Kronik Ağrı Tedavisinde Üçüncü Dalga Bilişsel-Davranışçı Terapiler: Anlatısal Bir Derleme

Abstract

Kronik ağrı, dünya genelinde yetişkin nüfusun yaklaşık beşte birini etkileyen önemli bir halk sağlığı sorunudur. Depresyon, anksiyete bozuklukları ve madde kullanım sorunlarının yanı sıra geniş çaplı işlevsellik kayıplarıyla yakından ilişkili olması, kronik ağrıyı hem bireysel hem de toplumsal düzeyde ciddi bir yük haline getirmektedir. Bu çok boyutluluk, tedavide biyopsikososyal yaklaşımı gerekli kılmakta ve özellikle psikoterapötik müdahaleleri sürecin merkezine yerleştirmektedir. Bu çerçevede uzun süre “altın standart” kabul edilen Bilişsel-Davranışçı Terapi’nin (BDT), ağrıya bağlı psikolojik semptomları hedef alarak hastaların yaşam kalitesini artırmada etkili olduğu çok sayıda çalışmada tutarlı biçimde ortaya konmuştur. Son yirmi yılda ise “üçüncü dalga BDT” olarak adlandırılan çağdaş terapi modelleri kabul, farkındalık ve şefkat temelli müdahaleler aracılığıyla kronik ağrı yönetimine yeni bir boyut kazandırmıştır. Bunlar arasında Kabul ve Adanmışlık Terapisi ile Mindfulness Temelli Bilişsel Terapi, en güçlü kanıt tabanına sahip yaklaşımlar olarak öne çıkarken, Diyalektik Davranış Terapisi, Şefkat Odaklı Terapi ve Fonksiyonel Analitik Psikoterapi henüz erken aşama kanıtlarla desteklenen, ancak giderek artan klinik ilgi gören modeller olarak dikkat çekmektedir. Bu derlemenin amacı, söz konusu üçüncü dalga bilişsel-davranışçı terapilerin kronik ağrıya uyarlamalarını kuramsal dayanakları, klinik uygulama biçimleri ve kanıt düzeyleri çerçevesinde ele almak; böylece hem klinik uygulamalara hem de gelecekteki araştırmalara yol gösterici olacak bir sentez sunmaktır.

Keywords

• bilişsel-davranışçı terapi
• kronik ağrı
• üçüncü dalga terapiler

Third Wave Cognitive-Behavioural Therapies in the Treatment of Chronic Pain: A Narrative Review

Abstract

Chronic pain is a significant public health issue affecting approximately one-fifth of the adult population worldwide. Its close association with depression, anxiety, substance use problems, and widespread functional impairment makes chronic pain a serious burden at both individual and societal levels. This multidimensional nature necessitates a biopsychosocial treatment approach and, in particular, positions psychotherapeutic interventions at the center of care. In this context, Cognitive-Behavioral Therapy (CBT), long regarded as the “gold standard,”, has been consistently demonstrated across numerous studies to improve patients’ quality of life by targeting pain-related psychological symptoms. Over the past two decades, however, contemporary therapy models known as the “third wave of CBT” have added a new dimension to chronic pain management through acceptance-, mindfulness-, and compassion-based interventions. Among these, Acceptance and Commitment Therapy and Mindfulness-Based Cognitive Therapy stand out as approaches with the strongest evidence base. In contrast, Dialectical Behavior Therapy, Compassion-Focused Therapy, and Functional Analytic Psychotherapy are supported by early-stage evidence but are attracting increasing clinical interest. This review aims to examine the adaptations of third-wave cognitive-behavioral therapies to chronic pain in terms of their theoretical foundations, clinical applications, and levels of evidence, thereby providing a synthesis to guide both clinical practice and future research.

Keywords

• chronic pain
• cognitive-behavioural therapy
• third wave therapies

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