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Chronisches Erschöpfungssyndrom

Evidenzbasierte Psychotherapie bei chronischer organisch unklarer Erschöpfung

Chronic fatigue syndrome

Evidenced-based psychotherapy for chronic medically unexplained fatigue

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Zusammenfassung

Chronische Erschöpfungszustände ohne bzw. ohne adäquate somatische Ursache sind für Betroffene sowie für Behandler ein Problem, da mit dem Fehlen einer eindeutigen nosologischen Zuordnung und eines eindeutigen Ätiologiemodells auch die Behandlungsoptionen nicht immer direkt auf der Hand liegen bzw. Gegenstand von Kontroversen sind (s. Gaab, in diesem Heft). Zur Behandlung des chronischen Erschöpfungssyndroms („chronic fatigue syndrome“, CFS) werden verschiedene psychotherapeutische Ansätze neben graduierter Aktivierung vorgeschlagen. Ziel des vorliegenden Beitrags ist es, den aktuellen Stand der Evidenzbasierung von Psychotherapie bei CFS auf Basis vorliegender Metaanalysen und neuerer randomisierter kontrollierter Studien darzustellen. Robuste Evidenz zeigt sich für die kognitive Verhaltenstherapie (KVT) mit im Durchschnitt moderater Wirksamkeit im Hinblick auf die Schwere der Erschöpfungssymptomatik und die körperliche Funktionseinschränkung nach Therapieabschluss sowie in kurz- bis mittelfristigen Katamnesen. Klinisch relevante Verbesserungen sind bei 40–50% der so behandelten Personen zu beobachten. Andere Psychotherapieverfahren wurden bislang selten evaluiert – vielversprechende Ergebnisse weisen jedoch Einzelstudien zu Gesprächspsychotherapie und Psychoedukation auf. Insgesamt besteht die Notwendigkeit, in der Therapie Konzepte zur Rückfallprophylaxe stärker zu berücksichtigen und die Nachhaltigkeit der therapeutisch erzielten Verbesserungen empirisch abzusichern.

Abstract

The treatment of chronic fatigue syndrome (CFS) may pose a challenge as controversial concepts of its aetiology are discussed. Psychotherapy and graded exercise therapy have been suggested for the treatment of CFS. The aim of the present literature review is to summarize the evidence for these treatments based on two meta-analyses and more recently published randomized controlled trials. There is robust evidence for the efficacy of cognitive-behavioural therapy for CFS, showing moderate effects especially on fatigue severity and physical functioning at post-treatment and at short to medium term follow-up. Other psychological treatments have mainly been tested as control conditions and not as bona fide psychotherapy; however, single trials suggest benefits of non-directive counselling and psycho-education. To further improve treatment results and their maintenance, relapse prevention strategies are important and a stronger empirical foundation of long-term effects is needed.

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Authors and Affiliations

  1. Psychosomatik: Psychotherapieforschung, Universitätsklinikum Erlangen, Friedrich-Alexander Universität Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Deutschland

    Alexandra Martin

  2. Klinische Psychologie und Psychotherapie, Psychologisches Institut, Universität Zürich, Attenhoferstr. 9, 8032, Zürich, Schweiz

    Jens Gaab

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  1. Alexandra Martin
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  2. Jens Gaab
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Correspondence to Alexandra Martin or Jens Gaab.

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Martin, A., Gaab, J. Chronisches Erschöpfungssyndrom. Psychotherapeut 56, 231–238 (2011). https://doi.org/10.1007/s00278-011-0828-1

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