Publikationsserver der Universitätsbibliothek Marburg

Titel: Optimierung der Behandlung von Patienten mit multiplen somatoformen Symptomen
Autor: Gottschalk, Japhia-Marie
Weitere Beteiligte: Rief, Winfried (Prof.Dr.)
Veröffentlicht: 2014
URI: https://archiv.ub.uni-marburg.de/diss/z2015/0005
URN: urn:nbn:de:hebis:04-z2015-00053
DOI: https://doi.org/10.17192/z2015.0005
DDC: Psychologie
Titel(trans.): Optimizing the treatment of patients with multiple somatoform symptoms
Publikationsdatum: 2015-01-14
Lizenz: https://rightsstatements.org/vocab/InC-NC/1.0/

Dokument

Schlagwörter:
Psychosomatic disorder, Psychotherapie, Psychotherapy, Psychosomatische Störung, emotion regulation, Emotionsregulation

Zusammenfassung:
Die Erforschung von wirksamen psychologischen Behandlungsmöglichkeiten für Patienten1 mit multiplen somatoformen Symptomen (MSS) zeigt sich als dringend indiziert. Die Übersichtsarbeit (Studie 1) liefert Informationen zu psychotherapeutischen Behandlungsmöglichkeiten, leitliniengerechtem Umgang und einen Überblick über randomisiert-kontrollierte Studien zur Psychotherapie von Patienten mit MSS. Es finden sich Hinweise für Emotionswahrnehmungs- und regulationsdefizite bei diesen Patienten, welche in bisherigen Behandlungsansätzen jedoch keine Beachtung fanden. In der vorliegenden Dissertation sollen zwei Aspekte zur Optimierung der Behandlung von Patienten mit MSS bearbeitet werden. Erstens wurde ein Behandlungsmanual ENCERT („ENriching Cognitive behavioral therapy with Emotion Regulation Training“) für Patienten mit MSS entwickelt, welches kognitiv verhaltenstherapeutische (KVT)-Elemente mit achtsamkeitsbasierten Strategien verbindet. Dieses selbstentwickelte Behandlungskonzept wurde im Rahmen einer nicht randomisierten-kontrollierten Pilotstudie (ENCERT: N = 20, KVT: N = 22) überprüft und hinsichtlich der Durchführbarkeit untersucht (Studie 2). Patienten mit MSS verbesserten sich während ENCERT und KVT gleichermaßen hinsichtlich Anzahl und Intensität ihrer unerklärten Körperbeschwerden und der damit einhergehenden Beeinträchtigung. ENCERT wies in nahezu allen Zielmaßen höhere Effektstärken auf als KVT, statistisch signifikante Gruppenunterschiede zeigten sich jedoch nicht. Zweitens wurde an einer Stichprobe von N = 48 Patienten mit MSS und N = 48 gematchten Gesunden auf experimenteller Ebene die kurzfristige Wirksamkeit verschiedener Emotionsregulationsstrategien (Akzeptanz, kognitive Umstrukturierung, positive Selbstunterstützung und Ablenkung) auf induzierte individuell beeinträchtigende somatoforme Symptome untersucht (Studie 3). Die Ergebnisse zeigen, dass Gesunde von allen Strategien in Bezug auf eine Reduktion der Symptom-Intensität, eine Reduktion der Beeinträchtigung und eine Steigerung des Aushaltens profitierten. Bei Patienten mit MSS zeigte sich in Bezug auf eine Reduktion der Beeinträchtigung die Akzeptanzstrategie überlegen gegenüber Ablenkung und Selbstunterstützung. Betreffend der Symptom-Intensität und der Steigerung des Aushaltens zeigten sich keine Unterschiede zwischen den Strategien. Im Rahmen der vorliegenden Arbeit wurde mit der Erstellung eines Manuals, welches achtsamkeitsbasierte Strategien mit klassischen KVT Interventionen vereint, eine wirksame und gut durchführbare Alternative zu klassischer KVT entwickelt. Weiterhin konnte gezeigt werden, dass die Wirksamkeit der untersuchten Strategien von den Outcome-Variablen abhängt und bei Patienten und Gesunden unterschiedlich ausfällt. Akzeptanzbasierte Strategien schienen zur Reduktion der Beeinträchtigung durch die Beschwerden gegenüber Strategien wie Ablenkung und Selbstunterstützung bei Patienten mit MSS überlegen zu sein, jedoch nicht gegenüber kognitiver Umstrukturierung. Eine Integration achtsamkeitsbasierter Strategien in KVT, nach vorheriger experimenteller Wirksamkeits-Untersuchung, scheint daher für die Bewältigung medizinisch unerklärter körperlicher Beschwerden sinnvoll.

Summary:
The review article (study 1) is giving an overview about psychotherapeutic approaches, effective dealing and randomized controlled treatment trials for patients with somatoform disorders and shows that powerful interventions are urgently required. Many of those patients seem to lack emotional awareness and show deficits in emotion regulation abilities, but the integration of emotion regulation training have not been assessed so far. The dissertation deals with two subjects for enhancing the treatment of patients with multiple somatoform symptoms (MSS). First, we developed the treatment manual ENCERT („ENriching CBT with Emotion Regulation Training“), by enriching cognitive behavioral treatment (CBT) with mindfulness based emotion regulation strategies. The objective was to validate the manual in a non-randomized controlled pilot-study (ENCERT: N = 20, CBT: N = 22) and to demonstrate its feasibility (study 2). Patients with MSS improve during ENCERT and CBT with tendentially larger effect sizes for ENCERT, but no group differences. Second, we experimentally compared short-term effects of acceptance, cognitive reappraisal, compassionate self-support, and distraction on induced somatic symptoms in a group of 48 patients with MSS and 48 matched healthy controls (study 3). The results show that healthy controls benefit from all emotion regulation strategies in reducing the intensity, the impairment and increasing the bearing. Concerning reducing the impairment in patients with MSS, acceptance showed to be significantly superior to compassionate self-support and distraction. However, there were no differences between the emotion regulation strategies regarding intensity and bearing of symptoms. To conclude, the dissertation provides a treatment manual, which demonstrated comparable effectivity to CBT and good feasibility. Furthermore, the results indicate that differences within effectiveness depend on outcome measures and are different between patients with MSS and healthy controls. In patients with MSS, acceptance showed to be significantly superior to compassionate self-support and distraction, but not to reappraisal. These findings support the integration of mindfulness-based strategies into CBT, but not until experimentally detecting its efficiencies in each patient.

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