ABSTRACT
The corona pandemic has led many people to experience an existential threat and has triggered different forms of coping with this persistent stress situation. The risk for the development of a generalized anxiety disorder (GAD) in particular has significantly increased. The established concepts of cognitive behavioral therapy (CBT) are only moderately effective in the treatment of GAD. Therefore, an integrative therapy concept is developed with reference to the biopsychosocial approach. This mediates a reference to early influences in the primary family (insecure ambivalent attachment, suppression of curiosity behavior) even during the psychoeducation as the cause of a permanent worrying and the underlying intolerance of uncertainty. The initial priority is on establishing a sustainable therapeutic relationship (alliance) in which the patient's autonomy and self-efficacy are promoted. Of central importance to therapeutic progress is the promotion of experiences that enhance self-efficacy and the reduction of avoidance behavior through exposure and behavioral experiments. The reduction of maladaptive anxiety coping through worry chains and reassurance behavior occurs through the development of an increasingly greater tolerance of uncertainty in actual daily life. Essential for the prognosis are the consideration of metacognitions and dysfunctional relationship patterns in the couple relationship as well as carrying out relaxation procedures and correctly dosed exercises. Finally, it is a matter of the processing of dysfunctional coping strategies, which promote chronification. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (German) Die Coronapandemie hat bei vielen Menschen zum Erleben einer existenziellen Bedrohung gefuhrt und unterschiedliche Formen der Bewaltigung dieser anhaltenden Stresssituation ausgelost. Besonders stark gestiegen ist das Risiko fur die Entwicklung einer generalisierten Angsterkrankung (generalized anxiety disorder", GAD). Die etablierten Konzepte der kognitiven Verhaltenstherapie (cognitive behavioral therapy", CBT) sind in der Behandlung einer GAD nur masig wirksam. Daher wird unter Bezugnahme auf den biopsychosozialen Ansatz ein integratives Therapiekonzept entwickelt. Dieses vermittelt bereits im Rahmen der Psychoedukation einen Bezug zu fruhen Pragungen in der Primarfamilie (unsicher-ambivalente Bindung, Unterdruckung von Neugierverhalten) als Ursache eines permanenten Sichsorgens und der dahinter stehenden Intoleranz fur Ungewissheit. Zunachst steht der Aufbau einer tragfahigen therapeutischen Beziehung (alliance") im Vordergrund, bei der die Autonomie und Selbstwirksamkeit des Patienten gefordert werden. Eine zentrale Bedeutung fur den therapeutischen Fortschritt haben die Forderung von Erfahrungen, die die Selbstwirksamkeit erhohen, sowie die Reduktion von Vermeidungsverhalten durch Exposition und Verhaltensexperimente. Der Abbau der maladaptiven Angstbewaltigung durch Sorgenketten und Ruckversicherungsverhalten geschieht durch die Entwicklung einer wachsenden Toleranz von Ungewissheit im jeweils aktuellen Lebensalltag. Prognostisch wesentlich sind die Berucksichtigung von Metakognitionen und dysfunktionalen Beziehungsmustern in der Paarbeziehung sowie die Durchfuhrung von Entspannungsverfahren und richtig dosierter Sporttherapie. Schlieslich geht es um die Bearbeitung dysfunktionaler Coping-Strategien, die die Chronifizierung fordern. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
BACKGROUND: The use of formal coercion such as seclusion, mechanical restraint, and forced medication is one of the most challenging and complex issues in mental health care, on the clinical, the legal, and the ethical level. Clinical ethics support aims at assisting healthcare practitioners in determining the morally most justifiable course of action in these situations. However, the effectiveness of clinical ethics support has hardly been studied so far. METHODS: Monthly moral case deliberation (MCD) was implemented in two acute wards of two different psychiatric hospitals in Switzerland. Frequency and intensity of coercion was measured on ward level (npatients = 405), and the Moral Attentiveness Scale, Knowledge on Coercion Scale, and Staff Attitudes towards Coercion Scale were applied on healthcare practitioner level (nHP = 46). Pre-post-comparisons were conducted using multi-level modeling where appropriate. RESULTS: After implementation of MCD, formal coercion was less frequent (particularly seclusion, small effect size; 9.6 vs. 16.7%, p = .034, Cramér's V = .105) and less intense (particularly mechanical restraint, large effect size; 86.8 ± 45.3 vs. 14.5 ± 12.1 h, exact p = .019, r = -.74), and approval for coercive measures among healthcare practitioners was lower when controlling for the number of MCD sessions attended. CONCLUSIONS: Clinical ethics support such as MCD may be a hitherto underutilized service for the reduction of coercion, complementing existing strategies and programs. Implementing clinical ethics support may help improve quality of care for persons suffering from severe mental illness.