Zur Therapie von Angststörungen (generalsierte Angststörung, Panikstörung, Panikattacken) und Phobien kommen verschiedene Behandlungsverfahren zum Einsatz. Die wichtigsten sind
- Entspannungsverfahren
- Verhaltenstherapie
- Kognitive Therapie
- Tiefenpsychologisch fundierte Psychotherapie, Psychoanalyse und psychodynamische Therapieverfahren
- Medikamente
Entspannungsverfahren
Ängste sind in aller Regel von körperlichen Symptomen, v.a. auch von Verspannungen begleitet, die wiederum negativ auf die Angstsymptomatik und die körperlichen Symptome zurückwirken und diese verstärken oder zumindest aufrechterhalten. Deshalb ist ein wichtiger Ansatz bei der Angsttherapie die Beseitigung von Spannungen durch Entspannungsverfahren. Zum Einsatz kommen
- Autogenes Training
- Progressive Muskelentspannung nach Jacobson
- Biofeedback-Methoden
Verhaltenstherapie
Bei der Verhaltenstherapie der Phobien, Angst- und Panikstörungen geht es v.a. darum, sich den Ängsten und angstbesetzten Situationen gezielt und in zunehmender Dosis auszusetzen, bis alle zuvor gemiedenen Situationen wieder in Besitz genommen und in das normale Leben integriert werden können. Man bedient sich hierzu folgender Verfahren:
- Reizkonfrontation
- Reizüberflutung („flooding“)
- Es erfolgt unter paralleler therapeutischer Begleitung eine Konfontation mit einer maximal angstauslösenden Situation, die solange ausgehalten werden muss, bis eine physiologische Gewöhnung eintritt und der Patient lernt, dass die gefürchteten katastrophalen Folgen ausbleiben
- Diese Verfahren hat die beste Heilungsquote, wird aber auch am wenigsten gut toleriert und akzeptiert
- Abgestufte Reizexposition
- systematische Desensibilisierung durch stufenweise gesteigerte Reizexposition, bis alle Hierarchiestufen bis zum Maximum durchlaufen wurde
- Reizüberflutung („flooding“)
Kognitive Therapie
Bei dieser Therapie, die gerne mit verhaltenstherapeutischen Verfahren kombiniert wird, soll der Patient seinen Denk- und Bewertungsstil ändern. Theoretische Grundlage ist die Annahme, dass vor allem eine „Fehlbewertung“ der angstauslösenden Situation die heftige Angst und Vermeidungsreaktion hervorruft und immer weiter verstärkt.
Tiefenpsychologisch fundierte Psychotherapie
Diese Behandlungsmethode beasiert auf den theoretischen Grundannahmen der Psychoanalyse, denen zufolge die Angstsymptomatik Ausdruck eines unbewussten Konfliktes mit misslungener Kompromisslösung darstellt. Die Aufdeckung dieses Konfliktes und das „Durcharbeiten“ unter Reaktivierung der ursprünglichen Affekte soll den Angstaffekt dann überflüssig machen und wieder zum Verschwinden bringen.
Medikamente
Zum Einsatz kommen:
- Antidepressiva
- SSRI (Selektive Serotonin-Wiederaufnahme-Hemmer)
- SNAR (Serotonin-Noradrenalin-Wiederaufnahme-Hemmer)
- trizyklische Antidepressiva, z.B.
- Imipramin oder
- Clomipramin
- reversible (und auch irreversible) MAO-Hemmer
- Moclobemid
- Buspiron
- Benzodiazepine, z.B.
- Alprazolam
- Clonazepam
Differentialindikation der Psychopharmakotherapie:
- Panikattacken
- SSRI (Serotonin-Wiederaufnahme-Hemmer, 1. Wahl)
- Trizyklische Antidepressiva, z.B.
- Imipramin
- Clomipramin
- Benzodiazepine, z.B.
- Alprazolam
- Clonazepam
- Lorazepam
- Diazepam
- MAO-Hemmer (2. Wahl)
- Generalisierte Angststörung
- Benzodiazepine, v.a.
- Alprazolam
- Buspiron
- Trizyklische Antidepressiva
- Opipramol (Insidon)
- Benzodiazepine, v.a.
- Soziale Phobie (Soziale Angst)
- SSRI (Serotonin-Wiederaufnahme-Hemmer), z.B.
- Paroxetin
- reversible MAO-Hemmer
- Moclobemid
- ß-Blocker
- Benzodiazepine
- irreversible MAO-Hemmer (2. Wahl)
- SSRI (Serotonin-Wiederaufnahme-Hemmer), z.B.
- Spezifische Phobien
- keine spezifische Pharmakotherapie
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