OBSESİF-KOMPÜLSİF BOZUKLUĞUN RUMİNASYON VE TEMİZLİK ALT BOYUTLARINDAKİ BİLİŞSEL HATALARIN BİLİŞSEL DAVRANIŞÇI TEDAVİ İLE DEĞİŞİMLERİNİN KARŞILAŞTIRILMASI

Year 2021, Volume: 23 Issue: 3, 635 - 644, 31.12.2021

Mehmet Hamdi Örüm

https://doi.org/10.24938/kutfd.804474

Cited By: 1

Abstract

Amaç: Obsesif-kompülsif bozukluğun ruminasyon ve temizlik boyutlarındaki bilişsel hata düzeyleri farklıdır. Bu çalışmada obsesif-kompülsif bozukluk-ruminasyon ve obsesif-kompülsif bozukluk-temizlik gruplarında ilaç tedavisine ek olarak uygulanan bilişsel davranışçı tedavinin bilişsel hatalar üzerine etkisi incelendi.

Gereç ve Yöntemler: Çalışmaya toplamda 31 hasta (obsesif-kompülsif bozukluk-ruminasyon grubu=15; obsesif-kompülsif bozukluk-temizlik=16) dâhil edildi. Bu ileriye yönelik çalışmada obsesif-kompülsif bozukluk tanısı DSM-5’e göre konuldu. Alt boyutlar klinik ve Maudsley Obsesif Kompülsif Soru Listesinin birlikte değerlendirilmesiyle belirlendi. Bilişsel hatalar düşünce özellikleri ölçeği ile, hastanın genel durumu global değerlendirme ölçeği ile değerlendirildi. Bilişsel davranışçı tedavi seansları 3-10 gün arasındaki sıklıklarda ve toplamda sekiz seans olarak gerçekleştirildi. Maudsley Obsesif Kompülsif Soru Listesi sadece tedavi başlangıcında, düşünce özellikleri ölçeği ve global değerlendirme ölçeği hem tedavi başlangıcında hem de sekiz haftalık tedavi sonrasında uygulandı.

Bulgular: Gruplar yaş ve eğitim durumu açısından benzerdi (sırasıyla p=0.345, p=0.258). Tedavi öncesinde gruplar arasında düşünce özellikleri ölçeği-IP (sosyal ilişki) açısından anlamlı farklılık vardı (p=0.025) ve bu anlamlı farklılık tedavi sonrasında da devam etti (p=0.012). Obsesif-kompülsif bozukluk-ruminasyon grubu düşünce özellikleri ölçeği-IP (p<0.001) ve düşünce özellikleri ölçeği-PA (kişisel başarı) (p=0.043) açısından bilişsel davranışçı tedaviden anlamlı olarak etkilenmişti. Obsesif-kompülsif bozukluk-temizlik grubu ise sadece düşünce özellikleri ölçeği-IP açısından bilişsel davranışçı tedaviden etkilenmişti (p=0.001).

Sonuç: Bu çalışmanın en önemli sonucu bilişsel davranışçı tedavinin sosyal ilişkilerdeki bilişsel hataları kişisel başarılardaki bilişsel hatalara göre daha fazla azaltmasıdır. Ayrıca, bireysel başarı ile ilişkili bilişsel hatalar ruminasyon alt boyutunda bilişsel davranışçı tedavi ile azalırken, temizlik alt boyutunda etkilenmemektedir.

Keywords

Obsesif-kompülsif bozukluk, biliş, alt boyut, bilişsel davranışçı tedavi

Comparison of Alterations of Cognitive Errors in Rumination and Cleaning Dimensions of Obsessive-Compulsive Disorder with Cognitive Behavioral Treatment

Abstract

Objective: Cognitive error levels in rumination and cleaning dimensions of obsessive-compulsive disorder are different. In this study, the effect of cognitive behavioral therapy applied in addition to drug therapy in obsessive-compulsive disorder-rumination and obsessive-compulsive disorder-cleaning groups on cognitive errors was examined.

Material and Methods: A total of 31 patients (obsessive-compulsive disorder-rumination=15; obsessive-compulsive disorder-cleaning=16) were included in the study. In this prospective study, obsessive-compulsive disorder diagnosis was made according to DSM-5. The sub-dimensions were determined by evaluating the clinical and Maudsley Obsessive Compulsive Inventory together. Cognitive errors were evaluated with the cognitive distortions scale, and the general condition of the patient was evaluated with the global assessment scale. Cognitive behavioral therapy sessions were carried out at frequencies between 3-10 days and in eight sessions in total. Maudsley Obsessive Compulsive Inventory was administered only at the beginning of the treatment, cognitive distortions scale and global assessment scale both at the beginning of the treatment and after eight weeks of treatment.

Results: The groups were similar in terms of age and education level (p=0.345 and p=0.258 respectively). Before the treatment, there was a significant difference between the groups in terms of cognitive distortions scale-IP (interpersonal relationship) (p=0.025), and this significant difference continued after the treatment (p=0.012). The obsessive-compulsive disorder-rumination group was significantly affected by cognitive behavioral therapy in terms of cognitive distortions scale-IP (p<0.001) and cognitive distortions scale-PA (personal achievement) (p=0.043). The obsessive-compulsive disorder-cleaning group was only affected by cognitive behavioral therapy in terms of cognitive distortions scale-IP (p=0.001).

Conclusion: The most important result of this study is that cognitive behavioral therapy reduces cognitive errors in social relationships more than cognitive errors in personal achievements. In addition, cognitive errors related to personal achievement were reduced by cognitive behavioral therapy in the rumination sub-dimension, while they were not affected in the cleaning sub-dimension.

Keywords

Obsessive-compulsive disorder, cognition, sub-dimension, cognitive behavioral therapy

References

• 1. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). American Psychiatric Association. 5th ed. Arlington, United States. American Psychiatric Publishing, 2013.
• 2. Williams MT, Mugno B, Franklin M, Faber S. Symptom dimensions in obsessive-compulsive disorder: phenomenology and treatment outcomes with exposure and ritual prevention. Psychopathology. 2013;46(6):365-76.
• 3. Özen ME, Kalenderoğlu A, Çelik M, Örüm MH, Hocaoğlu Ç. Obsesif kompulsif bozukluk güçlendirme tedavisinde aripiprazol, klomipramin ve buspironun etkinliği: Retrospektif bir araştırma. Adıyaman Üni Sağlık Bilimleri Derg. 2019;5(1):1293-302.
• 4. Ruscio A, Stein D, Chiu W, Kessler R. The epidemiology of obsessive-compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry. 2010;15(1):53-63.
• 5. Yorulmaz O, Işık B. Cultural context, obsessive-compulsive disorder symptoms, and cognitions: a preliminary study of three Turkish samples living in different countries. Int J Psychol. 2011;46(2):136-43.
• 6. Karadaĝ F, Oguzhanoglu NK, Ozdel O, Ateşci FC, Amuk T. OCD symptoms in a sample of Turkish patients: a phenomenological picture. Depress Anxiety. 2006;23(3):145-52..
• 7. Yee K, Serrano D, Kando J, McElroy SL. A psychometric analysis and revalidation of the Yale-Brown Obsessive Compulsive Scale modified for Binge Eating in adults with binge eating disorder. Qual Life Res. 2019;28(12):3385-94.
• 8. Baer L. Factor analysis of symptom subtypes of obsessive-compulsive disorder and their relation to personality and tic disorders. J Clin Psychiatry. 1994;55 Suppl:18-23.
• 9. Leckman JF, Grice DE, Boardman J, Zhang H, Vitale A, Bondi C et al. Symptoms of obsessive-compulsive disorder. Am J Psychiatry. 1997;154(7):911-7.
• 10. Mataix-Cols D, Rauch S, Manzo P, Jenike M, Baer L. Use of factor-analyzed symptom dimensions to predict outcome with serotonin reuptake inhibitors and placebo in the treatment of obsessive-compulsive disorder. Am J Psychiatry. 1999;156(9):1216-409.
• 11. Abramowitz JS, Franklin ME, Schwartz SA, Furr JM. Symptom presentation and outcome of cognitive-behavioral therapy for obsessive compulsive disorder. J Consult Clin Psychol. 2003;71(6):1049-57.
• 12. Hodsgon RJ, Rachman S. Obsessional-compulsive complaints. Behav Res Ther. 1977;15(5):389-95.
• 13. Erol N, Savaşır I. Maudsley obsesif kompulsif soru listesi. XXIV. Ulusal Psikiyatri ve Nörolojik Bilimler Kongresi Bildiri Kitabı, 23 Eylül 1988, Ankara, Türkiye. Ankara: GATA Basımevi; 1988:107-14.
• 14. Benzina N, Mallet L, Burguière E, N'Diaye K, Pelissolo A. Cognitive dysfunction in obsessive-compulsive disorder. Curr Psychiatry Rep. 2016;18(9):80.
• 15. Örüm MH. The relationship between cognitive errors and psychiatric symptoms in obsessive-compulsive disorder. Med J Ankara Tr Res Hosp. 2020;53(1):29-35.
• 16. Örüm MH. Cognitive error characteristics of rumination and cleaning dimensions of obsessive-compulsive disorder. Anadolu Psikiyatri Derg. 2020;21(6):592-9.
• 17. O'Connor K, Todorov C, Robillard S, Borgeat F, Brault M. Cognitive-behaviour therapy and medication in the treatment of obsessive-compulsive disorder: a controlled study. Can J Psychiatry. 1999;44(1):64-71.
• 18. Olatunji BO, Davis ML, Powers MB, Smits JA. Cognitive-behavioral therapy for obsessive-compulsive disorder: a meta-analysis of treatment outcome and moderators. J Psychiatr Res. 2013;47(1):33-41.
• 19. Keeley ML, Storch EA, Merlo LJ, Geffken GR. Clinical predictors of response to cognitive-behavioral therapy for obsessive-compulsive disorder. Clin Psychol Rev. 2008;28(1):118-30.
• 20. Özdel K, Taymur I, Guriz SO, Tulaci RG, Kuru E, Turkcapar MH. Measuring cognitive errors using the cognitive distortions scale (CDS): Psychometric properties in clinical and non-clinical samples. Plos ONE. 2014;9(8):E105956.
• 21. Endicott J, Spitzer RL, Fleiss JL, Cohen J. The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry. 1976;33(6):766-71.
• 22. Alvarenga PG, do Rosario MC, Cesar RC, Manfro GG, Moriyama TS, Bloch MH et al. Obsessive-compulsive symptoms are associated with psychiatric comorbidities, behavioral and clinical problems: a population-based study of Brazilian school children. Eur Child Adolesc Psychiatry. 2016;25(2):175-82.
• 23. Alemany-Navarro M, Cruz R, Real E, Segalàs C, Bertolín S, Rabionet R et al. Looking into the genetic bases of OCD dimensions: a pilot genome-wide association study. Transl Psychiatry. 2020;10(1):151.
• 24. Julien D, O’Connor KP, Aardema CT. The specificity of belief domains in obsessive–compulsive symptom subtypes. Pers Individ Differ. 2006;41(7):1205-16.
• 25. Sookman D, Pinard G. Overestimation of threat and intolerance of uncertainty in obsessive compulsive disorder. In: Frost RO, Steketee G, eds. Cognitive Approaches to Obsessions and Compulsions: Theory, Assessment and Treatment. Oxford. Elsevier, 2002:63-89.
• 26. Lee HJ, Kwon SM. Two different types of obsession: autogenous obsessions and reactive obsessions. Behav Res Ther. 2003;41:11-29.
• 27. Tolin DF, Woods CM, Abramowitz JS. Relationship between obsessive beliefs and obsessive-compulsive symptoms. Cognit Ther Res. 2003;27:657-69.
• 28. Emmelkamp PMG, Aardema A. Metacognition, specific obsessive–compulsive beliefs and obsessive–compulsive behaviour. Clin Psychol Psychother. 1999;6:139-45.
• 29. Öst LG, Riise EN, Wergeland GJ, Hansen B, Kvale G. Cognitive behavioral and pharmacological treatments of OCD in children: A systematic review and meta-analysis. J Anxiety Disord. 2016;43:58-69.
• 30. O’Connor KP, Aardema F, Robillard S, Guay S, Pélissier MC, Todorov C et al. Cognitive behaviour therapy and medication in the treatment of obsessive–compulsive disorder. Acta Psychiatrica Scandinavica. 2006;113(5):408-19.