Les aspects spirituels et existentiels jouent un rôle important pour de nombreuses personnes, non seulement dans les soins palliatifs en fin de vie, mais aussi dans les maladies chroniques. Mais comment la dimension spirituelle peut-elle être concrètement intégrée dans une approche thérapeutique multimodale? Quelles sont les approches utiles pour ne pas perdre de vue la personne dans sa globalité lors du traitement, malgré des ressources de temps et de personnel de plus en plus limitées, et pour prendre en compte non seulement les aspects psychosociaux, mais aussi les aspects spirituels?
Objective: Alexithymia is considered to be a personality trait with a tendency to express psychological distress in somatic rather than emotional form and, therefore, may play a vital role in somatization. Although, such a propensity can be found in patients suffering from tinnitus, the relationship between alexithymic characteristics and the subjective experience of tinnitus severity remains yet unclear. Our aim was to evaluate which alexithymic characteristics are linked to the subjective experience of tinnitus symptomatology. Methods: We evaluated tinnitus severity (Tinnitus Handicap Inventory, THI), alexithymia (20-item Toronto Alexithymia Scale, TAS-20) and depression (Beck Depression Inventory, BDI) in 207 outpatients with tinnitus. Correlation analyses and multiple regression analyses were calculated in order to investigate the relationship between alexithymic characteristics, tinnitus severity and depression. Results: Highly significant positive correlations were found between THI total score and TAS-20 total score as well as BDI score. Regarding the TAS-20 subscales, multiple regression analyses showed that only the TAS-20 subscale "difficulty in identifying feelings" (DIF) and the BDI significantly predicted the subjective experience of tinnitus severity. Regarding the THI subscales, only higher scores of the THI subscale "functional" demonstrated an independent moderate association with higher scores for DIF. Conclusion: We found an independent association between the subjective experience of tinnitus severity and alexithymic characteristics, particularly with regard to limitations in the fields of mental, social and physical functioning because of tinnitus and the difficulty of identifying feelings facet of alexithymia. These findings are conducive to a better understanding of affect regulation that may be important for the psychological adaptation of patients suffering from tinnitus.
Data about quality of life (QoL) are important to estimate the impact of diseases on functioning and well-being. The present study was designed to assess the association of different aspects of panic disorder (PD) with QoL and to examine the relationship between QoL and symptomatic outcome following brief cognitive-behavioral group therapy (CBGT).The sample consisted of 55 consecutively recruited outpatients suffering from PD who underwent CBGT. QoL was assessed by the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) at baseline, post-treatment and six months follow-up. SF-36 baseline scores were compared with normative data obtained from a large German population sample.Agoraphobia, disability, and worries about health were significantly associated with decreased QoL, whereas frequency, severity and duration of panic attacks were not. Treatment responders showed significantly better QoL than non-responders. PD symptom reduction following CBGT was associated with considerable improvement in emotional and physical aspects of QoL. However, the vitality subscale of the SF-36 remained largely unchanged over time.Our results are encouraging for cognitive-behavior therapists who treat patients suffering from PD in groups, since decrease of PD symptoms appears to be associated with considerable improvements in QoL. Nevertheless, additional interventions designed to target specific aspects of QoL, in particular vitality, may be useful to enhance patients' well-being.
Alexithyme Patientenmerkmale werden in der Literatur mit ungunstigenVerlaufen von psychotherapeutischen Behandlungen in Verbindung gebracht. Patienten mit Alexithymie seien wenig geeignet fur spezifische Psychotherapien und sollten eher supportiv oder medikamentos behandelt werden. In dieser Ubersichtsarbeit wird diese Einschatzung anhand einer Zusammenfassung der Resultate empirischer Studien infrage gestellt. Nicht in allen Untersuchungen psychodynamischer Therapien erwies sich Alexithymie als prognostisch ungunstig und fur kognitive Verhaltenstherapien spricht die Datenlage gegen einen solchen Einfluss der Alexithymie auf das Behandlungsergebnis. Vor diesem Hintergrund werden psychotherapeutische Vorgehensweisen diskutiert, welche Schwierigkeiten bei der Gefuhlswahrnehmung und -kommunikation berucksichtigen, um alexithyme Patienten mit psychischen Erkrankungen erfolgversprechend behandeln zu konnen und moglicherweise auch eine Veranderung alexithymer Merkmale zu bewirken. Wunschenswert ware, dass die Psychotherapieforschung das klinisch sehr relevante Thema Alexithymie zukunftig verstarkt aufgreift.
