Download PDF
Nervenheilkunde 2014; 33(04): 252-258
DOI: 10.1055/s-0038-1633391
Moderne Psychotherapien
Schattauer GmbH

Expositionsbasierte kognitive Therapie bei Depressionen

Evidence-based cognitive therapy for patients with depression
M. Grosse Holtforth
1   Psychologisches Institut, Universität Zürich, Schweiz
2   Institut für Psychologie, Universität Bern, Schweiz
,
T. Krieger
1   Psychologisches Institut, Universität Zürich, Schweiz
› Author Affiliations
Further Information

Publication History

eingegangen am: 30 November 2013

angenommen am: 17 December 2013

Publication Date:
02 February 2018 (online)

    Permissions and Reprints

Zusammenfassung

Depressionen können erfolgreich behandelt werden, doch die Nachhaltigkeit psychotherapeutischer Effekte ist weiterhin eine Herausforderung. Expositionsbasierte Kognitive Therapie (EBCT) versucht, gleichzeitig Symptomatik und Depressionsvulnerabilität durch verstärkte kognitiv-emotionale Verarbeitung zu verändern. Die EBCT umfasst drei Behandlungsphasen: Aufbauphase zur Stabilisierung und Stärkung inklusive Achtsamkeitsübungen, Expositionsphase zur Bearbeitung depressionsrelevanter Selbstanteile mit emotionsfokussierten Methoden und Konsolidierungsphase zum Transfer erworbener Fertigkeiten und Erkenntnisse in den Alltag. In empirischen Studien konnten Belege für die Umsetzbarkeit der Methodenintegration sowie Akzeptabilität der Behandlung erbracht werden. In einer Vergleichsstudie zeigten sich große und der kognitiven Verhaltenstherapie (KVT) vergleichbare Prä-Post-Effekte der EBCT. Die kognitiv-emotionale Verarbeitung erfolgte hauptsächlich in der Expositionsphase und sagte das Therapieergebnis vorher. Die EBCT ist ein Beispiel für die erfolgreiche Integration ursprünglich theoriefremder Interventionen in die KVT. Zukünftige Entwicklungen der Depressionstherapie werden diskutiert.

Summary

Depressive patients can be treated successfully, but long-term sustainability remains a challenge. Exposure Based Cognitive Therapy (EBCT) sets out to change both symptoms as well as depressive vulnerability by fostered cognitive-emotional processing. EBCT has three phases: Strengthening for stabilization and preparing the patient for challenging emotional work, including acquiring basic mindfulness skills, exposure for emotionally processing depression relevant aspects of the self via emotion-focused techniques, and consolidation for transferring acquired skills and insights into daily life. Empirical studies support the feasibility and acceptability of integrative method in acute outpatient treatment. In a randomized controlled trial, EBCT showed large pre-post effects that were in the range of effects of standard cognitive-behavioral therapy (CBT). In EBCT, cognitiveemotional processing took place mainly in the exposure phase and predicted therapy outcome. EBCT is an example for a successful integration of interventions from other theoretical backgrounds within a CBT framework. Future developments of psychotherapy against depression are discussed.

Schlüsselwörter

Depression - Psychotherapie - Integration - Emotion

Keywords

Depression - psychotherapy - exposure - emotion
 

  • Literatur

  • 1 Addis ME, Martell CR. Overcoming depression one step at a time: The new behavioral activation approach to getting your life back. New York: New Harbinger Press; 2004
    Google Scholar
  • 2 Barlow DH, Durand VM. Abnormal psychology: An integrative approach: Wadsworth Pub Co. 2011
    PubMedGoogle Scholar
  • 3 Barth J. et al. Comparative efficacy of seven psychotherapeutic interventions for patients with depression: A network meta-analysis. PLoS Medicine 2013; 10 (05) e1001454.
    CrossrefPubMedGoogle Scholar
  • 4 Beevers CG. Cognitive vulnerability to depression: A dual process model. Clinical Psychology Review. 200; 25. 975-1002.
    Google Scholar
  • 5 Beevers CG. Identifying processes that maintain depression: Strategies and suggestions. Clinical Psychology: Science and Practice 2011; 18 (04) 300-4.
    CrossrefGoogle Scholar
  • 6 Beshai S. et al. Relapse and recurrence prevention in depression: Current research and future prospects. Clinical Psychology Review 2011; 31 (08) 1349-60.
    CrossrefPubMedGoogle Scholar
  • 7 Brockmeyer T. et al. Capturing the concept of avoidance in depression: An integrative review. Eingereicht.
    Google Scholar
  • 8 Bronisch T. Der Suizid: Ursachen, Warnsignale, Prävention. München: CH Beck; 2007
    Google Scholar
  • 9 Carey TA. Exposure and reorganization: The what and how of effective psychotherapy. Clinical Psychology Review 2011; 31: 236-48.
    CrossrefPubMedGoogle Scholar
  • 10 Carver C, Johnson SL, Joormann J. Serotonergic function, two-mode models of self-regulation, and vulnerability to depression: what depression has in common with impulsive aggression. Psychological Bulletin 2008; 134 (06) 912.
    CrossrefPubMedGoogle Scholar
  • 11 Castonguay LG. et al. Cognitive-behavioral assimilative integration. In: Norcross JC, Goldfried MR. (Hrsg.). Handbook of psychotherapy integration. New York: Oxford University Press; 2008
    Google Scholar
  • 12 Ehlert U. et al. Emotionsfokussierte Depressionstherapie: Pro und Contra. Verhaltenstherapie 2011; 21: 133-6.
    CrossrefGoogle Scholar
  • 13 Flückiger C, Grosse MHoltforth. Ressourcenaktivierung und motivorientierte Beziehungsgestaltung – Bedürfnisbefriedigung in der Psychotherapie. In: Frank R. (Hrsg.). Therapieziel Wohlbefinden. Heidelberg: Springer; 2010
    Google Scholar
  • 14 Follette WC, Greenberg LS. Technique factors in treating dysphoric disorders. In: Castonguay LG, Beutler LE. (Hrsg.). Principles of therapeutic change that work. New York: Oxford University Press; 2005
    Google Scholar
  • 15 Forgeard MJ. et al. Beyond depression: toward a process-based approach to research, diagnosis, and treatment. Clinical Psychology: Science and Practice 2011; 18 (04) 275-99.
    CrossrefPubMedGoogle Scholar
  • 16 Grawe K. Research-informed psychotherapy. Psychotherapy Research 1997; 07 (01) 1-19.
    CrossrefPubMedGoogle Scholar
  • 17 Grawe K. Psychologische Therapie. Bern: Hogrefe; 1998
    Google Scholar
  • 18 Greenberg LS, Watson JC. Emotion-focused therapy for depression. Washington, DC: American Psychological Association; 2006
    Google Scholar
  • 19 Grosse MHoltforth. Avoidance motivation in psychological problems and psychotherapy. Psychotherapy Research 2008; 18 (02) 147-59.
    CrossrefPubMedGoogle Scholar
  • 20 Grosse MHoltforth. et al. Fostering cognitive-emotional processing in the treatment of depression: A preliminary investigation in Exposure-Based Cognitive Therapy. Psychotherapy and Psychosomatics 2012; 81: 259-60.
    CrossrefPubMedGoogle Scholar
  • 21 Grosse MHoltforth, Krieger T. Expositionsbasierte kognitive Therapie bei Depressionen. In: Teismann T, Kunz O. (Hrsg.). Moderne Ansätze in der Depresssionsbehandlung. Tübingen: dgvt-Verlag; 2014
    Google Scholar
  • 22 Grosse MHoltforth. et al. Exposure-based cognitive therapy as an intervention to foster emotional processing in depression – a randomized comparison with cognitive-behavioral therapy. Eingereicht.
    Google Scholar
  • 23 Grosse MHoltforth. et al. Expositionsbasierte kognitive Therapie bei Depressionen. Unveröffentliches Manual. Zürich: Universität Zürich; 2010
    Google Scholar
  • 24 Hautzinger M. Kognitive Verhaltenstherapie bei Depressionen: Behandlungsanleitungen und Materialien. Weinheim: Beltz PVU; 2003
    Google Scholar
  • 25 Hayes AM. et al. Avoidance and processing as predictors of symptom change and positive growth in an integrative therapy for depression. International Journal of Behavioral Medicine 2005; 12 (02) 111-22.
    CrossrefPubMedGoogle Scholar
  • 26 Hayes AM, Castonguay LG, Goldfried MR. Effectiveness of targeting the vulnerability factors of depression in cognitive therapy. Journal of Consulting and Clinical Psychology 1996; 64 (03) 623-7.
    CrossrefPubMedGoogle Scholar
  • 27 Hayes AM. et al. Discontinuities and cognitive changes in an exposure-based cognitive therapy for depression. Journal of Consulting and Clinical Psychology 2007; 75 (03) 409-21.
    CrossrefPubMedGoogle Scholar
  • 28 Hayes SC, Smith S. Get out of your mind and into your life: The new acceptance and commitment therapy. Santa Rosa, CA: New Harbinger Publications; 2005
    Google Scholar
  • 29 Herrmann I, Auszra L. Emotionsfokussierte Therapie der Depression. Psychother Psychiatrie Psychother Med Klin Psychol 2009; 14: 15-25.
    Google Scholar
  • 30 Holahan C J. et al. Stress generation, avoidance coping, and depressive symptoms: a 10-year model. Journal of Consulting and Clinical Psychology 2005; 73 (04) 658-66.
    CrossrefPubMedGoogle Scholar
  • 31 Krieger T. et al. Prädiktoren und Moderatoren von Therapieerfolg in einer randomisiert-kontrollierten Studie zur Behandlung von depressiven Störungen, Vortrag gehalten am 31. Symposium der DGPs Fachgruppe Klinische Psychologie und Psychotherapie. Trier. 2013
    PubMedGoogle Scholar
  • 32 Mennin DS. et al. United we stand: Emphasizing commonalities across cognitive-behavioral therapies. Behavior Therapy 2012; 36 (04) 482-508.
    Google Scholar
  • 33 Michalak J, Heidenreich T, Williams JMG. Achtsamkeit. Göttingen: Hogrefe; 2012
    Google Scholar
  • 34 Minami T. et al. Benchmarks for psychotherapy efficacy in adult major depression. Journal of Consulting and Clinical Psychology 2007; 75 (02) 232-43.
    CrossrefPubMedGoogle Scholar
  • 35 Norcross JC. A primer on psychotherapy integration. In: Norcross JC, Goldfried MR. (Hrsg.). Handbook of psychotherapy integration. Oxford: Oxford University Press; 2005
    Google Scholar
  • 36 Ottenbreit ND, Dobson KS. Avoidance. In: Dobson KS, Dozois DJA. (Hrsg.). Risk factors in depression. San Diego, CA: Elsevier Academic Press; 2008
    Google Scholar
  • 37 Samoilov A, Goldfried MR. Role of emotion in cognitive-behavior therapy. Clinical Psychology: Science and Practice 2000; 07 (04) 373-85.
    CrossrefGoogle Scholar
  • 38 Solomon DA, Keller MB, Leon AC. Multiple recurrences of major depressive disorder. American Journal of Psychiatry 2000; 157: 229-33.
    CrossrefPubMedGoogle Scholar
  • 39 Stangier U. et al. Maintenance cognitive-behavioral therapy and manualized psychoeducation in the treatment of recurrent depression: A multicenter prospective randomized controlled trial. American Journal of Psychiatry 2013; 170 (06) 624-32.
    CrossrefPubMedGoogle Scholar
  • 40 Teachman BA. et al. Automaticity in anxiety disorders and major depressive disorder. Clinical Psychology Review 2012; 32: 575-603.
    CrossrefPubMedGoogle Scholar
  • 41 Teismann T, Michalak J, Willutzki U. Kognitive Verhaltenstherapie depressiven Grübelns. Verhaltenstherapie 2008; 18 (03) 168-75.
    CrossrefGoogle Scholar
  • 42 Trew JL. Exploring the roles of approach and avoidance in depression: an integrative model. Clinical Psychology Review 2011; 31: 1156-68.
    CrossrefPubMedGoogle Scholar
  • 43 Vittengl J. et al. Reducing relapse and recurrence in unipolar depression: A comparative meta-analysis of cognitive-behavioral therapy’s effects. Journal of Consulting and Clinical Psychology 2007; 75 (03) 475-88.
    CrossrefPubMedGoogle Scholar
  • 44 Whelton WJ. Emotional processes in psychotherapy: Evidence across therapeutic modalities. Clinical Psychology & Psychotherapy 2004; 11 (01) 58-71.
    CrossrefGoogle Scholar
  • 45 Michalak J. et al. Zurück in die Gegenwart. Nervenheilkunde 2014; 33: 265-270.
    Article in Thieme ConnectGoogle Scholar
  • 46 Eifert GH. Akzeptanzund Commitment-Therapie. Nervenheilkunde 2014; 33: 233-240.
    Article in Thieme ConnectGoogle Scholar