Spezifische Psychotherapie der chronischen Depression mit dem Cognitive Behavioral Analysis System of Psychotherapy

Depressive Erkrankungen machen 36% aller psychiatrischen Störungen aus und münden in einem Drittel der Fälle in einen chronischen Verlauf, der schwierig zu therapieren ist. Einen Schlüssel zur Optimierung der Behandlung stellt die Veränderung der aufrechterhaltenen psychosozialen Faktoren durch spezifische Verhaltenstherapie dar. Das “Cognitive Behavioral Analysis System of Psychotherapy” – CBASP – nach James P. McCullough ist eine empirisch evaluierte Weiterentwicklung kognitiv-behavioraler und interpersoneller verhaltenstherapeutischer Strategien zur ambulanten Behandlung der chronischen Depression. Der Artikel fasst wichtige Informationen über die theoretische Basis, den entwicklungsbezogenen Einfluss von gelerntem und regelgeleitetem Verhalten auf die emotional kognitive Organisation, den interpersonellen Fokus der Therapie, die Behandlungsstrategien nach “Bottom-Up” und “TopDown” wirksamen Interventionen, die Behandlungsphasen und die wichtigsten Therapieziele zusammen.

[Interim results for the Patients' Rights Act and Infection Protection Act]

BACKGROUND

The Patient Rights Act has converted court rulings into legal paragraphs. Two new aspects have been introduced: the duty to hand over a copy of the signed written consent form to the patient (in which detailed recommendations are offered) and the obligation of a thorough documentation of findings and treatments within patient files. In addition the legislators, through the Joint Federal Committee (Gemeinsamer Bundesausschuss, GBA) have made the introduction of clinical risk management mandatory. The Infection Protection Act and its regulations have elevated the prerequisites of hygiene within hospitals and private practices with a parallel increase in liability.

RESULTS AND DISCUSSION

Both laws and regulations offer no reference as to who (and to what extent) is financially responsible for the excessive increase in personnel costs, which are as yet not included in the German diagnosis-related groups (G-DRG) system. Despite all additional measures within the area of risk management, mistakes (avoidable or unavoidable) will nevertheless occur. In order to avoid longstanding legal battles the authors recommend an open and rapid communication with the patient and family. The wall of silence should be a thing of the past.

[Humor therapy in the depressed elderly: results of an empirical study]

BACKGROUND

Positive effects of humor on older patients with depressive symptoms have been repeatedly reported. Empirical evidence, however, is rare. We investigated the effects of a standardized humor therapy group in a clinical context especially for older depressed patients.

PATIENTS AND METHODS

For this purpose, an experimental group with treatment (52 patients participating in the humor group) was compared to a control group with no specific treatment (38 patients); all 90 participants had clinical depressive symptoms according to ICD-10 classification. Questionnaires (among them GDS, SF-12, State-Trait Cheerfulness Inventory, Satisfaction with Life Scale) were administered at two time points (pre- and post-treatment).

RESULTS

From pre- to post-measurement, significant improvements could be shown only in the experimental group for resilience and satisfaction with life (p<0.05). Analyses of the subgroups with at least medium to severe depression showed further significant effects for cheerfulness, seriousness, bad mood, and satisfaction with life (p<0.05). These severely affected patients seemed to profit best from humor therapy.

CONCLUSION

Our results indicate the efficacy of this specific therapeutic intervention for older depressed patients.