Mit einem Trauma nach schwerer Krankheit umgehen

Mit einem Trauma nach schwerer Krankheit umgehen

Ein Trauma verbindet man meist mit Menschen, die Naturkatastrophen oder Kriege überlebt oder Gewalt erlebt haben. Doch auch eine lebensbedrohliche Krankheit kann schlimme seelische Folgen haben.

Eben schlendert man noch vergnügt durch die Straßen. Urplötzlich fällt dann das Atmen schwer, der Signalton des Monitors auf der Intensivstation fiept wieder im Ohr. Dabei schien alles überstanden. Wer eine schwere Krankheit durchlebt hat, der plagt sich oft mit den seelischen Folgen - wie aus heiterem Himmel kommen dabei schreckliche Erinnerungen wieder hoch ins Bewusstsein. Der Betroffene ist traumatisiert. Prof. Anke Ehlers vom Department of Experimental Psychology der Universität Oxford fügt hinzu „Ein Trauma ist ein überwältigendes Ereignis, verbunden mit extremer Bedrohung wie Lebensgefahr oder Demütigung“. Ulrike Schmidt von der Trauma-Ambulanz München am Max-Planck-Institut für Psychiatrie schätzt „Etwa 20 bis 25 Prozent der Patienten haben nach einer lebensbedrohlichen Krankheit eine akute Belastungsreaktion“, „Bei fünf Prozent der Betroffenen kann diese später in eine Posttraumatische Belastungsreaktion münden.“

Eine solche Belastungsreaktion zeigt sich etwa durch ein inneres Erstarren, eine innere Taubheit. Die meisten Betroffenen sind außerdem schreckhaft, gereizt und aggressiv, können sich nur mit Mühe konzentrieren, schlafen schlecht und leiden unter Alpträumen. Bestimmte Laute oder Gerüche sind meistens Urheber der Erinnerungen „Diese Flashbacks sind so lebhaft, dass es den Betroffenen so vorkommt, als passiere dies alles im Hier und Jetzt. Sie haben wieder Todesangst oder andere starke Gefühle wie Schuldgefühle oder Scham“, erklärt Ehlers. Schuldgefühle entstehen meistens, weil die betroffenen Menschen das schreckliche Erleben wieder und wieder durchgehen und darüber nachgrübeln, wie sie die Krankheit hätten vermeiden können.

Prof. Christine Knaevelsrud von der Deutschsprachigen Gesellschaft für Psychotraumatologie in Freiburg erläutert, dass die genannten Symptome gleich nach dem Ereignis eine ganz normale Reaktion sind. In der Regel ebben sie jedoch nach spätestens vier Wochen wieder ab. Es kann aber auch vorkommen, dass die Symptome erst nach Monaten auftreten; im akuten Krankheitsfall schalten Körper, Geist und Seele ohnehin auf Notfallprogramm um - der Betroffene "funktioniert" nur noch. Das wirkliche Grauen bricht sich dann erst nach und nach Bahn. Eben die, die körperlich wieder gesund sind, sind der Meinung, kein Recht auf seelisches Leid zu haben. „Der Schweregrad einer Krankheit oder die Krankheit selbst sind nicht der Punkt“, meint Knaevelsrud. „Es geht darum, wie ein Mensch die Krankheit erlebt hat.“ Dabei ist es keine Hilfe, sich gewaltsam zusammenreißen zu wollen. „Der Betroffene hat es erlebt. Er weiß, dass er überlebt hat, doch er fühlt es nicht“. Ehlers erklärt diesen Mechanismus: „Das Ereignis wird unvollständig verarbeitet und bruchstückartig im Gedächtnis gespeichert“. „Zudem sind die Erinnerungen an die schlimmsten Momente nur unvollständig verbunden mit den Erinnerungen an das, was vorher und hinterher geschah.“ Also wurde das Gedächtnis nicht aktualisiert und agiert korrigierend mit dem Wissen, dass alles gut gegangen ist.

Bildhaft gesprochen werden in der Regel im Gehirn Situationen wie Kleidungsstücke in einen Schrank einsortiert. Kommt es nun zu einem Trauma, dann gleicht das Abspeichern einem Kleiderknäuel mit Pullover, Blusen und Hosen (sprich: Gefühle, Geräusche, Gerüche, Menschen, Momente und Gebäude wie die Klinik), das unsortiert in den Schrank geworfen wird. „Ein Auslöser reicht, um die gesamte Kaskade, also das Kleiderknäuel, hochzuholen“, sagt Knaevelsrud. Zu den auslösenden Reizen können Gerüche oder Laute gehören, die den Betroffenen jäh an das Ereignis erinnern. „Wenn die Störung nicht behandelt wird, stellen sich oft Folgeprobleme wie Depressionen ein“, fügt Ehlers hinzu. In Aber auch ein erhöhtes Risiko für Herzerkrankungen kann auftreten. Zudem leiden die Betroffene meistens an Schwierigkeiten in der Partnerschaft und auf Arbeit. So greifen sie gerne zum Alkohol, um sich zu betäuben. Wenn die Symptome nun nach vier Wochen nicht nachlassen oder sich gar gravierende psychische Symptome einstellen, dann ist dem Betroffenen angeraten, baldmöglichst einen Therapeuten mit traumapsychotherapeutischer Ausbildung aufzusuchen. Dieser leitet dann eine kognitive Verhaltenstherapie ein, während der sich der Patient mit dem auseinandersetzen muss, was ihn in seinen Grundfesten erschüttert hat: Das traumatische Ereignis wird begleitet vom Therapeuten genau besprochen und auch das kommt zur Sprache, was heute noch schmerzhaft ist. „Wir aktualisieren die Momente des Traumas im Gedächtnis durch Verknüpfung mit dem, was der Patient aus heutiger Perspektive weiß oder im Gespräch mit dem Therapeuten herausgefunden hat“, erklärt Ehlers. „Wir helfen zudem, Auslöser wie bestimmte sensorische Reize, etwa Farben, Geräusche oder Gerüche, zu erkennen und zu sehen, dass die heutige Situation, in der der Auslöser auftritt, ganz anders ist als im Trauma“. Ziel der Behandlung ist nun laut Schmidt : „Man erkennt nicht nur vom Verstand her, dass man es geschafft hat, sondern erfasst es emotional, fühlt es“. Übertragen auf das Bild mit dem Kleiderschrank bedeutet das, dass jedes Stück des Kleiderknäuels für sich betrachtet, gefaltet und ordentlich weggelegt wird. „Es gibt kaum eine seelische Erkrankung, die so gut zu behandeln ist wie eine Posttraumatische Belastungsstörung“, sagt Knaevelsrud.

Die Therapie, für die die Krankenkasse in der Regel aufkommt, beinhaltet auch die Chance auf inneres Wachstum: Die Lebensüberzeugungen ändern sich und Probleme werden anders gewichtet. «Auch sind viele in der Lage, Alltagsprobleme besser zu bewältigen», fügt Schmidt hinzu. «Wir nennen dieses Phänomen «Posttraumatisches Wachstum».»

Informationen für Traumatisierte: http://dpaq.de/vmQ4n
Quelle: dpa

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