Friedhelm Stetter

Autogenic training: a meta-analysis of clinical outcome studies.

Autogenic training (AT) is a self-relaxation procedure by which a psychophysiological determined relaxation response is elicited. A meta-analysis was performed to evaluate the clinical effectiveness of AT. Seventy-three controlled outcome studies were found (published 1952–99). Sixty studies (35 randomized controlled trials [RCT]) qualified for inclusion in the meta-analysis. Medium-to-large effect sizes (ES) occurred for pre–post comparisons of disease-specific AT-effects, with the RCTs showing larger ES. When AT was compared to real control conditions, medium ES were found. Comparisons of AT versus other psychological treatment mostly resulted in no effects or small negative ES. This pattern of results was stable at follow-up. Unspecific AT-effects (i.e., effects on mood, cognitive performance, quality of life, and physiological variables) tended to be even larger than main effects. Separate meta-analyses for different disorders revealed a significant reduction of the heterogeneity of ES. Positive effects (medium range) of AT and of AT versus control in the meta-analysis of at least 3 studies were found for tension headache/migraine, mild-to-moderate essential hypertension, coronary heart disease, asthma bronchiale, somatoform pain disorder (unspecified type), Raynauds disease, anxiety disorders, mild-to-moderate depression/dysthymia, and functional sleep disorders.

Self-regulation of slow cortical potentials in psychiatric patients: Alcohol dependency

Ten unmedicated alcohol-dependent male inpatients participated in a Slow Cortical Potential (SCP) self-regulation task utilizing biofeedback and instrumental conditioning. These patients were hospitalized for treatment of alcohol dependency after chronic abuse of alcoholic beverages. Somatic withdrawal symptomatology had occurred recently and the patients were free of any withdrawal symptoms of the autonomic nervous system. Immediately after hospitalization patients were unable to control their SCPs without the reinforcement of immediate feedback across 4 sessions. Seven patients participated in a fifth session an average of 4 months later. Six out of these 7 patients had not had a relapse at the follow-up. In the fifth session these patients were immediately able to differentiate between the required negativity and negativity suppression, whereas the seventh patient, who had relapsed, was unable to control his brain potentials successfully. Results are further evidence that some of the frontocortical dysfunctions in alcohol-dependent patients are reversible. This could covary with a morphological restitution of the cortex.

Distraction resulting from disease related words in alcohol-dependent inpatients: a controlled dichotic listening study

To test whether alcoholics develop an information processing bias towards disease-related stimuli, 30 alcoholic inpatients and 30 controls were administered a dichotic listening task. Three different stimulus types were presented to the right (ignored) channel: neutral words, rare neutral words and alcohol-related words. The hypothesized information processing bias should cause patients to make disproportionally more shadowing errors in the third condition. An ANOVA revealed a significant condition effect (P<0.001), a tendency towards a group effect (P=0.09) and a significant interaction (P<0.01) in the expected direction. There was a marked increase of errors in alcoholics when disease-related stimuli were presented compared to the neutral conditions and to the controls.

Psychotherapie von Suchterkrankungen

ZusammenfassungSubstanzabhängige sind eine der größten Patientengruppen, die mit gutem Erfolg psychotherapeutisch behandelbar sind. Dennoch waren sie lange nicht nur „ungeliebte Kinder der Psychiatrie”, sondern auch der Psychotherapie. Im ersten Teil dieser Übersicht werden mögliche Bedenken hinsichtlich der Psychotherapie dieser Patienten diskutiert: Mangelnde Ausbildung, Versorgungsstrukturen, eine mutmaßliche Unzuverlässigkeit der Suchtkranken, befürchtete Misserfolge und eine Tabuisierung dieser Störungen unter Psychotherapeuten sind durchaus ernstzunehmende Argumente, Suchtkranke nicht zu behandeln. Es wird aber auch deutlich gemacht, dass diese Hinderungsgründe überwunden werden können. Es ist lohnend, sich diesen Patienten zuzuwenden, auch wenn die psychotherapeutische Arbeit mit Substanzabhängigen zumindest phasenweise anstrengend sein kann. Da sich Suchtkranke oft mit anderen Beschwerden vorstellen, ist es wichtig, die Substanzproblematik frühzeitig festzustellen. Die deskriptive Diagnostik basiert auf einer Differenzierung der Konsumfolgeschäden von dem Abhängigkeits- oder Missbrauchssyndrom. Bei Substanzabhängigen sind Änderungsbereitschaft und Therapiemotivation nicht Voraussetzung, sondern Gegenstand der Psychotherapie. Die „Motivationstherapie” basiert auf einer empathischen, aber reflektiert-klaren therapeutischen Haltung. Der erste Teil dieser Übersicht schließt mit der Beschreibung derartiger Interventionen und einer Skizze stationärer und ambulanter Settings. Im folgenden zweiten Teil werden spezifische Beiträge verschiedener Psychotherapieansätze vorgestellt.SummarySubstance dependency is one of the most frequent disorders, which can be treated successfully by psychotherapy. However reasons are discussed, why psychotherapists probably hesitate in treating these patients. Insufficient psychotherapeutic education concerning dependency, structural problems, expected difficulties with these patients or expected poor treatment outcome may be overcome as well as blind areas in healthprofessionals’ perception concerning dependency among their patients and themselves. Though psychotherapy with addicts is sometimes exhausting, the readiness of psychotherapists to treat patients with substance disorders is increasing. Diagnosis nowadays is based on the distinction between drug depencency and drug abuse on the one hand and substance induced disorders on the other hand. Readiness for change and motivation for treatment are basic objects of psychotherapy in these patients. Therapeutic approaches to deal with this promising aspect of psychotherapy are presented. They are based on an empathic and clear therapeutic attitude. They can be easily implemented in different settings. At the end of the first part of this review in- patient and outpatient settings for the treatment of substance disorders are outlined. This will be followed in the second part by an outline of different specific psychotherapeutic approaches.