Psychotherapie bei posttraumatischen Belastungsstörungen

Abstract

Since the diagnosis of posttraumatic stress disorder (PTSD) was introduced in DSM-III in 1980, a variety of psychotherapeutic approaches have been developed to address the specific problems and needs of traumatized patients. Successful treatment of PTSD requires a well thought-out therapeutic attitude. The therapist must find a well-balanced position between over-identification and turning away out of helplessness. A sensation-seeking attitude should be avoided as should the danger of vicarious traumatisation. In many instances, PTSD can not be treated sufficiently by psychotherapy alone: a comprehensive, multi-modal treatment plan may include pharmacotherapeutic, physical, social, legal, and other interventions. Early psychotherapeutic interventions in the immediate aftermath of a traumatic event follow the rules of crisis intervention (immediacy, focus on the current problems, time limitation). Special attention should be paid to the issues of developing a trusting therapeutic relationship, creating an atmosphere of safety, helping the patient to regain control over and/or distance himself from intrusive recollections. Eye Movement Desensitization and Reprocessing (EMDR) and other "power therapies" can offer quick relief from symptoms. After collective traumatization, psychological debriefings are widely used although the evidence for their usefulness in preventing PTSD is questionable. In patients with chronic PTSD, the psychotherapist should not work exclusively on the traumatic event and its sequelae: treatment should be oriented towards the future rather than the past. Instead of exploring, the therapist should try to activate the patients' resources and help them to find new meaning in their future life.

Resting‐state functional connectivity in patients with a complex PTSD or complex dissociative disorder before and after inpatient trauma treatment

“…CPTSD patients have symptoms of PTSD along with the three additional symptom clusters pertaining to emotional dysregulation, interpersonal difficulties, and negative self‐concept (Maercker et al., 2013 ). Although exposure therapy is beneficial in reducing PTSD symptoms (Schnyder, 2000 ), clinical observations in complex trauma patients indicate that exposure interventions can have considerable side effects in terms of exacerbation, compliance problems, and high drop‐out rates (Flatten et al., 2004 ). The current standard of care for cPTSD and dissociative disorders is a phase‐oriented treatment approach (Cloitre et al., 2012 ; Courtois, 1999 ; Ford et al., 2005 ; International Society for the Study of Trauma & Dissociation, 2011 ; Loewenstein & Welzant, 2010 ; Steele, Van der Hart, & Nijenhuis, 2001 , 2005 ).…”

Functional reorganization of neural networks involved in emotion regulation following trauma therapy for complex trauma disorders

“…Since emotional dysregulation is a core feature of all trauma-related disorders, trauma therapies generally aim to enhance emotion regulation skills. Although exposure therapy is effective in reducing (simple) PTSD symptoms (Schnyder, 2000), clinical observations of complex trauma patients such as complex PTSD (cPTSD) and dissociative disorder patients indicate that exposure can have strong side effects in terms of exacerbation, compliance problems, and high drop-out rates (Flatten et al, 2004). Individuals with chronic and early-life trauma-related disorders benefit more from exposure therapy and show fewer adverse effects when they are initially provided with skills helping them to manage distress and strong aversive feelings (Cloitre et al, 2002, Cloitre et al, 2010).…”

Functional connectivity changes in the delta frequency band following trauma treatment in complex trauma and dissociative disorder patients

“…Exposure therapy is effective in PTSD ( 16 ), however, as a stand-alone approach it can cause large side-effects in complex trauma-related disorders ( 17 ). The standard care for complex trauma and dissociative disorder patients such as cPTSD, DDNOS-1, and DID is a phase-oriented treatment ( 18 – 24 ).…”