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	<description>Petra Pinder – Medical practitioner (limited to the field of psychotherapy), Dipl.-Ing. in Business Engineering</description>
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		<title>Cannabis and the MPU: legal limits, combined use with alcohol and lasting change</title>
		<link>https://psychotherapy-pinder.de/en/cannabis-and-mpu-threshold-levels-of-mixed-consumption-with-alcohol-and-verifiable-changes/</link>
		
		<dc:creator><![CDATA[PePi]]></dc:creator>
		<pubDate>Sat, 10 Oct 2026 10:26:19 +0000</pubDate>
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		<guid ispermalink="false">https://psychotherapy-pinder.de/?p=394</guid>

					<description><![CDATA[MPU knowledge · Cannabis Cannabis and the MPU: Thresholds, mixed consumption with alcohol and understandable change What the German legal situation means for cannabis while driving – and why convincing change involves more than an inconspicuous measurement value. By Petra Pinder, Praxis für Psychotherapie in Bad Schwalbach · Reading time: approximately 7 minutes Who, after a drive under the influence of cannabis, posts […]]]></description>
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</style><article class="mpu-article"><header class="mpu-hero"><div class="eyebrow">MPU knowledge · Cannabis</div><h1>Cannabis and the MPU: legal limits, combined use with alcohol and lasting change</h1><p>What the legal situation in Germany means for cannabis while driving – and why a convincing change involves more than just an inconspicuous measurement value.</p><div class="mpu-meta">By Petra Pinder, Praxis for Psychotherapy in Bad Schwalbach · Reading time: about 7 minutes</div></header>
<section class="mpu-section"><p class="mpu-lead">In Germany, the medical-psychological assessment is known as the MPU. If you receive a letter from the driving-licence authority after driving under the influence of cannabis, first clarify whether it concerns a traffic offence, doubts about your fitness to drive or an assessment that has already been ordered. These questions have different legal requirements.</p><p>This article explains the applicable legal framework and provides guidance for personal reflection. It applies to Germany. The specific regulatory question and the circumstances of the individual case remain crucial.</p><nav class="mpu-toc" aria-label="In this post"><h2>In this post</h2><ol><li><a href="#grenzwert">THC limit and ability to drive</a></li><li><a href="#mischkonsum">Cannabis and alcohol – even below 0.5‰ (0.05% BAC)</a></li><li><a href="#fahranfaenger">Probation period and under 21 years</a></li><li><a href="#mpu-anordnung">When may an MPU be required?</a></li><li><a href="#fahreignung">Misuse, dependence and abstinence</a></li><li><a href="#veraenderung">What constitutes a viable change</a></li><li><a href="#fragen">Frequently asked questions</a></li></ol></nav></section>
<section class="mpu-section cream" id="grenzwert"><h2>THC limit and ability to drive</h2><p>Section 24a(1a) of the German Road Traffic Act (StVG) applies to driving a motor vehicle with at least <strong>3.5 ng/ml of THC in the blood serum</strong>. It refers to THC, not the breakdown product THC-COOH. The limit value is not a personal guarantee of safe driving ability. <a href="https://www.gesetze-im-internet.de/stvg/BJNR004370909.html" target="_blank" rel="noopener">Section 24a of the StVG</a></p><p>Cannabis can impair attention, responsiveness, and the processing of traffic situations. How long this lasts cannot be reliably assessed from subjective feelings alone. Therefore, a generalized waiting period does not provide individual certainty. <a href="https://www.drugcom.de/haeufig-gestellte-fragen/fragen-zu-cannabis/beeintraechtigt-cannabis-die-fahrtauglichkeit/" target="_blank" rel="noopener">BIÖG/drugcom: fitness to drive</a></p><p>A person unable to drive safely because of alcohol or other intoxicating substances may commit an offence under section 316 of the German Criminal Code (StGB). Where a specific danger is caused, section 315c may apply. The requirements of each offence must be met. <a href="https://www.gesetze-im-internet.de/stgb/__316.html" target="_blank" rel="noopener">Section 316 of the Criminal Code</a>, <a href="https://www.gesetze-im-internet.de/stgb/__315c.html" target="_blank" rel="noopener">Section 315c of the StGB</a></p></section>
<section class="mpu-section" id="mischkonsum"><h2>Cannabis and alcohol – even below 0.5‰ (0.05% BAC)</h2><p><strong>Section 24a paragraph 2a of the StVG is linked to at least 3.5 ng/ml of THC in the blood serum.</strong> In addition, drinking alcohol while driving or starting the drive under the influence of alcohol is prohibited. This rule does not specify an additional threshold of 0.5 per mille.</p><div class="mpu-callout"><p><strong>Example for classification:</strong> With 4.0 ng/ml THC and a blood alcohol concentration of 0.2‰ (0.02% BAC), the combined-use offence may apply. Below 3.5 ng/ml THC, these facts alone do not establish that offence; section 24c and criminal provisions may still be relevant. These examples are an interpretation of the statute, not a decision on an individual case. <a href="https://www.gesetze-im-internet.de/stvg/BJNR004370909.html" target="_blank" rel="noopener">StVG</a></p></div><p>Medically, the combination is particularly unfavorable: Even small amounts of alcohol can amplify the impairment caused by cannabis. The „first drink, then smoke“ order or vice versa does not create a safe exception. Anyone who has consumed both should organize their journey differently. <a href="https://www.drugcom.de/newsuebersicht/topthemen/alkohol-und-cannabis-am-steuer-erhoehen-unfallgefahr/" target="_blank" rel="noopener">BIÖG/drugcom: Alcohol and cannabis behind the wheel</a></p><p>A measured blood alcohol level below 0.5 per mille thus does not answer the question of safe driving or all legal questions.</p></section>
<section class="mpu-section cream" id="fahranfaenger"><h2>Probation period and under 21 years</h2><p>Section 24c of the German Road Traffic Act applies <strong>during the probation period or before the 21st birthday</strong>. It prohibits the consumption of alcohol or THC while driving a motor vehicle, as well as driving under the influence of such substances. The general THC limit is not a clearance here. <a href="https://www.gesetze-im-internet.de/stvg/BJNR004370909.html" target="_blank" rel="noopener">Section 24c of the StVG</a></p><p>For properly taken, specifically prescribed medical cannabis, there are legal exceptions. However, these do not allow driving when driving ability is lacking. Changes to the treatment should be handled by a physician. <a href="https://www.gesetze-im-internet.de/stvg/BJNR004370909.html" target="_blank" rel="noopener">Section 24a paragraph 4 and Section 24c paragraph 3 of the StVG</a>, <a href="https://www.gesetze-im-internet.de/fev_2010/anlage_4.html" target="_blank" rel="noopener">Annex 4 FeV, No. 9.6</a></p></section>
<section class="mpu-section" id="mpu-anordnung"><h2>When may an MPU be required?</h2><p>Section 13a of the FeV distinguishes between several cases:</p><ul><li>In cases where there are indications of cannabis addiction, a medical assessment is first required.</li><li>An MPU is required where there are signs or other facts indicating cannabis misuse, repeated traffic offences under the influence of cannabis, a previous withdrawal of the driving licence on those grounds, or a need to establish whether misuse or dependence has ended.</li><li>Exclusive violations of § 24c StVG remain unconsidered in the case of a repeat offense under § 13a Sentence 1 Number 2, letter b.</li></ul><p>A first offence does not automatically require an MPU merely because it occurred. However, additional facts may indicate misuse even after a first incident. Combined use also requires consideration of the overall circumstances. <a href="https://www.gesetze-im-internet.de/fev_2010/__13a.html" target="_blank" rel="noopener">Section 13a of the FeV</a></p><p>The penalty decision and the question of longer-term driving fitness must be distinguished. In addition, if there is an additional alcohol problem, the rules of § 13 of the FeV may also apply. <a href="https://www.gesetze-im-internet.de/fev_2010/__13.html" target="_blank" rel="noopener">Section 13 of the FeV</a></p></section>
<section class="mpu-section cream" id="fahreignung"><h2>Misuse, dependence and abstinence</h2><p>Annex 4 of the German Driving Licence Regulation (FeV) distinguishes cannabis misuse from cannabis dependence. In driving-licence law, misuse particularly concerns inadequate separation between driving and cannabis use that may affect road safety. Misuse or dependence means a lack of fitness to drive.</p><p>After misuse has ended, fitness to drive may be restored if the change in cannabis use is stable. Following dependence, Annex 4 requires that dependence no longer exists and that, as a rule, one year of abstinence has been demonstrated. <a href="https://www.gesetze-im-internet.de/fev_2010/anlage_4.html" target="_blank" rel="noopener">Annex 4 FeV, No. 9.2.1–9.2.4</a></p><p>There is no single required evidence period for all cannabis cases. Before starting a monitoring programme, clarify with a qualified assessment centre which evidence is required and recognised in your procedure. A private consumption diary or an online course attendance certificate does not replace any required forensic evidence of abstinence.</p></section>
<section class="mpu-section" id="veraenderung"><h2>What constitutes a viable change</h2><p>When reflecting on past behaviour, consider the details: When did you use cannabis? What role did stress, sleep, habits or your social environment play? How did you end up driving afterwards? What has actually changed in everyday life since then?</p><p>A sustainable plan identifies concrete alternatives: arrange a safe journey home before using cannabis, hand over your keys, manage cravings, recognise risky situations and seek support. The changes need to fit your own history and be practised repeatedly. Rehearsed answers cannot replace this work.</p><p>Anyone who wants to reduce or stop consumption will find it in <a href="https://psychotherapy-pinder.de/en/understanding-addiction-and-dependence-what-happens-in-the-brain-and-why-relapses-are-not-a-failure-of-willpower/#digitale-selbsthilfe">addiction knowledge article: information on digital self-help</a>These resources can provide additional support; they guarantee neither abstinence nor a positive MPU outcome.</p><p>In my practice, we can look at consumption patterns, burdens, and everyday changes together. Information on general preparation can be found in <a href="https://psychotherapy-pinder.de/en/mpu-preparation-what-really-counts-and-why-rote-learned-answers-do-not-convince/">Articles on MPU preparation</a>. For a personal inquiry, please use the <a href="https://psychotherapy-pinder.de/en/contact-2/">contact page</a>.</p></section>
<section class="mpu-section cream mpu-faq" id="fragen"><h2>Frequently asked questions</h2><details><summary>Does „I feel sober“ mean that I can drive?</summary><p>Our own judgment does not replace a reliable assessment of driving ability or the legal examination. If you are unsure, arrange for another means of transport.</p></details><details><summary>Does every person who consumes cannabis have to prove a year of abstinence?</summary><p>No. The standard case of one year mentioned in Appendix 4 concerns the restoration of fitness after dependency. An individual clarification is required.</p></details><details><summary>Is an online program also MPU preparation?</summary><p>The name of a programme does not establish this. Support for changing cannabis use, treatment, MPU preparation and recognised abstinence monitoring serve different purposes.</p></details></section>
<section class="mpu-section"><h2>Sources and timeliness</h2><p class="mpu-note">Status of the source review: October 10, 2026. The basis are the official legal texts linked above and information from the Federal Institute for Public Health. General information; an individual legal review is advisable in the case of a specific decision.</p></section></article>]]></content:encoded>
					
		
		
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		<title>Understanding addiction and dependency: What happens in the brain and why relapses are not a failure of willpower</title>
		<link>https://psychotherapy-pinder.de/en/understanding-addiction-and-dependence-what-happens-in-the-brain-and-why-relapses-are-not-a-failure-of-willpower/</link>
		
		<dc:creator><![CDATA[PePi]]></dc:creator>
		<pubDate>Tue, 22 Sep 2026 11:30:55 +0000</pubDate>
				<category><![CDATA[Uncategorized]]></category>
		<guid ispermalink="false">https://psychotherapy-pinder.de/?p=305</guid>

					<description><![CDATA[Addiction and dependence Understanding addiction and dependence: What happens in the brain and why relapses are not a lack of willpower Addiction does not simply arise from a lack of discipline; it develops in a complex interplay of learning experiences, changes in the reward and stress system, personal stressors, genetic predisposition, and the social environment. By Petra Pinder, Praxis für Psychotherapie in Bad Schwalbach · Estimated […]]]></description>
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</style><article class="sucht-article"><header class="sucht-hero"><div class="eyebrow">Addiction and dependency</div><h1>Understanding addiction and dependency: What happens in the brain and why relapses are not a failure of willpower</h1><p>Addiction doesn't simply arise from a lack of discipline. It develops through an interplay of learning experiences, changes in the reward and stress systems, personal burdens, genetic predisposition, and social environment.</p><div class="sucht-meta">From <a style="color:inherit;text-decoration:underline" href="https://psychotherapy-pinder.de/en/about-me/">Petra Pinder</a>, Psychotherapy Practice in Bad Schwalbach · Estimated reading time: about 13 minutes</div></header><section class="sucht-section"><p class="sucht-lead">Addiction does not simply arise from a lack of discipline. It develops through an interplay of learning experiences, changes in the reward and stress systems, personal burdens, genetic predisposition, and the social environment. In the process, the brain can adapt to a substance or a behaviour in such a way that the craving takes up more and more space, even though the negative consequences have long been known.</p><p>The term addiction memory describes an important part of this process. This does not refer to a single storage location in the brain. Rather, effects, feelings, situations and stimuli are linked together. Places, people, times of day, smells, music or internal states can later trigger craving. This explains why the desire can suddenly reappear even after a long period of abstinence. It also explains why relapse prevention involves more than just a firm resolution.</p></section><section class="sucht-section sucht-toc" id="in-diesem-beitrag"><h2>In this post</h2><ol><li><a href="#wann-wird-konsum-oder-verhalten-zur-abhaengigkeit">When does consumption or behaviour turn into an addiction?</a></li><li><a href="#stoffgebundene-und-stoffungebundene-abhaengigkeiten">Substance-related and behavioural addictions</a></li><li><a href="#was-geschieht-im-belohnungssystem">What happens in the reward system?</a></li><li><a href="#was-ist-das-suchtgedaechtnis">What is addiction memory?</a></li><li><a href="#welche-botenstoffe-sind-beteiligt">Which neurotransmitters are involved?</a></li><li><a href="#warum-entstehen-toleranz-entzug-und-suchtdruck">Why do tolerance, withdrawal and craving occur?</a></li><li><a href="#welche-rolle-spielen-stress-trauma-und-psychische-belastungen">What role do stress, trauma and psychological strain play?</a></li><li><a href="#warum-koennen-rueckfaelle-auch-nach-langer-zeit-auftreten">Why can relapses occur even after a long time?</a></li><li><a href="#was-kann-behandlung-leisten">What can treatment achieve?</a></li><li><a href="#digitale-selbsthilfe">Digital self-help: additional support</a></li><li><a href="#wann-ist-medizinische-hilfe-dringend-erforderlich">When is medical help urgently required?</a></li></ol></section><section class="sucht-section cream" id="wann-wird-konsum-oder-verhalten-zur-abhaengigkeit"><h2>When does consumption or behaviour turn into an addiction?</h2><p>Not every type of consumption and not every intensive behaviour is an addiction. The overall picture is what counts. Warning signs can include a progressive loss of control, the substance or behaviour becoming increasingly important and being continued despite recognisable harm. Additional factors may include strong cravings, unsuccessful attempts to cut down, neglect of other areas of life, development of tolerance and withdrawal symptoms.</p><p>There are many gradations between inconspicuous use and severe dependence. Even risky or harmful consumption can already have significant consequences without all the characteristics of a dependence being met. A diagnosis therefore cannot be made on the basis of a single symptom. It requires a careful professional medical history.</p></section><section class="sucht-section" id="stoffgebundene-und-stoffungebundene-abhaengigkeiten"><h2>Substance-related and behavioural addictions</h2><p>Substance-related addictions centre on a psychoactive substance. These include alcohol, nicotine, cannabis, opioids, cocaine, amphetamines, and sedatives and sleeping pills, among others. The substances act on different receptors and neurotransmitter systems. Nevertheless, similar core processes can develop: intensified learning processes, craving, loss of control, habit formation, and an increasing restriction of life to consumption and recovery from consumption.</p><p>In behavioural addictions, no psychoactive substance is consumed. The World Health Organization lists gambling disorder and gaming disorder in the ICD-11 as disorders due to addictive behaviours. Other behaviours, such as problematic use of social media, shopping or sexual activities, can also cause considerable distress. However, they are not automatically diagnostically equivalent to a recognised addiction. The decisive factors are loss of control, shift in priority, continuation despite negative consequences and significant impairment in daily life.</p><p>Further information on digital behavioural patterns can be found in the article <a href="https://psychotherapy-pinder.de/en/problematic-media-use-warning-signs-help/">Problematic media use: warning signs and help</a>.</p></section><section class="sucht-section cream" id="was-geschieht-im-belohnungssystem"><h2>What happens in the reward system?</h2><p>The reward system helps us to recognise meaningful experiences and repeat helpful behaviour. Involved in this, among other things, are the ventral tegmentum, the nucleus accumbens and areas of the prefrontal cortex. These regions work together with memory, emotion and stress systems.</p><p>Dopamine is often referred to simply as the happy hormone. Scientifically, this description is too simplistic. Dopamine plays a vital role in giving significance to a stimulus, updating expectations and reinforcing behaviour. Therefore, it supports learning and wanting rather than exclusively enjoyment.</p><p>Addictive substances can influence these learning processes particularly strongly. Gambling and certain digital services also use rapid, shifting and hard-to-predict rewards. Over time, the brain can weight addiction-related stimuli more heavily than other goals. At the same time, ordinary rewards, such as social encounters, exercise or everyday successes, lose their effect for some sufferers.</p></section><section class="sucht-section" id="was-ist-das-suchtgedaechtnis"><h2>What is addiction memory?</h2><p>During consumption or addictive behaviour, the brain does not just store the immediate effect. It also learns which stimuli herald this effect. These can be a specific environment, a person, a bank balance, a notification on a smartphone, a time of day or a stressful feeling.</p><p>The hippocampus is involved in context and memory. The amygdala links experiences with emotional significance. Striatal networks support habits and automated action sequences. The insular cortex processes signals from the body and may be involved in the conscious experience of craving. The prefrontal cortex is important for planning, balancing and inhibition. Addiction memory therefore describes a network of learned connections rather than a single location.</p><p>If a former trigger reappears, the learned pattern can be activated very quickly. The body may then react even before a conscious decision has been made. This does not mean that behaviour is unchangeable. However, it does mean that new reactions must be practised repeatedly in various everyday situations.</p><p>Erasing old connections is usually not the right metaphor. During unlearning, a new, competing experience is created instead. Old reactions can reappear under stress, after renewed use or in a previous environment. Relapse prevention therefore takes into account specific triggers, high-risk situations and a plan for dealing with acute cravings.</p></section><section class="sucht-section cream" id="welche-botenstoffe-sind-beteiligt"><h2>Which neurotransmitters are involved?</h2><p>Addiction cannot be reduced to a single messenger substance. Several systems work together:</p><ul><li><strong>Dopamine</strong> is involved in reinforcement, motivation, expectation, and the special significance of addiction-related cues.</li><li><strong>Glutamate</strong> is an important excitatory neurotransmitter and plays a central role in learning, memory and neuronal adaptation.</li><li><strong>GABA</strong> is the most important inhibitory neurotransmitter in the brain. Alcohol and benzodiazepines affect this system. In the case of physical dependence, sudden withdrawal can trigger dangerous hyperexcitability and seizures.</li><li><strong>endogenous opioids</strong> are involved in reward, pain relief and well-being. Opioids intervene particularly strongly in this system.</li><li><strong>Serotonin and noradrenaline</strong> contribute to mood, impulse control, attention and stress management, amongst other things.</li><li><strong>The endocannabinoid system</strong> regulates various processes such as stress, appetite, memory and reward processing. Cannabis interferes with this system.</li><li><strong>stress neurotransmitters such as CRF and dynorphin</strong> gain importance with repeated use. They contribute to tension, dysphoria and use for relief.</li></ul><p>Which changes occur depends on the substance, the duration and intensity of use, age and individual vulnerability. Neuroscientific models therefore describe networks and developmental processes, not a simple chemical cause.</p></section><section class="sucht-section" id="warum-entstehen-toleranz-entzug-und-suchtdruck"><h2>Why do tolerance, withdrawal and craving occur?</h2><p>The brain tries to compensate for repeated strong effects. This can lead to tolerance: a larger amount or more intensive use is required for the same effect. If the substance is withheld, withdrawal symptoms can occur.</p><p>Initially, consumption often occurs to experience a positive effect. Later, the motive may shift. Consumption then increasingly serves to reduce restlessness, emptiness, irritability, sleep problems or physical withdrawal symptoms. In professional terminology, this is referred to as negative reinforcement: the focus is no longer on the pleasant experience, but on the temporary cessation of an unpleasant state.</p><p>The well-known three-stage model of addiction describes a recurring cycle of intoxication or excessive behavior, withdrawal with negative affect, and preoccupation and anticipation. The systems involved in reward, stress, and self-regulation undergo reciprocal changes.</p></section><section class="sucht-section cream" id="welche-rolle-spielen-stress-trauma-und-psychische-belastungen"><h2>What role do stress, trauma and psychological strain play?</h2><p>Addiction rarely has just one cause. Genetic influences, early learning experiences, availability, social environment, chronic stress and mental health conditions can influence the risk. Substances or behaviours are sometimes used to briefly dampen anxiety, inner restlessness, loneliness, distressing memories or sleep problems. The relief is real, but usually only temporary. In the long term, this very effect can solidify the problematic pattern.</p><p>Traumatic experiences are neither present in all affected individuals nor do they explain every addiction. However, if unprocessed stress helps trigger craving, integrated treatment is advisable. Initially, safety, stabilisation and the management of consumption risks are the main priorities. EMDR can be used complementarily, where indicated appropriately, to process trauma-related stress. It does not replace addiction-medical diagnostics, necessary withdrawal treatment, or comprehensive treatment for the addiction.</p><p>You can find out more about the method in the article <a href="https://psychotherapy-pinder.de/en/emdr-therapy-procedure-application-areas/">EMDR Therapy: Procedure and Areas of Application</a>.</p></section><section class="sucht-section" id="warum-koennen-rueckfaelle-auch-nach-langer-zeit-auftreten"><h2>Why can relapses occur even after a long time?</h2><p>Relapses are not inevitable, but they are a known part of the risk trajectory of many addictive disorders. Previous triggers can cause drug craving, especially during stress, sleep deprivation, conflicts, positive excitement or renewed contact with the substance. A large meta-analysis showed that reactions to addiction-related cues and reported craving are associated with subsequent use and relapses.</p><p>A relapse does not mean that the entire treatment was ineffective. However, it should be taken seriously and carefully evaluated. Helpful questions are: What happened beforehand? Which warning signs were missed? What support was lacking? What needs to be changed in the emergency plan? This attitude avoids shame without trivialising the risk.</p></section><section class="sucht-section cream" id="was-kann-behandlung-leisten"><h2>What can treatment achieve?</h2><p>Good treatment is based on the type and severity of the addiction, any co-existing conditions, physical risks and the goals of the individual concerned. Depending on the situation, the following components may be useful:</p><ul><li>medical diagnostics and, where appropriate, professionally supervised detoxification</li><li>Motivational work and clarification of personal goals</li><li>cognitive behavioural therapy and relapse prevention</li><li>Identifying triggers and practising alternative responses</li><li>Treatment of anxiety, depression, trauma or other co-morbidities</li><li>medication-assisted treatment, if recommended for the respective dependency</li><li>Self-help groups, advisory centres and support from family members</li><li>Establishing a daily routine, relationships, physical activity and reliable positive experiences</li></ul><p>For opioid dependence, medication-assisted treatment can be lifesaving. For alcohol, nicotine, and other dependencies, effective medications and psychotherapeutic methods are also available, depending on the diagnosis. The selection belongs in the hands of a doctor or addiction medicine specialist.</p><p>In my practice, I combine my training in addiction counselling with psychotherapeutic work. This is not just about counting consumption or setting rules. Together, we examine the function, triggers, cravings, previous attempts to change and psychological distress. A prerequisite is the active cooperation of the individual concerned. Which treatment is suitable and whether additional medical or inpatient support is required can only be assessed after a detailed anamnesis.</p><p>If an addiction is related to a driving licence issue, you can find supplementary information in the article <a href="https://psychotherapy-pinder.de/en/mpu-preparation-what-really-counts-and-why-rote-learned-answers-do-not-convince/">MPU Preparation: What Really Matters</a>.</p></section><section class="sucht-section cream" id="digitale-selbsthilfe"><h2>Digital self-help: additional support</h2><p>A cannabis-use diary, exercises for managing cravings and structured online counselling can help you recognise your patterns and practise concrete changes in everyday life. These resources should suit your personal circumstances. They do not replace necessary medical treatment, medically supervised withdrawal or an individual diagnostic assessment.</p><h3>Free support for reducing or stopping cannabis use</h3><p><a href="https://www.quit-the-shit.net/" rel="noopener" target="_blank">Quit the Shit</a> is a free, anonymous German-language information and counselling service for people who want to reduce or stop using cannabis. The programme includes a four-week cannabis-use diary with individual support. Its website explains participation and privacy.</p><h3>What to look for in other online programmes</h3><p>Check the provider’s qualifications, evidence supporting effectiveness claims, privacy information, total costs, any subscriptions and cancellation terms. A course attendance certificate is not recognised evidence of abstinence for a German medical-psychological driving assessment (MPU). Promises of a guaranteed cure or a guaranteed positive MPU outcome are not a sound basis for choosing a programme.</p><div class="sucht-callout"><p><strong>Further online resources on cannabis consumption</strong></p><p><span aria-disabled="true">Currently not available.</span></p></div><p>If you are unsure whether self-help is sufficient or whether professional support is needed, a personal consultation can clarify the next step.</p><p class="sucht-note">Source for the mentioned program: <a href="https://www.quit-the-shit.net/" target="_blank" rel="noopener">Quit the Shit</a>, reviewed on October 10, 2026.</p></section><section class="sucht-section" id="wann-ist-medizinische-hilfe-dringend-erforderlich"><h2>When is medical help urgently required?</h2><p>Abrupt withdrawal from alcohol or benzodiazepines can be life-threatening. Possible consequences include severe circulatory problems, seizures or delirium. Immediate medical help is also required in cases of opioids, poly-substance use, pregnancy, severe physical illness, psychotic symptoms, impaired consciousness or suicidal thoughts.</p><p>In the event of acute danger, call the emergency services on 112. Planned withdrawal should be medically evaluated and, depending on the risk, accompanied on an outpatient or inpatient basis. This article is not a substitute for medical diagnostics and does not constitute an individual treatment recommendation.</p></section><section class="sucht-section cream" id="haeufige-fragen"><h2>Frequently asked questions</h2><h3>Is addiction an illness or a choice?</h3><p>The onset of substance use or behaviour can involve decision-making. As dependency increases, learned responses, cravings and control processes alter the scope for decision-making. Professionally, dependency is understood as a treatable health disorder, not a moral failure. Responsibility and compassion are not mutually exclusive in this context.</p><h3>Does the addiction memory remain forever?</h3><p>Learned associations can persist for a very long time. However, they do not mean that relapses are inevitable. New experiences, changed routines, treatment and a good support network can significantly improve how triggers are managed.</p><h3>Are behavioural addictions just as real?</h3><p>Yes. Gambling disorder and gaming disorder are recognised in the ICD-11 as disorders due to addictive behaviours. In the case of other problematic behaviours, it must be carefully examined which diagnosis and which treatment are professionally appropriate.</p><h3>Does dopamine fasting help with addiction?</h3><p>The term is scientifically misleading. Dopamine cannot be reset through temporary abstinence. It can be useful to interrupt specific triggers and automated habits. However, an addiction requires individual and professionally justified treatment.</p><h3>Can EMDR help with cravings?</h3><p>EMDR can be a useful adjunct if trauma-related memories or distressing experiences help trigger cravings. Whether the method is suitable must be assessed on an individual basis. It is not a substitute for medical treatment or comprehensive addiction therapy.</p></section><section class="sucht-section sucht-sources" id="wissenschaftliche-quellen-und-weiterfuehrende-informationen"><h2>Scientific sources and further information</h2><ol><li><a href="https://nida.nih.gov/publications/drugs-brains-behavior-science-addiction" target="_blank" rel="noopener">National Institute on Drug Abuse: Drugs, Brains, and Behavior, The Science of Addiction</a></li><li><a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC6135092/" target="_blank" rel="noopener">Koob and Volkow: Neurobiology of addiction, a neurocircuitry analysis, The Lancet Psychiatry 2016</a></li><li><a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC6135257/" target="_blank" rel="noopener">Volkow, Koob and McLellan: Neurobiologic Advances from the Brain Disease Model of Addiction, New England Journal of Medicine 2016</a></li><li><a href="https://www.who.int/standards/classifications/frequently-asked-questions/gaming-disorder" target="_blank" rel="noopener">World Health Organization: Gaming disorder in the ICD 11</a></li><li><a href="https://www.who.int/news-room/fact-sheets/detail/gambling" target="_blank" rel="noopener">World Health Organization: Gambling, fact sheet</a></li><li><a href="https://register.awmf.org/assets/guidelines/076-001l_S3-Screening-Diagnose-Behandlung-alkoholbezogene-Stoerungen_2025-01-verlaengert.pdf" target="_blank" rel="noopener">AWMF: S3 Guideline on alcohol-related disorders</a></li><li><a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC9161117/" target="_blank" rel="noopener">Vafaie and Kober: Association of Drug Cues and Craving With Drug Use and Relapse, systematic review and meta-analysis 2022</a></li><li><a href="https://nida.nih.gov/sites/default/files/podat-3rdEd-508.pdf" target="_blank" rel="noopener">National Institute on Drug Abuse: Principles of Drug Addiction Treatment</a></li></ol><p><strong>As of September 2026.</strong> This post is for general information purposes only. It is not a substitute for personal medical, psychiatric or psychotherapeutic diagnosis and does not constitute an individual treatment recommendation.</p></section></article>
<section class="pp-related" aria-label="Relevant articles and support" style="box-sizing:border-box;width:100%;max-width:900px;margin:0 auto;padding:48px 24px;color:#243447;font-family:Arial,sans-serif;font-size:18px;line-height:1.7"><h2 style="font-family:Arial,sans-serif;font-size:clamp(26px,4vw,36px);line-height:1.2">Relevant articles and support</h2><ul style="padding-left:22px"><li style="margin:10px 0"><a style="color:#1d5d82;text-decoration:underline;overflow-wrap:anywhere" href="https://psychotherapy-pinder.de/en/problematic-media-use-warning-signs-help/">Recognising problematic media use</a></li><li style="margin:10px 0"><a style="color:#1d5d82;text-decoration:underline;overflow-wrap:anywhere" href="https://psychotherapy-pinder.de/en/mpu-preparation-what-really-counts-and-why-rote-learned-answers-do-not-convince/">MPU preparation: What really matters</a></li><li style="margin:10px 0"><a style="color:#1d5d82;text-decoration:underline;overflow-wrap:anywhere" href="https://psychotherapy-pinder.de/en/emdr-therapy-procedure-application-areas/">EMDR: Procedure and areas of application</a></li></ul><p>Information about <a style="color:#1d5d82;text-decoration:underline" href="https://psychotherapy-pinder.de/en/services/">Working methods, services and framework of the private practice in Bad Schwalbach</a> and further topics in the <a style="color:#1d5d82;text-decoration:underline" href="https://psychotherapy-pinder.de/en/know/">Knowledge overview</a>.</p></section>]]></content:encoded>
					
		
		
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		<title>MPU preparation: What really matters and why memorised answers do not convince</title>
		<link>https://psychotherapy-pinder.de/en/mpu-preparation-what-really-counts-and-why-rote-learned-answers-do-not-convince/</link>
		
		<dc:creator><![CDATA[PePi]]></dc:creator>
		<pubDate>Tue, 22 Sep 2026 11:01:54 +0000</pubDate>
				<category><![CDATA[Uncategorized]]></category>
		<guid ispermalink="false">https://psychotherapy-pinder.de/?p=300</guid>

					<description><![CDATA[MPU Knowledge and Preparation MPU Preparation: What really matters and why memorized answers do not convince An MPU is not a knowledge test. What matters is whether you have understood your previous behavior, changed it credibly, and developed viable solutions for critical situations. Professional article by Petra Pinder · Reading time approximately 12 minutes Many people start their preparation by reading the MPU material […]]]></description>
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<header class="mpu-hero"><div class="eyebrow">MPU Knowledge and Preparation</div><h1>MPU preparation: What really matters and why memorised answers do not convince</h1><p>An MPU is not a test of knowledge. What is crucial is whether you have understood your past behaviour, changed credibly and developed viable solutions for critical situations.</p><div class="mpu-meta">Feature article by Petra Pinder · Reading time approx. 12 minutes</div></header>
<section class="mpu-section"><p class="mpu-lead">Many people begin their preparation by searching for typical questions and the most convincing answers possible. That is understandable, but it misses the core of the medical-psychological assessment. The assessor does not want to hear what sounds right. It is about whether your change has become personal, comprehensible and stable in everyday life.</p><div class="mpu-callout"><strong>In short:</strong> It is not perfect phrasing that is convincing, but an honest connection between your background, your insight, the changes already implemented, and your plan for the future.</div><nav class="mpu-toc" aria-label="Table of contents"><strong>In this post</strong><ol><li><a href="#was-ist-mpu">What is assessed during an MPU?</a></li><li><a href="#zahlen">How many MPU assessments are there?</a></li><li><a href="#cannabis">What has changed regarding cannabis?</a></li><li><a href="#abstinenz">When is proof of abstinence required?</a></li><li><a href="#vorbereitung">What makes for good preparation?</a></li><li><a href="#auswendiglernen">Why is rote learning not enough?</a></li><li><a href="#therapie">When craving has deeper causes</a></li></ol></nav></section>
<section class="mpu-section cream" id="was-ist-mpu"><div class="eyebrow">Mission and goal</div><h2>What is assessed during an MPU?</h2><p>The driving licence authority formulates a specific question regarding driving aptitude. The reason for this can be alcohol, cannabis, other drugs, medication, repeated traffic offences, criminal offences or health reasons. The assessment generally consists of a medical examination, a performance test and a psychological interview.</p><p>The focus is on the prognosis: can it be expected in future that you will act responsibly and not commit a similar offence again? In the case of alcohol, cannabis and other psychoactive substances, the Driving Licence Ordinance (Fahrerlaubnis-Verordnung) requires a fundamental change in attitude. In addition, conditions must be in place that make a relapse unlikely.</p><div class="mpu-grid"><div class="mpu-card"><h3>Understanding the past</h3><p>How did the problematic behaviour come about? What personal and external conditions played a role?</p></div><div class="mpu-card"><h3>Demonstrate the changes you have made</h3><p>What have you changed specifically? Since when has the change been stable and how does it manifest in everyday life?</p></div><div class="mpu-card"><h3>Identify risks</h3><p>Which situations could still become critical today? How do you notice warning signs early on?</p></div><div class="mpu-card"><h3>Secure the future</h3><p>What strategies, contacts and decisions protect you from a relapse or reoffending?</p></div></div></section>
<section class="mpu-section" id="zahlen"><div class="eyebrow">Current developments</div><h2>How many MPU assessments are there?</h2><p>The number of tests carried out has not increased recently, but rather decreased. The published figures from the Federal Highway Research Institute show a decline over three years.</p><div class="mpu-grid"><div class="mpu-card"><div class="mpu-stat">87.180</div><p>Investigations in 2022</p></div><div class="mpu-card"><div class="mpu-stat">82.261</div><p>Investigations in 2023</p></div><div class="mpu-card"><div class="mpu-stat">75.257</div><p>Investigations in 2024</p></div><div class="mpu-card"><div class="mpu-stat">57 percent</div><p>were assessed as suitable in 2024. Around 39 per cent were considered unsuitable, and about 4 per cent received a recommendation for a course.</p></div></div><p>In 2024, alcohol was the most common reason at around 43 percent. Drugs and medication accounted for about 25 percent. In 2023, this proportion was still approximately 33 percent. However, the figures alone do not reveal why fewer assessments were carried out. They record the assessments that took place, not all official orders or all the people still waiting for an appointment.</p></section>
<section class="mpu-section cream" id="cannabis"><div class="eyebrow">Legal situation since 2024</div><h2>Cannabis partial legalisation: More MPUs or new differentiation?</h2><p>The partial legalisation of cannabis in April 2024 has not resulted in every instance of cannabis consumption automatically triggering a medical-psychological assessment (MPU). Since August 2024, Section 13a of the Driving Licence Ordinance (Fahrerlaubnis-Verordnung) separately regulates the assessment in cases involving cannabis-related issues.</p><p>An MPU is particularly considered if there are signs of cannabis abuse, traffic regulations have been repeatedly violated under the influence of cannabis, the driving licence has already been revoked for this reason, or it needs to be clarified whether abuse or dependence no longer exists. In cases of facts that suggest cannabis dependence, a medical report is ordered first.</p><div class="mpu-callout"><strong>Important:</strong> Legal consumption does not automatically mean fitness to drive. The crucial factor remains whether consumption and driving are reliably separated and whether any effect relevant to road safety can be ruled out.</div><p>The statistics for 2024 show an overall decrease in MPU assessments and a significant drop in the proportion involving drugs and medication. Whether and to what extent this is due to the new cannabis regulations cannot be reliably deduced from a single reporting year. Reliable conclusions require further years and a more detailed analysis of the referral categories.</p></section>
<section class="mpu-section" id="abstinenz"><div class="eyebrow">Planning evidence correctly</div><h2>When is proof of abstinence required and for how long?</h2><p>Not every medical-psychological assessment (MPU) for alcohol or cannabis automatically requires abstinence. In the case of a previous dependency, there must be stable abstinence. Following dependency on alcohol, cannabis, or other psychoactive substances, the driving licence ordinance generally specifies one year of proven abstinence.</p><p>In cases of misuse without dependence, depending on the situation, a permanent change in consumption habits and a reliable separation of consumption and driving can be decisive. Whether controlled consumption is professionally justifiable or abstinence is required must therefore be clarified individually and as early as possible.</p><table class="mpu-table"><thead><tr><th>Period</th><th>urine tests according to standard programmes</th><th>Important notice</th></tr></thead><tbody><tr><td>6 months</td><td>at least 4 checks</td><td>Not sufficient for every background</td></tr><tr><td>12 months</td><td>at least 6 checks</td><td>Usually required in cases of previous dependency</td></tr><tr><td>15 months</td><td>at least 7 controls</td><td>May be necessary depending on the case and progress</td></tr></tbody></table><p>Alternatively, suitable hair analyses can cover past periods. For alcohol, a maximum of 3 centimetres of head hair and thus approximately 3 months are taken into account. For drugs, a maximum of 6 centimetres and thus roughly 6 months are possible. Cosmetic treatments, hair length, previous periods of use and potential contamination must be taken into account.</p><div class="mpu-callout"><strong>Please do not start on your own accord:</strong> Duration, procedure and laboratory must match your question. Only evidence from appropriately qualified bodies under the prescribed conditions will be accepted. A routine examination at the treating general practitioner's surgery is not automatically sufficient.</div></section>
<section class="mpu-section cream" id="vorbereitung"><div class="eyebrow">Credible change</div><h2>What makes a good MPU preparation?</h2><ol class="mpu-steps"><li><strong>Clarify the issue and the case file.</strong><br>The preparation is based on the actual occasion, the official documents and your personal history.</li><li><strong>To honestly reconstruct one's own behaviour.</strong><br>Consumption, traffic offences and previous decisions are neither played down nor sensationalised. Gaps and contradictions are clarified.</li><li><strong>Understanding function and causes.</strong><br>What role did stress, social situations, habits, feeling overwhelmed, cravings or distressing experiences play?</li><li><strong>Take responsibility.</strong><br>Credible insight means more than regret. It is shown by acknowledging risks and not merely explaining one's own decisions by external circumstances.</li><li><strong>Implementing changes in daily life.</strong><br>New rules, a changed approach to substances, support, therapy or a new daily routine must be put into practice.</li><li><strong>Develop relapse prevention.</strong><br>You should know your warning signs and be able to name concrete steps that you actually use in the event of cravings or critical situations.</li><li><strong>Organise proofs in good time.</strong><br>If abstinence needs to be proven, the time period and approved monitoring procedure should be clarified early on.</li></ol><p class="mpu-quote">Good preparation doesn't take your story away from you. It helps you to understand it and to rewrite it differently for the long term.</p><h3>Preparation requires your active participation</h3><p>A reputable MPU consultation is not a service where ready-made answers are provided and simply practiced. It requires openness, self-observation and the willingness to implement agreed steps in everyday life. The collaborative work can provide guidance, structure and professional feedback. However, credible change comes about through your own contribution.</p><h3>Why good preparation can pay off</h3><p>An MPU can fundamentally be passed even without professional preparation. However, according to TÜV SÜD, the chances of success vary greatly. Consequently, only about 10 to 15 per cent of unprepared participants pass. With professional preparation, success rates of about 85 to 95 per cent are reported. Accordingly, the rate of a negative result mentioned there after professional preparation is approximately 5 to 15 per cent.</p><p>These figures are no guarantee of personal success. However, they make clear just how important an early and professionally sound engagement with one's own history can be.</p><p>Failing an MPU doesn't just cost money. It can also significantly lengthen the path back to a driver's licence. Additional expenses frequently arise for another assessment, renewed preparation and possibly extended proof of abstinence. Therefore, it can make more sense to first carefully clarify what needs to be addressed and proven in the individual case before booking an MPU appointment.</p><p>Good preparation is not about rehearsing appropriate answers. It helps to understand the causes of past behaviour, to implement changes credibly and only to undergo an assessment when the prerequisites are genuinely met.</p></section>
<section class="mpu-section" id="auswendiglernen"><div class="eyebrow">No exam with model solution</div><h2>Why learnt-by-heart answers do not convince</h2><p>In the psychological interview, connections, developments and concrete situations are asked about. Standard answers frequently remain general. When follow-up questions are asked, inconsistencies arise because personal experiences, chronological sequences and actual changes do not fit together.</p><div class="mpu-grid"><div class="mpu-card"><h3>Learnt by heart</h3><p>„I've realised my mistake and I'll never do it again.“</p></div><div class="mpu-card"><h3>Understandable</h3><p>You can explain what you overlooked back then, how your assessment has changed, what concrete steps you have been taking since then, and how you react to a warning sign today.</p></div></div><p>It is not a matter of speaking particularly skilfully. Nervousness is not counter-evidence either. What is crucial is whether your statements fit your life story, your evidence and your current behaviour.</p></section>
<section class="mpu-section cream" id="therapie"><div class="eyebrow">Counselling and therapeutic support</div><h2>When craving has deeper causes</h2><p>Consumption can temporarily serve a function. It can soothe, dampen unpleasant feelings, keep memories at bay, or provide a short-term sense of control. When the urge to use is closely linked to traumatic experiences, losses, overwhelm, or other heavy burdens, a purely formal drink-drive medical (MPU) preparation is sometimes not enough.</p><p>Through my training in addiction counselling and MPU counselling, as well as my therapeutic work, I am able to combine both levels. Depending on your personal starting point, the support can include elements of MPU preparation, coaching and therapeutic work. Together, we work on the requirements of the MPU and, if it makes sense and is desired, also on the emotional triggers behind the behaviour.</p><h3>EMDR for stress-induced craving</h3><p>When craving is intensified by distressing memories, intense inner tension, or traumatic experiences, EMDR can, in suitable cases, support therapeutic work. The aim is not simply to make the craving go away. Rather, the underlying distress can be processed and automatic response patterns can be better understood and altered.</p><p>EMDR neither replaces the required proof of abstinence nor the examination of driving behaviour. However, it can be a useful therapeutic component if unprocessed stress increases craving or relapse risks. You can find out more about this in the linked article <a href="https://psychotherapy-pinder.de/en/emdr-therapy-procedure-application-areas/"><strong>EMDR Therapy: Process, Fields of Application and Potential Support for Distressing Triggers</strong></a>.</p><div class="mpu-callout"><strong>Important for working together:</strong> I can support you professionally, provide an honest reflection, and develop viable strategies with you. Nobody can guarantee a positive MPU. The prerequisite is your willingness to actively cooperate and actually live out changes.</div></section>
<section class="mpu-section mpu-faq"><div class="eyebrow">Frequently asked questions</div><h2>Briefly answered</h2><details><summary>Do I have to live abstinently for every alcohol MPU?</summary><p>No. Whether abstinence is required depends on the history and the diagnostic classification. In cases of past dependency, stable abstinence is demanded. In other cases, a consolidated change in drinking behaviour with reliable separation of consumption and driving may be sufficient.</p></details><details><summary>Does a first offence of driving under the influence of cannabis automatically lead to a medical-psychological assessment (MPU)?</summary><p>Not in every case. Section 13a of the Driving Licence Ordinance (Fahrerlaubnis-Verordnung) sets out specific prerequisites, such as signs of abuse, repeated offences or a previous revocation for corresponding reasons. The specific decision is made by the driving licensing authority.</p></details><details><summary>Can I prepare using a list of questions?</summary><p>A question catalogue can bring topics to light, but it does not replace personal processing. What is decisive are your own connections, your lived changes and robust relapse prevention.</p></details><details><summary>When should I start preparing?</summary><p>As early as possible. Particularly if there is a potential obligation to abstain, a verification period of several months may be required. Early clarification helps to avoid unnecessary loss of time and unsuitable evidence.</p></details></section>
<section class="mpu-section"><div class="mpu-cta"><h2>Would you like to approach your MPU preparation professionally and personally?</h2><p>In an initial consultation, we will clarify your question, the potential preparation required, and whether further therapeutic support may be beneficial.</p><a class="mpu-button" href="https://psychotherapy-pinder.de/en/contact-2/">Contact us</a></div></section>
<section class="mpu-section mpu-sources"><h2>Sources and further information</h2><ul><li><a href="https://www.gesetze-im-internet.de/fev_2010/__13a.html" target="_blank" rel="noopener">Driving Licences Ordinance, Section 13a: Clarification of doubts regarding suitability in cases of cannabis-related problems</a></li><li><a href="https://www.gesetze-im-internet.de/fev_2010/anlage_4.html" target="_blank" rel="noopener">Driving Licence Ordinance, Annex 4: Fitness and conditional fitness to drive motor vehicles</a></li><li><a href="https://www.gesetze-im-internet.de/fev_2010/anlage_4a.html" target="_blank" rel="noopener">Driving Licence Ordinance, Appendix 4a: Principles for examination and expert opinions</a></li><li><a href="https://www.tuvsud.com/de-de/presse-und-medien/2026/februar/mpu-in-deutschland-aktuelle-zahlen-und-die-haeufigsten-gruende" target="_blank" rel="noopener">TÜV SÜD: MPU in Germany, current figures based on the 2024 BASt annual statistics</a></li><li><a href="https://www.tuev-nord.de/de/dienstleistungen/fuehrerschein-und-fahrzeug/psychologie-medizin-mpu/mpu/abstinenznachweis/faq-abstinenznachweis/" target="_blank" rel="noopener">TÜV NORD: Frequently asked questions about abstinence proofs</a></li><li><a href="https://www.tuev-nord.de/de/dienstleistungen/fuehrerschein-und-fahrzeug/psychologie-medizin-mpu/mpu/mpu-gutachten/ursachen-fuehrerscheinentzug/" target="_blank" rel="noopener">TÜV NORD: Preparation can increase the chance of a positive report</a></li><li><a href="https://www.tuvsud.com/de-de/branchen/mobilitaet-und-automotive/fuehrerschein-und-pruefung/mpu-vorbereitung-pluspunkt/mpu-ohne-vorbereitung" target="_blank" rel="noopener">TÜV SÜD: Provider information on pass rates with and without preparation</a></li><li><a href="https://www.bast.de/DE/Publikationen/Medien/MPU/MPU.html" target="_blank" rel="noopener">Federal Highway Research Institute: Information on the MPU</a></li></ul><p class="mpu-note">As of September 2026. This article serves as general information and does not replace legal advice or an individual assessment. The specific questions raised by the driving licence authority and the evaluation in the specific individual case are decisive.</p></section>
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<section class="pp-related" aria-label="Relevant articles and support" style="box-sizing:border-box;width:100%;max-width:900px;margin:0 auto;padding:48px 24px;color:#243447;font-family:Arial,sans-serif;font-size:18px;line-height:1.7"><h2 style="font-family:Arial,sans-serif;font-size:clamp(26px,4vw,36px);line-height:1.2">Relevant articles and support</h2><ul style="padding-left:22px"><li style="margin:10px 0"><a style="color:#1d5d82;text-decoration:underline;overflow-wrap:anywhere" href="https://psychotherapy-pinder.de/en/understanding-addiction-and-dependence-what-happens-in-the-brain-and-why-relapses-are-not-a-failure-of-willpower/">Understanding addiction and dependency</a></li><li style="margin:10px 0"><a style="color:#1d5d82;text-decoration:underline;overflow-wrap:anywhere" href="https://psychotherapy-pinder.de/en/problematic-media-use-warning-signs-help/">Recognising problematic media use</a></li></ul><p>Information about <a style="color:#1d5d82;text-decoration:underline" href="https://psychotherapy-pinder.de/en/services/">Working methods, services and framework of the private practice in Bad Schwalbach</a> and further topics in the <a style="color:#1d5d82;text-decoration:underline" href="https://psychotherapy-pinder.de/en/know/">Knowledge overview</a>.</p></section>]]></content:encoded>
					
		
		
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		<title>Gen Z and mental health: Why young adults are under pressure</title>
		<link>https://psychotherapy-pinder.de/en/gen-z-and-mental-health-why-young-adults-are-under-pressure/</link>
		
		<dc:creator><![CDATA[PePi]]></dc:creator>
		<pubDate>Tue, 22 Sep 2026 10:41:06 +0000</pubDate>
				<category><![CDATA[Uncategorized]]></category>
		<guid ispermalink="false">https://psychotherapy-pinder.de/?p=290</guid>

					<description><![CDATA[Young adults and mental health Gen Z under pressure: Why the start of adulthood can feel so stressful How transitions, performance demands, social comparisons, and future uncertainty interact and what can help young adults without pathologizing an entire generation. By Petra PinderPsychotherapy practice in Bad SchwalbachReading time: approx. 16 minutes Being young does not mean […]]]></description>
										<content:encoded><![CDATA[<div id="pp-genz"><style>body.single-post #sidebar{display:none!important}body.single-post #main-content .container:before{display:none!important}body.single-post #left-area{width:100%!important;padding-right:0!important}#pp-genz{--navy:#243447;--gold:#c7a45a;--cream:#f7f1e7;--slate:#526373;color:var(--navy);font-family:Arial,sans-serif;line-height:1.7}#pp-genz *{box-sizing:border-box}#pp-genz h1,#pp-genz h2,#pp-genz h3{color:var(--navy);line-height:1.2}#pp-genz .wrap{max-width:980px;margin:auto;padding:58px 28px}#pp-genz .hero{background:linear-gradient(135deg,#243447,#49667b);color:#fff}#pp-genz .hero h1{color:#fff;font-size:clamp(38px,6vw,62px);margin:0 0 18px}#pp-genz .hero .lead{font-size:20px;max-width:820px;margin:0 0 24px}#pp-genz .kicker{color:var(--gold);font-size:13px;font-weight:700;letter-spacing:.16em;text-transform:uppercase}#pp-genz .meta{display:flex;flex-wrap:wrap;gap:10px 22px;font-size:15px}#pp-genz .intro{font-size:19px;color:var(--slate)}#pp-genz .toc,#pp-genz .box{padding:26px;border:1px solid rgba(199,164,90,.4);border-radius:10px;background:#fff}#pp-genz .toc a,#pp-genz .sources a{color:var(--navy)}#pp-genz section.alt{background:var(--cream)}#pp-genz h2{margin-top:0;font-size:clamp(28px,4vw,40px)}#pp-genz h3{font-size:23px}#pp-genz .grid{display:grid;grid-template-columns:1fr 1fr;gap:18px}#pp-genz .card{padding:24px;border:1px solid rgba(199,164,90,.35);border-radius:10px;background:#fff}#pp-genz .note{padding:22px;border-left:4px solid var(--gold);background:var(--cream)}#pp-genz .crisis{padding:24px;border:2px solid #9b3d3d;border-radius:10px;background:#fff7f7}#pp-genz .faq article{padding:20px 0;border-bottom:1px solid rgba(199,164,90,.35)}#pp-genz .sources{font-size:15px}#pp-genz .cta{text-align:center;background:var(--navy);color:#fff}#pp-genz .cta h2{color:#fff}#pp-genz .btn{display:inline-block;margin:6px;padding:12px 18px;border:2px solid var(--gold);border-radius:6px;background:var(--gold);color:var(--navy);font-weight:700;text-decoration:none}#pp-genz .btn.alt{background:transparent;color:#fff}@media(max-width:760px){#pp-genz .wrap{padding:44px 20px}#pp-genz .grid{grid-template-columns:1fr}#pp-genz .hero .lead{font-size:18px}}</style><section class="hero"><div class="wrap"><p class="kicker">Young adults and mental health</p><h1>Gen Z under pressure: Why starting adult life can feel so stressful</h1><p class="lead">How transitions, performance demands, social comparisons and future uncertainty interact, and what can help young adults without pathologising an entire generation.</p><div class="meta"><span>From <a style="color:inherit;text-decoration:underline" href="https://psychotherapy-pinder.de/en/about-me/">Petra Pinder</a></span><span>Psychotherapy practice in Bad Schwalbach</span><span>Reading time: approx. 16 minutes</span></div></div></section><section><div class="wrap"><p class="intro">Being young doesn't automatically mean being carefree. Training or university, starting a career, financial insecurity, relationships, moving away from the parental home, and the question of one's own identity can all demand attention at the same time. Many young adults experience a contradiction in this: outwardly, countless possibilities seem open to them, but inwardly they feel directionless, exhausted, or not good enough.</p><p>The term „Gen Z“ is frequently used for people born roughly between the late 1990s and the early 2010s. Such generational terms can describe societal experiences, but they say little about the individual. Not every burden is a mental disorder, and not every problem can be explained by the year of birth.</p><div class="toc"><strong>In this post</strong><ul><li><a href="#uebergaenge">Why transitions are particularly challenging</a></li><li><a href="#druck">Pressure to perform, comparisons and self-doubt</a></li><li><a href="#digital">What role social media play</a></li><li><a href="#risiken">Digital stress, maturation and self-efficacy</a></li><li><a href="#warnzeichen">When stress requires professional attention</a></li><li><a href="#hilft">What can help in everyday life</a></li><li><a href="#psychotherapie">How psychotherapy can help</a></li></ul></div></div></section><section id="uebergaenge" class="alt"><div class="wrap"><p class="kicker">development phase</p><h2>Why transitions can be particularly challenging</h2><p>Young adulthood is a phase of many decisions, while important areas of life are not yet stable. Place of residence, education, career, friendships, romantic relationships and financial security can change within a short space of time. At the same time, the expectation grows to function independently and to know a clear direction.</p><p>Transitions tie up mental energy. They demand adaptation, saying goodbye to the familiar and dealing with uncertainty. This can be exhausting even when the change is fundamentally desired. Difficulties are therefore not automatically a sign of weakness. What is crucial is whether recovery is achieved, everyday life can be managed and sufficient support is available.</p><div class="note"><strong>An important qualification:</strong> The Robert Koch Institute reported for 2024 that 37.7 per cent of 18- to 29-year-olds exhibited low psychological well-being. This figure does not describe a diagnosis and does not explain the causes. However, it shows that burdens in this age group should be taken seriously.</div></div></section><section id="druck"><div class="wrap"><p class="kicker">Internal and external requirements</p><h2>Pressure to perform, comparisons and self-doubt</h2><div class="grid"><article class="card"><h3>Many options, high decision pressure</h3><p>Anyone who can choose from numerous educational paths, working models and lifestyles experiences freedom. At the same time, the fear of making the wrong choice or missing out on a better opportunity can grow.</p></article><article class="card"><h3>Invisible standards</h3><p>Comparisons with peers easily create the impression that everyone else is further ahead, more successful or more confident. In the process, crises, detours and support often remain invisible in the background.</p></article><article class="card"><h3>Uncertain future</h3><p>High living costs, temporary work, the climate crisis and social tensions can make future plans more difficult. Worries about these are not irrational, but they can drain energy on a permanent basis.</p></article><article class="card"><h3>The aspiration to get everything right</h3><p>Perfectionism can boost performance in the short term. However, when one's self-worth is tied to flawlessness, procrastination, overwhelm and severe self-criticism frequently arise.</p></article></div><p>Psychological stress is rarely caused by a single factor. Personal experiences, relationships, physical health, financial conditions and societal influences interact. A careful medical history is therefore more helpful than blanket statements about a generation.</p></div></section><section id="digital" class="alt"><div class="wrap"><p class="kicker">digital world</p><h2>What role do social media play?</h2><p>Social media can connect, inform, enable creativity and create a sense of community, particularly for people with uncommon experiences or marginalised identities. At the same time, constant accessibility, social comparisons, derogatory comments and the fear of missing out can be distressing.</p><p>Research predominantly shows correlations, but not a simple cause-and-effect relationship for every individual. A major systematic review from 2024 found small, statistically significant correlations between social media use, depressive symptoms, anxiety and sleep problems. Therefore, what is particularly important is not just the minutes spent in front of the screen, but the type of usage, the content experienced, the timing, and whether sleep, relationships or responsibilities suffer as a result.</p><div class="note"><strong>What the US studies by Jean Twenge show:</strong> In an analysis of a nationally representative survey in the USA involving 611,880 people, the proportion of individuals experiencing a depressive episode rose by 52 percent among adolescents aged 12 to 17 between 2005 and 2017, and by 63 percent among young adults aged 18 to 25 between 2009 and 2017. Another study reported significant increases in depressive symptoms and suicide-related characteristics among adolescents in the USA between 2010 and 2015. Twenge and her team discuss digital communication, social media and shorter sleep duration as potential contributing factors. However, the data do not prove a single, simple cause and cannot be directly applied to Germany or to individuals.</div><h2 id="risiken">Digital strain is more than screen time</h2><p>The 2025 JIM study shows how naturally digital media belong to young people's everyday lives. 68 per cent report that they frequently stay on their phones longer than planned. Around 30 per cent often feel tired in the morning because they put their smartphones away too late at night. At the same time, 74 per cent use artificial intelligence for homework or studying. These figures do not describe an illness, but they do show how early self-regulation, sleep and concentration are challenged by digital offerings.</p><div class="grid"><article class="card"><h3>AI chatbots as companions</h3><p>Chatbots can help with learning and appear as low-threshold points of contact in stressful moments. Things can become problematic if a system replaces human relationships, encourages dependency or gives seemingly safe answers to psychological crises. Initial studies show a mixed picture. Particularly people who experience a chatbot as a friend or are prone to strong emotional attachment may report adverse psychosocial consequences. Cause and effect have not yet been conclusively clarified.</p></article><article class="card"><h3>Mobile games and loot boxes</h3><p>Many games use fast rewards, daily tasks, artificial scarcity and chance-based purchases. Loot boxes share key characteristics with gambling because money is staked for the chance of an unknown reward. Such mechanisms can encourage risky gaming behaviour and are particularly problematic for young people who are already at risk. However, a single use does not yet mean addiction.</p></article><article class="card"><h3>Class chats and cyberbullying</h3><p>Conflicts do not necessarily end with the school day nowadays. Belittlement, exclusion, embarrassing pictures or peer pressure can continue in the class chat at any time and reach a large audience. As a result, safe recovery spaces are often lacking for those affected. Cyberbullying should not be played down as mere arguing.</p></article><article class="card"><h3>Online grooming and early boundary violations</h3><p>During cybergrooming, adults deliberately build trust with minors online in order to initiate sexual contact, images or meetings. Children and young people bear no responsibility for this. Protection is achieved through age-appropriate education, clear contact persons and a reaction that does not cause shame or threaten blanket bans on mobile phones.</p></article></div><h3>Why these offers are so difficult to limit</h3><p>Platforms and games are not neutrally designed. So-called dark patterns steer decisions through pre-selected options, artificial time pressure, hard-to-find settings or repeated prompts. A study commissioned by the European Commission found such manipulative design patterns on 97 per cent of the 75 popular websites and apps examined. Young people must therefore develop their self-control in environments that deliberately compete for attention, data and money.</p><div class="note"><strong>The adolescent brain is particularly capable of learning:</strong> Rewards, social recognition and a sense of belonging carry great weight during this stage of development. This does not mean that digital media cause blanket damage to the brain. However, constant stimulation, sleep deprivation, anxiety, social pressure and a lack of recovery can impair concentration, mood and self-regulation.</div><h3>Later independence and self-efficacy</h3><p>The pointed phrasing „25 is the new 18“ describes the observation that some steps towards independence happen later nowadays. Large time series from the USA show that young people engage in certain activities—such as going out alone, paid work, or driving—less frequently or later on average than previous cohorts. It does not follow from this that an entire generation is immature. Furthermore, the data come from the USA and cannot be applied directly to Germany.</p><p>What is important is self-efficacy, that is the experience: I can try something, endure difficulties, correct mistakes and have an influence on my life. If challenges are permanently avoided out of fear or completely taken over by adults, such learning experiences are lacking. Small, age-appropriate areas of responsibility, real-life encounters and achievable tasks can strengthen confidence.</p><div class="box"><h3>More helpful than a blanket ban</h3><ul><li>Intentionally limit notifications and create screen-free times.</li><li>Unfollow accounts that regularly make you feel worse after consuming their content.</li><li>Do not replace active contacts and real-life encounters with passive scrolling.</li><li>Put the smartphone out of direct reach at night.</li><li>Trying out changes and observing one's own impact, rather than demanding perfect rules.</li></ul></div><div class="box"><h3>Further reading and perspectives</h3><ul><li><a href="https://www.anxiousgeneration.com/" target="_blank" rel="noopener">Jonathan Haidt: Generation Angst</a>, an influential, yet scientifically debated interpretation of the transformation of childhood and youth.</li><li><a href="https://janszky.de/buecher/" target="_blank" rel="noopener">Sven Gábor Jánszky: 2035</a>, a future scenario and food for thought, not a scientific study.</li></ul></div></div></section><section id="warnzeichen"><div class="wrap"><p class="kicker">Assess workload</p><h2>When is professional support useful?</h2><p>Difficult days, doubt and exhaustion are part of life. Seeking support can be helpful if symptoms persist for weeks, intensify or significantly impair studies, training, work, relationships or self-care.</p><div class="grid"><article class="card"><h3>Possible warning signs</h3><ul><li>persistent low mood or severe anxiety</li><li>marked withdrawal and solitude</li><li>sleep problems, exhaustion or loss of concentration</li><li>frequent panic, rumination or inner restlessness</li><li>increasing alcohol, drug or medication consumption</li><li>Eating problems or a strong preoccupation with weight and body</li></ul></article><article class="card"><h3>Sort it out early rather than enduring it for long</h3><p>A conversation with a general practitioner, psychiatric or psychotherapeutic specialist can help to classify physical and psychological factors. A diagnosis cannot be made on the basis of individual symptoms or an online article.</p></article></div><p><strong>Recommended reading:</strong> <a href="https://psychotherapy-pinder.de/en/understanding-panic-attacks-what-happens-in-the-body-and-what-can-help/">Understanding panic attacks: What happens in the body and what can help</a>.</p><div class="crisis"><strong>In the event of immediate danger:</strong> If you have suicidal thoughts with immediate danger or if you cannot safely protect yourself, call 112 or go to the nearest psychiatric emergency room. TelefonSeelsorge can be reached day and night free of charge on 0800 1110111, 0800 1110222 or 116 123.</div></div></section><section id="hilft" class="alt"><div class="wrap"><p class="kicker">Practical orientation</p><h2>What can help in everyday life?</h2><div class="grid"><article class="card"><h3>Make the next step smaller</h3><p>When feeling overwhelmed, the perfect overall plan rarely helps; instead, a concrete next action is needed: an email, an appointment, a meal, or ten minutes on a task.</p></article><article class="card"><h3>stabilise the basic rhythm</h3><p>Regular sleep, meals, daylight and exercise do not solve complex problems, but they can create a resilient foundation.</p></article><article class="card"><h3>Check comparisons</h3><p>The question „What is important to me?“ is often more helpful than „Where should I already be at my age?“. Life paths are rarely straightforward.</p></article><article class="card"><h3>Address support directly</h3><p>Instead of just saying „I'm not doing well“, a request can help: making a phone call together, looking for an appointment, going for a walk, or structuring a task.</p></article></div><p>Self-help has its limits. If stress persists or daily life increasingly spirals out of control, professional support is not failure, but an appropriate response.</p></div></section><section id="psychotherapie"><div class="wrap"><p class="kicker">Therapeutic support</p><h2>How can psychotherapy support young adults?</h2><p>At the beginning there is a detailed medical history. This involves examining current complaints, life situation, physical health, past stressors, relationships, resources and previous attempts at coping. This forms the basis for an individual assessment.</p><p>Psychotherapy can help to recognise automatic self-deprecation, excessive demands and avoidance behaviour. Together, realistic goals, a helpful way of dealing with uncertainty and concrete strategies for study, work and relationships can be developed. Depending on the symptoms, anxiety, depressive symptoms, sleep problems, trauma consequences or problematic media and substance use can also be specifically treated.</p><p>A specific treatment outcome cannot be guaranteed. Which method is suitable can only be assessed after a personal consultation. In the event of physical ailments or potential medical treatment, concurrent medical treatment is important.</p></div></section><section class="alt"><div class="wrap"><p class="kicker">Questions and Answers</p><h2>Frequently asked questions</h2><div class="faq"><article><h3>Is Gen Z less psychologically resilient?</h3><p>Such a blanket assessment is not professionally useful. Stressors, social conditions, language surrounding mental health and the willingness to seek help are all changing. What matters is the situation of the individual.</p></article><article><h3>Do social media make people mentally ill?</h3><p>They can increase stress, but are rarely the sole cause. Usage patterns, content, personal circumstances and the social environment all interact.</p></article><article><h3>When should I seek help?</h3><p>If symptoms persist for weeks, become more severe, or significantly affect daily life, relationships, sleep, and performance, a professional assessment is advisable.</p></article><article><h3>Can psychotherapy also help with disorientation?</h3><p>Yes. Therapy does not necessarily require a completed diagnosis. A psychotherapeutic consultation can clarify what distress is present and what support might be suitable.</p></article></div></div></section><section><div class="wrap sources"><p class="kicker">Sources and technical classification</p><h2>Scientific references</h2><ul><li><a href="https://www.rki.de/DE/Themen/Nichtuebertragbare-Krankheiten/Psychische-Gesundheit/Psychische-Gesundheit-und-Stoerungen/rki-panel-2024-faktenblatt_wohlbefinden.pdf?__blob=publicationFile&amp;v=1" target="_blank" rel="noopener">Robert Koch Institute: Mental well-being – Results of the RKI panel 2024</a></li><li><a href="https://www.rki.de/DE/Aktuelles/Publikationen/Journal-of-Health-Monitoring/GBEDownloadsJ/Focus/JHealthMonit_2025_4_Barrieren-psychotherapeutischer-Versorgung.pdf?__blob=publicationFile&amp;v=4" target="_blank" rel="noopener">Robert Koch Institute: Psychotherapeutic care for young adults, 2025</a></li><li><a href="https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health" target="_blank" rel="noopener">World Health Organization: Mental health of adolescents, 2025</a></li><li><a href="https://pubmed.ncbi.nlm.nih.gov/39242043/" target="_blank" rel="noopener">Ahmed and colleagues: Social media use, mental health and sleep: systematic review and meta-analyses, 2024</a></li><li><a href="https://pubmed.ncbi.nlm.nih.gov/30869927/" target="_blank" rel="noopener">Twenge and colleagues: Trends in mood disorders and suicide-related characteristics in the USA, 2005–2017</a></li><li><a href="https://doi.org/10.1177/2167702617723376" target="_blank" rel="noopener">Twenge and colleagues: Increases in depressive symptoms and suicide-related outcomes among US adolescents after 2010, 2018</a></li><li><a href="https://mpfs.de/studie/jim-studie-2025/" target="_blank" rel="noopener">Media Pedagogical Research Association Southwest: JIM Study 2025</a></li><li><a href="https://buendnis-gegen-cybermobbing.de/wp-content/uploads/2022/10/Cyberlife_Studie_2022_endfassung.pdf" target="_blank" rel="noopener">Alliance Against Cyberbullying: Cyberlife IV, Cyberbullying among School Pupils, 2022</a></li><li><a href="https://www.klicksafe.de/materialien/cybergrooming-sexuelle-gewalt-im-internet" target="_blank" rel="noopener">klicksafe: Cybergrooming, sexual violence online</a></li><li><a href="https://op.europa.eu/en/publication-detail/-/publication/606365bc-d58b-11ec-a95f-01aa75ed71a1" target="_blank" rel="noopener">European Commission: Behavioural study on unfair commercial practices in the digital environment, DOI 10.2838/859030</a></li><li><a href="https://www.forbrukerradet.no/?p=36303" target="_blank" rel="noopener">Norwegian Consumer Council: Insert Coin, Loot Boxes and Manipulative Game Design, 2022</a></li><li><a href="https://openai.com/index/affective-use-study/" target="_blank" rel="noopener">OpenAI and MIT Media Lab: Affective use and emotional well-being in ChatGPT, 2025</a></li><li><a href="https://onlinelibrary.wiley.com/doi/10.1111/cdev.12930" target="_blank" rel="noopener">Twenge and Park: Decline in typical coming-of-age activities among adolescents in the USA, 1976 to 2016</a></li><li><a href="https://www.telefonseelsorge.de/" target="_blank" rel="noopener">TelefonSeelsorge Deutschland: crisis support and contact options</a></li></ul><p>As of September 2026. This article serves as general information and does not replace an individual medical, diagnostic or therapeutic assessment.</p></div></section><section class="cta"><div class="wrap"><p class="kicker">In person or online</p><h2>Would you like to better understand your situation?</h2><p>In a free 30-minute initial telephone consultation, you can describe your concerns and clarify initial organisational questions.</p><a class="btn" href="https://vereto.de/vereto/php/p_termin_buchen.php?key=a7894460184cbd3b2bc5f1da17b34eff79cc01e1" target="_blank" rel="noopener">Free initial consultation</a><a class="btn alt" href="https://psychotherapy-pinder.de/en/contact-2/">Get in touch in writing</a></div></section></div>

<section class="pp-related" aria-label="Relevant articles and support" style="box-sizing:border-box;width:100%;max-width:900px;margin:0 auto;padding:48px 24px;color:#243447;font-family:Arial,sans-serif;font-size:18px;line-height:1.7"><h2 style="font-family:Arial,sans-serif;font-size:clamp(26px,4vw,36px);line-height:1.2">Relevant articles and support</h2><ul style="padding-left:22px"><li style="margin:10px 0"><a style="color:#1d5d82;text-decoration:underline;overflow-wrap:anywhere" href="https://psychotherapy-pinder.de/en/problematic-media-use-warning-signs-help/">Recognising problematic media use</a></li><li style="margin:10px 0"><a style="color:#1d5d82;text-decoration:underline;overflow-wrap:anywhere" href="https://psychotherapy-pinder.de/en/understanding-sleep-disorders-what-promotes-healthy-sleep-and-when-help-is-useful/">Understanding sleep disorders</a></li><li style="margin:10px 0"><a style="color:#1d5d82;text-decoration:underline;overflow-wrap:anywhere" href="https://psychotherapy-pinder.de/en/understanding-panic-attacks-what-happens-in-the-body-and-what-can-help/">Understanding panic attacks</a></li></ul><p>Information about <a style="color:#1d5d82;text-decoration:underline" href="https://psychotherapy-pinder.de/en/services/">Working methods, services and framework of the private practice in Bad Schwalbach</a> and further topics in the <a style="color:#1d5d82;text-decoration:underline" href="https://psychotherapy-pinder.de/en/know/">Knowledge overview</a>.</p></section>]]></content:encoded>
					
		
		
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		<title>Understanding Sleep Problems: What Supports Healthy Sleep and When to Seek Help</title>
		<link>https://psychotherapy-pinder.de/en/understanding-sleep-disorders-what-promotes-healthy-sleep-and-when-help-is-useful/</link>
		
		<dc:creator><![CDATA[PePi]]></dc:creator>
		<pubDate>Tue, 22 Sep 2026 10:03:48 +0000</pubDate>
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		<category><![CDATA[Ängste Phobien Schlaf]]></category>
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					<description><![CDATA[Sleep and internal tension Understanding sleep disorders: What promotes healthy sleep and when help is advisable Why one-sided sleep problems can occur, how stress, worry, and sleep pressure interact, and what support is scientifically recommended. By Petra PinderPsychotherapy practice in Bad SchwalbachReading time: approx. 13 minutes A bad night is not yet a sleep disorder. However, if the sleep is […]]]></description>
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<section class="hero"><div class="wrap"><p class="kicker">Sleep and stress</p><h1>Understanding Sleep Problems: What Supports Healthy Sleep and When to Seek Help</h1><p>Why difficulty falling and staying asleep can occur, how stress, rumination and sleep pressure interact, and what support is scientifically recommended.</p><div class="meta"><span>From <a style="color:inherit;text-decoration:underline" href="https://psychotherapy-pinder.de/en/about-me/">Petra Pinder</a></span><span>Psychotherapy practice in Bad Schwalbach</span><span>Reading time: approx. 13 minutes</span></div></div></section>

<article class="wrap article">
<p class="lead">A bad night's sleep does not yet constitute a sleep disorder. However, if sleep is absent over a prolonged period, is repeatedly interrupted or ends far too early, this can result in considerable strain. Fatigue, irritability, concentration problems and the worry about the coming night then frequently interlock. A differentiated view is important: sleep problems can have psychological, physical, hormonal, medication-related and behavioural influences. A hasty attribution does not do justice to this complexity.</p>

<nav class="toc" aria-label="Table of contents"><strong>In this post</strong><a href="#gesund">What is healthy sleep?</a><a href="#formen">What forms of sleep problems are there?</a><a href="#stress">How do stress, anxiety and rumination affect sleep?</a><a href="#koerper">What physical and hormonal influences are possible?</a><a href="#kreislauf">How does the cycle of insomnia develop?</a><a href="#hilfe">What has been proven to help?</a><a href="#abklaerung">When is a medical evaluation important?</a><a href="#psychotherapie">How can psychotherapy help?</a><a href="#faq">Frequently asked questions</a></nav>

<h2 id="gesund">What is healthy sleep?</h2>
<p>Healthy sleep cannot be recognised by a fixed number of hours alone. It encompasses sufficient duration, a sleeping position that suits one's daily routine, a certain degree of regularity, restorative quality and sufficient alertness during the day. The American Academy of Sleep Medicine generally recommends at least seven hours of sleep per night for healthy adults. Individual sleep requirements can nevertheless vary. Age, illness, periods of stress and a previously accumulated sleep deficit also play a role.</p>
<p>Short waking phases at night are normal and are often not remembered. Likewise, individual restless nights are part of human sleep. What is therefore crucial is not whether every night goes perfectly, but whether sleep is restorative overall and daily life can be managed.</p>
<div class="note"><strong>It is important to distinguish between:</strong> A chronic insomnia disorder is technically only diagnosed when difficulties falling or staying asleep, or early morning awakening, occur several times a week for at least three months despite adequate opportunity for sleep, and are associated with significant distress or daytime impairment. A diagnosis requires a professional medical examination and cannot be made based on a single symptom or online.</div>

<h2 id="formen">What forms of sleep problems are there?</h2>
<h3>difficulty falling asleep</h3>
<p>When having difficulty falling asleep, it regularly takes a long time before sleep occurs. Some people feel physically tired, but experience their head as awake and active. Thoughts jump around, the day is analysed or the coming night is controlled internally. The time on the clock alone does not determine whether there is a disorder. What is relevant are frequency, duration, distress and the consequences during the day.</p>
<h3>sleep maintenance insomnia</h3>
<p>Falling asleep is initially successful here, but sleep is repeatedly or lengthily interrupted. Short waking up is normal. It becomes distressing when longer waking phases occur frequently, falling back asleep is difficult and clear consequences show during the day.</p>
<h3>Early waking</h3>
<p>Some people wake up significantly earlier than intended and cannot get back to sleep. Early awakening can occur as part of insomnia, but also with changes in the sleep-wake cycle, physical ailments, hormonal changes or psychological stress. The timing alone does not allow for a diagnosis.</p>
<p>Sleep problems can occur in the short term after stress, illness, travel or changes in daily life. If temporary difficulties turn into persistent complaints, not only triggering factors but also maintaining habits and possible other sleep disorders should be considered.</p>

<h2 id="stress">How do stress, anxiety and rumination affect sleep?</h2>
<p>Sleep cannot be forced at will. For falling asleep, the level of activation must drop. Persistent stress, inner tension and anxiety can, however, keep the body on high alert. Attention, muscle tone and mental activity remain elevated. In sleep research, this pattern is frequently described as hyperarousal.</p>
<p>Broodining is often directed at the past, worries rather at what is to come. Both can become particularly present shortly before going to sleep because external distractions disappear. Added to this is the monitoring of one's own sleep: „Am I tired enough yet?“, „How many hours are left?“ or „How am I supposed to function tomorrow?“ Such thoughts are understandable. If they are experienced as threatening, internal activation can increase further.</p>
<p>Anxiety and sleep problems can reinforce each other. Poor sleep can make emotional regulation more difficult, while anxiety and heightened alertness can hinder falling asleep or getting back to sleep. This does not mean that sleep problems are automatically psychologically caused. Rather, it shows why a comprehensive medical history should consider physical, psychological, and everyday factors together.</p>

<h2 id="koerper">What physical and hormonal influences are possible?</h2>
<p>Sleep problems should not be hastily classified as purely psychological. Pain, respiratory diseases, reflux, cardiovascular diseases, neurological disorders, thyroid dysfunctions and other endocrinological changes can affect sleep. Medications, caffeine, nicotine, alcohol and other substances are also potential triggers or enhancers.</p>
<p>Hormonal changes can also play a role. During pregnancy, perimenopause and menopause, for example, hot flushes, night sweats, physical changes and mood swings can impair sleep. Biological and psychosocial factors often work together here. Deciding which examination or treatment is appropriate is a matter for a doctor or gynaecologist.</p>
<p>Other sleep disorders can act like insomnia or occur alongside it. Loud snoring, observed pauses in breathing or gasping for air at night may indicate a sleep-related breathing disorder. A pronounced urge to move or unpleasant sensations in the legs in the evening may point to restless legs syndrome. Disruptions to the sleep-wake rhythm, for example in shift work, also require their own specialist assessment.</p>

<h2 id="kreislauf">How does the cycle of insomnia develop?</h2>
<p>After a few bad nights, many sufferers try to control their sleep more strongly. This reaction is understandable. However, some measures inadvertently increase the pressure and weaken the clear connection between bed and sleep.</p>
<div class="cycle"><section class="step"><h3>Trigger</h3><p>Stress, illness, pain, hormonal changes or a stressful phase of life disrupt sleep.</p></section><section class="step"><h3>2. Fear of not sleeping</h3><p>The next night will be a test. Time, bodily signals and potential consequences are being observed ever more closely.</p></section><section class="step"><h3>3. Unfavourable adaptation</h3><p>Going to bed very early, lying awake for a long time, sleeping in late, or taking frequent naps are supposed to make up for lost sleep, but they can reduce the natural sleep pressure.</p></section><section class="step"><h3>4. Learned Vigilance</h3><p>The bed is increasingly associated with rumination, tension and wakefulness. The desire to sleep creates even more pressure.</p></section></div>
<p>Sleep pressure builds up with the duration of wakefulness. Anyone who spends a lot of time in bed after a poor night's sleep or sleeps for a long time during the day may have less sleep pressure in the evening. At the same time, the worry about not sleeping can increase the level of arousal. This creates a cycle of lower sleep pressure, greater monitoring and wake-maintaining habits.</p>

<h2 id="hilfe">What has been proven to help?</h2>
<h3>Sleep hygiene as a foundation</h3>
<p>Helpful basics include as consistent a wake-up time as possible, sufficient daylight and exercise, a quiet sleeping environment, and a conscious approach to caffeine, nicotine, and alcohol. Larger meals, intense exercise, or upsetting content immediately before sleep can be individually unhelpful. A short evening routine can help to mark the transition from day to night.</p>
<p>Screen light in the evening can also affect sleep. In particular, the blue-enriched light from smartphones and tablets can dampen or delay the evening release of melatonin, meaning that tiredness sets in later. However, this does not mean that no melatonin is produced at all. Stimulating or stressful content, notifications and endless scrolling can also make it harder to fall asleep. Therefore, it can be helpful to put phones and tablets aside in the last 30 to 60 minutes before going to bed and, as far as possible, avoid regularly using the bed for media consumption. When watching television, the direct effect of the light is often lower due to the greater distance, but here too, exciting content and going to bed late can impair sleep. Night mode and lower screen brightness reduce exposure to light, but do not completely replace a screen-free transition period.</p>
<p>These guidelines are not a rigid checklist. Anyone who tries to fulfil every recommendation perfectly can develop additional performance pressure. Current evidence also speaks against using sleep hygiene alone as a treatment for chronic insomnia. It is a sensible foundation, but does not replace individual diagnosis or disorder-specific therapy.</p>
<h3>Cognitive behavioural therapy for insomnia</h3>
<p>Cognitive behavioural therapy for insomnia, or CBT-I for short, is recommended as the first-line treatment by the German S3 guideline and international specialist guidelines. It combines several components: knowledge about sleep, a sleep diary, strengthening the association between bed and sleep, adjusting the time spent in bed, working on sleep-related cognitions, and strategies for managing tension and relapses.</p>
<p>In so-called stimulus control, the bed is more clearly associated with sleep again. Adjusting the sleep window is intended to bring the time spent in bed closer to the actual sleep time and to consolidate sleep pressure. Such measures are planned individually and reviewed in the course of treatment. Excessive restriction can lead to pronounced fatigue and is not suitable for every situation, such as in certain physical or mental illnesses, pregnancy or an increased risk of accidents. Therefore, it should be professionally supervised.</p>
<p>Cognitive elements focus, among other things, on catastrophic thoughts such as „I won't get through the day without eight hours“ or „If I don't sleep now, everything will go wrong tomorrow“. The aim is not positive thinking, but a more realistic evaluation and a less controlling approach to wakefulness. Randomised trials and clinical guidelines show that multi-component CBT-I can effectively reduce sleep complaints. However, a specific success cannot be guaranteed for the individual case.</p>

<h2 id="abklaerung">When is a medical evaluation important?</h2>
<p>Medical investigation is advisable if sleep problems arise for the first time, persist for weeks, significantly impair daily life, or change without an identifiable reason. It is particularly important in cases of loud snoring, observed pauses in breathing, nocturnal shortness of breath, a strong urge to move the legs, unusual nocturnal movements, pronounced daytime sleepiness, or unintended falling asleep.</p>
<p>Pain, a racing heart, changes in weight, hormonal issues, pregnancy, changes in medication or the regular use of sleeping pills should also be discussed with a doctor. Anyone who has to fight falling asleep while driving or at work should, for safety reasons, stop driving or pause dangerous activities and seek medical help promptly.</p>
<p>According to the S3 guideline, diagnostics include taking a medical history, a physical examination as well as sleep diaries and questionnaires. An examination in a sleep laboratory is not necessary for every case of insomnia, but can be important if there is a justified suspicion of other organic sleep disorders.</p>

<h2 id="psychotherapie">How can psychotherapeutic support help?</h2>
<p>At the beginning of every therapeutic classification is a detailed medical history. In the process, the course and form of the sleep problems, sleep times, daytime stresses, previous attempts, medications and substances, as well as physical and psychological comorbidities are recorded. A sleep diary kept for one to two weeks can make patterns visible without overestimating individual nights.</p>
<p>Psychotherapeutic support can help when stress, worries, inner tension or sleep-related anxiety are contributing to the cycle. Together, helpful habits can be tested, unhelpful appraisals reviewed and strategies for periods of wakefulness developed. In cases of chronic insomnia, treatment is based on the components of CBT-I. At the same time, it remains important to have physical and hormonal influences medically evaluated and, if necessary, treated in parallel.</p>
<p>Which steps are appropriate can only be assessed after the anamnesis. Psychotherapy can provide a structured framework in which changes are carefully planned and reviewed. It does not replace necessary medical diagnostics and cannot guarantee a specific course or treatment success.</p>
</article>

<section class="cream" id="faq"><div class="wrap"><p class="kicker">Questions and Answers</p><h2>Frequently asked questions about sleep disorders</h2><div class="faq">
<article><h3>When is it considered a sleep disorder?</h3><p>Temporary bad nights are common. For chronic insomnia, symptoms must occur despite adequate opportunity for sleep several times a week for at least three months and cause significant daytime distress. The diagnosis is made professionally.</p></article>
<article><h3>Why can't I sleep even though I'm tired?</h3><p>Fatigue and sleepiness are not the same thing. Stress, overthinking, anxiety about lying awake or an unfavourable sleep cycle can increase the level of arousal, even though one feels exhausted. Physical causes should also be considered.</p></article>
<article><h3>Can stress cause sleep maintenance insomnia?</h3><p>Yes, ongoing tension can make it harder to fall and get back to sleep. However, stress is only one possible explanation. Physical ailments, medication, hormonal changes and other sleep disorders can also play a part.</p></article>
<article><h3>What is the difference between sleep hygiene and CBT-I?</h3><p>Sleep hygiene encompasses general favourable conditions. CBT-I is a multi-component, disorder-specific treatment involving a sleep diary, behavioural changes and cognitive work. Guidelines do not recommend sleep hygiene as the sole therapy for chronic insomnia.</p></article>
<article><h3>Which hormones can affect sleep?</h3><p>Hormonal changes, such as during pregnancy, perimenopause and the menopause, or in thyroid disorders, can affect sleep. Which diagnostics are appropriate should be determined by a doctor.</p></article>
<article><h3>Should I stay in bed longer after a bad night's sleep?</h3><p>This initially seems obvious, but it can reduce sleep pressure the following evening. A regular wake-up time is often more helpful. Individual adjustments to the sleep window should be supervised professionally if problems persist.</p></article>
<article><h3>When should I see a doctor about sleep problems?</h3><p>In the event of persistent strain, new or significantly altered symptoms, pauses in breathing, pronounced daytime sleepiness, nocturnal restlessness, pain, hormonal issues or changes in medication, medical evaluation is important.</p></article>
<article><h3>Can psychotherapy help with sleep disorders?</h3><p>Following a detailed medical history, psychotherapy can help to change sleep-related anxiety, rumination, tension and unfavourable habits. For chronic insomnia, CBT-I is particularly well researched. Specific success cannot be guaranteed.</p></article>
</div></div></section>

<section><div class="wrap article"><p class="kicker">Sources and technical classification</p><h2>Scientific references</h2><ul class="sources">
<li><a href="https://register.awmf.org/assets/guidelines/063-003l_S3_Insomnie-bei-Erwachsenen_2025-04.pdf" target="_blank" rel="noopener">German Sleep Research and Sleep Medicine Society: S3 Guideline Insomnia in Adults, 2025 Update</a></li>
<li><a href="https://pubmed.ncbi.nlm.nih.gov/33164742/" target="_blank" rel="noopener">Edinger and colleagues: AASM Guideline on psychological and behavioural treatments for chronic insomnia, 2021</a></li>
<li><a href="https://www.acpjournals.org/doi/10.7326/M15-2175" target="_blank" rel="noopener">American College of Physicians: Guideline for the Treatment of Chronic Insomnia in Adults, 2016</a></li>
<li><a href="https://aasm.org/resources/pdf/pressroom/adult-sleep-duration-consensus.pdf" target="_blank" rel="noopener">American Academy of Sleep Medicine and Sleep Research Society: Consensus on recommended sleep duration for adults, 2015</a></li>
<li><a href="https://pubmed.ncbi.nlm.nih.gov/19454639/" target="_blank" rel="noopener">Morin and colleagues: Cognitive behavioural therapy alone and in combination with medication for persistent insomnia, randomised controlled trial, 2009</a></li>
<li><a href="https://pubmed.ncbi.nlm.nih.gov/30481333/" target="_blank" rel="noopener">Drake et al.: CBT-I, sleep window and sleep hygiene in postmenopausal women, randomised controlled trial, 2019</a></li>
<li><a href="https://pubmed.ncbi.nlm.nih.gov/29845764/" target="_blank" rel="noopener">Randomised trial on the evening use of light-emitting tablets and its effects on melatonin and sleep, 2018</a></li>
</ul><p class="sources">As of September 2026. This article serves as general information and does not replace an individual medical, diagnostic or therapeutic assessment.</p></div></section>

<section class="final"><div class="wrap"><p class="kicker">In person or online</p><h2>Would you like to better understand your sleep problems?</h2><p>In a free 30-minute initial telephone consultation, you can describe your concern and clarify initial organisational questions. Alternatively, you can book an appointment for therapy directly or get in touch in writing.</p><div class="actions"><a class="btn" href="https://vereto.de/vereto/php/p_termin_buchen.php?key=a7894460184cbd3b2bc5f1da17b34eff79cc01e1" target="_blank" rel="noopener">Free initial consultation</a><a class="btn alt" href="https://vereto.de/vereto/php/p_termin_buchen.php?key=a7894460184cbd3b2bc5f1da17b34eff79cc01e1" target="_blank" rel="noopener">Book a therapy appointment</a><a class="btn alt" href="https://psychotherapy-pinder.de/en/contact-2/">Get in touch in writing</a></div></div></section>
</div>
<section class="pp-related" aria-label="Relevant articles and support" style="box-sizing:border-box;width:100%;max-width:900px;margin:0 auto;padding:48px 24px;color:#243447;font-family:Arial,sans-serif;font-size:18px;line-height:1.7"><h2 style="font-family:Arial,sans-serif;font-size:clamp(26px,4vw,36px);line-height:1.2">Relevant articles and support</h2><ul style="padding-left:22px"><li style="margin:10px 0"><a style="color:#1d5d82;text-decoration:underline;overflow-wrap:anywhere" href="https://psychotherapy-pinder.de/en/understanding-panic-attacks-what-happens-in-the-body-and-what-can-help/">Understanding panic attacks</a></li><li style="margin:10px 0"><a style="color:#1d5d82;text-decoration:underline;overflow-wrap:anywhere" href="https://psychotherapy-pinder.de/en/understanding-obsessions-and-compulsions-why-rituals-provide-short-term-relief/">Understanding obsessions and compulsions</a></li><li style="margin:10px 0"><a style="color:#1d5d82;text-decoration:underline;overflow-wrap:anywhere" href="https://psychotherapy-pinder.de/en/problematic-media-use-warning-signs-help/">Recognising problematic media use</a></li></ul><p>Information about <a style="color:#1d5d82;text-decoration:underline" href="https://psychotherapy-pinder.de/en/services/">Working methods, services and framework of the private practice in Bad Schwalbach</a> and further topics in the <a style="color:#1d5d82;text-decoration:underline" href="https://psychotherapy-pinder.de/en/know/">Knowledge overview</a>.</p></section>]]></content:encoded>
					
		
		
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		<title>Understanding obsessions and compulsions: why rituals provide short-term relief</title>
		<link>https://psychotherapy-pinder.de/en/understanding-obsessions-and-compulsions-why-rituals-provide-short-term-relief/</link>
		
		<dc:creator><![CDATA[PePi]]></dc:creator>
		<pubDate>Tue, 22 Sep 2026 09:19:15 +0000</pubDate>
				<category><![CDATA[Uncategorized]]></category>
		<category><![CDATA[Ängste Phobien Schlaf]]></category>
		<guid ispermalink="false">https://psychotherapy-pinder.de/?p=285</guid>

					<description><![CDATA[Understanding compulsions: thoughts of compulsion and compulsive behaviors: why rituals provide short-term relief How a compulsion cycle can develop, why intrusive thoughts are not to be equated with intentions, and when professional support may be useful. By Petra PinderPsychotherapy practice in Bad SchwalbachReading time: approx. 10 minutes Almost every person occasionally checks a second time whether the door is locked or the […]]]></description>
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<section class="hero"><div class="wrap"><p class="kicker">Understanding OCD</p><h1>Obsessions and compulsions: why rituals provide short-term relief</h1><p>How a compulsion cycle can develop, why intrusive thoughts should not be equated with intentions, and when professional support can be helpful.</p><div class="meta"><span>From <a style="color:inherit;text-decoration:underline" href="https://psychotherapy-pinder.de/en/about-me/">Petra Pinder</a></span><span>Psychotherapy practice in Bad Schwalbach</span><span>Reading time: approx. 10 minutes</span></div></div></section>

<article class="wrap article">
<p class="lead">Almost everyone occasionally double-checks whether the door is locked or the stove is switched off. With obsessive-compulsive disorder, however, thoughts, doubts or rituals take up so much space that they can significantly impair everyday life. Those affected often know themselves that their fears or actions seem exaggerated. Nevertheless, the internal pressure cannot simply be turned off by willpower.</p>

<nav class="toc" aria-label="Table of contents"><strong>In this post</strong><a href="#definition">What are obsessions and compulsions?</a><a href="#kreislauf">How does the compulsion cycle develop?</a><a href="#gedanken">Do intrusive thoughts mean an actual intention?</a><a href="#sucht">Are compulsion and addiction the same thing?</a><a href="#unterstuetzung">What can provide psychotherapeutic support?</a><a href="#faq">Frequently asked questions</a></nav>

<h2 id="definition">What are obsessions and compulsions?</h2>
<p>Intrusive thoughts are recurring thoughts, images or impulses that force themselves upon a person unintentionally and are experienced as distressing. For example, they can relate to contamination, responsibility, mistakes, order, sexuality, religion or the fear of harming oneself or others.</p>
<p>Compulsions are repeated actions or mental rituals intended to reduce anxiety, uncertainty or a feared event. These include, among other things, frequent checking, washing, counting, ordering, repeating, mental neutralising or repeatedly seeking reassurance.</p>
<div class="note"><strong>It is important to distinguish between:</strong> Not every ritual and not every intrusive thought is an expression of obsessive-compulsive disorder. Crucial factors include the experienced loss of control, the time consumed, the distress and the impact on daily life, relationships or work. A professional assessment requires a careful medical history.</div>

<h3>Compulsions can also be invisible</h3>
<p>Not all compulsions are visible from the outside. Some people mainly perform mental rituals. They check memories, repeat certain phrases in their minds, analyse their feelings or try to neutralise a distressing thought with another thought. Constantly asking others for reassurance can also be part of the OCD cycle.</p>
<p>Because many sufferers are ashamed of the content of their thoughts, symptoms are sometimes concealed for a long time. An appreciative and non-judgmental conversational framework is therefore particularly important for diagnosis and therapy.</p>

<h2 id="kreislauf">How does the compulsion cycle develop?</h2>
<p>Compulsive behaviours do not stem from unreasonableness. Initially, they fulfil a comprehensible function: they are intended to reduce anxiety or uncertainty. However, it is precisely this short-term relief that can stabilise the cycle.</p>
<div class="cycle"><section class="step"><h3>Trigger</h3><p>A thought, a physical sensation, a memory or an everyday situation triggers uncertainty or fear.</p></section><section class="step"><h3>2. Threatening review</h3><p>The thought is evaluated as dangerous, significant or morally unacceptable.</p></section><section class="step"><h3>3. Ritual or avoidance</h3><p>Checking, washing, ruminating, seeking reassurance or avoidance are intended to reduce tension.</p></section><section class="step"><h3>4. Short-term relief</h3><p>The tension temporarily eases. Because of this, the ritual appears necessary and is used again at the next doubt.</p></section></div>
<p>Over time, more and more situations can become incorporated into this routine. What initially takes up a few minutes can increasingly dominate the daily schedule. Relatives sometimes unnoticeably become part of the system when they take over monitoring, offer reassurance again and again, or adapt their own routines to fit the compulsion.</p>

<h2 id="gedanken">Do intrusive thoughts mean an actual intention?</h2>
<p>Distressing intrusive thoughts are often experienced as so frightening precisely because their content contradicts personal values. A thought is not automatically a wish, an intention or an action. For a professional assessment, however, it is important to carefully distinguish between thoughts, impulses, actual intentions and potential risks.</p>
<p>The attempt to forcibly suppress a thought or to gain complete certainty about its meaning can focus attention further upon it. Repeatedly checking whether one feels secure enough can also become a ritual. In therapy, a different way of dealing with uncertainty and internal reactions can be developed.</p>

<h2 id="sucht">Are compulsion and addiction the same thing?</h2>
<p>Obsessive-compulsive disorders and addictive disorders are clinically distinct conditions. Nevertheless, individual mechanisms can be similar. In both, intense inner pressure, repetitive behaviour, a sense of limited control and short-term relief can play a role.</p>
<p>In the case of compulsions, the behaviour often serves to neutralise anxiety or prevent a feared consequence. In an addiction, depending on the type, the foreground is characterised by factors such as craving, reward, habituation, or the avoidance of withdrawal and unpleasant feelings. In individual cases, the boundaries cannot be drawn solely on the basis of a single behaviour.</p>
<p>Compulsions and addictions can also occur together. Some people try to regulate tension or distressing thoughts with alcohol, medication, nicotine or other behaviours. Therefore, a detailed medical history takes into account not only the obsessive-compulsive symptoms, but also substance use, medication, other psychological stress and physical illnesses.</p>

<h2 id="unterstuetzung">What can provide psychotherapeutic support?</h2>
<p>At the beginning, the focus is on understanding the personal symptoms in detail. Which thoughts, situations and feelings trigger the compulsion? Which visible or mental rituals follow? What is avoided? To what extent are daily life, relationships and work affected? Previous coping attempts, resources and personal goals are also part of the anamnesis.</p>
<h3>Cognitive behavioural therapy and exposure</h3>
<p>Cognitive behavioural therapy with exposure and response prevention is particularly well-researched scientifically. This involves a carefully prepared approach to feared situations or thoughts. The usual compulsive action or neutralisation is either not carried out or is reduced step by step. This allows the experience to emerge that tension can subside even without a ritual and that uncertainty can be tolerated.</p>
<p>Exposure does not mean confronting those affected unprepared with maximum anxiety. Planning, transparency, a viable therapeutic relationship and individual resilience are essential. Mental rituals and reassurance behaviours must also be recognised so that one visible action is not merely replaced by another safety mechanism.</p>
<h3>Further aspects of the treatment</h3>
<p>Depending on the severity, relatives can be involved and comorbid conditions treated alongside. Medical treatment may also be an option and should be managed by a doctor. If distressing experiences or internal images are significantly contributing to the current symptoms, EMDR can also be considered as a supplementary measure after careful evaluation. However, EMDR does not automatically replace the disorder-specific procedures recommended for obsessive-compulsive disorders.</p>
<p>In my private practice in Bad Schwalbach, I offer psychotherapeutic appointments either in person or online. Which approach is professionally appropriate in any individual case will be clarified together after a detailed case history.</p>
</article>

<section class="cream" id="faq"><div class="wrap"><p class="kicker">Questions and Answers</p><h2>Frequently asked questions about obsessive-compulsive disorders</h2><div class="faq">
<article><h3>Is frequent checking already obsessive-compulsive disorder?</h3><p>Not every checking behaviour is pathological. Decisive factors include internal pressure, time spent, psychological distress and limitations in everyday life. A diagnosis can only be made following a professional assessment.</p></article>
<article><h3>Can you simply ignore intrusive thoughts?</h3><p>Trying to suppress thoughts with all one's might can make them even more central. In therapy, a changed approach to thoughts, uncertainty and the urge to perform rituals can be developed.</p></article>
<article><h3>Are intrusive thoughts dangerous?</h3><p>An intrusive thought is not automatically an intention. Since an individual risk assessment can be important, distressing thoughts should be openly discussed within a safe professional setting.</p></article>
<article><h3>Can family members unintentionally enable OCD?</h3><p>Yes. Repeated reassurance or the taking over of rituals can provide short-term relief, but in the long term they stabilise the cycle. Relatives can therefore be usefully involved in the treatment.</p></article>
<article><h3>Is obsessive-compulsive disorder an addiction?</h3><p>No. They are different disorders. However, there are overlaps regarding inner tension, repetition and short-term relief. Both can also occur simultaneously.</p></article>
<article><h3>Can EMDR be used for obsessive-compulsive disorders?</h3><p>EMDR may be considered as a supplementary approach if distressing experiences significantly contribute to the symptoms. Whether this is appropriate will be decided after a detailed medical history.</p></article>
<article><h3>Are appointments also available online?</h3><p>Yes, I offer psychotherapeutic appointments in person in Bad Schwalbach or online. Whether an online appointment is suitable for the specific issue can be clarified during the initial contact.</p></article>
<article><h3>Does the health insurance cover the cost?</h3><p>Treatment at my private practice is self-funded. German statutory health insurance generally does not cover treatment by a psychotherapy practitioner authorised under the Heilpraktikergesetz. Reimbursement by private or supplementary health insurance depends on your policy. Please check directly with your insurer before starting treatment.</p></article>
</div></div></section>

<section><div class="wrap article"><p class="kicker">Sources and technical classification</p><h2>Further information</h2><ul class="sources">
<li><a href="https://register.awmf.org/assets/guidelines/038_017p1_S3_Zwangsstoerungen_2026-04.pdf" target="_blank" rel="noopener">AWMF: Patient Guideline on Obsessive-Compulsive Disorders (2026)</a></li>
<li><a href="https://register.awmf.org/assets/guidelines/038_017l_S3_Zwangsst%C3%B6rungen_2022-07.pdf" target="_blank" rel="noopener">AWMF: S3 Guideline on Obsessive-Compulsive Disorders</a></li>
<li><a href="https://gesund.bund.de/zwangsstoerung" target="_blank" rel="noopener">Gesund.bund.de: Obsessive-compulsive disorder, symptoms and treatment</a></li>
<li><a href="https://www.gesundheitsinformation.de/zwangsstoerungen.html" target="_blank" rel="noopener">Gesundheitsinformation.de: Obsessive-compulsive disorders</a></li>
<li><a href="https://www.gesundheitsinformation.de/behandlung-von-zwangsstoerungen.html" target="_blank" rel="noopener">Gesundheitsinformation.de: Treatment of obsessive-compulsive disorders</a></li>
<li><a href="https://www.nice.org.uk/guidance/cg31/chapter/Recommendations" target="_blank" rel="noopener">NICE: Obsessive-compulsive disorder, recommendations</a></li>
<li><a href="https://pubmed.ncbi.nlm.nih.gov/36179591/" target="_blank" rel="noopener">Song and co-workers: Exposure with response prevention in obsessive-compulsive disorders, systematic review and meta-analysis</a></li>
</ul><p class="sources">As of September 2026. This article serves as general information and does not replace an individual medical, diagnostic or therapeutic assessment.</p></div></section>

<section class="final"><div class="wrap"><p class="kicker">In person or online</p><h2>Would you like to better understand your obsessive thoughts or rituals?</h2><p>In a free 30-minute initial telephone consultation, you can describe your concern and clarify initial organisational questions. Alternatively, you can book an appointment for therapy directly or get in touch in writing.</p><div class="actions"><a class="btn" href="https://vereto.de/vereto/php/p_termin_buchen.php?key=a7894460184cbd3b2bc5f1da17b34eff79cc01e1" target="_blank" rel="noopener">Free initial consultation</a><a class="btn alt" href="https://vereto.de/vereto/php/p_termin_buchen.php?key=a7894460184cbd3b2bc5f1da17b34eff79cc01e1" target="_blank" rel="noopener">Book a therapy appointment</a><a class="btn alt" href="https://psychotherapy-pinder.de/en/contact-2/">Get in touch in writing</a></div></div></section>
</div>
<section class="pp-related" aria-label="Relevant articles and support" style="box-sizing:border-box;width:100%;max-width:900px;margin:0 auto;padding:48px 24px;color:#243447;font-family:Arial,sans-serif;font-size:18px;line-height:1.7"><h2 style="font-family:Arial,sans-serif;font-size:clamp(26px,4vw,36px);line-height:1.2">Relevant articles and support</h2><ul style="padding-left:22px"><li style="margin:10px 0"><a style="color:#1d5d82;text-decoration:underline;overflow-wrap:anywhere" href="https://psychotherapy-pinder.de/en/understanding-panic-attacks-what-happens-in-the-body-and-what-can-help/">Understanding panic attacks</a></li><li style="margin:10px 0"><a style="color:#1d5d82;text-decoration:underline;overflow-wrap:anywhere" href="https://psychotherapy-pinder.de/en/understanding-sleep-disorders-what-promotes-healthy-sleep-and-when-help-is-useful/">Understanding sleep disorders</a></li><li style="margin:10px 0"><a style="color:#1d5d82;text-decoration:underline;overflow-wrap:anywhere" href="https://psychotherapy-pinder.de/en/understanding-addiction-and-dependence-what-happens-in-the-brain-and-why-relapses-are-not-a-failure-of-willpower/">Understanding addiction and dependency</a></li></ul><p>Information about <a style="color:#1d5d82;text-decoration:underline" href="https://psychotherapy-pinder.de/en/services/">Working methods, services and framework of the private practice in Bad Schwalbach</a> and further topics in the <a style="color:#1d5d82;text-decoration:underline" href="https://psychotherapy-pinder.de/en/know/">Knowledge overview</a>.</p></section>]]></content:encoded>
					
		
		
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		<title>Understanding panic attacks: What happens in the body and what can help</title>
		<link>https://psychotherapy-pinder.de/en/understanding-panic-attacks-what-happens-in-the-body-and-what-can-help/</link>
		
		<dc:creator><![CDATA[PePi]]></dc:creator>
		<pubDate>Tue, 22 Sep 2026 08:36:37 +0000</pubDate>
				<category><![CDATA[Uncategorized]]></category>
		<category><![CDATA[Ängste Phobien Schlaf]]></category>
		<guid ispermalink="false">https://psychotherapy-pinder.de/?p=281</guid>

					<description><![CDATA[Fear and panic Understanding panic attacks: What happens in the body and what can help How a panic attack develops, why the physical reactions feel so threatening and when professional support may be useful. By Petra PinderPsychotherapy practice in Bad SchwalbachReading time: approx. 9 minutes A panic attack can feel as if the body is in acute danger. […]]]></description>
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<section class="hero"><div class="wrap"><p class="kicker">Anxiety and panic</p><h1>Understanding panic attacks: What happens in the body and what can help</h1><p>How a panic attack develops, why the physical reactions feel so threatening and when professional support can be useful.</p><div class="meta"><span>From <a href="https://psychotherapy-pinder.de/en/about-me/">Petra Pinder</a></span><span>Psychotherapy practice in Bad Schwalbach</span><span>Reading time: approx. 9 minutes</span></div></div></section>
<article class="wrap article"><p class="lead">A panic attack can feel as though the body is in acute danger. A racing heart, shortness of breath, dizziness or a feeling of a loss of control often set in very suddenly. The reactions are real and can be extremely distressing, even if no clear trigger is recognisable from the outside.</p>
<nav class="toc" aria-label="Table of contents"><strong>In this post</strong><a href="#definition">What is a panic attack?</a><a href="#koerper">What happens in the body during this process?</a><a href="#kreislauf">How does the cycle of anxiety develop?</a><a href="#abklaerung">When is a medical evaluation important?</a><a href="#unterstuetzung">What can help in dealing with panic?</a><a href="#faq">Frequently asked questions</a></nav>
<h2 id="definition">What is a panic attack?</h2><p>A panic attack is a sudden onset period of intense fear or severe discomfort. It often reaches a high intensity within a short time. Some people experience them in a specific situation, others seemingly without a specific trigger.</p><p>Possible symptoms include palpitations or a racing heart, sweating, trembling, shortness of breath, a tightness in the chest, nausea, dizziness, tingling, and feeling hot or cold. These may be accompanied by a feeling of unreality, a fear of losing control, or the fear of being seriously ill or of dying.</p><div class="note"><strong>It is important to distinguish between:</strong> A single panic attack does not automatically constitute a panic disorder. To make a clinical assessment, factors such as frequency, triggers, persistent worries about further attacks, avoidance behaviour and the impact on daily life are taken into account.</div>
<h2 id="koerper">What happens in the body during a panic attack?</h2><p>Fear is, initially, an important protective response. The autonomic nervous system puts the body on high alert. Stress hormones are released, the heart rate and breathing quicken, the muscles tense up and attention is focused on potential dangers. This response prepares the body to act quickly.</p><p>During a panic attack, this alarm system is triggered even though there may be no immediately apparent external danger. The physical changes are perceived very clearly. Anyone who interprets a racing heart, dizziness or shortness of breath as signs of a catastrophe experiences additional anxiety. This can cause the physical response to intensify further.</p><h3>Breathing and dizziness</h3><p>When experiencing anxiety, some people breathe faster and often more shallowly without realising it. If this exhales more carbon dioxide than the body produces, its concentration in the blood can temporarily drop. Dizziness, tingling, feelings of pressure or a sense of unreality can be the result. These sensations can in turn be interpreted as a threat and intensify the panic.</p><p>However, the reference to a possible fear response must not prematurely rule out physical causes. New, unusual or severe symptoms should be medically investigated.</p>
<h2 id="kreislauf">How does the cycle of anxiety develop?</h2><p>During a panic attack, physical sensations, thoughts, emotions and behaviour all interplay. The sequence might look something like this, for example:</p><div class="signs"><section class="sign"><h3>1. Physical signal</h3><p>The heart beats faster, breathing changes or dizziness occurs.</p></section><section class="sign"><h3>2. Threatening review</h3><p>The sensation is interpreted as an indication of a heart attack, fainting or loss of control.</p></section><section class="sign"><h3>3. Increasingly alarmed reaction</h3><p>Anxiety intensifies physical arousal. The symptoms are perceived more clearly.</p></section><section class="sign"><h3>4. Escape and avoidance</h3><p>The situation is left or avoided in future. This provides short-term relief, but can entrench the anxiety in the long term.</p></section></div><p>Many sufferers begin to observe their bodies intensively. Pulse, breathing and the smallest changes are checked repeatedly. So-called safety strategies can also develop, such as only leaving the house with a companion, always carrying a certain object, or only visiting places near an exit.</p><p>Such strategies are understandable. In the short term, they provide a sense of security. At the same time, however, one may miss out on the experience of realising that the situation can be managed even without this safety net. As a result, one’s personal freedom of action can sometimes become increasingly restricted.</p>
<h2>Why do panic attacks seem to come out of nowhere?</h2><p>Panic attacks do not always have a single, clear trigger. Often, several factors come together. These can include prolonged stress, stressful life events, physical exhaustion, lack of sleep, heightened awareness of bodily signals, or previous experiences of anxiety.</p><p>Substances and medication can also play a role. Caffeine, nicotine, alcohol, certain drugs or changes in medication can trigger or intensify physical reactions. Therefore, a careful medical history also includes asking about consumption, medication, physical health and current stressors.</p><p>Sometimes the initial trigger is not consciously perceived. The body can nevertheless react to inner images, memories, thoughts or physical sensations. The fact that an attack appears unexpected therefore does not mean that it is imagined.</p>
<h2 id="abklaerung">When is a medical evaluation important?</h2><p>Symptoms such as chest pain, shortness of breath, a racing heart, dizziness or a feeling of fainting can occur during panic, but can also have physical causes. Particularly a first-time attack, new or significantly changed symptoms as well as complaints after taking medication or substances should be evaluated by a doctor.</p><div class="note"><strong>In an emergency:</strong> In cases of severe or persistent chest pain, severe breathlessness, loss of consciousness, symptoms of paralysis or other signs of an acute life-threatening situation, the emergency number 112 should be called. An educational article cannot replace a medical examination.</div><p>A medical assessment can also provide reassurance and establish a reliable basis for further psychotherapeutic evaluation.</p>
<h2 id="unterstuetzung">What can help in dealing with panic?</h2><p>During an acute panic reaction, the initial priority is to regain orientation. It can be helpful to feel both feet on the floor, consciously let your gaze wander around the room, and allow the out-breath to become slightly longer, calmly and without pressure. Forcibly deep breathing, on the other hand, can intensify symptoms.</p><p>Some people are helped by an inner phrase such as: „My body is in alarm mode right now. I am observing the reaction and letting it pass.“ This is not a guarantee that the anxiety will subside immediately. However, it can help to evaluate the sensations in a less catastrophic way.</p><h3>Psychotherapeutic support</h3><p>During psychotherapy, it can first be clarified together how the attacks develop, which triggers and appraisals play a role, and which situations are now being avoided. Cognitive behavioural therapy approaches, in particular, are well researched scientifically. These include psychoeducation, working on anxiety-intensifying appraisals and a carefully planned approach to feared situations or bodily sensations.</p><p>Depending on the individual’s personal history, additional stabilising techniques, work with the nervous system or processing of traumatic experiences may also be incorporated. EMDR may be considered if past experiences or inner images play a significant role in shaping the anxiety response. Whether a particular method is clinically appropriate can only be assessed following a detailed medical history.</p><p>Therefore, every therapy begins with the personal situation, potential physical and psychological comorbidities, resources, previous coping strategies and individual goals. In my private practice in Bad Schwalbach, I offer psychotherapeutic appointments in person or online.</p></article>
<section class="cream" id="faq"><div class="wrap"><p class="kicker">Questions and Answers</p><h2>Frequently asked questions about panic attacks</h2><div class="faq"><article><h3>Is a panic attack dangerous?</h3><p>The fear response itself can feel very terrifying. Since similar symptoms can also have physical causes, new, unusual or severe symptoms should be checked by a doctor.</p></article><article><h3>How long does a panic attack last?</h3><p>The most intense fear often reaches its peak within a short time and then subsides again. The duration and progression can vary individually.</p></article><article><h3>Why does a panic attack happen for no apparent reason?</h3><p>Not every trigger is consciously perceived. Stress, exhaustion, bodily signals, thoughts, memories, substances or past learning experiences can interact.</p></article><article><h3>What is the difference between a panic attack and a panic disorder?</h3><p>A single attack does not constitute a panic disorder. What is decisive are recurring attacks, persistent worry, behavioural changes and the overall professional assessment.</p></article><article><h3>Can avoidance intensify panic?</h3><p>Avoidance provides short-term relief. In the long term, it can reinforce the expectation that a situation is unmanageable and restrict one's personal scope of movement.</p></article><article><h3>Can EMDR be used for panic attacks?</h3><p>EMDR may be considered if distressing experiences or internal images contribute to the panic reaction. Whether the method is suitable is decided after a careful case history.</p></article><article><h3>Are appointments also available online?</h3><p>Yes, I offer psychotherapeutic sessions in person in Bad Schwalbach or also online. Which setting is suitable can be clarified during the initial contact.</p></article><article><h3>Does the health insurance cover the cost?</h3><p>Treatment at my private practice is self-funded. German statutory health insurance generally does not cover treatment by a psychotherapy practitioner authorised under the Heilpraktikergesetz. Reimbursement by private or supplementary health insurance depends on your policy. Please check directly with your insurer before starting treatment.</p></article></div></div></section>
<section><div class="wrap article"><p class="kicker">Sources and technical classification</p><h2>Further information</h2><ul class="sources"><li><a href="https://register.awmf.org/assets/guidelines/051-028l_S3_Behandlung-von-Angststoerungen_2021-06.pdf" target="_blank" rel="noopener">AWMF: S3 Guideline on the Treatment of Anxiety Disorders</a></li><li><a href="https://register.awmf.org/assets/guidelines/051-028p_S3_Behandlung-von-Angststoerungen_2022-07.pdf" target="_blank" rel="noopener">AWMF: Patient guideline for the treatment of anxiety disorders</a></li><li><a href="https://gesund.bund.de/mit-angst-umgehen" target="_blank" rel="noopener">Gesund.bund.de: Coping with anxiety</a></li><li><a href="https://www.nice.org.uk/guidance/cg113" target="_blank" rel="noopener">NICE: Generalised anxiety disorder and panic disorder in adults</a></li><li><a href="https://pubmed.ncbi.nlm.nih.gov/37132646/" target="_blank" rel="noopener">Papola and colleagues: Cognitive behavioural therapy for panic disorder, systematic review and network analysis</a></li></ul><p class="sources">As of September 2026. This article serves as general information and does not replace an individual medical, diagnostic or therapeutic assessment.</p></div></section>

<section class="final"><div class="wrap"><p class="kicker">In person or online</p><h2>Would you like to better understand your panic reactions?</h2><p>In a free 30-minute initial telephone consultation, you can describe your concern and clarify initial organisational questions. Alternatively, you can book an appointment for therapy directly or get in touch in writing.</p><div class="actions"><a class="btn" href="https://vereto.de/vereto/php/p_termin_buchen.php?key=a7894460184cbd3b2bc5f1da17b34eff79cc01e1" target="_blank" rel="noopener">Free initial consultation</a><a class="btn alt" href="https://vereto.de/vereto/php/p_termin_buchen.php?key=a7894460184cbd3b2bc5f1da17b34eff79cc01e1" target="_blank" rel="noopener">Book a therapy appointment</a><a class="btn alt" href="https://psychotherapy-pinder.de/en/contact-2/">Get in touch in writing</a></div></div></section></div>
<section class="pp-related" aria-label="Relevant articles and support" style="box-sizing:border-box;width:100%;max-width:900px;margin:0 auto;padding:48px 24px;color:#243447;font-family:Arial,sans-serif;font-size:18px;line-height:1.7"><h2 style="font-family:Arial,sans-serif;font-size:clamp(26px,4vw,36px);line-height:1.2">Relevant articles and support</h2><ul style="padding-left:22px"><li style="margin:10px 0"><a style="color:#1d5d82;text-decoration:underline;overflow-wrap:anywhere" href="https://psychotherapy-pinder.de/en/understanding-sleep-disorders-what-promotes-healthy-sleep-and-when-help-is-useful/">Understanding sleep disorders</a></li><li style="margin:10px 0"><a style="color:#1d5d82;text-decoration:underline;overflow-wrap:anywhere" href="https://psychotherapy-pinder.de/en/understanding-obsessions-and-compulsions-why-rituals-provide-short-term-relief/">Understanding obsessions and compulsions</a></li><li style="margin:10px 0"><a style="color:#1d5d82;text-decoration:underline;overflow-wrap:anywhere" href="https://psychotherapy-pinder.de/en/emdr-therapy-procedure-application-areas/">EMDR: Procedure and areas of application</a></li><li style="margin:10px 0"><a style="color:#1d5d82;text-decoration:underline;overflow-wrap:anywhere" href="https://psychotherapy-pinder.de/en/anxieties-phobias-and-sleep/">Support for anxiety and panic in Bad Schwalbach</a></li></ul><p>Information about <a style="color:#1d5d82;text-decoration:underline" href="https://psychotherapy-pinder.de/en/services/">Working methods, services and framework of the private practice in Bad Schwalbach</a> and further topics in the <a style="color:#1d5d82;text-decoration:underline" href="https://psychotherapy-pinder.de/en/know/">Knowledge overview</a>.</p></section>]]></content:encoded>
					
		
		
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		<title>When does media use become problematic?</title>
		<link>https://psychotherapy-pinder.de/en/problematic-media-use-warning-signs-help/</link>
		
		<dc:creator><![CDATA[PePi]]></dc:creator>
		<pubDate>Mon, 21 Sep 2026 21:35:49 +0000</pubDate>
				<category><![CDATA[Uncategorized]]></category>
		<guid ispermalink="false">https://psychotherapy-pinder.de/?p=268</guid>

					<description><![CDATA[Problematic media use When does media use become problematic? How can a problematic pattern of use be recognized, why screen time alone does not tell us much, and what support is available. By Petra PinderPsychotherapy practice in Bad SchwalbachReading time: approx. 9 minutes Digital media are part of everyday life. They enable contact, information, entertainment, and professional participation. Their use becomes problematic not only due to the many hours spent in front of a screen, but also because of the […]]]></description>
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They enable contact, information, entertainment and professional participation. Their use becomes problematic not solely due to many hours in front of a screen, but above all when control is lost, other areas of life permanently take a back seat and use is continued despite noticeable disadvantages.</p><nav class="toc" aria-label="Table of contents"><strong>In this post</strong><a href="#begriff">What does problematic media use mean?</a><a href="#warnzeichen">What are the warning signs?</a><a href="#ursachen">Why does a problematic pattern develop?</a><a href="#veraenderung">What can help with a change?</a><a href="#faq">Frequently asked questions</a></nav><h2 id="begriff">What does problematic media use mean?</h2><p>The term encompasses various digital activities, such as gaming, social networks, messaging, streaming, online pornography or online shopping. Not every intensive use is an addiction. Anyone who works on the computer for a long time professionally or plays a lot for a time therefore does not yet meet the criteria for a mental disorder.</p><p>From a professional perspective, terms such as problematic use, internet use disorders or media-related behavioural addictions are used. The World Health Organisation lists gaming disorder as a distinct clinical condition in the ICD-11. Crucial factors are impaired control, increasing priority given to gaming, and continuation despite negative consequences. The pattern must lead to significant impairment in personal, family, social, educational or occupational life.</p><p>Social networks, pornography, streaming and shopping can also be used in an addictive manner. However, the scientific and diagnostic classification varies in its level of development depending on the form of use. Self-diagnosis based on individual characteristics is therefore inadequate.</p><div class="note"><strong>The most important distinction:</strong> Screen time alone is not the deciding factor. More informative is the function the usage fulfils, how well it can be controlled and what consequences it has on everyday life.</div><h2 id="warnzeichen">Which warning signs can indicate a problem?</h2><p>A single sign does not yet prove addiction. If several changes occur over a longer period, a professional assessment can be useful.</p><div class="signs"><section class="sign"><h3>Loss of control</h3><p>Use regularly takes longer than planned. Repeated attempts to limit it fail or are only briefly successful.</p></section><section class="sign"><h3>Appropriation of thought</h3><p>The next game, new news or content keeps occupying your mind even when other tasks are pending.</p></section><section class="sign"><h3>Neglect</h3><p>Sleep, exercise, relationships, work, study, housework or other interests are increasingly taking a back seat.</p></section><section class="sign"><h3>Continuation despite consequences</h3><p>Use is maintained despite the presence of conflicts, exhaustion, a drop in performance, financial problems or psychological distress.</p></section><section class="sign"><h3>Severe internal restlessness</h3><p>Without access to the medium, irritability, restlessness, emptiness or a strong desire to go online again arise.</p></section><section class="sign"><h3>concealment</h3><p>Duration of use, expenditure, or content are played down, concealed, or kept secret from family members.</p></section></div><p>Problematic media use does not only affect teenagers or Generation Z. Adults can also fall into a stressful pattern, for example during phases of loneliness, professional overload, relationship crises, pain or mental illness.</p><h2 id="ursachen">Why can digital usage become so difficult to control?</h2><p>Digital offerings are quickly available and deliver rewards at short intervals: new messages, reactions, game wins, interesting videos, or sexual stimuli. Many applications are designed in such a way that the next piece of content follows without a conscious decision. This can reinforce habits.</p><h3>Reward learning, dopamine and addiction memory</h3><p>Dopamine is involved in motivation, anticipation and learning processes within the reward system. With repeated use, the brain can learn to associate certain cues, such as a notification, a game icon, a time of day or an unpleasant feeling, with the expected reward or relief. Such stimuli can later trigger a strong craving even before the actual use. In everyday language, this learned connection is often referred to as an „addiction memory“.</p><p>Behavioural addictions and substance-related dependencies overlap, among other things in reward learning, cue reactivity, craving and declining control. However, they are not identical in every respect. Furthermore, the phrasing that digital media simply „flood the brain with dopamine“ would be too sweeping: what is decisive is the interplay of learning processes, individual preconditions, the situation, the specific offering and repeated reinforcement.</p><p>Addiction transfer can occur when a problematic behaviour is stopped, but its underlying function remains. For example, instead of gaming, social media, shopping, gambling or a substance may increasingly be used. This does not necessarily happen. In therapy, therefore, it is important not only to reduce the visible behaviour, but also to include triggers, needs, co-occurring disorders and alternative coping strategies.</p><p>Often, the usage fulfils a psychological function at the same time. It can provide short-term distraction from worries, unpleasant feelings, conflicts or inner emptiness. Gaming can foster a sense of competence and belonging, social media can promise recognition or connection, and streaming can create a sense of calm. Initially, these effects are understandable. It becomes problematic when digital usage becomes the predominant or sole strategy for dealing with stress.</p><p>Co-occurring symptoms such as depression, anxiety, ADHD, sleep problems, compulsions, or other dependencies can play a role. The direction of this relationship is not always clear: psychological distress can encourage intensive media use, while a dysregulated usage pattern can exacerbate existing problems.</p><h2>What do current figures from Germany show?</h2><p>The annual JIM study describes the media habits of 12- to 19-year-olds in Germany. For 2025, it found an average daily smartphone screen time of just under four hours. Around 30 percent of respondents reported frequently feeling tired in the mornings because they put their smartphones away too late at night. These figures initially describe habits and potential consequences. They are not diagnoses.</p><p>The DAK-UKE longitudinal study has been investigating risky and pathological usage patterns among 10- to 17-year-olds since 2019. In the analysis of the autumn 2025 survey wave, published in 2026, more than a quarter of children and adolescents showed problematic patterns in their use of social media. 6.6 per cent were classified as pathological. Risky and pathological patterns also increased in video streaming. The results underline the need for early perception and support, but cannot be applied across the board to adults.</p><h2>What does research say about social media and mental health?</h2><p>The psychologist Jean Twenge has described links in large datasets between intensive digital media use and lower psychological well-being among adolescents. Her work has significantly shaped the public and scientific debate.</p><p>For a balanced assessment, it is nevertheless important: a statistical correlation does not automatically prove that social media is the sole cause of psychological distress. Reviews point to on average rather small negative correlations and emphasise that the type of use, content, personal preconditions, life situation and platform design play a role. For an individual assessment, therefore, the daily duration of use is not sufficient.</p><h2 id="veraenderung">What can help with a change?</h2><p>Radical bans are not sensible for everyone and are often difficult to implement in everyday digital life. A more helpful first step is a realistic look at one's own pattern:</p><ul><li>Document usage times and typical triggers over a few days,</li><li>testing notification-free periods and clearly defined usage windows,</li><li>Remove smartphones, consoles or laptops from sleeping and resting areas,</li><li>disable autoplay and unnecessary notifications,</li><li>build alternative options for contact, relaxation, activity and reward,</li><li>View relapses not as personal failure, but as an indication of triggers.</li></ul><p>If your own modifications do not work or your everyday life is already significantly impaired, addiction counselling, medical assessment or psychotherapy can help. At the beginning of therapy, there is a detailed medical history. This involves examining not only the duration of use and content, but also the living situation, triggers, functions of use, co-morbidities, resources and personal goals.</p><p>In my private practice in Bad Schwalbach, I offer psychotherapy appointments both in person and online. Together, we can determine whether there is problematic media use and which approach is best suited to your individual situation.</p><div class="note"><strong>Further guidance:</strong> The <a href="https://www.fv-medienabhaengigkeit.de/" target="_blank" rel="noopener">Fachverband Medienabhängigkeit e. V.</a> provides specialist information as well as contact points for affected individuals and their families. Parents and educational professionals can also find information on media education and youth media protection at <a href="https://www.medien-sicher.de/" target="_blank" rel="noopener">medien-sicher.de</a> by Günter Steppich.</div></article><section class="cream" id="faq"><div class="wrap"><p class="kicker">Questions and Answers</p><h2>Frequently asked questions about media use</h2><div class="faq"><article><h3>From how many hours is media use problematic?</h3><p>There is no universally valid number of hours. What matters is the ability to maintain control, the function of the usage and its consequences for sleep, relationships, commitments and well-being.</p></article><article><h3>Is every intensive gaming session an addiction?</h3><p>No. Temporarily intense gaming is not automatically a computer gaming disorder. Decisive factors are a persistent pattern, significant impairments and the overall clinical assessment.</p></article><article><h3>Can social media be addictive?</h3><p>Social networks can be used in an addictive manner. Diagnostics examine whether control is lost, usage is given priority, and use is continued despite negative consequences.</p></article><article><h3>Does the use of pornography also count?</h3><p>Pornography can also be used problematically or compulsively. What is decisive are not moral evaluations, but loss of control, psychological distress, and impairments in everyday life or in relationships.</p></article><article><h3>What can family members do?</h3><p>Address specific observations calmly and without shaming. One's own boundaries are equally important. The professional association for media addiction and addiction counselling centres also offer guidance for relatives.</p></article><article><h3>Does the health insurance cover the cost?</h3><p>Treatment at my private practice is self-funded. German statutory health insurance generally does not cover treatment by a psychotherapy practitioner authorised under the Heilpraktikergesetz. Reimbursement by private or supplementary health insurance depends on your policy. Please check directly with your insurer before starting treatment.</p></article></div></div></section><section><div class="wrap article"><p class="kicker">Sources and technical classification</p><h2>Further information</h2><ul class="sources"><li><a href="https://www.awmf.org/aktuelles/awmf-aktuell/diagnostik-und-therapie-von-internetnutzungsstoerungen" target="_blank" rel="noopener">AWMF: Diagnosis and treatment of internet use disorders</a></li><li><a href="https://www.who.int/news/item/14-09-2018-inclusion-of-gaming-disorder-in-icd-11" target="_blank" rel="noopener">World Health Organization: Gaming Disorder in the ICD-11</a></li><li><a href="https://www.fv-medienabhaengigkeit.de/" target="_blank" rel="noopener">Fachverband Medienabhängigkeit e. V.</a></li><li><a href="https://www.suchtberatung.digital/beratung-bei-mediensucht/" target="_blank" rel="noopener">DigiSucht: Advice on media addiction and problematic media use</a></li><li><a href="https://www.medien-sicher.de/" target="_blank" rel="noopener">medien-sicher.de: Youth media protection and media education</a></li><li><a href="https://mpfs.de/studie/jim-studie-2025/" target="_blank" rel="noopener">Medienpädagogischer Forschungsverbund Südwest: JIM Study 2025</a></li><li><a href="https://www.dak.de/dak/unternehmen/reporte-forschung/dak-studie-mediensucht-2026_164552" target="_blank" rel="noopener">DAK-Gesundheit and UKE: Media Addiction Study 2026</a></li><li><a href="https://www.jeantwenge.com/research/" target="_blank" rel="noopener">Jean Twenge: Research overview on digital media and mental health</a></li><li><a href="https://pubmed.ncbi.nlm.nih.gov/32699511/" target="_blank" rel="noopener">Weinstein and Lejoyeux: Neurobiological mechanisms of computer gaming disorder</a></li></ul><p class="sources">As of September 2026. This article is for general information purposes only and does not replace an individual diagnostic or therapeutic assessment.</p></div></section><section class="final"><div class="wrap"><p class="kicker">In person or online</p><h2>Would you like to change your media consumption?</h2><p>In a free 30-minute initial telephone consultation, you can describe your concerns and clarify initial organisational questions. Alternatively, you can book a therapy appointment directly or get in touch in writing.</p><div class="actions"><a class="btn" href="https://vereto.de/vereto/php/p_termin_buchen.php?key=a7894460184cbd3b2bc5f1da17b34eff79cc01e1" target="_blank" rel="noopener">Free initial consultation</a><a class="btn alt" href="https://vereto.de/vereto/php/p_termin_buchen.php?key=a7894460184cbd3b2bc5f1da17b34eff79cc01e1" target="_blank" rel="noopener">Book a therapy appointment</a><a class="btn alt" href="https://psychotherapy-pinder.de/en/contact-2/">Get in touch in writing</a></div></div></section></div>
<section class="pp-related" aria-label="Relevant articles and support" style="box-sizing:border-box;width:100%;max-width:900px;margin:0 auto;padding:48px 24px;color:#243447;font-family:Arial,sans-serif;font-size:18px;line-height:1.7"><h2 style="font-family:Arial,sans-serif;font-size:clamp(26px,4vw,36px);line-height:1.2">Relevant articles and support</h2><ul style="padding-left:22px"><li style="margin:10px 0"><a style="color:#1d5d82;text-decoration:underline;overflow-wrap:anywhere" href="https://psychotherapy-pinder.de/en/gen-z-and-mental-health-why-young-adults-are-under-pressure/">Gen Z and mental health</a></li><li style="margin:10px 0"><a style="color:#1d5d82;text-decoration:underline;overflow-wrap:anywhere" href="https://psychotherapy-pinder.de/en/understanding-addiction-and-dependence-what-happens-in-the-brain-and-why-relapses-are-not-a-failure-of-willpower/">Understanding addiction and dependency</a></li><li style="margin:10px 0"><a style="color:#1d5d82;text-decoration:underline;overflow-wrap:anywhere" href="https://psychotherapy-pinder.de/en/understanding-sleep-disorders-what-promotes-healthy-sleep-and-when-help-is-useful/">Understanding sleep disorders</a></li></ul><p>Information about <a style="color:#1d5d82;text-decoration:underline" href="https://psychotherapy-pinder.de/en/services/">Working methods, services and framework of the private practice in Bad Schwalbach</a> and further topics in the <a style="color:#1d5d82;text-decoration:underline" href="https://psychotherapy-pinder.de/en/know/">Knowledge overview</a>.</p></section>]]></content:encoded>
					
		
		
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		<title>What is EMDR and can it only be used for trauma?</title>
		<link>https://psychotherapy-pinder.de/en/emdr-therapy-procedure-application-areas/</link>
		
		<dc:creator><![CDATA[PePi]]></dc:creator>
		<pubDate>Mon, 21 Sep 2026 21:14:29 +0000</pubDate>
				<category><![CDATA[Uncategorized]]></category>
		<guid ispermalink="false">https://psychotherapy-pinder.de/?p=265</guid>

					<description><![CDATA[Trauma and EMDR What is EMDR and is it only applicable in the case of trauma? How the psychotherapeutic method works, how a treatment is prepared and under what conditions EMDR can be considered. By Petra PinderPsychotherapy practice in Bad SchwalbachReading time: approx. 8 minutes EMDR is primarily known from the treatment of post-traumatic disorders. The method […]]]></description>
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However, the method can also play a role in other psychological distress, particularly when distressing memories, mental images or past experiences continue to shape current experiences.</p><nav class="toc" aria-label="Table of contents"><strong>In this post</strong><a href="#was-ist-emdr">What does EMDR stand for?</a><a href="#ablauf">How does EMDR work?</a><a href="#anwendungsgebiete">Is EMDR only usable for trauma?</a><a href="#voraussetzungen">Why medical history and stabilisation are important</a><a href="#faq">Frequently asked questions</a></nav><h2 id="was-ist-emdr">What does EMDR stand for?</h2><p>EMDR is the abbreviation for <em>Eye Movement Desensitisation and Reprocessing</em>. In German, this is mostly translated as „Desensibilisierung und Verarbeitung durch Augenbewegung“ (Eye Movement Desensitisation and Reprocessing). The method was developed in the late 1980s by the psychologist Francine Shapiro.</p><p>During an EMDR sequence, the patient directs their attention to a distressing memory for a short time and simultaneously to an external stimulus. Frequently, the gaze follows the therapist's fingers from right to left. Alternating tactile or auditory stimuli can also be used. This so-called bilateral stimulation is intended to support the processing of the activated memory.</p><p>EMDR does not mean deleting memories. Rather, the goal is for past experiences to be reprocessed and to cause less distress in the present. Exactly how the method works continues to be investigated scientifically. For the treatment of post-traumatic stress disorder, or PTSD for short, EMDR is well researched and anchored in recognised guidelines.</p><div class="note"><strong>Important:</strong> EMDR is not a single exercise carried out without preparation. The method is part of an overall therapeutic process and requires a careful assessment of one's personal situation.</div><h2 id="ablauf">How does EMDR treatment work?</h2><p>The exact procedure is tailored individually. A multi-phased approach has proven effective:</p><div class="steps"><section class="step"><h3>Anamnesis and clarification of assignment</h3><p>At the beginning, the current workload, personal background, existing resources and potential risks are carefully assessed. Together, it is clarified which concern is to be addressed.</p></section><section class="step"><h3>Preparation and stabilisation</h3><p>Before actual processing, methods for self-soothing and distancing are established. It is crucial that the affected person feels sufficiently secure and capable of action.</p></section><section class="step"><h3>Selection of the distressing memory</h3><p>A specific situation, an internal image, a negative thought, as well as the associated feelings and bodily sensations are recorded.</p></section><section class="step"><h3>Bilateral stimulation and processing</h3><p>The memory is activated in short segments and connected with bilateral stimulation. In between, notice which thoughts, images, feelings or bodily reactions emerge.</p></section><section class="step"><h3>Conclusion and debrief</h3><p>Ultimately, attention is paid to adequate stability. Changes and possible reactions between sessions are discussed and reassessed at the following appointment.</p></section></div><h2 id="anwendungsgebiete">Is EMDR only usable for trauma?</h2><p>No. The best-evidenced application is post-traumatic stress disorder. Beyond that, EMDR is also used in psychotherapeutic practice for other conditions or is being scientifically investigated. These may include, amongst others:</p><ul><li>stressful life events and trauma-related disorders,</li><li>Fears, panic reactions and phobias,</li><li>experiences of loss and separation as well as prolonged grief reactions,</li><li>addictive disorders and strong cravings, for example in connection with relapse triggers,</li><li>depressive symptoms, where stressful experiences play a significant role,</li><li>chronic pain, particularly when it is associated with emotionally distressing memories.</li></ul><p>Scientific evidence varies depending on the specific symptoms. Therefore, it cannot be deduced from the diagnosis alone whether EMDR is suitable. The decisive factors are the individual situation, potential contraindications, the therapeutic objectives, and a thorough medical history.</p><h2 id="voraussetzungen">Why medical history and stabilisation are important</h2><p>A thorough medical history is the starting point of every therapy. It helps to understand symptoms in the context of the patient's life story, assess resources and jointly develop a viable approach.</p><p>With EMDR, it is also important to check whether there is currently sufficient stability. Sometimes, the primary focus at first is not the direct processing of a memory, but rather building up security, orientation and options for self-regulation. The pace is guided by the person, not by a rigid schedule.</p><p>In my private practice in Bad Schwalbach, I offer psychotherapy appointments either in person or online. Whether EMDR is suitable for the respective concern and in what framework is discussed individually.</p></article><section class="cream" id="faq"><div class="wrap"><p class="kicker">Questions and Answers</p><h2>Frequently asked questions about EMDR</h2><div class="faq"><article><h3>Do I have to tell everything in detail during EMDR?</h3><p>Not every detail needs to be spoken aloud. For responsible treatment, however, sufficient information is required to jointly assess the burden, objective and safety.</p></article><article><h3>How many sessions are necessary?</h3><p>That cannot be answered in a blanket way. Duration and course depend, among other things, on the issue, the background, the current stability and the agreed treatment goal.</p></article><article><h3>Can EMDR also help with anxiety or phobias?</h3><p>EMDR can be considered if distressing experiences or internal images are contributing to an anxiety response. Whether the method is suitable is decided after a careful case history.</p></article><article><h3>Is EMDR also used for addiction?</h3><p>EMDR is used, among other things, for processing distressing triggers and addiction-related cravings. It must be embedded within an individual, more comprehensive treatment plan.</p></article><article><h3>Is EMDR possible online?</h3><p>Depending on the matter and your personal situation, an online session may be possible. It will be clarified in advance whether the framework is sufficiently secure and professionally appropriate.</p></article><article><h3>Does the health insurance cover the cost?</h3><p>Treatment at my private practice is self-funded. German statutory health insurance generally does not cover treatment by a psychotherapy practitioner authorised under the Heilpraktikergesetz. Reimbursement by private or supplementary health insurance depends on your policy. Please check directly with your insurer before starting treatment.</p></article></div></div></section><section><div class="wrap article"><p class="kicker">Sources and technical classification</p><h2>Further information</h2><ul class="sources"><li><a href="https://register.awmf.org/assets/guidelines/155-001l_S3_Posttraumatische-Belastungsstoerung_2026-05.pdf" target="_blank" rel="noopener">AWMF: S3 Guideline on Post-Traumatic Stress Disorder</a></li><li><a href="https://www.who.int/news-room/fact-sheets/detail/post-traumatic-stress-disorder" target="_blank" rel="noopener">World Health Organization: Post-traumatic stress disorder</a></li><li><a href="https://www.emdria.de/emdr/was-ist-emdr/" target="_blank" rel="noopener">EMDRIA Germany: What is EMDR?</a></li><li><a href="https://www.emdria.de/emdr/anwendungsgebiete" target="_blank" rel="noopener">EMDRIA Germany: Fields of Application</a></li></ul><p class="sources">As of September 2026. This article is for general information purposes only and does not replace an individual diagnostic or therapeutic assessment.</p></div></section><section class="final"><div class="wrap"><p class="kicker">In person or online</p><h2>Does EMDR fit your needs?</h2><p>In a free 30-minute initial telephone consultation, you can describe your concerns and clarify initial organisational questions. Alternatively, you can book a therapy appointment directly or get in touch in writing.</p><div class="actions"><a class="btn" href="https://vereto.de/vereto/php/p_termin_buchen.php?key=a7894460184cbd3b2bc5f1da17b34eff79cc01e1" target="_blank" rel="noopener">Free initial consultation</a><a class="btn alt" href="https://vereto.de/vereto/php/p_termin_buchen.php?key=a7894460184cbd3b2bc5f1da17b34eff79cc01e1" target="_blank" rel="noopener">Book a therapy appointment</a><a class="btn alt" href="https://psychotherapy-pinder.de/en/contact-2/">Get in touch in writing</a></div></div></section></div>
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