[What is the relationship between therapy dosage, action-state orientation, subjective contextual burden and rehabilitation success after psychosomatic rehabilitation?]

Abstract

Whether people carry out an intention, e. g. return to work after psychosomatic rehabilitation, depends, among other things, on action control strategies. The current action (AO) or state orientation (SO) or affect regulation determines strategy efficiency. The Reha-Integrative model project focused on treatment of inhibiting contextual factors with a double psychotherapy dose, as these complicate treatment of psychological symptoms in psychosomatic rehabilitation. The RCT study with repeated measures investigated whether therapy dose had an effect on self-regulation and subjective contextual burden and the relationship between action control, contextual burden, dose and (in-)direct rehabilitation success. 483 rehabilitants aged 18-64 years, 48% of whom were women, who completed psychosomatic rehab at Rehazentrum Oberharz between 2020-22 were examined.Intra-individual changes were mapped by the Reliable Change Index. Contribution and sickness benefit periods were taken from the accounts of Deutsche Rentenversicherung Braunschweig-Hannover exactly 1 year after rehabilitation. Regressions and moderator analyses according to Hayes were calculated.The mean increase in AO on discharge did not fall below baseline 1 year after rehabilitation. Descriptively, there was a decrease in depression and subjective contextual burden. Regressions showed a weak dose effect for AO at discharge, but not one year after rehab and not for subjective contextual burden. Moderator analyses showed a medium effect of SO at admission for depression reduction. AO benefited slightly from dose increase. AO and low contextual burden at discharge showed a medium association with more contribution months and fewer sickness benefit months. SO with high contextual burden resulted in an average 3 fewer months of contributions and 1.8 more months of sickness benefit receipt with a weak effect size.In line with action control theory, the results point to the importance of individual differences in volitional aspects and subjective contextual burden in relation to (in-)direct rehab success. Volitional differences and promotion of self-regulation skills should be given more attention in the therapeutic setting of psychosomatic rehabilitation and in personalized case management.