psychologische Schmerztherapie Psychologie Philipps-Universität Marburg opus:7964 monograph Therapieprozesse und Wirkmechanismen psychologischer Schmerztherapie Treatment processes and mechanisms of psychological pain treatments fear-avoidance urn:nbn:de:hebis:04-z2018-00425 2019-01-15 Chronischer Rückenschmerz Fear-Avoidance chronic low back pain This dissertation project investigated treatment processes and mechanisms of graded in vivo exposure and cognitive-behavioral therapy during the treatment of individuals suffering from chronic low back pain and high levels of fear-avoidance. A randomized controlled trial design with individuals suffering from chronic low back pain and high levels of fear-avoidance (n=61) was applied to investigate unique and common treatment processes based on weekly session-by-session measures. We identified changes in fear-avoidance belief as a common treatment process. In addition, changes in relaxation, distraction, confrontation, activity and self-efficacy influenced the treatment success of exposure and cognitive-behavioral therapy. A subsequent single-case design with individuals suffering from chronic low back pain and high levels of fear-avoidance (n=12) was used to evaluate isolated treatment elements based on daily processes measurements. Moreover, effects on biological stress markers were explored. While exposure experience initiated several immediate changes, cognitive-behavioral interventions seemed to build their effect later in time. Furthermore, the exposure group showed relatively lower cortisol levels during a behavioral test immediately after treatment. Thus, treatment effects on biological stress markers appear to be a promising object of future investigation. An experimental design with healthy female students (n=112) was applied to evaluate therapist instructions during the conduction of exposure sessions. These instructions were justified by competing theories on mechanisms of change. Assumptions of the habituation model and the inhibitory learning model were compared. Both instructions improved cognitive pain coping. Only the instruction according to the inhibitory learning model increased pain tolerance. Similarly, only the instruction according to the inhibitory learning model lead to specific psychophysiological changes. These psychophysiological changes can be better explained by assumptions of the inhibitory learning model compared to assumptions of the habituation model. Overall, this dissertation project contributes to an improved understanding of treatment process-es and mechanisms within psychological pain treatments. At the same time, isolated treatment elements and therapist instructions were evaluated. 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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. 2017 doctoralThesis treatment processes Therapieprozesse