Abstract: Background: In the treatment of patients with depressive disorders and associated addictions, the cognitive disease acceptance is in most cases the primary focus of therapeutic interventions. According to the concept of the Oberberg Clinics, private specialist emergency clinics which offer comprehensive medical and psychotherapeutic treatment for individuals suffering from emotional, psychosomatic and psychiatric problems, an emotional acceptance is of outstanding relevance for the long-term course of disease. Thus, we have developed an instrument to identify the levels and factors of acceptance, the "Emotional / Rational Disease Acceptance" (ERDA) questionnaire (Bussing et al., Health and Quality of Life Outcomes, 2008). In a multicenter prospective cohort study, we investigated how the weighting of the respective disease acceptance styles may change during the therapeutic intervention.
Methods: We consecutively enrolled 225 patients treated in the Oberberg Clinics Schwarzwald, Weserbergland and Berlin/Brandenburg: 39% were women; 60% men; mean age 50 +- 9 years; 45% depressive, 44% addictive, 9% anxiety, and 3% other psychiatric disorders. At the start and at the end of their hospital treatment, we anonymously applied the ERDA questionnaire, Beck/s Depression Inventory (BDI), SCL-90-R symptom checklist, Escape from Illness (AKU), and the Brief Multidimensional Life Satisfaction Scale (BMLSS).
Results: Reliability analysis of the 21-item ERDA questionnaire (Version 2) revealed a good internal consistency (Cronbach/s alpha = 0.88). Exploratory factor analysis revealed 5 factors which explain 63% of variance: Positive Life Construction, Contentedness, Well-being (emotional, ePLC); Rejection Irrational Dealing will Illness (emotional, eRIDI); Rejection of Guild / Failure (emotional, eRGF), Understanding Causes of Illness (rational, rUCI); Rational Disease Acceptance (RDA). eRIDI and RDA were strongly inter-correlated (r=0.55). ePLC correlated strongly with depression (BDI, r=-0.60; SCL-90-R/s Global Severity Index, r= -0.57), and life satisfaction (BMLSS, r=0.57). Escape correlated strongly with eRIDI (r= -0.62), and moderately with ePLC, eRGF and RDA (r > -0.50). BDI and SCL-90-R correlated moderately with eRIDI and eRGF (r> -0.39), and weakly with rUCD and RDA (r> -0.29). Life satisfaction correlated moderately with eRIDI and eRGF (r<0.35), and weakly with RDA (r=0.22), but not with rUCI (r=0.08)
During the hospital stay, both the ERDA and life satisfaction scores of the patients significantly increased, while BDI scores, Global Severity Index of the SCL-90-R and Escape significantly decreased. In patients with addictive, depressive and anxiety disorders, the treatment resulted in strong effects particularly with respect to ePLC (Cohen/s d = 0.95-1.18), strong effect sizes with respect to RDA in patients with depression and anxiety (0.85-1.55), moderate effect sizes in eRIDI and rUCI (0.53-0.80), and small effect sizes for eRGF particularly in patients with addictions (Cohen/s d = 0.34). The intervention resulted in strong effect sizes with respect to psychiatric symptoms (BDI, SCL-90-R: 0.83-1.82).
Conclusion: We were able to confirm the ERDA as a reliable and valid instrument which was sensitive to psychotherapeutic treatment effects. Because rational disease acceptance was highly expressed even at the start of treatment, particularly in patients with addictive and depressive disorders, this variable should not be regarded as a relevant marker of patients at risk.

Brief Biography of the Speaker:
Studied medicine at the Technical University Aachen from 1984-1991, worked at the Institute of Immunology of Technical University Aachen from 1992-1995, and became head of the Department of Applied Immunology, Krebsforschung Herdecke from 1995-2005. In 2002, he received his venia legendi at the University of Witten/Herdecke. Since 2005 he is senior researcher at the Chair of Medical Theory and Complementary Medicine of University Witten Herdecke, and became a full research professor in 2007. Arndt Bussing is editor of the German Journal of Oncology since 2004, and advisory board of the journal Research in Complementary Medicine since 2006.