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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
H.-P. Kapfhammer
1   Klinik für Psychiatrie, Medizinische Universität Graz
› Institutsangaben
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Publikationsverlauf

Eingegangen am: 28. März 2007

angenommen am: 08. März 2007

Publikationsdatum:
20. Januar 2018 (online)

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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
 

  • Literatur

  • 1 Bisson J, Andrew M. Psychological treatment of post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev; 2005
    Google Scholar
  • 2 Bisson JI. et al. Randomized controlled trial of psychological debriefing for victims of acute burn trauma. Br J Psychiatry 1997; 171: 78-81.
    CrossrefPubMedGoogle Scholar
  • 3 Bleiberg KL, Markowitz JC. A pilot study of interpersonal psychotherapy for posttraumatic stress disorder. Am J Psychiatry 2005; 162: 181-183.
    CrossrefPubMedGoogle Scholar
  • 4 Boudewyns PA. et al. PTSD among Vietnam veterans: An early look at treatment outcome using direct therapeutic exposure. J Trauma Stress 1990; 3: 359-368.
    CrossrefGoogle Scholar
  • 5 Bradley R. et al. A mulidimensional meta-analysis of psychotherapy for PTSD. Am J Psychiatry 2005; 162: 214-227.
    CrossrefPubMedGoogle Scholar
  • 6 Brewin CR. A cognitive neuroscience account of posttraumatic stress disorder and its treatment. Behav Res Ther 2001; 39: 373-393.
    PubMedGoogle Scholar
  • 7 Brewin CR. et al. Fear, helplessness, and horror in posttraumatic stress disorder: Investigating DSMIV criterion A2 in victims of violent crime. J Trauma Stress 2000; 13: 499-509.
    CrossrefPubMedGoogle Scholar
  • 8 Brewin CR, Dalgleish JS. A dual representation theory of posttraumatic stress disorder. Psychol Rev 1996; 103: 670-686.
    CrossrefPubMedGoogle Scholar
  • 9 Brewin CR, Holmes EA. Psychological theories of posttraumatic stress disorder. Clin Psychol Rev 2003; 23: 339-376.
    CrossrefPubMedGoogle Scholar
  • 10 Briere J, Spinazzola J. Phenomenology and psychological assessment of complex posttraumatic states. J Trauma Stress 2005; 18: 401-412.
    CrossrefPubMedGoogle Scholar
  • 11 Brom D. et al. Brief psychotherapy for posttraumatic stress disorder. J Consult Clin Psychol 1989; 57: 607-612.
    CrossrefPubMedGoogle Scholar
  • 12 Bryant RA. et al. Treatment of acute stress disorder: A comparison of cognitive-behavioral therapy and supportive counseling. J Consult Clin Psychol 1998; 66: 862-866.
    CrossrefPubMedGoogle Scholar
  • 13 Bryant RA. et al. The additive benefit of hypnosis and cognitive-behavioral therapy in treating acute stress disorder. J Consult Clin Psychol 2005; 73: 334-340.
    CrossrefPubMedGoogle Scholar
  • 14 Bryant RA. et al. Treating acute stress disorder following mild traumatic brain injury. Am J Psychiatry 2003; 160: 585-587.
    CrossrefPubMedGoogle Scholar
  • 15 Bryant RA. et al. Hypnotherapy and cognitive behaviour therapy of acute stress disorder: A 3-year follow-up. Behav Res Ther 2006; 44: 1331-1335.
    CrossrefPubMedGoogle Scholar
  • 16 Bryant RA, Panasetis P. The role of panic in acute dissociative reactions following trauma. Br J Clin Psychol 2005; 44: 489-494.
    CrossrefPubMedGoogle Scholar
  • 17 Bryant RA. et al. Treating acute stress disorder: An evaluation of cognitive behavior therapy and supportive counseling techniques. Am J Psychiatry 1999; 156: 1780-1786.
    PubMedGoogle Scholar
  • 18 Carlier IVE. et al. The influence of occupational debriefing on post-traumatic stress symptomatology in traumatized police officers. Br J Med Psychol 2000; 73: 87-98.
    CrossrefPubMedGoogle Scholar
  • 19 Chemtob CM. et al. Eye movement desensitization and reprocessing. In: Foa EB, Keane TM, Frieman MJ. Guidelines for treatment of PTSD. J Trauma Stress 2000; 13: 569-570.
    Google Scholar
  • 20 Cohen LR, Hien DA. Treatment outcomes for women with substance abuse and PTSD who have experienced complex trauma. Psychiatr Serv 2006; 57: 100-106.
    CrossrefPubMedGoogle Scholar
  • 21 Conlon L. et al. PTSD in ambulant RTA victims: A randomized controlled trial of debriefing. J Psychosom Res 1999; 46: 37-44.
    CrossrefPubMedGoogle Scholar
  • 22 Cooper NA, Clum GA. Imaginal flooding as a supplementary treatment for PTSD in combat veterans: A controlled study. Behav Ther 1989; 20: 381-391.
    CrossrefGoogle Scholar
  • 23 Davidson JRT, McFarlane AC. The extent and impact of mental health problems after disaster. J Clin Psychiatry 2006; 67 (Suppl. 02) 9-14.
    CrossrefPubMedGoogle Scholar
  • 24 Deahl M. Preventing psychological trauma in soldiers: The role of operational stress training and psychological debriefing. Br J Med Psychol 2000; 73: 77-85.
    CrossrefPubMedGoogle Scholar
  • 25 Deahl MP. et al. Psychological sequelae following the Gulf War. Factors associated with subsequent morbidity and the effectiveness of psychological debriefing. Br J Psychiatry 1994; 165: 60-65.
    CrossrefPubMedGoogle Scholar
  • 26 Ebert A, Dyck MJ. The experience of mental death: The core feature of complex posttraumatic stress disorder. Clin Psychol Rev 2004; 24: 617-635.
    CrossrefPubMedGoogle Scholar
  • 27 Ehlers A, Clark DM. A cognitive model of posttraumatic stress disorder. Behav Res Ther 2000; 38: 319-345.
    CrossrefPubMedGoogle Scholar
  • 28 Ehlers A. et al. A randomized controlled trial of cognitive therapy, a self-help booklet, and repeated assessments as early interventions for posttraumatic stress disorder. Arch Gen Psychiatry 2003; 60: 1024-1032.
    CrossrefPubMedGoogle Scholar
  • 29 Ehlers A. et al. Predicting response to exposure treatment in PTSD: The role of defeat and alienation. J Trauma Stress 1998; 11: 457-471.
    CrossrefPubMedGoogle Scholar
  • 30 Ehring T. et al. Contribution of cognitive factors to the prediction of post-traumatic stress disorder, phobia and depression after motor vehicle accidents. Behav Res Ther 2006; 44: 1699-1716.
    CrossrefPubMedGoogle Scholar
  • 31 Foa EB, Cahill SP. Specialized treatment for PTSD: Matching survivors to the appropriate modality. In: Yehuda R. (ed) Treating trauma survivors with PTSD. Washington, DC, London: American Psychiatric Publishing; 2002: 43-62.
    Google Scholar
  • 32 Foa EB. et al. Evaluation of a brief cognitive-behavioral program for the prevention of chronic PTSD in recent assault victims. J Consult Clin Psychol 1995; 63: 948-955.
    CrossrefPubMedGoogle Scholar
  • 33 Foa EB. et al. Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics. J Consult Clin Psychol 2005; 73: 953-964.
    CrossrefPubMedGoogle Scholar
  • 34 Foa EB, Kozak MJ. Emotional processing of fear: Exposure to corrective information. Psychol Bull 1986; 99: 20-35.
    CrossrefPubMedGoogle Scholar
  • 35 Foa EB, Meadows EA. Psychosocial treatments for posttraumatic stress disorder. In: Yehuda R. (ed) Psychological trauma. Review of Psychiatry, vol 17. Washington, DC London: American Psychiatric Press; 1998: 179-204.
    Google Scholar
  • 36 Foa EB. et al. The impact of fear activation and anger on the efficacy of exposure treatment for PTSD. Behav Ther 1995; 26: 487-499.
    CrossrefGoogle Scholar
  • 37 Foa EB, Rothbaum BO. Treating the trauma of rape: Cognitive behavioral therapy for PTSD. New York: Guilford Press; 1998
    Google Scholar
  • 38 Foa EB, Meadows EA. Psychosocial treatments for post-traumatic stress disorder: A critical review. Annu Rev Psychol 1997; 48: 449-480.
    CrossrefPubMedGoogle Scholar
  • 39 Freud S. Jenseits des Lustprinzips. Frankfurt a. Main: GW XIII, Fischer; 1920: 1-69.
    Google Scholar
  • 40 Galea S. et al. Psychological sequelae of the September 11 terrorist attacks in New York City. N Engl J Med 2002; 346: 982-987.
    CrossrefPubMedGoogle Scholar
  • 41 Gaston L. Dynamic therapy for post-traumatic stress disorder. In: Barber JP, Crits-Christoph P. (eds) Dynamic therapies for psychiatric disorders (axis I). New York: Basic Books; 1995: 161-192.
    Google Scholar
  • 42 Gray MJ, Litz BT. Behavioral interventions for recent trauma. Empirically informed practice guidelines. Behav Modification 2005; 29: 189-215.
    CrossrefPubMedGoogle Scholar
  • 43 Griffin MG. et al. Integrating objective indicators of treatment outcome in posttraumatic stress disorder. Ann NY Acad Sci 1997; 821: 388-409.
    CrossrefPubMedGoogle Scholar
  • 44 Herman JL. Trauma and recovery. New York: Basic Books; 1992
    Google Scholar
  • 45 Hobbs M. et al. A randomized controlled trial of psychological debriefing for victims of road traffic accidents. BMJ 1996; 313: 1438-1439.
    CrossrefPubMedGoogle Scholar
  • 46 Horowitz MJ. Stress response syndromes, 2nd edn. Northvale, NJ: Jason Aronson; 1986
    Google Scholar
  • 47 Horowitz MJ. et al. Brief dynamic psychotherapy of bereavement reactions. The relationship of process to outcome. Arch Gen Psychiatry 1984; 41: 438-448.
    CrossrefPubMedGoogle Scholar
  • 48 Hyer L, Brandsma JM. EMDR minus eye movement equals good psychotherapy. J Trauma Stress 1997; 10: 515-522.
    PubMedGoogle Scholar
  • 49 Janoff-Bulman R. Shattered assumptions: Towards a new psychology of trauma. New York: Free Press; 1992
    Google Scholar
  • 50 Jones C. et al. The organisation and content of trauma memories in survivors of road traffic accidents. Behav Res Ther 2006 (Epub ahead of print).
    PubMedGoogle Scholar
  • 51 Kapfhammer HP. Somatisierung als Korrelat komplexer posttraumatischer Persönlichkeitsveränderungen. Persönlichkeitsstörungen – Theorie und Therapie PTT 2005; 9: 116-126.
    Google Scholar
  • 52 Kapfhammer HP. Pharmakotherapie der Akuten und Posttraumatischen Belastungsstörung. Psychiatrie & Psychotherapie 2005; 1: 25-34.
    Google Scholar
  • 53 Kapfhammer HP. Zur Neurobiologie von Trauma, Dissoziation und Somatisierung. In Remmel A, Kernberg OF, Vollmoeller W, Strauss B. (Hrsg) Handbuch Körper und Persönlichkeit. Stuttgart: Schattauer; 2006: 369-389.
    Google Scholar
  • 54 Kapfhammer HP. Anpassungsstörung, Akute Belastungsstörung und Posttraumatische Belastungsstörung. In: Möller HJ, Laux G, Kapfhammer HP. (Hrsg) Psychiatrie und Psychotherapie. Berlin, Heidelberg: Springer; 2007
    Google Scholar
  • 55 Keane TM. et al. Implosive (flooding) therapy reduces symptoms of PTSD in Vietnam combat veterans. Behav Ther 1989; 20: 245-260.
    CrossrefGoogle Scholar
  • 56 Kilpatrick DG. et al. Psychological sequelae to rape: Assessment and treatment strategies. In: Doleys DM, Meredith RL, Ciminero AR. (eds) Behavioral medicine: Assessment and treatment strategies. New York: Plenum; 1982: 473-497
    Google Scholar
  • 57 Kudler HS. et al. Psychodynamic therapy. In: Foa EB, Keane TM, Frieman MJ. Guidelines for treatment of PTSD. J Traum Stress 2000; 13: 572-574.
    Google Scholar
  • 58 Laney C, Loftus EF. Traumatic memories are not necessarily accurate memories. Can J Psychiatry 2005; 50: 823-828.
    CrossrefPubMedGoogle Scholar
  • 59 Lee C. The influence of psychological debriefing on emotional adaptation in women following early miscarriage: A preliminary study. Br J Med Psychol 1996; 69: 47-58.
    CrossrefPubMedGoogle Scholar
  • 60 Lindy JD. Vietnam: A casebook. New York: Brunner/ Mazel; 1988
    Google Scholar
  • 61 Lindy JD. et al. Psychotherapy with survivors of the Beverly Hills Supper Club Fire. Am J Psychother 1983; 4: 593-610.
    Google Scholar
  • 62 Marks I. et al. Treatment of posttraumatic stress disorder by exposure and/or cognitive restructuring: A controlled study. Arch Gen Psychiatry 1998; 55: 317-325.
    PubMedGoogle Scholar
  • 63 Marmar CR. et al. Peritraumatic disssociation and posttraumatic stress in male Vietnam theater veterans. Am J Psychiatry 1994; 151: 902-907.
    CrossrefPubMedGoogle Scholar
  • 64 Maxfield L, Hyer LA. The relationship between efficacy and methodology in studies investigatin EMDR treatment of PTSD. J Clin Psychol 2002; 58: 23-41.
    CrossrefPubMedGoogle Scholar
  • 65 Mayou RA. et al. Psychological debriefing for road traffic accident victims. Three-year follow-up of a randomised controlled trial. Br J Psychiatry 2000; 176: 589-593.
    CrossrefPubMedGoogle Scholar
  • 66 McNally RJ. Psychological mechanisms in acute response to trauma. Biol Psychiatry 2003; 53: 779-788.
    CrossrefPubMedGoogle Scholar
  • 67 McNally RJ. Does early psychological intervention promote recovery from posttraumatic stress. Psychol Sci Public Interest 2003; 4: 45-79.
    CrossrefPubMedGoogle Scholar
  • 68 Mitchell JT. When disaster strikes the critical incident stress debriefing process. J Emergency Med Services 1983; 8: 36-39.
    Google Scholar
  • 69 Nijenhuis ERS. Somatoform dissociation, reported abuse and animal defence-like reactions. Austr New Zeal J Psychiatry 2004; 38: 678-686.
    Google Scholar
  • 70 Peniston EG. EMG feedback assisted desensitization treatment for Vietnam combat veterans posttraumatic stress disorder. Clin Biofeedback Health 1986; 9: 35-41.
    Google Scholar
  • 71 Perkins BR, Rouanzoin CC. A critical evaluation of current views regarding eye movement desensitization and reprocessing (EMDR): Clarifying points confusion. J Clin Psychol 2002; 58: 77-97.
    CrossrefPubMedGoogle Scholar
  • 72 Pitman RK. et al. Psychiatric complications during flooding therapy for posttraumatic stress disorder. J Clin Psychiatry 1991; 52: 17-20.
    PubMedGoogle Scholar
  • 73 Pitman RK. et al. Emotional processing during eye movement desensitization and reprocessing therapy of Vietnam veterans with chronic posttraumatic stress disorder. Compr Psychiatry 1996; 37: 419-429.
    CrossrefPubMedGoogle Scholar
  • 74 Power KG. et al. A controlled comparison of eye movement desensitization and reprocessing versus exposure plus cognitive restructuring, versus waiting list in the treatment of posttraumatic stres disorder. J Clin Psychol 2002; 9: 299-318.
    Google Scholar
  • 75 Resick PA. et al. A comparative outcome study of group behavioral therapy for sexual assault victims. Behav Ther 1988; 19: 385-401.
    CrossrefGoogle Scholar
  • 76 Resick PA, Schnicke MK. Cognitive processing therapy for sexual assault victims. J Consult Clin Psychol 1992; 60: 748-756.
    CrossrefPubMedGoogle Scholar
  • 77 Rose S. Psychological debriefing: History and methods. Counseling 1997; 8: 148-151.
    Google Scholar
  • 78 Rose S. et al. Psychological debriefing for preventing post traumatic stress disorder (PTSD). Cochrane Database Syst Rev 2002
    PubMedGoogle Scholar
  • 79 Rose S. et al. A randomized controlled trial of individual psychological debriefing for victims of violent crime. Psychol Med 1999; 29: 793-799.
    CrossrefPubMedGoogle Scholar
  • 80 Roth S. Group therapy for sexual-assault victims. Psychotherapy 1988; 25: 82-93.
    CrossrefGoogle Scholar
  • 81 Rothbaum BO. Prolonged exposure versus eye movement desensitization and reprocessing (EMDR) for PTSD rape victims. J Trauma Stress 2005; 18: 607-616.
    CrossrefPubMedGoogle Scholar
  • 82 Sachsse U, Reddemann L. Traumazentrierte Psychotherapie mit Imaginationen. Fund Psychiatr 1997; 11: 169-178.
    Google Scholar
  • 83 Sachsse U. et al. Results of psychodynamically oriented trauma-focused inpatient treatment for women with complex posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD). Bull Menninger Clin 2006; 70: 125-144.
    CrossrefPubMedGoogle Scholar
  • 84 Sack M. Metaanalyse der Studien zur EMDR-Behandlung von Patienten mit posttraumatischen Belastungsstörungen. Psychother Psychosom med Psychol 2001; 51: 350-355.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 85 Seidler GH, Wagner FE. Comparing the efficacy of EMDR and trauma-focused cognitive-behavioral therapy in the treatment of PTSD: A meta-analytic study. Psychol Med 2006 (Epub ahead of print).
    PubMedGoogle Scholar
  • 86 Seligman MEP. Helplessness. San Francisco: Freeman; 1975
    Google Scholar
  • 87 Shalev AY. Acute Stress Reactions in Adults. Biol Psychaitry 2002; 51: 532-543.
    Google Scholar
  • 88 Shapiro F. Eye movement desensitization and reprocessing: Basic principles, protocols, and procedures. New York: Guilford; 1995
    Google Scholar
  • 89 Shapiro F. Eye movement desensitization and reprocessing (EMDR) and the anxiety disorders: Clinical and research implications of an integrated psychotherapy treatment. J Anxiety Dis 1999; 13: 35-67.
    CrossrefPubMedGoogle Scholar
  • 90 Simeon D. et al. Dissociation and posttraumatic stress 1 year after the world trade center disaster: Follow-up of a longitudinal survey. J Clin Psychiatry 2005; 66: 231-237.
    CrossrefPubMedGoogle Scholar
  • 91 Solomon Z. et al. The effectiveness of the Koach Project: Negative psychometric outcome. J Trauma Stress 1992; 5: 225-246.
    CrossrefGoogle Scholar
  • 92 Spinazzola J. et al. Posttraumatic stress disorder treatment outcome research: The study of unrepresentative samples. J Trauma Stress 2005; 18: 425-436.
    CrossrefPubMedGoogle Scholar
  • 93 Stickgold R. EMDR: A putative neurobiological mechanism of action. J Clin Psychol 2002; 58: 61-75.
    CrossrefPubMedGoogle Scholar
  • 94 Van der Kolk BA. The complexity of adaptation to trauma. Self-regulation, stimulus discrimination, and characterological development. In: Van der Kolk B, McFarlane AC, Weisaeth L. (eds) Traumatic stress. The effects of overwhelming experience on mind, body, and society. New York: Guilford Press; 1996: 182-213.
    Google Scholar
  • 95 Van der Kolk BA. Psychobiology of posttraumatic stress disorder. In: Panksepp J. (ed) Textbook of biological psychiatry. New York: Wiley-Liss, Hoboken; 2004: 319-344.
    Google Scholar
  • 96 Van der Kolk BA, Fisler RE. Dissociation and the fragmentary nature of traumatic memories: Overview and exploratory study. J Trauma Stress 1995; 8: 505-525.
    CrossrefPubMedGoogle Scholar
  • 97 Van Emmerik AA. et al. Single session debriefing after psychological trauma: A meta-analysis. Lancet 2002; 360: 766-771.
    CrossrefPubMedGoogle Scholar
  • 98 Watson PJ, Shalev AY. Assessment and treatment of adult acute responses to traumatic stress following mass traumatic events. CNS Spectr 2005; 10: 123-131.
    CrossrefPubMedGoogle Scholar
  • 99 Zatzick D. et al. A randomized effectiveness trial of stepped collaborative care for acutely injured trauma survivors. Arch Gen Psychiatry 2004; 61: 498-506.
    CrossrefPubMedGoogle Scholar
  • 100 Foa EB. et al. Treatment of post-traumatic stress disorder in rape victimes. A comparision between cognitive-behavorial procedures and counseling. J Consult Clin Psychol 1991; 59: 715-723.
    CrossrefPubMedGoogle Scholar
  • 101 Litz BT. et al. Decision-making guidelines for the use of direct therapeutic exposure in the treatment of post-traumatic stress disorder. Behav Ther 2005; 13: 91-93.
    Google Scholar
  • 102 Kapfhammer HP. Pharmakotherapie der akuten und posttraumatischen Belastungsstörung. Psychiatrie & Psychotherapie 2005; 1: 25-34.
    Google Scholar