Psychother Psychosom Med Psychol 2016; 66(01): 9-20
DOI: 10.1055/s-0035-1559612
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

Psychodynamische Kurzzeittherapie der Depression – ein evidenzbasiertes vereinheitlichtes Therapieprotokoll

Short-Term Psychodynamic Therapy in Depression – An Evidence-Based Unified Protocol
Christiane Steinert
1   Klinik für Psychosomatische Medizin und Psychotherapie, Justus-Liebig-Universität Gießen
,
Henning Schauenburg
2   Klinik für Allgemeine Innere Medizin und Psychosomatik, Universität Heidelberg
,
Ulrike Dinger
2   Klinik für Allgemeine Innere Medizin und Psychosomatik, Universität Heidelberg
,
Falk Leichsenring
1   Klinik für Psychosomatische Medizin und Psychotherapie, Justus-Liebig-Universität Gießen
› Author Affiliations
Further Information

Publication History

eingereicht 22 April 2015

akzeptiert 13 July 2015

Publication Date:
18 November 2015 (online)

Zusammenfassung

Die Depression ist mit einer Lebenszeitprävalenz von circa 17% die häufigste psychische Störung. Klinische Studien belegen, dass Psychotherapie eine wirksame Behandlungsmethode bei depressiven Störungen ist. Hierbei scheint es keine signifikanten Unterschiede zwischen verschiedenen Psychotherapieformen zu geben. Im Bereich der psychodynamischen Therapie (PDT) haben sich verschiedene Therapiemodelle als wirksam erwiesen. Während dies einerseits positiv zu bewerten ist, bedeutet es jedoch gleichzeitig, dass die empirischen Wirksamkeitsnachweise für PDT quasi zwischen verschiedenen Unterformen der PDT „zersplittert“ sind. Dies kann Probleme in der Ausbildung angehender Psychotherapeuten sowie im Transfer von Forschung in die klinische Praxis mit sich bringen. Ein vereinheitlichtes Therapieprotokoll, das auf empirisch gestützten Methoden der PDT für Depression beruht, kann dazu beitragen diese Probleme zu lösen. Für die Entwicklung eines solchen Protokolls haben wir in einem ersten Schritt eine systematische Suche nach randomisiert kontrollierten Studien (RCTs) durchgeführt in denen sich manualisierte oder manualbasierte psychodynamische Einzeltherapie depressiver Störungen bei Erwachsenen im Vergleich zu Kontrollbedingungen als wirksam erwiesen hat. 11 Studien erfüllten alle Einschlusskriterien. Im Anschluss haben wir diese Studien systematisch hinsichtlich der darin verwendeten Behandlungskonzepte ausgewertet. Wir fanden eine hohe Übereinstimmung zwischen den Konzepten. Im nächsten Schritt haben wir aus diesen Konzepten 7 Behandlungskomponenten für die wirksame psychodynamische Behandlung der Depression herausdestilliert. Diese Komponenten werden im vorliegenden Artikel in Form von 7 miteinander verbundenen Behandlungsmodulen konzeptualisiert und in einem Therapieprotokoll integriert. Ein vereinheitlichtes psychodynamisches Therapieprotokoll zur Behandlung depressiver Störungen kann den empirischen Status der PDT verbessern sowie die therapeutische Ausbildung und den Transfer von Forschung in die klinische Praxis erleichtern. Darüber hinaus erwarten wir, dass es durch die gebündelte Anwendung von Therapieelementen, die sich bereits als wirksam erwiesen haben, einen zusätzlichen Nutzen für Patienten und somit auch einen positiven Einfluss auf das bestehende psychotherapeutische Versorgungssystem haben kann.

Abstract

With a lifetime prevalence of about 17% depression is the most common mental disorder. Psychotherapy is efficacious in the treatment of depression, with no significant differences between different forms of psychotherapies. For psychodynamic therapy (PDT) various models proved to be efficacious in randomized controlled trials (RCTs). As a consequence the evidence for PDT is scattered between different forms or orientations of PDT entailing problems regarding psychotherapy training and the transfer of research into clinical practice. Thus, our aim was to develop a unified protocol for the dynamic treatment of depression that is based on those models of PDT that proved efficacious in randomized controlled trials (RCTs). As a first step we conducted a systematic search of RCTs investigating manualized or manual-based individual psychodynamic therapy for depressive disorders in adults that proved to be efficacious compared to comparison conditions. 11 studies fulfilled our inclusion criteria. In a second step we systematically reviewed the studies with regard to the treatment concepts they had applied. 7 highly consistent treatment components could be identified. We conceptualized them in the form of 7 interrelated treatment modules which constitute the unified psychodynamic protocol for depression. The protocol may enhance the empirical status of PDT and facilitate both psychotherapy training as well as the transfer of research to clinical practice. Through the focused use of techniques that proofed efficacious it is expected to bring more benefit to depressed patients and therefore also have a positive impact on the health care system.

 
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