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      Praktische Anwendung von Achtsamkeit in der Suchttherapie am Beispiel des MBRP Programms und der DBT-Sucht

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          Abstract

          Hintergrund: „Achtsamkeitsbasierte Rückfallprävention bei Substanzabhängigkeit (MBRP) und das suchtspezifische Modul „Umgang mit Sucht“ der Dialektisch Behavioralen Therapie (DBT-S) integrieren Achtsamkeit als zentrale Fertigkeit und Grundhaltung in ihr Konzept der Behandlung von Abhängigkeitserkrankten. Innere und äußere Achtsamkeit beschreiben hier das konzentrierte, nicht bewertende Wahrnehmen oder Beschreiben des Umfeldes oder inneren Befindens einer Person. Sie ermöglicht dem Anwender durch ihre Bewertungsneutralität neue Wege aus der Sucht zu finden, Frühwarnzeichen zu erkennen und neue Lösungen für alte Probleme zu entdecken. Während Substanzkonsum Erleben reduziert, erhöht die Anwendung von Achtsamkeit den Erlebnishorizont und bietet eine Chance auf einen erweiterten Blick auf das eigene Leben. Achtsamkeit ermöglicht somit einen neuen Umgang mit Suchtmittelverlangen. Fragestellung: In diesem Artikel werden MBSR und DBT-S vorgestellt.

          Practical Application of Mindfulness in Addition Treatment – the Case of MBRP and DBT-S

          Background: „Mindfulness Relapse Prevention“ (MBRP) and Dialectic Behavioral Therapy for substance abuse (DBT-S) both focus on mindfulness skills for the treatment of patients with substance abuse and addiction. Mindfulness is shortly explained as a focused, nonjudgmental observing, describing and participating technique helping to improve internal or external awareness. Giving up a judgmental approach mindfulness improves effective relapse prevention and increases the likelihood for a more flexible problem solving. Whereas substance consumption decreases awareness, mindfulness increases awareness and thus it may offer a more objective view on selected topics of patients live as well as a more effective approach to handle craving for substances. Aim: This article gives a short introduction to MBSR and DBT-S.

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          Dialectical behavior therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder.

          We conducted a randomized controlled trial to evaluate whether dialectical behavior therapy (DBT), a treatment that synthesizes behavioral change with radical acceptance strategies, would be more effective for heroin-dependent women with borderline personality disorder (N = 23) than Comprehensive Validation Therapy with 12-Step (CVT + 12S), a manualized approach that provided the major acceptance-based strategies used in DBT in combination with participation in 12-Step programs. In addition to psychosocial treatment, subjects also received concurrent opiate agonist therapy with adequate doses of LAAM (thrice weekly; modal dose 90/90/130 mg). Treatment lasted for 12 months. Drug use outcomes were measured via thrice-weekly urinalyses and self-report. Three major findings emerged. First, results of urinalyses indicated that both treatment conditions were effective in reducing opiate use relative to baseline. At 16 months post-randomization (4 months post-treatment), all participants had a low proportion of opiate-positive urinalyses (27% in DBT; 33% in CVT + 12S). With regard to between-condition differences, participants assigned to DBT maintained reductions in mean opiate use through 12 months of active treatment while those assigned to CVT + 12S significantly increased opiate use during the last 4 months of treatment. Second, CVT + 12S retained all 12 participants for the entire year of treatment, compared to a 64% retention rate in DBT. Third, at both post-treatment and at the 16-month follow-up assessment, subjects in both treatment conditions showed significant overall reductions in level of psychopathology relative to baseline. A noteworthy secondary finding was that DBT participants were significantly more accurate in their self-report of opiate use than were those assigned to CVT + 12S. Copyright 2002 Elsevier Science Irealnd Ltd.
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            Dialectical Behavior Therapy for Substance Abusers

            Dialectical behavior therapy (DBT) is a well-established treatment for individuals with multiple and severe psychosocial disorders, including those who are chronically suicidal. Because many such patients have substance use disorders (SUDs), the authors developed DBT for Substance Abusers, which incorporates concepts and modalities designed to promote abstinence and to reduce the length and adverse impact of relapses. Among these are dialectical abstinence, “clear mind,” and attachment strategies that include off-site counseling as well as active attempts to find patients who miss sessions. Several randomized clinical trials have found that DBT for Substance Abusers decreased substance abuse in patients with borderline personality disorder. The treatment also may be helpful for patients who have other severe disorders co-occurring with SUDs or who have not responded to other evidence-based SUD therapies.
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              Dynamic association between negative affect and alcohol lapses following alcohol treatment.

              Clinical research has found a strong association between negative affect and returning to alcohol use after a period of abstinence. Yet little is known about the probability of a lapse given a particular level of negative affect or whether there is a reciprocal relationship between negative affect and alcohol use across time. The goal of the current study was to examine the association between negative affect and drinking behavior in the 1st year following alcohol treatment. The authors applied an associative latent transition analysis to the Project MATCH outpatient data (n = 952) and then replicated the model in the Project MATCH aftercare data (n = 774). Changes in drinking following treatment were significantly associated with current and prior changes in negative affect, and changes in negative affect were related to prior changes in drinking (effect size range = 0.13-0.33). The results supported the hypothesis that negative affect and alcohol lapses are dynamically linked and suggest that targeting the relationship between negative affect and alcohol use could greatly decrease the probability of lapses and improve alcohol treatment outcomes.
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                Author and article information

                Journal
                suc
                SUCHT
                Die Zeitschrift für Wissenschaft und Praxis
                Hogrefe AG, Bern
                0939-5911
                1664-2856
                Januar 2014
                : 60
                : 1
                : 29-36
                Affiliations
                [ 1 ] Oberbergkliniken, Berlin
                [ 2 ] Department of Psychiatry and Behavioral Sciences University of Washington, Center for the Study of Health and Risk Behaviors (CSHRB), Seattle, WA
                [ 3 ] Klinik für Psychiatrie und Psychotherapie, Charité Campus Mitte, Universitätsmedizin Berlin
                [ 4 ] Abteilung für Psychologische Medizin, Max Grundig Klinik GmbH, Bühl/Baden
                Author notes
                Prof. Dr. med. Götz Mundle, Oberbergkliniken, Charlottenstr. 60, 10117 Berlin, Deutschland, Tel.: +49 (0)1716127262, goetz.mundle@ 123456oberbergkliniken.de
                Article
                suc_60_1_29
                10.1024/0939-5911.a000289
                337c1fc8-cb8c-4dfe-9824-75eed69c2dfa
                Copyright @ 2014
                History
                Categories
                Therapeutische Verfahren

                Medicine,Psychology,Clinical Psychology & Psychiatry
                Achtsamkeit,Meditation,acceptance,meditation,relapse,addiction,Mindfulness,randomisierter Studie,Akzeptanz,Verhaltenstherapie,Rückfall,DBT-S,MBRP

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