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Schwerpunktbeiträge

Skills-assistierte Exposition in der Dialektisch Behavioralen Therapie der Posttraumatischen Belastungsstörung (DBT-PTSD)

Published Online:April 10, 2018https://doi.org/10.1026/1616-3443/a000445

Abstract

Zusammenfassung. Gewalterfahrungen in der Kindheit haben mit hoher Wahrscheinlichkeit schwerwiegende Folgen im Erwachsenenalter. Neben einer Posttraumatischen Belastungsstörung leiden die Betroffenen häufig unter Störungen der Emotionsregulation sowie vielfältiger weiterer Symptomatik. Als wesentliches Element praktisch aller wirksamen Behandlungsverfahren gilt die Auseinandersetzung mit den traumatischen Erinnerungen. Ziel dieser Übersichtsarbeit ist es, ein Behandlungsmodell vorzustellen, welches die Möglichkeit zur Expositionsbehandlung auch bei dieser schwerbelasteten Patientengruppe mit Störungen der Emotionsregulation bietet. Die Dialektisch Behavioralen Therapie der Posttraumatischen Belastungsstörung (DBT-PTSD) sowie die im Behandlungsprogramm integrierte Skills-assistierte Exposition werden hergeleitet und beschrieben. Die DBT-PTSD ist ein hoch-strukturiertes, multiple Komponenten beinhaltendes Therapieverfahren, welches im stationären Setting bereits sehr gut Wirksamkeitsnachweise erbringen konnte. Dadurch können auch bei Betroffenen einer Posttraumatischen Belastungsstörung nach interpersonellen Gewalterfahrungen in der Kindheit Expositionsverfahren erfolgreich angewendet werden.


Skills-Assisted Exposure in Dialectical Behavioral Therapy of Posttraumatic Stress Disorder (DBT-PTSD)

Abstract. There is a high probability that experiences of violence during childhood will have severe consequences in adulthood. Persons affected often suffer from, beside posttraumatic stress disorder (PTSD), emotion dysregulation as well as manifold symptoms. An important module in virtually all treatment programs is some form of exposure to the patient’s memory of their traumatic experiences. The aim of this article is to present a treatment rationale that offers the possibility of exposure treatment for this group of severely burdened patients. Dialectical behavioral therapy of posttraumatic stress disorder (DBT-PTSD) and the skills-assisted exposure integrated in the treatment rationale are derived and described. DBT-PTSD is a highly structured, multicomponent treatment. It is evaluated within a residential setting and has been shown to be effective. Exposure treatment can be applied successfully to patients with PTSD following interpersonal violence during childhood.

Literatur

  • Becker, C. B., Zayfert, C. & Anderson, E. (2004). A survey of psychologists’ attitudes towards and utilization of exposure therapy for PTSD. Behaviour Research and Therapy, 42, 277 – 292. First citation in articleCrossref, Google Scholar

  • Benedek, D. M., Friedman, M. J., Zatzick, D. & Ursano, R. J. (2009). Guideline Watch: Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder. Psychiatry Online, 7, 204 – 213. First citation in articleGoogle Scholar

  • Bisson, J. I., Ehlers, A., Matthews, R., Pilling, S., Richards, D. & Turner, S. (2007). Psychological treatments for chronic post-traumatic stress disorder. Systematic review and meta-analysis. British Journal of Psychiatry, 190, 97 – 104. First citation in articleCrossref, Google Scholar

  • Bisson, J. I., Roberts, N. P., Andrew, M., Cooper, R. & Lewis, C. (2013). Psychological therapies for chronic post-traumatic stress disorder (PTSD) in adults. Cochrane Database Systematic Review, 13, CD003388. First citation in articleGoogle Scholar

  • Bohus, M., Dyer, A. S., Priebe, K., Krüger, A., Kleindienst, N. & Schmahl, C., et al. (2013). DBT for PTSD after Childhood Sexual Abuse in Patients with and without Borderline Personality Disorder: A Randomised Controlled Trial. Psychotherapy and Psychosomatics, 82, 221 – 233. First citation in articleCrossref, Google Scholar

  • Bradley, R., Greene, J., Russ, E., Dutra, L. & Westen, D. (2005). A multidimensional meta-analysis of psychotherapy for PTSD. The American Journal of Psychiatry, 162, 214 – 227. First citation in articleCrossref, Google Scholar

  • Chen, L. P., Murad, M. H., Paras, M. L., Colbenson, K. M., Sattler, A. L. & Goranson, E. N., et al. (2010). Sexual abuse and lifetime diagnosis of psychiatric disorders: systematic review and meta-analysis. Mayo Clinic Proceedings, 85, 618 – 629. First citation in articleCrossref, Google Scholar

  • Clarke, S. B., Rizvi, S. L. & Resick, P. A. (2008). Borderline personality characteristics and treatment outcome in cognitive-behavioral treatments for PTSD in female rape victims. Behavior Therapy, 39, 72 – 78. First citation in articleCrossref, Google Scholar

  • Cloitre, M., Koenen, K. C., Cohen, L. R. & Han, H. (2002). Skills training in affective and interpersonal regulation followed by exposure: a phase based treatment for PTSD related to childhood abuse. Journal of Consulting and Clinical Psychology, 70, 1067 – 1074. First citation in articleCrossref, Google Scholar

  • Cloitre, M., Stovall-McClough, K. C., Nooner, K., Zorbas, P., Cherry, S. & Jackson, C. L., et al. (2010). Treatment for PTSD related to childhood abuse: a randomized controlled trial. American Journal of Psychiatry, 167, 915 – 924. First citation in articleCrossref, Google Scholar

  • Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T. & Vervliet, B. (2014). Maximizing exposure therapy: an inhibitory learning approach. Behavior Research and Therapy, 58, 10 – 23. First citation in articleCrossref, Google Scholar

  • Cutajar, M. C., Mullen, P. E., Ogloff, J. R., Thomas, S. D., Wells, D. L. & Spataro, J. (2010). Psychopathology in a large cohort of sexually abused children followed up to 43 years. Child Abuse and Neglect, 34, 813 – 822. First citation in articleCrossref, Google Scholar

  • DiLillo, D. & Damashek, A. (2003). Parenting characteristics of women reporting a history of childhood sexual abuse. Child Maltreatment, 8, 319 – 333. First citation in articleCrossref, Google Scholar

  • Dyer, A., Priebe, K., Steil, R., Krüger, A. & Bohus, M. (2009). Dialektisch-Behaviorale Therapie zur Behandlung der Posttraumatischen Belastungsstörung mit schweren Störungen der Emotionsregulation. Verhaltenstherapie und psychosoziale Praxis, 42, 283 – 307. First citation in articleGoogle Scholar

  • Ebner-Priemer, U. W., Mauchnik, J., Kleindienst, N., Schmahl, C., Peper, M. & Rosenthal, Z., et al. (2009). Emotional learning during dissociative states in borderline personality disorder. Journal of Psychiatry and Neuroscience, 34, 214 – 222. First citation in articleGoogle Scholar

  • Ehlers, A. & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319 – 345. First citation in articleCrossref, Google Scholar

  • Ehring, T., Welboren, R., Morina, N., Wicherts, J. M., Freitag, J. & Emmelkamp, P. M. (2014). Meta-analysis of psychological treatments for posttraumatic stress disorder in adult survivors of childhood abuse. Clinical Psychology Review, 34, 645 – 657. First citation in articleCrossref, Google Scholar

  • Feeny, N. C., Zoellner, L. A. & Foa, E. B. (2002). Treatment outcome for chronic PTSD among female assault victims with borderline personality characteristics: A preliminary examination. Journal of Personality Disorders, 16, 30 – 40. First citation in articleCrossref, Google Scholar

  • Feiring, C., Simon, V. A. & Cleland, C. M. (2009). Childhood sexual abuse, stigmatization, internalizing symptoms, and the development of sexual difficulties and dating aggression. Journal of Consulting and Clinical Psychology, 77, 127 – 137. First citation in articleCrossref, Google Scholar

  • Flatten, G., Gast, U., Hofmann, A., Lieberman, P., Reddemann, L. & Wöller, W., et al. (2011). S3-Leitlinie Posttraumatische Belastungsstörung. Trauma und Gewalt, 3, 202 – 210. First citation in articleGoogle Scholar

  • Fleming, J., Mullen, P. E., Sibthorpe, B. & Bammer, G. (1999). The long-term impact of childhood sexual abuse in Australian women. Child Abuse and Neglect, 23, 145 – 159. First citation in articleCrossref, Google Scholar

  • Foa, E. B., Hembree, E. & Rothbaum, B. O. (2007). Prolonged exposure therapy for PTSD. New York, NY: Oxford University Press. First citation in articleCrossref, Google Scholar

  • Foa, E. B., Keane, T. M., Friedman, M. J. & Cohen, J. A. (2008). Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies. New York, NY: Guilford Press. First citation in articleGoogle Scholar

  • Foa, E. B., Steketee, G. & Rothbaum, B. (1989). Behavioral / cognitive conzeptualizations of post-traumatic stress disorder. Behavior Therapy, 20, 155 – 176. First citation in articleCrossref, Google Scholar

  • Golding, J. M., Wilsnack, S. C. & Cooper, M. L. (2002). Sexual assault history and social support: six general population studies. Journal of Traumatic Stress, 15, 187 – 197. First citation in articleCrossref, Google Scholar

  • Hagenaars, M. A., Minnen, A. van & Hoogduin, K. A. L. (2010). The impact of dissociation and depression on the efficacy of prolonged exposure treatment for PTSD. Behaviour Research and Therapy, 48, 19 – 27. First citation in articleCrossref, Google Scholar

  • Harned, M., Korslund, K. E., Foa, E. B. & Linehan, M. M. (2012). Treating PTSD in suicidal and self-injuring women with borderline personality disorder: development and preliminary evaluation of a dialectical behavior therapy prolonged exposure protocol. Behaviour Research and Therapy, 50, 381 – 386. First citation in articleCrossref, Google Scholar

  • Harned, M. S., Tkachuck, M. A. & Youngberg, K. A. (2013). Treatment preference among suicidal and self-injuring women with borderline personality disorder and PTSD. Journal of Clinical Psychology, 69, 749 – 761. First citation in articleCrossref, Google Scholar

  • Hembree, E. A., Cahill, S. P. & Foa, E. B. (2004). Impact of personality disorders on treatment outcome for female assault survivors with chronic posttraumatic stress disorder. Journal of Personality Disorder, 18, 117 – 127. First citation in articleCrossref, Google Scholar

  • Jung, K. & Steil, R. (2012). The feeling of being contaminated in adult survivors of childhood sexual abuse and its treatment via a two-session program of cognitive restructuring and imagery modification: a case study. Behavior Modification, 36, 67 – 86. First citation in articleCrossref, Google Scholar

  • Kessler, R. C, Sonnega, A., Bromet, E., Hughes, M. & Nelson, C. B. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry, 52, 1048 – 1060. First citation in articleCrossref, Google Scholar

  • Kleindienst, N., Bohus, M., Ludaescher, P., Limberger, M. F., Kuenkele, K. & Ebner-Priemer, U. W., et al. (2008). Motives for non-suicidal self-injury among women with borderline personality disorder. Journal of Nervous and Mental Disease, 196, 230 – 236. First citation in articleCrossref, Google Scholar

  • Kleindienst, N., Priebe, K., Görg, N., Dyer, A., Steil, R. & Lyssenko, L., et al. (2016). State dissociation moderates response to dialectical behavior therapy for posttraumatic stress disorder in women with and without borderline personality disorder. European Journal of Psychotraumatology, 7 (1), 30375. https://doi.org/10.3402/ejpt.v7.30375 First citation in articleCrossref, Google Scholar

  • Krakow, B. & Neidhardt, J. (1992). Conquering Bad Dreams & Nightmares: A Guide to Understanding, Interpretation, and Cure. New York, NY: Berkley Books. First citation in articleGoogle Scholar

  • Krüger, A., Kleindienst, N., Priebe, K., Dyer, A. S., Steil, R. & Schmahl, C., et al. (2014). Non-suicidal self-injury during an exposure-based treatment in patients with posttraumatic stress disorder and borderline features. Behaviour Research and Therapy, 61, 136 – 141. First citation in articleCrossref, Google Scholar

  • Lenzenweger, M. F., Lane, M., Loranger, A. W. & Kessler, R. C. (2007). DSM-IV personality disorders in the National Comorbidity Survey Replication (NCS-R). Biological Psychiatry, 62, 553 – 564. First citation in articleCrossref, Google Scholar

  • Maercker, A., Forstmeier, S., Wagner, B., Glaesmer, H. & Brähler, E. (2008). Posttraumatische Belastungsstörungen in Deutschland. Ergebnisse einer gesamtdeutschen epidemiologischen Untersuchung. Nervenarzt, 79, 577 – 586. First citation in articleCrossref, Google Scholar

  • Maniglio, R (2009). The impact of child sexual abuse on health: a systematic review of reviews. Clinical Psychology Review, 29, 647 – 657. First citation in articleCrossref, Google Scholar

  • Maniglio, R. (2010). Child sexual abuse in the etiology of depression: A systematic review of reviews. Depression and Anxiety, 27, 631 – 642. First citation in articleCrossref, Google Scholar

  • McCullough, D. (2012). Therapeutische Beziehung und die Behandlung chronischer Depressionen. Cognitive Behavioral Analysis System of Psychotherapy (CBASP). Heidelberg: Springer. First citation in articleGoogle Scholar

  • McDonagh, A., Friedman, M., McHugo, G., Ford, J., Sengupta, A. & Mueser, K., et al. (2005). Randomized trial of cognitive-behavioral therapy for chronic posttraumatic stress disorder in adult female survivors of childhood sexual abuse. Journal of Consulting and Clinical Psychology, 73, 515 – 524. First citation in articleCrossref, Google Scholar

  • McFarlane, A. C. (2006). The relationship between personality and posttraumatic stress disorder. In J. StrelauT. Klonowicz (Eds.) People under extreme stress. (pp. 1 – 14). New York: Nova. First citation in articleGoogle Scholar

  • Molnar, B. E., Buka, S. L. & Kessler, R. C. (2001). Child sexual abuse and subsequent psychopathology: results from the National Comorbidity Survey. American Journal of Public Health, 91, 753 – 760. First citation in articleCrossref, Google Scholar

  • Mullen, P. E., Martin, J. L., Anderson, J. C., Romans, S. E. & Herbison, G. P. (1994). The effect of child sexual abuse on social, interpersonal and sexual function in adult life. British Journal of Psychiatry, 165, 35 – 47. First citation in articleCrossref, Google Scholar

  • National Collaborating Centre for Mental Health (NICE). (2005). Post-traumatic stress disorder: The management of PTSD in adults and children in primary and secondary care. London: Gaskell and the British Psychological Society. First citation in articleGoogle Scholar

  • Neuner, F. (2008). Stabilisierung vor Konfrontation in der Traumatherapie – Grundregel oder Mythos? Verhaltenstherapie, 18, 108 – 118. First citation in articleCrossref, Google Scholar

  • Pagura, J., Stein, M. B., Bolton, J. M., Cox, B. J., Grant, B. & Sareen, J. (2010). Comorbidity of borderline personality disorder and posttraumatic stress disorder in the U.S. population. Journal of Psychiatric Research, 44, 1190 – 1198. First citation in articleCrossref, Google Scholar

  • Paolucci, E. O., Genuis, M. L. & Violato, C. (2001). A meta-analysis of the published research on the effects of child sexual abuse. Journal of Psychology, 135, 17 – 36. First citation in articleCrossref, Google Scholar

  • Paras, M. L., Murad, M. H., Chen, L. P., Goranson, E. N., Sattler, A. L. & Colbenson, K. M., et al. (2009). Sexual abuse and lifetime diagnosis of somatic disorders: a systematic review and meta-analysis. JAMA, 302, 550 – 561. First citation in articleCrossref, Google Scholar

  • Peleikis, D. E. & Dahl, A. A. (2005). A systematic review of empirical studies of psychotherapy with women who were sexually abused as children. Psychotherapy Research, 15, 304 – 315. First citation in articleCrossref, Google Scholar

  • Peleikis, D. E., Mykletun, A. & Dahl, A. A. (2004). The relative influence of childhood sexual abuse and other family background risk factors on adult adversities in female outpatients treated for anxiety disorders and depression. Child Abuse and Neglect, 28, 61 – 76. First citation in articleCrossref, Google Scholar

  • Perkonigg, A., Kessler, R. C., Storz, S. & Wittchen, H.-U. (2000). Traumatic events and post-traumatic stress disorder in the community: prevalence, risk factors and comorbidity. Acta Psychiatrica Scandinavica, 101, 46 – 59. First citation in articleCrossref, Google Scholar

  • Pietrzak, R. H., Goldstein, R. B., Southwick, S. M. & Grant, B. F. (2011). Personality disorders associated with full and partial posttraumatic stress disorder in the U.S. population: results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Psychiatric Research, 25, 456 – 465. First citation in articleGoogle Scholar

  • Rachman, S., Shafran, R., Radomsky, A. S. & Zysk, E. (2011). Reducing contamination by exposure plus safety behaviour. Journal of Behavior Therapy and Experimental Psychiatry, 42, 397 – 404. First citation in articleCrossref, Google Scholar

  • Resick, P. A., Monson, C. M. & Chard, K. M. (2007). Cognitive processing therapy: Veteran / military version. Washington, DC: Department of Veterans Affairs. First citation in articleGoogle Scholar

  • Resick, P. A. & Schnicke, M. K. (1992). Cognitive processing therapy for sexual assault victims. Journal of Consulting and Clinical Psychology, 60, 748 – 756. First citation in articleCrossref, Google Scholar

  • Rosner, R., Henkel, C., Ginkel, K. & Mestel, R. (2010). Was passiert nach der stationären Stabilisierung mit komplex traumatisierten PTB-Patientinnen? Die Bedeutung von Stabilisierung und Konfrontation für die Behandlung traumatisierter Frauen. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie, 58, 127 – 135. First citation in articleLink, Google Scholar

  • Rüsch, N., Corrigan, P. W., Bohus, M., Kühler, T., Jacob, G. A. & Lieb, K. (2007). The impact of posttraumatic stress disorder on dysfunctional implicit and explicit emotions among women with borderline personality disorder. Journal of Nervous and Mental Disease, 195, 537 – 539. First citation in articleCrossref, Google Scholar

  • Rüsch, N., Schulz, D., Valerius, G., Steil, R., Bohus, M. & Schmahl, C. (2011). Disgust and implicit self-concept in women with borderline personality disorder and posttraumatic stress disorder. European Archives of Psychiatry and Clinical Neuroscience, 261, 369 – 376. First citation in articleCrossref, Google Scholar

  • Schnyder, U., Ehlers, A., Elbert, T., Foa, E. B., Gersons, B. P. R. & Resick, P. A., et al. (2015). Psychotherapies for PTSD: what do they have in common? European Journal of Psychotraumatology, 6, 28186. First citation in articleCrossref, Google Scholar

  • Smolak, L. & Murnen, S. K. (2002). A meta-analytic examination of the relationship between child sexual abuse and eating disorders. International Journal of Eating Disorders, 31, 136 – 150. First citation in articleCrossref, Google Scholar

  • Steil, R., Dittmann, C., Matulis, S., Müller-Engelmann, M. & Priebe, K. (2015). Dialektisch-behavioraleTherapie der PTBS bei Patientinnen mit schwerer Störung der Emotionsregulation. PSYCH up2date, 9, 33 – 74. First citation in articleCrossref, Google Scholar

  • Steil, R., Dyer, A., Priebe, K., Kleindienst, N. & Bohus, M. (2011). Dialectical behavior therapy for posttraumatic stress disorder related to childhood sexual abuse: a pilot study of an intensive residential treatment program. Journal of Traumatic Stress, 24, 102 – 106. First citation in articleCrossref, Google Scholar

  • Steil, R., Jung, K. & Stangier, U. (2011). Efficacy of a two session program of cognitive restructuring and imagery modification to reduce the feeling of being contaminated in adult survivors of childhood sexual abuse: a pilot study. Journal of Behavior Therapy and Experimental Psychiatry, 42, 325 – 329. First citation in articleCrossref, Google Scholar

  • Steil, R., Krüger, A., Dyer, A., Priebe, K., Feldmann, R. E. & Bohus, M. (2010). DBT-PTSD: Dialektisch Behaviorale Therapie zur Behandlung der Posttraumatischen Belastungsstörung mit schwerer Störung der Emotionsregulation nach sexualisierter Gewalt in der Kindheit und Jugend. Trauma und Gewalt, 2, 106 – 117. First citation in articleGoogle Scholar

  • Ursano, R. J., Bell, C., Spencer, E., Friedman, M., Norwood, A. & Pfefferbaum, B., et al. (2004). Practice guideline for the treatment of patients with acute stress disorder and posttraumatic stress disorder. American Journal of Psychiatry, 161, 3 – 31. https://doi.org/10.1176/appi.books.9780890423363.52257 First citation in articleGoogle Scholar