Kaygı Bozuklukları: Duygular, Duygu Düzenleme ve Tedavi Yöntemleri

Öz

Gündelik hayatta birçok duygu deneyimleriz ve bu duygular hayatın birçok alanda hayati role sahiptir. Bu duygular çoğunlukla normal ve işlevsel olurken aşırı, yoğun ve uzun süreli deneyimlenen duygular kişinin işlevselliğini ciddi ölçüde zedeleyebilmektedir. Kaygı bozuklukları üst başlığı altında ele alınan bozukluk listesine göz gezdirdiğimizde bu alanların her birinde duyguyla ilişkili süreçlerin önemli bir etkiye sahip olduğu görülmektedir. Ancak sanılanın aksine yalnızca kaygı ve korku gibi temel duygular değil aynı zamanda tiksinti, öfke, suçluluk ve utanç gibi duyguların da dikkate alınması gereken bir role sahip olduğu bilinmektedir. Bu çalışmada bahsi geçen duyguların ve duygu düzenleme süreçlerinin kaygı bozukluklarındaki rolü tartışılmıştır. Akabinde Bilişsel Davranışçı Terapi, Kabul ve Kararlılık Terapisi ve Metakognitif terapilerin kaygı bozukluğu ile çalışırken psikoterapide duyguları nasıl ele aldıklarına kısaca değinilmiştir. Bu çalışmanın psikoterapide duyguların rolünün daha iyi anlaşılması için bir temel oluşturması ve bu alandaki çalışmalar için yeni bakış açıları sunması amaçlanmaktadır.

Anahtar Kelimeler

• Duygular
• Kaygı Bozuklukları
• Psikoterapi
• Duygu Düzenleme.

Anxiety Disorders: Emotions, Emotion Regulation and Treatment Methods

Abstract

We experience many emotions in daily life and these emotions play a vital role in many areas of life. While these emotions are mostly normal and functional, excessive, intense and prolonged emotions can seriously damage the functionality of the person. When we take a look at the list of disorders under the title of anxiety disorders, it is seen that emotional processes have a significant effect in each of these areas. However, contrary to popular belief, it is known that not only some core emotions such as anxiety and fear, but also disgust, anger, guilt and shame have a role to be considered. In this study, the role of these emotions and emotion regulation skills in anxiety disorders is discussed. Subsequently, how Cognitive Behavioral Therapy, Acceptance and Commitment Therapy and Metacognitive therapy address emotions in psychotherapy when working with anxiety disorders is briefly mentioned. This study is intended to provide a basis for a better understanding of the role of emotions in psychotherapy and to offer new perspectives for studies in this field.

Keywords

• Emotions
• Anxiety Disorders
• Psychotherapy
• Emotion Regulation.

References

1. Albano, A. M., & Krain, A. (2005). Anxiety and anxiety disorders in girls. In Handbook of behavioral and emotional problems in girls (pp. 79-116). Springer, Boston, MA.
2. Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical psychology review, 30(2), 217-237.
3. Alden, L. E., & Taylor, C. T. (2010). Interpersonal processes in social anxiety disorder. In Interpersonal Processes in the Anxiety Disorders: Implications for understanding psychopathology and treatment. (pp. 125-152). American Psychological Association.
4. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders: DSM-5. Arlington, VA, American Psychiatric Association.
5. Amstadter, A. (2008). Emotion regulation and anxiety disorders. Journal of anxiety disorders, 22(2), 211-221.
6. Barlow, D. H. (1991). Disorders of emotion. Psychological inquiry, 2(1), 58-71.
7. Beesdo, K., Knappe, S., & Pine, D. S. (2009). Anxiety and anxiety disorders in children and adolescents: developmental issues and implications for DSM-V. Psychiatric Clinics, 32(3), 483-524.
8. Brown, R. A., Kahler, C. W., Zvolensky, M. J., Lejuez, C. W., & Ramsey, S. E. (2001). Anxiety sensitivity: Relationship to negative affect smoking and smoking cessation in smokers with past major depressive disorder. Addictive behaviors, 26(6), 887-899.

9. Buhr, K., & Dugas, M. J. (2009). The role of fear of anxiety and intolerance of uncertainty in worry: An experimental manipulation. Behaviour research and therapy, 47(3), 215-223.
10. Buhr, K., & Dugas, M. J. (2012). Fear of emotions, experiential avoidance, and intolerance of uncertainty in worry and generalized anxiety disorder. International Journal of Cognitive Therapy, 5(1), 1-17.
11. Campbell-Sills, L., Barlow, D. H., Brown, T. A. & Hofmann, S. G. (2006). Effects of suppression and acceptance on emotional responses of individuals with anxiety and mood disorders. Behaviour research and therapy, 44(9), 1251-1263.
12. Chambless, D. L., & Gracely, E. J. (1989). Fear of fear and the anxiety disorders. Cognitive therapy and research, 13(1), 9-20.
13. Chavira, D. A., Shipon-Blum, E., Hitchcock, C., Cohan, S., & Stein, M. B. (2007). Selective mutism and social anxiety disorder: all in the family?. Journal of the American Academy of Child & Adolescent Psychiatry, 46(11), 1464-1472.
14. Choy, Y., Fyer, A. J., & Lipsitz, J. D. (2007). Treatment of specific phobia in adults. Clinical psychology review, 27(3), 266-286.
15. Cisler, J. M., Olatunji, B. O., & Lohr, J. M. (2009). Disgust, fear, and the anxiety disorders: A critical review. Clinical psychology review, 29(1), 34-46.
16. Clark, D. M. (1986). A cognitive approach to panic. Behaviour research and therapy, 24(4), 461-470.
17. Craske M. G. & Barlow D. H. (2014) Panic disorder and agoraphobia. In: Barlow D, editor. Clinical Handbook of Psychological Disorders: A Step-by-Step Treatment Manual (ss. 1-61). New York: The Guilford Press.
18. D’Avanzato, C., Joormann, J., Siemer, M., & Gotlib, I. H. (2013). Emotion regulation in depression and anxiety: examining diagnostic specificity and stability of strategy use. Cognitive Therapy and Research, 37(5), 968-980.
19. De Jong, P. J., & Muris, P. (2002). Spider phobia: Interaction of disgust and perceived likelihood of involuntary physical contact. Journal of anxiety disorders, 16(1), 51-65.
20. Deacon, B., & Abramowitz, J. (2006). Anxiety sensitivity and its dimensions across the anxiety disorders. Journal of anxiety disorders, 20(7), 837-857.
21. Dennis, T. A. (2007). Interactions between emotion regulation strategies and affective style: Implications for trait anxiety versus depressed mood. Motivation and Emotion, 31(3), 200-207.
22. Deschênes, S. S., Dugas, M. J., Fracalanza, K., & Koerner, N. (2012). The role of anger in generalized anxiety disorder. Cognitive Behaviour Therapy, 41(3), 261-271.
23. DiMauro, J., Domingues, J., Fernandez, G., & Tolin, D. F. (2013). Long-term effectiveness of CBT for anxiety disorders in an adult outpatient clinic sample: A follow-up study. Behaviour research and therapy, 51(2), 82-86.
24. Dymond, S., Dunsmoor, J. E., Vervliet, B., Roche, B., & Hermans, D. (2015). Fear generalization in humans: systematic review and implications for anxiety disorder research. Behavior therapy, 46(5), 561-582.
25. Eftekhari, A., Zoellner, L. A. & Vigil, S. A. (2009). Patterns of emotion regulation and psychopathology. Anxiety, Stress & Coping, 22(5), 571-586.
26. Eng, W., Coles, M. E., Heimberg, R. G., & Safren, S. A. (2005). Domains of life satisfaction in social anxiety disorder: Relation to symptoms and response to cognitive-behavioral therapy. Journal of anxiety disorders, 19(2), 143-156.
27. Erwin, B. A., Heimberg, R. G., Schneier, F. R., & Liebowitz, M. R. (2003). Anger experience and expression in social anxiety disorder: Pretreatment profile and predictors of attrition and response to cognitive-behavioral treatment. Behavior Therapy, 34(3), 331-350.
28. Esala, J. J., & Del Rosso, J. (2020). Emotions into disorder: Anxiety disorders and the social meaning of fear. Symbolic Interaction, 43(2), 235-256.
29. Fehm, L., Beesdo, K., Jacobi, F., & Fiedler, A. (2008). Social anxiety disorder above and below the diagnostic threshold: prevalence, comorbidity and impairment in the general population. Social psychiatry and psychiatric epidemiology, 43(4), 257-265.
30. Fergus, T. A., Valentiner, D. P., McGrath, P. B., & Jencius, S. (2010). Shame-and guilt-proneness: Relationships with anxiety disorder symptoms in a clinical sample. Journal of anxiety disorders, 24(8), 811-815.
31. Forman, E. M., Herbert, J. D., Moitra, E., Yeomans, P. D., & Geller, P. A. (2007). A randomized controlled effectiveness trial of acceptance and commitment therapy and cognitive therapy for anxiety and depression. Behavior modification, 31(6), 772-799.
32. Fracalanza, K., Koerner, N., Deschênes, S. S., & Dugas, M. J. (2014). Intolerance of uncertainty mediates the relation between generalized anxiety disorder symptoms and anger. Cognitive Behaviour Therapy, 43(2), 122-132.
33. Francis, G., Last, C. G., & Strauss, C. C. (1987). Expression of separation anxiety disorder: The roles of age and gender. Child Psychiatry and Human Development, 18(2), 82-89.
34. Freeston, M. H., Rhéaume, J., Letarte, H., Dugas, M. J., & Ladouceur, R. (1994). Why do people worry?. Personality and individual differences, 17(6), 791-802.
35. Graham, B. M., & Milad, M. R. (2011). The study of fear extinction: implications for anxiety disorders. American Journal of Psychiatry, 168(12), 1255-1265.
36. Gross, J. J. & Thompson, R. A. (2007). Emotion regulation: Conceptual foundations. J. J. Gross (Ed.), Handbook of emotion regulation (ss. 3-24). New York: Guilford.
37. Gross, J. J. & Muñoz, R. F. (1995). Emotion regulation and mental health. Clinical psychology: Science and practice, 2(2), 151-164.
38. Gross, J. J. (1998). The emerging field of emotion regulation: an integrative review. Review of general psychology, 2(3), 271.
39. Gross, J. J. (2002). Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology, 39(3), 281-291.
40. Gross, J. J. (Ed.). (2014). Handbook of emotion regulation. New York: Guilford publications.
41. Halldorsdottir, T., & Ollendick, T. H. (2016). Long-term outcomes of brief, intensive CBT for specific phobias: The negative impact of ADHD symptoms. Journal of Consulting and Clinical Psychology, 84(5), 465.
42. Hawkins, K. A., & Cougle, J. R. (2011). Anger problems across the anxiety disorders: findings from a population‐based study. Depression and anxiety, 28(2), 145-152.
43. Hayes, S. C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior therapy, 35(4), 639-665.
44. Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour research and therapy, 44(1), 1-25.
45. Hedman, E., Ström, P., Stünkel, A., & Mörtberg, E. (2013). Shame and guilt in social anxiety disorder: Effects of cognitive behavior therapy and association with social anxiety and depressive symptoms. PloS one, 8(4), e61713.
46. Hofmann, S. G., Anu Asnaani, M. A., & Hinton, D. E. (2010). Cultural aspects in social anxiety and social anxiety disorder. Depression and anxiety, 27(12), 1117-1127.
47. Hofmann, S. G., Sawyer, A. T., Fang, A., & Asnaani, A. (2012). Emotion dysregulation model of mood and anxiety disorders. Depression and anxiety, 29(5), 409-416.
48. Hua, A., & Major, N. (2016). Selective mutism. Current opinion in pediatrics, 28(1), 114-120.
49. Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H. U. (2012). Twelve‐month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International journal of methods in psychiatric research, 21(3), 169-184.
50. Koole, S. L. (2009). The psychology of emotion regulation: An integrative review. Cognition and emotion, 23(1), 4-41.
51. Kring, A. M., & Bachorowski, J. A. (1999). Emotions and psychopathology. Cognition & Emotion, 13(5), 575-599.
52. Krysanski, V. L. (2003). A brief review of selective mutism literature. The Journal of Psychology, 137(1), 29-40.
53. Leahy, R. L. (1996). Cognitive therapy: Basic principles and applications. Jason Aronson, Incorporated.
54. LeBeau, R. T., Glenn, D., Liao, B., Wittchen, H. U., Beesdo‐Baum, K., Ollendick, T., & Craske, M. G. (2010). Specific phobia: a review of DSM‐IV specific phobia and preliminary recommendations for DSM‐V. Depression and anxiety, 27(2), 148-167.
55. Lissek, S., Powers, A. S., McClure, E. B., Phelps, E. A., Woldehawariat, G., Grillon, C., & Pine, D. S. (2005). Classical fear conditioning in the anxiety disorders: a meta-analysis. Behaviour research and therapy, 43(11), 1391-1424.
56. Manassis, K., Fung, D., Tannock, R., Sloman, L., Fiksenbaum, L., & McInnes, A. (2003). Characterizing selective mutism: is it more than social anxiety?. Depression and Anxiety, 18(3), 153-161.
57. Martin, R. C. & Dahlen, E. R. (2005). Cognitive emotion regulation in the prediction of depression, anxiety, stress, and anger. Personality and individual differences, 39(7), 1249-1260.
58. Masi, G., Mucci, M., & Millepiedi, S. (2001). Separation anxiety disorder in children and adolescents. CNS drugs, 15(2), 93-104.
59. Mason, E. C., & Richardson, R. (2010). Looking beyond fear: The extinction of other emotions implicated in anxiety disorders. Journal of Anxiety Disorders, 24(1), 63-70.
60. McLaughlin, K. A., Hatzenbuehler, M. L., Mennin, D. S. & Nolen-Hoeksema, S. (2011). Emotion dysregulation and adolescent psychopathology: A prospective study. Behaviour research and therapy, 49(9), 544-554.
61. McNally, R. J. (2002). Anxiety sensitivity and panic disorder. Biological psychiatry, 52(10), 938-946.
62. Moscovitch, D. A., McCabe, R. E., Antony, M. M., Rocca, L., & Swinson, R. P. (2008). Anger experience and expression across the anxiety disorders. Depression and anxiety, 25(2), 107-113.
63. Muris, P., Merckelbach, H., Schmidt, H., & Tierney, S. (1999). Disgust sensitivity, trait anxiety and anxiety disorders symptoms in normal children. Behaviour Research and Therapy, 37(10), 953-961.
64. Nezlek, J. B. & Kuppens, P. (2008). Regulating positive and negative emotions in daily life. Journal of personality, 76(3), 561-580.
65. Niles, A. N., Burklund, L. J., Arch, J. J., Lieberman, M. D., Saxbe, D., & Craske, M. G. (2014). Cognitive mediators of treatment for social anxiety disorder: Comparing acceptance and commitment therapy and cognitive-behavioral therapy. Behavior therapy, 45(5), 664-677.
66. Nolen-Hoeksema, S. & Aldao, A. (2011). Gender and age differences in emotion regulation strategies and their relationship to depressive symptoms. Personality and individual differences, 51(6), 704-708.
67. Normann, N., van Emmerik, A. A., & Morina, N. (2014). The efficacy of metacognitive therapy for anxiety and depression: A meta‐analytic review. Depression and anxiety, 31(5), 402-411.
68. Oerbeck, B., Overgaard, K. R., Stein, M. B., Pripp, A. H., & Kristensen, H. (2018). Treatment of selective mutism: a 5-year follow-up study. European Child & Adolescent Psychiatry, 27(8), 997-1009.
69. Olatunji, B. O., Cisler, J., McKay, D., & Phillips, M. L. (2010). Is disgust associated with psychopathology? Emerging research in the anxiety disorders. Psychiatry research, 175(1-2), 1-10.
70. Olatunji, B. O., Smits, J. A., Connolly, K., Willems, J., & Lohr, J. M. (2007). Examination of the decline in fear and disgust during exposure to threat-relevant stimuli in blood–injection–injury phobia. Journal of anxiety disorders, 21(3), 445-455.
71. Pittig, A., Treanor, M., LeBeau, R. T., & Craske, M. G. (2018). The role of associative fear and avoidance learning in anxiety disorders: Gaps and directions for future research. Neuroscience & Biobehavioral Reviews, 88, 117-140.
72. Rodebaugh, T. L., Holaway, R. M., & Heimberg, R. G. (2004). The treatment of social anxiety disorder. Clinical Psychology Review, 24(7), 883-908.
73. Salters-Pedneault, K., Roemer, L., Tull, M. T., Rucker, L., & Mennin, D. S. (2006). Evidence of broad deficits in emotion regulation associated with chronic worry and generalized anxiety disorder. Cognitive Therapy and Research, 30(4), 469-480.
74. Sawchuk, C. N., Lohr, J. M., Tolin, D. F., Lee, T. C., & Kleinknecht, R. A. (2000). Disgust sensitivity and contamination fears in spider and blood–injection–injury phobias. Behaviour Research and Therapy, 38(8), 753-762.
75. Schneider, S., Blatter-Meunier, J., Herren, C., Adornetto, C., In-Albon, T., & Lavallee, K. (2011). Disorder-specific cognitive-behavioral therapy for separation anxiety disorder in young children: a randomized waiting-list-controlled trial. Psychotherapy and psychosomatics, 80(4), 206-215.
76. Schoenleber, M., Chow, P. I., & Berenbaum, H. (2014). Self‐conscious emotions in worry and generalized anxiety disorder. British Journal of Clinical Psychology, 53(3), 299-314.
77. Shin, L. M., & Liberzon, I. (2010). The neurocircuitry of fear, stress, and anxiety disorders. Neuropsychopharmacology, 35(1), 169-191.
78. Shiota, M. N. & Kalat, J. W. (2012). Emotion (Second ed.). Belmont, CA: Wadswort.
79. Stech, E. P., Lim, J., Upton, E. L., & Newby, J. M. (2020). Internet-delivered cognitive behavioral therapy for panic disorder with or without agoraphobia: a systematic review and meta-analysis. Cognitive Behaviour Therapy, 49(4), 270-293.
80. Stein, M. B., & Sareen, J. (2015). Generalized anxiety disorder. New England Journal of Medicine, 373(21), 2059-2068.
81. Tangney, J. P., Wagner, P., & Gramzow, R. (1992). Proneness to shame, proneness to guilt, and psychopathology. Journal of abnormal psychology, 101(3), 469.
82. Taylor, S., Koch, W. J., & McNally, R. J. (1992). How does anxiety sensitivity vary across the anxiety disorders?. Journal of anxiety disorders, 6(3), 249-259.
83. Watson, D., Clark, L. A., & Stasik, S. M. (2011). Emotions and the emotional disorders: A quantitative hierarchical perspective. International Journal of Clinical and Health Psychology, 11(3), 429-442.
84. Wells, A. (1999). A metacognitive model and therapy for generalized anxiety disorder. Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice, 6(2), 86-95.
85. Werner, K. H., Goldin, P. R., Ball, T. M., Heimberg, R. G. & Gross, J. J. (2011). Assessing emotion regulation in social anxiety disorder: The emotion regulation interview. Journal of Psychopathology and Behavioral Assessment, 33(3), 346-354.
86. Yeganeh, R., Beidel, D. C., & Turner, S. M. (2006). Selective mutism: more than social anxiety?. Depression and anxiety, 23(3), 117-123.