Akute Trauer als normale Reaktion auf den Verlust einer nahestehenden Person wird in der Regel schmerzhaft erlebt. Dennoch bewältigen die meisten Betroffenen ihre Trauer ohne professionelle Hilfe. Eine Minderheit erlebt anhaltende und schwerwiegende Trauersymptome, die das Bild einer komplizierten Trauerstörung erfüllen können. Die Aufmerksamkeit für komplizierte Trauer als eigenständiges Störungsbild nimmt zu, auch bedingt durch die Berücksichtigung in den Neuauflagen der Klassifikationssysteme «International Statistical Classification of Diseases and Related Health Problems» (ICD-11) und «Diagnostisches und Statistisches Manual Psychischer Störungen» (DSM-5). Die Diagnostik muss allerdings die Gefahr einer Pathologisierung normaler Trauerreaktionen sowie Fehlklassifikationen berücksichtigen. Interventionen, die sich an alle Trauernden richten (universelle Prävention), zeigen nur minimale Effekte. Die Möglichkeit der Prävention komplizierter Trauer in Risikogruppen oder bei hochbelasteten Akuttrauernden wird kritisch diskutiert. Aktuelle randomisiert-kontrollierte Studien belegten aber die Überlegenheit störungsspezifischer gegenüber anderen Behandlungsansätzen (interpersonelle Psychotherapie) bei komplizierter Trauer. Bezüglich kognitiv-verhaltenstherapeutischer Interventionen sind die Exposition gegenüber trauer- oder verlustassoziierten Stimuli sowie die kognitive Umstrukturierung trauerspezifischer dysfunktionaler Gedanken hochgradig evidenzbasiert. Ein weiteres Behandlungselement ist die Etablierung neuer Ziele für ein Leben ohne die verstorbene Person. Auch die Verhaltensaktivierung zeigte erste positive Effekte. Neben der klassischen Face-to-Face-Psychotherapie sind dabei auch Internet-basierte Behandlungsangebote vielversprechend. Dennoch besteht weiterer Forschungsbedarf, beispielsweise hinsichtlich der differenziellen Effektivität einzelner Behandlungskomponenten.

Keywords:
Komplizierte Trauer, Kognitive Verhaltenstherapie
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2017
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