Evidenzbasierte Praxis lernen – Multiperspektivische Kompetenzentwicklung am Beispiel der generalisierten Angststörung

Zusammenfassung

Im Rahmen der evidenzbasierten Praxis der American Psychological Association (APA, 2006) werden psychotherapeutische Kernkompetenzen zumeist transdiagnostisch und transtheoretisch formuliert, schließen die systematische Berücksichtigung von symptomspezifischen Aspekten jedoch nicht aus. In diesem Artikel wird anhand eines exemplarischen Fallbeispiels einer Person, die an einer generalisierten Angststörung leidet, aufgezeigt, wie Kernkompetenzen der evidenzbasierte Praxis angewandt werden können. Die Teilaspekte der Kompetenzentwicklung beziehen sich auf (1) Abklärung und Psychodiagnostik, (2) gemeinsame Erarbeitung eines Erklärungsmodells, (3) Einbezug symptomspezifischer Modelle, (4) breite Mitberücksichtigung stringenter Interventionen, (5) Anwendung verschiedener Behandlungsmodalitäten, sowie (6) patient:innenfokussierte Behandlungsdurchführung. Der Beitrag schließt mit einer Auflistung von Studienbeispielen wie psychotherapeutische Kompetenzentwicklung im Rahmen des evidenzbasierten Praxis Modells erforscht werden kann.

Abstract

Within the framework of the evidence-based practice model of the American Psychological Association (APA, 2006), psychotherapeutic core competences are mostly formulated transdiagnostically and transtheoretically, but do not exclude the systematic consideration of symptom-specific aspects. This article provides an exemplary case study of a person suffering from a generalized anxiety disorder to illustrate how evidence-based practice can be implemented. Multi-perspective competence development can be stimulated in training through the following therapeutic areas: (1) through broad assessment and psychodiagnostics, (2) through joint development of an individual explanatory model, (3) through inclusion of symptom-specific models, (4) through broad consideration of stringent interventions, (5) through application of various treatment modalities, (6) through patient-centred treatment implementation. The article concludes with a list of study examples of how psychotherapeutic competence development can be researched within the framework of the evidence-based practice model.

Schlüsselwörter

Kernkompetenz - Kompetenzentwicklung - Evidenzbasierte Praxis - Generalisierte Angststörung

Keywords

Core competence - competence development - evidencebased practice - generalized anxiety

• Literatur

• 1 APA Presidential Task Force. Evidence-based Practice in Psychology. Am Psychol 2006; 61: 271-285
• 2 Sackett DL, Straus SE, Richardson WS. et al. Evidence-based medicine: How to practice and teach EBM. 2. Aufl. London: Churchill Livingstone; 2000
• 3 Bundesinstitut für Berufsbildung – BIBB. Kompetenz in der beruflichen Bildung. 2024. Verfügbar unter: https://www.bibb.de/dokumente/pdf/a1bud_auswahlbibliographie-kompetenz-in-der-beruflichen-bildung.pdf
• 4 Rief W, Strauß B. Integratives Störungsmodell als Grundlage der Therapieplanung. Psychotherapeut 2018; 63: 401-408
• 5 Grawe K. Neuropsychotherapie. Göttingen: Hogrefe; 2004
• 6 Frank JD, Frank JB. Persuasion and healing: A comparative study of psychotherapy. Baltimore: JHU Press; 1991
• 7 Zinbarg RE, Craske MG, Barlow DH. Mastery of your anxiety and worry. New York: Oxford University Press; 2006
• 8 Dugas M, Buhr K, Ladouceur R. The of intolerance of uncertainty in etiology and maintenance. In: Heimberg R, Mennin D, Turk C, eds. Generalized anxiety disorder: Advances in research and practice. New York: Guilford Press; 2004: 143-163
• 9 Przeworski A, Newman MG. The Contrast Avoidance Model: Conclusion and synthesis of new research in the special issue. J Anxiety Disord 2024; 102: 102830
• 10 Wells A. Metacognitive therapy for anxiety and depression. New York: Guilford Press; 2009
• 11 Roemer L, Orsillo SM. Expanding our conceptualization of and treatment for generalized anxiety disorder: integrating mindfulness/acceptance-based approaches with existing cognitive-behavioral models. Clin Psychol Sci Pract 2002; 9: 54-68
• 12 Watson J, Greenberg LS. Emotion-focused therapy for generalized anxiety. New York: American Psychological Association; 2017
• 13 Leichsenring F, Steinert C, Salzer S. Short-term psychodynamic therapy of Generalized Anxiety Disorder (GAD). In: Gerlach AL, Gloster AT, eds. Generalized Anxiety Disorder and Worrying: A comprehensive handbook for clinicians and researchers. Wiley; 2020: 273-296
• 14 World Health Organization – WHO. WHO Framework on integrated people-centered health services. 2019. Verfügbar unter: https://www.who.int/servicedeliverysafety/areas/people-centred-care/en/
• 15 Zinbarg RE, Eun Lee J, Lira Yoon K. Dyadic predictors of outcome in a cognitive-behavioral program for patients with generalized anxiety disorder in committed relationships: A “spoonful of sugar” and a dose of non-hostile criticism may help. Behav Res Ther 2007; 45: 699-713
• 16 Wampold BE, Flückiger C. The alliance in mental health care: conceptualization, evidence and clinical applications. World Psychiatry 2023; 22: 25-41
• 17 Barkham M, De Jong K, Delgadillo J. et al. Routine Outcome Monitoring (ROM) and Feedback: Research Review and Recommendations. Psychother Res 2023; 33: 841-855
• 18 de Jong K, Douglas S, Wolpert M. et al Using Progress Feedback to Enhance Treatment Outcomes: A Narrative Review. Adm Policy Ment Health 2024;
• 19 Lutz W, Schwartz B, Deisenhofer A-K. et al. Ein offenes transtheoretisches Therapie- und Trainingsmodell (4TM). Konzept für eine evidenzbasierte und personalisierte Psychotherapie-Praxis sowie Aus- und Weiterbildung. Die Psychotherapie 2024; 69: 5-14
• 20 Willutzki U, Ülsmann D, Schulte D. et al. Direkte Veränderungsmessung in der Psychotherapie: Der Bochumer Veränderungsbogen-2000 (BVB-2000). Z Klin Psychol Psychother 2013; 42: 256-268
• 21 Ladwig I, Rief W, Nestoriuc Y. What are the Risks and Side Effects to Psychotherapy? – Development of an Inventory for the Assessment of Negative Effects of Psychotherapy (INEP). Verhaltenstherapie 2014; 24: 252-263
• 22 Hill CE, Norcross JC. Skills and methods that work in psychotherapy: Observations and conclusions from the special issue. Psychotherapy 2023; 60: 407-416
• 23 Norcross JC, Rocha MN, Chrysler AA. Psychologists conducting psychotherapy in 2022: Contemporary practices and historical patterns of the Society for the Advancement of Psychotherapy. Psychotherapy 2023; 60: 587-592
• 24 Flückiger C, Regli D, Zwahlen D. et al. Der Berner Patienten- und Therapeutenstundenbogen 2000. Ein Instrument zur Erfassung von Therapieprozessen. Z Klin Psychol Psychother 2010; 39: 71-79
• 25 Schöttke H, Flückiger C, Goldberg SB. et al. Predicting psychotherapy outcome based on therapist interpersonal skills: A five-year longitudinal study of a therapist assessment protocol. Psychother Res 2017; 27: 642-652
• 26 Wolfer C, Vîslă A, Held J. et al. Assessing interpersonal skills: A comparison of trainee therapists' and students' interpersonal skills assessed with two established assessments for interpersonal skills. Clin Psychol Psychother 2021; 28: 226-232
• 27 Wolfer C, Hilpert P, Flückiger C. How therapists' interpersonal behaviour is perceived by their patients and close others: A longitudinal and cross-situational study. Clin Psychol Psychother 2022; 29: 289-298
• 28 Norcross JC, Lambert MJ. Psychotherapy relationships that work. 3. Aufl. Band I. New York, NY: Oxford University Press; 2019
• 29 Wampold BE, Imel ZE, Flückiger C. Die Psychotherapie Debatte – Was Psychotherapie wirksam macht. Bern: Hogrefe; 2018
• 30 Rønnestad MH, Orlinsky DE, Wiseman H. Professional development and personal therapy. In: Norcross JC, VandenBos GR, Freedheim DK, Campbell LF, Hrsg. APA Handbook of Clinical Psychology: Education and Profession. Washington, DC: American Psychological Association; 2016: 223-235
• 31 Van Hoy A, Rzeszutek M. Burnout and Psychological Wellbeing Among Psychotherapists: A Systematic Review. Front Psychol 2022; 13: 928191
• 32 Deisenhofer AK, Hehlmann MI, Rubel JA. et al Love yourself as a therapist, doubt yourself as an institution? Therapist and institution effects on outcome, treatment length, and dropout. Psychother Res 2024; 1-14 [Online vorab veröffentlicht]
• 33 Eells TD, Lombart KG, Salsman N. et al. Expert reasoning in psychotherapy case formulation. Psychother Res 2011; 21: 385-399
• 34 Flückiger C, Forrer L, Schnider B. et al. A single-blinded, randomized clinical trial of how to implement an evidence-based cognitive-behavioural therapy for generalised anxiety disorder [IMPLEMENT] – Effects of three different strategies of implementation. EBioMedicine 2016; 3: 163-171
• 35 Flückiger C, Vîslă A, Wolfer C. et al. Exploring change in cognitive-behavioral therapy for generalized anxiety disorder – A two-arms ABAB crossed-therapist randomized clinical implementation trial. J Consult Clin Psychol 2021; 89: 454-468
• 36 Gumz A. Messen und Trainieren therapeutischer Kompetenzen. Psychother Psych Med 2024;