Angsterkrankungen in der Rehabilitation

Abstract

Anxiety disorders are among the most common and socio-medically relevant mental illnesses. Correct diagnosis and initiation of appropriate therapy are of the utmost importance for patients' prognosis and for ensuring their social and occupational participation. This article therefore aims to provide an overview of new developments in the field of anxiety disorders relevant to rehabilitation.Within the framework of the changes in ICD-11, anxiety disorders now receive an independent chapter with a focus appropriate to their frequency and relevance. Further innovations concern the revised S3 guideline (2020) with the increasing consideration of digital therapy options, such as virtual reality exposure therapy (VER) as well as Internet-supported therapy methods as part of the therapy recommendations. Systemic therapy is also considered for the first time. However, the evidence for both procedures is significantly lower than for behavioral therapy, psychodynamic therapy, or pharmacotherapy. Online interventions are therefore not recommended as the sole therapy.Important for the practice in rehabilitation is the knowledge of the core symptoms of each of the above mentioned diagnoses as well as the diagnostic possibilities taking into account especially the correlations and interactions with physical diseases.Both psychotherapy and psychopharmacotherapy are available for treatment. In the field of psychotherapy, cognitive behavioral therapy (CBT) is the therapy of first choice due to the broadest base of evidence. In consideration of comorbid somatic diseases, attention must be paid to possible contraindications for antidepressants. Psychosomatic rehabilitation is an important resource in the overall treatment spectrum, especially if chronification or a threat to participation is foreseeable, in order to give the affected person confidence and motivation for further successful treatment of the anxiety disorder in an intensified treatment setting, in addition to teaching anxiety management strategies and socio-medical clarification. An important task of somatic rehabilitation is to recognize comorbid anxiety disorders and to provide the affected persons with an appropriate explanatory model of their complaints and to be able to initiate targeted treatment.