed in 85% of full-text manuscripts, but only in 31% of abstracts. A median of three usage metrics were reported; the most frequently reported usage metric (61%) was intervention completion. Manuscripts published in specialized electronic health journals more frequently included information on the relation of adherence and outcomes. Conclusions: We found substantial variety in the reporting of adherence and the usage metrics used to operationalize adherence. This limits the comparability of results and impedes the integration of findings from different studies. Based on our findings, we propose reporting standards for future publications on online interventions.
Raphael Schuster
added 2 research items
Objective: To examine immediate and long-term effectiveness of an adjunctive Internet intervention for depression in a large sample of patients undergoing routine psychotherapy. Method: The current study evaluated a subgroup of patients from the Evident trial, a randomized investigation of a 12-week minimally guided Internet intervention (Deprexis) in the treatment of mild to moderate depression. 340 adults (mean age = 43.3 years; 71.7 % female) of the original sample received routine outpatient psychotherapy during the trial period, resulting in a standard psychotherapy group (n = 174) and an augmented therapy group (n = 166). Outcomes were assessed at baseline, post-treatment and 6-month follow-up. Results: Intention-to-treat analyses indicated that combined treatment led to a greater reduction in symptoms of depression (effect size d = 0.32; p = .002), improved therapeutic progress (d = 0.36; p = .003), and higher mental health-related quality of life (d = 0.34; p = .004). There was no intervention effect on physical health-related quality of life. The same pattern was found at 6-month follow-up. Treatment success was independent from therapeutic orientation of combined face-to-face therapy. Median usage time of the adjunctive online intervention was 7.08 hours, indicating high patient engagement. Conclusion: Results indicate that the adjunctive use of the investigated intervention can produce additional and lasting effects in routine outpatient psychotherapy for mild to moderate levels of depression. The study adds to the ongoing literature on augmented effects of blended treatment. Future studies should investigate different types of blends in diverse populations by means of change-sensitive assessment strategies.
Therapists hold a key role for the uptake of digital mental health interventions (DMHI) within regular care services but have demonstrated cautious attitudes towards such interventions. It is relevant to explore in detail what factors may positively influence therapists' perception when considering DMHI implementation within routine care. We recently assessed therapist views towards Internet-based and blended treatment in Austria (low implementation level). The present study aims at testing the reliability of previous findings, and moreover, it compares therapists' appraisals to a country with advanced DMHI implementation (Sweden).An online survey was conducted February through June of 2019. Respondents were recruited via email and social media. The survey assessed first-hand experience with Internet-based treatment (IT) and blended treatment (BT). To start, the survey presented a short informational video to half of the respondents, then assessed therapists' views on 17 advantages and 13 disadvantages of IT and BT on 6-point Likert scales.In total N = 300 therapists responded to the invitation, of which N = 165 provided full survey data (Germany 114/220, 52%; Sweden 51/80, 64%). German therapists rated the advantages of IT and BT as neutral (IT, M = 3.6; BT, M = 3.8) and to some extent agreed with disadvantages of IT (IT, M = 4.5; BT, M = 3.5). In comparison, Swedish therapists rated significantly greater advantages (IT, M = 4.6; BT, M = 4.5) and less disadvantages (IT, M = 3.2; BT, M = 2.8). Effect sizes ranged from d = 0.89 to d = 1.83; all P's
Lasse B. Sander
added a research item
Internet-and mobile-based cognitive behavioral therapy (iCBT) might reduce suicidal ideation. However, recent meta-analyses found small effect sizes, and it remains unclear whether specific subgroups of participants experience beneficial or harmful effects. This is the study protocol for an individual participant meta-analysis (IPD-MA) aiming to determine the effectiveness of iCBT on suicidal ideation and identify moderators. We will systematically search CENTRAL, PsycINFO, Embase, and Pubmed for randomized controlled trials examining guided or self-guided iCBT for suicidality. All types of control conditions are eligible. Participants experiencing suicidal ideation will be included irrespective of age, diagnoses, or co-interventions. We will conduct a one-stage IPD-MA with suicidal ideation as the primary outcome, using a continuous measure, reliable improvement and deterioration, and response rate. Moderator analyses will be performed on participant-, study-, and intervention-level. Two independent reviewers will assess risk of bias and the quality of evidence using Cochrane's Risk of Bias Tool 2 and GRADE. This review was registered with OSF and is currently in progress. The IPD-MA will provide effect estimates while considering covariates and will offer novel insights into differential effects on a participant level. This will help to develop more effective, safe, and tailored digital treatment options for suicidal individuals.
Ingrid Titzler
added 5 research items
Background: Blended treatments, combining digital components with face-to-face (FTF) therapy, are starting to find their way into mental health care. Knowledge on how blended treatments should be set up is, however, still limited. To further explore and optimize blended treatment protocols, it is important to obtain a full picture of what actually happens during treatments when applied in routine mental health care. Objective: The aims of this study were to gain insight into the usage of the different components of a blended cognitive behavioral therapy (bCBT) for depression and reflect on actual engagement as compared with intended application, compare bCBT usage between primary and specialized care, and explore different usage patterns. Methods: Data used were collected from participants of the European Comparative Effectiveness Research on Internet-Based Depression Treatment project, a European multisite randomized controlled trial comparing bCBT with regular care for depression. Patients were recruited in primary and specialized routine mental health care settings between February 2015 and December 2017. Analyses were performed on the group of participants allocated to the bCBT condition who made use of the Moodbuster platform and for whom data from all blended components were available (n=200). Included patients were from Germany, Poland, the Netherlands, and France; 64.5% (129/200) were female and the average age was 42 years (range 18-74 years). Results: Overall, there was a large variability in the usage of the blended treatment. A clear distinction between care settings was observed, with longer treatment duration and more FTF sessions in specialized care and a more active and intensive usage of the Web-based component by the patients in primary care. Of the patients who started the bCBT, 89.5% (179/200) also continued with this treatment format. Treatment preference, educational level, and the number of comorbid disorders were associated with bCBT engagement. Conclusions: Blended treatments can be applied to a group of patients being treated for depression in routine mental health care. Rather than striving for an optimal blend, a more personalized blended care approach seems to be the most suitable. The next step is to gain more insight into the clinical and cost-effectiveness of blended treatments and to further facilitate uptake in routine mental health care.
Hintergrund: Blended Psychotherapy (bPT) ist ein Behandlungskonzept zur Integration von Internet-/Mobil-basierten Interventionen in die ambulante/stationäre Psychotherapie. Es kann den Therapieprozess bereichern, indem Online-basierte Behandlungselemente als verlängerter therapeutischer Arm genutzt und zwischen den Therapiesitzungen von PatientInnen zeit- und ortsunabhängig bearbeitet werden. Dadurch könnten die Effektivität von Psychotherapie potenziell verbessert oder mehr Therapieplätze durch die eingesparte Therapeutenzeit angeboten werden. Der Fallbericht soll ein Verständnis der Verzahnung der Behandlungselemente ermöglichen. Fallbericht: Die viermonatige Kurzzeit-Depressionsbehandlung einer 48-jährigen Patientin mit sechs Face-to-Face-Therapiesitzungen, sechs Online-Lektionen und App-Ratings wird nach den CARE-Richtlinien und auf Basis quantitativer und qualitativer Daten (Behandlungsdokumentation) dargestellt. Die depressive Sympto­matik reduzierte sich im Behandlungsverlauf klinisch signifikant (Patient Health Questionnaire [PHQ-9], 0–27: T0 = 17; T1 = 7) von einer mittel-schwergradigen zu einer subklinisch-milden Ausprägung und erfüllte im 12-Monats-Diagnostikinterview keine klinischen Diagnosekriterien. Die Patientin zeigte eine maximale Behandlungszufriedenheit (Fragebogen zur Patientenzufriedenheit [ZUF-8], 8–32: T1 = 32) sowie Adhärenz und bewertete die therapeutische Bezie­hung sehr positiv (Working Alliance Inventory [WAI], 12–60: T1 = 57). Schlussfolgerung: bPT war bei dieser Patientin ge­eignet, um depressive Symptome zu reduzieren. Stärken der Behandlung waren die gute Integrierbarkeit der Online-Behandlung in die Berufstätigkeit der Patientin und die Individualisierung in den Therapiegesprächen durch die Therapeutin. Die Vorgabe von sechs Therapiesitzungen schränkte den Behandlungserfolg insofern ein, dass nicht alle Behandlungsthemen therapeutisch bearbeitet und keine Rezidiv­prophylaxe durchgeführt werden konnten.
Introduction: High relapse rates in Major Depressive Disorder (MDD) indicate the need for interventions enhancing the sustainability of treatment outcomes. Primary aim of the present study was to evaluate the effectiveness of a text-message-based maintenance intervention for depression (TMMI-D). Additionally, we aimed to clarify whether the use of individualized messages would lead to better outcome than the use of standardized messages which focused upon adaptive ways of regulating undesired emotions. Methods: In this RCT, 226 individuals who had completed inpatient treatment for MDD were randomly allocated to a condition in which participants received TMMI-D with standardized messages targeting emotion regulation, or to a condition with individualized messages, or to a waitlist control condition. Primary outcome was depressive symptom severity assessed with the BDI-II. Results: Multilevel analyses suggest that participants receiving TIMMI-D with standardized messages reported a significantly smaller increase of depressive symptoms during the post-treatment and follow-up interval than did patients in the waitlist control condition. Contrastingly, there was no such effect for patients who had used TIMMI-D with individualized messages. Limitations: Limitations include proportions of missing data, thus, generalizing the findings of the present study might be an overestimation. Conclusion: Text-message-based interventions may help increase the sustainability of outcome after treatment for MDD. The unexpected superiority of the standardized over the individualized version is in line with research that points to the efficacy of interventions fostering adaptive emotion regulation as a means to treat depression (and other mental disorders).
Rüdiger Zwerenz
added 3 research items
Online interventions for the treatment of mental disorders and complaints: What are the current approaches, and how effective are they? Over the last number of years mental disorders have become the main reason for early retirement from gainful employment and one of the most frequent and enduring causes of incapacity for work. Due in part to problems in the provision of health care, online interventions have become increasingly important in the treatment of mental disorders. Despite the now considerable evidence of efficacy, however, in Germany – by comparison with the sometimes much more advanced trend in other countries (e.g. the Netherlands or the UK) – there are still some barriers (legal requirements, funding) to be met before online interventions become part of general health care provision. For mental disorders, online interventions offer a rich and important complement to care provision. However, they are no substitute for regular treatment, since the treatment of severe mental disease still requires the expertise of psychotherapists and personal contact.
Background: Mental disorders have become a major health issue, and a substantial number of afflicted individuals do not get appropriate treatment. Web-based interventions are promising supplementary tools for improving health care for patients with mental disorders, as they can be delivered at low costs and used independently of time and location. Although psychodynamic treatments are used frequently in the face-to-face setting, there has been a paucity of studies on psychodynamic Web-based self-help interventions. Objective: The objective of this study was to determine the feasibility and preliminary efficacy of a transdiagnostic affect-focused psychodynamic Web-based self-help intervention designed to increase emotional competence of patients with mental disorders. Methods: A total of 82 psychotherapy inpatients with mixed diagnoses were randomized into two groups. Following discharge, the intervention group (IG) got access to a guided version of the intervention for 10 weeks. After a waiting period of 10 weeks, the wait-list control group (WLCG) got access to an unguided version of the intervention. We reported the assessments at the beginning (T0) and at the end of the intervention, resp. the waiting period (T1). The primary outcome was satisfaction with the treatment at T1. Secondary outcome measures included emotional competence, depression, anxiety, and quality of life. Statistical analyses were performed with descriptive statistics (primary outcome) and analysis of covariance; a repeated measurement analysis of variance was used for the secondary outcomes. Effect sizes were calculated using Cohen d and data were analyzed as per protocol, as well as intention-to-treat (ITT). Results: Patients were chronically ill, diagnosed with multiple diagnoses, most frequently with depression (84%, 58/69), anxiety (68%, 47/69), personality disorder (38%, 26/69), and depersonalization-derealization disorder (22%, 15/69). A majority of the patients (86%, 36/42) logged into the program, of which 86% (31/36) completed the first unit. Satisfaction with the units mastered was rated as good (52%, 16/31) and very good (26%, 9/31). However, there was a steady decline of participation over the course of the program; only 36% of the participants (13/36) participated throughout the trial completing at least 50% of the sessions. According to the ITT analysis, participants improved statistically significantly and with moderate effect sizes (Cohen d) compared with the WLCG regarding depression (d=0.60), quality of life (d=0.53), and emotional competence (d=0.49). Effects were considerably stronger for the completers with respect to depression (d=1.33), quality of life (d=0.83), emotional competence (d=0.68), and general anxiety (d=0.62). Conclusions: Although overall program satisfaction and benefit of the program were favorable with respect to the indicators of emotional disorders, the rate of completion was low. Our findings point to the need to target the intervention more specifically to the needs and capabilities of participants and to the context of the intervention. Trial registration: Clinicaltrials.gov NCT02671929; https://clinicaltrials.gov/ct2/show/NCT02671929 (Archived by WebCite at http://www.webcitation.org/6ntWg1yWb).
Background: Depression is one of the most frequent and costly mental disorders. While there is increasing evidence for the efficacy of online self-help to improve depression or prevent relapse, there is little evidence in blended care settings, especially combined with inpatient face-to-face psychotherapy. Therefore, we evaluated whether an evidence-based online self-help program improves the efficacy of inpatient psychotherapy. Methods: A total of 229 depressed patients were randomly allocated either to an online self-help program (intervention group [IG]; Deprexis) or an active control group (CG; weekly online information on depression) in addition to inpatient psychodynamic psychotherapy. Both groups had access to their respective experimental intervention for 12 weeks, regardless of inpatient treatment duration. Reduction of depressive symptoms, as measured with the Beck Depression Inventory-II, was the primary outcome at the end of the intervention (T2). Results: Depressive symptoms were statistically significantly lower in the IG compared to the active CG at T2 with a moderate between-group effect size of d = 0.44. The same applied to anxiety (d = 0.33), quality of life (d = 0.34), and self-esteem (d = 0.38) at discharge from inpatient treatment (T1). No statistically significant differences were found regarding dysfunctional attitudes (d = 0.14) and work ability (d = 0.08) at T1. Conclusions: This is the first evidence for blended treatment combining online self-help with inpatient psychotherapy. The study opens new and promising avenues for increasing the efficacy of inpatient psychotherapy. Future studies should determine how integration of online self-help into the therapeutic process can be developed further.
Rüdiger Zwerenz
added 7 research items
Background: We recently showed in a randomized controlled trial that Web-based self-help as an adjunct improved the effectiveness of multimodal inpatient psychotherapy for depression. Objective: The aims of this study were (1) to determine whether a Web-based self-help adjunctive to multimodal inpatient psychotherapeutic treatment could also improve the course of depressive symptoms and (2) to identify predictors of residual depressive symptoms at follow-up. Methods: Overall, 229 patients were randomized either to the Web-based self-help intervention group (Deprexis) or an active control group (Web-based information about depression and depressive symptoms) in addition to multimodal inpatient psychotherapy. Participants in both groups were able to access their respective Web-based programs for 12 weeks, which meant that they typically had access after discharge from the inpatient unit (mean hospitalization duration: 40 days, T1). Follow-up was performed 6 months after study intake (T3). Results: At follow-up, participants of the Web-based self-help group had considerably lower symptom load regarding depressive symptoms (d=0.58) and anxiety (d=0.46) as well as a better quality of life (d=0.43) and self-esteem (d=0.31) than participants of the control group. Nearly 3 times as many participants of the intervention group compared with the control group achieved remission in accordance with less deterioration. The number needed to treat based on the Beck Depression Inventory-II (BDI-II) improved over time (T1: 7.84, T2: 7.09, and T3: 5.12). Significant outcome predictors were BDI at discharge and treatment group. Conclusions: Web-based self-help as an add-on to multimodal inpatient psychotherapy improved the short-term course of depressive symptoms beyond termination. Residual symptoms at discharge from inpatient treatment and utilization of the Web-based self-help were the major predictors of depressive symptoms at follow-up. Challenges and barriers (eg, costs, therapists' concerns, or technical barriers) of adding Web-based interventions to inpatient treatment have to be addressed. Trial registration: ClinicalTrials.gov NCT02196896; https://clinicaltrials.gov/ct2/show/NCT02196896.
Fragestellung: Nachdem die therapeutische Allianz als Wirkfaktor für die Face-to-Face Psychotherapie anerkannt ist, untersuchten wir erstmals Ausprägung, Einflussgrößen und Zusammenhang der therapeutischen Allianz mit dem Therapieerfolg bei einer psychodynamischen Online-Nachsorge. Methode: 165 Teilnehmer einer Online-Nachsorge mit therapeutisch begleiteter Schreibintervention nach dem Modell der „Supportiv-Expressiven Therapie“ (SET) schätzten neben körperlichen und psychischen Beschwerden im Verlauf auch die therapeutische Allianz ein. Ergebnisse: Die therapeutische Allianz wurde von den Teilnehmern mit M = 4,47 (SD = 0,85) signifikant höher eingeschätzt als von den Therapeuten mit M = 4,07 (SD = 0.96) und nahm mit der Zahl geschriebener Blogs sowie in der Patienteneinschätzung auch mit dem Behandlungserfolg zu. Diskussion: Es kann von einer guten therapeutischen Beziehung im Online-Setting ausgegangen werden. Die therapeutische Anleitung war bezüglich des zeitlichen Aufwands durchaus mit einer ambulanten Psychotherapie vergleichbar mit dem Unterschied, dass die Kommuni-kation nicht mit einem direkten Gegenüber und asynchron ablief. Weitere Studien sind erforderlich, um die spezifischen Merkmale der Allianz von Online-Interventionen zu untersuchen. Ärztliche Psychotherapie 2018; 13(4): 247-253
Personality Assessment in Online Psychotherapy Research Abstract: The number of evidence-based online psychotherapeutic interventions has been increasing in recent years. This raises the question whether personality traits have an impact on the use and success of online interventions. Initial findings indicate that broad (e. g. openness to experiences, conscientiousness) and narrow personality traits (e. g. attitude towards online psychotherapeutic interventions) are relevant predictors. Despite limited data for differential effects in clinical samples, personality traits represent an important source of effective, tailored psychotherapy, given the variety of online psychotherapeutic interventions for different psychological disorders. From a methodological point of view, online psychotherapy research enables multimodal assessment and aggregation of different data sources. This allows a reliable and valid assessment of personality and its facets. Keywords: personality assessment, personality, psychotherapy, e-mental health, online psychotherapeutic interventions
Helen Niemeyer
added 11 research items
Introduction As a consequence of sepsis and intensive care, considerable proportions of patients but also of their spouses develop a post-traumatic stress disorder (PTSD). However, only a very small number receive psychotherapeutic treatment. Internet-based cognitive–behavioural writing therapy (IB-CBWT) has proven to be an effective treatment option for PTSD. It seems to fit the specific needs of this cohort and to overcome treatment barriers. Aim of the REPAIR trial is to examine the efficacy, safety and applicability of IB-CBWT for PTSD in patients and their spouses after intensive care for sepsis. Methods and analysis Participants will be assigned randomly either to a treatment or a wait-list (WL) control group. The treatment group receives IB-CBWT for PTSD, actively involving the partners of the participants. IB-CBWT will be guided by a therapist and comprises two written assignments per week over a 5 week period. After completing the assignments, the participants obtain individual responses from the therapist. Participants of the WL control group will receive treatment after a waiting period of 5 weeks. The primary outcome is PTSD symptom severity in self-rated PTSD Checklist for Diagnostic and Statistical Manual Fifth Edition at the end of treatment and waiting time, respectively. Secondary outcomes are remission of PTSD, depression, anxiety, and somatisation measured by the Brief Symptom Inventory-18, marital satisfaction measured by the Relationship Assessment Scale, health-related quality of life measured by the EQ-5D-5L, and the feasibility of IB-CBWT for this cohort (ie, dropout rate). Statistical analysis will be performed according to the intent-to-treat principle. Ethics and dissemination The study is conducted according to the principles of Good Clinical Practice and has been approved by the ethics committee of the Friedrich-Schiller University Jena, Germany. Results will be disseminated at scientific conferences, published in peer-reviewed journals, and provided to consumers of healthcare. Trial registration number Pre-results, DRKS00010676.
Background: Oxytocin might promote favorable psychotherapy outcomes by strengthening the therapeutic alliance. Its involvement in psychotherapeutic processes, especially regarding the therapeutic alliance, needs further investigation. Patients and Methods: Blood oxytocin of 35 male German Armed Forces service members who were seeking treatment for posttraumatic stress disorder (PTSD) was analyzed before the onset of a 5-week internet-based, trauma-focused psychotherapy. We investigated whether oxytocin influenced patients’ ratings of the therapeutic alliance components “agreement on collaboration” and “emotional bond,” assessed during and after treatment. We further explored oxytocin’s impact on general change mechanisms of psychotherapy and on psychotherapy expectation and evaluation. Results: Oxytocin had no significant impact on early agreement on collaboration, which significantly predicted psychotherapy outcome. Early emotional bond was not predicted by oxytocin and was not predictive for psychotherapy outcome. Descriptive analyses showed that patients with higher pretreatment oxytocin concentrations provided higher ratings of general change mechanisms of psychotherapy. On a descriptive level, the associations between psychotherapy expectation and evaluation and oxytocin were mixed. Discussion and Conclusion: We found positive effects of higher pretreatment oxytocin concentrations in PTSD patients. This descriptive study is limited by its small sample size and needs replication in larger, independent samples. However, results indicate possible benefits of oxytocin on trauma-focused psychotherapy.
Lasse B. Sander
added 12 research items
Guided Internet- and mobile-based interventions (IMIs) are an effective and scientifically sound treatment option for depression. Meta-analyses revealed effect sizes comparable to those found for face-to-face treatment as well as pharmacotherapy. Today, most IMIs are based on cognitive behavioral therapy (CBT). While IMIs are well established in healthcare systems of many countries worldwide, Germany is still lagging behind. However, there are an increasing number of model projects trying to implement IMIs into routine healthcare for depression in Germany. Both, service providers and recipients would benefit from transparent quality assurance and data safety guidelines. © Georg Thieme Verlag KG Stuttgart · New York.
Background: Persons with chronic pain can be treated effectively with acceptance and commitment therapy (ACT). In this trial, we examined the effectiveness of guided and unguided ACT-based online treatment (ACTonPain) for chronic pain patients. Methods: 302 individuals were randomly assigned to ACTonPain with or without guidance (n = 100/101) or to a waiting-list control group (n=101). The primary outcome was pain interference as measured by the Multidimensional Pain Inventory. The secondary outcomes were physical and emotional functioning, pain intensity, ACT process variables, quality of life, satisfaction with the intervention, adherence, and participants' rating of overall improvement. The online measurements were carried out before randomization (T0) and 9 weeks and 6 months after randomization (T1 and T2, respectively). Intention-to-treat (ITT) data analysis was supplemented with additional per-protocol analyses. Results: The guided ACTonPain group showed significantly less pain interference than the control group in the ITT analysis (p = 0.01), with a moderate effect size at T1 and T2 (d = 0.58 respectively), corresponding to a number needed to treat (NNT) of 3.14 for both time points. Participants in the guided ACTonPain group also indicated higher pain acceptance (T1: d = 0.59; T2: d = 0.76). The unguided ACTonPain group showed to be significantly less depressed in comparison to the control group at at time T2 (d = 0.50). No significant differences with respect to effectiveness were found between the two ACTonPain groups (p>0.05). Conclusion: The online intervention ACTonPain is effective for persons with chronic pain when the program is guided. Further research in a variety of settings of health care is needed in order to determine whether and how ACTonPain can be implemented.
Background : Approximately 4.9 million individuals in Germany are affected by depression. Depression causes high personal and social burdens. Apps may improve health care in this field. In this systematic review, the quality, content, and practical relevance of German-language depression apps are assessed. Methods: A systematic search for apps explicitly targeting depression was conducted in the German app stores of Google Play and iTunes. The quality of the identified apps was rated by 2 independent researchers by means of a scale for the quality assessment of apps (Mobile Application Rating Scale). Apps that were found to be of high quality were evaluated by 2 practicing psychotherapists regarding their practical relevance. Results: 38 out of 1,156 identified depression apps were included in the study. Their content ranged from basic information to specific interventions. The overall quality was average (M = 3.01, standard deviation = 0.56). Four high-quality apps were identified. They were evaluated by 2 psychotherapists and recommended with reservations for practical use. No effectiveness study was found for any app included. Conclusions: Depression apps available in German showed an average quality. There is a general lack of evidence. The identified apps can only be recommended with reservations. A quality seal could help by marking high-quality apps with practically relevant contents. Thereby, users could be protected from misinformation and abuse, and therapists would be able to facilitate the use of digital media more easily. Zusammenfassung Hintergrund: In Deutschland sind etwa 4,9 Millionen Menschen an Depressionen erkrankt. Depressionen sind für die Betroffenen und die Gesellschaft mit enormen Belastungen verbunden. Gesundheits-Apps haben hier das Potenzial, die Versorgungslage zu verbessern. Das Ziel dieser systematischen Übersichtsarbeit ist es, die Qualität, Inhalte und Praxisrelevanz von deutschsprachigen Apps für die Anwendung bei Depressionen zu untersuchen. Methode: Die deutschen Google-Play- und iTunes-Stores wurden systematisch nach Apps durchsucht, die explizit mit der Thematik «Depression/Depressivität» warben. Die so ermittelten Apps wurden mithilfe einer Skala zur Einschätzung der Qualität (Mobile Application Rating Scale) von 2 unabhängigen Gutachtern bewertet. Apps mit überdurchschnittlichem Rating wurden von 2 praktisch tätigen Verhaltenstherapeuten im Hinblick auf ihren Nutzen für die klinische Praxis beurteilt. Ergebnisse: Von 1156 identifizierten Apps wurden 38 eingeschlossen. Inhaltlich reichten diese von Informations- bis zu Interventions- Apps. Die Apps wiesen eine mittlere Gesamtqualität auf (M = 3,01; Standardabweichung = 0,56). Vier Apps zeigten überdurchschnittliche Werte. Sie wurden durch 2 Psychotherapeuten getestet und als bedingt empfehlenswert für die klinische Praxis beurteilt. Zu keiner der eingeschlossenen Apps konnte eine Wirksamkeitsstudie gefunden werden. Schlussfolgerungen: Deutschsprachige Depressions-Apps weisen qualitative Mängel auf. Zusätzlich fehlt es an klinischen Studien zum Nutzen und zu Risiken, weshalb der Einsatz in der klinischen Praxis nur bedingt empfohlen werden kann. Ein Gütesiegel für qualitativ hochwertige und praxisrelevante Gesundheits-Apps könnte Nutzer vor Fehlinformationen und Missbrauch schützen und Leistungserbringern den Einsatz digitaler Medien substanziell erleichtern.
Lasse B. Sander
added an update
Hallo zusammen,
ich würde nochmal den Anlauf probieren um das 'RG Projekt' unserer Interessengruppe zu schärfen. Wer dem Projekt folgt oder mir per RG eine Nachricht zukommen lässt, den würde ich als Projektteilnehmer adden. Wer neue Artikel publiziert kann als Projekt gerne zusätzlich die Interessengruppe angeben - so bekommen wir etwas stärker mit, was die anderen Mitglieder unserer Interessengruppe forschen.
Liebe Grüße
Lasse
 
Lasse B. Sander
added a research item
Importance Depression is a frequent comorbid condition in patients with persistent back pain and is associated with substantial adverse consequences, including the risk of developing opioid use disorders. Shifting the focus from depression treatment to preventing depression might be a viable way to reduce the disease burden. Objective To evaluate the effectiveness of a web-based self-help intervention to reduce the incidence of major depressive episode (MDE) in patients with persistent back pain. Design, Setting, and Participants Prevention of Depression in Back Pain Patients (PROD-BP) was a pragmatic, observer-blinded randomized clinical trial with a parallel design conducted in Germany. Eligible adults with a diagnosis of persistent back pain and subclinical depressive symptoms, but who were depression free, were recruited either on-site or after discharge from 82 orthopedic clinics between October 1, 2015, and July 31, 2017. All analyses were conducted according to the intention-to-treat principle from October 31, 2018, to April 30, 2019. Interventions The intervention group received an e-coach–guided, web-based self-help intervention that was based on cognitive behavioral therapy and tailored to the needs of patients with persistent back pain. The intervention included 6 obligatory modules and 3 optional modules to be completed by participants as well as feedback from e-coaches. Both the intervention and control groups had unrestricted access to treatment as usual. Main Outcomes and Measures Primary outcome was time to onset of an MDE over a 12-month period as assessed by blinded diagnostic raters using the Structured Clinical Interview for DSM-5. Secondary outcomes included depression severity, quality of life, pain intensity, pain-related disability, pain self-efficacy, work capacity, and user satisfaction assessed with a variety of instruments. Results A total of 295 participants (mean [SD] age, 52.8 [7.7] years; 184 women [62.4%]) were recruited and randomized to either the intervention group (n = 149) or control group (n = 146). The intervention reduced the risk of MDE onset by 52% (hazard ratio, 0.48; 95% CI, 0.28-0.81; P < .001). Twenty-one participants (14.1%) in the intervention group and 41 participants (28.1%) in the control group experienced an MDE over the 12-month period. The number needed to treat to prevent 1 new case of MDE was 2.84 (95% CI, 1.79-9.44). Conclusions and Relevance Results of this trial showed that among patients with persistent back pain, depression can be prevented by a guided web-based self-help intervention in addition to treatment as usual. This finding suggests that using a scalable digital approach to integrate psychological treatment into routine pain management is feasible. Trial Registration German Clinical Trials Register Identifier: DRKS00007960.
Lasse B. Sander
added a research item
Nahezu sämtliche Bereiche des gesellschaftlichen Lebens sind von einer Welle der Digitalisierung betroffen. So auch unser Gesundheitssystem und mit diesem die psychotherapeutische Behandlung. Internet- und mobilbasierte Interventionen (IMI) können die reguläre psychotherapeutische Behandlung ergänzen und ihre Möglichkeiten erweitern. Gleichzeitig haben IMI das Potenzial, bislang unversorgte Menschen zu erreichen und können auf diese Weise eine Brücke in die reguläre psychotherapeutische Versorgung bauen (Paganini, Lin, Ebert & Baumeister, 2016; Rogers, Lemmen, Kramer, Mann & Chopra, 2017; Titov et al., 2019). Digitalisierung darf allerdings nicht als Selbstzweck verstanden werden und viele Produkte entsprechen nicht den notwendigen Standards bezogen auf Qualität, Wirksamkeit, Patientensicherheit und Datenschutz (Huckvale, Torous & Larsen, 2019). Gleichzeitig wirkt die große Menge an täglich neuen Entwicklungen verunsichernd und überfordernd auf Psychotherapeut*innen und Ärzt*innen, die teils offen gegenüber einer Optimierung ihrer Behandlung durch den Einsatz von digitalen Medien sind (Paul, Grünzig, Baumeister, Bengel & Krämer, 2019). Dieser Artikel gibt einen Überblick über das weite Feld von E-Mental-Health und zeigt Potenziale und Risiken auf. Psychotherapie Aktuell: 12. Jahrgang, Ausgabe 1.20 : www.dptv.de
Lasse B. Sander
added a project goal
The E-Health interest group consists of clinical psychologists who, within the framework of their scientific and practical activities, deal with issues of digitisation in clinical psychology and psychotherapy.
E-Health: Technology-based and IT-supported psychological interventions for health promotion, prevention and therapy of mental disorders and physical diseases
The use of new media for diagnosis, health promotion and treatment of mental disorders and physical diseases represents an innovative way of further improving the quality of care in our health system. Research on Internet- and mobile-based interventions (IMIs), virtual realities and artificial-intelligent systems has been one of the most productive areas of research within psychotherapy research over the last decade. E-health approaches are being discussed as promising technology-based solutions for the expansion and optimization of health care services both at various stages of health promotion and treatment (education, prevention, diagnostics, treatment and relapse prevention) and in various counselling and treatment settings (outpatient, (partially) inpatient, BGM). IMIs refer to a heterogeneous field of measures ranging from therapeutically accompanied or unaccompanied self-help interventions, to interlinked online/offline offers ("blended therapy") and synchronous online-based intervention, e.g. via video conferencing. In addition to IMIs, the possibility of using virtual reality and artificial-intelligent systems will significantly change the (digitalised) healthcare of the future. There is now a very comprehensive evidence base on the effectiveness and cost-effectiveness of technology and IT-based intervention approaches in relation to a wide range of mental health problems and disorders, health behaviour and physical illnesses. Of particular importance here is not only the question of whether e-health offers are effective, but also why. In addition, the investigation of relevant subgroups with specific risk profiles and special treatment requirements is of great importance. An important milestone for the implementation of these digital interventions in our health care system will be to establish technical and organizational, as well as data protection, professional and social legal frameworks and quality criteria in order to ensure sufficient treatment safety. In the area of technology development, however, it is also necessary to address and critically question social and ethical aspects of the digitalization of our health care.
The aim of the interest group is
Networking and communication among members of the group with a research and/or practical focus on e-health.
To systematize the broad and heterogeneous field of psychological e-health interventions for the prevention and treatment of mental disorders and physical illnesses and for the improvement of health behaviour.
Dissemination of the group's comprehensive expertise in this field, e.g. within the framework of satellite symposia at congresses of neighbouring and complementary subjects, by issuing statements and participating in task forces, committees, etc. Supporting the translation of research results into care practice and in health care institutions as well as into education and training.
Establishment as a central contact for stakeholders (ministries, service providers, service providers, professional associations, patient representatives, etc.) in the field of digitisation in the health care system; representation of the department's interests in cooperation with other departments and societies.
Acquisition of new specialist group members through active dissemination of the comprehensive activities and the associated increased visibility of the specialist group and its activities.
Creation of a platform for the necessary interdisciplinary exchange with complementary specialist areas (e.g. computer science, media design, medicine, law, business administration and economics, public health and health care research, etc.)
Promotion of the development of quality criteria for research, intervention safety, indication and implementation of e-health interventions.
Founding members in alphabetical order: Harald Baumeister, Matthias Berking, David Ebert, Severin Hennemann, Gitta Jacob, Corinna Jacobi, Christine Knaevelsrud, Lena Krämer, Jiaxi Lin, Andreas Maercker, Andreas Mühlberger, Thomas Probst, Lasse Sander, Rüdiger Zwerenz.