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Biopsychosoziale Therapie der generalisierten Angststörung

Ein integratives Behandlungskonzept

Biopsychosocial therapy of generalized anxiety disorder

Integrative treatment concept

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Zusammenfassung

Die Coronapandemie hat bei vielen Menschen zum Erleben einer existenziellen Bedrohung geführt und unterschiedliche Formen der Bewältigung dieser anhaltenden Stresssituation ausgelöst. Besonders stark gestiegen ist das Risiko für die Entwicklung einer generalisierten Angsterkrankung („generalized anxiety disorder“, GAD). Die etablierten Konzepte der kognitiven Verhaltenstherapie („cognitive behavioral therapy“, CBT) sind in der Behandlung einer GAD nur mäßig wirksam. Daher wird unter Bezugnahme auf den biopsychosozialen Ansatz ein integratives Therapiekonzept entwickelt. Dieses vermittelt bereits im Rahmen der Psychoedukation einen Bezug zu frühen Prägungen in der Primärfamilie (unsicher-ambivalente Bindung, Unterdrückung von Neugierverhalten) als Ursache eines permanenten Sichsorgens und der dahinter stehenden Intoleranz für Ungewissheit. Zunächst steht der Aufbau einer tragfähigen therapeutischen Beziehung („alliance“) im Vordergrund, bei der die Autonomie und Selbstwirksamkeit des Patienten gefördert werden. Eine zentrale Bedeutung für den therapeutischen Fortschritt haben die Förderung von Erfahrungen, die die Selbstwirksamkeit erhöhen, sowie die Reduktion von Vermeidungsverhalten durch Exposition und Verhaltensexperimente. Der Abbau der maladaptiven Angstbewältigung durch Sorgenketten und Rückversicherungsverhalten geschieht durch die Entwicklung einer wachsenden Toleranz von Ungewissheit im jeweils aktuellen Lebensalltag. Prognostisch wesentlich sind die Berücksichtigung von Metakognitionen und dysfunktionalen Beziehungsmustern in der Paarbeziehung sowie die Durchführung von Entspannungsverfahren und richtig dosierter Sporttherapie. Schließlich geht es um die Bearbeitung dysfunktionaler Coping-Strategien, die die Chronifizierung fördern.

Abstract

The corona pandemic has led many people to experience an existential threat and has triggered different forms of coping with this persistent stress situation. The risk for the development of a generalized anxiety disorder (GAD) in particular has significantly increased. The established concepts of cognitive behavioral therapy (CBT) are only moderately effective in the treatment of GAD. Therefore, an integrative therapy concept is developed with reference to the biopsychosocial approach. This mediates a reference to early influences in the primary family (insecure ambivalent attachment, suppression of curiosity behavior) even during the psychoeducation as the cause of a permanent worrying and the underlying intolerance of uncertainty. The initial priority is on establishing a sustainable therapeutic relationship (alliance) in which the patient’s autonomy and self-efficacy are promoted. Of central importance to therapeutic progress is the promotion of experiences that enhance self-efficacy and the reduction of avoidance behavior through exposure and behavioral experiments. The reduction of maladaptive anxiety coping through worry chains and reassurance behavior occurs through the development of an increasingly greater tolerance of uncertainty in actual daily life. Essential for the prognosis are the consideration of metacognitions and dysfunctional relationship patterns in the couple relationship as well as carrying out relaxation procedures and correctly dosed exercises. Finally, it is a matter of the processing of dysfunctional coping strategies, which promote chronification.

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Authors and Affiliations

  1. Psychiatrische Klinik Sanatorium Kilchberg/ZH, Alte Landstr. 70, 8802, Kilchberg/ZH, Schweiz

    Ulrich T. Egle, Isabelle Bättig, Joel Neufeld, Tobias Ballweg & Katja Cattapan

  2. Universitätsklinik für Psychiatrie und Psychotherapie, Universität Bern, Bern, Schweiz

    Katja Cattapan

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  1. Ulrich T. Egle
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Correspondence to Ulrich T. Egle.

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Interessenkonflikt

U.T. Egle, I. Bättig, J. Neufeld, T. Ballweg und K. Cattapan geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Egle, U.T., Bättig, I., Neufeld, J. et al. Biopsychosoziale Therapie der generalisierten Angststörung. Psychotherapeut 67, 240–247 (2022). https://doi.org/10.1007/s00278-021-00567-6

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