Therapiekonzeption für traumatisierte Patienten mit schweren Persönlichkeitsstörungen

Comorbidity between severe personality disorder and posttraumatic stress disorder is a frequent clinical problem. Severe personality disorders are characterized by an impaired regulation of emotions, a low mentalization capacity and deficits in personality integration. For severe personality disorders and posttraumatic stress disorder, a variety of evidence-based treatment approaches of psychodynamic and cognitive-behavioral origin are available. However, a closer inspection of these treatment concepts shows that they do not sufficiently take the respective comorbid condition into account. No single concept is able to cover all problem areas presented by patients with this comorbidity. Therefore, an attempt is made to present an integrative psychodynamically oriented therapy concept for traumatized patients with personality disorders which contains elements from psychodynamic, cognitive-behavioral and other concepts. The phase structure of the concept clarifies the sequence hierarchy of the therapeutic interventions. The content of the five phases are: (1) safety, holding and strengthening of coping capacities, (2) emotion regulation and self-care, (3) mentalization and development of stable representations, (4) gentle trauma processing and (5) conflict-oriented psychotherapy and treatment of maladaptive relationship patterns.     

Dialektisk beteendeterapi för suicidala borderline-kvinnor: En presentation

Abstract

Patients showing the features of Borderline Personality Disorder as defined in DSM-IV are notoriously difficult to treat. They are difficult to keep in therapy, frequently fail to respond to therapeutic efforts, and make considerable demands on the emotional resources of the therapist, particularly when suicidal and parasuicidal behaviors are prominent. Dialectical Behaviour Therapy, (DBT) devised by Marsha Linehan at the University of Washington in Seattle, is an innovative method of treatment that has been developed specifically for this difficult group of patients. In the present paper, the theoretical grounds for DBT are summarized, as well as the treatment format and different treatment techniques. The empirical evidence for the effectiveness of the method, which has so far been demonstrated in a few controlled studies, is also summarized. Finally, there is a presentation of a research project led by Professor Marie Åsberg at the Karolinska Hospital in Stockholm, where a group of female patients at high risk of suicide will be scientifically investigated and described. Besides this careful investigation, Otto Kernberg's treatment model (PDT), Marsha Linehan's treatment model (DBT) and treatment as usual (TAU) will be to be implemented and compared in a controlled treatment study for this group of patients.     

Onlineberatung für Betroffene von Essstörungen und deren Angehörige

An independent online consulting service for persons with eating disorders and their relatives (www.ab-server.de) exists in Germany since 1998, which was developed by physicians and psychologists. This study aims to comprehend the individual use of the online consulting for affected persons and their relatives. In order to do this, two online questionnaires were developed for these two groups. The questionnaires were sent digitally in two phases to those people who had posted an e-mail to the online consulting service from January 1999 to November 2003 and from January 2004 to July 2006 (phase 1: n=2,760; phase 2: n=1,419). A total of 493 data sets of affected persons and 127 of relatives were included in the analysis. The online consulting service is of great importance especially to establish the user’s first contact with professional help. The main reported effects were an improved understanding of the disease and the motivation to seek further professional help. This specific setting of internet-based intervention fulfils the function of a signpost within the German supply system.     

Flygrädsla i Sverige. En enkätundersökning av svenskars rädsla för trafikflyg som transportmedel

Abstract

Föreliggande arbete avser en enkätundersökning av svenskars flygrädsla. Tvätusen svenska med-borgare i äldrarna 18–75 är erhöll en enkät med 25 frägor angäende flygrädsla och hur denna päverkar viljan att utnyttja trafikflyget.

Christer L. Nordlund: A questionnaire of Swedes' fear of flying. During the spring and summer of 1982, 1 992 randomly selected individuals received a written questionnaire concerning fear of flying. 1 484 individuals returned the questionnaire and 169 of the remainders were interviewed by telephone and were included in the material. 76% of the individuals in the material had flown one or more times, while 6% reported that because of fear they had never flown. 17% reported that they could not consider flying, owing to fear, or for other reasons. 10% answered that they experienced relatively great or greater fear when flying, while 15% answered that they felt the same when thinking about flying. When asked about different parts of a flight, 25% revealed that they felt relatively great or greater fear during some part of it, and about 30% reported the same level of fear when clear air turbulence was encountered. The prevalence of flight fear depends upon the definition used. If “daring to fly” is used as a criterion, 10% of the Swedish population, i.e. 600 000 Swedes, can be considered to be afraid of flying. Given that flying is quite safe (from a statistical point of view), anyone experiencing discomfort during a flight could be regarded as demonstrating fear of flying. With this criterion, 50% of the interviewed individuals (= 3 000 000 Swedes) could be regarded as apprehensive about flying.     

Gruppenpsychotherapie für Brustkrebspatientinnen

Zusammenfassung  Der Brustkrebs erzwingt geradezu unsere Aufmerksamkeit mit seiner hohen Prävalenz—30% aller Krebsneuerkrankungen bei nordamerikanischen Frauen sind Brustkrebs—, und er ist die zweithäufigste Todesursache bei Frauen in Nordamerika. Weiße nordamerikanische Frauen haben ein Risiko von 1:9, im Laufe ihres Lebens an Brustkrebs zu erkranken. Es gibt zahlreiche Anknüpfungspunkte, darunter genetische und familiäre Prädisposition, primäre Krebserkrankung/Langzeitüberleben und rezidivierende oder metastasierende Krankheit. Brustkrebs ist eine Krankheit, bei der jede Form der Krebsbehandlung eingesetzt wird—Chirurgie, Chemotherapie, Bestrahlung, Hormontherapie und die viel versprechenden, kürzlich entwickelten immunologischen Interventionen. Zugleich ist die Brust als Körperteil kulturell hochgradig besetzt und als Symbol der Weiblichkeit, der Attraktivität, der Sexualität und der Fortpflanzung aufmerksam und emotional viel beachtet. In der vorliegenden Arbeit wird die Anwendung von Gruppenpsychotherapien auf dieses Spektrum klinischer Belange diskutiert.

Die postpartale Bindungsstörung: Eine Risikokonstellation für den Infantizid ?

Background

The effectiveness of preventive approaches in the field of child protection depends, amongst other things, upon identifying typical risk constellations of infanticide. Postpartum bonding disorder, a disorder affecting a mother’s emotional relationship with her child, is one of those risk constellations alongside other negative consequences to child development. It frequently accompanies postpartum depression, which is determined by other emotional qualities. The therapeutic response is a determinant factor for the success of preventive measures.

Method

42 mothers with postpartum disorders (25 depressive, 17 schizophrenic) undergoing treatment at a mother-baby-unit were examined for bonding disorders and the therapeutic response, primarily regarding the mother-child relationship. Perception of bonding, maternal self-efficacy and objectively measured parameters of mother-child interaction were the most important parameters assessed. Results. Nearly 60% of the mothers suffered from a bonding disorder. Overall, the results indicated a clear improvement in psychiatric disorder as well as in the assessed parameters for the mother-child relationship and the experience of motherhood.

Conclusions.

Maternal bonding disorders are strongly associated with postpartum depression and low maternal self-efficacy, which can lead to a risk constellation for infanticide. The data confirm the therapeutic response, thus demonstrating that early diagnosis and treatment of postpartum depression can represent a timely and effective preventive approach in the field of child protection.     

Principer För Beteendemodifikation

Stumphauzer, J S: Behavior Modification Principles. Behaviordelia, Michigan, 1977. 176 sid.