Neurobiologische Grundlagen psychotherapeutischer Verfahren

In the last few years the investigation of the neurobiological basis of psychotherapeutic treatments has gained importance. Therapy-associated functional changes have been studied in a number of different psychiatric diseases. It has been shown that diseases with a central role of emotions (e.g. depression, anxiety disorders, borderline personality disorder) often demonstrate dysfunctions in brain areas that are linked to emotional regulation. Psychotherapeutic interventions can lead to a kind of normalization of brain responses in these areas (e.g. amygdala, ventromedial prefrontal cortex, anterior cingulate cortex, orbitofrontal cortex). In addition, therapy-associated transformations were also demonstrated in areas which are related to attention processes and visual perception. Other studies have aimed at finding neurobiological parameters that can be used to predict a therapeutic outcome or to choose between various therapeutic strategies. For instance, in depression, the amygdala and the anterior cingulate cortex are assumed to play a major role. Altogether, knowledge on the neurobiological basis of psychotherapeutic procedures is limited. A comparatively small number of studies and several methodological problems (e.g. small sample sizes, insufficient control groups, variability of methods used) make it difficult to propose reliable statements.     

Complexity science: A framework for psychotherapy integration

The paradigm of complexity science provides a new way to address the problem of psychotherapy integration and allows us to bypass the various shortcomings of the linear-interventionist perspective. Nine criteria are outlined, which should be satisfied by any integrative approach to psychotherapy: (a) the use of complexity science to provide a meta-theoretical and generic understanding of change processes (from neuronal to social system levels); (b) a comprehensive and formalised modelling of change processes and personality development; (c) an integrative method of case formulation; (d) the ability to understand a variety of techniques in terms of basic change principles; (e) criteria to guide microdecisions; (f) the application of data-driven feedback and real-time monitoring of change dynamics; (g) standardised assessment of outcomes in naturalistic settings; (h) guidelines for training; and (i) strategies that are well-suited to science–practice integration. Using these criteria as a framework for evaluation, one may grasp the potential of complexity science to drive innovation in the pursuit of psychotherapy integration.     

Integration of Cognitive and Emotional Processing Predicts Poor and Good Outcomes of Psychotherapy

Journal of Contemporary Psychotherapy - With the aim of investigating analogies and differences between psychotherapeutic processes, ten good-outcome and ten poor-outcome cases were selected from a...     

Die Wirkung von traumatischem Stress auf biopsychische Selbstorganisationsprozesse

Social frameworks have influenced the understanding of trauma-reactive psychic disorders during the course of the past two centuries.The 20th century has further shaped this understanding by the various concepts established by the different therapeutic schools.The incorporation of scientific results, as well as the theory of complex dynamic systems particularly that of synergetics supply now abundant impulses stimulating the discussion of posttraumatic stress disorders on a psychodynamic, neurophysiological, and systemspecific basis, thereby leaving those schools behind.Comparing synergetic models with the current state of neuroscientific research of post traumatic stress disease (PTSD) gives surprising insights of the dynamics of this disorder,and the resulting therapeutic principles.Specific therapeutic approaches, with the two phases of stabilisation and of trauma processing can be derived from such functional principles of neuronal networks.     

Nonlinear dynamics: theoretical perspectives and application to suicidology

Despite decades of research, the prediction of suicidal behavior remains limited. As a result, searching for more specific risk factors and testing their predictive power are central in suicidology. This strategy may be of limited value because it assumes linearity to the suicidal process that is most likely nonlinear by nature and which can be more adequately described and analyzed with nonlinear dynamics. The goal of moving nonlinear dynamics from theory to practice and to real-world phenomena can now be realized with Internet-based monitoring systems such as the Synergetic Navigation System.     

Stationäre Rehabilitation alkoholabhängiger Patienten

Systemic therapy concepts are widely used in therapy and rehabilitation of alcohol addictive patients. Although very useful in practice, evaluation studies are rare. Adequate evaluation strategies should be developed and implemented. This study was realized in a clinical rehabilitation centre (Hirtenstein, Allgäu/Germany), whose systemic concept is characterized by patient's wideranged possibilities of choice concerning therapy measures and therapy goals, the activation of social and personal resources, the development of an individually appropriate life-style, the training of desired competencies, and an offer for marital and family therapy. The evaluation is based on a repeated measures design without control group. The instruments and constructs of the evaluation are: F-SOZU (perceived social support), IIP (perceived interpersonal problems), MLDL (quality of life), SOC (sense of coherence), and an assessment sheet for personal resources (RI). Patients (n= 44) reported increased personal ressources as well as an increased level of quality of life. Perceived social support and the sense of coherence changed only moderately. Scaling of treatment satisfaction and goal attainment at the end of the rehabilitation program resulted in high positive scores. Patients reported only positive, no negative treatment side effects. The results indicate the usefulness of systemic and resource oriented concepts in the rehabilitation of alcohol addictive patients.     

Dynamische Komplexität in der Therapeut-Klient-Interaktion

The importance of client-therapist-relationship in psychotherapy has often been stressed. On the one hand, the quality of this relationship has proved to be an important predictor of therapy outcome, on the other hand the relationship itself is realized as a complex dynamic pattern of interpersonal interaction. It seems appropriate to investigate this dynamics by a microprocess analysis with high resolution. Interactive plans (idiographic self-presentation unities) of client and therapist were coded by a sampling frequency of 10 seconds. The coding system of plan activation follows the idea of synchronous musical score notation of different orchestra instruments. It allows for the representation of contextualized interactive behaviors. The context is introduced by the consideration of synchronous and diachronous plan-activation patterns of the interaction partners. The observed dynamic patterns are fulfilling the prerequisites of usual definitions of “chaos”: irregularity of the process, restricted prediction horizon, and still some global order of the dynamic process. Based on nominal data (on-off-patterns), a method for the identification of order within irregular patterns of plan activations is presented. The frequency distributions of plans realize the shape of 1/f^α-noise, indicating features of self-organized criticality within the dynamic system of client-therapist-interaction.     

Neurobiologische Korrelate der Psychotherapie von Zwangsst?rungen

Obsessive-compulsive disorders are associated with different neuropsychological impairments concerning executive functions, error monitoring, decision making and other basic functionalities. Contemporary neurocircuitry models emphasize the dysfunction of the fronto-striato-thalamo-cortical network related to parietal regions, the orbitofrontal cortex, the anterior cingulate cortex and other limbic structures. In brief, studies on the functional neuroanatomy of psychotherapy effects realized by positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) are reported. Perspectives concern combined process-outcome research with repeated neuroimaging and highly resolved (daily) self-ratings focussing the nonlinear dynamics of psychotherapeutic change processes. New therapeutic approaches could explore the combination of psychotherapy with fMRI-based real-time neurofeedback and noninvasive neuromodulation with coordinated reset stimulation focusing on the desynchronization of pathologically oversynchronized neural populations and networks.