T. Bär

Charité Universitätsmedizin Berlin, Berlín, Berlin, Germany

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Publications (13)48.91 Total impact

  • Michael Linden · Doris Zubrägel · Thomas Bär
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    ABSTRACT: Cognitive-behaviour therapy (CBT) is efficacious in reducing symptoms of generalized anxiety disorders (GAD). The question is whether it is also efficient, i.e., whether there are also enduring effects with respect to improving utilization of medication and psychotherapy, or occupational functioning and sick leave after the end of treatment. The study was based on 44 outpatients (age 18-65 years; HAM-A score ≥18; GAD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria as assessed by standardized interview) who were treated with 25 sessions of CBT (treatment by 12 state-licensed behaviour therapists in office-based practice; no psychotropic treatment for the duration of the therapy). The rate of medication treatment, occupational functioning and sick leave was assessed for 8 months before and after the end of treatment. In the comparison of the pre-treatment and post-treatment periods, 46.5% versus 7.2% of patients used psychotropic medication for at least 4 weeks and had been 3.1 versus 1.1 days on sickness absence per month, respectively. About 70% of patients showed impairment in occupational role performance during the pre-treatment phase compared with 5% to 20%, depending on the dimension, in the follow-up period. The data suggest that CBT is not only efficacious in terms of symptom reduction but also efficient in terms of reducing inappropriate medication intake and improving occupational functioning.
    No preview · Article · May 2011 · Clinical Psychology & Psychotherapy
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    ABSTRACT: The therapeutic alliance is seen as an important dimension in any type of psychotherapy. But patient, therapist, or observers can have different views on the therapeutic alliance. The question is which perspective best represents the therapeutic alliance, and what are the differences between these alternative views. In the present study, the therapist–patient alliance (TPA, the view of the therapist), patient–therapist alliance (PTA, the view of the patient), and mutual therapeutic alliance (MTA, the view of an observer) were measured simultaneously in cognitive behavior therapy of patients suffering from generalized anxiety disorder. Additionally, the concordance between patient and therapist ratings (TPC) was calculated. Cognitive behavior therapists attained high positive scores in all perspectives for all dimensions of the therapeutic alliance, such as empathy, cooperation, transparency, focusing, and assurance of progress. Correlations were consistently higher for ratings between therapist and patient than between observer and patient. A relation with outcome (Hamilton Anxiety Scale) was only found for observer ratings. It was concluded that cognitive behavior therapists can achieve good alliances with their patients. Different perspectives on the therapeutic alliance should be distinguished and taken into account separately in studies on the therapeutic process and outcome.
    No preview · Article · Feb 2008 · Journal of Cognitive Psychotherapy
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    ABSTRACT: Generalized anxiety disorder (GAD) is a chronic stress disease with permanent physical tension and cognitive strain. Raised nerve growth factor (NGF) serum levels were reported as an acute stress reaction in soldiers before their first parachute jump even before the rise in cortisol. Taking GAD as a clinical model of chronic stress, we measured NGF in the serum of 22 patients with GAD before and after cognitive-behavioural therapy (CBT) and compared them to those of healthy normal controls. Treatment response was tested by the values of the State and Trait of Anxiety Inventory (STAI) and the Hamilton Anxiety Scale (HAM-A) as treatment outcome variables. The NGF values of patients and controls were similar at baseline (p=0.8941); however, with successful treatment, corresponding to a mean reduction in the HAM-A by more than 50% and a reduction in the clinical global impression scale (CGI) median from 4 to 1, the patients' NGF serum concentrations rose significantly (p=0.0006) which might correspond to an altered stress reaction, possibly contributing to good therapeutic response with CBT. There were 3 patients with a HAM-A decrease of less than 15%. In those patients NGF rose only marginally. Hence, the increase in serum NGF seems to indicate good treatment response.
    No preview · Article · Feb 2007 · Progress in Neuro-Psychopharmacology and Biological Psychiatry
  • M. Linden · M. Staats · T. Bär · D. Zubrägel
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    ABSTRACT: A new method of how to assess treatment strategy is presented. In a controlled clinical trial of cognitive–behavioral therapy (CBT) for generalized anxiety disorder (GAD), 12 therapists and 30 patients were asked, after each of 25 sessions, to write down what they viewed to be the most important topic of that particular session. A content analytic scheme for the classification of answers was developed and has good interrater reliability. In the initial sessions therapists focused on building a working alliance and on behavior analysis. They then progressed to psychoeducation and cognitive restructuring and coping. This sequence is paralleled by pivotal topics reported by the patients. At the beginning of treatment, patients placed greatest importance on the opportunity to talk, then realized that gaining insight and coping with anxiety were the central foci of treatment, and finally found that it required changing thoughts and learning competencies and self-confidence. Therapist and patient answers reflect central features of CBT for GAD in both content and sequence. Because similar topics are first mentioned by therapists and at a later point by patients, the assumption that the therapists lead the treatment process is supported. The Pivotal Topic Measure can be seen as a new way of assessing treatment strategy.
    No preview · Article · Oct 2005 · Psychotherapy Research
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    ABSTRACT: Generalized anxiety disorders (GAD) are amongst the most prevalent mental disorders. Recent studies have suggested that cognitive behaviour therapy (CBT) is an effective treatment for GAD. A controlled clinical trial was done to evaluate the efficacy of CBT treatment in outpatients with pure GAD who were treated by a therapist working in routine care. Seventy-two outpatients, fulfilling GAD criteria according to DSM-IV, were included in the study. From this group, 36 patients (CBT-A) were randomly assigned to 25 sessions of CBT and the other 36 formed a contact control group (CCG). After the contact control period (CC period), these patients were also treated with CBT (CBT-B), allowing not only a parallel group comparison but also an A-B comparison. Therapists were licensed full-time psychologists who worked routinely in outpatient care and had a professional training in CBT. Treatment was done in accordance with a manual, and treatment conformity was controlled by several methods. The reduction in the score on the Hamilton Anxiety Observer Rating Scale was 6.4% (1.5 points) in the CCG, 35.4% (9.5 points) in the CBT-A and 47.3% (10.3 points) in the CBT-B. In the self-rating Spielberger State-Trait Anxiety Inventory, a reduction of 2.7% was seen in CCG, 14.6% in CBT-A, and 11.6% in CBT-B. According to the Clinical Global Impression Rating, 65.6% of patients were still at least moderately ill at the end of the CC period, while this rate was 33.4% at the end of CBT-A, or 15.7% at the end of CBT-B. All these differences between treatment and control group are statistically highly significant. The clinical improvement remained stable over a follow-up period of 8 months. CBT is an effective method of treatment for GAD. Differences between control and treatment group are comparable to or larger than those reported in studies on antidepressant drugs.
    No preview · Article · Feb 2005 · Psychotherapy and Psychosomatics
  • Michael Linden · Thomas Bär · Hanfried Helmchen
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    ABSTRACT: The aim of this epidemiological study is to examine the prevalence and correlates of psychotropic drug use in the very old and to evaluate the appropriateness of psychotropic drug use in very old age. Data from the Berlin Aging Study (BASE), a multidisciplinary study of an age- and gender-stratified, randomly selected sample of elderly people living in Berlin are presented. Over-sampling, especially very old men, allows for powerful analyses of this population. All participants went through extensive psychiatric and somatic examinations. Medication intake was assessed by different data sources (interviewing patients and their family physicians, drug inspection at home). Results were brought together in a consensus-conference and research physicians gave operationalized ratings of medication appropriateness. The prevalence of elderly people who were taking at least one psychotropic medication within the 14 days immediately preceding investigation was 29.8%. Of these medications, 68.4% had been taken for longer than one year. There was no effect of age or gender on the scope of psychotropic drug use. Benzodiazepines were taken by 19.8% of the elderly. Antidepressants, neuroleptics and anti-dementia drugs were taken by about 3-4% each. People taking psychotropic drugs had significantly higher levels of psychiatric morbidity, as measured by syndromes and specified diagnoses. Psychotropic drugs were significantly less often judged to be indicated than somatic medications. This is mostly due to benzodiazepines. Psychotropic drug use is common in old age, but there is no additional increase in usage beyond the age of 70. Intake of psychotropics is mostly oriented at symptoms or syndromes, which explains why benzodiazepines are still the most commonly prescribed psychotropics.
    No preview · Article · Jan 2005 · International Psychogeriatrics
  • M Linden · T Bär · D Zubrägel

    No preview · Article · Jun 2004 · Journal of Psychosomatic Research
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    ABSTRACT: Current pathophysiological concepts of generalized anxiety disorder (GAD) assume a disturbed exteroceptive sensory system. Furthermore, central serotonergic neurotransmission has been shown to play an important role in anxiety disorder. Cortical signal processing as measured by auditory evoked potentials (AEPs) may reflect the integrity of the exteroceptive sensory system. Because a special aspect of AEP, the loudness dependence of the N1/P2-component (LD), has been related to central serotonergic activity, the LD may be useful for investigating serotonergic dysfunctions in GAD. The LD was recorded in 31 medication-free patients with GAD without any psychiatric co-morbidity and in 31 matched control subjects. Dipole source analysis was performed to separate the LD of regions including the primary (LD-tangential dipole) and regions including the secondary auditory cortex (LD-radial dipole). A shallower LD-tangential was observed in patients with GAD as compared to healthy control subjects [F(1,60) = 6.727, p =.012; one-way analysis of variance]. The LD-radial showed no differences between groups. Severity of the anxiety symptoms was not related to the LDs. The results indicate an altered exteroceptive sensory system in GAD occurring at the level of the primary but not secondary auditory cortex. Because a shallow LD of the primary auditory cortex was related to a high firing rate of neurons in the dorsal raphe nucleus, the results may support evidence for an enhanced serotonergic activity in GAD.
    Full-text · Article · Mar 2003 · Biological Psychiatry
  • M. Staats · T. Bär · M. Linden
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    ABSTRACT: Measurements of Therapist Compliance in Behaviour Therapy The assessment of therapist compliance or treatment integrity is of great importance for the validity of psychotherapy studies. Therapist compliance can be defined as the degree to which therapist behaviour complies with treatment standards. By the development of psychotherapy manuals which describe the interventions, techniques and strategies of a given treatment, measurement of therapist compliance has become possible. This article gives an overview of compliance scales in behaviour therapy and their use in therapy outcome studies. Limitations in the use of the scales are described and future developments discussed.
    No preview · Article · Jan 2003 · Verhaltenstherapie
  • M. Linden · T. Bär

    No preview · Article · Nov 1998 · European Neuropsychopharmacology
  • M Linden · T Bär · B Geiselmann
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    ABSTRACT: Long-term low-dosage dependence on benzodiazepines in traditionally explained by withdrawal symptoms. Previous research has not given much attention to reports that suggest that many patients oppose stopping benzodiazepines long before withdrawal symptoms have developed. This study investigates the scope of and factors associated with this pre-withdrawal treatment insistence. Patients receiving long-term low-dosage benzodiazepines in primary care were asked to take a drug-holiday of at least 3 weeks. Sociodemographic, medication, morbidity and attitudinal variables were assessed in addition to the GPs' perceptions of their patients. Two-thirds of the patients rejected the drug-holiday proposal. Patients who refused a drug-holiday were less educated and were using a higher percentage of long-acting benzodiazepines than patients who accepted the drug-holiday proposal. Those who refused were seen by their GPs as being more complaining, harder to satisfy and less co-operative. These results provide evidence for drug-seeking or craving behaviour of patients who receive low-dosage benzodiazepine prescriptions. A major problem in benzodiazepine withdrawal occurs before the withdrawal programme has even begun. These data show that benzodiazepine low-dosage dependence should be considered a real form of dependence.
    No preview · Article · Jun 1998 · Psychological Medicine
  • T.  BÄR  · B.  GEISELMANN 
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    ABSTRACT: Background. Long-term low-dosage dependence on benzodiazepines is traditionally explained by withdrawal symptoms. Previous research has not given much attention to reports that suggest that many patients oppose stopping benzodiazepines long before withdrawal symptoms have developed. This study investigates the scope of and factors associated with this pre-withdrawal treatment insistence.
    No preview · Article · Apr 1998 · Psychological Medicine

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