Abstract
Zusammenfassung.Theoretischer Hintergrund und Fragestellung: Chronische Wahnsymptomatik und Halluzinationen stellen ein großes Problem in der Behandlung schizophrener Störungen dar. Methode: Es handelt sich um eine Übersichtsarbeit mit einer Analyse theoretischer Konzepte, therapeutischer Strategien und empirischer Studien. Ergebnisse: Die kognitive Verhaltenstherapie setzt bei Wahn v.a. mit dem Aufbau funktionellerer Alternativerklärungen durch Reattributionstechniken, Reduktion von aufrechterhaltendem Meidungsverhalten und von negativen affektiven Folgen an. Halluzinatorische Symptomatik wird v.a. durch aufmerksamkeitslenkende Strategien und Umbewertungsprozesse angegangen. Schlußfolgerungen: Die Wirksamkeit kognitiver Verhaltenstherapie auch bei chronifiziertem Wahn und Halluzinationen ist belegt. Zukünftige Studien sollten die wesentlichen therapeutischen Wirkfaktoren für diese Veränderungen identifizieren helfen.
Abstract.Background and objective: In spite of progress in psychopharmacological treatment in schizophrenia delusions and hallucinations persist in a substantial proportion of patients. Method: A literature review with analysis and critical discussion of concepts, therapeutic interventions and empirical results is presented. Results: Cognitive-behavioral therapy (CBT) for chronic psychosis focused on social-cognitive deficits underlying persistent symptoms. Therefore CBT for delusions focused on reattribution and enhancement of self-control strategies. Low controllability expectation and monitoring deficts are discussed in persistent hallucinations. So CBT for chronic hallucinations focused on distancing strategies and reframing. Conclusions: The results of the review support that CBT contributes to the reduction of persistent delusions and hallucinations. Nevertheless future investigations are necessary to identify the essential therapeutic change agents.
Literatur
Appelbaum, P. S. , Robbins, P. C. , Roth, L. H. (1999). Dimensional approach to delusions: comparison across types and diagnoses.. American Journal of Psychiatry, 156, 1938– 1943 .Chadwick, P. , Birchwood, M. (1994). The omnipotence of voices. A cognitive approach to auditory hallucinations.. British Journal of Psychiatry, 164, 190– 201 .Chadwick, P. , Birchwood, M. , Trower, P. (1996). Cognitive therapy for delusions. . Chichester: John Wiley and Sons .Drury, V. M. , Birchwood, M. , Cochrane, R. , Macmillan, F. (1996). Cognitive therapy and recovery from acute psychosis: a controlled trial: Impact on psychotic symptoms.. British Journal of Psychiatry, 169, 593– 601 .Eickhoff, K. , Vauth, R. , Olbrich, H. M. (1997). Streß-/Angst-Management und Selbstkonzeptstabilisierung bei persistierender Wahnsymptomatik.. In C. Mundt, M. Linden, & W. Barnett (Hrsg.), Psychotherapie in der Psychiatrie (S. 101-108). Berlin: Springer .Falloon, I. , Talbot, R. E. (1981). Persistent auditory hallucinations: coping mechanisms and implications for management.. Psychological Medicine, 11, 329– 339 .Freeman, D. , Garety, P. (1999). Worry, worry processes and dimensions of delusions: An exploratory investigation of a role for anxiety processes in the maintenance of delusional distress.. Behavioural and Cognitive Psychotherapy, 27, 47– 62 .Garety, P. , Fowler, D. , Kuipers, E. (2000). Cognitive-behavioral therapy for medication-resistant symptoms.. Schizophrenia Bulletin, 26, 73– 86 .Garety, P. , Kuipers, E. , Fowler, D. , Chamberlain, F. , Dunn, G. (1994). Cognitive behavioural therapy for drug-resistant psychosis.. British Journal of Medical Psychology, 67, 259– 271 .Grawe, K. (1998). Psychologische Therapie. . Göttingen: Hogrefe .Haddock, G. , Tarrier, N. , Morrison, A. P. , Hopkins, R. , Drake, R. , Lewis, S. (1999). A pilot study evaluating the effectiveness of individual inpatient cognitive-behavioural therapy in early psychosis.. Social Psychiatry and Psychiatric Epidemiology, 34, 254– 258 .Harrow, M. , MacDonald, A. W. , Sands, J. R. , Silverstein, M. L. (1995). Vulnerability to delusions over time in schizophrenia and affective disorders.. Schizophrenia Bulletin, 21, 95– 109 .Horvath, A. O. , Symonds, B. D. (1991). Relationship between working allience and outcome in psychotherapy: a meta analysis.. Journal of Consulting and Clinical Psychology, 38, 149– .Jones, C. , Cormac, I. , Mota, J. (1998). Cognitive behavior therapy for schizophrenia. In The Cochrane Library. . Oxford, England: Update Software .Jorgensen, P. (1994). Course and outcome in delusional beliefs.. Psychopathology, 27, 89– 99 .Kemp, R. , David, A. , Haywood, P. (1996b). Compliance therapy: an intervention targeting insight and treatment adherence in psychotic patients.. Behavioral and Cognitive Psychotherapy, 24, 331– 350 .Kemp, R. , Hayward, P. , Applewhaite, G. , Everitt, B. , David, A. (1996a). Compliance therapy in psychotic patients: randomised controlled trial.. British Medical Journal, 312, 345– 349 .Kemp, R. , Kirov, G. , Everitt, P. , Haywood, P. (1998). Randomized controlled trial of compliance therapy: 18-month follow-up.. British Medical Journal, 172, 413– 419 .Kuipers, E. , Fowler, D. , Garety, P. , Chisolm, D. , Freeman, D. , Dunn, G. , Bebbington, P. , Hadley, C. (1998). London-East Anglia randomised controlled trial of cognitive behavioral therapy for psychosis: III. follow-up and economic evaluation at 18 months.. British Journal of Psychiatry, 173, 61– 68 .Kuipers, E. , Garety, P. , Fowler, D. , Dunn, G. , Bebbington, P. , Freeman, D. , Hadley, C. (1997). London-East Anglia randomised controlled trial of cognitive-behavioural therapy for psychosis: I. Effects of the treatment phase.. British Journal of Psychiatry, 171, 319– 327 .McGlashan, T. H. (1994). What has become of the psychotherapy of schizophrenia?. Acta Psychiatrica Scandinavica, Supplementum, 384, 147– 152 .McGorry, P. , Chanen, A. , McCarthy, E. (1991). Posttraumatic stress disorder following recent onset psychosis: an unrecognized postpsychotic syndrome.. Journal of Nervous and Mental Diseases, 179, 253– 258 .Miller, W. R. (1983). Motivational interviewing with problem drinkers.. Behavioural Psychotherapy, 11, 147– 172 .Mueser, K. T. , Gingerich, S. (1994). Coping with schizophrenia. A guide for families. . Oakland: New Harbinger Pulications .Sensky, T. , Turkington, D. , Kingdon, D. , Scott, J. L. , Scott, J. , Siddle, R. , O’Carroll, M. , Barnes, T. R. (2000). A randomized controlled trial of cognitive-behavioral therapy for persistent symptoms in schizophrenia resistant to medication.. Archives of General Psychiatry, 57, 165– 172 .Shergill, S. S. , Murray, R. M. , Mcguire, P. K. (1998). Auditory hallucinations: a review of psychological treatments.. Schizophrenia Research, 32, 137– 150 .Slade, P. D. , Bentall, R. P. (1988). Sensory deception: a scientific analysis of hallucination. . London: Croom Helm .Tarrier, N. , Yusupoff, L. , Kinney, C. , McCarthy, E. , Gledhill, A. , Haddock, G. , Morris, J. (1998). Randomised controlled trial of intensive cognitive behaviour therapy for patients with chronic schizophrenia.. British Medical Journal, 317, 303– 307 .Tien, A. Y. (1991). Distributions of hallucinations in the population.. Social Psychiatry and Psychiatric Epidemiology, 26, 287– 292 .Vauth, R. , Stieglitz, R.-D. (1994). Verhaltenstherapeutische Interventionen bei persistierender halluzinatorischer und wahnhafter Symptomatik schizophrener Patienten.. Verhaltenstherapie, 3, 177– 185 .
