Kognitiv-verhaltenstherapeutische Behandlung von Positivsymptomatik psychotischer Störungen

Zusammenfassung

Psychotherapeutische Interventionen galten lange als nicht indiziert für die Behandlung psychotischer Störungen. Seit Mitte der 1990er-Jahre wurde jedoch in Großbritannien systematisch daran gearbeitet, kognitiv verhaltenstherapeutische Strategien für die Behandlung dieser schweren psychischen Störungen zu adaptieren. Inzwischen liegt eine Vielzahl von Befunden aus randomisierten klinischen Studien vor, die die bisherige Zurückhaltung auf diesem Gebiet in Frage stellen. Metaanalysen zeigen für die kognitive Verhaltenstherapie (KVT) moderate, mittlere gewichtete Effektstärken um 0,4 über die Wirkung der antipsychotischen Medikation hinaus. Aktuelle Behandlungsleitlinien empfehlen vor diesem Hintergrund diese Behandlungsstrategie in der Routineversorgung.

Gleichwohl ist eine Vielzahl von Fragen offen. Darum wird im Rahmen der vom BMBF geförderten Psychotherapieforschungsverbünde eine multizentrische klinische Studie zur Frage gefördert, ob kognitive Verhaltenstherapie spezifisch wirksam ist, oder ob sich die beschriebenen Therapieeffekte auf unspezifische Faktoren zurückführen lassen. Im vorliegenden Beitrag wird die Therapiekonzeption der in dieser Studie durchgeführten kognitiven Verhaltenstherapie vorgestellt und anhand von Fallbeispielen erläutert.

Summary

For a long time, psychotherapeutic interventions had not been considered as indicated for the treatment of psychotic disorders. However, in the middle of the nineties of the last century British researchers systematically adapted cognitive behaviourally interventions for treatment of these severe mental diseases. In the meantime, there is a multitude of findings from randomised clinical trials which call the psychotherapeutic abstinence in this field into question. Meta-analyses showed moderate effect sizes about 0.4 for cognitive behavioural therapy (CBT) in addition to antipsychotic medication. On this background the current treatment guidelines recommend the implementation of CBT in routine treatment.

Nevertheless, there remain many unanswered questions. In the framework of the BMBF-funded research networks on psychotherapy a multicenter clinical study addresses the question whether CBT is specifically efficacious or whether the described treatment effects might be ascribed to unspecific factors. The present paper presents the treatment rational of CBT on the basis of case vignettes.

Schlüsselwörter

Psychotische Störungen - Positivsymptomatik - kognitive Verhaltenstherapie - Therapiekonzept

Keywords

Psychotic disorder - positive symptoms - cognitive behavioral therapy - therapy

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