Die Therapie der Posttraumatischen Belastungsstörung und anderer Traumatisierungs-Folgen gliedert sich in folgende Abschnitte:
- Allgemeine Massnahmen
- Spezifische stabilisierende Massnahmen
- Traumabearbeitung
Allgemeine Massnahmen
Die allgemeinen Massnahmen dienen in erster Linie der Herstellung einer geschützten Therapieumgebung (v.a. Schutz vor weiterer Traumatisierung), der Aufklärung über die nach einer Traumatisierung zu erwartenden Symptome und der Vorbereitung einer spezifischen Traumabehandlung (inkl. Beschaffung eines erfahrenen Traumatherapeuten, wenn möglich)
Spezifische stabilisierende Massnahmen
In diese Phase, die der Krisenintervention und der gezielten Vorbereitung auf die eigentliche Traumabearbeitung dient, kommen imaginative und distanzierende Techniken zum Einsatz, um den Patienten in die Lage zu versetzen, auch innerlich ausreichenden Schutz vor einer gefürchteten Überflutung mit Traumamaterial aufzubauen bzw. die Konfrontationen selber zu kontrollieren. Adjuvanz kommen auch Medikamente zum Einsatz, v.a. SSRI, möglichst keine Medikamente mit Suchtpotential, da bei PTSD-Patienten eine besonders hohe Suchtgefahr besteht!
Traumabearbeitung
Traumatisierte Patienten tun sich in der Regel sehr schwer, über die traumatisierende Situation zu erzählen, weil die Schilderungen in aller Regel begleitet sind von sehr heftigen, aufkommenden Gefühlen von Angst, Scham, Schuld, Hilflosigkeit. Unbedarftes „therapeutisches“ Vorgehen im Sinne einer gezielten Exploration des Traumas kann hier schädlich sein und eine Retraumatisierung begünstigen.
Laut Literatur besteht zwar kein Konsens darüber, ob für eine effektive Therapie der PTSD das Trauma vollumfänglich erinnert werden muss. Einigkeit besteht aber darüber, dass eine stabile und vertrauensvolle therapeutische Beziehung die Grundvoraussetzung für eine positive Traumaarbeit ist. Deshalb ist die supportive, stützende Ausrichtung der Therapie, v.a. in der Anfangsphase essentiell!
Zusätzlich zu diesen Grundeinsichten kommen verschiedene Therapieverfahren bei der Behandlung der PTSD zum Einsatz, die an dieser Stelle aber nur kurz aufgelistet werden können. Zur intensiveren Auseinandersetzung mit einer der Methoden verweise ich auf entsprechende spezialisierte Websites oder die Fachliteratur im Handel:
- Psychodynamische Ansätze mit der Ausrichtung des Fokus auf die Lösung intrapsychischer Konflikte im Zusammenhang mit dem erlittenen Trauma, der erlebten Täter-Opfer-Konstellation etc..
- Behaviorale und kognitive Therapie mit Verwendung diverser Techniken wie (nach Kapfhammer 2000):
- Angstmanagement
- Stressimpfungstraining
- Augenbewegungsdesensibilisierung (EMDR)
- Imaginatives Flooding
- Kognitive Umstrukturierung
- Psychopharmakologische Ansätze. Zum Einsatz kommen
- Trizyklische Antidepressiva, v.a. Amitriptylin
- SSRI (Serotonin-Wiederaufnahme-Hemmer) mit guter Wirksamkeit gegen die Gefühlsbetäubung und die Übererregbarkeit
- MAO-Hemmer
- Benzodiazepine (Achtung: hohe Suchtgefahr bei PTSD-Patienten!!!)
- Mood stabilizer, v.a. Lithium mit positiver Wirkung auf die affektive Labilität und die Übererregtheit
- Noradrenerg wirkende Substanzen (Propranolol oder Clonidin) mit positiver Wirkung auf die Intrusionen und die Übererregbarkeit
- Opioidantagonisten (Naltrexon) mit positiver Wirkung auf die Dissoziation, die Flashbacks und die Gefühlsbetäubung
- Neuroleptika, die ausser bei einer psychotischen Episode wegen fehlendem Wirksamkeitsnachweis bei PTSD und erheblichem Nebenwirkungsrisiko nicht empfohlen werden können
Umfangreiche Informationen über die Symptomatik, den Heilungsverlauf und die Rehabilitation nach Traumatisierungen, auch aus der Sicht von Hinterbliebenen entnehmen Sie bitte auch dem Vortrag von S. Jatzko (1998 und 2002)
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