Kognitive Therapie des chronischen dekompensierten Tinnitus

Chronic earnoises lead to severe emotional disturbances in many individuals. At the moment, it is not possible to treat chronic tinnitus effectively on a medical basis. If the individual suffers strongly, psychological interventions can help reduce the degree of subjective tinnitus annoyance. Psychotherapists are often insecure when treating tinnitus sufferers, because of their tendency to strongly focus on the chronic earnoises. Knowledge about typical dysfunctional beliefs and systematic cognitive mistakes, that hinder the habituation process in tinnitus sufferers, help understand the patient and help find an anchor point for reducing tinnitus annoyance. In this paper, the most important cognitive characteristics of tinnitus sufferers are summarised and the cognitive modification process is systematically described.     

Die akute Therapie des ischämischen Schlaganfalles

Seit Etablierung unserer ersten Stroke Units als Spezialstationen zur Akutbehandlung von Schlaganfallpatienten 1996 und 1998 sind die Herausforderungen an das Management im Bereich der akuten Schlaganfalltherapie durch steigende Patientenzahlen, zunehmende Lyseraten und abnehmende Liegedauer in Kombination mit neuen, Erfolg versprechenden Therapieoptionen stetig angestiegen.     

Tinnitus und das Leiden am Tinnitus

Psychosomatic findings from 287 patients with tinnitus are presented in this article, who were seen by medical psychotherapists specialized in ENT for a period of 15 months. They were assigned to all of the therapeutic methods being offered. As relevant proved to be the neurootological professional competence, especially for recognizing and treating auditory limitations (in 41% of the patients) as well as noticing and treating the psychological comorbidity (in 45.3% of the patients). While neurophysiological and psychophysiological models interpret the subjective tinnitus stress as the failing of habituation, dysfunctional attention processes and assessments, from a psychodynamic view a symptom having pathological significance, such as the suffering from tinnitus (not the tinnitus itself) may develop if the defensive mechanisms are exhausted, a conflict cannot be resolved on the conscious level or traumatic experiences were made. It is recommended that an approach specifically matched with the disturbance is made taking into account both possible psychodynamic causes and sustaining factors in the cognitive behavioral sense, all on an audiologic background.     

Tinnitus

Tinnitus is defined as the perception of sound in the absence of an acoustic stimulus. With a prevalence of about 10-15% among adults tinnitus is a common symptom. If tinnitus persists for a longer time and if the patient does not adapt to it, a range of associated problems can be found. The most common problems are sleep disturbance, emotional disturbance and concentration problems. Given the distress caused by tinnitus the risk of patients falling into a vicious circle of increased attention to tinnitus, dysfunctional appraisal processes, negative emotions and avoidance behaviour increases. This in turn, can severely affect tinnitus distress and quality of life in the long run. Different treatment approaches for tinnitus have been developed and cognitive-behavioural forms of treatment in particular were found to be effective in reducing tinnitus distress. The present paper provides an overview of the symptom tinnitus, etiological models, diagnostic approaches and different forms of treatment.     

Acceptance of Tinnitus: Validation of the Tinnitus Acceptance Questionnaire

Internet‐based interventions with therapist support have proven effective for treating a range of mental health conditions. This study examined whether frequency of therapist contact affected treatment outcomes. Fifty‐seven people with panic disorder (including 32 with agoraphobia) were randomly allocated to an 8‐week Internet‐based cognitive behavioural treatment intervention (Panic Online) with either frequent (three e‐mails per week) or infrequent (one e‐mail per week) support from a psychologist. Posttreatment, intention‐to‐treat analyses revealed that both treatments were effective at improving panic disorder and agoraphobia severity ratings, panic‐related cognitions, negative affect, and psychological and physical quality of life domains, with no differences between conditions. High end‐state functioning was achieved by 28.6% of the frequent and infrequent participants, respectively. Therapist alliance, treatment credibility, and satisfaction also did not differ between groups, despite significantly greater therapist time invested in the frequent contact condition. The results provide evidence that the effectiveness of Internet‐based mental health interventions may be independent of the frequency of therapist support and may, therefore, be more cost‐effective than previously reported.     

Musiktherapie bei chronisch-tonalem Tinnitus

Tinnitus therapy according to the Heidelberg model of music therapy integrates psychological strategies in order to manage the perception and approaches to tinnitus aimed at curing the underlying somatic disorder. The specific musical therapeutic interventions as well as the postulated specific effective factors are explained. Several multidisciplinary studies support the effectiveness of this form of therapy. The results indicate that the therapy is highly advantageous in terms of treatment duration, effectiveness, and follow-up stability compared to customary interventions. Furthermore, the results of brain imaging strongly suggest the usefulness of further investigations and discussion in the realm of neuronal modeling of chronic tinnitus.     

耳鸣的心理机制

现有研究表明, 耳鸣给患者带来的心理问题比机体自身的病理损伤更为严重, 其中最突出的是患者的注意与情绪问题。近年来, 研究者利用多种方法从多角度证实了耳鸣患者存在不同程度的注意障碍; 同时, 影像学研究也发现部分情绪脑区的活性增强与耳鸣患者的情绪障碍显著相关。这些研究成果不仅为耳鸣的客观评估提供了可行性依据, 也为心理治疗的进一步发展奠定了基础。随着耳鸣患者对生活质量要求的提高, 未来耳鸣研究应着重帮助患者缓解负性情绪, 纠正不良行为, 帮助其重新过上正常的生活。     

Psychoanalytische Therapie

A statement of the professional umbrella society DGPT is presented that was formulated in cooperation with the various professional societies and with the German Society of Psychosomatic Medicine and Psychotherapy and the Society of Child and Adolescent Therapy. The statement is a reaction to the public claim for effective evidence of psychotherapy and takes the opportunity for a comprehensive presentation of this field. In the introduction Alf Gerlach, as chairman of the umbrella society at the time of the formulation of this statement and now executive chairman responsible for coordinating research, describes the history of the development of the statement.There were two particular moments prompting this statement. On the one hand the Scientific Advisory Board for Psychotherapy as an advisory committee based on the law of psychotherapy, has presented demands for effective evidence that are incompatible with psychoanalysis. Thus, the recognition of psychoanalysis as a treatment method for illnesses was put in doubt. On the other hand, a suggestion was put forward to the Board to recognize psychodynamic psychotherapy as an independent entity. This questioned the unity of the psychotherapeutic field.The statement was passed onto the Scientific Advisory Board last autumn. It is intended for a professional audience and includes answers to important issues of this field. It will have an important role to play in future discussions about professional politics. For this reason, we have decided to begin the present issue of our journal with this statement and thus to open a wide discussion forum.

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Deutsche Gesellschaft für Psychoanalyse, Psychotherapie, Psychosomatik und Tiefenpsychologie e.V. (DGPT)In Verbindung mit:Deutsche Gesellschaft für Analytische Psychologie (DGAP)Deutsche Gesellschaft für Individualpsychologie (DGIP)Deutsche Gesellschaft für Psychotherapeutische Medizin (DGPM)Deutsche Psychoanalytische Gesellschaft (DPG)Deutsche Psychoanalytische Vereinigung (DPV)Vereinigung Analytischer Kinder- und Jugendlichen-Psychotherapeuten (VAKJP)Redaktion: Stephan Hau und Marianne Leuzinger-Bohleber

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Autobiographical Memory in Patients with Tinnitus

Studies on psychiatric patients have found that their memories of the past are often unspecific and overgeneral, but the extent to which this is the case for patients with somatic problems has so far only been examined in patients with chronic pain and in patients with diabetes. The present study investigated autobiographical memories in 19 tinnitus patients and 19 controls without tinnitus. Participants were administered the autobiographical memory test (AMT), the Controlled word association test, and self-report measures of depression, anxiety, and tinnitus distress. Compared to control participants, tinnitus patients had difficulty retrieving specific memories and showed longer retrieval latencies. Additionally, tinnitus patients had fewer specific memories to positive cue words. While AMT responses were associated with depression scores, the difference between controls and patients remained significant for positive cue words after controlling for depression scores. Results suggest that cognitive components should be an integral element of the psychological management of tinnitus. The use in future studies of experimental methods such as AMT in health psychology is encouraged.     

Anxiety Sensitivity in Patients with Chronic Tinnitus

Tinnitus is the perception of sounds (often ringing or buzzing) in the absence of any external auditory stimulation, hence sometimes called a ''phantom auditory perception''. Although most people tend to ignore their tinnitus, a significant proportion will show marked annoyance and reduced quality of life as a result of this complaint. It is difficult to predict those who are likely to develop severe problems with tinnitus, but psychosocial aspects such as anxiety and depression have been proposed as mediators. In this study we investigated the role of anxiety sensitivity defined as a trait tendency to fear anxietyrelated sensations. The study sample included 146 tinnitus patients with moderate to severe tinnitus. Results showed that anxiety sensitivity correlated significantly with tinnitus distress, but the association was significantly stronger in female participants who also displayed more signs of anxiety sensitivity. A multiple regression analysis revealed that anxiety sensitivity contributed to explained variance in tinnitus distress beyond audiological measures of tinnitus maskability and hearing thresholds. These results are discussed in light of related investigations on the role of anxiety sensitivity in somatic conditions.     

Optimierung expositionsbasierter Therapie

Exposure is an effective approach for treating anxiety disorders, although a substantial number of individuals fail to benefit or experience a return of fear. Research results suggest that anxious individuals show deficits in the mechanisms underlying exposure therapy, such as inhibitory learning. Targeting these processes may help improve the efficacy of exposure; however, there has been little discussion of how to implement this model in clinical practice. The primary aim of this paper is to provide examples to clinicians for how to apply this model to optimize exposure therapy, in ways that distinguish it from a fear habituation approach and a belief disconfirmation approach. Optimization strategies include (1) expectancy violation, (2) deepened extinction, (3) occasional reinforced extinction, (4) removal of safety signals, (5) variability, (6) retrieval cues, (7) multiple contexts and (8) affect labeling. Case studies illustrate methods of applying these techniques with a variety of anxiety disorders.     

Therapie und Theater

Theatre experience serve in drama therapies only as a background for a better understanding of the patients problems, whereas the dialogue between therapy and theatre contributes to the understanding of the process of therapy itself and the secrets of it’s effect. As the actor creates an “empty space” to express himself, so tries a therapist to eliminate all obstructions of understanding. Both dedicate their whole personality to the author respectively to the patient, which requires an enormous amount of humility and responsibility and can be achieved only by a continuous argument with himself. The closeness of profession and personal life is therefore unavoidable, which means various possibilities and impulses but great dangers as well. Therapy and theatre are not to compare with any other interpersonal relationship, for they are trying to achieve changes in the way of feeling, thinking and acting. Whether, on this way, the therapist’s and actor’s real emotional expression is more important than the rational analysis of all emotions or not, is a question often discussed controversially. Just like in a child’s play, it is always about the argument between fantasy and reality and, therefore, about the stimulation and development of the audience’s and the patient’s creativity. Therefore it is of greatest importance for the therapy as for the theatre that the process is immediate, vivid and unforeseen. They are paths towards life, experiencing their purpose and limits through this task.