Evidenzbasierte Psychotherapie

Zusammenfassung Seit einiger Zeit wird auch in der Psychotherapie – so wie in anderen Bereichen der Medizin – eine intensive und kontroverse Diskussion über die wissenschaftlichen Standards und deren Praxisrelevanz geführt. Dabei nehmen Fragen der Qualitätssicherung und der Entwicklung von Leitlinien einen zunehmenden Raum ein. Von besonderer Bedeutung sind in diesem Zusammenhang die Evidence Based Medicine (EbM) und ihre methodischen Standards, in deren Mittelpunkt experimentelle Therapiestudien stehen. Im Beitrag wird das Konzept der Evidence Based Medicine im Kontext der Psychotherapie (Evidence based Psychotherapy) vorgestellt und unter methodischen und inhaltlichen Gesichtspunkten diskutiert. Eine zentrale Frage ist dabei die inhaltliche Aussagekraft und die Übertragbarkeit von wissenschaftlichen Befunden auf die klinische Praxis.      

Islam hadhari: A Malaysian Islamic multiculturalism or another blank banner?

Islam hadhari (progressive Islam) appeared on the Malaysian political sphere in 2004 and seemed to create an alternative model to Western modernity and multiculturalism. It was proclaimed as progressive and forward-looking, yet steeped deeply in Islam’s nostalgic golden past. It was hailed as a novel form of Malaysian Islamic multiculturalism by some, derided by others as a new version of Islam and ignored by many as a government project. This paper conceptualizes Islam hadhari theoretically and places it within its Malaysian contexts to show what possibilities it engendered and how it can be best appraised today.

Cannabiskonsum und -missbrauch bei Jugendlichen und jungen Erwachsenen

After a long time of growth current studies on representative samples of adolescents indicate that the number of adolescent cannabis users in Germany is possibly decreasing. However, it may be presumptuous to expect a similar trend concerning the number of clients with cannabis-related disorders. Even if there is in fact a downward trend which is not yet proven, the rapidly growing number of clients presenting with these disorders in recent years cannot be explained by a similar growth in the number of regular cannabis users. Treatment centres should therefore expect a further inreasing number of especially male adolescents and young adults seeking help for problems related to cannabis use. The development, evaluation and implementation of specific treatment options concerning cannabis use disorders will be increasingly needed in the future. Cognitive-behavioral and motivational interventions have been shown to be evidence-based treatments. The paper describes some promising or already successful treatment approaches and related research projects in Germany.     

PALME

Background

Single mothers and their children are exposed to increased psychosocial burdens and risks. Nevertheless, in Germany offers of help especially designed for the needs of this group are lacking.

Method

An emotion-oriented parental training program (PALME, http://www.palme-elterntraining.de) based on the attachment theory was developed particularly for single mothers with preschool children. The training is guided by trained kindergarten nurses. The effectiveness of the parental training program on the measure of maternal psychological impairment, emotional competence and child problem behavior was investigated within a randomized, controlled study with 61 single mothers suffering from medium grade psychosocial impairment.

Results

Analyses of variance revealed significant group×time interaction effects in favor of the intervention group compared to controls. After the training the mothers showed improvement in their psychological impairment, depression and emotional competence. In addition, evidence suggests that behavioral problems of the children were reduced.

Conclusion

In view of the benefits of this parental training and its low costs it should be recommended as a regular offer of support for single mothers within community settings.     

Psychotherapie für Straftäter

The legal and administrative framework for psychotherapy of offenders in prisons and secure forensic hospitals is outlined. Established treatment programs for offenders are presented including different variations of standardized cognitive behavioral approaches, e. g. relapse prevention programs (RP), dialectic behavioral therapy (DBT), transference-focused psychotherapy (TFP), and mentalization-based treatment (MBT). The foci of the individual programs as well as their integrative tendencies are described. In psychodynamic therapies cognitive processes are taken into consideration and, vice versa, cognitive-behavioral therapists discover the significance of the therapeutic relationship.     

Zwischen Klinik und Politik

Based on the current debate on the traumatisation of soldiers in Afghanistan, the article traces the historical development of trauma concepts from the 19th century to the present day. Thereby, it is shown that without reflecting on the socio-political context on the part of therapists and experts, medical and psychotherapeutic measures are at risk of being exploited by undetected political interests.     

Goethes Studienkrise, Depression und seine Selbstbehandlungsstrategien

From a present day diagnostic viewpoint Goethe suffered from several episodes of depression beginning with his study crisis. In addition he wrote that he had a tendency towards dysthymic moods. In terms of modern psychotherapeutic procedures the various levels of Goethe’s self-therapy strategies are remarkable: acceptance of helpful bonding and relationships, correction of dysfunctional behavior and modification of pathogenic conceptions and beliefs as well as remembrance, enactment and mentalization of psychodynamic conflicts. Finally at an existential level his salutogenic strategies served to invoke a sence of coherence often threatened in his life. Anxieties, dysthymic moods, lack of self-esteem and existential conflicts were for him not only the reason and motive for realization of his extraordinary artistic potential. For modern psychotherapists and patients it is interesting that the acceptance of dysthymic moods and psychological conflicts and the transformation through relationships, cognitive behavior-oriented and psychodynamic strategies as well as an existential self-effective striving also lead to everyday creativity, i.e. coping with life.     

Clients’ in-session acceptance and cognitive defusion behaviors in acceptance-based treatment of tinnitus distress

Cognitive-behavioral treatment (CBT) is considered to be an effective treatment of distress associated with tinnitus (perception of internal noises without any outer auditory stimulation), but the processes by which the therapy works remain unclear. Mindfulness and acceptance is receiving increased attention in the treatment literature for chronic medical conditions. However, few studies have examined these and related processes with behavioral or observer measures. In the present study 57 videotapes (a total of 1710 min) from 19 clients who participated in a controlled trial of an acceptance-based treatment for tinnitus distress, were coded for frequency and peak level of verbal behaviors expressing either acceptance or cognitive defusion. Frequency of cognitive defusion behaviors and peak level of cognitive defusion as well as peak level of acceptance rated in Session 2, predicted symptom reduction 6 month following treatment. These relationships were not accounted for by the improvement that had occurred prior to the measurement point of the process variables. Moreover, prior symptom changes could not predict process variables rated later in therapy (after most of the improvement in therapy had occurred). Thus, clients’ in-session acceptance and cognitive defusion behaviors appear to play an important role in the reduction of negative impact of tinnitus.