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Psychotherapie der Zwangsstörung

Was ist evidenzbasiert?

Psychotherapy for obsessive-compulsive disorder

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Zusammenfassung

Die Zwangsstörung ist eine schwere und massiv beeinträchtigende psychische Erkrankung, die ohne adäquate Behandlung in der Regel chronisch verläuft. Kognitive Verhaltenstherapie mit Exposition stellt zum heutigen Zeitpunkt das am besten untersuchte und nach wissenschaftlichen Kriterien wirksamste Verfahren bei Zwängen dar. 60–70% der Patienten können hiermit zu einer klinisch bedeutsamen Verbesserung ihrer Symptome gelangen. Richtig angewandt, ist Expositionsbehandlung in vielen Fällen vergleichbar wirksam wie deren Kombination mit medikamentöser Behandlung und kennt nur wenige Kontraindikationen. Allerdings sind für die korrekte Durchführung einige Punkte zu beachten, die in dem folgenden Beitrag näher erläutert werden. Da ein Teil der Patienten von dem Behandlungsansatz dennoch nicht hinreichend profitiert, werden auch mögliche Alternativen und Erweiterungen des Expositionsansatzes vorgestellt. Bislang stehen Nachweise für deren Wirksamkeit über randomisierte, kontrollierte Studien jedoch noch aus.

Summary

Obsessive-compulsive disorder is a severe, very disabling condition that usually takes a chronic course if no adequate treatment is applied. Up to now, cognitive behavioural therapy with exposure and response prevention (CBT) is the most thoroughly investigated and most effective intervention, leading to a clinically significant symptom reduction in 60–70% of the patients. Correctly applied, this treatment can be equally effective as its combination with pharmacological management. For a correct implementation, however, several points have to be considered which are described in the following review. Considering the fact that some of the patients are unable to benefit sufficiently from this approach, potential alternatives and extensions of CBT are discussed. To date, however, no other treatment approach has proven to be effective based on randomised controlled trials.

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Authors and Affiliations

  1. Abteilung für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg, Hauptstr. 5, 79194, Freiburg, Deutschland

    A.K. Külz & U. Voderholzer

  2. Schön Klinik Roseneck, Prien, Deutschland

    U. Voderholzer

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  1. A.K. Külz
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  2. U. Voderholzer
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Correspondence to A.K. Külz.

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Külz, A., Voderholzer, U. Psychotherapie der Zwangsstörung. Nervenarzt 82, 308–318 (2011). https://doi.org/10.1007/s00115-010-2962-3

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