Indikation zur ambulanten Nachsorge (Curriculum Hannover) in der Psychosomatischen Rehabilitation

Outpatient psychosomatic aftercare (Curriculum Hannover) was introduced nationwide in 2000 by the pension scheme. The effectiveness and efficacy of outpatient psychosomatic aftercare has been widely researched. This publication presents an indication-model based on four levels (capacity, participation, activity and impairment) whereas empirical results and clinical experience concerning participation in psychosomatic outpatient aftercare following an in-patient rehabilitation are considered in accordance with the international classification of functioning, disability and health.     

Psychosoziale Risiken von Arbeitsplatzverlust und Arbeitslosigkeit

In a society centred around employment the strain that is associated with the experience of job loss is carrying considerable health risks. The empirical evidence of the differential effects of unemployment is reviewed in the framework of the victimization model and related to the background of health risks resulting from the former employment biography. Individual reactions are co-determined by a series of moderator variables which have been identified by differential unemployment research. From a health-related perspective also the indirect effects on the “victims-by-proxy”, e.g., the partners and children of unemployed people, have to be taken into consideration. Interventions can limit the psychosocial effects, especially if they are tailor-made and if they try to integrate elements of employment, qualification and social support. The necessity of the development of societal concepts of a “social convoy” (in the sense of a professional counselling) in occupational transitions is stressed. These should, however, start already during employment before the dismissal takes place. Theses concepts will take over social responsibility for restructuring and provide those being affected by dismissals with a legitimate claim for social support.     

Videotherapie bei postpartalen Störungen

Video recording is currently part of in- and out-patient therapy programs for parents with infants. The observation and analysis of video sequences allow the patient to gain an extraordinary insight with respect to its own experience and behaviour. Video Microanalytical Therapy (VMT) looks for the mother’s positive qualities in her relationship to the child and employs these qualities in order to support successful interactions. VMT is well-suited to the treatment of mothers with postpartal affective or psychotic disorders, because the typical cognitive distortions and reduced perception shown by these mothers can be avoided to a large extent through the use of pictures. In this study, a video microanalytical therapy concept will be presented, that was developed for the treatment of postpartally disordered mothers at the Psychiatric Centre Nordbaden in Wiesloch, Germany.     

Angststörungen bei Patienten mit implantiertem Kardioverter-Defibrillator (ICD)

Patients with an implantable cardioverter defibrillator (ICD) often show anxiety disorders as comorbid psychologycal disturbances. In a short review we discuss psychosocial aspects of the ICD-implantation. A case study of a 38 year old patient in inpatient treatment is presented for illustration of a cognitive-behavioral treatment method. The psychotherapeutic treatment was carried out in close cooperation with the clinic for cardiology.     

Psychoonkologie

Changes in the spectrum of illnesses have led to a predominance of chronic diseases, including oncological disorders, that are connected with substantial mental health problems. The needs of people with cancer are increasingly attracting the attention of psychosocial and psychosomatic disciplines as far as patient-oriented health care research and counselling practice are concerned. Psychosocial work in oncology appears to be becoming increasingly professionalized. Theories of the psychosocial origin of cancer are gradually losing ground in the scientific community, giving way to a rational attitude towards oncological diseases that counters the stigma of cancer. At the same time, the demand for psycho-oncological services is becoming more important if we take into account the high rate of psychiatric co-morbidity and the fact that these patients are poorly diagnosed and inadequately treated. This is all the more regrettable in that a broad range of evidence-based interventions are available which are gradually being implemented in the guidelines of rehabilitation facilities and oncological centres of excellence. The transfer of knowledge in the everyday care of cancer patients, however, has yet not been accomplished.     

Erfahrungsorientiertes Lernen in der Psychotherapie

Background

Based on principles of experiential learning, psychophysical exposure (PPE) on a tightrope course offers a promising intervention in the treatment of patients with mental disorders. A PPE program conducted on a hospital tightrope course is presented as an adjunct in inpatient psychotherapy.

Methods

The acceptance and effectiveness of the PPE were evaluated in a prospective controlled naturalistic study. A total of 155 patients, who were exposed at least once during their inpatient therapy, were compared with 92 control patients, who did not participate in the tightrope course. The main outcome criteria were self-reported depressive symptoms, state anxiety, locus of control, self-efficacy, and trait anxiety.

Results

The PPE was highly accepted by the participants. Patients who attended the tightrope courses showed greater improvement in the outcome criteria than patients who received inpatient treatment as usual. Particularly better effects were found on the personality variables.

Conclusions

Psychophysical exposure can successfully and effectively be integrated into a psychosomatic inpatient treatment program. Methodological limitations of the study, especially threats to internal validity, are discussed.