Publikationsserver der Universitätsbibliothek Marburg

Titel: Die Bedeutung des Selbstwertgefühls für die Entstehung und Aufrechterhaltung von Verfolgungswahn
Autor: Kesting, Marie-Luise
Weitere Beteiligte: Lincoln, Tania M., (Prof. Dr.)
Veröffentlicht: 2013
URI: https://archiv.ub.uni-marburg.de/diss/z2013/0250
DOI: https://doi.org/10.17192/z2013.0250
URN: urn:nbn:de:hebis:04-z2013-02501
DDC: Psychologie
Titel(trans.): The relevance of self-esteem for the formation and maintenance of persecutory delusions
Publikationsdatum: 2013-06-03
Lizenz: https://rightsstatements.org/vocab/InC-NC/1.0/

Dokument

Schlagwörter:
Verfolgungswahn, paranoia, schizophrenia, self-esteem, persecutory delusions, Paranoia, Selbstwertgefühl, Schizophrenie

Zusammenfassung:
Verfolgungsideen sind ein häufiges Symptom psychotischer Störungen. Psychologische Erklärungsmodelle betonen neben Auffälligkeiten in Attributions- und Entscheidungsprozessen die Relevanz eines erniedrigten Selbstwertgefühls für die Entstehung von Verfolgungswahn (Freeman, Garety, Kuipers, Fowler, & Bebbington, 2002). Auch eine Vielzahl von Studien spricht dafür, dass Patienten mit Verfolgungsideen unter großen Selbstwerteinbußen leiden (Freeman, 2007). In der Folge beinhalten kognitiv-behaviorale Therapien für Patienten mit Schizophrenie auch Interventionen zur Selbstwertsteigerung (Fowler, Garety, & Kuipers, 1995; Moritz, Vitzthum, Randjbar, Veckenstedt, & Woodward, 2010). Dennoch ist die spezifische Rolle des Selbstwertgefühls bei der Entstehung und Aufrechterhaltung von Verfolgungsideen bislang nicht vollständig geklärt. Insbesondere bestehen bezüglich des expliziten und impliziten Selbstwerts sowie bezüglich der Bedeutung von Selbstwertschwankungen im Entstehungsprozess paranoider Gedanken noch offene Fragen. Ziel dieser Dissertation ist es deshalb, diese Aspekte des Selbstwerts bei Menschen mit Verfolgungsideen differenziert zu untersuchen. Ein tieferes Verständnis des komplexen Zusammenhangs zwischen dem Selbstwertgefühl und Verfolgungsideen könnte insbesondere hilfreich sein, um weitere spezifische psychologische Interventionen für Patienten mit Wahn zu entwickeln. In Artikel 1 konnte bestätigt werden, dass Patienten mit akuten und remittierten Verfolgungsideen im Vergleich zu gesunden Probanden ein erniedrigtes explizites Selbstwertgefühl aufweisen, während sich keine Gruppenunterschiede im impliziten Selbstwertgefühl fanden. Innerhalb der Patientengruppe unterschieden sich der explizite und der implizite Selbstwert jedoch nicht. Artikel 2 gab Aufschluss über die Rolle des Selbstwertgefühls im Entstehungsprozess paranoider Gedanken. In einer nichtklinischen Stichprobe führte sozialer Stress bei vulnerablen Personen zu einem Anstieg paranoider Gedanken und dieser Prozess wurde durch eine Reduktion im Selbstwert mediiert. In Artikel 3 wurde die Bedeutung des Selbstwertgefühls und der Selbstschemata für Verfolgungsideen anhand des aktuellen Forschungsstandes im Rahmen eines Reviews untersucht. Hierbei erwies es sich als gut belegt, dass Menschen mit klinisch relevanten und subklinischen Verfolgungsideen durch ein erniedrigtes explizites Selbstwertgefühl und negative Selbstschemata charakterisiert sind. Zusätzlich gibt es wenige Studien mit jedoch einheitlichen Ergebnissen, die dafür sprechen, dass Patienten, die ihre Verfolgung als berechtigt wahrnehmen, einen erniedrigten Selbstwert haben und dass der Selbstwert bei Menschen mit Verfolgungsideen instabil ist. Insgesamt weisen die Ergebnisse dieser Dissertation somit darauf hin, dass ein global erniedrigtes explizites Selbstwertgefühl, negative Selbstschemata und eine momentane Reduktion im Selbstwertgefühl für die Entstehung und Aufrechterhaltung paranoider Gedanken von Bedeutung sind. Die Befunde werden abschließend in ein Erklärungsmodell integriert, das die Rolle des Selbstwertgefühls bei der Entstehung von Verfolgungsideen beschreibt und dabei frühere negative Lebensereignisse als eine mögliche Ursache für die Entstehung negativer Selbstschemata berücksichtigt. Die Ergebnisse dieser Dissertation untermauern schließlich die Notwendigkeit, in der Therapie von Patienten mit Wahn spezifische Interventionen zur Selbstwertsteigerung und -stabilisierung einzusetzen.

Summary:
Persecutory delusions are a prevalent symptom in psychotic disorders. In addition to attribution and reasoning biases, psychological models emphasize the relevance of low self-esteem for the formation of persecutory delusions (Freeman et al., 2002). Also, a number of studies speak for the notion that patients with persecutory delusions suffer from feelings of inferiority (Freeman, 2007). As a consequence, cognitive-behavioral therapy programs for patients with schizophrenia include interventions that aim at improving self-esteem (Fowler et al., 1995; Moritz, Vitzthum, et al., 2010). However, the specific role of self-esteem in the formation and maintenance of persecutory delusions is not clarified yet. In particular, there are still outstanding questions concerning the levels of explicit and implicit self-esteem in patients with persecutory delusions and concerning the role of fluctuations in self-esteem in the formation of paranoid beliefs. Therefore, the aim of the present dissertation project is to investigate these aspects of self-esteem in persons with persecutory delusions. A deeper understanding of the complex relation between self-esteem and persecutory delusions could be helpful in developing specific psychological interventions for patients with delusions. Paper 1 demonstrated that patients with acute and remitted persecutory delusions have low levels of explicit self-esteem compared to healthy individuals. However, there were no group differences in levels of implicit self-esteem. Also, there were no differences between levels of explicit and implicit self-esteem within the patient sample. Paper 2 provided information about the role of self-esteem in the formation of paranoid beliefs. In a nonclinical sample, social stress led to an increase of paranoid ideation in individuals with high vulnerability. This process was further mediated by a reduction in self-esteem. The study of paper 3 investigated the relevance of self-esteem and self-schema to persecutory delusions by reviewing the existing research in this field. There was sufficient evidence that persons with clinically relevant or subclinical persecutory beliefs are characterized by low global self-esteem and negative self-schemas. In addition, there was consistent evidence from a small number of studies that patients who believe that their persecution is deserved have low self-esteem and that self-esteem is instable in patients with persecutory delusions. Overall, the findings of the present dissertation project indicate that low global explicit self-esteem, negative self-schemas and an acute reduction in self-esteem are relevant factors for the formation and maintenance of persecutory beliefs. These results are integrated into an explanatory model, which describes the role of self-esteem in the formation of persecutory delusions and considers previous adverse experiences as a potential cause of impaired self-esteem. Finally, the findings of the present dissertation project stress the need for specific interventions that aim at improving and stabilizing the patients´ self-esteem.

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