soteria berne 1984-2011 basic concepts, practical realisation, results

Prof. Dr. med. em. Dr. h.c. Luc CiompiProf. Dr. med. em. Dr. h.c. Luc Ciompi

Berne / Switzerland Berne / Switzerland

IX. Symposium „Early intervention in psychiatry“IX. Symposium „Early intervention in psychiatry“Cordoba, March 24-26Cordoba, March 24-26thth, 2011, 2011

Soteria Berne 1984-2011Basic concepts, practical realisation, results

2

Plan of lecturePlan of lecture

1.1. Historical rootsHistorical roots

2.2.Basic conceptsBasic concepts

3.3.Practical realisationPractical realisation

4.4.Therapeutic resultsTherapeutic results

5.5.Hypotheses and open questionsHypotheses and open questions

4

3

1.1. Historical rootsHistorical roots

43

76

8

Long-term outcomeLong-term outcome

Full recovery 20-30 %Full recovery 20-30 %

Minor residuals 30-40 %Minor residuals 30-40 %

Severe chronicity 30-35 %Severe chronicity 30-35 %

7

9

Three phase model Three phase model of the long-term evolution of schizophreniaof the long-term evolution of schizophrenia

biological factors biological factors ⇆⇆ pychosocial factors pychosocial factors

↘↘↘↘↘↘ ↙↙↙↙↙↙premorbid vulnerabilitypremorbid vulnerability

↓↓↓↓↓↓

stressfull life-eventsstressfull life-events ↓↓↓↓↓↓

acute psychotic decompensation(s)acute psychotic decompensation(s)

↓↓↓↓↓↓ long-term evolutionlong-term evolution

↙↙↙↙↙↙ ↓↓↓↓↓↓ ↘↘↘↘↘↘ full recovery minor residuals severe chronicityfull recovery minor residuals severe chronicity

7

10

2. Basic concepts2. Basic concepts

Basic principle:Basic principle:

Do Do everything which lowers the emotional everything which lowers the emotional tension!tension!

Avoid everything which increases it!Avoid everything which increases it!

12

Eight basic therapeutic Eight basic therapeutic principlesprinciples

10

1.1. Small, open, „normal“ family-like settingSmall, open, „normal“ family-like setting

2.2. Relaxing therapeutic approachRelaxing therapeutic approach

3.3. Specially selected staffSpecially selected staff

4.4. Same information for patients, family, staffSame information for patients, family, staff

5.5. Therapeutic alliance with familyTherapeutic alliance with family

6.6. Elaboration of realistic goals and expectationsElaboration of realistic goals and expectations

7.7. Low medication strategiesLow medication strategies

8.8. Systematic post-care and relapse preventionSystematic post-care and relapse prevention

13

3. Practical realisation3. Practical realisation

26

29

Four phases of treatment

• Calming down (soft room)• Reinsertion into everyday reality• Reinsertion into external reality • Post-care

30

4. Results4. Results

31

global outcome = n.s. relapse rate = n.s.global outcome = n.s. relapse rate = n.s.

2-years global outcome and relapse-rates2-years global outcome and relapse-ratesfirst column = Soteria second column = controlsfirst column = Soteria second column = controls

blue = favorable blue = favorable lila = unfavorablelila = unfavorable

38

Soteria has neuroleptica-like effectsSoteria has neuroleptica-like effects

– – but without undesirable side-effects!but without undesirable side-effects!

39

5. Working hypothesis and open 5. Working hypothesis and open questionsquestions

★ Soteria acts by naturally induced sustained emotional relaxation

★ lack of long-term follow-ups

★ lack of large scale comparisions

★ lack of formal verifications of the working hypothesis

40

40

Further informationFurther information

www.ciompi.com

¡ Muchas gracias¡ Muchas gracias por su atenciòn ! por su atenciòn !