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Bericht

Intensivierte Exposition zur Förderung des Inhibitionslernens bei Angststörungen

Therapeutische Umsetzung in einer Studienambulanz

Published Online:December 18, 2020https://doi.org/10.1026/1616-3443/a000575

Abstract

Zusammenfassung. Die Wirksamkeit von Expositionsverfahren bei Angststörungen ist hervorragend belegt. Dennoch profitieren viele Patient_innen nicht oder nicht ausreichend, was die Notwendigkeit zur Verbesserung der Verfahren deutlich macht. Vielversprechende Optimierungsstrategien lassen sich aus Modellen des Inhibitionslernens ableiten, andererseits aus der Beobachtung, dass die in expositionsbasierten klinischen Trials erreichten hohen Effektstärken in der Mehrzahl durch deutlich kürzere und intensivere Therapien verglichen mit der Routineversorgung erreicht werden. Der Forschungsverbund PROTECT-AD (Providing Tools for Effective Care and Treatment of Anxiety Disorders) untersucht in einer multizentrischen randomisierten Studie die Effekte einer intensivierten Expositionstherapie (Intensivierte psychotherapeutische Intervention, IPI) mit zeitlich ausgedehnter Selbstmanagementphase im Vergleich zu einem inhaltlich identischen, aber zeitlich gestreckten treatment as ususal (TAU) bei über 600 Patient_innen mit verschiedenen Angststörungen. Hier berichten wir, wie Intensivierung als Optimierungsstrategie therapeutisch umgesetzt werden kann. Unsere Erfahrungen zeigen, dass intensivierte Exposition von den Patient_innen sehr gut angenommen wird und eine Reihe praktischer und gesundheitsökonomischer Vorteile bieten kann.


Intensified Exposure to Promote Inhibitory Learning in Anxiety Disorders. Therapeutic Implementation in a Clinical Trial

Abstract. The efficacy of exposure therapy in anxiety disorders is firmly established. Yet, a substantial proportion of patients does not or insufficiently respond, highlighting the need to optimize the treatment. Promising strategies can be derived from models of inhibitory learning. Further evidence stems from the observation that the high effect sizes reported in exposure-based clinical trials are mostly achieved using temporally intensified treatment protocols compared to exposure therapies in routine care. The research consortium PROTECT-AD (Providing Tools and Effective Care for the Treatment of Anxiety Disorders) tests in a multicentre randomized clinical trial with more than 600 patients whether a temporally condensed intensified psychological intervention (IPI) results in stronger and faster symptom reduction compared to an identical, but not intensified treatment as usual (TAU). Here we report on how intensified exposure can be implemented as an optimization strategy. Our experience shows that intensified exposure is well accepted by patients and may offer a number of practical and health economic advantages.

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