Skip to main content
Search
Search
    Quick Search anywhere
    Quick search in Citations
Advanced Search
Skip main navigationClose Drawer MenuOpen Drawer Menu
Next article

Evidenzbasierte Psychotherapie bei Zwangsstörungen

Empfehlungen der S3-Leitlinien für die Praxis und Konsequenzen für die Forschung

Published Online:December 11, 2015https://doi.org/10.1026/1616-3443/a000330

Abstract

Zusammenfassung. Theoretischer Hintergrund: Leitlinien im Bereich der Medizin und Psychotherapie basieren auf systematischen Zusammenstellungen der verfügbaren Evidenz und dienen der Entscheidungshilfe für Praktiker. Für die Zwangsstörung wurde 2013 eine S3-Leitlinie publiziert. Fragestellung und Methode: Hier werden deren wichtigste Empfehlungen zur psychotherapeutischen Behandlung zusammengefasst und verbleibende Forschungslücken bezüglich praxisrelevanter Fragen aufgezeigt. Ergebnisse: Die Kognitive Verhaltenstherapie (KVT) wird als Verfahren der ersten Wahl empfohlen, während für andere, auch sehr verbreitete Verfahren kaum Evidenz vorliegt. Einige wichtige prozedurale Aspekte der KVT sind jedoch nicht genügend untersucht. Schlussfolgerungen: Angesichts der klinischen Bedeutung der Zwangsstörung besteht erheblicher Forschungsbedarf. Es wird auf die Bedeutung von Praxisbewährungsstudien hingewiesen. Schließlich wird diskutiert, wie aus aktueller psychologischer und neurobiologischer Grundlagenforschung zur Zwangsstörung, hier ausgeführt am Beispiel der Endophänotypenforschung, innovative Interventionen entwickelt werden können. Diese zielen darauf ab, den Anteil klinisch signifikant gebesserter Patienten zu erhöhen und die Nachhaltigkeit der Besserung zu sichern.


Evidence-Based Psychotherapy for Obsessive-Compulsive Disorder

Abstract. Background: Practice guidelines in medicine and psychotherapy are based on systematic reviews of available evidence and serve as decision support for care providers. S3 guidelines for obsessive-compulsive disorder (OCD) were published in 2013. Objective and Method: Here, the core recommendations for psychotherapy care are reviewed, and the remaining gaps of evidence regarding practical care are identified. Results: Cognitive-behavioral therapy (CBT) is recommended as the first-line treatment, while the efficacy of alternative, widely used treatments has almost no evidence base. Some important procedural aspects of CBT are insufficiently investigated to date. Conclusion: Given the clinical significance of OCD there is a strong need for further research. Furthermore, the importance of effectiveness studies is highlighted. Finally, we discuss how innovative interventions may be developed from modern psychological and neurobiological research, as exemplified by endophenotype research. To increase the proportion of responders and remitters and to stabilize improvement are the ultimate aims of these efforts.

Literatur

  • Abramowitz, J. S., Baucom, D. H., Boeding, S., Wheaton, M. G., Pukay-Martin, N. D. & Fabricant, L. E., et al. (2013). Treating obsessive-compulsive disorder in intimate relationships: a pilot study of couple-based cognitive-behavior therapy. Behavior Therapy, 44, 395 – 407. First citation in articleCrossref, Google Scholar

  • Abramowitz, J. S., Franklin, M. E., Zoellner, L. A. & DiBernardo, C. L. (2002). Treatment compliance and outcome in obsessive-compulsive disorder. Behavior Modification, 26, 447 – 463. First citation in articleCrossref, Google Scholar

  • American Psychiatric Association (APA). (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Arlington, VA: American Psychiatric Publishing. First citation in articleGoogle Scholar

  • Andersson, E., Enander, J., Andrén, P., Hedman, E., Ljótsson, B. & Hursti, T., et al. (2012). Internet-based cognitive behavior therapy for obsessive-compulsive disorder: a randomized controlled trial. Psychological Medicine, 42, 2193 – 2203. First citation in articleCrossref, Google Scholar

  • Andersson, E., Hedman, E., Enander, J., Radu Djurfeldt, D., Ljótsson, B. & Cervenka, S., et al. (2015). D-Cycloserine vs placebo as adjunct to cognitive behavioral therapy for obsessive-compulsive disorder and interaction with antidepressants: A randomized clinical trial. JAMA Psychiatry, 72, 659 – 667. First citation in articleCrossref, Google Scholar

  • Chambless, D. L. (2012). Adjunctive couple and family intervention for patients with anxiety disorders. Journal of Clinical Psychology, 68, 548 – 560. First citation in articleCrossref, Google Scholar

  • Chambless, D. L. & Steketee, G. (1999). Expressed emotion and behavior therapy outcome: a prospective study with obsessive-compulsive and agoraphobic outpatients. Journal of Consulting and Clinical Psychology, 67, 658 – 665. First citation in articleCrossref, Google Scholar

  • Deng, X., Wang, G., Zhou, L., Zhang, X., Yang, M. & Han, G., et al. (2014). Randomized controlled trial of adjunctive EEG-biofeedback treatment of obsessive-compulsive disorder. Shanghai Archives of Psychiatry, 26, 272 – 279. First citation in articleGoogle Scholar

  • Denys, D., Mantione, M., Figee, M., Munckhof, P. van den, Koerselman, F. & Westenberg, H., et al. (2010). Deep brain stimulation of the nucleus accumbens for treatment-refractory obsessive-compulsive disorder. Archives of General Psychiatry, 67, 1061 – 1108. First citation in articleCrossref, Google Scholar

  • Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde e.V. (DGPPN). (2013). S3-Leitlinie Zwangsstörungen. AWMF Register-Nummer: 038/017. Zugriff am 04. 11. 2015. Verfügbar unter: http://www.awmf.org/leitlinien/detail/ll/038 – 017.html First citation in articleGoogle Scholar

  • Falkai, P. & Wittchen, H.-U. (Hrsg.). (2014). Diagnostisches und statistisches Manual psychischer Störungen DSM-5 (1. Auflage). Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Foa, E. B., Liebowitz, M. R., Kozak, M. J., Davies, S., Campeas, R. & Franklin, M. E., et al. (2005). Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. American Journal of Psychiatry, 162, 151 – 161. First citation in articleCrossref, Google Scholar

  • Franklin, M. E. & Foa, E. B. (2011). Treatment of obsessive compulsive disorder. Annual Review of Clinical Psychology 7, 229 – 243. First citation in articleCrossref, Google Scholar

  • Gilliam, C. M., Diefenbach, G. J., Whiting, S. E. & Tolin, D. F. (2010). Stepped care for obsessive-compulsive disorder: An open trial. Behaviour Research and Therapy, 48, 1144 – 1149. First citation in articleCrossref, Google Scholar

  • Hans, E. & Hiller, W. (2013). A meta-analysis of nonrandomized effectiveness studies on outpatient cognitive behavioral therapy for adult anxiety disorders. Clinical Psychology Review, 33, 954 – 964. First citation in articleCrossref, Google Scholar

  • Hohagen, F., Wahl-Kordon, A., Lotz-Rambaldi, W. & Muche-Borowski, C. (Hrsg.). (2015). S3-Leitlinie Zwangsstörungen. Berlin: Springer. First citation in articleCrossref, Google Scholar

  • Jacobi, F., Höfler, M., Strehle, J., Mack, S., Gerschler, A. & Scholl, L., et al. (2014). Psychische Störungen in der Allgemeinbevölkerung. Studie zur Gesundheit Erwachsener in Deutschland und ihr Zusatzmodul Psychische Gesundheit (DEGS1-MH). Nervenarzt, 85, 77 – 87. First citation in articleCrossref, Google Scholar

  • Klawohn, J., Endrass, T., Preuss, J., Riesel, A. & Kathmann, N. (in Druck). Modulation of hyperactive error signals in obsessive-compulsive disorder by dual task demands. Journal of Abnormal Psychology. First citation in articleGoogle Scholar

  • Külz, A. K., Landmann, S., Cludius, B., Hottenrott, B., Rose, N. & Heidenreich, T., et al. (2014). Mindfulness-based cognitive therapy in obsessive-compulsive disorder: protocol of a randomized controlled trial. BMC Psychiatry, 14, 314. First citation in articleCrossref, Google Scholar

  • Macy, A. S., Theo, J. N., Kaufmann, S. C., Ghazzaoui, R. B., Pawlowski, P. A. & Fakhry, H. I., et al. (2013). Quality of life in obsessive compulsive disorder. CNS Spectrums, 18, 21 – 33. First citation in articleCrossref, Google Scholar

  • Mahoney, A. E., Mackenzie, A., Williams, A. D., Smith, J. & Andrews, G. (2014). Internet cognitive behavioural treatment for obsessive compulsive disorder: A randomised controlled trial. Behaviour Research and Therapy, 63C, 99 – 106. First citation in articleGoogle Scholar

  • Manoach, D. S. & Agam, Y. (2013). Neural markers of errors as endophenotypes in neuropsychiatric disorders. Frontiers in Human Neurosciences, 7, 350. First citation in articleGoogle Scholar

  • Mataix-Cols, D., Marks, I. M., Greist, J. H., Kobak, K. A. & Baer, L. (2002). Obsessive-compulsive symptom dimensions as predictors of compliance with and response to behavior therapy: results from a controlled trial. Psychotherapy and Psychosomatics, 71, 255 – 262. First citation in articleCrossref, Google Scholar

  • Meyer, E., Souza, F., Heldt, E., Knapp, P., Cordioli, A. & Shavitt, R. G., et al. (2010). A randomized clinical trial to examine enhancing cognitive-behavioral group therapy for obsessive-compulsive disorder with motivational interviewing and thought mapping. Behavioural and Cognitive Psychotherapy, 38, 319 – 336. First citation in articleCrossref, Google Scholar

  • Najmi, S. & Amir, N. (2010). The effect of attention training on a behavioral test of contamination fears in individuals with subclinical obsessive-compulsive symptoms. Journal of Abnormal Psychology, 119 (1), 136 – 142. First citation in articleCrossref, Google Scholar

  • National Institute for Health and Care excellence (NICE). (2005). Obsessive-compulsive Disorder: Core Interventions in the Treatment of Obsessive-compulsive Disorder and Body Dysmorphic Disorder. NICE clinical guidelines, 31. Retrieved November 4, 2015, from http://www.guidance.nice.org.uk/CG31 First citation in articleGoogle Scholar

  • Olatunji, B. O., Davis, M. L., Powers, M. B. & Smits, J. A. (2013). Cognitive-behavioral therapy for obsessive-compulsive disorder: a meta-analysis of treatment outcome and moderators. Journal of Psychiatric Research, 47 (1), 33 – 41. First citation in articleCrossref, Google Scholar

  • Riesel, A., Endrass, T., Auerbach, L. A. & Kathmann, N. (2015). Overactive performance monitoring as an endophenotype for obsessive-compulsive disorder: Evidence from a treatment study. American Journal of Psychiatry, 172, 665 – 673. First citation in articleCrossref, Google Scholar

  • Riesel, A., Endrass, T., Kaufmann, C. & Kathmann, N. (2011). Overactive error-related brain activity as a candidate endophenotype for obsessive-compulsive disorder: evidence from unaffected first-degree relatives. American Journal of Psychiatry, 168, 317 – 324. First citation in articleCrossref, Google Scholar

  • Ruscio, A. M., Stein, D. J., Chiu, W. T. & Kessler, R. C. (2010). The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Molecular Psychiatry, 15 (1), 53 – 63. First citation in articleCrossref, Google Scholar

  • Sachdev, P. S., Loo, C. K., Mitchell, P. B., McFarquhar, T. F. & Malhi, G. S. (2007). Repetitive transcranial magnetic stimulation for the treatment of obsessive compulsive disorder: a double-blind controlled investigation. Psychological Medicine, 37, 1645 – 1649. First citation in articleCrossref, Google Scholar

  • Simpson, H. B., Maher, M. J., Wang, Y., Bao, Y., Foa, E. B. & Franklin, M. (2011). Patient adherence predicts outcome from cognitive behavioral therapy in obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 79, 247 – 252. First citation in articleCrossref, Google Scholar

  • Simpson, H. B., Marcus, S. M., Zuckoff, A., Franklin, M. & Foa, E. B. (2012). Patient adherence to cognitive-behavioral therapy predicts long-term outcome in obsessive-compulsive disorder. Journal of Clinical Psychiatry, 73, 1265 – 1266. First citation in articleCrossref, Google Scholar

  • World Health Organization (WHO). (1999). The „newly defined“ burden of mental problems. Fact Sheets nº 217. Geneva: WHO. First citation in articleGoogle Scholar