Klett-Cotta-Verlag Psychology

Traumabehandlung bei Psychose

August 2017, 11. Jahrgang, Heft 3, pp 216-233

DOI 10.21706/tg-11-3-216

Obgleich sowohl Traumatisierungen als auch posttraumatische Belastungsstörungen eine hohe Prävalenz bei Menschen mit Psychosen haben, zögern Therapeuten, dieser Gruppe PTBS-Richtlinienbehandlungen anzubieten. Sie befürchten, dass die direkte Verarbeitung traumatischer Erinnerungen für Patienten mit Psychose unerträglich sei und Symptomverschlimmerung, Destabilisierung und psychiatrische Krise die Folge sein könnten. Die verfügbaren Daten legen jedoch das Gegenteil nahe. Patienten mit schwerer psychischer Erkrankung können erfolgreich mit traumafokussierter Therapie (TFT) behandelt werden. Bei Patienten mit einer psychotischen Störung hat sich insbesondere die TFT mit direkter Prozessierung traumatischer Erinnerungen als effektive Intervention erwiesen. Diese Behandlungen sind außerdem offenbar sicher und führen zu positiven Nebeneffekten, z. B. einer Besserung der Depression und einer Reduzierung paranoider Vorstellungen. Die Autoren vertreten die These, dass ein Umdenken notwendig ist und dass Therapeuten, Ärzte und andere, die mit Menschen mit Psychose arbeiten, eine traumasensible Einstellung entwickeln und Traumata und andere negative Lebenserfahrungen in die Konzeptualisierung und Planung der Behandlung einbeziehen müssen. Wir haben diese Patientengruppe viel zu lange vernachlässigt. Es ist Zeit, dies zu ändern.

Treating Trauma in Psychosis
Although both trauma and PTSD are highly prevalent in people with psychosis, therapists are reluctant to offer guideline PTSD treatments to this group. Therapists fear that patients with psychosis won’t tolerate direct trauma memory processing and that this will result in symptom worsening, destabilization, and psychiatric crisis. The available data however suggests otherwise. Patients with severe mental illness can effectively be treated with trauma-focused treatment (TFT). In patients with a psychotic disorder especially TFTs with direct memory processing are found to be effective. Moreover, these treatments appear to be safe and result in positive side-effects like a reduction of depression and paranoid ideation. It is suggested that change is necessary. That professionals working with people with psychosis need to adopt a trauma-sensitive attitude and include trauma and other negative life experiences in the conceptualization and planning of treatment. We’ve neglected this group of patients for too long, it’s time for change.

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