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Emotionsregulation bei psychischen Störungen und in der Psychotherapie
Abstract
Dieses Kapitel behandelt den Zusammenhang zwischen Emotionsregulation (ER) und psychischen Störungen. Die Basis bildet ein Überblick zu klinischen Modellen der ER. Nachfolgend werden die Ergebnisse einer systematischen Literaturrecherche zu spezifischen ER-defiziten im Rahmen psychischer Störungen vorgestellt. Den Abschluss dieses Kapitels bildet die Betrachtung der ER als potenziell verfahrensübergreifender Behandlungsfokus in Psychotherapien.
... ■ Es kommt leicht zu »struktureller Ansteckung«. Personen auf »gutem« Strukturniveau verfügen über eine differenzierte, selbstreflexive Affektwahrnehmung (das Subjekt kann sich ganzpersonal zum Gegenstand seiner Wahrnehmung machen und sich damit vor sich selbst schämen; Seidler, 1997) und über adaptive Regulierungsstrategien (Holl et al., 2020). Scham und Schuld äußern sich als situationsangemessene Peinlichkeit bzw. ...
Im Kapitel wird ein Grundverständnis dafür entwickelt, wie sich die die jeweils eingesetzten Strategien zur Regulierung von Emotionen differenziert erfassen lassen. Einleitend werden zentrale empirische Erkenntnisse aus der Psychotherapieforschung vorgestellt, die zeigen, dass die therapeutische Arbeit an der Emotionsregulierung effektiv zu heilsamen Veränderungsprozessen in der psychodynamischen Psychotherapie beiträgt. Empirisch zeigt sich, dass eine klinisch bedeutsame Verringerung des psychischen Leidens in der psychodynamischen Psychotherapie vor allem durch einen konsequenten Affektfokus ermöglicht wird, der Patient:innen im Therapieprozess ein Erleben und Ausdrücken ihrer (vor allem aversiv besetzten) Emotionen ermöglicht, wodurch adaptivere Strategien der Emotionsregulierung entwickelt werden können. Anschließend wird für die Einschätzung der Emotionsregulierung in der klinischen Praxis eine Psychodynamische Systematik vorgestellt, mit der sich verschiedene Strategien zur Regulierung von Emotionen differenzieren und hinsichtlich ihrer Funktionalität einordnen lassen. Dabei werden mithilfe von zwei Achsen (bewusst vs. unbewusst / interpersonell vs. intrapsychisch) vier Bereiche der Emotionsregulierung unterschieden und mit psychodynamischen Konzepten näher beschrieben. Mithilfe des Modells lassen sich grundlegende Aspekte zur Beschreibung psychischer Prozesse in ihren jeweiligen emotionsregulierenden Funktionen einschätzen. Für jeden Bereich werden einfach handhabbare Tools für die klinische Praxis vorgestellt.
Zusammenfassung:
Während ICD und DSM bei der Schizioden
Persönlichkeitsstörung von einem Fehlen von
Wünschen, Beziehungen und Emotionen ausgehen,
verstehen psychodynamische Modelle
die Schizoidie als Schutz vor intensiven Wünschen
und Affekten, die Gefahr der Desintegration
bergen. Eine Auswertung der Daten der
DPG-Praxisstudie ergibt, dass die Schizoide
PS eher selten ist, dass aber schizoide Aspekte
häufig anzutreffen sind. Zudem zeigt sich, dass
Patienten mit Schizoider
PS durchaus intensive
negative Affekte erleben, dass diese aber nur
schlecht reguliert werden können. Das Fallbeispiel
in Form eines wörtlichen Verbatim-
Protokolls eines OPD-Interview-Ausschnitts
macht deutlich, dass die Patientin durchaus
den intensiven Wunsch nach nahen und tiefen
Beziehungen hat, dass solche Beziehungen zu
anderen Menschen aber für die Patientin kaum
regulierbar sind und sie stattdessen eine geradezu
mystisch-verschmolzene Liebesbeziehung
zu zwei Nagetieren entwickelt. Insgesamt wird
deutlich, dass das typisch schizoide Erleben und
Verhalten in erster Linie als Abwehrstrategie verstanden
werden sollte und weniger als schlichtes
Defizit.
Abstract:
Schizoidia and Emotion: While ICD and DSM
both assume an absence of desires, relationships,
and emotions in schizoid personality disorder,
psychodynamic models understand schizoidia
as a means of warding off intense desires and
affects that harbor the risk of disintegration. An
evaluation of the data from the DPG practice
study shows that schizoid PDs are quite rare,
whereas schizoid aspects are quite common.
In addition, it shows that patients with schizoid
PD do indeed experience intense negative affects
but are only poorly able to regulate them.
A case study in the form of a verbatim protocol
of a section of an OPD interview makes clear
that the patient does have an intense desire for
close and deep relationships, but that she finds
it very difficult to control such relationships with
other people and she instead develops a decidedly
mystical, bonding love relationship with
two rodents. All in all, it is clear that the typical
schizoid experience and behavior should be understood
primarily as a defense strategy and less
as a simple deficit.
Operationalisierungen, das heißt definierende Beschreibungen von diagnostischen, prozesshaften und Ergebniskomponenten psychodynamische Therapien waren lange Zeit umstritten. Die Kritik zielte darauf ab, dass die so gefundenen Begriffe und Definitionen die Komplexität therapeutischer Prozesse und ihrer Vielgestaltigkeit unzulässig vereinfachen. Im Verlauf der letzten Jahrzehnte konnten aber verschiedene Operationalisierungsversuche zeigen, dass sie die Diskussion und Auseinandersetzung um psychodynamische Kategorien bereichern. An erster Stelle steht hier im deutschsprachigen Raum die OPD, mit ihrer Zentrierung auf Beziehungsmuster, unbewusste Konflikte und strukturelle Merkmale. Auch im internationalen Feld wurden Instrumente entwickelt, die sich insbesondere mit therapeutischen Prozessen befassten. Und was die Ergebnismessung unter Berücksichtigung psychodynamischer Forderungen angeht, können wir wiederum auf die OPD zurückgreifen (Heidelberger Umstrukturierungsskala). Der vorliegende Artikel beschreibt etablierte Instrumente auf allen Ebenen und gibt einen Ausblick, wo zukünftige Entwicklungsschwerpunkte legen können.
In diesem Beitrag befassen wir uns mit der Frage, was sich aus psychologischer Perspektive zu Fragen der Lebenskunst beitragen lässt und inwiefern sich dabei gerade durch eine grundlegend psychoanalytische Orientierung ein Moment des ›Kritischen‹ angemessen berücksichtigen lässt. Ein solches Vorhaben sollte bei einer Erkenntnis ansetzen, die von der historisch-soziologischen Forschung inzwischen bis in das Alltagswissen herunter durchgesickert ist: der Erkenntnis, dass seit dem ausgehenden Mittelalter verschiedene gesellschaftliche und kulturelle Entwicklungen sich in einer fortwährenden Tendenz zur verstärkten Individualisierung in der Moderne zuspitzen.
Using a process model of emotion, a distinction between antecedent-focused and response-focused emotion regulation is proposed. To test this distinction, 120 participants were shown a disgusting film while their experiential, behavioral, and physiological responses were recorded. Participants were told to either (a) think about the film in such a way that they would feel nothing (reappraisal, a form of antecedent-focused emotion regulation), (b) behave in such a way that someone watching them would not know they were feeling anything (suppression, a form of response-focused emotion regulation), or (c) watch the film (a control condition). Compared with the control condition, both reappraisal and suppression were effective in reducing emotion-expressive behavior. However, reappraisal decreased disgust experience, whereas suppression increased sympathetic activation. These results suggest that these 2 emotion regulatory processes may have different adaptive consequences.
Innovations in CBT for Childhood Anxiety, OCD, and PTSD - edited by Lara J. Farrell April 2019
Open access: http://psycnet.apa.org/fulltext/2018-23951-001.pdf Abstract: The alliance continues to be one of the most investigated variables related to success in psychotherapy irrespective of theoretical orientation. We define and illustrate the alliance (also conceptualized as therapeutic alliance, helping alliance or working alliance) and then present a meta-analysis of 295 independent studies that covered more than 30,000 patients (published between 1978 and 2017) for face-to-face psychotherapy as well as internet-based psychotherapy. The relation of the alliance and treatment outcome was investigated using three-level meta- analysis with random-effects restricted maximum-likelihood estimators. The overall alliance- outcome association for face-to-face psychotherapy was r = .278 (95% CIs [.256, .299], p < .0001; equivalent of d = .579). There was heterogeneity among the ESs, and 2% of the 295 ESs indicated negative correlations. The correlation for internet-based psychotherapy was approximately the same (viz., r = .275, k = 23). These results confirm the robustness of the positive relation between the alliance and outcome. This relation remains consistent across assessor perspectives, alliance and outcome measures, treatment approaches, patient characteristics, and countries. The article concludes with causality considerations, research limitations, diversity considerations, and therapeutic practices.
Keywords: therapeutic alliance, psychotherapy relationship, working alliance, meta-analysis, psychotherapy outcome, face-to-face therapy, internet-based therapy
Individuals with borderline personality disorder (BPD) have difficulties regulating emotions, which may be a consequence of using less effective emotion regulation (ER) strategies to lessen the intensity of their negative emotions. It is not yet known whether people with BPD utilize particular ER strategies to modulate specific mood states and if these strategies are different from those used by individuals with depressive and anxiety disorders. In the present study, 90 participants (30 BPD, 30 anxiety and/or depressive disorders, and 30 healthy controls) underwent a mood induction procedure and specified which ER strategies they used and their perceived difficulty regulating mood following induction. Compared with healthy controls, BPD endorsed higher negative mood prior to, immediately following, and 4 min after neutral and negative mood inductions; more maladaptive ER strategies (e.g., rumination); and more perceived difficulty regulating negative mood. Compared with anxiety and/or depressive disorders, BPD endorsed similar ER strategies and subjective difficulty during mood inductions, endorsed higher negative mood following a neutral video and 1 negative video, and recorded higher RSA reactivity during and following 2 negative videos. Results suggest that individuals with BPD use a higher number of maladaptive ER strategies compared with healthy controls, which may lead to less effective modulation of negative mood and higher reports of difficulty regulating emotions. In addition, physiological measurements indicated that individuals with BPD may have higher RSA reactivity in response to negative mood induction compared with other mental disorders, which may reflect inefficient or disorganized attempts to regulate emotional arousal.
Objective:
Emotion regulation difficulties are implicated in psychological disorders but their role in obsessive-compulsive disorder (OCD) is unclear. Two studies examining these difficulties in OCD are presented.
Method:
A community sample (Study 1; n = 306) and a clinical OCD sample (Study 2; n = 59) completed the Difficulties in Emotion Regulation Scale (DERS) and measures of depression, anxiety, and OCD. In Study 2, the OCD sample was compared to a matched control group (n = 59, selected from Study 1).
Results:
In Study 1, OCD was positively correlated with DERS total and subscale scores, and the DERS significantly predicted OCD severity even after accounting for age, gender, depression, and anxiety. In Study 2, emotion regulation difficulties were significantly higher in the clinical sample compared to the matched control group, even after accounting for depression and anxiety.
Conclusion:
Results showed that emotion regulation difficulties in OCD cannot simply be attributed to mood difficulties. Theoretical and treatment implications are discussed.
Here we introduce a new assessment of emotion regulation called the Mentalized Affectivity Scale (MAS). A large online adult sample (N = 2,840) completed the 60-item MAS along with a battery of psychological measures. Results revealed a robust three-component structure underlying mentalized affectivity, which we labeled: Identifying emotions (the ability to identify emotions and to reflect on the factors that influence them); Processing emotions (the ability to modulate and distinguish complex emotions); and Expressing emotions (the tendency to express emotions outwardly or inwardly). Hierarchical modeling suggested that Processing emotions delineates from Identifying them, and Expressing emotions delineates from Processing them. We then showed how these components are associated with personality traits, well-being, trauma, and 18 different psychological disorders (including mood, neurological, and personality disorders). Notably, those with anxiety, mood, and personality disorders showed a profile of high Identifying and low Processing compared to controls. Further, results showed how mentalized affectivity scores varied across psychological treatment modalities and years spent in therapy. Taken together, the model of mentalized affectivity advances prior theory and research on emotion regulation and the MAS is a useful and reliable instrument that can be used in both clinical and non-clinical settings in psychology, psychiatry, and neuroscience.
There is accumulating evidence for deficits in the perception and regulation of one's own emotions, as well as the recognition of others' emotions in somatic symptom disorder (SSD). However, investigations of SSD focusing on specific aspects of emotion processing and how these might interact are missing. We included 35 patients with SSD and 35 healthy controls who completed questionnaires on the perception and regulation of their own emotions, as well as experimental investigations of emotion recognition and trust. In line with previous studies, our results show that SSD patients in comparison to healthy controls have difficulties in the identification and description of own feelings (ηp2 = .381 and ηp2 = .315). Furthermore, we found that patients apply less cognitive reappraisal (ηp2 = .185) but tend to use more expressive suppression (ηp2 = .047). In contrast to previous studies, we found SSD patients to perform superior in emotion recognition, in particular for anger (d = 0.40). In addition, patients with SSD invested less in a trust game (d = 0.73). These results point to a higher sensitivity for negative emotions and less trust in others. Further, these findings suggest a dissociation between the ability to recognize one's own emotions versus others' emotions in SSD. Future interventions targeting emotion processing in SSD might focus on the identification of one's own emotions, prior to the training of emotion regulation.
The Heidelberg Form for Emotion Regulation Strategies (HFERST) was developed to complement previous emotion regulation (ER) questionnaires and addresses some of their limitations by measuring eight ER strategies. An initial item pool was developed in German following expert discussions and adaptation of the items from existing ER scales. Following a stepwise selection based on the experts’ judgments, 32 items with the best content validity were chosen. Results of an exploratory factor analysis in Study 1 (N = 399) and two confirmatory factor analyses in Studies 2 (N = 715) and 3 (N = 408) supported the eight-factor structure of the HFERST and provided evidence for its internal consistency, construct and criterion validity, and clinical utility. Study 4 supported a 2-week stability of the HFERST and Study 5 showed that, following an ER intervention, the HFERST captured a reduction in dysfunctional and an improvement in functional ER strategies, which again supports the clinical utility of the HFERST.
Objective: Given the importance of emotion regulation (ER) in the aetiology and/or maintenance of psychopathology, we investigated subjective reports of ER in a group of bipolar individuals and compared the results to a group of depressed and healthy control participants. Additionally, we explored the impact of psychotropic medication on ER. Method: 24 participants diagnosed with bipolar disorder (BD), 38 participants diagnosed with major depression (MD), and 38 healthy controls (HC), were administered a multifaceted measure of ER. We also explored the impact antidepressants on ER and explored whether the amount of psychotropic medication had a differential effect on ER. Results: BD and MD participants scored significantly higher than the HC groups on the overall DERS, suggesting, predictably, that the diagnostic groups had more difficulties regulating their emotions. Additionally, comparing MD and HC groups, participants with depression showed difficulties with acceptance, engaging with goal-directed behaviour, impulsivity, and access to effective strategies. In contrast, BD participants showed selective difficulties with accessing emotion regulation strategies as compared to HC group. The exploratory part of the study failed to find a positive effect of antidepressants on ER or any impact of the amount of psychotropic medications on ER. Conclusions: Difficulties in regulating emotions differentiate between healthy controls and diagnostic groups. Furthermore, BD participants showed less difficulties regulating emotions than MD but still more difficulties than HC. Assessment of these differences appears possible if a multifaceted measure of ER is utilised. Additionally, our results showed that antidepressants did not improve ER and that the overall amount of medication was not associated with ER. Although robust conclusions regarding medications and ER are not possible in this exploratory part of our study, it appears that the precise effect of psychotropic, including antidepressants, is an area in need of further research.
Schon früh wurde versucht, bestimmte menschliche Eigenschaften mit dem Traum in Verbindung zu bringen. Der psychoanalytische Begriff der Struktur umfasst ein ausdifferenziertes Konstrukt, das insbesondere durch basale psychische Fähigkeiten gekennzeichnet ist. Das sich daraus ableitende Strukturniveau einer Person spiegelt ihre Fähigkeit zum kommunikativen Austausch sowie zum Umgang mit sich selbst und mit Sozialpartnern wider. Im Rahmen des Projekts „Affektivität, Beziehung und psychische Störung“ wurden Interviews gemäß der Operationalisierten Psychodynamischen Diagnostik (OPD) geführt, deren Traumberichte für die hiesige Untersuchung anhand des Traumgenerierungsmodells von Moser und von Zeppelin ausgewertet wurden. Ziel war es, Zusammenhänge zwischen Traummerkmalen und dem Strukturniveau zu untersuchen. Es wurden 4 Strukturindikatoren (Anzahl der Persönlichkeitsstörungen, OPD-2-Strukturniveau, Inventory of Personality Organization [IPO] und Abwehrreifequotient) bezüglich des Zusammenhangs mit Traummerkmalen gemäß Moser und von Zeppelin untersucht. In der vorliegenden Untersuchung ließen sich nur wenige Zusammenhänge zwischen Traummerkmalen und Strukturniveau nachweisen. Am klarsten waren die Zusammenhänge zwischen Reife der Abwehr und den Traummerkmalen. Träume von Personen mit einer reiferen Abwehr erscheinen komplexer und lebendiger. Träume von Personen mit guter struktureller Integration gemäß OPD-2 sind ebenfalls durch mehr „Bewegung“ gekennzeichnet als Träume von weniger strukturierten Personen. Die Träume von Personen mit mäßigem Strukturniveau unterscheiden sich nicht signifikant von denen mit geringer struktureller Integration. Die Ergebnisse werden in erster Linie methodenkritisch diskutiert.
Nach wie vor existiert eine starke Konkurrenz zwischen Psychotherapieschulen, sowohl in Bezug auf den Zugang zur Regelversorgung, als auch bezüglich dessen, was konzeptuell und therapeutisch für angemessen und wirksam gehalten wird. In diesem Buch geht es um einen Vergleich zwischen den beiden bedeutsamsten Richtungen, den Kognitiven Verhaltenstherapien und den Psychodynamischen Therapien. Zentrale Konzepte in beiden Therapieverfahren wie Vorstellungen zum Unbewussten, zu Beziehungsmustern, zum therapeutischen Vorgehen, aber auch zum Menschenbild werden historisch hergeleitet und miteinander in Beziehung gesetzt. Trotz aller Annäherungen bleiben interessante und bedeutsame Differenzen bestehen, deren Konsequenzen für die therapeutische Praxis aufgezeigt werden.
Background/aims:
Maltreatment in childhood and adolescence is a risk factor for substance use disorders (SUDs) in adulthood. This association has rarely been investigated in the light of emotion dysregulation. To fill this gap, this study examines emotion dysregulation and SUDs among adults with a history of early maltreatment.
Methods:
Comparison of emotion dysregulation in adults with a history of early abuse and neglect who developed either an SUD (n = 105) or no mental disorder (n = 54). Further, a mediation model for the association between the severity of early maltreatment and SUDs was tested. Participants completed research diagnostic interviews for psychopathology, the Difficulties in Emotion Regulation Scale, and the Childhood Trauma Questionnaire.
Results:
By using hierarchical regression techniques and mediational analyses controlling for age and gender, it was possible to provide evidence for the mediating role of emotion dysregulation between early emotional and physical maltreatment and later SUDs.
Conclusions:
Emotion dysregulation is a potential mechanism underlying the relationship between early emotional and physical maltreatment and the development of SUDs. In light of these findings, focusing on the early training of adaptive emotion regulation strategies after childhood maltreatment might be of considerable relevance to prevent the development of SUDs.
Recent research has emphasized the importance of studying the interaction between adaptive and maladaptive emotion regulation strategies in predicting mental health. In this respect, putatively maladaptive strategies (e.g., avoidance) have been found to moderate the link between putatively adaptive strategies (e.g., reappraisal) and psychopathology symptoms (e.g, Aldao & Nolen-Hoeksema, 2012; Aldao et al., 2014). Moreover, this line of work suggests that the direction of this moderation might vary as a function of symptom severity. However, research has yet to: 1) simultaneously examine how this interaction differs between clinical and non-clinical groups, and 2) test the interaction between specific emotion regulation strategies rather than composite scores of adaptive and maladaptive strategies. Doing so is essential in order to develop a more sophisticated understanding of the disturbances in the use of emotion regulation strategies in psychopathology. As such, we investigated the interaction between reappraisal and emotional nonacceptance in participants diagnosed with generalized anxiety disorder (GAD) and non-anxious controls. In the GAD group, there was a negative association between reappraisal and disability only when the use of nonacceptance was low, suggesting that the use of maladaptive strategies might interfere with the benefits typically associated with utilizing adaptive strategies. In the non-anxious group, there was a negative association between reappraisal and disability and depression symptoms, only when the use of nonacceptance was high, likely reflecting a compensatory and flexible use of regulation strategies. These findings highlight the importance of modeling interactions between specific emotion regulation strategies when seeking to understand their relationship to psychological functioning in GAD.
Emotion regulation strategies vary widely in use and effectiveness across psychological diagnostic categories. However, little data exists on (1) the use of these strategies in social anxiety disorder (SAD), and (2) how trait measures compare with actual daily use of emotion regulation strategies. We collected trait and daily assessments of emotion suppression, cognitive reappraisal, and positive and negative emotions from 40 adults with SAD and 39 matched healthy controls. Participants with SAD reported greater trait suppression and less cognitive reappraisal than healthy controls, and exhibited this same pattern of emotion regulation in daily life. Participants overall reported worse emotional experiences when suppressing positive (vs. negative) emotions, and better emotional experiences when reappraising to feel more positive (vs. less negative) emotions. However, SAD participants exhibited greater benefits (specifically increased positive emotions) from reappraising to feel less negative than healthy controls. These findings highlight the importance of positive emotion regulation strategies, particularly for individuals with SAD.
Objective: Although the relationship between Substance Use Disorders (SUDs) and emotion regulation is a topic of great scientific interest, little is still known about the nature of this association. The aim of the present study is to clarify which specific difficulties in emotion regulation describe SUD inpatients, studying whether this relationship is mediated by the use of defense mechanisms.
Method: Difficulties in emotion regulation and defense mechanisms were evaluated in 58 SUDs inpatients and 73 community participants.
Results: Results showed that SUDs are associated with limited access to emotion regulation strategies when negative emotions are experienced. This relationship between difficulty in accessing emotion regulation strategies and the presence of SUDs was mediated by mature defenses. The more difficulties in accessing such strategies were, the less mature defenses were used; the less mature defenses were used, the more likely the presence of SUDs was.
Conclusions: These findings suggest the importance of considering mature defense mechanisms in understanding difficulties in emotion regulation among SUD inpatients. Research and Clinical implications are discussed.
People respond to stressful events in different ways, depending on the event and on the regulatory strategies they choose. Coping and emotion regulation theorists have proposed dynamic models in which these two factors, the person and the situation, interact over time to inform adaptation. In practice, however, researchers have tended to assume that particular regulatory strategies are consistently beneficial or maladaptive. We label this assumption the fallacy of uniform efficacy and contrast it with findings from a number of related literatures that have suggested the emergence of a broader but as yet poorly defined construct that we refer to as regulatory flexibility. In this review, we articulate this broader construct and define both its features and limitations. Specifically, we propose a heuristic individual differences framework and review research on three sequential components of flexibility for which propensities and abilities vary: sensitivity to context, availability of a diverse repertoire of regulatory strategies, and responsiveness to feedback. We consider the methodological limitations of research on each component, review questions that future research on flexibility might address, and consider how the components might relate to each other and to broader conceptualizations about stability and change across persons and situations.
© The Author(s) 2013.
Zusammenfassung. Eine Vielzahl psychischer Storungen im DSM-IV und ICD-10 beinhalten Symptome einer maladaptiven Emotionsregulation. Der folgende Beitrag beinhaltet einen Uberblick zu Definition und Funktion von Emotionsregulation (ER). Danach werden neurowissenschaftliche Modellvorstellungen der ER und empirische Befunde zu neuronalen Korrelaten von ER-Prozessen vorgestellt. Anschliesend dokumentiere ich uberblicksartig Studienbefunde zur Bedeutung von ER-Prozessen fur internalisierende und externalisierende Storungen. Der Beitrag schliest mit Anregungen bezuglich zukunftiger Forschungsansatze und Integration in die Psychotherapieforschung.
Angst, Verzweiflung, Hilflosigkeit, Scham, Wut, Neid ...: Psychische Störungen sind immer eng mit negativen Affekten verknüpft. Daher spielen solche Gefühle – sowohl auf Seiten der Patienten als auch der Therapeuten – eine besondere Rolle in jeder Psychotherapie.
Der Autor beschreibt in diesem Band ein integratives Rahmenmodell zum Verständnis psychischer Störungen. Ausgehend davon erläutert er kenntnisreich typische Manifestationen von Kern-Affekten in der Psychotherapie sowie deren Diagnostik, und anhand von ausführlichen Fallbeispielen illustriert er den Umgang damit. Den Abschluss bildet ein Blick in die Psychotherapieprozessforschung, der die Bedeutung der Arbeit an (negativen) Affekten hervorhebt.
This online therapist guide is a radical departure from disorder-specific treatments of various emotional disorders, and is designed to be applicable to all anxiety and unipolar mood disorders, as well as other disorders with strong emotional components, such as many somatoform and dissociative disorders. It covers the Unified Protocol (UP), which capitalizes on the contributions made by cognitive-behavioral theorists by distilling and incorporating the common principles of CBT present in all evidenced based protocols for specific emotional disorders, as well as drawing on the field of emotion science for insights into deficits in emotion regulation. It covers the seven modules of UP, and focuses on four core strategies to help patients: becoming mindfully aware of emotional experience; reappraising rigid emotion laden attributions; identifying and preventing behavioral and emotional avoidance; and facilitating exposure to both interoceptive and situational cues associated with emotional experiences.
In diesem Band werden die allgemeinpsychologischen sowie die psychoanalytischen Motivations- und Emotionstheorien behandelt. In Teil 1 werden die allgemeinen Motivationstheorien den psychoanalytischen gegenübergestellt. Dabei wird besonders auf die starken Wandlungen der Motivationskonzepte in der psychoanalytischen Theoriebildung eingegangen. In Teil 2 werden die Ansätze der psychologischen Emotionsforschung dargestellt, um dann die psychoanalytische Sichtweise der Emotionen und Affekte zu beschreiben. Hierbei geht es vor allem um die Frage nach der Existenz unbewusster Emotionen. Ergebnisse der klinischen Emotionsforschung zeigen interpersonelle Beziehungen als das Manifestationsfeld von Motiven und Emotionen. Abschließend werden die erarbeiteten Bausteine in ein Modell der Emotionsdynamik integriert sowie eine mentalisierungstheoretisch basierte Neukonzeption des Triebbegriffs vorgeschlagen.
Given recent attention to emotion regulation as a potentially unifying function of diverse symptom presentations, there is a need for comprehensive measures that adequately assess difficulties in emotion regulation among adults. This paper (a) proposes an integrative conceptualization of emotion regulation as involving not just the modulation of emotional arousal, but also the awareness, understanding, and acceptance of emotions, and the ability to act in desired ways regardless of emotional state; and (b) begins to explore the factor structure and psychometric properties of a new measure, the Difficulties in Emotion Regulation Scale (DERS). Two samples of undergraduate students completed questionnaire packets. Preliminary findings suggest that the DERS has high internal consistency, good test–retest reliability, and adequate construct and predictive validity.
Das Lehrbuch der Gesprächspsychotherapie für Studium und Praxis
Die Gesprächspsychotherapie ist die von Carl Rogers begründete Psychotherapie humanistischer Grundorientierung, in deren Mittelpunkt die therapeutische Beziehung steht. Sie ist nicht durch spezifische Techniken bestimmt. Handlungsleitend ist eine Theorie des psychotherapeutischen Prozesses und der Entwicklung der Person.
Dieses praxisnahe Lehrbuch umfasst theoretische Grundlagen, aber auch konkretes Handwerkszeug für das tägliche therapeutische Handeln.
Fundiert und umfassend
- Klientenzentrierte Persönlichkeits- und Therapietheorie, Entwicklungs- und Krankheitslehre
- Therapieziele, Diagnostik und Indikationsstellung
- Messung des Therapieerfolgs, Evaluation und Qualitätssicherung
Anwendungsfelder und Settings
- Psychotherapie
- Personzentrierte Beratung
- Gesprächstherapie mit Kindern und Jugendlichen
Für die Praxis
- Exemplarische Abläufe (z. B. Erstinterview)
- Interventionsregeln
- Typische Probleme und störungsspezifische Besonderheiten
- Infos zur Aus- und Weiterbildung
Die Frage nach der Effizienz von Psychotherapie ist in neuerer Zeit abgelöst worden von der Frage: Was trägt entscheidend zur psychotherapeutischen Wirkung bei? Damit verbunden ist ein zunehmender Konsens, daß verschiedene therapeutische Techniken und Konzepte zum Gesamtwissen der Psychotherapie und der Wirkung von Psychotherapie ihre jeweiligen Beiträge leisten können. Der Aspekt der Schulenzugehörigkeit und der theoretischen Orientierung tritt somit zunehmend in den Hintergrund. Der Leser erhält Einblicke, welche Mechanismen in Psychotherapien allen Schulen gemeinsam zu sein scheinen und welche nicht. Die relevanten Wirkelemente in verschiedensten therapeutischen Techniken werden im Hinblick auf Ähnlichkeit und Gemeinsamkeit sowie auf differentielle Effekte analysiert und so konzeptübergreifend dargestellt.
What is the scientific status and the "truth value" of the concept of defense mechanisms? Among contemporary psychologists, three types of answers to this question may be expected. Some would wholeheartedly endorse the theoretical, clinical, and research value of this notion; others would reject it outright. Between these two extremes, a large number of observers, perhaps the majority, would suspend their judgment. Their attitude, compounded of hope and doubt, would capitalize on defense as an interesting and promising concept. At the same time, these psy chologists would express skepticism and disappointment over its clinical limitations, theoretical ambiguity, and research failures. The present volume is primarily addressed to the audience of hopeful skeptics-those who have not given up on the notion of defense, yet have been frustrated by the difficulties of incorporating it into the modern, streamlined structure of psychology. To this end, we have brought together theoretical and empirical contributions germane to defense together with reports about their applications to clinical and personality assessment, especially in relation to psychopathology, psychosomatics, and psycho therapeutic intervention.
A large body of research has implicated difficulties in emotion regulation as central to the development and maintenance of psychopathology. Emotion regulation has therefore been proposed as a transdiagnostic construct or an underlying mechanism in psychopathology. The transdiagnostic role of emotion regulation has yet to be systematically examined within the psychological treatment outcome literature. It can be proposed that if emotion regulation is indeed a transdiagnostic construct central to the maintenance of psychopathology, then changes in emotion regulation difficulties will occur after effective treatment and this will occur for different disorders. We conducted a systematic review, identifying 67 studies that measured changes in both emotion regulation and symptoms of psychopathology following a psychological intervention for anxiety, depression, substance use, eating pathology or borderline personality disorder. Results demonstrated that regardless of the intervention or disorder, both maladaptive emotion regulation strategy use and overall emotion dysregulation were found to significantly decrease following treatment in all but two studies. Parallel decreases were also found in symptoms of anxiety, depression, substance use, eating pathology and borderline personality disorder. These results contribute to the growing body of evidence supporting the conceptualization of emotion regulation as a transdiagnostic construct. The present study discusses the important implications of these findings for the development of unified treatments that target emotion regulation for individuals who present with multiple disorders.
Dieses Therapie- und Trainingsmanual richtet sich an Therapeuten, Trainer und Berater und bietet eine strukturierte Handlungsanleitung für ein 8-wöchiges Programm, in dem Klienten mit breitem Indikationsbereich lernen, ihre Emotionen zu regulieren. Die Anregungen sind auch im Einzelsetting einsetzbar, die Materialien sind im Buch enthalten und stehen zum Download zur Verfügung. Geschrieben für Psychologische Psychotherapeuten, Berater, Trainer, Psychiater, Ärzte, Studierende und Psychotherapeuten in der Ausbildung.
Aus dem Inhalt
Grundlagen: Emotion, Gefühl, Stimmung und Wohlbefinden – Indikationen und Kontraindikationen zum Emotionsregulationsprogramm – Heidelberger Fragebogen zur Erfassung von Emotionsregulation (H-FERST) – Evaluation – Gruppentraining in 8 Sitzungen mit Materialien – Abschluss und Booster.
Das Autorenteam
Prof. Dr. phil. Sven Barnow, Leiter des Lehrstuhls für Klinische Psychologie und Psychotherapie sowie der Psychotherapeutischen Hochschulambulanz an der Universität Heidelberg. Dr. phil. Eva Reinelt, Psychologische Psychotherapeutin (VT), Universität Heidelberg. Dr. Christina Sauer, Psychologische Psychotherapeutin i.A. (VT), Universität Heidelberg.
In response to rapidly growing rates of comorbidity among psychiatric disorders, clinical scientists have become interested in identifying transdiagnostic processes that can help explain dysfunction across diagnostic categories (e.g., Kring & Sloan, 2009). One factor that has received a great deal of attention is that of emotion regulation, namely, the ability to modulate the intensity and/or duration of emotional states (e.g., Cicchetti, Ackerman, & Izard, 1995; Gross, 1998). Recent theoretical and empirical work has begun to emphasize the role that emotion regulation plays in the temporal comorbidity between internalizing and externalizing conditions (e.g., Aldao & De Los Reyes, 2015; De Los Reyes & Aldao, 2015; Drabick & Kendall, 2010; Jarrett & Ollendick, 2008; Patrick & Hajcak, 2016). However, close inspection of this work reveals two very pertinent areas of growth: (a) this literature is characterized by mixed findings that are likely explained, in part, by methodological heterogeneity; and (b) emotion regulation tends to be studied in relatively narrow terms. To address these issues, we provide a series of recommendations for facilitating cross-study comparisons and leveraging multifaceted approaches to studying emotion regulation processes within a developmental psychopathology framework. We hope that our perspective can enhance the organization and growth of this very important area of inquiry, and ultimately result in more effective prevention and treatment programs.
Childhood abuse and neglect (CAN) is considered as a risk factor for substance use disorder (SUD). Based on the drinking to cope model, this study investigated the association of two trauma-relevant emotions (shame and sadness) and substance use. Using ecological momentary assessment we compared real-time emotion regulation in situations with high and low intensity of shame and sadness in currently abstinent patients with CAN and lifetime SUD (traumaSUD group), healthy controls with CAN (traumaHC group), and without CAN (nontraumaHC group). Multilevel analysis showed a positive linear relationship between high intensity of both emotions and substance use for all groups. The traumaSUD group showed heightened substance use in low, as well as in high, intensity of shame and sadness. In addition, we found an interaction between type of emotion, intensity, and group: the traumaHC group exhibited a fourfold increased risk for substance use in high intense shame situations relative to the traumaSUD group. Our findings provide evidence for the drinking to cope model. The traumaSUD group showed a reduced distress tolerance for variable intensity of negative emotions. The differential effect of intense shame for the traumaHC group emphazises its potential role in the development of SUD following CAN. In addition, shame can be considered a relevant focus for therapeutic preinterventions and interventions for SUD after CAN.
Einsicht gilt weithin als einer der spezifischen Wirkfaktoren in der psychoanalytischen Therapie. Vor allem in der Abgrenzung zur Verhaltenstherapie wurde betont, daß bei konfliktaufdeckenden Therapien Veränderungen durch Einsicht und nicht etwa durch Konditionierung oder durch Manipulation des Patienten zustande kommen. Manche Autoren vertraten die Auffassung, daß der Gewinn von Einsicht der einzige Weg sei, auf dem bleibende Veränderungen in der Psychoanalyse erzielt werden können (Segal 1962; Rangell 1981). Kritiker aus den Reihen der Verhaltenstherapie haben dagegen behauptet, daß Einsicht ein eher überflüssiges Begleitphänomen von Psychotherapie sei, und daß Veränderungen ebensogut ohne Einsicht zustande kämen (Hobbs 1962; Brady 1967). Inzwischen ist die Polemik zwischen Verhaltenstherapie und Psychoanalyse in den Hintergrund getreten und mit ihr der Streit um die Stellung der Einsicht. Der Anspruch, daß in der Psychoanalyse Veränderungen ausschließlich durch Einsicht des Patienten zustande kommen, läßt sich in dieser Form nicht mehr aufrechterhalten. Die klinische Erfahrung zeigt, daß es bleibende Veränderungen gibt, ohne daß eine Veränderung der Einsicht zu beobachten ist. Umgekehrt gibt es Patienten, die Einsichten zu entwickeln scheinen, ohne daß sie sich wesentlich verändern. Diese klinischen Eindrücke sind durch die Befunde des Menninger-Projektes (Wallerstein 1986) eindrucksvoll bestätigt worden: Diejenigen Patienten, denen von den Forschern und Therapeuten hohe Einsicht attestiert wurde, waren durchaus nicht immer jene mit eindrucksvollen strukturellen Veränderungen und umgekehrt (Appelbaum 1975).
Das Lehrbuch stellt die Komplexität der Klinischen Psychologie und Psychotherapie in ausgewogener Weise dar, indem auf die aktuellen Konzepte der unterschiedlichen theoretischen Orientierungen
eingegangen wird. Als integrierender roter Faden wird die in allen modernen Modellen zentrale Dimension der Emotionsregulierung herausgearbeitet. Emotionale Prozesse bilden den Kern psychischer Störungen und sind gleichzeitig hochgradig vernetzt mit anderen psychischen Dimensionen wie kognitiven Prozessen, unbewussten Konflikten, Beziehungsmustern etc. Die Bearbeitung von emotionalen Prozessen kann als gemeinsamer Nenner moderner Psychotherapien gesehen werden, wie auch die Ergebnisse der Psychotherapie-Prozessforschung zeigen. Das Lehrbuch zeichnet sich durch eine starke Vernetzung der
unterschiedlichen Themen aus. Dadurch gelingt eine ausgewogene und konsistente Darstellung des gesamten Fachgebietes.
The book, Letters from Jenny, by Gordon All port (1965) presented a series of letters written over an extended period by a woman named Jenny to her son, Ross. Jenny was a poor, hard-working woman who sacrificed almost everything she had for Ross. She supported him in an affluent lifestyle at an Ivy League college, while she barely had enough to eat. All that mattered to her was his well-being. Yet, she failed miserably in bringing fulfillment and happiness to him as well as to herself. When Ross began to form relationships with other women, Jenny disowned him, very likely contributing to his early death. She then derived more happiness from his memory than she had from his presence.
The second edition of The Great Psychotherapy Debate has been updated and revised to expand the presentation of the Contextual Model, which is derived from a scientific understanding of how humans heal in a social context and explains findings from a vast array of psychotherapies studies. This model provides a compelling alternative to traditional research on psychotherapy, which tends to focus on identifying the most effective treatment for particular disorders through emphasizing the specific ingredients of treatment. The new edition also includes a history of healing practices, medicine, and psychotherapy, an examination of therapist effects, and a thorough review of the research on common factors such as the alliance, expectations, and empathy.
The common factors have a long history in the field of psychotherapy theory, research and practice. To understand the evidence supporting them as important therapeutic elements, the contextual model of psychotherapy is outlined. Then the evidence, primarily from meta-analyses, is presented for particular common factors, including alliance, empathy, expectations, cultural adaptation, and therapist differences. Then the evidence for four factors related to specificity, including treatment differences, specific ingredients, adherence, and competence, is presented. The evidence supports the conclusion that the common factors are important for producing the benefits of psychotherapy.
Mental health professionals have long been concerned with describing and proscribing a structure around the myriad variations of psychological and emotional distress that are deemed to be disordered. This has frequently been characterized as a conflict between so-called “lumpers” and “splitters” – those who advocate broad categorizations based on overarching commonalities versus those who endeavor toward a highly refined structure emphasizing unique characteristics. Many would argue that with the era of the modern Diagnostic and Statistical Manual of Mental Disorders (DSM-III to DSM-5), a splitting ideology has been dominant despite re-emerging concerns that some groups of diagnoses, particularly disorders of anxiety and other emotions, may be more similar than different. As a result of such concerns, transdiagnostic or unified models of psychopathology have burgeoned. In this review, we describe the work of Barlow, Allen, and Choate (2004), whose invited paper Toward a Unified Treatment for Emotional Disorders reignited transdiagnostic perspectives of emotional disorders. We provide an update on the scientific models and evidence-based treatments that have followed in the wake of this 2004 publication including key areas for future study in the advancement of transdiagnostic and unified treatment of emotional disorders.
Some investigators have argued that emotions, especially animal emotions, are illusory concepts outside the realm of scientific inquiry. With advances in neurobiology and neuroscience, however, researchers are proving this position wrong while moving closer to understanding the biology and psychology of emotion. In Affective Neuroscience, Jaak Panksepp argues that emotional systems in humans, as well as other animals, are necessarily combinations of innate and learned tendencies; there are no routine and credible ways to really separate the influences of nature and nurture in the control of behavior. The book shows how to move toward a new understanding by taking a psychobiological approach to the subject, examining how the neurobiology and neurochemistry of the mammalian brain shape the psychological experience of emotion. It includes chapters on sleep and arousal, pleasure and pain systems, the sources of rage and anger, and the neural control of sexuality. The book will appeal to researchers and professors in the field of emotion.
Although research indicates that nonsuicidal self-injury (NSSI) may be used as a form of emotion regulation, studies have largely relied on the use of retrospective self-report data, which limits inferences about directionality of effects. Recently, researchers have started to employ lab-based experimental (e.g., guided imagery, acute pain) and moment sampling approaches to the study of NSSI.
In the present study, we conducted a review of this recent literature, using several electronic databases (e.g., PsychINFO, ERIC, CINAHL).
We identified 18 studies that met our inclusion criteria. Findings indicated that the administration of pain was associated with decreases in negative affect among both self-injurers and noninjurers, although these declines were more pronounced for self-injurers in some studies.
We discuss findings within the context of two central theories (i.e., opponent-process theory and distraction theory) and offer several recommendations for future research in this area.
© 2015 Wiley Periodicals, Inc.
Zusammenfassung. Die vorliegende U ¨ bersicht stellt Verfahren zur Erfassung von Emotionsregulationsstrategien im Kindes-, Jugend-und Erwachsenenalter zusammen. Selbst-und Fremdbeurteilungsverfahren im Kindes-und Jugendalter sowie Fragebögen des Er-wachsenenalters, für die eine validierte deutschsprachige U ¨ bersetzung vorliegt, werden betrachtet und hinsichtlich qualitativer Standards und psychometrischer Gütekriterien diskutiert. Es folgt die Darstellung der Methoden des Ecological Momentary Assessment, die es ermöglichen, emotionsregulierende Prozesse in der natürlichen Umwelt zu erfassen und Kontextfaktoren zu berücksichtigen. Der Beitrag schließt mit der Empfehlung, Emotionsregulationsstrategien multimethodal zu erfassen. Schlüsselwörter: Emotionsregulation, Fragebögen, Gütekriterien, EMA Approaches to measuring emotion regulation strategies – an overview Abstract. The article provides an overview of approaches to measuring emotion regulation strategies in children, youth, and adults. Self and external assessment procedures in children and adolescence and questionnaires for adults, for which a validated German-language translation exists, are considered separately and discussed in terms of quality and standards of psychometric quality criteria. Following methods of ecological momentary assessment are reviewed, which enables one to capture emotion regulatory processes in the natural environment and to take into account contextual factors. The paper concludes with the recommendation to use multimethod procedures for the assessment of emotion regulation strategies.