Skip to main content
Originalarbeit

Akzeptanz- und Commiment-Therapie mit therapieresistenten Störungen im stationären Setting

Eine Beobachtungsstudie

Published Online:https://doi.org/10.1026/1616-3443/a000532

Zusammenfassung.Hintergrund: Stationäre psychotherapeutische Behandlungen haben eine große Bedeutung im Versorgungsalltag. Ihre Bewährung bei schwergradigen und komorbiden Störungsbildern ist jedoch nur lückenhaft untersucht. Dies gilt besonders für die zunehmend angewendete Akzeptanz- und Commitment-Therapie (ACT). Fragestellung: In erster Linie soll die Wirksamkeit einer stationären störungsübergreifenden ACT-basierten Behandlung in erwähnten Stichproben untersucht werden. Ergänzend wird der zeitliche Verlauf der psychischen Flexibilität (PF), dem Kernkonzept der ACT, explorativ untersucht. Methode: Eine konsekutive Stichprobe von 47 Patientinnen und Patienten mit heterogenen und komorbiden Störungsbildern in stationärer Psychotherapie wurde im Rahmen einer explorativen Beobachtungsstudie mittels wöchentlicher Verlaufsmessungen sowie umfassender Prä-Post-Vergleiche untersucht. Ergebnisse: Die Effektstärken hinsichtlich allgemeiner Symptomreduktion, der Zunahme psychischer Flexibilität sowie weiterer ACT-spezifischer Fertigkeiten sind moderat bis hoch. Die Verlaufsmessungen weisen auf lineare Verbesserungen sowie hohe Übereinstimmungen zwischen Selbst- und Fremdrating hin. Schlussfolgerungen: Die Ergebnisse zeigen positive Effekte der ACT im stationären Setting bei einer diagnostisch heterogenen Stichprobe mit einem hohen Anteil komorbider Störungen.


Inpatient Acceptance and Commitment-Therapy for Treatment-Resistant Disorders: An Observational Study

Abstract.Background: Inpatient psychotherapeutic treatments are of great importance in everyday clinical care. However, research of specific inpatient treatments for severe and comorbid disorders is lacking. This is particularly true for acceptance and commitment therapy (ACT), which is increasingly used. Aim: The efficacy of an inpatient ACT-based treatment for transdiagnostic patients was investigated in the aforementioned sample. In addition, weekly process data on psychological flexibility, the core concept of ACT, were analyzed. Method: A consecutive sample of 47 patients with heterogeneous and comorbid disorders was investigated in an exploratory observational study using weekly progression measurements and pre-to-post comparisons. Results: The effect sizes regarding overall symptomatology, increase of psychological flexibility, and other ACT-specific processes were moderate to high. The process measures indicated linear improvements and high concurrence between self-report and clinical assessment. Conclusion: The results demonstrate the positive effects of an ACT-based inpatient therapy in a transdiagnostic sample with a high proportion of severe and comorbid disorders.

Literatur

  • ACBS. (2018, October 3). ACT Randomized Controlled Trials since 1986. Retrieved from https://contextualscience.org/ACT_Randomized_Controlled_Trials First citation in articleGoogle Scholar

  • A-Tjak, J. G. L., Davis, M. L., Morina, N., Powers, M. B., Smits, J. A. J. & Emmelkamp, P. M. G. (2015). A meta-analysis of the efficacy of acceptance and commitment therapy for clinically relevant mental and physical health problems. Psychotherapy and Psychosomatics, 84 (1), 30 – 36. https://doi.org/10.1159/000365764 First citation in articleCrossrefGoogle Scholar

  • Baer, R. A., Smith, G. T., Lykins, E., Button, D., Krietemeyer, J., Sauer, S., Walsh, E. et al. (2008). Construct validity of the five facet mindfulness questionnaire in meditating and nonmeditating samples. Assessment, 15, 329 – 342. https://doi.org/10.1177/1073191107313003 First citation in articleCrossrefGoogle Scholar

  • Benoy, C., Bader, K. & Schumann, I. (2015). Akzeptanz- und Commitment-Therapie : Ein transdiagnostischer Ansatz. PSYCH Up2date, 9, 237 – 255. First citation in articleCrossrefGoogle Scholar

  • Benoy, C., Knitter, B., Schumann, I., Bader, K., Walter, M. & Gloster, A. T. (2019). Treatment sensitivity: Its importance in the measurement of psychological flexibility. Journal of Contextual Behavioral Science, 13, 121 – 125. First citation in articleCrossrefGoogle Scholar

  • Benoy, C. & Schumann, I. (2015). Behandlung von Zwangserkrankungen : Zur Indikation eines stationären Settings. Psychiatrie & Neurologie, 4, 2 – 4. First citation in articleGoogle Scholar

  • Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K. et al. (2011). Preliminary Psychometric Properties of the Acceptance and Action Questionnaire-II: A Revised Measure of Psychological Inflexibility and Experiential Avoidance. Behavior Therapy, 42, 676 – 688. https://doi.org/10.1016/j.beth.2011.03.007 First citation in articleCrossrefGoogle Scholar

  • Catalan-Matamoros, D., Helvik-Skjaerven, L., Labajos-Manzanares, M. T., Martínez-de-Salazar-Arboleas, A. & Sánchez-Guerrero, E. (2011). A pilot study on the effect of Basic Body Awareness Therapy in patients with eating disorders : A randomized controlled trial. Clinical Rehabilitation, 25, 617 – 626. https://doi.org/10.1177/0269215510394223 First citation in articleCrossrefGoogle Scholar

  • Chawla, N. & Ostafin, B. (2007). Experiential Avoidance as a Functional Dimensional Approach to Psychopathology: An Empirical Review. Journal of Clinical Psychology, 63, 871 – 890. https://doi.org/10.1002/jclp First citation in articleCrossrefGoogle Scholar

  • Clarke, S., Kingston, J., James, K., Bolderston, H. & Remington, B. (2014). Acceptance and Commitment Therapy group for treatment-resistant participants: A randomized controlled trial. Journal of Contextual Behavioral Science, 3, 179 – 188. https://doi.org/10.1016/j.jcbs.2014.04.005 First citation in articleCrossrefGoogle Scholar

  • Craske, M. G. (2012). Transdiagnostic treatment for anxiety and depression. Depression and Anxiety, 29, 749 – 753. https://doi.org/10.1002/da.21992 First citation in articleCrossrefGoogle Scholar

  • Dimidjian, S., Arch, J. J., Schneider, R. L., Desormeau, P., Felder, J. N. & Segal, Z. V. (2016). Considering Meta-Analysis, Meaning, and Metaphor: A Systematic Review and Critical Examination of “Third Wave“ Cognitive and Behavioral Therapies. Behavior Therapy, 47, 886 – 905. https://doi.org/10.1016/j.beth.2016.07.002 First citation in articleCrossrefGoogle Scholar

  • Firsching, V. J., Villanueva, J., Rinner, T.B., Benoy, C., Kuhweide, V., Brogli, S. et al. (2018). Measuring Psychological Flexibility in a Context Sensitive Manner – Development and Preliminary Psychometric Proporties of a Short and Accessible Questionnaire. Poster-Vorstellung anlässlich der ACBS World Conference 16, Montreal, Canada. First citation in articleGoogle Scholar

  • Forman, E. M., Herbert, J. D., Moitra, E., Yeomans, P. D. & Geller, P. A. (2007). A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression. Behavior Modification, 31, 772 – 799. https://doi.org/10.1177/0145445507302202 First citation in articleCrossrefGoogle Scholar

  • Franke, G. H. (2015). BSCL-53®-S. Brief Symptom-Checklist–Standard–Deutsches Manual. Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Gaudiano, B. A. & Herbert, J. D. (2006). Acute treatment of inpatients with psychotic symptoms using Acceptance and Commitment Therapy: Pilot results. Behaviour Research and Therapy, 44 (3), 415 – 437. https://doi.org/10.1016/j.brat.2005.02.007 First citation in articleCrossrefGoogle Scholar

  • Gillanders, D. T., Bolderston, H., Bond, F. W., Dempster, M., Flaxman, P. E., Campbell, L. et al. (2014). The Development and Initial Validation of the Cognitive Fusion Questionnaire. Behavior Therapy, 45, 83 – 101. https://doi.org/10.1016/j.beth.2013.09.001 First citation in articleCrossrefGoogle Scholar

  • Gloster, A. T., Klotsche, J., Ciarrochi, J., Eifert, G., Sonntag, R., Wittchen, H. U. & Hoyer, J. (2017). Increasing valued behaviors precedes reduction in suffering: Findings from a randomized controlled trial using ACT. Behaviour Research and Therapy, 91, 64 – 71. https://doi.org/10.1016/j.brat.2017.01.013 First citation in articleCrossrefGoogle Scholar

  • Gloster, A. T., Meyer, A. H. & Lieb, R. (2017). Psychological flexibility as a malleable public health target: Evidence from a representative sample. Journal of Contextual Behavioral Science, 6 (2), 166 – 171. https://doi.org/10.1016/j.jcbs.2017.02.003 First citation in articleCrossrefGoogle Scholar

  • Gloster, A. T., Sonntag, R., Hoyer, J., Meyer, A. H., Heinze, S., Ströhle, A. et al. Wittchen & U., H. (2015). Treating treatment-resistant patients with panic disorder and agoraphobia using psychotherapy: A randomized controlled switching trial. Psychotherapy and Psychosomatics, 84 (2), 100 – 109. https://doi.org/10.1159/000370162 First citation in articleCrossrefGoogle Scholar

  • Graser, J., Bohn, C., Kelava, A., Schreiber, F., Hofmann, S. G. & Stangier, U. (2012). Der “affective style questionnaire (ASQ)“: Deutsche adaption und validitäten. Diagnostica, 58 (2), 100 – 111. https://doi.org/10.1026/0012-1924/a000056 First citation in articleLinkGoogle Scholar

  • Gratz, K. L. & Roemer, L. (2004). Multidimensional Assessment of Emotion Regulation and Dysregulation: Development, Factor Structure, and Initial Validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 26 (1), 41 – 54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94 First citation in articleCrossrefGoogle Scholar

  • Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A. & Lillis, J. (2006). Acceptance and commitment therapy: model, processes and outcomes. Behaviour Research and Therapy, 44 (1), 1 – 25. https://doi.org/10.1016/j.brat.2005.06.006 First citation in articleCrossrefGoogle Scholar

  • Hayes, S. C., Pistorello, J. & Levin, M. E. (2012). Acceptance and Commitment Therapy as a Unified Model of Behavior Change. The Counseling Psychologist, 40, 976 – 1002. https://doi.org/10.1177/0011000012460836 First citation in articleCrossrefGoogle Scholar

  • Hoyer, J. & Gloster, A. T. (2013). Psychologische Flexibilität messen: Der Fragebogen zu Akzeptanz und Handeln II. Verhaltenstherapie, 23, 42 – 44. https://doi.org/10.1159/000347040 First citation in articleCrossrefGoogle Scholar

  • Lamers, S. M. A., Westerhof, G. J., Bohlmeijer, E. T., ten Klooster, P. M. & Keyes, C. L. M. (2011). Evaluating the Psychometric Properties of the Mental Health Continuum-Short Form (MHC-SF). Journal of Clinical Psychology, 67 (1), 99 – 110. https://doi.org/10.1002/jclp.20741 First citation in articleCrossrefGoogle Scholar

  • Lang, A. J., Schnurr, P. P., Jain, S., Raman, R., Walser, R., Bolton, E. et al. Benedek, D. (2012). Evaluating transdiagnostic treatment for distress and impairment in veterans: A multi-site randomized controlled trial of Acceptance and Commitment Therapy. Contemporary Clinical Trials, 33 (1), 116 – 123. https://doi.org/10.1016/j.cct.2011.08.007 First citation in articleCrossrefGoogle Scholar

  • Liebherz, S. & Rabung, S. (2013). Wirksamkeit psychotherapeutischer Krankenhausbehandlung im deutschsprachigen Raum : Eine Meta-Analyse. Psychother Psych Med, 63, 355 – 364. First citation in articleGoogle Scholar

  • Luoma, B., Hayes, S. C. & Walser, R. D. (2009). ACT-Training. Handbuch der Acceptance & Commitment Therapie. Paderborn: Junfermann. First citation in articleGoogle Scholar

  • Mander, J., Blanck, P., Neubauer, A. B., Kröger, P., Flückiger, C., Lutz, W. et al. Heidenreich, T. (2019). Mindfulness and progressive muscle relaxation as standardized session-introduction in individual therapy: A randomized controlled trial. Journal of Clinical Psychology, 75, 21 – 45. https://doi.org/10.1002/jclp.22695 First citation in articleCrossrefGoogle Scholar

  • Ohmann, S., Schuch, B., Sackl, P., Werneck-Rohrer, S., Vesely, C., Gössler, R. & Popow, C. (2007). Kognitiv-verhaltenstherapeutische gruppentherapie für jugendliche mit angstbedingter schulverweigerung. Eine beobachtungsstudie. Verhaltenstherapie, 17, 175 – 181. https://doi.org/10.1159/000104353 First citation in articleCrossrefGoogle Scholar

  • Öst, L. G. (2014). The efficacy of Acceptance and Commitment Therapy: An updated systematic review and meta-analysis. Behaviour Research and Therapy, 61, 105 – 121. https://doi.org/10.1016/j.brat.2014.07.018 First citation in articleCrossrefGoogle Scholar

  • Petersen, C. L. & Zettle, R. D. (2009). Treating inpatients with comorbid depression and alcohol use disorders: A comparison of acceptance and commitment therapy versus treatment as usual. Psychological Record, 59, 521 – 536. https://doi.org/10.1007/BF03395679 First citation in articleCrossrefGoogle Scholar

  • Powers, M. B., Zum Vörde Sive Vörding, M. B. & Emmelkamp, P. M. G. (2009). Acceptance and commitment therapy: A meta-analytic review. Psychotherapy and Psychosomatics, 78 (2), 73 – 80. https://doi.org/10.1159/000190790 First citation in articleCrossrefGoogle Scholar

  • Roy-Byrne, P. (2017). Transdiagnostic Cognitive Behavioral Therapy and the Return ofthe Repressed. JAMA Psychiatry, 2, 1 – 2. https://doi.org/10.1176/appi.ajp.2017.17010057 First citation in articleGoogle Scholar

  • Ruiz, F. J. (2012). Acceptance and Commitment Therapy versus Traditional Cognitive Behavioral Therapy : A Systematic Review and Meta-analysis of Current Empirical Evidence. International Journal of Psychology & Psychological Therapy, 12, 333 – 357. https://doi.org/https://10.0.3.248/J.BRAT.2014.07.018 First citation in articleGoogle Scholar

  • Steger, M. F., Frazier, P., Oishi, S. & Kaler, M. (2006). The meaning in life questionnaire: Assessing the presence of and search for meaning in life. Journal of Counseling Psychology, 53 (1), 80 – 93. https://doi.org/10.1037/0022-0167.53.1.80 First citation in articleCrossrefGoogle Scholar

  • Voderholzer, U., Koch, S., Hillert, A. & Schlegl, S. (2012). Response und non-response in der stationären Psychotherapie depressiver patienten. Psychotherapeut, 57, 410 – 416. https://doi.org/10.1007/s00278-012-0931-y First citation in articleCrossrefGoogle Scholar

  • Wittchen, H. U., Zaudig, M. & Fydrich, T. (1997). SKID, Strukturiertes Klinisches Interview für DSM-IV. Achse I und II. Handanweisung. Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Wolitzky-Taylor, K. B., Arch, J. J., Rosenfield, D. & Craske, M. G. (2012). Moderators and non-specific predictors of treatment outcome for anxiety disorders: A comparison of cognitive behavioral therapy to acceptance and commitment therapy. Journal of Consulting and Clinical Psychology, 80, 786 – 799. https://doi.org/10.1037/a0029418 First citation in articleCrossrefGoogle Scholar