Background: Although skills of will (volitional competences), such as self-motivation or emotion regulation, are particularly necessary for patients with psychiatric and psychosomatic disorders, it is unknown whether volitional deficits can be reduced and thereby the efficacy of psychotherapy increased. We investigated the effect of a group therapy for improving volitional competence in an inpatient rehabilitation program. Methods: In a controlled clinical trial, patients from a rehabilitation clinic participated either in the volition group therapy in addition to the standard cognitive behavioral therapy (volition group, VG) or in the standard cognitive behavioral therapy (standard group, SG). Patients were tested for volitional competence, depressive symptoms, total psychiatric symptomatology, and physical complaints prior to, at the end of inpatient therapy and after 6 months of follow-up (n = 242). Results: At the end of inpatient therapy, better improvement in volitional competence was observed in the VG than in the SG [e.g. self-motivation: effect size (ES) 0.96 vs. 0.39; ANCOVA: F(1, 209) = 16.58; p < 0.001]. Patients with greater volitional improvements had a better rehabilitation outcome. In the VG, depressive symptoms as well as total psychiatric symptomatology decreased significantly more than in the SG [ES: 1.18 vs. 0.87, F(1, 207) = 4.68, p < 0.05, and ES 1.12 vs. 0.73, F(1, 205) = 4.68, p < 0.05, respectively], but not physical complaints [ES: 0.62 vs. 0.48, F(1, 207) = 1.08, n.s.]. Conclusions: Effect size increased in patients with initially low volitional competence and high motivation to participate in a volitional training. These results might lead to a more systematic assessment and training of volitional competence.

1.
Lambert MJ (ed): Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change, ed 5. New York, Wiley, 2004.
2.
Grawe K: Psychological Therapy. Cambridge, Hogrefe & Huber, 2002.
3.
Lamprecht F: Psychosomatic rehabilitation: a ‘must’ in secondary health care; in VDR (ed): Medical Rehabilitation in Germany – Experiences and Development. Bad Homburg, WDV, 2002.
4.
Schmidt J, Nübling R, Steffanowski A, Lichtenberg S, Wittmann WW: Assessment of the outcome quality of inpatient psychosomatic rehabilitation: a comparison between different strategies of evaluation and the development of new instruments of measurement; in Jäckel WH, Bengel J, Herdt J (eds): Research in Rehabilitation. Results from of a Research Network in Southwest Germany. Stuttgart, Thieme, 2005.
5.
Kuhl J: A theory of self-regulation: action versus state orientation, self-discrimination, and some applications. Appl Psychol Int Rev 1992;41:97–129.
6.
Kuhl J, Fuhrmann A: Decomposing self-regulation and self-control: the volitional components inventory; in Heckhausen J, Dweck CS (eds): Motivation and Self-Regulation across the Life Span. Cambridge, Cambridge University Press, 1998, pp 15–49.
7.
Kuhl J: The volitional basis of Personality Systems Interaction Theory: applications in learning and treatment contexts. Int J Educ Res 2000;33:665–705.
8.
Beckmann J, Kellmann M: Self-regulation and recovery: approaching an understanding of the process of recovery from stress. Psychol Rep 2004;95:1135–1153.
9.
Tangney JP, Baumeister RF, Boone AL: High self-control predicts good adjustment, less pathology, better grades, and interpersonal success. J Pers 2004;72:271–322.
10.
Luszczynska A, Diehl M, Gutiérrez Doña B, Kuusinen P, Schwarzer R: Measuring one component of dispositional self-regulation: attention control in goal pursuit. Pers Individ Dif 2004;37:555–566.
11.
Rholes WS, Michas L, Shroff J: Action control as a vulnerability factor in dysphoria. Cognit Ther Res 1989;13:263–274.
12.
Hautzinger M: Action control in the context of psychopathological disorders; in Kuhl J, Beckmann J (eds): Volition and Personality: Action versus State Orientation. Göttingen, Hogrefe, 1994.
13.
Forstmeier S: Training of Will. Improving Volitional Competences in Psychotherapy and Psychosomatic Rehabilitation (in German). Berlin, WiKu, 2005.
14.
Hartung J, Schulte D: Action and state orientation during therapy of phobic disorders; in Kuhl J, Beckmann J (eds): Volition and Personality: Action versus State Orientation. Göttingen, Hogrefe, 1994.
15.
Forstmeier S, Rüddel H: Manual of the group therapy for enhancing volitional competences (in German). Bad Kreuznach, Matthias Ess, 2002.
16.
Klaghofer R, Brähler E: Construction and test-statistical examination of a short form of the SCL-90-R (in German). Z Klin Psychol Psychiatr Psychother 2001;49:115–124.
17.
Radloff LS: The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1977;3:385–401.
18.
Brähler E, Scheer JW: Giessen Subjective Complaints List (in German). Bern, Huber, 1995.
19.
Task Force on Promotion and Dissemination of Psychological Procedures: Training in and dissemination of empirically validated psychological treatments: report and recommendations. Clin Psychol 1995;48:3–23.
20.
Chambless DL, Hollon SD: Defining empirically supported therapies. J Consult Clin Psychol 1998;66:7–18.
21.
Beutler LE: Identifying empirically supported treatments: what if we didn’t? J Consult Clin Psychol 1998;66:113–120.
22.
Seligman ME: The effectiveness of psychotherapy: the consumer reports study. Am Psychol 1995;50:965–974.
23.
Persons JB, Silberschatz G: Are results of randomized trials useful to psychotherapists? J Consult Clin Psychol 1998;66:126–135.
24.
King M, Nazareth I, Lampe F, Bower P, Chandler M, Morou M, Sibbald B, Lai R: Impact of participant and physician intervention preferences on randomized trials: a systematic review. JAMA 2005;293:1089–1099.
25.
Schulz KF: Subverting randomization in controlled trials. JAMA 1995;274:1456–1458.
26.
Forstmeier S, Rüddel H: On the superiority of self-regulation over self-control in psychotherapy and psychosomatic rehabilitation. Verhaltenstherapie 2005;15:158–166.
27.
Weiss M, Nordlie JW, Siegel EP: Mindfulness-based stress reduction as an adjunct to outpatient psychotherapy. Psychother Psychosom 2005;74:108–112.
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