Traumatisierung und Depression

Traumatisierung oder eine Vorgeschichte von belastenden Erfahrungen in der Kindheit finden sich bei bis zu 60% der Patienten mit einer depressiven Störung. Vermeidungsverhalten und fehlende Emotionsregulation beeinflussen dabei die interpersonellen Beziehungen der Patienten. Eine (traumabezogene) Verhaltenstherapie kann hier mit spezifischen Interventionen helfen.

Kernaussagen

• Bei mehr als der Hälfte der Patienten mit einer depressiven Störung finden sich belastende Ereignisse in der Kindheit oder eine Traumatisierung.

• Der Effekt von Traumatisierung und belastenden Kindheitsereignissen auf depressive Störungen wird vermutlich durch psychologische und psychobiologische Mechanismen vermittelt.

• Krisengenerierendes Verhalten führt zu weiteren belastenden Lebensereignissen.

• Traumabezogenes oder generalisiertes Vermeidungsverhalten führt zu Verstärkerdefiziten.

• Defizite in der Emotionsregulation führen zu mangelnder Bewältigung der Gegenwart.

• Defizite in der sozialen Kognition führen zur Aufrechterhaltung interpersoneller Konflikte.

• Grübel- und Sorgenprozesse interferieren mit einer angemessenen Handlungsplanung.

• Moderne verhaltenstherapeutische Methoden setzen entweder direkt an den traumatischen Erinnerungen und den daraus entstehenden Prozessen an oder adressieren die oben genannten vermittelnden Mechanismen.

Schlüsselwörter

Trauma - Depression - Kindheitsereignisse - PTSD - Interventionen - Fertigkeitentraining

• Literatur

• 1 Kendler KS, Myers J, Halberstadt LJ. Should the diagnosis of major depression be made independent of or dependent upon the psychosocial context?. Psychol Med 2010; 40: 771-780
• 2 Kessler RC, Berglund P, Demler O. et al. The epidemiology of major depressive disorder. Results from the national comorbidity survey replication (NCS-R). JAMA 2003; 289: 3095-3105
• 3 Moffitt TE, Caspi A, Taylor A. et al. How common are common mental disorders? Evidence that lifetime prevalence rates are doubled by prospective versus retrospective ascertainment. Psychol Med 2010; 40: 899-909
• 4 Solomon DA, Keller MB, Leon AC. et al. Multiple recurrences of major depressive disorder. Am J Psychiatry 2000; 157: 229-233
• 5 Blanco C, Okuda M, Markowitz JC. et al. The epidemiology of chronic major depressive disorder and dysthymic disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 2010; 71: 1645-1656
• 6 Duckers ML, Alisic E, Brewin CR. A vulnerability paradox in the cross-national prevalence of post-traumatic stress disorder. Br J Psychiatry 2016; 209: 300-305
• 7 Smith SM, Goldstein RB, Grant BF. The association between post-traumatic stress disorder and lifetime DSM-5 psychiatric disorders among veterans: Data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). J Psychiatric Res 2016; 82: 16-22
• 8 Hauffa R, Rief W, Brahler E. et al. Lifetime traumatic experiences and posttraumatic stress disorder in the German population: results of a representative population survey. J Nervous Ment Dis 2011; 199: 934-939
• 9 Fergusson DM, Horwood LJ, Boden JM. et al. Impact of a major disaster on the mental health of a well-studied cohort. JAMA Psychiatry 2014; 71: 1025-1031
• 10 Marmar CR, Schlenger W, Henn-Haase C. et al. Course of posttraumatic stress disorder 40 years after the Vietnam war: findings from the National Vietnam Veterans Longitudinal Study. JAMA Psychiatry 2015; 72: 875-881
• 11 Hovens JG, Giltay EJ, van Hemert AM. et al. Childhood maltreatment and the course of depressive and anxiety disorders: the contribution of personality characteristics. Depress Anxiety 2016; 33: 27-34
• 12 Nanni V, Uher R, Danese A. Childhood maltreatment predicts unfavorable course of illness and treatment outcome in depression: a meta-analysis. Am J Psychiatry 2012; 169: 141-151
• 13 Schussler-Fiorenza Rose SM, Xie D, Stineman M. Adverse childhood experiences and disability in U.S. adults. PM R 2014; 6: 670-680
• 14 Kendler KS, Eaves LJ, Loken EK. et al. The impact of environmental experiences on symptoms of anxiety and depression across the life span. Psychol Sci 2011; 22: 1343-1352
• 15 Eberhart NK, Hammen CL. Interpersonal style, stress, and depression: an examination of transactional and diathesis-stress models. J Soc Clin Psychol 2010; 29: 23-38
• 16 Bockers E, Roepke S, Michael L. et al. Risk recognition, attachment anxiety, self-efficacy, and state dissociation predict revictimization. PLoS One 2014; 9: e108206
• 17 Baxter jr. LR, Phelps ME, Mazziotta JC. et al. Cerebral metabolic rates for glucose in mood disorders. Studies with positron emission tomography and fluorodeoxyglucose F 18. Arch Gen Psychiatry 1985; 42: 441-447
• 18 Walsh K, DiLillo D, Messman-Moore TL. Lifetime sexual victimization and poor risk perception: does emotion dysregulation account for the links?. J Interpers Violence 2012; 27: 3054-3071
• 19 Wiersma JE, Hovens JG, van Oppen P. et al. The importance of childhood trauma and childhood life events for chronicity of depression in adults. J Clin Psychiatry 2009; 70: 983-989
• 20 Klein JP, Roniger A, Schweiger U. et al. The association of childhood trauma and personality disorders with chronic depression: A cross-sectional study in depressed outpatients. J Clin Psychiatry 2015; 76: e794-e801
• 21 Kiecolt-Glaser JK, Derry HM, Fagundes CP. Inflammation: depression fans the flames and feasts on the heat. Am J Psychiatry 2015; 172: 1075-1091
• 22 Heim C, Mletzko T, Purselle D. et al. The dexamethasone/corticotropin-releasing factor test in men with major depression: role of childhood trauma. Biol Psychiatry 2008; 63: 398-405
• 23 Francis DD, Meaney MJ. Maternal care and the development of stress responses. Curr Opin Neurobiol 1999; 9: 128-134
• 24 Vancampfort D, Stubbs B, Richards J. et al. Physical fitness in people with posttraumatic stress disorder: a systematic review. Disabil Rehabil 2016; DOI: 10.1080/09638288.2016.1226412.
• 25 Felitti VJ, Anda RF, Nordenberg D. et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The adverse childhood experiences (ACE) study. Am J Preventive Med 1998; 14: 245-258
• 26 Boos A. Kognitive Verhaltenstherapie nach chronischer Traumatisierung. Göttingen: Hogrefe; 2014
• 27 Ehlers A, Grey N, Wild J. et al. Implementation of cognitive therapy for PTSD in routine clinical care: effectiveness and moderators of outcome in a consecutive sample. Behav Res Ther 2013; 51: 742-752
• 28 Morina N, Lancee J, Arntz A. Imagery rescripting as a clinical intervention for aversive memories: A meta-analysis. J Behav Ther Experimental Psychiatry 2017; 55: 6-15
• 29 Nemeroff CB, Heim CM, Thase ME. et al. Differential responses to psychotherapy versus pharmacotherapy in patients with chronic forms of major depression and childhood trauma. Proc Natl Acad Sci USA 2003; 100: 14293-14296
• 30 Klein JP, Belz M. Psychotherapie chronischer Depression. Praxisleitfaden CBASP. Göttingen: Hogrefe; 2014
• 31 Wells A, Colbear JS. Treating posttraumatic stress disorder with metacognitive therapy: a preliminary controlled trial. J Clin Psychol 2012; 68: 373-381
• 32 Wells A, Schweiger U, Schweiger J. et al. Metakognitive Therapie bei Angst und Depression. Weinheim: Beltz; 2011
• 33 Renner F, Arntz A, Peeters FP. et al. Schema therapy for chronic depression: Results of a multiple single case series. J Behav Ther Exp Psychiatr 2016; 51: 66-73
• 34 Arntz A, Van Genderen H, Schweiger J. et al. Schematherapie bei Borderline-Persönlichkeitsstörung. Weinheim: Beltz; 2010
• 35 Linehan MM. DBT Skills Training Manual. New York: Guilford; 2014
• 36 Harned MS, Korslund KE, Linehan MM. A pilot randomized controlled trial of dialectical behavior therapy with and without the dialectical behavior therapy prolonged exposure protocol for suicidal and self-injuring women with borderline personality disorder and PTSD. Behav Res Ther 2014; 55: 7-17
• 37 Martell CR, Dimidjian S, Herman-Dunn R. et al. Verhaltensaktivierung bei Depression: Eine Methode zur Behandlung von Depression. Stuttgart: Kohlhammer; 2015
• 38 Bolton P, Bass JK, Zangana GA. et al. A randomized controlled trial of mental health interventions for survivors of systematic violence in Kurdistan, Northern Iraq. BMC Psychiatry 2014; 14: 360