Psychother Psychosom Med Psychol 2007; 57(3/04): 170-177
DOI: 10.1055/s-2006-951956
Originalarbeit

© Georg Thieme Verlag KG Stuttgart · New York

Achtsamkeitstraining als psychotherapeutische Interventionsmethode

Konzeptklärung, klinische Anwendung und aktuelle empirische BefundlageMindfulness Training as a Psychotherapeutic ToolClarification of Concept, Clinical Application and Current State of Empirical ResearchMatthias  Berking1 , Miriam  von Känel2
  • 1University of Washington, USA
  • 2Universität Bern, Schweiz
Weitere Informationen

Publikationsverlauf

eingereicht 4. Sept. 2006

akzeptiert 5. Januar 2007

Publikationsdatum:
14. März 2008 (online)

Zusammenfassung

Vor dem Hintergrund der sprunghaft angestiegenen Popularität achtsamkeitsbasierter Interventionen wird dargestellt: 1. Wie Achtsamkeit definiert und konzeptualisiert werden kann, 2. Wie Achtsamkeit zurzeit psychotherapeutisch genutzt wird, 3. Wie effektiv achtsamkeitsbasierte Interventionen sind und 4. Welche Wirkmechanismen für diese Effekte verantwortlich sein könnten. Die aktuelle Befundlage spricht dafür, dass Achtsamkeit als ein multidimensionales Konstrukt gesehen werden kann, das den Kern oder zumindest eine wichtige Komponente bei einer Reihe von Interventionsformen darstellt, welche sich bei der Behandlung von unterschiedlichen Problemen und Störungsbildern als effektiv erwiesen haben. In Bezug auf die Wirkmechanismen lässt sich vermuten, dass vor allem in der Steigerung der Akzeptanz- und Toleranzkompetenzen bei den Patienten eine wichtige spezifische Wirkung dieser Ansätze gesehen werden kann. Zukünftige Forschung sollte versuchen zu klären, für welche Patienten diese Kompetenzen besonders wichtig sind, und wie man sie bei den Patienten trainieren kann, die für achtsamkeitsorientierte Ansätze weniger offen sind.

Abstract

With mindfulness-based interventions becoming increasingly popular this review outlines: 1. How mindfulness is defined and conceptualized, 2. How mindfulness is applied in psychotherapy, 3. How effective mindfulness-based interventions are and 4. How the effectiveness of these methods might be explained. Findings show that mindfulness can be seen as a multidimensional concept which is the core or an important component of several psychotherapeutical methods that have been shown to be effective in the treatment of different psychological problems and disorders. With regard to possible mechanisms of change it is argued that enhancing patients' skills to accept and tolerate aversive experiences can be seen as a specific and important effect of these approaches. Future research should try to clarify for whom these skills are particularly important, and how these skills can be taught to patients who are less open for mindfulness-based approaches.

Literatur

  • 1 Segal Z V, Williams J MG, Teasdale J D. Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse. New York; Guilford Press 2002
  • 2 Kabat-Zinn J. An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: Theoretical considerations and preliminary results.  Gen Hosp Psychiatry. 1982;  4 33-47
  • 3 Kabat-Zinn J. Full Catastrophy Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness. New York; Delacorte Press 1990
  • 4 Kabat-Zinn J. Mindfulness-based intervention in context: Past, present and future.  Clin Psychol-Sci Pr. 2003;  10 144-156
  • 5 Bishop S R, Lau M, Shapiro S. et al . Mindfulness: A proposed optional definition.  Clin Psychol-Sci Pr. 2004;  11 230-241
  • 6 Berking M, Znoj H J. Achtsamkeit und Emotionsregulation: When East meets West - Chancen und Risiken.  Psychotherapie im Dialog. 2006;  7 307-312
  • 7 Walach H, Buchheld N, Buttenmüller V. et al .Empirische Erfassung der Achtsamkeit - Die Konstruktion des Freiburger Fragebogens zur Achtsamkeit (FFA) und weitere Validierungsstudien. In: Heidenreich T, Michalak J (Hrsg) Achtsamkeit und Akzeptanz in der Psychotherapie. Tübingen; DGVT-Verlag 2004: 727-765
  • 8 Brown K W, Ryan R M. The benefits of being present: Mindfulness and its role in psychological well-being.  J Pers Soc Psychol. 2003;  84 822-848
  • 9 Heidenreich T, Michalak J. Achtsamkeit („Mindfulness”) als Therapieprinzip in Verhaltenstherapie und Verhaltensmedizin.  Verhaltenstherapie. 2003;  13 264-274
  • 10 Nolen-Hoeksema S. Responses to depression and their effects on the duration of depressive episodes.  J Abnorm Psychol. 1991;  100 569-582
  • 11 Michalak J, Heidenreich T. Neue Wege der Rückfallprophylaxe bei Depressionen. Die achtsamkeitsbasierte kognitive Therapie.  Psychotherapeut. 2005;  50 415-422
  • 12 Linehan M M. Cognitive-Behavioral Treatment of Borderline Personality Disorder. New York; Guilford Press 1993
  • 13 Linehan M M. Skill Training Manual for Treating Borderline Personality Disorder. New York; Guilford Press 1993
  • 14 Hayes S C, Strosahl K D, Wilson K G. Acceptance and Commitment Therapy: An Experiental Approach to Behaviour Change. New York; Guilford Press 1999
  • 15 Margraf M, Berking M. Mit einem „Warum” im Herzen lässt sich fast jedes „Wie” ertragen: Konzeption und empirische Evaluation eines psychotherapeutischen Entschlusstrainings.  Verhaltenstherapie. 2005;  14 254-262
  • 16 Wells A. Emotional Disorders and Metacognition. Innovative Cognitive Therapy. Chichester; John Wiley, Sons Ltd 2000
  • 17 Ingram R E. Self-focused attention in clinical disorders: Review and a conceptual model.  Psychol Bull. 1990;  107 156-176
  • 18 Baer R A. Mindfulness training as a clinical intervention: A conceptual and empirical review.  Clin Psychol-Sci Pr. 2003;  10 125-143
  • 19 Grossmann P, Niemann L, Schmidt S, Walach H. Mindfulness-based stress reduction and health benefits: A meta-analysis.  J Psychosom Res. 2004;  57 43-53
  • 20 Newberg A B, Iversen J. The neural basis of the complex task of meditation: Neurotransmitter and neurochemical considerations.  Med Hypotheses. 2003;  61 282-291
  • 21 Shapiro S L, Astin J A, Bishop S R, Cordova M. Mindfulness-based stress reduction for health care professionals: Results from a randomized trial.  Int J Stress Manage. 2005;  12 164-176
  • 22 Carlson L, Garland S N. Impact of mindfulness-based stress reduction on sleep, mood, stress and fatigue symptoms in cancer outpatients.  Int J Behav Med. 2005;  12 278-285
  • 23 Bedard M, Felteau M, Gibbons C. et al . A mindfulness-based intervention to improve quality of life among individuals who sustained traumatic brain injuries: One year follow-up.  J Cog Rehab. 2005;  23 8-13
  • 24 Davidson R J, Kabat-Zinn J, Muller D. et al . Alternations in brain and immune function produced by mindfulness meditation.  Psychosom Med. 2003;  65 564-570
  • 25 Weiss M, Nordlie J W, Siegel E P. Mindfulness-based stress reduction as an adjunct to outpatient psychotherapy.  Psychother Psychosom. 2005;  74 108-112
  • 26 American Psychological Association (APA) .Division of Clinical Psychology. 1995
  • 27 Ma S H, Teasdale J D. Mindfulness-based cognitive therapy for depression: Replication and exploration of differential relapse prevention effects.  J Consult Clin Psych. 2004;  72 31-40
  • 28 Teasdale J D, Segal Z V, Williams J MG. Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy.  J Consult Clin Psych. 2000;  68 615-623
  • 29 Bohus M, Haaf B, Stiglmayr C. et al . Evaluation of inpatient dialectical-behavior therapy for borderline personality disorder - A prospective study.  Behav Res Ther. 2000;  38 875-887
  • 30 Koerner K, Dimeff L A. Further data on dialectical behavior therapy.  Clin Psychol-Sci Pr. 2000;  7 104-112
  • 31 Koons C R, Robins C J, Tweed J L. et al . Efficacy of dialectical behavior therapy in women veterans with borderline personality disorder.  Behav Ther. 2001;  32 371-390
  • 32 Linehan M M, Armstrong H E, Suarez A. et al . Cognitive-behavioral treatment of chronically parasuicidal borderline patients.  Arch Gen Psychiat. 1991;  48 1060-1064
  • 33 Linehan M M, Comtois K A, Brown M Z. et al . Suicide attempt self-injury interview (SASII): Development, reliability, and validity of a scale to assess suicide attempts and intentional self-injury.  Psychol Assess. 2006;  18 303-312
  • 34 Linehan M M, Dimeff L A, Reynolds S K. et al . Dialectical behavior therapy versus comprehensive validation plus 12 steps for the treatment of opioid dependent women meeting criteria for borderline personality disorder.  Drug Alcohol Depend. 2002;  67 13-26
  • 35 Linehan M M, Heard H L, Armstrong H E. Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients.  Arch Gen Psychiat. 1994;  51 422
  • 36 Linehan M M, Schmidt H, Dimeff L A. et al . Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence.  Am J Addict. 1999;  8 279-292
  • 37 Linehan M M, Tutek D A, Heard H L, Armstrong H E. Interpersonal outcome of cognitive behavioral treatment for chronically suicidal borderline patients.  Am J Psychiat. 1994;  151 1771-1776
  • 38 Simpson E B, Yen S, Costello E. et al . Combined dialectical behavior therapy and fluoxetine in the treatment of borderline personality disorder.  J Clin Psychiat. 2004;  65 379-385
  • 39 Verheul R, Bosch L M van den, Koeter M W. et al . Dialectical behavior therapy for women with borderline personality disorder: 12-month randomised clinical trial in the Netherlands.  Brit J Psychiat. 2003;  182 135-140
  • 40 Safer D L, Telch C F, Agras W. Dialectical behavior therapy for bulimia nervosa.  Am J Psychiat. 2001;  158 632-634
  • 41 Clyne C, Blampied N M. Training in emotion regulation as a treatment for binge-eating: A preliminary study.  Behav Change. 2004;  21 269-281
  • 42 Telch C F, Agras W S, Linehan M M. Dialectical behavior therapy for binge eating disorder.  J Consult Clin Psychol. 2001;  69 1061-1065
  • 43 Quigley S M. Dialectical behavior therapy and sex offender treatment: An integrative model.  Dissertation Abstracts International: Section B: The Sciences and Engineering. 2000;  60 (9-B)
  • 44 Becker C B, Zayfert C. Integrating DBT-based techniques and concepts to facilitate exposure treatment for PTSD.  Cog Behav Pract. 2001;  8 107-122
  • 45 Lynch T R, Morse J Q, Mendelson T, Robins C J. Dialectical behavior therapy for depressed older adults: A randomized pilot study.  Am J Geriat Psychiat. 2003;  11 33-45
  • 46 Robins C J, Chapman A L. Dialectical behavior therapy: Current status, recent developments, and future directions.  J Pers Disord. 2004;  18 73-89
  • 47 Dahl J, Wilson K G, Nilsson A. Acceptance and commitment therapy and the treatment of persons at risk for long-term disability resulting from stress and pain symptoms: A preliminary randomized trial.  Behav Ther. 2005;  35 785-801
  • 48 Gaudiano B A. Acceptance and commitment therapy for psychiatric inpatients with psychotic symptoms.  Dissertation Abstracts International: Section B: The Sciences and Engineering. 2004;  65 1546
  • 49 Bach P, Hayes S C. The use of acceptance and commitment therapy to prevent the rehospitalization of psychotic patients: A randomized controlled trial.  J Consult Clin Psychol. 2002;  70 1129-1139
  • 50 Twohig M P, Woods D W. A preliminary investigation of acceptance and commitment therapy and habit reversal as a treatment for trichotillomania.  Behav Ther. 2000;  35 803-820
  • 51 Gregg J A. A randomized controlled effectiveness trial comparing patient education with and without acceptance and commitment therapy for type 2 diabetes self-management.  Dissertation Abstracts International: Section B: The Sciences and Engineering. 2004;  65 (4B) 2094
  • 52 Hayes S C, Wilson K G, Gifford E V. et al . A preliminary trial of twelve-step facilitation and acceptance and commitment therapy with polysubstance-abusing methadone-maintained opiate addicts.  Behav Ther. 2004;  35 667-688
  • 53 Gifford E V, Kohlenberg B S, Hayes S C. et al . Acceptance-based treatment for smoking cessation.  Behav Ther. 2004;  35 689-705
  • 54 Twohig M P, Hayes S C, Akihiko M. Increasing willingness to experience obsessions: Acceptance and commitment therapy as a treatment for obsessive-compulsive disorder. Behav Ther 2007, in press
  • 55 Wells A, White J, Carter K. Attention training: Effects in anxiety and beliefs in panic and social phobia.  Clin Psychol Psychot. 1997;  4 226-232
  • 56 Wells A, Papageorgiou C. Social phobia: Effects of external attention on anxiety, negative beliefs, and perspective taking.  Behav Therap. 1998;  29 357-370
  • 57 Papageorgiou C, Wells A. Treatment of recurrent major depression with attention training.  Cog Behav Pract. 2000;  7 407-423
  • 58 Wells A, King P. Metacognitive therapy for generalized anxiety disorder: An open trial.  Journal of Behav Ther Exp Psy. 2006;  37 206-212
  • 59 Fisher P L, Wells A. Experimental modification of beliefs in obsessive-compulsive disorder: A test on the metacognitive model.  Behav Res Ther Behav. 2004;  43 821-829
  • 60 Wells A, Sembi S. Metacognitive therapy for PTSD: A preliminary investigation of a new brief treatment.  Behav Ther Exp Psy. 2004;  35 307-318
  • 61 Wells A, Welford M, Fraser J. et al .Treating chronic PTSD with metacognitive therapy: An open trial. Submitted
  • 62 Wells A. GAD, metacognition and mindfulness: An information processing analysis.  Clin Psychol-Sci Pr. 2002;  9 95-100
  • 63 Wallace R K, Orme-Johnson D W, Mills P J, Dillbeck M C. Academic achievement and the paired Hoffman reflex in students practicing meditation.  Int J Neurosci. 1984;  24 261-266
  • 64 Grawe K. Neuropsychotherapie. Göttingen; Hogrefe 2004
  • 65 Marlatt A, Gordon J R. Relapse prevention: Maintenance Strategies in the Treatment of Addictive Behavior. New York; Guilford Press 1985
  • 66 Huether G. Stress and the adaptive self-organization of neuronal connectivity during early childhood.  Int J Dev Neurosci. 1998;  16 297-306
  • 67 Öst L G. Applied relaxation: Description of a coping technique and review of controlled studies.  Behav Res Therap. 1987;  25 397-409
  • 68 Jacobsen E. Entspannung als Therapie. Progressive Relaxation in Theorie und Praxis. Stuttgart; Klett-Cotta 2002
  • 69 Berking M, Grawe K. Be smart - suffer less: About the importance of emotional intelligence for well-being and mental health. Paper presented at the 35th Annual Congress of the European Association of Cognitive Behavioral Therapy. Thessaloniki, Greece; 2005
  • 70 Berking M, Znoj H J. Entwicklung und Validierung eines Fragebogens zur standardisierten Selbsteinschätzung emotionaler Kompetenzen (SEK-27). Manuskript in Begutachtung
  • 71 Berking M. Training Emotionaler Kompetenzen - Manual für Kursleiter. Berlin; Springer 2007, in Druck

Dr. Matthias Berking
Prof. Dr. M. Linehan

Behavioral Research and Therapy Clinics, University of Washington, Department of Psychology

Box 351525

Seattle, WA 98195-1525/USA

eMail: Matthias.Berking@psy.unibe.ch