Kognitive Verhaltenstherapie bei schizophrenen Psychosen : Zentrale Komponenten und ihre Relevanz für die Praxis

The success of established treatments in the health care of patients with psychosis is still limited (Jääskelainen et al., 2013). The regular application of new and effective treatments and a continuous improvement of health care are therefore needed. Since the nineties British researchers have progressed in developing Cognitive Behavioral Therapy for Psychosis (CBTp). The evidence base of CBTp has been proven in various studies (Wykes et al., 2008). As a consequence, German and international guidelines recommend the application of CBTp (Gaebel, Falkai, Weinmann, & Wobrock, 2006; NICE, 2009). However, across countries the implementation and dissemination of CBTp in routine practice are deficient (Prytys et al., 2011). Still CBTp has great potential to improve routine health care of psychosis patients. The present dissertation addresses different approaches of how CBTp might help to improve treatment of people with psychosis in routine clinical practice. A possible approach is the isolated application of central components of CBTp. To investigate the effect of an isolated application of such central components study I and II used an experimental study design with healthy people who served as analogue patients. The CBTp based interventions were compared with interventions applied in routine clinical practice. Study I used an online study design to address the effect of different causal models on a person suffering from psychosis symptoms and seeking help in a clinical setting (N=461). Study II compared the effect of a normalizing and an educating approach on people presenting with delusions in experiments conducted in one-on-one encounters (N=81). Study III used a correlative study design to investigate how much priority clinical psychologists and psychiatrists across Germany (N=195) give to CBTp and which factors predict a higher priority to identify possible starting points for improving the implementation of CBTp. In study I participants who had heard a causal model that (similarly to the cognitive model in CBTp) combines biological and psychological factors reported higher treatment motivation and perceived personal control over symptoms compared to uniquely biological or psychological models or no causal model. In study II the normalizing approach resulted in higher treatment motivation compared to an educating approach. Study III found that clinical psychologists and psychiatrists in Germany gave only low priority to CBTp in the treatment of psychosis. Participants who were trained in CBT and in CBTp and who endorsed a normalizing rationale of psychosis reported a higher priority for CBTp. Following the results, the examined components of CBTp might have a beneficial effect even when applied isolated. The benefit on treatment motivation was superior compared to other approaches commonly practiced. The isolated application of central CBTp components could therefore improve routine psychosis treatment independently of the implementation of a comprehensive CBTp treatment. However, to further improve the implementation of CBTp (also as comprehensive treatment) specialized trainings turned out to be helpful. Furthermore, the normalizing rational of psychosis turned out to be of special importance. Trainings should therefore pay special attention to basic rationales co CBTp.