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Originalia

Die Wirksamkeit ambulanter Psychotherapie der Sozialen Angststörung in einer universitären Ambulanz

Wird die Forschung in die Praxis transportiert?

Published Online:July 08, 2009https://doi.org/10.1026/1616-3443.38.3.181

Abstract

Zusammenfassung.Hintergrund: Zur Übertragbarkeit der in randomisierten, kontrollierten Studien erzielten Wirksamkeit psychotherapeutischer Interventionen für soziale Angststörung in der psychotherapeutischen Praxis sowie zur Vorhersage des Therapieausgangs liegen bisher wenige Ergebnisse vor. Methode: In einer universitären psychotherapeutischen Hochschul- und Ausbildungsambulanz wurde an N = 131 Patienten mit einer Sozialen Phobie die Wirksamkeit einer verhaltenstherapeutisch orientierten Therapie überprüft. Die retrospektiv durch Aktenstudium erfassten angewandten Therapietechniken sowie weitere Variablen wurden als Prädiktoren des Therapieerfolgs untersucht. Ergebnisse: Intragruppen-Effektstärken unmittelbar nach der Therapie variierten zwischen 1.11–1.26 für die Completer-, sowie 0.64 – 0.81 für die Intent-to-Treat-Stichprobe. Keine der Behandlungen folgte vollständig einer manualisierten Therapieform, bei nur 31% basierten mehr als drei Viertel der Therapie auf demselben Therapierational. Überwiegend wurden Techniken aus der Kognitiven Therapie, der Konfrontationstherapie und des Sozialen Kompetenztrainings kombiniert. Das Ausmaß der positiven Veränderung auf störungsspezifischen Instrumenten war geringer bei Durchführung von Exposition in vivo im Vergleich zu den anderen Therapiebausteinen. Auch ergaben sich geringere Effektstärken, wenn Rollenspiele aus der Kognitiven Therapie isoliert ohne Einbau in ihren logischen Zusammenhang der behavioralen Überprüfung dysfunktionaler Gedanken (Verhaltensexperimente) eingesetzt wurden. Schlussfolgerungen: Die Psychotherapie in der Hochschul- und Ausbildungsambulanz der TU Braunschweig ist wirksam, jedoch sind die Effektstärken unter denen, die in neueren RCTs berichtet werden. Die verwendeten Therapietechniken setzten sich mehrheitlich aus unterschiedlichen Therapiemanualen zusammen und es wird nicht eine bestimmte Methode verfolgt, wie es in randomisierten Therapiestudien üblich ist. Dies impliziert eine Diskrepanz zwischen Leistungen, die im Rahmen von randomisierten Forschungsstudien im Vergleich zur Praxis erbracht werden.


Efficacy of outpatient psychotherapy for social anxiety in a university hospital: Are research results transported into practice?

Abstract.Background: There is a lack of empirical findings on the transportability of effective psychotherapy interventions and on the prediction of outcome for social anxiety disorder treated in the field. Methods: 131 patients diagnosed with social phobia were treated in a university-based psychotherapy outpatient clinic with a focus on cognitive-behavioral treatments. Techniques applied in individual treatments were identified retrospectively on the basis of patient files and investigated alongside other variables as predictors of treatment outcome. Results: Within-group effect sizes varied between 1.11 and 1.26 for completers, and between 0.64 and 0.81 for the intent-to-treat sample. None of the interventions was delivered according to only one treatment manual and only in 31% was at least three quarters of the treatment based on the same rationale. Most treatments drew on cognitive therapy, exposure therapy, and social skills training. There was a reduced positive effect size for exposure in vivo when compared to other treatment components. Furthermore, lower effect sizes occurred when role-play was implemented in isolation from its origin in behavioral experiments to examine dysfunctional thoughts. Conclusions: Treatment of social anxiety disorder in the outpatient clinic of the TU Braunschweig is effective; however, the effect sizes are below those reported in recent RCTs. The intervention techniques employed are predominantly drawn from different treatment manuals and they do not follow one specific method, as is customary in randomized treatment studies, indicating a discrepancy between services delivered in research versus field settings.

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