Psychotische Störungen: Kognitiv-verhaltens-therapeutische Behandlungsstrategien

Die Heterogenität von Psychosen erfordert differenzierte Therapiestrategien anhand von Störungsmodellen. Erfolgreich sind einige evidenzbasierte Ansätze aus der kognitiven Verhaltenstherapie, bei denen die Patienten die zugrunde liegenden Mechanismen erkennen lernen, um so ggf. rechtzeitig ein Rezidiv zu verhindern. Der Einbezug von Angehörigen und eine gut gestaltete Beziehung zwischen Therapeut und Patient sind dabei wichtige Eckpfeiler.

Abstract

Cognitive behavioral therapy (CBT) is an established treatment for the patients with psychosis including schizophrenia. The evidence for the efficacy of CBT is proved by randomized clinical trials and meta-analyses. Evidence-based treatment guidelines recommend CBT for routine treatment. The aim of this paper is to give a short practical guideline for different cognitive behavioral treatment strategies. Cognitive Behavior Therapy for psychosis (CBTp) is an adaptation of general principles of CBT modified for patients with psychotic disorders. Basis of CBT are cognitive models of symptoms to identify treatment targets. The major goal is to foster every-day functioning by realizing a self-management approach. A caring, genuine and real-life oriented therapeutic attitude can help to establish a therapeutic alliance. An individualized functional analysis should be the core for every intervention. Basic strategies like psychoeducation and crisis plans are briefly described. Relatives and close friends of patients should be involved in order to improve crisis management and problem solving. Behavioral and cognitive treatment strategies for delusions, hallucinations and negative symptoms are outlined. Metacognitive treatment as well as social competence training is presented.

Schlüsselwörter

Psychotische Erkrankungen - kognitive Verhaltenstherapie - Verzerrungen - therapeutische Beziehung - Angehörige

Key words

CBTp - schizophrenia - psychotic disorders - psychotherapy - psychosocial intervention

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