Konzepte zur Psychotherapie der akuten und posttraumatischen Belastungsstörung

H.-P. Kapfhammer

doi:10.1055/s-0038-1627107

Nervenheilkunde, Table of Contents

Nervenheilkunde 2008; 27(01/02): 28-39
DOI: 10.1055/s-0038-1627107

Original- und Übersichtsarbeiten - Original and Review Articles

Schattauer GmbH

Konzepte zur Psychotherapie der akuten und posttraumatischen Belastungsstörung

Concepts for psychotherapy of acute and posttraumatic stress disorders

Authors

H.-P. Kapfhammer

¹Klinik für Psychiatrie, Medizinische Universität Graz

Abstract

Zusammenfassung

Akute Belastungsstörung (ASD) und Posttraumatische Belastungsstörung (PTSD) sind häufige, aber nicht obligatorische psychische Störungen nach schwerwiegenden Traumatisierungen. Ihre typischen psychopathologischen Symptome werden heute vorteilhaft innerhalb eines multifaktoriellen Modells betrachtet, das sowohl neurobiologische als auch psychosoziale Einflussfaktoren berücksichtigt. Psychodynamische, vor allem kognitiv-behaviorale Modelle haben entscheidend zur Entwicklung störungsorientierter psychotherapeutischer Verfahren beigetragen. Ihr Einsatz wird vorteilhaft in den Abschnitten der frühen posttraumatischen Krise als präventive Maßnahme, als Frühintervention bei Risikopersonen mit bedeutsamer Psychopathologie (ASD) sowie als Therapie bei der PTSD getrennt bewertet. In einer kritischen Sicht der vorliegenden empirischen literatur kann dem Psychologischen Debriefing als universeller Präventionsstrategie kein positiver, eventuell im Hinblick auf die Langzeitperspektive sogar ein nachteiliger Effekt bescheinigt werden. Kognitiv-verhaltenstherapeutische Ansätze scheinen sich in der Frühintervention bei ASD-Patienten zu bewähren. Psychodynamische, besonders kognitivbehaviorale Ansätze und EMDR zeigen eine positive Wirksamkeit bei der PTSD. Angesichts bedeutsamer klinischer Einschränkungen in den vorliegenden Studien dürfen diese Ergebnisse aber nicht unilinear als schon ausreichende Behandlungsempfehlungen für die Routineversorgung verstanden werden.

Summary

Acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) are frequent, but not obligatory psychological sequelae following major trauma. The typical psychopathological symptoms of ASD and PTSD are best described within a multifactorial model integrating both neurobiological and psychosocial influences. Psychodynamic and above all cognitive-behavioral models serve as important rationale for disorder-specific psychotherapeutic approaches. Psychotherapeutic interventions have to be separately evaluated as general preventive strategy during the immediate posttraumatic aftermath, as early intervention with high risk persons showing signs of ASD, and as treatment of patients with PTSD. In a critical survey on empirical studies, psychological debriefing cannot be considered as a positive approach to be recommended as general preventive measure during the immediate posttraumatic phase. There are some empirical data demonstrating positive effects of cognitive-behavioral interventions in ASD, of psychodynamic psychotherapy, cognitive-behavioral therapy, and EMDR in the treatment of PTSD. Major clinical restrictions of patient sampling within special research facilities, however, do not allow an unconditional generalization of these data to psychiatric routine care.

Schlüsselwörter

Akute Belastungsstörung - posttraumatische Belastungsstörung - Psychotherapie - Debriefing - Kognitive Verhaltenstherapie - psychodynamische Psychotherapie - EMDR

Keywords

Acute stress disorder - posttraumatic stress disorder - psychotherapy - psychological debriefing - cognitive-behavioral therapy - psychodynamic psychotherapy - EMDR

Full Text

References

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