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Interozeptive Exposition Für Subtypen Der Panikstörung: Adjustierung Der Methode = Verbesserung Des Effekts?

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Interozeptive Exposition Für Subtypen Der Panikstörung: Adjustierung Der Methode = Verbesserung Des Effekts? Interozeptive Exposition für Subtypen der Panikstörung: Adjustierung der Methode = Verbesserung des Effekts? Inauguraldissertation zur Erlangung des Doktorgrades der Humanwissenschaftlichen Fakultät der Universität zu Köln nach der Promotionsordnung vom 18.12.2018 vorgelegt von Simon Matthias Baur aus Viersen Dezember 2019 Diese Dissertation wurde von der Humanwissenschaftlichen Fakultät der Universität zu Köln im Mai 2020 angenommen. 1. Berichterstatter: Univ.-Prof. Dr. Alexander L. Gerlach (Köln) 2. Berichterstatterin: Univ.-Prof. Dr. Charlotte Hanisch (Köln) Tag der mündlichen Prüfung: 06.05.2020 Danksagung Danksagung Ich danke Herrn Prof. Dr. Alexander L. Gerlach für die Betreuung dieser Arbeit. Seine fachliche und persönliche Unterstützung hat zum Gelingen dieser Arbeit wesentlich beigetragen. Ferner danke ich Herrn Dr. Peter Neudeck für die Unterstützung bei der Aufnahme dieser Dissertation. Mein Dank gilt ebenfalls allen MitarbeiterInnen des Panik-Projekts. Danken möchte ich insbesondere denjenigen KollegInnen, die beim Rekonstruieren nicht eindeutiger Datensätze halfen. Hierzu zählen Frau Anne Kordt, Herr Prof. Dr. Thomas Lang, Herr Dr. Jan Richter, Frau Dr. Anna Voßbeck-Elsebusch, Frau Dr. Gaby Bleichhardt sowie Frau Aniane Heilmann. Frau Isabelle Drenckhan-Schulz stellte freundlicherweise die Ergebnisse der Latent Class-Analysen und Latent Class-Faktoren-Analysen zur Verfügung, auf deren Grundlage Subtypen der Panikstörung identifiziert werden konnten. Ich danke Frau Dr. Ruth Cooper für die Einführung in die Parametrisierung mit Matlab. Für die Begutachtung dieser Arbeit danke ich Herrn Prof. Dr. Alexander L. Gerlach sowie Frau Prof. Dr. Charlotte Hanisch. Der Abschluss dieser Arbeit wäre ohne die Unterstützung meiner Familie, insbesondere Linda Baur, kaum zu realisieren gewesen. Für diese Unterstützung bedanke ich mich von ganzem Herzen. Inhaltsverzeichnis Inhaltsverzeichnis Zusammenfassung .......................................................................................................... 12 1 Einleitung ................................................................................................................ 13 2 Definition und Beschreibung der interozeptiven Exposition ................................ 17 3 Entwicklung der interozeptiven Exposition ........................................................... 22 4 Definition der Panikstörung ................................................................................... 26 5 Theorien zur Ätiologie der Panikstörung .............................................................. 28 5.1 Theorie der Angst-Sensitivität ..................................................................................... 28 5.2 Konditionierungs-Theorien ......................................................................................... 31 6 Wirkmechanismen der interozeptiven Exposition ................................................ 36 6.1 Emotional Processing Theory ...................................................................................... 36 6.2 Theorie des inhibitorischen Lernens ........................................................................... 39 Untersuchungsschwerpunkt A: Wirksamkeit und Wirkmechanismen der interozeptiven Exposition .............................................................................................. 41 7 Methoden der Symptomprovokation: Forschungsbefunde ................................... 43 8 Wirksamkeit der interozeptiven Exposition .......................................................... 47 8.1 Interozeptive Exposition innerhalb der KVT ............................................................ 47 8.1.1 Methodische Defizite der bislang publizierten Studien ................................................ 48 8.1.2 Therapieerfolg aufgrund der interozeptiven Exposition? ............................................. 49 8.1.3 Welche Methode wirkt? Interozeptive Exposition im Vergleich ................................. 52 8.1.4 Meta-Analysen zur Wirksamkeit der interozeptiven Exposition ................................ 55 8.1.5 Interozeptive Exposition innerhalb der KVT: Zusammenfassung .............................. 57 8.2 Effekte der interozeptiven Exposition ......................................................................... 58 9 Wirkmechanismen der interozeptiven Exposition ................................................ 60 9.1 Habituation und der Einfluss der Übungswiederholung ......................................... 61 10 Schlussfolgerung und Ableitung der Fragestellung ............................................... 63 10.1 Schlussfolgerung ............................................................................................................ 63 10.2 Ableitung der Fragestellung ......................................................................................... 64 11 Methode ................................................................................................................... 66 Inhaltsverzeichnis 11.1 Beschreibung der Studie und Patientenstichprobe ................................................... 66 11.2 Primäre und sekundäre Outcome-Maße .................................................................... 68 11.3 Beschreibung der Behandlung ..................................................................................... 70 11.4 Angaben zur Behandlungsintegrität ........................................................................... 72 11.5 Angaben zum Datensatz und zur Parametrisierung ................................................. 73 11.6 Statistische Auswertung ................................................................................................ 74 11.6.1 Angaben zu statistischen Methoden ................................................................................ 74 11.6.2 Überprüfung der Testvoraussetzungen ........................................................................... 76 12 Ergebnisse ................................................................................................................ 78 12.1 Wirkung der Symptomprovokationsübungen ........................................................... 78 12.2 Untersuchungen zum Therapieerfolg ......................................................................... 81 12.2.1 Ergebnisse der Gesamttherapie ........................................................................................ 81 12.2.2 Ergebnisse der interozeptiven Exposition ....................................................................... 81 12.3 Reduktion der Symptome und Ängste ........................................................................ 82 12.3.1 Reduktion der respiratorischen Symptom-und Angststärke ....................................... 84 12.3.2 Reduktion der vestibulären Symptom- und Angststärke ............................................. 84 12.4 Bedeutung der Reduktion der Symptome und Ängste für das Ergebnis der Therapie ...................................................................................................................................... 85 12.4.1 Bedeutung für das Ergebnis der Gesamttherapie ........................................................... 86 12.4.2 Bedeutung für das Ergebnis der interozeptiven Exposition ......................................... 89 12.5 Bedeutung der Übungswiederholung ......................................................................... 90 12.5.1 Bedeutung für das Ergebnis der Therapie ....................................................................... 90 12.5.1.1 Bedeutung für das Ergebnis der Gesamttherapie ..................................................................... 91 12.5.1.2 Bedeutung für das Ergebnis der interozeptiven Exposition.................................................... 92 12.5.2 Bedeutung für die Reduktion der Symptome und der Ängste ..................................... 93 13 Diskussion ............................................................................................................... 94 13.1 Zusammenfassung der Fragestellung und der Ergebnisse ....................................... 94 13.2 Diskussion der Ergebnisse ............................................................................................ 95 13.2.1 Diskussion zu der Wirkung der Symptomprovokationsübungen ............................... 95 13.2.2 Diskussion zu dem Ergebnis der Gesamttherapie ......................................................... 97 13.2.3 Diskussion zu dem Ergebnis der interozeptiven Exposition ........................................ 97 13.2.4 Diskussion zu der Reduktion der Angstreaktion ........................................................... 99 13.2.5 Diskussion zu der Bedeutung der Reduktion der Angstreaktion .............................. 101 Inhaltsverzeichnis 13.2.6 Diskussion zu der Bedeutung der Übungswiederholung für das Ergebnis der Therapie ........................................................................................................................................ 104 13.2.7 Diskussion zu der Bedeutung der Übungswiederholung für die Angstreduktion .. 105 Untersuchungsschwerpunkt B: Effekt einer für Subtypen der Panikstörung adjustierten IE .............................................................................................................. 106 14 Subtypen der Panikstörung .................................................................................. 107 14.1 Kritik an der Diagnose der Panikstörung ................................................................
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