Zusammenfassung
Hintergrund: Erfolgsprognosen ermöglichen eine stetige Weiterentwicklung und ökonomische Anwendung von Psychotherapie. Deren effizienter Einsatz in der Praxis bedarf einer einfach umzusetzenden Prognosestellung. Die vorliegende Studie prüft die Vorhersage von Therapieerfolg aufgrund des anfänglichen Belastungsniveaus. Methoden: Verwendet wurden Daten aus der Routineevaluation einer psychotherapeutischen Hochschulambulanz von 3’145 PatientInnen (MAlter = 35,8, 67% weiblich). Anhand vor Therapiebeginn vorliegender Kriterien (allgemeine psychische Belastung, Symptomatik, Vorbehandlung) wurden niedrig versus hoch belastete PatientInnen differenziert und bezüglich der Erfolgsmaße absolute Belastungsreduktion, (Early) Response, Remission und Therapieabbruch mithilfe von t-Tests und logistischen Regressionsanalysen verglichen. Response und Remission wurden über ein relatives (prozentuale Verbesserung) und ein absolutes Maß (Reliable Change Index, RCI) operationalisiert. Ergebnisse: Hohe psychische Belastung stand in negativem Zusammenhang mit Response gemäß prozentualer Verbesserung (OR = 0,62) und Remission (OR = 0,34) sowie in positivem Zusammenhang mit absoluter Belastungsreduktion (d = 0,63), RCI-Response (OR = 2,37) und Therapieabbruch (OR = 2,15). Early Response und Therapieabbruch nahmen im Zusammenhang von anfänglichem Belastungsniveau und Behandlungserfolg eine partiell vermittelnde Rolle ein. Schlussfolgerungen: Behandlungserfolge fallen bei hoher anfänglicher psychischer Belastung vergleichsweise geringer aus, wobei die Operationalisierung von Erfolg eine entscheidende Rolle spielt. Die vorgestellte Klassifizierung ist leicht umzusetzen und kann im Ausbildungssetting helfen, einer therapeutischen Überlastung entgegenzuwirken.
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