Diagnostik in der Verhaltenstherapie

After an introduction, a short historical review of the development of behaviour therapy and the importance of categorical classification of mental disorders is given. We present different assessment approaches that are important in behaviour therapy. They comprise anamnesis, categorical classification, somatic differential diagnosis, psychometric methods, ratings scales, and diaries. As the core assessment strategy in cognitive behaviour therapy, functional behavioural analysis is introduced in detail, in which methods of horizontal analysis of behaviour (SORKC model proposed by Kanfer) and the vertical analysis of behaviour are explained. The importance of computer-based assessment and specific approaches of assessment within behaviour therapy for children and adolescents are presented. By way of conclusion, the prospects of possible new developments of assessment in behaviour therapy are outlined.     

Kurz- und Langzeitbehandlung in der Verhaltenstherapie

In Germany, short and long-term psychotherapy are the two established forms for providing basic outpatient cognitive behavior therapy. The goal of the current study is to describe and discuss empirical evidence for these two structural forms; therefore, results from randomized controlled trials are presented and their implications related to the optimal number of therapy sessions are described. Furthermore, important results of naturalistic process outcome research are outlined. Additionally, the individual needs of patients for specific numbers of sessions are described based on data from the Association of Statutory Health Insurance Physicians. The results of randomized controlled trials generally showed strong empirical evidence for the efficacy of short-term cognitive behavior therapy of 7–20 sessions in patients with simple diagnoses; however, there is less empirical evidence in relation to the general efficacy and differential indications for long-term behavior therapy. These study results are supported by data from 200,000 patients receiving outpatient treatment in the German healthcare system. In two thirds of these patients, less than 25 sessions were sufficient to achieve subjectively adequate clinical improvement; however, approximately 10?% of the patients needed more than 60 therapy sessions. Empirical evidence concerning outcomes of long-term therapy with such a high number of sessions is scarce. Future research should address this research gap in order to identify empirically-based individual adaptation rules concerning the optimal number of treatment sessions in long-term therapy.     

Indikationsstellung zur Verhaltenstherapie

Behavioral therapy is a recognized guideline-conform procedure based on the principles of learning theory. The principle is that behavior that has been learnt can also be forgotten again, which was applied very early on to the example of anxieties. Furthermore, cognition and emotions as well as attention-based procedures play an important role in the behavioral therapeutic treatment of mental illnesses. The advantages compared to other guideline procedures are the rapid and universal applicability, the contemporary relevance and the transparency of the application as well as the wide variety of methods. Additionally, the methods are very evident and can be selectively or differentially implemented for a multitude of mental illnesses. This article summarizes the most important illnesses from the perspective of the application of behavioral therapeutic methods. Aspects of differential indications are discussed in relation to specific illnesses and personality characteristics.     

Pathologisch autodestruktives Verhalten und Verhaltenstherapie

The literature on pathological self-destructive behaviour (apart from psychotic, substance-induced or brain disorders) and behaviour therapy is reviewed. An introduction on definition, classification, current typological approaches, occurrence, pathogenesis, and psychopathology is given. From a behavioural theoretic perspective, functional aspects of self-destructive behaviour are emphasised. Basic treatment problems are outlined. They particularly concern covert self-destructive behaviour (artificial disease, Munchhausen-syndrome) that is typically met in a medical hospital setting. Recommendations from the literature are resumed. Most of the relevant publications are psychoanalytically based. Case reports on self-destructive patients predominate even in behaviour therapy publications. These are briefly reviewed. So far, the most elaborate approach is considered to be M. Linehan's Dialectic-Behavioral-Therapy which has been developed for the treatment of borderline personality disorders. A considerable overlap between overtly self-destructive patients and borderline patients underlines the usefulness of this approach. Nonetheless, a further development of behavioural therapeutic methods with regard to different types of self-destructive behaviour is considered to be indicated.     

Kognitive Verhaltenstherapie bei schizophrenen Psychosen

Cognitive behavioral therapy (CBT) can be regarded as an established intervention for the treatment of patients with schizophrenia. Based on randomized clinical trials and meta-analyses, which found evidence for the efficacy of CBT, almost all evidence-based treatment guidelines recommend CBT for routine treatment. This paper demonstrates that in psychoses CBT is a disorder-specific adaptation of general principles of CBT for the treatment of patients suffering from schizophrenia. The CBT procedure draws on cognitive models of symptoms for the identification of treatment targets and focuses on everyday problems of patients by implementing a self-management approach. Fostering motivation and the application of behavioral and cognitive treatment strategies characterize this approach. If the patients live in a family, other family members should be involved in order to improve crisis management and problem solving within the family. A major challenge for the future is to improve the availability of CBT under the German conditions of routine mental health care.     

Ambulante manualisierte Verhaltenstherapie bei Anorexia nervosa

Anorexia nervosa is a serious illness leading to high morbidity and mortality. Its treatment poses a particular challenge to psychotherapists offering outpatient treatment. Often therapists follow or work according to a treatment manual. Supervision in the treatment of anorexia nervosa patients intends to promote quality assurance as well as to foster therapists’ mental hygiene. It offers the opportunity to collect plenty of practical experiences. Some of these will be presented here to provide suggestions and support to therapists working with anorexia nervosa patients. Certain treatment modules of cognitive-behavioral therapy (CBT) such as motivation, eating behavior, case formulation and relapse prevention will be considered. Regarding the therapist-patient relationship ambivalent relation shaping and motivational interviewing will be targeted.     

Zukunft der Psychotherapie in der Psychiatrie

The conceptual development of the German mental health system can only be understood against the background of the specific historical development process; therefore, the emigration of psychodynamic psychotherapists during the Third Reich as well as the complicated reintegration of psychotherapy into psychiatry during the postwar period are of particular relevance. The current discussion concerning the relationship of psychiatry and psychotherapy is characterized by the development of new techniques and methods and the concept of modular psychiatry, whereas the traditional complex psychotherapeutic procedures are becoming less important. In the future, the development of clinical and scientific research should focus on psychotherapy in old age as well as adolescence psychotherapy, the combination of psychopharmacological and psychotherapeutic treatment and issues concerning chronic courses as well as resistance to therapy.     

Themen der Ausbildungsforschung in der Psychotherapie

This review is based upon an appraisal of training research in psychotherapy showing that many questions are still unanswered. By means of a schema for the organization of research results that differentiates input, process and output variables, unselected results are summarized relating to issues such as the choice of the psychotherapeutic profession, pre-experiences of candidates, the selection of an orientation, personality factors, characteristics of training institutes, quality standards, as well as the organisation and structure of training programs. Process oriented studies mainly focus on the operationalisation and development of skills, the significance, the effects of and the satisfaction with training components. Finally, the output category comprises results related to graduation, to professional development during and following training and to the development of competence and its prediction.