BİLİŞSEL DAVRANIŞÇI YAKLAŞIMA DAYALI ÇEVRİM İÇİ PSİKOLOJİK DANIŞMANIN SAĞLIK KAYGISINI NASIL ETKİLEDİĞİNE İLİŞKİN DANIŞAN GÖRÜŞLERİ

Year 2023, , 26 - 40, 27.12.2023

Burak Aydın

https://doi.org/10.17753/sosekev.1367444

Abstract

Bu çalışmanın amacı, bilişsel davranışçı yaklaşıma dayalı olarak yapılandırılan çevrim içi psikolojik danışma müdahalesinin sağlık kaygısı üzerinde nasıl bir etki oluşturduğuna ilişkin danışan görüşlerini incelenmektir. Bu çalışmada nitel araştırma yöntemlerinden durum çalışması deseni kullanılmıştır. Araştırma katılımcılarını belirlemede amaçlı örnekleme yöntemlerinden ölçüt örnekleme tekniğine yer verilmiştir. Buna göre araştırmanın çalışma grubunu tanı almamış ancak sağlık kaygısı yüksek olan ve Bilişsel Davranışçı Terapi (BDT) temelli çevrim içi psikolojik danışma müdahalesine dâhil olan üç danışan oluşturmuştur. Araştırmada veri toplama aracı olarak araştırmacı tarafından geliştirilen yarı yapılandırılmış görüşme formu kullanılmıştır. Araştırma verilerinin analizi aşamasında tematik analiz yöntemine yer verilmiştir. Verilerin analizi deneme sürümü edinilen NVivo 12 paket programı ile yapılmıştır. Araştırmadan elde edilen bulgulara göre çevrim içi BDT müdahalesinin sağlık kaygısını azalttığı, daha gerçekçi düşünebilme ve bilişsel düşünce özelliklerini fark edebilme becerilerini artırdığı, sosyal ilişkileri olumlu yönde etkilediği, sorun çözme becerilerini artırdığı ve sağlık kaygısı dışındaki endişeleri de azaltmada etkili olduğu belirlenmiştir. Bunun yanında terapi seanslarına farklı yer ve mekânlardan katılabilme imkânı vermesi çevrim içi BDT müdahalesinin olumlu bir özelliği olarak değerlendirilmiştir. Ayrıca zamanı verimli kullanabilme olanağı ve yüz yüze terapiye göre daha düşük maliyetler gerektirmesi danışanlar tarafından ön plana çıkarılan diğer olumlu özelliklerdir. Bunların yanında internet kaynaklı oluşabilecek teknik aksaklıklar ve beden dilinin daha az fark edilmesi sonucu ortaya çıkabilecek dikkat dağınıklığı sorunu çevrim içi BDT müdahalesinin olumsuz yönleri olarak ortaya çıkmıştır. Çalışmanın bulgularından yola çıkılarak uygulama sahasında çalışan ruh sağlığı uzmanlarına ve araştırmacılara önerilerde bulunulmuştur.

Keywords

Sağlık kaygısı, Bilişsel davranışçı terapi, Çevrim içi psikolojik danışma

Consultant Opinions on the Effect of Online Psychological Counselling Based on the Cognitive Behavioral Approach on Health Anxiety

Abstract

This research aims to investigate the client's perceptions of the effects of an online psychological counselling intervention built on a cognitive behavioural framework on health anxiety. The status study pattern from qualitative research techniques was applied in this study. Research subjects are chosen using a criteria sampling methodology from purpose sampling techniques. Accordingly, the research's working group has not been diagnosed, but has created three consultants who have high health concerns and are involved in online psychological counseling intervention based on Cognitive Behavioral Therapy (CBT). The research used a semi-structured interview form developed by the researcher as a data collection tool. In the analysis of research data, the thematic analysis method was included. Analysis of the data was done with the NVivo 12 package program, which received the trial version. According to the research findings, the online CBT intervention reduces health anxiety, improves the skills of thinking more realistically and realising cognitive thinking characteristics, and has a positive effect on social relations. It has also been determined that it improves problem solving skills and is effective in reducing concerns other than health anxiety. The ability to attend therapy sessions from different locations was also seen as a positive aspect of the online CBT intervention. The advisors also emphasised the ability to use time productively and the lower costs compared to in-person therapy as two additional benefits. Additionally, the issue of internet-related technical issues and distractions brought on by less variance in body language have been identified as undesirable aspects of the online CBT session. The study's conclusions have produced recommendations for professionals in the field of application who study mental health.

Keywords

Health anxiety, Cognitive behavioral therapy, Online psychological counseling

References

• Abramowitz, J. S., Olatunji, B. O., & Deacon, B. J. (2007). Health anxiety, hypochondriasis, and the anxiety disorders. Behavior Therapy, 38(1), 86-94. https://doi.org/10.1016/j.beth.2006.05.001
• Akyürek, M. İ. (2020). Uzaktan eğitim: Bir alanyazın taraması. Medeniyet Eğitim Araştırmaları Dergisi, 4(1), 1–9.
• Andersen, L. S., Magidson, J. F., O’Cleirigh, C., Remmert, J. E., Kagee, A., Leaver, M., … Joska, J. (2018). A pilot study of a nurse-delivered cognitive behavioral therapy intervention (Ziphamandla) for adherence and depression in HIV in South Africa. Journal of Health Psychology, 23(6), 776-787. https://doi.org/10.1177/1359105316643375
• Avşar, V. (2019). Bilişsel davranışçı terapiye dayalı bireysel psikolojik danışmanın sosyal kaygı, özyeterlik ve psikolojik iyi oluş üzerindeki etkisi (Tez No. 549132) [Doktora tezi, Ankara Üniversitesi]. Yükseköğretim Kurulu Ulusal Tez Merkezi.
• Axelsson, E., Andersson, E., Ljótsson, B., Björkander, D., Hedman-Lagerlöf, M., & Hedman-Lagerlöf, E. (2020). Effect of internet vs face-to-face cognitive behavior therapy for health anxiety: A randomized noninferiority clinical trial. JAMA Psychiatry, 77(9), 915-924. https://doi.org/10.1001/jamapsychiatry.2020.0940
• Axelsson, E., & Hedman-Lagerlöf, E. (2019). Cognitive behavior therapy for health anxiety: Systematic review and meta-analysis of clinical efficacy and health economic outcomes. Expert Review of Pharmacoeconomics & Outcomes Research, 19(6), 663-676. https://doi.org/10.1080/14737167.2019.1703182
• Barak, A., & Grohol, J. M. (2011). Current and future trends in ınternet-supported mental health interventions. Journal of Technology in Human Services, 29(3), 155-196. https://doi.org/10.1080/15228835.2011.616939
• Beck, A. T. (2019). A 60-year evolution of cognitive theory and therapy. Perspectives on Psychological Science, 14(1), 16-20. https://doi.org/10.1177/1745691618804187
• Beck, J. S. (2005). Cognitive therapy for challenging problems: What to do when the basics don’t work. Guilford.
• Bennett, P., Patterson, K., & Noble, S. (2016). Predicting post-traumatic stress and health anxiety following a venous thrombotic embolism. Journal of Health Psychology, 21(5), 863-871. https://doi.org/10.1177/1359105314540965
• Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77-101. https://doi.org/10.1191/1478088706qp063oa
• Büyüköztürk, Ş., Kılıç-Çakmak, E., Akgün, Ö. E., Karadeniz, Ş., & Demirel, F. (2020). Eğitimde bilimsel araştırma yöntemleri (34. baskı.). Pegem Akademi.
• Davidson, J. R., Dawson, S., & Krsmanovic, A. (2019). Effectiveness of group cognitive behavioral therapy for ınsomnia (CBT-I) in a primary care setting. Behavioral Sleep Medicine, 17(2), 191-201. https://doi.org/10.1080/15402002.2017.1318753
• Deale, A. (2007). Psychopathology and treatment of severe health anxiety. Psychiatry, 6(6), 240-246. https://doi.org/10.1016/j.mppsy.2007.03.005
• Douma, M., Joosten, M. M. H., Scholten, L., Maurice-Stam, H., & Grootenhuis, M. A. (2019). Online cognitive-behavioral group intervention for adolescents with chronic illness: A pilot study. Clinical Practices in Pediatric Psychology, 7(1), 79-92. https://doi.org/10.1037/cpp0000274
• Erdem, A., & Özdemi̇r, M. (2020). Çevrimiçi ve yüz yüze psikolojik danışmaya ilişkin algıları keşfetmek: Nitel bir çalışma. Psikiyatride Güncel Yaklaşımlar, 12, 331-363. https://doi.org/10.18863/pgy.793232
• Fergus, T. A. (2014). Health-related dysfunctional beliefs and health anxiety: Further evidence of cognitive specificity. Journal of Clinical Psychology, 70(3), 248-259. https://doi.org/10.1002/jclp.22012
• Freeman, D., Pugh, K., Dunn, G., Evans, N., Sheaves, B., Waite, F., ... & Fowler, D. (2014). An early phase II randomised controlled trial testing the effect on persecutory delusions of using CBT to reduce negative cognitions about the self: The potential benefits of enhancing self confidence. Schizophrenia Research, 160(1–3), 186-192. https://doi.org/10.1016/j.schres.2014.10.038
• Gibson, W. J., & Brown, A. (2009). Working with qualitative data. SAGE.
• Glesne, C. (2015). Nitel araştırmaya giriş (A. Ersoy & P. Yalçınoğlu, Çev.). Anı.
• Goonesekera, Y., & Donkin, L. (2022). A cognitive behavioral therapy chatbot (otis) for health anxiety management: Mixed methods pilot study. JMIR Formative Research, 6(10), 1-13. https://doi.org/10.2196/37877
• Hadjistavropoulos, H. D., Janzen, J. A., Kehler, M. D., Leclerc, J. A., Sharpe, D., & Bourgault-Fagnou, M. D. (2012). Core cognitions related to health anxiety in self-reported medical and non-medical samples. Journal of Behavioral Medicine, 35(2), 167-178. https://doi.org/10.1007/s10865-011-9339-3
• Hedman, E., Andersson, G., Andersson, E., Ljotsson, B., Ruck, C., Asmundson, G. J., ... Lindefors, N. (2011). Internet-based cognitive-behavioural therapy for severe health anxiety: Randomised controlled trial. The British Journal of Psychiatry, 198(3), 230–236. https://doi.org/10.1192/bjp.bp.110.086843
• Hedman, E., Axelsson, E., Görling, A., Ritzman, C., Ronnheden, M., Alaoui, S. E., … Ljótsson, B. (2014). Internet-delivered exposure-based cognitive–behavioural therapy and behavioural stress management for severe health anxiety: Randomised controlled trial. British Journal of Psychiatry, 205(4), 307-314. https://doi.org/10.1192/bjp.bp.113.140913
• Joinson, A. N., & Paine, C. B. (2007). Self-disclosure, privacy and the internet. In A. N. Joinson, K. Y. A. McKenna, T. Postmes, & U. D. Reips (Eds.), Oxford handbook of internet psychology (pp. 237-252). Oxford University.
• Josefowitz, N., & Myran, D. (2021). CBT made simple: A clinician’s guide to practicing cognitive behavioral therapy (2nd ed.). New Harbinger.
• Khanna, M.S., & Kendall, P.C. (2010). Computer-assisted cognitive behavioral therapy for child anxiety: Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 78(5), 737-745. https://doi.org/10.1037/a0019739
• Kilroe, C. (2010). A need assessment of potential online counseling service clients (Unpublished doctoral dissertation). University of Calgary, Canada.
• Leahy, R. L. (2008). Bilişsel terapi yöntemleri: Uygulamacının elkitabı (H. Türkçapar & E. Köroğlu, Çev.). HBY. Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Sage.
• Lipsitt, D. R. (2014). Psychodynamic models and therapeutic approaches to hypochondriasis. In V. Starcevic & R. Noyes (Eds.), Hypochondriasis and health anxiety: A guide for clinicians (pp. 222-240). Oxford University.
• Luik, A. I., Kyle, S. D., & Espie, C. A. (2017). Digital cognitive behavioral therapy (dCBT) for insomnia: A state-of-the-science review. Current Sleep Medicine Reports, 3(2), 48-56. https://doi.org/10.1007/s40675-017-0065-4
• Morrison, J. R. (2016). DSM-5’i kolaylaştıran klinisyenler için tanı rehberi (H. Uğur Kural & M. Şahin, Çev.). Nobel Akademik.
• Morriss, R., Patel, S., Malins, S., Guo, B., Higton, F., James, M., … Tyrer, H. (2019). Clinical and economic outcomes of remotely delivered cognitive behaviour therapy versus treatment as usual for repeat unscheduled care users with severe health anxiety: A multicentre randomised controlled trial. BMC Medicine, 17(16), 1-13. https://doi.org/10.1186/s12916-019-1253-5
• Neng, J. M. B., & Weck, F. (2015). Attribution of somatic symptoms in hypochon-driasis. Clinical Psychology and Psychotherapy, 22, 116–124. https://doi.org/10.1002/cpp.1871
• Newby, J. M., Mahoney, A. E. J., Mason, E. C., Smith, J., Uppal, S., & Andrews, G. (2016). Pilot trial of a therapist-supported internet-delivered cognitive behavioural therapy program for health anxiety. Internet Interventions, 6, 71-79. https://doi.org/10.1016/j.invent.2016.09.007
• Newby, J. M., & McElroy, E. (2020). The impact of internet-delivered cognitive behavioural therapy for health anxiety on cyberchondria. Journal of Anxiety Disorders, 69, 102-150. https://doi.org/10.1016/j.janxdis.2019.102150
• Newby, J. M., Smith, J., Uppal, S., Mason, E., Mahoney, A. E. J., & Andrews, G. (2018). Internet-based cognitive behavioral therapy versus psychoeducation control for illness anxiety disorder and somatic symptom disorder: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 86(1), 89-98. https://doi.org/10.1016/j.janxdis.2019.102150
• Odgen, J. (2019). Sağlık psikolojisi (5. baskı). Nobel Akademik.
• Osawa, C., Kamei, Y., Nozaki, K., Furusawa, Y., & Murata, M. (2021). Brief cognitive behavioral therapy for ınsomnia in parkinson’s disease: A case series study. Japanese Psychological Research, 63(2), 59-71. https://doi.org/10.1038/s41531-017-0027-z
• Özer, Ö., Yıkılmaz, M., Altınok, A., & Bayoğlu, F. (2016). Psikolojik danışmanların çevrimiçi (online) psikolojik danışmaya yönelik tutumlarının danışan perspektifinden incelenmesi. Akademik Bakış Dergisi, 58, 549-559. https://doi.org/10.18863/pgy.793232
• Polak, M., Tanzer, N. K., Bauernhofer, K., & Andersson, G. (2021). Disorder-specific internet-based cognitive-behavioral therapy in treating panic disorder, comorbid symptoms and improving quality of life: A meta-analytic evaluation of randomized controlled trials. Internet Interventions, 24, 1-18. https://doi.org/10.1016/j.invent.2021.100364
• Rachman, S. (2012). Health anxiety disorders: A cognitive construal. Behaviour Research and Therapy, 50(7-8), 502-512. https://doi.org/10.1016/j.brat.2012.05.001
• Rauen, K., Vetter, S., Eisele, A., Biskup, E., Delsignore, A., Rufer, M., & Weidt, S. (2020). Internet cognitive behavioral therapy with or without face-to-face psychotherapy: A 12-weeks clinical trial of patients with depression. Frontiers in Digital Health, 2, 1-10. https://doi.org/10.3389/fdgth.2020.00004
• Salkovskis, P. M., & Warwick, H. M. C. (1986). Morbid preoccupations, health anxiety and reassurance: A cognitive-behavioural approach to hypochondriasis. Behaviour Research and Therapy, 24(5), 597-602. https://doi.org/10.1016/0005-7967(86)90041-0
• Schlarb, A. A., Schulte, H., Selbmann, A., & Och, I. (2020). Online cognitive behavioral group therapy (iCBT-I) for insomnia for school children and their parents: Adaptation of an established treatment (KiSS training). Somnologie, 24(4), 259-266. https://doi.org/10.1007/s11818-020-00280-7
• Solem, S., Borgejordet, S., Haseth, S., Hansen, B., Håland, Å., & Bailey, R. (2015). Symptoms of health anxiety in obsessive–compulsive disorder: Relationship with treatment outcome and metacognition. Journal of Obsessive-Compulsive and Related Disorders, 5, 76-81. https://doi.org/10.1016/j.jocrd.2015.03.002
• Sørensen, P., Birket-Smith, M., Wattar, U., Buemann, I., & Salkovskis, P. (2011). A randomized clinical trial of cognitive behavioural therapy versus short-term psychodynamic psychotherapy versus no intervention for patients with hypochondriasis. Psychological Medicine, 41(2), 431-441. https://doi.org/10.1017/S0033291710000292
• Stapersma, L., van den Brink, G., van der Ende, J., Szigethy, E. M., Beukers, R., Korpershoek, T. A., … Utens, E. M. W. J. (2018). Effectiveness of disease-specific cognitive behavioral therapy on anxiety, depression, and quality of life in youth with inflammatory bowel disease: A randomized controlled trial. Journal of Pediatric Psychology, 43(9), 967-980. https://doi.org/10.1093/jpepsy/jsy029
• Starcevic, V., & Noyes, R. (Ed.). (2014). Hypochondriasis and health anxiety: A guide for clinicians. Oxford University.
• Türkçapar, M. H. (2019). Bilişsel davranışçı terapi-Temel ilkeler ve uygulama (2. baskı). Epsilon.
• Türkçapar, M. H. (2020). Covid-19 kaygısı ve travması. K. Sayar (Ed.), Kaygı Çağı içinde (ss. 17-44). Kapı.
• Villabø, M. A., Narayanan, M., Compton, S. N., Kendall, P. C., & Neumer, S.-P. (2018). Cognitive–behavioral therapy for youth anxiety: An effectiveness evaluation in community practice. Journal of Consulting and Clinical Psychology, 86(9), 751-764. https://doi.org/10.1037/ccp0000326
• Wenzel, A. (2018). Cognitive reappraisal. In S. C. Hayes & S. G. Hofmann (Eds.), Process-based CBT: the science and core clinical competencies of cognitive behavioral therapy (pp. 325-339). Oakland, CA: New Harbinger Publications.
• Willner, P, & Lindsay, W. R. (2016). Cognitive behavioral therapy. In N.N. Singh (Eds.), Handbook of Evidence-Based Practices in Intellectual and Developmental Disabilities, Evidence-Based Practices in Behavioral Health (pp. 283-310). Springer.
• World Health Organization. (2014). Basic documents. Geneva: World Health Organization. https://apps.who.int/gb/bd/PDF/bd48/basic-documents-48th-edition-en.pdf adresinden 20 Şubat 2021 tarihinde erişilmiştir.
• Wright, K. D., Lebell, M. A. N. A., & Carleton, R. N. (2016). Intolerance of uncertainty, anxiety sensitivity, health anxiety, and anxiety disorder symptoms in youth. Journal of Anxiety Disorders, 41, 35-42. https://doi.org/10.1016/j.janxdis.2016.04.011
• Yıldırım, A., & Şimşek, H. (2013). Sosyal bilimlerde nitel araştırma yöntemleri (9. baskı). Seçkin.
• Yin, R. K. (2017). Durum çalışması araştırması uygulamaları (İ. Günbayı, Çev.). Nobel Akademik.
• Zeren, Ş. G. (2016). Face-to-face and online counseling: Client problems and satisfaction. Eğitim ve Bilim, 40(182), 127-141. https://doi.org/10.15390/EB.2015.4696
• Zeren, Ş. G. (2017). Therapeutic alliance in face-to-face and online counseling: Opinions of counselor candidates. Journal of Human Sciences, 14(3), 2278-2307. https://doi.org/10.14687/jhs.v14i3.4203
• Zeren, Ş. G., & Bulut, E. (2018). Çevrimiçi psikolojik danışmada etik ve standartlar: Bir model önerisi. Türk Psikolojik Danışma ve Rehberlik Dergisi, 8(49), 63-80.
• Zhang, C., Yang, L., Liu, S., Xu, Y., Zheng, H., & Zhang, B. (2021). One-week self-guided ınternet cognitive behavioral treatments for ınsomnia in adults with situational ınsomnia during the covid-19 outbreak. Frontiers in Neuroscience, 14, 1-9. https://doi.org/10.3389/fnins.2020.622749