Kanser Tanısı Olan Kişilerde Kabul ve Kararlılık Terapisi Uygulamaları: Sistematik Bir Derleme

Year 2019, Volume: 39 Issue: 2, 459 - 485, 24.12.2019

Samet Baş Gülay Dirik

https://doi.org/10.26650/SP2019-0025

Abstract

Kanser, bu hastalığa sahip olan kişilerin fiziksel sağlık durumları üzerindeki olumsuz etkilerin yanı sıra önemli psikolojik sorunları da beraberinde getiren ciddi bir hastalıktır. Günümüzde psikolojik tedaviler olumsuz belirtilerin azaltılmasında etkili sonuçlar ortaya koymaktadır. Üçüncü kuşak bilişsel davranışçı psikoterapilerden biri olan Kabul ve Kararlılık Terapisi kanser hastalarında belirtilerin azaltılmasında önemli bir tedavi yaklaşımıdır. Özellikle hastalığın kendisinin ve olumsuz etkilerinin kabul edildiği ve psikolojik esneklik düzeyinin yüksek olduğu durumlar daha az belirti ve hastalık sürecine uyum gösterme davranışında artış gibi olumlu sonuçlarla ilişkili bulunmaktadır. Bu çalışma kapsamında kanser hastalarının psikolojik sorunlarına yönelik uygulanmış Kabul ve Kararlılık Terapisi temelli tedavi yaklaşımları sistematik bir şekilde değerlendirilmiştir. Sadece kanser hastaları örneklemini, en az ön test ve son test ölçümleri ve Kabul ve Kararlılık Terapisinin temel bileşenlerini kapsayan bir müdahaleyi kullanmak gibi içleme kriterlerini karşılayan on beş çalışma detaylı olarak incelenmiştir. Sonuçlar, uygulanan tedaviler sonrasında hem tedavi öncesine hem de kontrol gruplarına kıyasla kanser hastalarının psikolojik esneklik, travma sonrası gelişim, maneviyat ve yaşam kalitesi düzeylerinde anlamlı artışlar olduğunu; hastalığın tekrar edeceği korkusu, depresyon, kaygı, stres, duygusal kontrol ve düşünceleri bastırma davranışlarında ise anlamlı azalmalar olduğunu göstermektedir. Ayrıca, sadece tedavi öncesine göre farkındalık düzeylerinde artış gözlenirken, ağrı ve ilişkili belirtiler, tükenmişlik, uyku sorunları ve hareketsiz yaşam tarzında anlamlı azalmalar görülmüştür. Hem bireysel hem de grup olarak nispeten kısa süreli bir şekilde uygulanabilen Kabul ve Kararlılık Terapisi temelli müdahale yöntemleriyle kanser hastalarının olumsuz psikolojik belirtileri azaltılabilir ve bunun yanında yaşama dair beklentilerinin ve yaşam kalitelerinin artması sağlanabilir. Ancak müdahalenin güvenirliğinin artması ve farklı kanser hastalarına genellenebilmesi için gelecekte yöntemsel açıdan daha kontrollü ve terapi kazanımlarının daha uzun dönemli olarak takip edileceği çalışmalara ihtiyaç duyulmaktadır. 

Keywords

Kanser, kabul ve kararlılık terapisi, psikolojik esneklik, sistematik derleme

Acceptance and Commitment Therapy Interventions in Patients Diagnosed with Cancer: A Systematic Review

Abstract

Cancer is a serious disease that brings with it important psychological problems as well as the negative effects on the physical health of survivors. Nowadays, psychological treatments reveal effective results on reducing such negative symptoms. Acceptance and Commitment Therapy (ACT) - one of the third wave behavioral and cognitive psychotherapies - is an important treatment approach in reducing the negative symptoms of cancer survivors. In particular, situations in which the disease itself and its adverse effects were accepted and the level of psychological flexibility was high were found to be associated with less negative symptoms and more positive outcomes such as adherence with the disease process. This study systemtically evaluated ACT based interventions on the psychological problems of cancer survivors. Fifteen studies that met the following criteria were examined in detail: using only a sample of cancer patients, having at least a pre-test and a post-test assessment, and an intervention involving basic components of ACT. The results showed that following the treatments, there were significant increases in psychological flexibility, posttraumatic growth, spirituality, quality of life and significant decreases in fear of recurrence, depression, anxiety, stress, emotional control, and thought suppression levels of patients when comparing both pre-treatment and control groups. Additionally, there were significant increases in mindfulness compared to pre-treatment results alone, but a significant decrease in pain and related symptoms, burnout, sleep problems and sedentary behaviors. ACT interventions, which can be applied both individually or in groups and over relatively short period of time, are promising as an alternative treatment for cancer patients to reduce their negative psychological symptoms as well as to increase their life expectancy and quality of life. However, in order to generalize the findings for different cancer patients and to increase the confidence of intervention, future studies should be more controlled, reliable and long-term.

Keywords

Cancer, acceptance and commitment therapy, psychological flexibility, systematic review

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