Psychosoziale Krisenintervention

Literatur:

Gekle W & Tschacher W (2004). Differentielle Indikationsstellungen im Prozess der Krisenintervention. In: Riecher-Rössler A, Berger P, Yilmaz AT, & Stieglitz R-D (eds.) Psychiatrisch-psychotherapeutische Krisenintervention, (pp. 55-65). Göttingen: Hogrefe.

Tschacher W (1996). The Dynamics of Psychosocial Crises Time Courses and Causal Models. Journal of Nervous and Mental Disease, 184, 172-179.

Reisch T, Schlatter P, & Tschacher W (1999). Efficacy of Crisis Intervention. Crisis, 20, 78-85.

Tschacher W & Jacobshagen N (2002) Process Analysis of Crisis Intervention. Crisis, 23, 59-67.

Abstracts:

Tschacher W (1996)
The time courses of 34 psychosocial crises were studied at an in-patient psychiatric crisis intervention unit. For data acquisition, patients were instructed to rate their tension, activity and mood in self-report scales three times a day. The onset of crises before index admission were assessed by retrospective interviews. A combination of pre-post comparisons and time series analyses was used to evaluate the effectiveness of crisis intervention and to specify typologies of crises. Although distinct crisis trajectories were found at the group level which clearly reflect global treatment effects, there was little indication of specificity using a pre-post design. Consequently, the use of more fine-grained longitudinal methods is proposed. Time series models of individual patients (single systems approach) are helpful in designing appropriate therapeutic strategies. Agglutination of single case models points to distinct crisis courses, in which a cluster of depressive reactions is prominent. Consequently, a dynamical systems approach is suggested for application in psychiatry and psychology.

Reisch T, Schlatter P & Tschacher W (1999)
Evaluated the efficacy of crisis intervention in a specialized community-based psychiatric program with an emphasis on suicide and suicide prevention, focusing on the alleviation of depression, hopelessness, fear, phobia, and somatization, generally considered to contribute to suicidal ideation and behavior. Participants were 32 female and 19 male patients, aged 17 to 77 years, admitted to the crisis intervention unit in Bern, Switzerland. During the first and last days of a 2-3 week hospitalization, participants completed the Beck Depression Inventory (BDI), the Emotionalitaetsinventar-Befinden (EMI-B, an inventory of emotional well-being), the Giessen Test (GT-S, a personality diagnostic test), the Unsicherheitsfragebogen (UFB, a social anxiety questionnaire), and the Symptom Checklist (SCL-90-R). After crisis intervention, a reduction of symptoms contributing to suicidal ideation and behavior and significant improvements in psychopathology ratings, in particular in depression and anxiety, were found. However, residual symptoms and only moderate improvement in personality and social phobia measures indicated the need for a 2-step therapy approach: intensive intervention targeted at the precipitating cause of a crisis, followed by long-term therapy to treat underlying problems.

Tschacher W & Jacobshagen N (2002)
The remediation processes in psychosocial crisis intervention were modeled focussing on cognitive orientation. Frequent observations and subsequent process modeling constitute a novel approach to process research and reveal process-outcome associations. A sample of 40 in-patients who were assigned to treatment in a crisis intervention unit was monitored in order to study the process of crisis intervention. The process data consisted of patients' self-ratings of the variables mood, tension, and cognitive orientation which were assessed three times a day throughout hospitalization (M = 22.6 d). Linear time series models (vector autoregression) of the process data were computed to describe the prototypical dynamic patterns of the sample. Additionally, the outcome of crisis intervention was evaluated by pre-post questionnaires. Linear trends were found pointing to an improvement of mood, a reduction of tension, and an increase of outward cognitive orientation. Time series modeling showed that, on average, outward cognitive orientation preceded improved mood. The time series models partially predicted the treatment effect, notably the outcome domain 'Reduction of Social Anxiety', yet did not predict the domain of symptom reduction. In conclusion, crisis intervention should focus on having patients increasingly engage in outward cognitive orientation in order to stabilize mood, reduce anxiety, and activate their resources.



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