Evaluation einer stationären Kognitiv-behavioralen Gruppentherapie für einsatzbedingte psychische Erkrankungen deutscher Soldaten
Abstract
In der stationären Behandlungspraxis von kriegstraumatisierten deutschen Soldaten wurden bisher eingesetzte therapeutische Verfahren nicht ausreichend evaluiert. Im Rahmen einer Effectiveness-Studie am Traumazentrum Berlin wurde die Wirksamkeit einer stationären Kognitiv-behavioralen Gruppentherapie an 78 Patienten mit einsatzbedingten psychischen Erkrankungen zu drei Messzeitpunkten auf die Trauma- und komorbide Begleitsymptomatik untersucht. Es zeigten sich in der Traumasymptomatik, dem Ausmaß der dysfunktionalen traumabezogenen Überzeugungen sowie der Depressions- und Beschwerdesymptomatik signifikante Effekte nach Abschluss der Therapie und in der Katamnese. Die Effektstärken und der RCI (Reliable Change Index) dokumentieren die Wirksamkeit der Gruppentherapie. Spezifische einsatzbezogene Gruppenkonzepte stellen eine wertvolle Erweiterung des stationären Versorgungsangebotes für kriegstraumatisierte Soldaten dar. Schwierigkeiten in der Untersuchung und Probleme in der Behandlung traumatisierter Soldaten mit komorbiden Störungen werden diskutiert.
The current therapies used for in-patient treatment of war-traumatized German soldiers have so far not been evaluated sufficiently. As part of an effectiveness study at the Berlin Trauma Centre the effectiveness of in-patient cognitive-behavioural group therapy on trauma and comorbid symptoms was examined at three measurement times with 78 patients suffering from deployment-related mental illness. Significant effects were found on trauma symptoms and the extent of dysfunctional trauma-related beliefs as well as on depression and complaint symptoms after completion of the therapy and in catamnesis. The effect strengths and the Reliable Change Index (RCI) reflect the effectiveness of group therapy. Specific deployment-related group concepts are a valuable contribution to in-patient treatment available for war-traumatized soldiers. The column discusses the difficulties in the examination and the problems in the treatment of soldiers with comorbid disorders.
Literatur
(2010). Komorbidität und Behandlung einsatzbedingter psychischer Traumastörungen durch Kognitiv-behaviorale Gruppentherapie im Bundeswehrkrankenhaus Berlin. Wehrmedizinische Monatsschrift, 54, 182–185.
(2007). Psychological treatment for chronic post-traumatic stress disorder. Systematic review and meta-analysis. British Journal of Psychiatry, 190, 97–104.
(2000). Prevalence of personality disorders among combat veterans with posttraumatic stress disorder. Journal of Traumatic Stress, 13, 255–270.
(2004). Evaluating a cognitive – behavioral group treatment program for veterans with posttraumatic stress disorder. Psychological Service, 1, 140–146.
(2005). A multidimensional meta-analysis of psychotherapy for PTBS. American Journal of Psychiatry, 162, 214–227.
(2002). Skills training in affective and interpersonal regulation followed by exposure: A phase-based treatment for PTBS related to childhood abuse. Journal of Consulting and Clinical Psychology, 70, 1067–1074.
(1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale: Lawrence Erlbaum Associates.
(1993). Brief Symptom Inventory (BSI), administration, scoring and procedures manual (3rd ed.). Mineapolis, MN: National Computer Services.
(2004). Personality disorders in veterans with posttraumatic stress disorder and depression. Journal of Traumatic Stress, 17, 75–82.
(1996). Deutschsprachige Übersetzung der Posttraumatic Diagnostic Scale von Foa (1995). (unpublished manuscript). Oxford: Warneford Hospital, Department of Psychiatry.
(1999). The posttraumatic-cognitions-inventory (PTCI): Development and validation. Psychological Assessment, 11, 303–314.
(1997). Psychosocial treatment of posttraumatic stress disorder: a critical review. Annual Review of Psychology, 48, 449–480.
(2008). Naturalistic comparison of models of programmatic interventions for combat-related posttraumatic stress disorder. Australian and New Zealand Journal of Psychiatry, 42, 1051–1059.
(2000). Group Therapy. In E. B. Foa, T. M. Keane & M. J. Friedman (eds), Effective treatments for PTSD. Practice guidelines from the international association for traumatic stress studies. New York: Guilford Publications Inc.
(2000). Brief Symptom Inventory von L. R. Derogatis (Kurzform der SCL-90-R) – Deutsche Version. Göttingen: Hogrefe.
(2002). Das Brief Symptom Inventory (BSI) als Instrument zur Qualitätssicherung in der Psychotherapie. Diagnostica, 48, 28–36.
.(2006). Psychometric qualities of German version of the posttraumatic diagnostic scale (PTDS). Psychological Assessment, 18, 262–268.
(2002). Konzept zur Bewältigung einsatzbedingter psychischer Belastungen. Wehrmedizin und Wehrpharmazie, 26, 22–26.
(2005). BDI Beck-Depressions-Inventar. Bern: Huber.
(2008). Unerwünschte und schädliche Wirkungen von Psychotherapie. Psychotherapeut, 1, 4–16.
(2008). Cognitive-behavioral therapy for adult anxiety disorders: A meta-analysis of randomized placebo-controlled trials. The Journal of Clinical Psychiatry, 69, 621–632.
(2004). Combat duty in iraq and afghanistan, mental health problems, and barriers to care. New England Journal of Medicine, 351, 13–22.
(2002). Mental disorders among U.S. military personnel in the 1990s: Accociation with high levels of health care utilization and early military attrition. The American Journal of Psychiatry, 159, 1576–1583.
(1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.
(2006). A Pilot study of behavioral activation for veterans with posttraumatic stress disorder. Journal of Traumatic Stress, 19, 387–391.
(2008). Intensive coping skills training to reduce anxiety and depression for forward-deployed troops. Military Medicine, 172, 241–246.
(2004). The efficacy and effectiveness of psychotherapy. In M. J. Lambert (Ed.), Bergin and Garfield›s handbook of psychotherapy and behavior change, 139–193. New York: Wiley.
(2003). Progress and controversy in the study of posttraumatic stress disorder. Annual Review of Psychology, 54, 229–252.
(2006). Cognitive processing therapy for veterans with military-related posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 74, 898–907.
(2008). Group cognitive-behavioral therapy for insomnia in a VA mental health clinic. Cognitive and Behavioral Practice, 15, 426–438.
(2009). Prolonged exposure for PTSD in a veterans health administration PTSD clinic. Journal of Traumatic Stress, 22, 60–64.
(2000). Cognitive-behavioral therapy. In E. B. Foa, T. M. Keane & Friedman, M. J. (Eds.), Effective treatments for PTBS: Practice guidelines from the International Society for Traumatic Stress Studies (S. 320–325). New York: Guilford Press.
(2008). Military personnel›s population attributable fractions of mental disorders and mental health service use associated with combat and peacekeeping operations. American Journal of Public Health, 98, 2191–2198.
(2010). Correlates of perceived need for mental health care among active military personnel. Psychiatric Services, 61, 50–57.
(2007). Combat and peacekeeping operation in relation to prevalence of mental disorders and perceived need for mental health care. American Medical Association, 64, 843–852.
(2003). Randomized trial of trauma-focused group therapy for posttraumatic stress disorder. Archives of General Psychiatry, 60, 481–489.
(2009). Cape town consensus on posttraumatic stress disorder. CNS Spectrums 2009, 52–58.
(2009). A combined group treatment for nightmares and insomnia in combat veterans: A pilot study. Journal of Traumatic Stress, 22, 639–642.
(2008). Treating comorbid panic disorder in veterans with posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 76, 704–710.
(1998). Comparative efficacy of treatments for post-traumatic stress disorder: a meta-analysis. Clinical Psychology and Psychotherapy, 5, 126–144.
(2005). Die Wirksamkeit von EMDR im direkten Vergleich zur kognitiv-behavioralen Therapie in der Behandlung von PTBS – ein metaanalytische Betrachtung. Zeitschrift für Psychotraumatologie und Psychologische Medizin, 3, 61–72.
(1997). Strukturiertes Klinisches Interview für DSM-IV. Göttingen: Hogrefe.
(2009). Hospital admissions related to mental disorders in U.S. army soldiers in iraq and afghanistan. Military Medicine, 174, 1010–1018.
(1996). Anstieg von psychoreaktiven Störungen und Suchterkrankungen – Erklärungsansätze, Schlussfolgerungen. Wehrmedizische Monatsschrift, 40, 152–156.
(2008). In-patient, short-term group psychotherapy – a therapeutic option for Bundeswehr soldiers? Psychosocial Medicine, 5, 1–8.