Kernmerkmal der Binge-Eating-Störung (BES) sind wiederkehrende Essanfälle ohne einen regelmäßigen Einsatz von unangemessenen kompensatorischen Verhaltensweisen zur Vorbeugung einer Gewichtszunahme. Bei Essanfällen nehmen die Betroffenen große Nahrungsmengen zu sich und erleben einen Kontrollverlust über das eigene Essverhalten (Diagnostisches und Statistisches Manual Psychischer Störungen, DSM-5; American Psychiatric Association APA 2015). Die BES ist die häufigste Essstörung und geht in der Regel mit psychischer Komorbidität, reduzierter Lebensqualität, Übergewicht und Adipositas sowie deren Folgeerkrankungen einher. Darüber hinaus berichten Betroffene mit BES häufig von substantiellen Beziehungsproblemen, darunter dysfunktionaler Kommunikation und Unzufriedenheit in der Paarbeziehung, die zu Essanfällen beitragen (Whisman et al. 2012; Ansell et al. 2012). Jedoch bleibt weitgehend unklar, wie diese Beziehungsprobleme behandelt werden können (Cierpka et al. 2007). Die kognitive Verhaltenstherapie gilt laut evidenzbasierten Behandlungsleitlinien als die am besten belegte Therapie der BES (Arbeitsgemeinschaft der wissenschaftlich-medizinischen Fachgesellschaften, im Druck). Bislang brachte die Erweiterung dieses Ansatzes durch den Einbezug des Partners in die kognitiv-behaviorale Gruppentherapie keine zusätzlichen Vorteile (Gorin et al. 2003), möglicherweise da sie nicht speziell für Paare mit BES konzipiert wurde. Allgemein gilt die Wirksamkeit von kognitiv-verhaltenstherapeutischer Paartherapie zur Verbesserung der Beziehungsqualität von gesunden Paaren jedoch als bewiesen (Baucom et al. 2003). Weiterhin erwies sich die störungsspezifische kognitiv-behaviorale Paartherapie zur Behandlung psychischer Störungen, beispielsweise von Depression, als ebenso wirksam wie die evidenzbasierte Individualtherapie (Bodenmann et al. 2008). Aktuell zeigte auch die Anwendung paartherapeutischer Interventionen zur Behandlung von Anorexia Nervosa als wirksam (Baucom et al. 2017; Bulik et al. 2011; Kirby et al. 2015). Partnerschaftsprobleme werden auch für die Anorexia Nervosa als störungsaufrechterhaltend diskutiert (Teufel et al. 2017). Ziel dieser Fallstudie war es, ein störungsspezifisches Manual für kognitive Verhaltenstherapie für Paare mit BES zu entwickeln und zu erproben, und zwar an einem Paar, bei dem beide Partner von BES betroffen waren.

Cognitive behavioral therapy (CBT) is efficacious for panic disorder with agoraphobia (PD/A). Nevertheless, the active ingredients of treatment and the mechanisms through which CBT achieves its effects remain largely unknown. The mechanisms of action in CBT (MAC) study was established to investigate these questions in 369 patients diagnosed with PD/A. The MAC study utilized a multi-center, randomized controlled design, with two active treatment conditions in which the administration of exposure was varied, and a wait-list control group. The special feature of MAC is the way in which imbedded experimental, psychophysiological, and neurobiological paradigms were included to elucidate therapeutic and psychopathological processes. This paper describes the aims and goals of the MAC study and the methods utilized to achieve them. All aspects of the research design (e.g., assessments, treatment, experimental procedures) were implemented so as to facilitate the detection of active therapeutic components, and the mediators and moderators of therapeutic change. To this end, clinical, behavioral, physiological, experimental, and genetic data were collected and will be integrated.

No description available.

Cognitive behavioral therapy (CBT) is efficacious for panic disorder with agoraphobia (PD/A). Nevertheless, the active ingredients of treatment and the mechanisms through which CBT achieves its effects remain largely unknown. The mechanisms of action in CBT (MAC) study was established to investigate these questions in 369 patients diagnosed with PD/A. The MAC study utilized a multi-center, randomized controlled design, with two active treatment conditions in which the administration of exposure was varied, and a wait-list control group. The special feature of MAC is the way in which imbedded experimental, psychophysiological, and neurobiological paradigms were included to elucidate therapeutic and psychopathological processes. This paper describes the aims and goals of the MAC study and the methods utilized to achieve them. All aspects of the research design (e.g., assessments, treatment, experimental procedures) were implemented so as to facilitate the detection of active therapeutic components, and the mediators and moderators of therapeutic change. To this end, clinical, behavioral, physiological, experimental, and genetic data were collected and will be integrated.

Background: Cognitive behavioral therapy (CBT) is an effective treatment for panic disorder with agoraphobia (PD/AG). It is unknown, how variants of CBT differentially modulate brain networks involved in PD/AG. This study was aimed to evaluate the effects of therapist-guided (T+) versus selfguided (T–) exposure on the neural correlates of fear conditioning in PD/AG. Method: In a randomized, controlled multicenter clinical trial in medication-free patients with PD/AG who were treated with 12 sessions of manualized CBT, functional magnetic resonance imaging (fMRI) was used during fear conditioning before (t1) and after CBT (t2). Quality-controlled fMRI data from 42 patients and 42 healthy subjects (HS) were obtained. Patients were randomized to two variants of CBT (T+, n = 22, and T–, n = 20). Results: The interaction of diagnosis (PD/AG, HS), treatment group (T+, T–), time point (t1, t2) and stimulus type (conditioned stimulus: yes, no) revealed activation in the left hippocampus and the occipitotemporal cortex. The T+ group demonstrated increased activation of the hippocampus at t2 (t2 > t1), which was positively correlated with treatment outcome, and a decreased connectivity between the left inferior frontal gyrus and the left hippocampus across time (t1 > t2). Conclusion: After T+ exposure, contingency-encoding processes related to the posterior hippocampus are augmented and more decoupled from processes of the left inferior frontal gyrus, previously shown to be dysfunctionally activated in PD/AG. Linking single procedural variants to neural substrates offers the potential to inform about the optimization of targeted psychotherapeutic interventions.

No description available.