DEPRESYONDA BİLİŞSEL DAVRANIŞÇI TERAPİYE DAYALI ÇEVRİM İÇİ PSİKOLOJİK DANIŞMA: OLGU SUNUMU

Abstract

Bu makale, depresyonun bilişsel davranışçı terapi ile tedavisine ilişkin bir olgu sunumu içermektedir. Kadın danışan 20 yaşında bir üniversite öğrencisidir. Danışanda çökkün ve mutsuz duygudurum, karamsarlık, kararsızlık, odaklanmada zorluk, suçluluk-değersizlik ve ölüm düşünceleri, sosyal geri çekilme, enerji azlığı ve iştah azlığı belirtileri bulunmaktadır. Danışana DSM-5 tanı kriterleri temel alınarak sekiz hafta süresince bilişsel davranışçı psikoterapi uygulanmıştır. Psikoterapi süreci haftada bir gün, 50 dakika olacak şekilde yürütülmüştür. Tedavi sonlandıktan bir ay sonra izleme seansı yapılmıştır. Depresif belir-tileri olan danışanın bilişsel ve davranışsal müdahaleler ile iyi oluşuna katkı sağlamak amaçlanmıştır. Makalede danışanın öyküsü, depresif belirtileri, terapi süreci ve süreçteki ilerlemeler ele alınmıştır. Danışanın depresyon şiddeti ve psikolojik iyi oluş düzeyi Beck Depresyon Envanteri ve Psikolojik İyi Oluş Ölçeği aracılığıyla ölçülmüştür. Sekiz hafta sonunda danışanın Beck Depresyon Envanteri puanı 43’ten 5’e düşerken, Psikolojik İyi Oluş Ölçeği puanı 17’den 51’e yükselmiştir. İzleme seansı ardından danışan ölçekleri tekrar puanlamış ve Beck Depresyon Envanteri 4 puan, Psikolojik İyi Oluş Ölçeği 51 puan olarak ölçülmüştür. Danışan dönütleri ve yapılan ölçek puanlamaları değerlendirildiğinde danışanın depresif belirtilerinde ve iyi oluşunda iyileşmeler olduğu sonucuna ulaşılmıştır.

Keywords

• Depresyon
• Bilişsel davranışçı terapi
• Çevrim içi psikolojik danışma
• Olgu sunumu

Online Psychological Counseling Based on Cognitive Behavioral Theraphy in Depression A Case Study

Abstract

This article presents a case study on the treatment of depression with cognitive behavioral therapy. The female client is a 20-year-old university student. She exhibits symptoms of depressed and unhappy mood, pessimism, indecisiveness, difficulty concentrating, feelings of guilt and worthlessness, thoughts of death, social withdrawal, low energy, and loss of appetite. Cognitive behavioral psychotherapy was administered to the client for eight weeks based on the DSM-5 diagnostic criteria. The psychotherapy process was conducted once a week for 50 minutes. A follow-up session was conducted one month after the end of treat-ment. The aim was to contribute to the well-being of the client with depressive symptoms through cognitive and behavioral interventions. The article discusses the client's history, depressive symptoms, therapy process, and progress during the process. The client's depres-sion severity and psychological well-being level were measured using the Beck Depression Inventory and the Psychological Well-Being Scale. At the end of eight weeks, the client's Beck Depression Inventory score dropped from 43 to 5, while her Psychological Well-Being Scale score rose from 17 to 51. Following the follow-up session, the client was re-scored on the scales, with a Beck Depression Inventory score of 4 and a Psychological Well-Being Scale score of 51. Based on the client's feedback and the scale scores, it was concluded that the client had improved in terms of depressive symptoms and well-being.

Keywords

• Depression
• Cognitive behavioral therapy
• Online psychological counseling
• Case study

References

1. Aliyev, V. (2020). Majör depresif bozukluğu olan hastalarda farmakoterapinin bilişsel işlevler üzerine etkisi: Bir izlem çalışması. [Yayınlanmamış Tıpta Uzmanlık Tezi]. Ankara Üniversitesi.
2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5. baskı). American Psychiatric Publishing. https://doi.org/10.1176/appi.books.9780890425596
3. Andersson, G., Hesser, H., Veilord, A., Svedling, L., Andersson, F., Sleman, O., Mauritzson, L., Sarkohi, A., Claesson, E., Zetterqvist, V., Lamminen, M., Eriksson, T. & Carlbring, P. (2013). Randomised controlled non-inferiority trial with 3-year follow-up of internet-delivered versus face-to-face group cognitive behavioural therapy for depression. J Affect Disord., 151(3), 986-994.
4. Andersson, G., Titov, N., Dear, B.F., Rozental, A. & Carlbring, P. (2019). Internet-delivered psychological treatments: from innovation to implementation. World Psychiatry, 18(1), 20-28.
5. Andrews, G., Basu, A., Cuijpers, P., Craske, M.G., McEvoy, P., English, C.L. & Newby, J.M. (2018). Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: An updated meta-analysis. J. Anxiety Disord. 55, 70–78.
6. Baier, A.L., Kline, A.C. & Feeny, N.C. (2020). Therapeutic alliance as a mediator of change: A systematic review and evaluation of research. Clinical Psychology Review, 82, 101921.
7. Beck, A.T. (1967). Depression: Clinical, experimental and theoretical aspects. Harper and Row.
8. Beck, J.S. (2020). Bilişsel davranışçı terapi: Temelleri ve ötesi (2. Baskı). (M. Şahin, Çev.). Nobel Akademik Yayıncılık.

9. Bumbery, W., Oliver, J.M. & McClure, J.N. (1978). Validation of the Beck Depression Inventory in a University population using psychiatric estimate as the criterion. Journal of Consulting and Clinical Psychology, 46, 150-155.
10. Burns, D.D. & Spangler, D.L. (2000). Does psychotherapy homework lead to improvements in depression in cognitive-behavioral therapy or does improvement lead to doing more homework? Journal of Consulting and Clinical Psychology, 68(1), 46–56.
11. Buturak, V. (2006). Majör depresif bozukluk tanısı alan hastalarda psikiyatrik eş tanılar ve sosyodemografik özellikler. [Yayınlanmamış Tıpta Uzmanlık Tezi]. Mersin Üniversitesi.
12. Carlbring, P., Andersson, G., Cuijpers, P., Riper, H. & Hedman-Lagerlöf, E. (2018). Internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: an updated systematic review and meta-analysis. Cogn. Behav. Ther., 47(1), 1-18.
13. Cuijpers, P., Donker, T., van Straten, A., Li, J. & Andersson, G. (2010). Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychol Med., 40(12), 1943-1957.
14. Cuijpers, P., Noma, H., Karyotaki, E., Cipriani, A. & Furukawa, T.A. (2019). Effectiveness and acceptability of cognitive behavior therapy delivery formats in adults with depression: a network meta-analysis. JAMA Psychiatry, 76(7), 700-707.
15. Cuijpers, P., Noma, H., Karyotaki, E., Vinkers, C.H., Cipriani, A. & Furukawa, T.A. (2020). A network meta-analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression. World Psychiatry, 19(1), 92-107.
16. Cuijpers, P., Sijbrandij, M., Koole, S.L., Andersson, G., Beekman, A.T. & Reynolds, C.F. (2013). The efficacy of psychotherapy and pharmacotherapy in treating depressive and anxiety disorders: a meta-analysis of direct comparisons. World Psychiatry, 12(2), 137-48.
17. Çelik, F.H. & Hocaoğlu, Ç. (2016). Major depresif bozukluk tanımı, etiyolojisi ve epidemiyolojisi: bir gözden geçirme. Çağdaş Tıp Dergisi, 6(1), 51-66.
18. Deveci, S.E., Ulutaşdemir, N. & Açık, Y. (2013). Bir sağlık yüksekokulu öğrencilerinde depresyon belirtilerinin görülme sıklığı ve etkileyen faktörler. Fırat Tıp Dergisi, 18(2), 98-102.
19. Duffy, M.E., Twenge, J.M. & Joiner, T.E. (2019). Trends in mood and anxiety symptoms and suicide- related outcomes among US undergraduates, 2007–2018: Evidence from two national surveys. Journal of Adolescent Health, 65(5), 590–598.
20. Emslie, G.J. & Mayes, T.L. (1999). Depression in children and adolescents: A guide to diagnosis and treatment. CNS Drugs, 11(3), 181-189.
21. Etzelmueller, A., Vis, C., Karyotaki, E., Baumeister, H., Titov, N., Berking, M., Cuijpers, P., Riper, H. & Ebert, D.D. (2020). Effects of internet-based cognitive behavioral therapy in routine care for adults in treatment for depression and anxiety: systematic review and meta-analysis. J. Med. Internet Res., 22(8), e18100.
22. Farrer, L., Gulliver, A., Chan, J.K., Batterham, P.J., Reynolds, J., Calear, A., Tait, R., Bennett, K. & Griffiths, K.M. (2013). Technology-based interventions for mental health in tertiary students: systematic review. J. Med. Internet Res. 15(5), e101.
23. Glasman, D., Finlay, W.M.L. & Brock, D. (2004). Becoming a self-therapist: Using cognitivebehavioural therapy for recurrent depression and/or dysthymia after completing therapy. Psychology and Psychotherapy: Theory, Research and Practice, 77, 335–351.
24. Gökdağ, C. & Tekinsav-Sütçü, S. (2016). Majör depresif bozukluk tedavisinde bilişsel davranışçı grup terapisinin uzun dönemdeki etkililiği: Sistematik bir gözden geçirme. Psikiyatride Güncel Yaklaşımlar, 8(1), 23-38.
25. Göktaş, S., Işıklı, B. & Metintaş, S. (2018). Ruh sağlığı okuryazarlığı. Türk Dünyası Uygulama ve Araştırma Merkezi Halk Sağlığı Dergisi, 3(2), 68-75.
26. Hamaideh, S.H. (2017). Alexithymia among Jordanian university students: Its prevalence and correlates with depression, anxiety, stress, and demographics. Perspect Psychiatr Care, 54(2), 274-280.
27. Heinz, I., Baldofski, S., Beesdo-Baum, K., Knappe, S., Kohls. E. & Rummel-Kluge. C. (2021). "Doctor, my back hurts and I cannot sleep." depression in primary care patients: Reasons for consultation and perceived depression stigma. PLoS One, 16(3), e0248069.
28. Işık, E., Işık, U. & Taner, Y. (2013). Çocuk, Ergen, Erişkin ve Yaşlılarda Depresif ve Bipolar Bozukluklar. Ziraat Gurup Matbaacılık.
29. İbrahim, A.K., Kelly, S.J., Adams, C.E. & Glazebrook, C.A. (2013). A systematic review of studies of depression prevalence in university students. J Psychiatr Res., 47(3), 391–400.
30. Imel, Z.E., Malterer, M.B., McKay, K.M. & Wampold, B.E. (2008). A meta-analysis of psychotherapy and medication in unipolar depression and dysthymia. J Affect Disord., 110(3), 197-206.
31. Josephine, K., Josefine, L., Philipp, D., David, E. & Harald, B. (2017). Internet-and mobile- based depression interventions for people with diagnosed depression: A systematic review and meta-analysis. J. Affect. Disord. 223, 28–40.
32. Kafes, A. (2021). Depresyon ve anksiyete bozuklukları üzerine bir bakış. Uluslararası Psikolojik Danışma ve Rehberlik Araştırmaları Dergisi, 3(1), 186-194.
33. Kan, M. (2024). Depresyonun bı̇lı̇şsel davranışçı terapı̇ ı̇le tedavı̇sı̇nı̇n etkı̇nlı̇ğı̇: Son 10 yılın bulguları. İnteraktif Bilim: Disiplinlerarası Araştırma ve İncelemeler Dergisi, 4, 2158-2195.
34. Kan, M. (2024). Online terapi ı̇le yüz yüze terapi arasındaki etkililik farklılıkları; sistematik derleme ve meta-analiz. Journal of Synthesis Academic Research, 12, 271-286.
35. Karyotaki, E., Efthimiou, O., Miguel, C., Bermpohl, F.M.G., Furukawa, T.A., Cuijpers, P., Riper, H., Patel, V., Mira, A., Gemmil, A.W., Yeung, A.S., Lange, A., Williams, A.D., Mackinnon, A., Geraedts, A., van Straten, A., Meyer, B., Björkelund, C.,…Knaevelsrud, C. (2021). Internet-based cognitive behavioral therapy for depression: A systematic review and individual patient data network meta-analysis. JAMA Psychiatry 78(4), 361–371.
36. Kazantzis, N., Whittington, C. & Dattilio, F. (2010). Meta-analysis of homework effects in cognitive and behavioral therapy: A replication and extension. Clinical Psychology: Science and Practice, 17(2), 144-156.
37. Königbauer, J., Letsch, J., Doebler, P., Ebert, D. & Baumeister, H. (2017). Internet-and mobile-based depression interventions for people with diagnosed depression: A systematic review and meta-analysis. J Affect Disord., 223, 28-40.
38. Lépine, J.P. & Briley, M. (2011). The increasing burden of depression. Neuropsychiatr Dis Treat., 7(1), 3-7.
39. Malhi, G.S., Bell, E., Bassett, D., Boyce, P., Bryant, R., Hazell, P., Hopwood, M., Lyndon, B., Mulder, R., Porter, R., Singh, A.B. & Murray, G. (2021). The 2020 Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. Aust N Z J Psychiatry, 55(1), 7-117.
40. Matar Boumosleh, J. & Jaalouk, D. (2017). Depression, anxiety, and smartphone addiction in university students- A cross sectional study. PLoS One, 12(8), 1-14.
41. Mausbach, B.T., Moore, R., Roesch, S., Cardenas, V. & Patterson, T.L. (2010). The relationship between homework compliance and therapy outcomes: An updated meta-analysis. Cognitive Therapy and Research, 34(5), 429–438.
42. Mete, H.E. (2008). Kronik hastalık ve depresyon. Klinik Psikiyatri, 11(3), 3-18.
43. Mojtabai, R., Olfson, M., Sampson, N.A., Jin, R., Druss, B., Wang, P.S., Wells, K.B., Pincus, H.A. & Kessler, R.C. (2011). Barriers to mental health treatment: Results from the National Comorbidity Survey Replication. Psychological Medicine, 41(8), 1751–1761.
44. Molloy, A., Ellis, D.M., Su, L. & Anderson, P.L. (2021). Improving acceptability and uptake behavior for internet-based cognitive-behavioral therapy. Front. Digit. Health, 25(3), 653-686.
45. Morrison, J. (2019). DSM-5'i kolaylaştıran klinisyenler için tanı rehberi (H.U. Kural, Çev.). Nobel Akademik Yayıncılık.
46. Moshe, I., Terhorst, Y., Philippi, P., Domhardt, M., Cuijpers, P., Cristea, I., Pulkki-Raback, L., Baumeister, H. & Sander, L.B. (2021). Digital interventions for the treatment of depression: a meta-analytic review. Psychol. Bull. 147(8), 749–786.
47. National Institute for Health and Care Excellence. (2009). Depression in adults: recognition and management. https://www.nice.org.uk/guidance/cg90 adresinden 28 Eylül 2025 tarihinde alınmıştır.
48. Neimeyer R.A., Kazantzis N., Kassler D.M., Baker K.D. & Fletcher R. (2008). Group cognitive behavioural therapy for depression outcomes predicted by willingness to engage in homework, compliance with homework, and cognitive restructuring skill acquisition. Cogn Behav Ther, 37,199–215.
49. Olchanski, N., McInnis Myers, M., Halseth, M., Cyr, P.L., Bockstedt, L., Goss, T.F. & Howland, R.H. (2013). The economic burden of treatment-resistant depression. Clinical therapeutics, 35(4), 512-522.
50. Özdel, L., Bostancı, M., Özdel, O. & Oğuzhanoğlu, N.K. (2002). Üniversite öğrencilerinde depresif belirtiler ve sosyo-demografik özelliklerle ilişkisi. Anadolu Psikiyatri Dergisi, 3, 155-161.
51. Özdemir, Y. & Kalkan, M. (2022). Online psikolojik danışma hizmetlerinin etkililiği: Türkiye örneği. Türk Psikolojik Danışma ve Rehberlik Dergisi, 12(65), 45-59.
52. Özkürkçügil, A.Ç. (1999). Bir mediko-sosyal merkezine genel sağlık sorunlarıyla başvuran öğrencilerden psikiyatrik tanı alanlarda bazı sosyodemografik özellikler. Türk Psikiyatri Dergisi, 10, 115-122.
53. Öztürk, M.O. & Uluşahin, N.A. (2020). Ruh Sağlığı ve Bozuklukları. Nobel Tıp Yayınevleri.
54. Pang, Y., Zhang, X., Gao, R., Xu, L., Shen, M., Shi, H., Li, Y. & Li, F. (2021). Efficacy of web-based self-management interventions for depressive symptoms: A meta-analysis of randomized controlled trials. BMC Psychiatry, 21(1), 398.
55. Renner, F., Cuijpers, P. & Huibers, M.J.H. (2014). The effect of psychotherapy for depression on improvements in social functioning: A meta-analysis. Psychol. Med. 44, 2913–2926.
56. Rosenthal, B. & Wilson, W.C. (2008). Mental health services: use and disparity among diverse college students. J. Am. Coll. Heal. 57(1), 61–67.
57. Rosso, I.M., Killgore, W.D.S., Olson, E.A., Webb, C.A., Fukunaga, R., Auerbach, R.P., Gogel, H., Buchholz, J.L. & Rauch, S.L. (2017). Internet-based cognitive behavior therapy for major depressive disorder: A randomized controlled trial. Depress Anxiety, 34(3), 236-245.
58. Schlarb, A.A., Kulessa, D. & Gulewitsch, M.D. (2012). Sleep characteristics, sleep problems, and associations of self-efficacy among German university students. Nat Sci. Sleep, 9(4), 1–7.
59. Sherer, M. (1985). Depression and suicidal ideation in college students. Psychol Rep, 57, 1061-1062.
60. Sin, J., Galeazzi, G., McGregor, E., Collom, J., Taylor, A., Barrett, B., Lawrence, V. & Henderson, C. (2020). Digital interventions for screening and treating common mental disorders or symptoms of common mental illness in adults: Systematic review and meta-analysis. J. Med. Internet Res. 22(9), e20581.
61. Swartz, H.A. & Fournier, J. (2019). Can network meta-analysis substitute for direct comparisons in psychotherapy trials? JAMA Psychiatry, 76(7), 678-679.
62. Şencan, B. (2019). Majör depresif bozuklukta zihin kuramı. Psikiyatride Güncel Yaklaşımlar, 11(1), 42-54.
63. Twenge, J.M., Cooper, A.B., Joiner, T.E., Duffy, M.E. & Binau, S.G. (2019). Age, period, and cohort trends in mood disorder indicators and suicide-related outcomes in a nationally representative dataset, 2005–2017. Journal of abnormal psychology, 128(3), 185-199.
64. Ünal, S., Küey, M.L., Güleç, C., Bekaroğlu, M., Evlice, Y.E. ve Kırlı, S. (2002). Depresif bozukluklarda risk etkenleri. Türk Psikiyatri Dergisi, 5(1), 8-15.
65. Van Hees, M.L., Rotter, T., Ellermann, T. & Evers, S.M. (2013). The effectiveness of individual interpersonal psychotherapy as a treatment for major depressive disorder in adult outpatients: A systematic review. BMC Psychiatry., 13, 22.
66. Yıldırım, A. & Kalkan, M. (2021). Türkiye’de online psikolojik danışma hizmetlerinin yaygınlaşması ve etkililiği. Klinik Psikoloji Dergisi, 25(1), 35-50.
67. Wagner, B., Horn, A.B. & Maercker, A. (2014). Internet-based versus face-to-face cognitive-behavioral intervention for depression: A randomized controlled non-inferiority trial. J Affect Disord., 113(21), 152-154.
68. Weisel, K.K., Fuhrmann, L.M., Matthias, B., Baumeister, H., Cuijpers, P. & Ebert, D.D. (2019). Standalone smartphone apps for mental health-a systematic review and meta-analysis. NPJ Digital Medicine, 2, 118.