Zusammenfassung
Hintergrund
Die Entwicklung störungsspezifischer Psychotherapiemethoden hat wesentlich dazu beigetragen, dass sich die therapeutische Prognose für Menschen mit der Diagnose einer Borderline-Persönlichkeitsstörung (BPS) stark verbessert hat. Zu den am intensivsten beforschten Methoden zählen die Dialektisch-Behaviorale Therapie nach Linehan (DBT) sowie die Mentalisierungsbasierte Therapie (MBT) nach Fonagy.
Fragestellung
Wie ist der aktuelle Forschungsstand zu diesen Methoden? Welche Adaptationen liegen für bestimmte Patientengruppen vor, und welche Effekte werden beobachtet?
Material und Methoden
Die aktuellen Befunde aus randomisierten kontrollierten Studien zu DBT und MBT werden auf Basis des aktuellen Cochrane-Reviews zur Psychotherapie der BPS zusammengefasst. Ergänzend werden einige relevante Studien beleuchtet, die wesentliche neue Entwicklungen auf diesem Gebiet aufzeigen.
Ergebnisse
Metaanalytisch zeigen sich deutliche Effekte sowohl von DBT als auch MBT auf eine Vielzahl von Symptomausprägungen, insbesondere den BPS-Gesamtschweregrad, Suizidalität und selbstverletzendes Verhalten. Zwischenzeitlich liegt eine Reihe von Adaptationen beider Methoden vor, u. a. für unterschiedliche komorbide Störungen, Jugendliche und Angehörige.
Diskussion
Die vorliegende Evidenz stützt den Einsatz störungsspezifischer Methoden wie DBT und MBT zur Behandlung der BPS, während die Studienlage für andere Methoden noch sehr schwach ist. Erste Studienergebnisse weisen darauf hin, dass auch Jugendliche mit BPS oder ausgeprägten BPS-Symptomen von frühen Interventionen profitieren können.
Abstract
Background
Several disorder-specific psychotherapy methods have been developed for the treatment of borderline personality disorder (BPD). For this reason people with BPD are no longer regarded as untreatable. To date, dialectical behavior therapy (DBT) according to Linehan and the mentalization-based treatment (MBT) according to Fonagy have been most intensively studied.
Objective
The current evidence for DBT and MBT is surveyed. In addition, adaptations of the standard DBT and MBT treatments for specific patient groups are outlined along with findings from evaluation studies.
Material and methods
The current evidence from randomized controlled trials of DBT and MBT in BPD patients is summarized based on the current Cochrane review. In addition, some relevant studies are highlighted, which showed essential new developments in this field.
Results
In meta-analyses both DBT and MBT showed clear effects for many levels of expression of symptoms, especially BPD severity, suicidality and self-harm behavior. Several adaptations of both are now available, especially for a variety of comorbid disorders as well as adolescents and relatives of people with BPD.
Conclusion
The current evidence supports the use of disorder-specific methods, such as DBT and MBT for treatment of BPD, while the study situation for other methods is still scarce. Evidence is emerging that adolescents with BPD or severe BPD symptoms can also benefit from early interventions.
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J. Stoffers-Winterling ist psychologische Psychotherapeutin, Verfahren Verhaltenstherapie. O.J. Storebø und E. Simonsen geben an, dass kein Interessenkonflikt besteht. K. Lieb ist Facharzt für Psychiatrie und Psychotherapie und war an der Durchführung von Studien zur DBT sowie zur Schematherapie beteiligt.
Dieser Beitrag beinhaltet keine unmittelbaren Studien an Menschen oder Tieren. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.
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Stoffers-Winterling, J., Storebø, O.J., Simonsen, E. et al. Störungsspezifische Psychotherapie der Borderline-Persönlichkeitsstörung. Psychotherapeut 65, 344–350 (2020). https://doi.org/10.1007/s00278-020-00443-9
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DOI: https://doi.org/10.1007/s00278-020-00443-9