Publikationsserver der Universitätsbibliothek Marburg
Titel:Therapieprozesse und Wirkmechanismen psychologischer Schmerztherapie
Autor:Schemer, Lea
Weitere Beteiligte: Glombiewski, Julia Anna (PhD)
Veröffentlicht:2017
URI:https://archiv.ub.uni-marburg.de/diss/z2018/0042
URN: urn:nbn:de:hebis:04-z2018-00425
DOI: https://doi.org/10.17192/z2018.0042
DDC:150 Psychologie
Titel (trans.):Treatment processes and mechanisms of psychological pain treatments
Publikationsdatum:2019-01-15
Lizenz:https://rightsstatements.org/vocab/InC-NC/1.0/

Dokument

Schlagwörter:
psychologische Schmerztherapie, fear-avoidance, Chronischer Rückenschmerz, Fear-Avoidance, chronic low back pain, psychological pain treatments, mechanisms of change, Wirkmechanismen, treatment processes, Therapieprozesse

Zusammenfassung:
Das übergeordnete Ziel dieses Dissertationsprojektes war es Therapieprozesse und Wirkmechanismen von Expositionstherapie bzw. kognitiver Verhaltenstherapie zur Behandlung chronischer Rückenschmerzen zu untersuchen. Im Rahmen einer randomisiert kontrollierten Therapiestudie mit hochängstlichen chronischen Rückenschmerzpatientinnen und Rückenschmerzpatienten (n=61) wurden therapiespezifische und gemeinsame Therapieprozesse auf Grundlage wöchentlicher Prozessmessungen untersucht. Hierbei wurden Veränderungen in Angstvermeidungsüberzeugungen als gemeinsamer Therapieprozess identifiziert. Weiterhin beeinflussten Entspannung, Ablenkung, Konfrontation, Aktivitätsniveau und Selbstwirksamkeit sowohl den Therapieerfolg der Expositionstherapie als auch der kognitiven Verhaltenstherapie. Im Rahmen einer anschließenden Einzelfallstudie mit hochängstlichen chronischen Rücken-schmerzpatientinnen und Rückenschmerzpatienten (n=12) wurden einzelne Therapieelemente auf Grundlage täglicher Prozessmessungen evaluiert. Zudem wurden Effekte auf biologische Stressmarker exploriert. Während individuelle Expositionserfahrungen eine Reihe von unmittelbaren Veränderungsprozessen bewirkten, führte die kognitive Verhaltenstherapie eher zu zeitverzögerten Veränderungsprozessen. Weiterhin zeigten sich in der Expositionsgruppe vergleichsweise niedrigere Kortisolwerte während eines Verhaltenstests unmittelbar nach Therapieende. Die Erforschung von Therapieeffekten auf biologische Stressmarker scheint also ein vielversprechender Untersuchungsgegenstand für zukünftige Forschung. Im Rahmen eines Experiments mit gesunden Studentinnen (n=112) wurden zwei therapeutische Instruktionen während der Durchführung von Expositionen evaluiert. Diese Instruktionen beruhten auf konkurrierenden Theorien über zugrundeliegende Wirkmechanismen. Die Annahmen des Habituationsmodells und des Inhibitionsmodells wurden einander gegenübergestellt. Beide Instruktionen verbesserten die kognitive Schmerzbewältigung. Allerdings verbesserte nur die Instruktion gemäß des Inhibitionsmodells die Schmerztoleranz. Zudem führte nur die Instruktion gemäß des Inhibitionsmodells zu einem spezifischen psychophysiologischen Aktivierungsmuster, welches sich besser durch Annahmen des Inhibitionsmodells als durch Annahmen des Habituationsmodells erklären lässt. Insgesamt trägt die vorliegende Arbeit unter Einsatz unterschiedlicher Forschungsmethoden zu einem besseren Verständnis von Therapieprozessen und Wirkmechanismen psychologischer Schmerztherapie bei. Gleichzeitig wurden isolierte Therapieelemente sowie therapeutische Instruktionen evaluiert. Methodische Überlegungen bei der Auswahl der jeweiligen Forschungsdesigns werden im Hinblick auf zukünftige Psychotherapieforschung diskutiert.

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