In den letzten Jahren haben rezidivierende und chronische depressive Störungen als häufigste Verlaufsformen der Depression in der Forschung und klinischen Praxis an Aufmerksamkeit gewonnen. Aufgrund hoher Rückfall- und Chronifizierungsraten wurden neue Ansätze in der Rezidivprophylaxe aber auch in der Akuttherapie chronischer Depressionen entwickelt. Der vorliegende Artikel liefert einen Überblick über zentrale Ätiologiemodelle und Behandlungsverfahren bei rezidivierender und chronischer Depression. Dabei wird die These aufgestellt, dass ähnliche kognitive Prozesse, wie sie für die Entstehung eines Rezidivs angenommen werden, auch zur Aufrechterhaltung der depressiven Symptomatik bei chronischer Depression beitragen. Der Fokus dieses Artikels liegt auf Veränderungen solcher intrapsychischen Mechanismen durch Methoden der Dezentrierung als eine Form der bewussten Wahrnehmung kognitiver Prozesse sowie auf der Förderung motivationaler Aspekte im Hinblick auf eine effizientere Langzeitprophylaxe. Die Integration neuer Ansätze zur Modifikation kognitiver und motivationaler Prozesse stellt eine erfolgversprechende Perspektive für die Entwicklung eines wirkungsvolleren kognitiven Gesamtkonzepts dar.

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