Dokument

Zusammenfassung:
Erworbene Hirnschädigungen führen neben kognitiven Defiziten häufig auch zu anhaltenden motivationalen und emotionalen Störungen. Eine hohe Komorbidität mit psychischen Erkran-kungen ist belegt. Die Behandlung dieser komplexen Problemlagen erfordert die Integration neuropsychologischer und psychotherapeutischer Interventionstechniken. Für die Durchführung einer Therapiestudie zur ambulanten neuropsychologischen Psychotherapie an der Philipps-Universität Marburg wurde ein Behandlungsprogramm entwickelt, dass diese Techniken kombiniert. Im Rahmen dieser aktuell noch laufenden randomisierten kontrollierten Therapiestudie wurde in der vorliegenden Dissertation der therapeutischen Bedeutung von Lebenszielen nachgegan-gen. Einschränkungen in der Erreichbarkeit wichtiger Lebensziele stellen ein individuelles Abbild komplexer Krankheitsfolgen nach einer erworbenen Hirnschädigung dar. Darüber hinaus bieten sie sich aber auch als ein geeigneter Rahmen und zugleich auch als Erfolgsmaßstab einer indivi-duell zugeschnittenen neuropsychologischen Rehabilitation an. Die zentralen Hypothesen zweier Modelle aus der psychologischen Grundlagenforschung wur-den sowohl an ambulanten Studienteilnehmern , als auch an stationären neurologischen Pa-tienten geprüft, um so bereits bestehendes Wissen für die neuropsychologische Therapie ver-fügbar zu machen. Tatsächlich ließen sich zwei Hypothesen des teleonomischen Modells subjektiven Wohlbefindens (Brunstein, Schultheiß, & Maier, 1999) bestätigen: Es genügt nicht allein, wichtige Lebensziele zu haben. Entscheidend für das subjektive Wohlbefinden ist der wahrgenommene Zielerfolg. Die Realisierbarkeit wichtiger Lebensziele moderiert darüberhinaus den Zusammenhang zwischen Wichtigkeit und Erfolg. Die vom dualen Prozessmodell (Brandtstädter & Rothermund, 2002) fokussierten Diskrepanzen zwischen Zielwichtigkeit und Zielerfolg sind in beiden untersuchten klinischen Stichproben signi-fikant größer als bei Gesunden. Die Größe dieser Diskrepanzen ist mit dem Erleben subjektiven Wohlbefindens verknüpft. Die Diskrepanzreduktion durch die Förderung assimilativer und ak-komodativer Strategien könnte ein vielversprechendes therapeutisches Vorgehen darstellen. Auf der Basis dieser Befunde werden in der vorliegenden Arbeit empirisch und theoretisch be-legte Vorschläge für Lebenszielinterventionen in der neuropsychologischen Rehabilitation dar-gestellt. Sie sollen klassisch neuropsychologische Therapieansätze nicht ersetzen sondern indi-vidualisieren und so deren subjektive Sinnhaftigkeit und damit die Therapiemotivation erhöhen.

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