»Reliable, valid and efficient diagnostics are major tools for successful interventions.«

Ruth von Brachel

Diagnostic assessments for children, adolescents and adults

A major challenge for life-span research is valid age-appropriate assessment of mental health and disorders as well as their underlying mechanisms. Over the years the FBZ team has developed and tested diagnostic materials. These instruments are regularly adapted to current classification systems and tested in large populations for their test criteria. In addition, acceptance and barriers for the use of standardized diagnostics are tested in survey and experimental studies. Research into the causes of misdiagnosis and the promotion of reliable and valid diagnostics of mental disorders are central aims of the research of this working group.

Interviews for mental disorders

Diagnostics is an essential part of the daily practice of clinical psychologists, which involves many hurdles and challenges. The successful treatment of each patient depends on the "correct" diagnosis and thus on the appropriate classification of the mental disorder. The aim of the working group is to make criteria-based and reliable diagnoses with the help of structured interviews and thus to optimize the care of children, adolescents and adults in the long term.

Learning Diagnostic Skills Online (Diagnostik Skills online lernen – DiSkO)

Clinical psychologists give diagnoses to their patients everyday and these diagnoses determine if and how these patients will be treated. Misdiagnoses can have severely adverse effects. Therefore, teaching diagnostic skills to clinical psychologists is very important during their undergraduate, graduate and postgraduate training.

One major problem in teaching diagnostics is that there are too few opportunities to practice with real patients due to legal and ethical restrictions. The aim of the DiSkO-project is, therefore, the development and evaluation of a blended learning course to teach diagnostic skills to (future) clinical psychologists.

We would like to make the diagnostic training more practical by presenting a series of video files of simulated diagnostic interviews in an online course. These video files will be divided in different segments and presented with questions and automatic feedback. In a second step, learners will make a transfer to a real face-to-face diagnostic situation with an actor simulating a patient.

The DiSkO- course will be implemented on Moodle and will be evaluated in a randomized-controlled trial at three universities in Germany (Ruhr-University, University of Koblenz Landau, University of Cologne). We will conduct a noninferiority-analysis to test whether students are equally good in administering a diagnostic interview after taking the DiSkO-course compared to students who took part in a traditional face-to-face university course. Furthermore, we will compare diagnostic knowledge and attitudes toward evidence-based assessment after taking part in DiSkO vs. the face-to-face course.

We aim at disseminating our open source DiSkO-course to other universities or institutions of tertiary education in Germany together with the German Psychological Association and the German Association for Behavioral Child and Adolescent Therapy. We are convinced that we thereby can improve the diagnostic training for students, better prepare them for their clinical practice and thus improve patients’ health care in Germany.

Baby-DIPS

Early regulatory problems put a lot of distress on the affected families and they constitute a major risk factor for experiencing maltreatment and developing psychological disorders later in life. Nevertheless, little is known about the prevalence and etiological factors of these problems. We developed an interview for parents of children up to four years to facilitate the detection, study and treatment of early behavioral problems. In this study, we examine the acceptability and the psychometric properties of our interview (Baby-DIPS) in a community and a clinical sample.

Scales for mental health and problems

This research area is part of the international BOOM-Project. Its main focus is on the development and validation of instruments for the cross-cultural assessment of positive and negative facets of mental health. A special focus is on the Positive Mental Health Scale (PMH-Scale).

Bochum Optimism and Mental Health (BOOM)

The research program “Bochum Optimism and Mental Health (BOOM)” started in 2011. It is supported by the Alexander von Humboldt Foundation.

The main aim of BOOM is the identification of causal protective and risk factors of positive mental health as well as depression, anxiety and stress symptoms. It contains intercultural and transcultural cross- and longitudinal studies in which potentially causally significant combinations of epidemiological, experimental psychological and intervention approaches are investigated. The dual-factor model of mental health which describes mental health and mental illness as two interrelated but separate unipolar dimensions is the theoretical basis of BOOM.

Since 2011, cross-sectional and longitudinal data of student (Germany, Russia, China) and representative (Germany, Russia, USA) samples are continuously collected and analyzed (total N ≈ 40,000). Various methodological approaches are used to clarify the influence of different research methods and to provide insights into the transcultural measurement invariance of the investigated constructs and instruments.

First results show that life satisfaction, resilience, optimism, subjective happiness and social support have a salutogenic effect cross-culturally, and at the same time act as a buffer against negative effects of stress and psychopathological symptoms.

Brief Social Rhythm Scale (BSRS)

Social rhythm refers to the regularity with which one engages in social activities throughout the week, and has established links with bipolar disorder, as well as some links with depression and anxiety. Just as daily biological patterns, such as circadian rhythm, temperature fluctuations, and cortisol levels, are integral to good mental health, with disruptions associated with depression, so it appears are rhythmic social and behavioral patterns, for example in mealtimes, bedtimes, and patterns of social interaction.

Social rhythm was assessed using the Brief Social Rhythm Scale (BSRS; Margraf et al. 2016). This scale consists of ten items, which assess the irregularity with which participants engage in basic daily activities during the workweek and on the weekend. The BSRS assesses waking and bedtimes and breakfast and dinner mealtimes. It also assesses the regularity of time spent with others at work/school and during free time.

Participants are asked to rate the general regularity of each activity in their lives in general using a scale ranging from 1 (very regularly) to 6 (very irregularly), with high mean scores indicating high irregularity. This measure can be administered at a single time point, rather than requiring a week of daily data to score. Summary scores are the average across all 10 items.

The BSRS shows a slight positive skewed distribution. It is reliable, distinguishes among categories of mental health and detects relationships with physical and mental health, and is especially useful in large-scale or screening studies, where participant time is limited (Margraf et al. 2016).

Brief Daily Stressors Screening Tool (BDSST)

The BDSST is a short instrument for the recording of perceived general daily stressors in eight different areas of life. It is particularly suitable for use in large-scale studies or as a screening instrument for localizing areas of life where stress is particularly prevalent. A five-level Likert scale is used to measure the extent of the perceived stress experience. The more areas of life are affected and the higher the level of information, the more pronounced the subjective experience of general everyday stress.

The instrument has been used in the following studies:

Schönfeld, P., Brailovskaia, J., Bieda, A., Zhang, X. C., & Margraf, J. (2016). The effects of daily stress on positive and negative mental health: Mediation through self-efficacy. International Journal of Clinical and Health Psychology, 16(1), 1-10.

Brailovskaia, J., Teismann, T., & Margraf, J. (2018). Physical activity mediates the association between daily stress and Facebook addiction disorder (FAD)–A longitudinal approach among German students. Computers in Human Behavior, 86, 199-204.

Bibi, A., Blackwell, S. E., & Margraf, J. (2019). Mental health, suicidal ideation, and experience of bullying among university students in Pakistan. Journal of Health Psychology. DOI: 10.1177/1359105319869819.

Schönfeld, P., Brailovskaia, J., Zhang, X. C., & Margraf, J. (2019). Self-efficacy as a mechanism linking daily stress to mental health in students: A three-wave cross-lagged study. Psychological reports, 122(6), 2074-2095.

Villanueva, J., Meyer, A. H., Rinner, M. T., Firsching, V. J., Benoy, C., Brogli, S., ... & Gloster, A. T. (2019). “Choose change”: design and methods of an acceptance and commitment therapy effectiveness trial for transdiagnostic treatment-resistant patients. BMC psychiatry, 19(1), 173.

Niemeyer, H., Bieda, A., Michalak, J., Schneider, S., & Margraf, J. (2019). Education and mental health: Do psychosocial resources matter?. SSM-population health, 7, 100392.Brailovskaia, J., Teismann, T., & Margraf, J. (2020). Positive mental health, stressful life events, and suicide ideation. Crisis. DOI: 10.1027/0227-5910/a000652.

Schönfeld, P., Brailovskaia, J., Bieda, A., Zhang, X. C., & Margraf, J. (2016). The effects of daily stress on positive and negative mental health: Mediation through self-efficacy. International Journal of Clinical and Health Psychology, 16(1), 1-10.

Pre-school age assessments

Give children a voice: For a long time, the view prevailed that children and especially preschool children cannot provide reliable and valid information about their condition and behavior. In its studies, our working group is investigating this question and developing age-appropriate measuring instruments and testing them with regard to their quality criteria.

The Bear and the Box (BEAR-C)

The goal of the present study is the development and the evaluation of a new psychometric instrument focusing on avoidance as an emotion regulation strategy in children and adolescents with anxiety.

Avoidance plays a critical role in the development and the maintenance of anxiety disorders. However, valid and reliable psychometric measures for children, which distinguish different avoidance strategies, are scarce.

Derived from Gross‘ process model of emotion regulation the BAER-C was developed. This new questionnaire assesses the use of three avoidance strategies (cognitive avoidance, behavioural avoidance and security behaviour), as well as reappraisal in anxious situations via child self-evaluation and parent-evaluation for children aged 8 to 16.

So far, the validation studies have shown an interpretable factor structure, satisfactory internal consistency as well as positive convergent and discriminant validity. Children with anxiety disorder show significantly higher avoidance scores than healthy controls. The current study has the goal to further validate the questionnaire using a behavioural avoidance task, in which the participants are asked to explore a scary looking box. When the study is completed, the questionnaire will be published with open access on our website.

Picture Test for ODD, CD and ADHD (P-OCA)

The aim of this project was to develop a diagnostic instrument to assess young children’s self-report regarding externalizing disorders.

In diagnostics in child mental disorders, especially in ADHD, self-report of children is often neglected. Particularly for preschool children, there is a lack of age-appropriate instruments, which further complicates the inclusion of their view within the diagnostic process. Therefore we developed the Picture Test for ODD, CD and ADHD (P-OCA), a pictorial instrument which assesses 4-8 year old children’s self-report regarding externalizing disorders.

Two pilot-studies demonstrated the P-OCA’s comprehensibility, acceptance, quality and utility from both children’s and practitioners’ point of view. In the main-study, the findings regarding acceptance were replicated and further high internal consistencies and good test-retest-reliability of the P-OCA were revealed.

Additionally, first hints regarding validity in the sense of discriminating children with and without a diagnosis and an association between children’s perceived distress and child-reported symptom severity were found. These findings suggest the P-OCA is an age-appropriate instrument for reliably assessing self-report in young children. With this, it can contribute to the improvement of the diagnostic process for clinicians working with young children.

Beyond self-report: Routine multi-level assessment

A major focus of our research area is to break new ground in the diagnosis of mental disorders and in the investigation of clinical-psychological mechanisms. For this purpose, we explicitly use the potential of the FBZ to generate large samples which we hope to identify the sometimes quite small and often multi-causal effects under investigation.

Die Bochumer Dreiebenen-Diagnostik (BoDDi)

Typically, in psychotherapeutic outpatient clinics, symptom characteristics, severity of disorders and treatment success are assessed using self-report measures and standardized interviews. Physiological or behavioral variables are largely neglected.

Within the framework of the current project we have implemented a short protocol in the routine care of the FBZ: It consists of previously well validated, standardized paradigms. We capture subjective, behavioral and psychophysiological aspects of core mechanisms relevant for the understanding and classification of pathogenic processes and treatment success within the spectrum of internalizing disorders (i.e. emotional perception, emotional regulation, conditioning, extinction, approach and avoidance behavior). In accordance with the Research Domain Criteria (RDoC) of the NIMH, we consider mental disorders as dimensional constructs rather than distinct entities.

Ecological Momentary Assessment (EMA)

To improve ecological validity assessment of clinically-psychologically relevant mechanisms and cognitive processes we use the method of Ecological Momentary Assessment in a number of studies. In addition to the everyday-life recording of emotional processes or cognitions, physical activity is also regularly monitored using accelerometry. The focus here is on studies that examine, for example, the everyday-life behavior of depressive patients.